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Neri C, Ciliberti A, Dessì DA, Airoldi C, Basello K, Costanzi A, Familiari A, Tersigni C, Cappelletti M, Speciani AF, Lanzone A. B-cell-activating factor (BAFF) and platelet-activating factor (PAF) in pregnancies complicated by maternal obesity and diabetes: a preliminary study. J Matern Fetal Neonatal Med 2023; 36:2272010. [PMID: 37872771 DOI: 10.1080/14767058.2023.2272010] [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: 07/03/2023] [Accepted: 10/12/2023] [Indexed: 10/25/2023]
Abstract
OBJECTIVE In pregnancies complicated by maternal obesity and diabetes, a disruption in inflammatory mediators occurs, resulting in endothelial microvascular dysfunction, oxidative stress, tissue damage, and maternal and feto-neonatal complications. To outline this proinflammatory status, an innovative approach is represented by the measurement of proinflammatory cytokines. Among these biomarkers, B-cell-activating factor (BAFF) and platelet-activating factor (PAF) play a key role in metabolic regulation, immune response to infections, tissue homeostasis, and "food-related inflammation." The aim of the present study is to investigate the blood expression of BAFF and PAF in a cohort of pregnant women affected by obesity and diabetes compared with a control group of healthy pregnant women. METHODS A prospective longitudinal cohort study has been conducted on pregnant women referred to Fondazione Policlinico Universitario Gemelli IRCCS in Rome. For each pregnant woman, a capillary sample was collected with a swab in three different consecutive evaluations carried out in the three trimesters of pregnancy. RESULTS A total of 77 pregnant women have been enrolled. No significant differences in BAFF and PAF levels were longitudinally observed between groups. Focusing on the exposed group, in the third trimester of pregnancy, both PAF and BAFF levels were lower than the basal time. Among the selected group of patients who developed Gestational Diabetes, only PAF values were longitudinally lower when compared to other groups. The multivariate analysis showed that BAFF levels were positively correlated with thyroid-stimulating hormone levels. No macrosomia, no shoulder dystocia, no major perineal lacerations at birth, and no intrauterine growth restriction were observed in the whole population. CONCLUSIONS This study supports the involvement of metabolic and proinflammatory biomarkers in the mechanisms related to pregnancy complications. Improving a good metabolic environment for obese and diabetic pregnant women could break the vicious cycle connecting inflammation, oxidative stress, and metabolic disorders.
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Affiliation(s)
- Caterina Neri
- Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Alessandra Ciliberti
- Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Davide Archelao Dessì
- Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Chiara Airoldi
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | | | | | - Alessandra Familiari
- Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Chiara Tersigni
- Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | | | | | - Antonio Lanzone
- Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
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Ratsch A, Bogossian F, Burmeister EA, Ryu B, Steadman KJ. Higher blood nicotine concentrations following smokeless tobacco (pituri) and cigarette use linked to adverse pregnancy outcomes for Central Australian Aboriginal pregnancies. BMC Public Health 2022; 22:2157. [DOI: 10.1186/s12889-022-14609-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 11/14/2022] [Indexed: 11/25/2022] Open
Abstract
Abstract
Background
In central Australia, Aboriginal women use wild tobacco plants, Nicotiana spp. (locally known as pituri) as a chewed smokeless tobacco, with this use continuing throughout pregnancy and lactation. Our aim was to describe the biological concentrations of nicotine and metabolites in samples from mothers and neonates and examine the relationships between maternal self-reported tobacco use and maternal and neonatal outcomes.
Methods
Central Australian Aboriginal mothers (and their neonates) who planned to birth at the Alice Springs Hospital (Northern Territory, Australia) provided biological samples: maternal blood, arterial and venous cord blood, amniotic fluid, maternal and neonatal urine, and breast milk. These were analysed for concentrations of nicotine and five metabolites.
Results
A sample of 73 women were enrolled who self-reported: no-tobacco use (n = 31), tobacco chewing (n = 19), or smoking (n = 23). Not all biological samples were obtained from all mothers and neonates. In those where samples were available, higher total concentrations of nicotine and metabolites were found in the maternal plasma, urine, breast milk, cord bloods and Day 1 neonatal urine of chewers compared with smokers and no-tobacco users. Tobacco-exposed mothers (chewers and smokers) with elevated blood glucose had higher nicotine and metabolite concentrations than tobacco-exposed mothers without elevated glucose, and this was associated with increased neonatal birthweight. Neonates exposed to higher maternal nicotine levels were more likely to be admitted to Special Care Nursery. By Day 3, urinary concentrations in tobacco-exposed neonates had reduced from Day 1, although these remained higher than concentrations from neonates in the no-tobacco group.
Conclusions
This research provides the first evidence that maternal pituri chewing results in high nicotine concentrations in a wide range of maternal and neonatal biological samples and that exposure may be associated with adverse maternal and neonatal outcomes. Screening for the use of all tobacco and nicotine products during pregnancy rather than focusing solely on smoking would provide a more comprehensive assessment and contribute to a more accurate determination of tobacco and nicotine exposure. This knowledge will better inform maternal and foetal care, direct attention to targeted cessation strategies and ultimately improve long-term clinical outcomes, not only in this vulnerable population, but also for the wider population.
Note to readers
In this research, the central Australian Aboriginal women chose the term ‘Aboriginal’ to refer to themselves, and ‘Indigenous’ to refer to the broader group of Australian First Peoples. That choice has been maintained in the reporting of the research findings.
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Maggiulli O, Rufo F, Johns SE, Wells JC. Food taboos during pregnancy: meta-analysis on cross cultural differences suggests specific, diet-related pressures on childbirth among agriculturalists. PeerJ 2022; 10:e13633. [PMID: 35846875 PMCID: PMC9281602 DOI: 10.7717/peerj.13633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 06/03/2022] [Indexed: 01/17/2023] Open
Abstract
Pregnancy is the most delicate stage of human life history as well as a common target of food taboos across cultures. Despite puzzling evidence that many pregnant women across the world reduce their intake of nutritious foods to accomplish cultural norms, no study has provided statistical analysis of cross-cultural variation in food taboos during pregnancy. Moreover, antenatal practices among forager and agriculturalists have never been compared, despite subsistence mode being known to affect staple foods and lifestyle directly. This gap hinders to us from understanding the overall threats attributed to pregnancy, and their perceived nutritional causes around the world. The present study constitutes the first cross-cultural meta-analysis on food taboos during pregnancy. We examined thirty-two articles on dietary antenatal restrictions among agricultural and non-agricultural societies, in order to: (i) identify cross-culturally targeted animal, plant and miscellaneous foods; (ii) define major clusters of taboo focus; (iii) test the hypothesis that food types and clusters of focus distribute differently between agricultural and non-agricultural taboos; and (iv) test the hypothesis that food types distribute differently across the clusters of taboo focus. All data were analysed in SPSS and RStudio using chi-squared tests and Fisher's exact tests. We detected a gradient in taboo focus that ranged from no direct physiological interest to the fear of varied physiological complications to a very specific concern over increased birth weight and difficult delivery. Non-agricultural taboos were more likely to target non-domesticated animal foods and to be justified by concerns not directly linked to the physiological sphere, whereas agricultural taboos tended to targed more cultivated and processed products and showed a stronger association with concerns over increased birth weight. Despite some methodological discrepancies in the existing literature on food taboos during pregnancy, our results illustrate that such cultural traits are useful for detecting perception of biological pressures on reproduction across cultures. Indeed, the widespread concern over birth weight and carbohydrate rich foods overlaps with clinical evidence that obstructed labor is a major threat to maternal life in Africa, Asia and Eurasia. Furthermore, asymmetry in the frequency of such concern across subsistence modes aligns with the evolutionary perspective that agriculture may have exacerbated delivery complications. This study highlights the need for the improved understanding of dietary behaviors during pregnancy across the world, addressing the role of obstructed labor as a key point of convergence between clinical, evolutionary and cultural issues in human behavior.
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Affiliation(s)
| | | | | | - Jonathan C.K. Wells
- University College London Great Ormond Street Institute of Child Health, London, United Kingdom
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Oni HT, Buultjens M, Mohamed AL, Islam MM. Neonatal Outcomes of Infants Born to Pregnant Women With Substance Use Disorders: A Multilevel Analysis of Linked Data. Subst Use Misuse 2022; 57:1-10. [PMID: 34369268 DOI: 10.1080/10826084.2021.1958851] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE This study examines the associations of substance use disorders in pregnancy with a set of neonatal outcomes. METHODS This is a quantitative retrospective study. Three linked datasets of a 10-year period (2007-2016) from New South Wales, Australia, were examined. Pregnant women were identified positive for substance use disorders when at least one hospital admission during pregnancy or delivery had opioid-, or cannabis-, or stimulant-, or alcohol- or two or more of the four substance groups- related ICD-10-AM diagnostic code. As there was a hierarchical structure in the dataset, the adjusted odds ratio (AOR) was estimated using multilevel logistic regression. FINDINGS Of the 622,640 birth records, 1677 (0.27%) women had opioid-related, 1857 (0.30%) had cannabis-related, 552 (0.09%) had stimulant-related, 595 (0.10%) had alcohol-related and 591 (0.09%) had polysubstance-related ICD-10-AM diagnostic codes. There were significant relationships between opioid use in pregnancy and neonatal health outcomes including preterm birth (AOR 3.2; 95% CI 2.8, 3.7) and admission to the neonatal intensive care unit (NICU) (AOR 10.0; 95% CI 8.8, 11.3). Substance use disorders due to cannabis, stimulants, alcohol or polysubstance were significantly associated with preterm birth, low birthweight, low APGAR score and admission to NICU. Also, alcohol and polysubstance use disorders in pregnancy were found to be significantly associated with stillbirth. CONCLUSION Results demonstrate that substance use disorders in pregnancy are associated with an increased risk of adverse neonatal outcomes. Early identification of substance use disorders through screening and adherence to pharmacotherapy and other psychosocial interventions could improve neonatal outcomes.
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Affiliation(s)
- Helen T Oni
- Department of Public Health, La Trobe University, Bundoora, VIC, Australia
| | - Melissa Buultjens
- Department of Public Health, La Trobe University, Bundoora, VIC, Australia
| | - Abdel-Latif Mohamed
- Department of Public Health, La Trobe University, Bundoora, VIC, Australia.,Canberra Hospital, Canberra Hospital, Garran, ACT, Australia
| | - M Mofizul Islam
- Department of Public Health, La Trobe University, Bundoora, VIC, Australia
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Stern C, Schwarz S, Moser G, Cvitic S, Jantscher-Krenn E, Gauster M, Hiden U. Placental Endocrine Activity: Adaptation and Disruption of Maternal Glucose Metabolism in Pregnancy and the Influence of Fetal Sex. Int J Mol Sci 2021; 22:ijms222312722. [PMID: 34884524 PMCID: PMC8657775 DOI: 10.3390/ijms222312722] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 02/07/2023] Open
Abstract
The placenta is an endocrine fetal organ, which secretes a plethora of steroid- and proteo-hormones, metabolic proteins, growth factors, and cytokines in order to adapt maternal physiology to pregnancy. Central to the growth of the fetus is the supply with nutrients, foremost with glucose. Therefore, during pregnancy, maternal insulin resistance arises, which elevates maternal blood glucose levels, and consequently ensures an adequate glucose supply for the developing fetus. At the same time, maternal β-cell mass and function increase to compensate for the higher insulin demand. These adaptations are also regulated by the endocrine function of the placenta. Excessive insulin resistance or the inability to increase insulin production accordingly disrupts physiological modulation of pregnancy mediated glucose metabolism and may cause maternal gestational diabetes (GDM). A growing body of evidence suggests that this adaptation of maternal glucose metabolism differs between pregnancies carrying a girl vs. pregnancies carrying a boy. Moreover, the risk of developing GDM differs depending on the sex of the fetus. Sex differences in placenta derived hormones and bioactive proteins, which adapt and modulate maternal glucose metabolism, are likely to contribute to this sexual dimorphism. This review provides an overview on the adaptation and maladaptation of maternal glucose metabolism by placenta-derived factors, and highlights sex differences in this regulatory network.
