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Meng Z, Lin M, Song L, Chen Y, Deng S, Xia S, Huang X, Luo Y. The first-trimester triglyceride glucose-body mass index is a valuable predictor for adverse pregnancy outcomes. BMC Pregnancy Childbirth 2025; 25:142. [PMID: 39934742 DOI: 10.1186/s12884-025-07258-z] [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: 12/01/2024] [Accepted: 01/29/2025] [Indexed: 02/13/2025] Open
Abstract
BACKGROUND Although insulin resistance has been associated with unfavorable pregnancy outcomes, the ability of non-insulin-based insulin resistance indicators to predict adverse pregnancy outcomes has yet to be thoroughly understood. The study aims to investigate the association and predictability of triglyceride glucose-body mass index (TyG-BMI), a biomarker of non-insulin-based insulin resistance, with the risks of adverse pregnancy outcomes. METHOD The retrospective study included 1,136 subjects. Group-based trajectory modeling (GBTM) was employed to identify the TyG-BMI index trajectory. Logistic regression, restricted cubic spline (RCS) regression, and subgroup analysis were used to assess the association between the TyG-BMI index trajectory and the first-trimester TyG-BMI index with the risks of adverse pregnancy outcomes. Receiver-operating characteristic (ROC) curve analysis and the DeLong test were utilized to evaluate the prediction ability of the first-trimester TyG-BMI index for adverse pregnancy outcomes. RESULTS GBTM revealed three distinct trajectories of the TyG-BMI index. Using the "low-stable" trajectory as a reference, the "high-stable" trajectory was independently associated with an increased risk of gestational diabetes mellitus (GDM) (aOR = 2.01, 95% CI 1.20-3.37), hypertensive disorders of pregnancy (HDP) (aOR = 6.05, 95% CI 3.00-12.18), and large for gestational age (LGA) (aOR = 2.83, 95% CI 1.28-6.25). The highest quartile of the first-trimester TyG-BMI index was independently linked to elevated GDM (aOR = 3.27, 95% CI 1.92-5.59), HDP (aOR = 9.26, 95% CI 3.19-26.88), and LGA (aOR = 2.26, 95% CI 1.00-5.09)risks. Additionally, the third quartile of the first-trimester TyG-BMI index had 2.21-fold increased odds of GDM (aOR = 2.21, 95% CI 1.27-3.82). The first-trimester TyG-BMI index demonstrated a significant linear association with GDM, HDP, SGA, and LGA risks. Compared to the TyG-BMI index trajectory, the highest quartile of the first-trimester TyG-BMI index exhibited a stronger association with the risks of GDM and HDP (aOR = 3.09 and 7.39, respectively). Furthermore, according to the ROC curve, the first-trimester TyG-BMI index outperformed the TyG index and triglyceride/high-density lipoprotein cholesterol (TG/HDL-c) ratio at predicting HDP (0.726 [0.650-0.801] vs. 0.603 [0.527-0.679] vs. 0.615 [0.537-0.693]), LGA (0.619 [0.540-0.699] vs. 0.534 [0.454-0.613] vs. 0.540 [0.458-0.622]), and GDM (0.664 [0.622-0.705] vs. 0.632 [0.588-0.676] vs. 0.604 [0.560-0.649]). According to the DeLong test, the first-trimester TyG-BMI index was a more valuable predictor for LGA and HDP compared to TyG index and TG/HDL-c ratio. CONCLUSION Higher levels of first-trimester TyG-BMI and a "high-stable" trajectory were linked to a greater risk of adverse pregnancy outcomes. Furthermore, as compared to TyG and TG/HDL-c, the first-trimester TyG-BMI index is a valuable predictor for HDP, GDM, and LGA.
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Affiliation(s)
- Zhaoran Meng
- Department of Obstetrics & Gynecology, The First Affiliated Hospital of Sun Yat-Sen University, No.58, Zhong Shan Er Road, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Obstetrical and Gynecological Diseases, Guangzhou, China
- Department of Obstetrics & Gynecology, The Third Affiliated Hospital of Sun Yat-Sen University, No.600, Tianhe Road, Guangzhou, China
| | - Minhuan Lin
- Department of Obstetrics & Gynecology, The First Affiliated Hospital of Sun Yat-Sen University, No.58, Zhong Shan Er Road, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Obstetrical and Gynecological Diseases, Guangzhou, China
| | - Lizhu Song
- Department of Obstetrics & Gynecology, The First Affiliated Hospital of Sun Yat-Sen University, No.58, Zhong Shan Er Road, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Obstetrical and Gynecological Diseases, Guangzhou, China
| | - Yiqing Chen
- Department of Obstetrics & Gynecology, The First Affiliated Hospital of Sun Yat-Sen University, No.58, Zhong Shan Er Road, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Obstetrical and Gynecological Diseases, Guangzhou, China
| | - Songqing Deng
- Department of Obstetrics & Gynecology, The First Affiliated Hospital of Sun Yat-Sen University, No.58, Zhong Shan Er Road, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Obstetrical and Gynecological Diseases, Guangzhou, China
| | - Shuting Xia
- Department of Obstetrics & Gynecology, The First Affiliated Hospital of Sun Yat-Sen University, No.58, Zhong Shan Er Road, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Obstetrical and Gynecological Diseases, Guangzhou, China
| | - Xuewen Huang
- Department of Obstetrics & Gynecology, The First Affiliated Hospital of Sun Yat-Sen University, No.58, Zhong Shan Er Road, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Obstetrical and Gynecological Diseases, Guangzhou, China
| | - Yanmin Luo
- Department of Obstetrics & Gynecology, The First Affiliated Hospital of Sun Yat-Sen University, No.58, Zhong Shan Er Road, Guangzhou, China.
- Guangdong Provincial Clinical Research Center for Obstetrical and Gynecological Diseases, Guangzhou, China.
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Chen M, Xiong S, Zheng J, Zhang J, Ye D, Xian Y, Cao Q, Yan K. Association between cardiometabolic index and gestational diabetes mellitus: a cross-sectional study. Endocrine 2025; 87:569-577. [PMID: 39313707 DOI: 10.1007/s12020-024-04045-2] [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: 05/13/2024] [Accepted: 09/14/2024] [Indexed: 09/25/2024]
Abstract
BACKGROUND Cardiometabolic index (CMI) is a novel marker of diabetes mellitus. However, few studies have examined its association with gestational diabetes mellitus (GDM) risk. This study aimed to explore the association between CMI and GDM risk among pregnant women in the United States. METHODS We performed a cross-sectional study utilizing data recorded in the National Health and Nutrition Examination Survey database from 1999 to 2018. Univariate and multivariate logistic regression, restricted cubic splines (RCS), sensitivity, and subgroup analyses were performed to clarify the relationship between CMI and GDM risk. RESULTS A total of 710 pregnant women were recruited, among whom 113 were diagnosed with GDM based on established criteria. This population showed a significant association between a higher CMI value and GDM (odds ratio: 1.75, 95% confidence interval: 1.03-2.99, P = 0.038). RCS regression analysis identified a linear relationship between CMI and GDM (P-value < 0.001, P-nonlinear = 0.702). Sensitivity analysis further confirmed the validity of this relationship. Subgroup analysis indicated a positive association between CMI and GDM among women who drink or smoke and Mexican Americans. CONCLUSION This study demonstrates a significant positive association between CMI and GDM risk, suggesting that a higher CMI predicts GDM incidence during pregnancy. Further research is required to investigate the CMI index as an early predictor of GDM.
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Affiliation(s)
- Minchun Chen
- Department of Pharmacy, Xi'an No.3 Hospital, The Affiliated Hospital of Northwest University, Xi'an, 710018, China
| | - Suqiang Xiong
- Clinical Medical Research Center, Xi'an No.3 Hospital, The Affiliated Hospital of Northwest University, Xi'an, 710018, China
| | - Jie Zheng
- Department of Pharmacy, Xi'an No.3 Hospital, The Affiliated Hospital of Northwest University, Xi'an, 710018, China
| | - Jingyi Zhang
- Department of Pharmacy, Xi'an No.3 Hospital, The Affiliated Hospital of Northwest University, Xi'an, 710018, China
| | - Dan Ye
- Department of Pharmacy, Xi'an No.3 Hospital, The Affiliated Hospital of Northwest University, Xi'an, 710018, China
| | - Yusan Xian
- Department of Pharmacy, Xi'an No.3 Hospital, The Affiliated Hospital of Northwest University, Xi'an, 710018, China
| | - Qing Cao
- Department of Pharmacy, Xi'an No.3 Hospital, The Affiliated Hospital of Northwest University, Xi'an, 710018, China.
| | - Kangkang Yan
- Department of Pharmacy, Xi'an No.3 Hospital, The Affiliated Hospital of Northwest University, Xi'an, 710018, China.
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Sheng J, Ma CF, Wu XF, Li XX. Ratio of remnant cholesterol to high-density lipoprotein cholesterol in relation to gestational diabetes mellitus risk in early pregnancy among Korean women. PLoS One 2025; 20:e0316934. [PMID: 39752447 PMCID: PMC11698353 DOI: 10.1371/journal.pone.0316934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Accepted: 12/18/2024] [Indexed: 01/06/2025] Open
Abstract
OBJECTIVE There is no evidence to suggest that an association exists between the remnant cholesterol (RC) to high-density lipoprotein cholesterol (HDL-C) ratio and gestational diabetes mellitus (GDM). In this study, the RC/HDL-C ratio during the first trimester was examined as a potential indicator of the onset of GDM during the second trimester. METHODS This was a secondary analysis of data from a Korea-based prospective cohort study. The study involved 582 women within 14 weeks of pregnancy who were examined between November 2014 and July 2016 at two Korean hospitals. RC was calculated as total cholesterol (TC) minus the sum of low-density lipoprotein cholesterol (LDL-C) and HDL-C. The RC/HDL-C ratio was determined by dividing the RC content by the HDL-C content. The RC/HDL-C ratio and GDM occurrence were investigated utilizing a binary logistic regression model, various sensitivity analyses, and subgroup analyses. Additionally, the RC/HDL-C ratio was evaluated using receiver operating characteristic (ROC) analysis. RESULTS The average age of the pregnant women was 32.07 ± 3.78 years, and the RC/HDL-C ratio had a median value of 0.39. The prevalence of GDM was 6.01%. There was a positive association between the RC/HDL-C ratio and the incidence of GDM after adjusting for potential confounding variables (odds ratio: 21.78, 95% confidence interval [CI]: 3.55-133.73, P < 0.001). Furthermore, this association was validated by subgroup and sensitivity analyses. The results indicated that the RC/HDL-C ratio was a robust predictor of GDM, with an area under the ROC curve of 0.795 (95% CI: 0.723-0.868). The optimal threshold value was 0.45, with a sensitivity of 71.4% and a specificity of 75.3%. Compared with traditional lipid markers, including LDL-C, HDL-C, triglycerides, TC, and the emerging marker RC, the RC/HDL-C exhibited higher diagnostic efficacy. CONCLUSION There is an increased risk of GDM associated with higher levels of the RC/HDL-C ratio between 12 and 14 weeks of gestation, independent of traditional risk factors. The RC/HDL-C ratio is more effective in diagnosing GDM than traditional lipid markers.
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Affiliation(s)
- Jing Sheng
- Department of Clinical Laboratory, Suzhou Ninth People’s Hospital Affiliated to Soochow University, Suzhou, Jiangsu, China
| | - Chun-Fang Ma
- Department of Clinical Laboratory, Suzhou Ninth People’s Hospital Affiliated to Soochow University, Suzhou, Jiangsu, China
| | - Xiao-Fei Wu
- Department of Emergency Medicine, Suzhou Ninth People’s Hospital Affiliated to Soochow University, Suzhou, Jiangsu, China
| | - Xiang-Xiang Li
- Department of Clinical Laboratory, Suzhou Ninth People’s Hospital Affiliated to Soochow University, Suzhou, Jiangsu, China
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Song G, Wei Y, Juan J, Niu J, Yang H. The predictive ability of the triglyceride glucose index, fasting glucose and oral glucose tolerance test for postpartum hyperglycemia in women with a GDM history. J Matern Fetal Neonatal Med 2024; 37:2395495. [PMID: 39198029 DOI: 10.1080/14767058.2024.2395495] [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: 05/21/2024] [Revised: 07/15/2024] [Accepted: 08/18/2024] [Indexed: 09/01/2024]
Abstract
OBJECTIVE This study aimed to determine the likelihood of hyperglycemia postpartum in women with gestational diabetes mellitus (GDM) and to identify the predictors. METHODS The retrospective cohort study involved 1 527 GDM patients who delivered at Peking University First Hospital from 1 January 2021, to 31 December 2021. According to the blood glucose level of postpartum oral glucose tolerance test (OGTT), women were divided into a normal glucose tolerance (NGT) group and a hyperglycemia group, and their characteristics and risk factors of hyperglycemia were compared. RESULTS The prevalence of hyperglycemia was 33.9% (184/543) at 6-12 weeks postpartum. Compared with the NGT group, the fasting plasma glucose (FPG) of hyperglycemia group increased significantly during pregnancy and postpartum, the OGTT 1h postprandial glucose (PG) and 2hPG increased in the second trimester of pregnancy, the triglyceride (TG) increased in the first trimester of pregnancy and postpartum, the triglyceride glucose (TyG) index increased in the first trimester of pregnancy and postpartum, and the total cholesterol (TCHO) and low density lipoprotein cholesterol (LDL-C) decreased in the second trimester (p < 0.05). Fasting plasma glucose (FPG) in the first trimester [odds ratio (OR) = 3.583, p < 0.001], OGTT 2hPG in the second trimester (OR = 1.604, p < 0.001), the TyG index in the first trimester (OR = 1.863, p = 0.045) and FPG in third trimester (OR = 1.985, p = 0.024) were independent risk factors for postpartum hyperglycemia. CONCLUSIONS Approximately one-third of women with GDM have hyperglycemia 6-12 weeks after delivery. FPG and the TyG index in the first trimester, OGTT 2hPG in the second trimester and FPG in third trimester are risk factors for postpartum hyperglycemia.
