Glycemic control and fetal growth of women with diabetes mellitus and subsequent hypertensive disorders of pregnancy

Occupational noise exposure and maternal pregnancy complications: register-based cohort from urban areas in four Nordic countries

OBJECTIVE

To assess the role of occupational noise exposure on pregnancy complications in urban Nordic populations.

METHODS

A study population covering five metropolitan areas in Denmark, Finland, Norway and Sweden was generated using national birth registries linked with occupational and residential environmental exposures and sociodemographic variables. The data covered all pregnancies during 5-11 year periods in 2004‒2016, resulting in 373 184 pregnancies. Occupational noise exposure was based on a Swedish-developed job-exposure-matrix, containing measured A-weighted annual 8 hour noise levels (LAeq8h), and linked with person-specific job-history. Outcomes included diagnosed gestational diabetes, gestational hypertension, mild pre-eclampsia and severe pre-eclampsia. The data were analysed with logistic regression models separately in each country, adjusting for maternal (age, parity, birth year, education and marital status) and residential environmental factors (low neighbourhood income, NO2 and green and blue space). The results were combined by meta-analysis.

RESULTS

Occupational noise exceeding 80 dB, compared with less than 70 dB, was associated with an increased odds of gestational diabetes in all countries, with a combined OR of 1.26 (95% CI 1.04 to 1.51), and mild pre-eclampsia in all countries except Finland, resulting in a combined OR of 1.22 (95% CI 0.99 to 1.51). Further adjustment by maternal body-mass index attenuated these associations. No association with gestational hypertension or severe pre-eclampsia was found.

CONCLUSIONS

Register data from four nationalities show that gestational diabetes and, tentatively, mild pre-eclampsia was increased among pregnant workers working in occupations where noise levels exceed 80 dB LAeq8h but not in occupations with lower noise levels.

Systemic/Immune-Modulation of Olea europaea Leaf Extract in Fetuses of Alloxan-Induced T1 Diabetic Rats

Maternal glucose is the principal macronutrient that sustains fetal growth. Prolonged exposure of the fetus to hyperglycemia from the early stages of pregnancy accelerates the maturation of the stimulus-secretion coupling mechanism in β cell autoimmunity, which leads to early hyperinsulinemia in type 1 diabetes mellitus (T1DM). Nowadays, diabetes mellitus (DM) is the most common medical complication of pregnancy, and among young women, the prevalence of overt diabetes and undiagnosed hyperglycemia is rising. Even though conventional medication is effective in treating DM, it is expensive and has harmful side effects. Herbal medicine will thus incorporate alternative therapy and be more effective and less toxic. Due to their bioactive components, olive leaves (Olea europaea) are frequently used medicinally; however, little is known about how this plant affects the immune system when it comes to diabetes. The current study used a pregnant mother rat model of alloxan-induced T1DM to examine the antidiabetic properties and embryonic safety of olive leaves. Forty adult female Sprague Dawley rats were split up into four groups as follows: nondiabetic, diabetic, olive, and diabetic-olive groups. All the mother rats were sacrificed on the 20th day of pregnancy, and fetuses were collected for further investigations. In diabetic pregnant mothers, fetuses had systemic modulation-negative effects. These effects were significantly reversed when the diabetic groups were supplemented with extracts from olive leaves. The findings showed that the olive leaf extract inhibits the diabetogenic effect mediated by alloxan with effective and protective systemic immunomodulation during embryonic development.

A Review of Third-Trimester Complications in Pregnancies Complicated by Diabetes Mellitus

Pregnancies affected by both pregestational and gestational diabetes mellitus carry an increased risk of adverse maternal and neonatal outcomes. While the risks associated with diabetes in pregnancy have been well documented and span across all trimesters, maternal and neonatal morbidity have been associated with select third-trimester complications. Further, modifiable risk factors have been identified that can help improve pregnancy outcomes. This review aims to examine the relationship between select third-trimester complications (large for gestational age, intrauterine fetal demise, hypertensive disorders of pregnancy, preterm birth, perineal lacerations, shoulder dystocia, and cesarean delivery) and the aforementioned modifiable risk factors, specifically glycemic control, blood pressure control, and gestational weight gain. It also highlights how early optimization of these modifiable risk factors can reduce adverse maternal, fetal, and neonatal outcomes. KEY POINTS: · Diabetes mellitus in pregnancy increases the risk of third-trimester complications.. · Modifiable risk factors exist for these complications.. · Optimizing these modifiable risk factors improves maternal and neonatal outcomes..

