... Services Task Force (Task Force) has issued a final recommendation statement on Screening for Gestational Diabetes. This ... services, but these potential harms are small. The Final Recommendations on Screening Women for Gestational Diabetes: What ...
Gestational diabetes mellitus (GDM) is defined as glucose intolerance of various degrees that is first detected during pregnancy. GDM is detected through the screening of pregnant women for clinical risk factors and, among at-risk women, testing for abnormal glucose tolerance that is usually, but not invariably, mild and asymptomatic. GDM appears to result from the same broad spectrum of physiological and genetic abnormalities that characterize diabetes outside of pregnancy. Indeed, women with GDM are at high risk for having or developing diabetes when they are not pregnant. Thus, GDM provides a unique opportunity to study the early pathogenesis of diabetes and to develop interventions to prevent the disease.
Buchanan, Thomas A.; Xiang, Anny H.
Gestational diabetes (GDM) is defined as any degree of glucose intolerance with onset during pregnancy and is associated with increased feto-maternal morbidity as well as long-term complications in mothers and offspring. Women detected to have diabetes early in pregnancy receive the diagnosis of overt, non-gestational, diabetes. GDM is diagnosed by an oral glucose tolerance test (OGTT) or fasting glucose concentrations (> 92 mg/dl). Screening for undiagnosed type 2 diabetes at the first prenatal visit (Evidence level B) is recommended in women at increased risk using standard diagnostic criteria (high risk: history of GDM or pre-diabetes (impaired fasting glucose or impaired glucose tolerance); malformation, stillbirth, successive abortions or birthweight > 4,500 g in previous pregnancies; obesity, metabolic syndrome, age > 45 years, vascular disease; clinical symptoms of diabetes (e.g. glucosuria). Performance of the OGTT (120 min; 75 g glucose) may already be indicated in the first trimester in some women but is mandatory between 24 and 28 gestational weeks in all pregnant women with previous non-pathological glucose metabolism (Evidence level B). Based on the results of the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study GDM is defined, if fasting venous plasma glucose exceeds 92 mg/dl or 1 h 180 mg/dl or 2 h 153 mg/dl after glucose loading (OGTT; international consensus criteria). In case of one pathological value a strict metabolic control is mandatory. All women should receive nutritional counseling and be instructed in blood glucose self-monitoring. If blood glucose levels cannot be maintained in the normal range (fasting < 95 mg/dl and 1 h after meals < 140 mg/dl) insulin therapy should be initiated. Maternal and fetal monitoring is required in order to minimize maternal and fetal/neonatal morbidity and perinatal mortality. After delivery all women with GDM have to be reevaluated as to their glucose tolerance by a 75 g OGTT (WHO criteria) 6-12 weeks postpartum and every 2 years in case of normal glucose tolerance (Evidence level B). All women have to be instructed about their (sevenfold increased relative) risk of type 2 diabetes at follow-up and possibilities for diabetes prevention, in particular weight management and maintenance/increase of physical activity. Monitoring of the development of the offspring and recommendation of healthy lifestyle of the children and family is recommended. PMID:23250453
Kautzky-Willer, Alexandra; Bancher-Todesca, Dagmar; Pollak, Arnold; Repa, Andreas; Lechleitner, Monika; Weitgasser, Raimund
Gestational diabetes mellitus (GDM) diagnosis remains controversial. ACOG criteria are based on the long-term risk of maternal diabetes. ADA recently suggested diagnosing GDM with 1 elevated value on an oral glucose tolerance test based on a 1.75-fold risk of large-for-gestational age infants resulting in a 17.8% rate of GDM. Given the lack of neonatal-based outcomes for the traditional position and problems of reproducibility and benefit/harm balance of the ADA approach, an alternative is presented herein based on a 2-fold risk of a large-for-gestational age baby, requiring 2 separate abnormalities to reduce false positives giving a more balanced benefit/harm ratio (10% GDM rate). PMID:24005127
Ryan, Edmond A
Gestational diabetes is an asymptomatic metabolic disorder of pregnancy associated with increased morbidity in mother and fetus. Early detection and intervention improve pregnancy outcome. This article reviews the current approach to diagnosis and management. Specific guidelines for nutritional management and insulin use are included.
Blair, M. M.; Noc, A. M.
Background In this study of women with gestational diabetes we attempted to (a) Determine the magnitude of the long term risk of progression to diabetes and (b) Identify factors that predict the development of diabetes. Methods All women diagnosed with gestational diabetes (GDM) at Worcestershire Royal Hospital, UK from 1995 to 2003 were included in this observational cohort study and followed up till 2009. Diabetes was diagnosed if fasting glucose ? 7.0 mmol/L, random/two-hour glucose following 75 gram oral glucose test (OGTT) ? 11.1 mmol/L or HbA1c ? 7.0%. Results The risk of developing diabetes was 6.9% at five years and 21.1% at ten years following the initial diagnosis of GDM. Fasting and post-prandial glucose levels in the oral glucose tolerance test during pregnancy were associated with future risk of diabetes. There was no association with age, gestational age at diagnosis of GDM, numbers of previous and subsequent pregnancies. Conclusion Risk of progression to diabetes in a UK based cohort of women with GDM is estimated. Women with fasting antenatal glucose ? 7.0 mmol/L and/or an antenatal two-hour glucose ? 11.1 mmol/L are at higher risk and need close follow up.
Sivaraman, Subash Chander; Vinnamala, Sudheer; Jenkins, David
... I have a condition called polycystic ovarian syndrome (PCOS) ? I am taking a medication called Glucophage (metformin) ? ... or doctor who specializes in diabetes during pregnancy Nutrition counseling Exercise counseling Daily blood sugar testing You ...
... adults. Sometimes it can be treated just with diet. Diabetes pills or insulin may also be needed. Gestational diabetes— ... control my gestational diabetes by eating a healthy diet and staying active ? ... If I need medicine, can I take a pill or do I need a shot? For many ...
The National Institute for Health and Clinical Excellence (NICE) Diabetes Guideline (2008) recommends more screening for gestational diabetes in the UK. With increase in obesity, more women delaying childbirth, thus entering pregnancy with co-morbidities, and more ethnic minorities (CEMACH Report 2006–2008) results is an increase in gestational diabetes. Oral glucose tolerance test (OGTT) remains the preferred screening test, but the
C Burrell; Z Kropiwnicka; R Howard; E Casey; L Phillips
Women with gestational diabetes are at high risk of developing type 2 diabetes, which could be prevented or delayed by lifestyle modification. Lifestyle interventions need to take into account the specific situation of women with gestational diabetes. We aimed to gain a deeper understanding of women's experiences of gestational diabetes, their diabetes risk perceptions, and their views on type 2 diabetes prevention, to inform future lifestyle interventions. We conducted a metasynthesis that included 16 qualitative studies and identified 11 themes. Factors that require consideration when developing a type 2 diabetes prevention intervention in this population include addressing the emotional impact of gestational diabetes; providing women with clear and timely information about future diabetes risk; and offering an intervention that fits with women's multiple roles as caregivers, workers, and patients, and focuses on the health of the whole family. PMID:24682021
Parsons, Judith; Ismail, Khalida; Amiel, Stephanie; Forbes, Angus
Gestational diabetes has been a controversial subject in the midwifery community for many years. While the diagnosis and disease can be debated, one statistic remains without controversy: women who meet the diagnostic criteria for gestational diabetes are at risk for developing type 2 diabetes after delivery. This article discusses the importance of postpartum follow-up, whether gestational diabetes screening was completed in pregnancy or not, and what a midwife can do to lower her clients' risk of developing type 2 diabetes. PMID:24511847
This brochure addresses the problem of gestational diabetes and answers the most frequently asked questions about the disease. It begins by defining gestational diabetes and discussing its cause, then addresses such topics as: (1) how gestational diabetes differs from other types of diabetes; (2) who is at risk for developing gestational diabetes…
National Inst. of Child Health and Human Development (NIH), Bethesda, MD.
Gestational diabetes insipidus is an uncommon clinical disease whose prevalence is approximately two to three pregnancies per 100,000. It may be isolated or associated with preeclampsia. We report a case of gestational diabetes insipidus in a twin pregnancy, originally isolated during two months, and secondarily complicated by HELLP-syndrome. We recall the specific pathophysiology of polyuric-polydipsic syndrome during pregnancy and summarize its various causes. Finally, we discuss the indications, in case of isolated gestational diabetes insipidus, of treatment by dDAVP. PMID:23380272
De Mesmay, M; Rigouzzo, A; Bui, T; Louvet, N; Constant, I
The placenta is a fetal organ located at the interface between mother and fetus. Therefore, the placenta is susceptible to maternal and fetal derangements. In gestational diabetes, various hormones, growth factors, cytokines and metabolites have altered levels in the maternal, the fetal compartment and the placenta. Prominent determinants of placental and fetal growth and development are insulin and the insulin-like growth factors (IGF) 1 and 2. Their levels in the maternal and/or fetal circulation are altered resulting from gestational diabetes. This article will describe placental changes in gestational diabetes and discuss the role of insulin, IGF1 and IGF2 therein. PMID:20530933
Hiden, Ursula; Lang, Uwe; Desoye, Gernot
Managing Gestational Diabetes: A Patient's Guide to a Healthy Pregnancy provides some general guidelines for keeping yourself healthy and for promoting the best outcomes for your baby, if you have gestational diabetes. The booklet describes gestational di...
Myositis ossificans traumatica is a form of dystrophic calcification that leads to heterotopic ossification of intramuscular connective tissue. It is rare in the orofacial region. A history of trauma, conventional radiography and computed tomography, along with histopathological examination, can be used effectively to diagnose this condition. We present a unique case of infected myositis ossificans traumatica in the infraorbital region in an uncontrolled diabetic. PMID:24851394
Baliga, Mohan; Baptist, Joanna
Should women with gestational diabetes mellitus be treated to minimize both fetal and maternal complications? Although unanswered questions remain about the long-term benefits, the findings of a large, multicenter,randomized controlled trial suggest that treatment of gestational diabetes mellitus decreases perinatal complications. PMID:20098447
Zera, Chloe A; Seely, Ellen W
Gestational diabetes mellitus is an heterogeneous and complex disease that involves the maternal biological system, placental tissue and the fetus. It is characterized by glucose intolerance, "first met or recognized in pregnancy." In our country its frequency is around 7%. Important progress has been made in the systematization of diagnostics and treatment, allowing for preventive management of short- and long-term complications for mother and her offspring. Optimum management is to keep at "low risk" maternal glucemic levels, and so to break the future cycle of gestational diabetes mellitus becoming definitive diabetes mellitus. PMID:22185851
Sánchez-Turcios, Reinaldo Alberto; Hernández-López, Eugenia
Aims\\/hypothesis. To examine the association between maternal stature and gestational diabetes mellitus.¶Methods. We studied a sample of 5564 consecutive Brazilian women 20 or more years old, who were pregnant for approximately 21–28\\u000a weeks, had no history of diabetes outside pregnancy and were attending general prenatal care units in six state capitals in\\u000a Brazil from 1991 to 1995. We did a
L. Branchtein; M. I. Schmidt; M. C. G. Matos; T. Yamashita; J. M. D. C. Pousada; B. B. Duncan
Of the contraceptive choices open to a post-partum woman with gestational diabetes, this discussion concentrates on low-dose oral contraceptives. Although gestational diabetes usually clears at delivery, 75% of these women will go on to developed impaired glucose tolerance or overt diabetes, especially if they are obese or if their glucose level had been high. Many elect permanent sterilization, but those requiring reversible contraception usually choose the IUD or the pill. IUDs carry a high risk of infection and are less effective in diabetics. The author compared a low-dose combined pill with 400 mcg norethindrone and 35 mcg ethinyl estradiol (Ovcon 35), and a pill containing levonorgestrel (Triphasil), to barrier contraception in 230 women with recent gestational diabetes. After 6-13 months of use 11-17% of each group had impaired glucose tolerance, and 15-20% of each group had diabetes (n.s.). Insulin levels rose from 28.5 mIU/mL to 59.7 in controls, 32.0 to 71.8 in Ovcon 35 users, and from 40.2 to 85.1 in Triphasil users (p0.05). HDL values rose significantly in the group taking Ovcon, and LDL values fell significantly in all 3 groups. These low-dose pills can be used safely in postpartum gestational diabetic women, as long as they do not smoke, are encouraged to lose weight, and have no sign of cardiovascular disease as evidenced by albuminuria and an ophthalmoscopic exam. PMID:1679421
Shoupe, D; Bopp, B
A prospective study of 57 women with gestational diabetes mellitus was undertaken to determine actual insulin requirements throughout pregnancy. Women were placed on a multiple injection, mixed insulin regimen and monitored their blood glucose level 6.5 +/- 1 times per day using a memory-based reflectance meter to obtain verified data. A significant (p less than 0.01) increase in total insulin dose was found during the initial treatment period (7 +/- 2 days) until the target glucose range was achieved. Insulin requirements continued to significantly (p less than 0.01) rise until 30 +/- 1 gestational weeks, despite a stabilization of glucose level. Thereafter, there was no significant change (3%) in insulin requirement. A correlation of r = 0.58 (p less than 0.001) for the relationship between insulin dose at the 24 and 32 weeks' gestation, and an r = 0.99 (p less than 0.0001) for the relationship between insulin dose at 32 and 39 weeks' gestation was found. We concluded that an emphasis on ambulatory blood glucose control and insulin adjustments should occur in the early treatment phase of gestational diabetes. PMID:3307425
Langer, O; Anyaegbunam, A; Brustman, L; Guidetti, D; Mazze, R
Abstract Background: To evaluate waist circumference (WC) measured at 20-24 weeks of gestation as a predictor of gestational diabetes mellitus (GDM). Methods: This cross-sectional study included 240 women at 20-24 weeks of gestation. At enrollment, WC was measured, and both prepregnancy and gestational body mass index (BMI) were estimated. According to the results of 75-g oral glucose tolerance test (OGTT) performed at 24-28 weeks, subjects were allocated into two groups, non-GDM and GDM. WC sensitivity and specificity, and odds ratios (OR) and 95% confidence intervals for BMI and WC were estimated, and a receiver operating characteristics curve was generated. Results: Of the 240 pregnant women enrolled, 31 (13%) had GDM. Prepregnancy BMI (OR?=?4.21), gestational BMI (OR?=?3.17) and WC at 20-24 weeks (OR?=?4.02) correlated with GDM risk. At 20-24 weeks, a WC of 85.5-88.5?cm was the optimal cutoff point for predicting GDM (Sens/Spec balance between 87.1/41.1% and 77.4/56.9%). Conclusion: At 20-24 weeks of gestation, WC values in the range of 86-88?cm showed to be a good performance in predicting GDM. PMID:24053462
Bolognani, Cláudia Vicari; de Sousa Moreira Reis, Lilian Barros; de Souza, Sulani Silva; Dias, Adriano; Rudge, Marilza Vieira Cunha; de Mattos Paranhos Calderon, Iracema
\\u000a Identifying genes underlying complex diseases hold the promise of new drug targets, improved interventions, and the advent\\u000a of so-called “personalized medicine.” For almost 2 decades, investigators have attempted to identify genes underlying gestational\\u000a diabetes mellitus (GDM) and type 2 diabetes mellitus (T2DM), but until recently were mostly unsuccessful. Improvements in\\u000a genetic information and technology changed the landscape of complex disease
Richard M. Watanabe; MARY HELEN BLACK; ANNY H. XIANG; HOOMAN ALLAYEE; JEAN M. LAWRENCE; THOMAS A. BUCHANAN
ABSTRACT The purpose of our clinical case presentation is to emphasize the role of ear, nose and throat specialist in early recognition and urgent treatment of mucormycosis, which is a rare infection caused by fungus belonging to the order Mucorales. They are known opportunistic organisms, which potentially invade and infect a host with depressed immunity. In our paper we present a case of an uncontrolled diabetic male with orbital complications caused by a fungal pan-sinusitis. The typical presentation of rhino-orbital fungal infection is that of anterior orbital inflammation, severe visual loss, external ophthalmoplegia and fever. Our diagnostic was based on an otolaryngological, ophthalmological, imagistic but especially biopsy exam, which is the only one that can make the certain diagnostic in this case. We followed the standard treatment for these situations. Early recognition and treatment with urgent surgical debridement and systemic antifungal therapy is the key to the management of rhino-orbital mucormycosis and is necessary to limit the spread of infection, which can lead to high morbidity and mortality. Therefore, health practitioners should be familiar with the signs and symptoms of the disease. The authors certify that they do not have any financial or personal relationships that might bias the content of this work.
NICOLAE, Miruna; POPESCU, Cristian Radu; POPESCU, Bogdan; GRIGORE, Raluca
Gestational diabetes mellitus (GDM) is defined as glucose intolerance first diagnosed during pregnancy. This condition shares same array of underlying abnormalities as occurs in diabetes outside of pregnancy, for example, genetic and environmental causes. However, the role of a sedentary lifestyle and/or excess energy intake is more prominent in GDM. Physically active women are less likely to develop GDM and other pregnancy-related diseases. Weight gain in pregnancy causes increased release of adipokines from adipose tissue; many adipokines increase oxidative stress and insulin resistance. Increased intramyocellular lipids also increase cellular oxidative stress with subsequent generation of reactive oxygen species. A well-planned program of exercise is an important component of a healthy lifestyle and, in spite of old myths, is also recommended during pregnancy. This paper briefly reviews the role of adipokines in gestational diabetes and attempts to shed some light on the mechanisms by which exercise can be beneficial as an adjuvant therapy in GDM. In this regard, we discuss the mechanisms by which exercise increases insulin sensitivity, changes adipokine profile levels, and boosts antioxidant mechanisms.
Golbidi, Saeid; Laher, Ismail
Gestational diabetes mellitus (GDM) complicates a substantial number of pregnancies. There is consensus that in patients of GDM, excellent blood glucose control, with diet and, when necessary, oral hypoglycemics and insulin results in improved perinatal outcomes, and appreciably reduces the probability of serious neonatal morbidity compared with routine prenatal care. Goals of metabolic management of a pregnancy complicated with GDM have to balance the needs of a healthy pregnancy with the requirements to control glucose level. Medical nutrition therapy is the cornerstone of therapy for women with GDM. Surveillance with daily self-monitoring of blood glucose has been found to help guide management in a much better way than blood glucose checking in labs and clinics, which tends to be less frequent. Historically, insulin has been the therapeutic agent of choice for controlling hyperglycemia in pregnant women. However, difficulty in medication administration with multiple daily injections, potential for hypoglycemia, and increase in appetite and weight make this therapeutic option cumbersome for many pregnant patients. Use of oral hypogycemic agents (OHAs) in pregnancy has opened new vistas for GDM management. At present, there is a growing acceptance of glyburide (glibenclamide) use as the primary therapy for GDM. Glyburide and metformin have been found to be safe, effective and economical for the treatment of gestational diabetes. Insulin, however, still has an important role to play in GDM. GDM is a window of opportunity, which needs to be seized, for prevention of diabetes in future life. Goal of our educational programs should be not only to improve pregnancy outcomes but also to promote healthy lifestyle changes for the mother that will last long after delivery. Team effort on part of obstetricians and endocrinologists is required to make “the diabetes capital of the world” into “the diabetes care capital of the world”.
Magon, Navneet; Seshiah, V.
Gestational diabetes (GDM) is defined as glucose intolerance first diagnosed with a 75 gram oral glucose tolerance test based on IADPSG criteria which had been recently adopted by WHO. In industrial countries GDM?is one of the most frequent pregnancy complications. In 2012, in Germany GDM?had been diagnosed in 4,3?% of all births, overall 27,700 cases. GDM?has to be considered as a preliminary stage of type 2 diabetes with insulin resistance and inadequate ?-cell-compensation. Additionally, adverse metabolic profile, associations with inflammatory parameters, with D vitamin metabolism, and insufficient decline of renal threshold for glucose had been identified in women with GDM. Within 10 years after GDM?roughly 50?% of the women convert to overt diabetes, mostly type 2.?GDM?and type 2 diabetes share potential candidate genes. In about 1?% of GDM?in Caucasian women a mutation in glucokinase gene had been found (GCK-MODY). Predisposition to GDM?is predominantly characterized by family history of diabetes, previous GDM?in pregnancies, factors of metabolic syndrome, and unfavorable life style. The probability for GDM?rises with increasing mother's age and preconceptional BMI. Via fetal programming GDM?dispones to offspring obesity as early as school entry. Prevention of GDM?focus on regular physical exercise, normalizing body weight before conception, reducing excess intake of animal protein and soft drinks, planning of pregnancy in younger ages, and avoiding pollutant exposition as well as smoking cessation. PMID:24823983
Kleinwechter, H; Demandt, N; Schäfer-Graf, U
By its location between maternal and fetal bloodstreams the human placenta not only handles the materno-fetal transport of nutrients and gases, but may also be exposed to intrauterine conditions adversely affecting placental and fetal development. Such adverse conditions exist in pregnancies complicated by gestational diabetes mellitus (GDM), and have been associated with alterations in placental anatomy and physiology. These alterations are mainly based on changes on the micro-anatomical and/or even molecular level including aberrant villous vascularization, a disbalance of vasoactive molecules, and enhanced oxidative stress. The consequence thereof may be impaired fetal oxygenation and changes in transplacental nutrient supply. Although transplacental glucose flux is flow limited and independent of glucose transporter availability, transport of essential and nonessential amino acids and expression of genes involved in lipid transport and metabolism are significantly affected by GDM. PMID:22102097
Gauster, M; Desoye, G; Tötsch, M; Hiden, U
Gestational diabetes mellitus (GDM) complicates 7 %-14 % of pregnancies in the United States. Vitamin D deficiency also is common in pregnancy. Emerging evidence suggests that Vitamin D administration can improve insulin sensitivity and glucose tolerance, but whether vitamin D supplementation can prevent GDM is unknown. Observational studies provide conflicting evidence as to whether low serum 25-hydroxyvitmain D (25(OH)D) levels are associated with GDM. Two recent systematic reviews concluded that vitamin D deficiency is associated with a higher risk of GDM. However, these reviews are limited by the observational and diverse nature of the included studies. Of greatest concern is the inability to understand how important confounding variables such as race/ethnicity and adiposity might affect the association. Randomized controlled trial data remain limited but are critical to understanding whether supplementation with vitamin D beyond what is contained in routine prenatal vitamins will prevent GDM or improve glucose tolerance for women with GDM. PMID:24277676
Burris, Heather H; Camargo, Carlos A
Objective: We sought to evaluate the impact of the 1997 American Diabetes Association gestational diabetes mellitus screening guidelines applied to a universally screened population. Study Design: A retrospective analysis of 18,504 women universally screened for gestational diabetes mellitus at Mayo Clinic, Rochester, between January 1, 1986, and December 31, 1997, was performed. Diabetic screening consisted of plasma glucose determination 1
Diana R. Danilenko-Dixon; Jo T. Van Winter; Roger L. Nelson; Paul L. Ogburn
Gestational diabetes insipidus is a rare, but well recognized, complication of pregnancy. It is related to excess vasopressinase enzyme activity which is metabolized in the liver. A high index of suspicion of gestational diabetes insipidus is required in a correct clinical setting especially in the presence of other risk factors such as preeclampsia, HELLP syndrome, and twin pregnancies. We are presenting a case of gestational diabetes insipidus in a patient with HELLP syndrome. The newborn in this case also had hypernatremia thereby raising possibilities of vasopressinase crossing the placenta.
Gambito, Renela; Chan, Michael; Sheta, Mohamed; Ramirez-Arao, Precious; Gurm, Harmeet; Tunkel, Allan; Nivera, Noel
Background: Gestational diabetes mellitus is a metabolic disorder defined as glucose intolerance with onset or first recognition during pregnancy. Similar to other members of the Asian race, Pakistani women are also considered to be at a high risk for developing gestational diabetes. Materials and Methods: In order to better understand whether this heightened risk attributed to race really exists, we conducted a prospective study to assess the glycemic status of primigravida women presenting to our hospital. Results: The mean age of 135 subjects enrolled was 22 (16-31), with 21 (16%), 60 (44%), and 54 (40%) subjects in the first, second, and third trimesters of pregnancy, respectively. The mean fasting, 1-hour, and 2-hour plasma glucose levels were 69.9 mg/dL (3.9 mmol/L), 129 mg/dL (7.2 mmol/L), and 103.6 mg/dL (5.76 mmol/L), respectively. Of 135 women, 6 had a blood pressure reading ?140/90 mm Hg and only one met the criteria for gestational diabetes mellitus. In our study, despite using the newly proposed International Association of Diabetes and Pregnancy Study (IADPS) cut-offs for diagnosis of gestational diabetes, the incidence rate of gestational diabetes mellitus in primigravida was still <1%. Conclusion: Larger trials are needed to truly assess the disease burden of gestational diabetes mellitus in Pakistani women.
Jawa, Ali; Raza, Farhan; Qamar, Khola; Jawad, Ali; Akram, Javed
Gestational diabetes mellitus (GDM) is one of the most common complications of pregnancy. It is defined as diabetes that is first recognized during pregnancy. The diagnosis of GDM is important because it impacts maternal health care during and after pregnancy. The American Diabetes Association, American Congress of Obstetrics and Gynecology, the World Health Organization, and the National Diabetes Data Group all have recommendations for screening; however, there is no consensus. The Hyperglycemia and Adverse Pregnancy Outcome Research Cooperative Study Group published their findings that show hyperglycemia has a significant effect on pregnancy outcome. In addition, recent studies showed that treatment of mild hyperglycemia may affect adverse outcomes. However, at this time no new guidelines for screening and diagnosis of gestational diabetes have been published. This article summarizes the current state of screening for gestational diabetes. PMID:20425586
Mulla, Wadia R; Henry, Tasmia Q; Homko, Carol J
In a 2003 evidence report, the United States Preventive Services Task Force (USPSTF) concluded that the scientific evidence was insufficient to advise for or against routine screening for gestational diabetes mellitus (GDM) in all pregnant women. The 2003...
D. J. Pettitt E. P. Whitlock K. K. Vesco K. L. Pedula T. A. Hillier
... Child Health and Human Development (NICHD) has been working to answer these types of questions through research and clinical practice to improve the health of mothers, children, and families. Managing Gestational Diabetes: A Patient's ...
... Research Planning Scientific Resources Research Who can I go to for help with gestational diabetes? Skip sharing ... in how they get prenatal care. They might go to an obstetrician/gynecologist (OB/GYN) , a nurse- ...
Gestational diabetes mellitus (GDM) is defined as carbohydrate intolerance with onset or first recognition during pregnancy.\\u000a When medical nutrition therapy is not successful in maintaining target glucose values during pregnancy complicated by GDM,\\u000a medication is required. Insulin has been the traditional treatment under such circumstances. The use of oral antidiabetic\\u000a medications in the management of gestational diabetes has increased over
Michael J. Paglia; Donald R. Coustan
Background Diabetes in pregnant women is associated with an increased risk of maternal and neonatal morbidity and remains a significant medical challenge. Diabetes during pregnancy may be divided into clinical diabetes and gestational diabetes. Experimental models are developed with the purpose of enhancing understanding of the pathophysiological mechanisms of diseases that affect humans. With regard to diabetes in pregnancy, experimental findings from models will lead to the development of treatment strategies to maintain a normal metabolic intrauterine milieu, improving perinatal development by preventing fetal growth restriction or macrosomia. Based on animal models of diabetes during pregnancy previously reported in the medical literature, the present study aimed to compare the impact of streptozotocin-induced severe (glycemia >300 mg/dl) and mild diabetes (glycemia between 120 and 300 mg/dl) on glycemia and maternal reproductive and fetal outcomes of Wistar rats to evaluate whether the animal model reproduces the maternal and perinatal results of clinical and gestational diabetes in humans. Methods On day 5 of life, 96 female Wistar rats were assigned to three experimental groups: control (n = 16), severe (n = 50) and mild diabetes (n = 30). At day 90 of life, rats were mated. On day 21 of pregnancy, rats were killed and their uterine horns were exposed to count implantation and fetus numbers to determine pre- and post-implantation loss rates. The fetuses were classified according to their birth weight. Results Severe and mild diabetic dams showed different glycemic responses during pregnancy, impairing fetal glycemia and weight, confirming that maternal glycemia is directly associated with fetal development. Newborns from severe diabetic mothers presented growth restriction, but mild diabetic mothers were not associated with an increased rate of macrosomic fetuses. Conclusion Experimental models of severe diabetes during pregnancy reproduced maternal and fetal outcomes of pregnant women presenting uncontrolled clinical diabetes. On the other hand, the mild diabetes model caused mild hyperglycemia during pregnancy, although it was not enough to reproduce the increased rate of macrosomic fetuses seen in women with gestational diabetes.
Kiss, Ana CI; Lima, Paula HO; Sinzato, Yuri K; Takaku, Mariana; Takeno, Marisa A; Rudge, Marilza VC; Damasceno, Debora C
Screening for GDM is usually performed around 24-28 weeks of gestational age. We undertook a study to estimate the prevalence of glucose intolerance during different trimesters, as data in this aspect is sparse. A total of 4151 consecutive pregnant women irrespective of gestational weeks attending antenatal health posts across Chennai city underwent a 75 g OGTT recommended by WHO and diagnosed GDM if 2 hr PG value > or =140 mg/dl. Women who had normal OGTT at the first visit were screened with a repeat OGTT at the subsequent visits. Among the screened, 741 women (17.9%) had 2 hr PG> or =140 mg/dl and were identified to have gestational diabetes. Analysis based on gestational weeks revealed that out of the 741 GDM women, 121 (16.3%) were within 16 weeks, 166 (22.4%) were between 17 and 23 weeks and 454 (61.3%) were more than 24 weeks of gestation. Observation in this study was that 38.7% developed gestational diabetes even prior to 24th week of gestation. Out of the total 741 GDM women, 214 (28.9%) were diagnosed on repeat testing at subsequent visits. Glucose intolerance occurs in the early weeks of gestation. Women who had normal glucose tolerance in the first visit require repeat OGTT in the subsequent visits. PMID:17292506
Seshiah, V; Balaji, V; Balaji, Madhuri S; Paneerselvam, A; Arthi, T; Thamizharasi, M; Datta, Manjula
Gestational diabetes mellitus (GDM) is an established risk factor for the development of overt diabetes. Since the change in diagnostic criteria for diabetes in 1997, it is unclear whether there should be any preference for fasting or post-glucose challenge blood glucose in diagnosing diabetes after GDM. The study aimed at assessing the usefulness of both diagnostic methods in women after
K. Cypryk; L. Czupryniak; J. Wilczy?ski; A. Lewi?ski
Abstract The purpose of this study was to identify pre-gestational and gestational factors predicting subsequent insulin requirement in patients with gestational diabetes mellitus (GDM). Maternal parameters were compared between mothers achieving glycemic control with or without the addition of antenatal insulin therapy (AIT). Insulin was required only in 8/83 (10%) patients for glycemic control. Those who needed insulin had a stronger family history of diabetes and higher first hour plasma glucose along with multiple (>1) abnormal values during oral glucose tolerance test (OGTT) in univariate analysis (p?0.05). The first hour plasma glucose value of ?9.72?mmol/l predicted requirement of AIT in GDM mothers with a sensitivity of 100% and specificity of 73%. However, only positive family history of diabetes mellitus among first degree relatives and multiple abnormal values in OGTT were independent predictors for antenatal insulin requirement in regression analysis. PMID:24828607
Mitra, Subarna; Nayak, Prasanta Kumar; Sahoo, Jayaprakash; Mathew, Agnes; Padma, Alaganandam; Kamalanathan, Sadishkumar; Agrawal, Sarita
Objective: The aim of this study was to investigate thyroid function tests in Gestational Diabetes Mellitus (GDM) and pre-gestational DM and control group. Methodology : There were 61 pregnant diabetic women in study group and 35 pregnant women in control group. Serum T4, T3, T3RU, FTI, TSH and Anti TPO Ab were assessed in each person. Results : About 36% of patients had GDM and 64% pre-gestational DM. Thyroid dysfunction was detected in 18% of study group compared with 8.6% of control group (P = 0.2). There was Thyroid dysfunction in 4.5% of GDM and 25.6% of pregestational DM (P = 0.045). There was no statistically significant difference between thyroid dysfunction in GDM group and control group (P=0.99).27% of GDM and 36% of pregestational DM and 23% of control group had positive titer of Anti TPO Ab without statistically significant differences among the three groups. Conclusion : Thyroid dysfunction is prevalent in women with pre-gestational DM so, thyroid function should be evaluated in these patients during pregnancy. Rate of thyroid dysfunction in GDM patients is similar to normal pregnant control women. High prevalence of positive titer of TPO Ab was seen in diabetic and non-diabetic pregnant women. PMID:24353594
Shahbazian, Hajieh; Shahbazian, Nahid; Rahimi Baniani, Mahnaz; Yazdanpanah, Leila; Latifi, Seyed Mahmuod
Objective: The aim of this study was to investigate thyroid function tests in Gestational Diabetes Mellitus (GDM) and pre-gestational DM and control group. Methodology : There were 61 pregnant diabetic women in study group and 35 pregnant women in control group. Serum T4, T3, T3RU, FTI, TSH and Anti TPO Ab were assessed in each person. Results : About 36% of patients had GDM and 64% pre-gestational DM. Thyroid dysfunction was detected in 18% of study group compared with 8.6% of control group (P = 0.2). There was Thyroid dysfunction in 4.5% of GDM and 25.6% of pregestational DM (P = 0.045). There was no statistically significant difference between thyroid dysfunction in GDM group and control group (P=0.99).27% of GDM and 36% of pregestational DM and 23% of control group had positive titer of Anti TPO Ab without statistically significant differences among the three groups. Conclusion : Thyroid dysfunction is prevalent in women with pre-gestational DM so, thyroid function should be evaluated in these patients during pregnancy. Rate of thyroid dysfunction in GDM patients is similar to normal pregnant control women. High prevalence of positive titer of TPO Ab was seen in diabetic and non-diabetic pregnant women.
Shahbazian, Hajieh; Shahbazian, Nahid; Rahimi Baniani, Mahnaz; Yazdanpanah, Leila; Latifi, Seyed Mahmuod
The choice of thresholds to diagnose gestational diabetes mellitus (GDM) is a topic of ongoing controversy. In 2008, the Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study showed continuous graded relationships between increasing maternal plasma glucose and increasing frequency of adverse perinatal outcomes. Macrosomia (birth weight>90th percentile for gestational age), primary cesarean delivery, clinical neonatal hypoglycemia and hyperinsulinemia (cord serum C peptide>90th percentile) were all related to each of the 3 glucose values (fasting plasma glucose and at 1 and 2 hours after the 75 g oral glucose test). The associations were continuous with no obvious thresholds at which risks increased. The International Association of Diabetes and Pregnancy Study Group (IADPSG) recently issued recommendations that the diagnosis of GDM be made when any of the following thresholds are met or exceeded: fasting plasma glucose: 0,92 g/L; 1 hour: 1,80 g/L; or 2 hours: 1,53 g/L after the 75 g oral glucose test. These criteria were chosen to identify pregnancy with increased risk of adverse perinatal outcomes. By the new criteria, the total incidence of gestational diabetes in the HAPO population was 17, 8%. Fasting plasma glucose (FPG) in early pregnancy appears as an important predictive factor. Higher first trimester FPG (lower than those diagnostic of diabetes) are associated with increased risks of later diagnosis of gestational diabetes and adverse pregnancy outcomes. Whether this new consensus will be adopted by public health bodies and professionals remains to be seen. PMID:21388854
Legardeur, H; Girard, G; Mandelbrot, L
Pregnancy is susceptible to oxidative stress and antioxidant defenses can be altered in response to elevated levels of oxidative\\u000a stress. Limited data in gestational diabetes mellitus (GDM) suggest that products of lipid peroxidation may be increased and\\u000a antioxidant enzyme activities decreased, although the results have been inconsistent. As in type 2 diabetes mellitus (T2DM),\\u000a glycemic levels in patients with GDM
Xinhua Chen; Theresa O. Scholl
\\u000a Gestational diabetes mellitus (GDM), or diabetes first recognized during pregnancy, is associated with increased risk of adverse\\u000a perinatal outcomes. After GDM delivery, both mothers and offspring are at risk for long-term chronic disease. Clinical recognition\\u000a and treatment of GDM may reduce peripartum risk, but there is a lack of consensus on how to define, screen and treat GDM.\\u000a There is
Assiamira Ferrara; Catherine Kim
ABSTRACT OBJECTIVE To explore primary care provider (PCP) and patient perspectives on postpartum screening for type 2 diabetes (T2DM), including reasons for not completing oral glucose tolerance tests (OGTTs) specifically, preferred provider for organizing screening, and value of reminder letters for facilitating screening. DESIGN A follow-up survey, administered by fax or telephone, to PCPs and patients who participated in a randomized controlled trial assessing effectiveness of postpartum postal reminders to enhance screening for T2DM in women with gestational diabetes mellitus (GDM). SETTING The Ottawa Hospital, a university-affiliated tertiary centre in Ottawa, Ont. PARTICIPANTS A total of 223 female patients with previously identified GDM and their respective PCPs were surveyed; 173 PCPs and 140 patients participated. MAIN OUTCOME MEASURES Whether or not the patient was screened for T2DM post partum, the test used for screening, the factors contributing to the patient not being screened, perspectives on the importance of screening post partum, and opinions about which care provider should be responsible for screening in the postpartum period. RESULTS Response rates were 78% (173 of 223) for PCPs and 63% (140 of 223) for patients. Only 37% of the PCP responders had their patients complete OGTTs, while 85% of patient responders reported that they had completed OGTTs. The most common reason PCPs gave for not screening was no postpartum visit from the patient for any reason. Time pressures were the most common reason provided by patients for not being screened. More than 95% of patients and providers agreed that screening for T2DM was important. Patients and PCPs agreed that PCPs should be responsible for screening. Reminder letters were perceived as helpful by more than 85% of patients and PCPs. CONCLUSION This follow-up survey demonstrates that PCPs and patients value the importance of screening for diabetes, identify the PCP as pivotal to screening, and appreciate a reminder strategy. There continue to be barriers that affect screening rates, despite the perceived importance of screening by PCPs and patients. TRIAL REGISTRATION NUMBER NCT00212914 (ClinicalTrials.gov).
Keely, Erin; Clark, Heather; Karovitch, Alan; Graham, Ian
Objective In this study we aimed to determine the prevalence of cardiac malformations in fetuses of Iranian diabetic mothers with pre-gestational and gestational diabetes mellitus (GDM) and to find the patterns of different cardiac malformations. Methods One-hundred and seventy diabetic pregnant women (68 preGDM and 102 GDM) (mean age: 32.17±4.8 years) and 85 healthy controls (mean age: 31.35±4.55 years) were recruited from September 2008 to July 2012. Fetal echocardiography was performed to assess cardiac malformation. In order to study major factors that may affect the results, a complete history was obtained. Findings Fetal echocardiography was performed at mean gestational age of 24.7±5.4 and 20.27±3.9 weeks in diabetic patients and control group, respectively. Fifteen (8.8%) fetuses of diabetic mothers were detected to have cardiac malformations compared with 1 (1.17%) fetus in control group (OR: 8.13, 95%CI: 1.1-62.61, P-value=0.02). Hypertrophic cardiomyopathy noted as the most common cardiac malformation occurred in 6 out of 15 (40%) fetuses, and was found significantly more common in pre-GDM compared to GDM group (7.4% vs 1%, P-value =0.04). Despite the higher incidence of cardiac malformation in pre-GDM compared to GDM group, the difference was not significant. Further, no significant association was observed between the variables including; parity, diabetic regimen, parents’ consanguinity, maternal history of hypertension or hypothyroidism and occurring cardiac malformations (P-value>0.05). Conclusion In this study we detected cardiac malformations in 8.8% of our diabetic referrals. The result of the present study shows that screening diabetic mothers for fetal cardiac malformations could be beneficial.
Tabib, Avisa; Shirzad, Nooshin; Sheikhbahaei, Sara; Mohammadi, Sara; Qorbani, Mostafa; Haghpanah, Vahid; Abbasi, Farzaneh; Hasani-Ranjbar, Shirin; Baghaei-Tehrani, Ramin
Objectives: To study prevalence, risk factors, and maternal and infant outcomes of women with gestational diabetes mellitus (GDM). Methods: A retrospective cohort study was performed based on 111563 pregnancies delivered between 1991 through 1997 in 39 hospitals in northern and central Alberta, Canada. Multivariate logistic regression was used to estimate the odds ratios with 95% confidence intervals, and to control
X. Xiong; L. D. Saunders; F. L. Wang; N. N. Demianczuk
Objective. Obesity increases risk of many adverse outcomes, but its early origins are obscure. Gestational diabetes mellitus (GDM) reflects a metabol- ically altered fetal environment associated with high birth weight, itself associated with later obesity. Previous studies of GDM and offspring obesity, however, have been few and conflicting. The objectives of this study were to examine associations of birth weight
Matthew W. Gillman; Sheryl Rifas-Shiman; Catherine S. Berkey; Alison E. Field; Graham A. Colditz
Maternal diabetes constitutes an unfavorable environment for fetal-placental and embryonic development. It is has important repercussion in modern obstetrics, since it is associated to an increased risk of neonatal and maternal morbidity, and it still is a significant medical challenge. The increased occurrence of diabetes worldwide, the increase in diabetes type 2 in women at reproductive age and the crossed generation of intrauterine programming for diabetes type 2 are the bases for the growing interest in utilization of diabetic experimental samples, with the aim to acquire knowledge about the mechanisms that induce development alterations in gestational diabetes. Several studies have shown the benefits of diabetes prevention, with interventions in lifestyle, metabolic improvement and control of cardiovascular risk factors to substantially prevent the complications of this devastating disease. Despite these findings, the recent revolution in the scientific knowledge, and the infinite number of new therapies for diabetes, there is still a large gap between what was learned through research and what is really done in public, clinical and community health. The negative economic impact of this complacency in people, families, and national economies is alarming. It is expected that translational research in the binomial diabetes and pregnancy are implemented in centers of excellence, in both basic and applied research, and complemented by multicenter clinical studies, conducted in a pragmatic way to increase the level of scientific evidence with more reliable diagnostic and propaedeutic resources. PMID:24232813
Rudge, Marilza Vieira Cunha; Piculo, Fernanda; Marini, Gabriela; Damasceno, Débora Cristina; Calderon, Iracema Mattos Paranhos; Barbosa, Angélica Pascon
Fourteen pregnant women were shown by the oral glucose tolerance test to have gestational diabetes. In 13 an increased urinary xanthurenic-acid excretion after an oral load of L-tryptophan indicated a relative pyridoxine deficiency. All patients were treated with vitamin B6 (pyridoxine) 100 mg\\/day for 14 days by mouth, after which the pyridoxine deficiency disappeared and the oral glucose tolerance improved
H J Bennink; W H Schreurs
This quasi-experimental study examined the effectiveness of a behavior modification program for diabetic control in Thai elders with uncontrolled Type 2 Diabetes. Purposive sampling was used to select 30 elders from one community as an intervention group, and 30 from a neighboring community as a control group. The intervention group participated in a program of 12 weeks' duration involving activities related to group counseling, group discussion, and an empowerment process that enhanced appropriate consumption of healthy diet, medication taking, and exercise. Data were collected by interviews using a questionnaire to assess knowledge of diabetes, perceived self-efficacy, and diabetes control behavior, including fasting blood glucose and glycosylated hemoglobin, were examined at the baseline and three months thereafter. At program completion, the intervention group had significantly higher scores of knowledge, self-efficacy, and health behaviors than those in the control group, but blood glucose and glycosylated hemoglobin were not significantly different. Although nurses can use aspects of this program to benefit elders with diabetes who require support and education, further research is required to provide improved health outcomes such as better glycemic control. PMID:23991917
Ounnapiruk, Liwan; Wirojratana, Virapun; Meehatchai, Nitaya; Turale, Sue
The diagnosis of gestational diabetes mellitus (GDM) identifies patients with a pancreatic ?-cell defect. In some patients, the defect is transient or stable, but in most it is progressive, imparting a high risk of diabetes for at least a decade after the index pregnancy. The ?-cell defects in GDM can result from many causes, including genetic variants typical of monogenic forms of diabetes and autoimmunity typical of evolving type 1 diabetes. No specific disease-modifying therapies are available for those patients. The majority of women with GDM have clinical characteristics indicating a risk for type 2 diabetes (T2D). Available evidence indicates that T2D can be prevented or delayed by intensive lifestyle modification and by medications, particularly those that ameliorate insulin resistance. Clinical management should include assessment of glucose tolerance in the postpartum period to detect diabetes or assess diabetes risk. Women who don't have diabetes should be advised about their risk and participate in family planning to prevent subsequent pregnancies with undiagnosed hyperglycemia. All patients should be monitored for rising glycemia indicative of progressive ?-cell deterioration. We suggest a combination of fasting glucose and glycosylated hemoglobin measurements for this purpose. Monitoring should be initiated at least annually and should be intensified if glycemia is rising and/or impaired. Lifestyle modification is advised to reduce the risk for T2D. Like monitoring, lifestyle modification should be intensified for rising glycemia and/or development of impaired glucose levels. At present, there is insufficient evidence to recommend medications to prevent T2D. Close follow-up and monitoring will allow initiation of pharmacological treatment as soon as diabetes develops. Children of women with GDM are at increased risk for obesity and diabetes. They should receive education, monitoring, and lifestyle advice to minimize obesity and diabetes risk.
Page, Kathleen A.
Gestational diabetes mellitus (GDM) carries a small but potentially important risk of adverse perinatal outcomes and a long-term risk of obesity and glucose intolerance in offspring. Mothers with GDM have an excess of hypertensive disorders during pregnancy and a high risk of developing diabetes mellitus thereafter. Diagnosing and treating GDM can reduce perinatal complications, but only a small fraction of pregnancies benefit. Nutritional management is the cornerstone of treatment; insulin, glyburide and metformin can be used to intensify treatment. Fetal measurements complement maternal glucose monitoring in the identification of pregnancies that require such intensification. Glucose testing shortly after delivery can stratify the short-term diabetes risk in mothers. Thereafter, annual glucose and HbA(1c) testing can detect deteriorating glycaemic control, a harbinger of future diabetes mellitus, usually type 2 diabetes mellitus. Interventions that mitigate obesity or its metabolic effects are most potent in preventing or delaying diabetes mellitus. Lifestyle modification is the primary approach; use of medications for diabetes prevention after GDM remains controversial. Family planning enables optimization of health in subsequent pregnancies. Breastfeeding may reduce obesity in children and is recommended. Families should be encouraged to help children adopt lifestyles that reduce the risk of obesity. PMID:22751341
Buchanan, Thomas A; Xiang, Anny H; Page, Kathleen A
Gestational diabetes mellitus, most of which progress to type-2 diabetes mellitus is increasing worldwide. Identification of gestational diabetes and control of glucose can reduce such complications and improve maternal and neonatal health. A hospital based cross sectional study was conducted to find out maternal and fetal outcome of gestational diabetes from January to July 2011. Data were collected from 109 gestational diabetes mothers attending Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) hospital for delivery. Study revealed that gestational diabetes was more common among mothers aged >25 years old and multiparaous women. Mean gestational age of diagnosis was 16.82±9.54 weeks. Sixty eight (68%) mothers were diagnosed before 20 weeks of gestation and more than 90% mothers with gestational diabetes delivered by caesarean section. Mean pregnancy weight gain was 6.8±1.18kg. Adverse maternal outcome observed in 24% cases and adverse fetal outcome was present in 34% cases. In univariate analysis weeks of delivery and fasting blood sugar were statistically significantly associated with adverse pregnancy outcome. Babies born to mothers with only diet restriction had less birth weight than mothers with insulin therapy. Pregnancy thought to be the most vulnerable stage of women's life and protecting her health along with her fetus during this period yields a positive impact on the health of future generation. Particular attention should be given during antenatal period to initiate screening programme and treatment protocol for gestational diabetic mothers. PMID:24858157
Sajani, T T; Rahman, M T; Karim, M R
In gestational diabetes (GDM), achieving euglycemia through treatment decreases the risk of adverse outcomes associated with hyperglycemia. Treatment starts with diet and nutritional counseling; however, up to 50% of women will require pharmacologic therapy to meet glucose goals. Although insulin remains the only Federal Drug Administration-approved agent to treat GDM, oral hypoglycemic agents are an attractive and increasingly common alternative. Research suggests that glyburide and metformin can each effectively manage hyperglycemia in pregnancy. This review highlights research on efficacy, safety, and advantages versus disadvantages of each. We offer management and counseling strategies for clinicians caring for patients with GDM. PMID:24005130
Berggren, Erica K; Boggess, Kim A
Gestational diabetes (GDM) is one of the most common complications of pregnancy and its prevalence is increasing continuously. Diagnosis, screening of GDM and therapeutic interventions are topics of ongoing controversies and uncertainty that have contributed to make the management of GDM complex and different from one country to another. Recent studies, such as ACHOIS and HAPO, have contributed to better define screening criteria and international recommendations and have demonstrated that management of GDM, including glucose monitoring, diet and insulin if needed, is worthwhile. This article summarizes the current status of screening, management of GDM and postpartum follow-up. PMID:21751721
Tran, C; Boulvain, M; Philippe, J
Gestational diabetes mellitus (GDM) affects many women in pregnancy and is enhanced by epidemic conditions of obesity, increasing age at the time of the first pregnancy, stressful life conditions, a sedentary lifestyle with less physical activity and unhealthy nutrition with highly processed, high-calorie food intake. GDM does not affect the mother and offspring in pregnancy alone, as there is compelling evidence of the long-term effects of the hyperglycemic state in pregnancy postpartum. Type 2 diabetes mellitus, cardiovascular disease and metabolic syndrome are more common in GDM women, and even the offspring of GDM women are reported to have higher obesity rates and a higher risk for noncommunicable diseases. Early prevention of risk factors seems to be key to overcoming the vicious cycle of cardiometabolic disease onset. PMID:24328601
Harreiter, Jürgen; Dovjak, Gregor; Kautzky-Willer, Alexandra
Introduction and objective. Gestational diabetes mellitus (GDM) is a pregnancy complication which increases the risk for maternal and foetal complications during pregnancy, and also significantly increases the cardiovascular risk for women's health in the postpartum. Current literature provides contradictory information on the role of adiponectin (AdipoQ) in the course of GDM. The aim of the study was to measure AdipoQ concentration in blood of women with GDM and to find correlations between this adipokine and clinical and biochemical parameters of the atherogenic risk. Material and methods. The GDM group included 50 women diagnosed with GDM between 24 - 28 weeks of gestation who underwent routine prenatal tests for GDM in compliance with the guidelines of the Polish Diabetes Association. All patients underwent clinical and laboratory evaluation at GDM diagnosis. Laboratory tests included serum AdipoQ concentration, fasting glucose and insulin, OGTT, lipid parameters, C-reactive protein and fibrinogen in serum. Results. The GDM group showed significantly elevated fasting glucose, insulin, HOMA-IR values, total cholesterol, LDLcholesterol and triglicerydes as compared with the control group (p<0.05). The atherogenic index, CRP, fibrinogen in women with GDM were significantly higher than in the control group (p<0.05). AdipoQ concentrations did not differ significantly between the groups during gestation (p=0.7054). No correlations, except with the neonatal weight (r= - 0.29, p<0.05), were found between AdipoQ and the studied parameters. Conclusions. Based on the conducted studies, it may be conclude that women with early diagnosed and promptly treated GDM have a normal adiponectin level, although insulin resistant changes and increased cardiovascular risk in basic metabolic parameters are observed. Moreover, adiponectin does not reflect the atherogenic risk in pregnant women with GDM. PMID:24738514
Matyjaszek-Matuszek, Beata; Lenart-Lipi?ska, Monika; Kowalczyk-Bo?tu?, Jolanta; Szlichtyng, Wojciech; Paszkowski, Tomasz
Presents the preliminary results of an attempt to screen pregnant Hispanic migrant farm workers for gestational diabetes. They are slightly more prone than the overall population of pregnant women to suffer from it. Provides recommendations for management of women with gestational diabetes, and describes how this is performed at the Indian Health…
O'Donnell, Patrick J.
Our objective was to study the influence of chronic hypertension on pregnancy outcome in women with gestational diabetes (GDM). 418 women with GDM (30 with chronic hypertension and 388 nonhypertensives) were referred to our diabetes in pregnancy program. All patients were followed and assessed biweekly until delivery. When hypertensive GDM women (n = 30) wer compared to all nonhypertensive GDM (n = 388), there were significant (p < 0.05) differences in mean maternal age (34 +/- 4.1 vs. 30 +/- 4.6 years), maternal weight (90 +/- 21.2 vs. 70.6 +/- 14.9 kg) and gestational age at delivery (38.5 +/- 1.2 vs. 39.6 +/- 1.2 weeks). The mean birth weight for the hypertensive GDM group was significantly higher than that of the nonhypertensive GDM (3,360 +/- 578 vs. 3,293 +/- 581 g; p < 0.05). The frequencies of LGA (23.3 vs. 9.8%) and induction prior to onset of spontaneous labor were significantly (p < 0.05) higher in the hypertensive GDM group when compared to the nonhypertensive GDM. There were no differences with respect to the average blood glucose and frequencies of SGA deliveries. However, when the 30 hypertensive GDM pregnancies were compared to a control group of 60 nonhypertensive GDM women matched for age, weight and height, the only significant difference was a higher rate of inductions of labor (36.7 vs. 6.6%, p < 0.05) in hypertensive diabetic women. There were no significant differences in the incidence of LGA, low Apgar scores and SGA deliveries when hypertensive GDM were compared to nonhypertensive GDM women.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7789911
Anyaegbunam, A M; Scarpelli, S; Mikhail, M S
The relationship between optimal levels of glycemic control and perinatal outcome was assessed in a prospective study of 334 gestational diabetic women and 334 subjects matched for control of obesity, race, and parity. All women with gestational diabetes mellitus were instructed in the use of a memory-based reflectance meter. They were treated with the same metabolic goal according to a predetermined protocol. Three groups were identified on the basis of mean blood glucose level throughout pregnancy (low, less than or equal to 86 mg/dl; mid, 87 to 104 mg/dl; and high, greater than or equal to 105 mg/dl). The low group had a significantly higher incidence of small-for-gestational-age infants (20%). In contrast, the incidence of large-for-gestational-age infants was 21-fold higher in the mean blood glucose category than in the low mean blood glucose category (24% vs. 1.4%, p less than 0.0001). An overall incidence of 11% small-for-gestational-age and 12% large-for-gestational-age infants was calculated for the control group. A significantly higher incidence of small-for-gestational-age infants (20% vs. 11%, p less than 0.001) was found between the control and the low category. In the high mean blood glucose category an approximate twofold increase was found in the incidence of large-for-gestational-age infants when compared with the control group (p less than 0.03). No significant difference was found between the control and mean blood glucose categories (87 to 104 mg/dl). Our data suggest that a relationship exists between level of glycemic control and neonatal weight. This information is helpful in targeting the level of glycemic control while optimizing pregnancy outcome in gestational diabetes comparable to the general population. PMID:2782347
Langer, O; Levy, J; Brustman, L; Anyaegbunam, A; Merkatz, R; Divon, M
Gestational diabetes mellitus (GDM) is defined as glucose intolerance with onset or first recognition during pregnancy. Data from Western countries suggest that the prevalence of GDM is increasing, being almost 10% of pregnancies and probably reflecting the global obesity epidemic. The majority of women with GDM seem to have ?-cell dysfunction that appears on a background of chronic insulin resistance already present before pregnancy. In less than 10% of GDM patients, defects of ?-cell function can be due to autoimmune destruction of pancreatic ?-cells, as in type 1 diabetes, or caused by monogenic mutations, as in several MODY subtypes. Diagnostic criteria for GDM vary worldwide and there are no clear-cut plasma glucose cut-off values for identifying women at a higher risk of developing macrosomia or other fetal complications. Because the oral glucose tolerance test (OGTT) is restricted to high risk individuals, 40% of GDM cases are left undiagnosed. Therefore, in high risk populations almost universal screening is recommended; only women considered to have very low risk do not need screening. Diet and exercise are the key elements in the treatment of GDM. If necessary, either insulin, certain oral hypoglycemic agents or combinations can be used to achieve normoglycemia. After delivery, women with GDM and their offspring have an increased risk for developing the metabolic syndrome and type 2 diabetes. Thus, pregnancy may act as a “stress test”, revealing a woman’s predisposition to T2D and providing opportunities for focused prevention of important chronic diseases.