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Affiliation(s)
- Christina Stern
- Department of Obstetrics and Gynecology, Medical University of Graz, 8036 Graz, Austria; (C.S.); (S.S.); (E.J.-K.)
| | - Sarah Schwarz
- Department of Obstetrics and Gynecology, Medical University of Graz, 8036 Graz, Austria; (C.S.); (S.S.); (E.J.-K.)
| | - Gerit Moser
- Division of Cell Biology, Histology and Embryology, Gottfried Schatz Research Center, Medical University of Graz, 8010 Graz, Austria;
| | - Silvija Cvitic
- Research Unit of Analytical Mass Spectrometry, Cell Biology and Biochemistry of Inborn Errors of Metabolism, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, 8036 Graz, Austria;
| | - Evelyn Jantscher-Krenn
- Department of Obstetrics and Gynecology, Medical University of Graz, 8036 Graz, Austria; (C.S.); (S.S.); (E.J.-K.)
| | - Martin Gauster
- Division of Cell Biology, Histology and Embryology, Gottfried Schatz Research Center, Medical University of Graz, 8010 Graz, Austria;
- Correspondence: (M.G.); (U.H.); Tel.: +43-316385-71896 (M.G.); +43-136385-17837 (U.H.)
| | - Ursula Hiden
- Department of Obstetrics and Gynecology, Medical University of Graz, 8036 Graz, Austria; (C.S.); (S.S.); (E.J.-K.)
- Correspondence: (M.G.); (U.H.); Tel.: +43-316385-71896 (M.G.); +43-136385-17837 (U.H.)
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Murthi P, Rajaraman G. Inflammasomes in the Pathophysiology of Maternal Obesity: Potential Therapeutic Targets to Reduce Long-Term Adverse Health Outcomes in the Mother and Offspring. Curr Vasc Pharmacol 2021; 19:165-175. [PMID: 32493196 DOI: 10.2174/1570161118666200603131536] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 12/16/2022]
Abstract
Over the past 20 years, the prevalence of obesity has risen dramatically worldwide, with an increase in occurrence among women in their reproductive age. Obesity during pregnancy is associated with significantly increased maternal and fetal morbidity and mortality. In addition to the short-term adverse health outcomes, both mother and the child are prone to develop cardiovascular, metabolic and neurological disorders. Although associations between obesity during pregnancy and adverse maternalfetal health outcomes are clear, the complex molecular mechanisms underlying maternal obesity remain largely unknown. This review describes multimeric self-assembling protein complexes, namely inflammasomes, as potential molecular targets in the pathophysiology of maternal obesity. Inflammasomes are implicated in both normal physiological and in pathophysiological processes that occur in response to an inflammatory milieu throughout gestation. This review highlights the current knowledge of inflammasome expression and its activity in pregnancies affected by maternal obesity. Key discussions in defining pharmacological inhibition of upstream as well as downstream targets of the inflammasome signaling cascade; and the inflammasome platform, as a potential therapeutic strategy in attenuating the pathophysiology underpinning inflammatory component in maternal obesity are presented herein.
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Affiliation(s)
- Padma Murthi
- Cardiovascular Disease Program, Monash Biomedicine Discovery Institute and Department of Pharmacology, Monash University, Victoria, Australia
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Li C, Zhou P, Cai Y, Peng B, Liu Y, Yang T, Li Y, Hu Y, Fu Y, Wang Z, Peng H, Zhang Y, Chen J, Li T, Chen L. Associations between gestational diabetes mellitus and the neurodevelopment of offspring from 1 month to 72 months: study protocol for a cohort study. BMJ Open 2020; 10:e040305. [PMID: 33234643 PMCID: PMC7689080 DOI: 10.1136/bmjopen-2020-040305] [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: 11/04/2022] Open
Abstract
INTRODUCTION Gestational diabetes mellitus (GDM) is a common gestational disease and an important global public health problem. GDM may affect the short-term and long-term health of offspring, but the associations between GDM and the neurodevelopment of offspring of mothers with GDM (OGDM) are still unclear, and studies based on the Chinese population are lacking. We aim to determine the associations between GDM and the neurodevelopment of OGDM by studying a cohort of OGDM and offspring of non-GDM mothers. METHODS AND ANALYSIS The single-centre prospective cohort study is being conducted in China over 7 years. A total of 490 OGDM (GDM group) and 490 fromof healthy mothers (control group) will be enrolled during the same period. Baseline characteristics, neuropsychological development scores and clinical data at specific time points (at 0, 1, 3, 6, 12, 24, 36, 48, 60 and 72 months old) will be collected from the children in both groups until the age of 6 years. The associations between GDM and the neurodevelopment of OGDM from infancy to preschool age will be analysed using a multiple linear regression model adjusted for confounders. In addition, we will compare longitudinal data to further assess the effects of GDM on neurodevelopmental trajectories. ETHICS AND DISSEMINATION The study has been approved by the Ethics Committee of the Children's Hospital of Chongqing Medical University (Approval Number: (2019) Institutional Review Board (IRB) (STUDY) No. 85). The findings of this study will be disseminated through open access journals, peer-reviewed journals and scientific meetings. TRIAL REGISTRATION NUMBER NCT03997396.
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Affiliation(s)
- Chao Li
- Growth, Development and Mental Health Center of Children and Adolescents, Children's Hospital of Chongqing Medical University; National Clinical Research Center for Child Health and Disorders; Ministry of Education Key Laboratory of Child Development and Disorders; Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
- Department of Child Care, The First People's Hospital of Chongqing Liangjiang New Area, Chongqing, China
| | - Ping Zhou
- Growth, Development and Mental Health Center of Children and Adolescents, Children's Hospital of Chongqing Medical University; National Clinical Research Center for Child Health and Disorders; Ministry of Education Key Laboratory of Child Development and Disorders; Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
| | - Yixi Cai
- Department of Child Care, The First People's Hospital of Chongqing Liangjiang New Area, Chongqing, China
| | - Bin Peng
- Department of Health Statistics, Chongqing Medical University, Chongqing, China
| | - Yongfang Liu
- Growth, Development and Mental Health Center of Children and Adolescents, Children's Hospital of Chongqing Medical University; National Clinical Research Center for Child Health and Disorders; Ministry of Education Key Laboratory of Child Development and Disorders; Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
| | - Ting Yang
- Growth, Development and Mental Health Center of Children and Adolescents, Children's Hospital of Chongqing Medical University; National Clinical Research Center for Child Health and Disorders; Ministry of Education Key Laboratory of Child Development and Disorders; Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
| | - Yinying Li
- Department of Child Care, The First People's Hospital of Chongqing Liangjiang New Area, Chongqing, China
| | - Yirong Hu
- Department of Outpatient, The First People's Hospital of Chongqing Liangjiang New Area, Chongqing, China
| | - Yajun Fu
- Department of Obstetrics, The First People's Hospital of Chongqing Liangjiang New Area, Chongqing, China
| | - Zhenming Wang
- Department of Obstetrics, The First People's Hospital of Chongqing Liangjiang New Area, Chongqing, China
| | - Hong Peng
- Department of Child Care, The First People's Hospital of Chongqing Liangjiang New Area, Chongqing, China
| | - Yue Zhang
- Department of Child Care, The First People's Hospital of Chongqing Liangjiang New Area, Chongqing, China
| | - Jie Chen
- Growth, Development and Mental Health Center of Children and Adolescents, Children's Hospital of Chongqing Medical University; National Clinical Research Center for Child Health and Disorders; Ministry of Education Key Laboratory of Child Development and Disorders; Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
| | - Tingyu Li
- Growth, Development and Mental Health Center of Children and Adolescents, Children's Hospital of Chongqing Medical University; National Clinical Research Center for Child Health and Disorders; Ministry of Education Key Laboratory of Child Development and Disorders; Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
| | - Li Chen
- Growth, Development and Mental Health Center of Children and Adolescents, Children's Hospital of Chongqing Medical University; National Clinical Research Center for Child Health and Disorders; Ministry of Education Key Laboratory of Child Development and Disorders; Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
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Sex Specific Expression of Interleukin 7, 8 and 15 in Placentas of Women with Gestational Diabetes. Int J Mol Sci 2020; 21:ijms21218026. [PMID: 33126577 PMCID: PMC7663521 DOI: 10.3390/ijms21218026] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 10/19/2020] [Accepted: 10/23/2020] [Indexed: 12/16/2022] Open
Abstract
Gestational diabetes mellitus (GDM) is known to increase the risk for feto-maternal complications during pregnancy. A state of low-grade inflammation, with elevated levels of proinflammatory molecules, similar to patients with obesity or diabetes mellitus type 2 has also been partly described in GDM. The placenta, as unique interface between mother and fetus, is not only passively affected by changes in one of these organisms, but also acts as a modulator by expressing hormones and cytokines. This study aimed to investigate the expression of the proinflammatory cytokines Interleukin (IL) 7, 8 and 15 in GDM in placental tissue. A total number of 80 placentas were included (40 GDM/40 control group). The expression of IL-7, 8 and 15 was investigated in extravillous trophoblast (EVT) and syncytiotrophoblast (SCT) by immunohistochemistry and immunofluorescence double staining. The immunohistochemical staining was evaluated with the semiquanitfied immunoreactive score (IRS). While the expression IL-15 was significantly upregulated in EVTs of women with GDM. The expression of IL-8 was significantly decreased in EVT of the GDM group. Furthermore, significant fetal sex specific differences were detectable in all three cytokines. Our findings suggest an involvement of the investigated cytokines in the maintenance of a state of chronic low-grade inflammation on placental level in patients suffering from GDM.
