1
|
Kunasegaran T, Balasubramaniam VRMT, Thirunavuk Arasoo VJ, Palanisamy UD, Tan YK, Ramadas A. Diet, lifestyle and gut microbiota composition among Malaysian women with gestational diabetes mellitus: a prospective cohort study. Sci Rep 2024; 14:6891. [PMID: 38519592 PMCID: PMC10959929 DOI: 10.1038/s41598-024-57627-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 03/20/2024] [Indexed: 03/25/2024] Open
Abstract
The study addressed a significant gap in the profiling and understanding of the gut microbiota's influence on Malaysian Malay women with gestational diabetes mellitus (GDM). This prospective cohort study aimed to explore the intricate relationship between gut microbiota, dietary choices, and lifestyle factors among Malay women, both with and without GDM. The research specifically focused on participants during the second (T0) and third (T1) trimesters of pregnancy in Johor Bahru, Malaysia. In Part 1 of the study, a diverse pool of pregnant women at T0 was categorized into two groups: those diagnosed with GDM and those without GDM, with a total sample size of 105 individuals. The assessments encompassed demographic, clinical, lifestyle, and dietary factors at the T0 and T1 trimesters. Part 2 of the study delved into microbiome analysis, targeting a better understanding of the gut microbiota among the participants. Stool samples were randomly collected from 50% of the individuals in each group (GDM and non-GDM) at T0 and T1. The collected samples underwent processing, and 16s rRNA metagenomic analysis was employed to study the microbial composition. The results suggested an association between elevated body weight and glucose levels, poor sleep quality, lack of physical activity, greater intake of iron and meat, and reduced fruit consumption among women with GDM compared to non-GDM groups. The microbiome analysis revealed changes in microbial composition over time, with reduced diversity observed in the GDM group during the third trimester. The genera Lactiplantibacillus, Parvibacter, Prevotellaceae UCG001, and Vagococcus positively correlated with physical activity levels in GDM women in the second trimester. Similarly, the genus Victivallis exhibited a strong positive correlation with gravida and parity. On the contrary, the genus Bacteroides and Roseburia showed a negative correlation with omega-3 polyunsaturated fatty acids (PUFAs) in women without GDM in the third trimester. The study highlighted the multifaceted nature of GDM, involving a combination of lifestyle factors, dietary choices, and changes in gut microbiota composition. The findings emphasized the importance of considering these interconnected elements in understanding and managing gestational diabetes among Malaysian Malay women. Further exploration is essential to comprehend the mechanisms underlying this relationship and develop targeted interventions for effective GDM management.
Collapse
Affiliation(s)
- Thubasni Kunasegaran
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, 47500, Bandar Sunway, Malaysia
| | - Vinod R M T Balasubramaniam
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, 47500, Bandar Sunway, Malaysia
| | | | - Uma Devi Palanisamy
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, 47500, Bandar Sunway, Malaysia
| | - Yen Ker Tan
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, 47500, Bandar Sunway, Malaysia
- Mackay Base Hospital, Mackay, QLD, 4740, Australia
| | - Amutha Ramadas
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, 47500, Bandar Sunway, Malaysia.
| |
Collapse
|
2
|
Chen S, Zhao Z, Luo M, Gao Y, Zhou T, Hu J, Luo L, Liu W, Zhang G. Environmental tobacco smoke increased risk of gestational diabetes mellitus: A birth cohort study in Sichuan, China. Diabetes Metab Res Rev 2024; 40:e3724. [PMID: 37727006 DOI: 10.1002/dmrr.3724] [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: 03/22/2023] [Revised: 06/11/2023] [Accepted: 08/07/2023] [Indexed: 09/21/2023]
Abstract
INTRODUCTION Studies on the relationship between environmental tobacco smoke (ETS) and gestational diabetes mellitus (GDM) are limited. In this study, we aimed to clarify the association between ETS at different trimesters of pregnancy and the risk of GDM among non-smoking pregnant women. METHODS A total of 16,893 non-smoking mothers from the Southwest Birth Cohort, China, were included in the final analyses. Exposure and outcome measures included self-reported ETS status at different trimesters of pregnancy and GDM diagnosis. Multivariable logistic regression models were constructed to estimate the association between ETS and GDM. RESULTS The prevalence of ETS exposure was 25.7%. Compared with no ETS, ever ETS had an increased risk of GDM, with an adjusted odds ratio (95% confidence intervals) of 1.21 (1.09, 1.33). The association remained consistent at different trimesters of pregnancy ETS exposure. In the last trimester and with continuous ETS exposure, the risk of GDM increased significantly with the increase in the duration of the exposure. The risk of GDM associated with ever ETS during pregnancy significantly increased in mothers over 30 years old and pre-pregnancy overweight (P for interaction <0.05). CONCLUSIONS ETS exposure at different trimesters of pregnancy was associated with an increased risk of GDM among non-smoking pregnant women. These findings emphasise the importance of preventing ETS exposure during pregnancy.
