1
|
Wu W, Ren J, Wang J, Wang J, Yu D, Zhang Y, Zeng F, Huang B. Metalloestrogens exposure and risk of gestational diabetes mellitus: Evidence emerging from the systematic review and meta-analysis. ENVIRONMENTAL RESEARCH 2024; 248:118321. [PMID: 38307186 DOI: 10.1016/j.envres.2024.118321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/04/2024] [Accepted: 01/25/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND Metalloestrogens are metals and metalloid elements with estrogenic activity found everywhere. Their impact on human health is becoming more apparent as human activities increase. OBJECTIVE Our aim is to conduct a comprehensive systematic review and meta-analysis of observational studies exploring the correlation between metalloestrogens (specifically As, Sb, Cr, Cd, Cu, Se, Hg) and Gestational Diabetes Mellitus (GDM). METHODS PubMed, Web of Science, and Embase were searched to examine the link between metalloestrogens (As, Sb, Cr, Cd, Cu, Se, and Hg) and GDM until December 2023. Risk estimates were derived using random effects models. Subgroup analyses were conducted based on study countries, exposure sample, exposure assessment method, and detection methods. Sensitivity analyses and adjustments for publication bias were carried out to assess the strength of the findings. RESULTS Out of the 389 articles identified initially, 350 met our criteria and 33 were included in the meta-analysis, involving 141,175 subjects (9450 cases, 131,725 controls). Arsenic, antimony, and copper exposure exhibited a potential increase in GDM risk to some extent (As: OR = 1.28, 95 % CI [1.08, 1.52]; Sb: OR = 1.73, 95 % CI [1.13, 2.65]; Cu: OR = 1.29, 95 % CI [1.02, 1.63]), although there is a high degree of heterogeneity (As: Q = 52.93, p < 0.05, I2 = 64.1 %; Sb: Q = 31.40, p < 0.05, I2 = 80.9 %; Cu: Q = 21.14, p < 0.05, I2 = 71.6 %). Conversely, selenium, cadmium, chromium, and mercury exposure did not exhibit any association with the risk of GDM in our study. DISCUSSION Our research indicates that the existence of harmful metalloestrogens in the surroundings has a notable effect on the likelihood of GDM. Hence, we stress the significance of environmental elements in the development of GDM and the pressing need for relevant policies and measures.
Collapse
Affiliation(s)
- Wanxin Wu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, MOE Key Laboratory of Population Health Across Life Cycle, NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, 230032, Anhui, China
| | - Junjie Ren
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, 230032, Anhui, China
| | - Juan Wang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, MOE Key Laboratory of Population Health Across Life Cycle, NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, 230032, Anhui, China
| | - Jiamei Wang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, MOE Key Laboratory of Population Health Across Life Cycle, NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, 230032, Anhui, China
| | - Deshui Yu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, MOE Key Laboratory of Population Health Across Life Cycle, NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, 230032, Anhui, China
| | - Yan Zhang
- School of Biology and Food Engineering, Hefei Normal University, Hefei, 230092, Anhui, China.
| | - Fa Zeng
- Shenzhen Longhua Maternity and Child Healthcare Hospital, Shenzhen, 518109, Guangdong, China.
| | - Binbin Huang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, MOE Key Laboratory of Population Health Across Life Cycle, NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, 230032, Anhui, China.
| |
Collapse
|
2
|
Ju Y, Shen T, Guo Z, Kong Y, Huang Y, Hu J. Vitronectin promotes insulin resistance in trophoblast cells by activating JNK in gestational diabetes mellitus. Cell Biol Int 2024. [PMID: 38654431 DOI: 10.1002/cbin.12167] [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: 08/18/2023] [Revised: 03/13/2024] [Accepted: 04/12/2024] [Indexed: 04/26/2024]
Abstract
Gestational diabetes mellitus (GDM) is a common disorder in the clinic, which may lead to severe detrimental outcomes both for mothers and infants. However, the underlying mechanisms for GDM are still not clear. In the present study, we performed label-free proteomics using placentas from GDM patients and normal controls. Vitronectin caused our attention among differentially expressed proteins due to its potential role in the pathological progression of GDM. Vitronectin was increased in the placentas of GDM patients, which was confirmed by Western blot analysis. Vitronectin represses insulin signal transduction in trophoblast cells, whereas the knockdown of vitronectin further potentiates insulin-evoked events. Neutralization of CD51/61 abolishes the repressed insulin signal transduction in vitronectin-treated trophoblast cells. Moreover, vitronectin activates JNK in a CD51/61-depedent manner. Inhibition of JNK rescues impaired insulin signal transduction induced by vitronectin. Overall, our data indicate that vitronectin binds CD51/61 in trophoblast cells to activate JNK, and thus induces insulin resistance. In this regard, increased expression of vitronectin is likely a risk factor for the pathological progression of GDM. Moreover, blockade of vitronectin production or its receptors (CD51/61) may have therapeutic potential for dealing with GDM.
Collapse
Affiliation(s)
- Yuejun Ju
- Department of Endocrinology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, P.R. China
- Department of Endocrinology, Changshu No.2 People's Hospital, Affiliated Changshu Hospital of Nantong University, Changshu, Jiangsu, P.R. China
| | - Ting Shen
- Department of Endocrinology, Changshu No.2 People's Hospital, Affiliated Changshu Hospital of Nantong University, Changshu, Jiangsu, P.R. China
| | - Zhanhong Guo
- Department of Endocrinology, Changshu No.2 People's Hospital, Affiliated Changshu Hospital of Nantong University, Changshu, Jiangsu, P.R. China
| | - Yinghong Kong
- Department of Endocrinology, Changshu No.2 People's Hospital, Affiliated Changshu Hospital of Nantong University, Changshu, Jiangsu, P.R. China
| | - Yun Huang
- Department of Endocrinology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, P.R. China
| | - Ji Hu
- Department of Endocrinology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, P.R. China
| |
Collapse
|
3
|
Liu J, Lu C. SCUBE1 Promotes Gestational Diabetes Mellitus: A Bioinformatics and Experimental Investigation. Biochem Genet 2024:10.1007/s10528-024-10769-7. [PMID: 38565759 DOI: 10.1007/s10528-024-10769-7] [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: 12/20/2023] [Accepted: 03/01/2024] [Indexed: 04/04/2024]
Abstract
Gestational diabetes mellitus (GDM) is one of the most common metabolic diseases in pregnant women, posing significant risks to the life and health of both mothers and fetuses. With improving living standards, the incidence of GDM is increasing rapidly. Therefore, understanding the underlying mechanism of GDM is of paramount importance. We downloaded two datasets from the Gene Expression Omnibus (GEO) database, containing sequencing data specifically related to "gestational diabetes" and "placenta". By merging these two datasets, a mRNA expression dataset was obtained and subjected to bioinformatics analyses. To screen out corresponding genes, differential analysis and weighted correlation network analysis (WGCNA) were carried out. Lasso, support vector machine and random forest analyses were subsequently performed for identifying key genes from the differentially expressed genes (DEGs) jointly screened out through differential analysis and WGCNA. Afterwards, immunoinfiltration and correlation analysis were performed to screen immune cells that play a role in disease progression and explore the correlation between the screened key genes and immune cells, after which Western Blot, quantitative real-time polymerase chain reaction, Immunohistochemistry, methyl thiazolyl tetrazolium, flow cytometry, scratch and Transwell assays were, respectively, performed for verification. For further verification, we found that the expression levels of MAP6D1 and SCUBE1 in embryonic tissues of GDM patients was higher compared to those of healthy pregnant women, which was consistent with the results of bioinformatics analysis. Consequently, SCUBE1 was selected for follow-up experiment. In order to explore the role of SCUBE1 in the development of GDM, we treated the trophoblastic cells HTR-8/SVneo with high glucose, and on this basis downregulated the expression of SCUBE1. Through further analysis, we observed that SCUBE1 had a role in reducing cell activity, migration and invasion, and promoting cell apoptosis. In summary, SCUBE1 promotes the development of GDM by increasing cell apoptosis and reducing cell activity, migration, and invasion.
Collapse
Affiliation(s)
- Junru Liu
- Department of Endocrinology, Jinhua People's Hospital, No. 267 Danxi East Road, Jinhua, 321000, Zhejiang Province, China
| | - Caijuan Lu
- Department of Obstetrics, Hangzhou First People's Hospital, No. 261 Huansha Road, Hangzhou, 310006, Zhejiang Province, China.
| |
Collapse
|
4
|
Calvo MJ, Parra H, Santeliz R, Bautista J, Luzardo E, Villasmil N, Martínez MS, Chacín M, Cano C, Checa-Ros A, D'Marco L, Bermúdez V, De Sanctis JB. The Placental Role in Gestational Diabetes Mellitus: A Molecular Perspective. TOUCHREVIEWS IN ENDOCRINOLOGY 2024; 20:10-18. [PMID: 38812661 PMCID: PMC11132656 DOI: 10.17925/ee.2024.20.1.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 08/01/2023] [Indexed: 05/31/2024]
Abstract
During pregnancy, women undergo several metabolic changes to guarantee an adequate supply of glucose to the foetus. These metabolic modifications develop what is known as physiological insulin resistance. When this process is altered, however, gestational diabetes mellitus (GDM) occurs. GDM is a multifactorial disease, and genetic and environmental factors play a crucial role in its aetiopathogenesis. GDM has been linked to both macroscopic and molecular alterations in placental tissues that affect placental physiology. This review summarizes the role of the placenta in the development of GDM from a molecular perspective, including hormonal and pro-inflammatory changes. Inflammation and hormonal imbalance, the characteristics dominating the GDM microenvironment, are responsible for placental changes in size and vascularity, leading to dysregulation in maternal and foetal circulations and to complications in the newborn. In conclusion, since the hormonal mechanisms operating in GDM have not been fully elucidated, more research should be done to improve the quality of life of patients with GDM and their future children.
Collapse
Affiliation(s)
- María José Calvo
- Endocrine and Metabolic Diseases Research Center, School of Medicine, University of Zulia, Maracaibo, Venezuela
| | - Heliana Parra
- Endocrine and Metabolic Diseases Research Center, School of Medicine, University of Zulia, Maracaibo, Venezuela
| | - Raquel Santeliz
- Endocrine and Metabolic Diseases Research Center, School of Medicine, University of Zulia, Maracaibo, Venezuela
| | - Jordan Bautista
- Endocrine and Metabolic Diseases Research Center, School of Medicine, University of Zulia, Maracaibo, Venezuela
| | - Eliana Luzardo
- Endocrine and Metabolic Diseases Research Center, School of Medicine, University of Zulia, Maracaibo, Venezuela
| | - Nelson Villasmil
- Endocrine and Metabolic Diseases Research Center, School of Medicine, University of Zulia, Maracaibo, Venezuela
| | - María Sofía Martínez
- Endocrine and Metabolic Diseases Research Center, School of Medicine, University of Zulia, Maracaibo, Venezuela
| | - Maricamen Chacín
- Facultad de Ciencias de la Salud, Barranquilla, Universidad Simón Bolívar, Barranquilla, Colombia
| | - Clímaco Cano
- Endocrine and Metabolic Diseases Research Center, School of Medicine, University of Zulia, Maracaibo, Venezuela
| | - Ana Checa-Ros
- Research Group on Cardiorenal and Metabolic Diseases, Departamento de Medicina y Cirugía, Facultad de Ciencias de la Salud, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain
- School of Life and Health Sciences, Aston University, Birmingham, United Kingdom
| | - Luis D'Marco
- Research Group on Cardiorenal and Metabolic Diseases, Departamento de Medicina y Cirugía, Facultad de Ciencias de la Salud, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain
| | - Valmore Bermúdez
- Facultad de Ciencias de la Salud, Barranquilla, Universidad Simón Bolívar, Barranquilla, Colombia
| | - Juan Bautista De Sanctis
- Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic
| |
Collapse
|
5
|
Abindu V, Hope D, Aleni M, Andru M, Ayiasi RM, Afayo V, Oyet C, Kiconco R. Missed Diagnosis of Gestational Diabetes Mellitus Due to Selective Screening: Evidence from a Cross-Sectional Study in the West Nile Sub-Region, Uganda. Diabetes Metab Syndr Obes 2024; 17:1309-1319. [PMID: 38505540 PMCID: PMC10949170 DOI: 10.2147/dmso.s447855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/05/2024] [Indexed: 03/21/2024] Open
Abstract
Purpose To ascertain the prevalence and risk factors of gestational diabetes mellitus (GDM) in pregnant women receiving antenatal care (ANC) services within the West Nile subregion of Uganda. Patients and Methods An analytical cross-sectional study was conducted on 233 pregnant women who are within 24-28 weeks of gestation and are receiving ANC services in selected hospitals. GDM was diagnosed according to the World Health Organization (WHO) criteria (2013). A questionnaire and anthropometric measurements were used to obtain relevant data. The chi-square test and logistic regression were used to determine the association between GDM and the study variables, including participants' sociodemographic and medical characteristics. Results The prevalence of hyperglycemia first detected in pregnancy among the participants tested was 8%. Overall, 7.45% had GDM and 0.53% had diabetes mellitus in pregnancy. The fasting plasma glucose test alone was positive in 86.7% of the GDM cases. The factors that were significantly associated with GDM included age ≥25 years (p = 0.017, AOR = 3.51) and body mass index (BMI) ≥25 kg/m2 (p = 0.024, AOR = 2.67). Out of the participants diagnosed with GDM, 28.6% did not have a known risk factor. Of the pregnant women with GDM, 57% would have been missed if the selective screening in the national clinical guidelines had been followed. Urinary tract infection (UTI) and Candida were detected in 36.36% and 13.85% of the participants, respectively. Conclusion The study provides new data on the prevalence of GDM in rural settings in the West Nile subregion of Uganda. Of the participants, 7.5% were diagnosed with GDM, of which 57% would have been missed based on the selective screening of the national clinical guidelines. The study findings support the universal screening of GDM in pregnant women.
Collapse
Affiliation(s)
- Vincent Abindu
- Department of Nursing and Midwifery - Faculty of Health Sciences, Muni University, Arua, West Nile, Uganda
| | - Derick Hope
- Department of Medical Laboratory Science - Faculty of Health Sciences, Muni University, Arua, West Nile, Uganda
| | - Mary Aleni
- Department of Nursing and Midwifery - Faculty of Health Sciences, Muni University, Arua, West Nile, Uganda
| | - Monicah Andru
- Department of Nursing and Midwifery - Faculty of Health Sciences, Muni University, Arua, West Nile, Uganda
| | - Richard Mangwi Ayiasi
- Department of Public Health - Faculty of Health Sciences, Muni University, Arua, West Nile, Uganda
| | - Victor Afayo
- Department of Obstetrics and Gynaecology, Arua Regional Referral Hospital, Arua, West Nile, Uganda
| | - Caesar Oyet
- Department of Medical Laboratory Science - Faculty of Health Sciences, Clark International University, Kampala, Central, Uganda
| | - Ritah Kiconco
- Department of Clinical Biochemistry - Faculty of Health Sciences, Soroti University, Soroti, Teso, Uganda
- Department of Medical Laboratory Sciences - Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Southwestern, Uganda
| |
Collapse
|
6
|
Gao Y, Zhou M, Xu X, Ma JY, Qin MF. Body composition and risk of gestational diabetes mellitus: A univariable and multivariable Mendelian randomization study. J Diabetes Investig 2024; 15:346-354. [PMID: 38013660 PMCID: PMC10906022 DOI: 10.1111/jdi.14115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 11/05/2023] [Accepted: 11/14/2023] [Indexed: 11/29/2023] Open
Abstract
OBJECTIVE In this study, we employed a Mendelian randomization (MR) approach to investigate the independent causal associations of six body composition traits with gestational diabetes mellitus (GDM). METHODS Genome-wide significant levels (P < 10 × 5-8 ) of single nucleotide polymorphisms associated with body water mass, total protein, whole body fat-free mass, weight, whole body fat mass, and body fat percentage were used as instrumental variables. Data on GDM were obtained from the FinnGen Consortium, and both univariable and multivariable Mendelian randomization were performed. We utilized five different analytical methods including inverse-variance weighted (IVW), MR Egger, weighted median, simple mode, and weighted mode to assess the robustness of the results. RESULTS With univariable Mendelian randomization, the risk of GDM increased per 1-standard deviation (SD) increase in weight (ORweight = 1.297, P = 3.06 × 10-5 ), whole body fat mass (ORwhole body fat mass = 1.408, P = 1.32 × 10-6 ), and the risk of GDM increased per percent increase in body fat percentage (ORbody fat percentage = 1.661, P = 1.01 × 10-8 ). Total protein had a protective effect on the risk of GDM (ORtotal protein = 0.880, P = 0.048). However, there was no significant causal association between increases in body water mass and whole body fat-free mass per SD and the risk of GDM. Causal associations between weight, whole body fat mass, body fat percentage, and total protein with GDM were reduced to null in multivariable Mendelian randomization. CONCLUSION The present study furnishes genetic evidence to elucidate the causal relationship between body composition traits and GDM. Additionally, further studies are imperative to establish a causal connection between body composition traits and gestational diabetes mellitus.