Kaaja, Risto; Ronnemaa, Tapani
Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. Women with GDM and their offspring have an increased risk of developing type 2 diabetes mellitus in the future. The global incidence of GDM is difficult to estimate, due to lack of uniform diagnostic criteria. Various diagnostic criteria have been proposed. The benefit of treating GDM has also been controversial. The clinical significance of treating maternal hyperglycemia was made evident in the Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study. The HAPO study demonstrated that there is a continuous association of maternal glucose levels with adverse pregnancy outcomes and served as the basis for a new set of diagnostic criteria, proposed in 2010 by the International Association of Diabetes and Pregnancy Groups (IADPSG). According to these criteria the diagnosis of GDM is made if there is at least one abnormal value (?92, 180 and 153 mg/dl for fasting, one-hour and two-hour plasma glucose concentration respectively), after a 75 g oral glucose tolerance test (OGTT). PMID:20981162
Karagiannis, T; Bekiari, E; Manolopoulos, K; Paletas, K; Tsapas, A
Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. Women with GDM and their offspring have an increased risk of developing type 2 diabetes mellitus in the future. The global incidence of GDM is difficult to estimate, due to lack of uniform diagnostic criteria. Various diagnostic criteria have been proposed. The benefit of treating GDM has also been controversial. The clinical significance of treating maternal hyperglycemia was made evident in the Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study. The HAPO study demonstrated that there is a continuous association of maternal glucose levels with adverse pregnancy outcomes and served as the basis for a new set of diagnostic criteria, proposed in 2010 by the International Association of Diabetes and Pregnancy Groups (IADPSG). According to these criteria the diagnosis of GDM is made if there is at least one abnormal value (?92, 180 and 153 mg/dl for fasting, one-hour and two-hour plasma glucose concentration respectively), after a 75 g oral glucose tolerance test (OGTT).
Karagiannis, T; Bekiari, E; Manolopoulos, K; Paletas, K; Tsapas, A
The American Diabetes Association has endorsed the demanding recommendation by the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) that every pregnant woman should undergo the oral glucose tolerance test (OGTT) for the screening of gestational diabetes mellitus (GDM). The aim of this study was to find out if the fasting plasma glucose (FPG) and newer emerging technologies could simplify the cumbersome IADPSG algorithm. Two FPG thresholds (of the OGTT) were used to rule in and rule out GDM in the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) cohort (n = 23316) and a population at high risk for GDM (n = 10283). For the HAPO cohort and the high-risk population, respectively, FPG thresholds of: (a) ? 5.1 mmol/L (specificity 100%) independently ruled in GDM in 1769 (8.3%) women and 2975 (28.9%) women; and (b) ? 4.4 mmol/L ruled out GDM in 11526 (49.4%) women (84.1% sensitivity) and 2228 (21.7%) women (95.4% sensitivity). Use of the FPG independently could have avoided 13295 (57.0%) and 5203 (50.6%) OGTTs in the 2 groups. The initial FPG-by significantly reducing the number of cumbersome OGTTs needed-can make the IADPSG recommendations more acceptable worldwide. The number of GDM women missed is population dependent. For low-resource countries, alternative newer and cheaper tests in development hold an exciting future. PMID:22099438
Agarwal, Mukesh M; Weigl, Bernhard; Hod, Moshe
OBJECTIVE This study investigated the cost-effectiveness of treating mild gestational diabetes mellitus (GDM). STUDY DESIGN A decision analytic model was built to compare treating vs not treating mild GDM. The primary outcome was the incremental cost per quality-adjusted life year (QALY). All probabilities, costs, and benefits were derived from the literature. Base case, sensitivity analyses, and a Monte Carlo simulation were performed. RESULTS Treating mild GDM was more expensive, more effective, and cost-effective at $20,412 per QALY. Treatment remained cost-effective when the incremental cost to treat GDM was less than $3555 or if treatment met at least 49% of its reported efficacy at the baseline cost to treat of $1786. CONCLUSION Treating mild GDM is cost-effective in terms of improving maternal and neonatal outcomes including decreased rates of preeclampsia, cesarean sections, macrosomia, shoulder dystocia, permanent and transient brachial plexus injury, neonatal hypoglycemia, neonatal hyperbilirubinemia, and neonatal intensive care unit admissions.
Ohno, Mika S.; Sparks, Teresa N.; Cheng, Yvonne W.; Caughey, Aaron B.
Galectin-1 (gal-1) is a prototype carbohydrate-binding protein, whose dysregulation is associated with adverse pregnancy outcomes such as spontaneous abortion and pre-eclampsia. Furthermore, it is known that faulty gal-1 protein production or gene regulation can be caused by single-nucleotide polymorphisms in the LGALS1 gene. Gestational diabetes mellitus (GDM) is also an adverse pregnancy outcome and the most common metabolic disorder during gestation. However, gal-1 expression patterns during GDM remain largely unknown. Our aims were to define local and peripheral gal-1 expression patterns during pregnancy, and to investigate LGALS1 gene polymorphisms in GDM patients. Circulating gal-1 levels were determined by ELISA in GDM patients and normal pregnant controls, and LGALS1 gene polymorphisms were assessed for association with GDM. Placental tissues were collected from control and GDM term pregnancies to evaluate local gal-1 expression by immunofluorescence. Our results show that GDM is associated with a failure to increase circulating gal-1 levels during the second and third trimester, as well as overexpression of gal-1 in placental tissue. Additionally, the LGALS1 polymorphism rs4820294 was associated with the development of GDM. In pregnancies complicated by GDM, we observed gal-1 dysregulation both locally in the placenta and peripherally in the circulation. Furthermore, the association between the LGALS1 polymorphism and GDM may indicate a genetic contribution to this adverse pregnancy outcome. PMID:24637109
Blois, Sandra M; Gueuvoghlanian-Silva, Barbara Y; Tirado-González, Irene; Torloni, Maria R; Freitag, Nancy; Mattar, Rosiane; Conrad, Melanie L; Unverdorben, Laura; Barrientos, Gabriela; Knabl, Julia; Toldi, Gergely; Molvarec, Attila; Rose, Matthias; Markert, Udo R; Jeschke, Udo; Daher, Silvia
The possible effect of iron supplementation has been investigated in the normal population and patients with gestational diabetes mellitus (GDM). In this study, we survey the risk factors of GDM in pregnant women in contrast with normoglycemic patients in a case control study in patients using iron supplement. This case control study conducted on 52 pregnant women with GDM (25 women with type Al and 27 women with Type A2 of GDM). The control group randomly selected 50 normoglycemic women. Venous blood sampling was done between 24 and 28 weeks of pregnancy for measuring of ferritin, lipoproteins, uric acid and malondialdehyde serum levels. Under study variables including age, gestational age, weight and BMI were gathered. All the women were followed up until the time of delivery and pregnancy outcome were gathered. The serum ferritin levels in GDM group was 31.22+15.44, which is significantly higher than 24.76+8.94, in the control group with (P=0.012). Plasma hemogulobin in the control group was 12.2+0.1 compared to 12.9+0.1 in GDM group which was significantly lower (P=0.005). Triglycerides was significantly higher in GDM group in contrast with the control group, 275.08+143.17 and 192.30+92.13 (P=0.001), respectively. Finally, our findings indicate the concentration of serum ferritin levels was significantly higher in The GDM group. PMID:24902020
Javadian, Pouya; Alimohamadi, Shohreh; Gharedaghi, Mohammad Hadi; Hantoushzadeh, Sedigheh
Background Gestational diabetes (GDM) has been shown to have long-term sequelae for both the mother and infant. Women with GDM are at increased risk of macrosomia, which predisposes the infant to birth injuries. Previous studies noted increased rates of GDM in Asian and Pacific Islander (API) women; however, the rate of macrosomia in API women with GDM is unclear. The objective of this study was to examine the relationship between ethnicity, gestational diabetes (GDM), and macrosomia in Hawaii. Methods A retrospective cohort study was performed using Hawaii Pregnancy Risk Assessment Monitoring System (PRAMS) data. Data from 2009–2011, linked with selected items from birth certificates, were used to examine GDM and macrosomia by ethnicity. SAS-callable SUDAAN 10.0 was used to generate odds ratios, point estimates and standard errors. Results Data from 4735 respondents were weighted to represent all pregnancies resulting in live births in Hawaii from 2009–2011. The overall prevalence of GDM in Hawaii was 10.9%. The highest prevalence of GDM was in Filipina (13.1%) and Hawaiian/Pacific Islander (12.1%) women. The lowest prevalence was in white women (7.4%). Hawaiian/Pacific Islander, Filipina, and other Asian women all had an increased risk of GDM compared to white women using bivariate analysis. Adjusting for obesity, age, maternal nativity, and smoking, Asian Pacific Islander (API) women, which includes Hawaiian/Pacific Islander, Filipina, and other Asian women, had a 50% increased odds of having GDM compared to white women when compared using multivariate analysis. Among women with GDM, the highest prevalence of macrosomia was in white women (14.5%) while the lowest was in Filipina (5.3%) women. Conclusions API women in Hawaii have increased rates of GDM compared to white women. Paradoxically, this elevated GDM risk in API women is not associated with an increased rate of macrosomia. This suggests the relationship between GDM and macrosomia is more complex in this population.
Gestational diabetes mellitus (GDM) increases the future risk of developing type 2 diabetes mellitus (T2DM). There is now a growing evidence that breastfeeding has short- and long-term health benefits for mothers with GDM. Mothers with GDM who breastfeed have improved lipid and glucose metabolic profiles for the first 3 months after birth. However, women with GDM are less likely to breastfeed and, if they do, breastfeeding is usually continued for a shorter duration compared with women without GDM. One long-term prospective study followed women with GDM from delivery for up to 19 years postpartum, and found that breastfeeding for ?3 months reduced the risk of T2DM and delayed the development of T2DM by a further 10 years compared with breastfeeding for <3 months. However, the physiological mechanisms underlying the protective effects of breastfeeding are still unknown, even though it is important to gain a full understanding of the pathways involved in these effects. Therefore, the purpose of this review is to provide a comprehensive analysis of the recent developments in the field of GDM and breastfeeding. We reviewed data from animal experiments and human studies. We also provide insight into the molecular pathways and describe promising topics for future research.
Much, Daniela; Beyerlein, Andreas; Rossbauer, Michaela; Hummel, Sandra; Ziegler, Anette-G.
Abstract Objective Identification of unanswered research questions about the management of gestational diabetes mellitus (GDM) is necessary to focus future research endeavors. We developed a process for elucidating the highest priority research questions on GDM. Methods Using a systematic review on GDM as a starting point, we developed an eight-step process: (1) identification of research gaps, (2) feedback from the review's authors, (3) translation of gaps into researchable questions using population, intervention, comparators, outcomes, setting (PICOS) framework, (4) local institutions' stakeholders' refinement of research questions, (5) national stakeholders' use of Delphi method to develop consensus on the importance of research questions, (6) prioritization of outcomes, (7) conceptual framework, and (8) evaluation. Results We identified 15 high priority research questions for GDM. The research questions focused on medication management of GDM (e.g., various oral agents vs. insulin), delivery management for women with GDM (e.g., induction vs. expectant management), and identification of risk factors for, prevention of, and screening for type 2 diabetes in women with prior GDM. Stakeholders rated the development of chronic diseases in offspring, cesarean delivery, and birth trauma as high priority outcomes to measure in future studies. Conclusions We developed an eight-step process using a multidisciplinary group of stakeholders to identify 15 research questions of high clinical importance. Researchers, policymakers, and funders can use this list to direct research efforts and resources to the highest priority areas to improve care for women with GDM.
Robinson, Karen A.; Saldanha, Ian J.; Wilson, Lisa M.; Nicholson, Wanda K.
The authors examined the impact of universal screening on the diagnosis of gestational diabetes and its complications. All mothers and newborns registered by the Canadian Institute for Health Information from 1984 to 1996 (even-numbered fiscal years only) were included in the analysis. Over this time period, the proportion of women with gestational diabetes increased ninefold (from 0.3% to 2.7%) while the proportion with prepregnancy diabetes fell from 0.7% to 0.4%. As rates of gestational diabetes increased, a corresponding reduction in the risks of complications (polyhydramnios, amniotic cavity infection, cesarean delivery, and preeclampsia) occurred for women with gestational diabetes. The incidence of gestational diabetes fell in Metro-Hamilton (where screening was discontinued in 1989) but remained high in the rest of Ontario (where screening continued in most areas). No related temporal trends for fetal macrosomia, cesarean delivery, or other diabetes-related complications were observed, regardless of screening policy. The authors concluded that the substantial increase in gestational diabetes in Canada is an artifact caused by universal screening, with no evidence of beneficial effects on pregnancy outcomes. PMID:11117609
Wen, S W; Liu, S; Kramer, M S; Joseph, K S; Levitt, C; Marcoux, S; Liston, R M
Background Gestational diabetes mellitus (GDM) is any degree of impaired glucose tolerance first recognised during pregnancy. Most women with GDM revert to normal glucose metabolism after delivery of their babies; however, they are at risk of developing type 2 diabetes later in life as are their offspring. Determining a country’s GDM prevalence can assist with policy guidelines regarding GDM screening and management, and can highlight areas requiring research. This systematic review assesses GDM prevalence in Africa. Methods and Findings Three electronic databases were searched without language restrictions; PubMed, Scopus and the Cochrane Library. Thirty-one search terms were searched. Eligible articles defined GDM, stated what GDM screening approaches were employed and reported GDM prevalence. The reporting quality and risk of bias within each study was assessed. The PRISMA guidelines for systematic reviews were followed. The literature search identified 466 unique records. Sixty full text articles were reviewed of which 14 were included in the systematic review. One abstract, for which the full text article could not be obtained, was also included. Information regarding GDM classification, screening methods and prevalence was obtained for six African countries; Ethiopia (n?=?1), Morocco (n?=?1), Mozambique (n?=?1), Nigeria (n?=?6), South Africa (n?=?4) and Tanzania (n?=?1). Prevalence figures ranged from 0% (Tanzania) to 13.9% (Nigeria) with some studies focussing on women with GDM risk factors. Most studies utilised the two hour 75 g oral glucose tolerance test and applied the World Health Organization’s diagnostic criteria. Conclusions Six countries, equating to 11% of the African continent, were represented in this systematic review. This indicates how little is known about GDM in Africa and highlights the need for further research. Considering the increasing public health burden of obesity and type 2 diabetes, it is essential that the extent of GDM is understood in Africa to allow for effective intervention programmes.
Macaulay, Shelley; Dunger, David B.; Norris, Shane A.
The policy of screening for gestational diabetes mellitus (GDM) between 24 and 28 weeks of gestation and care has resulted in a few women delivering big babies despite good glycemic control. Hence we undertook a study to assess the merits of care given to women in whom GDM was diagnosed in different weeks of gestation and to find out the
V. Seshiah; Alexander Cynthia; V. Balaji; Madhuri S. Balaji; S. Ashalata; Rajan Sheela; M. Thamizharasi; T. Arthi
We performed a meta-analysis of the transcription profiles of type 1, type 2 and gestational diabetes to evaluate similarities and dissimilarities among these diabetes types. cRNA samples obtained from peripheral blood lymphomononuclear cells (PBMC) of 56 diabetes mellitus patients (type 1 = 19; type 2 = 20; gestational = 17) were hybridized to the same whole human genome oligomicroarray platform, encompassing 44,000 transcripts. The GeneSpring software was used to perform analysis and hierarchical clustering, and the DAVID database was used for gene ontology. The gene expression profiles showed more similarity between gestational and type 1 diabetes rather than between type 2 and gestational diabetes, a finding that was not influenced by patient gender and age. The meta-analysis of the three types of diabetes disclosed 3,747 differentially and significantly expressed genes. A total of 486 genes were characteristic of gestational diabetes, 202 genes of type 1, and 651 genes of type 2 diabetes. 19 known genes were shared by type 1, type 2 and gestational diabetes, highlighting EGF, FAM46C, HBEGF, ID1, SH3BGRL2, VEPH1, and TMEM158 genes. The meta-analysis of PBMC transcription profiles characterized each type of diabetes revealing that gestational and type 1 diabetes were transcriptionally related. PMID:23657602
Collares, C V A; Evangelista, A F; Xavier, D J; Takahashi, P; Almeida, R; Macedo, C; Manoel-Caetano, F; Foss, M C; Foss-Freitas, M C; Rassi, D M; Sakamoto-Hojo, E T; Passos, G A; Donadi, E A
We assessed the association between adherence to antihypertensive drug treatment and patient's perception of uncontrolled blood pressure (BP) in diabetic hypertensive subjects. This was a cross-sectional study that evaluated adherence to antihypertensives (Morisky questionnaire), patients' perception of abnormal BP, office BP, and ambulatory BP monitoring in diabetic hypertensive subjects. We evaluated 323 patients, 65.2% women, aged 56.5 ± 7 years, glycosylated hemoglobin (HbA1c) 8.0% (range, 6.9%-9.6%), diabetes duration of 10 years (range, 5-17 years). Adherence to drug treatment was 51.4%. Patients who reported hypertension-related symptoms (60.4%) had a lower level of adherence (P < .001). Non-adherence occurred four times more frequently in patients who reported hypertension-related symptoms (P < .001, adjusted for use of three or more anti-hypertensives, age, and duration of diabetes). Non-adherents had higher office diastolic BP (83.6 ± 11.9 vs. 79.8 ± 9.9; P = .003), but no difference between groups was observed considering systolic, diastolic, and mean BP evaluated by ambulatory BP monitoring. Low rates of adherence to antihypertensive drug treatment were observed in outpatient hypertensive diabetic subjects. Perception of uncontrolled BP levels was strongly and independently associated with non-adherence. Non-adherence determined repercussion on office BP that may have clinical implications in cardiovascular risk. PMID:23969287
Ledur, P S; Leiria, L F; Severo, M D; Silveira, D T; Massierer, D; Becker, A D; Aguiar, F M; Gus, M; Schaan, B D
A prospective study was undertaken to test the hypothesis that insulin treatment in patients with gestational diabetes mellitus (GDM) with fasting plasma glucose (FPG) greater than 5.3 mM significantly reduces adverse perinatal outcome. Assigned to insulin or diet treatment based on FPG were 471 GDM women. Four factors believed to be associated with infants large for gestational age (LGA) were evaluated: FPG, overall glycemic control, maternal weight, and treatment regimen. We found that when glycemic control was optimized, the key factors related to large infants were FPG and treatment modality. In the low-FPG group (less than 5.3 mM), diet therapy achieved an incidence of 5.3% LGA. When insulin therapy was used to optimize control, an incidence of 3.5% LGA was found. Patients in the mid-FPG group (5.3-5.8 mM) had a higher increased rate of LGA (28.6%) for diet-treated versus insulin-treated women (10.3%). In addition, a fourfold increased risk for LGA was found in the diet-treated obese subjects in the mid-FPG group compared with insulin-treated obese women. Finally, treatment with insulin resulted in similar incidence of LGA within all FPG groups. We concluded that FPG greater than 5.3 mM can be the basis for initiation of insulin treatment in GDM subjects with optimization of glycemic control as the goal. This approach may contribute significantly to reduced neonatal risk and may foster a standardized method for rapid and effective assignment to treatment. PMID:1748257
Langer, O; Berkus, M; Brustman, L; Anyaegbunam, A; Mazze, R
Purpose: Changes were examined in energy intakes and percentage of energy from macronutrients in response to nutritional intervention in women with gestational diabetes mellitus (GDM). Methods: The study included 17 women with GDM and 27 women with normal glucose tolerance (controls). Women with GDM were followed by a multidisciplinary team; they received dietary counselling by a registered dietitian, and were prescribed diets with 40% to 45% energy from carbohydrate (CHO), 20% to 25% from protein, and 30% to 35% from fat. Dietary intakes were assessed with food frequency questionnaires before the intervention (26.9 ± 3.8 weeks) and after the intervention (32.6 ± 0.6 weeks). Results: After the intervention, women with GDM reduced their total energy intake to reach lower values than did controls (P value for time-group interaction =0.05). A concomitant reduction in total CHO and glucose intakes in women with GDM led to significantly lower values compared with intakes in controls (P values for time-group interaction =0.001 for all). The post-intervention rate of weight gain in women with GDM was within the Institute of Medicine (IOM)-recommended values, while the post-intervention rate of weight gain in controls was above IOM-recommended values (0.30 ± 0.27 versus 0.61 ± 0.50 kg/week, P=0.05). Conclusions: These results suggest that this multidisciplinary medical and nutritional intervention was effective in the achievement of prescribed macronutrient distribution and controlling gestational weight gain in Canadian women with GDM. PMID:24897011
Morisset, Anne-Sophie; Côté, Julie Anne; Michaud, Andréanne; Robitaille, Julie; Tchernof, André; Dubé, Marie-Christine; Veillette, Johanne; Weisnagel, S John
There is uncertainty as to the optimal approach for screening and diagnosis of gestational diabetes mellitus (GDM). Based on systematic reviews published in 2003 and 2008, the U.S. Preventive Services Task Force concluded that there was insufficient evide...
There is uncertainty as to the optimal approach for screening and diagnosis of gestational diabetes mellitus (GDM). Based on systematic reviews published in 2003 and 2008, the U.S. Preventive Services Task Force concluded that there was insufficient evide...
The objective of the study was to investigate serum levels of the insulin-sensitizing adipokine vaspin in patients with gestational diabetes mellitus (GDM) and preeclampsia (PE) as compared with healthy controls of similar gestational age. Vaspin serum levels were quantified by enzyme-linked immunosorbent assay in control (n = 102), GDM (n = 40), and PE (n = 22) subjects. Median maternal
Holger Stepan; Susan Kralisch; Katrin Klostermann; Susanne Schrey; Constanze Reisenbüchler; Michael Verlohren; Hans-Joachim Verlohren; Kathrin Drynda; Matthias Blüher; Michael Stumvoll; Jürgen Kratzsch; Peter Kovacs; Mathias Fasshauer
Objective: This study tested the hypothesis that a standardized dose of jelly beans could be used as an alternative sugar source to the 50-g glucose beverage to screen for gestational diabetes mellitus. Study Design: One hundred sixty pregnant women at 24 to 28 weeks’ gestation were recruited for a prospective study to compare 2 sugar sources for serum glucose response,
Michael E. Lamar; Thomas J. Kuehl; Ann T. Cooney; L. Justin Gayle; Sonia Holleman; Steven R. Allen
Pregnancy and the postpartum period are associated with changes of the immune system. These changes might eventually result in autoimmune diseases, such as Graves' disease and type?1 diabetes mellitus, in the postpartum period. We describe a case of a patient with gestational diabetes who developed both Graves' disease and type?1 diabetes mellitus in the postpartum period. The pathology of gestational diabetes (GDM) is close to that of type?2 diabetes mellitus. However, the present case emphasizes the importance of screening and monitoring high-risk GDM patients for all available autoimmune antibodies throughout pregnancy and the postpartum period, as GDM has a risk of developing into type?1 diabetes and multiple autoimmune diseases. In addition, only Graves' disease was transient, whereas type?1 diabetes mellitus remained permanent in the present case. Thus, the present case shows etiological differences between these two autoimmune diseases. (J Diabetes Invest, doi: 10.1111/j.2040-1124.2010.00089.x,2011). PMID:24843507
Negishi, Mayumi; Shimomura, Kenju; Proks, Peter; Nakahara, Rieko; Murakami, Masami; Shimomura, Yohnosuke; Kobayashi, Isao
OBJECTIVE Factors associated with increasing maternal triglyceride concentrations in late pregnancy include gestational age, obesity, preeclampsia, and altered glucose metabolism. In a subgroup of women in the Metformin in Gestational Diabetes (MiG) trial, maternal plasma triglycerides increased more between enrollment (30 weeks) and 36 weeks in those treated with metformin compared with insulin. The aim of this study was to explain this finding by examining factors potentially related to triglycerides in these women. RESEARCH DESIGN AND METHODS Of the 733 women randomized to metformin or insulin in the MiG trial, 432 (219 metformin and 213 insulin) had fasting plasma triglycerides measured at enrollment and at 36 weeks. Factors associated with maternal triglycerides were assessed using general linear modeling. RESULTS Mean plasma triglyceride concentrations were 2.43 (95% CI 2.35–2.51) mmol/L at enrollment. Triglycerides were higher at 36 weeks in women randomized to metformin (2.94 [2.80–3.08] mmol/L; +23.13% [18.72–27.53%]) than insulin (2.65 [2.54–2.77] mmol/L, P = 0.002; +14.36% [10.91–17.82%], P = 0.002). At 36 weeks, triglycerides were associated with HbA1c (P = 0.03), ethnicity (P = 0.001), and treatment allocation (P = 0.005). In insulin-treated women, 36-week triglycerides were associated with 36-week HbA1c (P = 0.02), and in metformin-treated women, they were related to ethnicity. CONCLUSIONS At 36 weeks, maternal triglycerides were related to glucose control in women treated with insulin and ethnicity in women treated with metformin. Whether there are ethnicity-related dietary changes or differences in metformin response that alter the relationship between glucose control and triglycerides requires further study.
Barrett, Helen L.; Dekker Nitert, Marloes; Jones, Lee; O'Rourke, Peter; Lust, Karin; Gatford, Kathryn L.; De Blasio, Miles J.; Coat, Suzette; Owens, Julie A.; Hague, William M.; McIntyre, H. David; Callaway, Leonie; Rowan, Janet
The National Diabetes Education Program joins the American College of Obstetricians and Gynecologists (the College) to promote opportunities for obstetrician-gynecologists and other primary care providers to better meet the long-term health needs of women with prior gestational diabetes mellitus (GDM) and their children. Up to one third of GDM women may have diabetes or pre-diabetes postpartum, yet only about half of these women are tested postpartum, and about a quarter are tested 6 to 12 weeks postpartum. Women with GDM face a lifelong increased risk for subsequent diabetes, primarily type 2. Timely testing for pre-diabetes may provide an opportunity for obstetrician-gynecologists to prevent or delay the onset of type 2 diabetes through diet, physical activity, weight management, and/or pharmacological intervention. The College and American Diabetes Association recommend testing women with a history of GDM at six to 12 weeks postpartum. If the postpartum test is normal, retest every three years and at first prenatal visit in a subsequent pregnancy. If pre-diabetes is diagnosed, test annually. Since children of GDM pregnancies face an increased risk for obesity and type 2 diabetes, families need support to develop healthy eating and physical activity behaviors. Current criteria indicate that GDM occurs in 2 to 10 percent of all pregnancies. If new GDM diagnostic criteria are used, the frequency of GDM may increase to about 18 percent of pregnancies annually. The projected increase in the number of women with GDM and the potential subsequent associated risks underscore the need for proactive long-term primary care management of the mother and her offspring.
Landon, Mark; Warren-Boulton, Elizabeth; Fradkin, Judith
OBJECTIVE: To summarize the controversial aspects of gestational diabetes (GDM) and introduce readers to possible relevant research questions that could be examined to provide clinicians with good-quality data on which to base decisions about this relatively common pregnancy-related issue. DATA SOURCES AND STUDY SELECTION: Ongoing review of the English literature related to GDM. Sources were not restricted to prospective, controlled trials, as these are severely limited in number. SYNTHESIS: Controversial issues include the relevance of GDM to clinically meaningful outcomes in the index pregnancy, the effectiveness of current therapy in altering these outcomes, and the resultant questionable relevance of routine screening and diagnosis of an entity with as yet uncertain significance in pregnancy. CONCLUSIONS: Suggested questions to be addressed in multicentre controlled trials include randomization with respect to screening and with respect to treatment. Until such trials are completed, continuing with a standard approach to screening, diagnosis, and treatment, such as that suggested by the third international workshop on GDM, is recommended.
Okun, N.; Verma, A.; Demianczuk, N.
To evaluate retrospectively the prevalence of gestational diabetes (GD) in pregnancies obtained with myo-inositol administration in women with polycystic ovary syndrome. A total of 98 pregnancies in PCOS women obtained in a 3-year period, either with myo-inositol (n. 54), or with metformin (n. 44) were considered. While myo-inositol was assumed through the whole pregnancy, the group of women treated with metformin stopped the drug assumption after pregnancy diagnosis, and was considered as a control group. After having eliminated cases of miscarriages and twin pregnancies, a definitive number of 46 women in the myo-inositol group and 37 in the control group was taken in account to be retrospectively evaluated. The primary outcome measure was GD occurrence in both groups; whereas secondary outcome measures were pregnancy outcomes: hypertensive disorders, pre-term birth, macrosomia and caesarean section occurrence. Prevalence of GD in the myo-inositol group was 17.4% versus 54% in the control group, with a highly significant difference also after adjusting for covariates. Consequently, in the control group the risk of GD occurrence was more than double compared to the myo-inositol group, with an odds ratio 2.4 (confidence interval 95%, 1.3-4.4). There was no difference between the groups in relation to secondary outcome measures. This study suggests a possible effect of myo-inositol in the primary prevention of GD in PCOS women. PMID:22122627
D'Anna, R; Di Benedetto, V; Rizzo, P; Raffone, E; Interdonato, M L; Corrado, F; Di Benedetto, A
Objective There are some metabolic similarities between women with gestational diabetes mellitus (GDM) and polycystic ovary syndrome (PCOS); it is still uncertain, however, to what extent coexistence GDM and PCOS affects pregnancy outcome. The present study was designed to determine the obstetric and neonatal outcome in PCOS with GDM. Materials and methods A case-control study was conducted involving 261 GDM women. Thirty hundred-one cases had PCOS based on Rotterdam criteria and the other thirty hundred cases (control group) were women without PCOS. The subjects in each group were evaluated regarding obstetric and those women whose documentation's were complete entered the study. Results In present study, women with PCOS and GDM had more than twofold increased odds of preeclampsia (p = 0.003, CI = 1.56–5.01, and OR = 2.8) and PIH (p= 0.04, CI = 1.28–4.5, and OR= 2.4). Maternal PCOS and GDM were also associated with threefold increased odds of neonatal hypoglycemia (p= 0.004, CI= 1.49–6.58, and OR= 3.13). Conclusion Our finding emphasized that pregnant PCOS patients should be followed carefully for the occurrence of various pregnancy and neonatal complications including hypertension and hypoglycemia. We suggested that these neonates should be given more care regarding hypoglycemia symptoms.
Foroozanfard, Fatemeh; Moosavi, Seyed Gholam Abbas; Mansouri, Fariba
Adenosine transport was measured in human cultured umbilical artery smooth muscle cells, isolated from non-diabetic or gestational diabetic pregnancies, under basal conditions and after pretreatment in vitro with insulin. Adenosine transport in non-diabetic smooth muscle cells was significantly increased by insulin (half-maximal stimulation at 0.33 ± 0.02 nm, 8 h) and characterized by a higher maximal rate (Vmax) for nitrobenzylthioinosine (NBMPR)-sensitive (es) saturable nucleoside transport (17 ± 5 vs. 52 ± 12 pmol (?g protein)?1 min?1, control vs. insulin, respectively) and maximal binding sites (Bmax) for [3H]NBMPR (0.66 ± 0.07 vs. 1.1 ± 0.1 fmol (?g protein)?1, control vs. insulin, respectively), with no significant changes in Michaelis-Menten (Km) and dissociation (Kd) constants. In contrast, in smooth muscle cells from diabetic pregnancies, where the values of Vmax for adenosine transport (59 ± 4 pmol (?g protein)?1 min?1) and Bmax for [3H]NBMPR binding (1.62 ± 0.16 fmol (?g protein)?1) were significantly elevated by comparison with non-diabetic cells, insulin treatment (1 nm, 8 h) reduced the Vmax for adenosine transport and Bmax for [3H]NBMPR binding to levels detected in non-diabetic cells. In non-diabetic cells, the stimulatory effect of insulin on adenosine transport was mimicked by dibutyryl cGMP (100 nm) and reduced by inhibitors of phosphatidylinositol 3-kinase (10 nm wortmannin), nitric oxide synthase (100 ?mNG-nitro-l-arginine methyl ester, l-NAME) or protein synthesis (1 ?m cycloheximide), whereas inhibition of adenylyl cyclase (100 ?m SQ-22536) had no effect. Wortmannin or SQ-22536, but not l-NAME or cycloheximide, attenuated the inhibitory action of insulin on the diabetes-induced stimulation of adenosine transport. Protein levels of inducible NO synthase (iNOS) were similar in non-diabetic and diabetic cells, but were increased by insulin (1 nm, 8 h) only in non-diabetic smooth muscle cells. Our results suggest that adenosine transport via the es nucleoside transporter is modulated differentially by insulin in either cell type. Insulin increased adenosine transport in non-diabetic cells via NO and cGMP, but inhibited the diabetes-elevated adenosine transport via activation of adenylyl cyclase, suggesting that the biological actions of adenosine may be altered under conditions of sustained hyperglycaemia in uncontrolled diabetes.
Aguayo, Claudio; Flores, Carlos; Parodi, Jorge; Rojas, Romina; Mann, Giovanni E; Pearson, Jeremy D; Sobrevia, Luis
In women with previous gestational diabetes (pGDM), the risk of developing Type 2 diabetes is greatly increased, to the point that GDM represents an early stage in the natural history of Type 2 diabetes. In addition, in the years following the index pregnancy, women with pGDM exhibit an increased cardiovascular risk profile and an increased incidence of cardiovascular disease. This paper will review current knowledge on the metabolic modifications that occur in normal pregnancy, underlining the mechanism responsible for GDM, the link between these alterations and the associated long-term maternal complications. In women with pGDM, accurate follow-up and prevention strategies (e.g., weight control and regular physical exercise) are needed to reduce the subsequent development of overt diabetes and other metabolic abnormalities related to cardiovascular disease. Therefore, our paper will provide arguments in favor of performing follow-up programs aimed at modifying risk factors involved in the pathogenesis of Type 2 diabetes and cardiovascular disease. PMID:20088733
Di Cianni, Graziano; Ghio, Alessandra; Resi, Veronica; Volpe, Laura
Background Intrauterine exposure to gestational diabetes mellitus (GDM) may promote offspring obesity and higher systolic blood pressure (SBP) by adolescence. Few studies have examined adiposity or SBP in younger children exposed to GDM. This study’s objective was to examine associations of maternal glucose tolerance during pregnancy with offspring adiposity and SBP at age 3 years. Methods We studied 1,238 mother-child pairs in Project Viva, a prospective prebirth cohort study. Exposures were maternal blood glucose following oral glucose load, and GDM confirmed by 3-h glucose tolerance test. Main child outcomes were age 3-year body mass index (BMI) z-score, the sum (SS+TR) and ratio (SS/TR) of subscapular (SS) and tricep (TR) skinfold thicknesses, and SBP. We performed adjusted multivariable analyses. Results Fifty-one (4%) mothers had GDM. 9.3% of 3 year-old children were obese and mean (s.d.) SBP was 92 (11) mm Hg. Children exposed to GDM had higher SBP (3.2 mm Hg, 95% confidence interval (CI): 0.4, 5.9, P = 0.02) and greater adiposity when assessed by the sum of skinfolds (SS+TR 1.31 mm, 95% CI: 0.08, 2.55, P = 0.04) but not by BMI z-score (?0.08 units, 95% CI: ?0.37, 0.22, P = 0.61). After additional adjustment for the sum of skinfold thicknesses (SS+TR), the relationship between GDM and SBP was attenuated and no longer significant (2.6 mm Hg, 95% CI: ?0.2, 5.4, P = 0.07). Conclusions Children exposed to GDM have higher adiposity, which may mediate the higher SBP in these children. These findings extend to younger children the adverse effects of GDM previously found among adolescents and adults.
Wright, Charmaine S.; Rifas-Shiman, Sheryl L.; Rich-Edwards, Janet W.; Taveras, Elsie M.; Gillman, Matthew W.; Oken, Emily
Hair chromium concentration (HCC) of nor- mal and diabetic pregnant women was determined by atomic- absorption spectroscopy. For nondiabetic pregnant women the value from 68 hair samples was 472 ± 61 ng\\/g (1 ± 95% CI); for gestational diabetics it was 734 ± 155 ng\\/g from 42 hair samples. The difference was highly significant (P < 0.005). In- termediate hair
Ariel Aharoni; Betsalel Tesler; Yoav Paltieli; Joseph Tal; Zvi Don; Mordechai Sharf
An increasing number of patients from different ethnic groups is admitted to European diabetes treatment centers. Counseling programs are of central importance in disease treatment, especially in gestational diabetes where counseling is of influence also on the outcome of pregnancy. We report about the outcome of gestational diabetes in 39 Mediterranean Turkish and 72 Caucasian Austrian women treated at our outpatient clinic. Both groups of patients underwent repeated counseling including information about the cause of gestational diabetes and therapeutic instructions with an emphasis on dietary recommendations adapted to the eating habits. Individually adapted and repeated instructions with the help of trained translators were of great importance for the Turkish women because nearly one third of them turned out to be illiterates. Under comparable treatment modalities, Turkish and Austrian women revealed no differences in metabolic control, the mean birth weight of the children was 3311+/-467 and 3370+/-600g, respectively, and 12.8% of the Turkish and 16.6% of the Austrian children still had a birth weight above 4000g. These results suggest that women with gestational diabetes and different ethnicity reveal a comparable outcome of gestational diabetes when therapeutic instructions are adapted to the social and cultural background as well as to the individual need of the patient. PMID:11755772
Hoppichler, F; Lechleitner, M
Lowering blood pressure reduces cardiovascular risk, yet hypertension is poorly controlled in diabetic patients. In a pilot study we demonstrated that a home blood pressure telemonitoring system, which provided self-care messages on the smartphone of hypertensive diabetic patients immediately after each reading, improved blood pressure control. Messages were based on care paths defined by running averages of transmitted readings. The present study tests the system's effectiveness in a randomized, controlled trial in diabetic patients with uncontrolled systolic hypertension. Of 244 subjects screened for eligibility, 110 (45%) were randomly allocated to the intervention (n = 55) or control (n = 55) group, and 105 (95.5%) completed the 1-year outcome visit. In the intention-to-treat analysis, mean daytime ambulatory systolic blood pressure, the primary end point, decreased significantly only in the intervention group by 9.1 ± 15.6 mmHg (SD; P < 0.0001), and the mean between-group difference was 7.1 ± 2.3 mmHg (SE; P < 0.005). Furthermore, 51% of intervention subjects achieved the guideline recommended target of <130/80 mmHg compared with 31% of control subjects (P < 0.05). These improvements were obtained without the use of more or different antihypertensive medications or additional clinic visits to physicians. Providing self-care support did not affect anxiety but worsened depression on the Hospital Anxiety and Depression Scale (baseline, 4.1 ± 3.76; exit, 5.2 ± 4.30; P = 0.014). This study demonstrated that home blood pressure telemonitoring combined with automated self-care support reduced the blood pressure of diabetic patients with uncontrolled systolic hypertension and improved hypertension control. Home blood pressure monitoring alone had no effect on blood pressure. Promoting patient self-care may have negative psychological effects. PMID:22615116
Logan, Alexander G; Irvine, M Jane; McIsaac, Warren J; Tisler, Andras; Rossos, Peter G; Easty, Anthony; Feig, Denice S; Cafazzo, Joseph A
Objective Low perceived risk for type 2 diabetes (T2DM) may be a barrier to lifestyle change in women with recent gestational diabetes (GDM). We assessed perceived risk for T2DM at delivery and postpartum. Methods We used a validated diabetes risk perception instrument to survey women with GDM at delivery and postpartum. We compared women with low perceived risk for T2DM at delivery to those with high perceived risk. Results The majority (N=43 of 70, 61%) perceived high risk at delivery. Women who perceived low risk were younger (30.7 ± 6.3 versus 35.0 ± 4.5 years, p=0.003) than women who perceived high risk. Although knowledge of risk factors for T2DM was poor (mean 6.0 ± 1.9, of 11 points), 95% correctly identified GDM as a risk factor. Perceived risk was maintained in most (N=51 of 58, 88%) who returned for their postpartum visit. Low perceived risk was not associated with loss to follow up, however correct identification of GDM as a risk factor was protective (OR 0.05, 95% CI 0.005, 0.56). Conclusions Risk perception is accurate in most women with GDM at delivery and postpartum. Further study is needed to translate perceived risk into preventive behaviors in women with recent GDM.
Zera, Chloe A; Nicklas, Jacinda M; Levkoff, Sue E; Seely, Ellen W
OBJECTIVE To identify physiological and clinical variables associated with development of type 2 diabetes up to 12 years after pregnancies complicated by gestational diabetes. RESEARCH DESIGN AND METHODS Seventy-two islet cell antibody–negative nondiabetic Hispanic women had oral (oGTT) and intravenous (ivGTT) glucose tolerance tests, glucose clamps, and body composition assessed between 15 and 30 months after pregnancies complicated by gestational diabetes mellitus (GDM). They returned for oGTTs at 15-month intervals until they dropped out, developed diabetes, or reached 12 years postpartum. Cox regression analysis was used to identify baseline predictors and changes during follow-up that were associated with development of type 2 diabetes. RESULTS At baseline, relatively low insulin sensitivity, insulin response, and ?-cell compensation for insulin resistance were independently associated with development of diabetes. During follow-up, weight and fat gain and rates of decline in ?-cell compensation were significantly associated with diabetes, while additional pregnancy and use of progestin-only contraception were marginally associated with diabetes risk. CONCLUSIONS In Hispanic women, GDM represents detection of a chronic disease process characterized by falling ?-cell compensation for chronic insulin resistance. Women who are farthest along at diagnosis and/or deteriorating most rapidly are most likely to develop type 2 diabetes within 12 years after the index pregnancy. Weight gain, additional pregnancy, and progestin-only contraception are potential modifiable factors that increase diabetes risk.
Xiang, Anny H.; Kjos, Siri L.; Takayanagi, Miwa; Trigo, Enrique; Buchanan, Thomas A.
Diabetes is a chronic illness that requires continuous medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. This paper deals with study and development of algorithm to develop an initial stage expert system to provide diagnosis to the pregnant women who are suffering from Gestational Diabetes Mellitus (GDM) by means of Oral Glucose Tolerance Test (OGTT).
Sreedevi, E.; Vijaya Lakshmi, K.; Chaitanya Krishna, E.; Padmavathamma, M.
Glyburide's pharmacokinetics (PK) and pharmacodynamics have not been studied in women with gestational diabetes mellitus (GDM). The objective of this study was to assess steady-state PK of glyburide, as well as insulin sensitivity, ?-cell responsivity, and overall disposition indices after a mixed-meal tolerance test (MMTT) in women with GDM (n = 40), nonpregnant women with type 2 diabetes mellitus (T2DM)
MF Hebert; X Ma; SB Naraharisetti; KM Krudys; JG Umans; GDV Hankins; SN Caritis; M Miodovnik; JD Unadkat; EJ Kelly; D Blough; C Cobelli; Ahmed; WR Snodgrass; DB Carr; TR Easterling; P Vicini
Objective: This is a retrospective study that is designed to investigate the prognosis of the patients with abnormal diabetes screening\\u000a test and a negative 100 g oral glucose tolerance test that is accepted as the diagnostic test for gestational diabetes mellitus\\u000a (GDM). Materials and Method: The records of 281 pregnant patients were reviewed. The data of the patients divided into
A. Gezer; F. Esen; H. Mutlu; E. Öztürk; V. Ocak
OBJECTIVE: Our purpose was to assess maternal-fetal outcomes in patients with increasing carbohydrate intolerance not meeting the current criteria for the diagnosis of gestational diabetes.STUDY DESIGN: We conducted a prospective analytic cohort study in which nondiabetic women aged ?24 years, receiving prenatal care in three Toronto teaching hospitals, were eligible for enrollment. A glucose challenge test and an oral glucose
Mathew Sermer; C. David Naylor; Douglas J. Gare; Anne B. Kenshole; J. W. K. Ritchie; Dan Farine; Howard R. Cohen; Karen McArthur; Stephen Holzapfel; Anne Biringer; Erluo Chen
Background: Several studies have estimated associations between air pollution and birth outcomes, but few have evaluated potential effects on pregnancy complications. Objective: We investigated whether low-level exposure to air pollution is associated with gestational diabetes and preeclampsia. Methods: High-quality registry information on 81,110 singleton pregnancy outcomes in southern Sweden during 1999–2005 was linked to individual-level exposure estimates with high spatial resolution. Modeled exposure to nitrogen oxides (NOx), expressed as mean concentrations per trimester, and proximity to roads of different traffic densities were used as proxy indicators of exposure to combustion-related air pollution. The data were analyzed by logistic regression, with and without adjusting for potential confounders. Results: The prevalence of gestational diabetes increased with each NOx quartile, with an adjusted odds ratio (OR) of 1.69 (95% CI: 1.41, 2.03) for the highest (> 22.7 µg/m3) compared with the lowest quartile (2.5–8.9 µg/m3) of exposure during the second trimester. The adjusted OR for acquiring preeclampsia after exposure during the third trimester was 1.51 (1.32, 1.73) in the highest quartile of NOx compared with the lowest. Both outcomes were associated with high traffic density, but ORs were significant for gestational diabetes only. Conclusion: NOx exposure during pregnancy was associated with gestational diabetes and preeclampsia in an area with air pollution levels below current air quality guidelines.
Jakobsson, Kristina; Tinnerberg, Hakan; Rignell-Hydbom, Anna; Rylander, Lars
OBJECTIVE: To assess the prevalence of urinary incontinence and associated vaginal squeeze pressure in primiparous women with and without previous gestational diabetes mellitus two years post-cesarean delivery. METHODS: Primiparous women who delivered by cesarean two years previously were interviewed about the delivery and the occurrence of incontinence. Incontinence was reported by the women and vaginal pressure evaluated by a Perina perineometer. Sixty-three women with gestational diabetes and 98 women without the disease were screened for incontinence and vaginal pressure. Multiple logistic regression models were used to evaluate the independent effects of gestational diabetes. RESULTS: The prevalence of gestational incontinence was higher among women with gestational diabetes during their pregnancies (50.8% vs. 31.6%) and two years after a cesarean (44.8% vs. 18.4%). Decreased vaginal pressure was also significantly higher among women with gestational diabetes (53.9% vs. 37.8%). Maternal weight gain and newborn weight were risk factors for decreased vaginal pressure. Maternal age, gestational incontinence and decreased vaginal pressure were risk factors for incontinence two years after a cesarean. In a multivariate logistic model, gestational diabetes was an independent risk factor for gestational incontinence. CONCLUSIONS: The prevalence of incontinence and decreased vaginal pressure two years post-cesarean were elevated among women with gestational diabetes compared to women who were normoglycemic during pregnancy. We confirmed an association between gestational diabetes mellitus and a subsequent decrease of vaginal pressure two years post-cesarean. These results may warrant more comprehensive prospective and translational studies.
Barbosa, Angelica Mercia Pascon; Dias, Adriano; Marini, Gabriela; Calderon, Iracema Mattos Paranhos; Witkin, Steven; Rudge, Marilza Vieira Cunha
OBJECTIVE—The purpose of this study was to examine trends in postpartum glucose screening for women with gestational diabetes mellitus (GDM), predictors of screening, trends in postpartum impaired fasting glucose (IFG) and diabetes, and diabetes and pre-diabetes detected by postpartum fasting plasma glucose (FPG) versus a 75-g oral glucose tolerance test (OGTT). RESEARCH DESIGN AND METHODS—This was a cohort study of 14,448 GDM pregnancies delivered between 1995 and 2006. Postpartum screening was defined as performance of either an FPG or OGTT at least 6 weeks after delivery and within 1 year of delivery. RESULTS—Between 1995 and 2006, the age- and race/ethnicity-adjusted proportion of women who were screened postpartum rose from 20.7% (95% CI 17.8–23.5) to 53.8% (51.3–56.3). Older age, Asian or Hispanic race/ethnicity, higher education, earlier GDM diagnosis, use of diabetes medications during pregnancy, and more provider contacts after delivery were independent predictors of postpartum screening. Obesity and higher parity were independently associated with lower screening performance. Among women who had postpartum screening, the age- and race/ethnicity-adjusted proportion of IFG did not change over time (24.2 [95% CI 20.0–27.8] in 1995–1997 to 24.3 [22.6–26.0] in 2004–2006), but the proportion of women with diabetes decreased from 6.1 (95% CI 4.2–8.1) in 1995–1997 to 3.3 (2.6–4.0) in 2004–2006. Among women who received an OGTT in 2006, 38% of the 204 women with either diabetes or pre-diabetes were identified only by the 2-h glucose measurements. CONCLUSIONS—Postpartum screening has increased over the last decade, but it is still suboptimal. Compared with FPGs alone, the 2-h values identify a higher proportion of women with diabetes or pre-diabetes amenable to intervention.
Ferrara, Assiamira; Peng, Tiffany; Kim, Catherine
The impact of gestation and fetal–maternal interactions on pre-existent autoimmune beta cell destruction is widely unknown. The aim of this study was to investigate the influence of gestation per se and fetal mismatching on the onset of autoimmune diabetes in female non-obese diabetic (NOD) mice. We examined cumulative diabetes frequencies of NOD dams mated to syngeneic NOD, haploidentical CByB6F1/J and fully mismatched C57BL/6J male mice. Pregnancy from NOD males neither increased nor accelerated the diabetes onset of NOD dams (71% by age 28 weeks) compared to unmated female NOD mice (81% by age 28 weeks; P = 0·38). In contrast, delayed diabetes onset was observed when NOD dams were mated at 10 weeks of age with major histocompatibility complex (MHC) haploidentical CByB6F1/J male mice (38% at age 28 weeks; P = 0·01). Mating with fully MHC mismatched C57BL/6J male mice (72% diabetes by age 28 weeks; P = 0·22) or mating with the haploidentical males at the later time-point of age 13 weeks (64% versus 91% in unmated litter-matched controls; P = 0·13) did not delay diabetes significantly in NOD females. Because infusion of haploidentical male mouse splenocytes was found previously to prevent diabetes in NOD mice we looked for, but found no evidence of, persistent chimeric lymphocytes from haploidentical paternal origin within the dams' splenocytes. Gestation per se appears to have no aggravating or ameliorating effects on pre-existent autoimmune beta cell destruction, but pregnancy from MHC partially mismatched males delays diabetes onset in female NOD mice.
Adler, K; Krause, S; Fuchs, Y F; Foertsch, K; Ziegler, A-G; Bonifacio, E
Gestational diabetes is one of the most prevalent medical complications of pregnancy and causes increased fetal wastage. Investigation of placentas from diabetic mothers indicate chronic disturbances in intervillous, circulation, dilatation of capillaries, and a relatively immature villous structure. Abnormal levels of nitric oxide (NO) may contribute to maternal disorders such as the pathogenesis of diabetic vascular complications. In the normal placenta NO is generated only by endothelial NOS, which apparently serves to regulate vascular tone in the fetoplacental circulation. In contrast, studies have reported the absence of inducible nitric oxide synthase (iNOS) in human placentas under normal conditions. The aim of our study was to investigate whether iNOS is expressed in placentas from patients with gestational diabetes. Reverse transcription-polymerase chain reaction and Western blot analysis demonstrated iNOS mRNA and protein expression in placental tissue only from patients with gestational diabetes. Immunohistochemistry localized iNOS staining to endothelial cells and trophoblasts. We conclude that iNOS can be expressed in human placenta. Its expression might play an important role in placental pathophysiology. PMID:8635695
Schönfelder, G; John, M; Hopp, H; Fuhr, N; van Der Giet, M; Paul, M
Trends in Postpartum Diabetes Screening and Subsequent Diabetes and Impaired Fasting Glucose Among Women With Histories of Gestational Diabetes Mellitus A report from the Translating Research Into Action for Diabetes (TRIAD) Study
OBJECTIVE — The purpose of this study was to examine trends in postpartum glucose screening for women with gestational diabetes mellitus (GDM), predictors of screening, trends in postpartum impaired fasting glucose (IFG) and diabetes, and diabetes and pre-diabetes detected by postpartum fasting plasma glucose (FPG) versus a 75-g oral glucose tolerance test (OGTT). RESEARCH DESIGN AND METHODS — This was
ASSIAMIRA FERRARA; TIFFANY PENG; CATHERINE KIM
Objective We performed a qualitative study among women within 5 years of Gestational Diabetes (GDM) diagnosis. Our aim was to identify the key elements that would enhance participation in a type 2 diabetes (DM2) prevention program. Research Design and Methods Potential participants received up to three invitation letters from their GDM physician. Four focus groups were held. Discussants were invited to comment on potential facilitators/barriers to participation and were probed on attitudes towards meal replacement and Internet/social media tools. Recurring themes were identified through qualitative content analysis of discussion transcripts. Results Among the 1,201 contacted and 79 eligible/interested, 29 women attended a focus group discussion. More than half of discussants were overweight/obese, and less than half were physically active. For DM2 prevention, a strong need for social support to achieve changes in dietary and physical activity habits was expressed. In this regard, face-to-face interactions with peers and professionals were preferred, with adjunctive roles for Internet/social media. Further, direct participation of partners/spouses in a DM2 prevention program was viewed as important to enhance support for behavioural change at home. Discussants highlighted work and child-related responsibilities as potential barriers to participation, and emphasized the importance of childcare support to allow attendance. Meal replacements were viewed with little interest, with concerns that their use would provide a poor example of eating behaviour to children. Conclusions Among women within 5 years of a GDM diagnosis who participated in a focus group discussion, participation in a DM2 prevention program would be enhanced by face-to-face interactions with professionals and peers, provision of childcare support, and inclusion of spouses/partners.
