These are representative sample records from Science.gov related to your search topic.
For comprehensive and current results, perform a real-time search at Science.gov.
1

Gestational diabetes  

MedlinePLUS

Gestational diabetes most often starts halfway through the pregnancy. All pregnant women should receive an oral glucose tolerance test between the 24th and 28th week of pregnancy to look for the condition. Women who have risk ...

2

Gestational Diabetes  

Microsoft Academic Search

Summary Gestational diabetes (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. GDM is becoming an increasing health problem worldwide and one of the most common complications of pregnancy. The prevalence of GDM in Central Europe is 5–7 %. GDM is associated with increased feto-maternal morbidity as well as long-term complications in mothers and

Alexandra Kautzky-Willer; Dagmar Bancher-Todesca

2003-01-01

3

How to Treat Gestational Diabetes  

MedlinePLUS

... A Listen En Español How to Treat Gestational Diabetes Be sure to see the latest Diabetes Forecast ... and a healthy start for your baby. Gestational Diabetes – Looking Ahead Gestational diabetes usually goes away after ...

4

Gestational Diabetes and Pregnancy  

MedlinePLUS

... on "Find a Nutrition Professional") Â Exercise Regularly Exercise is another way to keep blood sugar under control. It helps to balance food intake. ... who has had gestational diabetes to continue to exercise and eat a healthy diet after ... sugar every 1 to 3 years. More Information Gestational ...

5

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/ ...

6

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

7

Management of Gestational Diabetes Mellitus  

Microsoft Academic Search

Gestational diabetes mellitus is a common but controversial disorder. While no large ran- domized controlled trials show that screening for and treating gestational diabetes affect perinatal outcomes, multiple studies have documented an increase in adverse pregnancy outcomes in patients with the disorder. Data on perinatal mortality, however, are inconsis- tent. In some prospective studies, treatment of gestational diabetes has resulted

DAVID K. TUROK; STEPHEN D. RATCLIFFE; ELIZABETH G. BAXLEY

2003-01-01

8

Gestational diabetes mellitus.  

PubMed

Gestational diabetes mellitus (GDM) is the most common medical complication of pregnancy. It is associated with maternal and neonatal adverse outcomes. Maintaining adequate blood glucose levels in GDM reduces morbidity for both mother and baby. There is a lack of uniform strategies for screening and diagnosing GDM globally. This review covers the latest update in the diagnosis and management of GDM. The initial treatment of GDM consists of diet and exercise. If these measures fail to achieve glycemic goals, insulin should be initiated. Insulin analogs are more physiological than human insulin, and are associated with less risk of hypoglycemia, and may provide better glycemic control. Insulin lispro, aspart, and detemir are approved to be used in pregnancy. Insulin glargine is not approved in pregnancy, but the existing studies did not show any contraindications. The use of oral hypoglycemic agents; glyburide and metformin seems to be safe and effective in pregnancy. PMID:25828275

Alfadhli, Eman M

2015-04-01

9

Gestational Diabetes: What You Need to Know  

MedlinePLUS

... Info Statistics Research Resources 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: ...

10

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

11

Gestational Diabetes: A Guide for Pregnant Women  

MedlinePLUS

... Sumaria de los Consumidores Aug. 25, 2010 Gestational Diabetes Related Products Future Research Needs: Prioritizing Research Needs ... Women" /> Consumer Summary – Aug. 5, 2009 Gestational Diabetes: A Guide for Pregnant Women Formats Consumer Guide ( ...

12

Screening for Gestational Diabetes  

MedlinePLUS

... Diabetes What is the U.S. Preventive Services Task Force? The Task Force is an independent group of ... recommendation statement. To learn more, visit the Task Force Web site. USPSTF Recommendation Grades Grade Definition A ...

13

Am I at Risk for Gestational Diabetes?  

MedlinePLUS

... high blood sugar or diabetes. Am I at risk for gestational diabetes? Answer the questions below to ... and your risk level. Total YES answers: Your risk level is: Your health care provider: 2 or ...

14

Gestational diabetes mellitus screening and outcomes  

PubMed Central

Objective To verify the usefulness of the World Health Organization criteria for the diagnosis of gestational diabetes mellitus in pregnant women and its effectiveness in the prevention of maternal and neonatal adverse results in women younger than 35 years without apparent risk factors for gestational diabetes mellitus. Material and Methods This is a retrospective study based on population involving 1360 pregnant women who delivered and who were followed-up in a university hospital in Istanbul. All women underwent the 75-g oral glucose tolerance test screening, usually in between the 24th–28th weeks of pregnancy. In all cases, the identification of gestational diabetes mellitus was determined in accordance with the World Health Organization criteria. Results Approximately 28% of the pregnant women aged younger than 35 years with no risk factors for gestational diabetes mellitus were diagnosed with the oral glucose tolerance test in this study. In the gestational diabetes mellitus group, the primary cesarean section rate was importantly higher than that in the non-gestational diabetes mellitus group. Preterm delivery was also associated with gestational diabetes mellitus. The diagnosis of gestational diabetes mellitus was strongly associated with admittance to the neonatal intensive care unit. Neonatal respiratory problems didn’t showed any significant deviation between the groups. There was a moderate association between gestational diabetes mellitus and metabolic complications. Conclusion Pregnant women with no obvious risk factors were diagnosed with gestational diabetes mellitus using the World Health Organization criteria. The treatment of these women potentially reduced their risk of adverse maternal and neonatal hyperglycemia-related events, such as cesarean section, polyhydramnios, preterm delivery, admission to neonatal intensive care unit, large for gestational age, and higher neonatal weight. PMID:25788845

Aktün, Hale Lebriz; Uyan, Derya; Yorgunlar, Betül; Acet, Mustafa

2015-01-01

15

What I need to know about Gestational Diabetes  

E-print Network

What 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?................................. 1 What causes gestational diabetes? ........................ 3 What are my chances of getting

Rau, Don C.

16

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.

17

Diabetes Risk after Gestational Diabetes What is the link between  

E-print Network

Gestational Diabetes Mellitus and Diabetes? Gestational diabetes mellitus (GDM) is a form of diabetes that is diagnosed during pregnancy and increases risk of complications during pregnancy and birth for both mother and fetus. While GDM may go away after pregnancy, women who have had GDM are seven times more likely to develop type 2 diabetes than women who have not had GDM in pregnancy. The children of pregnancies affected by GDM may also have a greater risk for obesity and type 2 diabetes. What is the prevalence of GDM? GDM affects at least 7 percent[1] and possibly as many as 18 percent of pregnancies in the United States. Using new diagnostic criteria, an international, multicenter study of gestational diabetes found that 18 percent of the pregnancies were affected by gestational diabetes.[2] Who is at risk for developing diabetes after GDM? Immediately after pregnancy, 5 to 10 percent of women with GDM are found to have diabetes, usually type 2.[1

unknown authors

18

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

19

Screening and management of gestational diabetes.  

PubMed

Gestational diabetes (GDM) is a frequent medical condition during pregnancy. It is associated with an increased risk of complications for both the mother and the baby during pregnancy and post partum. The International Association of Diabetes and Pregnancy Study Groups (IADPSG) has proposed a new screening strategy for overt diabetes in pregnancy and screening for GDM. However, there is still a lack of international uniformity in the approach to the screening and diagnosis of GDM. Controversies include universal versus selective screening, the optimal time for screening, appropriate tests and cutoff values, and whether testing should be conducted in one or two steps. This review gives an update on screening for GDM and overt diabetes during pregnancy. We also give an overview on the medical and obstetrical management of GDM. PMID:25457858

Benhalima, Katrien; Devlieger, Roland; Van Assche, André

2015-04-01

20

Type 2 Diabetes Risk After Gestational Diabetes What is the link between Gestational Diabetes Mellitus  

E-print Network

and type 2 Diabetes? Gestational Diabetes Mellitus (GDM) is a form of glucose intolerance that is diagnosed during pregnancy. After pregnancy, 5 to 10 percent of women who had GDM are found to have type 2 diabetes. Women who have had GDM have a 20 to 50 percent chance of developing diabetes in the next 5 to 10 years following pregnancy. 1, 2 The children of women with a history of GDM are at an increased risk for obesity and diabetes compared to other children. 3,4 What is the prevalence of GDM? In the United States, GDM affects about 7 percent of all pregnancies, resulting in more than 200,000 cases annually. 2 Recent reports have noted high or increasing prevalence rates for GDM in various parts of the United States, including: o Washington, D.C., where the prevalence rate in Hispanic/Latina women was 12 percent in 2003, 5 close to the highest rate of 14 percent seen in some American Indian communities. 6 o New York City, where the prevalence increased 46 percent from 2.6 percent in

unknown authors

21

Gestational Diabetes Mellitus: A Positive Predictor of Type 2 Diabetes?  

PubMed Central

The aim of this paper is to consider the relative benefits of screening for type two diabetes mellitus in women with a previous pregnancy complicated by gestational diabetes mellitus. Recent studies suggest that women who experience GDM are at a greater risk of developing type 2 diabetes within 10–20 years of their index pregnancy. If considered as a stand-alone indicator of the risk of developing type 2 diabetes, GDM is a poor diagnostic test. Most women do not develop GDM during pregnancy and of those that do most do not develop type 2 diabetes. There is, however, a clear need for better early detection of predisposition to disease and/or disease onset to significantly impact on this global pandemic. The putative benefits of multivariate approaches and first trimester and preconception screening to increase the sensitivity of risk assignment modalities for type 2 diabetes are proposed. PMID:22675354

Rice, Gregory E.; E. Illanes, Sebastian; Mitchell, Murray D.

2012-01-01

22

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

23

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

24

Risk factors and management of gestational diabetes.  

PubMed

Gestational diabetes mellitus (GDM) is considered to be a typical condition of glucose intolerance in which a woman previously undiagnosed with diabetes exhibits high levels of blood glucose during the third trimester of pregnancy. It can hence be defined as any degree of intolerance to glucose with its first recognition only during the pregnancy. Approximately 7 % of all cases of pregnancy are found to be variedly complicated with GDM and this result in more than 200,000 cases annually. In US only, GDM has been found to complicate about 7-14 % cases annually, and the trend seems to have increased by 35-100 % in the recent years. A history of GDM can be considered to be one of the sturdiest risk factors concerning the development of type 2 diabetes. Among women who have a history of GDM, the risk of developing classical type 2 diabetes usually ranges from 20 to 50 %. Evidences collected from various efficacy trials suggest that lifestyle interventions like weight management can modulate and prevent type 2 diabetes in at-risk individuals. The cornerstone of GDM management is glycemic control, and hence, it is attributed to be the main focus of attention for the therapy. In this review, we have tried to highlight the various risk factors associated with GDM along with the available therapeutic options in the treatment and management of the disease. PMID:25269773

Chen, Penglong; Wang, Shuxiang; Ji, Jianying; Ge, Aiping; Chen, Chunlai; Zhu, Yanfei; Xie, Ni; Wang, Yi

2015-03-01

25

[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

26

[Gestational diabetes: criteria for screening and diagnosis].  

PubMed

Gestational diabetes (GDM), defined as a carbohydrate intolerance of variable severity with onset of first recognition during pregnancy, is a significantly frequent condition, often pauci- or asymptomatic, which is associated with an increase of maternal, fetal and neonatal morbidity, plus an increased risk of later overt diabetes mellitus in the mother. Good glycemic control significantly reduces the risks of complications, so it is strongly recommended to detect GDM. The screening test suggested by the Workshop-Conference held in Chicago in 1991 and by the NDDG is the 50 g oral glucose load, venous plasma glucose measured 1 h later (OGCT) at the 24th-28th week gestation in all the pregnant women. The test may be administered earlier when factors of metabolic risks are present. If 1h-glycemia is > 140 mg/dl, a full diagnostic test, 100 g oral glucose load, venous plasma glucose fasting and 1, 2, 3 hours later, should be performed. Cut-off values are still controversial. WHO suggest to adopt for diagnosis the same method and criteria used in non pregnant adults: 75 g oral glucose load, venous plasma glucose fasting, 1 and 2 hours later. This load, followed by a 2 hours glycemia, is utilized for screening, too. Nevertheless, WHO detects an interesting status intermediate between GDM and normal tolerance the reduced glycemic tolerance. Outside a formal OGTT, a fasting glycemia > 140 mg/dl and/or a random plasmatic value > 200 mg/dl suggest diabetes.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7968928

Santini, C; Dradi Maraldi, C

1994-06-01

27

[Gestational diabetes mellitus: yesterday, today, tomorrow].  

PubMed

Gestational diabetes mellitus (GDM) is hyperglycemia that is first detected during pregnancy and does not meet the criteria for manifest diabetes. The incidence of GDM worldwide varies from 1 to 14% and that in Russia is as high as 4%. Hyperglycemia during pregnancy is associated with the development of preeclampsia, the birth of a big baby, emergency cesarean section, birth trauma, and neonatal hypoglycemia. The fact that there is no well-organized screening for GDM in our country leads to that the diagnosis of this condition is delayed for 4--20 weeks in 50-60% of cases. The risk group distribution of pregnant women leads ,to the diagnosis of GDM only in 50% of cases. At the same time, pregnancy is accompanied by physiological insulin resistance so the latter itself is a clinically important risk factor for carbohydrate metabolic disturbances. The Hyperglycemia and Adverse Pregnancy Outcomes (HYPO) study has indicated that the previously used diagnostic criteria for GDM require reconsideration. There is a need for uniform standards for the diagnosis and treatment of carbohydrate metabolic disturbances during pregnancy. The concepts (diabetes mellitus (DM)W and (manifest (new-onset DM during pregnancy( and directly UGDM( require clear clinical and laboratory definitions. Furthermore, GDM is a risk factor for obesity, type 2 DM and cardiovascular diseases in the mother and her offspring in future. PMID:25509903

Burumkulova, F F; Petrukhin, V A

2014-01-01

28

Orbital Complications of Fungal Pan-Sinusitis in Uncontrolled Diabetes  

PubMed Central

ABSTRACT The purpose of our clinical case presentation is to emphasize the role of ear, nose and throat specialist in early recognition and urgent treatment of mucormycosis, which is a rare infection caused by fungus belonging to the order Mucorales. They are known opportunistic organisms, which potentially invade and infect a host with depressed immunity. In our paper we present a case of an uncontrolled diabetic male with orbital complications caused by a fungal pan-sinusitis. The typical presentation of rhino-orbital fungal infection is that of anterior orbital inflammation, severe visual loss, external ophthalmoplegia and fever. Our diagnostic was based on an otolaryngological, ophthalmological, imagistic but especially biopsy exam, which is the only one that can make the certain diagnostic in this case. We followed the standard treatment for these situations. Early recognition and treatment with urgent surgical debridement and systemic antifungal therapy is the key to the management of rhino-orbital mucormycosis and is necessary to limit the spread of infection, which can lead to high morbidity and mortality. Therefore, health practitioners should be familiar with the signs and symptoms of the disease. The authors certify that they do not have any financial or personal relationships that might bias the content of this work. PMID:24371499

NICOLAE, Miruna; POPESCU, Cristian Radu; POPESCU, Bogdan; GRIGORE, Raluca

2013-01-01

29

Metformin in gestational diabetes: An emerging contender  

PubMed Central

Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance occurring first time during pregnancy. Its prevalence is simultaneously increasing with the global rise of diabesity. GDM commonly develops, when maternal glucose metabolism is unable to compensate for the progressive development of insulin resistance, arising primarily from the consistently rising diabetogenic placental hormones. It classically develops during the second or third trimester. Theoretically, insulin sensitizers should have been the ideal agent in its treatment, given the insulin resistance, the major culprit in its pathogenesis. Fortunately, majority of women can be treated satisfactorily with lifestyle modification, and approximately 20% requires more intensive treatment. For several decades, insulin has been the most reliable treatment strategy and the gold standard in GDM. Metformin is effective insulin sensitizing agent and an established first line drug in type 2 diabetes currently. As it crosses the placenta, a safety issue remains an obstacle and, therefore, metformin is currently not recommended in the treatment of GDM. Nevertheless, given the emerging clinically equivalent safety and efficacy data of metformin compared to insulin, it appears that it may perhaps open a rather new door in managing GDM. The aim of this review is to critically analyze, the safety and efficacy data of metformin regarding its use in GDM and pregnant mothers with polycystic ovarian disease, which has emerged in past decades. PMID:25729685

Singh, Awadhesh Kumar; Singh, Ritu

2015-01-01

30

Vascular Function in Women with Previous Gestational Diabetes mellitus  

Microsoft Academic Search

It is hypothesised that vascular dysfunction, which characterises type 2 diabetes, may predate development of hyperglycaemia. 17 women with previous gestational diabetes mellitus, and thus at risk of developing type 2 diabetes, were matched with normal controls for body mass index, menstrual phase, smoking, age, blood pressure, and lipid profiles. All had normal glucose tolerance. Tests of microvascular and macrovascular

Michael M. Hannemann; William G. Liddell; Angela C. Shore; Penny M. Clark; John E. Tooke

2002-01-01

31

Post natal glucose tolerance testing in gestational diabetes  

Microsoft Academic Search

Diabetes complicates 5% of all pregnancies. 87.5% are due to gestational diabetes mellitus (GDM). These women are at a high risk of developing Type 2 Diabetes Mellitus and up to 50% will be diagnosed in the following 10 years. Current recommendations are that we carry out an oral glucose tolerance test (OGTT) at 6 weeks postpartum and yearly thereafter. Postnatal

R M OLoughlin; M ORiordan

2011-01-01

32

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- ...

33

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. PMID:25284837

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

2012-01-01

34

Maternal outcomes and follow-up after gestational diabetes mellitus.  

PubMed

Gestational diabetes mellitus reflects impaired maternal insulin secretion relative to demand prior to pregnancy, as well as temporary metabolic stressors imposed by the placenta and fetus. Thus, after delivery, women with gestational diabetes have increased risk of diabetes and recurrent gestational diabetes because of their underlying impairment, which may be further exacerbated by fat accretion during pregnancy and post-partum deterioration in lifestyle behaviours. This hypothetical model is discussed in greater detail, particularly the uncertainty regarding pregnancy as an accelerator of ?-cell decline and the role of gestational weight gain. This report also presents risk estimates for future glucose intolerance and diabetes and reviews modifiable risk factors, particularly body mass and lifestyle alterations, including weight loss and breastfeeding. Non-modifiable risk factors such as race/ethnicity and insulin use during pregnancy are also discussed. The review concludes with current literature on lifestyle modification, recommendations for post-partum glucose screening, and future directions for research to prevent maternal disease. PMID:24341443

Kim, C

2014-03-01

35

Maternal outcomes and follow-up after gestational diabetes mellitus  

PubMed Central

Gestational diabetes mellitus reflects impaired maternal insulin secretion relative to demand prior to pregnancy, as well as temporary metabolic stressors imposed by the placenta and fetus. Thus, after delivery, women with gestational diabetes have increased risk of diabetes and recurrent gestational diabetes because of their underlying impairment, which may be further exacerbated by fat accretion during pregnancy and post-partum deterioration in lifestyle behaviours. This hypothetical model is discussed in greater detail, particularly the uncertainty regarding pregnancy as an accelerator of ?-cell decline and the role of gestational weight gain. This report also presents risk estimates for future glucose intolerance and diabetes and reviews modifiable risk factors, particularly body mass and lifestyle alterations, including weight loss and breastfeeding. Non-modifiable risk factors such as race/ethnicity and insulin use during pregnancy are also discussed. The review concludes with current literature on lifestyle modification, recommendations for post-partum glucose screening, and future directions for research to prevent maternal disease. PMID:24341443

Kim, C.

2014-01-01

36

Gestational Diabetes Mellitus: Diagnosis, Maternal and Fetal Outcomes, and Management  

Microsoft Academic Search

\\u000a Gestational diabetes mellitus (GDM), or diabetes first recognized during pregnancy, is associated with increased risk of adverse\\u000a perinatal outcomes. After GDM delivery, both mothers and offspring are at risk for long-term chronic disease. Clinical recognition\\u000a and treatment of GDM may reduce peripartum risk, but there is a lack of consensus on how to define, screen and treat GDM.\\u000a There is

Assiamira Ferrara; Catherine Kim

37

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

38

A simple index for detection of gestational diabetes mellitus  

Microsoft Academic Search

SUMMARY The conventional screening test for gestational diabetes mellitus is measurement of plasma glucose 1 hour after 50 g glucose by mouth. The sensitivity and specificity of this test are lower than desirable; we therefore developed an index including other plasma constituents. In a preliminary study, 138 pregnant women had the standard oral glucose load screening test, and plasma fructosamine

Rafael Perea-Carrasco; Rocio Perez-Coronel; Rogelio Albusac-Aguilar; Manuel Lombardo-Grifol; Elena Bassas-Baena de Leon; Carlos Romero-Diaz

39

Gestational Diabetes Mellitus: Physical Exercise and Health Outcomes  

Microsoft Academic Search

Purpose: Gestational diabetes mellitus (GDM) is a serious complication of pregnancy associated with increased risk of adverse outcomes for both mother and infant. This study assesses the association of maternal exercise during GDM pregnancy and selected maternal and infant adverse GDM-related outcomes. The analysis uses information derived from the 1988 National Maternal Infant Health Survey (NMIHS) data. Methods: Women in

Carol A. Snapp; Sue K. Donaldson

2008-01-01

40

Is Gestational Diabetes Linked to Autism?  

MedlinePLUS

... Tuesday, April 14, 2015 Related MedlinePlus Pages Autism Spectrum Disorder Diabetes and Pregnancy TUESDAY, April 14, 2015 ( ... to a moderately increased risk for an autism spectrum disorder in a study of more than 320, ...

41

Adverse effect of obesity on red cell membrane arachidonic and docosahexaenoic acids in gestational diabetes  

Microsoft Academic Search

Aims\\/hypothesis  Gestational diabetes is a metabolic disorder affecting 2–5% of women and is a predictor of obesity, Type 2 diabetes mellitus and cardiovascular disease. Insulin resistance, a characteristic of gestational diabetes and obesity, is correlated with the fatty acids profile of the red cell and skeletal muscle membranes. We investigated the plasma and red cell fatty acid status of gestational diabetes.

Y. Min; K. Ghebremeskel; C. Lowy; B. Thomas; M. A. Crawford

2004-01-01

42

Asymmetric dimethylarginine concentrations are elevated in women with gestational diabetes  

Microsoft Academic Search

As shown in the previous studies, asymmetric dimethylarginine (ADMA) is related to endothelial dysfunction, whereas high-sensitive\\u000a C-reactive protein (hCRP) is the marker of inflammation. In our study, we investigated ADMA, hCRP, and homocysteine concentrations\\u000a in women with gestational diabetes mellitus (GDM) and normal glucose tolerance (NGT) during late pregnancy. Fifty-four women\\u000a with GDM and 69 women with NGT between 32

Mujde Akturk; Alev Altinova; Ismail Mert; Aylin Dincel; Ayla Sargin; Umran Buyukkagnici; Metin Arslan; Nuri Danisman

2010-01-01

43

[Induce or not induce labor in gestational diabetes].  

PubMed

The most serious hazard of gestational diabetes is shoulder dystocia, which sometimes is complicated by Erb's palsy and maternal lacerations. This risk is linked to fetal weight, and is more frequent in cases of diabetes. So, a caesarean section performed when macrosomia is present is required and an induction of labor before severe macrosomia is proposed. Unfortunately, estimation of fetal weight is imprecise in spite of formulas from fetal parameters. Abdomen circumference (AC) alone is as effective as complex formulas. So, it is proposed to perform an elective section when AC is equal or above 38 cm, and to induce labor, after 38 weeks of gestation, for limiting the risk of macrosomia when AC is between 35 and 38 cm. Induction is also proposed when pregnancy is complicated by hypertension or when fetal heart septal hypertrophy occurs. The management of gestational diabetes means a strict control of glycemia, which can reduce macrosomia and the need for cesarean section or induction of labor. PMID:12451355

Fournié, A; Le Digabel, J F; Biquard, F; Vasseur, C; Gillard, P; Descamps, P

2002-10-01

44

Potential impact of American Diabetes Association (2000) criteria for diagnosis of gestational diabetes mellitus in Spain  

Microsoft Academic Search

Aims\\/hypothesis  This study was carried out to determine the impact of American Diabetes Association (ADA) 2000 criteria for the diagnosis of gestational diabetes mellitus (GDM) in the Spanish population.Methods  Pregnant women were assigned to one of four categories: negative screenees, false-positive screenees, ADA-only-GDM (untreated) and GDM according to National Diabetes Data Group (NDDG) criteria (treated). Fetal macrosomia and Caesarean section were defined

W. Ricart; J. López; J. Mozas; A. Pericot; M. A. Sancho; M. Balsells; R. Luna; A. Cortázar; P. Navarro; O. Ramírez; B. Flández; L. F. Pallardo; A. Hernández; J. Ampudia; J. M. Fernández-Real; R. Corcoy

2005-01-01

45

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

46

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

47

Gestational Diabetes Mellitus: Risks and Management during and after Pregnancy  

PubMed Central

Gestational diabetes mellitus (GDM) represents glucose levels in the high end of the population distribution during pregnancy. GDM carries a small but potentially important risk of adverse perinatal outcomes and a longer-term risk of obesity and glucose intolerance in offspring. Mothers with GDM have an excess of hypertensive disorders during pregnancy and a high risk of diabetes mellitus thereafter. Diagnosing and treating GDM can reduce perinatal complications, but only a small fraction of pregnancies benefit. Nutritional management is the cornerstone of treatment; insulin, glyburide and metformin can be used to intensify treatment. Fetal measurements compliment maternal glucose measurements in identifying pregnancies that need such intensification. Glucose testing shortly after pregnancy can stratify the near-term diabetes risk in mothers, Thereafter, annual glucose and HbA1C testing can detect deteriorating glycaemic control, a harbinger of future diabetes, usually type 2. Interventions that mitigate obesity or its metabolic effects are most potent in preventing or delaying diabetes. Lifestyle modification is the primary approach; use of medications for diabetes prevention after GDM remains controversial. Family planning allows optimization of health in subsequent pregnancies. Breastfeeding may reduce obesity in children and is recommended. Families should be encouraged to help children adopt lifestyles that reduce the risk of obesity. PMID:22751341

Buchanan, Thomas A.; Xiang, Anny H.; Page, Kathleen A.

2015-01-01

48

[Is there a standard biological screening of gestational diabetes mellitus?].  

PubMed

Universal screening for gestational diabetes mellitus (GDM) is contentious. There is insufficient evidence that universal screening for GDM substantially reduces perinatal complications such as cesarean section and Erb's palsy.However, risk assessment for GDM should be undertaken at the first prenatal visit and selective screening should be performed in high-risk women: diabetes mellitus in first-degree relatives, member of an ethnic group with a high prevalence of diabetes mellitus, body mass index > or 25 kg/m2, personal history of hyperglycemia or GDM, previous poor obstetric outcome. During the first trimester, a fasting glycemia over 1.05 g/l is associated with perinatal complications and should be treated. If fasting glycemia is below this level or unknown, or if glucosuria occurs, they should be re-tested between 24 and 28 weeks of gestation using a 75-g oral glucose load. The actual proposed glucose threshold values for GDM are, respectively, 1.05 and 1.55-1.60 g/l for fasting and 2 h. PMID:15217570

Lepercq, J

2004-06-01

49

New criteria for gestational diabetes in Tehran, Iran  

PubMed Central

Background: Gestational diabetes mellitus (GDM) is common problem during pregnancy. Diagnostic criteria of this problem are based on foreign population. Because of differences in racial, cultural, and nutritional characteristics, we need to determine these criteria are suitable for Iranian population. Objective: To determine whether different diagnostic criteria of gestational diabetes mellitus (GDM) are suitable for Iranian population. Materials and Methods: Prospective study was performed on 617 pregnant women. 1804 subjects referred for 50 g glucose challenge test (GCT) between 24th and 28th weeks of gestation. 617 women with abnormal GCT (blood glucose ?130 mg/dl) underwent 100-g 3-h oral glucose tolerance test (OGTT). The results were classified by three diagnostic criteria: new “Iranian” diagnostic criteria based on the results from the 100-g 3-h OGTT performed in healthy participating women; the Carpenter and Coustan (CC) criteria; and the National Diabetes Data Group (NDDG) criteria. Obstetric and neonatal outcomes were recorded. Results: With 89% as the statistical cutoff value for the 100-g 3-h OGTT, the new diagnostic criteria were 92, 179, 153, and 121 mg/dL at 0, 60, 120, and 180 min. The K value was 0.945 for the new criteria vs. the CC criteria and 0.657 for the new criteria vs. the NDDG criteria (p<0.001). In women with GDM, the incidence rates of adverse outcomes by the new and CC criteria were similar, but higher than NDDG criteria (p<0.05). Conclusion: Carpenter and Coustan criteria are applicable to Iranian pregnant women for diagnosis of GDM. PMID:25242999

Behboudi Gandevani, Samira; Garshasbi, Ahia; Shahpari Niri, Sara; Naghizade, Mohammad Mehdi

2012-01-01

50

Strategies in the Nutritional Management of Gestational Diabetes  

PubMed Central

Elucidating the optimal macronutrient composition for dietary management of gestational diabetes mellitus(GDM) has enormous potential to improve perinatal outcomes. Diet therapy may result in significant cost savings if effective in deterring the need for expensive medical management within this growing population. In only 6 randomized controlled trials(RCTs) in 250 women, data suggest that a diet higher in complex carbohydrate and fiber, low in simple sugar, and lower in saturated fat may be effective in blunting postprandial hyperglycemia, preventing worsened insulin resistance and excess fetal growth. The use of diet in GDM remains an area in grave need for high-quality RCTs. PMID:24047934

Hernandez, Teri L.; Anderson, Molly A.; Chartier-Logan, Catherine; Friedman, Jacob E.; Barbour, Linda A.

2013-01-01

51

The Association Between Gestational Diabetes Mellitus and Recreational Physical Activity  

Microsoft Academic Search

We aimed to investigate the association of recreational physical activity before pregnancy with gestational diabetes mellitus\\u000a (GDM). A cross-sectional study was performed using self-reported data from the Pregnancy Risk Assessment and Monitoring System.\\u000a The study population included 1,052 self-reported GDM cases and 10,351 non-GDM controls. Recreational physical activity in\\u000a the 3 months before pregnancy was recalled in postpartum structured interviews. Compared

Stephanie L. Redden; Michael J. LaMonte; Jo L. Freudenheim; Carole B. Rudra

2011-01-01

52

Parallel workflows to personalize clinical guidelines recommendations: Application to Gestational Diabetes Mellitus  

E-print Network

to Gestational Diabetes Mellitus G. García-Sáez1,2 , M. Rigla3 , E. Shalom4 , M. Peleg5 , E. Caballero2 , E. J Diabetes (GD). This paper presents a methodology to identify personalized recommendations, obtained from

Peleg, Mor

53

Gestational diabetes mellitus and cardiovascular risk after pregnancy.  

PubMed

Gestational diabetes mellitus (GDM) affects many women in pregnancy and is enhanced by epidemic conditions of obesity, increasing age at the time of the first pregnancy, stressful life conditions, a sedentary lifestyle with less physical activity and unhealthy nutrition with highly processed, high-calorie food intake. GDM does not affect the mother and offspring in pregnancy alone, as there is compelling evidence of the long-term effects of the hyperglycemic state in pregnancy postpartum. Type 2 diabetes mellitus, cardiovascular disease and metabolic syndrome are more common in GDM women, and even the offspring of GDM women are reported to have higher obesity rates and a higher risk for noncommunicable diseases. Early prevention of risk factors seems to be key to overcoming the vicious cycle of cardiometabolic disease onset. PMID:24328601

Harreiter, Jürgen; Dovjak, Gregor; Kautzky-Willer, Alexandra

2014-01-01

54

Frequency of gestational diabetes mellitus and the associated risk factors  

PubMed Central

Objective: This prospective study was undertaken to assess the frequency of gestational diabetes mellitus (GDM) and the associated risk factors during pregnancy. Methods: The sample consisted of 650 pregnant women who had no known risk factors for GDM and were followed-up at the Outpatient Clinic for Pregnant Women, Corum State Hospital between March 2009 and June 2010. The data were expressed as percentage, arithmetic mean, standard deviation and chi-square test. Results: Of the 650 pregnant women, 45 were diagnosed with GDM during the study period (6.9%). A statistically significant correlation between GDM and advanced age, family history, and body mass index was found, while no significant correlations existed between GDM and the frequency of pregnancy, number of pregnancy, parity, and number of live births. Conclusion: Advanced age, high body mass index and family history of diabetes mellitus emerged as risk factors for GDM in our study.

Duman, Nuriye Buyukkayaci

2015-01-01

55

Taurine in women with a history of gestational diabetes.  

PubMed

Taurine is the most abundant amino acid in the human body and seems to play an important role in increasing glucose-mediated insulin secretion, as well as in programming beta-cell maturation during the prenatal life in utero. To test the hypothesis that plasma taurine is related to glucose tolerance, insulin sensitivity and insulin secretion in subjects with history of beta-cell dysfunction such as women with history of gestational diabetes (GDM), we studied 72 non-diabetic women with history of GDM (n=43), impaired glucose tolerance (IGT; n=7), and normal glucose tolerance (NGT; n=22) as previously classified by a 100g-3h-OGTT performed between the 24th and the 28th gestational week. Insulin sensitivity (ISIogtt, calculated through Matsuda-DeFronzo index) and a proxy for insulin secretion (basal plasma C-peptide/fasting plasma glucose; CP/glucose) were measured during and after pregnancy. Plasma taurine was measured after a median period of 6 years (2-11 years) from index pregnancy, when glucose tolerance was retested by a 75 g-2h-OGTT. Plasma taurine was significantly lower in women who had experienced GDM and was unrelated to ISIogtt. Moreover, plasma taurine was inversely related to previous gestational area-under-curve of glucose and directly related to post-gestational CP/glucose, as well to CP/glucose measured during pregnancy (p<0.05 for both). The relative risk of altered glucose metabolism during previous pregnancies (IGT+GDM) was higher as plasma taurine decreased, even after adjusting for age, time-lag from pregnancy, body mass index and family history of diabetes (OR: 0.980; CI 95%: 0.963-0.999, p=0.003). In conclusion plasma taurine seems to be a fair marker of altered glucose metabolism during past pregnancies in women with antecedent GDM and appears to be inversely related to the previous as well as to the actual insulin secretion in these subjects. PMID:16996164

Seghieri, Giuseppe; Tesi, Federica; Bianchi, Loria; Loizzo, Alberto; Saccomanni, Giuseppe; Ghirlanda, Giovanni; Anichini, Roberto; Franconi, Flavia

2007-05-01

56

Gestational Diabetes Diagnostic Methods (GD2M) Pilot Randomized Trial.  

PubMed

To test the feasibility of conducting a pragmatic randomized controlled trial (RCT) comparing the International Association of Diabetes in Pregnancy Study Groups (IADPSG) versus Carpenter-Coustan diagnostic criteria for gestational diabetes (GDM), and to examine patient and provider views on GDM screening. A single-blinded pragmatic pilot RCT. Participants with a singleton pregnancy between 24 and 28 weeks gestation received a 50 g oral glucose challenge test and if the value was <200 mg/dL were randomized to either the 2 h 75 g OGTT using the IADPSG criteria or the 3 h 100 g OGTT using the Carpenter-Coustan criteria. Primary outcome was the feasibility of randomization and screening. Secondary outcomes included patient and provider views (or preferences) on GDM testing. Sixty-eight women were recruited, 48 (71 %) enrolled and 47 (69 %) were randomized. Participants in both study arms identified the main challenges to GDM testing to be: drinking the glucola, fasting prior to testing, waiting to have blood drawn, and multiple venipuntures. Women in both study arms would prefer the 2 h 75 g OGTT or whichever test is recommended by their doctor in a future pregnancy. Physicians and nurse midwives endorsed screening and were comfortable with being blinded to the GDM testing strategy and results values. Both pregnant women and providers value GDM screening, and pregnant women can be recruited to a blinded, randomized GDM screening trial with minimal attrition and missing data. PMID:25424454

Scifres, Christina M; Abebe, Kaleab Z; Jones, Kelley A; Comer, Diane M; Costacou, Tina; Freiberg, Matthew S; Simhan, Hyagriv N; Day, Nancy L; Davis, Esa M

2014-11-26

57

Previous Gestational Diabetes Mellitus and Markers of Cardiovascular Risk  

PubMed Central

The prevalence of gestational diabetes mellitus (GDM) in the developed world has increased at an alarming rate over the last few decades. GDM has been shown to be associated with postpartum diabetes, insulin resistance, hypertension, and dyslipidemia. A history of previous GDM (pGDM), associated or not with any of these metabolic abnormalities, can increase the risk of developing not only type 2 diabetes mellitus but also cardiovascular disease (CVD) independent of a diagnosis of type 2 diabetes later in life. In this paper we discuss the relationship among inflammatory markers, metabolic abnormalities, and vascular dysfunction in women with pGDM. We also review the current knowledge on metabolic modifications occurring in normal pregnancy and the link between alterations of a normal metabolic state with the long-term maternal complications that may result in increased CVD risk. Our review of studies on pGDM prompts us to recommend that these women be considered a population at risk for later CVD events, which however could be avoided via the use of specially designed follow-up programs in the future. PMID:22518122

Vrachnis, Nikolaos; Augoulea, Areti; Iliodromiti, Zoe; Lambrinoudaki, Irene; Sifakis, Stavros; Creatsas, George

2012-01-01

58

Weight Characteristics and Height in Relation to Risk of Gestational Diabetes Mellitus  

Microsoft Academic Search

Increasing prevalence of overweight and obesity motivated this prospective examination of gestational diabetes mellitus in relation to self-reported adult height, weight, and weight fluctuation. Gestational diabetes was assessed by use of medical records in 1,644 women enrolled in Seattle and Tacoma, Washington, between 1996 and 2002. After adjustment, risk was inversely related to height and directly related to pregravid body

Carole B. Rudra; Tanya K. Sorensen; Wendy M. Leisenring; Edward Dashow; Michelle A. Williams

2007-01-01

59

Glucose Tolerance and Risk of Gestational Diabetes Mellitus in Nulliparous Women Who Smoke during Pregnancy  

Microsoft Academic Search

Gestational diabetes mellitus has been associated with adverse maternal and infant outcomes, including preeclampsia and fetal macrosomia. Although cigarette smoking has been associated with increased insulin resistance, its effect on gestational diabetes mellitus risk is uncertain. The authors evaluated the effects of smoking on glucose tolerance in a cohort of pregnant women who participated in the Calcium for Preeclampsia Prevention

Lucinda J. England; Richard J. Levine; Cong Qian; Lisa M. Soule; Enrique F. Schisterman; Kai F. Yu; Patrick M. Catalano

60

Elevated Lipoprotein Lipids and Gestational Hormones in Women With Diet-Treated Gestational Diabetes Mellitus Compared to Healthy Pregnant Controls  

Microsoft Academic Search

The objective of this study was to describe plasma and lipoprotein perturbations in gestational diabetes mellitus (GDM) compared to controls, and determine if alterations in lipids are related to gestational hormones and\\/or glucose control. Maternal HbA1c, free fatty acids (FFA), ?-estradiol, progesterone, prolactin, and plasma, very-low-density lipoprotein (VLDL), low-density lipoprotein (LDL), high-density lipoprotein (HDL), HDL2 and HDL3 triglyceride (TG), cholesterol,

Sarah C Couch; Elliot H Philipson; Robert B Bendel; Lillian M Pujda; Robert A Milvae; Carol J Lammi-Keefe

1998-01-01

61

Height and the risk of gestational diabetes: variations by race/ethnicity  

PubMed Central

Aims Gestational diabetes is a common pregnancy complication affecting races/ethnicities disproportionally. Adult height, an indicator of both genetic and early-life factors, is inconsistently associated with gestational diabetes risk. We examined the association and whether it varies by races in a nationally representative US cohort. Methods Analyses were conducted among 135 861 pregnancies in the Consortium on Safe Labor study, 5567 of which were diagnosed with gestational diabetes based on medical records review. Generalized estimating equations were used to estimate odds ratios (95% confidence intervals) of gestational diabetes, controlling for other risk factors including body weight. Additionally, a meta-analysis of 15 761 pregnancies with gestational diabetes and 205 828 without gestational diabetes was conducted to estimate the pooled mean difference in height between those with gestational diabetes and control subjects. Results Height was inversely associated with gestational diabetes risk across races/ethnicities, with the strongest association among Asians (P for interaction < 0.01). Comparing extreme quartiles (> 168 vs. < 157 cm), adjusted odds ratios (95% confidence intervals) were 0.18 (0.09–0.36) for Asians/Pacific Islanders, 0.33 (0.29–0.38) for non-Hispanic white women, 0.39 (0.31–0.51) for Hispanics and 0.59 (0.47–0.75) for non-Hispanic black women. Meta-analysis found women with gestational diabetes to be significantly shorter than others. Conclusions Taller women are at lower risk of developing gestational diabetes, with the magnitude of association varying significantly across races/ethnicities. PMID:24308574

Brite, J.; Shiroma, E. J.; Bowers, K.; Yeung, E.; Laughon, S. K.; Grewal, J. G.; Zhang, C.

2014-01-01

62

Changing trends in management of gestational diabetes mellitus  

PubMed Central

Gestational diabetes mellitus (GDM) is on the rise globally. In view of the increasing prevalence of GDM and fetal and neonatal complications associated with it, there is a splurge of research in this field and management of GDM is undergoing a sea change. Trends are changing in prevention, screening, diagnosis, treatment and future follow up. There is emerging evidence regarding use of moderate exercise, probiotics and vitamin D in the prevention of GDM. Regarding treatment, newer insulin analogs like aspart, lispro and detemir are associated with better glycemic control than older insulins. Continuous glucose monitoring systems and continuous subcutaneous insulin systems may play a role in those who require higher doses of insulin for sugar control. Evidence exists that favors metformin as a safer alternative to insulin in view of good glycemic control and better perinatal outcomes. As the risk of developing GDM in subsequent pregnancies and also the risk of overt diabetes in later life is high, regular assessment of these women is required in future. Lifestyle interventions or metformin should be offered to women with a history of GDM who develop pre-diabetes. Further studies are required in the field of prevention of GDM for optimizing obstetric outcome. PMID:25789109

Poomalar, Gunasekaran Kala

2015-01-01

63

Changing trends in management of gestational diabetes mellitus.  

PubMed

Gestational diabetes mellitus (GDM) is on the rise globally. In view of the increasing prevalence of GDM and fetal and neonatal complications associated with it, there is a splurge of research in this field and management of GDM is undergoing a sea change. Trends are changing in prevention, screening, diagnosis, treatment and future follow up. There is emerging evidence regarding use of moderate exercise, probiotics and vitamin D in the prevention of GDM. Regarding treatment, newer insulin analogs like aspart, lispro and detemir are associated with better glycemic control than older insulins. Continuous glucose monitoring systems and continuous subcutaneous insulin systems may play a role in those who require higher doses of insulin for sugar control. Evidence exists that favors metformin as a safer alternative to insulin in view of good glycemic control and better perinatal outcomes. As the risk of developing GDM in subsequent pregnancies and also the risk of overt diabetes in later life is high, regular assessment of these women is required in future. Lifestyle interventions or metformin should be offered to women with a history of GDM who develop pre-diabetes. Further studies are required in the field of prevention of GDM for optimizing obstetric outcome. PMID:25789109

Poomalar, Gunasekaran Kala

2015-03-15

64

Gestational Diabetes: Pathogenesis and Consequences to Mother and Offspring  

PubMed Central

Gestational diabetes mellitus (GDM) is defined as glucose intolerance with onset or first recognition during pregnancy. Data from Western countries suggest that the prevalence of GDM is increasing, being almost 10% of pregnancies and probably reflecting the global obesity epidemic. The majority of women with GDM seem to have ?-cell dysfunction that appears on a background of chronic insulin resistance already present before pregnancy. In less than 10% of GDM patients, defects of ?-cell function can be due to autoimmune destruction of pancreatic ?-cells, as in type 1 diabetes, or caused by monogenic mutations, as in several MODY subtypes. Diagnostic criteria for GDM vary worldwide and there are no clear-cut plasma glucose cut-off values for identifying women at a higher risk of developing macrosomia or other fetal complications. Because the oral glucose tolerance test (OGTT) is restricted to high risk individuals, 40% of GDM cases are left undiagnosed. Therefore, in high risk populations almost universal screening is recommended; only women considered to have very low risk do not need screening. Diet and exercise are the key elements in the treatment of GDM. If necessary, either insulin, certain oral hypoglycemic agents or combinations can be used to achieve normoglycemia. After delivery, women with GDM and their offspring have an increased risk for developing the metabolic syndrome and type 2 diabetes. Thus, pregnancy may act as a “stress test”, revealing a woman’s predisposition to T2D and providing opportunities for focused prevention of important chronic diseases. PMID:19290380

Kaaja, Risto; Rönnemaa, Tapani

2008-01-01

65

Childhood Cognitive Ability: Relationship to Gestational Diabetes Mellitus in India  

PubMed Central

Aims/Hypothesis To test the hypothesis that maternal gestational diabetes mellitus (GDM) is associated with poorer cognitive ability in children born to mothers with GDM compared to children born to non-GDM mothers in India. Methods During 1997-98 maternal GDM status was assessed at 30±2 weeks of gestation. Between 2007-2008, at a mean age of 9.7 years, 515 children (32-offspring of GDM mothers (ODM’s); 483-offspring of non-GDM mothers (controls)) from the Mysore Parthenon birth cohort underwent cognitive function assessment using tests from the Kaufman Assessment Battery for children-second edition and additional tests measuring learning, long-term storage/retrieval, short-term memory, reasoning, attention and concentration, visuo-spatial and verbal abilities. Results Compared to controls, ODM’S scored higher in tests for learning, long-term retrieval/storage (p=0.008), reasoning (p=0.02), verbal ability (p=0.01) and attention and concentration (p=0.003). In multiple regression, adjusted for the child’s age, sex, gestation, neonatal weight and head circumference, maternal age, parity, BMI, parent’s socio-economic status, education and rural/urban residence, this difference remained significant only for learning, long-term retrieval/storage (?=0.4SD (95% CI: 0.01, 0.75); p=0.042) and verbal ability (?=0.5SD (95% CI: 0.09, 0.83); p=0.015) and not with other test scores. Conclusions/interpretation In this population of healthy Indian children, there was no evidence of lower cognitive ability in ODM’s. In fact some cognitive scores were higher in ODM’s. PMID:20614102

Veena, S R; Krishnaveni, G V; Srinivasan, K; Kurpad, A V; Muthayya, S; Hill, J C; Kiran, K N; Fall, C H D

2012-01-01

66

Facial nerve paralysis: A case report of rare complication in uncontrolled diabetic patient with mucormycosis  

PubMed Central

Mucormycosis is a rare opportunistic aggressive and fatal infection caused by mucor fungus. Seven types of mucormycosis are identified based on the extension and involvement of the lesion, of which the rhino orbital mucormycosis is most common in the head and neck region. Although it is widely spread in nature, clinical cases are rare and observed only in immunocompromised patients and patients with uncontrolled diabetes mellitus. Early symptoms include fever, nasal ulceration or necrosis, periorbital edema or facial swelling, paresthesia and reduced vision. Involvement of cranial nerves although not common, facial nerve palsy is a rare finding. The infection may spread through cribriform plate to the brain resulting in extensive cerebellar infarctions. Timely diagnosis and early recognition of the signs and symptoms, correction of underlying medical disorders, and aggressive medical and surgical intervention are necessary for successful therapeutic outcome.

Shekar, Vandana; Sikander, Jeelani; Rangdhol, Vishwanath; Naidu, Madhulika

2015-01-01

67

[Clinical significance, diagnosis and treatment of diabetes in pregnancy (gestational diabetes)].  

