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Jokelainen M, Stach-Lempinen B, Teramo K, Nenonen A, Kautiainen H, Klemetti MM. Large maternal waist circumference in relation to height is associated with high glucose concentrations in an early-pregnancy oral glucose tolerance test: A population-based study. Acta Obstet Gynecol Scand 2023; 102:496-505. [PMID: 36799298 PMCID: PMC10008291 DOI: 10.1111/aogs.14528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 02/18/2023]
Abstract
INTRODUCTION To explore the role of maternal anthropometric characteristics in early-pregnancy glycemia, we analyzed the associations and interactions of maternal early-pregnancy waist circumference (WC), height and pre-pregnancy body mass index (BMI) with plasma glucose concentrations in an oral glucose tolerance test (OGTT) at 12-16 weeks' gestation. MATERIAL AND METHODS A population-based cohort of 1361 pregnant women was recruited in South Karelia, Finland, from March 2013 to December 2016. All participants had their WC, weight, height, HbA1c , and blood pressure measured at 8-14 weeks' gestation and subsequently underwent a 2-h 75-g OGTT, including assessment of fasting insulin concentrations, at 12-16 weeks' gestation. BMI (kg/m2 ) was calculated using self-reported pre-pregnancy weight. Maternal WC ≥80 cm was defined as large. Maternal height ≥166 cm was defined as tall. Data on gestational diabetes treatment was extracted from hospital records. RESULTS In the total cohort, 901 (66%) of women had an early-pregnancy WC ≥80 cm, which was associated with higher early-pregnancy HbA1c, higher concentrations of fasting plasma glucose and serum insulin, higher post-load plasma glucose concentrations, higher HOMA-IR indices, higher blood pressure levels, and higher frequencies of pharmacologically treated gestational diabetes, than early-pregnancy WC <80 cm. Maternal height ≥166 cm was negatively associated with 1- and 2-h post-load plasma glucose concentrations. Waist-to-height ratio (WHtR) >0.5 was positively associated with both fasting and post-load plasma glucose concentrations at 12-16 weeks' gestation, even when adjusted for age, smoking, nulliparity, and family history of type 2 diabetes. The best cut-offs for WHtR (0.58 for 1-h plasma glucose, and 0.54 for 2-h plasma glucose) were better predictors of post-load glucose concentrations >90th percentile than the best cut-offs for BMI (28.1 kg/m2 for 1-h plasma glucose, and 26.6 kg/m2 for 2-h plasma glucose), with areas-under-the-curve (95% confidence interval) 0.73 (0.68-0.79) and 0.73 (0.69-0.77), respectively, for WHtR, and 0.68 (0.63-0.74) and 0.69 (0.65-0.74), respectively, for BMI. CONCLUSIONS In our population-based cohort, early-pregnancy WHtR >0.5 was positively associated with both fasting and post-load glucose concentrations at 12-16 weeks' gestation and performed better than BMI in the prediction of post-load glucose concentrations >90th percentile. Overall, our results underline the importance of evaluating maternal abdominal adiposity in gestational diabetes risk assessment.
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Affiliation(s)
- Mervi Jokelainen
- Obstetrics and Gynecology, South Karelia Central Hospital, Lappeenranta, Finland.,Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Beata Stach-Lempinen
- Obstetrics and Gynecology, South Karelia Central Hospital, Lappeenranta, Finland
| | - Kari Teramo
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Arja Nenonen
- Laboratory Center, South Karelia Central Hospital, Lappeenranta, Finland
| | - Hannu Kautiainen
- Folkhälsan Research Center, Helsinki, Finland.,Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland
| | - Miira M Klemetti
- Obstetrics and Gynecology, South Karelia Central Hospital, Lappeenranta, Finland.,Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Baran E, Akbayrak T, Özgül S, Nakip G, Çinar GN, Üzelpasacı E, Gursen C, Beksaç K, Aydin E, Çağan M, Beksaç MS. Musculoskeletal and anthropometric factors associated with urinary incontinence in pregnancy. Physiother Theory Pract 2021; 38:1789-1798. [PMID: 33522357 DOI: 10.1080/09593985.2021.1878568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Urinary incontinence (UI) is a common pelvic floor dysfunction in pregnancy. The relationship between biomechanical changes and pregnancy-related UI has not been fully elucidated. OBJECTIVE To investigate the association of various musculoskeletal and anthropometric changes in pregnancy that affect gestational UI. METHODS The study was conducted with 275 pregnant women. Ninety-three, 110 and 72 women were in first, second and third trimesters, respectively. Incontinence Impact Questionnaire for UI, Urogenital Distress Inventory-Short Form and Incontinence Severity Index were applied. Lumbar lordosis measurement was performed by Baseline Bubble Inclinometer while diastasis recti abdominis (DRA) measurement was carried out by finger-width method. Manual muscle test for rectus abdominis and right and left external oblique abdominal muscles, and Benign joint hypermobility test with Beighton scoring method were also applied as musculoskeletal measurements. Tape measurement at the waist, umbilical and hip levels, caliper with bi-iliac and bi-trochanteric diameters were also recorded as anthropometric measurements. RESULTS Significant associated factors for UI were: umbilical DRA (OR = 1.57; p = .012); rectus abdominis muscle strength (values of 3 and below, OR = 1.2; p = .014); umbilical environment (OR = 1.1; p = .029); bi-iliac diameter (OR = 1.1; p = .05;) and bi-trochanteric diameter (OR = 1.3; p = .05), respectively. CONCLUSION Changing musculoskeletal and anthropometric characteristics of pregnant women should be taken into consideration in UI follow-up during pregnancy.
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Affiliation(s)
- Emine Baran
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Samanpazari, Turkey
| | - Türkan Akbayrak
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Samanpazari, Turkey
| | - Serap Özgül
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Samanpazari, Turkey
| | - Gülbala Nakip
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Samanpazari, Turkey
| | - Gamze Nalan Çinar
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Samanpazari, Turkey
| | - Esra Üzelpasacı
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Samanpazari, Turkey
| | - Ceren Gursen
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Samanpazari, Turkey
| | - Kemal Beksaç
- Department of General Surgery, Ankara Oncology Hospital, Yenimahalle, Turkey
| | - Emine Aydin
- Department of Obstetrics and Gynecology, Istanbul Medipol University, Üsküdar, Turkey
| | - Murat Çağan
- Department of Obstetrics and Gynecology, Hacettepe University, Samanpazari, Turkey
| | - Mehmet Sinan Beksaç
- Department of Obstetrics and Gynecology, Hacettepe University, Samanpazari, Turkey
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Forczek W, Masłoń A, Frączek B, Curyło M, Salamaga M, Suder A. Does the first trimester of pregnancy induce alterations in the walking pattern? PLoS One 2019; 14:e0209766. [PMID: 30650108 DOI: 10.1371/journal.pone.0209766] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 12/11/2018] [Indexed: 11/19/2022] Open
Abstract
Introduction From among many studies observing the walking pattern throughout pregnancy, only two items monitor the influence of pregnancy on the movement system during gait considering the period before gestation. Research question Does the women’s gait pattern at the end of the first trimester undergo changes in comparison to body movement pattern before pregnancy? Methods All subjects who met the inclusion criteria gave signed and informed consent before the study. Two experimental sessions were arranged according to the same protocol: (P0) before pregnancy and (P1) at the end of the first trimester of pregnancy (12th week of gestation). At first the anthropometric measures were taken. Then, walking trials at a self-selected speed along a walkway were registered with Vicon 250 (Oxford Metrics Ltd.; Oxford, UK) and FreeMED force platform (Sensor Medica, Italy). Results An analysis of anthropometric parameters in 12th pregnancy week demonstrated significant changes in mean values of waist circumference and waist to hip ratio as well as waist to height ratio indexes compared to the results before pregnancy. No significant differences were found in the basic kinematic gait parameters between experimental conditions. Significant increase of mean inter—ankle distance during double support phase occurred during the first trimester of pregnancy. Also, the ratio of the ankle separation width to the pelvic width was noticeably higher in gestation. Then, angular changes of the pelvis in coronal and transverse planes throughout gait cycle during pregnancy demonstrated significant differences compared to those measured before pregnancy. At the same time in the first trimester of pregnancy no adaptive changes in the pattern of feet loading take place. Significance Since our study is of longitudinal character, in the course of pregnancy we expect compensatory mechanisms more clearly demonstrated. Therefore, we hope to identify a strategy of the gravid body progression in space.
