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1

Gestational diabetes  

MedlinePLUS

... blood sugar (glucose) levels, you may be prescribed diabetes medicine by mouth or insulin therapy. Most women who develop gestational diabetes will not need diabetes medicines or insulin, but some will.

2

Gestational Diabetes  

Microsoft Academic Search

Before the availability of insulin in the early 1920s, pregnant women with diabetes faced very high maternal and perinatal\\u000a mortality rates. Pregnancy was therefore not recommended in patients with diabetes. Today, with the advent of insulin, these\\u000a mortality rate increases have been virtually eliminated, so that pregnancy should no longer be discouraged in a young woman\\u000a with diabetes.

Jorge A. Arzac

3

Gestational Diabetes and Testing  

MedlinePLUS

... a healthy baby. You can! Journal of Midwifery & Women’s Health • www.jmwh.org 135 © 2006 by the American ... E S FOR MORE INFORMATION ABOUT GESTATIONAL DIABETES National Women’s Health Information Center Diabetes— http://www.4woman.gov/faq/ ...

4

Gestational diabetes: diagnosis and management  

Microsoft Academic Search

Purpose:To review the diagnosis and management of gestational diabetes.Epidemiology:In the United States, approximately 2 to 5% of all pregnant women have gestational diabetes. Those women with a family history of type 2 diabetes mellitus, Asian or native American race, Latina ethnicity or obesity are at higher risk for developing gestational diabetes.Conclusion:Women with gestational diabetes who are treated appropriately can achieve

Y W Cheng; A B Caughey

2008-01-01

5

[Gestational diabetes mellitus].  

PubMed

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

2012-12-01

6

Prevention of Gestational Diabetes  

PubMed Central

OBJECTIVE To examine the feasibility of an individualized exercise program to prevent gestational diabetes mellitus (GDM) in obese pregnant women. RESEARCH DESIGN AND METHODS The study was a pilot randomized controlled trial with obese pregnant women (intervention group, individualized exercise program [n = 25]; control group, usual care [n = 25]). Average weekly energy expenditure (MET hours per week and kilocalories per week) of exercise-specific activity was assessed during pregnancy using the Pregnancy Physical Activity Questionnaire. Fasting glucose and insulin and homeostasis model assessment of insulin resistance (HOMA-IR) were assessed at baseline and 20, 28, and 36 weeks' gestation. RESULTS Of the women in the intervention group, 16 of 22 (73%) achieved more than 900 kcal/week of exercise-based activity at 28 weeks compared with 8 of 19 women in the control group (42%), P = 0.047. However, insulin resistance (HOMA-IR) did not differ between the groups. CONCLUSION This intervention was feasible and prompted a modest increase in physical activity. However, we are not confident that this intervention would be sufficient to prevent GDM. PMID:20357374

Callaway, Leonie K.; Colditz, Paul B.; Byrne, Nuala M.; Lingwood, Barbara E.; Rowlands, Ingrid J.; Foxcroft, Katie; McIntyre, H. David

2010-01-01

7

What I Need to Know about Gestational Diabetes  

MedlinePLUS

... Diabetes What I need to know about Gestational Diabetes On this page: What is gestational diabetes? What ... Guide For More Information Acknowledgments What is gestational diabetes? Gestational * diabetes is a type of diabetes that ...

8

Gestational Diabetes: What You Need to Know  

MedlinePLUS

... Statistics Research Resources Order About Us Español National Diabetes Information Clearinghouse Publications Tools and Resources E-News ... Gestational Diabetes: What You Need to Know Gestational Diabetes: What You Need to Know On this page: ...

9

Trying to understand gestational diabetes  

PubMed Central

Women with normal glucose tolerance pre-gravid and developing gestational diabetes in late gestation have subclinical metabolic dysfunction prior to conception compared with women with normal glucose tolerance. Because of the 60 % decrease in insulin sensitivity with normal pregnancy, these women develop clinical hyperglycaemia/gestational diabetes in late gestation. The metabolic dysfunction includes impaired insulin response, decreased hepatic suppression of glucose production during insulin infusion and decreased insulin-stimulated glucose uptake in skeletal muscle, i.e. peripheral insulin resistance. The insulin resistance in normal glucose tolerance pregnancy is related to a decrease in the post-receptor insulin signalling cascade, specifically decreased insulin receptor substrate 1 tyrosine phosphorylation. In women with normal glucose tolerance this is reversed post-partum. In contrast, in gestational diabetes, in addition to the decrease in insulin receptor substrate 1 tyrosine phosphorylation, there is an additional decrease in tyrosine phosphorylation of the intracellular portion of the insulin receptor that is not related to the insulin receptor protein content. Post-partum women with gestational diabetes, who had retention of gestational weight gain, had no significant improvement in insulin sensitivity and increased inflammation expressed as increased plasma and skeletal muscle tumour necrosis factor alpha. The increased inflammation or meta-inflammation is a hallmark of obesity and during pregnancy develops in both white adipose tissue and placenta. Last gene array studies of placenta were associated with alterations in gene expression relating primarily to lipid in contrast to glucose metabolic pathways in gestational diabetes compared with Type 1 diabetes. Future studies are directed at decreasing inflammation prior to and during pregnancy using various lifestyle and nutritional interventions. PMID:24341419

Catalano, P. M.

2014-01-01

10

Screening for Gestational Diabetes  

MedlinePLUS

... fact sheet. When the Task Force recommends screening (Grade B), it is because it has more potential ... asymptomatic pregnant women after 24 weeks of gestation . Grade B 1 The Task Force concludes that the ...

11

Exercise: An Alternative Therapy for Gestational Diabetes.  

ERIC Educational Resources Information Center

Exercise is encouraged in the management of pregnant women with gestational diabetes or women with Type II diabetes who become pregnant. Although non-weight-bearing exercises may be best for sedentary women, moderate workouts appear to be safe for most women with gestational diabetes. The role of exercise, risk factors, warning signs, and examples…

Artal, Raul

1996-01-01

12

Understanding Gestational Diabetes: A Practical Guide to a Healthy Pregnancy.  

ERIC Educational Resources Information Center

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.

13

Myositis ossificans of infraorbital musculature in uncontrolled diabetic.  

PubMed

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

2014-03-01

14

What I need to know about Gestational Diabetes  

E-print Network

only during pregnancy. Diabetes means your blood glucose, also called blood sugar, is too high. YourWhat I need to know about Gestational Diabetes National Diabetes Information Clearinghouse #12;#12;What I need to know about Gestational Diabetes #12;#12;Contents What is gestational diabetes

Rau, Don C.

15

Diabetic ketoacidosis during gestational diabetes. A case report.  

PubMed

Diabetic ketoacidosis is an infrequent complication of gestational diabetes but results in fetal loss. It usually occurs in the later stages of pregnancy. We report two young pregnant women who were admitted because of newly diagnosed diabetes with ketoacidosis. One patient presented with intrauterine fetal demise. PMID:21632139

Pinto, Miguel E; Villena, Jaime E

2011-08-01

16

Iron, oxidative stress and gestational diabetes.  

PubMed

Both iron deficiency and hyperglycemia are highly prevalent globally for pregnant women. Iron supplementation is recommended during pregnancy to control iron deficiency. The purposes of the review are to assess the oxidative effects of iron supplementation and the potential relationship between iron nutrition and gestational diabetes. High doses of iron (~relative to 60 mg or more daily for adult humans) can induce lipid peroxidation in vitro and in animal studies. Pharmaceutical doses of iron supplements (e.g., 10× RDA or more for oral supplements or direct iron supplementation via injection or addition to the cell culture medium) for a short or long duration will induce DNA damage. Higher heme-iron intake or iron status measured by various biomarkers, especially serum ferritin, might contribute to greater risk of gestational diabetes, which may be mediated by iron oxidative stress though lipid oxidation and/or DNA damage. However, information is lacking about the effect of low dose iron supplementation (? 60 mg daily) on lipid peroxidation, DNA damage and gestational diabetes. Randomized trials of low-dose iron supplementation (? 60 mg daily) for pregnant women are warranted to test the relationship between iron oxidative stress and insulin resistance/gestational diabetes, especially for iron-replete women. PMID:25255832

Zhuang, Taifeng; Han, Huijun; Yang, Zhenyu

2014-09-01

17

Iron, Oxidative Stress and Gestational Diabetes  

PubMed Central

Both iron deficiency and hyperglycemia are highly prevalent globally for pregnant women. Iron supplementation is recommended during pregnancy to control iron deficiency. The purposes of the review are to assess the oxidative effects of iron supplementation and the potential relationship between iron nutrition and gestational diabetes. High doses of iron (~relative to 60 mg or more daily for adult humans) can induce lipid peroxidation in vitro and in animal studies. Pharmaceutical doses of iron supplements (e.g., 10× RDA or more for oral supplements or direct iron supplementation via injection or addition to the cell culture medium) for a short or long duration will induce DNA damage. Higher heme-iron intake or iron status measured by various biomarkers, especially serum ferritin, might contribute to greater risk of gestational diabetes, which may be mediated by iron oxidative stress though lipid oxidation and/or DNA damage. However, information is lacking about the effect of low dose iron supplementation (?60 mg daily) on lipid peroxidation, DNA damage and gestational diabetes. Randomized trials of low-dose iron supplementation (?60 mg daily) for pregnant women are warranted to test the relationship between iron oxidative stress and insulin resistance/gestational diabetes, especially for iron-replete women. PMID:25255832

Zhuang, Taifeng; Han, Huijun; Yang, Zhenyu

2014-01-01

18

Vaginal birth after cesarean among women with gestational diabetes  

Microsoft Academic Search

Objective: We sought to determine the pregnancy and infant outcomes of women with gestational diabetes who attempted vaginal birth after previous cesarean delivery. Study Design: We conducted a retrospective cohort study to compare women with gestational diabetes with matched control subjects without diabetes who attempted vaginal birth after cesarean at Grady Memorial Hospital, Atlanta, from January 1, 1989, through December

Traci L. Coleman; Hugh Randall; William Graves; Michael Lindsay

2001-01-01

19

Did You Have Gestational Diabetes When You Were Pregnant?  

MedlinePLUS

ENGLISH Did You Have Gestational Diabetes When You Were Pregnant? What You Need to Know. Some women get diabetes when they are pregnant. Doctors call this ... doctor or health care team if: • you had gestational diabetes • you want to get pregnant again Breastfeed your ...

20

A Comparative Study of Relationship between Micronutrients and Gestational Diabetes  

PubMed Central

In this paper, we studied the relation between the micronutrient and gestational diabetes. Therefore, we measured micronutrient concentration including Ni, Al, Cr, Mg, Fe, Zn, Cu, and Se in serum of women with gestational diabetes between 24 and 28 weeks of gestational age (study group) who had inclusion criteria and comparison with micronutrient levels in normal pregnant women with same gestational age (control group). Results showed that there was no significant difference between the serum micronutrient level (Ni, Al, Cr, Mg, Zn, Cu, Se) in study and control groups except serum level of iron which in serum of gestational diabetic women was lower than normal pregnant women and difference was significant. PMID:22988520

Akhlaghi, Farideh; Bagheri, Seyyed Majid; Rajabi, Omid

2012-01-01

21

Selective screening for gestational diabetes mellitus in adolescent pregnancies  

Microsoft Academic Search

Objective: It is unclear whether it is cost-effective to universally screen adolescent gravidas for gestational diabetes mellitus (GDM). Our objective was to identify the prevalence of gestational diabetes in our adolescent population and to review risk factors that would most easily identify a subset of adolescent patients at greatest risk for the development of gestational diabetes.Methods: Six hundred thirty-two adolescents

Mary L Khine; Amy Winklestein; Joshua A Copel

1999-01-01

22

Potential Mechanisms of Exercise in Gestational Diabetes  

PubMed Central

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. PMID:23691290

Golbidi, Saeid; Laher, Ismail

2013-01-01

23

[Predisposition and phenotypes of gestational diabetes].  

PubMed

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

2014-05-01

24

Prescribing physical activity to prevent and manage gestational diabetes.  

PubMed

Gestational diabetes mellitus (GDM) is the most prevalent metabolic disorder during pregnancy. Women diagnosed with GDM have a substantially greater risk of developing type 2 diabetes within 5-10 years after delivery, and the risk is increased by excess body weight. Uncontrolled hyperglycemia during pregnancy is potentially harmful to both mother and fetus, resulting in a greater need for Caesarian-section deliveries, delivery of larger infants with more excess body fat, a greater risk of infant death and stillbirth, and an elevated risk of infant hypoglycemia immediately after birth. Fortunately, engaging in physical activity prior to and during pregnancy may lower the risk of developing GDM. Pregnant women should also be advised how to safely increase their physical activity during pregnancy and the postpartum period. An initial approach to becoming more physically active can simply be to encourage women to incorporate more unstructured physical activity into daily living, both before and during pregnancy. Giving women an appropriate exercise prescription can encourage them to participate in physical activity safely and effectively throughout pregnancy to prevent and/or manage GDM. Engaging in 30 min of moderate intensity physical activity on most, if not all, days of the week has been adopted as a recommendation for all pregnant women. PMID:24379915

Colberg, Sheri R; Castorino, Kristin; Jovanovi?, Lois

2013-12-15

25

Managing Gestational Diabetes: A Patient's Guide to a Healthy Pregnancy  

MedlinePLUS

... Campaigns & Programs Safe to Sleep, Media-Smart Youth, Maternal/Child Health Education Program NICHD Publications Order/print ... and clinical practice to improve the health of mothers, children, and families. Managing Gestational Diabetes: A Patient's ...

26

Who Can I Go to for Help with Gestational Diabetes?  

MedlinePLUS

... 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- ...

27

Screening for Gestational Diabetes Mellitus. Evidence Synthesis Number 60.  

National Technical Information Service (NTIS)

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

2008-01-01

28

Gestational diabetes mellitus, programing and epigenetics.  

PubMed

Gestational diabetes mellitus (GDM) is a common medical complication in pregnancy. Offspring exposed to maternal hyperglycemia have a higher birth weight and are prone to develop metabolic disease in adult life. The intrauterine environmental or nutritional status seems to be involved in the fetal programing. The concept of "Developmental Origins of Health and Disease" (DOHaD) has been widely accepted and it brings new insights into the molecular pathogenesis of human diseases. The underlying mechanism is still under discussion and epigenetic mechanisms may provide an explanation for the phenomenon. The aim of this review is to illustrate the role of epigenetic modifications in the development of insulin resistance in metabolic diseases induced by adverse intrauterine exposures. Changes in epigenetic mechanism may be an early event in pathogenesis and progression of the metabolic disease in humans. Studies on epigenetic modifications contribute to our understanding of long-term effects of in utero exposure and shed light on the disease prevention and treatment by modulating epigenetic changes. PMID:24125565

Yan, Jie; Yang, Huixia

2014-08-01

29

Modulation of Adipokines and Cytokines in Gestational Diabetes and Macrosomia  

Microsoft Academic Search

Context\\/Objective: Not much is known about the implication of adipokines and different cytokines in gestational diabetes mellitus (GDM) and macrosomia. The purpose of this study was to assess the profile of these hormones and cytokines in macrosomic babies, born to gestational diabetic women. Design\\/Subjects: A total of 59 women (age, 19-42 yr) suffering from GDM with their macrosomic babies (4.35

J.-M. Ategbo; O. Grissa; A. Yessoufou; A. Hichami; K. L. Dramane; K. Moutairou; A. Miled; A. Grissa; M. Jerbi; Z. Tabka; N. A. Khan

2006-01-01

30

Prevalence, Trend and Determining Factors of Gestational Diabetes in Germany  

PubMed Central

Purpose: The true prevalence of gestational diabetes in Germany is unknown. Thus, the study?s purposes were to estimate the prevalence of gestational diabetes as well as to describe the temporal prevalence trend and to identify determinants. Material and Methods: We calculated prevalence estimates based on two datasets: the register-based German perinatal statistic (n?=?650?232) and the maternal self-reports from the German children and youth health survey (KiGGS; n?=?15?429). Differences between prevalence estimates were analysed using ?2 and trend tests, and determinants were identified using logistic regression. Results: According to the perinatal statistic, gestational diabetes was present in 3.7?% of pregnant women in Germany in 2010. The prevalence across the years 2001 to 2006 was estimated at 1.9?% which differed significantly from the prevalence estimate derived from the KiGGS dataset for the same period of time (5.3?%; 95?% confidence interval: 4.6–6.1?%). Both datasets show an increasing trend of gestational diabetes (p?gestational diabetes was mainly associated with age, BMI and social class of pregnant women as well as with multiple pregnancies. Conclusion: The lack of significant screening studies among representative samples hampers a sound estimation of the true prevalence of gestational diabetes in Germany. The increasing trend in gestational diabetes might continue due to the projected increase of important risk factors (e.g., maternal age, obesity). Our analyses support the current consensus recommendations regarding standardised gestational diabetes screening.

Huy, C.; Loerbroks, A.; Hornemann, A.; Rohrig, S.; Schneider, S.

2012-01-01

31

Perinatal Outcomes for Women Diagnosed with Gestational Diabetes Mellitus Who Participated in an Interdisciplinary Gestational Diabetes Program.  

National Technical Information Service (NTIS)

The purpose of this descriptive study was to describe the case management process and report the perinatal outcomes of women in an interdisciplinary gestational diabetes mellitus (GDM) program. This study examined the structure of the team which implement...

K. E. Sears

1997-01-01

32

Healthy Lifestyle Before Pregnancy May Cut Gestational Diabetes Risk  

MedlinePLUS

... who were at a normal weight at the start of pregnancy, and who didn't smoke and were physically active had a 52 percent lower risk of developing gestational diabetes than other women, according to the researchers. Although this study reports associations between the development of diabetes in ...

33

Italian risk factor-based screening for gestational diabetes.  

PubMed

There is a debate about whether universal or risk factors-based screening is most appropriate for gestational diabetes diagnosis. The aim of our retrospective study was to compare in our population the universal screening test recommended by the International Association of Diabetes in Pregnancy Study Group (IADPSG) panel and the American Diabetes Association (ADA) versus the selective screening proposed by the United Kingdom National Institute for Health and Clinical Excellence guidelines (NICE) but modified by the Italian National Institute of Health. From May 2010 to October 2011 all consecutive pregnant women were screened for gestational diabetes according to the IADPSG's panel criteria, while all the risk factors for each patient were registered. Of the 1015 pregnant women included in the study, 113 (11%) were diagnosed with gestational diabetes and 26 (23%) of them would not have been identified by the selective screening proposed by the Italian National Institute of Health. However, all the risk factors considered by the selective screening revealed a good predictive role except for maternal age ? 35 years (OR: 0.98). In the group without the risk factors considered, it was reported the predictive role for gestational diabetes of prepregnancy BMI and nulliparity. The selective risk factors-based screening proposed by the Italian National Institute of Health has detected 77% of gestational diabetes cases in our population, sparing the oral glucose tolerance test for more than 40% of pregnant women at the same time. More information on the clinical impact of this choice could be obtained by a strict analysis of treatment, perinatal outcome and follow-up of an adequate sample size of "missed" gestational diabetes. PMID:24175881

Corrado, F; Pintaudi, B; Di Vieste, G; Interdonato, M L; Magliarditi, M; Santamaria, A; D'Anna, R; Di Benedetto, A

2014-09-01

34

Gestational Diabetes and Gestational Impaired Glucose Tolerance in 1653 Teenage Pregnancies: Prevalence, Risk Factors and Pregnancy Outcomes  

Microsoft Academic Search

Study ObjectiveThe aim of this study was to determine the prevalence of gestational diabetes mellitus (GDM) and gestational impaired glucose tolerance (GIGT) in adolescent pregnancies, associated risk factors, and pregnancy complications.

Deniz Karcaaltincaba; Bahar Buyukkaragoz; Omer Kandemir; Serdar Yalvac; Sadiman K?ykac-Alt?nba?; Ali Haberal

2011-01-01

35

Large-for-gestational-age newborns in women with insulin-treated gestational diabetes under strict metabolic control  

Microsoft Academic Search

Summary OBJECTIVE: To assess the influence of strict metabolic control in women with insulin-treated gestational diabetes on the risk of large-for-gestational-age (LGA) newborns, the frequency of obstetrical complications and fetal outcome. METHODS: In this prospective cohort study, 875 women were screened for gestational diabetes mellitus with a 75 g oral glucose tolerance test (OGTT) between weeks 24 and 28 of gestation.

Heinz Leipold; Christof Worda; Christian J. Gruber; Alexandra Kautzky-Willer; Peter W. Husslein; Dagmar Bancher-Todesca

2005-01-01

36

Neighbourhood food environment and gestational diabetes in New York City.  

PubMed

The association between neighbourhood characteristics and gestational diabetes has not been examined previously. We investigated the relationship between the number of healthy food outlets (supermarkets; fruit/vegetable and natural food stores), and unhealthy food outlets (fast food; pizza; bodegas; bakeries; convenience, candy/nut and meat stores) in census tract of residence, and gestational diabetes in New York City. Gestational diabetes, census tract and individual-level covariates were ascertained from linked birth-hospital data for 210 926 singleton births from 2001 to 2002 and linked to commercial data on retail food outlets. Adjusted odds ratios (aOR) were estimated using a multilevel logistic model. No association between food environment measures and gestational diabetes was found, with aORs ranging from 0.95 to 1.04. However, an increased odds of pre-pregnancy weight >200 lbs for women living in a given neighbourhood with no healthy food outlets [aOR = 1.14, 95% CI 1.07, 1.21] or only one healthy food place [aOR = 1.10, 95% CI 1.04, 1.18] relative to two or more healthy food outlets was found. Due to probable misclassification of neighbourhood food environment and pre-pregnancy obesity results are likely to be biased towards the null. Future research, including validity studies, on the neighbourhood food environment, obesity during pregnancy and gestational diabetes is warranted. PMID:20415754

Janevic, Teresa; Borrell, Luisa N; Savitz, David A; Herring, Amy H; Rundle, Andrew

2010-05-01

37

Neighbourhood food environment and gestational diabetes in New York City  

PubMed Central

Summary The association between neighbourhood characteristics and gestational diabetes has not been examined previously. We investigated the relationship between the number of healthy food outlets (supermarkets; fruit/vegetable and natural food stores), and unhealthy food outlets (fast food; pizza; bodegas; bakeries; convenience, candy/nut and meat stores) in census tract of residence, and gestational diabetes in New York City. Gestational diabetes, census tract and individual-level covariates were ascertained from linked birth-hospital data for 210 926 singleton births from 2001 to 2002 and linked to commercial data on retail food outlets. Adjusted odds ratios (aOR) were estimated using a multilevel logistic model. No association between food environment measures and gestational diabetes was found, with aORs ranging from 0.95 to 1.04. However, an increased odds of pre-pregnancy weight >200 lbs for women living in a given neighbourhood with no healthy food outlets [aOR = 1.14, 95% CI 1.07, 1.21] or only one healthy food place [aOR = 1.10, 95% CI 1.04, 1.18] relative to two or more healthy food outlets was found. Due to probable misclassification of neighbourhood food environment and pre-pregnancy obesity results are likely to be biased towards the null. Future research, including validity studies, on the neighbourhood food environment, obesity during pregnancy and gestational diabetes is warranted. PMID:20415754

Janevic, Teresa; Borrell, Luisa N.; Savitz, David A.; Herring, Amy H.; Rundle, Andrew

2013-01-01

38

Evaluation of thyroid dysfunction in pregnant women with gestational and pre-gestational diabetes  

PubMed Central

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

2013-01-01

39

Am I at Risk for Gestational Diabetes?  

MedlinePLUS

... last 4 weeks to 8 weeks; early/preterm labor and delivery; and surgery to deliver the baby (cesarean section, or C-section) ... bodied, which can cause problems and injuries during delivery; low blood ... the best way to improve outcomes for babies whose mothers have gestational ...

40

Gestational Diabetes May Influence Daughter's Weight Later  

MedlinePLUS

... 23, 2014 Related MedlinePlus Pages Diabetes and Pregnancy Obesity in Children THURSDAY, Oct. 23, 2014 (HealthDay News) -- Daughters of ... reserved. More Health News on: Diabetes and Pregnancy Obesity in Children Recent Health News Page last updated on 24 ...

41

Maternal Gestational Diabetes, Birth Weight, and Adolescent Obesity  

Microsoft Academic Search

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

42

Gestational diabetes mellitus: postpartum opportunities for the diagnosis and prevention of type 2 diabetes mellitus  

Microsoft Academic Search

Gestational diabetes mellitus (GDM) affects approximately 4% of all pregnant women in the US and represents 90% of all cases of diabetes mellitus diagnosed during pregnancy. In addition to the adverse pregnancy outcomes associated with this complication, a history of GDM predisposes women to the future development of type 2 diabetes mellitus (T2DM). Incidence rates of GDM are increasing in

Sue Levkoff; Alison Stuebe; Ellen W Seely; Rhonda Bentley-Lewis

2008-01-01

43

Objectively recorded physical activity and the association with gestational diabetes.  

PubMed

The aim of this population-based study was to assess the association between objectively recorded physical activity (PA) in early gestation and gestational diabetes mellitus (GDM) identified at 28 weeks of gestation in a multi-ethnic cohort of healthy pregnant women in Oslo, Norway. In total, 759 women were included. In early gestation (<20 weeks), light-, moderate-, and vigorous-intensity PA and number of steps were objectively recorded (SenseWear™ Armband Pro3), and self-reported PA, demographics, and anthropometrics were collected. The 75-g oral glucose tolerance test was performed at 28 weeks of gestation. Women with GDM had fewer objectively recorded steps (mean 7964 steps/day vs 8879 steps/day, P?gestation than women without GDM. Additionally, 30% of women with GDM compared with 44% (P?gestation and GDM persisted after adjustment for ethnic origin, weeks of gestation, age, parity, pre-pregnancy BMI, early life socioeconomic position, and self-reported regular PA before pregnancy. The adjusted odds ratio for GDM decreased 19% per standard deviation (3159 steps) increase in objectively recorded steps per day (P?=?0.039). Daily life PA in early gestation measured as steps/day was associated with lower risk of GDM. PMID:24894027

Mørkrid, K; Jenum, A K; Berntsen, S; Sletner, L; Richardsen, K R; Vangen, S; Holme, I; Birkeland, K I

2014-10-01

44

Diabetic muscle infarction and diabetic dermopathy two manifestations of uncontrolled prolong diabetes mellitus presenting with severe leg pain and leg skin lesions  

PubMed Central

Diabetic muscular infarction (DMI) is a rare manifestation which can be seen in patients with long-standing diabetes mellitus. Patients usually come with painful swelling of an involved muscle in one extremity. MRI and biopsy histology can help diagnose this condition. Diabetic dermopathy is another manifestation of patients with diabetes. We present a patient with uncontrolled diabetes type 2 presented with pain, swelling, and a palpable tender mass in one leg along with new skin lesions. Biopsy of the skin lesion and T2-weighted MRI of the leg helped differentiate DMI and dermopathy. PMID:24559137

2014-01-01

45

A Multicenter, Randomized Trial of Treatment for Mild Gestational Diabetes  

PubMed Central

BACKGROUND It is uncertain whether treatment of mild gestational diabetes mellitus improves pregnancy outcomes. METHODS Women who were in the 24th to 31st week of gestation and who met the criteria for mild gestational diabetes mellitus (i.e., an abnormal result on an oral glucose-tolerance test but a fasting glucose level below 95 mg per deciliter [5.3 mmol per liter]) were randomly assigned to usual prenatal care (control group) or dietary intervention, self-monitoring of blood glucose, and insulin therapy, if necessary (treatment group). The primary outcome was a composite of stillbirth or perinatal death and neonatal complications, including hyperbilirubinemia, hypoglycemia, hyperinsulinemia, and birth trauma. RESULTS A total of 958 women were randomly assigned to a study group — 485 to the treatment group and 473 to the control group. We observed no significant difference between groups in the frequency of the composite outcome (32.4% and 37.0% in the treatment and control groups, respectively; P = 0.14). There were no perinatal deaths. However, there were significant reductions with treatment as compared with usual care in several prespecified secondary outcomes, including mean birth weight (3302 vs. 3408 g), neonatal fat mass (427 vs. 464 g), the frequency of large-for-gestational-age infants (7.1% vs. 14.5%), birth weight greater than 4000 g (5.9% vs. 14.3%), shoulder dystocia (1.5% vs. 4.0%), and cesarean delivery (26.9% vs. 33.8%). Treatment of gestational diabetes mellitus, as compared with usual care, was also associated with reduced rates of preeclampsia and gestational hypertension (combined rates for the two conditions, 8.6% vs. 13.6%; P = 0.01). CONCLUSIONS Although treatment of mild gestational diabetes mellitus did not significantly reduce the frequency of a composite outcome that included stillbirth or perinatal death and several neonatal complications, it did reduce the risks of fetal overgrowth, shoulder dystocia, cesarean delivery, and hypertensive disorders. PMID:19797280

Landon, Mark B.; Spong, Catherine Y.; Thom, Elizabeth; Carpenter, Marshall W.; Ramin, Susan M.; Casey, Brian; Wapner, Ronald J.; Varner, Michael W.; Rouse, Dwight J.; Thorp, John M.; Sciscione, Anthony; Catalano, Patrick; Harper, Margaret; Saade, George; Lain, Kristine Y.; Sorokin, Yoram; Peaceman, Alan M.; Tolosa, Jorge E.; Anderson, Garland B.

2009-01-01

46

Assessment of cardiac functions in fetuses of gestational diabetic mothers.  

PubMed

We investigated cardiac function in 67 fetuses of gestational diabetic mothers (FGDMs) and 122 fetuses of healthy mothers between 24 and 36 weeks of gestation. Cardiac functions were evaluated by M-mode, pulsed-wave, and tissue Doppler echocardiography. Fetal echocardiograms were performed at 24, 28, 32, and 36 weeks of gestation. Glycated hemoglobin (HbA1c) levels were obtained from all pregnant women at 24 weeks of gestation. The mean age of diabetic pregnant women was significantly greater than that of controls. Serum HbA1c values of both groups were within normal limits, but they were significantly greater in the diabetic group (p = 0.003). The increase in peak aortic and pulmonary artery velocities were greater in FGDM (p < 0.001). No pathological interventricular septal (IVS) hypertrophy was observed. There was a significant increase in IVS thickness in FGDM compared with controls, which was more prominent at the end of the third trimester (p < 0.001). During the course of pregnancy, mitral E-wave (p < 0.001), A-wave (p = 0.007), tricuspid E-wave (p < 0.001) and A-wave (p = 0.002) velocities were greater in FGDM. The increases in mitral E/A and tricuspid E/A ratios were lower in FGDM with advancing gestation. The E a-wave (p = 0.02), A a-wave (p = 0.04), and S a-wave (p < 0.001) velocities of the right-ventricular (RV) free wall and the E a (p = 0.02) and A a (p = 0.01) velocities of the left-ventricle (LV) posterior wall were greater in FGDM during the course of pregnancy. The E a/A a ratio of the RV posterior wall was greater in FGDM with advancing gestation (p < 0.03). LV and RV E/E a ratios were similar in both groups. The LV myocardial performance index measured by pulsed-wave Doppler was greater in FGDM (p < 0.001). We detected diastolic dysfunction in FGDM. The data suggest that gestational diabetes mellitus may impair ventricular diastolic functions without causing pathological fetal myocardial hypertrophy. We detected subclinical diastolic dysfunction using both pulsed-wave and tissue Doppler imaging in FGDM. PMID:23780554

Balli, Sevket; Pac, Feyza Aysenur; Ece, ?brahim; Oflaz, Mehmet Burhan; Kibar, Ayse Esin; Kandemir, Ömer

2014-01-01

47

Fungal necrotizing fasciitis of the head and neck in 3 patients with uncontrolled diabetes.  

PubMed

Necrotizing fasciitis is an uncommon, rapidly progressive soft-tissue infection that is associated with a high incidence of morbidity and mortality. It is usually caused by bacteria and rarely caused by or complicated by a fungus. We report 3 cases of necrotizing fasciitis of the head and neck in patients with uncontrolled diabetes. Fungi were isolated in all 3 cases. In 1 fatal case, the invasive zygomycete Apophysomyces elegans was isolated. Keys to the management of this condition are (1) early isolation of the causative organism by fungal smear and culture, (2) adequate control of diabetes, (3) maintenance of electrolyte balance, and (4) controlled aggressive surgical debridement at an early stage. We emphasize the importance of fungal smears and cultures in the management of this rapidly spreading infection. PMID:24652565

Prasanna Kumar, Saravanam; Ravikumar, Arunachalam; Somu, Lakshmanan

2014-03-01

48

The rising trend of invasive zygomycosis in patients with uncontrolled diabetes mellitus.  

PubMed

Zygomycosis is an emerging infection worldwide. A study was conducted to understand its spectrum in the Indian scenario. All patients diagnosed for invasive zygomycosis at a tertiary care center in north India from 2000-2004, were retrospectively analyzed. A total of 178 cases (mean average of 35.6 cases/year) of zygomycosis were diagnosed. Rhino-orbito-cerebral type (54.5%) was the commonest presentation followed by cutaneous (14.6%), disseminated (9.0%), and gastrointestinal (8.4%) zygomycosis. Renal and pulmonary zygomycosis were seen in 6.7% patients each. Uncontrolled diabetes mellitus (in 73.6% of cases) was the significant risk factor in all types (Odds Ratio 1.5-8.0) except renal zygomycosis. Breach of skin was the risk factor in 46.2% patients with cutaneous zygomycosis. However, no risk factor could be detected in 11.8% patients. Antemortem diagnosis was possible in 83.7% cases. The commonest (61.5%) isolate was Rhizopus oryzae followed by Apophysomyces elegans in 27% patients. Combination of debridement surgery and amphotericin B therapy was significantly better in survival of the patients (P<0.005) than amphotericin B alone (79.6% vs. 51.7% survival). Thus, a rising trend of invasive zygomycosis was observed in patients with uncontrolled diabetes mellitus in India. Consistent diagnosis of renal zygomycosis in apparently healthy hosts and the emergence of A. elegans in India demand further study. PMID:16772227

Chakrabarti, Arunaloke; Das, Ashim; Mandal, Jharna; Shivaprakash, M R; George, Varghese K; Tarai, Bansidhar; Rao, Pooja; Panda, Naresh; Verma, Subhash C; Sakhuja, Vinay

2006-06-01

49

Gestational diabetes: antepartum characteristics that predict postpartum glucose intolerance and type 2 diabetes in Latino women  

Microsoft Academic Search

We examined antepartum clinical characteristics along with measures of glucose tolerance, insulin sensitivity, pancreatic -cell function, and body composition in Latino women with gestational diabetes mellitus (GDM) for their ability to predict type 2 diabetes or impaired glucose tolerance (IGT) within 6 months after delivery. A total of 122 islet cell antibody-negative women under- went oral and intravenous glucose tolerance

Thomas A. Buchanan; Anny Xiang; Siri L. Kjos; W. P. Lee; Enrique Trigo; Isabel Nader; E. Anne Bergner; Jerry P. Palmer; Ruth K. Peters

1998-01-01

50

Pregnancy outcome in immigrant women with gestational diabetes mellitus.  

PubMed

Recent studies show adverse outcomes of pregnancy among immigrant women from countries with high diabetes rates. We compared maternal and fetal outcomes in immigrant and Italian women with gestational diabetes mellitus (GDM) followed up at our center. Maternal characteristics considered were age, pre-pregnancy body mass index (BMI), HbA1c, frequency of insulin treatment, timing and mode of delivery, and hypertensive disorders; and, for fetal outcome, infants large or small for gestational age, and fetal complications. Pre-pregnancy BMI and HbA1c were higher in immigrant GDM women than in Italians, and more of them were on insulin. No differences in maternal outcome emerged between the two groups. More large for gestational age (LGA) babies were born to immigrant women than to Italians, but no other differences emerged. Apart from newborn LGA, maternal and fetal outcomes were comparable in our immigrant and Italian GDM women. Immigrant GDM women have favourable outcomes if given access to health care and language and cultural barriers are removed. PMID:20528567

Dalfrà, Maria Grazia; Ragazzi, Eugenio; Masin, Michela; Bonsembiante, Barbara; Cosma, Chiara; Barison, Antonella; Toniato, Rosanna; Fedele, Domenico; Lapolla, Annunziata

2011-06-01

51

The Therapeutic Effect of Zuogui Wan in Gestational Diabetes Mellitus Rats  

PubMed Central

In this experiment, we established an animal model of gestational diabetes mellitus rats using streptozotocin. Using the rat model of GDM, the pregnant rats in 1-19d were divided into three groups: (1) Zuogui Wan gestational diabetes mellitus group (group I, n = 12), (2) gestational diabetes mellitus rats as the control group (group II, n = 11), and (3) rats of normal pregnancy group (group III, n = 11). Compared with gestational diabetes mellitus rats as the control group, Zuogui Wan can change the indexes of fasting blood glucose, body weight, total cholesterol, insulin, and metabolism cage index significantly in Zuogui Wan gestational diabetes mellitus group. We can conclude that Zuogui Wan has the therapeutic effect on gestational diabetes mellitus. PMID:25136475

Feng, Qianjin; Niu, Xin; Liu, Xinshe; Xu, Kaixia; Yang, Xiangzhu; Wang, Huifeng

2014-01-01

52

SYSTOLIC TIME INTERVALS IN UNCONTROLLED YOUNG DIABETICS : RESPONSE TO ACUTE LOWERING OF BLOOD GLUCOSE BY INSULIN PUMP  

Microsoft Academic Search

Left ventricular function can be assessed by noninvasive methods using systolic time intervals which correlate well with the direct measures of cardiac performance. The present study aimed at measuring the systolic time intervals in uncontrolled young diabetics and also to find out if there could be changes in these parameters to acute lowering of blood glucose using insulin pump. Materials

P. K. Mishra; C. R. Nayak; H. Mishra; M. Satpathy; K. C. Samal

53

Preconception metabolic indicators predict gestational diabetes and offspring birthweight.  

PubMed

Abstract Pregnancy conditions such as gestational diabetes (GDM) and macrosomia lead to an increased risk of diabetes and cardiovascular disease in the offspring, perpetuating a cycle of poor health. We hypothesized that (1) pre-pregnancy indicators of metabolism would be associated with GDM and birthweight; and (2) the lipid accumulation product (LAP; incorporating waist circumference and triglycerides) and visceral adiposity index (VAI; incorporating waist circumference, triglycerides, and HDL-c) would be better predictors of GDM and birthweight than other indicators. Data from the Cardiovascular Risk in Young Finns Study were linked to the Finnish birth registry for 349 women. BMI, triglycerides, waist circumference, insulin, HOMA-IR, LAP, and VAI at the visit prior to the pregnancy were examined as predictors of GDM and large-for-gestational-age (LGA) using logistic regression with adjustment for age, parity, and smoking. Waist circumference was the strongest predictor of GDM (adjusted odds ratio [aOR] 1.66, 95% confidence interval 1.16-2.38) and LGA (aOR 1.41, 1.00-1.99). For GDM, all markers had similar discrimination; for LGA, the area under the receiver operating curve for waist circumference was significantly higher than for BMI (p?

Harville, Emily W; Juonala, Markus; Viikari, Jorma S A; Raitakari, Olli T

2014-11-01

54

Elevated mean platelet volume is associated with gestational diabetes mellitus.  

PubMed

The mean platelet volume (MPV) is an indicator of the average size and activity of platelets. Elevated MPV values are associated with larger and more active platelets and perceived as a new independent cardiovascular risk factor. The aim of this study was to determine the MPV in women with gestational diabetes mellitus (GDM) and to determine the correlation of MPV with metabolic parameters in GDM. We retrospectively analyzed 30 women with GDM and 38 body mass index-matched women with healthy pregnancies as controls. MPV and platelet counts were recorded in the third trimester and at postpartum 6-12 months for GDM group and in the third trimester for control group. Third-trimester MPV was significantly higher in GDM group compared to control group (8.8?±?1.0 versus 8.1?±?0.7?fl, p?=?0.002). In women with GDM, there was a significant decrease in MPV in the postpartum period (8.8?±?1.0 versus 8.1?±?0.8?fl, p?gestational diabetes during pregnancy. PMID:24898134

Iyidir, Ozlem Turhan; Degertekin, Ceyla Konca; Yilmaz, Banu Aktas; Toruner, Fusun Balos; Akturk, Mujde; Arslan, Metin

2014-09-01

55

Migrant Health: A Preliminary Report on the Incidence of Gestational Diabetes in a Hispanic Migrant Population.  

ERIC Educational Resources Information Center

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.

1987-01-01

56

The Risk of Stillbirth and Infant Death Stratified by Gestational Age in Women with Gestational Diabetes  

PubMed Central

Objective To compare the different mortality risks between delivery and expectant management in women with gestational diabetes mellitus (GDM). Study Design This is a retrospective cohort study that included singleton pregnancies of women diagnosed with GDM delivering at 36-42 weeks gestational age (GA) in California from 1997-2006. A composite mortality rate was developed to estimate the risk of expectant management at each GA incorporating the stillbirth risk during the week of continuing pregnancy plus the infant mortality risk at the GA one week hence. Results In women with GDM, the risk of expectant management is lower than the risk of delivery at 36 weeks, (17.4 vs. 19.3 per 10,000), but at 39 weeks, the risk of expectant management exceeds that of delivery (RR 1.8, 95% CI: 1.2 – 2.6). Conclusion In women with GDM, infant mortality rates at 39 weeks are lower than the overall mortality risk of expectant management for one week absolute risks of stillbirth and infant death are low. PMID:22464068

ROSENSTEIN, Melissa G.; CHENG, Yvonne W.; SNOWDEN, Jonathan M.; NICHOLSON, James A.; DOSS, Amy E.; CAUGHEY, Aaron B.

2012-01-01

57

Getting too sweet: galectin-1 dysregulation in gestational diabetes mellitus.  

PubMed

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

2014-07-01

58

Early Prediction of Gestational Diabetes Mellitus in Vietnam  

PubMed Central

OBJECTIVE We aimed to compare the discriminative power of prognostic models for early prediction of women at risk for the development of gestational diabetes mellitus (GDM) using four currently recommended diagnostic criteria based on the 75-g oral glucose tolerance test (OGTT). We also described the potential effect of application of the models into clinical practice. RESEARCH DESIGN AND METHODS A prospective cross-sectional study of 2,772 pregnant women was conducted at a referral maternity center in Vietnam. GDM was determined by the American Diabetes Association (ADA), International Association of the Diabetes and Pregnancy Study Groups (IADPSG), Australasian Diabetes in Pregnancy Society (ADIPS), and World Health Organization (WHO) criteria. Prognostic models were developed using the Bayesian model averaging approach, and discriminative power was assessed by area under the curve. Different thresholds of predicted risk of developing GDM were applied to describe the clinical impact of the diagnostic criteria. RESULTS The magnitude of GDM varied substantially by the diagnostic criteria: 5.9% (ADA), 20.4% (IADPSG), 20.8% (ADIPS), and 24.3% (WHO). The ADA prognostic model, consisting of age and BMI at booking, had the best discriminative power (area under the curve of 0.71) and the most favorable cost-effective ratio if implemented in clinical practice. Selective screening of women for GDM using the ADA model with a risk threshold of 3% gave 93% sensitivity for identification of women with GDM with a 27% reduction in the number of OGTTs required. CONCLUSIONS A simple prognostic model using age and BMI at booking could be used for selective screening of GDM in Vietnam and in other low- and middle-income settings. PMID:23160727

Tran, Thach S.; Hirst, Jane E.; Do, My An T.; Morris, Jonathan M.; Jeffery, Heather E.

2013-01-01

59

Gestational diabetes mellitus: Get, set, go From diabetes capital of the world to diabetes care capital of the world  

PubMed Central

Screening and diagnosis for gestational diabetes mellitus (GDM) as well as interventions for its management evoke considerable controversy. There are different types of screening methods: universal or risk-based, one step or two step. Different thresholds for diagnosis of GDM have been in vogue. Previous definition and diagnostic criteria had no place for diagnosis of overt diabetes in pregnancy. Following Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study and International Association of Diabetes and Pregnancy Study Groups (IADPSG) recommendations, new screening and diagnostic criteria around the world seem to be gaining consensus. The present recommendation given by IADPSG for screening and diagnosis of diabetes mellitus in pregnancy has two discrete phases. The first is detection of women with overt diabetes not previously diagnosed or treated outside of pregnancy. Universal early testing in populations is recommended at the first prenatal visit. The second phase is a 75-g OGTT at 24–28 week gestation in all women not previously found to have overt diabetes or GDM. ACHOIS and MFMU Network trails have proven benefit in treating hyperglycemias less than what is diagnostic for diabetes. DIPSI has shown the alternative way for resource-challenged communities. Efforts from all stake holders with interest in GDM are required to make the diabetes capital of the world into the diabetes care capital of the world. PMID:21897891

Magon, Navneet

2011-01-01

60

Beneficial effects of breastfeeding in women with gestational diabetes mellitus?  

PubMed Central

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. PMID:24749058

Much, Daniela; Beyerlein, Andreas; Rossbauer, Michaela; Hummel, Sandra; Ziegler, Anette-G.

2014-01-01

61

Perception of uncontrolled blood pressure and non-adherence to anti-hypertensive agents in diabetic hypertensive patients.  

PubMed

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

2013-01-01

62

Gestational Diabetes Mellitus in Africa: A Systematic Review  

PubMed Central

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. PMID:24892280

Macaulay, Shelley; Dunger, David B.; Norris, Shane A.

2014-01-01

63

Reduced apoptosis in term placentas from gestational diabetic pregnancies.  

PubMed

Gestational diabetic mellitus (GDM) pregnancies have an increased risk of macrosomic infants and large placental mass, though the mechanisms explaining each of these is uncertain. We sought to evaluate the contribution of apoptosis to placental size and the expression of glucose transporters (SLC2A) in GDM pregnancies. Maternal age and pre-pregnancy body weight were documented. Newborn weights were recorded after delivery. Placentas 37-40-week gestation from control patients (no pregnancy complication) (n = 5), or with GDM (n = 5) were weighed immediately after delivery. Villous samples (4 mm diameter) were collected and divided into specimens; one was fixed in 4% paraformaldehyde for immunostaining using terminal deoxynucleotidyl transferase dUTP-mediated nick-end labeling (TUNEL) and activated caspase-3. The other specimen was snap frozen in liquid nitrogen and stored at -80°C for active caspase-3, poly(ADP-ribose) polymerase (PARP), SLC2A1 and SLC2A3 gene expression analysis. Our results showed that maternal age and pre-pregnancy body weight were significantly higher in the GDM group when compared with those from the controls (P < 0.05). The mean neonatal birth weight and placenta weight were significantly higher in the GDM group compared with that from the controls (P < 0.05). The apoptotic index of placentas (0.05 ± 0.01 v. 0.17 ± 0.04, P < 0.04), active caspase-3 polypeptide fragments and PARP protein were significantly decreased in GDM placentas as compared with controls. Further, the level of placental SLC2A1 protein expression was ?3-fold higher in GDM placentas. Our results suggest that reduced apoptosis in GDM placentas may contribute to increased placental tissue, which together with enhanced SLC2A1 expression, could play a role in fetal macrosomia. PMID:25054844

Belkacemi, L; Kjos, S; Nelson, D M; Desai, M; Ross, M G

2013-06-01

64

Low prevalence of glucokinase gene mutations in gestational diabetic patients with good glycemic control.  