PubMed

Early diagnosis of glucose intolerance by glucosuria testing is unreliable and should be replaced by blood sugar screening in the 24th to 28th week of gestation. If screening results are pathological (blood sugar in capillary whole blood over 140 mg% one hour after oral ingestion of 50 g glucose), a standardized glucose tolerance test should be performed. This screening test will reveal a glucose intolerance in approx. 3% of pregnant women. High-risk patients for gestational diabetes (previous pregnancies, complicated by gestational diabetes, family history of diabetes mellitus (first degree relatives), obesity (greater than 120% of ideal body weight), maternal age greater than 30 years, unexplained stillbirths) should have their glucose tolerance checked in early pregnancy, possibly before conception, but also in the 32nd to 36th week, if blood sugar screening is normal in weeks 24 to 28. If the glucose tolerance test is abnormal, blood sugar values must be controlled by diet on levels below 5 mmol (90 mg%) and postprandial below 7 mmol (126 mg%), measured in capillary whole blood. If these values are higher, an insulin treatment has to be discussed, since high blood glucose values result in an increased risk of infant morbidity and mortality. During insulin treatment, it might be possible that higher doses become necessary in order to avoid fetal hyperinsulinism with consecutive macrosomy. Although after childbirth often a normal glucose tolerance is noted, a manifestation of diabetes within the next 20 years will occur in one third of all gestational diabetics. Regular control of the glucose tolerance, e.g. in yearly intervals, as well as preventive measures (regulation of body weight) are indicated. PMID:2408184

Berger, W; Misteli, F

1990-01-01

68

Gestational diabetes and macrosomia by race/ethnicity in Hawaii  

PubMed Central

Background Gestational diabetes (GDM) has been shown to have long-term sequelae for both the mother and infant. Women with GDM are at increased risk of macrosomia, which predisposes the infant to birth injuries. Previous studies noted increased rates of GDM in Asian and Pacific Islander (API) women; however, the rate of macrosomia in API women with GDM is unclear. The objective of this study was to examine the relationship between ethnicity, gestational diabetes (GDM), and macrosomia in Hawaii. Methods A retrospective cohort study was performed using Hawaii Pregnancy Risk Assessment Monitoring System (PRAMS) data. Data from 2009–2011, linked with selected items from birth certificates, were used to examine GDM and macrosomia by ethnicity. SAS-callable SUDAAN 10.0 was used to generate odds ratios, point estimates and standard errors. Results Data from 4735 respondents were weighted to represent all pregnancies resulting in live births in Hawaii from 2009–2011. The overall prevalence of GDM in Hawaii was 10.9%. The highest prevalence of GDM was in Filipina (13.1%) and Hawaiian/Pacific Islander (12.1%) women. The lowest prevalence was in white women (7.4%). Hawaiian/Pacific Islander, Filipina, and other Asian women all had an increased risk of GDM compared to white women using bivariate analysis. Adjusting for obesity, age, maternal nativity, and smoking, Asian Pacific Islander (API) women, which includes Hawaiian/Pacific Islander, Filipina, and other Asian women, had a 50% increased odds of having GDM compared to white women when compared using multivariate analysis. Among women with GDM, the highest prevalence of macrosomia was in white women (14.5%) while the lowest was in Filipina (5.3%) women. Conclusions API women in Hawaii have increased rates of GDM compared to white women. Paradoxically, this elevated GDM risk in API women is not associated with an increased rate of macrosomia. This suggests the relationship between GDM and macrosomia is more complex in this population. PMID:24083634

2013-01-01

69

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

70

Glutathione synthesis is diminished in patients with uncontrolled diabetes and restored by dietary supplementation with cysteine and glycine  

Technology Transfer Automated Retrieval System (TEKTRAN)

Sustained hyperglycemia is associated with low cellular levels of the antioxidant glutathione (GSH), which leads to tissue damage attributed to oxidative stress. We tested the hypothesis that diminished GSH in adult patients with uncontrolled type 2 diabetes is attributed to decreased synthesis and ...

71

Contraception and the Risk of Type 2 Diabetes Mellitus in Latina Women With Prior Gestational Diabetes Mellitus  

Microsoft Academic Search

Context.— Effective contraception is essential in women with prior gestational diabetes mellitus (GDM) but should not increase their already substantial risk of developing type 2 diabetes. Objective.— To determine whether exposure to low-dose oral contraceptives increases the risk of developing type 2 diabetes mellitus in women with recent GDM. Design.— Retrospective cohort study of 904 Latinas with GDM who gave

Siri L. Kjos; Ruth K. Peters; Anny Xiang; Duncan Thomas; Ute Schaefer; Thomas A. Buchanan

2010-01-01

72

Odds, risks and appropriate diagnosis of gestational diabetes.  

PubMed

The International Association of the Diabetes and Pregnancy Study Groups (IADPSG) diagnostic process and criteria for gestational diabetes mellitus (GDM) have been recommended by the World Health Organization for adoption and were widely introduced into clinical practice in Australia from January 2015 - in Queensland, the Australian Capital Territory and variably across other states. The IADPSG criteria identify women at increased risk of a range of adverse pregnancy outcomes related to maternal hyperglycaemia. The relationship between maternal hyperglycaemia and adverse outcomes is continuous; however, one elevated glucose value is sufficient to impart a higher risk of pregnancy complications. We outline the background and statistical foundations of the IADPSG approach and refute the inference that invalid statistical reasoning underlies the IADPSG approach. The prevalence of GDM diagnosed by IADPSG criteria may be higher or lower than with other criteria, depending on the underlying population prevalence of fasting and post-glucose load hyperglycaemia, which in turn vary with ethnicity. Studies comparing previous Australian criteria to the IADPSG criteria suggest GDM prevalence may decrease or may increase by up to 35% in specific populations with the planned change in criteria. Pregnancy complications have multiple potential underlying causes. No set of glucose criteria will ever be able to fully separate women and babies at risk of pregnancy complications from those who are not. PMID:25832155

McIntyre, H David; Dyer, Alan R; Metzger, Boyd E

2015-04-01

73

The institute of medicine guidelines for gestational weight gain after a diagnosis of gestational diabetes and pregnancy outcomes.  

PubMed

Objective?The objective of this study was to assess the impact of gestational weight gain outside the Institute of Medicine (IOM) recommendations after the diagnosis of gestational diabetes (GDM) on perinatal outcomes. Materials and Methods?This was a retrospective cohort study. Women were classified as gestational weight gain (GWG) within, less than, or greater than IOM recommendations for body mass index as calculated by gestational weight gain per week after a diagnosis of GDM. Outcomes assessed were preeclampsia, cesarean delivery, A2 GDM, birth weight, small for gestational age (SGA), large for gestational age (LGA), macrosomia, and preterm delivery. Groups were compared using analysis of variance and chi-square test for trend, as appropriate. Backward stepwise logistic regression was used to adjust for significant confounding factors. Results?Of 635 subjects, 92 gained within, 175 gained less than, and 368 gained more than IOM recommendations. The risk of cesarean delivery and A2 GDM was increased in those gaining above the IOM recommendations compared with within. For every 1-lb/week increase in weight gain after diagnosis of GDM, there was a 36 to 83% increase in the risk of preeclampsia, cesarean delivery, A2 GDM, macrosomia, and LGA, without decreases in SGA or preterm delivery. Conclusion?Weight gain more than the IOM recommendations per week of gestation after a diagnosis of GDM is associated with adverse pregnancy outcomes. PMID:24971568

Harper, Lorie M; Tita, Alan; Biggio, Joseph R

2015-02-01

74

Preventive letter: doubling the return rate after gestational diabetes mellitus.  

PubMed

To measure the impact of a "Preventive Letter" designed to encourage the return of gestational diabetes mellitus (GDM) mothers to follow up visit after delivery, in the context of a worldwide concern about low return rates after delivery of these patients. Mothers with GDM require medical evaluation and an oral glucose tolerance test (OGTT) 6 weeks after delivery, in order to: [a] confirm remission of GDM and [b] provide advice on the prevention of type 2 diabetes. In the year 2003 we developed a "Preventive Letter", containing three aspects: [a] current treatment, [b] suggested management during labor, and [c] a stapled laboratory order for OGTT to be performed 6 weeks after delivery. The return rate after delivery was assessed in two groups of GDM mothers: [a] "Without Preventive Letter" (n = 253), and "With Preventive Letter" (n = 215). Both groups, similar with respect to age (33.0 ± 5.4 and 32.3 ± 4.9 years respectively, p = 0.166) and education time (14.9 ± 1.8 and 15.0 ± 1.8 years respectively, p = 0.494), showed a significant difference in the 1-year return rate after delivery, as assessed by the Kaplan-Meier test: 32.0 % for the group "Without Preventive Letter", and 76.0 % for the group "With Preventive Letter" (p < 0.001). The 1-year return rate after delivery of GDM mothers was 2.4 times higher in the group "With Preventive Letter" than in the group without it. We believe that this low-cost approach could be useful in other institutions caring for pregnant women with diabetes. PMID:25269853

Olmos, Pablo R; Borzone, Gisella R; Berkowitz, Loni; Mertens, Nicolás; Busso, Dolores; Santos, José L; Poblete, José A; Vera, Claudio; Belmar, Cristián; Goldenberg, Denisse; Samith, Bárbara; Acosta, Ana M; Escalona, Manuel

2015-05-01

75

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

76

Type 2 diabetes after gestational diabetes: The influence of changing diagnostic criteria  

PubMed Central

A previous diagnosis of gestational diabetes (GDM) carries a lifetime risk of progression to type 2 diabetes of up to 60%. Identification of those women at higher risk of progression to diabetes allows the timely introduction of measures to delay or prevent diabetes onset. However, there is a large degree of variability in the literature with regard to the proportion of women with a history of GDM who go on to develop diabetes. Heterogeneity between cohorts with regard to diagnostic criteria used, duration of follow-up, and the characteristics of the study population limit the ability to make meaningful comparisons across studies. As the new International Association for Diabetes in Pregnancy Study Group criteria are increasingly adopted worldwide, the prevalence of GDM is set to increase by two-to three-fold. Here, we review the literature to examine the evolution of diagnostic criteria for GDM, the implications of changing criteria on the proportion of women with previous GDM progressing to diabetes, and how the use of different diagnostic criteria may influence the development of appropriate follow-up strategies. PMID:25789105

Noctor, Eoin; Dunne, Fidelma P

2015-01-01

77

Type 2 diabetes after gestational diabetes: The influence of changing diagnostic criteria.  

PubMed

A previous diagnosis of gestational diabetes (GDM) carries a lifetime risk of progression to type 2 diabetes of up to 60%. Identification of those women at higher risk of progression to diabetes allows the timely introduction of measures to delay or prevent diabetes onset. However, there is a large degree of variability in the literature with regard to the proportion of women with a history of GDM who go on to develop diabetes. Heterogeneity between cohorts with regard to diagnostic criteria used, duration of follow-up, and the characteristics of the study population limit the ability to make meaningful comparisons across studies. As the new International Association for Diabetes in Pregnancy Study Group criteria are increasingly adopted worldwide, the prevalence of GDM is set to increase by two-to three-fold. Here, we review the literature to examine the evolution of diagnostic criteria for GDM, the implications of changing criteria on the proportion of women with previous GDM progressing to diabetes, and how the use of different diagnostic criteria may influence the development of appropriate follow-up strategies. PMID:25789105

Noctor, Eoin; Dunne, Fidelma P

2015-03-15

78

Life Course Weight Characteristics and the Risk of Gestational Diabetes  

PubMed Central

Aims/hypothesis To prospectively determine the risk of gestational diabetes (GDM) in association with life-course weight characteristics and adult abdominal adiposity. Methods We investigated the joint and independent impact of birth weight, childhood size by somatotypes, adolescent and adult body mass index (BMI) and abdominal adiposity on GDM risk among 21,647 women in the Nurses’ Health Study II who reported a singleton pregnancy between 1989 and 2001. 1,386 incident GDM cases were reported. Relative risk (RR) was estimated by pooled logistic regression adjusting for age, prematurity, race, smoking status, parental history of diabetes, age of first birth, parity, and physical activity. Results Birth weight was inversely associated with GDM risk (P-trend 0.02). Childhood somatotypes at ages 5 and 10 years were not associated with risk. U-shaped associations were found for BMI at age 18 and somatotype at age 20 years. Weight gain between adolescence and adulthood, pre-gravid BMI and abdominal adiposity were positively associated with risk (p-trends all<0.01). Multivariate adjusted RR for GDM from lowest to highest quintile of waist-to-hip ratio were 1.00, 1.50, 1.51, 2.03, 2.12 (P-trend 0.0003). Lower birth weight (<7 pounds) without adulthood overweight (BMI>25 kg/m2) was associated with 20% increased risk (95% CI: 1.02–1.41). However, adulthood overweight alone was related to 2.36 times greater GDM risk (95% CI: 2.12–3.77). Conclusions/Interpretation Although lower birth weight is an independent risk factor for GDM, weight gain since early adulthood, and overall and central obesity in adulthood were more strongly associated with elevated GDM risk independent of other known risk factors. PMID:20043144

Yeung, E.H.; Hu, F.B.; Solomon, C.G.; Chen, L.; Louis, G.M.; Schisterman, E.; Willett, W.C.; Zhang, C.

2010-01-01

79

Ethnic enclaves and gestational diabetes among immigrant women in New York City.  

PubMed

Previous research has shown that immigrants living in their own ethnic enclave are at decreased risk of poor health outcomes, but this question has not been studied in relation to gestational diabetes, an important early marker of lifecourse cardiovascular health. We ascertained gestational diabetes, census tract of residence, and individual-level covariates for Sub-Saharan African, Chinese, South Central Asian, Non-Hispanic Caribbean, Dominican, Puerto Rican, Mexican, and Central and South American migrant women using linked birth-hospital discharge data for 89,703 singleton live births in New York City for the years 2001-2002. Using 2000 census data, for each immigrant group we defined a given census tract as part of an ethnic enclave based on the population distribution for the corresponding ethnic group. We estimated odds ratios for associations between living in an ethnic enclave and risk of gestational diabetes adjusted for neighborhood deprivation, percent commercial space, education, age, parity, and insurance status, using multilevel logistic regression. Overall, we found no effect of ethnic enclave residence on gestational diabetes in most immigrant groups. Among South Central Asian and Mexican women, living in a residential ethnic enclave was associated with an increased odds of gestational diabetes. Several explanations are proposed for these findings. Mechanisms explaining an increased risk of gestational diabetes in South Central Asian and Mexican ethnic enclaves should be examined. PMID:25259656

Janevic, T; Borrell, L N; Savitz, D A; Echeverria, S E; Rundle, A

2014-11-01

80

Gestational diabetes mellitus. Unresolved issues and future research directions.  

PubMed Central

OBJECTIVE: To summarize the controversial aspects of gestational diabetes (GDM) and introduce readers to possible relevant research questions that could be examined to provide clinicians with good-quality data on which to base decisions about this relatively common pregnancy-related issue. DATA SOURCES AND STUDY SELECTION: Ongoing review of the English literature related to GDM. Sources were not restricted to prospective, controlled trials, as these are severely limited in number. SYNTHESIS: Controversial issues include the relevance of GDM to clinically meaningful outcomes in the index pregnancy, the effectiveness of current therapy in altering these outcomes, and the resultant questionable relevance of routine screening and diagnosis of an entity with as yet uncertain significance in pregnancy. CONCLUSIONS: Suggested questions to be addressed in multicentre controlled trials include randomization with respect to screening and with respect to treatment. Until such trials are completed, continuing with a standard approach to screening, diagnosis, and treatment, such as that suggested by the third international workshop on GDM, is recommended. PMID:9626427

Okun, N.; Verma, A.; Demianczuk, N.

1997-01-01

81

Myo-inositol may prevent gestational diabetes in PCOS women.  

PubMed

To evaluate retrospectively the prevalence of gestational diabetes (GD) in pregnancies obtained with myo-inositol administration in women with polycystic ovary syndrome. A total of 98 pregnancies in PCOS women obtained in a 3-year period, either with myo-inositol (n. 54), or with metformin (n. 44) were considered. While myo-inositol was assumed through the whole pregnancy, the group of women treated with metformin stopped the drug assumption after pregnancy diagnosis, and was considered as a control group. After having eliminated cases of miscarriages and twin pregnancies, a definitive number of 46 women in the myo-inositol group and 37 in the control group was taken in account to be retrospectively evaluated. The primary outcome measure was GD occurrence in both groups; whereas secondary outcome measures were pregnancy outcomes: hypertensive disorders, pre-term birth, macrosomia and caesarean section occurrence. Prevalence of GD in the myo-inositol group was 17.4% versus 54% in the control group, with a highly significant difference also after adjusting for covariates. Consequently, in the control group the risk of GD occurrence was more than double compared to the myo-inositol group, with an odds ratio 2.4 (confidence interval 95%, 1.3-4.4). There was no difference between the groups in relation to secondary outcome measures. This study suggests a possible effect of myo-inositol in the primary prevention of GD in PCOS women. PMID:22122627

D'Anna, R; Di Benedetto, V; Rizzo, P; Raffone, E; Interdonato, M L; Corrado, F; Di Benedetto, A

2012-06-01

82

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

83

Ability of Bacteriophage in Resolving Wound Infection Caused by Multidrug-Resistant Acinetobacter baumannii in Uncontrolled Diabetic Rats.  

PubMed

Acinetobacter baumannii, a substantial nosocomial pathogen, has developed resistance to almost all available antimicrobial drugs. Bacteriophage therapy is a possible alternative treatment for multidrug-resistant (MDR) bacterial infections. In this study, we have successfully isolated bacteriophage active against clinical strains of A. baumannii by enrichment from hospital sewage sludge using representatives of those strains. The bacteriophage isolated against A. baumannii formed plaques against beta-lactamases producing strains of A. baumannii. The utility of bacteriophage specific for A. baumannii to resolve wound infection in uncontrolled diabetic rats was evaluated. Five groups of uncontrolled diabetic rats were used. Group I was noninfected (Control), Group II was infected with MDR A. baumannii and challenged with bacteriophage, Group III was infected with MDR A. baumannii, Group IV was infected with MDR A. baumannii and challenged with antibiotic colistin, and Group V consisted of noninfected rats and sprayed with phage (Phage control). A significant decrease in infection, period of epithelization, and wound contraction was observed in the phage-challenged group when compared with antibiotic-treated uncontrolled diabetic rats and the control group. To conclude the study, new insights are provided into the biology of the broad host range of A. baumannii phage, demonstrating that A. baumannii phage has prospects for the treatment of infections caused by the MDR A. baumannii. PMID:25411824

Shivaswamy, VinodKumar Chickmangalure; Kalasuramath, Suneeta Basavaraj; Sadanand, Chethan Kumar; Basavaraju, Abhishek Kilagere; Ginnavaram, Varsha; Bille, Sumanth; Ukken, Sanjay Saju; Pushparaj, Usha Nandini

2015-04-01

84

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

85

Fast Food Consumption and Gestational Diabetes Incidence in the SUN Project  

PubMed Central

Background Gestational diabetes prevalence is increasing, mostly because obesity among women of reproductive age is continuously escalating. We aimed to investigate the incidence of gestational diabetes according to the consumption of fast food in a cohort of university graduates. Methods The prospective dynamic “Seguimiento Universidad de Navarra” (SUN) cohort included data of 3,048 women initially free of diabetes or previous gestational diabetes who reported at least one pregnancy between December 1999 and March 2011. Fast food consumption was assessed through a validated 136-item semi-quantitative food frequency questionnaire. Fast food was defined as the consumption of hamburgers, sausages, and pizza. Three categories of fast food were established: low (0–3 servings/month), intermediate (>3 servings/month and ?2 servings/week) and high (>2 servings/week). Non-conditional logistic regression models were used to adjust for potential confounders. Results We identified 159 incident cases of gestational diabetes during follow-up. After adjusting for age, baseline body mass index, total energy intake, smoking, physical activity, family history of diabetes, cardiovascular disease/hypertension at baseline, parity, adherence to Mediterranean dietary pattern, alcohol intake, fiber intake, and sugar-sweetened soft drinks consumption, fast food consumption was significantly associated with a higher risk of incident gestational diabetes, with multivariate adjusted OR of 1.31 (95% conficence interval [CI]:0.81–2.13) and 1.86 (95% CI: 1.13–3.06) for the intermediate and high categories, respectively, versus the lowest category of baseline fast food consumption (p for linear trend: 0.007). Conclusion Our results suggest that pre-pregnancy higher consumption of fast food is an independent risk factor for gestational diabetes. PMID:25215961

Dominguez, Ligia J.; Martínez-González, Miguel A.; Basterra-Gortari, Francisco Javier; Gea, Alfredo; Barbagallo, Mario; Bes-Rastrollo, Maira

2014-01-01

86

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

87

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

88

Total serum glycosylated proteins in detection and monitoring of gestational diabetes.  

PubMed

The goal of this study was to determine whether serum glycosylated protein levels (i.e., fructosamine) can reliably screen for gestational diabetes and whether these levels are valid markers of short-term glycemic control in the third trimester of pregnancy. Ninety-seven pregnant women at 26-28 wk gestation were evaluated over 9 mo. HbA1c and serum glycosylated protein (serum fructosamine) were determined at the baseline venipuncture of the 100-g oral glucose tolerance test performed to detect gestational diabetes. Of the 97 women studied, 13 tested positive for gestational diabetes (National Diabetes Data Group criteria). There were significant differences in the fasting and 1-, 2-, and 3-h glucose values between nondiabetic and diabetic patients (P less than 0.005 at each time point). No difference was noted in the baseline serum glycosylated protein level (2.02 +/- 0.08 vs. 1.98 +/- 0.02 mM, NS) or HbA1c level (4.42 +/- 0.2 vs. 4.6 +/- 0.3%, NS) between gestational and nondiabetic patients. Diabetic patients were followed at 2-wk intervals, with serum glycosylated protein analysis, HbA1c, fasting glucose, and mean glucose determined by outpatient monitoring. Serum glycosylated protein correlated significantly to fasting blood glucose (r = 0.81, P less than 0.001) and mean outpatient glucose (r = 0.62, P less than 0.001) at the 2-wk follow-up visits. No correlation was found between HbA1c and fasting blood glucose (r = 0.11, NS) or mean outpatient glucose (r = -0.12, NS) during the follow-up period. The serum glycosylated protein level (serum fructosamine) is not a useful screening test for gestational diabetes. However, this assay shows potential as an objective marker of short-term control in evaluating the maternal glycemic state. PMID:2209322

Cefalu, W T; Prather, K L; Chester, D L; Wheeler, C J; Biswas, M; Pernoll, M L

1990-08-01

89

The role of exercise in reducing the risks of gestational diabetes mellitus in obese women.  

PubMed

The global obesity epidemic continues unabated, now rapidly expanding to developing countries. Multiple comorbidities and premature mortality are associated with obesity, most frequently diabetes. The associated financial and economical burden is escalating as well. The sedentary lifestyle adopted by many pregnant women because of traditional practices and the current recommendation for gestational weight gain are contributing factors to the obesity and diabetes epidemic. Physical inactivity is recognized as an independent risk factor for obesity insulin resistance and type 2 diabetes; the physiological and hormonal changes associated with pregnancy magnify this risk. Conversely, evidence and accumulated experience indicate that antenatal lifestyle interventions that include physical activity and judicious dieting could improve the pregnancy outcome and reduce the risk of gestational diabetes and is effective as an adjunctive therapy for diabetes in pregnancy. All major professional organizations, among them American Congress of Obstetricians and Gynecologists (ACOG), American Diabetes Association (ADA), Royal College of Obstetricians and Gynaecologists (RCOG), and Society of Obstetricians and Gynaecologists of Canada (SOGC), recommend lifestyle interventions that include diet and exercise to prevent or manage gestational diabetes or diabetes mellitus. PMID:25240421

Artal, Raul

2015-01-01

90

Did You Have Gestational Diabetes When You Were Pregnant?  

MedlinePLUS

... play time in front of the computer, tablets, smartphones, and TV to 2 hours per day. Contact ... be healthy and lower their chances of getting type 2 diabetes. National Diabetes Education Program 1-888- ...

91

Longitudinal changes in glucose metabolism during pregnancy in obese women with normal glucose tolerance and gestational diabetes mellitus  

Microsoft Academic Search

Objective: This study prospectively evaluated the longitudinal changes in insulin sensitivity, insulin response, and endogenous (primarily hepatic) glucose production and suppression during insulin infusion in women with normal glucose tolerance (control) and gestational diabetes mellitus before and during a planned pregnancy. Study Design: Eight control subjects and 7 subjects in whom gestational diabetes mellitus developed were evaluated with an oral

Patrick M. Catalano; Larraine Huston; Saeid B. Amini; Satish C. Kalhan

1999-01-01

92

In uncontrolled diabetes, thyroid hormone and sympathetic activators induce thermogenesis without increasing glucose uptake in brown adipose tissue  

PubMed Central

Recent advances in human brown adipose tissue (BAT) imaging technology have renewed interest in the identification of BAT activators for the treatment of obesity and diabetes. In uncontrolled diabetes (uDM), activation of BAT is implicated in glucose lowering mediated by intracerebroventricular (icv) administration of leptin, which normalizes blood glucose levels in streptozotocin (STZ)-induced diabetic rats. The potent effect of icv leptin to increase BAT glucose uptake in STZ-diabetes is accompanied by the return of reduced plasma thyroxine (T4) levels and BAT uncoupling protein-1 (Ucp1) mRNA levels to nondiabetic controls. We therefore sought to determine whether activation of thyroid hormone receptors is sufficient in and of itself to lower blood glucose levels in STZ-diabetes and whether this effect involves activation of BAT. We found that, although systemic administration of the thyroid hormone (TR)?-selective agonist GC-1 increases energy expenditure and induces further weight loss in STZ-diabetic rats, it neither increased BAT glucose uptake nor attenuated diabetic hyperglycemia. Even when GC-1 was administered in combination with a ?3-adrenergic receptor agonist to mimic sympathetic nervous system activation, glucose uptake was not increased in STZ-diabetic rats, nor was blood glucose lowered, yet this intervention potently activated BAT. Similar results were observed in animals treated with active thyroid hormone (T3) instead of GC-1. Taken together, our data suggest that neither returning normal plasma thyroid hormone levels nor BAT activation has any impact on diabetic hyperglycemia, and that in BAT, increases of Ucp1 gene expression and glucose uptake are readily dissociated from one another in this setting. PMID:23384771

Matsen, Miles E.; Thaler, Joshua P.; Wisse, Brent E.; Guyenet, Stephan J.; Meek, Thomas H.; Ogimoto, Kayoko; Cubelo, Alex; Fischer, Jonathan D.; Kaiyala, Karl J.; Schwartz, Michael W.

2013-01-01

93

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

94

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

95

Nutritional Intake of Pregnant Women with Gestational Diabetes or Type 2 Diabetes Mellitus  

PubMed Central

Adequate intake of nutrients by pregnant women diagnosed with gestational diabetes mellitus (GDM) or type 2 diabetes (T2DM) is very important for appropriate weight gain and maintenance of normoglycemia without ketonuria. The aim of this study was to investigate the nutritional intake of pregnant women with GDM or T2DM who had not been provided with nutritional education regarding blood glucose management. Between June 2008 and May 2010, 125 pregnant women who had been diagnosed with GDM or T2DM and had not received any nutrition education regarding glycemic control and proper diet during pregnancy were interviewed to collect data regarding background characteristics, health-related behaviors, and course of pregnancy and instructed to record their dietary intake using a 24-hour recall method for one day. Using the collected data, the index of nutritional quality, nutrient adequacy ratio, and mean adequacy ratio values of the subjects were calculated. Analysis of the values indicated that the majority of the subjects did not meet recommended intake levels for most micronutrients and consumed an undesirable ratio of macronutrients, specifically a higher percentage of total carbohydrates than the current recommendation level. The GDM and T2DM groups obtained 56.6% and 63.6%, respectively (p = 0.012), of their calories by carbohydrate intake, which exceeded the recommended levels (125.8% in GDM groups, 141.3% in T2DM groups). PMID:23908974

Lim, Sun-Young; Yoo, Hyun-Jung; Kim, Ae-Lan; Oh, Jeong-Ah; Kim, Hun-Sung; Choi, Yoon-Hee; Cho, Jae-Hyoung

2013-01-01

96

Comparison of National Diabetes Data Group and World Health Organization criteria for detecting gestational diabetes mellitus.  

PubMed

We compared the criteria for diagnosis of gestational diabetes mellitus (GDM) of the National Diabetes Data Group (NDDG) and the World Health Organization (WHO) and studied the outcomes of pregnancy. A 50-g glucose screening test and 75-g oral glucose tolerance test (OGTT) were scheduled for 709 pregnant women in the same week between the 24th and 28th week of pregnancy. Blood glucose was measured 1 h after the 50-g glucose screening test and if found to be 7.8 mmol/l or more, a 100-g OGTT was scheduled within 7 days after a 75-g OGTT. The prevalence of GDM was found to be 1.4% (10/709) and 15.7% (111/709) by NDDG and WHO criteria (2 h > or = 7.8 mmol/l), respectively. Using NDDG criteria, all the GDM patients had abnormal 75-g OGTT by WHO criteria. NDDG and WHO criteria were significantly different when compared with normal OGTT by each criteria for age, BMI, pregnancy-induced hypertension, Caesarian delivery, macrosomia and neonatal hypoglycaemia. Of 14 women with macrosomic infants 6 had an abnormal WHO test while only 3 of 14 had an abnormal NDDG test. These findings suggest that WHO criteria GDM patients had significantly worse outcomes of pregnancy and fewer perinatal complications were missed than with the more cumbersome NDDG criteria, and no case of GDM as diagnosed by NDDG criteria was missed. PMID:8877291

Deerochanawong, C; Putiyanun, C; Wongsuryrat, M; Serirat, S; Jinayon, P

1996-09-01

97

Urinary incontinence and vaginal squeeze pressure two years post-cesarean delivery in primiparous women with previous gestational diabetes mellitus  

PubMed Central

OBJECTIVE: To assess the prevalence of urinary incontinence and associated vaginal squeeze pressure in primiparous women with and without previous gestational diabetes mellitus two years post-cesarean delivery. METHODS: Primiparous women who delivered by cesarean two years previously were interviewed about the delivery and the occurrence of incontinence. Incontinence was reported by the women and vaginal pressure evaluated by a Perina perineometer. Sixty-three women with gestational diabetes and 98 women without the disease were screened for incontinence and vaginal pressure. Multiple logistic regression models were used to evaluate the independent effects of gestational diabetes. RESULTS: The prevalence of gestational incontinence was higher among women with gestational diabetes during their pregnancies (50.8% vs. 31.6%) and two years after a cesarean (44.8% vs. 18.4%). Decreased vaginal pressure was also significantly higher among women with gestational diabetes (53.9% vs. 37.8%). Maternal weight gain and newborn weight were risk factors for decreased vaginal pressure. Maternal age, gestational incontinence and decreased vaginal pressure were risk factors for incontinence two years after a cesarean. In a multivariate logistic model, gestational diabetes was an independent risk factor for gestational incontinence. CONCLUSIONS: The prevalence of incontinence and decreased vaginal pressure two years post-cesarean were elevated among women with gestational diabetes compared to women who were normoglycemic during pregnancy. We confirmed an association between gestational diabetes mellitus and a subsequent decrease of vaginal pressure two years post-cesarean. These results may warrant more comprehensive prospective and translational studies. PMID:21915481

Barbosa, Angélica Mércia Pascon; Dias, Adriano; Marini, Gabriela; Calderon, Iracema Mattos Paranhos; Witkin, Steven; Rudge, Marilza Vieira Cunha

2011-01-01

98

Gestational diabetes and the incidence of diabetes in the 5 years following the index pregnancy in South Indian women  

PubMed Central

This study was carried out to examine the incidence of diabetes and the factors associated with this in a cohort of South Indian women 5 years after they were examined for gestational diabetes (GDM). Women (N = 630) whose GDM status was determined (Carpenter-Coustan criteria; GDM: N = 41) delivered live babies without major anomalies at the Holdsworth Memorial Hospital, Mysore. Of these, 526 women (GDM: N = 35) available for follow-up after 5 years underwent a 2-h oral glucose tolerance test and detailed anthropometry. Diabetes was determined using WHO criteria, and Metabolic Syndrome using IDF criteria recommended for south Asian women. The incidence of diabetes (37% versus 2%) and Metabolic Syndrome (60% versus 26%) was considerably higher in women with previous GDM compared to non-GDM women. GDM women who developed diabetes had lower gestational insulin area-under-the-curve (P = 0.05). They had larger waist-to-hip ratio, skinfolds, body mass index, and lower 30-min insulin increment at follow-up than other GDM women. In all, history of diabetes in first-degree relatives was independently associated with higher incidence of diabetes (P < 0.001). Our findings suggest high diabetes and cardiovascular risks in women with previous GDM. Follow-up of these women after delivery would provide opportunities to modify adverse lifestyle factors. PMID:17640759

Krishnaveni, Ghattu V.; Hill, Jacqueline C.; Veena, Sargoor R.; Geetha, Suguna; Jayakumar, Magudilu N.; Karat, Chitra L.S.; Fall, Caroline H.D.

2007-01-01

99

Gestational diabetes and the incidence of diabetes in the 5 years following the index pregnancy in South Indian women.  

PubMed

This study was carried out to examine the incidence of diabetes and the factors associated with this in a cohort of South Indian women 5 years after they were examined for gestational diabetes (GDM). Women (N=630) whose GDM status was determined (Carpenter-Coustan criteria; GDM: N=41) delivered live babies without major anomalies at the Holdsworth Memorial Hospital, Mysore. Of these, 526 women (GDM: N=35) available for follow-up after 5 years underwent a 2-h oral glucose tolerance test and detailed anthropometry. Diabetes was determined using WHO criteria, and Metabolic Syndrome using IDF criteria recommended for south Asian women. The incidence of diabetes (37% versus 2%) and Metabolic Syndrome (60% versus 26%) was considerably higher in women with previous GDM compared to non-GDM women. GDM women who developed diabetes had lower gestational insulin area-under-the-curve (P=0.05). They had larger waist-to-hip ratio, skinfolds, body mass index, and lower 30-min insulin increment at follow-up than other GDM women. In all, history of diabetes in first-degree relatives was independently associated with higher incidence of diabetes (P<0.001). Our findings suggest high diabetes and cardiovascular risks in women with previous GDM. Follow-up of these women after delivery would provide opportunities to modify adverse lifestyle factors. PMID:17640759

Krishnaveni, Ghattu V; Hill, Jacqueline C; Veena, Sargoor R; Geetha, Suguna; Jayakumar, Magudilu N; Karat, Chitra L S; Fall, Caroline H D

2007-12-01

100

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

101

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

102

Food Perceptions and Concerns of Aboriginal Women Coping with Gestational Diabetes in Winnipeg, Manitoba  

ERIC Educational Resources Information Center

Objective: To describe how Aboriginal women in an urban setting perceive dietary treatment recommendations associated with gestational diabetes mellitus (GDM). Design: Semi-structured explanatory model interviews explored Aboriginal women's illness experiences with GDM. Setting and Participants: Twenty-nine self-declared Aboriginal women who had…

Neufeld, Hannah Tait

2011-01-01

103

Prevalence and risk factors for gestational diabetes assessed by universal screening  

Microsoft Academic Search

In order to evaluate the prevalence of gestational diabetes mellitus (GDM) and the presence of risk factors for GDM, we conducted a retrospective study of a cohort of Italian women. In addition, we compared universal versus selective screening to validate the ADA's recommendations in our population. From June 1st, 1995 to December 31st, 2001, universal screening for GDM was performed

Graziano Di Cianni; L. Volpe; C. Lencioni; R. Miccoli; I. Cuccuru; A. Ghio; K. Chatzianagnostou; P. Bottone; G. Teti; S. Del Prato; L. Benzi

2003-01-01

104

Are the new IADPSG criteria for gestational diabetes useful in a country with a very high prevalence?  

PubMed

The International Association of Diabetes and Pregnancy Study Groups released new recommendations on screening methods and diagnostic criteria for gestational diabetes. The main objectives of the present study were to analyze characteristics of mothers who underwent the new screening test, and to assess the prevalence of gestational diabetes and related pregnancy complications such as the 5-minute Apgar score <7, in a urban maternity clinic in Djibouti. The effect of treating gestational diabetes was also evaluated. Totally, 231 mothers underwent the new screening test, and 106 were diagnosed as having gestational diabetes (45.9%). Mothers with gestational diabetes had an excess risk of low Apgar scores, even after adjustment for socio-economic and medical covariates, with an odds ratio of 6.34 (1.77-22.66), p value <0.005. Only 46.2% of mothers with gestational diabetes followed the recommendations regarding treatment. Among these patients, 18.6% of infants from untreated mothers had a 5-minute Apgar score <7, compared to 3.9% infants from treated mothers (p value?=?0.017). After adjustment, untreated mothers still had a high excess risk of low Apgar scores, although non-significant, with an odds ratio of 4.67 (0.78-27.87), p value?=?0.09. In conclusion, gestational diabetes is highly prevalent in Djibouti and is related to low Apgar scores. PMID:24805833

Minsart, Anne-Frederique; N'guyen, Thai-Son Pierre; Dimtsu, Hirut; Ratsimandresy, Rachel; Dada, Fouad; Ali Hadji, Rachid

2014-09-01

105

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

106

Oral glucose tolerance testing at gestational weeks ?16 could predict or exclude subsequent gestational diabetes mellitus during the current pregnancy in high risk group  

Microsoft Academic Search

Background:An oral glucose tolerance test with a result that is negative but close to the diagnostic cut-off in early pregnancy was hypothesized to serve as a predictor of subsequent gestational diabetes in a high risk group. The aim of the study was to determine those cut-off values of OGTT at gestational weeks ?16, which can predict or exclude subsequent onset

Tamás Bitó; Tibor Nyári; László Kovács; Attila Pál

2005-01-01

107

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 Câmara; de Melo, Larisse Rayanne M.; Bellot, Paula Emília N. R.; Dantas, Raquel Costa S.; Dimenstein, Roberto

2014-01-01

108

[New insights into diagnosis and management of gestational diabetes mellitus: recommendations of the Swiss Society for Endocrinology and Diabetes].  

PubMed

Physiology and current knowledge about gestational diabetes which led to the adoption of new diagnostic criterias and blood glucose target levels during pregnancy by the Swiss Society for Endocrinology and Diabetes are reviewed. The 6th International Workshop Conference on Gestational Diabetes mellitus in Pasedena (2008) defined new diagnostic criteria based on the results of the HAPO-Trial. These criteria were during the ADA congress in New Orleans in 2009 presented. According to the new criteria there is no need for screening, but all pregnant women have to be tested with a 75 g oral glucose tolerance test between the 24th and 28th week of pregnancy. The new diagnostic values are very similar to the ones previously adopted by the ADA with the exception that only one out of three values has to be elevated in order to make the diagnosis of gestational diabetes. Due to this important difference it is very likely that gestational diabetes will be diagnosed more frequently in the future. The diagnostic criteria are: Fasting plasma glucose > or = 5.1 mmol/l, 1-hour value > or = 10.0 mmol/l or 2-hour value > or = 8.5 mmol/l. Based on current knowledge and randomized trials it is much more difficult to define glucose target levels during pregnancy. This difficulty has led to many different recommendations issued by diabetes societies. The Swiss Society of Endocrinology and Diabetes follows the arguments of the International Diabetes Federation (IDF) that self-blood glucose monitoring itself lacks precision and that there are very few randomized trials. Therefore, the target levels have to be easy to remember and might be slightly different in mmol/l or mg/dl. The Swiss Society for Endocrinology and Diabetes adopts the tentative target values of the IDF with fasting plasma glucose values < 5.3 mM and 1- and 2-hour postprandial (after the end of the meal) values of < 8.0 and 7.0 mmol/l, respectively. The last part of these recommendations deals with the therapeutic options during pregnancy (nutrition, physical exercise and pharmaceutical treatment). If despite lifestyle changes the target values are not met, approximately 25 % of patients have to be treated pharmaceutically. Insulin therapy is still the preferred treatment option, but metformin (and as an exception glibenclamide) can be used, if there are major hurdles for the initiation of insulin therapy. PMID:19830677

Lehmann, Roger; Troendle, A; Brändle, M

2009-10-01

109

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

110

Impact of gestational diabetes mellitus nutrition practice guidelines implemented by registered dietitians on pregnancy outcomes.  

PubMed

Nutrition practice guidelines were developed for gestational diabetes mellitus by registered dietitians from the Diabetes Care and Education and the Women's Health and Reproductive Nutrition dietetic practice groups. To validate the guidelines, a clinical trial was designed with clinic sites randomly assigned to either nutrition practice guidelines care (12 sites) or usual nutrition care (13 sites), with diabetes, obstetric, and other clinic types represented in both groups. Volunteer dietitians served as study coordinators and recruited women diagnosed with gestational diabetes mellitus. The nutrition practice guidelines define medical nutrition therapy (MNT) for gestational diabetes and emphasize three areas-definition of MNT clinical goals with indexes to modify or advance MNT and criteria to start insulin; use of self-monitoring tools; and provision of three nutrition visits. Usual care sites provided prenatal nutrition care according to usual practice. The effect of nutrition care (sites following the nutrition care guidelines) and type of clinic site on changes in glycated hemoglobin and infant birth weight, adjusted for other covariates, were evaluated using linear regression. Differences in insulin use and other infant outcomes between treatment groups were evaluated using logistic regression. Generalized estimating equations were used to accommodate nonindependence within randomized clusters of patients within clinic sites. Data from 215 women indicated less insulin use at diabetes clinic sites in the nutrition practice guidelines groups and improved glycated hemoglobin control during the treatment period in diabetes clinics compared with obstetric or other clinics. A higher proportion of women in the usual care group had glycated hemoglobin levels that exceeded 6% at follow-up compared with women in the nutrition practice guidelines group (13.6% vs 8.1%), although not statistically significant (P=0.26). A significant clinic type and treatment group effect was found for birth weight. Nutrition practice guidelines for gestational diabetes mellitus reflected nutrition care already being provided by registered dietitians in diabetes clinics prior to this study because outcomes at these clinics were not impacted. Use of the guidelines by dietitians at obstetric and other clinics tended to improve outcomes at these sites. PMID:16963348

Reader, Diane; Splett, Patricia; Gunderson, Erica P

2006-09-01

111

Infratemporal Space Infection Following Maxillary Third Molar Extraction in an Uncontrolled Diabetic Patient  

PubMed Central

Infratemporal space infection is a rare but serious sequel of odontogenic infection. The diagnosis is difficult due to non spe-cific signs and symptoms. Diabetes mellitus as a definitive risk factor for odontogenic infections needs more consideration during clinical procedures. We report a case of an undiagnosed diabetic patient with isolated infratemporal space infection after tooth extraction with presentation of similar signs and symptoms of temporomandibular joint and muscle problem. PMID:22991649

Mesgarzadeh, Ali Hossein; Ghavimi, Mohammad Ali; Gok, Gul?en; Zarghami, Afsaneh

2012-01-01

112

One Hour versus Two Hours Postprandial Glucose Measurement in Gestational Diabetes: A Prospective Study  

Microsoft Academic Search

OBJECTIVE:To compare the rate of adverse perinatal outcomes among women with gestational diabetes mellitus (GDM), monitored by 1 versus 2 hour-postprandial glucose (PPG) measurements.METHODS:A total of 112 women diagnosed with GDM, by the criteria of Carpenter–Coustan, were included in the study population. Women were recruited from two different treatment settings, but were managed by the same team of health-care professionals

Boaz Weisz; Alon Shrim; Carol J Homko; Eyal Schiff; Gil S Epstein; Eyal Sivan

2005-01-01

113

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

114

Serum fructosamine and fructosamine – albumin ratio as screening tests for gestational diabetes mellitus  

Microsoft Academic Search

.   To evaluate the role of fructosamine\\/albumin ratio as an alternative screening parameter for gestational diabetes mellitus\\u000a (GDM), serum fructosamine, albumin, protein, fructosamine\\/albumin ratio, and oral glucose tolerance were measured in 56 non-pregnant\\u000a control healthy subjects, and in 96 pregnant women who screened positive after a 50 g glucose challenge-test. Oral glucose\\u000a tolerance test (OGTT) identified 12 of 96 pregnant

M. V. Bor; P. Bor; C. Çevik

1999-01-01

115

Oxidative stress and antioxidant status in patients with late-onset gestational diabetes mellitus  

Microsoft Academic Search

The relationship between late-onset gestational diabetes mellitus [GDM] and oxidative stress is not well known, and the importance\\u000a of the oxidant\\/antioxidant equilibrium in the clinical evolution and its complications require elucidation. The aim of the\\u000a study was to evaluate the relationships between maternal levels of markers of oxidative stress in women with late-onset GDM\\u000a that, potentially, may have considerable clinical

Cristina Lopez-TinocoMar; Mar Roca; Amor García-Valero; Mora Murri; Francisco J. Tinahones; Carmen Segundo; José L. Bartha; Manuel Aguilar-Diosdado

116

Oral glucose tolerance testing outcomes among women at high risk for gestational diabetes mellitus  

Microsoft Academic Search

AimsThis study aimed to determine the prevalence and relationships with known risk factors of gestational diabetes mellitus (GDM) at University College Hospital, Ibadan, Nigeria.MethodsRecords of all women referred for oral glucose tolerance testing at the metabolic research unit of the Hospital over a 2 year period were reviewed. Diagnosis of GDM was made in accordance with WHO criteria. GDM diagnosis

Modupe Akinrele Kuti; Fayeofori Mpakabaori Abbiyesuku; Kehinde Simeon Akinlade; Olubayo Michael Akinosun; Kayode Solomon Adedapo; Jokotade Oluremilekun Adeleye; Olubukola Adeponle Adesina

2011-01-01

117

Diagnosis of gestational diabetes mellitus using a modified 100 g oral glucose tolerance test  

Microsoft Academic Search

Objective:To determine an optimal cutoff level of a modified 100 g oral glucose tolerance test (OGTT) with its diagnostic performance for gestational diabetes mellitus (GDM).Study Design:Obstetric records of 909 women who had undergone a 100 g OGTT were reviewed. A modified 100 g OGTT referred to a test using a summation of 1 and 2 h plasma glucose levels after

C Phaloprakarn; S Tangjitgamol

2008-01-01

118

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

119

Metabolic Syndrome Risk after Gestational Diabetes: A Systematic Review and Meta-Analysis  

PubMed Central

Background A number of studies have been conducted to investigate the risk of metabolic syndrome (MS) after gestational diabetes mellitus (GDM), but the results are contradictory. Accordingly, we performed a systematic review and meta-analysis to assess the association between these two conditions. The aim was to better understand the risks of MS with prior gestational diabetes. Methods Pubmed, ISI Web of Science, and Cochrane databases from September 1, 1979 to July 11, 2013 were searched to identify relevant studies. 17 studies containing 5832 women and 1149 MS events were included. We calculated the odds ratio (OR) with 95% confidence interval (CI) in analysis for each study using a random-effect or fixed-effect model. We also determined heterogeneity among these 17 articles and their publication bias. Results Women with a history of gestational diabetes had a significantly higher risk of MS than those who had a normal pregnancy (OR, 3.96; 95% CI, 2.99 to 5.26), but had significant heterogeneity (I2?=?52.6%). The effect remained robust (OR, 4.54; 95% CI, 3.78–5.46) in the subgroup of Caucasians, but no association (OR, 1.28; 95% CI, 0.64–2.56) was found in Asians. Heterogeneity was reduced (body mass index (BMI) matched group I2?=?14.2%, BMI higher in the GDM group I2?=?13.2%) in the subgroup of BMI. In addition, mothers with higher BMI in the GDM group had higher risk of MS than those in the BMI matched group (BMI higher in GDM group OR, 5.39; 95% CI, 4.47–6.50, BMI matched group OR, 2.53; 95% CI, 1.88–3.41). Conclusions This meta-analysis demonstrated increased risk of MS after gestational diabetes. Therefore, attention should be given to preventing or delaying the onset of MS in GDM mothers, particularly in Caucasian and obese mothers. PMID:24498216

Sun, Lizhou; Yang, Haiwei; Jin, Bai; Cao, Xiaohui

2014-01-01

120

Bone density among infants of gestational diabetic mothers and macrosomic neonates.  