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Affiliation(s)
- Geng Song
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
- Beijing Key Laboratory of Maternal Fetal Medicine of Gestational Diabetes Mellitus, Beijing, China
| | - Yumei Wei
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
- Beijing Key Laboratory of Maternal Fetal Medicine of Gestational Diabetes Mellitus, Beijing, China
| | - Juan Juan
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
- Beijing Key Laboratory of Maternal Fetal Medicine of Gestational Diabetes Mellitus, Beijing, China
| | - Jianhua Niu
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
- Beijing Key Laboratory of Maternal Fetal Medicine of Gestational Diabetes Mellitus, Beijing, China
| | - Huixia Yang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
- Beijing Key Laboratory of Maternal Fetal Medicine of Gestational Diabetes Mellitus, Beijing, China
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Zhang B, Zhan Z, Zhang F, Xi S, Yuan X, Shi Z. Serum triglyceride to high density lipoprotein cholesterol ratio in late pregnancy as a potential predictor of adverse birth outcomes: an analysis of real-world data. Diabetol Metab Syndr 2024; 16:262. [PMID: 39497103 PMCID: PMC11536801 DOI: 10.1186/s13098-024-01503-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 10/29/2024] [Indexed: 11/06/2024] Open
Abstract
BACKGROUND The association between serum triglyceride to high density lipoprotein cholesterol ratio (THR) in late pregnancy and adverse birth outcomes (ABO) remains controversial because of inconsistent results. The present study assessed the association between maternal serum THR and incidence of ABO [preterm birth (PTB), small and large for gestational age (SGA/LGA), low birth weight (LBW) and macrosomia] in a Chinese population. METHODS A total of 11,553 consecutive participants from a real-world database with data on lipid profiles and birth outcomes were included. Logistic regression models were applied to assess the association between THR and incident ABO. Mediation analysis was performed to investigate the contribution of pregnancy complications [gestational diabetes mellitus (GDM), intrahepatic cholestasis of pregnancy (ICP) and pre-eclampsia (PE)] to this association. RESULTS Approximately 6.6% (762/11,553), 8.9% (1023/11,553), 15.5% (1792/11,553), 4.3% (494/11,553), and 7.4% (851/11,553) of individuals developed PTB, SGA, LGA, LBW and macrosomia, respectively. Significant trends across the quintiles of THR toward decreasing incidence of SGA and LBW and increasing incidence of LGA and macrosomia were observed. The multivariate-adjusted odds ratios (OR) in the top quintile of serum THR (> 3.16) versus the bottom quintile (< 1.44) were 0.52 for PTB, 0.48 for SGA, 0.64 for LBW, 2.80 for LGA and 3.80 for macrosomia, respectively. A 1-standard deviation (SD) increase in serum THR was associated with decreased risk of PTB [OR = 0.84, 95% confidence interval (CI): 0.76-0.93), SGA (OR = 0.71, 95% CI:0.65-0.78) and LBW (OR = 0.76, 95% CI:0.65-0.90) and increased risk of LGA (OR = 1.40, 95% CI:1.32-1.49) and macrosomia (OR = 1.49, 95% CI:1.38-1.62). In mediation analyses, PE mediated - 19.8%, -10.6% and - 24.6% of THR-associated PTB, SGA and LBW, respectively, GDM accounted for - 3.7%, 6.8% and 4.3% of THR-associated PTB, LGA and macrosomia, respectively, and ICP explained - 1.9% and - 2.1% of THR-associated PTB and LBW, respectively. In addition, incorporating THR to ABO predictive models significantly improved the area under the curve for SGA (0.743 vs. 0.753, P < 0.001), LGA (0.734 vs. 0.745, P < 0.001) and macrosomia (0.786 vs. 0.800, P < 0.001). CONCLUSION Real-world data showed an association between serum THR in late pregnancy and ABO risk, and this association may be partially mediated by prevalent pregnancy complications (PE/GDM/ICP), suggesting a potential role of THR in predicting ABO (SGA/LGA/macrosomia).
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Affiliation(s)
- Bin Zhang
- Department of Medical Genetics, Changzhou Maternal and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, China
| | - Zhaolong Zhan
- Department of Medical Genetics, Changzhou Maternal and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, China
| | - Feng Zhang
- Department of Medical Genetics, Changzhou Maternal and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, China
| | - Sijie Xi
- Department of Medical Genetics, Changzhou Maternal and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, China
| | - Xiaosong Yuan
- Department of Medical Genetics, Changzhou Maternal and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, China.
| | - Zhonghua Shi
- Department of Obstetrics, Changzhou Maternal and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, China.
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Inthavong S, Jatavan P, Tongsong T. Predictive Utility of Biochemical Markers for the Diagnosis and Prognosis of Gestational Diabetes Mellitus. Int J Mol Sci 2024; 25:11666. [PMID: 39519218 PMCID: PMC11545977 DOI: 10.3390/ijms252111666] [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: 10/07/2024] [Revised: 10/28/2024] [Accepted: 10/29/2024] [Indexed: 11/16/2024] Open
Abstract
Gestational diabetes mellitus (GDM) is a common complication during pregnancy with an increasing prevalence worldwide. Early prediction of GDM and its associated adverse outcomes is crucial for timely intervention and improved maternal and fetal health. The objective of this review is to provide a comprehensive summary of contemporary evidence on biomarkers, focusing on their potential to predict the development of GDM and serve as predictors of maternal, fetal, and neonatal outcomes in women with GDM. A literature search was conducted in the PubMed database using relevant terms. Original research articles published in English between 1 January 2015, and 30 June 2024, were included. A two-stage screening process was employed to identify studies on biomarkers for GDM diagnosis and prognosis and to evaluate the evidence for each biomarker's diagnostic performance and its potential prognostic correlation with GDM. Various biochemical markers, including adipokines, inflammatory markers, insulin resistance markers, glycemic markers, lipid profile markers, placenta-derived markers, and other related markers, have shown promise in identifying women at risk of developing GDM and predicting adverse pregnancy outcomes. Several promising markers with high predictive performance were identified. However, no single biomarker has demonstrated sufficient accuracy to replace the current diagnostic criteria for GDM. The complexity of multiple pathways in GDM pathogenesis highlights the need for a multi-marker approach to improve risk stratification and guide personalized management strategies. While significant progress has been made in GDM biomarker research, further studies are required to refine and validate these markers for clinical use and to develop a comprehensive, evidence-based approach to GDM prediction and management that can improve maternal and child health outcomes.
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Affiliation(s)
| | - Phudit Jatavan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (S.I.); (T.T.)
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Pan YQ, Huang XX, Jiang XM. Risk factors and prediction model for low-birth-weight infants born to women with gestational diabetes mellitus. Front Public Health 2024; 12:1432033. [PMID: 39469216 PMCID: PMC11514069 DOI: 10.3389/fpubh.2024.1432033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 09/16/2024] [Indexed: 10/30/2024] Open
Abstract
Aim To explore the risk factors for low-birth-weight infants born to pregnant women with GDM to develop a prediction model and to construct a prediction nomogram for the risk of low birth weight infants born to pregnant women with GDM. Methods The clinical data of singleton infants diagnosed with gestational diabetes mellitus in Southeast China in 2019 were retrospectively reviewed. Gestational conditions and neonatal weight were assessed. Results A total of 386 diabetic mothers and infants were enrolled, including 193 in the low birth weight group and 193 in the normal birth weight group. The statistically significant factors were age over 36 years (OR = 1.916, 95% CI 1.048-3.505), junior high school education (OR = 4.454, 95% CI 1.882-10.543), history of fetal distress (OR = 0.120, 95% CI 0.016-0.925), gestational hypertension (OR = 3.681, 95% CI 1.357-9.986), preeclampsia (OR = 24.652, 95% CI 5.956-102.036), threatened preterm birth (OR = 18.393, 95% CI 8.457-39.999), triglycerides (OR = 0.642, 95% CI 0.485-0.850), and inadequate gestational weight gain (OR = 1.997, 95% CI 1.162-3.432). The area under the receiver operating characteristic curve (AUC) was 0.834 (95% CI: 0.794-0.874, p < 0.001), and the sensitivity and specificity were 82.38 and 87.56%, respectively. The goodness-of-fit test likelihood ratio 2 was 2.089 (p = 0.978). The comprehensive nomogram model showed that the discrimination and mean absolute error were 0.834 and 0.015, respectively. The calibration curves showed acceptable agreement between the predictions of the column line plots and the observations. The DCA curves showed good positive net yields in the prediction model. Discussion This study established a prediction model and risk score for low birth weight in pregnant women with GDM. It helps pregnancy clinics to identify the risk of low birth weight in newborns promptly, in addition to glycemic control and weight management for pregnant women with GDM, and should improve the appropriate treatment plan for pregnant women with higher risk, to provide personalized and precise treatment for pregnant women with GDM and improve infant outcomes.
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Affiliation(s)
- Yu-qing Pan
- School of Nursing, Fujian Medical University, Fujian Province, China
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, Fujian, China
| | - Xin-xin Huang
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, Fujian, China
| | - Xiu-min Jiang
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, Fujian, China
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Bai X, Zhu Q, Wang W, Kan S, Hu S, Hao R, Wang S, Shi Z. Second-trimester triglyceride-glucose index to predict adverse outcomes in women with gestational diabetes mellitus: A retrospective multicenter cohort study. J Diabetes Investig 2024; 15:1489-1499. [PMID: 39007538 PMCID: PMC11442862 DOI: 10.1111/jdi.14269] [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: 06/01/2024] [Revised: 06/28/2024] [Accepted: 07/03/2024] [Indexed: 07/16/2024] Open
Abstract
AIMS/INTRODUCTION Women with gestational diabetes mellitus are at high risk for adverse maternal and neonatal outcomes. The study aimed to evaluate the performance of the triglyceride-glucose index in predicting the risk of developing adverse outcomes in women with gestational diabetes mellitus. MATERIALS AND METHODS This retrospective multicenter cohort study included 8,808 pregnant women with gestational diabetes mellitus in two grade-A tertiary hospitals in China during 2018-2022. The triglyceride-glucose index was defined as ln [triglyceride (mg/dL) × fasting blood glucose (mg/dL)/2]. Significant adverse gestational diabetes mellitus outcomes were chosen by generalized linear models as the main outcomes. Multivariable logistic regression models evaluated their association with the triglyceride-glucose index. Areas under the receiver operating characteristic curves predicted adverse pregnancy outcomes. The prediction efficiency was validated in the sensitivity analysis dataset and validation cohort. RESULTS The triglyceride-glucose index was associated with preeclampsia, severe preeclampsia, preterm birth, placenta accreta spectrum, and macrosomia before and after adjusting for confounding factors (P < 0.05). The predictive performance of the triglyceride-glucose index was relatively moderate. Incorporating the triglyceride-glucose index into the baseline clinical risk model improved the area under curves for the diagnosis of preeclampsia (0.749 [0.714-0.784] vs 0.766 [0.734-0.798], P = 0.033) and macrosomia (0.664 [0.644-0.685] vs 0.676 [0.656-0.697], P = 0.002). These predictive models exhibited good calibration and robustness. CONCLUSIONS The triglyceride-glucose index is positively associated with preeclampsia, severe preeclampsia, preterm birth, placenta accreta spectrum, and macrosomia and is useful for the early prediction and prevention of adverse outcomes in women with gestational diabetes mellitus.
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Affiliation(s)
- Xueqi Bai
- Changzhou Maternal and Child Health Care Hospital, Changzhou Medical CenterNanjing Medical UniversityChangzhouChina
| | - Qingyi Zhu
- Nanjing Women and Children's Healthcare HospitalWomen's Hospital of Nanjing Medical UniversityNanjingChina
| | - Wenli Wang
- Changzhou Maternal and Child Health Care Hospital, Changzhou Medical CenterNanjing Medical UniversityChangzhouChina
| | - Sutong Kan
- Changzhou Maternal and Child Health Care Hospital, Changzhou Medical CenterNanjing Medical UniversityChangzhouChina
| | - Shiman Hu
- Changzhou Maternal and Child Health Care Hospital, Changzhou Medical CenterNanjing Medical UniversityChangzhouChina
| | - Runrun Hao
- Changzhou Maternal and Child Health Care Hospital, Changzhou Medical CenterNanjing Medical UniversityChangzhouChina
| | - Shanshan Wang
- Changzhou Maternal and Child Health Care Hospital, Changzhou Medical CenterNanjing Medical UniversityChangzhouChina
| | - Zhonghua Shi
- Changzhou Maternal and Child Health Care Hospital, Changzhou Medical CenterNanjing Medical UniversityChangzhouChina
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Xu X, Luo S, Lin J, Zhou J, Zheng L, Yang L, Zhang Z, Dong Y, Ma M, Li H, Lin S, Xie X, Luo J, Wu S. Association between maternal lipid profiles and lipid ratios in early to middle pregnancy as well as their dynamic changes and gestational diabetes mellitus. BMC Pregnancy Childbirth 2024; 24:510. [PMID: 39075387 PMCID: PMC11285337 DOI: 10.1186/s12884-024-06692-9] [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: 02/02/2024] [Accepted: 07/10/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND Unfavourable lipid and glucose levels may play a crucial role in the pathogenesis of gestational diabetes mellitus (GDM). However, there is a lack of prospective studies on the relationship between lipid profiles, lipid ratios and GDM during pregnancy. AIMS To prospectively investigate the relationship between lipid profile and lipid ratios in early and mid-pregnancy and their pattern of change from early to mid-pregnancy and the risk of GDM. METHODS This nested case-control study was based on maternal and child healthcare hospitals from Fujian Province, China. We included pregnant women who delivered in the hospital from January 2021 to June 2023. Lipid profiles (TC, TG, ApoA1, ApoB, HDL-c, LDL-c) and fasting glucose were measured before 14 weeks of gestation and between 20 and 28 weeks of gestation, and lipid ratios (triglyceride glucose index, TG/HDL-c and TC/HDL-c) was constructed. Logistic regression was used to assess the relationship between lipid profile, lipid ratios and GDM. RESULTS Of 1586 pregnant women, 741 were diagnosed with GDM. After adjusting for potential confounders, TG, ApoA1, ApoB, LDL-c, triglyceride glucose index, TG/HDL-c, and TC/HDL-c in early pregnancy were positively associated with the risk of GDM (odds ratios [95% CI] for extreme interquartile comparisons were 2.040 (1.468-2.843), 1.506 (1.091-2.082), 1.529 (1.110-2.107), 1.504 (1.086-2.086), 1.952 (1.398-2.731), 2.127 (1.526-2.971), and 2.370 (1.700-3.312), all trend P < 0.05). HDL-c was negatively associated with the risk of GDM (0.639: 0.459-0.889, trend P all less than 0.05). Similarly, in mid-pregnancy, lower levels of HDL-c, higher levels of triglyceride glucose index, TG/HDL-c ratio, and TC/HDL-c ratio were associated with increased risk of GDM (all trends P < 0.05). Stably high levels (both ≥ median for early and mid-pregnancy) of triglyceride glucose index, TG/HDL-c and TC/HDL-c were associated with increased risk of GDM (OR [95% CI]: 2.369 (1.438-3.940), 1.588 (1.077-2.341), 1.921 (1.309-2.829), respectively). The opposite was true for HDL-c, where stable high levels were negatively associated with GDM risk (OR [95% CI]: 0.599 (0.405-0.883)). CONCLUSION Increases in triglyceride glucose index, TG/HDL-c ratio, and TC/HDL-c ratio in early and mid-pregnancy, as well as their stable high levels from early to mid-pregnancy, are associated with a higher risk of GDM. In contrast, increased levels of HDL-c, both in early and mid-pregnancy, and their stable high levels from early to mid-pregnancy were associated with a lower risk of GDM. That highlighted their possible clinical relevance in identifying those at high risk of GDM.
