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Skovsgaard CB, Møller A, Bjerre JV, Kampmann U, Kyng KJ. Diabetes in pregnancy and offspring cardiac function: a systematic review and meta-analysis. Front Pediatr 2024; 12:1404625. [PMID: 39091986 PMCID: PMC11291373 DOI: 10.3389/fped.2024.1404625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 07/02/2024] [Indexed: 08/04/2024] Open
Abstract
Introduction Diabetes in pregnancy is associated with impaired offspring cardiac function. The objective of this systematic review was to determine the effect of diabetes in pregnancy on cardiac function in the offspring measured by echocardiography. Methods PubMed, Embase, Cochrane CENTRAL and Web of Science databases were searched from 1992 to June 27, 2023. Studies reporting offspring (age < 18 years) cardiac function by echocardiography compared between any type of diabetes in pregnancy and healthy control pregnancies were included. Study selection, quality assessment and risk of bias was independently performed by two reviewers. Meta-analyses was performed where possible. Results Thirty-one observational studies were included 1,679 cases and 2,694 controls. In the first week of life (23 studies, n = 2,663), intraventricular septum diastolic diameter (hypertrophy) was increased, while myocardial performance index (global function) and LV E/A-ratio (diastolic function) were decreased. No difference was found for left ventricular ejection fraction (systolic function). At 1-6 months (4 studies, n = 454) studies found hypertrophy, and decreased global function, but no difference in systolic or diastolic function. At 1-8 years (7 studies, n = 1,609) no difference was found. The available data did not allow for sub-analysis based on the type of diabetes, treatment, or glycemic control. Conclusions Diabetes in pregnancy is associated with cardiac hypertrophy and impaired global cardiac function in infants up to six months old. The few studies reporting on older children found no difference in the parameters investigated. Longitudinal studies employing more advanced echocardiographic measures or MRI are needed to evaluate consequences for long-term cardiac health. Systematic Review Registration https://www.crd.york.ac.uk/, identifier (CRD42022312471).
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Affiliation(s)
- Camilla Bjørn Skovsgaard
- Department of Paediatrics, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Anna Møller
- Department of Paediatrics, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Jesper Vandborg Bjerre
- Department of Paediatrics, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Ulla Kampmann
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Kasper Jacobsen Kyng
- Department of Paediatrics, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
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2
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Topaloğlu Ören ED, Ünsal Avdal E, Polat G, Sofulu F, Düzgün G, Pamuk G. Experiences of women with gestational diabetes about fear of having diabetes in their babies: A qualitative study. Medicine (Baltimore) 2024; 103:e37755. [PMID: 38608114 PMCID: PMC11018210 DOI: 10.1097/md.0000000000037755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 03/08/2024] [Indexed: 04/14/2024] Open
Abstract
Gestational Diabetes Mellitus is an important public health problem that often occurs during pregnancy. This study aimed to reveal the experiences of women with gestational diabetes regarding the fear of having diabetes in their babies. A qualitative research method was carried out with a phenomenological approach. The interviews had a semi-structured form and were recorded on an online/face-to-face voice recorder, and thematic content analysis was performed on the MAXQDA22. Following the inclusion criteria, 12 women with gestational diabetes from the 2 hospitals in the study were included, and in this way, the study reached saturation. As a result of the interviews, 4 main themes and one subtheme were obtained from coding. The main themes were "sugar baby," "risky child," "raising a fearful baby," and "problematic gene carrier." From the main theme of "problematic gene carrier," the subtheme of "pregnancies with problematic genes" was created. This research sheds light on the problems women with gestational diabetes experience with themselves and their babies, and how they deal with these problems. Women with gestational diabetes try to accept and cope with the diagnosis. This research shows that the women were worried about both themselves and their babies. Illuminating the experiences of women with gestational diabetes is part of an integrative care approach that will help increase quality care and treatment in endocrine clinics. More qualitative studies are needed to learn more about the experiences of women with gestational diabetes in endocrine clinics.
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Affiliation(s)
- Ekin Dila Topaloğlu Ören
- Izmir Katip Celebi University Faculty of Health Science, Department of Obstetrics and Gynecology Nursing, İzmir, Türkiye
| | - Elif Ünsal Avdal
- Izmir Katip Celebi University Faculty of Health Science, Department of Internal Medicine Nursing, İzmir, Türkiye
| | - Gökşen Polat
- Izmir Tinaztepe University Faculty of Health Science, Department of Internal Medicine Nursing, İzmir, Türkiye
| | - Funda Sofulu
- Izmir Katip Celebi University Faculty of Health Science, Department of Internal Medicine Nursing, İzmir, Türkiye
| | - Gönül Düzgün
- İzmir Tinaztepe University Faculty of Health Science, Department of First Aid and Emergency, İzmir, Türkiye
| | - Gülseren Pamuk
- Izmir Katip Celebi University School of Medicine, Department of Family Medicine, İzmir, Türkiye
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Kristensen R, Omann C, Ekelund CK, Gaynor JW, Hjortdal VE. Impact of an Impaired Maternal-Fetal Environment on Death in Children With Congenital Heart Defects Undergoing Surgery in Denmark From 1994 to 2018. J Am Heart Assoc 2024; 13:e031575. [PMID: 38533951 PMCID: PMC11179785 DOI: 10.1161/jaha.123.031575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 02/28/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Studies show that an impaired maternal-fetal environment (iMFE) increases the mortality risk in children with single-ventricle congenital heart defects (CHDs). We investigated the impact of an iMFE on death in children with various surgically corrected CHDs. METHODS AND RESULTS In this nationwide register-based study, we examined the association between an iMFE (including preeclampsia, gestational hypertension, gestational diabetes, maternal smoking during pregnancy) and death in a large cohort of children with surgically corrected CHDs in Denmark (1994-2018). Survival analysis was done using Cox regression, adjusted for confounding and mediating covariates. The cohort included 3304 children: 1662 (50.3%) with minor CHD and 1642 (49.7%) with major CHD. Among them, 792 (24%) children were exposed to an iMFE. During the study, there were 290 deaths: 71 (9.3%) in children exposed to an iMFE and 219 (8.7%) in those unexposed. There were no differences in mortality risk between children with CHD exposed to an iMFE and those unexposed (hazard ratio [HR], 1.12 [95% CI, 0.86-1.47]; P=0.4). This was consistent across subgroups, including minor CHD (HR, 0.76 [95% CI, 0.39-1.47]; P=0.4), major CHD (HR, 1.23 [95% CI, 0.92-1.64]; P=0.2), and hypoplastic left heart syndrome/univentricular heart (HR, 1.08 [95% CI, 0.64-1.85]; P=0.8). CONCLUSIONS Impairment of the maternal-fetal environment did not impact the mortality rate in children with CHD undergoing operation in Denmark from 1994 to 2018. We believe the cause of these discrepant findings to previous studies may be due to differences in the composition of CHD and prenatal maternal health care and health status of the population.
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Affiliation(s)
- Rasmus Kristensen
- Department of Cardiothoracic SurgeryCopenhagen University Hospital – RigshospitaletDenmark
- Faculty of Health SciencesCopenhagen UniversityDenmark
| | - Camilla Omann
- Department of Clinical MedicineAarhus UniversityDenmark
- Department of Cardiothoracic & Vascular SurgeryAarhus University HospitalDenmark
| | - Charlotte K. Ekelund
- Faculty of Health SciencesCopenhagen UniversityDenmark
- Department of Obstetrics, Center for Fetal MedicineCopenhagen University Hospital – RigshospitaletCopenhagenDenmark
| | - J. William Gaynor
- Division of Cardiothoracic SurgeryChildren’s Hospital of PhiladelphiaPAUSA
| | - Vibeke E. Hjortdal
- Department of Cardiothoracic SurgeryCopenhagen University Hospital – RigshospitaletDenmark
- Faculty of Health SciencesCopenhagen UniversityDenmark
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4
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Davies M, van Houten CS, Bengtsson J, Elsenburg LK, Kragelund Nielsen K, Andersen GS, Damm P, Rod NH. Childhood adversity and the risk of gestational diabetes: A population-based cohort study of nulliparous pregnant women. Diabet Med 2024; 41:e15242. [PMID: 37845190 DOI: 10.1111/dme.15242] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/22/2023] [Accepted: 10/09/2023] [Indexed: 10/18/2023]
Abstract
AIMS Gestational diabetes mellitus (GDM) is one of the most common pregnancy complications, and though it may be linked to childhood adversity, the effect of different types of adversity remains unclear. Childhood adversity is linked to a younger maternal age, which may hide the overall impact of adversity on GDM risk. We therefore aimed to explore the association between different types of childhood adversity and GDM while accounting for the potential impact of maternal age. METHODS We used Danish nation-wide register data, including 208,207 women giving birth for the first time from 2004 to 2018. Five adversity groups were used to examine the effect of childhood adversity on GDM risk: (1) low (referent group), (2) early life material deprivation, (3) persistent deprivation, (4) loss or threat of loss within the family and (5) high adversity. RESULTS 5375 women were diagnosed with GDM in the study population (2.6% absolute risk). Compared to women who experienced low adversity, the other adversity groups had a higher GDM risk (absolute difference [%]) directly; early material deprivation (0.64% [95% CI 0.44; 0.84]), persistent deprivation (0.63% [0.41; 0.86]), loss or threat of loss (0.73% [0.42; 1.05]) and high adversity (0.80% [0.32; 1.27]). The indirect effect of maternal age attenuated the total effect of childhood adversity on GDM by an absolute difference of 0.25%-0.46%. CONCLUSIONS Experiencing childhood adversity to any extent is associated with a higher risk of GDM. Interventions aimed at preventing childhood adversity may have a positive effect in reducing GDM burden and the associated health risks.
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Affiliation(s)
- Megan Davies
- Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
| | | | - Jessica Bengtsson
- Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Gregers S Andersen
- Steno Diabetes Center Copenhagen, Copenhagen University Hospital, Herlev, Denmark
| | - Peter Damm
- Center for Pregnant Women with Diabetes, Department of Obstetrics, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Naja H Rod
- Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
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Leth-Møller M, Duvald CS, Stampe S, Greibe E, Hoffmann-Lücke E, Pedersen M, Ovesen PG. Transplacental Transport of Artificial Sweeteners. Nutrients 2023; 15:2063. [PMID: 37432196 DOI: 10.3390/nu15092063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/12/2023] [Accepted: 04/20/2023] [Indexed: 07/12/2023] Open
Abstract
The prevalence of obesity is increasing, and the origins of obesity and metabolic dysfunction may be traced back to fetal life. Currently, overweight pregnant women are advised to substitute sugar-sweetened beverages with diet drinks containing artificial sweeteners. Recent evidence suggests that the consumption of artificial sweeteners during pregnancy increases the risk of obesity in the child, but the mechanism is unknown. We hypothesized the transportation of artificial sweeteners across the placenta into the fetal circulation and the amniotic fluid. We included 19 pregnant women who were given an oral dose of acesulfame, cyclamate, saccharin, and sucralose immediately before a planned caesarean section. Nine women were included as controls, and they refrained from an intake of artificial sweeteners. The maternal and fetal blood and amniotic fluid were collected during the caesarean section, and concentrations of artificial sweeteners were measured using mass spectrometry. We found a linear relationship between the fetal plasma concentrations of artificial sweeteners and the maternal plasma concentrations, with adjusted coefficients of 0.49 (95% CI: 0.28-0.70) for acesulfame, 0.72 (95% CI: 0.48-0.95) for cyclamate, 0.51 (95% CI: 0.38-0.67) for saccharin, and 0.44 (95% CI: 0.33-0.55) for sucralose. We found no linear relationship between amniotic fluid and fetal plasma concentrations, but there were positive ratios for all four sweeteners. In conclusion, the four sweeteners investigated all crossed the placenta and were present in the fetal circulation and amniotic fluid.
