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Bashir M, Fagier Y, Ahmed B, C Konje J. An overview of diabetes mellitus in pregnant women with obesity. Best Pract Res Clin Obstet Gynaecol 2024; 93:102469. [PMID: 38359580 DOI: 10.1016/j.bpobgyn.2024.102469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/02/2024] [Accepted: 02/05/2024] [Indexed: 02/17/2024]
Abstract
Rates of obesity are increasing world-wide with an estimated 1billion people projected to be obese by 2030 if current trends remain unchanged. Obesity currently considered one of the most significant associated factors of non-communicable diseases poses the greatest threat to health. Diabetes mellitus is an important metabolic disorder closely associated with obesity. It is therefore expected that with the increasing rates of obesity, the rates of diabetes in pregnancy will also be rising. This disorder may pre-date pregnancy (diagnosed or undiagnosed and diagnosed for the first time in pregnancy) or may be of onset in pregnancy. Irrespective of the timing of onset, diabetes in pregnancy is associated with both fetal and maternal complications. Outcomes are much better if control is maximised. Early diagnosis, multidisciplinary care and tailored management with optimum glycaemic control is associated with a significant reduction in not only pregnancy complications but long-term consequences on both the mother and offspring. This review brings together the current understanding of the pathogenesis of the endocrine derangements that are associated with diabetes in pregnancy how screening should be offered and management including pre-pregnancy care and the role of newer agents in management.
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Affiliation(s)
- Mohammed Bashir
- Qatar Metabolic Institute, Hamad Medical Corporation, Doha, Qatar; Endocrinology, Weill Cornell Medicine, Doha, Qatar.
| | - Yassin Fagier
- Women's Clinical Management Group, Sidra Medicine, Doha, Qatar
| | - Badreldeen Ahmed
- Feto Maternal Centre, Al Markhiya Street, Doha, Qatar; Obstetrics and Gynaecology, Weill Cornell Medicine, Doha, Qatar; Obstetrics and Gynaecology, Qatar University, Doha, Qatar
| | - Justin C Konje
- Feto Maternal Centre, Al Markhiya Street, Doha, Qatar; Obstetrics and Gynaecology, Weill Cornell Medicine, Doha, Qatar; Obstetrics and Gynaecology, University of Leicester, UK
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Ćwiek D, Malinowski W, Ogonowski J, Zimny M, Szymoniak K, Czechowska K, Dawid W, Sipak-Szmigiel O, Iwanowicz-Palus G. The Effects of Breastfeeding and Gestational Diabetes Mellitus on Body Mass Composition and the Levels of Selected Hormones after Childbirth. Nutrients 2023; 15:4828. [PMID: 38004222 PMCID: PMC10675250 DOI: 10.3390/nu15224828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/14/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023] Open
Abstract
Breastfeeding may have a positive effect on glucose metabolism and insulin sensitivity, which may reduce the risk of developing diabetes following gestational diabetes mellitus (GDM). This study aimed to evaluate the effect of breastfeeding and GDM on the body mass composition of the studied women, the levels of leptin, ghrelin, adiponectin, resistin, and insulin, and weight loss during the 6-8-week postpartum period and 1 year after childbirth. MATERIALS AND METHODS The study group included 42 women with a singleton pregnancy, diagnosed with GDM between the 24th and 28th week of gestation. The control group consisted of 28 non-diabetic women with a singleton pregnancy. This study was carried out at 6-8 weeks as well as at 1 year postpartum. The women were subjected to body weight measurements and body composition analysis performed using a professional body composition analyzer TANITA DC-430 S MA. Waist circumference and subcutaneous fat was measured. Blood for laboratory tests was taken in the morning, on an empty stomach. RESULTS It was shown that, regardless of diabetes, exclusive breastfeeding had a significant impact on weight loss at 6-8 weeks postpartum (p = 0.014785) and lower insulin levels (p = 0.047). However, there was no effect of breastfeeding on the women's anthropometric measurements or hormone levels one year after delivery, except for the thickness of subcutaneous adipose tissue, which was significantly lower in breastfeeding women (p = 0.03). One year after delivery, breastfeeding women had a lower BMI (p = 0.0014), less-thick subcutaneous adipose tissue (p < 0.001), and a lower risk of obesity (p = 0.016). There were also higher insulin and ghrelin levels in both breastfeeding and non-breastfeeding women (p < 0.001), and lower resistin levels in non-breastfeeding women (p = 0.004). Women who had diabetes during pregnancy had a significantly reduced waist circumference and subcutaneous fat thickness after one year (p < 0.001 and p = 0.05, respectively). CONCLUSIONS Having diabetes during pregnancy did not significantly affect the results of anthropometric measurements and hormone levels noted at 6-8 weeks after delivery (the only exception was the thickness of subcutaneous fat tissue, which was greater in women without GDM). This may indicate normalization of carbohydrate metabolism after childbirth; however, the observation period is too short to elucidate long-term metabolic effects. This suggests the need for further research related to GDM and breastfeeding.
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Affiliation(s)
- Dorota Ćwiek
- Department of Obstetrics and Pathology of Pregnancy, Pomeranian Medical University in Szczecin, 71-210 Szczecin, Poland; (D.Ć.); (K.S.); (K.C.); (W.D.); (O.S.-S.)
| | - Witold Malinowski
- Faculty of Health Sciences in Płock, Masovian Public University, 09-402 Płock, Poland;
| | - Jarosław Ogonowski
- Diabetes Clinic—Independent Public Provincial Integrated Hospital in Szczecin, 71-455 Szczecin, Poland;
| | - Małgorzata Zimny
- Department of Obstetrics and Pathology of Pregnancy, Pomeranian Medical University in Szczecin, 71-210 Szczecin, Poland; (D.Ć.); (K.S.); (K.C.); (W.D.); (O.S.-S.)
| | - Katarzyna Szymoniak
- Department of Obstetrics and Pathology of Pregnancy, Pomeranian Medical University in Szczecin, 71-210 Szczecin, Poland; (D.Ć.); (K.S.); (K.C.); (W.D.); (O.S.-S.)
| | - Krystyna Czechowska
- Department of Obstetrics and Pathology of Pregnancy, Pomeranian Medical University in Szczecin, 71-210 Szczecin, Poland; (D.Ć.); (K.S.); (K.C.); (W.D.); (O.S.-S.)
| | - Weronika Dawid
- Department of Obstetrics and Pathology of Pregnancy, Pomeranian Medical University in Szczecin, 71-210 Szczecin, Poland; (D.Ć.); (K.S.); (K.C.); (W.D.); (O.S.-S.)
| | - Olimpia Sipak-Szmigiel
- Department of Obstetrics and Pathology of Pregnancy, Pomeranian Medical University in Szczecin, 71-210 Szczecin, Poland; (D.Ć.); (K.S.); (K.C.); (W.D.); (O.S.-S.)
| | - Grażyna Iwanowicz-Palus
- Department of Specialist Care in Obstetric, Chair of Obstetrics Development of Obstetrics Development, Faculty of Health Sciences, Medical University of Lublin, 20-081 Lublin, Poland;
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Belsti Y, Moran L, Handiso DW, Versace V, Goldstein R, Mousa A, Teede H, Enticott J. Models Predicting Postpartum Glucose Intolerance Among Women with a History of Gestational Diabetes Mellitus: a Systematic Review. Curr Diab Rep 2023; 23:231-243. [PMID: 37294513 PMCID: PMC10435618 DOI: 10.1007/s11892-023-01516-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/22/2023] [Indexed: 06/10/2023]
Abstract
PURPOSE OF REVIEW Despite the crucial role that prediction models play in guiding early risk stratification and timely intervention to prevent type 2 diabetes after gestational diabetes mellitus (GDM), their use is not widespread in clinical practice. The purpose of this review is to examine the methodological characteristics and quality of existing prognostic models predicting postpartum glucose intolerance following GDM. RECENT FINDINGS A systematic review was conducted on relevant risk prediction models, resulting in 15 eligible publications from research groups in various countries. Our review found that traditional statistical models were more common than machine learning models, and only two were assessed to have a low risk of bias. Seven were internally validated, but none were externally validated. Model discrimination and calibration were done in 13 and four studies, respectively. Various predictors were identified, including body mass index, fasting glucose concentration during pregnancy, maternal age, family history of diabetes, biochemical variables, oral glucose tolerance test, use of insulin in pregnancy, postnatal fasting glucose level, genetic risk factors, hemoglobin A1c, and weight. The existing prognostic models for glucose intolerance following GDM have various methodological shortcomings, with only a few models being assessed to have low risk of bias and validated internally. Future research should prioritize the development of robust, high-quality risk prediction models that follow appropriate guidelines, in order to advance this area and improve early risk stratification and intervention for glucose intolerance and type 2 diabetes among women who have had GDM.
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Affiliation(s)
- Yitayeh Belsti
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Lisa Moran
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Demelash Woldeyohannes Handiso
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Vincent Versace
- Deakin Rural Health, School of Medicine, Deakin University, Warrnambool, Australia
| | - Rebecca Goldstein
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
- Monash Health, Clayton, Melbourne, Australia
| | - Aya Mousa
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Helena Teede
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
- Monash Health, Clayton, Melbourne, Australia
| | - Joanne Enticott
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
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4
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Ikoh Rph CL, Tang Tinong R. The Incidence and Management of Type 2 Diabetes Mellitus After Gestational Diabetes Mellitus. Cureus 2023; 15:e44468. [PMID: 37664380 PMCID: PMC10471197 DOI: 10.7759/cureus.44468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2023] [Indexed: 09/05/2023] Open
Abstract
Gestational diabetes mellitus (GDM) refers to a transient state of impaired glucose tolerance that develops during pregnancy, affecting a significant proportion of expectant mothers globally. This review aimed to comprehensively examine the subsequent incidence and management of type 2 diabetes mellitus (T2DM) in women who have previously experienced GDM. The transition from GDM to T2DM is a well-recognized continuum, with affected women facing an increased risk of developing T2DM postpartum. Several studies have demonstrated that women with a history of GDM face a substantially higher risk of developing T2DM compared to normoglycemic pregnant women. The long-term consequences of developing T2DM following GDM are significant, as it not only affects the health of the mother but also poses risks to the offspring. The most common risk factors associated with the progression of GDM to T2DM include pregnancy at an advanced age, insulin treatment during pregnancy, and delivering an overweight baby. As GDM women are at higher risk of developing T2DM, effective management strategies such as lifestyle changes, postpartum care, breastfeeding, screening tests, and gaining awareness of risk are crucial to mitigate the risk of T2DM in this population. The current review was conducted to guide healthcare providers and women with a history of GDM about the potential risks of T2DM and management strategies to prevent the condition. This review provides a summary of evidence on the incidence rate of T2DM in GDM patients, its associated risk factors, and approaches to mitigate this challenge.
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Affiliation(s)
- Chinyere L Ikoh Rph
- Endocrinology, Diabetes and Metabolism, John F. Kennedy University of Medicine Curacao, Willemstad, CUW
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Battarbee AN, Mele L, Landon MB, Varner MW, Casey BM, Reddy UM, Wapner RJ, Rouse DJ, Thorp JM, Chien EK, Saade G, Plunkett BA, Blackwell SC. Long-Term Maternal Metabolic and Cardiovascular Phenotypes after a Pregnancy Complicated by Mild Gestational Diabetes Mellitus or Obesity. Am J Perinatol 2023; 40:589-597. [PMID: 36323337 PMCID: PMC10073247 DOI: 10.1055/a-1970-7892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the association of mild gestational diabetes mellitus (GDM) and obesity with metabolic and cardiovascular markers 5 to 10 years after pregnancy. STUDY DESIGN This was a secondary analysis of 5- to 10-year follow-up study of a mild GDM treatment trial and concurrent observational cohort of participants ineligible for the trial with abnormal 1-hour glucose challenge test only. Participants with 2-hour glucose tolerance test at follow-up were included. The primary exposures were mild GDM and obesity. The outcomes were insulinogenic index (IGI), 1/homeostatic model assessment of insulin resistance (HOMA-IR), and cardiovascular markers vascular endothelial growth factor, (VEGF), vascular cell adhesion molecule 1 (VCAM-1), cluster of differentiation 40 ligand (CD40L), growth differentiation factor 15 (GDF-15), and suppression of tumorgenesis 2 (ST-2). Multivariable linear regression estimated the association of GDM and obesity with biomarkers. RESULTS Of 951 participants in the parent study, 642 (68%) were included. Lower 1/HOMA-IR were observed in treated and untreated GDM groups, compared with non-GDM (mean differences, -0.24 and -0.15; 95% confidence intervals [CIs], -0.36 to -0.12 and -0.28 to -0.03, respectively). Lower VCAM-1 (angiogenesis) was observed in treated GDM group (mean difference, -0.11; 95% CI, -0.19 to -0.03). GDM was not associated with IGI or other biomarkers. Obesity was associated with lower 1/HOMA-IR (mean difference, -0.42; 95% CI, -0.52 to -0.32), but not other biomarkers. CONCLUSION Prior GDM and obesity are associated with more insulin resistance but not insulin secretion or consistent cardiovascular dysfunction 5 to 10 years after delivery. KEY POINTS · Mild GDM increases the risk of insulin resistance 5 to 10 years postpartum but not pancreatic dysfunction.. · Obesity increases the risk of insulin resistance 5 to 10 years postpartum but not pancreatic dysfunction.. · Neither mild GDM nor obesity increased the risk of cardiovascular dysfunction 5 to 10 years postpartum..
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Affiliation(s)
- Ashley N Battarbee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Lisa Mele
- George Washington University Biostatistics Center, Washington, District of Columbia
| | - Mark B Landon
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio
| | - Michael W Varner
- Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Brian M Casey
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Uma M Reddy
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Ronald J Wapner
- Department of Obstetrics and Gynecology, Columbia University, New York, New York
| | - Dwight J Rouse
- Department of Obstetrics and Gynecology, Brown University, Providence, Rhode Island
| | - John M Thorp
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Edward K Chien
- Department of Obstetrics and Gynecology, Case Western Reserve University-MetroHealth Medical Center, Cleveland, Ohio
| | - George Saade
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas
| | - Beth A Plunkett
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
| | - Sean C Blackwell
- Department of Obstetrics and Gynecology, University of Texas Health Science Center at Houston-Children's Memorial Hermann Hospital, Houston, Texas
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Saxon CE, Seely EW, Bertin KB, Suresh K, Skurnik G, Roche AT, Schultz C, Blair RA, Nicklas JM. Self-Efficacy and Readiness to Change Among Women with Recent Gestational Diabetes Engaging in a Web-Based Lifestyle Intervention: The Balance After Baby Intervention Trial. Am J Lifestyle Med 2023. [DOI: 10.1177/15598276231155147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Few evidence-based programs exist to help women with a history of gestational diabetes reduce their risk of developing type 2 diabetes. In secondary analyses from a randomized clinical trial of a web-based lifestyle intervention program for postpartum women with recent gestational diabetes, we studied changes in self-efficacy for diet and physical activity and readiness to change health behaviors. Women were randomized at ∼6 weeks postpartum and completed questionnaires at 6 weeks and 6, 12, 18, and 24 months. Our study included 181 women (mean age 32.4 ± 5.2 years; 48% White, 19% Asian, 14% Black or African American, 17% other/mixed race; 34% Hispanic). In a linear mixed effects model, women in the intervention had significantly greater improvement in overall self-efficacy scores for physical activity compared with the control group at 24 months (difference in change scores between groups .35, 95% CI: .03 to .67, P = .03). The intervention group also demonstrated significantly greater improvement in self-efficacy scores for both physical activity subdomains, specifically “sticking to it” at 24 months and “making time” at 12 months. Participants in the intervention did not experience a significant difference in change in self-efficacy for diet or readiness to change compared with those in the control arm.
