First-trimester diet quality in association with maternal subcutaneous and visceral adipose tissue thicknesses and glucose homeostasis during pregnancy.

We aimed to characterise the associations between first-trimester diet quality, adiposity, and glucose homeostasis measurements throughout pregnancy in a sample of 104 healthy pregnant women. Three Web-based 24-h recalls were completed, from which the Alternate Healthy Eating Index (AHEI) was calculated. At each trimester (12.5 ± 0.7, 22.8 ± 1.0, and 33.6 ± 1.3 weeks of gestation), fasting glucose and insulin were measured to compute an insulin resistance index (HOMA-IR). Subcutaneous and visceral adipose tissue thicknesses were estimated by ultrasound at the end of the first trimester. Inverse associations were observed between the first-trimester AHEI and first-trimester fasting insulin (r = 0.24; p < 0.05), and HOMA-IR (r = -0.22; p < 0.05), as well as third-trimester fasting insulin (r = -0.20; p < 0.05). A trend was also observed between first-trimester AHEI and first-trimester SAT thickness (r = -0.17; p < 0.1). Pre- and early-pregnancy adiposity measurements were identified as high predictors fasting insulin concentrations throughout pregnancy. Higher early-pregnancy diet quality is associated with more favourable metabolic measurements during pregnancy.

Dietary intakes in pregnant women with previous bariatric surgery.

PURPOSE: To (1) assess dietary intakes of pregnant women with previous bariatric surgery in comparison with Dietary Reference Intakes (DRIs); (2) compare their dietary intakes as well as their diet quality with a control group of pregnant women with no history of bariatric surgery. METHODS: Twenty-eight (28) pregnant women with previous surgery (sleeve gastrectomy, n = 7 and biliopancreatic diversion with duodenal switch, n = 21) were matched for pre-pregnancy body mass index with 28 pregnant women with no history of bariatric surgery. In at least one trimester, participants completed a minimum of 2 Web-based 24-h dietary recalls from which energy, macro- and micronutrient intakes as well as the Canadian Healthy Eating Index (C-HEI) were derived. RESULTS: No differences were observed for energy intake between groups. All women had protein intakes within the recommended range, but most women with previous surgery had carbohydrate (67%) and dietary fiber intakes (98%) below recommendations. In both groups, mean total fat, saturated fatty acids, free sugars and sodium intakes were above recommendations, as opposed to mean vitamin D, folic acid and iron dietary intakes below recommendations for most women. Compared with the control group, pregnant women with previous bariatric surgery had lower overall C-HEI scores. CONCLUSION: These results suggest that pregnant women with previous bariatric surgery would benefit from a nutritional follow-up throughout their pregnancy. LEVEL OF EVIDENCE: III: Evidence obtained from well-designed cohort or case-control analytic studies.

Dairy product intake modifies gut microbiota composition among hyperinsulinemic individuals.

PURPOSES: The objectives of this study were to investigate differences in gut microbiota (GM) composition after high dairy intake (HD) compared to adequate dairy intake (AD) and to correlate GM composition variations with the change in glycemic parameters in hyperinsulinemic subjects. METHODS: In this crossover study, 10 hyperinsulinemic adults were randomized to HD (≥ 4 servings/day) or AD (≤ 2 servings/day) for 6 weeks, separated by a 6-week washout period. Fasting insulin and glucose levels were measured after each intervention. Insulin resistance was calculated with the homeostasis model assessment of insulin resistance (HOMA-IR). GM was determined with 16S rRNA-based high-throughput sequencing at the end of each intervention. Paired t test, correlations and machine learning analyses were performed. RESULTS: Endpoint glycemic parameters were not different between HD and AD intake. After HD compared with AD intake, there was a decrease in the abundance of bacteria in Roseburia and Verrucomicrobia (p = 0.04 and p = 0.02, respectively) and a trend for an increase abundance in Faecalibacteria and Flavonifractor (p = 0.05 and p = 0.06, respectively). The changes in abundance of Coriobacteriia, Erysipelotrichia, and Flavonifractor were negatively correlated with the change in HOMA-IR between the AD and HD phases. Furthermore, a predictive GM signature, including Anaerotruncus, Flavonifractor, Ruminococcaceae, and Subdoligranulum, was related to HOMA-IR. CONCLUSION: Overall, these results suggest that HD modifies the abundance of specific butyrate-producing bacteria in Firmicutes and of bacteria in Verrucomicrobia in hyperinsulinemic individuals. In addition, the butyrate producing bacteria in Firmicutes phylum correlate negatively with insulin resistance.