PubMed

Decreased bone density has been found among infants of diabetic mothers and among large-for-gestational-age newborns. To evaluate which etiologies (physical or metabolic effect) have the greatest impact on neonatal bone density. A case-control study was conducted that included two study groups: one comprising 20 appropriate-for-gestational-age (AGA) infants of gestational diabetic mothers (IGDM) and matched controls, and the other comprising 20 macrosomic infants (birth weight > 4 kg) and matched controls. Bone density was examined along the tibia bone using quantitative ultrasound that measured speed of sound. Bone density among the group of macrosomic infants was significantly lower than among the control group (2,976 vs. 3,120 m/s respectively, p < 0.005). No differences in bone density were found between infants of diabetic mothers and their controls (3,005 vs. 3,043 m/s respectively, p = 0.286). Low bone density was predicted only by birth weight (for every increase of 100 g) (OR 1.148 [CI 1.014-1.299], p = 0.003). Bone density was found to be low among macrosomic newborn infants, whereas among AGA-IGDM infants bone density was similar to that of the control group. These findings strengthen the hypothesis that reduced fetal movements secondary to fetal macrosomia constitute the mechanism for reduced bone density . PMID:25138627

Schushan-Eisen, Irit; Cohen, Mor; Leibovitch, Leah; Maayan-Metzger, Ayala; Strauss, Tzipora

2015-03-01

121

Associations between ozone and preterm birth in women who develop gestational diabetes.  

PubMed

Prenatal exposure to ambient air pollutants might cause adverse birth outcomes; however, there have been few studies in which the association between air pollution and preterm birth was examined after stratifying by pregnancy complications. We conducted a population-based case-control study of 1,510,064 singleton births from the Taiwanese birth registry during 2001-2007. Of the total of 1,510,064 births, we designated all 86,224 preterm births as the case group and then randomly selected an additional 344,896 from the remaining births (equivalent to 4 full-term births for every 1 preterm birth) as the control sample. We used an inverse distance weighting approach to calculate an average exposure parameter for air pollutants. The adjusted odds ratio for preterm birth per 10-ppb increase in ozone was 1.12 (95% confidence interval: 1.01, 1.23) for women with gestational diabetes mellitus who were exposed in the third trimester and 1.02 (95% confidence interval: 1.01, 1.03) for women without gestational diabetes (P for interaction <0.001). These findings suggest that exposure to ozone in pregnancy is associated with an increased risk of preterm birth, particularly for women who have gestational diabetes mellitus. PMID:25652551

Lin, Yu-Ting; Jung, Chau-Ren; Lee, Yungling Leo; Hwang, Bing-Fang

2015-02-15

122

Hypocaloric diets and ketogenesis in the management of obese gestational diabetic women.  

PubMed

The extent to which given levels of caloric restriction will improve glycemic status but increase plasma ketone bodies in gestational diabetic women has received little attention. After reviewing the underlying physiology, we present data on two feeding studies investigating the question. In the first, a weight-maintaining approximately 2400-kcal/day diet was fed on a metabolic ward to 12 gestational diabetic women for 1 week. In the second week, subjects were randomized to a continuation of the 2400-kcal/day diet or to a 1200-kcal/day diet. Twenty-four-hour mean glucose levels remained unchanged in the control group but declined in the calorie-restricted group (6.7 mM or 121 mg/dl in week 1 vs 5.4 mM or 97.3 mg/dl in week 2) (p less than 0.01). Nine-hour overnight fasting plasma insulin also declined but oral glucose tolerance did not improve with caloric restriction. Fasting plasma beta-hydroxybutyrate rose in the calorie-restricted group, along with an increase in ketonuria, but not in the control group. A second study compared the impact of a 33% calorie-restricted diet or insulin to a full-calorie diet in a similar 2-week experimental design and measured hepatic glucose output and insulin sensitivity with dideuterated glucose before and during an insulin clamp. Diet in three subjects improved fasting and 24-hr mean glucose by 22 and 10%, respectively, whereas prophylactic insulin in three subjects produced 0 and 4% reductions, respectively. On average, ketonuria after a 9-hr fast declined to an equivalent degree with both treatments. Hepatic glucose output and insulin sensitivity were not statistically significantly altered by gestational diabetes or the therapeutic interventions compared to nondiabetic normal weight or obese pregnant controls. In conclusion, 50% caloric restriction improves glycemic status in obese women with gestational diabetes but is associated with an increase in ketonuria, which is of uncertain significance. An intermediate 33% level of caloric restriction (to 1600-1800 kcal daily) may be more appropriate in dietary management of obese woman with gestational diabetes mellitus and more effective than prophylactic insulin. Further studies are required to confirm these findings. PMID:1770194

Knopp, R H; Magee, M S; Raisys, V; Benedetti, T; Bonet, B

1991-12-01

123

Effect of pinitol on glucose metabolism and adipocytokines in uncontrolled type 2 diabetes.  

PubMed

Pinitol (3-O-methyl-D-chiro-inositol) was identified in putative insulin mediator fractions that have hypoglycemic activity, and appears to mimic the act effects of insulin by acting downstream in the insulin signaling pathway. We evaluated the effect of pinitol therapy in type 2 diabetic patients who were poorly controlled with hypoglycemic drugs, such as sulfonylurea, metformin and/or insulin. Twenty type 2 diabetic patients were enrolled in our study. Fasting glucose, fasting c-peptide, total cholesterol, triglyceride, and HDL- and LDL-cholesterol were checked before and after a 12-week pinitol treatment (20 mg kg(-1)day(-1)). All subjects continued their current medications during the study. Adipocytokines, such as adiponectin, leptin, free fatty acids, and c-reactive protein (CRP) were checked before and after pinitol treatment. After pinitol treatment, fasting glucose, post-prandial glucose levels, and hemoglobin A1c were significantly decreased (P<0.05). Fasting serum adiponectin, leptin, free fatty acid, and CRP levels did not change after pinitol treatment. In the unresponsive group, serum c-peptide levels were higher than in the responsive group. Twelve weeks of pinitol treatment altered glucose metabolism, but not lipid profiles or adipocytokine levels, in type 2 diabetic patients. Additional research is needed to define the physiological and potential therapeutic effects of pinitol administration. PMID:17467106

Kim, Mi Jin; Yoo, Kwang Ha; Kim, Ji Hoon; Seo, Young Tak; Ha, Byung Wook; Kho, Jang Hyun; Shin, Young Goo; Chung, Choon Hee

2007-09-01

124

Detection of subsequent episodes of gestational diabetes mellitus: a need for specific guidelines.  

PubMed

Guidelines for detection of individuals with gestational diabetes mellitus (GDM) indicate that glucose testing for women with a history of GDM should occur as soon as feasible with retesting of an initially negative screen to occur between the 24th and 28th week of gestation. The aim of this study was to evaluate medical records for individuals enrolled in a GDM management program that presented with two subsequent pregnancies with GDM and to determine if more specific guidelines for detection are needed. Records (n=60) from both pregnancies were reviewed for gestational age at enrollment, delivery, and when insulin was started, infant birth weights and complications (e.g., hypoglycemia), and maternal complications (e.g., emergency cesarean section). Over half [33/60 (55%)] of the women required insulin during both pregnancies, while 16.7% (10/60) required insulin during the second enrollment for GDM but not the first. For those requiring insulin during both pregnancies, 88% (29/33) required it earlier during the subsequent pregnancy (31.5+/-2.7 vs. 21.6+/-8.4 weeks of gestation, P<.001). During the subsequent pregnancy, approximately 1/2 of the women requiring insulin needed it before the 24th week of gestation while 1/3 required it by the 15th week. Also during the subsequent pregnancy, neonate birth weights declined (3494+/-521 vs. 3356+/-515 g, P<.05) and there were fewer complications. Given that approximately 70% of the women required insulin therapy during a subsequent GDM pregnancy and that this therapy was on average necessary by the 22nd week of gestation, we recommend that specific guidelines be established with a definitive time frame determined for the detection of repeat episodes of GDM. PMID:15120702

Maser, Raelene E; Lenhard, M James; Henderson, Bernardine C; Cobb, Rosemary S; Hands, Kathleen E

2004-01-01

125

[Self-care deficiencies in patients with gestational diabetes mellitus: a contribution to nursing].  

PubMed

Gestational diabetes mellitus can be controlled and its complications prevented, provided clients take part in self-care actions. The objective of the present study was to identify self care deficiencies in pregnant women suffering from diabetes, and to provide inputs for their educational support. This descriptive study included 12 pregnant women cared at a diabetes and hypertension reference institution in Fortaleza, Ceará, Brazil, in April and May, 2007. Data were collected using a semistructured interview. Analysis was based on Orem's Nursing General Theory. Self-care deficiencies were related to eating habits, physical activities, sleep and rest, and social interaction. Nurses must provide educational support to these patients, evaluate their self-care capacity, and propose actions that involve the family, as well as group activities in health services. PMID:19068573

Landim, Camila Aparecida Pinheiro; Milomens, Kallyne Moreira Pequeno; Diógenes, Maria Albertina Rocha

2008-09-01

126

Biochemical view on: Precocious markers of cardiovascular risk and vascular damage in apparently healthy women with previous gestational diabetes.  

PubMed

Women diagnosed with gestational diabetes mellitus have an increased risk of developing diabetes mellitus, which is a known risk factor for cardiovascular disease and insulin resistance. In the recently published article by Zajdenverg et al., they aimed to identify endothelial dysfunction and cardiovascular risk factors in women with previous gestational diabetes mellitus. However, authors did not evaluate the role of total homocysteine, which has important effects for endothelial dysfunction. Vitamin B12 and folic acid are important vitamins since their deficiency may lead to the probable microvascular abnormalities by increasing the tHcy, which is an independent risk factor for endothelial dysfunction. PMID:25798200

Kayadibi, Huseyin; Sertoglu, Erdim; Uyanik, Metin

2015-01-01

127

Clinical profile, outcomes, and progression to type 2 diabetes among Indian women with gestational diabetes mellitus seen at a diabetes center in south India  

PubMed Central

Aim: To describe the clinical profile, maternal and fetal outcomes, and the conversion rates to diabetes in women with gestational diabetes mellitus (GDM) seen at a tertiary care diabetes center in urban south India. Materials and Methods: Clinical case records of 898 women with GDM seen between 1991 and 2011 were extracted from the Diabetes Electronic Medical Records (DEMR) of a tertiary care diabetes center in Chennai, south India and their clinical profile was analyzed. Follow-up data of 174 GDM women was available. To determine the conversion rates to diabetes, oral glucose tolerance test (OGTT) was done in these women. Glucose tolerance status postpartum was classified based on World Health Organization (WHO) 2006 criteria. Results: The mean maternal age of the women was 29 ± 4 years and mean age of gestation at first visit were 24 ± 8.4 weeks. Seventy percent of the women had a family history of diabetes. Seventy-eight percent of the women delivered full-term babies and 65% underwent a cesarean section. The average weight gain during pregnancy was 10.0 ± 4.2 kg. Macrosomia was present in 17.9% of the babies, hypoglycemia in 10.4%, congenital anomalies in 4.3%, and the neonatal mortality rate was 1.9%. Mean follow-up duration of the 174 women of whom outcome data was available was 4.5 years. Out of the 174, 101 women who were followed-up developed diabetes, of whom half developed diabetes within 5 years and over 90%, within 10 years of the delivery. Conclusions: Progression to type 2 diabetes mellitus (T2DM) in Indian women with GDM is rapid. There is an urgent need to develop standardized protocols for GDM care in India that can improve the maternal and fetal outcomes and help prevent future diabetes in women with GDM. PMID:24944938

Mahalakshmi, Manni Mohanraj; Bhavadharini, Balaji; Kumar, Maheswari; Anjana, Ranjit Mohan; Shah, Sapna S.; Bridgette, Akila; Choudhury, Mridusmita; Henderson, Margaret; Desborough, Lane; Viswanathan, Mohan; Ranjani, Harish

2014-01-01

128

Fetal growth in relation to gestational weight gain in women with Type 2 diabetes: an observational study  

PubMed Central

Aims To evaluate fetal growth in relation to gestational weight gain in women with Type 2 diabetes. Methods A retrospective cohort study of 142 consecutive pregnancies in 28 women of normal weight, 39 overweight women and 75 obese women with Type 2 diabetes (pre-pregnancy BMI  < 25, 25–29.9,  ? 30 kg/m2, respectively). Gestational weight gain was categorized as excessive (exceeding the US Institute of Medicine recommendations) or as non-excessive (within or below the Institute of Medicine recommendations). Results Excessive and non-excessive gestational weight gain were seen in 61 (43%) and 81 women (57%) with a median (range) gestational weight gain of 14.3 (9–32) vs 7.0 (?5–16) kg (P < 0.001), respectively. Infants of women with excessive gestational weight gain were characterized by higher birth weight (3712 vs 3258 g; P = 0.001), birth weight z-score (1.14 vs -0.01, P = 0.001) and prevalence of large-for-gestational-age infants (48 vs 20%; P < 0.001). In normal weight, overweight and obese women with non-excessive gestational weight gain, the median weight gain in the first half of pregnancy was 371, 114 and 81 g/week, and in the second half of pregnancy 483, 427 and 439 g/week, respectively. In multiple linear regression analysis, gestational weight gain was associated with a higher infant birth weight z-score independent of pre-pregnancy BMI, smoking, HbA1c and insulin dose at last visit, ethnicity and parity [?=0.1 (95% CI 0.06–0.14), P < 0.001]. Conclusions Infant birth weight was almost 0.5 kg higher in women with Type 2 diabetes and excessive gestational weight gain than in women with Type 2 diabetes and non-excessive weight gain. PMID:25081349

Parellada, C B; Ásbjörnsdóttir, B; Ringholm, L; Damm, P; Mathiesen, E R

2014-01-01

129

Prevalence of gestational diabetes mellitus and its correlation with blood pressure in Manipuri women  

PubMed Central

Objective: The aim and objective was to study the prevalence of gestational diabetes mellitus (GDM) by using National Diabetes Data Group (NDDG) and American Diabetes Association (ADA) (2004) criteria and the correlation of GDM with gestational blood pressure (BP) and maternal age. Study Design: This was a cross-sectional study in which 300 pregnant women in 24-28 weeks of pregnancy who screened positive with 1-h glucose load ? 140 mg/dL underwent a diagnostic 3-h oral glucose tolerance test (OGTT). BP was obtained by review of the medical records. Results: Thirty-seven (12.33%) women were screened positive with 50 g glucose challenge test (GCT) (?140 mg%) out of the 300 participants. With 100 g 3-h OGTT among these 37 women, none of them fulfilled the NDDG diagnostic criteria for GDM. However, on using the ADA (2004) criteria, three (8.1%) women were diagnosed to have GDM. All three of them had systolic BP between 120 and 139 mmHg; two of them had diastolic BP between 80 and 89 mmHg. Among 37 subjects with GCT > 140 mg%, majority were older than 26 years. Conclusion: Using the ADA (2004) guideline, 1% of the total study population had GDM. The BP of these patients fell within the prehypertensive range, thus suggesting an association between GDM and BP. PMID:24381867

Vanlalhruaii; Ranabir, Salam; Prasad, Lallan; Singh, Naorem Nabakishore; Singh, Thangjam Premchand

2013-01-01

130

A Case Study of a Pregnant Patient with a Congenital Heart Block Accompanied by Left Isomerism and Uncontrolled Type 2 Diabetes Who Was Treated Successfully with Ritodrine  

Microsoft Academic Search

We present a case study of a patient with a congenital heart block associated with a left isomerism that was diagnosed during the 26th week of gestation. The mother had type 2 diabetes mellitus that was difficult to control during the early stages of the pregnancy. A fetal echocardiogram revealed an atrioventricular dissociation, with an atrial rate of 120 bpm

Takehiro Serikawa; Kaya Ichikawa; Akira Kikuchi; Koichi Takakuwa; Kenichi Tanaka

2010-01-01

131

Prevalence of gestational diabetes mellitus and its outcome in western Rajasthan  

PubMed Central

Background: Gestational diabetes mellitus (GDM) is a metabolic disorder defined as glucose intolerance with the onset or first recognition during pregnancy. Women with GDM are at increased risk for adverse obstetric and perinatal outcome. Hence, it is imperative that an early detection and management of the disease is done to ensure better maternal and fetal outcomes. Aims: This study was done to evaluate the prevalence of gestational diabetes using diabetes in pregnancy Study Group India (DIPSI) criteria and further assess its feto-maternal outcome in western Rajasthan. Materials and Methods: This study was carried out in 500 patients between 24 and 28 weeks of gestation, attending the antenatal outdoor. These patients were given 75 g oral glucose irrespective of the meals and their plasma glucose was estimated at 2 h. Patients with plasma glucose values ?140 mg/dl were labeled as GDM and the rest as the control or the non-GDM group. All GDM patients were followed up and treated with diet and/or insulin therapy till delivery to know maternal and fetal outcomes. Results: The prevalence of GDM in this study was 6.6%. Maternal and fetal complications in the GDM group were much higher than in the non-GDM group. Hypertension, vaginal candidiasis, and abruptio placentae were the common maternal complications, while macrosomia and stillbirths occurred in the fetuses. Conclusion: GDM as a disease entity adversely affects maternal and fetal outcomes. This also builds a strong case for following DIPSI guidelines in diagnosis and management of GDM. PMID:23961485

Kalra, Priyanka; Kachhwaha, Chetan Prakash; Singh, Hilda Victoria

2013-01-01

132

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

133

Prevalence of gestational diabetes mellitus & associated risk factors at a tertiary care hospital in Haryana  

PubMed Central

Background & objectives: Prevalence of gestational diabetes mellitus (GDM) is known to vary widely depending on the region of the country, dietary habits, and socio-economic status. This study was undertaken to determine the prevalence of GDM and risk factors associated with it, in women attending an antenatal care (ANC) clinic at a tertiary care hospital in Haryana. Methods: This study enrolled women, with their estimated gestational age between 24th and 28th week, attending antenatal care (ANC) clinic at a tertiary care hospital in Rohtak. After informing, women who consented to participate were given a standardized 2-h 75 g oral glucose tolerance test (OGTT). A proforma containing general information on demographic characteristics, socio-economic status, education level, parity, family history of diabetes and/or hypertension and past history of GDM was filled up. American Diabetes Association (ADA) criteria for 75 g 2-h OGTT was used for diagnosing GDM. Results: A total of 607 women participated in the study and GDM was diagnosed in 43 (7.1%) women. A single abnormal value was observed in additional 66 (10.87%) women. On bivariate analysis risk factors found to be significantly associated with GDM were age, educational level, socio-economic status, pre-pregnancy weight and BMI, weight gain, acanthosis nigricans, family history of diabetes or hypertension and past history of GDM but on multivariate analysis only upper middle class and presence of acanthosis nigricans were found to be significantly associated with GDM. Interpretation & conclusions: The prevalence of GDM was found to be 7.1 per cent in a tertiary care hospital in Haryana. Appropriate interventions are required for control and risk factor modifications. PMID:23703340

Rajput, Rajesh; Yadav, Yogesh; Nanda, Smiti; Rajput, Meena

2013-01-01

134

Gestational Diabetes  

MedlinePLUS Videos and Cool Tools

... loss Dealing with grief Research Research grants Infant health research Prematurity research Birth defects research Professionals Info for your patients Medical resources Professional education Perinatal Statistics Scholarships and grants Advocacy Federal Advocacy ...

135

Low rates of postpartum glucose screening among indigenous and non-indigenous women in Australia with gestational diabetes.  

PubMed

Women with gestational diabetes have a high risk of type 2 diabetes postpartum, with Indigenous women particularly affected. This study reports postpartum diabetes screening rates among Indigenous and non-Indigenous women with gestational diabetes, in Far North Queensland, Australia. Retrospective study including 1,012 women with gestational diabetes giving birth at a regional hospital from 1/1/2004 to 31/12/2010. Data were linked between hospital records, midwives perinatal data, and laboratory results, then analysed using survival analysis and logistic regression. Indigenous women had significantly longer times to first oral glucose tolerance test (OGTT) [hazards ratio (HR) 0.62, 95 % confidence interval (CI) 0.48-0.79, p < 0.0001) and 'any' postpartum glucose test (HR 0.81, 95 % CI 0.67-0.98, p = 0.03], compared to non-Indigenous women. Postpartum screening rates among all women were low. However, early OGTT screening rates (<6 months) were significantly lower among Indigenous women (13.6 vs. 28.3 %, p < 0.0001), leading to a persistent gap in cumulative postpartum screening rates. By 3 years postpartum, cumulative rates of receiving an OGTT, were 24.6 % (95 % CI 19.9-30.2 %) and 34.1 % (95 % CI 30.6-38.0 %) among Indigenous and non-Indigenous women, respectively. Excluding OGTTs in previous periods, few women received OGTTs at 6-24 months (7.8 vs. 6.7 %) or 2-4 years (5.2 vs. 6.5 %), among Indigenous and non-Indigenous women, respectively. Low rates of postpartum diabetes screening demonstrate that essential 'ongoing management' and 'equity' criteria for population-based screening for gestational diabetes are not being met; particularly among Indigenous women, for whom recent guideline changes have specific implications. Strategies to improve postpartum screening after gestational diabetes are urgently needed. PMID:24981736

Chamberlain, Catherine; McLean, Anna; Oats, Jeremy; Oldenburg, Brian; Eades, Sandra; Sinha, Ashim; Wolfe, Rory

2015-03-01

136

The Role of Metformin in Metabolic Disturbances during Pregnancy: Polycystic Ovary Syndrome and Gestational Diabetes Mellitus  

PubMed Central

Maintenance of gestation implicates complex function of multiple endocrine mechanisms, and disruptions of the global metabolic environment prompt profound consequences on fetomaternal well-being during pregnancy and postpartum. Polycystic Ovary Syndrome (PCOS) and gestational diabetes mellitus (GDM) are very frequent conditions which increase risk for pregnancy complications, including early pregnancy loss, pregnancy-induced hypertensive disorders, and preterm labor, among many others. Insulin resistance (IR) plays a pivotal role in the pathogenesis of both PCOS and GDM, representing an important therapeutic target, with metformin being the most widely prescribed insulin-sensitizing antidiabetic drug. Although traditional views neglect use of oral antidiabetic agents during pregnancy, increasing evidence of safety during gestation has led to metformin now being recognized as a valuable tool in prevention of IR-related pregnancy complications and management of GDM. Metformin has been demonstrated to reduce rates of early pregnancy loss and onset of GDM in women with PCOS, and it appears to offer better metabolic control than insulin and other oral antidiabetic drugs during pregnancy. This review aims to summarize key aspects of current evidence concerning molecular and epidemiological knowledge on metformin use during pregnancy in the setting of PCOS and GDM. PMID:25763406

Rojas, Joselyn; Chávez-Castillo, Mervin; Bermúdez, Valmore

2014-01-01

137

The effectiveness of medical assistant health coaching for low-income patients with uncontrolled diabetes, hypertension, and hyperlipidemia: protocol for a randomized controlled trial and baseline characteristics of the study population  

E-print Network

Diabetes, Hypertension, Hyperlipidemia, Safety net, Primaryprimary care practices for patients with uncontrolled type 2 dia- betes, hypertension,hypertension, or hyperlipidemia. A total of 441 patients from two San Francisco primary

Willard-Grace, Rachel; DeVore, Denise; Chen, Ellen H; Hessler, Danielle; Bodenheimer, Thomas; Thom, David H

2013-01-01

138

"GINEXMAL RCT: Induction of labour versus expectant management in gestational diabetes pregnancies"  

PubMed Central

Background Gestational Diabetes (GDM) is one of the most common complications of pregnancies affecting around 7% of women. This clinical condition is associated with an increased risk of developing fetal macrosomia and is related to a higher incidence of caesarean section in comparison to the general population. Strong evidence indicating the best management between induction of labour at term and expectant monitoring are missing. Methods/Design Pregnant women with singleton pregnancy in vertex presentation previously diagnosed with gestational diabetes will be asked to participate in a multicenter open-label randomized controlled trial between 38+0 and 39+0 gestational weeks. Women will be recruited in the third trimester in the Outpatient clinic or in the Day Assessment Unit according to local protocols. Women who opt to take part will be randomized according to induction of labour or expectant management for spontaneous delivery. Patients allocated to the induction group will be admitted to the obstetric ward and offered induction of labour via use of prostaglandins, Foley catheter or oxytocin (depending on clinical conditions). Women assigned to the expectant arm will be sent to their domicile where they will be followed up until delivery, through maternal and fetal wellbeing monitoring twice weekly. The primary study outcome is the Caesarean section (C-section) rate, whilst secondary measurement4s are maternal and neonatal outcomes. A total sample of 1760 women (880 each arm) will be recruited to identify a relative difference between the two arms equal to 20% in favour of induction, with concerns to C-section rate. Data will be collected until mothers and newborns discharge from the hospital. Analysis of the outcome measures will be carried out by intention to treat. Discussion The present trial will provide evidence as to whether or not, in women affected by gestational diabetes, induction of labour between 38+0 and 39+0 weeks is an effective management to ameliorate maternal and neonatal outcomes. The primary objective is to determine whether caesarean section rate could be reduced among women undergoing induction of labour, in comparison to patients allocated to expectant monitoring. The secondary objective consists of the assessment and comparison of maternal and neonatal outcomes in the two study arms. Trial Registration The study protocol has been registered in the ClinicalTrials.gov Protocol Registration System, identification number NCT01058772. PMID:21507262

2011-01-01

139

Protein turnover and 3-methylhistidine excretion in non-pregnant, pregnant and gestational diabetic women  

SciTech Connect

Protein turnover was studied in nine non-pregnant (NP) women, eight pregnant (P) and two gestational diabetic (GDM) women. Whole body protein turnover, synthesis and catabolism rates were measured using a single oral dose of /sup 15/N-glycine followed by measurement of enrichment of urinary ammonia. Urinary 3-methylhistidine (3MH) excretion was measured for three consecutive days, including the day of the protein turnover study. Whole body protein turnover and synthesis rates did not differ between the P and NP women, although the synthesis rates tended to be higher in the P group. Gestational diabetic women appeared to have considerably higher rates of both turnover and synthesis. Pregnant women excreted significantly more urinary 3MH than did non-pregnant women. GDM women appeared to have lower 3MH excretion than the P women. Correlation between 3MH excretion and protein turnover rates was nearly significant (p = .06) in the NP women, but was poorly correlated (p = .43) in the P women, suggesting that muscles may be a less important site of whole body protein turnover in pregnancy than in the non-pregnant state.

Fitch, W.L.; King, J.C.

1986-03-01

140

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

141

Diet Quality and History of Gestational Diabetes Mellitus Among Childbearing Women, United States, 2007–2010  

PubMed Central

Introduction Women with a history of gestational diabetes mellitus (GDM) have elevated risk of developing type 2 diabetes. Diet quality plays an important role in the prevention of type 2 diabetes. We compared diet quality among childbearing women with a history of GDM with the diet quality of childbearing women without a history of GDM. Methods We used data from the National Health and Nutrition Examination Survey for 2007 through 2010. We included women without diabetes aged 20 to 44 years whose most recent live infant was born within the previous 10 years and who completed two 24-hour dietary recalls. The Healthy Eating Index (HEI)-2010 estimated overall and component diet quality. Multivariable linear regression models estimated the association between a history of GDM and current diet quality, adjusting for age, education, smoking status, and health risk for diabetes. Results A history of GDM was reported by 7.7% of women. Compared with women without a history of GDM, women with a history of GDM had, on average, 3.4 points lower overall diet quality (95% confidence interval [CI], ?6.6 to ?0.2) and 0.9 points lower score for consumption of green vegetables and beans (95% CI, ?1.4 to ?0.4). Other dietary component scores did not differ by history of GDM. Conclusion In the United States, women with a history of GDM have lower diet quality compared with women who bore a child and do not have a history of GDM. Improving diet quality may be a strategy for preventing type 2 diabetes among childbearing women. PMID:25719215

Simas, Tiffany A. Moore; Person, Sharina D.; Goldberg, Robert J.; Waring, Molly E.

2015-01-01

142

Reasons for participation and non-participation in a diabetes prevention trial among women with prior gestational diabetes mellitus (GDM)  

PubMed Central

Background Gestational diabetes mellitus (GDM) is a risk factor for the development of type 2 diabetes. Lifestyle intervention can prevent progression to type 2 diabetes in high risk populations. We designed a randomised controlled trial (RCT) to evaluate the effectiveness of an established lifestyle intervention compared to standard care for delaying diabetes onset in European women with recent GDM. Recruitment into the RCT was more challenging than anticipated with only 89 of 410 (22%) women agreeing to participate. This paper identifies factors that could enhance participation of the target population in future interventions. Methods We hypothesised that women who agreed to participate would have higher diabetes risk profiles than those who declined, and secondly that it would be possible to predict participation on the bases of those risk factors. To test our hypothesis, we identified the subset of women for whom we had comprehensive data on diabetes risks factors 3-5 years following GDM, reducing the sample to 43 participants and 73 decliners. We considered established diabetes risk factors: smoking, daily fruit and vegetable intake, participation in exercise, family history of diabetes, glucose values and BMI scores on post-partum re-screens, use of insulin during pregnancy, and age at delivery. We also analysed narrative data from 156 decliners to further understand barriers to and facilitators of participation. Results Two factors differentiated participants and decliners: age at delivery (with women older than 34 years being more likely to participate) and insulin use during pregnancy (with women requiring the use of insulin in pregnancy less likely to participate). Binary logistic regression confirmed that insulin use negatively affected the odds of participation. The most significant barriers to participation included the accessibility, affordability and practicality of the intervention. Conclusions Women with recent GDM face multiple barriers to lifestyle change. Intervention designers should consider: (i) the practicalities of participation for this population, (ii) research designs that capitalise on motivational differences between participants, (iii) alleviating concerns about long-term diabetes management. We hope this work will support future researchers in developing interventions that are more relevant, effective and successful in recruiting the desired population. Trial registration Current Controlled Trials ISRCTN41202110 PMID:24461045

2014-01-01

143

Pregnancy glucose levels in women without diabetes or gestational diabetes and childhood cardiometabolic risk at 7 years of age  

PubMed Central

Objective To estimate the association between pregnancy glucose values in women without recognized pregestational diabetes or gestational diabetes (GDM) and cardiometabolic risk in their children. Study design This longitudinal cohort study of 211 Mexican-American mother-child pairs participating in CHAMACOS (Center for the Health Assessment of Mothers and Children of Salinas) used multiple logistic regression to estimate the children’s risk of non-fasting total cholesterol, non-fasting triglycerides, blood pressure and waist circumference g?75th percentile at 7 years of age associated with a 1 mmol/L (18 mg/dl) increase in maternal pregnancy glucose level, measured 1-hour after a 50-g oral glucose load. Results The odds ratios for children belonging to the upper quartile of diastolic blood pressure (DBP), systolic blood pressure (SBP), and waist circumference (WC) associated with a 1 mmol/L increase in pregnancy glucose level were 1.39 (95% CI 1.10-1.75), 1.38 (95% CI 1.10-1.73) and 1. 25 (95% CI 1.02-1.54), respectively. Pre-pregnancy obesity was independently associated with increased odds of children belonging to the upper quartile of WC; maternal sugar-sweetened beverage consumption and gestational weight gain prior to the glucose test were not independently associated with any of the cardiometabolic outcomes. Conclusion In Mexican-American women without recognized pregestational diabetes or GDM, we found an association between increasing pregnancy glucose values and the children’s DBP, SBP and WC at 7 years of age. Whether interventions to reduce pregnancy glucose values, even if below levels diagnostic of overt disease, will mitigate subsequent high BP and abdominal obesity in late childhood remains to be determined. PMID:22790183

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

2015-01-01

144

Women with gestational diabetes in Vietnam: a qualitative study to determine attitudes and health behaviours  

PubMed Central

Background Diabetes is increasing in prevalence globally, notably amongst populations from low- and middle- income countries. Gestational Diabetes Mellitus(GDM), a precursor for type 2 diabetes, is increasing in line with this trend. Few studies have considered the personal and social effects of GDM on women living in low and middle-income countries. The aim of this study was determine attitudes and health behaviours of pregnant women with GDM in Vietnam. Methods This was a qualitative study using focus group methodology conducted in Ho Chi Minh City. Pregnant women, aged over 18 years, with GDM were eligible to participate. Women were purposely sampled to obtain a range of gestational ages and severity of disease. They were invited to attend a 1-hour focus group. Questions were semi structured around six themes. Focus groups were recorded, transcribed, translated and cross-referenced. Non-verbal and group interactions were recorded. Thematic analysis was performed using a theoretical framework approach. Results From December 2010 to February 2011, four focus groups were conducted involving 34 women. Median age was 31.5 years (range 23 to 44), median BMI 21.8 kg/m2. Women felt confusion, anxiety and guilt about GDM. Many perceived their baby to be at increased risk of death. Advice to reduce dietary starch was confusing. Women reported being ‘hungry’ or ‘starving’ most of the time, unaware of appropriate food substitutions. They were concerned about transmission of GDM through breast milk. Several women planned not to breastfeed. All felt they needed more information. Current sources of information included friends, magazines, a health phone line or the Internet. Women felt small group sessions and information leaflets could benefit them. Conclusions This study highlights the need for culturally appropriate clinical education and health promotion activities for women with GDM in Vietnam. PMID:22873351

2012-01-01

145

Use of Ultrasound in the Metabolic Management of Gestational Diabetes and Preexisting Diabetes Mellitus in Pregnancy  

Microsoft Academic Search

\\u000a While in former times pregnancies of women with diabetes often ended unhappily with either intrauterine death or severe postnatal\\u000a problems for the child, current improved methods of glucose control and fetal surveillance provide the chance of a healthy\\u000a baby for this high risk group of pregnant women. Management of pregnancies with diabetes has been solely focused on the achievement\\u000a of

Schaefer-Graf UM

146

The relationship between low maternal serum 25-hydroxyvitamin D levels and gestational diabetes mellitus according to the severity of 25-hydroxyvitamin D deficiency  

PubMed Central

OBJECTIVE: To assess the relationship between low maternal serum 25-hydroxyvitamin D levels and gestational diabetes mellitus in Turkish pregnant women according to the severity of 25-hydroxyvitamin D deficiency and assess intact parathyroid hormone levels in women with gestational diabetes mellitus and controls with low and sufficient 25-hydroxyvitamin D levels. METHODS: We analyzed serum 25-hydroxyvitamin D and intact parathyroid hormone levels in 234 women with gestational diabetes mellitus and 168 controls. To define the deficiency status, 25-hydroxyvitamin D levels were further classified into severely deficient, deficient, insufficient and sufficient groups. RESULTS: Women with gestational diabetes mellitus had significantly lower 25-hydroxyvitamin D levels compared to controls (30.8±16.3 vs. 36.0±16.2 nmol/L). However, when subgroups of 25-hydroxyvitamin D were analyzed, gestational diabetes mellitus was significantly more common only in women with severely deficient 25-hydroxyvitamin D levels. After adjusting for covariates, only severely deficient 25-hydroxyvitamin D levels were independently associated with an increased relative risk of gestational diabetes mellitus. The relative risk of gestational diabetes mellitus in women with insufficient and deficient 25-hydroxyvitamin D levels was not statistically significant. Intact parathyroid hormone concentrations were also significantly higher in women with gestational diabetes mellitus compared to the controls (45.3±26.2 vs. 38.7±27.6 pg/ml). CONCLUSIONS: The results obtained from this study provide novel data indicating that only severely deficient maternal serum 25-hydroxyvitamin D levels are significantly associated with an elevated relative risk of gestational diabetes mellitus, even after adjusting for established risk factors of gestational diabetes mellitus. PMID:23778416

Zuhur, Sayid Shafi; Erol, Rumeysa Selvinaz; Kuzu, Idris; Altuntas, Yuksel

2013-01-01

147

Vitamin D insufficiency is common in Indian mothers but is not associated with gestational diabetes or variation in newborn size  

PubMed Central

Background/objectives: Vitamin D is required for bone growth and normal insulin secretion. Maternal hypovitaminosis D may impair fetal growth and increase the risk of gestational diabetes. We related maternal vitamin D status in pregnancy to maternal and newborn glucose and insulin concentrations, and newborn size, in a South Indian population. Subjects/methods: Serum 25 hydroxy vitamin D (25(OH)D) concentrations, glucose tolerance, and plasma insulin, proinsulin and 32-33 split proinsulin concentrations were measured at 30 weeks gestation in 559 women who delivered at the Holdsworth Memorial Hospital, Mysore. The babies' anthropometry and cord plasma glucose, insulin and insulin precursor concentrations were measured. Results: 66% of women had hypovitaminosis D [25(OH)D concentrations <50 nmol/l] and 31% were below 28 nmol/l. There was seasonal variation in 25(OH)D concentrations (P<0.0001). There was no association between maternal 25(OH)D and gestational diabetes (incidence 7% in women with and without hypovitaminosis D). Maternal 25(OH)D concentrations were unrelated to newborn anthropometry or cord plasma variables. In mothers with hypovitaminosis D, higher 25(OH)D concentrations were associated with lower 30-minute glucose concentrations (p=0.03) and higher fasting proinsulin concentrations (p=0.04). Conclusions: Hypovitaminosis D at 30 weeks gestation is common in Mysore mothers. It is not associated with an increased risk of gestational diabetes, impaired fetal growth, or altered neonatal cord plasma insulin secretory profile. PMID:18285809

Farrant, Hannah JW; Krishnaveni, Ghattu V; Hill, Jacqueline C; Boucher, Barbara J; Fisher, David J; Noonan, Kate; Osmond, Clive; Veena, Sargoor R; Fall, Caroline HD

2009-01-01

148

Primary prevention of gestational diabetes for women who are overweight and obese: a randomised controlled trial  

PubMed Central

Background Gestational Diabetes Mellitus (GDM) has well recognised adverse health implications for the mother and her newborn that are both short and long term. Obesity is a significant risk factor for developing GDM and the prevalence of obesity is increasing globally. It is a matter of public health importance that clinicians have evidence based strategies to inform practice and currently there is insufficient evidence regarding the impact of dietary and lifestyle interventions on improving maternal and newborn outcomes. The primary aim of this study is to measure the impact of a telephone based intervention that promotes positive lifestyle modifications on the incidence of GDM. Secondary aims include: the impact on gestational weight gain; large for gestational age babies; differences in blood glucose levels taken at the Oral Glucose Tolerance Test (OGTT) and selected factors relating to self-efficacy and psychological wellbeing. Method/design A randomised controlled trial (RCT) will be conducted involving pregnant women who are overweight (BMI >25 to 29.9 k/gm2) or obese (BMI >30?kgm/2), less than 14 weeks gestation and recruited from the Barwon South West region of Victoria, Australia. From recruitment until birth, women in the intervention group will receive a program informed by the Theory of Self-efficacy and employing Motivational Interviewing. Brief ( less than 5 minute) phone contact will alternate with a text message/email and will involve goal setting, behaviour change reinforcement with weekly weighing and charting, and the provision of health information. Those in the control group will receive usual care. Data for primary and secondary outcomes will be collected from medical record review and a questionnaire at 36 weeks gestation. Discussion Evidence based strategies that reduce the incidence of GDM are a priority for contemporary maternity care. Changing health behaviours is a complex undertaking and trialling a composite intervention that can be adopted in various primary health settings is required so women can be accessed as early in pregnancy as possible. Using a sound theoretical base to inform such an intervention will add depth to our understanding of this approach and to the interpretation of results, contributing to the evidence base for practice and policy. Trial registration This trial is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12613000125729 PMID:23497264

2013-01-01

149

Risk Factors That can Predict Antenatal Insulin Need in Gestational Diabetes  

PubMed Central

Background This study was undertaken to assess the association between insulin need in gestational diabetes mellitus (GDM) and clinical features and laboratory parameters. Factors that can predict insulin need are also identified. Methods Cases with GDM were included retrospectively from records. Cases which failed to achieve target blood glucose levels with medical nutrition therapy (MNT) and need insulin treatment were recorded. Risk factors which can predict antenatal insulin treatment (AIT) were identified as follows; the presence of diabetes in a first degree relative, body mass index prior to pregnancy, number of parity, history of GDM, macrosomic baby delivery (> 4,000 g), age, gestational week at time of diagnosis, body mass index during diagnosis, weight gain untill diagnosis, mean systolic and diastolic blood pressure, HbA1C level during diagnosis, and fasting plasma glucose on diagnostic oral glucose tolerance test. Presence of a statistical significance between those patient features and AIT was assessed. Independent predictors for AIT were evaluated. Results A total of 300 cases were recruited from records, 190 cases (63.3%) were followed only with MNT until delivery and 110 cases (36.7%) were initiated AIT. The association between AIT and patient factors like presence of diabetes in the pedigree, week of gestation at which GDM was diagnosed, BMI during diagnosis, HbA1C levels, and fasting plasma glucose during diagnosis was found (P = 0.03; 0.008; 0.049; 0.001 and 0.001respectively). Multivariant analysis showed that fasting plasma glucose levels during diagnosis and HbA1C levels were independent risk factors for AIT. Fasting plasma glucose values that can predict AIT were identified > 89.5 mg/dL with 72.7% sensitivity and 62.6% spesifity (P < 0.001). Positive predictive value was 73% (P < 0.001). Also, HbA1C levels that can predict AIT was found to be > 5.485% with 65.3% sensitivity and 66.7% spesifitiy(P < 0.001) with a positive predictive value 68% (P < 0.001). Conclusions Independent predictors for AIT were found as fasting plasma glucose on OGTT and HbA1c levels during diagnosis in GDM. Cases with fasting plasma glucose ? 89.5 mg/dL or HbA1C ? 5.485% should be closely followed for AIT in specified centers. PMID:23976911

Bakiner, Okan; Bozkirli, Emre; Ozsahin, Kursat; Sariturk, Cagla; Ertorer, Eda

2013-01-01

150

Sex-Specific Programming of Hypertension in Offspring of Late Gestation Diabetic Rats  

PubMed Central

Background The intrauterine environment strongly influences adult disease susceptibility. We utilized a rat model of third trimester maternal diabetes to test the hypothesis that adult offspring exposed to hyperglycemia in utero display increased blood pressure and alterations in vascular responsiveness. Methods Diabetes was induced by streptozotocin injection to pregnant rats on gestation day 13 (term 21 day) and partially controlled with insulin injections. Hemodynamic function was evaluated in 6–12 month old offspring. Results Male but not female offspring of diabetic mothers (ODM) had significantly increased blood pressure compared to controls, heart rate was similar. For both sexes, heart rate baroreflex responses were similar as were in vivo hemodynamic responses to angiotensin II, NOS inhibition and ganglionic blockade. Aortic contractility to angiotensin II was similar in both groups. NOS inhibition and the Cu/Zn superoxide dismutase (SOD) inhibitor diethyldithiocarbamate but not the SOD-mimetic Tempol significantly increased contractile responses to angiotensin II in controls but not ODM. NADPH stimulated superoxide production was greater in male ODM than controls (p<0.05). Conclusions Exposure to hyperglycemia in utero results in sex specific cardiovascular changes in adult offspring. Impaired NO - reactive oxygen species signaling may play a significant role in the hemodynamic phenotype of ODM. PMID:22805998

Katkhuda, Ragheed; Peterson, Emily S.; Roghair, Robert D.; Norris, Andrew W.; Scholz, Thomas D.; Segar, Jeffrey L.

2013-01-01

151

Placeholder record for supplementary data for forthcoming journal article - "Impact on offspring methylation patterns of maternal gestational diabetes mellitus and intrauterine growth restraint suggest common genes/pathways linked to subsequent type 2 diabetes risk"  

E-print Network

Placeholder for journal article Claire Quilter “Impact on offspring methylation patterns of maternal gestational diabetes mellitus and intrauterine growth restraint suggest common genes/pathways linked to subsequent type 2 diabetes...

Quilter, Claire

2014-06-19

152

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

153

Prevention of Gestational Diabetes: Design of a Cluster-Randomized Controlled Trial and One-Year Follow-Up  

Microsoft Academic Search

BACKGROUND: Annual prevalence of gestational diabetes mellitus (GDM) is 12.5% among Finnish pregnant women. The prevalence is expected to rise with the increasing overweight among women before pregnancy. Physical activity and diet are both known to have favourable effects on insulin resistance and possibly on the risk of GDM. We aimed to investigate, whether GDM can be prevented by counseling

Riitta M Luoto; Tarja I Kinnunen; Minna Aittasalo; Katriina Ojala; Kirsi Mansikkamäki; Erja Toropainen; Päivi Kolu; Tommi Vasankari

2010-01-01

154

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

155

Antioxidant Vitamins and Lipoperoxidation in Non-pregnant, Pregnant, and Gestational Diabetic Women: Erythrocytes Osmotic Fragility Profiles  

PubMed Central

Background Inconsistent reports are available in the literature regarding the oxidative status and antioxidant capacity during the pathogenesis of gestational diabetes. Present study was aimed to evaluate oxidative stress during the development of gestational diabetes and to evaluate antioxidant capability in non-pregnant (control), pregnant and gestational diabetics. Methods The study consisted of non-pregnant, healthy pregnant and patients suffering from gestational diabetes mellitus (GDM). Each group consisted of 23 women. We compared their oxidative and anti-oxidative system in blood. Their blood malondialdehyde (MDA) and antioxidant vitamins (C, E, A) were determined and compared to evaluate the oxidative status and anti-oxidative capacity of these groups. We have also compared the osmotic fragility profiles of the erythrocytes of these groups. Results Plasma MDA content in pregnant was significantly higher compared to non-pregnant (p < 0.001, 67.5%) and even in gestational diabetics; its value was found significantly further elevated (p = 0.001, 13.8%) compared to healthy pregnant. There was significant decline (p < 0.001, 41.9%) in the level of vitamin C in pregnant as compared to non-pregnant. Although in GDM the decrease was significant (p = 0.025, 20.6%) but comparatively lesser when compared to healthy pregnant. Vitamin E showed the increase of 9.6% during pregnancy, although this alteration was non-significant (p = 0.09), but the level was found to decline significantly (p < 0.001, 25.5%) in GDM compared to pregnant group. Vitamin A contents were also decreased in pregnant (p = 0.002, 17.4%) compared to non-pregnant and in GDM (p = 0.012, 11.2%) compared to pregnant group. Osmotic fragility (O.F.) profiles showed insignificant (p = 0.325) enhanced mean erythrocyte fragility (MEF) in pregnant but this increase was significant (p = 0.003) in case of GDM. The O.F. profiles of pregnant and GDM erythrocytes got shifted to the right side of the control one. Conclusions Our findings indicate highly enhanced lipid peroxidation and significant depletion in antioxidant capacity during the development of gestational diabetes, and these alterations are not the cause but the consequence of GDM. However, further studies are warranted to examine a wider range of biochemical parameters to evaluate the potential risks of oxidative damage in GDM. Keywords Gestational diabetes; Oxidative stress; Anti-oxidants; Vitamins C, E, A; Osmotic fragility; Non-pregnant; Pregnant; GDM PMID:22043260

Suhail, Mohd; Patil, Shridhar; Khan, Salma; Siddiqui, Sana

2010-01-01

156

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

157

Glucose and Fatty Acid Metabolism in Placental Explants From Pregnancies Complicated With Gestational Diabetes Mellitus.  

PubMed

Placental metabolism is an important mechanism for the regulation of fetal growth and long-term health of the newborns. In this study, we investigated the effects of maternal metabolic environment on human placental fatty acid and glucose metabolism. We used placental explants from uncomplicated pregnancies or pregnancies complicated with gestational diabetes mellitus (GDM), undergoing vaginal delivery (VD) or cesarean section (CS). Fatty acid oxidation (FAO) and glucose uptake (2-DOG) were similar in both modes of delivery in normal and GDM pregnancies. However, placental explants from GDM exhibited 40% to 50% reduced FAO capacity compared to control placentas in women undergoing VD or CS. In contrast, 2-DOG uptake was 2- to 3-fold higher in placental explants from GDM compared to control placentas in women undergoing VD or CS, respectively. In conclusion, ex vivo placental fuel selection is influenced by maternal GDM, but placental metabolic characteristics are not altered by the mode of delivery. PMID:25491487

Visiedo, Francisco; Bugatto, Fernando; Quintero-Prado, Rocío; Cózar-Castellano, Irene; Bartha, Jose L; Perdomo, Germán

2014-12-01

158

Upregulation of microRNA processing enzymes Drosha and Dicer in gestational diabetes mellitus.  