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Affiliation(s)
- Cara E. Saxon
- Department of Medicine, University of Colorado, Aurora, CO, USA (CS); Department of Medicine, Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA (ES, GS, AR); ACCORDS (Adult and Child Center for Outcomes Research and Delivery Science), University of Colorado School of Medicine, Aurora, CO, USA (KB); Department of Biostatistics and Informatics, University of Colorado School of Medicine, Aurora, CO, USA (KS); Department of Obstetrics
| | - Ellen W. Seely
- Department of Medicine, University of Colorado, Aurora, CO, USA (CS); Department of Medicine, Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA (ES, GS, AR); ACCORDS (Adult and Child Center for Outcomes Research and Delivery Science), University of Colorado School of Medicine, Aurora, CO, USA (KB); Department of Biostatistics and Informatics, University of Colorado School of Medicine, Aurora, CO, USA (KS); Department of Obstetrics
| | - Kaitlyn B. Bertin
- Department of Medicine, University of Colorado, Aurora, CO, USA (CS); Department of Medicine, Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA (ES, GS, AR); ACCORDS (Adult and Child Center for Outcomes Research and Delivery Science), University of Colorado School of Medicine, Aurora, CO, USA (KB); Department of Biostatistics and Informatics, University of Colorado School of Medicine, Aurora, CO, USA (KS); Department of Obstetrics
| | - Krithika Suresh
- Department of Medicine, University of Colorado, Aurora, CO, USA (CS); Department of Medicine, Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA (ES, GS, AR); ACCORDS (Adult and Child Center for Outcomes Research and Delivery Science), University of Colorado School of Medicine, Aurora, CO, USA (KB); Department of Biostatistics and Informatics, University of Colorado School of Medicine, Aurora, CO, USA (KS); Department of Obstetrics
| | - Geraldine Skurnik
- Department of Medicine, University of Colorado, Aurora, CO, USA (CS); Department of Medicine, Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA (ES, GS, AR); ACCORDS (Adult and Child Center for Outcomes Research and Delivery Science), University of Colorado School of Medicine, Aurora, CO, USA (KB); Department of Biostatistics and Informatics, University of Colorado School of Medicine, Aurora, CO, USA (KS); Department of Obstetrics
| | - Andrea T. Roche
- Department of Medicine, University of Colorado, Aurora, CO, USA (CS); Department of Medicine, Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA (ES, GS, AR); ACCORDS (Adult and Child Center for Outcomes Research and Delivery Science), University of Colorado School of Medicine, Aurora, CO, USA (KB); Department of Biostatistics and Informatics, University of Colorado School of Medicine, Aurora, CO, USA (KS); Department of Obstetrics
| | - Claire Schultz
- Department of Medicine, University of Colorado, Aurora, CO, USA (CS); Department of Medicine, Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA (ES, GS, AR); ACCORDS (Adult and Child Center for Outcomes Research and Delivery Science), University of Colorado School of Medicine, Aurora, CO, USA (KB); Department of Biostatistics and Informatics, University of Colorado School of Medicine, Aurora, CO, USA (KS); Department of Obstetrics
| | - Rachel A. Blair
- Department of Medicine, University of Colorado, Aurora, CO, USA (CS); Department of Medicine, Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA (ES, GS, AR); ACCORDS (Adult and Child Center for Outcomes Research and Delivery Science), University of Colorado School of Medicine, Aurora, CO, USA (KB); Department of Biostatistics and Informatics, University of Colorado School of Medicine, Aurora, CO, USA (KS); Department of Obstetrics
| | - Jacinda M. Nicklas
- Department of Medicine, University of Colorado, Aurora, CO, USA (CS); Department of Medicine, Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA (ES, GS, AR); ACCORDS (Adult and Child Center for Outcomes Research and Delivery Science), University of Colorado School of Medicine, Aurora, CO, USA (KB); Department of Biostatistics and Informatics, University of Colorado School of Medicine, Aurora, CO, USA (KS); Department of Obstetrics
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Doi SAR, Bashir M, Sheehan MT, Onitilo AA, Chivese T, Ibrahim IM, Beer SF, Furuya-Kanamori L, Abou-Samra AB, McIntyre HD. Unifying the diagnosis of gestational diabetes mellitus: Introducing the NPRP criteria. Prim Care Diabetes 2022; 16:96-101. [PMID: 34419366 DOI: 10.1016/j.pcd.2021.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/08/2021] [Accepted: 08/09/2021] [Indexed: 11/23/2022]
Abstract
AIMS Disagreement about the appropriate criteria for the diagnosis of gestational diabetes mellitus (GDM) persists. This study examines an alternative approach which combines information from all time-points on the glucose tolerance test (GTT) into a single index and expands the GDM spectrum into four categories using data from three geographically and ethnically distinct populations. METHODS A retrospective observational study design was used. Data from Wisconsin, USA (723 women) was used in derivation of the criterion and data from Doha, Qatar (1284 women) and Cape Town, South Africa (220 women) for confirmation. Pregnant women without pre-existing diabetes with a GTT done between 23 and 30 weeks gestation were included. A novel index was derived from the GTT termed the weighted average glucose (wAG). This was categorized into four pre-defined groups (henceforth National Priorities Research Program (NPRP) criterion); i) normal gestational glycemia (NGG), ii) impaired gestational glycemia (IGG), iii) GDM and iv) high risk GDM (hGDM). RESULTS In the Doha cohort, compared to the NGG group, the odds of large for gestational age babies increased 1.33 fold (P = 0.432), 2.86 fold (P < 0.001) and 3.35 fold (P < 0.001) in the IGG, GDM and hGDM groups respectively. The odds of pregnancy induced hypertension increased 2.10 fold (P = 0.024) in GDM & hGDM groups compared to the IGG and NGG groups. In the Cape Town cohort, a third of women in the GDM group and two-thirds in the hGDM group progressed to T2DM at 5 years. CONCLUSIONS The NPRP categorization identifies four distinct risk clusters of glycemia in pregnancy which may aid better decision making in routine management, avoid potential over-diagnosis of women at lower risk of complications and assist with diabetes prevention in women at high-risk after an index pregnancy with GDM.
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Affiliation(s)
- Suhail A R Doi
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar.
| | - Mohammed Bashir
- Division of Endocrinology and Qatar Metabolic Institute, Hamad Medical Corporation, Doha, Qatar.
| | - Michael T Sheehan
- Department of Endocrinology, Marshfield Clinic Health System -Weston Center, Weston, WI, USA
| | | | - Tawanda Chivese
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Ibrahim M Ibrahim
- Endocrinology and Diabetes Services Division, Sidra Medicine, Qatar Foundation, Doha, Qatar
| | - Stephen F Beer
- Division of Endocrinology and Qatar Metabolic Institute, Hamad Medical Corporation, Doha, Qatar
| | - Luis Furuya-Kanamori
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Australia
| | - Abdul-Badi Abou-Samra
- Division of Endocrinology and Qatar Metabolic Institute, Hamad Medical Corporation, Doha, Qatar
| | - H David McIntyre
- Mater Research and The University of Queensland, Brisbane, Queensland, Australia
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8
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Wang X, Zheng X, Yan J, Xu R, Xu M, Zheng L, Xu L, Lin Z. The Clinical Values of Afamin, Triglyceride and PLR in Predicting Risk of Gestational Diabetes During Early Pregnancy. Front Endocrinol (Lausanne) 2021; 12:723650. [PMID: 34803906 PMCID: PMC8597949 DOI: 10.3389/fendo.2021.723650] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 10/18/2021] [Indexed: 01/05/2023] Open
Abstract
Objective To establish a model to predict gestational diabetes mellitus (GDM) based on the clinical characteristics, early pregnancy (10-12 weeks gestation) peripheral blood routine, and biochemical indicators, and to explore its predictive efficiencies. Methods Data from 607 pregnant women with GDM were compared to the data from 833 pregnant women without GDM admitted to the Obstetrics Department of Fujian Maternity and Child Health Hospital (affiliated to Fujian Medical University) from May 2018 to December 2018 were retrospectively included. The ages of the pregnant women, paternal ages, number of pregnancies, number of deliveries, pre-pregnancy heights/weights, and the calculated body mass indexes (BMI) were recorded. In all participants, 10-12 weeks of pregnancy, afamin concentration, routine blood work, prenatal aneuploidy screening, and biochemical testing were performed. At weeks 24-28 of gestation, patients underwent oral glucose tolerance test (OGTT) for GDM screening. Results Multivariate logistic regression analysis showed that maternal age, early pregnancy afamin level, triglycerides, and platelet/lymphocyte ratio (PLR) were independent risk factors for gestational diabetes. The formula for predicting GDM probability was as follows: P = 1/1 + exp( - 6.054 + 0.774 × triglycerides + 0.002 × afamin + 0.155 × age - 0.012 × PLR)]. From the established ROC curve, the area under the curve (AUC) was 0.748, indicating that the model has a good degree of discrimination. When the predictive probability cut-off value was set on 0.358, sensitivity, specificity, positive predictive value, and negative predictive value were 69.2%, 68.3%, 42.5%, and 86.2%, respectively, and the accuracy rate was 70.2%. The Hosmer-Lemeshow test results showed that the goodness of the model fit has a good calibration ability (χ2 = 12.269, df=8, P=0.140). Conclusions Maternal age, early pregnancy afamin level, triglycerides, and PLR are independent risk factors for gestational diabetes. When combined, the above indicators are helpful for prediction, early diagnosis, and intervention of gestational diabetes.
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Affiliation(s)
- Xuechun Wang
- Department of Obstetrics, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Xiuqiong Zheng
- Department of Obstetrics, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Jianying Yan
- Department of Obstetrics, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Rongli Xu
- Department of Obstetrics, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Mu Xu
- Department of Obstetrics, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Lin Zheng
- Fujian Key Laboratory for Prenatal Diagnosis and Birth Defect, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Liangpu Xu
- Fujian Key Laboratory for Prenatal Diagnosis and Birth Defect, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Zhi Lin
- Department of Obstetrics, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
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Nabi T, Rafiq N, Trigotra S, Mishra S. Clinical Characteristics, Outcomes, and Progression to Type 2 Diabetes in Women with Hyperglycemia in Pregnancy. Indian J Endocrinol Metab 2021; 25:538-544. [PMID: 35355915 PMCID: PMC8959204 DOI: 10.4103/ijem.ijem_440_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/22/2021] [Accepted: 12/10/2021] [Indexed: 11/26/2022] Open
Abstract
CONTEXT Women with hyperglycemia in pregnancy (HIP) are at increased risk of developing type 2 diabetes (T2D). AIM The present study intended to study the incidence of postpartum diabetes among HIP women and predict its risk factors. SETTINGS AND DESIGN This was a prospective observational study done on 178 women with HIP diagnosed after the first trimester, attending the tertiary care hospitals between December 2018 and March 2020. MATERIALS AND METHODS Demographics, clinical variables, and feto-maternal outcomes were recorded. The postpartum glycemic status was determined using a 75 g oral glucose tolerance test (OGTT) at 1 and 6 months. STATISTICAL ANALYSIS All analyses were performed with SPSS software (version 21.0). RESULTS The mean age of women with HIP was 30.2 ± 6.1 years, with 38% having a family history of diabetes. Eighty percent of the women delivered full-term babies and 71.3% underwent a cesarean section. Gestational hypertension was present in 21.9% of patients. Macrosomia was present in 4.6% of the babies, hypoglycemia in 6.7%, and spontaneous abortion occurred in 7.7%. Postpartum OGTT at 6 months was completed by 76.4% of participants. The incidence of diabetes and glucose intolerance postpartum was 11.7 and 16.2%, respectively at 6 months. Logistic regression analysis showed that maternal obesity, diagnosis of HIP at an earlier trimester (<24 weeks), need for insulin treatment during pregnancy, signs of insulin resistance and fasting and 2-h plasma glucose >100 (>5.6 mmol/L) and >195 mg/dL (>10.9 mmol/L), respectively, and glycated hemoglobin > 6.5% (>48 mmol/mol) increased the risk of having postpartum diabetes significantly. CONCLUSION The incidence of postpartum glucose intolerance in women with HIP is high. Prospective diabetes evaluation is required and intervention should be considered in women with HIP who have obesity, diagnosis of HIP at an earlier trimester, signs of insulin resistance, and require insulin treatment during pregnancy.
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Affiliation(s)
- Tauseef Nabi
- Department of Endocrinology, All is Well Multi Speciality Hospital, Burhanpur, Madhya Pradesh, India
| | - Nadeema Rafiq
- Department of Physiology, Govt. Medical College Baramulla, Jammu and Kashmir, India
| | - Suchet Trigotra
- Department of Physiology, Dr. B. R. Ambedkar State Institute of Medical Sciences, Mohali, Punjab, India
| | - Smriti Mishra
- Department of Gynaecology and Obstetrics, All is Well Multi Speciality Hospital, Burhanpur, Madhya Pradesh, India
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Shigeno R, Horie I, Miwa M, Ito A, Haraguchi A, Natsuda S, Akazawa S, Nagata A, Hasegawa Y, Miura S, Miura K, Kawakami A, Abiru N. Bihormonal dysregulation of insulin and glucagon contributes to glucose intolerance development at one year post-delivery in women with gestational diabetes: a prospective cohort study using an early postpartum 75-g glucose tolerance test. Endocr J 2021; 68:919-931. [PMID: 33827994 DOI: 10.1507/endocrj.ej20-0795] [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: 11/23/2022] Open
Abstract
Gestational diabetes mellitus (GDM) is known to be a significant risk factor for the future development of type 2 diabetes. Here, we investigated whether a precise evaluation of β- and α-cell functions helps to identify women at high risk of developing glucose intolerance after GDM. Fifty-six women with GDM underwent a 75-g oral glucose tolerance test (OGTT) at early (6-12 weeks) postpartum. We measured their concentrations of glucose, insulin, proinsulin and glucagon at fasting and 30, 60 and 120 min. At 1-year post-delivery, we classified the women into a normal glucose tolerance (NGT) group or an impaired glucose tolerance (IGT)/diabetes mellitus (DM) group. Forty-three of the 56 women completed the study. At 1-year post-delivery, 17 women had developed IGT/DM and 26 women showed NGT. In the early-postpartum OGTTs, the IGT/DM group showed a lower insulinogenic index, a less glucagon suppression evaluated by the change from fasting to 30 min (ΔGlucagon 30 min), and a higher glucagon-to-insulin ratio at 30 min compared to the NGT group. There were no significant between-group differences in proinsulin levels or proinsulin-to-insulin ratios. Insulinogenic index <0.6 and ΔGlucagon 30 min >0 pg/mL were identified as predictors for the development of IGT/DM after GDM, independent of age, body mass index, and lactation intensity. These results suggest that the bihormonal disorder of insulin and glucagon causes the postpartum development of glucose intolerance. The measurement of plasma insulin and glucagon during the initial OGTT at early postpartum period can help to make optimal decisions regarding the postpartum management of women with GDM.
