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Lowe WL. Genetics and Epigenetics: Implications for the Life Course of Gestational Diabetes. Int J Mol Sci 2023; 24:6047. [PMID: 37047019 PMCID: PMC10094577 DOI: 10.3390/ijms24076047] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/19/2023] [Accepted: 03/21/2023] [Indexed: 04/14/2023] Open
Abstract
Gestational diabetes (GDM) is one of the most common complications of pregnancy, affecting as many as one in six pregnancies. It is associated with both short- and long-term adverse outcomes for the mother and fetus and has important implications for the life course of affected women. Advances in genetics and epigenetics have not only provided new insight into the pathophysiology of GDM but have also provided new approaches to identify women at high risk for progression to postpartum cardiometabolic disease. GDM and type 2 diabetes share similarities in their pathophysiology, suggesting that they also share similarities in their genetic architecture. Candidate gene and genome-wide association studies have identified susceptibility genes that are shared between GDM and type 2 diabetes. Despite these similarities, a much greater effect size for MTNR1B in GDM compared to type 2 diabetes and association of HKDC1, which encodes a hexokinase, with GDM but not type 2 diabetes suggest some differences in the genetic architecture of GDM. Genetic risk scores have shown some efficacy in identifying women with a history of GDM who will progress to type 2 diabetes. The association of epigenetic changes, including DNA methylation and circulating microRNAs, with GDM has also been examined. Targeted and epigenome-wide approaches have been used to identify DNA methylation in circulating blood cells collected during early, mid-, and late pregnancy that is associated with GDM. DNA methylation in early pregnancy had some ability to identify women who progressed to GDM, while DNA methylation in blood collected at 26-30 weeks gestation improved upon the ability of clinical factors alone to identify women at risk for progression to abnormal glucose tolerance post-partum. Finally, circulating microRNAs and long non-coding RNAs that are present in early or mid-pregnancy and associated with GDM have been identified. MicroRNAs have also proven efficacious in predicting both the development of GDM as well as its long-term cardiometabolic complications. Studies performed to date have demonstrated the potential for genetic and epigenetic technologies to impact clinical care, although much remains to be done.
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Affiliation(s)
- William L Lowe
- Department of Medicine, Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, Rubloff 12, 420 E. Superior Street, Chicago, IL 60611, USA
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He J, Hu K, Xing C, Wang B, Zeng T, Wang H. Puerperium experience and lifestyle in women with gestational diabetes mellitus and overweight/obesity in China: A qualitative study. Front Psychol 2023; 14:1043319. [PMID: 37008861 PMCID: PMC10050588 DOI: 10.3389/fpsyg.2023.1043319] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 02/27/2023] [Indexed: 03/17/2023] Open
Abstract
IntroductionWomen with overweight or obesity and gestational diabetes mellitus (GDM) are at a high risk of developing type 2 diabetes mellitus (T2DM) and other metabolic diseases. Healthy postpartum lifestyles in women with GDM are important for effectively preventing early T2DM occurrence; however, few studies and guidelines focus in China on this issue.AimsThis qualitative study aimed to understand the puerperium experience and lifestyle of women with overweight/obesity and GDM.MethodsA face-to-face, in-depth, and semi-structured interview was conducted using a hermeneutical phenomenology method to collect data that were analyzed through thematic analysis.ResultsOut of 61 recruited women with overweight/obesity and history of GDM, 14 women underwent an interview and provided detailed descriptions of their lifestyle experiences during puerperium. The interview data were used to generate four themes—puerperium dietary behavior, weight perception and “confinement” behavior, family support, disease knowledge, and perceived risk—and nine sub-themes.ConclusionUnhealthy lifestyles, misconceptions about food, the conflict between physical activity and confinement behavior, a lack of social and family support, and low awareness of disease risk are all common among overweight/obese women with a history of GDM. Thus, we emphasized that healthcare providers should provide continuous preventive care from pregnancy to postpartum and promote long-term health in high-risk populations with a history of GDM associated with overweight/obesity.
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Affiliation(s)
- Jing He
- Department of Nursing, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
- School of Nursing, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Kaili Hu
- Department of Nursing, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Cui Xing
- Department of Nursing, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Binghua Wang
- Department of Nursing, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Tieying Zeng
- Department of Nursing, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Hui Wang
- Department of Nursing, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Hui Wang,
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Kragelund Nielsen K, Davidsen E, Husted Henriksen A, Andersen GS. Gestational Diabetes and International Migration. J Endocr Soc 2022; 7:bvac160. [DOI: 10.1210/jendso/bvac160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Indexed: 11/18/2022] Open
Abstract
Abstract
In many countries, immigrant women constitute a substantial proportion of women giving birth. With gestational diabetes being one of the most common complications in pregnancy, understanding gestational diabetes in the context of international migration becomes increasingly relevant. Here, we examine the current evidence related to international migration and gestational diabetes, including short- and long-term adverse outcomes and the experiences of immigrant women with gestational diabetes care and long-term follow-up. Existing evidence focuses on immigrants in high-income countries, and has mainly examined differences in the risk of developing gestational diabetes, or on the experiences of immigrant women diagnosed with gestational diabetes. Studies suggest that the risk of gestational diabetes may be influenced by migration and that immigrant women likely experience particular barriers to care and follow-up. Current research on perinatal outcomes is inconclusive and studies on long-term outcomes are practically absent. Future research should include data on country of origin and examine the role of premigration and postmigration factors in developing gestational diabetes and its associated short- and long-term outcomes. Understanding these factors will provide useful insights into improving the health and health care needs of migrating populations and enable inclusion of culturally appropriate health care practices, thereby improving the health of our current and future generations.