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Buffarini R, Barros AJD, Matijasevich A, Loret de Mola C, Santos IS. Gestational diabetes mellitus, pre-gestational BMI and offspring BMI z-score during infancy and childhood: 2004 Pelotas Birth Cohort. BMJ Open 2019; 9:e024734. [PMID: 31289054 PMCID: PMC6629409 DOI: 10.1136/bmjopen-2018-024734] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Gestational diabetes mellitus (GDM) affects a significant number of women. Evidence regarding the association between GDM and offspring body mass index (BMI) is unclear due to small samples and lack of adequate confounding control. The objective of this study was to investigate the association between GDM and offspring BMI z-scores from birth to early adolescence and to examine the role of maternal pre-gestational BMI in this relationship. DESIGN Prospective study. SETTING Pelotas 2004 Birth Cohort, Brazil. PARTICIPANTS Cohort participants that were followed-up from birth up to early adolescence (~3500) and their mothers. PRIMARY OUTCOME MEASURES BMI z-scores at birth, 3, 12, 24, 48 months and 6 and 11 years of age, calculated according to the WHO growth charts. RESULTS Unadjusted and adjusted linear regressions were performed and interaction terms between maternal pre-gestational BMI and GDM were included. Prevalence of self-reported GDM was 2.6% (95% CI 2.1% to 3.1%). The offspring BMI z-scores (SD) at birth, 3, 12, 24, 48 months and at 6 and 11 years were 0.10 (1.12), -0.47 (1.10), 0.59 (1.10), 0.59 (1.08), 0.78 (1.32), 0.70 (1.43) and 0.75 (1.41), respectively. Unadjusted regression models showed positive associations between GDM and offspring BMI z-scores at birth, 6 and 11 years. After adjustment, the associations attenuated towards the null. Statistical evidence of effect modification between maternal pre-gestational BMI and GDM was observed at birth (p=0.007), with the association between GDM and offspring BMI z-score being apparent only in those children born to overweight or obese mothers (β=0.72, 95% CI 0.30 to 1.14 and β=0.61, 95% CI 0.20 to 1.01, respectively). CONCLUSIONS We observed that in the association between GDM and offspring BMI z-scores, there is a predominant role for maternal nutritional status before pregnancy and that the association between GDM and newborn's BMI is apparent only among those born to overweight or obese mothers.
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Affiliation(s)
- Romina Buffarini
- Postgraduate Program in Epidemiology, Federal University of Pelotas (UFPel), Pelotas, Rio Grande do Sul, Brazil
| | - Aluisio J D Barros
- Postgraduate Program in Epidemiology, Federal University of Pelotas (UFPel), Pelotas, Rio Grande do Sul, Brazil
| | | | | | - Ina S Santos
- Postgraduate Program in Epidemiology, Federal University of Pelotas (UFPel), Pelotas, Rio Grande do Sul, Brazil
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Donovan BM, Breheny PJ, Robinson JG, Baer RJ, Saftlas AF, Bao W, Greiner AL, Carter KD, Oltman SP, Rand L, Jelliffe-Pawlowski LL, Ryckman KK. Development and validation of a clinical model for preconception and early pregnancy risk prediction of gestational diabetes mellitus in nulliparous women. PLoS One 2019; 14:e0215173. [PMID: 30978258 PMCID: PMC6461273 DOI: 10.1371/journal.pone.0215173] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 03/27/2019] [Indexed: 12/18/2022] Open
Abstract
Implementation of dietary and lifestyle interventions prior to and early in pregnancy in high risk women has been shown to reduce the risk of gestational diabetes mellitus (GDM) development later in pregnancy. Although numerous risk factors for GDM have been identified, the ability to accurately identify women before or early in pregnancy who could benefit most from these interventions remains limited. As nulliparous women are an under-screened population with risk profiles that differ from their multiparous counterparts, development of a prediction model tailored to nulliparous women may facilitate timely preventive intervention and improve maternal and infant outcomes. We aimed to develop and validate a model for preconception and early pregnancy prediction of gestational diabetes mellitus based on clinical risk factors for nulliparous women. A risk prediction model was built within a large California birth cohort including singleton live birth records from 2007–2012. Model accuracy was assessed both internally and externally, within a cohort of women who delivered at University of Iowa Hospitals and Clinics between 2009–2017, using discrimination and calibration. Differences in predictive accuracy of the model were assessed within specific racial/ethnic groups. The prediction model included five risk factors: race/ethnicity, age at delivery, pre-pregnancy body mass index, family history of diabetes, and pre-existing hypertension. The area under the curve (AUC) for the California internal validation cohort was 0.732 (95% confidence interval (CI) 0.728, 0.735), and 0.710 (95% CI 0.672, 0.749) for the Iowa external validation cohort. The model performed particularly well in Hispanic (AUC 0.739) and Black women (AUC 0.719). Our findings suggest that estimation of a woman’s risk for GDM through model-based incorporation of risk factors accurately identifies those at high risk (i.e., predicted risk >6%) who could benefit from preventive intervention encouraging prompt incorporation of this tool into preconception and prenatal care.
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Affiliation(s)
- Brittney M. Donovan
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, United States of America
| | - Patrick J. Breheny
- Department of Biostatistics, University of Iowa College of Public Health, Iowa City, Iowa, United States of America
| | - Jennifer G. Robinson
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, United States of America
| | - Rebecca J. Baer
- Department of Pediatrics, University of California San Diego, La Jolla, California, United States of America
- California Preterm Birth Initiative, University of California San Francisco, San Francisco, California, United States of America
| | - Audrey F. Saftlas
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, United States of America
| | - Wei Bao
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, United States of America
| | - Andrea L. Greiner
- Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States of America
| | - Knute D. Carter
- Department of Biostatistics, University of Iowa College of Public Health, Iowa City, Iowa, United States of America
| | - Scott P. Oltman
- California Preterm Birth Initiative, University of California San Francisco, San Francisco, California, United States of America
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America
| | - Larry Rand
- California Preterm Birth Initiative, University of California San Francisco, San Francisco, California, United States of America
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - Laura L. Jelliffe-Pawlowski
- California Preterm Birth Initiative, University of California San Francisco, San Francisco, California, United States of America
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America
| | - Kelli K. Ryckman
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, United States of America
- Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States of America
- * E-mail:
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Prenatal exposure to gestational diabetes mellitus increases developmental defects in the enamel of offspring. PLoS One 2019; 14:e0211771. [PMID: 30811464 PMCID: PMC6392233 DOI: 10.1371/journal.pone.0211771] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 01/22/2019] [Indexed: 12/16/2022] Open
Abstract
Background and objective Gestational diabetes mellitus (GDM) is associated with short- and long-term maternal and perinatal repercussions. Our objective was to evaluate the long-term consequences of intrauterine exposure to hyperglycemia on Developmental Defects of Enamel (DDE) in offspring. Results Overall, 50 children of women with GDM and 250 children of normoglycemic women participated, the latter serving as controls. Children were examined at the age between 3 and 12 years. In addition to physical examination, two independent observers examined and rated photographs to identify specific types of DDE in a blinded fashion. Among offspring of mothers with GDM, rates of DDE (all types combined) and hypoplasia (specific type) were significantly higher (p<0.001, p = 0.04), in comparison to offspring of normoglycemic mothers. Considering only the affected teeth (1060 in GDM category; 5499 in controls), rates of DDE (all types combined) were significantly higher for total teeth (p <0.001) and deciduous teeth (p<0.001), but not permanent teeth. In specific types of DDE involving deciduous teeth, rates of demarcate opacity were significantly higher (p<0.001; canine and 2nd mandibular molars) and hypoplasia (p <0.001; 2nd maxillary molars and 2nd mandibular molars). In permanent teeth, the rate of diffuse opacity in association with GDM was significantly higher (p<0.001; maxillary central incisors and 1st maxillary molars). Conclusion GDM was associated with the adverse effects of DDE on offspring. This study lays the foundation for future studies to determine the impact of GDM on long-term risk of DDE.
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Murthi P, Vaillancourt C. RETRACTED: Placental serotonin systems in pregnancy metabolic complications associated with maternal obesity and gestational diabetes mellitus. Biochim Biophys Acta Mol Basis Dis 2019; 1866:165391. [PMID: 30738809 DOI: 10.1016/j.bbadis.2019.01.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 01/08/2019] [Accepted: 01/10/2019] [Indexed: 12/12/2022]
Abstract
This article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal).
The publication was retracted by request of the authors following an investigation by Monash University performed following its Procedures for Investigating Code Breaches and in accordance with the Australian Code for the Responsible Conduct of Research.
The University concluded on the balance of probability that a significant part of the text in the paper was included without knowledge, without consent and without correct attribution of the original author who, at the time, was a student at the University. The results discussed in the review article are still scientifically valid.
☆
This article is part of a Special Issue entitled: Membrane Transporters and Receptors in Pregnancy Metabolic Complications edited by Luis Sobrevia.
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Affiliation(s)
- Padma Murthi
- Department of Medicine, School of Clinical Sciences, Department of Physiology, Monash University, Clayton, Victoria, Australia; Hudson Institute of Medical Research, The Ritchie Centre, Clayton, Victoria, Australia; Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Victoria, Australia.
| | - Cathy Vaillancourt
- INRS-Institut Armand-Frappier, Université du Québec and Biomed Research Center, 531 Boulevard des Prairies, Laval, QC H7V 1B7, Canada; Center for Interdisciplinary Research on Well-Being, Health, Society and Environment, Université du Québec à Montréal, Montréal, QC H3C 3P8, Canada
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13
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The Effects of Different Types of Dietary Advice for Women With Gestational Diabetes Mellitus on Pregnancy Outcomes. CLIN NURSE SPEC 2018; 32:175-176. [PMID: 29878927 DOI: 10.1097/nur.0000000000000382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Khan T, Macaulay S, Norris SA, Micklesfield LK, Watson ED. Physical activity and the risk for gestational diabetes mellitus amongst pregnant women living in Soweto: a study protocol. BMC WOMENS HEALTH 2016; 16:66. [PMID: 27756289 PMCID: PMC5070198 DOI: 10.1186/s12905-016-0345-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 10/07/2016] [Indexed: 12/16/2022]
Abstract
Background Over the past decade the prevalence of gestational diabetes mellitus (GDM) has increased rapidly in both developed and developing countries and has become a growing health concern worldwide. A recent systematic review highlighted the paucity of data available on the prevalence and potential burden of GDM in Africa, which was emphasised by the fact that only 11 % of African countries were represented in the review. In South Africa, the prevalence of GDM remains unknown, although one would estimate it to be high due to urbanisation and the growing obesity epidemic. In addition, the association between physical activity (PA), sedentary behaviour (SB) and GDM is not well understood in this population. The aim of the proposed research is to determine whether there is an association between physical activity, sedentary behaviour and risk for GDM in pregnant black women living in urban Soweto in South Africa. Methods/Design This prospective cohort study of 80 participants will include pregnant women from Soweto enrolled into the Soweto First 1000 Days Study (S1000) at the MRC/Wits Departmental Pathways for Health Research Unit (DPHRU) based at the Chris Hani Baragwanath Academic Hospital in Soweto, South Africa. Women will be enrolled into the S1000 Study at <14 weeks gestation, and baseline demographic and anthropometric measures will be taken at 14–18 weeks gestation (visit 1). In addition, participants will complete the Global Physical Activity Questionnaire (GPAQ) to measure self-reported physical activity and will be given an ActiGraph accelerometer to wear for seven days to measure habitual physical activity at 14–18 weeks gestation (visit 1), and at 28–33 weeks gestation (visit 3). At visit 2 (24–28 weeks gestation) an oral glucose tolerance test (OGTT) will be conducted. Discussion Physical activity during pregnancy has been associated with minimum risk to a pregnancy and may play a role in improving glucose metabolism and therefore decreasing risk for GDM. This is particularly pertinent to assess amongst black South African women who are a potentially high risk population due to the high prevalence of obesity and type 2 diabetes (T2D). The findings of the study will assist in developing targeted interventions as well as feasible healthcare strategies.