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Affiliation(s)
- Magnus Leth-Møller
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus Nord, Denmark
- Comparative Medicine Lab, Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 11, 8200 Aarhus Nord, Denmark
- Department of Clinical Medicine, Health, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200 Aarhus Nord, Denmark
| | - Christina Søndergaard Duvald
- Comparative Medicine Lab, Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 11, 8200 Aarhus Nord, Denmark
| | - Sofie Stampe
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus Nord, Denmark
- Comparative Medicine Lab, Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 11, 8200 Aarhus Nord, Denmark
| | - Eva Greibe
- Department of Clinical Medicine, Health, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200 Aarhus Nord, Denmark
- Department of Clinical Biochemistry, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus Nord, Denmark
| | - Elke Hoffmann-Lücke
- Department of Clinical Medicine, Health, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200 Aarhus Nord, Denmark
- Department of Clinical Biochemistry, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus Nord, Denmark
| | - Michael Pedersen
- Comparative Medicine Lab, Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 11, 8200 Aarhus Nord, Denmark
| | - Per Glud Ovesen
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus Nord, Denmark
- Department of Clinical Medicine, Health, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200 Aarhus Nord, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Palle Juul-Jensens Boulevard 11, 8200 Aarhus Nord, Denmark
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6
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Scheuer CM, Andersen MH, Mathiesen ER, Ringholm L, Müller CL, Truong JM, Lie-Olesen MM, Overgaard M, McIntyre HD, Jensen DM, Damm P, Clausen TD. Regional divergence and time trends in the prevalence of gestational diabetes mellitus: a national Danish cohort study. Acta Diabetol 2023; 60:379-386. [PMID: 36539623 PMCID: PMC9931790 DOI: 10.1007/s00592-022-02013-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022]
Abstract
AIMS To evaluate the prevalence and time trends of gestational diabetes mellitus (GDM) across the five regions of Denmark with uniform national guidelines for screening and diagnosing GDM. METHODS This register-based national cohort study included 287,684 births from 2013 to 2017. Trends in GDM prevalence over time and differences between the five regions were evaluated. Crude and adjusted odd ratios (ORs) for GDM were calculated including potential confounding clinical risk factors as age, BMI, educational level, marital status, parity, country of origin and assisted reproduction. RESULTS From 2013 to 2017, GDM prevalence in Denmark increased by 7% per year (OR 1.07, 95% CI 1.06-1.09, P < 0.001). GDM prevalence varied considerably between regions and ranged from 3.0 to 5.9% in 2017, corresponding to a maximal regional difference of 97%. In crude analyses, the risk of GDM in 2017 was significantly different in four of five regions compared to the remaining regions (OR ranging from 0.60 to 1.55), and these differences persisted after adjusting for confounding clinical risk factors (adjusted OR: 0.59-1.45). CONCLUSION The prevalence of GDM increased over time in all Danish regions with substantial regional divergence. Up to a 97%, difference in GDM prevalence was observed between Danish regions, which was not explained by available clinical risk factors. This occurred despite national guidelines and raises the question of whether regional variations in screening efficacy, diagnostic procedures or inequality in clinical health care access may explain the observed differences.
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Affiliation(s)
- Cathrine M Scheuer
- Department of Gynaecology and Obstetrics, Nordsjællands Hospital, Hillerød, Denmark.
| | - Maria H Andersen
- Department of Gynaecology and Obstetrics, Nordsjællands Hospital, Hillerød, Denmark
| | - Elisabeth R Mathiesen
- Department of Endocrinology and Metabolism, Center for Pregnant Women with Diabetes, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lene Ringholm
- Department of Endocrinology and Metabolism, Center for Pregnant Women with Diabetes, Copenhagen, Denmark
| | - Clara L Müller
- Department of Gynaecology and Obstetrics, Nordsjællands Hospital, Hillerød, Denmark
| | - Jun-Mei Truong
- Department of Gynaecology and Obstetrics, Nordsjællands Hospital, Hillerød, Denmark
| | | | - Martin Overgaard
- Department of Clinical Biochemistry, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - H David McIntyre
- Mater Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Dorte M Jensen
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Peter Damm
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Obstetrics, Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark
| | - Tine D Clausen
- Department of Gynaecology and Obstetrics, Nordsjællands Hospital, Hillerød, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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7
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Nielsen JH, Fonager K, Kristensen JK, Overgaard C. Effect of an electronic reminder of follow-up screening after pregnancy complicated by gestational diabetes mellitus: a randomized controlled trial. BMC Public Health 2023; 23:153. [PMID: 36690965 PMCID: PMC9872380 DOI: 10.1186/s12889-023-15060-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 01/16/2023] [Indexed: 01/24/2023] Open
Abstract
AIM To determine the effectiveness of despatching an electronic reminder of participation in screening for gestational diabetes. The reminder was sent to the women 1-8 years after delivery. METHODS A registry-based, randomized controlled trial in the North Denmark Region among women with gestational diabetes. Randomization was made, which included seven groups stratified by the child's birth year (2012-2018). The intervention group received standard care supplemented by an electronic reminder through a secure nationwide email system (n = 731), while the control group received only standard care (n = 732). The primary outcome was based on blood testing for diabetes (OGTT, HbA1c or fasting P-glucose). RESULTS A total of 471 (32.1%) women participated in screening. The primary outcome was experienced by 257 women (35.1%) in the intervention group and 214 women (29.2%) in the control group. The effect of the reminder seemed to increase with recipient's age, non-western origin, urban dwelling, and multiparity. Of those who participated in follow-up screening, 56 (3.8%) were diagnosed with type 2 diabetes. CONCLUSION Electronic reminders, based on the principles of informed choice and patient-centred care, to women have been shown to support life-long participation in follow-up screening. Attempts to further stimulation of coverage could however be considered. TRAIL REGISTRATION ISRCTN registry (22/04/2022, ISRCTN23558707).
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Affiliation(s)
- Jane Hyldgaard Nielsen
- Department of Midwifery, University College of Northern Denmark, Aalborg Øst, Denmark.
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.
- Research Center for Health and Applied Technology, University College of Northern Denmark, Aalborg, Denmark.
- DECIPH'er, Cardiff School of Social Sciences, Cardiff University, Cardiff, Wales.
| | - Kirsten Fonager
- Department of Social Medicine, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Charlotte Overgaard
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Unit of Health Promotion, Department of Public Health, University of Southern Denmark, Esbjerg, Denmark
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8
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Nedergaard JB, Nielsen JH, Andersen LMB, Dahl TA, Overgaard C. A kind reminder-A qualitative process evaluation of women's perspectives on receiving a reminder of type 2 diabetes follow-up screening after gestational diabetes. J Eval Clin Pract 2022; 29:591-601. [PMID: 36585792 DOI: 10.1111/jep.13805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/07/2022] [Accepted: 12/13/2022] [Indexed: 01/01/2023]
Abstract
RATIONALE, AIMS AND OBJECTIVES Women with previous gestational diabetes mellitus (GDM) are more than eight times more likely to develop type 2 diabetes (T2DM) compared to women without GDM. Annual follow-up T2DM-screening is recommended, but participation rates decrease rapidly after the first year. In the North Denmark Region, an electronic reminder has been tested with the aim of improving follow-up care for women with prior GDM. The aim of this study was to explore women's perspectives on receiving an electronic reminder, and the role of reminders in both women's decision-making and informed choice regarding participation in follow-up screening. METHODS A qualitative process evaluation informed by a critical realistic perspective. Data consisted of 20 semi-structured interviews with women previously diagnosed with GDM who had received the reminder. Interviews were analyzed using reflexive thematic analysis. RESULTS The reminder affected women's decision-making and informed choices through a range of mechanisms. Its personalized design prompted feelings of co-responsibility and care from the healthcare system, supported continuity in women's care pathways, and helped women bridge the gap between healthcare sectors. Women's perception of diabetes risk and the importance of follow-up influenced their decision-making. Participation in follow-up screening was influenced by several contextual factors, as women's everyday life impeded their prioritizing follow-up screening. Women who experienced being met by their general practitioner (GP) with acknowledgement rather than stigmatization and received supportive information tailored to their life situation were more motivated to participate in future follow-up screenings. CONCLUSION The reminder indicated both concern and co-responsibility for women's follow-up care after GDM and was well received by the women. It supported participation in follow-up screening through an emphasis on shared decision-making and informed choice. Women's interaction with their GP played a significant role.
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Affiliation(s)
- Julie B Nedergaard
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Jane H Nielsen
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.,Department of Midwifery, University College of Northern Denmark, Aalborg, Denmark.,Research Center for Health and Applied Technology, University College of Northern Denmark, Aalborg, Denmark
| | - Laerke M B Andersen
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Tina A Dahl
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark
| | - Charlotte Overgaard
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.,Department of Public Health, University of Southern Denmark, Odense, Denmark
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9
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Dłuski DF, Ruszała M, Rudziński G, Pożarowska K, Brzuszkiewicz K, Leszczyńska-Gorzelak B. Evolution of Gestational Diabetes Mellitus across Continents in 21st Century. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15804. [PMID: 36497880 PMCID: PMC9738915 DOI: 10.3390/ijerph192315804] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/07/2022] [Accepted: 11/22/2022] [Indexed: 06/17/2023]
Abstract
Over the last few decades, several definitions of gestational diabetes mellitus (GDM) have been described. There is currently not enough research to show which way is the best to diagnose GDM. Opinions differ in terms of the optimal screening and diagnostic measures, in part due to the differences in the population risks, the cost-effectiveness considerations, and the lack of an evidence base to support large national screening programs. The basic method for identifying the disease is the measurement of glucose plasma levels which may be determined when fasting, two hours after a meal, or simply at any random time. The currently increasing incidence of diabetes in the whole population, the altering demographics and the presence of lifestyle changes still require better methods of screening for hyperglycemia, especially during pregnancy. The main aim of this review is to focus on the prevalence and modifications to the screening criteria for GDM across all continents in the 21st century. We would like to show the differences in the above issues and correlate them with the geographical situation. Looking at the history of diabetes, we are sure that more than one evolution in GDM diagnosis will occur, due to the development of medicine, appearance of modern technologies, and the dynamic continuation of research.
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Affiliation(s)
- Dominik Franciszek Dłuski
- Chair and Department of Obstetrics and Perinatology, Medical University of Lublin, 20-954 Lublin, Poland
| | - Monika Ruszała
- Chair and Department of Obstetrics and Perinatology, Medical University of Lublin, 20-954 Lublin, Poland
| | - Gracjan Rudziński
- Faculty of Medicine, Medical University of Lublin, 20-059 Lublin, Poland
| | - Kinga Pożarowska
- Faculty of Medicine, Medical University of Lublin, 20-059 Lublin, Poland
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10
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Toxvig L, Hyldgård Nielsen J, Jepsen I. Womeńs experiences with managing advice on gestational diabetes - a qualitative interview study. SEXUAL & REPRODUCTIVE HEALTHCARE 2022; 34:100780. [PMID: 36126359 DOI: 10.1016/j.srhc.2022.100780] [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: 12/18/2021] [Revised: 08/26/2022] [Accepted: 09/09/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study aims to gain insight into womeńs experiences with gestational diabetes and their strategies to cope with advice for changing lifestyle. Further, health care professionalś approach to women with gestational diabetes is discussed. METHODS Semi-structured interviews with nine women with gestational diabetes were conducted at a university hospital, adopting a phenomenological approach. RESULTS Three themes were created: 1) Experience of control, 2) personal strategies, and 3) unintended consequences. Women experienced that the monitoring at the outpatient clinic was associated with surveillance and safety and adopted different strategies to cope with gestational diabetes. Some women experienced feeling different and labelled due to the monitoring and their eating habits. Some women expressed concern for the baby and the risk of getting diabetes after birth. Womeńs experiences and how they transfer and cope with information about gestational diabetes at an outpatient obstetric clinic are brought forward, and it became evident that individual needs in gestational diabetes care are not being met in all situations. CONCLUSION Women experienced surveillance and safety while being monitored at the outpatient clinic. At the same time, self-monitoring seemed to stimulate feelings of concern about otherś reactions to the condition. In addition, we found that womeńs strategies for behaviour change included limited food intake, controlling food purchases, and being physically active. Concerning the management of gestational diabetes, some women felt that the information was not sufficiently adapted to their individual needs, thus health professionalś approach to gestational diabetes should be based on the womeńs perspective.
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Affiliation(s)
- Lene Toxvig
- Department of Midwifery, University College of Northern Denmark, Selma Lagerløfs, Vej 2, 9220 Aalborg Øst, Denmark.
| | - Jane Hyldgård Nielsen
- Department of Midwifery, University College of Northern Denmark, Selma Lagerløfs, Vej 2, 9220 Aalborg Øst, Denmark; Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Niels Jernes, Vej 14, 9220 Aalborg Øst, Denmark.
| | - Ingrid Jepsen
- Department of Midwifery, University College of Northern Denmark, Selma Lagerløfs, Vej 2, 9220 Aalborg Øst, Denmark.
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11
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Christensen MH, Rubin KH, Petersen TG, Nohr EA, Vinter CA, Andersen MS, Jensen DM. Cardiovascular and metabolic morbidity in women with previous gestational diabetes mellitus: a nationwide register-based cohort study. Cardiovasc Diabetol 2022; 21:179. [PMID: 36085031 PMCID: PMC9463733 DOI: 10.1186/s12933-022-01609-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 08/24/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Gestational diabetes mellitus (GDM) is associated with adverse pregnancy outcomes and has maternal health implications reaching beyond the perinatal period. We aimed to investigate the incidence and severity of cardiovascular and metabolic morbidity in women with previous GDM in a Danish population and to study whether proxies of impaired beta cell function—insulin treatment during GDM pregnancy and development of subsequent manifest diabetes mellitus—influence incident risk of cardiovascular and metabolic morbidity.