Dasgupta, Kaberi; Da Costa, Deborah; Pillay, Sabrina; De Civita, Mirella; Gougeon, Rejeanne; Leong, Aaron; Bacon, Simon; Stotland, Stephen; Chetty, V. Tony; Garfield, Natasha; Majdan, Agnieszka; Meltzer, Sara
AIMS—To study the metabolic derangements in the second half of pregnancy caused by gestational diabetes, on the long term development of children.?METHODS—The neuropsychological function of 32 school age children born to 32 mothers with well controlled gestational diabetes and 57 control children matched by age, birth order, and parental socioeconomic status was studied.?RESULTS—There were no differences in head circumference and height, but the children born to diabetic mothers were heavier. The verbal IQ scores of index children below the age of 9 years were lower than those of control children. No differences were found between the groups in various sensory and motor functions and in the Touwen and Prechtl neurological test. The young index group children performed less well than controls in fine and gross motor functions, as observed on the Bruininks-Oseretzky test of motor proficiency. The scores of young children born to mothers with gestational diabetes were also lower than controls on the Pollack tapper test, and there were more index group children who scored abnormally on the parents' Conners questionnaire. No correlation was found between the performance of the index group children on various neurodevelopmental tests and the severity of perinatal complications. The differences tended to disappear with age.?CONCLUSIONS—Gestational diabetes, as a result of the metabolic abnormalities in the second half of pregnancy, induces long term minor neurological deficits which are more pronounced in younger children. There does not seem to be any direct relation between the appearance of congenital anomalies and neurodevelopmental outcome.??
Ornoy, A; Wolf, A; Ratzon, N; Greenbaum, C; Dulitzky, M
The objective of the study was to determine the outcome of pregnancies with pre-gestational diabetes mellitus (PGDM) in the presence of a specialised maternal and fetal service. Prospective data included mothers with documented pre-gestational diabetes (PGDM) delivered between 1 January 2007 and 31 December 2009. A total of 138 patients with PGDM were included in this study. The post-lunch glucose level at 34 weeks was significantly lower than at 30 weeks' gestation (p =0.007) and 37 weeks' gestation (p =0.02). No correlation was observed between maternal blood sugar and birth weight. The incidence of pre-term labour, stillbirth and admission to the NICU was similar to the control group. Caesarean section rate was 39.1%, and the main indication was previous caesarean section. The incidence of fetal anomalies was significantly higher than in the control group. It was concluded that the presence of specialised maternal and fetal clinics reduces complications related to prenatal glycaemic control. However, complications related to preconception care remains high. PMID:22663311
Mirghani, H; Begam, M; Bekdache, G; Khan, F
Background A number of studies have been conducted to investigate the risk of metabolic syndrome (MS) after gestational diabetes mellitus (GDM), but the results are contradictory. Accordingly, we performed a systematic review and meta-analysis to assess the association between these two conditions. The aim was to better understand the risks of MS with prior gestational diabetes. Methods Pubmed, ISI Web of Science, and Cochrane databases from September 1, 1979 to July 11, 2013 were searched to identify relevant studies. 17 studies containing 5832 women and 1149 MS events were included. We calculated the odds ratio (OR) with 95% confidence interval (CI) in analysis for each study using a random-effect or fixed-effect model. We also determined heterogeneity among these 17 articles and their publication bias. Results Women with a history of gestational diabetes had a significantly higher risk of MS than those who had a normal pregnancy (OR, 3.96; 95% CI, 2.99 to 5.26), but had significant heterogeneity (I2?=?52.6%). The effect remained robust (OR, 4.54; 95% CI, 3.78–5.46) in the subgroup of Caucasians, but no association (OR, 1.28; 95% CI, 0.64–2.56) was found in Asians. Heterogeneity was reduced (body mass index (BMI) matched group I2?=?14.2%, BMI higher in the GDM group I2?=?13.2%) in the subgroup of BMI. In addition, mothers with higher BMI in the GDM group had higher risk of MS than those in the BMI matched group (BMI higher in GDM group OR, 5.39; 95% CI, 4.47–6.50, BMI matched group OR, 2.53; 95% CI, 1.88–3.41). Conclusions This meta-analysis demonstrated increased risk of MS after gestational diabetes. Therefore, attention should be given to preventing or delaying the onset of MS in GDM mothers, particularly in Caucasian and obese mothers.
Sun, Lizhou; Yang, Haiwei; Jin, Bai; Cao, Xiaohui
Proteins secreted from adipocytes - so-called adipokines - influence metabolic and vascular function. Recent data suggest that various adipokines are dysregulated in gestational diabetes mellitus (GDM) and pre-eclampsia (PE) and might be of pathophysiological and prognostic significance in these complications of pregnancy. This review gives an overview on the regulation and pathophysiology of leptin and adiponectin in GDM and PE. Furthermore, data on novel adipokines including resistin, visfatin, retinol-binding protein 4 and vaspin are summarized. PMID:21951069
Miehle, Konstanze; Stepan, Holger; Fasshauer, Mathias
Background: In populations at a high-risk for gestational diabetes (GDM), the recommendation of screening every pregnant woman with the oral glucose tolerance test (OGTT) is very demanding. Aim: To assess the usefulness of the portable, plasma optimized glucometer in simplifying the approach to screening of GDM. Methods: 1,662 pregnant women underwent the one-step 75 g OGTT for routine screening of
Mukesh M. Agarwal; Gurdeep S. Dhatt; Mohamed-Faouzi Safraou
Gestational diabetes mellitus (GDM) is defined as the glucose intolerance that is not present or recognized prior to pregnancy. Several risk factors of GDM depend on environmental factors that are thought to regulate the genome through epigenetic mechanisms. Thus, epigenetic regulation could be involved in the development of GDM. In addition, the adverse intrauterine environment in patients with GDM could also have a negative impact on the establishment of the epigenomes of the offspring.
Fernandez-Morera, J. L.; Rodriguez-Rodero, S.; Menendez-Torre, E.; Fraga, M. F.
The aim of this study was to assess whether the levels of physical activity before and during early pregnancy are associated\\u000a with the prevalence of gestational diabetes mellitus (GDM). The study group included 160 puerperas. Among them, 40 (25%) diagnosed\\u000a as having GDM during their recent pregnancy, whereas the remaining 120 (75%) served as controls. The international physical\\u000a activity questionnaire
Vicentia C. Harizopoulou; Alexandros Kritikos; Zisis Papanikolaou; Evangelia Saranti; Dimitrios Vavilis; Eleftherios Klonos; Ioannis Papadimas; Dimitrios G. Goulis
Objective: To compare three strategies for gestational diabetes screening (i) screening of high-risk pregnant women with the 50g oral glucose tolerance test (OGTT); (ii) screening of all pregnant women with the 50g OGTT; (iii) screening of all pregnant women according to the 75g OGTT. Study design: Cost-effectiveness analysis. The outcome measures, i.e. macrosomia, prematurity, perinatal mortality, hypertensive disorders rates were
Bénédicte Poncet; Sandrine Touzet; Laure Rocher; Michel Berland; Jacques Orgiazzi; Cyrille Colin
In populations with a high incidence of gestational diabetes (GDM), any form of oral glucose testing for screening or diagnosis excessively strains the health care system. We investigated the value of glycated proteins as potential screening tests in 430 pregnant women, i.e. protein corrected fructosamine (cFRUC) and hemoglobin A1c (HbA1c) both alone and in combination for a GDM diagnosis confirmed
M. M Agarwal; P. F Hughes; John Punnose; M Ezimokhai; L Thomas
OBJECTIVE: Is the precision of currently available glucose meters adequate for gestational diabetes screening?STUDY DESIGN: We performed a prospective cohort study of 62 gravid women and compared the precision of three glucose meters to laboratory standard technology.RESULTS: The HemoCue coefficient of variation was sufficiently low in venous whole blood and plasma and capillary whole blood and plasma (3.0%, 1.8%, 2.8%,
Stephen R. Carr; Julie Slocum; Loreen Teft; Barbara Haydon; Marshall Carpenter
Objective: To describe and assess low income, healthy, pregnant Hispanic women’s understanding of gestational diabetes (GDM) and willingness to change aspects of their diet.Design: One-on-one, in-person interviews conducted in Spanish with 94 women (primarily Mexican).Setting: Federal Qualified Community Health Center’s prenatal clinic.Method: Exploratory two-phased mixed method with a survey of knowledge and attitudes towards gestational diabetes and dietary change, and
Maria Elena Rhoads-Baeza; Janet Reis
The aim of the study: We assessed by echocardiography the left ventricular systolic and diastolic function in newborn infants of mothers with well-controlled pregestational type 1 or gestational diabetes (IDM) in comparison to normal term neonates. Subjects and methods: Two-dimensional\\/M-mode and Doppler transmitral flow velocity measurements were performed in 18 IDM and 26 control infants of non-diabetic mothers (gestational ages
Andrea Kozák-Bárány; Eero Jokinen; Pentti Kero; Juhani Tuominen; Tapani Rönnemaa; Ilkka Välimäki
In a cluster-randomized trial, Riitta Luoto and colleagues find that counseling on diet and activity can reduce the birthweight of babies born to women at risk of developing gestational diabetes mellitus (GDM), but fail to find an effect on GDM.
Riitta Luoto; Tarja I. Kinnunen; Minna Aittasalo; Päivi Kolu; Jani Raitanen; Katriina Ojala; Kirsi Mansikkamäki; Satu Lamberg; Tommi Vasankari; Tanja Komulainen; Sirkku Tulokas
For women with type 1 diabetes (T1DM), type 2 diabetes (T2DM), and gestational diabetes (GDM), poor maternal glycemic control can significantly increase maternal and fetal risk for adverse outcomes. Outpatient medical and nutrition therapy is recommended for all women with diabetes in order to facilitate euglycemia during the antepartum period. Despite intensive outpatient therapy, women with diabetes often require inpatient diabetes management prior to delivery as maternal hyperglycemia can significantly increase neonatal risk of hypoglycemia. Consensus guidelines recommend maternal glucose range of 80-110 mg/dL in labor. The most optimal inpatient strategies for the prevention of hyperglycemia and hypoglycemia proximate to delivery remain unclear and will depend upon factors such as maternal diabetes diagnosis, her baseline insulin resistance, duration and route of delivery etc. Low dose intravenous insulin and dextrose protocols are necessary to achieve optimal predelivery glycemic control for women with T1DM and T2DM. For most with GDM however, euglycemia can be maintained without intravenous insulin. Women treated with a subcutaneous insulin pump during the antepartum period represent a unique challenge to labor and delivery staff. Strategies for self-managed subcutaneous insulin infusion (CSII) use prior to delivery require intensive education and coordination of care with the labor team in order to maintain patient safety. Hospitalization is recommended for most women with diabetes prior to delivery and in the postpartum period despite appropriate outpatient glycemic control. Women with poorly controlled diabetes in any trimester have an increased baseline maternal and fetal risk for adverse outcomes. Common indications for antepartum hospitalization of these women include failed outpatient therapy and/or diabetic ketoacidosis (DKA). Inpatient management of DKA is a significant cause of maternal and fetal morbidity and remains a common indication for hospitalization of the pregnant woman with diabetes. Changes in maternal physiology increase insulin resistance and the risk for DKA. A systematic approach to its management will be reviewed. PMID:24414141
Garrison, Etoi A; Jagasia, Shubhada
Maternal diabetes constitutes an unfavorable environment for embryonic and fetoplacental development. Despite current treatments, pregnant women with pregestational diabetes are at increased risk for congenital malformations, materno-fetal complications, placental abnormalities and intrauterine malprogramming. The complications during pregnancy concern the mother (gravidic hypertension and/or preeclampsia, cesarean section) and the fetus (macrosomia or intrauterine growth restriction, shoulder dystocia, hypoglycemia and respiratory distress). The fetoplacental impairment and intrauterine programming of diseases in the offspring’s later life induced by gestational diabetes are similar to those induced by type 1 and type 2 diabetes mellitus. Despite the existence of several developmental and morphological differences in the placenta from rodents and women, there are similarities in the alterations induced by maternal diabetes in the placenta from diabetic patients and diabetic experimental models. From both human and rodent diabetic experimental models, it has been suggested that the placenta is a compromised target that largely suffers the impact of maternal diabetes. Depending on the maternal metabolic and proinflammatory derangements, macrosomia is explained by an excessive availability of nutrients and an increase in fetal insulin release, a phenotype related to the programming of glucose intolerance. The degree of fetal damage and placental dysfunction and the availability and utilisation of fetal substrates can lead to the induction of macrosomia or intrauterine growth restriction. In maternal diabetes, both the maternal environment and the genetic background are important in the complex and multifactorial processes that induce damage to the embryo, the placenta, the fetus and the offspring. Nevertheless, further research is needed to better understand the mechanisms that govern the early embryo development, the induction of congenital anomalies and fetal overgrowth in maternal diabetes.
Vambergue, Anne; Fajardy, Isabelle
Background:Background: Several early studies demonstrated that bile acid sequestrants were useful for lowering lipid levels in patients with hypercholesterolaemia and may also be useful for lowering glucose levels in patients with type 2 diabetes mellitus (T2DM) uncontrolled on existing treatment (metformin-, insulin- or sulfonylurea-based therapies). Abstract: Objective:Objective: This study modelled efficacy and safety data from the three clinical trials to
W. Robert. Simons; Michael A. Hagan
Purpose To simulate national estimates of prepregnancy and gestational diabetes mellitus (GDM) in non-Hispanic white (NHW) and non-Hispanic black (NHB) women. Methods Prepregnancy diabetes and GDM were estimated as a function of age, race/ethnicity, and body mass index (BMI) using South Carolina live singleton births from 2004–2008. Diabetes risk was applied to a simulated population. Age, natality and BMI were assigned to women according to race- and age-specific US Census, Natality and National Health and Nutrition Examination Surveys (NHANES) data, respectively. Results From 1980–2008, estimated GDM prevalence increased from 4.11% to 6.80% [2.68% (95% CI 2.58%–2.78%)] and from 3.96% to 6.43% [2.47% (95% CI 2.39%–2.55%)] in NHW and NHB women, respectively. In NHW women prepregnancy diabetes prevalence increased 0.90% (95% CI 0.85%–0.95%) from 0.95% in 1980 to 1.85% in 2008. In NHB women from 1980 through 2008 estimated prepregnancy diabetes prevalence increased 1.51% (95% CI 1.44%–1.57%), from 1.66% to 3.16%. Conclusions Racial disparities in diabetes prevalence during pregnancy appear to stem from a higher prevalence of prepregnancy diabetes, but not GDM, in NHB than NHW.
Mayorga, Maria E.; Reifsnider, Odette S.; Neyens, David M.; Gebregziabher, Mulugeta G.; Hunt, Kelly J.
Since 1964, the hypothesis of Pedersen has been used to explain fetal macrosomia observed in gestational diabetes mellitus (GDM), by a mechanism involving maternal hyperglycemia--fetal hyperglycemia--fetal hyperinsulinemia. However, since the 1980-89 decade, it is known that pregnant women with pre-gestational overweight not suffering from GDM still have a higher frequency of fetal macrosomia. Furthermore, pregnant women with GDM, despite being subjected to optimal glycemic control, still show unacceptably high frequencies of fetal macrosomia, a phenomenon that is concentrated in pregnancies with overweight or obesity prior to pregnancy. If glucose is not the single nutrient responsible for fetal macrosomia in pregnant women with gestational diabetes that undergo strict glycemic control, other nutrients may cause excessive fetal growth in pre-pregnancy overweight mothers. In this review, we propose that triglycerides (TG) could be responsible for this accelerated fetal growth. If this hypothesis is validated in animal models and clinical studies, then normal and pathological ranges of TG should be defined, and monitoring of triglyceride levels during pregnancy should be advised as a possible new alternative, besides a good glycemic control, for the management of fetal macrosomia in GDM women with overweight prior to pregnancy. PMID:24718471
Olmos, Pablo; Martelo, Grettel; Reimer, Verena; Rigotti, Attilio; Busso, Dolores; Belmar, Cristián; González, Rogelio; Goldenberg, Denisse; Samith, Bárbara; Santos, José-Luis; Escalona, Manuel; Quezada, Thomas; Faúndez, Jorge; Nicklitschek, Ian
Aim: To describe the clinical profile, maternal and fetal outcomes, and the conversion rates to diabetes in women with gestational diabetes mellitus (GDM) seen at a tertiary care diabetes center in urban south India. Materials and Methods: Clinical case records of 898 women with GDM seen between 1991 and 2011 were extracted from the Diabetes Electronic Medical Records (DEMR) of a tertiary care diabetes center in Chennai, south India and their clinical profile was analyzed. Follow-up data of 174 GDM women was available. To determine the conversion rates to diabetes, oral glucose tolerance test (OGTT) was done in these women. Glucose tolerance status postpartum was classified based on World Health Organization (WHO) 2006 criteria. Results: The mean maternal age of the women was 29 ± 4 years and mean age of gestation at first visit were 24 ± 8.4 weeks. Seventy percent of the women had a family history of diabetes. Seventy-eight percent of the women delivered full-term babies and 65% underwent a cesarean section. The average weight gain during pregnancy was 10.0 ± 4.2 kg. Macrosomia was present in 17.9% of the babies, hypoglycemia in 10.4%, congenital anomalies in 4.3%, and the neonatal mortality rate was 1.9%. Mean follow-up duration of the 174 women of whom outcome data was available was 4.5 years. Out of the 174, 101 women who were followed-up developed diabetes, of whom half developed diabetes within 5 years and over 90%, within 10 years of the delivery. Conclusions: Progression to type 2 diabetes mellitus (T2DM) in Indian women with GDM is rapid. There is an urgent need to develop standardized protocols for GDM care in India that can improve the maternal and fetal outcomes and help prevent future diabetes in women with GDM.
Mahalakshmi, Manni Mohanraj; Bhavadharini, Balaji; Kumar, Maheswari; Anjana, Ranjit Mohan; Shah, Sapna S.; Bridgette, Akila; Choudhury, Mridusmita; Henderson, Margaret; Desborough, Lane; Viswanathan, Mohan; Ranjani, Harish
Objective To analyze the association of hemoglobin A1c (HbA1c) at gestational diabetes mellitus (GDM) diagnosis with postpartum abnormal glucose in a cohort of women with GDM. Methods Women with singleton pregnancies managed for GDM at a large diabetes and pregnancy program located in Charlotte, North Carolina who completed a postpartum 2-hour oral glucose tolerance test were eligible for inclusion in this retrospective cohort study. Clinical information, including maternal HbA1c at diagnosis was abstracted from medical records. A parametric survival model was used to assess the association of HbA1c at GDM diagnosis with postpartum maternal abnormal glucose including impaired fasting glucose, impaired glucose tolerance, and any postpartum abnormal glucose. Results Of the 277 postpartum women with GDM 75 (32%) had impaired fasting glucose, 61 (28%) had impaired glucose tolerance, and 15 (9%) were diagnosed with type 2 diabetes after delivery. After adjustment for clinic, maternal age, parity, prepregnancy BMI 25 kg/m2 or higher, non-white race or ethnicity, and gestational week at first HbA1c we detected a trend of increased risk for impaired fasting glucose (p=0.01), impaired glucose tolerance (p=0.002), and any glucose abnormality (p <0.001) associated with increased quartile of HbA1c at GDM diagnosis. Conclusion HbA1c measured at GDM diagnosis may be a useful tool for identifying GDM patients at highest risk of developing postpartum abnormal glucose.
Katon, Jodie; Reiber, Gayle; Williams, Michelle A.; Yanez, David; Miller, Edith
Gestational diabetes mellitus (GDM) is a common pregnancy complication in high risk populations, and is associated with increased perinatal and long term outcomes for both mothers and newborns. Both its prevention and early management can be reinforced by identifying risks factors, particularly those factors influencing glucose metabolism. On the other hand, several epidemiological studies have shown an increased oxidative stress (OS) in pregnant women with GDM. Elevated OS was also reported in pregnant women supplemented with iron, which can generate OS and may also influence insulin resistance. This review summarizes the current state of knowledge, highlighting the potential relationship between OS induced by iron status and the development of GDM. PMID:24238846
Zein, Salam; Rachidi, Samar; Hininger-Favier, Isabelle
Continuous glucose monitoring (CGM) gives a unique insight into magnitude and duration of daily glucose fluctuations. Limited data are available on glucose variability (GV) in pregnancy. We aimed to assess GV in healthy pregnant women and cases of type 1 diabetes mellitus or gestational diabetes (GDM) and its possible association with HbA1c. CGM was performed in 50 pregnant women (20 type 1, 20 GDM, and 10 healthy controls) in all three trimesters of pregnancy. We calculated mean amplitude of glycemic excursions (MAGE), standard deviation (SD), interquartile range (IQR), and continuous overlapping net glycemic action (CONGA), as parameters of GV. The high blood glycemic index (HBGI) and low blood glycemic index (LBGI) were also measured as indicators of hyperhypoglycemic risk. Women with type 1 diabetes showed higher GV, with a 2-fold higher risk of hyperglycemic spikes during the day, than healthy pregnant women or GDM ones. GDM women had only slightly higher GV parameters than healthy controls. HbA1c did not correlate with GV indicators in type 1 diabetes or GDM pregnancies. We provided new evidence of the importance of certain GV indicators in pregnant women with GDM or type 1 diabetes and recommended the use of CGM specifically in these populations.
Dalfra, M. G.; Chilelli, N. C.; Di Cianni, G.; Mello, G.; Lencioni, C.; Biagioni, S.; Scalese, M.; Sartore, G.; Lapolla, A.
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Background We previously reported a high prevalence (22.3%) of gestational diabetes mellitus (GDM) in a large group of Sardinian women, in contrast with the prevalence of Type 2 diabetes. Sardinia has an unusual distribution of haplotypes and genotypes, with the highest population frequency of HLA DR3 in the world, and after Finland, the highest prevalence of Type 1 diabetes and Autoimmune-related Diseases. In this study we preliminarily tested the prevalence of serological markers of Type 1 diabetes in a group of Sardinian GDM patients. Methods We determined glutamic decarboxylase antibodies (anti-GAD65), protein tyrosine phosphatase ICA 512 (IA2) antibodies (anti-IA2), and IAA in 62 GDM patients, and in 56 controls with matching age, gestational age and parity. Results We found a high prevalence and very unusual distribution of antibodies in GDM patients (38.8%), the anti-IA2 being the most frequent antibody. Out of all our GDM patients, 38.8% (24 of 62) were positive for at least one antibody. Anti-IA2 was present in 29.0 % (18 out of 62) vs. 7.1% (4 out of 56) in the controls (P < 0.001). IAA was present in 14.5% (9 out of 62) of our GDM patients, and absent in the control subjects (P < 0.001). Anti-GAD65 was also present in GDM patients, with a prevalence of 3.2% (2 out of 62) while it was absent in the control group (P = NS). Pre-gestational weight was significantly lower (57.78 ± 9.8 vs 65.9 ± 17.3 P = 0.04) in auto-antibodies- positive GDM patients. Conclusion These results are in contrast with the very low prevalence of all antibodies reported in Italy. If confirmed, they could indicate that a large proportion of GDM patients in Sardinia have an autoimmune origin, in accordance with the high prevalence of Type 1 diabetes.
Murgia, Cinzia; Orru, Marisa; Portoghese, Elaine; Garau, Nicoletta; Zedda, Pierina; Berria, Rachele; Motzo, Costantino; Sulis, Simonetta; Murenu, Michela; Paoletti, Anna Maria; Melis, Gian Benedetto
Background and Objectives: Gestational diabetes mellitus (GDM) is a global health concern as it affects health status of both mother and fetus. In India, prevalence of GDM varies in different populations and no data is available from rural Haryana. This study was undertaken to determine the prevalence of GDM and risk factors associated with it in rural women of Haryana. Materials and Methods: Nine hundred and thirteen women, with estimated gestational age above 24 weeks from a rural block of Haryana who consented to participate were given a standardized 2-h 75-g oral glucose tolerance test (OGTT). Pro forma containing general information on demographic characteristics, educational level, gravida, family history of diabetes, and past history of GDM was filled-up. A World Health Organization (WHO) criterion for 2-h 75-g OGTT was used for diagnosing GDM. Results: GDM was diagnosed in 127/913 (13.9%) women with higher mean age as compared to non-GDM women. Majority (78.4%) of the women were housewives, rest engaged in agriculture (9.2%) and labor (5.5%). Women with gravida ?3 and positive family history of diabetes had significantly higher prevalence of GDM. History of macrosomia (birth weight ?4 kg) was significantly associated with prevalence of GDM (P = 0.002). On multiple logistic regression analysis, risk factors found to be significantly associated with GDM were maternal age >25 years, gravida >3, history of macrosomic baby, and family history of diabetes. Conclusion: The prevalence of GDM has been found quite high in rural Haryana. Appropriate interventions are required for control and risk factor modifications.
Rajput, Meena; Bairwa, Mohan; Rajput, Rajesh
Abstract We investigated adiponectin levels in women with gestational diabetes mellitus (GDM) and normal glucose tolerance (NGT) at 24-28 gestational weeks. Fasting serum adiponectin, glucose and glycated haemoglobin (HbA1c) were determined in 88 pregnant women, 44 with GDM and 44 with NGT. Pre-pregnancy and current body mass indices (BMI), weight gain and pregnancy outcomes were investigated. Serum adiponectin was significantly reduced in GDM compared with the NGT group (p = 0.000). Adiponectin was negatively correlated with age (r = -0.419, p = 0.000); glucose (r = -0.263, p = 0.013); HbA1c (r = -0.274, p = 0.01); BMI (pre-pregnancy and current) (r = -0.317, p = 0.003 and r = -0.303, p = 0.004) and positively correlated with gestational age at delivery (r = 0.278, p = 0.009). The GDM group delivered significantly earlier than the NGT group (p = 0.001). Adverse pregnancy outcomes and abdominal delivery were higher in the GDM group (p = 0.000, p = 0.033, respectively), and adiponectin was significantly reduced in patients with adverse outcomes (p = 0.003) and abdominal delivery (p = 0.032). Adiponectin is reduced in patients with GDM. Association of adiponectin with adverse pregnancy outcomes remains to be elucidated. PMID:24738829
Doruk, M; U?ur, M; Oruç, A S; Demirel, N; Yildiz, Y
Women with a history of gestational diabetes mellitus (GDM) are characterized by a high risk of type 2 diabetes mellitus (T2DM) (x 7), metabolic syndrome (x 2 to 5) and cardiovascular diseases (x 1,7). Women with lesser degrees of glucose intolerance share the same risks. T2DM may occur from post-partum (5 to 14%) to several years later, up to 25 years. Some factors associated with T2DM are identified: obesity, early diagnosis of GDM before 24 weeks gestation, high pregnancy OGTT blood glucose or insulin-therapy during GDM. Screening for T2DM only with fasting glucose provides less sensibility than with OGTT; HbA1c may supplant these dosages. The recurrence rate of GDM is between 30 and 84%, non-white ethnicity and insulinotherapy during GDM being the best proven predictors. High risk women need repeated life-long screenings for glycaemic abnormalities, or when another pregnancy is planned. Among obese women with history of GDM who show minor glycoregulation disturbances, modifications of lifestyle in intensive programs or metformin halve the risk of DT2. However, studies analysing practices show low adhesion to screening; without an intensive program, few women implement lifestyle modifications. These intensive programs should be implemented and proposed to high-risk women. Their therapeutic education should also include prevention of cardiovascular risk factors. PMID:21163424
Background Gestational Diabetes (GDM) is one of the most common complications of pregnancies affecting around 7% of women. This clinical condition is associated with an increased risk of developing fetal macrosomia and is related to a higher incidence of caesarean section in comparison to the general population. Strong evidence indicating the best management between induction of labour at term and expectant monitoring are missing. Methods/Design Pregnant women with singleton pregnancy in vertex presentation previously diagnosed with gestational diabetes will be asked to participate in a multicenter open-label randomized controlled trial between 38+0 and 39+0 gestational weeks. Women will be recruited in the third trimester in the Outpatient clinic or in the Day Assessment Unit according to local protocols. Women who opt to take part will be randomized according to induction of labour or expectant management for spontaneous delivery. Patients allocated to the induction group will be admitted to the obstetric ward and offered induction of labour via use of prostaglandins, Foley catheter or oxytocin (depending on clinical conditions). Women assigned to the expectant arm will be sent to their domicile where they will be followed up until delivery, through maternal and fetal wellbeing monitoring twice weekly. The primary study outcome is the Caesarean section (C-section) rate, whilst secondary measurement4s are maternal and neonatal outcomes. A total sample of 1760 women (880 each arm) will be recruited to identify a relative difference between the two arms equal to 20% in favour of induction, with concerns to C-section rate. Data will be collected until mothers and newborns discharge from the hospital. Analysis of the outcome measures will be carried out by intention to treat. Discussion The present trial will provide evidence as to whether or not, in women affected by gestational diabetes, induction of labour between 38+0 and 39+0 weeks is an effective management to ameliorate maternal and neonatal outcomes. The primary objective is to determine whether caesarean section rate could be reduced among women undergoing induction of labour, in comparison to patients allocated to expectant monitoring. The secondary objective consists of the assessment and comparison of maternal and neonatal outcomes in the two study arms. Trial Registration The study protocol has been registered in the ClinicalTrials.gov Protocol Registration System, identification number NCT01058772.
We studied the relationship between 1-h glucose response and the percentage of carbohydrates in a given meal in 14 gestational diabetic women who did not require insulin therapy and were between 32 and 36 wk gestation. Each subject was greater than 130% ideal body weight and was placed on a diet of 24 kcal.kg-1.24 h-1, with 12.5% of calories at breakfast and 28% of the calories at lunch and again at dinner, with other calorie intake divided among three snacks. Glycemic response was monitored by self-monitoring of blood glucose 1 h after the start of each meal. Ten postprandial values for each meal were averaged for each of the 14 women. The correlation between percentage of carbohydrates and postprandial glucose level at 1 h was strongest for dinner (r = 0.95, P less than 0.001), with more variability seen at breakfast (r = 0.75, P = 0.002) and lunch (r = 0.86, P = 0.001). To maintain a 1-h postprandial whole-blood glucose level less than 7.78 mM required the following percentages of carbohydrates in each meal: 45% at breakfast, 55% at lunch, and 50% at dinner. If 1-h postprandial whole-blood glucose level was to remain less than 6.67 mM, then the respective values were 33, 45, and 40%. We conclude that the glycemic response to a mixed meal in subjects with gestational diabetes is highly correlated with the percentage of carbohydrates of the ingested meal and varies among individuals and among breakfast, lunch, and dinner.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1748252
Peterson, C M; Jovanovic-Peterson, L
Previous gestational diabetes mellitus (pGDM) indicates future risk for type 2 diabetes (T2DM). Insulin resistance (IR) may precede T2DM in many years and is associated with an increased risk for cardiovascular diseases. Aim This study aims to identify endothelial dysfunction and cardiovascular risk factors in women with pGDM. Methods This cross-sectional analysis included 45 non diabetic women, 20 pGDM and 25 controls, at least one year after delivery. Body mass index (BMI), abdominal circumference (AC), blood pressure, serum lipids, liver enzymes, uric acid, nonesterified fatty acids, C-reactive protein and plasma glucose, insulin, fibrinogen and plasminogen activator inhibitor 1 were measured. HOMA IR and ? were calculated. Pre and post induced ischemia videocapillaroscopy was performed in hand nailfold to evaluate microvascular morphologic aspect and functional response. Results AC and fasting glucose were significantly higher in pGDM (p = 0.01 and p = 0.002 respectively). Women with pGDM and BMI < 25 kg/m2 had significantly higher levels of fasting insulin and HOMA IR than controls (p = 0.008 and 0.05 respectively). Abnormal morphologic findings were more frequent and papillae rectification were 3.3 times more prevalent in pGDM (p = 0.003). Other microvascular parameters did not differ between groups. Conclusion Cardiovascular risk factors and a microcirculation abnormality (papillae rectification) were significantly increased in young non-diabetic women with pGDM.
Abstract Background Women diagnosed with gestational diabetes mellitus (GDM) are at substantially increased risk of developing type 2 diabetes and obesity, currently at epidemic rates in the United States. GDM, therefore, identifies a population of women at high risk of developing type 2 diabetes and provides an opportunity to intervene before the development of this disorder. It is well recognized that acute as well as chronic physical activity improves glucose tolerance in type 2 diabetes. To date, however, primary prevention trials have not been conducted to test whether an increase in physical activity reduces risk of developing GDM among women at high risk of this disorder. Methods The aims of this study are to investigate the effects of a motivationally targeted, individually tailored 12-week physical activity intervention on (1) development of GDM, (2) serum biomarkers associated with insulin resistance, and (3) the adoption and maintenance of exercise during pregnancy. Women at high risk of GDM are recruited in early pregnancy and randomized to either an individually tailored exercise intervention or a comparison health and wellness intervention. Results The overall goal of the exercise intervention is to encourage pregnant women to achieve the American College of Obstetricians and Gynecologists guidelines for physical activity during pregnancy through increasing walking and developing a more active lifestyle. Conclusions The intervention takes into account the specific social, cultural, economic, and physical environmental challenges faced by pregnant women of diverse socioeconomic and ethnic backgrounds.
Marcus, Bess H.; Stanek, Edward; Ciccolo, Joseph T.; Marquez, David X.; Solomon, Caren G.; Markenson, Glenn
The objective of this study was to examine measures of insulin resistance and beta cell function in relation to ethnicity and the development of diabetes after gestational diabetes mellitus (GDM). Glucose homeostasis was assessed during a 75 g oral glucose tolerance test 1-2 years after delivery in 456 women with previous GDM (362 European, 94 non-European; including 41 Arab and 43 Asian women) and 133 control women. Insulin resistance was estimated using homeostasis model assessment of insulin resistance (HOMA-IR). The insulinogenic index (I/G30) and the disposition index [(I/G30)/HOMA-IR] were used to quantify insulin secretion. Women developing diabetes after GDM were characterized by increased HOMA-IR [p = 0.010, adjusted for body mass index (BMI)], whereas the disposition index was decreased in all women with previous GDM irrespective of glucose tolerance, most pronounced in the presence of diabetes (BMI-adjusted p = 1 × 10(-5)). Non-European origin was associated with increased HOMA-IR (p = 0.001 vs. European), strengthened by adjustment for BMI in Asian women (p = 0.046 vs. p = 0.016), but eradicated among Arab women (p = 0.004 vs. p = 0.65). Non-European women exhibited an increased frequency of diabetes after GDM (17 % vs. European 4 %, p = 2 × 10(-5)). In addition to BMI, non-European and Asian origin was associated with the development of diabetes after GDM in a multivariate logistic regression analysis, whereas Arab origin was not. Our results highlight the importance of preventive measures to ensure a healthy lifestyle in women with GDM, particularly in high-risk ethnic groups. PMID:23732816
Ignell, Claes; Shaat, Nael; Ekelund, Magnus; Berntorp, Kerstin
Background Gestational diabetes mellitus (GDM) is a risk factor for the development of type 2 diabetes. Lifestyle intervention can prevent progression to type 2 diabetes in high risk populations. We designed a randomised controlled trial (RCT) to evaluate the effectiveness of an established lifestyle intervention compared to standard care for delaying diabetes onset in European women with recent GDM. Recruitment into the RCT was more challenging than anticipated with only 89 of 410 (22%) women agreeing to participate. This paper identifies factors that could enhance participation of the target population in future interventions. Methods We hypothesised that women who agreed to participate would have higher diabetes risk profiles than those who declined, and secondly that it would be possible to predict participation on the bases of those risk factors. To test our hypothesis, we identified the subset of women for whom we had comprehensive data on diabetes risks factors 3-5 years following GDM, reducing the sample to 43 participants and 73 decliners. We considered established diabetes risk factors: smoking, daily fruit and vegetable intake, participation in exercise, family history of diabetes, glucose values and BMI scores on post-partum re-screens, use of insulin during pregnancy, and age at delivery. We also analysed narrative data from 156 decliners to further understand barriers to and facilitators of participation. Results Two factors differentiated participants and decliners: age at delivery (with women older than 34 years being more likely to participate) and insulin use during pregnancy (with women requiring the use of insulin in pregnancy less likely to participate). Binary logistic regression confirmed that insulin use negatively affected the odds of participation. The most significant barriers to participation included the accessibility, affordability and practicality of the intervention. Conclusions Women with recent GDM face multiple barriers to lifestyle change. Intervention designers should consider: (i) the practicalities of participation for this population, (ii) research designs that capitalise on motivational differences between participants, (iii) alleviating concerns about long-term diabetes management. We hope this work will support future researchers in developing interventions that are more relevant, effective and successful in recruiting the desired population. Trial registration Current Controlled Trials ISRCTN41202110
Background: The delivery of excess maternal nutrients to the fetus is known to increase the risk of macrosomia, even among infants of women without gestational diabetes mellitus. With the current obesity epidemic, maternal adiposity and its associated effects on circulating adipokines and inflammatory proteins may now have a greater impact on fetal growth. We sought to evaluate the independent effects of maternal glycemia, lipids, obesity, adipokines and inflammation on infant birth weight. Methods: We included 472 women who underwent an oral glucose tolerance test in late pregnancy and were found not to have gestational diabetes; 104 (22.0%) had gestational impaired glucose tolerance. We also measured fasting levels of insulin, low-and high-density lipoprotein cholesterol, triglycerides, leptin, adiponectin and C-reactive protein. Obstetric outcomes were assessed at delivery. Results: The mean birth weight was 3481 g (standard deviation 493 g); 68 of the infants were large for gestational age. On multiple linear regression analysis, positive determinants of birth weight were length of gestation, male infant, weight gain during pregnancy up to the time of the oral glucose tolerance test, body mass index (BMI) before pregnancy and impaired glucose tolerance in pregnancy. Leptin, adiponectin and C-reactive protein levels were each negatively associated with birth weight. On logistic regression analysis, the significant metabolic predictors of having a large-for-gestational-age infant were BMI before pregnancy (odds ratio [OR] 1.16, 95% confidence interval [CI] 1.05–1.27, per 1 kg/m2 increase), weight gain during pregnancy up to the time of the oral glucose tolerance test (OR 1.12, 95% CI 1.05–1.19, per 1 kg increase) and leptin level (OR 0.50, 95% CI 0.30–0.82, per 1 standard deviation change). Interpretation: Among women without gestational diabetes, maternal adiposity and leptin levels were the strongest metabolic determinants of having a large-for-gestational-age infant rather than glucose intolerance and lipid levels.
Retnakaran, Ravi; Ye, Chang; Hanley, Anthony J.G.; Connelly, Philip W.; Sermer, Mathew; Zinman, Bernard; Hamilton, Jill K.
Background Diabetes is increasing in prevalence globally, notably amongst populations from low- and middle- income countries. Gestational Diabetes Mellitus(GDM), a precursor for type 2 diabetes, is increasing in line with this trend. Few studies have considered the personal and social effects of GDM on women living in low and middle-income countries. The aim of this study was determine attitudes and health behaviours of pregnant women with GDM in Vietnam. Methods This was a qualitative study using focus group methodology conducted in Ho Chi Minh City. Pregnant women, aged over 18 years, with GDM were eligible to participate. Women were purposely sampled to obtain a range of gestational ages and severity of disease. They were invited to attend a 1-hour focus group. Questions were semi structured around six themes. Focus groups were recorded, transcribed, translated and cross-referenced. Non-verbal and group interactions were recorded. Thematic analysis was performed using a theoretical framework approach. Results From December 2010 to February 2011, four focus groups were conducted involving 34 women. Median age was 31.5 years (range 23 to 44), median BMI 21.8 kg/m2. Women felt confusion, anxiety and guilt about GDM. Many perceived their baby to be at increased risk of death. Advice to reduce dietary starch was confusing. Women reported being ‘hungry’ or ‘starving’ most of the time, unaware of appropriate food substitutions. They were concerned about transmission of GDM through breast milk. Several women planned not to breastfeed. All felt they needed more information. Current sources of information included friends, magazines, a health phone line or the Internet. Women felt small group sessions and information leaflets could benefit them. Conclusions This study highlights the need for culturally appropriate clinical education and health promotion activities for women with GDM in Vietnam.
Abstract Introduction: Adiponectin, resistin and visfatin are thought to play role in the pathophysiology of gestational diabetes (GDM). In this study, we aimed to investigate the association of maternal second trimester serum resistin and visfatin levels with GDM. Materials and methods: Screening and diagnosis for GDM was performed between the 24-28th gestational weeks. About 40 women diagnosed with GDM and 40 non-diabetic women constituted the study and control groups, respectively. Groups were compared for second trimester maternal serum resistin, visfatin and HbA1c levels, HOMA-IR and postpartum 75?g OGTT results. Results: Mean serum resistin (p?=?0.071) and visfatin (p?=?0.194) levels were similar between the groups. However, mean BMI (p?=?0.013), HOMA-IR (p?=?0.019), HbA1c (p?0.0001) and birth weight (p?=?0.037) were significantly higher in GDM group compared to controls. Type 2 diabetes and impaired glucose tolerance were detected in 2 (5%) and 7 (20%) women in the GDM group, respectively, with 75?g OGTT performed at the postpartum 6th week. Resistin levels of patients with GDM and postpartum glucose intolerance were higher than those with GDM but no postpartum glucose intolerance (p?=?0.012). Visfatin levels in the GDM group showed a positive correlation with biparietal diameter, head circumference, abdominal circumference and femur length (p?0.05). Conclusion: Maternal serum resistin and visfatin levels are unchanged in GDM. In patients with GDM, second trimester resistin levels may be predictive for postpartum glucose intolerance and second trimester visfatin levels may be related with fetal biometric measurements. Further larger studies are needed. PMID:24512558
Karatas, Ahmet; Tunçay I?ikkent, Nilüfer; Ozlü, Tülay; Demirin, Hilmi
Background The Mothers After Gestational Diabetes in Australia Diabetes Prevention Program (MAGDA-DPP) is a randomized controlled trial (RCT) that aims to assess the effectiveness of a structured diabetes prevention intervention for women who had gestational diabetes. Methods/Design The original protocol was published in Trials (http://www.trialsjournal.com/content/14/1/339). This update reports on an additional exclusion criterion and change in first eligibility screening to provide greater clarity. The new exclusion criterion “surgical or medical intervention to treat obesity” has been added to the original protocol. The risks of developing diabetes will be affected by any medical or surgical intervention as its impact on obesity will alter the outcomes being assessed by MAGDA-DPP. The screening procedures have also been updated to reflect the current recruitment operation. The first eligibility screening is now taking place either during or after pregnancy, depending on recruitment strategy. Trial registration Australian New Zealand Clinical Trials Registry ANZCTRN 12610000338066.
\\u000a While in former times pregnancies of women with diabetes often ended unhappily with either intrauterine death or severe postnatal\\u000a problems for the child, current improved methods of glucose control and fetal surveillance provide the chance of a healthy\\u000a baby for this high risk group of pregnant women. Management of pregnancies with diabetes has been solely focused on the achievement\\u000a of
OBJECTIVE The Diabetes Prevention Program (DPP) trial investigated rates of progression to diabetes among adults with prediabetes randomized to treatment with placebo, metformin, or intensive lifestyle intervention. Among women in the DPP, diabetes risk reduction with metformin was greater in women with prior gestational diabetes mellitus (GDM) compared with women without GDM but with one or more previous live births. RESEARCH DESIGN AND METHODS We asked if genetic variability could account for these differences by comparing ?-cell function and genetic risk scores (GRS), calculated from 34 diabetes-associated loci, between women with and without histories of GDM. RESULTS ?-Cell function was reduced in women with GDM. The GRS was positively associated with a history of GDM; however, the GRS did not predict progression to diabetes or modulate response to intervention. CONCLUSIONS These data suggest that a diabetes-associated GRS is associated with development of GDM and may characterize women at risk for development of diabetes due to ?-cell dysfunction. PMID:24271189
Sullivan, Shannon D; Jablonski, Kathleen A; Florez, Jose C; Dabelea, Dana; Franks, Paul W; Dagogo-Jack, Sam; Kim, Catherine; Knowler, William C; Christophi, Costas A; Ratner, Robert
Objective To investigate the possible association between total daily iron intake during pregnancy, haemoglobin in early pregnancy and the risk of gestational diabetes mellitus (GDM) in women at increased risk of GDM. Design A prospective cohort study (based on a cluster-randomised controlled trial, where the intervention and the usual care groups were combined). Setting Primary healthcare maternity clinics in 14 municipalities in south-western Finland. Participants 399 Pregnant women who were at increased risk of GDM participated in a GDM prevention trial and were followed throughout pregnancy. Main outcome measurements The main outcome was GDM diagnosed with oral glucose tolerance test at 26–28?weeks’ gestation or based on a diagnosis recorded in the Finnish Medical Birth registry. Data on iron intake was collected using a 181-item food frequency questionnaire and separate questions for supplement use at 26–28?weeks’ gestation. Results GDM was diagnosed in 72 women (18.1%) in the study population. The OR for total iron intake as a continuous variable was 1.006 (95% CI 1.000 to 1.011; p=0.038) after adjustment for body mass index, age, diabetes in first-degree or second-degree relatives, GDM or macrosomia in earlier pregnancy, total energy intake, dietary fibre, saturated fatty acids and total gestational weight gain. Women in the highest fifth of total daily iron intake had an adjusted OR of 1.66 (95% CI 0.84 to 3.30; p=0.15) for GDM. After excluding participants with low haemoglobin levels (?120?g/l) already in early pregnancy the adjusted OR was 2.35 (95% CI 1.13 to 4.92; p=0.023). Conclusions Our results suggest that high iron intake during pregnancy increases the risk of GDM especially in women who are not anaemic in early pregnancy and who are at increased risk of GDM. These findings suggest that routine iron supplementation should be reconsidered in this risk group of women.
Helin, Annika; Kinnunen, Tarja Inkeri; Raitanen, Jani; Ahonen, Suvi; Virtanen, Suvi M; Luoto, Riitta
Background/Aims Postpartum diabetes screening is recommended for women with gestational diabetes (GDM); up to 36.0% of them will have glucose abnormalities after delivery. To improve the <60% rate of postpartum diabetes screening in Kaiser Permanente Northwest, we conducted a multi- faceted process improvement project. Methods The intervention included revision of protocols used to guide outpatient care provided to pregnant patients with types 1, 2, and gestational diabetes, and revision of electronic order entry tools; development of an electronic reminder system to trigger phone calls to patients who had not completed postpartum glucose testing within 3 months after delivery; and a series of 60 minute educational sessions for clinicians, nurses, and medical assistants conducted between January and April 2009. The pre-implementation population was GDM-affected deliveries July 1, 2007—June 30, 2008 (n=200) and the post-implementation population was GDM-affected deliveries July 1, 2009— June 30, 2010 (n=179). Two main outcomes were evaluated: clinician orders for either a fasting blood glucose (FBG) test or 2-hr oral glucose tolerance test (OGTT) placed between one month before to 3 months after delivery, and a completed FBG or 2-hour OGTT performed between 14 days after delivery and December 31, 2008 (pre-implementation) or December 31, 2010 (post-implementation). Because patient characteristics did not differ significantly between the pre-and post-implementation populations, an unadjusted Cox Proportional Hazards model was used to evaluate test completion. Results The prevalence of GDM was 3.8% in pre-(200/5250) and post- populations (179/4765). The proportion of women who received an order for a postpartum glucose test within 3 months of delivery increased from 77.5% (155/200) to 88.8% (159/179) (p=.004); the proportion completing the test Within 3 months of delivery increased from 53.5% (107/200) to 60.3% (108/179) (p=.18). When including tests completed beyond the first 3 months postpartum (through December 2008 pre-and December 2010 post-implementation), women in the post-implementation group had a significantly higher rate of test completion (59.5% [119/200] vs. 71.5% [128/179], p=0.01, Hazards Ratio 1.37, 95% CI 1.07 to 1.7. Discussion Rates of postpartum diabetes testing among women with recent GDM can be improved with system changes and reminders to women.
Vesco, Kimberly; Bulkley, Joanna; Dietz, Patricia; Bruce, F. Carol; Callaghan, William; England, Lucinda; Kimes, Terry; Bachman, Don; Hartinger, Karen; Hornbrook, Mark
We have investigated the prospective association between excess gestational weight gain (GWG) and development of diabetes by 21 years post-partum using a community-based large prospective cohort study in Brisbane, Australia. There were 3386 mothers for whom complete data were available on GWG, pre-pregnancy BMI and self-reported diabetes 21 years post-partum. We used The Institute of Medicine (IOM) definition to categorize GWG as inadequate, adequate and excessive. We found 839 (25.78%) mothers gained inadequate weight, 1,353 (39.96%) had adequate weight gain and 1,194 (35.26%) had gained excessive weight during pregnancy. At 21 years post-partum, 8.40% of mothers self-reported a diagnosis of diabetes made by their doctor. In the age adjusted model, we found mothers who gained excess weight during pregnancy were 1.47(1.11,1.94) times more likely to experience diabetes at 21 years post-partum compared to the mothers who gained adequate weight. This association was not explained by the potential confounders including maternal age, parity, education, race, smoking, TV watching and exercise. However, this association was mediated by the current BMI. There was no association for the women who had normal BMI before pregnancy and gained excess weight during pregnancy. The findings of this study suggest that women who gain excess weight during pregnancy are at greater risk of being diagnosed with diabetes in later life. This relationship is likely mediated through the pathway of post-partum weight-retention and obesity. This study adds evidence to the argument that excessive GWG during pregnancy for overweight mothers has long term maternal health implications.
Al Mamun, Abdullah; Mannan, Munim; O'Callaghan, Michael J.; Williams, Gail M.; Najman, Jake M.; Callaway, Leonie K.
Objective: To determine whether elevated midpregnancy maternal serum lipid levels predict newborn weight at term and the risk of large for gestational age (LGA) infants in women with positive diabetic screen but normal glucose tolerance test.Methods: Japanese gravidas who had positive diabetic screens and normal 75-g oral glucose tolerance tests (GTT) at 24–32 weeks were enrolled. Subjects with complications, including
Michio Kitajima; Satoshi Oka; Ichiro Yasuhi; Masashi Fukuda; Youko Rii; Tadayuki Ishimaru
BACKGROUND: Gestational Diabetes Mellitus (GDM) has well recognised adverse health implications for the mother and her newborn that are both short and long term. Obesity is a significant risk factor for developing GDM and the prevalence of obesity is increasing globally. It is a matter of public health importance that clinicians have evidence based strategies to inform practice and currently there is insufficient evidence regarding the impact of dietary and lifestyle interventions on improving maternal and newborn outcomes. The primary aim of this study is to measure the impact of a telephone based intervention that promotes positive lifestyle modifications on the incidence of GDM. Secondary aims include: the impact on gestational weight gain; large for gestational age babies; differences in blood glucose levels taken at the Oral Glucose Tolerance Test (OGTT) and selected factors relating to self-efficacy and psychological wellbeing.Method/design: A randomised controlled trial (RCT) will be conducted involving pregnant women who are overweight (BMI >25 to 29.9 k/gm2) or obese (BMI >30kgm/2), less than 14 weeks gestation and recruited from the Barwon South West region of Victoria, Australia. From recruitment until birth, women in the intervention group will receive a program informed by the Theory of Self-efficacy and employing Motivational Interviewing. Brief ( less than 5 minute) phone contact will alternate with a text message/email and will involve goal setting, behaviour change reinforcement with weekly weighing and charting, and the provision of health information. Those in the control group will receive usual care. Data for primary and secondary outcomes will be collected from medical record review and a questionnaire at 36 weeks gestation. DISCUSSION: Evidence based strategies that reduce the incidence of GDM are a priority for contemporary maternity care. Changing health behaviours is a complex undertaking and trialling a composite intervention that can be adopted in various primary health settings is required so women can be accessed as early in pregnancy as possible. Using a sound theoretical base to inform such an intervention will add depth to our understanding of this approach and to the interpretation of results, contributing to the evidence base for practice and policy.Trial registration: This trial is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12613000125729. PMID:23497264
Nagle, Cate; Skouteris, Helen; Morris, Heather; Nankervis, Alison; Rasmussen, Bodil; Mayall, Peter; Kennedy, Richard L
Background Gestational Diabetes Mellitus (GDM) has well recognised adverse health implications for the mother and her newborn that are both short and long term. Obesity is a significant risk factor for developing GDM and the prevalence of obesity is increasing globally. It is a matter of public health importance that clinicians have evidence based strategies to inform practice and currently there is insufficient evidence regarding the impact of dietary and lifestyle interventions on improving maternal and newborn outcomes. The primary aim of this study is to measure the impact of a telephone based intervention that promotes positive lifestyle modifications on the incidence of GDM. Secondary aims include: the impact on gestational weight gain; large for gestational age babies; differences in blood glucose levels taken at the Oral Glucose Tolerance Test (OGTT) and selected factors relating to self-efficacy and psychological wellbeing. Method/design A randomised controlled trial (RCT) will be conducted involving pregnant women who are overweight (BMI >25 to 29.9 k/gm2) or obese (BMI >30?kgm/2), less than 14 weeks gestation and recruited from the Barwon South West region of Victoria, Australia. From recruitment until birth, women in the intervention group will receive a program informed by the Theory of Self-efficacy and employing Motivational Interviewing. Brief ( less than 5 minute) phone contact will alternate with a text message/email and will involve goal setting, behaviour change reinforcement with weekly weighing and charting, and the provision of health information. Those in the control group will receive usual care. Data for primary and secondary outcomes will be collected from medical record review and a questionnaire at 36 weeks gestation. Discussion Evidence based strategies that reduce the incidence of GDM are a priority for contemporary maternity care. Changing health behaviours is a complex undertaking and trialling a composite intervention that can be adopted in various primary health settings is required so women can be accessed as early in pregnancy as possible. Using a sound theoretical base to inform such an intervention will add depth to our understanding of this approach and to the interpretation of results, contributing to the evidence base for practice and policy. Trial registration This trial is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12613000125729
OBJECTIVE: To assess the relationship between low maternal serum 25-hydroxyvitamin D levels and gestational diabetes mellitus in Turkish pregnant women according to the severity of 25-hydroxyvitamin D deficiency and assess intact parathyroid hormone levels in women with gestational diabetes mellitus and controls with low and sufficient 25-hydroxyvitamin D levels. METHODS: We analyzed serum 25-hydroxyvitamin D and intact parathyroid hormone levels in 234 women with gestational diabetes mellitus and 168 controls. To define the deficiency status, 25-hydroxyvitamin D levels were further classified into severely deficient, deficient, insufficient and sufficient groups. RESULTS: Women with gestational diabetes mellitus had significantly lower 25-hydroxyvitamin D levels compared to controls (30.8±16.3 vs. 36.0±16.2 nmol/L). However, when subgroups of 25-hydroxyvitamin D were analyzed, gestational diabetes mellitus was significantly more common only in women with severely deficient 25-hydroxyvitamin D levels. After adjusting for covariates, only severely deficient 25-hydroxyvitamin D levels were independently associated with an increased relative risk of gestational diabetes mellitus. The relative risk of gestational diabetes mellitus in women with insufficient and deficient 25-hydroxyvitamin D levels was not statistically significant. Intact parathyroid hormone concentrations were also significantly higher in women with gestational diabetes mellitus compared to the controls (45.3±26.2 vs. 38.7±27.6 pg/ml). CONCLUSIONS: The results obtained from this study provide novel data indicating that only severely deficient maternal serum 25-hydroxyvitamin D levels are significantly associated with an elevated relative risk of gestational diabetes mellitus, even after adjusting for established risk factors of gestational diabetes mellitus.