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Affiliation(s)
- Tasneem Khan
- Centre for Exercise Science and Sports Medicine, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Shelley Macaulay
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics,School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Division of Human Genetics, School of Pathology Faculty of Health Sciences, University of the Witwatersrand and the National Health Laboratory Service, Johannesburg, South Africa
| | - Shane A Norris
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics,School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lisa K Micklesfield
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics,School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Estelle D Watson
- Centre for Exercise Science and Sports Medicine, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics,School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Babu GR, Murthy GVS, Deepa R, Yamuna, Prafulla, Kumar HK, Karthik M, Deshpande K, Benjamin Neelon SE, Prabhakaran D, Kurpad A, Kinra S. Maternal antecedents of adiposity and studying the transgenerational role of hyperglycemia and insulin (MAASTHI): a prospective cohort study : Protocol of birth cohort at Bangalore, India. BMC Pregnancy Childbirth 2016; 16:311. [PMID: 27741952 PMCID: PMC5065083 DOI: 10.1186/s12884-016-1088-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 09/22/2016] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND India is experiencing an epidemic of obesity-hyperglycaemia, which coincides with child bearing age for women. The epidemic can be sustained and augmented through transgenerational transmission of adiposity and glucose intolerance in women. This presents an opportunity for exploring a clear strategy for the control of this epidemic in India. We conducted a study between November 2013 and May 2015 to inform the design of a large pregnancy cohort study. Based on the findings of this pilot, we developed the protocol for the proposed birth cohort of 5000 women, the recruitment for which will start in April 2016. The protocol of the study documents the processes which aim at advancing the available knowledge, linking several steps in the evolution of obesity led hyperglycemia. METHODS Maternal Antecedents of Adiposity and Studying the Transgenerational role of Hyperglycemia and Insulin (MAASTHI) is a cohort study in the public health facilities in Bangalore, India. The objective of MAASTHI is to prospectively assess the effects of glucose levels in pregnancy on the risk of adverse infant outcomes, especially in predicting the possible risk markers of later chronic diseases. The primary objective of the proposed study is to investigate the effect of glucose levels in pregnancy on skinfold thickness (adiposity) in infancy as a marker of future obesity and diabetes in offspring. The secondary objective is to assess the association between psychosocial environment of mothers and adverse neonatal outcomes including adiposity. The study aims to recruit 5000 pregnant women and follow them and their offspring for a period of 4 years. The institutional review board at The Indian Institute of Public Health (IIPH)-H, Bangalore, Public Health Foundation of India has approved the protocol. All participants are required to provide written informed consent. DISCUSSION The findings from this study may help to address important questions on screening and management of high blood sugar in pregnancy. It may provide critical information on the specific determinants driving the underweight-obesity-T2DM epidemic in India. The study can inform the policy regarding the potential impact of screening and management protocols in public healthcare facilities. The public health implications include prioritising issues of maternal glycemic control and weight management and better understanding of the lifecourse determinants in the development of T2DM.
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Affiliation(s)
- Giridhara R. Babu
- Wellcome Trust-DBT India alliance Intermediate Research Fellow in Public Health, Additional Professor, Public Health Foundation of India (PHFI), IIPH-H, Bangalore campus, SIHFW premises, Beside leprosy hospital, 1st cross, Magadi road, Bangalore, 560023 India
| | - GVS Murthy
- Indian Institute of Public Health-Hyderabad, Plot # 1, A.N.V. Arcade, Amar Co-op Society, Kavuri Hills, Madhapur, Hyderabad, 500033 India
- ICEH, London School of Hygiene & Tropical Medicine, 3rd Floor, South Courtyard, Keppel Street, London, WC1E 7HT UK
| | - R. Deepa
- Research team of MAASTHI, Public Health Foundation of India, IIPH-H, Bangalore campus, SIHFW premises, Beside leprosy hospital, 1st cross, Magadi road, Bangalore, 560023 India
| | - Yamuna
- Research team of MAASTHI, Public Health Foundation of India, IIPH-H, Bangalore campus, SIHFW premises, Beside leprosy hospital, 1st cross, Magadi road, Bangalore, 560023 India
| | - Prafulla
- Research team of MAASTHI, Public Health Foundation of India, IIPH-H, Bangalore campus, SIHFW premises, Beside leprosy hospital, 1st cross, Magadi road, Bangalore, 560023 India
| | - H. Kiran Kumar
- Research team of MAASTHI, Public Health Foundation of India, IIPH-H, Bangalore campus, SIHFW premises, Beside leprosy hospital, 1st cross, Magadi road, Bangalore, 560023 India
| | - Maithili Karthik
- Research team of MAASTHI, Public Health Foundation of India, IIPH-H, Bangalore campus, SIHFW premises, Beside leprosy hospital, 1st cross, Magadi road, Bangalore, 560023 India
| | - Keerti Deshpande
- Research team of MAASTHI, Public Health Foundation of India, IIPH-H, Bangalore campus, SIHFW premises, Beside leprosy hospital, 1st cross, Magadi road, Bangalore, 560023 India
| | - Sara E. Benjamin Neelon
- Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Hampton House 755, Baltimore, MD 21205 USA
- Centre for Diet and Activity Research, MRC Epidemiology, University of Cambridge, Cambridge, UK
| | - D. Prabhakaran
- Centre for Control of Chronic Conditions (CCCC, Public Health Foundation of India (PHFI), New Delhi, India
- Centre for Chronic Disease Control (CCDC), New Delhi, India
- Department of Epidemiology, London School of Hygiene and Tropical Medicine, London, WC1E 7HT UK
- Emory Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA 30322 USA
| | - Anura Kurpad
- Nutrition Division, St John’s Research Institute, Bangalore, India
- Nutrition Society of India, National Institute of Nutrition Campus, Hyderabad, 500 007 India
- IAEA Collaborating Centre for Stable Isotope Technologies in Nutrition, St John’s Research Institute, Bangalore, India
- International Nutrition Foundation Protein Advisory Group and Chair, Expert Committee on Obesity, ICMR, New Delhi, India
| | - Sanjay Kinra
- Reader in Clinical Epidemiology & Honorary Consultant in Paediatric Obesity - London School of Hygiene & Tropical Medicine & University College London Hospital, London, UK
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Djelmis J, Pavić M, Mulliqi Kotori V, Pavlić Renar I, Ivanisevic M, Oreskovic S. Prevalence of gestational diabetes mellitus according to IADPSG and NICE criteria. Int J Gynaecol Obstet 2016; 135:250-254. [DOI: 10.1016/j.ijgo.2016.07.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 06/29/2016] [Accepted: 08/22/2016] [Indexed: 10/21/2022]
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Mahalakshmi MM, Bhavadharini B, Maheswari K, Kalaiyarasi G, Anjana RM, Ranjit U, Mohan V, Joseph K, Rekha K, Nallaperumal S, Malanda B, Kayal A, Belton A, Uma R. Comparison of maternal and fetal outcomes among Asian Indian pregnant women with or without gestational diabetes mellitus: A situational analysis study (WINGS-3). Indian J Endocrinol Metab 2016; 20:491-496. [PMID: 27366715 PMCID: PMC4911838 DOI: 10.4103/2230-8210.183469] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
AIM To compare the existing maternal and fetal outcomes in Asian Indian women with or without gestational diabetes mellitus (GDM) before the development of the Women in India with GDM Strategy (WINGS) GDM model of care (MOC). MATERIALS AND METHODS Records of pregnant women were extracted retrospectively from three maternity centers in Chennai. GDM was diagnosed using the International Association for Pregnancy Study Groups criteria or the Carpenter and Coustan criteria. Demographic details, obstetric history, antenatal follow-up, treatment for GDM, and outcomes of delivery were collected from the electronic medical records. RESULTS Of the 3642 records analyzed, 799 (21.9%) had GDM, of whom 456 (57.1%) were treated with insulin and medical nutrition therapy (MNT), 339 (42.4%) with MNT alone, and 4 (0.5%) with metformin. Women with GDM were older than those without (28.5 ± 4.5 vs. 27.1 ± 4.5 years; P < 0.001) and had higher mean body mass index at first booking (26.4 ± 5.2 kg/m(2) vs. 25.2 ± 5.1 kg/m(2); P < 0.001). Rates of cesarean section (26.2% vs. 18.7%; P < 0.001), preeclampsia (1.8% vs. 0.8%; P = 0.04), and macrosomia (13.9% vs. 10.8%; P = 0.02) were significantly higher among women with GDM. In women with GDM treated with insulin and MNT, emergency cesarean section (16.2% vs. 36.6%; P < 0.0001), preeclampsia (0.7% vs. 3.2%; P = 0.015), and macrosomia (9.9% vs. 18.6%; P = 0.0006) were significantly lesser compared to those treated with MNT alone. CONCLUSION Pregnancy outcomes were in general worse in GDM women. Treatment with insulin was associated with a significantly lower risk of complications. However, in countries with limited access to insulin and other medicines may lead to poor follow-up and management of GDM. Data from this retrospective study will form the basis for the development of the WINGS GDM MOC, which will address these gaps in GDM care in low-resource settings.
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Affiliation(s)
- Manni Mohanraj Mahalakshmi
- Department of Epidemiology and Diabetology, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Balaji Bhavadharini
- Department of Epidemiology and Diabetology, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Kumar Maheswari
- Department of Epidemiology and Diabetology, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Gunasekaran Kalaiyarasi
- Department of Epidemiology and Diabetology, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Ranjit Mohan Anjana
- Department of Epidemiology and Diabetology, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Unnikrishnan Ranjit
- Department of Epidemiology and Diabetology, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Viswanathan Mohan
- Department of Epidemiology and Diabetology, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Kurian Joseph
- Department of Obstetrics and Gynecology, Joseph Nursing Home, Chennai, Tamil Nadu, India
| | - Kurian Rekha
- Department of Obstetrics and Gynecology, Joseph Nursing Home, Chennai, Tamil Nadu, India
| | - Sivagnanam Nallaperumal
- Department of Diabetology, Prashanth Infertility Research Centre, Chennai, Tamil Nadu, India
| | - Belma Malanda
- Department of Policy and Programmes, International Diabetes Federation, Brussels, Belgium
| | - Arivudainambi Kayal
- Department of Policy and Programmes, International Diabetes Federation, Brussels, Belgium
| | - Anne Belton
- Department of Policy and Programmes, International Diabetes Federation, Brussels, Belgium
| | - Ram Uma
- Department of Obstetrics and Gynecology, Seethapathy Clinic and Hospital, Chennai, Tamil Nadu, India
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Bricelj K, Tul N, Lucovnik M, Kronhauser-Cerar L, Steblovnik L, Verdenik I, Blickstein I. Neonatal respiratory morbidity in late-preterm births in pregnancies with and without gestational diabetes mellitus. J Matern Fetal Neonatal Med 2016; 30:377-379. [PMID: 27052752 DOI: 10.3109/14767058.2016.1174208] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To evaluate neonatal respiratory morbidity in infants born late-preterm to mothers with or without gestational diabetes mellitus (GDM). METHODS Analysis of a population-based cohort of all live-born singletons, born at 34 0/7 to 36 6/7 weeks to mothers with and without GDM, focusing on transient tachypnea of the newborn (TTN) and respiratory distress syndrome (RDS). RESULTS The study group comprised 363 (4.7%) singletons born to mothers with GDM and the controls were 7400 born to mothers without GDM. Mothers with GDM were older (31.4 ± 5.1 versus 29.5 ± 5.1 years, p < 0.001) and were more likely to be hypertensive (OR 1.5, 95% CI 1.1-2.1). Neonates of GDM mothers were heavier at birth (2769 ± 539 versus 2636 ± 473 g, p < 0.001). We found a similar incidence of RDS and TTN in both groups. The multiple regression analysis showed cesarean delivery and lower gestational age were independently associated with RDS and TTN. CONCLUSION GDM, per se, is not a major contributor to RDS in late pre-term infants. Rather, the combination of prematurity and cesarean birth act independently to increase the risk of respiratory morbidity.