Collapse
Affiliation(s)
- Yuan Gao
- The Second Affiliated Hospital of Nanchang UniversityNanchangChina
- Nursing School of Nanchang UniversityNanchangChina
| | - Min Zhou
- The Second Affiliated Hospital of Nanchang UniversityNanchangChina
| | - Xuan Xu
- The Second Affiliated Hospital of Nanchang UniversityNanchangChina
| | - Jun Yang Ma
- School of Clinical MedicineJining Medical UniversityJiningChina
- Department of General SurgeryThe First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital)JinanChina
| | - Man Fen Qin
- The Second Affiliated Hospital of Nanchang UniversityNanchangChina
- Nursing School of Nanchang UniversityNanchangChina
| |
Collapse
|
7
|
Schenk S, Ravussin Y, Lacroix A, Quansah DY, Puder JJ. Weight Categories, Trajectories, Eating Behavior, and Metabolic Consequences during Pregnancy and Postpartum in Women with GDM. Nutrients 2024; 16:560. [PMID: 38398884 PMCID: PMC10892465 DOI: 10.3390/nu16040560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 02/13/2024] [Accepted: 02/15/2024] [Indexed: 02/25/2024] Open
Abstract
Pre-pregnancy overweight and obesity are associated with increased risk for adverse outcomes, such as gestational diabetes mellitus (GDM). This study investigated weight trajectories, eating behaviors, and metabolic consequences in women with GDM during pregnancy and postpartum according to pre-pregnancy BMI. We prospectively included 464 women with GDM. Intuitive eating (Intuitive Eating Scale-2 questionnaire), gestational weight gain (GWG), postpartum weight retention (PPWR) at 6-8 weeks and 1-year postpartum, and glucose intolerance (prediabetes and diabetes) at 1-year were assessed. Women with obesity (WOB) had lower GWG but gained more weight in the postpartum (p < 0.0001). PPWR at 1-year did not differ across BMI categories (p = 0.63), whereas postpartum weight loss was most pronounced in women with normal weight (p < 0.0001), and within this category, in their lowest tertile (p < 0.05). Intuitive eating was not linked to perinatal weight changes but differed among BMI categories. PPWR predicted a 2.5-fold increased risk of glucose intolerance at 1-year independent of pre-pregnancy BMI (p < 0.001), and the adverse metabolic impact of PPWR was most pronounced in WOB with odds of increased risk of glucose intolerance 8.9 times higher (95% CI 2.956;26.968). These findings suggest an adaptive capacity to relatively rapid weight changes in the perinatal period that is less present with higher BMI.
Collapse
Affiliation(s)
- Sybille Schenk
- Service of Endocrinology, Diabetes and Metabolism, Department of Medicine, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland;
- Obstetric Service, Department Woman-Mother-Child, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland;
| | - Yann Ravussin
- Department of Endocrinology, Metabolism and Cardiovascular System, Medicine Section, University of Fribourg, 1700 Fribourg, Switzerland;
| | - Alain Lacroix
- Institute of Higher Education and Research in Healthcare, University of Lausanne, 1010 Lausanne, Switzerland;
| | - Dan Yedu Quansah
- Obstetric Service, Department Woman-Mother-Child, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland;
| | - Jardena J. Puder
- Obstetric Service, Department Woman-Mother-Child, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland;
| |
Collapse
|
8
|
Jeyaparam S, Agha-Jaffar R, Mullins E, Pinho-Gomes AC, Khunti K, Robinson S. Retrospective cohort study of the association between socioeconomic deprivation and incidence of gestational diabetes and perinatal outcomes. BMC Public Health 2024; 24:184. [PMID: 38225599 PMCID: PMC10790393 DOI: 10.1186/s12889-023-17261-8] [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: 12/23/2022] [Accepted: 11/18/2023] [Indexed: 01/17/2024] Open
Abstract
INTRODUCTION Socioeconomic disparities have been shown to correlate with perinatal mortality and the incidence of type 2 diabetes. Few studies have explored the relationship between deprivation and the incidence of gestational diabetes (GDM). We aimed to identify the relationship between deprivation and incidence of GDM, after adjusting for age, BMI, and ethnicity. We also examined for relationships between deprivation and perinatal outcomes. METHODS A retrospective cohort analysis of 23,490 pregnancies from a major National Health Service Trust in Northwest London was conducted. The 2019 English Indices of Multiple Deprivation was used to identify the deprivation rank and decile for each postcode. Birthweight centile was calculated from absolute birthweight after adjusting for ethnicity, maternal height, maternal weight, parity, sex and outcome (live birth/stillbirth). Logistic regression and Kendall's Tau were used to identify relationships between variables. RESULTS After controlling for age, BMI & ethnicity, Index of Multiple Deprivation postcode decile was not associated with an increased risk of developing gestational diabetes. Each increase in decile of deprivation was associated with an increase in birthweight centile by 0.471 (p < 0.001). After adjusting for confounders, age was associated with a 7.1% increased GDM risk (OR: 1.076, p < 0.001); BMI increased risk by 5.81% (OR: 1.059, p < 0.001). There was no significant correlation between Index of Multiple Deprivation rank and perinatal outcomes. DISCUSSION Our analysis demonstrates that socioeconomic deprivation was not associated with incidence of GDM or adverse perinatal outcomes. Factors such as genetic predisposition and lifestyle habits may likely play a larger role in the development of GDM compared to socioeconomic deprivation alone.
Collapse
Affiliation(s)
- Srirangan Jeyaparam
- Department of Metabolism, Digestion & Reproduction, Imperial College London, London, UK.
| | - Rochan Agha-Jaffar
- Department of Metabolism, Digestion & Reproduction, Imperial College London, London, UK
- Department of Metabolic Medicine, Imperial College Healthcare NHS Trust, London, UK
| | - Edward Mullins
- Department of Obstetrics & Gynaecology, Imperial College Healthcare NHS Trust, London, UK
- The George Institute for Global Health, London, UK
| | | | | | - Stephen Robinson
- Department of Metabolic Medicine, Imperial College Healthcare NHS Trust, London, UK
| |
Collapse
|
9
|
Xie W, Zhang L, Wang J, Wang Y. Association of HHEX and SLC30A8 Gene Polymorphisms with Gestational Diabetes Mellitus Susceptibility: A Meta-analysis. Biochem Genet 2023; 61:2203-2221. [PMID: 37103601 DOI: 10.1007/s10528-023-10385-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 04/14/2023] [Indexed: 04/28/2023]
Abstract
Genetics plays a role in the development of gestational diabetes mellitus (GDM), which poses serious risks to pregnant women and their children. Several studies have demonstrated a link between GDM susceptibility and rs13266634 C/T polymorphism in SLC30A8 gene and rs1111875 C/T and rs5015480 C/T, which are located near the linkage disequilibrium block containing the IDE, HHEX, and KIF11 genes. However, the results are conflicting. Therefore, we aimed to investigate the association between susceptibility to GDM and HHEX and SLC30A8 gene polymorphisms. PubMed, Web of Science, EBSCO, CNKI, Wanfang Data, VIP, and SCOPUS were used to search for research articles. The quality of the selected literature was evaluated using the Newcastle-Ottawa scale. A meta-analysis was performed using Stata 15.1. Allelic, dominant, recessive, homozygote, and heterozygote models were used for the analysis. Nine articles with 15 studies were included. (1) Four studies about HHEX rs1111875 showed that the C allele was associated with the susceptibility to GDM; (2) three studies on HHEX rs5015480 indicated that the C allele in rs5015480 was significantly associated with GDM; (3) eight studies about SLC30A8 rs13266634 showed that the C allele was significantly associated with the susceptibility to GDM; and (4) a subgroup analysis showed that the rs5015480 polymorphism in HHEX and rs13266634 polymorphism in SLC30A8 gene were associated with GDM susceptibility in Asians. The meta-analysis provided evidence that the C allele in rs1111875 and rs5015480 in HHEX and rs13266634 in SLC30A8 can increase the risk of GDM.PROSPERO registration number CRD42022342280.
Collapse
Affiliation(s)
- Wanting Xie
- Department of Physical Fitness and Health, School of Sport Science, Beijing Sport University, No.48, Xinxi Road, Haidian District, Beijing, 100084, China
| | - Liuwei Zhang
- Department of Physical Fitness and Health, School of Sport Science, Beijing Sport University, No.48, Xinxi Road, Haidian District, Beijing, 100084, China.
- Key Laboratory of Exercise and Physical Fitness, Ministry of Education, Beijing Sport University, Beijing, 100084, China.
| | - Jiawei Wang
- Department of Physical Fitness and Health, School of Sport Science, Beijing Sport University, No.48, Xinxi Road, Haidian District, Beijing, 100084, China
| | - Yirui Wang
- Department of Physical Fitness and Health, School of Sport Science, Beijing Sport University, No.48, Xinxi Road, Haidian District, Beijing, 100084, China
| |
Collapse
|
10
|
Hong M, Liang F, Zheng Z, Chen H, Li X, Guo Y, Liu X, Li K, Xia H. Interaction and joint association of gestational diabetes mellitus and subsequent weight gain rate on macrosomia. Clin Nutr ESPEN 2023; 58:368-374. [PMID: 38057029 DOI: 10.1016/j.clnesp.2023.11.001] [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: 04/09/2023] [Revised: 10/13/2023] [Accepted: 11/06/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND & AIMS Gestational diabetes mellitus (GDM) and gestational weight gain are two crucial modifiable nutritional factors during pregnancy in preventing macrosomia, warranting appropriate management of both glycemic levels and weight gain to prevent macrosomia, particularly in individuals with GDM. Unfortunately, current general weight targets appear not to apply to individuals with GDM, suggesting that weight gain, specifically following an oral glucose tolerance test (OGTT), may affect risk of macrosomia dependent on GDM status. Therefore, this study aims to evaluate the interaction and joint association of GDM and post-OGTT weight gain rate (PWGR) in relation to macrosomia. METHODS This was a population-based cohort study of 59,421singleton pregnant women in South China during 2017-2020. Among them, 9856 were diagnosed with GDM while 49,565 did not have the condition. All participants underwent an OGTT between 20 and 28 weeks of pregnancy, typically occurring between 24 and 28 weeks. PWGR was defined as the average rate of change in maternal weight with gestational weeks following OGTT, which was estimated using a repeated linear mixed effects model including a random intercept and slope for each individual. The relative risk (RR) of macrosomia associated with GDM and PWGR was estimated using a multivariate generalized linear model. RESULTS There was a significant interaction between GDM and PWGR in increasing the risk of macrosomia. The combination of GDM and a 1-SD increase in PWGR was associated with a 2.26-fold higher risk of macrosomia (95% CI 1.92 to 2.65), with the interaction of these two factors contributing to 58.0% (95% CI 31.4%-84.7%) of this association. Moreover, we observed a significant heterogeneity in susceptibility to macrosomia due to increased PWGR between GDM and non-GDM populations, with the highest PWGR quartile having respective RRs of 2.27 (95% CI 1.62 to 3.18) and 1.41 (95% CI 1.18 to 1.69) compared to the lowest quartile category, which was corresponded to 55.9% (95% CI 38.3%-68.6%) and 29.1% (95% CI 15.3%-40.8%) preventable proportions of macrosomia cases in these populations. CONCLUSIONS GDM and PWGR had a synergistic effect in increasing the risk of macrosomia. Furthermore, individuals with GDM exhibited a heightened susceptibility to macrosomia due to elevated PWGR. These findings emphasize the importance of appropriate weight interventions during late pregnancy and suggest the need for different weight targets between these two populations, with a stricter PWGR potentially being more effective for the GDM population.
Collapse
Affiliation(s)
- Miao Hong
- Clinical Research & Data Center, Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, 510623, China
| | - Feng Liang
- Clinical Research & Data Center, Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, 510623, China
| | - Zheng Zheng
- Department of Obstetrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, 510623, China
| | - Huimin Chen
- Department of Clinical Nutrition, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, 510623, China
| | - Xiaojun Li
- Clinical Research & Data Center, Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, 510623, China
| | - Yi Guo
- Clinical Research & Data Center, Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, 510623, China
| | - Xihong Liu
- Department of Clinical Nutrition, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, 510623, China
| | - Kuanrong Li
- Clinical Research & Data Center, Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, 510623, China
| | - Huimin Xia
- Clinical Research & Data Center, Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, 510623, China; Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, 510623, China.
| |
Collapse
|
11
|
Deischinger C, Bastian M, Leitner K, Bancher-Todesca D, Kiss H, Baumgartner-Parzer S, Kautzky-Willer A, Harreiter J. Gremlin-1 in pregnancy and postpartum: relation to the fatty liver index, markers of bone health, glucose metabolism and gestational diabetes mellitus status. Acta Diabetol 2023; 60:1699-1707. [PMID: 37518503 PMCID: PMC10587257 DOI: 10.1007/s00592-023-02151-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 06/30/2023] [Indexed: 08/01/2023]
Abstract
INTRODUCTION Gremlin-1 is a peptide that functions as an antagonist to bone morphogenic proteins and is overexpressed in obesity and type 2 diabetes mellitus. Gremlin-1 has not yet been investigated in pregnancy, pregnancy-related insulin resistance or gestational diabetes mellitus (GDM). PATIENTS AND METHODS Gremlin-1 levels were measured throughout the pregnancy of 58 women at high risk for GDM at the Medical University of Vienna. Furthermore, an oral glucose tolerance test, fasting insulin, fasting glucose, sex hormones, blood lipids, liver and renal parameters, and markers of bone development were evaluated at two points during pregnancy (< 20 weeks of gestation (GW), GW 24-28) and 12-14 weeks postpartum. RESULTS Gremlin-1 levels decreased from < 20 GW (mean = 9.2 pg/ml, SD = 8.4 pg/ml) to GW 24-28 (mean = 6.7 pg/ml, SD = 5.7 pg/ml, p = 0.033) and increased again postpartum, albeit not significantly (mean = 10.7 pg/ml, SD = 13.1 pg/ml, p = 0.339). During pregnancy, Gremlin-1 levels correlated negatively with osteocalcin and procollagen type I aminoterminal propeptide (P1NP), markers of bone health. Concerning glucose metabolism, Gremlin-1 levels were inversely related to the Insulinogenic Index at GW < 20. However, Gremlin-1 levels were not significantly different between women with normal glucose tolerance and GDM during pregnancy. Postpartum, Gremlin-1 was associated with the fatty liver index, osteocalcin levels, diastolic blood pressure and weight. CONCLUSION Gremlin-1 levels decreased significantly during pregnancy. The biomarker is not related to GDM status, but correlates negatively with the Insulinogenic Index, an index related to beta cell function. Trial Registry Number ACTRN12616000924459.