PubMed

Glucokinase (GCK) plays a key role in glucose homeostasis. Gestational diabetes mellitus increases the risk of gestational complications in pregnant women and fetuses. We screened for mutations in coding and flanking regions of the GCK gene in pregnant women with or without gestational diabetes in a Brazilian population. A sample of 200 pregnant women classified as healthy (control, N = 100) or with gestational diabetes (N = 100) was analyzed for mutations in the GCK gene. All gestational diabetes mellitus patients had good glycemic control maintained by diet alone and no complications during pregnancy. Mutations were detected by single-strand conformation polymorphism and DNA sequencing. Thirteen of the 200 subjects had GCK gene mutations. The mutations detected were in intron 3 (c.43331A>G, new), intron 6 (c.47702T>C, rs2268574), intron 9 (c.48935C>T, rs2908274), and exon 10 (c.49620G>A, rs13306388). None of these GCK mutations were found to be significantly associated with gestational diabetes mellitus. In summary, we report a low frequency of GCK mutations in a pregnant Brazilian population and describe a new intronic variation (c.43331A>G, intron 3). We conclude that mutations in GCK introns and in non-translatable regions of the GCK gene do not affect glycemic control and are not correlated with gestational diabetes mellitus. PMID:22653590

Frigeri, H R; Santos, I C R; Réa, R R; Almeida, A C R; Fadel-Picheth, C M T; Pedrosa, F O; Souza, E M; Rego, F G M; Picheth, G

2012-01-01

65

Promoting Health After Gestational Diabetes: A National Diabetes Education Program Call to Action  

PubMed Central

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. PMID:22183225

Landon, Mark; Warren-Boulton, Elizabeth; Fradkin, Judith

2011-01-01

66

Glucose Intolerance after a Recent History of Gestational Diabetes  

PubMed Central

Aim. Our aim was to evaluate the uptake of our current screening strategy postpartum and the risk factors for glucose intolerance in women with a recent history of gestational diabetes (GDM). Methods. Retrospective analysis of files of women with a recent history of GDM diagnosed with the Carpenter and Coustan criteria from 01-01-2010 till 31-12-2013. Multivariable logistic regression was used to adjust for confounders. Results. Of all 231 women with a recent history of GDM, 21.4% (46) did not attend the scheduled postpartum OGTT. Of the women tested, 39.1% (66) had glucose intolerance and 5.3% (9) had diabetes. These women were more often overweight (39.7% versus 25.3%, P = 0.009), were more often treated with basal-bolus insulin injections (52.0% versus 17.4%, P = 0.032), and had a lower beta-cell function and lower insulin sensitivity, remaining significant after adjustment for age, BMI, and ethnicity (insulin secretion sensitivity index-2 (ISSI-2) in pregnancy 1.5 ± 0.5 versus 1.7 ± 0.4, P = 0.029; ISSI-2 postpartum 1.5 (1.2–1.9) versus 2.2 (1.8–2.6), P = 0.020; Matsuda index postpartum 3.8 (2.6–6.2) versus 6.0 (4.3–8.8), P = 0.021). Conclusion. Glucose intolerance is frequent in early postpartum and these women have a lower beta-cell function and lower insulin sensitivity. One fifth of women did not attend the scheduled OGTT postpartum. PMID:25180037

Calewaert, Peggy; Devlieger, Roland; Verhaeghe, Johan; Mathieu, Chantal

2014-01-01

67

Screening and Diagnosing Gestational Diabetes. Evidence Report/Technology Assessment Number 210.  

National Technical Information Service (NTIS)

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...

2012-01-01

68

Screening and Diagnosing Gestational Diabetes Mellitus. Evidence Report/Technology Assessment Number 210.  

National Technical Information Service (NTIS)

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...

2012-01-01

69

Healthy Pre-Pregnancy Diet and Exercise May Reduce Risk of Gestational Diabetes  

MedlinePLUS

... Media Resources Selected Profiles & Interviews Multimedia Healthy Pre-Pregnancy Diet and Exercise May Reduce Risk of Gestational ... With Their Doctors, Reduce Risk of Diabetes During Pregnancy A series of studies by an NICHD researcher ...

70

Dulce Mothers: an intervention to reduce diabetes and cardiovascular risk in Latinas after gestational diabetes.  

PubMed

Latina women with prior gestational diabetes mellitus (GDM) are at elevated risk for type 2 diabetes mellitus and cardiovascular disease. Few primary prevention programs are designed for low socioeconomic status, Spanish-speaking populations. We examined the effectiveness of a Diabetes Prevention Program (DPP) translation in low-income Latinas with a history of GDM. Eighty-four Latinas, 18-45 years old with GDM in the past 3 years, underwent an 8-week peer-educator-led group intervention, with tailoring for Latino culture and recent motherhood. Lifestyle changes and diabetes and cardiovascular risk factors were assessed at study baseline, month 3 and month 6. Participants showed significant improvements in lipids, blood pressure, physical activity, dietary fat intake, and fatalistic and cultural diabetes beliefs (p?diabetes risk in Latinas with GDM. PMID:24653773

Philis-Tsimikas, Athena; Fortmann, Addie L; Dharkar-Surber, Sapna; Euyoque, Johanna A; Ruiz, Monica; Schultz, James; Gallo, Linda C

2014-03-01

71

Hypothyroidism and diabetes mellitus - a risky dual gestational endocrinopathy  

PubMed Central

Objectives. Diabetes mellitus (DM) and hypothyroidism are each associated with increased rate of pregnancy complications. However, their combined morbidity during gestation is poorly studied. Therefore, the aims of this study were to determine the prevalence of the combined morbidity of DM & hypothyroidism and whether it is associated with adverse maternal and neonatal outcome. Study design. This population based retrospective cohort study included 87,213 women who had 232,293 deliveries. All deliveries were divided into the following groups: (1) hypothyroidism & DM (n = 171); (2) hypothyroidism (n = 1502); (3) DM (n = 13,324); and (4) deliveries of women with neither endocrinopathy, who served as a control group (n = 217, 296). Results. The prevalence of DM & hypothyroidism in our population was 0.17%. In comparisons to the other study groups, women with DM & hypothyroidism had higher rates of infertility (p < 0.001), preeclampsia (p < 0.001), chronic hypertension (p < 0.001), preterm birth (p < 0.001), and cesarean deliveries (p < 0.001). In Generalized Estimating Equations (GEE) model, hypothyroidism & DM was an independent risk factor for cesarean section (OR 3.46; 95% CI 2.53–4.75) and for preeclampsia (OR 1.82; 95%CI 1.16–2.84). Conclusion. The combination of DM & hypothyroidism is rare, yet it is associated with higher rate of infertility, cesarean sections, preterm deliveries, and hypertensive disorders of pregnancy than the rest of the population. This dual endocrinological combination is an independent risk factor for preeclampsia and cesarean section. These findings suggest that these patients are at risk for perinatal complications and should be followed and delivered as high risk pregnancies. PMID:23638390

Tirosh, Dan; Benshalom-Tirosh, Neta; Novack, Lena; Press, Fernanda; Beer-Weisel, Ruthy; Wiznitzer, Arnon; Mazor, Moshe

2013-01-01

72

Serum irisin concentration in women with gestational diabetes.  

PubMed

Irisin is a novel myokine and adipokine which induces an increase in total body energy expenditure, improving insulin sensitivity and glucose tolerance in experimental animals. In the present study, serum irisin concentration was measured by an enzyme immunoassay in 130 women with gestational diabetes mellitus (GDM) and 140 BMI-matched patients with normal glucose tolerance (NGT). Median irisin level was significantly lower in the patients with GDM than in the NGT subjects (1703.3 [1354.8-2097.9?ng/ml] versus 1873.8 [1519.8-2294.8?ng/ml], p?=?0.01); however, 3 months after childbirth its concentrations did not differ markedly between the two groups (1165.9 [872.1-1497.5] ng/ml versus 1139.0 [984.0-1376.7] ng/ml). In the whole group, irisin concentration correlated negatively with 2?h glucose level (R?=?-0.14, p?=?0.03). In the women with NGT, irisin concentration correlated positively with IS(OGTT) (R?=?0.22, p?=?0.04) and the disposition index (DI(120)) (R?=?0.24, p?=?0.03), as well as negatively with 2?h insulin level (R?=?-0.23, p?=?0.03) and HOMA-IR (R?=?-0.24, p?=?0.02). Multiple regression analysis revealed that 2?h glucose and DI(120) were the only variables significantly influencing serum irisin (??=?0.158, p?=?0.03 and ??=?0.159, p?=?0.02, respectively). Our results suggest that serum irisin concentration increases markedly in pregnant women, but this increase seems to be significantly lower in patients with GDM. PMID:24850254

Kuzmicki, Mariusz; Telejko, Beata; Lipinska, Danuta; Pliszka, Justyna; Szamatowicz, Michal; Wilk, Juliusz; Zbucka-Kretowska, Monika; Laudanski, Piotr; Kretowski, Adam; Gorska, Maria; Szamatowicz, Jacek

2014-09-01

73

Gestational Diabetes and Postpartum Physical Activity: Evidence of Lifestyle Change 1 Year After Delivery  

Microsoft Academic Search

Although women with gestational diabetes mellitus (GDM) are advised to incorporate physical activity into their lifestyle in order to reduce their risk of developing type 2 diabetes (T2DM), it is recognized that new mothers face barriers to postpartum exercise. Thus, we sought to determine whether, following the diagnosis of GDM, women indeed alter their postpartum physical activity patterns, as compared

Ravi Retnakaran; Ying Qi; Mathew Sermer; Philip W. Connelly; Bernard Zinman; Anthony J. Hanley

2010-01-01

74

Serum osteoprotegerin is associated with carotid intima media thickness in women with previous gestational diabetes  

Microsoft Academic Search

Circulating levels of osteoprotegerin (OPG) have been shown to be increased in patients with cardiovascular disorders and diabetes. The aim of this study was to determine serum OPG levels in women with previous gestational diabetes (GDM), and to investigate the relationship between OPG and carotid intima media thickness (IMT) and circulating cardiovascular risk factors.Serum OPG was measured in 46 women

Baris Akinci; Tevfik Demir; Aygul Celtik; Mustafa Baris; Serkan Yener; Mehmet Ali Ozcan; Faize Yuksel; Mustafa Secil; Sena Yesil

2008-01-01

75

Increased Carotid Artery Intima-Media Thickness in Pregnant Women with Gestational Diabetes Mellitus  

PubMed Central

Background: Pregnant women with previous gestational diabetes mellitus are at increased risk of progressive carotid artery disorders. The current study evaluated carotid intima-media thickness (IMT) in pregnant women with gestational diabetes at two time points of mid-term and full-term pregnancy to determine whether gestational diabetes mellitus causes increased IMT. Methods: This cross-sectional study carried out at Afzalipour Hospital (Kerman, Iran) between 2009 and 2010, recruited 50 women who were at high risk of gestational diabetes during pregnancy and had an oral glucose challenge test (OGCT) as screening for gestational diabetes. B-mode ultrasound scans were performed at baseline and at two time points of mid-term pregnancy (20 to 24 weeks) and full-term pregnancy (36 to 38 weeks) on all the participants. The mean IMT of common carotids and internal carotid arteries from two walls (near and far walls) at four different angles was assessed. Results: An overall comparison between the impaired OGCT test group and the control group revealed significant differences in carotid IMT in the mid-term (0.65 ± 0.07 vs. 0.59 ± 0.06 mm; p value = 0.002) and full-term (0.65 ± 0.05 vs. 0.59 ± 0.04 mm; p value < 0.001) pregnancy; however, the trend of the changes in carotid IMT during mid to full-term pregnancy was insignificant in each group (p value > 0.05). Conclusion: Carotid IMT was significantly higher in the women with gestational diabetes than that in the normoglycemic group in different trimesters. This finding denotes that atherosclerosis might start years before the diagnosis of gestational diabetes in vulnerable women. PMID:23323075

Yousefzadeh, Gholamreza; Hojat, Hashem; Enhesari, Ahmad; Shokoohi, Mostafa; Eftekhari, Nahid; Sheikhvatan, Mehrdad

2012-01-01

76

Early pregnancy metabolite profiling discovers a potential biomarker for the subsequent development of gestational diabetes mellitus.  

PubMed

Current early pregnancy screening tools to identify women at risk of developing gestational diabetes mellitus lack both specificity and sensitivity. As a result, the foetus and mother are often subjected to insult during disease progression, prior to diagnosis and treatment in later pregnancy. Metabolomics is an analytical approach, which allows for appraisal of small molecular mass compounds in a biofluid. The aim of this pilot study was to investigate the relationship between the early gestation serum metabolite profile and the subsequent development of gestational diabetes mellitus in the search for early pregnancy biomarkers and potential metabolic mechanisms. Our nested case-control study analysed maternal serum at 20 weeks' gestation, obtained from the New Zealand cohort of the Screening for Pregnancy Endpoints study. Metabolomic profiling was performed using gas chromatography coupled to mass spectrometry, and metabolites were identified using R software and an in-house mass spectral library. Statistical analysis was performed using SPSS version 21.0. Forty-eight metabolites were identified in the serum samples. Itaconic acid (P = 0.0003), with a false discovery rate of 0.012, was found to be significantly more abundant in women who subsequently developed gestational diabetes mellitus, when compared to controls with uncomplicated pregnancies. The current pilot study found that itaconic acid may have potential as a novel biomarker in early pregnancy to predict the subsequent development of gestational diabetes mellitus. However, the findings from this pilot study require validation with a larger, diverse population before translation into the clinical setting. PMID:25064235

de Seymour, Jamie V; Conlon, Cathryn A; Sulek, Karolina; Villas Bôas, Silas G; McCowan, Lesley M E; Kenny, Louise C; Baker, Philip N

2014-10-01

77

Adherence to healthy lifestyle and risk of gestational diabetes mellitus: prospective cohort study  

PubMed Central

Objective To quantify the association between a combination of healthy lifestyle factors before pregnancy (healthy body weight, healthy diet, regular exercise, and not smoking) and the risk of gestational diabetes. Design Prospective cohort study. Setting Nurses’ Health Study II, United States. Participants 20?136 singleton live births in 14?437 women without chronic disease. Main outcome measure Self reported incident gestational diabetes diagnosed by a physician, validated by medical records in a previous study. Results Incident first time gestational diabetes was reported in 823 pregnancies. Each lifestyle factor measured was independently and significantly associated with risk of gestational diabetes. The combination of three low risk factors (non-smoker, ?150 minutes a week of moderate to vigorous physical activity, and healthy eating (top two fifths of Alternate Healthy Eating Index-2010 adherence score)) was associated with a 41% lower risk of gestational diabetes compared with all other pregnancies (relative risk 0.59, 95% confidence interval 0.48 to 0.71). Addition of body mass index (BMI) <25 before pregnancy (giving a combination of four low risk factors) was associated with a 52% lower risk of gestational diabetes compared with all other pregnancies (relative risk 0.48, 0.38 to 0.61). Compared with pregnancies in women who did not meet any of the low risk lifestyle factors, those meeting all four criteria had an 83% lower risk of gestational diabetes (relative risk 0.17, 0.12 to 0.25). The population attributable risk percentage of the four risk factors in combination (smoking, inactivity, overweight, and poor diet) was 47.5% (95% confidence interval 35.6% to 56.6%). A similar population attributable risk percentage (49.2%) was observed when the distributions of the four low risk factors from the US National Health and Nutrition Examination Survey (2007-10) data were applied to the calculation. Conclusions Adherence to a low risk lifestyle before pregnancy is associated with a low risk of gestational diabetes and could be an effective strategy for the prevention of gestational diabetes. PMID:25269649

Tobias, Deirdre K; Chavarro, Jorge E; Bao, Wei; Wang, Dong; Ley, Sylvia H; Hu, Frank B

2014-01-01

78

Interactions Between Pregnancy, Obstructive Sleep Apnea, and Gestational Diabetes Mellitus  

PubMed Central

Context: Questionnaire studies linked symptoms of obstructive sleep apnea (OSA) to the risk of gestational diabetes mellitus (GDM). Whether this association is present when OSA is assessed objectively by polysomnography is not known. Objective: The objective of the study was to assess the relationship between pregnancy, OSA, and GDM. Design, Setting, and Participants: We conducted observational case-control studies using polysomnography in 15 nonpregnant, nondiabetic women (NP-NGT), 15 pregnant women with normal glucose tolerance (P-NGT), and 15 pregnant women with GDM (P-GDM). The groups were frequency matched for age and race/ethnicity. Pregnant women were studied during the late second to early third trimester. Main Outcome Measures: Comparisons of OSA diagnosis and sleep parameters between NP-NGT and P-NGT to assess the impact of pregnancy and between P-NGT and P-GDM to explore the association between GDM and OSA were measured. Results: Compared with NP-NGT, P-NGT women had a higher apnea hypopnea index (AHI) (median 2.0 vs 0.5, P = .03) and more disrupted sleep as reflected by a higher wake time after sleep onset (median 66 vs 21 min, P < .01) and a higher microarousal index (median 16.4 vs 10.6, P = .01). Among the pregnant women, P-GDM had markedly lower total sleep time (median 397 vs 464 min, P = .02) and a higher AHI (median 8.2 vs 2.0, P = .05) than P-NGT women. OSA was more prevalent in P-GDM than in P-NGT women (73% vs 27%, P = .01). After adjustment for prepregnancy body mass index, the diagnosis of GDM was associated with a diagnosis of OSA [odds ratio 6.60 (95% confidence interval 1.15–37.96)]. In pregnancy, after adjusting for prepregnancy body mass index, higher microarousal index significantly associated with higher hemoglobin A1c and fasting glucose levels. Higher oxygen desaturation index was associated with higher fasting glucose levels. Conclusion: Pregnancy is associated with sleep disturbances. Sleep is more disturbed in GDM than in P-NGT women. There is a strong association between GDM and OSA. PMID:23966237

Zaidi, Nausheen; Wroblewski, Kristen; Kay, Helen H.; Ismail, Mahmoud; Ehrmann, David A.; Van Cauter, Eve

2013-01-01

79

SPRING: an RCT study of probiotics in the prevention of gestational diabetes mellitus in overweight and obese women  

PubMed Central

Background Obesity is increasing in the child-bearing population as are the rates of gestational diabetes. Gestational diabetes is associated with higher rates of Cesarean Section for the mother and increased risks of macrosomia, higher body fat mass, respiratory distress and hypoglycemia for the infant. Prevention of gestational diabetes through life style intervention has proven to be difficult. A Finnish study showed that ingestion of specific probiotics altered the composition of the gut microbiome and thereby metabolism from early gestation and decreased rates of gestational diabetes in normal weight women. In SPRING (the Study of Probiotics IN the prevention of Gestational diabetes), the effectiveness of probiotics ingestion for the prevention of gestational diabetes will be assessed in overweight and obese women. Methods/design SPRING is a multi-center, prospective, double-blind randomized controlled trial run at two tertiary maternity hospitals in Brisbane, Australia. Five hundred and forty (540) women with a BMI > 25.0 kg/m2 will be recruited over 2 years and receive either probiotics or placebo capsules from 16 weeks gestation until delivery. The probiotics capsules contain > 1x109 cfu each of Lactobacillus rhamnosus GG and Bifidobacterium lactis BB-12 per capsule. The primary outcome is diagnosis of gestational diabetes at 28 weeks gestation. Secondary outcomes include rates of other pregnancy complications, gestational weight gain, mode of delivery, change in gut microbiome, preterm birth, macrosomia, and infant body composition. The trial has 80% power at a 5% 2-sided significance level to detect a >50% change in the rates of gestational diabetes in this high-risk group of pregnant women. Discussion SPRING will show if probiotics can be used as an easily implementable method of preventing gestational diabetes in the high-risk group of overweight and obese pregnant women. PMID:23442391

2013-01-01

80

Diet-controlled gestational diabetes mellitus does not influence the success rates for vaginal birth after cesarean delivery  

Microsoft Academic Search

ObjectiveWe sought to determine whether women with diet-controlled gestational diabetes mellitus who attempt vaginal birth after cesarean delivery are at increased risk of failure, when compared with their non-diabetic counterparts.

Dominic Marchiano; Mohammed Elkousy; Erika Stevens; Jeffrey Peipert; George Macones

2004-01-01

81

Gestational Diabetes mellitus in Women in the Fourth Decade – Is Treatment Worthwhile?  

Microsoft Academic Search

Aim: To examine the influence of diet-treated gestational diabetes mellitus on the obstetric performance of mothers aged 40 and above. Method: We reviewed the delivery records of 205 mothers aged 40 and above who delivered over a 3-year period. A 75-gram oral glucose tolerance test was performed in all cases and 64 (31.2%) (18 primiparas and 46 multiparas) had gestational

Ben Chong Pun Chan; Terence Tzu Hsi Lao

2005-01-01

82

The Inter- and Intragenerational Impact of Gestational Diabetes on the Epidemic of Type 2 Diabetes  

PubMed Central

Objectives. We investigated the contribution of gestational diabetes mellitus (GDM) to the historic epidemic of type 2 diabetes mellitus (T2DM) in Saskatchewan. Methods. We constructed a population-level simulation model of the inter- and intragenerational interaction of GDM and T2DM for the period 1956 to 2006. The model was stratified by gender, ethnicity, and age; parameterized with primary and secondary data; and calibrated to match historic time series. Risk of diabetes was sigmoidally trended to capture exogenous factors. Results. Best-fit calibrations suggested GDM may be responsible for 19% to 30% of the cases of T2DM among Saskatchewan First Nations people, but only for approximately 6% of cases among other persons living in Saskatchewan. The estimated contribution of GDM to the growth in T2DM was highly sensitive to assumptions concerning the post-GDM risk of developing T2DM. Conclusions. GDM may be an important driver for the T2DM epidemic in many subpopulations. Because GDM is a readily identifiable, preventable, and treatable condition, investments in prevention, rapid diagnosis, and evidence-based treatment of GDM in at-risk populations may offer substantial benefit in lowering the T2DM burden over many generations. Model-informed data collection can aid in assessing intervention tradeoffs. PMID:21148717

Dyck, Roland F.; Grassmann, Winfried K.

2011-01-01

83

Detailed Physiological Characterization of the Development of Type 2 Diabetes in Hispanic Women With Prior Gestational Diabetes Mellitus  

PubMed Central

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. PMID:20682697

Xiang, Anny H.; Kjos, Siri L.; Takayanagi, Miwa; Trigo, Enrique; Buchanan, Thomas A.

2010-01-01

84

Pregnancy Outcome of Women With Gestational Diabetes in a Tertiary Level Hospital of North India  

PubMed Central

Background: Women with gestational diabetes mellitus (GDM) pose an important public health problem because diabetes not only affects the maternal and fetal outcome, but these women and their fetuses are also at an increased risk of developing diabetes and related complications later in their life. Objectives: The study was conducted to determine the maternal and fetal outcomes of 50 diabetic vs 50 normoglycemic pregnancies. Materials and Methods: This was a retrospective analytical record-based study conducted in a tertiary level hospital. Detailed information regarding maternal, fetal, and labor outcome parameters was recorded in a prestructured proforma and compared in normoglycemic and diabetic pregnancies. Results: Patients with obesity, history of diabetes in the family, spontaneous abortions, and gestational diabetes in previous pregnancies had a greater incidence of GDM in current pregnancy (P<0.05 for all). Hypertension, polyhydramnios, macrosomia, fetopelvic disproportion, and cesarean sections were more (P<0.001) among diabetic pregnancies. Congenital anomalies, polycythemia, hypocalcemia, and hyperbilirubinemia were also observed to be more (P<0.05) in neonates born to diabetics, suggesting an adverse effect of hyperglycemia in utero. Conclusion: Diabetes during pregnancy is associated with higher maternal and fetal morbidity. Therefore, early screening, detection, close monitoring, and intervention is essential to reduce maternal and fetal short- and long-term adverse effects, especially in high-risk groups. Pregnancy provides an opportunity to the clinician to control the disease process and inculcate healthy lifestyle practices in these patients. PMID:21976796

Saxena, Pikee; Tyagi, Swati; Prakash, Anupam; Nigam, Aruna; Trivedi, Shubha Sagar

2011-01-01

85

Role of melanocortin signaling in neuroendocrine and metabolic actions of leptin in male rats with uncontrolled diabetes.  

PubMed

Although the antidiabetic effects of leptin require intact neuronal melanocortin signaling in rodents with uncontrolled diabetes (uDM), increased melanocortin signaling is not sufficient to mimic leptin's glucose-lowering effects. The current studies were undertaken to clarify the role of melanocortin signaling in leptin's ability to correct metabolic and neuroendocrine disturbances associated with uDM. To accomplish this, bilateral cannulae were implanted in the lateral ventricle of rats with streptozotocin-induced diabetes, and leptin was coinfused with varying doses of the melanocortin 3/4 receptor (MC3/4R) antagonist, SHU9119. An additional cohort of streptozotocin-induced diabetes rats received intracerebroventricular administration of either the MC3/4R agonist, melanotan-II, or its vehicle. Consistent with previous findings, leptin's glucose-lowering effects were blocked by intracerebroventricular SHU9119. In contrast, leptin-mediated suppression of hyperglucagonemia involves both melanocortin dependent and independent mechanisms, and the degree of glucagon inhibition was associated with reduced plasma ketone body levels. Increased central nervous system melanocortin signaling alone fails to mimic leptin's ability to correct any of the metabolic or neuroendocrine disturbances associated with uDM. Moreover, the inability of increased melanocortin signaling to lower diabetic hyperglycemia does not appear to be secondary to release of the endogenous MC3/4R inverse agonist, Agouti-related peptide (AgRP), because AgRP knockout mice did not show increased susceptibility to the antidiabetic effects of increased MC3/4R signaling. Overall, these data suggest that 1) AgRP is not a major driver of diabetic hyperglycemia, 2) mechanisms independent of melanocortin signaling contribute to leptin's antidiabetic effects, and 3) melanocortin receptor blockade dissociates leptin's glucose-lowering effect from its action on other features of uDM, including reversal of hyperglucagonemia and ketosis, suggesting that brain control of ketosis, but not blood glucose levels, is glucagon dependent. PMID:25137027

Meek, Thomas H; Matsen, Miles E; Damian, Vincent; Cubelo, Alex; Chua, Streamson C; Morton, Gregory J

2014-11-01

86

Modelling effective diagnosis of risk complications in gestational diabetes mellitus: an e-diabetic expert system for pregnant women  

NASA Astrophysics Data System (ADS)

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.

2012-04-01

87

Melatonin receptor 1 B polymorphisms associated with the risk of gestational diabetes mellitus  

Microsoft Academic Search

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\\u000a studies. Since T2DM and gestational diabetes mellitus (GDM) share similar characteristics, we suspected that the two genetic\\u000a polymorphisms in MTNR1B may be associated with GDM, and conducted association studies between the

Jason Y Kim; Hyun Sub Cheong; Byung-Lae Park; Sei Hyun Baik; Sunmin Park; Si Won Lee; Min-Hyoung Kim; Jin Hoon Chung; June Seek Choi; Moon-Young Kim; Jae-Hyug Yang; Dong-Hee Cho; Hyoung Doo Shin; Sung-Hoon Kim

2011-01-01

88

Maternal Plasma 25-Hydroxyvitamin D Concentrations and the Risk for Gestational Diabetes Mellitus  

Microsoft Academic Search

BackgroundEvidence is accumulating for a role of vitamin D in maintaining normal glucose homeostasis. However, studies that prospectively examined circulating concentrations of 25-hydroxyvitamin D (25-[OH] D) in relation to diabetes risk are limited. Our objective is to determine the association between maternal plasma 25-[OH] D concentrations in early pregnancy and the risk for gestational diabetes mellitus (GDM).MethodsA nested case-control study

Cuilin Zhang; Chunfang Qiu; Frank B. Hu; Robert M. David; Rob M. van Dam; Alexander Bralley; Michelle A. Williams; Per Westermark

2008-01-01

89

Promoting Breastfeeding Among Obese Women and Women with Gestational Diabetes Mellitus  

Microsoft Academic Search

Breastfeeding has many health benefits for women and their babies, but particularly if the woman is obese and\\/or had a pregnancy\\u000a affected with gestational diabetes mellitus (GDM). Women who have had GDM are at high risk for developing metabolic syndrome\\u000a or type 2 diabetes, and their offspring are at greater risk for these metabolic disorders both in childhood and later

Kimberly K. Trout; Tali Averbuch; Meghan Barowski

2011-01-01

90

Does insulin secretion in patients with one abnormal glucose tolerance test value mimic gestational diabetes mellitus?  

Microsoft Academic Search

Objective: The purpose of this study was to investigate the insulin response to a 3-hour oral glucose tolerance test and to compare the insulin levels in the gestational diabetes mellitus and single abnormal test value groups with a nondiabetic control group. Study Design: One hundred ten Turkish women with uncomplicated pregnancy participated in this prospective controlled study between 24 to

Tolga Ergin; Arda Lembet; Hakan Duran; Esra Kuscu; Tayfun Bagis; Esra Saygili; Sertac Batioglu

2002-01-01

91

Effect of fetal hyperinsulinism on oral glucose tolerance test results in patients with gestational diabetes mellitus  

Microsoft Academic Search

Objective: This study was undertaken to evaluate the impact of the fetoplacental glucose steal phenomenon on the results of oral glucose tolerance testing in pregnancies complicated by gestational diabetes mellitus with fetal hyperinsulinism. Study Design: This was an analysis of the cases of 34 patients with two consecutive abnormal oral glucose tolerance test results and amniotic fluid insulin measurement before

Peter A. M. Weiss; Heinz S. Scholz; Josef Haas; Karl F. Tamussino

2001-01-01

92

Excess Risk of Gestational Diabetes among Native American Mothers in Utah  

Microsoft Academic Search

The prevalence of gestational diabetes mellitus (GDM) and its underlying risk factors within minority populations has become a matter of increasing concern. National data indicate a particularly high risk for Native American mothers. This study focused on the patterns of GDM and two risk factors (maternal age and pre- pregnancy weight status) between Native American and non-Native American mothers in

Brenda Ralls; William F. Stinner; Richard Bullough; Michael F. Friedrichs; Jeffrey Duncan; Jenny Billy

2007-01-01

93

Dietary Fiber Intake, Dietary Glycemic Load, and the Risk for Gestational Diabetes Mellitus  

Microsoft Academic Search

OBJECTIVE — We aimed to examine whether pregravid dietary fiber consumptions from cereal, fruit, and vegetable sources and dietary glycemic load were related to gestational diabetes mellitus (GDM) risk. RESEARCH DESIGN AND METHODS — This study was a prospective cohort study among 13,110 eligible women in the Nurses' Health Study II. GDM was self-reported and validated by medical record review

CUILIN ZHANG; SIMIN LIU; CAREN G. SOLOMON; FRANK B. HU

94

Evaluation of DIABNET, a decision support system for therapy planning in gestational diabetes  

Microsoft Academic Search

DIABNET is a knowledge-based system designed to aid doctors with therapy planning in gestational diabetes. The system core is a qualitative model, implemented by a Causal Probabilistic Network, that is able to detect the insulin effectiveness on a daily basis. DIABNET analyses monitoring data and proposes quantitative changes in insulin therapy and qualitative diet modifications. This paper proposes an evaluation

M. Elena Hernando; Enrique J. Gómez; R. Corcoy; Francisco Del Pozo

2000-01-01

95

Gestational Diabetes Mellitus in Africa: A systematic Review  

E-print Network

towards more Westernised diets involves increased consumption of fats, sugars and refined carbohydrates. As a result, LMICs are experiencing a rapid increase in overweight and obesity as well as non-communicable diseases, such as diabetes, that accompany...

Macaulay, Shelley; Dunger, David B.; Norris, Shane A.

2014-06-03

96

The role of lifestyle interventions in the prevention of gestational diabetes.  

PubMed

Gestational diabetes is associated with adverse pregnancy outcomes, increased costs, and long-term risk of type 2 diabetes mellitus (T2DM) in the mother. Observational data have shown an association between reduced weight gain, healthy eating, and physical activity and reduced rates of gestational diabetes mellitus (GDM). Despite this, most randomized controlled trials of lifestyle interventions to prevent GDM have been negative. Dietary approaches appear to be more successful than exercise or a combination of diet and exercise at decreasing GDM. Reasons for negative studies may include lack of power, lack of intervention uptake, and severity of placenta mediated insulin resistance. Future studies should be powered for a reduction in GDM, monitor lifestyle changes closely, and include a psychological component in the intervention. PMID:24318074

Halperin, Ilana J; Feig, Denice S

2014-01-01

97

Who's responsible for the care of women during and after a pregnancy affected by gestational diabetes?  

PubMed

Despite its increasing incidence and high conferred risk to women and their children, gestational diabetes mellitus (GDM) is managed inconsistently during and after pregnancy due to an absence of a systemic approach to managing these women. New guidelines for GDM testing and diagnosis are based on stronger evidence, but raise concerns about increased workloads and confusion in a landscape of multiple, conflicting guidelines. Postnatal care and long-term preventive measures are particularly fragmented, with no professional group taking responsibility for this crucial role. Clearer guidelines and assistance from existing frameworks, such as the National Gestational Diabetes Register, could enable general practitioners to take ownership of the management of women at risk of type 2 diabetes following GDM, applying the principles of chronic disease management long term. PMID:25047889

Wilkinson, Shelley A; Lim, Siew S; Upham, Susan; Pennington, Andrew; O'Reilly, Sharleen L; Asproloupos, Dino; McIntyre, H David; Dunbar, James A

2014-08-01

98

Effect of Treatment of Gestational Diabetes Mellitus: A Systematic Review and Meta-Analysis  

PubMed Central

Objective To assess the efficacy and safety of treating pregnant women with gestational diabetes mellitus in comparison to usual antenatal care. Methods A systematic review and meta-analysis was conducted by including randomized controlled trials comparing any form of therapeutic intervention in comparison to usual antenatal care. A literature search was conducted using electronic databases together with a hand search of relevant journals and conference proceedings. Results Ten studies involving 3,881 patients contributed to meta-analysis. Our results indicated that gestational diabetes mellitus treatment significantly reduced the risk for macrosomia (RR, 0.47; 95% CI, 0.38–0.57), large for gestational age births (RR, 0.55; 95% CI, 0.45–0.67), shoulder dystocia (RR, 0.42; 95% CI, 0.23–0.77) and gestational hypertension (RR, 0.68; 95% CI, 0.53–0.87) without causing any significant increase in the risk for small for gestational age babies. However, no significant difference was observed between the two groups regarding perinatal/neonatal mortality, neonatal hypoglycemia, birth trauma, preterm births, pre-eclampsia, caesarean section and labor induction. Conclusion Treating GDM reduces risk for many important adverse pregnancy outcomes and its association with any harm seems unlikely. PMID:24658089

Poolsup, Nalinee; Suksomboon, Naeti; Amin, Muhammad

2014-01-01

99

Strategies to Optimize Participation in Diabetes Prevention Programs following Gestational Diabetes: A Focus Group Study  

PubMed Central

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. PMID:23861824

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

2013-01-01

100

Zinc and selenium levels in women with gestational diabetes mellitus at Medani Hospital, Sudan.  

PubMed

Abstract Gestational diabetes is a common medical disorder in pregnancy. There is a growing body of evidence of the association between zinc, selenium status and diabetes mellitus during pregnancy. A case-control study was conducted at Medani Hospital, Sudan, to compare zinc and selenium levels in pregnant women with gestational diabetes and normal pregnant women (controls). The two groups (31 in each arm) were well-matched in age, parity, gestational age, haemoglobin and body mass index. Zinc and selenium levels were measured using atomic absorption spectrophotometry. There were no significant differences in the median (interquartile) zinc (498.9 [395-703] vs 486.4 [404-667] ?g/l, p = 0.905) and selenium (164.4 [61-415] vs 204 [68-541] ?g/l, p = 0.838) values between the two groups. There were no significant correlations between zinc and selenium, or between these trace elements and body mass index, gestational age and blood glucose levels. PMID:24911198

Hamdan, H Z; Elbashir, L M; Hamdan, S Z; Elhassan, E M; Adam, I

2014-10-01

101

Women's experiences of factors that facilitate or inhibit gestational diabetes self-management  

PubMed Central

Background Gestational diabetes rates have increased dramatically in the past two decades and this pattern of increase appears to relate primarily to the obesity epidemic, older maternal age and migration from world areas of high GDM risk. Women from disadvantaged and migrant backgrounds are most at risk of developing and of mismanaging this condition. The aim of the study was to explore the factors that facilitated or inhibited gestational diabetes self-management among women in a socially deprived area. Methods Fifteen pregnant women, with a diagnosis of gestational diabetes, were purposively recruited for this study. Qualitative semi structured interviews and 1 focus group were conducted when participants were approximately 28–38 weeks gestation. The study’s theoretical framework was based on interpretative phenomenology and data was analysed using a thematic analysis approach. Results Women in this study identified a number of factors that complicated their task of GDM self-management. Barriers included: (1) time pressures; (2) physical constraints; (3) social constraints; (4) limited comprehension of requirements, and (5) insulin as an easier option. Factors facilitating GDM self-management included: thinking about the baby and psychological support from partners and families. Conclusion Women from low socio economic and migrant backgrounds often struggle to comprehend GDM self-management requirements. To improve adherence to management plans, these women require educational and supportive services that are culturally appropriate and aimed at a low level of literacy. PMID:22988897

2012-01-01

102

The significance of placental ratios in pregnancies complicated by small for gestational age, preeclampsia, and gestational diabetes mellitus  

PubMed Central

Objective This study aimed to evaluate the placental weight, volume, and density, and investigate the significance of placental ratios in pregnancies complicated by small for gestational age (SGA), preeclampsia (PE), and gestational diabetes mellitus (GDM). Methods Two hundred and fifty-four pregnant women were enrolled from August 2005 through July 2013. Participants were divided into four groups: control (n=82), SGA (n=37), PE (n=102), and GDM (n=33). The PE group was classified as PE without intrauterine growth restriction (n=65) and PE with intrauterine growth restriction (n=37). Birth weight, placental weight, placental volume, placental density, and placental ratios including birth weight/placental weight ratio (BPW) and birth weight/placental volume ratio (BPV) were compared between groups. Results Birth weight, placental weight, and placental volume were lower in the SGA group than in the control group. However, the BPW and BPV did not differ between the two groups. Birth weight, placental weight, placental volume, BPW, and BPV were all significantly lower in the PE group than in the control group. Compared with the control group, birth weight, BPW, and BPV were higher in the GDM group, whereas placental weight and volume did not differ in the two groups. Placental density was not significantly different among the four groups. Conclusion Placental ratios based on placental weight, placental volume, placental density, and birth weight are helpful in understanding the pathophysiology of complicated pregnancies. Moreover, they can be used as predictors of pregnancy complications.

Kim, Hee Sun; Cho, Soo Hyun; Kwon, Han Sung; Sohn, In Sook

2014-01-01

103

Clinical outcomes and health care costs combining metformin with sitagliptin or sulphonylureas or thiazolidinediones in uncontrolled type 2 diabetes patients  

PubMed Central

Objectives To compare clinical outcomes and health care costs across three cohorts of uncontrolled diabetic patients who initiated treatment with one of the following: sulphonylureas (SU), thiazolidinediones (TZD) or sitagliptin (SITA). Materials and methods We performed a retrospective study based on a linkage between administrative and laboratory databases maintained by three Italian local health units. The index period ranged from July 2008–June 2010. Patients were treatment-naïve to either SU, TZD, or SITA, but they were already treated with other oral hypoglycemic agents. Demographics and clinical characteristics were assessed at baseline. Adherence was measured by the medication possession ratio and adherent was defined as a patient with a medication possession ratio of 80% or greater. We used a Poisson regression model to estimate the risk ratios for disease-related hospitalizations that occurred during the 18-month follow-up period. The total annual costs included all the pharmacological treatments and the direct costs due to hospitalizations and outpatient services. Results We identified 928 patients treated with SU, 330 patients treated with TZD, and 83 patients treated with SITA. SITA patients were significantly younger and with fewer previous hospital discharges. The baseline mean glycated hemoglobin level was 8.1% for SU, 8.0% for TZD, and 8.3% for SITA patients. SITA-naïve patients were more adherent than the SU- and TZD-naïve patients (79.5% versus 53.2% and 62.8%, respectively; P<0.001). The SU and TZD group showed a significant increased risk of disease-related hospitalizations compared with the SITA group (the unadjusted rate was 10.42 and 7.16 per 100 person-years versus 1.64 per 100 person-years, P=0.003; compared with SU, the adjusted incidence rate ratio for SITA was 0.21, P=0.030). The total annual costs per patient were €972 for SITA, €706 for SU, and €908 for those treated with TZD. Conclusion Uncontrolled diabetic patients who initiated – as a second-line therapy in addition to metformin – treatment with SITA, compared to those who initiated treatment with SU or TZD, showed a reduced risk of disease-related hospitalizations. The total annual costs per patient were not significantly different among the three groups. PMID:25364266

Degli Esposti, Luca; Saragoni, Stefania; Buda, Stefano; Degli Esposti, Ezio

2014-01-01

104

Oral anti-diabetic agents for women with pre-existing diabetes mellitus/impaired glucose tolerance or previous gestational diabetes mellitus  

PubMed Central

Background While most guidelines recommend the use of insulin in women whose pregnancies are affected by pre-existing diabetes, oral agents have obvious benefits for patient acceptability and adherence. It is necessary, however, to assess the effects of these anti-diabetic agents on maternal and infant health outcomes. Additionally, women with previous gestational diabetes mellitus are increasingly found to be predisposed to impaired glucose tolerance and, despite the potential need for intervention for these women, there has been little evidence about the use of oral anti-diabetic agents by these women pre-conceptionally or during a subsequent pregnancy. Objectives To investigate the effect of oral anti-diabetic agents in women with pre-existing diabetes mellitus, impaired glucose tolerance or previous gestational diabetes planning a pregnancy or pregnant women with diabetes mellitus on maternal and infant health. The use of oral antidiabetic agents for management of gestational diabetes in a current pregnancy is evaluated in a separate Cochrane review. Search methods We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (March 2010). Selection criteria We included randomised and quasi-randomised trials. Data collection and analysis Two review authors independently assessed trial eligibility for inclusion. Main results We identified 13 trials published as 25 papers using the Cochrane Pregnancy and Childbirth group literature search, and an additional ongoing trial. We have not included any trials in the review. One trial is awaiting assessment and we have excluded twelve trials because they evaluated treatment of women with gestational diabetes or women with polycystic ovary syndrome, were not randomised controlled trials or data were not available. Authors’ conclusions Little randomised evidence is available evaluating the use of oral anti-diabetic agents in women with diabetes mellitus, impaired glucose tolerance, previous gestational diabetes mellitus planning a pregnancy or pregnant women with pre-existing diabetes mellitus. Large trials comparing any combination of oral anti-diabetic agent, insulin and dietary and lifestyle advice in these women, reporting on maternal and infant health outcomes, glycaemic control, women’s views on the intervention and long-term health outcomes for mother and child, are required to guide clinical practice. PMID:20927764

Tieu, Joanna; Coat, Suzette; Hague, William; Middleton, Philippa

2014-01-01

105

Alpha-tocopherol concentration in serum and colostrum of mothers with gestational diabetes mellitus  

PubMed Central

OBJECTIVE: To evaluate and compare the levels of ?-tocopherol in colostrum and in the serum of healthy and diabetic mothers. METHODS: This cross-sectional study enrolled 51 volunteer mothers, 20 with the diagnosis of gestational diabetes mellitus and 31 without associated diseases. Serum and colostrum samples were collected in fasting in the immediate postpartum period and ?-tocopherol was analyzed by high performance liquid chromatography (HPLC). In order to define the nutritional status of vitamin E, the cutoff point for the serum (697.7µg/dL) was adopted. Student's t-test for independent variables compared the average concentrations of ?-tocopherol in the serum and in the colostrum between control and gestational diabetes mellitus groups. Pearson's correlation was used to assess the relationship between the concentration of ?-tocopherol in serum and colostrum for both groups. Differences were considered significant when p<0.05. RESULTS: The ?-tocopherol concentration in colostrum was 1,483.1±533.8µg/dL for Control Group and 1,368.8±681.8µg/dL for diabetic women, without differences between groups (p=0.50). However, ?-tocopherol concentration in the serum was 1,059.5±372.7µg/dL in the Control Group and 1,391.4±531.5µg/dL in the diabetic one (p<0.01). No correlation was found between the concentration of ?-tocopherol in the serum and in the colostrum for control and diabetic groups. CONCLUSIONS: The groups had adequate nutritional status of vitamin E. Gestational diabetes was not associated with changes in ?-tocopherol concentration in colostrum. PMID:25119748

Resende, Fernanda Barros S.; Clemente, Heleni Aires; Bezerra, Dalila Fernandes; Grilo, Evellyn Camara; de Melo, Larisse Rayanne M.; Bellot, Paula Emilia N. R.; Dantas, Raquel Costa S.; Dimenstein, Roberto

2014-01-01

106

Neurodevelopmental outcome at early school age of children born to mothers with gestational diabetes  

PubMed Central

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.?? PMID:10375355

Ornoy, A; Wolf, A; Ratzon, N; Greenbaum, C; Dulitzky, M

1999-01-01

107

Patterns of congenital anomalies and relationship to initial maternal fasting glucose levels in pregnancies complicated by type 2 and gestational diabetes  

Microsoft Academic Search

Objectives: We sought to determine the types of congenital anomalies affecting infants of women with gestational diabetes mellitus or type 2 diabetes and to examine the relationship between those malformation types and measures of initial glycemia of women at entry into prenatal care with type 2 diabetes or at time of diagnosis in women with gestational diabetes mellitus. Study Design:

Ute M. Schaefer-Graf; Thomas A. Buchanan; Anny Xiang; Giuliana Songster; Martin Montoro; Siri L. Kjos

2000-01-01

108

Clinical predictors for a high risk for the development of diabetes mellitus in the early puerperium in women with recent gestational diabetes mellitus  

Microsoft Academic Search

Objective: The purpose of this study was to identify which maternal, antepartum, or neonatal clinical parameters were predictive for a high risk of diabetes mellitus in the puerperium in women with recent gestational diabetes mellitus and to calculate the associated diabetes mellitus rates and odds ratios. Study design: One thousand six hundred thirty-six women underwent an oral glucose tolerance test

Ute M. Schaefer-Graf; Thomas A. Buchanan; Anny H. Xiang; Ruth K. Peters; Siri L. Kjos

2002-01-01

109

Gestational diabetes screening of a multiethnic, high-risk population using glycated proteins  

Microsoft Academic Search

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

2001-01-01

110

Gestational Diabetes: Using a Portable Glucometer to Simplify the Approach to Screening  

Microsoft Academic Search

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

2008-01-01

111

Effect of Maternal Birthplace on Gestational Diabetes Prevalence in Colorado Hispanics  

Microsoft Academic Search

(1) Describe gestational diabetes mellitus (GDM) prevalence time trends in USborn (USWH) and Mexico-born (MWH), white Hispanic\\u000a Colorado women and (2) Determine effect of maternal birthplace on GDM prevalence. Retrospective population-based study of\\u000a 1995–2004 Colorado birth certificate data for live, singleton births to white, Hispanic mothers estimated prevalence, trends,\\u000a and association of GDM and maternal birthplace. Univariate, bivariate and logistic

Patricia A. BraunAmy; Amy G. Huebschmann; Christina A. Kim; Dennis C. Lezotte; Alyson Shupe; Dana Dabelea

2011-01-01

112

Cost-effectiveness analysis of gestational diabetes mellitus screening in France  

Microsoft Academic Search

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

2002-01-01

113

Metformin therapy throughout pregnancy reduces the development of gestational diabetes in women with polycystic ovary syndrome  

Microsoft Academic Search

Objective: To assess whether metformin safely reduced development of gestational diabetes in women with the polycystic ovary syndrome (PCOS).Design: Prospective and retrospective study.Setting: Outpatient clinical research center.Patient(s): The prospective study included 33 nondiabetic women with PCOS who conceived while taking metformin and had live births; of these, 28 were taking metformin through delivery. The retrospective study included 39 nondiabetic women

C. J Glueck; Ping Wang; Suichi Kobayashi; Harvey Phillips; Luann Sieve-Smith

2002-01-01

114

Short stature in Korean women: a contribution to the multifactorial predisposition to gestational diabetes mellitus  

Microsoft Academic Search

Summary   We examined the associations between demographic characteristics including short stature and the prevalence of gestational\\u000a diabetes mellitus (GDM) in Korean women. In this study, a total of 9005 pregnant women underwent universal screening for GDM.\\u000a Oral glucose tolerance tests (100 g OGTT) were performed in positive screenees (1 h plasma glucose ? 7.2 mmol\\/l) and GDM was\\u000a diagnosed using

H. C. Jang; H. K. Min; H. K. Lee; N. H. Cho; B. E. Metzger

1998-01-01

115

Sugar Smarts: an Educational Guide to Meal Planning with Gestational Diabetes  

Microsoft Academic Search

LEARNING OUTCOME: This guide will improve the management of low-literacy patients with gestational diabetes.An important challenge for healthcare professionals is to develop nutrition patient education materials that improve comprehension and encourage dietary compliance. This problem is compounded when designing materials for low-literacy patients. Despite the availability of these materials, few actively involve the patient We have developed a novel interactive

F. Austin

1996-01-01

116

The utility of a single test to identify women at risk for gestational diabetes  

Microsoft Academic Search

A number of single tests have been proposed as both screening and definitive tests of glucose intolerance during pregnancy.\\u000a Despite limitations imposed by a lack of uniformity in methodology and definitions of gestational diabetes mellitus, there\\u000a appears to be an independent relationship between some single-test results and clinically meaningful outcomes. Further study\\u000a is needed to identify those glucose values above

David A. Sacks

2001-01-01

117

Association Between Contraceptive Use and Gestational Diabetes: Missouri Pregnancy Risk Assessment Monitoring System, 2007-2008  

PubMed Central

Introduction The efficacy and safety of contraceptives have been questioned for decades; however, whether a relationship exists between hormonal contraceptives and gestational diabetes (GDM) is undetermined. The aim of this study was to investigate whether maternal risk for GDM was influenced by type of contraceptive method used before pregnancy. Methods Data collected in 2007 and 2008 by the Missouri Pregnancy Risk Assessment Monitoring System (PRAMS) were analyzed to determine if type of contraception before pregnancy influenced maternal risk for GDM. We used a logistic regression model to determine the adjusted odds for GDM given exposure to hormonal forms of contraception. Results Of the 2,741 women who completed the 2007–2008 PRAMS survey, 8.3% were diagnosed with gestational diabetes, and 17.9% of the respondents had used hormonal contraceptive methods. Women who used hormonal methods of birth control had higher odds for gestational diabetes (adjusted odds ratio [AOR] = 1.43; 95% confidence interval [CI], 1.32–1.55) than did women who used no contraception. A protective effect was also observed for women who had used barrier methods of contraception (AOR = 0.79; 95% CI, 0.72–0.86). Conclusion Findings suggest there may be a relationship between type of contraceptive method and GDM. More research is needed to verify contraception as a potential risk factor for GDM. PMID:25032836

Kramer, Brittney A.; Kintzel, Jeremy

2014-01-01

118

Gestational diabetes and hypertensive disorders of pregnancy as vascular risk signals: an overview and grading of the evidence.  

