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Benton M, Bird J, Pawlby S, Ismail K. The impact of gestational diabetes mellitus on perceived mother-infant bonding: a qualitative study. J Reprod Infant Psychol 2025; 43:487-500. [PMID: 37493446 PMCID: PMC11854049 DOI: 10.1080/02646838.2023.2239834] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 07/18/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND The prevalence of gestational diabetes mellitus (GDM) is rapidly increasing. It is associated with adverse physical and mental health outcomes for women and their babies. Mother-infant bonding is important for maternal health and infant development, but the effect of GDM on mother-infant bonding has not been examined. OBJECTIVE To explore and describe the impact of GDM on perceived mother infant-bonding in the antenatal and postnatal period. METHODS Qualitative, individual, semi-structured interviews were conducted with 33 women from diverse backgrounds with current or previous GDM. Data were analysed using reflexive inductive thematic analysis. RESULTS Three main themes were generated from the analysis: 1) Concern for baby's health and its impact on bonding; 2) GDM management, the pregnancy experience, and bonding; 3) Continuity and discontinuity of the impact on bonding between the antenatal and postnatal periods. CONCLUSION It was found that GDM can have both positive and negative impacts on perceived mother-infant bonding, which appear to change over the course of the perinatal period. Further observational research is needed to assist in understanding the impact of GDM on mother-infant bonding and the potential mediating effect of mental disorders, including depression.
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Affiliation(s)
- Madeleine Benton
- Department of Psychological Medicine, King’s College London, London, UK
| | - Jessica Bird
- Department of Psychological Medicine, King’s College London, London, UK
| | - Susan Pawlby
- Department of Psychological Medicine, King’s College London, London, UK
| | - Khalida Ismail
- Department of Psychological Medicine, King’s College London, London, UK
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Ye X, Baker PN, Tong C. The updated understanding of advanced maternal age. FUNDAMENTAL RESEARCH 2024; 4:1719-1728. [PMID: 39734537 PMCID: PMC11670706 DOI: 10.1016/j.fmre.2023.09.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 06/29/2023] [Accepted: 09/21/2023] [Indexed: 12/31/2024] Open
Abstract
The rising rates of pregnancies associated with advanced maternal age (AMA) have created unique challenges for healthcare systems worldwide. The elevated risk of poor maternal outcomes among AMA pregnancies is only partially understood and hotly debated. Specifically, AMA is associated with reduced fertility and an increased incidence of pregnancy complications. Finding a balance between global fertility policy, socioeconomic development and health care optimization ultimately depends on female fertility. Therefore, there is an urgent need to develop technologies and identify effective interventions. Support strategies should include prepregnancy screening, intervention and postpartum maintenance. Although some reviews have considered the relationship between AMA and adverse pregnancy outcomes, no previous work has comprehensively considered the long-term health effects of AMA on mothers. In this review, we will begin by presenting the current knowledge of global health issues associated with AMA and the effects of advanced age on the female reproductive system, endocrine metabolism, and placental function. We will then discuss physiological alterations, pregnancy complications, and long-term health problems caused by AMA.
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Affiliation(s)
- Xuan Ye
- National Clinical Research Center for Child Health and Disorder, Children's Hospital of Chongqing Medical University, Chongqing 401122, China
- State Key Laboratory of Maternal and Fetal Medicine of Chongqing Municipality, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Philip N. Baker
- State Key Laboratory of Maternal and Fetal Medicine of Chongqing Municipality, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
- College of Life Sciences, University of Leicester, Leicester LE1 7RH, UK
| | - Chao Tong
- National Clinical Research Center for Child Health and Disorder, Children's Hospital of Chongqing Medical University, Chongqing 401122, China
- State Key Laboratory of Maternal and Fetal Medicine of Chongqing Municipality, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
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Amini M, Kazemnejad A, Rasekhi A, Amirian A, Kariman N. Early prediction of gestational diabetes mellitus using first trimester maternal serum pregnancy-associated plasma protein-a: A cross-sectional study. Health Sci Rep 2024; 7:e70090. [PMID: 39355100 PMCID: PMC11439745 DOI: 10.1002/hsr2.70090] [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: 01/25/2024] [Revised: 07/16/2024] [Accepted: 09/05/2024] [Indexed: 10/03/2024] Open
Abstract
Background and Aims The oral glucose tolerance test with 75 g glucose is commonly regarded as the gold standard (GS) for the detection of gestational diabetes mellitus (GDM). However, one limitation of this test is its administration in the late second trimester of pregnancy in some countries (e.g., Iran). This study aimed to evaluate the accuracy of pregnancy-associated plasma protein-A (PAPP-A) for predicting GDM in the early first trimester of pregnancy using a novel statistical modeling technique. Methods The study population consisted of 344 pregnant women who participated in the first trimester screening program for GDM. Maternal serum PAPP-A levels were measured between 11 and 13 gestational weeks for all participants. A Bayesian latent profile model (LPM) under the skew-t (ST) distribution was employed to estimate the diagnostic accuracy measures of PAPP-A in the absence of GS test outcomes. Results The mean (standard deviation) age of the participants was 28.87 ± 5.20 years. The median (interquartile range (IQR)) PAPP-A MoM was 0.91 (0.69-1.34). Utilizing the LPM under the ST distribution while adjusting for covariates, the sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) of PAPP-A were 92% (95% credible interval [CrI]: 0.89, 0.98), 81% (95% CrI: 0.76, 0.91), and 0.91 (95% CrI: 0.83, 0.97), respectively. Notably, the pregnant women with GDM had significantly lower PAPP-A values (β = -0.52, 95% CrI [-0.61, -0.46]). Conclusion Generally, our findings confirmed that PAPP-A could serve as a potential screening tool for the identification of GDM in the early stages of pregnancy.
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Affiliation(s)
- Maedeh Amini
- Department of Biostatistics, Faculty of Medical SciencesTarbiat Modares UniversityTehranIran
| | - Anoshirvan Kazemnejad
- Department of Biostatistics, Faculty of Medical SciencesTarbiat Modares UniversityTehranIran
| | - Aliakbar Rasekhi
- Department of Biostatistics, Faculty of Medical SciencesTarbiat Modares UniversityTehranIran
| | - Azam Amirian
- Department of Midwifery, School of Nursing and MidwiferyJiroft University of Medical SciencesJiroftIran
| | - Nourossadat Kariman
- Department of Midwifery and Reproductive Health, School of Nursing and MidwiferyShahid Beheshti University of Medical SciencesTehranIran
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Tirado-Aguilar OA, Martinez-Cruz N, Arce-Sanchez L, Borboa-Olivares H, Reyes-Muñoz E, Espino-Y-Sosa S, Villafan-Bernal JR, Martinez-Portilla RJ, Estrada-Gutierrez G, Uribe-Torres R, Tirado Aguilar RD, Lopez-Torres MF, Ramos-Mendoza C, Camacho-Martinez ZA, Aguilar-Jaimes NY, Torres-Torres J. Earlier detection of gestational diabetes impacts on medication requirements, neonatal and maternal outcomes. Diabetes Obes Metab 2024; 26:3110-3118. [PMID: 38699781 DOI: 10.1111/dom.15633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/16/2024] [Accepted: 04/17/2024] [Indexed: 05/05/2024]
Abstract
AIM Gestational diabetes (GD) is a global health concern with significant implications for maternal and neonatal outcomes. This study investigates the association between early GD (eGD) diagnosis (<24 weeks), pharmacotherapy requirements and adverse neonatal outcomes. MATERIALS AND METHODS A cohort of 369 pregnant women underwent a 75-g oral glucose tolerance test. Maternal variables, pharmacotherapy prescriptions and neonatal outcomes were analysed employing t-tests, χ2 tests, and logistic regression. A p < .05 was considered significant. RESULTS Early GD increased the odds of neonatal hypoglycaemia [odds ratio (OR): 18.57, p = .013] and respiratory distress syndrome (OR: 4.75, p = .034). Nutritional therapy prescription by an accredited nutritionist was the most common treatment in women diagnosed after 24 weeks, but those with eGD required more frequently specialized nutritional consulting + metformin to achieve glycaemic control (p = .027). eGD was associated with a higher requirement of nutritional therapy prescription + metformin (OR: 2.26, 95% confidence interval: 1.25-4.09, p = .007) and with maternal hyperglycaemia during the post-partum period at 2 h of the oral glucose tolerance test (OR: 1.03, 95% confidence interval: 1.02-1.13, p = .024). CONCLUSION Timely diagnosis and personalized treatment of GD are desirable because an earlier presentation is related to a higher risk of adverse neonatal and maternal outcomes.
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Affiliation(s)
- Omar Alberto Tirado-Aguilar
- Department of Gynecology and Obstetrics, Instituto Nacional de Perinatología "Isidro Espinosa de los Reyes", Mexico City, Mexico
| | - Nayeli Martinez-Cruz
- Coordination of Endocrinology, Instituto Nacional de Perinatología "Isidro Espinosa de los Reyes", Mexico City, Mexico
| | - Lidia Arce-Sanchez
- Coordination of Endocrinology, Instituto Nacional de Perinatología "Isidro Espinosa de los Reyes", Mexico City, Mexico
| | - Hector Borboa-Olivares
- Community Interventions Research Branch, Instituto Nacional de Perinatología "Isidro Espinosa de los Reyes", Mexico City, Mexico
| | - Enrique Reyes-Muñoz
- Coordination of Gynecological and Perinatal Endocrinology, Instituto Nacional de Perinatología "Isidro Espinosa de los Reyes", Mexico City, Mexico
| | - Salvador Espino-Y-Sosa
- Clinical Research Branch, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Jose Rafael Villafan-Bernal
- Laboratory of Immunogenomics and Metabolic Diseases, Instituto Nacional de Medicina Genomica, Mexico City, Mexico
| | | | - Guadalupe Estrada-Gutierrez
- Clinical Research Branch, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Regina Uribe-Torres
- Clinical Research Branch, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
- Comisión Interinstitucional para la Formación de Recursos Humanos para la Salud, Mexico City, Mexico
| | | | - Maria Fernanda Lopez-Torres
- Department of Gynecology and Obstetrics, Instituto Nacional de Perinatología "Isidro Espinosa de los Reyes", Mexico City, Mexico
| | - Cecilia Ramos-Mendoza
- Department of Gynecology and Obstetrics, Instituto Nacional de Perinatología "Isidro Espinosa de los Reyes", Mexico City, Mexico
| | | | | | - Johnatan Torres-Torres
- Clinical Research Branch, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
- Gynecology and Obstetrics Deparment, Hospital General de Mexico "Dr. Eduardo Liceaga", Mexico City, Mexico
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Yumei P, Huiying K, Liqin S, Xiaoshan Z, Meijing Z, Yaping X, Huifen Z. The mediating effect of e-health literacy on social support and behavioral decision-making on glycemic management in pregnant women with gestational diabetes: a cross-sectional study. Front Public Health 2024; 12:1416620. [PMID: 39086804 PMCID: PMC11288816 DOI: 10.3389/fpubh.2024.1416620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 07/04/2024] [Indexed: 08/02/2024] Open
Abstract
Background Social support and e-health literacy are closely related to individual health behaviors, while behavior is premised on decision-making. Few studies have identified the relationships among social support, e-health literacy, and behavioral decision-making, and the nature of these relationships among pregnant women with gestational diabetes remains unclear. Therefore, this study aimed to investigate relationships among social support, e-health literacy, and glycemic management behavioral decisions in pregnant women with gestational diabetes. Methods Using continuous sampling, an online cross-sectional survey was conducted among pregnant women with gestational diabetes who met the inclusion and exclusion criteria at four Class 3 hospitals in Fujian Province from October to December 2023. A structured questionnaire was used to collect data on general characteristics, socioeconomic status, social support, e-health literacy, and behavioral decision-making regarding glycemic management. Descriptive statistical analyses, correlation analyses, and mediation effects were used to assess associations. Results A total of 219 pregnant women with gestational diabetes participated, and 217 valid results were obtained. The level of glycemic management behavior decision-making in women with gestational diabetes was positively correlated with e-health literacy (r = 0.741, p < 0.01) and with perceived social support (r = 0.755, p < 0.01). E-health literacy was positively correlated with perceived social support (r = 0.694, p < 0.01). The indirect effect of perceived social support on glycemic management behavior decisions through e-health literacy (a*b) was 0.153, accounting for 38% of the total effect. Conclusion Social support and e-health literacy in pregnant women with gestational diabetes are related to behavioral decision-making in glycemic management. The results of this study provide a reference for developing targeted measures to improve glycemic management behaviors in pregnant women with gestational diabetes, which is crucial for achieving sustainable glycemic management.
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Affiliation(s)
- Peng Yumei
- School of Nursing, Fujian Medical University, Fuzhou, China
| | - Ke Huiying
- School of Nursing, Fujian Medical University, Fuzhou, China
| | - Shen Liqin
- School of Nursing, Fujian Medical University, Fuzhou, China
| | - Zhao Xiaoshan
- Clinical Nursing Teaching and Research Department, Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Zhao Meijing
- Gynaecology and Obstetrics Department, Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Xie Yaping
- Clinical Nursing Teaching and Research Department, Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Zhao Huifen
- Clinical Nursing Teaching and Research Department, Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
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Chen X, Zhang Y, Lin L, Huang L, Zhong C, Li Q, Tan T, Wang W, Zhang H, Liu J, Sun G, Yi N, Yang X, Hao L, Yang H, Yang N. A Healthy, Low-Carbohydrate Diet During Pregnancy Is Associated With a Reduced Risk of Gestational Diabetes Mellitus. J Clin Endocrinol Metab 2024; 109:e956-e964. [PMID: 38057161 DOI: 10.1210/clinem/dgad705] [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: 09/01/2023] [Revised: 11/10/2023] [Accepted: 11/29/2023] [Indexed: 12/08/2023]
Abstract
CONTEXT Evidence on the associations of low-carbohydrate diet (LCD) during pregnancy with gestational diabetes mellitus (GDM) has been limited and inconsistent. OBJECTIVE We aimed to prospectively evaluate the risk of GDM associated with the LCD considering the quality of macronutrients. METHODS All participants were from a prospective cohort in Wuhan, China. The overall, healthy LCD (emphasizing low-quality carbohydrates, plant protein, and unsaturated fat), and unhealthy LCD (emphasizing high-quality carbohydrates, animal protein, and saturated fat) scores were calculated according to the percentage of energy intake from carbohydrates, protein, and fat. GDM was screened by a 75-g oral glucose tolerance test between 24 and 28 weeks. Poisson regression models were used to calculate relative risks (RRs) and 95% CIs. RESULTS Of 2337 pregnant women, 257 (11.0%) were diagnosed with GDM. Overall LCD score was not associated with risk of GDM, but the healthy and unhealthy LCD scores were associated with the risk of GDM. The multivariable-adjusted RRs (95% CI) were 0.68 (0.49-0.94) and 1.52 (1.11-2.08) for healthy and unhealthy LCD scores comparing the highest with the lowest quartile. Substituting high-quality carbohydrates for low-quality carbohydrates and animal protein, and substituting unsaturated fat for saturated fat, were associated with a 13% to 29% lower risk of GDM. CONCLUSION A healthy LCD during pregnancy characterized by high-quality carbohydrates, plant protein, and unsaturated fat was associated with a lower risk of GDM, whereas an unhealthy LCD consisting of low-quality carbohydrates, animal protein, and saturated fat was associated with a higher risk of GDM.