Collapse
Affiliation(s)
- Shiqi Chen
- Department of Obstetrics, Sichuan Provincial Maternity and Child Health Care Hospital (The Affiliated Women's and Children's Hospital of Chengdu Medical College), Chengdu, Sichuan, China
| | - Ziling Zhao
- Department of Obstetrics, Sichuan Provincial Maternity and Child Health Care Hospital (The Affiliated Women's and Children's Hospital of Chengdu Medical College), Chengdu, Sichuan, China
| | - Min Luo
- Department of Obstetrics, Sichuan Provincial Maternity and Child Health Care Hospital (The Affiliated Women's and Children's Hospital of Chengdu Medical College), Chengdu, Sichuan, China
| | - Yan Gao
- Department of Obstetrics, Sichuan Provincial Maternity and Child Health Care Hospital (The Affiliated Women's and Children's Hospital of Chengdu Medical College), Chengdu, Sichuan, China
| | - Tianjin Zhou
- Department of Obstetrics, Sichuan Provincial Maternity and Child Health Care Hospital (The Affiliated Women's and Children's Hospital of Chengdu Medical College), Chengdu, Sichuan, China
| | - Jinnuo Hu
- Department of Obstetrics, Sichuan Provincial Maternity and Child Health Care Hospital (The Affiliated Women's and Children's Hospital of Chengdu Medical College), Chengdu, Sichuan, China
| | - Liwei Luo
- Department of Obstetrics, Sichuan Provincial Maternity and Child Health Care Hospital (The Affiliated Women's and Children's Hospital of Chengdu Medical College), Chengdu, Sichuan, China
| | - Weixin Liu
- Department of Obstetrics, Sichuan Provincial Maternity and Child Health Care Hospital (The Affiliated Women's and Children's Hospital of Chengdu Medical College), Chengdu, Sichuan, China
| | - Gang Zhang
- Department of Obstetrics, Sichuan Provincial Maternity and Child Health Care Hospital (The Affiliated Women's and Children's Hospital of Chengdu Medical College), Chengdu, Sichuan, China
| |
Collapse
|
3
|
He LR, Yu L, Guo Y. Birth weight and large for gestational age trends in offspring of pregnant women with gestational diabetes mellitus in southern China, 2012-2021. Front Endocrinol (Lausanne) 2023; 14:1166533. [PMID: 37214242 PMCID: PMC10194652 DOI: 10.3389/fendo.2023.1166533] [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: 02/15/2023] [Accepted: 04/17/2023] [Indexed: 05/24/2023] Open
Abstract
Background With increasing prevalence of gestational diabetes mellitus (GDM) and changing management of GDM in pregnancy, it is imperative to understand the evolution of its current outcomes. The present study aimed to explore whether birth weight and large for gestational age (LGA) trends in women with GDM have changed over time in southern China. Methods In this hospital-based retrospective study, all singleton live births for the period 2012 to 2021 were collected from the Guangdong Women and Children Hospital, China. GDM was diagnosed following the criteria of the International Association of Diabetes and Pregnancy Study Group. The cutoff points for defining LGA (>90th centile) at birth based on INTERGROWTH-21st gender-specific standards. Linear regression was used to evaluate trends for birth weight over the years. Logistic regression analysis was used to determine the odds ratios (ORs) of LGA between women with GDM and those without GDM. Results Data from 115097 women with singleton live births were included. The total prevalence of GDM was 16.8%. GDM prevalence varied across different years, with the lowest prevalence in 2014 (15.0%) and the highest prevalence in 2021 (19.2%). The mean birth weight displayed decrease in women with GDM from 3.224kg in 2012 to 3.134kg in 2021, and the z score for mean birth weight decreased from 0.230 to -0.037 (P for trend < 0.001). Among women with GDM, the prevalence of macrosomia and LGA reduced significantly during the study period (from 5.1% to 3.0% in macrosomia and from 11.8% to 7.7% in LGA, respectively). Compared to women without GDM, women with GDM had 1.30 (95% CI: 1.23 - 1.38) times odds for LGA, and the ORs remained stable over the study period. Conclusions Among offspring of women with GDM, there are decreased trends of birth weight in parallel with reductions in LGA prevalence between 2012 and 2021. However, the risk of LGA in women with GDM remains stable at relatively high level over the 10-year period, and efforts are still needed to address regarding causes and effective intervention strategies.