PubMed

MicroRNAs (miRNAs) have been shown to play important roles in diverse cellular processes and linked to variety of disorders. Dicer and Drosha are two major enzymes in the miRNA biogenesis process. DGCR8 is the assistant of Drosha in the microprocessor complex. In this study, we evaluated the mRNA expression profiles of major miRNA processing machinery Drosha, Dicer, and DGCR8 in gestational diabetes mellitus (GDM), pregnant and healthy women. Our findings indicate that the expression levels of Drosha, Dicer and DGCR8 were upregulated in both pregnant and GDM patients compared to the control group. However, Drosha and Dicer were upregulated more than pregnant group. In conclusion, we detected dysregulation of Drosha, Dicer and DGCR8 expression in pregnant and GDM patients when compared to healthy control participants. Therefore, we favor the hypothesis that miRNAs are involved in the development of GDM. PMID:25295740

Rahimi, Giti; Jafari, Naser; Khodabakhsh, Mehnoush; Shirzad, Zohreh; Dogaheh, Hadi Peeri

2015-02-01

159

Impaired Increase of Plasma Abscisic Acid in Response to Oral Glucose Load in Type 2 Diabetes and in Gestational Diabetes  

PubMed Central

The plant hormone abscisic acid (ABA) is present and active in humans, regulating glucose homeostasis. In normal glucose tolerant (NGT) human subjects, plasma ABA (ABAp) increases 5-fold after an oral glucose load. The aim of this study was to assess the effect of an oral glucose load on ABAp in type 2 diabetes (T2D) subjects. We chose two sub-groups of patients who underwent an oral glucose load for diagnostic purposes: i) 9 treatment-naive T2D subjects, and ii) 9 pregnant women with gestational diabetes (GDM), who underwent the glucose load before and 8–12 weeks after childbirth. Each group was compared with matched NGT controls. The increase of ABAp in response to glucose was found to be abrogated in T2D patients compared to NGT controls. A similar result was observed in the women with GDM compared to pregnant NGT controls; 8–12 weeks after childbirth, however, fasting ABAp and ABAp response to glucose were restored to normal in the GDM subjects, along with glucose tolerance. We also retrospectively compared fasting ABAp before and after bilio-pancreatic diversion (BPD) in obese, but not diabetic subjects, and in obese T2D patients, in which BPD resulted in the resolution of diabetes. Compared to pre-BPD values, basal ABAp significantly increased 1 month after BPD in T2D as well as in NGT subjects, in parallel with a reduction of fasting plasma glucose. These results indicate an impaired hyperglycemia-induced ABAp increase in T2D and in GDM and suggest a beneficial effect of elevated ABAp on glycemic control. PMID:25723556

Ameri, Pietro; Bruzzone, Santina; Mannino, Elena; Sociali, Giovanna; Andraghetti, Gabriella; Salis, Annalisa; Ponta, Monica Laura; Briatore, Lucia; Adami, Giovanni F.; Ferraiolo, Antonella; Venturini, Pier Luigi; Maggi, Davide; Cordera, Renzo; Murialdo, Giovanni; Zocchi, Elena

2015-01-01

160

Elevated Plasma SPARC Levels Are Associated with Insulin Resistance, Dyslipidemia, and Inflammation in Gestational Diabetes Mellitus  

PubMed Central

Objective Recent studies suggested that secreted protein acidic and rich in cysteine (SPARC), a novel adipokine, is a key player in the pathology of obesity and type 2 diabetes. We aimed to determine whether concentrations of SPARC were altered in patients with gestational diabetes mellitus (GDM) compared to normal glucose tolerance (NGT) controls and to investigate the relationships between SPARC and metabolic parameters in pregnant women. Design/Methods Cross-sectional study of 120 pregnant women with GDM and 60 controls with NGT, in a university hospital setting. Plasma levels of SPARC, adiponectin, fibroblast growth factor 21 (FGF21), insulin and proinsulin were determined by ELISA. Results GDM women had higher SPARC and lower adiponectin than NGT subjects; no difference was found in FGF21. SPARC levels were the lowest in subjects in the third tertile of insulin sensitivity index (ISIOGTT) and correlated positively with pre-pregnant BMI, insulin and 3 h glucose during 100-g OGTT, HOMA-IR, fasting proinsulin, hsCRP and white blood cells count, and negatively with ISIOGTT, when adjusting for gestational age. Triglyceride (TG), Apolipoprotein A1, apolipoprotein B and lipoprotein (a) correlated with SPARC in partial Pearson correlation. Correlations between SPARC with adiponectin, systolic blood pressure and TG were marginally significant in partial Spearman correlation analysis. In multivariate regression analysis, SPARC was an independent negative indicator of ISIOGTT. Conclusions SPARC levels are correlated significantly with inflammation and may also be correlated with dyslipidemia and represent an independent determinant of insulin resistance in late pregnancy, indicating a potential role of SPARC in the pathophysiology of GDM. PMID:24349098

Xu, Lu; Ping, Fan; Yin, Jinhua; Xiao, Xinhua; Xiang, Hongding; Ballantyne, Christie M.; Wu, Huaizhu; Li, Ming

2013-01-01

161

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

162

Antepartum glucose tolerance test results as predictors of type 2 diabetes mellitus in women with a history of gestational diabetes mellitus: A systematic review  

Microsoft Academic Search

Background: Women with a history of gestational diabetes mellitus (GDM) are at high risk for type 2 diabetes mellitus (T2DM).Objective: We reviewed prospective studies of antepartum glucose tolerance test results as risk factors for development of T2DM among women with a history of GDM.Methods: We searched 4 electronic databases and hand-searched 13 journals for literature published through January 2007. The

Sherita Hill Golden; Wendy L. Bennett; Kesha Baptist-Roberts; Lisa M. Wilson; Bethany Barone; Tiffany L. Gary; Eric Bass; Wanda K. Nicholson

2009-01-01

163

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

164

Does Maternal BMI Influence Treatment Effect in Women with Mild Gestational Diabetes?  

PubMed Central

Objective To determine whether maternal body mass index (BMI) influences the beneficial effects of diabetes treatment in women with gestational diabetes (GDM). Study Design Secondary analysis of a multicenter randomized treatment trial of women with GDM. Outcomes of interest were elevated umbilical cord c-peptide levels (>90th percentile 1.77 ng/mL), LGA birth weight (>90th percentile), and neonatal fat mass (g). Women were grouped into five BMI categories adapted from the WHO International Classification of normal, overweight, and obese adults. Outcomes were analyzed according to treatment group assignment. Results A total of 958 women were enrolled (485 treated and 473 controls). Maternal BMI at enrollment was not related to umbilical cord c-peptide levels. However, treatment of women in the overweight, Class I, and Class II obese categories was associated with a reduction in both LGA birth weight and neonatal fat mass. Neither measure of excess fetal growth was reduced with treatment in normal weight (BMI <25) or Class III (BMI ? 40) obese women. Conclusion There was a beneficial effect of treatment on fetal growth in women with mild GDM who were overweight or Class I and II obese. These effects were not apparent for normal weight and very obese women. PMID:24839145

Casey, Brian M.; Mele, Lisa; Landon, Mark B.; Spong, Catherine Y.; Ramin, Susan M.; Wapner, Ronald J.; Varner, Michael W.; Rouse, Dwight J.; Thorp, John M.; Catalano, Patrick; Harper, Margaret; Saade, George; Sorokin, Yoram; Peaceman, Alan M.

2015-01-01

165

Investigation of Calpain 10 (rs2975760) gene polymorphism in Asian Indians with Gestational Diabetes Mellitus  

PubMed Central

Background Type 2 Diabetes Mellitus (T2DM) and Gestational Diabetes Mellitus (GDM) are part of a heterogeneous and complex metabolic group of disorders that share common pathophysiological circumstances, including ?-cell dysfunction and insulin resistance. The protein Calpain 10 (CAPN10) plays a role in glucose metabolism, pancreatic ?-cell insulin secretion, and thermogenesis. Objective Polymerase Chain Reaction–Restriction Fragment Length Polymorphism (PCR–RFLP) based genotyping of CAPN10 (rs2975760) polymorphism was carried out in T2DM and GDM with suitable controls for each of the pathologies from the same population. Genomic DNA was isolated from 787 participants, including 250 cases of T2DM, 287 pregnant women, of which 137 were identified as having GDM and the remaining 150 were confirmed as non-GDM, and 250 healthy control volunteers, and association analysis was carried out for genotypes and alleles. Results In the present study, T2DM was compared with healthy controls and was not found to be associated with the CAPN10 C allele (odds ratio, OR: 1.09; 95% CI = 0.8011–1.484; p = 0.5821). GDM also did not show any association when compared with non-GDM (OR: 1.124; 95% CI = 0.7585–1.667; p = 0.5606) respectively. Conclusion Our study suggests that the CAPN10 (rs2975760) polymorphism scrutinized in this study is not associated with T2DM and GDM. PMID:25606412

Khan, Imran Ali; Movva, Sireesha; Shaik, Noor Ahmad; Chava, Srinivas; Jahan, Parveen; Mukkavali, Kamal Kiran; Kamineni, Vasundhara; Hasan, Qurratulain; Rao, Pragna

2014-01-01

166

How Can We Increase Postpartum Glucose Screening in Women at High Risk for Gestational Diabetes Mellitus?  

PubMed Central

Women with a history of gestational diabetes mellitus (GDM) are at increased risk for diabetes mellitus but postpartum followup is problematic for frequent nonattendance. Our aim was to increase coverage of postpartum oral glucose tolerance tests (ppOGTTs) and examine associated factors. This was a prospective observational study of altogether 266 high-risk women for GDM from 2005 to 2008 in four Finnish municipalities. The groups were as follows: women (n = 54) who had previously participated in early pregnancy lifestyle intervention study and high-risk women (n = 102) from the same municipalities studied within one-year after delivery. Furthermore, in two neighboring municipalities nurses were reminded to perform a ppOGTT on high-risk women (n = 110). The primary outcome was the prevalence of ppOGTT performed and associated factors. Overall the ppOGTT was performed in 35.7% of women. Only 14.7% of women returned for testing to health care centers, 30.9% after a reminder in municipalities, and 82.5% to the central hospital, respectively. The most important explaining factor was a special call or reminder from the central hospital (OR 13.4 (4.6–38.1), P < 0.001). Thus, additional reminders improved communication between primary care and secondary care and more attention to postpartum oral glucose testing in primary care are of great importance. PMID:22536233

Korpi-Hyövälti, Eeva; Laaksonen, David E.; Schwab, Ursula; Heinonen, Seppo; Niskanen, Leo

2012-01-01

167

Diagnostics of gestational diabetes: which cutoff-values are valid for capillary whole blood?  

PubMed

National and international recommendations on diagnostics of diabetes are based on laboratory venous plasma examinations. In outpatients, however, most blood sugar determinations in Europe are performed with capillary whole blood and portable blood glucose meters. Our own investigations confirmed the literature findings that capillary blood sugar results cannot be converted to venous plasma values on an individual basis, whereas transformations of the recommended cutoff-values from venous plasma to capillary whole blood are feasible. On the basis of 203 oral glucose tolerance tests (75g) in non-diabetic pregnant women in the 24th-28th week of gestation, the transformation in fasting individuals amounts from 95 mg/dl in venous plasma to 82 mg/dl in capillary whole blood, whereas the 2-hour values of 155 mg/dl are identical. Capillary blood sugar determinations are the only qualified way to determine blood sugar in general practice at the moment, as up to this day no venous blood devices with complete antiglycolytic preservatives are commercially available. Blood sugar determination is one of the most frequently performed and simultaneously least reliable laboratory tests. PMID:15330507

Roggenbuck, Lennart F; Kleinwechter, Helmut J; Demandt, Norbert; Dörner, Klaus M

2004-01-01

168

The human colostrum whey proteome is altered in gestational diabetes mellitus.  

PubMed

Proteomics of human milk has been used to identify the comprehensive cargo of proteins involved in immune and cellular function. Very little is known about the effects of gestational diabetes mellitus (GDM) on lactation and breast milk components. The objective of the current study was to examine the effect of GDM on the expression of proteins in the whey fraction of human colostrum. Colostrum was collected from women who were diagnosed with (n = 6) or without (n = 12) GDM at weeks 24-28 in pregnancy. Colostral whey was analyzed for protein abundances using high-resolution, high-mass accuracy liquid chromatography tandem mass spectrometry. A total of 601 proteins were identified, of which 260 were quantified using label free spectral counting. Orthogonal partial least-squares discriminant analysis identified 27 proteins that best predict GDM. The power law global error model corrected for multiple testing was used to confirm that 10 of the 27 proteins were also statistically significantly different between women with versus without GDM. The identified changes in protein expression suggest that diabetes mellitus during pregnancy has consequences on human colostral proteins involved in immunity and nutrition. PMID:25338220

Grapov, Dmitry; Lemay, Danielle G; Weber, Darren; Phinney, Brett S; Azulay Chertok, Ilana R; Gho, Deborah S; German, J Bruce; Smilowitz, Jennifer T

2015-01-01

169

Experimental Gestational Diabetes Mellitus Induces Blunted Vasoconstriction and Functional Changes in the Rat Aorta  

PubMed Central

Diabetic conditions increase vascular reactivity to angiotensin II in several studies but there are scarce reports on cardiovascular effects of hypercaloric diet (HD) induced gestational diabetes mellitus (GDM), so the objective of this work was to determine the effects of HD induced GDM on vascular responses. Angiotensin II as well as phenylephrine induced vascular contraction was tested in isolated aorta rings with and without endothelium from rats fed for 7 weeks (4 before and 3 weeks during pregnancy) with standard (SD) or hypercaloric (HD) diet. Also, protein expression of AT1R, AT2R, COX-1, COX-2, NOS-1, and NOS-3 and plasma glucose, insulin, and angiotensin II levels were measured. GDM impaired vasoconstrictor response (P < 0.05 versus SD) in intact (e+) but not in endothelium-free (e?) vessels. Losartan reduced GDM but not SD e? vasoconstriction (P < 0.01 versus SD). AT1R, AT2R, and COX-1 and COX-2 protein expression were significantly increased in GDM vessels (P < 0.05 versus SD). Results suggest an increased participation of endothelium vasodilator mediators, probably prostaglandins, as well as of AT2 vasodilator receptors as a compensatory mechanism for vasoconstrictor changes generated by experimental GDM. Considering the short term of rat pregnancy findings can reflect early stage GDM adaptations. PMID:25610861

Tufiño, Cecilia; Villanueva-López, Cleva; Ibarra-Barajas, Maximiliano; Bracho-Valdés, Ismael; Bobadilla-Lugo, Rosa Amalia

2014-01-01

170

Type 2 diabetes-associated genetic variants discovered in the recent genome-wide association studies are related to gestational diabetes mellitus in the Korean population  

Microsoft Academic Search

Aims\\/hypothesis  New genetic variants associated with susceptibility to type 2 diabetes mellitus have been discovered in recent genome-wide\\u000a association (GWA) studies. The aim of the present study was to examine the association between these diabetogenic variants\\u000a and gestational diabetes mellitus (GDM).\\u000a \\u000a \\u000a \\u000a Methods  The study included 869 Korean women with GDM and 345 female and 287 male Korean non-diabetic controls. We genotyped the

Y. M. Cho; T. H. Kim; S. Lim; S. H. Choi; H. D. Shin; H. K. Lee; K. S. Park; H. C. Jang

2009-01-01

171

Fatty Liver Index Predicts Further Metabolic Deteriorations in Women with Previous Gestational Diabetes  

PubMed Central

Background and Aims Determinants of fatty liver (FL) might be predictive for further deterioration in insulin resistance (IR) in women with previous gestational diabetes (pGDM). The aim was to evaluate the association between pGDM, FL and future manifestation of type 2 diabetes (T2DM) by a detailed pathophysiological characterization early after pregnancy. Methods 68 pGDM and 29 healthy controls were included 3–6 months after delivery and underwent specific metabolic assessments: status of IR was determined via oral- and intravenous-glucose-tolerance-tests with analysis of proinflammatory factors and kinetics of free-fatty-acids (FFA). According to the fatty-liver-index (FLI), pGDMs were categorized into three groups with low (FLI?20), intermediate (20diabetes over 10 years of observation as compared to pGDMs with FLI?20 (HR:7.85, Cl:2.02–30.5, p?=?0.003). Conclusion FL is closely linked to GDM, especially to IR and inflammation. Most interestingly, subjects with the highest FLI values showed significant alterations in FFA kinetics and a higher risk to develop T2DM in future. PMID:22393439

Bozkurt, Latife; Göbl, Christian S.; Tura, Andrea; Chmelik, Marek; Prikoszovich, Thomas; Kosi, Lana; Wagner, Oswald; Roden, Michael; Pacini, Giovanni; Gastaldelli, Amalia; Kautzky-Willer, Alexandra

2012-01-01

172

Gestational diabetes mellitus and later cardiovascular disease: a Swedish population based case–control study  

PubMed Central

Objective To identify if gestational diabetes mellitus (GDM) is a clinically useful marker of future cardiovascular disease (CVD) risk and if GDM combined with other risks (smoking, hypertension or body mass) identifies high-risk groups. Design Population-based matched case–control study. Setting National Swedish register data from 1991 to 2008. Population A total of 2639 women with a cardiovascular event and matched controls. Methods Conditional logistic regression examined associations with CVD before and after adjustment for conventional risk factors and confounders. Effect modification for the association of GDM with CVD by body mass index (BMI), smoking and chronic hypertension was assessed by stratification and interaction testing. Adjustment for diabetes post-pregnancy evaluated its mediating role. Main outcome measures Inpatient diagnoses or causes of death identifying ischemic heart disease, ischemic stroke, atherosclerosis or peripheral vascular disease. Results The adjusted odds ratios (and 95% confidence intervals) for the association of CVD with GDM are 1.51 (1.07–2.14), 2.23 (2.01–2.48) for smoking, 1.98 (1.71–2.29) for obesity and 5.10 (3.18–8.18) for chronic hypertension. In stratified analysis the association of CVD with GDM was only seen among women with BMI ?25, with an odds ratio of 2.39 (1.39–4.10), but only women with a BMI <30 accounted for this increased risk. Adjustment for post-pregnancy diabetes attenuated it somewhat to 1.99 (1.13–3.52). Conclusions In the absence of other recognised cardiovascular risk factors, such as smoking, obesity or chronic hypertension, GDM is a useful marker of raised CVD risk among women with BMI between 25 and 29. PMID:24762194

Fadl, H; Magnuson, A; Östlund, I; Montgomery, S; Hanson, U; Schwarcz, E

2014-01-01

173

Gestational diabetes mellitus identification based on self-monitoring of blood glucose.  

PubMed

In Sherbrooke, the gestational diabetes mellitus (GDM) Regional Committee proposed GDM screening during the first trimester for all pregnant women based on a 50 g glucose challenge test (50 g GCT) followed directly by capillary self-monitoring blood glucose (SMBG) at home. We evaluated implementation of committee's recommendations on the clinical trajectory of women receiving prenatal care at our institution. We analyzed data collected systematically by the Blood Sampling in Pregnancy clinic from 2008 to 2011. We evaluated the clinical trajectory of 7710 pregnant women to assess GDM screening/diagnoses and referral rates to the diabetes care centre (DCC) for education and treatment during both the first and second trimesters. The Canadian Diabetes Association glycemic treatment targets in women with GDM were used as diagnosis thresholds and DCC referral decisions: Fasting glucose of 5.3 mmol/L and postprandial 2 h glucose of 6.7 mmol/L. We found that pregnant women were 28.0±4.8 years old, and their body mass indexes were 24.5±5.5 kg/m(2). During the first trimester, 47% of women were screened for GDM, mostly (84%) using the 50 g GCT. Following SMBG, 5.7% were referred to the DCC. Only 32% of women with early GDM had >1 GDM risk factor. Thereafter, 67% of normoglycemic women screened during the first trimester were screened again during the second trimester. Among women screened during the second trimester, most screening was done using 50 g GCT, and 8.8% were referred to the DCC following SMBG. Implementation of 50 g GCT testing followed by direct home SMBG was well implemented in our area. The importance of early GDM screening and rescreening during the second trimester still needs to be emphasized. PMID:25492558

Allard, Catherine; Sahyouni, Elie; Menard, Julie; Houde, Ghislaine; Pesant, Marie-Hélène; Perron, Patrice; Ouellet, Annie; Moutquin, Jean-Marie; Ardilouze, Jean-Luc; Hivert, Marie-France

2015-04-01

174

Glucose Absorption in Gestational Diabetes Mellitus During an Oral Glucose Tolerance Test  

PubMed Central

OBJECTIVE Women with gestational diabetes mellitus (GDM) show reduced insulin sensitivity and markedly elevated glucose excursions. After delivery, GDM mostly reverts to normal glucose tolerance (NGT), although leaving an increased risk of type 2 diabetes. Because gastrointestinal function changes during pregnancy causing vomiting, constipation, or reduced motility, we thought that gut glucose absorption in GDM or pregnancy might be altered to affect circulating glucose excursions. RESEARCH DESIGN AND METHODS By undergoing 180-min oral glucose tolerance tests (OGTTs), pregnant women with GDM (GDMpreg; n = 15, BMI = 32 ± 2 kg/m2, aged 33 ± 1 years) were compared with NGT women (NGTpreg; n = 7, BMI = 28 ± 1 kg/m2, aged 34 ± 2 years), matching for major anthropometric characteristics (each P > 0.2). After delivery (6–7 months later), both groups were studied the same way. We computed and mathematically modeled gut glucose absorption from insulin-mediated glucose disappearance and endogenous glucose production (EGP). Whole-body insulin sensitivity was calculated using the Clamp-like Index. RESULTS GDMpreg showed 16–25% higher plasma glucose concentrations (P < 0.04) during the final 2 h of OGTT, similar EGP, but lower (P < 0.01) insulin sensitivity (2.7 ± 0.2 mg · kg?1 · min?1 vs. NGTpreg: 4.5 ± 0.8 mg · kg?1 · min?1). In GDMpreg, gut glucose absorption rates were ?52% lower from 30 to 120 min (P < 0.03 vs. conditions after delivery or NGTpreg). In contrast, glucose absorption rates in NGTpreg were comparable during and after pregnancy. None of the studied women developed diabetes after delivery. CONCLUSIONS In GDMpreg, OGTT gut glucose absorption is markedly lower during hyperglycemia, whereas both glycemia and glucose absorption in NGTpreg are comparable between pregnant and postpartum states. Thus, hyperglycemia in GDM does not seem to result from too rapid or increased glucose absorption. PMID:21602425

Anderwald, Christian; Tura, Andrea; Winhofer, Yvonne; Krebs, Michael; Winzer, Christine; Bischof, Martin G.; Luger, Anton; Pacini, Giovanni; Kautzky-Willer, Alexandra

2011-01-01

175

Endoplasmic Reticulum Stress Is Increased in Adipose Tissue of Women with Gestational Diabetes  

PubMed Central

Maternal obesity and gestational diabetes mellitus (GDM) are two increasingly common and important obstetric complications that are associated with severe long-term health risks to mothers and babies. IL-1?, which is increased in obese and GDM pregnancies, plays an important role in the pathophysiology of these two pregnancy complications. In non-pregnant tissues, endoplasmic (ER) stress is increased in diabetes and can induce IL-1? via inflammasome activation. The aim of this study was to determine whether ER stress is increased in omental adipose tissue of women with GDM, and if ER stress can also upregulate inflammasome-dependent secretion of IL-1?. ER stress markers IRE1?, GRP78 and XBP-1s were significantly increased in adipose tissue of obese compared to lean pregnant women. ER stress was also increased in adipose tissue of women with GDM compared to BMI-matched normal glucose tolerant (NGT) women. Thapsigargin, an ER stress activator, induced upregulated secretion of mature IL-1? and IL-1? in human omental adipose tissue explants primed with bacterial endotoxin LPS, the viral dsRNA analogue poly(I:C) or the pro-inflammatory cytokine TNF-?. Inhibition of capase-1 with Ac-YVAD-CHO resulted in decreased IL-1? and IL-1? secretion, whereas inhibition of pannexin-1 with carbenoxolone suppressed IL-1? secretion only. Treatment with anti-diabetic drugs metformin and glibenclamide also reduced IL-1? and IL-1? secretion in infection and cytokine-primed adipose tissue. In conclusion, this study has demonstrated ER stress to activate the inflammasome in pregnant adipose tissue. Therefore, increased ER stress may contribute towards the pathophysiology of obesity in pregnancy and GDM. PMID:25849717

Liong, Stella; Lappas, Martha

2015-01-01

176

Exposure to Maternal Gestational Diabetes Is Associated With Higher Cardiovascular Responses to Stress in Adolescent Indians  

PubMed Central

Context: Altered endocrinal and autonomic nervous system responses to stress may link impaired intra-uterine growth with later cardiovascular disease. Objective: To test the hypothesis that offspring of gestational diabetic mothers (OGDM) have high cortisol and cardiosympathetic responses during the Trier Social Stress Test for Children (TSST-C). Design: Adolescents from a birth cohort in India (n = 213; mean age, 13.5 y), including 26 OGDM, 22 offspring of diabetic fathers (ODF), and 165 offspring of nondiabetic parents (controls) completed 5 minutes each of public speaking and mental arithmetic tasks in front of two unfamiliar “evaluators” (TSST-C). Salivary cortisol concentrations were measured at baseline and at regular intervals after the TSST-C. Heart rate, blood pressure (BP), stroke volume, cardiac output, and total peripheral resistance were measured continuously at baseline, during the TSST-C, and for 10 minutes after the test using a finger cuff; the beat-to-beat values were averaged for these periods. Results: Cortisol and cardiosympathetic parameters increased from baseline during stress (P < .001). OGDM had greater systolic BP (mean difference, 5.6 mm Hg), cardiac output (0.5 L/min), and stroke volume (4.0 mL) increases and a lower total peripheral resistance rise (125 dyn · s/cm5) than controls during stress. ODF had greater systolic BP responses than controls (difference, 4.1 mm Hg); there was no difference in other cardiosympathetic parameters. Cortisol responses were similar in all three groups. Conclusions: Maternal diabetes during pregnancy is associated with higher cardiosympathetic stress responses in the offspring, which may contribute to their higher cardiovascular disease risk. Further research may confirm stress-response programming as a predictor of cardiovascular risk in OGDM. PMID:25478935

Veena, Sargoor R.; Jones, Alexander; Srinivasan, Krishnamachari; Osmond, Clive; Karat, Samuel C.; Kurpad, Anura V.; Fall, Caroline H. D.

2015-01-01

177

Umbilical cord mesenchymal stromal cells affected by gestational diabetes mellitus display premature aging and mitochondrial dysfunction.  

PubMed

Human umbilical cord mesenchymal stromal cells (hUC-MSCs) of Wharton's jelly origin undergo adipogenic, osteogenic, and chondrogenic differentiation in vitro. Recent studies have consistently shown their therapeutic potential in various human disease models. However, the biological effects of major pregnancy complications on the cellular properties of hUC-MSCs remain to be studied. In this study, we compared the basic properties of hUC-MSCs obtained from gestational diabetes mellitus (GDM) patients (GDM-UC-MSCs) and normal pregnant women (N-UC-MSCs). Assessments of cumulative cell growth, MSC marker expression, cellular senescence, and mitochondrial function-related gene expression were performed using a cell count assay, senescence-associated ?-galactosidase staining, quantitative real-time reverse transcription-polymerase chain reaction, immunoblotting, and cell-based mitochondrial functional assay system. When compared with N-UC-MSCs, GDM-UC-MSCs showed decreased cell growth and earlier cellular senescence with accumulation of p16 and p53, even though they expressed similar levels of CD105, CD90, and CD73 MSC marker proteins. GDM-UC-MSCs also displayed significantly lower osteogenic and adipogenic differentiation potentials than N-UC-MSCs. Furthermore, GDM-UC-MSCs exhibited a low mitochondrial activity and significantly reduced expression of the mitochondrial function regulatory genes ND2, ND9, COX1, PGC-1?, and TFAM. Here, we report intriguing and novel evidence that maternal metabolic derangement during gestation affects the biological properties of fetal cells, which may be a component of fetal programming. Our findings also underscore the importance of the critical assessment of the biological impact of maternal-fetal conditions in biological studies and clinical applications of hUC-MSCs. PMID:25437179

Kim, Jooyeon; Piao, Ying; Pak, Youngmi Kim; Chung, Dalhee; Han, Yu Mi; Hong, Joon Seok; Jun, Eun Jeong; Shim, Jae-Yoon; Choi, Jene; Kim, Chong Jai

2015-03-01

178

Prevention of gestational diabetes through lifestyle intervention: study design and methods of a Finnish randomized controlled multicenter trial (RADIEL)  

PubMed Central

Background Maternal overweight, obesity and consequently the incidence of gestational diabetes are increasing rapidly worldwide. The objective of the study was to assess the efficacy and cost-effectiveness of a combined diet and physical activity intervention implemented before, during and after pregnancy in a primary health care setting for preventing gestational diabetes, later type 2 diabetes and other metabolic consequences. Methods RADIEL is a randomized controlled multi-center intervention trial in women at high risk for diabetes (a previous history of gestational diabetes or prepregnancy BMI ?30 kg/m2). Participants planning pregnancy or in the first half of pregnancy were parallel-group randomized into an intervention arm which received lifestyle counseling and a control arm which received usual care given at their local antenatal clinics. All participants visited a study nurse every three months before and during pregnancy, and at 6 weeks, 6 and 12 months postpartum. Measurements and laboratory tests were performed on all participants with special focus on dietary and exercise habits and metabolic markers. Of the 728 women [mean age 32.5 years (SD 4.7); median parity 1 (range 0-9)] considered to be eligible for the study 235 were non-pregnant and 493 pregnant [mean gestational age 13 (range 6 to 18) weeks] at the time of enrollment. The proportion of nulliparous women was 29.8% (n?=?217). Out of all participants, 79.6% of the non-pregnant and 40.4% of the pregnant women had previous gestational diabetes and 20.4% of the non-pregnant and 59.6% of the pregnant women were recruited because of a prepregnancy BMI ?30 kg/m2. Mean BMI at first visit was 30.1 kg/m2 (SD 6.2) in the non-pregnant and 32.7 kg/m2 (SD 5.6) in the pregnant group. Discussion To our knowledge, this is the first randomized lifestyle intervention trial, which includes, besides the pregnancy period, both the prepregnancy and the postpartum period. This study design also provides an opportunity to focus upon the health of the next generation. The study is expected to produce novel information on the optimal timing and setting of interventions and for allocating resources to prevent obesity and diabetes in women of reproductive age. Trial registration Clinicaltrials.gov Identifier: NCT01698385 PMID:24524674

2014-01-01

179

Identifying Postpartum Intervention Approaches to Reduce Cardiometabolic Risk Among American Indian Women With Prior Gestational Diabetes, Oklahoma, 2012–2013  

PubMed Central

Introduction Innovative approaches are needed to reduce cardiometabolic risk among American Indian women with a history of gestational diabetes. We assessed beliefs of Oklahoma American Indian women about preventing type 2 diabetes and cardiovascular disease after having gestational diabetes. We also assessed barriers and facilitators to healthy lifestyle changes postpartum and intervention approaches that facilitate participation in a postpartum lifestyle program. Methods In partnership with a tribal health system, we conducted a mixed-method study with American Indian women aged 19 to 45 years who had prior gestational diabetes, using questionnaires, focus groups, and individual interviews. Questionnaires were used to identify women’s cardiometabolic risk perceptions and feasibility and acceptability of Internet or mobile phone technology for delivery of a postpartum lifestyle modification program. Focus groups and individual interviews were conducted to identify key perspectives and preferences related to a potential program. Results Participants were 26 women, all of whom completed surveys; 11 women participated in focus group sessions, and 15 participated in individual interviews. Most women believed they would inevitably develop diabetes, cardiovascular disease, or both; however, they were optimistic that they could delay onset with lifestyle change. Most women expressed enthusiasm for a family focused, technology-based intervention that emphasizes the importance of delaying disease onset, provides motivation, and promotes accountability while accommodating women’s competing priorities. Conclusions Our findings suggest that an intervention that uses the Internet, text messaging, or both and that emphasizes the benefits of delaying disease onset should be tested as a novel, culturally relevant approach to reducing rates of diabetes and cardiovascular disease in this high-risk population. PMID:25837258

Peercy, Michael; Woods, J. Cedric; Parker, Stephany P.; Jackson, Teresa; Mata, Sara A.; McCage, Shondra; Levkoff, Sue E.; Nicklas, Jacinda M.; Seely, Ellen W.

2015-01-01

180

Maternal serum biomarkers for risk assessment in gestational diabetes. A potential universal screening test to predict GDM status  

PubMed Central

The prevalence of gestational diabetes mellitus (GDM) is increasing because of the worldwide obesity/diabetes epidemic. The complications of untreated GDM affect both the mother and baby and include complications during pregnancy as well as increased risk of subsequent type-2 diabetes in mothers and offspring. Standard tests for hyperglycemia in diabetes, such as fasting glucose and hemoglobin (HbA1c), are currently not recommended for GDM screening. Instead, an oral glucose tolerance test is specified, which is invasive, time-consuming, and not easily accessible to many at-risk populations. In this study, we describe a multi-analyte maternal serum profile test that incorporates novel glycoprotein biomarkers and previously described GDM-associated markers. In screening for GDM by multi-analyte panel, the detection rate was 87% at a false-positive rate of 1%. PMID:25593844

Nagalla, Srinivasa R.; Snyder, Caryn K.; Michaels, John E.; Laughlin, Mary J.; Roberts, Charles T.; Balaji, Madhuri; Balaji, V.; Seshiah, V.; Rao, Paturi V.

2015-01-01

181

Through the looking glass: gestational diabetes as a predictor of maternal and offspring long-term health.  

PubMed

Gestational diabetes mellitus (GDM) is gaining in importance as a predictor of future health risks for women and their offspring. In women, it is associated with increased long-term risks of diabetes, metabolic syndrome and increased cardiovascular disorders. For offspring of mothers with GDM, risks of GDM include abnormal glucose tolerance, obesity and metabolic syndrome. This review presents the evidence for GDM as a predictor of long-term health risks for mothers and their offspring. We highlight GDM as an opportune time to screen for and possibly intervene to prevent adverse health outcomes for both women and their offspring. PMID:22228678

Malcolm, Janine

2012-05-01

182

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

183

Carotid Intimal-Medial Thickness Is Not Increased in Women with Previous Gestational Diabetes Mellitus  

PubMed Central

Background Gestational diabetes mellitus (GDM) is known to increase the risk of cardiovascular diseases. Measuring the carotid artery intimal-medial thickness (CIMT) is a non-invasive technique used to evaluate early atherosclerosis and to predict future cardiovascular diseases. We examined the association between CIMT and cardiovascular risk factors in young Korean women with previous GDM. Methods One hundred one women with previous GDM and 19 women who had normal pregnancies (NP) were recruited between 1999 and 2002. At one year postpartum, CIMT was measured using high-resolution B-mode ultrasonography, and oral glucose tolerance tests were performed. Fasting glucose, glycated hemoglobin A1c (HbA1c), insulin levels and lipid profiles were also measured. CIMTs in the GDM and NP groups were compared, and the associations between CIMT and cardiovascular risk factors were analyzed in the GDM group. Results CIMT results of the GDM group were not significantly different from those of the NP group (GDM, 0.435±0.054 mm; NP, 0.460±0.046 mm; P=0.069). In the GDM group, a higher HbA1c was associated with an increase in CIMT after age adjustment (P=0.011). CIMT results in the group with HbA1c >6.0% were higher than those of the normal HbA1c (HbA1c ?6.0%) (P=0.010). Nine of the patients who are type 2 diabetes mellitus converters within one year postpartum but showed no significant difference in CIMT results compared to NP group. Conclusion Higher HbA1c is associated with an increase in CIMT in women with previous GDM. However, CIMT at one year postpartum was not increased in these women compared to that in NP women. PMID:22111041

Ku, Yun Hyi; Lim, Soo; Cho, Young Min; Park, Young Joo; Park, Kyong Soo; Kim, Seong Yeon; Jang, Hak Chul

2011-01-01

184

Inflammation and impaired endothelium-dependant vasodilatation in non obese women with gestational diabetes mellitus: preliminary results  

PubMed Central

Background To evaluate whether abnormal endothelial function, a common finding in gestational diabetes mellitus (GDM) pregnancies, can be explained by inflammatory cytokines. Methods Forearm skin blood flow (FSBF), into response to acetylcholine (Ach) (endothelium-dependent vasodilatation), were measured in 24 pregnant control subjects and 28 gestational diabetes mellitus (GDM) women, in the third trimester of gestation. A fasting glycemic and lipidic panel was obtained, and inflammatory cytokines (TNF-? and IL-6) and adiponectin were also determined. Results FSBF is significantly reduced in GDM group compared with control subjects (344.59 ± 57.791 vs.176.38 ± 108.52, P < 0.05). Among all subjects, FSBF showed a strong negative correlation with TNF-? and IL-6 (r = ?0.426, P < 0.0001 and r = ?0.564, P < 0.0001, respectively) and positive correlation with adiponectin (r = 0.468, P < 0.0001). Conclusions Endothelial function, an early marker of macrovascular disease, is present in non-obese pregnancies complicated by GDM. This alteration seems to be directly related to inflammatory status, which may represent a patho-physiological link between GDM and type 2 diabetes and, later on, metabolic syndrome. PMID:23805905

2013-01-01

185

Women's Views on Their Diagnosis and Management for Borderline Gestational Diabetes Mellitus  

PubMed Central

Introduction. Little is known about women's views relating to a diagnosis of borderline gestational diabetes mellitus (GDM) and the subsequent management. This study aimed to explore women's experiences after being diagnosed with borderline GDM, their attitudes about treatment, and factors important to them for achieving any lifestyle changes. Methods. We conducted face-to-face, semistructured interviews with women diagnosed with borderline GDM. Results. A total of 22 women were interviewed. After a diagnosis of borderline GDM, 14 (64%) women reported not being concerned or worried. Management of borderline GDM was thought by 21 (95%) women to be very important or important. Eighteen (82%) women planned to improve their diet and/or exercise to manage their borderline GDM. The most frequently mentioned enabler for achieving intended lifestyle change was being more motivated to improve the health of their baby and/or themselves (15 women). The most frequent barrier was tiredness and/or being physically unwell (11 women). Conclusions. A diagnosis of borderline GDM caused some concern to one-third of women interviewed. The majority of women believed managing their borderline GDM was important and they planned to improve their lifestyle. Women's own and their babies' future health were powerful motivators for lifestyle change. PMID:25785278

Han, Shanshan; Middleton, Philippa F.; Bubner, Tanya K.; Crowther, Caroline A.

2015-01-01

186

Metabolic programming of MEST DNA methylation by intrauterine exposure to gestational diabetes mellitus.  

PubMed

Epigenetic processes are primary candidates when searching for mechanisms that can stably modulate gene expression and metabolic pathways according to early life conditions. To test the effects of gestational diabetes mellitus (GDM) on the epigenome of the next generation, cord blood and placenta tissue were obtained from 88 newborns of mothers with dietetically treated GDM, 98 with insulin-dependent GDM, and 65 without GDM. Bisulfite pyrosequencing was used to compare the methylation levels of seven imprinted genes involved in prenatal and postnatal growth, four genes involved in energy metabolism, one anti-inflammatory gene, one tumor suppressor gene, one pluripotency gene, and two repetitive DNA families. The maternally imprinted MEST gene, the nonimprinted glucocorticoid receptor NR3C1 gene, and interspersed ALU repeats showed significantly decreased methylation levels (4-7 percentage points for MEST, 1-2 for NR3C1, and one for ALUs) in both GDM groups, compared with controls, in both analyzed tissues. Significantly decreased blood MEST methylation (3 percentage points) also was observed in adults with morbid obesity compared with normal-weight controls. Our results support the idea that intrauterine exposure to GDM has long-lasting effects on the epigenome of the offspring. Specifically, epigenetic malprogramming of MEST may contribute to obesity predisposition throughout life. PMID:23209187

El Hajj, Nady; Pliushch, Galyna; Schneider, Eberhard; Dittrich, Marcus; Müller, Tobias; Korenkov, Michael; Aretz, Melanie; Zechner, Ulrich; Lehnen, Harald; Haaf, Thomas

2013-04-01

187

Hidden Metabolic Disturbances in Women with Normal Glucose Tolerance Five Years after Gestational Diabetes  

PubMed Central

Background. The study aimed to assess whether women with prior gestational diabetes (pGDM), despite maintenance of normal glucose tolerance (NGT) five years after delivery, display metabolic disturbances compared to healthy controls. Methods. 45?pGDM with NGT were compared to 18 women without a history of GDM (CON), matched for age (37.0?±?4.1 versus 35.2?±?5.3, P = ns) and BMI (24.3?±?3.1 versus 23.3?±?3.3, P = ns). Metabolic parameters were derived from oral and intravenous glucose tolerance tests; furthermore lipid profile, C-reactive protein (CRP), adiponectin, leptin, and glucagon were assessed. Results. Five years postpartum, pGDM had increased glucose concentrations during the OGTT (AUC: 1.12?±?0.15 versus 1.0?±?0.12?mol/L ? min, P = 0.003) and insulin sensitivity was decreased compared to CON (OGIS: 467.2?±?64.1 versus 510.6?±?53.1?mL/min ? m2, P = 0.01). pGDM had lower adiponectin (8.1?±?2.6 versus 12.6?±?5.3, P < 0.008) but increased waist circumference and CRP compared to CON. Conclusions. Despite diagnosis of normal glucose tolerance, pGDM are characterized by hyperglycemia and insulin resistance compared to healthy controls, accompanied by decreased adiponectin and increased CRP concentrations, thus linking metabolic disturbances to an increased cardiovascular risk in pGDM. PMID:25873951

Tura, Andrea; Prikoszovich, Thomas; Winzer, Christine; Luger, Anton

2015-01-01

188

The Risk Factors and Incidence of Type 2 Diabetes Mellitus and Metabolic Syndrome in Women With Previous Gestational Diabetes  

PubMed Central

Background: Gestational diabetes mellitus (GDM) affects nearly 5% of pregnancies. Significant proportion of the women with previous GDM develops type 2 diabetes mellitus (T2DM) in the next years, which indicates a higher risk in them than in the general population. Objectives: We conducted this study to determine the risk factors and incidence of abnormal glucose level and metabolic syndrome (MetS) in women with a history of GDM in a long period after delivery in our region. Patients and Methods: We extracted the demographic characteristics of 110 women with GDM who had delivered during 2004 - 2010 in three main hospitals of Zanjan City, Iran. The patients were recalled to perform oral glucose tolerance test (OGTT) and other necessary tests for MetS diagnosis. Anthropometric measurements were recorded of all the participants. Results: In this study, 110 women with a history of GDM were studied at one to six years since delivery. Among these women, 36 (32.7%) developed T2DM and 11 (10%) had impaired fasting glucose (IFG) or impaired glucose tolerance (IGT). Moreover, 22 women (20%) had developed MetS. among those with abnormal results in glycemic test, 93.6% had fasting blood sugar (FBS) ? 95 mg/dL (? 5.27 mmol/L)at the time of GDM diagnosis in the index pregnancy that was significantly higher than the normal glycemic test (NGT) group with 42.9% being affected (OR, 19.55; P < 0.0001). There was a significant difference between those with abnormal results and NGT group in interval between delivery and performing laboratory tests (27 ± 18.8 and 18.5 ± 17.7 months, respectively; OR, 1.02; P = 0.02). No insulin use during pregnancy was discovered as a protective factor in women with a history of GDM (OR, 0.35; P = 0.01). Those with abnormal results were significantly different from NGT group in the number of parities (2.61 ± 1.4 vs. 2.05 ± 1.1, respectively; OR, 1.4; P = 0.03). The most common component of MetS among women with a history of GDM was FBS > 100 mg/dL (> 5.55 mmol/L). Conclusions: Regarding the high incidence of the T2DM and MetS among women with a history of GDM, they should be screened at a regular interval for diabetes and other cardiovascular risk factors. PMID:25892996

Valizadeh, Majid; Alavi, Nooshin; Mazloomzadeh, Saeideh; Piri, Zahra; Amirmoghadami, Hamidreza

2015-01-01

189

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; Strøm, Marin; Mills, James; Liu, Aiyi; Kiely, Michele; Zhang, Cuilin

2014-01-01

190

Glibenclamide, metformin, and insulin for the treatment of gestational diabetes: a systematic review and meta-analysis  

PubMed Central

Objective To summarize short term outcomes in randomized controlled trials comparing glibenclamide or metformin versus insulin or versus each other in women with gestational diabetes requiring drug treatment. Design Systematic review and meta-analysis. Eligibility criteria for selecting studies Randomized controlled trials that fulfilled all the following: (1) published as full text; (2) addressed women with gestational diabetes requiring drug treatment; (3) compared glibenclamide v insulin, metformin v insulin, or metformin v glibenclamide; and (4) provided information on maternal or fetal outcomes. Data sources Medline, CENTRAL, and Embase were searched up to 20 May 2014. Outcomes measures We considered 14 primary outcomes (6 maternal, 8 fetal) and 16 secondary (5 maternal, 11 fetal) outcomes. Results We analyzed 15 articles, including 2509 subjects. Significant differences for primary outcomes in glibenclamide v insulin were obtained in birth weight (mean difference 109 g (95% confidence interval 35.9 to 181)), macrosomia (risk ratio 2.62 (1.35 to 5.08)), and neonatal hypoglycaemia (risk ratio 2.04 (1.30 to 3.20)). In metformin v insulin, significance was reached for maternal weight gain (mean difference ?1.14 kg (?2.22 to ?0.06)), gestational age at delivery (mean difference ?0.16 weeks (?0.30 to ?0.02)), and preterm birth (risk ratio 1.50 (1.04 to 2.16)), with a trend for neonatal hypoglycaemia (risk ratio 0.78 (0.60 to 1.01)). In metformin v glibenclamide, significance was reached for maternal weight gain (mean difference ?2.06 kg (?3.98 to ?0.14)), birth weight (mean difference ?209 g (?314 to ?104)), macrosomia (risk ratio 0.33 (0.13 to 0.81)), and large for gestational age newborn (risk ratio 0.44 (0.21 to 0.92)). Four secondary outcomes were better for metformin in metformin v insulin, and one was worse for metformin in metformin v glibenclamide. Treatment failure was higher with metformin than with glibenclamide. Conclusions At short term, in women with gestational diabetes requiring drug treatment, glibenclamide is clearly inferior to both insulin and metformin, while metformin (plus insulin when required) performs slightly better than insulin. According to these results, glibenclamide should not be used for the treatment of women with gestational diabetes if insulin or metformin is available. Systematic review registration NCT01998113 PMID:25609400

Balsells, Montserrat; García-Patterson, Apolonia; Solà, Ivan; Roqué, Marta; Gich, Ignasi

2015-01-01

191

Beverage-consumption patterns and associations with metabolic risk factors among low-income Latinos with uncontrolled type 2 diabetes.  