Methods
A nationwide register-based cohort study was conducted on the complete cohort of 700,648 women delivering in Denmark during 1997–2018. The exposure variable was GDM and primary outcome was overall cardiovascular and metabolic morbidity. Secondary outcomes were major cardiovascular disease (ischemic heart disease, heart failure, and/or stroke/transient cerebral ischemia), hypertension, dyslipidemia, and venous thrombosis. Severity of morbidity was assessed using number of hospital contacts with diagnosis codes related to cardiovascular and metabolic morbidity and number of redemptions of prescribed medication related to cardiovascular and metabolic morbidity in women who developed cardiovascular and metabolic morbidity after pregnancy.
Results
The median follow-up period was 10.2–11.9 years with a total range of 0–21.9 years. GDM was associated with increased risk of any cardiovascular and metabolic morbidity (adjusted HR 2.13 [95% CI 2.07–2.20]), major cardiovascular disease (adjusted HR 1.69 [95% CI 1.55–1.84]), hypertension (adjusted HR 1.89 [95% CI 1.82–1.96], dyslipidemia (adjusted HR 4.48 [95% CI 4.28–4.69]), and venous thrombosis (adjusted HR 1.32 [95% CI 1.16–1.50]). Insulin treatment during pregnancy and subsequent development of manifest diabetes exacerbated the risk estimates. Previous GDM was associated with more hospital contacts and more redeemed prescriptions in women developing cardiovascular and metabolic morbidity (p < 0.001).
Conclusions
Previous GDM was associated with significantly higher risk of cardiovascular and metabolic morbidity, especially incident dyslipidemia. Risks were exacerbated by proxies of beta cell impairment. Severity of morbidity was significantly worse if GDM preceded cardiovascular and metabolic morbidity.
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12
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Follow-up after gestational diabetes: a qualitative study of perspectives from general practices. BJGP Open 2022; 6:BJGPO.2021.0241. [PMID: 35443978 DOI: 10.3399/bjgpo.2021.0241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/25/2022] [Accepted: 04/05/2022] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Women whose pregnancies are complicated by gestational diabetes mellitus are approximately eight times more likely to develop type two diabetes. Although regular participation in follow-up screening increases the chance of early detection of diabetes, participation rates are often suboptimal. A better understanding of general practice as a key contextual setting for screening could help inform the development and adoption of, for example, electronic reminder interventions to support women's participation. AIM To explore the perspectives of general practitioners and relevant staff members engaged in early detection of diabetes after gestational diabetes in order to identify barriers to and facilitators of follow-up screening. DESIGN & SETTING A qualitative interview study undertaken in general practices in the North Denmark Region. METHOD Based on a purposive sample strategy, 18 semi-structured interviews of 12 general practitioners and six staff members, who were either nurses or midwives, were analysed using a reflexive thematic analytical approach. RESULTS Three main themes were formulated: (1) Challenges of addressing women's risk; (2) Prioritisation of early detection of diabetes; (3) System influence on clinical procedures. CONCLUSION Follow-up screening was facilitated by knowledge of guidelines. We found professional collaboration and adaptation support to lead to successful implementation of guidelines in general practice. Supporting GPs and their staff's reflection and discussion of ways to engage in communication and decision-making processes with women is however important, hence it was found to create an important barrier to follow-up screening. Overall, our findings can help inform the future development of interventions to increase uptake.
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13
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Paulo MS, Abdo NM, Bettencourt-Silva R, Al-Rifai RH. Gestational Diabetes Mellitus in Europe: A Systematic Review and Meta-Analysis of Prevalence Studies. Front Endocrinol (Lausanne) 2021; 12:691033. [PMID: 34956073 PMCID: PMC8698118 DOI: 10.3389/fendo.2021.691033] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 11/17/2021] [Indexed: 01/14/2023] Open
Abstract
Background Gestational Diabetes Mellitus (GDM) is defined as the type of hyperglycemia diagnosed for the first-time during pregnancy, presenting with intermediate glucose levels between normal levels for pregnancy and glucose levels diagnostic of diabetes in the non-pregnant state. We aimed to systematically review and meta-analyze studies of prevalence of GDM in European countries at regional and sub-regional levels, according to age, trimester, body weight, and GDM diagnostic criteria. Methods Systematic search was conducted in five databases to retrieve studies from 2014 to 2019 reporting the prevalence of GDM in Europe. Two authors have independently screened titles and abstracts and full text according to eligibility using Covidence software. A random-effects model was used to quantify weighted GDM prevalence estimates. The National Heart, Lung, and Blood Institute criteria was used to assess the risk of bias. Results From the searched databases, 133 research reports were deemed eligible and included in the meta-analysis. The research reports yielded 254 GDM-prevalence studies that tested 15,572,847 pregnant women between 2014 and 2019. The 133 research reports were from 24 countries in Northern Europe (44.4%), Southern Europe (27.1%), Western Europe (24.1%), and Eastern Europe (4.5%). The overall weighted GDM prevalence in the 24 European countries was estimated at 10.9% (95% CI: 10.0-11.8, I2 : 100%). The weighted GDM prevalence was highest in the Eastern Europe (31.5%, 95% CI: 19.8-44.6, I2 : 98.9%), followed by in Southern Europe (12.3%, 95% CI: 10.9-13.9, I2 : 99.6%), Western Europe (10.7%, 95% CI: 9.5-12.0, I2 : 99.9%), and Northern Europe (8.9%, 95% CI: 7.9-10.0, I2 : 100). GDM prevalence was 2.14-fold increased in pregnant women with maternal age ≥30 years (versus 15-29 years old), 1.47-fold if the diagnosis was made in the third trimester (versus second trimester), and 6.79- fold in obese and 2.29-fold in overweight women (versus normal weight). Conclusions In Europe, GDM is significant in pregnant women, around 11%, with the highest prevalence in pregnant women of Eastern European countries (31.5%). Findings have implications to guide vigilant public health awareness campaigns about the risk factors associated with developing GDM. Systematic Review Registration PROSPERO [https://www.crd.york.ac.uk/PROSPERO/], identifier CRD42020161857.
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Affiliation(s)
- Marília Silva Paulo
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Noor Motea Abdo
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Rita Bettencourt-Silva
- Department of Endocrinology and Nutrition, Unidade Local de Saúde do Alto Minho, Viana do Castelo, Portugal
- Department of Endocrinology, Hospital Lusíadas Porto, Porto, Portugal
| | - Rami H. Al-Rifai
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
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14
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Kragelund Nielsen K, Andersen GS, Damm P, Nybo Andersen AM. Migration, Gestational Diabetes, and Adverse Pregnancy Outcomes: A Nationwide Study of Singleton Deliveries in Denmark. J Clin Endocrinol Metab 2021; 106:e5075-e5087. [PMID: 34272865 DOI: 10.1210/clinem/dgab528] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT It remains unclear if migrants have different odds for adverse outcomes associated with gestational diabetes mellitus (GDM). OBJECTIVE We investigated if the associations between GDM and adverse pregnancy outcomes are modified by country of origin and examined the odds of these outcomes according to GDM status and country of origin. METHODS Data were extracted from a nationwide register-based study of singleton deliveries in Denmark, 2004-2015. We used logistic regression models and tested for interaction. RESULTS Among the 710 413 singleton deliveries, 2.6% had GDM and 14.4% were immigrants. Country of origin modified the association between GDM and pre-eclampsia, large for gestational age (LGA), and small for gestational age (SGA) but not between GDM and planned or emergency cesarean section and preterm delivery. GDM increased the risk of pre-eclampsia among women from Denmark (OR 1.28; 95% CI, 1.18-1.39), Lebanon (OR 3.34; 95% CI, 1.35-8.26), and Morocco (OR 2.28; 95% CI, 1.16-6.88). GDM was associated with increased odds of LGA among women from most countries, particularly women from Sri Lanka (OR 4.20; 95% CI, 2.67-6.61), and was associated with reduced odds of SGA in some countries. Compared with Danish-born women with GDM, the odds of LGA were significantly lower and the odds of SGA higher among women with GDM from India, Lebanon, Pakistan, Iraq, and Somalia. CONCLUSIONS Our study documents that different immigrant groups have higher odds of different GDM-associated adverse pregnancy outcomes and also among countries of origin often grouped together. This highlights the importance of increased awareness to both immigrant background and GDM status in the clinical assessment.
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Affiliation(s)
- Karoline Kragelund Nielsen
- Steno Diabetes Center Copenhagen, 2820 Gentofte, Denmark
- Section of Epidemiology, Department of Public Health, University of Copenhagen, 1353 Copenhagen, Denmark
- Danish Diabetes Academy, 5000 Odense, Denmark
| | | | - Peter Damm
- Center for Pregnant Women with Diabetes, Department of Obstetrics, Rigshospitalet, 2100 Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Anne-Marie Nybo Andersen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, 1353 Copenhagen, Denmark
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15
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Bagger S, Maindal HT, Nielsen KK, Vrå AG, Aagaard-Hansen J. Perceptions of risk and motivation for healthy living among immigrants from non-western countries with prior gestational diabetes mellitus living in Denmark. Health Psychol Behav Med 2021; 9:761-777. [PMID: 34484976 PMCID: PMC8409963 DOI: 10.1080/21642850.2021.1969235] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective To explore perceptions of risk and motivation for healthy living among immigrant women from non-western countries with prior gestational diabetes mellitus (GDM) living in Denmark. Design Seventeen semi-structured interviews were conducted with 12 female immigrants with prior GDM from non-western countries living in Denmark. The women were recruited through a public hospital and other health services and nongovernmental organisations. The theoretical approach was inspired by Arthur Kleinman’s Explanatory Models. Data were analysed using qualitative content analysis. Results A diagnosis of GDM entailed great worry for the future. Participants’ fears were primarily linked to the potential later development of type 2 diabetes (T2D) and poor health. Women’s perceptions of GDM reflected their experiences with T2D-related complications and even death among relatives. The risk perception of GDM was also influenced by participants’ challenges and trauma unrelated to diabetes. Their motivation for healthy living was strengthened by their experiences with T2D among relatives, while unrelated challenges and trauma generally reduced their capacity for healthier behaviours. Conclusion Among women with a non-western immigrant background and prior GDM living in Denmark, experiences with T2D among family members and their close communities affect their perceptions of risk and motivation to prevent the development of T2D. Furthermore, the challenges of daily life and past trauma were critical factors in their levels of available resources for health. Health promotion in this population should address health in a holistic way by integrating mental and social health with interventions aimed at preventing the development of T2D.
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Affiliation(s)
- Stine Bagger
- Health Promotion Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Helle Terkildsen Maindal
- Health Promotion Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark.,Department of Public Health, Section for Health Promotion, Aarhus University, Aarhus, Denmark
| | | | | | - Jens Aagaard-Hansen
- Health Promotion Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark.,Faculty of Health Sciences, SA MRC Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
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16
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Punnose J, Malhotra RK, Sukhija K, Sharma A, Vij P, Rijhwani RM, Choudhary N. Prevalence of 'Hyperglycemia in pregnancy' remained stable between 2006 and 2015, despite rise in conventional risk factors: A hospital based study in Delhi, North India. Diabetes Res Clin Pract 2021; 177:108872. [PMID: 34051281 DOI: 10.1016/j.diabres.2021.108872] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 02/12/2021] [Accepted: 05/24/2021] [Indexed: 10/21/2022]
Abstract
AIMS Between 2006 and 2015, the trends in prevalence of Hyperglycemia in pregnancy (HIP); Gestational diabetes (GDM), Diabetes in Pregnancy (DIP), Pre existing diabetes (PDM) and GDM risk factors were studied in 30,692 pregnancies among Asian Indian women. METHODS GDM (n = 4089) and DIP (n = 259) diagnoses were by 75 g OGTT, while PDM (n = 103) was identified by ICD code O24. Women with DIP and PDM were grouped together as pre-gestational diabetes (PGDM n = 362). Crude and age-adjusted prevalence trend analysis by Poisson and Jointpoint regression models respectively, were done in GDM and PGDM groups. RESULTS During study years, the GDM prevalence by WHO 1999 and modified IADPSG criteria, showed decreasing and static trends respectively, while PGDM prevalence remained static. In a subgroup of 2560 women, mean BMI increased from 24.12 ± 4.16 in year 2011 to 25.18 ± 4.7 Kg/m2 in 2015 (p < 0.014), but this rise had no impact on GDM prevalence. GDM risk factors; maternal age, gravidity ≥3, previous GDM and abortion, high income, diabetes and hypertension in family, were higher in 2011-2015 than in 2006-2010 period. On multivariate analysis, BMI was not an independent GDM risk factor. CONCLUSION Despite rise in conventional GDM risk factors, HIP prevalence was static for a decade among pregnant Asian Indian women.