PubMed

The occurrence of common pregnancy-related medical disorders identifies women at high risk of developing future vascular disease. Systematic reviews of cohort studies demonstrate that gestational diabetes confers a 7-fold risk increase for type 2 diabetes, and preeclampsia confers a 1.8-fold risk increase for type 2 diabetes and 3.4-fold risk increase for hypertension. Gestational diabetes and hypertensive disorders of pregnancy (HDP) increase the risk of premature vascular disease, but the 2-fold risk increase associated with preeclampsia is only partially explained by the development of traditional vascular risk factors. Despite the compelling evidence for gestational diabetes and HDP as vascular risk indicators, there are no published Canadian vascular prevention guidelines that recognize these postpartum women. In contrast, the 2011 American Heart Association guidelines on cardiovascular disease in women include gestational diabetes and HDP in their vascular risk assessment. Studies indicate that the importance surveillance of vascular risk factors in these women after pregnancy is underappreciated by the women themselves and their physicians. Although a prudent diet and physically active lifestyle were demonstrated to reduce diabetes risk in women with a gestational diabetes history in the American Diabetes Prevention Program trial, adoption of these health behaviours is low; qualitative studies confirm a need for tailored strategies that address barriers and provide social support. Further research is also needed on approaches to reduce vascular risk in women with a history of gestational diabetes and HDP. Otherwise, an early window of opportunity for chronic disease prevention in young, high-risk women will be missed. PMID:24726053

Nerenberg, Kara; Daskalopoulou, Stella S; Dasgupta, Kaberi

2014-07-01

119

CTX (Crosslaps) Rather than Osteopontin Is Associated with Disturbed Glucose Metabolism in Gestational Diabetes  

PubMed Central

Objective Reciprocal interaction between bone and glucose metabolism might play a pivotal role in the development of type 2 diabetes. We recently demonstrated that osteocalcin is increased in women with gestational diabetes (GDM) compared to healthy pregnant women and related to enhanced insulin secretion. Here, we aimed to investigate the role of the bone resorption marker CTX and osteopontin (OPN), a key molecule in subclinical inflammation underlying insulin resistance, in gestational diabetes. Methods Insulin sensitivity and secretion (derived from OGTT) as well as CTX and osteopontin were investigated in 26 GDM and 52 women with normal glucose tolerance during pregnancy [CON] between 24th and 28th gestational weeks; 24 women also underwent postpartum examination. Results CTX was significantly higher in GDM compared to CON (0.44±0.20 vs.0.28±0.12 ng/ml, p<.0001) and positively correlated with osteocalcin (R?=?0.64, p<.0001) and parameters of insulin secretion. Osteopontin plasma concentrations were decreased in GDM compared to CON (28.81±22.12 vs.37.68±19.63 ng/ml, p?=?0.04), and did not show any relation to insulin secretion or sensitivity, but were significantly correlated with CRP (R?=?0.3, p<0.007) and liver enzymes. Twelve weeks after delivery CTX and OPN were increased compared to pregnancy (both p<.0001) and did not differ between GDM and CON. Conclusion Our findings support the idea of a tight regulation between bone and glucose metabolism, and suggest, that less curbed CTX during pregnancy might be involved in osteocalcin-mediated amelioration of insulin secretion in GDM. On the other hand, osteopontin was unrelated to insulin resistance in GDM, but associated with inflammatory markers and liver enzymes in all women. PMID:22844418

Winhofer, Yvonne; Kiefer, Florian W.; Handisurya, Ammon; Tura, Andrea; Klein, Katharina; Schneider, Barbara; Marculescu, Rodrig; Wagner, Oswald F.; Pacini, Giovanni; Luger, Anton; Stulnig, Thomas M.; Kautzky-Willer, Alexandra

2012-01-01

120

Gestational diabetes: a strong independent risk factor for severe neonatal respiratory failure after 34 weeks  

Microsoft Academic Search

Purpose  To evaluate if gestational diabetes (GD) exposes neonates delivered after 34 weeks to an increased risk of severe neonatal\\u000a respiratory failure (NRF).\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Data from 3,237 women who delivered after 34 weeks with systematic screening for GD were analyzed. Diagnosis of severe NRF\\u000a required the association of clinical and radiological criteria with a minimum of 24 h of ventilation and admission to neonatal\\u000a intensive

Pauline Vignoles; Catherine Gire; Julien Mancini; Florence Bretelle; Léon Boubli; Eustase Janky; Xavier Carcopino

121

Diabetes in pregnancy. Skeletal malformations in the offspring of diabetic rats after intermittent withdrawal of insulin in early gestation.  

PubMed

Precise timing of the teratogenic period in diabetic pregnancy is of clinical importance since correction of the glucose intolerance during this period may protect the offspring from malformations. An experimental approach to elucidate this problem with regard to skeletal development was made in groups of pregnant streptozotocin-diabetic rats (MDI), which were treated with daily insulin injections except for a 2-day period in the first half of pregnancy. The degree of metabolic derangement was estimated by measurements of serum glucose concentrations. During the insulin-free period, the rats showed severe hyperglycemia (greater than 20 mM) while during ongoing insulin treatment, only brief periods of hyper- or hypoglycemia were observed. Insulin treatment was withdrawn successively between gestational days 3 and 12. Control groups consisted of normal pregnant rats (N) or pregnant rats with manifest diabetes (MD) without insulin treatment. The serum glucose levels of the N animals were below 6 mM while those of the MD animals were above 25 mM throughout pregnancy. Skeletal malformations in the viable offspring were recorded on gestational day 20 after Alizarin staining of calcified ossification centers, which also allowed an estimate of skeletal development as a whole. Untreated diabetes in the MD rats induced a high rate of fetal resorptions, a decrease in fetal weight and viability, as well as retardation of skeletal development. Intermittent insulin treatment in the MDI rats ameliorated, but did not abolish, these changes. In the MD group 9 of 48 viable fetuses showed severe malformations of either the lower jaw (micrognathia) or of the lumbosacral region (caudal dysgenesis).(ABSTRACT TRUNCATED AT 250 WORDS) PMID:6360760

Eriksson, U J; Dahlström, E; Hellerström, C

1983-12-01

122

A national survey of implementation of guidelines for gestational diabetes mellitus.  

PubMed

In 2010, national guidelines for the management of gestational diabetes mellitus (GDM) were published by the Health Service Executive (HSE). In 2012, a questionnaire was distributed to all maternity units to survey implementation of the guidelines. All units screened women for GDM, but used different screening tests with fifteen units (79%) using the recommended 75g OGTT, three units (16%) using a 100g OGTT and one unit (5%) using a 50g glucose challenge test. Optimal outcomes are best achieved through multidisciplinary diabetes-obstetric care and this was available in nine of the units (47%). The prevalence of GDM varied from 2.2 - 7.4%. Insulin usage varied from 15-56%. Six centres (31%) had not implemented the national guidelines in full because of lack of resources. Despite national endorsement of the guideline, significant variations remain in implementation. This may lead to differences in clinical outcomes depending on where a woman attends for obstetric care. PMID:25282959

O'Higgins, A; Dunne, F; Lee, B; Smith, D; Turner, M J

2014-09-01

123

Hepatic Rather Than Cardiac Steatosis Relates to Glucose Intolerance in Women with Prior Gestational Diabetes  

PubMed Central

Background Increased myocardial lipid accumulation has been described in patients with pre- and overt type 2 diabetes and could underlie the development of left-ventricular dysfunction in metabolic diseases (diabetic cardiomyopathy). Since women with prior gestational diabetes (pGDM) display a generally young population at high risk of developing diabetes and associated cardiovascular complications, we aimed to assess whether myocardial lipid accumulation can be detected at early stages of glucose intolerance and relates to markers of hepatic steatosis (Fatty Liver Index), cardiac function, insulin sensitivity and secretion. Methods Myocardial lipid content (MYCL), left-ventricular function (1H-magnetic-resonance-spectroscopy and -imaging), insulin sensitivity/secretion (oral glucose tolerance test) and the fatty liver index (FLI) were assessed in 35 pGDM (45.6±7.0 years, 28.3±4.8 kg/m2) and 14 healthy control females (CON; 44.7±9.8 years, 26.1±2.5 kg/m2), matching for age and body-mass-index (each p>0.1). Results Of 35 pGDM, 9 displayed normal glucose tolerance (NGT), 6 impaired glucose regulation (IGR) and 20 had been already diagnosed with type 2 diabetes (T2DM). MYCL and cardiac function were comparable between pGDM and CON; in addition, no evidence of left-ventricular dysfunction was observed. MYCL was inversely correlated with the ejection fraction in T2DM (R?=??0.45, p<0.05), while the FLI was tightly correlated with metabolic parameters (such as HbA1C, fasting plasma glucose and HDL-cholesterol) and rose along GT-groups. Conclusions There is no evidence of cardiac steatosis in middle-aged women with prior gestational diabetes, suggesting that cardiac complications might develop later in the time-course of diabetes and may be accelerated by the co-existence of further risk factors, whereas hepatic steatosis remains a valid biomarker for metabolic diseases even in this rather young female cohort. PMID:24621572

Winhofer, Yvonne; Krssak, Martin; Wolf, Peter; Tura, Andrea; Anderwald, Christian-Heinz; Kosi, Lana; Reiter, Gert; Pacini, Giovanni; Trattnig, Siegfried; Luger, Anton; Krebs, Michael; Kautzky-Willer, Alexandra

2014-01-01

124

Prevention of Diabetes in Women with a History of Gestational Diabetes: Effects of Metformin and Lifestyle Interventions  

PubMed Central

Context: A past history of gestational diabetes mellitus (GDM) confers a very high risk of postpartum development of diabetes, particularly type 2 diabetes. Objective: The Diabetes Prevention Program (DPP) sought to identify individuals with impaired glucose tolerance (IGT) and intervene in an effort to prevent or delay their progression to diabetes. This analysis examined the differences between women enrolled in DPP with and without a reported history of GDM. Design: The DPP was a randomized, controlled clinical trial. Setting: The study was a multicenter, National Institutes of Health-sponsored trial carried out at 27 centers including academic and Indian Health Services sites. Patients: A total of 2190 women were randomized into the DPP and provided information for past history of GDM. This analysis addressed the differences between those 350 women providing a past history of GDM and those 1416 women with a previous live birth but no history of GDM. Interventions: Subjects were randomized to either standard lifestyle and placebo or metformin therapy or to an intensive lifestyle intervention. Main Outcomes: The primary outcome was the time to development of diabetes ascertained by semiannual fasting plasma glucose and annual oral glucose tolerance testing. Assessments of insulin secretion and insulin sensitivity were also performed. Results: Whereas entering the study with similar glucose levels, women with a history of GDM randomized to placebo had a crude incidence rate of diabetes 71% higher than that of women without such a history. Among women reporting a history of GDM, both intensive lifestyle and metformin therapy reduced the incidence of diabetes by approximately 50% compared with the placebo group, whereas this reduction was 49 and 14%, respectively in parous women without GDM. These data suggest that metformin may be more effective in women with a GDM history as compared with those without. Conclusions: Progression to diabetes is more common in women with a history of GDM compared with those without GDM history despite equivalent degrees of IGT at baseline. Both intensive lifestyle and metformin are highly effective in delaying or preventing diabetes in women with IGT and a history of GDM. PMID:18826999

Ratner, Robert E.; Christophi, Costas A.; Metzger, Boyd E.; Dabelea, Dana; Bennett, Peter H.; Pi-Sunyer, Xavier; Fowler, Sarah; Kahn, Steven E.

2008-01-01

125

RBP4 Gene Variants Are Associated with Insulin Resistance in Women with Previous Gestational Diabetes  

PubMed Central

Objective. This study aimed to examine possible genetic effects of some retinol binding protein-4 (RBP4) single nucleotide polymorphisms (SNPs) on the risk of gestational diabetes mellitus (GDM). In addition, the SNPs were examined for their possible association with insulin resistance at 6 weeks after delivery. Methods. This was a prospective study of 100 women with GDM and 100 participants with normal gestation who were evaluated at gestational week 30 and 6 weeks postpartum. Three SNPs of RBP4 (rs3758539, rs116736522, and rs34571439) were genotyped using TaqMan assay. The genotype distributions between GDM patients and normal controls were analyzed using logistic regression models. In addition, differences in clinical characteristics among subjects grouped by genotype were assessed using the analysis of covariance test. Results. The frequencies of the rare alleles were not significantly different between GDM patients and controls. However, we identified two variants rs3758539 and rs34571439 associated with insulin levels and insulin resistance in women with previous GDM. Conclusion. Noncoding SNPs of the RBP4 gene are not associated with GDM, but two SNPs showed associations with insulin resistance and insulin levels in women with prior GDM. Additional studies with increased sample size will be necessary in other GDM cohorts. PMID:24665145

Hernandez, Marcelino; Puello, Edgardo; Ostrosky-Wegman, Patricia

2014-01-01

126

Reassessment of the new diagnostic thresholds for gestational diabetes mellitus: an opportunity for improvement.  

PubMed

The International Association of Diabetes and Pregnancy Study Groups has recommended new blood glucose levels (BGLs) for the diagnosis of gestational diabetes mellitus (GDM). These BGLs supposedly identify women with at least a 75% increased risk of developing certain adverse neonatal outcomes. The new criteria result in a significant increase in the number of women diagnosed with GDM. Most of the women diagnosed with GDM according to the new criteria have only one elevated BGL. Due to the unrecognised effect of the other BGLs being normal, up to 50% of these women are inappropriately diagnosed with GDM as they do not meet the agreed risk threshold. In absolute terms, for every 100 women diagnosed with GDM who have only one elevated BGL, nearly 50 do not meet the agreed risk threshold for diagnosis, and there are only up to seven extra cases of large-for-gestational-age infants. A more statistically valid basis for diagnosing GDM consistent with the recommended risk threshold is suggested. PMID:25164847

d'Emden, Michael C

2014-08-18

127

Physician Care Patterns and Adherence to Postpartum Glucose Testing after Gestational Diabetes Mellitus in Oregon  

PubMed Central

Objective This study examines obstetrician/gynecologists and family medicine physicians' reported care patterns, attitudes and beliefs and predictors of adherence to postpartum testing in women with a history of gestational diabetes mellitus. Research Design and Methods In November–December 2005, a mailed survey went to a random, cross-sectional sample of 683 Oregon licensed physicians in obstetrician/gynecologists and family medicine from a population of 2171. Results Routine postpartum glucose tolerance testing by both family physicians (19.3%) and obstetrician/gynecologists physicians (35.3%) was reportedly low among the 285 respondents (42% response rate). Factors associated with high adherence to postpartum testing included physician stated priority (OR 4.39, 95% CI: 1.69–7.94) and physician beliefs about norms or typical testing practices (OR 3.66, 95% CI: 1.65–11.69). Specialty, sex of physician, years of practice, location, type of practice, other attitudes and beliefs were not associated with postpartum glucose tolerance testing. Conclusions Postpartum glucose tolerance testing following a gestational diabetes mellitus pregnancy was not routinely practiced by responders to this survey. Our findings indicate that physician knowledge, attitudes and beliefs may in part explain suboptimal postpartum testing. Although guidelines for postpartum care are established, some physicians do not prioritize these guidelines in practice and do not believe postpartum testing is the norm among their peers. PMID:23071709

Hunsberger, Monica L.; Donatelle, Rebecca J.; Lindsay, Karen; Rosenberg, Kenneth D.

2012-01-01

128

A Randomized Controlled Trial of Prenatal Physical Activity to Prevent Gestational Diabetes: Design and Methods  

PubMed Central

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. PMID:19514827

Marcus, Bess H.; Stanek, Edward; Ciccolo, Joseph T.; Marquez, David X.; Solomon, Caren G.; Markenson, Glenn

2009-01-01

129

Precocious markers of cardiovascular risk and vascular damage in apparently healthy women with previous gestational diabetes  

PubMed Central

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. PMID:24955136

2014-01-01

130

Adiponectin and IGFBP-1 in the development of gestational diabetes in obese mothers  

PubMed Central

Objective Gestational diabetes mellitus (GDM) is more common in pregnancies complicated by obesity and both diseases increase the risk for fetal overgrowth and long-term adverse health consequences for the mother and child. Previous studies have linked low maternal serum adiponectin to GDM in normal and overweight women. We hypothesized that lower adiponectin, in particular the high-molecular-weight form, and insulin-like growth factor I (IGF-I) and its binding protein (IGFBP-1) are associated with GDM in pregnant obese Hispanic women. Methods 72 obese, predominantly Hispanic (92%), women were recruited at 24–28?weeks of gestation. Adiposity was assessed, fasting serum samples were collected, and glucose, insulin, triglyceride, cholesterol levels, adipokines, and hormones associated with obesity and insulin resistance were measured. 30 women had been recently diagnosed with GDM. Results Gestational weeks, body mass index, triceps skinfold thickness, mid-arm circumference, serum leptin, IGF-I, tumor necrosis factor ?, and interleukin-6 did not differ in the two groups. Obese women with GDM had significantly higher fasting glucose, A1C, triglycerides, very-low-density lipoprotein cholesterol and lower high-density lipoprotein cholesterol, adiponectin, and IGFBP-1 compared to obese women without GDM. Homeostasis model assessment of insulin resistance was positively correlated to IGF-I and negatively correlated to adiponectin. Conclusions Obese pregnant women with recently diagnosed GDM had a significantly exacerbated metabolic profile, low serum adiponectin and IGFBP-1 levels at 24–28?weeks of gestation, as compared to women with obesity alone. Because low adiponectin is well established to cause insulin resistance and decreased IGFBP-1 indicates increased IGF-I bioavailability, we propose that these changes are mechanistically linked to the development of GDM in obese Hispanic women.

Ramirez, Vanessa I; Miller, Evelyn; Meireles, Christiane L; Gelfond, Jonathan; Krummel, Debra A; Powell, Theresa L

2014-01-01

131

Disproportionate Body Composition and Neonatal Outcome in Offspring of Mothers With and Without Gestational Diabetes Mellitus  

PubMed Central

OBJECTIVE High birth weight is a risk factor for neonatal complications. It is not known if the risk differs with body proportionality. The primary aim of this study was to determine the risk of adverse pregnancy outcome in relation to body proportionality in large-for-gestational-age (LGA) infants stratified by maternal gestational diabetes mellitus (GDM). RESEARCH DESIGN AND METHODS Population-based study of all LGA (birth weight [BW] >90th percentile) infants born to women with GDM (n = 1,547) in 1998–2007. The reference group comprised LGA infants (n = 83,493) born to mothers without diabetes. Data were obtained from the Swedish Birth Registry. Infants were categorized as proportionate (P-LGA) if ponderal index (PI) (BW in grams/length in cm3) was ?90th percentile and as disproportionate (D-LGA) if PI >90th percentile. The primary outcome was a composite morbidity: Apgar score 0–3 at 5 min, birth trauma, respiratory disorders, hypoglycemia, or hyperbilirubinemia. Logistic regression analysis was used to obtain odds ratios (ORs) for adverse outcomes. RESULTS The risk of composite neonatal morbidity was increased in GDM pregnancies versus control subjects but comparable between P- and D-LGA in both groups. D-LGA infants born to mothers without diabetes had significantly increased risk of birth trauma (OR 1.19 [95% CI 1.09–1.30]) and hypoglycemia (1.23 [1.11–1.37]). D-LGA infants in both groups had significantly increased odds of Cesarean section. CONCLUSIONS The risk of composite neonatal morbidity is significantly increased in GDM offspring. In pregnancies both with and without GDM, the risk of composite neonatal morbidity is comparable between P- and D-LGA. PMID:24159180

Persson, Martina; Fadl, Helena; Hanson, Ulf; Pasupathy, Dharmintra

2013-01-01

132

Genetics in gestational diabetes mellitus: association with incidence, severity, pregnancy outcome and response to treatment.  

PubMed

Constant advances in gene mapping technology have allowed research to focus from rare monogenic disorders on common complex diseases involving multiple susceptibility genes-environment interactions. Gestational diabetes mellitus (GDM) is a heterogeneous pathogenic condition affecting 2-5% of all pregnant women during pregnancy. GDM is considered to result when genetic predisposition is triggered by increased insulin resistance during pregnancy leading to what seems to be one of the primary characteristics of GDM, the pancreatic b-cell impairment. Genetic predisposition to GDM has been suggested given the occurrence of the disease within family members. Furthermore, GDM is reported to be often present in women with maturity onset diabetes of the young (MODY) gene mutations. In addition, candidate susceptibility gene variants have been suggested to increase the risk of GDM. These genes include glucokinase (GCK), HLA antigens, insulin receptor (INSR), insulin-like growth factor-2 (IGF2), HNF4A, insulin gene (INS-VNTR), plasminogen activator inhibitor 1 (PAI-1), potassium inwardly rectifying channel subfamily J, member 11 (KCNJ11), hepatocyte nuclear factor-4a (HNF4A). Identification of the possible underlying genetic factors of GDM would eventually enrich our knowledge on the pathophysiologic mechanism of the disease and contribute to the individualization of both prevention and treatment of complications for the mother and fetus. However, so far, little is known about the genetic basis of GDM and its potential clinical significance. This review focuses on possible gestational diabetes mellitus susceptibility genes and their association with the disease incidence and severity as well as the pregnancy outcome and the response to treatment. PMID:20879971

Lambrinoudaki, Irene; Vlachou, Sophia A; Creatsas, George

2010-11-01

133

Histopathology and ex vivo insulin secretion of pancreatic islets in gestational diabetes: A case report.  

PubMed

Gestational diabetes (GD) results from insufficient endogenous insulin supply. No information is available on features of islet cells in human GD. Herein, we describe several properties of islets from a woman with GD. Immunohistochemical stainings and EM analyses were performed on pancreatic samples. Islet isolation was achieved by enzymatic dissociation and density gradient centrifugation. Ex vivo insulin secretion was studied in response to fuel secretagogues. Control islets were obtained from matched non-pregnant, non-diabetic women. Total insulin positive area was lower in GD, mainly due to the presence of smaller islets. ?-cell apoptosis and the presence of Ki67 positive islet cells were similar in GD and controls, whereas the amount of insulin positive cells in or close to the ducts was decreased in GD. Ex vivo insulin secretion did not differ between GD and non-pregnant, non-diabetic islets. These findings suggest that in this case of human GD there might mainly be a defect of ?-cell amount, not due to increased apoptosis, but possibly to insufficient regeneration. PMID:21765242

Tancredi, Mariella; Marselli, Lorella; Lencioni, Cristina; Masini, Matilde; Bugliani, Marco; Suleiman, Mara; Masiello, Pellegrino; Boggi, Ugo; Filipponi, Franco; Dotta, Francesco; Marchetti, Piero; Di Cianni, Graziano

2011-01-01

134

Women Born Preterm or with Inappropriate Weight for Gestational Age Are at Risk of Subsequent Gestational Diabetes and Pre-Eclampsia  

PubMed Central

Introduction Low birthweight, which can be caused by inappropriate intrauterine growth or prematurity, is associated with development of gestational diabetes mellitus (GDM) as well as pre-eclampsia later in life, but the relative effects of prematurity and inappropriate intrauterine growth remain uncertain. Methods Through nation-wide registries we identified all Danish mothers in the years 1989–2007. Two separate cohorts consisting mothers born 1974–1977 (n?=?84219) and 1978–1981 (n?=?32376) were studied, due to different methods of registering birthweight and gestational age in the two periods. Data was linked with information on GDM, pre-eclampsia and education. Results In a multivariate logistic regression model the odds of developing GDM was increased by 5–7% for each week the mother was born before term (p?=?0.018 for 1974–1977, p?=?0.048 for 1978–1981), while the odds were increased by 13–17% for each standard deviation (SD) reduction in birthweight for gestational age for those who were small or normal for gestational age (p<0.0001 and p?=?0.035) and increased by 118–122% for each SD increase above the normal range (p<0.0001 and p?=?0.024). The odds of pre-eclampsia was increased by 3–5% for each week the mother was born before term (p?=?0.064 and p?=?0.04), while the odds were increased 11–12% for each SD reduction in birthweight for gestational age (p<0.0001 and p?=?0.0002). Conclusion In this cohort of young Danish mothers, being born premature or with increasingly low birthweight for gestational age was associated with an increased risk of GDM and pre-eclampsia in adulthood, while increasingly high birthweight for gestational age was associated with an increased risk of GDM and a decreased risk of pre-eclampsia. Inappropriate weight for gestational age was a more important risk factor than prematurity. PMID:22479500

a Rogvi, Rasmus; Forman, Julie Lyng; Damm, Peter; Greisen, Gorm

2012-01-01

135

An Exploratory Mixed Method Assessment of Low Income, Pregnant Hispanic Women's Understanding of Gestational Diabetes and Dietary Change  

ERIC Educational Resources Information Center

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:…

Rhoads-Baeza, Maria Elena; Reis, Janet

2012-01-01

136

Is fasting glucose level during oral glucose tolerance test an indicator of the insulin need in gestational diabetes?  

Microsoft Academic Search

Maintenance of a good metabolic control improves foetal and maternal outcomes in gestational diabetes mellitus (GDM). The aim of this study is to investigate the utility of diagnostic oral glucose tolerance test (OGTT) in prediction of the need of insulin in patients with GDM.One hundred and fifty five consecutive patients with GDM were included in the study. Patients were ordered

Baris Akinci; Aygul Celtik; Serkan Yener; Sena Yesil

2008-01-01

137

Pre-pregnancy body mass index and weight gain during pregnancy: relations with gestational diabetes and hypertension, and birth  

E-print Network

Pre-pregnancy body mass index and weight gain during pregnancy: relations with gestational diabetes and hypertension, and birth outcomes. Running head: Maternal anthropometry and pregnancy outcomes B Heude1,2 , O program, INSERM Nutrition Research Program, French Ministry of Health Perinatality Program, French Agency

Paris-Sud XI, Université de

138

Estimating the risk of gestational diabetes mellitus: a clinical prediction model based on patient characteristics and medical history  

Microsoft Academic Search

Objective To develop a clinical prediction rule that can help the clinician to identify women at high and low risk for gestational diabetes mellitus (GDM) early in pregnancy in order to improve the efficiency of GDM screening. Design We used data from a prospective cohort study to develop the clinical prediction rule. Setting The original cohort study was conducted in

Leeuwen van M; B. C. Opmeer; E. J. K. Zweers; Ballegooie van E; Brugge ter H. G; Valk de H. W; G. H. A. Visser; B. W. J. Mol

2010-01-01

139

Food cravings and intake of sweet foods in healthy pregnancy and mild gestational diabetes mellitus. A prospective study  

Microsoft Academic Search

Pregnancy is associated with increased sweet food cravings, but the relationship between sweet cravings and dietary intake remains uncertain. Gestational diabetes mellitus (GDM) is glucose intolerance first recognized during pregnancy. GDM may further perpetuate sweet food cravings and intake in pregnancy, although this has not been investigated. This study longitudinally assessed sweet food cravings across pregnancy in women who developed

Lisa M. Belzer; John C. Smulian; Shou-En Lu; Beverly J. Tepper

2010-01-01

140

Intrahepatic Fat is Increased in Neonatal Offspring of Obese Women with Gestational Diabetes  

PubMed Central

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. PMID:23260099

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

2012-01-01

141

Accuracy of Fetal Weight Estimation in Women with Diet Controlled Gestational Diabetes  

PubMed Central

Purpose: To evaluate whether ultrasound accuracy of estimated fetal weight (EFW) differs in women with diet controlled gestational diabetes mellitus (GDM) compared to nondiabetic pregnant women. Material and Methods: We included 363 patients, 121 patients with diet controlled GDM and 242 patients with a normal oral glucose tolerance test (oGTT). Each case of diet controlled GDM was matched with 2 unaffected controls. All patients were screened/diagnosed for GDM by means of an oGTT. Both groups received ultrasound examination including fetal biometry, using Hadlock?s Formula, within 7 days to delivery. After birth, gestational age, birthweight and Apgar scores were collected from each newborn. Results: There was a good correlation between EFW and birth weight (coefficient?=?0.747, p?

Husslein, H.; Worda, C.; Leipold, H.; Szalay, Stefan

2012-01-01

142

Maternal leptin, adiponectin, resistin, visfatin and tumor necrosis factor-alpha in normal and gestational diabetes.  

PubMed

Gestational diabetes mellitus (GDM) is a common medical complication associated with pregnancy. The present study evaluates the changes in maternal adipocytokines (leptin, adiponectin, resistin, visfatin and tumor necrosis factor-alpha; TNF-?) in pregnancy complicated with GDM compared to normal pregnancy at 2nd and 3rd trimesters. The study included total number of 142 pregnant women classified into 4 groups: normal pregnancy (n = 33) and pregnancy with GDM (n = 24) both at 2nd trimester and normal pregnancy (n = 38) and GDM (n = 47) at 3rd trimester. Both GDM groups were significantly presented with elevated body mass index, fasting blood sugar and abnormal oral glucose tolerance test compared to their matched control. Results indicated reduction in maternal serum leptin and adiponectin in GDM compared to normal pregnancy at 3rd trimester. Elevated resistin and TNF-? were evident among pregnancy complicated with GDM at both tested trimesters. On the other hand, significant elevation in maternal visfatin was noted between GDM and matched control at 2nd trimester only. Significant increase in maternal leptin and visfatin and resistin was noted by advances in gestational period in healthy pregnancy. On the other hand, reduced adiponectin and elevated visfatin mean values were noticed in GDM at 3rd compared to 2nd trimester. It could be concluded that increased insulin resistance accompanies GDM is associated with suppressed leptin and adiponectin and increased resistin and TNF-? which might suggest their involvement in the development of GDM. PMID:25298627

Noureldeen, Amani F H; Qusti, Safaa Y; Al-Seeni, Madeha N; Bagais, Maram H

2014-10-01

143

Gestational Diabetes Outcome in a Single Center Study: Higher BMI in Children After Six Months.  

PubMed

The aim of the study was to examine obstetric outcomes and metabolic disorders in patients with gestational diabetes mellitus (GDM) and their offspring compared to mothers without GDM and their offspring. We performed a retrospective single center cohort study of mothers with GDM using a questionnaire with items concerning the maternal medical history, neonatal complications, and child development. Mothers with gestational diabetes (GDM; n=130) and those with normal glucose tolerance (NGT; n=77) were recruited. GDM mothers were older (37.58 years vs. 34.32 years, p<0.0001) and had a greater body mass index (25.18?kg/m² vs. 23.37?kg/m², p<0.01). There were no significant differences regarding the mean birth weight, the frequency of Cesarean sections, and the prevalence of macrosomia (>?4?000?g). At follow-up (pediatric U5 screening visit after 6 months of birth) children of mothers with GDM had significantly higher BMI than the children of the NGT group (17.07?kg/m² vs. 16.59?kg/m², p=0.042). GDM women in need of insulin therapy during pregnancy had higher BMI than dieting GDM mothers and experienced more frequently an operative vaginal delivery (17.95% vs. 6.17%, OR 3.23, p=0.04). We found less significant differences between GDM mothers with treatment of impaired glucose tolerance and NGT mothers concerning the neonatal outcome than expected. Despite higher BMI of the GDM group's offspring at follow-up U5 visit, the children did not show any other development disorder. In conclusion treatment of GDM could minimize the frequency of obstetric and neonatal complications in this risk group. PMID:24867135

König, A B; Junginger, S; Reusch, J; Louwen, F; Badenhoop, K

2014-10-01

144

The Belgian Diabetes in Pregnancy Study (BEDIP-N), a multi-centric prospective cohort study on screening for diabetes in pregnancy and gestational diabetes: methodology and design  

PubMed Central

Background The International Association of Diabetes and Pregnancy Study Groups (IADPSG) recommends universal screening with a 75 g oral glucose tolerance test (OGTT) using stricter criteria for gestational diabetes (GDM). This may lead to important increases in the prevalence of GDM and associated costs, whereas the gain in health is unclear. The goal of ‘The Belgian Diabetes in Pregnancy Study’ (BEDIP-N) is to evaluate the best screening strategy for pregestational diabetes in early pregnancy and GDM in an ethnically diverse western European population. The IADPSG screening strategy will be followed, but in addition risk questionnaires and a 50 g glucose challenge test (GCT) will be performed, in order to define the most practical and most cost effective screening strategy in this population. Methods BEDIP-N is a prospective observational cohort study in 6 centers in Belgium. The aim is to enroll 2563 pregnant women in the first trimester with a singleton pregnancy, aged 18–45 years, without known diabetes and without history of bariatric surgery. Women are universally screened for overt diabetes and GDM in the first trimester with a fasting plasma glucose and for GDM between 24–28 weeks using the 50 g GCT and independently of the result of the GCT, all women will receive a 75 g OGTT using the IADPSG criteria. Diabetes and GDM will be treated according to a standardized routine care protocol. Women with GDM, will be reevaluated three months postpartum with a 75 g OGTT. At each visit blood samples are collected, anthropometric measurements are obtained and self-administered questionnaires are completed. Recruitment began in April 2014. Discussion This is the first large, prospective cohort study rigorously assessing the prevalence of diabetes in early pregnancy and comparing the impact of different screening strategies with the IADPSG criteria on the detection of GDM later in pregnancy. Trial registration ClinicalTrials.gov: NCT02036619. Registered 14-1-2014. PMID:25015413

2014-01-01

145

Maternal Lipids as Strong Determinants of Fetal Environment and Growth in Pregnancies With Gestational Diabetes Mellitus  

PubMed Central

OBJECTIVE—To determine the contribution of maternal glucose and lipids to intrauterine metabolic environment and fetal growth in pregnancies with gestational diabetes mellitus (GDM). RESEARCH DESIGN AND METHODS—In 150 pregnancies, serum triglycerides (TGs), cholesterol, free fatty acids (FFAs), glycerol, insulin, and glucose were determined in maternal serum and cord blood during the 3rd trimester. Maternal glucose values came from oral glucose tolerance testing and glucose profiles. Measurements of fetal abdominal circumference (AC) were performed simultaneously with maternal blood sampling and birth weight, and BMI and neonatal fat mass were obtained following delivery. RESULTS—Maternal TGs and FFAs correlated with fetal AC size (at 28 weeks: triglycerides, P = 0.001; FFAs, P = 0.02), and at delivery they correlated with all neonatal anthropometric measures (FFA: birth weight, P = 0.002; BMI, P = 0.001; fat mass, P = 0.01). After adjustment for confounding variables, maternal FFAs and TGs at delivery remained the only parameters independently related to newborns large for gestational age (LGA) (P = 0.008 and P = 0.04, respectively). Maternal FFA levels were higher in mothers with LGA newborns than in those with appropriate for gestational age (AGA) newborns (362.8 ± 101.7 vs. 252.4 ± 10.1, P = 0.002). Maternal levels of TGs, FFAs, and glycerol at delivery correlated with those in cord blood (P = 0.003, P = 0.004, and P = 0.005, respectively). Fetal triglyceride and cholesterol levels were negatively correlated with newborn birth weight (P = 0.001), BMI (P = 0.004), and fat mass (P = 0.001). TGs were significantly higher in small for gestational age (SGA) newborns compared with AGA or LGA newborns, while insulin-to-glucose ratio and FFAs were the highest in LGA newborns. CONCLUSIONS—In well-controlled GDM pregnancies, maternal lipids are strong predictors for fetal lipids and fetal growth. Infants with abnormal growth seem to be exposed to a distinct intrauterine environment compared with those with appropriate growth. PMID:18606978

Schaefer-Graf, Ute M.; Graf, Kristof; Kulbacka, Irina; Kjos, Siri L.; Dudenhausen, Joachim; Vetter, Klaus; Herrera, Emilio

2008-01-01

146

Ultrasonographic visceral fat thickness in the first trimester can predict metabolic syndrome and gestational diabetes mellitus.  

PubMed

The aim of this study is to evaluate whether ultrasonographic visceral fat thickness measurement in the early gestational period is useful for predicting the development of gestational diabetes mellitus (GDM) and metabolic syndrome (MS). The visceral fat thickness and subcutaneous fat thickness were measured via ultrasound at the first prenatal visit. The correlation between visceral and subcutaneous fat thickness and MS parameters, such as dyslipidemia, hypertension, and insulin resistance, was assessed. We also compared the use of visceral fat thickness measurement with body mass index (BMI) and waist circumference (WC) measurements for predicting the development of GDM. The subcutaneous fat thickness was found to be similar in the normal glucose metabolism and GDM groups at the first visit, whereas the visceral fat thickness was found to be considerably higher in the GDM groups (p = 0.04). The visceral fat thickness in the early stage of the gestation was correlated with hyperglycemia, dyslipidemia, high diastolic blood pressure, and insulin resistance. In contrast to subcutaneous fat thickness, BMI, and WC, only the visceral fat thickness was correlated with insulin resistance. The subcutaneous and visceral fat thicknesses at the first visit were significantly higher in the MS group (p = 0.02). There was a good correlation between visceral and subcutaneous fat thicknesses (r = 0.492, p < 0.001); however, there were poor correlations between visceral fat thickness and BMI and WC (r = 0.338, p = 0.01; r = 0.312, p = 0.02). The visceral fat thickness seemed to be a more sensitive predictor of GDM than WC and BMI. The optimal cutoff points for predicting GDM were visceral fat thickness 19.5 mm [area under curve (AUC) = 0.66, p = 0.043], WC 103.5 cm (AUC = 0.64, p = 0.079), and BMI 34.5 (AUC = 0.64, p = 0.069). Ultrasonographic visceral fat thickness measurement in the early period of gestation may be an easy, safe, and cost-effective scan test for predicting the development of metabolic diseases and GDM. PMID:24452873

Gur, Esra Bahar; Ince, Ozlem; Turan, Guluzar Arzu; Karadeniz, Muammer; Tatar, Sumeyra; Celik, Esin; Yalcin, Murat; Guclu, Serkan

2014-11-01

147

Pregnancy glycemia in Mexican-American women without diabetes or gestational diabetes and programming for childhood obesity.  

PubMed

In the present study, we estimated the association between pregnancy glucose levels and offspring body mass index (BMI) z scores at 2, 3.5, 5, and 7 years of age, as well as z score trajectories across this age range, among Mexican-American women without diabetes or gestational diabetes. Beginning in 1999-2000, the Center for the Health Assessment of Mothers and Children of Salinas prospectively followed women from Monterey County, California (52 obese and 214 nonobese women) and their children. Plasma glucose values obtained 1 hour after a 50-g oral glucose load comprised the exposure. Offspring BMIs were compared with national data to calculate z scores. Increasing pregnancy glucose levels were associated with increased offspring BMI z scores at 7 years of age; a 1-mmol/L increase in glucose corresponded to an increase of 0.11 (standard deviation = 0.044) z-score units (P < 0.05). In nonobese women only, the mean z score over this age range increased with increasing glucose levels. The average BMI z score at 4.5 years of age increased by 0.12 (standard error, 0.059) units for each 1-mmol/L increase in glucose (P = 0.04). In obese women only, increasing glucose was associated with increases in BMI z score over time (P = 0.07). Whether interventions to reduce glucose values in women free of disease could mitigate childhood obesity remains unknown. PMID:23504745

Ehrlich, Samantha F; Rosas, Lisa G; Ferrara, Assiamira; King, Janet C; Abrams, Barbara; Harley, Kim G; Hedderson, Monique M; Eskenazi, Brenda

2013-04-15

148

Pregnancy Glycemia in Mexican-American Women Without Diabetes or Gestational Diabetes and Programming for Childhood Obesity  

PubMed Central

In the present study, we estimated the association between pregnancy glucose levels and offspring body mass index (BMI) z scores at 2, 3.5, 5, and 7 years of age, as well as z score trajectories across this age range, among Mexican-American women without diabetes or gestational diabetes. Beginning in 1999–2000, the Center for the Health Assessment of Mothers and Children of Salinas prospectively followed women from Monterey County, California (52 obese and 214 nonobese women) and their children. Plasma glucose values obtained 1 hour after a 50-g oral glucose load comprised the exposure. Offspring BMIs were compared with national data to calculate z scores. Increasing pregnancy glucose levels were associated with increased offspring BMI z scores at 7 years of age; a 1-mmol/L increase in glucose corresponded to an increase of 0.11 (standard deviation = 0.044) z-score units (P < 0.05). In nonobese women only, the mean z score over this age range increased with increasing glucose levels. The average BMI z score at 4.5 years of age increased by 0.12 (standard error, 0.059) units for each 1-mmol/L increase in glucose (P = 0.04). In obese women only, increasing glucose was associated with increases in BMI z score over time (P = 0.07). Whether interventions to reduce glucose values in women free of disease could mitigate childhood obesity remains unknown. PMID:23504745

Ehrlich, Samantha F.; Rosas, Lisa G.; Ferrara, Assiamira; King, Janet C.; Abrams, Barbara; Harley, Kim G.; Hedderson, Monique M.; Eskenazi, Brenda

2013-01-01

149

Improving care for women with a history of gestational diabetes: a provider perspective.  

PubMed

To identify perceived roles with regard to care for women with gestational diabetes mellitus (GDM) history and resources for improving care among women with a history of GDM from the perspective of obstetrician/gynecologists (OB/GYNs), certified nurse midwives (CNM), family practitioners, and internists. In 2010, a survey was sent to a random sample of OB/GYNs, CNM, family practitioners, and internists (n = 2,375) in Ohio to assess knowledge, attitudes, and postpartum practices regarding diabetes prevention for women with a history of GDM. A total of 904 practitioners completed the survey (46 %). Over 70 % of CNMs strongly agreed it is part of their job to help women with GDM history improve diet and increase exercise, compared with 60 % of family practitioners/internists and 55 % of OB/GYNs (p < 0.001). More OB/GYNs and CNMs identified a need for more local nutrition specialists and patient education materials, compared with family practitioners/ internists. Between 60 and 70 % of OB/GYNs and CNMs reported lifestyle modification programs and corresponding reimbursement would better support them to provide improved care. Health care providers giving care to women with GDM history have varying perceptions of their roles, however, there was agreement on resources needed to improve care. PMID:24343308

Oza-Frank, Reena; Ko, Jean Y; Wapner, Andrew; Rodgers, Loren; Bouchard, Jo M; Conrey, Elizabeth J

2014-09-01

150

Gestational diabetes induces alterations in the function of neonatal endothelial colony forming cells  

PubMed Central

Background Children born to mothers with gestational diabetes mellitus (GDM) experience increased risk of developing hypertension, type 2 diabetes mellitus, and obesity. Disrupted function of endothelial colony forming cells (ECFCs) may contribute to this enhanced risk. The goal of this study was to determine if cord blood ECFCs from GDM pregnancies exhibit altered functionality. Methods ECFCs isolated from the cord blood of control and GDM pregnancies were assessed for proliferation, senescence, and Matrigel network formation. The requirement for p38MAPK in hyperglycemia-induced senescence was determined using inhibitor and overexpression studies. Results GDM ECFCs were more proliferative than control ECFCs. However, GDM ECFCs exhibited decreased network forming ability in Matrigel. Aging of ECFCs by serial passaging led to increased senescence and reduced proliferation of GDM ECFCs. ECFCs from GDM pregnancies were resistant to hyperglycemia-induced senescence compared to controls. In response to hyperglycemia, control ECFCs activated p38MAPK, which was required for hyperglycemia-induced senescence. In contrast, GDM ECFCs had no change in p38MAPK activation under equivalent conditions. Conclusion Intrauterine exposure of ECFCs to GDM induces unique phenotypic alterations. The resistance of GDM ECFCs to hyperglycemia-induced senescence and decreased p38MAPK suggest that these progenitor cells have undergone changes to induce tolerance to a hyperglycemic environment. PMID:24232636

Blue, Emily K.; DiGiuseppe, Robert; Derr-Yellin, Ethel; Acosta, Juan Carlos; Pay, S. Louise; Hanenberg, Helmut; Schellinger, Megan M.; Quinney, Sara K.; Mund, Julie A.; Case, Jamie; Haneline, Laura S.

2014-01-01

151

Gestational Diabetes Mellitus: Maternal and Perinatal Outcomes in 220 Saudi Women  

PubMed Central

Objectives To assess the maternal and fetal complications of pregnancy in mothers with gestational diabetes mellitus (GDM) compared with non-diabetic patients who delivered in the hospital during the study period. Methods The outcome of pregnancy in 220 Saudi patients with GDM identified from the delivery register/hospital database and matched for age, parity and body mass index with 220 non-diabetic controls were studied retrospectively from their case files. Patients with multiple pregnancies and abnormal presentation of the fetus were excluded from the study. Results The GDM patients were treated with either diet alone or with additional insulin in some patients who required better control of their blood sugar levels. Patients with GDM had a significantly higher incidence of pre-eclampsia (p<0.0001); preterm delivery (p=0.0226); induction of labor (p<0.0001); cesarean section (p=0.0019); higher mean birth weight (p<0.0001) of babies; large for gestational age infants (p=0.0011); macrosomia (p=0.0186); and admission to the neonatal intensive care unit (p=0.0003), compared with the control group. However, the rates of Apgar score <7 at 5 minutes, respiratory distress syndrome, neonatal hypoglycemia, hyperbilirubinemia and the need for phototherapy were similar in both groups of patients. Congenital anomalies and perinatal mortality rates were not significantly different in the two groups. Conclusion GDM is recognized to be associated with increased rates of adverse maternal and neonatal outcomes, which are supported by the findings of this study. Even the mild form of GDM seems to have significant consequences for women and their offspring and is recommended to be aggressively treated. Evidence suggests that early diagnosis and strict control of blood sugar levels throughout the pregnancy can significantly reduce maternal and fetal complications. A multicenter, randomized controlled trial, based on universally accepted criteria for GDM screening test, standardized diagnostic OGTT and management of all patients with GDM versus the standard obstetric management of the control is warranted. PMID:22496940

Gasim, Turki

2012-01-01

152

Declining ?-Cell Compensation for Insulin Resistance in Hispanic Women With Recent Gestational Diabetes Mellitus  

PubMed Central

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. PMID:19933993

Xiang, Anny H.; Kawakubo, Miwa; Trigo, Enrique; Kjos, Siri L.; Buchanan, Thomas A.

2010-01-01

153

The degree of fetal metformin exposure does not influence fetal outcome in gestational diabetes mellitus.  