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Affiliation(s)
- Riyoko Shigeno
- Department of Endocrinology and Metabolism, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan
| | - Ichiro Horie
- Department of Endocrinology and Metabolism, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan
| | - Masaki Miwa
- Department of Endocrinology and Metabolism, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan
| | - Ayako Ito
- Department of Endocrinology and Metabolism, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan
| | - Ai Haraguchi
- Department of Endocrinology and Metabolism, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan
| | - Shoko Natsuda
- Department of Endocrinology and Metabolism, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan
| | - Satoru Akazawa
- Department of Endocrinology and Metabolism, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan
| | - Ai Nagata
- Department of Obstetrics and Gynecology, Nagasaki University Hospital, Nagasaki 852-8501, Japan
| | - Yuri Hasegawa
- Department of Obstetrics and Gynecology, Nagasaki University Hospital, Nagasaki 852-8501, Japan
| | - Shoko Miura
- Department of Obstetrics and Gynecology, Nagasaki University Hospital, Nagasaki 852-8501, Japan
| | - Kiyonori Miura
- Department of Obstetrics and Gynecology, Nagasaki University Hospital, Nagasaki 852-8501, Japan
| | - Atsushi Kawakami
- Department of Endocrinology and Metabolism, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan
| | - Norio Abiru
- Department of Endocrinology and Metabolism, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan
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11
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Association between serum adiponectin levels with gestational diabetes mellitus and postpartum metabolic syndrome:A case control study. Endocr Regul 2021; 54:119-125. [PMID: 32597154 DOI: 10.2478/enr-2020-0014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE Pregnancy can cause diabetic conditions and gestational diabetes is the most common metabolic disorder of the era. Scientific evidence suggests that obesity increases the incidence and severity of gestational diabetes. Adipokines are proteins secreted from adipose tissue in response to extracellular stimuli and altered metabolism. These hormones are involved in regulating the energy balance, lipid metabolism, and insulin sensitivity. One of the types of adipokines is called adiponectin, which has anti-diabetic, anti-inflammatory, and anti-atherogenic effects. Accordingly, this study is aimed to investigate the correlation between the serum adiponectin level with the gestational diabetes and the postpartum metabolic syndrome. METHODS This case-control study was carried out on 37 pregnant women (in Sari, Iran) with gestational diabetes and 37 non-diabetic pregnant women who were matched regarding age and body mass index (BMI). Serum adiponectin and glucose levels were measured. Finally, six weeks after termination of pregnancy, women in both groups were evaluated for metabolic syndrome. All statistical analyses of this study were performed using IBM SPSS software version 21 and, in all cases, the two-way p value less than 0.05 was considered statistically significant. RESULTS The mean age of pregnant women was 28.46±4.11 years in the non-diabetic group and 30.03±4.71 in the diabetic group. There was no statistically significant difference found between the mean age (p=0.123) and BMI (p=0.727) in two groups. Serum adiponectin levels in the diabetic group (5.51±3.15 µg/ml) were significantly lower than in the non-diabetic group (8.35±4.54 µg/ml) (p=0.003). In the diabetic group, serum adiponectin level did not correlate with the maternal age, maternal BMI, and postpartum metabolic syndrome (p>0.005). CONCLUSIONS The results of the present study indicate a correlation of low adiponectin concentrations with gestational diabetes, but this association with postpartum metabolic syndrome is uncertain. However, to elucidate the mechanism of adiponectin in predicting gestational diabetes and postpartum metabolic syndrome further studies are required.
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Wang H, Huang B, Hou A, Xue L, Wang B, Chen J, Li M, Zhang JV. High NOV/CCN3 expression during high-fat diet pregnancy in mice affects GLUT3 expression and the mTOR pathway. Am J Physiol Endocrinol Metab 2021; 320:E786-E796. [PMID: 33586490 DOI: 10.1152/ajpendo.00230.2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We investigated the expression levels of nephroblastoma overexpressed [NOV or CCN3 (cellular communication network factor 3)] in the serum and placenta of pregnant women and of pregnant mice fed a high-fat diet (HFD), and its effect on placental glucose transporter 3 (GLUT3) expression, to examine its role in gestational diabetes mellitus (GDM). NOV/CCN3 expression was increased in the mouse serum during pregnancy. At gestational day 18, NOV/CCN3 protein expression was increased in the serum and placenta of the HFD mice compared with that of mice fed a normal diet. Compared with non-GDM patients, the patients with GDM had significantly increased serum NOV/CCN3 protein expression and placental NOV/CCN3 mRNA expression. Therefore, we hypothesized that NOV/CCN3 signaling may be involved in the pathogenesis of GDM. We administered NOV/CCN3 recombinant protein via intraperitoneal injections to pregnant mice fed HFD or normal diet. NOV/CCN3 overexpression led to glucose intolerance. Combined with the HFD, NOV/CCN3 exacerbated glucose intolerance and caused insulin resistance. NOV/CCN3 upregulates GLUT3 expression and affects the mammalian target of rapamycin (mTOR) pathway in the GDM environment in vivo and in vitro. In summary, our results demonstrate, for the first time, the molecular mechanism of NOV/CCN3 signaling in maternal metabolism to regulate glucose balance during pregnancy. NOV/CCN3 may be a potential target for detecting and treating GDM.NEW & NOTEWORTHY NOV/CCN3 regulates glucose homeostasis in mice during pregnancy. NOV/CCN3 upregulates GLUT3 expression and affects the mTOR pathway in the GDM environment in vivo and in vitro.
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Affiliation(s)
- Hefei Wang
- Center for Energy Metabolism and Reproduction, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, People's Republic of China
- Department of Clinical Pharmacy and Translational Medicine, School of Pharmacy and Biomedicine, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, People's Republic of China
| | - Binbin Huang
- Center for Energy Metabolism and Reproduction, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, People's Republic of China
- Department of Clinical Pharmacy and Translational Medicine, School of Pharmacy and Biomedicine, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, People's Republic of China
| | - Anli Hou
- Department of Gynaecology, University of Chinese Academy of Sciences Shenzhen Hospital, Shenzhen, People's Republic of China
- Tsinghua Shenzhen International Graduate School, Tsinghua University, Shenzhen, People's Republic of China
| | - Li Xue
- Center for Energy Metabolism and Reproduction, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, People's Republic of China
- Department of Clinical Pharmacy and Translational Medicine, School of Pharmacy and Biomedicine, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, People's Republic of China
| | - Baobei Wang
- Center for Energy Metabolism and Reproduction, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, People's Republic of China
- Department of Clinical Pharmacy and Translational Medicine, School of Pharmacy and Biomedicine, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, People's Republic of China
| | - Jie Chen
- Center for Energy Metabolism and Reproduction, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, People's Republic of China
- Department of Clinical Pharmacy and Translational Medicine, School of Pharmacy and Biomedicine, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, People's Republic of China
| | - Mengxia Li
- Center for Energy Metabolism and Reproduction, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, People's Republic of China
- Department of Clinical Pharmacy and Translational Medicine, School of Pharmacy and Biomedicine, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, People's Republic of China
| | - Jian V Zhang
- Center for Energy Metabolism and Reproduction, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, People's Republic of China
- Department of Clinical Pharmacy and Translational Medicine, School of Pharmacy and Biomedicine, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, People's Republic of China
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Bengtson AM, Ramos SZ, Savitz DA, Werner EF. Risk Factors for Progression From Gestational Diabetes to Postpartum Type 2 Diabetes: A Review. Clin Obstet Gynecol 2021; 64:234-243. [PMID: 33306495 PMCID: PMC7855576 DOI: 10.1097/grf.0000000000000585] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Gestational diabetes mellitus (GDM) complicates 6% to 8% of pregnancies and up to 50% of women with GDM progress to type 2 diabetes mellitus (DM) within 5 years postpartum. Clinicians have little guidance on which women are most at risk for DM progression or when evidence-based prevention strategies should be implemented in a woman's lifecycle. To help address this gap, the authors review identifiable determinants of progression from GDM to DM across the perinatal period, considering prepregnancy, pregnancy, and postpartum periods. The authors categorize evidence by pathways of risk including genetic, metabolic, and behavioral factors that influence progression to DM among women with GDM.
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Affiliation(s)
- Angela M Bengtson
- Department of Epidemiology, Brown University School of Public Health
| | - Sebastian Z Ramos
- Department of Obstetrics and Gynecology, Women & Infants Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - David A Savitz
- Department of Epidemiology, Brown University School of Public Health
- Department of Obstetrics and Gynecology, Women & Infants Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Erika F Werner
- Department of Epidemiology, Brown University School of Public Health
- Department of Obstetrics and Gynecology, Women & Infants Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
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14
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Li Z, Wang D, Cheng Y, Chen P, Ding W, Wang Z. Association between neonatal birthweight and risk of maternal glucose intolerance after gestational diabetes mellitus. J Diabetes Investig 2020; 12:425-433. [PMID: 32628808 PMCID: PMC7926240 DOI: 10.1111/jdi.13349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 06/27/2020] [Accepted: 07/01/2020] [Indexed: 12/13/2022] Open
Abstract
Aims/Introduction To evaluate whether the neonatal birthweight (NBW) is associated with early postpartum glucose intolerance in women with gestational diabetes mellitus. Materials and Methods A total of 1,113 women diagnosed with gestational diabetes mellitus who completed an oral glucose tolerance test at 6–9 weeks postpartum between 1 April 2014 and 8 January 2020 were included in this observational prospective cohort study. They were grouped by neonatal birthweight quartiles, and the odds ratios of postpartum glucose intolerance for different levels of neonatal birthweight were assessed. Results A lower NBW quartile was associated with an increased maternal risk of postpartum glucose intolerance after gestational diabetes mellitus. The adjusted odds ratios for maternal glucose intolerance were 1.69 (95% confidence interval 1.13–2.51) in the lowest NBW quartile (NBW 1,980–2,930 g) when compared with the highest NBW quartile (NBW 3,410–4,610 g). The association between lower NBW and maternal glucose intolerance was significantly stronger in women who delivered a girl. Additionally, NBW ≥3,100 g appears to be associated with a lower risk of maternal glucose intolerance postpartum. Conclusions Our findings suggest that low NBW is a previously unrecognized risk factor for maternal glucose intolerance after gestational diabetes in early postpartum in South China.
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Affiliation(s)
- Zhuyu Li
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Dongyu Wang
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yunjiu Cheng
- Department of Cardiology, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Peisong Chen
- Department of Clinical Laboratory, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Wenjing Ding
- Department of Obstetrics and Gynaecology, Faculty of Medicine, the Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Zilian Wang
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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15
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Thayer SM, Lo JO, Caughey AB. Gestational Diabetes: Importance of Follow-up Screening for the Benefit of Long-term Health. Obstet Gynecol Clin North Am 2020; 47:383-396. [PMID: 32762924 DOI: 10.1016/j.ogc.2020.04.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Gestational diabetes mellitus (GDM) is the most common obstetric metabolic disorder. Long-term health consequences, including type 2 diabetes, metabolic syndrome, and cardiovascular disease, are common with GDM. Postpartum glucose screening is recommended for women with a prior GDM pregnancy. Rates of postpartum screening compliance remain low. Interventions ranging from appointment reminder systems to personalized chronic disease education are being used, emphasizing future chronic disease risk for patients with a history of GDM. With these practice changes, clinicians can more thoroughly engage in the early identification, intervention, and prevention of chronic disease for women with a history of GDM.
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Affiliation(s)
- Sydney M Thayer
- Department of Obstetrics and Gynecology, Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239, USA.
| | - Jamie O Lo
- Department of Obstetrics and Gynecology, Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239, USA
| | - Aaron B Caughey
- Department of Obstetrics and Gynecology, Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239, USA
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Okba A, Hosny SS, Elsherbeny A, Kamal MM. Study of Possible Relation between Fasting Plasma Glucagon, Gestational Diabetes and Development of Type 2 DM. Curr Diabetes Rev 2020; 16:148-155. [PMID: 30961504 DOI: 10.2174/1573399815666190405171907] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 03/07/2019] [Accepted: 03/31/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND AIMS Women who develop GDM (gestational diabetes mellitus) have a relative insulin secretion deficiency, the severity of which may be predictive for later development of diabetes. This study aimed to investigate the role of fasting plasma glucagon in the prediction of later development of diabetes in pregnant women with GDM. MATERIALS AND METHODS The study was conducted on 150 pregnant women with GDM after giving informed oral and written consents and being approved by the research ethical committee according to the declaration of Helsinki. The study was conducted in two phases, first phase during pregnancy and the second one was 6 months post-partum, as we measured fasting plasma glucagon before and after delivery together with fasting and 2 hour post-prandial plasma sugar. RESULTS Our findings suggested that glucagon levels significantly increased after delivery in the majority 14/25 (56%) of GDM women who developed type 2 DM within 6 months after delivery compared to 6/20 (30%) patients with impaired fasting plasma glucose (IFG) and only 22/105 (20%) non DM women, as the median glucagon levels were 80,76, 55, respectively. Also, there was a high statistical difference between fasting plasma glucagon post-delivery among diabetic and non-diabetic women (p ≤ 0.001). These results indicated the useful role of assessing fasting plasma glucagon before and after delivery in patients with GDM to predict the possibility of type 2 DM. CONCLUSION There is a relatively high glucagon level in GDM patients, which is a significant pathogenic factor in the incidence of subsequent diabetes in women with a history of GDM. This could be important in the design of follow-up programs for women with previous GDM.
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Affiliation(s)
- Ashraf Okba
- Internal Medicine Department, Ain Shams University Hospitals, Cairo, Egypt
| | - Salwa Seddik Hosny
- Internal Medicine Department, Ain Shams University Hospitals, Cairo, Egypt
| | - Alyaa Elsherbeny
- Internal Medicine Department, Ain Shams University Hospitals, Cairo, Egypt
| | - Manal Mohsin Kamal
- Clinical Pathology Department, Ain Shams University Hospitals, Cairo, Egypt
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Oh TJ, Kim YG, Kang S, Moon JH, Kwak SH, Choi SH, Lim S, Park KS, Jang HC, Hong JS, Cho NH. Oral Glucose Tolerance Testing Allows Better Prediction of Diabetes in Women with a History of Gestational Diabetes Mellitus. Diabetes Metab J 2019; 43:342-349. [PMID: 30604595 PMCID: PMC6581542 DOI: 10.4093/dmj.2018.0086] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 08/09/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND We aimed to identify the postpartum metabolic factors that were associated with the development of diabetes in women with a history of gestational diabetes mellitus (GDM). In addition, we examined the role of the oral glucose tolerance test (OGTT) in the prediction of future diabetes. METHODS We conducted a prospective study of 179 subjects who previously had GDM but did not have diabetes at 2 months postpartum. The initial postpartum examination including a 75-g OGTT and the frequently sampled intravenous glucose tolerance test (FSIVGTT) was performed 12 months after delivery, and annual follow-up visits were made thereafter. RESULTS The insulinogenic index (IGI30) obtained from the OGTT was significantly correlated with the acute insulin response to glucose (AIRg) obtained from the FSIVGTT. The disposition indices obtained from the OGTT and FSIVGTT were also significantly correlated. Women who progressed to diabetes had a lower insulin secretory capacity including IGI30, AIRg, and disposition indices obtained from the FSIVGTT and OGTT compared with those who did not. However, the insulin sensitivity indices obtained from the OGTT and FSIVGTT did not differ between the two groups. Multivariate logistic regression analysis showed that the 2-hour glucose and disposition index obtained from the FSIVGTT were significant postpartum metabolic risk factors for the development of diabetes. CONCLUSION We identified a crucial role of β-cell dysfunction in the development of diabetes in Korean women with previous GDM. The 2-hour glucose result from the OGTT is an independent predictor of future diabetes. Therefore, the OGTT is crucial for better prediction of future diabetes in Korean women with previous GDM.