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Affiliation(s)
| | - Emma Davidsen
- Health Promotion Research, Steno Diabetes Center Copenhagen , 2730 Herlev , Denmark
| | | | - Gregers S Andersen
- Clinical Research, Steno Diabetes Center Copenhagen , 2730 Herlev , Denmark
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Liu Y, Kuang A, Bain JR, Muehlbauer MJ, Ilkayeva OR, Lowe LP, Metzger BE, Newgard CB, Scholtens DM, Lowe WL. Maternal Metabolites Associated With Gestational Diabetes Mellitus and a Postpartum Disorder of Glucose Metabolism. J Clin Endocrinol Metab 2021; 106:3283-3294. [PMID: 34255031 PMCID: PMC8677596 DOI: 10.1210/clinem/dgab513] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Indexed: 12/15/2022]
Abstract
CONTEXT Gestational diabetes is associated with a long-term risk of developing a disorder of glucose metabolism. However, neither the metabolic changes characteristic of gestational diabetes in a large, multi-ancestry cohort nor the ability of metabolic changes during pregnancy, beyond glucose levels, to identify women at high risk for progression to a disorder of glucose metabolism has been examined. OBJECTIVE This work aims to identify circulating metabolites present at approximately 28 weeks' gestation associated with gestational diabetes mellitus (GDM) and development of a disorder of glucose metabolism 10 to 14 years later. METHODS Conventional clinical and targeted metabolomics analyses were performed on fasting and 1-hour serum samples following a 75-g glucose load at approximately 28 weeks' gestation from 2290 women who participated in the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study. Postpartum metabolic traits included fasting and 2-hour plasma glucose following a 75-g glucose load, insulin resistance estimated by the homeostasis model assessment of insulin resistance, and disorders of glucose metabolism (prediabetes and type 2 diabetes) during the HAPO Follow-Up Study. RESULTS Per-metabolite analyses identified numerous metabolites, ranging from amino acids and carbohydrates to fatty acids and lipids, before and 1-hour after a glucose load that were associated with GDM as well as development of a disorder of glucose metabolism and metabolic traits 10 to 14 years post partum. A core group of fasting and 1-hour metabolites mediated, in part, the relationship between GDM and postpartum disorders of glucose metabolism, with the fasting and 1-hour metabolites accounting for 15.7% (7.1%-30.8%) and 35.4% (14.3%-101.0%) of the total effect size, respectively. For prediction of a postpartum disorder of glucose metabolism, the addition of circulating fasting or 1-hour metabolites at approximately 28 weeks' gestation showed little improvement in prediction performance compared to clinical factors alone. CONCLUSION The results demonstrate an association of multiple metabolites with GDM and postpartum metabolic traits and begin to define the underlying pathophysiology of the transition from GDM to a postpartum disorder of glucose metabolism.
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Affiliation(s)
- Yu Liu
- Department of Endocrinology and Metabolism, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, P. R. China
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA
| | - Alan Kuang
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA
| | - James R Bain
- Sarah W. Stedman Nutrition and Metabolism Center, Duke University School of Medicine, Durham, North Carolina 27705, USA
- Duke Molecular Physiology Institute, Durham, North Carolina 27701, USA
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina 27707, USA
| | - Michael J Muehlbauer
- Sarah W. Stedman Nutrition and Metabolism Center, Duke University School of Medicine, Durham, North Carolina 27705, USA
- Duke Molecular Physiology Institute, Durham, North Carolina 27701, USA
| | - Olga R Ilkayeva
- Sarah W. Stedman Nutrition and Metabolism Center, Duke University School of Medicine, Durham, North Carolina 27705, USA
- Duke Molecular Physiology Institute, Durham, North Carolina 27701, USA
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina 27707, USA
| | - Lynn P Lowe
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA
| | - Boyd E Metzger
- Department of Endocrinology and Metabolism, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, P. R. China
| | - Christopher B Newgard
- Sarah W. Stedman Nutrition and Metabolism Center, Duke University School of Medicine, Durham, North Carolina 27705, USA
- Duke Molecular Physiology Institute, Durham, North Carolina 27701, USA
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina 27707, USA
| | - Denise M Scholtens
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA
| | - William L Lowe
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA
- Correspondence: William L. Lowe Jr, MD, Department of Medicine, Northwestern University Feinberg School of Medicine, Rubloff 12, 420 E Superior St, Chicago, IL 60611, USA.
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Postpartum dietary and physical activity-related beliefs and behaviors among women with recent gestational diabetes mellitus: a qualitative study from Singapore. BMC Pregnancy Childbirth 2021; 21:612. [PMID: 34493247 PMCID: PMC8424799 DOI: 10.1186/s12884-021-04089-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 08/29/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND A woman with a history of GDM has at least seven-fold increased lifetime risk of developing type 2 diabetes mellitus (T2DM), compared to women who have normoglycemic pregnancies. Postpartum lifestyle modification has been shown to reduce postpartum weight retention and prevent the progression to T2DM. The aim of this study was to explore the postpartum dietary and physical activity-related beliefs and behaviors among women in Singapore who had GDM in their most recent pregnancies. METHODS Semi-structured in-depth interviews were conducted with 14 women, who were up to four months postpartum and had GDM in their most recent pregnancies. Interview data were analyzed using thematic analysis. RESULTS Three themes were identified in the analysis: (1) risk perception and knowledge regarding future diabetes, (2) suboptimal diet and physical activity after delivery and (3) factors influencing the postpartum lifestyle. CONCLUSIONS The study findings provided useful information on the postpartum lifestyle beliefs and behaviors among women with a history of GDM. Most participants had low risk perception of future diabetes and their diet and physical activity after delivery were suboptimal due to various influences. These insights can be used to design tailored materials and programs to support women who have had GDM reduce their risk of developing future T2DM.
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Bastidas K, Romero XC, Uriel M, De la Hoz JA. Perinatal outcomes associated with the diagnosis of gestational diabetes: Systematic review and meta-analysis. Diabetes Metab Syndr 2021; 15:102262. [PMID: 34509793 DOI: 10.1016/j.dsx.2021.102262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 08/18/2021] [Accepted: 08/24/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To compare perinatal outcomes in pregnant women diagnosed with gestational diabetes using the one-step and the two-step test. METHODS Meta-analysis of observational studies pregnancies women with gestational diabetes from January 2014 to February 2019. The outcomes studied were induction of labor and delivery, preterm delivery, fetal macrosomia, neonatal hypoglycemia, hyperbilirubinemia, low birth weight, and admission to the neonatal intensive care unit. RESULTS Eight studies were included with a population of 108,609 pregnancies. Statistical differences were obtained for fetal macrosomia RR0.9 (95%CI0.85-0.97; I20%) and neonatal hypoglycemia RR1.1 (95%CI1.01-1.40; I248.5%). CONCLUSION Neonatal macrosomia appears to be less present when the one-step diagnostic test is used and neonatal hypoglycemia was lower with the two-step test. Register PROSPERO CRD42020215062.
