Intuitive eating was associated with anxiety, depression, pregnancy weight and blood glucose in women with gestational diabetes mellitus: a prospective longitudinal study.

Background: Outside of pregnancy, intuitive eating (IE) is associated with lower body weight, blood glucose, and higher positive mood. However, little was known about the relationship between IE and anxiety-depression in the GDM population. Thus, this study aimed to investigate the association of IE with anxiety and depression, pregnancy weight and pregnancy blood glucose in the first and second GDM visit. Methods: Data from 310 pregnant women with GDM from the Fujian Maternal and Child Health Hospital Trial (Approval Number: 2020Y9133) were analyzed. IE was assessed using the Intuitive Eating Scale-2 subscales of Eating for Physiological Reasons rather than Emotional Reasons (EPR), Relying on Hunger and Satiety Cues (RHSC) and Body-Food Choice Consistency (B-FCC). Observations included weight, body mass index (BMI), fasting plasma glucose (FPG) and 2-h postprandial blood glucose; the Hospital Anxiety and Depression Scale (HADS) was used to assess the level of anxiety and depression in pregnant women with GDM. Linear regression analysis was used to assess the correlation between IE and anxiety, depression, pregnancy blood glucose and weight. Results: The cross-sectional analysis showed that the EPR eating behavior was negatively correlated with anxiety and depression, and the B-FCC eating behavior was negatively correlated with depression at both the first and second GDM visit; in addition, the B-FCC eating behavior was associated with lower BMI in the third trimester (all p < 0.05). In longitudinal analyses, the EPR eating behavior in the first visit for GDM predicted lower levels of anxiety and depression in the second GDM visit, whereas the RHSC eating behavior in the first visit for GDM was associated with lower FPG in the second GDM visit (all p < 0.01). Conclusion: These results suggest that practicing intuitive eating may be beneficial and that higher intuitive eating adherence can lead to lower levels of anxiety and depression and more ideal gestational weight and blood glucose values.

Risk factors and diagnostic performance of predictors as a screening technique for gestational diabetes mellitus: a retrospective cross-sectional study.

Background: Gestational diabetes mellitus (GDM) is a condition that can have negative impacts on both mother and baby. Detecting GDM early is crucial, and fasting plasma glucose (FPG) has been suggested as a possible screening method. This retrospective cross-sectional study aims to investigate potential risk factors and complications associated with GDM. Additionally, it aims to establish the diagnostic performance of predictive factors as a screening method for GDM. Methods: Data were collected from the medical records of 247 pregnant women who visited outpatient Obstetrics clinics between 2021 and 2022. The study investigated potential risk factors and complications associated with GDM, including impaired fasting glucose/impaired glucose tolerance (IFG/IGT), family history of diabetes mellitus (DM), and medical conditions. Moreover, the study evaluated the diagnostic performance of potential predictors as screening techniques for GDM. Results: The study found that IFG/IGT (P<0.001), a history of GDM (P<0.001), and a family history of DM (P=0.022) were significant factors associated with GDM. Healthy individuals had a lower risk of developing GDM (P<0.001). No significant correlation was found between GDM and macrosomia, hypertension, polycystic ovarian syndrome, or other obstetric complications. Although a weak association was observed between fasting blood glucose levels during the first trimester and GDM, it was not significant. Conclusion: In conclusion, this study found that IFG/IGT and a past history of GDM were significantly associated with GDM. Additionally, a family history of diabetes increased the likelihood of developing GDM, while no significant association was found between GDM and other obstetric complications. Although a weak association was observed between fasting blood glucose levels during the first trimester and GDM, it was not statistically significant.

Progression of gestational diabetes mellitus to pregnancy-associated fulminant type 1 diabetes: a case report.

