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Bastobbe S, Heimann Y, Schleußner E, Groten T, Weschenfelder F. Using flash glucose monitoring in pregnancies in routine care of patients with gestational diabetes mellitus: a pilot study. Acta Diabetol 2023; 60:697-704. [PMID: 36840782 PMCID: PMC10063475 DOI: 10.1007/s00592-023-02042-x] [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: 01/03/2023] [Accepted: 01/24/2023] [Indexed: 02/26/2023]
Abstract
AIM Flash glucose monitoring (FGM) has been approved for the care of pregnant women with preexisting diabetes since 2017. However, its use in gestational diabetes (GDM) has been critically discussed. Inaccuracy and missing recommendations for target values are the main arguments against the use of FGM in GDM. To date, there is a lack of data to justify routine use of FGM in GDM pregnancies. Consequently, this new technology has been withheld from GDM-patients. Aim of our pilot study was to analyze the impact of FGM use on pregnancy outcomes, patient's satisfaction and to confirm the safe use in GDM pregnancies. METHODS Cohort study of 37 FGM-managed GDM pregnancies compared with 74 matched women using self-monitoring of blood glucose (SMBG). Group comparison using nonparametric testing concerning patients characteristic and perinatal outcome focusing on adverse outcomes (preeclampsia, preterm delivery, large for gestational age, C-sections, neonatal intensive care unit admission, hyperbilirubinemia and hypoglycemia). Evaluation of patient's treatment satisfaction using the "Diabetes Treatment Satisfaction Questionnaire change" (DTSQc) and patient interviews. RESULTS No significant differences in patient's characteristics despite gestational age at diagnosis (FGM with 20 vs. SMBG with 25 weeks). No difference in gestational weight gain, HbA1c progression and perinatal outcome. Treatment satisfaction obtained by the DTSQc revealed a high level of satisfaction with FGM use. CONCLUSION FGM use was well accepted and did not affect perinatal outcome. Use of FGM during pregnancy is safe and non-inferior to the management with SBGM. FGM should be considered as an option in the management of GDM patients.
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Affiliation(s)
- Sophie Bastobbe
- Department of Obstetrics, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Yvonne Heimann
- Department of Obstetrics, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Ekkehard Schleußner
- Department of Obstetrics, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Tanja Groten
- Department of Obstetrics, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany.
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Weschenfelder F, Lohse K, Lehmann T, Schleußner E, Groten T. Predictors of Treatment Requirements in Women with Gestational Diabetes: A Retrospective Analysis. J Clin Med 2021; 10:jcm10194421. [PMID: 34640439 PMCID: PMC8509276 DOI: 10.3390/jcm10194421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/20/2021] [Accepted: 09/23/2021] [Indexed: 12/18/2022] Open
Abstract
The diagnosis of gestational diabetes is usually very stressful for pregnant women, especially because they fear that insulin treatment may become necessary. Knowledge about personal risk factors predicting the probability of insulin treatment could therefore help to improve acceptance of the diagnosis and therapy adherence. The aim of this study was to find potential risk factors for insulin dependency and treatment requirements using information available at the time of diagnosis of gestational diabetes during pregnancy. We included 454 singleton pregnancies diagnosed ≥24 weeks of gestation. Multivariate regression analysis was used to evaluate independent associations of metabolic, anthropometric and fetal ultrasound parameters with the general need for insulin treatment and further stratified treatment options: diet (n = 275), bolus insulin only (n = 45), basal insulin only (n = 73) and multiple daily injections (n = 61). Receiver operator characteristics and cut-off values for independent variables were generated. Treatment groups differed significantly concerning pre-pregnancy weight and BMI as well as fasting glucose and 1 h glucose test values. Significant cut-offs for insulin dependency were HbA1c level of 5.4%, FPG of 5.5 mmol/L and 1 h glucose of 10.6 mmol/L. At time of diagnosis, certain patient characteristics and measurements can help to predict treatment necessities and therefore improve individualized counselling.