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Affiliation(s)
- Tae Jung Oh
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yeong Gi Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sunyoung Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Joon Ho Moon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Soo Heon Kwak
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sung Hee Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Soo Lim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Kyong Soo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hak C Jang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
| | - Joon Seok Hong
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Nam H Cho
- Department of Preventive Medicine, Ajou University School of Medicine, Suwon, Korea
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El Ouahabi H, Doubi S, Boujraf S, Ajdi F. Gestational Diabetes and Risk of Developing Postpartum Type 2 Diabetes: How to Improve Follow-up? Int J Prev Med 2019; 10:51. [PMID: 31143425 PMCID: PMC6528419 DOI: 10.4103/ijpvm.ijpvm_3_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 02/19/2018] [Indexed: 11/17/2022] Open
Abstract
Background: Gestational diabetes mellitus (GDM) is defined by World Health Organization as glucose intolerance diagnosed for the first time during pregnancy; GDM affects 7% of pregnancies. Women with earlier GDM have higher risk to develop type 2 diabetes (T2D). The aim of our study was to evaluate the outcomes of GDM and to assess the impact of recalling patients in the postpartum stage by phone, the target was to assess T2D or impaired glucose tolerance in women with a history of GDM. Methods: This prospective study included 200 patients with GDM that have received education sessions regarding the major interest of screen T2D using 75 g of oral glucose tolerance testing in the 3rd month after birth. Results: Only 22.5% (n = 45) women spontaneously complied to assess T2D. About 15% have had developed T2D and 28% prediabetes. Risk factors of T2D onset were younger gestational age at the occurrence GD, higher fasting blood glucose, and frequent use of insulin. Conclusions: Women with GD history demonstrated high risk of developing T2D. Simple changes of lifestyle were shown to be an efficient prevention protocol. Despite therapeutical education, few women spontaneously complied with T2D screening. The telephone reminders could improve the screening observance therefore patient's outcome.
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Affiliation(s)
- Hanan El Ouahabi
- Department of Endocrinology, Diabetology and Nutrition, University Hospital of Fez, Fez, Morocco
| | - Sana Doubi
- Department of Endocrinology, Diabetology and Nutrition, University Hospital of Fez, Fez, Morocco
| | - Saïd Boujraf
- Department of Biophysics and Clinical MRI Methods, Faculty of Medicine and Pharmacy, University of Fez, Fez, Morocco
| | - Farida Ajdi
- Department of Endocrinology, Diabetology and Nutrition, University Hospital of Agadir, Agadir, Morocco
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Reyes-López R, Perez-Luque E, Malacara JM. Relationship of lactation, BMI, and rs12255372 TCF7L2 polymorphism on the conversion to type 2 diabetes mellitus in women with previous gestational diabetes. Gynecol Endocrinol 2019; 35:412-416. [PMID: 30614312 DOI: 10.1080/09513590.2018.1531984] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Women with previous gestational diabetes mellitus (pGDM) have a high risk of developing postpartum type 2 diabetes mellitus (T2DM). This study aimed to analyze the relationship between lactation, BMI, and TCF7L2 polymorphisms in the conversion to T2DM in women with pGDM. One hundred and fifty-three women con pGDM were recruited from public hospitals of León Guanajuato México. Three groups: normal glucose tolerance (NGT), impaired glucose intolerance (IGT), and T2DM after the oral glucose tolerance test were formed. Metabolic and hormone variables were measured, and genotyping was made by PCR-RFLP. The questionnaire included data on lactation (yes/no), duration of lactation, and full lactation. After 35 (21-49) months from the last partum, 54% of women had an NGT, 30.7% IGT, and 15% T2DM. BMI and rs12255372 are associated with the risk of conversion to IGT and T2DM [OR = 1.07 (95% IC 1.0-1.14, p = .041; OR =2.14, 95% IC 1.01-4.55, p = .04 respectively), while the lactation shows a strong protective effects OR = 0.15 (95% IC 0.062-0.39, p = .00007), and an apparent interaction with rs12255372T decreasing the risk in carriers (OR =2.15; 95% IC 0.97-4.7, p = .05). BMI is an independent risk factor of IGT/T2DM development. The lactation shows a strong protective effect and a possible interaction with rs12255372 polymorphism.
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Affiliation(s)
- Ruth Reyes-López
- a Department of Medical Sciences, Division of Health Sciences , University of Guanajuato , León , Mexico
| | - Elva Perez-Luque
- a Department of Medical Sciences, Division of Health Sciences , University of Guanajuato , León , Mexico
| | - Juan Manuel Malacara
- a Department of Medical Sciences, Division of Health Sciences , University of Guanajuato , León , Mexico
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20
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Nicklas JM, Rosner BA, Zera CA, Seely EW. Association Between Changes in Postpartum Weight and Waist Circumference and Changes in Cardiometabolic Risk Factors Among Women With Recent Gestational Diabetes. Prev Chronic Dis 2019; 16:E47. [PMID: 31002638 PMCID: PMC6513485 DOI: 10.5888/pcd16.180308] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Women with gestational diabetes mellitus (GDM) have a 30% to 70% risk for developing type 2 diabetes and are at increased risk for cardiovascular disease. Little is known about how anthropometric changes in the first postpartum year modify cardiometabolic risk factors. METHODS We randomly assigned women in the Balance After Baby study to an intervention group consisting of participation in a web-based lifestyle program or to a control group in which no program was offered. We measured weight, height, waist circumference, blood pressure, lipids, insulin, adiponectin, interleukin-6, and high-sensitivity C-reactive protein, and we conducted 2-hour oral glucose tolerance tests at 6 weeks, 6 months, and 12 months postpartum. We evaluated whether women assigned to the intervention had improved cardiometabolic risk markers compared with the control group. We then conducted a post-hoc analysis, pooling the 2 groups to compare changes in weight and waist circumference with changes in cardiometabolic risk factors. RESULTS Women in the intervention group did not significantly improve cardiometabolic risk markers compared with women in the control group. We noted a large overlap of weight change and change in waist circumference between groups. In our post-hoc analysis pooling groups, changes in diabetes and cardiovascular risk factors were significantly correlated with changes in weight and waist circumference. The strongest associations were observed for fasting insulin, HOMA, and fasting glucose. CONCLUSION Anthropometric changes in weight and waist circumference in women with recent GDM may affect cardiometabolic risk factors, even in the first postpartum year. Our study demonstrates the importance of the postpartum year as an opportunity to decrease future risk for diabetes and cardiovascular disease in women with a history of GDM.
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Affiliation(s)
- Jacinda M Nicklas
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, Massachusetts
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO 80045.
| | - Bernard A Rosner
- Channing Division of Network Medicine, Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts
| | - Chloe A Zera
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital Boston, Massachusetts
| | - Ellen W Seely
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, Massachusetts
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21
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Peter R, Bright D, Cheung WY, Luzio SD, Dunseath GJ. Proinsulin in the identification and risk stratification of gestational diabetes mellitus: study protocol for a prospective, longitudinal cohort study. BMJ Open 2018; 8:e022571. [PMID: 30158232 PMCID: PMC6119441 DOI: 10.1136/bmjopen-2018-022571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Gestational diabetes mellitus (GDM) is a common metabolic disorder occurring in up to 10% of pregnancies in the western world. Most women with GDM are asymptomatic; therefore, it is important to screen, diagnose and manage the condition as it is associated with an increased risk of maternal and perinatal complications. Diagnosis of GDM is made in the late second trimester or early third trimester because accurate diagnosis or risk stratification in the first trimester is still lacking. An increase in serum proinsulin may be seen earlier in pregnancy and before a change in glycaemic control can be identified. This study will aim to establish if fasting proinsulin concentrations at 16-18 weeks gestation will help to identify or risk stratify high-risk pregnant women with GDM. METHODS AND ANALYSIS This is a prospective, longitudinal cohort study. Two oral glucose tolerance tests will be carried out at 16-18 and 24-28 weeks gestation in 200 pregnant women with at least one risk factor for GDM (body mass index>30 kg/m2, previous macrosomic baby (>4.5 kg), previous gestational diabetes, first degree relative with type 2 diabetes mellitus) recruited from antenatal clinics. Blood samples will be taken fasting and at 30 min, 1 and 2 hours following the 75 g glucose load. In addition, a fasting blood sample will be taken 6-weeks post delivery. All samples will be analysed for glucose, insulin, C peptide and proinsulin. Recruitment began in November 2017. Optimal cut-off points for proinsulin to diagnose gestational diabetes according to National Institute for Health and Care Excellence (2015) criteria will be established by the receiver operating characteristic plot and sensitivity and specificity will be calculated to assess the diagnostic accuracy of proinsulin at 16-18 weeks gestation. ETHICS AND DISSEMINATION This study received ethical approval from the Wales Research Ethics Committee (Panel 6) (Ref. 17/WA/0194). Data will be presented at international conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER ISRCTN16416602; Pre-results.
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Affiliation(s)
- Rajesh Peter
- Diabetes Research Group, Swansea University, Swansea, UK
| | - Dominic Bright
- Diabetes Research Group, Swansea University, Swansea, UK
| | - Wai-Yee Cheung
- Diabetes Research Group, Swansea University, Swansea, UK
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Inoue H, Ishikawa K, Takeda K, Kobayashi A, Kurita K, Kumagai J, Yokoh H, Yokote K. Postpartum risk of diabetes and predictive factors for glucose intolerance in East Asian women with gestational diabetes. Diabetes Res Clin Pract 2018; 140:1-8. [PMID: 29596944 DOI: 10.1016/j.diabres.2018.03.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 03/05/2018] [Accepted: 03/20/2018] [Indexed: 01/23/2023]
Abstract
AIMS Women with a history of gestational diabetes mellitus (GDM) are likely to develop postpartum diabetes mellitus (DM). We examined women in the early stages of pregnancy who were at high risk of postpartum DM progression to establish a follow-up method for early detection. METHODS We performed the oral glucose tolerance test (OGTT) and identified predictive factors for postpartum impaired glucose tolerance (IGT) or DM in 77 women after GDM, for 2 years after delivery, retrospectively. Cutoff values for each factor were determined. We classified these women with GDM into four groups using these predictive factors and evaluated postpartum glucose intolerance (GI) in each group. RESULTS In total, 44.1% of the women with a GDM history had developed postpartum GI within 2 years. We determined three risk factors for postpartum GI: elevated glucose level 120 min after a 75-g OGTT (Glu120), elevated glycated hemoglobin (HbA1c) level at diagnosis, and perinatal complications. The cutoff Glu120 and the HbA1c level were 155 mg/dl and 5.3% (34 mmol/mol), respectively. Type 2 DM developed in 53.8% of women, and IGT developed in 38.5% of women within 2 years in groups with high Glu120 and high HbA1c. CONCLUSIONS High-risk groups require careful follow-up observation.
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Affiliation(s)
- Hiromi Inoue
- Department of Clinical Cell Biology and Medicine, Chiba University Graduate School of Medicine, Chiba, Japan; Division of Metabolism and Endocrinology, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Ko Ishikawa
- Department of Clinical Cell Biology and Medicine, Chiba University Graduate School of Medicine, Chiba, Japan; Division of Metabolism and Endocrinology, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan.
| | - Kenji Takeda
- Department of Clinical Cell Biology and Medicine, Chiba University Graduate School of Medicine, Chiba, Japan; Division of Metabolism and Endocrinology, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Akina Kobayashi
- Department of Clinical Cell Biology and Medicine, Chiba University Graduate School of Medicine, Chiba, Japan; Division of Metabolism and Endocrinology, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Kenichi Kurita
- Department of Clinical Cell Biology and Medicine, Chiba University Graduate School of Medicine, Chiba, Japan; Division of Metabolism and Endocrinology, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Jin Kumagai
- Department of Clinical Cell Biology and Medicine, Chiba University Graduate School of Medicine, Chiba, Japan; Division of Metabolism and Endocrinology, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Hidetaka Yokoh
- Department of Clinical Cell Biology and Medicine, Chiba University Graduate School of Medicine, Chiba, Japan; Division of Metabolism and Endocrinology, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Koutaro Yokote
- Department of Clinical Cell Biology and Medicine, Chiba University Graduate School of Medicine, Chiba, Japan; Division of Metabolism and Endocrinology, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
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Das Gupta R, Gupta S, Das A, Biswas T, Haider MR, Sarker M. Ethnic predisposition of diabetes mellitus in the patients with previous history of gestational diabetes mellitus: a review. Expert Rev Endocrinol Metab 2018; 13:149-158. [PMID: 30058900 DOI: 10.1080/17446651.2018.1471354] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 04/27/2018] [Indexed: 01/03/2023]
Abstract
INTRODUCTION The worldwide prevalence of Gestational Diabetes Mellitus (GDM) is increasing day by day. However, there is a knowledge gap regarding the effect of ethnic and geographical distribution on the risk of developing Diabetes Mellitus (DM) in women with history of GDM. This review was conducted to find out the role of ethnic and geographical distribution on the risk of developing DM is women with GDM. AREAS COVERED In this review we conducted a comprehensive search of published studies through different electronic databases (PubMed, Google Scholar, CINAHL, CINAHL plus and EMBASE) published between 1990 and 2017. The studies which were published in English investigated the risk of development of DM in women with previous history of GDM, reported outcome according to ethnicity with specific criteria of reporting DM and GDM, reported development of diabetes after 6 month of delivery in women with GDM during pregnancy were included. Initially, 350 articles were identified, among which 16 articles were included in the final review. EXPERT COMMENTARY Studies showed the increased risk of developing subsequent DM is associated with precedent GDM. Around 7-84% women developed diabetes after GDM in five years follow up, where some studies reported the risk continues to increase with increasing age. Risk of DM was found higher for some specific ethnicities, irrespective of the location of the study conducted. East Indian women showed the highest risk of postpartum DM after GDM and the crude prevalence remained almost similar in all form of study worldwide. Public health programme should focus more on women belonging to high-risk ethnicity of GDM for the prevention of postpartum DM.
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Affiliation(s)
- Rajat Das Gupta
- a BRAC James P Grant School of Public Health , BRAC University , Dhaka , Bangladesh
| | - Sabyasachi Gupta
- b Department of Medicine , Chittagong Medical College and Hospital , Chittagong , Bangladesh
| | - Anupom Das
- c The JiVitA Project , Johns Hopkins University , Gaibandha , Bangladesh
| | - Tuhin Biswas
- d Health System and Population Studies Division , The International Centre for Diarrhoeal Disease Research , Dhaka , Bangladesh
| | - Mohammad Rifat Haider
- e Department of Public Health and Informatics , Jahangirnagar University , Dhaka , Bangladesh
- f Department of Health, Promotion, Education & Behavior, Norman J Arnold School of Public Health , University of South Carolina , Columbia , South Carolina , United States
| | - Malabika Sarker
- a BRAC James P Grant School of Public Health , BRAC University , Dhaka , Bangladesh
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Wanthong S, Lertwattanarak R, Sunsaneevithayakul P, Sriussadaporn S, Vannasaeng S, Sriwijitkamol A. High prevalence of diabetes and abnormal glucose tolerance in Thai women with previous gestational diabetes mellitus. J Clin Transl Endocrinol 2017; 9:21-24. [PMID: 29067265 PMCID: PMC5651303 DOI: 10.1016/j.jcte.2017.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 06/19/2017] [Accepted: 06/28/2017] [Indexed: 11/29/2022] Open
Abstract
AIM To determine the prevalence of and risk factors for abnormal glucose tolerance (AGT) in previous gestational diabetes mellitus (pGDM) women. METHODS 100 pGDM women randomly selected from the database of the Department of Obstetrics/Gynecology. 75 g-OGTT were performed in subjects without known diabetes. AGT was diagnosed using the American Diabetes Association criteria. RESULTS The mean age, pre-gestational BMI, and time since delivery were 38 ± 5 years, 24.5 ± 5.7 kg/m2, and 46 ± 26 months. Overall, 81% of the subjects had AGT, including IGT (38%), IGT + IFG (5%), T2DM (38%). Plasma glucose (PG) at 1 h after a 50 g-glucose challenge test (GCT), PG at 1 h after 100 g-OGTT, HbA1c, and HOMA-IR were significantly greater in women with AGT than normal glucose tolerance (NGT) women. The proportion of women with ≥3 abnormal PG values during 100 g-OGTT was greater in AGT than NGT group (50.7% vs. 15.8%). Multivariate analysis showed that PG ≥ 150 mg/dl at 1 h after a 50 g-GCT and ≥3 abnormal PG values in 100 g-OGTTs were risk factors for developing AGT. CONCLUSIONS Eighty-one percent of pGDM women developed AGT within 4 years after delivery. Risk factors for AGT were PG ≥ 150 mg/dl at 1 h after a 50 g-GCT and ≥3 abnormal PG values in a 100 g-OGTT.