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Affiliation(s)
- Xingyan Xu
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Minhou County, Fuzhou, Fujian, China
| | - Suping Luo
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Minhou County, Fuzhou, Fujian, China
| | - Jie Lin
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Minhou County, Fuzhou, Fujian, China
- The Second Attached Hospital of Fujian Medical University, Quanzhou, 362000, China
| | - Jungu Zhou
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Minhou County, Fuzhou, Fujian, China
| | - Liuyan Zheng
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Minhou County, Fuzhou, Fujian, China
| | - Le Yang
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Minhou County, Fuzhou, Fujian, China
| | - Zhiyu Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Minhou County, Fuzhou, Fujian, China
| | - Yuting Dong
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Minhou County, Fuzhou, Fujian, China
| | - Mei Ma
- Department of Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, 350001, China
| | - Huangyuan Li
- Department of Preventive Medicine, School of Public Health, Fujian Medical University, Minhou County, Fuzhou, 350122, China
| | - Shaowei Lin
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Minhou County, Fuzhou, Fujian, China
| | - Xiaoxu Xie
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Minhou County, Fuzhou, Fujian, China.
| | - Jinying Luo
- Department of Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, 350001, China.
| | - Siying Wu
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Minhou County, Fuzhou, Fujian, China.
- Department of Epidemiology and Health Statistics, the Key Laboratory of Environment and Health among Universities and Colleges in Fujian, School of Public Health, Fujian Medical University, Minhou County, Fuzhou, China.
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Zhu YT, Xiang LL, Chen YJ, Zhong TY, Wang JJ, Zeng Y. Developing and validating a predictive model of delivering large-for-gestational-age infants among women with gestational diabetes mellitus. World J Diabetes 2024; 15:1242-1253. [PMID: 38983822 PMCID: PMC11229959 DOI: 10.4239/wjd.v15.i6.1242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 03/05/2024] [Accepted: 04/25/2024] [Indexed: 06/11/2024] Open
Abstract
BACKGROUND The birth of large-for-gestational-age (LGA) infants is associated with many short-term adverse pregnancy outcomes. It has been observed that the proportion of LGA infants born to pregnant women with gestational diabetes mellitus (GDM) is significantly higher than that born to healthy pregnant women. However, traditional methods for the diagnosis of LGA have limitations. Therefore, this study aims to establish a predictive model that can effectively identify women with GDM who are at risk of delivering LGA infants. AIM To develop and validate a nomogram prediction model of delivering LGA infants among pregnant women with GDM, and provide strategies for the effective prevention and timely intervention of LGA. METHODS The multivariable prediction model was developed by carrying out the following steps. First, the variables that were associated with LGA risk in pregnant women with GDM were screened by univariate analyses, for which the P value was < 0.10. Subsequently, Least Absolute Shrinkage and Selection Operator regression was fit using ten cross-validations, and the optimal combination factors were selected by choosing lambda 1se as the criterion. The final predictors were determined by multiple backward stepwise logistic regression analysis, in which only the independent variables were associated with LGA risk, with a P value < 0.05. Finally, a risk prediction model was established and subsequently evaluated by using area under the receiver operating characteristic curve, calibration curve and decision curve analyses. RESULTS After using a multistep screening method, we establish a predictive model. Several risk factors for delivering an LGA infant were identified (P < 0.01), including weight gain during pregnancy, parity, triglyceride-glucose index, free tetraiodothyronine level, abdominal circumference, alanine transaminase-aspartate aminotransferase ratio and weight at 24 gestational weeks. The nomogram's prediction ability was supported by the area under the curve (0.703, 0.709, and 0.699 for the training cohort, validation cohort, and test cohort, respectively). The calibration curves of the three cohorts displayed good agreement. The decision curve showed that the use of the 10%-60% threshold for identifying pregnant women with GDM who are at risk of delivering an LGA infant would result in a positive net benefit. CONCLUSION Our nomogram incorporated easily accessible risk factors, facilitating individualized prediction of pregnant women with GDM who are likely to deliver an LGA infant.
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Affiliation(s)
- Yi-Tian Zhu
- Department of Clinical Laboratory, Jinling Clinical Medical College of Nanjing Medical University, Nanjing 210002, Jiangsu Province, China
- Department of Clinical Laboratory, Women’s Hospital of Nanjing Medical University, Nanjing Women and Children’s Healthcare Hospital, Nanjing 210003, Jiangsu Province, China
| | - Lan-Lan Xiang
- Department of Clinical Laboratory, Women’s Hospital of Nanjing Medical University, Nanjing Women and Children’s Healthcare Hospital, Nanjing 210003, Jiangsu Province, China
| | - Ya-Jun Chen
- Department of Clinical Laboratory, Women’s Hospital of Nanjing Medical University, Nanjing Women and Children’s Healthcare Hospital, Nanjing 210003, Jiangsu Province, China
| | - Tian-Ying Zhong
- Department of Clinical Laboratory, Women’s Hospital of Nanjing Medical University, Nanjing Women and Children’s Healthcare Hospital, Nanjing 210003, Jiangsu Province, China
| | - Jun-Jun Wang
- Department of Clinical Laboratory, Jinling Clinical Medical College of Nanjing Medical University, Nanjing 210002, Jiangsu Province, China
| | - Yu Zeng
- Department of Clinical Laboratory, Women’s Hospital of Nanjing Medical University, Nanjing Women and Children’s Healthcare Hospital, Nanjing 210003, Jiangsu Province, China
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Zhang J, Yin B, Xi Y, Bai Y. Triglyceride-glucose index: A promising biomarker for predicting risks of adverse pregnancy outcomes in Hangzhou, China. Prev Med Rep 2024; 41:102683. [PMID: 38524277 PMCID: PMC10957496 DOI: 10.1016/j.pmedr.2024.102683] [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: 10/13/2023] [Revised: 03/10/2024] [Accepted: 03/11/2024] [Indexed: 03/26/2024] Open
Abstract
Introduction The triglyceride-glucose (TyG) index has been recommended as an alternative indicator of insulin resistance (IR). However, the association between the TyG index and adverse pregnancy outcomes remains to be elucidated. Methods The present retrospective study was conducted at Women's Hospital, Zhejiang University School of Medicine and involved a total of 8,514 participants. Maternal fasting lipid profiles and glucose concentrations were measured. Based on the TyG index, the participants were categorized into quartiles. Logistic regression analysis was used to calculate odds ratios (ORs) for each quartile with reference to the first quartile, while receiver operating characteristic (ROC) curve analysis, Hosmer-Lemeshow test, and calibration curve analysis were employed to evaluate the predictive ability of the TyG index for adverse pregnancy outcomes. Results The TyG index was higher in patients with preeclampsia, preterm birth, and macrosomia. On univariate analysis, there was an increased risk of developing adverse pregnancy outcomes with increasing quartiles of the TyG. After adjusting for potential confounders in multivariable logistic regression analysis, a positive independent correlation was found between the TyG index and preeclampsia, preterm birth, and macrosomia. In ROC curve analysis for predicting the risks of preeclampsia, preterm birth, and macrosomia, the area under the curve (AUC) could reach 0.665, 0.588, and 0.606, respectively. These predictive models demonstrated good calibration (all P > 0.05). Conclusions The TyG index showed a good predictive capacity for assessing the risk of adverse pregnancy outcomes, and it should receive sufficient clinical attention.
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Affiliation(s)
- Jinghua Zhang
- Department of Clinical Laboratory, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Binbin Yin
- Department of Clinical Laboratory, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ya Xi
- Department of Central Laboratory, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Yongying Bai
- Department of Clinical Laboratory, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Guo Y, Lu J, Bahani M, Ding G, Wang L, Zhang Y, Zhang H, Liu C, Zhou L, Liu X, Li F, Wang X, Ding H. Triglyceride-glucose index in early pregnancy predicts the risk of gestational diabetes: a prospective cohort study. Lipids Health Dis 2024; 23:87. [PMID: 38528508 PMCID: PMC10962154 DOI: 10.1186/s12944-024-02076-2] [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: 01/04/2024] [Accepted: 03/10/2024] [Indexed: 03/27/2024] Open
Abstract
OBJECTIVE This study aimed to investigate the association between the triglyceride-glucose (TyG) index in early pregnancy and the development of gestational diabetes mellitus (GDM) in the second trimester. The primary objectives were to evaluate the predictive potential of the TyG index for GDM, determine the optimal threshold value of the TyG index for GDM assessment, and compare the predictive performance of the TyG index alone versus its combination with maternal age and pre-pregnancy body mass index on GDM. Moreover, the study explored the association between the TyG index in early pregnancy and the risk of other pregnancy-related complications (PRCs), such as placental abruption and gestational hypertension. PATIENTS AND METHODS This prospective cohort study recruited 1,624 pregnant women who underwent early pregnancy antenatal counseling and comprehensive assessments with continuous monitoring until delivery. To calculate the TyG index, health indicators, including maternal triglycerides and fasting plasma glucose, were measured in early pregnancy (< 14 weeks of gestation). The predictive power of the TyG index for evaluating GDM in Chinese pregnant women was determined using multifactorial logistic regression to derive the odds ratios and 95% confidence interval (CI). Subgroup analyses were conducted, and the efficacy of the TyG index in predicting PRCs was assessed via receiver operating characteristic (ROC) curve analysis and restricted cubic spline, with the optimal cutoff value calculated. RESULTS Logistic regression analyses revealed a 2.10-fold increase in the GDM risk for every 1-unit increase in the TyG index, after adjusting for covariates. The highest GDM risk was observed in the group with the highest TyG index compared with the lowest quintile group (odds ratios: 3.25; 95% CI: 2.23-4.75). Subgroup analyses indicated that exceeding the recommended range of gestational weight gain and an increased GDM risk were significantly associated (P = 0.001). Regarding predictive performance, the TyG index exhibited the highest area under the curve (AUC) value in the ROC curve for GDM (AUC: 0.641, 95% CI: 0.61-0.671). The optimal cutoff value was 8.890, with both sensitivity and specificity of 0.617.The combination of the TyG index, maternal age, and pre-pregnancy body mass index proved to be a superior predictor of GDM than the TyG index alone (AUC: 0.672 vs. 0.641, P < 0.01). After adjusting for multiple factors, the analyses indicated that the TyG index was associated with an increased risk of gestational hypertension. However, no significant association was noted between the TyG index and the risk of preeclampsia, placental abruption, intrauterine distress, or premature rupture of membranes. CONCLUSION The TyG index can effectively identify the occurrence of GDM in the second trimester, aligning with previous research. Incorporating the TyG index into routine clinical assessments of maternal health holds significant practical implications. Early identification of high-risk groups enables healthcare providers to implement timely interventions, such as increased monitoring frequency for high-risk pregnant women and personalized nutritional counseling and health education. These measures can help prevent or alleviate potential maternal and infant complications, thereby enhancing the overall health outcomes for both mothers and babies.
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Affiliation(s)
- Yufeng Guo
- Department of Public Health, Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, 830000, China
| | - Junwen Lu
- Department of Public Health, Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, 830000, China
| | - Mailiman Bahani
- Department of Public Health, Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, 830000, China
| | - Guifeng Ding
- Urumqi Maternal and Child Health Hospital, Urumqi, Xinjiang Uygur Autonomous Region, 830000, China
| | - Lei Wang
- Urumqi Maternal and Child Health Hospital, Urumqi, Xinjiang Uygur Autonomous Region, 830000, China
| | - Yuxia Zhang
- Urumqi Maternal and Child Health Hospital, Urumqi, Xinjiang Uygur Autonomous Region, 830000, China
| | - Huanmei Zhang
- Department of Maternal and Child Nutrition, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, 100050, China
| | - Chengyao Liu
- Department of Public Health, Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, 830000, China
| | - Lijun Zhou
- Department of Public Health, Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, 830000, China
| | - Xiaolan Liu
- Department of Public Health, Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, 830000, China
| | - Fangshen Li
- Department of Public Health, Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, 830000, China
| | - Xiaoli Wang
- Maternal and Child Health Care Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang Uygur Autonomous Region, 830000, China
| | - Hong Ding
- Department of Public Health, Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, 830000, China.