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Affiliation(s)
- John Punnose
- Department of Endocrinology, St. Stephen's Hospital, Delhi, India.
| | | | - Komal Sukhija
- Department of Endocrinology, St. Stephen's Hospital, Delhi, India
| | - Asha Sharma
- Department of Obstetrics and Gynaecology, St. Stephen's Hospital, Delhi, India
| | - Prassan Vij
- Department of Reproductive Medicine, St. Stephen's Hospital, Delhi, India
| | | | - Naimaa Choudhary
- Department of Obstetrics and Gynaecology, St. Stephen's Hospital, Delhi, India
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17
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Perception of and Motivation for Physical Activity among Women with a History of Gestational Diabetes. WOMEN 2021. [DOI: 10.3390/women1020010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
(1) Background: Women with a history of gestational diabetes mellitus (GDM) have a high risk of developing type 2 diabetes (T2DM). This risk can be reduced with lifestyle interventions, including physical activity. However, studies have shown that many women with prior GDM are not physically active. The aim of this study was to investigate the motivation for physical activity among women with prior GDM. (2) Methods: A qualitative study was carried out based on a phenomenological approach using semi-structured individual interviews with nine Danish women between 29 and 36 years of age with a minimum of one earlier GDM-affected pregnancy. (3) Results: Five themes were identified; perception of physical activity, risk perception, emotional distress, competing priorities and social support. The perception of physical activity varied among the women. The GDM diagnosis or the awareness of elevated risk for T2DM did not seem to be a decisive factor for the women’s motivation to be active. Competing priorities, including being in control of everyday life choices and support from social relations, were found to be important motivational factors. (4) Conclusion: Future interventions for women with prior GDM to increase motivation for physical activity should be compatible with and take into account the women’s perceptions, earlier lived experiences, possible competing priorities and support systems.
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18
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Metabolic syndrome in women with previous gestational diabetes. Sci Rep 2021; 11:11558. [PMID: 34078945 PMCID: PMC8172609 DOI: 10.1038/s41598-021-90832-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 05/07/2021] [Indexed: 11/30/2022] Open
Abstract
To evaluate the incidence and timing of the diagnosis of metabolic syndrome in a cohort of Danish women after a pregnancy with gestational diabetes (GDM) to estimate the optimum time for preventative actions in relation to metabolic syndrome (MetS). In this follow-up study, 435 women were included from a consecutive cohort with prior history of GDM. Data on dyslipidemia, hypertension and other cardiovascular disorders (CVD) were extracted from the electronic patient journal. Any antidiabetic, cardiovascular and cholesterol-lowering medicine was ascertained in the national prescription database. Similarly, any blood test taken was evaluated. We defined a patient having MetS if the criteria of the WHO based definition of diabetes or impaired glucose regulation were met. Further, we added as alternative for glucose intolerance, a glycosylated hemoglobin (HbA1c) > 44 mmol/mol or the former level ≥ 6.5%. Further, dyslipidemia, lipid lowering medications, BMI > 30 kg/m2 or antihypertensive treatment were used. For MetS outcome, diagnosis or medication for CVD was registered. All women were followed for median 5.7 years (range 0; 9). The incidence of MetS was 28%. Thirteen percent of these qualified already within one year after pregnancy for the diagnosis of MetS. Postpartum MetS was detected after a median of 3 years (range 0; 7 years); further, 36 (8%) had been diagnosed with manifest diabetes after pregnancy. The diagnosis of postpartum MetS was strongly associated with the prevalence of manifest diabetes. Six years after pregnancy the rate of metabolic syndrome was more than tripled (25 vs. 89%, no DM vs manifest DM, RR: 6.7; 95% CI 2.7–17, p < 0.001). At 40 years the MetS rate nearly tripled if manifest DM was diagnosed (26 vs. 78%, no DM vs. manifest DM, RR: 3.3, 95% CI 1.8–6, p < 0.001). We found that GDM and later on manifest DM in women increase the risk of metabolic syndrome. There seems to be a window of opportunity before the early thirties where it would be especially beneficial to begin preventive efforts in women with GDM.
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19
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Strandberg RB, Iversen MM, Jenum AK, Sørbye LM, Vik ES, Schytt E, Aasheim V, Nilsen RM. Gestational diabetes mellitus by maternal country of birth and length of residence in immigrant women in Norway. Diabet Med 2021; 38:e14493. [PMID: 33290601 DOI: 10.1111/dme.14493] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 12/01/2020] [Accepted: 12/03/2020] [Indexed: 12/16/2022]
Abstract
AIMS Immigrant women are at higher risk for gestational diabetes mellitus (GDM) than non-immigrant women. This study described the prevalence of GDM in immigrant women by maternal country of birth and examined the associations between immigrants' length of residence in Norway and GDM. METHODS This Norwegian national population-based study included 192,892 pregnancies to immigrant and 1,116,954 pregnancies to non-immigrant women giving birth during the period 1990-2013. Associations were reported as odds ratios (ORs) with 95% confidence intervals (CIs) using logistic regression models, adjusted for year of delivery, maternal age, marital status, health region, parity, education and income. RESULTS The prevalence and adjusted OR [CI] for GDM were substantially higher in immigrant women from Bangladesh (7.4%, OR 8.38 [5.41, 12.97]), Sri Lanka (6.3%, OR 7.60 [6.71, 8.60]), Pakistan (4.3%, OR 5.47 [4.90, 6.11]), India (4.4%, OR 5.18 [4.30, 6.24]) and Morocco (4.3%, OR 4.35 [3.63, 5.20]) compared to non-immigrants (prevalence 0.8%). Overall, GDM prevalence increased from 1.3% (OR 1.25 [1.14, 1.36]) to 3.3% (OR 2.55 [2.39, 2.71]) after 9 years of residence in immigrants compared to non-immigrant women. This association was particularly strong for women from South Asia. CONCLUSIONS Gestational diabetes mellitus prevalence varied substantially between countries of maternal birth and was particularly high in immigrants from Asian countries. GDM appeared to increase with longer length of residence in certain immigrant groups.
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Affiliation(s)
- Ragnhild B Strandberg
- Faculty of Health and Social Sciences, Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Marjolein M Iversen
- Faculty of Health and Social Sciences, Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Anne K Jenum
- General Practice Research Unit (AFE), Department of General Practice, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Linn Marie Sørbye
- Faculty of Health and Social Sciences, Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Norwegian National Advisory Unit on Women's Health, Oslo University Hospital, Oslo, Norway
| | - Eline S Vik
- Faculty of Health and Social Sciences, Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Erica Schytt
- Faculty of Health and Social Sciences, Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Centre for Clinical Research Dalarna, Uppsala University, Falun, Sweden
| | - Vigdis Aasheim
- Faculty of Health and Social Sciences, Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Roy M Nilsen
- Faculty of Health and Social Sciences, Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
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20
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Tryggvadottir EA, Halldorsson TI, Landberg R, Hrolfsdottir L, Birgisdottir BE, Magnusdottir OK, Hreidarsdottir IT, Hardardottir H, Gunnarsdottir I. Higher Alkylresorcinol Concentrations, a Consequence of Whole-Grain Intake, are Inversely Associated with Gestational Diabetes Mellitus in Iceland. J Nutr 2021; 151:1159-1166. [PMID: 33693761 DOI: 10.1093/jn/nxaa449] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/12/2020] [Accepted: 12/22/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND A diet rich in whole grains may provide benefits for pregnant women due to whole grains' high nutritional value and dietary fiber content. OBJECTIVES To study the associations of whole-grain consumption, as well as the plasma alkylresorcinol concentration, a whole-grain consumption biomarker, in early pregnancy with gestational diabetes mellitus (GDM) diagnoses. METHODS Subjects were women from the prospective study Pregnant Women in Iceland II (PREWICE II; n = 853) who attended their ultrasound appointment in gestational weeks 11-14 during the period from October 2017 to March 2018. During that visit, whole-grain consumption was estimated using a diet screening questionnaire, and blood samples were collected for analysis of plasma alkylresorcinols (ARs). Information on GDM diagnoses was later extracted from medical records. Multivariate log-binomial regression was used to evaluate the association of dietary whole-grain and AR concentrations with GDM. RESULTS In total, 14.9% of the women adhered to the national food-based dietary guidelines (n = 127), which recommend 2 portions of whole grains daily. GDM was diagnosed in 127 women (14.9%). The frequency of whole-grain consumption was lower in women who were later diagnosed with GDM compared to the women without GDM (median, 5 times/week vs. 6 times/week, respectively; P = 0.02). This difference was reflected in the lower median concentration of total AR in women diagnosed with GDM (163 nmol/L vs. 209 nmol/L, respectively; P < 0.01). The quartile with the highest concentrations of AR had a RR of 0.50 (95% CI: 0.27-0.90) of being diagnosed with GDM, in comparison to the lowest quartile. There was a significant dose response in the GDM risk with higher AR levels. CONCLUSIONS We found that a higher consumption of whole grains, reflected both by reported consumption according to the FFQ and AR biomarkers, was associated with a decreased risk of receiving a GDM diagnosis.
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Affiliation(s)
- Ellen A Tryggvadottir
- Unit for Nutrition Research, Landspitali University Hospital and Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland
| | - Thorhallur I Halldorsson
- Unit for Nutrition Research, Landspitali University Hospital and Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland.,Centre for Fetal Programming, Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Rikard Landberg
- Division of Food and Nutrition Science, Department of Biology and Biological Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Laufey Hrolfsdottir
- Unit for Nutrition Research, Landspitali University Hospital and Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland.,Institution of Health Science Research, University of Akureyri and Akureyri Hospital, Akureyri, Iceland
| | - Bryndis E Birgisdottir
- Unit for Nutrition Research, Landspitali University Hospital and Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland
| | - Ola K Magnusdottir
- Unit for Nutrition Research, Landspitali University Hospital and Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland
| | | | - Hildur Hardardottir
- Faculty of Medicine, University of Iceland Reykjavík, Reykjavík, Iceland.,Livio Reykjavík, Reproductive Center in Reykjavík, Reykjavík, Iceland
| | - Ingibjorg Gunnarsdottir
- Unit for Nutrition Research, Landspitali University Hospital and Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland
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21
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Ørtenblad L, Høtoft D, Krogh RH, Lynggaard V, Juel Christiansen J, Vinther Nielsen C, Hedeager Momsen AM. Women's perspectives on motivational factors for lifestyle changes after gestational diabetes and implications for diabetes prevention interventions. ENDOCRINOLOGY DIABETES & METABOLISM 2021; 4:e00248. [PMID: 34277972 PMCID: PMC8279634 DOI: 10.1002/edm2.248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/02/2021] [Accepted: 02/27/2021] [Indexed: 12/12/2022]
Abstract
Introduction Gestational diabetes mellitus (GDM) is a common complication in pregnancy and constitutes a public health problem due to the risk of developing diabetes and other diseases. Most women face barriers in complying with preventive programs. This study aimed to explore motivational factors for lifestyle changes among women with a history of GDM and their suggestions for preventive programs. Methods This study used a qualitative approach in six focus group interviews with a total of 32 women. The selection criteria were time since onset of GDM, including women diagnosed with GDM, six months and five years after GDM, diagnosed and not diagnosed with diabetes. Inductive analysis was performed. Results The women reacted with anxiety about their GDM diagnosis and experienced persistent concerns about the consequences of GDM. They were highly motivated to take preventive initiatives, but faced major adherence challenges. The demotivating factors were lack of time and resources, too little family involvement, lack of knowledge and social norms that may obstruct healthy eating. A powerful motivational factor for complying with preventive strategies was the well-being of their children and partners. Conclusions Preventive initiatives should be rooted in the women's perception of GDM/diabetes and based on their experiences with barriers and motivational factors. The well-being and the quality of life within the family are dominant motivational factors which offer powerful potentials for supporting the women's coping capability. Further, there is a need to be responsiveness to the women and their families even a long time after the onset of GDM.