Background: Pregnancy-associated fulminant type 1 diabetes (PF) occurs during pregnancy or within 2 weeks of delivery. Although it occurs infrequently, it is associated with high fetal mortality rate. Few studies have examined whether PF is associated with gestational diabetes mellitus (GDM). Case Description: A 29-year-old woman diagnosed with GDM at 24 weeks of gestation developed a fever, sore throat, nausea and vomiting at 29 weeks of gestation. Ketoacidosis was considered based on her blood ketone and glucose levels and the results of a blood gas analysis. Since the patient's islet function declined rapidly, fluid replacement, insulin therapy, and other treatments were administered. The patient was ultimately diagnosed with PF, and has required ongoing insulin therapy. She delivered a healthy baby girl by elective cesarean section at 37-week gestation. Her blood glucose has been satisfactorily controlled over the 12 months since her acute presentation. Conclusions: PF is characterized by poor maternal and infant outcomes and a high stillbirth rate. Blood glucose should be regularly monitored in pregnant women with GDM. A sudden increase in blood glucose may indicate the possibility of PF, which needs to be managed in a timely manner to avoid adverse pregnancy outcomes.

Healthcare costs attributable to diabetes in pregnancy: A cost of illness study in Tasmania, Australia.

AIMS: To estimate the direct costs during the prenatal, delivery and postpartum periods in mothers with diabetes in pregnancy, compared to those without. METHODS: This study used a population-based dataset from 2004 to 2017, including 57,090 people with diabetes and 114,179 people without diabetes in Tasmania, Australia. Based on diagnostic codes, delivery episodes with gestational diabetes mellitus (GDM) were identified and matched with delivery episodes without diabetes in pregnancy. A group of delivery episodes with pre-existing diabetes was identified for comparison. Hospitalisation, emergency department and pathology costs of these groups were calculated and adjusted to 2020-2021 Australian dollars. RESULTS: There were 2774 delivery episodes with GDM, 2774 delivery episodes without diabetes and 237 delivery episodes with pre-existing diabetes identified. Across the 24-month period, the pre-existing diabetes group required the highest costs, totalling $23,536/person. This was followed by the GDM ($13,210/person), and the no diabetes group ($11,167/person). The incremental costs of GDM over the no diabetes group were $890 (95% CI 635; 1160) in the year preceding delivery; $812 (616; 1031) within the delivery period and $341 (110; 582) in the year following delivery (p < 0.05). Within the year preceding delivery, the incremental costs in the prenatal period were $803 (579; 1058) (p < 0.05). Within the year following delivery, the incremental costs in the postpartum period were $137 (55; 238) (p < 0.05). CONCLUSIONS: Our results emphasised the importance of proper management of diabetes in pregnancy in the prenatal and postpartum periods and highlighted the significance of screening and preventative strategies for diabetes in pregnancy.

Monocyte-to-lymphocyte ratio in the early second trimester is a predictor of gestational diabetes mellitus.

OBJECTIVE: To evaluate neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), neutrophil-to-monocyte ratio (NMR), and other hemogram-derived inflammatory parameters measured in the early second trimester and their association with the risk of gestational diabetes mellitus (GDM). METHODS: This case-control study was conducted with 105 women with GDM and 205 healthy pregnant women, matched for maternal age at a 1:2 ratio with the cases at two regional maternity hospitals between January 2021 and August 2022. The inflammatory blood cell indices were tested in the early second trimester, and the patient's characteristics and the course of the pregnancy were analyzed. Logistic regression was used to determine the association between hematological parameters and the risk of GDM. Data were analyzed using SPSS, version 25.0 (SPSS, Chicago, IL). RESULTS: The final analysis included 310 pregnant women. The GDM group showed a higher pre-pregnancy BMI compared to the healthy controls (p < .01). There was no difference in NMR, PLR, and NLR between the groups (p = .63, .54, and .39, respectively). GDM was only positively associated with MLR (p = .02). After adjusting for potential confounding risk factors including maternal age, parity, and BMI, the multivariate regression analysis showed a higher level of MLR, with a cutoff point of 0.312, was independently associated with the risk of GDM (OR = 2.15, 95%CI 1.51-4.31, p = .03). However, ROC analysis showed that the AUC value of MLR was poor (0.670). CONCLUSIONS: We found that MLR, an inflammatory combined index derived from whole blood counts, may potentially serve as a predictor of GDM in the early second trimester.

