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Barzen C, Vogel M, Kiess W, Poulain T. Associations between gestational weight gain and weight development of the offspring: Differences depending on maternal pre-pregnancy BMI. Arch Gynecol Obstet 2024; 310:395-403. [PMID: 38609672 DOI: 10.1007/s00404-024-07487-1] [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: 01/18/2024] [Accepted: 03/17/2024] [Indexed: 04/14/2024]
Abstract
PURPOSE Obesity rates are rising, and the gestational weight gain (GWG) of most women does not comply with current guidelines. This study assesses the association of pre-pregnancy BMI (ppBMI) and GWG with the child's weight development and investigates whether associations with GWG differ depending on ppBMI. METHODS Data were obtained from the cohort study LIFE Child (Germany), comprising 691 mother-child pairs. Children's weight was followed until age five. Associations between maternal ppBMI, GWG, and children's weight were evaluated using regression analyses. RESULTS The association between GWG and birth weight (BW) was significantly positive in normal and underweight (n/u) women (βGWG = 0.05, p < 0.01, 95% confidence interval (CI) 0.03-0.07), but not in women with overweight or obesity (o/o) (βGWG = 0.0002, p = 0.99, 95% CI -0.03 to 0.03). The risk of giving birth to an infant who was large for gestational age (LGA) increased with rising GWG in n/u women (OR = 1.6, p < 0.01, 95% CI 1.23-2.25). Women with o/o were at increased risk for a LGA baby regardless of GWG (OR = 3, p < 0.01, 95% CI 1.34-6.97). This trend persisted in the child's weight development during the first 5 years of life. CONCLUSION Women with o/o might increase their offspring's risk for higher weight at birth and in early childhood. In n/u women, GWG might be the more influential factor. Women should strive for normal weight before conception and should be more attentive to GWG.
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Affiliation(s)
- Charlotte Barzen
- LIFE Leipzig Research Center for Civilization Diseases, University of Leipzig, Philipp-Rosenthal-Strasse 27, 04103, Leipzig, Germany.
| | - Mandy Vogel
- LIFE Leipzig Research Center for Civilization Diseases, University of Leipzig, Philipp-Rosenthal-Strasse 27, 04103, Leipzig, Germany
- Department of Women and Child Health, Hospital for Children and Adolescents and Center for Paediatric Research (CPL), Leipzig University, Liebigstraße 20a, Haus 6, 04103, Leipzig, Germany
| | - Wieland Kiess
- LIFE Leipzig Research Center for Civilization Diseases, University of Leipzig, Philipp-Rosenthal-Strasse 27, 04103, Leipzig, Germany
- Department of Women and Child Health, Hospital for Children and Adolescents and Center for Paediatric Research (CPL), Leipzig University, Liebigstraße 20a, Haus 6, 04103, Leipzig, Germany
| | - Tanja Poulain
- LIFE Leipzig Research Center for Civilization Diseases, University of Leipzig, Philipp-Rosenthal-Strasse 27, 04103, Leipzig, Germany
- Department of Women and Child Health, Hospital for Children and Adolescents and Center for Paediatric Research (CPL), Leipzig University, Liebigstraße 20a, Haus 6, 04103, Leipzig, Germany
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Venkatesh KK, Perak AM, Wu J, Catalano P, Josefon JL, Costantine MM, Landon MB, Lancki N, Scholtens D, Lowe W, Khan SS, Grobman WA. Impact of hypertensive disorders of pregnancy and gestational diabetes mellitus on offspring cardiovascular health in early adolescence. Am J Obstet Gynecol 2024:S0002-9378(24)00563-5. [PMID: 38703941 DOI: 10.1016/j.ajog.2024.04.037] [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: 02/19/2024] [Revised: 04/24/2024] [Accepted: 04/26/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Adverse pregnancy outcomes, including hypertensive disorders of pregnancy and gestational diabetes mellitus, influence maternal cardiovascular health long after pregnancy, but their relationship to offspring cardiovascular health following in-utero exposure remains uncertain. OBJECTIVE To examine associations of hypertensive disorders of pregnancy or gestational diabetes mellitus with offspring cardiovascular health in early adolescence. STUDY DESIGN This analysis used data from the prospective Hyperglycemia and Adverse Pregnancy Outcome Study from 2000 to 2006 and the Hyperglycemia and Adverse Pregnancy Outcome Follow-Up Study from 2013 to 2016. This analysis included 3317 mother-child dyads from 10 field centers, comprising 70.8% of Hyperglycemia and Adverse Pregnancy Outcome Follow-Up Study participants. Those with pregestational diabetes and chronic hypertension were excluded. The exposures included having any hypertensive disorders of pregnancy or gestational diabetes mellitus vs not having hypertensive disorders of pregnancy or gestational diabetes mellitus, respectively (reference). The outcome was offspring cardiovascular health when aged 10-14 years, on the basis of 4 metrics: body mass index, blood pressure, total cholesterol level, and glucose level. Each metric was categorized as ideal, intermediate, or poor using a framework provided by the American Heart Association. The primary outcome was defined as having at least 1 cardiovascular health metric that was nonideal vs all ideal (reference), and the second outcome was the number of nonideal cardiovascular health metrics (ie, at least 1 intermediate metric, 1 poor metric, or at least 2 poor metrics vs all ideal [reference]). Modified poisson regression with robust error variance was used and adjusted for covariates at pregnancy enrollment, including field center, parity, age, gestational age, alcohol or tobacco use, child's assigned sex at birth, and child's age at follow-up. RESULTS Among 3317 maternal-child dyads, the median (interquartile) ages were 30.4 (25.6-33.9) years for pregnant individuals and 11.6 (10.9-12.3) years for children. During pregnancy, 10.4% of individuals developed hypertensive disorders of pregnancy, and 14.6% developed gestational diabetes mellitus. At follow-up, 55.5% of offspring had at least 1 nonideal cardiovascular health metric. In adjusted models, having hypertensive disorders of pregnancy (adjusted risk ratio, 1.14 [95% confidence interval, 1.04-1.25]) or having gestational diabetes mellitus (adjusted risk ratio, 1.10 [95% confidence interval, 1.02-1.19]) was associated with a greater risk that offspring developed less-than-ideal cardiovascular health when aged 10-14 years. The above associations strengthened in magnitude as the severity of adverse cardiovascular health metrics increased (ie, with the outcome measured as ≥1 intermediate, 1 poor, and ≥2 poor adverse metrics), albeit the only statistically significant association was with the "1-poor-metric" exposure. CONCLUSION In this multinational prospective cohort, pregnant individuals who experienced either hypertensive disorders of pregnancy or gestational diabetes mellitus were at significantly increased risk of having offspring with worse cardiovascular health in early adolescence. Reducing adverse pregnancy outcomes and increasing surveillance with targeted interventions after an adverse pregnancy outcome should be studied as potential avenues to enhance long-term cardiovascular health in the offspring exposed in utero.
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Affiliation(s)
- Kartik K Venkatesh
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH.
| | - Amanda M Perak
- Department of Preventive Medicine, Northwestern University, Chicago, IL; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jiqiang Wu
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH
| | - Patrick Catalano
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Tufts University, Boston, MA
| | - Jami L Josefon
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Maged M Costantine
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH
| | - Mark B Landon
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH
| | - Nicola Lancki
- Department of Preventive Medicine, Northwestern University, Chicago, IL
| | - Denise Scholtens
- Department of Preventive Medicine, Northwestern University, Chicago, IL
| | - William Lowe
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Tufts University, Boston, MA
| | - Sadiya S Khan
- Department of Preventive Medicine, Northwestern University, Chicago, IL; Department of Medicine, Northwestern University Feinberg School of Medicine Chicago, IL
| | - William A Grobman
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH
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Bitar G, Cornthwaite JA, Sadek S, Ghorayeb T, Daye N, Nazeer S, Ghafir D, Cornthwaite J, Chauhan SP, Sibai BM, Fishel Bartal M. Continuous Glucose Monitoring and Time in Range: Association with Adverse Outcomes among People with Type 2 or Gestational Diabetes Mellitus. Am J Perinatol 2024; 41:e1370-e1377. [PMID: 36858069 DOI: 10.1055/s-0043-1764208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
OBJECTIVE Continuous glucose monitoring (CGM) has become available for women with type 2 diabetes mellitus (T2DM) or gestational diabetes mellitus (GDM) during pregnancy. The recommended time in range (TIR, blood glucose 70-140 mg/dL) and its correlation with adverse pregnancy outcomes in this group is unknown. Our aim was to compare maternal and neonatal outcomes in pregnant people with T2DM or GDM with average CGM TIR values >70 versus ≤70%. STUDY DESIGN We conducted a retrospective cohort study of all individuals using CGM during pregnancy from January 2017 to June 2022. Individuals with type 1 diabetes mellitus, or those missing CGM or delivery data were excluded. Primary composite neonatal outcome included any of the following: large for gestational age, NICU admission, need for intravenous glucose, respiratory support, or neonatal death. Secondary outcomes included other maternal and neonatal outcomes. Regression models were used to estimate adjusted odds ratio (aOR) and 95% confidence interval (CI). RESULTS During the study period, 141 individuals with diabetes utilized CGM during pregnancy, with 65 (46%) meeting inclusion criteria. Of the study population, 28 (43%) had TIR ≤70% and 37 (57%) had TIR > 70%. Compared with those with TIR > 70%, the primary composite outcome occurred more frequently in neonates of individuals TIR ≤70% (71.4 vs. 37.8%, aOR: 4.8, 95% CI: 1.6, 15.7). Furthermore, individuals with TIR ≤70% were more likely to have hypertensive disorders (42.9 vs. 16.2%, OR: 3.9, 95% CI: 1.3, 13.0), preterm delivery (54 vs. 27%, OR: 3.1, 95% CI: 1.1, 9.1): , and cesarean delivery (96.4 vs. 51.4%, OR: 4.6, 95% CI: 2.2, 15.1) compared with those with TIR >70%. CONCLUSION Among people with T2DM or GDM who utilized CGM during pregnancy, 4 out 10 individuals had TIR ≤70% and, compared with those with TIR > 70%, they had a higher likelihood of adverse neonatal and maternal outcomes. KEY POINTS · Time in range can be utilized as a metric for pregnant patients using continuous glucose monitor.. · Time in range >70% is achievable by 6 out of 10 patients.. · Time in range below goal is associated with adverse neonatal and maternal outcomes..
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Affiliation(s)
- Ghamar Bitar
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Joycelyn A Cornthwaite
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Sandra Sadek
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Tala Ghorayeb
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Nahla Daye
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Sarah Nazeer
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Danna Ghafir
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - John Cornthwaite
- Department of Earth, Environmental and Planetary Science, Rice University, Houston, Texas
| | - Suneet P Chauhan
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Baha M Sibai
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Michal Fishel Bartal
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
- Department of Obstetrics and Gynecology, Sheba Medical Center at Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Amitrano F, Krishnan M, Murphy R, Okesene-Gafa KAM, Ji M, Thompson JMD, Taylor RS, Merriman TR, Rush E, McCowan M, McCowan LME, McKinlay CJD. The impact of CREBRF rs373863828 Pacific-variant on infant body composition. Sci Rep 2024; 14:8825. [PMID: 38627436 PMCID: PMC11021527 DOI: 10.1038/s41598-024-59417-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/10/2024] [Indexed: 04/19/2024] Open
Abstract
In Māori and Pacific adults, the CREBRF rs373863828 minor (A) allele is associated with increased body mass index (BMI) but reduced incidence of type-2 and gestational diabetes mellitus. In this prospective cohort study of Māori and Pacific infants, nested within a nutritional intervention trial for pregnant women with obesity and without pregestational diabetes, we investigated whether the rs373863828 A allele is associated with differences in growth and body composition from birth to 12-18 months' corrected age. Infants with and without the variant allele were compared using generalised linear models adjusted for potential confounding by gestation length, sex, ethnicity and parity, and in a secondary analysis, additionally adjusted for gestational diabetes. Carriage of the rs373863828 A allele was not associated with altered growth and body composition from birth to 6 months. At 12-18 months, infants with the rs373863828 A allele had lower whole-body fat mass [FM 1.4 (0.7) vs. 1.7 (0.7) kg, aMD -0.4, 95% CI -0.7, 0.0, P = 0.05; FM index 2.2 (1.1) vs. 2.6 (1.0) kg/m2 aMD -0.6, 95% CI -1.2,0.0, P = 0.04]. However, this association was not significant after adjustment for gestational diabetes, suggesting that it may be mediated, at least in part, by the beneficial effect of CREBRF rs373863828 A allele on maternal glycemic status.
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Affiliation(s)
| | - Mohanraj Krishnan
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
- Department of Medicine, University of Auckland, Auckland, New Zealand
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rinki Murphy
- Department of Medicine, University of Auckland, Auckland, New Zealand
- Te Whatu Ora, Counties Manukau, Auckland, New Zealand
- Maurice Wilkins Centre for Molecular Biodiscovery, University of Auckland, Auckland, New Zealand
| | - Karaponi A M Okesene-Gafa
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
- Te Whatu Ora, Counties Manukau, Auckland, New Zealand
| | - Maria Ji
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - John M D Thompson
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Rennae S Taylor
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Tony R Merriman
- Department of Microbiology and Immunology, University of Otago, Dunedin, New Zealand
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Elaine Rush
- Faculty of Health and Environmental Science, Auckland University of Technology, Auckland, New Zealand
| | - Megan McCowan
- Te Whatu Ora, Counties Manukau, Auckland, New Zealand
| | - Lesley M E McCowan
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
- Te Whatu Ora, Counties Manukau, Auckland, New Zealand
| | - Christopher J D McKinlay
- Te Whatu Ora, Counties Manukau, Auckland, New Zealand.
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand.
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Nair S, Razo-Azamar M, Jayabalan N, Dalgaard LT, Palacios-González B, Sørensen A, Kampmann U, Handberg A, Carrion F, Salomon C. Advances in extracellular vesicles as mediators of cell-to-cell communication in pregnancy. Cytokine Growth Factor Rev 2024; 76:86-98. [PMID: 38233286 DOI: 10.1016/j.cytogfr.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 12/27/2023] [Indexed: 01/19/2024]
Abstract
Cell-to-cell communication mediated by Extracellular Vesicles (EVs) is a novel and emerging area of research, especially during pregnancy, in which placenta derived EVs can facilitate the feto-maternal communication. EVs comprise a heterogeneous group of vesicle sub-populations with diverse physical and biochemical characteristics and originate by specific biogenesis mechanisms. EVs transfer molecular cargo (including proteins, nucleic acids, and lipids) between cells and are critical mediators of cell communication. There is growing interest among researchers to explore into the molecular cargo of EVs and their functions in a physiological and pathological context. For example, inflammatory mediators such as cytokines are shown to be released in EVs and EVs derived from immune cells play key roles in mediating the immune response as well as immunoregulatory pathways. Pregnancy complications such as gestational diabetes mellitus, preeclampsia, intrauterine growth restriction and preterm birth are associated with altered levels of circulating EVs, with differential EV cargo and bioactivity in target cells. This implicates the intriguing roles of EVs in reprogramming the maternal physiology during pregnancy. Moreover, the capacity of EVs to carry bioactive molecules makes them a promising tool for biomarker development and targeted therapies in pregnancy complications. This review summarizes the physiological and pathological roles played by EVs in pregnancy and pregnancy-related disorders and describes the potential of EVs to be translated into clinical applications in the diagnosis and treatment of pregnancy complications.
