Gestational diabetes mellitus: Impacts on fetal neurodevelopment, gut dysbiosis, and the promise of precision medicine

Association Between Gestational Diabetes Mellitus and Risk of Overall and Site-Specific Cancers (Pancreatic, Liver, Thyroid, Lung): A Systematic Review and Meta-Analysis

Background: Gestational diabetes mellitus (GDM) is a common endocrine and metabolic disorder during pregnancy. However, current studies have not reached a consensus on the correlation between GDM and the risk of developing cancers. Objective: This systematic review and meta-analysis aims to comprehensively evaluate the association between GDM and the risk of overall cancer and cancers at specific sites (pancreatic cancer, thyroid cancer, liver cancer, lung cancer). Methods: A systematic search was conducted in PubMed, Web of Science, Scopus, EMBASE, and Cochrane Library databases from the establishment of the databases to 16 January 2025. Two researchers independently assessed the quality of the included studies using the Newcastle-Ottawa Scale and extracted relevant data. Data were analyzed using STATA Version 17.0. Results: This systematic review and meta-analysis included a total of 8 studies involving 1,936,836 participants. We calculated the pooled hazard ratio (HR) to evaluate the association, and the results showed that the pooled HR for overall cancer risk was 1.16 (95%CI: 1.04-1.28), indicating a significant increase in the risk of overall malignancies among patients with GDM. GDM was also significantly associated with the risk of pancreatic cancer (HR = 2.80; 95%CI: 1.20-6.55), thyroid cancer (HR = 1.21; 95%CI: 1.08-1.36), and liver cancer (HR = 1.33; 95%CI: 1.10-1.61). Additionally, the association between GDM and lung cancer was close to being statistically significant (HR = 1.19; 95%CI: 0.98-1.44). Conclusion: Our study suggests that GDM is associated with an increased risk of overall cancer, as well as pancreatic cancer, thyroid cancer, and liver cancer.

Extra-Thyroidal Impacts of Serum Iodine Concentrations During Early Pregnancy on Metabolic Profiles and Pregnancy Outcomes: Prospective Study Based on Huizhou Mother-Infant Cohort

Objectives: This study aimed to test the extra-thyroidal impacts of maternal serum iodine concentrations (SICs) on metabolic factors and subsequent pregnancy outcomes. Methods: Single pregnant women aged 18-49 years were recruited during their first prenatal visits. SICs at first trimester (T1) were tested by ICP-MS. Metabolic factors [body mass index (BMI), fat %, glucose, lipids, uric acid, and blood pressure] were measured, and composite indices [the triglyceride-glucose (TyG) index, TyG-BMI, and the Framingham steatosis index (FSI)] were estimated. Obstetric and birth outcomes were retrieved from the hospital information system, including gestational diabetes (GDM), gestational hypertension (GH), fetal distress, postpartum hemorrhage, premature rupture of membrane, small and large for gestational age (SGA and LGA), preterm birth, and low birth weight. Multivariable linear and logistic regression models were applied to explore the associations between maternal SIC, metabolic factors, and pregnancy outcomes. Results: A total of 1456 mothers were included for analysis. Maternal LgSIC values at T1 were inversely associated with early gestational weight gain (β = -0.113, p < 0.001) and BMI at T1 (β = -0.070, p = 0.006), but they were positively associated with triglycerides (β = 0.142, p < 0.001), the TyG index (β = 0.137, p < 0.001), and uric acid (β = 0.060, p = 0.018). However, upon further adjustment for thyroid hormones, the associations were attenuated. The joint effects of high SIC and metabolic conditions (hyperlipidemia, high FSI, and GH) suggested increased adverse pregnancy outcomes (increased postpartum bleeding, reduced birth length, and reduced delivery weeks). Conclusions: Our prospective data in the iodine replete region indicated that high SICs at T1 were associated with increased risk of metabolic conditions and adverse birth outcomes, with the associations being independent of thyroid hormones.