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Affiliation(s)
- Karina Bastidas
- Maternal Fetal Medicine Fellowship. El Bosque University. El Bosque Research Group of Maternal Fetal Medicine and Gynecology, Bogotá, Colombia
| | - Ximena C Romero
- El Bosque Research Group of Maternal Fetal Medicine and Gynecology. El Bosque University, Bogotá, Colombia; Ecodiagnóstico El Bosque S.A.S. Maternal Fetal Medicine Unit, Bogotá, Colombia.
| | - Montserrat Uriel
- El Bosque Research Group of Maternal Fetal Medicine and Gynecology. El Bosque University, Bogotá, Colombia; Ecodiagnóstico El Bosque S.A.S. Maternal Fetal Medicine Unit, Bogotá, Colombia
| | - José A De la Hoz
- Master's Degree in Epidemiology El Bosque University, Bogotá, Colombia
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Women's engagement with diabetes prevention activities and the influence of contact by the Australian national gestational diabetes register. PRACTICAL DIABETES 2021. [DOI: 10.1002/pdi.2336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Potzel AL, Gar C, Seissler J, Lechner A. A Smartphone App (TRIANGLE) to Change Cardiometabolic Risk Behaviors in Women Following Gestational Diabetes Mellitus: Intervention Mapping Approach. JMIR Mhealth Uhealth 2021; 9:e26163. [PMID: 33973864 PMCID: PMC8150415 DOI: 10.2196/26163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/11/2021] [Accepted: 03/19/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is the most common complication during pregnancy and is associated with an increased risk for the development of cardiometabolic diseases. Behavioral interventions can reduce this risk, but current solutions insufficiently address the requirements for such a program. The systematic development of a scalable mobile health (mHealth) promotion program for mothers during the first years post-GDM may contribute to solving this problem. OBJECTIVE The aim of this project was to systematically plan and develop a theory- and evidence-based mHealth intervention to change cardiometabolic risk behaviors in women during the first 5 years post-GDM that meets women's expected standards of commercial health apps. METHODS The intervention mapping steps 1 to 4 structured the systematic planning and development of the mHealth program described in this paper. Steps 1 and 2 led to a theory- and evidence-based logic model of change for cardiometabolic health. Based on this model, the prevention program was designed (step 3) and produced (step 4) in cooperation with industrial partners to ensure a high technological standard of the resulting smartphone app for the iPhone (Apple Inc). Step 4 included a user study with women during the first 5 years post-GDM once a beta version of the app ("TRIANGLE") was available. The user study comprised 2 test rounds of 1 week (n=5) and 4 weeks (n=6), respectively. The tests included validated questionnaires on user acceptance, user logs, and think-alouds with semistructured interviews. RESULTS The novel TRIANGLE app is among the first self-paced smartphone apps for individual habit change in the 3 lifestyle areas of physical activity, nutrition, and psychosocial well-being. The 3 core features-a challenge system, human coaching, and a library-address 11 behavioral determinants with 39 behavior change methods to support lifestyle changes. Participants in the user study showed a high acceptance, high perceived quality, and high perceived impact of the TRIANGLE app on their health behaviors. Participants tested the app regularly, used it intuitively, and suggested improvements. We then adapted the TRIANGLE app according to the insights from the user study before the full TRIANGLE program production. CONCLUSIONS The intervention mapping approach was feasible to plan and develop an innovative and scalable smartphone solution for women during the first 5 years post-GDM. The resulting TRIANGLE intervention has the potential to support behavior change for cardiometabolic disease prevention. However, the app needs further refinement and testing in clinical trials. Intervention mapping steps 5 (implementation plan) and 6 (evaluation plan) may support the integration of the TRIANGLE intervention into routine care. TRIAL REGISTRATION German Clinical Trials Register DRKS00012736; https://www.drks.de/DRKS00012736.
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Affiliation(s)
- Anne Lotte Potzel
- Diabetes Research Group, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany
- CCG Type 2 Diabetes, Helmholtz Zentrum München, Munich, Germany
- German Center for Diabetes Research, Neuherberg, Germany
| | - Christina Gar
- Diabetes Research Group, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany
- CCG Type 2 Diabetes, Helmholtz Zentrum München, Munich, Germany
- German Center for Diabetes Research, Neuherberg, Germany
| | - Jochen Seissler
- Diabetes Research Group, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany
- CCG Type 2 Diabetes, Helmholtz Zentrum München, Munich, Germany
- German Center for Diabetes Research, Neuherberg, Germany
| | - Andreas Lechner
- Diabetes Research Group, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany
- CCG Type 2 Diabetes, Helmholtz Zentrum München, Munich, Germany
- German Center for Diabetes Research, Neuherberg, Germany
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Read SH, Rosella LC, Berger H, Feig DS, Fleming K, Kaul P, Ray JG, Shah BR, Lipscombe LL. Diabetes after pregnancy: a study protocol for the derivation and validation of a risk prediction model for 5-year risk of diabetes following pregnancy. Diagn Progn Res 2021; 5:5. [PMID: 33678196 PMCID: PMC7938478 DOI: 10.1186/s41512-021-00095-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 02/08/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Pregnancy offers a unique opportunity to identify women at higher future risk of type 2 diabetes mellitus (DM). In pregnancy, a woman has greater engagement with the healthcare system, and certain conditions are more apt to manifest, such as gestational DM (GDM) that are important markers for future DM risk. This study protocol describes the development and validation of a risk prediction model (RPM) for estimating a woman's 5-year risk of developing type 2 DM after pregnancy. METHODS Data will be obtained from existing Ontario population-based administrative datasets. The derivation cohort will consist of all women who gave birth in Ontario, Canada between April 2006 and March 2014. Pre-specified predictors will include socio-demographic factors (age at delivery, ethnicity), maternal clinical factors (e.g., body mass index), pregnancy-related events (gestational DM, hypertensive disorders of pregnancy), and newborn factors (birthweight percentile). Incident type 2 DM will be identified by linkage to the Ontario Diabetes Database. Weibull accelerated failure time models will be developed to predict 5-year risk of type 2 DM. Measures of predictive accuracy (Nagelkerke's R2), discrimination (C-statistics), and calibration plots will be generated. Internal validation will be conducted using a bootstrapping approach in 500 samples with replacement, and an optimism-corrected C-statistic will be calculated. External validation of the RPM will be conducted by applying the model in a large population-based pregnancy cohort in Alberta, and estimating the above measures of model performance. The model will be re-calibrated by adjusting baseline hazards and coefficients where appropriate. DISCUSSION The derived RPM may help identify women at high risk of developing DM in a 5-year period after pregnancy, thus facilitate lifestyle changes for women at higher risk, as well as more frequent screening for type 2 DM after pregnancy.