Fetal glycated albumin levels in offspring of obese women

OBJECTIVE

To determine the association between maternal obesity and fetal glycated albumin (GA) levels among pregnant women.

METHODS

A comparative, cross-sectional study of 59 consenting, normoglycemic, pregnant women, who met the criteria for maternal obesity, attending the antenatal clinic of the University College Hospital, Nigeria, from June 2019 to December 2019. They were recruited at 36 weeks of gestation, followed up until delivery, and compared with 58 nonobese, normoglycemic pregnant controls. At delivery, blood samples were taken from the mothers and from the umbilical cords of their newborns for serum GA assay. Maternal and newborn variables were recorded, and comparisons were made using χ² tests, independent t tests, odds ratios, analysis of variance, and Pearson correlates. Statistical significance was set at P < 0.05.

RESULTS

The odds of elevated newborn GA were 3.21 times higher in obese women compared with nonobese women (P = 0.005) and 5-min APGAR scores were higher in the newborns of nonobese women (P = 0.039). There was a significant correlation between maternal and neonatal GA for all participants (r = 0.346, P = 0.000).

CONCLUSION

These findings suggest that maternal obesity is associated with elevated fetal GA and low APGAR scores at 5 min in normoglycemic women.

Metabolomic analysis-identified 2-hydroxybutyric acid might be a key metabolite of severe preeclampsia

This study set out to determine the key metabolite changes underlying the pathophysiology of severe preeclampsia (PE) using metabolic analysis. We collected sera from 10 patients with severe PE and from 10 healthy pregnant women of the same trimester and analyzed them using liquid chromatography mass spectrometry. A total of 3,138 differential metabolites were screened, resulting in the identification of 124 differential metabolites. Kyoto encyclopedia of genes and genomes pathway analysis revealed that they were mainly enriched in the following metabolic pathways: central carbon metabolism in cancer; protein digestion and absorption; aminoacyl-transfer RNA biosynthesis; mineral absorption; alanine, aspartate, and glutamate metabolism; and prostate cancer. After analysis of 124 differential metabolites, 2-hydroxybutyric acid was found to be the most critical differential metabolite, and its use allowed the differentiation of women with severe PE from healthy pregnant women. In summary, our analysis revealed that 2-hydroxybutyric acid is a potential key metabolite for distinguishing severe PE from healthy controls and is also a marker for the early diagnosis of severe PE, thus allowing early intervention.

Maternal and Fetal Outcomes among Pregnant Women with Diabetes

The aim of this study was to examine the differences in pregnancy complications, delivery characteristics, and neonatal outcomes between women with type 1 diabetes mellitus (T1DM), type 2 diabetes mellitus (T2DM), and gestational diabetes mellitus (GDM). This study included all pregnant women with diabetes in pregnancy in Belgrade, Serbia, between 2010 and 2020. The total sample consisted of 6737 patients. In total, 1318 (19.6%) patients had T1DM, 138 (2.0%) had T2DM, and 5281 patients (78.4%) had GDM. Multivariate logistic regression with the type of diabetes as an outcome variable showed that patients with T1DM had a lower likelihood of vaginal delivery (OR: 0.73, 95% CI: 0.64-0.83), gestational hypertension (OR: 0.47, 95% CI: 0.36-0.62), higher likelihood of chronic hypertension (OR: 1.88, 95% CI: 1.55-2.29),and a higher likelihood ofgestational age at delivery before 37 weeks (OR: 1.38, 95% CI: 1.18-1.63) compared to women with GDM. Multivariate logistic regression showed that patients with T2DM had a lower likelihood ofgestational hypertension compared to women with GDM (OR: 0.37, 95% CI: 0.15-0.92).Our results indicate that the highest percentage of diabetes in pregnancy is GDM, and the existence of differences in pregnancy complications, childbirth characteristics, and neonatal outcomes are predominantly between women with GDM and women with T1DM.

Recurrence Risk of Fetal Growth Restriction: Management of Subsequent Pregnancies

Fetal growth restriction (FGR) is a common obstetric complication that predisposes to mortality across the lifespan. Women with a prior pregnancy affected by FGR have a 20% to 30% risk of recurrence, but effective preventive strategies are lacking. Pharmacologic interventions to prevent FGR are lacking. Low-dose aspirin may be somewhat effective, but low-molecular-weight heparin and sildenafil are not. Surveillance in a subsequent pregnancy may consist of serial ultrasonography with timing and frequency determined by the clinical severity in the index pregnancy. Once FGR is diagnosed, the principal management strategy consists of close surveillance and carefully timed delivery.