Collapse
Affiliation(s)
- Li-Rong He
- Department of Obstetrics, Guangdong Women and Children Hospital, Guangzhou Medical University, Guangzhou, China
| | - Li Yu
- Department of Children’s Health Care, Guangdong Women and Children Hospital, Guangzhou Medical University, Guangzhou, China
| | - Yong Guo
- Department of Children’s Health Care, Guangdong Women and Children Hospital, Guangzhou Medical University, Guangzhou, China
| |
Collapse
|
4
|
Zhang R, Gao X, Sun T, Li H, Yang Q, Li B, Zhu D, Wang R. Longer physical exercise duration prevents abnormal fasting plasma glucose occurrences in the third trimester: Findings from a cohort of women with gestational diabetes mellitus in Shanghai. Front Endocrinol (Lausanne) 2023; 14:1054153. [PMID: 36761189 PMCID: PMC9902932 DOI: 10.3389/fendo.2023.1054153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/04/2023] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE This study aims to investigate the relationship between daily physical exercise (PE) duration and frequency of abnormal plasma glucose (PG) times both during fasting and 2 h after a standard diet in women with gestational diabetes mellitus (GDM). METHODS We established a cohort involving 878 GDM women. GDM was confirmed by a diagnostic 75-g oral glucose tolerance test. Information was extracted from the delivery records and antenatal checkup forms. Physical exercise information was collected through a questionnaire. RESULTS Over 80% of GDM women were under 35 years old. An abnormal fasting PG with ≥1 occurrence presented in 742/878 (84.51%), and the abnormal PG 2 h after standard diet with ≥1 occurrence presented in 634/878 (72.21%). Compared to GDM women with ≥4 occurrences of abnormal fasting PG, GDM women with 0 occurrences (odds ratio (OR) = 2.56), one occurrence (OR = 1.94), two occurrences (OR = 2.29), and three occurrences (OR = 2.16) had a higher proportion of PE duration being in the 45-60-min/day group than those in the <45-min/day group, and GDM women also had a higher proportion of PE during being in the 61-90- and >90-min/day group than those in the <45-min/day group. However, the duration of PE was not associated to the number of abnormal PG occurrences 2-h after the standard diet. CONCLUSION Moderate-intensity PE duration in GDM women was negatively associated with the number of abnormal fasting PG occurrences but not with the number of PG occurrences 2 h after the standard diet.
Collapse
Affiliation(s)
- Rui Zhang
- Shanghai Skin Disease Hospital, Tongji University, Shanghai, China
| | - Xiangjin Gao
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ting Sun
- Obstetrics Department, Songjiang Maternal and Child Health Hospital, Shanghai, China
| | - Huan Li
- Obstetrics Department, Songjiang Maternal and Child Health Hospital, Shanghai, China
| | - Qing Yang
- Obstetrics Department, Songjiang Maternal and Child Health Hospital, Shanghai, China
| | - Bin Li
- Shanghai Skin Disease Hospital, Tongji University, Shanghai, China
- *Correspondence: Bin Li, ; Dongshan Zhu, ; Ruiping Wang,
| | - Dongshan Zhu
- School of Public Health, Shandong University, Jinan, Shandong, China
- *Correspondence: Bin Li, ; Dongshan Zhu, ; Ruiping Wang,
| | - Ruiping Wang
- Shanghai Skin Disease Hospital, Tongji University, Shanghai, China
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- *Correspondence: Bin Li, ; Dongshan Zhu, ; Ruiping Wang,
| |
Collapse
|
5
|
Dłuski DF, Ruszała M, Rudziński G, Pożarowska K, Brzuszkiewicz K, Leszczyńska-Gorzelak B. Evolution of Gestational Diabetes Mellitus across Continents in 21st Century. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15804. [PMID: 36497880 PMCID: PMC9738915 DOI: 10.3390/ijerph192315804] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/07/2022] [Accepted: 11/22/2022] [Indexed: 06/17/2023]
Abstract
Over the last few decades, several definitions of gestational diabetes mellitus (GDM) have been described. There is currently not enough research to show which way is the best to diagnose GDM. Opinions differ in terms of the optimal screening and diagnostic measures, in part due to the differences in the population risks, the cost-effectiveness considerations, and the lack of an evidence base to support large national screening programs. The basic method for identifying the disease is the measurement of glucose plasma levels which may be determined when fasting, two hours after a meal, or simply at any random time. The currently increasing incidence of diabetes in the whole population, the altering demographics and the presence of lifestyle changes still require better methods of screening for hyperglycemia, especially during pregnancy. The main aim of this review is to focus on the prevalence and modifications to the screening criteria for GDM across all continents in the 21st century. We would like to show the differences in the above issues and correlate them with the geographical situation. Looking at the history of diabetes, we are sure that more than one evolution in GDM diagnosis will occur, due to the development of medicine, appearance of modern technologies, and the dynamic continuation of research.