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Kennedy N, Quinton A, Peek MJ, Lanzarone V, Benzie R, Nanan R. Anthropometric and ultrasound measures of maternal adiposity in the first trimester of pregnancy. Australas J Ultrasound Med 2018; 21:147-155. [PMID: 34760515 DOI: 10.1002/ajum.12092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Aim Estimations of central adiposity in pregnancy is a difficult undertaking due to physiological changes that occur in the body. Therefore, the value of some anthropometric measures particularly in pregnancy, such as body mass index (BMI), waist and hip measures are in doubt. The aim was to compare ultrasound (US) measured abdominal subcutaneous fat (USSFT) with other simple anthropometric methods for obesity assessment, evaluating these measures in pregnancy. Method Recruited from a larger study, anthropometric measurements were performed between 11-14 weeks' gestation on 575 women. Measuring height, weight, hip, waist circumference, skin-folds of the triceps, thigh and supra-iliac and USSFT. Percentage maternal fat mass was calculated using skin-fold measures. Correlations of these measures were performed to gauge relationships. Results The anthropometric measures demonstrated good correlation (0.54-0.93) between individual adipose measures skin-folds, waist, hip, waist to height ratio (WSR) and USSFT with BMI, percentage fat mass and weight. USSFT correlated well with all anthropometric measures (0.54-0.73) correlating best with waist, WSR, BMI and weight. Waist/hip ratio demonstrated a poor correlation with USSFT, BMI, percentage fat mass and weight (0.3-0.41). Mean anthropometric measures were stratified across BMI categories describing adiposity distribution. Conclusion USSFT correlates well with most anthropometric measures in early pregnancy. Limitations of the gravid uterus on waist measurements, hydration and compressibility of skin-fold measures and pregnancy influences on weight and BMI assessments could be overcome using US measures. There is a potential for post hoc evaluation using US for pregnancy complications. Maternal research could benefit from a more accurate measure of adiposity.
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Affiliation(s)
- Narelle Kennedy
- Discipline of Obstetrics, Gynaecology and Neonatology Sydney Medical School Nepean University of Sydney Nepean Hospital Penrith New South Wales 2750 Australia.,Christopher Kohlenberg Department of Perinatal Ultrasound Nepean Hospital Penrith New South Wales 2750 Australia
| | - Ann Quinton
- Discipline of Obstetrics, Gynaecology and Neonatology Sydney Medical School Nepean University of Sydney Nepean Hospital Penrith New South Wales 2750 Australia.,Medical Sonography School of Health, Medical and Applied Science Central Queensland University Sydney New South Wales 2000 Australia
| | - Michael John Peek
- ANU Medical School College of Health and Medicine The Australian National University Centenary Hospital for Women and Children Garran Australian Capital Territory 2605 Australia
| | - Valeria Lanzarone
- Discipline of Obstetrics, Gynaecology and Neonatology Sydney Medical School Nepean University of Sydney Nepean Hospital Penrith New South Wales 2750 Australia.,Ultrasound for Women Penrith Nepean Hospital Penrith New South Wales Australia
| | - Ron Benzie
- Discipline of Obstetrics, Gynaecology and Neonatology Sydney Medical School Nepean University of Sydney Nepean Hospital Penrith New South Wales 2750 Australia.,Christopher Kohlenberg Department of Perinatal Ultrasound Nepean Hospital Penrith New South Wales 2750 Australia
| | - Ralph Nanan
- Discipline of Obstetrics, Gynaecology and Neonatology Sydney Medical School Nepean University of Sydney Nepean Hospital Penrith New South Wales 2750 Australia.,Charles Perkins Centre, Nepean Sydney New South Wales Australia
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Han Q, Shao P, Leng J, Zhang C, Li W, Liu G, Zhang Y, Li Y, Li Z, Ren Y, Chan JCN, Yang X. Interactions between general and central obesity in predicting gestational diabetes mellitus in Chinese pregnant women: A prospective population-based study in Tianjin, China. J Diabetes 2018; 10:59-67. [PMID: 28383185 DOI: 10.1111/1753-0407.12558] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 03/14/2017] [Accepted: 04/02/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The aim of the present study was to define cut-off points of body mass index (BMI) and waist circumference (WC) for gestational diabetes mellitus (GDM) and to investigate any interactions between high BMI and high WC on the risk of GDM in pregnant Chinese women. METHODS From 2010 to 2012, 17 803 women in Tianjin, China, who were at 4-12 weeks gestation were recruited to the study. Gestational diabetes mellitus was diagnosed according to the criteria of the International Association of Diabetes and Pregnancy Study Group at 24-28 weeks gestation. Binary logistic regression was used to obtain odds ratios (ORs) and 95% confidence intervals (CIs) while controlling for the confounding effects of traditional risk factors. Restricted cubic spline was used to identify cut-off points of WC and BMI, if any, for GDM. RESULTS Gestational diabetes mellitus developed in 1383 (7.8%) women. The risk of GDM increased steeply with increasing WC from ≥78.5 cm and BMI ≥22.5 kg/m2 . If BMI <22.5 kg/m2 and WC <78.5 cm were used as the reference, BMI between ≥22.5 and <24.0 kg/m2 (multivariable OR 1.76; 95%CI 1.47-2.10) and WC between ≥78.5 and <85.0 cm (multivariable OR 1.53; 95%CI 1.31-1.78) were independently associated with increased risks of GDM. In addition, the presence of both BMI ≥22.5 kg/m2 and WC ≥78.5 cm further increased the OR to 2.83 (95% CI 2.44-3.28), with significant additive interaction. CONCLUSIONS Body mass index ≥22.5 kg/m2 and WC ≥78.5 cm measured up to 12 weeks of gestation were independently and synergistically associated with increased risks of GDM in Chinese pregnant women.
