1
|
Creswell L, Rolnik DL, Burke B, Daly S, O'Gorman N. Perinatal and neonatal outcomes of high-risk asymptomatic women from a specialist preterm birth surveillance clinic. Eur J Obstet Gynecol Reprod Biol 2024; 296:114-119. [PMID: 38428382 DOI: 10.1016/j.ejogrb.2024.02.047] [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: 11/27/2023] [Revised: 02/10/2024] [Accepted: 02/25/2024] [Indexed: 03/03/2024]
Abstract
OBJECTIVES To report the perinatal outcomes of high-risk asymptomatic women who attended a specialist preterm surveillance clinic (PSC) to undergo screening for spontaneous preterm birth (PTB) in Ireland. METHODS Single center, retrospective cohort study of asymptomatic high risk women who attended the PSC between January 2019 and December 2022. A comprehensive database of all patients who attended the clinic during the study period was constructed and analyzed. Overall outcomes were reported, and stratified per the occurrence of preterm or term birth. Iatrogenic PTBs were included in the outcome data. RESULTS Following exclusions for loss-to-follow-up, 762 cases were analyzed, constituting 2262 PSC visits. Of those, 183 women were prescribed progesterone (24.0 %), and 100 women underwent cervical cerclage (13.1 %) to prevent spontaneous PTB. Overall, 2.4 %, 6.2 % and 18.6 % of participants gave birth prior to 30 weeks, 34 weeks, and 37 weeks, respectively. The median gestational age at birth for the entire cohort was 38.6 weeks (inter-quartile range (IQR) 37.2-39.6 weeks). Women who delivered < 37 weeks were significantly more likely to be smokers (p = 0.030), have a previous spontaneous PTB (p = 0.016), have multiple pregnancies (p < 0.001), type 1 or 2 diabetes (p = 0.044), or have a previous full dilatation caesarean section birth (p = 0.024). Infants born prior to 37 weeks were more likely to have a lower median birthweight (2270 vs 3300 g, p < 0.001), be admitted to a neonatal intensive care unit (53.8 % vs 2.3 %, p < 0.001) or experience short-term morbidity, including respiratory support (38.0 % vs 1.6 %, p < 0.001). CONCLUSIONS Over 80% of women deemed to be at high risk of PTB gave birth at term gestations following attendance at a PSC during pregnancy. Most women can be successfully managed without interventions, instead employing a policy of serial cervical surveillance, to identify those at greatest risk of PTB.
Collapse
Affiliation(s)
- L Creswell
- Department of Obstetrics and Gynecology, The Coombe Hospital, Dublin, Ireland.
| | - D L Rolnik
- Department of Obstetrics and Gynecology, Monash University, Melbourne, Australia
| | - B Burke
- Department of Obstetrics and Gynecology, The Coombe Hospital, Dublin, Ireland
| | - S Daly
- Department of Obstetrics and Gynecology, The Coombe Hospital, Dublin, Ireland
| | - N O'Gorman
- Department of Obstetrics and Gynecology, The Coombe Hospital, Dublin, Ireland
| |
Collapse
|
2
|
Costa RM, Cerqueira DM, Francis L, Bruder-Nascimento A, Alves JV, Sims-Lucas S, Ho J, Bruder-Nascimento T. In utero exposure to maternal diabetes exacerbates dietary sodium intake-induced endothelial dysfunction by activating cyclooxygenase 2-derived prostanoids. Am J Physiol Endocrinol Metab 2024; 326:E555-E566. [PMID: 38446637 DOI: 10.1152/ajpendo.00009.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 03/04/2024] [Accepted: 03/05/2024] [Indexed: 03/08/2024]
Abstract
Prenatal exposure to maternal diabetes has been recognized as a significant cardiovascular risk factor, increasing the susceptibility to the emergence of conditions such as high blood pressure, atherosclerosis, and heart disease in later stages of life. However, it is unclear if offspring exposed to diabetes in utero have worse vascular outcomes on a high-salt (HS) diet. To test the hypothesis that in utero exposure to maternal diabetes predisposes to HS-induced vascular dysfunction, we treated adult male wild-type offspring (DM_Exp, 6 mo old) of diabetic Ins2+/C96Y mice (Akita mice) with HS (8% sodium chloride, 10 days) and analyzed endothelial function via wire myograph and cyclooxygenase (COX)-derived prostanoids pathway by ELISA, quantitative PCR, and immunochemistry. On a regular diet, DM_Exp mice did not manifest any vascular dysfunction, remodeling, or inflammation. However, HS increased aortic contractility to phenylephrine and induced endothelial dysfunction (analyzed by acetylcholine-induced endothelium-dependent relaxation), vascular hydrogen peroxide production, COX2 expression, and prostaglandin E2 (PGE2) overproduction. Interestingly, ex vivo antioxidant treatment (tempol) or COX1/2 (indomethacin) or COX2 (NS398) inhibitors improved or reverted the endothelial dysfunction in DM_Exp mice fed a HS diet. Finally, DM_Exp mice fed with HS exhibited greater circulating cytokines and chemokines accompanied by vascular inflammation. In summary, our findings indicate that prenatal exposure to maternal diabetes predisposes to HS-induced vascular dysfunction, primarily through the induction of oxidative stress and the generation of COX2-derived PGE2. This supports the concept that in utero exposure to maternal diabetes is a cardiovascular risk factor in adulthood.NEW & NOTEWORTHY Using a unique mouse model of prenatal exposure to maternal type 1 diabetes, our study demonstrates the novel observation that prenatal exposure to maternal diabetes results in a predisposition to high-salt (HS) dietary-induced vascular dysfunction and inflammation in adulthood. Mechanistically, we demonstrated that in utero exposure to maternal diabetes and HS intake induces vascular oxidative stress, cyclooxygenase-derived prostaglandin E2, and inflammation.
Collapse
Affiliation(s)
- Rafael M Costa
- Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
- Center for Pediatrics Research in Obesity and Metabolism, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
- Endocrinology Division, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
- Institute of Health Sciences, Federal University of Jatai, Jatai, Goiás, Brazil
| | - Débora Malta Cerqueira
- Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
- Nephrology Division, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Lydia Francis
- Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
- Nephrology Division, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Ariane Bruder-Nascimento
- Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
- Center for Pediatrics Research in Obesity and Metabolism, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
- Endocrinology Division, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
- Institute of Health Sciences, Federal University of Jatai, Jatai, Goiás, Brazil
| | - Juliano V Alves
- Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
- Center for Pediatrics Research in Obesity and Metabolism, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
- Endocrinology Division, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
- Institute of Health Sciences, Federal University of Jatai, Jatai, Goiás, Brazil
| | - Sunder Sims-Lucas
- Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
- Nephrology Division, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Jacqueline Ho
- Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
- Nephrology Division, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Thiago Bruder-Nascimento
- Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
- Center for Pediatrics Research in Obesity and Metabolism, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
- Endocrinology Division, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
- Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| |
Collapse
|
3
|
Knorr S, Aalders J, Overgaard M, Støvring H, Mathiesen ER, Damm P, Clausen TD, Bjerre-Christensen U, Andersen LLT, Vinter C, Kofoed-Enevoldsen A, Lauenborg J, Kampmann U, Fuglsang J, Ovesen PG, Christensen TT, Sørensen A, Ringholm L, Jensen DM. Danish Diabetes Birth Registry 2: a study protocol of a national prospective cohort study to monitor outcomes of pregnancies of women with pre-existing diabetes. BMJ Open 2024; 14:e082237. [PMID: 38670616 PMCID: PMC11057310 DOI: 10.1136/bmjopen-2023-082237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 03/28/2024] [Indexed: 04/28/2024] Open
Abstract
INTRODUCTION Despite technological developments and intensified care, pregnancies in women with pre-existing diabetes are still considered high-risk pregnancies. The rate of adverse outcomes in pregnancies affected by diabetes in Denmark is currently unknown, and there is a limited understanding of mechanisms contributing to this elevated risk. To address these gaps, the Danish Diabetes Birth Registry 2 (DDBR2) was established. The aims of this registry are to evaluate maternal and fetal-neonatal outcomes based on 5 years cohort data, and to identify pathophysiology and risk factors associated with short-term and long-term outcomes of pregnancies in women with pre-existing diabetes. METHODS AND ANALYSIS The DDBR2 registry is a nationwide 5-year prospective cohort with an inclusion period from February 2023 to February 2028 of pregnancies in women with all types of pre-existing diabetes and includes registry, clinical and questionnaire data and biological samples of mother-partner-child trios. Eligible families (parents age ≥18 years and sufficient proficiency in Danish or English) can participate by either (1) basic level data obtained from medical records (mother and child) and questionnaires (partner) or (2) basic level data and additional data which includes questionnaires (mother and partner) and blood samples (all). The primary maternal outcome is Hemoglobin A1c (HbA1c) levels at the end of pregnancy and the primary offspring endpoint is the birth weight SD score. The DDBR2 registry will be complemented by genetic, epigenetic and metabolomic data as well as a biobank for future research, and the cohort will be followed through data from national databases to illuminate possible mechanisms that link maternal diabetes and other parental factors to a possible increased risk of adverse long-term child outcomes. ETHICS AND DISSEMINATION Approval from the Ethical Committee is obtained (S-20220039). Findings will be sought published in international scientific journals and shared among the participating hospitals and policymakers. TRIAL REGISTRATION NUMBER NCT05678543.
Collapse
Affiliation(s)
- Sine Knorr
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jori Aalders
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Martin Overgaard
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Clinical Biochemistry, Odense University Hospital, Odense, Syddanmark, Denmark
| | - Henrik Støvring
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Elisabeth R Mathiesen
- Center for Pregnant Women with Diabetes, Department of Endocrinology and Metabolism, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Peter Damm
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Center for Pregnant Women with Diabetes, Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Tine D Clausen
- Center for Pregnant Women with Diabetes, Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | | | - Lise Lotte T Andersen
- Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
| | - Christina Vinter
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
| | | | - Jeannet Lauenborg
- Department of Obstetrics and Gynecology, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - Ulla Kampmann
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jens Fuglsang
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus N, Denmark
| | - Per G Ovesen
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus N, Denmark
| | - Trine T Christensen
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
| | - Anne Sørensen
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Lene Ringholm
- Center for Pregnant Women with Diabetes, Department of Endocrinology and Metabolism, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Dorte M Jensen
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
4
|
Provendier A, Migliorelli F, Loussert L, Boileau BG, Vayssiere C, Hamdi SM, Hanaire H, Dupuis N, Guerby P. The sFLT-1/PlGF Ratio for the Prediction of Preeclampsia-Related Adverse Fetal and Maternal Outcomes in Women with Preexisting Diabetes. Reprod Sci 2024:10.1007/s43032-024-01540-9. [PMID: 38605263 DOI: 10.1007/s43032-024-01540-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 04/02/2024] [Indexed: 04/13/2024]
Abstract
To evaluate the predictive value of the sFlt-1/PlGF ratio for the prediction of preeclampsia in women with preexisting diabetes mellitus. This is a monocentric retrospective observational study conducted between January 2018 and December 2020. All singleton pregnancies with preexisting diabetes mellitus, who had a dosage of the sFlt-1/PlGF ratio between 30 and 34 + 6 weeks of gestation were included. The principal outcome was preeclampsia. The secondary outcomes were preterm preeclampsia, gestational hypertension, placental abruption, intrauterine fetal death, IUGR, small for gestational age and a composite outcome named "hypertensive disorder of pregnancy" including gestational hypertension, preeclampsia and HELLP syndrome (hemolysis, elevated liver enzymes and low platelet count). Of 63 patients, 22% presented preeclampsia. The area under the curve of sFlt-1/PlGF ratio was 0.90 (95% CI: 0.79-0.96) for the prediction of preeclampsia. The receiver operator characteristic analysis suggested that the optimal sFlt-1/PlGF cutoff to predict preeclampsia was 29, with a sensitivity of 86% (95% CI: 60.1-96.0) and a specificity of 92% (95% CI: 80.8-96.8). A cut-off of 38 provided a sensitivity of 71% (95% CI: 45.4-88.3), a specificity of 92% (95% CI: 80.8-96.8). Further analysis using multivariable methods revealed nephropathy was significantly associated with PE (p = 0.014). The use of the sFlt-1/PlGF ratio during the third trimester of pregnancy seems to be of interest as a prognostic tool to improve multidisciplinary management of patients with preexisting diabetes mellitus.
Collapse
Affiliation(s)
- Anais Provendier
- Department of Obstetrics and Gynecology, Paule de Viguier maternity, CHU Toulouse, 330 avenue de Grande-Bretagne, 70034 31059, Toulouse, TSA, France
| | - Federico Migliorelli
- Department of Obstetrics and Gynecology, Paule de Viguier maternity, CHU Toulouse, 330 avenue de Grande-Bretagne, 70034 31059, Toulouse, TSA, France
| | - Lola Loussert
- Department of Obstetrics and Gynecology, Paule de Viguier maternity, CHU Toulouse, 330 avenue de Grande-Bretagne, 70034 31059, Toulouse, TSA, France
| | - Béatrice Guyard Boileau
- Department of Obstetrics and Gynecology, Paule de Viguier maternity, CHU Toulouse, 330 avenue de Grande-Bretagne, 70034 31059, Toulouse, TSA, France
| | - Christophe Vayssiere
- Department of Obstetrics and Gynecology, Paule de Viguier maternity, CHU Toulouse, 330 avenue de Grande-Bretagne, 70034 31059, Toulouse, TSA, France
| | - Safouane M Hamdi
- Department of Biochemistry and Hormonology, University Paul Sabatier, Toulouse, France
| | - Hélène Hanaire
- Department of Endocrinology and Diabetology, University Paul Sabatier, Toulouse, France
| | - Ninon Dupuis
- Department of Obstetrics and Gynecology, Paule de Viguier maternity, CHU Toulouse, 330 avenue de Grande-Bretagne, 70034 31059, Toulouse, TSA, France
| | - Paul Guerby
- Department of Obstetrics and Gynecology, Paule de Viguier maternity, CHU Toulouse, 330 avenue de Grande-Bretagne, 70034 31059, Toulouse, TSA, France.
- Toulouse Institute for Infectious and Inflammatory Diseases, Inserm UMR 1291 - CNRS UMR 5051- University Toulouse III, Toulouse, France.
| |
Collapse
|
5
|
Finnegan C, Dicker P, Asandei D, Higgins M, O'Gorman N, O' Riordan M, Dunne F, Gaffney G, Newman C, McAuliffe F, Ciprike V, Fernandez E, Malone FD, Breathnach FM. The IRELAnD study-investigating the role of early low-dose aspirin in diabetes mellitus: a double-blinded, placebo-controlled, randomized trial. Am J Obstet Gynecol MFM 2024; 6:101297. [PMID: 38461094 DOI: 10.1016/j.ajogmf.2024.101297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 01/19/2024] [Indexed: 03/11/2024]
Abstract
BACKGROUND Although aspirin therapy is being increasingly advocated with the intention of risk modification for a wide range of pregnancy complications, women with prepregnancy diabetes mellitus are commonly excluded from clinical trials. OBJECTIVE The primary aim of this study was to examine the effect of aspirin therapy on a composite measure of adverse perinatal outcome in pregnancies complicated by pregestational diabetes mellitus. STUDY DESIGN A double-blinded, placebo-controlled randomized trial was conducted at 6 university-affiliated perinatology centers. Women with type 1 diabetes mellitus or type 2 diabetes mellitus of at least 6 months' duration were randomly allocated to 150-mg daily aspirin or placebo from 11 to 14 weeks' gestation until 36 weeks. Established vascular complications of diabetes mellitus, including chronic hypertension or nephropathy, led to exclusion from the trial. The primary outcome was a composite measure of placental dysfunction (preeclampsia, fetal growth restriction, preterm birth <34 weeks' gestation, or perinatal mortality). The planned sample size was 566 participants to achieve a 35% reduction in the primary outcome, assuming 80% statistical power. Secondary end points included maternal and neonatal outcomes and determination of insulin requirements across gestation. Data were centrally managed using ClinInfo and analyzed using SAS 9.4. The 2 treatment groups were compared using t tests or chi-square tests, as required, and longitudinal data were compared using a repeated-measures analysis. RESULTS From February 2020 to September 2022, 191 patients were deemed eligible, 134 of whom were enrolled (67 randomized to aspirin and 67 to placebo) with a retrospective power of 64%. A total of 101 (80%) women had type 1 diabetes mellitus and 25 (20%) had type 2 diabetes mellitus. Reaching the target sample size was limited by the impact of the COVID-19 pandemic. Baseline characteristics were similar between the aspirin and placebo groups. Treatment compliance was very high and similar between groups (97% for aspirin, 94% for placebo). The risk of the composite measure of placental dysfunction did not differ between groups (25% aspirin vs 21% placebo; P=.796). Women in the aspirin group had significantly lower insulin requirements throughout pregnancy compared with the placebo group. Insulin requirements in the aspirin group increased on average from 0.7 units/kg at baseline to 1.1 units/kg by 36 weeks' gestation (an average 83% within-patient increase), and increased from 0.7 units/kg to 1.3 units/kg (a 181% within-patient increase) in the placebo group, over the same gestational period (P=.002). Serial hemoglobin A1c levels were lower in the aspirin group than in the placebo group, although this trend did not reach statistical significance. CONCLUSION In this multicenter, double-blinded, placebo-controlled randomized trial, aspirin did not reduce the risk of adverse perinatal outcome in pregnancies complicated by prepregnancy diabetes mellitus. Compared with the placebo group, aspirin-treated patients required significantly less insulin throughout pregnancy, indicating a beneficial effect of aspirin on glycemic control. Aspirin may exert a plausible placenta-mediated effect on pregestational diabetes mellitus that is not limited to its antithrombotic properties.