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Affiliation(s)
- Soumyalekshmi Nair
- Translational Extracellular Vesicles in Obstetrics and Gynae-Oncology Group, University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4029, Australia.
| | - Melissa Razo-Azamar
- Translational Extracellular Vesicles in Obstetrics and Gynae-Oncology Group, University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4029, Australia; Laboratorio de Envejecimiento Saludable del Instituto Nacional de Medicina Genómica (INMEGEN) en el Centro de Investigación sobre Envejecimiento (CIE-CINVESTAV Sede Sur), CDMX, 14330, Mexico
| | - Nanthini Jayabalan
- Translational Extracellular Vesicles in Obstetrics and Gynae-Oncology Group, University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4029, Australia
| | | | - Berenice Palacios-González
- Laboratorio de Envejecimiento Saludable del Instituto Nacional de Medicina Genómica (INMEGEN) en el Centro de Investigación sobre Envejecimiento (CIE-CINVESTAV Sede Sur), CDMX, 14330, Mexico
| | - Anne Sørensen
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Ulla Kampmann
- Steno Diabetes Center Aarhus, Aarhus University Hospital, and Department of Clinical Medicine, Aarhus University, Denmark
| | - Aase Handberg
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
| | - Flavio Carrion
- Departamento de Investigación, Postgrado y Educación Continua (DIPEC), Facultad de Ciencias de la Salud, Universidad del Alba, Santiago, Chile
| | - Carlos Salomon
- Translational Extracellular Vesicles in Obstetrics and Gynae-Oncology Group, University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4029, Australia; Departamento de Investigación, Postgrado y Educación Continua (DIPEC), Facultad de Ciencias de la Salud, Universidad del Alba, Santiago, Chile.
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Dalfrà MG, Burlina S, Ragazzi E, Pastrolin S, Sartore G, Lapolla A. Lipid profile in women of different ethnicity with gestational diabetes: Relationship with fetal growth. J Diabetes Investig 2024; 15:355-363. [PMID: 38087914 PMCID: PMC10906017 DOI: 10.1111/jdi.14124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 10/23/2023] [Accepted: 11/20/2023] [Indexed: 03/02/2024] Open
Abstract
AIMS/INTRODUCTION Pregnancy complicated by gestational diabetes mellitus (GDM) is characterized by excessive insulin resistance that impairs the metabolism of glucose and lipids. the aim of the study was to examine lipid profiles during pregnancy of women with GDM, and its impact on fetal growth in a multiethnic population. MATERIALS AND METHODS The study included 322 pregnant women of different ethnicity with GDM attending a clinical unit specializing in metabolic diseases. RESULTS The area under the curve for the 75-g oral glucose tolerance test and glycated hemoglobin were significantly different among all groups. At the time of being diagnosed with GDM, Asian and African mothers had significantly lower levels of total and low-density liprotein cholesterol than European mothers (P < 0.001). The trend for high-density liprotein cholesterol was similar. Triglycerides levels in the Asian group (193.6 ± 65.5 mg/dL) were higher than in the African group (133.2 ± 49.6 mg/dL, P < 0.001), whereas the European group presented intermediate values (175.8 ± 58.8 mg/dL), which differed significantly only versus the African group (P < 0.001). Pre-partum lipid profiles showed a trend quite similar to that observed at diagnosis. The newborn's birthweight was significantly different, with that of African women (3,437 ± 503 g) being the highest, followed by that of European women (3,294 ± 455 g) and of Asian women (3,006 ± 513 g). The rates of macrosomia showed a trend with higher values in the African group (13.5%), followed by the European group (5.7%, P = 0.1162), whereas that of the Asian group was zero (P = 0.0023 vs African). CONCLUSIONS Our data show that lipid profiles in women with GDM differ by ethnicity. The impact of lipid profile on fetal growth is limited and uninfluenced by ethnicity.
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Affiliation(s)
| | - Silvia Burlina
- Department of Medicine – DIMEDUniversity of PadovaPadovaItaly
| | - Eugenio Ragazzi
- Department of Pharmaceutical and Pharmacological SciencesUniversity of PadovaPadovaItaly
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Feldman KM, Coughlin A, Feliciano J, Stoffels G, Wang KZ, Strauss TS, Grubman O, Al-Ibraheemi Z, Cole D, Ashmead G, Hussain F, Shchur SS, Lee D, Brustman L. Neonatal Birth Weight With Daily Compared With Every-Other-Day Glucose Monitoring in Gestational Diabetes Mellitus: A Randomized Controlled Trial. Obstet Gynecol 2024:00006250-990000000-01021. [PMID: 38330409 DOI: 10.1097/aog.0000000000005528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/21/2023] [Indexed: 02/10/2024]
Abstract
OBJECTIVE To assess whether universal use of every-other-day glucose monitoring in patients with gestational diabetes mellitus (GDM) resulted in similar birth weights and medication use and was preferred by the patient compared with traditional daily glucose monitoring. METHODS This was a noninferiority randomized controlled trial conducted at a single New York City hospital between April 2021 and May 2022. Patients with singleton pregnancies who were diagnosed with GDM after 20 weeks of gestation and had a minimum of 7 days of previous daily blood glucose testing were randomly assigned to test blood glucose values daily or every other day. The primary outcome was neonatal birth weight. We calculated a total sample size of 196 participants needed for noninferiority to be tested, assuming the mean birth weight in the every-other-day group, compared with the daily group, was no higher than the predefined noninferiority margin of 200 g (80% power and one-sided alpha of 0.05). Postrandomization characteristics, including blood glucose values and medication initiation and timing, were recorded. Satisfaction with treatment group was assessed using the validated Oxford Maternity Diabetes Treatment Satisfaction Questionnaire. RESULTS A total of 197 patients were randomized: 98 in the daily group and 99 in the every-other-day group. Baseline characteristics were similar between groups. The mean neonatal birth weight was similar between groups (mean±SD 3,090±418 g among newborns in the daily group compared with 3,181±482 g among newborns in the every-other-day group). For the primary outcome, the every-other-day group was found to be noninferior to the daily group with an upper confidence limit for the mean difference in mean birth weight of 197 g, which was below the noninferiority margin of 200 g (P=.046). Postrandomization, there were no significant differences in the number of patients who required medication, the gestational age at which medication was started, or the type of medication used. Average fasting and postprandial glucose values were similar between groups. There was an increase in adherence to treatment group in those randomized to every-other-day blood sugars, but no difference in patient satisfaction. CONCLUSION In patients with GDM, testing blood glucose values every other day was as effective as testing daily, without apparent effects on birth weight, medication initiation, or glucose control. Reduced frequency of blood glucose monitoring might help decrease the emotional, physical, and financial burden experienced by patients with GDM. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT04857073.
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Affiliation(s)
- Kristina Martimucci Feldman
- Division of Maternal-Fetal Medicine, Obstetrics, Gynecology and Reproductive Medicine, Mount Sinai West, Obstetrics, Gynecology and Reproductive Medicine, Mount Sinai West, and the Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
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8
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Jung YM, Wi W, Cho KD, Hong SJ, Kim HY, Ahn KH, Hong SC, Kim HJ, Oh MJ, Cho GJ. The Risk of Hypertension and Diabetes Mellitus According to Offspring's Birthweight in Women With Normal Body Mass Index: A Nationwide Population-Based Study. J Korean Med Sci 2024; 39:e50. [PMID: 38317450 PMCID: PMC10843973 DOI: 10.3346/jkms.2024.39.e50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 11/27/2023] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Maladaptation to vascular, metabolic, and physiological changes during pregnancy can lead to fetal growth disorders. Moreover, adverse outcomes during pregnancy can further increase the risk of cardiovascular and metabolic diseases in mothers. Delivering a large-for-gestational-age (LGA) baby may indicate a pre-existing metabolic dysfunction, whereas delivering a small-for-gestational-age (SGA) baby may indicate a pre-existing vascular dysfunction. This study aims to assess the risk of hypertension (HTN) and diabetes mellitus (DM) in women with normal body mass index (BMI) scores who did not experience gestational DM or hypertensive disorders during pregnancy based on the offspring's birthweight. METHODS This retrospective nationwide study included women with normal BMI scores who delivered a singleton baby after 37 weeks. Women with a history of DM or HTN before pregnancy and those with gestational DM or hypertensive disorders, were excluded from the study. We compared the risk of future maternal outcomes (HTN and DM) according to the offspring's birthweight. Multivariate analyses were performed to estimate the hazard ratio (HR) for the future risk of HTN or DM. RESULTS A total of 64,037 women were included in the analysis. Of these, women who delivered very LGA babies (birthweight > 97th percentile) were at a higher risk of developing DM than those who delivered appropriate-for-gestational-age (AGA) babies (adjusted HR = 1.358 [1.068-1.727]), and women who delivered very SGA babies (birthweight < 3rd percentile) were at a higher risk of developing HTN than those who delivered AGA babies (adjusted HR = 1.431 [1.181-1.734]), even after adjusting for age, parity, gestational age at delivery, fetal sex, maternal BMI score, and a history of smoking. CONCLUSION These findings provide a novel support for the use of the offspring's birthweight as a predictor of future maternal diseases such as HTN and DM.
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Affiliation(s)
- Young Mi Jung
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
| | - Wonyoung Wi
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
| | - Kyu-Dong Cho
- Big Data Department, National Health Insurance Service, Wonju, Korea
| | - Su Jung Hong
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
| | - Ho Yeon Kim
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
| | - Ki Hoon Ahn
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
| | - Soon-Cheol Hong
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
| | - Hai-Joong Kim
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
| | - Min-Jeong Oh
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
| | - Geum Joon Cho
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea.
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Yen IW, Lin SY, Lin MW, Lee CN, Kuo CH, Chen SC, Tai YY, Kuo CH, Kuo HC, Lin HH, Juan HC, Lin CH, Fan KC, Wang CY, Li HY. The association between plasma angiopoietin-like protein 4, glucose and lipid metabolism during pregnancy, placental function, and risk of delivering large-for-gestational-age neonates. Clin Chim Acta 2024; 554:117775. [PMID: 38220135 DOI: 10.1016/j.cca.2024.117775] [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: 09/11/2023] [Revised: 12/18/2023] [Accepted: 01/08/2024] [Indexed: 01/16/2024]
Abstract
BACKGROUND Large-for-gestational-age (LGA) neonates have increased risk of adverse pregnancy outcomes and adult metabolic diseases. We aimed to investigate the relationship between plasma angiopoietin-like protein 4 (ANGPTL4), a protein involved in lipid and glucose metabolism during pregnancy, placental function, growth factors, and the risk of LGA. METHODS We conducted a prospective cohort study and recruited women with singleton pregnancies at the National Taiwan University Hospital between 2013 and 2018. First trimester maternal plasma ANGPTL4 concentrations were measured. RESULTS Among 353 pregnant women recruited, the LGA group had higher first trimester plasma ANGPTL4 concentrations than the appropriate-for-gestational-age group. Plasma ANGPTL4 was associated with hemoglobin A1c, post-load plasma glucose, plasma triglyceride, plasma free fatty acid concentrations, plasma growth hormone variant (GH-V), and birth weight, but was not associated with cord blood growth factors. After adjusting for age, body mass index, hemoglobin A1c, and plasma triglyceride concentrations, plasma ANGPTL4 concentrations were significantly associated with LGA risk, and its predictive performance, as measured by the area under the receiver operating characteristic curve, outperformed traditional risk factors for LGA. CONCLUSIONS Plasma ANGPTL4 is associated with glucose and lipid metabolism during pregnancy, plasma GH-V, and birth weight, and is an early biomarker for predicting the risk of LGA.
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Affiliation(s)
- I-Weng Yen
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu County, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shin-Yu Lin
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Wei Lin
- Department of Obstetrics and Gynecology, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu County, Taiwan
| | - Chien-Nan Lee
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chun-Heng Kuo
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Internal Medicine, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan
| | | | - Yi-Yun Tai
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ching-Hua Kuo
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei 100, Taiwan; The Metabolomics Core Laboratory, Centers of Genomic and Precision Medicine, National Taiwan University, Taipei 100, Taiwan
| | - Han-Chun Kuo
- The Metabolomics Core Laboratory, Centers of Genomic and Precision Medicine, National Taiwan University, Taipei 100, Taiwan
| | - Heng-Huei Lin
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsien-Chia Juan
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chia-Hung Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan
| | - Kang-Chih Fan
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu County, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chih-Yuan Wang
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan
| | - Hung-Yuan Li
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan.
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10
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Horgan R, Hage Diab Y, Fishel Bartal M, Sibai BM, Saade G. Continuous Glucose Monitoring in Pregnancy. Obstet Gynecol 2024; 143:195-203. [PMID: 37769316 DOI: 10.1097/aog.0000000000005374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/06/2023] [Indexed: 09/30/2023]
Abstract
Diabetes mellitus in pregnancy is associated with adverse maternal and neonatal outcomes. Optimal glycemic control is associated with improved outcomes. Continuous glucose monitoring is a less invasive alternative to blood glucose measurements. Two types of continuous glucose monitoring are available in the market: real time and intermittently scanned. Continuous glucose monitoring is gaining popularity and is now recommended by some societies for glucose monitoring in pregnant women. In this review, we discuss the differences between the two types of continuous glucose monitoring, optimal treatment goals, and whether there is an improvement in maternal or neonatal outcomes.
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Affiliation(s)
- Rebecca Horgan
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia; and the Department of Obstetrics, Gynecology and Reproductive Sciences, UTHealth Houston, Houston, Texas
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11
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Borges MC, Clayton GL, Freathy RM, Felix JF, Fernández-Sanlés A, Soares AG, Kilpi F, Yang Q, McEachan RRC, Richmond RC, Liu X, Skotte L, Irizar A, Hattersley AT, Bodinier B, Scholtens DM, Nohr EA, Bond TA, Hayes MG, West J, Tyrrell J, Wright J, Bouchard L, Murcia M, Bustamante M, Chadeau-Hyam M, Jarvelin MR, Vrijheid M, Perron P, Magnus P, Gaillard R, Jaddoe VWV, Lowe WL, Feenstra B, Hivert MF, Sørensen TIA, Håberg SE, Serbert S, Magnus M, Lawlor DA. Integrating multiple lines of evidence to assess the effects of maternal BMI on pregnancy and perinatal outcomes. BMC Med 2024; 22:32. [PMID: 38281920 PMCID: PMC10823651 DOI: 10.1186/s12916-023-03167-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 11/09/2023] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND Higher maternal pre-pregnancy body mass index (BMI) is associated with adverse pregnancy and perinatal outcomes. However, whether these associations are causal remains unclear. METHODS We explored the relation of maternal pre-/early-pregnancy BMI with 20 pregnancy and perinatal outcomes by integrating evidence from three different approaches (i.e. multivariable regression, Mendelian randomisation, and paternal negative control analyses), including data from over 400,000 women. RESULTS All three analytical approaches supported associations of higher maternal BMI with lower odds of maternal anaemia, delivering a small-for-gestational-age baby and initiating breastfeeding, but higher odds of hypertensive disorders of pregnancy, gestational hypertension, preeclampsia, gestational diabetes, pre-labour membrane rupture, induction of labour, caesarean section, large-for-gestational age, high birthweight, low Apgar score at 1 min, and neonatal intensive care unit admission. For example, higher maternal BMI was associated with higher risk of gestational hypertension in multivariable regression (OR = 1.67; 95% CI = 1.63, 1.70 per standard unit in BMI) and Mendelian randomisation (OR = 1.59; 95% CI = 1.38, 1.83), which was not seen for paternal BMI (OR = 1.01; 95% CI = 0.98, 1.04). Findings did not support a relation between maternal BMI and perinatal depression. For other outcomes, evidence was inconclusive due to inconsistencies across the applied approaches or substantial imprecision in effect estimates from Mendelian randomisation. CONCLUSIONS Our findings support a causal role for maternal pre-/early-pregnancy BMI on 14 out of 20 adverse pregnancy and perinatal outcomes. Pre-conception interventions to support women maintaining a healthy BMI may reduce the burden of obstetric and neonatal complications. FUNDING Medical Research Council, British Heart Foundation, European Research Council, National Institutes of Health, National Institute for Health Research, Research Council of Norway, Wellcome Trust.
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Affiliation(s)
- Maria Carolina Borges
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK.