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Affiliation(s)
- Xi Chen
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, PR China
- Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, PR China
| | - Yuhao Zhang
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, PR China
- Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, PR China
| | - Lixia Lin
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, PR China
- Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, PR China
| | - Li Huang
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, PR China
- Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, PR China
| | - Chunrong Zhong
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, PR China
- Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, PR China
| | - Qian Li
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, PR China
- Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, PR China
| | - Tianqi Tan
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, PR China
- Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, PR China
| | - Weiming Wang
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, PR China
- Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, PR China
| | - Huaqi Zhang
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, PR China
- Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, PR China
| | - Jin Liu
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, PR China
- Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, PR China
| | - Guoqiang Sun
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Wuhan, Hubei, 430070, PR China
| | - Nianhua Yi
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Wuhan, Hubei, 430070, PR China
| | - Xuefeng Yang
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, PR China
- Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, PR China
| | - Liping Hao
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, PR China
- Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, PR China
| | - Hongying Yang
- Institute of Health Education, Hubei Provincial Center for Disease Control and Prevention, Wuhan, Hubei 430030, PR China
| | - Nianhong Yang
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, PR China
- Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, PR China
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Jeyaparam S, Agha-Jaffar R, Mullins E, Pinho-Gomes AC, Khunti K, Robinson S. Retrospective cohort study of the association between socioeconomic deprivation and incidence of gestational diabetes and perinatal outcomes. BMC Public Health 2024; 24:184. [PMID: 38225599 PMCID: PMC10790393 DOI: 10.1186/s12889-023-17261-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 11/18/2023] [Indexed: 01/17/2024] Open
Abstract
INTRODUCTION Socioeconomic disparities have been shown to correlate with perinatal mortality and the incidence of type 2 diabetes. Few studies have explored the relationship between deprivation and the incidence of gestational diabetes (GDM). We aimed to identify the relationship between deprivation and incidence of GDM, after adjusting for age, BMI, and ethnicity. We also examined for relationships between deprivation and perinatal outcomes. METHODS A retrospective cohort analysis of 23,490 pregnancies from a major National Health Service Trust in Northwest London was conducted. The 2019 English Indices of Multiple Deprivation was used to identify the deprivation rank and decile for each postcode. Birthweight centile was calculated from absolute birthweight after adjusting for ethnicity, maternal height, maternal weight, parity, sex and outcome (live birth/stillbirth). Logistic regression and Kendall's Tau were used to identify relationships between variables. RESULTS After controlling for age, BMI & ethnicity, Index of Multiple Deprivation postcode decile was not associated with an increased risk of developing gestational diabetes. Each increase in decile of deprivation was associated with an increase in birthweight centile by 0.471 (p < 0.001). After adjusting for confounders, age was associated with a 7.1% increased GDM risk (OR: 1.076, p < 0.001); BMI increased risk by 5.81% (OR: 1.059, p < 0.001). There was no significant correlation between Index of Multiple Deprivation rank and perinatal outcomes. DISCUSSION Our analysis demonstrates that socioeconomic deprivation was not associated with incidence of GDM or adverse perinatal outcomes. Factors such as genetic predisposition and lifestyle habits may likely play a larger role in the development of GDM compared to socioeconomic deprivation alone.
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Affiliation(s)
- Srirangan Jeyaparam
- Department of Metabolism, Digestion & Reproduction, Imperial College London, London, UK.
| | - Rochan Agha-Jaffar
- Department of Metabolism, Digestion & Reproduction, Imperial College London, London, UK
- Department of Metabolic Medicine, Imperial College Healthcare NHS Trust, London, UK
| | - Edward Mullins
- Department of Obstetrics & Gynaecology, Imperial College Healthcare NHS Trust, London, UK
- The George Institute for Global Health, London, UK
| | | | | | - Stephen Robinson
- Department of Metabolic Medicine, Imperial College Healthcare NHS Trust, London, UK
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Sobngwi E, Sobngwi-Tambekou J, Katte JC, Echouffo-Tcheugui JB, Balti EV, Kengne AP, Fezeu L, Ditah CM, Tchatchoua AP, Dehayem M, Unwin NC, Rankin J, Mbanya JC, Bell R. Gestational diabetes mellitus in Cameroon: prevalence, risk factors and screening strategies. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2024; 4:1272333. [PMID: 38374923 PMCID: PMC10876121 DOI: 10.3389/fcdhc.2023.1272333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 12/07/2023] [Indexed: 02/21/2024]
Abstract
Background The burden of gestational diabetes (GDM) and the optimal screening strategies in African populations are yet to be determined. We assessed the prevalence of GDM and the performance of various screening tests in a Cameroonian population. Methods We carried out a cross-sectional study involving the screening of 983 women at 24-28 weeks of pregnancy for GDM using serial tests, including fasting plasma (FPG), random blood glucose (RBG), a 1-hour 50g glucose challenge test (GCT), and standard 2-hour oral glucose tolerance test (OGTT). GDM was defined using the World Health Organization (WHO 1999), International Association of Diabetes and Pregnancy Special Group (IADPSG 2010), and National Institute for Health Care Excellence (NICE 2015) criteria. GDM correlates were assessed using logistic regressions, and c-statistics were used to assess the performance of screening strategies. Findings GDM prevalence was 5·9%, 17·7%, and 11·0% using WHO, IADPSG, and NICE criteria, respectively. Previous stillbirth [odds ratio: 3·14, 95%CI: 1·27-7·76)] was the main correlate of GDM. The optimal cut-points to diagnose WHO-defined GDM were 5·9 mmol/L for RPG (c-statistic 0·62) and 7·1 mmol/L for 1-hour 50g GCT (c-statistic 0·76). The same cut-off value for RPG was applicable for IADPSG-diagnosed GDM while the threshold was 6·5 mmol/L (c-statistic 0·61) for NICE-diagnosed GDM. The optimal cut-off of 1-hour 50g GCT was similar for IADPSG and NICE-diagnosed GDM. WHO-defined GDM was always confirmed by another diagnosis strategy while IADPSG and GCT independently identified at least 66·9 and 41·0% of the cases. Interpretation GDM is common among Cameroonian women. Effective detection of GDM in under-resourced settings may require simpler algorithms including the initial use of FPG, which could substantially increase screening yield.
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Affiliation(s)
- Eugene Sobngwi
- Department of Internal Medicine and Specialities, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- Laboratory of Molecular Medicine and Metabolism, Biotechnology Center, University of Yaoundé I, Yaoundé, Cameroon
- Department of Non-Communicable Diseases, Recherche Santé et Développement (RSD) Institute, Yaoundé, Cameroon
| | - Joelle Sobngwi-Tambekou
- Department of Non-Communicable Diseases, Recherche Santé et Développement (RSD) Institute, Yaoundé, Cameroon
| | - Jean Claude Katte
- Department of Non-Communicable Diseases, Recherche Santé et Développement (RSD) Institute, Yaoundé, Cameroon
- Department of Clinical and Biomedical Sciences, University of Exeter Medical School, Exeter, United Kingdom
| | - Justin B. Echouffo-Tcheugui
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Eric V. Balti
- Diabetes Research Center, Faculty of Medicine and Pharmacy, Brussels Free University-Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Andre-Pascal Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council and University of Cape Town, Cape Town, South Africa
| | - Leopold Fezeu
- Nutritional Epidemiology Research Unit-UMR U557 Institut National de la Santé et de la Recherche Médicale (INSERM), U1125 INRA, CNAM, University of Paris 13, Bobigny, France
| | - Chobufo Muchi Ditah
- Department of Internal Medicine and Specialities, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Alain-Patrick Tchatchoua
- Department of Internal Medicine and Specialities, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Mesmin Dehayem
- Department of Internal Medicine and Specialities, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Nigel C. Unwin
- Faculty of Medical Sciences, Public Health and Epidemiology, University of the West Indies at Cave Hill, Bridgetown, Barbados
| | - Judith Rankin
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Jean Claude Mbanya
- Department of Internal Medicine and Specialities, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- Laboratory of Molecular Medicine and Metabolism, Biotechnology Center, University of Yaoundé I, Yaoundé, Cameroon
| | - Ruth Bell
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, United Kingdom
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Ahmed MA, Bailey HD, Pereira G, White SW, Hare MJ, Wong K, Marriott R, Shepherd CC. Overweight/obesity and other predictors of gestational diabetes among Aboriginal and non-Aboriginal women in Western Australia. Prev Med Rep 2023; 36:102444. [PMID: 37840590 PMCID: PMC10568432 DOI: 10.1016/j.pmedr.2023.102444] [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: 01/20/2023] [Revised: 09/21/2023] [Accepted: 09/22/2023] [Indexed: 10/17/2023] Open
Abstract
This population-based study investigated the association of BMI and other predictors with gestational diabetes mellitus (GDM) among Australian Aboriginal and non-Aboriginal mothers. We conducted a state-wide retrospective cohort study that included all singleton births in Western Australia (n = 134,552) between 2012 and 2015 using population health datasets linked by the Western Australian Data Linkage Branch. Associations between GDM and its predictors were estimated as adjusted relative risks (aRRs) from multivariable generalised linear models. Adjusted ratio of relative risks (aRRRs) compared RRs in Aboriginal and non-Aboriginal mothers. Adjusted population attributable fractions estimated the contribution of overweight/obesity to GDM burden, and adjusted predicted probabilities for GDM were plotted against BMI levels. The following predictors had stronger associations with GDM in Aboriginal, compared to non-Aboriginal, mothers: maternal obesity (aRR [95% CI] 3.16 [2.54-3.93]; aRRR 1.57 [1.26-1.94]), previous LGA (aRR 1.70 [1.37-2.12]; aRRR 1.41 [1.13-1.76]) and previous macrosomia (birthweight ≥ 4 kg) (aRR 1.55 [1.24-1.94]; aRRR 1.53 [1.22-1.91]). 46.1% (95% CI: 36.6-54.1) of GDM cases in Aboriginal women (23.3% in non-Aboriginal mothers, 95% CI: 21.6-25.1) were attributed to overweight/obesity. Compared to non-Aboriginal mothers, adjusted GDM probabilities were higher at all BMI levels and showed greater increase with BMI. Overweight/obesity is a key driver of GDM among Aboriginal women. Association between BMI and GDM is stronger in Aboriginal, compared to non-Aboriginal, women especially at higher BMI.
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Affiliation(s)
- Marwan Awad Ahmed
- Telethon Kids Institute, University of Western Australia, Perth, Australia
- School of Population and Global Health, The University of Western Australia, Perth, Australia
| | - Helen D. Bailey
- Telethon Kids Institute, University of Western Australia, Perth, Australia
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Gavin Pereira
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- Centre for Fertility and Health (CeFH), Norwegian Institute of Public Health, Oslo, Norway
- enAble Institute, Curtin University, Perth, Western Australia, Australia
| | - Scott W. White
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, WA, Australia
- Maternal Fetal Medicine Service, King Edward Memorial Hospital, Subiaco, WA, Australia
| | - Matthew J.L. Hare
- Wellbeing and Chronic Preventable Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Department of Endocrinology, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Kingsley Wong
- Telethon Kids Institute, University of Western Australia, Perth, Australia
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Rhonda Marriott
- Ngangk Yira Institute for Change, Murdoch University, Perth, WA, Australia
| | - Carrington C.J. Shepherd
- Telethon Kids Institute, University of Western Australia, Perth, Australia
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Perth, Australia
- Ngangk Yira Institute for Change, Murdoch University, Perth, WA, Australia
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Joó JG, Sulyok E, Bódis J, Kornya L. Disrupted Balance of the Oxidant-Antioxidant System in the Pathophysiology of Female Reproduction: Oxidative Stress and Adverse Pregnancy Outcomes. Curr Issues Mol Biol 2023; 45:8091-8111. [PMID: 37886954 PMCID: PMC10605220 DOI: 10.3390/cimb45100511] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 09/29/2023] [Accepted: 10/02/2023] [Indexed: 10/28/2023] Open
Abstract
The significance of oxidative stress in the pathophysiology of male reproductive processes has been closely studied in the last two decades. Recently, it has become clear that oxidative stress can lead to numerous pathological conditions during female reproductive processes as well, contributing to the development of endometriosis, polycystic ovary syndrome and various forms of infertility. During pregnancy, physiological generation of reactive oxygen species (ROS) occurs in association with several developmental processes including oocyte maturation and implantation. An overproduction of ROS can lead to disturbances in fetal development and increases the risk for missed abortion, intrauterine growth restriction, pre-eclampsia, premature delivery and gestational diabetes. Our review focuses on the etiological role of the disrupted oxidant-antioxidant system during human gestation as it relates to adverse pregnancy outcomes.
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Affiliation(s)
- József Gábor Joó
- Department of Obstetrics and Gynecology, Semmelweis University, 1088 Budapest, Hungary
| | - Endre Sulyok
- Faculty of Health Sciences, University of Pécs, 7621 Pécs, Hungary
| | - József Bódis
- Faculty of Health Sciences, University of Pécs, 7621 Pécs, Hungary
| | - László Kornya
- Central Hospital of South Pest National Institute of Hematology and Infectious Diseases, 1476 Budapest, Hungary
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11
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Verho L, Tikkanen M, Äyräs O, Aarnio K, Rantanen K, Korhonen A, Richardt A, Laivuori H, Gissler M, Ijäs P. Pregnancy-associated stroke and the recurrence of stroke and other complications in subsequent pregnancies: Population-based retrospective cohort study. BJOG 2023; 130:1421-1429. [PMID: 37088716 DOI: 10.1111/1471-0528.17503] [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: 09/22/2022] [Revised: 03/05/2023] [Accepted: 03/08/2023] [Indexed: 04/25/2023]
Abstract
OBJECTIVE To examine the outcomes of the subsequent pregnancies from women with a previous pregnancy-associated stroke (PAS) in comparison to matched controls. DESIGN Population-based retrospective cohort study. SETTING AND POPULATION All women with a PAS in Finland 1987-2016 (n = 235) and controls (n = 694). METHODS We identified all subsequent deliveries and induced and spontaneous abortions for women with a previous PAS and their matched controls from the Medical Birth Register and the Hospital Discharge Register until 2016. The number, course and outcomes of the subsequent pregnancies were compared. Patient records were studied for PAS recurrence. MAIN OUTCOME MEASURES PAS recurrence and pregnancy complications. RESULTS Women with a previous PAS had fewer subsequent deliveries: 73 (31.1%) women had 122 deliveries in all, whereas 303 (47.3%) of the controls had 442 deliveries (age-adjusted odds ratio [OR] 0.54, 95% CI 0.38-0.76). Hypertensive disorders of pregnancy (HDP) (17.2% versus 5.7%, age-adjusted OR 4.0, 95% CI 1.7-9.3), especially chronic hypertension (age-adjusted OR 5.9, 95% CI 1.5-24.7), and any diabetes during pregnancy (24.6% versus 14.5%, age-adjusted OR 2.0, 95% CI 1.1-3.8) were more common in cases. Regarding HDP, the difference between groups was explained by underlying factors such as index pregnancy HDP (multivariable OR 2.4, 95% CI 0.8-6.7). PAS recurred in four cases (5.5%). CONCLUSIONS Subsequent pregnancies of women with a history of PAS are more often complicated with hypertensive disorders of pregnancy and any diabetes during pregnancy. PAS recurrence risk is considerable.