Collapse
Affiliation(s)
- Catherine Finnegan
- RCSI Fetal Centre, Rotunda Hospital, Dublin, Ireland (PhD Finnegan, MSc Dicker, MPhil Asandei, MD Breathnach and MD Malone).
| | - Patrick Dicker
- RCSI Fetal Centre, Rotunda Hospital, Dublin, Ireland (PhD Finnegan, MSc Dicker, MPhil Asandei, MD Breathnach and MD Malone)
| | - Denisa Asandei
- RCSI Fetal Centre, Rotunda Hospital, Dublin, Ireland (PhD Finnegan, MSc Dicker, MPhil Asandei, MD Breathnach and MD Malone)
| | - Mary Higgins
- UCD Perinatal Research Centre, University College Dublin, National Maternity Hospital, Dublin, Ireland (MD Higgins and FRCOG McAuliffe)
| | - Neil O'Gorman
- Coombe Women and Infants University Hospital, Dublin, Ireland (MD O'Gorman)
| | - Mairead O' Riordan
- Infant Research Centre, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland (MRCOG O' Riordan)
| | - Fidelma Dunne
- University College Hospital Galway, Galway, Ireland (PhD Dunne, MD Gaffney, and MD Newman)
| | - Geraldine Gaffney
- University College Hospital Galway, Galway, Ireland (PhD Dunne, MD Gaffney, and MD Newman)
| | - Christine Newman
- University College Hospital Galway, Galway, Ireland (PhD Dunne, MD Gaffney, and MD Newman)
| | - Fionnuala McAuliffe
- UCD Perinatal Research Centre, University College Dublin, National Maternity Hospital, Dublin, Ireland (MD Higgins and FRCOG McAuliffe)
| | - Vineta Ciprike
- Our Lady of Lourdes Hospital, Drogheda, Ireland (MD Ciprike)
| | | | - Fergal D Malone
- RCSI Fetal Centre, Rotunda Hospital, Dublin, Ireland (PhD Finnegan, MSc Dicker, MPhil Asandei, MD Breathnach and MD Malone)
| | - Fionnuala M Breathnach
- RCSI Fetal Centre, Rotunda Hospital, Dublin, Ireland (PhD Finnegan, MSc Dicker, MPhil Asandei, MD Breathnach and MD Malone)
| |
Collapse
|
6
|
Schiller T, Gassner T, Winter Shafran Y, Knobler H, Schiller O, Kirzhner A. Prenatal Breastfeeding Counseling Intervention in Women with Pre-Gestational Diabetes Mellitus-A Randomized Controlled Trial. Healthcare (Basel) 2024; 12:406. [PMID: 38338291 PMCID: PMC10855396 DOI: 10.3390/healthcare12030406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 01/31/2024] [Accepted: 02/02/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Data on breastfeeding rates and targeted interventions in women with pre-gestational diabetes mellitus are inconclusive. The aim of the study was to evaluate breastfeeding rates up to one year postpartum and whether targeted counseling towards the end of pregnancy can impact breastfeeding rates and duration. An additional goal was to evaluate whether counseling affected women's perceptions regarding breastfeeding. METHODS Women with pre-gestational diabetes mellitus were cluster-randomized between 32 and 36 weeks of gestation, either to face-to-face instruction with a certified lactation consultant or to receive written information on breastfeeding. Thirty-eight women without diabetes served as controls and were given written information on breastfeeding. All women filled out a questionnaire regarding intended breastfeeding duration, exclusivity, and perceptions, before intervention and at three, six, and twelve months post-partum. RESULTS Fifty-two women with pre-gestational diabetes mellitus consented to participate. All completed the questionnaires, 26 in each group. At three, six, and twelve months postpartum, rates of any breastfeeding were around 60%, 50%, and 30%, respectively. Approximately one-third breastfed exclusively in each group at three and six months. No significant difference in breastfeeding rates was noted between face-to-face instruction, written information, and controls. End-of-pregnancy counseling improved confidence in breastfeeding knowledge and confidence in being able to manage blood glucose. CONCLUSIONS Breastfeeding rates in pre-gestational diabetes mellitus were comparable to those of women without diabetes and were unchanged by mode of instruction at the end of pregnancy. However, targeted diabetes-oriented breastfeeding instruction at the end of pregnancy improved knowledge and confidence among women with pre-gestational diabetes mellitus.
Collapse
Affiliation(s)
- Tal Schiller
- Department of Diabetes, Endocrinology and Metabolism, Kaplan Medical Center, Rehovot 7661041, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9160401, Israel
| | - Tali Gassner
- Department of Diabetes, Endocrinology and Metabolism, Kaplan Medical Center, Rehovot 7661041, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9160401, Israel
| | - Yael Winter Shafran
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9160401, Israel
- Obstetric and Gynecology Department, Kaplan Medical Center, Faculty of Medicine, Rehovot 7661041, Israel
| | - Hilla Knobler
- Department of Diabetes, Endocrinology and Metabolism, Kaplan Medical Center, Rehovot 7661041, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9160401, Israel
| | - Ofer Schiller
- Pediatric Cardiac Intensive Care Unit, Schneider Children’s Medical Center of Israel, Petah Tikva 4941492, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Alena Kirzhner
- Department of Diabetes, Endocrinology and Metabolism, Kaplan Medical Center, Rehovot 7661041, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9160401, Israel
- Department of Medicine A, Kaplan Medical Center, Faculty of Medicine, Rehovot 7661041, Israel
| |
Collapse
|
7
|
Nandam N, Thung S, Venkatesh KK, Gabbe S, Ma J, Peng J, Dungan K, Buschur EO. Tandem T:Slim X2 Insulin Pump Use in Clinical Practice Among Pregnant Individuals With Type 1 Diabetes: A Retrospective Observational Cohort Study. Cureus 2024; 16:e52369. [PMID: 38361690 PMCID: PMC10868538 DOI: 10.7759/cureus.52369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Insulin pump use is increasing in frequency among pregnant individuals with type 1 diabetes (T1D). Automated insulin delivery (AID) technologies have not been studied extensively in pregnancy. METHOD We present a retrospective case series of eight individuals with T1D who used the Tandem t:slim X2 insulin pump (Tandem Diabetes Care, Inc., CA, USA) during pregnancy. Weekly continuous glucose monitor and insulin pump data were analyzed from electronic medical records and data-sharing portals. Safety, glycemic control, and pregnancy outcomes were examined with both the control IQ (CIQ) and basal IQ (BIQ) algorithms. RESULTS Six CIQ and two BIQ users were studied. The mean glycated hemoglobin (A1C) during pregnancy was 6.1%, and the average time in pregnancy-recommended glycemic range (TIR; 63-140mg/dL) was 67.9%. There were no instances of diabetic ketoacidosis or severe hypoglycemia. CIQ users had a higher mean sensor glucose (127.6 mg/dL) compared to BIQ participants (118.4 mg/dL). However, the average time below range (<63 mg/dL) was 6.1% in BIQ participants compared to 1.5% in CIQ participants. CIQ participants used several strategies to achieve glycemic targets, including daytime use of sleep activity. An increased basal-to-bolus insulin ratio was negatively correlated with TIR (r=-0.415). CONCLUSIONS Tandem t:slim X2 insulin pumps were safely used during pregnancy in eight individuals with T1D, with variable success in achieving recommended glycemic targets. Further research is needed to understand differences in CIQ and BIQ use in pregnancy. AID device manufacturers must additionally develop further methods to target lower glucose for pregnant users.
Collapse
Affiliation(s)
- Neeharika Nandam
- Department of Endocrinology, Diabetes, and Metabolism, Cleveland Clinic, Cleveland, USA
| | - Stephen Thung
- Division of Maternal Fetal-Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, Bridgeport, USA
| | - Kartik K Venkatesh
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Ohio State University Wexner Medical Center, Columbus, USA
| | - Steven Gabbe
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Ohio State University Wexner Medical Center, Columbus, USA
| | - Jianing Ma
- Center for Biostatistics, Ohio State University Wexner Medical Center, Columbus, USA
| | - Jing Peng
- Center for Biostatistics, Ohio State University Wexner Medical Center, Columbus, USA
| | - Kathleen Dungan
- Division of Endocrinology, Diabetes, and Metabolism, Ohio State University Wexner Medical Center, Columbus, USA
| | - Elizabeth O Buschur
- Division of Endocrinology, Diabetes, and Metabolism, Ohio State University Wexner Medical Center, Columbus, USA
| |
Collapse
|
8
|
Huang R, Xiao L, Zhu J, Cheng J, Torrie J, McHugh NGL, Auger N, Luo ZC. Population-based birth cohort study on diabetes in pregnancy and infant hospitalisations in Cree, other First Nations and non-Indigenous communities in Quebec. BMJ Open 2023; 13:e074518. [PMID: 38040430 PMCID: PMC10693854 DOI: 10.1136/bmjopen-2023-074518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 11/08/2023] [Indexed: 12/03/2023] Open
Abstract
OBJECTIVES Diabetes in pregnancy, whether pre-gestational (chronic) or gestational (de novo hyperglycaemia), increases the risk of adverse birth outcomes. It is unclear whether gestational diabetes increases the risk of postnatal morbidity in infants. Cree First Nations in Quebec are at high risk for diabetes in pregnancy. We assessed whether pre-gestational or gestational diabetes may increase infant hospitalisation (an infant morbidity indicator) incidence, and whether this may be related to more frequent infant hospitalisations in Cree and other First Nations in Quebec. DESIGN Population-based birth cohort study through administrative health data linkage. SETTING AND PARTICIPANTS Singleton infants (≤1 year) born to mothers in Cree (n=5070), other First Nations (9910) and non-Indigenous (48 200) communities in rural Quebec. RESULTS Both diabetes in pregnancy and infant hospitalisation rates were much higher comparing Cree (23.7% and 29.0%) and other First Nations (12.4% and 34.1%) to non-Indigenous (5.9% and 15.5%) communities. Compared with non-diabetes, pre-gestational diabetes was associated with an increased risk of any infant hospitalisation to a greater extent in Cree and other First Nations (relative risk (RR) 1.56 (95% CI 1.28 to 1.91)) than non-Indigenous (RR 1.26 (1.15 to 1.39)) communities. Pre-gestational diabetes was associated with increased risks of infant hospitalisation due to diseases of multiple systems in all communities. There were no significant associations between gestational diabetes and risks of infant hospitalisation in all communities. The population attributable risk fraction of infant hospitalisations (overall) for pre-gestational diabetes was 6.2% in Cree, 1.6% in other First Nations and 0.3% in non-Indigenous communities. CONCLUSIONS The study is the first to demonstrate that pre-gestational diabetes increases the risk of infant hospitalisation overall and due to diseases of multiple systems, but gestational diabetes does not. High prevalence of pre-gestational diabetes may partly account for the excess infant hospitalisations in Cree and other First Nations communities in Quebec.
Collapse
Affiliation(s)
- Rong Huang
- Department of Obstetrics and Gynecology, Lunenfeld-Tanenbaum Research Institute, Prosserman Population Health Center, Mount Sinai Hospital, Institute of Health Policy, Management and Evaluation, Dalla Luna School of Public Health, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Obstetrics and Gynecology, Sainte-Justine Hospital, Montreal, Québec, Canada
| | - Lin Xiao
- Sainte-Justine Hospital Research Center, Montreal, Québec, Canada
| | - Jane Zhu
- Department of Obstetrics and Gynecology, Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Justin Cheng
- Department of Obstetrics and Gynecology, Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jill Torrie
- Public-Health Department, Cree Board of Health and Social Services of James Bay, Mistissini, Quebec, Canada
| | - Nancy Gros-Louis McHugh
- First Nations of Quebec and Labrador Health and Social Service Commission, Wendake, Quebec, Canada
| | - Nathalie Auger
- University of Montreal Hospital Centre Research Centre, Montreal, Québec, Canada
| | - Zhong-Cheng Luo
- Department of Obstetrics and Gynecology, Lunenfeld-Tanenbaum Research Institute, Prosserman Population Health Center, Mount Sinai Hospital, Institute of Health Policy, Management and Evaluation, Dalla Luna School of Public Health, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Obstetrics and Gynecology, Sainte-Justine Hospital, Montreal, Québec, Canada
| |
Collapse
|
9
|
Chou HH, Chen CC, Tsai CF, Kuo PL, Chiou YY. Associations between maternal chronic diseases and congenital anomalies of the kidney and urinary tract in offspring: a population-based cohort study. Clin Kidney J 2023; 16:2652-2660. [PMID: 38046024 PMCID: PMC10689185 DOI: 10.1093/ckj/sfad217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Indexed: 12/05/2023] Open
Abstract
Background The relationship between maternal chronic diseases and congenital anomalies of the kidneys and urinary tract (CAKUT) in offspring still needs elucidation. This study aimed to comprehensively evaluate the associations between maternal chronic disease and CAKUT in their offspring. Methods Data of mothers and children were extracted from the Taiwan Maternal and Child Health Database and National Health Insurance Research Database. The concept of developmental origins of health and disease (DOHaD) was used to select maternal chronic diseases. Results The study cohort included 1 196 175 mothers and 1 628 706 offspring. Analysis showed that maternal chronic diseases, especially type 1 diabetes, type 2 diabetes, gestational diabetes, connective tissue disorders and CAKUT were highly associated with CAKUT in the offspring. Higher maternal age, abnormal birthweight (>3500 g or <2500 g), gestational age <36 weeks and birth order <2 were all associated with a higher risk of CAKUT. Maternal chronic hypertension and taking angiotensin-related drugs increased the odds ratios of obstructive kidney disease in the offspring. Offspring tended to have the same type of CAKUT as their mothers. Conclusion Maternal chronic diseases, older maternal age and abnormal birthweight are risk factors for CAKUT. Also, a percentage of patients with CAKUT were not full-term newborns. Results support prenatal counselling and health management of pregnant women with chronic diseases and extra care for infants with a high risk of anomalies. It is strongly recommended that prevention of CAKUT in offspring should start with care of the mothers' prenatal chronic diseases.
Collapse
Affiliation(s)
- Hsin-Hsu Chou
- Department of Pediatrics, Ditmanson Medical Foundation Chiayi Christian Hospital, Chia-Yi City, Taiwan
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung City, Taiwan
| | - Chih-Chia Chen
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
- Department of Pediatrics, Division of Pediatric Nephrology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Ching-Fang Tsai
- Department of Medical Research, Clinical Data Center, Ditmanson Medical Foundation Chiayi Christian Hospital, Chia-Yi City, Taiwan
| | - Pao-Lin Kuo
- Department of Obstetrics and Gynecology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Yuan-Yow Chiou
- Department of Pediatrics, Division of Pediatric Nephrology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| |
Collapse
|
10
|
Guibert C, Amoura L, Rakotoarisoa L, Plat F, Sonnet E, Lablanche S, Tréglia C, Sarde E, Leca V, Rimareix F, Melki V, Baucher F, Betari B, Meyer L, Kessler L. MiniMed TM 780G Advanced Hybrid Closed-Loop System Study in Pregnant Women with Type 1 Diabetes. Diabetes Technol Ther 2023; 25:893-901. [PMID: 37956265 DOI: 10.1089/dia.2023.0267] [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: 11/15/2023]
Abstract
Background: Evaluate the impact of the MiniMed™ 780G advanced hybrid closed-loop (AHCL) system on the glucose profile of pregnant women with type 1 diabetes (T1D) and maternal-neonatal complications. Methods: From April 2021 to September 2022, pregnant women with T1D treated with the AHCL system were included in an observational multicenter retrospective study. Continuous glucose monitoring parameters were analyzed monthly during pregnancy as well as maternal-neonatal complications. Results: Thirteen pregnant women, including a twin pregnancy (age: 33 ± 3 years, hemoglobin A1c [HbA1c]: 7.3% ± 0.7%, insulin doses: 0.72 ± 0.21 U/kg/day) were analyzed. At delivery, gestational age was 37 ± 2 weeks. During first 2 weeks of pregnancy, time in range (TIR, 63-140 mg/dL) was 46% (34-55) and increased to 54% (51-59) (P < 0.01), 64% (48-68) (P < 0.01), and 66% (60-70) (P < 0.001) during the first, second, and third trimester, respectively. During the night, TIR (63-140 mg/dL) was >70% throughout pregnancy. Time below the range <63 mg/dL increased from 0.5% (0-2) to 1.3% (0.7-2.2), 2% (1.2-3.5) (P < 0.05), and 1.3% (1.31-3) (P < 0.05) during the first, second, and third trimester, respectively. At delivery, insulin doses increased to 0.89 ± 0.35 IU/kg/day (P < 0.01), and HbA1c decreased to 6.4% ± 0.6% (P = 0.005). The reported carbohydrate amount increased from 167 ± 363 g/d during early pregnancy to 243 ± 106 g/d (P < 0.01) at delivery. The birthweight was 3134 ± 711 g, with 5/14 macrosomia and 2/14 neonatal hypoglycemia. Moreover, 5/13 patients had a preeclampsia and 9/13 a cesarean section, including three cases of scarred uterus. The Clinical Trial Registration number is: CE-2022-55. Conclusion: The AHCL system provided good glucose control during pregnancy and recommendation targets were reached during the nocturnal period only. The maternal and neonatal complications remained high.
Collapse
Affiliation(s)
- Clara Guibert
- Obstetrics and Gynecology Department, Diabetes, and Nutrition Department, University Hospital of Strasbourg, Strasbourg, France
| | - Lamia Amoura
- Endocrinology, Diabetes, and Nutrition Department, University Hospital of Strasbourg, Strasbourg, France
| | - Luc Rakotoarisoa
- Endocrinology, Diabetes, and Nutrition Department, University Hospital of Strasbourg, Strasbourg, France
- Regenerative Nanomedicine, Inserm UMR 1260, University of Strasbourg, Strasbourg, France
| | - Francoise Plat
- Department of Endocrinology and Metabolic Diseases, Hospital of Avignon, Avignon, France
| | - Emmanuel Sonnet
- Department of Endocrinology, University Hospital of Brest, Brest, France
| | - Sandrine Lablanche
- Department of Endocrinology, Grenoble University Hospital, Grenoble Alpes University, Grenoble, France
| | - Clémence Tréglia
- Department of Endocrinology, Conception Hospital, Marseille University Hospital, Marseille, France
| | - Elisa Sarde
- Endocrinology, Diabetes, and Nutrition Department, Hospital of Rayettes, Martigues, France
| | - Viviane Leca
- Endocrinology, Diabetes, and Nutrition Department, Hospital of Rayettes, Martigues, France
| | - Frédérique Rimareix
- Department of Endocrinology and Metabolic Diseases, Rangueil University Hospital, Toulouse, France
| | - Vincent Melki
- Department of Endocrinology and Metabolic Diseases, Rangueil University Hospital, Toulouse, France
| | - Franciane Baucher
- Department of Endocrinology, Saint Roch Medical Center, Cabestany, France
| | - Bouchra Betari
- Department of Endocrinology, Sud Francilien Hospital, Corbeil-Essonnes, France
| | - Laurent Meyer
- Endocrinology, Diabetes, and Nutrition Department, University Hospital of Strasbourg, Strasbourg, France
| | - Laurence Kessler
- Endocrinology, Diabetes, and Nutrition Department, University Hospital of Strasbourg, Strasbourg, France
- Regenerative Nanomedicine, Inserm UMR 1260, University of Strasbourg, Strasbourg, France
| |
Collapse
|
11
|
Citro F, Bianchi C, Nicolì F, Aragona M, Marchetti P, Di Cianni G, Bertolotto A. Advances in diabetes management: have pregnancy outcomes in women with type 1 diabetes changed in the last decades? Diabetes Res Clin Pract 2023; 205:110979. [PMID: 37890701 DOI: 10.1016/j.diabres.2023.110979] [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: 08/10/2023] [Revised: 10/12/2023] [Accepted: 10/24/2023] [Indexed: 10/29/2023]
Abstract
AIMS Over the recent years multiple therapeutic and management opportunities have been made available to treat pregnant women with Type 1 diabetes (T1DM). However, analyses assessing whether these different approaches may have any specific advantage/disadvantage in metabolic control and neonatal outcomes is still limited. The aim of this study was to compare metabolic control and neonatal outcomes in pregnant women with T1DM among different basal insulins (NPH vs. analogue), insulin administration ways [Multiple Daily Injections (MDI) vs. Continuous Subcutaneous Insulin Infusion (CSII)] and glucose monitoring systems [Self-Monitoring of Blood Glucose (SMBG) vs. real-time/intermittently scanned Continuous Glucose Monitoring (rtCGM/isCGM)]. METHODS A retrospective analysis on metabolic data and neonatal outcomes of 136 T1DM pregnant women (76% on MDI, based on NPH (51%) or analogue (49%); 24% on CSII; 24% using rtCGM/isCGM), managed between 2008 and 2020, was performed, comparing different therapeutic approaches. RESULTS Metabolic data and neonatal outcomes were comparable among women treated with different basal insulins. Women on CSII planned their pregnancy more frequently (82 vs. 60%; p = 0.043) and had better pregestational HbA1c (52 ± 5 vs. 60 ± 13 mmol/mol; p = 0.044) and first trimester HbA1c (48 ± 4 vs. 51 ± 8 mmol/mol; p = 0.047). Pregestational and first trimester HbA1c were also lower in women using rtCGM/isCGM (53 ± 8 vs. 58 ± 13 mmol/mol; p = 0.027 and 46 ± 5 vs. 51 ± 7 mmol/mol; p = 0.034, respectively). In the whole cohort, LGA risk was directly correlated to HbA1c at third trimester (correlation coefficient: 0.335, p = 0.001) and inversely correlated to the achievement of HbA1c target (≤6% [<42 mmol/mol]) at third trimester (correlation coefficient: - 0.367, p < 0.001). CONCLUSION Treatment with insulin analogs didn't significantly change metabolic control and neonatal outcomes in T1DM women, while CSII and rtCGM/isCGM can optimize preconception and first trimester pregnancy glycemic control. Irrespective of the therapeutic management, third trimester HbA1c remains the strongest risk factor for LGA.
