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Lin L, Huang Y, Chen L, Zheng L, Feng Y, Lin J, Yan J. Gestational weight trajectory and risk of adverse pregnancy outcomes among women with gestational diabetes mellitus: A retrospective cohort study. MATERNAL & CHILD NUTRITION 2024; 20:e13645. [PMID: 38517119 PMCID: PMC11168372 DOI: 10.1111/mcn.13645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 02/23/2024] [Accepted: 02/28/2024] [Indexed: 03/23/2024]
Abstract
The aim of this study was to explore gestational weight gain (GWG) trajectories and their associations with adverse pregnancy outcomes. A retrospective cohort study including 11,064 women with gestational diabetes mellitus (GDM) was conducted between 2015 and 2019 in China. The latent class trajectory model was used to identify GWG trajectories, and logistic regression was performed to examine odds ratio (OR) of pregnancy outcomes. Three trajectories of GWG were identified in these 11,604 women with GDM. Trajectory 1: 64.02% of women had sustained moderate GWG throughout pregnancy; Trajectory 2: 17.75% of women showed a high initial GWG but followed by a low GWG from the third trimester until delivery; Trajectory 3: 18.23% had low initial GWG but followed by drastic GWG from the second trimester until delivery. Compared with pregnant women with Trajectory 1, women with Trajectory 2 had a higher risk of large for gestational age (adjusted odds ratio [AOR]: 1.29, 95% confidence interval [CI]: 1.12-1.48) but at a lower risk of having hypertensive disorders of pregnancy (AOR: 0.76, 95% CI: 0.57-0.96). Women in Trajectory 3 were more likely to develop small for gestational age (AOR: 2.12, 95% CI: 1.62-2.78), low birthweight (AOR: 1.49, 95% CI: 1.07-2.08), preterm birth (AOR: 1.28, 95% CI: 1.05-1.63), caesarean section (AOR: 1.26, 95% CI: 1.112-1.42) and hypertensive disorders of pregnancy (AOR: 2.24, 95% CI: 1.82-2.76). The association of GWG trajectory with adverse pregnancy outcomes differs across prepregnancy body mass index and GWG categories. Women with a slow initial GWG but followed by drastic GWG had higher risks of adverse pregnancy outcomes. Early clinical recognition of poor GWG trajectory will contribute to early intervention in high-risk groups to minimise adverse outcomes.
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Affiliation(s)
- Lihua Lin
- Department of Healthcare, Fujian Maternity and Child Health HospitalAffiliated Hospital of Fujian Medical UniversityFuzhouPeople's Republic of China
| | - Yanhong Huang
- Department of Healthcare, Fujian Maternity and Child Health HospitalAffiliated Hospital of Fujian Medical UniversityFuzhouPeople's Republic of China
| | - Lijuan Chen
- Department of Child Healthcare Center, Fujian Maternity and Child Health HospitalAffiliated Hospital of Fujian Medical UniversityFuzhouPeople's Republic of China
| | - Lianghui Zheng
- Department of Obstetric, Fujian Maternity and Child Health HospitalAffiliated Hospital of Fujian Medical UniversityFuzhouPeople's Republic of China
| | - Yebin Feng
- Department of Research Office, Fujian Maternity and Child Health HospitalAffiliated Hospital of Fujian Medical UniversityFuzhouPeople's Republic of China
| | - Juan Lin
- Department of Obstetric, Fujian Maternity and Child Health HospitalAffiliated Hospital of Fujian Medical UniversityFuzhouPeople's Republic of China
| | - Jianying Yan
- Department of Obstetric, Fujian Maternity and Child Health HospitalAffiliated Hospital of Fujian Medical UniversityFuzhouPeople's Republic of China
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Zheng X, Zhang Q, Su W, Liu W, Huang C, Shi X, Li X. Dietary Intakes of Women with Gestational Diabetes Mellitus and Pregnancy Outcomes: A Prospective Observational Study. Diabetes Metab Syndr Obes 2024; 17:2053-2063. [PMID: 38770431 PMCID: PMC11104373 DOI: 10.2147/dmso.s455827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/30/2024] [Indexed: 05/22/2024] Open
Abstract
Purpose Nutrient intake for pregnant women with gestational diabetes mellitus (GDM) is important to ensure satisfactory birth outcomes. This study aims to explore the dietary profiles of patients with GDM, compare the results with the Chinese dietary guidelines or Dietary Reference Intakes (DRIs) from China and investigate the relationship between maternal dietary intake and pregnancy outcomes. Patients and Methods A total of 221 patients with GDM in the second trimester were included in the cohort. Dietary intake data were collected using a 24-hour recall method for three consecutive days. The pregnancy outcomes of these participants were subsequently monitored. Both univariate logistic regression and multivariate logistic regression analyses were conducted to explore the associations between dietary intake variables or general characteristics variables and adverse pregnancy outcomes. Results Participants with adverse pregnancy outcomes showed a lower intake of iodine and vitamin D, a lower percentage of dietary energy intake from carbohydrates and a higher percentage of dietary energy intake from fats, compared to participants without adverse pregnancy outcomes. The gestational weight gain and family history of diabetes were associated with an increased risk of adverse pregnancy outcomes. Conversely, regular exercise, the intake of iodine and Vitamin D, and the percentage of dietary energy intake from carbohydrates were associated with a decreased risk. Conclusion The daily diet of pregnant women with GDM in China did not meet the dietary guidelines or DRIs. The low intake of Vitamin D and iodine, the low dietary carbohydrate ratio, family history of diabetes, lack of exercise, and high gestational weight gain were associated with increased risk of adverse pregnancy outcomes in pregnant women with GDM.