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Gemma L Clayton
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
| | - Rachel M Freathy
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
- Institute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Janine F Felix
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Alba Fernández-Sanlés
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
| | - Ana Gonçalves Soares
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
| | - Fanny Kilpi
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
| | - Qian Yang
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
| | - Rosemary R C McEachan
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Trust, Bradford, UK
| | - Rebecca C Richmond
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
| | - Xueping Liu
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Line Skotte
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Amaia Irizar
- Department of Preventive Medicine and Public Health, University of the Basque Country, Leioa, Spain
- BIODONOSTIA Health Research Institute, Paseo Dr. Beguiristain, 20014, San Sebastian, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Andrew T Hattersley
- Institute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Barbara Bodinier
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Denise M Scholtens
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ellen A Nohr
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Tom A Bond
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
- The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, Australia
| | - M Geoffrey Hayes
- Division of Endocrinology, Metabolism, and Molecular Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jane West
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Trust, Bradford, UK
| | - Jessica Tyrrell
- Institute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, Exeter, UK
| | - John Wright
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Trust, Bradford, UK
| | - Luigi Bouchard
- Department of Biochemistry and Functional Genomics, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Mario Murcia
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Epidemiology and Environmental Health Joint Research Unit, FISABIO-Universitat Jaume I-Universitat de València, Valencia, Spain
| | - Mariona Bustamante
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- ISGlobal, Institute for Global Health, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Marc Chadeau-Hyam
- Faculty of Medicine, School of Public Health, Imperial College London, London, UK
| | | | - Martine Vrijheid
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- ISGlobal, Institute for Global Health, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Patrice Perron
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke (CR-CHUS), Sherbrooke, Québec, Canada
- Department of Medicine, Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Québec, Canada
| | - Per Magnus
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Romy Gaillard
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Vincent W V Jaddoe
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - William L Lowe
- Division of Endocrinology, Metabolism, and Molecular Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Bjarke Feenstra
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Marie-France Hivert
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, MA, USA
- Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Thorkild I A Sørensen
- Department of Public Health, Section of Epidemiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Novo Nordisk Foundation Center for Basic Metabolic Diseases, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Siri E Håberg
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Sylvain Serbert
- Center For Life-Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Maria Magnus
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Deborah A Lawlor
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK.
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK.
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12
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Lapolla A, Dalfrà MG. Comments on TOBOGM study: treatment of gestational diabetes mellitus diagnosed early in pregnancy. J Endocrinol Invest 2024:10.1007/s40618-024-02316-3. [PMID: 38281262 DOI: 10.1007/s40618-024-02316-3] [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: 11/15/2023] [Accepted: 12/29/2023] [Indexed: 01/30/2024]
Affiliation(s)
- A Lapolla
- Department of Medicine, DIMED University of Padova, Via Giustiniani n 2, Padova, Italy.
| | - M G Dalfrà
- Department of Medicine, DIMED University of Padova, Via Giustiniani n 2, Padova, Italy
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13
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Karachaliou GS, Suzuki A. Metabolic dysfunction-associated steatotic liver disease: Emerging risk factors for adverse pregnancy outcomes. Clin Liver Dis (Hoboken) 2024; 23:e0121. [PMID: 38379767 PMCID: PMC10878550 DOI: 10.1097/cld.0000000000000121] [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: 05/15/2023] [Accepted: 11/07/2023] [Indexed: 02/22/2024] Open
Affiliation(s)
| | - Ayako Suzuki
- Division of Gastroenterology, Duke University, Durham, North Carolina, USA
- Department of Medicine, Durham VA Medical Center, Durham, North Carolina, USA
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14
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Kamiński M, Mierzyński R, Poniedziałek-Czajkowska E, Sadowska A, Sotowski M, Leszczyńska-Gorzelak B. Comparative Evaluation of Adipokine Metrics for the Diagnosis of Gestational Diabetes Mellitus. Int J Mol Sci 2023; 25:175. [PMID: 38203346 PMCID: PMC10778639 DOI: 10.3390/ijms25010175] [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: 11/24/2023] [Revised: 12/19/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
Gestational diabetes mellitus (GDM) is one of the most common medical disorders in pregnancy. Adipokines, predominantly secreted by adipose tissue, are involved in numerous metabolic processes. The exact role of adipokines in the pathogenesis of GDM is still not well known, and numerous adipokines have been analysed throughout pregnancy and proposed as biomarkers of GDM. This study aimed to evaluate serum adiponectin, chemerin, lipocalin and apelin levels in GDM and non-GDM women, to assess them as clinically useful biomarkers of the occurrence of GDM and to demonstrate the correlation between the levels of the above adipokines in the blood serum and the increased risk of the development of GDM. The role of these adipokines in the pathogenesis of GDM was also analysed. The statistically significant differences between the levels of adiponectin (7234.6 vs. 9837.5 ng/mL, p < 0.0001), chemerin (264.0 vs. 206.7 ng/mL, p < 0.0001) and lipocalin (39.5 vs. 19.4 ng/mL, p < 0.0001) were observed between pregnant women with GDM and healthy ones. The diagnostic usefulness of the tested adipokines in detecting GDM was also assessed. The research results confirm the hypothesis on the significance of adiponectin, chemerin, lipocalin and apelin in the pathophysiological mechanisms of GDM. We speculate that these adipokines could potentially be established as novel biomarkers for the prediction and early diagnosis of GDM.
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Affiliation(s)
| | - Radzisław Mierzyński
- Chair and Department of Obstetrics and Perinatology, Medical University of Lublin, 20-954 Lublin, Poland; (M.K.); (A.S.); (M.S.); (B.L.-G.)
| | - Elżbieta Poniedziałek-Czajkowska
- Chair and Department of Obstetrics and Perinatology, Medical University of Lublin, 20-954 Lublin, Poland; (M.K.); (A.S.); (M.S.); (B.L.-G.)
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15
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Vedika R, Sharma P, Reddy A. Signature precursor and mature microRNAs in cervical ripening during gestational diabetes mellitus lead to pre-term labor and other impediments in future. J Diabetes Metab Disord 2023; 22:945-965. [PMID: 37975145 PMCID: PMC10638342 DOI: 10.1007/s40200-023-01232-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 04/29/2023] [Indexed: 11/19/2023]
Abstract
Gestational diabetes mellitus (GDM) is a pathological condition in which the placenta releases a hormone called human placental lactogen that prevents maternal insulin uptake. GDM is characterised by varying degrees of carbohydrate intolerance and is first identified during pregnancy. Around 5-17% of pregnancies are GDM pregnancies. Older or obese women have a higher risk of developing GDM during gestation. Hyperglycemia is a classic manifestation of GDM and leads to alterations in eNOS and iNOS expression and subsequently causes ROS and RNS overproduction. ROS and RNS play an important role in maintaining normal physiology, when present in low concentrations. Increased concentrations of ROS is harmful and can cause cellular and tissue damage. Oxidative stress is defined as an imbalance between pro-oxidant and antioxidant molecules that manifests due to hyperglycemia. miRNAs are short, non-coding RNAs that play a critical role in regulating gene expression. Studies have shown that the placenta expresses more than 500 miRNAs, which play a crucial role in trophoblast division, movement, and apoptosis. Latest research has revealed that hyperglycemic conditions and increased oxidative stress, characteristic of GDM, can lead to the dysregulation of miRNAs. The placenta also releases miRNAs into the maternal circulation. The secreted miRNAs are encapsulated in exosomes or vesicles. These exosomes interact with tissues and organs at distant sites, releasing their cargo intracellularly. This crosstalk between hyperglycemia, ROS and miRNA expression in GDM has detrimental effects on both foetal and maternal health. One of the complications of GDM is preterm labour. GDM induced iNOS expression has been implicated in cervical ripening, which in turn causes preterm birth. This article focuses on the speculations of oxidative and nitrative stress markers that lead to detrimental effects in GDM. We have also envisaged the role of non-coding miRNA interactions in regulating gene expression for oxidative damage. Graphical Abstract Holistic view of miRNA in GDM. I)(A) Placenta as a metabolic organ that provides the foetus with nutrients, oxygen and hormones to maintain pregnancy. Human placental lactogen (hPL) is one such hormone that is released into maternal circulation. hPL is known to induce insulin resistance. (B) ß-cell dysfunction leads to reduced glucose sensing and insulin production. Insulin resistance, a characteristic of GDM, exacerbates insulin ß cell dysfunction leading to maternal hyperglycemia. Hyperglycemia leads to increased ROS and RNS production through several mechanisms. Consequently, GDM is characterised by increased oxidative and nitrative stress.II)Exposure to maternal hyperglycemia causes increased ROS and RNS production in trophoblast cells. Oxidative stress caused by hyperglycemia may lead to eNOS uncoupling, causing eNOS to behave as a superoxide producing enzyme. iNOS expression in trophoblast cells leads to increased NO production. iNOS-derived NO reacts with ROS to produce RNS, thereby increasing nitrosative stress. Expression of antioxidant defences are reduced. Hyperglycemia and oxidative stress may alter the expression of some miRNAs. Some miRNAs are upregulated while others are downregulated. Some miRNAs are secreted into maternal circulation in the form of exosomes. Oxidative stress markers, nitrative stress markers and circulating miRNAs are found to be increased in maternal circulation.
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Affiliation(s)
- R. Vedika
- Animal cell culture laboratory, Department of Biotechnology, SRMIST, Kattankulathur, Tamil Nadu India
| | - Priyanshy Sharma
- Animal cell culture laboratory, Department of Biotechnology, SRMIST, Kattankulathur, Tamil Nadu India
| | - Amala Reddy
- Animal cell culture laboratory, Department of Biotechnology, SRMIST, Kattankulathur, Tamil Nadu India
- Department of Biotechnology, SRMIST, Kattankulathur, Kancheepuram 603203 India
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16
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Bersain R, Mishra D, Juneja M, Kumar D, Garg S. Comparison of Neurodevelopmental Status in Early Infancy of Infants of Women With and Without Gestational Diabetes Mellitus. Indian J Pediatr 2023; 90:1083-1088. [PMID: 37256447 DOI: 10.1007/s12098-023-04639-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 04/24/2023] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To study the neurodevelopmental status of offsprings of mothers with gestational diabetes (OGDM) aged 3½ mo. METHODS This cross-sectional study was conducted at a tertiary hospital, New Delhi which included infants aged 3½ mo (+1 wk) who were either offsprings of women with gestational diabetes (cases) or infants of mothers without gestational diabetes mellitus presenting to tertiary care public hospital in India from January, 2018 through March, 2019, with enrollment of infants done between 10 April, 2018 and 30 March, 2019. RESULTS The development quotient (DQ) using Developmental Assessment Scales for Indian Infants (DASII) was calculated as Motor DQ, Mental DQ and a composite DQ. The mean motor DQ of the enrolled infants was 101.7 (12.02); it was significantly lower for OGDM than controls [101 (1.41) vs. 109.5 (10.6); P <0.001]. The mean mental DQ of the enrolled infants was 88.9 (12.0); it was significantly lower for OGDM than the control group [84 (9.89 vs. 88 (8.48); P = 0.03]. The total development quotient for the enrolled infants was 95.3 (11.3). The total development quotient for study group was significantly lower than the control group [92.5 (5.65) vs. 98.75 (9.54); P = 0.001]. CONCLUSIONS The mean motor, mental total DQ of offsprings of mothers with GDM were significantly lower than those born to mothers without GDM. Hence follow up, early intervention should be considered for this high risk group.
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Affiliation(s)
- Rimjhim Bersain
- Department of Pediatrics, Maulana Azad Medical College & Associated Lok Nayak Hospital (Delhi University), New Delhi, India
| | - Devendra Mishra
- Department of Pediatrics, Maulana Azad Medical College & Associated Lok Nayak Hospital (Delhi University), New Delhi, India.
| | - Monica Juneja
- Department of Pediatrics, Maulana Azad Medical College & Associated Lok Nayak Hospital (Delhi University), New Delhi, India
- Child Development Center, Department of Pediatrics, Maulana Azad Medical College & Associated Lok Nayak Hospital (Delhi University), New Delhi, India
| | - Devender Kumar
- Department of Obstetrics and Gynaecology, Maulana Azad Medical College & Associated Lok Nayak Hospital (Delhi University), New Delhi, India
| | - Sandeep Garg
- Department of Internal Medicine, Maulana Azad Medical College & Associated Lok Nayak Hospital (Delhi University), New Delhi, India
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17
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Jackson KE, Hamad R, Karasek D, White JS. Sugar-Sweetened Beverage Taxes and Perinatal Health: A Quasi-Experimental Study. Am J Prev Med 2023; 65:366-376. [PMID: 36966893 PMCID: PMC10518370 DOI: 10.1016/j.amepre.2023.03.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 03/20/2023] [Accepted: 03/20/2023] [Indexed: 04/05/2023]
Abstract
INTRODUCTION One in 5 pregnant individuals report consuming sugar-sweetened beverages at least once per day. Excess sugar consumption during pregnancy is associated with several perinatal complications. As sugar-sweetened beverage taxes become increasingly common public health measures to reduce sugar-sweetened beverage consumption, evidence of the downstream effects of sugar-sweetened beverage taxes on perinatal health remains limited. METHODS This longitudinal retrospective study examines whether sugar-sweetened beverage taxes in 5 U.S. cities were associated with decreased risk of perinatal complications, leveraging 2013-2019 U.S. national birth certificate data and a quasi-experimental difference-in-differences approach to estimate changes in perinatal outcomes. Analysis occurred from April 2021 through January 2023. RESULTS The sample included 5,324,548 pregnant individuals and their live singleton births in the U.S. from 2013 through 2019. Sugar-sweetened beverage taxes were associated with a 41.4% decreased risk of gestational diabetes mellitus (-2.2 percentage points; 95% CI= -4.2, -0.2), a -7.9% reduction in weight-gain-for-gestational-age z-score (-0.2 standard deviations; 95% CI= -0.3, -0.01), and decreased risk of infants born small for gestational age (-4.3 percentage points; 95% CI= -6.5, -2.1). There were heterogeneous effects across subgroups, particularly for weight-gain-for-gestational-age z-score. CONCLUSIONS Sugar-sweetened beverage taxes levied in five U.S. cities were associated with improvements in perinatal health. Sugar-sweetened beverage taxes may be an effective policy instrument for improving health during pregnancy, a critical window during which short-term dietary exposures can have lifelong consequences for the birthing person and child.
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Affiliation(s)
- Kaitlyn E Jackson
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California
| | - Rita Hamad
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California; Department of Family & Community Medicine, University of California San Francisco, San Francisco, California
| | - Deborah Karasek
- Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California San Francisco, San Francisco, California
| | - Justin S White
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California; Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California.
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18
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Chen Y, Crockett AH, Britt JL, Zhang L, Nianogo RA, Qian T, Nan B, Chen L. Group vs Individual Prenatal Care and Gestational Diabetes Outcomes: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2330763. [PMID: 37642966 PMCID: PMC10466168 DOI: 10.1001/jamanetworkopen.2023.30763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 07/18/2023] [Indexed: 08/31/2023] Open
Abstract
Importance The impact of group-based prenatal care (GPNC) model in the US on the risk of gestational diabetes (GD) and related adverse obstetric outcomes is unknown. Objective To determine the effects of the GPNC model on risk of GD, its progression, and related adverse obstetric outcomes. Design, Setting, and Participants This is a single-site, parallel-group, randomized clinical trial conducted between February 2016 and March 2020 at a large health care system in Greenville, South Carolina. Participants were individuals aged 14 to 45 years with pregnancies earlier than 21 weeks' gestational age; follow-up continued to 8 weeks post partum. This study used an intention-to-treat analysis, and data were analyzed from March 2021 to July 2022. Interventions Eligible participants were randomized to receive either CenteringPregnancy, a widely used GPNC model, with 10 group-based sessions or traditional individual prenatal care (IPNC). Main Outcomes and Measures The primary outcome was the incidence of GD diagnosed between 24 and 30 weeks of gestation. The secondary outcomes included progression to A2 GD (ie, GD treated with medications) and GD-related adverse obstetric outcomes (ie, preeclampsia, cesarean delivery, and large for gestational age). Log binomial models were performed to estimate risk differences (RDs), 95% CIs, and P values between GPNC and IPNC groups, adjusting for all baseline covariates. Results Of all 2348 participants (mean [SD] age, 25.1 [5.4] years; 952 Black participants [40.5%]; 502 Hispanic participants [21.4%]; 863 White participants [36.8%]), 1176 participants were randomized to the GPNC group and 1174 were randomized to the IPNC group. Among all participants, 2144 (91.3%) completed a GD screening (1072 participants [91.3%] in GPNC vs 1071 [91.2%] in IPNC). Overall, 157 participants (6.7%) developed GD, and there was no difference in GD incidence between the GPNC (83 participants [7.1%]) and IPNC (74 participants [6.3%]) groups, with an adjusted RD of 0.7% (95% CI, -1.2% to 2.7%). Among participants with GD, GPNC did not reduce the risk of progression to A2 GD (adjusted RD, -6.1%; 95% CI, -21.3% to 9.1%), preeclampsia (adjusted RD, -7.9%; 95% CI, -17.8% to 1.9%), cesarean delivery (adjusted RD, -8.2%; 95% CI, -12.2% to 13.9%), and large for gestational age (adjusted RD, -1.2%; 95% CI, -6.1% to 3.8%) compared with IPNC. Conclusions and Relevance In this secondary analysis of a randomized clinical trial among medically low-risk pregnant individuals, the risk of GD was similar between participants who received GPNC intervention and traditional IPNC, indicating that GPNC may be a feasible treatment option for some patients. Trial Registration ClinicalTrials.gov Identifier: NCT02640638.