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Affiliation(s)
| | - Karolin Lohse
- Unit Neonatology, Department of Paediatrics, University Hospital Jena, 07747 Jena, Germany;
| | - Thomas Lehmann
- Institute of Medical Statistics and Computer Science, University Hospital Jena, Friedrich Schiller University, 07747 Jena, Germany;
| | - Ekkehard Schleußner
- Department of Obstetrics, University Hospital Jena, 07747 Jena, Germany; (F.W.); (E.S.)
| | - Tanja Groten
- Department of Obstetrics, University Hospital Jena, 07747 Jena, Germany; (F.W.); (E.S.)
- Correspondence: ; Tel.: +49-(0)3641-9329207; Fax: +49-(0)3641-9329202
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Weschenfelder F, Lohse K, Lehmann T, Schleußner E, Groten T. Circadian rhythm and gestational diabetes: working conditions, sleeping habits and lifestyle influence insulin dependency during pregnancy. Acta Diabetol 2021; 58:1177-1186. [PMID: 33837820 PMCID: PMC8316165 DOI: 10.1007/s00592-021-01708-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 03/16/2021] [Indexed: 11/02/2022]
Abstract
OBJECTIVE Management of gestational diabetes (GDM) is currently changing toward a more personalized approach. There is a growing number of GDM patients requiring only a single dose of basal insulin at night to achieve glucose control. Well-known risk factors like obesity, parity and family history have been associated with GDM treatment requirements. Sleep quality and lifestyle factors interfering with the circadian rhythm are known to affect glucose metabolism. The aim of this study was to investigate the impact of such lifestyle factors on insulin requirement in GDM patients, in particular on long-acting insulin to control fasting glucose levels. RESEARCH DESIGN AND METHODS A total of 805 patients treated for GDM between 2012 and 2016 received a study questionnaire on lifestyle conditions. Sleep quality and work condition categories were used for subgroup analysis. Independent effects on treatment approaches were evaluated using multivariate regression. RESULTS In total, 235 (29.2%) questionnaires returned. Women reporting poor sleep conditions had higher pre-pregnancy weight and BMI, heavier newborns, more large for gestational age newborns and higher rates of hyperbilirubinemia. Treatment requirements were related to sleep and work condition categories. Multivariate regression for 'Basal' insulin-only treatment revealed an adjOR 3.4 (CI 1.23-9.40, p < 0.05) for unfavorable work conditions and adjOR 4.3 (CI 1.28-14.50, p < 0.05) for living with children. CONCLUSIONS Our findings suggest that external stressors like unfavorable work conditions and living with children are independently associated with the necessity of long-acting insulin at night in GDM patients. Thus, fasting glucose levels of pregnant women presenting with such lifestyle conditions may be subject to close monitoring.
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Affiliation(s)
| | - Karolin Lohse
- Unit Neonatology, Department of Paediatrics, University Hospital Jena, Jena, Germany
| | - Thomas Lehmann
- Institute of Medical Statistics and Computer Science, University Hospital Jena, Friedrich Schiller University Jena, Jena, Germany
| | - Ekkehard Schleußner
- Department of Obstetrics, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Tanja Groten
- Department of Obstetrics, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany.
