Physical activity, gestational weight gain in obese patients with early gestational diabetes and the perinatal outcome - a randomised-controlled trial.

BACKGROUND: Excessive gestational weight gain, especially among women with gestational diabetes, is associated with several adverse perinatal outcomes. Our study aimed to analyse the impact of the use of pedometers to supervise physical activity on maternal health and the obstetric outcomes of pregnant women with obesity and early gestational diabetes. METHODS: 124 pregnant patients were enrolled in the presented research. INCLUSION CRITERIA: singleton pregnancy, age > 18 years, gestational diabetes diagnosed in the first half of pregnancy (< 20th week of pregnancy), obesity according to the American Endocrine Society criteria. Each patient was advised to take at least 5000 steps daily. Patients were randomly assigned to pedometers (N = 62), and were recommended to monitor daily the number of steps. The group without pedometers (N = 62) was not observed. Visit (V1) was scheduled between the 28th and 32nd gestational week (GW), and visit (V2) occurred between the 37th and 39th GW. Anthropometric measurements and blood samples were collected from all patients at each appointment. Foetal and maternal outcomes were analysed at the end of the study. RESULTS: In the group supervised by pedometers, there were significantly fewer newborns with macrosomia (p = 0,03). Only 45% of patients satisfied the recommended physical activity guidelines. Patients who walked more than 5000 steps per day had significantly higher body weight at baseline (p = 0,005), but weight gain was significantly lower than in the group that did not exceed 5000 steps per day (p < 0,001). The perinatal outcome in the group of patients performing more than 5000 steps did not demonstrate significant differences with when compared to less active group. ROC curve for weight gain above the guidelines indicated a statistically substantial cut-off point for this group at the level of 4210 steps/day (p = 0.00001). CONCLUSIONS: Monitoring the activity of pregnant patients with gestational diabetes and obesity by pedometers did not have a significantly impact on their metabolic control and weight gain. However, it contributed to less macrosomia. Furthermore, physical activity over 5,000 steps per day positively affects weight loss, as well as contributes to improved obstetric and neonatal outcomes.

Time Perspective as a Mediator of Depressive Symptoms in Patients with Polycystic Ovary Syndrome.

BACKGROUND: Polycystic ovary syndrome (PCOS) is a chronic endocrinopathy characterized by oligo- or anovulation, clinical and/or biochemical markers of hyperandrogenism, and polycystic ovaries, and it is associated with an increased prevalence of depression. Research conducted on psychiatric patients has shown correlations between depression and decreased cognitive function. The aim of this study was to examine the possible mediation of the time perspective (TP) in the development of depressive symptoms in patients with PCOS. METHODS: A study was conducted on 83 patients with PCOS and 65 healthy women. Standardized questionnaires were used to assess depressive symptoms (Beck Depression Inventory-BDI-II) and time perspective (Zimbardo Time Perspective Inventory-ZTPI). RESULTS: Our study revealed an indirect influence of depressive symptoms on PCOS through the positive future time perspective. In the logistic regression model, which included depression and a given time perspective as predictors of PCOS, only the future TP (ß = -0.004, p < 0.003, OR = 1.004, 95% CI [1.001, 1.008]) was significantly independently related to the occurrence of PCOS. CONCLUSIONS: Our result is another argument for the role of psychoeducation and appropriate communication with a patient from the risk group in a way that builds hope and allows to regain influence on life situation.

Adropin in pregnancy complicated by hyperglycemia and obesity - a preliminary study.