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Affiliation(s)
- Yixin Chen
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles
| | - Amy H. Crockett
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Prisma Health, Greenville, South Carolina
- University of South Carolina School of Medicine, Greenville
| | - Jessica L. Britt
- Department of Obstetrics and Gynecology, Prisma Health, Greenville, South Carolina
| | - Lu Zhang
- Department of Public Health Sciences, Clemson University, Clemson, South Carolina
| | - Roch A. Nianogo
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles
- California Center for Population Research, Los Angeles
| | - Tianchen Qian
- Department of Statistics, University of California, Irvine
| | - Bin Nan
- Department of Statistics, University of California, Irvine
| | - Liwei Chen
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles
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19
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Casey C, Kemp BJ, Cassidy L, Patterson CC, Tully MA, Hill AJ, McCance DR. The influence of diet and physical activity on bone density of children aged 5-7 years: The Belfast HAPO family study. Bone 2023; 172:116783. [PMID: 37121559 DOI: 10.1016/j.bone.2023.116783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 04/21/2023] [Accepted: 04/25/2023] [Indexed: 05/02/2023]
Abstract
OBJECTIVE Osteoporosis is a global health issue, and modifiable behavioural factors need to be identified in childhood to reduce the risk of osteoporosis in later life. The aim of this study was to investigate the influence of diet and physical activity on bone density of children aged 5-7 years participating in the Belfast Hyperglycaemia and Adverse Pregnancy Outcome (HAPO) Family study. DESIGN AND METHODS Pregnant women were recruited to the Belfast centre of the HAPO study at 24-32 weeks gestation. Offspring were followed up at 5-7 years as part of the Belfast HAPO Family Study. Heel bone mineral density (BMD) and bone mineral apparent density (BMAD) were measured and calculated, respectively. Physical activity in the offspring was measured by accelerometery and dietary intakes were measured using a 4-day food diary. RESULTS Results from 793 offspring were analysed. Mean age of the offspring ± standard deviation was 6.4 ± 0.5 years. A mean of 48.3 ± 22.4 min each day was spent in moderate to vigorous physical activity (MVPA). Median (interquartile range) dietary calcium and vitamin D intakes were 844 (662-1073) mg/day and 1.7 (1.1-2.5) μg/day, respectively. Neither dietary vitamin D nor calcium intakes were significantly associated with offspring heel BMD or BMAD in multiple regression. However, controlling for confounders, a 30-min greater MVPA was associated with significantly larger heel BMD (0.018 g/cm2 in boys and 0.010 g/cm2 in girls) and BMAD (0.005 g/cm3 in boys and 0.003 g/cm3 in girls). CONCLUSION Physical activity was associated with better BMD and BMAD in 5-7-year-old children. Dietary calcium and vitamin D were not predictive of BMD and BMAD.
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Affiliation(s)
- Claire Casey
- Centre for Public Health, Queen's University Belfast, Belfast BT12 6BA, Northern Ireland, UK
| | - Bridie J Kemp
- Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast BT12 6BA, Northern Ireland, UK; School of Nursing and Midwifery, Queen's University Belfast, Belfast BT12 6BA, Northern Ireland, UK
| | - Laura Cassidy
- Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast BT12 6BA, Northern Ireland, UK
| | - Chris C Patterson
- Centre for Public Health, Queen's University Belfast, Belfast BT12 6BA, Northern Ireland, UK
| | - Mark A Tully
- Institute of Mental Health Sciences, School of Health Sciences, Ulster University, Newtownabbey BT37 0QB, Northern Ireland, UK
| | - Alyson J Hill
- Nutrition Innovation Centre for Food and Health, Ulster University, Coleraine BT52 1SA, Northern Ireland, UK
| | - David R McCance
- Centre for Public Health, Queen's University Belfast, Belfast BT12 6BA, Northern Ireland, UK; Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast BT12 6BA, Northern Ireland, UK.
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20
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Jardine IR, Christie HE, Oetsch K, Sabag A, Kennedy M, Meyer BJ, Francois ME. Physical Activity, but Not Glycaemic Load, Is Associated with Lower Real-Time Glycaemic Control in Free-Living Women with Gestational Diabetes Mellitus. Nutrients 2023; 15:nu15081974. [PMID: 37111193 PMCID: PMC10142701 DOI: 10.3390/nu15081974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/29/2023] [Accepted: 04/06/2023] [Indexed: 04/29/2023] Open
Abstract
Maintaining blood glucose within the target range is the primary treatment goal for women with gestational diabetes mellitus (GDM). Foods with low glycaemic loads are recommended in clinical practice; however, the relative importance of other key lifestyle variables is unexplored. This pilot study explored the associations of glycaemic load, carbohydrates and physical activity parameters on blood glucose concentrations in free-living women with GDM. Twenty-nine women (28-30 weeks gestation, 34 ± 4 years) with GDM were enrolled. Continuous glucose monitoring, physical activity (ActivPAL inclinometer) and dietary intake and dietary quality were measured concurrently for 3 days. Pearson correlation analyses determined the association between glucose levels and lifestyle variables. Despite all receiving the same nutrition education, only 55% of women were following a low glycaemic load diet with a large range of carbohydrate intakes (97-267 g/day). However, the glycaemic load did not correlate with 3-hr postprandial glucose (r2 = 0.021, p = 0.56) or 24-h glucose iAUC (r2 = 0.021, p = 0.58). A significant relationship between total stepping time and lower 24-h glucose iAUC (r2 = 0.308, p = 0.02) and nocturnal glucose (r2 = 0.224, p = 0.05) was found. In free-living women with diet-controlled GDM, more physical activity, i.e., steps accumulated across the day, may be a simple and effective strategy for improving maternal blood glucose concentrations.
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Affiliation(s)
- Isabelle R Jardine
- School of Medical, Indigenous and Health Sciences, Faculty of Science, Medicine and Health University of Wollongong, Wollongong, NSW 2522, Australia
| | - Hannah E Christie
- School of Medical, Indigenous and Health Sciences, Faculty of Science, Medicine and Health University of Wollongong, Wollongong, NSW 2522, Australia
- Illawarra Health and Medical Research Institute, Wollongong, NSW 2522, Australia
| | - Kate Oetsch
- School of Medical, Indigenous and Health Sciences, Faculty of Science, Medicine and Health University of Wollongong, Wollongong, NSW 2522, Australia
- Illawarra Health and Medical Research Institute, Wollongong, NSW 2522, Australia
| | - Angelo Sabag
- NICM Health Research Institute, Western Sydney University, Westmead, NSW 2145, Australia
| | - Meredith Kennedy
- School of Medical, Indigenous and Health Sciences, Faculty of Science, Medicine and Health University of Wollongong, Wollongong, NSW 2522, Australia
- Illawarra Shoalhaven Local Health District, Diabetes Service, Wollongong, NSW 2500, Australia
| | - Barbara J Meyer
- School of Medical, Indigenous and Health Sciences, Faculty of Science, Medicine and Health University of Wollongong, Wollongong, NSW 2522, Australia
- Illawarra Health and Medical Research Institute, Wollongong, NSW 2522, Australia
- Molecular Horizons, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Monique E Francois
- School of Medical, Indigenous and Health Sciences, Faculty of Science, Medicine and Health University of Wollongong, Wollongong, NSW 2522, Australia
- Illawarra Health and Medical Research Institute, Wollongong, NSW 2522, Australia
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21
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Aldahmash W, Harrath AH, Aljerian K, Sabr Y, Alwasel S. Expression of Glucose Transporters 1 and 3 in the Placenta of Pregnant Women with Gestational Diabetes Mellitus. Life (Basel) 2023; 13:life13040993. [PMID: 37109521 PMCID: PMC10143906 DOI: 10.3390/life13040993] [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: 03/06/2023] [Revised: 03/29/2023] [Accepted: 04/06/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND The annual prevalence of gestational diabetes mellitus-characterized by an increase in blood glucose in pregnant women-has been increasing worldwide. The goal of this study was to evaluate the expression of glucose transporter 1 (GLUT1) and glucose transporter 3 (GLUT3) in the placenta of women with gestational diabetes mellitus. METHODS Sixty-five placentas from women admitted to the King Saud University Medical City, Riyadh, Saudi Arabia, were analyzed; 34 and 31 placentas were from healthy pregnant women and women with gestational diabetes, respectively. The expressions of GLUT1 and GLUT3 were assessed using RT-PCR, Western blotting, and immunohistochemical methods. The degree of apoptosis in the placental villi was estimated via a TUNEL assay. RESULTS The results of the protein expression assays and immunohistochemical staining showed that the levels of GLUT1 and GLUT3 were significantly higher in the placentas of pregnant women with gestational diabetes than those in the placentas of healthy pregnant women. In addition, the findings showed an increase in apoptosis in the placenta of pregnant women with gestational diabetes compared to that in the placenta of healthy pregnant women. However, the results of gene expression assays showed no significant difference between the two groups. CONCLUSIONS Based on these results, we conclude that gestational diabetes mellitus leads to an increased incidence of apoptosis in the placental villi and alters the level of GLUT1 and GLUT3 protein expressions in the placenta of women with gestational diabetes. Understanding the conditions in which the fetus develops in the womb of a pregnant woman with gestational diabetes may help researchers understand the underlying causes of the development of chronic diseases later in life.
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Affiliation(s)
- Waleed Aldahmash
- Zoology Department, College of Science, King Saud University, P.O. Box 2455, Riyadh 11451, Saudi Arabia
| | - Abdel Halim Harrath
- Zoology Department, College of Science, King Saud University, P.O. Box 2455, Riyadh 11451, Saudi Arabia
| | - Khaldoon Aljerian
- Pathology Department, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia
| | - Yasser Sabr
- Obstetrics and Gynaecology Department, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia
| | - Saleh Alwasel
- Zoology Department, College of Science, King Saud University, P.O. Box 2455, Riyadh 11451, Saudi Arabia
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22
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Gleason B, Kuang A, Bain JR, Muehlbauer MJ, Ilkayeva OR, Scholtens DM, Lowe WL. Association of Maternal Metabolites and Metabolite Networks with Newborn Outcomes in a Multi-Ancestry Cohort. Metabolites 2023; 13:metabo13040505. [PMID: 37110162 PMCID: PMC10145069 DOI: 10.3390/metabo13040505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 03/23/2023] [Accepted: 03/28/2023] [Indexed: 04/03/2023] Open
Abstract
The in utero environment is important for newborn size at birth, which is associated with childhood adiposity. We examined associations between maternal metabolite levels and newborn birthweight, sum of skinfolds (SSF), and cord C-peptide in a multinational and multi-ancestry cohort of 2337 mother–newborn dyads. Targeted and untargeted metabolomic assays were performed on fasting and 1 h maternal serum samples collected during an oral glucose tolerance test performed at 24–32 week gestation in women participating in the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study. Anthropometric measurements were obtained on newborns at birth. Following adjustment for maternal BMI and glucose, per-metabolite analyses demonstrated significant associations between maternal metabolite levels and birthweight, SSF, and cord C-peptide. In the fasting state, triglycerides were positively associated and several long-chain acylcarnitines were inversely associated with birthweight and SSF. At 1 h, additional metabolites including branched-chain amino acids, proline, and alanine were positively associated with newborn outcomes. Network analyses demonstrated distinct clusters of inter-connected metabolites significantly associated with newborn phenotypes. In conclusion, numerous maternal metabolites during pregnancy are significantly associated with newborn birthweight, SSF, and cord C-peptide independent of maternal BMI and glucose, suggesting that metabolites in addition to glucose contribute to newborn size at birth and adiposity.
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23
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Tsarna E, Eleftheriades A, Tsomi E, Ziogou G, Vakas P, Panoskaltsis T, Christopoulos P. The Role of Diet during Pregnancy in Protecting against Gestational Diabetes Mellitus in a Population with Mediterranean Dietary Habits: A Cross-Sectional Study. J Clin Med 2023; 12:jcm12051857. [PMID: 36902644 PMCID: PMC10003761 DOI: 10.3390/jcm12051857] [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: 01/06/2023] [Revised: 02/20/2023] [Accepted: 02/24/2023] [Indexed: 03/02/2023] Open
Abstract
Gestational diabetes mellitus (GDM) is a common metabolic disorder among pregnant women. Dietary habits during pregnancy might alter the risk of GDM development, and populations following the Mediterranean diet are relatively understudied. This was a cross-sectional, observational study of 193 low-risk women admitted to a private maternity hospital in Greece to give birth. Food frequency data on specific food categories, selected based on previous research, were analyzed. Logistic regression models, both crude and adjusted for maternal age, body mass index before pregnancy, and gestational weight gain, were fitted. We observed no association of carbohydrate-rich meals, sweets, soft drinks, coffee, rice, pasta, bread and crackers, potatoes, lentils, and juices with GDM diagnosis. Cereals (crude p = 0.045, adjusted p = 0.095) and fruits and vegetables (crude p = 0.07, adjusted p = 0.04) appeared to have a protective effect against GDM, while frequent tea consumption was linked to higher risk of GDM development (crude p = 0.067, adjusted p = 0.035). These results strengthen previously identified associations and underline the importance and potential impact of changing dietary habits even during pregnancy in adjusting one's risk of metabolic pregnancy complications, such as GDM. The importance of healthy dietary habits is highlighted, with the goal of raising awareness amongst obstetric care specialists regarding the provision of systematic nutrition recommendations to pregnant women.
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Affiliation(s)
- Ermioni Tsarna
- 2nd Department of Obstetrics and Gynecology, Aretaieion University Hospital, Athens Medical School, 11527 Athens, Greece
| | - Anna Eleftheriades
- Postgraduate Programme “Maternal Fetal Medicine”, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Efthymia Tsomi
- 2nd Department of Obstetrics and Gynecology, Aretaieion University Hospital, Athens Medical School, 11527 Athens, Greece
| | - Georgia Ziogou
- 2nd Department of Obstetrics and Gynecology, Aretaieion University Hospital, Athens Medical School, 11527 Athens, Greece
| | - Panagiotis Vakas
- 2nd Department of Obstetrics and Gynecology, Aretaieion University Hospital, Athens Medical School, 11527 Athens, Greece
| | - Theodoros Panoskaltsis
- 2nd Department of Obstetrics and Gynecology, Aretaieion University Hospital, Athens Medical School, 11527 Athens, Greece
| | - Panagiotis Christopoulos
- 2nd Department of Obstetrics and Gynecology, Aretaieion University Hospital, Athens Medical School, 11527 Athens, Greece
- Correspondence:
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24
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Chen P, Gu M, Wan S, Jiang X, Zhang F, Li Y, Zhou Q, Lu Y, Li L, Wang X. Gestational Diabetes Mellitus Impedes Fetal Lung Development Through Exosome-Dependent Crosstalk Between Trophoblasts and Lung Epithelial Cells. Int J Nanomedicine 2023; 18:641-657. [PMID: 36789391 PMCID: PMC9922507 DOI: 10.2147/ijn.s396194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 02/02/2023] [Indexed: 02/10/2023] Open
Abstract
Background Fetal lung underdevelopment (FLUD) is associated with neonatal and childhood severe respiratory diseases, among which gestational diabetes mellitus (GDM) play crucial roles as revealed by recent prevalence studies, yet mechanism underlying GDM-induced FLUD, especially the role of trophoblasts, is not all known. Methods From the perspective of trophoblast-derived exosomes, we established in vitro, ex vivo, in vivo and GDM trophoblast models. Utilizing placenta-derived exosomes (NUB-exos and GDMUB-exos) isolated from normal and GDM umbilical cord blood plasma and trophoblast-derived exosomes (NC-exos and HG-exos) isolated from HTR8/SVneo trophoblasts medium with/without high glucose treatment, we examined their effects on fetal lung development and biological functions. Results We found that, compared with the NUB-exos group, the exosome concentration increased in GDMUB-exos group, and the content of exosomes also changed evidenced by 61 dysregulated miRNAs. After applying these exosomes to A549 alveolar type II epithelial cells, the proliferation and biological functions were suppressed while the proportion of apoptotic cells was increased as compared to the control. In ex vivo studies, we found that GDMUB-exos showed significant suppression on the growth of the fetal lung explants, where the number of terminal buds and the area of explant surface decreased and shrank. Besides, the expression of Fgf10, Vegfa, Flt-1, Kdr and surfactant proteins A, B, C, and D was downregulated in GDMUB-exos group, whilst Sox9 was upregulated. For in vivo studies, we found significant suppression of fetal lung development in GDMUB-exos group. Importantly, we found consistent alterations when we used NC-exos and HG-exos, suggesting a dominant role of trophoblasts in placenta-derived exosome-induced FLUD. Conclusion In conclusion, GDM can adversely affect trophoblasts and alter exosome contents, causing crosstalk disorder between trophoblasts and fetal lung epithelial cells and finally leading to FLUD. Findings of this study will shine insight into the theoretical explanation for the pathogenesis of FLUD.