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Affiliation(s)
- Sirisawat Wanthong
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Raweewan Lertwattanarak
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Prasert Sunsaneevithayakul
- Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sutin Sriussadaporn
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sathit Vannasaeng
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Apiradee Sriwijitkamol
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Charwat-Resl S, Yarragudi R, Heimbach M, Leitner K, Leutner M, Gamper J, Giurgea GA, Mueller M, Koppensteiner R, Gschwandtner ME, Kautzky-Willer A, Schlager O. Microvascular function in women with former gestational diabetes: A cohort study. Diab Vasc Dis Res 2017; 14:214-220. [PMID: 28111976 DOI: 10.1177/1479164116683148] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE In the long term, diabetes mellitus is potentially associated with the occurrence of microvascular damage. This study sought to assess whether a history of prior gestational diabetes mellitus is associated with long-term effects on the women's microcirculation. METHODS Within the scope of a long-term follow-up of the 'Viennese Post-Gestational Diabetes Project', women with prior gestational diabetes mellitus as well as women with previous pregnancy but with no history of gestational diabetes mellitus (controls) were enrolled in this cross-sectional study. Microvascular function was assessed by post-occlusive reactive hyperaemia using laser Doppler fluxmetry. Baseline perfusion, biological zero, peak perfusion, time to peak and recovery time were recorded and compared between both groups. RESULTS Microvascular function was assessed in 55 women with prior gestational diabetes mellitus (46.1 ± 4.6 years) and 32 women with previous pregnancy but without prior gestational diabetes mellitus (42.9 ± 5.3 years). The mean period of time between delivery and the assessment of microvascular function was 16.2 ± 5.2 years in women with prior gestational diabetes mellitus group and 14.2 ± 4.8 years in controls. Regarding microvascular function, baseline perfusion, biological zero, peak perfusion, time to peak and recovery time did not differ between women with prior gestational diabetes mellitus and controls (all p > 0.05). CONCLUSION In the long term, microvascular function appears not to be impaired in women with prior gestational diabetes mellitus.
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Affiliation(s)
- Silvia Charwat-Resl
- 1 Division of Angiology, Department of Medicine II, Medical University of Vienna, Vienna, Austria
- 2 Cardiology and Intensive Care Medicine, Department of Medicine II, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Rajashri Yarragudi
- 3 Gender Medicine Unit, Division of Endocrinology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Moritz Heimbach
- 1 Division of Angiology, Department of Medicine II, Medical University of Vienna, Vienna, Austria
| | - Karoline Leitner
- 3 Gender Medicine Unit, Division of Endocrinology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Michael Leutner
- 3 Gender Medicine Unit, Division of Endocrinology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Jutta Gamper
- 4 Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Georgiana-Aura Giurgea
- 1 Division of Angiology, Department of Medicine II, Medical University of Vienna, Vienna, Austria
| | - Markus Mueller
- 1 Division of Angiology, Department of Medicine II, Medical University of Vienna, Vienna, Austria
| | - Renate Koppensteiner
- 1 Division of Angiology, Department of Medicine II, Medical University of Vienna, Vienna, Austria
| | - Michael E Gschwandtner
- 1 Division of Angiology, Department of Medicine II, Medical University of Vienna, Vienna, Austria
| | - Alexandra Kautzky-Willer
- 3 Gender Medicine Unit, Division of Endocrinology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Oliver Schlager
- 1 Division of Angiology, Department of Medicine II, Medical University of Vienna, Vienna, Austria
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Hamel MS, Werner EF. Interventions to Improve Rate of Diabetes Testing Postpartum in Women With Gestational Diabetes Mellitus. Curr Diab Rep 2017; 17:7. [PMID: 28150160 DOI: 10.1007/s11892-017-0835-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
PURPOSE OF REVIEW Gestational diabetes mellitus (GDM) is one of the most common medical complications of pregnancy. In the USA, four million women are screened annually for GDM in pregnancy in part to improve pregnancy outcomes but also because diagnosis predicts a high risk of future type 2 diabetes mellitus (T2DM). Therefore, among women with GDM, postpartum care should be focused on T2DM prevention. This review describes the current literature aimed to increase postpartum diabetes testing among women with GDM. RECENT FINDINGS Data suggest that proactive patient contact via a health educator, a phone call, or even postal mail is associated with higher rates of postpartum diabetes testing. There may also be utility to changing the timing of postpartum diabetes testing. Despite the widespread knowledge regarding the importance of postpartum testing for women with GDM, testing rates remain low. Alternative testing strategies and large randomized trials addressing postpartum testing are warranted.
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Affiliation(s)
- Maureen S Hamel
- Department of Obstetrics & Gynecology, Alpert Medical School of Brown University, 101 Dudley Street, Providence, RI, 02905, USA.
| | - Erika F Werner
- Department of Obstetrics & Gynecology, Alpert Medical School of Brown University, 101 Dudley Street, Providence, RI, 02905, USA
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Moon JH, Kwak SH, Jang HC. Prevention of type 2 diabetes mellitus in women with previous gestational diabetes mellitus. Korean J Intern Med 2017; 32:26-41. [PMID: 28049284 PMCID: PMC5214732 DOI: 10.3904/kjim.2016.203] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Accepted: 12/12/2016] [Indexed: 02/07/2023] Open
Abstract
Gestational diabetes mellitus (GDM), defined as any degree of glucose intolerance with onset or first recognition during pregnancy, is characterized by underlying maternal defects in the β-cell response to insulin during pregnancy. Women with a previous history of GDM have a greater than 7-fold higher risk of developing postpartum diabetes compared with women without GDM. Various risk factors for postpartum diabetes have been identified, including maternal age, glucose levels in pregnancy, family history of diabetes, pre-pregnancy and postpartum body mass index, dietary patterns, physical activity, and breastfeeding. Genetic studies revealed that GDM shares common genetic variants with type 2 diabetes. A number of lifestyle interventional trials that aimed to ameliorate modifiable risk factors, including diet, exercise, and breastfeeding, succeeded in reducing the incidence of postpartum diabetes, weight retention, and other obesity-related morbidities. The present review summarizes the findings of previous studies on the incidence and risk factors of postpartum diabetes and discusses recent lifestyle interventional trials that attempted to prevent postpartum diabetes.
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Affiliation(s)
- Joon Ho Moon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Soo Heon Kwak
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hak C. Jang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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28
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Nouhjah S, Shahbazian H, Shahbazian N, Jahanshahi A, Jahanfar S, Cheraghian B. Incidence and Contributing Factors of Persistent Hyperglycemia at 6-12 Weeks Postpartum in Iranian Women with Gestational Diabetes: Results from LAGA Cohort Study. J Diabetes Res 2017; 2017:9786436. [PMID: 28491872 PMCID: PMC5405388 DOI: 10.1155/2017/9786436] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 01/19/2017] [Accepted: 01/29/2017] [Indexed: 12/31/2022] Open
Abstract
Background. A history of gestational diabetes is an important predictor of many metabolic disturbances later in life. Method. Life after gestational diabetes Ahvaz Study (LAGAs) is an ongoing population-based cohort study. Up to February 2016, 176 women with gestational diabetes underwent a 75 g oral glucose tolerance test (OGTT) at 6-12 weeks postpartum in Ahvaz (southwestern of Iran). Gestational diabetes was diagnosed according to the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria and the American Diabetes Association (ADA) criteria applied for diagnosis of postpartum prediabetes and diabetes. Univariate and multivariate regression analysis were done. Results. Overall incidence of early postpartum glucose intolerance was 22.2% (95% CI, 16.3-29.0), 17.6% prediabetes (95% CI, 12.3-24.1) and 4.5% diabetes (95% CI, 2.0-8.8%). Independent risk factors for glucose intolerance were FPG ≥ 100 at the time of OGTT (OR 3.86; 95% CI; 1.60-9.32), earlier diagnosis of GDM (OR 0.92; 95% CI; 0.88-0.97), systolic blood pressure (OR 1.02; 95% CI; 1.002-1.04), and insulin or metformin therapy (OR 3.14; 95% CI; 1.20-8.21). Conclusion. Results determined a relatively high rate of glucose intolerance at 6-12 weeks after GDM pregnancy. Early postpartum screening of type 2 diabetes is needed particularly in women at high risk of type 2 diabetes.
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Affiliation(s)
- Sedigheh Nouhjah
- Diabetes Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Hajieh Shahbazian
- Diabetes Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- *Hajieh Shahbazian:
| | - Nahid Shahbazian
- Department of Obstetrics and Gynecology, Fertility, Infertility and Perinatology Research Center, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Alireza Jahanshahi
- Diabetes Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Internal Medicine Ward, Golestan Teaching Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Shayesteh Jahanfar
- School of Health Sciences, Central Michigan University, Building 2212, Room 2239, Mount Pleasant, MI 48859, USA
| | - Bahman Cheraghian
- Department of Epidemiology and Biostatistics, Faculty of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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29
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Allalou A, Nalla A, Prentice KJ, Liu Y, Zhang M, Dai FF, Ning X, Osborne LR, Cox BJ, Gunderson EP, Wheeler MB. A Predictive Metabolic Signature for the Transition From Gestational Diabetes Mellitus to Type 2 Diabetes. Diabetes 2016; 65:2529-39. [PMID: 27338739 PMCID: PMC5001181 DOI: 10.2337/db15-1720] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 05/27/2016] [Indexed: 12/12/2022]
Abstract
Gestational diabetes mellitus (GDM) affects 3-14% of pregnancies, with 20-50% of these women progressing to type 2 diabetes (T2D) within 5 years. This study sought to develop a metabolomics signature to predict the transition from GDM to T2D. A prospective cohort of 1,035 women with GDM pregnancy were enrolled at 6-9 weeks postpartum (baseline) and were screened for T2D annually for 2 years. Of 1,010 women without T2D at baseline, 113 progressed to T2D within 2 years. T2D developed in another 17 women between 2 and 4 years. A nested case-control design used 122 incident case patients matched to non-case patients by age, prepregnancy BMI, and race/ethnicity. We conducted metabolomics with baseline fasting plasma and identified 21 metabolites that significantly differed by incident T2D status. Machine learning optimization resulted in a decision tree modeling that predicted T2D incidence with a discriminative power of 83.0% in the training set and 76.9% in an independent testing set, which is far superior to measuring fasting plasma glucose levels alone. The American Diabetes Association recommends T2D screening in the early postpartum period via oral glucose tolerance testing after GDM, which is a time-consuming and inconvenient procedure. Our metabolomics signature predicted T2D incidence from a single fasting blood sample. This study represents the first metabolomics study of the transition from GDM to T2D validated in an independent testing set, facilitating early interventions.
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Affiliation(s)
- Amina Allalou
- Department of Medicine, University of Toronto, Ontario, Canada
| | - Amarnadh Nalla
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark Department of Physiology, University of Toronto, Ontario, Canada
| | - Kacey J Prentice
- Department of Physiology, University of Toronto, Ontario, Canada
| | - Ying Liu
- Department of Physiology, University of Toronto, Ontario, Canada
| | - Ming Zhang
- Department of Physiology, University of Toronto, Ontario, Canada
| | - Feihan F Dai
- Department of Physiology, University of Toronto, Ontario, Canada
| | - Xian Ning
- Kaiser Permanente Northern California, Division of Research, Oakland, CA
| | - Lucy R Osborne
- Department of Medicine, University of Toronto, Ontario, Canada Department of Molecular Genetics, University of Toronto, Ontario, Canada
| | - Brian J Cox
- Department of Physiology, University of Toronto, Ontario, Canada Department of Obstetrics and Gynaecology, University of Toronto, Ontario, Canada
| | - Erica P Gunderson
- Kaiser Permanente Northern California, Division of Research, Oakland, CA
| | - Michael B Wheeler
- Department of Medicine, University of Toronto, Ontario, Canada Department of Physiology, University of Toronto, Ontario, Canada
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Unnikrishnan R, Shanthi Rani CS, Anjana RM, Uthra SC, Vidya J, Sankari GU, Venkatesan U, Rani SJ, Mohan V. Postpartum development of type 1 diabetes in Asian Indian women with gestational diabetes. Indian J Endocrinol Metab 2016; 20:702-706. [PMID: 27730084 PMCID: PMC5040054 DOI: 10.4103/2230-8210.190562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
AIM To study the postpartum conversion of gestational diabetes mellitus (GDM) to different types of diabetes among Asian Indian women. MATERIALS AND METHODS Using data from electronic medical records, 418 women with GDM seen at a tertiary diabetes care center for diabetes in Chennai in South India between 1991 and 2014 were evaluated for development of diabetes postpartum. RESULTS Of the 418 GDM women followed up postpartum, 388 progressed to diabetes. Of these 359 (92.5%) developed type 2 diabetes (T2DM) and 29 women (7.5%) developed type 1 diabetes (T1DM). The median time to development of T1DM was 2 years (interquartile range 2 [IQR]) while for T2DM it was 5 years (IQR 6). Women who developed T1DM had significantly lower mean body mass index (BMI) (20.4 ± 2.8 vs. 27.5 ± 4.4 kg/m2, P = 0.001), and higher fasting plasma glucose (222 ± 105 vs. 165 ± 62 mg/dl P = 0.008) and glycated hemoglobin levels (10.2 ± 2.7 vs. 8.5 ± 2.1% P < 0.001) compared to those who developed T2DM. Glutamic acid decarboxylase (GAD) autoantibodies were present in 24/29 (82.7%) of women who developed T1DM. CONCLUSION A small but significant proportion of women with GDM progress to T1DM postpartum. Measurement of GAD antibodies in leaner women with more severe diabetes could help to identify women who are likely to develop T1DM and thus prevent their presentation with acute hyperglycemic emergencies after delivery.
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Affiliation(s)
- Ranjit Unnikrishnan
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu, India
| | | | - Ranjit Mohan Anjana
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu, India
| | - Subash Chandrabose Uthra
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu, India
| | - Jaydeep Vidya
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu, India
| | - Ganesan Uma Sankari
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu, India
| | - Ulagamathesan Venkatesan
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu, India
| | - Saravanan Jeba Rani
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu, India
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu, India
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Bhavadharini B, Anjana RM, Mahalakshmi MM, Maheswari K, Kayal A, Unnikrishnan R, Ranjani H, Ninov L, Pastakia SD, Usha S, Malanda B, Belton A, Uma R, Mohan V. Glucose tolerance status of Asian Indian women with gestational diabetes at 6weeks to 1year postpartum (WINGS-7). Diabetes Res Clin Pract 2016; 117:22-7. [PMID: 27329018 DOI: 10.1016/j.diabres.2016.04.050] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 03/12/2016] [Accepted: 04/26/2016] [Indexed: 01/18/2023]
Abstract
AIM To determine postpartum glucose tolerance status among women with gestational diabetes mellitus (GDM) recruited under the Women In India with GDM Strategy (WINGS) Model of Care (MOC). METHODS Through the WINGS MOC programme, 212 women with GDM were followed till delivery between November 2013 and August 2015. All women were advised to return for a postpartum oral glucose tolerance test (OGTT) 6-12weeks after delivery. A multivariate logistic regression (MLR) model was developed to identify the risk factors for postpartum dysglycemia which was defined as presence of diabetes (DM) or prediabetes. RESULTS 203/212(95.8%) women completed their postpartum OGTT. Of the 161 women (79.3%) who came back for the test between 6 and 12weeks, 2(1.2%) developed DM, 5(3.1%), isolated IFG, 13(8.1%), isolated IGT and 5(3.1%) combined IFG/IGT [dysglycemia 25(15.5%)]. 136 women (84.5%) reverted to normal glucose tolerance (NGT). Of the 42 women who came back between 12weeks and a year, 5(11.9%) developed DM, 10(23.8%), isolated IFG and 1(2.4%) combined IFG/IGT [dysglycemia 16(38.1%)]. 26/42 women (61.9%) reverted to NGT. Thus overall dysglycemia occurred in 41/203 women (20.2%). MLR showed that BMI ⩾25kg/m(2) was significantly associated with postpartum dysglycemia (odds ratio: 4.47; 95% confidence interval: 1.8-11.2, p=0.001). CONCLUSION Among Asian Indian women with GDM, over 20% develop dysglycemia within one year postpartum, and BMI ⩾25kg/m(2) increased this risk four-fold. Early postpartum screening can identify high risk women and help plan strategies for prevention of type 2 diabetes in the future.