Collapse
Affiliation(s)
- Fabrizia Citro
- Department of Clinical and Experimental Medicine, University of Pisa, Italy.
| | | | - Francesca Nicolì
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | | | - Piero Marchetti
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | | | | |
Collapse
|
12
|
Rathinavelu J, Sarvepalli SM, Bailey B, D'Alessio D, Hadziahmetovic M. The Impact of Pregnancy on Diabetic Retinopathy: A Single-Site Study of Clinical Risk Factors. Ophthalmic Res 2023; 66:1169-1180. [PMID: 37573783 PMCID: PMC10614555 DOI: 10.1159/000533416] [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: 03/28/2023] [Accepted: 07/25/2023] [Indexed: 08/15/2023]
Abstract
INTRODUCTION This study aimed to provide information on modifiable and non-modifiable risk factors for the progression and development of diabetic retinopathy (DR) and diabetic macular edema (DME). This retrospective chart review case-control study was designed to provide perspective on clinical variables. METHODS Single-center study analysis was completed with chart review, identifying 50 patients (100 eyes) ultimately included in the final analysis. Included patients were women with type 1 or 2 diabetes that entered prenatal care and had a delivery from January 2010 to December 2022. The primary outcome measure was clinical variables between progression and no progression groups. Data were analyzed via χ2 analysis and independent samples t test when appropriate. Significantly different variables were further analyzed by binary logistic regression. RESULTS The DR progression group had significantly higher prepregnancy HbA1c levels (9.9) when compared to the no progression group (8.5, p value 0.028). DR progression group also had higher rates (51.9%) of full-term births. The DME progression group had significantly higher rates of type 2 diabetics (100%) compared to the no progression group (30.9%, p value 0.029). Hypertension treatment before (81.8%; p value 0.008) pregnancy was also more common in the DME progression group. Intravitreal injections were more common in patients with visual acuity deterioration (26.7%, p value 0.046). The average number of fetal complications was significantly higher in the visual acuity non-worsening group (1.1) compared to the progression group (0.5, p value 0.04). These variables were not statistically significant after entry into multivariate analysis. DISCUSSION Severity and treatment of retinopathy before pregnancy, type of diabetes, and blood pressure control are all significant factors affecting the progression and development of severe ocular complications in pregnancy.
Collapse
Affiliation(s)
- Jay Rathinavelu
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Swara M Sarvepalli
- Central Michigan University College of Medicine, Mount Pleasant, Michigan, USA,
| | - Beth Bailey
- Central Michigan University College of Medicine, Mount Pleasant, Michigan, USA
| | - David D'Alessio
- Department of Endocrinology, Duke University, Durham, North Carolina, USA
| | | |
Collapse
|
13
|
Fazekas-Pongor V, Svébis MM, Major D, Pártos K, Dósa N, Mészáros Á, Horváth VJ, Domján BA, Zsirai L, Tabák AG. Trend of pregnancy outcomes in type 1 diabetes compared to control women: a register-based analysis in 1996-2018. Front Endocrinol (Lausanne) 2023; 14:1232618. [PMID: 37501784 PMCID: PMC10369353 DOI: 10.3389/fendo.2023.1232618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 06/19/2023] [Indexed: 07/29/2023] Open
Abstract
Introduction In 1989, the St Vincent declaration aimed to approximate pregnancy outcomes of diabetes to that of healthy pregnancies. We aimed to compare frequency and trends of outcomes of pregnancies affected by type 1 diabetes and controls in 1996-2018. Methods We used anonymized records of a mandatory nation-wide registry of all deliveries between gestational weeks 24 and 42 in Hungary. We included all singleton births (4,091 type 1 diabetes, 1,879,183 controls) between 1996 and 2018. We compared frequency and trends of pregnancy outcomes between type 1 diabetes and control pregnancies using hierarchical Poisson regression. Results The frequency of stillbirth, perinatal mortality, large for gestational age, caesarean section, admission to neonatal intensive care unit (NICU), and low Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) score was 2-4 times higher in type 1 diabetes compared to controls, while the risk of congenital malformations was increased by 51% and SGA was decreased by 42% (all p<0.05). These observations remained significant after adjustment for confounders except for low APGAR scores. We found decreasing rate ratios comparing cases and controls over time for caesarean sections, low APGAR scores (p<0.05), and for NICU admissions (p=0.052) in adjusted models. The difference between cases and controls became non-significant after 2009. No linear trends were observed for the other outcomes. Conclusions Although we found that the rates of SGA, NICU care, and low APGAR score improved in pregnancies complicated by type 1 diabetes, the target of the St Vincent Declaration was only achieved for the occurrence of low APGAR scores.
Collapse
Affiliation(s)
- Vince Fazekas-Pongor
- Department of Public Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Mark M. Svébis
- Department of Internal Medicine and Oncology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - David Major
- Department of Public Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Katalin Pártos
- Department of Public Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Norbert Dósa
- Department of Public Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Ágota Mészáros
- Department of Public Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Viktor J. Horváth
- Department of Internal Medicine and Oncology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Beatrix A. Domján
- Department of Internal Medicine and Oncology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - László Zsirai
- Department of Gynecology and Family Planning, Istenhegyi Gene Diagnostic Center, Budapest, Hungary
| | - Adam G. Tabák
- Department of Public Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary
- Department of Internal Medicine and Oncology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
- University College London (UCL) Brain Sciences, University College London, London, United Kingdom
| |
Collapse
|
14
|
Sokou R, Parastatidou S, Iliodromiti Z, Lampropoulou K, Vrachnis D, Boutsikou T, Konstantinidi A, Iacovidou N. Knowledge Gaps and Current Evidence Regarding Breastfeeding Issues in Mothers with Chronic Diseases. Nutrients 2023; 15:2822. [PMID: 37447149 DOI: 10.3390/nu15132822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/16/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023] Open
Abstract
The prevalence of chronic maternal disease is rising in the last decades in the developed world. Recent evidence indicated that the incidence of chronic maternal disease ranges from 10 to 30% of pregnancies worldwide. Several epidemiological studies in mothers with chronic diseases have mainly focused on the risk for adverse obstetric outcomes. Evidence from these studies supports a correlation between maternal chronic conditions and adverse perinatal outcomes, including increased risk for preeclampsia, cesarean section, preterm birth, and admission in the Neonatal Intensive Care Unit (NICU). However, there is a knowledge gap pertaining to the management of these women during lactation. This review aimed at summarizing the available research literature regarding breastfeeding in mothers with chronic diseases. Adjusted and evidence-based support may be required to promote breastfeeding in women with chronic diseases; however, our comprehension of breastfeeding in this subpopulation is still unclear. The literature related to breastfeeding extends in various scientific areas and multidisciplinary effort is necessary to compile an overview of current evidence and knowledge regarding breastfeeding issues in mothers with chronic diseases.
Collapse
Affiliation(s)
- Rozeta Sokou
- Neonatal Intensive Care Unit, "Agios Panteleimon" General Hospital of Nikea, 3 D.Mantouvalou Str., Nikea, 18454 Piraeus, Greece
- Neonatal Department, School of Medicine, National and Kapodistrian University of Athens, Aretaieio Hospital, 11528 Athens, Greece
| | - Stavroula Parastatidou
- Neonatal Intensive Care Unit, "Elena Venizelou" Maternity Hospital, 11521 Athens, Greece
| | - Zoi Iliodromiti
- Neonatal Department, School of Medicine, National and Kapodistrian University of Athens, Aretaieio Hospital, 11528 Athens, Greece
| | - Katerina Lampropoulou
- Neonatal Intensive Care Unit, School of Medicine, University of Ioannina, 45110 Ioannina, Greece
| | - Dionysios Vrachnis
- Endocrinology Unit, 2nd Department of Obstetrics and Gynecology, School of Medicine, National and Kapodistrian University of Athens, Aretaieio Hospital, 11528 Athens, Greece
| | - Theodora Boutsikou
- Neonatal Department, School of Medicine, National and Kapodistrian University of Athens, Aretaieio Hospital, 11528 Athens, Greece
| | - Aikaterini Konstantinidi
- Neonatal Intensive Care Unit, "Agios Panteleimon" General Hospital of Nikea, 3 D.Mantouvalou Str., Nikea, 18454 Piraeus, Greece
| | - Nicoletta Iacovidou
- Neonatal Department, School of Medicine, National and Kapodistrian University of Athens, Aretaieio Hospital, 11528 Athens, Greece
| |
Collapse
|
15
|
Waker CA, Hwang AE, Bowman-Gibson S, Chandiramani CH, Linkous B, Stone ML, Keoni CI, Kaufman MR, Brown TL. Mouse models of preeclampsia with preexisting comorbidities. Front Physiol 2023; 14:1137058. [PMID: 37089425 PMCID: PMC10117893 DOI: 10.3389/fphys.2023.1137058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/17/2023] [Indexed: 04/08/2023] Open
Abstract
Preeclampsia is a pregnancy-specific condition and a leading cause of maternal and fetal morbidity and mortality. It is thought to occur due to abnormal placental development or dysfunction, because the only known cure is delivery of the placenta. Several clinical risk factors are associated with an increased incidence of preeclampsia including chronic hypertension, diabetes, autoimmune conditions, kidney disease, and obesity. How these comorbidities intersect with preeclamptic etiology, however, is not well understood. This may be due to the limited number of animal models as well as the paucity of studies investigating the impact of these comorbidities. This review examines the current mouse models of chronic hypertension, pregestational diabetes, and obesity that subsequently develop preeclampsia-like symptoms and discusses how closely these models recapitulate the human condition. Finally, we propose an avenue to expand the development of mouse models of preeclampsia superimposed on chronic comorbidities to provide a strong foundation needed for preclinical testing.
Collapse
Affiliation(s)
- Christopher A. Waker
- Department of Neuroscience, Cell Biology and Physiology, Boonshoft School of Medicine, Wright State University, Dayton, OH, United States
| | - Amy E. Hwang
- Department of Neuroscience, Cell Biology and Physiology, Boonshoft School of Medicine, Wright State University, Dayton, OH, United States
| | - Scout Bowman-Gibson
- Department of Neuroscience, Cell Biology and Physiology, Boonshoft School of Medicine, Wright State University, Dayton, OH, United States
| | - Chandni H. Chandiramani
- Department of Neuroscience, Cell Biology and Physiology, Boonshoft School of Medicine, Wright State University, Dayton, OH, United States
- Department of Obstetrics and Gynecology, Boonshoft School of Medicine, Wright State University, Dayton, OH, United States
| | - Bryce Linkous
- Department of Neuroscience, Cell Biology and Physiology, Boonshoft School of Medicine, Wright State University, Dayton, OH, United States
| | - Madison L. Stone
- Department of Neuroscience, Cell Biology and Physiology, Boonshoft School of Medicine, Wright State University, Dayton, OH, United States
| | - Chanel I. Keoni
- Department of Neuroscience, Cell Biology and Physiology, Boonshoft School of Medicine, Wright State University, Dayton, OH, United States
| | - Melissa R. Kaufman
- Department of Neuroscience, Cell Biology and Physiology, Boonshoft School of Medicine, Wright State University, Dayton, OH, United States
| | - Thomas L. Brown
- Department of Neuroscience, Cell Biology and Physiology, Boonshoft School of Medicine, Wright State University, Dayton, OH, United States
- Department of Obstetrics and Gynecology, Boonshoft School of Medicine, Wright State University, Dayton, OH, United States
- *Correspondence: Thomas L. Brown,
| |
Collapse
|
16
|
Mathiesen ER, Alibegovic AC, Corcoy R, Dunne F, Feig DS, Hod M, Jia T, Kalyanam B, Kar S, Kautzky-Willer A, Marchesini C, Rea RD, Damm P. Insulin degludec versus insulin detemir, both in combination with insulin aspart, in the treatment of pregnant women with type 1 diabetes (EXPECT): an open‑label, multinational, randomised, controlled, non-inferiority trial. Lancet Diabetes Endocrinol 2023; 11:86-95. [PMID: 36623517 DOI: 10.1016/s2213-8587(22)00307-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 10/13/2022] [Accepted: 10/14/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND Insulin degludec (degludec) is a second-generation basal insulin with an improved pharmacokinetic-pharmacodynamic profile compared with first-generation basal insulins, but there are few data regarding its use during pregnancy. In this non-inferiority trial, we aimed to compare the efficacy and safety of degludec with insulin detemir (detemir), both in combination with insulin aspart (aspart), in pregnant women with type 1 diabetes. METHODS This open-label, multinational, randomised, controlled, non-inferiority trial (EXPECT) was conducted at 56 sites (hospitals and medical centres) in 14 countries. Women aged at least 18 years with type 1 diabetes who were between gestational age 8 weeks (+0 days) and 13 weeks (+6 days) or planned to become pregnant were randomly assigned (1:1), via an interactive web response system, to degludec (100 U/mL) once daily or detemir (100 U/mL) once or twice daily, both with mealtime insulin aspart (100 U/mL), all via subcutaneous injection. Participants who were pregnant received the trial drug at randomisation, throughout pregnancy and until 28 days post-delivery (end of treatment). Participants not pregnant at randomisation initiated the trial drug before conception. The primary endpoint was the last planned HbA1c measurement before delivery (non-inferiority margin of 0·4% for degludec vs detemir). Secondary endpoints included efficacy, maternal safety, and pregnancy outcomes. The primary endpoint was assessed in all randomly assigned participants who were pregnant during the trial. Safety was assessed in all randomly assigned participants who were pregnant during the trial and exposed to at least one dose of trial drug. This study is registered with ClinicalTrials.gov, NCT03377699, and is now completed. FINDINGS Between Nov 22, 2017, and Nov 8, 2019, from 296 women screened, 225 women were randomly assigned to degludec (n=111) or detemir (n=114). Mean HbA1c at pregnancy baseline was 6·6% (SD 0·6%; approximately 49 mmol/mol; SD 7 mmol/mol) in the degludec group and 6·5% (0·8%; approximately 48 mmol/mol; 9 mmol/mol) in the detemir group. Mean last planned HbA1c measurement before delivery was 6·2% (SE 0·07%; approximately 45 mmol/mol; SE 0·8 mmol/mol) in the degludec group and 6·3% (SE 0·07%; approximately 46 mmol/mol; SE 0·8 mmol/mol) in the detemir group (estimated treatment difference -0·11% [95% CI -0·31 to 0·08]; -1·2 mmol/mol [95% CI: -3·4 to 0·9]; pnon-inferiority<0·0001), confirming non-inferiority. Compared with detemir, no additional safety issues were observed with degludec. INTERPRETATION In pregnant women with type 1 diabetes, degludec was found to be non-inferior to detemir. FUNDING Novo Nordisk.
Collapse
Affiliation(s)
- Elisabeth R Mathiesen
- Center for Pregnant Women with Diabetes, Departments of Endocrinology and Obstetrics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | | | - Rosa Corcoy
- Servei d'Endocrinologia i Nutrició, Hospital de la Santa Creu i Sant Pau-Dos de Maig, Barcelona, Spain; CIBER-Bioengineering Biomaterials and Nanomedicine, Madrid, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Fidelma Dunne
- Clinical Research Facility, College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland
| | - Denice S Feig
- Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto and the Lunenfeld-Tanenbaum Research Institute, Toronto, ON, Canada
| | - Moshe Hod
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ting Jia
- Novo Nordisk A/S, Søborg, Denmark
| | | | - Soumitra Kar
- Novo Nordisk Service Centre India Private, Bangalore, India
| | | | | | - Rustam D Rea
- Oxford Centre for Diabetes Endocrinology and Metabolism and NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Peter Damm
- Center for Pregnant Women with Diabetes, Departments of Endocrinology and Obstetrics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | |
Collapse
|
17
|
Gupta HP, Pandey R, Ravi Ram K. Altered sperm fate in the reproductive tract milieu due to oxidative stress leads to sub-fertility in type 1 diabetes females: A Drosophila-based study. Life Sci 2023; 313:121306. [PMID: 36543282 DOI: 10.1016/j.lfs.2022.121306] [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: 05/02/2022] [Revised: 07/13/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022]
Abstract
AIMS Female sub-fertility, a prominent complication due to Type 1 diabetes (T1D), is generally attributed to disturbances in menstrual cycles and/or ovarian defects/disorders. T1D women, however, are high in oxidative stress, although the impact of the same on their reproduction and associated events remains unknown. Therefore, we assessed the repercussions of elevated oxidative stress on the sperm fate (storage/utilization) in the reproductive tract milieu of T1D females and their fertility using the Drosophila T1D model (Df[dilp1-5]), which lacks insulin-like peptides and displays reduced female fertility. MAIN METHODS We mated Df[dilp1-5] females to normal males and thereafter examined sperm storage and/or utilization in conjunction with oxidative stress parameters in mated Df[dilp1-5] females at different time points. Also, the impact of antioxidant (Amla or Vitamin C) supplementation on the above oxidative stress parameters in Df[dilp1-5] females and the consequences on their sperm and fertility levels were examined. KEY FINDINGS Df[dilp1-5] females showed elevated oxidative stress parameters and a few of their reproductive tract proteins are oxidatively modified. Also, these females stored significantly fewer sperm and also did not utilize sperm as efficiently as their controls. Surprisingly, amelioration of the oxidative stress in Df[dilp1-5] females' milieu through antioxidant (Amla or vitamin C) supplementation enhanced sperm storage and improved fertility. SIGNIFICANCE Hyperglycemia coupled with elevated oxidative stress within the female reproductive tract environment affects the sperm fate, thereby reducing female fertility in T1D. In addition, these findings suggest that antioxidant supplementation may substantially aid in the mitigation of sub-fertility in T1D females.