Collapse
Affiliation(s)
- Dominik Franciszek Dłuski
- Chair and Department of Obstetrics and Perinatology, Medical University of Lublin, 20-954 Lublin, Poland
| | - Monika Ruszała
- Chair and Department of Obstetrics and Perinatology, Medical University of Lublin, 20-954 Lublin, Poland
| | - Gracjan Rudziński
- Faculty of Medicine, Medical University of Lublin, 20-059 Lublin, Poland
| | - Kinga Pożarowska
- Faculty of Medicine, Medical University of Lublin, 20-059 Lublin, Poland
| | | | | |
Collapse
|
6
|
Lara-Cinisomo S, Loret de Mola JR, Flores-Carter K, Tabb KM, Roloff K. Prenatal Depressive Symptoms, Self-Rated Health, and Diabetes Self-Efficacy: A Moderated Mediation Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192013603. [PMID: 36294181 PMCID: PMC9602843 DOI: 10.3390/ijerph192013603] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/07/2022] [Accepted: 10/09/2022] [Indexed: 05/31/2023]
Abstract
BACKGROUND Diabetes leads to risk for pregnant persons and their fetuses and requires behavioral changes that can be compromised by poor mental health. Poor self-rated health (SRH), a reliable predictor of morbidity and mortality, has been associated with depressive symptoms and lower self-efficacy in patients with diabetes. However, it is unclear whether SRH mediates the association between depressive symptoms and self-efficacy in pregnant patients with diabetes and whether the healthcare site moderates the mediation. Thus, we sought to test these associations in a racially and ethnically diverse sample of pregnant individuals diagnosed with diabetes from two clinical settings. MATERIALS AND METHODS This was an observational, cross-sectional study of 137 pregnant individuals diagnosed with diabetes at two clinical study sites. Participants self-administered a demographic questionnaire and measures designed to assess depressive symptoms, SRH in pregnancy, and diabetes self-efficacy. A moderated mediation model tested whether these indirect effects were moderated by the site. RESULTS The results show that SRH mediated the association between depressive symptoms and diabetes self-efficacy. The results also showed the site moderated the mediating effect of SRH on depressive symptoms and diabetes self-efficacy. CONCLUSIONS Understanding the role of clinical care settings can help inform when and how SRH mediates that association between prenatal depressive symptoms and self-efficacy in diabetic patients.
Collapse
Affiliation(s)
- Sandraluz Lara-Cinisomo
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, 1206 S. Fourth Street, Champaign, IL 61820, USA
| | - Julio Ricardo Loret de Mola
- Department of Obstetrics and Gynecology, Southern Illinois University School of Medicine, 415 N. 9th St. Suite 6W100, Springfield, IL 62794, USA
| | - Kendra Flores-Carter
- Department of Social Work, College of Behavioral and Social Sciences, California Baptist University, 8432 Magnolia Avenue, Riverside, CA 92504, USA
| | - Karen M. Tabb
- School of Social Work, University of Illinois Urbana-Champaign, 1010 W. Nevada St., Urbana, IL 61801, USA
| | - Kristina Roloff
- Department of Women’s Health, Arrowhead Regional Medical Center, 400 N. Pepper Avenue, Colton, CA 92324, USA
| |
Collapse
|
7
|
Junhasavasdikul S, Panburana P, Bumrungphuet S, Dulyaphat W. The Correlation Between Three-Dimensional Ultrasound Measurement of Fetal Adrenal Gland and Maternal Serum Fructosamine Level in Gestational Diabetes Mellitus: Prospective Cohort Study. Int J Womens Health 2022; 14:1465-1476. [PMID: 36277447 PMCID: PMC9586166 DOI: 10.2147/ijwh.s373087] [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: 05/07/2022] [Accepted: 09/26/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE Gestational diabetes mellitus (GDM) has an impact on fetal adrenal gland size and volume, which are greater in the GDM population. This study used 2D and 3D ultrasound scanning to determine the correlation of fetal adrenal gland size and volume with fructosamine levels, HbA1c levels, estimated fetal weight (EFW), and neonatal birth weight in GDM patients. METHODS This study included eighty singleton pregnant women diagnosed with GDM between 24-28 weeks of gestation. During weeks 32-34 of gestation, the length, width, and depth of the fetal zone and total adrenal gland were measured using transabdominal 2D ultrasound. Virtual organ computer-aided analysis (VOCAL) software was used to evaluate fetal zone and total adrenal gland volume in 3D ultrasound. All the participants were followed until delivery. Pearson's correlation analysis was conducted to examine the correlation between fetal adrenal gland ultrasound measurements and the factors of interest. RESULTS The study consisted of sixty-six (82.5%) pregnant women with diet-controlled GDM (GDMA1) and fourteen (17.5%) pregnant women with insulin-managed GDM (GDMA2). There was no difference in fetal adrenal gland measurements between the diet-controlled (GDMA1) and the insulin-managed (GDMA2) groups. All the participants had achieved optimal glucose levels at the time of ultrasound acquisition. The total adrenal gland length and fetal zone volume had statistically significant positive correlations with EFW (r = 0.69, p = 0.02 and r = 0.84, p = 0.01, respectively). After adjusting for EFW, only the fetal zone volume was significantly correlated with fructosamine levels (adjusted-OR = 2.4, 95% CI: 1.5, 3.9, p = 0.01) and HbA1c levels (adjusted-OR = 2.5, 95% CI: 1.6, 4.3, p = 0.01). CONCLUSION The fetal zone volume is correlated with EFW, fructosamine levels, and HbA1c levels. This non-invasive technique may be beneficial as an indirect marker for glycemic monitoring in GDM.