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Mo Z, Cao C, Han Y, Hu H, He Y, Zuo X. Relationships between triglyceride-glucose index and incident gestational diabetes mellitus: a prospective cohort study of a Korean population using publicly available data. Front Public Health 2024; 12:1294588. [PMID: 38414896 PMCID: PMC10896852 DOI: 10.3389/fpubh.2024.1294588] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 01/29/2024] [Indexed: 02/29/2024] Open
Abstract
Background The connection between the triglyceride-glucose index (TyG index) and gestational diabetes mellitus (GDM) is currently debated. Our study aimed to investigate the connection between the TyG index and GDM within the Korean population. Methods Using publically accessible data in Korea, we performed a secondary study on a sample of 589 pregnant women who were carrying a single fetus. The analysis employed a binary logistic regression model, some sensitivity analyses, and subgroup analysis to investigate the association between the TyG index and the occurrence of GDM. To assess the TyG index's potential to predict GDM, a receiver operating characteristic (ROC) study was also carried out. Results The mean age of the pregnant women was 32.065 ± 3.798 years old, while the mean TyG index was 8.352 ± 0.400. The prevalence rate of GDM was found to be 6.112%. Upon adjusting for potential confounding variables, a positive association was detected between the TyG index and incident GDM (OR = 12.923, 95%CI: 3.581-46.632, p = 0.00009). The validity of this connection was further confirmed by subgroup analysis and sensitivity analyses. With an area under the ROC curve of 0.807 (95%CI: 0.734-0.879), the TyG index showed strong predictive power for GDM. The TyG index's ideal cutoff value for detecting GDM was found to be 8.632, with a sensitivity of 78.7% and a specificity of 72.2%. Conclusion The findings of our study provide evidence that an increased TyG index is significantly associated with the occurrence of GDM. Utilizing the TyG index during the 10-14 week gestational period may be a valuable tool in identifying pregnant individuals at a heightened risk for developing GDM. Early detection enables timely and efficacious interventions, thereby enhancing the prognosis of affected individuals.
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Affiliation(s)
- Zihe Mo
- Department of Physical Examination, DongGuan Tungwah Hospital, Dongguan, Guangdong, China
| | - Changchun Cao
- Department of Rehabilitation, Shenzhen Dapeng New District Nan'ao People's Hospital, Shenzhen, Guangdong, China
| | - Yong Han
- Department of Emergency, Shenzhen Second People's Hospital and The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
| | - Haofei Hu
- Department of Nephrology, Shenzhen Second People's Hospital and The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
| | - Yongcheng He
- Department of Nephrology, Shenzhen Hengsheng Hospital, Shenzhen, Guangdong, China
- Department of Nephrology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Xin Zuo
- Department of Endocrinology, Shenzhen Third People's Hospital, Shenzhen, Guangdong, China
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Yen IW, Lin SY, Lin MW, Lee CN, Kuo CH, Chen SC, Tai YY, Kuo CH, Kuo HC, Lin HH, Juan HC, Lin CH, Fan KC, Wang CY, Li HY. The association between plasma angiopoietin-like protein 4, glucose and lipid metabolism during pregnancy, placental function, and risk of delivering large-for-gestational-age neonates. Clin Chim Acta 2024; 554:117775. [PMID: 38220135 DOI: 10.1016/j.cca.2024.117775] [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: 09/11/2023] [Revised: 12/18/2023] [Accepted: 01/08/2024] [Indexed: 01/16/2024]
Abstract
BACKGROUND Large-for-gestational-age (LGA) neonates have increased risk of adverse pregnancy outcomes and adult metabolic diseases. We aimed to investigate the relationship between plasma angiopoietin-like protein 4 (ANGPTL4), a protein involved in lipid and glucose metabolism during pregnancy, placental function, growth factors, and the risk of LGA. METHODS We conducted a prospective cohort study and recruited women with singleton pregnancies at the National Taiwan University Hospital between 2013 and 2018. First trimester maternal plasma ANGPTL4 concentrations were measured. RESULTS Among 353 pregnant women recruited, the LGA group had higher first trimester plasma ANGPTL4 concentrations than the appropriate-for-gestational-age group. Plasma ANGPTL4 was associated with hemoglobin A1c, post-load plasma glucose, plasma triglyceride, plasma free fatty acid concentrations, plasma growth hormone variant (GH-V), and birth weight, but was not associated with cord blood growth factors. After adjusting for age, body mass index, hemoglobin A1c, and plasma triglyceride concentrations, plasma ANGPTL4 concentrations were significantly associated with LGA risk, and its predictive performance, as measured by the area under the receiver operating characteristic curve, outperformed traditional risk factors for LGA. CONCLUSIONS Plasma ANGPTL4 is associated with glucose and lipid metabolism during pregnancy, plasma GH-V, and birth weight, and is an early biomarker for predicting the risk of LGA.
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Affiliation(s)
- I-Weng Yen
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu County, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shin-Yu Lin
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Wei Lin
- Department of Obstetrics and Gynecology, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu County, Taiwan
| | - Chien-Nan Lee
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chun-Heng Kuo
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Internal Medicine, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan
| | | | - Yi-Yun Tai
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ching-Hua Kuo
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei 100, Taiwan; The Metabolomics Core Laboratory, Centers of Genomic and Precision Medicine, National Taiwan University, Taipei 100, Taiwan
| | - Han-Chun Kuo
- The Metabolomics Core Laboratory, Centers of Genomic and Precision Medicine, National Taiwan University, Taipei 100, Taiwan
| | - Heng-Huei Lin
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsien-Chia Juan
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chia-Hung Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan
| | - Kang-Chih Fan
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu County, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chih-Yuan Wang
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan
| | - Hung-Yuan Li
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan.
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Li X, Bai L, Niu Z, Lu Q. Correlation Between Neck Circumference and Gestational Diabetes. Diabetes Metab Syndr Obes 2023; 16:4179-4185. [PMID: 38155931 PMCID: PMC10752816 DOI: 10.2147/dmso.s439413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 12/21/2023] [Indexed: 12/30/2023] Open
Abstract
Purpose The objective of this study was to explore whether neck circumference can serve as an early predictor of the risk of Gestational Diabetes (GDM). Patients and Methods A total of 318 singleton pregnant women who underwent routine prenatal examinations at Qinhuangdao Maternal and Child Health Hospital from September 2017 to September 2020 were selected and categorized into the GDM group and the normal glucose tolerance group (NGT) based on the results of the oral glucose tolerance test (OGTT) conducted during the second trimester. The general information and laboratory test results were compared and analyzed. Inter-group comparison was conducted using the t-test, and multivariate logistic regression analysis was employed to analyze the independent risk factors of GDM. The predictive threshold of various indicators for GDM occurrence during pregnancy was determined using the subject's work curve. Results The GDM group exhibited significantly higher levels of pre-pregnancy weight, pre-pregnancy BMI, neck circumference, waist circumference, hip circumference, triglycerides (TG), uric acid (UA), TG/HDL-C ratio, and waist-hip ratio compared to the NGT group. Additionally, HDL cholesterol (HDL-C) levels were significantly lower in the GDM group, and blood glucose levels at each point of the OGTT were markedly higher compared to the NGT group (P<0.05). Multivariate logistic regression analysis revealed that neck circumference (OR=1.239, P<0.001) and early pregnancy TG (OR=1.842, P<0.001) were independent risk factors for GDM. The receiver operating characteristic analysis demonstrated that the optimal critical value of neck circumference for predicting GDM was 32.6 cm, with a sensitivity of 50% and specificity of 74.3%. Conclusion The neck circumference during early pregnancy was found to be related to GDM, and the predictive cutoff point of 32.6 cm for neck circumference could be employed as a simple index to predict GDM in early pregnancy.
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Affiliation(s)
- Xiaojing Li
- Department of Obstetrics, First Hospital of Qinhuangdao, Qinhuangdao, Hebei, 066000, People’s Republic of China
| | - Liwei Bai
- Department of Obstetrics, Qinhuangdao Hospital for Maternal and Child Health, Qinhuangdao, Hebei, 066000, People’s Republic of China
| | - Ziru Niu
- Department of Endocrinology, First Hospital of Qinhuangdao, Qinhuangdao, Hebei, 066000, People’s Republic of China
| | - Qiang Lu
- Department of Endocrinology, First Hospital of Qinhuangdao, Qinhuangdao, Hebei, 066000, People’s Republic of China
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Cao Y, Sheng J, Zhang D, Chen L, Jiang Y, Cheng D, Su Y, Yu Y, Jia H, He P, Wang L, Xu X. The role of dietary fiber on preventing gestational diabetes mellitus in an at-risk group of high triglyceride-glucose index women: a randomized controlled trial. Endocrine 2023; 82:542-549. [PMID: 37737931 DOI: 10.1007/s12020-023-03478-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 08/01/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Pregnant women with a high triglyceride-glucose (TyG) index during early pregnancy may increase the risk of gestational diabetes mellitus (GDM), and dietary fiber could play an important role in glucose and lipid metabolism. However, no trials have tested the effects of dietary fiber on preventing GDM in women with a high TyG index. This study aims to investigate whether GDM can be prevented by dietary fiber supplementation in women with a TyG index ≥8.5 during early pregnancy (<20 weeks). METHODS A randomized clinical trial was performed among 295 women with a TyG index ≥8.5 before 20 weeks of gestation, divided into a fiber group (24 g dietary fiber powder/day) or a control group (usual care). The intervention was conducted from 20 to 24+6 gestational weeks, and both groups received guidance on exercise and diet. The primary outcomes were the incidence of GDM diagnosed by a 75 g oral glucose tolerance test at 25-28 gestational weeks, and levels of maternal blood glucose, lipids. Secondary outcomes include gestational hypertension, postpartum hemorrhage, preterm birth, and other maternal and neonatal complications. RESULTS GDM occurred at 11.2% (10 of 89) in the fiber group, which was significantly lower than 23.7 (44 of 186) in the control group (P = 0.015). The mean gestational weeks increased dramatically in the fiber group compared with the control group (39.07 ± 1.08 vs. 38.58 ± 1.44 weeks, P = 0.006). The incidence of preterm birth was 2.3% (2 of 86) of women randomized to the fiber group compared with 9.4% (17 of 181) in the control group (P = 0.032). The concentrations of 2 h postprandial blood glucose showed statistically higher in the control group compared with the intervention group (6.69 ± 1.65 vs. 6.45 ± 1.25 mmol/L, P = 0.026). There were no other significant differences between groups in lipid profile values, or other secondary outcomes. CONCLUSION An intervention with dietary fiber supplementation during pregnancy may prevent GDM and preterm birth in women with a TyG index ≥8.5 before 20 weeks of gestation.
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Affiliation(s)
- Yannan Cao
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 201600, China
| | - Jing Sheng
- Department of Radiology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200062, China
| | - Dongyao Zhang
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 201600, China
- Department of Obstetrics and Gynecology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Li Chen
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 201600, China
| | - Ying Jiang
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 201600, China
- Nursing Department, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 201600, China
| | - Decui Cheng
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 201600, China
| | - Yao Su
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 201600, China
| | - Yuexin Yu
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 201600, China
| | - Haoyi Jia
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 201600, China
| | - Pengyuan He
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 201600, China
| | - Li Wang
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 201600, China
| | - Xianming Xu
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 201600, China.
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Wei J, Shen N, Shi C, Li N, Yin C, Feng Y, Lu H, Yang X, Zhou L. Exploration of Serum lipid levels during twin pregnancy. J Matern Fetal Neonatal Med 2023; 36:2254891. [PMID: 37710986 DOI: 10.1080/14767058.2023.2254891] [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: 01/30/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 09/16/2023]
Abstract
Objective: This study aims to characterize changes in serum lipid levels throughout twin pregnancies and explore the relationship between lipid levels and gestational diabetes mellitus (GDM) and hypertensive disorders complicating pregnancy (HDCP).Methods: We retrospectively studied 297 twin pregnancies of women who received regular prenatal care and delivered at the Beijing Obstetrics and Gynecology Hospital over a period of two years. Demographic and medical data of the participants were collected by questionnaires and medical records review. Serum lipid levels were measured in the first trimester (6-13 weeks), second trimester (24-28 weeks), and third trimester (34-37 weeks). A multivariate regression model was constructed to examine the association between lipid levels and pregnancy complications. A decision tree was used to explore the relationship between early serum lipid glucose levels and GDM and HDCP in twin pregnancies.Results: Triglyceride (TG), total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) levels increased significantly from the first trimester to the third trimester, with the exception of high-density lipoprotein cholesterol (HDL-C), which decreased in the third trimester in twin pregnancies (p < 0.001). The levels of TC in the GDM and HDCP group were significantly elevated compared to those in the normal group in early pregnancies (p < 0.05, p < 0.05). In the second trimester, TG in the HDCP group was substantially higher than that in the normal group (p = 0.01). In the third trimester, LDL-C and HDL-C levels in the GDM group are significantly lower than that in the normal group (p < 0.05, p < 0.05). After adjusting for confounders, body mass index (BMI) is independently associated with GDM (odds ratio [OR] = 1.129, 95% confidence interval [CI]: 1.007-1.266) and HDCP(odds ratio [OR] = 1.170, 95% confidence interval [CI]: 1.031-1.329). The variation amplitude of HDL-C in the third trimester is related to the occurrence of GDM and HDCP(GDM:OR = 0.271, 95%CI: 0.095-0.778; HDCP: OR =0.249, 95% CI: 0.075-0.823). TG and TC levels in DCDA twins were significantly higher than that in MCDA twins in the first trimester(TG: p < 0.05, TC: p < 0.05). In the decision tree model for GDM, fasting blood glucose in the first trimester (FBG), TC, and pre-pregnancy BMI were identified as important nodes, while in the HDCP model, pre-pregnancy BMI, TC, and TG were key nodes.Conclusion: Serum lipid levels in twin pregnancies increase gradually during pregnancy. BMI is independently associated with the occurrence of GDM and HDCP. HDL-C may serve as a protective factor for GDM and HDCP. The predictive effect of early blood lipid on GDM and HDCP in twin pregnancy needs further study.