Collapse
Affiliation(s)
- Himanshu Pawankumar Gupta
- Embryotoxicology Laboratory, Environmental Toxicology Group, CSIR-Indian Institute of Toxicology Research (CSIR-IITR), Vishvigyan Bhavan, 31, Mahatma Gandhi Marg, Lucknow 226 001, Uttar Pradesh, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201 002, India
| | - Richa Pandey
- Embryotoxicology Laboratory, Environmental Toxicology Group, CSIR-Indian Institute of Toxicology Research (CSIR-IITR), Vishvigyan Bhavan, 31, Mahatma Gandhi Marg, Lucknow 226 001, Uttar Pradesh, India
| | - Kristipati Ravi Ram
- Embryotoxicology Laboratory, Environmental Toxicology Group, CSIR-Indian Institute of Toxicology Research (CSIR-IITR), Vishvigyan Bhavan, 31, Mahatma Gandhi Marg, Lucknow 226 001, Uttar Pradesh, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201 002, India.
| |
Collapse
|
18
|
Gundersen TW, Ebbehoj A, Knorr S, Jensen D, Damm P, Løkkegaard ECL, Mathiesen E, Thomsen RW, Clausen TD. Validation of Danish registry-cases of type 1 diabetes in women giving live birth using a clinical cohort as gold standard. Endocrinol Diabetes Metab 2022; 6:e374. [PMID: 36412090 PMCID: PMC9836239 DOI: 10.1002/edm2.374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 08/29/2022] [Accepted: 09/04/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The aim of this study was to validate type 1 diabetes in women giving live birth in the Danish national registries against a clinical cohort of confirmed cases (the Danish Diabetes Birth Registry [DDBR] cohort). METHODS National registries including diagnosis codes, redeemed prescriptions and background data were combined. Three main algorithms were constructed to define type 1 diabetes in women giving live birth: (1) Any diabetes diagnosis registered before delivery and before age of 30, (2) a specific type 1 diabetes diagnosis registered before delivery regardless of maternal age and (3) a 'preexisting type 1 diabetes in pregnancy' diagnosis registered before delivery. In additional sub-algorithms, we added information on anti-diabetic medicine and gestational diabetes diagnosis. We calculated positive predictive value (PPV) and completeness using the DDBR cohort as gold standard. Since DDBR included between 75 and 93% of women with confirmed type 1 diabetes giving live birth, we used quantitative bias analysis to assess the potential impact of missing data on PPV and completeness. RESULTS Main algorithm 2 had the highest PPV (77.4%) and shared the highest completeness (92.4%) with main algorithm 1. Information on anti-diabetic medicine and gestational diabetes increased PPV, on expense of completeness. All algorithms varied with PPV between 65.7 and 87.6% and completeness between 73.6 and 92.4%. The quantitative bias analysis indicated that PPV was underestimated, and completeness overestimated for all algorithms. For algorithm 2, corrected PPV was between 82.1 and 94.6% and corrected completeness between 84.7 and 91.2%. CONCLUSIONS The Danish national registries can identify type 1 diabetes in women giving live birth with a reasonably high accuracy. The registries are a valuable source for future comparative outcome studies and may also be suitable for monitoring prevalence and incidence of type 1 diabetes in women giving live birth.
Collapse
Affiliation(s)
- Tina Wullum Gundersen
- Department of Gynecology and ObstetricsNordsjællands Hospital and University of CopenhagenHillerødDenmark
| | - Andreas Ebbehoj
- Department of Endocrinology and Internal MedicineAarhus University HospitalAarhusDenmark
| | - Sine Knorr
- STENO Diabetes Center AarhusAarhus University HospitalAarhusDenmark
| | - Dorte Møller Jensen
- STENO Diabetes Center OdenseOdense University HospitalOdenseDenmark,Department of Gynecology and ObstetricsOdense University HospitalOdenseDenmark,Department of Clinical Research, Faculty of Health ScienceUniversity of Southern DenmarkOdenseDenmark
| | - Peter Damm
- Center for Pregnant Women with Diabetes, Department of ObstetricsRigshospitalet and University of CopenhagenCopenhagenDenmark,Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
| | - Ellen Christine Leth Løkkegaard
- Department of Gynecology and ObstetricsNordsjællands Hospital and University of CopenhagenHillerødDenmark,Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
| | - Elisabeth R. Mathiesen
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark,Center for Pregnant Women with Diabetes, Department of EndocrinologyRigshospitalet and University of CopenhagenCopenhagenDenmark
| | - Reimar W. Thomsen
- Department of Clinical Epidemiology, Department of Clinical MedicineAarhus University and Aarhus University HospitalAarhusDenmark
| | - Tine Dalsgaard Clausen
- Department of Gynecology and ObstetricsNordsjællands Hospital and University of CopenhagenHillerødDenmark,Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
| |
Collapse
|
19
|
Gupta A, Immanuel J, Ho V, Dalal R, Symons P, Simmons D. Placental abnormalities in type 1 and type 2 diabetes mellitus: a systematic review and metaanalysis of shear wave elastography. Am J Obstet Gynecol MFM 2022; 4:100736. [PMID: 36049626 DOI: 10.1016/j.ajogmf.2022.100736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 08/22/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study aimed to describe the placental changes occurring in women with preexisting diabetes mellitus and to determine if elastography can detect placental changes in vivo. DATA SOURCES PubMed, Embase, Medline, and Cochrane were searched to identify English language studies published until July 2020. STUDY ELIGIBILITY CRITERIA 1) For key question 1, studies that described histopathologic changes in placentas from women with known diabetes mellitus and 2) for key question 2, those that described structural-placental changes detectable by elastography in high-risk pregnancies (eg, those complicated by preeclampsia and/or fetal growth restriction), were included. METHODS For key question 1, we grouped placental pathologies using the Amsterdam International Consensus Group definitions. For key question 2, we conducted a metaanalysis including all data from studies reporting placental stiffness in meters per second (m/s) or kilopascals (kPa). The mean difference (95% confidence interval) was calculated using a random effects model. RESULTS Data were extracted from 14 studies of placental histopathology in women with known diabetes. In this group, a wide variety of placental histopathologic changes are described, though none are considered pathognomonic. The histopathologic changes including maternal vascular malperfusion, fetal vascular malperfusion, and/or infectious/inflammatory/other changes were divided into 3 broad categories on the basis of presumed etiology. A total of 15 studies reported the placental stiffness scores in women with a high-risk pregnancy vs those with a normal pregnancy. Only 1 reported stiffness scores for placentas in women with preexisting diabetes mellitus (N<10 women). Pooled analysis of 14 studies with available data included 478 "high-risk pregnancies" and 828 control or healthy pregnancies. Maternal-derived pathologies resulted in higher placental stiffness (mean difference 4.5 kPa [95% confidence interval, 3.16-5.87]) compared with control or healthy pregnancies. Fetal-derived pathologies also resulted in higher placental stiffness (mean difference of 6.5 kPa [95% confidence interval, 1.08-11.86]) compared with control or healthy pregnancies. CONCLUSION Shear wave elastography may provide an in vivo approximation of placental histopathology in women with certain kinds of high-risk pregnancies. A high-risk pregnancy may involve maternal- and fetal-derived pathologies. Further studies, particularly in women with preexisting diabetes, are needed to confirm this observation.
Collapse
Affiliation(s)
- Akhil Gupta
- Macarthur Clinical School of Medicine, Western Sydney University, New South Wales, Australia (Drs Gupta, Immanuel, Ho, Dalal, and Simmons); Department of Medicine, Campbelltown Hospital, Sydney, New South Wales, Australia (Drs Gupta, Ho, and Simmons); Department of Diabetes and Endocrinology, Blacktown Hospital, Sydney, New South Wales, Australia (Dr Gupta).
| | - Jincy Immanuel
- Macarthur Clinical School of Medicine, Western Sydney University, New South Wales, Australia (Drs Gupta, Immanuel, Ho, Dalal, and Simmons)
| | - Vincent Ho
- Macarthur Clinical School of Medicine, Western Sydney University, New South Wales, Australia (Drs Gupta, Immanuel, Ho, Dalal, and Simmons)
| | - Raiyomand Dalal
- Macarthur Clinical School of Medicine, Western Sydney University, New South Wales, Australia (Drs Gupta, Immanuel, Ho, Dalal, and Simmons)
| | - Patricia Symons
- South Western Sydney Clinical School, UNSW Medicine, Warwick Farm, Australia (Dr Symons)
| | - David Simmons
- Macarthur Clinical School of Medicine, Western Sydney University, New South Wales, Australia (Drs Gupta, Immanuel, Ho, Dalal, and Simmons); Department of Medicine, Campbelltown Hospital, Sydney, New South Wales, Australia (Drs Gupta, Ho, and Simmons); Department of Anatomical Pathology, Liverpool Hospital, Sydney, New South Wales, Australia (Dr Symons).
| |
Collapse
|
20
|
Blonde L, Umpierrez GE, Reddy SS, McGill JB, Berga SL, Bush M, Chandrasekaran S, DeFronzo RA, Einhorn D, Galindo RJ, Gardner TW, Garg R, Garvey WT, Hirsch IB, Hurley DL, Izuora K, Kosiborod M, Olson D, Patel SB, Pop-Busui R, Sadhu AR, Samson SL, Stec C, Tamborlane WV, Tuttle KR, Twining C, Vella A, Vellanki P, Weber SL. American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. Endocr Pract 2022; 28:923-1049. [PMID: 35963508 PMCID: PMC10200071 DOI: 10.1016/j.eprac.2022.08.002] [Citation(s) in RCA: 132] [Impact Index Per Article: 66.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The objective of this clinical practice guideline is to provide updated and new evidence-based recommendations for the comprehensive care of persons with diabetes mellitus to clinicians, diabetes-care teams, other health care professionals and stakeholders, and individuals with diabetes and their caregivers. METHODS The American Association of Clinical Endocrinology selected a task force of medical experts and staff who updated and assessed clinical questions and recommendations from the prior 2015 version of this guideline and conducted literature searches for relevant scientific papers published from January 1, 2015, through May 15, 2022. Selected studies from results of literature searches composed the evidence base to update 2015 recommendations as well as to develop new recommendations based on review of clinical evidence, current practice, expertise, and consensus, according to established American Association of Clinical Endocrinology protocol for guideline development. RESULTS This guideline includes 170 updated and new evidence-based clinical practice recommendations for the comprehensive care of persons with diabetes. Recommendations are divided into four sections: (1) screening, diagnosis, glycemic targets, and glycemic monitoring; (2) comorbidities and complications, including obesity and management with lifestyle, nutrition, and bariatric surgery, hypertension, dyslipidemia, retinopathy, neuropathy, diabetic kidney disease, and cardiovascular disease; (3) management of prediabetes, type 2 diabetes with antihyperglycemic pharmacotherapy and glycemic targets, type 1 diabetes with insulin therapy, hypoglycemia, hospitalized persons, and women with diabetes in pregnancy; (4) education and new topics regarding diabetes and infertility, nutritional supplements, secondary diabetes, social determinants of health, and virtual care, as well as updated recommendations on cancer risk, nonpharmacologic components of pediatric care plans, depression, education and team approach, occupational risk, role of sleep medicine, and vaccinations in persons with diabetes. CONCLUSIONS This updated clinical practice guideline provides evidence-based recommendations to assist with person-centered, team-based clinical decision-making to improve the care of persons with diabetes mellitus.
Collapse
Affiliation(s)
| | | | - S Sethu Reddy
- Central Michigan University, Mount Pleasant, Michigan
| | | | | | | | | | | | - Daniel Einhorn
- Scripps Whittier Diabetes Institute, La Jolla, California
| | | | | | - Rajesh Garg
- Lundquist Institute/Harbor-UCLA Medical Center, Torrance, California
| | | | | | | | | | | | - Darin Olson
- Colorado Mountain Medical, LLC, Avon, Colorado
| | | | | | - Archana R Sadhu
- Houston Methodist; Weill Cornell Medicine; Texas A&M College of Medicine; Houston, Texas
| | | | - Carla Stec
- American Association of Clinical Endocrinology, Jacksonville, Florida
| | | | - Katherine R Tuttle
- University of Washington and Providence Health Care, Seattle and Spokane, Washington
| | | | | | | | - Sandra L Weber
- University of South Carolina School of Medicine-Greenville, Prisma Health System, Greenville, South Carolina
| |
Collapse
|
21
|
Drapeau L, Beaumier M, Esbelin J, Comoz F, Figueres L, Piccoli GB, Kervella D. Complex Management of Nephrotic Syndrome and Kidney Failure during Pregnancy in a Type 1 Diabetes Patient: A Challenging Case. J Clin Med 2022; 11:jcm11195725. [PMID: 36233591 PMCID: PMC9571482 DOI: 10.3390/jcm11195725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 09/23/2022] [Accepted: 09/24/2022] [Indexed: 11/18/2022] Open
Abstract
Pregnancy with chronic kidney disease is challenging, and patients with diabetic nephropathy are at particular risk of a rapid kidney function decline during pregnancy. While indications for the management of pregnant patients with initial diabetic nephropathy are widely available in the literature, data on patients with severe nephrotic syndrome and kidney function impairment are lacking, and the decision on whether and when dialysis should be initiated is not univocal. We report a type 1 diabetes patient who started pregnancy with a severe nephrotic syndrome and shifted from CKD stage 3b to stage 5 during pregnancy. The management was complicated by a fetal heart malformation and by poorly controlled diabetes. The evidence for and against starting dialysis was carefully evaluated, and the choice of strict nephrological and obstetrical monitoring, nutritional management, and diuretic treatment made it possible to avoid dialysis in pregnancy, after ruling out pre-eclampsia. This experience enables examination of some open issues and contributes to the discussion of when to start dialysis in pregnancy.
Collapse
Affiliation(s)
- Leo Drapeau
- Néphrologie et Immunologie Clinique, CHU de Nantes, Nantes Université, 44000 Nantes, France
| | - Mathilde Beaumier
- Néphrologie, Centre Hospitalier Public du Cotentin, 50100 Cherbourg, France
| | - Julie Esbelin
- Service de Gynécologie-Obstétrique, CHU de Nantes, 44000 Nantes, France
| | - François Comoz
- Anatomie et Cytologie Pathologiques, CHU Caen Normandie, 14033 Caen, France
| | - Lucile Figueres
- Néphrologie et Immunologie Clinique, CHU de Nantes, Nantes Université, 44000 Nantes, France
| | | | - Delphine Kervella
- Center for Research in Transplantation and Translational Immunology, UMR 1064, ITUN, Inserm, CHU de Nantes, Nantes Université, F-44000 Nantes, France
- Correspondence:
| |
Collapse
|
22
|
Knorr S, Skakkebæk A, Just J, Johannsen EB, Trolle C, Vang S, Lohse Z, Bytoft B, Damm P, Højlund K, Jensen DM, Gravholt CH. Epigenetic and transcriptomic alterations in offspring born to women with type 1 diabetes (the EPICOM study). BMC Med 2022; 20:338. [PMID: 36138412 PMCID: PMC9503228 DOI: 10.1186/s12916-022-02514-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 08/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Offspring born to women with pregestational type 1 diabetes (T1DM) are exposed to an intrauterine hyperglycemic milieu and has an increased risk of metabolic disease later in life. In this present study, we hypothesize that in utero exposure to T1DM alters offspring DNA methylation and gene expression, thereby altering their risk of future disease. METHODS Follow-up study using data from the Epigenetic, Genetic and Environmental Effects on Growth, Metabolism and Cognitive Functions in Offspring of Women with Type 1 Diabetes (EPICOM) collected between 2012 and 2013. SETTING Exploratory sub-study using data from the nationwide EPICOM study. PARTICIPANTS Adolescent offspring born to women with T1DM (n=20) and controls (n=20) matched on age, sex, and postal code. MAIN OUTCOME MEASURES This study investigates DNA methylation using the 450K-Illumina Infinium assay and RNA expression (RNA sequencing) of leucocytes from peripheral blood samples. RESULTS We identified 9 hypomethylated and 5 hypermethylated positions (p < 0.005, |ΔM-value| > 1) and 38 up- and 1 downregulated genes (p < 0.005, log2FC ≥ 0.3) in adolescent offspring born to women with T1DM compared to controls. None of these findings remained significant after correction for multiple testing. However, we identified differences in gene co-expression networks, which could be of biological significance, using weighted gene correlation network analysis. Interestingly, one of these modules was significantly associated with offspring born to women with T1DM. Functional enrichment analysis, using the identified changes in methylation and gene expression as input, revealed enrichment in disease ontologies related to diabetes, carbohydrate and glucose metabolism, pathways including MAPK1/MAPK3 and MAPK family signaling, and genes related to T1DM, obesity, atherosclerosis, and vascular pathologies. Lastly, by integrating the DNA methylation and RNA expression data, we identified six genes where relevant methylation changes corresponded with RNA expression (CIITA, TPM1, PXN, ST8SIA1, LIPA, DAXX). CONCLUSIONS These findings suggest the possibility for intrauterine exposure to maternal T1DM to impact later in life methylation and gene expression in the offspring, a profile that may be linked to the increased risk of vascular and metabolic disease later in life.
Collapse
Affiliation(s)
- Sine Knorr
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Hedeager 3, 2. fl, 8200, Aarhus, DK, Denmark. .,Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark. .,Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark.
| | - Anne Skakkebæk
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark
| | - Jesper Just
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Emma B Johannsen
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Christian Trolle
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Søren Vang
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Zuzana Lohse
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - Birgitte Bytoft
- Center for Pregnant Women with Diabetes, Department of Obstetrics, Rigshospitalet, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Peter Damm
- Center for Pregnant Women with Diabetes, Department of Obstetrics, Rigshospitalet, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kurt Højlund
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - Dorte M Jensen
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - Claus H Gravholt
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
23
|
Kaur RJ, Smith BH, Ozaslan B, Pinsker JE, Trinidad MC, O'Malley G, Desjardins D, Castorino KN, Levister C, Reid C, McCrady-Spitzer S, Ogyaadu SJ, Church MM, Piper M, Kremers WK, Rosenn B, Doyle FJ, Dassau E, Levy CJ, Kudva YC. Hypoglycemia in Prospective Multicenter Study of Pregnancies with Pre-Existing Type 1 Diabetes on Sensor-Augmented Pump Therapy: The LOIS-P Study. Diabetes Technol Ther 2022; 24:544-555. [PMID: 35349353 PMCID: PMC9353990 DOI: 10.1089/dia.2021.0479] [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: 01/05/2023]
Abstract
Background: Pregnancies in type 1 diabetes are high risk, and data in the United States are limited regarding continuous glucose monitoring (CGM)-based hypoglycemia throughout pregnancy while on sensor-augmented insulin pump therapy. Materials and Methods: Pregnant women with type 1 diabetes in the LOIS-P Study (Longitudinal Observation of Insulin use and glucose Sensor metrics in Pregnant women with type 1 diabetes using continuous glucose monitors and insulin pumps) were enrolled before 17 weeks gestation at three U.S. centers and we used their personal insulin pump and a study Dexcom G6 CGM. We analyzed data of 25 pregnant women for CGM hypoglycemia based on international consensus guidelines for percentage time <63 and 54 mg/dL, hypoglycemic events and prolonged hypoglycemia events for 24-h, daytime, and overnight periods, and severe hypoglycemia (SH) episodes. Results: For a 24-h period, biweekly median percentage of time <63 mg/dL ranged from 0.8% at biweek 4-5 to 3.7% at biweek 14-15 with high variability throughout pregnancy. Median percentage of time <63 and 54 mg/dL was higher overnight than daytime (P < 0.01). Hypoglycemic events occurred throughout the pregnancy, ranged 1-4 events per 2 weeks, significantly decreased after the 20th week, and occurred predominantly during daytime (P < 0.01). For overnight period, hypoglycemia and events were more concentrated from 12 to 3 am. Seven prolonged hypoglycemia events without any associated SH occurred in four participants (16%), primarily overnight. Three participants experienced a single episode of SH. Conclusions: Our results suggest a higher overall risk of hypoglycemia throughout pregnancy during the overnight period with continued daytime risk of hypoglycemic events in pregnancies complicated by type 1 diabetes.