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Affiliation(s)
- Qian Han
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Ping Shao
- Department of Women Health, Tianjin Women and Children's Health Center, Tianjin, China
| | - Junhong Leng
- Department of Women Health, Tianjin Women and Children's Health Center, Tianjin, China
| | - Cuiping Zhang
- Department of Women Health, Tianjin Women and Children's Health Center, Tianjin, China
| | - Wei Li
- Department of Women Health, Tianjin Women and Children's Health Center, Tianjin, China
| | - Guifeng Liu
- Nankai District Women and Children's Health Center, Tianjin, China
| | - Yuanyuan Zhang
- Heping District Women and Children's Health Center, Tianjin, China
| | - Yi Li
- Department of Women Health, Tianjin Women and Children's Health Center, Tianjin, China
| | - Zhe Li
- Department of Women Health, Tianjin Women and Children's Health Center, Tianjin, China
| | - Yanfeng Ren
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Juliana C N Chan
- Department of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Xilin Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
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Egan AM, Vellinga A, Harreiter J, Simmons D, Desoye G, Corcoy R, Adelantado JM, Devlieger R, Van Assche A, Galjaard S, Damm P, Mathiesen ER, Jensen DM, Andersen L, Lapolla A, Dalfrà MG, Bertolotto A, Mantaj U, Wender-Ozegowska E, Zawiejska A, Hill D, Jelsma JGM, Snoek FJ, Worda C, Bancher-Todesca D, van Poppel MNM, Kautzky-Willer A, Dunne FP. Epidemiology of gestational diabetes mellitus according to IADPSG/WHO 2013 criteria among obese pregnant women in Europe. Diabetologia 2017; 60:1913-1921. [PMID: 28702810 PMCID: PMC6448875 DOI: 10.1007/s00125-017-4353-9] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 05/26/2017] [Indexed: 12/03/2022]
Abstract
AIMS/HYPOTHESIS Accurate prevalence estimates for gestational diabetes mellitus (GDM) among pregnant women in Europe are lacking owing to the use of a multitude of diagnostic criteria and screening strategies in both high-risk women and the general pregnant population. Our aims were to report important risk factors for GDM development and calculate the prevalence of GDM in a cohort of women with BMI ≥29 kg/m2 across 11 centres in Europe using the International Association of the Diabetes and Pregnancy Study Groups (IADPSG)/WHO 2013 diagnostic criteria. METHODS Pregnant women (n = 1023, 86.3% European ethnicity) with a BMI ≥29.0 kg/m2 enrolled into the Vitamin D and Lifestyle Intervention for GDM Prevention (DALI) pilot, lifestyle and vitamin D studies of this pan-European multicentre trial, attended for an OGTT during pregnancy. Demographic, anthropometric and metabolic data were collected at enrolment and throughout pregnancy. GDM was diagnosed using IADPSG/WHO 2013 criteria. GDM treatment followed local policies. RESULTS The number of women recruited per country ranged from 80 to 217, and the dropout rate was 7.1%. Overall, 39% of women developed GDM during pregnancy, with no significant differences in prevalence across countries. The prevalence of GDM was high (24%; 242/1023) in early pregnancy. Despite interventions used in the DALI study, a further 14% (94/672) had developed GDM when tested at mid gestation (24-28 weeks) and 13% (59/476) of the remaining cohort at late gestation (35-37 weeks). Demographics and lifestyle factors were similar at baseline between women with GDM and those who maintained normal glucose tolerance. Previous GDM (16.5% vs 7.9%, p = 0.002), congenital malformations (6.4% vs 3.3%, p = 0.045) and a baby with macrosomia (31.4% vs 17.9%, p = 0.001) were reported more frequently in those who developed GDM. Significant anthropometric and metabolic differences were already present in early pregnancy between women who developed GDM and those who did not. CONCLUSIONS/INTERPRETATION The prevalence of GDM diagnosed by the IADPSG/WHO 2013 GDM criteria in European pregnant women with a BMI ≥29.0 kg/m2 is substantial, and poses a significant health burden to these pregnancies and to the future health of the mother and her offspring. Uniform criteria for GDM diagnosis, supported by robust evidence for the benefits of treatment, are urgently needed to guide modern GDM screening and treatment strategies.
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Affiliation(s)
- Aoife M Egan
- Galway Diabetes Research Centre, College of Medicine, Nursing and Health Sciences, National University of Ireland, University Road, Galway, H91 TK33, Ireland
| | - Akke Vellinga
- Galway Diabetes Research Centre, College of Medicine, Nursing and Health Sciences, National University of Ireland, University Road, Galway, H91 TK33, Ireland
| | - Jürgen Harreiter
- Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - David Simmons
- Institute of Metabolic Science, Addenbrookes Hospital, Cambridge, UK
- Macarthur Clinical School, Western Sydney University, Sydney, NSW, Australia
| | - Gernot Desoye
- Department of Obstetrics and Gynecology, Medizinische Universitaet Graz, Graz, Austria
| | - Rosa Corcoy
- Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- CIBER Bioengineering, Biomaterials and Nanotechnology, Instituto de Salud Carlos III, Zaragoza, Spain
| | - Juan M Adelantado
- Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Roland Devlieger
- KU Leuven Department of Development and Regeneration: Pregnancy, Fetus and Neonate, University Hospitals Leuven, Leuven, Belgium
- Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
| | - Andre Van Assche
- KU Leuven Department of Development and Regeneration: Pregnancy, Fetus and Neonate, University Hospitals Leuven, Leuven, Belgium
- Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
| | - Sander Galjaard
- KU Leuven Department of Development and Regeneration: Pregnancy, Fetus and Neonate, University Hospitals Leuven, Leuven, Belgium
- Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Peter Damm
- Center for Pregnant Women with Diabetes, Departments of Endocrinology and Obstetrics, Rigshospitalet, Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Elisabeth R Mathiesen
- Center for Pregnant Women with Diabetes, Departments of Endocrinology and Obstetrics, Rigshospitalet, Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Dorte M Jensen
- Department of Endocrinology, Odense University Hospital, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
- Department of Gynaecology and Obstetrics, Odense University Hospital, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
- Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - Liselotte Andersen
- Department of Endocrinology, Odense University Hospital, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
- Department of Gynaecology and Obstetrics, Odense University Hospital, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
- Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | | | | | | | - Urszula Mantaj
- Medical Faculty I, Poznan University of Medical Sciences, Poznan, Poland
| | | | | | - David Hill
- Recherche en Santé Lawson SA, St Gallen, Switzerland
| | - Judith G M Jelsma
- Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Centre, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands
| | - Frank J Snoek
- Department of Medical Psychology, EMGO+ Institute for Health and Care Research, VU University Medical Centre and Medical Psychology AMC, Amsterdam, the Netherlands
| | - Christof Worda
- Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Dagmar Bancher-Todesca
- Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Mireille N M van Poppel
- Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Centre, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands.
- Institute of Sports Science, University of Graz, Graz, Austria.
| | - Alexandra Kautzky-Willer
- Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Fidelma P Dunne
- Galway Diabetes Research Centre, College of Medicine, Nursing and Health Sciences, National University of Ireland, University Road, Galway, H91 TK33, Ireland.
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Mele L, Myatt L, Roberts J, Hauth J, Leveno K, Varner M, Wapner R, Thorp J, Peaceman A, Ramin S, Sciscione A, Tolosa J, Sorokin Y, Basraon S. Relationship of Early Pregnancy Waist-to-Hip Ratio versus Body Mass Index with Gestational Diabetes Mellitus and Insulin Resistance. Am J Perinatol 2016; 33:114-21. [PMID: 26352680 PMCID: PMC5283057 DOI: 10.1055/s-0035-1562928] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To determine the risk of gestational diabetes mellitus (GDM) and insulin resistance (IR) in obesity defined by body mass index (BMI), waist-to-hip ratio (WHR), or both combined. METHODS Secondary analysis of a randomized multicenter trial of antioxidant supplementation versus placebo in nulliparous low-risk women to prevent pregnancy associated hypertension. Women between 9 and 16 weeks with data for WHR and BMI were analyzed for GDM (n = 2,300). Those with fasting glucose and insulin between 22 and 26 weeks (n = 717) were analyzed for IR by homeostatic model assessment of IR (normal, ≤ 75th percentile). WHR and BMI were categorized as normal (WHR, < 0.80; BMI, < 25 kg/m(2)); overweight (WHR, 0.8-0.84; BMI, 25-29.9 kg/m(2)); and obese (WHR, ≥ 0.85; BMI ≥ 30 kg/m(2)). Receiver operating characteristic curves and logistic regression models were used. RESULTS Compared with normal, the risks of GDM or IR were higher in obese by BMI or WHR. The subgroup with obesity by WHR but not by BMI had no increased risk of GDM. BMI was a better predictor of IR (area under the curve [AUC]: 0.71 [BMI], 0.65 [WHR], p = 0.03) but similar to WHR for GDM (AUC: 0.68 [BMI], 0.63 [WHR], p = 0.18). CONCLUSION Increased WHR and BMI in early pregnancy are associated with IR and GDM. BMI is a better predictor of IR compared with WHR. Adding WHR to BMI does not improve its ability to detect GDM or IR.