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Affiliation(s)
- Pengzheng Chen
- Department of Obstetrics and Gynaecology, Shandong Provincial Hospital, Shandong University, Jinan, People’s Republic of China
| | - Mengqi Gu
- Department of Obstetrics and Gynaecology, Shandong Provincial Hospital, Shandong University, Jinan, People’s Republic of China
| | - Shuting Wan
- Department of Obstetrics and Gynaecology, Shandong Provincial Hospital, Shandong University, Jinan, People’s Republic of China
| | - Xiaotong Jiang
- Department of Obstetrics and Gynaecology, Shandong Provincial Hospital, Shandong University, Jinan, People’s Republic of China
| | - Fengyuan Zhang
- Department of Obstetrics and Gynaecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China
| | - Yuchen Li
- Department of Obstetrics and Gynaecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China
| | - Qian Zhou
- Department of Obstetrics and Gynaecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China
| | - Yuan Lu
- Department of Obstetrics and Gynaecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China
| | - Lei Li
- Department of Obstetrics and Gynaecology, Shandong Provincial Hospital, Shandong University, Jinan, People’s Republic of China,Department of Obstetrics and Gynaecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China,Laboratory of Medical Science and Technology Innovation Center (Institute of Translational Medicine), Shandong First Medical University (Shandong Academy of Medical Sciences), Jinan, People’s Republic of China,Correspondence: Lei Li; Xietong Wang, Department of Obstetrics and Gynaecology, Shandong Provincial Hospital, Shandong University, Jinan, People’s Republic of China, Tel +8615168889200; +8615168888928, Email ;
| | - Xietong Wang
- Department of Obstetrics and Gynaecology, Shandong Provincial Hospital, Shandong University, Jinan, People’s Republic of China,Department of Obstetrics and Gynaecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China,Laboratory of Medical Science and Technology Innovation Center (Institute of Translational Medicine), Shandong First Medical University (Shandong Academy of Medical Sciences), Jinan, People’s Republic of China,Key Laboratory of Birth Regulation and Control Technology of National Health Commission of China, Shandong Provincial Maternal and Child Health Care Hospital, Jinan, People’s Republic of China
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Lee SH, Yu J, Han K, Lee SW, You SY, Kim HS, Cho JH, Yoon KH, Kim MK. Predicting the Risk of Insulin-Requiring Gestational Diabetes before Pregnancy: A Model Generated from a Nationwide Population-Based Cohort Study in Korea. Endocrinol Metab (Seoul) 2023; 38:129-138. [PMID: 36702473 PMCID: PMC10008663 DOI: 10.3803/enm.2022.1609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 01/02/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGRUOUND The severity of gestational diabetes mellitus (GDM) is associated with adverse pregnancy outcomes. We aimed to generate a risk model for predicting insulin-requiring GDM before pregnancy in Korean women. METHODS A total of 417,210 women who received a health examination within 52 weeks before pregnancy and delivered between 2011 and 2015 were recruited from the Korean National Health Insurance database. The risk prediction model was created using a sample of 70% of the participants, while the remaining 30% were used for internal validation. Risk scores were assigned based on the hazard ratios for each risk factor in the multivariable Cox proportional hazards regression model. Six risk variables were selected, and a risk nomogram was created to estimate the risk of insulin-requiring GDM. RESULTS A total of 2,891 (0.69%) women developed insulin-requiring GDM. Age, body mass index (BMI), current smoking, fasting blood glucose (FBG), total cholesterol, and γ-glutamyl transferase were significant risk factors for insulin-requiring GDM and were incorporated into the risk model. Among the variables, old age, high BMI, and high FBG level were the main contributors to an increased risk of insulin-requiring GDM. The concordance index of the risk model for predicting insulin-requiring GDM was 0.783 (95% confidence interval, 0.766 to 0.799). The validation cohort's incidence rates for insulin-requiring GDM were consistent with the risk model's predictions. CONCLUSION A novel risk engine was generated to predict insulin-requiring GDM among Korean women. This model may provide helpful information for identifying high-risk women and enhancing prepregnancy care.
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Affiliation(s)
- Seung-Hwan Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jin Yu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
| | - Seung Woo Lee
- Department of Medical Statistics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sang Youn You
- College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hun-Sung Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae-Hyoung Cho
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kun-Ho Yoon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Mee Kyoung Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Corresponding author: Mee Kyoung Kim. Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 10 63-ro, Yeongdeungpo-gu, Seoul 07345, Korea Tel: +82-2-3779-1368, Fax: +82-2-595-2534, E-mail:
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Sperling MM, Leonard SA, Miller SE, Hurtado J, El-Sayed YY, Herrero T, Faig J, Carter S, Blumenfeld YJ. Fasting Compared With Fed and Oral Intake Before the 1-Hour Oral Glucose Tolerance Test: A Randomized Controlled Trial. Obstet Gynecol 2023; 141:126-133. [PMID: 36701613 DOI: 10.1097/aog.0000000000005013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/22/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To evaluate the effect of fasting compared with eating before the 1-hour oral glucose tolerance test (OGTT) on gestational diabetes mellitus (GDM) screening results. METHODS In a single-center, prospective randomized trial, participants were randomized to: 1) fasting for 6 or more hours or 2) oral intake ("fed") within 2 hours of the 50-g, 1-hour OGTT. The 1-hour OGTT was administered after 24 weeks of gestation. A positive screen result was defined as a serum glucose level of 140 mg/dL or higher. Protocol adherence was assessed by a survey administered immediately after the OGTT. We planned to enroll 100 participants in each group to detect an absolute difference of 20 percentage points or more on the 1-hour OGTT screen-positive rate using Fisher exact test, assuming an estimated screen-positive rate of 45% in the fasting and 25% in the fed group and 10% attrition, with a two-sided α=0.05, power=0.8. The primary outcome was the 1-hour OGTT screen-positive rate. Secondary outcomes included mean 1-hour OGTT glucose values, GDM diagnosis, maternal and neonatal outcomes, and patient perceptions regarding the 1-hour OGTT. RESULTS From November 2020 through April 2021, 200 participants were randomized. One hundred ninety-five completed the 1-hour OGTT (97 fasting, 98 fed). Participant surveys confirmed 97.9% (n=95) adherence to the fasting and 91.8% (n=90) adherence to the fed groups. The screen-positive rate was significantly higher in the fasting than the fed group (32.0% vs 13.3%, respectively, P=.002), as was the mean glucose value (127.7 mg/dL vs 113.3 mg/dL, P=.002). The incidence of GDM in the fasting group was 12.4% (n=12) and in the fed group was 5.1% (n=5) (P=.08). There were no significant differences in maternal or neonatal outcomes. CONCLUSION Fasting for 6 or more hours doubled the incidence of a positive 1-hour OGTT result when compared with eating within 2 hours of the test. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT04547023.
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Affiliation(s)
- Meryl M Sperling
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
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Cooke H, Craig S, Kahal H, Talbot F, Lonnen K. Impact of using fasting plasma glucose and
HbA
1c
instead of
OGTT
as a screening tool for gestational diabetes: a retrospective study. PRACTICAL DIABETES 2023. [DOI: 10.1002/pdi.2434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Hannah Cooke
- Department of Diabetes and Endocrinology, Southmead Hospital, North Bristol NHS Trust Bristol UK
| | - Stephen Craig
- Department of Diabetes and Endocrinology, Southmead Hospital, North Bristol NHS Trust Bristol UK
| | - Hassan Kahal
- Department of Diabetes and Endocrinology, Southmead Hospital, North Bristol NHS Trust Bristol UK
| | - Fleur Talbot
- Department of Diabetes and Endocrinology, Southmead Hospital, North Bristol NHS Trust Bristol UK
| | - Kathryn Lonnen
- Department of Diabetes and Endocrinology, Southmead Hospital, North Bristol NHS Trust Bristol UK
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Xu T, Jiang Y, Guo X, Campbell JA, Ahmad H, Xia Q, Lai X, Yan D, Ma L, Fang H, Palmer AJ. Maternal choices and preferences for screening strategies of gestational diabetes mellitus: A exploratory study using discrete choice experiment. Front Public Health 2022; 10:864482. [PMID: 36388335 PMCID: PMC9664193 DOI: 10.3389/fpubh.2022.864482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 10/17/2022] [Indexed: 01/21/2023] Open
Abstract
Aims This study aimed to investigate maternal preferences for gestational diabetes mellitus (GDM) screening options in rural China to identify an optimal GDM screening strategy. Methods Pregnant women at 24-28 gestational weeks were recruited from Shandong province, China. A discrete choice experiment (DCE) was conducted to elicit pregnant women's preferences for GDM screening strategy defined by five attributes: number of blood draws, out-of-pocket costs, screening waiting-time, number of hospital visits, and positive diagnosis rate. A mixed logistic model was employed to quantify maternal preferences, and to estimate the relative importance of included attributes in determining pregnant women's preferences for two routinely applied screening strategies ("one-step": 75 g oral glucose tolerance test [OGTT] and "two-step": 50 g glucose challenge-test plus 75 g OGTT). Preference heterogeneity was also investigated. Results N = 287 participants completed the DCE survey. All five predefined attributes were associated with pregnant women's preferences. Diagnostic rate was the most influential attribute (17.5 vs. 8.0%, OR: 2.89; 95%CI: 2.10 to 3.96). When changes of the attributes of "two-step" to "one-step" strategies, women's uptake probability from full "two-step" to "one-step" significantly increased with 71.3% (95%CI: 52.2 to 90.1%), but no significant difference with the first step of "two-step" (-31.0%, 95%CI: -70.2 to 8.1%). Conclusion Chinese pregnant women preferred the "one-step" screening strategy to the full "two-step" strategy, but were indifferent between "one-step" and the first step of "two-step" strategies.
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Affiliation(s)
- Tingting Xu
- Department of Health Management and Policy, School of Public Health, Capital Medical University, Beijing, China,China Center for Health Development Studies, Peking University, Beijing, China
| | - Yan Jiang
- Obstetrics and Gynecology, Dong E Hospital, Liaocheng, China
| | - Xiuyan Guo
- Obstetrics and Gynecology, Dong E Hospital, Liaocheng, China
| | - Julie A. Campbell
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Hasnat Ahmad
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Qing Xia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Xiaozhen Lai
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Di Yan
- Department of Public Health Sciences, University of Rochester Medical Center, New York, NY, United States
| | - Liangkun Ma
- Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, China
| | - Hai Fang
- China Center for Health Development Studies, Peking University, Beijing, China,*Correspondence: Hai Fang
| | - Andrew J. Palmer
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
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Jamieson EL, Dimeski G, Flatman R, Hickman PE, Ross Dallas Jones G, V Marley J, David McIntyre H, McNeil AR, Nolan CJ, Potter JM, Sweeting A, Ward P, Williams P, Rita Horvath A. Oral glucose tolerance test to diagnose gestational diabetes mellitus: Impact of variations in specimen handling. Clin Biochem 2022; 115:33-48. [PMID: 36244469 DOI: 10.1016/j.clinbiochem.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/10/2022] [Accepted: 10/04/2022] [Indexed: 11/03/2022]
Abstract
To improve birth outcomes, all pregnant women without known diabetes are recommended for an oral glucose tolerance test (OGTT) to screen for hyperglycaemia in pregnancy (diabetes in pregnancy or gestational diabetes mellitus (GDM)). This narrative review presents contemporary approaches to minimise preanalytical glycolysis in OGTT samples with a focus on GDM diagnosis using criteria derived from the Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study. The challenges of implementing each approach across a diverse Australian healthcare setting were explored. Many Australian sites currently collect and transport OGTT samples at ambient temperature in sodium fluoride (NaF) tubes which is likely to lead to missed diagnosis of GDM in a significant proportion of cases. Alternative preanalytical solutions should be pragmatic and tailored to individual settings and as close as possible to the preanalytical conditions of the HAPO study for correct interpretation of OGTT results. Rapid centrifugation of barrier tubes to separate plasma could be suitable in urban settings provided time to centrifugation is strictly controlled. Tubes containing NaF and citrate could be useful for remote or resource poor settings with long delays to analysis but the impact on the interpretation of OGTT results should be carefully considered. Testing venous blood glucose at the point-of-care bypasses the need for glycolytic inhibition but requires careful selection of devices with robust analytical performance. Studies to evaluate the potential error of each solution compared to the HAPO protocol are required to assess the magnitude of misdiagnosis and inform clinicians regarding the potential impact on patient safety and healthcare costs.
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30
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A framework for understanding how midwives perceive and provide care management for pregnancies complicated by gestational diabetes or hypertensive disorders of pregnancy. Midwifery 2022; 115:103498. [PMID: 36191384 DOI: 10.1016/j.midw.2022.103498] [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: 05/21/2021] [Revised: 06/20/2022] [Accepted: 09/25/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Both gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDP) are common, and each are associated with adverse maternal and perinatal outcomes. Midwives may be the first point of care when these conditions arise. This study evaluated the experiences of midwives when providing care to women and people with pregnancies complicated by GDM or HDP. METHODS A mixed methods study was completed in Ontario, Canada, using a sequential, explanatory approach. A total of 144 online surveys were completed by midwives, followed by 20 semi-structured interviews that were audio recorded and transcribed verbatim. Survey data were analysed using descriptive statistics. Thematic analysis was used to generate codes from the interview data, which were mapped to the Theoretical Domains Framework (TDF), to elucidate factors that might influence management. RESULTS Most of the midwives' clinical behaviours relating to GDM or HDP were in keeping with guidelines and regulatory standards set by existing provincial standards. Six theoretical domains from the TDF appeared to influence midwives'care pathway: "Internal influences" included knowledge, skills and beliefs about capabilities; while "external influences" included social/professional role and identity, environmental context, and social influences. Interprofessional collaboration emerged as a significant factor on both the internal and external levels of influence. CONCLUSIONS We identified barriers and facilitators that may improve the experiences of midwives and clients when GDM or HDP newly arises in a pregnancy, necessitating further consultation or management by another health care provider.
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31
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Screening of Gestational Diabetes and Its Risk Factors: Pregnancy Outcome of Women with Gestational Diabetes Risk Factors According to Glycose Tolerance Test Results. J Clin Med 2022; 11:jcm11174953. [PMID: 36078883 PMCID: PMC9456276 DOI: 10.3390/jcm11174953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 08/19/2022] [Accepted: 08/20/2022] [Indexed: 12/23/2022] Open
Abstract
Background: Gestational diabetes mellitus (GDM) can cause maternal and neonatal health problems, and its prevalence is increasing worldwide. We assessed the screening of GDM during a 7-year period and compared the outcome of pregnancies at high risk for GDM. Methods: We analyzed non-selected pregnant women (n = 5021) receiving antenatal care in Tartu University Hospital, Estonia in 2012–2018. Pregnant women were classified based on the absence or presence of GDM risk factors as low risk (n = 2302) or high risk for GDM (n = 2719), respectively. The latter were divided into subgroups after the oral glycose tolerance test (OGTT): GDM (n = 423), normal result (n = 1357) and not tested (n = 939). Results: The proportion of women with GDM risk factors increased from 43.5% in 2012 to 57.8% in 2018, and the diagnosis of GDM more than doubled (5.2% vs. 13.7%). Pregnancies predisposed to GDM but with normal OGTT results were accompanied by an excessive gestational weight gain and increased odds to deliver a LGA baby (AOR 2.3 (CI 1.8–3.0)). Conclusions: An increasing number of pregnancies presenting GDM risk factors are diagnosed with GDM. Pregnant women with GDM risk factors are, despite normal OGTT, at risk of increased weight gain and LGA newborns.