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Affiliation(s)
- Katja Bricelj
- a Department of Perinatology , Division of Obstetrics and Gynecology, University Medical Centre Ljubljana , Ljubljana , Slovenia , and
| | - Natasa Tul
- a Department of Perinatology , Division of Obstetrics and Gynecology, University Medical Centre Ljubljana , Ljubljana , Slovenia , and
| | - Miha Lucovnik
- a Department of Perinatology , Division of Obstetrics and Gynecology, University Medical Centre Ljubljana , Ljubljana , Slovenia , and
| | - Lilijana Kronhauser-Cerar
- a Department of Perinatology , Division of Obstetrics and Gynecology, University Medical Centre Ljubljana , Ljubljana , Slovenia , and
| | - Lili Steblovnik
- a Department of Perinatology , Division of Obstetrics and Gynecology, University Medical Centre Ljubljana , Ljubljana , Slovenia , and
| | - Ivan Verdenik
- a Department of Perinatology , Division of Obstetrics and Gynecology, University Medical Centre Ljubljana , Ljubljana , Slovenia , and
| | - Isaac Blickstein
- b Department of Obstetrics and Gynecology , Kaplan Medical Center , Rehovot , Israel
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Global architecture of gestational diabetes research: density-equalizing mapping studies and gender analysis. Nutr J 2016; 15:36. [PMID: 27044432 PMCID: PMC4820855 DOI: 10.1186/s12937-016-0154-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 03/29/2016] [Indexed: 12/25/2022] Open
Abstract
Objective Gestational diabetes mellitus (GDM) is associated with substantial morbidity for mothers and their offspring. While clinical and basic research activities on this important disease grow constantly, there is no concise analysis of global architecture of GDM research. Hence, it was the objective of this study to assess the global scientific performance chronologically, geographically and in relation to existing research networks and gender distribution of publishing authors. Study design On the basis of the New Quality and Quantity Indices in Science (NewQIS) platform, scientometric methods were combined with modern visualizing techniques such as density equalizing mapping, and the Web of Science database was used to assess GDM-related entries from 1900 to 2012. Results Twelve thousand five hundred four GDM-related publications were identified and analyzed. The USA (4295 publications) and the UK (1354 publications) dominated the field concerning research activity, overall citations and country-specific Hirsch-Index, which quantified the impact of a country’s published research on the scientific community. Semi-qualitative indices such as country-specific citation rates ranked New Zealand and the UK at top positions. Annual collaborative publications increased steeply between the years 1990 and 2012 (71 to 1157 respectively). Subject category analysis pointed to a minor interest of public health issues in GDM research. Gender analysis in terms of publication authorship revealed a clear dominance of the male gender until 2005; then a trend towards gender equity started and the activity of female scientists grew visibly in many countries. The country-specific gender analysis revealed large differences, i.e. female scientists dominated the scientific output in the USA, whereas the majority of research was published by male authors in countries such as Japan. Conclusion This study provides the first global sketch of GDM research architecture. While North-American and Western-European countries were dominating the GDM-related scientific landscape, a disparity exists in terms of research output between developed and low-resource countries. Since GDM is linked to considerable mortality and morbidity of mothers and their offspring and constitutes a tremendous burden for the healthcare systems in underserved countries, our findings emphasize the need to address disparities by fostering research endeavors, public health programs and collaborative efforts in these nations.
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Becquet O, El Khabbaz F, Alberti C, Mohamed D, Blachier A, Biran V, Sibony O, Baud O. [Insulin treatment of gestational diabetes and respiratory outcome in late-preterm and term babies]. Arch Pediatr 2016; 23:261-7. [PMID: 26879967 DOI: 10.1016/j.arcped.2015.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 07/15/2015] [Accepted: 12/18/2015] [Indexed: 10/22/2022]
Abstract
While the incidence of diabetes mellitus (DM) during pregnancy has been steadily increasing in recent years, the link between gestational DM and respiratory outcome in neonates has not been firmly established. To address this gap in understanding, we asked whether DM status and its treatment during pregnancy influence risk of neonatal respiratory distress. We conducted retrospective analysis of a large cohort to determine the relationship between maternal DM status (non-DM, insulin-treated DM [DTI], and non-insulin-treated DM [DTR]) and respiratory distress in term and near-term singletons, born at Robert-Debré Hospital over a 7-year period. Of 18,095 singletons delivered at 34 weeks of gestation or later, 412 (2.3%) were admitted to the NICU for respiratory distress within the first hours of life. The incidence of NICU admissions due to respiratory distress was 2.2% in the non-DM group, 2.1% in the DTR group, and 5.7% in the DTI group. Insulin treatment of DM, together with several other perinatal factors, was associated with an increased risk for severe respiratory distress. In a multivariate model, we found that DTI, but not DTR, was a risk factor independent of gestational age and cesarean section, with an IRR of 1.44 (95% CI, 1.00-2.08). The data indicate that newborns of mothers with DM treated with diet are not at risk for severe respiratory distress. Conversely, newborns of mothers with DM treated with insulin are associated with elevated risk for severe respiratory disease and should therefore be closely monitored.
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Affiliation(s)
- O Becquet
- Université Paris Diderot, Sorbonne Paris Cité, 75019 Paris, France; Neonatal Intensive Care Unit, hôpital Robert-Debré, Assistance publique-Hôpitaux de Paris, 75019 Paris, France
| | - F El Khabbaz
- Neonatal Intensive Care Unit, hôpital Robert-Debré, Assistance publique-Hôpitaux de Paris, 75019 Paris, France
| | - C Alberti
- Université Paris Diderot, Sorbonne Paris Cité, 75019 Paris, France; Inserm U1123, CIC-EC 1426, Unit of Clinical Epidemiology, hôpital Robert-Debré, Assistance publique-Hôpitaux de Paris, 75019 Paris, France
| | - D Mohamed
- Inserm U1123, CIC-EC 1426, Unit of Clinical Epidemiology, hôpital Robert-Debré, Assistance publique-Hôpitaux de Paris, 75019 Paris, France
| | - A Blachier
- Département d'information médicale, hôpital Robert-Debré, Assistance publique-Hôpitaux de Paris, 75019 Paris, France
| | - V Biran
- Université Paris Diderot, Sorbonne Paris Cité, 75019 Paris, France; Neonatal Intensive Care Unit, hôpital Robert-Debré, Assistance publique-Hôpitaux de Paris, 75019 Paris, France
| | - O Sibony
- Université Paris Diderot, Sorbonne Paris Cité, 75019 Paris, France; Service de gynécologie-obstétrique, hôpital Robert-Debré, Assistance publique-Hôpitaux de Paris, 75019 Paris, France
| | - O Baud
- Université Paris Diderot, Sorbonne Paris Cité, 75019 Paris, France; Neonatal Intensive Care Unit, hôpital Robert-Debré, Assistance publique-Hôpitaux de Paris, 75019 Paris, France.
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Mehta Y, Shitole C, Setia MS. Factors Associated With Changes in Magnesium Levels in Asymptomatic Neonates: A Longitudinal Analysis. IRANIAN JOURNAL OF PEDIATRICS 2016; 26:e2662. [PMID: 26848372 PMCID: PMC4733288 DOI: 10.5812/ijp.2662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 10/26/2015] [Accepted: 10/31/2015] [Indexed: 11/21/2022]
Abstract
Background: Neonates and infants with hypomagnesemia present with seizures and psychomotor delay. Objectives: The present study evaluated the changes in magnesium (Mg) levels and factors associated with these in the first three days of life. Materials and Methods: We monitored 50 clinically asymptomatic neonates; they were not given any magnesium supplements even if they had hypomagnesemia at baseline. The variables analysed were: serum Mg; gestational age; birth weight; length; and the ponderal index. We used random effects (RE) models for longitudinal analysis of these data. Results: The mean standard deviation (SD) gestational age was 36.3 (3.6) weeks and the mean (SD) weight was 2604.2 (754.4) grams. About 31% of the neonates had hypomagnesemia (< 1.6 mg/dL) on day one; however, all had normal magnesium levels by day three of life (P < 0.001). At birth, after adjusting for intrauterine growth retardation status (IUGR), serum Mg levels were lower by 0.0097 mg/dL (95% CI: -0.019 to -0.0003) per 100 grams increase in weight of the neonate. After adjusting for IUGR status, the mean increase in the serum Mg levels was 0.14 mg/dL (95% confidence intervals [CI]: 0.10 to 0.18) per day. The per-day increase in magnesium levels was significantly higher in low birth weight babies (0.10, 95% CI: 0.01 to 0.18) compared with normal birth weight babies. Conclusions: Asymptomatic neonates may have a high prevalence of hypomagnesemia; however, the levels become normal without any magnesium supplementation. Even though regular monitoring of magnesium levels is useful, no supplements are required - particularly in clinically asymptomatic neonates.
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Affiliation(s)
- Yogesh Mehta
- Department of Pediatrics, Dr. L H Hiranandani Hospital, Mumbai, India
- Corresponding author: Yogesh Mehta, Department of Pediatrics, Dr. L H Hiranandani Hospital, Hillside Avenue, Hiranandani Gardens, Mumbai, India. Tel: +91-2225763333, Fax: +91-2225763344, E-mail:
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Becquet O, El Khabbaz F, Alberti C, Mohamed D, Blachier A, Biran V, Sibony O, Baud O. Insulin treatment of maternal diabetes mellitus and respiratory outcome in late-preterm and term singletons. BMJ Open 2015; 5:e008192. [PMID: 26038361 PMCID: PMC4458616 DOI: 10.1136/bmjopen-2015-008192] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES While the incidence of diabetes mellitus (DM) during pregnancy has been steadily increasing in recent years, the link between gestational DM and respiratory outcome in neonates has not been definitely established. We asked the question whether DM status and its treatment during pregnancy could influence the risk of neonatal respiratory distress. DESIGN We studied in a large retrospective cohort the relationship between maternal DM status (non-DM, insulin-treated DM (IT-DM) and non-insulin-treated DM (NIT-DM)), and respiratory distress in term and near-term inborn singletons. RESULTS Among 18,095 singletons delivered at 34 weeks of gestation or later, 412 (2.3%) were admitted to the neonatal intensive care unit (NICU) for respiratory distress within the first hours of life. The incidence of NICU admission due to respiratory distress groups was 2.2%, 5.7% and 2.1% in the non-DM, IT-DM and NIT-DM groups, respectively. Insulin treatment of DM, together with several other perinatal factors, was associated with a significant increased risk for respiratory distress. Several markers of the severity of respiratory illness, including durations of mechanical ventilation and supplemental oxygen, and hypertrophic cardiomyopathy were also found increased following IT-DM as compared with NIT-DM. In a multivariate model, we found that IT-DM, but not NIT-DM, was significantly associated with respiratory distress independent of gestational age and caesarean section, with an incidence rate ratio of 1.44 (1.00-2.08). CONCLUSIONS This study shows that the treatment of maternal DM with insulin during pregnancy is an independent risk factor for respiratory distress in term and near-term newborns.