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Affiliation(s)
- Stephanie H Read
- Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, Ontario, M5S 1B2, Canada.
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
- Evidence and Access, Certara, London, UK.
| | - Laura C Rosella
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
| | - Howard Berger
- Division of Maternal-Fetal Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Denice S Feig
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Sinai Health System, Toronto, Ontario, Canada
| | - Karen Fleming
- Department of Family and Community Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Padma Kaul
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Joel G Ray
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Obstetrics and Gynaecology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Baiju R Shah
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Division of Maternal-Fetal Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Lorraine L Lipscombe
- Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, Ontario, M5S 1B2, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Lim S, Chen M, Makama M, O'Reilly S. Preventing Type 2 Diabetes in Women with Previous Gestational Diabetes: Reviewing the Implementation Gaps for Health Behavior Change Programs. Semin Reprod Med 2021; 38:377-383. [PMID: 33511581 DOI: 10.1055/s-0040-1722315] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Gestational diabetes mellitus (GDM) places a woman at high risk of developing subsequent type 2 diabetes mellitus (T2DM), particularly in the first 5 years postpartum. Engaging women in health behavior change during this period is challenging and current diabetes prevention programs were developed for middle-aged adults, all of which have limited the evidence on successful implementation for this high-risk population. In this review, we will first summarize the effects of existing diabetes prevention programs in women with a history of GDM. Second, we suggest that the programs need to be modified according to the facilitators and barriers faced by this population. Third, we propose that improving program penetration, fidelity, and participation is critical for population-level success. Finally, we outline the research priorities to improve the implementation of diabetes prevention programs for postpartum women with a history of GDM.
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Affiliation(s)
- Siew Lim
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
| | - Mingling Chen
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
| | - Maureen Makama
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
| | - Sharleen O'Reilly
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
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Monk C, Webster RS, McNeil RB, Parker CB, Catov JM, Greenland P, Bairey-Merz CN, Silver RM, Simhan HN, Ehrenthal DB, Chung JH, Haas DM, Mercer BM, Parry S, Polito L, Reddy UM, Saade GR, Grobman WA. Associations of perceived prenatal stress and adverse pregnancy outcomes with perceived stress years after delivery. Arch Womens Ment Health 2020; 23:361-369. [PMID: 31256258 PMCID: PMC6935433 DOI: 10.1007/s00737-019-00970-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 04/22/2019] [Indexed: 02/07/2023]
Abstract
Maternal stress is a risk factor for adverse pregnancy outcomes (APOs). This study evaluates the associations of prenatal stress and APOs with maternal stress years after pregnancy. The 10-item Perceived Stress Scale (PSS) (0-40 range) was completed in the first and third trimesters, and 2-7 years after delivery among a subsample (n = 4161) of nulliparous women enrolled at eight US medical centers between 2010 and 2013 in a prospective, observational cohort study. Demographics, medical history, and presence of APOs (gestational diabetes (GDM), hypertensive disorders of pregnancy (HDP), preeclampsia (PE), and medically indicated or spontaneous preterm birth (miPTB, sPTB)) were obtained. The associations of prenatal PSS and the presence of APOs with PSS scores years after delivery were estimated using multivariable linear regression. Mean PSS scores were 12.5 (95% CI 12.3, 12.7) and 11.3 (95% CI 11.1, 11.5) in the first and third trimesters respectively and 14.9 (95% CI 14.7, 15.1) 2-7 years later, an average increase of 2.4 points (95% CI 2.2, 2.6) from the start of pregnancy. Regressing PSS scores after delivery on first-trimester PSS and PSS increase through pregnancy showed positive associations, with coefficients (95% CI) of 2.8 (2.7, 3.0) and 1.5 (1.3, 1.7) per 5-point change, respectively. Adding APO indicator variables separately showed higher PSS scores for women with HDP (0.7 [0.1, 1.3]), PE (1.3 [0.6, 2.1]), and miPTB (1.3 [0.2, 2.4]), but not those with GDM or sPTB. In this geographically and demographically diverse sample, prenatal stress and some APOs were positively associated with stress levels 2-7 years after pregnancy.ClinicalTrials.gov Registration number NCT02231398.
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Affiliation(s)
- Catherine Monk
- Departments of Psychiatry and Obstetrics and Gynecology, Columbia University, 630 West 168th Street, PH1540H, New York, NY, 10032, USA.