Trimester-Specific and Total Gestational Weight Gain in Two Consecutive Pregnancies.

OBJECTIVE: This retrospective study aimed to characterize trimester-specific and total gestational weight gain (GWG) over the course of two consecutive pregnancies, as well as maternal determinants associated with interpregnancy weight change (IPWC) and excessive GWG in the second pregnancy. METHODS: We analyzed the electronic medical records of women who delivered their first two consecutive infants at term between 2001 and 2017. RESULTS: Weight gain trajectories differed between the first and second pregnancy for the 1497 women included in this study, with lower second- and third-trimester weight gain in the second pregnancy. Respectively, 53% and 41% of women had excessive GWG in the first and second pregnancies, with a higher proportion of excessive GWG found in women with a higher body mass index (BMI). Most women (55%) experienced interpregnancy weight gain. Maternal determinants of IPWC were BMI before first pregnancy, first-trimester and total GWG in the first pregnancy, and interpregnancy interval (P < 0.0001). Maternal risk factors associated with excessive GWG in the second pregnancy were excessive total GWG in the first pregnancy (OR 6.23; 95% CI 4.67-8.32), interpregnancy weight gain (OR 1.58; 95% CI 1.19-2.09), and interpregnancy interval (OR 1.18; 95% CI 1.07-1.29) as well as BMI before the second pregnancy (OR 1.04, 95% CI 1.02-1.07). CONCLUSION: Weight gain trajectories differ between consecutive pregnancies. GWG in the first pregnancy is a key determinant for IPWC and GWG in the second pregnancy.

Effect of liraglutide on food consumption, appetite sensations and eating behaviours in overweight people with type 1 diabetes.

AIMS: To investigate the effects of 24 weeks of treatment with liraglutide added to basal/bolus insulin on energy intake, appetite sensations and eating behaviours in overweight/obese participants with type 1 diabetes (T1D). METHODS: In a double-blinded crossover fashion, 15 participants were randomly assigned (1:1) to receive placebo or liraglutide for 24 weeks including a 1-month titration period from 0.6 to 1.2 to 1.8 mg, in addition to their insulin. The treatment was followed by a 1-month wash-out period. Participants were then assigned to the other treatment for another 24 weeks. Food intake was measured, visual analogue scales and Three-Factor Eating Questionnaires were completed. Paired rank tests were used to compare the variables. RESULTS: When treated with liraglutide, participants modified their ad libitum food consumption with decreased total intake and % fat and increased carbohydrates. Their appetite sensations were modified: fasting desire to eat, hunger and prospective food consumption were significantly reduced. The sensation of fullness was prolonged for a few hours after a standardized breakfast. Restraint and disinhibition were significantly reduced by liraglutide. CONCLUSIONS: In this randomized clinical trial, the addition of liraglutide to basal/bolus insulin therapy for 24 weeks in overweight/obese individuals with T1D significantly improved their food consumption, appetite sensations and eating behaviours.

Changes in Eating Behaviours Throughout Pregnancy: Associations with Gestational Weight Gain and Pre-pregnancy Body Mass Index.

OBJECTIVE: Most pregnant women gain weight above recommended levels, and this weight gain affects mothers' and children's health. Factors influencing gestational weight gain (GWG) are numerous and include eating behaviours. The objective of this study was to evaluate the association between eating behaviours and GWG while considering pre-pregnancy body mass index (BMI). METHODS: Fifty-three (n = 53) women were recruited at 9.4 ± 0.6 gestational weeks. At each trimester, they completed the Three-Factor Eating Questionnaire, which evaluates disinhibition, dietary restraint, and susceptibility to hunger. Using a weight gain curve, trimester-specific GWG was calculated with interpolated weights. Total GWG was calculated as the difference between maternal weight before delivery and self-reported pre-pregnancy weight (Canadian Task Force Classification II-2). RESULTS: Women were aged 31.5 ± 3.5, and 81.1% had a university degree. The proportion of women who gained weight within recommendations was 21%, 28%, and 26%, at each trimester, respectively, and 38% for total pregnancy. Overall, dietary restraint score was lower in the third trimester in comparison with the first (6.1 ± 4.1 vs. 7.2 ± 4.6; P = 0.049), whereas no difference was observed for disinhibition or susceptibility to hunger. Our data suggest that variations in eating behaviours throughout pregnancy were similar among women who exhibited total GWG below, within, or above recommendations (Ptrim × GWG = NS) (NS: not significant; trim: trimester). Similar observations were reported when women were compared according to their pre-pregnancy BMI (Ptrim × BMI = NS). CONCLUSION: Maintaining high levels of restraint may be challenging considering the increase in hunger, which could explain the decrease observed in dietary restraint scores. Changes in eating behaviours were not associated with total GWG or pre-pregnancy BMI.