Effects of Prebiotic Phytocompound Administration in Gestational Diabetic Dams and Its Influence on Offspring Cognitive Outcomes

Gestational diabetes mellitus (GD)-induced gut dysbiosis in pregnant mothers may increase the risk of cognitive impairment and neurological disorders in both the mother and offspring as they age. Restoring gut balance could improve cognitive outcomes for both. Despite advancements in GD treatment, side effects have increased, and long-term neurocognitive impacts on offspring born to GD mothers remain underexplored. This study uses a GD mouse model, inducing pancreatic dysfunction in 3-month-old pregnant C57BL/6J mice with Streptozotocin. The efficacy and mechanism of the prebiotic phytocompound green leaf extract (Allmania nodiflora) were assessed, with metformin as the standard. GD dams exhibited weight and glucose reduction, pancreatic IL-6 elevation, GLUT3 reduction, astroglia changes in the cerebral cortex, gut barrier impairment, cognitive impairment, and heightened anxiety compared to controls. Bacterial 16s rRNA sequencing revealed dysbiosis, with reduced Erysipelotrichales in GD dams compared to controls. Metformin lowered blood glucose levels but failed to rescue functional and behavioral phenotypes in both GD dams and offspring. Phytocompound treatment improved blood glucose, reduced pancreatic inflammation, improved gut barrier integrity, reversed dysbiosis, and enhanced brain health. It rescued behavioral deficits and improved cognitive outcomes in offspring, suggesting the prebiotic phytocompound may be a more effective therapeutic agent for GD in humans.

Microbiome and Pregnancy Dysbiosis: A Narrative Review on Offspring Health

Background: Emerging evidence suggests that the maternal microbiome plays a crucial role in shaping fetal neurodevelopment, immune programming, and metabolic health. Dysbiosis during pregnancy-whether gastrointestinal, oral, or vaginal-can significantly influence pregnancy outcomes and long-term child health. Materials and Methods: The search was performed using databases such as PubMed, Scopus, and Google Scholar including research published from January 2000 to January 2025. The keywords used were "Fetal Programming", " Maternal Immune Activation", "Maternal microbiome", "Microbiota-Gut-Brain Axis", and "Pregnancy Dysbiosis". Results: The maternal microbiome undergoes substantial changes during pregnancy, with alterations in microbial diversity and function linked to conditions such as gestational diabetes, obesity, and preeclampsia. Pregnancy-related dysbiosis has been associated with adverse neurodevelopmental outcomes, including an increased risk of autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), and cognitive impairments in offspring. Conclusions: Understanding the intricate relationship between maternal microbiota and fetal health is essential for developing targeted interventions. Personalized microbiome-based strategies, including dietary modifications and probiotic supplementation, hold promise in optimizing pregnancy outcomes and promoting health in offspring.

Association between protein intake and sources in mid-pregnancy and the risk of gestational diabetes mellitus

OBJECTIVES

This study aimed to investigate the relationship between dietary protein intake and sources in the second trimester of pregnancy and the risk of gestational diabetes mellitus (GDM) and to further investigate the effects of total protein and animal protein intake on the risk of GDM.

METHODS

A case-control study was conducted, which involved 947 pregnant women in the second trimester from three hospitals in Jiangsu, China. Dietary intake was assessed using a 3-day 24-hour dietary recall and a food frequency questionnaire. Two models (leave-one-out and partition models) in nutritional epidemiology were used for substitution analysis, and logistic regression was performed to explore the relationships, adjusting for multiple confounding factors.

RESULTS

After adjusting for confounding factors, total protein intake was negatively correlated with GDM risk (OR [95% CI], 0.10 [0.04-0.27]; P<0.001). Animal protein also negatively correlated with GDM risk, but this became insignificant when total calorie, carbohydrate and fat intake were added as covariates to the analysis (0.68 [0.34-1.34]; P = 0.263). No association was found between plant protein and GDM(1.04 [0.69-1.58]; P = 0.852). Replacing carbohydrates with an equal energy ratio(5% of total energy intake) of total protein, animal protein and plant protein respectively reduced the risk of GDM by 45%, 46% and 51%.

CONCLUSIONS

The intake of total protein and animal protein, especially eggs, dairy products, and fish, can reduce the risk of GDM while consuming unprocessed red meat increases the risk. There is no significant association between the intakes of plant protein, processed meat, and poultry meat and the occurrence of GDM. The results of this study are expected to provide a basis for precise nutritional education, health guidance during pregnancy, and early prevention of GDM.