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Affiliation(s)
- Liisa Verho
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Obstetrics and Gynaecology, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Minna Tikkanen
- Obstetrics and Gynaecology, University of Helsinki, Helsinki, Finland
| | - Outi Äyräs
- Obstetrics and Gynaecology, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Karoliina Aarnio
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kirsi Rantanen
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Aino Korhonen
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anna Richardt
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Hannele Laivuori
- Medical and Clinical Genetics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Institute for Molecular Medicine Finland, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
- Department of Obstetrics and Gynaecology, Tampere University Hospital and Tampere University, Faculty of Medicine and Health Technology, Centre for Child, Adolescent, and Maternal Health Research, Tampere, Finland
| | - Mika Gissler
- Department of Knowledge Brokers, Finnish Institute for Health and Welfare, Helsinki, Finland
- Region Stockholm, Academic Primary Health Care Centre, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Petra Ijäs
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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12
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Liu L, Liu Z, Duan B, Zhang Q, Zhou Z, Liu W. Effects of a low glycemic index or low glycemic load diet on pregnant women at high risk of gestational diabetes: A meta-analysis of randomized controlled trials. Nutr Metab Cardiovasc Dis 2023; 33:2006-2018. [PMID: 37558553 DOI: 10.1016/j.numecd.2023.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 06/01/2023] [Accepted: 06/29/2023] [Indexed: 08/11/2023]
Abstract
AIMS To evaluate the effect of low glycemic index or low glycemic load diets on maternal and neonatal outcomes at high risk of gestational diabetes mellitus (GDM). DATA SYNTHESIS Several databases (PubMed, Cochrane Library, Web of Science, Embase, OVID, Clinical Trials. gov, China National Knowledge Infrastructure, China Biomedical Database, and Wanfang Database) were searched from January 1990 to January 2022 (updated to November 2022). Randomized controlled trials of low glycemic index diets interventions for women at high risk of GDM were included. From 2131 articles initially were screened, after eliminating duplicates, 1749 titles and abstracts were analyzed. 71 documents that met the inclusion criteria were selected and 3 documents were obtained through searching the reference lists. After reading the full text, 10 studies were retained. Two authors evaluated the studies, extracted data and conducted quality assessment independently. A total of 10 studies with 2304 patients met the inclusion criteria. Compared with the control group, a low glycemic index diet could control the range of weight gain (WMD -1.01, 95% CI -1.41 to -0.61), decrease the incidence of excessive weight gain (OR 0.69, 95% CI 0.54-0.87), lessen the incidence of large-for-gestational-age infants (OR 0.32, 95% CI 0.16-0.62) and reduce the incidence of preterm infants (OR 0.45, 95% CI 0.29-0.71). CONCLUSION A low glycemic index or low glycemic load diet could control maternal weight gain, reduce the incidence of excessive weight gain, and decrease the incidence of large-for-gestational-age infants and preterm infants in group with high risk of GDM. PROSPERO CRD42022322697.
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Affiliation(s)
- Leyang Liu
- School of Nursing, Capital Medical University, Beijing, China
| | - Zhe Liu
- School of Nursing, Capital Medical University, Beijing, China
| | - Beibei Duan
- School of Nursing, Capital Medical University, Beijing, China
| | | | - Zheyi Zhou
- Ballarat Base Hospital, Victoria, Australia
| | - Weiwei Liu
- School of Nursing, Capital Medical University, Beijing, China.
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Punnose J, Sukhija K, Rijhwani RM. Intermediate hyperglycemia in early pregnancy: A South Asian perspective. World J Diabetes 2023; 14:573-584. [PMID: 37273252 PMCID: PMC10236988 DOI: 10.4239/wjd.v14.i5.573] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/28/2023] [Accepted: 04/07/2023] [Indexed: 05/15/2023] Open
Abstract
"Intermediate hyperglycemia in early pregnancy (IHEP)" refers to mild hyperglycemia detected before 24 gestational weeks (GW), satisfying the criteria for the diagnosis of gestational diabetes mellitus. Many professional bodies recommend routine screening for "overt diabetes" in early pregnancy, which identifies a significant number of women with mild hyperglycemia of undetermined significance. A literature search revealed that one-third of GDM women in South Asian countries are diagnosed before the conventional screening period of 24 GW to 28 GW; hence, they belong in the IHEP category. Most hospitals in this region diagnose IHEP by oral glucose tolerance test (OGTT) using the same criteria used for GDM diagnosis after 24 GW. There is some evidence to suggest that South Asian women with IHEP are more prone to adverse pregnancy events than women with a diagnosis of GDM after 24 GW, but this observation needs to be proven by randomized control trials. Fasting plasma glucose is a reliable screening test for GDM that can obviate the need for OGTT for GDM diagnosis among 50% of South Asian pregnant women. HbA1c in the first trimester predicts GDM in later pregnancy, but it is not a reliable test for IHEP diagnosis. There is evidence to suggest that HbA1c in the first trimester is an independent risk factor for several adverse pregnancy events. Further research to identify the patho-genetic mechanisms behind the fetal and maternal effects of IHEP is strongly recommended.
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Affiliation(s)
- John Punnose
- Department of Endocrinology and Metabolism, St. Stephen’s Hospital, Delhi 110054, India
| | - Komal Sukhija
- Department of Endocrinology, St.Stephen’s Hospital, Delhi 110054, India
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14
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Sun M, Luo M, Wang T, Wei J, Zhang S, Shu J, Zhong T, Liu Y, Chen Q, Zhu P, Qin J. Effect of the interaction between advanced maternal age and pre-pregnancy BMI on pre-eclampsia and GDM in Central China. BMJ Open Diabetes Res Care 2023; 11:11/2/e003324. [PMID: 37085280 PMCID: PMC10124205 DOI: 10.1136/bmjdrc-2023-003324] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 03/30/2023] [Indexed: 04/23/2023] Open
Abstract
INTRODUCTION To investigate the independent and combined effects of advanced maternal age and pre-pregnancy body mass index (BMI) on the risk of pre-eclampsia and gestational diabetes mellitus (GDM). RESEARCH DESIGN AND METHODS Logistic regression models were used to estimate the OR and 95% CIs of pre-eclampsia and GDM with advanced maternal age and pre-pregnancy BMI, respectively, and the interaction between advanced maternal age and pre-pregnancy BMI. We also used causal mediation analysis to assess the mediating role of pre-pregnancy BMI on maternal age-pre-eclampsia/GDM associations. RESULTS In this study, 788 cases (2.31%) were diagnosed with pre-eclampsia and 5430 cases (15.92%) were diagnosed with GDM. We found that advanced maternal age was associated with a higher risk for pre-eclampsia and GDM, with adjusted ORs (aORs) of 1.74 (95% CI 1.49-2.05) and 1.76 (95% CI 1.65-1.89) after adjusting for potential confounders, respectively. In addition, maternal pre-pregnancy overweight/obesity was associated with the risk of pre-eclampsia and GDM, with the corresponding aORs of 3.64 (95% CI 3.12-4.24) and 1.71 (95% CI 1.60-1.85), respectively. We also observed the interaction between maternal age and pre-pregnancy BMI for the risk of pre-eclampsia/GDM (all p for interaction <0.001). In the mediating effect analysis, we found that maternal pre-pregnancy BMI mediated the associations between maternal age and the development of pre-eclampsia and GDM. CONCLUSIONS Advanced maternal age and pre-pregnancy BMI were respectively associated with the risk of pre-eclampsia/GDM, and there was an interaction between the two risk factors. In addition, we found that pre-pregnancy BMI served as a mediator of the association between advanced maternal age and the risk of pre-eclampsia/GDM, providing an essential target for the prevention of maternal overweight/obesity.
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Affiliation(s)
- Mengting Sun
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Manjun Luo
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Tingting Wang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
- National Health Committee (NHC) Key Laboratory of Birth Defect for Research and Prevention, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China
| | - Jianhui Wei
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Senmao Zhang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Jing Shu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Taowei Zhong
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Yiping Liu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Qian Chen
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Ping Zhu
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Jiabi Qin
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
- National Health Committee (NHC) Key Laboratory of Birth Defect for Research and Prevention, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha, Hunan, China
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15
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Borràs-Novell C, Herranz Barbero A, Balcells Esponera C, López-Abad M, Aldecoa Bilbao V, Izquierdo Renau M, Iglesias Platas I. Influence of maternal and perinatal factors on macronutrient content of very preterm human milk during the first weeks after birth. J Perinatol 2023; 43:52-59. [PMID: 35931800 PMCID: PMC9839448 DOI: 10.1038/s41372-022-01475-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/15/2022] [Accepted: 07/21/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To identify changes in macronutrient content of very preterm human milk associated with perinatal factors. STUDY DESIGN Milk macronutrients were measured on weeks 1, 2, 4 and 8 with mid-infrared transmission spectrometers. RESULT We assessed 625 samples (from 117 mothers and 130 very preterm infants). Average concentrations were: protein 1.3 ± 0.3 g/dl, carbohydrates 7.3 ± 0.6 g/dl, fat 3.7 ± 1.0 g/dl and energy 296.0 ± 41.0 kJ/dl (70.7 kcal/dl). Gestational age negatively correlated with protein (rho: -0.307, p < 0.001) and energy (r: -0.193, p = 0.003). Advanced maternal age, gestational age and intrauterine growth restriction were independently associated with milk protein content over the first 4 weeks (adjusted R2: 0.113, p = 0.002). CONCLUSION These findings may help neonatologists identify patients fed Mother´s Own Milk who are at increased risk of poor postnatal growth.
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Affiliation(s)
- Cristina Borràs-Novell
- Neonatology Department. BCNatal - Centre de Medicina Maternofetal i Neonatologia de Barcelona. Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.
| | - Ana Herranz Barbero
- grid.5841.80000 0004 1937 0247Neonatology Department. BCNatal – Centre de Medicina Maternofetal i Neonatologia de Barcelona. Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Carla Balcells Esponera
- grid.5841.80000 0004 1937 0247Neonatology Department. BCNatal – Centre de Medicina Maternofetal i Neonatologia de Barcelona. Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Miriam López-Abad
- grid.5841.80000 0004 1937 0247Neonatology Department. BCNatal – Centre de Medicina Maternofetal i Neonatologia de Barcelona. Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Victoria Aldecoa Bilbao
- grid.5841.80000 0004 1937 0247Neonatology Department. BCNatal – Centre de Medicina Maternofetal i Neonatologia de Barcelona. Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Montserrat Izquierdo Renau
- grid.5841.80000 0004 1937 0247Neonatology Department. BCNatal – Centre de Medicina Maternofetal i Neonatologia de Barcelona. Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Isabel Iglesias Platas
- grid.5841.80000 0004 1937 0247Neonatology Department. BCNatal – Centre de Medicina Maternofetal i Neonatologia de Barcelona. Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain ,grid.416391.80000 0004 0400 0120Neonatal Intensive Care Unit, Norfolk and Norwich University Hospital, Norwich, UK
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16
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Fuller H, Iles M, Moore JB, Zulyniak MA. Unique Metabolic Profiles Associate with Gestational Diabetes and Ethnicity in Low- and High-Risk Women Living in the UK. J Nutr 2022; 152:2186-2197. [PMID: 35883228 PMCID: PMC9535440 DOI: 10.1093/jn/nxac163] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 04/28/2022] [Accepted: 07/20/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is the most common global pregnancy complication; however, prevalence varies substantially between ethnicities, with South Asians (SAs) experiencing up to 3 times the risk of the disease compared with white Europeans (WEs). Factors driving this discrepancy are unclear, although the metabolome is of great interest as GDM is known to be characterized by metabolic dysregulation. OBJECTIVES The primary aim was to characterize and compare the metabolic profiles of GDM in SA and WE women (at <28 wk of gestation) from the Born in Bradford (BIB) prospective birth cohort in the United Kingdom. METHODS In total, 146 fasting serum metabolites, from 2,668 pregnant WE and 2,671 pregnant SA women (average BMI 26.2 kg/m2, average age 27.3 y) were analyzed using partial least squares discriminatory analyses to characterize GDM status. Linear associations between metabolite values and post-oral glucose tolerance test measures of dysglycemia (fasting glucose and 2 h postglucose) were also examined. RESULTS Seven metabolites associated with GDM status in both ethnicities (variable importance in projection ≥1), whereas 6 additional metabolites associated with GDM only in WE women. Unique metabolic profiles were observed in healthy-weight women who later developed GDM, with distinct metabolite patterns identified by ethnicity and BMI status. Of the metabolite values analyzed in relation to dysglycemia, lactate, histidine, apolipoprotein A1, HDL cholesterol, and HDL2 cholesterol associated with decreased glucose concentration, whereas DHA and the diameter of very low-density lipoprotein particles (nm) associated with increased glucose concertation in WE women, and in SAs, albumin alone associated with decreased glucose concentration. CONCLUSIONS This study shows that the metabolic risk profile for GDM differs between WE and SA women enrolled in BiB in the United Kingdom. This suggests that etiology of the disease differs between ethnic groups and that ethnic-appropriate prevention strategies may be beneficial.
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Affiliation(s)
- Harriett Fuller
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Mark Iles
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
| | - J Bernadette Moore
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Michael A Zulyniak
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK
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Xu HB, Li MH, Tang XF, Lu J. The relationship between poor glycaemic control at different time points of gestational diabetes mellitus and pregnancy outcomes. J OBSTET GYNAECOL 2022; 42:2979-2986. [PMID: 36149633 DOI: 10.1080/01443615.2022.2124852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
We aimed to identify the complications of gestational diabetes mellitus (GDM) associated with poor control of fasting plasma glucose (FPG) and postload plasma glucose (PPG) on the 75-g oral glucose tolerance test (OGTT). This retrospective study included 997 singleton pregnancy GDM patients who were assigned to poor or good glycaemic control groups. Multivariate analysis indicated that poor FPG control and poor PPG control were both independent predictors of hypertensive disorder complicating pregnancy (HDCP) (odd ratio (OR) of 2.551 (95% CI [1.146-5.682], p = .022) and OR of 2.084 (95% [1.115-3.894], p = .021) compared with good glycaemic control groups, respectively). Poor PPG control promoted the rate of caesarean delivery (1.534 (95% CI [1.063-2.214]), p = .022), whereas good PPG control increased the risk of premature rupture of membranes (PROM) (0.373 (95% CI [0.228-0.611]), p < .001). Conclusively, poor control FPG and PPG dissimilarly affect pregnancy complications in GDM; these findings may help clinicians in the effective implementation of measures to prevent pregnancy complications in GDM.IMPACT STATEMENTWhat is already known on this subject? Previous studies displayed that GDM patients with 2-h PPG elevated at 24-28 week of gestation had a 2.254-fold increased risk of postpartum dysglycaemia. Abnormal plasma glucose in GDM mother increased the probability of childhood obesity in the offspring. With the implementation of China's second-child policy, the incidence of GDM is rising.What do the results of this study add? Our results indicated that the older patients with GDM, the greater the risk of abnormal plasma glucose control. In addition, maternal age and prenatal BMI were notably correlated with poor plasma glucose control of FPG and PPG, respectively. We also found that both poor FPG and PPG control notably increased the incidence of HDCP in pregnant women. The incidence of PROM was higher in the good PPG control group compared with the poor PPG control group.What are the implications of these findings for clinical practice and/or further research? This study displayed that the effects of poor FPG and PPG control on pregnancy complications and newborn outcomes were heterogeneous, which might be related to the specificity of plasma glucose metabolism at different time points. Good glycaemic control, especially PPG control, was of great significance for improving pregnancy complications and perinatal conditions.