PubMed

In the United States, Latinos experience disproportionately higher rates of type 2 diabetes and diabetes-related complications than non-Latino whites. Sugar-sweetened beverage (SSB) consumption is strongly associated with increased risk of developing type 2 diabetes. Reducing caloric intake, particularly from energy-dense, low-nutrient foods or beverages, can be an effective and key strategy for metabolic and weight control. However, little is known about the contribution of various types of beverages, including but not limited to SSBs, to total caloric intake among Latinos with type 2 diabetes. Low-income Latinos (87.7% Puerto Rican) participating in a diabetes self-management intervention trial (N=238) provided cross-sectional, descriptive data on beverage-consumption patterns, anthropometric outcomes, and metabolic characteristics. Beverages accounted for one fifth of the total daily caloric intake. SSBs and milk beverages, respectively, contributed 9.6% of calories to overall daily caloric intake. Interventions directed at diabetes risk factors among low-income Latinos with diabetes can benefit from consideration of beverage-consumption behaviors as an important strategy to reduce caloric and sugar intake. PMID:23999278

Wang, Monica L; Lemon, Stephenie C; Olendzki, Barbara; Rosal, Milagros C

2013-12-01

192

Beverage Consumption Patterns and Associations with Metabolic Risk Factors Among Low-Income Latinos with Uncontrolled Type 2 Diabetes  

PubMed Central

In the U.S., Latinos experience disproportionately higher rates of type 2 diabetes and diabetes-related complications than non-Latino whites. Sugar-sweetened beverage (SSB) consumption is strongly associated with increased risk of developing type 2 diabetes. Reducing caloric intake, particularly from energy-dense, low-nutrient foods or beverages, can be an effective and key strategy for metabolic and weight control. However, little is known about the contribution of various types of beverages, including but not limited to SSBs, to total caloric intake among Latinos with type 2 diabetes. Low-income Latinos (87.7% Puerto Rican) participating in a diabetes self-management intervention trial (N=238) provided cross-sectional, descriptive data on beverage consumption patterns, anthropometric outcomes, and metabolic characteristics. Beverages accounted for one-fifth of the total daily caloric intake. SSBs and milk beverages, respectively, contributed 9.6% of calories to overall daily caloric intake. Interventions directed at diabetes risk factors among low-income Latinos with diabetes may benefit from consideration of beverage consumption behaviors as an important strategy to reduce caloric and sugar intake. PMID:23999278

Wang, Monica L.; Lemon, Stephenie C.; Olendzki, Barbara; Rosal, Milagros C.

2013-01-01

193

Ohio Primary Health Care Providers’ Practices and Attitudes Regarding Screening Women With Prior Gestational Diabetes for Type 2 Diabetes Mellitus — 2010  

PubMed Central

Introduction Gestational diabetes mellitus (GDM) is associated with a 7-fold increased lifetime risk for developing type 2 diabetes mellitus. Early diagnosis of type 2 diabetes is crucial for preventing complications. Despite recommendations for type 2 diabetes screening every 1 to 3 years for women with previous diagnoses of GDM and all women aged 45 years or older, screening prevalence is unknown. We sought to assess Ohio primary health care providers’ practices and attitudes regarding assessing GDM history and risk for progression to type 2 diabetes. Methods During 2010, we mailed surveys to 1,400 randomly selected Ohio family physicians and internal medicine physicians; we conducted analyses during 2011–2013. Overall responses were weighted to adjust for stratified sampling. Chi-square tests compared categorical variables. Results Overall response rate was 34% (380 eligible responses). Among all respondents, 57% reported that all new female patients in their practices are routinely asked about GDM history; 62% reported screening women aged 45 years or younger with prior GDM every 1 to 3 years for glucose intolerance; and 42% reported that screening for type 2 diabetes among women with prior GDM is a high or very high priority in their practice. Conclusion Because knowing a patient’s GDM history is the critical first step in the prevention of progression to type 2 diabetes for women who had GDM, suboptimal screening for both GDM history and subsequent glucose abnormalities demonstrates missed opportunities for identifying and counseling women with increased risk for type 2 diabetes. PMID:25474385

Conrey, Elizabeth J.; Wapner, Andrew; Ko, Jean Y.; Dietz, Patricia M.; Oza-Frank, Reena

2014-01-01

194

Mothers After Gestational Diabetes in Australia Diabetes Prevention Program (MAGDA-DPP) post-natal intervention: study protocol for a randomized controlled trial  

PubMed Central

Background Gestational diabetes mellitus (GDM) is defined as glucose intolerance with its onset or first recognition during pregnancy. Post-GDM women have a life-time risk exceeding 70% of developing type 2 diabetes mellitus (T2DM). Lifestyle modifications reduce the incidence of T2DM by up to 58% for high-risk individuals. Methods/Design The Mothers After Gestational Diabetes in Australia Diabetes Prevention Program (MAGDA-DPP) is a randomized controlled trial aiming to assess the effectiveness of a structured diabetes prevention intervention for post-GDM women. This trial has an intervention group participating in a diabetes prevention program (DPP), and a control group receiving usual care from their general practitioners during the same time period. The 12-month intervention comprises an individual session followed by five group sessions at two-week intervals, and two follow-up telephone calls. A total of 574 women will be recruited, with 287 in each arm. The women will undergo blood tests, anthropometric measurements, and self-reported health status, diet, physical activity, quality of life, depression, risk perception and healthcare service usage, at baseline and 12 months. At completion, primary outcome (changes in diabetes risk) and secondary outcome (changes in psychosocial and quality of life measurements and in cardiovascular disease risk factors) will be assessed in both groups. Discussion This study aims to show whether MAGDA-DPP leads to a reduction in diabetes risk for post-GDM women. The characteristics that predict intervention completion and improvement in clinical and behavioral measures will be useful for further development of DPPs for this population. Trial registration Australian New Zealand Clinical Trials Registry ANZCTRN 12610000338066 PMID:24135085

2013-01-01

195

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. PMID:25405027

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

2014-01-01

196

The 6-week postpartum oral glucose tolerance test for women with gestational diabetes: an opportune time for risk assessment and for implementing lifestyle changes  

Microsoft Academic Search

National Institute for Health and Clinical Excellence guidelines for ‘Diabetes in Pregnancy’ recommend women with gestational diabetes (GDM) have a fasting blood glucose (FBG) measurement 6 weeks after delivery as opposed to oral glucose tolerance test (OGTT), a cost saving to the National Health Service without affecting outcomes.Study objectives were to evaluate benefits of a 6-week postpartum OGTT (PP OGTT)

A Bird; J OBrien; C Candelier

2010-01-01

197

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

198

Dysregulation of Placental Endothelial Lipase in Obese Women With Gestational Diabetes Mellitus  

PubMed Central

OBJECTIVE This study addressed the hypothesis that placental endothelial lipase (EL) expression is affected by pregnancies complicated by obesity and gestational diabetes mellitus (GDM). RESEARCH DESIGN AND METHODS EL expression in placental tissues from pregnancies complicated by obesity, GDM, or obesity combined with GDM (obese-GDM) was analyzed by quantitative RT-PCR. Moreover, primary placental cells were isolated and treated with insulin, glucose, leptin, or tumor necrosis factor (TNF)-?, and EL expression was measured. Inhibitors of nuclear factor (NF)-?B or mitogen-activated protein kinase (MAPK) signaling were used to detect potential pathways of EL regulation in primary placental endothelial cells (ECs). RESULTS In placentas from obese-GDM pregnancies, EL expression was upregulated by 1.9-fold (P < 0.05) compared with lean pregnancies, whereas obesity or GDM alone had no significant effect. Analyses of metabolic parameters in maternal venous and umbilical venous plasma revealed significantly increased insulin and leptin as well as slightly increased glucose and TNF-? values in the obese and obese-GDM groups. Cell culture experiments identified TNF-? and leptin, but not glucose or insulin, as regulators of EL expression in ECs. Induction of EL expression by these mediators occurred in a para/endocrine manner, since only leptin and TNF-? receptors, but not the cytokines themselves, were expressed in ECs. Inhibitor experiments suggested that TNF-? and leptin-mediated upregulation of EL may occur via two different routes. Whereas TNF-? induced EL upregulation in ECs by activation of the NF-?B pathway, leptin did not stimulate NF-?B or MAPK signaling pathways in these cells. CONCLUSIONS Metabolic inflammation with high leptin and locally increased TNF-? concentrations at the fetal-placental interface regulates placental EL expression. PMID:21852675

Gauster, Martin; Hiden, Ursula; van Poppel, Mireille; Frank, Sasa; Wadsack, Christian; Hauguel-de Mouzon, Sylvie; Desoye, Gernot

2011-01-01

199

Differential expression and regional distribution of aquaporins in amnion of normal and gestational diabetic pregnancies.  

PubMed

The region of the amnion overlying the placenta plays an active role in fluid exchange between amniotic fluid and fetal blood perfusing the surface of the placenta, whereas little transfer occurs across the reflected amnion that contacts the membranous chorion. Because aquaporins (AQPs) facilitate rapid movement of water across cells, we hypothesized that AQP gene expression in placental amnion is higher than in reflected amnion. Furthermore, because gestational diabetes mellitus (GDM) is often associated with polyhydramnios, we hypothesized that amnion AQP gene expression is reduced when amniotic fluid volume is elevated. Human placental and reflected amnion were obtained at cesarean delivery and subjected to relative quantitation of AQP mRNA by real-time RT-qPCR and proteins by western immunoblot. Amnion mRNA levels of five AQPs differed by up to 400-fold (P < 0.001), with AQP1 and AQP3 most abundant, AQP8 least and AQP9 and AQP11 intermediately expressed. Aquaporin proteins showed a similar profile. Aquaporin mRNA abundance was higher (P < 0.001) in placental than reflected amnion, whereas protein levels were lower (P < 0.01). In GDM pregnancies, neither AQP mRNA nor protein levels were different from normal. There was no correlation between AQP mRNA or protein levels with the amniotic fluid index in normal or GDM subjects. We conclude that there is a strong differential expression profile among individual AQPs and between regions of the amnion. These findings suggest differences in contribution of individual AQPs to water transport in the two regions of the amnion. Furthermore, AQP expression in the amnion is not altered in patients with GDM. PMID:25742957

Bednar, Amy D; Beardall, Michael K; Brace, Robert A; Cheung, Cecilia Y

2015-03-01

200

Female Sexual Function of Overweight Women with Gestational Diabetes Mellitus – A Cross-Sectional Study  

PubMed Central

Obesity and gestational diabetes mellitus (GDM) are increasing worldwide and may compromise female sexual function. We hypothesize that among GDM patients in the third trimester of pregnancy, those with excess body fat would have worse female sexual function scores than normal weight women. Our aim was to assess the sexual function of overweight compared to normal weight women with GDM. This was a cross-sectional survey involving 143 Brazilian women with GDM in the third trimester of pregnancy: 76 were overweight (pre-pregnancy body mass index-BMI?25.0 Kg/m2) and 67 were normal weight (BMI 18.5–24.9 Kg/m2). Participants were recruited from March 2010 to April 2013 at the antenatal clinic of a single public tertiary teaching institution. The Female Sexual Function Index (FSFI) questionnaire was used to assess sexual function. Overall, 51.7% of the 143 participants were at risk for sexual dysfunction symptoms (FSFI scores ?26); this rate was significantly higher among overweight compared to normal weight women (60.5% versus 41.8%, p?=?0.038). Mean total FSFI scores were significantly lower in overweight compared to normal weight women (21.7±9.2 versus 24.9±8.0, p?=?0.029). Compared to normal weight women, overweight participants had lower mean scores in desire (3.4±1.2 versus 4.0±1.4, p?=?0.007) and lubrication (3.8±2.0 versus 4.5±1.6, p?=?0.023). According to these results, overweight women with GDM in the third trimester of pregnancy have lower female sexual function scores than normal weight women with the same disorder. PMID:24736490

Ribeiro, Meireluci Costa; Nakamura, Mary Uchiyama; Torloni, Maria Regina; Scanavino, Marco de Tubino; Scomparini, Flávia Burin; Mattar, Rosiane

2014-01-01

201

Patient-oriented Computerized Clinical Guidelines for Mobile Decision Support in Gestational Diabetes.  

PubMed

The risks associated with gestational diabetes (GD) can be reduced with an active treatment able to improve glycemic control. Advances in mobile health can provide new patient-centric models for GD to create personalized health care services, increase patient independence and improve patients' self-management capabilities, and potentially improve their treatment compliance. In these models, decision-support functions play an essential role. The telemedicine system MobiGuide provides personalized medical decision support for GD patients that is based on computerized clinical guidelines and adapted to a mobile environment. The patient's access to the system is supported by a smartphone-based application that enhances the efficiency and ease of use of the system. We formalized the GD guideline into a computer-interpretable guideline (CIG). We identified several workflows that provide decision-support functionalities to patients and 4 types of personalized advice to be delivered through a mobile application at home, which is a preliminary step to providing decision-support tools in a telemedicine system: (1) therapy, to help patients to comply with medical prescriptions; (2) monitoring, to help patients to comply with monitoring instructions; (3) clinical assessment, to inform patients about their health conditions; and (4) upcoming events, to deal with patients' personal context or special events. The whole process to specify patient-oriented decision support functionalities ensures that it is based on the knowledge contained in the GD clinical guideline and thus follows evidence-based recommendations but at the same time is patient-oriented, which could enhance clinical outcomes and patients' acceptance of the whole system. PMID:24876573

García-Sáez, Gema; Rigla, Mercedes; Martínez-Sarriegui, Iñaki; Shalom, Erez; Peleg, Mor; Broens, Tom; Pons, Belén; Caballero-Ruíz, Estefanía; Gómez, Enrique J; Hernando, M Elena

2014-03-01

202

The identification of irisin in human cerebrospinal fluid: influence of adiposity, metabolic markers, and gestational diabetes.  

PubMed

Peripheral action of irisin improves glucose homeostasis and increases energy expenditure, with no data on a central role of irisin in metabolism. These studies sought to examine 1) presence of irisin in human cerebrospinal fluid (CSF) and banked human hypothalamic tissue, 2) serum irisin in maternal subjects across varying adiposities with or without gestational diabetes (GDM), and 3) their respective neonate offspring. CSF, serum, and neonatal cord serum were collected from 91 pregnant women with and without GDM attending for an elective cesarean section [body mass index (BMI): 37.7 ± 7.6 kg/m(2); age: 32 ± 8.3 yr]. Irisin was assessed by ELISA and correlated with biochemical and anthropometric data. Irisin expression was examined in human hypothalamus by immunohistochemical staining. Serum irisin in pregnant women was significantly lower in nonobese compared with obese and GDM subjects, after adjusting for BMI, lipids, and glucose. Irisin was present in neonatal cord serum (237 ± 8 ng/ml) and maternal CSF (32 ± 1.5 ng/ml). CSF irisin correlated positively with serum irisin levels from nonobese and obese pregnant women (P < 0.01), with CSF irisin significantly raised in GDM subjects (P < 0.05). Irisin was present in human hypothalamic sections in the paraventricular neurons, colocalized with neuropeptide Y. Irisin was detectable in CSF and in paraventricular neurons. Maternal serum irisin was lower in nonobese pregnant women after adjusting for BMI and a number of metabolic parameters. These studies indicate that irisin may have a central role in metabolism in addition to the known peripheral role. Further studies investigating the central action of irisin in human metabolic disease are required. PMID:24398403

Piya, Milan K; Harte, Alison L; Sivakumar, Kavitha; Tripathi, Gyanendra; Voyias, Philip D; James, Sean; Sabico, Shaun; Al-Daghri, Nasser M; Saravanan, Ponnusamy; Barber, Thomas M; Kumar, Sudhesh; Vatish, Manu; McTernan, Philip G

2014-03-01

203

Differential expression and regional distribution of aquaporins in amnion of normal and gestational diabetic pregnancies  

PubMed Central

The region of the amnion overlying the placenta plays an active role in fluid exchange between amniotic fluid and fetal blood perfusing the surface of the placenta, whereas little transfer occurs across the reflected amnion that contacts the membranous chorion. Because aquaporins (AQPs) facilitate rapid movement of water across cells, we hypothesized that AQP gene expression in placental amnion is higher than in reflected amnion. Furthermore, because gestational diabetes mellitus (GDM) is often associated with polyhydramnios, we hypothesized that amnion AQP gene expression is reduced when amniotic fluid volume is elevated. Human placental and reflected amnion were obtained at cesarean delivery and subjected to relative quantitation of AQP mRNA by real-time RT-qPCR and proteins by western immunoblot. Amnion mRNA levels of five AQPs differed by up to 400-fold (P < 0.001), with AQP1 and AQP3 most abundant, AQP8 least and AQP9 and AQP11 intermediately expressed. Aquaporin proteins showed a similar profile. Aquaporin mRNA abundance was higher (P < 0.001) in placental than reflected amnion, whereas protein levels were lower (P < 0.01). In GDM pregnancies, neither AQP mRNA nor protein levels were different from normal. There was no correlation between AQP mRNA or protein levels with the amniotic fluid index in normal or GDM subjects. We conclude that there is a strong differential expression profile among individual AQPs and between regions of the amnion. These findings suggest differences in contribution of individual AQPs to water transport in the two regions of the amnion. Furthermore, AQP expression in the amnion is not altered in patients with GDM. PMID:25742957

Bednar, Amy D; Beardall, Michael K; Brace, Robert A; Cheung, Cecilia Y

2015-01-01

204

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

205

Dietary interventions, lifestyle changes, and dietary supplements in preventing gestational diabetes mellitus: a literature review.  

PubMed

Gestational diabetes mellitus (GDM) is associated with increased rates of fetal morbidity and mortality, both during the pregnancy and in the postnatal life. Current treatment of GDM includes diet with or without medications, but this management is expensive and poorly cost-effective for the health care systems. Strategies to prevent such condition would be preferable with respect to its treatment. The aim of this literature review was to evaluate studies reporting the efficacy of the most used approaches to prevent GDM as well as evidences of efficacy and safety of dietary supplementations. Systematic literature searches were performed in electronic databases, covering the period January 1983 to April 2014. Randomized controlled clinical trials were included. Quality of the articles was evaluated with the Jadad scale. We did not evaluate those articles that were already entered in the most recent systematic reviews, and we completed the research with the trials published thereafter. Of 55 articles identified, 15 randomized controlled trials were eligible. Quality and heterogeneity of the studies cannot allow firm conclusions. Anyway, trials in which only intake or expenditure has been targeted mostly reported negative results. On the contrary, combined lifestyle programs including diet control (orienting food intake, restricting energy intake) associated with moderate but continuous physical activity exhibit better efficacy in reducing GDM prevalence. The results from dietary supplements with myoinositol or probiotics are promising. The actual evidences provide enough arguments for implementing large-scale, high-quality randomized controlled trials looking at the possible benefits of these new approaches for preventing GDM. PMID:25409159

Facchinetti, Fabio; Dante, Giulia; Petrella, Elisabetta; Neri, Isabella

2014-11-01

206

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

207

Screening in high-risk group of gestational diabetes mellitus with its maternal and fetal outcomes  

PubMed Central

Background: Gestational diabetes mellitus (GDM) is a metabolic disorder defined as glucose intolerance with the onset or first recognition during pregnancy. Women with GDM are at increased risk for adverse obstetric and perinatal outcome. The complications associated with GDM can be prevented by early recognition, intense monitoring and proper treatment. Aims: The present study was done to screen the high-risk pregnancy group for GDM, to find the incidence of abnormal results on screening and to correlate the abnormal results with the maternal and fetal outcomes. The study was done in a tertiary care hospital and teaching institute. It was a prospective cohort study. Materials and Methods: Selective screening for GDM was done in 150 pregnant women with high-risk factors. Screening was done with 50 g glucose challenge test (GCT) after 18 weeks, and if GCT was negative then the test was repeated after 28 weeks of pregnancy. The patients who were having an abnormal GCT were subjected to 100 g oral glucose tolerance test (OGTT). All GDM patients were followed up and treated with diet and/or insulin therapy till delivery to know maternal and fetal outcomes. The period of study was from April 2008 to March 2009. Results: 7.3% of study population was OGCT positive. 6% of the study population was OGTT positive. Age >25 years, obesity, family history of DM, and past history of GDM were the risk factors significantly associated with GDM. One newborn had hypoglycemia and one had hyperbilirubinemia. The fetal and maternal outcome in GDM patients was good in our study due to early diagnosis and intervention. Conclusion: Women with GDM are at an increased risk for adverse obstetric and perinatal outcome. The increased morbidity in GDM is preventable by meticulous antenatal care. PMID:22701851

Nilofer, Angadi Rajasab; Raju, V. S.; Dakshayini, B. R.; Zaki, Syed Ahmed

2012-01-01

208

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

209

The Effects of Implementing the International Association of Diabetes and Pregnancy Study Groups Criteria for Diagnosing Gestational Diabetes on Maternal and Neonatal Outcomes  

PubMed Central

Background In 2010, the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) recommended a new strategy for the screening and diagnosis of gestational diabetes mellitus (GDM). However, no study has indicated that adopting the IADPSG recommendations improves perinatal outcomes. The objective of this study was to evaluate the effects of implementing the IADPSG criteria for diagnosing GDM on maternal and neonatal outcomes. Methodology/Principal Findings Previously, we used a two-step approach (a 1-h, 50-g glucose challenge test followed by a 3-h, 100-g glucose tolerance test when indicated) to screen for and diagnose GDM. In July 2011, we adopted the IADPSG recommendations in our routine obstetric care. In this study, we retrospectively compared the rates of various maternal and neonatal outcomes in all women who delivered after 24 weeks of gestation during the periods before (P1, between January 1, 2009 and December 31, 2010) and after (P2, between January 1, 2012 and December 31, 2013) the IADPSG criteria were implemented. Pregnancies complicated by multiple gestations, fetal chromosomal or structural anomalies, and pre-pregnancy diabetes mellitus were excluded. Our results showed that the incidence of GDM increased from 4.6% using the two-step method to 12.4% using the IADPSG criteria. Compared to the women in P1, the women in P2 experienced less weight gain during pregnancy, lower birth weights, shorter labor courses, and lower rates of macrosomia (<4000 g) and large-for-gestational age (LGA) infants. P2 was a significant independent factor against macrosomia (adjusted odds ratio [OR] 0.63, 95% confidence interval [CI] 0.43–0.90) and LGA (adjusted OR 0.74, 95% CI 0.61–0.89) after multivariable logistic regression analysis. Conclusions/Significance The adoption of the IADPSG criteria for diagnosis of GDM was associated with significant reductions in maternal weight gain during pregnancy, birth weights, and the rates of macrosomia and LGA. PMID:25756838

Hung, Tai-Ho; Hsieh, T’sang-T’ang

2015-01-01

210

Psychosocial deprivation in women with gestational diabetes mellitus is associated with poor fetomaternal prognoses: an observational study  

PubMed Central

Objective To evaluate the prognoses associated with psychosocial deprivation in women with gestational diabetes mellitus (GDM). Design Observational study considering the 1498 multiethnic women with GDM who gave birth between January 2009 and February 2012. Setting Four largest maternity units in the northeastern suburban area of Paris. Participants The 994 women who completed the Evaluation of Precarity and Inequalities in Health Examination Centers (EPICES) questionnaire. Main outcome measure Main complications of GDM (large infant for gestational age (LGA), shoulder dystocia, caesarean section, pre-eclampsia). Results Psychosocial deprivation (EPICES score ?30.17) affected 577 women (56%) and was positively associated with overweight/obesity, parity and non-European origin, and negatively associated with family history of diabetes, fruit and vegetable consumption and working status. The psychosocially deprived women were diagnosed with GDM earlier, received insulin treatment during pregnancy more often and were more likely to have LGA infants (15.1% vs 10.6%, OR=1.5 (95% CI 1.02 to 2.2), p<0.05) and shoulder dystocia (3.1% vs 1.2%, OR=2.7 (0.97 to 7.2), p<0.05). In addition to psychosocial deprivation, LGA was associated with greater parity, obesity, history of GDM, ethnicity, excessive gestational weight gain and insulin therapy. A multivariate analysis using these covariates revealed that the EPICES score was independently associated with LGA infants (per 10 units, OR=1.12 (1.03 to 1.20), p<0.01). Conclusions In our area, psychosocial deprivation is common in women with GDM and is associated with earlier GDM diagnoses and greater insulin treatment, an increased likelihood of shoulder dystocia and, independently of obesity, gestational weight gain and other confounders with LGA infants. PMID:25748416

Cosson, Emmanuel; Bihan, Hélène; Reach, Gérard; Vittaz, Laurence; Carbillon, Lionel; Valensi, Paul

2015-01-01

211

Assessment of Noninvasive Risk Markers of Subclinical Atherosclerosis in Premenopausal Women with Previous History of Gestational Diabetes Mellitus  

PubMed Central

Introduction: Gestational diabetes mellitus (GDM) is state of carbohydrate intolerance detected first time during pregnancy. GDM represents a significant risk factor for the development of CVD in women. The degree to which women with histories of gestational diabetes are at risk for cardiovascular disease, beyond their predisposition to future diabetes, is still unclear. The aim of our study was to assess the presence of surrogate markers of subclinical atherosclerosis which can be present in them even without developing type 2 diabetes. Subjects and Methods: In this descriptive cross-sectional hospital based study, 50 patients 20-45 yrs of age, premenopausal, at least 1 yr past her most recent pregnancy, and not more than 5 yr past her index pregnancy with GDM. These patients and controls who did not have GDM were assessed for carotid intima media thickness,endothelial dysfunction, epicardial fat thickness and other cardiovascular risk factors. Results: Women with pGDM were found to have unfavourable cardiovascular risk parameters. They also demonstrated more frequent occurrence of metabolic syndrome(64% vs 10%) than control subjects. Individual components of MS increased with increasing BMI in both the groups. As far as markers of subclinical atherosclerosis were concerned women with pGDM had significantly higher CIMT, FMD and epicardial fat thickness than control group. Conclusion: Women with pGDM, even before development of diabetes have significant differences in CVD risk factors when compared to those who do not have such history. Postpartum screening for glucose intolerance and efforts to minimize modifiable cardiovascular risk factors, including hypertension, viscerall adiposity, and dyslipidemia should be the most effective measures for lowering of cardiovascular risk.

Karoli, Ritu; Siddiqi, Zeba; Fatima, Jalees; Shukla, Vaibhav; Mishra, Punj Prakash; Khan, Faraz Ahmad

2015-01-01

212

Impact of gestational diabetes and lactational insulin replacement on structure and secretory function of offspring rat ventral prostate.  

PubMed

Clinical and experimental studies have shown that exposure to adverse conditions during the critical stages of embryonic, fetal or neonatal development lead to a significantly increased risk of later disease. Diabetes during pregnancy has been linked to increased risk of obesity and diabetes in offspring. Here, we investigated whether mild gestational diabetes mellitus (GDM) followed or not by maternal insulin replacement affects the ventral prostate (VP) structure and function in male offspring at puberty and adulthood. Pregnant rats were divided into the following 3 groups: control (CT); streptozotocin (STZ)-induced diabetes (D); and D plus insulin replacement during lactation (GDI). The male offspring from different groups were euthanized at postnatal day (PND) 60 and 120. Biometrical parameters, hormonal levels and prostates were evaluated. Mild-GDM promoted reduction in the glandular parenchyma and increased collagen deposition. Insulin replacement during lactation restored the VP morphology. Most importantly, mild-GDM decreased the androgen-induced secretory function as determined by prostatein expression, and insulin replacement reversed this effect. Our results demonstrated that mild GDM impairs VP parenchyma maturation, which is associated with an increase in the fibromuscular stroma compartment. Functionally, the reduction in the VP parenchyma decreases the glandular secretory activity as demonstrated by low expression of prostatein, a potent immunosuppressor factor that protects sperm from immunologic damage into the feminine reproductive tract. This change could lead to impairment of reproductive function in male offspring from diabetic mothers. Maternal insulin replacement during the weaning period apparently restores the prostate function in male offspring. PMID:24983773

Santos, Sérgio A A; Rinaldi, Jaqueline C; Martins, Amanda E; Camargo, Ana C L; Leonelli, Carina; Delella, Flávia K; Felisbino, Sérgio L; Justulin, Luis A

2014-09-15

213

Comparison of Insulin Lispro Protamine Suspension with NPH Insulin in Pregnant Women with Type 2 and Gestational Diabetes Mellitus: Maternal and Perinatal Outcomes  

PubMed Central

Insulin therapy is still the gold standard in diabetic pregnancy. Insulin lispro protamine suspension is an available basal insulin analogue. Aim. To study pregnancy outcomes of women with type 2 and gestational diabetes mellitus when insulin lispro protamine suspension or human NPH insulin was added to medical nutrition therapy and/or short-acting insulin. Methods. In this retrospective study, for maternal outcome we recorded time and mode of delivery, hypertension, glycaemic control (fasting blood glucose and HbA1c), hypoglycemias, weight increase, and insulin need. For neonatal outcome birth weight and weight class, congenital malformations was recorded and main neonatal complications. Two-tail Student's t-test and chi-square test were performed when applicable; significant P < 0.05. Results. Eighty-nine pregnant women (25 with type 2 diabetes and 64 with gestational diabetes mellitus; 53 under insulin lispro protamine suspension and 36 under human NPH insulin) were recruited. Maternal and neonatal outcomes were quite similar between the two therapeutic approaches; however, insulin need was higher in NPH. At the end of pregnancy, eight women with gestational diabetes continued to use only basal insulin analogue. Conclusions. Pregnancy outcome in type 2 and gestational diabetes mellitus with insulin lispro protamine suspension was similar to that with NPH insulin, except for a lower insulin requirement. PMID:23840206

Visalli, Natalia; Abbruzzese, Santina; Bongiovanni, Marzia; Napoli, Angela

2013-01-01

214

myo-Inositol Supplementation and Onset of Gestational Diabetes Mellitus in Pregnant Women With a Family History of Type 2 Diabetes  

PubMed Central

OBJECTIVE To check the hypothesis that myo-inositol supplementation may reduce gestational diabetes mellitus (GDM) onset in pregnant women with a family history of type 2 diabetes. RESEARCH DESIGN AND METHODS A 2-year, prospective, randomized, open-label, placebo-controlled study was carried out in pregnant outpatients with a parent with type 2 diabetes who were treated from the end of the first trimester with 2 g myo-inositol plus 200 µg folic acid twice a day (n = 110) and in the placebo group (n = 110), who were only treated with 200 µg folic acid twice a day. The main outcome measure was the incidence of GDM in both groups. Secondary outcome measures were as follows: the incidence of fetal macrosomia (>4,000 g), gestational hypertension, preterm delivery, caesarean section, shoulder dystocia, neonatal hypoglycemia, and neonatal distress respiratory syndrome. GDM diagnosis was performed according to the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) recommendations. RESULTS Incidence of GDM was significantly reduced in the myo-inositol group compared with the placebo group: 6 vs. 15.3%, respectively (P = 0.04). In the myo-inositol group, a reduction of GDM risk occurrence was highlighted (odds ratio 0.35). A statistically significant reduction of fetal macrosomia in the myo-inositol group was also highlighted together with a significant reduction in mean fetal weight at delivery. In the other secondary outcome measures, there were no differences between groups. CONCLUSIONS myo-Inositol supplementation in pregnant women with a family history of type 2 diabetes may reduce GDM incidence and the delivery of macrosomia fetuses. PMID:23340885

D’Anna, Rosario; Scilipoti, Angela; Giordano, Domenico; Caruso, Carmela; Cannata, Maria Letizia; Interdonato, Maria Lieta; Corrado, Francesco; Di Benedetto, Antonino

2013-01-01

215

Combined use of basal insulin analog and acarbose reduces postprandial glucose in patients with uncontrolled type 2 diabetes  

PubMed Central

Aims/Introduction Early initiation of basal insulin therapy is recommended for normalizing fasting blood glucose in type 2 diabetes mellitus. However, basal insulin treatment might not adequately control postprandial glucose levels. The present study evaluated whether the combination of the ?-glucosidase inhibitor, acarbose, and basal insulin improved blood glucose control under daily-life treatment conditions in a large sample of Korean patients. Materials and Methods The present study was a multicenter, prospective, observational study under daily-life treatment conditions. A total of 539 patients with type 2 diabetes who were treated with basal insulin and additional acarbose were enrolled and followed up for 20 weeks. Changes in hemoglobin A1c, fasting and postprandial blood glucose were evaluated at baseline and at the end of the observation period. The physician and patient satisfaction of the combination treatment and safety were assessed. Results Hemoglobin A1c decreased by 0.55 ± 1.05% from baseline (P < 0.0001). Fasting and postprandial blood glucose levels were reduced by 0.89 ± 3.79 and 2.59 ± 4.77 mmol/L (both P < 0.0001). The most frequently reported adverse drug reactions were flatulence (0.37%) and abnormal gastrointestinal sounds (0.37%), and all were mild in intensity and transient. In the satisfaction evaluation, 79.0% of physicians and 77.3% of patients were ‘very satisfied’ or ‘satisfied’ with the combined basal insulin and acarbose therapy. Conclusions Combination therapy of basal insulin and acarbose in patients with type 2 diabetes improved glucose control, and had no drug-specific safety concerns, suggesting that the treatment might benefit individuals who cannot control blood glucose with basal insulin alone. PMID:25802730

Kim, Ji-Hyun; Ahn, Ji-Hyun; Kim, Soo-Kyung; Lee, Dae-Ho; Kim, Hye-Soon; Shon, Ho-Sang; Jeon, Hyun-Jeong; Kim, Tae-Hwa; Cho, Yong-Wook; Kim, Jae-Taek; Han, Sung-Min; Chung, Choon-Hee; Ryu, Ohk-Hyun; Lee, Jae-Min; Lee, Soon-Hee; Kwon, Min-Jeong; Kim, Tae-kyun; Namgoong, Il-Seong; Kim, Eun-Sook; Jung, In-Kyung; Moon, Sung-Dae; Han, Je-Ho; Kim, Chong-Hwa; Cho, Eun-Hee; Kim, Ki-Young; Park, Hee-Baek; Lee, Ki-Sang; Lee, Sung-Woo; Lee, Sang-Cheol; Kang, Cheol-Min; Jeon, Byung-Sook; Song, Min-Seop; Yun, Seung-Baik; Chung, Hyung-Keun; Seong, Jong-Ho; Jeong, Jin-Yi; Cha, Bong-Yun

2015-01-01

216

Global Methylation in the Placenta and Umbilical Cord Blood From Pregnancies With Maternal Gestational Diabetes, Preeclampsia, and Obesity  

PubMed Central

Emerging evidence indicates that maternal medical risk during pregnancy, such as gestational diabetes mellitus (GDM), preeclampsia, and obesity, predisposes the offspring to suboptimal development. However, the underlying biological/epigenetic mechanism in utero is still unknown. The current pilot study (N = 50) compared the levels of global methylation in the placenta and umbilical cord blood among women with and without each risk condition (GDM, preeclampsia, and obesity) and explored whether the levels of global methylation were associated with fetal/infant growth. Results show that global methylation levels in the placenta were lower in patients with gestational diabetes (P = .003) and preeclampsia (P = .05) but higher with obesity (P = .01). Suggestive negative associations were found between global methylation level in the placenta and infant body length and head circumference. While preliminary, it is possible that the placenta tissue, but not umbilical cord blood, may be epigenetically programmed by maternal GDM, preeclampsia, and obesity to carry out its own specific functions that influence fetal growth. PMID:23765376

Nomura, Yoko; Lambertini, Luca; Rialdi, Alexander; Lee, MenJean; Mystal, Elana Ying; Grabie, Mordy; Manaster, Isaac; Huynh, Nancy; Finik, Jackie; Davey, Mia; Davey, Kei; Ly, Jenny; Stone, Joanne; Loudon, Holly; Eglinton, Gary; Hurd, Yasmin; Newcorn, Jeffrey H.; Chen, Jia

2014-01-01

217

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

218

Fetal cerebral hemodynamic in gestational diabetic versus normal pregnancies: a Doppler velocimetry of middle cerebral and umbilical arteries.  

PubMed

Gestational diabetes mellitus (GDM) is one of the most common complications in pregnancies. Evaluating other conditions, including intra uterine growth restriction and pre-eclampsia, some studies have shown significant changes in blood flow velocity of fetal middle cerebral artery (MCA). Our study is one of the few that has aimed to assess the effects of GDM on Doppler parameters of the fetal MCA and umbilical artery (UA) and to compare with normal pregnancies. This cross-sectional study was performed on 66 pregnant women, including 33 women with GDM and the others without it, in Akbar-Abadi University Hospital in Tehran, Iran during 2010-2011. Peak systolic and diastolic velocities, pulsatility index (PI), resistance index (RI) and systolic diastolic ratio (SD) were recorded in UA as well as both right and left fetal MCAs for every recruited pregnant women by means of Doppler ultrasonography. The mean gestational age at the time of examination was 34.45 (SD = 2.62) weeks in GDM group. Although all of the measured Doppler parameters had higher values in GDM pregnancies, the differences were not significant between two groups of study; except for the left fetal MCA-PI, which was significantly higher in GDM group [2.07 (SD = 0.07) vs. 1.85 (SD = 0.74), P = 0.03]. Our results show that gestational diabetes may contribute to an elevated PI in the fetal MCA. Although there is not yet strong proof for the effect of GDM on the fetal brain hemodynamics, the significant higher MCA-PI warrants more attention towards better controlling of the hyperglycemia during pregnancy. PMID:23797352

Shabani Zanjani, Mansoureh; Nasirzadeh, Roya; Fereshtehnejad, Seyed-Mohammad; Yoonesi Asl, Ladan; Alemzadeh, Seyed-Amir Pooya; Askari, Sareh

2014-03-01

219

Maternal Glucose during Pregnancy and after Delivery in Women with Gestational Diabetes Mellitus on Overweight Status of Their Children  

PubMed Central

Objective. To examine the association of maternal glycemia during pregnancy and after delivery with anthropometry in the offspring of mothers with gestational diabetes mellitus (GDM). Methods. A total of 1,263 GDM mothers and their children finished the health survey at 1–5 years after delivery. Results. Offspring of GDM mothers who were diagnosed with diabetes during pregnancy had higher prevalence of overweight, higher mean weight for height Z scores, and higher mean BMI for age Z scores at 1–5 years old than the offspring of GDM mothers who were diagnosed with impaired glucose tolerance (IGT) during pregnancy. Offspring of GDM mothers who developed diabetes 1–5 years after delivery had higher mean values of Z scores for weight for height and BMI for age at 1–5 years old than the offspring of GDM mothers who had normal glucose or prediabetes after delivery. Conclusions. Offspring of GDM mothers who were diagnosed with diabetes during pregnancy or after delivery had an increased risk of childhood overweight or weight gain at 1–5 years old compared with children of GDM mothers with IGT during pregnancy or with normal glucose or prediabetes after delivery. PMID:25802854

Zhang, Shuang; Liu, Huikun; Zhang, Cuiping; Wang, Leishen; Li, Nan; Leng, Junhong; Li, Yi; Liu, Gongshu; Fan, Xiangwei; Yu, Zhijie; Yang, Xilin; Baccarelli, Andrea A.; Hou, Lifang

2015-01-01

220

Acceptability and user satisfaction of a smartphone-based, interactive blood glucose management system in women with gestational diabetes mellitus.  

PubMed

The increase in gestational diabetes mellitus (GDM) is challenging maternity services. We have developed an interactive, smartphone-based, remote blood glucose (BG) monitoring system, GDm-health. The objective was to determine women's satisfaction with using the GDm-health system and their attitudes toward their diabetes care. In a service development program involving 52 pregnant women (September 2012 to June 2013), BG was monitored using GDm-health from diagnosis until delivery. Following birth, women completed a structured questionnaire assessing (1) general satisfaction, (2) equipment issues, and (3) relationship with the diabetes care team. Responses were scored on a 7-point Likert-type scale. Reliability and validity of the questionnaire were assessed using statistical methods. Of 52 women, 49 completed the questionnaire; 32 had glucose tolerance test confirmed GDM (gestation at recruitment 29 ± 4 weeks (mean ± SD), and 17 women previous GDM recommended for BG monitoring (18 ± 6 weeks). In all, 45 of 49 women agreed their care was satisfactory and the best for them, 47 of 49 and 43 of 49 agreed the equipment was convenient and reliable respectively, 42 of 49 agreed GDm-health fitted into their lifestyle, and 46 of 49 agreed they had a good relationship with their care team. Written comments supported these findings, with very positive reactions from the majority of women. Cronbach's alpha was .89 with factor analysis corresponding with question thematic trends. This pilot demonstrates that GDm-health is acceptable and convenient for a large proportion of women. Effects on clinical and economic outcomes are currently under investigation in a randomized trial (clinicaltrials.gov NCT01916694). PMID:25361643

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

2015-01-01

221

LOW PLASMA VITAMIN B12 AND HIGH FOLATE CONCENTRATIONS IN PREGNANCY ARE ASSOCIATED WITH GESTATIONAL DIABESITY AND INCIDENT DIABETES  

PubMed Central

Aim To test the hypothesis that low plasma vitamin B12 concentrations combined with high folate concentrations in pregnancy are associated with higher incidence of gestational diabetes (GDM) and later diabetes. Methods Women (N=785) attending the antenatal clinics of the Holdsworth Memorial Hospital, Mysore, India had their anthropometry, insulin resistance (Homeostasis Model Assessment) and glucose tolerance assessed at 30 weeks gestation (100g Oral Glucose Tolerance Test/ OGTT; Carpenter-Coustan criteria), and five years after delivery (75g OGTT, WHO 1999). Vitamin B12 and folate concentrations in pregnancy were measured in stored frozen plasma samples. Results Low vitamin B12 concentrations (<150 pmol/l, B12 deficiency) were observed in 43% of women and low folate concentrations (<7 nmol/l) in 4%. Women with vitamin B12 deficiency had higher body mass index (BMI; P<0.001), sum of skinfolds (P<0.001), insulin resistance (P=0.02) and a higher incidence of GDM (8.7% v 4.6%; OR=2.14, P=0.02; P=0.1 after adjusting for maternal BMI) than non-deficient women. Among vitamin B12-deficient women the incidence of GDM increased with folate concentration (5.6%, 8.8%, 12.8% respectively from lowest to highest third; P for interaction=0.2). B12 deficiency during pregnancy predicted larger skinfolds, increased insulin resistance (P<0.05) and incident diabetes at 5-year follow-up (P=0.02, after adjusting for current BMI). Conclusion Maternal vitamin B12 deficiency is associated with increased adiposity and, in turn, with increased insulin resistance and GDM, especially in the presence of high folate concentrations. Vitamin B12 deficiency may be an important factor underlying the high risk of diabesity in south Asian Indians. PMID:19707742

Krishnaveni, GV; Hill, JC; Veena, SR; Bhat, DS; Wills, AK; Chachyamma, KJ; Karat, SC; Yajnik, CS; Fall, CHD

2012-01-01

222

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

223

Gestational Diabetes Mellitus Impairs Nrf2-Mediated Adaptive Antioxidant Defenses and Redox Signaling in Fetal Endothelial Cells In Utero  

PubMed Central

In utero exposure to gestational diabetes mellitus (GDM) is associated with an increased risk of type 2 diabetes and cardiovascular disease in later life, yet the underlying mechanisms remain to be elucidated. We examined the effects of GDM on the proteome, redox status, and nuclear factor erythroid 2–related factor 2 (Nrf2)-mediated antioxidant gene expression in human fetal endothelial cells. Proteomic analysis revealed that proteins involved in redox homeostasis were significantly altered in GDM and associated with increased mitochondrial superoxide generation, protein oxidation, DNA damage, and diminished glutathione (GSH) synthesis. In GDM cells, the lipid peroxidation product 4-hydroxynonenal (HNE) failed to induce nuclear Nrf2 accumulation and mRNA and/or protein expression of Nrf2 and its target genes NAD(P)H:quinone oxidoreductase 1 (NQO1), Bach1, cystine/glutamate transporter, and glutamate cysteine ligase. Although methylation of CpG islands in Nrf2 or NQO1 promoters was unaltered by GDM, decreased DJ-1 and increased phosphorylated glycogen synthase kinase 3? levels may account for impaired Nrf2 signaling. HNE-induced increases in GSH and NQO1 levels were abrogated by Nrf2 small interfering RNA in normal cells, and overexpression of Nrf2 in GDM cells partially restored NQO1 induction. Dysregulation of Nrf2 in fetal endothelium may contribute to the increased risk of type 2 diabetes and cardiovascular disease in offspring. PMID:23974919

Cheng, Xinghua; Chapple, Sarah J.; Patel, Bijal; Puszyk, William; Sugden, David; Yin, Xiaoke; Mayr, Manuel; Siow, Richard C.M.; Mann, Giovanni E.

2013-01-01

224

From screening to postpartum follow-up – the determinants and barriers for gestational diabetes mellitus (GDM) services, a systematic review  

PubMed Central

Background Gestational diabetes mellitus (GDM) – a transitory form of diabetes first recognised during pregnancy complicates between?diabetes in mother and offspring, timely detection, optimum treatment, and preventive postpartum care and follow-up is necessary. However the area remains grossly under-prioritised. Methods To investigate determinants and barriers to GDM care from initial screening and diagnosis to prenatal treatment and postpartum follow-up, a PubMed database search to identify quantitative and qualitative studies on the subject was done in September 2012. Fifty-eight relevant studies were reviewed. Results Adherence to prevailing GDM screening guidelines and compliance to screening tests seems sub-optimal at best and arbitrary at worst, with no clear or consistent correlation to health care provider, health system or client characteristics. Studies indicate that most women express commitment and motivation for behaviour change to protect the health of their unborn baby, but compliance to recommended treatment and advice is fraught with challenges, and precious little is known about health system or societal factors that hinder compliance and what can be done to improve it. A number of barriers related to health care provider/system and client characteristics have been identified by qualitative studies. Immediately following a GDM pregnancy many women, when properly informed, desire and intend to maintain healthy lifestyles to prevent future diabetes, but find the effort challenging. Adherence to recommended postpartum screening and continued lifestyle modifications seems even lower. Here too, health care provider, health system and client related determinants and barriers were identified. Studies reveal that sense of self-efficacy and social support are key determinants. Conclusions The paper identifies and discusses determinants and barriers for GDM care, fully recognising that these are highly dependent on the context. PMID:24450389

2014-01-01

225

Maternal Gestational Smoking, Diabetes, Alcohol Drinking, Pre-Pregnancy Obesity and the Risk of Cryptorchidism: A Systematic Review and Meta-Analysis of Observational Studies  

PubMed Central

Background Maternal gestational smoking, diabetes, alcohol drinking, and pre-pregnancy obesity are thought to increase the risk of cryptorchidism in newborn males, but the evidence is inconsistent. Method We conducted a systematic review and meta-analysis of studies on the association between maternal gestational smoking, diabetes, alcohol drinking, and pre-pregnancy obesity and the risk of cryptorchidism. Articles were retrieved by searching PubMed and ScienceDirect, and the meta-analysis was conducted using Stata/SE 12.0 software. Sensitivity analysis was used to evaluate the influence of confounding variables. Results We selected 32 articles, including 12 case—control, five nested case—control, and 15 cohort studies. The meta-analysis showed that maternal smoking (OR = 1.17, 95% CI: 1.11–1.23) or diabetes (OR = 1.21, 95%CI: 1.00–1.46) during pregnancy were associated with increased risk of cryptorchidism. Overall, the association between maternal alcohol drinking (OR = 0.97, 95% CI: 0.87–1.07), pre-pregnancy body mass index (OR = 1.02, 95% CI: 0.95–1.09) and risk of cryptorchidism were not statistically significant. Additional analysis showed reduced risk (OR = 0.89, 95% CI: 0.82–0.96) of cryptorchidism with moderate alcohol drinking during pregnancy. No dose—response relationship was observed for increments in body mass index in the risk of cryptorchidism. Sensitivity analysis revealed an unstable result for the association between maternal diabetes, alcohol drinking and cryptorchidism. Moderate heterogeneity was detected in studies of the effect of maternal alcohol drinking and diabetes. No publication bias was detected. Conclusion Maternal gestational smoking, but not maternal pre-pregnancy overweight or obesity, was associated with increased cryptorchidism risk in the offspring. Moderate alcohol drinking may reduce the risk of cryptorchidism while gestational diabetes may be a risk factor, but further studies are needed to verify this. PMID:25798927

Zhang, Lin; Wang, Xing-Huan; Zheng, Xin-Min; Liu, Tong-Zu; Zhang, Wei-Bin; Zheng, Hang; Chen, Mi-Feng

2015-01-01

226

SUGAR: Spotting Undiagnosed Glucose Abnormal Results-A New Protocol To Increase Postpartum Testing Among Women With Gestational Diabetes Mellitus.  