Collapse
Affiliation(s)
- Saowapak Junhasavasdikul
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Faculty of Medicine, Mahidol University, Ramathibodi Hospital, Bangkok, Thailand
| | - Panyu Panburana
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Faculty of Medicine, Mahidol University, Ramathibodi Hospital, Bangkok, Thailand
| | - Sommart Bumrungphuet
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Faculty of Medicine, Mahidol University, Ramathibodi Hospital, Bangkok, Thailand
| | - Wirada Dulyaphat
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Faculty of Medicine, Mahidol University, Ramathibodi Hospital, Bangkok, Thailand,Correspondence: Wirada Dulyaphat, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand, Tel +66-873017028, Fax +66 02-2011416, Email
| |
Collapse
|
8
|
Wang Y, Zhu X. The effect of maternal gestational diabetes on maternal and neonatal outcomes in twin pregnancies: a systematic review and meta-analysis. J OBSTET GYNAECOL 2022; 42:2592-2602. [PMID: 36017972 DOI: 10.1080/01443615.2022.2112558] [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] [Indexed: 01/06/2023]
Abstract
Diabetes and twin pregnancies are known risk factors for poor perinatal and neonatal outcomes. However, the effects of these two entities occurring together are still unclear. PubMed, Scopus and Google Scholar databases were searched in a systematic manner to identify observational studies among twin pregnancies, which documented the association of gestational diabetes with maternal and neonatal outcomes. All the analysis was done using STATA software. The meta-analysis included 21 studies, of which majority were retrospective data based. Mothers with gestational diabetes had higher risks of hypertensive disorder in pregnancy, caesarean section, large for gestational age baby, NICU admission and neonatal hypoglycaemia compared to mothers without gestational diabetes. Diabetic mothers were at reduced risk of small for gestational age baby and low APGAR score. No statistically significant differences in the risk of low birth weight, mean birth weight, prematurity and neonatal death were noted. This meta-analysis observed increased risks of detrimental maternal, neonatal and perinatal outcomes in twin pregnancies complicated by gestational diabetes, underscoring the need for the early detection and management of gestational diabetes.
Collapse
Affiliation(s)
- Yuejuan Wang
- Department of Obstetrics, Shaoxing People's Hospital, Shaoxing, China
| | - Xuhui Zhu
- Department of Emergency, ZhuJi Maternity and Child Care Hospital, Zhuji, China
| |
Collapse
|
9
|
Hamdan HZ, Hamdan SZ, Adam I. Association of Selenium Levels with Gestational Diabetes Mellitus: An Updated Systematic Review and Meta-Analysis. Nutrients 2022; 14:3941. [PMID: 36235594 PMCID: PMC9570773 DOI: 10.3390/nu14193941] [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] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/14/2022] [Accepted: 09/20/2022] [Indexed: 11/16/2022] Open
Abstract
Several studies have investigated the association between selenium levels and gestational diabetes mellitus (GDM); however, their results are not conclusive. This systematic review and meta-analysis aimed to update and draw conclusions regarding the evidence from published studies that investigated selenium levels in relation to GDM. PubMed, Google Scholar, Cochrane Library and ScienceDirect were searched for studies related to selenium and GDM, published from the inception of each database through to July 2022. The meta-analysis was conducted by measuring the standardized mean difference (SMD) between the selenium levels of women with GDM and those pregnant without GDM (control group). Stratified meta-analysis, meta-regression analysis and reporting bias were applied. The "meta" package in the open-access software R was used to analyze all of the data. A total of 12 studies, including 940 pregnant women with GDM and 1749 controls met this study's inclusion criteria. The selenium levels were significantly lower in women with GDM compared with the control group (SMD = -0.66; 95% confidence interval (CI): (-1.04, -0.28); p ≤ 0.001). Due to significant heterogeneity (I2 = 94%, Cochrane Q = 186.7; p ≤ 0.0001), the random-effects model was followed. The stratified meta-analysis showed that the selenium levels were lower in the cases compared with the normal controls in the third trimester (SMD = -1.85 (-3.03, -0.66); p ≤ 0.01). The same trend was observed in the studies published before the year 2014 (SMD = -0.99 (-1.70, -0.28); p ≤0.01) and those published in or after 2014 (SMD = -0.45 (-0.90, 0.00); p = 0.05). None of the investigated covariates in the meta-regression analysis (each study's geographic location, trimester of selenium quantification, World Bank economic classification, method of selenium determination, study design, study quality score, publication year and study's sample size) were significantly associated with the selenium SMD. The current evidence indicates that selenium levels are lower among women with GDM in comparison to those without GDM; however, after the correction of the reporting bias, the result was no longer significant. Further studies with more prospective designs are needed to confirm this evidence and explain the function of selenium in GDM throughout pregnancy.