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Affiliation(s)
- Jianxia Wei
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
- Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Nan Shen
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
- Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Cuixia Shi
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
- Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Na Li
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
- Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Chunnan Yin
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
- Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Yi Feng
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
- Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Hongyan Lu
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
- Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Xiaokui Yang
- Beijing Maternal and Child Health Care Hospital, Beijing, China
- Department of Human Reproductive Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Li Zhou
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
- Beijing Maternal and Child Health Care Hospital, Beijing, China
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Cui S, Zhu X, Li S, Zhang C. Study on the predictive value of serum hypersensitive C-reactive protein, homocysteine, fibrinogen, and omentin-1 levels with gestational diabetes mellitus. Gynecol Endocrinol 2023; 39:2183046. [PMID: 36996863 DOI: 10.1080/09513590.2023.2183046] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/01/2023] Open
Abstract
Objective: To investigate whether hypersensitive C-reactive protein (Hs-CRP), homocysteine, fibrinogen, and omentin-1 could predict gestational diabetes mellitus (GDM) risk. Methods: Case-control study was conducted at Hengshui People's Hospital. The GDM group included data about 150 patients aged between 22 and 35 years in 24-28 weeks. An equivalent comparative control group without GDM was composed of the same pool of patients. Body mass index (BMI), total cholesterol (TC), triglyceride, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), oral glucose tolerance test (OGTT) 0-2h, hs-CRP, homocysteine, fibrinogen, and omentin-1 levels were studied in the serum samples of research groups. Univariate logistic regression analysis was used to explore the risk factors of GDM. The area under the curve (AUC) was calculated by the receiver operating characteristic curve (ROC) to analyze the predictive values. Results: Hs-CRP, homocysteine, and fibrinogen in GDM group were significantly higher than those in non-GDM group. Omentin-1 were significantly lower than those in non-GDM group. Logistic regression showed that hs-CRP, homocysteine, fibrinogen, and omentin-1 were risk factors for GDM. The AUC of the established GDM risk prediction model was 0.977, and the sensitivity and specificity were 92.10% and 98.70%, respectively; which were greater than that of hs-CRP, homocysteine, fibrinogen, and omentin-1 alone. Conclusions: Hs-CRP, homocysteine, fibrinogen, and omentin-1 in pregnancy have important clinical value for the prediction of GDM. We used these laboratory indications to establish a GDM risk prediction model that allows for early detection and treatment of GDM, lowering the morbidity of maternal and infant complications.
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Affiliation(s)
- Shaoyong Cui
- Department of Clinical Laboratory, Hengshui People's Hospital, Hengshui, China
| | - Xiaocui Zhu
- Department of Clinical Laboratory, Hengshui People's Hospital, Hengshui, China
| | - Sen Li
- Department of Clinical Laboratory, Hengshui People's Hospital, Hengshui, China
| | - Changgeng Zhang
- Department of Clinical Laboratory, Hengshui People's Hospital, Hengshui, China
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19
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Liu PJ, Ma L, Li R, Liu Y. The Association Between the Imbalance of Single-Carbon Nutrients in Early Pregnancy and Gestational Diabetes Mellitus Risk is Influenced by Serum Selenium Status: A Cohort Study. Diabetes Metab Syndr Obes 2023; 16:3275-3283. [PMID: 37881350 PMCID: PMC10596188 DOI: 10.2147/dmso.s428286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/10/2023] [Indexed: 10/27/2023] Open
Abstract
Purpose The role of imbalanced one-carbon nutrients in gestational diabetes mellitus (GDM) risk has garnered significant interest, yet existing studies yield inconsistent results. Our objective was to assess whether the association between an unbalanced ratio of folate to vitamin B12 and GDM risk is influenced by the status of other micronutrients. Methods This cohort study included 366 singleton-pregnancy Han women enrolled at the Shunyi District Maternal and Child Health Hospital in Beijing, China. During the first trimester of pregnancy, we measured red blood cell (RBC) folate, serum levels of vitamin B12, vitamin D, and selenium. We examined the association between the imbalanced status of RBC folate and vitamin B12 and GDM risk using logistic regression, stratified by serum selenium or vitamin D status. Results Among the 366 women, 67 (18.3%) were diagnosed with GDM, 201 (54.9%) had vitamin D deficiency, and 245 (66.9%) had selenium deficiency. Overall, women with higher RBC folate/vitamin B12 ratios did not exhibit a significantly higher risk of GDM compared to those in reference tertile (all P > 0.05). Subsequently, we divided women into deficient and non-deficient groups based on serum selenium or vitamin D levels. In women with selenium deficiency, those in the highest tertile of the RBC folate/vitamin B12 ratio had the highest odds of GDM [OR: 3.40 (1.16-9.97), P=0.026] after adjusting for covariates. However, similar findings were not observed in pregnancies with normal selenium status. Irrespective of vitamin D status, women with higher RBC folate/vitamin B12 ratios did not exhibit a significantly increased risk of GDM. Conclusion Micronutrient deficiencies are common in early pregnancy. Women with a higher folate/vitamin B12 ratio coupled with selenium deficiency in early pregnancy have a higher GDM risk. These findings underscore the importance of micronutrient assessment in early pregnancy and subsequent interventions for micronutrient deficiencies.
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Affiliation(s)
- Peng Ju Liu
- Department of Clinical Nutrition, Peking Union Medical College Hospital, China Academic Medical Science and Peking Union Medical College, Beijing, People’s Republic of China
| | - Liangkun Ma
- Department of Gynaecology and Obstetrics, Peking Union Medical College Hospital, China Academic Medical Science and Peking Union Medical College, Beijing, People’s Republic of China
| | - Rui Li
- Department of Clinical Nutrition, Peking Union Medical College Hospital, China Academic Medical Science and Peking Union Medical College, Beijing, People’s Republic of China
| | - Yanping Liu
- Department of Clinical Nutrition, Peking Union Medical College Hospital, China Academic Medical Science and Peking Union Medical College, Beijing, People’s Republic of China
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20
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Zeng Y, Yin L, Yin X, Zhao D. Association of triglyceride-glucose index levels with gestational diabetes mellitus in the US pregnant women: a cross-sectional study. Front Endocrinol (Lausanne) 2023; 14:1241372. [PMID: 37881497 PMCID: PMC10597685 DOI: 10.3389/fendo.2023.1241372] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 09/25/2023] [Indexed: 10/27/2023] Open
Abstract
Objective This investigation aimed to assess the correlation between the triglyceride-glucose (TyG) index and gestational diabetes mellitus (GDM) in pregnant women in the United States. Methods We calculated the TyG index utilizing data from pregnant women who participated in the National Health and Nutrition Examination Survey (NHANES) through 1999 to March 2020, and then employed multivariate logistic regression, smoothed curve fitting, and subgroup analysis to investigate the association between the TyG index and gestational diabetes during pregnancy. Results Logistic regression models revealed a positive association between the TyG index and GDM, remaining significant even after adjusting for all confounding variables (OR=3.43, 95% CI: 1.20-9.85, P = 0.0216). Subgroup analysis demonstrated consistent correlations and showed that there is no difference in the TyG index among first trimester subgroup. The TyG index had limited diagnostic efficacy for GDM (AUC=0.57, 95% CI: 0.50-0.63). Conclusion The TyG index correlates positively with the GDM, however its diagnostic efficacy is limited. Further research on the TyG index as an early predictor of GDM is required.
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Affiliation(s)
- Yan Zeng
- Department of Obstetrics and Gynecology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
- Guiyang Maternal and Child Health Care Hospital, Guiyang Children’s Hospital, Guizhou Medical University, Guiyang, China
| | - Li Yin
- Department of Obstetrics and Gynecology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Xiaoping Yin
- Department of Obstetrics and Gynecology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Danqing Zhao
- Department of Obstetrics and Gynecology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
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21
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You Y, Hu H, Cao C, Han Y, Tang J, Zhao W. Association between the triglyceride to high-density lipoprotein cholesterol ratio and the risk of gestational diabetes mellitus: a second analysis based on data from a prospective cohort study. Front Endocrinol (Lausanne) 2023; 14:1153072. [PMID: 37576966 PMCID: PMC10415043 DOI: 10.3389/fendo.2023.1153072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 06/30/2023] [Indexed: 08/15/2023] Open
Abstract
Background Although there is strong evidence linking triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio to insulin resistance and diabetes mellitus, its clinical importance in pregnant women has not been well determined. This study sought to determine the connection between the TG/HDL-C ratio in the first trimester and the eventual onset of gestational diabetes mellitus (GDM). Methods We performed a secondary analysis of open-access data from a prospective cohort study. This present study included 590 singleton pregnant women at 10-14 weeks who visited the outpatient clinics for prenatal checks and were recorded at Incheon Seoul Women's Hospital and Seoul Metropolitan Government Seoul National University Boramae Medical Center in Korea. A binary logistic regression model, a series of sensitivity analyses, and subgroup analysis were used to examine the relationship between TG/HDL-C ratio and incident GDM. A receiver operating characteristic (ROC) analysis was also conducted to assess the ability of the TG/HDL-C ratio to predict GDM. Results The mean age of the included individuals was 32.06 ± 3.80 years old. The mean TG/HDL-C ratio was 1.96 ± 1.09. The incidence rate of GDM was 6.27%. After adjustment for potentially confounding variables, TG/HDL-C ratio was positively associated with incident GDM (OR=1.77, 95%CI: 1.32-2.38, P=0.0001). Sensitivity analyses and subgroup analysis demonstrated the validity of the relationship between the TG/HDL-C ratio and GDM. The TG/HDL-C ratio was a good predictor of GDM, with an area under the ROC curve of 0.7863 (95% CI: 0.7090-0.8637). The optimal TG/HDL-C ratio cut-off value for detecting GDM was 2.2684, with a sensitivity of 72.97% and specificity of 75.05%. Conclusion Our results demonstrate that the elevated TG/HDL-C ratio is related to incident GDM. The TG/HDL-C ratio at 10-14 weeks could help identify pregnant women at risk for GDM and may make it possible for them to receive early and effective treatment to improve their prognosis.
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Affiliation(s)
- Yun You
- Department of Obstetrics, Shantou University Medical College, Shantou, Guangdong, China
- Department of Obstetrics, Shenzhen Second People’s Hospital, Shenzhen, Guangdong, China
| | - Haofei Hu
- Department of Nephrology, Shenzhen Second People’s Hospital, Shenzhen, Guangdong, China
| | - Changchun Cao
- Department of Rehabilitation, Shenzhen Dapeng New District Nan’ao People’s Hospital, Shenzhen, Guangdong, China
| | - Yong Han
- Department of Emergency, Shenzhen Second People’s Hospital, Shenzhen, Guangdong, China
| | - Jie Tang
- Department of Obstetrics, Shenzhen Second People’s Hospital, Shenzhen, Guangdong, China
| | - Weihua Zhao
- Department of Obstetrics, Shantou University Medical College, Shantou, Guangdong, China
- Department of Obstetrics, Shenzhen Second People’s Hospital, Shenzhen, Guangdong, China
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22
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Ouyang P, Duan S, You Y, Jia X, Yang L. Risk prediction of gestational diabetes mellitus in women with polycystic ovary syndrome based on a nomogram model. BMC Pregnancy Childbirth 2023; 23:408. [PMID: 37268889 DOI: 10.1186/s12884-023-05670-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 05/03/2023] [Indexed: 06/04/2023] Open
Abstract
Women with polycystic ovary syndrome are prone to develop gestational diabetes mellitus, a disease which may have significant impact on the postpartum health of both mother and infant. We performed a retrospective cohort study to develop and test a model that could predict gestational diabetes mellitus in the first trimester in women with polycystic ovary syndrome. Our study included 434 pregnant women who were referred to the obstetrics department between December 2017 and March 2020 with a diagnosis of polycystic ovary syndrome. Of these women, 104 were diagnosed with gestational diabetes mellitus in the second trimester. Univariate analysis revealed that in the first trimester, Hemoglobin A1c (HbA1C), age, total cholesterol(TC), low-density lipoprotein cholesterol (LDL-C), SBP (systolic blood pressure), family history, body mass index (BMI), and testosterone were predictive factors of gestational diabetes mellitus (P < 0.05). Logistic regression revealed that TC, age, HbA1C, BMI and family history were independent risk factors for gestational diabetes mellitus. The area under the ROC curve of the gestational diabetes mellitus risk prediction model was 0.937 in this retrospective analysis, demonstrating a great discriminatory ability. The sensitivity and specificity of the prediction model were 0.833 and 0.923, respectively. The Hosmer-Lemeshow test also showed that the model was well calibrated.
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Affiliation(s)
- Peilin Ouyang
- Hunan Provincial Maternal and Child Health Care Hospital, 53, Xiangchun Road, Changsha, Hunan, People's Republic of China
| | - Siqi Duan
- Hunan Provincial Maternal and Child Health Care Hospital, 53, Xiangchun Road, Changsha, Hunan, People's Republic of China
| | - Yiping You
- Hunan Provincial Maternal and Child Health Care Hospital, 53, Xiangchun Road, Changsha, Hunan, People's Republic of China
| | - Xiaozhou Jia
- Hunan Provincial Maternal and Child Health Care Hospital, 53, Xiangchun Road, Changsha, Hunan, People's Republic of China
| | - Liqin Yang
- Hunan Provincial Maternal and Child Health Care Hospital, 53, Xiangchun Road, Changsha, Hunan, People's Republic of China.
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Wu W, Zhou Y, Liu Y, Liu C, Ren J, Liu X, Korevaar TIM, Fan J. Triglycerides Mediate the Relationship Between Maternal Free Thyroxine and Birth Weight: A Prospective Cohort Study from China. Thyroid 2023; 33:615-624. [PMID: 36905364 DOI: 10.1089/thy.2022.0459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
BACKGROUND Fetal overgrowth (large for gestational age, LGA), is associated with an increased risk of maternal and fetal morbidity and adverse health outcomes. Thyroid hormones are key regulators of metabolism during pregnancy and fetal development. Lower maternal free thyroxine (FT4) and higher maternal triglyceride (TG) levels during early pregnancy are associated with higher birth weight. We aimed to examine the mediating role of maternal TG in the association between maternal FT4 and birth weight. METHODS We performed a large prospective cohort study including pregnant Chinese women who were treated at a tertiary obstetric center during the period of January 2016 to December 2018. We included 35,914 participants with complete medical records. We performed causal mediation analysis to decompose the overall effect of FT4 on birth weight and LGA with maternal TG as the mediator. RESULTS We observed statistically significant associations between maternal FT4, TG levels and birth weight (all p<0.0001). Using a four-way decomposition model, we identified a controlled direct effect (coefficient [95% confidence interval, CI], -0.038 [-0.047 to -0.029], p<0.0001) that accounted for 63.9% of the total effect, in addition to the other three estimated effects (reference interaction, coefficient [95% CI]= -0.006 [-0.009 to -0.001], p=0.008; mediated interaction, coefficient [95% CI]= 0.0004 [0.000 to 0.001], p=0.008; and pure indirect effect, coefficient [95% CI]= -0.009 [-0.013 to -0.005], p<0.0001) of TG on the association between FT4 and birth weight z-score. Moreover, maternal TG accounted for 21.6% and 20.7% (via mediation) and 13.6% and 41.6% (via maternal FT4 and TG interaction) of the total effect of maternal FT4 on fetal birth weight and LGA, respectively. The proportions of the total associations that could be reduced by "eliminating" the effect of maternal TG were 36.1% for birth weight and 65.1% for LGA, respectively. CONCLUSIONS High maternal TG levels may play substantial mediating roles in the relationship between low FT4 levels in early pregnancy and increased birth weight and a higher risk of LGA. Furthermore, the occurrence of fetal overgrowth may also be influenced by possible synergistic effects between FT4 and TG.
