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Mousavi M, Saei Ghare Naz M, Firouzi F, Azizi F, Ramezani Tehrani F. Impact of adiposity indices changes across the lifespan on risk of diabetes in women: trajectory modeling approach. BMC Public Health 2024; 24:2429. [PMID: 39243051 PMCID: PMC11378475 DOI: 10.1186/s12889-024-19996-4] [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: 03/19/2024] [Accepted: 09/04/2024] [Indexed: 09/09/2024] Open
Abstract
AIMS The impact of life-course different adiposity indices on diabetes mellitus (DM) is poorly understood. We aimed to do trajectory analysis with repeated measurements of adiposity indices in the development of DM among women across the lifespan. METHODS This study prospectively investigated the 1,681 population of Tehran Lipid and Glucose Study. At baseline, all individuals were free of diabetes. Trajectory analysis was used to identify homogeneous distinct clusters of adiposity indices trajectories and assign individuals to unique clusters. RESULTS Of the 1681 healthy women, 320 progressed to the DM. Three distinct body mass index (BMI) trajectories and 2 distinct trajectories of other adiposity indices (waist circumstance (WC), conicity index (C-index), and body roundness index (BRI)) were chosen as the best fitting of the latent class growth mixture model. In the adjusted model, total participants [HR (CI 95%): 2.83 (2.05, 3.91); p < 0.001], and menopause [1.35 (1.10, 2.11); p = 0.001] and reproductive-age women [2.93 (1.80, 4.78); p = 0.003] of the high BMI trajectory compared to the ones in the low trajectory of BMI were more likely to develop DM. The high BRI in menopause had a significantly higher risk of DM compared to the low trajectory. In menopause (1.80 (1.26, 2.58)) and reproductive-age women (4.32 (2.49, 7.47)) with high trajectory of C-index, the DM risk decreased after adjustment. CONCLUSIONS The risk of DM was greater for high BMI, WC, C-index, and BRI trajectories than for lower trajectories. Hence, the development of general, abdominal, and visceral obesity trajectories in the prevention of DM should be considered by clinicians.
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Affiliation(s)
- Maryam Mousavi
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Marzieh Saei Ghare Naz
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Faegheh Firouzi
- Tehran Medical Branch, Islamic Azad University, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- The foundation for research & Education Excellence, Vestaria Hills, Al, USA
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Wang M, Yuan H, Lei F, Zhang S, Jiang L, Yan J, Feng D. Abdominal Fat is a Reliable Indicator of Lumbar Intervertebral Disc Degeneration than Body Mass Index. World Neurosurg 2024; 182:e171-e177. [PMID: 38000674 DOI: 10.1016/j.wneu.2023.11.066] [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: 11/13/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023]
Abstract
OBJECTIVE The objective of this study was to determine whether abdominal fat status correlates with low back pain (LBP) and lumbar intervertebral disc degeneration (IVDD) and to identify a new anthropometric index to predict the likelihood of developing LBP. METHODS Patients with chronic low back pain admitted to the Affiliated Hospital of Southwest Medical University from June 2022 to May 2023 were collected as the experimental group. Volunteers without LBP from June 2022 to May 2023 were also recruited as the control group. They underwent lumbar spine magnetic resonance imaging and had their body mass index (BMI) measured. Abdominal parameters were measured on T2-weighted median sagittal magnetic resonance imaging at the L3/4 level: abdominal diameter, sagittal abdominal diameter (SAD), and subcutaneous abdominal fat thickness (SAFT). Each lumbar IVDD was assessed using the Pfirrmann grading system. The differences in abdominal parameters and BMI between the experimental and control groups were compared, and the correlations between abdominal parameters, BMI, LBP, and IVDD were analyzed. RESULTS Abdominal diameter, SAD, and SAFT had moderate-to-strong correlations with BMI. SAD was significantly associated with severe IVDD at L4-L5 and L5-S1 levels with odds ratio of 3.201 (95% confidence interval [CI]: 1.850-5.539, P < 0.001) and 1.596 (95% CI: 1.072-2.378, P = 0.021), respectively. BMI had no significant association with severe IVDD. In women, SAFT and BMI were significantly correlated with LBP; in men, only SAFT was significantly correlated with LBP. Appropriate cutoff values for men and women were 1.52 cm (area under the curve = 0.702, 95% CI: 0.615-0.789, P < 0.001) and 1.97 cm (area under the curve = 0.740, 95% CI: 0.662-0.818, P < 0.001), respectively. Men and women with SAFT of >1.52 cm and >1.97 cm, respectively, had significantly higher rates of LBP. CONCLUSIONS SAD could predict severe IVDD better than BMI. SAFT is a better predictor of LBP than BMI, especially in men, and reliably distinguished patients with LBP from asymptomatic subjects with reliable cutoff values for men and women.
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Affiliation(s)
- Minglang Wang
- Department of Spinal Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Hao Yuan
- Department of Spinal Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Fei Lei
- Department of Spinal Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Shilin Zhang
- Department of Spinal Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Lin Jiang
- Department of Proctology, Yanjiang District People's Hospital of Ziyang City, Ziyang, Sichuan, China
| | - Jiyuan Yan
- Department of Spinal Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Daxiong Feng
- Department of Spinal Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China.
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Semnani-Azad Z, Gaillard R, Hughes AE, Boyle KE, Tobias DK, Perng W. Predictors and risk factors of short-term and long-term outcomes among women with gestational diabetes mellitus (GDM) and their offspring: Moving toward precision prognosis? MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.04.14.23288199. [PMID: 37131686 PMCID: PMC10153333 DOI: 10.1101/2023.04.14.23288199] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
As part of the American Diabetes Association Precision Medicine in Diabetes Initiative (PMDI) - a partnership with the European Association for the Study of Diabetes (EASD) - this systematic review is part of a comprehensive evidence evaluation in support of the 2 nd International Consensus Report on Precision Diabetes Medicine. Here, we sought to synthesize evidence from empirical research papers published through September 1 st , 2021 to evaluate and identify prognostic conditions, risk factors, and biomarkers among women and children affected by gestational diabetes mellitus (GDM), focusing on clinical endpoints of cardiovascular disease (CVD) and type 2 diabetes (T2D) among women with a history of GDM; and adiposity and cardiometabolic profile among offspring exposed to GDM in utero. We identified a total of 107 observational studies and 12 randomized controlled trials testing the effect of pharmaceutical and/or lifestyle interventions. Broadly, current literature indicates that greater GDM severity, higher maternal body mass index, belonging to racial/ethnic minority group; and unhealthy lifestyle behaviors would predict a woman's risk of incident T2D and CVD, and an unfavorable cardiometabolic profile among offspring. However, the level of evidence is low (Level 4 according to the Diabetes Canada 2018 Clinical Practice Guidelines for diabetes prognosis) largely because most studies leveraged retrospective data from large registries that are vulnerable to residual confounding and reverse causation bias; and prospective cohort studies that may suffer selection and attrition bias. Moreover, for the offspring outcomes, we identified a relatively small body of literature on prognostic factors indicative of future adiposity and cardiometabolic risk. Future high-quality prospective cohort studies in diverse populations with granular data collection on prognostic factors, clinical and subclinical outcomes, high fidelity of follow-up, and appropriate analytical approaches to deal with structural biases are warranted.
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Hu G, Liu H, Leng J, Wang L, Li W, Zhang S, Li W, Liu G, Tian H, Yang S, Yu Z, Yang X, Tuomilehto J. Effects of a Lifestyle Intervention in Young Women with GDM and Subsequent Diabetes. Nutrients 2022; 14:5232. [PMID: 36558389 PMCID: PMC9785424 DOI: 10.3390/nu14245232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/01/2022] [Accepted: 12/02/2022] [Indexed: 12/13/2022] Open
Abstract
The purpose of this study was to examine whether a 9-month intensive lifestyle intervention could lead to weight loss and improve cardiovascular risk factors among young women with both gestational diabetes mellitus (GDM) and newly diagnosed diabetes. A total of 83 young women, who had GDM and were subsequently diagnosed as type 2 diabetes at an average of 2.6 years after delivery, participated in a 9-month intensive lifestyle intervention and a follow-up survey at 6-9 years postintervention. After the 9-month intervention, these women had a weight loss of 2.90 kg (-4.02% of initial weight), decreased waist circumference (-3.12 cm), body fat (-1.75%), diastolic blood pressure (-3.49 mmHg), fasting glucose (-0.98 mmol/L) and HbA1c (-0.72%). During the 6-9 years postintervention period, they still had lower weight (-3.71 kg; -4.62% of initial weight), decreased waist circumference (-4.56 cm) and body fat (-2.10%), but showed a slight increase in HbA1c (0.22%). The prevalence of using glucose-lowering agents increased from 2.4% at baseline to 34.6% after the 9-month lifestyle intervention, and to 48.4% at 6-9 years postintervention. A 9-month intensive lifestyle intervention can produce beneficial effects on body weight, HbA1c and other cardiovascular risk factors among young women with previous GDM who subsequently developed new diabetes.