Collapse
Affiliation(s)
- Hamdan Z. Hamdan
- Department of Basic Medical Sciences, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah 56219, Saudi Arabia
- Faculty of Medicine, Al-Neelain University, Khartoum 12702, Sudan;
| | | | - Ishag Adam
- Department of Obstetrics and Gynecology, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah 56219, Saudi Arabia;
| |
Collapse
|
10
|
Prüst JT, Brummaier T, Wah M, Yee HH, Win NN, Pimanpanarak M, Min AM, Gilder ME, Tun NW, Ilozumba O, Kabeer BSA, Terranegra A, Nosten F, Lee SJ, McGready R. Risk factor-based screening compared to universal screening for gestational diabetes mellitus in marginalized Burman and Karen populations on the Thailand-Myanmar border: An observational cohort. Wellcome Open Res 2022; 7:132. [PMID: 36874585 PMCID: PMC9976631.2 DOI: 10.12688/wellcomeopenres.17743.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2023] [Indexed: 01/19/2023] Open
Abstract
Background: Gestational diabetes mellitus (GDM) contributes to maternal and neonatal morbidity. As data from marginalized populations remains scarce, this study compares risk-factor-based to universal GDM screening in a low resource setting. Methods: This is a secondary analysis of data from a prospective preterm birth cohort. Pregnant women were enrolled in the first trimester and completed a 75g oral glucose tolerance test (OGTT) at 24-32 weeks' gestation. To define GDM cases, Hyperglycaemia and Adverse Pregnancy Outcomes (HAPO trial) criteria were used. All GDM positive cases were treated. Sensitivity and specificity of risk-factor-based selection for screening (criteria: age ≥30y, obesity (Body mass index (BMI) ≥27.5kg/m 2), previous GDM, 1 st degree relative with diabetes, previous macrosomia (≥4kg), previous stillbirth, or symphysis-fundal height ≥90th percentile) was compared to universal screening using the OGTT as the gold standard. Adverse maternal and neonatal outcomes were compared by GDM status. Results: GDM prevalence was 13.4% (50/374) (95% CI: 10.3-17.2). Three quarters of women had at least one risk factor (n=271 women), with 37/50 OGTT positive cases correctly identified: sensitivity 74.0% (59.7-85.4) and specificity 27.8% (3.0-33.0). Burman women (self-identified) accounted for 29.1% of the cohort population, but 38.0% of GDM cases. Percentiles for birthweight (p=0.004), head circumference (p=0.002), and weight-length ratio (p=0.030) were higher in newborns of GDM positive compared with non-GDM mothers. 21.7% (75/346) of newborns in the cohort were small-for-gestational age (≤10 th percentile). In Burman women, overweight/obese BMI was associated with a significantly increased adjusted odds ratio 5.03 (95% CI: 1.43-17.64) for GDM compared with normal weight, whereas in Karen women, the trend in association was similar but not significant (OR 2.36; 95% CI 0.95-5.89). Conclusions: Risk-factor-based screening missed one in four GDM positive women. Considering the benefits of early detection of GDM and the limited additional cost of universal screening, a two-step screening program was implemented.
Collapse
Affiliation(s)
- Janna T Prüst
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, 1081, The Netherlands
| | - Tobias Brummaier
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
- Swiss Tropical and Public Health Institute, Allschwill, 4123, Switzerland
- University of Basel, Basel, 4001, Switzerland
| | - Mu Wah
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
| | - Htay Htay Yee
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
| | - Nyo Nyo Win
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
| | - Mupawjay Pimanpanarak
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
| | - Aung Myat Min
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
| | - Mary Ellen Gilder
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Nay Win Tun
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
| | - Onaedo Ilozumba
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, 1081, The Netherlands
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | | | | | - Francois Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7LG, UK
| | - Sue J Lee
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7LG, UK
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, 10400, Thailand
| | - Rose McGready
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7LG, UK
| |
Collapse
|
11
|
Prüst JT, Brummaier T, Wah M, Yee HH, Win NN, Pimanpanarak M, Min AM, Gilder ME, Tun NW, Ilozumba O, Kabeer BSA, Terranegra A, Nosten F, Lee SJ, McGready R. Risk factor-based screening compared to universal screening for gestational diabetes mellitus in marginalized Burman and Karen populations on the Thailand-Myanmar border: An observational cohort. Wellcome Open Res 2022; 7:132. [PMID: 36874585 PMCID: PMC9976631 DOI: 10.12688/wellcomeopenres.17743.1] [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: 03/30/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Gestational diabetes mellitus (GDM) contributes significantly to maternal and neonatal morbidity, but data from marginalized populations remains scarce. This study aims to compare risk-factor-based screening to universal testing for GDM among migrants along the Thailand-Myanmar border. Methods: From the prospective cohort (September 2016, February 2019), 374 healthy pregnant women completed a 75g oral