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Brown JA, Leonard M, Clinton T, Bower JK, Gillespie SL, Fareed N, Thomas N, Prater L, Lorenz A, May S, Voisin C, Thung S, Oza-Frank R, Bose Brill S. Mothers' Perspectives on a Mother/Infant Dyad Postpartum Primary Care Program Following Gestational Diabetes Mellitus: A Qualitative Pilot Study. Sci Diabetes Self Manag Care 2022; 48:247-257. [PMID: 35658777 DOI: 10.1177/26350106221100539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this study is to characterize mothers' experiences within a mother/infant dyad postpartum primary care program (Dyad) following gestational diabetes mellitus (GDM) to inform improvements in the delivery of care. METHODS A qualitative pilot study of women (n = 10) enrolled in a mother/infant Dyad program was conducted in a primary care practice at a large, urban academic medical center. Respondents were asked a series of open-ended questions about their experience with GDM, the Dyad program, and health behaviors. Interviews were audio-recorded, transcribed verbatim, and analyzed using ground theory with NVivo 12 Plus software. RESULTS Three key themes emerged: (1) Dyad program experience, (2) implementation of health behavior changes, and (3) acknowledgment of future GDM and type 2 diabetes mellitus (T2DM) health risks. Respondents found the Dyad program respondents felt that the program conveniently served mother and infant health care needs in a single appointment. Respondents also valued support from primary care providers when implementing health behavior changes. The Dyad program provided an opportunity for respondents to understand their current and future risk for developing GDM and T2DM. CONCLUSIONS Postpartum women enrolled in the Dyad program received highly personalized primary care services. The results of our study will help integrate patient-centered strategies into models for GDM care to maintain patient engagement in postpartum clinical services.
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Affiliation(s)
- Jordyn A Brown
- Division of Epidemiology, The Ohio State University College of Public Health, Columbus, Ohio.,Division of General Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio
| | - Melissa Leonard
- Ohio Colleges of Medicine Government Resource Center, Columbus, Ohio
| | - Tiffany Clinton
- Department of Obstetrics and Gynecology, Henry Ford Health System, Detroit, Michigan
| | - Julie K Bower
- Division of Epidemiology, The Ohio State University College of Public Health, Columbus, Ohio
| | - Shannon L Gillespie
- The Martha S. Pitzer Center for Women, Children and Youth, The Ohio State College of Nursing, Columbus, Ohio
| | - Naleef Fareed
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Nikki Thomas
- Division of General Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio
| | - Laura Prater
- Division of General Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio.,Harborview Injury Prevention and Research Center, Harborview Medical Center, University of Washington, Seattle, Washington.,Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
| | - Allison Lorenz
- Ohio Colleges of Medicine Government Resource Center, Columbus, Ohio
| | - Sara May
- Ohio Colleges of Medicine Government Resource Center, Columbus, Ohio
| | - Christiane Voisin
- Division of General Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio
| | - Stephen Thung
- Division of General Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio
| | - Reena Oza-Frank
- Bureau of Maternal, Child and Family Health, Ohio Department of Health, Columbus, Ohio
| | - Seuli Bose Brill
- Division of General Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio
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Network Approaches to Integrate Analyses of Genetics and Metabolomics Data with Applications to Fetal Programming Studies. Metabolites 2022; 12:metabo12060512. [PMID: 35736446 PMCID: PMC9229972 DOI: 10.3390/metabo12060512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/27/2022] [Accepted: 05/27/2022] [Indexed: 02/04/2023] Open
Abstract
The integration of genetics and metabolomics data demands careful accounting of complex dependencies, particularly when modelling familial omics data, e.g., to study fetal programming of related maternal–offspring phenotypes. Efforts to identify genetically determined metabotypes using classic genome wide association approaches have proven useful for characterizing complex disease, but conclusions are often limited to a series of variant–metabolite associations. We adapt Bayesian network models to integrate metabotypes with maternal–offspring genetic dependencies and metabolic profile correlations in order to investigate mechanisms underlying maternal–offspring phenotypic associations. Using data from the multiethnic Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study, we demonstrate that the strategic specification of ordered dependencies, pre-filtering of candidate metabotypes, incorporation of metabolite dependencies, and penalized network estimation methods clarify potential mechanisms for fetal programming of newborn adiposity and metabolic outcomes. The exploration of Bayesian network growth over a range of penalty parameters, coupled with interactive plotting, facilitate the interpretation of network edges. These methods are broadly applicable to integration of diverse omics data for related individuals.
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Zhang H, Li X, Niu Y, Yang Z, Lu Y, Su Q, Qin L. Fasting serum fructose is associated with risk of gestational diabetes mellitus. BMC Pregnancy Childbirth 2022; 22:446. [PMID: 35643436 PMCID: PMC9148505 DOI: 10.1186/s12884-022-04768-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 05/05/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Objective
To investigate the association of fasting serum fructose concentrations and the incidence of GDM.
Research design and methods
Five hundred twenty six pregnant women who attended the obstetric clinic of Xinhua Hospital, Chongming Branch were recruited prospectively from September 2019 to November 2020. Fasting serum fructose concentrations were measured by a validated liquid chromatography–tandem mass spectrometry method. GDM was diagnosed according to the criteria of the IADPSG. Independent sample t-test was used to compare the differences between groups. Multiple stepwise regression analysis was used to estimate the associations of serum fructose and other variables. Multivariate logistic regression models were adopted to evaluate the odds ratios (ORs) for GDM.
Results
Of the 526 pregnant women, 110 were diagnosed with GDM. Fasting fructose concentrations were increased significantly in GDM patients compared to those without GDM (1.30 ug/ml vs 1.16 ug/ml, p<0.001). Fasting fructose concentration was independently associated with GDM after adjusting the potential confounders, 1 ug/ml increase in fasting serum fructose level was associated with an 81.1% increased risk of GDM (1.811, [1.155-2.840]). Taking fructose <1.036 ug/ml as the reference, the OR for GDM was significantly higher in fructose ≥1.036 ug/ml group (OR, 1.669; 95% CI, 1.031–2.701) after all the potential confounders were adjusted.
Conclusions
Increased fasting serum fructose levels were independently associated with the incidence of GDM.
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Rosinha PMO, Dantas RAB, Alves MIP, Azevedo TCMF, Inácio IMR, Ferreira SGE, Pedrosa CAV, Ferreira MS, Sousa IMA, da Costa JGM. Body mass index and gestational weight gain: relevance in gestational diabetes and outcomes - A retrospective cohort study. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2022; 66:261-268. [PMID: 35420269 PMCID: PMC9832902 DOI: 10.20945/2359-3997000000463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Objective To evaluate the influence of maternal pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) on blood glucose levels at diagnosis of gestational diabetes mellitus (GDM) and obstetric/neonatal outcomes. Methods Retrospective cohort study including 462 women with GDM and singleton pregnancy delivered in our institution between January 2015 and June 2018 and grouped according to BMI/GWG. Results The diagnosis of GDM was more likely to be established in the 1st trimester (T) in women with obesity than in normal-weight (55.8% vs 53.7%, p = 0.008). BMI positively and significantly correlated with fasting plasma glucose (FPG) levels in the 1stT (rs = 0.213, p = 0.001) and 2ndT (rs = 0.210, p = 0.001). Excessive GWG occurred in 44.9% women with overweight and in 40.2% with obesity (p < 0.001). From women with obesity, 65.1% required pharmacological treatment (p < 0.001). Gestational hypertension (GH) was more frequent in women with obesity (p = 0.016). During follow-up, 132 cesareans were performed, the majority in mothers with obesity (p = 0.008). Of the 17 large-for-gestational-age (LGA) birthweight delivered, respectively 6 and 9 were offsprings of women with overweight and obesity (p = 0.019). Maternal BMI had a predictive value only for macrosomia [aOR 1.177 (1.006-1.376), p = 0.041]. BMI and GWG positively correlated with birthweight (rs = 0.132, p = 0.005; rs = 0.188, p = 0.005). Conclusion Maternal obesity is related with a major probability of diagnosis of GDM in 1stT, fasting hyperglycemia in 2ndT and a more frequent need for pharmacological therapy. Pre-gestational obesity is associated with GH, cesarean delivery and fetal macrosomia.
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Ortega-Contreras B, Armella A, Appel J, Mennickent D, Araya J, González M, Castro E, Obregón AM, Lamperti L, Gutiérrez J, Guzmán-Gutiérrez E. Pathophysiological Role of Genetic Factors Associated With Gestational Diabetes Mellitus. Front Physiol 2022; 13:769924. [PMID: 35450164 PMCID: PMC9016477 DOI: 10.3389/fphys.2022.769924] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 03/15/2022] [Indexed: 11/13/2022] Open
Abstract
Gestational Diabetes Mellitus (GDM) is a highly prevalent maternal pathology characterized by maternal glucose intolerance during pregnancy that is, associated with severe complications for both mother and offspring. Several risk factors have been related to GDM; one of the most important among them is genetic predisposition. Numerous single nucleotide polymorphisms (SNPs) in genes that act at different levels on various tissues, could cause changes in the expression levels and activity of proteins, which result in glucose and insulin metabolism dysfunction. In this review, we describe various SNPs; which according to literature, increase the risk of developing GDM. These SNPs include: (1) those associated with transcription factors that regulate insulin production and excretion, such as rs7903146 (TCF7L2) and rs5015480 (HHEX); (2) others that cause a decrease in protective hormones against insulin resistance such as rs2241766 (ADIPOQ) and rs6257 (SHBG); (3) SNPs that cause modifications in membrane proteins, generating dysfunction in insulin signaling or cell transport in the case of rs5443 (GNB3) and rs2237892 (KCNQ1); (4) those associated with enzymes such as rs225014 (DIO2) and rs9939609 (FTO) which cause an impaired metabolism, resulting in an insulin resistance state; and (5) other polymorphisms, those are associated with growth factors such as rs2146323 (VEGFA) and rs755622 (MIF) which could cause changes in the expression levels of these proteins, producing endothelial dysfunction and an increase of pro-inflammatory cytokines, characteristic on GDM. While the pathophysiological mechanism is unclear, this review describes various potential effects of these polymorphisms on the predisposition to develop GDM.
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Affiliation(s)
- B. Ortega-Contreras
- Pregnancy Diseases Laboratory, Department of Clinical Biochemistry and Immunology, Faculty of Pharmacy, Universidad de Concepción, Concepción, Chile
| | - A. Armella
- Pregnancy Diseases Laboratory, Department of Clinical Biochemistry and Immunology, Faculty of Pharmacy, Universidad de Concepción, Concepción, Chile
| | - J. Appel
- Pregnancy Diseases Laboratory, Department of Clinical Biochemistry and Immunology, Faculty of Pharmacy, Universidad de Concepción, Concepción, Chile
| | - D. Mennickent
- Pregnancy Diseases Laboratory, Department of Clinical Biochemistry and Immunology, Faculty of Pharmacy, Universidad de Concepción, Concepción, Chile
- Department of Instrumental Analysis, Faculty of Pharmacy, Universidad de Concepción, Concepción, Chile
| | - J. Araya
- Department of Instrumental Analysis, Faculty of Pharmacy, Universidad de Concepción, Concepción, Chile
| | - M. González
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universidad de Concepción, Concepción, Chile
| | - E. Castro
- Departamento de Obstetricia y Puericultura, Facultad de Ciencias de la Salud, Universidad de Atacama, Copiapó, Chile
| | - A. M. Obregón
- Faculty of Health Care, Universidad San Sebastián, Concepción, Chile
| | - L. Lamperti
- Pregnancy Diseases Laboratory, Department of Clinical Biochemistry and Immunology, Faculty of Pharmacy, Universidad de Concepción, Concepción, Chile
| | - J. Gutiérrez
- Faculty of Health Sciences, Universidad San Sebastián, Santiago,Chile
| | - E. Guzmán-Gutiérrez
- Pregnancy Diseases Laboratory, Department of Clinical Biochemistry and Immunology, Faculty of Pharmacy, Universidad de Concepción, Concepción, Chile
- *Correspondence: E. Guzmán-Gutiérrez,
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Cao S, Li N, Zhang C, Liu J, Wang H, Leng J, Wang L, Li W, Yu Z, Hu G, Li J, Yang X. Adverse pregnancy outcomes are associated with an increased risk of postpartum prediabetes and diabetes in Chinese women with gestational diabetes. Diabetes Res Clin Pract 2022; 186:109817. [PMID: 35247530 DOI: 10.1016/j.diabres.2022.109817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 02/24/2022] [Accepted: 02/28/2022] [Indexed: 11/03/2022]
Abstract
AIMS To explore associations between adverse pregnancy outcomes and risk of postpartum diabetes and prediabetes among Chinese women with gestational diabetes mellitus (GDM). METHODS A total of 507 women with GDM who participated in a randomized controlled trial were successfully followed up at a median of 9.1 (interquartile range: 7.7-11.3) weeks after delivery and underwent a 75 g 2-h oral glucose tolerance test. GDM was diagnosed according to the International Association of Diabetes and Pregnancy Study Group's criteria. Postpartum diabetes and prediabetes were defined by the World Health Organization's. Generalized logit model was used to obtain odds ratios (OR) and 95% confidence interval (CI) of adverse pregnancy outcomes for postpartum diabetes, prediabetes and abnormal glucose regulation (AGR). RESULTS Of 507 women with GDM, 3.7% (19) women developed postpartum diabetes, 35.1% (178) women developed postpartum prediabetes. Preterm birth was associated with increased risk of postpartum prediabetes and AGR (adjusted OR: 3.24, 95%CI: 1.48-7.07 & 3.16, 1.46-6.85). Low birth weight was associated with the risk of postpartum prediabetes, diabetes and AGR (adjusted OR: 2.78, 95%CI: 1.13-6.86; 5.21, 1.13-24.02 & 2.99, 1.24-7.21). CONCLUSIONS Preterm birth and low birth weight were predictive of postpartum prediabetes, diabetes or AGR in Chinese women with GDM.
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Affiliation(s)
- Shu Cao
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Ninghua Li
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Cuiping Zhang
- Tianjin Women and Children's Health Centre, Tianjin, China
| | - Jinnan Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Hui Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Junhong Leng
- Tianjin Women and Children's Health Centre, Tianjin, China
| | - Leishen Wang
- Tianjin Women and Children's Health Centre, Tianjin, China
| | - Weiqin Li
- Tianjin Women and Children's Health Centre, Tianjin, China
| | - Zhijie Yu
- Population Cancer Research Program, Dalhousie University, Halifax, NS, Canada
| | - Gang Hu
- Chronic Disease Epidemiology Laboratory, Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Jing Li
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China; Tianjin Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin, China; Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China.
| | - Xilin Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China; Tianjin Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin, China; Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China.