PubMed

Objective?Over 70% of women with gestational diabetes mellitus (GDM) will develop diabetes mellitus (DM), but only 30% follow through with the recommended postpartum oral glucose tolerance testing (OGTT). HbA1c is approved to diagnose DM, and combined with a fasting plasma glucose it can identify 93% of patients with dysglycemia. We tested the hypothesis that a single blood draw to assess for dysglycemia at the postpartum visit could improve testing rates compared with those required to obtain an OGTT at an outside laboratory. Study Design?Prospective cohort study of all women with GDM who delivered between July 2010 and December 2011. When insurance status required testing at an outside laboratory an OGTT was ordered, when insurance allowed testing at our center a random sugar and HbA1c were drawn at the postpartum visit (SUGAR Protocol). Results?Of the 40 women, 36 attended a postpartum visit. In the SUGAR arm, 19 of 19 (100%) were tested versus 9 of 17 (53%) in the OGTT arm; relative risk of testing was 1.9 (95% confidence interval, 1.2-3.0). 36% were glucose intolerant. Conclusion?This pilot study found that an in-office testing model doubled the rate of postpartum testing in this clinic population, and was reasonably sensitive at detecting dysglycemia. PMID:25093913

Carson, Michael P; Morgan, Benjamin; Gussman, Debra; Brown, Monica; Rothenberg, Karen; Wisner, Theresa A

2015-02-01

227

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. PMID:25284836

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

2012-01-01

228

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

229

Pathophysiological Characteristics and Effects of Obesity in Women With Early and Late Manifestation of Gestational Diabetes Diagnosed by the International Association of Diabetes and Pregnancy Study Groups Criteria  

PubMed Central

Context: Appropriate risk stratification is essential in gestational diabetes (GDM) diagnosis to optimize therapeutic strategies during pregnancy. However, there are sparse data related to the newly recommended International Association of Diabetes and Pregnancy Study Groups criteria and their use in early pregnancy. Objective: This study sought to evaluate clinical and pathophysiological characteristics less up to gestational week (GW) 21 in women with early and late GDM onset. Design and Setting: This was a prospective study conducted at the Medical University of Vienna. Patients and Interventions: Pregnant women (n = 211) underwent an oral glucose tolerance test at 16 GW (interquartile range, 14–18 wk) with multiple measurements of glucose, insulin, and C-peptide for evaluation of insulin sensitivity and ß-cell function in addition to detailed obstetrical risk assessment. Clinical followups were performed until end of pregnancy. Main outcome measure: We performed a metabolic characterization of early-onset GDM. Results: Of 81 women, 49 (23%) showed early (GDMEarly ? 21 GW) and 32 (15%) later manifestation (GDMLate ? 24 GW) whereas 130 (62%) remained normal-glucose-tolerant (NGT). In contrast with GDMLate, GDMEarly were affected by decreased insulin sensitivity (GDMEarly vs NGT, P < .001; GDMEarlyvs GDMLate, P < .001; GDMLate vs NGT, P = .410). However, both early and late manifested subjects showed impairments in ß-cell function. GDMEarly showed highest levels of preconceptional and actual body mass index (BMI), which was related to fasting glucose (r = 0.42, P < .001) and particularly insulin sensitivity (r = ?0.51, P < .001). Differences in glucose disposal between the subgroups remained constant in multivariable analysis including the strongest risk factors for GDM, ie, age, history of GDM, and BMI in our population. Conclusions: Early manifestation of GDM is affected by insulin resistance that is partly explained by higher degree in obesity. However, ß-cell dysfunction was also detectable in GDMLate, indicating defective compensatory mechanisms emerging already in early pregnancy. PMID:25574889

Bozkurt, Latife; Göbl, Christian S.; Pfligl, Lisa; Leitner, Karoline; Bancher-Todesca, Dagmar; Luger, Anton; Baumgartner-Parzer, Sabina; Pacini, Giovanni

2015-01-01

230

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

231

Postpartum Outcomes in Women with Gestational Diabetes and their Offspring: POGO Study Design and First-Year Results  

PubMed Central

BACKGROUND: Gestational diabetes mellitus (GDM) is a risk factor for mothers to develop type 2 diabetes (T2D) postpartum, and for their children to develop obesity. The aim of the ongoing POGO study is to identify long-lasting changes in the maternal and fetal metabolism and microbiome, after GDM, which contribute to subsequent development of T2D and obesity. METHODS: Women screened for GDM are asked to attend a postpartum study visit together with their offspring. At the visit, demographic, nutritional, and anthropometric data are recorded. Additionally, data about physical activity, metabolism, and genetic susceptibility are collected using accelerometers, breath gas analyses, 75g oral glucose tolerance tests (OGTT), and bio-samples such as blood and stool. RESULTS: To date, 121 women (median follow-up time postpartum: 5.5 years) have been enrolled together with 133 index children. GDM has been diagnosed using OGTT in 105 women (and 117 children). It showed that 47 mothers had abnormal glucose tolerance, including 19 cases of impaired glucose tolerance, 19 of impaired fasting glucose, eight with T2D, and one with type 1 diabetes (T1D). The prevalence of obesity in the offspring of GDM mothers was 5.1%. Of 61 children tested by OGTT, three were diagnosed with impaired glucose tolerance, another three with impaired fasting glucose, and none with T1D or T2D. CONCLUSIONS: The POGO study will contribute to the understanding of the pathogenesis of T2D and obesity after GDM, and will thus help to develop appropriate prevention and intervention strategies. This article presents the first results of the ongoing study, which are looking promising. PMID:24172698

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

2013-01-01

232

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 ...

233

Beta-Cell Function and Visceral Fat in Lactating Women With a History of Gestational Diabetes  

E-print Network

and diabetes risk, although associations between breastfeeding (BF), glucose tolerance, and adipose tissue woman completed a 75-g oral glucose tolerance test (OGTT), a frequently sampled intravenous glucose feeding and solid foods. Oral Glucose Tolerance Test Each woman completed an oral glucose tolerance test

Cunningham, Ian

234

Is a low level of free thyroxine in the maternal circulation associated with altered endothelial function in gestational diabetes?  

PubMed Central

Synthesis of thyroid hormones, thyroxine (T4) and tri-iodothyronine (T3), in the human fetus starts from 17 to 19th weeks of gestation. Despite the majority of normal pregnant women reaching adequate levels of circulating thyroid hormones, in some cases, women with normal pregnancies have low level of free T4 during first trimester of pregnancy, suggesting that T4 action may be compromised in those women and their fetuses. In addition, pathological low levels of thyroid hormones are detected in isolated maternal hypothyroxemia (IMH) and clinical hypothyroidism. Nevertheless, human placenta regulates T3/T4 concentration in the fetal circulation by modulating the expression and activity of both thyroid hormone transporters (THT) and deiodinases. Then, placenta can control the availability of T3/T4 in the feto-placental circulation, and therefore may generate an adaptive response in cases where the mother courses with low levels of T4. In addition, T3/T4 might control vascular response in the placenta, in particularly endothelial cells may induce the synthesis and release of vasodilators such as nitric oxide (NO) or vasoconstrictors such as endothelin-1 mediated by these hormones. On the other hand, low levels of T4 have been associated with increase in gestational diabetes (GD) markers. Since GD is associated with impaired placental vascular function characterized by increased NO synthesis in placental arteries and veins, as well as elevated placental angiogenesis, it is unknown whether reduced T4 level at the maternal circulation could result in an altered placental endothelial function during GD. In this review, we analyze available information regarding thyroid hormones and endothelial dysfunction in GD; and propose that low maternal levels of T4 observed in GD may be compensated by increased placental availability of T3/T4 via elevation in the activity of THT and/or reduction in deiodinases in the feto-placental circulation. PMID:24936187

Guzmán-Gutiérrez, Enrique; Veas, Carlos; Leiva, Andrea; Escudero, Carlos; Sobrevia, Luis

2014-01-01

235

The IDEAL study: investigation of dietary advice and lifestyle for women with borderline gestational diabetes: a randomised controlled trial - study protocol  

PubMed Central

Background The Australian Carbohydrate Intolerance Study in Pregnant Women (ACHOIS) showed that treatment of pregnant women with mild gestational diabetes mellitus is beneficial for both women and their infants. It is still uncertain whether there are benefits of similar treatment for women with borderline gestational diabetes. This trial aims to assess whether dietary and lifestyle advice and treatment given to pregnant women who screen for borderline gestational diabetes reduces neonatal complications and maternal morbidities. Methods/design Design: Multicentre, randomised controlled trial. Inclusion criteria: Women between 240 and 346 weeks gestation with a singleton pregnancy, a positive oral glucose challenge test (venous plasma glucose ?7.8 mmol/L) and a normal oral 75 gram glucose tolerance test (fasting venous plasma glucose <5.5 mmol/L and a 2 hour glucose <7.8 mmol/L) with written, informed consent. Trial entry and randomisation: Women with an abnormal oral glucose tolerance test (fasting venous plasma glucose ?5.5 mmol/L or 2 hour glucose ?7.8 mmol/L) will not be eligible and will be offered treatment for gestational diabetes, consistent with recommendations based on results of the ACHOIS trial. Eligible women will be randomised into either the ‘Routine Care Group’ or the ‘Intervention Group’. Study groups: Women in the ‘Routine Care Group’ will receive routine obstetric care reflecting current clinical practice in Australian hospitals. Women in the ‘Intervention Group’ will receive obstetric care, which will include dietary and lifestyle advice, monitoring of blood glucose and further medical treatment for hyperglycaemia as appropriate. Primary study outcome: Incidence of large for gestational age infants. Sample size: A sample size of 682 women will be sufficient to show a 50% reduction in the risk of large for gestational age infants (alpha 0.05 two-tailed, 80% power, 4% loss to follow up) from 14% to 7% with dietary and lifestyle advice and treatment. Discussion A conclusive trial outcome will provide reliable evidence of relevance for the care of women with borderline glucose intolerance in pregnancy and their infants. Trial registration Australian New Zealand Clinical Trials Registry - ACTRN12607000174482 PMID:23046499

2012-01-01

236

ATLANTIC-DIP: prevalence of metabolic syndrome and insulin resistance in women with previous gestational diabetes mellitus by International Association of Diabetes in Pregnancy Study Groups criteria.  

PubMed

Women with previous gestational diabetes (GDM) are a high-risk group for future development of diabetes, metabolic syndrome, and cardiovascular disease. The new International Association of Diabetes in Pregnancy Study Groups (IADPSG) criteria significantly increase the number of women diagnosed with GDM. The long-term metabolic outcome in these women is unknown. We set out to determine the prevalence of metabolic syndrome, using adult treatment panel-III criteria; and insulin resistance, using HOMA2-IR, in white European women with previous GDM. Using a cohort design, we invited women meeting IADPSG GDM criteria across four Irish antenatal centres between 2007 and 2010 to participate. Two hundred and sixty-five women with previous values meeting IADPSG criteria for GDM participated (44 % of the population eligible for participation). Mean age was 36.7 years (SD 5.0). These women were compared with a randomly selected control group of 378 women (mean age 37.6 years, SD 5.1) known to have normal glucose tolerance (NGT) in pregnancy during the same period. A total of 25.3 % of women with previous IADPSG-defined GDM met metabolic syndrome criteria, compared to 6.6 % of women with NGT [at 2.6 (SD 1.0) vs. 3.3 years (SD 0.7) post-partum]. The prevalence of HOMA2-IR >1.8 was higher in women with previous IADPSG-defined GDM (33.6 vs. 9.1 % with NGT, p < 0.001). Women with previous GDM by IADPSG criteria demonstrate a greater than threefold prevalence of metabolic syndrome compared to women with NGT in pregnancy. Efforts to prevent projected long-term consequences of this should focus on interventions both in the preconception and post-partum periods. PMID:25002067

Noctor, Eoin; Crowe, Catherine; Carmody, Louise A; Kirwan, Breda; O'Dea, Angela; Glynn, Liam G; McGuire, Brian E; O'Shea, Paula M; Dunne, Fidelma P

2015-02-01

237

Identification of a model of non-esterified fatty acids dynamics through genetic algorithms: the case of women with a history of gestational diabetes.  

PubMed

Elevation in non-esterified fatty acids (NEFA) has been shown to modulate insulin secretion and it is considered as a risk factor for the development of type 2 diabetes. Here we present a method that complements a mathematical model of NEFA kinetics with genetic algorithms for model identification. The complemented strategy allowed to assess parameters of NEFA kinetics and to get insight into their relationship with insulin during oral glucose tolerance tests in women with former gestational diabetes: (i) providing a reliable estimation of the model parameters, (ii) assuring the usability of the model, and (iii) promoting and facilitating its application in a clinical context. PMID:21333978

Morbiducci, Umberto; Di Benedetto, Giacomo; Kautzky-Willer, Alexandra; Deriu, Marco A; Pacini, Giovanni; Tura, Andrea

2011-03-01

238

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

239

Spontaneous preterm delivery and gestational diabetes: the impact of glycemic control  

Microsoft Academic Search

Objective  Opinions differ whether the rate of spontaneous preterm delivery (sPTD) increases in pregnancies complicated with GDM. We\\u000a sought to characterize, which factors may influence the rate of sPTD in GDM.\\u000a \\u000a \\u000a \\u000a Methods  We conducted a retrospective study with 1,526 GDM patients, all treated at the same center by the same diabetic protocol using\\u000a self-blood glucose monitoring. The rate of sPTD was compared

Yariv Yogev; Oded Langer

2007-01-01

240

Gestational Diabetes Is Characterized by Reduced Mitochondrial Protein Expression and Altered Calcium Signaling Proteins in Skeletal Muscle  

PubMed Central

The rising prevalence of gestational diabetes mellitus (GDM) affects up to 18% of pregnant women with immediate and long-term metabolic consequences for both mother and infant. Abnormal glucose uptake and lipid oxidation are hallmark features of GDM prompting us to use an exploratory proteomics approach to investigate the cellular mechanisms underlying differences in skeletal muscle metabolism between obese pregnant women with GDM (OGDM) and obese pregnant women with normal glucose tolerance (ONGT). Functional validation was performed in a second cohort of obese OGDM and ONGT pregnant women. Quantitative proteomic analysis in rectus abdominus skeletal muscle tissue collected at delivery revealed reduced protein content of mitochondrial complex I (C-I) subunits (NDUFS3, NDUFV2) and altered content of proteins involved in calcium homeostasis/signaling (calcineurin A, ?1-syntrophin, annexin A4) in OGDM (n?=?6) vs. ONGT (n?=?6). Follow-up analyses showed reduced enzymatic activity of mitochondrial complexes C-I, C-III, and C-IV (?60–75%) in the OGDM (n?=?8) compared with ONGT (n?=?10) subjects, though no differences were observed for mitochondrial complex protein content. Upstream regulators of mitochondrial biogenesis and oxidative phosphorylation were not different between groups. However, AMPK phosphorylation was dramatically reduced by 75% in the OGDM women. These data suggest that GDM is associated with reduced skeletal muscle oxidative phosphorylation and disordered calcium homeostasis. These relationships deserve further attention as they may represent novel risk factors for development of GDM and may have implications on the effectiveness of physical activity interventions on both treatment strategies for GDM and for prevention of type 2 diabetes postpartum. PMID:25216282

Boyle, Kristen E.; Hwang, Hyonson; Janssen, Rachel C.; DeVente, James M.; Barbour, Linda A.; Hernandez, Teri L.; Mandarino, Lawrence J.; Lappas, Martha; Friedman, Jacob E.

2014-01-01

241

Concentrations of preptin, salusins and hepcidins in plasma and milk of lactating women with or without gestational diabetes mellitus.  

PubMed

This study was undertaken to ascertain whether human milk contains preptin, salusin-alpha (salusin-?) and -beta (salusin-?) and pro-hepcidin and hepcidin-25, and whether there are relationships between plasma and milk preptin, salusin-? and -? and pro-hepcidin and hepcidin-25 concentrations in lactating mothers with and without gestational diabetes mellitus (GDM). Blood was obtained from non-lactating women (n = 12), non-diabetic lactating women (n = 12), and GDM lactating women (n = 12). Colostrum, transitional milk, and mature milk samples were collected just before suckling from healthy and GDM lactating women. Peptides concentrations were determined by ELISA and EIA. Mammary gland tissues were screened immunohistochemically for these peptides. Women with GDM had significantly higher plasma and colostum preptin concentrations than healthy lactating women during the colostral and transitional milk period. Salusin-alpha and -beta levels in milk and plasma were lower in women with GDM. Salusin-? and -? were significantly lower in both plasma and colostrums of GDM than of healthy lactating women. Women with GDM had significantly higher colostum prohepcidin and hepcidin-25 concentrations than healthy lactating women during the colostral period. Plasma prohepcidin was also higher in women with GDM than in healthy lactating women during the colostral period, but plasma prohepcidin and hepcidin-25 levels decreased during mature milk period. Transitional milk pro-hepcidin and hepcidin-25 levels in women with GDM were higher than in healthy lactating women. All these results revealed that the mammary gland produces those peptides, which were present in milk at levels correlating with plasma concentrations. PMID:24060315

Aydin, Suleyman; Celik, Onder; Gurates, Bilgin; Sahin, Ibrahim; Ulas, Mustafa; Yilmaz, Musa; Kalayci, Mehmet; Kuloglu, Tuncay; Catak, Zekiye; Aksoy, Aziz; Ozercan, Ibrahim Hanefi; Kumru, Selahattin

2013-11-01

242

The influence of fasting insulin level in post-gestational diabetes mellitus women receiving low-glycaemic-index diets  

PubMed Central

Post-gestational diabetes mellitus (GDM) women are recommended weight loss to manage increased cardio-metabolic risks. We investigated the effects of lowering diet glycaemic index (GI) on fasting blood glucose (FBG), serum lipids, body weight and composition of post-GDM women with varying fasting insulin levels (INS). Seventy-seven Asian, non-diabetic women with previous GDM (aged 20–40 years, mean BMI: 26.4±4.6?kg?m?2) were recruited. At baseline, 20 subjects with INS <2??IU?ml?1 and 18 with INS ?2??IU?ml?1 received conventional dietary recommendations (CHDR) only. CHDR emphasised energy and fat intake restriction and encouraged increase in dietary fibre intakes. Twenty-four subjects with INS <2??IU?ml?1 and 15 with INS ?2??IU?ml?1, in addition to CHDR, received low-GI education (LGI). Changes in FBG, serum lipids, body weight and body composition were evaluated. Subjects with INS <2??IU?ml?1 had similar outcomes with both diets. After 1 year, subjects with INS ?2??IU?ml?1 who received LGI education had reductions in FBG and triglycerides. Subjects who received CHDR observed increase in both FBG and triglycerides (P<0.05). Among all subjects, diet GI was lower and dietary fibre intakes were higher in LGI compared with CHDR subjects (all P<0.05). Thus, in Asian post-GDM women with normal/higher INS, adding low-GI education to CHDR improved management of FBG and triglycerides. PMID:24535618

Ghani, R A; Shyam, S; Arshad, F; Wahab, N A; Chinna, K; Safii, N S; Nisak, M Y B; Kamaruddin, N A

2014-01-01

243

A Novel Mutation in the Von Hippel-Lindau Tumor Suppressor Gene Identified in a Patient Presenting with Gestational Diabetes Mellitus  

PubMed Central

Background Von Hippel-Lindau (VHL) disease is an autosomal dominantly inherited, multisystemic tumor syndrome caused by mutations in the VHL gene. To date, more than 1,000 germline and somatic mutations of the VHL gene have been reported. We present a novel mutation in the VHL tumor suppressor gene that presented with gestational diabetes mellitus. Methods A 30-year-old woman presented with gestational diabetes mellitus. She sequentially showed multiple pancreatic cysts, spinal cord hemangioblastoma, cerebellar hemangioblastoma, and clear cell type renal cell carcinomas. Also, her father and brother had brain hemangioblastomas. Each of the three exons of the VHL gene was individually amplified by polymerase chain reaction and direct sequencing was performed using an ABI 3730 DNA analyzer. Results DNA sequence analysis to determine the presence of VHL mutation in her family revealed del291C, a novel frameshift mutation. Conclusion We found a novel mutation in the VHL tumor suppressor gene that presented with gestational diabetes mellitus. PMID:24396697

Ku, Yun Hyi; Ahn, Chang Ho; Jung, Chan-Hyeon; Lee, Jie Eun; Kim, Lee-Kyung; Kwak, Soo Heon; Jung, Hye Seung; Park, Kyong Soo

2013-01-01

244

Newborn meconium and urinary metabolome response to maternal gestational diabetes mellitus: a preliminary case-control study.  

PubMed

Recently, the number of women suffering from gestational diabetes mellitus (GDM) has risen dramatically. GDM attracts increasing attention due to its potential harm to the heath of both the fetus and the mother. We designed this case-control study to investigate the metabolome response of newborn meconium and urine to maternal GDM. GDM mothers (n = 142) and healthy controls (n = 197) were recruited during June-July 2012 in Xiamen, China. The newborns' metabolic profiles were acquired using liquid chromatography coupled to mass spectrometry. The data showed that meconium and urine metabolome patterns clearly discriminated GDM cases from controls. Fourteen meconium metabolic biomarkers and three urinary metabolic biomarkers were tentatively identified for GDM. Altered levels of various endogenous biomarkers revealed that GDM may induce disruptions in lipid metabolism, amino acid metabolism, and purine metabolism. An unbalanced lipid pattern is suspected to be a GDM-specific feature. Furthermore, the relationships between the potential biomarkers and GDM risk were evaluated by binary logistic regression and receiver operating characteristic analysis. A combined model of nine meconium biomarkers showed a great potential in diagnosing GDM-induced disorders. PMID:25722016

Peng, Siyuan; Zhang, Jie; Liu, Liangpo; Zhang, Xueqin; Huang, Qingyu; Alamdar, Ambreen; Tian, Meiping; Shen, Heqing

2015-04-01

245

The urgent need for universally applicable simple screening procedures and diagnostic criteria for gestational diabetes mellitus – lessons from projects funded by the World Diabetes Foundation  

PubMed Central

Background To address the risks of adverse pregnancy outcomes and future type 2 diabetes associated with gestational diabetes mellitus (GDM), its early detection and timely treatment is essential. In the absence of an international consensus, multiple different guidelines on screening and diagnosis of GDM have existed for a long time. This may be changing with the publication of the recommendations by the International Association of Diabetes and Pregnancy Study Groups. However, none of these guidelines take into account evidence from or ground realities of resource-poor settings. Objective This study aimed to investigate whether GDM projects supported by the World Diabetes Foundation in developing countries utilize any of the internationally recommended guidelines for screening and diagnosis of GDM, explore experiences on applicability and usefulness of the guidelines and barriers if any, in implementing the guidelines. These projects have reached out to thousands of pregnant women through capacity building and improvement of access to GDM screening and diagnosis in the developing world and therefore provide a rich field experience on the applicability of the guidelines in resource-poor settings. Design A mixed methods approach using questionnaires and interviews was utilised to review 11 GDM projects. Two projects were conducted by the same partner; interviews were conducted in person or via phone by the first author with nine project partners and one responded via email. The interviews were analysed using content analysis. Results The projects use seven different screening procedures and diagnostic criteria and many do not completely adhere to one guideline alone. Various challenges in adhering to the recommendations emerged in the interviews, including problems with screening women during the recommended time period, applicability of some of the listed risk factors used for (pre-)screening, difficulties with reaching women for testing in the fasting state, time consuming nature of the tests, intolerance to high glucose load due to nausea, need for repeat tests, issues with scarcity of test consumables and lack of equipment making some procedures impossible to follow. Conclusion Though an international consensus on screening and diagnosis for GDM is welcome, it should ensure that the recommendations take into account feasibility and applicability in low resource settings to ensure wider usage. We need to move away from purely academic discussions focusing on sensitivity and specificity to also include what can actually be done at the basic care level. PMID:22855644

Nielsen, Karoline Kragelund; de Courten, Maximilian; Kapur, Anil

2012-01-01

246

Nutritional Manipulation for the Primary Prevention of Gestational Diabetes Mellitus: A Meta-Analysis of Randomised Studies  

PubMed Central

Introduction The rise in gestational diabetes (GDM), defined as first onset or diagnosis of diabetes in pregnancy, is a global problem. GDM is often associated with unhealthy diet and is a major contributor to adverse outcomes maternal and fetal outcomes. Manipulation of nutrition has the potential to prevent GDM. Methods We assessed the effects of nutritional manipulation in pregnancy on GDM and relevant maternal and fetal outcomes by a systematic review of the literature. We searched MEDLINE, EMBASE, and Cochrane Database from inception to March 2014 without any language restrictions. Randomised controlled trials (RCT) of nutritional manipulation to prevent GDM were included. We summarised dichotomous data as relative risk (RR) and continuous data as standardised mean difference (SMD) with 95% confidence interval (CI). Results From 1761 citations, 20 RCTs (6,444 women) met the inclusion criteria. We identified the following interventions: diet-based (n = 6), mixed approach (diet and lifestyle) interventions (n = 13), and nutritional supplements (myo-inositol n = 1, diet with probiotics n = 1). Diet based interventions reduced the risk of GDM by 33% (RR 0.67; 95% CI 0.39, 1.15). Mixed approach interventions based on diet and lifestyle had no effect on GDM (RR 0.95; 95% CI 0.89, 1.22). Nutritional supplements probiotics combined with diet (RR 0.40; 95% CI 0.20, 0.78) and myo-inositol (RR 0.40; 95% CI 0.16, 0.99) were assessed in one trial each and showed a beneficial effect. We observed a significant interaction between the groups based on BMI for diet-based intervention. The risk of GDM was reduced in obese and overweight pregnant women for GDM (RR 0.40, 95% CI 0.18, 0.86). Conclusions Nutritional manipulation in pregnancy based on diet or mixed approach do not appear to reduce the risk of GDM. Nutritional supplements show potential as agents for primary prevention of GDM. PMID:25719363

Hitman, Graham A.; Khan, Khalid S.; Thangaratinam, Shakila

2015-01-01

247

Prevalence Estimates of Gestational Diabetes Mellitus in the United States, Pregnancy Risk Assessment Monitoring System (PRAMS), 2007–2010  

PubMed Central

Introduction The true prevalence of gestational diabetes mellitus (GDM) is unknown. The objective of this study was 1) to provide the most current GDM prevalence reported on the birth certificate and the Pregnancy Risk Assessment Monitoring System (PRAMS) questionnaire and 2) to compare GDM prevalence from PRAMS across 2007–2008 and 2009–2010. Methods We examined 2010 GDM prevalence reported on birth certificate or PRAMS questionnaire and concordance between the sources. We included 16 states that adopted the 2003 revised birth certificate. We also examined trends from 2007 through 2010 and included 21 states that participated in PRAMS for all 4 years. We combined GDM prevalence across 2-year intervals and conducted t tests to examine differences. Data were weighted to represent all women delivering live births in each state. Results GDM prevalence in 2010 was 4.6% as reported on the birth certificate, 8.7% as reported on the PRAMS questionnaire, and 9.2% as reported on either the birth certificate or questionnaire. The agreement between sources was 94.1% (percent positive agreement = 3.7%, percent negative agreement = 90.4%). There was no significant difference in GDM prevalence between 2007–2008 (8.1%) and 2009–2010 (8.5%, P = .15). Conclusion Our results indicate that GDM prevalence is as high as 9.2% and is more likely to be reported on the PRAMS questionnaire than the birth certificate. We found no statistical difference in GDM prevalence between the 2 phases. Further studies are needed to understand discrepancies in reporting GDM by data source. PMID:24945238

Kim, Shin Y.; Sharma, Andrea J.

2014-01-01

248

Comparative analysis of vaspin in pregnant women with and without gestational diabetes mellitus and healthy non-pregnant women.  

PubMed

To explore serum vaspin, leptin, and adiponectin levels and their correlation with insulin resistance (IR) in pregnant women with and without gestational diabetes mellitus (GDM) and healthy non-pregnant women. A total of 262 individuals, including pregnant women with GDM (n = 86), those without GDM (n = 92), and age-matched healthy non-pregnant women (n = 84) were enrolled in this case-control study. Vaspin, leptin, adiponectin, glucose, insulin, hemoglobin A1C (HbA1c), and lipid parameters were measured. The homeostasis model assessment-insulin resistance (HOMA-IR), quantitative insulin sensitivity check index, and body mass index were calculated. Data inferred higher concentrations of vaspin (2.72 ± 2.20 vs. 1.84 ± 1.57 vs. 0.81 ± 1.02) in GDM than during normal pregnancy and in non-pregnant women, higher leptin (23.42 ± 12.18 vs. 22.19 ± 10.55 vs. 12.10 ± 11.26), and lower adiponectin (4,164.83 ± 2,650.39 vs. 4,871.66 ± 2,803.51 vs. 7,202.85 ± 4,893.13) in GDM and normal pregnancy as compared to non-pregnant women (p < 0.05). Vaspin was positively correlated to leptin (r = 0.273, p = 0.012), HOMA-IR (r = 0.387, p = 0.000), and triglycerides (TG, r = 0.218, p = 0.046) in GDM. In addition, leptin was negatively correlated to adiponectin in GDM (r = -0.336, p = 0.002) and normal pregnancy (r = -0.256, p = 0.014). Furthermore, vaspin was significantly correlated to GDM and HOMA-IR, and the weight gain might play a vital role in the occurrence of GDM. During pregnancy, high vaspin concentration is significantly associated with IR in GDM. PMID:24929806

Jia, Xiaojiao; Wang, Shuyi; Ma, Ning; Li, Xiaojing; Guo, Likui; Liu, Xiaoli; Dong, Tao; Liu, Yali; Lu, Qiang

2015-03-01

249

First-trimester maternal vitamin D status and risk for gestational diabetes (GDM) a nested case-control study  

PubMed Central

Background Vitamin D deficiency may contribute to impaired glucose metabolism. There are sparse data regarding vitamin D and the development of gestational diabetes (GDM). The objective of this study was to assess if first-trimester vitamin D deficiency is more prevalent in women later diagnosed with GDM compared with women with uncomplicated pregnancies. Methods We conducted a nested case-control study of pregnant women who had previously given blood for routine genetic multiple marker screening and subsequently delivered at a tertiary hospital between November 2004 and July 2009. From an overall cohort of 4225 women, 60 cases of GDM were matched by race/ethnicity with 120 women delivering at term (?37 weeks) with uncomplicated pregnancies. Banked maternal serum was used to measure maternal 25-hydroxyvitamin D [25(OH)D]. Results The prevalence of first-trimester maternal vitamin D deficiency (defined as 25(OH)D <50 nmol/L) was comparable among women with GDM compared with controls (5/60 vs 8/120, p = 0.90). The median 25(OH)D level for all subjects was 89 nmol/L (interquartile range, 73–106 nmol/L). Seventy three percent (117/160) of the cohort had 25(OH)D levels ?75 nmol/L. Conclusions In a cohort of pregnant women with mostly sufficient levels of serum 25(OH)D, vitamin D deficiency was not associated with GDM. Further studies are warranted with larger cohorts, especially in populations with lower levels of vitamin D. PMID:21818838

Baker, Arthur M.; Haeri, Sina; Camargo, Carlos A.; Stuebe, Alison M.; Boggess, Kim A.

2015-01-01

250

Increased Endothelial Inflammation, sTie-2 and Arginase Activity in Umbilical Cords Obtained from Gestational Diabetic Mothers  

PubMed Central

Objective The aim of this study was to determine subclinical inflammation in umbilical vein derived endothelial cells (HUVECs) obtained from Asian Indian subjects with gestational diabetes (GDM) and to determine levels of angiogenic factors and arginase activity in their cord blood. Methods This case-control study included 38 control and 30 GDM subjects. Subjects were confirmed as GDM based on 75g oral glucose tolerance test (OGTT) conducted in the second trimester of pregnancy. Angiogenic markers and arginase activity were measured in cord blood by ELISA and colorimetric methods respectively. Endothelial inflammation was assessed through adhesion of PKH26-labelled leukocytes onto HUVEC monolayer obtained from the study groups. Gene and surface expression of adhesion molecules were confirmed via reverse transcription polymerase chain reaction (RT-PCR) and flow cytometry respectively. Results The study revealed increased adhesion of leukocytes to HUVECs isolated from GDM subjects compared to controls. HUVECs of babies born to GDM mothers had increased surface and mRNA expression of E-selectin. sTie2 levels were significantly higher in the cord blood for GDM subjects (3869 ± 370 ng/L) compared to controls (3045 ± 296 ng/L). Furthermore, arginase activity was higher in cord blood of GDM mothers as opposed to the control group (7.75 ± 2.4 µmoles of urea/ml/hour vs 2.88 ±0.49 µmoles of urea/ml/hour; p-value= 0.019). Spearman’s correlation analysis revealed positive correlation of cord blood arginase activity with glucose intolerance (?=0.596, p=0.004) and post load glucose values (?=0.472, p=0.031) of mothers observed during the second trimester of pregnancy. Conclusions HUVECs derived from Asian Indian GDM mothers, exhibit signs of sub-clinical endothelial inflammation along with increased levels of sTie2 and arginase activity in their cord blood serum. PMID:24376824

Giri, Hemant; Chandel, Shivam; Dwarakanath, Linga S.; Sreekumar, Sooriyakala; Dixit, Madhulika

2013-01-01

251

Movement - uncontrolled or slow  

MedlinePLUS

... leg movements - uncontrollable; Slow involuntary movements of large muscle groups; Athetoid movements ... The slow twisting movements of muscles (athetosis) or jerky muscle ... including: Cerebral palsy Drug side effects Encephalitis ...

252

Prevalence of Gestational Diabetes Mellitus and Its Risk Factors in Chinese Pregnant Women: A Prospective Population-Based Study in Tianjin, China  

PubMed Central

Objective We compared the increases in the prevalence of gestational diabetes mellitus (GDM) based on the 1999 World Health Organization (WHO) criteria and its risk factors in Tianjin, China, over a 12-year period. We also examined the changes in the prevalence using the criteria of International Association of Diabetes and Pregnancy Study Group (IADPSG). Methods In 2010-2012, 18589 women who registered within 12 weeks of gestation underwent a glucose challenge test (GCT) at 24-28 gestational weeks. Amongst them, 2953 women with 1-hour plasma glucose ?7.8 mmol/L underwent a 75-gram 2-hour oral glucose tolerance test (OGTT) and 781 women had a positive GCT but absented from the standard OGTT. An adjusted prevalence of GDM was calculated for the whole cohort of women by including an estimate of the proportion of women with positive GCTs who did not have OGTTs but would have been expected to have GDM. Logistic regression was used to obtain odds ratios and 95% confidence intervals using the IADPSG criteria. The prevalence of GDM risk factors was compared to the 1999 survey. Results The adjusted prevalence of GDM by the 1999 WHO criteria was 8.1%, a 3.5-fold increase as in 1999. Using the IADPSG criteria increased the adjusted prevalence further to 9.3%. Advanced age, higher pre-pregnancy body mass index, Han-nationality, higher systolic blood pressure (BP), a family history of diabetes, weight gain during pregnancy and habitual smoking were risk factors for GDM. Compared to the 1999 survey, the prevalence of overweight plus obesity had increased by 1.8 folds, age?30 years by 2.3 folds, systolic BP by 2.3 mmHg over the 12-year period. Conclusions Increasing prevalence of overweight/obesity and older age at pregnancy were accompanied by increasing prevalence of GDM, further increased by change in diagnostic criteria. PMID:25799433

Leng, Junhong; Shao, Ping; Zhang, Cuiping; Tian, Huiguang; Zhang, Fuxia; Zhang, Shuang; Dong, Ling; Li, Lili; Yu, Zhijie; Chan, Juliana C. N.; Hu, Gang; Yang, Xilin

2015-01-01

253

The comparison of 50 grams glucose challenge test, HbA1c and fructosamine levels in diagnosis of gestational diabetes mellitus.  

PubMed

We evaluated the sensitivity, specificity, positive and negative predictive values of 50 grams glucose challenge test, serum fructosamine and HbA1c levels as screening tests for gestational diabetes mellitus. Forty-two pregnant patients between the 24th and 28th week of their pregnancies were included in the study. Blood fructosamine and HbA1c levels did not differ significantly from the 50 grams glucose challenge test and were concluded to be alternatives to this test. Any combination of these 3 tests gives better results than a single test, but no one of the combinations is superior to the others. PMID:7554262

Uncu, G; Ozan, H; Cengiz, C

1995-01-01

254

Integrative analysis of the transcriptome profiles observed in type 1, type 2 and gestational diabetes mellitus reveals the role of inflammation  

PubMed Central

Background Type 1 diabetes (T1D) is an autoimmune disease, while type 2 (T2D) and gestational diabetes (GDM) are considered metabolic disturbances. In a previous study evaluating the transcript profiling of peripheral mononuclear blood cells obtained from T1D, T2D and GDM patients we showed that the gene profile of T1D patients was closer to GDM than to T2D. To understand the influence of demographical, clinical, laboratory, pathogenetic and treatment features on the diabetes transcript profiling, we performed an analysis integrating these features with the gene expression profiles of the annotated genes included in databases containing information regarding GWAS and immune cell expression signatures. Methods Samples from 56 (19 T1D, 20 T2D, and 17 GDM) patients were hybridized to whole genome one-color Agilent 4x44k microarrays. Non-informative genes were filtered by partitioning, and differentially expressed genes were obtained by rank product analysis. Functional analyses were carried out using the DAVID database, and module maps were constructed using the Genomica tool. Results The functional analyses were able to discriminate between T1D and GDM patients based on genes involved in inflammation. Module maps of differentially expressed genes revealed that modulated genes: i) exhibited transcription profiles typical of macrophage and dendritic cells; ii) had been previously associated with diabetic complications by association and by meta-analysis studies, and iii) were influenced by disease duration, obesity, number of gestations, glucose serum levels and the use of medications, such as metformin. Conclusion This is the first module map study to show the influence of epidemiological, clinical, laboratory, immunopathogenic and treatment features on the transcription profiles of T1D, T2D and GDM patients. PMID:24885568

2014-01-01

255

The effectiveness of medical assistant health coaching for low-income patients with uncontrolled diabetes, hypertension, and hyperlipidemia: protocol for a randomized controlled trial and baseline characteristics of the study population  

PubMed Central

Background Many patients with chronic disease do not reach goals for management of their conditions. Self-management support provided by medical assistant health coaches within the clinical setting may help to improve clinical outcomes, but most studies to date lack statistical power or methodological rigor. Barriers to large scale implementation of the medical assistant coach model include lack of clinician buy-in and the absence of a business model that will make medical assistant health coaching sustainable. This study will add to the evidence base by determining the effectiveness of health coaching by medical assistants on clinical outcomes and patient self-management, by assessing the impact of health coaching on the clinician experience, and by examining the costs and potential savings of health coaching. Methods/Design This randomized controlled trial will evaluate the effectiveness of clinic-based medical assistant health coaches to improve clinical outcomes and self-management skills among low-income patients with uncontrolled type 2 diabetes, hypertension, or hyperlipidemia. A total of 441 patients from two San Francisco primary care clinics have been enrolled and randomized to receive a health coach (n?=?224) or usual care (n?=?217). Patients participating in the health coaching group will receive coaching for 12 months from medical assistants trained as health coaches. The primary outcome is a change in hemoglobin A1c, systolic blood pressure, or LDL cholesterol among patients with uncontrolled diabetes, hypertension and hyperlipidemia, respectively. Self-management behaviors, perceptions of the health care team and clinician, BMI, and chronic disease self-efficacy will be measured at baseline and after 12 months. Clinician experience is being assessed through surveys and qualitative interviews. Cost and utilization data will be analyzed through cost-predictive models. Discussion Medical assistants are an untapped resource to provide self-management support for patients with uncontrolled chronic disease. Having successfully completed recruitment, this study is uniquely poised to assess the effectiveness of the medical assistant health coaching model, to describe barriers and facilitators to implementation, and to develop a business case for sustainability. Trial registration ClinicalTrials.gov identifier NCT-01220336 PMID:23433349

2013-01-01

256

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...

257

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, Amélie; Pharisien, Isabelle; Nguyen, Minh Tuan; Revaux, Aurélie; Lormeau, Boris; Sandre-Banon, Dorian; Assad, Nabil; Pillegand, Camille; Valensi, Paul; Carbillon, Lionel

2013-01-01

258

Effects of an aquatic physical exercise program on glycemic control and perinatal outcomes of gestational diabetes: study protocol for a randomized controlled trial  

PubMed Central

Background Gestational diabetes mellitus (GDM) is increasing worldwide and has been associated with adverse perinatal outcomes and high risk for chronic disease both for the mother and for the child. Physical exercise is feasible for diabetic pregnant women and contributes to better glycemic control and to a decrease in adverse perinatal outcomes. However, there are no randomized controlled trials (RCT) assessing the effects of aquatic physical exercise on GDM control and adverse maternal and fetal outcomes. Methods/Design An RCT will be conducted at Instituto de Medicina Integral Prof Fernando Figueira (IMIP), Brazil. A total of 72 pregnant women will be studied; 36 gestational diabetics will undergo an aquatic physical exercise program in a thermal pool, 3 times per week over 2 months. The primary endpoint will be glucose level control and use of insulin; secondary endpoints will be the following maternal and fetal outcomes: weight gain during pregnancy, blood pressure, pre-eclampsia diagnosis, intrauterus growth restriction, preterm birth, Cesarean section, macrosomia and maternal or neonatal intensive care admission. Endpoints between intervention and control group will analyzed by t test for unpaired data and ?2 test, and the level of significance will set at <0.05. Discussion The physical proprieties of water make aquatic exercises ideal for pregnant women. An aquatic physical exercise program developed for GDM women will be trialed in a thermal pool and under the supervision of physiotherapist to ensure compliance. It is expected that this study will provide evidence as to the effect of aquatic physical exercise on GDM control. Trial registration ClinicalTrial.gov, NCT01940003. PMID:24245914

2013-01-01

259

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

260

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

261

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. PMID:25182943

Aranha, Algenes; Malabu, Usman H; Vangaveti, Venkat; Reda, Elham Saleh; Tan, Yong Mong; Sangla, Kunwarjit Singh

2014-01-01

262

Nutrition and multiple gestation.  

PubMed

Multiple pregnancy represents a state of magnified nutritional requirements, resulting in a greater nutrient drain on maternal resources and an accelerated depletion of nutritional reserves. The accelerated starvation which occurs in pregnancy is exaggerated with a multiple gestation, particularly during the second half of pregnancy, with more rapid depletion of glycogen stores and resultant metabolism of fat between meals and during an overnight fast. A reduced glucose stream from mother to fetus results in slower fetal growth, smaller birth size, as well as a higher risk of preterm labor and preterm birth. For this reason, diet therapy with a diabetic regimen of 20% of calories from protein, 40% of calories from carbohydrate, and 40% of calories from fat may be particularly useful. Iron-deficiency anemia has also been linked to preterm delivery and other adverse pregnancy outcomes. Mobilization of maternal iron stores, in addition to an adequate amount and pattern of gestational weight gain (including BMI-specific weight gain goals by 20 and 28 weeks gestation), has been associated with significantly better fetal growth and longer gestations in twin pregnancies. Supplementation with calcium, magnesium, and zinc, as well as multivitamins and essential fatty acids may also reduce pregnancy complications and improve postnatal health for infants born from a multiple gestation. Diet therapy for women pregnant with multiples is an important component of effective prenatal care. PMID:16360494

Luke, Barbara

2005-10-01

263

Trp64Arg Polymorphism of the b3Adrenergic Receptor Gene in Pregnancy: Association with Mild Gestational Diabetes Mellitus  

Microsoft Academic Search

A missense mutation of the b3-adrenergic receptor gene (Trp 64 Arg) has been associated with obesity and increased capacity to gain weight in nonpregnant populations. Furthermore, the mutation is a potential modifying factor in the etiology of impaired glucose toler- ance and type 2 diabetes. We studied the relation of the b3-adrenergic receptor genotype to glucose tolerance during pregnancy, a

ANDREAS FESTA; WALTER KRUGLUGER; NADJA SHNAWA; PIERRE HOPMEIER; STEVEN M. HAFFNER; GUNTRAM SCHERNTHANER

264

Diabetes  

MedlinePLUS

... version of this page please turn Javascript on. Diabetes What is Diabetes? Too Much Glucose in the Blood Diabetes means ... high, causing pre-diabetes or diabetes. Types of Diabetes There are three main kinds of diabetes: type ...