Collapse
Affiliation(s)
- Carola Deischinger
- Gender Medicine Unit, Clinical Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Magdalena Bastian
- Gender Medicine Unit, Clinical Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Karoline Leitner
- Gender Medicine Unit, Clinical Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Dagmar Bancher-Todesca
- Division of Fetomaternal Medicine, Department of Obstetrics and Gynaecology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Herbert Kiss
- Division of Fetomaternal Medicine, Department of Obstetrics and Gynaecology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Sabina Baumgartner-Parzer
- Gender Medicine Unit, Clinical Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Alexandra Kautzky-Willer
- Gender Medicine Unit, Clinical Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Jürgen Harreiter
- Gender Medicine Unit, Clinical Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| |
Collapse
|
12
|
Tao J, Huang Y, Li Y, Dai W. Platelet-to-lymphocyte ratio and serum hsCRP levels in third trimester and adverse pregnancy outcomes in women with gestational diabetes mellitus. Sci Rep 2023; 13:20963. [PMID: 38017249 PMCID: PMC10684644 DOI: 10.1038/s41598-023-48371-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 11/25/2023] [Indexed: 11/30/2023] Open
Abstract
Gestational diabetes mellitus (GDM) is a major complication of pregnancy. GDM is associated with a higher risk of adverse pregnancy outcomes (APO). The purpose of this study was to assess the association between third-trimester platelet to lymphocyte ratio (PLR) and high-sensitivity C-reactive protein (hsCRP) concentration and the risk of APO in GDM pregnant women. This study selected 406 non-elderly gestational diabetes patients diagnosed in the Renmin Hospital of Wuhan University from May 2021 to February 2023 as the research objects. According to the presence or absence of APO, they were divided into an APO group (n = 171) and a non-APO group (n = 235). Logistic regression model to evaluate the correlation between PLR and hsCRP and APO in women with GDM; Restricted cubic spline analyses was used to explore nonlinear correlations between PLR or hsCRP and the risk of APO; ROC curve analysis of the diagnostic performance of PLR and hsCRP for APO in women with GDM. APO occurred in 171 of the 406 included participants. Compared with the non-APO group, patients in the APO group had higher PLR and hsCRP levels. The incidence of APO was positively associated with PLR and the hsCRP level in each logistic regression model (P < 0.05). After adjusting for all the risk factors included in this study, restricted cubic spline analyses found that the PLR and the hsCRP level were positively associated with the risk of APO. The levels of PLR and hsCRP in the third trimester are related to the occurrence of APO in women with GDM, and high levels of PLR and hsCRP may indicate the occurrence of APO.
Collapse
Affiliation(s)
- Jun Tao
- Department of Clinical Laboratory, Institute of Translational Medicine, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yun Huang
- Department of Clinical Laboratory, Institute of Translational Medicine, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yan Li
- Department of Clinical Laboratory, Institute of Translational Medicine, Renmin Hospital of Wuhan University, Wuhan, China.
| | - Wen Dai
- Department of Clinical Laboratory, Institute of Translational Medicine, Renmin Hospital of Wuhan University, Wuhan, China.
| |
Collapse
|
13
|
Coelho S, Canha M, Leite AR, Neves JS, Oliveira AI, Carvalho D. Relation between weight gain during pregnancy and postpartum reclassification in gestational diabetes. Endocrine 2023; 82:296-302. [PMID: 37668927 DOI: 10.1007/s12020-023-03441-4] [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: 04/01/2023] [Accepted: 06/22/2023] [Indexed: 09/06/2023]
Abstract
PURPOSE Gestational diabetes mellitus (GDM) is the most common metabolic disease in pregnancy. It is known that GDM is a precursor to type 2 diabetes (T2D). There is evidence that excessive gestational weight variation (GWV) increases the risk of GDM. So, in this study, we aimed to evaluate the association between GWV and the persistence of diabetes in postpartum reclassification. METHODS A retrospective observational study including pregnant women based on data from the Portuguese National Registry of Gestational Diabetes. Six-to-eight weeks after delivery, all women included underwent a reclassification test. We performed unadjusted and adjusted logistic regression models to evaluate the associations between GWV and diabetes diagnosis at the reclassification test. A subgroup analysis according to the pre-gestational BMI was also performed. RESULTS We included 10,389 pregnant women, of which 19.6% had GDM in a previous pregnancy. The median of GWV was 10.0 [6.4, 14.0] kg and was found to be higher for those with a normal BMI. At the DM reclassification test, 1% of the women were diagnosed with T2D. We found a negative association between GWV and postpartum diabetes mellitus (DM). We also present a subgroup analysis, and these associations were only significant for the group with a normal pre-gestational BMI. CONCLUSION Our results showed that women with normal pre-gestational BMI and lower GWV were more likely to have a diagnosis of DM in the postpartum reclassification test. This study helps to fill the gap in the effect of GWG on the persistence of diabetes in postpartum reclassification.
Collapse
Affiliation(s)
- Sofia Coelho
- Department of Biomedicins, Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal.
| | - Marta Canha
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal
| | - Ana Rita Leite
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal
| | - João Sérgio Neves
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal
| | | | - Davide Carvalho
- Instituto de Investigação e Inovação em Saúde (i3s), Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal
| |
Collapse
|
14
|
Massa MG, Scott RL, Cara AL, Cortes LR, Vander PB, Sandoval NP, Park JW, Ali SL, Velez LM, Wang HB, Ati SS, Tesfaye B, Reue K, van Veen JE, Seldin MM, Correa SM. Feeding neurons integrate metabolic and reproductive states in mice. iScience 2023; 26:107918. [PMID: 37817932 PMCID: PMC10561062 DOI: 10.1016/j.isci.2023.107918] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 07/27/2023] [Accepted: 09/12/2023] [Indexed: 10/12/2023] Open
Abstract
Balance between metabolic and reproductive processes is important for survival, particularly in mammals that gestate their young. How the nervous system coordinates this balance is an active area of study. Herein, we demonstrate that somatostatin (SST) neurons of the tuberal hypothalamus alter feeding in a manner sensitive to metabolic and reproductive states in mice. Whereas chemogenetic activation of SST neurons increased food intake across sexes, ablation decreased food intake only in female mice during proestrus. This ablation effect was only apparent in animals with low body mass. Fat transplantation and bioinformatics analysis of SST neuronal transcriptomes revealed white adipose as a key modulator of these effects. These studies indicate that SST hypothalamic neurons integrate metabolic and reproductive cues by responding to varying levels of circulating estrogens to modulate feeding differentially based on energy stores. Thus, gonadal steroid modulation of neuronal circuits can be context dependent and gated by metabolic status.
Collapse
Affiliation(s)
- Megan G. Massa
- Department of Integrative Biology and Physiology, University of California – Los Angeles, Los Angeles, CA 90095, USA
- Neuroscience Interdepartmental Doctoral Program, University of California – Los Angeles, Los Angeles, CA 90095, USA
| | - Rachel L. Scott
- Department of Integrative Biology and Physiology, University of California – Los Angeles, Los Angeles, CA 90095, USA
| | - Alexandra L. Cara
- Department of Integrative Biology and Physiology, University of California – Los Angeles, Los Angeles, CA 90095, USA
| | - Laura R. Cortes
- Department of Integrative Biology and Physiology, University of California – Los Angeles, Los Angeles, CA 90095, USA
| | - Paul B. Vander
- Department of Integrative Biology and Physiology, University of California – Los Angeles, Los Angeles, CA 90095, USA
| | - Norma P. Sandoval
- Department of Integrative Biology and Physiology, University of California – Los Angeles, Los Angeles, CA 90095, USA
| | - Jae W. Park
- Department of Integrative Biology and Physiology, University of California – Los Angeles, Los Angeles, CA 90095, USA
| | - Sahara L. Ali
- Department of Integrative Biology and Physiology, University of California – Los Angeles, Los Angeles, CA 90095, USA
| | - Leandro M. Velez
- Department of Human Genetics, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Huei-Bin Wang
- Department of Integrative Biology and Physiology, University of California – Los Angeles, Los Angeles, CA 90095, USA
| | - Shomik S. Ati
- Department of Integrative Biology and Physiology, University of California – Los Angeles, Los Angeles, CA 90095, USA
| | - Bethlehem Tesfaye
- Department of Integrative Biology and Physiology, University of California – Los Angeles, Los Angeles, CA 90095, USA
| | - Karen Reue
- Department of Human Genetics, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - J. Edward van Veen
- Department of Integrative Biology and Physiology, University of California – Los Angeles, Los Angeles, CA 90095, USA
| | - Marcus M. Seldin
- Department of Biological Chemistry, School of Medicine, University of California – Irvine, Irvine, CA 92697, USA
| | - Stephanie M. Correa
- Department of Integrative Biology and Physiology, University of California – Los Angeles, Los Angeles, CA 90095, USA
| |
Collapse
|
15
|
Veneti S, Grammatikopoulou MG, Kintiraki E, Mintziori G, Goulis DG. Ketone Bodies in Diabetes Mellitus: Friend or Foe? Nutrients 2023; 15:4383. [PMID: 37892458 PMCID: PMC10609881 DOI: 10.3390/nu15204383] [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: 09/18/2023] [Revised: 10/12/2023] [Accepted: 10/14/2023] [Indexed: 10/29/2023] Open
Abstract
In glucose-deprived conditions, ketone bodies are produced by the liver mitochondria, through the catabolism of fatty acids, and are used peripherally, as an alternative energy source. Ketones are produced in the body under normal conditions, including during pregnancy and the neonatal period, when following a ketogenic diet (KD), fasting, or exercising. Additionally, ketone synthesis is also augmented under pathological conditions, including cases of diabetic ketoacidosis (DKA), alcoholism, and several metabolic disorders. Nonetheless, diet is the main regulator of total body ketone concentrations. The KDs are mimicking the fasting state, altering the default metabolism towards the use of ketones as the primary fuel source. Recently, KD has gained recognition as a medical nutrition therapy for a plethora of metabolic conditions, including obesity and diabetes mellitus (DM). The present review aims to discuss the role of ketones, KDs, ketonemia, and ketonuria in DM, presenting all the available new evidence in a comprehensive manner.
Collapse
Affiliation(s)
- Stavroula Veneti
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, GR-54124 Thessaloniki, Greece; (S.V.); (E.K.)
| | - Maria G. Grammatikopoulou
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, GR-54124 Thessaloniki, Greece; (S.V.); (E.K.)
- Unit of Immunonutrition and Clinical Nutrition, Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, GR-41110 Larissa, Greece
| | - Evangelia Kintiraki
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, GR-54124 Thessaloniki, Greece; (S.V.); (E.K.)
| | - Gesthimani Mintziori
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, GR-54124 Thessaloniki, Greece; (S.V.); (E.K.)
| | - Dimitrios G. Goulis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, GR-54124 Thessaloniki, Greece; (S.V.); (E.K.)
| |
Collapse
|
16
|
Meng Y, Thornburg LL, Hoeger KM, Núñez ZR, Kautz A, Evans AT, Wang C, Miller RK, Groth SW, O’Connor TG, Barrett ES. Association between sex steroid hormones and subsequent hyperglycemia during pregnancy. Front Endocrinol (Lausanne) 2023; 14:1213402. [PMID: 37766683 PMCID: PMC10520461 DOI: 10.3389/fendo.2023.1213402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 08/08/2023] [Indexed: 09/29/2023] Open
Abstract
Objective Sex steroid hormones may play a role in insulin resistance and glucose dysregulation. However, evidence regarding associations between early-pregnancy sex steroid hormones and hyperglycemia during pregnancy is limited. The primary objective of this study was to assess the relationships between first trimester sex steroid hormones and the subsequent development of hyperglycemia during pregnancy; with secondary evaluation of sex steroid hormones levels in mid-late pregnancy, concurrent with and subsequent to diagnosis of gestational diabetes. Methods Retrospective analysis of a prospective pregnancy cohort study was conducted. Medically low-risk participants with no known major endocrine disorders were recruited in the first trimester of pregnancy (n=319). Sex steroid hormones in each trimester, including total testosterone, free testosterone, estrone, estradiol, and estriol, were assessed using high-performance liquid chromatography and tandem mass spectrometry. Glucose levels of the 1-hour oral glucose tolerance test and gestational diabetes diagnosis were abstracted from medical records. Multivariable linear regression models were fitted to assess the associations of individual first trimester sex steroids and glucose levels. Results In adjusted models, first trimester total testosterone (β=5.24, 95% CI: 0.01, 10.46, p=0.05) and free testosterone (β=5.98, 95% CI: 0.97, 10.98, p=0.02) were positively associated with subsequent glucose concentrations and gestational diabetes diagnosis (total testosterone: OR=3.63, 95% CI: 1.50, 8.78; free testosterone: OR=3.69; 95% CI: 1.56, 8.73). First trimester estrone was also positively associated with gestational diabetes (OR=3.66, 95% CI: 1.56, 8.55). In mid-late pregnancy, pregnant people with gestational diabetes had lower total testosterone levels (β=-0.19, 95% CI: -0.36, -0.02) after adjustment for first trimester total testosterone. Conclusion Early-pregnancy sex steroid hormones, including total testosterone, free testosterone, and estrone, were positively associated with glucose levels and gestational diabetes in mid-late pregnancy. These hormones may serve as early predictors of gestational diabetes in combination with other risk factors.
Collapse
Affiliation(s)
- Ying Meng
- School of Nursing, University of Rochester, Rochester, NY, United States
| | - Loralei L. Thornburg
- Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, United States
| | - Kathleen M. Hoeger
- Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, United States
| | - Zorimar Rivera- Núñez
- Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, United States
- Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, NJ, United States
| | - Amber Kautz
- Public Health Sciences, University of Rochester Medical Center, Rochester, NY, United States
| | - Adam T. Evans
- Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, United States
| | - Christina Wang
- Division of Endocrinology, Department of Medicine and Clinical and Translational Science Institue, The Lundquist Institute at Harbor-University of California, Los Angeles (UCLA) Medical Center, Torrance, CA, United States
| | - Richard K. Miller
- Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, United States
| | - Susan W. Groth
- School of Nursing, University of Rochester, Rochester, NY, United States
| | - Thomas G. O’Connor
- Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, United States
- Department of Psychiatry, University of Rochester, Rochester, NY, United States
- Department of Neuroscience, University of Rochester Medical Center, Rochester, NY, United States
- Wynne Center for Family Research, University of Rochester Medical Center, Rochester, NY, United States
| | - Emily S. Barrett
- Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, United States
- Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, United States
- Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, NJ, United States
- Public Health Sciences, University of Rochester Medical Center, Rochester, NY, United States
| |
Collapse
|
17
|
Jaworsky K, DeVillez P, Alexander JM, Basu A. Effects of an Eating Pattern Including Colorful Fruits and Vegetables on Management of Gestational Diabetes: A Randomized Controlled Trial. Nutrients 2023; 15:3624. [PMID: 37630814 PMCID: PMC10458836 DOI: 10.3390/nu15163624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/15/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023] Open
Abstract
Gestational diabetes mellitus (GDM), defined as abnormal glucose tolerance that presents during the second and third trimesters of pregnancy, is a growing issue in the United States and worldwide. If left untreated or poorly controlled, GDM can result in numerous consequences for both the mother and the fetus; thus, it is imperative that different avenues of management for GDM be explored. There is a paucity of studies that examine how lifestyle changes, including dietary and physical activity, affect management of GDM. We examined how counseling on lifestyle changes can affect cardiometabolic risks in women with GDM. We conducted a 12-week randomized controlled trial based on behavioral counseling in which women with GDM (N = 38) were randomized into either a nutrition education (control) (N = 18) group or nutrition intervention (N = 20) group. The nutrition education group were given dietary counseling regarding healthy dietary choices based on USDA guidelines, while the nutrition intervention group were instructed to consume a total of one cup of whole berries and one cup of leafy vegetables daily along with performing postprandial exercise (walking). Blood samples, anthropometric measures, and dietary and physical activity data, recorded in daily food and activity logs, were collected at baseline and at the end of the study and compared between the two groups. Dietary counseling on supplementation with whole berries and leafy vegetables resulted in increased fiber intake, increased antioxidant intake and total serum antioxidant capacity, improved random blood glucose, decreased serum IL-6, and improved HDL cholesterol versus the control group (all p < 0.05). These results highlight that whole berry and leafy vegetable supplementation-based dietary counseling can improve the metabolic pathways involved in gestational diabetes pathogenesis and prognosis. These functional foods must be recommended in the management of pregnancies affected by GDM.