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Affiliation(s)
- Odile Becquet
- Neonatal Intensive Care Unit, Université Paris Diderot, Sorbonne Paris Cité, Paris, France Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France PremUP Foundation, Paris, France
| | - Fares El Khabbaz
- Neonatal Intensive Care Unit, Université Paris Diderot, Sorbonne Paris Cité, Paris, France Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France PremUP Foundation, Paris, France
| | - Corinne Alberti
- PremUP Foundation, Paris, France Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1123, ECEVE, Paris, France Unit of Clinical Epidemiology, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France INSERM, U1123 and CIC-EC 1426, Paris, France
| | - Damir Mohamed
- Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1123, ECEVE, Paris, France Unit of Clinical Epidemiology, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France INSERM, U1123 and CIC-EC 1426, Paris, France
| | - Audrey Blachier
- Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Département d'information médicale, Paris, France
| | - Valérie Biran
- Neonatal Intensive Care Unit, Université Paris Diderot, Sorbonne Paris Cité, Paris, France Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France PremUP Foundation, Paris, France
| | - Olivier Sibony
- Neonatal Intensive Care Unit, Université Paris Diderot, Sorbonne Paris Cité, Paris, France Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France PremUP Foundation, Paris, France Université Paris Diderot, Sorbonne Paris Cité, Paris, France Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Service de Gynécologie Obstétrique, Paris, France
| | - Olivier Baud
- Neonatal Intensive Care Unit, Université Paris Diderot, Sorbonne Paris Cité, Paris, France Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France PremUP Foundation, Paris, France
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Pantham P, Aye ILMH, Powell TL. Inflammation in maternal obesity and gestational diabetes mellitus. Placenta 2015; 36:709-15. [PMID: 25972077 DOI: 10.1016/j.placenta.2015.04.006] [Citation(s) in RCA: 361] [Impact Index Per Article: 40.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 04/08/2015] [Accepted: 04/13/2015] [Indexed: 12/30/2022]
Abstract
BACKGROUND The prevalence of maternal obesity is rising rapidly worldwide and constitutes a major obstetric problem, increasing mortality and morbidity in both mother and offspring. Obese women are predisposed to pregnancy complications such as gestational diabetes mellitus (GDM), and children of obese mothers are more likely to develop cardiovascular and metabolic disease in later life. Maternal obesity and GDM may be associated with a state of chronic, low-grade inflammation termed "metainflammation", as opposed to an acute inflammatory response. This inflammatory environment may be one mechanism by which offspring of obese women are programmed to develop adult disorders. METHODS Herein we review the evidence that maternal obesity and GDM are associated with changes in the maternal, fetal and placental inflammatory profile. RESULTS Maternal inflammation in obesity and GDM may not always be associated with fetal inflammation. CONCLUSION We propose that the placenta 'senses' and adapts to the maternal inflammatory environment, and plays a central role as both a target and producer of inflammatory mediators. In this manner, maternal obesity and GDM may indirectly program the fetus for later disease by influencing placental function.
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Affiliation(s)
- P Pantham
- Department of Pediatrics, Section of Neonatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - I L M H Aye
- Department of Obstetrics & Gynecology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - T L Powell
- Department of Pediatrics, Section of Neonatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Hematian H, Khaksar Z, Jelodar G. Neural tube alteration in fetuses of diabetic rats. COMPARATIVE CLINICAL PATHOLOGY 2014. [DOI: 10.1007/s00580-013-1775-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ultrastructural changes in rat ovarian cells of fetuses and neonates from diabetic mothers. COMPARATIVE CLINICAL PATHOLOGY 2014. [DOI: 10.1007/s00580-013-1758-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Babu GR, Garadi L, Murthy GVS, Kinra S. Effect of hyperglycaemia in pregnancy on adiposity in their infants in India: a protocol of a multicentre cohort study. BMJ Open 2014; 4:e005417. [PMID: 24972608 PMCID: PMC4078779 DOI: 10.1136/bmjopen-2014-005417] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION The carbohydrate 'fuel' metabolism in a pregnant woman may have a long-term impact on the development of her offspring ('fuel-mediated teratogenesis' hypothesis) including in utero exposure to maternal hyperglycaemia leading to fetal hyperinsulinaemia, and the consequent increase in fetal fat cells. Therefore, a feed-forward loop can exist of rising adiposity and hyperinsulinaemia throughout childhood, perhaps leading to obesity and diabetes in later life. There is a need for prospective examination of body fat distribution in children born to mothers with different glycaemic levels to understand the plausible association between glucose metabolism and future risk of diabetes in offspring. The hypothesis is that maternal glucose levels in pregnant women are related to skinfold thickness in their infants. METHODS AND ANALYSIS Hyperglycaemia in pregnancy and adiposity in infants is a multicentre cohort study to evaluate the effects of glucose levels in pregnancy on the risk of adverse infant outcomes, especially in predicting the risk of chronic diseases in infants. The study aims to recruit 1045 participants over a period of 1 year, who will be followed up irrespective of their glycaemia status for a period of 15 months, beginning in the 24th week of gestation. The glucose levels in pregnant women would be obtained through oral glucose tolerance testing. The primary outcome of our study was skinfold thickness in infants at the age of 6 weeks, 3rd and 9th month (as a proxy for fat distribution/adiposity). ETHICS AND DISSEMINATION The institutional review board at The Indian Institute of Public Health (IIPH)-Hyderabad, Public Health Foundation of India has approved the protocol. All participants are required to provide written informed consent.
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Affiliation(s)
- Giridhara R Babu
- IIPH-H, Bangalore Campus, Public Health Foundation of India, Bangalore, Karnataka, India
| | - Lavanya Garadi
- IIPH-H, Bangalore Campus, Public Health Foundation of India, Bangalore, Karnataka, India
| | - G V S Murthy
- IIPH Hyderabad, Hyderabad, Andhra Pradesh, India
- Faculty of Infectious and Tropical Diseases, Department of Clinical Research, Public Health Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - Sanjay Kinra
- Faculty of Epidemiology and Population Health, Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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Khaksar Z, Jelodar G, Hematian H, Poorahmadi M. Alterations in gonadal and testicular cells of male fetuses and neonates of diabetic rats. COMPARATIVE CLINICAL PATHOLOGY 2013. [DOI: 10.1007/s00580-012-1537-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Khaksar Z, Jelodar G, Hematian H, Poorahmadi M. Alterations of the ovarian histomorphometry at pre-puberty in rat offspring from diabetic mothers. Reprod Med Biol 2013; 12:173-178. [PMID: 29699143 DOI: 10.1007/s12522-013-0151-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Accepted: 04/30/2013] [Indexed: 11/26/2022] Open
Abstract
Purpose Maternal diabetes leads to increased blood glucose concentration in the mother and consequently in the foetus, causing various neonatal problems. This study was conducted to evaluate the effects of maternal diabetes on foetal ovarian structure. Methods Sixteen adult female rats were allocated into two equal groups. Diabetes was induced in one group by alloxan. Both groups became pregnant by natural mating. Thirty days after birth, the female offspring were terminated, the body weight and blood glucose of the animals measured and their ovaries removed. Various histological and cellular parameters were determined using histological and electron microscopy techniques. Results Results revealed a significant increase in body weight and blood glucose in the offspring of the diabetic mothers (ODM) compared to that of the controls. The weight, volume and diameter of the ovary and the ovarian capsule thickness were inclined to decrease in ODM compared to that of controls. The number and diameter of primary, pre-antral and antral follicles were decreased in ovaries in the ODM. The electro-micrographs have demonstrated the organelle alterations in oocytes and granulosa cells that suggest the apoptosis progress and oxidative stress. Conclusions Maternal hyperglycaemia exhibited deleterious effects on the female reproductive system in the offspring.
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Affiliation(s)
- Zabihollah Khaksar
- Department of Basic Sciences, School of Veterinary Medicine Shiraz University Shiraz Iran
| | - Gholamali Jelodar
- Department of Basic Sciences, School of Veterinary Medicine Shiraz University Shiraz Iran
| | - Hooman Hematian
- Department of Veterinary Sciences, Yasooj Branch Islamic Azad University Yasooj Iran
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Abstract
Diabetes mellitus is responsible for nearly 10% of fetal anomalies in diabetic pregnancies. Although aggressive perinatal care and glycemic control are available in developed countries, the birth defect rate in diabetic pregnancies remains higher than that in the general population. Major cellular activities (ie, proliferation and apoptosis) and intracellular metabolic conditions (ie, nitrosative, oxidative, and endoplasmic reticulum stress) have been shown to be associated with diabetic embryopathy using animal models. Translating advances made in animal studies into clinical applications in humans requires collaborative efforts across the basic research, preclinical, and clinical communities.
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Affiliation(s)
- Zhiyong Zhao
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
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Reece EA, Moore T. The diagnostic criteria for gestational diabetes: to change or not to change? Am J Obstet Gynecol 2013; 208:255-9. [PMID: 23123381 DOI: 10.1016/j.ajog.2012.10.887] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 10/22/2012] [Accepted: 10/26/2012] [Indexed: 01/21/2023]
Abstract
The different screening and diagnostic methods for gestational diabetes mellitus (GDM) currently in clinical use have led the National Institutes of Health Office of Disease Prevention to organize a consensus conference to better understand the potential ramifications of changing the current screening and diagnostic criteria in the United States vs keeping current practices in place. Research has demonstrated that even mild forms of hyperglycemia potentially pose significant adverse health consequences for pregnant women and their children. Thus, it is anticipated that lowering the diagnostic criteria for GDM will significantly reduce morbidity and health care costs in the long term. However, such a change would dramatically increase the number of women identified as having this disease and place a significantly greater burden on an already overburdened primary health care system. Although several cost-benefit analyses suggest that such a change will improve health outcomes for mothers and babies, at least 1 study found that these anticipated public health benefits will not occur unless a higher level of care is devoted to these newly diagnosed patients. There also is a distinct possibility that changing the diagnostic criteria for GDM will increase cesarean delivery rates, which might offset many of the public health gains engendered by diagnosing more women with this condition. The scientific dilemma to change or not to change, thus, requires a rigorous analysis of the scientific, economic, practice, and legal pros and cons to achieve a satisfactory answer.