Collapse
Affiliation(s)
- Ravinder Jeet Kaur
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - Byron H. Smith
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Basak Ozaslan
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Minnesota, USA
| | | | - Mari Charisse Trinidad
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - Grenye O'Malley
- Division of Endocrinology, Diabetes and Metabolism and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Donna Desjardins
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Camilla Levister
- Division of Endocrinology, Diabetes and Metabolism and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Corey Reid
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - Shelly McCrady-Spitzer
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - Selassie J. Ogyaadu
- Division of Endocrinology, Diabetes and Metabolism and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mei Mei Church
- Sansum Diabetes Research Institute, Santa Barbara, California, USA
| | - Molly Piper
- Sansum Diabetes Research Institute, Santa Barbara, California, USA
| | - Walter K. Kremers
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Barak Rosenn
- Division of Endocrinology, Diabetes and Metabolism and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Francis J. Doyle
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Minnesota, USA
| | - Eyal Dassau
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Minnesota, USA
| | - Carol J. Levy
- Division of Endocrinology, Diabetes and Metabolism and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Yogish C. Kudva
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
24
|
Spangmose AL, Skipper N, Knorr S, Wullum Gundersen T, Beck Jensen R, Damm P, Lykke Mortensen E, Pinborg A, Svensson J, Clausen T. School performance in Danish children exposed to maternal type 1 diabetes in utero: A nationwide retrospective cohort study. PLoS Med 2022; 19:e1003977. [PMID: 35472047 PMCID: PMC9041831 DOI: 10.1371/journal.pmed.1003977] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 03/29/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Conflicting results have been reported concerning possible adverse effects on the cognitive function of offspring of mothers with type 1 diabetes (O-mT1D). Previous studies have included offspring of parents from the background population (O-BP), but not offspring of fathers with type 1 diabetes (O-fT1D) as the unexposed reference group. METHODS AND FINDINGS This is a population-based retrospective cohort study from 2010 to 2016. Nationally standardized school test scores (range, 1 to 100) were obtained for public school grades 2, 3, 4, 6, and 8 in O-mT1D and compared with those in O-fT1D and O-BP. Of the 622,073 included children, 2,144 were O-mT1D, and 3,474 were O-fT1D. Multiple linear regression models were used to compare outcomes, including the covariates offspring with type 1 diabetes, parity, number of siblings, offspring sex, smoking during pregnancy, parental age, and socioeconomic factors. Mean test scores were 54.2 (standard deviation, SD 24.8) in O-mT1D, 54.4 (SD 24.8) in O-fT1D, and 56.4 (SD 24.7) in O-BP. In adjusted analyses, the mean differences in test scores were -1.59 (95% CI -2.48 to -0.71, p < 0.001) between O-mT1D and O-BP and -0.78 (95% CI -1.48 to -0.08, p = 0.03) between O-fT1D and O-BP. No significant difference in the adjusted mean test scores was found between O-mT1D and O-fT1D (p = 0.16). The study's limitation was no access to measures of glycemic control during pregnancy. CONCLUSIONS O-mT1D achieved lower test scores than O-BP but similar test scores compared with O-fT1D. Glycemic control during pregnancy is essential to prevent various adverse pregnancy outcomes in women with type 1 diabetes. However, the present study reduces previous concerns regarding adverse effects of in utero hyperglycemia on offspring cognitive function.
Collapse
Affiliation(s)
- Anne Lærke Spangmose
- Fertility Department, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- * E-mail:
| | - Niels Skipper
- Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark
- Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark
| | - Sine Knorr
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | | | - Rikke Beck Jensen
- Department of Growth and Reproduction, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Peter Damm
- Center for Pregnant Women with Diabetes, Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Erik Lykke Mortensen
- Department of Public Health and Center for Healthy Aging, University of Copenhagen, Denmark
| | - Anja Pinborg
- Fertility Department, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jannet Svensson
- Department of Paediatric and Adolescents, Copenhagen University Hospital, Herlev-Gentofte, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Steno Diabetes Center Copenhagen, Copenhagen, Denmark
| | - Tine Clausen
- Department of Clinical Medicine, University of Copenhagen, Denmark
| |
Collapse
|
25
|
Oxman R, Roe AH, Ullal J, Putman MS. Gestational and pregestational diabetes in pregnant women with cystic fibrosis. J Clin Transl Endocrinol 2022; 27:100289. [PMID: 34984172 PMCID: PMC8693285 DOI: 10.1016/j.jcte.2021.100289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 12/04/2022] Open
Abstract
As cystic fibrosis transmembrane regulator (CFTR) modulator therapies offer greater longevity and improved health quality, women living with cystic fibrosis (CF) are increasingly pursuing pregnancy. Maternal risks for pregnant women with CF largely depend on a woman's baseline pulmonary and pancreatic function, and the majority of CF pregnancies will successfully end in live births. Diabetes, either gestational or pre-existing cystic fibrosis-related diabetes (CFRD), is highly prevalent in women with CF, affecting 18 to 62% of pregnancies in recent CF center reports. In addition to the rising incidence of CFRD with age, gestational diabetes is also more common in women with CF due to lower insulin secretion, higher insulin resistance, and increased hepatic glucose production as compared to pregnant women without CF. Diabetes occurring during pregnancy has important implications for maternal and fetal health. It is well established in women without CF that glycemic control is directly associated with risks of fetal malformation, neonatal-perinatal mortality, cesarean delivery and need for neonatal intensive care. Small studies in women with CF suggest that pregnancies affected by diabetes have an increased risk of preterm delivery, lower gestational age, and lower fetal birth weight compared to those without diabetes. Women with CF preparing for pregnancy should be counseled on the risks of diabetes and should undergo routine screening for CFRD with oral glucose tolerance testing (OGTT) if not already completed in the past six months. Glycemic control in those with pre-gestational CFRD should be optimized prior to conception. Insulin is preferred for the management of diabetes in pregnant women with CF via multiple daily injections or insulin pump therapy, and continuous glucose monitors (CGM) can be useful in mitigating hypoglycemia risks. Women with CF face many unique challenges impacting diabetes care during pregnancy and would benefit from support by a multidisciplinary care team, including nutrition and endocrinology, to ensure healthy pregnancies.
Collapse
Affiliation(s)
- Rachael Oxman
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Andrea H. Roe
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Jagdeesh Ullal
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Melissa S. Putman
- Division of Endocrinology, Boston Children's Hospital, Boston, MA, USA
- Division of Endocrinology, Massachusetts General Hospital, Boston, MA, USA
- Departments of Pediatrics and Medicine, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
26
|
Bayless DR, Caldarera TM, Harirah HM. Autoimmune polyglandular syndrome type 2 in pregnancy: a case report and review of the literature. CASE REPORTS IN PERINATAL MEDICINE 2022. [DOI: 10.1515/crpm-2020-0058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Objectives
Autoimmune polyglandular syndromes are uncommon heterogeneous conditions characterized by the association of two or more organ-specific endocrinopathies. Very few cases of these syndromes have been described during pregnancy. Here we report a case of autoimmune polyglandular syndrome type-2 presenting during pregnancy and complicated by preeclampsia with severe features.
Case presentation
The patient is a 35-year-old G7P0242 woman with a history of adrenal insufficiency, type 1 diabetes mellitus, and chronic lymphocytic thyroiditis. She was admitted to our institution at 34 weeks’ gestation for preterm contractions, nausea, and lower extremity edema for a few weeks prior to admission. At 35 weeks’ gestation, she developed preeclampsia with severe features requiring repeat cesarean section with good maternal and fetal outcomes. Recognizing the occurrence of this rare syndrome during pregnancy, adequate replacement of the deficient hormones, and close maternal and fetal surveillance are essential to achieving favorable outcomes.
Conclusions
To our knowledge, this is the first reported case of a pregnant woman with autoimmune polyglandular syndrome type-2 complicated by preeclampsia with severe features.
Collapse
Affiliation(s)
- David R. Bayless
- Department of Obstetrics and Gynecology , Division of Maternal-Fetal Medicine, University of Texas Medical Branch , Galveston , TX , USA
| | - Trevor M. Caldarera
- Department of Obstetrics and Gynecology , Division of Maternal-Fetal Medicine, University of Texas Medical Branch , Galveston , TX , USA
| | - Hassan M. Harirah
- Department of Obstetrics and Gynecology , Division of Maternal-Fetal Medicine, University of Texas Medical Branch , Galveston , TX , USA
| |
Collapse
|
27
|
Oliveira LMD, Belfort GP, Padilha PDC, Rosado EL, Silva LBGD, Fagherazzi S, Zajdenverg L, Zagury RL, Saunders C. Impact of Carbohydrate Counting Method during Pregnancy in Women with Pregestational Diabetes Mellitus: A Controlled Clinical Trial. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRICIA : REVISTA DA FEDERACAO BRASILEIRA DAS SOCIEDADES DE GINECOLOGIA E OBSTETRICIA 2022; 44:220-230. [PMID: 35139572 PMCID: PMC9948103 DOI: 10.1055/s-0042-1742291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To evaluate the effect of the carbohydrate counting method (CCM) on glycemic control, maternal, and perinatal outcomes of pregnant women with pregestational diabetes mellitus (DM). METHODS Nonrandomized controlled clinical trial performed with 89 pregnant women who had pregestational DM and received prenatal care in a public hospital in Rio de Janeiro, state of Rio de Janeiro, Brazil, between 2009 and 2014, subdivided into historic control group and intervention group, not simultaneous. The intervention group (n = 51) received nutritional guidance from the carbohydrate counting method (CCM), and the historical control group (n = 38), was guided by the traditional method (TM). The Mann-Whitney test or the Wilcoxon test were used to compare intra- and intergroup outcomes and analysis of variance (ANOVA) for repeated measures, corrected by the Bonferroni post-hoc test, was used to assess postprandial blood glucose. RESULTS Only the CCM group showed a reduction in fasting blood glucose. Postprandial blood glucose decreased in the 2nd (p = 0.00) and 3rd (p = 0.00) gestational trimester in the CCM group, while in the TM group the reduction occurred only in the 2nd trimester (p = 0.015). For perinatal outcomes and hypertensive disorders of pregnancy, there were no differences between groups. Cesarean delivery was performed in 82% of the pregnant women and was associated with hypertensive disorders (gestational hypertension or pre-eclampsia; p = 0.047). CONCLUSION Both methods of nutritional guidance contributed to the reduction of postprandial glycemia of women and no differences were observed for maternal and perinatal outcomes. However, CCM had a better effect on postprandial glycemia and only this method contributed to reducing fasting blood glucose throughout the intervention. REBEC CLINICAL TRIALS DATABASE The present study was registered in the ReBEC Clinical Trials Database (Registro Brasileiro de Ensaios Clínicos, number RBR-524z9n).
Collapse
Affiliation(s)
- Larissa Mello de Oliveira
- Programa de Pós-graduação em Nutrição do Instituto de Nutrição Josué de Castro da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro - RJ, Brazil
| | - Gabriella Pinto Belfort
- Programa de Pós-graduação em Nutrição do Instituto de Nutrição Josué de Castro da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro - RJ, Brazil
| | - Patricia de Carvalho Padilha
- Programa de Pós-graduação em Nutrição do Instituto de Nutrição Josué de Castro da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro - RJ, Brazil
| | - Eliane Lopes Rosado
- Programa de Pós-graduação em Nutrição do Instituto de Nutrição Josué de Castro da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro - RJ, Brazil
| | - Letícia Barbosa Gabriel da Silva
- Programa de Pós-graduação em Nutrição do Instituto de Nutrição Josué de Castro da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro - RJ, Brazil
| | | | | | | | - Claudia Saunders
- Programa de Pós-graduação em Nutrição do Instituto de Nutrição Josué de Castro da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro - RJ, Brazil.,Maternidade Escola da UFRJ, Rio de Janeiro - RJ, Brazil
| |
Collapse
|
28
|
Wilkie G, Orr L, Leung K, Leftwich H. Comparison of intrapartum glycemic management strategies in pregnant women with type 1 diabetes mellitus. J Matern Fetal Neonatal Med 2021; 35:8756-8760. [PMID: 34871147 DOI: 10.1080/14767058.2021.2004114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Achieving intrapartum maternal euglycemia in women with type 1 diabetes mellitus (T1DM) is critical to reducing the risk of neonatal hypoglycemia. OBJECTIVE This study sought to compare the maternal and neonatal outcomes among women with T1DM by different intrapartum glycemic control strategies of continuation of subcutaneous insulin pumps versus intravenous insulin infusion. METHODS A retrospective cohort study was performed to identify all women with type 1 diabetes mellitus in pregnancy between 1 October 2017 and 1 August 2020 at our tertiary medical center. Medical records were reviewed for sociodemographic, clinical characteristics, and perinatal outcomes. A composite neonatal outcome was created to include one or more of the following outcomes: 5-minute APGAR less than 7, neonatal intensive care unit admission, neonatal hypoglycemia, or respiratory distress. RESULTS We identified 75 women with T1DM that met inclusion criteria, 27(36%) who remained on their subcutaneous insulin pump and 48(64%) who were transitioned to intravenous insulin infusion intrapartum. Women that continued subcutaneous insulin were more likely to be older (30.5 vs. 28.1, p = .04), multiparous (74% vs. 50%, p = .042), and have a continuous glucose monitor (CGM) (93% vs. 43%, p < .001). There was no difference in maternal hypoglycemic events (14.8% vs. 18.8%, p = .76) or severe hyperglycemia (greater than 250 mg/dL)/development of diabetic ketoacidosis (3.7% vs. 4.2%, p = .99) in labor between both groups. There was no difference in neonatal composite outcome when adjusted for gestational age at delivery, maternal age, parity, and CGM use for both groups (aOR 0.73, 95% CI 0.12-4.43, p = .728). CONCLUSION Continuation of subcutaneous insulin in the intrapartum period appears to be a reasonable option in women with T1DM, however future, larger studies are needed to confirm this. Both patient and provider must be comfortable with this intrapartum strategy for effective glycemic control.
Collapse
Affiliation(s)
- Gianna Wilkie
- Department of Obstetrics and Gynecology, University of Massachusetts Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA, USA
| | - Lauren Orr
- Department of Obstetrics and Gynecology, University of Massachusetts Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA, USA
| | - Katherine Leung
- Department of Obstetrics and Gynecology, University of Massachusetts Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA, USA
| | - Heidi Leftwich
- Department of Obstetrics and Gynecology, University of Massachusetts Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA, USA
| |
Collapse
|
29
|
O'Malley G, Ozaslan B, Levy CJ, Castorino K, Desjardins D, Levister C, McCrady-Spitzer S, Church MM, Kaur RJ, Reid C, Kremers WK, Doyle FJ, Trinidad MC, Rosenn B, Pinsker JE, Kudva YC, Dassau E. Longitudinal Observation of Insulin Use and Glucose Sensor Metrics in Pregnant Women with Type 1 Diabetes Using Continuous Glucose Monitors and Insulin Pumps: The LOIS-P Study. Diabetes Technol Ther 2021; 23:807-817. [PMID: 34270347 PMCID: PMC9057877 DOI: 10.1089/dia.2021.0112] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background: Suboptimal glycemic control is associated with maternal and neonatal morbidity and mortality in pregnancy complicated by type 1 diabetes (T1D). Prospective analysis of continuous glucose monitoring (CGM) metrics, insulin pump settings, and insulin delivery can better characterize the changes in glycemic levels and insulin use throughout pregnancy with T1D. Materials and Methods: Prescribed parameters, insulin delivery, carbohydrate intake, and CGM data for 25 pregnant women with T1D from three U.S. sites were collected. Participants enrolled before 17 weeks gestation and used personal insulin pumps and study CGM. Mean daily total, basal, and bolus insulin doses (units/kg), CGM time in range (TIR: 63-140 mg/dL), and pump-entered carbohydrates were analyzed for every 2-week gestational interval. Linear mixed-effects regression models were used to evaluate changes across gestational ages compared to 12-14 weeks. Results: Basal insulin was higher during weeks 6-12 and 24-40. Daily bolus and total insulin were higher during weeks 20-40. Pump parameters were adjusted to intensify insulin therapy from 22 weeks onward. Average TIR across pregnancy was 59% ± 14%. Between 18 and 30 weeks, TIR was significantly lower, and time above range was significantly higher compared to the reference biweek. Time below target was lower between 22 and 34 weeks. Seven participants achieved >70% recommended TIR for pregnancy. Participants with maternal complications or infant neonatal intensive care unit admissions had lower TIR. Conclusion: While insulin dosing changed significantly with advancing gestation, most participants did not achieve >70% TIR. Customized anticipatory pump setting adjustments and automated systems aimed toward the designated TIR are needed to improve outcomes for this population. NCT03761615.
Collapse
Affiliation(s)
- Grenye O'Malley
- Icahn School of Medicine at Mount Sinai, Division of Endocrinology, Diabetes and Bone Diseases, New York, New York, USA
| | - Basak Ozaslan
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts, USA
| | - Carol J. Levy
- Icahn School of Medicine at Mount Sinai, Division of Endocrinology, Diabetes and Bone Diseases, New York, New York, USA
| | | | - Donna Desjardins
- Mayo Clinic, Division of Endocrinology, Diabetes, Metabolism & Nutrition, Rochester, Minnesota, USA
| | - Camilla Levister
- Icahn School of Medicine at Mount Sinai, Division of Endocrinology, Diabetes and Bone Diseases, New York, New York, USA
| | - Shelly McCrady-Spitzer
- Mayo Clinic, Division of Endocrinology, Diabetes, Metabolism & Nutrition, Rochester, Minnesota, USA
| | - Mei Mei Church
- Sansum Diabetes Research Institute, Santa Barbara, California, USA
| | - Ravinder Jeet Kaur
- Mayo Clinic, Division of Endocrinology, Diabetes, Metabolism & Nutrition, Rochester, Minnesota, USA
| | - Corey Reid
- Mayo Clinic, Division of Endocrinology, Diabetes, Metabolism & Nutrition, Rochester, Minnesota, USA
| | - Walter K. Kremers
- Mayo Clinic, Division of Endocrinology, Diabetes, Metabolism & Nutrition, Rochester, Minnesota, USA
| | - Francis J. Doyle
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts, USA
| | | | - Barak Rosenn
- Icahn School of Medicine at Mount Sinai, Mount Sinai West Hospital, Division of Obstetrics and Maternal-Fetal Medicine, NY, NY, USA
| | | | - Yogish C. Kudva
- Mayo Clinic, Division of Endocrinology, Diabetes, Metabolism & Nutrition, Rochester, Minnesota, USA
| | - Eyal Dassau
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts, USA
| |
Collapse
|
30
|
Scott R, Oliver N, Thomas M, Agha-Jaffar R. Pregnancy and contraception in women with Pre-Gestational diabetes in secondary Care- A questionnaire study. Diabetes Res Clin Pract 2021; 182:109124. [PMID: 34740741 DOI: 10.1016/j.diabres.2021.109124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/10/2021] [Accepted: 10/31/2021] [Indexed: 11/24/2022]
Abstract
AIMS To establish the knowledge of women with pre-gestational diabetes about of the risks of diabetes in pregnancy, and investigate their pregnancy plans, contraceptive choices, and preparedness for pregnancy. METHODS Women of reproductive age attending diabetes clinics across a single busy metropolitan NHS Trust were invited to fill in a questionnaire about pregnancy and contraception. The electronic health records of those women were also reviewed. RESULTS Ninety-six women completed the questionnaire. The majority of respondents (94%) had Type 1 Diabetes. Only 3% of women met the criteria of 'prepared for pregnancy'. Low efficacy contraception was used by 32% of women. Most women were only aware of a few risks to the mother and fetus in pregnancy, though the majority of women were aware of the importance of good glycaemic control before pregnancy. Previous pregnancies, or attendance at pre-conception counselling, did not improve participant knowledge. CONCLUSIONS Many women with diabetes of reproductive age are poorly prepared for pregnancy, but many are also using less effective contraceptive methods. These areas should be addressed if the poor pregnancy outcome in women with diabetes are to be improved, possibly through the development of an evidenced-based structured education course to target pre-conception and contraception.