Research on the application effect of self-transcendence nursing model in patients with gestational diabetes mellitus: a randomised controlled trial

BACKGROUND

Gestational diabetes mellitus is hyperglycemia in special populations (pregnant women), however gestational diabetes mellitus (GDM) not only affects maternal health, but also has profound effects on offspring health. The prevalence of gestational diabetes in my country is gradually increasing.

OBJECTIVE

To study the application effect of self-transcendence nursing model in GDM patients.

METHODS

One hundred fourteen GDM patients undergoing prenatal examination in Hai'an People's Hospital from January 2019 to November 2021 were selected and divided into two groups of 57 cases respectively according to the principle of random single blind. The patients in the control group should receive pregnancy health care under the routine nursing mode, while those in the observation group should receive pregnancy health care under the self-transcendence nursing mode. Then, we would compare the insulin utilization rate, admission before delivery, gestational weeks, delivery outcome and neonatal conditions between the two groups, examine the changes of blood glucose related indexes in the two groups and evaluate the differences between the two groups' Diabetes Distress Scale (DDS) scores and Chinese Versions of Diabetes Management Self-efficacy Scale (C-DMSES) scores.

RESULTS

The number of hospital admissions (1.12 ± 0.31) and the hospital stay (7.54 ± 1.45) days in the observation group were less than those in the control group (1.56 ± 0.42) and (10.23 ± 2.32) days. There was no difference between the two groups after statistical analysis of gestational weeks and insulin utilization rate (P > 0.05). After the intervention, the total DDS score and emotional burden, doctor/life law/interpersonal relationship related distress score of GDM in the two groups were lower than those before the intervention, while the scores of healthy diet, regular exercise, regular monitoring of blood glucose and medication compliance in C-DMSES were higher than those before the intervention. In addition, the improvements of overall DDS scores and C-DMSES scores of GDM in the observation group were significantly better than those in the control group, so there was statistical significance (P < 0.05). In terms of the pregnancy outcomes and neonatal conditions, the rates of premature delivery and neonatal delivery in the observation group were higher than those in the control group, and there was no difference (P > 0.05) in other aspects of pregnancy outcomes and neonatal conditions.

CONCLUSION

Self-transcendence nursing mode intervention can improve blood sugar, reduce psychological distress, and improve self-efficacy in GDM patients, thereby reducing the rate of pregnancy-induced hypertension and premature birth.

Maternal Diabetes and Neurodevelopmental Outcomes of Infants Born Before 29 Weeks' Gestation

OBJECTIVE

To compare the neurodevelopmental outcomes of infants born at <29 weeks' gestation and exposed to diabetes in pregnancy with those unexposed.

STUDY DESIGN

This was a retrospective cohort study using the Canadian Neonatal Network and Canadian Neonatal Follow-Up Network databases. Infants born <29 weeks' gestation and admitted to a level 3 neonatal intensive care unit from 2009 through 2018 who had neurodevelopmental assessments at 18-24 months corrected age were eligible. The 2 primary outcomes were as follows: (1) Neurodevelopmental impairment (NDI) (≥1 of Bayley-III scores < 85 in any domain, cerebral palsy, or vision or hearing impairment); and (2) significant NDI (sNDI) (≥1 of Bayley-III scores < 70 in any domain, cerebral palsy Gross Motor Function Classification System ≥ 3, bilateral blindness, or need for hearing aids or cochlear implants). Secondary outcomes were the individual components of NDI and sNDI. Adjusted odds ratios with 95% CIs were calculated to determine outcomes between groups.

RESULTS

Of 13 988 eligible infants, 55% attended neurodevelopmental follow-up assessments. Infants exposed to diabetes had increased odds of NDI compared with those unexposed (aOR 1.09 (95% CI 1.08-1.54); there was no difference in sNDI (aOR 1.07 (95% CI 0.84-1.36). Language and motor delays were more common in those exposed to maternal diabetes.

CONCLUSIONS

Higher rates of NDI, language, or motor delays were present in infants born at <29 weeks' gestation exposed to diabetes in utero. Future research is needed to determine the etiology and clinical significance of these findings.