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Lowe LP, Perak AM, Kuang A, Lloyd-Jones DM, Sacks DA, Deerochanawong C, Maresh M, Ma RC, Lowe WL, Metzger BE, Scholtens DM. Associations of glycemia and lipid levels in pregnancy with dyslipidemia 10-14 years later: The HAPO follow-up study. Diabetes Res Clin Pract 2022; 185:109790. [PMID: 35192911 PMCID: PMC9210945 DOI: 10.1016/j.diabres.2022.109790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/21/2022] [Accepted: 02/17/2022] [Indexed: 11/03/2022]
Abstract
AIMS To examine associations of pregnancy glycemia with future dyslipidemia. METHODS We analyzed data from Hyperglycemia and Adverse Pregnancy Outcome Follow-Up Study participants. We examined associations of gestational diabetes (GDM), sum of fasting, 1-hour, and 2-hour glucose z-scores after 75-g load, insulin sensitivity, and lipid levels at 24-32 weeks' gestation with dyslipidemia 10-14 years postpartum. RESULTS Among 4,693 women, 14.3% had GDM. At follow-up, mean (SD) age was 41.7 (5.7) years, 32.3% had total cholesterol (TC) ≥ 5.17, 27.2% had HDL cholesterol < 1.29, 22.4% had LDL cholesterol (LDL-C) ≥ 3.36, 10.9% had triglycerides ≥ 1.69 mmol/L, and 2.9% had type 2 diabetes. After covariate adjustment, pregnancy glycemic measures were associated with all follow-up dyslipidemias. After additional adjustment for pregnancy lipids, GDM remained associated with TC ≥ 5.17 mmol/L (odds ratio [95% CI], 1.63 [1.22-2.18]) and LDL-C ≥ 3.36 mmol/L (1.63 [1.20-2.22]), even in the absence of type 2 diabetes development (1.55 [1.15-2.10] and 1.56 [1.13-2.16], respectively). Continuous glycemic measures in pregnancy were significantly associated with all follow-up dyslipidemias, independent of pregnancy lipids and type 2 diabetes. CONCLUSIONS Pregnancy glycemia was associated with dyslipidemia 10-14 years later, independent of pregnancy lipid levels and in the absence of type 2 diabetes development. Lipid screening after GDM deserves special consideration.
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Affiliation(s)
- Lynn P Lowe
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Amanda M Perak
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
| | - Alan Kuang
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - David A Sacks
- Kaiser Permanente of Southern California, Pasadena, CA, USA
| | | | - Michael Maresh
- Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Ronald C Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - William L Lowe
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Boyd E Metzger
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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de Mendonça ELSS, Fragoso MBT, de Oliveira JM, Xavier JA, Goulart MOF, de Oliveira ACM. Gestational Diabetes Mellitus: The Crosslink among Inflammation, Nitroxidative Stress, Intestinal Microbiota and Alternative Therapies. Antioxidants (Basel) 2022; 11:129. [PMID: 35052633 PMCID: PMC8773111 DOI: 10.3390/antiox11010129] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 12/30/2021] [Accepted: 01/04/2022] [Indexed: 01/09/2023] Open
Abstract
Gestational diabetes mellitus (GDM) is characterized by a set of metabolic complications arising from adaptive failures to the pregnancy period. Estimates point to a prevalence of 3 to 15% of pregnancies. Its etiology includes intrinsic and extrinsic aspects of the progenitress, which may contribute to the pathophysiogenesis of GDM. Recently, researchers have identified that inflammation, oxidative stress, and the gut microbiota participate in the development of the disease, with potentially harmful effects on the health of the maternal-fetal binomial, in the short and long terms. In this context, alternative therapies were investigated from two perspectives: the modulation of the intestinal microbiota, with probiotics and prebiotics, and the use of natural products with antioxidant and anti-inflammatory properties, which may mitigate the endogenous processes of the GDM, favoring the health of the mother and her offspring, and in a future perspective, alleviating this critical public health problem.
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Affiliation(s)
- Elaine Luiza Santos Soares de Mendonça
- Institute of Chemistry and Biotechnology, Federal University of Alagoas, Maceio 57072-970, Alagoas, Brazil; (E.L.S.S.d.M.); (M.B.T.F.); (J.M.d.O.); (J.A.X.)
| | - Marilene Brandão Tenório Fragoso
- Institute of Chemistry and Biotechnology, Federal University of Alagoas, Maceio 57072-970, Alagoas, Brazil; (E.L.S.S.d.M.); (M.B.T.F.); (J.M.d.O.); (J.A.X.)
| | - Jerusa Maria de Oliveira
- Institute of Chemistry and Biotechnology, Federal University of Alagoas, Maceio 57072-970, Alagoas, Brazil; (E.L.S.S.d.M.); (M.B.T.F.); (J.M.d.O.); (J.A.X.)
| | - Jadriane Almeida Xavier
- Institute of Chemistry and Biotechnology, Federal University of Alagoas, Maceio 57072-970, Alagoas, Brazil; (E.L.S.S.d.M.); (M.B.T.F.); (J.M.d.O.); (J.A.X.)
| | - Marília Oliveira Fonseca Goulart
- Institute of Chemistry and Biotechnology, Federal University of Alagoas, Maceio 57072-970, Alagoas, Brazil; (E.L.S.S.d.M.); (M.B.T.F.); (J.M.d.O.); (J.A.X.)
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Di Filippo D, Ahmadzai M, Chang MHY, Horgan K, Ong RM, Darling J, Akhtar M, Henry A, Welsh A. Continuous Glucose Monitoring for the Diagnosis of Gestational Diabetes Mellitus: A Pilot Study. J Diabetes Res 2022; 2022:5142918. [PMID: 36299907 PMCID: PMC9592228 DOI: 10.1155/2022/5142918] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 09/23/2022] [Accepted: 09/29/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is diabetes first diagnosed in pregnancy. GDM, together with its short- and long-term negative outcomes, is increasing in incidence all over the world. The current diagnostic method for GDM, the oral glucose tolerance test (OGTT), is dated and has been reported as inconvenient for women as well as poorly reproducible and reliable. AIMS We aimed at assessing the acceptability, feasibility, and accuracy of continuous glucose monitoring (CGM) as a diagnostic test for GDM and explore its correlation with the OGTT and risk factors for GDM. METHODS In this prospective cohort study, pregnant women due for or having completed OGTT underwent CGM for seven days, performing daily finger-prick blood glucose levels before completing an acceptability questionnaire. Data on GDM risk factors and CGM variability were analyzed and compared with OGTT results. RESULTS Seventy-three women completed CGM (40 GDM, 33 normal glucose tolerances); 34 concurrently underwent OGTT. CGM was acceptable and generally well-tolerated, with skin irritation/itchiness the only adverse event (11 mild, one severe). CGM and OGTT strongly correlated for fasting glucose values (r = 0.86, p < 0.05) only. Triangulating GDM risk factors, OGTT results and CGM variability parameters with the application of machine learning highlighted the possibility of unmasking false positive (11 showed low CGM variability and demographic risks but positive OGTT) and false-negative OGTT diagnoses (1 showed high CGM variability and demographic risks but negative OGTT). CONCLUSIONS CGM was well-tolerated, showing poorer glycaemic control in GDM, and revealing potential misdiagnosis of the OGTT when combined with GDM risk factors. Future research is needed to determine cut-off values for CGM-defined and OGTT-independent screening criteria for GDM.
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Affiliation(s)
- Daria Di Filippo
- School of Women's and Children's Health, University of New South Wales Sydney, Locked Bag 2000, Barker Street, Randwick, NSW 2031, Australia
| | - Marrwah Ahmadzai
- School of Women's and Children's Health, University of New South Wales Sydney, Locked Bag 2000, Barker Street, Randwick, NSW 2031, Australia
| | - Melissa Han Yiin Chang
- School of Women's and Children's Health, University of New South Wales Sydney, Locked Bag 2000, Barker Street, Randwick, NSW 2031, Australia
| | - Ksana Horgan
- School of Women's and Children's Health, University of New South Wales Sydney, Locked Bag 2000, Barker Street, Randwick, NSW 2031, Australia
| | - Ru Min Ong
- School of Women's and Children's Health, University of New South Wales Sydney, Locked Bag 2000, Barker Street, Randwick, NSW 2031, Australia
| | - Justine Darling
- Diabetes Clinic, Royal Hospital for Women, Barker street-Randwick, NSW 2031, Australia
| | - Mahmood Akhtar
- School of Women's and Children's Health, University of New South Wales Sydney, Locked Bag 2000, Barker Street, Randwick, NSW 2031, Australia
| | - Amanda Henry
- School of Women's and Children's Health, University of New South Wales Sydney, Locked Bag 2000, Barker Street, Randwick, NSW 2031, Australia
| | - Alec Welsh
- School of Women's and Children's Health, University of New South Wales Sydney, Locked Bag 2000, Barker Street, Randwick, NSW 2031, Australia
- Department of Maternal-Fetal Medicine, Royal Hospital for Women, Barker street-Randwick, NSW 2031, Australia
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41
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Prüst JT, Brummaier T, Wah M, Yee HH, Win NN, Pimanpanarak M, Min AM, Gilder ME, Tun NW, Ilozumba O, Kabeer BSA, Terranegra A, Nosten F, Lee SJ, McGready R. Risk factor-based screening compared to universal screening for gestational diabetes mellitus in marginalized Burman and Karen populations on the Thailand-Myanmar border: An observational cohort. Wellcome Open Res 2022; 7:132. [PMID: 36874585 PMCID: PMC9976631.2 DOI: 10.12688/wellcomeopenres.17743.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2023] [Indexed: 01/19/2023] Open
Abstract
Background: Gestational diabetes mellitus (GDM) contributes to maternal and neonatal morbidity. As data from marginalized populations remains scarce, this study compares risk-factor-based to universal GDM screening in a low resource setting. Methods: This is a secondary analysis of data from a prospective preterm birth cohort. Pregnant women were enrolled in the first trimester and completed a 75g oral glucose tolerance test (OGTT) at 24-32 weeks' gestation. To define GDM cases, Hyperglycaemia and Adverse Pregnancy Outcomes (HAPO trial) criteria were used. All GDM positive cases were treated. Sensitivity and specificity of risk-factor-based selection for screening (criteria: age ≥30y, obesity (Body mass index (BMI) ≥27.5kg/m 2), previous GDM, 1 st degree relative with diabetes, previous macrosomia (≥4kg), previous stillbirth, or symphysis-fundal height ≥90th percentile) was compared to universal screening using the OGTT as the gold standard. Adverse maternal and neonatal outcomes were compared by GDM status. Results: GDM prevalence was 13.4% (50/374) (95% CI: 10.3-17.2). Three quarters of women had at least one risk factor (n=271 women), with 37/50 OGTT positive cases correctly identified: sensitivity 74.0% (59.7-85.4) and specificity 27.8% (3.0-33.0). Burman women (self-identified) accounted for 29.1% of the cohort population, but 38.0% of GDM cases. Percentiles for birthweight (p=0.004), head circumference (p=0.002), and weight-length ratio (p=0.030) were higher in newborns of GDM positive compared with non-GDM mothers. 21.7% (75/346) of newborns in the cohort were small-for-gestational age (≤10 th percentile). In Burman women, overweight/obese BMI was associated with a significantly increased adjusted odds ratio 5.03 (95% CI: 1.43-17.64) for GDM compared with normal weight, whereas in Karen women, the trend in association was similar but not significant (OR 2.36; 95% CI 0.95-5.89). Conclusions: Risk-factor-based screening missed one in four GDM positive women. Considering the benefits of early detection of GDM and the limited additional cost of universal screening, a two-step screening program was implemented.
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Affiliation(s)
- Janna T Prüst
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, 1081, The Netherlands
| | - Tobias Brummaier
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
- Swiss Tropical and Public Health Institute, Allschwill, 4123, Switzerland
- University of Basel, Basel, 4001, Switzerland
| | - Mu Wah
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
| | - Htay Htay Yee
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
| | - Nyo Nyo Win
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
| | - Mupawjay Pimanpanarak
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
| | - Aung Myat Min
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
| | - Mary Ellen Gilder
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Nay Win Tun
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
| | - Onaedo Ilozumba
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, 1081, The Netherlands
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | | | | | - Francois Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7LG, UK
| | - Sue J Lee
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7LG, UK
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, 10400, Thailand
| | - Rose McGready
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7LG, UK
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42
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Wu W, Zhang LF, Li YT, Hu TX, Chen DQ, Tian YH. Early Rise of Serum hCG in Gestational Diabetes Mellitus Women With Live Birth Through In Vitro Fertilization Procedure. Front Endocrinol (Lausanne) 2022; 13:724198. [PMID: 35242105 PMCID: PMC8886717 DOI: 10.3389/fendo.2022.724198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 01/12/2022] [Indexed: 11/13/2022] Open
Abstract
Gestational diabetes mellitus (GDM) is one of the most common complications of pregnancy. The characteristics of early human chorionic gonadotropin (hCG) levels and the rise pattern in patients with GDM after in vitro fertilization (IVF) are unclear. The present investigation was a retrospective cohort analysis of eligible viable pregnancies achieved through IVF in the authors' hospital between October 2015 and June 2020. The characteristics of initial hCG concentration and the rise pattern in patients with GDM after IVF, and the difference between those of normoglycemic pregnant women, were explored. Using random-effects models, the preferred pattern to describe the increase in log hCG was a quadratic. When gestational age was within 39 days, the linear model adequately characterized the profile, and the average slope was 0.173, yielding a predicted increase of 1.55 (55%) in 1 day and 3.11 (211%) in 2 days. Absolute hCG values-but not the rate of rise-were significantly higher in double embryo transfers and twin pregnancies. Curves reflecting hCG rise from the GDM and non-GDM groups did not differ substantially. The proportion of patients with low initial hCG values (16 days post-oocyte retrieval <100 mIU/ml) was higher in the GDM group (5% vs. 2.09%), although the difference was not statistically significant. Early hCG rise in pregnant women after IVF-whether GDM or non-GDM-could be characterized by quadratic and linear models. However, hCG values on days 14 and 16 post-oocyte retrieval in the GDM group were lower than those in the non-GDM group, with the exception of twin pregnancies. Low hCG values in early pregnancy may be a clue to help predict GDM in the subsequent gestation period.
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Affiliation(s)
- Wei Wu
- Department of Reproductive Endocrinology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Li-Feng Zhang
- Department of Reproductive Endocrinology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yi-Ting Li
- Department of Reproductive Endocrinology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Tian-Xiao Hu
- Department of Endocrinology, Chinese PLA 903rd Hospital (Former Chinese PLA 117th Hospital), Hangzhou, China
- College of Life Science, Zhejiang Chinese Medical University, Hangzhou, China
| | - Dan-Qing Chen
- Department of Obstetrics, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
- *Correspondence: Yong-Hong Tian, ; Dan-Qing Chen,
| | - Yong-Hong Tian
- Department of Reproductive Endocrinology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Key Laboratory of Reproductive Genetics, Ministry of Education, Hangzhou, China
- *Correspondence: Yong-Hong Tian, ; Dan-Qing Chen,
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43
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Maresh M, Lawrence JM, Scholtens DM, Kuang A, Lowe LP, Deerochanawong C, Sacks DA, Lowe WL, Dyer AR, Metzger BE. Association of glucose metabolism and blood pressure during pregnancy with subsequent maternal blood pressure. J Hum Hypertens 2022; 36:61-68. [PMID: 33536549 PMCID: PMC8329103 DOI: 10.1038/s41371-020-00468-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 11/09/2020] [Accepted: 12/07/2020] [Indexed: 01/31/2023]
Abstract
The goal of this study was to examine associations of measures of maternal glucose metabolism and blood pressure during pregnancy with blood pressure at follow-up in the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) cohort. The HAPO Follow-Up Study included 4747 women who had a 75-g oral glucose tolerance test (OGTT) at ~28 weeks' gestation. Of these, 4572 women who did not have chronic hypertension during their pregnancy or other excluding factors, had blood pressure evaluation 10-14 years after the birth of their HAPO child. Primary outcomes were systolic blood pressure (SBP), diastolic blood pressure (DBP), and hypertension (SBP ≥ 140 and/or DBP ≥ 90 or treatment for hypertension) at follow-up. Blood pressure during pregnancy was associated with all blood pressure outcomes at follow-up independent of glucose and insulin sensitivity during pregnancy. The sum of glucose z-scores was associated with blood pressure outcomes at follow-up but associations were attenuated in models that included pregnancy blood pressure measures. Associations with SBP were significant in adjusted models, while associations with DBP and hypertension were not. Insulin sensitivity during pregnancy was associated with all blood pressure outcomes at follow-up, and although attenuated after adjustments, remained statistically significant (hypertension OR 0.79, 95%CI 0.68-0.92; SBP beta -0.91, 95% CI -1.34 to -0.49; DBP beta -0.50, 95% CI -0.81 to -0.19). In conclusion, maternal glucose values at the pregnancy OGTT were not independently associated with maternal blood pressure outcomes 10-14 years postpartum; however, insulin sensitivity during pregnancy was associated independently of blood pressure, BMI, and other covariates measured during pregnancy.