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Affiliation(s)
- Xin Zheng
- Department of Endocrinology and Diabetes, Xiamen Diabetes Institute, Fujian Province Key Laboratory of Translational Research for Diabetes, the First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, People’s Republic of China
| | - Qiaoqing Zhang
- Department of Endocrinology and Diabetes, Xiamen Diabetes Institute, Fujian Province Key Laboratory of Translational Research for Diabetes, the First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, People’s Republic of China
| | - Weijuan Su
- Department of Endocrinology and Diabetes, Xiamen Diabetes Institute, Fujian Province Key Laboratory of Translational Research for Diabetes, the First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, People’s Republic of China
| | - Wei Liu
- Department of Endocrinology and Diabetes, Xiamen Diabetes Institute, Fujian Province Key Laboratory of Translational Research for Diabetes, the First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, People’s Republic of China
| | - Caoxin Huang
- Department of Endocrinology and Diabetes, Xiamen Diabetes Institute, Fujian Province Key Laboratory of Translational Research for Diabetes, the First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, People’s Republic of China
| | - Xiulin Shi
- Department of Endocrinology and Diabetes, Xiamen Diabetes Institute, Fujian Province Key Laboratory of Translational Research for Diabetes, the First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, People’s Republic of China
| | - Xuejun Li
- Department of Endocrinology and Diabetes, Xiamen Diabetes Institute, Fujian Province Key Laboratory of Translational Research for Diabetes, the First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, People’s Republic of China
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Niebrzydowska-Tatus M, Pełech A, Rekowska AK, Satora M, Masiarz A, Kabała Z, Kimber-Trojnar Ż, Trojnar M. Recent Insights and Recommendations for Preventing Excessive Gestational Weight Gain. J Clin Med 2024; 13:1461. [PMID: 38592297 PMCID: PMC10932422 DOI: 10.3390/jcm13051461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 02/13/2024] [Accepted: 02/28/2024] [Indexed: 04/10/2024] Open
Abstract
Recommendations for weight gain during pregnancy are based on pre-pregnancy body mass index (BMI). Pregnancy is a risk factor for excessive weight gain and many endocrine problems, making it difficult to return to pre-pregnancy weight and increasing the risk of postpartum obesity and, consequently, type 2 diabetes and metabolic syndrome. Both excessive gestational weight gain (EGWG) and obesity are associated with an increased risk of gestational hypertension, pre-eclampsia, gestational diabetes, cesarean section, shoulder dystocia, and neonatal macrosomia. In the long term, EGWG is associated with increased morbidity and mortality, particularly from diabetes, cardiovascular disorders, and some cancers. This study aims to present recommendations from various societies regarding weight gain during pregnancy, dietary guidance, and physical activity. In addition, we discuss the pathophysiology of this complication and the differential diagnosis in pregnant women with EGWG. According to our research, inadequate nutrition might contribute more significantly to the development of EGWG than insufficient physical activity levels in pregnant women. Telehealth systems seem to be a promising direction for future EGWG prevention by motivating women to exercise. Although the importance of adequate pre-pregnancy weight and weight gain during pregnancy is well known, an increasing number of women gain excessive weight during pregnancy.