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Affiliation(s)
- Hong-Bin Xu
- Department of Obstetrics and Gynecology, Changzhou Second People's Hospital affiliated to Nanjing Medical University, Changzhou, Jiangsu Province, China
| | - Min-Hui Li
- Department of Obstetrics and Gynecology, Changzhou Second People's Hospital affiliated to Nanjing Medical University, Changzhou, Jiangsu Province, China
| | - Xiao-Fang Tang
- Department of Obstetrics and Gynecology, Changzhou Second People's Hospital affiliated to Nanjing Medical University, Changzhou, Jiangsu Province, China
| | - Jing Lu
- Department of Obstetrics and Gynecology, Changzhou Second People's Hospital affiliated to Nanjing Medical University, Changzhou, Jiangsu Province, China
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Puthussery S, Tseng PC, Sharma E, Harden A, Griffiths M, Bamfo J, Li L. Disparities in the timing of antenatal care initiation and associated factors in an ethnically dense maternal cohort with high levels of area deprivation. BMC Pregnancy Childbirth 2022; 22:713. [PMID: 36123628 PMCID: PMC9484064 DOI: 10.1186/s12884-022-04984-6] [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: 07/27/2021] [Accepted: 08/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Late access to antenatal care is a contributor to excess mortality and morbidity among ethnic minority mothers compared to White British in the UK. While individual ethnicity and socioeconomic disadvantage are linked to late antenatal care initiation, studies have seldom explored patterns of late initiation and associated factors in ethnically dense socially disadvantaged settings. This study investigated disparities in the timing of antenatal care initiation, and associated factors in an ethnically dense socially disadvantaged maternal cohort. METHODS A retrospective cross-sectional study using routinely collected anonymous data on all births between April 2007-March 2016 in Luton and Dunstable hospital, UK (N = 46,307). Late initiation was defined as first antenatal appointment attended at > 12 weeks of gestation and further classified into moderately late (13-19 weeks) and extremely late initiation (≥ 20 weeks). We applied logistic and multinomial models to examine associations of late initiation with maternal and sociodemographic factors. RESULTS Overall, one fifth of mothers (20.8%) started antenatal care at > 12 weeks of gestation. Prevalence of late initiation varied across ethnic groups, from 16.3% (White British) to 34.2% (Black African). Late initiation was strongly associated with non-White British ethnicity. Compared to White British mothers, the odds of late initiation and relative risk of extremely late initiation were highest for Black African mothers [adjusted OR = 3.37 (3.05, 3.73) for late initiation and RRR = 4.03 (3.51, 4.64) for extremely late initiation]. The odds did not increase with increasing area deprivation, but the relative risk of moderately late initiation increased in the most deprived ([RRR = 1.53 (1.37, 1.72)] and second most deprived areas [RRR = 1.23 (1.10, 1.38)]. Late initiation was associated with younger mothers and to a lesser extent, older mothers aged > 35 years. Mothers who smoked during pregnancy were at higher odds of late initiation compared to mothers who did not smoke. CONCLUSIONS There is a need to intensify universal and targeted programmes/services to support mothers in ethnically dense socially disadvantaged areas to start antenatal care on time. Local variations in ethnic diversity and levels of social disadvantage are essential aspects to consider while planning services and programmes to ensure equity in maternity care provision.
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Affiliation(s)
- Shuby Puthussery
- Maternal and Child Health Research Centre, Institute for Health Research, University of Bedfordshire, Park Square, Luton, LU1 3JU, Bedfordshire, UK.
| | - Pei-Ching Tseng
- Maternal and Child Health Research Centre, Institute for Health Research, University of Bedfordshire, Park Square, Luton, LU1 3JU, Bedfordshire, UK
| | - Esther Sharma
- Maternal and Child Health Research Centre, Institute for Health Research, University of Bedfordshire, Park Square, Luton, LU1 3JU, Bedfordshire, UK
| | - Angela Harden
- School of Health Sciences, Division of Health Services Research and Management, City, University of London, Northampton Square, EC1V 0HB, London, England
| | - Malcolm Griffiths
- Department of Obstetrics and Gynaecology, The Luton and Dunstable University Hospital NHS Foundation Trust, Lewsey Rd, Luton, LU4 0DZ, Bedford, UK
| | - Jacqueline Bamfo
- Department of Obstetrics and Gynaecology, The Luton and Dunstable University Hospital NHS Foundation Trust, Lewsey Rd, Luton, LU4 0DZ, Bedford, UK
| | - Leah Li
- Population, Policy and Practice Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, London, WC1N 1EH, UK
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Rahnemaei FA, Abdi F, Kazemian E, Shaterian N, Shaterian N, Behesht Aeen F. Association between body mass index in the first half of pregnancy and gestational diabetes: A systematic review. SAGE Open Med 2022; 10:20503121221109911. [PMID: 35898952 PMCID: PMC9310335 DOI: 10.1177/20503121221109911] [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: 12/03/2021] [Accepted: 06/07/2022] [Indexed: 11/17/2022] Open
Abstract
Gestational diabetes mellitus is a more common complication in pregnancy and rising worldwide and screening for treating gestational diabetes mellitus is an opportunity for preventing its complications. Abnormal body mass index is the cause of many complications in pregnancy that is one of the major and modifiable risk factors in pregnancy too. This systematic review aimed to define the association between body mass index in the first half of pregnancy (before 20 weeks of gestation) and gestational diabetes mellitus. Web of Science, PubMed/Medline, Embase, Scopus, ProQuest, Cochrane library, and Google Scholar databases were systematically explored for articles published until April 31, 2022. Participation, exposure, comparators, outcomes, study design criteria include pregnant women (P), body mass index (E), healthy pregnant women (C), gestational diabetes mellitus (O), and study design (cohort, case–control, and cross-sectional). Newcastle–Ottawa scale checklists were used to report the quality of the studies. Eighteen quality studies were analyzed. A total of 41,017 pregnant women were in the gestational diabetes mellitus group and 285,351 pregnant women in the normal glucose tolerance group. Studies have reported an association between increased body mass index and gestational diabetes mellitus. Women who had a higher body mass index in the first half of pregnancy were at higher risk for gestational diabetes mellitus. In the first half of pregnancy, body mass index can be used as a reliable and available risk factor to assess gestational diabetes mellitus, especially in some situations where the pre-pregnancy body mass index is not available.
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Affiliation(s)
- Fatemeh Alsadat Rahnemaei
- Reproductive Health Research Center, Department of Obstetrics & Gynecology, Al-Zahra Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Fatemeh Abdi
- Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Elham Kazemian
- Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Negar Shaterian
- Student Research Committee, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Negin Shaterian
- Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Behesht Aeen
- Student Research Committee, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
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Coetzee A, Hall DR, Conradie M. Hyperglycemia First Detected in Pregnancy in South Africa: Facts, Gaps, and Opportunities. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2022; 3:895743. [PMID: 36992779 PMCID: PMC10012101 DOI: 10.3389/fcdhc.2022.895743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 04/01/2022] [Indexed: 06/19/2023]
Abstract
This review contextualizes hyperglycemia in pregnancy from a South-African perspective. It aims to create awareness of the importance of hyperglycemia in pregnancy in low-middle-income countries. We address unanswered questions to guide future research on sub-Saharan African women with hyperglycemia first detected in pregnancy (HFDP). South African women of childbearing age have the highest prevalence of obesity in sub-Saharan Africa. They are predisposed to Type 2 diabetes (T2DM), the leading cause of death in South African women. T2DM remains undiagnosed in many African countries, with two-thirds of people living with diabetes unaware. With the South African health policy's increased focus on improving antenatal care, women often gain access to screening for non-communicable diseases for the first time in pregnancy. While screening practices and diagnostic criteria for gestational diabetes mellitus (GDM) differ amongst geographical areas in South Africa (SA), hyperglycemia of varying degrees is often first detected in pregnancy. This is often erroneously ascribed to GDM, irrespective of the degree of hyperglycemia and not overt diabetes. T2DM and GDM convey a graded increased risk for the mother and fetus during and after pregnancy, with cardiometabolic risk accumulating across the lifespan. Resource limitations and high patient burden have hampered the opportunity to implement accessible preventative care in young women at increased risk of developing T2DM in the broader public health system in SA. All women with HFDP, including those with true GDM, should be followed and undergo glucose assessment postpartum. In SA, studies conducted early postpartum have noted persistent hyperglycemia in a third of women after GDM. Interpregnancy care is advantageous and may attain a favourable metabolic legacy in these young women, but the yield of return following delivery is suboptimal. We review the current best evidence regarding HFDP and contextualize the applicability in SA and other African or low-middle-income countries. The review identifies gaps and shares pragmatic solutions regarding clinical factors that may improve awareness, identification, diagnosis, and management of women with HFDP.
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Affiliation(s)
- Ankia Coetzee
- Department of Medicine, Division of Endocrinology Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - David R. Hall
- Department of Obstetrics and Gynecology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Magda Conradie
- Department of Medicine, Division of Endocrinology Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
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Cao J, Xu W, Liu Y, Zhang B, Zhang Y, Yu T, Huang T, Zou Y, Zhang B. Trends in maternal age and the relationship between advanced age and adverse pregnancy outcomes: a population-based register study in Wuhan, China, 2010–2017. Public Health 2022; 206:8-14. [DOI: 10.1016/j.puhe.2022.02.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 01/24/2022] [Accepted: 02/09/2022] [Indexed: 10/18/2022]
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Wu W, Zhang LF, Li YT, Hu TX, Chen DQ, Tian YH. Early Rise of Serum hCG in Gestational Diabetes Mellitus Women With Live Birth Through In Vitro Fertilization Procedure. Front Endocrinol (Lausanne) 2022; 13:724198. [PMID: 35242105 PMCID: PMC8886717 DOI: 10.3389/fendo.2022.724198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 01/12/2022] [Indexed: 11/13/2022] Open
Abstract
Gestational diabetes mellitus (GDM) is one of the most common complications of pregnancy. The characteristics of early human chorionic gonadotropin (hCG) levels and the rise pattern in patients with GDM after in vitro fertilization (IVF) are unclear. The present investigation was a retrospective cohort analysis of eligible viable pregnancies achieved through IVF in the authors' hospital between October 2015 and June 2020. The characteristics of initial hCG concentration and the rise pattern in patients with GDM after IVF, and the difference between those of normoglycemic pregnant women, were explored. Using random-effects models, the preferred pattern to describe the increase in log hCG was a quadratic. When gestational age was within 39 days, the linear model adequately characterized the profile, and the average slope was 0.173, yielding a predicted increase of 1.55 (55%) in 1 day and 3.11 (211%) in 2 days. Absolute hCG values-but not the rate of rise-were significantly higher in double embryo transfers and twin pregnancies. Curves reflecting hCG rise from the GDM and non-GDM groups did not differ substantially. The proportion of patients with low initial hCG values (16 days post-oocyte retrieval <100 mIU/ml) was higher in the GDM group (5% vs. 2.09%), although the difference was not statistically significant. Early hCG rise in pregnant women after IVF-whether GDM or non-GDM-could be characterized by quadratic and linear models. However, hCG values on days 14 and 16 post-oocyte retrieval in the GDM group were lower than those in the non-GDM group, with the exception of twin pregnancies. Low hCG values in early pregnancy may be a clue to help predict GDM in the subsequent gestation period.
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Affiliation(s)
- Wei Wu
- Department of Reproductive Endocrinology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Li-Feng Zhang
- Department of Reproductive Endocrinology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yi-Ting Li
- Department of Reproductive Endocrinology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Tian-Xiao Hu
- Department of Endocrinology, Chinese PLA 903rd Hospital (Former Chinese PLA 117th Hospital), Hangzhou, China
- College of Life Science, Zhejiang Chinese Medical University, Hangzhou, China
| | - Dan-Qing Chen
- Department of Obstetrics, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
- *Correspondence: Yong-Hong Tian, ; Dan-Qing Chen,
| | - Yong-Hong Tian
- Department of Reproductive Endocrinology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Key Laboratory of Reproductive Genetics, Ministry of Education, Hangzhou, China
- *Correspondence: Yong-Hong Tian, ; Dan-Qing Chen,
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Zhang R, Viswambharan H, Cheng CW, Garstka MA, Kain K. Inter-ankle Systolic Blood Pressure Difference Is a Marker of Increased Fasting Blood-Glucose in Asian Pregnant Women. Front Endocrinol (Lausanne) 2022; 13:842254. [PMID: 35712250 PMCID: PMC9195077 DOI: 10.3389/fendo.2022.842254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 04/15/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE This cross-sectional study aimed to determine the relationship between clinical blood pressures and blood pressures measured using Doppler with blood glucose in pregnancy by ethnicity. METHODS We recruited 179 (52% White European, 48% Asian) pregnant women at 24-28 weeks of gestation who underwent a glucose tolerance test in an antenatal clinic in Bradford Royal Infirmary, the UK, from 2012 to 2013. Systolic blood pressures in the arm (left and right brachial) and ankle [left and right posterior tibial (PT) and dorsalis pedalis (DP)] blood pressures were measured using a Doppler probe. The inter-arm (brachial) and inter-ankle (PT and DP) systolic blood pressure differences were obtained. A multivariate linear regression model adjusted for age, body mass index, and diabetes risk was used to assess the relationship between blood pressures and blood glucose. RESULTS Asian pregnant women had higher blood glucose but lower ankle blood pressures than White Europeans. In White Europeans, brachial blood pressures and clinical blood pressures were positively associated with fasting blood glucose (FBG), but brachial blood pressures did not perform better as an indicator of FBG than clinical blood pressures. In Asians, increased inter-ankle blood pressure difference was associated with increased FBG. For each 10 mmHg increase in the inter-ankle blood pressure difference, FBG increased by 0.12 mmol/L (Beta=0.12, 95%CI: 0.01-0.23). CONCLUSION The relationship between blood pressures with blood glucose differed by ethnicity. In Asians, inter-ankle systolic blood pressure difference was positively associated with blood glucose. This is first ever report on ankle blood pressures with blood glucose in pregnancy which suggests future potential as a non-invasive gestational diabetes risk screening tool.