| | - Rachel S. Webster
- Columbia University Vagelos College of Physicians and
Surgeons, New York, New York
| | | | | | - Janet M. Catov
- Department of Obstetrics and Gynecology, University of
Pittsburgh, Pittsburgh, Pennsylvania
| | - Philip Greenland
- Division of Cardiology, Department of Medicine,
Northwestern University, Chicago, Illinois
| | - C. Noel Bairey-Merz
- Division of Cardiology, Department of Medicine,
Cedars-Sinai Medical Center, Los Angeles, California
| | - Robert M. Silver
- Department of Obstetrics and Gynecology, University of Utah
and Intermountain Healthcare, Salt Lake City, Utah
| | - Hyagriv N. Simhan
- Department of Obstetrics and Gynecology, University of
Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Judith H. Chung
- Department of Obstetrics and Gynecology, University of
California, Irvine, California
| | - David M. Haas
- Department of Obstetrics and Gynecology, School of
Medicine, Indiana University, Indianapolis, Indiana
| | - Brian M. Mercer
- Department of Obstetrics and Gynecology, Case Western
Reserve University, Cleveland, Ohio
| | - Samuel Parry
- Department of Obstetrics and Gynecology, University of
Pennsylvania, Philadelphia, Pennsylvania
| | - LuAnn Polito
- Department of Obstetrics and Gynecology, Case Western
Reserve University, Cleveland, Ohio
| | - Uma M. Reddy
- Eunice Kennedy Shriver National Institute of Child Health
and Human Development, Bethesda, Maryland
| | - George R. Saade
- Department of Obstetrics and Gynecology, University of
Texas Medical Branch, University of Texas, Galveston, Texas
| | - William A. Grobman
- Department of Obstetrics and Gynecology, Northwestern
University, Chicago, Illinois
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12
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Sutherland L, Neale D, Henderson J, Clark J, Levine D, Bennett WL. Provider Counseling About and Risk Perception for Future Chronic Disease Among Women with Gestational Diabetes and Preeclampsia. J Womens Health (Larchmt) 2020; 29:1168-1175. [PMID: 32471323 PMCID: PMC7520911 DOI: 10.1089/jwh.2019.7767] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background: Women diagnosed with gestational diabetes or preeclampsia are at a greater risk of developing future type 2 diabetes mellitus, high blood pressure, and cardiovascular disease. Increased perception of future chronic disease risk is positively associated with making health behavior changes, including in pregnant women. Although gestational diabetes is a risk factor for type 2 diabetes, few women have heightened risk perception. Little research has assessed receipt of health advice from a provider among women with preeclampsia and its association with risk perception regarding future risk of high blood pressure and cardiovascular disease. Among women with recent diagnoses of preeclampsia or gestational diabetes, we assessed associations between receipt of health advice from providers, psychosocial factors, and type of pregnancy complication with risk perception for future chronic illness. Methods: We conducted a cross-sectional analysis among 79 women diagnosed with preeclampsia and/or gestational diabetes using surveys and medical record abstraction after delivery and at 3 months postpartum. Results: Overall, fewer than half of the 79 women with preeclampsia and gestational diabetes reported receiving health advice from a provider, and women with preeclampsia were significantly less likely to receive counseling as compared with women with gestational diabetes (odds ratio 0.23). We did not identify a difference in the degree of risk perception by pregnancy complication or receipt of health advice. There were no significant differences in risk perception based on age, race, education, or health insurance coverage. Conclusions: We demonstrated that women with preeclampsia and gestational diabetes are not routinely receiving health advice from providers regarding future chronic disease risk, and that women with preeclampsia are less likely to be counseled on their risk, compared with women with gestational diabetes. Provider and patient-centered interventions are needed to improve postpartum care and counseling for women at high risk for chronic disease based on recent pregnancy complications.
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Affiliation(s)
- Lauren Sutherland
- Division of General Internal Medicine, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- The Welch Center for Prevention, Epidemiology, and Clinical Research, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Donna Neale
- Department of Gynecology and Obstetrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Janice Henderson
- Department of Gynecology and Obstetrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jeanne Clark
- Division of General Internal Medicine, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- The Welch Center for Prevention, Epidemiology, and Clinical Research, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - David Levine
- Division of General Internal Medicine, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Wendy L. Bennett
- Division of General Internal Medicine, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- The Welch Center for Prevention, Epidemiology, and Clinical Research, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Postpartum lifestyle modifications for women with gestational diabetes: A qualitative study. Eur J Obstet Gynecol Reprod Biol 2020; 252:105-111. [PMID: 32592917 DOI: 10.1016/j.ejogrb.2020.04.060] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 04/18/2020] [Accepted: 04/24/2020] [Indexed: 01/11/2023]
Abstract
The prevalence of gestational diabetes mellitus increased to 8% in France in 2012, and the risk of developing type 2 diabetes after receiving a gestational diabetes diagnosis increases 7-fold. Education delivered during pregnancy aims to reduce this risk by reminding women to maintain dietary and lifestyle modifications after delivery. OBJECTIVE The primary objective of this study was to describe and analyze the feelings and daily lifestyle changes, including physical activity and dietary changes, among women who experienced gestational diabetes and the roles played by their general practitioners during follow-up. STUDY DESIGN We conducted a qualitative study examining women's attitudes during the 6-12 months postpartum, after receiving a gestational diabetes diagnosis and associated education. All women participated in semi-structured, individual, telephone-based interviews. RESULTS Out of 47 patients contacted, we interviewed 16 women. All interviewed women modified their behaviors, at least slightly, and described changes that included more balanced diets and the incorporation of mild physical activity. Lack of time, lack of awareness regarding the long-term risk of developing type 2 diabetes, resistance to long-term dietary changes, and cultural habits were identified as the primary barriers to long-term lifestyle modifications, whereas family support was found to be beneficial. The reported interactions between each woman and her physician appeared to be weak. CONCLUSION Our study showed that educational attitudes and preventive interventions must be reinforced, especially during the long-term, and not only during the immediate postpartum period. Raising awareness among primary care physicians regarding the need to provide continuous education for this high-risk population appears to be necessary.
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Wang J, Smail-Crevier R, Nannarone M, Manuel D, MacQueen G, Patten SB, Lashewicz B, Schmitz N. The accuracy of depression risk perception in high risk Canadians. J Affect Disord 2020; 265:410-415. [PMID: 32090767 DOI: 10.1016/j.jad.2020.01.099] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 12/21/2019] [Accepted: 01/20/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Prevention and early detection of depression is a top public health priority. Accurate perception of depression risk may play an important role in health behavior change and prevention of depression. However, the way in which people in the community perceive their risk of developing depression is currently unknown. METHODS We analyzed the baseline data from a randomized controlled trial in 358 men and 356 women who are at high risk of having a major depressive episode (MDE). The predicted risk was assessed by sex-specific multivariable risk predictive algorithms for MDE. We compared participants' perceived risk and their predicted risk. Accurate risk perception was defined as perceived risk is in the range of predicted risk ± 10%. RESULTS In men, 29.7% perceived their risk accurately; 47.5% overestimated their risk; 22.8% underestimated their risk. In women, the proportions were 21.7%, 59.6% and 18.7%, respectively. Compared to men, women were more likely to overestimate their risk and less likely to be accurate. Regression modeling revealed that poor self-rated health and higher predicted depression risk were associated with inaccuracy of risk perception in men; a family history of MDE, higher psychological distress and lower predicted risk were associated with inaccuracy of risk perception in women. CONCLUSIONS Individuals who are at high risk of developing depression tend to overestimate their risk, especially women. Inaccurate depression risk perception is related to people's health status. Educational interventions are needed to enhance the accuracy of risk perception to encourage positive behavior change and uptake of preventive strategies.