Associations between fruit and vegetables intake and abnormal glucose tolerance among women with prior gestational diabetes mellitus.

PURPOSE: Women with prior gestational diabetes mellitus (GDM) are at higher risk of type 2 diabetes (T2D). The aim of this study was to investigate the association between fruit and vegetables (FV) intake and abnormal glucose tolerance (AGT) among women with prior GDM. METHODS: A total of 281 women with prior GDM have been recruited a mean of 6 years after their pregnancy in this cohort study. FV intake was obtained with a validated food frequency questionnaire (FFQ). Anthropometric and glycemic components were measured during their clinical visit and women were stratified according to normal glucose tolerance (NGT) or AGT. RESULTS: A cross-sectional analysis showed that a total of 155 women had NGT and 126 AGT. Women with AGT had significantly lower FV (6.5 ± 0.2) and vegetables servings (3.9 ± 0.2) and tended to have lower fruit servings (2.6 ± 0.2) than women with NGT (7.4 ± 0.2, 4.5 ± 0.2 and 3.0 ± 0.1, respectively) (p = 0.001, p = 0.04 and p = 0.10, respectively, adjusted for age and BMI). FV intake, per one serving increase, was associated with a reduced likelihood of having AGT [OR = 0.88 (0.81-0.97) after adjustment for age and BMI]. Vegetables or fruit intake tended to be associated with a reduced likelihood of having AGT [OR = 0.88 (0.78-1.00) and OR = 0.88 (0.76-1.02), respectively, after adjustment for age and BMI]. CONCLUSIONS: Higher intake of FV may be associated with a lower likelihood of AGT among women with prior GDM. Further studies are needed to confirm these results in this high-risk population.

Association between early introduction of fruit juice during infancy and childhood consumption of sweet-tasting foods and beverages among children exposed and unexposed to gestational diabetes mellitus in utero.

BACKGROUND: Children exposed to gestational diabetes mellitus (GDM) in utero are at high-risk of obesity. Given that nutritional habits can track from infancy to childhood, the aim of this study was to evaluate the association between the timing of fruit juice introduction in infancy and later consumption of sweet-tasting foods and beverages among children exposed (GDM+) and unexposed (GDM-) to GDM. METHODS: A total of 107 GDM+ and 59 GDM- participated in the project. Data on the timing of fruit juice introduction during infancy were retrospectively collected for 62 GDM+ and 32 GDM- children. Current dietary intakes were collected with two 24-hour dietary recall questionnaires. Children were divided into groups according to the median timing of juice introduction (9 months). RESULTS: Mean age of children was 6.3 ± 2.6 and 7.6 ± 3.7 years for GDM+ and GDM- children, respectively (p = 0.08). Mean age of fruit juice introduction was similar between groups (p > 0.05). Consuming >1 serving of fruit juice per day was 2.72 times more prevalent among GDM+ children introduced to fruit juice <9 months, compared to GDM+ children introduced ≥9 months (CI: 1.19-6.20). This association was not observed in the GDM- group. The timing of fruit juice introduction was not associated with later consumption of sweets, desserts and sweet-tasting beverages when adjustment for children's age was made among GDM+ and GDM- children. CONCLUSION: Early introduction of fruit juice in infant diet is associated with higher prevalence of consumption of >1 serving of fruit juice per day in GDM+ children.

Increased body fat mass explains the positive association between circulating estradiol and insulin resistance in postmenopausal women.