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Affiliation(s)
| | - Aleksandra Pełech
- Department of Obstetrics and Perinatology, Medical University of Lublin, 20-090 Lublin, Poland; (M.N.-T.); (A.P.)
| | - Anna K. Rekowska
- Student’s Scientific Association and Department of Obstetrics and Perinatology, Medical University of Lublin, 20-090 Lublin, Poland; (A.K.R.); (M.S.); (A.M.); (Z.K.)
| | - Małgorzata Satora
- Student’s Scientific Association and Department of Obstetrics and Perinatology, Medical University of Lublin, 20-090 Lublin, Poland; (A.K.R.); (M.S.); (A.M.); (Z.K.)
| | - Angelika Masiarz
- Student’s Scientific Association and Department of Obstetrics and Perinatology, Medical University of Lublin, 20-090 Lublin, Poland; (A.K.R.); (M.S.); (A.M.); (Z.K.)
| | - Zuzanna Kabała
- Student’s Scientific Association and Department of Obstetrics and Perinatology, Medical University of Lublin, 20-090 Lublin, Poland; (A.K.R.); (M.S.); (A.M.); (Z.K.)
| | - Żaneta Kimber-Trojnar
- Department of Obstetrics and Perinatology, Medical University of Lublin, 20-090 Lublin, Poland; (M.N.-T.); (A.P.)
| | - Marcin Trojnar
- Department of Internal Diseases, Medical University of Lublin, 20-059 Lublin, Poland;
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Jo H, Kim BG. Effects of dietary fiber in gestating sow diets - A review. Anim Biosci 2023; 36:1619-1631. [PMID: 37641826 PMCID: PMC10623041 DOI: 10.5713/ab.23.0206] [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: 06/02/2023] [Revised: 07/12/2023] [Accepted: 08/12/2023] [Indexed: 08/31/2023] Open
Abstract
The objective of this review was to provide an overview of the effects of dietary fiber (DF) on reproductive performance in gestating sows. Dietary fibers have been suggested to modulate microbiota in the intestine and the immune system of gestating sows and to improve gut health. Thus, DF may help alleviate the adverse effects of the stressful production cycle of gestating sows. These benefits may subsequently result in improved reproductive performance of sows. Previous studies have reported changes in microbiota by providing gestating sows with DF, and the responses of microbiota varied depending on the source of DF. The responses by providing DF to gestating sows were inconsistent for antioxidative capacity, hormonal response, and inflammatory response among the studies. The effects of DF on reproductive performance were also inconsistent among the previous studies. Potential reasons contributing to these inconsistent results would include variability in reproductive performance data, insufficient replication, influence of other nutrients contained in the DF diets, characteristics of DF, and experimental periods. The present meta-analysis suggests that increasing the total DF concentration by 10 percentage units (e.g., 12% to 22% as-fed basis) in gestating sow diets compared to the control group improves the litter born alive by 0.49 pigs per litter. However, based on the present review, questions remain regarding the benefits of fibers in gestating sow diets. Further research is warranted to clarify the mode of action of fibers and the association with subsequent reproductive performance in gestating sows.
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Affiliation(s)
- Hyunwoong Jo
- Department of Animal Science and Technology, Konkuk University, Seoul 05029,
Korea
| | - Beob Gyun Kim
- Department of Animal Science and Technology, Konkuk University, Seoul 05029,
Korea
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Le DC, Vu TB, Tran TN, Nguyen TL, Nguyen TB, Nguyen DC, Hoang VT. The Effectiveness of Lifestyle Changes in Glycemic Control among Pregnant Women with Gestational Diabetes Mellitus. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1587. [PMID: 37763706 PMCID: PMC10537217 DOI: 10.3390/medicina59091587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/26/2023] [Accepted: 08/29/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: Gestational diabetes mellitus (GDM) is a type of diabetes that develops during pregnancy and affects approximately 10% of pregnant women worldwide. Understanding the impact of lifestyle changes on glycemic control in GDM is important for improving maternal and fetal outcomes and reducing the risk of diabetes in both the mother and child. The aim of this study is to evaluate the effectiveness as well as the factors affecting glycemic control by lifestyle changes in pregnant women with GDM. Materials and Methods: A descriptive cross-sectional study was conducted at three hospitals in the Thai Binh Province from June 2021 to May 2022. All pregnant women at 24-28 weeks of gestation, aged 18 years or older, were enrolled. GDM was diagnosed according to the guidelines of the International Association of the Diabetes and Pregnancy Study Groups. Lifestyle changes including diet and physical exercise were carried out for two weeks. The main outcome measured was successful glycemic control according to the 2018 ADA Recommendations for the Management and Treatment of GDM. Results: 1035 women were included and 20.2% diagnosed with GDM. After two weeks of lifestyle change intervention, 82.6% of the pregnant women with GDM had successful glycemic control. Pregnant women aged under 35 years had a 3.2 times higher rate of gestational glycemic control than those older than 35 (aOR = 3.22, p-value = 0.004). Women with a pre-pregnancy BMI of less than 25 had a higher rate of gestational glycemic control than those with a BMI of over 25 (aOR = 10.84, p-value < 0.001). Compared to women who had all three diagnostic criteria for gestational diabetes, those with two diagnostic criteria and one criterion were 3.8 times and 3 times more likely to have successful blood sugar control (aOR = 3.78, p-value = 0.01 and aOR = 3.03, p-value = 0.03, respectively). Conclusion: Lifestyle changes can be an effective measure for achieving glycemic control in women with GDM. Healthcare providers should consider individualized treatment plans based on the specific needs of each patient.