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Affiliation(s)
- JianLi Wang
- The Institute of Mental Health Research, University of Ottawa, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
| | - Rachel Smail-Crevier
- The Institute of Mental Health Research, University of Ottawa, Ottawa, Ontario, Canada
| | - Molly Nannarone
- The Institute of Mental Health Research, University of Ottawa, Ottawa, Ontario, Canada
| | - Douglas Manuel
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Glenda MacQueen
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Scott B Patten
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Bonnie Lashewicz
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Norbert Schmitz
- Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, Canada
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O'Reilly SL, Leonard Y, Dasgupta K, Terkildsen Maindal H. Diabetes after pregnancy prevention trials: Systematic review for core outcome set development. MATERNAL AND CHILD NUTRITION 2020; 16:e12947. [PMID: 31943785 PMCID: PMC7296791 DOI: 10.1111/mcn.12947] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 12/04/2019] [Accepted: 12/15/2019] [Indexed: 01/24/2023]
Abstract
Diabetes prevention intervention studies in women with previous gestational diabetes have increased, but no consensus exists on core outcomes to support comparisons and synthesis of findings. We aimed to systematically catalogue outcomes in diabetes after pregnancy prevention interventions with the goal of developing a core outcome set. Embase, Medline, Cochrane Library, Cochrane Pregnancy and Childbirth Trials Register, and CINAHL were searched from inception to October 2017. Post‐partum lifestyle and diabetes screening intervention studies in women with previous gestational diabetes and/or their families were eligible. No limits were placed on intervention type, duration, or location. Two authors independently screened and performed data extraction on outcomes, measurement tools, and relevant study characteristics. We analysed data from 38 studies (29 randomised controlled trials and 9 pre–post intervention evaluations) comprising 12,509 participants. Most publications (80%) occurred between the years 2012 and 2017. Among 172 outcomes, we identified 36 outcome groups and classified them under three domains: health status (body weight, body composition, diabetes risk, cardiometabolic risk, diabetes development, mental health, pregnancy outcomes, and fitness), health behaviours (dietary, physical activity, diabetes screening, behaviour change, and breastfeeding), and intervention processes (implementation). The health status domain contained the most commonly reported outcomes, but measurement tools were very heterogeneous. Despite the recent explosion in diabetes after pregnancy prevention studies, large variation in outcomes and measurement methods exists. Research is needed to define a core outcome set to standardise diabetes after pregnancy prevention interventions. The core outcome set should engage a wide group of stakeholders to identify impactful indicators for future trials.
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Affiliation(s)
- Sharleen L O'Reilly
- UCD Institute of Food and Health, School of Agriculture and Food Science, University College Dublin, Ireland.,School of Agriculture and Food Science, University College Dublin, Ireland
| | - Yvonne Leonard
- School of Agriculture and Food Science, University College Dublin, Ireland
| | - Kaberi Dasgupta
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec, Canada
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Daneshmand SS, Stortz S, Morrisey R, Faksh A. Bridging Gaps and Understanding Disparities in Gestational Diabetes Mellitus to Improve Perinatal Outcomes. Diabetes Spectr 2019; 32:317-323. [PMID: 31798289 PMCID: PMC6858080 DOI: 10.2337/ds19-0013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IN BRIEF For a woman who is facing financial, cultural, psychological, or social challenges, discovering that she has gestational diabetes mellitus (GDM) represents a significant burden. By better understanding challenges underserved women with GDM face, multidisciplinary clinical teams can make essential changes in health care delivery to optimize outcomes not just during pregnancy, but also, equally importantly, beyond pregnancy to prevent long-term disease.
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Affiliation(s)
- Sean S. Daneshmand
- Division of Perinatology, Department of Obstetrics and Gynecology, Scripps Memorial Hospital La Jolla, San Diego, CA
| | - Sharon Stortz
- Department of Obstetrics and Gynecology, Naval Medical Center, San Diego, CA
| | | | - Arij Faksh
- Division of Perinatology, Department of Obstetrics and Gynecology, Scripps Memorial Hospital La Jolla, San Diego, CA
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Guo J, Tang Y, Zhang H, Lommel L, Chen JL. The risk, perceived and actual, of developing type 2 diabetes mellitus for mothers of preschool children in urban China. PLoS One 2019; 14:e0222839. [PMID: 31560718 PMCID: PMC6764680 DOI: 10.1371/journal.pone.0222839] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 09/08/2019] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The perceived risk of developing type 2 diabetes mellitus (T2DM) can motivate individuals to adopt preventive health behaviors. Compared with fathers, mothers of young children often experience unique risk factors for developing T2DM: pregnancy-related weight gain, lifestyle changes related to child care, and the increased incidence of gestational diabetes mellitus. Understanding how actual risk factors affect the perceived risk of developing T2DM can foster effective diabetes prevention interventions for this population. The aims of this study were to describe the risk, perceived and actual, of developing T2DM and to explore the influencing factors of perceived risk for Chinese mothers of preschool children in China. METHODS A multisite, cross-sectional survey was conducted and included 176 mothers (mean age of 31.19 years old) of preschool children (aged 3-7 years old) from four preschools in Changsha, the capital city of Hunan Province, China. The overall perceived risk of developing T2DM was measured by one item "Your own personal health risk is at almost no risk, slight risk, moderate risk or high risk from diabetes" from the Risk Perception Survey for Developing Diabetes (RPS-DD). PRS-DD and the Chinese version of the Canadian Diabetes Risk Assessment Questionnaire (CHINARISK) were used to assess perceived risk related worry, personal control, optimistic bias, and diabetes risk knowledge and actual risk of T2DM. Mothers also reported their height, weight, and waist circumference followed by the NIH protocol. Pearson correlation and stepwise multivariate linear regression were used to explore how the actual risk factors affected the perceived risk of developing diabetes (RPS-DD)). RESULTS Nearly 90% of mothers perceived almost no/slight risk for developing diabetes. Nearly half of the mothers had parents or siblings with diabetes. Roughly 70% of the mothers did not eat five servings of fruits and vegetables per day, and more than 50% did not exercise at least 30 minutes a day. In the five stepwise multivariate linear regression models, young mothers (95% CI .400-1.311) and those with a family history of diabetes (95% CI -0.74- .000) were founded a higher overall perceived risk. Mothers who reported more sedentary time (95% CI -0.029- -0.008) and less physical activity had less personal control (95% CI -0.354- -0.046). Mothers with more sedentary time had more worries about developing T2DM(95% CI 0.008-0.035) . Mothers who were older (95% CI -0.440-0.055) or had more physical activities (95% CI 0.003-0.048) had more optimistic bias of not developing T2DM. Mothers who had a higher education level (95% CI .354-1.422) and a family history of diabetes (95% CI .029-2.231) had more diabetes risk knowledge of developing T2DM. CONCLUSION This study found that Chinese mothers of preschool children in urban areas reported low perceived risk of developing T2DM, although they have actual risk factors. These women did not associate anthropometric, health history, or health behavior factors with the risk of developing T2DM. Anthropometrics and risk factors associated with behavioral risk factors may be the focus of diabetes prevention programs.