glucose tolerance test (OGTT) at 24-32 weeks gestation. Fasting, one hour and two hour cut-offs were based on Hyperglycaemia and Adverse Pregnancy Outcomes (HAPO trial) criteria and cases were treated. The sensitivity and specificity of risk-factor-based screening criteria was calculated using OGTT as the gold standard. Risk factors included at least one positive finding among 10 criteria, e.g., obesity (body mass index (BMI) ≥27.5kg/m 2), 1 st degree relative with diabetes etc. Adverse maternal and neonatal outcomes were compared by GDM status, and risk factors for GDM were explored. Results: GDM prevalence was 13.4% (50/374) (95% CI: 10.3-17.2). Risk-factors alone correctly identified 74.0% (37/50) OGTT positive cases: sensitivity 74.0% (59.7-85.4) and specificity 27.8% (3.0-33.0). Burman women accounted for 29.1% of the cohort population, but 38.0% of GDM cases. Percentiles for birthweight (p=0.004), head circumference (p=0.005), and weight-length ratio (p=0.010) were higher in newborns of GDM mothers compared with non-GDM, yet 21.7% (75/346) of newborns in the cohort were small-for-gestational age. In Burman women, overweight/obese BMI was associated with a significantly increased adjusted odds ratio 5.03 (95% CI: 1.43-17.64) for GDM compared to normal weight, whereas underweight and overweight/obese in Karen women were both associated with similarly elevated adjusted odds, approximately 2.4-fold (non-significant) for GDM. GDM diagnosis by OGTT was highest prior to peak rainfall. Conclusions: Risk-factor-based screening was not sufficiently sensitive or specific to be useful to diagnose GDM in this setting among a cohort of low-risk pregnant women. A two-step universal screening program has thus been implemented.
Collapse
Affiliation(s)
- Janna T. Prüst
- Shoklo Malaria Research Unit, Mahidol–Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, 1081, The Netherlands
| | - Tobias Brummaier
- Shoklo Malaria Research Unit, Mahidol–Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
- Swiss Tropical and Public Health Institute, Allschwill, 4123, Switzerland
- University of Basel, Basel, 4001, Switzerland
| | - Mu Wah
- Shoklo Malaria Research Unit, Mahidol–Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
| | - Htay Htay Yee
- Shoklo Malaria Research Unit, Mahidol–Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
| | - Nyo Nyo Win
- Shoklo Malaria Research Unit, Mahidol–Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
| | - Mupawjay Pimanpanarak
- Shoklo Malaria Research Unit, Mahidol–Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
| | - Aung Myat Min
- Shoklo Malaria Research Unit, Mahidol–Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
| | - Mary Ellen Gilder
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Nay Win Tun
- Shoklo Malaria Research Unit, Mahidol–Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
| | - Onaedo Ilozumba
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, 1081, The Netherlands
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | | | | | - Francois Nosten
- Shoklo Malaria Research Unit, Mahidol–Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7LG, UK
| | - Sue J. Lee
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7LG, UK
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, 10400, Thailand
| | - Rose McGready
- Shoklo Malaria Research Unit, Mahidol–Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7LG, UK
| |
Collapse
|
12
|
Gámez-Valdez JS, García-Mazcorro JF, Montoya-Rincón AH, Rodríguez-Reyes DL, Jiménez-Blanco G, Rodríguez MTA, de Vaca RPC, Alcorta-García MR, Brunck M, Lara-Díaz VJ, Licona-Cassani C. Differential analysis of the bacterial community in colostrum samples from women with gestational diabetes mellitus and obesity. Sci Rep 2021; 11:24373. [PMID: 34934118 PMCID: PMC8692321 DOI: 10.1038/s41598-021-03779-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 12/06/2021] [Indexed: 02/07/2023] Open
Abstract
Gestational Diabetes Mellitus (GDM) and obesity affect the functioning of multiple maternal systems and influence colonization of the newborn gastrointestinal through the breastmilk microbiota (BMM). It is currently unclear how GDM and obesity affect the human BMM composition. Here, we applied 16S-rRNA high-throughput sequencing to human colostrum milk to characterize BMM taxonomic changes in a cohort of 43 individuals classified in six subgroups according to mothers patho-physiological conditions (healthy control (n = 18), GDM (n = 13), or obesity (n = 12)) and newborn gender. Using various diversity indicators, including Shannon/Faith phylogenetic index and UniFrac/robust Aitchison distances, we evidenced that BMM composition was influenced by the infant gender in the obesity subgroup. In addition, the GDM group presented higher microbial diversity compared to the control group. Staphylococcus, Corynebacterium 1, Anaerococcus and Prevotella were overrepresented in colostrum from women with either obesity or GDM, compared to control samples. Finally, Rhodobacteraceae was distinct for GDM and 5 families (Bdellovibrionaceae, Halomonadaceae, Shewanellaceae, Saccharimonadales and Vibrionaceae) were distinct for obesity subgroups with an absolute effect size greater than 1 and a q-value ≤ 0.05. This study represents the first effort to describe the impact of maternal GDM and obesity on BMM.