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Atia HC, Koren Y, Weintraub AY, Novack L, Sheiner E. Is a value of over 200 mg/dL in the oral glucose tolerance test, a marker of severity in patients with gestational diabetes mellitus? J Matern Fetal Neonatal Med 2013; 26:1259-62. [DOI: 10.3109/14767058.2013.777421] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Ovarian histomorphometric changes in adult offspring of diabetic rat mothers. COMPARATIVE CLINICAL PATHOLOGY 2013. [DOI: 10.1007/s00580-011-1392-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Khaksar Z, Jelodar G, Hematian H. Ultra-structural changes in cells from the CNS in offspring from diabetic rats. COMPARATIVE CLINICAL PATHOLOGY 2012. [DOI: 10.1007/s00580-011-1263-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Guermouche B, Yessoufou A, Soulimane N, Merzouk H, Moutairou K, Hichami A, Khan NA. n-3 Fatty Acids Modulate T-Cell Calcium Signaling in Obese Macrosomic Rats. ACTA ACUST UNITED AC 2012; 12:1744-53. [PMID: 15601968 DOI: 10.1038/oby.2004.216] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE We investigated the effects of a diet containing EPAX-7010, rich in PUFAs such as eicosapentaenoic acid [20:5(n-3)] and docosahexaenoic acid [22:6(n-3)], i.e., a PUFA/EPAX regimen, on T-cell activation in diabetic pregnant rats and their obese pups. RESEARCH METHODS AND PROCEDURES Mild hyperglycemia in pregnant rats was induced by intraperitoneal injection of streptozotocin on Day 5 of gestation. T-cell blastogenesis was assayed by using (3)H-thymidine, whereas intracellular free calcium concentrations ([Ca(2+)]i) were measured by using Fura-2 in diabetic pregnant rats and their obese offspring. RESULTS Concavalin-A-stimulated T-cell proliferation was decreased in both pregnant diabetic rats and their obese pups as compared with control animals. Feeding the PUFA/EPAX diet restored T-cell proliferation in both groups of animals. We also employed ionomycin, which at 50 nM opens calcium channels, and thapsigargin (TG), which recruits [Ca(2+)]i from endoplasmic reticulum pool. We observed that ionomycin-induced increases in [Ca(2+)]i in T-cells of diabetic mothers and obese offspring were greater than in those of control rats. Furthermore, feeding PUFA/EPAX diet diminished significantly the ionomycin-evoked rise in [Ca(2+)]i in diabetic and obese animals. TG-induced increases in [Ca(2+)]i in T-cells of diabetic pregnant rats and their obese offspring were greater than in those of control rats. The feeding of the experimental diet significantly curtailed the TG-evoked increases in [Ca(2+)]i in both diabetic and obese rats. DISCUSSION Together, these observations provide evidence that T-cell activation and T-cell calcium signaling are altered during gestational diabetes and macrosomia. Hence, dietary fish oils, particularly eicosapentaenoic acid and docosahexaenoic acid, may restore these T-cell abnormalities.
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Affiliation(s)
- Baya Guermouche
- Départment de Biologie, Faculté des Sciences, Université de Tlemcen, Algeria
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Driggers RW, Baschat A. The 12th meeting of the Diabetes in Pregnancy Study Group of North America (DPSG-NA): introduction and overview. J Matern Fetal Neonatal Med 2011; 25:3-4. [PMID: 21954980 DOI: 10.3109/14767058.2012.626917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The Diabetes in Pregnancy Study Group of North America (DPSG-NA) held its 12th meeting April 1-2, 2011 in Washington DC. The meeting, which was co-hosted by the Washington Hospital Center and the University of Maryland School of Medicine focused on five broad themes: (i) the prevention of diabetes and its risk factors, such as obesity, in pregnancy; (ii) the appropriate use of pharmacotherapies for managing diabetes in pregnancy; (iii) optimal glycemic control; (iv) the value of nutrition, exercise and limiting weight gain during pregnancy and (v) the diagnosis and consequences of diabetic fetopathy. These proceedings reflect peer-reviewed papers of data presented at the meeting. Time also was allocated to discuss the perceived barriers to using the one-step, 75 g oral glucose tolerance test as the first-line approach to diagnosing gestational diabetes mellitus. Responses from a survey of participants on perceived barriers to adopting this method into widespread clinical practice are discussed.
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Shah A, Stotland NE, Cheng YW, Ramos GA, Caughey AB. The association between body mass index and gestational diabetes mellitus varies by race/ethnicity. Am J Perinatol 2011; 28:515-20. [PMID: 21404165 PMCID: PMC3666587 DOI: 10.1055/s-0031-1272968] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
We examined body mass index (BMI) as a screening tool for gestational diabetes (GDM) and its sensitivity among different racial/ethnic groups. In a retrospective cohort study of 24,324 pregnant women at University of California, San Francisco, BMI was explored as a screening tool for GDM and was stratified by race/ethnicity. Sensitivity and specificity were examined using chi-square test and receiver-operator characteristic curves. BMI of ≥25.0 kg/m (2) as a screening threshold identified GDM in >76% of African-Americans, 58% of Latinas, and 46% of Caucasians, but only 25% of Asians ( P < 0.001). Controlling for confounders and comparing to a BMI of ≤25, African-Americans had the greatest increased risk of GDM (adjusted odds ratio [AOR] 5.1, 95% confidence interval [CI]: 3.0 to 8.5), followed by Caucasians (AOR 3.6, 95% CI: 2.7 to 4.8), Latinas (AOR 2.7, 95% CI: 1.9 to 3.8), and Asians (AOR 2.3, 95% CI: 1.8 to 3.0). BMI's screening characteristics to predict GDM varied by race/ethnicity. BMI can be used to counsel regarding the risk of developing GDM, but alone it is not a good screening tool.
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Affiliation(s)
- Amy Shah
- Department of Obstetrics and Gynecology, University of California, Los Angeles
| | - Naomi E. Stotland
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco
| | - Yvonne W. Cheng
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco
| | - Gladys A. Ramos
- Department of Reproductive Medicine, University of California, San Diego
| | - Aaron B. Caughey
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon
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Makni M, Sefi M, Garoui EM, Fetoui H, Boudawara T, Zeghal N. Dietary polyunsaturated fatty acid prevents hyperlipidemia and hepatic oxidant status in pregnant diabetic rats and their macrosomic offspring. J Diabetes Complications 2011; 25:267-74. [PMID: 21458299 DOI: 10.1016/j.jdiacomp.2011.02.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Accepted: 02/15/2011] [Indexed: 02/02/2023]
Abstract
A considerable amount of clinical and experimental evidence now exists and suggests the involvement of fatty acids and free radical-mediated oxidative processes in the pathogenesis of diabetic complications. Fetuses from diabetic mothers are at increased risk of developing neonatal macrosomia and oxidative stress. We investigated the modulation of antioxidant status and liver biochemical parameters in normal and diabetic pregnant rats and their offspring. Animals were randomly allocated into three groups of six rats each: a control group, a diabetic group and diabetic rats fed with flax and sesame seeds mixture group. The time course of changes in lipid metabolism and antioxidant status by dietary rich in ω3- and ω6-polyunsaturated fatty acids in alloxan-induced diabetic pregnant rats and their macrosomic offspring was studied. Glucose and insulin levels were also assessed in order to characterize the diabetic state of dams and their offspring. The diabetic rats presented a significant increase in glycemia, plasma and liver lipid parameters compared with those of control group. In addition, liver malonaldialdehyde levels significantly increased. Antioxidant enzyme activities such as catalase and superoxide dismutase and reduced glutathione levels significantly decreased in the liver of diabetic rats when compared with controls. Diet supplemented with flax and sesame seeds mixture in pregnant diabetic rats ameliorated lipid parameters, antioxidant enzyme activities, level of reduced glutathione and significantly decreased malonaldialdehyde levels. These ameliorations were also observed in pups whose pregnant diabetic mothers were fed seeds mixture. Our results suggested that flax and sesame seeds mixture supplemented to diet of pregnant diabetic rats might be helpful in preventing diabetic complications in adult dams and their offspring.
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Affiliation(s)
- Mohamed Makni
- Animal Physiology Laboratory, Faculty of Sciences, BP1171, 3000 Sfax. University of Sfax, Tunisia
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Betti M, Ceccatelli G, Belcari F, Moscuzza F, Cuttano A, Vuerich M, Boldrini A, Ghirri P. Neonatal outcome in newborns from mothers with endocrinopathies. Gynecol Endocrinol 2011; 27:248-50. [PMID: 20518638 DOI: 10.3109/09513590.2010.487618] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Hypothyroidism and gestational diabetes are common endocrine disorders in pregnancy. Our aim is to evaluate the outcome of newborns from mothers with hypothyroidism and from mothers with gestational diabetes. PATIENTS AND METHODS The study analysed 216 newborns: 112 from mothers with gestational diabetes and 104 from mothers with hypothyroidism. For each case, we included as a control a newborn of same sex and gestational age from a mother without diabetes or thyreopathy. RESULTS In newborns from mothers with gestational diabetes there was an increased frequency of hypoglycaemia and hypocalcaemia, of lower head circumference and of small-for-gestational age (SGA) birth or macrosomy (LGA) than controls. The newborns from mothers with hypothyroidism are more frequently SGA or LGA and they have a slightly increased risk of hypoglycaemia. CONCLUSIONS Newborns from mothers with diabetes mellitus or hypothyroidism have an increased risk of being SGA or LGA, and to develop a mild transient hypoglycaemia. Newborns from mothers with diabetes mellitus have also an increased risk to develop hypocalcaemia and to have a lower head circumference than controls. Thus, to prevent SGA or LGA births, it is very important an early diagnosis and treatment, and a strict metabolic control of these conditions.
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Affiliation(s)
- M Betti
- Division of Neonatology and Neonatal Intensive Care Unit, S. Chiara Hospital, University of Pisa, Pisa, Italy
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Miller MQ, Morris LA. Developmental considerations in working with newborn infants of mothers with diabetes. Neonatal Netw 2011; 30:37-45. [PMID: 21317096 DOI: 10.1891/0730-0832.30.1.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Infants of diabetic mothers (IDMs) are at risk for an altered developmental course beginning with physiologic alterations in utero. This article describes physiologic and behavioral factors that impact the fetus and newborn infant and may have long-term developmental consequences. A clinical reasoning process to support development optimizes the outcomes of IDMs while in the NICU. Specific interventions are suggested.
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Vignoles P, Gire C, Mancini J, Bretelle F, Boubli L, Janky E, Carcopino X. Gestational diabetes: a strong independent risk factor for severe neonatal respiratory failure after 34 weeks. Arch Gynecol Obstet 2010; 284:1099-104. [DOI: 10.1007/s00404-010-1810-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Accepted: 12/06/2010] [Indexed: 11/30/2022]
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Reece EA. The fetal and maternal consequences of gestational diabetes mellitus. J Matern Fetal Neonatal Med 2010; 23:199-203. [PMID: 20121460 DOI: 10.3109/14767050903550659] [Citation(s) in RCA: 201] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Gestational diabetes mellitus (GDM) is a type of diabetes that presents during pregnancy and usually disappears shortly after a woman gives birth. Better recognition of the risk factors of GDM, combined with more universal screening for the disease in many countries, has led to the increased detection of GDM along with other forms of pregestational diabetes. There is growing evidence that GDM significantly increases the risk of a number of short- and long-term adverse consequences for the fetus and mother, the most significant of which is a predisposition to the development of metabolic syndrome and Type 2 diabetes. Maternal and childhood obesity as well as cardiovascular disease are also potential long-term consequences of GDM. On the other hand, there is a growing body of evidence suggesting that the risk of many of these consequences can be significantly reduced or eliminated by aggressive treatment of GDM. There remains, however, a great deal of controversy over when to begin screening for hyperglycemia in pregnancy and at what level of hyperglycemia should aggressive intervention be initiated.
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Affiliation(s)
- E Albert Reece
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland School of Medicine, 655 W. Baltimore Street, Room 14-029, Baltimore, MD 21201-1559, USA.
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Abstract
Gestational diabetes mellitus is a substantial and growing health concern in many parts of the world. Certain populations are especially vulnerable to developing this condition because of genetic, social, and environmental factors. Gestational diabetes has serious, long-term consequences for both baby and mother, including a predisposition to obesity, metabolic syndrome, and diabetes later in life. Early detection and intervention can greatly improve outcomes for women with this condition and their babies. Unfortunately, screening and diagnostic tests are not uniform worldwide, which could lead not only to underdiagnosis but also undermanagement of the illness. Here, we report the controversies surrounding the causes, screening, diagnosis, management, and prevention of gestational diabetes, and give specific recommendations for research studies to address the major issues of this medical condition.