PubMed

The purpose of the study was to examine in vivo placental transfer of metformin, its association with neonatal outcome in metformin-treated gestational diabetes (GDM) patients, and influence of metformin exposure on maternal glycemic control and weight gain. Two hundred and seventeen GDM patients were randomized to metformin or insulin in Turku University Hospital, Finland. Metformin concentrations were determined by mass spectrometry in maternal serum at 36 gestational weeks (gw) and at birth, and in umbilical cord blood. Main outcome measures were birth weight, gw at birth, umbilical artery pH and neonatal hypoglycemia, maternal weight gain, HbA1c and fructosamine concentration. Median umbilical cord/maternal serum metformin concentration ratio was 0.73. There were no differences in birth weight measured in grams or SD units (p = 0.49), or gw at birth (p always ?0.49) between insulin- and metformin-treated patients stratified by trough metformin concentration tertiles measured at 36 gw. Rate of neonatal hypoglycemia (p = 0.92) and umbilical artery pH value (p = 0.78) was similar in insulin- and metformin-treated patients stratified by cord metformin concentration tertiles. Maternal glycemic control was similar in metformin concentration tertiles at 36 gw. Maternal weight gain was 223 g greater per week (p = 0.038) in the lowest metformin tertile compared to other tertiles combined. Maternal and fetal exposure to metformin is similar. Maternal or fetal metformin concentrations do not predict maternal glycemic control or neonatal outcome, but low maternal exposure may lead to greater maternal weight gain. PMID:24633859

Tertti, Kristiina; Laine, Kari; Ekblad, Ulla; Rinne, Valtteri; Rönnemaa, Tapani

2014-10-01

154

Effect of maternal weight, adipokines, glucose intolerance and lipids on infant birth weight among women without gestational diabetes mellitus  

PubMed Central

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. PMID:22619341

Retnakaran, Ravi; Ye, Chang; Hanley, Anthony J.G.; Connelly, Philip W.; Sermer, Mathew; Zinman, Bernard; Hamilton, Jill K.

2012-01-01

155

Audit of public sector primary diabetes care in Cape Town, South Africa: high prevalence of complications, uncontrolled hyperglycaemia, and hypertension.  

PubMed

This study was undertaken to investigate the prevalence of diabetes complications and level of glycaemic and blood pressure control in Black African patients at the primary care level in the public sector Cape Town, South Africa. A stratified random sample of 300 patients attending the three largest ambulatory diabetes clinics in community health centres in Black African residential areas of Cape Town (100 patients from each) during the last 6 months of 1992 was selected. Each patient had a clinical examination, interview, and 1 year retrospective record review. Eighty-one per cent of the sampled patients were reviewed, 90% were non-insulin-dependent (NIDDM) and 10% were treated with insulin. The mean duration of diabetes was 8 (range 0-28) years. Acceptable glycaemic control was present in 49.4% (95% Confidence Intervals 45.6-53.5) of patients while 38.5% (CI 24.8-52.2) of hypertensive patients had acceptable blood pressure control. The prevalence of any grade of retinopathy was 55.4% (CI 48.90-62.9), proliferative and preproliferative retinopathy 15.6% (CI 8.5-22.8), cataracts 7.9% (CI 4.4-11.4), peripheral neuropathy 27.6% (CI 15.2-39.4), absent foot pulses 8.2% (CI 5.2-12.6), amputations 1.4% (CI 0.4-2.4), persistent proteinuria 5.3% (CI 2.5-8.1) and an elevated albumin-creatinine ratio 36.7% (CI 29.0-44.4). The complications were not documented in the clinic records of the preceding year with the exception of 1 patient with absent foot pulses and the 12 patients with proteinuria. The high prevalence of suboptimal glycaemic and blood pressure control as well as complications of diabetes, largely unrecorded in the preceding years' clinic notes, demonstrates the deficiency of and need for preventative diabetes care at the primary care level. The design, institution, and evaluation of effective intervention programmes are a priority to improve the quality of care provided and the health of diabetic patients. PMID:9455936

Levitt, N S; Bradshaw, D; Zwarenstein, M F; Bawa, A A; Maphumolo, S

1997-12-01

156

Physical activity during pregnancy: predictors of change, perceived support and barriers among women at increased risk of gestational diabetes.  

PubMed

The aim of this study was to examine the predictors of change in intensity-specific leisure-time physical activity (LTPA) during pregnancy, and the perceived support and barriers of LTPA in Finnish pregnant women at increased risk of gestational diabetes. The study population consisted of 399 pregnant women who participated in a randomized controlled trial aiming to prevent gestational diabetes. Evaluation of LTPA was based on a self-report at baseline, 26-28, and 36-37 weeks' gestation. Data on predictors of change, perceived support and barriers were collected with questionnaires and from the maternity cards. Multinomial logistic regression was used to assess associations between the variables. The average weekly minutes of light-intensity LTPA were 179 at baseline, 161 at 26-28 weeks' gestation, and 179 at 36-37 weeks' gestation. The corresponding minutes of moderate-to-vigorous-intensity LTPA were 187, 133 and 99. At 26-28 weeks' gestation, the strongest predictors for light-intensity LTPA were meeting the PA recommendations prior to pregnancy, having polytechnic education and working part-time, while having a physically active spouse prior to pregnancy was the strongest predictor for moderate-to-vigorous-intensity LTPA. The people and/or factors that encouraged women to LTPA the most were the spouse, a child, other family members and weather, whereas tiredness, nausea, perceived health, work and lack of time restricted their LTPA the most. The strongest predictors for maintaining LTPA during pregnancy were pre-pregnancy LTPA, education, working part-time and a spouse's LTPA. Most common barriers were perceived health, work and lack of time. PMID:24615354

Leppänen, Marja; Aittasalo, Minna; Raitanen, Jani; Kinnunen, Tarja I; Kujala, Urho M; Luoto, Riitta

2014-11-01

157

GESTATIONAL DIABETES MELLITUS ALTERS APOPTOTIC AND INFLAMMATORY GENE EXPRESSION OF TROPHOBASTS FROM HUMAN TERM PLACENTA  

PubMed Central

AIM Increased placental growth secondary to reduced apoptosis may contribute to the development of macrosomia in GDM pregnancies. We hypothesize that reduced apoptosis in GDM placentas is caused by dysregulation of apoptosis related genes from death receptors or mitochondrial pathway or both to enhance placental growth in GDM pregnancies. METHODS Newborn and placental weights from women with no pregnancy complications (controls; N=5), or with GDM (N=5) were recorded. Placental villi from both groups were either fixed for TUNEL assay, or snap frozen for gene expression analysis by apoptosis PCR microarrays and qPCR. RESULTS Maternal, placental and newborn weights were significantly higher in the GDM group vs. Controls. Apoptotic index of placentas from the GDM group was markedly lower than the Controls. At a significant threshold of 1.5, seven genes (BCL10, BIRC6, BIRC7, CASP5, CASP8P2, CFLAR, and FAS) were down regulated, and 13 genes (BCL2, BCL2L1, BCL2L11, CASP4, DAPK1, I?B?E, MCL1, NF?BIZ, NOD1, PEA15, TNF, TNFRSF25, and XIAP) were unregulated in the GDM placentas. qPCR confirmed the consistency of the PCR microarray. Using Western blotting we found significantly decreased placental pro-apoptotic FAS receptor and FAS ligand (FASL), and increased mitochondrial anti-apoptotic BCL2 post GDM insult. Notably, caspase-3, which plays a central role in the execution-phase of apoptosis, and its substrate poly (ADP-ribose) polymerase (PARP) were significantly down regulated in GDM placentas, as compared to non-diabetic Control placentas. CONCLUSION . Women with gestational diabetes (GDM) are at increased risk for having macrosomic newborns, and larger placentas with reduced apoptosis. Decreased apoptosis subsequent to alterations in apoptotic and inflammatory genes may promote elevated weight in the GDM placentas. PMID:24768206

MAGEE, Thomas R.; ROSS, Michael G.; WEDEKIND, Lauren; DESAI, Mina; KJOS, Siri; BELKACEMI, Louiza

2014-01-01

158

Gestational diabetes mellitus epigenetically affects genes predominantly involved in metabolic diseases  

PubMed Central

Offspring exposed to gestational diabetes mellitus (GDM) have an increased risk for chronic diseases, and one promising mechanism for fetal metabolic programming is epigenetics. Therefore, we postulated that GDM exposure impacts the offspring’s methylome and used an epigenomic approach to explore this hypothesis. Placenta and cord blood samples were obtained from 44 newborns, including 30 exposed to GDM. Women were recruited at first trimester of pregnancy and followed until delivery. GDM was assessed after a 75-g oral glucose tolerance test at 24–28 weeks of pregnancy. DNA methylation was measured at > 485,000 CpG sites (Infinium HumanMethylation450 BeadChips). Ingenuity Pathway Analysis was conducted to identify metabolic pathways epigenetically affected by GDM. Our results showed that 3,271 and 3,758 genes in placenta and cord blood, respectively, were potentially differentially methylated between samples exposed or not to GDM (p-values down to 1 × 10?06; none reached the genome-wide significance levels), with more than 25% (n = 1,029) being common to both tissues. Mean DNA methylation differences between groups were 5.7 ± 3.2% and 3.4 ± 1.9% for placenta and cord blood, respectively. These genes were likely involved in the metabolic diseases pathway (up to 115 genes (11%), p-values for pathways = 1.9 × 10?13 < p < 4.0 × 10?03; including diabetes mellitus p = 4.3 × 10?11). Among the differentially methylated genes, 326 in placenta and 117 in cord blood were also associated with newborn weight. Our results therefore suggest that GDM has epigenetic effects on genes preferentially involved in the metabolic diseases pathway, with consequences on fetal growth and development, and provide supportive evidence that DNA methylation is involved in fetal metabolic programming. PMID:23975224

Ruchat, Stephanie-May; Houde, Andree-Anne; Voisin, Gregory; St-Pierre, Julie; Perron, Patrice; Baillargeon, Jean-Patrice; Gaudet, Daniel; Hivert, Marie-France; Brisson, Diane; Bouchard, Luigi

2013-01-01

159

2D-DIGE to identify proteins associated with gestational diabetes in omental adipose tissue.  

PubMed

Gestational diabetes mellitus (GDM) is a significant risk factor for the type 2 diabetes epidemic in many populations. Maternal adipose tissue plays a central role in the pathophysiology of GDM. Thus, the aim of this study was to determine the effect of GDM on the proteome of adipose tissue. Omental adipose tissue was obtained at the time of term Caesarean section from women with normal glucose tolerance (NGT) or GDM. 2D-difference gel electrophoresis (DIGE), followed by mass spectrometry, was used to identify protein spots (n = 6 patients per group). Western blotting was used for confirmation of six of the spot differences (n = 6 patients per group). We found 14 proteins that were differentially expressed between NGT and GDM adipose tissue (? 1.4-fold, P < 0.05). GDM was associated with an up-regulation of four proteins: collagen alpha-2(VI) chain (CO6A2 (COL6A2)), fibrinogen beta chain (FIBB (FGB)), lumican (LUM) and S100A9. On the other hand, a total of ten proteins were found to be down-regulated in adipose tissue from GDM women. These were alpha-1-antitrypsin (AIAT (SERPINA 1)), annexin A5 (ANXA5), fatty acid-binding protein, adipocyte (FABP4), glutathione S-transferase P (GSTP (GSTP1)), heat-shock protein beta-1 (HSP27 (HSPB1)), lactate dehydrogenase B chain (LDHB), perilipin-1 (PLIN1), peroxiredoxin-6 (PRX6 (PRDX6)), selenium-binding protein 1 (SBP1) and vinculin (VINC (VCL)). In conclusion, proteomic analysis of omental fat reveals differential expression of several proteins in GDM patients and NGT pregnant women. This study revealed differences in expression of proteins that are involved in inflammation, lipid and glucose metabolism and oxidative stress and added further evidence to support the role of visceral adiposity in the pathogenesis of GDM. PMID:23709000

Oliva, Karen; Barker, Gillian; Rice, Gregory E; Bailey, Mark J; Lappas, Martha

2013-01-01

160

The gestational diabetes mellitus conferences. Three are history: focus on the fourth.  

PubMed

This study reviews the summary and recommendations of the first three International Workshops Conferences on Gestational Diabetes Mellitus (GDM) and highlights areas of controversy requiring further research and discussion. The International Workshop Conferences on GDM held in 1979, 1984, and 1990 established a definition of GDM, confirmed the value of universal screening with a 50-g oral glucose load, recommended use of the 100-g oral glucose tolerance test with interpretation according to the diagnostic criteria of O'Sullivan and Mahan, and emphasized the importance of classification after pregnancy with a 75-g oral glucose tolerance test with classification according to the criteria of the National Diabetes Data Group or the World Health Organization. Recommendations for management have included nutritional counseling with limitation of the intake of concentrated sweets, monitoring maternal glucose levels to maintain the fasting plasma glucose < 105 mg/dl and the 2-h postprandial plasma glucose < 120 mg/dl, initiating insulin therapy if treatment with diet fails, and prohibiting the use of oral hypoglycemic agents. Antepartum fetal surveillance with emphasis on the evaluation of fetal growth using clinical and ultrasonographic techniques to detect macrosomia were also proposed. Although much has been accomplished in the first three conferences, areas of continued controversy include establishing a definition and method of detection for GDM that can be agreed on worldwide; defining the appropriate glucose levels to initiate dietary and/or insulin therapy; preventing macrosomia, as well as detecting and managing it, to reduce the cesarean delivery rate; and determining the long-term consequences for the mother with GDM and her infant through further studies. PMID:9704218

Gabbe, S G

1998-08-01

161

Pre-Pregnancy Body Mass Index and Weight Gain During Pregnancy: Relations with Gestational Diabetes and Hypertension, and Birth Outcomes  

Microsoft Academic Search

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

162

Activated translation signaling in placenta from pregnant women with gestational diabetes mellitus: possible role of leptin.  

PubMed

Placentas from gestational diabetes (GDM) suffer from structural and functional changes including overgrowth. That is why we aimed to study [³H]-leucine incorporation into protein in addition to translation signaling in placenta from GDM. Thus, we investigated the expression of leptin and leptin receptor (LEPR), as well as the activation state of signaling proteins regulating protein synthesis, such as mTOR, S6 Kinase, EIF4E-BP1, EIF4E, and eEF2 by measuring protein phosphorylation by immunoblot. [³H]-Leucine incorporation into protein also was determined in trophoblastic placenta explants from GDM and control pregnancy. We found that leptin and LEPR expression are increased in placentas from GDM and the translation machinery activity as well as [³H]-leucine incorporation into protein were higher in placentas from GDM compared with placentas from control pregnancy. In conclusion, protein synthesis rate is increased in placenta from GDM patients, and this may be due, at least in part, by the activation of translation signaling. The increased expression of leptin and LEPR may contribute to these effects. These results may provide a possible mechanism for the previously observed increase in placenta growth in GDM. PMID:23386416

Pérez-Pérez, A; Maymó, J L; Gambino, Y P; Guadix, P; Dueñas, J L; Varone, C L; Sánchez-Margalet, V

2013-06-01

163

Gestational diabetes screening of a multiethnic, high-risk population using glycated proteins.  

PubMed

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 (HbA(1c)) both alone and in combination for a GDM diagnosis confirmed by the 'gold standard' 100-g oral glucose tolerance test (OGTT). Two cut-off values were used for each test, the upper to rule in and the lower to rule out GDM. At the lower cut-off values for cFRUC of 210 micromol/l and HbA(1c) of 5%, the sensitivities achieved were 92.2 and 92.1% while the negative predictive values were 88.9 and 86.9%, respectively. The upper cut-off values did not achieve acceptable positive predictive values to be useful for ruling in GDM. Screening of our multiethnic, high-risk pregnant population with a combination of cFRUC and HbA(1c) on a single fasting sample would have avoided the cumbersome OGTT (by ruling out GDM) in 37.9% women with only a 3.9% misclassification rate. This potentially simpler approach, though not universally applicable, would be clinically useful and more acceptable to patients in selected high-risk populations. PMID:11137184

Agarwal, M M; Hughes, P F; Punnose, J; Ezimokhai, M; Thomas, L

2001-01-01

164

MTNR1B Genetic Variability Is Associated with Gestational Diabetes in Czech Women.  

PubMed

The gene MTNR1B encodes a receptor for melatonin. Melatonin receptors are expressed in human ?-cells, which implies that genetic variants might affect glucose tolerance. Meta-analysis confirmed that the rs10830963 shows the most robust association. The aim of the study was to assess the rs10830963 in Czech GDM patients and controls and to study relations between the SNP and biochemical as well as anthropometric characteristics. Our cohort consisted of 880 women; 458 were diagnosed with GDM, and 422 were normoglycemic controls without history of GDM. Despite similar BMI, the GDM group showed higher WHR, waist circumference, abdominal circumference, and total body fat content. The risk allele G was more frequent in the GDM group (38.3 versus 29.4% in controls, OR 1.49 CI95% [1.22; 1.82]; P OR = 0.0001). In spite of higher frequency, the G allele in the GDM group was not associated with any markers of glucose metabolism. In contrast, controls showed significant association of the allele G with FPG and with postchallenge glycemia during the oGTT. Frequency analysis indicates that rs10830963 is involved in gestational diabetes in Czech women. However, the association of the SNP with glucose metabolism, which is obvious in controls, is covert in women who have experienced GDM. PMID:25132852

Vejrazkova, Daniela; Lukasova, Petra; Vankova, Marketa; Vcelak, Josef; Bradnova, Olga; Cirmanova, Veronika; Andelova, Katerina; Krejci, Hana; Bendlova, Bela

2014-01-01

165

MTNR1B Genetic Variability Is Associated with Gestational Diabetes in Czech Women  

PubMed Central

The gene MTNR1B encodes a receptor for melatonin. Melatonin receptors are expressed in human ?-cells, which implies that genetic variants might affect glucose tolerance. Meta-analysis confirmed that the rs10830963 shows the most robust association. The aim of the study was to assess the rs10830963 in Czech GDM patients and controls and to study relations between the SNP and biochemical as well as anthropometric characteristics. Our cohort consisted of 880 women; 458 were diagnosed with GDM, and 422 were normoglycemic controls without history of GDM. Despite similar BMI, the GDM group showed higher WHR, waist circumference, abdominal circumference, and total body fat content. The risk allele G was more frequent in the GDM group (38.3 versus 29.4% in controls, OR 1.49 CI95% [1.22; 1.82]; POR = 0.0001). In spite of higher frequency, the G allele in the GDM group was not associated with any markers of glucose metabolism. In contrast, controls showed significant association of the allele G with FPG and with postchallenge glycemia during the oGTT. Frequency analysis indicates that rs10830963 is involved in gestational diabetes in Czech women. However, the association of the SNP with glucose metabolism, which is obvious in controls, is covert in women who have experienced GDM. PMID:25132852

Cirmanova, Veronika; Andelova, Katerina; Krejci, Hana

2014-01-01

166

Pregnancy outcome of overweight and obese Chinese women with gestational diabetes.  

PubMed

Abstract We investigated the pregnancy outcome of overweight and obese Chinese women with gestational diabetes mellitus (GDM). Patients diagnosed as GDM from January 2010 to December 2011 were categorised into three groups, as normal weight, overweight and obese, according to the maternal pre-pregnancy body mass index (BMI) (kg/m(2)), 18.5-24.9, 25-29.9 and ? 30, respectively. Of the 604 GDM cases, 241 (39.9%), 211 (34.9%) and 152 (25.2%) subjects were normal weight, overweight and obese, respectively. Compared with subjects of normal weight, the incidence of assisted reproductive technology (ART) pregnancy, advanced maternal age, fetal macrosomia and emergency caesarean delivery were significantly higher in overweight and obese groups (p < 0.05). Obese women were at increased risk of premature rupture of membranes, pre-eclampsia and caesarean section compared with the other two groups (p < 0.05). Overweight and obese women with GDM have an increased risk of adverse pregnancy outcomes, even with good glycaemic control. PMID:24911378

Zhang, Y; Wang, Z-L; Liu, B; Cai, J

2014-11-01

167

Ethnic differences in the association between gestational diabetes and pregnancy outcome.  

PubMed

The purpose of the study was to examine ethnic variation in the impact of Gestational Diabetes Mellitus (GDM) on birth outcome. The authors examined the association between GDM and pregnancy-induced hypertension, macrosomia, primary Cesarean delivery, and preterm birth, using New York City Birth Certificate data from 2001-2006. Logistic regression was used to evaluate the crude and adjusted odds ratios of GDM with each adverse perinatal event, stratified by ethnicity. GDM was associated with increased risk of adverse perinatal events among all ethnic groups, with modest variation by ethnicity. Across ethnic groups, adjusted odds ratios comparing women with and without GDM ranged from 1.4-2.9 for pregnancy-induced hypertension, 1.0-2.2 for macrosomia, 1.1-1.8 for primary Cesarean delivery, and 1.3-1.8 for preterm birth. Overall, Caribbean, Sub-Saharan African, and African American women tended to show a larger relative impact of GDM, while North African, South Central Asian, and Chinese women showed a comparatively smaller impact of GDM. Although some ethnic variation was seen, differences in effect size were not large enough to support ethnic-specific thresholds for GDM diagnosis and treatment. PMID:21365298

Mocarski, M; Savitz, D A

2012-02-01

168

Disparities in the risk of gestational diabetes by race-ethnicity and country of birth  

PubMed Central

Little information exists on the association between maternal country of birth and risk of gestational diabetes (GDM). We examined within each race-ethnicity group whether the risk of GDM differs between women born inside and outside the US. The study was a cohort study of 216 089 women who delivered an infant between 1995 and 2004 with plasma glucose data from the screening 50-g glucose challenge test and the diagnostic 100-g, 3-h oral glucose tolerance test. The age-adjusted prevalence of GDM varied by race-ethnicity and was lowest for non-Hispanic white (4.1%) and highest among Asian Indians (11.1%). In multivariable models, being born outside of the US was associated with an increased risk of GDM among black, Asian Indian, Filipina, Pacific Islanders, Chinese, Mexicans and non-Hispanic white women, whereas, Japanese and Korean foreign-born women had a decreased risk of GDM. Clinicians should be aware that among certain race-ethnicity groups women born outside the US may be at increased risk of GDM and may warrant special preventive and culturally sensitive care. PMID:20670225

Hedderson, Monique M.; Darbinian, Jeanne A.; Ferrara, Assiamira

2014-01-01

169

Physical Activity and Sedentary Behaviors Associated With Risk of Progression From Gestational Diabetes Mellitus to Type 2 Diabetes Mellitus  

PubMed Central

IMPORTANCE Women with a history of gestational diabetes mellitus (GDM) are at substantially increased risk of type 2 diabetes mellitus (T2DM). The identification of important modifiable factors could help prevent T2DM in this high-risk population. OBJECTIVE To examine the role of physical activity and television watching and other sedentary behaviors, and changes in these behaviors in the progression from GDM to T2DM. DESIGN, SETTING, AND PARTICIPANTS Prospective cohort study of 4554 women from the Nurses’ Health Study II who had a history of GDM, as part of the ongoing Diabetes & Women’s Health Study. These women were followed up from 1991 to 2007. EXPOSURES Physical activity and television watching and other sedentary behaviors were assessed in 1991, 1997, 2001, and 2005. MAIN OUTCOMES AND MEASURE Incident T2DM identified through self-report and confirmed by supplemental questionnaires. RESULTS We documented 635 incident T2DM cases during 59287 person-years of follow-up. Each 5–metabolic equivalent hours per week (MET-h/wk) increment of total physical activity, which is equivalent to 100 minutes per week of moderate-intensity physical activity, was related to a 9% lower risk of T2DM (adjusted relative risk [RR], 0.91; 95% CI, 0.88–0.94); this inverse association remained significant after additional adjustment for body mass index (BMI). Moreover, an increase in physical activity was associated with a lower risk of developing T2DM. Compared with women who maintained their total physical activity levels, women who increased their total physical activity levels by 7.5 MET-h/wk or more (equivalent to 150 minutes per week of moderate-intensity physical activity) had a 47% lower risk of T2DM (RR, 0.53; 95% CI, 0.38–0.75); the association remained significant after additional adjustment for BMI. The multivariable adjusted RRs (95% CIs) for T2DM associated with television watching of 0 to 5, 6 to 10, 11 to 20, and 20 or more hours per week were 1 (reference), 1.28 (1.04–1.59), 1.41 (1.11–1.79), and 1.77 (1.28–2.45), respectively (P value for trend <.001); additional adjustment for BMI attenuated the association. CONCLUSIONS AND RELEVANCE Increasing physical activity may lower the risk of progression from GDM to T2DM. These findings suggest a hopeful message to women with a history of GDM, although they are at exceptionally high risk for T2DM, promoting an active lifestyle may lower the risk. PMID:24841449

Bao, Wei; Tobias, Deirdre K.; Bowers, Katherine; Chavarro, Jorge; Vaag, Allan; Grunnet, Louise Groth; Str?m, Marin; Mills, James; Liu, Aiyi; Kiely, Michele; Zhang, Cuilin

2014-01-01

170

Obesity and diabetes genes are associated with being born small for gestational age: Results from the Auckland Birthweight Collaborative study  

PubMed Central

Background Individuals born small for gestational age (SGA) are at increased risk of rapid postnatal weight gain, later obesity and diseases in adulthood such as type 2 diabetes, hypertension and cardiovascular diseases. Environmental risk factors for SGA are well established and include smoking, low pregnancy weight, maternal short stature, maternal diet, ethnic origin of mother and hypertension. However, in a large proportion of SGA, no underlying cause is evident, and these individuals may have a larger genetic contribution. Methods In this study we tested the association between SGA and polymorphisms in genes that have previously been associated with obesity and/or diabetes. We undertook analysis of 54 single nucleotide polymorphisms (SNPs) in 546 samples from the Auckland Birthweight Collaborative (ABC) study. 227 children were born small for gestational age (SGA) and 319 were appropriate for gestational age (AGA). Results and Conclusion The results demonstrated that genetic variation in KCNJ11, BDNF, PFKP, PTER and SEC16B were associated with SGA and support the concept that genetic factors associated with obesity and/or type 2 diabetes are more prevalent in those born SGA compared to those born AGA. We have previously determined that environmental factors are associated with differences in birthweight in the ABC study and now we have demonstrated a significant genetic contribution, suggesting that the interaction between genetics and the environment are important. PMID:20712903

2010-01-01

171

Gestational A PATIENT'S  

E-print Network

diabetes, its causes, and its features and includes a general treatment plan to help control the conditionManaging Gestational Diabetes A PATIENT'S GUIDE TO A HEALTHY PREGNANCY U.S. Department of Health to improve the health of mothers, children, and families. Managing Gestational Diabetes: A Patient's Guide

Rau, Don C.

172

Maternal Characteristics Influencing the Development of Gestational Diabetes in Obese Women Receiving 17-alpha-Hydroxyprogesterone Caproate  

PubMed Central

Objective. Gestational diabetes (GDM) and obesity portend a high risk for subsequent type 2 diabetes. We examined maternal factors influencing the development of gestational diabetes (GDM) in obese women receiving 17-alpha-hydroxyprogesterone caproate (17OHPC) for preterm delivery prevention. Materials and Methods. Retrospectively identified were 899 singleton pregnancies with maternal prepregnancy body mass indices of ?30?kg/m2 enrolled for either 17OHPC weekly administration (study group) or daily uterine monitoring and nursing assessment (control group). Patients with history of diabetes type 1, 2, or GDM were excluded. Maternal characteristics were compared between groups and for women with and without development of GDM. A logistic regression model was performed on incidence of GDM, controlling for significant univariate factors. Results. The overall incidence of GDM in the 899 obese women studied was 11.9%. The incidence of GDM in the study group (n = 491) was 13.8% versus 9.6% in the control group (n = 408) (P = 0.048). Aside from earlier initiation of 17OHP and advanced maternal age, other factors including African American race, differing degrees of obesity, and use of tocolysis were not significant risks for the development of GDM. Conclusion. In obese women with age greater than 35 years, earlier initiation of 17OHPC may increase the risk for GDM.

Egerman, Robert; Ramsey, Risa; Istwan, Niki; Rhea, Debbie; Stanziano, Gary

2014-01-01

173

Association of metabolic syndrome with inflammatory mediators in women with previous gestational diabetes mellitus  

PubMed Central

Background An increased risk of metabolic syndrome (MS) has been observed among women with previous gestational diabetes mellitus (pGDM). Increased inflammatory markers such as C-reactive protein (CRP) and interleukin 6 (IL-6) usually accompany. We performed this survey to examine the relationship between pGDM and MS, CRP and IL-6. Methods 77 women with pGDM and 67 randomly sampled women free from GDM participated in this study, 2–3 years after index pregnancy. Laboratory and anthropometric measurements were performed. MS was defined according to ATP III criteria. Statistical analyses were conducted using SPSS 18. Results CRP were different between groups with and without pGDM [2.69 (2.86 mg/dl and 1.56 (1.39) mg/dl, respectively; p < 0.01]. The presence of each MS component by itself was associated with significantly higher CRP Levels, except for fasting blood glucose. In linear regression models, CRP and IL-6 were significantly associated with BMI (? =0. 25, 0.23; p < 0.01), waist circumference (?=0. 27, 0.05; p < 0.01) and HOMA-IR (?=0. 39, 0.39; p < 0.01). After adjustment for age and BMI the occurrence of pGDM in the group with both high CRP and MS was significantly associated with CRP level (OR= 5.11; CI=1.59-16.43; p < 0.01). Conclusion Since CRP and Il-6 were higher in women with both pGDM and MS it appears that the presence of pGDM with MS components have a synergistic effect on the elevation of serum levels of inflammatory markers which can be partly as a result of visceral obesity. Further long-term studies are necessary to confirm the relationship between CRP, IL-6 and MS in women with pGDM. PMID:23497664

2013-01-01

174

A Study of Snack Consumption, Night-Eating Habits, and Nutrient Intake in Gestational Diabetes Mellitus  

PubMed Central

This study was performed to identify dietary behavior such as snack consumption, night-eating and nutrients intake associated with gestational diabetes mellitus (GDM). The study was conducted on 219 normal glucose tolerance (NGT) subjects and 44 GDM subjects by using a questionnaire including dietary behavior, food frequency and 3-day food record. The mean age, OGTT, and delivery weight of GDM subjects were statistically higher than those in NGT. A larger proportion of NGT subjects consumed black coffee (49.8%) while the majority of GDM subjects (61.4%) drank mixed coffee with sugar and cream. Dairy products were the most frequently consumed snack item in NGT subjects (40.7%), while fruits were most frequently consumed food item in GDM subjects (34.4%). Many of NGT subjects (49.8%) answered that they hardly took night-eating snacks whereas most of GDM subjects (61.4%) took night-eating snacks more than once a week. For change of taste preference, the proportion of NGT subjects who showed less preference for salty taste (33.3%) or greasy taste (16.9%) was higher than that of GDM subjects (11.4%). Nutrient intakes of energy, fat, cholesterol, saturated fatty acid (SFA), monounsaturated fatty acid (MUFA), polyunsaturated fatty acid (PUFA), carbohydrate, vitamin B1, vitamin B2, vitamin C, and vitamin E in GDM group were significantly higher than those in NGT group. Nutrient densities of SFA and vitamin C in GDM group were higher and nutrient density of calcium was lower than those in NGT group. Taken together, it is recommended to reduce night-eating snack and choose less salty and fatty foods, black-coffee rather than coffee with cream and sugar, and more dairy products to prevent GDM. PMID:23431085

Park, Hee-jin; Lee, JinJu; Kim, Ji-Myung; Lee, Hyun Ah

2013-01-01

175

A study of snack consumption, night-eating habits, and nutrient intake in gestational diabetes mellitus.  

PubMed

This study was performed to identify dietary behavior such as snack consumption, night-eating and nutrients intake associated with gestational diabetes mellitus (GDM). The study was conducted on 219 normal glucose tolerance (NGT) subjects and 44 GDM subjects by using a questionnaire including dietary behavior, food frequency and 3-day food record. The mean age, OGTT, and delivery weight of GDM subjects were statistically higher than those in NGT. A larger proportion of NGT subjects consumed black coffee (49.8%) while the majority of GDM subjects (61.4%) drank mixed coffee with sugar and cream. Dairy products were the most frequently consumed snack item in NGT subjects (40.7%), while fruits were most frequently consumed food item in GDM subjects (34.4%). Many of NGT subjects (49.8%) answered that they hardly took night-eating snacks whereas most of GDM subjects (61.4%) took night-eating snacks more than once a week. For change of taste preference, the proportion of NGT subjects who showed less preference for salty taste (33.3%) or greasy taste (16.9%) was higher than that of GDM subjects (11.4%). Nutrient intakes of energy, fat, cholesterol, saturated fatty acid (SFA), monounsaturated fatty acid (MUFA), polyunsaturated fatty acid (PUFA), carbohydrate, vitamin B(1), vitamin B(2), vitamin C, and vitamin E in GDM group were significantly higher than those in NGT group. Nutrient densities of SFA and vitamin C in GDM group were higher and nutrient density of calcium was lower than those in NGT group. Taken together, it is recommended to reduce night-eating snack and choose less salty and fatty foods, black-coffee rather than coffee with cream and sugar, and more dairy products to prevent GDM. PMID:23431085

Park, Hee-Jin; Lee, Jinju; Kim, Ji-Myung; Lee, Hyun Ah; Kim, Sung-Hoon; Kim, Yuri

2013-01-01

176

The independent effects of maternal obesity and gestational diabetes on the pregnancy outcomes  

PubMed Central

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?

2014-01-01

177

Gestational diabetes mellitus modulates neonatal high-density lipoprotein composition and its functional heterogeneity.  

PubMed

Gestational diabetes mellitus (GDM) is related to neonatal macrosomia and an increased risk of vascular events. We hypothesized that GDM exerts qualitative effects on neonatal high-density lipoprotein (HDL). HDL was isolated from control (n=11) and GDM maternal/neonatal donors (n=9) and subjected to shotgun proteomics. Differences in HDL mobility were assessed by FPLC and native gel-electrophoresis. Paraoxonase (PON1) activity, cholesterol ester-transfer protein (CETP) mass and activity, phospholipid, triglyceride and cholesterol concentrations were quantified with commercial kits. Total anti-oxidative capacity and cholesterol efflux capability of HDLs were measured. Four proteins involved in lipid metabolism, inflammation and innate immunity were differentially expressed between controls and GDM neonates. ApoM (decreased, p<0.05) and SAA1 (increased, p<0.05) showed the same differences on both, maternal and neonatal GDM HDL. Lower PON1 protein expression was corroborated by lower activity (p<0.05) which in turn was associated with attenuated anti-oxidant capacity of GDM HDL. Protein changes were accompanied by increased levels of triglycerides and decreased levels of cholesterol esters, respectively. The observed differences in GDM HDL lipid moiety may be related to CETP mass and activity alterations. The rate of cholesterol efflux from term trophoblasts to maternal and from placental endothelial cells to neonatal GDM HDL was impaired (p<0.05). In conclusion, GDM causes changes in HDL composition and is intimately associated with impaired cholesterol efflux capability as well as diminished anti-oxidative particle properties. Remodeling of neonatal GDM HDL in utero supports the hypothesis that maternal conditions in pregnancy impact neonatal lipoprotein metabolism. PMID:25130684

Sreckovic, Ivana; Birner-Gruenberger, Ruth; Besenboeck, Carolin; Miljkovic, Milica; Stojakovic, Tatjana; Scharnagl, Hubert; Marsche, Gunther; Lang, Uwe; Kotur-Stevuljevic, Jelena; Jelic-Ivanovic, Zorana; Desoye, Gernot; Wadsack, Christian

2014-11-01

178

Human Breath Gas Analysis in the Screening of Gestational Diabetes Mellitus  

PubMed Central

Abstract Background We present a pilot study on the feasibility of the application and advantages of online, noninvasive breath gas analysis (BGA) by proton transfer reaction quadrupole mass spectrometry for the screening of gestational diabetes mellitus (GDM) in 52 pregnant women by means of an oral glucose tolerance test (OGTT). Subjects and Methods We collected and identified samples of end-tidal breath gas from patients during OGTT. Time evolution parameters of challenge-responsive volatile organic compounds (VOCs) in human breath gas were estimated. Multivariate analysis of variance and permutation analysis were used to assess feasibility of BGA as a diagnostic tool for GDM. Results Standard OGTT diagnosis identified pregnant women as having GDM (n=8), impaired glucose tolerance (n=12), and normal glucose tolerance (n=32); a part of this latter group was further subdivided into a “marginal” group (n=9) because of a marginal high 1-h or 2-h OGTT value. We observed that OGTT diagnosis (four metabolic groups) could be mapped into breath gas data. The time evolution of oxidation products of glucose and lipids, acetone metabolites, and thiols in breath gas after a glucose challenge was correlated with GDM diagnosis (P=0.035). Furthermore, basal (fasting) values of dimethyl sulfide and values of methanol in breath gas were inversely correlated with phenotype characteristics such as homeostasis model assessment of insulin resistance index (R=?0.538; P=0.0002, Pcorrected=0.0034) and pregestational body mass index (R=?0.433; P=0.0013, Pcorrected=0.022). Conclusions Noninvasive BGA in challenge response studies was successfully applied to GDM diagnosis and offered an insight into metabolic pathways involved. We propose a new approach to the identification of diagnosis thresholds for GDM screening. PMID:22775148

Halbritter, Susanne; Fedrigo, Mattia; Höllriegl, Vera; Szymczak, Wilfried; Maier, Joerg M.; Hummel, Michael

2012-01-01

179

Gestational diabetes mellitus prevalence in Maela refugee camp on the Thai-Myanmar Border: a clinical report  

PubMed Central

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. PMID:24824580

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

2014-01-01

180

Impact on offspring methylation patterns of maternal gestational diabetes mellitus and intrauterine growth restraint suggest common genes and pathways linked to subsequent type 2 diabetes risk.  

PubMed

Size at birth, postnatal weight gain, and adult risk for type 2 diabetes may reflect environmental exposures during developmental plasticity and may be mediated by epigenetics. Both low birth weight (BW), as a marker of fetal growth restraint, and high birth weight (BW), especially after gestational diabetes mellitus (GDM), have been linked to increased risk of adult type 2 diabetes. We assessed DNA methylation patterns using a bead chip in cord blood samples from infants of mothers with GDM (group 1) and infants with prenatal growth restraint indicated by rapid postnatal catch-up growth (group 2), compared with infants with normal postnatal growth (group 3). Seventy-five CpG loci were differentially methylated in groups 1 and 2 compared with the controls (group 3), representing 72 genes, many relevant to growth and diabetes. In replication studies using similar methodology, many of these differentially methylated regions were associated with levels of maternal glucose exposure below that defined by GDM [the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study] or were identified as changes observed after randomized periconceptional nutritional supplementation in a Gambian cohort characterized by maternal deprivation. These studies provide support for the concept that similar epigenetic modifications may underpin different prenatal exposures and potentially increase long-term risk for diseases such as type 2 diabetes.-Quilter, C. R., Cooper, W. N., Cliffe, K. M., Skinner, B. M., Prentice, P. M., Nelson, L., Bauer, J., Ong, K. K., Constância, M., Lowe, W. L., Affara, N. A., Dunger, D. B. Impact on offspring methylation patterns of maternal gestational diabetes mellitus and intrauterine growth restraint suggest common genes and pathways linked to subsequent type 2 diabetes risk. PMID:25145626

Quilter, Claire R; Cooper, Wendy N; Cliffe, Kerry M; Skinner, Benjamin M; Prentice, Philippa M; Nelson, LaTasha; Bauer, Julien; Ong, Ken K; Constância, Miguel; Lowe, William L; Affara, Nabeel A; Dunger, David B

2014-11-01

181

Primary Prevention of Gestational Diabetes Mellitus and Large-for-Gestational-Age Newborns by Lifestyle Counseling: A Cluster-Randomized Controlled Trial  

PubMed Central

Background Our objective was to examine whether gestational diabetes mellitus (GDM) or newborns' high birthweight can be prevented by lifestyle counseling in pregnant women at high risk of GDM. Method and Findings We conducted a cluster-randomized trial, the NELLI study, in 14 municipalities in Finland, where 2,271 women were screened by oral glucose tolerance test (OGTT) at 8–12 wk gestation. Euglycemic (n?=?399) women with at least one GDM risk factor (body mass index [BMI] ?25 kg/m2, glucose intolerance or newborn's macrosomia (?4,500 g) in any earlier pregnancy, family history of diabetes, age ?40 y) were included. The intervention included individual intensified counseling on physical activity and diet and weight gain at five antenatal visits. Primary outcomes were incidence of GDM as assessed by OGTT (maternal outcome) and newborns' birthweight adjusted for gestational age (neonatal outcome). Secondary outcomes were maternal weight gain and the need for insulin treatment during pregnancy. Adherence to the intervention was evaluated on the basis of changes in physical activity (weekly metabolic equivalent task (MET) minutes) and diet (intake of total fat, saturated and polyunsaturated fatty acids, saccharose, and fiber). Multilevel analyses took into account cluster, maternity clinic, and nurse level influences in addition to age, education, parity, and prepregnancy BMI. 15.8% (34/216) of women in the intervention group and 12.4% (22/179) in the usual care group developed GDM (absolute effect size 1.36, 95% confidence interval [CI] 0.71–2.62, p?=?0.36). Neonatal birthweight was lower in the intervention than in the usual care group (absolute effect size ?133 g, 95% CI ?231 to ?35, p?=?0.008) as was proportion of large-for-gestational-age (LGA) newborns (26/216, 12.1% versus 34/179, 19.7%, p?=?0.042). Women in the intervention group increased their intake of dietary fiber (adjusted coefficient 1.83, 95% CI 0.30–3.25, p?=?0.023) and polyunsaturated fatty acids (adjusted coefficient 0.37, 95% CI 0.16–0.57, p<0.001), decreased their intake of saturated fatty acids (adjusted coefficient ?0.63, 95% CI ?1.12 to ?0.15, p?=?0.01) and intake of saccharose (adjusted coefficient ?0.83, 95% CI ?1.55 to ?0.11, p ?=? 0.023), and had a tendency to a smaller decrease in MET minutes/week for at least moderate intensity activity (adjusted coefficient 91, 95% CI ?37 to 219, p?=?0.17) than women in the usual care group. In subgroup analysis, adherent women in the intervention group (n?=?55/229) had decreased risk of GDM (27.3% versus 33.0%, p?=?0.43) and LGA newborns (7.3% versus 19.5%, p?=?0.03) compared to women in the usual care group. Conclusions The intervention was effective in controlling birthweight of the newborns, but failed to have an effect on maternal GDM. Trial registration Current Controlled Trials ISRCTN33885819 Please see later in the article for the Editors' Summary PMID:21610860

Luoto, Riitta; Kinnunen, Tarja I.; Aittasalo, Minna; Kolu, Paivi; Raitanen, Jani; Ojala, Katriina; Mansikkamaki, Kirsi; Lamberg, Satu; Vasankari, Tommi; Komulainen, Tanja; Tulokas, Sirkku

2011-01-01

182

Factors associated with depressive symptoms in the early postpartum period among women with recent gestational diabetes mellitus.  

PubMed

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

2013-11-01

183

Effect of gestational weight gain on perinatal outcomes in women with type 2 diabetes mellitus using the 2009 Institute of Medicine guidelines  

PubMed Central

OBJECTIVE We sought to examine associations between gestational weight gain according to the 2009 Institute of Medicine (IOM) guidelines and perinatal outcomes in overweight/obese women with type 2 diabetes mellitus (T2DM). STUDY DESIGN This is a retrospective cohort study of 2310 women with T2DM enrolled in the California Diabetes and Pregnancy Program. Gestational weight gain was categorized by 2009 IOM guidelines. Perinatal outcomes were assessed using the ?2 test and multivariable logistic regression analysis. RESULTS With excessive gestational weight gain, the odds of having large-for-gestational age (adjusted odds ratio [aOR], 2.00; 95% confidence interval [CI], 1.33–3.00) or macrosomic (aOR, 2.59; 95% CI, 1.56 – 4.30) neonates and cesarean delivery (aOR, 1.47; 95% CI, 1.03–2.10) was higher. Women with excessive gestational weight gain per week had increased odds of preterm delivery (aOR, 1.57; 95% CI, 1.11–2.20). CONCLUSION In overweight or obese women with T2DM, gestational weight gain greater than the revised IOM guidelines was associated with higher odds of perinatal morbidity, suggesting these guidelines are applicable to a diabetic population. PMID:22071055

Yee, Lynn M.; Cheng, Yvonne W.; Inturrisi, Maribeth; Caughey, Aaron B.

2012-01-01

184

The use of HbA1c as an aid in the diagnosis of gestational diabetes mellitus.  

PubMed

Abstract The ability of HbA1c was evaluated in the diagnosis of gestational diabetes mellitus (GDM) and for the implications of its use in clinical practice. A total of 339 pregnant women with an estimated gestational age of 24-28 weeks were evaluated for GDM using an oral glucose tolerance test (OGTT) based on International Association of Diabetes and Pregnancy Study Group (IADPSG) criteria. A ROC curve was drawn to determine the sensitivity and specificity of HbA1c in detecting GDM. An HbA1c cut-off value of ? 5.2% had sensitivity of 64.15% and specificity of 67.48% in diagnosing GDM, and a positive predictive value of 26.77%. Using two cut-offs in the 'rule-in and rule-out' algorithm, 94.4% of the GDM cases would have been detected but 33% (43 of the 130) women would had been misclassified. HbA1c is not suitable to use alone for the diagnosis of GDM and is not useful in decreasing the need for OGT testing. PMID:25340849

Sevket, O; Sevket, A; Ozel, A; Dansuk, R; Kelekci, S

2014-11-01

185

Rapid screening test for gestational diabetes: public health need, market requirement, initial product design, and experimental results  

NASA Astrophysics Data System (ADS)

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

2013-03-01

186

A simple scoring method using cardiometabolic risk measurements in pregnancy to determine 10-year risk of type 2 diabetes in women with gestational diabetes  

PubMed Central

Objective: To examine if clustering of cardiometabolic risk factors in pregnancy predicts type 2 diabetes and cardiovascular disease (CVD) risk at 10 years in women with gestational diabetes mellitus (GDM). Study design and subjects: A prospective case–control study in 150 GDM and 72 overweight women with normal glucose tolerance (NGT) measured cardiometabolic risk factors (body mass index (BMI), systolic blood pressure (SBP), fasting glucose, insulin, and triglycerides and high-density lipoprotein (HDL) cholesterol) at 28 weeks gestation and 6 months and 10 years after pregnancy. Cluster analysis of cardiometabolic risk factors in pregnancy was used to stratify GDM as ‘high' and ‘low risk' for diabetes and CVD risk at 10 years. The data in pregnancy were used to determine a simple method for assessing risk of future diabetes. Results: BMI in the 150 GDM at study entry was similar to NGT, but 35% of GDM fell into a ‘high-risk cluster' with elevated BMI, SBP, glucose, insulin and triglycerides and lower HDL levels. At 10 years, type 2 diabetes was sixfold higher in ‘high-risk' GDM (odds ratio (OR)=6.75, confidence interval (CI)=2.0, 22.7, P=0.002) compared with ‘low-risk' GDM and was not reported in NGT. The ‘high-risk' cluster predicted type 2 diabetes better than BMI>30 (OR=2.13, CI=0.71, 6.4, P=0.179) or fasting glucose >5.5?mmol?l–1, (OR=4.56, CI=1.50, 13.85, P=0.007). We determined that GDM with any four of the cardiometabolic risk factors (BMI>30?kg?m–2, fasting glucose>5.0?mmol?l–1, insulin>7.8?mU?l–1, triglycerides >2.4?mmol?l–1, HDL<1.6?mmol?l–1 or SBP>105?mm?Hg) in pregnancy would be in a ‘high-risk' cluster. Conclusions: A metabolic syndrome-like cluster in pregnant GDM identifies risk for type 2 diabetes providing an opportunity to focus on rigorous lifestyle interventions after delivery to reduce the burden of disease attributed to this condition. PMID:23732679

Barden, A; Singh, R; Walters, B; Phillips, M; Beilin, L J

2013-01-01

187

Is bisphenol-A exposure during pregnancy associated with blood glucose levels or diagnosis of gestational diabetes?  

