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Li K, Li X, Morse AN, Fan J, Yang C, Gu C, Liu H. Residual risk associations between initial hyperglycemia and adverse pregnancy outcomes in a large cohort including 6709 women with gestational diabetes. DIABETES & METABOLISM 2022; 48:101320. [PMID: 35026381 DOI: 10.1016/j.diabet.2022.101320] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 12/23/2021] [Accepted: 01/02/2022] [Indexed: 01/21/2023]
Abstract
AIMS . - To estimate the residual risk associations between hyperglycemia and adverse pregnancy outcomes after glycemia-controlling intervention. METHODS . - Among 41,067 Chinese women, those with gestational diabetes mellitus (GDM), according to the IADPSG criteria, received standard interventions to control glycemia. Risk associations of plasma glucose (PG) levels with excess newborn birth weight, primary cesarean section, and preterm delivery were estimated and compared with those in the Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study, where hyperglycemia was left untreated. RESULTS . - A total of 6,709 (16.3%) women developed GDM and thus received predominantly lifestyle interventions. The incidence of excess newborn birth weight, primary cesarean section, and preterm delivery was 6.1%, 19.1%, and 4.0%, respectively. Higher fasting and higher post-load PG levels during 75-g oral glucose tolerance test (OGTT) were statistically significantly associated with increased risks of excess newborn birth weight and pre-term delivery. Compared with the HAPO study, the association of fasting PG level with excess newborn birth weight showed similar strength and dose-response pattern, contrasting with considerably weakened associations for post-load PG levels that involved glycemic control. Contrary risk associations were seen across GDM subtypes compared with non-GDM, isolated fasting GDM was associated with increased, whereas isolated post-load GDM was associated with decreased, risks of excess newborn birth weight and primary cesarean section. Limiting the analysis to non-GDM women and GDM women with low HbA1c (<6.0%) ≥30 days after interventions overall attenuated the risk associations. CONCLUSIONS . - Residual risk associations exist between hyperglycemia and adverse pregnancy outcomes despite seemingly appropriate glycemic control.
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Affiliation(s)
- Kuanrong Li
- Clinical Epidemiology Group, Department of Clinical Research, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
| | - Xiaojun Li
- Clinical Epidemiology Group, Department of Clinical Research, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | | | - Jiaying Fan
- Department of Gynecology and Obstetrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Chuanzi Yang
- Clinical Epidemiology Group, Department of Clinical Research, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Chongjuan Gu
- Department of Gynecology and Obstetrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Huishu Liu
- Department of Gynecology and Obstetrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
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Kaymak O, İskender D, Danışman N. Comparison of one hour versus 90 minute postprandial glucose measurement in women with gestational diabetes; which one is more effective? J OBSTET GYNAECOL 2021; 42:447-451. [PMID: 34159893 DOI: 10.1080/01443615.2021.1920005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In the present study, we aimed to compare postprandial 90 minute measurements and postprandial 1 hour (PP1-HR) measurements for prediction of foetal growth disturbances and pregnancy complications. This was a prospective study conducted in Acıbadem Mehmet Ali Aydınlar University Altunizade Hospital in Department of Perinatology. The study group consisted of patients diagnosed with gestational diabetes. In each antepartum visit, the patients fasting plasma glucose as well as PP1-HR and 90 minute measurements were made. Perinatal and neonatal data were obtained from each patient. The rate of large for gestational age infants was increased in patients when either PP1-HR measurement above 140 mg/dl or postprandial 90 minute measurement above 165 mg/dl compared to patients with normal PP1-HR or postprandial 90 minute measurement. Preterm delivery rate was increased in patients with postprandial 90 minute measurement above 165 mg/dl but not in patients with PP1-HR measurement above 140 mg/dl. The optimal cut-off for postprandial 90 minute measurement was 165 mg/dl based on receiver operating characteristics curve. Our preliminary data show that postprandial 90 minute measurements are superior to PP1-HR measurements in predicting large for gestational age infants.Impact StatementWhat is already known on this subject? Gestational diabetes (GDM) is defined as any degree of glucose intolerance with onset or first recognition in pregnancy. Maternal hyperglycaemia has been linked to metabolic alterations in the foetus and thus brings about foetal macrosomia as well as other pregnancy complications such as preterm delivery and preeclampsia.What the results of this study add? The findings of the present study suggest that postprandial 90 minute predicted more cases of LGA infants than postprandial 1-hour (PP1-HR) measurements. In addition, the rate of preterm deliveries was found to be increased in patients with mean postprandial 90 minute measurements above 165 mg/dl compared to patients with postprandial 90 minute measurements below 165 mg/dl. However, the rate of preterm deliveries was similar in patients with elevated PP1-HR measurements and patients with normal PP1-HR measurements.What the implications are of these findings for clinical practice and/or further research? Our study is the first to investigate the usefulness of postprandial 90 minute in a prospective design. Our preliminary data show that postprandial 90 minute measurements are superior to PP 1 measurements in predicting LGA babies. It also correlates better with preterm deliveries.