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Affiliation(s)
- Gang Hu
- Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA 70808, USA
| | - Huikun Liu
- Tianjin Women’s and Children’s Health Center, Tianjin 300071, China
| | - Junhong Leng
- Tianjin Women’s and Children’s Health Center, Tianjin 300071, China
| | - Leishen Wang
- Tianjin Women’s and Children’s Health Center, Tianjin 300071, China
| | - Weiqin Li
- Tianjin Women’s and Children’s Health Center, Tianjin 300071, China
| | - Shuang Zhang
- Tianjin Women’s and Children’s Health Center, Tianjin 300071, China
| | - Wei Li
- Tianjin Women’s and Children’s Health Center, Tianjin 300071, China
| | - Gongshu Liu
- Tianjin Women’s and Children’s Health Center, Tianjin 300071, China
| | - Huiguang Tian
- Tianjin Women’s and Children’s Health Center, Tianjin 300071, China
| | - Shengping Yang
- Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA 70808, USA
| | - Zhijie Yu
- Population Cancer Research Program, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Xilin Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin 300070, China
| | - Jaakko Tuomilehto
- Department of Public Health, University of Helsinki, 00014 Helsinki, Finland
- Population Health Unit, Finnish Institute for Health and Welfare, 00271 Helsinki, Finland
- Saudi Diabetes Research Group, King Abdulaziz University, Jeddah 21589, Saudi Arabia
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A clinical diabetes risk prediction model for prediabetic women with prior gestational diabetes. PLoS One 2021; 16:e0252501. [PMID: 34170930 PMCID: PMC8232404 DOI: 10.1371/journal.pone.0252501] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 05/18/2021] [Indexed: 12/23/2022] Open
Abstract
Introduction Without treatment, prediabetic women with a history of gestational diabetes mellitus (GDM) are at greater risk for developing type 2 diabetes compared with women without a history of GDM. Both intensive lifestyle intervention and metformin can reduce risk. To predict risk and treatment response, we developed a risk prediction model specifically for women with prior GDM. Methods The Diabetes Prevention Program was a randomized controlled trial to evaluate the effectiveness of intensive lifestyle intervention, metformin (850mg twice daily), and placebo in preventing diabetes. Data from the Diabetes Prevention Program (DPP) was used to conduct a secondary analysis to evaluate 11 baseline clinical variables of 317 women with prediabetes and a self-reported history of GDM to develop a 3-year diabetes risk prediction model using Cox proportional hazards regression. Reduced models were explored and compared with the main model. Results Within three years, 82 (25.9%) women developed diabetes. In our parsimonious model using 4 of 11 clinical variables, higher fasting glucose and hemoglobin A1C were each associated with greater risk for diabetes (each hazard ratio approximately 1.4), and there was an interaction between treatment arm and BMI suggesting that metformin was more effective relative to no treatment for BMI ≥ 35kg/m2 than BMI < 30kg/m2. The model had fair discrimination (bias corrected C index = 0.68) and was not significantly different from our main model using 11 clinical variables. The estimated incidence of diabetes without treatment was 37.4%, compared to 20.0% with intensive lifestyle intervention or metformin treatment for women with a prior GDM. Conclusions A clinical prediction model was developed for individualized decision making for prediabetes treatment in women with prior GDM.
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Mao P, Jiang S, Guo J, Jiang Y, Long Q, Tang Y, Luo J, Wiley J, Vorderstrasse A. Progression to Abnormal Glucose Tolerance and Its Related Risk Factors Among Women with Prior Gestational Diabetes in Rural Communities of China. Diabetes Metab Syndr Obes 2020; 13:2259-2268. [PMID: 32636660 PMCID: PMC7334007 DOI: 10.2147/dmso.s252542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 06/08/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The purpose of this study was to describe the status of abnormal glucose tolerance with a longer duration after delivery among women with prior gestational diabetes mellitus (GDM) in a rural community of China, and to explore the influence of socio-demographic factors, GDM-related factors (family history of diabetes, number of children, receipt of treatment for GDM), psychosocial factors (perceived stress, self-efficacy, and social support), lifestyle behaviors (physical activity, sedentary activity, fruit or vegetables intake), and obesity indicators (body mass index and waist circumferences) on abnormal glucose tolerance. PATIENTS AND METHODS A cross-sectional descriptive survey was conducted among women with prior GDM in two county-level hospitals in Western and Eastern Hunan, China from November 2017 to June 2018. Under the guidance of life course theory, data were collected using self-report measures of socio-demographic and GDM-related factors as well as psychosocial factors (perceived stress, self-efficacy, and social support) and postpartum lifestyle behaviors (physical activity, sedentary activity, and fruit and vegetable intake). Additionally, a 75-g oral glucose tolerance test was conducted, and weight, height, and waist circumference were measured on site. RESULTS A total of 425 women were included in this study, with an average postpartum duration of 18.04 months. Of these women, 20.9% had abnormal glucose tolerance (AGT). A multivariate analysis indicated that the proportion of abnormal glucose tolerance increased with increased age (OR = 2.13; 1.27-3.57, p=0.004), ethnic minority (OR: 1.62, 95% CI: 0.96-2.72, p=0.069), lower educational levels (OR:0.58, 95% CI: 0.33-1.02, p=0.057), receipt of treatment for GDM during pregnancy (OR =1.93; 1.11-3.37, p=0.020) and larger waist circumference (OR = 1.08; 1.05-1.12, p=0.000). CONCLUSION More than one-fifth of the women with GDM in rural China had progression to AGT. More postpartum programs aimed at reducing waist circumference are warranted to delay or prevent progression to type 2 diabetes mellitus for rural Chinese women with prior GDM.
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Affiliation(s)
- Ping Mao
- Department of Nursing, Third Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of China
| | - Shan Jiang
- Xiangya School of Nursing, Central South University, Changsha, Hunan, People’s Republic of China
| | - Jia Guo
- Xiangya School of Nursing, Central South University, Changsha, Hunan, People’s Republic of China
| | - Yuanyuan Jiang
- Xiangya School of Nursing, Central South University, Changsha, Hunan, People’s Republic of China
| | - Qing Long
- Xiangya School of Nursing, Central South University, Changsha, Hunan, People’s Republic of China
| | - Yujia Tang
- Xiangya School of Nursing, Central South University, Changsha, Hunan, People’s Republic of China
| | - Jiaxin Luo
- Xiangya School of Nursing, Central South University, Changsha, Hunan, People’s Republic of China
| | - James Wiley
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA
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Mao P, Jiang S, Guo J, Long Q, Zhang H, Chen JL. Do obesity and low levels of physical activity increase the risk for developing type 2 diabetes mellitus among women with prior gestational diabetes in rural China? Res Nurs Health 2020; 43:387-395. [PMID: 32515856 DOI: 10.1002/nur.22043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 03/22/2020] [Accepted: 05/19/2020] [Indexed: 12/15/2022]
Abstract
Moderate-to-vigorous intensity physical activity (MVPA) and obesity play important roles in the development of type 2 diabetes mellitus (T2DM) among women with prior gestational diabetes mellitus (GDM). Yet, how MVPA affects the risk of developing T2DM among women with prior GDM across the different categories of obesity indicators is unclear. This study aimed to describe the levels of postpartum abnormal glucose tolerance (AGT), obesity indicators (body mass index [BMI] and waist circumference [WC]), and MVPA and to explore the independent effect and joint effect of MVPA and obesity indicators (BMI and WC) on the risk for developing AGT among women with prior GDM in rural China. A total of 425 women with prior GDM were recruited from two county-level hospitals in Western and Eastern Hunan, China. Data were collected with self-reported measurements on sociodemographics and clinical factors as well as postpartum weight-related behaviors (physical activity and dietary intake). The 75-g oral glucose tolerance test, weight, height, and WC were measured on site. Binary logistic regression models and multiplitive interaction models were used to explore the independent and joint associations of BMI and MVPA as well as WC and MVPA on AGT, respectively. One-fifth (20.9%) of the sample women had AGT. The obesity indicators were significantly associated with an increased risk of postpartum AGT, but MVPA was not. In joint effect analyses, larger WC and insufficient MVPA were not significantly associated with increased risk of AGT compared with normal WC and sufficient MVPA (mutually adjusted odds ratio [OR], 1.43; 95% confidence interval [CI], 0.46-4.43; p > .05). In joint effect analyses of MVPA and BMI, the mutually adjusted OR for developing AGT in women who were obese and had insufficient MVPA was 4.49 (95% CI, 1.35-14.92; p < .05) compared with normal weight and sufficient MVPA. Adequate weight management and increased MVPA are warranted for Chinese women with prior GDM to prevent T2DM.
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Affiliation(s)
- Ping Mao
- Department of Nursing, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Shan Jiang
- Department of Clinical Nursing, Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Jia Guo
- Department of Clinical Nursing, Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Qing Long
- Department of Clinical Nursing, Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Honghui Zhang
- Department of Hepatobiliary Surgery, Hunan Provincial People's Hospital, Chingsha, Hunan, China
| | - Jyu-Lin Chen
- Department of Family Nursing, School of Nursing, University of California, San Francisco, California
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Lu J, Gu Y, Wang L, Li W, Zhang S, Liu H, Leng J, Liu J, Wang S, Baccarelli AA, Hou L, Hu G. Glucose metabolism among obese and non-obese children of mothers with gestational diabetes. BMJ Open Diabetes Res Care 2020; 8:8/1/e000822. [PMID: 32179515 PMCID: PMC7073815 DOI: 10.1136/bmjdrc-2019-000822] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 02/09/2020] [Accepted: 02/14/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Abdominal obesity is more closely associated with diabetes than general obesity in adults, however, it is unknown which kind of obesity is more closely associated with abnormal glucose metabolism in children. RESEARCH DESIGN AND METHODS We recruited 973 children (aged 3.08±1.06) of mothers with prior gestational diabetes mellitus (GDM). Children's height, weight, waist circumstance, fasting glucose and insulin were measured using standardized methods. Logistic regression models were used to assess the single and joint associations of general and abdominal obesity with the risks of hyperglycemia (the upper quartile of fasting glucose), insulin resistance (the upper quartile of homeostatic model assessment of insulin resistance (HOMA-IR)), and β-cell dysfunction (the lower quartile of HOMA-%β). RESULTS Compared with normal weight children, children with general overweight/obesity had higher levels of HOMA-IR and HOMA-%β, higher ORs for hyperglycemia (1.56, 95% CI 1.06 to 2.30) and insulin resistance (3.44, 95% CI 2.32 to 5.09), but a lower OR for β-cell dysfunction (0.65, 95% CI 0.41 to 1.04). Children with abdominal obesity had an increased risk of insulin resistance (2.54, 95% CI 1.71 to 3.76) but not hyperglycemia and β-cell dysfunction compared with children with normal waist circumstance. In the joint analyses, general overweight children with and without abdominal obesity had an increased risk of hyperglycemia and insulin resistance compared with normal weight children. CONCLUSIONS General obesity was more closely associated with abnormal glucose metabolism than abdominal obesity in children of mothers with GDM.