Zuhur, Sayid Shafi; Erol, Rumeysa Selvinaz; Kuzu, Idris; Altuntas, Yuksel
Background This study was undertaken to assess the association between insulin need in gestational diabetes mellitus (GDM) and clinical features and laboratory parameters. Factors that can predict insulin need are also identified. Methods Cases with GDM were included retrospectively from records. Cases which failed to achieve target blood glucose levels with medical nutrition therapy (MNT) and need insulin treatment were recorded. Risk factors which can predict antenatal insulin treatment (AIT) were identified as follows; the presence of diabetes in a first degree relative, body mass index prior to pregnancy, number of parity, history of GDM, macrosomic baby delivery (> 4,000 g), age, gestational week at time of diagnosis, body mass index during diagnosis, weight gain untill diagnosis, mean systolic and diastolic blood pressure, HbA1C level during diagnosis, and fasting plasma glucose on diagnostic oral glucose tolerance test. Presence of a statistical significance between those patient features and AIT was assessed. Independent predictors for AIT were evaluated. Results A total of 300 cases were recruited from records, 190 cases (63.3%) were followed only with MNT until delivery and 110 cases (36.7%) were initiated AIT. The association between AIT and patient factors like presence of diabetes in the pedigree, week of gestation at which GDM was diagnosed, BMI during diagnosis, HbA1C levels, and fasting plasma glucose during diagnosis was found (P = 0.03; 0.008; 0.049; 0.001 and 0.001respectively). Multivariant analysis showed that fasting plasma glucose levels during diagnosis and HbA1C levels were independent risk factors for AIT. Fasting plasma glucose values that can predict AIT were identified > 89.5 mg/dL with 72.7% sensitivity and 62.6% spesifity (P < 0.001). Positive predictive value was 73% (P < 0.001). Also, HbA1C levels that can predict AIT was found to be > 5.485% with 65.3% sensitivity and 66.7% spesifitiy(P < 0.001) with a positive predictive value 68% (P < 0.001). Conclusions Independent predictors for AIT were found as fasting plasma glucose on OGTT and HbA1c levels during diagnosis in GDM. Cases with fasting plasma glucose ? 89.5 mg/dL or HbA1C ? 5.485% should be closely followed for AIT in specified centers.
Bakiner, Okan; Bozkirli, Emre; Ozsahin, Kursat; Sariturk, Cagla; Ertorer, Eda
The Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study showed significant perinatal risks at levels of maternal hyperglycemia below values that are diagnostic for diabetes. A Consensus Panel of the International Association of Diabetes and Pregnancy Study Groups (IADPSG) reviewed HAPO Study results and other work that examined associations of maternal glycemia with perinatal and long-term outcomes in offspring and published recommendations for diagnosis and classification of hyperglycemia in pregnancy in 2010. Subsequently, some commentaries and debate challenged the IADPSG recommendations. In this review, we provide details regarding some points that were considered by the IADPSG Consensus Panel but not published and address the following issues: 1) what should be the frequency of gestational diabetes mellitus (GDM); 2) were appropriate outcomes and odds ratios used to define diagnostic thresholds for GDM; 3) to improve perinatal outcome, should the focus be on GDM, obesity, or both; 4) should results of randomized controlled trials of treatment of mild GDM influence recommendations for diagnostic thresholds; and, 5) other issues related to diagnosis of GDM. Other groups are independently considering strategies for the diagnosis of GDM. However, after careful consideration of these issues, we affirm our support for the recommendations of the IADPSG Consensus Panel. PMID:22876884
Metzger, Boyd E; Gabbe, Steven G; Persson, Bengt; Buchanan, Thomas A; Catalano, Patrick M; Damm, Peter; Dyer, Alan R; Hod, Moshe; Kitzmiller, John L; Lowe, Lynn P; McIntyre, H David; Oats, Jeremy J N; Omori, Yasue
Objective Women with gestational diabetes (GDM) are at increased risk for type 2 diabetes (T2DM), but many do not receive recommended follow-up. We sought to identify barriers to follow-up screening. Study design We surveyed primary care (PCPs) and obstetric and gynecology care providers (OBCPs) in a large health system. We also assessed documentation of GDM history in the health care system’s electronic medical record. Results 478 clinicians were surveyed, among whom 207 responded. Most participants (81.1%) gave an accurate estimate of risk of progression to T2DM. PCPs were less likely than OBCPs to ask patients about history of GDM (OR 0.43, 95% CI 0.20–0.90), but they were far more likely to indicate that they order glucose screening for women with a known history (OR 4.31, 95% CI 2.01–9.26). Providers identified poor communication between OBCPs and PCPs as a major barrier to screening. Fewer than half (45.8%) of 450 women with GDM by GTT criteria had that history documented on their electronic problem list. Conclusions Clinicians are aware that women with GDM are at high risk of developing type 2 diabetes, but they do not routinely assess and screen patients, and communication between OBCPs and PCPs can be improved.
Stuebe, Alison; Ecker, Jeffrey; Bates, David W.; Zera, Chloe; Bentley-Lewis, Rhonda; Seely, Ellen
Women with gestational diabetes (GDM) are at increased risk for type 2 diabetes (T2DM), but many do not receive recommended follow-up. We sought to identify barriers to follow-up screening. We surveyed primary care providers (PCPs) and obstetric and gynecology care providers (OBCPs) in a large health system. We also assessed documentation of GDM history in the health care system's electronic medical record. Four hundred seventy-eight clinicians were surveyed, among whom 207 responded. Most participants (81.1%) gave an accurate estimate of risk of progression to T2DM. PCPs were less likely than OBCPs to ask patients about history of GDM (odds ratio [OR] 0.43, 95% confidence interval [CI] 0.20 to 0.90), but they were far more likely to indicate that they order glucose screening for women with a known history (OR 4.31, 95% CI 2.01 to 9.26). Providers identified poor communication between OBCPs and PCPs as a major barrier to screening. Fewer than half (45.8%) of 450 women with GDM by glucose tolerance test criteria had that history documented on their electronic problem list. Clinicians are aware that women with GDM are at high risk of developing type 2 diabetes, but they do not routinely assess and screen patients, and communication between OBCPs and PCPs can be improved. PMID:20387186
Stuebe, Alison; Ecker, Jeffrey; Bates, David W; Zera, Chloe; Bentley-Lewis, Rhonda; Seely, Ellen
Objective. To investigate the incidence of Gestational Diabetes Mellitus at the Mt. Hope Women's Hospital and to describe its epidemiological pattern. Design. A retrospective observational study (Jan 2005 to Dec 2007). Setting. A teaching hospital of The University of the West Indies. Population/Sample. Pregnant women who gave birth. Methods. A sample size of 720. The variables analyzed were: age, ethnicity, BMI of mother, family history of diabetes; history of GDM, obstetric history, birth weight and APGAR score of infant. Main Outcome Measures. (1) Incidence of cases of GDM. (2) Impact of the measured variable. Chi-squares, odds ratios and logistic regression were performed. Results. The incidence of GDM was 4.31% (95% C.I. 2.31%, 6.31%). The proportion of GDM patients for the years 2005, 2006, and 2007 were 1.67%, 4.58%, and 6.67%, respectively. Age, Obesity Ethnicity, Family history of diabetes and a history of GDM were determined risk factors. Associations between GDM and (1) Mode of Delivery and (2) APGAR score of the baby were found. Discussion & Conclusion. There was an apparent increase in the incidence of GDM. Additional studies should be conducted to measure the occurrence of GDM in Trinidad and Tobago. Efforts to promote public awareness and a healthy lifestyle should be made to reverse this trend. PMID:19946648
Clapperton, M; Jarvis, J; Mungrue, K
Objective. To investigate the incidence of Gestational Diabetes Mellitus at the Mt. Hope Women's Hospital and to describe its epidemiological pattern. Design. A retrospective observational study (Jan 2005 to Dec 2007). Setting. A teaching hospital of The University of the West Indies. Population/Sample. Pregnant women who gave birth. Methods. A sample size of 720. The variables analyzed were: age, ethnicity, BMI of mother, family history of diabetes; history of GDM, obstetric history, birth weight and APGAR score of infant. Main Outcome Measures. (1) Incidence of cases of GDM. (2) Impact of the measured variable. Chi-squares, odds ratios and logistic regression were performed. Results. The incidence of GDM was 4.31% (95% C.I. 2.31%, 6.31%). The proportion of GDM patients for the years 2005, 2006, and 2007 were 1.67%, 4.58%, and 6.67%, respectively. Age, Obesity Ethnicity, Family history of diabetes and a history of GDM were determined risk factors. Associations between GDM and (1) Mode of Delivery and (2) APGAR score of the baby were found. Discussion & Conclusion. There was an apparent increase in the incidence of GDM. Additional studies should be conducted to measure the occurrence of GDM in Trinidad and Tobago. Efforts to promote public awareness and a healthy lifestyle should be made to reverse this trend.
Clapperton, M.; Jarvis, J.; Mungrue, K.
Abstract Objective: The aim of the present study was to determine specific obstetrical and neonatal complications associated with diet-treated gestational diabetes (DTGD) and medically treated gestational diabetes (MTGD). Methods: This is a prospective cohort study of women followed in the Robert Debré Hospital (France, Paris) and who have given birth between 1 January, 2004, and 19 November, 2010. Clinical, biological, maternal and neonatal data were reported in the maternity database. Associations between obstetrical and neonatal complications and gestational diabetes were evaluated by estimating odd ratios (ORs) and their 95% CIs, using a logistic regression model. Results: 16,244 pregnancies were included in the study. 1515 (9.3%) women had gestational diabetes: 1108 (7.3%) had DTGD, 243 (1.7%) had MTGD. After full adjustment, MTGD was associated with an increased risk of nonscheduled cesarean (ORnonscheduled=2.3; 95% CI: 1.6-3.3; P<0.001) while DTGD was not (ORnonscheduled=1.0; 95% CI: 0.8-1.3; P<0.96). Clinical macrosomia was positively associated with DTGD (OR=2; 95% CI: 1.7-2.4; P<0.0001) or MTGD (OR=2.9; 95% CI: 2.1-3.9; P<0.0001). Conclusion: This study confirms that macrosomia is the main complication of DTGD. By contrast, DTGD was not associated with neonatal hypoglycemia and cesarean, while these complications were associated with MTGD. PMID:24246283
Blachier, Audrey; Alberti, Corinne; Korb, Diane; Schmitz, Thomas; Patrick, Vexiau; Christine, Boissinot; Oury, Jean-François; Sibony, Olivier
Abstract Objective: To evaluate the blood flow in orbital arteries in patients with gestational diabetes mellitus (GDM). Material: We have examined 65 GDM patients and 38 healthy pregnant women at 28-32 weeks. Doppler parameters were assessed in ophthalmic, central retinal and short posterior ciliary arteries. Results: In ophthalmic arteries V2 was significantly higher and RI lower in GDM. In the subgroup treated with insulin V1 and V2 in ciliary artery and V2 in central retinal artery were significantly lower and PI in ciliary artery was higher when compared to subgroup on diet. Conclusion: Doppler examination can be useful in detection of pre-clinical ophthalmological changes in GDM patients. PMID:24090506
Moneta-Wielgos, Joanna; Golebiewska, Joanna; Brydak-Godowska, Joanna; Ciszewska, Joanna; Bomba-Opon, Dorota A; Wegrzyn, Piotr; Kecik, Dariusz
Objective: To observe the effects of exogenous insulin on placental, fetal and maternal outcomes in Gestational Diabetes Mellitus (GDM). Methods: After screening and diagnoses(WHO criteria) 30 GDM patients(Group A) were kept on diet control and 39 GDM (Group B) who did not achieve glycemic targets were added subcutaneous insulin. Term placental weight, size, shape, consistency, fibrinoid necrosis, hemorrhages, cord color, length of the cord, completeness of membranes, weight and condition of baby and mode of delivery were assessed in 25 patients in each group. Result: Placental weight, cord width and baby weight were found to be more in Group B, than Group A and were statistically significant with p value 0.005, 0.02 and 0.003 respectively. Ten patients in group A and 17 patients in group B had cesarean deliveries. Conclusion: Exogenous insulin produces significant effects on the placental, fetal and maternal outcomes in patients with GDM
Arshad, Rabia; Karim, Nasim; Ara Hasan, Jahan
Objectives To assess the precision magnetic resonance imaging (MRI) in the neonate and determine if there is an early maternal influence on the pattern of neonatal fat deposition in the offspring of mothers with gestational diabetes (GDM) and obesity compared with the offspring of normal weight women. Study design 25 neonates, born to normal weight mothers (n=13) and to obese mothers with GDM (n=12), underwent MRI for measurement of subcutaneous and intra-abdominal fat and magnetic resonance spectroscopy for the measurement of intrahepatocellular (IHCL) fat at 1-3 weeks of age. Results Infants born to obese/GDM mothers had a mean 68% increase in IHCL compared with infants born to normal weight mothers. For all infants, IHCL correlated with maternal pre-pregnancy BMI but not with subcutaneous adiposity. Conclusion Deposition of liver fat in the neonate correlates highly with maternal BMI. This finding may have implications for understanding the developmental origins of childhood NAFLD.
Brumbaugh, David E; Tearse, Phillip; Cree-Green, Melanie; Fenton, Laura Z; Brown, Mark; Scherzinger, Ann; Reynolds, Regina; Alston, Meredith; Hoffman, Camille; Pan, Zhaoxing; Friedman, Jacob E; Barbour, Linda A
Gestational diabetes mellitus (GDM) is a public health problem in Mexico and diet therapy is the main form of treatment. Self-management abilities are required to control the disease. Five women with GDM were studied to assess GDM risk perception and experiences related with self-management practices. Sociodemographic data were obtained and in-depth interviews were conducted and subsequently analyzed using Atlas ti V.5 software. The results revealed that women were conscious regarding the role of diet and physical activity in improving GDM control, and about the perinatal risks associated with the disease. Adherence to diet recommendations was partial, but gradual and positive lifestyle changes were observed. Emotionally, perception about having GDM was a key factor with respect to adhering to the diet. In conclusion, the medical and dietary treatment influences the cultural food behavior of women with GDM. Health professionals should consider sociocultural determinants when designing and implementing treatment strategies. PMID:24897466
Chávez-Courtois, Mayra; Graham, Chelsea; Romero-Pérez, Irma; Sánchez-Miranda, Georgina; Sánchez-Jiménez, Bernarda; Perichart-Perera, Otilia
OBJECTIVE To determine racial/ethnic differences in perinatal outcomes among women with gestational diabetes mellitus (GDM). STUDY DESIGN Retrospective cohort study of 32,193 singleton births among GDMs in California from 2006, using Vital Statistics Birth and Death Certificate and Patient Discharge Data. Women were divided by race/ethnicity: White, Black, Hispanic, or Asian. Multivariable logistic regression analyzed associations between race/ethnicity and adverse outcomes, controlling for potential confounders. Outcomes included: primary cesarean, preeclampisa, neonatal hypoglycemia, preterm delivery, macrosomia, fetal anomaly, respiratory distress syndrome (RDS). RESULTS Compared to other races, Black women had higher odds of preeclampsia [aOR=1.57, 95%CI(1.47-1.95)], neonatal hypoglycemia [aOR=1.79, 95%CI(1.07-3.00)], and preterm delivery <37 weeks [aOR=1.56, 95%CI(1.33-1.83)]. Asians had the lowest odds of primary cesarean [aOR=0.75, 95%CI(0.69-0.82)], large for gestational age infants [aOR=0.40, 95%CI(0.33-0.48)], and neonatal RDS [aOR=0.54, 95%CI(0.40-0.73)]. CONCLUSION Perinatal outcomes among women with GDM differ by race/ethnicity and may be attributed to inherent sociocultural differences that may impact glycemic control, the development of chronic co-morbidities, genetic variability, and variation in access to as well as quantity and quality of prenatal care.
NGUYEN, Brian T.; CHENG, Yvonne W.; SNOWDEN, Jonathan M.; ESAKOFF, Tania F.; FRIAS, Antonio E.; CAUGHEY, Aaron B.
OBJECTIVES To examine the association of maternal early pregnancy oxidative stress with risk of gestational diabetes mellitus (GDM). DESIGN AND METHODS A pilot prospective, nested case-control study was conducted. Study participants were recruited before 20 weeks gestation. Maternal urinary 8-hydroxydeoxyguanosine (8-OHdG), a biomarker of systemic oxidative DNA damage and repair, was measured using competitive immunoassays. Logistic regression was used to calculate odds ratio (OR) and 95% confidence intervals (95%CI). RESULTS Elevations in early pregnancy urinary 8-OHdG concentrations were associated with increased GDM risk. After adjusting for confounders, the OR for extreme quartiles (?8.01 vs. <4.23ng/mg creatinine) of 8-OHdG was 3.79 (95%CI 1.03-14.00). The risk for GDM was highest for overweight women with urine 8-OHdG concentrations ? 8.01ng/mg creatinine (OR=5.36, 95%CI 1.33-21.55) when compared with lean women who had 8-OHdG concentrations < 8.01ng/mg creatinine. CONCLUSIONS Elevated urine 8-OHdG concentrations in early pregnancy appear to be associated with increased GDM risk.
Qiu, Chunfang; Hevner, Karin; Abetew, Dejene; Enquobahrie, Daniel A.; Williams, Michelle A.
Toll-like receptors (TLRs) are pattern recognition receptors and play an important role in innate immune responses and the occurrence of inflammatory disease. TLR4 is a member of the TLR family and its activation is capable of inducing inflammatory responses, reflecting a relationship between the innate and adaptive immune systems. However, whether TLR4 is expressed in patients with gestational diabetes mellitus (GDM) has not been elucidated. The aim of the present study was to investigate whether TLR4 is expressed in maternal peripheral blood monocytes of patients with GDM. A case-control study, using standard quantitative polymerase chain reaction and western blotting, was performed to assess the TLR4 expression in 30 females with GDM and 32 healthy pregnant females at similar gestational ages. Serum tumor necrosis factor (TNF)-? levels were assessed using ELISA in all the females. The TLR4 expression levels in the maternal peripheral blood monocytes and the serum TNF-? levels were increased in females with GDM compared with healthy pregnant females (P<0.05). Additionally, there was a positive correlation between the TLR4 expression level in peripheral blood monocytes and serum TNF-? levels in all the females. These results indicate that TLR4-mediated release of inflammatory cytokines may represent one factor leading to increased glucose levels in patients with GDM. In addition, TLR4 may be involved in the pathogenesis of GDM.
XIE, BAO-GUO; JIN, SONG; ZHU, WEI-JIE
In all, 1,702 unselected pregnant women from the city of La Plata were tested for gestational diabetes mellitus (GDM) and evaluated to determine GDM prevalence and risk factors. In women with GDM, we evaluated compliance with guidelines for GDM management, and perinatal complications attributable to GDM. GDM prevalence was 5.8%, and its risk factors were pre-gestational obesity, previous hyperglycaemia, age > 30 years, previous GDM (and its surrogate markers). In primi-gravida (PG) subjects, GDM was equally prevalent in the presence (4.2%) or absence (4.0%) of risk factors. In multi-gravida (MG) women, although risk factors doubled the prevalence of GDM (8.6%), in the absence of risk factors GDM prevalence was similar to that of PG women (3.9%). Half of all women with GDM received inadequate post-diagnosis obstetric control, and this induced a fourfold increase in infant perinatal complications. In conclusion, all non-hyperglycaemic 24-28-week pregnant women should be tested for GDM, although particular attention must be paid to MG women with risk factors. PMID:19300898
McCarthy, Antonio Desmond; Curciarello, Renata; Castiglione, Nicolás; Tayeldín, Marina Fernández; Costa, Diego; Arnol, Verónica; Prospitti, Anabela; Aliano, Analía; Archuby, Daniela; Graieb, Augusto; Torres, María J; Etcheverry, Susana B; Apezteguía, María C
Abstract Objective: To study various biomarkers in prediction of gestational diabetes mellitus (GDM). Patients and methods: Prospective observational study included 400 pregnant women. Maternal serum sex hormone binding globulin (SHBG), high-sensitive C-reactive protein (hs-CRP), uric acid, creatinine and albumin were measured before 15 weeks of gestation. Patients were followed-up for development of GDM. Results: A total of 269 women were eligible for analysis. GDM complicated 27 (10.03%) of pregnancies. Hs-CRP levels were significantly higher and SHBG levels were significantly lower among women who subsequently developed GDM compared with normoglycemics. Uric acid, albumin and creatinine levels were not significantly different between both groups. For prediction of GDM, hs-CRP at a cutoff value of 2.55?mg/l showed a sensitivity and a specificity of 89% and 55%, respectively. SHBG at a cutoff value of 211.5?nmol/l showed a sensitivity and a specificity of 85% and 37%, respectively. Low SHBG with high hs-CRP predicted GDM with a sensitivity and specificity of 74.07% and 75.62%, respectively with an overall accuracy of 75.46%. Conclusion: Hs-CRP and SHBG are important early predictors of GDM. Adding SHBG to hs-CRP improves specificity and serves good overall accuracy. Uric acid, creatinine and albumin have no role in GDM prediction. PMID:24090161
Maged, Ahmed Mohamed; Moety, Ghada Abdel Fattah; Mostafa, Walaa Ahmed; Hamed, Dalia Ahmed
Few studies have explored the consequences of environmental exposure to organochlorine pesticides for gestational hypertension (GH), preeclampsia (PE) and gestational diabetes mellitus (GDM). Chlordecone is a persistent organochlorine pesticide that was used intensively, and almost exclusively, in the French West Indies until 1993. We investigated the impact of prenatal exposure to chlordecone on the occurrence of GDM, GH and PE by studying 779 pregnant women enrolled in a prospective mother-child cohort (Timoun Study) in Guadeloupe between 2004 and 2007. Chlordecone exposure was determined by assaying maternal plasma and information about pregnancy complications was obtained from midwives, pediatricians and hospital medical records after delivery. The risks of GH (n=65), PE (n=31) and GDM (n=71) were estimated by multiple logistic regression including potential confounders. Levels of chlordecone plasma concentration in the third (OR=0.2; 95% confidence interval (CI): 0.1, 0.5) and fourth quartiles (OR=0.3; 95% CI: 0.2, 0.7) were associated with a statistically significant decrease in the risk of GH. A log10 increase in chlordecone concentration was significantly associated with lower risk of GH (OR=0.4; 95% CI: 0.2, 0.6). No significant associations were observed between the chlordecone exposure and the risk of PE or GDM. This study suggests an inverse association between chlordecone exposure during pregnancy and GH. Further studies are required to determine the underlying mechanism, or the potential unknown confounding factors, resulting in this association. PMID:24727072
Saunders, Lauren; Kadhel, Philippe; Costet, Nathalie; Rouget, Florence; Monfort, Christine; Thomé, Jean-Pierre; Guldner, Laurence; Cordier, Sylvaine; Multigner, Luc
Backgrounds Two SNPs in melatonin receptor 1B gene, rs10830963 and rs1387153 showed significant associations with fasting plasma glucose levels and the risk of Type 2 Diabetes Mellitus (T2DM) in previous studies. Since T2DM and gestational diabetes mellitus (GDM) share similar characteristics, we suspected that the two genetic polymorphisms in MTNR1B may be associated with GDM, and conducted association studies between the polymorphisms and the disease. Furthermore, we also examined genetic effects of the two polymorphisms with various diabetes-related phenotypes. Methods A total of 1,918 subjects (928 GDM patients and 990 controls) were used for the study. Two MTNR1B polymorphisms were genotyped using TaqMan assay. The allele distributions of SNPs were evaluated by x2 models calculating odds ratios (ORs), 95% confidence intervals (CIs), and corresponding P values. Multiple regressions were used for association analyses of GDM-related traits. Finally, conditional analyses were also performed. Results We found significant associations between the two genetic variants and GDM, rs10830963, with a corrected P value of 0.0001, and rs1387153, with the corrected P value of 0.0008. In addition, we also found that the two SNPs were associated with various phenotypes such as homeostasis model assessment of beta-cell function and fasting glucose levels. Further conditional analyses results suggested that rs10830963 might be more likely functional in case/control analysis, although not clear in GDM-related phenotype analyses. Conclusion There have been studies that found associations between genetic variants of other genes and GDM, this is the first study that found significant associations between SNPs of MTNR1B and GDM. The genetic effects of two SNPs identified in this study would be helpful in understanding the insight of GDM and other diabetes-related disorders.
OBJECTIVE There is growing evidence that osteocalcin, an osteoblast-derived protein locally acting on bone formation, can increase insulin secretion as well as insulin sensitivity and thus prevent the development of obesity and diabetes in experimental animals. In humans, osteocalcin has been reported to be decreased in patients with type 2 diabetes. Because gestational diabetes mellitus (GDM) can serve as a model of pre–type 2 diabetes, the aim of this study was to investigate osteocalcin in GDM. RESEARCH DESIGN AND METHODS Osteocalcin measurement and an oral glucose tolerance test were performed in 78 pregnant women (26 women had GDM and 52 women had normal glucose tolerance [NGT] during pregnancy; women were matched for age and BMI) and in 34 women postpartum. RESULTS During pregnancy osteocalcin was significantly higher in the women with GDM than in the women with NGT (15.6 ± 6.4 vs. 12.6 ± 4.0 ng/ml; P < 0.015), whereas no difference was observed between the two groups at 12 weeks postpartum (36.2 ± 10.2 vs. 36.2 ± 13.0 ng/ml), when osteocalcin was found to be increased compared with the level in the pregnant state in all women (+145 ± 102% in GDM vs. +187 ± 119% in NGT; P < 0.0001). Moreover, osteocalcin showed a significant correlation with basal and total insulin secretion in the whole study group (R = 0.3, P < 0.01). CONCLUSIONS In GDM osteocalcin was higher and thus less restrained than in women with NGT during pregnancy and furthermore correlated with insulin secretion parameters. Therefore, it could be hypothesized that osteocalcin can enhance insulin secretion in insulin-resistant states; alternatively an effect of hyperinsulinemia on osteocalcin secretion cannot be excluded.
Winhofer, Yvonne; Handisurya, Ammon; Tura, Andrea; Bittighofer, Christina; Klein, Katharina; Schneider, Barbara; Bieglmayer, Christian; Wagner, Oswald F.; Pacini, Giovanni; Luger, Anton; Kautzky-Willer, Alexandra
The unpredictable behavior of uncontrolled type 1 diabetes often involves frequent swings in blood glucose levels that impact maintenance of a daily routine. An intensified insulin regimen is often unsuccessful, while other therapeutic options, such as amylin analog injections, use of continuous glucose sensors, and islet or pancreas transplantation are of limited clinical use. In efforts to provide patients with a more compliable treatment method, Oramed Pharmaceuticals tested the capacity of its oral insulin capsule (ORMD-0801, 8 mg insulin) in addressing this resistant clinical state. Eight Type I diabetes patients with uncontrolled diabetes (HbA1c: 7.5–10%) were monitored throughout the 15-day study period by means of a blind continuous glucose monitoring device. Baseline patient blood glucose behavior was monitored and recorded over a five-day pretreatment screening period. During the ensuing ten-day treatment phase, patients were asked to conduct themselves as usual and to self-administer an oral insulin capsule three times daily, just prior to meal intake. CGM data sufficient for pharmacodynamics analyses were obtained from 6 of the 8 subjects. Treatment with ORMD-0801 was associated with a significant 24.4% reduction in the frequencies of glucose readings >200 mg/dL (60.1±7.9% pretreatment vs. 45.4±4.9% during ORMD-0801 treatment; p?=?0.023) and a significant mean 16.6% decrease in glucose area under the curve (AUC) (66055±5547 mg/dL/24 hours vs. 55060±3068 mg/dL/24 hours, p?=?0.023), with a greater decrease during the early evening hours. In conclusion, ORMD-0801 oral insulin capsules in conjunction with subcutaneous insulin injections, well tolerated and effectively reduced glycemia throughout the day. Trial Registration Clinicaltrials.gov NCT00867594.
Eldor, Roy; Arbit, Ehud; Corcos, Asher; Kidron, Miriam
Human tissue kallikrein (hK1) is reduced in hypertension, cardiovascular and renal diseases. There is little information on the participation of hK1 in type 1 diabetes mellitus (DM), type 2 DM, and gestational diabetes mellitus (GDM), respectively. The aim of this study was to evaluate the roles of insulin and hyperglycemia on urinary hK1 activity in type 1 DM and in
Gilmar Machado Miranda; Carolina Antunes Magalhães; Adriana Aparecida Bosco; Janice Sepulveda Reis; Antônio Ribeiro-Oliveira; Anelise Impelizieri Nogueira; Ricardo Barsaglini da Silva Leite; Paulo Augusto Carvalho Miranda; Amintas Fabiano de Souza Figueiredo
Background A high prevalence of gestational diabetes mellitus and type 2 diabetes has been observed among the Cree of James Bay, Quebec. To address this problem, a diet and activity intervention during pregnancy, which was based on social learning theory, was initiated in 4 Cree communities. Methods A prospective intervention compared dietary, weight and glycemic indicators for 107 control subjects and for 112 women who received the intervention during the course of their pregnancy. A control period in 4 communities (July 1995–March 1996) was followed by an intervention period (April 1996–January 1997) when subjects were offered regular, individual diet counselling, physical activity sessions and other activities related to nutrition. Results The intervention and control groups did not differ at baseline regarding their mean age (24.3 years [SD 6.29] v. 23.8 years [SD 5.86]), mean prepregnancy weight (81.0 kg [SD 19.46] v. 78.9 kg [SD 17.54]) and mean gestational age at recruitment (17.1 weeks [SD 7.06] v. 18.5 weeks [SD 6.92]). The intervention did not result in differences in diet measured at 24–30 weeks' gestation, rate of weight gain over the second half of pregnancy (0.53 kg per week [SD 0.32] v. 0.53 kg per week [SD 0.27]) or plasma glucose level (50 g oral glucose screen) between 24 and 30 weeks (7.21 mmol/L [SD 2.09] v. 7.43 mmol/L [SD 2.10]). Mean birth weights were similar (3741 g [SD 523] v. 3686 g [SD 686]), as was maternal weight at 6 weeks post partum (88.1 kg [SD 16.8] v. 86.4 kg [SD 19.0]). The only changes in dietary intake were a reduction in caffeine (pregnancy) and an increase in folate (post partum). Interpretation This intervention had only a minor impact on diet; finding ways of encouraging appropriate body weight and activity levels remains a challenge.
Gray-Donald, Katherine; Robinson, Elizabeth; Collier, Aileen; David, Kinga; Renaud, Lise; Rodrigues, Shaila
Maternal hyperglycemia in gestational diabetes mellitus (GDM), especially hyperglycemic excursions, is associated with increased risks of adverse pregnancy outcomes. Continuous glucose monitoring (CGM) system (CGMS) is better than intermittent self-measurements in detecting detailed glucose profiles on the magnitude and duration of glucose fluctuations. Hyperglycemia resulted from impaired ? cell function. This study analyzed the characteristics of glycemic variability in GDM with 24-28 gestational weeks and its association with ? cell function. Thirty GDM with 24-28 gestational weeks (GDM group) were included in this study, and 20 normal gestational women (NGW group) and 20 normal glucose regulation non-pregnant women (NGRW group) were set as controls. The three groups were monitored using the CGMS for consecutive 72 h. The parameters of glycemic variability included the standard deviation of blood glucose (SDBG), mean of continuous 24-h blood glucose (MBG), mean amplitude of glycemic excursions (MAGEs), and mean of daily differences (MODDs). Homeostasis model assessments were applied to access the insulin resistance (HOMA-IR). The early insulinogenic index (?I30/?G30) and the area under the curve of insulin (AUCI180) derived from 75-g oral glucose tolerance test were applied to evaluate the early-phase insulin secretion and second-phase insulin secretion, respectively. After CGM, MAGE and MBG value increased progressively from NGRW, NGW to GDM group (p < 0.05); MODD and SDBG values of GDM group were all higher than those of NGRW and NGW groups (p < 0.05), but there are no differences in MODD and SDBG between NGRW and NGW groups (p > 0.05). After comparison of ? cell function, ?I30/?G30 decreased progressively from NGRW, NGW to GDM group (p < 0.05); HOMA-IR and AUCI180 increased progressively from NGRW, NGW to GDM group (p < 0.05). MAGE value was correlated with ?I30/?G30 and HOMA-IR in GDM group (r = -0.78 and 0.65, respectively, p < 0.05). Multiple linear stepwise regression analysis showed that ?I30/?G30 and HOMA-IR were the independent factors of MAGE (? = -0.61, 0.34, respectively, p < 0.05). Glycemic variability in GDM was higher than in normal pregnant women, and glycemic variability evaluated by MAGE correlates well with impaired early-phase insulin secretion in GDM. Further large-scale studies are needed to formulate treatment strategies to make up for the impaired early-phase insulin secretion and flat glycemic variability, and analyze the association between pregnancy outcomes improvement and glycemic variability remission in GDM. PMID:22815046
Su, Jian-bin; Wang, Xue-qin; Chen, Jin-feng; Wu, Gang; Jin, Yan; Xu, Feng; Wang, Xiao-hua; Liu, Yu-tian
The routine use of self-monitoring of capillary blood glucose by pregnant diabetic patients currently provides the basis for both clinical management and ongoing investigation. Strategies must therefore be developed to ensure that these data are reliable and accurately reported by patients and are not influenced by diverse socioeconomic levels or varied geographic locations. To explore this issue, we used glucose reflectance meters with a memory microchip capable of storing up to 440 consecutive blood glucose determinations. Two diverse groups of women from Texas and New York who had gestational diabetes performed self-monitoring of blood glucose from diagnosis until delivery. Both groups recorded their blood glucose results daily in a logbook. The reporting performance of all the participating subjects resulted in an actual compliance rate of 60% to 70% of testings required of the patients. Comparison of African-American, Mexican-American, and white populations revealed no significant differences in patient performance or compliance. Moreover, no differences were found between the groups at different geographic locations (New York, Texas) in patients' willingness and ability to comply with the regimen of self-monitoring blood glucose. These findings suggest that the use of memory reflectance meters, in conjunction with patient education and positive interaction between patient and care provider, will result in high patient compliance regardless of socioeconomic level or ethnic diversity. PMID:7772936
Langer, O; Langer, N; Piper, J M; Elliott, B; Anyaegbunam, A
Postpartum screening is critical for early identification of type 2 diabetes in women previously diagnosed with gestational diabetes mellitus (GDM). Nevertheless, its rate remains disappointingly low. Thus, we plan to examine the rate of postpartum glucose tolerance test (ppOGTT) for Italian women with GDM, before and after counseling, and identify demographic, clinical, and/or biochemical predictors of adherence. With these aims, we retrospectively enrolled 1159 women with GDM, in Calabria, Southern Italy, between 2004 and 2011. During the last year, verbal and written counseling on the importance of followup was introduced. Data were analyzed by multiple regression analysis. A significant increase of the return rate was observed following introduction of the counseling [adjusted odds ratio (AOR) 5.17 (95% CI, 3.83–6.97), P < 0.001]. Interestingly, previous diagnosis of polycystic ovary syndrome (PCOS) emerged as the major predictor of postpartum followup [AOR 5.27 (95% CI, 3.51–8.70), P < 0.001], even after stratification for the absence of counseling. Previous diagnosis of GDM, higher educational status, and insulin treatment were also relevant predictors. Overall, our data indicate that counseling intervention is effective, even if many women fail to return, whereas PCOS represents a new strong predictor of adherence to postpartum testing.
Capula, Carmelo; Vero, Anna; Iiritano, Stefania; Arcidiacono, Biagio; Puccio, Luigi; Pullano, Vittorio; Foti, Daniela; Brunetti, Antonio; Vero, Raffaella
Glyburide’s PK and PD have not been studied in women with gestational diabetes mellitus (GDM). The objective was to assess steady-state PK of glyburide as well as insulin sensitivity, beta-cell responsivity and overall disposition indices following a mixed meal tolerance test (MMTT) in GDM (n=40), non-pregnant type 2 diabetic (T2DM) (n=26) and healthy pregnant (n=40, MMTT only) women. At equivalent doses, glyburide plasma concentrations were ~50% lower in pregnancy compared to non-pregnant women. Average glyburide umbilical cord to maternal plasma concentration ratio at the time of delivery was 0.7 ± 0.4. Insulin sensitivity was ~5-fold lower in women with GDM compared to healthy pregnancy. Despite comparable beta-cell responsivity index, average beta-cell function corrected for insulin resistance was >3.5- fold lower in women with glyburide-treated GDM than healthy pregnancy. Women with GDM that fail glyburide may benefit from alternate medication selection or dosage escalation, though fetal safety should be considered.
Hebert, MF; Ma, X; Naraharisetti, SB; Krudys, KM; Umans, JG; Hankins, GDV; Caritis, SN; Miodovnik, M; Mattison, DR; Unadkat, JD; Kelly, EJ; Blough, D; Cobelli, C; Ahmed, MS; Snodgrass, WR; Carr, DB; Easterling, TR; Vicini, P
Normal human pregnancy is considered a state of enhanced oxidative stress. In pregnancy, it plays important roles in embryo development, implantation, placental development and function, fetal development, and labor. However, pathologic pregnancies, including gestational diabetes mellitus (GDM), are associated with a heightened level of oxidative stress, owing to both overproduction of free radicals and/or a defect in the antioxidant defenses. This has important implications on the mother, placental function, and fetal well-being. Animal models of diabetes have confirmed the important role of oxidative stress in the etiology of congenital malformations; the relative immaturity of the antioxidant system facilitates the exposure of embryos and fetuses to the damaging effects of oxidative stress. Of note, there are only a few clinical studies evaluating the potential beneficial effects of antioxidants in GDM. Thus, whether or not increased antioxidant intake can reduce the complications of GDM in both mother and fetus needs to be explored. This review provides an overview and updated data on our current understanding of the complications associated with oxidative changes in GDM. PMID:21675877
Lappas, Martha; Hiden, Ursula; Desoye, Gernot; Froehlich, Julia; Hauguel-de Mouzon, Sylvie; Jawerbaum, Alicia
OBJECTIVE Women with gestational diabetes mellitus (GDM) show reduced insulin sensitivity and markedly elevated glucose excursions. After delivery, GDM mostly reverts to normal glucose tolerance (NGT), although leaving an increased risk of type 2 diabetes. Because gastrointestinal function changes during pregnancy causing vomiting, constipation, or reduced motility, we thought that gut glucose absorption in GDM or pregnancy might be altered to affect circulating glucose excursions. RESEARCH DESIGN AND METHODS By undergoing 180-min oral glucose tolerance tests (OGTTs), pregnant women with GDM (GDMpreg; n = 15, BMI = 32 ± 2 kg/m2, aged 33 ± 1 years) were compared with NGT women (NGTpreg; n = 7, BMI = 28 ± 1 kg/m2, aged 34 ± 2 years), matching for major anthropometric characteristics (each P > 0.2). After delivery (6–7 months later), both groups were studied the same way. We computed and mathematically modeled gut glucose absorption from insulin-mediated glucose disappearance and endogenous glucose production (EGP). Whole-body insulin sensitivity was calculated using the Clamp-like Index. RESULTS GDMpreg showed 16–25% higher plasma glucose concentrations (P < 0.04) during the final 2 h of OGTT, similar EGP, but lower (P < 0.01) insulin sensitivity (2.7 ± 0.2 mg · kg?1 · min?1 vs. NGTpreg: 4.5 ± 0.8 mg · kg?1 · min?1). In GDMpreg, gut glucose absorption rates were ?52% lower from 30 to 120 min (P < 0.03 vs. conditions after delivery or NGTpreg). In contrast, glucose absorption rates in NGTpreg were comparable during and after pregnancy. None of the studied women developed diabetes after delivery. CONCLUSIONS In GDMpreg, OGTT gut glucose absorption is markedly lower during hyperglycemia, whereas both glycemia and glucose absorption in NGTpreg are comparable between pregnant and postpartum states. Thus, hyperglycemia in GDM does not seem to result from too rapid or increased glucose absorption.
Anderwald, Christian; Tura, Andrea; Winhofer, Yvonne; Krebs, Michael; Winzer, Christine; Bischof, Martin G.; Luger, Anton; Pacini, Giovanni; Kautzky-Willer, Alexandra
OBJECTIVE To identify factors associated with declining ?-cell compensation for insulin resistance. RESEARCH DESIGN AND METHODS In a cohort of Hispanic women with recent gestational diabetes mellitus, oral glucose tolerance tests (OGTTs), intravenous glucose tolerance tests (IVGTTs), and bioelectrical impedance measurements were performed at 15-month intervals for up to 5 years, or until fasting plasma glucose exceeded 140 mg/dl (7.8 mmol/l). Data were analyzed to identify predictors of declining ?-cell compensation for insulin resistance (the disposition index [DI]) and to examine the mechanism of weight gain and changes in circulating levels of selected adipokines and inflammatory markers on ?-cell compensation decline. RESULTS A total of 60 nondiabetic women had a median of four sets of OGTT + IVGTT during a median follow-up of 52 months. Fourteen of the women developed diabetes. None of the baseline characteristics were significantly predictive of a decline in DI. There were significant univariate associations between declining DI and weight gain (specifically fat gain), declining adiponectin and rising C-reactive protein. Multivariate analysis showed that the weight gain was the most significant factor associated with declining DI. The amount of association between weight gain and declining DI was explained 31% by changes in adiponectin and C-reactive protein and 40% by changes in insulin resistance. CONCLUSIONS These results identify weight gain as the strongest factor associated with declining ?-cell compensation for insulin resistance in Hispanic women at high risk for type 2 diabetes. Such effect may be mediated through at least two effects: alterations in adipokine levels and increasing insulin resistance.
Xiang, Anny H.; Kawakubo, Miwa; Trigo, Enrique; Kjos, Siri L.; Buchanan, Thomas A.
This study examined prepregnancy cardiometabolic risk factors and gestational diabetes mellitus (GDM) in subsequent pregnancies. The authors selected 1,164 women without diabetes before pregnancy who delivered 1,809 livebirths between 5 consecutive examinations from 1985 to 2006 in the Coronary Artery Risk Development in Young Adults (CARDIA) Study. The authors measured prepregnancy cardiometabolic risk factors and performed multivariate repeated-measures logistic regression to compute the odds of GDM adjusted for race, age, parity, birth order, and other covariates. Impaired fasting glucose (100–125 vs. <90 mg/dL), elevated fasting insulin (>15–20 and >20 vs. <10 ?U/mL), and low levels of high-density lipoprotein cholesterol (<40 vs. >50 mg/dL) before pregnancy were directly associated with GDM: The odds ratios = 4.74 (95% confidence interval (CI): 2.14, 10.51) for fasting glucose, 2.19 (95% CI: 1.15, 4.17) for middle insulin levels and 2.36 (95% CI: 1.20, 4.63) for highest insulin levels, and 3.07 (95% CI: 1.62, 5.84) for low levels of high-density lipoprotein cholesterol among women with a negative family history of diabetes; all P < 0.01. Among overweight women, 26.7% with 1 or more cardiometabolic risk factors developed GDM versus 7.4% with none. Metabolic impairment exists before GDM pregnancy in nondiabetic women. Interconceptual metabolic screening could be included in routine health assessments to identify high-risk women for GDM in a subsequent pregnancy and to potentially minimize fetal exposure to metabolic abnormalities that program future disease.
Gunderson, Erica P.; Quesenberry, Charles P.; Jacobs, David R.; Feng, Juanran; Lewis, Cora E.; Sidney, Stephen
Background and Aims Determinants of fatty liver (FL) might be predictive for further deterioration in insulin resistance (IR) in women with previous gestational diabetes (pGDM). The aim was to evaluate the association between pGDM, FL and future manifestation of type 2 diabetes (T2DM) by a detailed pathophysiological characterization early after pregnancy. Methods 68 pGDM and 29 healthy controls were included 3–6 months after delivery and underwent specific metabolic assessments: status of IR was determined via oral- and intravenous-glucose-tolerance-tests with analysis of proinflammatory factors and kinetics of free-fatty-acids (FFA). According to the fatty-liver-index (FLI), pGDMs were categorized into three groups with low (FLI?20), intermediate (20
Bozkurt, Latife; Gobl, Christian S.; Tura, Andrea; Chmelik, Marek; Prikoszovich, Thomas; Kosi, Lana; Wagner, Oswald; Roden, Michael; Pacini, Giovanni; Gastaldelli, Amalia; Kautzky-Willer, Alexandra
Aim To assess the glucose tolerance of South Asian and Caucasian women with previous gestational diabetes mellitus (GDM). Method A retrospective follow?up study of 189 women diagnosed with GDM between 1995 and 2001. Glucose tolerance was reassessed by oral glucose tolerance test at a mean duration since pregnancy of 4.38 years. Results South Asian women comprised 65% of the GDM population. Diabetes developed in 36.9% of the population, affecting more South Asian (48.6%) than Caucasian women (25.0%). Women developing diabetes were older at follow?up (mean (SD) 38.8 (5.7) vs 35.9 (5.6) years; p<0.05) and had been heavier (body mass index 31.4 (6.3) vs 27.7 (6.7)?kg/m2; p<0.05), more hyperglycaemic (Gl0 6.5 (1.7) vs 5.2 (1.1)?mmol/l; p<0.01: G120 11.4 (3.3) vs 9.6 (1.8)?mmol/l; p<0.01: HbA1c 6.4 (1.0) vs 5.6 (0.7); p<0.01) and more likely to require insulin during pregnancy (88.1% vs 34.0%; p<0.01). Future diabetes was associated with and predicted by HbA1c taken at GDM diagnosis in both South Asian (odds ratio 4.09, 95% confidence interval 1.35 to 12.40; p<0.05) and Caucasian women (OR 9.15, 95% CI 1.91 to 43.87; p<0.01) as well as by previously reported risk factors of increasing age at follow?up, pregnancy weight, increasing hyperglycaemia and insulin requirement during pregnancy. Conclusion GDM represents a significant risk factor for future DM development regardless of ethnicity. Glycated haemoglobin values at GDM diagnosis have value in predicting future diabetes mellitus.
Oldfield, Matthew D; Donley, Penelope; Walwyn, Linda; Scudamore, Ian; Gregory, Robert
Evaluation of efficacy and tolerability of glimepiride and metformin combination: a multicentric study in patients with type-2 diabetes mellitus, uncontrolled on monotherapy with sulfonylurea or metformin.
The objectives of this study were to evaluate the efficacy and tolerability of glimepiride plus extended release metformin (MET) on glycemic control in patients with type-2 diabetes mellitus uncontrolled on monotherapy with sulfonylurea or MET. This was a prospective, open-labeled, multicentric study over 12 weeks. Patients who were diagnosed with type-2 diabetes and were uncontrolled on monotherapy with single oral hypoglycemic agents such as glimepiride or MET and characterized by glycosylated hemoglobin (HbA1c) ?7% and ?10% and fasting plasma glucose (FPG) ? 140 mg/dL were enrolled in this study. Treatment regimen was started at 1 mg of glimepiride plus 500 mg of MET once a day and was titrated to next dose level depending on the clinician's judgment, not exceeding a total daily dose of 8 mg of glimepiride and 2000 mg of MET. After 12-weektreatment, glimepiride plus MET combination showed improvement in metabolic control as assessed by changes in HbA1c, FPG, and post prandial glucose (PPG). Primary efficacy parameter, HbA1c, was significantly reduced to (7.65 ± 1.70) at the end of the treatment from the baseline value (8.35 ± 0.93) (P < 0.001). Of the patients, 65.79% showed ?0.5% reduction in HbA1c and or HbA1c <7% at the end of the therapy. FPG and PPG were significantly reduced at the end of the therapy as compared with baseline values (P < 0.001). Moreover, the lipid profile was also improved during the treatment period. The addition of glimepiride to MET is an effective treatment for patients inadequately controlled on sulfonylurea or Met alone. A combination of glimepiride with MET achieves good glycemic control with better tolerability profile. PMID:21326082
Pareek, Anil; Chandurkar, Nitin B; Salkar, Harsha R; Borkar, Mangala S; Tiwari, Dharmendra
Evaluation of efficacy and tolerability of gliclazide and metformin combination: a multicentric study in patients with type 2 diabetes mellitus uncontrolled on monotherapy with sulfonylurea or metformin.
The objective of this study was to compare the effects of gliclazide/metformin on glycemic control in patients with Type 2 diabetes mellitus uncontrolled on monotherapy with sulfonylurea or metformin. This was a prospective, open-labeled, multicentric study over 12 weeks. Patients who were diagnosed of Type 2 diabetes and were uncontrolled on monotherapy with oral hypoglycemic agents, including gliclazide and metformin, characterized by HbA1c 7% or greater and 10% or less and fasting plasma glucose (FPG) 140 mg/dL or greater were enrolled in this study. The treatment regimen was started at 80 mg gliclazide plus 500 mg metformin once a day and was titrated to the next dose level depending on the clinician's judgment, not exceeding a total daily dose of 320 mg gliclazide and 2000 mg metformin. Changes from baseline HbA1c, FPG, and postprandial glucose were examined. After 12-weeks treatment, the gliclazide + metformin combination showed improvement in metabolic control as assessed by changes in HbA1c, FPG, and postprandial glucose. The primary efficacy parameter, HbA1c, was significantly reduced to 7.35 ± 1.10 at the end of treatment from the baseline value (8.51 ± 0.77) (P < 0.001). A total of 84.35% of patients showed a 0.5% or greater reduction in HbA1c and 37.39% of patients reported less than 7% HbA1c at the end of therapy. FPG and postprandial glucose were significantly reduced at the end of therapy as compared with baseline values (P < 0.001). Moreover, the lipid profile was also improved during the treatment period. The addition of gliclazide to metformin is an effective treatment for patients inadequately controlled on sulfonylurea or metformin alone. A combination of gliclazide with metformin achieves good glycemic control and improves lipid levels with better tolerability profile. PMID:20093927
Pareek, Anil; Chandurkar, Nitin; Zawar, Shyamsundar; Agrawal, Navneet
Background/Aims The aim was to compare the insulin sensitivity and secretion index of pregnant Korean women with normal glucose tolerance (NGT), gestational impaired glucose tolerance (GIGT; only one abnormal value according to the Carpenter and Coustan criteria), and gestational diabetes mellitus (GDM). Methods A cross-sectional study was performed with 1,163 pregnant women with positive (1-hour plasma glucose ? 7.2 mmol/L) in a 50-g oral glucose challenge test (OGCT). The 100-g oral glucose tolerance test (OGTT) was used to stratify the participants into three groups: NGT (n = 588), GIGT (n = 294), and GDM (n = 281). Results The GDM group had higher homeostasis model assessment of insulin resistance and lower insulin sensitivity index (ISOGTT), quantitative insulin sensitivity check index, homeostasis model assessment for estimation of index ?-cell secretion (HOMA-B), first and second phase insulin secretion, and insulin secretion-sensitivity index (ISSI) than the NGT group (p ? 0.001 for all). Moreover, the GIGT group had lower ISOGTT, HOMA-B, first and second phase insulin secretion, and ISSI than the NGT group (p < 0.001 for all). Among the GIGT subjects, the 1-hour plasma glucose abnormal levels group showed significantly greater weight gain during pregnancy and higher values in the 50-g OGCT than the other two groups. Moreover, the 1-hour and 2-hour abnormal levels groups had poorer insulin secretion status than the 3-hour abnormal levels group. Conclusions Korean women with GDM show impairments of both insulin secretion and insulin sensitivity. In addition, GIGT is associated with both ?-cell dysfunction and insulin resistance.
Yang, Sae Jeong; Kim, Tae Nyun; Baik, Sei Hyun; Kim, Tae Sun; Lee, Kwan Woo; Nam, Moonsuk; Park, Yong Soo; Woo, Jeong-Teak; Kim, Young Seol
The invention relates to methods and compositions for identifying subjects having, or predisposed to having, gestational diabetes, preeclampsia, and gestational hypertension. The methods are applicable to urine and/or blood samples and can be conducted pr...
R. I. Thadhani S. A. Karumanchi
Recently soluble CD163 (sCD163), a cleaved form of the macrophage receptor CD163, was identified as a macrophage-specific risk-predictor for developing Type 2 Diabetes. Here, we investigate circulating levels of sCD163 in gestational diabetes mellitus (GDM). Furthermore, given the role of the placenta in the pathogenesis of GDM, we assessed placental contribution to sCD163 secretion. Paired maternal (venous) and umbilical vein blood samples from GDM (n?=?18) and Body Mass Index (BMI) matched control women (n?=?20) delivered by caesarean section at 39–40 week gestation were assessed for circulating levels of sCD163, Tumour necrosis factor alpha (TNF-?) and Interleukin 6 (IL-6). Media from explant culture of maternal subcutaneous fat and corresponding placental tissues were assayed for these same molecules. CD163 positive cell numbers were determined in placental and adipose tissues of GDM and control women. We found significantly elevated circulating sCD163 levels in GDM mothers (688.4±46.9 ng/ml vs. 505.6±38.6 ng/ml) and their offspring (418.2±26.6 ng/ml vs. 336.3±24.4 ng/ml [p<0.05 for both]) as compared to controls, together with elevated circulating TNF-? and IL-6 levels. Moreover, both GDM placentae (268.1±10.8 ng/ml/mg vs. 187.6±20.6 ng/ml/mg) and adipose explants (41.1±2.7 ng/ml/mg vs. 26.6±2.4 ng/ml/mg) released significantly more sCD163 than controls. Lastly, significantly more CD163 positive cells were observed in GDM placentae (25.7±1.1 vs. 22.1±1.2) and adipose tissue (19.1±1.1 vs 12.7±0.9) compared to controls. We describe elevated sCD163 levels in GDM and identify human placenta as a novel source of sCD163 suggesting that placental tissues might contribute to the increased levels of circulating sCD163 in GDM pregnancies.