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Affiliation(s)
- Oktay Kaymak
- Department of Perinatology, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Dicle İskender
- Department of Hematology, Dr. Abdurrahman Yurtaslan Ankara Oncology Research and Training Hospital, Ankara, Turkey
| | - Nuri Danışman
- Department of Perinatology, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
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Crowther CA, Alsweiler JM, Hughes R, Brown J. Tight or less tight glycaemic targets for women with gestational diabetes mellitus for reducing maternal and perinatal morbidity? (TARGET): study protocol for a stepped wedge randomised trial. BMC Pregnancy Childbirth 2018; 18:425. [PMID: 30373539 PMCID: PMC6206938 DOI: 10.1186/s12884-018-2060-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 10/16/2018] [Indexed: 01/04/2023] Open
Abstract
Background Gestational diabetes mellitus (GDM) is strongly associated with significant adverse maternal and perinatal health outcomes that have lifelong consequences. Treatment for women with GDM aims to normalise maternal blood glucose concentrations to reduce these adverse health risks. Target recommendations for glycaemic control in women with GDM vary amongst international organisations. All their recommendations rely on consensus, as there have been no published randomised trials that compare different intensities of glucose control in women with GDM. The TARGET Trial aims to determine whether tighter targets for glycaemic control in women with GDM compared with less tight targets, reduce maternal and perinatal morbidity without adverse health consequences. Methods/design Using a stepped wedge, cluster randomised trial the 10 participating hospitals will be randomised to the timing of the change from the less tight to the tighter glycaemic target period. During the less tight target period, all health professionals at the hospital will aim to use the less tight glycaemic targets for treatment of women with GDM (fasting plasma glucose < 5.5 mmol/L; 1 h postprandial < 8.0 mmol/L; 2 h postprandial < 7.0 mmol/L). During the tighter target period all health professionals at the hospital will aim to use the tighter glycaemic targets for treatment of women with GDM (fasting plasma glucose ≤5.0 mmol/L, 1 h postprandial ≤7.4 mmol/L; 2 h postprandial ≤6.7 mmol/L). The primary study outcome is large for gestational age infant (birth weight > 90th centile). A sample size of 1080 participants will detect a treatment difference of 6% in the proportion of large for gestational age babies from 13% with less tight glycaemic targets to 7% with tighter targets, assuming an intra-cluster correlation coefficient of 0.05. Discussion The TARGET Trial will provide high-level evidence of direct relevance for clinical practice. If tighter treatment targets for women with GDM clearly result in significantly fewer large for gestational age infants and less adverse maternal and perinatal outcomes then they should be recommended for women with GDM. This would be of great importance to these women, their children, health services and communities. Trial registration Australian New Zealand Clinical Trials Registry - ACTRN 12615000282583.
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Affiliation(s)
- Caroline A Crowther
- Liggins Institute, The University of Auckland, Building 503, Level 2, 85 Park Road, Private Bag 92019, Auckland, 1142, New Zealand.
| | - Jane M Alsweiler
- Newborn Services, Auckland City Hospital, Auckland, New Zealand.,Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Ruth Hughes
- Department of Obstetrics and Gynaecology, Christchurch Women's Hospital, University of Otago, Christchurch, New Zealand
| | - Julie Brown
- Liggins Institute, The University of Auckland, Building 503, Level 2, 85 Park Road, Private Bag 92019, Auckland, 1142, New Zealand
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Yeh T, Yeung M, Mendelsohn Curanaj FA. Inpatient Glycemic Management of the Pregnant Patient. Curr Diab Rep 2018; 18:73. [PMID: 30112679 DOI: 10.1007/s11892-018-1045-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE OF REVIEW There is a rising prevalence of type 1 diabetes (T1DM), type 2 diabetes (T2DM), and gestational diabetes (GDM) in pregnancy. Reaching and maintaining glycemic targets during and after this time are important for both the health of the mother and her baby. RECENT FINDINGS Based on recently published guidelines from various societies, we review the diagnosis of diabetes in pregnancy, types of therapies available to maintain euglycemia, important keys to management of T1DM, T2DM, and GDM, and strategies for reaching inpatient glycemic targets during the peripartum period. Care for pregnant patients with T1DM is especially challenging, and providers should be aware of the varying insulin requirements at different stages of pregnancy and how to reduce hypoglycemia and avoid diabetic ketoacidosis. Insulin sensitivity fluctuates throughout pregnancy due to physiologic changes, especially during labor and delivery and immediately post-partum. We review recommendations regarding how to manage this dynamic time and present our own institution's inpatient management protocol. Finally, we review management of diabetes post-partum, including medications, breast-feeding, and continued monitoring and screening. With the collaborative efforts of the patient and an interdisciplinary team and in-depth knowledge of the most up-to-date management principles, it is possible to achieve euglycemia during this critical time of a mother and baby's life.