Collapse
Affiliation(s)
- Kataryna Jaworsky
- Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas, NV 89154, USA;
- Department of Kinesiology and Nutrition Sciences, School of Integrated Health Sciences, University of Nevada, Las Vegas, NV 89154, USA;
| | - Pamela DeVillez
- Department of Kinesiology and Nutrition Sciences, School of Integrated Health Sciences, University of Nevada, Las Vegas, NV 89154, USA;
| | - James M. Alexander
- Department of Obstetrics and Gynecology, UNR School of Medicine, University of Nevada, Reno, NV 89557, USA;
| | - Arpita Basu
- Department of Kinesiology and Nutrition Sciences, School of Integrated Health Sciences, University of Nevada, Las Vegas, NV 89154, USA;
| |
Collapse
|
18
|
Mendez Y, Alpuing Radilla LA, Delgadillo Chabolla LE, Castillo Cruz A, Luna J, Surani S. Gestational diabetes mellitus and COVID-19: The epidemic during the pandemic. World J Diabetes 2023; 14:1178-1193. [PMID: 37664480 PMCID: PMC10473953 DOI: 10.4239/wjd.v14.i8.1178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 06/24/2023] [Accepted: 07/17/2023] [Indexed: 08/11/2023] Open
Abstract
During the global coronavirus disease 2019 (COVID-19) pandemic, people worldwide have experienced an unprecedented rise in psychological distress and anxiety. In addition to this challenging situation, the prevalence of diabetes mellitus (DM), a hidden epidemic, has been steadily increasing in recent years. Lower-middle-income countries have faced significant barriers in providing accessible prenatal care and promoting a healthy diet for pregnant women, and the pandemic has made these challenges even more difficult to overcome. Pregnant women are at a higher risk of developing complications such as hyper-tension, preeclampsia, and gestational diabetes, all of which can have adverse implications for both maternal and fetal health. The occurrence of gestational diabetes has been on the rise, and it is possible that the pandemic has worsened its prevalence. Although data is limited, studies conducted in Italy and Canada suggest that the pandemic has had an impact on gestational diabetes rates, especially among women in their first trimester of pregnancy. The significant disruptions to daily routines caused by the pandemic, such as limited exercise options, indicate a possible link between COVID-19 and an increased likelihood of experiencing higher levels of weight gain during pregnancy. Notably, individuals in the United States with singleton pregnancies are at a significantly higher risk of excessive gestational weight gain, making this association particularly important to consider. Although comprehensive data is currently lacking, it is important for clinical researchers to explore the possibility of establishing correlations between the stress experienced during the pandemic, its consequences such as gestational gain weight, and the increasing incidence of gestational DM. This knowledge would contribute to better preventive measures and support for pregnant individuals during challenging times.
Collapse
Affiliation(s)
- Yamely Mendez
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX 77030, United States
| | - Linda A Alpuing Radilla
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX 77030, United States
| | | | - Alejandra Castillo Cruz
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX 77030, United States
| | - Johanan Luna
- Department of Medicine, Xochicalco University, Mexicali 21376, BC, Mexico
- Department of Medicine, Mt. Olympus Medical Research, Sugarland, TX 77479, United States
| | - Salim Surani
- Department of Medicine & Pharmacology, Texas A&M University, College Station, TX 77843, United States
| |
Collapse
|
19
|
Bilder DA, Worsham W, Sullivan S, Esplin MS, Burghardt P, Fraser A, Bakian AV. Sex-specific and sex-independent steroid-related biomarkers in early second trimester maternal serum associated with autism. Mol Autism 2023; 14:30. [PMID: 37573326 PMCID: PMC10422808 DOI: 10.1186/s13229-023-00562-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 08/01/2023] [Indexed: 08/14/2023] Open
Abstract
BACKGROUND Prenatal exposure to maternal metabolic conditions associated with inflammation and steroid dysregulation has previously been linked to increased autism risk. Steroid-related maternal serum biomarkers have also provided insight into the in utero steroid environment for offspring who develop autism. OBJECTIVE This study examines the link between autism among offspring and early second trimester maternal steroid-related serum biomarkers from pregnancies enriched for prenatal metabolic syndrome (PNMS) exposure. STUDY DESIGN Early second trimester maternal steroid-related serum biomarkers (i.e., estradiol, free testosterone, total testosterone, and sex hormone binding globulin) were compared between pregnancies corresponding to offspring with (N = 68) and without (N = 68) autism. Multiple logistic regression analyses were stratified by sex and gestational duration. One-way ANCOVA with post hoc tests was performed for groups defined by autism status and PNMS exposure. RESULTS Increased estradiol was significantly associated with autism only in males (AOR = 1.13 per 100 pg/ml, 95% CI 1.01-1.27, p = 0.036) and only term pregnancies (AOR = 1.17 per 100 pg/ml, 95% CI 1.04-1.32, p = 0.010). Autism status was significantly associated with decreased sex hormone binding globulin (AOR = 0.65 per 50 nmol/L, 95% CI 0.55-0.78, p < 0.001) overall and when stratified by sex and term pregnancy status. The inverse association between sex hormone binding globulin and autism was independent of PNMS exposure. LIMITATIONS The relative racial and ethnic homogeneity of Utah's population limits the generalizability of study results. Although significant differences by autism status were identified in concentrations of sex hormone binding globulin overall and of estradiol in participant subgroups, differences by PNMS exposure failed to reach statistical significance, which may reflect insufficient statistical power. CONCLUSION Both elevated maternal serum estradiol in males only and low maternal serum sex hormone binding globulin in both sexes are associated with increased autism risk. Further investigation is merited to identify how steroid, metabolic, and inflammatory processes can interact to influence neurodevelopment in early second trimester.
Collapse
Affiliation(s)
- Deborah A Bilder
- University of Utah Huntsman Mental Health Institute, 383 Colorow Drive, Room 360, Salt Lake City, UT, 84108, USA.
| | - Whitney Worsham
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | | | - M Sean Esplin
- University of Utah School of Medicine, Salt Lake City, UT, USA
- Intermountain Healthcare, Salt Lake City, UT, USA
| | | | - Alison Fraser
- University of Utah Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Amanda V Bakian
- University of Utah Huntsman Mental Health Institute, 383 Colorow Drive, Room 360, Salt Lake City, UT, 84108, USA
| |
Collapse
|
20
|
Han T, Chen Q, Huang J, Zhang J, Li A, Xu W, Peng Z, Li Z, Chen L. Low-dose esketamine with sufentanil for postcesarean analgesia in women with gestational diabetes mellitus: a prospective, randomized, double-blind study. Front Endocrinol (Lausanne) 2023; 14:1202734. [PMID: 37635978 PMCID: PMC10454896 DOI: 10.3389/fendo.2023.1202734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 07/24/2023] [Indexed: 08/29/2023] Open
Abstract
Background Pregnant women with gestational diabetes mellitus (GDM) require more analgesics after cesarean delivery than those who do not have GDM. Uncontrolled pain following cesarean delivery is a major problem in women with GDM. We investigate the efficacy of low-dose esketamine combined with sufentanil intravenous patient-controlled analgesia (PCA)for postcesarean analgesia in women with GDM. Methods One hundred forty pregnant women with GDM were enrolled participate in this randomized controlled trial and were randomized into two groups (70 in each group). The esketamine (S) group was given esketamine +sufentanil + ondansetron, and the control (C) group was given sufentanil +ondansetron. The primary outcome is sufentanil consumption at 24 hours postoperatively, the secondary outcomes are sufentanil consumption at 6 hours postoperatively, pain scores at 6, 24 and 48 hours postoperatively. Results Compared with group C, group S had significantly lower sufentanil consumption at 6 and 24 hours postoperatively (P= 0.049 and P<0.001), significantly lower activities VAS(pain during activities)scores at 6 hours postoperatively, rest and activities VAS (pain at rest and pain during activities)scores at 24 hours postoperatively, and activities VAS scores at 48 hours postoperatively(P=0.022, P =0.002, P=0.001 and P=0.007). Compared to group C, the time to bowel function return was significantly shorter in group S. There was no significant difference in rest VAS (pain at rest) scores at 6 and 48 hours postoperatively (P>0.05). The time to first lactation was not significantly different between the two groups (P>0.05). There was no significant difference in neonatal neurobehavioral scores between the two groups (P>0.05). Conclusion Compared to sufentanil PCA, adding low dose of esketamine significantly reduced the consumption of sufentanil while providing equally effective post cesarean analgesia in the patients with gestational diabetes.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Liang Chen
- Department of Anesthesiology, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, China
| |
Collapse
|
21
|
Kang DH, Kim MJ, Mohamed EA, Kim DS, Jeong JS, Kim SY, Kang HG, Lee GS, Hong EJ, Ahn C, Jung EM, An BS, Kim SC. Regulation of uterus and placenta remodeling under high estradiol levels in gestational diabetes mellitus models†. Biol Reprod 2023; 109:215-226. [PMID: 37255320 DOI: 10.1093/biolre/ioad059] [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: 01/30/2023] [Revised: 04/25/2023] [Accepted: 05/18/2023] [Indexed: 06/01/2023] Open
Abstract
The present study aimed to investigate the regulation of placentas and uterus remodeling and involvement of estradiol in gestational diabetes mellitus. To achieve this, we established in vitro and in vivo models for gestational diabetes mellitus placentas by culturing human placental choriocarcinoma cells (BeWo) under hyperglycemic concentration and treating pregnant rats with streptozotocin. We evaluated the expression of angiogenesis-related proteins. The expression of the anti-angiogenic factor, excess placental soluble fms-like tyrosine kinase 1 was increased in our in vitro gestational diabetes mellitus model compared with the control. Moreover, the expressions of placental soluble fms-like tyrosine kinase 1 and the von Willebrand factor were also significantly elevated in the placenta of streptozotocin-treated rats. These data indicate the disruption of angiogenesis in the gestational diabetes mellitus placentas. The expression levels of connexin 43, a component of the gap junction and collagen type I alpha 2 chain, a component of the extracellular matrix, were decreased in the gestational diabetes mellitus uterus. These results suggest that uterus decidualization and placental angiogenesis are inhibited in gestational diabetes mellitus rats. Our results also showed upregulation of the expression of genes regulating estradiol synthesis as well as estrogen receptors in vivo models. Accordingly, the concentration of estradiol measured in the culture medium under hyperglycemic conditions, as well as in the serum and placenta of the streptozotocin-treated rats, was significantly elevated compared with the control groups. These results suggest that the dysregulated remodeling of the placenta and uterus may result in the elevation of estradiol and its signaling pathway in the gestational diabetes mellitus animal model to maintain pregnancy.
Collapse
Affiliation(s)
- Da Hee Kang
- Department of Biomaterials Science (BK21 Four Program), College of Natural Resources & Life Science, Pusan National University, Miryang, Republic of Korea
| | - Min Jae Kim
- Department of Biomaterials Science (BK21 Four Program), College of Natural Resources & Life Science, Pusan National University, Miryang, Republic of Korea
- Developmental and Reproductive Toxicology Research Group, Korea Institute of Toxicology, Daejeon, Republic of Korea
| | - Elsayed A Mohamed
- Department of Biomaterials Science (BK21 Four Program), College of Natural Resources & Life Science, Pusan National University, Miryang, Republic of Korea
- Department of Genetics, Assiut University, Assiut, Egypt
| | - Da Som Kim
- Department of Biomaterials Science (BK21 Four Program), College of Natural Resources & Life Science, Pusan National University, Miryang, Republic of Korea
| | - Jea Sic Jeong
- Department of Biomaterials Science (BK21 Four Program), College of Natural Resources & Life Science, Pusan National University, Miryang, Republic of Korea
| | - So Young Kim
- Department of Biomaterials Science (BK21 Four Program), College of Natural Resources & Life Science, Pusan National University, Miryang, Republic of Korea
| | - Hyeon-Gu Kang
- Department of Biomaterials Science (BK21 Four Program), College of Natural Resources & Life Science, Pusan National University, Miryang, Republic of Korea
| | - Geun-Shik Lee
- Department of Veterinary Medicine, Kangwon National University, Chuncheon, Gangwon, Republic of Korea
| | - Eui-Ju Hong
- Department of Veterinary Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Changhwan Ahn
- Department of Veterinary Medicine, Jeju National University, Jeju, Republic of Korea
| | - Eui-Man Jung
- Department of Molecular Biology, College of Natural Sciences, Pusan National University, Busan, Republic of Korea
| | - Beum-Soo An
- Department of Biomaterials Science (BK21 Four Program), College of Natural Resources & Life Science, Pusan National University, Miryang, Republic of Korea
| | - Seung-Chul Kim
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Busan, Republic of Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| |
Collapse
|
22
|
Alex NS, Khan HR, Ramachandra SG, Medhamurthy R. Pregnancy-associated Steroid Effects on Insulin Sensitivity, Adipogenesis, and Lipogenesis: Role of Wnt/β-Catenin Pathway. J Endocr Soc 2023; 7:bvad076. [PMID: 37440965 PMCID: PMC10334487 DOI: 10.1210/jendso/bvad076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Indexed: 07/15/2023] Open
Abstract
Context The shift in maternal energy metabolism characteristic of pregnancy is thought to be driven by various hormonal changes, especially of ovarian and placental steroids. Imbalances in circulating estradiol (E2) and progesterone (P4) levels during this period are often associated with metabolic disturbances leading to the development of gestational diabetes mellitus (GDM). Since abnormalities in the Wnt pathway effector transcription factor 7-like 2 (TCF7L2) are commonly associated with the occurrence of GDM, we hypothesized that the canonical or β-catenin-dependent Wnt signaling pathway mediates the metabolic actions of E2 and P4. Objective Our study was aimed at elucidating the metabolic function of the steroids E2 and P4, and examining the role of the canonical Wnt signaling pathway in mediating the actions of these steroids. Methods The ovariectomized (OVX) rat was used as a model system to study the effect of known concentrations of exogenously administered E2 and P4. Niclosamide (Nic) was administered to block Wnt signaling. 3T3-L1 cells were used to analyze changes in differentiation in the presence of the steroids or niclosamide. Results In the present study, we observed that E2 enhanced insulin sensitivity and inhibited lipogenesis while P4 increased lipogenic gene expression-in 3T3-L1 adipocytes, and in adipose tissue and skeletal muscle of OVX rats when the dosage of E2 and P4 mimicked that of pregnancy. Both E2 and P4 were also found to upregulate Wnt signaling. Nic nhibited the steroid-mediated increase in Wnt signaling in adipocytes and OVX rats. The insulin-sensitizing and antilipogenic actions of E2 were found to be mediated by the canonical Wnt pathway, but the effects of P4 on lipogenesis appeared to be independent of it. Additionally, it was observed that inhibition of Wnt signaling by Nic hastened adipogenic differentiation, and the inhibitory effect of E2 on differentiation was prevented by Nic. Conclusion The findings presented in this study highlight the role of steroids and Wnt pathway in glucose and lipid metabolism and are relevant to understanding the pathophysiology of metabolic disorders arising from hormonal disturbances.
Collapse
Affiliation(s)
- Neethu Sara Alex
- Department of Molecular Reproduction, Development and Genetics, Indian Institute of Science, Bangalore, India
| | - Habibur Rahaman Khan
- Department of Molecular Reproduction, Development and Genetics, Indian Institute of Science, Bangalore, India
| | - Subbaraya Gudde Ramachandra
- Department of Molecular Reproduction, Development and Genetics, Indian Institute of Science, Bangalore, India
| | - Rudraiah Medhamurthy
- Department of Molecular Reproduction, Development and Genetics, Indian Institute of Science, Bangalore, India
| |
Collapse
|
23
|
Krutilova P, Williams R, Morey R, Field C, Byrth V, Tepe M, McQueen A, Herrick C. Gestational diabetes knowledge improves with interactive online training modules: a pre-post analysis. RESEARCH SQUARE 2023:rs.3.rs-2860961. [PMID: 37398401 PMCID: PMC10312972 DOI: 10.21203/rs.3.rs-2860961/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Background The risk of developing type 2 diabetes mellitus (T2DM) is up to 50% among women with gestational diabetes mellitus (GDM). GDM also increases risks for pre-term birth, macrosomia, fetal hypoglycemia, and C-section delivery. Education for expectant mothers with GDM about nutrition, exercise, and the risks of developing T2DM after delivery enhances the probability of postpartum diabetes screening. However, the availability of diabetes education is limited. To bridge this gap, our team developed four training modules on GDM tailored for nurses and community health workers. This pilot study assesses changes in knowledge, self-efficacy for providing diabetes education, attitudes, and intentions to recommend diabetes prevention before and after training completion. Methods These interactive online modules, each lasting 45-60 minutes and featuring engaging case studies and integrated knowledge assessment questions, were disseminated through various professional organizations to clinical staff providing care for women with GDM. Optional pre- and post-training surveys were conducted to gauge the effectiveness of the modules. Collected data did not follow a normal distribution pattern. We provided an overview of the baseline characteristics of the population, self-efficacy, attitudes, intentions, and GDM knowledge by calculating the median scores and interquartile ranges. We assessed the changes in scores on self-efficacy, attitudes, intentions, and GDM knowledge before and after training using non-parametric Wilcoxon matched-pair signed rank tests. Results Eighty-two individuals completed baseline evaluation and 20 individuals accessed all modules and completed post-training assessments. Among those completing the training, improvement was noted in GDM knowledge [56.5% (16.0) v. 78.3% (22.0), p < 0.001], Self-efficacy for providing diabetes education [6.60 (2.73) v. 9.33 (0.87), p < 0.001], attitudes toward the value of tight control [4.07 (0.79) v. 4.43 (0.86), p = 0.003], and intentions to recommend diabetes prevention measures [4.81 (0.63) v. 5.00 (0.00), p = 0.009)]. Conclusions Completion of our interactive online modules improved knowledge, intention to recommend diabetes prevention methods, self-efficacy to provide diabetes education, and attitudes toward the value of tight control among individuals caring for women with GDM. Enhanced accessibility to such curricula is crucial to improve access to diabetes education. Trial registration This study was registered at clinicaltrials.gov, identifier: NCT04474795.