Collapse
Affiliation(s)
- R Scott
- Department of Diabetes & Endocrinology, St Mary's Hospital, Imperial College Healthcare NHS Trust, Praed Street, London W2 1NY, England; Faculty of Medicine, 10(th) Floor Commonwealth Building, Hammersmith Hospital Campus, Imperial College London, Du Cane Road, London W12 0NN, England.
| | - N Oliver
- Department of Diabetes & Endocrinology, St Mary's Hospital, Imperial College Healthcare NHS Trust, Praed Street, London W2 1NY, England; Faculty of Medicine, 10(th) Floor Commonwealth Building, Hammersmith Hospital Campus, Imperial College London, Du Cane Road, London W12 0NN, England.
| | - M Thomas
- Faculty of Medicine, 10(th) Floor Commonwealth Building, Hammersmith Hospital Campus, Imperial College London, Du Cane Road, London W12 0NN, England
| | - R Agha-Jaffar
- Department of Diabetes & Endocrinology, St Mary's Hospital, Imperial College Healthcare NHS Trust, Praed Street, London W2 1NY, England; Faculty of Medicine, 10(th) Floor Commonwealth Building, Hammersmith Hospital Campus, Imperial College London, Du Cane Road, London W12 0NN, England.
| |
Collapse
|
31
|
O'Malley G, Wang A, Ogyaadu S, Levy CJ. Assessing Glycemic Control Using CGM for Women with Diabetes in Pregnancy. Curr Diab Rep 2021; 21:44. [PMID: 34735626 DOI: 10.1007/s11892-021-01415-2] [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] [Accepted: 08/25/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE OF REVIEW Diabetes during pregnancy increases the risk of maternal and fetal complications. This article reviews the types of CGM currently available, the glucose metrics which correlate with pregnancy outcomes, endocrine organization recommendations, clinical considerations for CGM implementation, and anticipated directions for future research. RECENT FINDINGS CGM use during pregnancy is increasing, and recommendations for use have been incorporated into many organizations' consensus guidelines. Increased time spent within a target range of 63-140 mg/dL and lower mean glucose are associated with lower risk of neonatal complications including large for gestational age infants. Use of CGM during pregnancy can detect postprandial and nocturnal hyperglycemia missed by self-monitoring of blood glucose (SMBG) which can be used for prognosis and to guide pharmacologic interventions. The use of continuous glucose monitoring (CGM) during pregnancies complicated by type 1, type 2, and gestational diabetes has been shown to improve outcomes.
Collapse
Affiliation(s)
- Grenye O'Malley
- Icahn School of Medicine At Mount Sinai, Division of Endocrinology, Diabetes and Bone Disease, New York, NY, USA.
| | - Ally Wang
- Icahn School of Medicine At Mount Sinai, Division of Endocrinology, Diabetes and Bone Disease, New York, NY, USA
| | - Selassie Ogyaadu
- Icahn School of Medicine At Mount Sinai, Division of Endocrinology, Diabetes and Bone Disease, New York, NY, USA
| | - Carol J Levy
- Icahn School of Medicine At Mount Sinai, Division of Endocrinology, Diabetes and Bone Disease, New York, NY, USA.
| |
Collapse
|
32
|
Bowers K, Ehrlich S, Dolan LM, Gupta R, Altaye M, Ollberding NJ, Szczesniak R, Catalano P, Smith E, Khoury JC. Elevated Anthropometric and Metabolic Indicators among Young Adult Offspring of Mothers with Pregestational Diabetes: Early Results from the Transgenerational Effect on Adult Morbidity Study (the TEAM Study). J Diabetes Res 2021; 2021:6590431. [PMID: 34761006 PMCID: PMC8575612 DOI: 10.1155/2021/6590431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 09/30/2021] [Accepted: 10/15/2021] [Indexed: 12/03/2022] Open
Abstract
Exposure to maternal diabetes in utero increases the risk in the offspring for a range of metabolic disturbances. However, the timing and variability of in utero hyperglycemic exposure necessary to cause impairment have not been elucidated. The TEAM Study was initiated to evaluate young adult offspring of mothers with pregestational diabetes mellitus. This paper outlines the unique enrollment challenges of the TEAM Study and preliminary analysis of the association between exposure to diabetes in pregnancy and adverse metabolic outcomes. The TEAM Study enrolls offspring of women who participated in a Diabetes in Pregnancy (DiP) Program Project Grant between 1978 and 1995. The DiP Study collected medical and obstetric data across pregnancy. The first 96 eligible offspring of women with pregestational diabetes were age-, sex-, and race-matched to adults from the National Health and Nutrition Examination Survey (NHANES) 2015-2016 with an OGTT. Descriptive and regression analyses were employed to compare TEAM participants to NHANES participants. Among a subset of TEAM participants, we compared the metabolic outcomes across maternal glucose profiles using a longitudinal data clustering technique that characterizes level and variability, in maternal glucose across pregnancy. By comparing categories of BMI, TEAM Study participants had over 2.0 times the odds of being obese compared to matched NHANES participants (for class III obesity, OR = 2.81; 95% confidence interval (CI): 1.15, 6.87). Increasing levels of two-hour glucose were also associated with in utero exposure to pregestational diabetes in matched analyses. Exposure to pregestational diabetes in utero may be associated with an increased risk of metabolic impairment in the offspring with clinical implications.
Collapse
Affiliation(s)
- Katherine Bowers
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- University of Cincinnati College of Medicine, Department of Pediatrics, Cincinnati, Ohio, USA
| | - Shelley Ehrlich
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- University of Cincinnati College of Medicine, Department of Pediatrics, Cincinnati, Ohio, USA
| | - Lawrence M. Dolan
- University of Cincinnati College of Medicine, Department of Pediatrics, Cincinnati, Ohio, USA
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Resmi Gupta
- Biostatistics and Epidemiology/Research Design Component, Division of Clinical and Translational Sciences, Department of Internal Medicine, University of Texas McGovern Medical School, Houston, Texas, USA
| | - Mekibib Altaye
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- University of Cincinnati College of Medicine, Department of Pediatrics, Cincinnati, Ohio, USA
| | - Nicholas J. Ollberding
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- University of Cincinnati College of Medicine, Department of Pediatrics, Cincinnati, Ohio, USA
| | - Rhonda Szczesniak
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- University of Cincinnati College of Medicine, Department of Pediatrics, Cincinnati, Ohio, USA
| | - Patrick Catalano
- Tufts University School of Medicine, Friedman School of Nutrition, Science and Policy, Boston, Massachusetts, USA
| | - Emily Smith
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jane C. Khoury
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- University of Cincinnati College of Medicine, Department of Pediatrics, Cincinnati, Ohio, USA
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| |
Collapse
|
33
|
Mathiesen ER, Ali N, Alibegovic AC, Anastasiou E, Cypryk K, de Valk H, Dores J, Dunne F, Gall MA, Garcia SD, Hanaire HP, Husemoen LLN, Ivanišević M, Kempe HP, McCance DR, Damm P. Risk of Major Congenital Malformations or Perinatal or Neonatal Death With Insulin Detemir Versus Other Basal Insulins in Pregnant Women With Preexisting Diabetes: The Real-World EVOLVE Study. Diabetes Care 2021; 44:2069-2077. [PMID: 34330786 PMCID: PMC8740922 DOI: 10.2337/dc21-0472] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 05/24/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To compare the risk of severe adverse pregnancy complications in women with preexisting diabetes. RESEARCH DESIGN AND METHODS Multinational, prospective cohort study to assess the prevalence of newborns free from major congenital malformations or perinatal or neonatal death (primary end point) following treatment with insulin detemir (detemir) versus other basal insulins. RESULTS Of 1,457 women included, 727 received detemir and 730 received other basal insulins. The prevalence of newborns free from major congenital malformations or perinatal or neonatal death was similar between detemir (97.0%) and other basal insulins (95.5%) (crude risk difference 0.015 [95% CI -0.01, 0.04]; adjusted risk difference -0.003 [95% CI -0.03, 0.03]). The crude prevalence of one or more congenital malformations (major plus minor) was 9.4% vs. 12.6%, with a similar risk difference before (-0.032 [95% CI -0.064, 0.000]) and after (-0.036 [95% CI -0.081, 0.009]) adjustment for confounders. Crude data showed lower maternal HbA1c during the first trimester (6.5% vs. 6.7% [48 vs. 50 mmol/mol]; estimated mean difference -0.181 [95% CI -0.300, -0.062]) and the second trimester (6.1% vs. 6.3% [43 vs. 45 mmol/mol]; -0.139 [95% CI -0.232, -0.046]) and a lower prevalence of major hypoglycemia (6.0% vs. 9.0%; risk difference -0.030 [95% CI -0.058, -0.002]), preeclampsia (6.4% vs. 10.0%; -0.036 [95% CI -0.064, -0.007]), and stillbirth (0.4% vs. 1.8%; -0.013 [95% CI -0.024, -0.002]) with detemir compared with other basal insulins. However, differences were not significant postadjustment. CONCLUSIONS Insulin detemir was associated with a similar risk to other basal insulins of major congenital malformations, perinatal or neonatal death, hypoglycemia, preeclampsia, and stillbirth.
Collapse
Affiliation(s)
- Elisabeth R Mathiesen
- Department of Endocrinology, Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark .,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Norsiah Ali
- Masjid Tanah Health Clinic, Malacca, Malaysia
| | | | - Eleni Anastasiou
- Department of Endocrinology-Diabetes Center, Princess Alexandra Hospital, Athens, Greece
| | - Katarzyna Cypryk
- Department of Internal Medicine and Diabetology, Medical University of Łódź, Łódź, Poland
| | - Harold de Valk
- Department of Internal Medicine, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Jorge Dores
- Department of Endocrinology, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Fidelma Dunne
- College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | | | | | - Hélène P Hanaire
- Department of Diabetology, Metabolic Diseases and Nutrition, University Hospital of Toulouse, University of Toulouse, Toulouse, France
| | | | - Marina Ivanišević
- Department of Obstetrics and Gynecology, State Referral Center for Diabetes in Pregnancy, Clinical Hospital Center Zagreb, Zagreb, Croatia
| | - Hans-Peter Kempe
- Centre for Diabetes and Nutrition Ludwigshafen, Ludwigshafen, Germany
| | | | - Peter Damm
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Obstetrics, Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark
| |
Collapse
|
34
|
Søholm JC, Vestgaard M, Ásbjörnsdóttir B, Do NC, Pedersen BW, Storgaard L, Nielsen BB, Ringholm L, Damm P, Mathiesen ER. Potentially modifiable risk factors of preterm delivery in women with type 1 and type 2 diabetes. Diabetologia 2021; 64:1939-1948. [PMID: 34146144 DOI: 10.1007/s00125-021-05482-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 04/01/2021] [Indexed: 12/01/2022]
Abstract
AIMS/HYPOTHESIS We aimed to identify potentially modifiable risk factors and causes for preterm delivery in women with type 1 or type 2 (pre-existing) diabetes. METHODS A secondary analysis of a prospective cohort study of 203 women with pre-existing diabetes (117 type 1 and 86 type 2 diabetes) was performed. Consecutive singleton pregnancies were included at the first antenatal visit between September 2015 and February 2018. RESULTS In total, 27% (n = 55) of the 203 women delivered preterm at median 36 + 0 weeks. When stratified by diabetes type, 33% of women with type 1 diabetes delivered preterm compared with 20% in women with type 2 diabetes (p = 0.04). Women delivering preterm were characterised by a higher prevalence of pre-existing kidney involvement (microalbuminuria or diabetic nephropathy) (16% vs 3%, p = 0.002), preeclampsia (26% vs 5%, p < 0.001), higher positive ultrasound estimated fetal weight deviation at 27 gestational weeks (2.7% vs -1.6% from the mean, p = 0.008), higher gestational weight gain (399 g/week vs 329 g/week, p = 0.01) and similar HbA1c levels in early pregnancy (51 mmol/mol [6.8%] vs 49 [6.6%], p = 0.22) when compared with women delivering at term. Independent risk factors for preterm delivery were pre-existing kidney involvement (OR 12.71 [95% CI 3.0, 53.79]), higher gestational weight gain (per 100 g/week, OR 1.25 [1.02, 1.54]), higher positive ultrasound estimated fetal weight deviation at 27 gestational weeks (% from the mean, OR 1.07 [1.03, 1.12]) and preeclampsia (OR 7.04 [2.34, 21.19]). Two-thirds of preterm deliveries were indicated and one-third were spontaneous. Several contributing factors to indicated preterm delivery were often present in each woman. The main indications were suspected fetal asphyxia (45%), hypertensive disorders (34%), fetal overgrowth (13%) and maternal indications (8%). Suspected fetal asphyxia mainly included falling insulin requirement and abnormal fetal haemodynamics. CONCLUSIONS/INTERPRETATIONS Presence of preeclampsia, higher positive ultrasound estimated fetal weight deviation at 27 gestational weeks and higher gestational weight gain were independent potentially modifiable risk factors for preterm delivery in this cohort of women with pre-existing diabetes. Indicated preterm delivery was common with suspected fetal asphyxia or preeclampsia as the most prevalent causes. Prospective studies evaluating whether modifying these predictors will reduce the prevalence of preterm delivery are warranted.
Collapse
Affiliation(s)
- Julie C Søholm
- Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark
| | - Marianne Vestgaard
- Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark
- Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark
- Department of Obstetrics, Rigshospitalet, Copenhagen, Denmark
| | - Björg Ásbjörnsdóttir
- Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark
- Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Nicoline C Do
- Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark
- Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Berit W Pedersen
- Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark
- Department of Obstetrics, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lone Storgaard
- Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark
- Department of Obstetrics, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Birgitte B Nielsen
- Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark
- Department of Obstetrics, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lene Ringholm
- Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark
- Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark
| | - Peter Damm
- Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark
- Department of Obstetrics, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Elisabeth R Mathiesen
- Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark.
- Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark.
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| |
Collapse
|
35
|
Seah JM, Kam NM, Wong L, Tanner C, Shub A, Houlihan C, Ekinci EI. Risk factors for pregnancy outcomes in Type 1 and Type 2 diabetes. Intern Med J 2021; 51:78-86. [PMID: 32237194 DOI: 10.1111/imj.14840] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 02/04/2020] [Accepted: 03/21/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Understanding the risk factors and pregnancy outcomes in women affected by Type 1 and Type 2 diabetes is important for pre-pregnancy counselling. AIM To explore differences in pregnancy outcomes between women with Type 1 and Type 2 diabetes, and healthy controls, and to examine the relationships between potential adverse risk factors and pregnancy outcomes in this cohort of women. METHODS This is a 10-year retrospective study of women with Type 1 diabetes (n = 92), Type 2 diabetes (n = 106) and healthy women without diabetes (controls) (n = 119) from a tertiary obstetric centre. Clinical and biochemical characteristics of women with Type 1 and Type 2 diabetes were determined and related to major obstetric outcomes using univariate analysis. RESULTS Women with pre-existing diabetes had higher adverse pregnancy outcomes (preeclampsia, emergency caesarean section, preterm birth <32 and 37 weeks, large for gestational age, neonatal jaundice, Apgar score < 7 at 5 min, neonatal intensive care admission and neonatal hypoglycaemia) compared to controls. A higher birth weight gestational centile (97.4% vs 72.4%, P = 0.001) and large for gestational age rate (63.4% vs 35.8%, P = 0.001) were observed in Type 1 diabetes compared to Type 2 diabetes. There were no differences in other outcomes between women with Type 1 and 2 diabetes. CONCLUSION In this exploratory study, risk factors for maternal adverse outcomes differ between Type 1 and Type 2 diabetes. Maternal and foetal adverse outcomes were higher in pregnancies affected by diabetes compared to healthy women but occurred with similar frequency in women with Type 1 and Type 2 diabetes.
Collapse
Affiliation(s)
- Jas-Mine Seah
- Department of Perinatal Medicine, Mercy Health, Melbourne, Victoria, Australia.,Department of Endocrinology, Austin Health, Melbourne, Victoria, Australia.,Department of Medicine Austin Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ning M Kam
- Department of Endocrinology, Austin Health, Melbourne, Victoria, Australia.,Department of Medicine Austin Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Lydia Wong
- Department of Endocrinology, Austin Health, Melbourne, Victoria, Australia
| | - Cara Tanner
- Department of Endocrinology, Austin Health, Melbourne, Victoria, Australia.,Department of Medicine Austin Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Alexis Shub
- Department of Perinatal Medicine, Mercy Health, Melbourne, Victoria, Australia.,Department of Medicine Austin Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Christine Houlihan
- Department of Perinatal Medicine, Mercy Health, Melbourne, Victoria, Australia.,Department of Endocrinology, Austin Health, Melbourne, Victoria, Australia
| | - Elif I Ekinci
- Department of Endocrinology, Austin Health, Melbourne, Victoria, Australia.,Department of Medicine Austin Health, The University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
36
|
Wang C, Luo S, Yang D, Yan J, Ding Y, Wang S, Ling P, Yao B, Zheng X, Weng J. Current practice and perspectives of healthcare providers regarding preconception care for women with type 1 diabetes in China. Diabetes Metab Res Rev 2021; 37:e3454. [PMID: 33811427 DOI: 10.1002/dmrr.3454] [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] [Received: 07/10/2020] [Revised: 03/01/2021] [Accepted: 03/23/2021] [Indexed: 11/08/2022]
Abstract
AIMS We aimed to investigate the current practice and perspectives of healthcare providers (HCPs) regarding preconception care (PCC) for women with type 1 diabetes (T1D) in China. MATERIALS AND METHODS A questionnaire based on in-depth interviews with HCPs involved in PCC was released online and advertised via doctor unions in China. The data were categorical variables and were analysed by multivariable logistic regression, Chi-square test, or Wilcoxon rank-sum test. RESULTS From November 2016 to January 2017, 992 responses from 31 provinces of China were received (77.3% doctors and 22.7% nurses). Regarding the current status of PCC for T1D, 62.5% of HCPs treated ≤1 woman with T1D monthly on average. Only 16.5% thought they provided proper PCC, and 29.6% reported having sufficient knowledge. Regarding attitudes towards pregnancy with T1D, 92.2% were in favour of women with T1D getting pregnant after proper glycaemic control, and 94.7% perceived their worries regarding pregnancy. Regarding doctor-patient communication, 56.6% spent <10 min per visit, while 58.3% thought ≥20 min was required for adequate communication. HCPs emphasised the importance of multidisciplinary PCC, professional training, and social support. PCC practice was associated with hospital level (OR = 2.450, 95%CI: 1.580-3.799, p < 0.001), HCPs' experience of treating women with T1D (OR = 2.196, 95%CI: 1.516-3.180, p < 0.001), and their communication sufficiency (OR = 3.706, 95%CI: 2.550-5.387, p < 0.001). CONCLUSIONS The current PCC practice for T1D in China was suboptimal and it was associated with hospital level, HCPs' experience and communication. It is necessary to reinforce professional training and appeal for social resources to improve PCC.