Does the gestational age at which the glucose challenge test (GCT) is conducted influence the diagnosis of gestational diabetes mellitus (GDM)?

PURPOSE: This study's objective is to investigate disparities in the rates of gestational diabetes mellitus (GDM) diagnosis, influenced by the timing of the glucose challenge test GCT. METHODS: This retrospective cohort study included women with singleton or twin pregnancies exhibiting abnormal GCT result between 24 and 28 weeks of gestation, followed by an oral glucose tolerance test OGTT during the same period. Data regarding pregnancy follow-up from patients' deliveries at a singular tertiary medical from 2014 to 2022 were retrieved. The probability of GDM diagnosis was stratified based on the gestational week of the GCT and the definition of a positive OGTT, delineated by one or two abnormal values. RESULTS: The study included 636 women with abnormal GCT between 24 and 28 weeks of gestation. Of them, 157 unerwent the GCT between 24.0 and 24.6 weeks, 204 between 25.0 and 25.6 weeks, 147 between 26.0 and 26.6 weeks, and 128 between 27.0 and 28.6 weeks. We found that the highest incidence of GDM, defined by one or two pathological values of the OGTT, following the initial screening with a GCT, where abnormal results were defined as values exceeding 140 mg/dL, was diagnosed in patients who underwent GCT between 26.0 and 26.6 weeks of gestation. Conversely, the lowest rates were observed in patients screened between 24.0 and 24.6 weeks of gestation. CONCLUSION: The timing of screening for GDM using the GCT significantly affects the rate of diagnosis. Clinicians managing pregnancies should consider this data when formulating treatment plans.

Pregnancy and Diabetes in Turin: Lights and Shadows from Real Life Data.

BACKGROUND: From 2021, PSDTA for women with pregnancy complicated by diabetes will be active in the ASL city of Turin; given the city's increasing multiculturalism, we decided to evaluate from this point of view the patients who entered this pathway. METHODS: Data on women from 1/10/2022 to 30/09/2023 were collected from the computerized medical record. RESULTS: Total patients: 304, Type of diabetes: T1D 3%; MODY < 1%; T2D 4% Diabetes manifested in pregnancy (DMIP) 2%, GDM 90%, Foreigners prevalence: GDM: 67%, T2D%, T1D: Foreign 11%, Planned vs. neglected pregnancies: GDM 47% vs 18%, T2D 31% vs 32%, DMIP 28% vs 50%, T1D: 66% vs 11%, Therapy: GDM: insulin 31% (multi-injective <30%), metformin 5%, T2D: insulin 100% (multi-injective 68%, metformin in 20%); continuous glycemic sensor in 48%, DMIP: insulin 50% (multi-injective 50%), T1D: multi-injective therapy 33%; pump and glycemic sensor 33%; integrated sensor-micro-infuser system 33%. CONCLUSION: In the aspect of ISTAT data indicating that for northern Italy, a foreign origin for 26% of mothers, our population is "unbalanced" between GDM, T2D, and DMIP on one side and T1D on the other. The higher percentage of foreigners in the GDM group could be attributable to the higher share of Italian women opting for private practice, conversely, the "missing" share of foreign women with T1D is more difficult to interpret. Unplanned or even neglected pregnancies are significant in women with GDM and DMIP (who are mostly foreign). If these data are confirmed in other Italian realities, corrective strategies need to be planned.

Distinct Plasma Metabolomic and Gut Microbiome Profiles after Gestational Diabetes Mellitus Diet Treatment: Implications for Personalized Dietary Interventions.