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Affiliation(s)
- Lisbeth Ørtenblad
- DEFACTUM - Public Health and Rehabilitation Research Central Denmark Region Aarhus Denmark.,Department of Public Health Aarhus University Aarhus Denmark
| | - Diana Høtoft
- DEFACTUM - Public Health and Rehabilitation Research Central Denmark Region Aarhus Denmark
| | - Rubab H Krogh
- Department of Gynaecology and Obstetrics Gødstrup Hospital Herning Denmark
| | - Vibeke Lynggaard
- Steno Diabetes Center Aarhus Health Promotion Research Aarhus Denmark.,Cardiovascular Research Unit Department of Cardiology Gødstrup Hospital Aarhus Denmark
| | - Jens Juel Christiansen
- Steno Diabetes Center Aarhus Health Promotion Research Aarhus Denmark.,Department of Medicine Gødstrup Hospital Aarhus Denmark
| | - Claus Vinther Nielsen
- DEFACTUM - Public Health and Rehabilitation Research Central Denmark Region Aarhus Denmark.,Department of Public Health Aarhus University Aarhus Denmark.,Section for Clinical Social Medicine and Rehabilitation Gødstrup Hospital Aarhus Denmark
| | - Anne-Mette Hedeager Momsen
- DEFACTUM - Public Health and Rehabilitation Research Central Denmark Region Aarhus Denmark.,Department of Public Health Aarhus University Aarhus Denmark
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22
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Could Subtle Obstetrical Brachial Plexus Palsy Be Related to Unilateral B Glenoid Osteoarthritis? J Clin Med 2021; 10:jcm10061196. [PMID: 33809287 PMCID: PMC7999215 DOI: 10.3390/jcm10061196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/04/2021] [Accepted: 03/04/2021] [Indexed: 02/06/2023] Open
Abstract
Background: Several factors associated with B glenoid are also linked with obstetrical brachial plexus palsy (OBPP). The purpose of this observational study was to determine the incidence of OBPP risk factors in type B patients. Methods: A cohort of 154 patients (68% men, 187 shoulders) aged 63 ± 17 years with type B glenoids completed a questionnaire comprising history of perinatal characteristics related to OBPP. A literature review was performed following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) to estimate the incidence of OBPP risk factors in the general population. Results: Twenty-seven patients (18%) reported one or more perinatal OBPP risk factors, including shoulder dystocia (n = 4, 2.6%), macrosomia >4 kg (n = 5, 3.2%), breech delivery (n = 6, 3.9%), fetal distress (n = 8, 5.2%), maternal diabetes (n = 2, 1.3%), clavicular fracture (n = 2, 1.3%), and forceps delivery (n = 4, 2.6%). The comparison with the recent literature suggested that most perinatal OBPP risk factors were within the normal range, although the incidence of shoulder dystocia, forceps and vaginal breech deliveries exceeded the average rates. Conclusion: Perinatal factors related to OBPP did not occur in a higher frequency in patients with Walch type B OA compared to the general population, although some of them were in the high normal range.
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23
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Healthcare Professionals' Perspectives on the Cross-Sectoral Treatment Pathway for Women with Gestational Diabetes during and after Pregnancy-A Qualitative Study. J Clin Med 2021; 10:jcm10040843. [PMID: 33670723 PMCID: PMC7923110 DOI: 10.3390/jcm10040843] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 02/16/2021] [Accepted: 02/17/2021] [Indexed: 01/14/2023] Open
Abstract
Gestational diabetes mellitus (GDM) increases the risk of adverse outcomes during and after pregnancy, including a long-term risk of type 2 diabetes. Women with GDM are treated by numerous healthcare professionals during pregnancy and describe a lack of preventive care after pregnancy. We aim to investigate healthcare professionals’ perspectives on the cross-sectoral treatment pathway for women with GDM—during and after pregnancy. A qualitative study was conducted using systematic text condensation. Nine healthcare professionals (two general practitioners, four midwives, two obstetricians and one diabetes nurse) were interviewed and eight health visitors participated in two focus group discussions., Three major themes emerged: (1) “professional identities”, which were identified across healthcare professionals and shaped care practices; (2) ”unclear guidelines on type 2 diabetes prevention after GDM”, which contributed to uncertainty about tasks and responsibilities during and after pregnancy; and (3) “cross-sectoral collaboration”, which relied heavily on knowledge transfers between hospitals, general practice and the local municipality. The findings implicate that clear, transparent guidelines for all sectors should be prioritized to strengthen cross-sectoral care to women with GDM during and after pregnancy. As a result, strong cross-sectoral care throughout the GDM care pathway may improve maternal health by supporting healthy behaviors, facilitate weight loss and reduce the risk of subsequent GDM and early onset diabetes.
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24
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Behboudi-Gandevani S, Parajuli R, Vaismoradi M. A Systematic Review of the Prevalence of Gestational Diabetes in Norway. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041423. [PMID: 33546492 PMCID: PMC7913746 DOI: 10.3390/ijerph18041423] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 01/23/2021] [Accepted: 02/01/2021] [Indexed: 12/13/2022]
Abstract
Gestational diabetes mellitus (GDM) is a major public health problem and a threat to maternal and child health. There is a lack of integrated and systematically synthesized knowledge about the prevalence GDM in Norway. Therefore, this systemic review aimed to present the best available peer-reviewed published evidence from the past 20 years about the prevalence of GDM in Norway. A comprehensive literature search was performed on online databases consisting of PubMed (including Medline), Web of Science, and Scopus to retrieve original research articles published on the prevalence of GDM up to August 2020. Also, databases of Norart and SveMed+ in the Norwegian language were searched to enhance the search coverage. Data were extracted using a standardized protocol and data collection form and were presented narratively. A total of 11 studies were selected to include for data analysis and synthesis with the total sample size of 2,314,191 pregnant women. The studies included heterogenous populations and mostly reported the prevalence of GDM in healthy mothers with singleton pregnancies. The prevalence of GDM in population registered-based studies in Norway was reported to be lower than 2%, using the World Health Organization (WHO) 1999 criteria. However, studies on high-risk populations such as the non-European ethnicity reported prevalence rates ranging from 8% to 15%. Given the evidence from available literature that reported trends in the prevalence of GDM, an increase in the prevalence of GDM across most racial/ethnic groups studied in Norway was observed. Overall, the prevalence of GDM in the low risk population of Norway is fairly low, but the available literature supports the perspective that the prevalence of GDM has shown an increasing trend in recent decades. This finding is very important for health service planning and evaluation, policy development, and research in Norway. Large-scale prospective studies, using the national data, are warranted to provide firm evidence over coming years. Our review findings can help policy makers devise appropriate strategies for improving women's reproductive health.
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25
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Pedersen DC, Bjerregaard LG, Rasmussen KM, Nohr EA, Baker JL. Risk of gestational diabetes mellitus in nulliparous women - Associations with early life body size and change in body mass index from childhood to adulthood. Diabetes Res Clin Pract 2021; 171:108564. [PMID: 33271232 DOI: 10.1016/j.diabres.2020.108564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/06/2020] [Accepted: 11/16/2020] [Indexed: 11/24/2022]
Abstract
AIMS We examined whether a woman's birthweight, childhood height, body mass index (BMI), and BMI changes from childhood to pregnancy were associated with risks of gestational diabetes mellitus (GDM). METHODS We studied 13,031 women from the Copenhagen School Health Records Register born 1959-1996 with birthweight and measured anthropometric information at ages 7 and/or 13. The diagnosis of GDM (n = 255) was obtained from a national health register. Risk ratios (RR) were estimated using log-linear binomial regression. RESULTS Own birthweight and childhood height were inversely associated with GDM. Girls with overweight at age 7 had a higher risk of GDM than girls with normal-weight (RR: 1.79, 95% CI: 1.31, 2.47). Compared to women with normal-weight in childhood and adulthood, risks of GDM were higher in women who developed overweight from age 7 to pregnancy (RR: 4.62; 3.48, 6.14) or had overweight at both times (RR: 4.71; 3.24, 6.85). In women whose BMI normalized from age 7 to pregnancy the RR for GDM was 1.08 (0.47, 2.46). CONCLUSIONS Lower birthweight, shorter childhood height, and higher childhood BMI are associated with increased risks of GDM. Efforts to help girls maintain a normal BMI before pregnancy may be warranted to minimize risks of GDM.
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Affiliation(s)
- Dorthe C Pedersen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region, Copenhagen, Denmark
| | - Lise G Bjerregaard
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region, Copenhagen, Denmark
| | | | - Ellen A Nohr
- Research Unit of Obstetrics and Gynecology, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jennifer L Baker
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region, Copenhagen, Denmark.
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26
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Qi Y, Sun X, Tan J, Zhang G, Chen M, Xiong Y, Chen P, Liu C, Zou K, Liu X. Excessive gestational weight gain in the first and second trimester is a risk factor for gestational diabetes mellitus among women pregnant with singletons: A repeated measures analysis. J Diabetes Investig 2020; 11:1651-1660. [PMID: 32324966 PMCID: PMC7610133 DOI: 10.1111/jdi.13280] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 03/24/2020] [Accepted: 04/15/2020] [Indexed: 02/05/2023] Open
Abstract
AIMS/INTRODUCTION To evaluate gestational weight gain (GWG) in the first and second trimester as a risk factor for gestational diabetes mellitus (GDM) among women pregnant with singletons. MATERIALS AND METHODS This was a cohort study of women with singleton pregnancies who delivered between 1 January 2013 and 31 October 2014 in a Chinese hospital. We collected data from medical records from the first antenatal visit to delivery. All pregnant women were subjected to an oral glucose tolerance test for diagnosis of GDM during the second trimester. GWG in the first and second trimester was calculated by subtracting the prepregnancy weight from weight within 4 weeks of the oral glucose tolerance test. We categorized GWG into insufficient, appropriate and excessive according to the Institute of Medicine guidelines and population quantiles. Univariable and multivariable analyses were used to determine the association between GWG and GDM risk. RESULTS Of 10,422 pregnant women, we identified 8,356 eligible women with 1,622 (19.4%) diagnosed with GDM. Univariable analysis showed that GWG that exceeded the Institute of Medicine recommendation might be associated with risk of GDM (P < 0.05), but this association was not observed by multivariable analysis (adjusted odds ratio 1.07, [95% confidence interval 0.94-1.21]). Univariable and multivariable analyses both showed that GWG exceeding the 90th and 95th quantiles of included women, respectively, were at increased risk for GDM (adjusted odds ratio >P90 vs P10 -P90 adjusted odds ratio 1.31, [95% confidence interval 1.12-1.52]; >P95 vs P5 -P95 adjusted odds ratio 1.45 [95% confidence interval 1.16-1.81]). CONCLUSIONS Excessive GWG in the first and second trimester might be a risk factor for GDM, which highlights the importance of appropriate weight gain during pregnancy.
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Affiliation(s)
- Yana Qi
- Chinese Evidence‐based Medicine CenterWest China HospitalSichuan UniversityChengduChina
| | - Xin Sun
- Chinese Evidence‐based Medicine CenterWest China HospitalSichuan UniversityChengduChina
| | - Jing Tan
- Chinese Evidence‐based Medicine CenterWest China HospitalSichuan UniversityChengduChina
| | - Guiting Zhang
- Chinese Evidence‐based Medicine CenterWest China HospitalSichuan UniversityChengduChina
| | - Meng Chen
- Department of Obstetrics and GynecologyWest China Second University HospitalSichuan UniversityChengduChina
| | - Yiquan Xiong
- Chinese Evidence‐based Medicine CenterWest China HospitalSichuan UniversityChengduChina
| | - Peng Chen
- Department of Obstetrics and GynecologyWest China Second University HospitalSichuan UniversityChengduChina
| | - Chunrong Liu
- Chinese Evidence‐based Medicine CenterWest China HospitalSichuan UniversityChengduChina
| | - Kang Zou
- Chinese Evidence‐based Medicine CenterWest China HospitalSichuan UniversityChengduChina
| | - Xinghui Liu
- Department of Obstetrics and GynecologyWest China Second University HospitalSichuan UniversityChengduChina
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27
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Aagaard KA, Al-Far HM, Piscator U, Krogh RA, Lauszus FF. Manifest diabetes after gestational diabetes: a double-cohort, long-term follow-up in a Danish population. Arch Gynecol Obstet 2020; 302:1271-1278. [PMID: 32656592 DOI: 10.1007/s00404-020-05669-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 06/25/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE The aim was to follow-up two cohorts of women with GDM to investigate the incidence and time of diagnosis of manifest diabetes mellitus (DM) postpartum and identify the risk factors for diabetes in our population. METHODS A follow-up study on two independent cohorts having oral glucose tolerance test (OGTT) in 1991/1992 and 2011-2016: Cohort 1 consisted of 406 women including 54 with GDM and 352 with a non-GDM OGTT-test and cohort 2 had 433 women diagnosed with GDM. The first cohort had nearly 25 years of follow-up and gave information on magnitude, conversion rate and type of diabetes manifestation. The second cohort was started recently to evaluate whether newer diagnostic criteria and baseline information on the old cohort are still valid for prediction of diabetes risk. RESULTS The risk of manifest diabetes in cohort 1 at the end of follow-up was six times higher in women with previous GDM compared with non-GDM (RR = 6; 95% CI 4-11). We observed a 70% diabetes rate 25 years after pregnancy. Only family history of diabetes in cohort 2 was associated with conversion to manifest diabetes (p = 0.002), also after adjustment for age, BMI, non-Danish origin and smoking during pregnancy (p < 0.001) CONCLUSION: The incidence of diabetes after GDM is higher than that previously reported in Scandinavian populations and the rate of manifest diabetes rises steeply 15 years after pregnancy and after 40 years of age. The women of cohort 2 with recent GDM are at risk of DM at a higher rate. On this background our results are useful in identifying the time where GDM women may benefit from the effective implementation of evidence-based treatment to postpone and advert manifest DM.