265

Increased Plasma Levels of FABP4 and PTEN are Associated with More Severe Insulin Resistance in Women with Gestational Diabetes Mellitus  

PubMed Central

Background The aim of this study was to investigate the relationship between plasma fatty acid binding protein 4 (FABP4), phosphatase and tensin homolog (PTEN), and insulin resistance in patients with gestational diabetes mellitus (GDM). Material/Methods Plasma FABP4 and PTEN were determined by ELISA in GDM patients (GDM group, n=30) and in euglycemic pregnant women (control group, n=30). The clinical features, body mass index (BMI), homeostasis model assessment of insulin resistance (HOMA-IR), and lipid profiles were compared between the 2 groups. The influence of risk factors on insulin resistance, including BMI, lipid profiles, FABP4, and PTEN, were further investigated by multiple-factor stepwise regression analysis. Results Higher levels of BMI, ?BMI, triglyceride (TG), fasting plasma glucose (FPG), 2-hour plasma glucose (2hPG), fasting insulin, HOMA-IR, FABP4, PTEN, and lower level of high-density lipoprotein cholesterol (HDL-C) were found in the GDM patients than in the controls (all P<0.005). The plasma FABP4 was 1.47±0.25 vs. 0.20±0.07 ng/ml in the GDM and control group, respectively (P<0.0001). Plasma PTEN was 6.46±1.57 vs. 4.72±0.82 ng/ml in the GDM and control group, respectively (P<0.0001). There was a positive relation between plasma FABP4 and PTEN when all blood samples, including GDM and control groups, were analyzed (P<0.05). The multiple-factor regression analysis revealed that plasma FABP4, TG, and PTEN were independent risk factors for increased insulin resistance. Conclusions GDM patients have more severe insulin resistance compared to euglycemic pregnant women. Higher levels of plasma FABP4 and PTEN are associated with increased insulin resistance and may participate in the pathogenesis of insulin resistance during gestation. PMID:25659997

Li, Yuan-yuan; Xiao, Rui; Li, Cai-ping; Huangfu, Jian; Mao, Jiang-feng

2015-01-01

266

Risk Factors for Diabetes Mellitus Type 2 and Metabolic Syndrome Are Comparable for Previously Growth Hormone-Treated Young Adults Born Small for Gestational Age (SGA) and Untreated Short SGA Controls  

Microsoft Academic Search

Context: Low birth weight might increase risk of diabetes mellitus type 2 and metabolic syndrome (MS). GH has insulin-antagonistic properties. Therefore, long-term follow-up of GH-treated children born small for gestational age (SGA) is important. Objective and Patients: The objective of the study was to evaluate insulin sensitivity (Si) and disposition index (DI), all components of the MS and IGF-I and

Marije van Dijk; Ellen M. N. Bannink; Yvonne K. van Pareren; Paul G. H. Mulder; Anita C. S. Hokken-Koelega

267

Placental weight and placental weight-to-birth weight ratio are increased in diet- and exercise-treated gestational diabetes mellitus subjects but not in subjects with one abnormal value on 100-g oral glucose tolerance test  

Microsoft Academic Search

The aim of the present study was to determine whether the placental weight and placental weight-to-birth weight ratio (PW\\/BW) increased in pregnant women with one abnormal value (OAV) on 100-g oral glucose tolerance test (OGTT) and diet- and exercise-treated, non-insulin-requiring gestational diabetes mellitus (GDM) subjects. The 50-g glucose challenge test (GCT) was administered to 324 pregnant women. Women with abnormal

Mert Kucuk; Fadime Doymaz

2009-01-01

268

Lower Adiponectin Levels at First Trimester of Pregnancy Are Associated With Increased Insulin Resistance and Higher Risk of Developing Gestational Diabetes Mellitus  

PubMed Central

OBJECTIVE To evaluate the associations between adiponectin levels and 1) the risk of developing gestational diabetes mellitus (GDM), and 2) insulin resistance/sensitivity, ?-cell function, and compensation indices in a prospective cohort representative of the general population of pregnant women. RESEARCH DESIGN AND METHODS We performed anthropometric measurements and collected blood samples at 1st (6–13 weeks) and 2nd (24–28 weeks) trimesters. Diagnosis of GDM was made at 2nd trimester based on a 75-g oral glucose tolerance test (International Association of the Diabetes and Pregnancy Study Groups criteria). Insulin was measured (ELISA; Luminex) to estimate homeostasis model assessment of insulin resistance (HOMA-IR), ?-cell function (HOMA-B), insulin sensitivity (Matsuda index), insulin secretion (AUCinsulin/glucose), and ?-cell compensation (insulin secretion sensitivity index-2). Adiponectin was measured by radioimmunoassay. RESULTS Among the 445 participants included in this study, 38 women developed GDM. Women who developed GDM had lower 1st-trimester adiponectin levels (9.67 ± 3.84 vs. 11.92 ± 4.59 µg/mL in women with normal glucose tolerance). Lower adiponectin levels were associated with higher risk of developing GDM (OR, 1.12 per 1 µg/mL decrease of adiponectin levels; P = 0.02, adjusted for BMI and HbA1c at 1st trimester). Adiponectin levels at 1st and 2nd trimesters were associated with HOMA-IR (both: r = ?0.22, P < 0.0001) and Matsuda index (r = 0.28, P < 0.0001, and r = 0.29, P < 0.0001). After adjustment for confounding factors, we found no significant association with HOMA-B and AUCinsulin/glucose. CONCLUSIONS Pregnant women with lower adiponectin levels at 1st trimester have higher levels of insulin resistance and are more likely to develop GDM independently of adiposity or glycemic measurements. PMID:23300287

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

2013-01-01

269

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

270

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

271

GSK3? Is Increased in Adipose Tissue and Skeletal Muscle from Women with Gestational Diabetes Where It Regulates the Inflammatory Response  

PubMed Central

Infection and inflammation, through their ability to increase pro-inflammatory cytokines and chemokines and adhesion molecules, are thought to play a central role in the pathophysiology of insulin resistance and type 2 diabetes. Recent studies have shown that glycogen synthase kinase 3 (GSK3) plays a central role in regulating this inflammation. There are, however, no studies on the role of GSK3 in pregnancies complicated by gestational diabetes mellitus (GDM). Thus, the aims of this study were (i) to determine whether GSK3 is increased in adipose tissue and skeletal muscle from women with GDM; and (ii) to investigate the effect of GSK3 inhibition on inflammation in the presence of inflammation induced by bacterial endotoxin lipopolysaccharide (LPS) or the pro-inflammatory cytokine IL-1?. Human omental adipose tissue and skeletal muscle were obtained from normal glucose tolerant (NGT) women and BMI-matched women with diet-control GDM at the time of Caesarean section. Western blotting was performed to determine GSK3 protein expression. Tissue explants were performed to determine the effect of the GSK3 inhibitor CHIR99021 on markers of inflammation. When compared to women with NGT, omental adipose tissue and skeletal muscle obtained from women with diet-controlled GDM had significantly higher GSK3? activity as evidenced by a decrease in the expression of GSK3? phosphorylated at serine 9. The GSK3 inhibitor CHIR99021 significantly reduced the gene expression and secretion of the pro-inflammatory cytokines TNF-?, IL-1? and IL-6; the pro-inflammatory chemokines IL-8 and MCP-1; and the adhesion molecules ICAM-1 and VCAM-1 in tissues stimulated with LPS or IL-1?. In conclusion, GSK3 activity is increased in GDM adipose tissue and skeletal muscle and regulates infection- and inflammation-induced pro-inflammatory mediators. PMID:25541965

Lappas, Martha

2014-01-01

272

G22A Polymorphism of Adenosine Deaminase and its Association with Biochemical Characteristics of Gestational Diabetes Mellitus in an Iranian Population  

PubMed Central

Adenosine deaminase (ADA) is an important regulator of insulin action. The single nucleotide polymorphism (SNP) G22A in the ADA gene decreases enzymatic activity of ADA. The aim of this study was to investigate the relationship between the SNP G22A and blood glycemic control, insulin resistance, and obesity of gestational diabetes mellitus (GDM) patients in an Iranian population. SNP G22A was determined in women with GDM (N=70) and healthy pregnant women (control, N=70) using polymerase chain reaction-restriction fragment length polymorphism. Fasting plasma glucose (FPG), hemoglobin A1C (HbA1c), plasma insulin levels and plasma lipids were measured using commercial kits. Homeostasis model of assessment for insulin resistance (HOMA-IR) was calculated. The distribution of genotypes and alleles among GDM patients was similar to that of the control group. FPG and HbA1c were significantly higher in GDM patients with GG genotype compared with GDM patients with GA+AA genotype and non-GDM patients. The frequency of GG genotype was significantly higher in obese GDM patients compared to lean GDM patients. The SNP G22A in the ADA gene was not associated with the risk of GDM in our population. GG genotype was associated with poor glycemic control and obesity in GDM patients.

Takhshid, Mohammad Ali; Zahediannejad, Zinab; Aboualizadeh, Farzaneh; Moezzi, Leili; Ranjbaran, Reza

2015-01-01

273

Serum selenium concentrations correlate significantly with inflammatory biomarker high-sensitive CRP levels in Hungarian gestational diabetic and healthy pregnant women at mid-pregnancy.  

PubMed

Selenium is an essential trace element and a component of various enzymes with antioxidant functions. High-sensitive C-reactive protein (hsCRP) is an early indicator of increased lipid peroxidation. The serum selenium concentration, lipid parameters, and hsCRP values of gestational diabetic pregnant women (GD), control pregnant women (CP), and healthy nonpregnant controls (HC) were compared. Blood was taken between the 24th and the 28th week of pregnancy when the oral glucose tolerance test was performed. Selenium concentration was determined by atomic absorption spectrometry after hydride generation. HsCRP was measured by immunturbidimetry. HC had significantly higher serum selenium concentrations than GD and CP women (HC = 77.4 +/- 14.82, GD = 51.7 +/- 11.62, and CP = 40.5 +/- 8.03 microg/l, respectively). HsCRP values of both GD and nondiabetic pregnant women were significantly higher compared to controls. Significant negative correlations were found between serum selenium and total cholesterol, low-density lipoprotein cholesterol, and hsCRP values indicating that low selenium levels are associated with increased lipid peroxidation. Serum selenium concentrations of Hungarian pregnant women are low compared to internationally published data. PMID:17960332

Molnar, Jeannette; Garamvolgyi, Zoltan; Herold, Magdolna; Adanyi, Nora; Somogyi, Aniko; Rigo, Janos

2008-01-01

274

Obesity and Blood Pressure in 17-Year-Old Offspring of Mothers with Gestational Diabetes: Insights from the Jerusalem Perinatal Study  

PubMed Central

Objective. Gestational diabetes mellitus (GDM) influences fetal development and offspring's metabolic risk. We evaluated this association in 17-year-old offspring adjusting for birth weight (BW) and prepregnancy maternal BMI (mBMI). Study Design. The JPS birth cohort contains extensive data on 92,408 births from 1964 to 1976. Offspring's BMI and blood pressure (BP) were obtained from military records. For a subcohort born between 1974 and 1976, prepregnancy mBMI was available. Offspring were classified as born to mothers with GDM (n = 293) or born to mothers without recorded GDM (n = 59,499). Results. GDM offspring had higher mean BMI and systolic and diastolic BP compared to no-recorded-GDM offspring. After adjusting for BW, GDM remained significantly associated with offspring BMI and diastolic BP (? = 1.169 and 1.520, resp.). In the subcohort, when prepregnancy mBMI was entered to the models, it markedly attenuated the associations with GDM. Conclusions. Maternal characteristics have long-term effects on cardiometabolic outcomes of their offspring aged 17 years. PMID:21804818

Avgil Tsadok, Meytal; Friedlander, Yechiel; Paltiel, Ora; Manor, Orly; Meiner, Vardiella; Hochner, Hagit; Sagy, Yael; Sharon, Nir; Yazdgerdi, Shoshanah; Siscovick, David; Elchalal, Uriel

2011-01-01

275

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

276

Body and Liver Fat Mass Rather Than Muscle Mitochondrial Function Determine Glucose Metabolism in Women With a History of Gestational Diabetes Mellitus  

PubMed Central

OBJECTIVE Ectopic lipid storage in muscle (intramyocellular lipids [IMCL]) and liver (hepatocellular lipids [HCL]) coexists with impaired myocellular flux through ATP synthase (fATPase) in certain cohorts with increased risk of type 2 diabetes. Because women with a history of gestational diabetes mellitus (pGDM) have elevated ectopic lipids and diabetes risk, we tested whether deteriorated energy metabolism contributes to these abnormalities. RESEARCH DESIGN AND METHODS A total of 23 glucose-tolerant nonobese pGDM and eight women with normal glucose metabolism during pregnancy with similar age, body mass, and physical activity underwent oral glucose tolerance tests (OGTT) and intravenous glucose tolerance tests at 4–5 years after delivery. OGTT values <463 mL ? min?1 ? m?2 were considered to indicate insulin resistance. pGDM were further stratified into insulin-resistant (pGDM-IR) and insulin-sensitive (pGDM-IS) groups. IMCL, HCL, and fATPase were measured with 1H/31P magnetic resonance spectroscopy. RESULTS pGDM had 36% higher fat mass and 12% lower insulin sensitivity. Log-transformed fATPase was lower in pGDM (10.6 ± 3.8 µmol ? mL muscle?1 ? min?1 vs. 12.1 ± 1.4 µmol ? mL muscle?1 ? min?1, P < 0.03) and related to plasma adiponectin after adjustment for body fat (r = 0.44, P < 0.04). IMCL were 61% and 69% higher in pGDM-IR (P < 0.05 vs. pGDM-IS) and insulin resistant women (P < 0.003 vs. insulin sensitive), respectively. HCL were doubled (P < 0.05) in pGDM and insulin resistant women, and correlated positively with body fat mass (r = 0.50, P < 0.01) and inversely with insulin sensitivity (r = ?0.46, P < 0.05). CONCLUSIONS Glucose-tolerant pGDM show increased liver fat but only slightly lower muscular insulin sensitivity and ATP synthesis. This suggests that alteration of hepatic lipid storage represents an early and predominant abnormality in this cohort. PMID:20978097

Prikoszovich, Thomas; Winzer, Christine; Schmid, Albrecht Ingo; Szendroedi, Julia; Chmelik, Marek; Pacini, Giovanni; Krššák, Martin; Moser, Ewald; Funahashi, Tohru; Waldhäusl, Werner; Kautzky-Willer, Alexandra; Roden, Michael

2011-01-01

277

Diabetes: Oral Effects  

MedlinePLUS

... can increase your risk of tooth decay (cavities). Saliva normally washes away sugars and bits of food ... with uncontrolled diabetes may have decreased flow of saliva. However, it's not clear whether diabetics have more ...

278

Copeptin, adropin and irisin concentrations in breast milk and plasma of healthy women and those with gestational diabetes mellitus.  

PubMed

Copeptin, adropin and irisin are polypeptide hormones implicated in energy homostasis and diabetes. The purposes of this study were (1) to compare the copeptin, adropin and irisin concentrations between colostrum, transitional and mature milk and plasma in lactating women with and without GDM and (2) to compare these values with those from non-lactating women. Venous blood samples were obtained before suckling from 15 healthy lactating women aged 26-30 years, 15 lactating women with GDM aged 26-32 years, and 14 age-matched controls aged 25-31 years. Colostrum, transitional milk and mature milk samples were collected just before suckling. The concentration of copeptin was determined by EIA while the concentrations of adropin and irisin were determined by ELISA. The levels of copeptin, adropin and irisin in the colostrum were significantly higher than those in transitional and mature milk samples from healthy women; also, transitional milk had higher copeptin, adropin and irisin concentrations than mature milk. The amounts of copeptin in the colostrum and transitional milk were significantly higher than in mature milk samples from women with GDM, while the amounts of adropin and irisin were significantly lower. The relative concentrations of copeptin, adropin and irisin in the plasma samples from these groups of women were similar to those in the colostrum, transitional and mature milk samples, but the latter concentrations were higher than those in the plasma. These peptides could influence the regulation of metabolic pathways and the postnatal growth and development of different organs in the newborn. PMID:23850897

Aydin, Suleyman; Kuloglu, Tuncay; Aydin, Suna

2013-09-01

279

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

280

Insulin Restores Gestational Diabetes Mellitus–Reduced Adenosine Transport Involving Differential Expression of Insulin Receptor Isoforms in Human Umbilical Vein Endothelium  

PubMed Central

OBJECTIVE To determine whether insulin reverses gestational diabetes mellitus (GDM)–reduced expression and activity of human equilibrative nucleoside transporters 1 (hENT1) in human umbilical vein endothelium cells (HUVECs). RESEARCH DESIGN AND METHODS Primary cultured HUVECs from full-term normal (n = 44) and diet-treated GDM (n = 44) pregnancies were used. Insulin effect was assayed on hENT1 expression (protein, mRNA, SLC29A1 promoter activity) and activity (initial rates of adenosine transport) as well as endothelial nitric oxide (NO) synthase activity (serine1177 phosphorylation, l-citrulline formation). Adenosine concentration in culture medium and umbilical vein blood (high-performance liquid chromatography) as well as insulin receptor A and B expression (quantitative PCR) were determined. Reactivity of umbilical vein rings to adenosine and insulin was assayed by wire myography. Experiments were in the absence or presence of l-NG-nitro-l-arginine methyl ester (l-NAME; NO synthase inhibitor) or ZM-241385 (an A2A-adenosine receptor antagonist). RESULTS Umbilical vein blood adenosine concentration was higher, and the adenosine- and insulin-induced NO/endothelium-dependent umbilical vein relaxation was lower in GDM. Cells from GDM exhibited increased insulin receptor A isoform expression in addition to the reported NO–dependent inhibition of hENT1-adenosine transport and SLC29A1 reporter repression, and increased extracellular concentration of adenosine and NO synthase activity. Insulin reversed all these parameters to values in normal pregnancies, an effect blocked by ZM-241385 and l-NAME. CONCLUSIONS GDM and normal pregnancy HUVEC phenotypes are differentially responsive to insulin, a phenomenon where insulin acts as protecting factor for endothelial dysfunction characteristic of this syndrome. Abnormal adenosine plasma levels, and potentially A2A-adenosine receptors and insulin receptor A, will play crucial roles in this phenomenon in GDM. PMID:21515851

Westermeier, Francisco; Salomón, Carlos; González, Marcelo; Puebla, Carlos; Guzmán-Gutiérrez, Enrique; Cifuentes, Fredi; Leiva, Andrea; Casanello, Paola; Sobrevia, Luis

2011-01-01

281

Follow-Up of Gestational Diabetes Mellitus in an Urban Safety Net Hospital: Missed Opportunities to Launch Preventive Care for Women  

PubMed Central

Abstract Background: Our study assessed the follow-up of gestational diabetes mellitus (GDM) in the postpartum period among a racially and ethnically diverse group of women receiving care in a major urban medical center. Methods: We conducted cross-sectional analysis of clinical and administrative data on women aged 18–44 years who gave birth at Boston Medical Center (BMC) between 2003 and 2009, had GDM, and used BMC for regular care. We calculated the rate of glucose testing by 70 days and by 180 days after delivery and used logistic regression to assess the predictors of testing. Results: By 6 months postpartum, only 23.4% of GDM-affected women received any kind of glucose test. Among these, over half had been completed by 10 weeks but only 29% were the recommended oral glucose tolerance test (OGTT). After accounting for sociodemographic and health service factors, women aged ?35 years of age and women with a family practice provider were significantly less likely to be tested than their counterparts (odds ratio [OR] 0.51; 95% confidence interval [CI] 0.32, 0.83 and OR 0.36; 95% CI 0.19, 0.71 respectively). Women who attended a primary care visit within 180 days after birth had three times higher odds of being tested than those without such a visit (OR 3.10; 95% CI 1.97, 4.87). Conclusions: Despite widely disseminated clinical guidelines, postpartum glucose testing rates are exceedingly low, marking a critical missed opportunity to launch preventive care for women at high risk of type 2 DM. Failed follow-up of GDM by providers of prenatal and postpartum care also reflects a broader systems failure: the absence of a well-supported transition from pregnancy care to ongoing primary care for women. PMID:24707899

Bernstein, Judith; Winter, Michael; Iverson, Ronald; Lee-Parritz, Aviva

2014-01-01

282

Asymmetric dimethylarginine is associated with high-sensitivity C-reactive protein and early carotid atherosclerosis in women with previous gestational diabetes mellitus.  

PubMed

Asymmetric dimethylarginine (ADMA) is increased in subjects with previous gestational diabetes mellitus (GDM). The aim of this study was to investigate the relationship between serum ADMA levels and early carotid atherosclerosis in women with history of GDM. A total of 42 normoglycemic women with previous GDM and 42 age-matched healthy controls were enrolled. Serum levels of ADMA, lipids, insulin, fasting and 2-h glucose following 75-g oral glucose tolerance test, and high sensitivity C-reactive protein (hsCRP) were measured. Carotid atherosclerosis was evaluated by ultrasonographically determined intima-media thickness (IMT). Serum ADMA and hsCRP were higher in women with previous GDM compared to the healthy controls (0.72 ± 0.16 vs. 0.41 ± 0.15 ?mol/L, p < 0.001; 1.81 ± 0.32 vs. 1.05 ± 0.26 mg/L, p < 0.001; respectively). Carotid IMT was also increased in the previous GDM group (0.77 ± 0.14 vs. 0.52 ± 0.13 mm, p < 0.001). In women with previous GDM, ADMA was positively correlated with hsCRP (r = 41, p < 0.001) and carotid IMT (r = 0.38, p < 0.001). Multiple linear regression analysis revealed that ADMA was a significant predictor for elevated carotid IMT in subjects with previous GDM after adjusting for traditional risk factors (? = 0.26, p = 0.017). Our data demonstrated that serum ADMA was associated with hsCRP and carotid IMT in normoglycemic women with previous GDM. PMID:24962795

Xia, Wei; Li, Dajiang; Zhang, Chunquan; Xu, Li; Xu, Wenliang; Shao, Yibing

2015-03-01

283

High-risk pregnancy in rhesus monkeys (Macaca mulatta): a case of ectopic, abdominal pregnancy with birth of a live, term infant, and a case of gestational diabetes complicated by pre-eclampsia  

PubMed Central

Several cases of abdominal pregnancy have been described in nonhuman primates. These previous occurrences have been mummified fetuses found in the abdominal cavity. This report describes a case of abdominal pregnancy in a timed-bred rhesus monkey with delivery of a live term infant. The mother died 14 days later from complications of septic peritonitis. At necropsy, the monkey had an intestinal adenocarcinoma that may have allowed leakage of intestinal contents into the abdomen. The second case of pregnancy complication was a rhesus monkey found to have gestational diabetes that later developed pre-eclampsia. She was treated for 5 days with a regimen similar to that used in women, and a live infant was delivered at day 157 of gestation by Caesarian section. These cases of high-risk pregnancy underscore the value of timed-breeding and careful monitoring of pregnant monkeys and the similarities between pregnancy complications in women and in nonhuman primates. PMID:19490364

Krugner-Higby, Lisa; Luck, Melissa; Hartley, Deborah; Crispen, Heather M.; Lubach, Gabriele R.; Coe, Christopher L.

2009-01-01

284

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-Sad?ecka, Ma?gorzata; Grabiec, Marek; Ro??, Danuta

2014-01-01

285

Streptozotocin-Induced Diabetes Models: Pathophysiological Mechanisms and Fetal Outcomes  

PubMed Central

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

286

Evaluating factors associated with uncontrolled hypertension: Isfahan cohort study, Iran  

PubMed Central

BACKGROUND Hypertension (HTN) considers as one of the most common risk factors, which potentially raises the risk of cardiovascular disease. Regarding high prevalence of HTN among Iranian population this study designed to examine a range of socio-demographic and clinical variables to determine the association with failure to achieve blood pressure control in a cohort of hypertensive subjects. METHODS This retrospective cohort study is a part of Isfahan cohort study which carried out on adults aged 35 years old or more. Subjects with confirmed HTN entered in this sub-study. For all subjects questionnaire included socio-demographic characteristics, clinical data and lifestyle behavior completed by trained nurses. Uncontrolled HTN was defined as systolic and diastolic blood pressure more than 140/90 in the presence or absent of pharmacological treatment. RESULTS The prevalence of uncontrolled men was significantly higher than controlled in both 2001 and 2007 (P < 0.001). A significant association was found between sex and control of blood pressure: compared with women, being men [odds ratio (OR) = 2.31; 95 % confidence interval (CI) = 1.64-3.24] was significantly associated with uncontrolled HTN in 2001 and (OR = 2.38; 95% CI = 1.78-3.18). Among lifestyle behaviors, tendency for more consumption of salty foods increased the risk of uncontrolled HTN in 2001 by 1.73 times [OR = 1.73, 95% CI = 1.20-2.50, (P = 0.003)]. Patients who were naive to mono-therapy without considering the type of antihypertensive drug were found to be associated with uncontrolled blood pressure (OR = 0.14; 95 % CI =0.1-0.2). CONCLUSION Uncontrolled HTN was sex, marital status, diabetes, tendency to salty foods and medication adherence. Assessment of them presence of these risk factors is warranted to recommend an aggressive HTN management with the goal of reducing excessive risk of cardiovascular events caused by uncontrolled HTN.

Khosravi, Alireza; Pourheidar, Behrouz; Roohafza, Hamidreza; Moezzi, Masoumeh; Mousavi, Mehdi; Hajiannejad, Alireza; Bidram, Peyman; Gharipour, Mojgan; Shirani, Shahin; Golshahi, Jafar; Boshtam, Mansoureh; Sarrafzadegan, Nizal

2014-01-01

287

[Why do we still hesitate to accept the new international criteria for the diagnosis of gestational diabetes mellitus? The current screening is non-uniform and does not correspond with evidence-based medicine].  

PubMed

Gestational diabetes mellitus (GDM) is the most common internal complication in pregnancy and similarly as the frequency of Type 2 diabetes rises in general population so does the frequency of GDM. The causes include unhealthy life style, growing incidence of overweight and obesity as well as older age of pregnant women. Older data reported the frequency of GDM in 3-4% of all pregnancies in the Czech Republic, whereas nowadays its frequency with using the same diagnostic criteria is more than two times higher. If we include the measurement of glycemia in 1 hour of oGTT, the frequency of GDM reaches more than 20%. In case we accept the new recommendation of the International Association for Diabetes in Pregnancy Study Groups (IADPSG), it is expected that the frequency of GDM will be even higher. IADPSG recommendation resulted from HAPO study (Hyperglycemia and Adverse Pregnancy Outcomes), a large international observational study on the relationship between mild hyperglycemia and pregnancy outcomes. Adoption of these new criteria is intensively discussed among experts all over the world. WHO adopted the IADPSG criteria in 2013. The Czech Diabetes Society committee adopted them in April 2014. Any official statement about the new criteria has not yet been issued by the Czech Gynecology and Obstetrics Society. This article analyzes the old and the new diagnostic criteria, summarizes the most common arguments in favor and against the IADPSG thresholds and tries to open the discussion about this important topic. PMID:25054957

Krej?í, H; Anderlová, K

2014-06-01

288

Diabetes  

MedlinePLUS

... prevent or delay the start of type 2 diabetes. Type 1 diabetes cannot be prevented. ... Elsevier; 2011:chap 31. Eisenbarth GS, Buse JB. Type 1 diabetes mellitus. In: Kronenberg HM, Melmed S, Polonsky KS, Larsen ...

289

Getting control of uncontrolled asthma.  

PubMed

Despite various treatment modalities, a large proportion of patients have asthma that remains uncontrolled. These patients remain at an increased risk of developing severe exacerbations, have a poor quality of life, and pose a high economic healthcare burden, with an estimated mean annual cost more than double that of patients with good symptom control. It is therefore important to accurately diagnose asthma and continually assess asthma control. Several validated tools are available to do this, including questionnaires, biomarker analysis, and bronchoscopy. Current guidelines advise physicians to establish a self-management program for the patient to assess and monitor asthma control. A further recommendation is the establishment of an educational action plan to increase treatment adherence and to improve asthma control. National and international guidelines provide long-term management strategies for these patients and recommend a stepwise approach for achieving and maintaining asthma control. Despite availability of a wide range of controller and reliever therapies, uncontrolled asthma remains a challenge and reflects the need for new therapeutic options. This review discusses current global guidelines for the assessment and management of asthma control and summarizes the broad spectrum of novel therapeutic agents currently under development for the treatment of asthma, including anticholinergics, chemoattractant receptor-homologous molecules expressed on T-helper 2 lymphocyte antagonists, and anti-interleukin (IL)-5, anti-IL-13, and anti-IL-4 agents. PMID:24844737

Wechsler, Michael E

2014-11-01

290

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

291

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

292

Diagnosis of Diabetes and Prediabetes  

MedlinePLUS

... located behind the stomach. As the blood glucose level rises after a meal, the pancreas is triggered to ... insulin in response to meals, and blood glucose levels rise. Gestational diabetes is a type of diabetes that ...

293

Toward universal criteria for gestational diabetes: Relationships between seventy-five and one hundred gram glucose loads and between capillary and venous glucose concentrations  

Microsoft Academic Search

OBJECTIVES: Replacement of the two-step, 100 gm, 3-hour National Diabetes Data Group procedure by the one-step, 75 gm, 2-hour World Health Organization oral glucose tolerance test has been hindered by a paucity of data comparing the two tests during pregnancy. The current series compared 100 gm and 75 gm glucose loads and glucose measurements in venous plasma or capillary blood.

Peter A. Weiss; Martin Haeusler; Franz Kainer; Peter Pürstner; Josef Haas

1998-01-01

294

Diabetes  

MedlinePLUS

... to develop type 2 diabetes later in life. Polycystic ovary syndrome Polycystic ovary syndrome (PCOS) is a condition that occurs when an imbalance ... to form on the ovaries. Women who have PCOS are at an increased risk of developing type ...

295

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? ...

296

Optimization and validation of a chiral GC-MS method for the determination of free d-amino acids ratio in human urine: Application to a Gestational Diabetes Mellitus study.  

PubMed

Gestational Diabetes Mellitus (GDM) is defined as glucose intolerance with onset or first recognition during pregnancy. It is affecting approximately up to 14% of all pregnancies with an increasing tendency. GDM has been related to relevant short-term and long-term health complications for both mother and offspring. Recent studies strongly emphasized the role of several essential amino acids in the pathogenesis of obesity and highlighted their strong correlation with insulin resistance, but there are no references related to modifications in d-AAs in biological fluids. As d-AA elimination proceeds mainly by renal excretion, urine was the selected sample to evaluate the alterations in free d-AAs ratio in a GDM study. Only 1mL of first void urine or standard solution was required for purification, by using a Discovery DSC-SCX SPE cartridge (500mg/3mL) and derivatization into their N(O)-pentafluoropropionyl amino acid 2-propyl esters. Enantiomeric separation was carried out by GC-MS on a Chirasil-l-Val N-propionyl-l-valine-tert-butylamide polysiloxane fused-silica capillary column (25m×0.25mm I.D., 0.12?m film thickness, Agilent Technologies, Waldbronn, Germany), under programmed temperature elution. Detection was performed with an ion trap mass analyzer, operating in the full scan mode in the m/z 50-350 range. 14 pairs of derivatives of d-and l-AAs were separated. The steps of sample preparation, derivatization and GC-MS conditions were optimized for both urine and standards. Several conditions affecting the SPE procedure, such as sorbent mass/volume ratio of the cartridge, sample dilution and pH, were optimized. Volume of reagents and solvents and reaction temperature and time were also tested for the derivatization. Regarding the GC-MS parameters, split ratio, temperature program and mass range were optimized. The final method was validated in terms of linearity, sensitivity, accuracy and precision for d-Ala, d-Pro, d-Ser, d-Met, d-Phe, d-Glu, d-Orn and d-Lys. Identification of AAs in urine samples was based on retention time and mass spectra. Urine from 20 women with GDM and 20 pregnant women with normal glucose tolerance (after 2-h 75-g oral glucose tolerance test), matched according to the week of gestation and age (22-28 week of gestation and age 24-37 years), were enrolled into the study. %d-Relative amounts were determined for Ala, Val, Thr, Ser, Leu, Asx (Asp+Asn), Glx (Glu+Gln), Met, Phe, Tyr, Orn and Lys. Statistically significant differences (p<0.05) were observed only for d-Phe and higher values were found in the GDM group. It is possible that d-Phe could be involved in metabolic/signaling pathways to compensate early stages of insulin resistance, although further work is necessary to confirm this hypothesis. PMID:25679092

Lorenzo, M Paz; Dudzik, Danuta; Varas, Elena; Gibellini, Manuel; Skotnicki, Mariusz; Zorawski, Marcin; Zarzycki, Wieslaw; Pellati, Federica; García, Antonia

2015-03-25

297

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.

298

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; Vilsbøll, Tina

2013-01-01

299

Angiogenesis in diabetes and obesity.  

PubMed

The prevalence of diabetes mellitus and obesity continues to increase globally. Diabetic vascular complications are the main chronic diabetic complications and associated with mortality and disability. Angiogenesis is a key pathological characteristic of diabetic microvascular complications. However, there are two tissue-specific paradoxical changes in the angiogenesis in diabetic microvascular complications: an excessive uncontrolled formation of premature blood vessels in some tissues, such as the retina, and a deficiency in the formation of small blood vessels in peripheral tissues, such as the skin. This review will discuss the paradoxical phenomena of angiogenesis and its underlying mechanism in obesity, diabetes and diabetic complications. PMID:25663658

Cheng, Rui; Ma, Jian-Xing

2015-03-01

300

Diabetic ketoacidosis in toddler with a diaper rash  

Microsoft Academic Search

The term diabetes does not denote a single disease entity but rather a clinical syndrome. Fundamental to all types of diabetes is impairment of insulin secretion by the pancreatic beta cells. Diabetes is divided into (1) diabetes associated with certain syndromes or conditions, (2) gestational diabetes, (3) non–insulin-dependent diabetes or type 2 diabetes, and (4) insulin-dependent diabetes (IDDM) or type

Mark D. Williams; Don Sallee; Matthew Robinson

2008-01-01

301

Diabetes mellitus and oral care.  

PubMed

Diabetes is a common condition. Its incidence is increasing. It can lead to medical complications including visual impairment, neuropathies, renal and cardiovascular disease. Diabetes can have an adverse effect on oral health and healthcare. Conversely, poor oral health can have an adverse effect on blood glucose control. Repeated oral infections can indicate uncontrolled diabetes and lead to its diagnosis. Whereas hyperglycaemia may occur in untreated diabetes, hypoglycaemic episodes are not uncommon in well-controlled diabetes Type 2. The tight glycaemic control required to prevent its long-term complications can be destabilized by infection, anxiety or missed meals. PMID:15188524

Fiske, Janice

2004-05-01

302

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

303

Metabolic Aspects of Insulin Resistance in Individuals Born Small for Gestational Age  

Microsoft Academic Search

Numerous studies have shown an association between low weight at birth and being born small for gestational age (SGA) on the one hand and risk of developing insulin resistance and type 2 diabetes on the other. Our studies in twins have indicated a non-genetic age-dependent origin of insulin resistance and type 2 diabetes associated with being born SGA. In order

A. Vaag; C. Bjørn Jensen; P. Poulsen; C. Brøns; K. Pilgaard; L. Grunnet; S. Vielwerth; A. Alibegovic

2006-01-01

304

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

305

Pregnancy-Onset Habitual Snoring, Gestational Hypertension, and Pre-eclampsia: Prospective Cohort Study  

PubMed Central

Objective This study aimed to prospectively examine the impact of chronic vs. pregnancy-onset habitual snoring on gestational hypertension, pre-eclampsia, and gestational diabetes. Study Design Third trimester pregnant women were recruited from a large, tertiary medical center, between March 2007 and December 2010 and screened for the presence and duration of habitual snoring, as a known marker for sleep-disordered breathing. Clinical diagnoses of gestational hypertension, pre-eclampsia, and gestational diabetes were obtained. Results Of 1,719 pregnant women, 34% reported snoring, with 25% reporting pregnancy-onset snoring. After adjusting for confounders pregnancy-onset, but not chronic snoring, was independently associated with gestational hypertension (odds ratio 2.36, 95%CI 1.48–3.77, p<0.001) and pre-eclampsia (odds ratio 1.59, 95%CI 1.06–2.37 p=0.024) but not gestational diabetes. Conclusion New-onset snoring during pregnancy is a strong risk factor for gestational hypertension and pre-eclampsia. In view of the significant morbidity and healthcare costs associated with hypertensive diseases of pregnancy, simple screening of pregnant women may have clinical utility. Trial registration: Clinical Trials NCT01030003 PMID:22999158

O’BRIEN, Louise M.; BULLOUGH, Alexandra S.; OWUSU, Jocelynn T.; TREMBLAY, Kimberley A.; BRINCAT, Cynthia A.; CHAMES, Mark C.; KALBFLEISCH, John D.; CHERVIN, Ronald D.

2012-01-01

306

Insights From Twin Research: Conference at Royal Childrens Hospital, Melbourne, Australia / Twin Studies: Timing of Monozygotic Splitting and Commentary; Gestational Diabetes; ICOMBO'S Post-Partum Depression Study; Photographs of Conjoined Twins / Human Interest: Rare Quadruplets; Mistaken Identity on the Soccer Field; Prenatal Laser Surgery on Triplets; Twins Born to Prince and Princess of Monaco.  

PubMed

Highlights from a conference, 'Healthier Kids: Insights From Twin Research', held in Melbourne, Australia on December 5, 2014, are summarized. In addition to informative and exciting presentations and discussions of recent findings, three key themes emerged: (1) results from twin research have important implications for non-twins, (2) researchers from diverse disciplines should be encouraged to participate actively in twin research, and (3) investigators, twins and families need to work more collaboratively. Next, papers and studies concerning the biological bases of monozygotic (MZ) twinning, gestational diabetes and post-partum depression are reviewed. Finally, general interest reports of rare quadruplets, mistaken identity, prenatal laser surgery and a royal twin birth are provided. PMID:25740114

Segal, Nancy L

2015-04-01

307

Rapid epigenetic adaptation to uncontrolled heterochromatin spreading  

PubMed Central

Heterochromatin, a highly compact chromatin state characterized by histone H3K9 methylation and HP1 protein binding, silences the underlying DNA and influences the expression of neighboring genes. However, the mechanisms that regulate heterochromatin spreading are not well understood. In this study, we show that the conserved Mst2 histone acetyltransferase complex in fission yeast regulates histone turnover at heterochromatin regions to control heterochromatin spreading and prevents ectopic heterochromatin assembly. The combined loss of Mst2 and the JmjC domain protein Epe1 results in uncontrolled heterochromatin spreading and massive ectopic heterochromatin, leading to severe growth defects due to the inactivation of essential genes. Interestingly, these cells quickly recover by accumulating heterochromatin at genes essential for heterochromatin assembly, leading to their reduced expression to restrain heterochromatin spreading. Our studies discover redundant pathways that control heterochromatin spreading and prevent ectopic heterochromatin assembly and reveal a fast epigenetic adaptation response to changes in heterochromatin landscape. DOI: http://dx.doi.org/10.7554/eLife.06179.001 PMID:25774602

Wang, Jiyong; Reddy, Bharat D; Jia, Songtao

2015-01-01

308

Abdominal packing for surgically uncontrollable hemorrhage.  

PubMed Central

Planned intra-abdominal packing for surgically uncontrollable hemorrhage from liver and retroperitoneal injuries exacerbated by hypothermia, acidosis, and coagulopathy regained popularity over the past decade. The authors reviewed 39 patients injured between August 1985 and September 1990; 31 packed for liver injuries, eight for nonliver injuries. The overall mortality rate was 44% (17/39); 9 (23%) exsanguinated, 3 (8%) died of head injuries, 3 (8%) of multisystem organ failure, 2 (5%) of late complications. The mean age was 33.9 +/- 16.2 (range, 16 to 79); there were 26 men and 13 women. Relaparotomy for pack removal was performed 2.0 +/- 1.1 days (range, 1 to 7) after initial operation. The authors identified intraoperative risk factors of pH less than or equal to 7.18, temperature less than or equal to 33 C, prothrombin time greater than or equal to 16, partial thromboplastin time greater than or equal to 50, and transfusion of 10 units or more of blood as highly predictive of outcome. Patients with four to five risk factors (n = 3) had a 100% mortality rate (p less than 0.04); two to three risk factors (n = 12), 83% mortality rate (p less than 0.003), compared with zero to one risk factors (n = 24), 18% mortality rate. Complications developed in six of 22 survivors (27%): 5 abdominal abscesses (23%), 2 wound dehiscences (9%), and 2 enterocutaneous fistulae (9%). Intra-abdominal packing will not stop all bleeding; 23% of the patients exsanguinated. In 77%, packing helped achieve hemostasis we believed was not otherwise possible. Packing may be done to prevent the development of acidosis, hypothermia, and coagulopathy or may be done early in the treatment of cold, acidotic patients rather than massive transfusion in the face of surgically uncorrectable bleeding. PMID:1616383

Sharp, K W; Locicero, R J

1992-01-01

309

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

310

Statistical Issues for Uncontrolled Reentry Hazards  

NASA Technical Reports Server (NTRS)

A number of statistical tools have been developed over the years for assessing the risk of reentering objects to human populations. These tools make use of the characteristics (e.g., mass, shape, size) of debris that are predicted by aerothermal models to survive reentry. The statistical tools use this information to compute the probability that one or more of the surviving debris might hit a person on the ground and cause one or more casualties. The statistical portion of the analysis relies on a number of assumptions about how the debris footprint and the human population are distributed in latitude and longitude, and how to use that information to arrive at realistic risk numbers. This inevitably involves assumptions that simplify the problem and make it tractable, but it is often difficult to test the accuracy and applicability of these assumptions. This paper looks at a number of these theoretical assumptions, examining the mathematical basis for the hazard calculations, and outlining the conditions under which the simplifying assumptions hold. In addition, this paper will also outline some new tools for assessing ground hazard risk in useful ways. Also, this study is able to make use of a database of known uncontrolled reentry locations measured by the United States Department of Defense. By using data from objects that were in orbit more than 30 days before reentry, sufficient time is allowed for the orbital parameters to be randomized in the way the models are designed to compute. The predicted ground footprint distributions of these objects are based on the theory that their orbits behave basically like simple Kepler orbits. However, there are a number of factors - including the effects of gravitational harmonics, the effects of the Earth's equatorial bulge on the atmosphere, and the rotation of the Earth and atmosphere - that could cause them to diverge from simple Kepler orbit behavior and change the ground footprints. The measured latitude and longitude distributions of these objects provide data that can be directly compared with the predicted distributions, providing a fundamental empirical test of the model assumptions.

Matney, Mark

2008-01-01

311

14 CFR 31.19 - Performance: Uncontrolled descent.  

Code of Federal Regulations, 2010 CFR

...be determined for the most critical uncontrolled descent that can result from any single failure of the heater assembly, fuel cell system, gas value system, or maneuvering vent system, or from any single tear in the balloon envelope between...

2010-01-01

312

EMISSIONS OF PCDD/F FROM UNCONTROLLED, DOMESTIC WASTE BURNING  

EPA Science Inventory

Emissions of polychlorinated bibenzodioxin and dibenzofuran (PCDD/F) result from inefficiencies of combustion processes, most typically waste combustion. Uncontrolled combustion, such as occurs during so-called "backyard burning" of domestic waste, may therefore produce optimal ...

313

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...

314

Quantifying Uncontrolled Air Emissions from Two Florida Landfills  

EPA Science Inventory

Landfill gas emissions, if left uncontrolled, contribute to air toxics, climate change, trospospheric ozone, and urban smog. Measuring emissions from landfills presents unique challenges due to the large and variable source area, spatial and temporal variability of emissions, and...

315

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

316

METHODOLOGY TO INVENTORY, CLASSIFY, AND PRIORITIZE UNCONTROLLED WASTE DISPOSAL SITES  

EPA Science Inventory

A comprehensive method to inventory uncontrolled waste disposal sites integrates all available historic, engineering, geologic, land use, water supply, and public agency or private company records in order to develop a complete and accurate site profile. Detailed information on s...

317

Uncontrolled Face Recognition by Individual Stable Neural Network  

Microsoft Academic Search

There usually exist diverse variations in face images taken under uncontrolled conditions. Most previous work on face recognition\\u000a focuses on particular variations and usually assume the absence of others. Such work is called controlled face recognition. Instead of the ‘divide and conquer’ strategy adopted by controlled face recognition, this paper presents one of the first\\u000a attempts directly aiming at uncontrolled

Xin Geng; Zhi-Hua Zhou; Honghua Dai

318

Screening and diagnosis of diabetes in children and pregnant women.  

PubMed

The incidence and prevalence of diabetes in children has increased in recent decades. The findings of a nationwide screening program in Taiwan show that type 2 diabetes has replaced type 1 diabetes as the leading cause of diabetes in children and adolescents. Important risk factors for diabetes in children are high or low birth weights, obesity, and a family history of diabetes. The incidence of diabetes reaches plateaus during puberty. Therefore, we have developed a strategy to screen seventh-grade children with diabetes based on urinalysis and a risk score. Gestational diabetes is associated with various adverse perinatal outcomes, particularly macrosomia and birth injury, and a higher rate of Cesarean section. The 100 g oral glucose tolerance test (OGTT) for gestational diabetes was initially designed to predict maternal diabetes after delivery, and was revised by Carpenter and Coustan to predict adverse fetal outcomes. In 2010, the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) proposed a 75 g OGTT to define gestational diabetes, resulting in a significant increase in the prevalence of gestational diabetes. Our data suggest that adopting the new IADPSG criteria is reasonable, since they reduce adverse perinatal outcomes and are cost-efficient. PMID:25550055

Li, Hung-Yuan; Wei, Jung-Nan; Chuang, Lee-Ming; Wu, En-Tzu; Lee, Chien-Nan

2014-12-01

319

Difference between 2 h and 3 h 75 g glucose tolerance test in the diagnosis of gestational diabetes mellitus (GDM): Results from a national survey on prevalence of GDM  

Microsoft Academic Search

The possibility of the 2 h oral glucose tolerance test (OGTT) as an alternative to the 3 h OGTT was investigated based on\\u000a data from a national survey on pregnancy-associated diabetes. Data were retrieved from 4179 pregnant women who had OGTT performed\\u000a after an abnormal 50 g glucose challenge test (GCT). All of the 4 glucose levels during their OGTT

Xue-Lian Gao; Yu-Mei Wei; Hui-Xia Yang; Xian-Ming Xu; Ling Fan; Jing He; Ning Liu; San-Cun Zhao; Ya-Li Hu; Zi Yang; Yun-Ping Zhang; Xing-Hui Liu; Xu Chen; Jian-Ping Zhang; Wen-Li Gou; Mei Xiao; Hai-Rong Wu; Mei-Hua Zhang

2010-01-01

320

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

321

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

322

[Fetus, small for gestational age].  

PubMed

A small for gestational age foetus is defined by the foetal weight below the 10th centile for the corresponding gestational age. However, the vast majority of these cases has no apparent underlying abnormality, while in other cases a serious causative pathological condition can be identified. The detection, follow-up and treatment of an intrauterine growth retarded, compromised foetus has great obstetric and neonatologic relevance. In this review, the causes, clinical aspects and screening methods of intrauterine growth retardation are summarized based on the most recent international guidelines. Furthermore, recommendations regarding the monitoring and the optimal timing of the labour induction of pregnancies complicated with intrauterine growth retardation are discussed. PMID:25109915

Pásztor, Norbert; Kozinszky, Zoltán; Pál, Attila

2014-08-17

323

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

324

Appraisal of uncontrolled flowing artesian wells in Florida  

USGS Publications Warehouse

An estimated 15,000 uncontrolled flowing wells, many discharging water of poor quality are wastefully discharging about 790 million gallons per day by surface and internal flow. Internal flow in principal problem areas have been identified in Brevard, Charlotte, Clay, De Soto, Duval, Flagler, Glades, Hendry, Hillsborough, Lee, Manatee, Martin, Nassau, and Sarasota Counties. In many areas, uncontrolled discharge over the years has caused a decline in the potentiometric surface locally and regionally, and a deterioration of the potable water aquifers. Programs for control of flowing wells are being carried on by State, county, municipal, or Federal agencies in 21 countries. (Woodard-USGS)

Healy, Henry G.

1978-01-01

325

Prenatal Exposure to Nitrates, Nitrites, Nitrosatable Drugs, and Small-For-Gestational-Age Births  

E-print Network

of delivery FFQ Food frequency questionnaire GDM Gestational diabetes mellitus IUGR Intrauterine growth restriction NBDPS National Birth Defects Prevention Study NDMA N-nitrosodimethylamine NO2 Nitrogen dioxide NRT Nicotine replacement... identified to be associated with intrauterine growth restriction (IUGR) into following groups: genetic and constitutional factors (maternal height, prepregnancy weight); obstetrical factors (parity, history of low birthweight infant, general morbidity...

Shinde, Mayura

2013-11-27

326

Altered cardiovascular rhythmicity in children born small for gestational age.  

PubMed

Low birth weight is frequently associated with a disproportionately high incidence of cardiovascular disease, diabetes mellitus, and kidney disease in adulthood. Epidemiological studies have identified an inverse association between low birth weight or being small for gestational age and hypertension in adulthood. We hypothesized that children born with low birth weight might have altered circadian and ultradian cardiovascular rhythmicity independent of the prevailing blood pressure level. Twenty-four-hour ambulatory blood pressure and heart rate rhythmicity was prospectively evaluated by Fourier analysis in a cohort of healthy children born with low birth weight and compared with normative pediatric data. Seventy-five children born small for gestational age (mean age, 8.1±2.2 years) and 139 controls matched for age and sex were investigated. In addition to increased 24-hour, daytime, and especially nighttime blood pressure levels (P<0.05), children born small for gestational age exhibited blunted circadian (24-hour) and ultradian (12-, 8-, and 6-hour) blood pressure rhythmicity (P<0.05). In a multivariate analysis including children born with low birth weight and controls, being born with low birth weight independently influenced ultradian blood pressure rhythmicity, whereas in a multivariate analysis including children born with low birth weight only, circadian and ultradian rhythms were independently influenced by catch-up growth, gestational age, and blood pressure level. This study demonstrates blunted circadian and ultradian cardiovascular rhythmicity in prepubertal children born small for gestational age, independent from the presence of arterial hypertension. Circadian and ultradian rhythms may be sensitive indicators for detecting subtle early abnormalities of cardiovascular regulation. PMID:22733461

Wolfenstetter, Ann; Simonetti, Giacomo D; Pöschl, Johannes; Schaefer, Franz; Wühl, Elke

2012-09-01

327

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...

328

Conditions that Influence Drivers' Yielding Behavior for Uncontrolled Crossings  

ERIC Educational Resources Information Center

Pedestrians with visual impairments need to cross streets where traffic signals and traffic signage are not present. This study examined the influences of several interventions, including a pedestrian's use of a mobility cane, on the behavior of drivers when they were expected to yield to a pedestrian crossing at an uncontrolled crossing.…

Bourquin, Eugene; Emerson, Robert Wall; Sauerburger, Dona

2011-01-01

329

Performance Decrements Following Stress: Learned Helplessness, Passive Uncontrollability, or Distrust?  

ERIC Educational Resources Information Center

Three explanations for post-stress performance decrement were investigated--learned helplessness, passive uncontrollability, and distrust. A group of male and female undergraduates at Carthage College (N=112) were exposed to one of four stress treatment conditions: escapable noise (EN), inescapable noise (IN), noise experienced with no expectation…

Twiton, Elizabeth M.; Anderson, Ernest B.