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Affiliation(s)
- Ruo Zhang
- Department of Endocrinology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Hema Viswambharan
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Chew Weng Cheng
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
- *Correspondence: Malgorzata Anna Garstka, ; Chew Weng Cheng,
| | - Malgorzata Anna Garstka
- Core Research Laboratory, Department of Endocrinology, Department of Tumor and Immunology, Precision Medical Institute, Western China Science and Technology Innovation Port, The Second Affiliated Hospital, Health Science Center, Xi’an Jiaotong University, Xi’an, China
- *Correspondence: Malgorzata Anna Garstka, ; Chew Weng Cheng,
| | - Kirti Kain
- NHS England & NHS Improvement (North East and Yorkshire), Leeds, United Kingdom
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Martine-Edith G, Johnson W, Hunsicker E, Hamer M, Petherick ES. Associations between maternal characteristics and pharmaceutical treatment of gestational diabetes: an analysis of the UK Born in Bradford (BiB) cohort study. BMJ Open 2021; 11:e053753. [PMID: 34732497 PMCID: PMC8572403 DOI: 10.1136/bmjopen-2021-053753] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES To identify the maternal characteristics associated with pharmaceutical treatment of gestational diabetes mellitus (GDM). DESIGN Prospective birth cohort study. SETTING Bradford, UK. PARTICIPANTS 762 women from the Born in Bradford (BiB) cohort who were treated for GDM in a singleton pregnancy. BiB cohort participants were recruited from 2007 to 2010. All women booked for delivery were screened for GDM between 26 and 28 weeks of gestation using a 75 g 2-hour oral glucose tolerance test (OGTT). OUTCOME MEASURE GDM treatment type: lifestyle changes advice (lifestyle changes), lifestyle changes advice with supplementary insulin (insulin) and lifestyle changes advice with supplementary metformin (metformin). RESULTS 244 (32%) women were prescribed lifestyle changes advice alone while 518 (68%) were offered supplemental pharmaceutical treatment. The odds of receiving pharmaceutical treatment relative to lifestyle changes advice alone were increased for mothers who were obese (OR 4.6, 95% CI 2.8 to 7.5), those who smoked (OR 2.6, 95% CI 1.2 to 5.5) and had higher fasting glucose levels at OGTT (OR 2.1, 95% CI 1.6 to 2.7). The odds of being prescribed pharmaceutical treatment rather than lifestyle changes advice were lower for Pakistani women (OR 0.7, 95% CI 0.4 to 1.0)) than White British women. Relative to insulin treatment, metformin was more likely to be offered to obese women than normal weight women (relative risk ratio, RRR 3.2, 95% CI 1.3 to 7.8) and less likely to be prescribed to women with higher fasting glucose concentrations at OGTT (RRR 0.3, 95% CI 0.2 to 0.6). CONCLUSIONS In the BiB cohort, GDM pharmaceutical treatment tended to be prescribed to women who were obese, White British, who smoked and had more severe hyperglycaemia. The characteristics of metformin-treated mothers differed from those of insulin-treated mothers as they were more likely to be obese but had lower glucose concentrations at diagnosis.
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Affiliation(s)
- Gilberte Martine-Edith
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - William Johnson
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | | | - Mark Hamer
- Institute of Sport, Exercise and Health, Division Surgery Interventional Science, University College London, London, UK
| | - Emily S Petherick
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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Park JY, Kim WJ, Chung YH, Kim B, Park Y, Park IY, Ko HS. Association between pregravid liver enzyme levels and gestational diabetes in twin pregnancies: a secondary analysis of national cohort study. Sci Rep 2021; 11:18695. [PMID: 34548558 PMCID: PMC8455664 DOI: 10.1038/s41598-021-98180-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 08/24/2021] [Indexed: 12/11/2022] Open
Abstract
Multiple pregnancies are prone to gestational diabetes mellitus (GDM). This study investigated the association between pregravid liver enzyme levels and the development of GDM in a twin pregnancy. Women who had the National Health Screening Examination and delivered their twin babies within one year were enrolled. Pregravid liver enzyme levels were divided into high and low level. Risks for developing GDM by high levels of liver enzymes were analyzed, in subgroups by pregravid obesity or metabolic syndrome. Among the 4348 twin pregnancies, 369 women (8.5%) developed GDM not requiring insulin treatment (GDM - IT), and 119 women (2.7%) developed GDM requiring insulin treatment(GDM + IT). High levels of pregravid GGT and ALT were related to risks of GDM + IT not only in women with obesity or metabolic syndrome (odds ratio[OR] 6.348, 95% confidence interval [CI] 2.579-15.624 and OR 6.879, 95% CI 2.232-21.204, respectively), but also in women without obesity (OR 3.05, 95% CI 1.565-5.946) or without metabolic syndrome (OR 3.338, 95% CI 1.86-5.992), compared to in women with low levels of those. However, there were no significant associations in the pregravid ALT and GGT levels and risks for development of GDM - IT, unrelated to pregravid obesity or metabolic syndrome. Therefore, this study suggests that women with high levels of pregravid GGT and ALT need to recognize their increased risk of GDM + IT, regardless of pregravid obesity or MetS, when they get pregnant twin.
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Affiliation(s)
- Jae-Young Park
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Woo Jeng Kim
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Yoo Hyun Chung
- Department of Obstetrics and Gynecology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Bongseong Kim
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yonggyu Park
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - In Yang Park
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Hyun Sun Ko
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
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Hou Q, Yan F, Dong X, Liu H, Wu J, Li J, Ding Y. Assessment of fetal cardiac diastolic function of gestational diabetes mellitus using dual-gate Doppler. Medicine (Baltimore) 2021; 100:e26645. [PMID: 34260564 PMCID: PMC8284756 DOI: 10.1097/md.0000000000026645] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 06/24/2021] [Indexed: 01/04/2023] Open
Abstract
Gestational Diabetes Mellitus (GDM), as a common complication of pregnancy, has an increasing trend globally. GDM leads to maternal complications and fetal complications. Fetal cardiac diastolic dysfunction is strongly associated with GDM. This study aims to assess the ventricular diastolic function of fetuses exposed to GDM by looking into the diagnostic parameters using both conventional method and Dual-gate Doppler method (DD). And to investigate the potential of DD method in early detection of fetal cardiac diastolic dysfunction.56 women diagnosed with GDM and 55 non-GDM pregnant women were enrolled in their 24 to 30 weeks of gestation. Conventional method and DD method were applied to measure mitral and tricuspid inflow velocities E-waves, A-waves on pulsed-wave Doppler, and mitral and tricuspid annular velocities e'-waves, a'-waves on Tissue Doppler imaging. E/A, e'/a' and E/e' ratio was calculated. The difference between GDM and control groups was statistically tested and analysed using one-sample Kolmogorov-Smirnov test, Student t test, Mann-Whitney U test and Kruskal-Wallis test and Bland-Altman plot analysis.Intraobserver intraclass correlation coefficients of E/A, e'/a', and E/e' value of both mitral and tricuspid valve are all greater than 0.80, while interobserver intraclass correlation coefficients are between 0.71 and 0.88. Right (6.35 vs 6.79; P = .001) ventricular function showed significantly lower E/e' ratios in the GDM group compared with control fetuses by conventional method. Both left (6.16 vs 6.59; P = .036) and right (6.28 vs 6.75; P = .01) ventricular function showed significantly lower E/e' ratios in the GDM group compared with control fetuses by DD method.Exposure to high level of maternal blood glucose leads to impaired diastolic function in the fetuses. Fetal right ventricular function is a potential key point to study to enable an early detection for fetal diastolic dysfunction since the alteration and damage are more likely to happen in right ventricular. Measurement of E/e' ratio using DD method is considered as a promising method in fetal cardiac diastolic function assessment. Well or poorly control of the GDM does not have significant influence on the fetal diastolic function thus an early detection of GDM and GDM induced fetal cardiac dysfunction is necessary.
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Affiliation(s)
- Qingsha Hou
- Department of Ultrasound, Yan’an Hospital Affiliated to Kunming Medical University, 245, East of Renmin Road, Kunming, Yunnan, P.R. China
- Department of Obstetrical, The First People's Hospital of Yunnan Province, No. 157 Jinbi Rd, Xishan District, Kunming, Yunnan, P.R. China
| | - Fang Yan
- Department of Obstetrical, The First People's Hospital of Yunnan Province, No. 157 Jinbi Rd, Xishan District, Kunming, Yunnan, P.R. China
| | - Xudong Dong
- Department of Obstetrical, The First People's Hospital of Yunnan Province, No. 157 Jinbi Rd, Xishan District, Kunming, Yunnan, P.R. China
| | - Huanling Liu
- Department of Obstetrical, The First People's Hospital of Yunnan Province, No. 157 Jinbi Rd, Xishan District, Kunming, Yunnan, P.R. China
| | - Jie Wu
- Department of Obstetrical, The First People's Hospital of Yunnan Province, No. 157 Jinbi Rd, Xishan District, Kunming, Yunnan, P.R. China
| | - Jiao Li
- Department of Obstetrical, The First People's Hospital of Yunnan Province, No. 157 Jinbi Rd, Xishan District, Kunming, Yunnan, P.R. China
| | - Yunchuan Ding
- Department of Ultrasound, Yan’an Hospital Affiliated to Kunming Medical University, 245, East of Renmin Road, Kunming, Yunnan, P.R. China
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Karasneh RA, Migdady FH, Alzoubi KH, Al-Azzam SI, Khader YS, Nusair MB. Trends in maternal characteristics, and maternal and neonatal outcomes of women with gestational diabetes: A study from Jordan. Ann Med Surg (Lond) 2021; 67:102469. [PMID: 34178318 PMCID: PMC8213882 DOI: 10.1016/j.amsu.2021.102469] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 05/28/2021] [Accepted: 06/04/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is a major health issue that poses its risk on pregnancy. It is prevalence has been globally increasing. AIM This study aimed to examine trends in demographic and socioeconomic characteristics, maternal BMI, behavioral factors, obstetric interventions, pregnancy complications, and maternal pre-existing medical conditions and maternal and neonatal outcomes in women with GDM in Jordan. We also aimed to equate the occurrence of emergency cesarean delivery with GDM. METHODS The study is a part of a comprehensive national study of perinatal mortality that was conducted in Jordan. This study included all women who gave birth in the selected hospitals during the study period. Maternal and medical conditions during pregnancy and neonatal outcomes were compared among women who did not develop gestational diabetes mellitus and those who developed gestational diabetes mellitus. RESULTS The overall incidence rate of gestational diabetes mellitus (GDM) was 1.2%. Women with gestational diabetes had a higher weight, and BMI, more likely to be overweight, obese, or morbidly obese and less likelihood to be underweight. A significant association was detected between previous spontaneous abortions/miscarriages, previous preterm, previous stillbirths, previous children born with birth weight less than 2500 g, and previous children born alive and died before 28 days, and the incidence of GDM. Women with GDM were at high risk for complications in pregnancy such as hypertension, preeclampsia, premature delivery and labor induction. The offspring of GDM patients were at high risk of complications such as macrosomia, stillbirth, neonatal hypoglycemia, and neonatal jaundice and admittance to the NICU. CONCLUSIONS The incidence of GDM was linked to several clinical factors. Women with GDM are at high risk for complications of pregnancy and at higher risk of neonatal complications.
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Affiliation(s)
- Reema A. Karasneh
- Department of Basic Medical Sciences, Faculty of Medicine, Yarmouk University, Irbid, 21163, Jordan
| | - Fedaa H. Migdady
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, 21110, Jordan
| | - Karem H. Alzoubi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, 21110, Jordan
- Department of Pharmacy Practice and Pharmacotherapeutics, University of Sharjah, Sharjah, UAE
| | - Sayer I. Al-Azzam
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, 21110, Jordan
| | - Yousef S. Khader
- Department of Public Health, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Mohammad B. Nusair
- Department of Pharmacy Practice, Faculty of Pharmacy, Yarmouk University, Irbid, 21110, Jordan
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Phoswa WN, Khaliq OP. The Role of Oxidative Stress in Hypertensive Disorders of Pregnancy (Preeclampsia, Gestational Hypertension) and Metabolic Disorder of Pregnancy (Gestational Diabetes Mellitus). OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2021; 2021:5581570. [PMID: 34194606 PMCID: PMC8184326 DOI: 10.1155/2021/5581570] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 04/25/2021] [Indexed: 11/17/2022]
Abstract
Purpose of the Review.To highlight the role of oxidative stress in hypertensive disorders of pregnancy (HDP) and metabolic disorders of pregnancy (gestational diabetes mellitus). Recent Findings. In both preeclampsia (PE) and gestational hypertension (GH), oxidative stress leads to inadequate placental perfusion thus resulting in a hypoxic placenta, which generally leads to the activation of maternal systemic inflammatory response. In PE, this causes inflammation in the kidneys and leads to proteinuria. A proteinuria marker known as urinary 8-oxoGuo excretion is expressed in preeclampsia. In GDM, oxidative stress plays a role in the pathogenesis of the disease, as a result of over secretion of insulin during pregnancy. This uncontrolled secretion of insulin results in the production of lipid peroxidation factors that also mask the secretion of antioxidants. Therefore, ROS becomes abundant at cellular level and prevents the cells from transporting glucose to body tissues. Summary. There is a need for more research investigating the role of oxidative stress, especially in obstetrics-related conditions. More studies are required in order to understand the difference between the pathogenesis and pathophysiology of PE versus GH since investigations on the differences in genetic aspects of each condition are lacking. Furthermore, research to improve diagnostic procedures for GDM in pregnancy is needed.
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Affiliation(s)
- Wendy N. Phoswa
- Department of Life and Consumer Sciences, University of South Africa (UNISA), Science Campus, Private Bag X6, Florida, Roodepoort 1710, South Africa
| | - Olive P. Khaliq
- Department of Obstetrics and Gynaecology and Women's Health and HIV Research Group, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
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Bastola K, Koponen P, Skogberg N, Gissler M, Kinnunen TI. Gestational diabetes among women of migrant origin in Finland-a population-based study. Eur J Public Health 2021; 31:784-789. [PMID: 34059900 PMCID: PMC8561240 DOI: 10.1093/eurpub/ckab078] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Migrant women may have a higher risk for gestational diabetes mellitus (GDM) and the related adverse outcomes. We studied the prevalence of GDM among migrant-origin women in Finland. METHODS This study used data from the nationwide Medical Birth Register. Information on the most recent singleton births of women delivering between 2004 and 2014 (N = 379 634) was included. Women were classified into nine regional categories based on the country of origin. Finnish origin women were the reference group. Generalized linear models adjusted for maternal age, parity, socioeconomic position, pre-pregnancy body mass index and year of delivery were used to study the association between region/country of origin and GDM. RESULTS Among the study population, almost 8% were of migrant origin. The prevalence of GDM varied from 6.1% (women of Latin American/Caribbean origin) to 18.4% (South Asian origin), compared to 8.7% in the Finnish reference group. When adjusted for confounders, women of South Asian, East Asian, Middle Eastern/North African and Russian/former USSR origin had a higher risk for GDM than Finnish origin women. By country of origin, women originating from Pakistan, Bangladesh, Sri Lanka, India, Afghanistan, Nepal, China, Philippines, Vietnam, Thailand, Morocco, Turkey, Iran, Iraq and former USSR had a higher risk for GDM than Finnish origin women. CONCLUSIONS There is substantial variation in the prevalence of GDM by country of origin. Women of South Asian, East Asian and Middle Eastern/North African origin had the highest risk for GDM and may warrant special attention.