Collapse
Affiliation(s)
- J S Gámez-Valdez
- Tecnológico de Monterrey, Escuela de Ingeniería y Ciencias, Ave. Eugenio Garza Sada 2501 sur, Monterrey, NL, 64849, México
| | - J F García-Mazcorro
- Research and Development, MNA de México, San Nicolás de los Garza, NL, México
| | - A H Montoya-Rincón
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, NL, México
| | - D L Rodríguez-Reyes
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, NL, México
| | - G Jiménez-Blanco
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, NL, México
| | - M T Alanís Rodríguez
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, NL, México
| | - R Pérez-Cabeza de Vaca
- Coordinación de Investigación y División de Investigación Biomédica, C.M.N. "20 de Noviembre", ISSSTE, Ciudad de México, México
| | - M R Alcorta-García
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, NL, México.,Departamento de Neonatología, Hospital Regional Materno Infantil, Servicios de Salud de Nuevo León, Guadalupe, México
| | - M Brunck
- Tecnológico de Monterrey, Escuela de Ingeniería y Ciencias, Ave. Eugenio Garza Sada 2501 sur, Monterrey, NL, 64849, México.,Division of Experimental Medicine, The Institute for Obesity Research, Tecnológico de Monterrey, Monterrey, NL, México
| | - V J Lara-Díaz
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, NL, México
| | - C Licona-Cassani
- Tecnológico de Monterrey, Escuela de Ingeniería y Ciencias, Ave. Eugenio Garza Sada 2501 sur, Monterrey, NL, 64849, México. .,Division of Integrative Biology, The Institute for Obesity Research, Tecnológico de Monterrey, Monterrey, NL, México.
| |
Collapse
|
13
|
Chen Y, Lu M, Nie J, Liu J, Liu Y, Meng Y, Sun X, Ji C, Zhang J, Yang X. Increasing prevalence of gestational diabetes mellitus when carrying the T variant allele of the MTHFR gene C677T polymorphism: a systematic review and meta-analysis. Arch Gynecol Obstet 2021; 305:1193-1202. [DOI: 10.1007/s00404-021-06303-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 10/18/2021] [Indexed: 12/28/2022]
|
14
|
Kunasegaran T, Balasubramaniam VRMT, Arasoo VJT, Palanisamy UD, Ramadas A. The Modulation of Gut Microbiota Composition in the Pathophysiology of Gestational Diabetes Mellitus: A Systematic Review. BIOLOGY 2021; 10:biology10101027. [PMID: 34681126 PMCID: PMC8533096 DOI: 10.3390/biology10101027] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/08/2021] [Accepted: 10/08/2021] [Indexed: 02/08/2023]
Abstract
Simple Summary Recent studies have placed a great deal of emphasis on the importance of the microbiome, especially the link between the alteration of gut microbiota and multiple associated diseases. Gut microbiota changes in pregnancy have a significant impact on metabolic function and may contribute to gestational diabetes mellitus (GDM). Although GDM carries long-term health risks that affect women, there are also significant short- and severe long-term consequences for the offspring. Regardless, there is a notable lack of research focusing on the impact of prominent microorganisms involved in the development of GDM. A comprehensive review was conducted to gather relevant data on the types of microorganisms that have been associated with GDM. The review found that certain microorganisms impact the onset and progression of GDM during pregnancy. Several bacterial strains associated with GDM are influenced by a diet high in fat and low in fiber. Therefore, integrating the idea of a microbiome-based individualized dietary intervention into gestational diabetes management may be incredibly beneficial. Abstract General gut microbial dysbiosis in diabetes mellitus, including gestational diabetes mellitus (GDM), has been reported in a large body of literature. However, evidence investigating the association between specific taxonomic classes and GDM is lacking. Thus, we performed a systematic review of peer-reviewed observational studies and trials conducted among women with GDM within the last ten years using standard methodology. The National Institutes of Health (NIH) quality assessment tools were used to assess the quality of the included studies. Fourteen studies investigating microbial interactions with GDM were found to be relevant and included in this review. The synthesis of literature findings demonstrates that Bacteroidetes, Proteobacteria, Firmicutes, and Actinobacteria phyla, such as Desulfovibrio, Ruminococcaceae, P. distasonis, Enterobacteriaceae, Collinsella, and Prevotella, were positively associated with GDM. In contrast, Bifidobacterium and Faecalibacterium, which produce butyrate, are negatively associated with GDM. These bacteria were associated with inflammation, adiposity, and glucose intolerance in women with GDM. Lack of good diet management demonstrated the alteration of gut microbiota and its impact on GDM glucose homeostasis. The majority of the studies were of good quality. Therefore, there is great potential to incorporate personalized medicine targeting microbiome modulation through dietary intervention in the management of GDM.
Collapse
|