OBJECTIVES: According to the data, approximately 33-37% of women of reproductive age are obese. These numbers are reflected in the increasing number of complications in pregnancy, including gestational diabetes. The study aims to assess the concentrations of adropin in the course of gestational diabetes and their possible relationship with the occurrence of obstetric complications characteristic for it. MATERIAL AND METHODS: The study included 65 obese and overweight pregnant patients (BMI > 27 kg/m²) with glycemic disorders diagnosed during pregnancy. Blood samples we collected during visits: V0 - the first half of pregnancy V1 - 28-32 weeks of gestation, and V2 - 37-39 weeks of gestation. The concentrations of adropin were measured during V1 and V2 by ELISA tests. We analyzed the studied patients' anthropometric, metabolic parameters and obstetrical results. RESULTS: In the study group, at the visit V1, the mean level of adropin was 525.5 mmol/mL and 588.1 mmol/mL for the V2 visit. The comparison of adropin concentration between visits showed a statistically significant increase (p = 0.02). The concentration of adropin did not differ between obese and morbidly obese patients at V1, but at V2, there was a significant lover adropin level in morbidly obese patients. CONCLUSIONS: In overweight and obese pregnant patients with gestational diabetes, the levels of adropin in serum increased significantly in the last trimester of pregnancy. The increase in concentration was significantly lower in the morbidly obese patients than in the obese group. The study provides the basis for further analyses of the role of adropin in pregnancies complicated by obesity and gestational diabetes.

Fetal growth trajectory in type 1 pregestational diabetes (PGDM) - an ultrasound study.

OBJECTIVES: Growth disorders are frequent in diabetic pregnancies. However, they are difficult to predict and capture early during pregnancy. These newborns are at risk of obesity, diabetes, and cardiovascular disease. While developing, fetal growth abnormalities are typically progressive. Therefore, capturing the earliest moment when they emerge is essential to guide subsequent obstetric management. MATERIAL AND METHODS: We aimed to analyze fetal ultrasound growth trajectories in type 1 diabetics. Moreover, we aimed to establish time points when first ultrasound manifestations of fetal growth abnormalities appear and to identify factors that affect fetal growth in women with diabetes. We collected clinical and ultrasound data from 200 patients with PGDM managed in the third-referential centre for diabetes in pregnancy. During every visit, patients underwent an ultrasound examination according to a standard protocol giving 1072 ultrasound scan's records. Every ultrasound consisted of fetal weight estimation, according to the Hadlock 3 formula. Retrospectively patients were divided into three groups depending on neonatal weight. In the group of 200 patients, 60 (30%) delivered LGA and 9 (4.5%) SGA newborns. RESULTS: Fetal growth trajectories show different patterns among fetuses with growth abnormalities in women with type 1 diabetes. The moment, when fetal growth curves diverge, seems to take place in the second trimester, just after the 23rd week of gestation. CONCLUSIONS: It suggests that fetal growth abnormalities in type 1 diabetes may have its roots much earlier than expected. In the first trimester, there were differences in LDL-cholesterol, total cholesterol, triglyceride levels and in insulin requirements between AGA, SGA and LGA subgroups.

Maternal risk factors for neonatal acidosis in women with type 1 diabetes.

INTRODUCTION Type 1 diabetes in the mother is associated with high risk of adverse neonatal outcomes. OBJECTIVES The aim of this study was to identify maternal factors associated with low arterial pH values (pH <7.10) in infants of mothers with type 1 diabetes. PATIENTS AND METHODS Data from 789 women were included in the analysis. Based on pH values in the umbilical arteries of infants, women were divided into 2 groups: those with normal pH, defined as pH of 7.1 or higher, and those with low pH, defined as pH lower than 7.1. A logistic regression analysis was used to identify the determinants of low pH in the umbilical artery, with data presented as odds ratios and 95% CIs. RESULTS Low umbilical artery pH was observed in 72 infants (9.1%). There was an association between maternal glycated hemoglobin A1c (HbA1c) levels measured before delivery and low umbilical artery pH (odds ratio [OR] 1.40; 95% CI, 1.11-1.78; P = 0.01). A similar association was found for HbA1c levels measured between 20 and 24 weeks' gestation (OR 1.29; 95% CI, 1.03-1.63; P = 0.03). There was no association between the levels of HbA1c in the first trimester or lack of preconception care and low umbilical artery pH. In logistic regression, urgent cesarean section was associated with low umbilical artery pH (OR, 1.64; 95% CI, 1.11-2.44; P = 0.01), and this association was independent of HbA1c levels measured before delivery. CONCLUSIONS Lack of sufficient glycemic control in pregnancy is the strongest predictor of neonatal acidosis in women with type 1 diabetes.