Gestational diabetes mellitus (GDM) triggers alterations in the maternal microbiome. Alongside metabolic shifts, microbial products may impact clinical factors and influence pregnancy outcomes. We investigated maternal microbiome-metabolomic changes, including over 600 metabolites from a subset of the "Choosing Healthy Options in Carbohydrate Energy" (CHOICE) study. Women diagnosed with GDM were randomized to a diet higher in complex carbohydrates (CHOICE, n = 18, 60% complex carbohydrate/25% fat/15% protein) or a conventional GDM diet (CONV, n = 16, 40% carbohydrate/45% fat/15% protein). All meals were provided. Diets were eucaloric, and fiber content was similar. CHOICE was associated with increases in trimethylamine N-oxide, indoxyl sulfate, and several triglycerides, while CONV was associated with hippuric acid, betaine, and indole propionic acid, suggestive of a healthier metabolome. Conversely, the microbiome of CHOICE participants was enriched with carbohydrate metabolizing genes and beneficial taxa such as Bifidobacterium adolescentis, while CONV was associated with inflammatory pathways including antimicrobial resistance and lipopolysaccharide biosynthesis. We also identified latent metabolic groups not associated with diet: a metabolome associated with less of a decrease in fasting glucose, and another associated with relatively higher fasting triglycerides. Our results suggest that GDM diets produce specific microbial and metabolic responses during pregnancy, while host factors also play a role in triglycerides and glucose metabolism.

The attenuation of gut microbiota-derived short-chain fatty acids elevates lipid transportation through suppression of the intestinal HDAC3-H3K27ac-PPAR-γ axis in gestational diabetes mellitus.

Gut flora is considered to modulate lipid transport from the intestine into the bloodstream, and thus may potentially participate in the development of GDM. Although previous studies have shown that the intestinal microbiota influences lipid transport and metabolism in GDM, the precise mechanisms remain elusive. To address this, we used a high-fat diet (HFD)-induced GDM mouse model and conducted 16s rRNA sequencing and fecal metabolomics to assess gut microbial community shifts and associated metabolite changes. Western blot, ELISA, and chromatin immunoprecipitation (ChIP) were utilized to elucidate how gut microbiota affect intestinal lipid transport and the insulin sensitivity of hepatic, adipose, and skeletal muscle tissues. We found that HFD impaired the oral glucose tolerance test (OGTT) and insulin tolerance test (ITT) in pregnant mice. 16s rRNA sequencing demonstrated profound compositional changes, especially in the relative abundances of Firmicutes and Bacteroidetes. Metabolomics analysis presented a decline in the concentration of short-chain fatty acids (SCFAs) in the GDM group. Western blot analyses showed an upregulation of HDAC3 and a concurrent reduction in H3K27 acetylation in the intestine. ChIP-qPCR showed that PPAR-γ was inhibited, which in turn activated lipid-transporter CD36. ELISA and insulin signaling pathway detection in insulin-target organs showed high concentrations of circulating fatty acids and triglycerides and insulin resistance in insulin-target organs. Our results suggest that gut microbiota is closely associated with the development of GDM, partly because decreased gut flora-associated SCFAs activate CD36 by suppressing the HDAC3-H3K27ac-PPAR-γ axis to transport excessive fatty acids and triglycerides into blood circulation, thereby dysregulating the insulin sensitivity of insulin target organs.

Assessing Mental Health Conditions in Women with Gestational Diabetes Compared to Healthy Pregnant Women.