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Affiliation(s)
- Jun Lu
- Department of Endocrinology and Metabolism, Fengxian Hospital Affiliated to Southern Medical University, Shanghai Jiao Tong University Affiliated Sixth People's Hospital South Campus, Shanghai University of Medicine and Health Sciences Affiliated Shanghai Sixth People's Hospital South Campus, Shanghai, China
- Chronic Disease Epidemiology, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Yuying Gu
- Chronic Disease Epidemiology, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
- Department of Mathematics, Shanghai Business School-Fengpu Campus, Shanghai, China
| | - Leishen Wang
- Tianjin Health and Family Planning Commission, Tianjin, China
| | - Weiqin Li
- Tianjin Health and Family Planning Commission, Tianjin, China
| | - Shuang Zhang
- Tianjin Health and Family Planning Commission, Tianjin, China
| | - Huikun Liu
- Tianjin Health and Family Planning Commission, Tianjin, China
| | - Junhong Leng
- Tianjin Health and Family Planning Commission, Tianjin, China
| | - Jin Liu
- Tianjin Health and Family Planning Commission, Tianjin, China
| | - Shuo Wang
- Tianjin Health and Family Planning Commission, Tianjin, China
| | - Andrea A Baccarelli
- Columbia University Mailman School of Public Health, New York, New York, USA
| | - Lifang Hou
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Gang Hu
- Chronic Disease Epidemiology, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
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Li W, Leng J, Liu H, Zhang S, Wang L, Hu G, Mi J. Nomograms for incident risk of post-partum type 2 diabetes in Chinese women with prior gestational diabetes mellitus. Clin Endocrinol (Oxf) 2019; 90:417-424. [PMID: 30257051 PMCID: PMC6375795 DOI: 10.1111/cen.13863] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 09/19/2018] [Accepted: 09/20/2018] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Counselling patients with gestational diabetes mellitus (GDM) on their individual risk of post-partum type 2 diabetes (T2D) is challenging. This study aimed to develop nomograms for predicting incident risk of post-partum T2D in women with GDM diagnosed by WHO 1998 criteria. METHODS We performed a retrospective cohort study in 1263 Chinese women with GDM, of whom 83 were diagnosed as T2D at 2.3 years post-partum. Multivariate Cox proportional hazards models were used to investigate the independent predictors for post-partum T2D. The results of multivariate analyses were used to formulate nomograms for predicting incident risk of post-partum T2D. The predictive accuracy was evaluated using the area under the receiver operating characteristic curve (AUROC). RESULTS On multivariate analysis, independent predictors of post-partum T2DM in women with GDM included family history of diabetes [hazard ratio (HR) and its 95% confidential interval (95% CI): 2.06 (95% CI: 1.32-3.22)], history of pregnancy-induced hypertension [3.11 (95% CI: 1.86-5.21)], pre-pregnancy BMI [1.00, 1.90 (95% CI: 1.14-3.16), and 3.67 (95% CI: 2.03-6.63) for BMI <24, 24-28, and ≥28 kg/m2 ], and 2-hour glucose at 26-30 gestational weeks [1.00, 2.84 (95% CI: 1.42-5.69), and 9.42 (95% CI: 4.46-19.90) for 2-hour glucose at 7.8 ~ <8.5, 8.5 ~ <11.1, and ≥11.1 mmol/L). The overall AUROC of nomogram was 82.8% (95% CI: 78.1%-87.5%), with AUROCs of 85.9% (95% CI: 79.7%-92.1%) and 83.2% (95% CI: 77.9%-88.6%) for post-partum 2-year and 3-year risk of T2D, respectively. CONCLUSIONS This easy-to-use nomogram, with non-invasive clinical characteristics, can accurately predict the risk of post-partum T2D in women with GDM. It may facilitate risk communication between patients and clinicians.
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Affiliation(s)
- Weiqin Li
- Tianjin Women's and Children's Health Center, Tianjin, China
- Department of Epidemiology, Capital Institute of Pediatrics, Beijing, China
- Graduate School of Peking Union Medical College, Beijing, China
| | - Junhong Leng
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - Huikun Liu
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - Shuang Zhang
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - Leishen Wang
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - Gang Hu
- Pennington Biomedical Research Center, Baton Rouge, Louisiana
| | - Jie Mi
- Department of Epidemiology, Capital Institute of Pediatrics, Beijing, China
- Graduate School of Peking Union Medical College, Beijing, China
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Risk prediction for breast Cancer in Han Chinese women based on a cause-specific Hazard model. BMC Cancer 2019; 19:128. [PMID: 30732565 PMCID: PMC6367757 DOI: 10.1186/s12885-019-5321-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 01/25/2019] [Indexed: 01/03/2023] Open
Abstract
Background Considering the lack of efficient breast cancer prediction models suitable for general population screening in China. We aimed to develop a risk prediction model to identify high-risk populations, to help with primary prevention of breast cancer among Han Chinese women. Methods A cause-specific competing risk model was used to develop the Han Chinese Breast Cancer Prediction model. Data from the Shandong Case-Control Study (328 cases and 656 controls) and Taixing Prospective Cohort Study (13,176 participants) were used to develop and validate the model. The expected/observed (E/O) ratio and C-statistic were calculated to evaluate calibration and discriminative accuracy of the model, respectively. Results Compared with the reference level, the relative risks (RRs) for highest level of number of abortions, age at first live birth, history of benign breast disease, body mass index (BMI), family history of breast cancer, and life satisfaction scores were 6.3, 3.6, 4.3, 1.9, 3.3, 2.4, respectively. The model showed good calibration and discriminatory accuracy with an E/O ratio of 1.03 and C-statistic of 0.64. Conclusions We developed a risk prediction model including fertility status and relevant disease history, as well as other modifiable risk factors. The model demonstrated good calibration and discrimination ability. Electronic supplementary material The online version of this article (10.1186/s12885-019-5321-1) contains supplementary material, which is available to authorized users.
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Han L, Duan D, Zhang S, Li W, Wang L, Liu H, Leng J, Li N, Shang X, Hu G, Qi L. Effects of the interaction between glycated haemoglobin genetic risk score and postpartum weight reduction on glycaemic changes: A gene-weight interaction analysis. Diabetes Obes Metab 2018; 20:2733-2739. [PMID: 29974585 PMCID: PMC6231972 DOI: 10.1111/dom.13452] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 06/11/2018] [Accepted: 06/24/2018] [Indexed: 10/28/2022]
Abstract
AIM To investigate the effects of the interaction between glycated haemoglobin (HbA1c) genetic risk score and weight changes during and after pregnancy (postpartum weight reduction and gestational weight gain) on long-term glycaemic changes in the largest cohort of women with a history of gestational diabetes mellitus (GDM). METHODS This was a retrospective cohort using the baseline data from the Tianjin Gestational Diabetes Mellitus Prevention Programme. A genetic risk score was established by combining 10 HbA1c-related single-nucleotide polymorphisms, which were identified by genome-wide association studies. General linear regression models were applied to evaluate the effect of interaction between HbA1c genetic risk score and weight changes during and after pregnancy (postpartum weight reduction and gestational weight gain) on glycaemic changes. RESULTS 'A total of 1156 women with a history of GDM were included in this respective cohort study. Statistical differences in pre-pregnancy weight, pre-delivery weight and postpartum weight were evidenced across different groups of postpartum weight reduction. After adjusting for covariates, statistical significance for changes in HbA1c level was only observed in the postpartum weight reduction <5 kg/y group (P = 0.002), and a significant effect of interaction between HbA1c genetic risk score and postpartum weight reduction on long-term changes in HbA1c was evidenced (P interaction = 0.01). In women with postpartum weight reduction ≥8 kg/y, those with a lower HbA1c genetic risk score had a greater decrease in HbA1c level. CONCLUSIONS HbA1c genetic risk score interacts with postpartum weight reduction to affect long-term changes in HbA1c levels among women with a history of GDM.
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Affiliation(s)
- Liyuan Han
- Department of Preventive Medicine, Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, China
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Donghui Duan
- Department of Preventive Medicine, Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, China
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
- Department of Chronic Disease, Institute of Non-Communicable Disease Control and Prevention, Ningbo Municipal Center for Disease Control and Prevention, Ningbo, China
| | - Shuang Zhang
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - Weiqin Li
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - Leishen Wang
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - Huikun Liu
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - Junhong Leng
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - Nan Li
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - Xiaoyun Shang
- Children's Pediatrics, Children's Hospital New Orleans, New Orleans, Louisiana
| | - Gang Hu
- Pennington Biomedical Research Center, Baton Rouge, Louisiana
| | - Lu Qi
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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12
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Wu Y, Zhang J, Peng S, Wang X, Luo L, Liu L, Huang Q, Tian M, Zhang X, Shen H. Multiple elements related to metabolic markers in the context of gestational diabetes mellitus in meconium. ENVIRONMENT INTERNATIONAL 2018; 121:1227-1234. [PMID: 30385065 DOI: 10.1016/j.envint.2018.10.044] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 10/03/2018] [Accepted: 10/21/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is a typical fetus development niches dysfunction and many toxic/nutrient elements have been associated with its onset and progression. However, the classic epidemiologic approach is regarded as "black-box epidemiology" and fails to elucidate these elements' biological roles on the damaged fetus developmental microenvironment. OBJECTIVE We aimed to characterize the associations between meconium of multiple elements with GDM for illustrating their interruption effects on in-uterus microenvironment. METHODS In this case-control study (n = 137 cases; n = 197 controls), the participants were nested from a cross-sectional retrospection of 1359 recruitments in Xiamen, China. Twenty-one meconium elements were characterized using inductively coupled plasma mass spectrometry (ICP-MS) or inductively coupled plasma optical emission spectrometry (ICP-OES). For shifting the present paradigm from a black-box approach to a molecular approach, GDM-related metabolic markers were identified in our previous metabolome report. Based on the meet-in-middle strategy, the associations among the elements, metabolic markers and GDM incidence were assessed by using redundancy analysis and correlation-adjusted correlation; mediation analysis was further used to test the hypothesis that metabolic markers mediate the associations of the elements with GDM incidence. RESULTS Eight elements were related with the GDM occurrence in dose-dependent manners, which positively (Al, As, Ba, Cd, Hg, and Sn) or negatively (Ca and V) associated with GDM. Among them, As, Cd, Ba, and Ca significantly contributed to the variation of GDM-related metabolic markers. Additionally, the associations of Cd, Ba, Ca and As with GDM were mediated by the metabolic markers which majorly involved in the lipid metabolism and the Adenosine/l-Arginine/Nitric Oxide (ALANO) pathways. CONCLUSIONS The two-side mediations of meconium metabolic markers between the multiple elements and GDM occurrence indicated that maternal exposure to As, Ba, Cd, and Ca may be associated with the dysfunction of fetus development niche through disrupting lipid metabolism and ALANO pathways.