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Greiner GG, Viehmann A, Linnenkamp U, Wilm S, Leve V, Neuenschwander M, Kuss O, Fehm T, Ensenauer R, Schumacher L, Lange U, Müller-Bößmann D, Lappe V, Ihle P, Adamczewski H, Kaltheuner M, Tamayo M, Gräfe V, Westerhoff B, Wallerich-Herf N, Schellhammer S, Kerres T, Schmitz-Losem I, Cramer S, Rupprecht CJ, Klüppelholz B, Meyer F, Koch-Schulte S, Jüngling U, Icks A. Study protocol for a mixed methods exploratory investigation of aftercare services for gestational diabetes in women to develop a new patient-centred model in Germany: the GestDiNa_basic study. BMJ Open 2021; 11:e046048. [PMID: 34341040 PMCID: PMC8330567 DOI: 10.1136/bmjopen-2020-046048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Women with gestational diabetes mellitus (GDM) have a higher risk of developing type 2 diabetes mellitus compared with women who never had GDM. Consequently, the question of structured aftercare for GDM has emerged. In all probability, many women do not receive care according to the guidelines. In particular, the process and interaction between obstetrical, diabetic, gynaecological, paediatric and general practitioner care lacks clear definitions. Thus, our first goal is to analyse the current aftercare situation for women with GDM in Germany, for example, the participation rate in aftercare diabetes screening, as well as reasons and attitudes stated by healthcare providers to offer these services and by patients to participate (or not). Second, we want to develop an appropriate, effective and patient-centred care model. METHODS AND ANALYSIS This is a population-based mixed methods study using both quantitative and qualitative research approaches. In various working packages, we evaluate data of the GestDiab register, of the Association of Statutory Health Insurance Physicians of North Rhine and the participating insurance companies (AOK Rheinland/Hamburg, BARMER, DAK Gesundheit, IKK classic, pronova BKK). In addition, quantitative (postal surveys) and qualitative (interviews) surveys will be conducted with randomly selected healthcare providers (diabetologists, gynaecologists, paediatricians and midwives) and affected women, to be subsequently analysed. All results will then be jointly examined and evaluated. ETHICS AND DISSEMINATION The study was approved by the ethics committee of the Faculty of Medicine, Heinrich-Heine-University Düsseldorf (Ethics Committee No.: 2019-738). Participants of the postal surveys and interviews will be informed in detail about the study and the use of data as well as the underlying data protection regulations before voluntarily participating. The study results will be disseminated through peer-reviewed journals, conferences and public information. TRIAL REGISTRATION NUMBER DRKS00020283.
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Affiliation(s)
- Gregory Gordon Greiner
- Institute for Health Services Research and Health Economics, Centre for Health and Society (chs), Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Nordrhein-Westfalen, Germany
- Institute for Health Services Research and Health Economics, German Diabetes Center, Leibniz Institute for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Nordrhein-Westfalen, Germany
| | - Anja Viehmann
- Institute for Health Services Research and Health Economics, Centre for Health and Society (chs), Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Nordrhein-Westfalen, Germany
- Institute for Health Services Research and Health Economics, German Diabetes Center, Leibniz Institute for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Nordrhein-Westfalen, Germany
| | - Ute Linnenkamp
- Institute for Health Services Research and Health Economics, Centre for Health and Society (chs), Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Nordrhein-Westfalen, Germany
- Institute for Health Services Research and Health Economics, German Diabetes Center, Leibniz Institute for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Nordrhein-Westfalen, Germany
- Department of Gynecology and Obstetrics, University Hospital, Heinrich Heine University Düsseldorf, Düsseldorf, Nordrhein-Westfalen, Germany
| | - Stefan Wilm
- Institute of General Practice, Centre for Health and Society (chs), Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Nordrhein-Westfalen, Germany
| | - Verena Leve
- Institute of General Practice, Centre for Health and Society (chs), Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Nordrhein-Westfalen, Germany
| | - Manuela Neuenschwander
- Institute for Biometrics and Epidemiology, German Diabetes Center Leibniz Institute for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Nordrhein-Westfalen, Germany
| | - Oliver Kuss