PubMed

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-h 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-h 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 tertile1: 13/24; in tertile 2: 6/24; in 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. PMID:24053363

Robledo, Candace; Peck, Jennifer D; Stoner, Julie A; Carabin, Hélène; Cowan, Linda; Koch, Holger M; Goodman, Jean R

2013-01-01

188

Gestational diabetes as a risk factor for pancreatic cancer: a prospective cohort study  

Microsoft Academic Search

BACKGROUND: Diabetes is known to be associated with cancer of the pancreas, though there is some debate as to whether it is a cause or a consequence of the disease. We investigated the incidence of pancreatic cancer in a cohort of 37926 Israeli women followed for 28–40 years for whom information on diabetes had been collected at the time they

MC Perrin; MB Terry; K Kleinhaus; L Deutsch; R Yanetz; E Tiram; R Calderon; Y Friedlander; O Paltiel; S Harlap

2007-01-01

189

DALI: Vitamin D and lifestyle intervention for gestational diabetes mellitus (GDM) prevention: an European multicentre, randomised trial - study protocol  

PubMed Central

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 PMID:23829946

2013-01-01

190

Weighing the evidence of low glycemic index dietary intervention for the management of gestational diabetes mellitus: an Asian perspective.  

PubMed

This review aims to evaluate the effectiveness of low glycemic index (GI) dietary intervention for the treatment of gestational diabetes mellitus (GDM), specifically from the Asian perspective. A systematic review of the literature using multiple databases without time restriction was conducted. Three studies were retrieved based upon a priori inclusion criteria. While there was a trend towards improvement, no significant differences were observed in overall glycemic control and pregnancy outcomes in GDM women. However, a tendency for lower birth weight and birth centile if the intervention began earlier was noted. Low GI diets were well accepted and had identical macro-micronutrient compositions as the control diets. However, due to genetic, environment and especially food pattern discrepancies between Western countries and Asians, these results may not be contributed to Asian context. Clearly, there are limited studies focusing on the effect of low GI dietary intervention in women with GDM, particularly in Asia. PMID:24517860

Mohd Yusof, Barakatun-Nisak; Firouzi, Somayyeh; Mohd Shariff, Zalilah; Mustafa, Norlaila; Mohamed Ismail, Nor Azlin; Kamaruddin, Nor Azmi

2014-03-01

191

Effects of soybean oligosaccharides on antioxidant enzyme activities and insulin resistance in pregnant women with gestational diabetes mellitus.  

PubMed

The effects of soybean oligosaccharides (SBOS) on antioxidant enzyme activities and insulin resistance in pregnant women with gestational diabetes mellitus (GDM) were investigated. Ninety-seven pregnant women with GDM were randomly divided into two groups, the control group (51 cases) and the SBOS group (46 cases). Before the group separation, the blood sugar level in patients was maintained stable by regular diet and insulin treatment. The control group was continued with the insulin treatment, while the SBOS group was treated with the combination of insulin and SBOS. Results showed that SBOS were able to reduce oxidative stress and alleviate insulin resistance in pregnant women with GDM, which indicates that SBOS may play an important role in the control of GDM complications. PMID:24731365

Fei, Bei-bei; Ling, Li; Hua, Chen; Ren, Shu-yan

2014-09-01

192

Comparison of the world health organization and the International association of diabetes and pregnancy study groups criteria in diagnosing gestational diabetes mellitus in South Indians  

PubMed Central

Aim: We aimed to compare the International Association of Diabetes and Pregnancy Study Groups (IADPSG) and the World Health Organization (WHO) criteria to diagnose gestational diabetes mellitus (GDM) in Chennai, India. Materials and Methods: We reviewed the retrospective data of 1351 pregnant women who underwent screening for GDM at four selected diabetes centers at Chennai (three private and one government). All women underwent an oral glucose tolerance test using 75g glucose load and fasting, 1-h, and 2-h samples were collected. The IADPSG and WHO criteria were compared for diagnosis of GDM. Results: A total of 839 women had GDM by either the IADPSG or the WHO criteria, of whom the IADPSG criteria identified 699 and the WHO criteria also identified 699 women as having GDM. However, only 599/839 women (66.6%) were identified by both criteria. Thus, 140/839 women (16.7%) were missed by both the IADPSG and the WHO criteria. 687/699 (98.2%) of the women with GDM were identified by the WHO criteria. In contrast, each value of IADPSG criteria i.e., fasting, 1 h, and 2 h identified only 12.5%, 14%, and 22%, respectively. Conclusions: A single WHO cut-point of 2 h > 140 mg/dl appears to be suitable for large-scale screening for GDM in India and other developing countries. PMID:24083175

Nallaperumal, Sivagnanam; Bhavadharini, Balaji; Mahalakshmi, Manni Mohanraj; Maheswari, Kumar; Jalaja, Ramesh; Moses, Anand; Anjana, Ranjit Mohan; Deepa, Mohan; Ranjani, Harish; Mohan, Viswanathan

2013-01-01

193

Rationale, design, and methodology for the optimizing outcomes in women with gestational diabetes mellitus and their infants study  

PubMed Central

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 PMID:24112417

2013-01-01

194

Serum lipid, lipoprotein and apolipoprotein changes in gestational diabetes mellitus: a cross-sectional and prospective study.  

PubMed Central

AIMS: To compare serum lipid, lipoprotein and apolipoprotein concentrations during and six to 12 months after pregnancy in control and diabetic women. METHODS: The serum lipid, lipoprotein and apolipoprotein concentrations were measured in 20 women with gestational diabetes mellitus (GDM) and 22 women with normal glucose tolerance (controls) during the third trimester of pregnancy and six to 12 months after delivery. RESULTS: During pregnancy the women with GDM had higher serum triglyceride (mean (95% confidence interval (CI)), 2.91 (2.22-3.51) v 2.1 (1.75-2.52)) but lower low density lipoprotein (LDL) cholesterol concentrations compared with controls (mean (SD), 3.08 (1.2) v 4.01 (1.1). Total cholesterol, high density lipoprotein (HDL) cholesterol and apolipoprotein concentrations were not significantly different between the two groups. After pregnancy, total cholesterol, HDL cholesterol, triglyceride, and apolipoprotein A1 and B decreased in a parallel manner, resulting in lower concentrations, comparable between the two groups. LDL cholesterol concentrations decreased after pregnancy in the controls (mean (SD), 4.01 (1.1) v 2.69 (0.6)) but not in those with GDM (3.08 (1.2) v 2.72 (0.7)). The change in lipid concentrations was not related to change in weight. CONCLUSION: Development of diabetes during pregnancy induces a state of dyslipidaemia characterised by elevated triglyceride concentrations, as seen in other insulin resistance states. However, GDM seems to blunt the increase in LDL cholesterol during pregnancy and this requires further investigation. Whether the changes in lipoprotein metabolism in GDM are significant for the health status of the mother and the foetus requires further study. PMID:8881912

Koukkou, E; Watts, G F; Lowy, C

1996-01-01

195

Is early postpartum HbA1c an appropriate risk predictor after pregnancy with gestational diabetes mellitus?  

PubMed

Compared to the 2-h oral glucose tolerance test (OGTT), the assessment of HbA1c was proposed as a less time-consuming alternative to detect pathologies in carbohydrate metabolism. This report aims to assess the predictive accuracy of HbA1c to detect alterations in glucose disposition early after gestational diabetes mellitus (GDM) pregnancy. A detailed metabolic characterization was performed in 77 women with previous GDM (pGDM) and 41 controls 3-6 month after delivery: 3-h OGTT, frequently sampled intravenous glucose tolerance test. Follow-up examinations of pGDMs were performed up to 10 years. HbA1c (venous samples, HPLC) was assessed at baseline as well as during the follow-up period (475 patient contacts). Moderate associations were observed between HbA1c and measurements of plasma glucose during the OGTT at the baseline examination: The strongest correlation was found for FPG (r = 0.40, p < 0.001), decreasing after ingestion. No associations were detected between HbA1c and OGTT dynamics of insulin or C-peptide. Moreover, baseline HbA1c showed only modest correlation with insulin sensitivity (r = -0.25, p = 0.010) and disposition index (r = -0.26, p = 0.007). A linear model including fasting as well as post-load glucose levels was not improved by HbA1c. However, pGDM females with overt diabetes manifestation during the follow-up period showed more pronounced increasing HbA1c in contrast to females remaining normal glucose tolerant or developing prediabetes. It is suggested that the performance of HbA1c assessed early after delivery is inferior to the OGTT for the detection of early alterations in glucose metabolism. However, an increase in HbA1c levels could be used as an indicator of risk for diabetes manifestation. PMID:24626995

Göbl, Christian S; Bozkurt, Latife; Yarragudi, Rajashri; Tura, Andrea; Pacini, Giovanni; Kautzky-Willer, Alexandra

2014-10-01

196

Differences in the Incidence of Gestational Diabetes between Women of Turkish and German Origin: An Analysis of Health Insurance Data From a Statutory Health Insurance in Berlin, Germany (AOK), 2005-2007  

PubMed Central

Background: Gestational diabetes increases the risk of maternal and infant complications and long-term health effects. A study of differences in the incidence of gestational diabetes between women of Turkish and German origin can identify high risk groups and may indicate the need for culturally sensitive diabetes information and treatment during pregnancy. Method: We analysed all pregnancy related health insurance data from the AOK Berlin (a statutory health insurance in Berlin) based on data from 2005 to 2007, using a name algorithm to identify cases with Turkish migrant background. A group of German women insured with the AOK Berlin served as a comparison group. Results: After exclusion of miscarriages and multiple births the data set comprised 3338 pregnancies in total. The incidence of gestational diabetes was significantly higher in women of Turkish origin with 183 per 1000 pregnancies than in German women (138 per 1000 pregnancies). Regression analyses showed that women of Turkish origin with obesity were at the highest risk of gestational diabetes (OR?=?2.67; 95?% confidence interval 1.97–3.60). Conclusion: Obesity is an important factor in explaining the higher incidence of gestational diabetes in women of Turkish origin, especially among young Turkish women. These findings should stimulate discussion as to whether or not information about risk factors such as diabetes within the scope of prenatal care adequately addresses the needs of migrant women. Further research is needed to identify potential differences in undetected and primarily in insufficiently treated gestational diabetes between Turkish and German women.

Reeske, A.; Zeeb, H.; Razum, O.; Spallek, J.

2012-01-01

197

Fetal Male Gender and the Benefits of Treatment of Mild Gestational Diabetes  

PubMed Central

Objective We evaluated whether improvements in pregnancy outcomes after treatment of mild GDM differed in magnitude based on fetal gender. Methods This is a secondary analysis of a masked RCT of treatment for mild GDM. Outcomes included preeclampsia or gestational hypertension, birth weight, neonatal fat mass, and composite adverse outcomes for both neonate (preterm birth, SGA or NICU admission) and mother (labor induction, cesarean delivery, preeclampsia or gestational hypertension). After stratification according to fetal gender, the interaction of gender with treatment status was estimated for these outcomes. Results Of 469 pregnancies with male fetuses, 244 were randomized to treatment and 225 to routine care. For those with female fetuses, these numbers were 463, 233 and 230 respectively. The interaction of gender with treatment status was significant for fat mass (p=0.04) and birthweight centile (p = 0.02). Among women who were assigned to the treatment group, male offspring were significantly more likely to have both a lower birth weight centile (50.7 ± 29.2 vs 62.5 ± 30.2 centile, p < 0.0001) and less neonatal fat mass (487 ± 229.6 vs. 416.6 ± 172.8 g, p = 0.0005) whereas these differences were not significant among female offspring. There was no interaction between fetal gender and treatment group with regard to other outcomes. Conclusion The magnitude of the reduction of a newborn’s birth weight centile and neonatal fat mass related to the treatment of mild GDM appears greater for male neonates. PMID:22542118

BAHADO-SINGH, Ray O.; MELE, Lisa; LANDON, Mark B.; RAMIN, Susan M.; CARPENTER, Marshall W.; CASEY, Brian; WAPNER, Ronald J.; VARNER, Michael W.; ROUSE, Dwight J.; THORP, John M.; SCISCIONE, Anthony; CATALANO, Patrick; HARPER, Margaret; SAADE, George; CARITIS, Steve N.; PEACEMAN, Alan M.; TOLOSA, Jorge E.

2014-01-01

198

Efficacy and Safety of Oral Antidiabetic Drugs in Comparison to Insulin in Treating Gestational Diabetes Mellitus: A Meta-Analysis  

PubMed Central

Objective To assess the efficacy and safety of oral antidiabetic drugs (OADs) in gestational diabetes mellitus (GDM) in comparison to insulin. Methods A meta-analysis of randomized controlled trials was conducted. The efficacy and safety of OADs in comparison to insulin in GDM patients were explored. Studies were identified by conducting a literature search using the electronic databases of Medline, CENTRAL, CINAHL, LILACS, Scopus and Web of Science in addition to conducting hand search of relevant journals from inception until October 2013. Results Thirteen studies involving 2,151 patients met the inclusion criteria. These studies were randomized controlled trials of metformin and glyburide in comparison to insulin therapy. Our results indicated a significant increase in the risk for preterm births (RR, 1.51; 95% CI, 1.04–2.19, p?=?0.03) with metformin compared to insulin. However, a significant decrease in the risk for gestational hypertension (RR, 0.54; 95% CI, 0.31–0.91, p?=?0.02) was found. Postprandial glucose levels also decreased significantly in patients receiving metformin (MD, ?2.47 mg/dL; 95% CI, ?4.00, ?0.94, p?=?0.002). There was no significant difference between the two groups for the remaining outcomes. There were significant increases in the risks of macrosomia (RR, 2.34; 95% CI, 1.18–4.63, p?=?0.03) and neonatal hypoglycemia (RR, 2.06; 95% CI, 1.27–3.34, p?=?0.005) in the glyburide group compared to insulin whereas results for the other analyzed outcomes remained non-significant. Conclusion The available evidence suggests favorable effects of metformin in treating GDM patients. Metformin seems to be an efficacious alternative to insulin and a better choice than glyburide especially those with mild form of disease. PMID:25302493

Poolsup, Nalinee; Suksomboon, Naeti; Amin, Muhammad

2014-01-01

199

Diabetes and Pregnancy  

MedlinePLUS

Diabetes is a disease in which your blood glucose, or blood sugar, levels are too high. When ... pregnant women in the United States get gestational diabetes. Gestational diabetes is diabetes that happens for the ...

200

Types of Diabetes  

MedlinePLUS

... of developing type 2 diabetes. Treatment includes taking diabetes medicines, making wise food choices, exercising regularly, taking aspirin ... and cholesterol, and use of oral or injected insulin. Gestational Diabetes Some women develop gestational diabetes during the late ...

201

A Prospective Cohort Study of Modifiable Risk Factors for Gestational Diabetes among Hispanic Women: Design and Baseline Characteristics  

PubMed Central

Abstract Objectives Women diagnosed with gestational diabetes mellitus (GDM) are at high risk for future diabetes, with rates of GDM consistently higher in Hispanic than non-Hispanic white women. Currently recognized risk factors for GDM are absent in up to half of affected women, and studies addressing modifiable risk factors for GDM in Hispanic women are sparse. Methods Proyecto Buena Salud is an ongoing prospective cohort study of Hispanic women in Massachusetts designed to assess physical activity, psychosocial stress, and GDM risk. Bilingual interviewers recruit prenatal care patients early in pregnancy and assess activity, trait anxiety, perceived stress, and depressive symptoms using validated questionnaires. Results Baseline characteristics of the first 632 participants are presented. Women were predominantly young (69% <24 years), were unmarried (87%), and had low levels of education (48% had less than high school). Women with high acculturation were less likely to live with a partner (OR: 0.6, 95% CI 0.4-0.8) than women with low acculturation. Few participants met physical activity guidelines during pregnancy (5.2%). Levels of perceived stress (mean 26.9?±?7.1), trait anxiety (mean 41.6?±?10.4), and depressive symptoms (33.2%) were high. Conclusions Proyecto Buena Salud represents a high-risk population of pregnant Hispanic women who are predominantly inactive, with higher levels of perceived stress, trait anxiety, and depressive symptoms compared to predominantly non-Hispanic white cohorts studied earlier. Therefore, Proyecto Buena Salud provides a unique opportunity to prospectively evaluate modifiable risk factors for GDM. Findings will inform prenatal behavioral intervention programs designed to address modifiable GDM risk factors. PMID:20088667

Fortner, Renee Turzanski; Gollenberg, Audra; Buonnaccorsi, John; Dole, Nancy; Markenson, Glenn

2010-01-01

202

Paired values of serum fructosamine and blood glucose for the screening of gestational diabetes mellitus: A retrospective study of 165 Saudi pregnant women  

Microsoft Academic Search

This study reports the utilization of serum fructosamine and blood glucose for the screening of gestational diabetes mellitus\\u000a (GDM). Blood samples from 165 pregnant women were analyzed for fasting blood glucose (FBG), random blood glucose (RBG) and\\u000a serum fructosamine. The actual fructosamine levels were corrected for serum protein (c-Fruct) for more precise presentation.\\u000a Two cut-off values of FBG (>5.3 mmol\\/L

Haseeb Ahmad Khan; Samia Hasan Sobki; Abdullah Saleh Alhomida; Shaukat Ali Khan

2007-01-01

203

Strategies for recruiting Hispanic women into a prospective cohort study of modifiable risk factors for gestational diabetes mellitus  

PubMed Central

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. PMID:20003350

2009-01-01

204

High oleic/stearic fatty acid desaturation index in cord plasma from infants of mothers with gestational diabetes  

PubMed Central

Objective Enhanced fatty acid desaturation by stearoyl-CoA desaturase enzyme-1 (SCD1) is associated with obesity. This study determined desaturation in 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 VLDL desaturation indices were determined to approximate liver SCD1 activity. Results 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, Jennifer K.; Mao, Catherine S.; Ross, Michael G.; Paul Lee, W. N.; Desai, Mina; Toda, Audrey; Kjos, Siri L.; Hicks, Rebecca A.; Patterson, Mary E.

2014-01-01

205

Gestational Diabetes Independently Increases Birth Length and Augments the Effects of Maternal BMI on Birth Weight: A Retrospective Cohort Study  

PubMed Central

Objective: To investigate the effect of the interaction between gestational diabetes mellitus (GDM) and maternal body mass index (BMI) on the individual neonatal growth parameters. Design: Retrospective cohort study. Setting: A tertiary maternity service in Sydney, Australia, between 2005 and 2009. Population: A cohort of 8859 women. Methods: Generalized linear models. Main outcome measures: Neonatal growth parameters, represented by z-scores for infant birth weight (BW), birth length (BL), and head circumference (HC) in GDM and non-GDM groups. Results: Only GDM alone had an independent and positive effect on BL (p?=?0.02) but not on BW or HC. In addition, in pregnancies complicated with GDM, the association between maternal weight and BW was significantly stronger (p?

Bystrom, Magdalena; Liu, Anthony; Quinton, Ann Elizabeth; Champion, Bernard Linton; Mann, Kristy; Peek, Michael; Nanan, Ralph Kay Heinrich

2014-01-01

206

A meta-analysis of the association between gestational diabetes mellitus and chronic hepatitis B infection during pregnancy  

PubMed Central

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. PMID:24618120

2014-01-01

207

Food cravings and intake of sweet foods in healthy pregnancy and mild gestational diabetes mellitus. A prospective study.  

PubMed

Pregnancy is associated with increased sweet food cravings, but the relationship between sweet cravings and dietary intake remains uncertain. Gestational diabetes mellitus (GDM) is glucose intolerance first recognized during pregnancy. GDM may further perpetuate sweet food cravings and intake in pregnancy, although this has not been investigated. This study longitudinally assessed sweet food cravings across pregnancy in women who developed mild GDM (n = 15), normal glucose tolerant pregnant women (NGT; n = 93) and nonpregnant controls (n = 19). Food frequency questionnaires and craving surveys were completed 3 times during pregnancy, and again during postpartum. While 55% of NGT women reported sweet cravings at 24-28 wk; this percentage fell significantly at term. Sweet cravings in these women coincided with higher reported sweet food and beverage intake. Only 40% of GDM women reported sweet cravings at 24-28 wk. However, at 34-38 wk, this subset of GDM women reported twice the frequency of sweet cravings than NGT women (12.1 ± 2.8 times/wk vs. 5.9 ± 1.0 times/wk, respectively). Sweet cravings appear to be a feature of late pregnancy in GDM, but may not threaten dietary adherence in women with mild GDM. Future studies should investigate sweet cravings in women with more severe GDM. PMID:20869416

Belzer, Lisa M; Smulian, John C; Lu, Shou-En; Tepper, Beverly J

2010-12-01

208

UNCONTROLLED COMBUSTION EMISSIONS CHARACTERIZATION  

EPA Science Inventory

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...

209

Lower vitamin D levels at first trimester are associated with higher risk of developing gestational diabetes mellitus.  

PubMed

The progressive increase of insulin resistance observed in pregnancy contributes to the pathophysiology of gestational diabetes mellitus (GDM). There is controversy whether vitamin D deficiency contributes to abnormal glycemic regulation in pregnancy. We tested the associations between first trimester 25-hydroxyvitamin D (25OHD) levels and: 1) the risk of developing GDM; 2) insulin resistance/sensitivity, beta cell function and compensation indices in a large population-based prospective cohort of pregnant women. Participants (n = 655) were seen at first (6-13 weeks) and second (24-28 weeks) trimesters for blood samples. At first trimester, 25OHD levels were measured. At second trimester, glucose and insulin were measured 3 times during the oral glucose tolerance test to estimate insulin resistance (HOMA-IR), beta cell function (HOMA-B), insulin sensitivity (Matsuda index), insulin secretion (AUCins/gluc) and beta cell compensation (ISSI-2). Based on IADPSG criteria, 54 participants (8.2 %) developed GDM. Lower first trimester 25OHD levels were associated with higher risk of developing GDM even after adjustment for vitamin D confounding factors and GDM risk factors (OR = 1.48 per decrease of one SD in 25OHD levels; P = 0.04). Lower first trimester 25OHD levels were associated with higher HOMA-IR (r = - 0.08; P = 0.03), lower Matsuda index (r = 0.13; P = 0.001) and lower ISSI-2 (r = 0.08; P = 0.04). After adjustment for confounders, we found no significant association with HOMA-B and AUCins/gluc. Our results suggest that low levels of 25OHD at first trimester are (1) an independent risk factor for developing GDM and (2) associated with insulin resistance at second trimester. PMID:24526261

Lacroix, Marilyn; Battista, Marie-Claude; Doyon, Myriam; Houde, Ghislaine; Ménard, Julie; Ardilouze, Jean-Luc; Hivert, Marie-France; Perron, Patrice

2014-08-01

210

The association between serum asymmetric dimethyl arginine levels and a history of gestational diabetes among healthy women.  

PubMed

In recent years, asymmetric dimethyl arginine (ADMA) has emerged as an early marker and/or mediator of endothelial dysfunction and it has been proved to be a novel, independent risk factor of cardiovascular and metabolic diseases. Our aim in this study was to compare the ADMA concentrations among patients with a history of gestational diabetes mellitus (GDM) with controls. Thirty women with a history of GDM and 40 age-matched and BMI-matched healthy controls were enrolled in this study. ADMA concentrations, fasting blood glucose levels, 75-g oral glucose tolerance test (OGTT) second hour plasma glucose levels, and insulin levels were compared between two groups. The fasting blood glucose levels were also significantly higher in patients with GDM history. Although second hour values of 75-g OGTT were higher in patients with GDM history, the difference between groups was not statistically significant. However, the insulin and homeostatic model assessment insulin resistance levels were statistically significantly higher in patients with a history of GDM. The concentrations of ADMA were found to be statistically higher in patients with a history of GDM (0.45 ± 0.11 vs. 0.31 ± 0.13 ?mol/l, respectively; P = 0.01). This study shows that women who had a history of GDM are under risk for cardiovascular diseases, although they seem to be healthy and have normal blood biochemical levels, because of elevated serum ADMA levels. Clinicians should be aware of this increased cardiovascular disease risk among patients with a history of GDM. PMID:22576284

Gumus, Ilknur I; Kargili, Ayse; Kaygusuz, Ikbal; Derbent, Aysel; Karakurt, Feridun; Kasapoglu, Benan; Uysal, Sema

2012-07-01

211

Diabetic uterus environment may play a key role in alterations of DNA methylation of several imprinted genes at mid-gestation in mice  

PubMed Central

Background Maternal diabetes mellitus not only has severe deleterious effects on fetal development, but also it affects transmission to the next generation. However, the underlying mechanisms for these effects are still not clear. Methods We investigated the methylation patterns and expressions of the imprinted genes Peg3, Snrpn, and H19 in mid-gestational placental tissues and on the whole fetus utilizing the streptozotocin (STZ)-induced hyperglycemic mouse model for quantitative analysis of methylation by PCR and quantitative real-time PCR. The protein expression of Peg3 was evaluated by Western blot. Results We found that the expression of H19 was significantly increased, while the expression of Peg3 was significantly decreased in dpc10.5 placentas of diabetic mice. We further found that the methylation level of Peg3 was increased and that of H19 was reduced in dpc10.5 placentas of diabetic mice. When pronuclear embryos of normal females were transferred to normal/diabetic (NN/ND) pseudopregnant females, the methylation and expression of Peg3 in placentas was also clearly altered in the ND group compared to the NN group. However, when the pronuclear embryos of diabetic female were transferred to normal pesudopregnant female mice (DN), the methylation and expression of Peg3 and H19 in dpc10.5 placentas was similar between the two groups. Conclusions We suggest that the effects of maternal diabetes on imprinted genes may primarily be caused by the adverse uterus environment. PMID:24378208

2013-01-01

212

Am I at risk for gestational  

E-print Network

careful management and control of blood sugar levels. The best way to control gestational diabetes in the blood gets higher and higher. This is called high blood sugar or diabetes. #12;Am I at riskAm I at risk for gestational diabetes? U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES NatioNal i

Rau, Don C.

213

Screening for gestational diabetes mellitus: cost–utility of different screening strategies based on a woman’s individual risk of disease  

Microsoft Academic Search

Aims\\/hypothesis  The cost-effectiveness of eight strategies for screening for gestational diabetes (including no screening) was estimated with\\u000a respect to the level of individual patient risk.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Cost–utility analysis using a decision analytic model populated with efficacy evidence pooled from recent randomised controlled\\u000a trials, from the funding perspective of the National Health Service in England and Wales. Seven screening strategies using\\u000a various combinations

J. A. Round; P. Jacklin; R. B. Fraser; R. G. Hughes; M. A. Mugglestone; R. I. G. Holt

2011-01-01

214

Diabetes diet - gestational  

MedlinePLUS

... snacks. Keep the amount and types of food (carbohydrates, fats, and proteins) the same from day to ... can help you keep your blood sugar stable. CARBOHYDRATES Less than half the calories you eat should ...

215

Staying Healthy with Diabetes  

MedlinePLUS

... help people with diabetes stay healthy? Research studies in the United States and other countries have shown that controlling blood ... Diabetes Issues Rate of Increase Type 2 Diabetes in the United States CDC Study Gestational Diabetes Diabetes in the United ...

216

Diagnostic and Prognostic Performances Over 9 Years of a Selective Screening Strategy for Gestational Diabetes Mellitus in a Cohort of 18,775 Subjects  

PubMed Central

OBJECTIVE We aimed to evaluate a selective screening strategy for gestational diabetes mellitus (GDM) based on the presence of risk factors: BMI ?25 kg/m2, age ?35 years, family history of diabetes, personal history of GDM, or birth of a child with macrosomia. RESEARCH DESIGN AND METHODS Of 20,630 deliveries between 2002 and 2010, we selected 18,775 deliveries in women with no known diabetes and for whom all risk factors were known. GDM was universally screened and defined as fasting plasma glucose level ?5.3 mmol/L and/or 2-h postload (75 g) glucose level ?7.8 mmol/L. RESULTS The prevalence of at least one risk factor has increased since 2002 (P < 0.001) from 51.7 to 61.5%, with no change in the GDM prevalence (mean 14.4%, intention to screen). At least one risk factor was present in 58.5% of women who represented 65.3% of all those with GDM. The presence of risk factors was significantly associated with GDM (odds ratio 1.4 [95% CI 1.3–1.5], P < 0.001) and with GDM-related events (preeclampsia/large for gestational age/dystocia) (P < 0.001) with the following incidences: no GDM/no risk factor 8.8%, no GDM/risk factor 11.1%, GDM/no risk factor 16.7%, and GDM/risk factor 18.2%. CONCLUSIONS The presence of risk factors increased during the last decade. This condition is predictive of GDM and GDM-related events. However, a selective screening would lead to missing one-third of the women with GDM who, even without risk factors, had more events than women without GDM. Therefore, these data stand against the present selective screening currently proposed in the French guidelines. PMID:23150287

Cosson, Emmanuel; Benbara, Amelie; Pharisien, Isabelle; Nguyen, Minh Tuan; Revaux, Aurelie; Lormeau, Boris; Sandre-Banon, Dorian; Assad, Nabil; Pillegand, Camille; Valensi, Paul; Carbillon, Lionel

2013-01-01

217

Design of FitFor2 study: the effects of an exercise program on insulin sensitivity and plasma glucose levels in pregnant women at high risk for gestational diabetes  

Microsoft Academic Search

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

2009-01-01

218

78 FR 14561 - Notice of Diabetes Mellitus Interagency Coordinating Committee Meeting  

Federal Register 2010, 2011, 2012, 2013

...Committee Meeting SUMMARY: The Diabetes Mellitus Interagency Coordinating...Federal Initiatives to Address Gestational Diabetes Mellitus.'' The meeting...Federal Initiatives to Address Gestational Diabetes Mellitus.'' Any member...

2013-03-06

219

Group-based activities with on-site childcare and online support improve glucose tolerance in women within 5 years of gestational diabetes pregnancy  

PubMed Central

Background Women with gestational diabetes history are at increased risk for type 2 diabetes. They face specific challenges for behavioural changes, including childcare responsibilities. The aim of this study is to test a tailored type 2 diabetes prevention intervention in women within 5 years of a pregnancy with gestational diabetes, in terms of effects on weight and cardiometabolic risk factors. Methods The 13-week intervention, designed based on focus group discussions, included four group sessions, two with spousal participation and all with on-site childcare. Web/telephone-based support was provided between sessions. We computed mean percentage change from baseline (95% confidence intervals, CI) for anthropometric measures, glucose tolerance (75 g Oral glucose tolerance test), insulin resistance/sensitivity, blood pressure, physical activity, dietary intake, and other cardiometabolic risk factors. Results Among the 36 enrolled, 27 completed final evaluations. Most attended???3 sessions (74%), used on-site childcare (88%), and logged onto the website (85%). Steps/day (733 steps, 95% CI 85, 1391) and fruit/vegetable intake (1.5 servings/day, 95% CI 0.3, 2.8) increased. Proportions decreased for convenience meal consumption (?30%, 95% CI ?50, ?9) and eating out (?22%, 95% CI ?44, ?0)???3 times/month. Body mass index and body composition were unchanged. Fasting (?4.9%, 95% CI ?9.5, ?0.3) and 2-hour postchallenge (?8.0%, 95% CI ?15.6, ?0.5) glucose declined. Insulin sensitivity increased (ISI 0,120 23.7%, 95% CI 9.1, 38.4; Matsuda index 37.5%, 95% CI 3.5, 72.4). Insulin resistance (HOMA-IR ?9.4%, 95% CI ?18.6, ?0.1) and systolic blood pressure (?3.3%, 95% CI ?5.8, ?0.8) decreased. Conclusions A tailored group intervention appears to lead to improvements in health behaviours and cardiometabolic risk factors despite unchanged body mass index and body composition. This approach merits further study. Clinical trial registration ClinicalTrials.gov (NCT01814995). PMID:24981579

2014-01-01

220

Proportion of gestational diabetes mellitus attributable to overweight and obesity among non-Hispanic black, non-Hispanic white, and Hispanic women in South Carolina.  

PubMed

Objective was to estimate race-specific proportions of gestational diabetes mellitus (GDM) attributable to overweight and obesity in South Carolina. South Carolina birth certificate and hospital discharge data were obtained from 2004 to 2006. Women who did not have type 2 diabetes mellitus before pregnancy were classified with GDM if a diagnosis was reported in at least one data source. Relative risks (RR) and 95 % confidence intervals were calculated using the log-binomial model. The modified Mokdad equation was used to calculate population attributable fractions for overweight body mass index (BMI: 25.0-29.9 kg/m(2)), obese (30.0-34.9 kg/m(2)), and extremely obese (?35 kg/m(2)) women after adjusting for age, gestational weight gain, education, marital status, parity, tobacco use, pre-pregnancy hypertension, and pregnancy hypertension. Overall, the adjusted RR of GDM was 1.6, 2.3, and 2.9 times higher among the overweight, obese, and extremely obese women compared to normal-weight women in South Carolina. RR of GDM for extremely obese women was higher among White (3.1) and Hispanic (3.4) women than that for Black women (2.6). The fraction of GDM cases attributable to extreme obesity was 14.0 % among White, 18.1 % among Black, and 9.6 % among Hispanic women. The fraction of GDM cases attributable to obesity was about 12 % for all racial groups. Being overweight (BMI: 25.0-29.9) explained 8.8, 7.8, and 14.4 % of GDM cases among White, Black, and Hispanic women, respectively. Results indicate a significantly increased risk of GDM among overweight, obese, and extremely obese women. The strength of the association and the proportion of GDM cases explained by excessive weight categories vary by racial/ethnic group. PMID:24531925

Cavicchia, Philip P; Liu, Jihong; Adams, Swann A; Steck, Susan E; Hussey, James R; Daguisé, Virginie G; Hebert, James R

2014-10-01

221

Macrosomia in non-gestational diabetes pregnancy: glucose tolerance test characteristics and feto-maternal complications in tropical Asia Pacific Australia  

PubMed Central

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

2014-01-01

222

What do we know about gestational diabetes mellitus and risk for postpartum depression among ethnically diverse low-income women in the USA?  

PubMed

Many women develop postpartum mental health symptoms, ranging from the maternity blues to clinically diagnosed postpartum depression (PPD). Substantial literature supports an association between depression and type 2 diabetes, but there is limited literature regarding to what extent this relationship pertains to gestational diabetes (GDM) and postpartum depression. Review of the literature regarding GDM and PPD with a particular focus on describing the prevalence of PPD among women who may be at increased risk for GDM, including low-income and ethnic minority groups, was performed. Literature searches were conducted across four databases for studies reporting postpartum mental health outcomes (including postpartum depression, behavioral symptoms, mental disorders, mood, anxiety, quality of life) following a diagnosis of GDM. Studies including subgroups of women with GDM were included if postpartum mental health outcomes were reported. Of the 245 abstracts identified, ten studies were included in the final review. Findings suggest that PPD was high among low-income, ethnic minority women. Additional research is required to understand the complex relationship between GDM and PPD among low-income women, with the ultimate goal of implementing tailored interventions to address their medical and psychiatric needs. PMID:25298252

Barakat, Suzanne; Martinez, Diana; Thomas, Melanie; Handley, Margaret

2014-12-01

223

Introduction to Type 2 Diabetes (Revised).  

National Technical Information Service (NTIS)

Contents: What is Type 2 Diabetes; The Cycle of Type 2 Diabetes; Tupe 1 vs Type 2; Risk Factors for Type 2 Diabetes in American Indians; Diagnosing Diabetes; Diagnostic Criteria for Diabetes Mellitus, Impaired Glucose Tolerance, and Gestational Diabetes; ...

B. Drabant, K. Acton, B. Tolbert

1996-01-01

224

Identifying common and specific microRNAs expressed in peripheral blood mononuclear cell of type 1, type 2, and gestational diabetes mellitus patients  

PubMed Central

Background Regardless the regulatory function of microRNAs (miRNA), their differential expression pattern has been used to define miRNA signatures and to disclose disease biomarkers. To address the question of whether patients presenting the different types of diabetes mellitus could be distinguished on the basis of their miRNA and mRNA expression profiling, we obtained peripheral blood mononuclear cell (PBMC) RNAs from 7 type 1 (T1D), 7 type 2 (T2D), and 6 gestational diabetes (GDM) patients, which were hybridized to Agilent miRNA and mRNA microarrays. Data quantification and quality control were obtained using the Feature Extraction software, and data distribution was normalized using quantile function implemented in the Aroma light package. Differentially expressed miRNAs/mRNAs were identified using Rank products, comparing T1DxGDM, T2DxGDM and T1DxT2D. Hierarchical clustering was performed using the average linkage criterion with Pearson uncentered distance as metrics. Results The use of the same microarrays platform permitted the identification of sets of shared or specific miRNAs/mRNA interaction for each type of diabetes. Nine miRNAs (hsa-miR-126, hsa-miR-1307, hsa-miR-142-3p, hsa-miR-142-5p, hsa-miR-144, hsa-miR-199a-5p, hsa-miR-27a, hsa-miR-29b, and hsa-miR-342-3p) were shared among T1D, T2D and GDM, and additional specific miRNAs were identified for T1D (20 miRNAs), T2D (14) and GDM (19) patients. ROC curves allowed the identification of specific and relevant (greater AUC values) miRNAs for each type of diabetes, including: i) hsa-miR-1274a, hsa-miR-1274b and hsa-let-7f for T1D; ii) hsa-miR-222, hsa-miR-30e and hsa-miR-140-3p for T2D, and iii) hsa-miR-181a and hsa-miR-1268 for GDM. Many of these miRNAs targeted mRNAs associated with diabetes pathogenesis. Conclusions These results indicate that PBMC can be used as reporter cells to characterize the miRNA expression profiling disclosed by the different diabetes mellitus manifestations. Shared miRNAs may characterize diabetes as a metabolic and inflammatory disorder, whereas specific miRNAs may represent biological markers for each type of diabetes, deserving further attention. PMID:24279768

2013-01-01

225

Serum Concentrations of Fibroblast Growth Factors 19 and 21 in Women with Gestational Diabetes Mellitus: Association with Insulin Resistance, Adiponectin, and Polycystic Ovary Syndrome History  

PubMed Central

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. PMID:24260557

Wang, Dongyu; Zhu, Wenjing; Li, Jieming; An, Chongyou; Wang, Zilian

2013-01-01

226

Maternal glucose level and body mass index measured at gestational diabetes mellitus screening and the risk of macrosomia: results from a perinatal cohort study  

PubMed Central

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. PMID:24844269

Liu, Jian; Leng, Junhong; Tang, Chen; Liu, Gongshu; Hay, John; Wang, Jing; Wen, Shiwu; Li, Zhenling; She, Ye

2014-01-01

227

Development of a real-time smartphone solution for the management of women with or at high risk of gestational diabetes.  

PubMed

Gestational diabetes mellitus (GDM) is defined as new onset or recognition of glucose intolerance in pregnancy. Evidence supports tight blood glucose regulation to prevent adverse maternal and fetal outcomes. Finger-prick blood glucose (BG) testing with frequent clinic review remains the most common method of managing diabetes in pregnancy. The prevalence of GDM is rising globally, pressuring resource-limited services. We have developed an intuitive, interactive, reliable, and accurate management system to record BG measurements and deliver management of GDM remotely. Following an initial scoping phase, a prototype software application was developed using an Android smartphone with BG meter linkage via Bluetooth. A custom website was built for clinician review of the data transmitted by the smartphone. After system refinement, further evaluation was undertaken for usability and reliability in a 48-patient service development project. Women used the system for an average of 13.1 weeks. In all, 19 686 BG measures were transmitted, 98.6% of which had a meal tag. A total of 466 text messages were transmitted. A mean of 30 BG readings per woman per week were transmitted, and 85% of women submitted the minimum requirement of 18 readings per week. We have developed a novel, real-time, smartphone-based BG monitoring management system that allows clinician review of real-time patient-annotated BG results. Results indicate high usage and excellent compliance by women. Robust clinical, economic, and satisfaction evaluations are required. To address these requirements, we are currently conducting a randomized controlled pilot trial. PMID:25004915

Mackillop, Lucy; Loerup, Lise; Bartlett, Katy; Farmer, Andrew; Gibson, Oliver J; Hirst, Jane E; Kenworthy, Yvonne; Kevat, Dev A; Levy, Jonathan C; Tarassenko, Lionel

2014-11-01

228

Diet and Carbohydrate Food Knowledge of Multi-Ethnic Women: A Comparative Analysis of Pregnant Women with and without Gestational Diabetes Mellitus  

PubMed Central

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. PMID:24069200

Ali, Habiba I.; Jarrar, Amjad H.; El Sadig, Mohamed; B. Yeatts, Karin

2013-01-01

229

Dietary fat and gestational hyperglycaemia  

Microsoft Academic Search

.\\u000a Aims\\/hypothesis:   The purpose of this study was to investigate the relation between life-style habits and glucose abnormalities in Caucasian\\u000a women with and without conventional risk factors for gestational diabetes. \\u000a \\u000a \\u000a \\u000a Methods:   A total of 126 pregnant women with gestational diabetes, 84 with impaired glucose tolerance and 294 with normal glucose tolerance,\\u000a identified by sequential screening, were interviewed to determine their

S. Bo; G. Menato; A. Lezo; A. Signorile; C. Bardelli; F. De Michieli; M. Massobrio; G. Pagano

2001-01-01

230

Hemoglobin A1c for Diagnosis of Postpartum Abnormal Glucose Tolerance among Women with Gestational Diabetes Mellitus: Diagnostic Meta-Analysis  

PubMed Central

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. PMID:25014072

Qu, Xinye; Tian, Yaqiang; Zhang, Guangzhen

2014-01-01

231

Maternal Circulating Concentrations of Tumor Necrosis Factor-Alpha, Leptin, and Adiponectin in Gestational Diabetes Mellitus: A Systematic Review and Meta-Analysis  

PubMed Central

Gestational diabetes mellitus (GDM) is one of the most common pregnancy complications. Inflammation may play a role in the pathogenesis of GDM. We performed a systematic review and meta-analysis to determine whether maternal serum concentration of tumor necrosis factor-alpha (TNF-?), leptin, and adiponectin were associated with GDM. A systematic search of PubMed and Medline was undertaken. In total, 27 trials were evaluated by meta-analyses using the software Review Manager 5.0. The results showed that maternal TNF-? (P = 0.0003) and leptin (P < 0.00001) concentrations were significantly higher in GDM patients versus controls. However, maternal adiponectin (P < 0.00001) concentration was significantly lower in GDM patients compared with controls. Subgroup analysis taking in consideration the effect of obesity on maternal adipokine levels showed that circulating levels of TNF-? and leptin remained elevated in GDM patients compared to their body mass index (BMI) matched controls, and adiponectin level remained depressed in GDM individuals. Our findings strengthen the clinical evidence that GDM is accompanied by exaggerated inflammatory responses.

Xu, Jie; Zhao, Yan Hong; Chen, Yun Ping; Yuan, Xiao Lei; Wang, Jiao; Zhu, Hui; Lu, Chun Mei

2014-01-01

232

Low glycaemic index diets improve glucose tolerance and body weight in women with previous history of gestational diabetes: a six months randomized trial  

PubMed Central

Background Gestational Diabetes Mellitus (GDM) increases risks for type 2 diabetes and weight management is recommended to reduce the risk. Conventional dietary recommendations (energy-restricted, low fat) have limited success in women with previous GDM. The effect of lowering Glycaemic Index (GI) in managing glycaemic variables and body weight in women post-GDM is unknown. Objective To evaluate the effects of conventional dietary recommendations administered with and without additional low-GI education, in the management of glucose tolerance and body weight in Asian women with previous GDM. Method Seventy seven Asian, non-diabetic women with previous GDM, between 20- 40y were randomised into Conventional healthy dietary recommendation (CHDR) and low GI (LGI) groups. CHDR received conventional dietary recommendations only (energy restricted, low in fat and refined sugars, high-fibre). LGI group received advice on lowering GI in addition. Fasting and 2-h post-load blood glucose after 75 g oral glucose tolerance test (2HPP) were measured at baseline and 6 months after intervention. Anthropometry and dietary intake were assessed at baseline, three and six months after intervention. The study is registered at the Malaysian National Medical Research Register (NMRR) with Research ID: 5183. Results After 6 months, significant reductions in body weight, BMI and waist-to-hip ratio were observed only in LGI group (P<0.05). Mean BMI changes were significantly different between groups (LGI vs. CHDR: -0.6 vs. 0 kg/m2, P= 0.03). More subjects achieved weight loss ?5% in LGI compared to CHDR group (33% vs. 8%, P=0.01). Changes in 2HPP were significantly different between groups (LGI vs. CHDR: median (IQR): -0.2(2.8) vs. +0.8 (2.0) mmol/L, P=0.025). Subjects with baseline fasting insulin?2 ?IU/ml had greater 2HPP reductions in LGI group compared to those in the CHDR group (?1.9±0.42 vs. +1.31±1.4 mmol/L, P<0.001). After 6 months, LGI group diets showed significantly lower GI (57±5 vs. 64±6, P<0.001), GL (122±33 vs. 142±35, P=0.04) and higher fibre content (17±4 vs.13±4 g, P<0.001). Caloric intakes were comparable between groups. Conclusion In women post-GDM, lowering GI of healthy diets resulted in significant improvements in glucose tolerance and body weight reduction as compared to conventional low-fat diets with similar energy prescription. PMID:23705645

2013-01-01

233

No consensus on gestational diabetes mellitus screening regimes in Sweden: pregnancy outcomes in relation to different screening regimes 2011 to 2012, a cross-sectional study  

PubMed Central

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. PMID:24884711

2014-01-01

234

Gestational Diabetes Mellitus Worsens the Profile of Cardiometabolic Risk Markers and Decrease Indexes of Beta-Cell Function Independently of Insulin Resistance in Nondiabetic Women with a Parental History of Type 2 Diabetes  

PubMed Central

Background. Women with a history of both parental type 2 diabetes (pt2DM) and previous gestational diabetes (pGDM) represent a group at high risk of cardiovascular events. We hypothesized that pGDM changes cardiometabolic risk markers levels as well as theirs associations with glucose indices in nondiabetic pt2DM women. Methods. Anthropometric parameters, glucose regulation (OGTT), insulin resistance (HOMA-IR), beta-cell function, lipid levels, parameters of endothelial dysfunction, and inflammation were evaluated in 55 women with pt2DM, 40 with both pt2DM and pGDM 2–24 months postpartum, and 35 controls. Results. Prediabetes was diagnosed more frequently in women with both pt2DM and pGDM in comparison with women with only pt2DM (10 versus 8, P = 0.04). The pGDM group had higher LDL-cholesterol, sICAM-1, tPa Ag, fibrinogen, and lower beta-cell function after adjustment for HOMA-IR, in comparison with pt2DM group. In pt2DM group postchallenge glucose correlated independently with hsCRP and in pGDM group fasting glucose with HOMA-IR. Conclusions. pGDM exerts a combined effect on cardiometabolic risk markers in women with pt2DM. In these women higher LDL-cholesterol, fibrinogen, sICAM-1, tPa Ag levels and decreased beta cell function are associated with pGDM independently of HOMA-IR index value. Fasting glucose is an important cardiometabolic risk marker and is independently associated with HOMA-IR. PMID:25097861

Sokup, Alina; Ruszkowska-Ciastek, Barbara; Walentowicz-Sadlecka, Malgorzata; Grabiec, Marek; Rosc, Danuta

2014-01-01

235

Streptozotocin-induced diabetes models: pathophysiological mechanisms and fetal outcomes.  

PubMed

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. PMID:24977161

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

2014-01-01

236

Favourable effects of the Dietary Approaches to Stop Hypertension diet on glucose tolerance and lipid profiles in gestational diabetes: a randomised clinical trial.  