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Affiliation(s)
- Kalpana Bastola
- Unit of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
- Correspondence: Kalpana Bastola, Faculty of Social Sciences, Tampere University, Tampere 33014, Finland, Tel: +358 44 972 7708, e-mail:
| | - Päivikki Koponen
- Department of Health, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Natalia Skogberg
- Department of Health, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Mika Gissler
- Department of Information Services, Finnish Institute for Health and Welfare, Helsinki, Finland
- Division of Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Tarja I Kinnunen
- Unit of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
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Helmersen M, Sørensen M, Lukasse M, Laine HK, Garnweidner-Holme L. Women's experience with receiving advice on diet and Self-Monitoring of blood glucose for gestational diabetes mellitus: a qualitative study. Scand J Prim Health Care 2021; 39:44-50. [PMID: 33555201 PMCID: PMC7971282 DOI: 10.1080/02813432.2021.1882077] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE We aimed to explore how women with gestational diabetes mellitus (GDM) experience advice about diet and self-monitoring of blood glucose received in primary health care (PHC) and secondary health care (SHC) with a focus on how women perceived the care coordination and collaboration between healthcare professionals. DESIGN, SETTING AND SUBJECTS Individual interviews were conducted with 12 pregnant women diagnosed with GDM. Six women had immigrant backgrounds, and six were ethnic Norwegian. Women received GDM care in the area of Oslo, Norway. Interviews were analysed using thematic analysis. RESULTS Women described feeling shocked when they were diagnosed with GDM and feeling an immediate need for information about the consequences and management of GDM. Most of the women felt that their general practitioner (GP) had too little knowledge about GDM. Women with an immigrant background felt that the PHC midwives provided them with sufficient dietary advice related to GDM. Ethnic Norwegian women appreciated receiving more individually tailored dietary advice in SHC. Self-monitoring of blood glucose influenced women's daily lives; however, they perceived the training in PHC and SHC as adequate. The women experienced poor collaboration between healthcare professionals in PHC and SHC, which implied that they sometimes had to initiate follow-up steps in their GDM care by themselves. CONCLUSIONS Ideally, women diagnosed with GDM should meet healthcare professionals with sufficient knowledge about GDM as soon as possible after being diagnosed. The collaboration between healthcare professionals involved in the care of women with GDM should be improved to avoid having women feel that they need to coordinate their own care.KEY POINTSCurrent awareness•The management of gestational diabetes mellitus requires appropriate follow-up by healthcare professionalsMain statements•Pregnant women's need for information about the consequences and management of gestational diabetes mellitus was highest immediately after diagnosis•Women perceived that they received more individually tailored information about diet and self-monitoring of blood glucose in secondary health care compared to primary health care•Women felt that general practitioners had insufficient knowledge about gestational diabetes mellitus•Based on our results, care coordination and collaboration between healthcare professionals involved in the care of women with gestational diabetes mellitus should be improved.
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Affiliation(s)
- Maria Helmersen
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Monica Sørensen
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Mirjam Lukasse
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
- Faculty of Health and Social Sciences, Centre for Women’s, Family and Child Health, University of South-Eastern Norway, Kongsberg, Norway
| | - Hely Katariina Laine
- Department of Obstetrics, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Lisa Garnweidner-Holme
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
- CONTACT Lisa Garnweidner-Holme Department of Nursing and Health Promotion, Oslo Metropolitan University, St Olavs Plass, PO Box 4, Oslo, 0310, Norway
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Ahmeidat A, Bhattacharya S, Luben RN, Khaw KT, Myint PK. Long-term effects of gestational diabetes on bone mineral density and fracture risk: Analysis of the Norfolk cohort of the European Prospective Investigation into Cancer (EPIC-Norfolk) population-based study. Maturitas 2021; 144:68-73. [PMID: 33358211 DOI: 10.1016/j.maturitas.2020.11.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 10/29/2020] [Accepted: 11/14/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Gestational diabetes mellitus (GDM) is a common pregnancy complication. This study aims to investigate the association between a history of GDM and bone mineral density (BMD), fractures, and falls in later life. STUDY DESIGN We used data from the Norfolk cohort of the European Prospective Investigation into Cancer (EPIC-Norfolk) where BMD at calcaneum was measured at second health check (1997-2000) using broadband ultrasound attenuation (BUA) and velocity of sound (VOS) in 7,515 women. Fractures and falls were documented from hospital admissions data via linkage with ENCORE (East Norfolk Commission Record) and history of GDM from health questionnaires at baseline. We examined the relationship between GDM and BUA/VOS using linear regression. Cox regression was used to estimate hazard ratios (HRs) for incident fractures and falls, controlling for age, BMI, smoking status, physical activity, area deprivation, self-reported stroke, use of diuretics, calcium and vitamin D supplements, social class and education, statin and total blood cholesterol, prevalent diabetes, hormone therapy and menopausal status. RESULTS History of GDM (n = 183) was not statistically significantly associated with BUA/VOS in fully adjusted linear regression models with unstandardised beta coefficients (standard error): -0.37 (1.40) and -5.41 (3.48). GDM was significantly (p < 0.05) associated with risk of hip and all fractures, fully adjusted HRs(95 %CI) 2.46(1.54-3.92) and 1.60(1.09-2.35), respectively. Median follow-up from first live birth to date of admission was 53 and 52 years, respectively. CONCLUSION There was an association between history of GDM and risk of any fracture as well as hip fracture specifically. Further research is required to confirm this.
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Affiliation(s)
- Annes Ahmeidat
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, Scotland, UK
| | - Sohinee Bhattacharya
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, Scotland, UK
| | - Robert N Luben
- Clinical Gerontology Unit, University of Cambridge, Cambridge, UK
| | - Kay-Tee Khaw
- Clinical Gerontology Unit, University of Cambridge, Cambridge, UK
| | - Phyo K Myint
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, Scotland, UK.
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Alsaedi SA, Altalhi AA, Nabrawi MF, Aldainy AA, Wali RM. Prevalence and risk factors of gestational diabetes mellitus among pregnant patients visiting National Guard primary health care centers in Saudi Arabia. Saudi Med J 2021; 41:144-150. [PMID: 32020147 PMCID: PMC7841639 DOI: 10.15537/smj.2020.2.24842] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Objectives: To measure the prevalence of gestational diabetes mellitus (GDM) and its risk factors in Saudi Arabia, in comparison with developed and developing countries worldwide. Methods: We enrolled pregnant women aged 15-45 years who visited 3 National Guard-Health Affairs’ primary health care centers in Jeddah, Saudi Arabia between January 2017 and December 2017. We used stratified samples and computer-generated random numbers to collect data. This data includes demographics, obstetric history, blood pressure, non-fasting 1-hour glucose challenge test (GCT), 3-hour oral glucose tolerance test (OGTT), hemoglobin level, rubella immunization status, hepatitis B surface antigen status, urinalysis results, and labor, and delivery notes. We categorized the patients into 2 groups, GDM and non-GDM, based on GCT and OGTT. Results: We enrolled 347 women in the study (mean age, 28.8±6 years; range, 18-45 years). On GCT, 36.6% of women showed abnormal values and 6.9% exhibited diagnostic values. Oral glucose tolerance test indicated impairment in 18.7% of patients and a diagnostic finding in 15% of patients. Women diagnosed with GDM tended to be older and have greater body mass index (BMI) values. Conclusion: The prevalence of GDM in Saudi Arabia is high compared to other countries. Advanced maternal age and higher BMI values were associated with increased prevalence of GDM. Thus, early prevention and management of GDM is vital to minimize the risks to both the mother and fetus.
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Affiliation(s)
- Saleem A Alsaedi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Kingdom of Saudi Arabia. E-mail.
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Hu J, Liu Y, Wei X, Li L, Gao M, Liu Y, Ma Y, Wen D. Association of gestational diabetes mellitus with offspring weight status across infancy: a prospective birth cohort study in China. BMC Pregnancy Childbirth 2021; 21:21. [PMID: 33407256 PMCID: PMC7789150 DOI: 10.1186/s12884-020-03494-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 12/11/2020] [Indexed: 01/22/2023] Open
Abstract
Background The association between gestational diabetes mellitus (GDM) and childhood body weight remains controversial, and additional study is needed, especially in Asian populations. Methods This prospective study investigated the association between maternal glucose concentration, and GDM status and infant body weight from birth to 12 months of age. Linear mixed effects (LME) models and multiple linear regression were used to assess the longitudinal association of GDM with infant growth measured by weight-for-length z-scores (WFLZ), weight-for-age z-scores (WFAZ), and length-for-age z-scores (LFAZ) at birth, 1, 3, 6, 8, and 12 months of age. Results Offspring born to mothers with GDM had higher WFLZ [β: 0.26 SD units (95% CI: 0.13–0.40)] across infancy than those of mothers without GDM. When stratified analysis by maternal pre-pregnancy body mass index (BMI) status, the association was pronounced in normal-weight [β:0.28 SD units (95% CI: 0.11–0.45)] and overweight/obese women [β: 0.34 SD units (95% CI: 0.09–0.58)] but not in underweight women (P for interaction < 0.05). Multiple linear regression found that the effect estimate of GDM on infant WFLZ was highest at birth [β: 0.36 SD units (95% CI: 0.11–0.61)], remained significant at 1 [β: 0.22 SD units (95% CI: 0.03–0.41)] and 3 [β:0.19 SD units (95% CI: 0.01–0.37)] months of age and decreased across infancy. Maternal GDM status was not associated with infant WFAZ or LFAZ. Conclusions Maternal GDM status was associated with infant WFLZ, but not WFAZ or LFAZ. The association between GDM status and offspring WFLZ was more pronounced in early infancy or in normal-weight and overweight/obese women. Increased public health efforts to prevent GDM in normal-weight and overweight/obese pre-pregnancy mothers are recommended to control offspring overweight or obesity. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-020-03494-7.
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Affiliation(s)
- Jiajin Hu
- Institute of Health Sciences, China Medical University, Shenyang, 110122, Liaoning, China.,Research Center of China Medical University Birth Cohort, China Medical University, Shenyang, 110122, Liaoning, China.,Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School, Boston, MA, 02215, USA
| | - Yilin Liu
- Institute of Health Sciences, China Medical University, Shenyang, 110122, Liaoning, China
| | - Xiaotong Wei
- Institute of Health Sciences, China Medical University, Shenyang, 110122, Liaoning, China
| | - Lin Li
- Institute of Health Sciences, China Medical University, Shenyang, 110122, Liaoning, China
| | - Ming Gao
- Institute of Health Sciences, China Medical University, Shenyang, 110122, Liaoning, China
| | - Yang Liu
- Institute of Health Sciences, China Medical University, Shenyang, 110122, Liaoning, China
| | - Yanan Ma
- Department of Epidemiology and Health Statistics, School of Public Health, China Medical University, Shenyang, 110122, Liaoning, China
| | - Deliang Wen
- Institute of Health Sciences, China Medical University, Shenyang, 110122, Liaoning, China.
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Yahaya TO, Salisu T, Abdulrahman YB, Umar AK. Update on the genetic and epigenetic etiology of gestational diabetes mellitus: a review. EGYPTIAN JOURNAL OF MEDICAL HUMAN GENETICS 2020; 21:13. [DOI: 10.1186/s43042-020-00054-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 02/11/2020] [Indexed: 02/08/2023] Open
Abstract
Abstract
Background
Many studies have been conducted on the genetic and epigenetic etiology of gestational diabetes mellitus (GDM) in the last two decades because of the disease’s increasing prevalence and role in global diabetes mellitus (DM) explosion. An update on the genetic and epigenetic etiology of GDM then becomes imperative to better understand and stem the rising incidence of the disease. This review, therefore, articulated GDM candidate genes and their pathophysiology for the awareness of stakeholders.
Main body (genetic and epigenetic etiology, GDM)
The search discovered 83 GDM candidate genes, of which TCF7L2, MTNR1B, CDKAL1, IRS1, and KCNQ1 are the most prevalent. Certain polymorphisms of these genes can modulate beta-cell dysfunction, adiposity, obesity, and insulin resistance through several mechanisms. Environmental triggers such as diets, pollutants, and microbes may also cause epigenetic changes in these genes, resulting in a loss of insulin-boosting and glucose metabolism functions. Early detection and adequate management may resolve the condition after delivery; otherwise, it will progress to maternal type 2 diabetes mellitus (T2DM) and fetal configuration to future obesity and DM. This shows that GDM is a strong risk factor for T2DM and, in rare cases, type 1 diabetes mellitus (T1DM) and maturity-onset diabetes of the young (MODY). This further shows that GDM significantly contributes to the rising incidence and burden of DM worldwide and its prevention may reverse the trend.
Conclusion
Mutations and epigenetic changes in certain genes are strong risk factors for GDM. For affected individuals with such etiologies, medical practitioners should formulate drugs and treatment procedures that target these genes and their pathophysiology.
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Silva CM, Arnegard ME, Maric-Bilkan C. Dysglycemia in Pregnancy and Maternal/Fetal Outcomes. J Womens Health (Larchmt) 2020; 30:187-193. [PMID: 33147099 PMCID: PMC8020552 DOI: 10.1089/jwh.2020.8853] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Maternal dysglycemia-including diabetes, impaired glucose tolerance, and impaired fasting glucose-affects one in six pregnancies worldwide and represents a significant health risk to the mother and the fetus. Maternal dysglycemia is an independent risk factor for perinatal mortality, major congenital anomalies, and miscarriages. Furthermore, it increases the longer-term risk of type 2 diabetes mellitus, metabolic syndrome, cardiovascular morbidity, malignancies, and ophthalmic, psychiatric, and renal diseases in the mother. The most commonly encountered form of maternal dysglycemia is gestational diabetes. Currently, international consensus does not exist for diagnostic criteria defining gestational diabetes at 24-28 weeks gestation, and potential diagnostic glucose thresholds earlier in gestation require further investigation. Likewise, recommendations regarding the timing and modality (e.g., lifestyle or pharmacological) of treatment vary greatly. Because a precise diagnosis determines the appropriate treatment and outcome of the pregnancy, it is imperative that a better definition of maternal dysglycemia and its treatment be achieved. This article will address some of the controversies related to diagnosing and managing maternal dysglycemia. In addition, the article will discuss the impact of maternal dysglycemia on complications experienced by the mother and infant, both at birth and in later life.