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Affiliation(s)
- Jia Guo
- Xiangya School of Nursing, Central South University, Changsha, Hunan, PR China
- * E-mail:
| | - Yujia Tang
- Xiangya School of Nursing, Central South University, Changsha, Hunan, PR China
| | - Honghui Zhang
- Department of Hepatobiliary Surgery, Hunan General Hospital, Changsha, Hunan, PR China
| | - Lisa Lommel
- School of Nursing, University of California, San Francisco, CA, United States of America
| | - Jyu-Lin Chen
- School of Nursing, University of California, San Francisco, CA, United States of America
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Kwong W, Ray JG, Wu W, Feig DS, Lowe J, Lipscombe LL. Perinatal Outcomes Among Different Asian Groups With Gestational Diabetes Mellitus in Ontario: A Cohort Study. Can J Diabetes 2019; 43:606-612. [PMID: 31492620 DOI: 10.1016/j.jcjd.2019.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 06/18/2019] [Accepted: 06/20/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The aim of this study was to determine whether perinatal outcomes differ between Caucasian and Asian subgroups of women with gestational diabetes mellitus (GDM) through use of standard vs ethnicity-specific birthweight curves. METHODS This retrospective cohort study included 537 women with GDM, within the ethnically diverse province of Ontario, Canada. Study outcomes included large-for-gestational-age (LGA) and small-for-gestational-age (SGA) birthweights in newborns of women from prevalent Asian ethnic groups compared with newborns of Caucasian women. Odds ratios were adjusted for maternal age, parity, prepregnancy body mass index, gestational weight gain and insulin use in pregnancy. RESULTS Of the 537 women participing in the study, 228 (35.8%) were Caucasian, 109 (17.1%) South Asian, 141 (22.1%) East Asian and 59 (9.3%) Filipino. Using standard birthweight curves, compared with Caucasian women, the risk of LGA was lower among South Asian (adjusted odds ratio [aOR], 0.065; 95% confidence interval [CI], 0.01 to 0.49) and East Asian (aOR, 0.36; 95% CI, 0.14 to 0.95) women. The aOR for SGA was notably higher among South Asian women (aOR, 2.96; 95% CI, 1.24 to 7.09). Significant effects were not seen among Filipino women. Use of ethnicity-specific birthweight curves largely attenuated these associations, except for LGA in South Asian mothers (aOR, 0.27; 95% CI, 0.09 to 0.81). CONCLUSION South Asian women with GDM are at lower risk of having an LGA newborn, even after accounting for maternal risk factors or the use of an ethnicity-specific birthweight curve.
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Affiliation(s)
- Wilson Kwong
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Joel G Ray
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; St Michael's Hospital, Toronto, Ontario, Canada
| | - Wei Wu
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Denice S Feig
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Sinai Health System, Toronto, Ontario, Canada
| | - Julia Lowe
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Sunnybrook Hospital, Toronto, Ontario, Canada
| | - Lorraine L Lipscombe
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.
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19
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The role of smartphone-based education on the risk perception of type 2 diabetes in women with gestational diabetes. HEALTH AND TECHNOLOGY 2019. [DOI: 10.1007/s12553-019-00342-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Batal M, Decelles S. A Scoping Review of Obesity among Indigenous Peoples in Canada. J Obes 2019; 2019:9741090. [PMID: 31281674 PMCID: PMC6589240 DOI: 10.1155/2019/9741090] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 03/15/2019] [Accepted: 03/25/2019] [Indexed: 11/21/2022] Open
Abstract
Indigenous populations in Canada are heavily affected by the burden of obesity, and certain communities, such as First Nations on reserve, are not included in the sampling framework of large national health surveys. A scoping review of ever published original research reporting obesity rates (body mass index ≥ 30), among adult Indigenous peoples in Canada, was conducted to identify studies that help close the Canadian Community Health Survey (CCHS) data gap for obesity prevalence in Indigenous populations in Canada and to make comparisons based on ethnicity, sex, time, and geography. First Nations on reserve with self-reported height and weight had higher rates of obesity (30%-51%) than First Nations off reserve (21%-42%) and non-Indigenous populations (12%-31%) in their respective province or territory, with the exception of Alberta, where rates in First Nations on reserve (30% and 36%) were lower or similar to those reported in First Nations off reserve (38%). First Nations on reserve with predominantly measured height and weight (42%-66%) had higher rates of obesity compared to Inuit in Quebec (28%), Nunavut (33%), and Newfoundland and Labrador (41%), while the rates were similar to those in Inuit in Northwest Territories (49%). Obesity in these large studies conducted among Inuit was based solely on measured height and weight. Studies in First Nations and Inuit alike showed higher prevalence of obesity in women, as well as an increase with time. No recent studies measured the obesity rates for First Nations in Yukon and Northwest Territories and for Métis living in settlements of Northern Alberta. Researchers are encouraged to conduct total diet studies in these regions, and to use existing data to analyze the associations between obesity, road access, latitude, food environment, and traditional food intake, to further inform community planning and development.