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Affiliation(s)
- Yan Wu
- Key Lab of Urban Environment and Health, Institute of Urban Environment, Chinese Academy of Sciences, China; University of Chinese Academy of Sciences, Beijing, China
| | - Jie Zhang
- Key Lab of Urban Environment and Health, Institute of Urban Environment, Chinese Academy of Sciences, China
| | - Siyuan Peng
- Key Lab of Urban Environment and Health, Institute of Urban Environment, Chinese Academy of Sciences, China
| | - Xiaofei Wang
- Department of Chemistry and The MOE Key Laboratory of Spectrochemical Analysis and Instrumentation, College of Chemistry and Chemical Engineering, Xiamen University, Xiamen, China
| | - Lianzhong Luo
- Department of Pharmacy, Xiamen Medical College, Xiamen, China
| | - Liangpo Liu
- Key Lab of Urban Environment and Health, Institute of Urban Environment, Chinese Academy of Sciences, China
| | - Qingyu Huang
- Key Lab of Urban Environment and Health, Institute of Urban Environment, Chinese Academy of Sciences, China
| | - Meiping Tian
- Key Lab of Urban Environment and Health, Institute of Urban Environment, Chinese Academy of Sciences, China
| | - Xueqin Zhang
- Xiamen Maternity and Child Health Care Hospital, Xiamen, China.
| | - Heqing Shen
- Key Lab of Urban Environment and Health, Institute of Urban Environment, Chinese Academy of Sciences, China.
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Nisa H, Qi KHT, Leng J, Zhou T, Liu H, Li W, Wang L, Li N, Hu G, Qi L. The Circadian Rhythm-Related MTNR1B Genotype, Gestational Weight Gain, and Postpartum Glycemic Changes. J Clin Endocrinol Metab 2018; 103:2284-2290. [PMID: 29590381 PMCID: PMC6276711 DOI: 10.1210/jc.2018-00071] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 03/19/2018] [Indexed: 11/19/2022]
Abstract
Context Disturbed circadian rhythms and sleep quality during pregnancy have been related to gestational weight gain and gestational diabetes mellitus (GDM), which affect postpartum glucose metabolism and future risk of type 2 diabetes. Objective We assessed whether the circadian rhythm-related melatonin receptor 1B (MTNR1B) genotype was associated with 1 to 5 years of postpartum glycemic changes among women with a history of GDM and whether gestational weight gain modified such associations. Design, Settings, and Participants The established circadian rhythm-associated MTNR1B genetic variant (rs10830963) was genotyped in 1025 Chinese women with a history of GDM. Body weight and glycemic traits, during and after pregnancy, were longitudinally collected. Main Outcome Measures The main outcome measure was postpartum glycemic changes. Results We found that women carrying different MTNR1B genotypes showed distinct postpartum changes in 2-hour oral glucose tolerance test: 0.36, 0.20, and -0.19 mM per additional copy of the shorter sleep duration-related G allele in women with inadequate, adequate, and excessive gestational weight gain, respectively (for interaction, P = 0.028). The corresponding changes in fasting glucose were 0.14, 0.13, and 0.01 mM, although the modification effect of gestational weight gain on the genetic association was marginally significant (for interaction, P = 0.067). Conclusions Our findings suggest that gestational weight gain may modify the circadian rhythm-related MTNR1B genetic variant on long-term glycemic changes, highlighting the significance of gestational weight management in diabetes prevention among women with GDM.
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Affiliation(s)
- Hoirun Nisa
- Department of Epidemiology, School of Public Health and Tropical Medicine,
Tulane University, New Orleans, Louisiana
- Department of Public Health, Faculty of Health Sciences, State Islamic
University, Jakarta, Indonesia
| | | | - Junhong Leng
- Tianjin Women’s and Children’s Health Center, Tianjin, China
| | - Tao Zhou
- Department of Epidemiology, School of Public Health and Tropical Medicine,
Tulane University, New Orleans, Louisiana
| | - Huikun Liu
- Tianjin Women’s and Children’s Health Center, Tianjin, China
| | - Weiqin Li
- Tianjin Women’s and Children’s Health Center, Tianjin, China
| | - Leishen Wang
- Tianjin Women’s and Children’s Health Center, Tianjin, China
| | - Nan Li
- Tianjin Women’s and Children’s Health Center, Tianjin, China
| | - Gang Hu
- Pennington Biomedical Research Center, Baton Rouge, Louisiana
| | - Lu Qi
- Department of Epidemiology, School of Public Health and Tropical Medicine,
Tulane University, New Orleans, Louisiana
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston,
Massachusetts
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14
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Qiu SH, Xue C, Sun ZL, Steinacker JM, Zügel M, Schumann U. Attenuated heart rate recovery predicts risk of incident diabetes: insights from a meta-analysis. Diabet Med 2017; 34:1676-1683. [PMID: 28945922 DOI: 10.1111/dme.13517] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/19/2017] [Indexed: 12/23/2022]
Abstract
AIMS To assess the association between attenuated heart rate recovery, a non-invasive measure of autonomic dysfunction, and risk of diabetes in the general population. METHODS Databases were searched for cohort studies up to May 2017 that reported the association of heart rate recovery with the risk of diabetes. The overall hazard ratios for slowest vs fastest heart rate recovery (the referent) and for every 10-beats-per-min decrement in heart rate recovery were calculated using a random effects meta-analysis model. RESULTS Four cohort studies with 430 incident cases of diabetes among a total of 9113 participants during a mean follow-up period of 8.1 years were included. Results showed that the slowest heart rate recovery was associated with a higher risk of diabetes (hazard ratio 1.66, 95% CI 1.16 to 2.38) vs the fastest heart rate recovery, and the hazard ratio of risk of diabetes for every 10-beats-per-min decrement in heart rate recovery was 1.29 (95% CI 1.13 to 1.48). No significant interaction effect was observed regarding the efficacy of 1-min and 2-min heart rate recovery in predicting risk of diabetes (both Pfor interaction >0.60); however, a linear dose-response relationship existed for overall studies and for studies using 1-min heart rate recovery as the exposure (both P >0.60 for non-linearity). CONCLUSIONS Attenuated heart rate recovery is associated with an increased risk of diabetes in a dose-dependent manner, and measurement of heart rate recovery is worth recommending as part of diabetes risk assessment in clinical routines.
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Affiliation(s)
- S H Qiu
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing, P. R. China
| | - C Xue
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing, P. R. China
| | - Z L Sun
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing, P. R. China
| | - J M Steinacker
- Division of Sports and Rehabilitation Medicine, Ulm University Medical Centre, Ulm, Germany
| | - M Zügel
- Division of Sports and Rehabilitation Medicine, Ulm University Medical Centre, Ulm, Germany
| | - U Schumann
- Division of Sports and Rehabilitation Medicine, Ulm University Medical Centre, Ulm, Germany
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15
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Leng J, Wang L, Wang J, Li W, Liu H, Zhang S, Li L, Tian H, Xun P, Yang X, Yu Z, Hu G. Uric acid and diabetes risk among Chinese women with a history of gestational diabetes mellitus. Diabetes Res Clin Pract 2017; 134:72-79. [PMID: 28993154 PMCID: PMC5723553 DOI: 10.1016/j.diabres.2017.09.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 09/02/2017] [Accepted: 09/27/2017] [Indexed: 01/06/2023]
Abstract
AIMS To assess the association of uric acid (UA) with the risks of postpartum type 2 diabetes and prediabetes among women with prior gestational diabetes mellitus (GDM). METHODS We performed a cross-sectional study of 1262 GDM women at 1-5 years after delivery using the baseline data from the Tianjin Gestational Diabetes Mellitus Prevention Program. Logistic regression models were used to estimate the association of different levels of serum UA with the risks of type 2 diabetes and prediabetes. RESULTS The multivariable-adjusted odds ratios (ORs) across quartiles of serum UA were 1.00, 1.23 (95% confidence interval [CI] 0.55-2.78), 2.05 (95% CI 0.96-4.39), and 3.17 (95% CI 1.54-6.55) (Ptrend < 0.001) for type 2 diabetes, and 1.00, 1.50 (95% CI 1.03-2.19), 2.28 (95% CI 1.58-3.30), and 2.88 (95% CI 1.99-4.17) (Ptrend < 0.001) for prediabetes, respectively. Restricted cubic splines models showed positive linear associations of serum UA as a continuous variable with the risks of type 2 diabetes and prediabetes. This positive association was significant when stratified by healthy weight and overweight participants. CONCLUSIONS Serum UA levels have a graded positive association with the risks of type 2 diabetes and prediabetes among Chinese with a history of GDM.
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Affiliation(s)
- Junhong Leng
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - Leishen Wang
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - Jing Wang
- Tianjin Women's and Children's Health Center, Tianjin, China; Chronic Disease Epidemiology Laboratory, Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Weiqin Li
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - Huikun Liu
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - Shuang Zhang
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - Lili Li
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - Huiguang Tian
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - Pengcheng Xun
- Department of Epidemiology and Biostatistics, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
| | - Xilin Yang
- Department of Epidemiology and Biostatistics, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin, China
| | - Zhijie Yu
- Population Cancer Research Program, Dalhousie University, 1494 Carlton Street, Halifax, NS, Canada
| | - Gang Hu
- Chronic Disease Epidemiology Laboratory, Pennington Biomedical Research Center, Baton Rouge, LA, USA.