Collapse
Affiliation(s)
- Petra Krutilova
- Washington University School of Medicine, Metabolism & Lipid Research
| | - Roxann Williams
- Washington University School of Medicine, Metabolism & Lipid Research
| | | | - Carole Field
- Washington University School of Medicine, Metabolism & Lipid Research
| | | | | | | | - Cynthia Herrick
- Washington University School of Medicine, Metabolism & Lipid Research
| |
Collapse
|
24
|
Punnose J, Sukhija K, Rijhwani RM. Intermediate hyperglycemia in early pregnancy: A South Asian perspective. World J Diabetes 2023; 14:573-584. [PMID: 37273252 PMCID: PMC10236988 DOI: 10.4239/wjd.v14.i5.573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/28/2023] [Accepted: 04/07/2023] [Indexed: 05/15/2023] Open
Abstract
“Intermediate hyperglycemia in early pregnancy (IHEP)” refers to mild hyperglycemia detected before 24 gestational weeks (GW), satisfying the criteria for the diagnosis of gestational diabetes mellitus. Many professional bodies recommend routine screening for “overt diabetes” in early pregnancy, which identifies a significant number of women with mild hyperglycemia of undetermined significance. A literature search revealed that one-third of GDM women in South Asian countries are diagnosed before the conventional screening period of 24 GW to 28 GW; hence, they belong in the IHEP category. Most hospitals in this region diagnose IHEP by oral glucose tolerance test (OGTT) using the same criteria used for GDM diagnosis after 24 GW. There is some evidence to suggest that South Asian women with IHEP are more prone to adverse pregnancy events than women with a diagnosis of GDM after 24 GW, but this observation needs to be proven by randomized control trials. Fasting plasma glucose is a reliable screening test for GDM that can obviate the need for OGTT for GDM diagnosis among 50% of South Asian pregnant women. HbA1c in the first trimester predicts GDM in later pregnancy, but it is not a reliable test for IHEP diagnosis. There is evidence to suggest that HbA1c in the first trimester is an independent risk factor for several adverse pregnancy events. Further research to identify the patho-genetic mechanisms behind the fetal and maternal effects of IHEP is strongly recommended.
Collapse
Affiliation(s)
- John Punnose
- Department of Endocrinology and Metabolism, St. Stephen’s Hospital, Delhi 110054, India
| | - Komal Sukhija
- Department of Endocrinology, St.Stephen’s Hospital, Delhi 110054, India
| | | |
Collapse
|
25
|
Al-Shahrani AM. Predictors of Neonatal Intensive Care Unit Admission and Adverse Outcomes Related to Gestational Diabetes. Cureus 2023; 15:e38579. [PMID: 37153839 PMCID: PMC10161799 DOI: 10.7759/cureus.38579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is a type of diabetes that manifests itself in pregnant women. It poses a significant risk to the mother's health as well as the health of the infant, including more babies being brought to the neonatal intensive care unit (NICU). It puts both the mother's and the child's health at serious risk, increasing the likelihood that newborns may need to be treated in a neonatal critical care unit. This study aimed to determine the factors that predict GDM-related NICU admission and other adverse newborn outcomes. METHODS The study was a cross-sectional analysis of 175 pregnant women who presented with gestational diabetes at the Maternity and Children's Hospital in Bisha (MCH-Bisha), Saudi Arabia, between January 1 and December 31, 2022. A logistic regression model was used to analyze the data to predict adverse outcomes for newborns and NICU admissions and identify associations between maternal variables and outcomes. RESULTS Maternal characteristics highly associated with adverse neonatal outcomes included advanced maternal age (greater than 30 years), a family history of DM, and a history of greater than or equal to four previous pregnancies. Logistic regression models revealed that newborns delivered to mothers older than 30 years were 7.17 times more likely to be admitted to the NICU than newborns born to mothers younger than 30 years. Saudi nationality, urban residence, and cesarean section delivery factors account for nearly all adverse neonatal outcomes (91%, 75%, and 91%, respectively). Newborns delivered by cesarean section were 3.38 times more likely to be admitted to NICU, and the association was significant. CONCLUSIONS Maternal age greater than 30 years and a history of more than or equal to four pregnancies were the strongest indicators of infant adverse outcomes and NICU admittance among women with gestational diabetes. These findings highlight the need for approaches to GDM management that are efficient, thorough, and multidisciplinary.
Collapse
|
26
|
Pinto Y, Frishman S, Turjeman S, Eshel A, Nuriel-Ohayon M, Shrossel O, Ziv O, Walters W, Parsonnet J, Ley C, Johnson EL, Kumar K, Schweitzer R, Khatib S, Magzal F, Muller E, Tamir S, Tenenbaum-Gavish K, Rautava S, Salminen S, Isolauri E, Yariv O, Peled Y, Poran E, Pardo J, Chen R, Hod M, Borenstein E, Ley RE, Schwartz B, Louzoun Y, Hadar E, Koren O. Gestational diabetes is driven by microbiota-induced inflammation months before diagnosis. Gut 2023; 72:918-928. [PMID: 36627187 PMCID: PMC10086485 DOI: 10.1136/gutjnl-2022-328406] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 12/26/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Gestational diabetes mellitus (GDM) is a condition in which women without diabetes are diagnosed with glucose intolerance during pregnancy, typically in the second or third trimester. Early diagnosis, along with a better understanding of its pathophysiology during the first trimester of pregnancy, may be effective in reducing incidence and associated short-term and long-term morbidities. DESIGN We comprehensively profiled the gut microbiome, metabolome, inflammatory cytokines, nutrition and clinical records of 394 women during the first trimester of pregnancy, before GDM diagnosis. We then built a model that can predict GDM onset weeks before it is typically diagnosed. Further, we demonstrated the role of the microbiome in disease using faecal microbiota transplant (FMT) of first trimester samples from pregnant women across three unique cohorts. RESULTS We found elevated levels of proinflammatory cytokines in women who later developed GDM, decreased faecal short-chain fatty acids and altered microbiome. We next confirmed that differences in GDM-associated microbial composition during the first trimester drove inflammation and insulin resistance more than 10 weeks prior to GDM diagnosis using FMT experiments. Following these observations, we used a machine learning approach to predict GDM based on first trimester clinical, microbial and inflammatory markers with high accuracy. CONCLUSION GDM onset can be identified in the first trimester of pregnancy, earlier than currently accepted. Furthermore, the gut microbiome appears to play a role in inflammation-induced GDM pathogenesis, with interleukin-6 as a potential contributor to pathogenesis. Potential GDM markers, including microbiota, can serve as targets for early diagnostics and therapeutic intervention leading to prevention.
Collapse
Affiliation(s)
- Yishay Pinto
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Sigal Frishman
- Helen Schneider Hospital for Women, Rabin Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Institute of Biochemistry, School of Nutritional Sciences Food Science and Nutrition, The School of Nutritional Sciences, The Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Sondra Turjeman
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Adi Eshel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | | | - Oshrit Shrossel
- Department of Mathematics, Bar-Ilan University, Ramat Gan, Israel
| | - Oren Ziv
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - William Walters
- Department of Microbiome Science, Max Planck Institute for Developmental Biology, Tubingen, Germany
| | - Julie Parsonnet
- Department of Medicine, Stanford University, Stanford, California, USA
- Department of Epidemiology and Population Health, Stanford University, Stanford, California, USA
| | - Catherine Ley
- Department of Medicine, Stanford University, Stanford, California, USA
| | | | - Krithika Kumar
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA
| | - Ron Schweitzer
- Department of Natural Compounds and Analytical Chemistry, Migal-Galilee Research Institute, Kiryat Shmona, Israel
- Analytical Chemistry Laboratory, Tel-Hai College, Upper Galilee, Israel
| | - Soliman Khatib
- Department of Natural Compounds and Analytical Chemistry, Migal-Galilee Research Institute, Kiryat Shmona, Israel
- Analytical Chemistry Laboratory, Tel-Hai College, Upper Galilee, Israel
| | - Faiga Magzal
- Laboratory of Human Health and Nutrition Sciences, Migal-Galilee Technology Center, Kiryat Shmona, Israel
- Nutritional Science Department, Tel Hai College, Upper Galilee, Israel
| | - Efrat Muller
- The Blavatnik School of Computer Science, Tel Aviv University, Tel Aviv, Israel
| | - Snait Tamir
- Laboratory of Human Health and Nutrition Sciences, Migal-Galilee Technology Center, Kiryat Shmona, Israel
- Nutritional Science Department, Tel Hai College, Upper Galilee, Israel
| | - Kinneret Tenenbaum-Gavish
- Helen Schneider Hospital for Women, Rabin Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Samuli Rautava
- Department of Pediatrics, University of Turku and Turku University Hospital, Turku, Finland
- University of Helsinki & Helsinki University Hospital, New Children's Hospital, Pediatric Research Center, Helsinki, Finland
| | - Seppo Salminen
- Functional Foods Forum, University of Turku, Turku, Finland
| | - Erika Isolauri
- Department of Pediatrics, University of Turku and Turku University Hospital, Turku, Finland
| | - Or Yariv
- Clalit Health Services, Tel Aviv, Israel
| | - Yoav Peled
- Helen Schneider Hospital for Women, Rabin Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Clalit Health Services, Tel Aviv, Israel
| | - Eran Poran
- Clalit Health Services, Tel Aviv, Israel
| | - Joseph Pardo
- Helen Schneider Hospital for Women, Rabin Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Clalit Health Services, Tel Aviv, Israel
| | - Rony Chen
- Helen Schneider Hospital for Women, Rabin Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moshe Hod
- Helen Schneider Hospital for Women, Rabin Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elhanan Borenstein
- The Blavatnik School of Computer Science, Tel Aviv University, Tel Aviv, Israel
- Department of Clinical Microbiology and Immunology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Santa Fe Institute, Santa Fe, New Mexico, USA
| | - Ruth E Ley
- Department of Microbiome Science, Max Planck Institute for Developmental Biology, Tubingen, Germany
| | - Betty Schwartz
- Institute of Biochemistry, School of Nutritional Sciences Food Science and Nutrition, The School of Nutritional Sciences, The Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Yoram Louzoun
- Department of Mathematics, Bar-Ilan University, Ramat Gan, Israel
| | - Eran Hadar
- Helen Schneider Hospital for Women, Rabin Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Omry Koren
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| |
Collapse
|
27
|
Özer YE, Cengiz H, Demirci T, Kızılgül M, Varim C, Tamer A. Glycemic responses to whole grain sourdough bread versus refined white bread in patients with gestational diabetes. Wien Klin Wochenschr 2023:10.1007/s00508-023-02200-9. [PMID: 37106088 DOI: 10.1007/s00508-023-02200-9] [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: 12/23/2022] [Accepted: 03/25/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND Nutritional therapy remains a key tool for prevention and management of gestational diabetes (GDM). Carbohydrate type and absorption rate rather than the carbohydrate amount have more impact on postprandial glucose (PPG) levels in GDM. The effect of refined white bread and whole grain sourdough bread on glycemic indexes were compared in GDM patients. METHODS A total of 43 patients with GDM and 38 healthy pregnant women were included. A similar breakfast menu was given to both groups of patients at two different times in consecutive weeks; however, different types of bread with the same weight were used for both breakfasts; 1) white wheat (WW) bread, 2) sourdough whole grain wheat (SWGW) bread. Blood glucose, insulin and C‑peptide levels were compared before and after breakfast. RESULTS Fasting glucose, insulin and c‑peptide levels were similar between groups (p > 0.05). While the second hour glucose levels were similar between the groups, the first hour results of glucose, insulin and C‑peptide levels were lower in the SWGW group (p < 0.05). In the control patients, first hour glucose, insulin and C‑peptide levels were also lower in the SWGW group (p < 0.05). CONCLUSION The WW bread, which is more preferred in daily life routine, causes 45.5% more insulin secretion and 9.6% more first hour postprandial blood glucose compared to SWGW bread both in GDM patients and healthy pregnant women. According to the results of this study, we recommend that sourdough whole grain bread should be preferred in order to increase the success in the management of GDM.
Collapse
Affiliation(s)
- Yunus Emre Özer
- Department of Internal Medicine, Sakarya Training and Research Hospital, Sakarya, Turkey
| | - Hasret Cengiz
- Department of Endocrinology, Sakarya Training and Research Hospital, Sakarya, Turkey
| | - Taner Demirci
- Department of Endocrinology and Metabolism, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Muhammed Kızılgül
- Department of Endocrinology and Metabolism, Ankara Etlik State Hospital, Ankara, Turkey
| | - Ceyhun Varim
- Department of Internal Medicine, Faculty of Medicine, Sakarya University, Sakarya, Turkey.
| | - Ali Tamer
- Department of Internal Medicine, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| |
Collapse
|
28
|
Ghamri KA, Alsulami SS, Alotaibi LA, Salem IW, Tash RF, Yousof SM. Determinants of insulin therapy among women with gestational diabetes mellitus: A cross-sectional study. Niger J Clin Pract 2023; 26:417-423. [PMID: 37203105 DOI: 10.4103/njcp.njcp_447_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Background Gestational diabetes mellitus (GDM) is a common complication in pregnancy that occurs during the second half of pregnancy. In the majority of patients, medical nutritional therapy (MNT) alone is sufficient to achieve the glycemic goal. Aim To evaluate the clinical and biochemical factors that predict the need for insulin therapy in women with GDM. Materials and Methods Between March 2020 and November 2021, an analytic cross-sectional study was conducted on 127 women diagnosed with GDM at their final antenatal visit. Multivariate logistic regression was used to determine the variables associated with the likelihood of insulin requirement in patients with GDM. Results To achieve glycemic control, 56.7% of the study population required insulin treatment. Fasting glucose, pre-conceptional body mass index (BMI), parity, and third-trimester glycated hemoglobin levels were all higher in the insulin-treated group (P = 0.00, 0.01, 0.01, and 0.02), respectively. Fasting glucose level is the main determinant of insulin use in patients with GDM (odds ratio [OR]: 1.110; 95% confidence interval [CI]: 1.001-1.191; P = 0.004). Conclusions Fasting glucose level is the most important predictor of the need for insulin therapy.