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Affiliation(s)
- Lisa Mele
- Biostatistics Center, George Washington University, Washington, District of Columbia
| | | | | | - John Hauth
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Kenneth Leveno
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Michael Varner
- University of Utah Health Sciences Center, Salt Lake City, Utah
| | | | - John Thorp
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Susan Ramin
- University of Texas Health Science Center at Houston-Children's Memorial Hermann Hospital, Houston, Texas
| | | | - Jorge Tolosa
- Oregon Health & Science University, Portland, Oregon
| | | | - Sanmaan Basraon
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas
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Tomedi LE, Simhan HN, Chang CCH, McTigue KM, Bodnar LM. Gestational weight gain, early pregnancy maternal adiposity distribution, and maternal hyperglycemia. Matern Child Health J 2015; 18:1265-70. [PMID: 24101436 DOI: 10.1007/s10995-013-1361-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
To estimate the effects of gestational weight gain (GWG), central adiposity and subcutaneous fat on maternal post-load glucose concentration, pregnant women [n = 413, 62% black, 57% with pregravid body mass index (BMI) ≥25] enrolled in a cohort study at ≤13 weeks gestation. GWG was abstracted from medical records. In a sub-sample of women (n = 214), waist circumference (WC), and biceps and triceps skinfold thicknesses were measured at enrollment. At 24-28 weeks gestation, post-load glucose concentration was measured using a 50-g 1-h oral glucose tolerance test. After adjustment for pre-pregnancy BMI, age, parity, race/ethnicity, smoking, marital status, annual family income, education, family history of diabetes, and gestational age of GDM screening, each 0.3-kg/week increase in weight in the first trimester was associated with a 2.2 (95% CI 0.1, 4.3)-mg/dl increase in glucose concentration. Each 8.6-mm increase in biceps skinfold thickness and each 11.7-mm increase in triceps skinfold thickness was associated with 4.3 (95% CI 0.2, 8.5)-mg/dl increase in maternal glucose, independent of BMI and other confounders. Neither GWG in the second trimester nor WC at ≤13 weeks was significantly associated with glucose concentration after confounder adjustment. Independent of pre-pregnancy BMI, high early pregnancy GWG and maternal subcutaneous body fat may be positively associated with maternal glucose concentrations at 24-28 weeks.
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Affiliation(s)
- Laura E Tomedi
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, 130 DeSoto Street, Pittsburgh, PA, 15261, USA
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Zajdenverg L, Rodacki M, Faria JP, Pires MLE, Oliveira JEP, Halfoun VLC. Precocious markers of cardiovascular risk and vascular damage in apparently healthy women with previous gestational diabetes. Diabetol Metab Syndr 2014; 6:63. [PMID: 24955136 PMCID: PMC4064263 DOI: 10.1186/1758-5996-6-63] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 05/19/2014] [Indexed: 11/10/2022] Open
Abstract
UNLABELLED Previous gestational diabetes mellitus (pGDM) indicates future risk for type 2 diabetes (T2DM). Insulin resistance (IR) may precede T2DM in many years and is associated with an increased risk for cardiovascular diseases. AIM This study aims to identify endothelial dysfunction and cardiovascular risk factors in women with pGDM. METHODS This cross-sectional analysis included 45 non diabetic women, 20 pGDM and 25 controls, at least one year after delivery. Body mass index (BMI), abdominal circumference (AC), blood pressure, serum lipids, liver enzymes, uric acid, nonesterified fatty acids, C-reactive protein and plasma glucose, insulin, fibrinogen and plasminogen activator inhibitor 1 were measured. HOMA IR and β were calculated. Pre and post induced ischemia videocapillaroscopy was performed in hand nailfold to evaluate microvascular morphologic aspect and functional response. RESULTS AC and fasting glucose were significantly higher in pGDM (p = 0.01 and p = 0.002 respectively). Women with pGDM and BMI < 25 kg/m(2) had significantly higher levels of fasting insulin and HOMA IR than controls (p = 0.008 and 0.05 respectively). Abnormal morphologic findings were more frequent and papillae rectification were 3.3 times more prevalent in pGDM (p = 0.003). Other microvascular parameters did not differ between groups. CONCLUSION Cardiovascular risk factors and a microcirculation abnormality (papillae rectification) were significantly increased in young non-diabetic women with pGDM.
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Affiliation(s)
- Lenita Zajdenverg
- Nutrology and Diabetes Section, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Melanie Rodacki
- Nutrology and Diabetes Section, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Janaina Polo Faria
- Nutrology and Diabetes Section, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Maria Lúcia Elias Pires
- Nutrology and Diabetes Section, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Boghossian NS, Yeung EH, Mumford SL, Zhang C, Gaskins AJ, Wactawski-Wende J, Schisterman EF; BioCycle Study Group. Adherence to the Mediterranean diet and body fat distribution in reproductive aged women. Eur J Clin Nutr 2013; 67:289-94. [PMID: 23388669 DOI: 10.1038/ejcn.2013.4] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background/Objectives Adherence to the Mediterranean Diet (MD) high in fruits, vegetables and monounsaturated fats, has been associated with lower body mass index. Associations with measured body fat, including regional adiposity, have not been previously investigated. We examined the associations between the alternate Mediterranean Diet Score (aMED), anthropometry and measured adiposity by dual energy x-ray absorptiometry. Subjects/Methods This study included 248 healthy females, aged 18–44 years from the BioCycle Study. Each woman’s aMED (range 0–9) was calculated from up to eight 24-hr dietary recalls over 1–2 menstrual cycles (>97% had ≥7 recalls). Multiple linear regression was used to determine whether aMED and its specific components were associated with total and regional adiposity after adjusting for age, race, education, physical activity and energy intake. Results Participants had an average (SD) aMED of 4.2 (1.7) and percent body fat of 29.5 (6.0)%. Significant inverse associations were found between aMED and all the examined adiposity measures except waist to hip ratio. Among the DXA measures, a 1-unit increment in aMED was associated with a 0.06 (95% CI:−0.09,−0.02) lower trunk-to-leg fat ratio (T/L), a measure of upper to lower body fat. In an analysis examining T/L as an outcome with the separate components of the aMED, T/L was lower with increased legume consumption (β=−0.280, 95% CI:−0.550,−0.010) but was higher with increased consumption of red and processed meat (β=0.060, 95% CI:0.002,0.117). Conclusions Adherence to the aMED was associated with lower total and regional adiposity, adding to the mounting evidence of the health benefits of the MD.