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16
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de Carvalho AM, Shao P, Liu H, Cheng HL, Zheng Y, Leng J, Li W, Huang T, Wang T, Wang L, Zhang S, Hu G, Qi L. The MC4R genotype is associated with postpartum weight reduction and glycemic changes among women with prior gestational diabetes: longitudinal analysis. Sci Rep 2017; 7:9654. [PMID: 28852042 PMCID: PMC5575005 DOI: 10.1038/s41598-017-10101-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 08/03/2017] [Indexed: 01/06/2023] Open
Abstract
The genetic variants near the Melanocortin-4 receptor gene (MC4R), a key protein regulating energy balance and adiposity, have been related to obesity and glucose metabolism. We aimed to assess whether the MC4R genotype affected longitudinal changes in body weight and glucose metabolism biomarkers among women with prior gestational diabetes mellitus (GDM). The MC4R genotype, postpartum weight reduction, and glycemic changes between after delivery and pregnancy were assessed in a cohort of 1208 Chinese women who had experienced GDM. The adiposity-increasing allele (C) of the MC4R variant rs6567160 was associated with greater postpartum increase of HbA1c (β = 0.08%; P = 0.03) and 2-hour OGTT glucose concentrations (β = 0.25 mmol/L; P = 0.02). In addition, we found an interaction between the MC4R genotype and postpartum weight reduction on changes in fasting plasma glucose (P-interaction = 0.03). We found that the MC4R genotype was associated with postpartum glycemic changes; and the association with fasting glucose were significantly modified by postpartum weight reduction in women who had experienced GDM.
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Affiliation(s)
- Aline Martins de Carvalho
- Department of Nutrition, University of Sao Paulo School of Public Health, Sao Paulo, Brazil
- Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Ping Shao
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - Huikun Liu
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - Han-Ling Cheng
- Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Yan Zheng
- Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Junhong Leng
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - Weiqin Li
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - Tao Huang
- Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Tiange Wang
- Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Leishen Wang
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - Shuang Zhang
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - Gang Hu
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Lu Qi
- Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts, USA.
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA.
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17
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Zhang S, Wang L, Leng J, Liu H, Li W, Zhang T, Li N, Li W, Tian H, Baccarelli AA, Hou L, Hu G. Hypertensive disorders of pregnancy in women with gestational diabetes mellitus on overweight status of their children. J Hum Hypertens 2017; 31:731-736. [PMID: 28300070 PMCID: PMC5600626 DOI: 10.1038/jhh.2017.17] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 12/20/2016] [Accepted: 01/17/2017] [Indexed: 12/16/2022]
Abstract
Hypertensive disorders of pregnancy (HDP) as a group of medical complications in pregnancy are believed to be associated with an increased risk of poor fetal growth, but the influence on offspring’s body composition is not clear. The aim of the present study was to evaluate the association between maternal hypertensive disorders of pregnancy and overweight status in the offspring of mothers with gestational diabetes mellitus (GDM). A cross-sectional study among 1263 GDM mother-child pairs was performed in Tianjin, China. General linear models and logistic regression models were used to assess the associations of maternal hypertension in pregnancy with anthropometry and overweight status in the offspring from birth to 1–5 years old. Offspring of GDM mothers who were diagnosed with hypertensive disorders during pregnancy had higher mean values of Z scores for birth weight for gestational age and birth weight for length, and higher mean values of Z scores for weight for age, weight for length/height, and body mass index for age at 1–5 years old than those of GDM mothers with normal blood pressure during pregnancy. Maternal hypertensive disorders of pregnancy were associated with increased risks of large for gestational age (OR 1.74, 95%CI 1.08–2.79) and macrosomia (OR 2.02, 95%CI 1.23–3.31) at birth and childhood overweight/obesity at 1–5 years old age (OR 1.88, 95%CI 1.16–3.04). For offspring of mothers with GDM, maternal hypertension during pregnancy was a risk factor for macrosomia at birth and childhood overweight and obesity, and controlling the maternal hypertension may be more important for preventing large for gestational age babies and childhood obesity.
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Affiliation(s)
- S Zhang
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - L Wang
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - J Leng
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - H Liu
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - W Li
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - T Zhang
- Tianjin Women's and Children's Health Center, Tianjin, China.,Chronic Disease Epidemiology Laboratory, Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - N Li
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - W Li
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - H Tian
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - A A Baccarelli
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - L Hou
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - G Hu
- Chronic Disease Epidemiology Laboratory, Pennington Biomedical Research Center, Baton Rouge, LA, USA
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18
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Physical Activity, TV Watching Time, Sleeping, and Risk of Obesity and Hyperglycemia in the Offspring of Mothers with Gestational Diabetes Mellitus. Sci Rep 2017; 7:41115. [PMID: 28120866 PMCID: PMC5264639 DOI: 10.1038/srep41115] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 12/15/2016] [Indexed: 01/06/2023] Open
Abstract
We investigated the association of physical activity, TV watching time, sleeping time with the risks of obesity and hyperglycemia among 1263 offspring aged 1-5 years of mothers with gestational diabetes (GDM) in a cross-sectional study. Logistic regression models were used to obtain the odd ratios (ORs) (95% confidence intervals [CI]) of childhood obesity and hyperglycemia associated with different levels of indoor activity, outdoor activity, TV watching, and sleeping time. The multivariable-adjusted ORs of obesity based on different levels of TV watching time (0, <1.0, and ≥1.0 hour/day) were 1.00, 1.21 (95% CI 0.72-2.05), and 2.20 (95% CI 1.33-3.63) (Ptrend = 0.003), respectively. The multivariable-adjusted ORs of hyperglycemia based on different levels of indoor activity (<5.0, 5.0-6.9, and ≥7.0 hours/day) were 1.00, 0.74 (95% CI 0.45-1.21), and 0.49 (95% CI 0.28-0.84) (Ptrend = 0.034), respectively. The multivariable-adjusted ORs of hyperglycemia associated with different levels of sleeping time (<11.0, 11.0-11.9, and ≥12.0 hours/day) were 1.00, 0.67 (95% CI 0.42-1.05), and 0.39 (95% CI 0.23-0.67) (Ptrend = 0.003), respectively. The present study indicated a positive association of TV watching with the risk of obesity, and an inverse association of either indoor activity or sleeping time with the risk of hyperglycemia among offspring born to GDM mothers in Tianjin, China.
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Wang T, Liu H, Wang L, Huang T, Li W, Zheng Y, Heianza Y, Sun D, Leng J, Zhang S, Li N, Hu G, Qi L. Zinc-Associated Variant in SLC30A8 Gene Interacts With Gestational Weight Gain on Postpartum Glycemic Changes: A Longitudinal Study in Women With Prior Gestational Diabetes Mellitus. Diabetes 2016; 65:3786-3793. [PMID: 27600066 PMCID: PMC5127244 DOI: 10.2337/db16-0730] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Accepted: 08/30/2016] [Indexed: 11/13/2022]
Abstract
Zinc transporter 8 genetic variant SLC30A8 has been associated with postpartum risk of type 2 diabetes among women with gestational diabetes mellitus (GDM). Gestational weight gain is one of the strongest risk factors for postpartum hyperglycemia. We assessed the interaction between type 2 diabetes-associated SLC30A8 rs13266634 and gestational weight gain on 1-5 years of postpartum glycemic changes in 1,071 women with prior GDM in a longitudinal study. Compared with gestation of 26-30 weeks, postpartum levels of fasting glucose, oral glucose tolerance test 2-h glucose, and hemoglobin A1c (HbA1c) increased across rs13266634 TT, CT, and CC genotypes in women with excessive gestational weight gain, whereas opposite genetic associations were found in women with inadequate or adequate gestational weight gain. Postpartum changes in fasting glucose per additional copy of the C allele were -0.18, -0.04, and 0.12 mmol/L in women with inadequate, adequate, and excessive gestational weight gain, respectively (P for interaction = 0.002). We also found similar interactions for changes in 2-h glucose and HbA1c (P for interaction = 0.003 and 0.005, respectively). Our data indicate that gestational weight gain may modify SLC30A8 variant on long-term glycemic changes, highlighting the importance of gestational weight control in the prevention of postpartum hyperglycemia in women with GDM.
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Affiliation(s)
- Tiange Wang
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA
- Shanghai Institute of Endocrine and Metabolic Diseases, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huikun Liu
- Tianjin Women and Children's Health Center, Tianjin, China
| | - Leishen Wang
- Tianjin Women and Children's Health Center, Tianjin, China
| | - Tao Huang
- Epidemiology Domain, Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Weiqin Li
- Tianjin Women and Children's Health Center, Tianjin, China
| | - Yan Zheng
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Yoriko Heianza
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA
| | - Dianjianyi Sun
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA
| | - Junhong Leng
- Tianjin Women and Children's Health Center, Tianjin, China
| | - Shuang Zhang
- Tianjin Women and Children's Health Center, Tianjin, China
| | - Nan Li
- Tianjin Women and Children's Health Center, Tianjin, China
| | - Gang Hu
- Pennington Biomedical Research Center, Baton Rouge, LA
| | - Lu Qi
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Noctor E, Crowe C, Carmody LA, Saunders JA, Kirwan B, O'Dea A, Gillespie P, Glynn LG, McGuire BE, O'Neill C, O'Shea PM, Dunne FP. Abnormal glucose tolerance post-gestational diabetes mellitus as defined by the International Association of Diabetes and Pregnancy Study Groups criteria. Eur J Endocrinol 2016; 175:287-97. [PMID: 27422889 DOI: 10.1530/eje-15-1260] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 07/15/2016] [Indexed: 12/19/2022]
Abstract
OBJECTIVE An increase in gestational diabetes mellitus (GDM) prevalence has been demonstrated across many countries with adoption of the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) diagnostic criteria. Here, we determine the cumulative incidence of abnormal glucose tolerance among women with previous GDM, and identify clinical risk factors predicting this. DESIGN Two hundred and seventy women with previous IADPSG-defined GDM were prospectively followed up for 5years (mean 2.6) post-index pregnancy, and compared with 388 women with normal glucose tolerance (NGT) in pregnancy. METHODS Cumulative incidence of abnormal glucose tolerance (using American Diabetes Association criteria for impaired fasting glucose, impaired glucose tolerance and diabetes) was determined using the Kaplan-Meier method of survival analysis. Cox regression models were constructed to test for factors predicting abnormal glucose tolerance. RESULTS Twenty-six percent of women with previous GDM had abnormal glucose tolerance vs 4% with NGT, with the log-rank test demonstrating significantly different survival curves (P<0.001). Women meeting IADPSG, but not the World Health Organization (WHO) 1999 criteria, had a lower cumulative incidence than women meeting both sets of criteria, both in the early post-partum period (4.2% vs 21.7%, P<0.001) and at longer-term follow-up (13.7% vs 32.6%, P<0.001). Predictive factors were glucose levels on the pregnancy oral glucose tolerance test, family history of diabetes, gestational week at testing, and BMI at follow-up. CONCLUSIONS The proportion of women developing abnormal glucose tolerance remains high among those with IADPSG-defined GDM. This demonstrates the need for continued close follow-up, although the optimal frequency and method needs further study.