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Affiliation(s)
- Corinne M Silva
- Division of Diabetes, Endocrinology, and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Matthew E Arnegard
- Office of Research on Women's Health, Division of Program Coordination, Planning, and Strategic Initiatives, Office of the Director, National Institutes of Health, Bethesda, Maryland, USA
| | - Christine Maric-Bilkan
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
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Garnweidner-Holme L, Henriksen L, Torheim LE, Lukasse M. Effect of the Pregnant+ Smartphone App on the Dietary Behavior of Women With Gestational Diabetes Mellitus: Secondary Analysis of a Randomized Controlled Trial. JMIR Mhealth Uhealth 2020; 8:e18614. [PMID: 33146620 PMCID: PMC7673980 DOI: 10.2196/18614] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 04/23/2020] [Accepted: 09/25/2020] [Indexed: 12/12/2022] Open
Abstract
Background The prevalence of gestational diabetes mellitus (GDM) is increasing worldwide. A healthy diet and stable blood glucose levels during pregnancy can prevent adverse health outcomes for the mother and the newborn child. Mobile health may be a useful supplement to prenatal care, providing women with targeted dietary information concerning GDM. Objective We analyzed secondary data from a two-arm, multicentered, nonblinded randomized controlled trial to determine if a smartphone app with targeted dietary information and blood glucose monitoring had an effect on the dietary behavior of women with GDM. Methods Women with a 2-hour oral glucose tolerance test level of ≥9 mmol/L were individually randomized to either the intervention group receiving the Pregnant+ app and usual care or the control group receiving usual care only. Eligible women were enrolled from 5 diabetes outpatient clinics in the Oslo region, Norway, between October 2015 and April 2017. The Pregnant+ app promoted 10 GDM-specific dietary recommendations. A healthy dietary score for Pregnant+ (HDS-P+) was constructed from a 41-item food frequency questionnaire and used to assess the intervention effect on the dietary behavior completed at trial entry and at around gestation week 36. Dietary changes from baseline to week 36 were examined by a paired sample two-tailed t test. Between-group dietary differences after the intervention were estimated with analysis of covariance, with adjustment for baseline diet. Results A total of 238 women participated: 115 were allocated to the intervention group and 123 to the control group. Of the 238 women, 193 (81.1%) completed the food frequency questionnaire both at baseline and around gestational week 36. All the participants showed improvements in their HDS-P+ from baseline. However, the Pregnant+ app did not have a significant effect on their HDS-P+. The control group reported a higher weekly frequency of choosing fish meals (P=.05). No other significant differences were found between the intervention and control groups. There were no significant demographic baseline differences between the groups, except that more women in the intervention group had a non-Norwegian language as their first language (61 vs 46; P=.02). Conclusions Our findings do not support the supplementation of face-to-face follow-up of women with GDM with a smartphone app in the presence of high-standard usual care, as the Pregnant+ app did not have a beneficial effect on pregnant women’s diet. Trial Registration ClinicalTrials.gov NCT02588729; https://clinicaltrials.gov/ct2/show/NCT02588729
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Affiliation(s)
| | - Lena Henriksen
- OsloMet - Oslo Metropolitan University of Applied Sciences, Oslo, Norway
| | - Liv Elin Torheim
- OsloMet - Oslo Metropolitan University of Applied Sciences, Oslo, Norway
| | - Mirjam Lukasse
- OsloMet - Oslo Metropolitan University of Applied Sciences, Oslo, Norway.,Faculty of Heath and Social Sciences, University of South-Eastern Norway, Campus Vestfold, Norway
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Angali KA, Shahri P, Borazjani F. Maternal dietary pattern in early pregnancy is associated with gestational weight gain and hyperglycemia: A cohort study in South West of Iran. Diabetes Metab Syndr 2020; 14:1711-1717. [PMID: 32916554 DOI: 10.1016/j.dsx.2020.08.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 08/06/2020] [Accepted: 08/11/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND AND AIMS Maternal dietary pattern could influence on fetal health outcome. Thus, this study was conducted to evaluate the relationship between maternal dietary pattern and Gestational Weight Gain (GWG) in each trimester and hyperglycemia amongst Arab pregnant women in south-west of Iran. METHODS This longitudinally study was performed in urban healthcare centers of south-west of Iran. Among 610 candidates, 488 pregnant women were included in the final analysis. Consequently, two diet patterns were determined by principal component analysis and the association between GWG and blood glucose level was determined using quartile regression. Using generalized linear model, a model was adjusted for pre-pregnancy BMI, maternal age, income, and education levels. RESULTS Two dietary patterns were identified as follows: "high fat -fast food" and "vegetable-fruits & protein" pattern. High adherence to "high fat -fast food" pattern was associated with higher GWG and hyperglycemia in 3rd trimester (adjusted β: 0.029 95%CI 0.012; 0.049 P = 0.001) (adjusted β: 0.029 95%CI 0.012; 0.049 P = 0.001) respectively. High tendency to "vegetable-fruits & protein" pattern was inversely associated with development of hyperglycemia in 3rd trimester. Higher SES level was associated with low adherence to "high fat-fast food" pattern. CONCLUSION Findings of the study revealed that, higher adherence to high -fat diet is related to excessive GWG and hyperglycemia in late pregnancy.
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Affiliation(s)
- Kambiz Ahmadi Angali
- Social Determinants of Health Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Department of Biostatistics, School of Health Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Parvin Shahri
- Social Determinants of Health Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Department of Public Health, School of Health Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Fatemeh Borazjani
- Nutrition and Metabolic Disease Research Center, Ahvaz Jundishapur University of medical science, Ahvaz, Iran; Department of Nutrition, Faculty of Paramedicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
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Prevalence of diabetes mellitus and hypertension during pregnancy in eastern China after the implementation of universal two-child policy. Int J Diabetes Dev Ctries 2020. [DOI: 10.1007/s13410-020-00872-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Liu S, Mo M, Xiao S, Li L, Hu X, Hong L, Wang L, Lian R, Huang C, Zeng Y, Diao L. Pregnancy Outcomes of Women With Polycystic Ovary Syndrome for the First In Vitro Fertilization Treatment: A Retrospective Cohort Study With 7678 Patients. Front Endocrinol (Lausanne) 2020; 11:575337. [PMID: 33101210 PMCID: PMC7546360 DOI: 10.3389/fendo.2020.575337] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/08/2020] [Indexed: 12/16/2022] Open
Abstract
Background The risk of adverse pregnancy outcomes is increased by having a polycystic ovary syndrome (PCOS) diagnosis. However, the confounders in previous studies preclude firm conclusions, and further studies are warranted. Objectives To investigate whether PCOS affects pregnancy outcomes and complications in infertile women undergoing their first in vitro fertilization (IVF) treatment, taking into account important confounders. Methods We performed a retrospective cohort study of 7,678 infertile women, including 666 women with PCOS and 7,012 controls undergoing their first IVF treatment at a private fertility center from January 2010 to December 2017. Our main outcome was the impact of PCOS on adverse pregnancy outcomes (miscarriage, preterm delivery, pregnancy-induced hypertension) and pregnancy outcomes (live birth rate, clinical pregnancy rate, implantation rate). PCOS effects were summarized by adjusted odds ratios (aORs) with 95% confidence intervals (CIs) after controlling for maternal characteristics. Results After adjusting for differences in maternal age, BMI, infertility duration, total dose of gonadotropin, serum E2 and endometrial thickness on the day of hCG trigger, number of fertilized occytes, number of embryos transferred, embryo type (cleavage-stage embryo or blastocyst) and quality, women with PCOS had an increased risk of developing unfavorable pregnancy complications, including miscarriage (aOR 1.629, 95% CI 1.240-2.141), very preterm delivery (< 32 weeks) (aOR 2.072, 95% CI 1.133-3.791). For pregnancy outcomes, PCOS was associated with higher clinical pregnancy rate (aOR 1.248, 95% CI 1.038-1.501) and implantation rate (aOR 1.238, 95% CI 1.030-1.489) after adjusting for the above-mentioned confounders. Conclusions Women with PCOS are at increased risk of adverse pregnancy outcomes after adjusting for differences in maternal characteristics. These women may need more frequent medical consultants and management during pregnancy and parturition.
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Mohammad Moin S, Richmond Ronald G, KM Thouhidur R, ABM Kamrul H, Shah Mohammad F. Comparison of risk factors, management and outcome between early and lately detected gestational diabetes mellitus patients. INTERNATIONAL JOURNAL OF CLINICAL ENDOCRINOLOGY AND METABOLISM 2020:025-029. [DOI: 10.17352/ijcem.000049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Halvatsiotis P, Panagiotou O, Koulouvaris P, Raptis A, Bamias A, Kalantaridou S, Valsamakis G. Benefits of exercise in pregnancies with gestational diabetes. J Matern Fetal Neonatal Med 2020; 35:2524-2529. [PMID: 32631105 DOI: 10.1080/14767058.2020.1786515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
A significant proportion of pregnancies are complicated by diabetes mellitus. Most of them concern women with gestational diabetes mellitus, while proportionally are presented with preexisting DM 1 and DM 2. Metabolic derangements of the diabetic syndrome are likely to generate serious complications for both the mother and the fetus with a significant impact on their later health. Undoubtedly, all appropriate interventions that will contribute to the smoothest and most uncomplicated course of pregnancy are considered essential. Healthy diet adjustments, glucose monitoring and an appropriate insulin regimen, if needed, are considered effective tools for a safe gestation. Courses with aerobic, anaerobic stretching and relaxation exercises are presented with significant benefits in the therapeutic struggle for the general public. Extended research has been conducted assessing the role of exercise incorporation in a diabetic pregnancy. As evidence would support based on recent literature, exercise is an important mean in the prevention of carbohydrate intolerance during gestation and even more facilitates a smoother management of a diabetic pregnancy. Thus, exercise poses an essential role for maternal and neonatal health.
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Affiliation(s)
- Panagiotis Halvatsiotis
- 2nd Department of Internal Medicine-Propaedeutic and Diabetes Center, University General Hospital "Attikon", Medical School, National and Kapodistrian University of Athens Greece, Athens, Greece
| | - Ourania Panagiotou
- 2nd Department of Internal Medicine-Propaedeutic and Diabetes Center, University General Hospital "Attikon", Medical School, National and Kapodistrian University of Athens Greece, Athens, Greece
| | - Panagiotis Koulouvaris
- 1st Department of Orthopaedic Surgery University General Hospital "Attikon", Medical School, National and Kapodistrian University of Athens Greece, Athens, Greece
| | - Athanasios Raptis
- 2nd Department of Internal Medicine-Propaedeutic and Diabetes Center, University General Hospital "Attikon", Medical School, National and Kapodistrian University of Athens Greece, Athens, Greece
| | - Aristotelis Bamias
- 2nd Department of Internal Medicine-Propaedeutic and Diabetes Center, University General Hospital "Attikon", Medical School, National and Kapodistrian University of Athens Greece, Athens, Greece
| | - Sophia Kalantaridou
- Reproductive Endocrinology Unit, 3rd Department of Obstetrics and Gynecology, University General Hospital "Attikon", Medical School, National and Kapodistrian University of Athens Greece, Athens, Greece
| | - Georgios Valsamakis
- Reproductive Endocrinology Unit, 3rd Department of Obstetrics and Gynecology, University General Hospital "Attikon", Medical School, National and Kapodistrian University of Athens Greece, Athens, Greece
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Garnweidner‐Holme L, Torheim LE, Henriksen L, Borgen I, Holmelid S, Lukasse M. Adherence to the Norwegian dietary recommendations in a multi-ethnic pregnant population prior to being diagnosed with gestational diabetes mellitus. Food Sci Nutr 2020; 8:3031-3040. [PMID: 32724567 PMCID: PMC7382101 DOI: 10.1002/fsn3.1248] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/16/2019] [Accepted: 09/21/2019] [Indexed: 12/14/2022] Open
Abstract
Maternal diet is a modifiable risk factor for the development of gestational diabetes mellitus (GDM). Even though pregnant women are considered to be motivated to eat healthy, previous research found unhealthy eating patterns among some ethnic and lower socio-economic status groups. This cross-sectional study assessed adherence to national dietary recommendations prior to GDM diagnosis in a multi-ethnic population comprising 237 pregnant women. Participants were diagnosed with GDM after performing a two-hour oral glucose tolerance test ≥ 9 mmol/L. Participants answered a 41-item Food Frequency Questionnaire about dietary habits prior to being diagnosed with GDM from October 2015 to March 2018. Their scores were based on adherence to the recommended intake in each food group and summed into a Healthy Diet Score (HDS). Results showed low adherence to national dietary recommendations. A significantly higher proportion of non-native Norwegian-speaking women had a high HDS compared with native Norwegian-speaking women. Participants with a normal prepregnancy weight were more likely to have a high HDS compared with overweight or obese participants. Participants showed low adherence to the recommendations for whole grains, vegetables, and fruits and berries, and a relatively low proportion adhered to the recommendations for intakes of fish, red/processed meat, and ready-made meals. However, the food group intakes varied by country of birth. Given the increase in women with GDM and the emerging evidence that maternal diet is a modifiable risk factor for GDM, effective nutrition communication strategies in antenatal care are urgently needed.
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Affiliation(s)
- Lisa Garnweidner‐Holme
- Faculty of Health SciencesInstitute of Nursing and Health PromotionOsloMet – Oslo Metropolitan UniversityOsloNorway
| | - Liv Elin Torheim
- Faculty of Health SciencesInstitute of Nursing and Health PromotionOsloMet – Oslo Metropolitan UniversityOsloNorway
| | - Lena Henriksen
- Faculty of Health SciencesInstitute of Nursing and Health PromotionOsloMet – Oslo Metropolitan UniversityOsloNorway
| | - Iren Borgen
- Faculty of Health SciencesInstitute of Nursing and Health PromotionOsloMet – Oslo Metropolitan UniversityOsloNorway
| | - Sigrid Holmelid
- Faculty of Health SciencesInstitute of Nursing and Health PromotionOsloMet – Oslo Metropolitan UniversityOsloNorway
| | - Mirjam Lukasse
- Faculty of Health SciencesInstitute of Nursing and Health PromotionOsloMet – Oslo Metropolitan UniversityOsloNorway
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Li Y, Ren X, He L, Li J, Zhang S, Chen W. Maternal age and the risk of gestational diabetes mellitus: A systematic review and meta-analysis of over 120 million participants. Diabetes Res Clin Pract 2020; 162:108044. [PMID: 32017960 DOI: 10.1016/j.diabres.2020.108044] [Citation(s) in RCA: 136] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 12/20/2019] [Accepted: 01/27/2020] [Indexed: 11/20/2022]
Abstract
AIMS The objective of the present analysis was to evaluate and quantify the risk for gestational diabetes mellitus (GDM) according to maternal age. METHODS Three electronic databases were searched for publications from inception to July 2018. Odds ratio (OR) and 95% confidence interval (95% CI) were calculated. A dose-response analsis was performed using generalised least squares regression. Subgroup and meta-regression analyses were conducted to explore the source of identified heterogeneity among studies. RESULTS Twenty-four studies were included in the present meta-analysis. The ORs and 95% CIs for women aged <20 years vs 25-29 years, 30-34 years, 35-39 years and ≥40 years were 0.60 (95% CI = 0.50-0.72), 1.69 (95% CI = 1.49-1.93), 2.73 (95% CI = 2.28-3.27), 3.54 (95% CI = 2.88-4.34) and 4.86 (95% CI = 3.78-6.24), respectively. Dose-response analysis showed that GDM risk exhibited a linear relationship with maternal age (Ptrend < 0.001). For each one-year increase in maternal age from 18 years, GDM risk for the overall population, Asian, and Europid increased by 7.90%, 12.74%, and 6.52%, respectively. Subgroup analyses indicated that from the age of 25, Asian women had a significantly higher risk of developing GDM than Europid women (all Pinteractions < 0.001). CONCLUSIONS This meta-analysis demonstrates that the risk of GDM increases linearly with successive age-groups.
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Affiliation(s)
- Yueyi Li
- The First Affiliated Hospital, Jinan University, Guangzhou 510630, China
| | - Xinghua Ren
- School of Traditional Chinese Medicine, Jinan University, Guangzhou 510630, China
| | - Lilan He
- The First Affiliated Hospital, Jinan University, Guangzhou 510630, China
| | - Jing Li
- The First Affiliated Hospital, Jinan University, Guangzhou 510630, China
| | - Shiyi Zhang
- The First Affiliated Hospital, Jinan University, Guangzhou 510630, China
| | - Weiju Chen
- The First Affiliated Hospital, Jinan University, Guangzhou 510630, China.