Collapse
Affiliation(s)
- K A Ghamri
- Department of Internal Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - S S Alsulami
- Department of Internal Medicine, Rabigh Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - L A Alotaibi
- Internal Medicine Department, King Abdulaziz Hospital, Endocrine and Diabetic Center, Jeddah, Saudi Arabia
| | - I W Salem
- Community Medicine Department, King Abdulaziz University, Rabigh, Saudi Arabia; Community Medicine Department, Al Azhar University, Cairo, Egypt
| | - R F Tash
- Anatomy and Embryology Department, Faculty of Medicine, King Abdulaziz University, Rabigh, Saudi Arabia; Anatomy and Embryology Department, Faculty of Medicine, Ain Shams University, Abassia, Cairo, Egypt
| | - S M Yousof
- Physiology Department, Faculty of Medicine, King Abdulaziz University, Rabigh, Saudi Arabia; Physiology Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| |
Collapse
|
29
|
Tian Q, Zhang C, Guo P, Xu M, Yu S, Liu Y, Cao M, Yu L, Yang S, Zhang W. Cognitive appraisal of health and its influencing factors among pregnant women with gestational diabetes mellitus: A cross‐sectional study. J Obstet Gynaecol Res 2023. [DOI: 10.1111/jog.15635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 02/28/2023] [Indexed: 04/04/2023]
Affiliation(s)
- Qi Tian
- School of Nursing Jilin University Changchun Jilin China
| | - Chunmiao Zhang
- Department of Obstetrics and Gynecology The Second Hospital of Jilin University Changchun Jilin China
| | - Pingping Guo
- School of Nursing Jilin University Changchun Jilin China
| | - Mengmeng Xu
- School of Nursing Jilin University Changchun Jilin China
| | - Shuanghan Yu
- School of Nursing Jilin University Changchun Jilin China
| | - Yantong Liu
- School of Nursing Jilin University Changchun Jilin China
| | - Minglu Cao
- School of Nursing Jilin University Changchun Jilin China
| | - Lin Yu
- School of Nursing Jilin University Changchun Jilin China
| | - Shu Yang
- School of Nursing Jilin University Changchun Jilin China
| | - Wei Zhang
- School of Nursing Jilin University Changchun Jilin China
| |
Collapse
|
30
|
Amniotic fluid and vaginal microbiota in pregnant women with gestational diabetes mellitus by metagenomics. MEDICINE IN MICROECOLOGY 2023. [DOI: 10.1016/j.medmic.2022.100074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
|
31
|
Björk Javanshiri A, Calling S, Modig S. Follow-up and screening for type-2 diabetes mellitus in women with previous gestational diabetes in primary care. Scand J Prim Health Care 2023; 41:98-103. [PMID: 36855772 PMCID: PMC10088914 DOI: 10.1080/02813432.2023.2182632] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
OBJECTIVE Gestational diabetes mellitus (GDM) is an established risk factor for developing type 2 diabetes mellitus (T2DM) that is possible to prevent by systematic follow-up and preventive measures. The aim of this study was to examine whether women with previous GDM were offered follow-up in primary care, according to Swedish national guidelines. DESIGN Retrospective review of electronic medical records. SETTING Primary care in southern Sweden, Skåne county. SUBJECTS Women who received a GDM diagnosis in 2018 at the Endocrinology department, Skåne University Hospital in Lund. The study population consisted of a total number of 161 patients, whereof 83 patients were included. MAIN OUTCOME MEASURES Whether primary care offered follow-up for T2DM after GDM and if any communication took place between secondary and primary care. Furthermore, it was examined whether the quality of the follow-up was in accordance with the national guidelines. RESULTS Of the study population, a total of 29% (n = 24) had been followed-up by primary care. In 55% (n = 46) of the cases, there was no communication between secondary and primary care. Plasma glucose was checked in all (n = 20) cases where follow-up could be evaluated. Conversations about lifestyle habits took place in 70% (n = 14) of the cases. Weight and risk factors for cardiovascular disease were controlled in less than half (n = 9) of the patients. Lifestyle advice was offered in two cases and in 24% (n = 20) of the cases an annual check-up was planned. CONCLUSIONS The follow-up of women with previous GDM in primary care in southern Sweden was lacking in seven out of 10 cases and showed great potential for improvement.Key PointsGestational diabetes is an established risk factor for developing type 2 diabetes.Earlier research has recognized that risk reduction is possible by systematic follow-up and preventive measures, but the extent of follow-up in primary care in southern Sweden remains unknown.This study demonstrates a lack of follow-up according to national guidelines for women with previous gestational diabetes in primary care in southern Sweden.There is great potential to improve the care of these patients with relatively simple means.
Collapse
Affiliation(s)
- Amanda Björk Javanshiri
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Susanna Calling
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Sara Modig
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| |
Collapse
|
32
|
Pintus R, Dessì A, Mussap M, Fanos V. Metabolomics can provide new insights into perinatal nutrition. Acta Paediatr 2023; 112:233-241. [PMID: 34487568 PMCID: PMC10078676 DOI: 10.1111/apa.16096] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 09/01/2021] [Accepted: 09/03/2021] [Indexed: 01/13/2023]
Abstract
Perinatal nutrition is a key factor related to the Developmental Origin of Health and Disease hypothesis, which states that each and every event that happens during the periconceptional period and pregnancy can affect the health status of an individual. Metabolomics can be a very useful tool for gathering information about the effect of perinatal nutrition on both mothers and newborn infants. This non-systematic review focuses on the main metabolites detected by this technique, with regard to gestational diabetes, intrauterine growth restriction and breast milk. Conclusion. Nutrition, metabolome and microbiome interactions are gaining interest in the scientific community.
Collapse
Affiliation(s)
- Roberta Pintus
- Neonatal Intensive Care Unit, AOU Cagliari Department of Surgery, University of Cagliari, Cagliari, Italy
| | - Angelica Dessì
- Neonatal Intensive Care Unit, AOU Cagliari Department of Surgery, University of Cagliari, Cagliari, Italy
| | - Michele Mussap
- Neonatal Intensive Care Unit, AOU Cagliari Department of Surgery, University of Cagliari, Cagliari, Italy
| | - Vassilios Fanos
- Neonatal Intensive Care Unit, AOU Cagliari Department of Surgery, University of Cagliari, Cagliari, Italy
| |
Collapse
|
33
|
Massa MG, Scott RL, Cara AL, Cortes LR, Sandoval NP, Park JW, Ali S, Velez LM, Tesfaye B, Reue K, van Veen JE, Seldin M, Correa SM. Feeding Neurons Integrate Metabolic and Reproductive States in Mice. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.01.25.525595. [PMID: 36747631 PMCID: PMC9900829 DOI: 10.1101/2023.01.25.525595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Trade-offs between metabolic and reproductive processes are important for survival, particularly in mammals that gestate their young. Puberty and reproduction, as energetically taxing life stages, are often gated by metabolic availability in animals with ovaries. How the nervous system coordinates these trade-offs is an active area of study. We identify somatostatin neurons of the tuberal nucleus (TNSST) as a node of the feeding circuit that alters feeding in a manner sensitive to metabolic and reproductive states in mice. Whereas chemogenetic activation of TNSST neurons increased food intake across sexes, selective ablation decreased food intake only in female mice during proestrus. Interestingly, this ablation effect was only apparent in animals with a low body mass. Fat transplantation and bioinformatics analysis of TNSST neuronal transcriptomes revealed white adipose as a key modulator of the effects of TNSST neurons on food intake. Together, these studies point to a mechanism whereby TNSST hypothalamic neurons modulate feeding by responding to varying levels of circulating estrogens differentially based on energy stores. This research provides insight into how neural circuits integrate reproductive and metabolic signals, and illustrates how gonadal steroid modulation of neuronal circuits can be context-dependent and gated by metabolic status.
Collapse
Affiliation(s)
- Megan G Massa
- Department of Integrative Biology and Physiology, University of California, Los Angeles, CA
| | - Rachel L Scott
- Department of Integrative Biology and Physiology, University of California, Los Angeles, CA
| | - Alexandra L Cara
- Department of Integrative Biology and Physiology, University of California, Los Angeles, CA
| | - Laura R Cortes
- Department of Integrative Biology and Physiology, University of California, Los Angeles, CA
| | - Norma P Sandoval
- Department of Integrative Biology and Physiology, University of California, Los Angeles, CA
| | - Jae W Park
- Department of Integrative Biology and Physiology, University of California, Los Angeles, CA
| | - Sahara Ali
- Department of Integrative Biology and Physiology, University of California, Los Angeles, CA
| | - Leandro M Velez
- Department of Biological Chemistry, School of Medicine, University of California, Irvine, CA
| | - Bethlehem Tesfaye
- Department of Integrative Biology and Physiology, University of California, Los Angeles, CA
| | - Karen Reue
- Department of Human Genetics, David Geffen School of Medicine at University of California, Los Angeles, CA
| | - J Edward van Veen
- Department of Integrative Biology and Physiology, University of California, Los Angeles, CA
| | - Marcus Seldin
- Department of Biological Chemistry, School of Medicine, University of California, Irvine, CA
| | - Stephanie M Correa
- Department of Integrative Biology and Physiology, University of California, Los Angeles, CA
| |
Collapse
|
34
|
Facanha CFS, Alencar VS, Machado PS, Macêdo RBL, de Bruin PFC, Costa E Forti A, Rocha TM, de Bruin VMS. Morningness/eveningness in gestational diabetes mellitus: clinical characteristics and maternal-neonatal outcomes. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2023; 67:92-100. [PMID: 36155121 PMCID: PMC9983797 DOI: 10.20945/2359-3997000000515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Objective This study aims to evaluate the impact of morning-evening preference in pregnancy outcomes in gestational diabetes mellitus (GDM). Methods This is a prospective cohort study of 2nd-3rd trimester GDM outpatient care in Fortaleza, Brazil (2018-2020). Eveningness was defined by the Horne-Östberg Morningness-Eveningness-Questionnaire (MEQ ≤ 41). Furthermore, we obtained a 7-day actigraphic register. Subjective sleep quality, daytime somnolence, insomnia, fatigue and depressive symptoms were also evaluated. Associations with pregnancy outcomes were investigated. Results Among 305 patients with GDM, evening preference was found in 21 (6.9%). Patients with evening preference had worse sleep quality (p < 0.01), greater severity of insomnia (p < 0.005), fatigue (p < 0.005) and depressive symptoms (<0.009). Evening chronotype was associated with preeclampsia [p = 0.01; OR = 0.27; CI 0.09-0.79] and a greater need for admission to a neonatal intensive care unit (NICU) [p = 0.02; OR = 0.23; CI .0.06-0.80]. A lower MEQ score confirmed an association with preeclampsia [p = 0.002; OR = 0.94; CI 0.90-0.97] and this was maintained after controlling for age, arterial hypertension, sleep quality, fatigue and depressive symptoms [p < 005; OR = 0.91; CI 0.87-0.95]. Conclusion In GDM, patients with evening preference had worse sleep quality, more insomnia, fatigue, and depressive symptoms. Furthermore, eveningness was independently associated with preeclampsia. These results indicate the important role of eveningness in adverse pregnancy outcomes.
Collapse
Affiliation(s)
- Cristina Figueiredo Sampaio Facanha
- Departamento de Medicina, Universidade Federal do Ceará, Fortaleza, CE, Brasil, ; .,Departamento de Medicina, Centro Universitário Christus, Fortaleza, CE, Brasil.,Centro Integrado de Diabetes e Hipertensão do Ceará (CIDH), Secretaria Estadual de Saúde do Ceará, Fortaleza, CE, Brasil
| | | | | | - Rejane Belchior Lima Macêdo
- Departamento de Medicina, Universidade Federal do Ceará, Fortaleza, CE, Brasil.,Centro Integrado de Diabetes e Hipertensão do Ceará (CIDH), Secretaria Estadual de Saúde do Ceará, Fortaleza, CE, Brasil
| | | | - Adriana Costa E Forti
- Departamento de Medicina, Universidade Federal do Ceará, Fortaleza, CE, Brasil.,Centro Integrado de Diabetes e Hipertensão do Ceará (CIDH), Secretaria Estadual de Saúde do Ceará, Fortaleza, CE, Brasil
| | - Thaine Mirla Rocha
- Departamento de Medicina, Centro Universitário Christus, Fortaleza, CE, Brasil
| | | |
Collapse
|
35
|
Wang Y, Li L, Li P. Novel single nucleotide polymorphisms in gestational diabetes mellitus. Clin Chim Acta 2023; 538:60-64. [PMID: 36375523 DOI: 10.1016/j.cca.2022.11.010] [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: 06/04/2022] [Revised: 11/06/2022] [Accepted: 11/07/2022] [Indexed: 11/13/2022]
Abstract
The association between gestational diabetes mellitus (GDM) and single nucleotide polymorphisms (SNPs) has attracted global research attention. Exploring SNPs can help us further understand the pathogenesis of GDM, predict the risk of GDM, and guide the management of GDM patients. In this review, we summarized the studies on the association between SNPs and GDM, focusing on novel SNPs published in the last 10 years. The SNPs identified to be associated with GDM included HMG20A (rs7178572), CDKAL1 (rs7756992, rs7754840, and rs7747752), ADIPOQ (rs266729 and rs17300539), MTHFR (rs1801133), IL10 (rs3021094), CDKN2B (rs1063192), and TRPM5 (rs35197079). However, the role of SNPs in the prediction, diagnosis, treatment, and prognosis of GDM, as a polygenic disease, needs to be further explored in multiple ethnic populations.
Collapse
Affiliation(s)
- Yuqi Wang
- Department of Endocrinology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, People's Republic of China
| | - Ling Li
- Department of Endocrinology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, People's Republic of China
| | - Ping Li
- Department of Endocrinology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, People's Republic of China.
| |
Collapse
|
36
|
Dugas C, Laberee L, Perron J, St-Arnaud G, Richard V, Perreault V, Leblanc N, Marc I, Di Marzo V, Doyen A, Veilleux A, Robitaille J. Gestational Diabetes Mellitus, Human Milk Composition, and Infant Growth. Breastfeed Med 2023; 18:14-22. [PMID: 36409543 DOI: 10.1089/bfm.2022.0085] [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] [Indexed: 11/23/2022]
Abstract
Background: Gestational diabetes mellitus (GDM) is known to affect human milk composition. Aims of this study were to compare macronutrient and energy content of human milk of women with (GDM+) and without GDM (GDM-), to assess the association between maternal health and human milk macronutrient and energy content and association between human milk macronutrient and energy content and infant growth. Study Design and Methods: Two months after delivery, hindmilk samples were collected. Triglyceride (TG), lactose, and protein content of human milk were measured. An oral glucose tolerance test was performed. Infant weight and length at birth and 2 months were collected. Weight-for-age (WAZ) and weight-for-length z-scores were calculated. Results: Twenty-four GDM+ and 29 GDM- women were included. Protein, lactose, and energy content of human milk were similar between groups. TG concentration was higher in GDM+ than in GDM- women (6.3 ± 2.0 versus 5.3 ± 1.2, p = 0.04). This difference was no longer significant after adjustment for maternal age and infant sex (p = 0.23). Maternal age was associated with TG (r = 0.28, p = 0.04) and lactose (r = -0.30, p = 0.03), while fasting glucose was associated with proteins (r = 0.30, p = 0.03) and tended to be associated with TG (r = 0.27, p = 0.05) and energy (r = 0.24, p = 0.08). TG levels in human milk were associated with weight (β: 0.26, 95% confidence interval [CI]: 0.02 to 0.50) and WAZ (β: 0.40, 95% CI: 0.05 to 0.75) at 2 months among children unexposed (GDM-) to GDM, but not among children exposed (GDM+) Conclusions: In conclusion, GDM status, maternal age, and fasting glucose level were associated with human milk composition. Finally, TG in human milk was associated with infant growth among GDM- children but not among GDM+ children. ClinicalTrials.gov NCT02872402.
Collapse
Affiliation(s)
- Camille Dugas
- Centre de recherche Nutrition, Santé et Société (NUTRISS), Institute of Nutrition and Functional Foods (INAF), Université Laval, Quebec City, Canada.,School of Nutrition, Université Laval, Quebec City, Canada
| | | | - Julie Perron
- Centre de recherche Nutrition, Santé et Société (NUTRISS), Institute of Nutrition and Functional Foods (INAF), Université Laval, Quebec City, Canada
| | - Gabrielle St-Arnaud
- Centre de recherche Nutrition, Santé et Société (NUTRISS), Institute of Nutrition and Functional Foods (INAF), Université Laval, Quebec City, Canada.,School of Nutrition, Université Laval, Quebec City, Canada
| | - Véronique Richard
- Centre de recherche Nutrition, Santé et Société (NUTRISS), Institute of Nutrition and Functional Foods (INAF), Université Laval, Quebec City, Canada
| | | | - Nadine Leblanc
- School of Nutrition, Université Laval, Quebec City, Canada.,Canada Excellence Research Chair on the Microbiome-Endocannabinoidome Axis in Metabolic Health, Université Laval, Quebec City, Canada
| | - Isabelle Marc
- Department of Pediatrics, Université Laval, Centre de recherche du CHU de Quebec, Quebec, Canada
| | - Vincenzo Di Marzo
- Centre de recherche Nutrition, Santé et Société (NUTRISS), Institute of Nutrition and Functional Foods (INAF), Université Laval, Quebec City, Canada.,Canada Excellence Research Chair on the Microbiome-Endocannabinoidome Axis in Metabolic Health, Université Laval, Quebec City, Canada.,Heart and Lung Research Institute of Université Laval, Quebec City, Canada
| | - Alain Doyen
- Centre de recherche Nutrition, Santé et Société (NUTRISS), Institute of Nutrition and Functional Foods (INAF), Université Laval, Quebec City, Canada.,Department of Food Sciences, Université Laval, Quebec City, Canada
| | - Alain Veilleux
- Centre de recherche Nutrition, Santé et Société (NUTRISS), Institute of Nutrition and Functional Foods (INAF), Université Laval, Quebec City, Canada.,School of Nutrition, Université Laval, Quebec City, Canada.,Canada Excellence Research Chair on the Microbiome-Endocannabinoidome Axis in Metabolic Health, Université Laval, Quebec City, Canada
| | - Julie Robitaille
- Centre de recherche Nutrition, Santé et Société (NUTRISS), Institute of Nutrition and Functional Foods (INAF), Université Laval, Quebec City, Canada.,School of Nutrition, Université Laval, Quebec City, Canada
| |
Collapse
|
37
|
Gestational Diabetes Mellitus and Antenatal Corticosteroid Therapy-A Narrative Review of Fetal and Neonatal Outcomes. J Clin Med 2022; 12:jcm12010323. [PMID: 36615121 PMCID: PMC9820953 DOI: 10.3390/jcm12010323] [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: 11/06/2022] [Revised: 12/17/2022] [Accepted: 12/26/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND There, we review the pathogenesis of gestational diabetes mellitus (GDM), its influence on fetal physiology, and neonatal outcomes, as well as the usage of antenatal corticosteroid therapy (ACST) in pregnancies complicated by GDM. METHODS MEDLINE and PubMed search was performed for the years 1990-2022, using a combination of keywords on such topics. According to the aim of the investigation, appropriate articles were identified and included in this narrative review. RESULTS GDM is a multifactorial disease related to unwanted pregnancy course and outcomes. Although GDM has an influence on the fetal cardiovascular and nervous system, especially in preterm neonates, the usage of ACST in pregnancy must be considered taking into account maternal and fetal characteristics. CONCLUSIONS GDM has no influence on neonatal outcomes after ACST introduction. The ACST usage must be personalized and considered according to its gestational age-specific effects on the developing fetus.