Bari, Muhammad Furqan; Weickert, Martin O.; Sivakumar, Kavitha; James, Sean G.; Snead, David R. J.; Tan, Bee Kang; Randeva, Harpal Singh
Background Women who develop gestational diabetes mellitus (GDM) have an increased risk for the development of type 2 diabetes. Despite this "window of opportunity," few intervention studies have targeted postpartum women with a history of GDM. We sought perspectives of women with a history of GDM to identify a) barriers and facilitators to healthy lifestyle changes postpartum, and b) specific intervention approaches that would facilitate participation in a postpartum lifestyle intervention program. Methods We used mixed methods to gather data from women with a prior history of GDM, including focus groups and informant interviews. Analysis of focus groups relied on grounded theory and used open-coding to categorize data by themes, while frequency distributions were used for the informant interviews. Results Of 38 women eligible to participate in focus groups, only ten women were able to accommodate their schedules to attend a focus group and 15 completed informant interviews by phone. We analyzed data from 25 women (mean age 35, mean pre-pregnancy BMI 28, 52% Caucasian, 20% African American, 12% Asian, 8% American Indian, 8% refused to specify). Themes from the focus groups included concern about developing type 2 diabetes, barriers to changing diet, and barriers to increasing physical activity. In one focus group, women expressed frustration about feeling judged by their physicians during their GDM pregnancy. Cited barriers to lifestyle change were identified from both methods, and included time and financial constraints, childcare duties, lack of motivation, fatigue, and obstacles at work. Informants suggested facilitators for lifestyle change, including nutrition education, accountability, exercise partners/groups, access to gyms with childcare, and home exercise equipment. All focus group and informant interview participants reported access to the internet, and the majority expressed interest in an intervention program delivered primarily via the internet that would include the opportunity to work with a lifestyle coach. Conclusion Time constraints were a major barrier. Our findings suggest that an internet-based lifestyle intervention program should be tested as a novel approach to prevent type 2 diabetes in postpartum women with a history of GDM. Trial Registration ClinicalTrials.gov: NCT01102530
Higher egg and cholesterol intakes are associated with increased risk of type 2 diabetes mellitus. However, their association with gestational diabetes mellitus (GDM) has not been evaluated. The authors assessed such associations in both a prospective cohort study (1996–2008; 3,158 participants) and a case-control study (1998–2002; 185 cases, 411 controls). A food frequency questionnaire was used to assess maternal diet. Multivariable models were used to derive relative risks and 95% confidence intervals. Compared with no egg consumption, adjusted relative risks for GDM were 0.94, 1.01, 1.12, 1.54, and 2.52 for consumption of ?1, 2–3, 4–6, 7–9, and ?10 eggs/week, respectively (P for trend = 0.008). Women with high egg consumption (?7/week) had a 1.77-fold increased risk compared with women with lower consumption (95% confidence interval (CI): 1.19, 2.63). The relative risk for the highest quartile of cholesterol intake (?294 mg/day) versus the lowest (<151 mg/day) was 2.35 (95% CI: 1.35, 4.09). In the case-control study, the adjusted odds ratio for consuming ?7 eggs/week versus <7 eggs/week was 2.65 (95% CI: 1.48, 4.72), and the odds of GDM increased with increasing cholesterol intake (P for trend = 0.021). In conclusion, high egg and cholesterol intakes before and during pregnancy are associated with increased risk of GDM.
Qiu, Chunfang; Frederick, Ihunnaya O.; Zhang, Cuilin; Sorensen, Tanya K.; Enquobahrie, Daniel A.; Williams, Michelle A.
Background: Previous studies observed inverse associations of adherence to the alternate Mediterranean (aMED), Dietary Approaches to Stop Hypertension (DASH), and alternate Healthy Eating Index (aHEI) dietary patterns with risk of type 2 diabetes; however, their associations with gestational diabetes mellitus (GDM) risk are unknown. Objective: This study aimed to assess usual prepregnancy adherence to well-known dietary patterns and GDM risk. Design: Our study included 21,376 singleton live births reported from 15,254 participants of the Nurses’ Health Study II cohort between 1991 and 2001. Pregnancies were free of prepregnancy chronic disease or previous GDM. Prepregnancy dietary pattern adherence scores were computed based on participants’ usual intake of the patterns’ components, assessed with a validated food-frequency questionnaire. Multivariable logistic regressions with generalized estimating equations were used to estimate the RRs and 95% CIs. Results: Incident first-time GDM was reported in 872 pregnancies. All 3 scores were inversely associated with GDM risk after adjustment for several covariables. In a comparison of the multivariable risk of GDM in participants in the fourth and first quartiles of dietary pattern adherence scores, aMED was associated with a 24% lower risk (RR: 0.76; 95% CI: 0.60, 0.95; P-trend = 0.004), DASH with a 34% lower risk (RR: 0.66; 95% CI: 0.53, 0.82; P-trend = 0.0005), and aHEI with a 46% lower risk (RR: 0.54; 95% CI: 0.43, 0.68; P-trend < 0.0001). Conclusion: Prepregnancy adherence to healthful dietary patterns is significantly associated with a lower risk of GDM.
Tobias, Deirdre K; Zhang, Cuilin; Chavarro, Jorge; Bowers, Katherine; Rich-Edwards, Janet; Rosner, Bernard; Mozaffarian, Dariush; Hu, Frank B
We compared pre- to post-pregnancy change in weight, body mass index (BMI), waist circumference, diet and physical activity in women with and without gestational diabetes mellitus (GDM). Using the Coronary Artery Risk Development in Young Adults (CARDIA) study we identified women with at least one pregnancy during 20 years of follow-up (n=1,488 with 3,125 pregnancies). We used linear regression with generalized estimating equations to compare pre- to post-pregnancy changes in health behaviors and anthropometric measurements between 137 GDM pregnancies and 1,637 non GDM pregnancies, adjusted for parity, age at delivery, outcome measure at the pre-pregnancy exam, race, education, mode of delivery, and interval between delivery and post-pregnancy examination. Compared with women without GDM in pregnancy, women with GDM had higher pre-pregnancy mean weight (158.3 vs. 149.6 lb, p=0.011) and BMI (26.7 vs. 25.1 kg/m2, p=0.002), but non-significantly lower total daily caloric intake and similar levels of physical activity. Both GDM and non GDM groups had higher average postpartum weight of 7–8 lbs and decreased physical activity on average 1.4 years after pregnancy. Both groups similarly increased total caloric intake but reduced fast food frequency. Pre- to post- pregnancy changes in body weight, BMI, waist circumference, physical activity and diet did not differ between women with and without GDM in pregnancy. Following pregnancy women with and without GDM increased caloric intake, BMI and weight, decreased physical activity, but reduced their frequency of eating fast food. Given these trends, postpartum lifestyle interventions, particularly for women with GDM, are needed to reduce obesity and diabetes risk.
Liu, Su-Hsun; Yeh, Hsin-Chieh; Nicholson, Wanda K.; Gunderson, Erica P.; Lewis, Cora E.; Clark, Jeanne M.
Increased cord blood C-peptide levels in neonates born to mothers with gestational diabetes (GD) were directly correlated with the increased relative birth weight ratio (BWR) of these neonates. In addition, the percentage oxygen saturation of the cord blood was inversely correlated with cord blood C-peptide levels and with the relative BWR. These correlations were absent in neonates delivered to normal mothers. The results indicate the presence of both hyperinsulinaemia and mild hypoxaemia in neonates of mothers with GD. In poorly controlled diabetic pregnancy this hypoxaemia may constitute an important fetal risk factor. PMID:3966198
Macfarlane, C M; Tsakalakos, N
To study the relationship between pre-pregnancy body mass index (BMI) and weight gain during pregnancy with pregnancy and\\u000a birth outcomes, with a focus on gestational diabetes and hypertension and their role in the association with fetal growth.\\u000a We studied 1,884 mothers and offspring from the Eden mother–child cohort. Weight before pregnancy (W1) and weight after delivery\\u000a (W2) were collected and
B. Heude; O. Thiébaugeorges; V. Goua; A. Forhan; M. Kaminski; B. Foliguet; M. Schweitzer; G. Magnin; M. A. Charles
A 60-year-old man with uncontrolled type 2 diabetes mellitus (DM) (glycated haemoglobin 11%) had the unusual symptoms of palpitations and sweating after drinking an excessive amount of soft drinks. Three-hour data in the 75-g oral glucose tolerance test (75g-OGTT) repeatedly showed normoinsulinaemic hypoglycaemia. His diabetic disorder was based on a delayed insulin secretory response to hyperglycaemia and daily excessive intake of glucose from a high caloric diet and soft drinks. However, we paradoxically observed increased insulin sensitivity evaluated by a hyperinsulinaemic-euglycaemic clamp (glucose infusion rate: 64.83 ?mol/kg/min). We considered that insulin supersensitivity might be involved in the pathogenic mechanisms of his clinical normoinsulinaemic hypoglycaemia. He was successfully treated by diet and exercise therapy without any hypoglycaemic medications or insulin. Assessment after the 75g-OGTT is useful for investigating the pathogenesis of DM. Insulin supersensitivity and normoinsulinaemic hypoglycaemia might play a role in clinical manifestation and pathogenesis of type 2 DM. PMID:24713709
Sugiyama, Seigo; Jinnouchi, Hideaki; Hieshima, Kunio; Jinnouchi, Tomio
Epigenetic processes are primary candidates when searching for mechanisms that can stably modulate gene expression and metabolic pathways according to early life conditions. To test the effects of gestational diabetes mellitus (GDM) on the epigenome of the next generation, cord blood and placenta tissue were obtained from 88 newborns of mothers with dietetically treated GDM, 98 with insulin-dependent GDM, and 65 without GDM. Bisulfite pyrosequencing was used to compare the methylation levels of seven imprinted genes involved in prenatal and postnatal growth, four genes involved in energy metabolism, one anti-inflammatory gene, one tumor suppressor gene, one pluripotency gene, and two repetitive DNA families. The maternally imprinted MEST gene, the nonimprinted glucocorticoid receptor NR3C1 gene, and interspersed ALU repeats showed significantly decreased methylation levels (4–7 percentage points for MEST, 1–2 for NR3C1, and one for ALUs) in both GDM groups, compared with controls, in both analyzed tissues. Significantly decreased blood MEST methylation (3 percentage points) also was observed in adults with morbid obesity compared with normal-weight controls. Our results support the idea that intrauterine exposure to GDM has long-lasting effects on the epigenome of the offspring. Specifically, epigenetic malprogramming of MEST may contribute to obesity predisposition throughout life.
El Hajj, Nady; Pliushch, Galyna; Schneider, Eberhard; Dittrich, Marcus; Muller, Tobias; Korenkov, Michael; Aretz, Melanie; Zechner, Ulrich; Lehnen, Harald; Haaf, Thomas
Gestational diabetes mellitus (GDM) is defined as a glucose intolerance of varying severity with onset or first recognition during pregnancy. The prevalence of GDM is growing rapidly worldwide, resulting in numerous and serious complications for both mother and foetus. Two major metabolic disorders, insulin resistance and ? cells dysfunction, are currently linked to the pathogenesis of GDM, although the cellular mechanisms involved in the development of GDM are not yet completely understood. Increasing evidence from clinical and experimental studies indicates that adipose tissue dysfunction, characterised by abnormal production of adipokines, is an essential factor linked to insulin resistance and GDM. To date, several adipose tissue-derived hormones have been identified, including leptin, adiponectin, resistin, visfatin, apelin, retinol-binding protein 4 (RBP-4), vaspin, and omentin. The relationship of leptin and adiponectin to insulin resistance in GDM is relatively well documented, but the molecular mechanisms by which these hormones affect insulin resistance are not yet fully known. The other aforementioned adipokines appear to be also important players in the pathophysiology of GDM, although their precise function in this complex process remains to be established. The aim of this article is to review the literature concerning the relationship between the above-mentioned adipokines and GDM, and to clarify their role in the pathophysiology of GDM. PMID:24802737
Wójcik, Marzena; Chmielewska-Kassassir, Ma?gorzata; Grzywnowicz, Karolina; Wo?niak, Lucyna; Cypryk, Katarzyna
The aim of our study was to evaluate serum amyloid A (SAA), an acute phase reactant, and carotid intima-media thickness (CIMT) as a valid predictor of atherosclerosis in women with gestational diabetes mellitus (GDM). Serum samples from 39 pregnant women with GDM and 25 healthy pregnant women were collected for the analysis of SAA. CIMT was measured in both groups to evaluate future atherosclerotic heart disease risk. The SAA level was measured with ELISA. The mean arterial blood pressure (MABP), CIMT and SAA levels were significantly higher in women with GDM compared with healthy pregnant controls (p = 0.033, p = 0.001 and p = 0.004, respectively). There were significant correlations between SAA and age, BMI, MABP, 50-g oral glucose tolerance test (OGTT), and A1c (p = 0.048, p = 0.037, p = 0.035, p = 0.042 and p = 0.048, respectively) and between CIMT and BMI, MABP, and 50-g OGTT, (p = 0.001, p = 0.004 and p < 0.001, respectively) in correlation analysis. Furthermore, there was a correlation between SAA and CIMT (p = 0.048). Increased SAA and CIMT values in GDM compared with healthy controls might indicate an increased risk of subclinical atherosclerosis and future atherosclerotic heart disease and the importance of inflammation in this process. These changes were associated with obesity, hypertension and glucose intolerance-related factors (BMI, MABP, and 50-g OGTT), which may be relevant to GDM pathophysiology. PMID:22827403
Eren, Mehmet Ali; Vural, Mehmet; Cece, Hasan; Camuzcuoglu, Hakan; Yildiz, Sema; Toy, Harun; Aksoy, Nurten
Objective To evaluate obesity and rate of weight change during the 5 years before pregnancy and risk of gestational diabetes mellitus (GDM) in a nested case-control study. Study Design GDM cases (n=251) and controls (n=204) were selected from a multiethnic cohort of 14,235 women who delivered a live birth between 1996 and 1998. Women who gained or lost weight were compared with those with a stable weight (± 1.0 kg/year). Results Women who gained weight at a rate of 1.1 to 2.2 kg/year had a small nonsignificant increased risk of GDM (odds ratio(OR): 1.63 [95% CI: 0.95-2.81]) and women who gained weight at a rate of 2.3 to 10.0 kg/year had 2.5 fold increased risk of GDM (OR: 2.61 [95% CI: 1.50-4.57]), compared to women with stable weight (after adjusting for age, race-ethnicity, parity and “baseline” body mass index). Conclusion: These results suggest that weight gain within five years before pregnancy may increase the risk of GDM.
Hedderson, Monique M.; Williams, Michelle A.; Holt, Victoria L.; Weiss, Noel S.; Ferrara, Assiamira
Changes in the quality and quantity of carbohydrate foods may compromise nutrient intake in women with gestational diabetes mellitus (GDM). We hypothesized that glycemic index, glycemic load (GL), carbohydrate intake, grains, and cereal product consumption would be associated with nutrient adequacy. Eighty-two women with GDM (61% of Asian background, 34% whites) completed a 3-day food record following their routine group nutrition education session. Nutrient intakes were compared to Nutrient Reference Values (NRV) for Australia and New Zealand. Nutrient intake across energy-adjusted tertiles of glycemic index, GL, carbohydrate intake, and intake of grains and cereal products were assessed. The majority of women (66%-99%) did not meet the NRV for fiber, folate, vitamin D, iodine, and iron, and exceeded NRV for saturated fat and sodium. Higher dietary GL was associated with lower intakes of total, monounsaturated, and polyunsaturated fat; vitamin E; and potassium (all P < .001). Higher grain intake was not significantly associated with intake of any micronutrients. In Australian women with GDM, high dietary GL predicts greater risk of poor nutrition. PMID:23602242
Louie, Jimmy Chun Yu; Markovic, Tania P; Ross, Glynis P; Foote, Deborah; Brand-Miller, Jennie C
Background To evaluate whether abnormal endothelial function, a common finding in gestational diabetes mellitus (GDM) pregnancies, can be explained by inflammatory cytokines. Methods Forearm skin blood flow (FSBF), into response to acetylcholine (Ach) (endothelium-dependent vasodilatation), were measured in 24 pregnant control subjects and 28 gestational diabetes mellitus (GDM) women, in the third trimester of gestation. A fasting glycemic and lipidic panel was obtained, and inflammatory cytokines (TNF-? and IL-6) and adiponectin were also determined. Results FSBF is significantly reduced in GDM group compared with control subjects (344.59 ± 57.791 vs.176.38 ± 108.52, P < 0.05). Among all subjects, FSBF showed a strong negative correlation with TNF-? and IL-6 (r = ?0.426, P < 0.0001 and r = ?0.564, P < 0.0001, respectively) and positive correlation with adiponectin (r = 0.468, P < 0.0001). Conclusions Endothelial function, an early marker of macrovascular disease, is present in non-obese pregnancies complicated by GDM. This alteration seems to be directly related to inflammatory status, which may represent a patho-physiological link between GDM and type 2 diabetes and, later on, metabolic syndrome.
To determine the risk factors of gestational diabetes mellitus in refugee populations in the Gaza Strip, a retrospective case-control study was performed between March and June 2011 in the United Nations Relief and Works Agency (UNRWA) primary health care clinics. Data were collected on maternal sociodemographics and the prevalence of diagnosed GDM according to World Health Organization criteria from clinics where postnatal Palestinian refugee women had been diagnosed with GDM during previous pregnancies, and non-GDM women were used as controls. Sociodemographic characteristics, pre-pregnancy body-mass index (BMI), obstetrics history and family history of diabetes were used as study variables. In total, 189 incident cases of GDM were identified. The most significant risk factors for GDM were: history of miscarriage more than once; overweight before pregnancy; history of stillbirth; history of caesarean birth; and positive family history of diabetes mellitus. PMID:24995734
AlKasseh, A S M; Zaki, N M; Aljeesh, Y I; Soon, L K
Background Individuals in conflict-affected areas rarely get appropriate care for chronic or non-infectious diseases. The prevalence of gestational diabetes mellitus (GDM) is increasing worldwide, and new evidence shows conclusively that the negative effects of hyperglycemia occur even at mild glucose elevations and that these negative effects can be attenuated by treatment. Scientific literature on gestational diabetes in refugee camp settings is critically limited. Methods A 75 g 2-hour glucose tolerance test was administered to 228 women attending the antenatal care (ANC) clinic in Maela refugee camp on the Thai–Myanmar border. Prevalence of GDM was determined using the HAPO trial cut-offs [?92 mg/dL (fasting),?180 (1 hour), and?153 (2 hour)] and the WHO criteria [?126 mg/dL (fasting), and 140 mg/dL (2 hour)]. Results From July 2011 to March 2012, the prevalence of GDM was 10.1% [95% confidence interval (CI): 6.2–14.0] when the cut-off determined by the HAPO trial was applied. Applying the older WHO criteria yielded a prevalence of 6.6% (95% CI 3.3–9.8). Age, parity, and BMI emerged as characteristics that may be significantly associated with GDM in this population. Other risk factors that are commonly used in screening guidelines were not applicable in this diabetes-naïve population. Discussion The prevalence of GDM is lower in this population compared with other populations, but still complicates 10% of pregnancies. New evidence regarding gestational diabetes raises new dilemmas for healthcare providers in resource-poor settings. Efforts to identify and treat patients at risk for adverse outcomes need to be balanced with awareness of the risks and burdens associated with over diagnosis and unnecessary interventions. Screening approaches based on risk factors or using higher cut-off values may help minimize this burden and identify those most likely to benefit from intervention.
Gilder, Mary Ellen; Zin, Thet Wai; Wai, Nan San; Ner, Ma; Say, Paw Si; Htoo, Myint; Say, Say; Htay, Win Win; Simpson, Julie A.; Pukrittayakamee, Sasithon; Nosten, Francois; McGready, Rose
Obesity and gestational diabetes mellitus (GDM) are increasing worldwide and may compromise female sexual function. We hypothesize that among GDM patients in the third trimester of pregnancy, those with excess body fat would have worse female sexual function scores than normal weight women. Our aim was to assess the sexual function of overweight compared to normal weight women with GDM. This was a cross-sectional survey involving 143 Brazilian women with GDM in the third trimester of pregnancy: 76 were overweight (pre-pregnancy body mass index-BMI?25.0 Kg/m2) and 67 were normal weight (BMI 18.5–24.9 Kg/m2). Participants were recruited from March 2010 to April 2013 at the antenatal clinic of a single public tertiary teaching institution. The Female Sexual Function Index (FSFI) questionnaire was used to assess sexual function. Overall, 51.7% of the 143 participants were at risk for sexual dysfunction symptoms (FSFI scores ?26); this rate was significantly higher among overweight compared to normal weight women (60.5% versus 41.8%, p?=?0.038). Mean total FSFI scores were significantly lower in overweight compared to normal weight women (21.7±9.2 versus 24.9±8.0, p?=?0.029). Compared to normal weight women, overweight participants had lower mean scores in desire (3.4±1.2 versus 4.0±1.4, p?=?0.007) and lubrication (3.8±2.0 versus 4.5±1.6, p?=?0.023). According to these results, overweight women with GDM in the third trimester of pregnancy have lower female sexual function scores than normal weight women with the same disorder.
Ribeiro, Meireluci Costa; Nakamura, Mary Uchiyama; Torloni, Maria Regina; Scanavino, Marco de Tubino; Scomparini, Flavia Burin; Mattar, Rosiane
Background: Fatty acids play a vital role in glucose homeostasis; however, studies on habitual dietary fat intakes and gestational diabetes mellitus (GDM) risk are limited and provide conflicting findings. Objective: We determined whether the total amount and the type and source of prepregnancy dietary fats are related to risk of GDM. Design: A prospective study was conducted in 13,475 women who reported a singleton pregnancy between 1991 and 2001 in the Nurses’ Health Study II. In these women, 860 incident GDM cases were reported. The adjusted RR of GDM was estimated for quintiles of total fat, specific fat, and the source of fat intakes by pooled logistic regression. Results: Higher animal fat and cholesterol intakes were significantly associated with increased GDM risk. Across increasing quintiles of animal fat, RRs (95% CIs) for GDM were 1.00 (reference), 1.55 (1.20, 1.98), 1.43 (1.09, 1.88), 1.40 (1.04, 1.89), and 1.88 (1.36, 2.60) (P-trend = 0.05). Corresponding RRs (95% CIs) for dietary cholesterol were 1.00 (reference), 1.08 (0.84, 1.32), 1.02 (0.78, 1.29), 1.20 (0.93, 1.55), and 1.45 (1.11, 1.89) (P-trend = 0.04). The substitution of 5% of energy from animal fat for an equal percentage of energy from carbohydrates was associated with significantly increased risk of GDM [RR (95% CI): 1.13 (1.08, 1.18); P < 0.0001]. No significant associations were observed between dietary polyunsaturated fat, monounsaturated fat, or trans fat intakes and GDM risk. Conclusion: Higher prepregnancy intakes of animal fat and cholesterol were associated with elevated GDM risk.
Bowers, Katherine; Tobias, Deirdre K; Yeung, Edwina; Hu, Frank B
Although vaspin is regarded an insulin-sensitizing adipokine, its role in gestational diabetes mellitus (GDM) is currently unknown. We aimed to evaluate serum vaspin levels and their correlation with insulin resistance in women with and without GDM. Forty-four women with GDM [GDM Group - 20 managed with diet only (GDM-diet) and 24 with diet plus insulin (GDM-insulin)] and 44 age-matched pregnant women with normal glucose tolerance (Control Group) were studied. Serum glucose, lipids, uric acid, insulin and vaspin were measured at the 2nd and 3rd trimester of pregnancy and postpartum. The quantitative insulin sensitivity check index (QUICKI) and homeostasis model of assessment-insulin resistance (HOMA-IR) were calculated. Circulating vaspin levels decreased significantly postpartum in all groups (p<0.001), but did not differ between GDM or GDM Subgroups and Control Group in any time point. At the 3rd trimester of pregnancy vaspin was positively correlated to insulin (p=0.022), HOMA-IR (p=0.016) and triglycerides (p=0.033) and negatively correlated to QUICKI (p=0.016) in the GDM women, but not in the Controls. These correlations were not observed at the 2nd trimester or postpartum. Vaspin, in contrast to HOMA-IR, could not independently predict GDM in binary logistic regression. In patients with GDM, insulin treatment did not affect vaspin levels. In conclusion, our data suggest that vaspin levels gradually decrease from the 2nd trimester to postpartum; however, decreases are similar between women with or without GDM. Serum vaspin cannot independently predict GDM and it is not affected by the degree of glucose metabolism deregulation or the exogenous administration of insulin. PMID:23041430
Gkiomisi, Athina; Makedou, Kali G; Anastasilakis, Athanasios D; Polyzos, Stergios A; Kourtis, Anargyros; Gerou, Spyridon; Gavana, Elpida; Dagklis, Themistoklis; Rousso, David; Giannoulis, Charalambos
Universal screening for gestational diabetes mellitus (GDM) is advocated in Indian women as they have the highest frequency of GDM, among South Asian population. For this the diagnostic procedure has to be simple, economical and evidence based. Hence, this study was undertaken to compare the point-of-care measuring capillary blood glucose (CBG) by glucometer and venous plasma glucose (VPG) estimated in the laboratory and to suggest the feasible diagnostic tool. Consecutive pregnant women in the third trimester were included in this study with the approval of the institutional ethical committee. They were given 75 g oral glucose in the fasting state. After 2 hours, CBG was measured by finger-prick using one touch select simple glucometer and venous blood was drawn to estimate VPG in the laboratory by GOD- POD method. The diagnosis of GDM was based on 2 hours plasma glucose > or = 7.8 mmol/l. Among a cohort of 500 pregnant women, 32 (6.4%) were diagnosed as GDM in their first visit. The CBG value at 2 hours plasma glucose > or = 7.8 mmol/l had a sensitivity of 93.8% and specificity of 97.4% with a false positive and false negative of 2.6% and 6.2%, respectively. The area under the receiver operating characteristic curve of CBG was 0.993. CBG value at 2 hours plasma glucose > or = 7.8 mmol/l may be recommended for the diagnosis of GDM in healthcare centres where laboratory technology is not available. PMID:23360023
Balaji, Vijayam; Balaji, Madhuri S; Paneerselvam, Arunachalam; Thiyagarajah, Arthi; Seshiah, Veerasamy
Maternal peripheral insulin resistance and increased inflammation are two features of pregnancies, complicated by gestational diabetes mellitus (GDM). The nucleotide-binding oligomerisation domain (NOD) intracellular molecules recognise a wide range of microbial products, as well as other intracellular danger signals, thereby initiating inflammation through activation of nuclear factor ?B (NF?B). The aim of this study was to determine whether levels of NOD1 and NOD2 are increased in adipose tissue of women with GDM. The effect of NOD1 and NOD2 activation on inflammation and the insulin signalling pathway was also assessed. NOD1, but not NOD2, expression was higher in omental and subcutaneous adipose tissues obtained from women with GDM when compared with those from women with normal glucose tolerance (NGT). In both omental and subcutaneous adipose tissues from NGT and GDM women, the NOD1 ligand g-d-glutamyl-meso-diaminopimelic acid (iE-DAP) significantly induced the expression and secretion of the pro-inflammatory cytokine interleukin 6 (IL6) and chemokine IL8; COX2 (PTGS2) gene expression and subsequent prostaglandin production; the expression and secretion of the extracellular matrix remodelling enzyme matrix metalloproteinase 9 (MMP9) and the gene expression and secretion of the adhesion molecules ICAM1 and VCAM1. There was no effect of the NOD2 ligand muramyl dipeptide on any of the endpoints tested. The effects of the NOD1 ligand iE-DAP were mediated via NF?B, as the NF?B inhibitor BAY 11-7082 significantly attenuated iE-DAP-induced expression and secretion of pro-inflammatory cytokines, COX2 gene expression and subsequent prostaglandin production, MMP9 expression and secretion and ICAM1 and VCAM1 gene expression and secretion. In conclusion, the present findings describe an important role for NOD1 in the development of insulin resistance and inflammation in pregnancies complicated by GDM. PMID:24829218
Background Gestational diabetes mellitus (GDM) is a common pregnancy condition. In this study, the risk of having a history of previous GDM (pGDM) on serum homocysteine level was assessed Methods Biomedical parameters, serum homocysteine, Insulin, homeostatic model assessment (HOMA) in women with (n?=?52) and without pGDM (n?=?51) were assessed. According to their current status of Oral Glucose Tolerance Test (GTT), the participants in each group were divided into two subgroups of normal or impaired GTT. Results Mean serum homocysteine in normal women was 8.56?±?3.19 vs 11.44?±?7.34 ?mol/L (p?0.01) in women with pGDM. Two groups had significant differences in respect to serum insulin levels (8.35?±?5.12 vs 12.48?±?5.44, p?0.002), and HOMA-IR (1.90?±?1.30 vs 2.91?±?1.30, p?0.002). In women without pGDM, serum homocysteine in normal and impaired GTT were 7.60?±?1.69 and 10.52?±?3.65 ?mol/L (p?=?0.03), respectively, while in women with pGDM, the figures were 8.38?±?2.52 and 14.00?±?10.17 (p?0.01), respectively. In multi regression analysis an association between history of GDM and homocysteine levels was presented (OR: 7.71, 95% CI: 1.67-35.42, p?0.001). Conclusion A trend of elevation of homocysteine is presented in women with pGDM, that is more prominent in women with impaired GTT, and shows a significant correlation with history of GDM. Further studies with larger sample size are suggested.
Objectives. To evaluate pregnancy outcomes and its determinants in women with polycystic ovary syndrome (PCOS). Methods. Two-hundred and twenty pregnant PCOS and 594 healthy women were followed from early pregnancy. Incidences of gestational diabetes mellitus (GDM), pregnancy-induced hypertension (PIH), preterm birth, twinning, and fetal growth restriction (FGR) were determined. Results. The incidence of GDM was notably higher among all PCOS combined (54.9%; OR: 2.9, 95% CI: 2.0–4.1) and PCOS subgroups, whether they conceived spontaneously (51.5%; OR: 3.3, 95% CI: 2.0–5.4), or via IVF-ET or ovarian stimulation, compared with controls (14.3%; P < 0.001). The incidence of PIH was also higher among all PCOS (10.4%; OR: 2.2, 95% CI: 1.1–4.4) and the subgroup conceiving spontaneously (11.8%; OR: 2.6, 95% CI: 1.1–6.2; P < 0.001) but not for those conceiving with IVF-ET (9.1%) or ovarian stimulation (9.4%). Lean women with PCOS (BMI <24 kg/m2) had higher incidences of GDM (51.1% versus 14.5%; OR: 5.6, 95% CI: 3.4–9.0) and PIH (8.9% versus 3.2%; OR: 3.0, 95% CI: 1.3–7.1) than lean controls. PCOS woemn with normal glucose tolerance had higher risk for PIH than their comparable control group (OR: 4.0, 95% CI: 1.3–11.7). Conclusion. This study suggested that PCOS is an independent risk factor for the development of GDM and PIH. This trial is registered with ChiCTR-RCC-11001824.
Wang, Yunhui; Zhao, Huidan; Ding, Hong; Tan, Jianping; Chen, Jingte; Zhang, Rui; Azziz, Ricardo; Yang, Dongzi
Influxes of migrant women of childbearing age to receiving countries have made their perinatal health status a key priority for many governments. The international research collaboration Reproductive Outcomes And Migration (ROAM) reviewed published studies to assess whether migrants in countries of resettlement have a greater risk of gestational diabetes mellitus (GDM) than women in receiving countries. A systematic review of the literature from Medline, Embase, PsychInfo and CINAHL from 1990 to 2009 included studies of migrant women and GDM. Studies were excluded if there was no cross-border movement or comparison group or if the receiving country was not the country of resettlement. Studies were assessed for quality, analysed descriptively and meta-analysed. Twenty-four reports (representing >120,000 migrants) met our inclusion criteria. Migrants were described primarily by geographic origin; other relevant aspects (e.g. time in country, language fluency) were rarely studied. Migrants' results for GDM were worse than those for receiving-country women in 79% of all studies. Meta-analyses showed that, compared with receiving-country women, Caribbean, African, European and Northern European women were at greater risk of GDM, while North Africans and North Americans had risks similar to receiving-country women. Although results of the 31 comparisons of Asians, East Africans or non-Australian Oceanians were too heterogeneous to provide a single GDM risk estimate for migrant women, only one comparison was below the receiving-country comparison group, all others presented a higher risk estimate. The majority of women migrants to resettlement countries are at greater risk for GDM than women resident in receiving countries. Research using clear, specific migrant definitions, adjusting for relevant risk factors and including other aspects of migration experiences is needed to confirm and understand these findings. PMID:21980947
Gagnon, Anita J; McDermott, Sarah; Rigol-Chachamovich, Juliana; Bandyopadhyay, Mridula; Stray-Pedersen, Babill; Stewart, Donna
Physiological changes during normal pregnancy are characterized by an inflammatory immune response and insulin resistance. Therefore, we hypothesize that gestational diabetes mellitus (GDM) may be caused by an inappropriate adaption of the maternal immune system to pregnancy. In this study we examined the role of regulatory T cell (Treg ) differentiation for the development of GDM during pregnancy. We used six-colour flow cytometric analysis to demonstrate that the total CD4(+) CD127(low+/-) CD25(+) forkhead box protein 3 (FoxP3(+) ) Treg pool consists of four different Treg subsets: naive CD45RA(+) Tregs , HLA-DR(-) CD45RA(-) memory Tregs (DR(-) Tregs ) and the highly differentiated and activated HLA-DR(low+) CD45RA(-) and HLA-DR(high+) CD45RA(-) memory Tregs (DR(low+) and DR(high+) Tregs ). Compared to healthy pregnancies, the percentage of CD4(+) CD127(low+/-) CD25(+) FoxP3(+) Tregs within the total CD4(+) T helper cell pool was not different in patients affected by GDM. However, the suppressive activity of the total CD4(+) CD127(low+/-) CD25(+) Treg pool was significantly reduced in GDM patients. The composition of the total Treg pool changed in the way that its percentage of naive CD45RA(+) Tregs was decreased significantly in both patients with dietary-adjusted GDM and patients with insulin-dependent GDM. In contrast, the percentage of DR(-) -memory Tregs was increased significantly in patients with dietary-adjusted GDM, while the percentage of DR(low+) and DR(high+) memory Tregs was increased significantly in patients with insulin-dependent GDM. Hence, our findings propose that alterations in homeostatic parameters related to the development and function of naive and memory Tregs may cause the reduction of the suppressive capacity of the total Treg pool in GDM patients. However, as this is an exploratory analysis, the results are only suggestive and require further validation. PMID:24547967
Schober, L; Radnai, D; Spratte, J; Kisielewicz, A; Schmitt, E; Mahnke, K; Fluhr, H; Uhlmann, L; Sohn, C; Steinborn, A
Background: Gestational diabetes mellitus (GDM) is a metabolic disorder defined as glucose intolerance with the onset or first recognition during pregnancy. Women with GDM are at increased risk for adverse obstetric and perinatal outcome. The complications associated with GDM can be prevented by early recognition, intense monitoring and proper treatment. Aims: The present study was done to screen the high-risk pregnancy group for GDM, to find the incidence of abnormal results on screening and to correlate the abnormal results with the maternal and fetal outcomes. The study was done in a tertiary care hospital and teaching institute. It was a prospective cohort study. Materials and Methods: Selective screening for GDM was done in 150 pregnant women with high-risk factors. Screening was done with 50 g glucose challenge test (GCT) after 18 weeks, and if GCT was negative then the test was repeated after 28 weeks of pregnancy. The patients who were having an abnormal GCT were subjected to 100 g oral glucose tolerance test (OGTT). All GDM patients were followed up and treated with diet and/or insulin therapy till delivery to know maternal and fetal outcomes. The period of study was from April 2008 to March 2009. Results: 7.3% of study population was OGCT positive. 6% of the study population was OGTT positive. Age >25 years, obesity, family history of DM, and past history of GDM were the risk factors significantly associated with GDM. One newborn had hypoglycemia and one had hyperbilirubinemia. The fetal and maternal outcome in GDM patients was good in our study due to early diagnosis and intervention. Conclusion: Women with GDM are at an increased risk for adverse obstetric and perinatal outcome. The increased morbidity in GDM is preventable by meticulous antenatal care.
Nilofer, Angadi Rajasab; Raju, V. S.; Dakshayini, B. R.; Zaki, Syed Ahmed
Background Obesity and gestational diabetes (GDM) in pregnancy are recognized risk factors for adverse outcomes, including cesarean section (CS), macrosomia and preeclampsia. The aim of this study was to investigate the independent effect of GDM and obesity on the adverse pregnancy outcomes at term. Methods A retrospective cohort of postpartum women, in King Khalid University Hospital, were stratified according to body mass index (obese ?30 kg/m2, non-obese <30 kg/m2) and the results of GDM screening into the following groups, women with no obesity and no GDM (reference group), women with no obesity but with GDM, women with obesity but no GDM and women with both GDM and obesity. Adverse pregnancy outcomes included high birth weight, macrosomia, CS delivery and preeclampsia. Multiple logistic regression used to examine independent associations of GDM and obesity with macrosomia and CS. Results 2701 women were included, 44% of them were obese and 15% had GDM. 63% of the women with GDM were obese. There was significant increase in the percentage of macrosomia, P?0.001, high birth weight, P?0.001, CS, P?0.001 and preeclampsia, P?0.001 in women with GDM and obesity compared to the reference group. Obesity increased the estimated risk of CS delivery, odds ratio (OR) 2.16, confidence intervals (CI) 1.74-2.67. The combination of GDM and obesity increased the risk of macrosomia OR 3.45, CI 2.05-5.81 and the risk of CS delivery OR 2.26, CI 1.65-3.11. Conclusion Maternal obesity and GDM were independently associated with adverse pregnancy outcomes. The combination of both conditions further increase the risk.
OBJECTIVE This study addressed the hypothesis that placental endothelial lipase (EL) expression is affected by pregnancies complicated by obesity and gestational diabetes mellitus (GDM). RESEARCH DESIGN AND METHODS EL expression in placental tissues from pregnancies complicated by obesity, GDM, or obesity combined with GDM (obese-GDM) was analyzed by quantitative RT-PCR. Moreover, primary placental cells were isolated and treated with insulin, glucose, leptin, or tumor necrosis factor (TNF)-?, and EL expression was measured. Inhibitors of nuclear factor (NF)-?B or mitogen-activated protein kinase (MAPK) signaling were used to detect potential pathways of EL regulation in primary placental endothelial cells (ECs). RESULTS In placentas from obese-GDM pregnancies, EL expression was upregulated by 1.9-fold (P < 0.05) compared with lean pregnancies, whereas obesity or GDM alone had no significant effect. Analyses of metabolic parameters in maternal venous and umbilical venous plasma revealed significantly increased insulin and leptin as well as slightly increased glucose and TNF-? values in the obese and obese-GDM groups. Cell culture experiments identified TNF-? and leptin, but not glucose or insulin, as regulators of EL expression in ECs. Induction of EL expression by these mediators occurred in a para/endocrine manner, since only leptin and TNF-? receptors, but not the cytokines themselves, were expressed in ECs. Inhibitor experiments suggested that TNF-? and leptin-mediated upregulation of EL may occur via two different routes. Whereas TNF-? induced EL upregulation in ECs by activation of the NF-?B pathway, leptin did not stimulate NF-?B or MAPK signaling pathways in these cells. CONCLUSIONS Metabolic inflammation with high leptin and locally increased TNF-? concentrations at the fetal-placental interface regulates placental EL expression.
Gauster, Martin; Hiden, Ursula; van Poppel, Mireille; Frank, Sasa; Wadsack, Christian; Hauguel-de Mouzon, Sylvie; Desoye, Gernot
The aim of the study is to evaluate the association between gestational diabetes mellitus (GDM) and maternal obesity and weight gain during pregnancy. A prospective cohort study screened 614 consecutive gravid patients for GDM using 50?g glucose challenge test (GCT). The pregnant women were divided into 4 groups according to their prepregnancy body mass index (BMI). Group I, II, III and IV constituted when the BMI < 18.5?kg/m² (n = 16), 18.5-24.9?kg/m² (n = 455), 25-29.9?kg/m² (n = 122), and >30?kg/m² (n = 21) respectively. All the pregnant women were also evaluated in terms of their weight gain during pregnancy and these cases were recruited in 3 groups as low, ideal and high weight gain groups. Overall, a positive 50?g GCT result was identified in 106/614 (17.8%) women. GDM was further diagnosed in 12/614 (1.95%) of subjects. The prevalence of GDM in Group II, III and IV was 1.31%, 3.28% and 9.52% respectively (p < 0.05). The cases of Group II in first and second trimester and Group III only in second trimester showed statistically significant positive results of 50?g GCT when they had excess weight gain compared to the ones whose weight gain were in normal range. Women planning pregnancy should be educated about the disadvantages of obesity, being over-weight and should be advised to have an ideal prepregnancy BMI and ideal weight gain during pregnancy. PMID:23110595
Baci, Yelda; Üstüner, I??k; Keskin, Hüseyin Levent; Ersoy, Reyhan; Av?ar, Ay?e Filiz
Although a significantly higher level of plasma galanin was found in patients with gestational diabetes mellitus (GDM) in our previous study, it is unknown whether plasma galanin is biomarker for the prediction of GDM. The present study aims to further evaluate the relationship between endogenous galanin and GDM in pregnant women and to find out the precise mechanism by which galanin plays role in the pathogenesis of GDM. The study registered thirty pregnant women with GDM and thirty pregnant women with normal glucose tolerance (NGT). Demographic and biochemical parameters and fasting venous blood samples of two groups were collected from all cases. Galanin was analyzed by an enzyme-linked immunosorbent assay. Gamma-glutamyl transferase (GGT) was measured by enzymatic methods. The plasma galanin and GGT levels were found higher in GDM compared with NGT (P<0.001). In addition, a significant positive correlation was shown between galanin and fasting glucose (P=0.049), 1-h glucose (P=0.033), body mass index (BMI) (P<0.001) and GGT (P=0.048) in pregnant women with GDM, whereas there was significant positive correlation between galanin and BMI (P=0.030) in NGT group. The plasma galanin and GGT levels are higher in patients with GDM. The plasma galanin levels appear to be related to the changes of blood glucose, BMI and GTT in GDM. The higher level of galanin observed in GDM may represent a adaptation to the rise of glucose, weight, GGT associated with GDM. The higher level of plasma galanin is a novel biomarker for the prediction of GDM. PMID:24503374
Zhang, Zhenwen; Gu, Chunmei; Fang, Penghua; Shi, Mingyi; Wang, Yan; Peng, Yan; Bo, Ping; Zhu, Yan
Background\\/Aims: To evaluate the incidence of placental abnormalities, cord plasma erythropoietin (EPO) levels and nucleated red blood cell (NRBC) counts, maternal and cord plasma malondialdehyde (MDA) and vascular endothelial growth factor (VEGF) levels in women with gestational diabetes mellitus (GDM) and nondiabetic controls. Methods: Twenty-two women with GDM, diagnosed according to the current criteria of the American Diabetes Association, were
Abdullah Tuten; Zerrin Calay; Hafize Uzun; Seyfettin Uludag; Vildan Ocak
Aim The efficacy and safety of insulin degludec (IDeg), a new basal insulin with an ultra-long duration of action, was compared to sitagliptin (Sita) in a 26-week, open-label trial. Methods Insulin-naïve subjects with type 2 diabetes [n = 458, age: 56 years, diabetes duration: 7.7 years, glycosylated haemoglobin (HbA1c):8.9% (74 mmol/mol)] were randomized (1:1) to once-daily IDeg or Sita (100 mg orally) as add-on to stable treatment with 1 or 2 oral antidiabetic drugs (OADs). Results Superiority of IDeg to Sita in improving HbA1c and fasting plasma glucose (FPG) was confirmed [estimated treatment difference (ETD) IDeg–Sita for HbA1c: ?0.43%-points [95% confidence interval (CI): ?0.61; ?0.24, p < 0.0001] and for FPG: ?2.17 mmol/l (95% CI: ?2.59; ?1.74, p < 0.0001)]. HbA1c < 7% (<53 mmol/mol) was achieved by 41% (IDeg) versus 28% (Sita) of patients, estimated odds ratio IDeg/Sita: 1.60 (95% CI: 1.04; 2.47, p = 0.034). There was no statistically significant difference in the rate of nocturnal confirmed hypoglycaemia between IDeg and Sita [0.52 vs. 0.30 episodes/patient-year, estimated rate ratio (ERR): IDeg/Sita: 1.93 (95% CI: 0.90; 4.10, p = 0.09)]. Rates of overall confirmed hypoglycaemia were higher with IDeg than with Sita [3.1 vs. 1.3 episodes/patient-year, ERR IDeg/Sita: 3.81 (95% CI: 2.40; 6.05, p < 0.0001)]. IDeg was associated with a greater change in body weight than Sita [ETD IDeg–Sita: 2.75 kg (95% CI: 1.97; 3.54, p < 0.0001)]. The overall rates of adverse events were low and similar for both groups. Conclusions In patients unable to achieve good glycaemic control on OAD(s), treatment intensification with IDeg offers an effective, well-tolerated alternative to the addition of a second or third OAD.
Philis-Tsimikas, A; Del Prato, S; Satman, I; Bhargava, A; Dharmalingam, M; Skj?th, T V; Rasmussen, S; Garber, A J
Background Pre-gestational diabetes mellitus is associated with increased risk for maternal and fetal adverse outcomes. This systematic review was carried out to evaluate the effectiveness and safety of pre-pregnancy care in improving the rate of congenital malformations and perinatal mortality for women with pre-gestational diabetes mellitus. Methods We searched the following databases, MEDLINE, EMBASE, WEB OF SCIENCE, Cochrane Library, including the CENTRAL register of controlled trials and CINHAL up to December 2011, without language restriction, for any pre-pregnancy care aiming at health promotion, glycemic control and screening and treatment of diabetes complications in women with type I or type II diabetes mellitus. Study design were trials (randomized and non-randomized), cohort and case–control studies. Results Of the 2452 title scanned 54 full papers were retrieved of those 21 studies were included in this review. Twelve cohort studies at low and medium risk of bias, with 3088 women, were included in the meta-analysis. Meta-analysis suggested that pre-pregnancy care is effective in reducing congenital malformation, Risk Ratio (RR) 0.25 (95% CI 0.16-0.37), number needed to treat (NNT) 19 (95% CI 14–24), and perinatal mortality RR 0.34 (95% CI 0.15-0.75), NNT?=?46 (95% CI 28–115). Pre-pregnancy care lowers glycosylated hemoglobin A1c (HbA1c) in the first trimester of pregnancy by an average of 1.92% (95% CI ?2.05 to ?1.79). However women who received pre-pregnancy care were at increased risk of hypoglycemia during the first trimester of pregnancy RR 1.51 (95% CI 1.15-1.99). Conclusion Pre-pregnancy care for women with pre-gestational type 1 or type 2 diabetes mellitus is effective in improving rates of congenital malformations, perinatal mortality and in reducing maternal HbA1C in the first trimester of pregnancy. Pre-pregnancy care might cause maternal hypoglycemia in the first trimester of pregnancy.
Insulin receptor binding was examined in the microvillous membranes of mid-term (20–22 weeks of gestation, MT) and full-term (FT) placentas from patients with gestational diabetes mellitus (GDM) and in normal pregnant control (N). Mid-term placentas were obtained from patients who have had spontaneous abortion. The maximum per cent specific binding (%SB) in MT placenta for GDM was significantly lower (4.8%)
Omar S. Al-Attas
The aim of this study was to compare pregnancy outcomes of Chinese women diagnosed with gestational hyperglycaemia by the well-established American Diabetes Association (ADA) criteria, with those women meeting the newer criteria established by International Association of Diabetes and Pregnancy Study Groups (IADPSG). The study subjects consisted of 6,201 pregnant Chinese women with a singleton pregnancy who had received prenatal care and delivered between December 2008 and December 2011. Women who were screened positive with 1 h glucose load of ? 7.8 mmol/l underwent a diagnostic 3 h oral glucose tolerance test. Gestational hyperglycaemia was diagnosed using the ADA criteria and re-diagnosed according to the IADPSG criteria. The correlation between the incidences of adverse pregnant outcomes with gestational hyperglycaemia was analysed. In total, 570 patients (9.19% of 6,201) met the ADA criteria and 676 (10.90% of 6,201) met the IADPSG criteria. The 518 patients who met both standards showed a reduced caesarean section rate, as compared with 158 patients who only met the IADPSG standard and received no intervention (71.2% vs 79.7%, p < 0.05). The IADPSG-only group also had a higher rate of macrosomia and pre-eclampsia than the control group. The IADPSG criteria identified a group of women previously classified as normal according to the ADA criteria, but revealing poor pregnancy outcomes and requiring management. Therefore, we conclude that the IADPSG criteria are more suitable for the diagnosis of gestational hyperglycaemia in China. PMID:24456434
Shang, M; Lin, L; Ma, L; Yin, L
Women with gestational diabetes mellitus (GDM) have a substantial risk of subsequently developing type 2 diabetes. This risk may be mitigated by engaging in healthy eating, physical activity, and weight loss when indicated. Since postpartum depressive symptoms may impair a woman's ability to engage in lifestyle changes, we sought to identify factors associated with depressive symptoms in the early postpartum period among women with recent GDM. The participants are part of the baseline cohort of the TEAM GDM (Taking Early Action for Mothers with Gestational Diabetes Mellitus) study, a one-year randomized trial of a lifestyle intervention program for women with a recent history of GDM, conducted in Boston, Massachusetts between June 2010 and September 2012. We administered the Edinburgh Postnatal Depression Scale (EPDS) at 4-15 weeks postpartum to women whose most recent pregnancy was complicated by GDM (confirmed by laboratory data or medical record review). An EPDS score ?9 indicated depressive symptoms. We measured height and thyroid stimulating hormone, and administered a questionnaire to collect demographic data and information about breastfeeding and sleep. We calculated body mass index (BMI) using self-reported pre-pregnancy weight and measured height. We reviewed medical records to obtain data about medical history, including history of depression, mode of delivery, and insulin use during pregnancy. We conducted bivariable analyses to identify correlates of postpartum depressive symptoms, and then modeled the odds of postpartum depressive symptoms using multivariable logistic regression. Our study included 71 women (mean age 33 years ± 5; 59 % White, 28 % African-American, 13 % Asian, with 21 % identifying as Hispanic; mean pre-pregnancy BMI 30 kg/m(2) ± 6). Thirty-four percent of the women scored ?9 on the EPDS at the postpartum visit. In the best fit model, factors associated with depressive symptoms at 6 weeks postpartum included cesarean delivery (aOR 4.32, 95 % CI 1.46, 13.99) and gestational weight gain (aOR 1.21 [1.02, 1.46], for each additional 5 lbs gained). Use of insulin during pregnancy, breastfeeding, personal history of depression, and lack of a partner were not retained in the model. Identifying factors associated with postpartum depression in women with GDM is important since depression may interfere with lifestyle change efforts in the postpartum period. In this study, cesarean delivery and greater gestational weight gain were correlated with postpartum depressive symptoms among women with recent GDM (Clinicaltrials.gov NCT01158131). PMID:23124798
Nicklas, Jacinda M; Miller, Laura J; Zera, Chloe A; Davis, Roger B; Levkoff, Sue E; Seely, Ellen W
Gestational diabetes is a global epidemic where many urban areas in Southeast Asia have found prevalence rates as high as 20%, exceeding the highest prevalence rates in the developed world. It can have serious and life-threatening consequences for mothers and babies. We are developing two variants of a new, simple, low-cost rapid test for screening for gestational diabetes mellitus for use primarily in low-resource settings. The pair of assays, both semiquantitative rapid diagnostic strip tests for glycated albumin, require neither fasting nor an oral glucose challenge test. One variant is an extremely simple strip test to estimate the level of total glycated albumin in blood. The other, which is slightly more complex and expensive, is a test that determines the ratio of glycated albumin to total albumin. The screening results can be used to refer women to receive additional care during delivery to avoid birth complications as well as counseling on diet and exercise during and after pregnancy. Results with the latter test may also be used to start treatment with glucose-lowering drugs. Both assays will be read visually. We present initial results of a preliminary cost-performance comparison model evaluating the proposed test versus existing alternatives. We also evaluated user needs and schematic paper microfluidics-based designs aimed at overcoming the challenge of visualizing relatively narrow differences between normal and elevated levels of glycated albumin in blood.
Weigl, Bernhard H.; Zwisler, Greg; Peck, Roger; Abu-Haydar, Elizabeth
Gestational diabetes mellitus (GDM) is one of the most common complications in pregnancies. Evaluating other conditions, including intra uterine growth restriction and pre-eclampsia, some studies have shown significant changes in blood flow velocity of fetal middle cerebral artery (MCA). Our study is one of the few that has aimed to assess the effects of GDM on Doppler parameters of the fetal MCA and umbilical artery (UA) and to compare with normal pregnancies. This cross-sectional study was performed on 66 pregnant women, including 33 women with GDM and the others without it, in Akbar-Abadi University Hospital in Tehran, Iran during 2010-2011. Peak systolic and diastolic velocities, pulsatility index (PI), resistance index (RI) and systolic diastolic ratio (SD) were recorded in UA as well as both right and left fetal MCAs for every recruited pregnant women by means of Doppler ultrasonography. The mean gestational age at the time of examination was 34.45 (SD = 2.62) weeks in GDM group. Although all of the measured Doppler parameters had higher values in GDM pregnancies, the differences were not significant between two groups of study; except for the left fetal MCA-PI, which was significantly higher in GDM group [2.07 (SD = 0.07) vs. 1.85 (SD = 0.74), P = 0.03]. Our results show that gestational diabetes may contribute to an elevated PI in the fetal MCA. Although there is not yet strong proof for the effect of GDM on the fetal brain hemodynamics, the significant higher MCA-PI warrants more attention towards better controlling of the hyperglycemia during pregnancy. PMID:23797352
Shabani Zanjani, Mansoureh; Nasirzadeh, Roya; Fereshtehnejad, Seyed-Mohammad; Yoonesi Asl, Ladan; Alemzadeh, Seyed-Amir Pooya; Askari, Sareh
Abstract Objectives Women with a history of gestational diabetes mellitus (GDM) have an increased risk of developing type 2 diabetes (T2DM) but often do not return for follow-up care. We explored barriers to and facilitators of postpartum follow-up care in women with recent GDM. Methods We conducted 22 semistructured interviews, 13 in person and 9 by telephone, that were audiotaped and transcribed. Two investigators independently coded transcripts. We identified categories of themes and subthemes. Atlas.ti qualitative software (Berlin, Germany) was used to assist data analysis and management. Results Mean age was 31.5 years (standard deviation) [SD] 4.5), 63% were nonwhite, mean body mass index (BMI) was 25.9?kg/m2 (SD 6.2), and 82% attended a postpartum visit. We identified four general themes that illustrated barriers and six that illustrated facilitators to postpartum follow-up care. Feelings of emotional stress due to adjusting to a new baby and the fear of receiving a diabetes diagnosis at the visit were identified as key barriers; child care availability and desire for a checkup were among the key facilitators to care. Conclusions Women with recent GDM report multiple barriers and facilitators of postpartum follow-up care. Our results will inform the development of interventions to improve care for these women to reduce subsequent diabetes risk.
Ennen, Christopher S.; Carrese, Joseph A.; Hill-Briggs, Felicia; Levine, David M.; Nicholson, Wanda K.; Clark, Jeanne M.