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Affiliation(s)
- Eoin Noctor
- Galway Diabetes Research CentreNational University of Ireland, Galway, Ireland
| | - Catherine Crowe
- Galway Diabetes Research CentreNational University of Ireland, Galway, Ireland
| | - Louise A Carmody
- Galway Diabetes Research CentreNational University of Ireland, Galway, Ireland
| | - Jean A Saunders
- Statistical Consulting Unit/CSTAR @ ULUniversity of Limerick, Limerick, Ireland
| | - Breda Kirwan
- Galway Diabetes Research CentreNational University of Ireland, Galway, Ireland
| | | | | | | | - Brian E McGuire
- School of PsychologyNational University of Ireland, Galway, Ireland
| | | | - P M O'Shea
- Department of Clinical BiochemistryUniversity Hospital Galway, Galway, Ireland
| | - F P Dunne
- Galway Diabetes Research CentreNational University of Ireland, Galway, Ireland
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Yuan X, Liu H, Wang L, Zhang S, Zhang C, Leng J, Dong L, Lv L, Lv F, Tian H, Qi L, Tuomilehto J, Hu G. Gestational hypertension and chronic hypertension on the risk of diabetes among gestational diabetes women. J Diabetes Complications 2016; 30:1269-74. [PMID: 27185731 PMCID: PMC5512696 DOI: 10.1016/j.jdiacomp.2016.04.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 04/15/2016] [Accepted: 04/30/2016] [Indexed: 01/03/2023]
Abstract
AIMS We aimed to examine the association of gestational hypertension and chronic hypertension at the inter-conception examination with type 2 diabetes risk among women with a history of gestational diabetes. METHODS We conducted a population-based study among 1261 women who had a history of gestational diabetes at 1-5years after delivery in Tianjin, China. Logistic regression or Cox regression was used to assess the associations of gestational hypertension and chronic hypertension at the inter-conception examination with pre-diabetes and type 2 diabetes risks. RESULTS Gestational diabetic women who had a history of gestational hypertension but did not use antihypertensive drugs during pregnancy had a 3.94-fold higher risk (95% CI: 1.94-8.02) of developing type 2 diabetes compared with those who were normotensive in index pregnancy. Compared with gestational diabetic women who had normal blood pressure at the inter-conception examination, hypertensive women at the inter-conception examination were 3.38 times (95% CI: 1.66-6.87) and 2.97 times (95% CI: 1.75-5.05) more likely to develop diabetes and prediabetes, respectively. The odds ratios of type 2 diabetes and prediabetes associated with each 5mmHg increase in systolic blood pressure were 1.25 (95% CI: 1.03-1.51) and 1.20 (95% CI: 1.06-1.35). Each 5mmHg increase in diastolic blood pressure contributed to a 1.49-fold higher risk (95% CI: 1.18-1.88) for type 2 diabetes and a 1.42-fold higher risk (95% CI: 1.22-1.65) for prediabetes. CONCLUSIONS For women with prior gestational diabetes, gestational hypertension and chronic hypertension at the inter-conception examination were risk factors for type 2 diabetes.
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Affiliation(s)
- Xiaojing Yuan
- Pennington Biomedical Research Center, Baton Rouge, LA
| | - Huikun Liu
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - Leishen Wang
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - Shuang Zhang
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - Cuiping Zhang
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - Junhong Leng
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - Ling Dong
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - Li Lv
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - Fengjun Lv
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - Huiguang Tian
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - Lu Qi
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA; Department of Nutrition, Harvard School of Public Health, Boston, MA, USA
| | - Jaakko Tuomilehto
- Department of Public Health, University of Helsinki, Helsinki, Finland; Centre for Vascular Prevention, Danube-University Krems, Krems, Austria; Diabetes Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland; Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia; Dasman Diabetes Institute, Dasman, Kuwait
| | - Gang Hu
- Pennington Biomedical Research Center, Baton Rouge, LA.
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Model for individual prediction of diabetes up to 5 years after gestational diabetes mellitus. SPRINGERPLUS 2016; 5:318. [PMID: 27065426 PMCID: PMC4788663 DOI: 10.1186/s40064-016-1953-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 02/29/2016] [Indexed: 01/21/2023]
Abstract
Aims To identify predictors of diabetes development up to 5 years after gestational diabetes mellitus (GDM) and to develop a prediction model for individual use. Methods Five years after GDM, a 75-g oral glucose tolerance test (OGTT) was performed in 362 women, excluding women already diagnosed with diabetes at 1- to 2-year follow-up or later (n = 45). All but 21 women had results from follow-up at 1–2 years, while 84 women were lost from that point. Predictive variables were identified by logistic regression analysis. Results Five years after GDM, 28/362 women (8 %) were diagnosed with diabetes whereas 187/362 (52 %) had normal glucose tolerance (NGT). Of the latter, 139/187 (74 %) also had NGT at 1- to 2-year follow-up. In simple regression analysis, using NGT at 1–2 years and at 5 years as the reference, diabetes at 1- to 2-year follow-up or later was clearly associated with easily assessable clinical variables, such as BMI at 1- to 2-year follow-up, 2-h OGTT glucose concentration during pregnancy, and non-European origin (P < 0.0001). A prediction model based on these variables resulting in 86 % correct classifications, with an area under the receiver-operating characteristic curve of 0.91 (95 % CI 0.86–0.95), was applied in a function-sheet line diagram illustrating the individual effect of weight on diabetes risk. Conclusions The results highlight the importance of BMI as a potentially modifiable risk factor for diabetes after GDM. Our proposed prediction model performed well, and should encourage validation in other populations in future studies.
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Liu H, Zhang S, Wang L, Leng J, Li W, Li N, Li M, Qiao Y, Tian H, Tuomilehto J, Yang X, Yu Z, Hu G. Fasting and 2-hour plasma glucose, and HbA1c in pregnancy and the postpartum risk of diabetes among Chinese women with gestational diabetes. Diabetes Res Clin Pract 2016; 112:30-36. [PMID: 26686048 PMCID: PMC4753114 DOI: 10.1016/j.diabres.2015.11.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 10/26/2015] [Accepted: 11/18/2015] [Indexed: 01/11/2023]
Abstract
AIMS Very few studies have assessed the association of fasting and 2h glucose, and HbA1c during pregnancy with postpartum diabetes risk among women with prior gestational diabetes mellitus (GDM). We assessed the association of fasting glucose, 2h glucose and HbA1c at 26-30 gestational weeks with postpartum diabetes risk among women with prior GDM. METHODS A cohort study in 1263 GDM women at 1-5 years after delivery was performed. Cox proportional hazards regression models were used to evaluate the association of fasting and 2h plasma glucose, and HbA1c at 26-30 gestational weeks with the risk of diabetes at postpartum. RESULTS The multivariable-adjusted (age, pre-pregnancy body mass index, weight gain during pregnancy, current body mass index, family history of diabetes, marital status, education, family income, smoking status, passive smoking, leisure-time physical activity, alcohol drinking, and intake of energy, saturated fat, and dietary fiber) hazard ratios of postpartum diabetes were 1.61 (95% confidence interval [CI]: 1.36-1.91) for each 1 mmol/l increase in fasting glucose during pregnancy, 1.63 (95% CI: 1.45-1.84) for each 1 mmol/l increase in 2h glucose during pregnancy, 2.11 (95% CI: 1.50-2.97) for each 1 unit (%) increase in HbA1c during pregnancy. When fasting glucose, 2h glucose and HbA1c during pregnancy were entered multivariable-adjusted model simultaneously, 2h glucose and HbA1c but not fasting glucose remained to be significant and positive predictors for postpartum diabetes. CONCLUSIONS For women with prior GDM, 2h plasma glucose and HbA1c during pregnancy are independent predictors of postpartum diabetes, but fasting plasma glucose during pregnancy is not.