Collapse
|
38
|
Muacevic A, Adler JR, Bisht K, Kant R, Singh A, Khoiwal K, Singh B. A Comparative Morphometric and Histological Study of Human Fetus and Fetal Pancreas in Hyperglycemic and Normoglycemic Mothers. Cureus 2022; 14:e33008. [PMID: 36712777 PMCID: PMC9879539 DOI: 10.7759/cureus.33008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND A significant percentage of pregnancies with gestational diabetes mellitus (GDM) has been found to result in the delivery of macrosomic babies. The current study intends to highlight the correlation between maternal diabetes and fetal parameters as well as the histogenesis of the fetal pancreas in humans. MATERIALS AND METHODS The study included thirty aborted fetuses, categorized into seven groups according to their gestational age. Morphometric analysis of fetal parameters and fetal pancreas was done, and the values were compared within different gestational age groups. Pancreatic tissue was processed, stained with Hematoxylin & Eosin, and examined. A comparison was then made between fetuses with and without gestational diabetes. Results: All the fetal biometrics as well as pancreatic parameters showed greater numeric values in mothers with GDM as compared to the controls of the same gestational age groups. However, the difference was not statistically significant. Histogenesis in such fetuses revealed GDM-related hyperplasia of islets of Langerhans. CONCLUSION A timely diagnosis of GDM is thus of paramount significance due to its potential implications so that appropriate interventions can be done on time, to improve the overall outcome.
Collapse
|
39
|
Huang L, Sililas P, Thonusin C, Tongsong T, Luewan S, Chattipakorn N, Chattipakorn SC. Association Between Gut Microbiota and Insulin Therapy in Women With Gestational Diabetes Mellitus. Can J Diabetes 2022; 46:804-812.e2. [PMID: 35840501 DOI: 10.1016/j.jcjd.2022.05.009] [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: 10/24/2021] [Revised: 05/11/2022] [Accepted: 05/24/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVES At the time of diagnosis, the blood glucose of women with gestational diabetes mellitus (GDM) who require subsequent insulin treatment does not differ from that of women with adequate diet control. Hence, in this study, we aimed to determine the role of maternal gut microbiota as a marker of insulin necessity in GDM and to identify the effect of insulin therapy on gut microbiota composition in mothers with GDM and their newborns. METHODS Seventy-one pregnant women were enrolled into the study, including 38 GDM and 33 non-GDM participants. During the follow-up period, 8 of the 38 GDM subjects required insulin therapy (GDM-I group), whereas 30 of the 38 GDM cases with sufficient glycemic control by diet alone (GDM-D group). Maternal blood and feces were obtained at the time of GDM diagnosis (pretreatment; 24 to 28 weeks of gestation) and before delivery (posttreatment; ≥37 weeks of gestation). Meconium and first feces of the newborns were also collected. RESULTS Pretreatment, the glycemic profile did not differ between the GDM-D and GDM-I groups. However, the proportions of Clostridiales, Lactobacillus and Bacteroidetes were higher in the GDM-I group than in the non-GDM and GDM-D groups. After treatment, gut microbiota composition showed no difference between non-GDM and GDM-I groups. Interestingly, a higher Firmicutes/Bacteroidetes (F/B) ratio was displayed in GDM-D mothers at posttreatment, and this was also observed in both meconium and first feces of GDM-D newborns. CONCLUSION Insulin therapy changed maternal gut microbiota composition, which could be transferable to the mothers' newborns.
Collapse
Affiliation(s)
- Lingling Huang
- Neurophysiology Unit, Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai, Thailand; School of Basic Medical Sciences, Youjiang Medical University for Nationalities, Baise, Guangxi, China
| | - Palin Sililas
- Maternal Fetal Medicine Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Chanisa Thonusin
- Neurophysiology Unit, Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai, Thailand; Cardiac Electrophysiology Unit, Department of Physiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Theera Tongsong
- Maternal Fetal Medicine Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Suchaya Luewan
- Maternal Fetal Medicine Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nipon Chattipakorn
- Neurophysiology Unit, Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai, Thailand; Cardiac Electrophysiology Unit, Department of Physiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Siriporn C Chattipakorn
- Neurophysiology Unit, Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai, Thailand; Department of Oral Biology and Diagnostic Sciences, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand.
| |
Collapse
|
40
|
Muacevic A, Adler JR. The Association Between Serum Homocysteine Levels and Placenta-Mediated Complications: A Narrative Review. Cureus 2022; 14:e31305. [PMID: 36514664 PMCID: PMC9733802 DOI: 10.7759/cureus.31305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 11/09/2022] [Indexed: 11/11/2022] Open
Abstract
The most extremely unfavourable outcome of pregnancy is the death of the mother and newborn. Negative outcomes for mothers or babies can occur as a result of complications or issues during pregnancy, birth or the post-partum period. Early elevated maternal homocysteine (Hct) levels during pregnancy have been linked to altered placental development. There is evidence that suggests an elevated maternal blood Hct level is the new obstetrical risk factor, and the association between hyperhomocysteinemia (HHct) and numerous obstetrical problems was recently recognised. Hct is an essential amino acid, which contains sulphur and is formed from the metabolism of methionine. HHct has several known aetiologies, including genetic anomalies; a deficiency in folic acid, vitamin B6 and vitamin B12; hypothyroidism; old age; and renal illnesses. Vascular problems, coronary artery disease, atherosclerosis and embolic illnesses can all occur as a result of high blood levels of Hct. Hct levels are lower in normal pregnancies than it is in women who are not pregnant. Many pregnancy-related problems, including pre-eclampsia (PE), recurrent pregnancy loss (RPL), placental abruption, premature delivery and foetal growth restriction (FGR) have been connected to HHct in recent research. We looked for pertinent literature using a thorough and systematic search from PubMed, Medline, Embase, Cochrane Library, Google, etc., and articles that were published before August 2022 based on serum Hct levels and various placenta-mediated complications for this review. In this review, we described the synthesis and metabolism of Hct in humans, Hct levels at various phases of normal pregnancy and the association between Hct and placenta-mediated pregnancy complications. The outcomes discovered can help obstetricians increase the likelihood of a successful pregnancy in cases where placenta-mediated issues are present. Lowering Hct levels with a high dose of folic acid tablets during the subsequent pregnancy may be useful for women who experienced these difficulties in prior pregnancies as a result of HHct.
Collapse
|
41
|
Demirer B, Samur G. Possible effects of dietary advanced glycation end products on maternal and fetal health: a review. Nutr Rev 2022:6762058. [PMID: 36250798 DOI: 10.1093/nutrit/nuac090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Excessive accumulation of advanced glycation end products (AGEs) in the body has been associated with many adverse health conditions. The common point of the pathologies associated at this point is oxidative stress and inflammation. Pregnancy is an important period in which many physiological, psychological, and biological changes are experienced. Along with the physiological changes that occur during this period, the mother maintaining an AGE-rich diet may cause an increase in the body's AGE pool and may increase oxidative stress and inflammation, as seen in healthy individuals. Studies have reported the negative effects of maternal AGE levels on maternal and fetal health during pregnancy. Although gestational diabetes, preeclampsia, endothelial dysfunction, and pelvic diseases constitute maternal complications, a number of pathological conditions such as intrauterine growth retardation, premature birth, neural tube defect, neurobehavioral developmental disorders, fetal death, and neonatal asphyxia constitute fetal complications. It is thought that the mechanisms of these complications have not been confirmed yet and more clinical studies are needed on this subject. The possible effects of dietary AGE levels during pregnancy on maternal and fetal health are examined in this review.
Collapse
Affiliation(s)
- Büşra Demirer
- Nutrition and Dietetics, Karabuk University, Karabuk, Turkey
| | - Gülhan Samur
- Nutrition and Dietetics, Hacettepe University, Ankara, Turkey
| |
Collapse
|
42
|
Assessment of atrial conduction time and P-wave dispersion in patients with gestational diabetes mellitus. Int J Diabetes Dev Ctries 2022. [DOI: 10.1007/s13410-022-01136-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
43
|
Modzelewski R, Stefanowicz-Rutkowska MM, Matuszewski W, Bandurska-Stankiewicz EM. Gestational Diabetes Mellitus—Recent Literature Review. J Clin Med 2022; 11:jcm11195736. [PMID: 36233604 PMCID: PMC9572242 DOI: 10.3390/jcm11195736] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/25/2022] [Accepted: 09/25/2022] [Indexed: 11/16/2022] Open
Abstract
Gestational diabetes mellitus (GDM), which is defined as a state of hyperglycemia that is first recognized during pregnancy, is currently the most common medical complication in pregnancy. GDM affects approximately 15% of pregnancies worldwide, accounting for approximately 18 million births annually. Mothers with GDM are at risk of developing gestational hypertension, pre-eclampsia and termination of pregnancy via Caesarean section. In addition, GDM increases the risk of complications, including cardiovascular disease, obesity and impaired carbohydrate metabolism, leading to the development of type 2 diabetes (T2DM) in both the mother and infant. The increase in the incidence of GDM also leads to a significant economic burden and deserves greater attention and awareness. A deeper understanding of the risk factors and pathogenesis becomes a necessity, with particular emphasis on the influence of SARS-CoV-2 and diagnostics, as well as an effective treatment, which may reduce perinatal and metabolic complications. The primary treatments for GDM are diet and increased exercise. Insulin, glibenclamide and metformin can be used to intensify the treatment. This paper provides an overview of the latest reports on the epidemiology, pathogenesis, diagnosis and treatment of GDM based on the literature.
Collapse
Affiliation(s)
- Robert Modzelewski
- Endocrinology, Diabetology and Internal Medicine Clinic, Department of Internal Medicine, University of Warmia and Mazury in Olsztyn, 10-719 Olsztyn, Poland
| | | | - Wojciech Matuszewski
- Endocrinology, Diabetology and Internal Medicine Clinic, Department of Internal Medicine, University of Warmia and Mazury in Olsztyn, 10-719 Olsztyn, Poland
| | - Elżbieta Maria Bandurska-Stankiewicz
- Endocrinology, Diabetology and Internal Medicine Clinic, Department of Internal Medicine, University of Warmia and Mazury in Olsztyn, 10-719 Olsztyn, Poland
| |
Collapse
|
44
|
Gao R, Zhao K, Zhou J, Wang X, Liu T, Lian S, Li J, Huang Y, Qiu C, Wu Y, He J, Liu C. Effects of gestational diabetes mellitus and assisted reproductive technology treatment on the risk of preterm singleton birth. Front Nutr 2022; 9:977195. [PMID: 36185666 PMCID: PMC9515569 DOI: 10.3389/fnut.2022.977195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 08/29/2022] [Indexed: 11/24/2022] Open
Abstract
Background Although assisted reproductive technology (ART) plays a critical role in reducing infertility, ART pregnant women are reported at higher risk of preterm birth (PTB). Besides, women undergoing ART encounter a higher risk of developing gestational diabetes mellitus (GDM). However, existing studies on the combined effect of ART treatment and GDM on PTB risk are sparse. Methods This population-based retrospective cohort study used nationwide birth certificate data from the US National Vital Statistics System 2015-2019. All mothers who had a singleton live birth without pre-pregnancy diabetes were included. Multivariable logistic regression models were used to estimate the odds ratio (OR) of PTB. Results We finally included 18,140,241 American mother-infant pairs. The overall rate of PTB was 7.92% (n = 1,436,328). The PTB rate for non-ART mothers without GDM, ART mothers without GDM, non-ART mothers with GDM, and ART mothers with GDM were 7.67, 10.90, 11.23, and 14.81%, respectively. The incidence of GDM in ART mothers (10.48%) was significantly higher than in non-ART mothers (6.26%). After adjusting for potential confounders, compared with non-ART mothers without GDM, the PTB risk was significantly increased for ART mothers without GDM (AOR: 1.47, 95% CI 1.44-1.50), non-ART mothers with GDM (AOR:1.35, 95% CI 1.34-1.36) and ART mothers with GDM (AOR: 1.82, 95% CI 1.74-1.90) respectively, showing an increasing tendency. This phenomenon was stable among mothers in all groups of mothers older than 25 years. Conclusion To prevent PTB, effective approaches for the prevention of GDM are crucial to mothers who conceived through ART.
Collapse
Affiliation(s)
- Rui Gao
- Shenzhen Cadre and Talent Health Institute (Shenzhen Talent Institute), Shenzhen, Guangdong, China
- Shenzhen Birth Cohort Study Center, Department of Science and Education, Nanshan Maternity and Child Healthcare Hospital of Shenzhen, Shenzhen, Guangdong, China
| | - Ke Zhao
- Department of Nutrition, School of Medicine, Jinan University, Guangzhou, Guangdong, China
| | - Jiaxin Zhou
- Department of Nutrition, School of Medicine, Jinan University, Guangzhou, Guangdong, China
| | - Xiaona Wang
- Department of Nutrition, School of Medicine, Jinan University, Guangzhou, Guangdong, China
| | - Ting Liu
- Department of Nutrition, School of Medicine, Jinan University, Guangzhou, Guangdong, China
| | - Shaoyan Lian
- Department of Nutrition, School of Medicine, Jinan University, Guangzhou, Guangdong, China
| | - Jieying Li
- Department of Nutrition, School of Medicine, Jinan University, Guangzhou, Guangdong, China
| | - Yuanyan Huang
- Department of Nutrition, School of Medicine, Jinan University, Guangzhou, Guangdong, China
| | - Chuhui Qiu
- Department of Nutrition, School of Medicine, Jinan University, Guangzhou, Guangdong, China
| | - Yuxiao Wu
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, United States
| | - Jiang He
- Department of Mathematics and Physics, School of Biomedical Engineering, Southern Medical University, Guangzhou, Guangdong, China
- *Correspondence: Jiang He,
| | - Chaoqun Liu
- Department of Nutrition, School of Medicine, Jinan University, Guangzhou, Guangdong, China
- Chaoqun Liu,
| |
Collapse
|
45
|
Zhang X, Yang N, Wang M, Ge J, Zhu H, He J, Ge W. Establishment and validation of a sensitive LC-MS/MS method for quantification of urinary estrogens in women with gestational diabetes mellitus. J Pharm Biomed Anal 2022; 221:115044. [PMID: 36126614 DOI: 10.1016/j.jpba.2022.115044] [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: 06/17/2022] [Revised: 09/04/2022] [Accepted: 09/11/2022] [Indexed: 10/31/2022]
Abstract
Gestational diabetes mellitus (GDM) is not only a threat to the health of pregnant women, but also has profound effects on the health of offspring. Studies have shown that the imbalance of estrogen metabolism is associated with an increased risk of GDM. In this study, an ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) method was established and validated for simultaneous quantification of thirteen estrogens in the urine of GDM women, including estrone (E1), estradiol (E2), estriol (E3), and their hydroxylated and methylated metabolites. The method was achieved on a Waters CORTECS C18 column (2.1 mm × 150 mm, 1.6 µm) within 8.5 min. The linear range of thirteen estrogens in urine was 2-1000 pg·mL-1. Both intra- and inter-day precision for each analyte were less than 15%, with accuracies ranging from 8.3% to 7.3%. The extraction recoveries rate were between 86% and 111%, and stability verification results met the requirements for determination of biological samples. The results suggested that the concentrations of estrogens in all urine samples range from 0.08 to 134.06 (pg·mg-1 creatinine). The mean levels of E1, E2 and most estrogen metabolites in the urine of GDM women were higher than those in healthy pregnant women. Notably, the mean level of 2-hydroxyestrone (2-OHE1) in GDM women was 13.2-fold lower than that in healthy pregnant women. The types of estrogens with the highest mean levels in the urine of GDM and healthy pregnant women were obviously different, which are 2-methoxyestrone (2MeOE1) and E3, respectively. Our results demonstrated that this specific and sensitive method is suitable for quantifying estrogens in human urine and could provide support for further research on estrogen-related pathological mechanisms in GDM and other diseases.