INTRODUCTION: Pregnant women with gestational diabetes mellitus (GDM) experience higher psychological stress levels than healthy pregnant women. The objectives of the current study were to examine (1) the differences in anxiety, depression, stress, and somatization levels between women diagnosed with GDM and healthy pregnant women, and (2) the differences in anxiety, depression, stress, and somatization levels among women with well-controlled blood sugar levels compared to those who are not well controlled. METHODS: A quantitative cross-sectional study was conducted, involving 103 women who had been pregnant at least once, including 40 women diagnosed with GDM and 63 healthy pregnant women. An online questionnaire was distributed that included three parts: socio-demographic parameters, the DASS-21 questionnaire assessing anxiety, depression, and stress, and the Brief Symptom Inventory (BSI) questionnaire assessing somatization. RESULTS: Differences in the anxiety (t = 14.470, <0.001), depression (t = 8.17, <0.001), stress (t = 16.354, <0.001), and somatization (t = 13.679, <0.001) levels between women diagnosed with GDM and healthy pregnant women were found. Women diagnosed with GDM reported higher levels of anxiety, depression, stress, and somatization compared to those without GDM. Additionally, women with better blood sugar control, as indicated by lower glycated hemoglobin (HbA1c) levels had lower anxiety (t (38) = -2.04, p < 0.05), depression (t(38) = -2.88, p < 0.01), stress (t(38) = -1.88, p < 0.05), and somatization (t(38) = -1.88, p < 0.05) levels compared to women with poorer blood sugar control. CONCLUSIONS: Pregnant women diagnosed with GDM report higher levels of negative mental health conditions such as anxiety, depression, stress, and somatization compared to healthy pregnant women.

Association of mRNA expression and polymorphism of antioxidant glutathione-S-transferase (GSTM1 and GSTT1) genes with the risk of Gestational Diabetes Mellitus (GDM).

Gestational Diabetes Mellitus (GDM) is a medical complication during the gestational period in which woman who had never been diagnosed with diabetes develops hyperglycemia. Prior studies have demonstrated that the advancement of GDM and its consequences arises from a disparity between oxidants and antioxidants in the cells. The observed outcomes can be attributed to an excessive formation of reactive oxygen species (ROS) within the cells, coupled with a reduced activity of anti-oxidative enzymes. Glutathione S-transferase (GSTs) is recognized as an antioxidant enzyme that is belong to as a phase II family member of detoxifying enzymes. These metabolic multigene catalysts are found into the cytoplasm of the cell. GSTs play a vital part in the elimination of cellular ROS or free radicals. The study involves total 300 pregnant women, (150 GDM cases and 150 healthy controls). The polymorphism study of GSTs genes (GSTM1 and GSTT1) was determined by conventional Polymerase Chain Reaction (PCR). The mRNA expression study of GSTM1 and GSTT1 genes analysed by qPCR/ RT-PCR (quantitative PCR/Real-Time PCR) followed by statistical analysis done using Prism8 software (version 8.01). The study revealed statistically significant variations in biochemical parameters between GDM cases and controls. It was found GSTM1-null (GSTM1-/-) polymorphism significantly (P < 0.0001) most prevalent in GDM cases (56.7%) when compared to healthy control (28%). However, no significant difference was observed for GSTT1 null and present polymorphism (P = 0.906). The gene expression levels of both GSTM1 and GSTT1 were found considerably downregulated in individuals with GDM as compared to the control group (P < 0.0001). The downregulation of gene expression has a significant (P<0.0001) association with the null/deletion polymorphism of both GSTM1/ GSTT1 genes respectively. Null/deletion genotype of GSTM1 gene and its expression showed significant association with GDM. Therefore, this gene variant has the potential to be used as a prognostic biomarker for GDM. However, there is need to study this gene variant in larger sample size and different ethnicity.

Unveiling the role of microRNAs in metabolic dysregulation of Gestational Diabetes Mellitus.