- Institute for Biometrics and Epidemiology, German Diabetes Center Leibniz Institute for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Nordrhein-Westfalen, Germany
| | - Tanja Fehm
- Department of Gynecology and Obstetrics, University Hospital, Heinrich Heine University Düsseldorf, Düsseldorf, Nordrhein-Westfalen, Germany
| | - Regina Ensenauer
- Institute of Child Nutrition, Max Rubner-Institute Federal Research Institute of Nutrition and Food, Karlsruhe, Baden-Württemberg, Germany
- Department of General Paediatrics, Neonatology, and Paediatric Cardiology, University Children's Hospital, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Nordrhein-Westfalen, Germany
| | - Liesa Schumacher
- Department of General Paediatrics, Neonatology, and Paediatric Cardiology, University Children's Hospital, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Nordrhein-Westfalen, Germany
| | - Ute Lange
- Department of Applied Heath Sciences, Bochum University of Applied Sciences, Bochum, Nordrhein-Westfalen, Germany
| | - Dorit Müller-Bößmann
- Department of Applied Heath Sciences, Bochum University of Applied Sciences, Bochum, Nordrhein-Westfalen, Germany
| | - Veronika Lappe
- PMV Research Group, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Nordrhein-Westfalen, Germany
| | - Peter Ihle
- PMV Research Group, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Nordrhein-Westfalen, Germany
| | | | | | - Miguel Tamayo
- Association of Statutory Health Insurance Physicians of North Rhine (KV Nordrhein), Düsseldorf, Nordrhein-Westfalen, Germany
| | - Viola Gräfe
- Association of Statutory Health Insurance Physicians of North Rhine (KV Nordrhein), Düsseldorf, Nordrhein-Westfalen, Germany
| | | | | | | | - Thomas Kerres
- DAK Gesundheit, Statutory Health Insurance, Hamburg, Germany
| | - Imke Schmitz-Losem
- pronova BKK, Statutory Health Insurance, Ludwigshafen, Rheinland-Pfalz, Germany
| | - Stefan Cramer
- pronova BKK, Statutory Health Insurance, Ludwigshafen, Rheinland-Pfalz, Germany
| | - Christoph J Rupprecht
- AOK Rheinland/Hamburg, Statutory Health Insurance, Düsseldorf, Nordrhein-Westfalen, Germany
| | - Birgit Klüppelholz
- AOK Rheinland/Hamburg, Statutory Health Insurance, Düsseldorf, Nordrhein-Westfalen, Germany
| | - Frank Meyer
- IKK classic, Statutory Health Insurance, Münster, Nordrhein-Westfalen, Germany
| | - Simone Koch-Schulte
- IKK classic, Statutory Health Insurance, Münster, Nordrhein-Westfalen, Germany
| | - Ute Jüngling
- Patient Representative, Dortmund, Nordrhein-Westfalen, Germany
| | - Andrea Icks
- Institute for Health Services Research and Health Economics, Centre for Health and Society (chs), Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Nordrhein-Westfalen, Germany
- Institute for Health Services Research and Health Economics, German Diabetes Center, Leibniz Institute for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Nordrhein-Westfalen, Germany
- German Center for Diabetes Research, Neuherberg, Bayern, Germany
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Reinders P, Zoellner Y, Schneider U. Real-world evaluation of adverse pregnancy outcomes in women with gestational diabetes mellitus in the German health care system. Prim Care Diabetes 2020; 14:633-638. [PMID: 33032937 DOI: 10.1016/j.pcd.2020.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/21/2020] [Accepted: 04/25/2020] [Indexed: 11/18/2022]
Abstract
AIMS This study aims to estimate the incidence of adverse pregnancy outcomes in women with gestational diabetes mellitus (GDM) in Germany. METHODS Pregnant women were identified from a health claims database for the year of 2016. Three groups were defined: general population without GDM, women with GDM without treatment and women with GDM and insulin treatment. Operationalisation of outcomes was aligned with the hyperglycaemia and adverse pregnancy outcomes (HAPO) study. RESULTS The cohort consisted of 58,297 mother-child pairs. Of those, 7245 had a GDM diagnosis and 1407 had a GDM diagnosis with a prescription of insulin. Adverse pregnancy outcomes were higher in both GDM groups compared to the control group. Birthweight (OR 2.08 [95% CI 1.50-2.90]), primary caesarean section (OR 1.70 [95% CI 1.48-1.95]), intensive neonatal care (OR 1.25 [95% CI 1.04-1.50]), preeclampsia (OR 1.51 [95% CI 1.23-1.85]), and clinical neonatal hypoglycaemia (OR 5.32 [95% CI 4.27-6.62]) were higher in the GDM+insulin group in comparison to a control group after adjustment for potential confounders. CONCLUSION Most of the adverse pregnancy outcomes were moderately higher in both identified GDM groups in comparison to women without GDM. Women receiving insulin treatment are at an increased risk of most of the defined adverse pregnancy outcomes.