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Affiliation(s)
- Weibin Wu
- Shanghai Jiao Tong University School of Medicine, 56694, 145 Guangyuan Rd, Shanghai, China, China, 200030;
| | - Yulai Zhou
- Shanghai Jiao Tong University School of Medicine, 56694, obgyn, 910 Hengshan Road, Shanghai, 200030, Shanghai, SHANGHAI, China, 200030;
| | - Yindi Liu
- International Peace Maternity and Child Health Hospital, 545449, Shanghai, China, Shanghai, China, 200000;
| | - Chunxiao Liu
- Shanghai Jiao Tong University School of Medicine, 56694, International Peace Maternal and child health hospital, 910 Hengshan Road, Shanghai, Shanghai, China, 200030;
| | - Jiabin Ren
- International Peace Maternity and Child Health Hospital, 545449, Shanghai, China;
| | - Xiaorui Liu
- International Peace Maternity and Child Health Hospital, 545449, Shanghai, China;
| | - Tim I M Korevaar
- Erasmus University Medoical Center, Endocrinology, Epidemiology, dr Molewaterplein 50, Rotterdam, Netherlands, 3015 GE;
| | - Jianxia Fan
- Shanghai Jiao Tong University School of Medicine, 56694, Obstetrics and Gynecology, 910 Hengshan Road,Shanghai,200030,China, Shanghai, China, 200025
- United States;
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Li H, Miao C, Liu W, Gao H, Li W, Wu Z, Cao H, Zhu Y. First-Trimester Triglyceride-Glucose Index and Risk of Pregnancy-Related Complications: A Prospective Birth Cohort Study in Southeast China. Diabetes Metab Syndr Obes 2022; 15:3705-3715. [PMID: 36465992 PMCID: PMC9717426 DOI: 10.2147/dmso.s378964] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 10/01/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose To evaluate the relationships of the triglyceride-glucose (TyG) index with pregnancy-related complications (PRCs) and to clarify the predictability of the TyG index for PRCs. Patients and Methods Totally of 11,387 women with a singleton pregnancy were prospectively followed until after delivery. Maternal fasting lipids and glucose concentration were measured in the first trimester (11 weeks gestation on average). The TyG index was calculated as ln [triglyceride (mg/dL) × fasting plasma glucose (mg/dL)/2]. We used generalized linear models to calculate the relative risks and 95% confidence intervals. Receiver-operating characteristic curve analysis was employed to assess the ability of the TyG index to predict the risks of PRCs. Results Smooth spline reveals that the probability of gestational diabetes mellitus (GDM) is intensified with the increasing TyG index. Multivariate logistic regression adjusted for risk factors demonstrates a 1-unit and a 1-SD increment in the TyG index raises the risk of GDM by 3.63 and 1.57 times, respectively. Identically, the risk of GDM maximizes in the TyG quintile 5 (OR: 3.14; 95% CI: 2.55~3.85) relative to the lowest TyG index group. However, no association between TyG index and the risk of other PRCs was observed after full adjustment. The area under receiver operating characteristic curves is 0.647 (95% CI: 0.632-0.66) for GDM, and the optimal predictive cut-off is 8.55, with a specificity of 0.679 and sensitivity of 0.535. Conclusion The first-trimester TyG index is significantly associated with the risk of incident GDM, while the relationships between the TyG index and other PRCs need further exploration.
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Affiliation(s)
- Haibo Li
- Division of Birth Cohort Study, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, People’s Republic of China
| | - Chong Miao
- Department of Information, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, People’s Republic of China
| | - Wenjuan Liu
- Division of Birth Cohort Study, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, People’s Republic of China
- Division of Birth Cohort Study, Fujian Children’s Hospital, Fuzhou, People’s Republic of China
| | - Haiyan Gao
- Division of Birth Cohort Study, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, People’s Republic of China
- Division of Birth Cohort Study, Fujian Obstetrics and Gynecology Hospital, Fuzhou, People’s Republic of China
| | - Wei Li
- Division of Birth Cohort Study, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, People’s Republic of China
- Division of Birth Cohort Study, Fujian Obstetrics and Gynecology Hospital, Fuzhou, People’s Republic of China
| | - Zhengqin Wu
- Division of Birth Cohort Study, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, People’s Republic of China
- Division of Birth Cohort Study, Fujian Obstetrics and Gynecology Hospital, Fuzhou, People’s Republic of China
| | - Hua Cao
- Division of Birth Cohort Study, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, People’s Republic of China
- Fujian Key Laboratory of Women and Children’s Critical Disease Research, Fuzhou, People’s Republic of China
| | - Yibing Zhu
- Division of Birth Cohort Study, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, People’s Republic of China
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Salvatori B, Linder T, Eppel D, Morettini M, Burattini L, Göbl C, Tura A. TyGIS: improved triglyceride-glucose index for the assessment of insulin sensitivity during pregnancy. Cardiovasc Diabetol 2022; 21:215. [PMID: 36258194 PMCID: PMC9580191 DOI: 10.1186/s12933-022-01649-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 09/28/2022] [Indexed: 11/21/2022] Open
Abstract
Background The triglyceride-glucose index (TyG) has been proposed as a surrogate marker of insulin resistance, which is a typical trait of pregnancy. However, very few studies analyzed TyG performance as marker of insulin resistance in pregnancy, and they were limited to insulin resistance assessment at fasting rather than in dynamic conditions, i.e., during an oral glucose tolerance test (OGTT), which allows more reliable assessment of the actual insulin sensitivity impairment. Thus, first aim of the study was exploring in pregnancy the relationships between TyG and OGTT-derived insulin sensitivity. In addition, we developed a new version of TyG, for improved performance as marker of insulin resistance in pregnancy. Methods At early pregnancy, a cohort of 109 women underwent assessment of maternal biometry and blood tests at fasting, for measurements of several variables (visit 1). Subsequently (26 weeks of gestation) all visit 1 analyses were repeated (visit 2), and a subgroup of women (84 selected) received a 2 h-75 g OGTT (30, 60, 90, and 120 min sampling) with measurement of blood glucose, insulin and C-peptide for reliable assessment of insulin sensitivity (PREDIM index) and insulin secretion/beta-cell function. The dataset was randomly split into 70% training set and 30% test set, and by machine learning approach we identified the optimal model, with TyG included, showing the best relationship with PREDIM. For inclusion in the model, we considered only fasting variables, in agreement with TyG definition. Results The relationship of TyG with PREDIM was weak. Conversely, the improved TyG, called TyGIS, (linear function of TyG, body weight, lean body mass percentage and fasting insulin) resulted much strongly related to PREDIM, in both training and test sets (R2 > 0.64, p < 0.0001). Bland–Altman analysis and equivalence test confirmed the good performance of TyGIS in terms of association with PREDIM. Different further analyses confirmed TyGIS superiority over TyG. Conclusions We developed an improved version of TyG, as new surrogate marker of insulin sensitivity in pregnancy (TyGIS). Similarly to TyG, TyGIS relies only on fasting variables, but its performances are remarkably improved than those of TyG. Supplementary Information The online version contains supplementary material available at 10.1186/s12933-022-01649-8.
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Affiliation(s)
| | - Tina Linder
- Department of Obstetrics and Gynaecology, Medical University of Vienna, 1090, Vienna, Austria
| | - Daniel Eppel
- Department of Obstetrics and Gynaecology, Medical University of Vienna, 1090, Vienna, Austria
| | - Micaela Morettini
- Department of Information Engineering, Università Politecnica Delle Marche, 60131, Ancona, Italy
| | - Laura Burattini
- Department of Information Engineering, Università Politecnica Delle Marche, 60131, Ancona, Italy
| | - Christian Göbl
- Department of Obstetrics and Gynaecology, Medical University of Vienna, 1090, Vienna, Austria
| | - Andrea Tura
- CNR Institute of Neuroscience, Corso Stati Uniti 4, 35127, Padua, Italy.
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Habibi N, Mousa A, Tay CT, Khomami MB, Patten RK, Andraweera PH, Wassie M, Vandersluys J, Aflatounian A, Bianco‐Miotto T, Zhou SJ, Grieger JA. Maternal metabolic factors and the association with gestational diabetes: A systematic review and meta-analysis. Diabetes Metab Res Rev 2022; 38:e3532. [PMID: 35421281 PMCID: PMC9540632 DOI: 10.1002/dmrr.3532] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/10/2022] [Accepted: 02/26/2022] [Indexed: 11/10/2022]
Abstract
Gestational diabetes (GDM) is associated with several adverse outcomes for the mother and child. Higher levels of individual lipids are associated with risk of GDM and metabolic syndrome (MetS), a clustering of risk factors also increases risk for GDM. Metabolic factors can be modified by diet and lifestyle. This review comprehensively evaluates the association between MetS and its components, measured in early pregnancy, and risk for GDM. Databases (Cumulative Index to Nursing and Allied Health Literature, PubMed, Embase, and Cochrane Library) were searched from inception to 5 May 2021. Eligible studies included ≥1 metabolic factor (waist circumference, blood pressure, fasting plasma glucose (FPG), triglycerides, and high-density lipoprotein cholesterol), measured at <16 weeks' gestation. At least two authors independently screened potentially eligible studies. Heterogeneity was quantified using I2 . Data were pooled by random-effects models and expressed as odds ratio and 95% confidence intervals (CIs). Of 7213 articles identified, 40 unique articles were included in meta-analysis. In analyses adjusting for maternal age and body mass index, GDM was increased with increasing FPG (odds ratios [OR] 1.92; 95% CI 1.39-2.64, k = 7 studies) or having MetS (OR 2.52; 1.65, 3.84, k = 3). Women with overweight (OR 2.17; 95% CI 1.89, 2.50, k = 12) or obesity (OR 4.34; 95% CI 2.79-6.74, k = 9) also were at increased risk for GDM. Early pregnancy assessment of glucose or the MetS, offers a potential opportunity to detect and treat individual risk factors as an approach towards GDM prevention; weight loss for pregnant women with overweight or obesity is not recommended. Systematic review registration: PROSPERO CRD42020199225.
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Affiliation(s)
- Nahal Habibi
- Robinson Research InstituteUniversity of AdelaideAdelaideSouth AustraliaAustralia
- Adelaide Medical SchoolUniversity of AdelaideAdelaideSouth AustraliaAustralia
| | - Aya Mousa
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash UniversityMelbourneVictoriaAustralia
| | - Chau Thien Tay
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash UniversityMelbourneVictoriaAustralia
| | - Mahnaz Bahri Khomami
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash UniversityMelbourneVictoriaAustralia
| | - Rhiannon K. Patten
- Institute for Health and SportVictoria UniversityMelbourneVictoriaAustralia
| | - Prabha H. Andraweera
- Robinson Research InstituteUniversity of AdelaideAdelaideSouth AustraliaAustralia
- Adelaide Medical SchoolUniversity of AdelaideAdelaideSouth AustraliaAustralia
- Department of Cardiology, Lyell McEwin HospitalElizabeth ValeSouth AustraliaAustralia
| | - Molla Wassie
- School of Agriculture, Food and Wine, and Waite Research Institute, University of AdelaideAdelaideSouth AustraliaAustralia
| | - Jared Vandersluys
- School of Agriculture, Food and Wine, and Waite Research Institute, University of AdelaideAdelaideSouth AustraliaAustralia
| | - Ali Aflatounian
- School of Women's and Children's Health, University of New South WalesSydneyNew South WalesAustralia
| | - Tina Bianco‐Miotto
- Robinson Research InstituteUniversity of AdelaideAdelaideSouth AustraliaAustralia
- School of Agriculture, Food and Wine, and Waite Research Institute, University of AdelaideAdelaideSouth AustraliaAustralia
| | - Shao J. Zhou
- Robinson Research InstituteUniversity of AdelaideAdelaideSouth AustraliaAustralia
- School of Agriculture, Food and Wine, and Waite Research Institute, University of AdelaideAdelaideSouth AustraliaAustralia
| | - Jessica A. Grieger
- Robinson Research InstituteUniversity of AdelaideAdelaideSouth AustraliaAustralia
- Adelaide Medical SchoolUniversity of AdelaideAdelaideSouth AustraliaAustralia
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Ye W, Luo C, Huang J, Li C, Liu Z, Liu F. Gestational diabetes mellitus and adverse pregnancy outcomes: systematic review and meta-analysis. BMJ 2022; 377:e067946. [PMID: 35613728 PMCID: PMC9131781 DOI: 10.1136/bmj-2021-067946] [Citation(s) in RCA: 314] [Impact Index Per Article: 104.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To investigate the association between gestational diabetes mellitus and adverse outcomes of pregnancy after adjustment for at least minimal confounding factors. DESIGN Systematic review and meta-analysis. DATA SOURCES Web of Science, PubMed, Medline, and Cochrane Database of Systematic Reviews, from 1 January 1990 to 1 November 2021. REVIEW METHODS Cohort studies and control arms of trials reporting complications of pregnancy in women with gestational diabetes mellitus were eligible for inclusion. Based on the use of insulin, studies were divided into three subgroups: no insulin use (patients never used insulin during the course of the disease), insulin use (different proportions of patients were treated with insulin), and insulin use not reported. Subgroup analyses were performed based on the status of the country (developed or developing), quality of the study, diagnostic criteria, and screening method. Meta-regression models were applied based on the proportion of patients who had received insulin. RESULTS 156 studies with 7 506 061 pregnancies were included, and 50 (32.1%) showed a low or medium risk of bias. In studies with no insulin use, when adjusted for confounders, women with gestational diabetes mellitus had increased odds of caesarean section (odds ratio 1.16, 95% confidence interval 1.03 to 1.32), preterm delivery (1.51, 1.26 to 1.80), low one minute Apgar score (1.43, 1.01 to 2.03), macrosomia (1.70, 1.23 to 2.36), and infant born large for gestational age (1.57, 1.25 to 1.97). In studies with insulin use, when adjusted for confounders, the odds of having an infant large for gestational age (odds ratio 1.61, 1.09 to 2.37), or with respiratory distress syndrome (1.57, 1.19 to 2.08) or neonatal jaundice (1.28, 1.02 to 1.62), or requiring admission to the neonatal intensive care unit (2.29, 1.59 to 3.31), were higher in women with gestational diabetes mellitus than in those without diabetes. No clear evidence was found for differences in the odds of instrumental delivery, shoulder dystocia, postpartum haemorrhage, stillbirth, neonatal death, low five minute Apgar score, low birth weight, and small for gestational age between women with and without gestational diabetes mellitus after adjusting for confounders. Country status, adjustment for body mass index, and screening methods significantly contributed to heterogeneity between studies for several adverse outcomes of pregnancy. CONCLUSIONS When adjusted for confounders, gestational diabetes mellitus was significantly associated with pregnancy complications. The findings contribute to a more comprehensive understanding of the adverse outcomes of pregnancy related to gestational diabetes mellitus. Future primary studies should routinely consider adjusting for a more complete set of prognostic factors. REVIEW REGISTRATION PROSPERO CRD42021265837.