Context Zinc-?2-Glycoprotein (ZAG) is an adipokine with lipolytic action and is positively associated with adiponectin in adipose tissue. We hypothesize that ZAG may be related with hydrocarbonate metabolism disturbances observed in gestational diabetes mellitus (GDM). Objective The aim of this study was to analyze serum ZAG concentration and its relationship with carbohydrate metabolism in pregnant women and its influence on fetal growth. Design 207 pregnant women (130 with normal glucose tolerance (NGT) and 77 with GDM) recruited in the early third trimester and their offspring were studied. Cord blood was obtained at delivery and neonatal anthropometry was assessed in the first 48 hours. ZAG was determined in maternal serum and cord blood. Results ZAG concentration was lower in cord blood than in maternal serum, but similar concentration was observed in NGT and GDM pregnant women. Also similar levels were found between offspring of NGT and GDM women. In the bivariate analysis, maternal ZAG (mZAG) was positively correlated with adiponectin and HDL cholesterol, and negatively correlated with insulin and triglyceride concentrations, and HOMA index. On the other hand, cord blood ZAG (cbZAG) was positively correlated with fat-free mass, birth weight and gestational age at delivery. After adjusting for confounding variables, gestational age at delivery and HDL cholesterol emerged as the sole determinants of cord blood ZAG and maternal ZAG concentrations, respectively. Conclusion mZAG was not associated with glucose metabolism during pregnancy. ZAG concentration was lower in cord blood compared with maternal serum. cbZAG was independently correlated with gestational age at delivery, suggesting a role during the accelerated fetal growth during latter pregnancy.
Naf, Silvia; Escote, Xavier; Yanez, Rosa Elena; Ballesteros, Monica; Simon, Inmaculada; Gil, Pilar
Recent epidemiological studies indicate bisphenol-A (BPA), an estrogenic chemical used in production of epoxy, polycarbonate and plastic may increase risk of insulin resistance and type 2 diabetes. Exposure to BPA during pregnancy may contribute to development of gestational diabetes mellitus (GDM), a precursor to type 2 diabetes in women. This pilot study examined the association between BPA exposure, fasting blood glucose levels (FBG) and GDM diagnosis during pregnancy. Banked urine samples from 22 cases of GDM and 72 controls were analyzed for total (free BPA + conjugates) urinary BPA concentrations (?g/L). FBG levels (mg/dl) were obtained from 1 h 50 g glucose tolerance tests (GTT) that women underwent for routine GDM screening (mean gestational age=26.6 weeks sd=3.8). Those with an initial screening value ?135 mg/dl underwent 3-hr 100 g oral GTT. GDM diagnoses were made when the initial screening value was ? 200 mg/dl or when values at ? 2 time points exceeded 3-hr oral GTT thresholds. Among controls, median FBG levels (mg/dL) did not differ across exposure tertiles, defined according to the distribution of total specific-gravity adjusted urinary BPA concentrations. Logistic regression models controlling for race/ethnicity did not provide evidence of association between BPA exposure and case status across increasing tertiles of BPA exposure (number of GDM cases/controls in tertile 1: 13/24, tertile 2: 6/24 tertile 3: 3/24).. Findings do not support a relationship between total urinary BPA concentrations and altered glucose metabolism during pregnancy. However, due to study limitations findings need to be interpreted with caution.
Robledo, Candace; Peck, Jennifer D.; Stoner, Julie A.; Carabin, Helene; Cowan, Linda; Koch, Holger M.; Goodman, Jean R.
Background: Gestational diabetes mellitus (GDM) is the most common metabolic disorder during pregnancy. GDM causes substantial morbidity and mortality and long- term complications. GDM-related risk factors have not been completely identified yet. Some studies have found relationship between increased serum ferritin and impaired oral glucose tolerance test but the relationship between serum ferritin and risk of GDM has been controversial. The aim of the study was to determine serum iron and ferritin levels and total iron binding capacity (TIBC) in women with GDM and comparison with normal pregnant women. Materials and Methods: This case-control study was performed among 200 pregnant women (case = 100, control = 100) who were referred to Yahya-Nejad Hospital in the second trimester in Babol from 2008 to 2009. GDM was diagnosed by impaired OGTT based on Carpenter and Coustan criteria. The 2 groups were matched in age, gestational age and parity. Results: High serum ferritin level increased the risk of gestational diabetes to 2.4-fold [OR = 2.4 (0.83-6.9) CI = 95% (P = 0.10)], while in those with low ferritin levels, the risk of developing gestational diabetes was reduced to 82% [OR = 0.8 with (0.08-0.37) CI = 95% (P = 0.001)]. Using the logistic regression model, after adjustment for BMI, the OR was 2.37 [(0.80-7.01) CI = 95% (P = 0.11)] for low ferritin level and OR = 0.20 [(0.09-0.44) CI = 95% (P = 0.0001)] for high ferritin level, which was statistically significant. Conclusion: The serum ferritin level was markedly higher in women with gestational diabetes than in normal pregnant women; therefore, high ferritin can be regarded as a significant risk factor for the development of gestational diabetes.
Amiri, Fatemeh Nasiri; Basirat, Zahra; Omidvar, Shabnam; Sharbatdaran, Majid; Tilaki, Karimollah Hajian; Pouramir, Mahdi
Background There is lack of consensus concerning the best screening strategy for gestational diabetes (GDM). The aim of our survey was therefore to investigate attitudes and practices of all obstetrical centers in the northern part of Belgium regarding screening for pregestational diabetes in early pregnancy and screening for GDM. We also aimed to identify the penetrance of the ‘International Association of Diabetes in Pregnancy Study Groups’ (IADPSG) screening strategy for GDM. Methods The survey was conducted from May 2012 till January 2013. The survey was distributed to every obstetrical center in the northern part of Belgium by email and/or mail with reminders by phone and personal contact. Results From the 65 obstetrical centers, 69% responded. Of all centers, 27% had a structured database on the number of women with GDM. Of all centers, 82% screened for pregestational diabetes in early pregnancy and 56% of centers screened for GDM before 24 weeks. Screening before 24 weeks was mostly based on risk factors. Screening for GDM after 24 weeks, was done universally in 87% of centers. The mean estimated prevalence of GDM was 7?±?5%. The most commonly used screening strategy was a two-step approach with a glucose challenge test (GCT) and 100 g oral glucose tolerance test (OGTT), used by 56% of centers, with 23 centers using the Carpenter & Coustan criteria. The 75 g OGTT with the IADPSG criteria was used by 33% of centers but 4 of these centers still used a GCT before proceeding to the full OGTT. Conclusions This survey demonstrates that in the northern part of Belgium, there still is a large variation in screening strategy for pregestational diabetes in early pregnancy and GDM. Only 25% of centers have already implemented the one-step IADPSG screening strategy.
Background Gestational diabetes mellitus (GDM) is an increasing problem world-wide. Lifestyle interventions and/or vitamin D supplementation might help prevent GDM in some women. Methods/design Pregnant women at risk of GDM (BMI?29 (kg/m2)) from 9 European countries will be invited to participate and consent obtained before 19+6 weeks of gestation. After giving informed consent, women without GDM will be included (based on IADPSG criteria: fasting glucose<5.1mmol; 1 hour glucose <10.0 mmol; 2 hour glucose <8.5 mmol) and randomized to one of the 8 intervention arms using a 2×(2×2) factorial design: (1) healthy eating (HE), 2) physical activity (PA), 3) HE+PA, 4) control, 5) HE+PA+vitamin D, 6) HE+PA+placebo, 7) vitamin D alone, 8) placebo alone), pre-stratified for each site. In total, 880 women will be included with 110 women allocated to each arm. Between entry and 35 weeks of gestation, women allocated to a lifestyle intervention will receive 5 face-to-face, and 4 telephone coaching sessions, based on the principles of motivational interviewing. The lifestyle intervention includes a discussion about the risks of GDM, a weight gain target <5kg and either 7 healthy eating ‘messages’ and/or 5 physical activity ‘messages’ depending on randomization. Fidelity is monitored by the use of a personal digital assistance (PDA) system. Participants randomized to the vitamin D intervention receive either 1600 IU vitamin D or placebo for daily intake until delivery. Data is collected at baseline measurement, at 24–28 weeks, 35–37 weeks of gestation and after delivery. Primary outcome measures are gestational weight gain, fasting glucose and insulin sensitivity, with a range of obstetric secondary outcome measures including birth weight. Discussion DALI is a unique Europe-wide randomised controlled trial, which will gain insight into preventive measures against the development of GDM in overweight and obese women. Trial registration ISRCTN70595832
Oxidative stress (OS) is defined as an imbalance between pro- and antioxidant factors that can lead to cellular and tissue damage. Under condition of gestational diabetes, OS is exacerbated and can cause vascular dysfunction in the placenta, leading to fetal and perinatal complications. We investigated the oxidative status of diabetic pregnant women and of their babies. A group of those diabetic women received lutein, and another group did not receive anything. In order to verify a possible antioxidant function of lutein, we compared the OS values of the two groups. OS appeared lower in treated gravidas than in untreated ones; however, there was not a statistically significant difference between the two groups. As far as newborns are concerned, there was a significant difference of OS values between babies born to mothers treated with lutein and newborns to mothers untreated at 2?h of life. However, at 48?h, there was not a significant difference between the two groups. In conclusion, lutein administration during pregnancy significantly reduced neonatal OS at birth. Further studies are necessary to evaluate the effects of combined administration to mother and infants. PMID:23808391
Lorenzoni, Francesca; Giampietri, Matteo; Ferri, Giulia; Lunardi, Sara; Madrigali, Valeria; Battini, Lorella; Boldrini, Antonio; Ghirri, Paolo
Background: A potential effect of ezetimibe, a novel cholesterol-absorption inhibitor, on insulin resistance has been reported in an animal model. Objective: The aim of this study was to evaluate the effects of ezetimibe on glucose metabolism in patients with type 2 diabetes mellitus (T2DM). Methods: Between March and June 2008, outpatients with T2DM who were being treated at Yokohama Sakae Kyosai Hospital, Yokohama, Japan, were enrolled in this pilot study if they had not achieved the target lipid levels recommended by the Japan Atherosclerosis Society Guidelines despite diet and exercise or a statin therapy for ?3 months. At baseline and at 4 and 12 weeks after open-label treatment with ezetimibe 10 mg/d, the levels of lipid parameters, fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1c), and high-sensitivity C-reactive protein were measured. Adverse effects (AEs) were assessed at each study visit by patient interviews and laboratory testing. Results: A total of 21 consecutive patients (10 men, 11 women; mean [SD] age, 72  years; weight, 63.4 [10.5] kg; body mass index, 25.5 [3.2] kg/m2) were enrolled in this study. The mean (SD) level of LDL-C decreased significantly from 146 (31) to 114 (27) mg/dL (?21%; P < 0.001) after 12 weeks of treatment with ezetimibe. The mean level of remnant-like particle cholesterol also decreased significantly from 6.5 (3.8) to 4.8 (2.2) mg/dL (?15%; P = 0.03). Treatment with ezetimibe was associated with a reduction in FPG level from 127 (31) to 119 (30) mg/dL (P = 0.02), and HbAlc from 6.3% (0.6%) to 6.1% (0.7%) (P = 0.003). No AEs were observed or reported during the study period. Conclusion: In this small, open-label, uncontrolled, pilot study, ezetimibe was associated with a significant decrease in lipid parameters and improvement in glucose metabolism in these patients with T2DM.
Nozue, Tsuyoshi; Michishita, Ichiro; Mizuguchi, Ichiro
Comparison of effects of gliclazide, metformin and pioglitazone monotherapies on glycemic control and cardiovascular risk factors in patients with newly diagnosed uncontrolled type 2 diabetes mellitus.
Objective: The objective of this study was to evaluate and compare the effects of gliclazide-modified release (gliclazide-MR), metformine (MET) and pioglitazone (PIO) monotherapies on glycemic control and conventional/non-conventional cardiovascular risk factors in patients with newly diagnosed type 2 diabetes mellitus (T2DM). Material and Methods: A single center, randomized, 52-wk comparator-controlled clinical study was carried out in patients with newly diagnosed uncontrolled T2DM. A total of 57 patients were randomized into gliclazide-MR, metformin and pioglitazone groups. Drugs were administered for 12 months. Anthropometric measurements, fasting plasma glucose (FPG), postprandial plasma glucose (PPG), HbA1c, insulin, HOMA-IR, lipid parameters, the markers of coagulation/fibrinolysis, inflammation and endothelial dysfunction were measured at baseline and at months 3, 6, and 12. Results: In the gliclazide-MR group, HC, FPG, HbA1c, insulin, HOMA-IR, TC, trigylcerides, Lp (a), E-selectin and Hcy were significantly decreased after treatment compared to baseline. In the MET group, BMI, WC, FPG, PPG, HbA1c, ICAM-1 and Hcy significantly decreased after treatment compared to baseline. In PIO group, WC, HC, FPG, PPG, HbA1c, C-peptid, HOMA-IR, trigylcerides, vWF, IL-6, ICAM-1, E-selectin and Hcy significantly decreased after treatment compared to baseline, whereas, HDL-C increased. At the end of the month 12, the decreases in insulin and HOMA-IR score were more pronounced with PIO compared to gliclazide. Conclusions: Gliclazide-MR, MET and PIO monotherapies, were equally effective in proving glycemic control in patients with newly diagnosed, oral antidiabetic (OAD)-naive T2DM. But, improvements in conventional/non-conventional cardiovascular risk factors were more pronounced in patients on PIO therapy compared to gliclazide and MET therapies. Also, all of the 3 drugs represent effective and safe first-line pharmacological treatment options in these patients. PMID:24710641
Erem, C; Ozbas, H M; Nuhoglu, I; Deger, O; Civan, N; Ersoz, H O
This research was an exploratory study of physical activity, pregnancy and Gestational Diabetes Mellitus (GDM) with implications for health promotion interventions. The study aimed to explore women’s physical activity levels before, during and after pregnancy including women who experienced GDM; factors that influenced levels of physical activity; women’s attitudes and information received in relation to physical activity; the influence of
Frances Mary Doran
This study aims to identify novel markers for gestational diabetes (GDM) in the biochemical profile of maternal urine using NMR metabolomics. It also catalogs the general effects of pregnancy and delivery on the urine profile. Urine samples were collected at three time points (visit V1: gestational week 8–20; V2: week 28±2; V3?10–16 weeks post partum) from participants in the STORK Groruddalen program, a prospective, multiethnic cohort study of 823 healthy, pregnant women in Oslo, Norway, and analyzed using 1H-NMR spectroscopy. Metabolites were identified and quantified where possible. PCA, PLS-DA and univariate statistics were applied and found substantial differences between the time points, dominated by a steady increase of urinary lactose concentrations, and an increase during pregnancy and subsequent dramatic reduction of several unidentified NMR signals between 0.5 and 1.1 ppm. Multivariate methods could not reliably identify GDM cases based on the WHO or graded criteria based on IADPSG definitions, indicating that the pattern of urinary metabolites above micromolar concentrations is not influenced strongly and consistently enough by the disease. However, univariate analysis suggests elevated mean citrate concentrations with increasing hyperglycemia. Multivariate classification with respect to ethnic background produced weak but statistically significant models. These results suggest that although NMR-based metabolomics can monitor changes in the urinary excretion profile of pregnant women, it may not be a prudent choice for the study of GDM.
Sachse, Daniel; Sletner, Line; M?rkrid, Kjersti; Jenum, Anne Karen; Birkeland, Kare I.; Rise, Frode; Piehler, Armin P.; Berg, Jens Petter
Background: The objective of this study was to investigate whether the sex hormone binding globulin (SHBG) levels before conception are predictive of gestational diabetes mellitus (GDM) in women with polycystic ovarian syndrome (PCOS). Materials and Methods: A total of 180 women with PCOS were enrolled and followed up during pregnancy. Diagnosis of GDM was based on a 2-hour, 75 g oral glucose tolerance test (GTT) performed at 24-28 weeks of gestational age. SHBG levels were measured from serum samples that had collected before conception. We examined the incidence of GDM and plotted a receiver operating characteristic (ROC) curve to assess discrimination. Results: Of the 180 women, 50 (27.8%) were diagnosed with GDM. Those with lower levels of SHBG before conception were more likely to develop GDM than those with higher SHBG (44.4 ± 14.8 nmol/l vs. 63.5 ± 22.7 nmol/l, P < 0.001). The area under the ROC was 77.0% (95% confidence interval [CI] 71.3-78.8). The optimal cut-off value for detecting GDM was a SHBG ?62.5 nmol/l. For every 1 nmol/l increase in SHBG value, there was a 7% reduction in the risk for development of GDM (Odds ratio 0.93 [95% CI 0.90-0.96], P < 0.001). Conclusion: In women with PCOS preconception, SHBG levels are strongly associated with development of GDM.
Mehrabian, Ferdous; Rezae, Marzieh
Background Gestational diabetes mellitus (GDM) – a transitory form of diabetes first recognised during pregnancy complicates between?1% and 28% of all pregnancies. GDM has important short and long-term health consequences for both the mother and her offspring. To prevent adverse pregnancy outcomes and to prevent or delay future onset of type 2 diabetes in mother and offspring, timely detection, optimum treatment, and preventive postpartum care and follow-up is necessary. However the area remains grossly under-prioritised. Methods To investigate determinants and barriers to GDM care from initial screening and diagnosis to prenatal treatment and postpartum follow-up, a PubMed database search to identify quantitative and qualitative studies on the subject was done in September 2012. Fifty-eight relevant studies were reviewed. Results Adherence to prevailing GDM screening guidelines and compliance to screening tests seems sub-optimal at best and arbitrary at worst, with no clear or consistent correlation to health care provider, health system or client characteristics. Studies indicate that most women express commitment and motivation for behaviour change to protect the health of their unborn baby, but compliance to recommended treatment and advice is fraught with challenges, and precious little is known about health system or societal factors that hinder compliance and what can be done to improve it. A number of barriers related to health care provider/system and client characteristics have been identified by qualitative studies. Immediately following a GDM pregnancy many women, when properly informed, desire and intend to maintain healthy lifestyles to prevent future diabetes, but find the effort challenging. Adherence to recommended postpartum screening and continued lifestyle modifications seems even lower. Here too, health care provider, health system and client related determinants and barriers were identified. Studies reveal that sense of self-efficacy and social support are key determinants. Conclusions The paper identifies and discusses determinants and barriers for GDM care, fully recognising that these are highly dependent on the context.
Gestational diabetes mellitus (GDM) and obesity in pregnancy (OP) are pathological conditions associated with placenta vascular dysfunction coursing with metabolic changes at the fetoplacental microvascular and macrovascular endothelium. These alterations are seen as abnormal expression and activity of the cationic amino acid transporters and endothelial nitric oxide synthase isoform, that is, the “endothelial L-arginine/nitric oxide signalling pathway.” Several studies suggest that the endogenous nucleoside adenosine along with insulin, and potentially arginases, are factors involved in GDM-, but much less information regards their role in OP-associated placental vascular alterations. There is convincing evidence that GDM and OP prone placental endothelium to an “altered metabolic state” leading to fetal programming evidenced at birth, a phenomenon associated with future development of chronic diseases. In this paper it is suggested that this pathological state could be considered as a metabolic marker that could predict occurrence of diseases in adulthood, such as cardiovascular disease, obesity, diabetes mellitus (including gestational diabetes), and metabolic syndrome.
Leiva, Andrea; Pardo, Fabian; Ramirez, Marco A.; Farias, Marcelo; Casanello, Paola; Sobrevia, Luis
The epidemic increase of type 2 diabetes and obesity in developed countries cannot be explained by overnutrition, physical inactivity and/or genetic factors alone. Epidemiologic evidence suggests that an adverse intrauterine environment, in particular a shortage or excess of nutrients is associated with increased risks for many complex diseases later in life. An impressive example for the ‘fetal origins of adult disease’ is gestational diabetes mellitus which usually presents in 1% to >10% of third trimester pregnancies. Intrauterine hyperglycemia is not only associated with increased perinatal morbidity and mortality, but also with increased lifelong risks of the exposed offspring for obesity, metabolic, cardiovascular and malignant diseases. Accumulating evidence suggests that fetal overnutrition (and similarly undernutrition) lead to persistent epigenetic changes in developmentally important genes, influencing neuroendocrine functions, energy homeostasis and metabolism. The concept of fetal programming has important implications for reproductive medicine. Because during early development the epigenome is much more vulnerable to environmental cues than later in life, avoiding adverse environmental factors in the periconceptional and intrauterine period may be much more important for the prevention of adult disease than any (i.e. dietetic) measures in infants and adults. A successful pregnancy should not primarily be defined by the outcome at birth but also by the health status in later life.
Lehnen, Harald; Zechner, Ulrich; Haaf, Thomas
Pregnant women with gestational diabetes mellitus (GDM) and type 2 diabetes mellitus (T2DM) share a common pathophysiology associated with similar risk factors. Genetic variants used to determine the risk of developing T2DM might also be associated with the prevalence of GDM. The aim of the present study was to scrutinize the relationship between the G972R polymorphism of the insulin receptor substrate-1 (IRS-1) gene with GDM in the Saudi female population. This is a case-control study that monitored 500 Saudi women. Subjects with GDM (n = 200) were compared with non-GDM (n = 300) controls. We opted to evaluate rs1801278 polymorphism in the IRS1 gene, which plays a critical role in the insulin-signaling pathway. Genotyping was performed with the Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP) method. The frequency of the rs1801278 polymorphism was significantly higher in women with GDM than in women with non-GDM (for TT + CT versus CC: P = 0.02). Additionally, there was a significant increase in the frequency of the Arg-encoding mutant allele from GDM to non-GDM (for T versus C: P = 0.01). Our results suggest that the rs1801278 polymorphism in the IRS-1 gene is involved in the occurrence of GDM in the Saudi population. PMID:24695443
Alharbi, Khalid Khalaf; Khan, Imran Ali; Abotalib, Zeinab; Al-Hakeem, Malak Mohammed
Introduction Women with a history of gestational diabetes mellitus (GDM) are at higher risk of developing type 2 diabetes (T2DM); however, little is known about the association between other common pregnancy complications (eg, preterm birth, macrosomia) and T2DM risk. We examined the associations between first-pregnancy preterm, postterm birth, low birth weight, and macrosomia with subsequent risk of T2DM. Methods We conducted a prospective cohort study of Nurses’ Health Study II (NHSII) participants; 51,728 women in the study had a single live birth and complete pregnancy history. NHSII confirmed incident diabetes mellitus through supplemental questionnaires. Participants were followed from year of first birth until 2005. We defined gestational age as very preterm (20 to ?32 weeks), moderate preterm (33 to ?37 weeks), term (38 to ?42 weeks), and postterm (?43 weeks). We defined low birth weight as an infant born at term weighing less than 5.5 pounds, and we defined macrosomia as an infant born at term weighing 10 pounds or more. We used Cox proportional hazards models, adjusting for potential confounders. Results Women with a very preterm birth (2%) had an increased T2DM risk (adjusted hazard ratio, 1.34; 95% confidence interval [CI], 1.05–1.71). This increased risk emerged in the decade following pregnancy. Macrosomia (1.5%) was associated with a 1.61 increased T2DM risk, after adjusting for risk factors, including GDM (95% CI, 1.24–2.08). This association was apparent within the first 5 years after pregnancy. Moderate preterm and term low birth weight did not significantly increase the risk of T2DM over the 35-year follow-up time. Conclusion Women who experienced a very preterm birth or had an infant that weighed 10 pounds or more may benefit from lifestyle intervention to reduce T2DM risk. If replicated, these findings could lead to a reduced risk of T2DM through improved primary care for women experiencing a preterm birth or an infant of nonnormal birth weight.
Karumanchi, S. Ananth; Hibert, Eileen L.; Mason, Susan M.; Vadnais, Mary A.; Hu, Frank B.; Rich-Edwards, Janet W.
Objectives Circulating Fibroblast Growth Factor 21 (FGF21) levels are increased in insulin resistant states such as obesity, type 2 diabetes mellitus and gestational diabetes mellitus (GDM). In addition, GDM is associated with serious maternal and fetal complications. We sought to study human cerebrospinal fluid (CSF) and corresponding circulating FGF21 levels in women with gestational diabetes mellitus (GDM) and in age and BMI matched control subjects. We also assessed FGF21 secretion from GDM and control human placental explants. Design CSF and corresponding plasma FGF21 levels of 24 women were measured by ELISA [12 GDM (age: 26–47 years, BMI: 24.3–36.3 kg/m2) and 12 controls (age: 22–40 years, BMI: 30.1–37.0 kg/m2)]. FGF21 levels in conditioned media were secretion from GDM and control human placental explants were also measured by ELISA. Results Glucose, HOMA-IR and circulating NEFA levels were significantly higher in women with GDM compared to control subjects. Plasma FGF21 levels were significantly higher in women with GDM compared to control subjects [234.3 (150.2–352.7) vs. 115.5 (60.5–188.7) pg/ml; P<0.05]. However, there was no significant difference in CSF FGF21 levels in women with GDM compared to control subjects. Interestingly, CSF/Plasma FGF21 ratio was significantly lower in women with GDM compared to control subjects [0.4 (0.3–0.6) vs. 0.8 (0.5–1.6); P<0.05]. FGF21 secretion into conditioned media was significantly lower in human placental explants from women with GDM compared to control subjects (P<0.05). Conclusions The central actions of FGF21 in GDM subjects maybe pivotal in the pathogenesis of insulin resistance in GDM subjects. The significance of FGF21 produced by the placenta remains uncharted and maybe crucial in our understanding of the patho-physiology of GDM and its associated maternal and fetal complications. Future research should seek to elucidate these points.
Bari, Muhammad F.; Vatish, Manu; Randeva, Harpal S.
Background Women who are diagnosed with gestational diabetes mellitus (GDM) are at increased risk for developing prediabetes and type 2 diabetes mellitus (T2DM). To date, there have been few interdisciplinary interventions that target predominantly ethnic minority low-income women diagnosed with GDM. This paper describes the rationale, design and methodology of a 2-year, randomized, controlled study being conducted in North Carolina. Methods/Design Using a two-group, repeated measures, experimental design, we will test a 14- week intensive intervention on the benefits of breastfeeding, understanding gestational diabetes and risk of progression to prediabetes and T2DM, nutrition and exercise education, coping skills training, physical activity (Phase I), educational and motivational text messaging and 3 months of continued monthly contact (Phase II). A total of 100 African American, non-Hispanic white, and bilingual Hispanic women between 22–36 weeks of pregnancy who are diagnosed with GDM and their infants will be randomized to either the experimental group or the wait-listed control group. The first aim of the study is to determine the feasibility of the intervention. The second aim of study is to test the effects of the intervention on maternal outcomes from baseline (22–36 weeks pregnant) to 10 months postpartum. Primary maternal outcomes will include fasting blood glucose and weight (BMI) from baseline to 10 months postpartum. Secondary maternal outcomes will include clinical, adiposity, health behaviors and self-efficacy outcomes from baseline to 10 months postpartum. The third aim of the study is to quantify the effects of the intervention on infant feeding and growth. Infant outcomes will include weight status and breastfeeding from birth through 10 months of age. Data analysis will include general linear mixed-effects models. Safety endpoints include adverse event reporting. Discussion Findings from this trial may lead to an effective intervention to assist women diagnosed with GDM to improve maternal glucose homeostasis and weight as well as stabilize infant growth trajectory, reducing the burden of metabolic disease across two generations. Trial registration NCT01809431
Background Alobar holoprosencephaly is a rare and severe brain malformation due to early arrest in brain cleavage and rotation.\\u000a \\u000a \\u000a \\u000a Case report We report a congenital anomalous fetus with alobar holoprosencephaly, prenatally diagnosed by two-dimensional (2D) sonography\\u000a at the 40 weeks of gestation. The mother was affected by gestational diabetes mellitus and was obese (BMI > 30 kg\\/m2). 2D Ultrasound depicted the cerebral malformation, cyclopy, proboscis, cardiac
Giampiero Capobianco; Pier Luigi Cherchi; Guido Ambrosini; Erich Cosmi; Alessandra Andrisani; Salvatore Dessole
BACKGROUND: Gestational diabetes mellitus (GDM) is a risk factor for mothers to develop type 2 diabetes (T2D) postpartum, and for their children to develop obesity. The aim of the ongoing POGO study is to identify long-lasting changes in the maternal and fetal metabolism and microbiome, after GDM, which contribute to subsequent development of T2D and obesity. METHODS: Women screened for GDM are asked to attend a postpartum study visit together with their offspring. At the visit, demographic, nutritional, and anthropometric data are recorded. Additionally, data about physical activity, metabolism, and genetic susceptibility are collected using accelerometers, breath gas analyses, 75g oral glucose tolerance tests (OGTT), and bio-samples such as blood and stool. RESULTS: To date, 121 women (median follow-up time postpartum: 5.5 years) have been enrolled together with 133 index children. GDM has been diagnosed using OGTT in 105 women (and 117 children). It showed that 47 mothers had abnormal glucose tolerance, including 19 cases of impaired glucose tolerance, 19 of impaired fasting glucose, eight with T2D, and one with type 1 diabetes (T1D). The prevalence of obesity in the offspring of GDM mothers was 5.1%. Of 61 children tested by OGTT, three were diagnosed with impaired glucose tolerance, another three with impaired fasting glucose, and none with T1D or T2D. CONCLUSIONS: The POGO study will contribute to the understanding of the pathogenesis of T2D and obesity after GDM, and will thus help to develop appropriate prevention and intervention strategies. This article presents the first results of the ongoing study, which are looking promising.
Hummel, Sandra; Much, Daniela; Rossbauer, Michaela; Ziegler, Anette-G.; Beyerlein, Andreas
Gestational diabetes and pregnancy outcomes - a systematic review of the World Health Organization (WHO) and the International Association of Diabetes in Pregnancy Study Groups (IADPSG) diagnostic criteria
Background Two criteria based on a 2 h 75 g OGTT are being used for the diagnosis of gestational diabetes (GDM), those recommended over the years by the World Health Organization (WHO), and those recently recommended by the International Association for Diabetes in Pregnancy Study Group (IADPSG), the latter generated in the HAPO study and based on pregnancy outcomes. Our aim is to systematically review the evidence for the associations between GDM (according to these criteria) and adverse outcomes. Methods We searched relevant studies in MEDLINE, EMBASE, LILACS, the Cochrane Library, CINHAL, WHO-Afro library, IMSEAR, EMCAT, IMEMR and WPRIM. We included cohort studies permitting the evaluation of GDM diagnosed by WHO and or IADPSG criteria against adverse maternal and perinatal outcomes in untreated women. Only studies with universal application of a 75 g OGTT were included. Relative risks (RRs) and their 95% confidence intervals (CI) were obtained for each study. We combined study results using a random-effects model. Inconsistency across studies was defined by an inconsistency index (I2) > 50%. Results Data were extracted from eight studies, totaling 44,829 women. Greater risk of adverse outcomes was observed for both diagnostic criteria. When using the WHO criteria, consistent associations were seen for macrosomia (RR = 1.81; 95%CI 1.47-2.22; p < 0.001); large for gestational age (RR = 1.53; 95%CI 1.39-1.69; p < 0.001); perinatal mortality (RR = 1.55; 95% CI 0.88-2.73; p = 0.13); preeclampsia (RR = 1.69; 95%CI 1.31-2.18; p < 0.001); and cesarean delivery (RR = 1.37;95%CI 1.24-1.51; p < 0.001). Less data were available for the IADPSG criteria, and associations were inconsistent across studies (I2 ? 73%). Magnitudes of RRs and their 95%CIs were 1.73 (1.28-2.35; p = 0.001) for large for gestational age; 1.71 (1.38-2.13; p < 0.001) for preeclampsia; and 1.23 (1.01-1.51; p = 0.04) for cesarean delivery. Excluding either the HAPO or the EBDG studies minimally altered these associations, but the RRs seen for the IADPSG criteria were reduced after excluding HAPO. Conclusions The WHO and the IADPSG criteria for GDM identified women at a small increased risk for adverse pregnancy outcomes. Associations were of similar magnitude for both criteria. However, high inconsistency was seen for those with the IADPSG criteria. Full evaluation of the latter in settings other than HAPO requires additional studies.
OBJECTIVE Serial measurements of the fetal abdominal circumference have been used to guide metabolic management of pregnancies complicated by gestational diabetes mellitus (GDM). A reduction in the number of repeat ultrasound examinations would save resources. Our purpose was to determine the number of serial abdominal circumference measurements per patient necessary to reliably predict the absence of fetal overgrowth. RESEARCH DESIGN AND METHODS Women who had GDM were asked to return for repeat ultrasound at 3- to 4-week intervals starting at initiation of care (mean 26.9 ± 5.7 weeks). Maternal risk factors associated with fetal overgrowth were determined. RESULTS A total of 4,478 ultrasound examinations were performed on 1,914 subjects (2.3 ± 1.2 per pregnancy). Of the 518 women with fetal abdominal circumference >90th percentile, it was diagnosed in 73.9% with the first ultrasound examination at entry and in 13.1% with the second ultrasound examination. Of the fetuses, 85.9 and 86.9% of the fetuses were born non-large for gestational age (LGA) when abdominal circumference was <90th percentile at 24–27 weeks and 28–32 weeks, respectively, and 88.0% were born non-LGA when both scans showed normal growth. For those women who had no risk factors for fetal overgrowth (risk factors: BMI >30 kg/m2, history of macrosomia, and fasting glucose > 100 mg/dl), the accuracy of prediction of a non-LGA neonate was 90.0, 89.5, and 95.2%. The predictive ability did not increase with more than two normal scans. CONCLUSIONS The yield of sonographic diagnosis of a large fetus drops markedly after the finding of a fetal abdominal circumference <90th percentile on two sonograms, which excludes with high reliability the risk of a LGA newborn. The ability was enhanced in women who had no risk factors for neonatal macrosomia.
Schaefer-Graf, Ute M.; Wendt, Luise; Sacks, David A.; Kilavuz, Oemer; Gaber, Bettina; Metzner, Sabine; Vetter, Klaus; Abou-Dakn, Michael
The association between maternal gestational diabetes (GDM) and manifestations of metabolic syndrome among Caucasian adolescents was studied with data from the population-based Northern Finland 1986 Birth Cohort. This is a longitudinal cohort study from early pregnancy until offspring age 16 years and includes data from a risk group-based GDM screen of pregnant mothers by an oral glucose tolerance test. Metabolic outcomes were compared between the offspring of women with GDM (OGDM; n = 95) and reference group offspring (n = 3,909). The prevalence of overweight was significantly higher in the OGDM group (18.8 vs. 8.4%; P < 0.001) than in the reference group. The median body mass index (20.8 vs. 20.2 kg/m(2), 95% confidence interval (CI) for the percentage difference adjusted for sex: 3.5%, 9.5%), waist circumference (73.3 vs. 71.5 cm, 95% CI: 3.2%, 7.5%), and fasting insulin (10.20 vs. 9.30 milliunits/L, 95% CI: 5.9%, 26.0%) were higher, and homeostatic model assessment-insulin sensitivity (74.7 vs. 82.3, 95% CI: -20.6%, -5.4%) was lower in the OGDM group. These differences were similar after an additional adjustment for birth weight and gestational age. The differences in waist circumference, insulin, and homeostatic model assessment-insulin sensitivity were attenuated but remained statistically significant after additional adjustment for body mass index at 16 years. These findings highlight the importance of prevention strategies among children born to women with GDM. PMID:19363101
Vääräsmäki, Marja; Pouta, Anneli; Elliot, Paul; Tapanainen, Päivi; Sovio, Ulla; Ruokonen, Aimo; Hartikainen, Anna-Liisa; McCarthy, Mark; Järvelin, Marjo-Riitta
Synthesis of thyroid hormones, thyroxine (T4) and tri-iodothyronine (T3), in the human fetus starts from 17 to 19th weeks of gestation. Despite the majority of normal pregnant women reaching adequate levels of circulating thyroid hormones, in some cases, women with normal pregnancies have low level of free T4 during first trimester of pregnancy, suggesting that T4 action may be compromised in those women and their fetuses. In addition, pathological low levels of thyroid hormones are detected in isolated maternal hypothyroxemia (IMH) and clinical hypothyroidism. Nevertheless, human placenta regulates T3/T4 concentration in the fetal circulation by modulating the expression and activity of both thyroid hormone transporters (THT) and deiodinases. Then, placenta can control the availability of T3/T4 in the feto-placental circulation, and therefore may generate an adaptive response in cases where the mother courses with low levels of T4. In addition, T3/T4 might control vascular response in the placenta, in particularly endothelial cells may induce the synthesis and release of vasodilators such as nitric oxide (NO) or vasoconstrictors such as endothelin-1 mediated by these hormones. On the other hand, low levels of T4 have been associated with increase in gestational diabetes (GD) markers. Since GD is associated with impaired placental vascular function characterized by increased NO synthesis in placental arteries and veins, as well as elevated placental angiogenesis, it is unknown whether reduced T4 level at the maternal circulation could result in an altered placental endothelial function during GD. In this review, we analyze available information regarding thyroid hormones and endothelial dysfunction in GD; and propose that low maternal levels of T4 observed in GD may be compensated by increased placental availability of T3/T4 via elevation in the activity of THT and/or reduction in deiodinases in the feto-placental circulation.
Guzman-Gutierrez, Enrique; Veas, Carlos; Leiva, Andrea; Escudero, Carlos; Sobrevia, Luis
Synthesis of thyroid hormones, thyroxine (T4) and tri-iodothyronine (T3), in the human fetus starts from 17 to 19th weeks of gestation. Despite the majority of normal pregnant women reaching adequate levels of circulating thyroid hormones, in some cases, women with normal pregnancies have low level of free T4 during first trimester of pregnancy, suggesting that T4 action may be compromised in those women and their fetuses. In addition, pathological low levels of thyroid hormones are detected in isolated maternal hypothyroxemia (IMH) and clinical hypothyroidism. Nevertheless, human placenta regulates T3/T4 concentration in the fetal circulation by modulating the expression and activity of both thyroid hormone transporters (THT) and deiodinases. Then, placenta can control the availability of T3/T4 in the feto-placental circulation, and therefore may generate an adaptive response in cases where the mother courses with low levels of T4. In addition, T3/T4 might control vascular response in the placenta, in particularly endothelial cells may induce the synthesis and release of vasodilators such as nitric oxide (NO) or vasoconstrictors such as endothelin-1 mediated by these hormones. On the other hand, low levels of T4 have been associated with increase in gestational diabetes (GD) markers. Since GD is associated with impaired placental vascular function characterized by increased NO synthesis in placental arteries and veins, as well as elevated placental angiogenesis, it is unknown whether reduced T4 level at the maternal circulation could result in an altered placental endothelial function during GD. In this review, we analyze available information regarding thyroid hormones and endothelial dysfunction in GD; and propose that low maternal levels of T4 observed in GD may be compensated by increased placental availability of T3/T4 via elevation in the activity of THT and/or reduction in deiodinases in the feto-placental circulation. PMID:24936187
Guzmán-Gutiérrez, Enrique; Veas, Carlos; Leiva, Andrea; Escudero, Carlos; Sobrevia, Luis
A growing body of literature suggests that chronic disease has much of its origins in the fetal response to the intrauterine environment, a concept known as "fetal programming." Longitudinal studies have demonstrated that higher rates of obesity, impaired glucose tolerance, hypertension, and dyslipidemia are evident in the offspring of diabetic women. This review focuses on the implications of intrauterine exposure to an altered maternal metabolic milieu and the risk of childhood obesity and metabolic dysfunction. PMID:22893552
Durnwald, Celeste; Landon, Mark
Objective The International Association of Diabetes and Pregnancy Study Groups (IADPSG) recently proposed new criteria for diagnosing gestational diabetes mellitus (GDM). We compared prevalence rates, risk factors, and the effect of ethnicity using the World Health Organization (WHO) and modified IADPSG criteria. Methods This was a population-based cohort study of 823 (74% of eligible) healthy pregnant women, of whom 59% were from ethnic minorities. Universal screening was performed at 28±2 weeks of gestation with the 75?g oral glucose tolerance test (OGTT). Venous plasma glucose (PG) was measured on site. GDM was diagnosed as per the definition of WHO criteria as fasting PG (FPG) ?7.0 or 2-h PG ?7.8?mmol/l; and as per the modified IADPSG criteria as FPG ?5.1 or 2-h PG ?8.5?mmol/l. Results OGTT was performed in 759 women. Crude GDM prevalence was 13.0% with WHO (Western Europeans 11%, ethnic minorities 15%, P=0.14) and 31.5% with modified IADPSG criteria (Western Europeans 24%, ethnic minorities 37%, P< 0.001). Using the WHO criteria, ethnic minority origin was an independent predictor (South Asians, odds ratio (OR) 2.24 (95% confidence interval (CI) 1.26–3.97); Middle Easterners, OR 2.13 (1.12–4.08)) after adjustments for age, parity, and prepregnant body mass index (BMI). This increased OR was unapparent after further adjustments for body height (proxy for early life socioeconomic status), education and family history of diabetes. Using the modified IADPSG criteria, prepregnant BMI (1.09 (1.05–1.13)) and ethnic minority origin (South Asians, 2.54 (1.56–4.13)) were independent predictors, while education, body height and family history had little impact. Conclusion GDM prevalence was overall 2.4-times higher with the modified IADPSG criteria compared with the WHO criteria. The new criteria identified many subjects with a relatively mild increase in FPG, strongly associated with South Asian origin and prepregnant overweight.
Jenum, Anne K; M?rkrid, Kjersti; Sletner, Line; Vange, Siri; Torper, Johan L; Nakstad, Britt; Voldner, Nanna; Rognerud-Jensen, Odd H; Berntsen, Sveinung; Mosd?l, Annhild; Skrivarhaug, Torild; Vardal, Mari H; Holme, Ingar; Yajnik, Chittaranjan S; Birkeland, Kare I
Gestational diabetes mellitus (GDM) complicates approximately 3-11% of pregnancies and increases the risk on prenatal morbidity and later development of type 2 diabetes mellitus. Physical activity and sedentary behaviour are thought to play a role in the development of GDM, independent of overweight and obesity. The aim of this study was to examine the relationships between physical activity, sedentary behaviour and the development of GDM using a population-based prospective cohort study. Data from the youngest (1973-1978) cohort of the Australian Longitudinal Study on Women's Health (n=2913) were used to determine the influences of self-reported physical activity, and sedentary behaviour in 2000 and 2003 on the development of GDM over subsequent three year periods, with adjustment for socio-demographic and lifestyle factors. In this cohort of Australian women, physical activity and sedentary behaviour in 2000 and 2003 were not associated with the development of GDM in the subsequent three years. In adjusted models, odds ratios for the development of GDM were 1.92 (95% CI 1.25-2.96) for overweight women (BMI 25-30 kg/m2) and 3.11 (1.92-5.03) for obese women (BMI?30 kg/m2) compared with normal weight women. Those with lower education and women born in an Asian country also had higher risk of developing GDM than more highly educated and Australian born women, respectively. In conclusion, pre-pregnancy physical activity and sedentary behaviour appear to be less important in the development of GDM in this cohort than overweight and obesity. PMID:21030304
van der Ploeg, Hidde P; van Poppel, Mireille N M; Chey, Tien; Bauman, Adrian E; Brown, Wendy J
Post-gestational diabetes mellitus (GDM) women are recommended weight loss to manage increased cardio-metabolic risks. We investigated the effects of lowering diet glycaemic index (GI) on fasting blood glucose (FBG), serum lipids, body weight and composition of post-GDM women with varying fasting insulin levels (INS). Seventy-seven Asian, non-diabetic women with previous GDM (aged 20–40 years, mean BMI: 26.4±4.6?kg?m?2) were recruited. At baseline, 20 subjects with INS <2??IU?ml?1 and 18 with INS ?2??IU?ml?1 received conventional dietary recommendations (CHDR) only. CHDR emphasised energy and fat intake restriction and encouraged increase in dietary fibre intakes. Twenty-four subjects with INS <2??IU?ml?1 and 15 with INS ?2??IU?ml?1, in addition to CHDR, received low-GI education (LGI). Changes in FBG, serum lipids, body weight and body composition were evaluated. Subjects with INS <2??IU?ml?1 had similar outcomes with both diets. After 1 year, subjects with INS ?2??IU?ml?1 who received LGI education had reductions in FBG and triglycerides. Subjects who received CHDR observed increase in both FBG and triglycerides (P<0.05). Among all subjects, diet GI was lower and dietary fibre intakes were higher in LGI compared with CHDR subjects (all P<0.05). Thus, in Asian post-GDM women with normal/higher INS, adding low-GI education to CHDR improved management of FBG and triglycerides.
Ghani, R A; Shyam, S; Arshad, F; Wahab, N A; Chinna, K; Safii, N S; Nisak, M Y B; Kamaruddin, N A
Objective:Enhanced fatty-acid desaturation by stearoyl-CoA desaturase enzyme-1 (SCD1) is associated with obesity. This study determined desaturation in the cord plasma of newborns of mothers with and without gestational diabetes (GDM).Study design:Newborns of mothers with GDM (n=21) and without (control, n=22) were recruited. Cord plasma fatty-acid desaturation indices (palmitoleic/palmitic, oleic/stearic ratios) were compared, and correlated with anthropometrics and biochemical measures. A subset of very low-density lipoprotein (VLDL) desaturation indices were determined to approximate the liver SCD1 activity.Result:The total oleic/stearic index was higher in GDM, despite adjustment for cord glucose concentrations. Among GDM and controls, the oleic/stearic index correlated with cord glucose concentrations (rs=0.36, P=0.02). Both palmitoleic/palmitic and oleic/stearic indices correlated with waist circumference (r=0.47, P=0.001; r=0.37, P=0.01). The VLDL oleic/stearic index was higher in GDM.Conclusion:The elevated total oleic/stearic index suggests increased lipogenesis in GDM newborns. Factors in addition to glucose supply may influence fetal SCD1 activity. PMID:24577432
Yee, J K; Mao, C S; Ross, M G; Lee, W N P; Desai, M; Toda, A; Kjos, S L; Hicks, R A; Patterson, M E
Background Chronic hepatitis B (CHB) infection during pregnancy is associated with insulin resistance. A meta-analytic technique was used to quantify the evidence of an association between CHB infection and the risk of gestational diabetes (GDM) among pregnant women. Methods We searched PubMed for studies up to September 5th 2013. Additional studies were obtained from other sources. We selected studies using a cohort-study design and reported a quantitative association between CHB infection during pregnancy and risk of GDM. A total of 280 articles were identified, of which fourteen publications involving 439,514 subjects met the inclusion criteria. A sequential algorithm was used to reduce between-study heterogeneity, and further meta-analysis was conducted using a random-effects model. Results Ten out of the fourteen studies were highly homogeneous, indicating an association of 1.11 [the adjusted odds ratio, 95% confidence interval 0.96 - 1.28] between CHB infection during pregnancy and the risk of developing GDM. The heterogeneity of the additional four studies may be due to selection bias or possible aetiological differences for special subsets of pregnant women. Conclusions These results indicate that CHB infection during pregnancy is not associated with an increased risk of developing GDM among pregnant women except those from Iran.
The placenta is thought to have a critical role in the pathogenesis of gestational diabetes mellitus (GDM), as GDM?associated complications resolve following delivery. Placenta?specific microRNAs (miRNAs) may contribute to the pathology of the development of GDM. The aim of the present study was to evaluate whether the placenta?specific miR?518d contributes to the development of GDM. It was revealed that miR?518d expression was higher in placentas taken from patients with GDM compared with control placentas, whereas the protein levels of the predicted miR?518d target gene, peroxisome proliferator?activated receptor?? (PPAR?), were lower in placentas from patients with GDM compared with those from control subjects. It was also demonstrated that PPAR? was a direct target of miR?518d with a specific binding site at the seed sequence, which determines target specificity. In the placentas of females with GDM increased levels of miR?518d were negatively correlated with the levels of PPAR? protein. As PPAR? dysregulation may be related to the development of GDM, it is suggested that upregulation of miR?518d may be associated with the pathogenesis of GDM via an effect on the regulation of PPAR? expression. PMID:24639097
Zhao, Chun; Zhang, Ting; Shi, Zhonghua; Ding, Hongjuan; Ling, Xiufeng
Background The purpose of this article was to describe effective strategies for recruitment of Hispanic women into a prospective cohort study of modifiable risk factors for gestational diabetes mellitus (GDM). Although Hispanic women have two to four times the risk of developing GDM compared with non-Hispanic white women, few GDM prevention studies have included Hispanic women. Methods The study was conducted in the ambulatory obstetrical practices of Baystate Medical Center located in a socioeconomically and ethnically diverse city in Massachusetts. The study employed a range of strategies to recruit Hispanic women based on a review of the literature as well as prior experience with the study population. Results Over a period of 32 months, a total of 851 Hispanic prenatal care patients were recruited. Among eligible women, 52.4% agreed to participate. Participants were young (70% <25 years), with low levels of education, and on public health insurance (81.5%); 88% were unmarried. Study design features such as use of bilingual recruiters, a flexible recruitment process, training recruiters to be culturally sensitive, use of culturally tailored materials, prescreening participants, participant compensation, seeking the cooperation of clinic staff, and continuous monitoring of recruitment goals emerged as important issues influencing recruitment. Conclusions Findings suggest that investigators can successfully recruit pregnant women from ethnic minority groups of low socioeconomic status into observational studies. The study provides culturally appropriate recruitment strategies useful for practice-based settings recruiting Hispanic research participation.
OBJECTIVE This study aims to describe body composition in term infants of mothers with gestational diabetes mellitus (GDM) compared with infants of mothers with normal glucose tolerance (NGT). RESEARCH DESIGN AND METHODS This cross-sectional study included 599 term babies born at Royal Prince Alfred Hospital, Sydney, Australia. Neonatal body fat percentage (BF%) was measured within 48 h of birth using air-displacement plethysmography. Glycemic control data were based on third-trimester HbA1c levels and self-monitoring blood glucose levels. Associations between GDM status and BF% were investigated using linear regression adjusted for relevant maternal and neonatal variables. RESULTS Of 599 babies, 67 (11%) were born to mothers with GDM. Mean ± SD neonatal BF% was 7.9 ± 4.5% in infants with GDM and 9.3 ± 4.3% in infants with NGT, and this difference was not statistically significant after adjustment. Good glycemic control was achieved in 90% of mothers with GDM. CONCLUSIONS In this study, neonatal BF% did not differ by maternal GDM status, and this may be attributed to good maternal glycemic control.
Au, Cheryl P.; Raynes-Greenow, Camille H.; Turner, Robin M.; Carberry, Angela E.; Jeffery, Heather E.
The prevalence of polycystic ovaries (PCO) and clinical, endocrine, and metabolic features were investigated in women with previous gestational diabetes (GDM). Thirty-three women with a history of GDM and 48 controls were studied. Glucose and insulin secretion capacity was evaluated by means of the oral glucose tolerance test (OGTT), and insulin action was determined by means of a euglycemic insulin clamp. Compared with control women, women with previous GDM more often had significantly abnormal OGTT, a higher prevalence of PCO (39.4% vs. 16.7%; P = 0.03), higher serum concentrations of cortisol, dehydroepiandrosterone, and dehydroepiandrosterone sulfate and a greater area under the glucose curve. Women with previous GDM showed a lowered early phase insulin response to glucose and impaired insulin sensitivity, which was accounted for mainly by decreased glucose nonoxidation. They also demonstrated a significantly lower fasting serum C peptide/insulin ratio than the controls, indicating that women with previous GDM have impaired hepatic insulin extraction, which tended to be more marked among women with PCO. This may explain why women with PCO and previous GDM were significantly more hyperinsulinemic than women with normal ovaries. In conclusion, our data demonstrate that women with previous GDM often have PCO and abnormal OGTT. They are insulin resistant as a result of lowered glucose nonoxidation and show inappropriately low insulin responses to glucose, reflecting impaired beta-cell function. They also have higher adrenal androgen secretion, which may be associated with abdominal obesity. PMID:11397859
Koivunen, R M; Juutinen, J; Vauhkonen, I; Morin-Papunen, L C; Ruokonen, A; Tapanainen, J S
The Agency has recognized open and uncontrolled burning of waste and biomass as a significant source of poorly documented air toxics. Over the last 3 years, we have documented emissions from woodstoves; barrel burns of domestic waste; forest fires; wheat, grass, and rice straw fi...