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Affiliation(s)
- P Reinders
- Hamburg University of Applied Sciences, Hamburg, Germany.
| | - Y Zoellner
- Hamburg University of Applied Sciences, Hamburg, Germany
| | - U Schneider
- Techniker Krankenkasse (TK), Hamburg, Germany
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Weschenfelder F, Baum N, Lehmann T, Schleußner E, Groten T. The Relevance of Fetal Abdominal Subcutaneous Tissue Recording in Predicting Perinatal Outcome of GDM Pregnancies: A Retrospective Study. J Clin Med 2020; 9:E3375. [PMID: 33096839 PMCID: PMC7594040 DOI: 10.3390/jcm9103375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/03/2020] [Accepted: 10/17/2020] [Indexed: 11/16/2022] Open
Abstract
Guidelines on the management of gestational diabetes (GDM) instruct physicians to involve ultrasound-based monitoring of fetal growth in addition to blood glucose. So far, glucose control besides clinical parameters like maternal body mass index (BMI) and gestational weight gain have been shown to predict neonatal outcome. We aimed to evaluate the discriminative ability of fetal abdominal subcutaneous tissue (FAST) in addition to standard ultrasound parameters like abdominal circumference (AC) and estimated fetal weight (EFW) for perinatal complications like large for gestational age (LGA), hypoglycemia, hyperbilirubinemia, mode of delivery and admission to neonatal intensive care unit (NICU). Ultrasound data and neonatal outcome was collected of 805 GDM cases from 2012 to 2016: 3205 FAST, 3195 AC-measurements and 3190 EFW calculations were included. AC, EFW and FAST increased linear with gestational age. Combining ultrasound and clinical parameters improved predictive power for LGA. In the subgroup where fetuses grow with an AC > 75th additional adding of FAST to standard ultrasound parameters increased predictive power for hypoglycemia. Our results confirm inclusion of ultrasound parameters to be beneficial in monitoring GDM pregnancies. Additional FAST determination revealed to be of potential clinical relevance in the subgroup AC > 75th percentile.
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Affiliation(s)
| | - Nadin Baum
- Department of Obstetrics, University Hospital Jena, 07747 Jena, Germany; (F.W.); (N.B.); (E.S.)
| | - Thomas Lehmann
- Institute of Medical Statistics and Computer Science, University Hospital Jena, Friedrich Schiller University Jena, 07747 Jena, Germany;
| | - Ekkehard Schleußner
- Department of Obstetrics, University Hospital Jena, 07747 Jena, Germany; (F.W.); (N.B.); (E.S.)
| | - Tanja Groten
- Department of Obstetrics, University Hospital Jena, 07747 Jena, Germany; (F.W.); (N.B.); (E.S.)
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Rancourt RC, Ott R, Ziska T, Schellong K, Melchior K, Henrich W, Plagemann A. Visceral Adipose Tissue Inflammatory Factors (TNF-Alpha, SOCS3) in Gestational Diabetes (GDM): Epigenetics as a Clue in GDM Pathophysiology. Int J Mol Sci 2020; 21:ijms21020479. [PMID: 31940889 PMCID: PMC7014132 DOI: 10.3390/ijms21020479] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 01/07/2020] [Accepted: 01/09/2020] [Indexed: 12/19/2022] Open
Abstract
Gestational diabetes (GDM) is among the most challenging diseases in westernized countries, affecting mother and child, immediately and in later life. Obesity is a major risk factor for GDM. However, the impact visceral obesity and related epigenetics play for GDM etiopathogenesis have hardly been considered so far. Our recent findings within the prospective ‘EaCH’ cohort study of women with GDM or normal glucose tolerance (NGT), showed the role, critical factors of insulin resistance (i.e., adiponectin, insulin receptor) may have for GDM pathophysiology with epigenetically modified expression in subcutaneous (SAT) and visceral (VAT) adipose tissues. Here we investigated the expression and promoter methylation of key inflammatory candidates, tumor necrosis factor-alpha (TNF-α) and suppressor of cytokine signaling 3 (SOCS3) in maternal adipose tissues collected during caesarian section (GDM, n = 19; NGT, n = 22). The mRNA expression of TNF-α and SOCS3 was significantly increased in VAT, but not in SAT, of GDM patients vs. NGT, accompanied by specific alterations of respective promoter methylation patterns. In conclusion, we propose a critical role of VAT and visceral obesity for the pathogenesis of GDM, with epigenetic alterations of the expression of inflammatory factors as a potential factor.