Collapse
Affiliation(s)
- Chaofan Wang
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Diabetes Prevention and Control Research Center, Guangdong Provincial Key Laboratory of Diabetology, Guangzhou, China
| | - Sihui Luo
- Department of Endocrinology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Daizhi Yang
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Diabetes Prevention and Control Research Center, Guangdong Provincial Key Laboratory of Diabetology, Guangzhou, China
| | - Jinhua Yan
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Diabetes Prevention and Control Research Center, Guangdong Provincial Key Laboratory of Diabetology, Guangzhou, China
| | - Yu Ding
- Department of Endocrinology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Siqi Wang
- Department of Endocrinology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Ping Ling
- Department of Endocrinology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Bin Yao
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Diabetes Prevention and Control Research Center, Guangdong Provincial Key Laboratory of Diabetology, Guangzhou, China
| | - Xueying Zheng
- Department of Endocrinology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Jianping Weng
- Department of Endocrinology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| |
Collapse
|
37
|
Nørgaard SK, Mathiesen ER, Nørgaard K, Clausen TD, Damm P, Ringholm L. CopenFast trial: Faster-acting insulin Fiasp versus insulin NovoRapid in the treatment of women with type 1 or type 2 diabetes during pregnancy and lactation - a randomised controlled trial. BMJ Open 2021; 11:e045650. [PMID: 33837106 PMCID: PMC8043014 DOI: 10.1136/bmjopen-2020-045650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Faster-acting insulin aspart (Fiasp) is approved for use in pregnancy and lactation, but no clinical study has evaluated its effects during this life stage in women with pre-existing diabetes. The aim of the CopenFast trial is to evaluate the effect of Fiasp compared with insulin aspart (NovoRapid) on maternal glycaemic control during pregnancy, delivery and lactation and on fetal growth and infant health. METHODS AND ANALYSIS An open-label randomised controlled trial of pregnant women with type 1 or type 2 diabetes including women on multiple daily injection (MDI) therapy or insulin pump therapy. During a 2-year inclusion period, approximately 220 women will be randomised 1:1 to Fiasp or NovoRapid in early pregnancy and followed until 3 months after delivery. At 9, 21 and 33 gestational weeks and during planned induction of labour or caesarean section, women are offered blinded continuous glucose monitoring (CGM) for 7 days. Randomisation will stratify for type of diabetes and insulin treatment modality (MDI or insulin pump therapy, respectively). Health status of the infants will be followed until 3 months of age. The primary outcome is birth weight SD score adjusted for gestational age and gender. Secondary outcomes include maternal glycaemic control including glycated haemoglobin, preprandial and postprandial self-monitored plasma glucose levels, episodes of mild and severe hypoglycaemia, maternal gestational weight gain and weight retention, CGM time spent in, above and below target ranges as well as pregnancy outcomes including pre-eclampsia, preterm delivery, perinatal mortality and neonatal morbidity. Data analysis will be performed according to the intention-to-treat principle. ETHICS AND DISSEMINATION The trial has been approved by the Regional Ethics Committee (H-19029966) on 7 August 2019. Results will be sought disseminated in peer-reviewed journals and at scientific meetings. TRIAL REGISTRATION NUMBER NCT03770767.
Collapse
Affiliation(s)
- Sidse Kjærhus Nørgaard
- Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark
- Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark
| | - Elisabeth Reinhardt Mathiesen
- Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark
- Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | | | - Tine Dalsgaard Clausen
- Department of Clinical Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
- Department of Gynaecology and Obstetrics, Nordsjaellands Hospital, Hillerod, Denmark
| | - Peter Damm
- Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
- Department of Obstetrics, Rigshospitalet, Copenhagen, Denmark
| | - Lene Ringholm
- Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark
- Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark
| |
Collapse
|
38
|
Wolka E, Deressa W, Reja A. Magnitude of Pre-Existing Diabetes Mellitus Among Pregnant Women in Southern Ethiopia: A Cross-Sectional Study. Risk Manag Healthc Policy 2021; 14:1025-1031. [PMID: 33737843 PMCID: PMC7966303 DOI: 10.2147/rmhp.s292000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 02/24/2021] [Indexed: 11/27/2022] Open
Abstract
Background The presence of maternal diabetes mellitus (DM) during pregnancy has complications for both mother and child. Pre-existing DM can result in higher risk of maternal and child mortality and morbidity. In Ethiopia, the magnitude of pre-existing DM among pregnant women is not well studied. The aim of this study was to assess the magnitude of pre-existing DM among pregnant women in Wolaita Zone, Southern Ethiopia. Methods A retrospective document review was carried out to determine the magnitude of pre-existing DM in three hospitals and four health centers in Wolaita Zone, Southern Ethiopia. A total of 600 pregnant mothers who attended maternity services at the study health facilities in one year period from January 1, to December 31, 2017 were included in the study. Data were collected from medical records of mothers. Chi-square and logistic regression analysis model were used to check the relationship between pre-existing DM and independent variables. Results A total of 600 mothers were included in the analysis. The magnitude of pre-existing DM among mothers receiving maternity care within a one year period was 2.8% (95% CI: 1.5, 4.2). The magnitudes among urban and rural residents were 3.4% and 1.4%, respectively. Pre-existing DM is significantly associated with family history of diabetes (Chi square 24.8, P-value, 0.001). Previous history of spontaneous abortion (aOR: 5.3; 95% CI: 1.6–17.4) and fetal macrosomia (aOR: 3.9; 95% CI: 1.2–13.1), was identified to be significantly associated with pre-existing DM. The magnitude of pre-existing DM is comparable with International Diabetes Federation Estimate to Ethiopia in the study area. Family history of DM was found to be associated with pre-existing DM. Pre-existing DM is associated with increased risk of abortion and fetal macrosomia. Conclusion The magnitude of pre-existing DM is comparable with previous estimates to the country. A nationwide, large-scale study is important to estimate the burden of pre-existing DM and associated risk factors among pregnant mothers at national level.
Collapse
Affiliation(s)
- Eskinder Wolka
- School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Wakgari Deressa
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ahmed Reja
- School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| |
Collapse
|
39
|
Jazdarehee A, Shearer D, Thompson D, Lee J, Dahl M, Khurana R, Pawlowska M. The Power of Small Conversations: Bridging the Gap Between Diabetes and Pregnancy Planning. Can J Diabetes 2021; 45:714-717.e1. [PMID: 33722493 DOI: 10.1016/j.jcjd.2021.01.007] [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: 07/20/2020] [Revised: 01/06/2021] [Accepted: 01/14/2021] [Indexed: 11/17/2022]
Abstract
Despite the established importance of preconception counselling among women with pre-existing diabetes, many Canadian women of this demographic continue to report inadequate medical planning of pregnancy. Primarily due to the teratogenic effects of hyperglycemia in the early weeks of pregnancy, minimizing the risk of adverse pregnancy outcomes requires a proactive approach toward medical optimization before conception. Primary care providers are well placed to provide preconception counselling to reproductive age women with pre-existing diabetes to alert them to the importance of pregnancy planning. This counselling may not necessarily require dedicated visits but may take the form of simple check-ins and key messages interspaced between other interactions. Herein we discuss the importance and challenges of preconception counselling among women with pre-existing diabetes and provide a pragmatic approach to the delivery of preconception counselling among primary care providers.
Collapse
Affiliation(s)
- Aria Jazdarehee
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Daniel Shearer
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - David Thompson
- Division of Endocrinology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Julie Lee
- Division of Endocrinology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marshall Dahl
- Division of Endocrinology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Reena Khurana
- Jim Pattison Outpatient Care and Surgery Centre, Vancouver, British Columbia, Canada
| | - Monika Pawlowska
- Division of Endocrinology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
| |
Collapse
|
40
|
Roskjær AB, Ásbjörnsdóttir B, Tetens I, Larnkjær A, Mølgaard C, Mathiesen ER. Dietary intake of carbohydrates in pregnant women with type 1 diabetes-A narrative review. Food Sci Nutr 2021; 9:17-24. [PMID: 33473266 PMCID: PMC7802534 DOI: 10.1002/fsn3.1982] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 09/21/2020] [Accepted: 09/26/2020] [Indexed: 12/02/2022] Open
Abstract
In pregnant women with type 1 diabetes, a low but sufficient, intake of carbohydrates is important to aim for near normal glycemic control. However, knowledge about the carbohydrate intake in this group is limited. To assess the average quantity and quality of carbohydrate intake in pregnant women with type 1diabetes compared to healthy pregnant women and current dietary reference intakes. A narrative literature search was performed in PubMed, Embase, and Cochrane Library and by using a snow-ball search technique to identify papers published on studies conducted in industrialized countries within the last 20 years. Intakes of carbohydrate were assessed qualitatively in relation to the Dietary Reference Intakes recommended by the American Diabetes Association and quantitatively as mean intake of dietary fiber. Five observational studies including 810 pregnant women with type 1 diabetes and 15 observational studies with a total of 118,246 healthy pregnant women were identified. The mean total carbohydrate intake was within the Acceptable Macronutrient Distribution Range (45%-64% of energy intake) in both groups. In pregnant women with type 1 diabetes, the average total intake was 218 ± 19 g/day, which was 20% (53 g/day) lower than in healthy pregnant women. Mean intake of dietary fiber in women with diabetes was lower than the recommended adequate intake for healthy women. With the limitations of pronounced heterogeneity across the included studies, pregnant women with type 1 diabetes reported a mean total carbohydrate intake, which was lower than in healthy pregnant women but still within the recommended range.
Collapse
Affiliation(s)
- Ann B. Roskjær
- Department of Nutrition, Exercise and SportsUniversity of CopenhagenDenmark
| | - Björg Ásbjörnsdóttir
- Center for Pregnant Women with DiabetesCopenhagenDenmark
- Department of EndocrinologyRigshospitaletCopenhagenDenmark
- Institute of Clinical MedicineFaculty of Health SciencesUniversity of CopenhagenDenmark
| | - Inge Tetens
- Department of Nutrition, Exercise and SportsUniversity of CopenhagenDenmark
| | - Anni Larnkjær
- Department of Nutrition, Exercise and SportsUniversity of CopenhagenDenmark
| | - Christian Mølgaard
- Department of Nutrition, Exercise and SportsUniversity of CopenhagenDenmark
- Pediatric Nutrition UnitRigshospitaletCopenhagenDenmark
| | - Elisabeth R. Mathiesen
- Center for Pregnant Women with DiabetesCopenhagenDenmark
- Department of EndocrinologyRigshospitaletCopenhagenDenmark
- Institute of Clinical MedicineFaculty of Health SciencesUniversity of CopenhagenDenmark
| |
Collapse
|
41
|
Z. I. I, C. J. N, P. Y. L, N. H. Factors influencing pregnancy planning of multi-ethnic Asian women with diabetes: A qualitative study. PLoS One 2020; 15:e0242690. [PMID: 33270663 PMCID: PMC7714241 DOI: 10.1371/journal.pone.0242690] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 11/09/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction Pregnancy planning varies among women with diabetes. Observing that the literature examining the factors affecting diabetic women’s pregnancy intentions in multi-ethnic Asian populations is limited, we sought to explore these factors to give a better perspective on these women’s pregnancy planning. Methods This qualitative study used individual in-depth interviews to capture the views and experiences of non-pregnant diabetic women of reproductive age in four public health clinics in a southwestern state of peninsular Malaysia from May 2016 to February 2017. The participants were purposively sampled according to ethnicity and were interviewed using a semi-structured topic guide. Interviews were audio-recorded, and transcripts were analysed using thematic analysis. Results From the 33 interviews that were analysed, four important factors influencing participants’ decisions regarding pregnancy planning were identified. Participants’ perception of poor pregnancy outcomes due to advanced age and medical condition was found to have an impact. However, despite these fears and negative relationships with doctors, personal, family and cultural influences supported by religious ‘up to God’ beliefs took centre stage in the pregnancy intention of some participants. Participants demonstrated a variety of understandings of pregnancy planning. They outlined some activities for pregnancy preparation, although many also reported limited engagement with pre-pregnancy care. Conclusions This study emphasised the known dilemma experienced by diabetic women considering their desire for an ideal family structure against their perceived pregnancy risks, heterogeneous religious beliefs and the impact of cultural demands on pregnancy intention. This study urges healthcare providers to increase their engagement with the women in pregnancy planning in a more personalised approach.
Collapse
Affiliation(s)
- Irmi Z. I.
- Faculty of Medicine, Department of Primary Care Medicine, University Malaya, Kuala Lumpur, Malaysia
- Faculty of Medicine and Health Sciences, Department of Family Medicine, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Ng C. J.
- Faculty of Medicine, Department of Primary Care Medicine, University Malaya, Kuala Lumpur, Malaysia
- * E-mail:
| | - Lee P. Y.
- Faculty of Medicine and Health Sciences, Department of Family Medicine, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Hussein N.
- Faculty of Medicine, Department of Primary Care Medicine, University Malaya, Kuala Lumpur, Malaysia
| |
Collapse
|
42
|
Karaca C, Bostancıeri N, Ovayolu A, Kahraman DT. The effect of vascular complications of diabetes mellitus on human umbilical cord tissue and the number of Wharton Jelly's mesenchymal stem cells. Mol Biol Rep 2020; 47:9313-9323. [PMID: 33179142 DOI: 10.1007/s11033-020-05965-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 10/30/2020] [Indexed: 11/30/2022]
Abstract
The current study investigated the change in umbilical cord tissue and the number of markers of Wharton's jelly mesenchymal stem cells (WJ-MSC) in pregnant women with gestational diabetes (GDM), with chronic diabetes who developed nephropathy as vascular complication (VC-PGDM), and healthy pregnant women as the control. The umbilical cords (UC) were investigated by the histomorphological method and the number of WJ-MSC were detected by flow-cytometry using the CD90, CD44, CD105, and CD73 markers in Wharton's jelly (WJ) isolated from fresh umbilical cords. The number of positive cells for CD 90, CD44, CD105, and CD73 were found to be elevated in the GDM group, whereas it was significantly diminished in the VC-PGDM group (p = 0.001, p = 0.001, p = 0.001, and p = 0.001). The only histopathological sign in the GDM group were an increased number of pores in the Wharton jelly. Artery wall thickness/cord diamater ratio was increased, which indicates an increase of the artery wall thickness in the VC- PGDM group (p = 0.039 and p = 0.048). The increase in umbilical cord diameter and number of Wharton jelly mesenchymal stem cells in babies of gestational diabetic mothers was considered as an effect of macrosomia seen in babies of mothers with gestational diabetes. Vasculopathy, a long-term complication of diabetes, is known to affect all tissues by causing marked lower perfusion and hypoxia, as well as a decrease in the MSC number in our study.
Collapse
Affiliation(s)
- Cigdem Karaca
- Department of Histology Embriology, Afyonkarahisar Health Science University Faculty of Medicine, Afyonkarahisar, Turkey.
| | - Nuray Bostancıeri
- Department of Histology Embriology, Gaziantep Ünivercity Faculty of Medicine, Gaziantep, Turkey
| | - Ali Ovayolu
- Department of Obstetrics and Gynecology, Cengiz Gökcek Women's and Children's Hospital, Gaziantep, Turkey
| | - Demet Tasdemir Kahraman
- Department of Medical Biochemistry, Gaziantep Ünivercity Faculty of Medicine, Gaziantep, Turkey
| |
Collapse
|
43
|
Assi E, D'Addio F, Mandò C, Maestroni A, Loretelli C, Ben Nasr M, Usuelli V, Abdelsalam A, Seelam AJ, Pastore I, Magagnotti C, Abdi R, El Essawy B, Folli F, Corradi D, Zuccotti G, Cetin I, Fiorina P. Placental proteome abnormalities in women with gestational diabetes and large-for-gestational-age newborns. BMJ Open Diabetes Res Care 2020; 8:8/2/e001586. [PMID: 33188009 PMCID: PMC7668299 DOI: 10.1136/bmjdrc-2020-001586] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 09/24/2020] [Accepted: 10/12/2020] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Gestational diabetes mellitus (GDM) is the most frequent metabolic complication during pregnancy and is associated with development of short-term and long-term complications for newborns, with large-for-gestational-age (LGA) being particularly common. Interestingly, the mechanism behind altered fetal growth in GDM is only partially understood. RESEARCH DESIGN AND METHODS A proteomic approach was used to analyze placental samples obtained from healthy pregnant women (n=5), patients with GDM (n=12) and with GDM and LGA (n=5). Effects of altered proteins on fetal development were tested in vitro in human embryonic stem cells (hESCs). RESULTS Here, we demonstrate that the placental proteome is altered in pregnant women affected by GDM with LGA, with at least 37 proteins differentially expressed to a higher degree (p<0.05) as compared with those with GDM but without LGA. Among these proteins, 10 are involved in regulating tissue differentiation and/or fetal growth and development, with bone marrow proteoglycan (PRG2) and dipeptidyl peptidase-4 (DPP-4) being highly expressed. Both PRG2 and DPP-4 altered the transcriptome profile of stem cells differentiation markers when tested in vitro in hESCs, suggesting a potential role in the onset of fetal abnormalities. CONCLUSIONS Our findings suggest that placental dysfunction may be directly responsible for abnormal fetal growth/development during GDM. Once established on a larger population, inhibitors of the pathways involving those altered factors may be tested in conditions such as GDM and LGA, in which therapeutic approaches are still lacking.