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Affiliation(s)
| | | | | | | | | | | | | | - Lyudmil Ninov
- International Diabetes Federation, Brussels, Belgium
| | | | - Sriram Usha
- Associates in Clinical Endocrinology Education and Research (ACEER), Chennai, India
| | - Belma Malanda
- International Diabetes Federation, Brussels, Belgium
| | - Anne Belton
- International Diabetes Federation, Brussels, Belgium
| | - Ram Uma
- Seethapathy Clinic and Hospital, Chennai, India
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Inoue S, Shinagawa T, Horinouchi T, Kozuma Y, Yonemoto K, Hori D, Ushijima K. Predictors of Abnormal Glucose Tolerance in the Early Postpartum Period in Patients with Gestational Diabetes. Kurume Med J 2016; 62:47-51. [PMID: 27237938 DOI: 10.2739/kurumemedj.ms65006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This study was designed to investigate the clinical predictors of abnormal glucose tolerance 5-7 weeks after delivery. Subjects were 155 women diagnosed with gestational diabetes mellitus (GDM) between October 2005 and September 2013 whose pregnancy and delivery were managed at our center. Subjects were divided into a normal glucose tolerance group (NGT; n = 113), or abnormal glucose tolerance group (AGT; n = 42) with borderline or overt diabetes mellitus, based on 75-g oral glucose tolerance test (75 gOGTT) results 5-7 weeks after delivery. We extracted profiles by which abnormal glucose tolerance levels 5-7 weeks after delivery were predicted using a classification and regression tree (CART) from parameters measured at the time of GDM diagnosis. Logistic regression analysis was used to determine prediction accuracy. Subjects with fasting plasma glucose (FPG) ≥92 mg/dL and immuno-reactive insulin level <100 μU/mL 60 min after load (IRI60min) at time of diagnosis showed a significantly higher risk of developing abnormal glucose tolerance 5-7 weeks after delivery than subjects with FPG <92 mg/dL (p < 0.0001). Subjects with FPG ≥92 mg/dL and IRI60min ≥ 100 μU/mL had the same risk as those with FPG of <92 mg/dL. Patients with gestational diabetes who met the criteria specified above at diagnosis were at a higher risk of developing diabetes mellitus in the future. By explaining this issue to patients, we expect to improve the rate of postpartum follow-up. This should facilitate early detection of diabetes, and help prevent associated complications.
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Affiliation(s)
- Shigeru Inoue
- Department of Obstetrics and Gynecology, Kurume University School of Medicine
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Wendland EM, Duncan BB, Schmidt MI. Interventions for the prevention of type 2 diabetes mellitus in women with previous gestational diabetes. Hippokratia 2016. [DOI: 10.1002/14651858.cd009283.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Eliana M Wendland
- Federal University of Health Sciences of Porto Alegre (UFCSPA); Department of Public Health; Rua Sarmento Leite 245 Sala 411 Porto Alegre RS Brazil 90050-170
| | - Bruce B Duncan
- Federal University of Rio Grande do Sul; Social Medicine; Ramiro Barcelos 2400, 2 floor Porto Alegre Brazil 90035-003
| | - Maria I Schmidt
- Federal University of Rio Grande do Sul; Graduate Studies Programme in Epidemiology; Rua Ramiro Barcelos 2600/414 Porto Alegre RS Brazil 90035003
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Ryan AS. Improvements in insulin sensitivity after aerobic exercise and weight loss in older women with a history of gestational diabetes and type 2 diabetes mellitus. Endocr Res 2016; 41:132-41. [PMID: 26925596 PMCID: PMC4961462 DOI: 10.3109/07435800.2015.1094087] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To determine whether a hypocaloric diet alone (WL) or with exercise training (AEX + WL) is effective in improving body composition, fitness, glucose utilization and CVD risk factors in sedentary women with a history of gestational diabetes (GDM) and with type 2 diabetes (T2DM). MATERIALS AND METHODS Longitudinal clinical investigation of 25 overweight/obese (BMI: 32 ± 1 kg/m(2)) women (59 ± 1 yrs) with a GDM history (n = 20) or T2DM (n = 5). Women completed 6 months WL (n = 10) or AEX+WL (n = 15) with VO2max, body composition, and glucose tolerance testing. Insulin sensitivity was measured during the last 30 min of 2 h hyperinsulinemic-euglycemic clamps (40 mU·m(-2.)min(-1)) before and after interventions. RESULTS Body weight decreased ~7% after WL and AEX+WL (p < 0.001), with an 11-12% decrease in fat mass (p < 0.0001). Visceral fat and subcutaneous abdominal fat decreased 27 and 10% after WL (p < 0.01) and 14 and 11% after AEX + WL (p < 0.05). VO2max increased 16% after AEX + WL (p < 0.001) and did not change after WL. Glucose AUC decreased 14 and 13% after WL (p < 0.05) and AEX + WL (p < 0.01) with a 42% decrease in insulin AUC after AEX + WL (p < 0.01). Glucose utilization increased 25% (p = 0.05) with AEX + WL and 7% with WL. CONCLUSIONS A six-month aerobic exercise program combined with moderate weight loss reduces body weight, visceral and subcutaneous abdominal fat, and improves insulin sensitivity in older women who had previously been diagnosed with GDM and those with T2DM. These findings should encourage women with a history of GDM to engage in an active lifestyle and reduce caloric intake to lower the risk for the development of T2DM.
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Affiliation(s)
- Alice S Ryan
- a VA Maryland Health Care System, Research Service, Department of Medicine, Division of Gerontology and Geriatric Medicine , University of Maryland School of Medicine , Baltimore , MD , USA
- b Baltimore Geriatric Research, Education and Clinical Center (GRECC) , Baltimore , MD , USA
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Schmidt MI, Duncan BB, Castilhos C, Wendland EM, Hallal PC, Schaan BD, Drehmer M, Costa E Forti A, Façanha C, Nunes MA. Lifestyle INtervention for Diabetes prevention After pregnancy (LINDA-Brasil): study protocol for a multicenter randomized controlled trial. BMC Pregnancy Childbirth 2016; 16:68. [PMID: 27029489 PMCID: PMC4812654 DOI: 10.1186/s12884-016-0851-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 03/17/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM), a hyperglycemic state detected during pregnancy, is an established risk factor for diabetes. However, treatment during pregnancy in and of itself is not able to eliminate this risk, and a considerable fraction of women with GDM will develop frank diabetes in the decade following pregnancy. Our aim is to conduct a multicenter randomized controlled trial to investigate the effectiveness of a lifestyle intervention program implemented after a pregnancy complicated by GDM in delaying or preventing the development of type 2 diabetes. METHODS Women aged 18 or older identified as having recent GDM are recruited and followed by telephone to assess eligibility for the trial. To be eligible, women must have used insulin during pregnancy or present intermediate hyperglycemia postpartum. Women are encouraged to enter the trial as early as 10 weeks, and are permitted to do so up to 2 years after a pregnancy with GDM. An estimated 740 women will be randomized to either conventional care or to coach-based interventions focused on breastfeeding, weight loss, healthy eating, and increased physical activity, and predominantly delivered by telephone. Women are followed annually to detect new onset diabetes, the primary outcome, and additional secondary outcomes which include reversion to normoglycemia, weight loss, physical activity and fitness, and insulin resistance. DISCUSSION Though previous studies have demonstrated that type 2 diabetes can be delayed or prevented, no study has yet demonstrated the feasibility and effectiveness of similar interventions implemented in the postpartum period for women with recent GDM. If shown to be successful, this approach could become an important means of preventing diabetes in primary care settings. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02327286; Registered 23 December 2014.
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Affiliation(s)
- Maria Inês Schmidt
- Postgraduate Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, R. Ramiro Barcelos, 2600, Sala 414, Porto Alegre, RS, 90035-003, Brazil. .,Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.
| | - Bruce B Duncan
- Postgraduate Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, R. Ramiro Barcelos, 2600, Sala 414, Porto Alegre, RS, 90035-003, Brazil.,Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | | | - Eliana Márcia Wendland
- Postgraduate Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, R. Ramiro Barcelos, 2600, Sala 414, Porto Alegre, RS, 90035-003, Brazil.,Department of Collective Health, Federal University of Health Sciences, Porto Alegre, RS, Brazil
| | - Pedro C Hallal
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Beatriz D'Agord Schaan
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.,Postgraduate Studies Program in Endocrinology, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Michele Drehmer
- Postgraduate Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, R. Ramiro Barcelos, 2600, Sala 414, Porto Alegre, RS, 90035-003, Brazil.,Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Adriana Costa E Forti
- Department of Internal Medicine, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil.,Integrated Center for Diabetes and Hypertension, Ceará State Health Department, Fortaleza, Ceará, Brazil
| | - Cristina Façanha
- Integrated Center for Diabetes and Hypertension, Ceará State Health Department, Fortaleza, Ceará, Brazil.,School of Medicine, Centro Universitário Unichristus, Fortaleza, Ceará, Brazil
| | - Maria Angélica Nunes
- Postgraduate Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, R. Ramiro Barcelos, 2600, Sala 414, Porto Alegre, RS, 90035-003, Brazil
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Mottola MF, Artal R. Fetal and maternal metabolic responses to exercise during pregnancy. Early Hum Dev 2016; 94:33-41. [PMID: 26803360 DOI: 10.1016/j.earlhumdev.2016.01.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 01/07/2016] [Indexed: 01/13/2023]
Abstract
Pregnancy is characterized by physiological, endocrine and metabolic adaptations creating a pseudo-diabetogenic state of progressive insulin resistance. These adaptations occur to sustain continuous fetal requirements for nutrients and oxygen. Insulin resistance develops at the level of the skeletal muscle, and maternal exercise, especially activity involving large muscle groups improve glucose tolerance and insulin sensitivity. We discuss the maternal hormonal and metabolic changes associated with a normal pregnancy, the metabolic dysregulation that may occur leading to gestational diabetes mellitus (GDM), and the consequences to mother and fetus. We will then examine the acute and chronic (training) responses to exercise in the non-pregnant state and relate these alterations to maternal exercise in a low-risk pregnancy, how exercise can be used to regulate glucose tolerance in women at risk for or diagnosed with GDM. Lastly, we present key exercise guidelines to help maintain maternal glucose regulation and suggest future research directions.
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Affiliation(s)
- Michelle F Mottola
- R. Samuel McLaughlin Foundation-Exercise & Pregnancy Laboratory, School of Kinesiology, Faculty of Health Sciences, Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, Children's Health Research Institute, University of Western Ontario, London N6A 3K7, Canada.
| | - Raul Artal
- Department of Obstetrics/Gynecology and Women's Health, Saint Louis University, United States.
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Ryan AS, Serra MC. Skeletal Muscle CAP Expression Increases after Dietary Restriction and Aerobic Training in Women with a History of Gestational Diabetes. ACTA ACUST UNITED AC 2016; 5. [PMID: 28989819 DOI: 10.4172/2167-7182.1000354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The purpose is to determine the effects of 6 months caloric restriction and aerobic training (3x/wk) (CR+AEX) on c-CBL associated protein (CAP) gene expression in women with a history of GDM. CAP is involved in cell signaling and protein ubiquitination, and is linked to the development of insulin resistance. Obese (BMI=32 ± 1 kg/m2, % fat=46 ± 2, X ± SEM), sedentary (VO2 max=21.2 ± 1.2 ml/kg/min), women aged 52 ± 2 years participated in 6 months D+WL (n=10) with body composition, fitness (VO2 max), and glucose tolerance testing. Insulin sensitivity was assessed during the last 30 min of 2-hour hyperinsulinemic-euglycemic clamps (40 mU.m-2.min-1) pre and post interventions. Vastus lateralis skeletal muscle biopsies (n=7) were conducted and CAP, GLUT4 and glycogen synthase (GS) gene expression measured by RT-PCR. No change in FFM by DXA was observed, but body weight decreased 8% with losses of total body fat mass (P<0.05) and a 10% increase in VO2 max (P<0.01). Glucose and insulin areas under the curve by OGTT decreased (P<0.05). Glucose utilization during the clamp increased 27% (23.1 ± 3.8 vs. 29.4 ± 3.6 umol.kg.min-1, P<0.05). Vastus lateralis skeletal muscle CAP expression increased 21% (P<0.05) but GLUT4 did not. Results suggest that changes in CAP could be involved in the improvement in glucose metabolism with caloric restriction and aerobic training in women with a history of gestational diabetes.
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Affiliation(s)
- Alice S Ryan
- Department of Medicine, University of Maryland School of Medicine, USA
| | - Monica C Serra
- Department of Medicine, University of Maryland School of Medicine, USA
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Gunderson EP, Hurston SR, Ning X, Lo JC, Crites Y, Walton D, Dewey KG, Azevedo RA, Young S, Fox G, Elmasian CC, Salvador N, Lum M, Sternfeld B, Quesenberry CP. Lactation and Progression to Type 2 Diabetes Mellitus After Gestational Diabetes Mellitus: A Prospective Cohort Study. Ann Intern Med 2015; 163:889-98. [PMID: 26595611 PMCID: PMC5193135 DOI: 10.7326/m15-0807] [Citation(s) in RCA: 157] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Lactation improves glucose metabolism, but its role in preventing type 2 diabetes mellitus (DM) after gestational diabetes mellitus (GDM) remains uncertain. OBJECTIVE To evaluate lactation and the 2-year incidence of DM after GDM pregnancy. DESIGN Prospective, observational cohort of women with recent GDM. (ClinicalTrials.gov: NCT01967030). SETTING Integrated health care system. PARTICIPANTS 1035 women diagnosed with GDM who delivered singletons at 35 weeks' gestation or later and enrolled in the Study of Women, Infant Feeding and Type 2 Diabetes After GDM Pregnancy from 2008 to 2011. MEASUREMENTS Three in-person research examinations from 6 to 9 weeks after delivery (baseline) and annual follow-up for 2 years that included 2-hour, 75-g oral glucose tolerance testing; anthropometry; and interviews. Multivariable Weibull regression models evaluated independent associations of lactation measures with incident DM adjusted for potential confounders. RESULTS Of 1010 women without diabetes at baseline, 959 (95%) were evaluated up to 2 years later; 113 (11.8%) developed incident DM. There were graded inverse associations for lactation intensity at baseline with incident DM and adjusted hazard ratios of 0.64, 0.54, and 0.46 for mostly formula or mixed/inconsistent, mostly lactation, and exclusive lactation versus exclusive formula feeding, respectively (P trend = 0.016). Time-dependent lactation duration showed graded inverse associations with incident DM and adjusted hazard ratios of 0.55, 0.50, and 0.43 for greater than 2 to 5 months, greater than 5 to 10 months, and greater than 10 months, respectively, versus 0 to 2 months (P trend = 0.007). Weight change slightly attenuated hazard ratios. LIMITATION Randomized design is not feasible or desirable for clinical studies of lactation. CONCLUSION Higher lactation intensity and longer duration were independently associated with lower 2-year incidences of DM after GDM pregnancy. Lactation may prevent DM after GDM delivery. PRIMARY FUNDING SOURCE National Institute of Child Health and Human Development.