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Carmichael SL, Rasmussen SA, Shaw GM. Prepregnancy obesity: A complex risk factor for selected birth defects. ACTA ACUST UNITED AC 2010; 88:804-10. [DOI: 10.1002/bdra.20679] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Coolen JC, Verhaeghe J. Physiology and clinical value of glycosuria after a glucose challenge during pregnancy. Eur J Obstet Gynecol Reprod Biol 2010; 150:132-6. [DOI: 10.1016/j.ejogrb.2010.02.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Revised: 01/28/2010] [Accepted: 02/10/2010] [Indexed: 01/27/2023]
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Yeung EH, Hu FB, Solomon CG, Chen L, Louis GM, Schisterman E, Willett WC, Zhang C. Life-course weight characteristics and the risk of gestational diabetes. Diabetologia 2010; 53:668-78. [PMID: 20043144 PMCID: PMC2901841 DOI: 10.1007/s00125-009-1634-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2009] [Accepted: 11/26/2009] [Indexed: 02/06/2023]
Abstract
AIMS/HYPOTHESIS We prospectively determined the risk of gestational diabetes mellitus in association with life-course weight characteristics and adult abdominal adiposity. METHODS We investigated the joint and independent impact of birthweight, childhood size by somatotypes, adolescent and adult BMI, and abdominal adiposity on gestational diabetes mellitus risk among the 21,647 women in the Nurses' Health Study II who reported a singleton pregnancy between 1989 and 2001. A total of 1,386 incident cases of gestational diabetes mellitus were reported. Relative risk was estimated by pooled logistic regression adjusting for age, prematurity, race, smoking status, parental history of diabetes, age of first birth, parity and physical activity. RESULTS Birthweight was inversely associated with gestational diabetes mellitus risk (p = 0.02 for trend). Childhood somatotypes at ages 5 and 10 years were not associated with risk. U-shaped associations were found for BMI at age 18 years and somatotype at age 20 years. Weight gain between adolescence and adulthood, pre-gravid BMI and abdominal adiposity were positively associated with risk (p < 0.01 for all trends). Multivariate adjusted RRs for gestational diabetes from lowest to highest quintile of WHR were 1.00, 1.50, 1.51, 2.03, 2.12 (p = 0.0003 for trend). Lower birthweight (<7 lb) without adulthood overweight (BMI > 25 kg/m(2)) was associated with a 20% increased risk (95% CI 1.02-1.41). However, adulthood overweight alone was related to a 2.36 times greater risk (95% CI 2.12-3.77). CONCLUSIONS/INTERPRETATION Although lower birthweight is an independent risk factor for gestational diabetes mellitus, weight gain since early adulthood, and overall and central obesity in adulthood were more strongly associated with elevated risk of the condition independently of other known risk factors.
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Affiliation(s)
- E H Yeung
- Epidemiology Branch, Division of Epidemiology, Statistics, and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6100 Executive Blvd, 7B03, Bethesda, MD 20892, USA.
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Negrato CA, Jovanovic L, Rafacho A, Tambascia MA, Geloneze B, Dias A, Rudge MVC. Association between different levels of dysglycemia and metabolic syndrome in pregnancy. Diabetol Metab Syndr 2009; 1:3. [PMID: 19825195 PMCID: PMC2758580 DOI: 10.1186/1758-5996-1-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2009] [Accepted: 08/26/2009] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND In this study, we sought to evaluate the prevalence of metabolic syndrome (MS) in a cohort of pregnant women with a wide range of glucose tolerance, prepregnancy risk factors for MS during pregnancy, and the effects of MS in the outcomes in the mother and in the newborn. METHODS One hundred and thirty six women with positive screening for gestational diabetes mellitus (GDM) were classified by two diagnostic methods: glycemic profile and 100 g OGTT as normoglycemic, mild gestational hyperglycemic, GDM, and overt GDM. Markers of MS were measured between 2428th during the screening. RESULTS The prevalence of MS was: 0%; 20.0%; 23.5% and 36.4% in normoglycemic, mild hyperglycemic, GDM, and overt GDM groups, respectively. Previous history of GDM with or without insulin use, BMI >/= 25, hypertension, family history of diabetes in first degree relatives, non-Caucasian ethnicity, history of prematurity and polihydramnios were statistically significant prepregnancy predictors for MS in the index pregnancy, that by its turn increased the adverse outcomes in the mother and in the newborn. CONCLUSION The prevalence of MS increases with the worsening of glucose tolerance; impaired glycemic profile identifies pregnancies with important metabolic abnormalities even in the presence of a normal OGTT, in patients that are not classified as having GDM.
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Affiliation(s)
- Carlos A Negrato
- School of Medicine of Botucatu, São Paulo State University - UNESP, Botucatu, São Paulo, Brazil
| | - Lois Jovanovic
- Sansum Diabetes Research Institute, Santa Barbara, California, USA
| | - Alex Rafacho
- School of Sciences, São Paulo State University - UNESP, Bauru, São Paulo, Brazil
| | - Marcos A Tambascia
- School of Medical Sciences, State University of Campinas - UNICAMP, Campinas, São Paulo, Brazil
| | - Bruno Geloneze
- School of Medical Sciences, State University of Campinas - UNICAMP, Campinas, São Paulo, Brazil
| | - Adriano Dias
- School of Medicine of Botucatu, São Paulo State University - UNESP, Botucatu, São Paulo, Brazil
| | - Marilza VC Rudge
- School of Medicine of Botucatu, São Paulo State University - UNESP, Botucatu, São Paulo, Brazil
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Bo S, Menato G, Villois P, Gambino R, Cassader M, Cotrino I, Cavallo-Perin P. Iron supplementation and gestational diabetes in midpregnancy. Am J Obstet Gynecol 2009; 201:158.e1-6. [PMID: 19527900 DOI: 10.1016/j.ajog.2009.04.049] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2008] [Revised: 02/02/2009] [Accepted: 04/22/2009] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Iron supplementation in pregnancy seems beneficial for neonatal/maternal outcomes, but it was associated with diabetes and hypertension in the general population. STUDY DESIGN We investigated the association between iron supplementation during midpregnancy and metabolic/hypertensive abnormalities in 500 consecutive gestational diabetes mellitus (GDM) and 500 normoglycemic women. RESULTS Iron-supplement users (n = 212/1000) showed significantly higher values of prepregnancy body mass index (BMI), actual BMI, waist circumference, blood pressure, fasting glucose, Homeostasis-Model-Assessment-Insulin-Resistance, and lower high-density lipoprotein-cholesterol than nonusers. The prevalence of GDM (70.8% vs 44.4%), hypertension (25.9% vs 9.8%), metabolic syndrome (25.9% vs 10.4%) was significantly higher in the former with a 2- to 3-fold-increased risk at multiple regression analyses. Most glucose values of the oral glucose tolerance test were significantly higher in iron supplemented women, both in GDM and normoglycemic individuals. CONCLUSION Iron supplementation is associated with glucose impairment and hypertension in midpregnancy; its potential harmful effects might be carefully debated regarding its effectiveness.
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Affiliation(s)
- Simona Bo
- Department of Internal Medicine, University of Turin, Corso Dogliotti 14, Turin 10126, Italy.
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Abstract
BACKGROUND There is growing interest in the effect of childbearing on the development of chronic medical conditions. In the present study we aim at seeing whether parity is associated with increased waist circumference (WC) and other anthropometric indices of obesity, or not, in a sample of Iraqi women. METHODS This was a cross sectional study conducted during the period from January 2006 to the end of December 2007. Subjects were women attending two primary health care centers in a rural district population in Basrah (Abu-Al-khasib district), Iraq. RESULTS A total of 9135 women with a mean age of 46.4+/-15.5 years were included in the study. The mean weight was 69.9+/-16.9 kg and the mean WC was 92.7+/-15.0 cm with 78.9% of women having WC >or=80 cm. The mean and the standard deviation of other anthropometric variables were 27.0+/-6.25 for body mass index (BMI), 0.57+/-0.09 for waist-to-height ratio (WHtR) and 0.89+/-0.08 for waist-to-hip ratio (WHpR). Body weight, WC, BMI, WHpR, and WHtR progressively and significantly increased with increasing parity (p<0.001). Increasing age and higher number of births were associated with a consistent significant increase in the risk of increasing WC. While the reverse was true with respect to education, the risk of increased WC significantly decreased with the increase in education. The risk of increased WC was higher among housewives compared to employed women. On multiple logistic regression analyses of parity and risk of increasing WC, the number of births remained significantly and independently associated with increased WC after adjustment for a range of potential confounders (age, BMI, employment, education, and marital status). However, when parity was analyzed as a dichotomous variable (parous versus nulliparous), no significant association was found (p>0.05). CONCLUSION Parity was associated with increased WC and other anthropometric indices of obesity in a sample of rural Iraqi women attending two primary health care centers.