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Affiliation(s)
| | | | | | | | | | | | - Van Thuan Hoang
- Thai Binh University of Medicine and Pharmacy, Thai Binh 410000, Vietnam; (D.C.L.); (T.B.V.); (T.N.T.); (T.L.N.); (T.B.N.); (D.C.N.)
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Lin L, Wu J, Xu L, Fang J, Lin J. Maternal body mass index and risk of fetal overgrowth in women with gestational diabetes Mellitus in Southeast China: a retrospective cohort study. Diabetol Metab Syndr 2023; 15:121. [PMID: 37291681 DOI: 10.1186/s13098-023-01093-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 05/22/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND To investigate the relationship between body mass index (BMI) changes and large for gestational age (LGA) in women with gestational diabetes mellitus (GDM). METHODS A retrospective cohort study including 10,486 women with GDM was conducted. A dose‒response analysis of BMI changes and the occurrence of LGA was performed. Binary logistic regressions were performed to assess crude and adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Receiver operating characteristic (ROC) curves and areas under the curve (AUCs) were used to assess the ability of BMI changes to predict LGA. RESULTS The probability of LGA increased with increasing BMI. The risk of LGA increased across the BMI change quartiles. The BMI change remained positively associated with the risk of LGAafter stratification analysis. The AUC was 0.570 (95% CI: 0.557 ~ 0.584)in the entire study population, and the best optimal predictive cut-off value was 4.922, with a sensitivity of 0.622 and a specificity of 0.486. The best optimal predictive cut-off value decreased from the underweight group to the overweight and obese group. CONCLUSIONS BMI changes are related to the risk of LGA and may be a useful predictor of the incidence of LGA in singleton pregnant women with GDM.
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Affiliation(s)
- Lihua Lin
- Department of Healthcare, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350001, Fujian Province, P.R. China
| | - Jianhang Wu
- Department of Ultrasonography, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350001, Fujian Province, P.R. China
| | - Libo Xu
- Department of Computer center, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350001, Fujian Province, P.R. China
| | - Jianqi Fang
- Department of women's health care, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350001, Fujian Province, P.R. China.
| | - Juan Lin
- Department of women's health care, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350001, Fujian Province, P.R. China.
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Screening of Gestational Diabetes and Its Risk Factors: Pregnancy Outcome of Women with Gestational Diabetes Risk Factors According to Glycose Tolerance Test Results. J Clin Med 2022; 11:jcm11174953. [PMID: 36078883 PMCID: PMC9456276 DOI: 10.3390/jcm11174953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 08/19/2022] [Accepted: 08/20/2022] [Indexed: 12/23/2022] Open
Abstract
Background: Gestational diabetes mellitus (GDM) can cause maternal and neonatal health problems, and its prevalence is increasing worldwide. We assessed the screening of GDM during a 7-year period and compared the outcome of pregnancies at high risk for GDM. Methods: We analyzed non-selected pregnant women (n = 5021) receiving antenatal care in Tartu University Hospital, Estonia in 2012–2018. Pregnant women were classified based on the absence or presence of GDM risk factors as low risk (n = 2302) or high risk for GDM (n = 2719), respectively. The latter were divided into subgroups after the oral glycose tolerance test (OGTT): GDM (n = 423), normal result (n = 1357) and not tested (n = 939). Results: The proportion of women with GDM risk factors increased from 43.5% in 2012 to 57.8% in 2018, and the diagnosis of GDM more than doubled (5.2% vs. 13.7%). Pregnancies predisposed to GDM but with normal OGTT results were accompanied by an excessive gestational weight gain and increased odds to deliver a LGA baby (AOR 2.3 (CI 1.8–3.0)). Conclusions: An increasing number of pregnancies presenting GDM risk factors are diagnosed with GDM. Pregnant women with GDM risk factors are, despite normal OGTT, at risk of increased weight gain and LGA newborns.
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