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Affiliation(s)
- Erica P. Gunderson
- From Kaiser Permanente Northern California and the Permanente Medical Group, Oakland, and University of California, Davis, Davis, California
| | - Shanta R. Hurston
- From Kaiser Permanente Northern California and the Permanente Medical Group, Oakland, and University of California, Davis, Davis, California
| | - Xian Ning
- From Kaiser Permanente Northern California and the Permanente Medical Group, Oakland, and University of California, Davis, Davis, California
| | - Joan C. Lo
- From Kaiser Permanente Northern California and the Permanente Medical Group, Oakland, and University of California, Davis, Davis, California
| | - Yvonne Crites
- From Kaiser Permanente Northern California and the Permanente Medical Group, Oakland, and University of California, Davis, Davis, California
| | - David Walton
- From Kaiser Permanente Northern California and the Permanente Medical Group, Oakland, and University of California, Davis, Davis, California
| | - Kathryn G. Dewey
- From Kaiser Permanente Northern California and the Permanente Medical Group, Oakland, and University of California, Davis, Davis, California
| | - Robert A. Azevedo
- From Kaiser Permanente Northern California and the Permanente Medical Group, Oakland, and University of California, Davis, Davis, California
| | - Stephen Young
- From Kaiser Permanente Northern California and the Permanente Medical Group, Oakland, and University of California, Davis, Davis, California
| | - Gary Fox
- From Kaiser Permanente Northern California and the Permanente Medical Group, Oakland, and University of California, Davis, Davis, California
| | - Cathie C. Elmasian
- From Kaiser Permanente Northern California and the Permanente Medical Group, Oakland, and University of California, Davis, Davis, California
| | - Nora Salvador
- From Kaiser Permanente Northern California and the Permanente Medical Group, Oakland, and University of California, Davis, Davis, California
| | - Michael Lum
- From Kaiser Permanente Northern California and the Permanente Medical Group, Oakland, and University of California, Davis, Davis, California
| | - Barbara Sternfeld
- From Kaiser Permanente Northern California and the Permanente Medical Group, Oakland, and University of California, Davis, Davis, California
| | - Charles P. Quesenberry
- From Kaiser Permanente Northern California and the Permanente Medical Group, Oakland, and University of California, Davis, Davis, California
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Staff AC, Redman CWG, Williams D, Leeson P, Moe K, Thilaganathan B, Magnus P, Steegers EAP, Tsigas EZ, Ness RB, Myatt L, Poston L, Roberts JM. Pregnancy and Long-Term Maternal Cardiovascular Health: Progress Through Harmonization of Research Cohorts and Biobanks. Hypertension 2015; 67:251-60. [PMID: 26667417 DOI: 10.1161/hypertensionaha.115.06357] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Anne Cathrine Staff
- From the Faculty of Medicine, University of Oslo, Oslo, Norway and Departments of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway (A.C.S., K.M.); Nuffield Department of Obstetrics and Gynaecology (C.W.G.R), Radcliffe Department of Medicine (P.L.), University of Oxford, Oxford, United Kingdom; Department of Maternal Medicine, Institute for Women's Health, University College London, London, United Kingdom (D.W.); Department of Obstetrics and Gynaecology, St. George's Hospital, London, United Kingdom (B.T.); Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway (P.M.); Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands (E.A.P.S.); Preeclampsia Foundation, Melbourne, FL (E.Z.T.); Division of Epidemiology and Disease Control, University of Texas School of Public Health, Houston (R.B.N.); University of Texas Health Science Center San Antonio (L.M.); Department of Women's Health, King's College London, London, United Kingdom (L.P.); and Department of Obstetrics Gynecology and Reproductive Sciences, Epidemiology and Clinical and Translational Research, Magee-Womens Institute, University of Pittsburgh, PA (J.M.R.)
| | - Christopher W G Redman
- From the Faculty of Medicine, University of Oslo, Oslo, Norway and Departments of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway (A.C.S., K.M.); Nuffield Department of Obstetrics and Gynaecology (C.W.G.R), Radcliffe Department of Medicine (P.L.), University of Oxford, Oxford, United Kingdom; Department of Maternal Medicine, Institute for Women's Health, University College London, London, United Kingdom (D.W.); Department of Obstetrics and Gynaecology, St. George's Hospital, London, United Kingdom (B.T.); Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway (P.M.); Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands (E.A.P.S.); Preeclampsia Foundation, Melbourne, FL (E.Z.T.); Division of Epidemiology and Disease Control, University of Texas School of Public Health, Houston (R.B.N.); University of Texas Health Science Center San Antonio (L.M.); Department of Women's Health, King's College London, London, United Kingdom (L.P.); and Department of Obstetrics Gynecology and Reproductive Sciences, Epidemiology and Clinical and Translational Research, Magee-Womens Institute, University of Pittsburgh, PA (J.M.R.)
| | - David Williams
- From the Faculty of Medicine, University of Oslo, Oslo, Norway and Departments of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway (A.C.S., K.M.); Nuffield Department of Obstetrics and Gynaecology (C.W.G.R), Radcliffe Department of Medicine (P.L.), University of Oxford, Oxford, United Kingdom; Department of Maternal Medicine, Institute for Women's Health, University College London, London, United Kingdom (D.W.); Department of Obstetrics and Gynaecology, St. George's Hospital, London, United Kingdom (B.T.); Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway (P.M.); Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands (E.A.P.S.); Preeclampsia Foundation, Melbourne, FL (E.Z.T.); Division of Epidemiology and Disease Control, University of Texas School of Public Health, Houston (R.B.N.); University of Texas Health Science Center San Antonio (L.M.); Department of Women's Health, King's College London, London, United Kingdom (L.P.); and Department of Obstetrics Gynecology and Reproductive Sciences, Epidemiology and Clinical and Translational Research, Magee-Womens Institute, University of Pittsburgh, PA (J.M.R.)
| | - Paul Leeson
- From the Faculty of Medicine, University of Oslo, Oslo, Norway and Departments of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway (A.C.S., K.M.); Nuffield Department of Obstetrics and Gynaecology (C.W.G.R), Radcliffe Department of Medicine (P.L.), University of Oxford, Oxford, United Kingdom; Department of Maternal Medicine, Institute for Women's Health, University College London, London, United Kingdom (D.W.); Department of Obstetrics and Gynaecology, St. George's Hospital, London, United Kingdom (B.T.); Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway (P.M.); Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands (E.A.P.S.); Preeclampsia Foundation, Melbourne, FL (E.Z.T.); Division of Epidemiology and Disease Control, University of Texas School of Public Health, Houston (R.B.N.); University of Texas Health Science Center San Antonio (L.M.); Department of Women's Health, King's College London, London, United Kingdom (L.P.); and Department of Obstetrics Gynecology and Reproductive Sciences, Epidemiology and Clinical and Translational Research, Magee-Womens Institute, University of Pittsburgh, PA (J.M.R.)
| | - Kjartan Moe
- From the Faculty of Medicine, University of Oslo, Oslo, Norway and Departments of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway (A.C.S., K.M.); Nuffield Department of Obstetrics and Gynaecology (C.W.G.R), Radcliffe Department of Medicine (P.L.), University of Oxford, Oxford, United Kingdom; Department of Maternal Medicine, Institute for Women's Health, University College London, London, United Kingdom (D.W.); Department of Obstetrics and Gynaecology, St. George's Hospital, London, United Kingdom (B.T.); Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway (P.M.); Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands (E.A.P.S.); Preeclampsia Foundation, Melbourne, FL (E.Z.T.); Division of Epidemiology and Disease Control, University of Texas School of Public Health, Houston (R.B.N.); University of Texas Health Science Center San Antonio (L.M.); Department of Women's Health, King's College London, London, United Kingdom (L.P.); and Department of Obstetrics Gynecology and Reproductive Sciences, Epidemiology and Clinical and Translational Research, Magee-Womens Institute, University of Pittsburgh, PA (J.M.R.)
| | - Basky Thilaganathan
- From the Faculty of Medicine, University of Oslo, Oslo, Norway and Departments of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway (A.C.S., K.M.); Nuffield Department of Obstetrics and Gynaecology (C.W.G.R), Radcliffe Department of Medicine (P.L.), University of Oxford, Oxford, United Kingdom; Department of Maternal Medicine, Institute for Women's Health, University College London, London, United Kingdom (D.W.); Department of Obstetrics and Gynaecology, St. George's Hospital, London, United Kingdom (B.T.); Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway (P.M.); Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands (E.A.P.S.); Preeclampsia Foundation, Melbourne, FL (E.Z.T.); Division of Epidemiology and Disease Control, University of Texas School of Public Health, Houston (R.B.N.); University of Texas Health Science Center San Antonio (L.M.); Department of Women's Health, King's College London, London, United Kingdom (L.P.); and Department of Obstetrics Gynecology and Reproductive Sciences, Epidemiology and Clinical and Translational Research, Magee-Womens Institute, University of Pittsburgh, PA (J.M.R.)
| | - Per Magnus
- From the Faculty of Medicine, University of Oslo, Oslo, Norway and Departments of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway (A.C.S., K.M.); Nuffield Department of Obstetrics and Gynaecology (C.W.G.R), Radcliffe Department of Medicine (P.L.), University of Oxford, Oxford, United Kingdom; Department of Maternal Medicine, Institute for Women's Health, University College London, London, United Kingdom (D.W.); Department of Obstetrics and Gynaecology, St. George's Hospital, London, United Kingdom (B.T.); Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway (P.M.); Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands (E.A.P.S.); Preeclampsia Foundation, Melbourne, FL (E.Z.T.); Division of Epidemiology and Disease Control, University of Texas School of Public Health, Houston (R.B.N.); University of Texas Health Science Center San Antonio (L.M.); Department of Women's Health, King's College London, London, United Kingdom (L.P.); and Department of Obstetrics Gynecology and Reproductive Sciences, Epidemiology and Clinical and Translational Research, Magee-Womens Institute, University of Pittsburgh, PA (J.M.R.)
| | - Eric A P Steegers
- From the Faculty of Medicine, University of Oslo, Oslo, Norway and Departments of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway (A.C.S., K.M.); Nuffield Department of Obstetrics and Gynaecology (C.W.G.R), Radcliffe Department of Medicine (P.L.), University of Oxford, Oxford, United Kingdom; Department of Maternal Medicine, Institute for Women's Health, University College London, London, United Kingdom (D.W.); Department of Obstetrics and Gynaecology, St. George's Hospital, London, United Kingdom (B.T.); Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway (P.M.); Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands (E.A.P.S.); Preeclampsia Foundation, Melbourne, FL (E.Z.T.); Division of Epidemiology and Disease Control, University of Texas School of Public Health, Houston (R.B.N.); University of Texas Health Science Center San Antonio (L.M.); Department of Women's Health, King's College London, London, United Kingdom (L.P.); and Department of Obstetrics Gynecology and Reproductive Sciences, Epidemiology and Clinical and Translational Research, Magee-Womens Institute, University of Pittsburgh, PA (J.M.R.)
| | - Eleni Z Tsigas
- From the Faculty of Medicine, University of Oslo, Oslo, Norway and Departments of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway (A.C.S., K.M.); Nuffield Department of Obstetrics and Gynaecology (C.W.G.R), Radcliffe Department of Medicine (P.L.), University of Oxford, Oxford, United Kingdom; Department of Maternal Medicine, Institute for Women's Health, University College London, London, United Kingdom (D.W.); Department of Obstetrics and Gynaecology, St. George's Hospital, London, United Kingdom (B.T.); Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway (P.M.); Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands (E.A.P.S.); Preeclampsia Foundation, Melbourne, FL (E.Z.T.); Division of Epidemiology and Disease Control, University of Texas School of Public Health, Houston (R.B.N.); University of Texas Health Science Center San Antonio (L.M.); Department of Women's Health, King's College London, London, United Kingdom (L.P.); and Department of Obstetrics Gynecology and Reproductive Sciences, Epidemiology and Clinical and Translational Research, Magee-Womens Institute, University of Pittsburgh, PA (J.M.R.)
| | - Roberta B Ness
- From the Faculty of Medicine, University of Oslo, Oslo, Norway and Departments of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway (A.C.S., K.M.); Nuffield Department of Obstetrics and Gynaecology (C.W.G.R), Radcliffe Department of Medicine (P.L.), University of Oxford, Oxford, United Kingdom; Department of Maternal Medicine, Institute for Women's Health, University College London, London, United Kingdom (D.W.); Department of Obstetrics and Gynaecology, St. George's Hospital, London, United Kingdom (B.T.); Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway (P.M.); Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands (E.A.P.S.); Preeclampsia Foundation, Melbourne, FL (E.Z.T.); Division of Epidemiology and Disease Control, University of Texas School of Public Health, Houston (R.B.N.); University of Texas Health Science Center San Antonio (L.M.); Department of Women's Health, King's College London, London, United Kingdom (L.P.); and Department of Obstetrics Gynecology and Reproductive Sciences, Epidemiology and Clinical and Translational Research, Magee-Womens Institute, University of Pittsburgh, PA (J.M.R.)
| | - Leslie Myatt
- From the Faculty of Medicine, University of Oslo, Oslo, Norway and Departments of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway (A.C.S., K.M.); Nuffield Department of Obstetrics and Gynaecology (C.W.G.R), Radcliffe Department of Medicine (P.L.), University of Oxford, Oxford, United Kingdom; Department of Maternal Medicine, Institute for Women's Health, University College London, London, United Kingdom (D.W.); Department of Obstetrics and Gynaecology, St. George's Hospital, London, United Kingdom (B.T.); Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway (P.M.); Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands (E.A.P.S.); Preeclampsia Foundation, Melbourne, FL (E.Z.T.); Division of Epidemiology and Disease Control, University of Texas School of Public Health, Houston (R.B.N.); University of Texas Health Science Center San Antonio (L.M.); Department of Women's Health, King's College London, London, United Kingdom (L.P.); and Department of Obstetrics Gynecology and Reproductive Sciences, Epidemiology and Clinical and Translational Research, Magee-Womens Institute, University of Pittsburgh, PA (J.M.R.)
| | - Lucilla Poston
- From the Faculty of Medicine, University of Oslo, Oslo, Norway and Departments of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway (A.C.S., K.M.); Nuffield Department of Obstetrics and Gynaecology (C.W.G.R), Radcliffe Department of Medicine (P.L.), University of Oxford, Oxford, United Kingdom; Department of Maternal Medicine, Institute for Women's Health, University College London, London, United Kingdom (D.W.); Department of Obstetrics and Gynaecology, St. George's Hospital, London, United Kingdom (B.T.); Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway (P.M.); Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands (E.A.P.S.); Preeclampsia Foundation, Melbourne, FL (E.Z.T.); Division of Epidemiology and Disease Control, University of Texas School of Public Health, Houston (R.B.N.); University of Texas Health Science Center San Antonio (L.M.); Department of Women's Health, King's College London, London, United Kingdom (L.P.); and Department of Obstetrics Gynecology and Reproductive Sciences, Epidemiology and Clinical and Translational Research, Magee-Womens Institute, University of Pittsburgh, PA (J.M.R.)
| | - James M Roberts
- From the Faculty of Medicine, University of Oslo, Oslo, Norway and Departments of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway (A.C.S., K.M.); Nuffield Department of Obstetrics and Gynaecology (C.W.G.R), Radcliffe Department of Medicine (P.L.), University of Oxford, Oxford, United Kingdom; Department of Maternal Medicine, Institute for Women's Health, University College London, London, United Kingdom (D.W.); Department of Obstetrics and Gynaecology, St. George's Hospital, London, United Kingdom (B.T.); Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway (P.M.); Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands (E.A.P.S.); Preeclampsia Foundation, Melbourne, FL (E.Z.T.); Division of Epidemiology and Disease Control, University of Texas School of Public Health, Houston (R.B.N.); University of Texas Health Science Center San Antonio (L.M.); Department of Women's Health, King's College London, London, United Kingdom (L.P.); and Department of Obstetrics Gynecology and Reproductive Sciences, Epidemiology and Clinical and Translational Research, Magee-Womens Institute, University of Pittsburgh, PA (J.M.R.)