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Affiliation(s)
- A A Mansour
- Department of Medicine, Basrah College of Medicine, Basrah, Iraq.
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Negrato CA, Jovanovic L, Tambascia MA, Calderon IDMP, Geloneze B, Dias A, Rudge MVC. Mild gestational hyperglycaemia as a risk factor for metabolic syndrome in pregnancy and adverse perinatal outcomes. Diabetes Metab Res Rev 2008; 24:324-30. [PMID: 18254163 DOI: 10.1002/dmrr.815] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The aims of this study were to evaluate the prevalence of metabolic syndrome (MS) in a cohort of pregnant women with a wide range of glucose tolerance, pre-pregnancy risk factors for MS during pregnancy and the effects of MS in the occurrence of adverse perinatal outcomes. RESEARCH DESIGN AND METHODS One hundred and thirty six women with positive screening for gestational diabetes (GDM) were classified by two diagnostic methods: glycaemic profile and 100 g oral glucose tolerance test (OGTT) as normoglycaemic, mild gestational hyperglycaemic, GDM, and overt GDM. Markers of insulin resistance were measured between 24-28 and 36th week of gestation, and 6 weeks after delivery. RESULTS The prevalence of MS was 0; 20.0; 23.5 and 36.4% in normoglycaemic, mild hyperglycaemic, GDM and overt GDM groups, respectively. Previous history of GDM with or without insulin use, body mass index (BMI) > or = 25, hypertension, family history of diabetes in first-degree relatives, non-Caucasian ethnicity, history of prematurity and polyhydramnios were statistically significant pre-pregnancy predictors for MS in the index pregnancy, that by its turn increased the occurrence of adverse perinatal outcomes (p = 0.01). CONCLUSIONS The prevalence of MS increases with the worsening of glucose tolerance and is an independent predictor of adverse perinatal outcomes; impaired glycaemic profile identifies pregnancies with important metabolic abnormalities that are linked to the occurrence of adverse perinatal outcomes even in the presence of a normal OGTT, in patients that are not currently classified as having GDM.
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Wendland EMDR, Duncan BB, Mengue SS, Nucci LB, Schmidt MI. Waist circumference in the prediction of obesity-related adverse pregnancy outcomes. CAD SAUDE PUBLICA 2007; 23:391-8. [PMID: 17221088 DOI: 10.1590/s0102-311x2007000200015] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2005] [Accepted: 02/02/2006] [Indexed: 11/21/2022] Open
Abstract
The aim of this study is to evaluate the diagnostic properties of waist circumference in the prediction of obesity-related gestational outcomes. Pregnant women 20 years or older were consecutively enrolled in six Brazilian State capitals from 1991 to 1995. Weight, height, and waist circumference were measured and an oral glucose tolerance test was performed. Patients were followed through childbirth by chart review. Diagnostic performance for the different outcomes, as measured by area under the receiver operating characteristic (ROC) curve, was estimated through logistic regression. Areas under the ROC curve (95%CI) for waist circumference were 0.621(0.589-0.652) for gestational diabetes, 0.640 (0.588-0.692) for preeclampsia, and 0.645(0.617-0.673) for macrosomia. These areas were similar to those for BMI (p > 0.05). A waist circumference of 82cm jointly maximized sensitivity (63%) and specificity (57%). Cutoff points of 23kg/m² for pre-pregnancy BMI and 26kg/m² for BMI at enrollment produced similar diagnostic properties. In conclusion, waist circumference predicts obesity-related adverse pregnancy outcomes at least as well as BMI.
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Affiliation(s)
- Eliana M D R Wendland
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
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Nohr EA, Bech BH, Vaeth M, Rasmussen KM, Henriksen TB, Olsen J. Obesity, gestational weight gain and preterm birth: a study within the Danish National Birth Cohort. Paediatr Perinat Epidemiol 2007; 21:5-14. [PMID: 17239174 DOI: 10.1111/j.1365-3016.2007.00762.x] [Citation(s) in RCA: 141] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The aim of the present study was to assess the impact of obesity and gestational weight gain on the risk of subtypes of preterm birth, because little is known about these associations. The study included 62 167 women within the Danish National Birth Cohort for whom self-reported information about prepregnancy body mass index (BMI) and gestational weight gain was available. Information about spontaneous preterm birth with or without preterm premature rupture of membranes (PPROM) and about induced preterm deliveries was obtained from national registers. Cox regression analyses were used to examine associations of prepregnancy BMI and gestational weight gain with subtypes of preterm birth. The crude risks of PPROM and of induced preterm deliveries were higher in obese women (BMI > or = 30) than in normal-weight women (18.5 < or = BMI < 25), especially before 34 completed weeks of gestation, when obese women faced twice the risk. In the adjusted analysis, the hazard ratios and 95% confidence intervals for PPROM and for induced preterm delivery in obese women were 1.5 [1.2, 1.9] and 1.2 [1.0, 1.6] respectively. When obesity-related diseases were accounted for, no excess risk of induced preterm deliveries was seen in obese women, but the increased risk of PPROM was unchanged. Low weight gain was associated with an increased risk of all subtypes of preterm birth compared with normal weight gain, especially in early spontaneous preterm births, where the risk was doubled. We concluded that prepregnancy obesity was associated with a higher risk of PPROM and early induced preterm deliveries.
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Affiliation(s)
- Ellen Aagaard Nohr
- Danish Epidemiology Science Centre, Department of Epidemiology, Institute of Public Health, University of Aarhus, 8000 Aarhus C, Denmark.
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Abstract
OBJECTIVE While high parity is hypothesized to be associated with insulin resistance and type 2 diabetes, few studies have examined this association in diverse racial samples or geographical areas. Our objectives were to estimate the magnitude of association between parity and diabetes and to determine if higher parity is predictive of future risk of diabetes. RESEARCH DESIGN AND METHODS This was a population-based, prospective cohort study of 7,024 Caucasian and African-American women from the Atherosclerosis Risk in Communities study, a prospective epidemiological study of men and women aged 45-64 years, with 9 years of follow-up. Incident diabetes was defined by the 1997 American Diabetes Association diagnostic criteria. Parity was defined as the number of live births (no live births [nulliparity], one to two live births, three to four live births, and five or more live births [grandmultiparity]). Parity and risk of diabetes was estimated for 754 incident cases of diabetes with Cox proportional hazard regression models, adjusting for sociodemographic, clinical, and lifestyle factors and inflammatory markers. RESULTS Incidence rates were highest among women with five or more live births (23/1,000 person-years [95% CI 20.3-26.7]) and lowest among women with one to two live births (11/1,000 person-years [9.6-12.5]). Adjustment indicated that much of the risk was due to sociodemographic factors and higher obesity, but after adjustment for all covariates, grandmultiparity (five or more) was still associated with a 27% increased risk for diabetes (hazard ratio 1.27 [95% CI 1.02-1.57]). CONCLUSIONS Grandmultiparity is predictive of future risk of diabetes after adjustment for confounders.
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Affiliation(s)
- Wanda K Nicholson
- Johns Hopkins School of Medicine, 600 N. Wolfe St., Phipps 247, Baltimore, MD 21287, USA.