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Affiliation(s)
- Kristina Aaskjær Aagaard
- Department of Gynecology and Obstetrics, Herning Hospital, Gl. Landevej 61, 7400, Herning, Denmark
| | - Hanine Mustafa Al-Far
- Department of Gynecology and Obstetrics, Herning Hospital, Gl. Landevej 61, 7400, Herning, Denmark
| | - Ulrika Piscator
- Department of Gynecology and Obstetrics, Herning Hospital, Gl. Landevej 61, 7400, Herning, Denmark
| | - Rubab Agha Krogh
- Department of Gynecology and Obstetrics, Herning Hospital, Gl. Landevej 61, 7400, Herning, Denmark
| | - Finn Friis Lauszus
- Department of Gynecology and Obstetrics, Herning Hospital, Gl. Landevej 61, 7400, Herning, Denmark.
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Zhang H, Wang Q, He S, Wu K, Ren M, Dong H, Di J, Yu Z, Huang C. Ambient air pollution and gestational diabetes mellitus: A review of evidence from biological mechanisms to population epidemiology. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 719:137349. [PMID: 32114225 DOI: 10.1016/j.scitotenv.2020.137349] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 02/06/2020] [Accepted: 02/14/2020] [Indexed: 05/26/2023]
Abstract
Gestational diabetes mellitus (GDM) is a serious complication of pregnancy that could cause adverse health effects on both mothers and fetuses, and its prevalence has been increasing worldwide. Experimental and epidemiological studies suggest that air pollution may be an important risk factor of GDM, but conclusions are inconsistent. To provide a comprehensive overview of ambient air pollution on GDM, we summarized existing evidence concerning biological linkages between maternal exposure to air pollutants and GDM based on mechanism studies. We also performed a quantitative meta-analysis based on human epidemiological studies by searching English databases (Pubmed, Web of Science and Embase) and Chinese databases (Wanfang, CNKI). As a result, the limited mechanism studies indicated that β-cell dysfunction, neurohormonal disturbance, inflammation, oxidative stress, imbalance of gut microbiome and insulin resistance may be involved in air pollution-GDM relationship, but few studies were performed to explore the direct biological linkage. Additionally, a total of 13 epidemiological studies were included in the meta-analysis, and the air pollutants considered included PM2.5, PM10, SO2, NO2 and O3. Most studies were retrospective and mainly conducted in developed regions. The results of meta-analysis indicated that maternal first trimester exposure to SO2 increased the risk of GDM (standardized odds ratio (OR) = 1.392, 95% confidence intervals (CI): 1.010, 1.773), while pre-pregnancy O3 exposure was inversely associated with GDM risk (standardized OR = 0.981, 95% CI: 0.977, 0.985). No significant effects were observed for PM2.5, PM10 and NO2. In conclusion, additional mechanism studies on the molecular level are needed to provide persuasive rationale underlying the air pollution-GDM relationship. Moreover, other important risk factors of GDM, including maternal lifestyle and road traffic noise exposure that may modify the air pollution-GDM relationship should be considered in future epidemiological studies. More prospective cohort studies are also warranted in developing countries with high levels of air pollution.
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Affiliation(s)
- Huanhuan Zhang
- School of Public Health, Zhengzhou University, Zhengzhou 450001, China; School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Qiong Wang
- School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Simin He
- School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Kaipu Wu
- School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Meng Ren
- School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Haotian Dong
- School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Jiangli Di
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, China.
| | - Zengli Yu
- School of Public Health, Zhengzhou University, Zhengzhou 450001, China.
| | - Cunrui Huang
- School of Public Health, Zhengzhou University, Zhengzhou 450001, China; School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; Shanghai Typhoon Institute, China Meteorological Administration, Shanghai 200030, China; Shanghai Key Laboratory of Meteorology and Health, Shanghai Meteorological Service, Shanghai 200030, China.
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29
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Kragelund Nielsen K, Andersen GS, Damm P, Andersen AMN. Gestational Diabetes Risk in Migrants. A Nationwide, Register-Based Study of all Births in Denmark 2004 to 2015. J Clin Endocrinol Metab 2020; 105:5707566. [PMID: 31950143 DOI: 10.1210/clinem/dgaa024] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 01/13/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Much remains to be understood about socioeconomic position and body mass index (BMI) in the pathways linking ethnicity, migration, and gestational diabetes mellitus (GDM). We investigated differences in GDM prevalence according to maternal country of origin and the role played by socioeconomic position and BMI on this relationship. Finally, we examined how length of residency was associated with GDM. METHODS A register-based cohort study of the 725 482 pregnancies that resulted in a birth in Denmark, 2004 to 2015. Of these, 14.4% were by women who had migrated to Denmark. A GDM diagnosis was registered in 19 386 (2.7%) pregnancies, of which 4464 (23.0%) were in immigrant women. The crude risk of GDM according to maternal country of origin compared to Danish-born women ranged from an odds ratio (OR) of 0.50 (95% CI 0.34-0.71) for women from Sweden to an OR of 5.11 (95% CI 4.28-6.11) for women from Sri Lanka. Adjustment for socioeconomic position slightly attenuated the risks. Adjusting for BMI resulted in increased ORs for women, especially from Asian countries. The separate and joint effects of migration and overweight on GDM risk differed substantially between the countries of origin (P value interaction term < .001). Immigrants with 10 or more years of residency had a 56% increased risk of GDM (OR 1.56, 95% CI 1.44-1.68) compared to immigrants with less than 5 years in Denmark. This risk was somewhat diluted when adjusting for age and BMI. CONCLUSIONS This study demonstrates substantial variation in the risk of GDM according to country of origin. The risk associations are only slightly affected by socioeconomic position and BMI.
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Affiliation(s)
- Karoline Kragelund Nielsen
- Steno Diabetes Center, Gentofte, Denmark
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Danish Diabetes Academy, Odense, Denmark
| | | | - Peter Damm
- Center for Pregnant Women with Diabetes, Department of Obstetrics, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anne-Marie Nybo Andersen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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30
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Nielsen KK, Dahl-Petersen IK, Jensen DM, Ovesen P, Damm P, Jensen NH, Thøgersen M, Timm A, Hillersdal L, Kampmann U, Vinter CA, Mathiesen ER, Maindal HT. Protocol for a randomised controlled trial of a co-produced, complex, health promotion intervention for women with prior gestational diabetes and their families: the Face-it study. Trials 2020; 21:146. [PMID: 32033613 PMCID: PMC7006376 DOI: 10.1186/s13063-020-4062-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 01/09/2020] [Indexed: 12/17/2022] Open
Abstract
Background Gestational diabetes mellitus (GDM) is associated with an increased risk of future diabetes in both mother, father and offspring. More knowledge is needed about how to effectively reduce the risk of diabetes through sustained behavioural interventions in these families. The Face-it intervention is a complex health promotion intervention embedded in multi-level supportive environments. The aim of the intervention is to reduce type 2 diabetes risk and increase quality of life among families in the first year following a GDM-affected pregnancy by promoting physical activity, healthy dietary behaviours and breastfeeding through a focus on social support, motivation, self-efficacy, risk perception and health literacy. Methods This national multicentre study is a two-arm randomised controlled trial including 460 women with GDM in a ratio of 2 (intervention):1 (usual care). The Face-it intervention consists of three main components: 1) additional visits from municipal health visitors, 2) digital health coaching tailored to family needs and 3) a structured cross-sectoral communication system in the health care system. The intervention runs from 3 to 12 months after delivery. The primary outcome is maternal body mass index at 12 months after delivery as a proxy for diabetes risk. The women will be examined at baseline and at follow-up, and this examination will include blood tests, oral glucose tolerance test (OGTT), anthropometrics, blood pressure, self-reported diet and physical activity, breastfeeding, quality of life, health literacy, physical and mental health status, risk perception and social support. Aside from those data collected for OGTT and breastfeeding and offspring parameters, the same data will be collected for partners. Data on offspring anthropometry will also be collected. Information on pregnancy- and birth-related outcomes will be derived from the medical records of the woman and child. Discussion This randomised controlled trial seeks to demonstrate whether the Face-it intervention, addressing the individual, family and health care system levels, is superior to usual care in reducing diabetes risk for mothers and their families. Coupled with a process evaluation and an economic analysis, the study will provide evidence for policymakers and health services about health promotion among families affected by GDM and the potential for reducing risk of type 2 diabetes and associated conditions. Trial registration ClinicalTrials.gov NCT03997773. Registered June 25, 2019 – Retrospectively registered.
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Affiliation(s)
| | | | - Dorte Møller Jensen
- Steno Diabetes Center Odense, Odense, Denmark.,Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Per Ovesen
- Department of Obstetrics, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Damm
- Centre for Pregnant Women with Diabetes, Department of Obstetrics, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Maja Thøgersen
- Health Promotion, Steno Diabetes Center Copenhagen, Niels Steensens Vej 6, 2820, Gentofte, Denmark
| | - Anne Timm
- Health Promotion, Steno Diabetes Center Copenhagen, Niels Steensens Vej 6, 2820, Gentofte, Denmark.,Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Line Hillersdal
- Health Promotion, Steno Diabetes Center Copenhagen, Niels Steensens Vej 6, 2820, Gentofte, Denmark.,Department of Anthropology, University of Copenhagen, Copenhagen, Denmark
| | | | - Christina Anne Vinter
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Elisabeth Reinhardt Mathiesen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Centre for Pregnant Women with Diabetes, Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark
| | - Helle Terkildsen Maindal
- Health Promotion, Steno Diabetes Center Copenhagen, Niels Steensens Vej 6, 2820, Gentofte, Denmark.,Department of Public Health, Aarhus University, Aarhus, Denmark
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31
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Karaçam Z, Çelİk D. The prevalence and risk factors of gestational diabetes mellitus in Turkey: a systematic review and meta-analysis. J Matern Fetal Neonatal Med 2019; 34:1331-1341. [PMID: 31220964 DOI: 10.1080/14767058.2019.1635109] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To identify the prevalence and related risk factors of gestational diabetes mellitus (GDM) based on studies on the condition conducted in Turkey. METHODS The study is a systematic review and meta-analysis and was conducted over the period November-December 2017 by performing a search of the Turkish and English literature. The international databases were accessed using the keywords "gestational diabetes" and "Turkey" and the national databases were scanned using the word groups, "gestational diabetes", "diabetes in pregnancy", "pregnancy and diabetes," and "pregnancy diabetes". Forty-one complete articles on research carried out in Turkey over the period 2004-2016 and published in 2006-2018 on the prevalence of GDM and/or a reported risk factor were included in the study. Combined percentage calculations were employed to determine GDM prevalence. RESULTS It was found in this systematic review and meta-analysis of the studies examined that out of the total of 50,767 pregnant women included in the studies, 3891 had GDM. Based on these data, combined GDM prevalence was calculated as 7.7% (range: 1.9-27.9%). It was observed that the highest combined GDM prevalence was 17.6% in the black Sea Region and the lowest was 5.1% in the Central Anatolian Region. Fourteen risk factors had been reported as statistically significant in the studies included in the systematic review. The most commonly reported of these was advanced maternal age, being overweight prior to pregnancy, gaining weight in pregnancy, diabetes in the family, a history of GDM or giving birth to a large baby. CONCLUSIONS It was observed in this meta-analysis that the prevalence of GDM in Turkey is notably high and risk factors are similar to what has been reported in current international literature. The continuation of routine screening tests to detect GDM may contribute to controlling the condition while ensuring that risk groups take special preventive measures and mother-child health is protected. IMPLICATIONS FOR PRACTICE Results of this study might be used in the organization of prenatal care, especially high-risk pregnant women for GDM. Nursing researchers and health care managers should consider this situation in the implementing of prenatal care serving.