Context: The performance of standard selective screening strategies for gestational diabetes mellitus (GDM) may vary according to ethnicity. Objective: We aimed to evaluate the diagnostic and prognostic performance of a selective screening tool to determine whether it accurately predicts GDM and events in women of different ethnicities. The tool selectively screens based on patients having one or more of the following risk factors (RFs): body mass index ?25 kg/m(2), age ?35 years, family history of diabetes, and personal history of GDM or macrosomia. Design and Setting: We conducted an observational prospective study at a university hospital. Participants: We included 17 344 women of European (30.9%), North African (29.6%), Sub-Saharan African (22.2%), Caribbean (8.7%), Indian-Pakistani-Sri Lankan (5.5%), and Asian (3.3%) ethnicities who were without pregravid diabetes and had singleton deliveries (2002-2010). Main Outcome Measures: We universally screened GDM and GDM-related events (pre-eclampsia, birth weight ?4000 g, or dystocia). Results: Independent of confounding factors, North African (odds ratio [OR], 1.35; 95% confidence interval [CI], 1.21-1.52; P < .001) and Indian-Pakistani-Sri Lankan (OR, 2.52; 95% CI, 2.13-3.00; P < .001) women had more GDM than Europeans, whereas Sub-Saharan African women had less (OR, 0.82; 95% CI, 0.71-0.94; P < .01). Having one or more RFs was associated with GDM among Europeans (OR, 1.45; 95% CI, 1.22-1.76), North African (OR, 1.33; 95% CI, 1.13-1.55), Sub-Saharan African (OR, 1.48; 95% CI, 1.20-1.83), and Caribbean (OR, 1.55; 95% CI, 1.12-2.14) women. Having one or more RFs was also associated with GDM-related events only in European (P < .01) and North African (P < .05) women, with the following incidences in Europeans: no GDM/no RF, 6.9%; no GDM/RF, 9.0%; GDM/no RF, 14.7%; and GDM/RF, 12.6%. Conclusion: Standard selective screening criteria were not predictive of GDM in women from India-Pakistan-Sri Lanka and Asia and were associated with GDM-related events only in European and North African women. However, the women with GDM, who were routinely treated, had a poor prognosis, even for those free of RFs. These results support universal screening, irrespective of ethnicity. PMID:24423342
Cosson, Emmanuel; Cussac-Pillegand, Camille; Benbara, Amélie; Pharisien, Isabelle; Jaber, Yahya; Banu, Isabela; Nguyen, Minh Tuan; Valensi, Paul; Carbillon, Lionel
The effectiveness of medical assistant health coaching for low-income patients with uncontrolled diabetes, hypertension, and hyperlipidemia: protocol for a randomized controlled trial and baseline characteristics of the study population
Background Many patients with chronic disease do not reach goals for management of their conditions. Self-management support provided by medical assistant health coaches within the clinical setting may help to improve clinical outcomes, but most studies to date lack statistical power or methodological rigor. Barriers to large scale implementation of the medical assistant coach model include lack of clinician buy-in and the absence of a business model that will make medical assistant health coaching sustainable. This study will add to the evidence base by determining the effectiveness of health coaching by medical assistants on clinical outcomes and patient self-management, by assessing the impact of health coaching on the clinician experience, and by examining the costs and potential savings of health coaching. Methods/Design This randomized controlled trial will evaluate the effectiveness of clinic-based medical assistant health coaches to improve clinical outcomes and self-management skills among low-income patients with uncontrolled type 2 diabetes, hypertension, or hyperlipidemia. A total of 441 patients from two San Francisco primary care clinics have been enrolled and randomized to receive a health coach (n?=?224) or usual care (n?=?217). Patients participating in the health coaching group will receive coaching for 12 months from medical assistants trained as health coaches. The primary outcome is a change in hemoglobin A1c, systolic blood pressure, or LDL cholesterol among patients with uncontrolled diabetes, hypertension and hyperlipidemia, respectively. Self-management behaviors, perceptions of the health care team and clinician, BMI, and chronic disease self-efficacy will be measured at baseline and after 12 months. Clinician experience is being assessed through surveys and qualitative interviews. Cost and utilization data will be analyzed through cost-predictive models. Discussion Medical assistants are an untapped resource to provide self-management support for patients with uncontrolled chronic disease. Having successfully completed recruitment, this study is uniquely poised to assess the effectiveness of the medical assistant health coaching model, to describe barriers and facilitators to implementation, and to develop a business case for sustainability. Trial registration ClinicalTrials.gov identifier NCT-01220336
Introduction The true prevalence of gestational diabetes mellitus (GDM) is unknown. The objective of this study was 1) to provide the most current GDM prevalence reported on the birth certificate and the Pregnancy Risk Assessment Monitoring System (PRAMS) questionnaire and 2) to compare GDM prevalence from PRAMS across 2007–2008 and 2009–2010. Methods We examined 2010 GDM prevalence reported on birth certificate or PRAMS questionnaire and concordance between the sources. We included 16 states that adopted the 2003 revised birth certificate. We also examined trends from 2007 through 2010 and included 21 states that participated in PRAMS for all 4 years. We combined GDM prevalence across 2-year intervals and conducted t tests to examine differences. Data were weighted to represent all women delivering live births in each state. Results GDM prevalence in 2010 was 4.6% as reported on the birth certificate, 8.7% as reported on the PRAMS questionnaire, and 9.2% as reported on either the birth certificate or questionnaire. The agreement between sources was 94.1% (percent positive agreement = 3.7%, percent negative agreement = 90.4%). There was no significant difference in GDM prevalence between 2007–2008 (8.1%) and 2009–2010 (8.5%, P = .15). Conclusion Our results indicate that GDM prevalence is as high as 9.2% and is more likely to be reported on the PRAMS questionnaire than the birth certificate. We found no statistical difference in GDM prevalence between the 2 phases. Further studies are needed to understand discrepancies in reporting GDM by data source.
Kim, Shin Y.; Sharma, Andrea J.
Objective The aim of this study was to determine the effect of gestational diabetes mellitus (GDM) on fetal insulin resistance or ?-cell function in Chinese pregnant women with GDM. Measurements Maternal fasting blood and venous cord blood samples (reflecting fetal condition) were collected in 65 well-controlled Chinese GDM mothers (only given dietary intervention) and 83 control subjects. The insulin, glucose and proinsulin concentrations of both maternal and cord blood samples were measured, and the homeostasis model assessment of insulin resistance (HOMA-IR) and the proinsulin-to-insulin ratios (an indicator of fetal ?-cell function) were calculated in maternal and cord blood respectively. Results Both maternal and fetal levels of insulin, proinsulin and HOMA-IR but not proinsulin-to-insulin ratios were significantly higher in the GDM group than in the control group (maternal insulin, 24.8 vs. 15.4 µU/mL, P?=?0.004, proinsulin, 23.3 vs. 16.2 pmol/L, P?=?0.005, and HOMA-IR, 5.5 vs. 3.5, P?=?0.041, respectively; fetal: insulin, 15.1 vs. 7.9 µU/mL, P<0.001, proinsulin, 25.8 vs. 15.1 pmol/L, P?=?0.015, and HOMA-IR, 2.8 vs. 1.4, P?=?0.017, respectively). Fetal HOMA-IR but not proinsulin-to-insulin ratios was significantly correlated to maternal HOMA-IR (r?=?0.307, P?=?0.019), in the pregnant women with GDM. Conclusions Fetal insulin resistance was higher in Chinese pregnant women with GDM than control subjects, and correlated with maternal insulin resistance.
Wang, Qiuwei; Huang, Ruiping; Yu, Bin; Cao, Fang; Wang, Huiyan; Zhang, Ming; Wang, Xinhong; Zhang, Bin; Zhou, Hong; Zhu, Ziqiang
Very little is known about the effects of gestational diabetes mellitus (GDM) on lactation and milk components. Recent reports suggested that hyperglycemia during pregnancy was associated with altered breast milk immune factors. Human milk oligosaccharides (HMOs) and N-glycans of milk immune-modulatory proteins are implicated in modulation of infant immunity. The objective of the current study was to evaluate the effect of GDM on HMO and protein-conjugated glycan profiles in breast milk. Milk was collected at 2 wk postpartum from women diagnosed with (n = 8) or without (n = 16) GDM at week 24-28 in pregnancy. Milk was analyzed for HMO abundances, protein concentrations, and N-glycan abundances of lactoferrin and secretory immunoglobulin A (sIgA). HMOs and N-glycans were analyzed by mass spectrometry and milk lactoferrin and sIgA concentrations were analyzed by the Bradford assay. The data were analyzed using multivariate modeling confirmed with univariate statistics to determine differences between milk of women with compared with women without GDM. There were no differences in HMOs between milk from women with vs. without GDM. Milk from women with GDM compared with those without GDM was 63.6% lower in sIgA protein (P < 0.05), 45% higher in lactoferrin total N-glycans (P < 0.0001), 36-72% higher in lactoferrin fucose and sialic acid N-glycans (P < 0.01), and 32-43% lower in sIgA total, mannose, fucose, and sialic acid N-glycans (P < 0.05). GDM did not alter breast milk free oligosaccharide abundances but decreased total protein and glycosylation of sIgA and increased glycosylation of lactoferrin in transitional milk. The results suggest that maternal glucose dysregulation during pregnancy has lasting consequences that may influence the innate immune protective functions of breast milk. PMID:24047700
Smilowitz, Jennifer T; Totten, Sarah M; Huang, Jincui; Grapov, Dmitry; Durham, Holiday A; Lammi-Keefe, Carol J; Lebrilla, Carlito; German, J Bruce
Gestational diabetes mellitus (GDM) is associated with a wide range of tissue-specific changes depending on the quality of glycemic control of the mothers. Here we tested the hypothesis that GDM is associated with alterations in the human term placenta proteome. For this aim, two different approacheswere employed. The placenta homogenates from 20 healthy subjects and those from 20 GDM pregnant women were pooled. The two samples thus obtained were analyzed by matrix-assisted laser desorption/ionization mass spectrometry (MALDI-MS) and the proteins detected were tentatively identified by comparison of their molecular weight with the Human Protein Reference Database, restricting the search to the species expressed in the placenta tissue. However this approach led to misleading results: in fact, an in deep analysis of the spectra and tandem mass spectrometry (MS/MS) measurements of the digestion products from the protein detected, unequivocally proved that the species observed are maternal and fetal globins. Consequently, the two pools were analyzed by 1D sodium dodecyl sulphate polyacrylamide gel electrophoresis; the different bands obtained were digested by trypsin and the digestion products were analyzed by MALDI-MS; the protein identification was carried out by comparison of the peptide mass fingerprint with databases. Only modest quantitative differences were observed between the placenta protein profiles of healthy and GDM subjects, indicating that GDM, if well controlled, induces only minor changes in the placental proteome. One example of differently expressed proteins in the placenta homogenate pool from GDM and the controls was the SRRM1 protein, a member of the serine-arginine protein kinase family; for GDM samples, the MALDI spectrum of its digestion products showed the presence of molecular species attributable to glycation and glyco-oxidation processes. PMID:24308201
Lapolla, Annunziata; Porcu, Simona; Roverso, Marco; Desoye, Gernot; Cosma, Chiara; Nardelli, Giovanni Battista; Bogana, Gianna; Carrozzini, Monica; Traldi, Pietro
Gestational diabetes mellitus (GDM) is a common complication of pregnancy that is characterized by glucose intolerance, leads to dyslipidemia, and is aggravated by obesity. Cholesterol is taken up by the placenta as part of lipoproteins through the scavenger receptor class B type I receptor (SRBI), low-density lipoprotein receptor (LDLR), and very low density lipoprotein receptor (VLDLR), and its efflux is then mediated by ABCA1 and ABCG1. PCSK9 is involved in the degradation of LDLR and VLDLR. The goal of this study was to evaluate the impact of GDM and prepregnancy body mass index (BMI) on cholesterol transport through the modulation of the expression of several key players. Human full-term placenta, maternal, and venous cord blood samples were obtained at delivery from normal-weight women without GDM (n = 10), normal-weight women with GDM (n = 6), and overweight/obese women with GDM (n = 6). Lipids (total cholesterol, high-density lipoprotein, low-density lipoprotein, triglycerides, free fatty acids, apolipoprotein A1, apolipoprotein B100) levels were evaluated in blood samples. Messenger RNA and protein expression levels (LDLR, VLDLR, SRBI, ABCA1, ABCG1, proprotein convertase subtilisin/kexin type 9, liver x receptors, peroxisome proliferator-activated receptors) were assessed in human full-term placenta, respectively, by real-time RT-PCR and Western blots. Lipoprotein lipase activity was evaluated using a commercial kit on tissue homogenates. Overall, our study demonstrates that GDM affects the maternal and neonatal lipid profiles as well as different key players of placental cholesterol transfer from the maternal to the fetal circulation, depending on the maternal BMI. These changes could affect the fetal metabolism and predispose the fetus to future metabolic diseases. PMID:23221398
Dubé, Evemie; Ethier-Chiasson, Maude; Lafond, Julie
Objective: To determine the association between high hemoglobin with gestational diabetes mellitus (GDM) and preeclampsia in pregnant women in the first trimester. Methods: This cohort study was conducted among 973 pregnant women who started their antenatal booking in the first trimester (first 14 weeks of gestation). Women with first-visit high Hb levels (> 12.5 g/L) on first visit of the pregnancy period were selected as the study group and were compared with those who had normal Hb value (< 12.5 g/L) as controls. Adverse pregnancy outcomes including preeclampsia and GDM were compared between the two groups. Results: Complete obstetric records of 448 women with high Hb levels and 486 women with normal Hb levels were studied. The follow up showed that the women with high Hb levels had significantly higher rates of preeclampsia and GDM than those with normal Hb levels; the risks were 5.4 (95% cl; 2.8 to 10.5) and 3.7 (95%cl; 2.2 to 6.4), respectively. Conclusion: This study found that high Hb in the first trimester is associated with higher risk of subsequent preeclampsia and gestational diabetes mellitus (GDM). PMID:24353673
Mehrabian, Ferdous; Hosseini, Seyyed Mohammad
Objective: To determine the association between high hemoglobin with gestational diabetes mellitus (GDM) and preeclampsia in pregnant women in the first trimester. Methods: This cohort study was conducted among 973 pregnant women who started their antenatal booking in the first trimester (first 14 weeks of gestation). Women with first-visit high Hb levels (> 12.5 g/L) on first visit of the pregnancy period were selected as the study group and were compared with those who had normal Hb value (< 12.5 g/L) as controls. Adverse pregnancy outcomes including preeclampsia and GDM were compared between the two groups. Results: Complete obstetric records of 448 women with high Hb levels and 486 women with normal Hb levels were studied. The follow up showed that the women with high Hb levels had significantly higher rates of preeclampsia and GDM than those with normal Hb levels; the risks were 5.4 (95% cl; 2.8 to 10.5) and 3.7 (95%cl; 2.2 to 6.4), respectively. Conclusion: This study found that high Hb in the first trimester is associated with higher risk of subsequent preeclampsia and gestational diabetes mellitus (GDM).
Mehrabian, Ferdous; Hosseini, Seyyed Mohammad
During gestation, heterozygous C57BLKS/J-Lepr(db/+) mice develop spontaneous gestational diabetes mellitus (GDM), and the newborn fetuses are macrosomic compared with offspring from wild-type (+/+) mothers. To investigate the effects of the leptin receptor mutation on maternal metabolism and fetal growth during pregnancy, we studied +/+, db/+, and db/+ transgenic mice that overexpress the human GLUT4 gene two- to three-fold (db/+TG6). During pregnancy, fasting plasma glucose and hepatic glucose production were twofold greater in db/+ than +/+ mice, despite similar insulin levels. In skeletal muscle, insulin-stimulated tyrosine phosphorylation was decreased in pregnant +/+ mice, and even more so in db/+ mice: insulin receptor beta (IR-beta), +/+ 34%, db/+ 57% decrease, P<0.05; insulin receptor substrate 1 (IRS-1), +/+ 44%, db/+ 61% decrease, P<0.05; and phosphoinositol (PI) 3-kinase (p85alpha), +/+ 33%, db/+ 65% decrease, P<0.05. Overexpression of GLUT4 in db/+TG6 mice markedly improved glucose-stimulated insulin secretion, by 250%, and increased IRbeta, IRS-1, and p85alpha phosphorylation twofold, despite no change in concentration of these proteins. Plasma leptin concentration increased 40-fold during pregnancy, from 2.2+/-0.5 to 92+/-11 ng/ml and 3.6+/-0.1 to 178+/-34 ng/ml in +/+ and db/+ mice, respectively (P<0.01), but was increased to only 23+/-3 ng/ml in pregnant db/+TG6 mice (P<0.001). Maternal fat mass and energy intake were greater in db/+ mice, and fat mass was reduced by GLUT4 overexpression, independent of food intake. Fetal body weight was increased by 8.1 and 7.9% in db/+ and db/+TG6 mothers, respectively (P<0.05), regardless of fetal genotype, whereas fetuses from db/+TG8 mothers (four- to fivefold overexpression) weighed significantly less compared with pups from +/+ or db/+ mothers (P<0.05). These results suggest that the single mutant db allele effects susceptibility to GDM through abnormalities in insulin receptor signaling, defective insulin secretion, and greater nutrient availability. GLUT4 overexpression markedly improves insulin-signaling in GDM, resulting in increased insulin secretion and improved glycemic control. However, maternal hyperglycemia appears not to be the sole cause of fetal macrosomia. These data suggest that GDM is associated with defects in insulin receptor signaling in maternal skeletal muscle, and this may be an important factor provoking maternal and fetal perinatal complications. PMID:10331411
Ishizuka, T; Klepcyk, P; Liu, S; Panko, L; Liu, S; Gibbs, E M; Friedman, J E
To investigate FoxO1 expression in term placenta and omental adipose tissue between pregnant women with gestational diabetes mellitus (GDM) and those with normal glucose tolerance (control). The relationship between FoxO1 and tumor necrosis factor-? (TNF-?) in cultured trophoblast cells was also investigated.Maternal serum, term placenta and omental adipose tissue were collected from the GDM group (n=20) and the control group (n=20). Serum TNF-?, IL-6 and IL-1? concentration was measured. Fasting plasma glucose (FPG) and fasting serum insulin (FIN) were investigated to calculate an insulin resistance index (HOMA-IR). Immunohistochemistry (IHC) was performed to examine the localization of FoxO1 protein in the placenta and adipose tissue. Real time RT-PCR and Western blotting were used to compare the levels of FoxO1 and TNF-? gene and protein between the 2 groups. Trophoblast cells (HTR-8/SVneo and BeWo cells) were cultured to detect the regulation of TNF-? on FoxO1 expression. The effect of FoxO1 knockdown on TNF-? stimulated expression of pro-inflammatory cytokines was also investigated.Compared to control group, Serum TNF-?, IL-6 and IL-1? concentration was higher in GDM group. FoxO1 was expressed in both the placenta and omental adipose tissue. The gene and protein expression of FoxO1 and TNF-? was higher in the GDM group than the control group in both tissues. The expression of FoxO1 in the placenta was positively correlated with HOMA-IR and TNF-?. Stimulation of TNF-? gene increased the expression of FoxO1 in cultured trophoblast cells. FoxO1 deletion in these cells attenuated TNF-?-induced expression of the pro-inflammatory cytokines IL-1? and IL-6.FoxO1 has a potential role as a pro-inflammatory factor in GDM, and may be involved in the development of IR through interaction with TNF-?. PMID:24839223
Xu, Y; Jin, B; Sun, L; Yang, H; Cao, X; Zhang, G
... Hibert EL, Mason SM, Vadnais MA, Hu FB, et al. Gestational Age, Infant Birth Weight, and Subsequent ... risk women. In a previous study by Lykke et al based on vital statistics registry data from ...
Background Type 1 diabetes (T1D) is an autoimmune disease, while type 2 (T2D) and gestational diabetes (GDM) are considered metabolic disturbances. In a previous study evaluating the transcript profiling of peripheral mononuclear blood cells obtained from T1D, T2D and GDM patients we showed that the gene profile of T1D patients was closer to GDM than to T2D. To understand the influence of demographical, clinical, laboratory, pathogenetic and treatment features on the diabetes transcript profiling, we performed an analysis integrating these features with the gene expression profiles of the annotated genes included in databases containing information regarding GWAS and immune cell expression signatures. Methods Samples from 56 (19 T1D, 20 T2D, and 17 GDM) patients were hybridized to whole genome one-color Agilent 4x44k microarrays. Non-informative genes were filtered by partitioning, and differentially expressed genes were obtained by rank product analysis. Functional analyses were carried out using the DAVID database, and module maps were constructed using the Genomica tool. Results The functional analyses were able to discriminate between T1D and GDM patients based on genes involved in inflammation. Module maps of differentially expressed genes revealed that modulated genes: i) exhibited transcription profiles typical of macrophage and dendritic cells; ii) had been previously associated with diabetic complications by association and by meta-analysis studies, and iii) were influenced by disease duration, obesity, number of gestations, glucose serum levels and the use of medications, such as metformin. Conclusion This is the first module map study to show the influence of epidemiological, clinical, laboratory, immunopathogenic and treatment features on the transcription profiles of T1D, T2D and GDM patients.
Aims. This paper aims to evaluate characteristics and pregnancy outcomes in women prior classified normal by Carpenter and Coustan criteria (old criteria) and now gestational diabetes (GDM) by the IADPSG criteria. Methods. Retrospective analysis of 6727 pregnancies is used. Using the old criteria, 222 had GDM (old GDM). Using the IADPSG criteria, 382 had GDM of which 160 had a normal glucose tolerance with the old criteria (new GDM). We compared the new GDM group with the old GDM group and women with normal glucose tolerance with both criteria (NGT group, 6345). Results. New GDM women were younger (31.6 ± 4.7 versus 33.3 ± 7.2 years, P = 0.010) than old GDM women. Caesarean section was performed in 30.5% of new GDM, in 32.4% of old GDM (P = 0.706), and in 23.3% of NGT women (P = 0.001). Large for gestational age occurred in 10.8% of new GDM, in 13.8% of old GDM (P = 0.473), and in 9.0% of NGT women (P = 0.099). Shoulder dystocia occurred in 3.9% of new GDM, in 3.2% of old GDM (P = 0.736), and in 1.4% of NGT women (P = 0.007). Conclusion. Using the IADPSG criteria, more women are identified as having GDM, and these women carry an increased risk for adverse gestational outcome compared to women without GDM.
Benhalima, Katrien; Hanssens, Myriam; Devlieger, Roland; Verhaeghe, Johan; Mathieu, Chantal
We have conducted a systematic universal screening for gestational diabetes mellitus (GDM) since 2008, following the criteria outlined by the International Association of Diabetes and Pregnancy Study Group (IADPSG) since 2011. However, we recently replaced the IADPSG standards with those established by the Belgian French Language Gynecologists and Obstetricians Group (GGOLFB). These new criteria indicate GDM when fasting plasma glucose (FPG) is ?0·92 g/l at the beginning of pregnancy or when an orally provoked hyperglycaemia test (75 g of glucose) between the twenty-fourth and twenty-eighth week results in an FPG of ?0·92 g/l and/or ?1·80 g/l after 1 hour and/or ?1·53 g/l after 2 hours. The goal of this retrospective study was to evaluate the incidence of GDM, neonatal outcomes, and the use of insulin therapy 21 months post-implementation of the IADPSG criteria within our centre. A total of 393 patients were diagnosed with GDM from January 2009 to December 2012. After applying the new criteria, the incidence of GDM rose significantly from 8 to 23% (P<0·0001). However, there were no significant changes in the proportion of GDM patients requiring insulin therapy (34·2% versus 34·7%) or the rate of foetal large for gestational age (11·2% versus 8·8%). In addition, the ?90% percentile decreased non-significantly from 96·3±0·6% to 94·3±0·70% (P?=?0·057), whereas the lower quartiles and the proportion of cesarean deliveries (27·0% versus 25·6%) did not change significantly. Therefore, non-targeted screening significantly increased the incidence of GDM in our centre without significantly decreasing large for gestational age or the number of cesarean deliveries. PMID:24635392
Oriot, P; Selvais, P; Radikov, J; Jacobs, J L; Gilleman, U; Loumaye, R; Fernandez, C
Glycosylated hemoglobin and glycosylated serum protein have been suggested as tools for evaluation of long- and short-term glycemic control, respectively. Twenty-six patients with gestational diabetes were prospectively studied to determine the relationship of glycosylated hemoglobin and glycosylated serum protein to metabolic control. To verify the accuracy of blood glucose data, a memory-based reflectance meter was used for subjects with gestational diabetes who tested 6.5 +/- 1 times per day. Our analysis revealed that despite a statistically positive correlation between glycosylated hemoglobin, glycosylated serum protein, and verified data, their use as a clinical tool is limited because of their poor predictability. PMID:3631170
Brustman, L; Langer, O; Engel, S; Anyaegbunam, A; Mazze, R
There is a paucity of information on perinatal data regarding gestational diabetes mellitus (GDM) by the new criteria from a real experience because the number of health care associations implementing the new criteria is still limited. The aim of this study is to investigate perinatal features of the new criteria-defined GDM. We reviewed a total of 995 women with singleton pregnancy that underwent GDM screening followed by a diagnostic oral glucose tolerance test (OGTT). All women found to have GDM underwent self-monitoring of blood glucose measurements as well as dietary management. Insulin treatment was initiated when dietary treatment did not achieve the glycemic goal. Of the 995 women, 141 had GDM (14.2%): 104 with one, 27 with two, and 10 with three abnormal OGTT values. Women with two or three abnormal OGTT values (2/3-AV) needed insulin treatment more frequently than those with one abnormal OGTT value (1-AV) (70.3% vs 23.1%, P < 0.0001). After adjustment for age, pregravid overweight, gestational weeks at diagnosis, a first-degree family history of diabetes was correlated with the implementation of insulin treatment in women with 1-AV (adjusted odds ratio 3.9; 95% Confidence Interval 1.7-9.2; P = 0.001). When compared perinatal outcomes between women with normal glucose tolerance and GDM, fetal growth and the occurrence of pregnancy-induced hypertension were comparable between the two groups. Our data suggest that the IADPSG-defined GDM with 1-AV show less severe glucose intolerance, but might be at risk of insulin requirement when a first-degree family history of diabetes exists. PMID:24430729
Ikenoue, Satoru; Miyakoshi, Kei; Saisho, Yoshifumi; Sakai, Kensuke; Kasuga, Yoshifumi; Fukutake, Marie; Izumi, Yoko; Matsumoto, Tadashi; Minegishi, Kazuhiro; Yoshimura, Yasunori
An evaluation of Croi MyAction community lifestyle modification programme compared to standard care to reduce progression to diabetes/pre-diabetes in women with prior gestational diabetes mellitus (GDM): study protocol for a randomised controlled trial.
BACKGROUND: Universal screening using the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria has identified a prevalence of gestational diabetes mellitus (GDM) of 12.4% in women living in Ireland. Women with prior GDM are at increased risk of developing type 2 diabetes later in life. A number of risk factors linked to the development of type 2 diabetes are potentially modifiable through lifestyle and behaviour changes, and medical management. No previous Irish studies have adequately investigated the efficacy of lifestyle intervention programmes in reducing these risk factors in women with prior GDM. Through a two-group, parallel randomised controlled trial (RCT), this study aims to assess the clinical impact, cost-effectiveness and psychological experience of the Croi MyAction intensive lifestyle modification programme for women with prior GDM. METHODS: A total of 54 women with a history of GDM and persistent post-partum glucose dysfunction (impaired glucose tolerance (IGT) or impaired fasting glucose (IFG)), are randomly assigned to a control arm (n = 27) or to the Croi MyAction intervention group (n = 27). The control arm receives usual health care advice - written information on diet and lifestyle changes for reducing diabetes risks and visits with general practitioners as required. The intervention group receives usual health care as per the control group in addition to attending a 12-week intensive lifestyle modification programme known as Croi MyAction. Croi MyAction involves 2.5 hour sessions once per week (for 12 weeks) comprising a group exercise programme, group health promotion or education seminars, and one-to-one meetings with a multidisciplinary health care team to personalise risk factor reductions. Randomisation and allocation to the intervention arms is carried out by an independent researcher, ensuring that the allocation sequence is concealed from study researchers until the interventions are assigned. The primary analysis is based on glucose dysfunction, comparing a mean reduction in fasting plasma glucose (FPG) levels on a 75 gram oral glucose tolerance test (OGTT) in the two groups at a one-year, post-intervention follow-up. The trial is funded by the Irish Health Research Board (HRB). Ethics approval was obtained on 27 March 2012 from the Clinical Research Ethics Committee, Galway University Hospitals, Health Service Executive of Ireland (Ref: C.A.691).Trial registration: Current Controlled Trials ISRCTN41202110. PMID:23782471
Infanti, Jennifer J; Dunne, Fidelma P; O Dea, Angela; Gillespie, Paddy; Gibson, Irene; Glynn, Liam G; Noctor, Eoin; Newell, John; McGuire, Brian E
BACKGROUND: Pregnancy is a period in the life of women that is often associated with decreased daily physical activity and\\/or exercise. However, maintaining adequate levels of daily physical activity during pregnancy is important for mother and child. Studies suggest that moderate daily physical activity and exercise during pregnancy are associated with reductions in the risk of gestational diabetes mellitus (GDM).
Nicolette Oostdam; Mireille NM van Poppel; Elisabeth MW Eekhoff; Maurice GAJ Wouters; Willem van Mechelen
Caudal regression syndrome is a rare congenital malformation with varying degrees of early gestational developmental failure. It is also known as sacral agenesis or caudal dysplasia. The cause of this malformation is thought to be defects in neuralization around the 28th day of the gestational period. Although maternal uncontrolled diabetes, genetic predisposition and vascular hypoperfusion are the possible risk factors, actual pathogenesis is unclear. CRS is generally diagnosed at prenatal assessment, but also a varying number of newborns with some degree of anomaly may be presented. In our case, we diagnosed a caudal regression syndrome fetus early in the second trimester. Determination of the pathology early in the gestational age gives parents a chance for termination of pregnancy. Although diabetes mellitus is the major risk factor for CRS, as in our case, sporadic presentations may occur. So clinicians should consider CRS when CRL is shorter than expected and incomplete vertebral ossification is observed both in gray scala and 3D imaging ultrasonography.
Yeniel, Ahmet Ozgur; Ergenoglu, Ahmet Mete; Sagol, Sermet
Background: Gestational diabetes mellitus (GDM) is associated with increased risk of mortality and morbidity for pregnant women and newborns. Identifying pregnant women with risk factors for GDM based on the clinical suspicion is a popular approach. However, the effectiveness of the use of a structured checklist of risk factors is yet to be evaluated. This study assessed the effectiveness of a structured checklist of risk factors in identifying pregnant women at risk of GDM at the University College Hospital, Ibadan. Materials and Methods: It was a comparative cross-sectional study implemented in two phases. The first phase (Group A) of the study was a prospective study that involved 530 pregnant women who presented at the booking clinic. A structured checklist containing risk factors was used to identify women at the risk of GDM. The second phase (Group B) was a retrospective study of 530 pregnant women managed 2 years previously who were selected by systematic random technique. Results: The mean age, gestational age at booking, gestational age at delivery and birth weight were 30.2 ± 5.2 years, 21 ± 10.8 weeks, 38.7 ± 2.7 weeks and 3.1 ± 0.7 kg respectively. The prevalence of GDM in Group A and B were 4.9% and 1.6% respectively ( P < 0.05). There was about three fold increase in identification of women at risk of GDM by use of a checklist. Conclusion: Identification of women at risk of GDM was approximately 3-4 fold higher with the use of checklist of risk factors. Exhaustive clinical identification with a checklist of risk factors for GDM should be encouraged. PMID:24909476
Fawole, A O; Ezeasor, C; Bello, F A; Roberts, A; Awoyinka, B S; Tongo, O; Adeleye, J O; Ipadeola, A
Objective To look into the glucose tolerance test characteristics and determine complications in non-gestational diabetes pregnant subjects. Methods From 2006 to 2009 all non-gestational diabetes mellitus (non-GDM) pregnant women who delivered macrosomia at the North Australia's Townsville Hospital were retrospectively reviewed by extracting data from clinical record. Glucose tolerance tests results were analysed in the light of an earlier diagnosis of non-GDM. Results Ninety-one non-GDM mothers with macrosomia were studied and compared with 41 normoglycemic subjects without macrosomia. Of the subjects with non-GDM macrosomia, 45 (49.4%) had normal 50 g glucose challenge test (GCT) without further testing, another 8 (8.8%) had abnormal GCT but normal 75 g oral glucose tolerance test (OGTT). A total of 4 (4.4%) subjects had normal GCT and OGTT. Interestingly, 14 out of 16 (87.5%) subjects who were tested with OGTT owing to past history of macrosomia had normal results but delivered macrosomic babies. Only 12 subjects had both GCT and OGTT, the rest of the cohort had either of the two tests. Subjects with non-GDM macrosomia had higher frequency of neonatal hypoglycaemia 34% as compared to 10% in non-macrosomic babies (P=0.003). Other feto-maternal complications were similar in both groups. Conclusions No significant pattern of glucose tolerance characteristics was identified in non-GDM mothers with macrosomic babies. In spite of being normoglycemic significant neonatal hypoglycaemia was recorded in non-GDM macrosomic babies. Further prospective studies on a larger population are needed to verify our findings.
Aranha, Algenes; Malabu, Usman H; Vangaveti, Venkat; Reda, Elham Saleh; Tan, Yong Mong; Sangla, Kunwarjit Singh
Context The Activin A-Follistatin system has emerged as an important regulator of lipid and glucose metabolism with possible repercussions on fetal growth. Objective To analyze circulating activin A, follistatin and follistatin-like-3 (FSTL3) levels and their relationship with glucose metabolism in pregnant women and their influence on fetal growth and neonatal adiposity. Design and methods A prospective cohort was studied comprising 207 pregnant women, 129 with normal glucose tolerance (NGT) and 78 with gestational diabetes mellitus (GDM) and their offspring. Activin A, follistatin and FSTL3 levels were measured in maternal serum collected in the early third trimester of pregnancy. Serial fetal ultrasounds were performed during the third trimester to evaluate fetal growth. Neonatal anthropometry was measured to assess neonatal adiposity. Results Serum follistatin levels were significantly lower in GDM than in NGT pregnant women (8.21±2.32 ng/mL vs 9.22±3.41, P?=?0.012) whereas serum FSTL3 and activin A levels were comparable between the two groups. Serum follistatin concentrations were negatively correlated with HOMA-IR and positively with ultrasound growth parameters such as fractional thigh volume estimation in the middle of the third trimester and percent fat mass at birth. Also, in the stepwise multiple linear regression analysis serum follistatin levels were negatively associated with HOMA-IR (??=??0.199, P?=?0.008) and the diagnosis of gestational diabetes (??=??0.138, P?=?0.049). Likewise, fractional thigh volume estimation in the middle of third trimester and percent fat mass at birth were positively determined by serum follistatin levels (??=?0.214, P?=?0.005 and ??=?0.231, P?=?0.002, respectively). Conclusions Circulating follistatin levels are reduced in GDM compared with NGT pregnant women and they are positively associated with fetal growth and neonatal adiposity. These data suggest a role of the Activin-Follistatin system in maternal and fetal metabolism during pregnancy.
Naf, Silvia; Escote, Xavier; Ballesteros, Monica; Yanez, Rosa Elena; Simon-Muela, Inmaculada; Gil, Pilar; Albaiges, Gerard
Purpose Patients with gestational diabetes mellitus (GDM) have been reported to exhibit the same genetic susceptibility as that observed in those with type 2 diabetes mellitus (T2DM). Recent polymorphism studies have shown that several genes are related to T2DM and GDM. The aim of this study was to examine whether certain candidate genes, previously shown to be associated with T2DM, also offer a specific genetic predisposition to GDM. Materials and Methods The current study was conducted in 136 Korean pregnant women, who gave birth at Gil Hospital, from October 2008 to May 2011. These study subjects included 95 subjects with GDM and 41 non-diabetic controls. We selected the specific genes of PPAR?2, IGF2BP2, and KCNQ1 for study and amplified them using the polymerase chain reaction. This was followed by genotyping for single nucleotide polymorphisms. We then compared the genotype frequencies between patients with GDM and non-diabetic controls using the ?2 test. We obtained and analyzed clinical information using Student's t-test, and statistical analyses were conducted using logistic regression with SPSS Statistics software, version 19.0. Results Significant differences were observed in maternal age, body mass index, weight gain and weight at time of delivery between the groups compared. Among pregnant women, polymorphisms in PPAR?2 and IGF2BP2 were shown to be highly correlated with GDM occurrence, whereas no correlation was found for KCNQ1 polymorphisms. Conclusion Our results indicated that genetic polymorphisms could also be of value in predicting the occurrence and diagnosis of GDM.
Chon, Seung Joo; Cho, Nu Ree; Min, Dle Lae; Hwang, Yu Jin; Mamura, Mizuko
We examined whether pregnant women with a normal glucose tolerance test (OGTT) by New Zealand (NZ) criteria, but elevated HbA1c are a clinically important group with gestational diabetes (GDM). Eighty women with a normal OGTT and HbA1c > 40 mmol/mol, compared with others with GDM, had a significantly higher BMI and were more likely Pacific. Pharmacotherapy was prescribed in 77.5%. Post-partum OGTT and HbA1c were abnormal in 9/43(20.9%) and 27/42(64.3%), respectively. In 1090 women being screened for GDM by OGTT, most women with GDM had an HbA1c ? 40 mmol/mol. In the 22.1% of women with an HbA1c > 40 mmol/mol, the OGTT was normal in 61.8%. For centres using HbA1c to screen for underlying prediabetes/diabetes, these data show that a result >40 mmol/mol identifies women who are likely to require pharmacotherapy. An OGTT is still recommended to diagnose GDM, but these data raise questions about a possible role for HbA1c in high risk women with a nondiagnostic OGTT. PMID:24359339
Rowan, Janet A; Budden, Astrid; Sadler, Lynn C
Metformin is an effective insulin sensitizer treating type 2 diabetes mellitus. However, the functional consequences of metformin administration throughout pregnancy on gestational diabetes mellitus (GDM) with polycystic ovary syndrome (PCOS) have not been assessed. We therefore performed a meta-analysis and system review to determine the effect of metformin on GDM in PCOS. A meta-analysis was performed on the published studies before December, 2013. Meta-analysis examined whether metformin could reduce GDM occurrence in PCOS with a fixed effect model. The odds ratio (OR) with 95% confidence interval (95% CI) was calculated to estimate the strength of association. A total of 13 studies including 5 RCTs and 8 non-RCTs were enrolled. Ultimately, effectiveness analysis demonstrated that, in total, there was no significant availability of metformin on GDM in PCOS in contrast to placebo (OR?=?1.07, 95% CI 0.60–1.92) in RCTs and significant availability of metformin on GDM (OR?=?0.19, 95% CI 0.13–0.27) was indicated in non-RCTs. In summary, according to the results of our meta-analysis, strictly, metformin did not significantly effect on GDM with PCOS, though more multicenters RCTs still need to be investigated.
Zhuo, Zhihong; Wang, Aiming; Yu, Huimin
Urinary tract infections are accounted to serious complications, particularly in pregnancy complicated by diabetes. In this paper, cases of pregnancy have been analysed, affected by diabetes of type 1 and type 2, according to status of metabolic control and the type of urinary tract infection. In a group of 217 diabetic pregnant women, the incidence of urinary tract infections was 26.7%, 19.0% of them being recurrent. In the group with bad metabolic control, infections were statistically more frequent (17.4% vs. 37.3%, p = 0.001); bacteriuria without clinical demonstrations 10.4% vs. 19.6% (p > 0.05), pyelonephritis (7.0% vs. 17.7%, p = 0.001). The following types of pathogenic bacteria were found: E. coli--44.4%, Staphylococcous--28.9%, Enterococcocus--18.7%. A high frequency of Gram (+) bacteria was observed. A good metabolic control without chronic diabetic complications correlated with less frequent infections of the urinary tract. PMID:10615813
Sobczak, M; Wilczy?ski, J; Cypryk, K; Woch, G
Objective. To study fetal lung maturity (FLM) as determined by amniotic fluid (AF) tests in diabetic pregnancies (DP) under euglycemic metabolic control, in comparison with matched controls (C).Patients and methods. From 514 consecutive pregnancies where amniocentesis was performed for FLM assessment, we selected 45 glycemic controlled DP. Nineteen DP were Type I (IDDM) and 26 pregnancies were diagnosed Type III
Juan J. Piazze; Maurizio M. Anceschi; Luca Maranghi; Valeria Brancato; Emanuela Marchiani; Ermelando V. Cosmi
Background Fibroblast growth factor 19 (FGF19) and FGF21 are considered to be novel adipokines that improve glucose tolerance and insulin sensitivity. In the current study, we investigated serum FGF19 and FGF21 levels in patients with gestational diabetes mellitus (GDM) and explored their relationships with anthropometric and endocrine parameters. Method Serum FGF19 and FGF21 levels were determined by enzyme-linked immunosorbent assay (ELISA) in patients with GDM (n?=?30) and healthy pregnant controls (n?=?60) matched for maternal and gestational age. Serum FGF19 and FGF21 levels were correlated with anthropometric, metabolic, and endocrine parameters. Results Circulating levels of FGF19 were significantly reduced in patients with GDM relative to healthy pregnant subjects, whereas FGF21 levels were increased in GDM patients. Serum FGF19 levels independently and inversely correlated with insulin resistance (increased homeostasis model assessment of insulin resistance, HOMA-IR) and were positively related to serum adiponectin in both groups. In contrast, serum FGF21 levels independently and positively correlated with insulin resistance and serum triglycerides and were inversely related to serum adiponectin. In addition, in the combined population of both groups, those women with preconception polycystic ovary syndrome (PCOS) history had the lowest levels of FGF19, which were significantly lower than those in GDM patients without PCOS history and those in controls without PCOS history. Conclusions Circulating FGF19 levels are reduced in GDM patients, in contrast with FGF21 levels. Both serum FGF19 and FGF21 levels are strongly related to insulin resistance and serum levels of adiponectin. Considering the different situation between FGF19 and FGF21, we suggest that reduced serum FGF19 levels could be involved in the pathophysiology of GDM, while increased serum FGF21 levels could be in a compensatory response to this disease.
Wang, Dongyu; Zhu, Wenjing; Li, Jieming; An, Chongyou; Wang, Zilian
Aims\\/hypothesis The insulinotropic effect of gastric inhibitory polypeptide (GIP) is reduced in patients with type 2 diabetes and around 50% of their first-degree relatives under hyperglycaemic conditions. It is unknown whether this is a result of a specific defect in GIP action or of a general reduction in beta cell function. Moreover, impaired secretion of glucagon-like peptide 1 (GLP-1) has been
J. J. Meier; B. Gallwitz; M. Askenas; K. Vollmer; C. F. Deacon; J. J. Holst; W. E. Schmidt; M. A. Nauck
Objective To examine the impact of maternal blood glucose (BG) level and body mass index (BMI) measured at gestational diabetes mellitus (GDM) screening on the risk of macrosomia. Design A perinatal cohort of women were followed up from receiving perinatal healthcare to giving birth. Setting Beichen District, Tianjin, China between June 2011 and October 2012. Participants 1951 women aged 19–42?years with valid values of BMI and BG level at GDM screening (24–28?weeks gestation), singleton birth and birth weight (BW)>2500?g. Main outcomes and measures Primary outcome was macrosomia (BW>4000?g). BG level and BMI were measured at GDM screening. Results 191 (9.7%) newborns were macrosomia. The ORs (95% CIs) of macrosomia from multiple logistic regression were 1.14 (1.10 to 1.19, p<0.0001) for BMI and 1.11 (1.01 to 1.23, p=0.03) for BG. When BMI and BG levels (continuous) were modelled simultaneously, the OR for BMI was similar, but significantly attenuated for BG. Areas of receiver operating characteristics (ROC) were 0.6530 (0.6258 to 0.6803) for BMI and 0.5548 (0.5248 to 0.5848) for BG (?2=26.17, p<0.0001). BG (mmol/L, <6.7, 6.7–7.8 or ?7.8) and BMI in quintiles (Q1–Q5) were evaluated with BG <6.7 and Q2 BMI as the reference group. The ORs of macrosomia were not statistically different for mothers in Q1 or Q2 of BMI regardless of the BG levels; the ORs for ?Q3 of BMI were elevated significantly with the highest OR observed in Q5 of BMI and BG levels ?7.8 (6.93 (2.61 to 18.43), p<0.0001). Conclusions High BMI measured at GDM screening was the most important determinant for risk of macrosomia. These findings suggest that GDM screening may be a critical gestational time point to initiate maternal weight control oriented intervention strategy to lower the risk.
Liu, Jian; Leng, Junhong; Tang, Chen; Liu, Gongshu; Hay, John; Wang, Jing; Wen, Shiwu; Li, Zhenling; She, Ye
OBJECTIVE To evaluate the associations between adiponectin levels and 1) the risk of developing gestational diabetes mellitus (GDM), and 2) insulin resistance/sensitivity, ?-cell function, and compensation indices in a prospective cohort representative of the general population of pregnant women. RESEARCH DESIGN AND METHODS We performed anthropometric measurements and collected blood samples at 1st (6–13 weeks) and 2nd (24–28 weeks) trimesters. Diagnosis of GDM was made at 2nd trimester based on a 75-g oral glucose tolerance test (International Association of the Diabetes and Pregnancy Study Groups criteria). Insulin was measured (ELISA; Luminex) to estimate homeostasis model assessment of insulin resistance (HOMA-IR), ?-cell function (HOMA-B), insulin sensitivity (Matsuda index), insulin secretion (AUCinsulin/glucose), and ?-cell compensation (insulin secretion sensitivity index-2). Adiponectin was measured by radioimmunoassay. RESULTS Among the 445 participants included in this study, 38 women developed GDM. Women who developed GDM had lower 1st-trimester adiponectin levels (9.67 ± 3.84 vs. 11.92 ± 4.59 µg/mL in women with normal glucose tolerance). Lower adiponectin levels were associated with higher risk of developing GDM (OR, 1.12 per 1 µg/mL decrease of adiponectin levels; P = 0.02, adjusted for BMI and HbA1c at 1st trimester). Adiponectin levels at 1st and 2nd trimesters were associated with HOMA-IR (both: r = ?0.22, P < 0.0001) and Matsuda index (r = 0.28, P < 0.0001, and r = 0.29, P < 0.0001). After adjustment for confounding factors, we found no significant association with HOMA-B and AUCinsulin/glucose. CONCLUSIONS Pregnant women with lower adiponectin levels at 1st trimester have higher levels of insulin resistance and are more likely to develop GDM independently of adiposity or glycemic measurements.
Lacroix, Marilyn; Battista, Marie-Claude; Doyon, Myriam; Menard, Julie; Ardilouze, Jean-Luc; Perron, Patrice; Hivert, Marie-France
Background Diet therapy is the cornerstone for the management of gestational diabetes mellitus (GDM). Carbohydrate is the primary nutrient affecting postprandial blood glucose levels. Hence, knowledge of food containing carbohydrates can assist women with GDM optimize glycemic control. Despite that, there is a paucity of research on carbohydrate-related knowledge of women with GDM. The United Arab Emirates (UAE) has one of the highest prevalence of diabetes (19.2%) in the world. This study compared diet and knowledge of carbohydrate-containing foods among pregnant women with and without GDM in the UAE. Methods The sample consisted of multi-ethnic women with GDM (n?=?94) and a control group of healthy pregnant women (n?=?90) attending prenatal clinics in three hospitals in Al Ain, UAE. Data were collected using a questionnaire and a 24-hour recall. Knowledge of food sources of carbohydrate, dietary patterns, and nutrient intakes of the two groups were compared. Results There were no significant differences in the mean knowledge score of food sources of carbohydrate between women with GDM and that of pregnant women without GDM. Similarly, there were no significant differences in energy and nutrient intakes between the two groups with the exception of percent energy from protein. Women with GDM reported significantly lower intake of fruits and fruit juices (P?=?0.012) and higher consumption of milk and yogurt (P?=?0.004) compared to that of women without GDM. Twenty-two percent of women with GDM indicated they never visited a dietitian for counseling while 65% reported they visited a dietitian only once or twice during the pregnancy. Predictors of carbohydrate knowledge score were perceived knowledge of diet and GDM and parity among women with GDM and parity and educational level among those without GDM. Conclusion The results of the study highlight the urgent need to provide nutrition education for women with GDM in the UAE.
Ali, Habiba I.; Jarrar, Amjad H.; El Sadig, Mohamed; B. Yeatts, Karin
Placental weight and placental weight-to-birth weight ratio are increased in diet- and exercise-treated gestational diabetes mellitus subjects but not in subjects with one abnormal value on 100-g oral glucose tolerance test
The aim of the present study was to determine whether the placental weight and placental weight-to-birth weight ratio (PW\\/BW) increased in pregnant women with one abnormal value (OAV) on 100-g oral glucose tolerance test (OGTT) and diet- and exercise-treated, non-insulin-requiring gestational diabetes mellitus (GDM) subjects. The 50-g glucose challenge test (GCT) was administered to 324 pregnant women. Women with abnormal
Mert Kucuk; Fadime Doymaz
Objective To evaluate the accuracy of glycosylated hemoglobin A1c (HbA1c) for the diagnosis of postpartum abnormal glucose tolerance among women with gestational diabetes mellitus (GDM). Methods After a systematic review of related studies, the sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and other measures about the accuracy of HbA1c in the diagnosis of postpartum abnormal glucose tolerance were pooled using random-effects models. The summary receiver operating characteristic (SROC) curve was used to summarize the overall test performance. Results Six studies met our inclusion criteria. The pooled results on SEN, SPE, PLR, NLR, and DOR were 0.36 (95% CI 0.23–0.52), 0.85 (95% CI 0.73–0.92), 2.4 (95% CI 1.6–3.6), 0.75 (95% CI 0.63–0.88) and 3 (95% CI 2–5). The area under the summary receiver operating characteristic (SROC) curve was 0.67 with a Q value of 0.63. Conclusions Measurement of HbA1c alone is not a sensitive test to detect abnormal glucose tolerance in women with prior GDM.
Qu, Xinye; Tian, Yaqiang; Zhang, Guangzhen
Abstract Background: Lifestyle interventions are effective in preventing type 2 diabetes (T2D). Women with history of gestational diabetes mellitus (GDM) may have barriers to lifestyle changes, and the previous results of lifestyle interventions are contradictory reporting either favorable outcomes or no significant beneficial effects. Our aim was to compare cardio-metabolic risk profile and responses to a 1-year lifestyle intervention program in women with and without history of GDM. Methods: The Implementation Project of the Program for Prevention of Type 2 Diabetes (FIN-D2D) was conducted in Finland in five hospital districts. Altogether 1,661 women aged ?45 years participated in the program. One-year follow-up was available for 393 women who did not have screen-detected T2D at baseline, and 265 of them had at least one intervention visit [115 (43.4%) women with history of GDM and 150 (56.6%) without history of GDM]. Results: At baseline, women with GDM had similar baseline glucose tolerance but better anthropometric characteristics, blood pressure, and lipid profile than women without GDM after adjustment for age. Beneficial changes in cardiovascular risk profile existed among women with and without GDM during follow-up and the effect of lifestyle intervention was similar between the groups, except that low-density lipoprotein cholesterol improved only in women with GDM. Altogether, 4.0% of those with GDM and 5.0% of those without GDM developed T2D (p=0.959 adjustment for age). Conclusions: The effect of a 1-year lifestyle intervention in primary healthcare setting was similar regardless of history of GDM, both women with and without GDM benefitted from participation in the lifestyle intervention. PMID:24787505
Rautio, Nina; Jokelainen, Jari; Korpi-Hyövälti, Eeva; Oksa, Heikki; Saaristo, Timo; Peltonen, Markku; Moilanen, Leena; Vanhala, Mauno; Uusitupa, Matti; Tuomilehto, Jaakko; Keinänen-Kiukaanniemi, Sirkka
A case of massive hypertrophy of the breasts in pregnancy was seen in our institution, which is a tertiary referral centre for the United Arab Emirates region with a delivery rate of 7000/year. It is a very rare condition (1 in 100000) and the only case seen in our hospital over the past 20 years. No similar case has been reported from the United Arab Emirates or Gulf regions, to our knowledge. The patient presented at a gestational age of 18 weeks on account of progressive swelling of the breasts which started at 14 weeks’ gestation. In pregnancy she was managed conservatively with analgesics, bromocriptine and breast support. She had bilateral reduction mammoplasty 1 year after delivery. The outcome was satisfactory, and the patient was pleased with the cosmetic result.
John, Mary K; Rangwala, Tasneem Husaini
Gestational surrogacy is a treatment option available to women with certain clearly defined medical problems, usually an absent uterus, to help them have their own genetic children. IVF allows the creation of embryos from the gametes of the commissioning couple and subsequent transfer of these embryos to the uterus of a surrogate host. The indications for treatment include absent uterus, recurrent miscarriage, repeated failure of IVF and certain medical conditions. Treatment by gestational surrogacy is straightforward and follows routine IVF procedures for the commissioning mother, with the transfer of fresh or frozen-thawed embryos to the surrogate host. The results of treatment are good, as would be expected from the transfer of embryos derived from young women and transferred to fit, fertile women who are also young. Clinical pregnancy rates achieved in large series are up to 40% per transfer and series have reported 60% of hosts achieving live births. The majority of ethical or legal problems that have arisen out of surrogacy have been from natural or partial surrogacy arrangements. The experience of gestational surrogacy has been largely complication-free and early results of the follow-up of children, commissioning couples and surrogates are reassuring. In conclusion, gestational surrogacy arrangements are carried out in a few European countries and in the USA. The results of treatment are satisfactory and the incidence of major ethical or legal complications has been limited. IVF surrogacy is therefore a successful treatment for a small group of women who would otherwise not be able to have their own genetic children. PMID:14640380
Brinsden, Peter R
Background Women with previous gestational diabetes mellitus (pGDM) face a higher risk of developing type 2 diabetes and, consequently, a higher cardiovascular risk. This study aimed to compare the carotid intima-media thickness (cIMT) from young women with pGDM to those with metabolic syndrome (MS) and to healthy controls (CG) to verify whether a past history of pGDM could be independently associated with increased cIMT. Methods This is a cross-sectional study performed in two academic referral centers. Seventy-nine women with pGDM, 30 women with MS, and 60 CG aged between 18 and 47 years were enrolled. They all underwent physical examination and had blood glucose, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol (LDLc), and triglycerides determined. The cIMT was measured by ultrasound in several carotid segments. The primary endpoint was cIMT and clinically relevant parameters included as predictors were: age, systolic blood pressure, waist, BMI, total cholesterol, LDLc, triglycerides, fasting glucose, previous history of GDM as a whole group, previous history of GDM without MS, presence of DM, presence of MS, and parity. Results cIMT was significantly higher in pGDM when compared to CG in all sites of measurements (P?0.05) except for the right common carotid. The pGDM women showed similar cIMT measurements to MS in all sites of measurements, except for the left carotid bifurcation, where it was significantly higher than MS (P?0.001). In a multivariate analysis which included classical cardiovascular risk factors and was adjusted for confounders, pGDM was shown to be independently associated with increased composite cIMT (P?0.01). The pGDM without risk factors further showed similar cIMT to MS (P?>?0.05) and an increased cIMT when compared to controls (P?0.05). Conclusions Previous GDM was independently associated with increased composite cIMT in this young population, similarly to those with MS and regardless the presence of established cardiovascular risk factors.
Background Although associated adverse pregnancy outcomes, no international or Swedish consensus exists that identifies a cut-off value or what screening method to use for definition of gestational diabetes mellitus. This study investigates the following: i) guidelines for screening of GDM; ii) background and risk factors for GDM and selection to OGTT; and iii) pregnancy outcomes in relation to GDM, screening regimes and levels of OGTT 2 hour glucose values. Methods This cross-sectional and population-based study uses data from the Swedish Maternal Health Care Register (MHCR) (2011 and 2012) combined with guidelines for GDM screening (2011–2012) from each Maternal Health Care Area (MHCA) in Sweden. The sample consisted of 184,183 women: 88,140 in 2011 and 96,043 in 2012. Chi-square and two independent samples t-tests were used. Univariate and multivariate logistic regression analyses were performed. Results Four screening regimes of oral glucose tolerance test (OGTT) (75 g of glucose) were used: A) universal screening with a 2-hour cut-off value of 10.0 mmol/L; B) selective screening with a 2-hour cut-off value of 8.9 mmol/L; C) selective screening with a 2-hour cut-off value of 10.0 mmol/L; and D) selective screening with a 2-hour cut-off value of 12.2 mmol/L. The highest prevalence of GDM (2.9%) was found with a 2-hour cut-off value of 8.9 mmol/L when selective screening was applied. Unemployment and low educational level were associated with an increased risk of GDM. The OR was 4.14 (CI 95%: 3.81-4.50) for GDM in obese women compared to women with BMI <30 kg/m2. Women with non-Nordic origin presented a more than doubled risk for GDM compared to women with Nordic origin (OR?=?2.24; CI 95%: 2.06-2.43). Increasing OGTT values were associated with increasing risks of adverse pregnancy outcomes. Conclusions There was no consensus regarding screening regimes for GDM from 2011 through 2012 when four different regimes were applied in Sweden. Increasing levels of OGTT 2-hour glucose values were strongly associated with adverse pregnancy outcomes. Based on these findings, we suggest that Sweden adopts the recent recommendations of the International Association of Diabetes and Pregnancy Study Group (IADPSG) concerning the performance of OGTT and the diagnostic criteria for GDM.