The relationship between circulating estrogen levels and cardiometabolic risk factors such as insulin resistance is unclear in postmenopausal women. High estradiol (E2) levels have been reported to predict increased risk of type 2 diabetes in this population. We aimed to examine associations among estrogen levels, adiposity measurements, and cardiometabolic risk variables including insulin resistance in postmenopausal women. One hundred-one healthy participants (mean ± SD: age 57 ± 4 yr, BMI 27.9 ± 4.8 kg/m2) were included in the analysis. Fifteen plasma steroids or metabolites were measured by liquid chromatography-tandem mass spectrometry. Insulin sensitivity was assessed with a hyperinsulinemic-euglycemic clamp. Body composition and fat distribution were determined with hydrostatic weighing and computed tomography, respectively. Blood lipids and circulating cytokines were also measured. Circulating E2 was positively correlated with all adiposity indexes ( r = 0.62 to 0.42, P < 0.0001) except waist-to-hip ratio. E2 was positively correlated with VLDL-cholesterol, plasma-, VLDL-, and HDL-triglyceride levels ( r = 0.31 to 0.24, P < 0.02) as well as with hs-CRP and IL-6 ( r = 0.52 and 0.29, P < 0.005) and negatively with HDL-cholesterol, adiponectin, and insulin sensitivity ( r = -0.36 to -0.20, P < 0.02). With adjustments for percent body fat, correlations between E2 and metabolic risk variables were no longer significant. Similar results were observed for circulating estrone (E1) and estrone-sulfate (E1-S) levels. In conclusion, circulating estrogen concentrations are proportional to adipose mass in postmenopausal women, although they remain in the low range. Insulin resistance as well as altered blood lipids and cytokines are observed when circulating estrogen levels are high within that range, but these differences are explained by concomitant variation in total adiposity.

Beyond glycaemic control: A cross-over, double-blinded, 24-week intervention with liraglutide in type 1 diabetes.

AIMS: To investigate the effects of 24 weeks of treatment with liraglutide added to basal/bolus insulin on anthropometric and metabolic parameters in overweight participants with type 1 diabetes. METHODS: In a double-blinded cross-over fashion, 15 participants were randomly assigned (1:1) to receive placebo (saline solution) or liraglutide for 24 weeks including a 1-month titration period from 0.6 to 1.2 to 1.8 mg, in addition to their insulin. The treatment was followed by a 1-month wash-out period. Participants were then assigned to the other treatment for another 24 weeks. Paired rank tests were used to compare the metabolic parameters. RESULTS: There was no treatment effect on HbA1c nor on insulin dose. Heart rate was increased by about 8 beats per minute with liraglutide. There were significant reductions in metabolic measures: weight, body mass index, waist and hip circumferences, body fatness, computed tomography scan abdominal and mid-thigh measurements, systolic and diastolic blood pressures (all P ≤ .05). There was no increase in time spent in hypoglycaemia with liraglutide. CONCLUSIONS: The addition of liraglutide to basal/bolus insulin therapy for 24 weeks in overweight/obese individuals with type 1 diabetes improved the anthropometric and metabolic profiles without an increase in hypoglycaemia. Clinical Trials.gov No: NCT01787916.

Dietary intakes in the nutritional management of gestational diabetes mellitus.

PURPOSE: Changes were examined in energy intakes and percentage of energy from macronutrients in response to nutritional intervention in women with gestational diabetes mellitus (GDM). METHODS: The study included 17 women with GDM and 27 women with normal glucose tolerance (controls). Women with GDM were followed by a multidisciplinary team; they received dietary counselling by a registered dietitian, and were prescribed diets with 40% to 45% energy from carbohydrate (CHO), 20% to 25% from protein, and 30% to 35% from fat. Dietary intakes were assessed with food frequency questionnaires before the intervention (26.9 ± 3.8 weeks) and after the intervention (32.6 ± 0.6 weeks). RESULTS: After the intervention, women with GDM reduced their total energy intake to reach lower values than did controls (P value for time-group interaction =0.05). A concomitant reduction in total CHO and glucose intakes in women with GDM led to significantly lower values compared with intakes in controls (P values for time-group interaction =0.001 for all). The post-intervention rate of weight gain in women with GDM was within the Institute of Medicine (IOM)-recommended values, while the post-intervention rate of weight gain in controls was above IOM-recommended values (0.30 ± 0.27 versus 0.61 ± 0.50 kg/week, P≤0.05). CONCLUSIONS: These results suggest that this multidisciplinary medical and nutritional intervention was effective in the achievement of prescribed macronutrient distribution and controlling gestational weight gain in Canadian women with GDM.

GLP-1 response during pregnancy: variations between trimesters and associations with appetite sensations and usual energy intake.