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Affiliation(s)
- Wenrui Ye
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hypothalamic Pituitary Research Centre, Xiangya Hospital, Central South University, Changsha, China
| | - Cong Luo
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jing Huang
- National Clinical Research Centre for Mental Disorders, Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Department of Psychiatry, Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Chenglong Li
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhixiong Liu
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hypothalamic Pituitary Research Centre, Xiangya Hospital, Central South University, Changsha, China
| | - Fangkun Liu
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hypothalamic Pituitary Research Centre, Xiangya Hospital, Central South University, Changsha, China
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Song S, Zhang Y, Qiao X, Duo Y, Xu J, Peng Z, Zhang J, Chen Y, Nie X, Sun Q, Yang X, Wang A, Lu Z, Sun W, Fu Y, Dong Y, Yuan T, Zhao W. ALT/AST as an Independent Risk Factor of Gestational Diabetes Mellitus Compared with TG/HDL-C. Int J Gen Med 2022; 15:115-121. [PMID: 35023950 PMCID: PMC8743491 DOI: 10.2147/ijgm.s332946] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 11/02/2021] [Indexed: 12/22/2022] Open
Abstract
Objective This study aimed to find the association between alanine transaminase-to-aspartate aminotransferase ratio (ALT/AST) and the incidence of gestational diabetes mellitus (GDM). Methods A total of 1128 pregnant women were included in this prospective, double-center, observational cohort study. ALT, AST and total bilirubin (TBil) were tested during 6–12 weeks of gestation and 75-g oral glucose tolerance test (OGTT) was conducted during 24–28 weeks of gestation to screen GDM. The association between ALT/AST and glucose concentration during OGTT was analyzed by linear regression model. The OR with 95% CI for incidence of GDM associated with ALT/AST was estimated by binary logistic regression. The discriminatory values of ALT/AST and triglyceride/high-density lipoprotein cholesterol (TG/HDL-C) for GDM were calculated by the area under the receiver operating characteristic curve (ROC-AUC). Results The incidence of GDM was 22.07% (249/1128). ALT/AST was higher in GDM group than in NGT group (0.92 [0.75, 1.18] vs 0.80[0.65, 1.02], P <0.001). ALT/AST had positive correlations with fasting blood glucose, 1-hour and 2-hour blood glucose concentration during OGTT (0.089 [95% CI: 0.034, 0.163], 0.176 [95% CI: 0.052, 0.104], and 0.115 [95% CI: 0.199, 0.609], respectively). The OR of ALT/AST for incidence of GDM was 1.603 (95% CI:1.097, 2.344). The ROC-AUC of ALT/AST and TG/HDL-C reached 0.615 (95% CI: 0.575, 0.655) and 0.619 (95% CI: 0.580, 0.659), respectively. Conclusion ALT/AST in early pregnancy was an independent risk factor of GDM. The predictive ability of ALT/AST was similar to TG/HDL-C for GDM.
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Affiliation(s)
- Shuoning Song
- Department of Endocrinology, Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China
| | - Yuemei Zhang
- Department of Obstetrics, Haidian District Maternal and Child Health Care Hospital, Beijing, People's Republic of China
| | - Xiaolin Qiao
- Department of Obstetrics, Beijing Chaoyang District Maternal and Child Health Care Hospital, Beijing, People's Republic of China
| | - Yanbei Duo
- Department of Endocrinology, Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China
| | - Jiyu Xu
- Core Facility of Instrument, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, People's Republic of China
| | - Zhenyao Peng
- Department of Dean's Office, Haidian District Maternal and Child Health Care Hospital, Beijing, People's Republic of China
| | - Jing Zhang
- Department of Laboratory, Haidian District Maternal and Child Health Care Hospital, Beijing, People's Republic of China
| | - Yan Chen
- Department of Obstetrics, Beijing Chaoyang District Maternal and Child Health Care Hospital, Beijing, People's Republic of China
| | - Xiaorui Nie
- Department of Obstetrics, Beijing Chaoyang District Maternal and Child Health Care Hospital, Beijing, People's Republic of China
| | - Qiujin Sun
- Department of Clinical Laboratory, Beijing Chaoyang District Maternal and Child Health Care Hospital, Beijing, People's Republic of China
| | - Xianchun Yang
- Department of Clinical Laboratory, Beijing Chaoyang District Maternal and Child Health Care Hospital, Beijing, People's Republic of China
| | - Ailing Wang
- National Center for Women and Children's Health, China CDC, Beijing, People's Republic of China
| | - Zechun Lu
- National Center for Women and Children's Health, China CDC, Beijing, People's Republic of China
| | - Wei Sun
- Core Facility of Instrument, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, People's Republic of China
| | - Yong Fu
- Department of Endocrinology, Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China
| | - Yingyue Dong
- Department of Endocrinology, Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China
| | - Tao Yuan
- Department of Endocrinology, Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China
| | - Weigang Zhao
- Department of Endocrinology, Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China
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Song T, Su G, Chi Y, Wu T, Xu Y, Chen C. Triglyceride-glucose index predicts the risk of gestational diabetes mellitus: a systematic review and meta-analysis. Gynecol Endocrinol 2022; 38:10-15. [PMID: 34184968 DOI: 10.1080/09513590.2021.1940932] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
AIMS We aimed to investigate the potential predictive efficacy of triglyceride-glucose (T/Gly) index for gestational diabetes mellitus (GDM) in a systematic review and meta-analysis. MATERIALS AND METHODS Cohort studies demonstrating the association between T/Gly index measured at the first trimester or before pregnancy and the subsequent incidence of GDM were identified by search of PubMed, Embase, China National Knowledge Infrastructure, and WanFang databases. A random-effect model incorporating the heterogeneity was applied to pool the results. Five cohort studies including 382,213 women were included in this meta-analysis. RESULTS Compared to those with the lowest category of T/Gly index, women with the highest category of T/Gly index were independently associated with higher risk of subsequent GDM (odds ratio [OR]: 2.52, 95% confidence interval [CI]: 1.33 ∼ 4.67, I2=65%, p=.004) after adjustment of potential confounding factors including age, body mass index, and family history of diabetes. The association was stronger in prospective cohort studies than retrospective cohort studies (p for subgroup difference=.007), and a significant association was detected in Asian women (OR: 3.30, 95% CI: 1.50-7.28, p =.003), but not in non-Asian women (OR: 0.96, 95% CI: 0.35-2.63, p=.94). CONCLUSIONS Higher T/Gly index may independently predict the risk of GDM in Asian women.
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Affiliation(s)
- Tianrong Song
- Department of Obstetrics and Gynecology, Distinct Healthcare, Shenzhen, P. R. China
| | - Guidong Su
- Department of Obstetrics and Gynecology, Nanfang Hospital Affiliated to Southern Medical University, Guangzhou, P. R. China
| | - Yali Chi
- Department of Obstetrics and Gynecology, Nanfang Hospital Affiliated to Southern Medical University, Guangzhou, P. R. China
| | - Ting Wu
- Department of Obstetrics and Gynecology, University of Hong Kong Shenzhen Hospital, Shenzhen, P. R. China
| | - Yue Xu
- Department of Obstetrics and Gynecology, University of Hong Kong Shenzhen Hospital, Shenzhen, P. R. China
| | - Chunchun Chen
- Department of Obstetrics and Gynecology, University of Hong Kong Shenzhen Hospital, Shenzhen, P. R. China
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Fan Y, Zhong H, Cai L, Xiao Y. An age matched case-control study on the risk factors for the gestational diabetes mellitus among primiparous women. ZHONG NAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF CENTRAL SOUTH UNIVERSITY. MEDICAL SCIENCES 2021; 46:1346-1353. [PMID: 35232903 PMCID: PMC10930575 DOI: 10.11817/j.issn.1672-7347.2021.200466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Gestational diabetes mellitus (GDM) is one of the most common complications of pregnancy. It is associated with a wide range of short and long term adverse health consequences for both mother and offspring. As we know, the risk factors of the GDM are complex and diverse, and the incidence of GDM is directly correlated with the age and the times of women delivery. In the process of exploring the risk factors of GDM, if the 2 known independent risk factors are unevenly distributed among groups, the effects of other risk factors may be concealed. To avoid the influence of the 2 factors on the research results, we collected primiparous women as the participants through the method of the case-control study of age 1꞉1 paired design. Through this way, we want to provide early intervention for the pregnant women with the high risk factors so as to reduce the possibility of the GDM during the pregnancy and promote the maternal and infant's health. METHODS This study was a retrospective study. A total of 2 425 pregnant women were collected as the participants, who accepted the regular prenatal examination or nutrition health guidance in the Department of Obstetrics or Nutrition in the Women and Children's Hospital, School of Medicine, Xiamen University from August 2018 to October 2019. According to the inclusion and exclusion criteria, 2 287 pregnant women were included in the study. Among them, 231 pregnant women with the complete information were collected as a case group because of the abnormal results of the oral glucose tolerance test (OGTT) that executed between the 24th and 28th weeks during the pregnancy. Meanwhile, among the participants with the normal results of the OGTT, 231 pregnant women with the complete information were selected randomly as a control group through the method of the age 1꞉1 paired with the case group. The age range of the all subjects was 22 to 45 (28.82±4.03) years old. We collected their clinical and basic data retrospectively, including the BMI before pregnancy, the level of uric acid, fasting blood glucose, serum lipid index, and glycosylated hemoglobin (HbA1c) in the early pregnancy, the body weight gain before the 13th and 24th weeks during the pregnancy, the times of the abortions, the positive of HBsAg, the family history of diabetes or hypertension etc. The differences in these indexes were compared between the 2 groups. The logistic regression analysis was used to explore the risk factors for GDM and the stratified analysis was used to explore the difference of the body weight gain before the 24th week during the pregnancy between the 2 groups. RESULTS The BMI before pregnancy, the uric acid, the fasting blood glucose, the body weight gain before the 13th and 24th weeks during the pregnancy in the GDM group were higher than those in the control group, and the differences were significant (all P<0.05). The LDL level in the early pregnancy of the GDM group was higher than that of the control group, however, the HDL level in the early pregnancy of the GDM group was lower than that of the control group, and the differences were significant (both P<0.05). The rates of the pregnant women in the GDM group with more than 2 abortions, obesity or overweight before pregnancy, the fasting blood glucose in the early pregnancy over 5.1 mmol/L were significantly higher than those in the control group (all P<0.05). With the uptrend of the cut-off point of the body weight gain before the 24th week during the pregnancy, the risk of the GDM was gradually increasing. When the cut-off point reached at 10 kg, the difference was significant (OR=1.988, P=0.004). The level of HDL in the early pregnancy over 1.6 mmol/L was the protective factor for GDM (OR=0.460, P=0.016). Meanwhile, the body weight gain over 10 kg before the 24th week during the pregnancy (OR=1.743, P=0.032), the fasting blood glucose in the early pregnancy over 5.1 mmol/L (OR=3.488, P=0.001), the LDL in the early pregnancy over 2.5 mmol/L (OR=2.179, P=0.032) were the risk factors for the GDM. Among them, the fasting blood glucose in the early pregnancy over 5.1 mmol/L had the greatest impact on the increase of risk for the GDM. CONCLUSIONS After excluding the influence of the age, for primiparous women, the higher level of the LDL and the fasting blood glucose in the early pregnancy, the higher possibility to be the GDM. Meanwhile, the pregnant women should control their diet as soon as possible to control the body weight gain within 10 kg before the 24th week during the pregnancy so as to reduce the possibility of being GDM.