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Nilsson C, Ursing D, Strevens H, Landin-Olsson M. Towards normalized birthweight in gestational diabetes mellitus. Acta Obstet Gynecol Scand 2015; 94:1090-4. [PMID: 26073567 DOI: 10.1111/aogs.12695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 06/03/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The objective was to describe pregnancy outcomes in gestational diabetes mellitus (GDM) in comparison with general population in Sweden. MATERIAL AND METHODS A population-based retrospective study using University hospital records and Swedish Medical Birth Register was carried out on pregnant women with well-monitored GDM (n = 870) and pregnancies in the Swedish Medical Birth Register (n = 1 553 420). Data from GDM pregnancies was compared to pregnancies in the whole of Sweden during 1995-2010. The main outcome measures were age, first bodyweight in and weight gain during pregnancy, birthweight, gestational length, percentage of cesarean deliveries. RESULTS First maternal bodyweight during the GDM pregnancy was higher than in the general population, 72.4 ± 17.4 kg (n = 837) vs. 67.3 ± 12.6 kg (n = 1 383 000; p < 0.0001). Women with GDM gained less weight during pregnancy 9.9 ± 5.8 kg (n = 703) compared to the general population, 13.2 ± 5.7 kg (n = 482 860; p < 0.0001). Mean birthweight in GDM pregnancies was 3564 ± 500 g (n = 743) compared to 3580 ± 483 g for the general population (n = 1 316 364; p = ns). Gestational length was slightly shorter, 39.4 weeks in the GDM pregnancies (n = 683) vs. 39.5 weeks (n = 1 319 876; p = 0.02) in the general population and the percentage of cesarean deliveries higher in the GDM pregnancies at 18.4% (n = 712) vs. 13.3% (n = 1 322 242; p < 0.0001). CONCLUSIONS Though many studies have shown an increased risk of macrosomia in GDM pregnancies, remaining even after ambitious management programs, we show no difference in birthweight. This may be due to a combination of intense efforts to achieve good metabolic control during pregnancy and shorter pregnancy duration. Preventing unduly large babies is crucial to minimize adverse pregnancy outcomes.
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Affiliation(s)
- Charlotta Nilsson
- Department of Pediatrics, Institution of Clinical Science, Helsingborg Hospital, Lund University, Helsingborg, Sweden
| | - Dag Ursing
- Department of Endocrinology, Institution of Clinical Science, Skåne University Hospital, Lund University, Lund, Sweden
| | - Helena Strevens
- Department of Obstetrics and Gynecology, Institution of Clinical Science, Skåne University Hospital, Lund University, Lund, Sweden
| | - Mona Landin-Olsson
- Department of Endocrinology, Institution of Clinical Science, Skåne University Hospital, Lund University, Lund, Sweden
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An improved electromagnetism-like mechanism algorithm and its application to the prediction of diabetes mellitus. J Biomed Inform 2015; 54:220-9. [DOI: 10.1016/j.jbi.2015.02.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 01/12/2015] [Accepted: 02/03/2015] [Indexed: 11/23/2022]
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Winhofer Y, Tura A, Thomas A, Prikoszovich T, Winzer C, Pacini G, Luger A, Kautzky-Willer A. Hidden metabolic disturbances in women with normal glucose tolerance five years after gestational diabetes. Int J Endocrinol 2015; 2015:342938. [PMID: 25873951 PMCID: PMC4385652 DOI: 10.1155/2015/342938] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 09/09/2014] [Indexed: 01/20/2023] Open
Abstract
Background. The study aimed to assess whether women with prior gestational diabetes (pGDM), despite maintenance of normal glucose tolerance (NGT) five years after delivery, display metabolic disturbances compared to healthy controls. Methods. 45 pGDM with NGT were compared to 18 women without a history of GDM (CON), matched for age (37.0 ± 4.1 versus 35.2 ± 5.3, P = ns) and BMI (24.3 ± 3.1 versus 23.3 ± 3.3, P = ns). Metabolic parameters were derived from oral and intravenous glucose tolerance tests; furthermore lipid profile, C-reactive protein (CRP), adiponectin, leptin, and glucagon were assessed. Results. Five years postpartum, pGDM had increased glucose concentrations during the OGTT (AUC: 1.12 ± 0.15 versus 1.0 ± 0.12 mol/L ∗ min, P = 0.003) and insulin sensitivity was decreased compared to CON (OGIS: 467.2 ± 64.1 versus 510.6 ± 53.1 mL/min ∗ m(2), P = 0.01). pGDM had lower adiponectin (8.1 ± 2.6 versus 12.6 ± 5.3, P < 0.008) but increased waist circumference and CRP compared to CON. Conclusions. Despite diagnosis of normal glucose tolerance, pGDM are characterized by hyperglycemia and insulin resistance compared to healthy controls, accompanied by decreased adiponectin and increased CRP concentrations, thus linking metabolic disturbances to an increased cardiovascular risk in pGDM.
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Affiliation(s)
- Yvonne Winhofer
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
- *Yvonne Winhofer:
| | - Andrea Tura
- Metabolic Unit, Institute of Biomedical Engineering, National Research Council, 35127 Padova, Italy
| | - Anita Thomas
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Thomas Prikoszovich
- Division of Nephrology, Department of Internal Medicine III, Medical University of Vienna, 1090 Vienna, Austria
| | - Christine Winzer
- Division of Nephrology, Department of Internal Medicine III, Medical University of Vienna, 1090 Vienna, Austria
| | - Giovanni Pacini
- Metabolic Unit, Institute of Biomedical Engineering, National Research Council, 35127 Padova, Italy
| | - Anton Luger
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Alexandra Kautzky-Willer
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
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Chang Y, Chen X, Cui H, Zhang Z, Cheng L. Follow-up of postpartum women with gestational diabetes mellitus (GDM). Diabetes Res Clin Pract 2014; 106:236-40. [PMID: 25271112 DOI: 10.1016/j.diabres.2014.08.020] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Revised: 08/01/2014] [Accepted: 08/29/2014] [Indexed: 12/25/2022]
Abstract
AIM The incidence of type 2 diabetes in postpartum women with gestational diabetes mellitus (GDM) is high, and blood glucose screening for postpartum women is recommended. Follow-up procedures for women with GDM in the postnatal period need to be improved. We investigated the incidence of GDM and the follow-up of women with GDM in Tianjin, China. METHODS Postpartum women who delivered at Tianjin Obstetrics and Gynecology Hospital from January 1st, 2008 to December 31st, 2010 were interviewed by telephone about their blood glucose screening. Thirty obstetricians were interviewed to evaluate awareness about the importance of follow-up. RESULTS The incidence rate of GDM increased from 6.9% in 2008, to 8.8% in 2009, and 9.9% in 2010. A total of 2152 women were interviewed, including 282 women (13.1%) screened for blood glucose. The top three reasons for failed blood glucose screening included: not being informed by their physicians, believing that GDM would disappear after delivery, and being occupied with the baby. Methods for GDM screening included testing of random blood glucose levels, fasting blood glucose levels, oral glucose tolerance, and glycosylated hemoglobin. Of the 30 obstetricians interviewed, 25 were aware of the need for blood glucose screening for women with GDM after delivery, but only 15 of them had informed their patients. CONCLUSION In China, most women with GDM are not screened for type 2 diabetes after delivery. Standard clinical procedures that will enable and encourage all women to return for glucose screening following GDM are needed.
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Affiliation(s)
- Ying Chang
- Department of Obstetrics, Tianjin Center Hospital of Obstetrics and Gynecology, Tianjin 300100, China
| | - Xu Chen
- Department of Obstetrics, Tianjin Center Hospital of Obstetrics and Gynecology, Tianjin 300100, China.
| | - Hongyan Cui
- Department of Obstetrics, Tianjin Center Hospital of Obstetrics and Gynecology, Tianjin 300100, China
| | - Zhikun Zhang
- Department of Obstetrics, Tianjin Center Hospital of Obstetrics and Gynecology, Tianjin 300100, China
| | - Lan Cheng
- Department of Obstetrics, Tianjin Center Hospital of Obstetrics and Gynecology, Tianjin 300100, China
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Abstract
Lactating women exhibit more favorable blood glucose and insulin profiles, as well as increased insulin sensitivity than nonlactating women. Yet, much less is known about whether these favorable effects on metabolic risk factors persist long-term among women with gestational diabetes mellitus (GDM). The evidence that lactation reduces incident type 2 diabetes after GDM pregnancy is limited and inconsistent. Well-controlled, prospective studies that measure lactation intensity and duration, and comprehensively screen for postpartum glucose tolerance are needed to conclusively determine whether lactation can lead to reduced risk of type 2 diabetes after GDM pregnancy.
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46
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Kim C. Maternal outcomes and follow-up after gestational diabetes mellitus. Diabet Med 2014; 31:292-301. [PMID: 24341443 PMCID: PMC3944879 DOI: 10.1111/dme.12382] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 10/12/2013] [Accepted: 11/29/2013] [Indexed: 12/25/2022]
Abstract
Gestational diabetes mellitus reflects impaired maternal insulin secretion relative to demand prior to pregnancy, as well as temporary metabolic stressors imposed by the placenta and fetus. Thus, after delivery, women with gestational diabetes have increased risk of diabetes and recurrent gestational diabetes because of their underlying impairment, which may be further exacerbated by fat accretion during pregnancy and post-partum deterioration in lifestyle behaviours. This hypothetical model is discussed in greater detail, particularly the uncertainty regarding pregnancy as an accelerator of β-cell decline and the role of gestational weight gain. This report also presents risk estimates for future glucose intolerance and diabetes and reviews modifiable risk factors, particularly body mass and lifestyle alterations, including weight loss and breastfeeding. Non-modifiable risk factors such as race/ethnicity and insulin use during pregnancy are also discussed. The review concludes with current literature on lifestyle modification, recommendations for post-partum glucose screening, and future directions for research to prevent maternal disease.
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Affiliation(s)
- C Kim
- Departments of Medicine and Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
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Abstract
Lactating compared with nonlactating women display more favorable metabolic parameters, including less atherogenic blood lipids, lower fasting and postprandial blood glucose as well as insulin, and greater insulin sensitivity in the first 4 months postpartum. However, direct evidence demonstrating that these metabolic changes persist from delivery to postweaning is much less available. Studies have reported that longer lactation duration may reduce long-term risk of cardiometabolic disease, including type 2 diabetes, but findings from most studies are limited by self-report of disease outcomes, absence of longitudinal biochemical data, or no assessment of maternal lifestyle behaviors. Studies of women with a history gestational diabetes mellitus (GDM) also reported associations between lactation duration and lower the incidence of type 2 diabetes and the metabolic syndrome. The mechanisms are not understood, but hormonal regulation of pancreatic β-cell proliferation and function or other metabolic pathways may mediate the lactation association with cardiometabolic disease in women.
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Affiliation(s)
- Erica P Gunderson
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA,
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48
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Kim C. Gestational diabetes mellitus in korean women: similarities and differences from other racial/ethnic groups. Diabetes Metab J 2014; 38:1-12. [PMID: 24627822 PMCID: PMC3950189 DOI: 10.4093/dmj.2014.38.1.1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Gestational diabetes mellitus (GDM) reflects defects in insulin secretion in response to the metabolic demands of pregnancy. While GDM is increasingly common worldwide due in large part to the obesity epidemic, its frequency is relatively low in Korean women. In this report, the prevalence and risk factors for GDM, perinatal outcomes, and postpartum course are compared in non-Korean and Korean women. While Koreans and non-Koreans with GDM share pathophysiology and complications, there may be differences in the role of obesity and thus the effectiveness of interventions targeting obesity in GDM women. Further investigations of the effectiveness of weight loss interventions and pharmacotherapy specifically among Korean women are needed. Dietary and other lifestyle data from Korean populations could inform prevention and treatment strategies in other countries which suffer from significantly higher prevalences of GDM.
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Affiliation(s)
- Catherine Kim
- Department of Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI, USA
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Predicting the metabolic condition after gestational diabetes mellitus from oral glucose tolerance test curves shape. Ann Biomed Eng 2014; 42:1112-20. [PMID: 24473701 DOI: 10.1007/s10439-014-0979-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 01/17/2014] [Indexed: 02/01/2023]
Abstract
The objective of this feasibility study is to predict the metabolic condition in women with a history of gestational diabetes mellitus (GDM) from the shape of oral glucose tolerance test (OGTT) data. The rationale for this approach is that the evolution to a metabolic condition could be traceable in the shape of OGTT curves. 3-h OGTT data of 136 women with follow up, for a total of 401 OGTTs were analyzed. Subjects were classified as having normal (NGT) or non-normal glucose tolerance (NON-NGT), according to the American Diabetes Association criteria. The measured glucose, insulin, C-peptide data and combination of them were used to build up NGT and NON-NGT reference curves. Similarity between reference and individual OGTT-based curves was calculated using the Kullback-Leibler divergence. Our findings suggest that the shape of OGTT curves (1) contains information on the evolution to disease and (2) could be a reliable indicator to predict with high sensitivity (75%) and high specificity (69%) the metabolic condition of women with a history of GDM. In the future, the proposed shape-based prediction could be easily translated to the clinical practice, because it does not require the intervention of an operator specifically trained, thus facilitating its application in a clinical setting and ultimately empowering risk estimation, by improving/complementing the information which is currently adopted for risk stratification after pregnancy with GDM.
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Kwak SH, Choi SH, Kim K, Jung HS, Cho YM, Lim S, Cho NH, Kim SY, Park KS, Jang HC. Prediction of type 2 diabetes in women with a history of gestational diabetes using a genetic risk score. Diabetologia 2013; 56:2556-63. [PMID: 24057154 DOI: 10.1007/s00125-013-3059-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 09/04/2013] [Indexed: 12/25/2022]
Abstract
AIMS/HYPOTHESIS Women with a history of gestational diabetes mellitus (GDM) are at increased risk of future development of type 2 diabetes. Recently, over 65 genetic variants have been confirmed to be associated with diabetes. We investigated whether this genetic information could improve the prediction of future diabetes in women with GDM. METHODS This was a prospective cohort study consisting of 395 women with GDM who were followed annually with an OGTT. A weighted genetic risk score (wGRS), consisting of 48 variants, was assessed for improving discrimination (C statistic) and risk reclassification (continuous net reclassification improvement [NRI] index) when added to clinical risk factors. RESULTS Among the 395 women with GDM, 116 (29.4%) developed diabetes during a median follow-up period of 45 months. Women with GDM who went on to develop diabetes had a significantly higher wGRS than those who did not (9.36 ± 0.92 vs 8.78 ± 1.07; p < 1.56 × 10(-7)). In a complex clinical model adjusted for age, prepregnancy BMI, family history of diabetes, blood pressure, fasting glucose and fasting insulin concentration, the C statistic marginally improved from 0.741 without the wGRS to 0.775 with the wGRS (p = 0.015). The addition of the wGRS to the clinical model resulted in a modest improvement in reclassification (continuous NRI 0.430 [95% CI 0.218, 0.642]; p = 7.0 × 10(-5)). CONCLUSIONS/INTERPRETATION In women with GDM, who are at high risk of diabetes, the wGRS was significantly associated with the future development of diabetes. Furthermore, it improved prediction over clinical risk factors.
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Affiliation(s)
- Soo Heon Kwak
- Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-Ro, Chongno-Gu, Seoul, 110-744, South Korea
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