Further research is required to understand hormonal regulation of food intake during pregnancy and its association with energy intake. The objectives are to (i) compare postprandial responses of plasma glucagon-like peptide-1 (GLP-1) between trimesters, (ii) compare postprandial appetite sensations between trimesters, and (iii) examine trimester-specific associations between GLP-1 levels, appetite sensations, and usual energy intake. At each trimester, participants (n = 26) consumed a standard test meal following a 12 h fast. Plasma GLP-1 levels were measured by enzyme-linked immunosorbent assay method at fasting and at 30, 60, 120, and 180 min postprandial. A visual analogue scale assessing appetite sensations was completed at fasting and at 15, 30, 45, 60, 90, 120, 150, and 180 min postprandial. Mean energy intake was assessed using three web-based 24 h dietary recalls at each trimester. Lower postprandial GLP-1 responses were observed in the 2nd (p = 0.004) and 3rd trimesters (p < 0.001) compared to the 1st trimester. Greater postprandial sensations of desire to eat, hunger, and prospective food consumption were noted in the 3rd trimester compared to the 1st trimester (p < 0.04, for all). Fasting GLP-1 was negatively associated with fasting appetite sensations (except fullness) at the 2nd trimester (p < 0.02, for all). Postprandially, significant associations were observed for incremental areas under the curve from 0 to 30 min between GLP-1 and fullness at the 2nd (p = 0.01) and 3rd trimesters (p = 0.03). No associations between fasting or postprandial GLP-1 and usual energy intake were observed. Overall, GLP-1 and appetite sensation responses significantly differ between trimesters, but few associations were observed between GLP-1, appetite sensations, and usual energy intake.

Use of glycated hemoglobin and waist circumference for diabetic screening in women with a history of gestational diabetes.

OBJECTIVE: Although their risk of type 2 diabetes is markedly increased, women with prior gestational diabetes mellitus (GDM) do not receive appropriate testing following their pregnancy. Identifying a less burdensome testing method might increase postpartum testing rates. Our objective was to examine the adequacy of glycated hemoglobin (A1C) and waist circumference (WC) measurements to detect impaired glucose metabolism among women with prior GDM. METHODS: The analysis included 178 women who had GDM between 2003 and 2010. WC and A1C were measured, and a 75g 2h-OGTT was performed. Pre-diabetes was defined as a fasting plasma glucose (FPG) ≥ 5.6 and < 7.0 mmol/L or a 2-hour plasma glucose (2h-PG) ≥ 7.8 and < 11.0 mmol/L, and type 2 diabetes was defined as a FPG ≥ 7.0 mmol/L and/or a 2h-PG ≥ 11.1 mmol/L. Sensitivity and specificity analyses were performed. RESULTS: The mean age of subjects was 36.4 ± 4.8 years, and testing occurred at a mean 3.5 ± 1.9 years following delivery. Combining A1C ≥ 5.7% and WC ≥ 88 cm to detect pre-diabetes had a sensitivity of 76% and specificity of 62%, and to detect type 2 diabetes it had a sensitivity of 91% and specificity of 34%. Compared with women who had A1C and WC within the normal range, women with A1C ≥ 5.7% and WC ≥ 88 cm were more likely to have type 2 diabetes (OR 4.4; 95% CI 2.0 to 9.9). CONCLUSION: These analyses suggest that the combination of A1C and WC could represent a sensitive test for pre-diabetes and type 2 diabetes in the years following a pregnancy complicated by GDM. Further validation of this testing method is required.

Objectif : Bien que leur risque de présenter un diabète de type 2 connaisse une hausse considérable, les femmes ayant déjà connu un diabète sucré gestationnel (DSG) ne bénéficient pas de services de dépistage adéquats à la suite de leur grossesse. L'identification d'une méthode de dépistage moins lourde pourrait accroître les taux de dépistage postpartum. Nous avions pour objectif d'examiner le caractère adéquat des mesures du taux d'hémoglobine glyquée (A1C) et du tour de taille (TT) pour ce qui est de la détection de l'altération du métabolisme du glucose chez les femmes ayant déjà connu un DSG. Méthodes : L'analyse portait sur 178 femmes ayant connu un DSG entre 2003 et 2010. Le TT et le taux d'A1C ont été mesurés, et une épreuve d'hyperglycémie provoquée par voie orale (75 g, 2 h) a été menée. Le prédiabète a été défini comme étant une glycémie à jeun (GJ) ≥ 5,6 et < 7,0 mmol/l ou une glycémie à 2 heures (G-2 h) ≥ 7,8 et < 11,0 mmol/l, tandis que le diabète de type 2 a été défini comme étant une GJ ≥ 7,0 mmol/l et/ou une G-2 h ≥ 11,1 mmol/l. Des analyses de sensibilité et de spécificité ont été menées. Résultats : L'âge moyen des sujets était de 36,4 ± 4,8 ans et le dépistage s'est déroulé, en moyenne, 3,5 ± 1,9 ans à la suite de l'accouchement. La combinaison d'un taux de A1C ≥ 5,7 % et d'un TT ≥ 88 cm pour détecter le prédiabète comptait une sensibilité de 76 % et une spécificité de 62 %; pour ce qui est de la détection du diabète de type 2, cette combinaison comptait une sensibilité de 91 % et une spécificité de 34 %. Par comparaison avec les femmes qui présentaient un taux d'A1C et un TT se situant dans la plage normale, les femmes qui présentaient un taux d'A1C ≥ 5,7 % et un TT ≥ 88 cm étaient plus susceptibles de connaître un diabète de type 2 (RC, 4,4; IC à 95 %, 2,0 - 9,9). Conclusion : Ces analyses semblent indiquer que la combinaison du taux d'A1C et de la mesure du TT pourrait constituer un test sensible pour le dépistage du prédiabète et du diabète de type 2 au cours des années qui suivent une grossesse ayant été compliquée par la présence d'un DSG. La tenue d'autres études permettant de valider cette méthode de dépistage s'avère requise.