Collapse
Affiliation(s)
- Emma Assi
- International Center for T1D Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, Department of Biomedical and Clinical Sciences, Università di Milano, Milano, Italy
| | - Francesca D'Addio
- International Center for T1D Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, Department of Biomedical and Clinical Sciences, Università di Milano, Milano, Italy
| | - Chiara Mandò
- "G. Pardi" Laboratory of Maternal-Fetal Translational Research, Department of Biomedical and Clinical Sciences "L. Sacco", Università di Milano, Milano, Lombardia, Italy
| | - Anna Maestroni
- International Center for T1D Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, Department of Biomedical and Clinical Sciences, Università di Milano, Milano, Italy
| | - Cristian Loretelli
- International Center for T1D Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, Department of Biomedical and Clinical Sciences, Università di Milano, Milano, Italy
| | - Moufida Ben Nasr
- International Center for T1D Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, Department of Biomedical and Clinical Sciences, Università di Milano, Milano, Italy
- Nephrology Division, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Vera Usuelli
- International Center for T1D Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, Department of Biomedical and Clinical Sciences, Università di Milano, Milano, Italy
- Nephrology Division, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Ahmed Abdelsalam
- International Center for T1D Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, Department of Biomedical and Clinical Sciences, Università di Milano, Milano, Italy
| | - Andy Joe Seelam
- International Center for T1D Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, Department of Biomedical and Clinical Sciences, Università di Milano, Milano, Italy
| | - Ida Pastore
- Department of Endocrinology, ASST Fatebenefratelli-Sacco, Milano, Lombardia, Italy
| | - Cinzia Magagnotti
- ProMiFa, Protein Microsequencing Facility, Ospedale San Raffaele, Milano, Lombardia, Italy
| | - Reza Abdi
- Transplantation Research Center, Renal Division, Brigham & Women's, Harvard University, Boston, Massachusetts, USA
| | - Basset El Essawy
- Transplantation Research Center, Renal Division, Brigham & Women's, Harvard University, Boston, Massachusetts, USA
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Franco Folli
- Endocrinologia e Metabolismo, Dipartimento di Scienze della Salute, Universita di Milano, Milano, Italy
| | - Domenico Corradi
- Department of Biomedical, Biotechnological and Translational Sciences, Unit of Pathology, University of Parma, Parma, Emilia-Romagna, Italy
| | - Gianvincenzo Zuccotti
- International Center for T1D Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, Department of Biomedical and Clinical Sciences, Università di Milano, Milano, Italy
- Department of Pediatrics, Ospedale dei Bambini V Buzzi, Milano, Lombardia, Italy
| | - Irene Cetin
- "G. Pardi" Laboratory of Maternal-Fetal Translational Research, Department of Biomedical and Clinical Sciences "L. Sacco", Università di Milano, Milano, Lombardia, Italy
| | - Paolo Fiorina
- International Center for T1D Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, Department of Biomedical and Clinical Sciences, Università di Milano, Milano, Italy
- Nephrology Division, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Endocrinology, ASST Fatebenefratelli-Sacco, Milano, Lombardia, Italy
| |
Collapse
|
44
|
Guo Y, Luo R, Corsi DJ, Retnakaran R, Walker MC, Wen SW. Caucasian and Asian difference in role of type 1 diabetes on large-for-gestational-age neonates. BMJ Open Diabetes Res Care 2020; 8:8/2/e001746. [PMID: 33214189 PMCID: PMC7678233 DOI: 10.1136/bmjdrc-2020-001746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/10/2020] [Accepted: 10/26/2020] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Racial differences in the association between type 1 diabetes mellitus (T1DM) and large-for-gestational-age (LGA) neonates remain unclear. The objective of this study was to compare the effect of T1DM on LGA neonates between Caucasian and Asian women. RESEARCH DESIGN AND METHODS A population-based retrospective cohort study was conducted among Caucasian and Asian women who had prenatal screening and gave a singleton live birth in an Ontario hospital between April 2015 and March 2018. Multivariable log-binomial regression models were used to estimate the adjusted relative risks (aRRs) and 95% CIs of T1DM on LGA for Caucasian and Asian women. Relative contribution of T1DM to LGA was examined by multivariable logistic regression model, stratified by Caucasian and Asian women. RESULTS A total of 232 503 women (69.4% Caucasians and 30.6% Asians) were included in the final analysis. The rate of T1DM was higher in Caucasians (0.5%) than in Asians (0.2%), and the rate of LGA neonates was also higher in Caucasians (11.0%) than in Asians (5.0%). The association between T1DM and LGA in Caucasians (aRR 4.18, 95% CI (3.84 to 4.55)) was more robust than that in Asians (aRR 2.11, 95% CI (1.24 to 3.59)). T1DM was the fourth strongest contributor to LGA in Caucasians, while T1DM was the seventh contributor to LGA in Asians. CONCLUSIONS T1DM plays a more substantial role in LGA among Caucasians than Asians. Clinicians should be aware of the Caucasian-Asian differences of effects of T1DM on LGA when developing pregnancy management strategies.
Collapse
Affiliation(s)
- Yanfang Guo
- Better Outcomes Registry & Network Ontario, Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- OMNI Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Rong Luo
- OMNI Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Daniel J Corsi
- Better Outcomes Registry & Network Ontario, Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- OMNI Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Ravi Retnakaran
- Division of Endocrinology and Metabolism, University of Toronto, Toronto, Ontario, Canada
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Mark C Walker
- Better Outcomes Registry & Network Ontario, Ottawa, Ontario, Canada
- OMNI Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
- Department of Obstetrics, Gynecology, and Newborn Care, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Shi Wu Wen
- OMNI Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
- Department of Obstetrics, Gynecology, and Newborn Care, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| |
Collapse
|
45
|
Lekšić G, Baretić M, Ivanišević M, Jurišić-Eržen D. Pregnancy in Patients with Type One Diabetes Mellitus Treated with Continuous Subcutaneous Insulin Infusion-Preconception Basal Insulin Dose as a Potential Risk Factor for Fetal Overgrowth? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186566. [PMID: 32916984 PMCID: PMC7558540 DOI: 10.3390/ijerph17186566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 09/03/2020] [Accepted: 09/04/2020] [Indexed: 11/16/2022]
Abstract
Despite widespread use of technology, type one diabetes mellitus (T1DM) is still a great clinical challenge during pregnancy. This study aims to assess how prenatal variables of T1DM patients using continuous subcutaneous insulin infusion (CSII) influence pregnancy outcomes. We performed a retrospective study of 35 patients with T1DM treated with CSII during pregnancy. Alterable preconception variables (A1C, body mass index, basal and bolus insulin dose) were analysed as possible contributors to birth weight and large-for-gestational-age (LGA) prevalence. Inclusion criteria were presence of T1DM for more than two years, A1C < 7.4% and treatment with CSII for at least three months prior to conception. The preconception basal insulin dose and A1C had a significant correlation to the neonatal birth weight (p = 0.01, r = 0.4 and p = 0.04, r = 0.3, respectively) and were significant in regression analysis together contributing 22% of the variance in birth weight percentiles (sig = 0.17, R square = 0.22). Prevalence of LGA was 46%. Women who had LGA neonates also had a higher preconception basal insulin dose compared to women with non-LGA neonates (26 ± 9 vs. 18 ± 7 IU (international units), p = 0.01). The LGA group had a higher preconception A1C, but it did not reach statistical significance (6.5 ± 0.5% vs. 6.2 ± 0.9%, respectively, p = 0.2). Women with T1DM treated with CSII who had unregulated glycaemia and more basal insulin were at greater risk for development of LGA neonates.
Collapse
Affiliation(s)
- Gloria Lekšić
- Department of Internal Medicine, University Hospital Centre Zagreb, 10000 Zagreb, Croatia;
| | - Maja Baretić
- Division of Endocrinology and Diabetes, Department of Internal Medicine, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia;
- Correspondence:
| | - Marina Ivanišević
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia;
- Department of Gynaecology and Obstetrics, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
| | - Dubravka Jurišić-Eržen
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Clinical Hospital Centre Rijeka, 51000 Rijeka, Croatia;
- School of Medicine, University of Rijeka, 51000 Rijeka, Croatia
| |
Collapse
|
46
|
Seah JM, Kam NM, Wong L, Tanner C, MacIsaac RJ, Shub A, Ekinci EI, Houlihan C. The association between maternal renal function and pregnancy outcomes in type 1 and type 2 diabetes. Diabetes Res Clin Pract 2020; 165:108225. [PMID: 32442556 DOI: 10.1016/j.diabres.2020.108225] [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: 10/24/2019] [Revised: 04/02/2020] [Accepted: 05/14/2020] [Indexed: 10/24/2022]
Abstract
AIMS To investigate the prognostic value of estimated glomerular filtration rate (eGFR) and albuminuria in determining pregnancy outcomes in women with type 1 and type 2 diabetes. METHODS An observational study of pregnant women with type 1 (n = 92) and type 2 diabetes (n = 106) who delivered between 2004 and 2014 at a single tertiary obstetric centre. Clinical and biochemical characteristics were determined and related to major obstetric outcomes: preeclampsia, preterm birth <32 and <37 weeks, and neonatal intensive care admission. We used univariate analyses and multivariable logistic regression models with eGFR using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation and albuminuria as covariates. RESULTS In the pooled diabetes cohort, multivariable logistic regression with eGFR and albuminuria status demonstrated that the presence of albuminuria (albumin-to-creatinine ratio ≥ 3.5 mg/mmol) (OR, 2.7; 95% CI, 1.42-4.99; P = 0.002) was associated with preeclampsia, whilst an eGFR of < 120 mL/min/1.73 m2 was associated with preterm birth < 32 weeks (OR, 1.04; 95% CI, 1.00-1.09; P = 0.02). CONCLUSIONS Despite its recognized limitations in pregnancy, lower eGFR values were associated with increased risk of adverse outcomes. Our exploratory data suggest eGFR, along with albuminuria, can aid in identifying women at high risk of developing adverse obstetric outcomes.
Collapse
Affiliation(s)
- Jas-Mine Seah
- Department of Perinatal Medicine, Mercy Health, 163 Studley Road, Heidelberg, VIC 3084, Australia; Department of Endocrinology and Diabetes, Austin Health, 145 Studley Road, Heidelberg, VIC 3084, Australia; Department of Medicine, The University of Melbourne, Grattan Street, Parkville, VIC 3010, Australia
| | - Ning Mao Kam
- Department of Endocrinology and Diabetes, Austin Health, 145 Studley Road, Heidelberg, VIC 3084, Australia; Department of Medicine, The University of Melbourne, Grattan Street, Parkville, VIC 3010, Australia
| | - Lydia Wong
- Department of Endocrinology and Diabetes, Austin Health, 145 Studley Road, Heidelberg, VIC 3084, Australia
| | - Cara Tanner
- Department of Endocrinology and Diabetes, Austin Health, 145 Studley Road, Heidelberg, VIC 3084, Australia; Department of Medicine, The University of Melbourne, Grattan Street, Parkville, VIC 3010, Australia
| | - Richard J MacIsaac
- Department of Medicine, The University of Melbourne, Grattan Street, Parkville, VIC 3010, Australia; Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, 41 Victoria Street, Fitzroy, VIC 3065, Australia.
| | - Alexis Shub
- Department of Perinatal Medicine, Mercy Health, 163 Studley Road, Heidelberg, VIC 3084, Australia; Department of Medicine, The University of Melbourne, Grattan Street, Parkville, VIC 3010, Australia.
| | - Elif I Ekinci
- Department of Endocrinology and Diabetes, Austin Health, 145 Studley Road, Heidelberg, VIC 3084, Australia; Department of Medicine, The University of Melbourne, Grattan Street, Parkville, VIC 3010, Australia.
| | - Christine Houlihan
- Department of Perinatal Medicine, Mercy Health, 163 Studley Road, Heidelberg, VIC 3084, Australia; Department of Endocrinology and Diabetes, Austin Health, 145 Studley Road, Heidelberg, VIC 3084, Australia.
| |
Collapse
|
47
|
Meah VL, Davies GA, Davenport MH. Why can't I exercise during pregnancy? Time to revisit medical 'absolute' and 'relative' contraindications: systematic review of evidence of harm and a call to action. Br J Sports Med 2020; 54:1395-1404. [PMID: 32513676 DOI: 10.1136/bjsports-2020-102042] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Clinical guidelines recommend pregnant women without contraindication engage in regular physical activity. This is based on extensive evidence demonstrating the safety and benefits of prenatal exercise. However, certain medical conditions or contraindications warrant a reduction, modification or cessation of activity due to potential health risks. AIM To review and evaluate the evidence related to medical disorders which may warrant contraindication to prenatal exercise. METHODS Online databases were searched up to 5 April 2019. Forty-four unique studies that reported data on our Population (pregnant women with contraindication to exercise), Intervention (subjective/objective measures of acute or chronic exercise), Comparator (not essential) and Outcomes (adverse maternal or fetal outcomes) were included in the review. KEY FINDINGS We found that the majority of medical conditions listed as contraindications were based on expert opinion; there is minimal empirical evidence to demonstrate harm of exercise and benefit of activity restriction. We identified 11 complications (eg, gestational hypertension, twin pregnancy) previously classified as contraindications where women may in fact benefit from regular prenatal physical activity with or without modifications. However, the evidence suggests that severe cardiorespiratory disease, placental abruption, vasa previa, uncontrolled type 1 diabetes, intrauterine growth restriction, active preterm labour, severe pre-eclampsia and cervical insufficiency are associated with strong potential for maternal/fetal harm and warrant classification as absolute contraindications. CONCLUSION Based on empirical evidence, we provide a call to re-evaluate clinical guidelines related to medical disorders that have previously been considered contraindications to prenatal exercise. Removing barriers to physical activity during pregnancy for women with certain medical conditions may in fact be beneficial for maternal-fetal health outcomes.
Collapse
Affiliation(s)
- Victoria L Meah
- Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sport, and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Gregory A Davies
- Department of Obstetrics and Gynecology, Queen's University, Kingston, Ontario, Canada
| | - Margie H Davenport
- Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sport, and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
48
|
Shub A, Lappas M. Pregestational diabetes in pregnancy: Complications, management, surveillance, and mechanisms of disease-A review. Prenat Diagn 2020; 40:1092-1098. [PMID: 32333803 DOI: 10.1002/pd.5718] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 03/12/2020] [Accepted: 04/20/2020] [Indexed: 12/16/2022]
Abstract
Diabetes is an increasingly common diagnosis among pregnant women. Pregestational diabetes is associated with an increase in many adverse pregnancy outcomes, which impact both on the woman and her fetus. The models of pregnancy care for women with diabetes are based largely on observational data or consensus opinion. Strategies for aneuploidy screening and monitoring for fetal well-being should be modified in women with diabetes. There is an increasing understanding of the mechanisms by which congenital anomalies and disorders of fetal growth occur, involving epigenetic modifications, changes in gene expression in critical developmental pathways, and oxidative stress. This knowledge may lead to pathways for improved care for these high-risk pregnancies.
Collapse
Affiliation(s)
- Alexis Shub
- Department of Obstetrics and Gynecology, University of Melbourne, Parkville, Australia.,Perinatal Department, Mercy Hospital for Women, Heidelberg, Australia
| | - Martha Lappas
- Department of Obstetrics and Gynecology, University of Melbourne, Parkville, Australia
| |
Collapse
|
49
|
Polsky S, Garcetti R, Pyle L, Joshee P, Demmitt JK, Snell-Bergeon JK. Continuous glucose monitor use with and without remote monitoring in pregnant women with type 1 diabetes: A pilot study. PLoS One 2020; 15:e0230476. [PMID: 32298269 PMCID: PMC7162510 DOI: 10.1371/journal.pone.0230476] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 03/01/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND To examine whether continuous glucose monitoring (CGM) with remote monitoring by followers (family/friends) changes glucose management, follower interventions, and health outcomes compared to CGM alone in pregnant women with diabetes. METHODS We prospectively stratified first trimester pregnant women with Type 1 Diabetes to CGM Share (remote monitoring) or CGM Alone. We enrolled a main follower per woman. We retrospectively acquired data for pregnant women who did not use CGM (no CGM). We compared hemoglobin A1c (HbA1c) between groups. We compared sensor glucose, follower interventions, and gestational outcomes between CGM Alone and CGM Share. Longitudinal mixed effects models were used for analyses of changes in outcomes over time. RESULTS HbA1c decreased in all groups throughout pregnancy and was significantly lower over time in women using CGM Share (n = 15) compared to CGM Alone (n = 13) or no CGM (n = 8) (p = 0.0042). CGM Share users had lower median sensor glucose levels (p = 0.0331) and percent time spent >180 mg/dL (p = 0.0228) across pregnancy. There were no significant differences in maternal and fetal outcomes between groups. CGM Share followers had more alerts for hypoglycemia, but did fewer interventions. CONCLUSIONS In this small pilot study, use of CGM with remote monitoring improved some glycemic metrics in pregnant women with diabetes.
Collapse
Affiliation(s)
- Sarit Polsky
- Barbara Davis Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
- * E-mail:
| | - Rachel Garcetti
- Barbara Davis Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Laura Pyle
- Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Prakriti Joshee
- Barbara Davis Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Jamie K. Demmitt
- Barbara Davis Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Janet K. Snell-Bergeon
- Barbara Davis Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
| |
Collapse
|
50
|
Allen LA, Cannings-John RL, Evans A, Thayer DS, French R, Paranjothy S, Fone DL, Dayan CM, Gregory JW. Pregnancy in teenagers diagnosed with type 1 diabetes mellitus in childhood: a national population-based e-cohort study. Diabetologia 2020; 63:799-810. [PMID: 31863141 PMCID: PMC7054376 DOI: 10.1007/s00125-019-05063-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 11/05/2019] [Indexed: 11/25/2022]
Abstract
AIMS/HYPOTHESIS The aim of this study was to describe the characteristics and outcomes of pregnancies in a national cohort of teenage (<20 years) and young adult women (≥20 years) with and without childhood-onset (<15 years) type 1 diabetes. We hypothesised that, owing to poor glycaemic control during the teenage years, pregnancy outcomes would be poorer in teenage mothers with type 1 diabetes than young adult mothers with type 1 diabetes and mothers without diabetes. METHODS The Brecon Register of childhood-onset type 1 diabetes diagnosed in Wales since 1995 was linked to population-based datasets in the Secure Anonymised Information Linkage (SAIL) Databank, creating an electronic cohort (e-cohort) of legal births (live or stillbirths beyond 24 weeks' gestation) to women aged less than 35 years between 1995 and 2013 in Wales. Teenage pregnancy rates were calculated based on the number of females in the same birth cohort in Wales. Pregnancy outcomes, including pre-eclampsia, preterm birth, low birthweight, macrosomia, congenital malformations, stillbirths and hospital admissions during the first year of life, were obtained from electronic records for the whole Welsh population. We used logistic and negative binomial regression to compare outcomes among teenage and young adult mothers with and without type 1 diabetes. RESULTS A total of 197,796 births were eligible for inclusion, including 330 to girls and women with childhood-onset type 1 diabetes, of whom 68 were teenagers (age 14-19 years, mean 17.9 years) and 262 were young adults (age 20-32 years, mean 24.0 years). The mean duration of diabetes was 14.3 years (9.7 years for teenagers; 15.5 years for young adults). Pregnancy rates were lower in teenagers with type 1 diabetes than in teenagers without diabetes (mean annual teenage pregnancy rate between 1999 and 2013: 8.6 vs 18.0 per 1000 teenage girls, respectively; p < 0.001). In the background population, teenage pregnancy was associated with deprivation (p < 0.001), but this was not the case for individuals with type 1 diabetes (p = 0.85). Glycaemic control was poor in teenage and young adult mothers with type 1 diabetes (mean HbA1c based on closest value to conception: 81.3 and 80.2 mmol/mol [9.6% and 9.5%], respectively, p = 0.78). Glycaemic control improved during pregnancy in both groups but to a greater degree in young adults, who had significantly better glycaemic control than teenagers by the third trimester (mean HbA1c: 54.0 vs 67.4 mmol/mol [7.1% vs 8.3%], p = 0.01). All adverse outcomes were more common among mothers with type 1 diabetes than mothers without diabetes. Among those with type 1 diabetes, hospital admissions during the first year of life were more common among babies of teenage vs young adult mothers (adjusted OR 5.91 [95% CI 2.63, 13.25]). Other outcomes were no worse among teenage mothers with type 1 diabetes than among young adult mothers with diabetes. CONCLUSIONS/INTERPRETATION Teenage girls with childhood-onset type 1 diabetes in Wales are less likely to have children than teenage girls without diabetes. Teenage pregnancy in girls with type 1 diabetes, unlike in the background population, is not associated with social deprivation. In our cohort, glycaemic control was poor in both teenage and young adult mothers with type 1 diabetes. Pregnancy outcomes were comparable between teenage and young adult mothers with type 1 diabetes, but hospital admissions during the first year of life were five times more common among babies of teenage mothers with type 1 diabetes than those of young adult mothers with diabetes.
Collapse
Affiliation(s)
- Lowri A Allen
- Diabetes Research Group , C2 link corridoe University Hospital of Wales Heath Park, Cardiff, CF14 4XN, UK.
| | | | - Annette Evans
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Daniel S Thayer
- SAIL Databank, School of Medicine, Swansea University, Swansea, UK
| | - Robert French
- Diabetes Research Group , C2 link corridoe University Hospital of Wales Heath Park, Cardiff, CF14 4XN, UK
| | | | - David L Fone
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Colin M Dayan
- Diabetes Research Group , C2 link corridoe University Hospital of Wales Heath Park, Cardiff, CF14 4XN, UK
| | - John W Gregory
- Division of Population Medicine, Cardiff University, Cardiff, UK
| |
Collapse
|