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Hassani Zadeh S, Boffetta P, Hosseinzadeh M. Dietary patterns and risk of gestational diabetes mellitus: A systematic review and meta-analysis of cohort studies. Clin Nutr ESPEN 2020; 36:1-9. [PMID: 32220350 DOI: 10.1016/j.clnesp.2020.02.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 01/19/2020] [Accepted: 02/15/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND & AIMS The association between dietary patterns and Gestational Diabetes Mellitus (GDM) risk was investigated in many studies, but the findings were inconclusive. METHODS We conducted a systematic review and meta-analysis of cohort studies. To find the relevant articles several databases were searched. We found that 13 studies met our inclusion criteria. So, the relevant dietary patterns were selected and the random-effect model was used to compute the summary risk estimates and 95 percent confidence intervals. RESULTS This meta-analysis revealed that "prudent" (RR = 0.78, CI = 0.63-0.96), "vegetable" (RR = 0.86, CI = 0.76-0.98), and "Mediterranean" (RR = 0.71, CI = 0.56-0.91) dietary patterns with high levels of whole grain, fruits, vegetables, and low fat dairy intake decreased the risk of GDM. However, the western dietary pattern, determined by high intakes of red meat, process meat, fried food, and refined grain could increase the risk of GDM (RR = 1.27, CI = 1.03-1.56). CONCLUSIONS Western dietary pattern could increase the risk of GDM; while the healthy dietary patterns including "Mediterranean", "prudent", and "vegetable" dietary patterns could decrease the risk of GDM.
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Affiliation(s)
- Shirin Hassani Zadeh
- Nutrition and Food Security Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran; Department of Nutrition, Faculty of Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Paolo Boffetta
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Mahdieh Hosseinzadeh
- Nutrition and Food Security Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran; Department of Nutrition, Faculty of Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
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Kragelund Nielsen K, Andersen GS, Damm P, Andersen AMN. Gestational Diabetes Risk in Migrants. A Nationwide, Register-Based Study of all Births in Denmark 2004 to 2015. J Clin Endocrinol Metab 2020; 105:5707566. [PMID: 31950143 DOI: 10.1210/clinem/dgaa024] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 01/13/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Much remains to be understood about socioeconomic position and body mass index (BMI) in the pathways linking ethnicity, migration, and gestational diabetes mellitus (GDM). We investigated differences in GDM prevalence according to maternal country of origin and the role played by socioeconomic position and BMI on this relationship. Finally, we examined how length of residency was associated with GDM. METHODS A register-based cohort study of the 725 482 pregnancies that resulted in a birth in Denmark, 2004 to 2015. Of these, 14.4% were by women who had migrated to Denmark. A GDM diagnosis was registered in 19 386 (2.7%) pregnancies, of which 4464 (23.0%) were in immigrant women. The crude risk of GDM according to maternal country of origin compared to Danish-born women ranged from an odds ratio (OR) of 0.50 (95% CI 0.34-0.71) for women from Sweden to an OR of 5.11 (95% CI 4.28-6.11) for women from Sri Lanka. Adjustment for socioeconomic position slightly attenuated the risks. Adjusting for BMI resulted in increased ORs for women, especially from Asian countries. The separate and joint effects of migration and overweight on GDM risk differed substantially between the countries of origin (P value interaction term < .001). Immigrants with 10 or more years of residency had a 56% increased risk of GDM (OR 1.56, 95% CI 1.44-1.68) compared to immigrants with less than 5 years in Denmark. This risk was somewhat diluted when adjusting for age and BMI. CONCLUSIONS This study demonstrates substantial variation in the risk of GDM according to country of origin. The risk associations are only slightly affected by socioeconomic position and BMI.
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Affiliation(s)
- Karoline Kragelund Nielsen
- Steno Diabetes Center, Gentofte, Denmark
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Danish Diabetes Academy, Odense, Denmark
| | | | - Peter Damm
- Center for Pregnant Women with Diabetes, Department of Obstetrics, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anne-Marie Nybo Andersen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Glazer KB, Danilack VA, Werner EF, Field AE, Savitz DA. Elucidating the role of overweight and obesity in racial and ethnic disparities in cesarean delivery risk. Ann Epidemiol 2020; 42:4-11.e4. [PMID: 32005568 DOI: 10.1016/j.annepidem.2019.12.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 09/16/2019] [Accepted: 12/30/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE We aimed to quantify the extent to which overweight and obesity explain cesarean delivery risk among women of different racial and ethnic backgrounds. METHODS Using administrative records for 216,481 singleton, nulliparous births in New York City from 2008 to 2013, we calculated risk ratios, risk differences, and population attributable fractions for associations between body mass index (BMI) and cesarean, stratified by race and ethnicity. RESULTS The population attributable fraction (95% confidence interval) for BMI was 6.8% (6.2%-7.3%) among Asian, 10.9% (10.4%-11.4%) among White, 14.6% (13.7%-15.5%) among Hispanic, and 17.4% (16.2%-18.6%) among Black women. Although overweight and obesity were most prevalent among Black and Hispanic women, the risk gradient was strongest among Whites (adjusted risk ratio [95% CI] from 1.37 [1.33-1.41] for overweight to 2.23 [2.07-2.39] for class III obesity). Additional adjustment for gestational complications partially attenuated associations, and accounting for delivery hospital eliminated the stronger gradient among White women. CONCLUSIONS Prepregnancy overweight and obesity contribute proportionally more to cesarean risk among Black and Hispanic women because of higher prevalence compared to White or Asian women. Although preconception weight management is important to decrease cesarean risk, results encourage attention to clinical approaches in low-risk pregnancies to mitigate racial and ethnic perinatal disparities.
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Affiliation(s)
- Kimberly B Glazer
- Department of Population Health Science and Policy and the Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Epidemiology, Brown University School of Public Health, Providence, RI.
| | - Valery A Danilack
- Department of Population Health Science and Policy and the Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY; Division of Research, Women & Infants Hospital, Providence, RI; Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Providence, RI
| | - Erika F Werner
- Department of Population Health Science and Policy and the Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Providence, RI; Department of Obstetrics and Gynecology, Women & Infants Hospital, Providence, RI
| | - Alison E Field
- Department of Population Health Science and Policy and the Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - David A Savitz
- Department of Population Health Science and Policy and the Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Providence, RI
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Li G, Wei T, Ni W, Zhang A, Zhang J, Xing Y, Xing Q. Incidence and Risk Factors of Gestational Diabetes Mellitus: A Prospective Cohort Study in Qingdao, China. Front Endocrinol (Lausanne) 2020; 11:636. [PMID: 33042010 PMCID: PMC7516372 DOI: 10.3389/fendo.2020.00636] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 08/06/2020] [Indexed: 12/21/2022] Open
Abstract
Background: Obesity and maternal age are the two most important factors independently affecting the risk of gestational diabetes mellitus (GDM). However, the age differences in the association between obesity and GDM remain unclear. The objectives of this cohort study included: (1) to determine the current incidence of GDM in Qingdao; and (2) to evaluate the risk factors for GDM, such as the interaction between pre-pregnancy body mass index (BMI) and age. Methods: The cohort included 17,145 pregnant women who registered at 15 to 20 gestational weeks from August 1, 2018, to March 1, 2019. A 75-g 2-h oral glucose tolerance test (OGTT) was conducted for each participant at 24-28 gestational weeks. The age-adjusted incidence of GDM was calculated using logistic regression. Multivariate logistic regression analysis was used to identify risk factors. Interaction between age (reference group <30 years) and BMI (reference group <25 kg/m2) was determined using strata-specific analysis. Results: The incidence and age-adjusted incidence of GDM in Qingdao were 17.42 and 17.45%, respectively. The incidence of GDM appeared to increase steadily with age in all pre-pregnancy BMI groups (all P < 0.05). Older age (≥30 years), gestational BMI gain from pre-pregnancy to 15-20 weeks of gestation, history of GDM and thyroid diseases were risk factors for GDM. There were significant interactions between pre-pregnancy BMI and age (P < 0.05) after adjustment for other confounders. The odds ratio (OR) of pre-pregnancy BMI ≥ 30 kg/m2 at the age of <30 years, 30-34 years and ≥35 years was 1.30 (95% CI: 0.74-2.28, P = 0.36), 3.21 (95% CI: 2.28-4.52, P < 0.0001) and 1.55 (95% CI: 1.02-2.36, P = 0.0424), respectively. This indicated that pre-pregnancy BMI ≥ 30 kg/m2 had a stronger effect on GDM in the group aged 30-34 years than those under 30 years old. Conclusions: The incidence of GDM was high in Qingdao. Overweight and obesity prior to pregnancy, gestational BMI gain from conception to 15-20 weeks of gestation and older age were correlated with an increased risk of GDM. Public health measures may be helpful to prevent excessive gestational weight gain.
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Affiliation(s)
- Guoju Li
- Qingdao Women and Children's Hospital, Qingdao University, Qingdao City, China
| | - Tao Wei
- Qingdao Women and Children's Hospital, Qingdao University, Qingdao City, China
| | - Wei Ni
- Qingdao Women and Children's Hospital, Qingdao University, Qingdao City, China
| | - Ai Zhang
- Qingdao Women and Children's Hospital, Qingdao University, Qingdao City, China
| | - Jun Zhang
- Qingdao Women and Children's Health Care and Family Planning Service Center, Qingdao City, China
| | - Yuhan Xing
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- *Correspondence: Yuhan Xing
| | - Quansheng Xing
- Qingdao Women and Children's Hospital, Qingdao University, Qingdao City, China
- Quansheng Xing
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Natamba BK, Namara AA, Nyirenda MJ. Burden, risk factors and maternal and offspring outcomes of gestational diabetes mellitus (GDM) in sub-Saharan Africa (SSA): a systematic review and meta-analysis. BMC Pregnancy Childbirth 2019; 19:450. [PMID: 31779584 PMCID: PMC6883645 DOI: 10.1186/s12884-019-2593-z] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 11/11/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The burden, determinants and outcomes of gestational diabetes mellitus (GDM) in sub-Saharan Africa are not known. We summarized existing evidence on the prevalence, risk factors and complications of GDM in the region. METHODS PubMed was searched from inception to January 31st 2019. Studies were included if carried out in any of the sub-Saharan Africa countries and were available as abstracts or full texts. Interventional studies and those only including qualitative data were excluded. We employed random effects modelling to estimate the pooled GDM prevalence and risk ratios (RRs) for risk factors and outcomes of GDM and their 95%CI. RESULTS 283 papers were identified in the initial search, 33 of which met the inclusion criteria. Data on GDM burden suggest a pooled prevalence of 9% (95%CI, 7-12%). Family history of type 2 diabetes and previous history of GDM, macrosomia, stillbirth and abortion were important risk factors of GDM. In addition, being overweight or obese, over 25 years of age or hypertensive increased the risk of GDM. In terms of complications, GDM more than doubles the risk macrosomia (RR; 95%CI: 2.2; 1.1-4.4). CONCLUSIONS There is a high burden of gestational diabetes mellitus in sub-Saharan Africa, but more studies are needed to document locally important risk factors as well as maternal and offspring outcomes. Interventions to reduce obesity among older African women might lead to reduced risk of GDM in sub-Saharan Africa.
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Affiliation(s)
| | - Arthur Araali Namara
- MRC/UVRI and LSHTM Uganda Research Unit, Plot 51-59, Nakiwogo Road, PO Box 49, Entebbe, Uganda
| | - Moffat Joha Nyirenda
- MRC/UVRI and LSHTM Uganda Research Unit, Plot 51-59, Nakiwogo Road, PO Box 49, Entebbe, Uganda
- Department of Noncommunicable Diseases EpidemiologyFaculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Hasbullah FY, Mohd Yusof BN, Shariff ZM, Rejali Z, Yong HY, Mitri J. Factors associated with dietary glycemic index and glycemic load in pregnant women and risk for gestational diabetes mellitus. Int J Food Sci Nutr 2019; 71:516-524. [PMID: 31686557 DOI: 10.1080/09637486.2019.1686752] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The risk of gestational diabetes mellitus (GDM) increases during the second trimester of pregnancy. However, the role of dietary glycemic index (GI) and glycemic load (GL) on GDM risk is controversial. We aimed to determine the association of established risk factors of GDM with GI and GL among healthy pregnant women, and whether GI and GL were subsequently related to GDM risk. Dietary GI and GL were assessed in healthy pregnant women from the Seremban Cohort Study using a food frequency questionnaire. After adjusting for energy intake, high GI was significantly associated with lower household income, shorter stature, higher proportion of carbohydrate intake, lower sugar proportion and lower fibre intake. High GL was significantly associated with younger maternal age, higher carbohydrate proportion and lower fibre intake. GI and GL intakes were not significantly associated with GDM risk. However, they were associated with a few established risk factors of GDM.
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Affiliation(s)
- Farah Yasmin Hasbullah
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Barakatun Nisak Mohd Yusof
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia.,Research Centre of Excellence, Nutrition and Non-Communicable Diseases (NNCD), Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Zalilah Mohd Shariff
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Zulida Rejali
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Heng Yaw Yong
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Joanna Mitri
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA
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Shaukat S, Nur U. Effect of prepregnancy maternal BMI on adverse pregnancy and neonatal outcomes: results from a retrospective cohort study of a multiethnic population in Qatar. BMJ Open 2019; 9:e029757. [PMID: 31501116 PMCID: PMC6738680 DOI: 10.1136/bmjopen-2019-029757] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Given the small number of studies on the topic, we aimed to identify the impact of prepregnancy maternal body mass index (BMI) on adverse pregnancy outcomes (POs) in a low-risk, multiethnic population, and to calculate related population attributable fractions (PAFs). METHODS This retrospective cohort study included 1134 nulliparous women of 50 nationalities (classified into Arab and non-Arab ethnicity) in Qatar who had their first antenatal visit at a Primary Healthcare Corporation (PHCC) facility in June 2016-March 2017 and their PO at a Hamad Medical Corporation facility before 10 November 2017. We used multiple imputation to handle missing values and multivariate logistic regression to calculate adjusted ORs (aORs) for adverse POs in overweight and women with obesity. RESULTS Overweight Arab women and women with obesity were at high risk for gestational diabetes mellitus (GDM) (aOR=2.38, 95% CI 1.51 to 3.84) and caesarean section (aOR=1.57, 95% CI 1.00 to 2.48). Non-Arab women with obesity were at high risk for pre-eclampsia (aOR=3.83, 95% CI 1.00 to 15.00). PAFs showed that 41.63% of pre-eclampsia, 17.36% of pregnancy-induced hypertension, 17.17% of large for gestational age, 15.89% of preterm deliveries, 14.75% of GDM and 13.99% of caesarean sections could be avoided if all mothers had normal prepregnancy BMI. There were no major differences in PAFs by ethnicity. CONCLUSION Adverse POs were attributable to maternal obesity. This suggests that, in contrast to existing PHCC protocol, overweight and women with obesity in Qatar should be targeted earlier in their pregnancy; preferably prior to getting pregnant. We observed ethnic differences in the risk of adverse POs.
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Affiliation(s)
- Shazia Shaukat
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Ula Nur
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
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