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Affiliation(s)
- Rebecca C. Rancourt
- Division of ‘Experimental Obstetrics’, Clinic of Obstetrics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum, 13353 Berlin, Germany; (R.O.); (T.Z.); (K.S.); (K.M.); (A.P.)
- Correspondence:
| | - Raffael Ott
- Division of ‘Experimental Obstetrics’, Clinic of Obstetrics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum, 13353 Berlin, Germany; (R.O.); (T.Z.); (K.S.); (K.M.); (A.P.)
| | - Thomas Ziska
- Division of ‘Experimental Obstetrics’, Clinic of Obstetrics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum, 13353 Berlin, Germany; (R.O.); (T.Z.); (K.S.); (K.M.); (A.P.)
| | - Karen Schellong
- Division of ‘Experimental Obstetrics’, Clinic of Obstetrics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum, 13353 Berlin, Germany; (R.O.); (T.Z.); (K.S.); (K.M.); (A.P.)
| | - Kerstin Melchior
- Division of ‘Experimental Obstetrics’, Clinic of Obstetrics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum, 13353 Berlin, Germany; (R.O.); (T.Z.); (K.S.); (K.M.); (A.P.)
| | - Wolfgang Henrich
- Clinic of Obstetrics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum, 13353 Berlin, Germany;
| | - Andreas Plagemann
- Division of ‘Experimental Obstetrics’, Clinic of Obstetrics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum, 13353 Berlin, Germany; (R.O.); (T.Z.); (K.S.); (K.M.); (A.P.)
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Domanski G, Lange AE, Ittermann T, Allenberg H, Spoo RA, Zygmunt M, Heckmann M. Evaluation of neonatal and maternal morbidity in mothers with gestational diabetes: a population-based study. BMC Pregnancy Childbirth 2018; 18:367. [PMID: 30200916 PMCID: PMC6131836 DOI: 10.1186/s12884-018-2005-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 08/31/2018] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is the most frequent complication during pregnancy. Untreated GDM is a severe threat to maternal and neonatal health. Based on recent evidence, up to 15% of all pregnancies may be affected by GDM. We hypothesized that in a rural birth cohort, higher maternal BMI and adverse socioeconomic conditions would promote GDM, which in turn would lead to adverse effects on pregnancy outcomes. METHODS The current study is a part of a population-based cohort study examining the health and socioeconomic information from 5801 mothers and their children. The study, titled the Survey of Neonates in Pomerania (SNiP), was based in northeastern Pomerania, Germany (2002-2008). RESULTS The cumulative incidence of GDM was 5.1%. Multiple logistic regression revealed prepregnancy overweight (OR 1.84 (95% CI 1.27-2.68)), prepregnancy obesity (OR 3.67 (2.48-5.44)) and maternal age (OR 1.06 (1.03-1.08)) as risk factors for GDM (p = 0.001). Alcohol use during pregnancy (OR 0.61 (0.41-0.90), a higher monthly income (OR 0.62 (0.46-0.83)), and the highest level of education (OR 0.44 (0.46-0.83)) decreased the risk of GDM. Newborns of GDM mothers had an increased risk of hypoglycaemia (OR 11.71 (7.49-18.30)) or macrosomia (OR 2.43 (1.41-4.18)) and were more often delivered by primary (OR 1.76 (1.21-2.60)) or secondary C-section (OR 2.00 (1.35-2.97)). Moreover, they were born 0.78 weeks (95% CI -1.09 - -0.48 weeks) earlier than infants of mothers without diabetes, resulting in higher percentage of late preterm infants with a gestational age of 32-36 weeks (11.1% vs. 6.96%). CONCLUSIONS Age and BMI before pregnancy were the predominant mediators of the increased risk of GDM, whereas a higher income and educational level were protective. GDM affected relevant perinatal and neonatal outcomes based on its association with an increased risk of delivery by C-section, preterm birth, macrosomia at birth and neonatal hypoglycaemia.