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Affiliation(s)
- M Maresh
- Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - J M Lawrence
- Kaiser Permanente Southern California, Pasadena, CA, USA
| | - D M Scholtens
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - A Kuang
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - L P Lowe
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - D A Sacks
- Kaiser Permanente Southern California, Pasadena, CA, USA
| | - W L Lowe
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - A R Dyer
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - B E Metzger
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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44
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Zapater JL, Lednovich KR, Khan MW, Pusec CM, Layden BT. Hexokinase domain-containing protein-1 in metabolic diseases and beyond. Trends Endocrinol Metab 2022; 33:72-84. [PMID: 34782236 PMCID: PMC8678314 DOI: 10.1016/j.tem.2021.10.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 10/11/2021] [Accepted: 10/18/2021] [Indexed: 12/16/2022]
Abstract
Glucose phosphorylation by hexokinases (HKs) traps glucose in cells and facilitates its usage in metabolic processes dependent on cellular needs. HK domain-containing protein-1 (HKDC1) is a recently discovered protein with wide expression containing HK activity, first noted through a genome-wide association study (GWAS) to be linked with gestational glucose homeostasis during pregnancy. Since then, HKDC1 has been observed to be expressed in many human tissues. Moreover, studies have shown that HKDC1 plays a role in glucose homeostasis by which it may affect the progression of many pathophysiological conditions such as gestational diabetes mellitus (GDM), nonalcoholic steatohepatitis (NASH), and cancer. Here, we review the key studies contributing to our current understanding of the roles of HKDC1 in human pathophysiological conditions and potential therapeutic interventions.
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Affiliation(s)
- Joseph L Zapater
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA; Jesse Brown VA Medical Center, Chicago, IL, USA
| | - Kristen R Lednovich
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Md Wasim Khan
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Carolina M Pusec
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Brian T Layden
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA; Jesse Brown VA Medical Center, Chicago, IL, USA.
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45
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He H, Liu Y, Sun M. Nesfatin-1 alleviates high glucose/high lipid-induced injury of trophoblast cells during gestational diabetes mellitus. Bioengineered 2021; 12:12789-12799. [PMID: 34895049 PMCID: PMC8810041 DOI: 10.1080/21655979.2021.2001205] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Gestational diabetes mellitus (GDM) is a common disease in pregnant women, imposing risks on both mother and fetus. Dysregulated nesfatin-1 has been observed in women with GDM, but the specific role of nesfatin-1 underlying the pathological process of GDM is unclear. The main objective of this study is to investigate the role and the molecular mechanism of nesfatin-1 in GDM. HTR-8/SVneo cells were treated with high glucose (HG)/high lipid (HL) to mimic the injured trophoblast of GDM in vitro. Cell viability, cytotoxicity and apoptosis were measured using CCK-8, LDH and TUNEL assays, respectively. The levels of inflammatory cytokines and antioxidant factors were detected using their commercial kits. ATP level and cytochrome c were determined with corresponding detecting kits. Quantitative real-time PCR and Western blot were performed to detect the expression of corresponding genes. The results showed that nesfatin-1 was downregulated upon HG/HL stimulation. Nesfatin-1 treatment greatly alleviated HG/HL-induced cell viability loss, cytotoxicity, inflammatory response, oxidative stress, and apoptosis in HTR-8/SVneo cells. In addition, nesfatin-1 promoted ATP generation, reduced the leakage of cytochrome c from mitochondria to cytoplasm, and upregulated mitochondrial transcription factor A (TFAM) and nuclear respiratory factor 1 (NRF1), alleviating mitochondrial dysfunction. Furthermore, nesfatin-1 inhibited p38 MAPK signaling. p79350, an agonist of p38 MAPK signaling, remarkably hindered the protective role of nesfatin-1 in HG/HL-induced HTR-8/SVneo cells. In conclusion, nesfatin-1 exerted a protective effect on GDM model in vitro, by regulating p38 MAPK signaling pathway, providing novel insights of treating GDM.
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Affiliation(s)
- Huanling He
- Department of Obstetrical, Suzhou Kowloon Hospital, Shanghai Jiaotong University School of Medicine, Suzhou, Jiangsu Province, China
| | - Yingyu Liu
- Department of Obstetrical, Suzhou Kowloon Hospital, Shanghai Jiaotong University School of Medicine, Suzhou, Jiangsu Province, China
| | - Minghe Sun
- Department of Obstetrical, Suzhou Kowloon Hospital, Shanghai Jiaotong University School of Medicine, Suzhou, Jiangsu Province, China
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Mikolajczak A, Sallam NA, Singh RD, Scheidl TB, Walsh EJ, Larion S, Huang C, Thompson JA. Accelerated developmental adipogenesis programs adipose tissue dysfunction and cardiometabolic risk in offspring born to dams with metabolic dysfunction. Am J Physiol Endocrinol Metab 2021; 321:E581-E591. [PMID: 34459218 PMCID: PMC8791794 DOI: 10.1152/ajpendo.00229.2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
This study determined if a perturbation in in utero adipogenesis leading to later life adipose tissue (AT) dysfunction underlies programming of cardiometabolic risk in offspring born to dams with metabolic dysfunction. Female mice heterozygous for the leptin receptor deficiency (Hetdb) had 2.4-fold higher prepregnancy fat mass and in late gestation had higher plasma insulin and triglycerides compared with wild-type (Wt) females (P < 0.05). To isolate the role of the intrauterine milieu, wild-type (Wt) offspring from each pregnancy were studied. Differentiation potential in isolated progenitors and cell size distribution analysis revealed accelerated adipogenesis in Wt pups born to Hetdb dams, accompanied by a higher accumulation of neonatal fat mass. In adulthood, whole body fat mass by NMR was higher in male (69%) and female (20%) Wt offspring born to Hetdb versus Wt pregnancies, along with adipocyte hypertrophy and hyperlipidemia (all P < 0.05). Lipidomic analyses by gas chromatography revealed an increased lipogenic index (16:0/18:2n6) after high-fat/fructose diet (HFFD). Postprandial insulin, ADIPO-IR, and ex vivo AT lipolytic responses to isoproterenol were all higher in Wt offspring born to Hetdb dams (P < 0.05). Intrauterine metabolic stimuli may direct a greater proportion of progenitors toward terminal differentiation, thereby predisposing to hypertrophy-induced adipocyte dysfunction.NEW & NOTEWORTHY This study reveals that accelerated adipogenesis during the perinatal window of adipose tissue development predisposes to later life hypertrophic adipocyte dysfunction, thereby compromising the buffering function of the subcutaneous depot.
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Affiliation(s)
- Anna Mikolajczak
- Department of Physiology and Pharmacology, University of Calgary, Calgary, Alberta, Canada
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - Nada A Sallam
- Department of Physiology and Pharmacology, University of Calgary, Calgary, Alberta, Canada
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Faculty of Pharmacy, Cairo University, Giza, Egypt
| | - Radha D Singh
- Department of Physiology and Pharmacology, University of Calgary, Calgary, Alberta, Canada
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute, Calgary, Alberta, Canada
| | - Taylor B Scheidl
- Department of Physiology and Pharmacology, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - Emma J Walsh
- Department of Physiology and Pharmacology, University of Calgary, Calgary, Alberta, Canada
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sebastian Larion
- Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina
| | - Carol Huang
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - Jennifer A Thompson
- Department of Physiology and Pharmacology, University of Calgary, Calgary, Alberta, Canada
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
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47
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Liu Y, Kuang A, Bain JR, Muehlbauer MJ, Ilkayeva OR, Lowe LP, Metzger BE, Newgard CB, Scholtens DM, Lowe WL. Maternal Metabolites Associated With Gestational Diabetes Mellitus and a Postpartum Disorder of Glucose Metabolism. J Clin Endocrinol Metab 2021; 106:3283-3294. [PMID: 34255031 PMCID: PMC8677596 DOI: 10.1210/clinem/dgab513] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Indexed: 12/15/2022]
Abstract
CONTEXT Gestational diabetes is associated with a long-term risk of developing a disorder of glucose metabolism. However, neither the metabolic changes characteristic of gestational diabetes in a large, multi-ancestry cohort nor the ability of metabolic changes during pregnancy, beyond glucose levels, to identify women at high risk for progression to a disorder of glucose metabolism has been examined. OBJECTIVE This work aims to identify circulating metabolites present at approximately 28 weeks' gestation associated with gestational diabetes mellitus (GDM) and development of a disorder of glucose metabolism 10 to 14 years later. METHODS Conventional clinical and targeted metabolomics analyses were performed on fasting and 1-hour serum samples following a 75-g glucose load at approximately 28 weeks' gestation from 2290 women who participated in the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study. Postpartum metabolic traits included fasting and 2-hour plasma glucose following a 75-g glucose load, insulin resistance estimated by the homeostasis model assessment of insulin resistance, and disorders of glucose metabolism (prediabetes and type 2 diabetes) during the HAPO Follow-Up Study. RESULTS Per-metabolite analyses identified numerous metabolites, ranging from amino acids and carbohydrates to fatty acids and lipids, before and 1-hour after a glucose load that were associated with GDM as well as development of a disorder of glucose metabolism and metabolic traits 10 to 14 years post partum. A core group of fasting and 1-hour metabolites mediated, in part, the relationship between GDM and postpartum disorders of glucose metabolism, with the fasting and 1-hour metabolites accounting for 15.7% (7.1%-30.8%) and 35.4% (14.3%-101.0%) of the total effect size, respectively. For prediction of a postpartum disorder of glucose metabolism, the addition of circulating fasting or 1-hour metabolites at approximately 28 weeks' gestation showed little improvement in prediction performance compared to clinical factors alone. CONCLUSION The results demonstrate an association of multiple metabolites with GDM and postpartum metabolic traits and begin to define the underlying pathophysiology of the transition from GDM to a postpartum disorder of glucose metabolism.
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Affiliation(s)
- Yu Liu
- Department of Endocrinology and Metabolism, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, P. R. China
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA
| | - Alan Kuang
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA
| | - James R Bain
- Sarah W. Stedman Nutrition and Metabolism Center, Duke University School of Medicine, Durham, North Carolina 27705, USA
- Duke Molecular Physiology Institute, Durham, North Carolina 27701, USA
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina 27707, USA
| | - Michael J Muehlbauer
- Sarah W. Stedman Nutrition and Metabolism Center, Duke University School of Medicine, Durham, North Carolina 27705, USA
- Duke Molecular Physiology Institute, Durham, North Carolina 27701, USA
| | - Olga R Ilkayeva
- Sarah W. Stedman Nutrition and Metabolism Center, Duke University School of Medicine, Durham, North Carolina 27705, USA
- Duke Molecular Physiology Institute, Durham, North Carolina 27701, USA
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina 27707, USA
| | - Lynn P Lowe
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA
| | - Boyd E Metzger
- Department of Endocrinology and Metabolism, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, P. R. China
| | - Christopher B Newgard
- Sarah W. Stedman Nutrition and Metabolism Center, Duke University School of Medicine, Durham, North Carolina 27705, USA
- Duke Molecular Physiology Institute, Durham, North Carolina 27701, USA
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina 27707, USA
| | - Denise M Scholtens
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA
| | - William L Lowe
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA
- Correspondence: William L. Lowe Jr, MD, Department of Medicine, Northwestern University Feinberg School of Medicine, Rubloff 12, 420 E Superior St, Chicago, IL 60611, USA.
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48
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Tantengco OAG, Aquino IMC, Asis JLB, Tan JJE, Uy MNAR, Pacheco EP. Research trends in gestational diabetes mellitus in Southeast Asia: A bibliometric analysis (1975-2020). Diabetes Metab Syndr 2021; 15:102202. [PMID: 34265490 DOI: 10.1016/j.dsx.2021.102202] [Citation(s) in RCA: 4] [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: 04/30/2021] [Revised: 07/02/2021] [Accepted: 07/06/2021] [Indexed: 01/01/2023]
Abstract
AIMS To determine the characteristics and trends of published articles in the field of gestational diabetes mellitus (GDM) in Southeast Asia (SEA) through a bibliometric analysis. METHODS Systematic review of literature on GDM in SEA countries was performed using the Ovid MEDLINE®, Scopus, and WPRIM databases between 1975 and 2020. All published studies on GDM conducted in or published by authors from any SEA country were included in our analysis. Bibliometric information was obtained from Scopus and bibliometrics diagrams were created using VOSviewer software. RESULTS A total of 322 articles were obtained in this study. The number of publications showed an upward trend starting 2011. The country with the greatest number of publications was Malaysia while The National University of Singapore was the most productive institution in GDM research in SEA. The focus of GDM research in SEA were on the prevalence, prevention, diagnosis, and pregnancy outcomes. GDP, research expenditure, and researchers per million people were positively correlated with research productivity and impact in GDM research in SEA. CONCLUSIONS This is the first bibliometric analysis on GDM in SEA countries. GDM research in SEA continued to increase in the past years but still lagged behind that of other regions. The SEA countries should consider increasing support for research to produce substantial research that can serve as basis for evidence-based and locally applicable GDM interventions.
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Affiliation(s)
| | - Inah Marie C Aquino
- College of Medicine, University of the Philippines Manila, Ermita, Manila, Philippines
| | - Joannes Luke B Asis
- College of Medicine, University of the Philippines Manila, Ermita, Manila, Philippines
| | - Joanne Jennifer E Tan
- College of Medicine, University of the Philippines Manila, Ermita, Manila, Philippines
| | | | - Elizabeth P Pacheco
- Division of Endocrinology, Department of Medicine, University of the Philippines - Philippine General Hospital, Taft Avenue, Manila, Philippines.
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49
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Zhou CD, Seah RL, Papatheodorou SI. The role of biomarker ykl-40 in risk stratification and diagnosis of gestational diabetes mellitus: A systematic review and meta-analysis. ENDOCRINE AND METABOLIC SCIENCE 2021. [DOI: 10.1016/j.endmts.2021.100094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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50
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Pace NP, Vassallo J, Calleja-Agius J. Gestational diabetes, environmental temperature and climate factors - From epidemiological evidence to physiological mechanisms. Early Hum Dev 2021; 155:105219. [PMID: 33046275 DOI: 10.1016/j.earlhumdev.2020.105219] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Gestational diabetes (GDM) is a common metabolic complication of pregnancy that is generally asymptomatic in its clinical course, although it is potentially associated with a wide range of both maternal and foetal complications. The population prevalence of GDM varies widely, depending on the clinical diagnostic criteria, ethnicity, demographics and background prevalence of type 2 diabetes. Climate variability and environmental temperature have recently come to the forefront as potential direct or indirect determinants of human health. The association between GDM and environmental temperature is complex, and studies have often reported conflicting findings. Epidemiologic studies have shown a direct relation between rising environmental temperature and the risk of both GDM and impaired beta cell function. Seasonal trends in the prevalence of GDM have been reported in several populations, with a higher prevalence in summer months. Multiple mechanisms have been proposed to explain the GDM-temperature correlation. A growing body of evidence supports a link between temperature, energy expenditure and adipose tissue metabolism. Brown adipose tissue thermogenesis, induced by cold temperatures, improves insulin sensitivity. Further biological explanations for the GDM-temperature correlation lie in potential association with low vitamin D levels, which varies according to sunshine exposure. Observational studies are also complicated by lifestyle factors, such as diet and physical activity, that could exhibit seasonal variation. In this review article, we provide a systematic overview of available epidemiological evidence linking environmental temperature and gestational diabetes. Furthermore, the physiological mechanisms that give biological plausibility to association between GDM and temperature are explored. As future climate patterns could drive global changes in GDM prevalence, this knowledge has important implications for both clinicians and researchers.
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Affiliation(s)
- Nikolai Paul Pace
- Department of Anatomy, Faculty of Medicine and Surgery, Biomedical Sciences Building, University of Malta, Msida MSD 2080, Malta.
| | - Josanne Vassallo
- Department of Medicine, Faculty of Medicine and Surgery, Biomedical Sciences Building, University of Malta, Msida MSD 2080, Malta
| | - Jean Calleja-Agius
- Department of Anatomy, Faculty of Medicine and Surgery, Biomedical Sciences Building, University of Malta, Msida MSD 2080, Malta
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