PubMed

Although gestational diabetes mellitus (GDM) is associated with an increased risk of maternal and neonatal morbidity, there is no consensus as to the optimal approach of nutritional management in these patients. The present study was designed to assess the effect of the Dietary Approaches to Stop Hypertension (DASH) eating plan on glucose tolerance and lipid profiles of pregnant women with GDM. The present randomised controlled clinical trial was performed among thirty-four women diagnosed with GDM at 24-28 weeks of gestation. Subjects were randomly assigned to consume either the control diet (n 17) or the DASH eating pattern (n 17) for 4 weeks. The control diet was designed to contain 45-55% carbohydrates, 15-20% protein and 25-30% total fat. The macronutrient composition of the DASH diet was similar to the control diet; however, the DASH diet was rich in fruits, vegetables, whole grains and low-fat dairy products, and contained lower amounts of saturated fats, cholesterol and refined grains with a total of 2400 mg Na/d. Fasting blood samples were taken at baseline and after 4 weeks of intervention to measure fasting plasma glucose, glycated Hb (HbA1c) and lipid profiles. Participants underwent a 3 h oral glucose tolerance tests and blood samples were collected at 60, 120 and 180 min to measure plasma glucose levels. Adherence to the DASH eating pattern, compared with the control diet, resulted in improved glucose tolerance such that plasma glucose levels reduced at 60 (21·86 v. 20·45 mmol/l, Pgroup = 0·02), 120 (22·3 v. 0·2 mmol/l, Pgroup = 0·001) and 180 min (21·7 v. 0·22 mmol/l, Pgroup = 0·002) after the glucose load. Decreased HbA1c levels (20·2 v. 0·05 %, Pgroup = 0·001) was also seen in the DASH group compared with the control group. Mean changes for serum total (20·42 v. 0·31 mmol/l, Pgroup = 0·01) and LDL-cholesterol (20·47 v. 0·22 mmol/l, Pgroup = 0·005), TAG (20·17 v. 0·34 mmol/l, Pgroup = 0·01) and total:HDL-cholesterol ratio (20·6 (SD 0·9) v. 0·3 (SD 0·8), Pgroup = 0·008) were significantly different between the two diets. Additionally, consumption of the DASH diet favourably influenced systolic blood pressure (22·6 v. 1·7 mmHg, Pgroup = 0·001). Mean changes of fasting plasma glucose (20·29 v. 0·15 mmol/l, Pgroup = 0·09) were nonsignificant comparing the DASH diet with the control diet. In conclusion, consumption of the DASH eating pattern for 4 weeks among pregnant women with GDM resulted in beneficial effects on glucose tolerance and lipid profiles compared with the control diet. PMID:23148885

Asemi, Zatollah; Tabassi, Zohreh; Samimi, Mansooreh; Fahiminejad, Taherh; Esmaillzadeh, Ahmad

2013-06-01

237

Effect of maternal obesity with and without gestational diabetes on offspring subcutaneous and preperitoneal adipose tissue development from birth up to year-1  

PubMed Central

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 PMID:24720885

2014-01-01

238

How to Treat Gestational Diabetes  

MedlinePLUS

... Health Treatment & Care Blood Glucose Testing Medication Doctors, Nurses & More Oral Health & Hygiene Women A1C Insulin Pregnancy ... less You will need help from your doctor, nurse educator, and other members of your health care ...

239

Obstetric management in gestational diabetes.  

PubMed

Reviewing the areas of controversy related to the obstetric management of women with GDM, we are unfortunately unable to provide significant refinement of the recommendations agreed upon after the Fourth International Workshop-Conference due to the lack of properly controlled and powered clinical studies in this area since 1997. In the area of the need for antenatal fetal surveillance in women with milder degrees of GDM, we may be able to draw indirect conclusions from ongoing cohort studies that will include large numbers of women. In the area of optimal timing and mode of delivery to avoid fetal injury, large well-controlled prospective studies do not currently exist and are urgently needed. In addition, refinement of fetal and pelvic imaging techniques to more accurately identify the maternal-fetal pairs most likely to benefit from avoiding vaginal delivery, and the more widespread availability of these technologies, may also prove to be of benefit in the obstetric management of women with GDM. PMID:17596468

Conway, Deborah L

2007-07-01

240

Tolerability and efficacy of exenatide and titrated insulin glargine in adult patients with type 2 diabetes previously uncontrolled with metformin or a sulfonylurea: A multinational, randomized, open-label, two-period, crossover noninferiority trial  

Microsoft Academic Search

Objective: This study was conducted to compare the efficacy and safety profiles of exenatide and insulin glargine therapy in patients with type 2 diabetes who had not achieved glucose control with metformin or sulfonylurea monotherapy.Methods: This multinational, randomized, open-label, crossover noninferiority study compared the efficacy of exenatide 10 pg BID and insulin glargine QD (titrated targeting a fasting serum glucose

Anthony H. Barnett; Jude Burger; Don Johns; Robert Brodows; David M. Kendall; Anthony Roberts; Michael E. Trautmann

2007-01-01

241

Face recognition for uncontrolled environments  

NASA Astrophysics Data System (ADS)

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

2010-04-01

242

Take Charge of Your Diabetes (Nerve Damage)  

MedlinePLUS

... 2 Diabetes in the United States CDC Study Gestational Diabetes Diabetes in the United States Heart Disease and ... Must Not Be Shared Lifetime Risk for Diabetes Mellitus in the United States Screening for Type 2 ...

243

Effects of Diabetes on a Male  

MedlinePLUS

... 2 Diabetes in the United States CDC Study Gestational Diabetes Diabetes in the United States Heart Disease and ... Must Not Be Shared Lifetime Risk for Diabetes Mellitus in the United States Screening for Type 2 ...

244

IHS Introduction to Type 2 Diabetes. A Guide for Health Care Providers (Revised).  

National Technical Information Service (NTIS)

Contents: What is Type 2 Diabetes; The Cycle of Type 2 Diabetes; Type 1 vs. Type 2 Diabetes; Risk Factors for Type 2 Diabetes in American Indians; Diagnosing Diabetes; Diagnostic Criteria for Diabetes Mellitus, Impaired Glucose Metabolism, and Gestational...

1998-01-01

245

Diabetes Report Card 2012: National and State Profile of Diabetes and Its Complications  

MedlinePLUS

... 2 Diabetes in the United States CDC Study Gestational Diabetes Diabetes in the United States Heart Disease and ... Must Not Be Shared Lifetime Risk for Diabetes Mellitus in the United States Screening for Type 2 ...

246

Pilot preference and procedures at uncontrolled airports  

NASA Technical Reports Server (NTRS)

The report presents the results of a pilot questionnaire utilized at the 1974 Reading, Pennsylvania Air Show to obtain data on pilot procedures and preference in the terminal airspace of uncontrolled airports.

Parker, L. C.

1975-01-01

247

Effects of dietary counselling on food habits and dietary intake of Finnish pregnant women at increased risk for gestational diabetes - a secondary analysis of a cluster-randomized controlled trial.  

PubMed

The incidence of gestational diabetes mellitus (GDM) is increasing and GDM might be prevented by improving diet. Few interventions have assessed the effects of dietary counselling on dietary intake of pregnant women. This study examined the effects of dietary counselling on food habits and dietary intake of Finnish pregnant women as secondary outcomes of a trial primarily aiming at preventing GDM. A cluster-randomized controlled trial was conducted in 14 municipalities in Finland, including 399 pregnant women at increased risk for developing GDM. The intervention consisted of dietary counselling focusing on dietary fat, fibre and saccharose intake at four routine maternity clinic visits. Usual counselling practices were continued in the usual care municipalities. A validated 181-item food frequency questionnaire was used to assess changes in diet from baseline to 26-28 and 36-37 weeks gestation. The data were analysed using multilevel mixed-effects linear regression models. By 36-37 weeks gestation, the intervention had beneficial effects on total intake of vegetables, fruits and berries (coefficient for between-group difference in change 61.6 g day(-1), 95% confidence interval 25.7-97.6), the proportions of high-fibre bread of all bread (7.2% units, 2.5-11.9), low-fat cheeses of all cheeses (10.7% units, 2.6-18.9) and vegetable fats of all dietary fats (6.1% -units, 2.0-10.3), and the intake of saturated fatty acids (-0.67 energy-%-units, -1.16 to -0.19), polyunsaturated fatty acids (0.38 energy-%-units, 0.18-0.58), linoleic acid (764 mg day(-1), 173-1354) and fibre (2.07 g day(-1) , 0.39-3.75). The intervention improved diet towards the recommendations in pregnant women at increased risk for GDM suggesting the counselling methods could be implemented in maternity care. PMID:22735030

Kinnunen, Tarja I; Puhkala, Jatta; Raitanen, Jani; Ahonen, Suvi; Aittasalo, Minna; Virtanen, Suvi M; Luoto, Riitta

2014-04-01

248

Diabetes in pregnancy  

Microsoft Academic Search

Diabetes is the most common medical condition to complicate pregnancy and includes pregestational type 1 and type 2 diabetes and gestational diabetes, defined as glucose intolerance first diagnosed during pregnancy. Risks for the fetus include malformation, spontaneous abortion, stillbirth, neonatal death, macrosomia and intrauterine growth retardation. Risks for the mother include severe hypoglycaemia, diabetic ketoacidosis, progression of eye or renal

Rosemary Temple

2006-01-01

249

Diabetes  

NSDL National Science Digital Library

Diabetes, in a variety of forms, affects many Americans and is the 4th leading cause of death by disease in the US. Diabetes is fundamentally a disease in which the body cannot produce or effectively use a critical hormone called insulin. Untreated / unmanaged diabetes can lead to blindness, kidney failure, heart disease, loss of limbs and stroke.

Dr. Leslie Nader (MSMR)

1993-04-14

250

Gestational Hypertension and Preeclampsia  

MedlinePLUS

... to your dashboard . Gestational hypertension and preeclampsia 4:17 Gestational hypertension is high blood pressure that develops ... Show with 1:02 Teen2Teen: Truth and 10:17 How your baby grows: 1:27 Executive Engagement ...

251

Diabetes and Flu: What You Need to Know and Do  

MedlinePLUS

... 2 Diabetes in the United States CDC Study Gestational Diabetes Diabetes in the United States Heart Disease and ... Must Not Be Shared Lifetime Risk for Diabetes Mellitus in the United States Screening for Type 2 ...

252

Gestational age in twins  

Microsoft Academic Search

Dubowitz et al. have offered a scoring system for estimating the gestational age of newborn babies. If the system is applied to twin pairs, the heavier twin is generally estimated to have a greater gestational age than the lighter one. Previously this has been interpreted as a flaw in the scoring system. However, it may well be that in some

W H James

1980-01-01

253

DIABETES  

PubMed Central

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. PMID:24393784

Urano, Fumihiko

2014-01-01

254

Metabolic effects of two years of exenatide treatment on diabetes, obesity, and hepatic biomarkers in patients with type 2 diabetes: An interim analysis of data from the open-label, uncontrolled extension of three double-blind, placebo-controlled trials  

Microsoft Academic Search

Background:Exenatide, an incretin mimetic for adjunctive treatment of type 2 diabetes mellitus (T2DM), reduced glycosylated hemoglobin (HbA1c) and weight in 30-week placebo-controlled trials. Some patients were followed up in open-label extensions to provide ‘real-world’ exenatide clinical experience.

John B. Buse; David C. Klonoff; Loretta L. Nielsen; Xuesong Guan; Christopher L. Bowlus; John H. Holcombe; David G. Maggs; Matthew E. Wintle

2007-01-01

255

Pre-Diabetes  

MedlinePLUS

... good" cholesterol) High triglycerides High blood pressure A history of gestational diabetes Being African-American, American Indian, Asian-American, Pacific Islander or Hispanic American/Latino If ...

256

Meal Planning for People with Diabetes, 2nd Edition = Planificacion de Comidas para Personas con Diabetes, 2 Edicion.  

ERIC Educational Resources Information Center

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.

257

Did You Have Gestional Diabetes When You Were Pregnant? What You Need to Know  

MedlinePLUS

... Corro riesgo? You are here: NDEP Home > Publications Did You Have Gestational Diabetes When You Were Pregnant? ... these languages: Spanish Last reviewed: 04/01/2014 Did You Have Gestational Diabetes When You Were Pregnant? ...

258

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  

PubMed Central

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). PMID:24176797

Foghsgaard, Signe; Vedtofte, Louise; Mathiesen, Elisabeth R; Svare, Jens A; Gluud, Lise L; Holst, Jens J; Damm, Peter; Knop, Filip K; Vilsb?ll, Tina

2013-01-01

259

Differential expression of microRNAs in omental adipose tissue from gestational diabetes mellitus subjects reveals miR-222 as a regulator of ER? expression in estrogen-induced insulin resistance.  

PubMed

Omental adipose tissue plays a central role in insulin resistance in gestational diabetes mellitus (GDM), and the molecular mechanisms leading to GDM remains vague. Evidence demonstrates that maternal hormones, such as estradiol, contribute to insulin resistance in GDM. In this study we determined the differential expression patterns of microRNAs (miRNAs) in omental adipose tissues from GDM patients and pregnant women with normal glucose tolerance using AFFX miRNA expression chips. MiR-222, 1 of 17 identified differentially expressed miRNAs, was found to be significantly up-regulated in GDM by quantitative real-time PCR (P < .01), and its expression was closely related with serum estradiol level (P < .05). Furthermore, miR-222 expression was significantly increased in 3T3-L1 adipocytes with a high concentration of 17?-estradiol stimulation (P < .01), whereas the expressions of estrogen receptor (ER)-? protein and insulin-sensitive membrane transporter glucose transporter 4 (GLUT4) protein (P < .01) were markedly reduced. In addition, ER? was shown to be a direct target of miR-222 in 3T3-L1 adipocytes by using the luciferase assay. Finally, antisense oligonucleotides of miR-222 transfection was used to silence miR-222 in 3T3-L1 adipocytes. The results showed that the expressions of ER? and GLUT4, the insulin-stimulated translocation of GLUT4 from the cytoplasm to the cell membrane and glucose uptake in mature adipocytes were dramatically increased (P < .01). In conclusion, miR-222 is a potential regulator of ER? expression in estrogen-induced insulin resistance in GDM and might be a candidate biomarker and therapeutic target for GDM. PMID:24601884

Shi, Zhonghua; Zhao, Chun; Guo, Xirong; Ding, Hongjuan; Cui, Yugui; Shen, Rong; Liu, Jiayin

2014-05-01

260

Juvenile diabetes mellitus in Ethiopians.  

PubMed

The clinical features seen in 27 Ethiopian juvenile diabetics, which were similar to those of juvenile diabetics elsewhere, are summarized in this first published report from an African country of childhood diabetes. Control was difficult and admission to hospital frequent because of poverty, uncontrolled diets and irregular supplies of insulin. This group of childhood diabetics represents 9.8% of patients attending a diabetic clinic in Addis Ababa. Survey of the published information on diabetes mellitus in African populations reveals that most series do contain several children and a significant number of teenagers. It is concluded that juvenile diabetes mellitus is not rare in African countries. PMID:395728

Lester, F T

1979-01-01

261

Gestational age in twins.  

PubMed

Dubowitz et al. have offered a scoring system for estimating the gestational age of newborn babies. If the system is applied to twin pairs, the heavier twin is generally estimated to have a greater gestational age than the lighter one. Previously this has been interpreted as a flaw in the scoring system. However, it may well be that in some twin pairs the gestational ages are slightly different and that therefore, the heavier twin would be expected to have a greater gestational age. Such cases would arise through superfecundation (the formation of two zygotes from different coitions). Superfecundation can be proved only in rare case (those with two fathers). It can be argued that the rarity of such cases is accounted for by the rarity with which women expose themselves to the risk of bearing such twins (and by the improbability of detection), rather than by the rarity of superfecundation. It is inferred that superfecundation by the same man is relatively common and that therefore dizygotic twins quite often have different gestational ages. The scoring system of Dubowitz can be tested for bias by submitting monozygotic pairs to it: the association between weight and estimated gestational age should be absent in such pairs. If the system proves free of such bias, then a finding first reported here will assume some interest: it is that in opposite-sexed twin pairs, the male is significantly more often assessed as having the greater gestational age. It is suggested that this finding should be provisionally accepted as evidence for the hyopthesis that male zygotes are formed earlier than females. PMID:7191240

James, W H

1980-04-01

262

Gestational age in twins.  

PubMed Central

Dubowitz et al. have offered a scoring system for estimating the gestational age of newborn babies. If the system is applied to twin pairs, the heavier twin is generally estimated to have a greater gestational age than the lighter one. Previously this has been interpreted as a flaw in the scoring system. However, it may well be that in some twin pairs the gestational ages are slightly different and that therefore, the heavier twin would be expected to have a greater gestational age. Such cases would arise through superfecundation (the formation of two zygotes from different coitions). Superfecundation can be proved only in rare case (those with two fathers). It can be argued that the rarity of such cases is accounted for by the rarity with which women expose themselves to the risk of bearing such twins (and by the improbability of detection), rather than by the rarity of superfecundation. It is inferred that superfecundation by the same man is relatively common and that therefore dizygotic twins quite often have different gestational ages. The scoring system of Dubowitz can be tested for bias by submitting monozygotic pairs to it: the association between weight and estimated gestational age should be absent in such pairs. If the system proves free of such bias, then a finding first reported here will assume some interest: it is that in opposite-sexed twin pairs, the male is significantly more often assessed as having the greater gestational age. It is suggested that this finding should be provisionally accepted as evidence for the hyopthesis that male zygotes are formed earlier than females. PMID:7191240

James, W H

1980-01-01

263

Gestational Diabetes: A Guide for Pregnant Women  

MedlinePLUS

... Practice Center. The review was updated in the journal Obstetrics & Gynecology in 2009. The Agency for Healthcare Research and Quality (AHRQ) created the Eisenberg Center at Oregon Health & Science University to make research helpful for consumers. This guide was written by Erin Davis, B. ...

264

A life-course perspective on U.S. migration experience and later-life diabetes, hypertension, and depression for middle-aged and older Mexican adults  

E-print Network

blood sugar as a result of uncontrolled diabetes can lead tothat you have diabetes or a high blood sugar level? ” and “sugar, and fat, which may contribute to increase risk for hypertension and diabetes (

Torres, Jacqueline Marie

2014-01-01

265

Controlled and uncontrolled asthma display distinct alveolar tissue matrix compositions  

PubMed Central

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. PMID:24950767

2014-01-01

266

Predicting pilot intent and aircraft trajectory in uncontrolled airspace  

E-print Network

The ability to predict the likely trajectory is a key element of safely integrating Unmanned Aerial Systems (UAS) in the National Airspace System (NAS). A particularly challenging environment is in the vicinity of uncontrolled ...

Lowe, Christopher D., S.M. (Christopher David). Massachusetts Institute of Technology

2014-01-01

267

COSTS OF REMEDIAL RESPONSE ACTIONS AT UNCONTROLLED HAZARDOUS WASTE SITES  

EPA Science Inventory

The primary purpose of this study was to update conceptual design cost estimates for remedial action unit operations portrayed in earlier reports. Thirty-five remedial action unit operations conceptual designs, addressing uncontrolled landfill or impoundment disposal sites, were ...

268

LEVEL 1 ASSESSMENT OF UNCONTROLLED SINTER PLANT EMISSIONS  

EPA Science Inventory

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...

269

BARRIER ANALYSIS WORKSHEET HAZARD: What uncontrolled energy caused  

E-print Network

BARRIER ANALYSIS WORKSHEET HAZARD: What uncontrolled energy caused (or had the potential to cause are determined generally in Step 4 and 5 #12;BARRIER ANALYSIS WORKSHEET HAZARD: TARGET: What Was The Barrier (or

270

77 FR 64347 - Notice of Diabetes Mellitus Interagency Coordinating Committee Meeting  

Federal Register 2010, 2011, 2012, 2013

...communication, and collaboration on diabetes among government entities. DMICC...and discuss current and future diabetes programs in DMICC member organizations...Federal Initiatives To Address Gestational Diabetes Mellitus.'' Any member...

2012-10-19

271

Health experiences of adolescents with uncontrolled severe asthma  

Microsoft Academic Search

Background and aimsMany adolescents with asthma experience continued symptoms and impaired quality of life despite modern therapy. This study sought to understand their experience and to use this understanding to improve their clinical management.Design and subjectsQualitative study based on in-depth semi-structured interviews conducted with adolescents with uncontrolled severe asthma.Results22 adolescents (11–18 years) with uncontrolled severe asthma were interviewed. Two of

Kate Edgecombe; Sue Latter; Sheila Peters; Graham Roberts

2010-01-01

272

Intrafetal glucose infusion alters glucocorticoid signaling and reduces surfactant protein mRNA expression in the lung of the late-gestation sheep fetus.  

PubMed

Increased circulating fetal glucose and insulin concentrations are potential inhibitors of fetal lung maturation and may contribute to the pathogenesis of respiratory distress syndrome (RDS) in infants of diabetic mothers. In this study, we examined the effect of intrafetal glucose infusion on mRNA expression of glucose transporters, insulin-like growth factor signaling, glucocorticoid regulatory genes, and surfactant proteins in the lung of the late-gestation sheep fetus. The numerical density of the cells responsible for producing surfactant was determined using immunohistochemistry. Glucose infusion for 10 days did not affect mRNA expression of glucose transporters or IGFs but did decrease IGF-1R expression. There was reduced mRNA expression of the glucocorticoid-converting enzyme HSD11B-1 and the glucocorticoid receptor, potentially reducing glucocorticoid responsiveness in the fetal lung. Furthermore, surfactant protein (SFTP) mRNA expression was reduced in the lung following glucose infusion, while the number of SFTP-B-positive cells remained unchanged. These findings suggest the presence of a glucocorticoid-mediated mechanism regulating delayed maturation of the surfactant system in the sheep fetus following glucose infusion and provide evidence for the link between abnormal glycemic control during pregnancy and the increased risk of RDS in infants of uncontrolled diabetic mothers. PMID:24990855

McGillick, Erin V; Morrison, Janna L; McMillen, I Caroline; Orgeig, Sandra

2014-09-01

273

Programming of Adult Cardiovascular Disease following Exposure to Late-Gestation Hyperglycemia  

Microsoft Academic Search

Background: In utero exposure to hyperglycemia is becoming increasingly prevalent as the number of women entering pregnancy with type II diabetes, or developing gestational diabetes, increases. Both animal studies and epidemiologic investigations have found cardiovascular abnormalities in adult offspring of hyperglycemic mothers (OHM). Objective: We hypothesized that adult OHM would have abnormal cardiac function in vivo and increased susceptibility to

Melissa Agoudemos; Benjamin E. Reinking; Stacia L. Koppenhafer; Jeffrey L. Segar; Thomas D. Scholz

2011-01-01

274

Births Rate of Maternal Diabetes 1  

E-print Network

System (APORS) with one or more birth defects are significantly more likely to have diabetic mothers than other Illinois newborns (p diabetes.] The birth certificate also contains a field that indicates whether the mother had diabetes during pregnancy, but does not distinguish between gestational vs. pre-existing diabetes. Table 1. The rate (per 10,000 live births) of maternal diabetes among different populations of Illinois children, 1994-1998

unknown authors

275

Acute chorea-dystonia heralding diabetes mellitus.  

PubMed

Hemichorea-hemiballism associated with non-ketotic hyperglycaemia is a rare dyskinetic syndrome during uncontrolled or undiagnosed diabetes. We reported a 41-year-old man suffering from sudden choreodystonic movements and undiagnosed hyperglycaemia. We described a combination of several rare aspects, emphasising the importance of screening for diabetes as a cause of acute onset of hyperkinetic movement disorders. PMID:24000205

D'Angelo, Roberto; Rinaldi, Rita; Pinardi, Federica; Guarino, Maria

2013-01-01

276

Maternal Glycemia and Risk of Large-for-Gestational-Age Babies in a Population-Based Screening  

Microsoft Academic Search

OBJECTIVE — Gestational diabetes is a risk factor for large-for-gestational-age (LGA) new- borns, but many LGA babies are born to mothers with normal glucose tolerance. We aimed to clarify the association of maternal glycemia across the whole distribution with birth weight and risk of LGA births in mothers with normal glucose tolerance. RESEARCH DESIGN AND METHODS — We undertook a

ZSUZSA KERENYI; G. Tamas; M. Kivimaki; ANDREA PETERFALVI; E. Madarasz; ZSOLT BOSNYAK; A. G. Tabak

2009-01-01

277

Diabetes A Growing Epidemic Michael McKee, MD, MPH  

E-print Network

Gestational Diabetes #12;Prediabetes Glucose (sugar) is higher than normal but not high enough to diagnoseDiabetes ­ A Growing Epidemic Michael McKee, MD, MPH March 28, 2013 #12;Goals Diabetes Introduction Types of Diabetes Testing Prevention Treatments #12;In Memory of Benno Houver Bernd "Benno" Houver (1973

Goldman, Steven A.

278

Rational action and uncontrolled violence: Explaining Hindu communalism  

Microsoft Academic Search

The assertion of Hindu identity in contemporary India takes two characteristic forms: organized movements notable for their effective action; and uncontrolled mob violence. Understanding this apparent paradox entails both general religio-historical explanation and culturally specific interpretation. From a general perspective, organized movements and mob violence each offers a means of identifying with the same religious object—in this case, the Hindu

Daniel Gold

1991-01-01

279

APPROACHES FOR REMEDIATION OF UNCONTROLLED WOOD PRESERVING SITES  

EPA Science Inventory

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...

280

MODELING REMEDIAL ACTIONS AT UNCONTROLLED HAZARDOUS WASTE SITES  

EPA Science Inventory

The document provides guidance on the selection and use of models for the purpose of evaluating the effectiveness of remedial actions at uncontrolled hazardous waste sites. It consists of four sections, each covering a specific facet on modeling remedial actions, including select...

281

LEVEL 1 ASSESSMENT OF UNCONTROLLED Q-BOP EMISSIONS  

EPA Science Inventory

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...

282

Sedation for Uncontrolled Symptoms in a South African Hospice  

Microsoft Academic Search

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

1998-01-01

283

Physical Activity and Risk of Small-for-Gestational-Age Birth Among Predominantly Puerto Rican Women  

Microsoft Academic Search

To estimate the association between multiple domains of physical activity and risk of small-for-gestational-age (SGA) birth.\\u000a We utilized data from 1,040 participants in the Latina Gestational Diabetes Mellitus Study, a prospective cohort of predominantly\\u000a Puerto Rican prenatal care patients in Massachusetts. Physical activity was assessed by bilingual interviewers using a modified\\u000a version of the Kaiser physical activity survey in early

Audra L. Gollenberg; Penelope Pekow; Elizabeth R. Bertone-Johnson; Patty S. Freedson; Glenn Markenson; Lisa Chasan-Taber

2011-01-01

284

Scope for prevention of diabetes--'focus intrauterine milieu interieur'.  

PubMed

The prevalence of diabetes is increasing globally and India is no exception. The lifestyle modification and drug intervention are likely to delay or postpone the development of overt diabetes in persons diagnosed to have impaired glucose tolerance. This is a post primary prevention strategy. The primary prevention is more important as this effort is likely to reverse or halt the epidemic of disease. Women with Gestational Diabetes Mellitus (GDM) are an ideal group for the primary prevention of diabetes as they are at increased risk of future diabetes, predominantly type 2 diabetes, as are their children. Pima Indians have the highest prevalence of diabetes. This is attributed to the children exposed in utero to maternal diabetes. Hence as a policy to identify GDM and its consequences on the infant, a 75 gm Oral Glucose Tolerance Test has been recommended to all Pima Indian women during the 3rd trimester of pregnancy. Ethnically Asian Indian women also have high prevalence of diabetes and the relative risk of developing Gestational Diabetes Mellitus in them is 11.3 times compared to White women. This necessitates universal screening for gestational diabetes during pregnancy in India. Probably the undiagnosed gestational diabetes that has been occurring in the past has resulted in the increased prevalence of diabetes in India. The timely action taken now in screening all pregnant women for glucose intolerance, achieving euglycemia in them and ensuring adequate nutrition may prevent in all possibility, India becoming the diabetes capital of the world. PMID:18472512

Seshiah, V; Balaji, V; Balaji, Madhuri S

2008-02-01

285

UNCONTROLLED SEIZURES AND BONE HEALTH AMONG ADULT EPILEPSY PATIENTS  

E-print Network

. Expert Opin Drug Saf 2010;9:561-71. 34. Mintzer S. Metabolic consequences of antiepileptic drugs. Curr Opin Neurol 2010;23:164-9. 35. Mintzer S, Boppana P, Toguri J, DeSantis A. Vitamin D levels and bone turnover in epilepsy patients taking... UNCONTROLLED SEIZURES AND BONE HEALTH AMONG ADULT EPILEPSY PATIENTS BY Mikiko Yamada, M.S., Nagasaki University Graduate School of Pharmaceutical Sciences, 2000 Pharm.D., University of Southern Nevada, 2009 Submitted...

Yamada, Mikiko

2013-12-31

286

A teenager with uncontrolled hypertension: a case report  

PubMed Central

Background Takayasu Arteritis is a vasculitis occurring mostly in young females which may present in diverse ways. Here we report a teenager with Takayasu Arteritis who presented with uncontrolled hypertension. This case depicts an atypical presentation of this disease where the girl visited many physicians for controlling the level of hypertension and put a diagnostic dilemma about the underlying etiology of young hypertension. Case presentation A 13 year old girl presented with epistaxis, persistent headache and uncontrolled hypertension. Her clinical examination revealed normal radial, very feeble femoral and absent other lower limb pulses. There was a blood pressure discrepancy of 50/40 mm of Hg between two arms. There were bruits over multiple areas including the abdominal aorta. She had features of left ventricular hypertrophy. Her Arch aortogram showed hugely dilated arch of aorta which became abruptly normal just after origin of left subclavian artery. There was ostio-proximal stenosis of right bracheocephalic artery, left common carotid and left subclavian artery with post stenotic dilatation of all the vessels. Abdominal aortogram revealed critical stenosis of abdominal aorta above the origin of renal arteries with a pressure gradient of 80/11 mm of Hg. Conclusion Takayasu’s Arteritis should also be kept in mind while searching for the cause of uncontrolled hypertension in the young age group. PMID:23194278

2012-01-01

287

Accuracy of Sonographic Chorionicity Classification in Twin Gestations  

PubMed Central

Objectives To evaluate the accuracy of sonographic classification of chorionicity in a large cohort of twins and investigate which factors may be associated with sonographic accuracy. Methods We conducted a secondary analysis of a randomized trial of preterm birth prevention in twins. Sonographic classification of chorionicity was compared with pathologic examination of the placenta. Maternal (age, body mass index, diabetes, and hypertension), obstetric (prior cesarean delivery, gestational age at the first sonographic examination, and antepartum bleeding), and sonographic (oligohydramnios, polyhydramnios, and twin-twin transfusion syndrome) factors were assessed for their possible association with accuracy. Results A total of 545 twin sets in which chorionicity was classified by sonography before 20 weeks’ gestation were included; 455 were dichorionic and 90 were monochorionic based on pathologic examination. Sonography misclassified 35 of 545 twin pregnancies (6.4%): 18 of 455 dichorionic twins (4.0%) and 17 of 90 monochorionic twins (19.0%). The sensitivity and specificity of sonographic diagnosis of monochorionicity were 81.1% and 96.0%, respectively. In a multivariable analysis, pregnancies with initial sonographic examinations before 14 weeks’ gestation were less likely to have misclassified chorionicity than those with sonographic examinations at 15 to 20 weeks (odds ratio [OR], 0.47; 95% confidence interval [CI], 0.23–0.96). For each week increase in gestational age, the odds of misclassification rose by 10% (OR, 1.10; 95% CI, 1.01–1.2). In the multivariable analysis, maternal age, body mass index, parity, and prior cesarean delivery were not associated with sonographic accuracy. Conclusions Sonography before 20 weeks incorrectly classified chorionicity in 6.4% of twin gestations. Those with first sonographic examinations performed at earlier gestational ages had improved chorionicity diagnosis. PMID:25425377

Blumenfeld, Yair J.; Momirova, Valerija; Rouse, Dwight J.; Caritis, Steve N.; Sciscione, Anthony; Peaceman, Alan M.; Reddy, Uma M.; Varner, Michael W.; Malone, Fergal D.; Iams, Jay D.; Mercer, Brian M.; Thorp, John M.; Sorokin, Yoram; Carpenter, Marshall W.; Lo, Julie; Ramin, Susan M.; Harper, Margaret

2014-01-01

288

Outcomes of Small for Gestational Age Infants < 27 Weeks' Gestation  

PubMed Central

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. PMID:23415614

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.

2014-01-01

289

with Diabetes With Diabetes  

E-print Network

with Diabetes Dining A Program For People With Diabetes And Their Families Now is the time to take charge of your diabetes. What is diabetes? Diabetes is a common, serious, and costly disease. The Centers for Disease Control and Prevention (CDC) has reported that diabetes is the 6th leading cause of death

290

Gestational lung adenocarcinoma: case report.  

PubMed

Gestational cancer is a dramatic situation, with a deep impact on the patient and family, with an overall incidence of 1 per 100 pregnancies. Lung cancers are extremely rare during pregnancy but have become more frequent in past years, as the mean age of pregnancy has increased. The purpose of this case report is to present a gestational lung adenocarcinoma, with metastasis in the liver and ovaries, diagnosed in the third trimester, with a fatal outcome in days after birth through cesarean section. PMID:24771256

Ceau?u, Mihai; Hostiuc, Sorin; Sajin, Maria; Roman, Gheorghe; Nicodin, Ovidiu; Dermengiu, Dan

2014-10-01

291

Small for Gestational Age (SGA)  

MedlinePLUS

... ContactUs@magicfoundation.org ) Join our Small for Gestational Age Facebook private group for parents with hundreds of families "LIKE" our MAGIC Facebook page to stay current on this topic LEGAL NOTE:The information in this article is copywritten ...

292

Robust Crop and Weed Segmentation under Uncontrolled Outdoor Illumination  

PubMed Central

An image processing algorithm for detecting individual weeds was developed and evaluated. Weed detection processes included were normalized excessive green conversion, statistical threshold value estimation, adaptive image segmentation, median filter, morphological feature calculation and Artificial Neural Network (ANN). The developed algorithm was validated for its ability to identify and detect weeds and crop plants under uncontrolled outdoor illuminations. A machine vision implementing field robot captured field images under outdoor illuminations and the image processing algorithm automatically processed them without manual adjustment. The errors of the algorithm, when processing 666 field images, ranged from 2.1 to 2.9%. The ANN correctly detected 72.6% of crop plants from the identified plants, and considered the rest as weeds. However, the ANN identification rates for crop plants were improved up to 95.1% by addressing the error sources in the algorithm. The developed weed detection and image processing algorithm provides a novel method to identify plants against soil background under the uncontrolled outdoor illuminations, and to differentiate weeds from crop plants. Thus, the proposed new machine vision and processing algorithm may be useful for outdoor applications including plant specific direct applications (PSDA). PMID:22163954

Jeon, Hong Y.; Tian, Lei F.; Zhu, Heping

2011-01-01

293

Diabetic foot ulcer due to scedosporium apiospermum.  

PubMed

We report a case of diabetic foot ulcer caused by Scedosporium apiospermum in a seventy year old male patient with uncontrolled diabetes. Scedosporium apiospermum, the asexual phase of Pseudallescheria boydii a fungus isolated from a variety of natural substrates throughout the world including soil, polluted water, sewage and manure of poultry and cattle. P.boydii is now recognized as a medically important opportunistic fungus. This case has been reported for its rarity. PMID:24392407

D, Vijaya; T, Nagaratnamma; Jv, Sathish

2013-11-01

294

Diabetic Foot Ulcer Due to Scedosporium Apiospermum  

PubMed Central

We report a case of diabetic foot ulcer caused by Scedosporium apiospermum in a seventy year old male patient with uncontrolled diabetes. Scedosporium apiospermum, the asexual phase of Pseudallescheria boydii a fungus isolated from a variety of natural substrates throughout the world including soil, polluted water, sewage and manure of poultry and cattle. P.boydii is now recognized as a medically important opportunistic fungus. This case has been reported for its rarity. PMID:24392407

D., Vijaya; T., Nagaratnamma; JV., Sathish

2013-01-01

295

Women and Diabetes -- Diabetes Medicines  

MedlinePLUS

Women and Diabetes - Diabetes Medicines Diabetes can make it hard to control how much sugar (called glucose) is in your blood. There is ... Warning Signs Diabetes Medicines Learn More about Diabetes Diabetes Tips Talk to your doctor before you change ...

296

Zinc concentrations during mice gestation.  

PubMed

Severe maternal zinc deficiency has a devastating effect on pregnancy outcome. Studies of humans and experimental animals show that maternal zinc deficiency can cause infertility, prolonged labor, intrauterine growth retardation, teratogenesis, severe immunological deficiencies, or fetal death. The additional need for zinc during pregnancy can be met by an increase in zinc intake. An increase in zinc supplements, when excessive, can cause a decrease in copper. Therefore, it is important to determine the zinc and copper concentrations in embryonic tissue in experimental models and their relationship with embryo number and viability. BALB/c mice were divided into groups according to zinc oral supplementation and gestational age. Phagocytosis was assessed in peritoneal macrophages from dams. The zinc and copper concentrations were obtained by inductively coupled plasma-optical emission spectrometry. Zn and Cu data concentrations in all the analyzed samples were above the detection limits. No spectral interferences were found in both elements. Zinc concentrations show a tendency to increase in embryos (14 gestational days and 21 gestational days) supplemented with zinc. Copper concentrations showed a noticeable tendency to diminish (36% and 27%, respectively) in the same period. In contrast, in placenta Zn values were increased by 30% and Cu values were decreased by 26%. We suggest a pivotal role of the placenta metabolism with its homeostatic mechanisms, in these findings. An important increment appeared in the +Zn embryo number (40%) relative to control (-Zn) embryos at 21 d gestational age. Embryo mortality was at 6% in +Zn embryos and at 20% in -Zn embryos. We consider these findings, both in the number and in the viability of +Zn embryos, outstanding. PMID:16034165

Lastra, Ma Dolores; Saldívar, Liliana; Martínez, Kristel; Munguía, Nadia; Márquez, Ciro; Aguilar, Ana Esther

2005-01-01

297

Design and methods for a randomized clinical trial of a diabetes self-management intervention for low-Income Latinos: Latinos en Control  

Microsoft Academic Search

BACKGROUND: US Latinos have greater prevalence of type 2 diabetes (diabetes), uncontrolled diabetes and diabetes co-morbidities compared to non-Latino Whites. They also have lower literacy levels and are more likely to live in poverty. Interventions are needed to improve diabetes control among low-income Latinos. METHODS AND DESIGN: This randomized clinical trial tested the efficacy of a culturally- and literacy-tailored diabetes

Milagros C. Rosal; Mary Jo White; Angela Restrepo; Barbara C. Olendzki; Jeffrey Scavron; Elise Sinagra; Ira S. Ockene; Michael Thompson; Stephenie C. Lemon; Lucy M. Candib; George W. Reed

2009-01-01

298

Increased accumulation of sorbitol in offspring of manifest diabetic rats.  

PubMed

The effects of maternal diabetes on somatic development and activity of the polyol pathway were investigated during early and late gestation in a rat model for diabetic pregnancy. We studied embryo-fetal growth, mortality, and malformation rate in the offspring of nondiabetic rats and in the offspring of diabetic rats either treated with an aldose reductase inhibitor during gestation or left untreated. The numbers of embryo-fetal resorptions and malformations were significantly increased in the diabetic groups compared with the controls despite maternal treatment with the aldose reductase inhibitor. The sorbitol content of embryos and membranes from the diabetic rats in early gestation was increased 3-5 times over the control values. Similarly, elevated sorbitol levels were observed in the fetal livers and placentas of the diabetic rats in late gestation. Administration of the aldose reductase inhibitor to the pregnant diabetic rats normalized the sorbitol levels in the embryos and their membranes, whereas the sorbitol contents of the fetal livers and placentas were significantly lowered but not completely corrected. Furthermore, in the diabetic groups, no differences in sorbitol levels could be demonstrated between malformed and nonmalformed offspring. The results of this study suggest that enhanced polyol metabolism leading to increased sorbitol accumulation is present in the embryos of diabetic mothers as early as organogenesis. This accumulation is apparently not a major factor in the early developmental disturbances (e.g., growth perturbations and congenital malformations) of diabetic pregnancy. PMID:3770312

Eriksson, U J; Naeser, P; Brolin, S E

1986-12-01

299

Diabetes mellitus and pregnancy  

PubMed Central

Diabetes mellitus is the most common medical complication of pregnancy and it carries a significant risk to the foetus and the mother. Congenital malformations and perinatal morbidity remain common compared with the offspring of non diabetic pregnancies. Diabetic mothers are at risk of progression of microvascular diabetic complications as well as early pregnancy loss, pre-eclampsia, polyhydramnios and premature labour. Glycaemic control before and during pregnancy is critical and the benefit may result in a viable, healthy off spring. Gestational diabetes mellitus (GDM) which manifests for the first time during pregnancy is common and on the increase, its proper management will reduce the risk of neonatal macrosomia and hypoglycaemia. Post-partum evaluation of glucose tolerance and appropriate counselling in women with GDM may help decrease the high risk of subsequent type 2 diabetes in the longterm. This article will briefly review the changes in the carbohydrate metabolism that characterise normal pregnancy and will focus on a practical approach to the care of patients with pre-existing diabetes as well as GDM. PMID:21526019

Abourawi, Fathi I

2006-01-01

300

Treatment of gestational trophoblastic disease.  

PubMed

Gestational trophoblastic disease (GTD) forms a spectrum of illness from the borderline malignancy of hydatidiform mole to the highly aggressive behaviour of choriocarcinoma. In the past, many women have died from this group of disorders. However, during the last 45 years highly effective chemotherapy regimens have been developed which can be appropriately tailored to the individual patient's risk of becoming resistant to the treatment. As a result, the management of GTD is one of the modern success stories in oncology. Today, with an integrated approach to management few women die from their trophoblastic tumours. PMID:9443572

Seckl, M J; Newlands, E S

1997-11-01

301

Attenuation of landfill leachate at two uncontrolled landfills  

NASA Astrophysics Data System (ADS)

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. Variations of various parameters including dissolved organic carbon (DOC), dissolved oxygen (DO), alkalinity, pH, electrical conductivity (EC), redox potential (ORP), ammonia (NH3), nitrate (NO{3/-}), sulfate (SO{4/2-}), and chloride (Cl-) were examined along groundwater flow path. All these parameters were analyzed every month for a year. In the interior of the landfills, typical anaerobic conditions revealed by low DO and NO3 concentrations, negative ORP values, high NH3, alkalinity, and Cl- concentrations were observed. Generally, higher levels of contaminants (DOC, NH3, and Cl-) were detected in the dry season while they were greatly lowered in the wet season. Significantly, large decrease of Cl- concentration in the wet season indicates that the dilution or mixing is one of dominant attenuation mechanisms of leachate. But detailed variation behaviors in the two landfills are different and they were largely dependent on permeability of surface and subsurface layers. The intermediately permeable surface of the landfills receives part of direct rainfall infiltration but most rainwater is lost to fast runoff. The practically impermeable surface of clayey silt (paddy field) at immediately adjacent to the Cheonan landfill boundary prevented direct rainwater infiltration and hence redox condition of the ground waters were largely affected by that of the upper landfill and the less permeable materials beneath the paddy fields prohibited dispersion of the landfill leachate into down gradient area. In the Wonju landfill, there are three different permeability divisions, the landfill region, the sandy open field and the paddy field. Roles of the landfill and paddy regions are very similar to those at the Cheonan. The very permeable sandy field receiving a large amount of rainwater infiltration plays a key role in controlling redox condition of the down gradient area and contaminant migration. This paper reports details of the attenuation and redox conditions of the landfill leachates at the two uncontrolled landfills.

Lee, Jin-Yong; Cheon, Jeong-Yong; Kwon, Hyung-Pyo; Yoon, Hee-Sung; Lee, Seong-Sun; Kim, Jong-Ho; Park, Joung-Ku; Kim, Chang-Gyun

2006-12-01

302

Diabetes Insipidus  

MedlinePLUS

... Z List of Topics and Titles : Diabetes Insipidus Diabetes Insipidus On this page: What is diabetes insipidus? ... Hope through Research For More Information What is diabetes insipidus? Diabetes insipidus (DI) is a rare disease ...

303

An obese young man with uncontrolled diabetes and insatiable hunger: Prader-Willi syndrome  

PubMed Central

Prader-Willi syndrome (PWS) is a rare cause of obesity. With the rising incidence of obesity, clinicians need to be aware of genetic causes of obesity and when to suspect them. A case of PWS, which was diagnosed in adulthood, has been discussed. This case is special because of lack of history of floppiness in infancy and predominance behavioral problems. PMID:24910837

Nair, Abilash; Kishore, Shyam; Gupta, Ranjan; Sharma, A.; Jyotsna, V. P.

2013-01-01

304

Biomechanical analysis of skull fractures after uncontrolled hanging release.  

PubMed

In forensic research, biomechanical analyses of falls are widely reported. However, no study on falls consecutive to uncontrolled hanging release, when a hanging body is cut down, has ever been published. In such cases, the presence of cranial trauma can raise interpretation issues, and there may be doubt as to whether the fall was an accident or a crime disguised as suicide. The problem remains as to whether or not a fall after a free hanging release can lead to a skull fracture. To address this question, numerical simulations, post-mortem human subject tests and parametric studies were performed. We first recreated the kinematics and velocity of this atypical fall with post-mortem human subject tests and multibody simulations. We then tested the influence of biological variability on fracture production using a finite element model of the head. Our results show that fall severity depends largely on the direction of the fall. The risk of fracture is highest in the occipital region and with a backward fall. Our study also highlights the frequent occurrence of lower limb trauma in a free hanging release. Most importantly, we show that a fracture is produced in only 3.4% of falls that occur in a 10-90 cm height range. The overall findings of this study provide tools for pathologists and magistrates to decide on the most likely scenario and to justify further forensic investigations if required. PMID:24314523

Thollon, Lionel; Llari, Maxime; André, Lucile; Adalian, Pascal; Leonetti, Georges; Piercecchi-Marti, Marie-Dominique

2013-12-10

305

Gestational choriocarcinoma of the cervix.  

PubMed

Choriocarcinoma is the most aggressive, malignant form of gestational trophoblastic disease and has varying incidence, increasing in patients older than 40 years. It usually develops after a malignant alteration in a molar pregnancy, but rarely after an abortion or normal or ectopic pregnancies. The most common localization is the uterus, but it can also be found rarely in the ovaries, fallopian tubes, vagina, vulva, cervix or pelvic region. A 38-year-old multiparous woman, with no complications in three previous labors and four miscarriages, presented to her gynecologist one year after the last miscarriage complaining of abnormal vaginal bleeding. Clinical examinations showed normal ultrasound and histopathology findings. Blood analysis demonstrated moderate anemia and low elevated serum b-human chorionic gonadotropin. Due to profuse hemorrhage and anemia after the curettage, the medical council decided that a total hysterectomy should be performed. Macroscopic examination of the post-operative material showed regular morphology of the uterus, fallopian tubes and ovaries. However, a whitish brown lesion with a maximum diameter of 22 mm was noted in a longitudinal section of the cervix. Using standard histopathology and immunohistochemical analysis, a cervical gestational choriocarcinoma was diagnosed. Knowledge of the characteristics of the choriocarcinoma is very important for accurate diagnosis and treatment, especially when the tumor is localized on the rare locations and where a high level of serum b-human chorionic gonadotropin is absent. PMID:25365622

Mitrovic, Slobodanka Lj; Arsenijevic, Petar S; Kljakic, Dusko; Djuric, Janko M; Milosavljevic, Milos Z; Protrka, Zoran M; Vojinovic, Radisa H

2014-11-01

306

Uncontrollable Stress, Coping, and Subjective Well-Being in Urban Adolescents  

ERIC Educational Resources Information Center

The purpose of this study was to determine whether uncontrollable stress related to levels of subjective well-being (SWB) in a group of ethnically diverse urban adolescents. Additionally, the researchers examined what types of coping skills were utilized in the face of high levels of uncontrollable stress. Finally, a moderation model was proposed,…

Coyle, Laura D.; Vera, Elizabeth M.

2013-01-01

307

Vasopressin During Uncontrolled Hemorrhagic Shock: Less Bleeding Below the Diaphragm, More Perfusion Above  

Microsoft Academic Search

n 1990, about 5 million people died worldwide as a result of injury, and it seems likely that the global epidemic of deadly trauma is only beginning. By 2020, deaths from injury are expected to increase to 8 million worldwide (2), and 30% of these fatalities will be attributable to uncontrolled hemorrhagic shock (3). Resuscitation of patients in uncontrolled hemorrhagic

Karl H. Stadlbauer; Volker Wenzel; Anette C. Krismer; Wolfgang G. Voelckel; Karl H. Lindner

2005-01-01

308

Folic acid supplementation during early pregnancy and the risk of gestational hypertension and preeclampsia.  