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Affiliation(s)
- Zekiye Karaçam
- Division of Midwifery, Faculty of Health Sciences, Aydın Adnan Menderes University, Aydın, Turkey
| | - Demet Çelİk
- Division of Nursing, Faculty of Health Sciences, Karamanoglu Mehmetbey Universitesi, Karaman, Turkey
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Gortazar L, Flores-Le Roux JA, Benaiges D, Sarsanedas E, Payà A, Mañé L, Pedro-Botet J, Goday A. Trends in prevalence of gestational diabetes and perinatal outcomes in Catalonia, Spain, 2006 to 2015: the Diagestcat Study. Diabetes Metab Res Rev 2019; 35:e3151. [PMID: 30865356 DOI: 10.1002/dmrr.3151] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 02/24/2019] [Accepted: 03/09/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND No recent epidemiologic studies on gestational diabetes mellitus (GDM) have been conducted in Spain. The present study aimed to explore trends in the prevalence of GDM and ascertain whether the risk of adverse perinatal outcomes changed between 2006 and 2015 in Catalonia. METHODS In this population-based study, all hospital admissions for singleton births in Catalonia for the period 2006 to 2015 were collected from the Spanish Minimum Basic Data Set. Cases of GDM were identified from hospital delivery discharge reports using ICD-9-CM codes. Data regarding maternal characteristics and perinatal outcomes were analysed. Crude and age-adjusted annual prevalences were calculated. The Poisson regression model was used to assess trends in prevalence and perinatal outcomes, adjusted for age and smoking habit; however, they could not be adjusted for body mass index (BMI) and ethnicity. RESULTS Data from 743 762 deliveries were collected. GDM prevalence over the study period was 4.80% (95% CI 4.75-4.85%). Crude GDM prevalence rose from 3.81% (95% CI 3.67-3.95%) in 2006 to 6.53% (95% CI 6.33-6.72%) in 2015 (P < 0.001). Women with GDM showed a stable trend in rates of preeclampsia (2.56%), prematurity (15.7%), and large-for-gestational age (LGA) newborns (18.3%), whereas a lower rate of macrosomia was observed during the study period (from 9.16% to 7.84%). Caesarean deliveries rose from 28% to 31%; however, significance was lost after adjustment. CONCLUSIONS The prevalence of GDM in Catalonia almost doubled between 2006 and 2015. During the study period, the frequency of macrosomia decreased whereas pre-eclampsia, prematurity, LGA, and age-adjusted Caesarean rates remained stable.
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Affiliation(s)
- Lucía Gortazar
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Juana A Flores-Le Roux
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - David Benaiges
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Eugènia Sarsanedas
- Health Information Management Department, Hospital del Mar, Barcelona, Spain
| | - Antonio Payà
- Department of Gynecology and Obstetrics, Hospital del Mar, Barcelona, Spain
| | - Laura Mañé
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Juan Pedro-Botet
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Alberto Goday
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
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Abualhamael S, Mosli H, Baig M, Noor AM, Alshehri FM. Prevalence and Associated Risk Factors of Gestational Diabetes Mellitus at a University Hospital in Saudi Arabia. Pak J Med Sci 2019; 35:325-329. [PMID: 31086509 PMCID: PMC6500800 DOI: 10.12669/pjms.35.2.498] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 02/06/2019] [Accepted: 02/12/2019] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES We aimed to find out the prevalence and associated risk factors of GDM among females who attended antenatal clinic at King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia (SA). METHODS This retrospective study was carried out from 25th September 2016 till 20th December 2016, at the Endocrine Clinic, Faculty of Medicine, KAUH, Jeddah, SA. A total of 5000 women attended antenatal clinic and 637 women were referred to the endocrine clinic for GDM. The data of only 103 GDM was included in the study because only these patients' complete data was available. The electronic record of 93 pregnant age and BMI matched females, not having GDM were selected as a control group. RESULTS The prevalence of GDM was 12.75% (637/5000). Parity was associated with GDM (X2=16.82, P=.001) and GDM was significantly higher in multigravida while no association of GDM was found with working status, place of living, hypertension, family history of DM and BMI. Logistic regression analysis revealed that grand multigravida female had the lower risk of GDM as compared to multi, primi and nulligravida while age, working status, place of living, hypertension, family history of DM and BMI were not found significant risk factors for GDM. In GDM group, according to nationality, 68(66%) women were Saudi while 35(34%) were expatriates' (Yemeni 11.2%, Egyptians 3.9%, Indians 3.9%, Pakistanis 2.9%, Sudanese 2.9%, Syrians 2.9% and others). CONCLUSIONS The prevalence of GDM was 12.75% and it was not associated with working status, place of living, hypertension, family history of diabetes and BMI.
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Affiliation(s)
- Shahad Abualhamael
- Dr. Shahad Abualhamael, SBIM, Department of Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Hala Mosli
- Dr. Hala Mosli, ABEM, Department of Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mukhtiar Baig
- Prof. Mukhtiar Baig, Ph.D, Department of Clinical Biochemistry, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abdulelah M. Noor
- Dr. Abdulelah M. Noor, MBBS, Department of Medicine, King Abdullah Medical City, Makkah, Saudi Arabia
| | - Fahd M. Alshehri
- Dr. Fahd M. Alshehri, MBBS, Department of Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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KAYA R, KARAÇAM Z. Gestasyonel Diyabet Görülme Sıklığı ve Anne-Bebek Sağlığı ile İlişkisi. DÜZCE ÜNIVERSITESI SAĞLIK BILIMLERI ENSTITÜSÜ DERGISI 2019. [DOI: 10.33631/duzcesbed.397362] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Dayyani I, Terkildsen Maindal H, Rowlands G, Lou S. A qualitative study about the experiences of ethnic minority pregnant women with gestational diabetes. Scand J Caring Sci 2019; 33:621-631. [DOI: 10.1111/scs.12655] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 12/18/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Ida Dayyani
- School of Midwifery University College Nordjylland Aalborg Denmark
| | | | - Gillian Rowlands
- Department of Public Health Aarhus University Aarhus Denmark
- Institute of Health and Society New Castle University New Castle UK
| | - Stina Lou
- Defactum – Public Health and Health Services Research Central Denmark Region Aarhus Denmark
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Pedersen ML. Diabetes care in the dispersed population of Greenland. A new model based on continued monitoring, analysis and adjustment of initiatives taken. Int J Circumpolar Health 2019; 78:1709257. [PMID: 31996108 PMCID: PMC7034430 DOI: 10.1080/22423982.2019.1709257] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 12/17/2019] [Accepted: 12/19/2019] [Indexed: 12/16/2022] Open
Abstract
Diabetes used to be a rare condition among Inuit in Greenland. However, research in recent decades has shown a high prevalence of undiagnosed diabetes. Addressing diabetes in the geographically dispersed population of Greenland presents a challenge to the health care system. In 2008, a new model of diabetes care was introduced in Greenland that included continual monitoring, analysis, and adjustment of initiatives taken. The overall aim of this review was to review the feasibility of the monitoring of an ongoing national diabetes care programme. After ten years of observation it was clear that monitoring of such a programme based on information in electronic medical records in Greenland was feasible. It was found that the majority of the population in Greenland was in contact with the health care system. Increased diagnostic activity resulted in an increased prevalence of diagnosed diabetes. The quality of diabetes care in Greenland and the testing effectiveness of gestational diabetes were improved. Microvascular complications were frequently observed among Greenlandic diabetic patients, except for retinopathy that was as an exception. In summary, this model may improve diabetes care and potentially care for other chronic conditions in Greenland, and may also be helpful in other remote settings where chronic disease care is difficult.Abbreviations: AD: Anno Domini; ADA: American Diabetes Association; BC: Before Christ; BMI: Body Mass Index; BP: Blood Pressure; CWB: Capillary Whole Blood; EMR: Electronic Medical Record; EASD: European Association for Study of Diabetes; GA: Gestational Age; GDM: Gestational Diabetes Mellitus; FIGO: The International Federation of Gynaecology and Obstetrics; HbA1c: Glycosylated haemoglobin; IDF: International Diabetes Federation; LDL: Low density lipoprotein; NDQIA: National Diabetes Quality Improvement Alliancel; NICE: National Institute for Health and Care Excellence; OECD: Organisation for Economic Co-operation and Development; OGTT: Oral Glucose Tolerance Test; QIH: Queen Ingrid Hospital; RCT: Randomised Controlled Tria;l T1D: Type 1 Diabetes; T2D: Type 2 Diabetes; UACR: Urine Albumin Creatinine Ratio; WHO: World Health Organisation.
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Affiliation(s)
- Michael Lynge Pedersen
- Greenland Center for Health Research, Institute Nursing and Health Science, University of Greenland, Nuuk, Greenland
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Zhang J, Ma S, Guo C, Long S, Wu S, Tan H. Research progress on etiology of gestational diabetes mellitus. GLOBAL HEALTH JOURNAL 2018. [DOI: 10.1016/s2414-6447(19)30179-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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38
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Keller A, Stougård M, Frederiksen P, Thorsteinsdottir F, Vaag A, Damm P, Jacobsen R, L Heitmann B. In utero exposure to extra vitamin D from food fortification and the risk of subsequent development of gestational diabetes: the D-tect study. Nutr J 2018; 17:100. [PMID: 30388966 PMCID: PMC6215342 DOI: 10.1186/s12937-018-0403-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 10/14/2018] [Indexed: 12/14/2022] Open
Abstract
Background The primary aim of this study was to assess whether exposure during fetal life to extra vitamin D from food fortification was associated with a reduction in the risk of subsequently developing gestational diabetes mellitus (GDM). Furthermore, we examined whether the effect of the vitamin D from fortification differed by women’s season of birth. Methods This semi-ecological study is based on the cancellation in 1985 of the mandatory policy to fortify margarine with vitamin D in Denmark, with inclusion of entire national adjacent birth cohorts either exposed or unexposed to extra vitamin D in utero. The identification of GDM cases later in life among both exposure groups was based on the Danish national health registers. Logistic regression analyses generating odds ratios (ORs) and 95% confidence intervals (95% CIs) were performed. Results Women who were prenatally exposed to the extra vitamin D from fortification tended to have a lower risk of subsequently developing GDM than unexposed women (OR 0.87, 95%CI 0.74,1.02, P = 0.08). When analyses were stratified by women’s season of birth, exposed women born in spring had a lower risk of developing GDM compared to unexposed subjects (OR 0.68, 95%CI 0.50,0.94, p = 0.02). Conclusion This study suggests that prenatal exposure to extra vitamin D from mandatory fortification may lower the risk of developing gestational diabetes among spring-born women. Trial registration This study is part of the D-tect project, which is registered on clinicaltrials.gov: NCT03330301. Electronic supplementary material The online version of this article (10.1186/s12937-018-0403-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Amélie Keller
- Research Unit for Dietary Studies at The Parker Institute Bispebjerg and Frederiksberg Hospital, part of the Copenhagen University Hospital - The capital Region, Nordre Fasanvej 57, vej 8, entrance 11, 2000, Frederiksberg, Denmark.