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Verhaeghe J, van Bree R, Lambin S, Caluwaerts S. Adipokine profile and C-reactive protein in pregnancy: effects of glucose challenge response versus body mass index. ACTA ACUST UNITED AC. 2005;12:330-334. [PMID: 15979544 DOI: 10.1016/j.jsgi.2005.02.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2004] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To test the hypothesis that gravidas who have an abnormal response to glucose loading have dysfunctional adipose tissue cells that produce more insulin resistance-inducing and proinflammatory adipokines but less insulin-sensitizing adipokines. METHODS We performed a nested case-control study within a larger sample of gravidas who had a glucose challenge test (GCT) at 24-29 weeks; we compared 73 cases with an abnormal GCT (>8.3 mM) and 146 controls with a strictly normal GCT (<7.2 mM) matched for body mass index (BMI) and height (mean difference between cases and controls: 0.1 kg/m(2) and 1 cm, respectively). We measured plasma insulin, adipokines (leptin, adiponectin, resistin, tumor necrosis factor [TNF]-alpha, interleukin [IL]-6), soluble leptin receptor (sOb-R), the main leptin-binding protein, and C-reactive protein (CRP). RESULTS The cases showed a 48% increase in insulin concentrations and a 27% increase in TNF-alpha concentrations compared to the controls (both P < .0001), but leptin, sOb-R, IL-6, and adiponectin, as well as CRP, concentrations were comparable between cases and controls. In the whole group (n = 219), BMI was correlated with insulin, leptin, IL-6, and CRP, and inversely with sOb-R and adiponectin concentrations (all P < .0003). CONCLUSIONS Plasma leptin, sOb-R, IL-6, and adiponectin, as well as CRP, are strongly related to BMI in gravidas at 24-29 weeks gestational age but not to the glucose loading response. However, TNF-alpha is higher in women with an abnormal GCT. Further studies should disclose the source of increased TNF-alpha in these women, and to assess whether TNF-alpha is causally related to glucose intolerance during pregnancy.
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Bo S, Signorile A, Menato G, Gambino R, Bardelli C, Gallo ML, Cassader M, Massobrio M, Pagano GF. C-reactive protein and tumor necrosis factor-alpha in gestational hyperglycemia. J Endocrinol Invest 2005; 28:779-86. [PMID: 16370555 DOI: 10.1007/bf03347566] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVES AND STUDY DESIGN Increasing evidences support an inflammatory origin for gestational hyperglycemia. This paper aims at investigating, cross-sectionally and prospectively, the relationships between tumor necrosis factor-alpha (TNF-alpha) and C-reactive protein (CRP) levels in normoglycemic and hyperglycemic pregnancies of women with and without conventional risk factors for gestational diabetes (GDM). RESULTS Both at simple and multiple correlations TNF-alpha levels are associated to fasting insulin, homeostasis model assessment-insulin resistance (HOMA-IR) values and gestational hyperglycemia, while high sensitivity CRP (hsCRP) levels to body mass index (BMI). Furthermore, the TNF-alpha levels of the second trimester and their increments in the third trimester are significant predictors of insulin levels measured at 32-36 weeks in the subgroup of hyperglycemic women with < or = 35 yr, BMI <25 kg/m2 and the absence of a first-degree relative with Type 2 diabetes (respectively, beta=1.1; 95%CI 0.66-1.48; p=0.002 and beta=1.0; 95%CI 0.36-1.66; p=0.02), in a multiple regression model, after multiple adjustments. In a second cohort of women at low risk for GDM (<25 yr, BMI <25 kg/m2 and absence of a first-degree relative with Type 2 diabetes), 24-28 weeks TNF-alpha levels are highly associated with corresponding insulin and HOMA values in the same model (respectively, beta=0.27; 95%CI 0.11-0.43; p=0.001 and beta=0.30; 95%CI 0.14-0.46; p<0.001). CONCLUSIONS The data support the developing hypothesis that low-grade systemic inflammation is associated to GDM, in particular for pregnant women without conventional risk factors for gestational hyperglycemia, whose insulin resistance seems less explainable.
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Affiliation(s)
- S Bo
- Department of Internal Medicine, University of Turin, Italy.
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Abstract
Women with a history of gestational diabetes mellitus (GDM) have a high risk of progression to type 2 diabetes mellitus (T2DM). Risk factors are similar for GDM and T2DM and include, among others, obesity, family history, and ethnic background. GDM is also associated with the metabolic syndrome. Women with impaired glucose tolerance or "prediabetes" postpartum have the highest risk of progression. In women with impaired glucose tolerance, lifestyle modification or pharmacologic therapy may prevent or delay the onset of T2DM.
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Affiliation(s)
- Stacy L Strehlow
- Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
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Bo S, Menato G, Gallo ML, Bardelli C, Lezo A, Signorile A, Gambino R, Cassader M, Massobrio M, Pagano G. Mild gestational hyperglycemia, the metabolic syndrome and adverse neonatal outcomes. Acta Obstet Gynecol Scand 2004; 83:335-40. [PMID: 15005779 DOI: 10.1111/j.0001-6349.2004.00314.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the prevalence of the metabolic syndrome and its effect on neonatal outcomes in pregnancies with different degrees of hyperglycemia. METHODS One hundred and fifty women with gestational diabetes, 100 with one abnormal value on the oral glucose tolerance test, 100 with a normal oral glucose challenge test and 350 with an abnormal challenge test and normal tolerance test were enrolled. RESULTS The prevalence of the metabolic syndrome was: 0%, 4.9%, 20% and 18% in the normal challenge test, abnormal challenge and normal tolerance test, one abnormal value and gestational diabetes patients, respectively. Offspring birth weights, prevalence of large-for-gestational age babies and icterus were significantly higher in women with an abnormal challenge test (both with a normal tolerance test or one abnormal value or gestational diabetes). Metabolic syndrome was the best predictor of the presence of large-for-gestational age babies in patients with an abnormal challenge and normal tolerance test (OR = 3.15), one abnormal value (OR = 3.53) and gestational diabetes (OR = 4.15). CONCLUSIONS Metabolic syndrome in mid-pregnancy was an independent predictor of macrosomia in women with any degree of gestational hyperglycemia; the oral glucose challenge test identifies pregnancies with metabolic abnormalities and adverse neonatal outcomes also in the presence of a normal oral glucose tolerance test.
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Affiliation(s)
- Simona Bo
- Department of Internal Medicine, University of Turin, Turin, Italy.
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Bo S, Menato G, Signorile A, Bardelli C, Lezo A, Gallo ML, Gambino R, Cassader M, Massobrio M, Pagano G. Obesity or diabetes: what is worse for the mother and for the baby? Diabetes Metab 2003; 29:175-8. [PMID: 12746640 DOI: 10.1016/s1262-3636(07)70026-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The aim of the present study is to evaluate pregnancy outcomes in a cohort of Caucasian pregnant women in relation to their body mass index and glucose tolerance status; the role of central fat distribution, as indicated by waist-to-hip circumference ratio, was also considered. METHODS Seven hundred women were studied; they had gestational diabetes or impaired glucose tolerance (250) or normoglycaemia (450). Among them 117 had pre-pregnancy overweight/obesity (44 were obese), 133 hyperglycaemia, but normal weight, and 117 hyperglycaemia and overweight/obesity (42 were obese). RESULTS Hypertension, cesarean delivery and prevalence of large-for-gestational age babies were higher in obese (both with normoglycaemia and hyperglycaemia), mainly in those with greater gestational weight gain and central fat distribution (waist-to-hip ratio > 0.90). Normal weight hyperglycaemic women showed better outcomes than obese normoglycaemic women did. In a multiple logistic regression model, obesity (OR=10.6; 95% CI 5.00-22.54) was directly related to hypertension, and independent predictors of cesarean section were: gestational hyperglycaemia (OR=1.78; 95% CI 1.21-2.62), gestational weight gain (OR=1.06; 95% CI 1.02-1.10), and central obesity (OR=1.51; 95% CI 1.02-2.24), while obesity (OR=4.48; 95% CI 2.30-8.71) gestational weight gain (OR=1.08; 95% CI 1.03-1.12) and central fat distribution (OR=1.81: 95% CI 1.12-2.93) were directly related to delivering larger babies, after multiple adjustments. CONCLUSION These results suggest that pre-pregnancy obesity and gestational hyperglycaemia were independent risk factors for different adverse pregnancy and neonatal outcomes, while central distribution of fat, and gestational weight gain play an additive adverse role on these outcomes.