PubMed

Emerging evidence has suggested that folic acid-containing multivitamins may markedly reduce the risk of gestational hypertension or preeclampsia. We examined whether maternal supplementation with folic acid alone during early pregnancy can prevent the occurrence of gestational hypertension and preeclampsia. The data are from a large population-based cohort study established to evaluate the effectiveness of the campaign to prevent neural tube defects with folic acid supplementation in China. We selected participants who were registered in 2 southern provinces, had exact information on folic acid use, and were not affected by chronic hypertension or diabetes mellitus before 20 weeks gestation. A logistic regression model was used to adjust for the effects of the main potential confounders, including age, body mass index, education, occupation, parity, and multiple births. The study size had 99.9% power (?=0.05) to detect a decrease of 10% over the unexposed rate of 9.4% for gestational hypertension. Among the 193 554 women (47.9% took folic acid, 52.1% did not), the overall incidence of gestational hypertension and preeclampsia was 9.5% and 2.5%, respectively. The incidence of gestational hypertension and preeclampsia was 9.7% and 2.5% for women who took folic acid, and 9.4% and 2.4% for women who did not use it. The adjusted risk ratio associated with folic acid use was 1.08 (95% confidence interval, 1.04-1.11) for gestational hypertension and 1.11 (95% confidence interval, 1.04-1.18) for preeclampsia. Our findings suggest that daily consumption of 400 ?g folic acid alone during early pregnancy cannot prevent the occurrence of gestational hypertension and preeclampsia. PMID:23399716

Li, Zhiwen; Ye, Rongwei; Zhang, Le; Li, Hongtian; Liu, Jianmeng; Ren, Aiguo

2013-04-01

309

Detection of Mogibacterium timidum in subgingival biofilm of aggressive and non-diabetic and diabetic chronic periodontitis patients  

PubMed Central

The aim of the present study was to evaluate the frequency of detection of Mogibacterium timidum in subgingival samples of subjects with generalized aggressive periodontitis (GAgP) and uncontrolled diabetic and non-diabetic subjects with generalized chronic periodontitis (GChP). 48 patients with GAgP, 50 non-diabetic and 39 uncontrolled (glycated hemoglobin >7%) type 2 diabetic subjects with GChP were enrolled in this study. Subgingival biofilm were collected from deep pockets (probing depth > 7 mm). After DNA extraction, M. timidum was detected by Nested Polymerase Chain Reaction and chi-square test was used to data analysis (p>0.05). There were no differences in the frequency of detection of M. timidum between subjects with GAgP (35%) and non-diabetic subjects with GChP (40%) (p>0.05). The frequency of detection of M. timidum was significantly higher in deep pockets of diabetic subjects with GChP (56%) when compared to GAgP (p<0.05), but similar to non-diabetic subjects with GChP (p>0.05). The frequency of detection of M. timidum was higher in subjects GChP presenting uncontrolled type 2 diabetes mellitus, when compared to GAgP subjects. PMID:24031909

Casarin, Renato Correa Viana; Saito, Daniel; Santos, Vanessa Renata; Pimentel, Suzana Peres; Duarte, Poliana Mendes; Casati, Marcio Zaffalon; Goncalves, Reginaldo Bruno

2012-01-01

310

Expert consensus on gestational diabetes mellitus. Methods and organization.  

PubMed

Reminder of the aim of clinical practice recommendations (CPR). The ever more rapid development of new techniques and the diffusion of large amounts of information in the medical literature make it difficult for clinicians to assimilate and synthesize everything, giving rise to major variations in practices that are sometimes inappropriate or even unnecessary. This situation has led several countries to establish recommendations for treatment, diagnosis, prevention methods and disease care. These recommendations aim to help clinicians in decision-making by offering a synthesis with a certain level of scientific proof or professional consensus. PMID:21163416

Vayssière, C; Grandjean, H

2010-12-01

311

Transabdominal ultrasonography diagnosis of ectopic twin gestation  

Microsoft Academic Search

The coexistence of ectopic and intrauterine pregnancy is rare; presence of ectopic twin is even less frequent. We report a rare case of live ectopic tubal twin gestation, which detected preoperatively at 11 weeks of gestation by transabdominal sonography, when patient experienced severe lower abdominal pain.

Gamanagatti Shivanand; Deep Narayana Srivastava; Hiralal; S. Subramanian

2004-01-01

312

Level of A1C control and its predictors among Lebanese type 2 diabetic patients  

PubMed Central

Aim: Lebanon is among the top 10 countries with the highest prevalence of diabetes in the Middle East region with estimates reaching as high as 16.6% in adults aged 20–79 years. The objective of this study was to assess the level of A1C control among a cohort of type 2 diabetic patients and factors associated with uncontrolled A1C. Methods: We carried out a retrospective observational study among type 2 diabetes mellitus patients attending an outpatient endocrinologist’s clinic between June 2008 and July 2012 in Beirut, Lebanon. Two groups were compared, based on their diabetic control (A1C < 7% and A1C ? 7%). Results: A total of 551 patients were included in this study, where 31.8% attained A1C control. Crude analyses showed that some factors were significantly associated with uncontrolled A1C, and these were long-standing diabetes, diabetes-related complications, uncontrolled blood pressure, lipid profile, as well as the use of metformin, sulfonylurea, or insulin. When multivariate analysis was carried out, the chances of having uncontrolled A1C were significantly higher among patients who developed neuropathy (odds ratio [OR] 2.08, 95% confidence interval [CI] 1.11–3.90), had uncontrolled triglycerides (OR 1.98, 95% CI 1.33–2.94), used insulin (OR 4.52, 95% CI 2.32–8.83), and sulfonylureas (OR 2.88, 95% CI 1.88–4.40). Conclusion: Uncontrolled diabetes is more likely to exist in patients with neuropathy, uncontrolled triglycerides and those using insulin or sulfonylurea. Further research is needed to confirm the findings. PMID:25126407

Noureddine, Hanan; Nakhoul, Nancy; Galal, Amal; Soubra, Lama

2014-01-01

313

Kidney transplantation from donors after cardiac death: uncontrolled versus controlled donation.  

PubMed

Kidney donation after cardiac death has been popularized over the last decade. The majority of these kidneys are from controlled donors. The number of organs for transplantation can be further increased by uncontrolled donors after cardiac death. The outcome of uncontrolled compared to controlled donor kidney transplantation is relatively unknown. We compared the long-term outcome of kidney transplantation from uncontrolled (n = 128) and controlled (n = 208) donor kidneys procured in the Maastricht region from January 1, 1981 until January 1, 2008, and transplanted in the Eurotransplant region. The incidence of primary nonfunction and delayed graft function in both uncontrolled and controlled donor kidneys is relatively high (22% vs. 21%, and 61% vs. 56%, p = 0.43, respectively). Ten-year graft and recipient survival are similar in both groups (50% vs. 46%, p = 0.74 and 61% vs. 60%, p = 0.76, respectively). Estimated glomerular filtration rates 1 year after transplantation are 40 ± 16 versus 42 ± 19 mL/min/1.73 m(2) , p = 0.55, with a yearly decline thereafter of 0.67 ± 3 versus 0.70 ± 7 mL/min/1.73 m(2) /year, p = 0.97. The outcome of kidney transplantation from uncontrolled and controlled donors after cardiac death is equivalent. This justifies the expansion of the donor pool with uncontrolled donors to reduce the still growing waiting list for renal transplantation, and may stimulate the implementation of uncontrolled kidney donation programs. PMID:21668628

Hoogland, E R P; Snoeijs, M G J; Winkens, B; Christaans, M H L; van Heurn, L W E

2011-07-01

314

Interrelationships of blood sugar and ketones in insulin-treated diabetics  

Microsoft Academic Search

A survey of ketonuria in insulin-treated diabetics showed that its significance might vary according to the time of day at which the test was performed. Some of the patients had uncontrolled diabetes in the early morning, when severe hyperglycaemia and hyperketonaemia occurred together, while later during the same day or night an episode of hypoglycaemia caused hyperketonaemia, indicating that too

P. J. Watkins; M. G. FitzGerald; J. M. Malins

1969-01-01

315

Mechanism of placental glycogen deposition in diabetes in the rat  

Microsoft Academic Search

Summary  The metabolic basis for glycogen accumulation in the placenta of rats with diabetes induced by streptozotocin on day 12 of pregnancy was studied on days 15 and 20. On day 15 glycogen content of the placenta was 1.5-fold higher in the diabetic than in the control rats and this difference increased to > fivefold on day 20 of gestation whether

V. Barash; A. Gutman; E. Shafrir

1983-01-01

316

Diabetic Neuropathy  

MedlinePLUS

NINDS Diabetic Neuropathy Information Page Table of Contents (click to jump to sections) What is Diabetic Neuropathy? Is there any ... Trials Organizations Additional resources from MedlinePlus What is Diabetic Neuropathy? Diabetic neuropathy is a peripheral nerve disorder caused ...

317

Diabetes Alters the Expression and Activity of the Human Placental GLUT1 Glucose Transporter  

Microsoft Academic Search

This study was designed to investigate the effects of maternal diabetes on glucose transporter expression and glucose transport activity in the human placenta. Syncytiotrophoblast microvillous and basal membranes were prepared from placental tissue obtained at term from pregestational diabetics (White class B) and gestational diabetics controlled either by diet alone (class A1) or by diet and insulin (class A2). These

KECIA GAITHER; ABID N. QURAISHI; NICHOLAS P. ILLSLEY

2010-01-01

318

Mode of Delivery and Neonatal Outcomes in Preterm, Small-for-Gestational-Age Newborns  

PubMed Central

Objective To compare neonatal outcomes by method of delivery in preterm (34 weeks of gestation or prior), small-for-gestational-age (SGA) newborns in a large diverse cohort. Methods Birth data for 1995–2003 from New York City were linked to hospital discharge data. Data were limited to singleton, liveborn, vertex neonates delivered between 25 and 34 weeks of gestation. Births complicated by known congenital anomalies and birth weight less than 500 g were excluded. Small for gestational age was used as a surrogate for intrauterine growth restriction. Associations between method of delivery and neonatal morbidities were estimated using logistic regression. Results Two thousand eight hundred eighty-five SGA neonates meeting study criteria were identified; 42.1% were delivered vaginally, and 57.9% were delivered by cesarean. There was no significant difference in intraventricular hemorrhage, subdural hemorrhage, seizure, or sepsis between the cesarean delivery and vaginal delivery groups. Cesarean delivery compared with vaginal delivery was associated with increased odds of respiratory distress syndrome. The increased odds persisted after controlling for maternal age, parity, ethnicity, education, primary payer, prepregnancy weight, gestational age at delivery, diabetes, and hypertension. Conclusion Cesarean delivery was not associated with improved neonatal outcomes in preterm SGA newborns and was associated with an increased risk of respiratory distress syndrome. PMID:22914464

Werner, Erika F.; Savitz, David A.; Janevic, Teresa M.; Ehsanipoor, Robert M.; Thung, Stephen F.; Funai, Edmund F.; Lipkind, Heather S.

2013-01-01

319

Thyroid Function in Small for Gestational Age Newborns: A Review  

PubMed Central

Several studies have shown that small for gestational age (SGA) babies have a different hormonal profile than those born with a birth weight appropriate for gestational age (AGA). Thyroid hormones play an important role in growth and neurocognitive development. Only few studies analyzed the concentrations of thyroid-stimulating hormone (TSH) and thyroxine (T4) during fetal and extrauterine life in SGA and AGA newborns, and the existing data on the possible alterations of these hormones in postnatal life are controversial. It remains to be established whether SGA newborns have different blood concentrations of thyroid hormones as compared with AGA infants and if so, whether these findings play a role in the development of obesity, short stature, hypertension, and diabetes - disorders, already known to be related with SGA birth. It has also not yet been established whether and when substitutive therapy with levothyroxine (LT4) should be initiated in preterm and full-term SGA newborns. Further trials are needed to determine the thyroid hormone profile in both preterm and full-term SGA newborns and also to evaluate the effectiveness and safety of LT4 treatment in these infants. Conflict of interest:None declared. PMID:23149390

Bagnoli, Franco; Laura, Farmeschi; Sara, Nappini; Salvatore, Grosso

2013-01-01

320

Epigenetic programing of depression during gestation.  

PubMed

Gestational factors play a role in the development of several neuropsychiatric disorders including schizophrenia and autism. In utero conditions influence future mental health through epigenetic mechanisms, which alter gene expression without affecting DNA coding sequence. Environmental factors account for at least 60% of the risk for developing major depression, and earlier onset of depressive illness has been observed over the past decades. I speculate that gestational factors may play a greater role in programing depression than previously recognized. Here, I examine recent evidence for a role for gestational factors in programing mood disorders, and how epigenetic mechanisms mediate this effect. PMID:24446085

Dulawa, Stephanie C

2014-04-01

321

Salvage transjugular intrahepatic portosystemic shunt for uncontrolled variceal bleeding in patients with decompensated cirrhosis  

Microsoft Academic Search

Background\\/Aims: The place of transjugular intrahepatic porto–systemic shunt (TIPS) for variceal haemorrhage uncontrolled by sclerotherapy and medical treatment is still undefined. To investigate the outcome of early salvage TIPS for active uncontrolled variceal haemorrhage, and to identify the factors associated with mortality.Methods: Salvage TIPS was performed in 58 patients as soon as possible after the diagnosis of variceal bleeding refractory

Daniel Azoulay; Denis Castaing; Pietro Majno; Faouzi Saliba; Allaoua Smail; Valérie Delvart; Monzer Danaoui; Didier Samuel; Henri Bismuth

2001-01-01

322

Hippocampal Neuropathology of Diabetes Mellitus is Relieved by Estrogen Treatment  

Microsoft Academic Search

  1. A recently recognized complication of uncontrolled diabetes mellitus is the encephalopathy involving, among other regions, the hippocampus. Since estrogens bring neuroprotection in cases of brain injury and degenerative diseases, we have studied if estradiol (E2) administration counteracts some hippocampal abnormalities of streptozotocin (STZ)-diabetic adult mice.2. We first report the ability of E2 to modulate neurogenesis in the dentate gyrus

Flavia E. Saravia; Juan Beauquis; Yanina Revsin; Francoise Homo-Delarche; E. Ronald de Kloet; Alejandro F. De Nicola

2006-01-01

323

Drugs Approved for Gestational Trophoblastic Disease  

Cancer.gov

This page lists cancer drugs approved by the Food and Drug Administration (FDA) for gestational trophoblastic disease. The list includes generic names and brand names. The drug names link to NCI's Cancer Drug Information summaries.

324

Effects of Hypertension and Diabetes on Sentence Comprehension in Aging  

PubMed Central

Objectives. To assess the impact of hypertension and diabetes mellitus on sentence comprehension in older adults. Method. Two hundred and ninety-five adults aged 55 to 84 (52% men) participated in this study. Self-report mail survey combined with medical evaluations were used to determine eligibility. Multiple sources were used to determine whether hypertension and diabetes were present or absent and controlled or uncontrolled. Sentence comprehension was evaluated with two tasks: embedded sentences (ES) and sentences with multiple negatives (MN). Outcome measures were percent accuracy and mean reaction time of correct responses on each task. Results. Regression models adjusted for age, gender, and education showed that the presence of hypertension impaired comprehension on the multiple negatives task (p < .01), whereas the presence of diabetes impaired the comprehension of embedded sentences (p < .05). Uncontrolled diabetes significantly impaired accurate comprehension of sentences with multiple negatives (p < .05). No significant patterns were found for reaction time. Discussion. The presence of hypertension and diabetes adversely affected sentence comprehension, but the relative contribution of each was different. These findings support the researchers’ earlier speculations on the neurobiological mechanisms underlying the effects of hypertension and diabetes on language and cognition in aging. Uncontrolled disease status demonstrated more complicated age-related effects on sentence processing, highlighting the clinical importance for cognitive aging of identifying and managing vascular risk factors. PMID:23052364

2013-01-01

325

Oxytocin and Psychological Factors Affecting Type 2 Diabetes Mellitus  

PubMed Central

Background. The aim of this study was to investigate the association of oxytocin with trait and state psychological factors in type 2 diabetic patients. Methods. OXT and psychological variables were analyzed from 86 controlled diabetic patients (glycosylated haemoglobin A1c (HbA1c) < 7%) from 45 uncontrolled diabetic patients (HbA1c ? 7). Psychological characteristics were assessed with the Eysenck Personality Questionnaire (EPQ), while state psychological characteristics were measured with the Symptom Checklist 90-R (SCL 90-R). Blood samples were taken for measuring oxytocin in both subgroups during the initial phase of the study. One year later, the uncontrolled diabetic patients were reevaluated with the use of the same psychometric instruments. Results. During the first evaluation of the uncontrolled diabetic patients, a statistically significant positive relationship between the levels of OXT and psychoticism in EPQ rating scale (P < 0.013) was observed. For controlled diabetic patients, a statistically significant negative relationship between oxytocin and somatization (P < 0.030), as well as obsessive-compulsive scores (P < 0.047) in SCL-90 rating scale, was observed. During the second assessment, the values of OXT decreased when the patients managed to control their metabolic profile. Conclusions. The OXT is in association with psychoticism, somatization, and obsessionality may be implicated in T2DM. PMID:22997507

Kontoangelos, K.; Raptis, A. E.; Papageorgiou, C. C.; Tsiotra, P. C.; Papadimitriou, G. N.; Rabavilas, A. D.; Dimitriadis, G.; Raptis, S. A.

2012-01-01

326

Diabetes UK  

Microsoft Academic Search

Diabetes UK is the operating name of the British Diabetic Association, the largest organization in the UK working for people with diabetes. The goals of the organization are funding research, advocacy, and helping people live with diabetes. The Diabetes UK Web site helps health consumers find authoritative, reliable information about the condition, the organization, research efforts, and opportunities for getting

Denise Shereff

2010-01-01

327

Mid-Gestational Gene Expression Profile in Placenta and Link to Pregnancy Complications  

PubMed Central

Despite the importance of placenta in mediating rapid physiological changes in pregnancy, data on temporal dynamics of placental gene expression are limited. We completed the first transcriptome profiling of human placental gene expression dynamics (GeneChips, Affymetrix®; ?47,000 transcripts) from early to mid-gestation (n?=?10; gestational weeks 5–18) and report 154 genes with significant transcriptional changes (ANOVA, FDR P<0.1). TaqMan RT-qPCR analysis (n?=?43; gestational weeks 5–41) confirmed a significant (ANOVA and t-test, FDR P<0.05) mid-gestational peak of placental gene expression for BMP5, CCNG2, CDH11, FST, GATM, GPR183, ITGBL1, PLAGL1, SLC16A10 and STC1, followed by sharp decrease in mRNA levels at term (t-test, FDR P<0.05). We hypothesized that normal course of late pregnancy may be affected when genes characteristic to mid-gestation placenta remain highly expressed until term, and analyzed their expression in term placentas from normal and complicated pregnancies [preeclampsia (PE), n?=?12; gestational diabetes mellitus (GDM), n?=?12; small- and large-for-gestational-age newborns (SGA, LGA), n?=?12+12]. STC1 (stanniocalcin 1) exhibited increased mRNA levels in all studied complications, with the most significant effect in PE- and SGA-groups (t-test, FDR P<0.05). In post-partum maternal plasma, the highest STC1 hormone levels (ELISA, n?=?129) were found in women who had developed PE and delivered a SGA newborn (median 731 vs 418 pg/ml in controls; ANCOVA, P?=?0.00048). Significantly higher expression (t-test, FDR P<0.05) of CCNG2 and LYPD6 accompanied with enhanced immunostaining of the protein was detected in placental sections of PE and GDM cases (n?=?15). Our study demonstrates the importance of temporal dynamics of placental transcriptional regulation across three trimesters of gestation. Interestingly, many genes with high expression in mid-gestation placenta have also been implicated in adult complex disease, promoting the discussion on the role of placenta in developmental programming. The discovery of elevated maternal plasma STC1 in pregnancy complications warrants further investigations of its potential as a biomarker. PMID:23145134

Uuskula, Liis; Mannik, Jaana; Rull, Kristiina; Minajeva, Ave; Koks, Sulev; Vaas, Pille; Teesalu, Pille; Reimand, Juri; Laan, Maris

2012-01-01

328

Diabetes Medicines  

MedlinePLUS

Diabetes means your blood glucose, or blood sugar, levels are too high. If you can't control your diabetes with wise food choices and physical activity, you may need diabetes medicines. The kind of medicine you take depends ...

329

Ghrelin reverses experimental diabetic neuropathy in mice  

SciTech Connect

Ghrelin, an acylated peptide produced in the stomach, increases food intake and growth hormone secretion, suppresses inflammation and oxidative stress, and promotes cell survival and proliferation. We investigated the pharmacological potential of ghrelin in the treatment of polyneuropathy in uncontrolled streptozotocin (STZ)-induced diabetes in mice. Ghrelin or desacyl-ghrelin was administered daily for 4 weeks after STZ-induced diabetic polyneuropathy had developed. Ghrelin administration did not alter food intake, body weight gain, blood glucose levels, or plasma insulin levels when compared with mice given saline or desacyl-ghrelin administration. Ghrelin administration ameliorated reductions in motor and sensory nerve conduction velocities in diabetic mice and normalized their temperature sensation and plasma concentrations of 8-isoprostaglandin {alpha}, an oxidative stress marker. Desacyl-ghrelin failed to have any effect. Ghrelin administration in a mouse model of diabetes ameliorated polyneuropathy. Thus, ghrelin's effects represent a novel therapeutic paradigm for the treatment of this otherwise intractable disorder.

Kyoraku, Itaru; Shiomi, Kazutaka [Division of Neurology, Respirology, Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki 889-1692 (Japan)] [Division of Neurology, Respirology, Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki 889-1692 (Japan); Kangawa, Kenji [Department of Biochemistry, National Cardiovascular Center Research Institute, Osaka 565-8565 (Japan)] [Department of Biochemistry, National Cardiovascular Center Research Institute, Osaka 565-8565 (Japan); Nakazato, Masamitsu, E-mail: nakazato@med.miyazaki-u.ac.jp [Division of Neurology, Respirology, Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki 889-1692 (Japan)] [Division of Neurology, Respirology, Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki 889-1692 (Japan)

2009-11-20

330

Maternal and Fetal Outcomes of Triplet Gestation in a Tertiary Hospital in Oman  

PubMed Central

Objectives: The aim of this study was to describe the fetal and maternal outcomes of triplet gestation and to report on the maternal characteristics of those pregnancies in a tertiary care centre in Oman. Methods: A retrospective study was undertaken of all triplet pregnancies delivered at Sultan Qaboos University Hospital, Muscat, Oman, between January 2009 and December 2011. Results: Over the three-year study period, there were 9,140 deliveries. Of these, there were 18 triplet pregnancies, giving a frequency of 0.2%. The mean gestational age at delivery was 31.0 ± 3.0 weeks, and the mean birth weight was 1,594 ± 460 g. The most common maternal complications were preterm labour in 13 pregnancies (72.2%), gestational diabetes in 7 (39%) and gestational hypertension in 5 (28%). Of the total deliveries, there were 54 neonates. Neonatal complications among these included hyaline membrane disease in 25 neonates (46%), hyperbilirubinaemia in 24 (43%), sepsis in 18 (33%) and anaemia in 8 (15%). The perinatal mortality rate was 55 per 1,000 births. Conclusion: The maternal and neonatal outcomes of triplet pregnancies were similar to those reported in other studies. PMID:24790743

Al-Shukri, Maryam; Khan, Durdana; Al-Hadrami, Atka; Al-Riyami, Nihal; Gowri, Vaidyanathan; Haddabi, Rahma; Abdellatif, Mohammed; Al-Dughaishi, Tamima

2014-01-01

331

Cytokine Gene Polymorphisms and Length of Gestation  

PubMed Central

OBJECTIVE To estimate whether there is an association between length of gestation and gene polymorphisms that effect transcription of tumor necrosis factor-? (TNF-?), interleukin-6 (IL-6), or interleukin-1? (IL-1?). METHODS Blood for DNA analysis was collected from 834 women at high risk enrolled in a randomized, clinical trial of omega-3 fatty acid supplementation for the prevention of recurrent preterm birth. Genotyping was performed for three single nucleotide polymorphisms (SNPs), TNF-? ?308, IL-6 ?174, and IL-1? +3954. Women with the homozygous minor genotype were compared with women with either the heterozygous or the homozygous major genotype. Kaplan-Meier curves of gestational age at delivery and odds ratios for extreme preterm delivery were adjusted for African-American race and treatment group. RESULTS Women who were homozygous for the minor allele at the ?308 position in the promoter region of the TNF-? gene had significantly shorter length of gestation than women who were either heterozygous or homozygous for the major allele (adjusted hazard ratio 1.74, 95% confidence interval [CI] 1.04–2.90, P=.03). Among women with this genotype, 20% (3/15) experienced extreme spontaneous preterm delivery (less than 28 weeks of gestation; adjusted odds ratio 7.51, 95% CI 1.84–30.72, P=.005). There was no difference in length of gestation or risk of extreme spontaneous preterm delivery by genotype for the IL-6 ?174 or the IL-1? +3954 SNP. CONCLUSION Polymorphism at the ?308 position in the TNF-? promoter region is associated with shorter gestation and an increased risk of spontaneous extreme preterm delivery. PMID:21173653

Harper, Margaret; Zheng, S. Lilly; Thom, Elizabeth; Klebanoff, Mark A.; Thorp, John; Sorokin, Yoram; Varner, Michael W.; Iams, Jay D.; Dinsmoor, Mara; Mercer, Brian M.; Rouse, Dwight J.; Ramin, Susan M.; Anderson, Garland D.

2013-01-01

332

Alaska Diabetes Alaska Diabetes  

E-print Network

The plan was based on the recommendations of Alaskans from village clinics, universities, community health centers, non-profit organizations, elementary, middle, and high schools, state and municipal agencies, faithbased institutions, public health agencies, hospitals, health professional organizations, public and private health insurance agencies, peer review organizations, and Alaskans with diabetes. The Alaska Diabetes Strategic Plan establishes a unified course of action to reduce the burden (i.e., premature mortality, morbidity, and economic costs) of this disease among the 18,700 adult Alaskans already diagnosed with diabetes. The plan also addresses the prevention of diabetes in the general population through education, policy and lifestyle modifications. The rapidly increasing prevalence of this disease in Alaska calls for creative and cost-effective strategies. Implementing these strategies calls for action and cooperation by multiple partners statewide. Putting this plan into action presents a challenging opportunity to influence the health of current and future Alaskans. It is

Barbara Stillwater Rn

2005-01-01

333

Pulmonary disease in gestational trophoblastic neoplasms.  

PubMed Central

Gestational trophoblastic neoplasms can present as pulmonary nodules without significant disease of the reproductive organs. This article describes a case of metastatic gestational trophoblastic disease to the lungs. This entity must be considered in the differential diagnosis in any female of reproductive age who presents with multiple pulmonary nodules. Thoracotomy has a limited role in the initial evaluation of patients with this disease. However, it may be needed in patients who have evidence of persistent pulmonary disease, despite appropriate therapy. Images Figure 1 Figure 2 Figure 3 PMID:1324326

McNair, O. M.; Polk, O. D.

1992-01-01

334

Women and Diabetes  

MedlinePLUS Videos and Cool Tools

... Pregnancy Podcast: Diabetes and Depression American Diabetes Association Women and Diabetes Diabetes is a serious illness that ... your diabetes. This video provides tips to help women with diabetes safely use their diabetes medicines. View ...

335

Movimentos respiratórios fetais em gestações com diabetes mellitus pré-gestacional Fetal breathing movements in pregnancies complicated by pregestational diabetes mellitus  

Microsoft Academic Search

Pu RPOse: to analyze the pattern of fetal breathing movements (FBM) in diabetic pregnant women in the third trimester of pregnancy. Meth Ods: sixteen pregestational diabetic and 16 nondiabetic (control group) pregnant subjects were included fulfilling the following criteria: singleton, between 36-40 weeks of gestation, absence of other maternal diseases and absence of fetal anomalies. The fetal biophysical profile (FBP)

Roseli Mieko

336

Gestational surrogacy: Viewpoint of Iranian infertile women  

PubMed Central

BACKGROUND: Surrogacy is a popular form of assisted reproductive technology of which only gestational form is approved by most of the religious scholars in Iran. Little evidence exists about the Iranian infertile women's viewpoint regarding gestational surrogacy. AIM: To assess the viewpoint of Iranian infertile women toward gestational surrogacy. SETTING AND DESIGN: This descriptive study was conducted at the infertility clinic of Tabriz University of Medical Sciences, Iran. MATERIALS AND METHODS: The study sample consisted of 238 infertile women who were selected using the eligible sampling method. Data were collected by using a researcher developed questionnaire that included 25 items based on a five-point Likert scale. STATISTICAL ANALYSIS: Data analysis was conducted by SPSS statistical software using descriptive statistics. RESULTS: Viewpoint of 214 women (89.9%) was positive. 36 (15.1%) women considered gestational surrogacy against their religious beliefs; 170 women (71.4%) did not assume the commissioning couple as owners of the baby; 160 women (67.2%) said that children who were born through surrogacy would better not know about it; and 174 women (73.1%) believed that children born through surrogacy will face mental problems. CONCLUSION: Iranian infertile women have positive viewpoint regarding the surrogacy. However, to increase the acceptability of surrogacy among infertile women, further efforts are needed. PMID:22346081

Rahmani, Azad; Sattarzadeh, Nilofar; Gholizadeh, Leila; Sheikhalipour, Zahra; Allahbakhshian, Atefeh; Hassankhani, Hadi

2011-01-01

337

Ectopic gestation following emergency contraceptive pill administration  

Microsoft Academic Search

Emergency contraceptive pill prescription following rape is common. We report a case of ectopic gestation after emergency contraceptive pill failure and review the literature on this rare complication. A 26-year-old woman with a normal menstrual period 2 weeks before was administered an emergency contraceptive pill 8 hours after a single sexual assault. The assault was her only sexual activity before

Carin L. Nielsen; Leslie Miller

2000-01-01

338

Incidence of perihepatic adhesions in ectopic gestation  

Microsoft Academic Search

Objective: To compare the incidence of perihepatic adhesions in patients undergoing surgery for ectopic pregnancy with the incidence in patients undergoing elective laparoscopic sterilization. Fitz-Hugh-Curtis syndrome is a perihepatitis that usually occurs as a complication of pelvic inflammatory disease. Perihepatic adhesions may be an aftereffect of the acute hepatic episode, and because the cause of ectopic gestation is thought to

Vaseem Ali; James F Lilja; Alice Z Chuang; Ratnasri V Mogallapu; Eric Sabonghy

1998-01-01

339

Birthweight between 14 and 42 weeks' gestation  

Microsoft Academic Search

Data representing fetal weight gain between 14 and 42 weeks' gestation are presented; firstly to provide suitable curves enabling the growth of the very immature infant to be monitored and secondly to examine the influence of the improved techniques of paediatric and obstetric assessment developed since the publication of previous studies. Data have been collected from the 57 866 livebirths

D V Keen; R G Pearse

1985-01-01

340

Sodium Intake, Dietary Knowledge, and Illness Perceptions of Controlled and Uncontrolled Rural Hypertensive Patients  

PubMed Central

Introduction and Objectives. Nutritional knowledge of the patients is important in dietary adherence. This study aimed to determine the relationship between illness perceptions and nutritional knowledge with the amounts of sodium intake among rural hypertensive patients. Methods. In a cross-sectional study, 671 hypertensive patients were selected in a multistage random sampling from the rural areas of Ardabil city, Iran, in 2013. Data were collected using a questionnaire consisting of four sections and were analyzed using Pearson correlation and multiple linear regressions by SPSS-18. Results. The mean of sodium intake in the uncontrolled hypertensive patients was 3599 ± 258?mg/day and significantly greater than controlled group (2654 ± 540?mg/day) (P < 0.001). Knowledge and illness perceptions could predict 47.2% of the variation in sodium intake of uncontrolled group. A significant negative relationship was found between knowledge and illness perceptions of uncontrolled hypertensive patients with dietary sodium intake (r = ?0.66, P < 0.001 and r = ?0.65, P < 0.001, resp.). Conclusion. Considering the fact that patients' nutritional knowledge and illness perceptions could highly predict their sodium intake, the importance of paying more attention to improve patients' information and perceptions about hypertension is undeniable, especially among the uncontrolled hypertensive patients. PMID:24678414

Azadbakht, Leila; Sharifirad, Gholamreza; Mahaki, Behzad; Sharghi, Afshan

2014-01-01

341

Detecting Parkinsons' Symptoms in Uncontrolled Home Environments: A Multiple Instance Learning Approach  

E-print Network

Detecting Parkinsons' Symptoms in Uncontrolled Home Environments: A Multiple Instance Learning of Parkinson's Disease motor symptoms in daily living environ- ments. Our primary goal is to develop-prone time windows on other days and approximately localize the symptom instances. We monitored two Parkinson

Gupta, Abhinav

342

Recurrence after Ischemic Stroke in Chinese Patients: Impact of Uncontrolled Modifiable Risk Factors  

Microsoft Academic Search

Background: Data concerning stroke occurrence and recurrence in China are extremely rare. This study was designed to analyze determinants of stroke recurrence in a cohort of Chinese patients. Methods: Subjects were patients with ischemic stroke registered in the Nanjing Stroke Registry Program. Modifiable risk factors for stroke were identified and stratified into 3 levels: without, controlled and uncontrolled. Cox proportional

Gelin Xu; Xinfeng Liu; Wentao Wu; Renliang Zhang; Qin Yin

2007-01-01

343

Uncontrolled Attitude Motion of the Foton-12 Satellite and Quasi-Steady Microaccelerations onboard It  

Microsoft Academic Search

The results of determination of the uncontrolled attitude motion of the Foton-12 satellite (placed in orbit on September 9, 1999, terminated its flight on September 24, 1999) are presented. The determination was carried out by the onboard measurement data of the Earth's magnetic field strength vector. Intervals with a duration of several hours were selected from data covering almost the

V. I. Abrashkin; V. L. Balakin; I. V. Belokonov; K. E. Voronov; A. S. Zaitsev; V. V. Ivanov; A. E. Kazakova; V. V. Sazonov; N. D. Semkin

2003-01-01

344

Transvenous Embolization to Treat Uncontrolled Hemobilia and Peritoneal Bleeding After Transjugular Liver Biopsy  

SciTech Connect

Hemobilia is one of the complications that can occur after a transjugular liver biopsy. Various treatment options have been described for the management of this condition, including transarterial embolization and open surgery. We describe a patient who developed uncontrolled hemobilia after a transjugular liver biopsy that required a transvenous approach for embolization and treatment purposes.

Koshy, Chiramel George, E-mail: gkchiramel@gmail.co [Christian Medical College, Department of Radiology (India); Eapen, C. E. [Christian Medical College, Department of Clinical Gastroenterology and Hepatology (India); Lakshminarayan, Raghuram [Christian Medical College, Department of Radiology (India)

2010-06-15

345

VARIABLES AFFECTING EMISSIONS OF PCDDS/FS FROM UNCONTROLLED COMBUSTION OF HOUSEHOLD WASTE IN BARRELS  

EPA Science Inventory

The uncontrolled burning of household waste in barrels has recently been implicated as a major source of airborne emissions of polychlorinated dibenzo-p-dioxins and polychlorinated dibenzofurans (PCDDs/Fs). Based on the need to generate a more accurate emission factor for burn ba...

346

A method for the remote sensing identification of uncontrolled landfills: formulation and validation  

Microsoft Academic Search

The identification of uncontrolled landfills is a central environmental problem in all developed and developing countries, where several illegal waste deposits exist as a result of rapid industrial growth over the past century. Remote sensing can potentially provide crucial information for the identification of contaminated sites, but surprisingly there is a marked lack of rigorously validated approaches. In this paper

S. Silvestri; M. Omri

2008-01-01

347

Young-Age Gender Differences in Mathematics Mediated by Independent Control or Uncontrollability  

ERIC Educational Resources Information Center

We studied whether the origins of math anxiety can be related to a biologically supported framework of stress induction: (un)controllability perception, here indicated by self-reported independent efforts in mathematics. Math anxiety was tested in 182 children (8- to 11-year-olds). "Latent factor modeling" was used to test hypotheses on…

Zirk-Sadowski, Jan; Lamptey, Charlotte; Devine, Amy; Haggard, Mark; Szucs, Dénes

2014-01-01

348

OBJECTIVE: To study the relationship between pre-pregnancy body mass index (BMI) and weight gain during pregnancy with pregnancy and birth outcomes, with a focus on gestational  

E-print Network

Abstract OBJECTIVE: To study the relationship between pre-pregnancy body mass index (BMI) and weight gain during pregnancy with pregnancy and birth outcomes, with a focus on gestational diabetes and offspring from the Eden mother-child cohort. Weight before pregnancy (W1) and weight after delivery (W2

Paris-Sud XI, Université de

349

Common crossroads in diabetes management  

PubMed Central

The prevalence and impact of type 2 diabetes are reaching epidemic proportions in the United States. Data suggest that effective management can reduce the risk for both microvascular and macrovascular complications of diabetes. In treating patients with diabetes, physicians must be prepared not only to tailor the initial treatment to the individual and his or her disease severity but also to advance treatment as necessary and in step with disease progression. The majority of patients with diabetes are not at goal for glycated hemoglobin A1C, fasting plasma glucose, or postprandial plasma glucose levels. Although lifestyle changes based on improved diet and exercise practices are basic elements of therapy at every stage, pharmacologic therapy is usually necessary to achieve and maintain glycemic control. Oral antidiabetic agents may be effective early in the disease but, eventually, they are unable to compensate as the disease progresses. For patients unable to achieve glycemic control on 2 oral agents, current guidelines strongly urge clinicians to consider the initiation of insulin as opposed to adding a third oral agent. Recent research suggests that earlier initiation of insulin is more physiologic and may be more effective in preventing complications of diabetes. Newer, longer-lasting insulin analogs and the use of simplified treatment plans may overcome psychological resistance to insulin on the part of physicians and patients. This article summarizes the risks associated with uncontrolled fasting and postprandial hyperglycemia, briefly reviews the various treatment options currently available for type 2 diabetes, presents case vignettes to illustrate crossroads encountered when advancing treatment, and offers guidance to the osteopathic physician on the selection of appropriate treatments for the management of type 2 diabetes. PMID:18279520

Valitutto, Michael

2008-01-01

350

Common crossroads in diabetes management.  

PubMed

The prevalence and impact of type 2 diabetes are reaching epidemic proportions in the United States. Data suggest that effective management can reduce the risk for both microvascular and macrovascular complications of diabetes. In treating patients with diabetes, physicians must be prepared not only to tailor the initial treatment to the individual and his or her disease severity but also to advance treatment as necessary and in step with disease progression.The majority of patients with diabetes are not at goal for glycated hemoglobin A1C, fasting plasma glucose, or postprandial plasma glucose levels. Although lifestyle changes based on improved diet and exercise practices are basic elements of therapy at every stage, pharmacologic therapy is usually necessary to achieve and maintain glycemic control. Oral antidiabetic agents may be effective early in the disease but, eventually, they are unable to compensate as the disease progresses. For patients unable to achieve glycemic control on 2 oral agents, current guidelines strongly urge clinicians to consider the initiation of insulin as opposed to adding a third oral agent. Recent research suggests that earlier initiation of insulin is more physiologic and may be more effective in preventing complications of diabetes. Newer, longer-lasting insulin analogs and the use of simplified treatment plans may overcome psychological resistance to insulin on the part of physicians and patients.This article summarizes the risks associated with uncontrolled fasting and postprandial hyperglycemia, briefly reviews the various treatment options currently available for type 2 diabetes, presents case vignettes to illustrate crossroads encountered when advancing treatment, and offers guidance to the osteopathic physician on the selection of appropriate treatments for the management of type 2 diabetes. PMID:18279520

Valitutto, Michael

2008-01-01

351

New Developments in Quantum Control: Phase Space Learning Algorithms and Uncontrollable Quantum Systems  

NASA Astrophysics Data System (ADS)

This talk has two parts. The first deals with a new representation of shaped ultrafast laser pulses based on a von Neumann time-frequency lattice. We show that a pulse defined in terms of an amplitude and a phase at N frequency points can be represented on the von Neumann lattice using N points in frequency and N in time without loss of information. The transformation from the frequency (or time) representation to the von Neumann representation is one-to-one and therefore invertible. We discuss three possible applications of the von Neumann representation of pulses: 1) for cleaning and interpreting complex pulses; 2) for performing systematic scans of the effect of timing and frequency on molecular control; 3) as genes to be used in mutations and crossover in evolutionary algorithms. The second part of the talk deals with the classification of uncontrollable quantum systems. It is well-known that for a quantum system to be controllable the Lie algebra spanned by iterated commutators of H0 and H1 must span the full space of the dynamical algebra. We pose the following questions: When a system is not completely controllable, can we classify different families of uncontrollable systems? If so, can we associate these different types of mathematical structures with different underlying physics (for example, dark states or generalized entangled states)? We show that uncontrollable quantum systems fall into two categories: reducible and irreducible. The former is associated with dark states and the latter with generalized entangled states. Based on Lie subalgebras we give a complete characterization of irreducible uncontrollable systems for systems up to 9 levels. Finally, we show that an earlier intuitive concept of connectivity only incompletely captures this Lie algebraic structure of uncontrollable systems.

Tannor, David J.

2008-03-01

352

Embryonic Pig Pancreatic Tissue Transplantation for the Treatment of Diabetes  

PubMed Central

Background Transplantation of embryonic pig pancreatic tissue as a source of insulin has been suggested for the cure of diabetes. However, previous limited clinical trials failed in their attempts to treat diabetic patients by transplantation of advanced gestational age porcine embryonic pancreas. In the present study we examined growth potential, functionality, and immunogenicity of pig embryonic pancreatic tissue harvested at different gestational ages. Methods and Findings Implantation of embryonic pig pancreatic tissues of different gestational ages in SCID mice reveals that embryonic day 42 (E42) pig pancreas can enable a massive growth of pig islets for prolonged periods and restore normoglycemia in diabetic mice. Furthermore, both direct and indirect T cell rejection responses to the xenogeneic tissue demonstrated that E42 tissue, in comparison to E56 or later embryonic tissues, exhibits markedly reduced immunogenicity. Finally, fully immunocompetent diabetic mice grafted with the E42 pig pancreatic tissue and treated with an immunosuppression protocol comprising CTLA4-Ig and anti–CD40 ligand (anti-CD40L) attained normal blood glucose levels, eliminating the need for insulin. Conclusions These results emphasize the importance of selecting embryonic tissue of the correct gestational age for optimal growth and function and for reduced immunogenicity, and provide a proof of principle for the therapeutic potential of E42 embryonic pig pancreatic tissue transplantation in diabetes. PMID:16768546

Katchman, Helena; Shezen, Elias; Aronovich, Anna; Hecht, Gil; Dekel, Benjamin; Rechavi, Gideon; Blazar, Bruce R; Feine, Ilan; Tal, Orna; Freud, Enrique; Reisner, Yair

2006-01-01

353

Oral Contraceptive Use and Risk of Gestational Trophoblastic Tumors  

Microsoft Academic Search

Background: Gestational trophoblastic disease refers to a spectrum of rare be- nign and malignant gynecologic disor- ders whose pathogenesis is not well un- derstood. Recent studies from China and the United States have raised the hypothesis that long-term use of oral contraceptives before conception may increase the risk of gestational tropho- blastic tumors. A multicenter case- control study of gestational

Julie R. Palmer; Shirley G. Driscoll; Lynn Rosenberg; Ross S. Berkowitz; John R. Lurain; John Soper; Leo B. Twiggs; David M. Gershenson; Ernest I. Kohorn; Michael Berman; Samuel Shapiro; R. Sowmya

354

Movement - uncontrollable  

MedlinePLUS

... Medical history questions may include: Are there muscle contractions that may be causing the abnormal posture? Are the arms affected? Are the legs affected? When did this movement begin? Did it ...

355

New technologies permit safe abortion at less than six weeks' gestation and provide timely detection of ectopic gestation  

Microsoft Academic Search

OBJECTIVE: The previously held dictum that elective abortion before 6 weeks' gestation carried greater risks than a later procedure was challenged by this protocol.STUDY DESIGN: This study evaluated a protocol for abortion before the customary 6 weeks' gestation. Patients willing to return to the clinic within 72 hours were given the option of elective abortion even when no gestational sac

Jerry Edwards; Sandra Ann Carson

1997-01-01

356

Tubal conservation with ectopic gestations. A reappraisal.  

PubMed

Ectopic pregnancies have shown an increasing trend during the past decade. Factors that appear to be responsible are the intrauterine device (IUD), fallopian tube surgery (ligation reversals, reconstructive tuboplasty), and more effective antibiotics against pelvic inflammatory disease (precluding radical pelvic surgery). Our ability to diagnose an ectopic pregnancy at an earlier gestation (prior to rupture) through the use of highly sensitive pregnancy tests (Beta-HCG), ultrasonography, and diagnostic laparoscopy, has significantly altered our approach in treatment. Because these ectopic gestations are seen in a younger population, older nulliparous patients, and patients who desire future fertility, earlier diagnosis precludes an emergency approach to a now-elective procedure. In this paper, we will explore the pros and cons of conservative management for ectopic pregnancies, emphasizing present day evaluation and microsurgical approaches for repair. PMID:6231872

Starks, G

1984-04-01

357

Proteomics and Peptidomics of Gestational Disease  

Microsoft Academic Search

Many of the currently used tests for gestational disease provide only an estimation of risk as many mothers and foetuses never\\u000a actually have or will ever develop the disease. Hence, it is vital to develop new prenatal screening tests that are more reliable\\u000a and specific. We believe peptide markers may be able to fill this niche, however, ideally they should

Nigel M. Page

358

Gestational psittacosis in a Montana sheep rancher.  

PubMed

In humans, psittacosis is primarily a flulike illness following exposure to psittacine birds. In rare cases, pregnant women exposed to Chlamydia psittaci can contract gestational psittacosis: atypical pneumonia, sepsis, and placental insufficiency resulting in premature birth or miscarriage. In the United States, only two cases of gestational psittacosis have been reported, both from exposure to psittacine birds. Eleven other cases have been reported worldwide, mostly in the United Kingdom, all from exposure to infected birth fluids and membranes of farm mammals, notably sheep and goats. In these mammals, C. psittaci inhabit the reproductive tract, are transmitted sexually or by the fecal-oral route, and cause miscarriages. The case of gestational psittacosis in a Montana sheep rancher is the first farm animal-related case reported in the United States. Pregnant women should avoid close contact with C. psittaci-infected animals, particularly sheep and goats during the birthing season. Obstetricians should consider this diagnosis along with early antibiotic treatment and cesarean section delivery in the context of the patient's case history. PMID:9204302

Jorgensen, D M

1997-01-01

359

Diabetes Travel Tips Video  

MedlinePLUS Videos and Cool Tools

... Resources > Diabetes Travel Tips Video Diabetes Travel Tips Video Diabetes doesn’t keep David from traveling. But ... Subtitle Diabetes Travel Tips Transcript Diabetes Travel Tips Video (MP4) Keywords: self-management , behavior change , National Diabetes ...

360

Communicating potential risks of uncontrolled site development at a Fusrap site  

SciTech Connect

This paper describes a particular risk communication challenge at the FUSRAP Maywood Superfund Site (the Site) in Maywood, New Jersey, USA. That challenge is communicating the potential human exposure risks of uncontrolled site development to landowners, tenants, private contractors and public works entities that may engage in construction activities at or adjacent to Site properties. This is of special concern because the Site does not have the authority to establish physical control over most of the properties where contamination is known or suspected to exist. Consequently, a range of communications techniques have been employed to alert property owners and others to the risks of uncontrolled site development. Each technique has its particular limitations, but collectively this multi-channel communication strategy has proved successful in delivering the risk message. (authors)

Roos, A.D. [U.S. Army Corps of Engineers, New York District, New York, NY (United States); Kollar, W. [Shaw Environmental, Inc., Maywood, NJ (United States)

2008-07-01

361

Diabetes Complications  

MedlinePLUS

If you have diabetes, your blood glucose, or blood sugar, levels are too high. Over time, this can cause problems with other body ... as your kidneys, nerves, feet, and eyes. Having diabetes can also put you at a higher risk ...