330

Optimal Rendezvous Path Planning to an Uncontrolled Tumbling Target  

E-print Network

). Another problem is that -- according to Orbital Space Debris Program (2011) -- the number of dangerous.chudej@uni-bayreuth.de). Abstract: As the number of uncontrollable objects in low earth orbit is rising, the thread of collisions objects from the important orbits are taken into account by the international space associations

Dettweiler, Michael

331

Uncontrolled Face Recognition by Individual Stable Neural Network  

Microsoft Academic Search

There usually exist diverse variations in face images taken under uncontrolled conditions. Most previous work on face recognition focuses on particular variations and usually assume the absence of oth- ers. Such work is called controlled face recognition. Instead of the 'divide and conquer' strategy adopted by controlled face recognition, this paper presents one of the flrst attempts directly aiming at

Xin Geng; Zhi-hua Zhou; Honghua Dai

2006-01-01

332

Term Based Comparison Metrics for Controlled and Uncontrolled Indexing Languages  

ERIC Educational Resources Information Center

Introduction: We define a collection of metrics for describing and comparing sets of terms in controlled and uncontrolled indexing languages and then show how these metrics can be used to characterize a set of languages spanning folksonomies, ontologies and thesauri. Method: Metrics for term set characterization and comparison were identified and…

Good, B. M.; Tennis, J. T.

2009-01-01

333

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...

334

Body mass index and acid phosphatase locus 1 in diabetic disorders.  

PubMed

The polymorphic enzyme acid phosphatase locus 1 (ACP1) is a candidate gene for obesity disorders. The enzyme is able to dephosphorylate the insulin receptor. Our group has observed a lower plasma glucose level in diabetic subjects carrying the low activity ACP1 phenotypes A and BA, and a positive association between these genotypes and body mass index (BMI). We have now analysed the relationship between BMI and ACP1 in gestational diabetes and in women with type 1 diabetes. We have studied 106 Caucasian women with type 1 diabetes who had previously delivered a liveborn infant, 99 Caucasian women who had had gestational diabetes and 387 healthy fertile women from the same population as controls. ACP1 phenotype was determined by starch gel electrophoresis. In overweight women (BMI > 25), the proportion of low activity ACP1 phenotypes is much lower in type 1 diabetes than in gestational diabetes and in healthy females. In women with BMI ? 25, the proportion of low activity ACP1 phenotypes is slightly lower in gestational diabetes than in type 1 diabetes. Low activity ACP1 phenotypes have diverse effects on susceptibility to overweight depending on the class of diabetic disorder: in subjects with type 2 diabetes and in subjects with gestational diabetes low activity ACP1 phenotypes predispose to an increase in BMI, while in type 1 diabetes these ACP1 phenotypes seem to protect from overweight. PMID:19855922

Gloria-Bottini, F; Magrini, A; Di Renzo, L; De Lorenzo, A; Bergamaschi, A; Bottini, E

2010-12-01

335

Effective strategies to improve the management of diabetes: case illustration from the diabetes health and wellness institute.  

PubMed

Many patients with diabetes do not have access to clinical care or medications, resulting in cases of undiagnosed diabetes or uncontrolled diabetes, especially in patients of low socioeconomic status. Given these considerations, new strategies are needed to control the rampant growth of diabetes and prevent new cases. This article discusses effective strategies for improving the management of diabetes in underserved populations, with special reference to the Juanita J. Craft Diabetes Health and Wellness Institute, a unique partnership between a large, urban integrated health care system, the City of Dallas, and a South Dallas community. PMID:22608871

Rice, Donna; Bain, Tyson M; Collinsworth, Ashley; Boyer, Karen; Fleming, Neil S; Miller, Esteria

2012-06-01

336

Growth Factors in Proliferative Diabetic Retinopathy  

PubMed Central

Many growth factors are implicated in the pathogenesis of proliferative diabetic retinopathy. Alteration of growth factors and their receptors in diabetes has been shown in both experimental and clinical studies. Sustained hyperglycemia resulting from long-standing diabetes leads to several biochemical abnormalities that consequently result in retinal hypoxia. Retinal oxygenation state regulates various growth factors that promote angiogenesis in order to meet the oxygen demands of the tissue. However, unregulated expression of these growth factors and induction of complex cascades leading to augmentation of other proangiogenic factors, which may not be regulated by tissue oxygenation, leads to uncontrolled retinal neovascularization and blindness in diabetic patients. PMID:14668050

Khan, Zia Ali

2003-01-01

337

A rare case of type 1 diabetes mellitus with pituitary hypoplasia.  

PubMed

Growth failure and pubertal abnormalities are not uncommon in chronic uncontrolled metabolic diseases like diabetes mellitus. We present a young girl with uncontrolled type 1 diabetes mellitus, who presented with short stature and primary amenorrhea, and on evaluation was found to have anterior pituitary hypoplasia. In addition to uncontrolled diabetes mellitus, she presented with early onset growth failure and lack of spontaneous secondary sexual characteristics. She had central hypothyroidism and inappropriately normal gonadotropin levels. However her serum cortisol levels were normal. MRI of the sellar-suprasellar region revealed a small anterior pituitary gland with thinning of the pituitary stalk consistent with pituitary hypoplasia. While uncontrolled type 1 diabetes itself may cause growth retardation and pubertal abnormalities, this girl had coexisting pituitary maldevelopment - a rare co-existence of two major illnesses of unrelated etiologies. The partial pituitary hormonal deficiency, which spared the hypothalamo-pituitary-adrenal axis, may be due to a transcription factor defect. PMID:25220923

Pinto, Jostol; Sudeep, K; Venkatesha, B M

2014-01-01

338

Diabetic ketoacidosis in toddler with a diaper rash.  

PubMed

The term diabetes does not denote a single disease entity but rather a clinical syndrome. Fundamental to all types of diabetes is impairment of insulin secretion by the pancreatic beta cells. Diabetes is divided into (1) diabetes associated with certain syndromes or conditions, (2) gestational diabetes, (3) non-insulin-dependent diabetes or type 2 diabetes, and (4) insulin-dependent diabetes (IDDM) or type 1 diabetes. The impairment of insulin secretion seen in diabetes is due to progressive loss of pancreatic beta-cell function secondary to an autoimmune-mediated process. Diabetes mellitus is the most common metabolic disorder of childhood (2). We present a patient with a common finding in children, diaper candidiasis. Surprisingly, our patient was found to have IDDM and be in diabetic ketoacidosis. PMID:18774050

Williams, Mark D; Sallee, Don; Robinson, Matthew

2008-09-01

339

Approach speeds at uncontrolled intersections with restricted sight distances  

Microsoft Academic Search

An unobtrusive study was made of vehicles approaching low-volume, uncontrolled cross-intersections, with restricted right sight distances, at which the give-way-to-the-right rule was operative. The hypotheses were that one factor that influenced motorists' approach speeds on the major road was the frequency with which vehicles emerged from the right and that most drivers exceeded the safe approach speed when this probability

S. Austin Lovegrove

1978-01-01

340

Structural analysis of reinforced concrete chimneys subjected to uncontrolled fire  

Microsoft Academic Search

We studied the behavior and residual structural capacity of reinforced concrete chimneys subjected to an uncontrolled fire. We used a combination of a heat transfer finite element model–to obtain the temporal distributions of temperature during the fire event–and the structural model of concrete chimney design provided by the American Concrete Institute (ACI 307–08). This approach allows estimating the reduction in

Ashkan Vaziri; Amin Ajdari; Hosam Ali; Artemis Agelaridou Twohig

2011-01-01

341

Preconception care in diabetic women  

PubMed Central

Introduction: Diabetes is increasingly becoming prevalent worldwide. Pregnancy with diabetes is prone to maternal and fetal complications. Preconception care (PCC) is an important factor in alleviating gestational complications in those women who suffer from diabetes. This study seeks to gain insight into experiences of diabetic women and providers about PCC. Subjects and Methods: The present research was a qualitative research conducted on eight women with diabetes during the reproductive age and 15 health care providers of the public and private medical centers, which provide health care for women with diabetes in Isfahan (Iran), with a qualitative approach. Based on the aims of research, purposive sampling was done through semi-structuralized individual interview. Data were analyzed using conventional qualitative content analysis method. Results: Data analysis revealed three major categories: (1) Health centers weakness in providing PCC for diabetic women, (2) lack of a comprehensive PCC plan for diabetic women and (3) diabetic women's negligence about having planned pregnancy. Conclusion: In order to improve diabetic women's health, precise training of students, health care providers and patients themselves with respect to PCCs should be taken into account. Designing diabetic PCC system is an essential factor to succeed in this trend.

Nekuei, Nafisehsadat; Kohan, Shahnaz; Kazemi, Ashraf

2015-01-01

342

[New insights in steroid diabetes].  

PubMed

Glucocorticoids (GC) are the cornerstone in the treatment of numerous chronic autoimmune and inflammatory diseases. GC treatment is accompanied by significant metabolic adverse effects, including insulin resistance, glucose intolerance and diabetes, visceral adiposity, dyslipidemia and skeletal muscle atrophy. GCs are the most common cause of drug-induced diabetes mellitus. However, not everyone treated with glucocorticoids develops diabetes. Predictors of development of diabetes are age, weight, family history of diabetes mellitus, or personal history of gestational diabetes. There is evidence that patients with decreased insulin secretory reserve are much more likely to develop diabetes. Diabetes from topical steroid use is uncommon, but high-dose steroids have been associated with significant hyperglycemia, including development of hyperglycemic hyperosmolar syndrome and even diabetic ketoacidosis in patients with type 1 diabetes mellitus. Several mechanisms contribute to the development of hyperglycemia and steroid-induced diabetes, including decreased peripheral insulin sensitivity, increased hepatic glucose production, and inhibition of pancreatic insulin production and secretion. Physicians treating patients with GCs should be aware of the induction of metabolic disturbances and should not solely rely on fasting measurements. In addition, our review indicates that insulin therapy could be considered when treating patients on GC therapy. PMID:23814973

Kurir, Tina Ticinovi?; Bozi?, Josko; Markoti?, Anita; Novak, Anela

2012-10-01

343

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 ...

344

An Uncontrolled Walking Toy That Cannot Stand Still  

NASA Astrophysics Data System (ADS)

We built a simple two-leg toy that can walk stably with no control system. It walks downhill powered only by gravity. It seems to be the first McGeer-like passive-dynamic walker that is statically unstable in all standing positions, yet is stable in motion. It is one of a few known mechanical devices that are stable near a statically unstable configuration but do not depend on spinning parts. Its design is loosely based on simulations which do not predict its observed stability. Its motion highlights the possible role of uncontrolled nonholonomic mechanics in balance.

Coleman, Michael J.; Ruina, Andy

1998-04-01

345

Women and Diabetes -- Diabetes Medicines  

MedlinePLUS

... Audience For Women Women's Health Topics Women and Diabetes - Diabetes Medicines Print and Share (PDF 372 KB) Diabetes ... 1-800-332-1088 to request a form. Diabetes Medicines The different kinds of diabetes medicines are ...

346

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

347

Ethanol Consumption by Rat Dams During Gestation,  

E-print Network

beverages. Maternal consumption of alcohol during pregnancy and nursing leads to blood- ethanol levelsEthanol Consumption by Rat Dams During Gestation, Lactation and Weaning Increases Ethanol examined effects of ethanol consumption in rat dams during gestation, lactation, and weaning on voluntary

Galef Jr., Bennett G.

348

What Are the Key Statistics for Gestational Trophoblastic Disease?  

MedlinePLUS

... for gestational trophoblastic disease? What are the key statistics about gestational trophoblastic disease? Gestational trophoblastic (jeh-STAY- ... Symptoms of Cancer Treatments & Side Effects Cancer Facts & Statistics News About Cancer Expert Voices Blog Programs & Services ...

349

Problems and Immediate Outcome of Infants of Diabetic Mothers  

Microsoft Academic Search

Summary: Objective:The present study was undertaken to evaluate the problems and immediate outcome of infants of diabetic mothers(IDMs) in early neonatal period and to compare the results between infants of gestational and pregestational diabetic mothers. Design: A hospital based prospective study. Setting: The study was done in Chittagong Medical College Hospital, a tertiary hospital in Chittagong city. Method: Within one

CB MAHMOOD; MI KAYES

2008-01-01

350

Embryonic Pig Pancreatic Tissue Transplantation for the Treatment of Diabetes  

Microsoft Academic Search

BackgroundTransplantation 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

Smadar Eventov-Friedman; Dalit Tchorsh; Helena Katchman; Elias Shezen; Anna Aronovich; Gil Hecht; Benjamin Dekel; Gideon Rechavi; Bruce R. Blazar; Ilan Feine; Orna Tal; Enrique Freud; Yair Reisner

2006-01-01

351

What I Need to Know about Gestational Diabetes  

MedlinePLUS

... Pacific Islander American have a hormonal disorder called polycystic ovary syndrome , also known as PCOS [ Top ] How can I lower my chances of ... nuh-KOL-uh-jist) pancreas (PAN-kree-uhss) polycystic ovary syndrome (POL-ee-SISS-tik) (OH-vuh-ree) (SIN- ...

352

Pulmonary tuberculosis and mucormycosis co-infection in a diabetic patient  

PubMed Central

Uncontrolled diabetes mellitus is associated with a variety of infections which pose management difficulties. Herein, we report a case of diabetic patient who developed combined pulmonary tuberculosis and mucormycosis. The case illustrates management of this rare co-infection which despite being potentially fatal was treated successfully. PMID:25624598

Aggarwal, Deepak; Chander, Jagdish; Janmeja, Ashok K.; Katyal, Rahul

2015-01-01

353

Face recognition in real uncontrolled environment with correlation filters  

NASA Astrophysics Data System (ADS)

Face recognition is a task that humans perform daily and effortlessly. In pattern recognition and computer vision, there has been an increasing interest in automatic face recognition over the past years. Facial recognition systems face challenging problems owing to inherent variations of some factors at image acquisition, such as nonuniform illumination, pose changes, occlusion and ageing. Numerous techniques were proposed for face recognition in still images. Despite recent achievements in this area, the problem of a reliable facial recognition in a real uncontrolled scene still remains open. This work introduces an algorithm that is based on composite correlation filters and does not require prior face segmentation. Optimal filters with respect to the discrimination capability criterion are derived and used to synthesize a single composite filter that can be used for distortion invariant face recognition. Computer simulation results obtained with the suggested algorithm are presented and discussed.

Garduño-Massieu, Susana; Kober, Vitaly

2012-10-01

354

Circulatory death determination in uncontrolled organ donors: a panel viewpoint.  

PubMed

One barrier for implementing programs of uncontrolled organ donation after the circulatory determination of death is the lack of consensus on the precise moment of death. Our panel was convened to study this question after we performed a similar analysis on the moment of death in controlled organ donation after the circulatory determination of death. We concluded that death could be determined by showing the permanent or irreversible cessation of circulation and respiration. Circulatory irreversibility may be presumed when optimal cardiopulmonary resuscitation efforts have failed to restore circulation and at least a 7-minute period has elapsed thereafter during which autoresuscitation to restored circulation could occur. We advise against the use of postmortem organ support technologies that reestablish circulation of warm oxygenated blood because of their risk of retroactively invalidating the required conditions on which death was declared. PMID:23796628

Bernat, James L; Bleck, Thomas P; Blosser, Sandralee A; Bratton, Susan L; Capron, Alexander M; Cornell, Danielle; DeVita, Michael A; Fulda, Gerard J; Glazier, Alexandra K; Gries, Cynthia J; Mathur, Mudit; Nakagawa, Thomas A; Shemie, Sam D

2014-04-01

355

Diabetic Neuropathy  

MedlinePLUS

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

356

Menopause and risk of diabetes in the Diabetes Prevention Program  

PubMed Central

Objective The study objective was to examine the association between menopause status and diabetes risk among women with glucose intolerance and to determine if menopausal status modifies response to diabetes prevention interventions. Methods The study population included women in premenopause (n=708), natural postmenopause (n=328), and bilateral oophorectomy (n=201) in the Diabetes Prevention Program (DPP), a randomized placebo-controlled trial of lifestyle intervention and metformin among glucose intolerant adults. Associations between menopause and diabetes risk were evaluated using Cox proportional hazard models that adjusted for demographic variables (age, race/ethnicity, family history of diabetes, history of gestational diabetes mellitus), waist circumference, insulin resistance and corrected insulin response. Similar models were constructed after stratification by menopause type and hormone therapy (HT) use. Results After adjustment for age, there was no association between natural menopause or bilateral oophorectomy and diabetes risk. Differences by study arm were observed in women who reported bilateral oophorectomy. In the lifestyle arm, women with bilateral oophorectomy had a lower adjusted hazard for diabetes (HR 0.19, 95% CI 0.04, 0.94), although observations were too few to determine if this was independent of HT use. No significant differences were seen in the metformin (HR 1.29, 95% CI 0.63, 2.64) or placebo arms (HR 1.37, 95% CI 0.74, 2.55). Conclusions Among women at high-risk for diabetes, natural menopause was not associated with diabetes risk and did not affect response to diabetes prevention interventions. In the lifestyle intervention, bilateral oophorectomy was associated with decreased diabetes risk. PMID:21709591

Kim, Catherine; Edelstein, Sharon L.; Crandall, Jill P.; Dabelea, Dana; Kitabchi, Abbas E.; Hamman, Richard F.; Montez, Maria G.; Perreault, Leigh; Foulkes, Mary A.; Barrett-Connor, Elizabeth

2012-01-01

357

Diabetes Prevention Interventions for Women with a History of GDM  

Microsoft Academic Search

\\u000a Women with a history of gestational diabetes (GDM) are at increased risk of later developing type 2 diabetes. Lifestyle modification\\u000a interventions promoting weight loss and pharmacotherapy interventions to improve insulin sensitivity have been shown to be\\u000a effective in preventing or delaying the onset of type 2 diabetes in older women with impaired glucose tolerance and\\/or a previous\\u000a pregnancy complicated by

Assiamira Ferrara; Samantha F. Ehrlich

358

Physical Activity, Obesity, and Diabetes in Pregnancy  

Microsoft Academic Search

Gestational diabetes mellitus (GDM) is the most common medical complication of pregnancy. Women with GDM are at elevated risk for numerous maternal health complications, and their infants are at elevated risk for death and morbidity. Management of GDM has traditionally been through diet and close monitoring of glucose levels, with initiation of insulin therapy when diet alone fails to maintain

Timothy D. Dye; Kerry L. Knox; Raul Artal; Richard H. Aubry; Martha A. Wojtowycz

359

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.

360

Treatment Options for Gestational Trophoblastic Disease  

MedlinePLUS

... has spread to other places, such as the lung or abdomen . Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with placental-site gestational trophoblastic tumor and epithelioid ...

361

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

362

Exercise and Type 2 Diabetes  

PubMed Central

Although physical activity (PA) is a key element in the prevention and management of type 2 diabetes, many with this chronic disease do not become or remain regularly active. High-quality studies establishing the importance of exercise and fitness in diabetes were lacking until recently, but it is now well established that participation in regular PA improves blood glucose control and can prevent or delay type 2 diabetes, along with positively affecting lipids, blood pressure, cardiovascular events, mortality, and quality of life. Structured interventions combining PA and modest weight loss have been shown to lower type 2 diabetes risk by up to 58% in high-risk populations. Most benefits of PA on diabetes management are realized through acute and chronic improvements in insulin action, accomplished with both aerobic and resistance training. The benefits of physical training are discussed, along with recommendations for varying activities, PA-associated blood glucose management, diabetes prevention, gestational diabetes mellitus, and safe and effective practices for PA with diabetes-related complications. PMID:21115758

Colberg, Sheri R.; Sigal, Ronald J.; Fernhall, Bo; Regensteiner, Judith G.; Blissmer, Bryan J.; Rubin, Richard R.; Chasan-Taber, Lisa; Albright, Ann L.; Braun, Barry

2010-01-01

363

Homocysteine, Cortisol, Diabetes Mellitus, and Psychopathology  

PubMed Central

Objective. This study investigates the association of homocysteine and cortisol with psychological factors in type 2 diabetic patients. Method. Homocysteine, cortisol, and psychological variables were analyzed from 131 diabetic patients. Psychological factors were assessed with the Eysenck Personality Questionnaire (EPQ), Hostility and Direction of Hostility Questionnaire (HDHQ), the Symptom Checklist 90-R (SCL 90-R), the Zung Self-Rating Depression Scale (ZDRS), and the Maudsley O-C Inventory Questionnaire (MOCI). Blood samples were taken by measuring homocysteine and cortisol in both subgroups during the initial phase of the study (T0). One year later (T1), the uncontrolled diabetic patients were reevaluated with the use of the same psychometric instruments and with an identical blood analysis. Results. The relation of psychoticism and homocysteine is positive among controlled diabetic patients (P value = 0.006 < 0.05) and negative among uncontrolled ones (P value = 0.137). Higher values of cortisol correspond to lower scores on extraversion subscale (rp = ?0.223, P value = 0.010). Controlled diabetic patients showed a statistically significant negative relationship between homocysteine and the act-out hostility subscale (rsp = ?0.247, P = 0.023). There is a statistically significant relationship between homocysteine and somatization (rsp = ?0.220, P = 0.043). Conclusions. These findings support the notion that homocysteine and cortisol are related to trait and state psychological factors in patients with diabetes mellitus type 2. PMID:25722989

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

2015-01-01

364

Acute Infectious Morbidity in Multiple Gestation  

PubMed Central

Objectives. Physiologic and immunologic changes in pregnancy result in increased susceptibility to infection. These shifts are more pronounced in pregnancies complicated by multiple gestation. The objective of this study was to determine the association between multiple gestation and risk of infectious morbidity. Study Design. The Nationwide Inpatient Sample for the years 2008–2010 was used to identify pregnant women during admission for delivery with International Classification of Diseases codes. Logistic regression was used to compute odds ratios and 95% confidence intervals for demographic data, preexisting medical conditions, and acute medical and infectious complications for women with multiple versus singleton gestations. Results. Among women with multiple gestation, 38.4 per 1,000 women had an infectious complication compared to 12.8 per 1,000 women with singletons. The most significant infectious morbidity associated with multiple gestation was intestinal infections, pyelonephritis, influenza, and pneumonia. After controlling for confounding variables, infectious complications at delivery persisted for women with multiples, though the association was dependent on mode of delivery. Conclusions. Women with multiple gestations are at increased risk for infectious morbidity identified at the time of delivery. This association was diminished among women who had a cesarean suggesting that operative delivery is not responsible for this association. PMID:25684973

Grotegut, Chad A.; Heine, R. Phillips

2015-01-01

365

Impaired activity of serum alpha-1-antitrypsin in diabetes mellitus  

Microsoft Academic Search

Alpha-1-antitrypsin (AAT) is the prototypic member of the serine protease inhibitor (serpin) superfamily of proteins, which has a major role in inactivating neutrophil elastase and other proteases to maintain protease–antiprotease balance. In this study, the serum AAT was measured using enzymatic assay in diabetic patients.The serum trypsin inhibitory capacity (s-TIC) was determined in 144 outpatients with uncontrolled insulin-dependent diabetes mellitus

Mohammad Hashemi; Mohammad Naderi; Homaira Rashidi; Saeid Ghavami

2007-01-01

366

Fault analysis of uncontrolled rectifier HVDC links for the connection of off-shore wind farms  

Microsoft Academic Search

The present paper introduces the use of an uncontrolled rectifier HVDC link for the connection of off-shore wind farms. The use of an uncontrolled rectifier instead of a line commutated thyristor (LCT) rectifier represents clear advantages in terms of installation cost and operation reliability. However, the rectifier can no longer be used to limit the HVDC link current during on-shore

R. Blasco-Gimenez; S. Ano-Villalba; J. Rodriguez; R. Pena; R. Cardenas; S. Bernal; F. Morant

2009-01-01

367

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

368

Effects of Maternal and Infant Characteristics on Birth Weight and Gestation Length in a Colony of Rhesus Macaques (Macaca mulatta)  

PubMed Central

A retrospective study using maternal and birth statistics from an open, captive rhesus macaque colony was done to determine the effects of parity, exposure to simian retrovirus (SRV), housing, maternal parity, and maternal birth weight on infant birth weight, viability and gestation length. Retrospective colony statistics for a 23-y period indicated that birth weight, but not gestation length, differed between genders. Adjusted mean birth weights were higher in nonviable infants. Mothers positive for SRV had shorter gestations, but SRV exposure did not affect neonatal birth weights or viability. Infants born in cages had longer gestations than did those born in pens, but neither birth weight nor viability differed between these groups. Maternal birth weight did not correlate with infant birth weight but positively correlated with gestation length. Parity was correlated with birth weight and decreased viability. Increased parity of the mother was associated with higher birth weight of the infant. A transgenerational trend toward increasing birth weight was noted. The birth statistics of this colony were consistent with those of other macaque colonies. Unlike findings for humans, maternal birth weight had little predictive value for infant outcomes in rhesus macaques. Nonviable rhesus infants had higher birth weights, unlike their human counterparts, perhaps due to gestational diabetes occurring in a sedentary caged population. Similar to the situation for humans, multiparity had a protective effect on infant viability in rhesus macaques. PMID:19149417

Hopper, Kelly J; Capozzi, Denise K; Newsome, Joseph T

2008-01-01

369

Effects of nutritional management intervention on gestational weight gain and perinatal outcome  

PubMed Central

ABSTRACT Objectives: To evaluate whether nutritional management intervention can prevent excessive weight gain during pregnancy and improve perinatal outcomes. Methods: This cross-sectional study included 276 pregnant women undergoing prenatal care between June 2010 and December 2011 at the Obstetrics and Gynecology Department of the Second Affiliate Hospital of the ChongQing University of Medical Sciences, Chongqing, China. Of them, 131 women received individualized nutritional management in addition to routine prenatal care (intervention group), and 145 women received only routine prenatal care (control group). The primary study outcome was gestational weight gain (GWG). Secondary outcomes included birth weight, Apgar score, and incidence of pregnancy complications. Results: Baseline demographic characteristics of the 2 groups were the same. The average GWG was higher in the control group (12.57±4.62 kg) compared with the intervention group (7.58±1.59 kg; p=0.000). The incidence rate of preeclampsia was 3.1% and gestational diabetes was 3.8% for the intervention group, compared with 11% for preeclampsia and 14.5% gestational diabetes for the control group (p<0.05). The incidence rates of premature rupture of membranes, preterm labor, birth weight, birth of a newborn, and major congenital anomalies did not significantly differ between the 2 groups. Conclusion: Nutritional management intervention prevented excessive GWG and improved perinatal outcomes. These results support the hypothesis that nutritional management intervention can decrease the rate of complications experienced by expecting mothers. PMID:25316475

Luo, Xiao-Dong; Dong, Xiaojing; Zhou, Jin

2014-01-01

370

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

371

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 ...

372

Monogenic Diabetes  

MedlinePLUS

... gene. In contrast, the most common types of diabetes—type 1 and type 2—are caused by multiple genes ( ... some children with monogenic diabetes are misdiagnosed with type 1 diabetes and are given insulin. When correctly diagnosed, some ...

373

Complications during gestation in the cow.  

PubMed

Uterine torsion and vaginal prolapse are accidents of gestation; this paper first reviews the predisposition, symptoms, diagnosis, and treatment of uterine torsion, and the predisposition, pathogenesis, symptoms, treatment, and prognosis of vaginal prolapse during late gestation in the cow. Other noninfectious complications of gestation are either fetal or placental in origin. Two relatively unusual fetal problems, mummification and maceration, are also discussed, followed by a comparison of two hydropic conditions (hydrallantois and hydramnios). Hydrops allantois, primarily a placental problem, occurs about nine times more frequently than hydrops amnii, which is a result of fetal anomalies. Abnormal offspring syndrome is a more recent phenomenon associated with the transfer of IVF or SCNT embryos. Finally, reference is made to teratology in general and a website of illustrations is cited. PMID:17531308

Drost, M

2007-08-01

374

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

375

A comparison of maternal and cord blood glucose levels in diabetic and non-diabetic nigerians in relation to birth weight and maternal body mass index  

Microsoft Academic Search

Pregnancy exerts a diabetogenic effect even in normal females..Mthough reports ~ show no elevation of the fasting blood glucose, postabsorptive glucose levels during glucose tolerance testing showed a general rise with the progression of pregnancy. Newborn infants of diabetics or women with gestatJonal diabetes are frequently longer and heavier than those of nondiabetics. The excess length and weight have been

Jones O. Akpan

1989-01-01

376

Statistical Issues for Uncontrolled Reentry Hazards Empirical Tests of the Predicted Footprint for Uncontrolled Satellite Reentry Hazards  

NASA Technical Reports Server (NTRS)

A number of statistical tools have been developed over the years for assessing the risk of reentering objects to human populations. These tools make use of the characteristics (e.g., mass, material, shape, size) of debris that are predicted by aerothermal models to survive reentry. The statistical tools use this information to compute the probability that one or more of the surviving debris might hit a person on the ground and cause one or more casualties. The statistical portion of the analysis relies on a number of assumptions about how the debris footprint and the human population are distributed in latitude and longitude, and how to use that information to arrive at realistic risk numbers. Because this information is used in making policy and engineering decisions, it is important that these assumptions be tested using empirical data. This study uses the latest database of known uncontrolled reentry locations measured by the United States Department of Defense. The predicted ground footprint distributions of these objects are based on the theory that their orbits behave basically like simple Kepler orbits. However, there are a number of factors in the final stages of reentry - including the effects of gravitational harmonics, the effects of the Earth s equatorial bulge on the atmosphere, and the rotation of the Earth and atmosphere - that could cause them to diverge from simple Kepler orbit behavior and possibly change the probability of reentering over a given location. In this paper, the measured latitude and longitude distributions of these objects are directly compared with the predicted distributions, providing a fundamental empirical test of the model assumptions.

Matney, Mark

2011-01-01

377

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

378

COSTS OF REMEDIAL ACTIONS AT UNCONTROLLED HAZARDOUS WASTE SITES: WORKER HEALTH AND SAFETY CONSIDERATIONS  

EPA Science Inventory

Superfund resources are currently being spent to clean up many uncontrolled hazardous waste sites. Pursuant to requirements stipulated in Section 105 of the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) of 1980, the cost-effectiveness of remedial ...

379

Analysis of means of improving the uncontrolled lateral motions of personal airplanes  

NASA Technical Reports Server (NTRS)

A theoretical analysis has been made of means of improving the uncontrolled motions of personal airplanes. The purpose of this investigation was to determine whether such airplanes could be made to fly uncontrolled for an indefinite period of time without getting into dangerous attitudes and for a reasonable period of time (1 to 3 min) without deviating excessively from their original course. The results of this analysis indicated that the uncontrolled motions of a personal airplane could be made safe as regards spiral tendencies and could be greatly improved as regards maintenance of course without resort to an autopilot. The only way to make the uncontrolled motions completely satisfactory as regards continuous maintenance of course, however, is to use a conventional type of autopilot.

Mckinney, Marion O , Jr

1951-01-01

380

USE OF REMOTE SENSING TECHNIQUES IN A SYSTEMATIC INVESTIGATION OF AN UNCONTROLLED HAZARDOUS WASTE SITE  

EPA Science Inventory

This report describes the use and evaluation of several remote sensing techniques in conjunction with direct sample collection in order to develop a systematic approach for subsurface investigations at uncontrolled hazardous waste sites. Remote sensing techniques (electrical resi...

381

DIOXIN EMISSIONS FROM OPEN AND UNCONTROLLED BURNING OF BIOMASS AND WASTE  

EPA Science Inventory

Emissions of polychlorinated dibenzodioxins and dibenszofurans (PCDD/PCDF) from uncontrolled burring of biomass and waste are responsible for a significant, if not major, portion of the global releases. Limited testing for emissions, coupled with activity factors, shows that som...

382

Mid-gestational serum uric acid concentration effect on neonate birth weight and insulin resistance in pregnant women  

PubMed Central

Objective To investigate the relationship between mid-gestational serum uric acid and birth weight in diabetic pregnant women with or without insulin resistance. Methods: In a prospective cohort study, fasting uric acid, blood glucose, and serum insulin were measured in 247 pregnant women between 20-22 weeks of gestational period. Insulin resistance was estimated using the homeostasis model assessment-insulin resistance (HOMA-IR). Stratification analysis and independent t-test was used to assess the association between uric acid and birth weights regarding to insulin resistance. Results: The means of the mid-gestational serum uric acid concentrations were not significantly different in women with and without insulin resistance. But stratification analysis showed that there was a significant difference between uric acid concentration and macrosomic birth in diabetic women without insulin resistance. Conclusions: Higher mid – gestation serum uric acid concentration, even if it does not exceed the normal range, is accompanied by lower birth weight only in non-insulin resistance women. Insulin resistance could have a negative confounding effect on hyperuriemia and birth weight.

Nasri, Khadijeh; Razavi, Maryamsadat; Rezvanfar, Mohammad Reza; Mashhadi, Esmat; Chehrei, Ali; Mohammadbeigi, Abolfazl

2015-01-01

383

Placental hyaluronidase expression during gestation in swine  

Technology Transfer Automated Retrieval System (TEKTRAN)

Previous results have shown that microscopic folds of the epithelial bilayer of the porcine placenta deepen as gestation advances and that epithelial folds of placenta associated with small fetuses deepen more than placenta of large fetuses. These modifications likely provide more surface area for m...

384

Nonamyloidotic Fibrillar Glomerulopathy and Recurrent Gestational Anasarca  

Microsoft Academic Search

Congo-red-negative microfibrils have been described in various glomerular diseases, some of which have no known etiology. We report the unusual case of a young woman who, over a period of 17 years, developed recurrent gestational anasarca but was asymptomatic between pregnancies except for proteinuria. Her blood pressure and renal function have remained normal over the years. A renal biopsy done

Asad A. Bakir; Herman Ainis; Hwaja L. Rhee

1990-01-01

385

Diabetes among Alaska Natives: a review.  

PubMed

This review summarizes the published information on diabetes mellitus and gestational diabetes among Alaska Natives. The most recently published age-adjusted prevalence was 28.3/1000 in 1998. There is evidence of a steadily increasing prevalence, documented both by cross sectional screening studies and patient registry methods. The overall incidence rates in 1986-1998 of lower extremity amputation (6.1/1000) and renal replacement therapy (2.1/1000) appear to be lower than those in other Native American populations in the United States. Incidence of stroke and MI in 1986-1998 varied widely by ethnic group and gender with Eskimo women having the highest rate of stroke (19.6/1000), and Aleut men the highest rate of MI (14/1000). The overall mortality among diabetic Alaska Native people in 1986-1993 (43.2/1000) was somewhat lower than that in other US diabetic populations, with heart disease being the most common cause of death. A high rate of gestational diabetes (6.7%) was reported in one region in 1987-88, but this appeared to decline following nutritional education intervention. In screening studies, the prevalence of abnormal glucose tolerance has been found to be positively associated with body mass index and negatively associated with daily seal oil or salmon consumption and higher levels of physical activity. Observations on the prevalence and relationships among other factors in the insulin resistance syndrome are summarized. Suggestions for prevention of diabetes and further studies are presented. PMID:14964764

Naylor, J L; Schraer, C D; Mayer, A M; Lanier, A P; Treat, C A; Murphy, N J

2003-12-01

386

The effect of pregestational diabetes on fetal heart function.  

PubMed

Pregestational diabetes affects nearly 2% of all pregnancies. Moreover, Type 2 diabetes in child-bearing women is on the rise because of the childhood obesity epidemic. Pregestational diabetes can affect the fetal heart in several ways. First, the risk of fetal congenital heart disease is markedly increased; second, fetal hypertrophic cardiomyopathy may occur even with good glycemic control; third, studies have shown impaired function of the hearts of some infants and fetuses of diabetic pregnancies, which can occur with and without septal hypertrophy. Small-for-gestational-age infants of diabetic mothers may have diminished cardiovascular health in the long term. This review mainly discusses methods to detect fetal diabetic cardiomyopathy prenatally. The focus is on the noninvasive diagnostic markers that can serve as an outcome measure for future therapeutic trials, which are still lacking. There is some experimental research on treatment strategies to prevent fetal heart disease in diabetic pregnancies but little clinical data. PMID:25431859

Pauliks, Linda B

2015-01-01

387

The diabetic foot: a review.  

PubMed

Diabetic foot ulceration (DFU) is among the most frequent complications of diabetes. Neuropathy and ischaemia are the initiating factors and infection is mostly a consequence. We have shown in this review that any DFU should be considered to have vascular impairment. DFU will generally heal if the toe pressure is >55 mmHg and a transcutaneous oxygen pressure (TcPO2) <30 mmHg has been considered to predict that a diabetic ulcer may not heal. The decision to intervene is complex and made according to the symptoms and clinical ?ndings. If both an endovascular and a bypass procedure are possible with an equal outcome to be expected, endovascular treatments should be preferred. Primary and secondary mid-term patency rates are better after bypass, but there is no difference in limb salvage. Bedridden patients with poor life expectancy and a non-revascularisable leg are indications for performing a major amputation. A deep infection is the immediate cause of amputation in 25% to 50% of diabetic patients. Patients with uncontrolled abscess, bone or joint involvement, gangrene, or necrotising fasciitis have a "foot-at risk" and need prompt surgical intervention with debridement and revascularisation. As demonstrated in this review, foot ulcer in diabetic is associated with high mortality and morbidity. Early referral, non-invasive vascular testing, imaging and intervention are crucial to improve DFU healing and to prevent amputation. Diabetics are eight to twenty-four times more likely than non-diabetics to have a lower limb amputation and it has been suggested that a large part of those amputations could be avoided by an early diagnosis and a multidisciplinary approach. PMID:24126512

Ricco, J B; Thanh Phong, L; Schneider, F; Illuminati, G; Belmonte, R; Valagier, A; Régnault De La Mothe, G

2013-12-01

388

Delayed interval delivery in a triplet gestation.  

PubMed

A 27-year-old Ghanaian primigravida with a known triamniotic trichorionic triplet pregnancy presented at 17 weeks gestation following a miscarriage of one triplet at home. Examination and investigation revealed no signs of imminent delivery or infection. After careful counselling with regard to prognosis and options available for management, the couple opted for intervention including rescue cerclage. The patient received antibiotic prophylaxis for five days and daily progesterone suppositories until delivery. An ultrasound scan was performed every three weeks to monitor fetal growth and cervical length. At 24 weeks corticosteroids for fetal lung maturity were given. At 31 weeks gestation she experienced spontaneous rupture of membranes followed by active labour and forceps delivery. There were no maternal complications. Both babies were born in a good condition, but required ventilatory support for 72 h. PMID:23188854

Wooldridge, Rachel J; Oliver, Emily A; Singh, Tulika

2012-01-01

389

Gestational weight gain among Hispanic women.  

PubMed

To describe gestational weight gain among Hispanic women and to examine psychological, social, and cultural contexts affecting weight gain. A total of 282 Hispanic women were surveyed post-partum before leaving the hospital. Women were queried about their prepregnancy weight and weight gained during pregnancy. Adequacy of gestational weight gain was based on guidelines set by the Institute of Medicine in 2009. Independent risk factors for excessive or insufficient weight gain were examined by logistic regression. Most women were unmarried (59 %), with a mean age of 28.4 ± 6.6 years and an average weight gain of 27.9 ± 13.3 lbs. Approximately 45 % of women had gained too much, 32 % too little, and only 24 % had an adequate amount of weight gain. The mean birth weight was 7.3, 7.9, and 6.8 lbs among the adequate, excessive, and insufficient weight gain groups. Among women who exercised before pregnancy, two-thirds continued to do so during pregnancy; the mean gestational weight gain of those who continued was lower than those who stopped (26.8 vs. 31.4 lbs, p = 0.04). Independent risk factors for excessive weight gain were being unmarried, U.S. born, higher prepregnancy body mass index, and having indifferent or negative views about weight gain. Independent risk factors for insufficient weight gain were low levels of support and late initiation of prenatal care. Depression, stress, and a woman's or her partner's happiness regarding pregnancy were unrelated to weight gain. The results of this study can be used by prenatal programs to identify Hispanic women at risk for excessive or insufficient gestational weight gain. PMID:23456347

Sangi-Haghpeykar, Haleh; Lam, Kim; Raine, Susan P

2014-01-01

390

Cognitive restraint, uncontrolled eating and emotional eating: correlations between parent and adolescent.  

PubMed

The purpose of this study was to examine, in a general population, the resemblance in eating behaviour between adolescents and their parents. This study was based on the first examination of a community-based epidemiological study in Northern France. Subjects were offspring aged 14-22 years (135 boys and 125 girls) and their parents (174 fathers and 205 mothers). The Three-Factor Eating Questionnaire Revised 18-item version (TFEQ-R18) identified three aspects of eating behaviour: cognitive restraint of eating, uncontrolled eating and emotional eating. Familial resemblance in eating behaviour was measured by partial Spearman's correlations, adjusted for age and body mass index. Sons' uncontrolled eating was positively related to fathers' cognitive restraint of eating (r = 0.36), but not to fathers' uncontrolled eating (r = 0.07), nor to mothers' eating behaviour. Sons' cognitive restraint of eating was related to no parental eating behaviour scores. In daughters, cognitive restraint of eating was positively related to mothers' uncontrolled eating (r = 0.26), but not to mothers' cognitive restraint of eating (r = 0.13). Daughters' uncontrolled eating and emotional eating were positively associated with the same scores in mothers. Finally, daughters' eating behaviour was not related to fathers' eating behaviour. In conclusion, correlations in eating behaviour were higher with the parent of the same gender, and eating behaviours in adolescents seem to reflect opposition to parents' behaviour more than familial resemblance. PMID:19292751

de Lauzon-Guillain, Blandine; Romon, Monique; Musher-Eizenman, Dara; Heude, Barbara; Basdevant, Arnaud; Charles, Marie Aline

2009-04-01

391

Canine and feline diabetes mellitus: nature or nurture?  

PubMed

There is evidence for the role of genetic and environmental factors in feline and canine diabetes. Type 2 diabetes is the most common form of diabetes in cats. Evidence for genetic factors in feline diabetes includes the overrepresentation of Burmese cats with diabetes. Environmental risk factors in domestic or Burmese cats include advancing age, obesity, male gender, neutering, drug treatment, physical inactivity, and indoor confinement. High-carbohydrate diets increase blood glucose and insulin levels and may predispose cats to obesity and diabetes. Low-carbohydrate, high-protein diets may help prevent diabetes in cats at risk such as obese cats or lean cats with underlying low insulin sensitivity. Evidence exists for a genetic basis and altered immune response in the pathogenesis of canine diabetes. Seasonal effects on the incidence of diagnosis indicate that there are environmental influences on disease progression. At least 50% of diabetic dogs have type 1 diabetes based on present evidence of immune destruction of beta-cells. Epidemiological factors closely match those of the latent autoimmune diabetes of adults form of human type 1 diabetes. Extensive pancreatic damage, likely from chronic pancreatitis, causes approximately 28% of canine diabetes cases. Environmental factors such as feeding of high-fat diets are potentially associated with pancreatitis and likely play a role in the development of pancreatitis in diabetic dogs. There are no published data showing that overt type 2 diabetes occurs in dogs or that obesity is a risk factor for canine diabetes. Diabetes diagnosed in a bitch during either pregnancy or diestrus is comparable to human gestational diabetes. PMID:15284406

Rand, Jacquie S; Fleeman, Linda M; Farrow, Heidi A; Appleton, Delisa J; Lederer, Rose

2004-08-01

392

Regulation of calcitriol biosynthesis and activity: focus on gestational vitamin D deficiency and adverse pregnancy outcomes.  

PubMed

Vitamin D has garnered a great deal of attention in recent years due to a global prevalence of vitamin D deficiency associated with an increased risk of a variety of human diseases. Specifically, hypovitaminosis D in pregnant women is highly common and has important implications for the mother and lifelong health of the child, since it has been linked to maternal and child infections, small-for-gestational age, preterm delivery, preeclampsia, gestational diabetes, as well as imprinting on the infant for life chronic diseases. Therefore, factors that regulate vitamin D metabolism are of main importance, especially during pregnancy. The hormonal form and most active metabolite of vitamin D is calcitriol. This hormone mediates its biological effects through a specific nuclear receptor, which is found in many tissues including the placenta. Calcitriol synthesis and degradation depend on the expression and activity of CYP27B1 and CYP24A1 cytochromes, respectively, for which regulation is tissue specific. Among the factors that modify these cytochromes expression and/or activity are calcitriol itself, parathyroid hormone, fibroblast growth factor 23, cytokines, calcium and phosphate. This review provides a current overview on the regulation of vitamin D metabolism, focusing on vitamin D deficiency during gestation and its impact on pregnancy outcomes. PMID:25584965

Olmos-Ortiz, Andrea; Avila, Euclides; Durand-Carbajal, Marta; Díaz, Lorenza

2015-01-01

393

Regulation of Calcitriol Biosynthesis and Activity: Focus on Gestational Vitamin D Deficiency and Adverse Pregnancy Outcomes  

PubMed Central

Vitamin D has garnered a great deal of attention in recent years due to a global prevalence of vitamin D deficiency associated with an increased risk of a variety of human diseases. Specifically, hypovitaminosis D in pregnant women is highly common and has important implications for the mother and lifelong health of the child, since it has been linked to maternal and child infections, small-for-gestational age, preterm delivery, preeclampsia, gestational diabetes, as well as imprinting on the infant for life chronic diseases. Therefore, factors that regulate vitamin D metabolism are of main importance, especially during pregnancy. The hormonal form and most active metabolite of vitamin D is calcitriol. This hormone mediates its biological effects through a specific nuclear receptor, which is found in many tissues including the placenta. Calcitriol synthesis and degradation depend on the expression and activity of CYP27B1 and CYP24A1 cytochromes, respectively, for which regulation is tissue specific. Among the factors that modify these cytochromes expression and/or activity are calcitriol itself, parathyroid hormone, fibroblast growth factor 23, cytokines, calcium and phosphate. This review provides a current overview on the regulation of vitamin D metabolism, focusing on vitamin D deficiency during gestation and its impact on pregnancy outcomes. PMID:25584965

Olmos-Ortiz, Andrea; Avila, Euclides; Durand-Carbajal, Marta; Díaz, Lorenza

2015-01-01

394

Recurrent Myonecrosis Involving Adductor Muscle Group Bilaterally: A Rare Complication of ?Diabetes Mellitus  

PubMed Central

Diabetic myonecrosis is a rare and underdiagnosed complication of long-standing, uncontrolled diabetes. It usually occurs in patients with long-standing diabetes in the presence of microvascular complications. Thigh muscles are more commonly affected and the usual presentation is thigh swelling with or without pain, systemic features being rare. Magnetic resonance imaging is the gold standard for diagnosis. Most patients recover spontaneously with bed rest, adequate analgesia and good glycemic control. We present a case of recurrent myonecrosis of adductor muscles of the thigh in a patient with long standing type 2 diabetes mellitus who recovered with conservative management. PMID:25584163

Bhat, Manzoor; Laway, Bashir; Kuchay, Muhammad; Mir, Shahnaz; Dar, Farhat; Raja, Waseem

2014-01-01

395

Endothelial dysfunction, inflammation, and insulin resistance: A focus on subjects at risk for type 2 diabetes  

Microsoft Academic Search

Subjects with obesity, family history of type 2 diabetes, polycystic ovary syndrome, previous gestational diabetes, dyslipidemia,\\u000a hypertension, impaired glucose tolerance or impaired fasting glucose, and those with metabolic syndrome are at risk for the\\u000a development of type 2 diabetes. Some of them are also at risk for cardiovascular disease. Some underlying abnormalities such\\u000a as insulin resistance, endothelial dysfunction, and low-grade

A. Enrique Caballero

2004-01-01

396

Diabetes and Vascular Disease  

MedlinePLUS

... for daily life. There are several types of diabetes: Type 1 diabetes (previously called “juvenile diabetes”) is an autoimmune ... 5-10% of Americans who are diagnosed with diabetes have type 1 diabetes. Type 2 diabetes (previously called “adult onset ...

397

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 ...

398

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 ...

399

Diabetic Retinopathy  

MedlinePLUS

... Prevalence Rates for Diabetic Retinopathy by Age, and Race/Ethnicity Hispanic Americans age 50 and older are ... Ethnicity 2010 Prevalence Rates of Diabetic Retinopathy by Race In 2010, Hispanic Americans age 50 and older ...

400

Diabetic Neuropathy  

MedlinePLUS

... need to be treated at a hospital. In severe cases, you may need to have your foot amputated (removed). Because diabetes makes ... What can I do to avoid diabetic neuropathy? The most important thing is to keep ...