Gestational Diabetes Mellitus (GDM) presents a significant health concern globally, necessitating a comprehensive understanding of its metabolic intricacies for effective management. MicroRNAs (miRNAs) have emerged as pivotal regulators in GDM pathogenesis, influencing glucose metabolism, insulin signaling, and lipid homeostasis during pregnancy. Dysregulated miRNA expression, both upregulated and downregulated, contributes to GDM-associated metabolic abnormalities. Ethnic and temporal variations in miRNA expression underscore the multifaceted nature of GDM susceptibility. This review examines the dysregulation of miRNAs in GDM and their regulatory functions in metabolic disorders. We discuss the involvement of specific miRNAs in modulating key pathways implicated in GDM pathogenesis, such as glucose metabolism, insulin signaling, and lipid homeostasis. Furthermore, we explore the potential diagnostic and therapeutic implications of miRNAs in GDM management, highlighting the promise of miRNA-based interventions for mitigating the adverse consequences of GDM on maternal and offspring health.

Timing of gestational diabetes diagnosis and progression to type 2 Diabetes: A comparative analysis.

AIM: To evaluate and compare the risk of progressing to type 2 diabetes (T2DM) based on the timing of gestational diabetes (GDM) diagnosis during pregnancy. METHODS: Retrospective analysis of pregnant individuals with gestational diabetes and post-pregnancy follow up. Data sourced from Meuhedet HMO's computerized laboratory system, cross-tabulated with the Israeli National Diabetes Registry. The cohort was divided into normoglycemic, early GDM (diagnosed by fasting plasma glucose 92-125 mg/dL (5.1-6.9 mM) at < 15 weeks), 2nd trimester GDM (diagnosed at 24-28 weeks), and late GDM (diagnosed after 29 weeks). Statistics included univariate analysis followed by survival analysis. Risk was further analyzed for individuals by obesity status. RESULTS: 75,459 entered the analysis: 90 % normoglycemic, 7.9 % early GDM, 1.4 % 2nd trimester GDM, and 0.7 % late GDM. Median post-pregnancy follow-up time was 4.3 (IQR 3.3-5.1). 2nd trimester GDM showed the highest T2DM risk annually after pregnancy. Cox regression analysis, adjusted for confounders, revealed a significantly higher T2DM risk for 2nd-trimester GDM compared to early and late GDM. Late GDM did not confer additional significant T2DM risk. Stratification by obesity status highlighted that early GDM increased the risk of T2DM only in individuals without obesity. CONCLUSIONS: GDM diagnosis timing significantly impacts T2DM risk. 2nd trimester GDM carries the highest T2DM risk.

Trends in the Incidence of Gestational Diabetes Mellitus Among the Medicaid Population Before and During the COVID-19 Pandemic.

Importance: Although there are many regional and national studies on the trends in the incidence of gestational diabetes mellitus (GDM), the trends in the incidence of GDM among the Medicaid population are lacking, especially before and during coronavirus disease of 2019 (COVID-19). Objective: To investigate the trends in the incidence of GDM before and during COVID-19 pandemic (2016-2021) among the Louisiana Medicaid population. Design, Setting, and Participants: This study included 111,936, Louisiana Medicaid pregnant women of age 18-50 between January 1, 2016, to December 31, 2021. Main Outcomes and Measures: Pregnancies, GDM, and pre-pregnancy diabetes cases were identified by using the Tenth Revisions of the International Classification of Disease code. The annual incidence of GDM and annual prevalence of pre-pregnancy diabetes were calculated for each age and race subgroup. Results: The age-standardized incidence of GDM increased from 10.2% in 2016 to 14.8 in 2020 and decreased to 14.0% in 2021. The age-standardized prevalence of pre-pregnancy diabetes increased from 2.8% in 2016 to 3.4% in 2018 and decreased to 2.3% in 2021. The age-standardized rate of GDM was the highest among Asian women (23.0%), then White women (15.5%), and African American women (13.9%) (p for difference <0.001). The COVID-19 pandemic saw an increase in the incidence of GDM, with a rise in prominent GDM risk factors, such as obesity and sedentary behaviors, suggesting an association. Conclusion and Relevance: The incidence of GDM significantly increased during the COVID-19 pandemic. Potential reasons might include increased sedentary behavior and increased prevalence of obesity. GDM is a major public health issue, and the prevention of GDM is particularly essential for the Louisiana Medicaid population owing to the high prevalence of GDM-related risk factors in this population.