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Affiliation(s)
- S Bo
- Department of Internal Medicine, University of Turin, Italy.
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Bo S, Menato G, Pinach S, Signorile A, Bardelli C, Lezo A, Marchisio B, Gentile L, Cassader M, Massobrio M, Pagano G. Clinical characteristics and outcome of pregnancy in women with gestational hyperglycaemia with and without antibodies to beta-cell antigens. Diabet Med 2003; 20:64-8. [PMID: 12519322 DOI: 10.1046/j.1464-5491.2003.00721.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIMS To evaluate the prevalence of beta-cell autoantibodies in women with gestational diabetes and impaired glucose tolerance, and identify clinical characteristics differentiating hyperglycaemic patients with and without autoantibodies. METHODS One hundred and twenty-three pregnant patients with gestational diabetes, 84 with impaired glucose tolerance and 290 with normoglycaemia were evaluated for anti-islet cell antibodies, glutamic acid decarboxylase (GAD) autoantibodies, and the components of the metabolic syndrome. RESULTS Autoantibody positivity was 8.9%, 17.9% and 0.3% in patients with diabetes, impaired tolerance and normoglycaemia, respectively. Hyperglycaemic patients with autoantibodies had lower body mass index, waist, weight gain at the time of the screening test and a lower percentage of previous pregnancies than those without autoantibodies. In addition, their fasting insulin values were significantly lower and inversely related to the presence of autoantibodies (odds ratio (OR) = 0.64; 95% confidence interval (CI) 0.42-0.96), the lowest values being found in anti-GAD+ patients. Autoantibody-positive women with diabetes were more frequently treated with insulin than negative patients (OR = 7.21; 95% CI 1.85-28.08). CONCLUSIONS Autoantibody-positive women with gestational hyperglycaemia displayed fewer features of insulin resistance and required more frequent insulin therapy than negative women and presumably had presymptomatic Type 1 diabetes. If this conclusion is corroborated by the follow-up of larger series, clinical and immunological distinction of types of gestational hyperglycaemia would be useful.
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Affiliation(s)
- S Bo
- Department of Internal Medicine, University of Turin, Turin, Italy
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Abstract
Low birthweight is uncommon among Mexican-American infants, despite the substantial proportion of mothers who live in poverty. This apparent paradox has generated studies of factors protecting fetal growth, but may have masked other important health problems in the Mexican-American community. Obesity, impaired glucose tolerance and diabetes are common among Mexican-American women of childbearing age and during pregnancy. Prevalence of these conditions is two to four times higher in Mexican-American than in non-Hispanic white women. As obesity and glucose intolerance during pregnancy are associated with fetal overgrowth and increased risk of subsequent obesity and type 2 diabetes in mother and child, the adequacy of birthweight as a measure of maternal and infant risk may be obscured in populations with a high prevalence of these conditions. Their possible contribution to the increasing incidence of obesity and type 2 diabetes in Mexican-American children, adolescents and young adults has not been examined. Appropriate preconception, prenatal and follow-up care may identify high-risk women, improve weight and metabolic status and reduce the severity and impact of diabetes and its complications. However, late or no prenatal care is common among Mexican-American women and the frequency of follow-up care is unknown. As low birthweight is a major public health indicator of maternal and neonatal health, perceived 'good birth outcomes' have reduced health policy, programme and research attention to Mexican-American mothers and infants. Studies of the impact of obesity and glucose intolerance during pregnancy on the birthweights of Mexican-American infants should be undertaken, along with systematic assessment of the subsequent health status and preventive health-care needs of women and children in this population.
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Affiliation(s)
- E C Kieffer
- Department of Health Behavior and Health Education, Ann Arbor, MI 48109-2029, USA.
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Abstract
BACKGROUND The James Bay Cree of Canada have one of the highest recorded rates of gestational diabetes mellitus (GDM) among aboriginal people worldwide; the reasons for this elevated risk remain to be documented. OBJECTIVE Our objective was to compare predictors and risk of GDM between the James Bay Cree and non-Native Canadians. DESIGN Risk for GDM was compared between Cree and non-Native women by 1) adjusting statistically for differences in age, parity, pregravid weight, and smoking status (n = 402 Cree, 7718 non-Natives), and 2) matching Cree women with non-Native women for age and pregravid weight (n = 394 Cree, 788 non-Natives). Dietary and physical activity information was available for a subset of Cree women (n = 152). RESULTS Age and pregravid weight were independent predictors of GDM in both Cree and non-Native women. After these predictors were controlled for, normal-weight (</=77 kg) Cree women were not at increased risk of GDM (OR: 1.42; 95% CI: 0.67, 2.71) but overweight Cree women had a higher risk than did overweight non-Native women (OR: 2.25; 95% CI: 1.32, 3.80). CONCLUSIONS Overweight Cree women are at increased risk of GDM. Given the high prevalence of pregravid overweight among the Cree, the burden of GDM is higher than among non-Native Canadians.
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Affiliation(s)
- S Rodrigues
- School of Dietetics and Human Nutrition, McGill University, Montreal
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Davis CL, Gutt M, Llabre MM, Marks JB, O'Sullivan MJ, Potter JE, Landel JL, Kumar M, Schneiderman N, Gellman M, Skyler JS. History of gestational diabetes, insulin resistance and coronary risk. J Diabetes Complications 1999; 13:216-23. [PMID: 10616862 DOI: 10.1016/s1056-8727(99)00048-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The purpose of this study was to examine characteristics associated with the insulin metabolic syndrome, including insulin resistance, abnormal glucose tolerance, dyslipidemia, obesity, and elevated blood pressure, among women who have experienced gestational diabetes. 39 nondiabetic, young (20-42 years), postpartum (3-18 months) white women were recruited from obstetrical clinics. Twenty-one women had a history of gestational diabetes; 18 had uncomplicated pregnancies. Multivariate analyses revealed a significant difference between groups in insulin resistance (M, measured by euglycemic clamp) and insulin levels (from an oral glucose tolerance test), with insulin resistance showing a statistically stronger difference than insulin levels. Groups also differed significantly when compared on a set of variables associated with insulin metabolic syndrome: glucose tolerance, triglycerides, blood pressure, and body-mass index. Using insulin resistance as a covariate eliminated these group differences, suggesting that insulin resistance is the key factor underlying insulin metabolic syndrome. The higher risk of later developing type 2 diabetes and hypertension in women who have a history of gestational diabetes is explicable by their poorer profile on variables associated with insulin metabolic syndrome, and appears to be attributable to insulin resistance. Thus, insulin resistance appears to distinguish young women at risk for cardiovascular disease.
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Affiliation(s)
- C L Davis
- Department of Psychology, University of Miami, Coral Gables, Florida 33124-2070, USA
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