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Affiliation(s)
- Yanfeng Fan
- Departmen of Nutrition, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen Fujian 361003.
| | - Hongxiu Zhong
- Department of Obstetrics, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen Fujian 361003, China.
| | - Liqian Cai
- Departmen of Nutrition, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen Fujian 361003
| | - Yunshan Xiao
- Department of Obstetrics, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen Fujian 361003, China
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Jotic AZ, Stoiljkovic MM, Milicic TJ, Lalic KS, Lukic LZ, Macesic MV, Stanarcic Gajovic JN, Milovancevic MM, Gojnic Dugalic MG, Jeremic VM, Lalic NM. Prevalence and Metabolic Predictors for Early Diagnosed Prediabetes in Women with Previous Gestational Diabetes: Observational Cohort Study. Diabetes Ther 2021; 12:2691-2700. [PMID: 34458964 PMCID: PMC8479028 DOI: 10.1007/s13300-021-01144-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 08/16/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Women with previous gestational diabetes (pGD) are at higher risk of prediabetes (PD) after delivery. The aim of this study was to determine the prevalence of and predictors for PD among women with pGD. METHODS The study included 186 women with pGD treated by lifestyle modification. After delivery, the women were divided into group A (n = 80) with PD and group B (n = 106) with normal glucose tolerance (NGT), defined by the results of the 2-h oral glucose tolerance test at 4-12 weeks after delivery. We recorded age, body mass index (BMI) at conception and after delivery, fasting glucose (FG), glycated hemoglobin (HbA1c), total cholesterol (TC), triglycerides (Tg), low density lipoprotein cholesterol (LDL-c), high-density lipoprotein cholesterol (HDL-c) and the Tg/HDL-c ratio measured in the third trimester of pregnancy. RESULTS Of the 186 women with pGD enrolled in the study, 43% showed prediabetes at 4-12 weeks after delivery, with 13.9% of these women showing impaired FG (IFG), 12.9% showing impaired glucose tolerance (IGT) and 16.2% with IFG/IGT. The groups differed in terms of age and BMI at conception and after delivery. In the third trimester of pregnancy, HbA1c was higher in women in group A than in those in group B (mean ± standard deviation: 5.6 ± 0.4 vs. 5.2 ± 0.3%; p < 0.001), while FG was comparable. Compared to women in group B, women in group A had higher TC (7.1 ± 0.8 vs. 6.6 ± 1.0 mmol/L), Tg (2.7 ± 0.9 vs. 2.1 ± 0.6 mmol/L) and LDL-c (4.7 ± 0.8 vs. 4.3 ± 1.0 mmol/L) (all p < 0.001), lower HDL-c (1.0 ± 0.2 vs. 1.4 ± 1.0; p < 0.001) and higher median Tg/HDL-c (5.4 [range 4.6-14.3] vs. 4.9 [range 1.1-11.5]; p < 0.001). Univariate analysis found an association between prediabetes and age, BMI at conception and after delivery, HbA1c, TC, LDL-c, HDL-c, Tg and Tg/HDL-c ratio. Of these variables, the multivariate analysis showed age (odds ratio [OR] 1.19; p < 0.001), HbA1c (OR 31.06; p < 0.001), Tg (OR 4.09; p < 0.001) and LDL-c (OR 2.00; p = 0.005) as predictors for prediabetes. CONCLUSION High prevalence of early diagnosed PD in women with pGD was accompanied by advanced age and higher BMI at conception and after delivery. Moreover, age, HbA1c, Tg and LDL-c were predictors for PD.
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Affiliation(s)
- Aleksandra Z Jotic
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Center of Serbia, Dr. Subotica 13, 11000, Belgrade, Serbia.
- Faculty of Medicine, University of Belgrade, Dr. Subotica 8, 11000, Belgrade, Serbia.
| | - Milica M Stoiljkovic
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Center of Serbia, Dr. Subotica 13, 11000, Belgrade, Serbia
| | - Tanja J Milicic
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Center of Serbia, Dr. Subotica 13, 11000, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Dr. Subotica 8, 11000, Belgrade, Serbia
| | - Katarina S Lalic
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Center of Serbia, Dr. Subotica 13, 11000, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Dr. Subotica 8, 11000, Belgrade, Serbia
| | - Ljiljana Z Lukic
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Center of Serbia, Dr. Subotica 13, 11000, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Dr. Subotica 8, 11000, Belgrade, Serbia
| | - Marija V Macesic
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Center of Serbia, Dr. Subotica 13, 11000, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Dr. Subotica 8, 11000, Belgrade, Serbia
| | - Jelena N Stanarcic Gajovic
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Center of Serbia, Dr. Subotica 13, 11000, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Dr. Subotica 8, 11000, Belgrade, Serbia
| | - Mina M Milovancevic
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Center of Serbia, Dr. Subotica 13, 11000, Belgrade, Serbia
| | - Miroslava G Gojnic Dugalic
- Faculty of Medicine, University of Belgrade, Dr. Subotica 8, 11000, Belgrade, Serbia
- Clinic for Gynecology and Obstetrics, University Clinical Center of Serbia, Visegradska 26, 11000, Belgrade, Serbia
| | - Veljko M Jeremic
- Department for Operations Research and Statistics, Faculty of Organizational Sciences, University of Belgrade, Belgrade, Serbia
| | - Nebojsa M Lalic
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Center of Serbia, Dr. Subotica 13, 11000, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Dr. Subotica 8, 11000, Belgrade, Serbia
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Maternal Lipid Profile as a Risk Factor for Gestational Diabetes Mellitus in Obese Women. CURRENT HEALTH SCIENCES JOURNAL 2021; 47:209-214. [PMID: 34765240 PMCID: PMC8551905 DOI: 10.12865/chsj.47.02.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 05/26/2021] [Indexed: 11/30/2022]
Abstract
As dyslipidemia is frequently associated with gestational diabetes mellitus, the aim of this study was to establish a correlation between the evolution of the maternal lipid profile evaluated in the first and third pregnancy trimester for a series of parameters: triglycerides, cholesterol, high-density lipoprotein cholesterol (HDL-C), blood sugar fasting (BSF), triglyceride-glucose index (TyG index), TG/HDL-C ratio, leptin and the risk of gestational diabetes mellitus occurrence. The results were statistically interpreted, establishing the mean value of the obtained results and the standard deviation. From the studied parameters, only HDL-C and Tyg were statistically significant different in the first trimester for the two study groups, while in the third trimester statistically significant differences were observed also for triglycerides, blood sugar fasting and the TG/HDL-C ratio.
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Ruiz-Jaramillo MDLC, López-Acevedo M. Triglycerides/high-density lipoprotein-cholesterol ratio in children with metabolic syndrome. CHILD AND ADOLESCENT OBESITY 2021. [DOI: 10.1080/2574254x.2021.1903297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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Song S, Duo Y, Zhang Y, Qiao X, Xu J, Zhang J, Peng Z, Chen Y, Nie X, Sun Q, Yang X, Wang A, Sun W, Fu Y, Dong Y, Lu Z, Yuan T, Zhao W. The Predictive Ability of Hepatic Steatosis Index for Gestational Diabetes Mellitus and Large for Gestational Age Infant Compared with Other Noninvasive Indices Among Chinese Pregnancies: A Preliminary Double-center Cohort Study. Diabetes Metab Syndr Obes 2021; 14:4791-4800. [PMID: 34938090 PMCID: PMC8687517 DOI: 10.2147/dmso.s335364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 10/27/2021] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To evaluate the association of hepatic steatosis index (HSI) in the first trimester and the risk of gestational diabetes mellitus (GDM) as well as large for gestational age (LGA) infant in Chinese women. METHODS A total of 1082 pregnant women were included in this study. Maternal basic laboratory data, including ALT, AST, FBG, insulin, TG, and HDL-C, were tested during 6-12 weeks of gestation and anthropometric characteristics were monitored during gestation. A 75-g oral glucose tolerance test (OGTT) was conducted at 24-28 weeks of gestation. HSI, nonalcoholic fatty liver disease (NAFLD) liver fat score, triglyceride/high-density lipoprotein cholesterol (TG/HDL-C) and triglyceride-glucose (TyG) index were calculated. Odds ratio with 95% confidence interval for subsequent risk of GDM and LGA by HSI quartiles were assessed by binary logistic regression model. The predictive ability of HSI for GDM and LGA was evaluated by the receiver operating characteristic (ROC) curve analysis and was compared with other indices. RESULTS The incidence of GDM and LGA were 22.09% (239/1082) and 10.53% (87/826). HSI was higher in GDM group than in NGT group (median, interquartile range: 30.67, 27.20-35.10 vs 27.98, 25.70-30.82, P<0.001). Incidence of GDM was gradually increased with increasing HSI values. Women in the highest HSI quartile had significantly higher risk of LGA delivery than those in the lowest HSI quartile (P<0.05). The area under the ROC curves of HSI for GDM and LGA were higher than other indices, reaching 0.646 (95%CI: 0.605-0.686) and 0.600 (95%CI: 0.541-0.660), respectively. CONCLUSION Higher HSI was independently associated with higher risk of GDM and LGA in Chinese women. HSI in the first trimester can predict the risk of GDM and LGA.
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Affiliation(s)
- Shuoning Song
- Department of Endocrinology, Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People’s Republic of China
| | - Yanbei Duo
- Department of Endocrinology, Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People’s Republic of China
| | - Yuemei Zhang
- Department of Obstetrics, Haidian District Maternal and Child Health Care Hospital, Beijing, People’s Republic of China
| | - Xiaolin Qiao
- Department of Obstetrics, Beijing Chaoyang District Maternal and Child Health Care Hospital, Beijing, People’s Republic of China
| | - Jiyu Xu
- Core Facility of Instrument, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, People’s Republic of China
| | - Jing Zhang
- Department of Laboratory, Haidian District Maternal and Child Health Care Hospital, Beijing, People’s Republic of China
| | - Zhenyao Peng
- Department of Dean’s Office, Haidian District Maternal and Child Health Care Hospital, Beijing, People’s Republic of China
| | - Yan Chen
- Department of Obstetrics, Beijing Chaoyang District Maternal and Child Health Care Hospital, Beijing, People’s Republic of China
| | - Xiaorui Nie
- Department of Obstetrics, Beijing Chaoyang District Maternal and Child Health Care Hospital, Beijing, People’s Republic of China
| | - Qiujin Sun
- Department of Clinical Laboratory, Beijing Chaoyang District Maternal and Child Health Care Hospital, Beijing, People’s Republic of China
| | - Xianchun Yang
- Department of Clinical Laboratory, Beijing Chaoyang District Maternal and Child Health Care Hospital, Beijing, People’s Republic of China
| | - Ailing Wang
- National Center for Women and Children’s Health, China CDC, Beijing, People’s Republic of China
| | - Wei Sun
- Core Facility of Instrument, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, People’s Republic of China
| | - Yong Fu
- Department of Endocrinology, Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People’s Republic of China
| | - Yingyue Dong
- Department of Endocrinology, Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People’s Republic of China
| | - Zechun Lu
- National Center for Women and Children’s Health, China CDC, Beijing, People’s Republic of China
| | - Tao Yuan
- Department of Endocrinology, Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People’s Republic of China
| | - Weigang Zhao
- Department of Endocrinology, Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People’s Republic of China
- Correspondence: Tao Yuan; Weigang Zhao Email ;
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Chen YM, Zhu Q, Cai J, Zhao ZJ, Yao BB, Zhou LM, Ji LD, Xu J. Upregulation of T Cell Receptor Signaling Pathway Components in Gestational Diabetes Mellitus Patients: Joint Analysis of mRNA and circRNA Expression Profiles. Front Endocrinol (Lausanne) 2021; 12:774608. [PMID: 35046894 PMCID: PMC8763273 DOI: 10.3389/fendo.2021.774608] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 12/01/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Gestational diabetes mellitus (GDM) is one of the most common complications of pregnancy, and its pathogenesis is still unclear. Studies have shown that circular RNAs (circRNAs) can regulate blood glucose levels by targeting mRNAs, but the role of circRNAs in GDM is still unknown. Therefore, a joint microarray analysis of circRNAs and their target mRNAs in GDM patients and healthy pregnant women was carried out. METHODS In this study, microarray analyses of mRNA and circRNA in 6 GDM patients and 6 healthy controls were conducted to identify the differentially expressed mRNA and circRNA in GDM patients, and some of the discovered mRNAs and circRNAs were further validated in additional 56 samples by quantitative realtime PCR (qRT-PCR) and droplet digital PCR (ddPCR). RESULTS Gene ontology and pathway analyses showed that the differentially expressed genes were significantly enriched in T cell immune-related pathways. Cross matching of the differentially expressed mRNAs and circRNAs in the top 10 KEGG pathways identified 4 genes (CBLB, ITPR3, NFKBIA, and ICAM1) and 4 corresponding circRNAs (circ-CBLB, circ-ITPR3, circ-NFKBIA, and circ-ICAM1), and these candidates were subsequently verified in larger samples. These differentially expressed circRNAs and their linear transcript mRNAs were all related to the T cell receptor signaling pathway, and PCR results confirmed the initial microarray results. Moreover, circRNA/miRNA/mRNA interactions and circRNA-binding proteins were predicted, and circ-CBLB, circ-ITPR3, and circ-ICAM1 may serve as GDM-related miRNA sponges and regulate the expression of CBLB, ITPR3, NFKBIA, and ICAM1 in cellular immune pathways. CONCLUSION Upregulation of T cell receptor signaling pathway components may represent the major pathological mechanism underlying GDM, thus providing a potential approach for the prevention and treatment of GDM.
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Affiliation(s)
- Yan-ming Chen
- Department of Science and Education, Affiliated People’s Hospital of Ningbo University, Ningbo, China
- Department of Preventive Medicine, School of Medicine, Ningbo University, Ningbo, China
| | - Qiong Zhu
- Department of Pediatrics, Affiliated People’s Hospital of Ningbo University, Ningbo, China
| | - Jie Cai
- Department of Reproductive Medicine, Ningbo Women and Children’s Hospital, Ningbo, China
| | - Zhi-jia Zhao
- Department of Preventive Medicine, School of Medicine, Ningbo University, Ningbo, China
| | - Bin-bin Yao
- Department of Preventive Medicine, School of Medicine, Ningbo University, Ningbo, China
| | - Li-ming Zhou
- Department of Reproductive Medicine, Ningbo Women and Children’s Hospital, Ningbo, China
| | - Lin-dan Ji
- Department of Science and Education, Affiliated People’s Hospital of Ningbo University, Ningbo, China
- Department of Biochemistry, School of Medicine, Ningbo University, Ningbo, China
- Zhejiang Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, China
- *Correspondence: Lin-dan Ji, ; Jin Xu,
| | - Jin Xu
- Department of Preventive Medicine, School of Medicine, Ningbo University, Ningbo, China
- Zhejiang Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, China
- *Correspondence: Lin-dan Ji, ; Jin Xu,
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