Promoting healthy eating in early pregnancy in individuals at risk of gestational diabetes mellitus: does it improve glucose homeostasis? A study protocol for a randomized control trial.

Background: Healthy eating during pregnancy has favorable effects on glycemic control and is associated with a lower risk of gestational diabetes mellitus (GDM). According to Diabetes Canada, there is a need for an effective and acceptable intervention that could improve glucose homeostasis and support pregnant individuals at risk for GDM. Aims: This unicentric randomized controlled trial (RCT) aims to evaluate the effects of a nutritional intervention initiated early in pregnancy, on glucose homeostasis in 150 pregnant individuals at risk for GDM, compared to usual care. Methods: Population: 150 pregnant individuals ≥18 years old, at ≤14 weeks of pregnancy, and presenting ≥1 risk factor for GDM according to Diabetes Canada guidelines. Intervention: The nutritional intervention initiated in the first trimester is based on the health behavior change theory during pregnancy and on Canada's Food Guide recommendations. It includes (1) four individual counseling sessions with a registered dietitian using motivational interviewing (12, 18, 24, and 30 weeks), with post-interview phone call follow-ups, aiming to develop and achieve S.M.A.R.T. nutritional objectives (specific, measurable, attainable, relevant, and time-bound); (2) 10 informative video clips on healthy eating during pregnancy developed by our team and based on national guidelines, and (3) a virtual support community via a Facebook group. Control: Usual prenatal care. Protocol: This RCT includes three on-site visits (10-14, 24-26, and 34-36 weeks) during which a 2-h oral glucose tolerance test is done and blood samples are taken. At each trimester and 3 months postpartum, participants complete web-based questionnaires, including three validated 24-h dietary recalls to assess their diet quality using the Healthy Eating Food Index 2019. Primary outcome: Difference in the change in fasting blood glucose (from the first to the third trimester) between groups. This study has been approved by the Ethics Committee of the Centre de recherche du CHU de Québec-Université Laval. Discussion: This RCT will determine whether a nutritional intervention initiated early in pregnancy can improve glucose homeostasis in individuals at risk for GDM and inform Canadian stakeholders on improving care trajectories and policies for pregnant individuals at risk for GDM. Clinical trial registration: https://clinicaltrials.gov/study/NCT05299502, NCT05299502.

Cord blood C-peptide levels relate to the metabolic profile of women with and without gestational diabetes.

Plasma C-peptide reflects the insulin-secretory activity of pancreatic ß-cells which modulates fetal growth. Cord blood C-peptide levels were measured in women with gestational diabetes mellitus (GDM) and in women with normal glucose tolerance (NGT). Forty-one women underwent a 75-g oral glucose tolerance test (18 GDM, 23 NGT). Cord blood C-peptide (p = 0.09) and glucose levels (p = 0.08) from newborns of GDM women tended to be higher than those from NGT women. In the entire group, cord blood C-peptide correlated with maternal insulin, fasting C-peptide, insulin sensitivity, interleukin-6, weight and body mass index measured at screening (ρ from 0.34 to 0.48, all p < 0.05) and tended to correlate with offspring weight (ρ = 0.28, p = 0.08). Newborns of GDM women tended to have elevated cord blood C-peptide which correlated with maternal insulin, insulin sensitivity and anthropometric measures at diagnosis and with offspring characteristics. This suggests that insulin-secretory activity of the newborn is related to maternal metabolic parameters.