Diabetes during Pregnancy: A Maternal Disease Complicating the Course of Pregnancy with Long-Term Deleterious Effects on the Offspring. A Clinical Review

In spite of the huge progress in the treatment of diabetes mellitus, we are still in the situation that both pregestational (PGDM) and gestational diabetes (GDM) impose an additional risk to the embryo, fetus, and course of pregnancy. PGDM may increase the rate of congenital malformations, especially cardiac, nervous system, musculoskeletal system, and limbs. PGDM may interfere with fetal growth, often causing macrosomia, but in the presence of severe maternal complications, especially nephropathy, it may inhibit fetal growth. PGDM may also induce a variety of perinatal complications such as stillbirth and perinatal death, cardiomyopathy, respiratory morbidity, and perinatal asphyxia. GDM that generally develops in the second half of pregnancy induces similar but generally less severe complications. Their severity is higher with earlier onset of GDM and inversely correlated with the degree of glycemic control. Early initiation of GDM might even cause some increase in the rate of congenital malformations. Both PGDM and GDM may cause various motor and behavioral neurodevelopmental problems, including an increased incidence of attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). Most complications are reduced in incidence and severity with the improvement in diabetic control. Mechanisms of diabetic-induced damage in pregnancy are related to maternal and fetal hyperglycemia, enhanced oxidative stress, epigenetic changes, and other, less defined, pathogenic mechanisms.

Improvement Effect of Metformin on Female and Male Reproduction in Endocrine Pathologies and Its Mechanisms

Metformin (MF), a first-line drug to treat type 2 diabetes mellitus (T2DM), alone and in combination with other drugs, restores the ovarian function in women with polycystic ovary syndrome (PCOS) and improves fetal development, pregnancy outcomes and offspring health in gestational diabetes mellitus (GDM) and T2DM. MF treatment is demonstrated to improve the efficiency of in vitro fertilization and is considered a supplementary drug in assisted reproductive technologies. MF administration shows positive effect on steroidogenesis and spermatogenesis in men with metabolic disorders, thus MF treatment indicates prospective use for improvement of male reproductive functions and fertility. MF lacks teratogenic effects and has positive health effect in newborns. The review is focused on use of MF therapy for restoration of female and male reproductive functions and improvement of pregnancy outcomes in metabolic and endocrine disorders. The mechanisms of MF action are discussed, including normalization of metabolic and hormonal status in PCOS, GDM, T2DM and metabolic syndrome and restoration of functional activity and hormonal regulation of the gonadal axis.

Associations between glycosylated hemoglobin level at less than 24 weeks of gestation and adverse pregnancy outcomes in Japan: The Japan Environment and Children's Study (JECS)

AIMS

To investigate the associations between glycosylated hemoglobin (HbA1c) levels at less than 24 weeks of gestation and adverse pregnancy outcomes in Japan.

METHODS

This was a prospective nationwide birth cohort study of 77,526 subjects with an HbA1c level of <6.5% (<48 mmol/mol) at less than 24 weeks of gestation. Associations of HbA1c level with adverse pregnancy outcomes were evaluated using multivariate analyses.

RESULTS

The adjusted odds ratios per 1% (11 mmol/mol) increase in HbA1c level were 1.77 (95% confidence interval [CI]: 1.48-2.12) for hypertensive disorders of pregnancy; 1.78 (95% CI: 1.12-2.83) for placental abruption; 1.30 (95% CI: 1.12-1.50) for preterm birth; 2.11 (95% CI: 1.41-3.16) for very preterm birth; 1.49 (95% CI: 1.33-1.68) for low birth weight infants; 1.95 (95% CI: 1.42-2.70) for macrosomia; 1.23 (95% CI: 1.09-1.39) for small for gestational age; 1.15 (95% CI: 1.04-1.28) for large for gestational age; and 1.29 (95% CI: 1.20-1.39) for the composite adverse pregnancy outcome.

CONCLUSIONS

The higher the HbA1c level, the higher the risk of adverse pregnancy outcomes in Japan. Further studies will be needed to determine prenatal management based on the HbA1c level in pregnant women with HbA1c <6.5% (<48 mmol/mol) at less than 24 weeks of gestation.