Background The prevalence of gestational diabetes mellitus (GDM) is increasing worldwide. GDM and the risks associated with GDM lead to increased health care costs and losses in productivity. The objective of this study is to evaluate whether the FitFor2 exercise program during pregnancy is cost-effective from a societal perspective as compared to standard care. Methods A randomised controlled trial (RCT) and simultaneous economic evaluation of the FitFor2 program were conducted. Pregnant women at risk for GDM were randomised to an exercise program to prevent high maternal blood glucose (n?=?62) or to standard care (n?=?59). The exercise program consisted of two sessions of aerobic and strengthening exercises per week. Clinical outcome measures were maternal fasting blood glucose levels, insulin sensitivity and infant birth weight. Quality of life was measured using the EuroQol 5-D and quality-adjusted life-years (QALYs) were calculated. Resource utilization and sick leave data were collected by questionnaires. Data were analysed according to the intention-to-treat principle. Missing data were imputed using multiple imputations. Bootstrapping techniques estimated the uncertainty surrounding the cost differences and incremental cost-effectiveness ratios. Results There were no statistically significant differences in any outcome measure. During pregnancy, total health care costs and costs of productivity losses were statistically non-significant (mean difference €1308; 95%CI €-229 - €3204). The cost-effectiveness analyses showed that the exercise program was not cost-effective in comparison to the control group for blood glucose levels, insulin sensitivity, infant birth weight or QALYs. Conclusion The twice-weekly exercise program for pregnant women at risk for GDM evaluated in the present study was not cost-effective compared to standard care. Based on these results, implementation of this exercise program for the prevention of GDM cannot be recommended. Trial registration NTR1139
OBJECTIVE To determine the concentrations of adipocyte fatty acid–binding protein (AFABP) and other adipocytokines in maternal and cord serum of pregnant women with gestational diabetes mellitus (GDM) and of control subjects and to relate them to indexes of insulin sensitivity. RESEARCH DESIGN AND METHODS In 86 control and 98 GDM pregnant women, venous blood was collected before vaginal delivery and arterial blood from cord immediately after delivery. Serum insulin and adipocytokines were measured by enzyme-linked immunosorbent assay (ELISA). RESULTS GDM women had higher prepregnancy BMI, and data were adjusted for it. Maternal serum insulin, insulin-to-glucose ratio, homeostasis model assessment (HOMA), AFABP, and retinol-binding protein 4 (RBP4) were higher and adiponectin was lower in GDM than in control subjects, whereas serum glucose, insulin, insulin-to-glucose ratio, HOMA, nonesterified fatty acids, and RBP4 were higher and glycerol, AFABP, and adiponectin were lower in cord blood serum of GDM than of control subjects. AFABP and adiponectin in cord serum of control subjects were higher than in maternal serum; in GDM women no difference was found for AFABP in cord versus maternal serum, although adiponectin remained higher in cord. Values of leptin in both groups were lower in cord than in maternal serum, and those of RBP4 were lower in only GDM women. CONCLUSIONS It is suggested that fetal tissues are the main source of cord arterial serum AFABP, and in GDM fetuses AFABP values correlate with adiposity markers. A downregulation of adiponectin and upregulation of RBP4 in GDM mothers and their fetuses may be related to their insulin-resistant condition, whereas changes in AFABP do not seem to be related.
Ortega-Senovilla, Henar; Schaefer-Graf, Ute; Meitzner, Katrin; Abou-Dakn, Michael; Graf, Kristof; Kintscher, Ulrich; Herrera, Emilio
Abstract Background: Our study assessed the follow-up of gestational diabetes mellitus (GDM) in the postpartum period among a racially and ethnically diverse group of women receiving care in a major urban medical center. Methods: We conducted cross-sectional analysis of clinical and administrative data on women aged 18-44 years who gave birth at Boston Medical Center (BMC) between 2003 and 2009, had GDM, and used BMC for regular care. We calculated the rate of glucose testing by 70 days and by 180 days after delivery and used logistic regression to assess the predictors of testing. Results: By 6 months postpartum, only 23.4% of GDM-affected women received any kind of glucose test. Among these, over half had been completed by 10 weeks but only 29% were the recommended oral glucose tolerance test (OGTT). After accounting for sociodemographic and health service factors, women aged ?35 years of age and women with a family practice provider were significantly less likely to be tested than their counterparts (odds ratio [OR] 0.51; 95% confidence interval [CI] 0.32, 0.83 and OR 0.36; 95% CI 0.19, 0.71 respectively). Women who attended a primary care visit within 180 days after birth had three times higher odds of being tested than those without such a visit (OR 3.10; 95% CI 1.97, 4.87). Conclusions: Despite widely disseminated clinical guidelines, postpartum glucose testing rates are exceedingly low, marking a critical missed opportunity to launch preventive care for women at high risk of type 2 DM. Failed follow-up of GDM by providers of prenatal and postpartum care also reflects a broader systems failure: the absence of a well-supported transition from pregnancy care to ongoing primary care for women. PMID:24707899
McCloskey, Lois; Bernstein, Judith; Winter, Michael; Iverson, Ronald; Lee-Parritz, Aviva
OBJECTIVE To determine whether insulin reverses gestational diabetes mellitus (GDM)–reduced expression and activity of human equilibrative nucleoside transporters 1 (hENT1) in human umbilical vein endothelium cells (HUVECs). RESEARCH DESIGN AND METHODS Primary cultured HUVECs from full-term normal (n = 44) and diet-treated GDM (n = 44) pregnancies were used. Insulin effect was assayed on hENT1 expression (protein, mRNA, SLC29A1 promoter activity) and activity (initial rates of adenosine transport) as well as endothelial nitric oxide (NO) synthase activity (serine1177 phosphorylation, l-citrulline formation). Adenosine concentration in culture medium and umbilical vein blood (high-performance liquid chromatography) as well as insulin receptor A and B expression (quantitative PCR) were determined. Reactivity of umbilical vein rings to adenosine and insulin was assayed by wire myography. Experiments were in the absence or presence of l-NG-nitro-l-arginine methyl ester (l-NAME; NO synthase inhibitor) or ZM-241385 (an A2A-adenosine receptor antagonist). RESULTS Umbilical vein blood adenosine concentration was higher, and the adenosine- and insulin-induced NO/endothelium-dependent umbilical vein relaxation was lower in GDM. Cells from GDM exhibited increased insulin receptor A isoform expression in addition to the reported NO–dependent inhibition of hENT1-adenosine transport and SLC29A1 reporter repression, and increased extracellular concentration of adenosine and NO synthase activity. Insulin reversed all these parameters to values in normal pregnancies, an effect blocked by ZM-241385 and l-NAME. CONCLUSIONS GDM and normal pregnancy HUVEC phenotypes are differentially responsive to insulin, a phenomenon where insulin acts as protecting factor for endothelial dysfunction characteristic of this syndrome. Abnormal adenosine plasma levels, and potentially A2A-adenosine receptors and insulin receptor A, will play crucial roles in this phenomenon in GDM.
Westermeier, Francisco; Salomon, Carlos; Gonzalez, Marcelo; Puebla, Carlos; Guzman-Gutierrez, Enrique; Cifuentes, Fredi; Leiva, Andrea; Casanello, Paola; Sobrevia, Luis
Glucose homeostasis is controlled by endocrine pancreatic cells, and any pancreatic disturbance can result in diabetes. Because 8% to 12% of diabetic pregnant women present with malformed fetuses, there is great interest in understanding the etiology, pathophysiological mechanisms, and treatment of gestational diabetes. Hyperglycemia enhances the production of reactive oxygen species, leading to oxidative stress, which is involved in diabetic teratogenesis. It has also been suggested that maternal diabetes alters embryonic gene expression, which might cause malformations. Due to ethical issues involving human studies that sometimes have invasive aspects and the multiplicity of uncontrolled variables that can alter the uterine environment during clinical studies, it is necessary to use animal models to better understand diabetic pathophysiology. This review aimed to gather information about pathophysiological mechanisms and fetal outcomes in streptozotocin-induced diabetic rats. To understand the pathophysiological mechanisms and factors involved in diabetes, the use of pancreatic regeneration studies is increasing in an attempt to understand the behavior of pancreatic beta cells. In addition, these studies suggest a new preventive concept as a treatment basis for diabetes, introducing therapeutic efforts to minimize or prevent diabetes-induced oxidative stress, DNA damage, and teratogenesis.
Damasceno, D. C.; Netto, A. O.; Iessi, I. L.; Gallego, F. Q.; Corvino, S. B.; Dallaqua, B.; Sinzato, Y. K.; Bueno, A.; Calderon, I. M. P.; Rudge, M. V. C.
Background Maternal obesity and gestational diabetes mellitus (GDM) may independently influence offspring fat mass and metabolic disease susceptibility. In this pilot study, body composition and fat distribution in offspring from obese women with and without GDM and lean women were assessed within the 1st year of life, and maternal and newborn plasma factors were related to offspring adipose tissue distribution. Methods Serum and plasma samples from pregnant obese women with (n?=?16) or without (n?=?13) GDM and normoglycemic lean women (n?=?15) at 3rd trimester and offspring cord plasma were used for analyzing lipid profiles, insulin and adipokine levels. At week-1 and 6, month-4 and year-1, offspring anthropometrics and skinfold thickness (SFT) were measured and abdominal subcutaneous (SCA) and preperitoneal adipose tissue (PPA) were determined by ultrasonography. Results Cord insulin was significantly increased in the GDM group, whereas levels of cord leptin, total and high molecular weight (HMW) adiponectin were similar between the groups. Neonates of the GDM group showed significantly higher SFT and fat mass until week-6 and significantly increased SCA at week-1 compared to the lean group that persisted as strong trend at week-6. Interestingly, PPA in neonates of the GDM group was significantly elevated at week-1 compared to both the lean and obese group. At month-4 and year-1, significant differences in adipose tissue growth between the groups were not observed. Multiple linear regression analyses revealed that cord insulin levels are independently related to neonatal PPA that showed significant relation to PPA development at year-1. Maternal fasted C-peptide and HMW adiponectin levels at 3rd trimester emerged to be determinants for PPA at week-1. Conclusion Maternal pregravid obesity combined with GDM leads to newborn hyperinsulinemia and increased offspring fat mass until week-6, whereas pregravid obesity without GDM does not. This strongly suggests the pivotal role of GDM in the adverse offspring outcome. Maternal C-peptide and HMW adiponectin levels in pregnancy emerge to be predictive for elevated PPA in newborns and might be indicative for the obesity risk at later life. Altogether, the findings from our pilot study warrant evaluation in long-term studies. Trial registration German Clinical Trials Register DRKS00004370
OBJECTIVE The conventional diet approach to gestational diabetes mellitus (GDM) advocates carbohydrate restriction, resulting in higher fat (HF), also a substrate for fetal fat accretion and associated with maternal insulin resistance. Consequently, there is no consensus about the ideal GDM diet. We hypothesized that, compared with a conventional, lower-carbohydrate/HF diet (40% carbohydrate/45% fat/15% protein), consumption of a higher-complex carbohydrate (HCC)/lower-fat (LF) Choosing Healthy Options in Carbohydrate Energy (CHOICE) diet (60/25/15%) would result in 24-h glucose area under the curve (AUC) profiles within therapeutic targets and lower postprandial lipids. RESEARCH DESIGN AND METHODS Using a randomized, crossover design, we provided 16 GDM women (BMI 34 ± 1 kg/m(2)) with two 3-day isocaloric diets at 31 ± 0.5 weeks (washout between diets) and performed continuous glucose monitoring. On day 4 of each diet, we determined postprandial (5 h) glucose, insulin, triglycerides (TGs), and free fatty acids (FFAs) following a controlled breakfast meal. RESULTS There were no between-diet differences for fasting or mean nocturnal glucose, but 24-h AUC was slightly higher (?6%) on the HCC/LF CHOICE diet (P = 0.02). The continuous glucose monitoring system (CGMS) revealed modestly higher 1- and 2-h postprandial glucose on CHOICE (1 h, 115 ± 2 vs. 107 ± 3 mg/dL, P ? 0.01; 2 h, 106 ± 3 vs. 97 ± 3 mg/dL, P = 0.001) but well below current targets. After breakfast, 5-h glucose and insulin AUCs were slightly higher (P < 0.05), TG AUC was no different, but the FFA AUC was significantly lower (?19%; P ? 0.01) on the CHOICE diet. CONCLUSIONS This highly controlled study randomizing isocaloric diets and using a CGMS is the first to show that liberalizing complex carbohydrates and reducing fat still achieved glycemia below current treatment targets and lower postprandial FFAs. This diet strategy may have important implications for preventing macrosomia. PMID:24595632
Hernandez, Teri L; Van Pelt, Rachael E; Anderson, Molly A; Daniels, Linda J; West, Nancy A; Donahoo, William T; Friedman, Jacob E; Barbour, Linda A
... 800–860–8747. [ Top ] Diagnosis of Gestational Diabetes Health care providers test for gestational diabetes using the OGTT. Women may ... diabetes should be tested using standard diabetes blood tests during their first visit to the health care provider during pregnancy to see if they had ...
A new face recognition algorithm has been proposed which is robust to variations in pose, expression, illumination and occlusions such as sunglasses. The algorithm is motivated by the Edit Distance used to determine the similarity between strings of one dimensional data such as DNA and text. The key to this approach is how to extend the concept of an Edit Distance on one-dimensional data to two-dimensional image data. The algorithm is based on mapping one image into another and using the characteristics of the mapping to determine a two-dimensional Pictorial-Edit Distance or P-Edit Distance. We show how the properties of the mapping are similar to insertion, deletion and substitution errors defined in an Edit Distance. This algorithm is particularly well suited for face recognition in uncontrolled environments such as stand-off and other surveillance applications. We will describe an entire system designed for face recognition at a distance including face detection, pose estimation, multi-sample fusion of video frames and identification. Here we describe how the algorithm is used for face recognition at a distance, present some initial results and describe future research directions.(
Podilchuk, Christine; Hulbert, William; Flachsbart, Ralph; Barinov, Lev
Thousands of self-ignited coal fires, naturally occurring coal fires, and coal fires resulting from human activities persist for decades in underground coal mines, coal waste piles, and un-mined coal beds. These uncontrolled coal fires occur in all coal-bearing parts of the world and pose multiple threats to the global environment due to emission of greenhouse gases (GHG) such as CO2, CO, CH4, and other toxic substances such as mercury (Hg). Estimates of the amount of coal that is involved globally range between 20 and 600 Mt sing simple calculations, the only published peer-reviewed estimate of CO2 and Hg emissions from coal-fires in the United States (U.S.) are between 14 to 290 Mt/yr and 0.1 to 11.5 t/yr, respectively. In comparison, the U.S. coal-fired power plant fleet -the largest known anthropogenic source of CO2 and Hg to the atmosphere in the U.S.- emits ~2.4 Gt, and ~45 t annually, respectively. This paper builds on these results and will present result of a first-of-a-kind U.S.-based field campaign combining airborne remote sensing using thermal infrared technique and ground based measurements as a first step to constraining and scaling-up the emission factors, nature and extent of coal-fire emissions of CO2 and Hg to a global scale, which will allow for these emission sources to be better accounted for in global atmospheric models.
Terschure, A. F.; Engle, M.; Heffern, E.; Hower, J.; Kolker, A.; Prakash, A.; Radke, L.
\\u000a As diabetes becomes more prevalent in younger women, diabetes and maternal-child health issues such as breastfeeding coexist\\u000a with increasing frequency in clinical practice. Women with diabetes of any kind including type 1 diabetes (DM1), type 2 diabetes\\u000a (DM2) or gestational diabetes (GDM) should be strongly encouraged to breastfeed because of the maternal and pediatric benefits\\u000a specific to obesity and diabetes
Julie Scott Taylor; Melissa Nothnagle; Susanna R. Magee
Maternal Moderate Physical Training during Pregnancy Attenuates the Effects of a Low-Protein Diet on the Impaired Secretion of Insulin in Rats: Potential Role for Compensation of Insulin Resistance and Preventing Gestational Diabetes Mellitus
The effects of pregestational and gestational low-to-moderate physical training on insulin secretion in undernourished mothers were evaluated. Virgin female Wistar rats were divided into four groups as follows: control (C, n = 5); trained (T, n = 5); low-protein diet (LP, n = 5); trained with a low-protein diet (T + LP, n = 5). Trained rats ran on a treadmill over a period of 4 weeks before mate (5 days week?1 and 60?min day?1, at 65% of VO2max). At pregnancy, the intensity and duration of the exercise were reduced. Low-protein groups were provided with an 8% casein diet, and controls were provided with a 17% casein diet. At third day after delivery, mothers and pups were killed and islets were isolated by collagenase digestion of pancreas and incubated for a further 1?h with medium containing 5.6 or 16.7?mM glucose. T mothers showed increased insulin secretion by isolated islets incubated with 16.7?mM glucose, whereas LP group showed reduced secretion of insulin by isolated islets when compared with both C and LP + T groups. Physical training before and during pregnancy attenuated the effects of a low-protein diet on the secretion of insulin, suggesting a potential role for compensation of insulin resistance and preventing gestational diabetes mellitus.
Leandro, Carol Gois; Fidalgo, Marco; Bento-Santos, Adriano; Falcao-Tebas, Filippe; Vasconcelos, Diogo; Manhaes-de-Castro, Raul; Carpinelli, Angelo Rafael; Hirabara, Sandro Massao; Curi, Rui
Is intensive counseling in maternity care feasible and effective in promoting physical activity among women at risk for gestational diabetes? Secondary analysis of a cluster randomized NELLI study in Finland
Background Women who are physically active during early pregnancy have notably lower odds of developing gestational diabetes than do inactive women. The purpose of the intervention was to examine whether intensified physical activity (PA) counseling in Finnish maternity care is feasible and effective in promoting leisure-time PA (LTPA) among pregnant women at risk of gestational diabetes. Methods Fourteen municipalities were randomized to intervention (INT) and usual care group (UC). Nurses in INT integrated five PA counseling sessions into routine maternity visits and offered monthly group meetings on PA instructed by physiotherapists. In UC conventional practices were continued. Feasibility evaluation included safety (incidence of PA-related adverse events; questionnaire), realization (timing and duration of sessions, number of sessions missed, attendance at group meetings; systematic record-keeping of the nurses and physiotherapists) and applicability (nurses’ views; telephone interview). Effectiveness outcomes were weekly frequency and duration of total and intensity-specific LTPA and meeting PA recommendation for health self-reported at 8-12 (baseline), 26-28 and 36-37?weeks’ gestation. Multilevel analysis with adjustments was used in testing for between-group differences in PA changes. Results The decrease in the weekly days of total and moderate-to-vigorous-intensity LTPA was smaller in INT (N?=?219) than in UC (N?=?180) from baseline to the first follow-up (0.1 vs. -1.2, p?=?0.040 and ?0.2 vs. -1.3, p?=?0.016). A similar trend was seen in meeting the PA recommendation (?11%-points vs. -28%-points, p?=?0.06). INT did not experience more adverse events classified as warning signs to terminate exercise than UC, counseling was implemented as planned and viewed positively by the nurses. Conclusions Intensified counseling had no effects on the duration of total or intensity-specific weekly LTPA. However, it was able to reduce the decrease in the weekly frequency of total and moderate-to-vigorous-intensity LTPA from baseline to the end of second trimester and was feasibly embedded into routine practices. Trial registration ISRCTN 33885819 ( http://www.isrctn.org)
Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study: Common Genetic Variants in GCK and TCF7L2 Are Associated With Fasting and Postchallenge Glucose Levels in Pregnancy and With the New Consensus Definition of Gestational Diabetes Mellitus From the International Association of Diabetes and Pregnancy Study Groups
OBJECTIVE Common genetic variants in GCK and TCF7L2 are associated with higher fasting glucose and type 2 diabetes in nonpregnant populations. However, their associations with glucose levels from oral glucose tolerance tests (OGTTs) in pregnancy have not been assessed in a large sample. We hypothesized that these variants are associated with quantitative measures of glycemia in pregnancy. RESEARCH DESIGN AND METHODS We analyzed the associations between variants rs1799884 (GCK) and rs7903146 (TCF7L2) and OGTT outcomes at 24–32 weeks' gestation in 3,811 mothers of European (U.K. and Australia) and 1,706 mothers of Asian (Thailand) ancestry from the HAPO cohort. We also tested associations with offspring birth anthropometrics. RESULTS The maternal GCK variant was associated with higher fasting glucose in Europeans (P = 0.001) and Thais (P < 0.0001), 1-h glucose in Europeans (P = 0.001), and 2-h glucose in Thais (P = 0.005). It was also associated with higher European offspring birth weight, fat mass, and skinfold thicknesses (P < 0.05). The TCF7L2 variant was associated with all three maternal glucose outcomes (P = 0.03, P < 0.0001, and P < 0.0001 for fasting and 1-h and 2-h glucose, respectively) in the Europeans but not in the Thais (P > 0.05). In both populations, both variants were associated with higher odds of gestational diabetes mellitus according to the new International Association of Diabetes and Pregnancy Study Groups recommendations (P = 0.001–0.08). CONCLUSIONS Maternal GCK and TCF7L2 variants are associated with glucose levels known to carry an increased risk of adverse pregnancy outcome in women without overt diabetes. Further studies will be important to determine the variance in maternal glucose explained by all known genetic variants.
Freathy, Rachel M.; Hayes, M. Geoffrey; Urbanek, Margrit; Lowe, Lynn P.; Lee, Hoon; Ackerman, Christine; Frayling, Timothy M.; Cox, Nancy J.; Dunger, David B.; Dyer, Alan R.; Hattersley, Andrew T.; Metzger, Boyd E.; Lowe, William L.
Unexplained intra-uterine fetal death is still a problem in diabetic pregnancies, especially in those with an LGA-infant. We hypothesized that in these pregnancies impaired placental function, in terms of abnormal placental weight and\\/or abnormal placental histology, may account for this phenomenon.To test this hypothesis, we assessed the relative placental weight and scored several histological abnormalities in 34 AGA- and 24
I. M Evers; P. G. J Nikkels; J. M Sikkema; G. H. A Visser
Aim: To investigate the association of uncontrolled hypertension with psychological factors associated with high cardiovascular morbidity and mortality (type D personality, depression, posttraumatic stress-related symptoms). Methods: 205 consecutive outpatient hypertensives completed three questionnaires evaluating Type D personality (DS 16), post traumatic symptoms (revised Impact of Events Scale), symptoms of anxiety, hostility, depression and obsessive-compulsive traits (subscales of the Symptom Checklist). Uncontrolled hypertension was diagnosed when clinic sitting blood pressure was above 140/90 mmHg (130/80 in the presence of diabetes or nephropathy), despite reported adherence to treatment with at least three antihypertensive medications, including a diuretic. Results: Uncontrolled hypertension (39%), was predicted by lower scores at Symptom Checklist obsessive-compulsive subscale and higher number of post traumatic avoidance symptoms, older age, diabetes, higher systolic pressure at first visit and longstanding hypertension. Type D personality correlated with depression, hostility, anxiety, compulsiveness, history of malignancy, and older age, but not with uncontrolled hypertension. Conclusions: Uncontrolled hypertension is associated with low obsessionality and avoidance symptoms, which reduce compliance to treatment. On the contrary, type D personality is not correlated with uncontrolled hypertension, as it includes compulsiveness, which improves compliance. A multidisciplinary approach to the hypertensive patient is mandatory to establish if the psychological profile affects compliance.
Realdi, Anna; Favaro, Angela; Santonastaso, Paolo; Nuti, Marco; Parotto, Emanuela; Inverso, Giulia; Leoni, Matteo; Macchini, Luisa; Vettore, Francesca; Calo, Lorenzo; Semplicini, Andrea
Gestational trophoblastic disease (GTD) represents a wide range of clinical and pathological distinct entities. The villous forms of GTD includes developmental disorders of the placental tree, like blighted ovum, embryonal, partial and complete moles. The risk of persistent GTD is estimated of 2-14% in partial and up to 50% in complete moles. So, the morphologic differentiation between the different entities of villous forms of GTD is clinical very important. Sometimes, early forms of complete moles (up to 12th weeks of gestation) may represent diagnostic problems, even in the diagnosis of regressive alterations of the placental villous tree after intrauterine retention. PMID:15197483
Vogel, M; Horn, L-C
... Performance: Uncontrolled descent. 31.19 Section 31.19 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION...AIRWORTHINESS STANDARDS: MANNED FREE BALLOONS Flight Requirements Â§ 31.19 Performance: Uncontrolled...
... Performance: Uncontrolled descent. 31.19 Section 31.19 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION...AIRWORTHINESS STANDARDS: MANNED FREE BALLOONS Flight Requirements Â§ 31.19 Performance: Uncontrolled...
A review of present practices in the assessment and treatment of diabetes during pregnancy is presented, including preconception\\u000a counseling, insulin therapy, nutrition and exercise therapy of patients with pre-existing diabetes, care of patients with\\u000a gestational diabetes, and post-partum care for infants and mothers of both conditions.
Elizabeth S. Halprin
Limited options for clinical management of patients with juvenile-onset diabetes mellitus call for a novel therapeutic paradigm. Two innovative studies support endoplasmic reticulum as an emerging target for combating both autoimmune and heritable forms of this disease.
The purpose of this study was to identify any changing trends in the incidence and caesarean section (CS) rate of pre-gestational diabetes mellitus (DM) and gestational diabetes mellitus (GDM) over a 10- year period, between 1999 and 2008. Although the incidence of pre-gestational DM has not significantly changed over the course of the last 10 years, there is an obvious rising trend in the incidence of GDM. Despite an increase in the overall CS rate during this time period, a parallel increase in the CS rate has not been observed among women whose pregnancies are complicated either by gestational or by pre-gestational diabetes (PGD). PMID:24456432
Khalifeh, A; Breathnach, F; Coulter-Smith, S; Robson, M; Fitzpatrick, C; Malone, F
Our aim was to evaluate and compare the diagnostic performance of three methods commonly used for GDM screening: fasting plasma glucose (FPG), two-step 50 g glucose challenge test (GCT), and 75 g glucose tolerance test (GTT) in a randomized study design to predict GDM in the first trimester and determine the best approach in predicting GDM. In a non-blind, parallel-group prospective randomized controlled study; 736 singleton pregnant women underwent FPG testing in the first trimester and randomly assigned to two groups; two-step 50 g GCT and 75 g GTT. GDM diagnosis was made according to Carpenter-Coustan or ADA (American Diabetes Association) criteria in two-step 50 g GCT and 75 g GTT groups, respectively. Subsequent testing was performed by two-step 50 g GCT at 24-28 weeks for screen negatives. After excluding the women who were lost to follow-up or withdrawn as a result of pregnancy loss, 486 pregnant women were recruited in the study. The FPG, two-step GCT, and one-step GTT methods identified GDM in 25/486 (5.1 %), 15/248 (6.0 %), and 27/238 (11.3 %) women, respectively. Area under ROC curves were 0.623, 0.708, and 0.792, respectively. Sensitivities were 47.17, 68.18, and 87.1 %, respectively. Specificities were 77.37, 100, and 100 %, respectively. Positive predictive values were 20.33, 100, and 100 %, respectively. Negative predictive values were 92.29, 97, and 98.1 %, respectively. Until superior screening alternatives become available, the 75 g GTT may be preferred for GDM screening in the first trimester. PMID:24282036
Yeral, M Ilkin; Ozgu-Erdinc, A Seval; Uygur, Dilek; Seckin, K Doga; Karsli, M Fatih; Danisman, A Nuri
... Assessment Monitoring System questionnaire as well as state birth certificate records to compare rates of gestational diabetes from ... gestational diabetes. State reporting of the condition on birth certificates also may vary. The data from this study ...
The effect of a glucagon-like peptide-1 receptor agonist on glucose tolerance in women with previous gestational diabetes mellitus: protocol for an investigator-initiated, randomised, placebo-controlled, double-blinded, parallel intervention trial
Introduction Pregnancy is associated with decreased insulin sensitivity, which is usually overcome by a compensatory increase in insulin secretion. Some pregnant women are not able to increase their insulin secretion sufficiently, and consequently develop gestational diabetes mellitus (GDM). The disease normally disappears after delivery. Nevertheless, women with previous GDM have a high risk of developing type 2 diabetes (T2D) later in life. We aim to investigate the early development of T2D in women with previous GDM and to evaluate whether treatment with the glucagon-like peptide-1 receptor (GLP-1R) agonist, liraglutide, may modify their risk of developing T2D. Methods and analyses 100 women with previous GDM will be randomised to either liraglutide or placebo treatment for 1?year (blinded) with an open-label extension for another 4?years. Additionally, 15 women without previous GDM will constitute a baseline control group. Women will be tested with an oral glucose tolerance test (primary endpoint: area under the curve for plasma glucose) and an isoglycaemic intravenous glucose infusion at baseline, after 1?year and after 5?years. Additional evaluations include a glucagon test, dual-energy X-ray absorptiometry, imaging of the liver (ultrasound elastography and fibroscanning), an ad libitum meal for food intake evaluation and questionnaires related to appetite, quality of life and alcohol consumption habits. Ethics and dissemination The protocol has been approved by the Danish Medicines Agency, the Scientific-Ethical Committee of the Capital Region of Denmark, and the Danish Data Protection Agency and will be carried out under the surveillance and guidance of the GCP unit at Copenhagen University Hospital Bispebjerg in compliance with the ICH-GCP guidelines and in accordance with the Helsinki Declaration. Positive, negative and inconclusive results will be published at scientific conferences and as one or more scientific manuscripts in peer-reviewed journals. Registrations The trial is registered at https://eudract.ema.europa.eu (2012-001371-37) and http://www.clinicaltrials.gov (NCT01795248).
Foghsgaard, Signe; Vedtofte, Louise; Mathiesen, Elisabeth R; Svare, Jens A; Gluud, Lise L; Holst, Jens J; Damm, Peter; Knop, Filip K; Vilsb?ll, Tina
This booklet provides information about diabetes and meal planning particularly designed for migrant individuals. The first section defines diabetes, explains different types of diabetes, lists results of uncontrolled diabetes, and describes the goals and components of a diabetic meal plan. The second section explains the exchange system of…
National Migrant Resource Program, Inc., Austin, TX.
The new recommendations on the pharmacological treatment of type 2 diabetes have introduced two important changes. The first is to have common strategies between European and American diabetes societies. The second, which is certainly the most significant, is to develop a patient centred approach suggesting therapies that take into account the patient's preferences and use of decision support tools. The individual approach integrates six factors: the capacity and motivation of the patient to manage his illness and its treatment, the risks of hypoglycemia, the life expectancy, the presence of co-morbidities and vascular complications, as well as the financial resources of the patient and the healthcare system. Treatment guidelines for cardiovascular risk reduction in diabetic remains the last point to develop. PMID:23409644
There has been a marked increase in the prevalence of diabetes in Asia over recent years. Diabetes complicating pregnancy, in particular gestational diabetes, has also increased markedly in the region. Multi-ethnic studies have highlighted the increased risk of gestational diabetes mellitus among the different Asian populations. Prevalence of gestational diabetes in Asian countries varies substantially according to the screening strategy and diagnostic criteria applied, and ranges from 1% to 20%, with evidence of an increasing trend over recent years. The International Association for Diabetes in Pregnancy Study group criteria have been adopted by some Asian countries, although they present significant challenges in implementation, especially in low-resource settings. Studies on offspring of mothers with gestational diabetes have reported adverse cardiometabolic profiles and increased risk of diabetes and obesity. Gestational diabetes is likely to be a significant factor contributing to the epidemic of diabetes and other non-communicable diseases in the Asian region. In recognition of this, several large-scale prevention and intervention programmes are currently being implemented in different Asian countries in order to improve glucose control during pregnancy, as well as overall maternal health. Lessons emerging from gestational diabetes studies in Asia may help inform and provide insights on the overall burden and treatment strategies to target gestational diabetes, with the ultimate aim to reduce its adverse short- and long-term consequences. PMID:24417604
Tutino, G E; Tam, W H; Yang, X; Chan, J C N; Lao, T T H; Ma, R C W
This booklet summarizes what health professionals know about type 2 diabetes what it is, who is at risk for it, how it can be prevented, and how it is treated. It describes how researchers study the disease and what individuals can do to help reduce the rising number of diabetes cases now affecting millions of children and adults around the country.The Science Inside e-book series is ntended to be a bridge between the consumer health brochure and the scientific paper, the booklets in this series focus on the science that is inside of, or behind, the disease its cause, its possible cure, its treatment, promising research, and so on. These booklets are designed to appeal to people who have not had the opportunity to study the science and to understand why they may have been given some of the advice that they have been given through some of the more consumer-oriented materials.
American Association for the Advancement of Science (;)
This booklet summarizes what health professionals know about type 2 diabetes what it is, who is at risk for it, how it can be prevented, and how it is treated. It describes how researchers study the disease and what individuals can do to help reduce the rising number of diabetes cases now affecting millions of children and adults around the country.The Science Inside e-book series is intended to be a bridge between the consumer health brochure and the scientific paper, the booklets in this series focus on the science that is inside of, or behind, the disease its cause, its possible cure, its treatment, promising research, and so on. These booklets are designed to appeal to people who have not had the opportunity to study the science and to understand why they may have been given some of the advice that they have been given through some of the more consumer-oriented materials.
American Association for the Advancement of Science (American Association for the Advancement of Science;)
Gestational transient thyrotoxicosis refers to non-autoimmune hyperthyroidism in pregnant women and it is associated with hyperemesis gravidarum. During pregnancy, there are some alterations in thyroid gland, such as elevation of thyroxine binding globulin, increased iodium clearance in kidneys, and stimulation of thyroid gland by human chorionic gonadotropin. Hitherto, the pathophysiology underlying the development of gestational transient thyrotoxicosis has not been fully recognized. Studies showed that human chorionic gonadotropin, an agonist of thyroid stimulating hormone, may stimulate thyroid stimulating hormone receptor, leading to increased thyroid hormone. Diagnosis of gestational transient thyrotoxicosis is established based on inexistence history of previous hyperthyroidism, elevation of thyroid hormone, absence of hyperthyroid abnormalities signs on physical examination (such as: enlargement of thyroid gland, exophthalmia), and the absent of positive thyroid autoantibody. Generally, gestational transient thyrotoxicosis does not require medication, unless if hyperemesis gravidarum is present, thus the patient has to be hospitalized to receive intravenous rehydration, electrolyte correction and antiemetic medication. On cases with worsened or prolonged symptoms, anti-thyroid agents such as short term propiltiourasil is needed. PMID:19390130
Albaar, M Taha; Adam, John M F
Familial molar pregnancies and gestational trophoblastic disease are exceedingly rare. In this case report, a family including four sisters and their cousin had molar pregnancies. Eldest sister had repeated molar pregnancies. Second sister had early abortion at her first pregnancy and partial molar pregnancy following blighted ovum by intrauterine insemination at her second pregnancy. Third sister had two molar pregnancies
In the course of history, exposure to radioactive sources escaping regular control, has been the main cause of fatal accidents, with the exception of the reactor accident at Chernobyl. After the disintegration of the Soviet Union, numerous lost sources have been found, sometimes with serious physical damage. The attacks of September 11, 2001 have focussed the attention on the possibility of nuclear terrorism. Although the risks of fatal consequences are rather limited, the possible uncontrolled exposure to ionizing radiation has an important psycho-social impact on the population. After a brief survey of the types of radioactive sources for medical and industrial applications and a discussion of the risks and exposure routes, possible scenarios are illustrated by well documented case histories. The main conclusions of this analysis are: Radioactive materials are not unique as a potential threat by toxic materials. The most serious consequences for individuals occur as the result of external radiation, mostly with skin contact with medium-active sources which are relatively easily accessible. The collective impact is mostly psycho-social and is more important for a dispersed contamination of the environment. Many sources are detected via medical complaints. The knowledge of the specific symptoms is consequently very important. A dispersion of radioactive contamination has usually considerable economic consequences. Accidents occur particularly, but certainly not exclusively, in relatively unstable countries. Change of owner or final evacuation of the source constitute a critical phase in many scenarios. PMID:16408827
The concept of gestational diabetes was described more than a half century ago and has been studied extensively for more than 30 years. Available data indicate that the prevalence is highly variable, probably reflecting underlying risk factors. In addition, gestational diabetes is not a specific disease, but rather an abnormal laboratory value. Criteria for diagnosis are variable, and there is
Catherine A Carr
Diabetic fibrous mastopathy is an uncommon self-limiting fibroinflammatory diseae of the breast that is seen predominantly in premenopausal women with long standing type I (insulin dependent) diabetes mellitus. In this report, we present a 29 years old female with uncontrolled diabetes mellitus presenting with bilateral breast masses which were irregular and hypoechoic on ultrasound, gradual enhancement on MRI and diagnosed as diabetic fibrous mastopathy on histopathology. It is quite difficult to distinguish it from malignancy on mammographic and ultrasonographic features or clinical findings. Correlation of the pathological features may help to make the correct diagnosis for this disease. PMID:24717992
Gunduz, Yasemin; Tatli, Lacin; Kara, Rabia Oztas; Cakar, Gozde Cakirsoy; Akdemir, Nermin; Dilek, Fatma Hüsniye
Objective Whether distal inflammation in asthmatics also leads to structural changes in the alveolar parenchyma remains poorly examined, especially in patients with uncontrolled asthma. We hypothesized that patients who do not respond to conventional inhaled corticosteroid therapy have a distinct tissue composition, not only in central, but also in distal lung. Methods Bronchial and transbronchial biopsies from healthy controls, patients with controlled atopic and patients with uncontrolled atopic asthma were processed for immunohistochemical analysis of fibroblasts and extracellular matrix molecules: collagen, versican, biglycan, decorin, fibronectin, EDA-fibronectin, matrix metalloproteinase (MMP)-9 and tissue-inhibitor of matrix metalloproteinase (TIMP)-3. Results In central airways we found increased percentage areas of versican and decorin in patients with uncontrolled asthma compared to both healthy controls and patients with controlled asthma. Percentage area of biglycan was significantly higher in both central airways and alveolar parenchyma of patients with uncontrolled compared to controlled asthma. Ratios of MMP-9/TIMP-3 were decreased in both uncontrolled and controlled asthma compared to healthy controls. In the alveolar parenchyma, patients with uncontrolled asthma had increased percentage areas of collagen, versican and decorin compared to patients with controlled asthma. Patients with uncontrolled asthma had significantly higher numbers of myofibroblasts in both central airways and alveolar parenchyma compared to patients with controlled asthma. Conclusions Tissue composition differs, in both central and distal airways, between patients with uncontrolled and controlled asthma on equivalent doses of ICS. This altered structure and possible change in tissue elasticity may lead to abnormal mechanical properties, which could be a factor in the persistent symptoms for patients with uncontrolled asthma.
A number of statistical tools have been developed over the years for assessing the risk of reentering objects to human populations. These tools make use of the characteristics (e.g., mass, shape, size) of debris that are predicted by aerothermal models to survive reentry. The statistical tools use this information to compute the probability that one or more of the surviving debris might hit a person on the ground and cause one or more casualties. The statistical portion of the analysis relies on a number of assumptions about how the debris footprint and the human population are distributed in latitude and longitude, and how to use that information to arrive at realistic risk numbers. This inevitably involves assumptions that simplify the problem and make it tractable, but it is often difficult to test the accuracy and applicability of these assumptions. This paper looks at a number of these theoretical assumptions, examining the mathematical basis for the hazard calculations, and outlining the conditions under which the simplifying assumptions hold. In addition, this paper will also outline some new tools for assessing ground hazard risk in useful ways. Also, this study is able to make use of a database of known uncontrolled reentry locations measured by the United States Department of Defense. By using data from objects that were in orbit more than 30 days before reentry, sufficient time is allowed for the orbital parameters to be randomized in the way the models are designed to compute. The predicted ground footprint distributions of these objects are based on the theory that their orbits behave basically like simple Kepler orbits. However, there are a number of factors - including the effects of gravitational harmonics, the effects of the Earth's equatorial bulge on the atmosphere, and the rotation of the Earth and atmosphere - that could cause them to diverge from simple Kepler orbit behavior and change the ground footprints. The measured latitude and longitude distributions of these objects provide data that can be directly compared with the predicted distributions, providing a fundamental empirical test of the model assumptions.
The report gives results of sampling and analysis of uncontrolled emissions from two sinter plants, to characterize and quantify the particulate, organic, and inorganic species present. One plant used revert (waste products of other steelmaking operations) material (series 1); th...
Uncontrolled storage test of the Modular Artillery Charges System (MACS) M232 charge was conducted at Yuma Proving Grounds in 2002. The test was conducted to determine effect of ambient temperature conditioning on muzzle velocity precision. Data from this...
C. Patel W. Zepp
BACKGROUND Uncontrolled hypertension, a major concern among hypertensive patients, may be caused by various factors such as inadequate knowledge and inappropriate attitude, unhealthy lifestyle, and ineffective treatment. The present study tried to cast light on factors leading to uncontrolled hypertension. METHODS In this cross-sectional study, all hypertensive participants of the third phase of the Isfahan Healthy Heart Program were contacted and invited to take part in the study. A questionnaire including knowledge of and attitude toward hypertension and its control and treatment methods, and practice about lifestyle and pharmacological treatment was completed for all patients who consented to participate. The participants’ anthropometric indices and blood pressure were then measured. Chi-square and Student’s t-tests were used to compare the groups with controlled and uncontrolled blood pressure. The effect of each factor on uncontrolled blood pressure was assessed by employing stepwise logistic regression. RESULTS Of 114 participants, 43 (37.12%) and 71 (62.28%) individuals had controlled and uncontrolled blood pressure, respectively. Stepwise logistic regression revealed body mass index > 25 kg/m2 to have the greatest effects on uncontrolled blood pressure [Odds ratio (OR) = 13.091, Confidence interval of 95% (95% CI): 1.437-116.352, P = 0.021). In addition, male gender increased the risk for uncontrolled blood pressure (OR = 8.475, CI95%: 1.276-56.313, P = 0.027), while inappropriate attitude decreased the mentioned risk (OR = 0.047, CI95%: 0.007-0.318, P = 0.002). CONCLUSION According to our findings, obesity is the most important cause of uncontrolled blood pressure. Therefore, weight has to be closely monitored and controlled in hypertensive patients.
Arabzadeh, Somayeh; Sadeghi, Masoumeh; Rabiei, Katayoun; Sarrafzadegan, Nizal; Taheri, Ladan; Golshahi, Jafar
1. Diabetes mellitus is diagnosed by finding a random plasma glucose > 11 mmol/L, or a fasting plasma glucose > 8 mmol/L. The prevalence in the general population is between 1-2% rising to approximately 4-9% in the age group 65+ (Williams, 1985; Croxson et al., 1991). It is more prevalent in people from the Indian subcontinent and in Afro-Caribbeans. 2. Approximately 75% of patients can be treated without recourse to insulin. The development of non-fasting ketonuria and/or significant weight loss suggests the onset of insulin dependence. These patients should be referred for specialist advice rapidly. 3. Chronic, uncontrolled hyperglycaemia greatly increases the risk of developing diabetic eye, nerve and kidney complications. 4. Treatment and follow-up aim: to abolish symptoms, to prevent and/or treat diabetic complications, to promote self-care and self-monitoring by patients, to avoid iatrogenic problems from overtreatment, to promote optimum nutrition for these patients. 5. Advice and assessment from the following specialists need to be built into the treatment plan: dietitian, competent fundoscopist (eg optometrist, general practitioner, hospital specialist depending upon local circumstances), chiropodist, diabetes education nurse and diabetes nurse specialist. 6. All patients need appropriate education about: the nature of diabetes mellitus, the importance of good control and the early detection of complications, a healthy lifestyle, the consequences of diabetes for driving and insurance. 7. All patients with diabetes should be reviewed clinically at least once a year. Diet, understanding of diabetes, self-monitoring, metabolic control and complications should be assessed. More frequent clinical review is required in poorly controlled patients, or those with significant complications, or intercurrent illness.(ABSTRACT TRUNCATED AT 250 WORDS)
Hurwitz, B.; Yudkin, J.
The peripartum control of diabetes is very important for the well-being of the newborn as higher incidence of neonatal hypoglycemia is seen if maternal hyperglycemia happens during this period. Type of diabetes (type 1, type 2 or gestational diabetes) also has an effect on the glucose concentration during intrapartum period. During the latent phase of labor, the metabolic demands are stable but during active labor there is increased metabolic demand and decreased insulin requirement. After delivery once the placenta is extracted, insulin resistance rapidly comes down and in patients with pre-gestational diabetes there will be a sudden drop in insulin requirement and the insulin may not be required in women with gestational diabetes, but they just need close monitoring. During breast-feeding blood glucose levels fall because of high metabolic demand and women need to take extra calories to maintain the levels and more vigilance especially in type 1 and type 2 diabetic mothers is required. The protocols used for the management of peripartum management of diabetes mostly rely on glucose and insulin infusion to maintain maternal blood sugars between 70 and 110 mg/dl. The data is mostly from retrospective studies and few randomized control trials done mainly in type 1 diabetes patients. The review summarizes guidelines, which are used for peripartum management of blood glucose.
Kalra, Pramila; Anakal, Manjunath
Objective This study aimed to prospectively examine the impact of chronic vs. pregnancy-onset habitual snoring on gestational hypertension, pre-eclampsia, and gestational diabetes. Study Design Third trimester pregnant women were recruited from a large, tertiary medical center, between March 2007 and December 2010 and screened for the presence and duration of habitual snoring, as a known marker for sleep-disordered breathing. Clinical diagnoses of gestational hypertension, pre-eclampsia, and gestational diabetes were obtained. Results Of 1,719 pregnant women, 34% reported snoring, with 25% reporting pregnancy-onset snoring. After adjusting for confounders pregnancy-onset, but not chronic snoring, was independently associated with gestational hypertension (odds ratio 2.36, 95%CI 1.48–3.77, p<0.001) and pre-eclampsia (odds ratio 1.59, 95%CI 1.06–2.37 p=0.024) but not gestational diabetes. Conclusion New-onset snoring during pregnancy is a strong risk factor for gestational hypertension and pre-eclampsia. In view of the significant morbidity and healthcare costs associated with hypertensive diseases of pregnancy, simple screening of pregnant women may have clinical utility. Trial registration: Clinical Trials NCT01030003
O'BRIEN, Louise M.; BULLOUGH, Alexandra S.; OWUSU, Jocelynn T.; TREMBLAY, Kimberley A.; BRINCAT, Cynthia A.; CHAMES, Mark C.; KALBFLEISCH, John D.; CHERVIN, Ronald D.
An estimated 15,000 uncontrolled flowing wells, many discharging water of poor quality are wastefully discharging about 790 million gallons per day by surface and internal flow. Internal flow in principal problem areas have been identified in Brevard, Charlotte, Clay, De Soto, Duval, Flagler, Glades, Hendry, Hillsborough, Lee, Manatee, Martin, Nassau, and Sarasota Counties. In many areas, uncontrolled discharge over the years has caused a decline in the potentiometric surface locally and regionally, and a deterioration of the potable water aquifers. Programs for control of flowing wells are being carried on by State, county, municipal, or Federal agencies in 21 countries. (Woodard-USGS)
Healy, Henry G.
Attenuation characteristics of landfill leachate were examined for two uncontrolled landfills in Korea. The two landfills containing municipal wastes without appropriate bottom liner and leachate treatment system have different landfill age, waste volume, and most importantly different hydrogeologic settings. One landfill (Cheonan landfill) is situated in an open flat area while the other (Wonju landfill) is located in a valley.
Jin-Yong Lee; Jeong-Yong Cheon; Hyung-Pyo Kwon; Hee-Sung Yoon; Seong-Sun Lee; Jong-Ho Kim; Joung-Ku Park; Chang-Gyun Kim
Pedestrians with visual impairments need to cross streets where traffic signals and traffic signage are not present. This study examined the influences of several interventions, including a pedestrian's use of a mobility cane, on the behavior of drivers when they were expected to yield to a pedestrian crossing at an uncontrolled crossing.…
Bourquin, Eugene; Emerson, Robert Wall; Sauerburger, Dona
This document provides an overview of remediation of uncontrolled wood preserving sites. It is, in part, a distillation of discussions that took place at a Forum on Wood Preserving Waste that was held in San Francisco, California, in October 1988. Information from this workshop h...
This article reviews the descriptive literature on sexual revictimization and the evidence for the theoretical models that have been formulated to explain this phenomenon. Also, a speculative account of sexual revictimization is presented. The proposed model emphasizes individuals' attempts to influence or control the quality, frequency, intensity, or duration of fear and arousal associated with a history of uncontrollable and
Brian P. Marx; Jennifer M. Heidt; Sari D. Gold
The report gives results of sampling and analysis of uncontrolled emissions from a Q-BOP, a bottom-blown Basic Oxygen Process for steelmaking, undertaken to characterize and quantify the particulate, organic, and inorganic species emitted during hot metal addition to precharged s...
The need to sedate terminally ill patients for uncontrolled symptoms has been previously documented in a few reports. A retrospective consecutive chart review was undertaken at a hospice in Cape Town, South Africa, to develop an understanding of the local experience and assess the potential for improved patient management. Twenty-three of seventy-six (30%) patients received sedating therapies: twenty patients for
Robin L. Fainsinger; Willie Landman; Mark Hoskings; Eduardo Bruera
Routine ophthalmic examinations of 600 full-term neonates, including 54 born to mothers with insulin-dependent diabetes mellitus and 12 whose mothers had developed gestational diabetes, revealed significant tortuosity and dilatation of the iris vessels in over half of the infants born to diabetic mothers. Ninety percent of the newborns in the diabetic group presented hypoplasia of the iris stroma and pupil
Benedetto Ricci; Maria Gabriella Scullica; Francesco Ricci; Alessandro Santo
Objective To determine whether small for gestational age (SGA) infants <27 weeks gestation is associated with mortality, morbidity, growth and neurodevelopmental impairment at 18–22 months’ corrected age (CA). Study design This was a retrospective cohort study from National Institute of Child Health and Human Development Neonatal Research Network’s Generic Database and Follow-up Studies. Infants born at <27 weeks’ gestation from January 2006 to July 2008 were included. SGA was defined as birth weight <10th percentile for gestational age by the Olsen growth curves. Infants with birth weight ?10th percentile for gestational age were classified as non-SGA. Maternal and infant characteristics, neonatal outcomes and neurodevelopmental data were compared between the groups. Neurodevelopmental impairment was defined as any of the following: cognitive score <70 on BSID III, moderate or severe cerebral palsy, bilateral hearing loss (+/? amplification) or blindness (vision <20/200). Logistic regression analysis evaluated the association between SGA status and death or neurodevelopmental impairment. Results There were 385 SGA and 2586 non-SGA infants. Compared with the non-SGA group, mothers of SGA infants were more likely to have higher level of education, prenatal care, cesarean delivery, pregnancy-induced hypertension and antenatal corticosteroid exposure. SGA infants were more likely to have postnatal growth failure, a higher mortality and to have received prolonged mechanical ventilation and postnatal steroids. SGA status was associated with higher odds of death or neurodevelopmental impairment [OR 3.91 (95% CI: 2.91–5.25), P<0.001]. Conclusion SGA status among infants <27 weeks’ gestation was associated with an increased risk for postnatal steroid use, mortality, growth failure and neurodevelopmental impairment at 18–22 months’ CA.
De Jesus, Lilia C.; Pappas, Athina; Shankaran, Seetha; Li, Lei; Das, Abhik; Bell, Edward F.; Stoll, Barbara J.; Laptook, Abbot R.; Walsh, Michele C.; Hale, Ellen C.; Newman, Nancy S.; Bara, Rebecca; Higgins, Rosemary D.
The general aviation air traffic flow patterns at uncontrolled airports are investigated and analyzed and traffic pattern concepts are developed to minimize the midair collision hazard in uncontrolled airspace. An analytical approach to evaluate midair collision hazard probability as a function of traffic densities is established which is basically independent of path structure. Two methods of generating space-time interrelationships between terminal area aircraft are presented; one is a deterministic model to generate pseudorandom aircraft tracks, the other is a statistical model in preliminary form. Some hazard measures are presented for selected traffic densities. It is concluded that the probability of encountering a hazard should be minimized independently of any other considerations and that the number of encounters involving visible-avoidable aircraft should be maximized at the expense of encounters in other categories.
Baxa, E. G., Jr.; Scharf, L. L.; Ruedger, W. H.; Modi, J. A.; Wheelock, S. L.; Davis, C. M.
Summary Sixty pregnant maturity-onset (insulin-independent), established and gestational, diabetics were treated with Metformin in the second and third trimester after dietary treatment had failed. The incidence of Metformin failure was 53.8% in the established diabetics and 28.6% in the gestational diabetics. The 27 Metformin failures were transferred to other therapy, leaving for further analysis 33 patients who received Metformin up till
E. J. Coetzee; W. P. U. Jackson
Gestational diabetes mellitus is a major complication of human pregnancy. The oral clearance (CL) of glyburide, an oral antidiabetic drug, increases 2-fold in pregnant women during late gestation versus nonpregnant controls. In this study, we examined gestational age-dependent changes in maternal-fetal pharmacokinetics (PK) of glyburide and metabolites in a pregnant mouse model. Nonpregnant and pregnant FVB mice were given glyburide by retro-orbital injection. Maternal plasma was collected over 240 minutes on gestation days (gd) 0, 7.5, 10, 15, and 19; fetuses were collected on gd 15 and 19. Glyburide and metabolites were quantified using high-performance liquid chromatography-mass spectrometry, and PK analyses were performed using a pooled data bootstrap approach. Maternal CL of glyburide increased approximately 2-fold on gd 10, 15, and 19 compared with nonpregnant controls. Intrinsic CL of glyburide in maternal liver microsomes also increased as gestation progressed. Maternal metabolite/glyburide area under the curve ratios were generally unchanged or slightly decreased throughout gestation. Total fetal exposure to glyburide was <5% of maternal plasma exposure, and was doubled on gd 19 versus gd 15. Fetal metabolite concentrations were below the limit of assay detection. This is the first evidence of gestational age-dependent changes in glyburide PK. Increased maternal glyburide clearance during gestation is attributable to increased hepatic metabolism. Metabolite elimination may also increase during pregnancy. In the mouse model, fetal exposure to glyburide is gestational age-dependent and low compared with maternal plasma exposure. These results indicate that maternal glyburide therapeutic strategies may require adjustments in a gestational age-dependent manner if these same changes occur in humans. PMID:24898265
Shuster, Diana L; Risler, Linda J; Liang, Chao-Kang J; Rice, Kenneth M; Shen, Danny D; Hebert, Mary F; Thummel, Kenneth E; Mao, Qingcheng
Intrauterine growth restriction (IUGR) can lead to infants being born small for gestational age (SGA). SGA is associated with increased neonatal morbidity and mortality as well as short stature, cardiovascular disease, insulin resistance, diabetes mellitus type 2, dyslipidemia and end-stage renal disease in adulthood. In addition, SGA children have decreased levels of intelligence and cognition, although the effects are mostly
H. M. A. de Bie; K. J. Oostrom; H. A. Delemarre-van de Waal