| | - Maria Stougård
- Research Unit for Dietary Studies at The Parker Institute Bispebjerg and Frederiksberg Hospital, part of the Copenhagen University Hospital - The capital Region, Nordre Fasanvej 57, vej 8, entrance 11, 2000, Frederiksberg, Denmark
| | - Peder Frederiksen
- Research Unit for Dietary Studies at The Parker Institute Bispebjerg and Frederiksberg Hospital, part of the Copenhagen University Hospital - The capital Region, Nordre Fasanvej 57, vej 8, entrance 11, 2000, Frederiksberg, Denmark
| | - Fanney Thorsteinsdottir
- Research Unit for Dietary Studies at The Parker Institute Bispebjerg and Frederiksberg Hospital, part of the Copenhagen University Hospital - The capital Region, Nordre Fasanvej 57, vej 8, entrance 11, 2000, Frederiksberg, Denmark
| | - Allan Vaag
- Cardiovascular, Renal and Metabolic Disease (CVRM) Translational Medicine Unit, Early Clinical Development, IMED Biotech Unit, AstraZeneca, Gothenburg, Sweden
| | - Peter Damm
- Center for Pregnant Women with Diabetes, Department of Obstetrics, Rigshospitalet, Copenhagen, Denmark.,Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ramune Jacobsen
- Research Unit for Dietary Studies at The Parker Institute Bispebjerg and Frederiksberg Hospital, part of the Copenhagen University Hospital - The capital Region, Nordre Fasanvej 57, vej 8, entrance 11, 2000, Frederiksberg, Denmark.,Research Unit for Chronic Conditions, Center of Clinical Research and Prevention, Bispebjerg og Frederiksberg Hospital, Capital Region, Frederiksberg, Denmark
| | - Berit L Heitmann
- Research Unit for Dietary Studies at The Parker Institute Bispebjerg and Frederiksberg Hospital, part of the Copenhagen University Hospital - The capital Region, Nordre Fasanvej 57, vej 8, entrance 11, 2000, Frederiksberg, Denmark.,The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, University of Sydney, Sydney, Australia.,The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.,The Department of Public Health, Section for General Medicine, University of Copenhagen, Copenhagen, Denmark
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Maslova E, Hansen S, Strøm M, Halldorsson TI, Grunnet LG, Vaag AA, Olsen SF. Fish Intake in Pregnancy and Offspring Metabolic Parameters at Age 9⁻16-Does Gestational Diabetes Modify the Risk? Nutrients 2018; 10:nu10101534. [PMID: 30336645 PMCID: PMC6213471 DOI: 10.3390/nu10101534] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 10/09/2018] [Accepted: 10/15/2018] [Indexed: 12/18/2022] Open
Abstract
Oily fish, an important source of marine n-3 long-chain polyunsaturated fatty acids (LCPUFA), has shown to reduce cardiometabolic risk in adults. Whether maternal fish intake affects offspring metabolic health is less established, especially among high-risk pregnancies. We aimed to examine the association of fish intake in pregnancy with offspring metabolic health who were either exposed or unexposed to gestational diabetes mellitus (GDM). Our study included 1234 mother-offspring dyads (608 with a GDM index pregnancy and 626 control dyads) nested within the Danish National Birth Cohort, which is a prebirth cohort. Maternal seafood and marine n-3 LCPUFA consumption was quantified by a food frequency questionnaire (gestational week 25) and a sub-sample with interview data (weeks 12 and 30). The offspring were clinically examined at 9–16 years, including a Dual energy X-ray Absorptiometry (DXA) scan and a fasting blood sample. We calculated multivariable effect estimates and 95% confidence intervals (CI) for anthropometric, adiposity, and metabolic parameters. The median (IQR) intake of total seafood was 23(24) g/day. We found largely no association for total seafood and marine n-3 LCPUFA with offspring metabolic parameters in either group. Using interview data, GDM-exposed women reporting no fish in week 12 and 30 (versus intake >2 times/week) had offspring with a higher Body Mass Index (BMI) (ratio of geometric means (RGM): 1.28, 95% CI: 1.06, 1.55), waist circumference (RGM: 1.22, 95% CI: 1.05, 1.40), triglycerides (RGM: 1.77, 95% CI: 1.03, 3.03), and homeostatic model assessment of insulin resistance HOMA-IR (RGM: 2.16, 95% CI: 1.17, 3.97). We found no associations of n-3 LCPUFA and seafood intake with offspring metabolic outcomes. However, GDM-exposed women who consistently reported eating no fish had offspring with a poorer metabolic profile. Fish intake in pregnancy may mitigate some adverse effects of intrauterine hyperglycemia, however, these findings need replication in better powered studies.
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Affiliation(s)
- Ekaterina Maslova
- Centre for Fetal Programming, Department of Epidemiology Research, Statens Serum Institut, DK-2300 Copenhagen, Denmark.
- Department of Primary Care and Public Health, Imperial College, London W6 6RP, UK.
- Danish Diabetes Academy, DK-5000 Odense, Denmark.
| | - Susanne Hansen
- Centre for Fetal Programming, Department of Epidemiology Research, Statens Serum Institut, DK-2300 Copenhagen, Denmark.
- Research Centre for Prevention and Health, Rigshospitalet-Glostrup, DK-2600 Copenhagen, Denmark.
| | - Marin Strøm
- Centre for Fetal Programming, Department of Epidemiology Research, Statens Serum Institut, DK-2300 Copenhagen, Denmark.
- Faculty of Natural and Health Sciences, University of Faroe Islands, 100 Torshavn, Faroe Islands.
| | - Thorhallur I Halldorsson
- Centre for Fetal Programming, Department of Epidemiology Research, Statens Serum Institut, DK-2300 Copenhagen, Denmark.
- Faculty of Food Science and Nutrition, School of Health Sciences, University of Iceland, 101 Reykjavik, Iceland.
- Unit for Nutrition Research, Landspitali University Hospital, IS-101 Reykjavik, Iceland.
| | - Louise G Grunnet
- Danish Diabetes Academy, DK-5000 Odense, Denmark.
- Department of Endocrinology-Diabetes and Metabolism, Rigshospitalet, DK-2100 Copenhagen, Denmark.
| | - Allan A Vaag
- Department of Endocrinology-Diabetes and Metabolism, Rigshospitalet, DK-2100 Copenhagen, Denmark.
- Cardiovascular and Metabolic Disease (CVMD) Translational Medicine Unit, Early Clinical Development, IMED Biotech Unit, AstraZeneca, 431 50 Gothenburg, Sweden.
| | - Sjurdur F Olsen
- Centre for Fetal Programming, Department of Epidemiology Research, Statens Serum Institut, DK-2300 Copenhagen, Denmark.
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
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Zhou J, Wu NN, Yin RL, Ma W, Yan C, Feng YM, Zhang CH, Zhao D. Activation of brown adipocytes by placental growth factor. Biochem Biophys Res Commun 2018; 504:470-477. [PMID: 30195493 DOI: 10.1016/j.bbrc.2018.08.106] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 08/14/2018] [Indexed: 01/06/2023]
Abstract
Gestational diabetes mellitus (GDM) is a type of diabetes and occurs during pregnancy. Brown adipose tissue (BAT) improves glucose homeostasis and mitigates insulin resistance, however, its activity is reduced in GDM. Placenta growth factor (PlGF) is an angiogenic factor produced by placental trophoblasts. Nevertheless, whether and how PlGF could affect BAT function in GDM are not defined. To investigate this question, 91 non-diabetic pregnant participants and 73 GDM patients were recruited to Gynaecology and Obstetrics Centre in Lu He hospital. Serum levels of PlGF were quantified by ELISA. Skin temperature was measured by far infrared thermography in the supraclavicular region where classical BATs were located. The direct effect of PlGF on BAT function was explored using the established human preadipocyte differentiation system. Thereby, we demonstrated that serum levels of PlGF were lower in GDM patients compared with controls, which was accompanied by decreased skin temperature in the supraclavicular region. By qPCR and western blot, mRNA and protein expression of UCP1 and OXPHOS were elevated in differentiated adipocytes treated with PlGF. PlGF stimulated mitochondrion transcription and increased copy number of mitochondrial. When subjected for respirometry, PlGF-treated differentiated adipocytes showed higher oxygen consumption rates than controls. PlGF induced AMPK phosphorylation and blockade of AMPK phosphorylation blunted UCP1 and OXPHOS expression in differentiated adipocytes. PlGF administration reduced cholesterol and triglyceride content in the liver and improved insulin sensitivity in db mice compared with control. In Conclusion, PlGF could activate BAT function. Downregulation of PlGF might contribute to the reduced BAT activity in GDM.
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Affiliation(s)
- Jing Zhou
- Beijing Key Laboratory of Diabetes Prevention and Research, Endocrinology Centre, Lu He Hospital, Capital Medical University, Beijing, 101149, China(2)
| | - Nan-Nan Wu
- Beijing Key Laboratory of Diabetes Prevention and Research, Endocrinology Centre, Lu He Hospital, Capital Medical University, Beijing, 101149, China(2)
| | - Rui-Li Yin
- Beijing Key Laboratory of Diabetes Prevention and Research, Endocrinology Centre, Lu He Hospital, Capital Medical University, Beijing, 101149, China(2)
| | - Wei Ma
- Gynecology and Obstetrics Centre, Lu He Hospital, Capital Medical University, Beijing, 101149, China(2)
| | - Cen Yan
- Beijing Key Laboratory of Diabetes Prevention and Research, Endocrinology Centre, Lu He Hospital, Capital Medical University, Beijing, 101149, China(2)
| | - Ying-Mei Feng
- Beijing Key Laboratory of Diabetes Prevention and Research, Endocrinology Centre, Lu He Hospital, Capital Medical University, Beijing, 101149, China(2)
| | - Chuan-Hai Zhang
- Beijing Advanced Innovation Centre for Food Nutrition and Human Health, College Food Science and Nutritional Engineering, China Agricultural University, Beijing, 100083, China(3).
| | - Dong Zhao
- Beijing Key Laboratory of Diabetes Prevention and Research, Endocrinology Centre, Lu He Hospital, Capital Medical University, Beijing, 101149, China(2).
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Abstract
PURPOSE OF REVIEW Ethnicity has long been described as a major risk factor for the development of gestational diabetes mellitus (GDM), and it is widely recognised that women from ethnicities other than Europids are at higher risk of developing GDM. There are also described differences between ethnicities in key GDM pregnancy outcomes. This review describes some of the factors that relate to the ethnic disparities in GDM. RECENT FINDINGS The global prevalence of GDM has been steadily increasing and estimated to be 16.2% from the International Diabetes Federation extrapolation. Reported prevalence rates may understate the true prevalence, due to factors of access and attitudes to GDM diagnosis and screening in low resource settings for foreign-born women and indigenous populations. Other factors may relate to genes associated with specific ethnicities, obesity, body composition and gestational weight gain. Various factors such as access to screening, body composition, genetics and gestational weight gain may result in ethnic disparities in the prevalence and outcomes of GDM.
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Affiliation(s)
- Lili Yuen
- School of Medicine, Western Sydney University, Sydney, NSW, Australia.
| | - Vincent W Wong
- Diabetes and Endocrine Service, Liverpool Hospital, Liverpool, NSW, Australia
- University of New South Wales, Liverpool, NSW, Australia
| | - David Simmons
- School of Medicine, Western Sydney University, Sydney, NSW, Australia
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Comparison of the Screening Tests for Gestational Diabetes Mellitus between "One-Step" and "Two-Step" Methods among Thai Pregnant Women. Obstet Gynecol Int 2018; 2018:1521794. [PMID: 29581725 PMCID: PMC5822918 DOI: 10.1155/2018/1521794] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 12/26/2017] [Indexed: 12/25/2022] Open
Abstract
Objective To compare the prevalence and pregnancy outcomes of GDM between those screened by the “one-step” (75 gm GTT) and “two-step” (100 gm GTT) methods. Methods A prospective study was conducted on singleton pregnancies at low or average risk of GDM. All were screened between 24 and 28 weeks, using the one-step or two-step method based on patients' preference. The primary outcome was prevalence of GDM, and secondary outcomes included birthweight, gestational age, rates of preterm birth, small/large-for-gestational age, low Apgar scores, cesarean section, and pregnancy-induced hypertension. Results A total of 648 women were screened: 278 in the one-step group and 370 in the two-step group. The prevalence of GDM was significantly higher in the one-step group; 32.0% versus 10.3%. Baseline characteristics and pregnancy outcomes in both groups were comparable. However, mean birthweight was significantly higher among pregnancies with GDM diagnosed by the two-step approach (3204 ± 555 versus 3009 ± 666 g; p=0.022). Likewise, the rate of large-for-date tended to be higher in the two-step group, but was not significant. Conclusion The one-step approach is associated with very high prevalence of GDM among Thai population, without clear evidence of better outcomes. Thus, this approach may not be appropriate for screening in a busy antenatal care clinic like our setting or other centers in developing countries.
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Ovesen PG, Fuglsang J, Andersen MB, Wolff C, Petersen OB, David McIntyre H. Temporal Trends in Gestational Diabetes Prevalence, Treatment, and Outcomes at Aarhus University Hospital, Skejby, between 2004 and 2016. J Diabetes Res 2018; 2018:5937059. [PMID: 29736403 PMCID: PMC5875052 DOI: 10.1155/2018/5937059] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 01/30/2018] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The prevalence of gestational diabetes (GDM) is increasing worldwide. The most important risk of GDM in pregnancy is excessive fetal growth, increasing the risk of complications during delivery as well as long-term complications like obesity and diabetes in both the mother and the offspring. METHOD All women with GDM who delivered a singleton between 2004 and 2016 were included. The treatment of GDM patients sought to achieve normal blood glucose levels, primarily by diet and exercise. If the glycemic targets were not reached, insulin therapy was initiated. Birth weight and birth weight Z-score was calculated corrected for gender and gestational age at delivery. RESULTS The study included 1910 women. The number of GDM women increased significantly each year over the course of the study, as did the proportion requiring insulin therapy. Birth weight and birth weight Z-score fell significantly over the years largely due to a decrease in large for gestational age frequency from 29% to around 19%. CONCLUSION During the last 13 years, the number of women diagnosed with GDM has increased. Furthermore, the proportion of GDM women receiving insulin treatment has increased. The birth weight in diet-treated women has been virtually normal for the last 5 years of the reported period.
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Affiliation(s)
- Per Glud Ovesen
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Fuglsang
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Charlotte Wolff
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Olav Bjørn Petersen
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - H. David McIntyre
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
- Danish Diabetes Academy, Odense University Hospital, Odense, Denmark
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