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Affiliation(s)
- Malek Batal
- Nutrition Department, Faculty of Medicine, Université de Montréal, 2405 Ch de la Côte Ste-Catherine, Montréal, Québec, Canada H3T 1A8
- WHO Collaborating Centre on Nutrition Changes and Development (TRANSNUT), Nutrition Department, Université de Montréal, Montreal, Canada H3T 1A8
| | - Stéphane Decelles
- WHO Collaborating Centre on Nutrition Changes and Development (TRANSNUT), Nutrition Department, Université de Montréal, Montreal, Canada H3T 1A8
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Can Nurse-Based Management Screening Ensure Adequate Outcomes in Patients With Gestational Diabetes? A Comparison of 2 Organizational Models. Qual Manag Health Care 2018; 28:51-62. [PMID: 30586123 DOI: 10.1097/qmh.0000000000000202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is an impaired glucose tolerance with onset or first recognition during pregnancy. The purpose of this study is to evaluate the clinical outcomes of a blood glucose monitoring protocol implemented by nurses and dietitians in a diabetes team to the previously established protocol of direct monitoring of GDM patients by a diabetologist. METHODS Two groups of patients were formed: The first group was based on a traditional protocol (P1: 230 patients) with patients' blood glucose constantly checked by a diabetologist. In the second structured group (P2: 220 patients) patients were referred to a diabetologist only if they required insulin therapy. RESULTS The number of medical visits (P2: 1.28 ± 0.70 vs P1: 3.27 ± 1.44; P < .001) and the percentage of patients with hypoglycemia (P2: 6.8% vs P1: 15.2%; P < .006) were found to be lower in group P2 than in group P1. In both groups, a direct relationship was found between a parental history of diabetes and the risk of GDM (odds ratio [OR]: P1 = 2.2 [1.17-4.12]; P2 = 2.5 [1.26-5.12]). In group P1, it was observed that hyperweight gain in patients who were already overweight before becoming pregnant significantly increased the risk of macrosomia (OR: 3.11 [1.39-25.7]), whereas this was not detected in patients in group P2. In group P2, a correlation was found between macrosomia and insulin therapy (OR: 0.066 vs 0.34). In group P1 and group P2, a correlation was observed between insulin therapy and a family history of diabetes (OR: 2.20 vs 2.27), and a body mass index of greater than 30 kg/m in group P2 (OR: 3.0 vs 1.47). CONCLUSIONS The data we collected show that creating a structured protocol for GDM management reduces the number of medical visits required by patients without increasing the risk of hypoglycemia, macrosomia, or hyperweight gain during pregnancy.
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MacQuillan E, Curtis A, Baker K, Paul R. Geospatial Analysis of Birth Records to Target Programming for Mothers With Gestational Diabetes Mellitus in Michigan, 2013. Public Health Rep 2018; 134:27-35. [PMID: 30521763 DOI: 10.1177/0033354918815183] [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] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVES The incidence of gestational diabetes mellitus (GDM) in the United States has increased during the past several decades. The objective of this study was to use birth records and a combination of statistical and geographic information system (GIS) analyses to evaluate GDM rates among subgroups of pregnant women in Michigan. MATERIALS AND METHODS We obtained data on maternal demographic and health-related characteristics and regions of residence from 2013 Michigan birth records. We geocoded (ie, matched to maternal residence) the birth data, calculated proportions of births to women with GDM, and used logistic regression models to determine predictors of GDM. We calculated odds ratios (ORs) from the exponentiated beta statistic of the logistic regression test. We also used kernel density estimations and local indicators of spatial association (LISA) analyses to determine GDM rates in regions in the state and identify GDM hot spots (ie, areas with a high GDM rate surrounded by areas with a high GDM rate). RESULTS We successfully geocoded 104 419 of 109 168 (95.6%) births in Michigan in 2013. Of the geocoded births, 5185 (5.0%) were to mothers diagnosed with GDM. LISA maps showed a hot spot of 8 adjacent counties with high GDM rates in southwest Michigan. Of 11 064 births in the Southwest region, 829 (7.5%) were to mothers diagnosed with GDM, the highest rate in the state and a result confirmed by geospatial analyses. PRACTICE APPLICATIONS Birth data and GIS analyses may be used to measure statewide pregnancy-associated disease risk and identify populations and geographic regions in need of targeted public health and maternal-child health interventions.
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Affiliation(s)
- Elizabeth MacQuillan
- 1 Department of Allied Health Sciences, Grand Valley State University, Grand Rapids, MI, USA
| | - Amy Curtis
- 2 Health Data Research, Analysis and Mapping Center at Western Michigan University, Kalamazoo, MI, USA
| | - Kathleen Baker
- 2 Health Data Research, Analysis and Mapping Center at Western Michigan University, Kalamazoo, MI, USA
| | - Rajib Paul
- 2 Health Data Research, Analysis and Mapping Center at Western Michigan University, Kalamazoo, MI, USA
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Moore AP, D'Amico MI, Cooper NAM, Thangaratinam S. Designing a lifestyle intervention to reduce risk of type 2 diabetes in postpartum mothers following gestational diabetes: An online survey with mothers and health professionals. Eur J Obstet Gynecol Reprod Biol 2017; 220:106-112. [PMID: 29202393 DOI: 10.1016/j.ejogrb.2017.11.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 10/17/2017] [Accepted: 11/13/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The aim of this study was to identify what components of a postpartum lifestyle intervention would engage postpartum mothers who had a diagnosis of gestational diabetes. STUDY DESIGN Two online surveys were conducted, one involving postnatal mothers with GDM (n=83), and a second for health professionals (n=46). RESULTS Seventy-eight percent of mothers were aware that healthy eating, exercise and weight management were all important to reduce risk of subsequent type 2 diabetes. However, 80% of women in this survey were not ready to engage in a postpartum lifestyle intervention within the first 6 months of giving birth; in contrast 52% of health professionals recommended they should be engaged in the first six weeks. Group sessions were the most commonly chosen format to deliver an intervention (30%). A community setting was preferred to a medical one. Mothers wanted recipe ideas (95%) in preference to general dietary advice (76%) or cooking skills courses (39%). Walking was the main form of exercise for 79% of mothers in this sample. Women highlighted difficulty in focusing on their own health goals because of competing demands of looking after a baby (41% agreed, Median 3, IQR 2), tiredness (65% agreed, Md 4, IQR 1) and the need for childcare (64% agreed, Md 4, IQR 2). CONCLUSION A walking programme, recipe ideas and weight monitoring may be useful components when designing a postpartum lifestyle intervention. Barriers to engagement are evident and the intervention should allow women to engage at a time that is appropriate for them.
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Affiliation(s)
- Amanda P Moore
- The Diabetes and Nutritional Sciences Division, Faculty of Life Sciences & Medicine, King's College London, UK
| | - Maria I D'Amico
- Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University London, London, UK.
| | - Natalie A M Cooper
- Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University London, London, UK
| | - Shakila Thangaratinam
- Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University London, London, UK; Multidisciplinary Evidence Synthesis Hub (mEsh), Barts and the London School of Medicine and Dentistry, Queen Mary University London, London, UK
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Alemu BT, Cramer RJ, Carlisle KL, Akpinar-Elci M. A Theoretical Analysis of Health Beliefs of Physical Activity Among Women with Previous Gestational Diabetes—A Commentary. AMERICAN JOURNAL OF HEALTH EDUCATION 2017. [DOI: 10.1080/19325037.2017.1335627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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