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Affiliation(s)
- Tiffany Yeh
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Weill Cornell Medicine/New York-Presbyterian Hospital, 525 East 68th St, Baker 2023, New York, NY, 10065, USA
| | - Michele Yeung
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Weill Cornell Medicine/New York-Presbyterian Hospital, 525 East 68th St, Baker 2023, New York, NY, 10065, USA
| | - Felicia A Mendelsohn Curanaj
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Weill Cornell Medicine/New York-Presbyterian Hospital, 525 East 68th St, Baker 2023, New York, NY, 10065, USA.
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Dupont FO, Hivert MF, Allard C, Ménard J, Perron P, Bouchard L, Robitaille J, Pasquier JC, Auray-Blais C, Ardilouze JL. Glycation of fetal hemoglobin reflects hyperglycemia exposure in utero. Diabetes Care 2014; 37:2830-3. [PMID: 25011951 DOI: 10.2337/dc14-0549] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The lifetime risk of metabolic diseases in offspring of women with gestational diabetes mellitus (GDM) depends, at least in part, on the impact of glycemic fetal programming. To quantify this impact, we have developed and validated a unique mass spectrometry method to measure the percentage of glycated hemoglobin in cord blood. RESEARCH DESIGN AND METHODS This case-control study includes 37 GDM women and 30 pregnant women with normal glucose tolerance (NGT). RESULTS Glycation of the α-chain (Glα) was higher in neonates from GDM (2.32 vs. 2.20%, P < 0.01). Glα strongly correlated with maternal A1C measured at delivery in the overall cohort (r = 0.67, P < 0.0001) as well as in each group (GDM: r = 0.66, P < 0.0001; NGT: r = 0.50, P = 0.01). CONCLUSIONS Thus, Glα may reflect hyperglycemic exposure during the last weeks of fetal development. Future studies will confirm Glα is a predictive biomarker of prenatally programmed lifetime metabolic health and disease.
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Affiliation(s)
- Felix O Dupont
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Marie-France Hivert
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada Endocrine Division, Université de Sherbrooke, Sherbrooke, QC, Canada Harvard Pilgrim Health Care Institute, Department of Population Medicine, Harvard Medical School, Boston, MA
| | - Catherine Allard
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Julie Ménard
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Patrice Perron
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada Endocrine Division, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Luigi Bouchard
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada Department of Biochemistry, Université de Sherbrooke, Sherbrooke, QC, Canada ECOGENE-21 and Lipid Clinic, Chicoutimi Hospital, Saguenay, QC, Canada
| | - Julie Robitaille
- Department of Food Science and Nutrition, Laval University, Quebec, QC, Canada
| | - Jean-Charles Pasquier
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada Department of Gynaecology-Obstetrics, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Christiane Auray-Blais
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada Department of Pediatrics, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Jean-Luc Ardilouze
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada Endocrine Division, Université de Sherbrooke, Sherbrooke, QC, Canada
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Abstract
Insulin therapy is essential for optimal glycemic control during pregnancy in women with type 1 diabetes and is frequently required to optimize control in women with type 2 diabetes. Less commonly, women with gestational diabetes mellitus (GDM) require insulin for glycemic control. However, because of its greater prevalence, GDM is the most common reason for insulin use in pregnancy. The most frequently used insulin regimen in pregnancy is a basal/bolus combination of long- and short-acting insulin preparations. There is no evidence base to support one treatment regimen over another. Therapy should be individualized and based on local expertise.
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Affiliation(s)
- Aidan McElduff
- Discipline of Medicine, Sydney University, Sydney, NSW, Australia.
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