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Affiliation(s)
- Grzegorz Domanski
- Department of Neonatology and Pediatric Intensive Care, University Medicine Greifswald, Ferdinand-Sauerbruch-Strasse, 17487 Greifswald, Germany
| | - Anja Erika Lange
- Department of Neonatology and Pediatric Intensive Care, University Medicine Greifswald, Ferdinand-Sauerbruch-Strasse, 17487 Greifswald, Germany
| | - Till Ittermann
- Institute for Community Medicine, Div. SHIP – Clinical Epidemiological Research, University Medicine Greifswald, Walter Rathenau Str. 48, 17475 Greifswald, Germany
| | - Heike Allenberg
- Department of Neonatology and Pediatric Intensive Care, University Medicine Greifswald, Ferdinand-Sauerbruch-Strasse, 17487 Greifswald, Germany
| | - Robert Andreas Spoo
- Department of Neonatology and Pediatric Intensive Care, University Medicine Greifswald, Ferdinand-Sauerbruch-Strasse, 17487 Greifswald, Germany
| | - Marek Zygmunt
- Department of Gynecology and Obstetrics, University Medicine Greifswald, Ferdinand-Sauerbruch-Str, 17487 Greifswald, Germany
| | - Matthias Heckmann
- Department of Neonatology and Pediatric Intensive Care, University Medicine Greifswald, Ferdinand-Sauerbruch-Strasse, 17487 Greifswald, Germany
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Tamayo T, Tamayo M, Rathmann W, Potthoff P. Prevalence of gestational diabetes and risk of complications before and after initiation of a general systematic two-step screening strategy in Germany (2012-2014). Diabetes Res Clin Pract 2016; 115:1-8. [PMID: 27242116 DOI: 10.1016/j.diabres.2016.03.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 02/02/2016] [Accepted: 03/01/2016] [Indexed: 11/24/2022]
Abstract
AIMS Information on the prevalence of gestational diabetes mellitus is scarce on national and international level. On July 1st, 2013, a general two-step screening was implemented in Germany harmonizing gestational diabetes diagnoses. We aim to provide prevalence estimates for gestational diabetes and pregnancy-related complications for the large region of North Rhine for the 12 months before and after introduction of the general screening. METHODS Routine care data covering all outpatient diagnoses of more than 150,000 pregnancies per 12-month period in women aged 15-55 years was used to determine cases of gestational diabetes. Gestational diabetes diagnosis and pregnancy-related complications were assessed according to the International Statistical Classification of Diseases and Related Health Problems (ICD-10). Relative Risks for pregnancy-related complications were calculated in pregnancies with and without gestational diabetes. RESULTS Before the screening, diagnosis of gestational diabetes was made in 6.02% of pregnancies and in 6.81% after this date (other types of diabetes mellitus: 1.67% and 1.76% respectively). The prevalence of GDM increased with age and was highest at age 36-40 years (8.45%). The relative increase in prevalence after introduction of the screening was highest in the age group≤25 years (24.9%). The frequency of pregnancy-related complications such as hypertension, pre-eclampsia, cesarean section was increased in pregnancies with gestational diabetes in comparison to those without independent of observation period. CONCLUSIONS We found a high prevalence of gestational diabetes, which has relatively increased by 13.12% after the introduction of the general screening.
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Affiliation(s)
- T Tamayo
- Institute of Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
| | - M Tamayo
- Kassenärztliche Vereinigung Nordrhein, Düsseldorf, Germany
| | - W Rathmann
- Institute of Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - P Potthoff
- Kassenärztliche Vereinigung Nordrhein, Düsseldorf, Germany
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Hauner H, Friese K. [Pregnancy at the family doctor's office]. MMW Fortschr Med 2012; 154:48. [PMID: 22352250 DOI: 10.1007/s15006-012-0105-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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