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Affiliation(s)
- E Albert Reece
- University of Maryland School of Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Baltimore, MD 21201-1559, USA.
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Krugner-Higby L, Luck M, Hartley D, Crispen HM, Lubach GR, Coe CL. High-risk pregnancy in rhesus monkeys (Macaca mulatta): a case of ectopic, abdominal pregnancy with birth of a live, term infant, and a case of gestational diabetes complicated by pre-eclampsia. J Med Primatol 2009; 38:252-6. [PMID: 19490364 DOI: 10.1111/j.1600-0684.2009.00349.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cases of abdominal pregnancy, in the form of intra-abdominal mummified fetuses, have been described in nonhuman primates. Gestational diabetes and pre-eclampsia are common pregnancy complications in women. METHODS Two timed-bred rhesus monkeys had high-risk pregnancies, an abdominal pregnancy with delivery of a live term infant, and a case of gestational diabetes that later developed pre-eclampsia. RESULTS The monkey that had abdominal pregnancy later died from septic peritonitis. The monkey had a colonic adenocarcinoma that may have allowed leakage of intestinal contents into the abdomen. Her infant was fostered to another female and survived. The monkey with gestational diabetes and pre-eclampsia was treated with a regimen similar to that used in women, and a live infant was delivered at day 157 of gestation by Caesarian section. CONCLUSION These cases underscore the value of timed-breeding and the similarities between pregnancy complications in women and in nonhuman primates.
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Affiliation(s)
- Lisa Krugner-Higby
- Research Animal Resources Center, University of Wisconsin-Madison, Madison, WI, USA.
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Johns K, Olynik C, Mase R, Kreisman S, Tildesley H. Gestational Diabetes Mellitus Outcome in 394 Patients. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2006; 28:122-7. [PMID: 16643713 DOI: 10.1016/s1701-2163(16)32068-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To determine whether women with gestational diabetes mellitus (GDM) and their offspring have pregnancy outcomes and complications of pregnancy that are different from those in the general obstetric population. METHODS Through medical record coding, we identified women with GDM and a singleton pregnancy with cephalic presentation who delivered at St. Paul's Hospital between January 1, 1995, and December 31, 2001. In total, 394 births were analyzed and their outcomes compared with those of a control group of 100 non-diabetic women with the same gestational age (38 weeks) at delivery. RESULTS Women with gestational diabetes were of lesser parity (P 0.05), appreciably older (P 0.05), and less likely to be Caucasian (P 0.005) than the general obstetric population. Women with GDM also had a higher risk of Caesarean section (P 0.05), gestational hypertension (P 0.05), and large for gestational age (LGA) deliveries (P 0.005). Of women with GDM, those treated with insulin had a higher incidence of LGA deliveries than those on diet therapy alone. The incidence of respiratory distress syndrome and of need for phototherapy was similar in babies whose mothers had GDM and in those whose mothers did not. CONCLUSION Although the rate of complications remains low, GDM creates a predisposition to increased maternal and neonatal complications.
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Affiliation(s)
- Kevin Johns
- Division of Endocrinology, Department of Internal Medicine, St. Paul's Hospital, Vancouver BC
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Soulimane-Mokhtari NA, Guermouche B, Yessoufou A, Saker M, Moutairou K, Hichami A, Merzouk H, Khan NA. Modulation of lipid metabolism by n-3 polyunsaturated fatty acids in gestational diabetic rats and their macrosomic offspring. Clin Sci (Lond) 2005; 109:287-95. [PMID: 15898958 DOI: 10.1042/cs20050028] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The time course of changes in lipid metabolism by dietary n-3 PUFAs (polyunsaturated fatty acids) in streptozotocin-induced diabetic rats during pregnancy (days 12 and 21) and their macrosomic offspring at birth (day 0) and through adulthood (days 60 and 90) was studied with respect to adipose tissue, liver and serum lipid concentrations, and fatty acid composition. Glucose and insulin levels were also assessed in order to characterize the diabetic state of macrosomic offspring. Pregnant diabetic and control rats were fed either an Isio-4 or EPAX diet (enriched with n-3 PUFA). The same diets were also consumed by pups at weaning. Compared with control rats, during pregnancy diabetic rats had a significant elevation in liver and serum triacylglycerol (triglyceride) and cholesterol concentrations. At birth, macrosomic pups had higher serum insulin and glucose levels than control pups. The macrosomic rats maintained accelerated postnatal growth combined with high adipose tissue weight and lipid content through the first 12 weeks of age. The macrosomic pups from diabetic rats fed the Isio-4 diet also showed a significant enhancement in liver and serum triacylglycerol and cholesterol levels at birth and during adulthood. Feeding the EPAX diet to diabetic mothers as well as their macrosomic pups increased serum and liver levels of EPA (eicospentaenoic acid) and DHA (docosahexaenoic acid) with a reduction in arachidonic acid. The EPAX diet induced a significant decrease in liver and serum triacylglycerol and cholesterol concentrations in mothers during pregnancy and in their macrosomic pups during adulthood. Since the EPAX diet improves lipid anomalies considerably in diabetic mothers and their macrosomic offspring, it may prevent long-term metabolic abnormalities associated with macrosomia.
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Claudius I, Fluharty C, Boles R. The Emergency Department Approach to Newborn and Childhood Metabolic Crisis. Emerg Med Clin North Am 2005; 23:843-83, x. [PMID: 15982549 DOI: 10.1016/j.emc.2005.03.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
For most emergency medicine physicians, the phrases "newborn workup" and "metabolic disease" are, at best, uncomfortable. This article, however, provides a simple approach to the recognition,evaluation, and treatment of infants with all manners of metabolic issues, including hypoglycemia, inborn errors of metabolism, jaundice, and electrolyte abnormalities. The disorders are grouped based on symptomatology, and have simple guidelines for work-up and management, with an emergency department practitioner perspective in mind.
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MESH Headings
- Acid-Base Equilibrium
- Adrenal Hyperplasia, Congenital/diagnosis
- Adrenal Hyperplasia, Congenital/metabolism
- Diagnosis, Differential
- Electrolytes/blood
- Emergency Service, Hospital
- Humans
- Hypoglycemia/diagnosis
- Hypoglycemia/drug therapy
- Hypoglycemia/physiopathology
- Infant, Newborn
- Infant, Newborn, Diseases/diagnosis
- Infant, Newborn, Diseases/therapy
- Jaundice, Neonatal/diagnosis
- Jaundice, Neonatal/physiopathology
- Jaundice, Neonatal/therapy
- Metabolism, Inborn Errors/diagnosis
- Metabolism, Inborn Errors/therapy
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Affiliation(s)
- Ilene Claudius
- Department of Emergency and Transport Medicine, Children's Hospital Los Angeles, 4650 Sunset Boulevard, MS113, Los Angeles, CA 90027, USA
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Petersson KH, Pinar H, Stopa EG, Sadowska GB, Hanumara RC, Stonestreet BS. Effects of exogenous glucose on brain ischemia in ovine fetuses. Pediatr Res 2004; 56:621-9. [PMID: 15319457 DOI: 10.1203/01.pdr.0000139415.96985.bf] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We examined the effects of prolonged moderate hyperglycemia with and without an additional rapid glucose injection on ischemic brain injury in the fetus. Twenty-five ewes (117-124 d of gestation) were assigned to one of four groups: 1) glucose-infused fetuses exposed to 30 min of carotid artery occlusion followed by 48 h of reperfusion (I/R-Glu, n = 8); 2) glucose-infused plus rapid glucose injection given 100 min before 30 min of occlusion followed by 48 h of reperfusion (I/R-GluR, n = 4); 3) placebo-infused exposed to 30 min of occlusion and 48 h of reperfusion (I/R-PL, n = 8); and 4) glucose-infused sham occlusion and 48 h of sham reperfusion (control, n = 5). After baseline measurements, fetuses were infused with glucose (9-16 mg/kg/min) for 48 h before and after carotid occlusion or sham treatment. The I/R-PL group received 0.9% NaCl. Brain pathologic outcome was determined. Serial sections stained with Luxol fast blue-hematoxylin and eosin were scored for white matter, cerebral cortical, and hippocampal lesions. These areas received graded pathologic scores of 0 to 5, reflecting the amount of injury, where 0 = 0%, 1 = 1-25%, 2 = 26-50%, 3 = 51-75%, 4 = 76-95%, and 5 = 96-100% of the area damaged. Comparisons of the pathologic scores for cerebral cortex (CC), white matter (WM), and hippocampus (H) demonstrated that the I/R-GluR (CC: 4.56 +/- 0.11, WM: 4.50 +/- 0.11, H: 3.44 +/- 0.48, mean +/- SEM) had more (p < 0.05) damage than the I/R-Glu (CC: 2.46 +/- 0.47, WM: 1.97 +/- 0.37, H: 1.81 +/- 0.36) and control (CC: 1.12 +/- 0.13, WM: 0.82 +/- 0.34, H: 0.80 +/- 0.34) groups. The pathologic scores in the I/R-Glu were (p < 0.05) greater than the control, but not the I/R-PL (CC: 2.12 +/- 0.35, WM: 2.20 +/- 0.44, H: 1.59 +/- 0.41) group. We conclude that exposure to prolonged moderate hyperglycemia before ischemia and during reperfusion does not affect the extent of brain injury, but exposure to an additional acute increase in plasma glucose concentration before ischemia is extremely detrimental to the fetal brain.
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Affiliation(s)
- Katherine H Petersson
- Department of Pediatrics, Brown University Medical School, Providence, Rhode Island 02905, USA
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Boksa P. Animal models of obstetric complications in relation to schizophrenia. ACTA ACUST UNITED AC 2004; 45:1-17. [PMID: 15063096 DOI: 10.1016/j.brainresrev.2004.01.001] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2004] [Indexed: 12/16/2022]
Abstract
Epidemiological studies have provided strong evidence that exposure to obstetric complications is associated with an increased risk for later development of schizophrenia. These human studies have now begun to tease out which specific pregnancy, labor/delivery or neonatal complications might confer greatest risk for schizophrenia. Animal modeling can be a useful tool to directly ask if a particular obstetric complication can actually cause changes in brain function or behavior resembling changes in schizophrenia. This review describes currently available animal models for some of the obstetric complications with greatest effect size for schizophrenia, including maternal diabetes, preeclampsia, infection and stress during pregnancy, intrauterine growth retardation and fetal/neonatal hypoxia. Where available, evidence that these types of obstetric complications in animals produce alterations in CNS function or behavior, related to features of schizophrenic pathology, is presented. Animal models might provide insights into the mechanisms by which specific obstetric complications have long-term influence on brain development leading to increased risk for schizophrenia. Factors common to several obstetric complications associated with schizophrenia may also be discerned. In this way, animal modeling may provide the framework for human studies to ask further more refined questions concerning the role of specific obstetric factors contributing to schizophrenia, and may provide clues to prevention.
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Affiliation(s)
- Patricia Boksa
- Department of Psychiatry, McGill University, Douglas Hospital Research Centre, 6875 LaSalle Boulevard, Montreal, Quebec, Canada H4H 1R3.
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