Impact of a mother's weight history on her offspring.

OBJECTIVE: To explore the relationship between maternal lifelong body weight history and anthropometric measurements in the offspring. METHODS: We studied a prospective sample of 48 pregnant women with either gestational diabetes mellitus (GDM, n = 21) or normal glucose tolerance (NGT, n = 27). Reported maternal weight at birth, 20 years of age and 30 years of age, and pre-pregnancy and maximal weight outside pregnancy were obtained by questionnaire. BMI was calculated using data from the questionnaire. Maternal anthropometric parameters were measured during pregnancy. Offspring anthropometrics were obtained at birth and eight weeks later. RESULTS: Maternal weight at birth, weight or BMI at 20 years of age and at 30 years of age, and maximal weight or BMI did not differ between groups. In all women, maternal birth weight, BMI at 20 years of age, and maximal BMI correlated with newborn birth weight (ρ = 0.39, 0.37, and 0.27, respectively, P ≤ 0.05), with newborn length (ρ = 0.46, 0.32, and 0.30 respectively, P < 0.05), and with infant weight eight weeks later (ρ = 0.43, 0.30, and 0.31, respectively, P < 0.05). Reported maternal BMI at 30 years of age correlated with infant weight (ρ = 0.31) and cranial circumference (ρ = 0.33) at eight weeks of life (P < 0.05). Besides gestational age, maternal weight at screening was the most significant predictor of infant birth weight. CONCLUSION: Several parameters of maternal weight history were related to offspring anthropometric measurements in early life in a sample of women with and without GDM.

Determinants of Healthy Diet Among Children Exposed and Unexposed to Gestational Diabetes.

OBJECTIVES: To evaluate the association between individual and environmental determinants of diet quality with diet quality of children exposed to gestational diabetes mellitus (GDM+) and unexposed (GDM-); to study the association between mother and child vegetables and fruit (VF) intakes. DESIGN: Cross-sectional study. PARTICIPANTS: One hundred forty-two children (104 GDM+; 38 GDM-) aged 6.2 ± 2.5 years. VARIABLES: Canadian Healthy Eating Index 2007 (HEI-C) and VF were obtained with 2 24-hour dietary recall questionnaires in children. Maternal VF was obtained by a validated food frequency questionnaire, and weight and height were measured. Sociodemographic determinants were obtained by questionnaires. ANALYSIS: Linear regression models were used to evaluate the association between individual and environmental determinants and the HEI-C score with interaction for GDM status. RESULTS: Family meals were associated with HEI-C among GDM- but not GDM+ children (ß = 9.97, P = 0.01 and ß = -0.41, P = 0.84, respectively; P for interaction = 0.02). Children's age (ß = -1.45; 95% confidence interval, -2.19 to -0.72; P < 0.001) was a determinant of HEI-C among all children. Maternal VF intakes were positively associated with children's VF intake (r = 0.30, P < 0.001, r2 = 0.09), with association of larger variance among GDM- children (r = 0.38, r2 = 0.14, P = 0.02) than GDM+ children (r = 0.23, r2 = 0.05, P = 0.02). CONCLUSIONS: The food environment at home was associated differently with the diet quality of GDM+ and GDM- children. Whether targeting family meals and maternal diet quality is a good strategy to improve children's diet quality among GDM+ children needs to be further investigated.

Prevalence of Vertebral Fractures in Adults With Type 1 Diabetes: DenSiFy Study (Diabetes Spine Fractures).

CONTEXT: Vertebral fracture (VF) prevalence up to 24% has been reported among young people with type 1 diabetes (T1D). If this high prevalence is confirmed, individuals with T1D could benefit from preventative VF screening. OBJECTIVE: We compared the prevalence of VFs between adults with T1D and nondiabetic controls. METHODS: This cross-sectional study included 127 adults with T1D, and 65 controls with a similar age, sex, and BMI distribution, from outpatient clinics of 2 tertiary care centers. Vertebral fracture assessment (VFA) by dual-energy x-ray absorptiometry (DXA) was used for prevalent VFs. The modified algorithm-based qualitative (mABQ) method was applied. Bone mineral density (BMD) and trabecular bone score (TBS) were assessed by DXA. Serum bone turnover markers and sclerostin were measured in a subgroup of participants. RESULTS: Participants with T1D (70 women, 57 men) had a mean age of 42.8 ±â€…14.8 years, median diabetes duration of 25.8 (15.8-34.4) years, mean BMI of 26.6 ±â€…5.4 kg/m2 and mean HbA1c over the past 3 years of 7.5 ±â€…0.9%. Controls (35 women, 30 men) had mean age of 42.2 ±â€…15.9 years and mean BMI of 26.1 ±â€…5.1 kg/m2. VF prevalence was comparable between groups (2.4% vs 3.1%, P = 0.99). TBS, BMD at the total hip and femoral neck, and bone formation and resorption markers were lower while sclerostin levels were similar in participants with T1D vs controls. CONCLUSION: Our VFA results using the mABQ method do not confirm increased prevalence of VFs in men and women with relatively well-controlled T1D.