362

Diabetes Insipidus  

MedlinePLUS

Diabetes insipidus (DI) causes frequent urination. You become extremely thirsty, so you drink. Then you urinate. This ... is almost all water. DI is different from diabetes mellitus (DM), which involves insulin problems and high ...

363

Obesity susceptibility loci and uncontrolled eating, emotional eating and cognitive restraint behaviors in men and women  

PubMed Central

Objective Many confirmed genetic loci for obesity are expressed in regions of the brain that regulate energy intake and reward-seeking behavior. Whether these loci contribute to the development of specific eating behaviors has not been investigated. We examined the relationship between a genetic susceptibility to obesity and cognitive restraint, uncontrolled and emotional eating. Design and Methods Eating behavior and body mass index (BMI) were determined by questionnaires for 1471 men and 2381 women from two U.S cohorts. Genotypes were extracted from genome-wide scans and a genetic-risk score (GRS) derived from 32 obesity-loci was calculated. Results The GRS was positively associated with emotional and uncontrolled eating(P<0.002). In exploratory analysis, BMI-increasing variants of MTCH2, TNNI3K and ZC3H4 were positively associated with emotional eating and those of TNNI3K and ZC3H4 were positively associated with uncontrolled eating. The BMI-increasing variant of FTO was positively and those of LRP1B and TFAP2B were inversely associated with cognitive restraint. These associations for single SNPs were independent of BMI but were not significant after multiple-testing correction. Conclusions An overall genetic susceptibility to obesity may also extend to eating behaviors. The link between specific loci and obesity may be mediated by eating behavior but larger studies are warranted to confirm these results. PMID:23929626

Cornelis, Marilyn C.; Rimm, Eric B.; Curhan, Gary C.; Kraft, Peter; Hunter, David J.; Hu, Frank B.; van Dam, Rob M.

2013-01-01

364

Dental implant survival in diabetic patients; review and recommendations  

PubMed Central

Rising population of diabetic individuals across the world has become a big concern to the society. The persistent hyperglycemia may affect each and every tissue and consequently results in morbidity and eventually mortality in diabetic patients. A direct negative response of diabetes has been observed on oral tissues with few contradictions however, little are known about effect of diabetes on dental implant treatment and the consequent results. Many studies concerned with osteointegration and prognosis of dental implant in diabetic patients have been conducted and published since 1994. These studies have been critically reviewed to understand the impact of diabetes on the success of dental implant and the factors to improve osseointegration and consequently survival of dental implant in diabetic patients. Theoretical literatures and studies in diabetic animals substantiate high failure rate of implants but most of clinical studies indicated statistically insignificant failure of dental implants even in moderately uncontrolled diabetic patients. Success of dental implant in well and fairly controlled diabetic patients with proper treatment planning, prophylactic remedies and adequate postsurgical maintenance appears as good as normal individuals. PMID:24665167

Dubey, Rajendra Kumar; Gupta, Deepesh Kumar; Singh, Amit Kumar

2013-01-01

365

Double vs single internal thoracic artery harvesting in diabetic patients: role in perioperative infection rate  

Microsoft Academic Search

BACKGROUND: The aim of this prospective study is to evaluate the role in the onset of surgical site infections of bilateral internal thoracic arteries harvesting in patients with decompensated preoperative glycemia. METHODS: 81 consecutive patients with uncontrolled diabetes mellitus underwent elective CABG harvesting single or double internal thoracic arteries. Single left ITA was harvested in 41 patients (Group 1, 50.6%),

Marco Agrifoglio; Matteo Trezzi; Fabio Barili; Luca Dainese; Faisal H Cheema; Veli K Topkara; Chiara Ghislandi; Alessandro Parolari; Gianluca Polvani; Francesco Alamanni; Paolo Biglioli

2008-01-01

366

Progression of kidney disease in type 2 diabetes – beyond blood pressure control: an observational study  

Microsoft Academic Search

BACKGROUND: The risk factors for progression of chronic kidney disease (CKD) in type 2 diabetes mellitus (DM) have not been fully elucidated. Although uncontrolled blood pressure (BP) is known to be deleterious, other factors may become more important once BP is treated. METHODS: All patients seen in the outpatient clinics of our hospital between January 1993 and September 2002 with

David J Leehey; Holly J Kramer; Tarek M Daoud; Maninder P Chatha; Majd A Isreb

2005-01-01

367

Carbohydrates and Diabetes  

MedlinePLUS

... Manage a Serious Allergic Reaction Quiz: Baseball Injuries Carbohydrates and Diabetes KidsHealth > Teens > Diabetes Center > Diabetes & Nutrition > Carbohydrates and Diabetes Print A A A Text Size ...

368

Diabetes insipidus - nephrogenic  

MedlinePLUS

Nephrogenic diabetes insipidus; Acquired nephrogenic diabetes insipidus; Congenital diabetes insipidus ... be removed and returned to the blood. Nephrogenic diabetes insipidus (NDI) occurs when the kidney tubules do ...

369

A lipid-rich gestational diet predisposes offspring to nonalcoholic fatty liver disease: a potential sequence of events  

PubMed Central

Nonalcoholic fatty liver disease (NAFLD) is the hepatic manifestation of metabolic syndrome. It affects 20%–30% of the US population, and it is increasing worldwide. Recently, the role of lipid-rich maternal gestational nutrition in spurring the development of NAFLD among offspring has been indicated. Fetal predisposition to NAFLD involves numerous physiological reroutings that are initiated by increased delivery of nonesterified fatty acids to the fetal liver. Hampered ?-oxidation, uncontrolled oxidative stress, increased triacylglycerol synthesis, and the endoplasmic reticulum unfolded protein response are all implicated in sculpting a hepatic phenotype with a propensity to develop NAFLD in the postnatal state. This review suggests a mechanism that integrates outcomes reported by a variety of studies conducted in an analysis of fetal hepatic metabolic capacity amid the maternal consumption of a high-fat diet. Potential preventive measures and therapies for use both as part of prenatal nutrition and for those at risk for the development of NAFLD are also discussed. PMID:24696627

Hughes, Alexandria N; Oxford, Julia Thom

2014-01-01

370

Impact of metformin on reproductive tissues: an overview from gametogenesis to gestation  

PubMed Central

Metformin is an oral anti-hyperglycemic drug that acts as an insulin sensitizer in the treatment of diabetes mellitus type 2. It has also been widely used in the treatment of polycystic ovary syndrome (PCOS) and gestational diabetes. This drug has been shown to activate a protein kinase called 5' AMP-activated protein kinase or AMPK. AMPK is present in many tissues making metformin’s effect multi factorial. However as metformin crosses the placenta, its use during pregnancy raises concerns regarding potential adverse effects on the mother and fetus. The majority of reports suggest no significant adverse effects or teratogenicity. However, disconcerting reports of male mouse offspring that were exposed to metformin in utero that present with a reduction in testis size, seminiferous tubule size and in Sertoli cell number suggest that we do not understand the full suite of effects of metformin. In addition, recent molecular evidence is suggesting an epigenetic effect of metformin which could explain some of the long-term effects reported. Nevertheless, the data are still insufficient to completely confirm or disprove negative effects of metformin. The aims of this review are to provide a summary of the safety of metformin in various aspects of sexual reproduction, the use of metformin by gestating mothers, and its possible side-effects on offspring from women who are administered metformin during pregnancy. PMID:25333030

Bertoldo, Michael J.; Faure, Melanie; Dupont, Joelle

2014-01-01

371

Care of the infant of the diabetic mother.  

PubMed

Gestational diabetes mellitus (GDM) from all causes of diabetes is the most common medical complication of pregnancy and is increasing in incidence, particularly as type 2 diabetes continues to increase worldwide. Despite advances in perinatal care, infants of diabetic mothers (IDMs) remain at risk for a multitude of physiologic, metabolic, and congenital complications such as preterm birth, macrosomia, asphyxia, respiratory distress, hypoglycemia, hypocalcemia, hyperbilirubinemia, polycythemia and hyperviscosity, hypertrophic cardiomyopathy, and congenital anomalies, particularly of the central nervous system. Overt type 1 diabetes around conception produces marked risk of embryopathy (neural tube defects, cardiac defects, caudal regression syndrome), whereas later in gestation, severe and unstable type 1 maternal diabetes carries a higher risk of intrauterine growth restriction, asphyxia, and fetal death. IDMs born to mothers with type 2 diabetes are more commonly obese (macrosomic) with milder conditions of the common problems found in IDMs. IDMs from all causes of GDM also are predisposed to later-life risk of obesity, diabetes, and cardiovascular disease. Care of the IDM neonate needs to focus on ensuring adequate cardiorespiratory adaptation at birth, possible birth injuries, maintenance of normal glucose metabolism, and close observation for polycythemia, hyperbilirubinemia, and feeding intolerance. PMID:22094826

Hay, William W

2012-02-01

372

Preterm twin gestation and cystic periventricular leucomalacia  

PubMed Central

Objective: To identify risk factors for the development of cystic periventricular leucomalacia (PVL) in twin gestation. Design: Retrospective case-control study. Setting: Tertiary care university hospital, Department of Paediatrics, Division of Neonatology, Graz, Austria. Patients: Preterm twin gestations with one sibling having developed cystic PVL, diagnosed by ultrasound scans, compared with their co-twins without PVL, in hospital between 1988 and 2000. Main outcome measures: Perinatal and postnatal risk factors for the development of PVL. Results: Eighteen preterm twin gestations were included. Monochorionicity was evident in 47% of the pregnancies, and twin to twin transfusion syndrome occurred in two cases (11%). Fetal distress correlated inversely with PVL (15% v 53%, p  =  0.019, relative risk (RR)  =  2.057, 95% confidence interval (CI)  =  1.067 to 3.968). Hypocarbia with PCO2 levels below 30 mm Hg (4 kPa) was diagnosed in 29% of the cases compared with 6% of the controls (p  =  0.038, RR  =  1.944, 95% CI  =  1.113 to 3.396). There were no significant differences between groups with regard to premature rupture of the membranes, early onset infection, respiratory distress syndrome, mechanical ventilation, arterial hypotension, persistent ductus arteriosus, and hyperbilirubinaemia. Asphyxia was only evident in three controls. Three infants died and another three were lost to follow up. None of the cases compared with 62% of the controls were diagnosed as having developed normally (p < 0.001), and 14 cases (82%) compared with two controls (15%) developed cerebral palsy (p < 0.001). Conclusion: Hypocarbia was the only risk factor strongly associated with cystic PVL. The general outcome of the infants was poor. PMID:15210663

Resch, B; Jammernegg, A; Vollaard, E; Maurer, U; Mueller, W; Pertl, B

2004-01-01

373

Emergency surgery in gestational trophoblastic tumours.  

PubMed

The prognosis in patients with placental tumours, invasive mole or choriocarcinoma, is excellent. Chemotherapy offers, in the majority of cases, complete cure with preservation of fertility. However, surgery still plays a role in this group of diseases. Elective surgery aiming at curing the patient plays a minor but definitive role in selected patients. This study discusses emergency surgical procedures. In 92 patients treated because of gestational trophoblastic neoplasia at one institution 10 patients (11%) were subjected to invasive surgery, for the most part because of life threatening haemorrhage. PMID:7958163

Flam, F

1994-06-30

374

40 CFR 63.5870 - How do I calculate annual uncontrolled and controlled organic HAP emissions from my wet-out area...  

Code of Federal Regulations, 2011 CFR

...calculate annual uncontrolled and controlled organic HAP emissions from my wet-out area...calculate annual uncontrolled and controlled organic HAP emissions from my wet-out area...your annual uncontrolled and controlled organic HAP emissions from your wet-out...

2011-07-01

375

The Lipid Accumulation Product for the Early Prediction of Gestational Insulin Resistance and Glucose Dysregulation  

PubMed Central

Abstract Background Recent insights linking insulin resistance and lipid overaccumulation suggest a novel approach for the early identification of women who may soon experience glucose dysregulation. Among women without a history of gestational diabetes, we tested the association between the lipid accumulation product (LAP) obtained in early pregnancy and glucose dysregulation or insulin resistance in the second trimester. Methods A total of 180 white pregnant women of French-Canadian origin were included in this study. At 11–14 weeks' gestation, fasting insulin, glucose, C-peptide concentrations, and estimated insulin resistance (HOMA-IR) were obtained. The waist circumference (WC) and fasting triglycerides (TG) were measured to calculate LAP as (WC[cm] ? 58)×TG[mmol/L]. At 24–28 weeks' gestation, glucose was measured 2 hours after a 75-g oral glucose challenge and other fasting variables were repeated. Results Among the nulliparous women tested at the end of the second trimester, fasting insulin, C-peptide, insulin resistance (HOMA-IR index), fasting glucose, and 2-hour glucose progressively increased (p?0.002) according to their first-trimester LAP tertiles. Similar results were observed in parous women except for the glucose variables. The first-trimester LAP tended to show a stronger correlation to the second-trimester HOMA-IR index (r=0.56) than fasting triglyceride levels alone (r=0.40) or waist circumference alone (r=0.44) among nulliparous women. Similar associations were observed for parous women. Adjustment for body mass index weakened these associations, especially among parous women. Conclusions An increased value of LAP at the beginning of a pregnancy could be associated with an increased risk of insulin resistance or hyperglycemia later in gestation. PMID:23717842

Perron, Patrice; Kahn, Henry S.; Gaudet, Daniel; Bouchard, Luigi

2013-01-01

376

Variation in ultraviolet radiation and diabetes: evidence of an epigenetic effect that modulates diabetics’ lifespan  

PubMed Central

Background Published research has shown that month-of-birth variations modulate the incidence of adult human diseases. This article explores diabetes type 2 as one of those diseases. This study uses the death records of approximately 829,000 diabetics (approximately 90% were type-2) born before the year 1945 (and dying between 1979 and 2005) to show that variations in adult lifespan vary with ultraviolet radiation (UVR) at solar cycle peaks (MAX, approximately a three-year period) with less at non-peaks (MIN, approximately an eight-year period). The MAX minus MIN (in years) was our measure of sensitivity (for example, responsiveness) to long-term variations in UVR. Results Diabetics were less sensitive than non-diabetics, and ethnic minorities were more sensitive than whites. Diabetic males gained 6.1 years, and females 2.3 years over non-diabetics, with diabetic males gaining an average of 3.8 years over diabetic females. Most variation in lifespan occurred in those conceived around the seasonal equinoxes, suggesting that the human epigenome at conception is especially influenced by rapid variation in UVR. With rapidly decreasing UVR at conception, lifespan decreased in the better-nourished, white, female diabetic population. Conclusions Rapidly changing UVR at the equinoxes modulates the expression of an epigenome involving the conservation of energy, a mechanism especially canalized in women. Decreasing UVR at conception and early gestation stimulates energy conservation in persons we consider ‘diabetic’ in today’s environment of caloric surfeit. In the late 19th and early 20th centuries ethnic minorities had poorer nutrition, laborious work, and leaner bodies, and in that environment a calorie-conserving epigenome was a survival advantage. Ethnic minorities with a similar epigenome lived long enough to express diabetes as we define it today and exceeded the lifespan of their non-diabetic contemporaries, while that epigenome in diabetics in the nutritional environment of today is detrimental to lifespan. PMID:23548082

2013-01-01

377

Chemical Lesion of the Bed Nucleus of the Stria Terminalis Blocks the Behavioral Consequences of Uncontrollable Stress  

Microsoft Academic Search

Uncontrollable or inescapable shock (IS) produces behavioral changes that are characterized by a sensitized fear system and a deficit in fight-flight responding. These behavioral changes have been argued to represent an anxiety-like state produced by the uncontrollability of the stressor. The bed nucleus of the stria terminalis (BNST) has been implicated in the mediation of long-duration responses to unpredictable stressors,

Sayamwong E. Hammack; Kristen J. Richey; Linda R. Watkins; Steven F. Maier

2004-01-01

378

Climate Extremes and the Length of Gestation  

PubMed Central

Background: Although future climate is predicted to have more extreme heat conditions, the available evidence on the impact of these conditions on pregnancy length is very scarce and inconclusive. Objectives: We investigated the impact of maternal short-term exposure to extreme ambient heat on the length of pregnancy. Methods: This study was based on a cohort of births that occurred in a major university hospital in Barcelona during 2001–2005. Three indicators of extreme heat conditions based on 1-day exposure to an unusually high heat–humidity index were applied. Each mother was assigned the measures made by the meteorological station closest to maternal residential postcodes. A two-stage analysis was developed to quantify the change in pregnancy length after maternal exposure to extreme heat conditions adjusted for a range of covariates. The second step was repeated for lags 0 (delivery date) to 6 days. Results: We included data from 7,585 pregnant women in our analysis. We estimated a 5-day reduction in average gestational age at delivery after an unusually high heat–humidity index on the day before delivery. Conclusion: Extreme heat was associated with a reduction in the average gestational age of children delivered the next day, suggesting an immediate effect of this exposure on pregnant women. Further studies are required to confirm our findings in different settings. PMID:21659038

Basagana, Xavier; Sartini, Claudio; Figueras, Francesc; Vrijheid, Martine; de Nazelle, Audrey; Sunyer, Jordi; Nieuwenhuijsen, Mark J.

2011-01-01

379

Celiac disease in type-I diabetes mellitus: coexisting phenomenon  

PubMed Central

BACKGROUND: This study aimed to determine the prevalence of celiac disease in type I diabetic patients and to compare the symptoms and complications of celiac in patients with diabetes and celiac with patients with diabetes only. METHODS: A total of 241 type I diabetic patients age ? 18 who needed insulin intake were recruited from diabetic patients attending the Diabetic Research Center in Kermanshah, Iran. Sample was screened for celiac disease by drawing 5cc blood for complete blood count (CBC), and anti-endomysial antibody test (AEA). Patients then were classified based on immunofluorescent method for the presence of AEA. Those with AEA positive underwent biopsy. The biopsy tissues were classified based on Marsh classification. RESULTS: Twenty one patients tested positive for celiac disease based on AEA test (8.7%) and 20 (8.3%) tested positive based on the biopsy. Prevalence of celiac among diabetic patients in comparison to normal population was 8.3% vs. 0.6%; and 70% were in the stages III and IV. Weight loss was significantly more prevalent among the celiac patients, who were 4 times more likely to lose weight. Other parameters such as anemia, mucocutaneous and cutaneous hemorrhage, milk intolerance, related oral aphthous, diarrhea and steatorrhea, alopecia, dermatitis herpetiform and alopecia were higher in celiac patients but not high enough to be statistically significant. CONCLUSIONS: There is a need to improve screening identification and treatment of celiac among all diabetic patients type I, especially in cases with uncontrolled diabetic or weight loss. PMID:22247725

Bashiri, Homayoon; Keshavarz, Aliasghar; Madani, Hamid; Hooshmandi, Ahmadreza; Bazargan-Hejazi, Shahrzad; Ahmadi, Alireza

2011-01-01

380

Uterine Rupture Due to Invasive Metastatic Gestational Trophoblastic Neoplasm  

PubMed Central

While complete molar pregnancies are rare, they are wrought with a host of potential complications to include invasive gestational trophoblastic neoplasia. Persistent gestational trophoblastic disease following molar pregnancy is a potentially fatal complication that must be recognized early and treated aggressively for both immediate and long-term recovery. We present the case of a 21-year-old woman with abdominal pain and presyncope 1 month after a molar pregnancy with a subsequent uterine rupture due to invasive gestational trophoblastic neoplasm. We will discuss the complications of molar pregnancies including the risks and management of invasive, metastatic gestational trophoblastic neoplasia. PMID:24106538

Bruner, David I.; Pritchard, Amy M.; Clarke, Jonathan

2013-01-01

381

Intraocular pressure after phacoemulsification in patients with uncontrolled primary open angle glaucoma  

PubMed Central

Abstract Rationale (hypothesis). Although cataract and glaucoma represent an increasingly common situation encountered concomitantly, the management of this association is still debatable. Objective (aim). We aimed to assess intraocular pressure dynamics after phacoemulsification in patients with uncontrolled primary open angle glaucoma (POAG). Methods and Results. The present study was designed as a prospective, non-randomized, cohort study. The study population comprised of 38 patients with medically uncontrolled POAG who underwent cataract surgery by phacoemulsification between 2011 and 2012. Most of the patients (32/38, 84.2%) needed glaucoma surgery after a variable time (mean time between surgeries was 11.6 +/- 4.18 months). Mean preoperative IOP decreased with 2,1 +/- 3,7 mmHg at 6 months (CI 95% 1.96 to 3.56) and with 1,9 +/- 3,9 mmHg at 12 months compared with the baseline IOP. Postoperative IOP was statistically significant lower compared with its preoperative value at 6 months (p=9.11 x 10??) and at one year (p=9.2 x 10??). The difference between mean IOP at 6 months and 1 year after cataract surgery was not statistically significant (p>0.05). Preoperatively, all the patients received topical antiglaucoma therapy. After phacoemulsification, their number did not change statistically significant, but it showed a slight increase. Average number of topical glaucoma medications used preoperatively was 2.66 + / -0.66, while at 6 months after surgery it was 2.71 + / - 0,75 and at 12 months postoperatively, 2.9 +/- 0.53. Discussion. IOP decreased statistically significant after phacoemulsification in patients with uncontrolled POAG, but the decrease was not sufficient for optimal glaucoma management; therefore, many patients needed subsequent glaucoma surgery. PMID:24653751

Iancu, R; Corbu, C

2014-01-01

382

CAUSAL ANALYSIS OF THE UNCONTROLLED MODERATOR IN THE HFEF MAIN CELL  

SciTech Connect

On 11/07/2012 while investigating the cause of defects in neutron radiography film at HFEF, oil was discovered near the elevator shaft located at the 4M location within the Main Cell. Subsequent investigation identified oil (untracked moderator) in several locations ofthe HFEF Main Cell. Initial analysis determined that oil leaking from a 1M shielding window had leaked past a compensatory containment system resulting in a thin layer of oil found in several locations on the main cell floor. The result of this condition is uncontrolled moderator in moderator controlled zones, which is a violation of Criticality Hazard Control Statements (CHCS) for HFEF.

Charles R. Posegate; Bryan P. Crofts

2012-12-01

383

Three-Dimensional Statistical Gas Distribution Mapping in an Uncontrolled Indoor Environment  

SciTech Connect

In this paper we present a statistical method to build three-dimensional gas distribution maps (3D-DM). The proposed mapping technique uses kernel extrapolation with a tri-variate Gaussian kernel that models the likelihood that a reading represents the concentration distribution at a distant location in the three dimensions. The method is evaluated using a mobile robot equipped with three 'e-noses' mounted at different heights. Initial experiments in an uncontrolled indoor environment are presented and evaluated with respect to the ability of the 3D map, computed from the lower and upper nose, to predict the map from the middle nose.

Reggente, Matteo; Lilienthal, Achim J. [AASS Research Center-Learning Systems Lab Oerebro University (Sweden)

2009-05-23

384

The Relationship of Objectively Measured Physical Activity and Sedentary Behaviour with Gestational Weight Gain and Birth Weight  

PubMed Central

Objective. To evaluate the relationship of physical activity (PA) and sedentary behaviour with gestational weight gain (GWG) and birth weight. Design. Combined data from two prospective studies: (1) nulliparous pregnant women without BMI restrictions and (2) overweight and obese pregnant women at risk for gestational diabetes. Methods. Daily PA and sedentary behaviour were measured with an accelerometer around 15 and at 32–35 weeks of gestation. The association between time spent in moderate-to-vigorous PA (MVPA) and in sedentary activities with GWG and birth weight was determined. Main outcome measures were GWG between 15 and 32 weeks of gestation, average GWG per week, and birth weight. Results. We studied 111 women. Early in pregnancy, 32% of women spent ?30 minutes/day in at least moderate PA versus 12% in late pregnancy. No significant associations were found between time spent in MVPA or sedentary behaviour with GWG or birth weight. Conclusions. We found no relation between MVPA and sedentary behaviour with GWG or birth weight. The small percentage of women meeting the recommended levels of PA indicates the need to inform and support pregnant women to maintain regular PA, as there seems to be no adverse effect on birth weight and maintaining PA increases overall health.

Ruifrok, Anneloes E.; Althuizen, Ellen; Oostdam, Nicolette; van Mechelen, Willem; de Groot, Christianne J. M.; van Poppel, Mireille N. M.

2014-01-01

385

Mild Diabetes Models and Their Maternal-Fetal Repercussions  

PubMed Central

The presence of diabetes in pregnancy leads to hormonal and metabolic changes making inappropriate intrauterine environment, favoring the onset of maternal and fetal complications. Human studies that explore mechanisms responsible for changes caused by diabetes are limited not only for ethical reasons but also by the many uncontrollable variables. Thus, there is a need to develop appropriate experimental models. The diabetes induced in laboratory animals can be performed by different methods depending on dose, route of administration, and the strain and age of animal used. Many of these studies are carried out in neonatal period or during pregnancy, but the results presented are controversial. So this paper, addresses the review about the different models of mild diabetes induction using streptozotocin in pregnant rats and their repercussions on the maternal and fetal organisms to propose an adequate model for each approached issue. PMID:23878822

Damasceno, D. C.; Sinzato, Y. K.; Bueno, A.; Netto, A. O.; Dallaqua, B.; Gallego, F. Q.; Iessi, I. L.; Corvino, S. B.; Serrano, R. G.; Marini, G.; Piculo, F.; Calderon, I. M. P.; Rudge, M. V. C.

2013-01-01

386

Diabetes Mellitus  

Microsoft Academic Search

Diabetic nephropathy is a complication of diabetes mellitus (DM) that can be prevented or slowed by medical and nutritional\\u000a interventions. Glycemic control coupled with the management of hypertension and dyslipidemia can alter the progression of\\u000a chronic kidney disease (CKD) in stages 1 through 4. Careful management of carbohydrate (CHO) intake is essential to diabetes\\u000a meal planning, emphasizing how much and

Joni J. Pagenkemper

387

Diabetic Neuropathy  

Microsoft Academic Search

Polyneuropathy is one of the commonest complications of the diabetes and the commonest form of neuropathy in the developed\\u000a world. Diabetic polyneuropathy encompasses several neuropathic syndromes, the most common of which is distal symmetrical neuropathy,\\u000a the main initiating factor for foot ulceration. The epidemiology of diabetic neuropathy has recently been reviewed in reasonable\\u000a detail (1). Several clinic- (2,3) and populationbased

Solomon Tesfaye

388

Diabetes Fact Sheet  

MedlinePLUS

... Alaska Natives Pregnancy What is diabetes? What is pre-diabetes? What are the different types of diabetes? Who ... with birth defects. Return to top What is pre-diabetes? Pre-diabetes means your blood glucose is higher ...

389

Paediatric diabetes.  

PubMed

Diabetes does not spare any section of society, and its prevalence in the paediatric and adolescent age group is rising. This review highlights the etiological and clinical features of childhood diabetes, including secular changes in epidemiology. It discusses the aspects of non pharmacological and pharmacological therapy which are unique to the paediatric age group, and explores current use of novel therapeutic modalities. The article calls for modulation of the psychological environment of the child with diabetes, to help improve his or her quality of life, and sensitizes physicians to take proactive, affirmative action to address the special needs of children with type1 diabetes. PMID:24601207

Kalra, Sanjay

2013-09-01

390

Cardiogenic diabetes.  

PubMed

It has been well established since the Framingham studies that diabetes mellitus is a risk factor for heart failure. Several recent reports suggested that the reverse is also true, and heart failure may also predispose to diabetes. We reviewed the literature and summarized the evidence of a higher incidence of new-onset diabetes in heart failure. Because a high rate of insulin resistance in heart failure is a known phenomenon, a higher incidence of diabetes in heart failure is intuitive. Although the facts confirming such connection is surprisingly scarce, we felt it was important to collect, analyze, and summarize the evidence. PMID:24174218

Guglin, Maya; Villafranca, Arnaldo; Morrison, Anthony

2014-09-01

391

Diabetes mellitus classification.  

PubMed

The right classification for diabetes mellitus (DM) allows a more adequate treatment and comprises four categories: type 1 DM, type 2 DM, other types, and gestational diabetes. In some cases, there might be a superposition of situations, especially with regard to the DM that initiates in the young adult or is initially presented with diabetic ketoacidosis intermediately to type 1 and 2 DM. Thus, additions to the classic classification system have been proposed as assessing the presence of autoimmunity (antibody) and b cell function (C-peptide) to precisely define the subtypes. The aim of this literature review was to analyze these diagnostic indexes` performance in the DM classification and to describe subtypes with details. The antibodies against pancreas confirm autoimmunity, and the antibody against insulin is more accurate before 5 years old, while the anti-glutamic acid decarboxylase is more accurate after 20 years old, a test which remains positive for a longer period. The measurement of C-peptide evaluates the pancreatic insulin reserve, and the most largely used methods of stimulation are the measurement after meals or after intravenous glucagon. C-peptide values < 1.5 ng/ml define a patient with absent pancreatic function and, above this value, patients with preserved function. When the presence of antibodies (A+) directed to the pancreas is combined to its insulin secretion capability (?+), it is possible to subdivide DM`s classification in type 1A (A+?-) and 1B (A+?-); and type 2A (A+?+) and 2B (A-?+), which allows a more precise classification and treatment besides opening horizons for the understanding of DM pathogenesis. PMID:20857049

Maraschin, Jorge de Faria; Murussi, Nádia; Witter, Vanessa; Silveiro, Sandra Pinho

2010-08-01

392

Placental enzymes of glycolysis, gluconeogenesis and lipogenesis in the diabetic rat and in starvation  

Microsoft Academic Search

Summary  The activity of several regulatory enzymes representing the pathways of glycolysis, gluconeogenesis, NADPH generation and\\u000a lipogenesis was measured in rat placenta, maternal and foetal livers on the 20th day of gestation. Streptozotocin diabetes,\\u000a induced on the 12th day of gestation, or 48 h of fasting did not induce adaptive changes in the activity of placental enzymes\\u000a while producing a typical

Y. Z. Diamant; E. Shafrir

1978-01-01

393

Influence of calcium intake on gestational hypertension.  

PubMed

Calcium intake during the third trimester of pregnancy was determined in 82 pregnant women by recording the consumption of foods over a 5-day period and by calculation of the quantity of this element provided by dietary supplements. For each subject, blood pressures were measured once per week using an aneroid sphygmomanometer, to detect and analyze differences in calcium intake between those with normal blood pressure and those suffering from gestational hypertension (7.3%). Calcium intake was significantly lower amongst subjects with high blood pressure (757.7 +/- 154.5 compared to 986.4 +/- 502.3 mg/day in normotensive subjects). The relationship between calcium intake and blood pressure was independent of other variables such as body mass index, number of previous pregnancies, weight gain, subject age or hematocrit levels. Though further investigation is needed, the results obtained seem to support the idea that pregnant women should try to maintain an optimal calcium intake. PMID:10364629

Ortega, R M; Martínez, R M; López-Sobaler, A M; Andres, P; Quintas, M E

1999-01-01

394

Dietary restraint and gestational weight gain  

PubMed Central

Objective To determine whether a history of preconceptional dieting and restrained eating was related to higher weight gains in pregnancy. Design Dieting practices were assessed among a prospective cohort of pregnant women using the Revised Restraint Scale. Women were classified on three separate subscales as restrained eaters, dieters, and weight cyclers. Subjects Participants included 1,223 women in the Pregnancy, Infection and Nutrition Study. Main outcome measures Total gestational weight gain and adequacy of weight gain (ratio of observed/expected weight gain based on Institute of Medicine (IOM) recommendations). Statistical analyses performed Multiple linear regression was used to model the two weight gain outcomes, while controlling for potential confounders including physical activity and weight gain attitudes. Results There was a positive association between each subscale and total weight gain, as well as adequacy of weight gain. Women classified as cyclers gained an average of 2 kg more than non-cyclers, and showed higher observed/expected ratios by 0.2 units. Among restrained eaters and dieters, there was a differential effect by BMI. With the exception of underweight women, all other weight status women with a history of dieting or restrained eating gained more weight during pregnancy and had higher adequacy of weight gain ratios. In contrast, underweight women with a history of restrained eating behaviors gained less weight compared to underweight women without those behaviors. Conclusions Restrained eating behaviors were associated with weight gains above the IOM recommendations for normal, overweight, and obese women, and weight gains below the recommendations for underweight women. Excessive gestational weight gain is of concern given its association with postpartum weight retention. The dietary restraint tool is useful for identifying women who would benefit from nutritional counseling prior to or during pregnancy in regards to achieving targeted weight gain recommendations. PMID:18926129

Mumford, Sunni L.; Siega-Riz, Anna Maria; Herring, Amy; Evenson, Kelly R.

2008-01-01

395

Pregnancy outcome at 24-31 weeks' gestation: neonatal survivors  

Microsoft Academic Search

All surviving babies of less than 32 weeks' gestation born to mothers resident in the Northern region in 1983 were assessed. No baby was lost to follow up, and 230 long term survivors were assessed when 2 years old, by a single observer. Among 248 neonatal survivors, severe disability was present in 10 of the 37 at 24-27 weeks' gestation

U Wariyar; S Richmond; E Hey

1989-01-01

396

ANNUAL REPRODUCTION, DEPENDENCY PERIOD, AND APPARENT GESTATION PERIOD  

E-print Network

by Johnson and Jameson 3 indi- cates annual reproduction in at least some Prince William Sound sea ottersNOTES ANNUAL REPRODUCTION, DEPENDENCY PERIOD, AND APPARENT GESTATION PERIOD IN TWO CALIFORNIAN SEA the reproductive cycle included a 7.5 mo gestation period; Bara- bash-Nikiforov (1935) estimated an 8-9 mo gesta

397

The effect of smoking on the risk of gestational hypertension  

Microsoft Academic Search

Data from the 1988 National Maternal and Infant Health Survey were used to examine the effect of smoking on the risk of gestational hypertension (GH). GH was defined as the occurrence of two consecutive diastolic blood pressure readings of at least 90 mmHg after the 20th week of gestation in the absence of proteinuria in subjects normotensive prior to pregnancy.

Dawn P. Misra; John L. Kiely

1995-01-01

398

Estimation of gestational age at birth. Comparison of two methods  

Microsoft Academic Search

Seventy-three low birthweight babies were independently assessed for gestational age using the scoring system of Dubowitz et al. (1970) and 5 neurological reflexes described by Robinson (1966). The results obtained by the 5 reflexes were compared with those obtained by the scoring system and were found to be accurate estimations of gestational age. The 5 reflexes may be used for

G L Serfontein; A M Jaroszewicz

1978-01-01

399

TSH Levels in Relation to Gestation, Birth Weight and Sex  

Microsoft Academic Search

Aims: Low birth weight is associated with hypothyroidism and an adverse metabolic profile in later life. Our aim was to examine the relationship between neonatal TSH and birth weight, gestational age and sex. Methods: We compared blood spot filter paper TSH levels with birth weight, gestational age and sex in a 10% sample of infants screened for congenital hypothyroidism at

Murthy Korada; Mark S. Pearce; Enid Avis; Steve Turner; Tim Cheetham

2009-01-01

400

[Experimental study on diabetes and pregnancy: with special reference to the effects of insulin treatment on fetuses of diabetic dams].  

PubMed

Through the development of treatment of diabetes mellitus, diabetic cases of pregnancy have been increasing, and the effects of maternal hyperglycemia and insulin-treated hypoglycemia on the growth and life of fetuses and newborns are becoming very important problems. However, it is difficult for us to investigate the fetuses of human diabetic mothers as experimental models. Although many reports deal with the development of newborns of diabetic mothers and about their secretory changes of insulin and C-peptide reactivity, there have been few reports concerning the effects of severe diabetes on pregnancy and the effects of insulin treatment on fetuses. Concerning experimental animals, there are also few reports about the effects of insulin treatment on diabetic pregnant animals. We conducted the present investigation to determine the effects of insulin treatment on the growth and metabolism of the fetuses of diabetic pregnant rats. Virgin female Wistar rats weighing 200 approximately 300 g were caged overnight with male rats. The mated females were isolated and the gestational age was calculated from noon of this day (zero). Seventeen of 24 pregnant rats received a rapid intravenous injection of 50 mg/kg body weight of streptozotocin (STZ) in 0.4 ml of 0.01 M citrate buffer (pH 4.5) immediately after blood samples were collected through the jugular vein under light ether anaesthesia on the 5th day of gestation. Seven pregnant rats were injected with only 0.4 ml of citrate buffer and served as the controls. These rats were divided into four groups, and each group was named as follows: Normal pregnant rats group (group I, n = 7), diabetic pregnant rats group (group II, n = 6) and insulin-treated diabetic pregnant rats group (group III: plasma glucose level 60 approximately 300 mg/dl, n = 6 and group IV: plasma glucose level below 60 mg/dl, n = 5). Group III and IV rats were treated with a subcutaneous injection of Lente Insulin (from 2 u. to 6 u.) every day from the 13th to the 19th day of gestation. Group II rats were injected with saline every day in the same way. Maternal blood samples were collected under light ether anaesthesia after feeding ad libitum on the 5th and 12th days of gestation. On the 20th day of gestation, the pregnant rats were anaesthetized by an intraperitoneal injection of sodium pentobarbital, and blood samples were collected in the manner stated above. Each fetus and placenta was taken out individually by hysterotomy.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:6363146

Kawara, A; Matsuura, M; Takahata, K; Hirose, Y; Ishihara, K; Makimura, H; Utsumi, M; Doi, K; Baba, S; Yoshida, M

1983-08-20

401

Addition of Manidipine Improves the Antiproteinuric Effect of Candesartan in Hypertensive Patients With Type II Diabetes and Microalbuminuria  

Microsoft Academic Search

Background: We sought to compare the effect of manidipine versus hydrochlorothiazide (HCTZ) in addition to candesartan on the urinary albumin excretion rate (UAER) in hypertensive patients with type II diabetes and microalbuminuria.Methods: After a 2-week washout and run-in period, and 8-week monotherapy with candesartan 16 mg every day, 174 microalbuminuric diabetic hypertensive patients with uncontrolled blood pressure (BP) (>130\\/80 mm

Roberto Fogari; Luca Corradi; Annalisa Zoppi; Pierangelo Lazzari; Amedeo Mugellini; Paola Preti; Andrea Rinaldi

2007-01-01

402

Resistin in Cord Blood of Small for Gestation Age and Appropriate for Gestation Age Term Neonates  

PubMed Central

Objective Placental hormones such as resistin, adiponectin, ghrelin and leptin are known to have considerable role in fetal growth and there are some articles published in this area recently. Nevertheless there is a shortage of data showing association between resistin level and fetal growth; that was why we decided to conduct a study to evaluate this association. Methods This study was approved by ethic committee of pediatric health research center and research vice chancellor of Tabriz University of Medical Sciences. In this case-control study we measured the insulin, glucose and resistin in the cord blood of neonates with gestational age of 37 weeks or more in Al Zahra tertiary hospital from March 2011 to March 2012. Thirty-nine appropriate for gestation age (AGA) neonates and 41 small for gestation age (SGA) neonates were studied. Findings The umbilical cord blood resistin level was not found to have significant correlation with the type of delivery [normal vaginal delivery (NVD) or cesarean-section (C-S)], neonate’s gender, maternal age or body mass index (BMI). There was no significant difference in the levels of Insulin and glucose between AGA and SGA groups. Resistin level of blood cord in AGA group was 613.76±180.10 (range: 132.6-983.80 ng/ml) and in SGA group it was 1303.47±537.07 (range: 800.9-3001 ng/ml) (P<0.001). Neonates’ weight in AGA group was 3162.82±407.92 g and in SGA group it was 2425.85±32.84 g (P<0.001). Conclusion In this study resistin level had reverse correlation with fetal weight in term neonates. The SGA neonates with growth insufficiency have higher resistin levels in their cord blood than AGA neonates with same gestational age. It is recommended to conduct more studies in future with larger population of patients to clarify the resistin role in neonatal birth weight. PMID:24910744

Farid, Sina Davari; Najati, Naiere; Gharebaghi, Manizheh Mostafa; Haghjo, Ali Ghorbani; Ghojazadeh, Morteza

2013-01-01

403

Household food insecurity is associated with self-reported pregravid weight status, gestational weight gain and pregnancy complications  

PubMed Central

Background Household food insecurity is positively associated with weight among women. The association between household food insecurity and pregnancy related weight gain and complications is not well understood. Objective To identify if an independent association exists between household food insecurity and pregnancy related complications. Design Data from the Pregnancy, Infection and Nutrition prospective cohort study were used to assess household food insecurity retrospectively using the United States Department of Agriculture (USDA) 18-item Core Food Security Module (CFSM) among 810 pregnant women with incomes ? 400% of the income/poverty ratio, recruited between January 2001 and June 2005 and followed through pregnancy. Main outcome measures Self-reported pregravid body mass index, gestational weight gain, second trimester anemia, pregnancy-induced hypertension, and gestational diabetes mellitus. Statistical analyses performed: Multivariate linear, multinomial logistic and logistic regression analyses. Results Among 810 pregnant women, 76% were from fully food secure, 14% were from marginally food secure, and 10% were from food insecure households. In adjusted models, living in a food insecure household was significantly associated with severe pregravid obesity [adjusted odds ratio (AOR) 2.97, 95% confidence intervals (CI) 1.44, 6.14], higher gestational weight gain [adjusted ? coefficient 1.87, 95% CI 0.13, 3.62] and with a higher adequacy of weight gain ratio [adjusted ? 0.27, CI 0.07, 0.50]. Marginal food security was significantly associated with gestational diabetes mellitus [AOR 2.76, 95% CI 1.00, 7.66]. Conclusions This study highlights the possibility that living in a food insecure household during pregnancy may increase risk of greater weight gain and pregnancy complications. PMID:20430130

Laraia, Barbara A.; Siega-Riz, Anna Maria; Gundersen, Craig

2010-01-01

404

Fetal scapular length in the ultrasonographic assessment of gestational age.  

PubMed

A prospective cross-sectional study of 515 singleton fetuses of ages between 15 and 42 weeks' gestation was performed. At gestational ages greater than 26 weeks, only fetuses with a sonographic estimated fetal weight between the 10th and 90th percentiles for growth were included. Scapular length (cm) as a function of gestational age (weeks) was expressed by the regression equation: SL = 0.3289 + 0.9553 (GA) with a Pearson correlation coefficient of R2 = 0.942. This study defines the normal limits of scapular length, demonstrates a high correlation between scapular length, gestational age, and other standard measurements of fetal growth, and indicates that scapular length can predict gestational age in fetuses with normal growth. PMID:7933014

Sherer, D M; Plessinger, M A; Allen, T A

1994-07-01

405

A high-selenium diet induces insulin resistance in gestating rats and their offspring  

PubMed Central

Although supranutrition of selenium (Se) is considered a promising anti-cancer strategy, recent human studies have shown an intriguing association between high body Se status and diabetic risk. This study was done to determine if a prolonged high intake of dietary Se actually induced gestational diabetes in rat dams and insulin resistance in their offspring. Forty-five 67-day-old female Wistar rats (n=15/diet) were fed a Se-deficient (0.01 mg/kg) corn–soy basal diet (BD) or BD+Se (as Se-yeast) at 0.3 or 3.0 mg/kg from 5 weeks before breeding to day 14 postpartum. Offspring (n=8/diet) of the 0.3 and 3.0 mg Se/kg dams were fed with the same respective diet until age 112 days. Compared with the 0.3 mg Se/kg diet, the 3.0 mg/kg diet induced hyperinsulinemia (P<0.01), insulin resistance (P<0.01), and glucose intolerance (P<0.01) in the dams at late gestation and/or day 14 postpartum and in the offspring at age 112 days. These impairments concurred with decreased (P<0.05) mRNA and/or protein levels of six insulin signal proteins in liver and muscle of dams and/or pups. Dietary Se produced dose-dependent increases in Gpx1 mRNA or GPX1 activity in pancreas, liver, and erythrocytes of dams. The 3.0 mg Se/kg diet decreased Selh (P<0.01), Sepp1 (P=0.06), and Sepw1 (P<0.01), but increased Sels (P<0.05) mRNA levels in the liver of the offspring, compared with the 0.3 mg Se/kg diet. In conclusion, supranutrition of Se as a Se-enriched yeast in rats induced gestational diabetes and insulin resistance. Expression of six selenoprotein genes, in particular Gpx1, was linked to this metabolic disorder. PMID:22342560

Zeng, Min-Shu; Li, Xi; Liu, Yan; Zhao, Hua; Zhou, Ji-Chang; Li, Ke; Huang, Jia-Qiang; Sun, Lv-Hui; Tang, Jia-Yong; Xia, Xin-Jie; Wang, Kang-Ning; Lei, Xin Gen

2012-01-01

406

Temperament of Small-for-Gestational-Age and Appropriate- for-Gestational-Age Infants across the First Year of Life.  

ERIC Educational Resources Information Center

Temperament development was studied in 39 full-term small-for-gestational-age infants and 30 full-term appropriate-for-gestational-age infants. Temperament was measured at 4, 8, and 12 months of age using a behavioral assessment procedure and questionnaire ratings. Findings indicated that restricted fetal growth negatively affects infant…

Halpern, Leslie F.; Coll, Cynthia T. Garcia

2000-01-01

407

Clinical Characteristics, Patient-Reported Outcomes, and Previous Therapeutic Management of Patients with Uncontrolled Neuropathic Pain Referred to Pain Clinics  

PubMed Central

Background. The aim of this report was to evaluate the clinical profile and previous management of patients with uncontrolled neuropathic pain who were referred to pain clinics. Methods. We included adult patients with uncontrolled pain who had a score of ?4 in the DN4 questionnaire. In addition to sociodemographic and clinical data, we evaluated pain levels using a visual analog scale as well as anxiety, depression, sleep, disability, and treatment satisfaction employing validated tools. Results. A total of 755 patients were included in the study. The patients were predominantly referred to pain clinics by traumatologists (34.3%) and primary care physicians (16.7%). The most common diagnoses were radiculopathy (43%) and pain of oncological origin (14.3%). The major cause for uncontrolled pain was suboptimal treatment (88%). Fifty-three percent of the patients were depressed, 43% had clinical anxiety, 50% rated their overall health as bad or very bad, and 45% noted that their disease was severely or extremely interfering with their daily activities. Conclusions. Our results showed that uncontrolled neuropathic pain is a common phenomenon among the specialties that address these clinical entities and, regardless of its etiology, uncontrolled pain is associated with a dramatic impact on patient well-being. PMID:24891950

de Andres, Jose; de la Calle, Jose-Luis; Perez, Maria; Lopez, Vanessa

2014-01-01

408

Maternal Diabetes in Pregnancy: Early and Long-Term Outcomes on the Offspring and the Concept of "Metabolic Memory"  

PubMed Central

The adverse outcomes on the offspring from maternal diabetes in pregnancy are substantially documented. In this paper, we report main knowledge on impacts of maternal diabetes on early and long-term health of the offspring, with specific comments on maternal obesity. The main adverse outcome on progenies from pregnancy complicated with maternal diabetes appears to be macrosomia, as it is commonly known that intrauterine exposure to hyperglycemia increases the risk and programs the offspring to develop diabetes and/or obesity at adulthood. This “fetal programming”, due to intrauterine diabetic milieu, is termed as “metabolic memory”. In gestational diabetes as well as in macrosomia, the complications include metabolic abnormalities, degraded antioxidant status, disrupted immune system and potential metabolic syndrome in adult offspring. Furthermore, there is evidence that maternal obesity may also increase the risk of obesity and diabetes in offspring. However, women with GDM possibly exhibit greater macrosomia than obese women. Obesity and diabetes in pregnancy have independent and additive effects on obstetric complications, and both require proper management. Management of gestational diabetes mellitus and maternal obesity is essential for maternal and offspring's good health. Increasing physical activity, preventing gestational weight gain, and having some qualitative nutritional habits may be beneficial during both the pregnancy and offspring's future life. PMID:22144985

Yessoufou, Akadiri; Moutairou, Kabirou

2011-01-01