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Affiliation(s)
- Huikun Liu
- Tianjin Women's and Children's Health Center, 96 Guizhou Road, Heping District, Tianjin 300070, China
| | - Shuang Zhang
- Tianjin Women's and Children's Health Center, 96 Guizhou Road, Heping District, Tianjin 300070, China
| | - Leishen Wang
- Tianjin Women's and Children's Health Center, 96 Guizhou Road, Heping District, Tianjin 300070, China
| | - Junhong Leng
- Tianjin Women's and Children's Health Center, 96 Guizhou Road, Heping District, Tianjin 300070, China
| | - Weiqin Li
- Tianjin Women's and Children's Health Center, 96 Guizhou Road, Heping District, Tianjin 300070, China
| | - Nan Li
- Tianjin Women's and Children's Health Center, 96 Guizhou Road, Heping District, Tianjin 300070, China
| | - Min Li
- Tianjin Women's and Children's Health Center, 96 Guizhou Road, Heping District, Tianjin 300070, China
| | - Yijuan Qiao
- Tianjin Women's and Children's Health Center, 96 Guizhou Road, Heping District, Tianjin 300070, China
| | - Huiguang Tian
- Tianjin Women's and Children's Health Center, 96 Guizhou Road, Heping District, Tianjin 300070, China
| | - Jaakko Tuomilehto
- Department of Public Health, University of Helsinki, Helsinki, Finland; Centre for Vascular Prevention, Danube-University Krems, 3500 Krems, Austria; Department of Chronic Disease Prevention, National Institute for Health and Welfare, 00271 Helsinki, Finland; Diabetes Research Group, King Abdulaziz University, 21589 Jeddah, Saudi Arabia
| | - Xilin Yang
- Department of Epidemiology and Biostatistics, Tianjin Medical University, 22 Qixiangtai Road, Heping district, Tianjin 300070, China
| | - Zhijie Yu
- Population Cancer Research program, Dalhousie University, 6299 South Street, Halifax, NS, Canada B3H 4R2
| | - Gang Hu
- Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA 70808, USA.
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Wang T, Leng J, Li N, Martins de Carvalho A, Huang T, Zheng Y, Li W, Liu H, Wang L, Hu G, Qi L. Genetic Predisposition to Polycystic Ovary Syndrome, Postpartum Weight Reduction, and Glycemic Changes: A Longitudinal Study in Women With Prior Gestational Diabetes. J Clin Endocrinol Metab 2015; 100:E1560-7. [PMID: 26431507 PMCID: PMC4667164 DOI: 10.1210/jc.2015-2664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Polycystic ovary syndrome (PCOS) is a common condition in reproductive-aged women and a major female-specific risk factor of obesity, impaired glucose tolerance, and diabetes. OBJECTIVE We examined whether the genetic variation predisposing to PCOS affected glycemic changes in women with prior gestational diabetes mellitus (GDM) and whether such an effect was modified by changes in body adiposity, especially during and after pregnancy. DESIGN, SETTING, AND PARTICIPANTS This is a longitudinal study in Tianjin, China. We genotyped 7 genome-wide association study-identified PCOS single nucleotide polymorphisms and assessed gestational weight gain and changes in glycemic traits and weight at 1 to 5 years postpartum in 1133 women with prior GDM. MAIN OUTCOME MEASURES The main outcome measure was postpartum glycemic changes. RESULTS The PCOS genetic risk score significantly interacted with postpartum weight reduction on changes in fasting glucose and 2-h glucose (P for interaction = .032 and .007; respectively) after multivariable adjustment. In women with postpartum weight reduction of ≥ 5 kg/y, the genetic risk score was associated with decreased fasting and 2-h glucose, whereas an opposite genetic effect was found in women who lost less weight. The association between postpartum weight reduction and glycemic improvement was more significant among women with a higher genetic risk score. CONCLUSIONS In a large cohort of Chinese women with a history of GDM, our data for the first time indicate that the genetic predisposition to PCOS may interact with postpartum weight reduction on long-term glycemic changes, emphasizing the importance of postpartum weight management in prevention of diabetes in this subgroup of women.
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Affiliation(s)
- Tiange Wang
- Department of Epidemiology (T.W., T.H., L.Q.), School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana 70112; Department of Nutrition (T.W., A.M.d.C., T.H., Y.Z., L.Q.), Harvard T. H. Chan School of Public Health, Boston, Massachusetts 02115; Shanghai Clinical Center for Endocrine and Metabolic Diseases (T.W.), Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; Tianjin Women's and Children's Health Center (J.L., N.L., W.L., H.L., L.W.), Tianjin 300000, China; and Pennington Biomedical Research Center (G.H.), Baton Rouge, Louisiana 70808
| | - Junhong Leng
- Department of Epidemiology (T.W., T.H., L.Q.), School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana 70112; Department of Nutrition (T.W., A.M.d.C., T.H., Y.Z., L.Q.), Harvard T. H. Chan School of Public Health, Boston, Massachusetts 02115; Shanghai Clinical Center for Endocrine and Metabolic Diseases (T.W.), Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; Tianjin Women's and Children's Health Center (J.L., N.L., W.L., H.L., L.W.), Tianjin 300000, China; and Pennington Biomedical Research Center (G.H.), Baton Rouge, Louisiana 70808
| | - Nan Li
- Department of Epidemiology (T.W., T.H., L.Q.), School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana 70112; Department of Nutrition (T.W., A.M.d.C., T.H., Y.Z., L.Q.), Harvard T. H. Chan School of Public Health, Boston, Massachusetts 02115; Shanghai Clinical Center for Endocrine and Metabolic Diseases (T.W.), Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; Tianjin Women's and Children's Health Center (J.L., N.L., W.L., H.L., L.W.), Tianjin 300000, China; and Pennington Biomedical Research Center (G.H.), Baton Rouge, Louisiana 70808
| | - Aline Martins de Carvalho
- Department of Epidemiology (T.W., T.H., L.Q.), School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana 70112; Department of Nutrition (T.W., A.M.d.C., T.H., Y.Z., L.Q.), Harvard T. H. Chan School of Public Health, Boston, Massachusetts 02115; Shanghai Clinical Center for Endocrine and Metabolic Diseases (T.W.), Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; Tianjin Women's and Children's Health Center (J.L., N.L., W.L., H.L., L.W.), Tianjin 300000, China; and Pennington Biomedical Research Center (G.H.), Baton Rouge, Louisiana 70808
| | - Tao Huang
- Department of Epidemiology (T.W., T.H., L.Q.), School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana 70112; Department of Nutrition (T.W., A.M.d.C., T.H., Y.Z., L.Q.), Harvard T. H. Chan School of Public Health, Boston, Massachusetts 02115; Shanghai Clinical Center for Endocrine and Metabolic Diseases (T.W.), Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; Tianjin Women's and Children's Health Center (J.L., N.L., W.L., H.L., L.W.), Tianjin 300000, China; and Pennington Biomedical Research Center (G.H.), Baton Rouge, Louisiana 70808
| | - Yan Zheng
- Department of Epidemiology (T.W., T.H., L.Q.), School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana 70112; Department of Nutrition (T.W., A.M.d.C., T.H., Y.Z., L.Q.), Harvard T. H. Chan School of Public Health, Boston, Massachusetts 02115; Shanghai Clinical Center for Endocrine and Metabolic Diseases (T.W.), Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; Tianjin Women's and Children's Health Center (J.L., N.L., W.L., H.L., L.W.), Tianjin 300000, China; and Pennington Biomedical Research Center (G.H.), Baton Rouge, Louisiana 70808
| | - Weiqin Li
- Department of Epidemiology (T.W., T.H., L.Q.), School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana 70112; Department of Nutrition (T.W., A.M.d.C., T.H., Y.Z., L.Q.), Harvard T. H. Chan School of Public Health, Boston, Massachusetts 02115; Shanghai Clinical Center for Endocrine and Metabolic Diseases (T.W.), Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; Tianjin Women's and Children's Health Center (J.L., N.L., W.L., H.L., L.W.), Tianjin 300000, China; and Pennington Biomedical Research Center (G.H.), Baton Rouge, Louisiana 70808
| | - Huikun Liu
- Department of Epidemiology (T.W., T.H., L.Q.), School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana 70112; Department of Nutrition (T.W., A.M.d.C., T.H., Y.Z., L.Q.), Harvard T. H. Chan School of Public Health, Boston, Massachusetts 02115; Shanghai Clinical Center for Endocrine and Metabolic Diseases (T.W.), Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; Tianjin Women's and Children's Health Center (J.L., N.L., W.L., H.L., L.W.), Tianjin 300000, China; and Pennington Biomedical Research Center (G.H.), Baton Rouge, Louisiana 70808
| | - Leishen Wang
- Department of Epidemiology (T.W., T.H., L.Q.), School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana 70112; Department of Nutrition (T.W., A.M.d.C., T.H., Y.Z., L.Q.), Harvard T. H. Chan School of Public Health, Boston, Massachusetts 02115; Shanghai Clinical Center for Endocrine and Metabolic Diseases (T.W.), Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; Tianjin Women's and Children's Health Center (J.L., N.L., W.L., H.L., L.W.), Tianjin 300000, China; and Pennington Biomedical Research Center (G.H.), Baton Rouge, Louisiana 70808
| | - Gang Hu
- Department of Epidemiology (T.W., T.H., L.Q.), School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana 70112; Department of Nutrition (T.W., A.M.d.C., T.H., Y.Z., L.Q.), Harvard T. H. Chan School of Public Health, Boston, Massachusetts 02115; Shanghai Clinical Center for Endocrine and Metabolic Diseases (T.W.), Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; Tianjin Women's and Children's Health Center (J.L., N.L., W.L., H.L., L.W.), Tianjin 300000, China; and Pennington Biomedical Research Center (G.H.), Baton Rouge, Louisiana 70808
| | - Lu Qi
- Department of Epidemiology (T.W., T.H., L.Q.), School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana 70112; Department of Nutrition (T.W., A.M.d.C., T.H., Y.Z., L.Q.), Harvard T. H. Chan School of Public Health, Boston, Massachusetts 02115; Shanghai Clinical Center for Endocrine and Metabolic Diseases (T.W.), Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; Tianjin Women's and Children's Health Center (J.L., N.L., W.L., H.L., L.W.), Tianjin 300000, China; and Pennington Biomedical Research Center (G.H.), Baton Rouge, Louisiana 70808
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Li W, Liu H, Qiao Y, Lv F, Zhang S, Wang L, Leng J, Liu H, Qi L, Tuomilehto J, Hu G. Metabolic syndrome of weight change from pre-pregnancy to 1-5 years post-partum among Chinese women with prior gestational diabetes. Diabet Med 2015; 32:1492-9. [PMID: 25962467 PMCID: PMC4615340 DOI: 10.1111/dme.12790] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/07/2015] [Indexed: 01/23/2023]
Abstract
AIMS Few studies have evaluated the effect of weight change from pre-pregnancy to post-partum with the risk of cardiometabolic diseases among women with a history of gestational diabetes mellitus. The aim of this study was to evaluate the association between weight change from pre-pregnancy to 1-5 years post-partum with metabolic syndrome among Chinese women with prior gestational diabetes mellitus. METHODS We performed a retrospective cohort study in 1263 women with gestational diabetes mellitus at 1-5 years post-partum. Participants were divided into four groups based on their weight change from pre-pregnancy to 1-5 years post-partum: loss of ≥ 3 kg, ± 3 kg, gain of 3-7 kg and gain of ≥7 kg. RESULTS The prevalence of metabolic syndrome was 12.1%, 16.2%, 26.0% and 44.3% among women with weight loss ≥ 3 kg, stable weight ( ± 3 kg), weight gain 3-7 kg and weight gain ≥ 7 kg from pre-pregnancy to post-partum, respectively. The positive association between weight change and metabolic syndrome was observed among women with pre-pregnancy normal weight (BMI < 24 kg/m(2)), overweight (BMI 24-27.9 kg/m(2)) and obesity (BMI ≥ 28 kg/m(2)). The prevalence of metabolic syndrome was almost similar among pre-pregnancy normal weight women with weight gain ≥ 7 kg, pre-pregnancy overweight women with stable weight ( ± 3 kg) and pre-pregnancy obese women with weight loss ≥ 3 kg from pre-pregnancy to post-partum (P = 0.62). CONCLUSIONS Women with gestational diabetes mellitus who had large weight gain from pre-pregnancy to post-partum were more likely to develop metabolic syndrome. Women who are pre-pregnancy overweight/obesity and also diagnosed as gestational diabetes mellitus during pregnancy need more weight control after delivery.