Trimester-Specific Serum Fructosamine in Association with Abdominal Adiposity, Insulin Resistance, and Inflammation in Healthy Pregnant Individuals.

This study aimed to (1) characterize the variations in serum fructosamine across trimesters and according to pre-pregnancy BMI (ppBMI), and (2) examine associations between fructosamine and adiposity/metabolic markers (ppBMI, first-trimester adiposity, leptin, glucose homeostasis, and inflammation measurements) during pregnancy. Serum fructosamine, albumin, fasting glucose and insulin, leptin, adiponectin, interleukin-6 (IL-6), and C-reactive protein (CRP) concentrations were measured at each trimester. In the first trimester, subcutaneous (SAT) and visceral (VAT) adipose tissue thicknesses were estimated by ultrasound. In the 101 healthy pregnant individuals included (age: 32.2 ± 3.5 y.o.; ppBMI: 25.5 ± 5.5 kg/m2), fructosamine concentrations decreased during pregnancy whereas albumin-corrected fructosamine concentrations increased (p < 0.0001 for both). Notably, fructosamine concentrations were inversely associated with ppBMI, first-trimester SAT, VAT, and leptin (r = −0.55, r = −0.61, r = −0.48, r = −0.47, respectively; p < 0.0001 for all), first-trimester fasting insulin and HOMA-IR (r = −0.46, r = −0.46; p < 0.0001 for both), and first-trimester IL-6 (r = −0.38, p < 0.01). However, once corrected for albumin, most of the correlations lost strength. Once adjusted for ppBMI, fructosamine concentrations were positively associated with third-trimester fasting glucose and CRP (r = 0.24, r = 0.27; p < 0.05 for both). In conclusion, serum fructosamine is inversely associated with adiposity before and during pregnancy, with markers of glucose homeostasis and inflammation, but the latter associations are partially influenced by albumin concentrations and ppBMI.

Circulating interleukin-6 concentrations during and after gestational diabetes mellitus.

OBJECTIVE: Recent studies have shown that high interleukin-6 (IL-6) secretion may aggravate insulin resistance in pregnancy and participate in the pathogenesis of gestational diabetes mellitus (GDM). The aim of this study was to determine whether the presence of GDM is associated with elevated IL-6 concentrations and whether this association remains after delivery, independent of body mass index. DESIGN: Longitudinal study. SETTING: Hospital-based. SAMPLE: Forty-seven women were screened for GDM with a 75g oral glucose tolerance test at 26.1±3.7 weeks of pregnancy following the Canadian Diabetes Association guidelines (20 GDM, 27 control subjects). MAIN OUTCOME MEASURES: Interleukin-6 levels were measured by ELISA at the time of GDM screening and two months post-partum. RESULTS: Interleukin-6 concentrations were significantly higher in women with GDM compared with control women at the time of GDM screening (1.47±0.72 vs. 0.90±0.32pg/mL, p≤0.01). Similar results were obtained two months post-partum, where IL-6 levels remained significantly higher in women with GDM compared with control women (1.88±0.85 vs. 1.41±0.87pg/mL, p≤0.05). Interleukin-6 concentrations were significantly correlated with the Matsuda insulin sensitivity index, measured at the two time points (r=-0.60, p≤0.01 and r=-0.34, p≤0.05). The Matsuda insulin sensitivity index was an independent and significant predictor of IL-6 concentrations at the time of GDM screening, explaining 35.6% of the variance (p≤0.0001) in this variable. IL-6 concentration measured at GDM screening was identified as an independent and significant predictor of post-partum IL-6 concentrations, explaining 28.6% of the variance (p≤0.001). CONCLUSIONS: These results show that GDM is associated with elevated IL-6 levels independent of obesity levels, both during pregnancy and after delivery.