Collapse
Affiliation(s)
- Xiaoli Zhang
- Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing 210008, PR China
| | - Na Yang
- Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing 210008, PR China; Department of Pharmacy, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, PR China; Nanjing Medical Center for Clinical Pharmacy, Nanjing 210008, PR China
| | - Min Wang
- Department of Pharmacy, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, PR China
| | - JiaJia Ge
- Department of Pharmacy, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, PR China
| | - Huaijun Zhu
- Department of Pharmacy, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, PR China
| | - Jun He
- Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing 210008, PR China.
| | - Weihong Ge
- Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing 210008, PR China; Department of Pharmacy, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, PR China; Nanjing Medical Center for Clinical Pharmacy, Nanjing 210008, PR China.
| |
Collapse
|
46
|
Dash S, Tiwari M, Dash P, Kar K, Mohakud NK. Complications of Hypertriglyceridemia in Pregnancy and Its Impact on Neonates: a Hospital-Based Study From Odisha. Cureus 2022; 14:e28399. [PMID: 36171850 PMCID: PMC9508935 DOI: 10.7759/cureus.28399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2022] [Indexed: 11/17/2022] Open
Abstract
Objective Hypertriglyceridemia (HTG) in pregnancy causes an increased risk for maternal and fetal complications. But, reports on the impact of HTG in pregnancy on maternal and fetal outcomes are scarce in developing countries. We aim to determine the maternal and neonatal complications of HTG in pregnancy. Materials and methods This prospective observational study was conducted on 150 pregnant women with HTG in the department of obstetrics and gynecology, KIMS, Bhubaneswar, from December 2019 to November 2020. Measurement of triglycerides during the first trimester, second trimester, and delivery was done. Maternal complications and neonatal outcomes in HTG mothers and mothers with normal triglyceride levels were compared. Results Out of 150 HTG cases, hypothyroidism, preeclampsia, acute pancreatitis, and sickle cell crisis occurred in 41 (27.3%), 22 (14.7%), six (4%), and three (2%) cases, respectively. The triglyceridemia (TG) levels raised from 133.7±48.2 mg/dl in the first trimester to 232.8±151.0 mg/dl in the third trimester. There is a significant increase in TG levels at the time of delivery compared to the first and second trimesters (p< .001). Out of 140 neonates, 30 (21.4%) were preterm, eight (5.7%) had intrauterine growth restriction (IUGR), and four (6.06%) were macrosomic. Intrauterine death, preterm, and macrosomia are significantly associated with maternal HTG compared to normal mothers (p < .032). All mortalities were due to acute pancreatitis (6; 4%) among mothers and four intrauterine fetal death. Conclusion There is a steady increase in TG levels in the successive trimesters of pregnancy. Gestational severe hypertriglyceridemia causes life-threatening complications. HTG-induced acute pancreatitis needs to be managed aggressively to prevent maternal death. Neonates of HTG mothers suffer from complications like prematurity, IUGR, and macrosomia.
Collapse
|
47
|
Sun Z, Deng Z, Wei X, Wang N, Yang J, Li W, Wu M, Liu Y, He G. Circulating saturated fatty acids and risk of gestational diabetes mellitus: A cross-sectional study and meta-analysis. Front Nutr 2022; 9:903689. [PMID: 35978962 PMCID: PMC9376316 DOI: 10.3389/fnut.2022.903689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background Previous studies have analyzed the associations between the circulating saturated fatty acids (SFAs) and gestational diabetes mellitus (GDM), but no consistent conclusions have been reached. The aim of this study was to evaluate whether plasma SFAs were in correlation with GDM risks in our in-house women cross-sectional study and to better define their associations on the clinical evidence available to date by a dose-response meta-analysis. Methods We carried out a cross-sectional study of 807 pregnant women in 2018–2019 (Shanghai, China). GDM was defined according to the criteria of the International Association of Diabetes and Pregnancy Study Groups (IADPSG). Gas chromatography was used to determine the plasma fatty acids (FAs) in the 24–28 gestational weeks. The SFAs levels of non-GDM and GDM participants were compared by Mann–Whitney test, and the association between SFAs and GDM was explored by multivariate logistic models. Further, the potential diagnostic value of plasma SFAs was evaluated using the method of receiver operating characteristic (ROC) analysis. For meta-analysis, five databases were systematically searched from inception to March 2022, and we included 25 relevant studies for calculating pooled standard mean differences (SMDs) and 95% CI to describe the differences in SFAs profiles between non-GDM and GDM women. Study-specific, multivariable-adjusted ORs and 95% CI were also pooled using a fixed-effect model or random-effects model according to the heterogeneity to evaluate the associations between circulating SFAs and GDM prevalence. Results In our cross-sectional study, we found plasma proportion of palmitic acid (C16:0) was positively associated (aOR: 1.10 per 1% increase; 95% CI: 1.04, 1.17), while plasma stearic acid (C18:0) (aOR: 0.76 per 1% increase; 95% CI: 0.66, 0.89), arachidic acid (C20:0) (aOR: 0.92 per 0.1% increase; 95% CI: 0.87, 0.97), behenic acid (C22:0) (aOR: 0.94 per 0.1% increase; 95% CI: 0.92, 0.97), and lignoceric acid (C24:0) (aOR: 0.94 per 0.1% increase; 95% CI: 0.92, 0.97) were inversely associated with GDM. The area under the receiver operative characteristic curve increased from 0.7503 (the basic diagnostic model) to 0.8178 (p = 0.002) after adding total very-long-chain SFAs (VLcSFAs). A meta-analysis from 25 studies showed the circulating levels of three individual SFAs of GDM women were different from those of normal pregnant women. The summarized ORs for GDM was 1.593 (95% CI: 1.125, 2.255, p = 0.009), 0.652 (95% CI: 0.472, 0.901, p = 0.010) and 0.613 (95% CI: 0.449, 0.838, p = 0.002), respectively, comparing the highest vs. lowest quantile of the concentrations of C16:0, C22:0, and C24:0. Conclusion Our results, combined with the findings from meta-analysis, showed that women with GDM had a particular circulating SFA profile, characterized by higher levels of palmitic acid, and lower levels of VLcSFAs. Alterations in the chain lengths of blood SFA profile were shown to be associated with the occurrence of GDM.
Collapse
Affiliation(s)
- Zhuo Sun
- School of Public Health, Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, China
| | - Zequn Deng
- School of Public Health, Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, China
| | - Xiaohui Wei
- School of Public Health, Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, China
| | - Na Wang
- School of Public Health, Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, China.,Nursing Department, Obstetrics and Gynaecology Hospital of Fudan University, Shanghai, China
| | - Jiaqi Yang
- School of Public Health, Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, China
| | - Wenyun Li
- School of Public Health, Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, China
| | - Min Wu
- School of Public Health, Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, China
| | - Yuwei Liu
- School of Public Health, Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, China
| | - Gengsheng He
- School of Public Health, Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, China
| |
Collapse
|
48
|
Zheng MM, Lu Y, Cai YS, Li MX, Fei Y, Zheng D. Preventive effect of one-day outpatient health management on adverse pregnancy outcomes in patients with gestational diabetes mellitus: a retrospective cohort study. Transl Pediatr 2022; 11:1362-1373. [PMID: 36072537 PMCID: PMC9442207 DOI: 10.21037/tp-22-324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 08/05/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND One-day outpatient health management has been applied to treat gestational diabetes mellitus (GDM) and prevent further complications. However, the relationships between one-day outpatient health management and adverse pregnancy outcomes remain ambiguous, because of limited evidence. We analyzed the effects of one-day outpatient health management on premature birth, macrosomia and low-birth-weight infants in patients with GDM. METHODS We retrospectively enrolled pregnant women with GDM who delivered at Guiyang Maternal and Child Health Hospital between 2019 and 2021. Patients could voluntarily choose to participate in either the general outpatient health education or a one-day outpatient health management. Data on demographic and clinical characteristics were collected and pregnancy outcomes ascertained. Logistic regression analysis was used to detect the potential relationship between one-day outpatient health management and adverse pregnancy outcomes including preterm birth, macrosomia, and low-birth-weight infants. GDM, preterm birth, low birth weight and macrosomia was diagnosed according to the criteria established by Obstetrics and Gynecology (9th edition). RESULTS A total of 3,249 patients with GDM were included, and 798 (24.56%) patients participated in the one-day outpatient health management. Statistically significant differences were observed in the maternal age (P<0.05) and gravidity (P<0.001) between the study and control groups. The incidences of premature birth, low-birth-weight infant, and macrosomia in patients attending the one-day outpatient service were 9.6%, 8.1%, and 4.5%, while the incidences of those who did not attend the one-day outpatient service were 12.4%, 11.1%, and 7.5%. After adjusting for maternal age, ethnic groups, body mass index (BMI) before pregnancy, family history of diabetes, history of abnormal pregnancy, history of polycystic ovary syndrome, gravidity, hyperthyroidism and hypothyroidism, multivariate logistic regression analyses showed that this one-day outpatient health management was a protective factor for premature birth [odds ratio (OR) 0.751, 95% confidence interval (CI): 0.576-0.981], macrosomia (OR 0.567, 95% CI: 0.385-0.834) and low-birth-weight infants (OR 0.699, 95% CI: 0.522-0.937). CONCLUSIONS The degree of acceptance of patients with GDM to a one-day outpatient health management is still low. This one-day outpatient health management may reduce the incidence of adverse pregnancy outcomes in women with GDM to a certain extent.
Collapse
Affiliation(s)
- Meng-Mou Zheng
- Department of Preventive Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Yang Lu
- Department of Women Healthcare, Guiyang Maternal and Child Health Hospital, Guiyang, China
| | - Yu-Shu Cai
- Department of Women Healthcare, Guiyang Maternal and Child Health Hospital, Guiyang, China
| | - Ming-Xuan Li
- Department of Women Healthcare, Guiyang Maternal and Child Health Hospital, Guiyang, China
| | - Yu Fei
- Department of Preventive Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Dan Zheng
- Department of Women Healthcare, Guiyang Maternal and Child Health Hospital, Guiyang, China
| |
Collapse
|
49
|
Zhou G, Chen C, Han G, Jiang H, Cao M. Relationship between different hepatitis B virus infection status and gestational diabetes mellitus prevalence among pregnant women with chronic HBV infection: A retrospective study. J Viral Hepat 2022; 29:596-603. [PMID: 35582862 DOI: 10.1111/jvh.13700] [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: 11/24/2021] [Accepted: 03/18/2022] [Indexed: 12/09/2022]
Abstract
To investigate the relationships between different hepatitis B virus (HBV) infection status and gestational diabetes mellitus (GDM) and analyse the potential risk factors, we conducted an observational retrospective study in HBV-infected pregnant women to compare the differences of GDM prevalence and clinical outcomes between groups divided by HBV infection status. Spearman's correlation coefficient was used to evaluate the correlations among hepatitis B e antigen (HBeAg), HBV DNA and liver function. Logistic regression model was used to analyse the risk factors. In all, 1390 HBsAg-positive pregnant women were enrolled. HBeAg titre and HBV DNA, ALT and AST were correlated (r = 0.743, p < 0.001; r = 0.813, p < 0.001). Overall GDM prevalence was 21%. GDM prevalence of HBV-infected women with abnormal liver function was higher than those with normal liver function (26.8% vs. 20%, p = 0.027). Age over 35 years and abnormal liver function over 5 times ULN and 1-2 times ULN were independent risk factors for GDM prevalence with odds ratio (OR) of 1.858 (95% CI 1.227-2.815), 1.589 (95% CI 1.023-2.468) and 2.203 (95% CI 1.029-4.718), respectively. GDM prevalence in HBV-infected pregnancies with abnormal liver function was higher than those with normal liver function. Age over 35 years and abnormal liver function were independent risk factors for GDM in HBV-infected women.
Collapse
Affiliation(s)
- Guanlun Zhou
- Department of Obstetrics and Gynecology, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Chao Chen
- Department of Obstetrics and Gynecology, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Guorong Han
- Department of Obstetrics and Gynecology, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Hongxiu Jiang
- Department of Obstetrics and Gynecology, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Minkai Cao
- Department of Obstetrics and Gynecology, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China
| |
Collapse
|
50
|
Yap PPH, Papachristou Nadal I, Rysinova V, Basri NI, Samsudin IN, Forbes A, Noor NM, Supian ZA, Hassan H, Paimin F, Zakaria R, Mohamed Alias SR, Ismail Bukhary NB, Benton M, Ismail K, Chew BH. Study protocol on risk factors for the diagnosis of gestational diabetes mellitus in different trimesters and their relation to maternal and neonatal outcomes (GDM-RIDMAN). BMJ Open 2022; 12:e052554. [PMID: 35882454 PMCID: PMC9330332 DOI: 10.1136/bmjopen-2021-052554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Gestational diabetes mellitus (GDM) is often associated with adverse pregnancy outcomes. However, the association of risk factors with GDM diagnosis, maternal and neonatal health outcomes is less established when compared with women without GDM. We aim to examine the diagnostic accuracy of the conventional and novel risk factors for a GDM diagnosis and their impact on maternal and neonatal health outcomes. METHODS AND ANALYSIS This retrospective cohort and nested case-control study at six public health clinics is based on medical records and questionnaire survey of women between 2 and 12 months postpartum. The estimated required sample size is 876 complete records (292 cases, 584 control, at a ratio of 1:2). Oral glucose tolerance test results will be used to identify glucose dysregulation, and maternal and neonatal outcomes include maternal weight gain, pre-eclampsia, polyhydramnios, mode of delivery, preterm or postdate birth, complications in labour, birth weight, gestational age at birth, Apgar score, congenital anomaly, congenital hypothyroidism, neonatal death or stillbirth, hypoglycaemia and hyperbilirubinaemia. Psychosocial measures include the WHO Quality of Life: brief, mother-infant bonding (14-item Postpartum Bonding Questionnaire and 19-item Maternal Postnatal Attachment Scale), anxiety (7-item Generalised Anxiety Disorder), depression (9-item Patient Health Questionnaire) and stress (Perceived Stress Scale symptoms) questionnaires. The comparative incidences of maternal and neonatal health outcomes, the comparative prevalence of the psychosocial outcomes between women with GDM and without GDM, specificity, sensitivity, positive and negative predictive values of the risk factors, separately and combined, will be reported. All GDM risk factors and outcomes will be modelled using multivariable regression analysis and the receiver operating characteristics curve will be reported. ETHICS AND DISSEMINATION This study was approved by the Malaysia Research and Ethics Committee, Ministry of Health Malaysia. Informed consent will be obtained from all participants. Findings will be submitted for publications in scientific journals.
Collapse
Affiliation(s)
- Pamela Phui Har Yap
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Iliatha Papachristou Nadal
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Department of Psychological Medicine, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Veronika Rysinova
- Department of Psychological Medicine, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Nurul Iftida Basri
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Intan Nureslyna Samsudin
- Department of Pathology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Angus Forbes
- Division of Care in Long-term Conditions, King's College London, London, UK
| | - Nurain Mohd Noor
- Clinical Research Centre (CRC), Hospital Putrajaya Malaysia, Putrajaya, Malaysia
| | - Ziti Akthar Supian
- Klinik Kesihatan Seri Kembangan, Ministry of Health Malaysia, Seri Kembangan, Selangor, Malaysia
| | - Haslinda Hassan
- Klinik Kesihatan Puchong, Ministry of Health Malaysia, Puchong, Selangor, Malaysia
| | - Fuziah Paimin
- Klinik Kesihatan Putrajaya Presint 9, Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Rozita Zakaria
- Klinik Kesihatan Putrajaya Presint 18, Ministry of Health Malaysia, Putrajaya, Malaysia
| | | | | | - Madeleine Benton
- Department of Psychological Medicine, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Khalida Ismail
- Department of Psychological Medicine, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Boon How Chew
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- Department of Psychological Medicine, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
- Clinical Research Unit, Hospital Pengajar Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| |
Collapse
|