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Affiliation(s)
- W Li
- Tianjin Women's and Children's Health Center, Tianjin, China
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - H Liu
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - Y Qiao
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - F Lv
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - S Zhang
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - L Wang
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - J Leng
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - H Liu
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - L Qi
- Department of Nutrition, Harvard School of Public Health, Boston, MA, USA
| | - J Tuomilehto
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - G Hu
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
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Leng J, Li W, Zhang S, Liu H, Wang L, Liu G, Li N, Redman LM, Baccarelli AA, Hou L, Hu G. GDM Women's Pre-Pregnancy Overweight/Obesity and Gestational Weight Gain on Offspring Overweight Status. PLoS One 2015; 10:e0129536. [PMID: 26098307 PMCID: PMC4476720 DOI: 10.1371/journal.pone.0129536] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 05/11/2015] [Indexed: 01/22/2023] Open
Abstract
Objectives To examine the association of maternal pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) with anthropometry in the offspring of mothers with gestational diabetes mellitus (GDM). Methods We performed a retrospective cohort study in 1263 GDM mother-child pairs. General linear models and Logistic regression models were used to assess the single and joint associations of maternal pre-pregnancy BMI (normal weight, overweight, and obesity) and GWG (inadequate, adequate and excessive GWG) with anthropometry and overweight status in the offspring from birth to 1-5 years old. Results Maternal pre-pregnancy BMI and GWG were positively associated with birth weight for gestational age Z score and birth weight for length for gestational age Z score at birth, and weight for age Z score, length/height for age Z score, and weight for length/height Z score at of 1-5 years old offspring. Maternal pre-pregnancy overweight, obesity, and excessive GWG were associated with increased risks of large for gestational age [ORs 95% CIs = 1.87 (1.37-2.55), 2.98 (1.89-4.69), and 2.93 (2.07-4.13), respectively] and macrosomia [ORs 95% CIs = 2.06 (1.50-2.84), 2.89 (1.78-4.70), and 2.84 (1.98-4.06), respectively] at birth and childhood overweight at 1-5 years old [ORs 95% CIs = 1.26 (0.92-1.73), 1.96 (1.24-3.09), and 1.59 (1.15-2.21), respectively]. Conclusions Offspring born to GDM mothers with pre-pregnancy overweight/obesity or excessive GWG were associated with increased risks of large for gestational age and macrosomia at birth, and childhood overweight at 1-5 years old, compared with those born to GDM mothers with pre-pregnancy normal weight and adequate GWG.
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Affiliation(s)
- Junhong Leng
- Project Office, Tianjin Women’s and Children’s Health Center, Tianjin, China
| | - Weiqin Li
- Project Office, Tianjin Women’s and Children’s Health Center, Tianjin, China
- Chronic Disease Epidemiology Laboratory, Pennington Biomedical Research Center, Baton Rouge, Louisiana, United States of America
| | - Shuang Zhang
- Project Office, Tianjin Women’s and Children’s Health Center, Tianjin, China
| | - Huikun Liu
- Project Office, Tianjin Women’s and Children’s Health Center, Tianjin, China
| | - Leishen Wang
- Project Office, Tianjin Women’s and Children’s Health Center, Tianjin, China
| | - Gongshu Liu
- Project Office, Tianjin Women’s and Children’s Health Center, Tianjin, China
| | - Nan Li
- Project Office, Tianjin Women’s and Children’s Health Center, Tianjin, China
| | - Leanne M. Redman
- Chronic Disease Epidemiology Laboratory, Pennington Biomedical Research Center, Baton Rouge, Louisiana, United States of America
| | - Andrea A. Baccarelli
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, United States of America
- Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Lifang Hou
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Gang Hu
- Chronic Disease Epidemiology Laboratory, Pennington Biomedical Research Center, Baton Rouge, Louisiana, United States of America
- * E-mail:
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Noctor E, Dunne FP. Type 2 diabetes after gestational diabetes: The influence of changing diagnostic criteria. World J Diabetes 2015; 6:234-244. [PMID: 25789105 PMCID: PMC4360417 DOI: 10.4239/wjd.v6.i2.234] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 11/17/2014] [Accepted: 12/17/2014] [Indexed: 02/05/2023] Open
Abstract
A previous diagnosis of gestational diabetes (GDM) carries a lifetime risk of progression to type 2 diabetes of up to 60%. Identification of those women at higher risk of progression to diabetes allows the timely introduction of measures to delay or prevent diabetes onset. However, there is a large degree of variability in the literature with regard to the proportion of women with a history of GDM who go on to develop diabetes. Heterogeneity between cohorts with regard to diagnostic criteria used, duration of follow-up, and the characteristics of the study population limit the ability to make meaningful comparisons across studies. As the new International Association for Diabetes in Pregnancy Study Group criteria are increasingly adopted worldwide, the prevalence of GDM is set to increase by two-to three-fold. Here, we review the literature to examine the evolution of diagnostic criteria for GDM, the implications of changing criteria on the proportion of women with previous GDM progressing to diabetes, and how the use of different diagnostic criteria may influence the development of appropriate follow-up strategies.
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Peng S, Zhang J, Liu L, Zhang X, Huang Q, Alamdar A, Tian M, Shen H. Newborn Meconium and Urinary Metabolome Response to Maternal Gestational Diabetes Mellitus: A Preliminary Case–Control Study. J Proteome Res 2015; 14:1799-809. [DOI: 10.1021/pr5011857] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Siyuan Peng
- Key
Lab of Urban Environment and Health, Institute of Urban Environment, Chinese Academy of Sciences, Xiamen 361021, P.R. China
| | - Jie Zhang
- Key
Lab of Urban Environment and Health, Institute of Urban Environment, Chinese Academy of Sciences, Xiamen 361021, P.R. China
| | - Liangpo Liu
- Key
Lab of Urban Environment and Health, Institute of Urban Environment, Chinese Academy of Sciences, Xiamen 361021, P.R. China
| | - Xueqin Zhang
- Xiamen Maternity and Child Health Care Hospital, Xiamen 361003, P.R. China
| | - Qingyu Huang
- Key
Lab of Urban Environment and Health, Institute of Urban Environment, Chinese Academy of Sciences, Xiamen 361021, P.R. China
| | - Ambreen Alamdar
- Key
Lab of Urban Environment and Health, Institute of Urban Environment, Chinese Academy of Sciences, Xiamen 361021, P.R. China
| | - Meiping Tian
- Key
Lab of Urban Environment and Health, Institute of Urban Environment, Chinese Academy of Sciences, Xiamen 361021, P.R. China
| | - Heqing Shen
- Key
Lab of Urban Environment and Health, Institute of Urban Environment, Chinese Academy of Sciences, Xiamen 361021, P.R. China
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Maternal glucose during pregnancy and after delivery in women with gestational diabetes mellitus on overweight status of their children. BIOMED RESEARCH INTERNATIONAL 2015; 2015:543038. [PMID: 25802854 PMCID: PMC4352735 DOI: 10.1155/2015/543038] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 11/21/2014] [Accepted: 12/05/2014] [Indexed: 02/07/2023]
Abstract
Objective. To examine the association of maternal glycemia during pregnancy and after delivery with anthropometry in the offspring of mothers with gestational diabetes mellitus (GDM). Methods. A total of 1,263 GDM mothers and their children finished the health survey at 1–5 years after delivery. Results. Offspring of GDM mothers who were diagnosed with diabetes during pregnancy had higher prevalence of overweight, higher mean weight for height Z scores, and higher mean BMI for age Z scores at 1–5 years old than the offspring of GDM mothers who were diagnosed with impaired glucose tolerance (IGT) during pregnancy. Offspring of GDM mothers who developed diabetes 1–5 years after delivery had higher mean values of Z scores for weight for height and BMI for age at 1–5 years old than the offspring of GDM mothers who had normal glucose or prediabetes after delivery. Conclusions. Offspring of GDM mothers who were diagnosed with diabetes during pregnancy or after delivery had an increased risk of childhood overweight or weight gain at 1–5 years old compared with children of GDM mothers with IGT during pregnancy or with normal glucose or prediabetes after delivery.
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