Prenatal exposure to polycyclic aromatic hydrocarbons and phthalate acid esters and gestational diabetes mellitus: A prospective cohort study.

BACKGROUND: Polycyclic aromatic hydrocarbons and phthalate acid esters (PAHs & PAEs), known as endocrine disrupting chemicals (EDCs), widely exist in daily life and industrial production. Previous studies have suggested that PAHs & PAEs may modify the intrauterine homeostasis and have adverse effects on fetal development. However, epidemiological evidence on the associations between PAHs & PAEs and gestational diabetes mellitus (GDM) is still limited. OBJECTIVE: To investigate the effects of prenatal PAHs &PAEs exposure on the risk of GDM and hyperglycemia in pregnant women. METHODS: The study population was a total of 725 pregnant women from a prospective birth cohort study conducted from December 2019 to December 2021. Blood glucose levels were collected by the hospital information system. Urinary PAHs & PAEs concentrations were determined by gas chromatography tandem mass spectrometry. The Poisson regression in a generalized linear model (GLM), multiple linear regression, quantile-based g-computation method (qgcomp), and Bayesian kernel machine regression (BKMR) were applied to explore and verify the individual and overall effects of PAHs & PAEs on glucose homeostasis. Potential confounders were adjusted in all statistical models. RESULTS: A total of 179 (24.69%) women were diagnosed with GDM. The Poisson regression suggested that a ln-unit increment of 4-OHPHE (4-hydroxyphenanthrene) (adjusted Risk Ratio (aRR) = 1.13; 1.02-1.26) was associated with the increased GDM risk. Mixed-exposure models showed similar results. We additionally found that MBZP (mono-benzyl phthalate) (aRR = 1.19; 1.02-1.39) was positively related to GDM risk in qgcomp model. Although neither model demonstrated that 2-OHNAP (2-hydroxynaphthalene) and 9-OHFLU (9-hydroxyfluorene) increased the risk of GDM, 2-OHNAP and 9-OHFLU exposure significantly increased blood glucose levels. BKMR model further confirmed that overall effects of PAHs & PAEs were significantly associated with the gestational hyperglycemia and GDM risk. CONCLUSIONS: Our study presents that environmental exposure to PAHs & PAEs was positively associated with gestational glucose levels and the risks of developing GDM. In particular, 2-OHNAP, 9-OHFLU, 4-OHPHE and MBZP may serve as important surveillance markers to prevent the development of GDM.

Circular RNA hsa_circ_0002268 (PHACTR1) Is Specific to Gestational Diabetes Mellitus in a Polish Pregnant Population.

Gestational diabetes mellitus (GDM) is an intolerance of carbohydrate of any degree, which appears for the first time or is diagnosed during pregnancy. The objective of this study is to assess the differences in circular RNA (circRNA) in a Polish pregnant population with and without GDM. A total of 62 pregnant women, 34 with GDM and 28 controls, were enrolled in the study. Total RNAs were extracted from plasma and reverse transcription to complementary DNA (cDNA) was performed. A panel covering 271 amplicons, targeting both linear and circular as well as negative control gene transcripts, was used. Next-generation sequencing was used to evaluate the circRNA quantity. Data analysis was performed using the Coverage Analysis plugin in the Torrent Suite Software (Torrent Suite 5.12.3). A two-step normalization was performed by dividing each transcript read count by the total number of reads generated for the sample, followed by dividing the quantity of each transcript by ß-actin gene expression. Both circular and linear forms of RNAs were independently evaluated. A total of 57 transcripts were dysregulated between pregnant women with GDM and controls. Most of the targets (n = 25) were downregulated (cut-off ratio below 0.5), and one target showed a trend toward strong upregulation (ratio 1.45). A total of 39 targets were positively correlated with fasting plasma glucose (FPG), but none of the tested targets were correlated with insulin, CRP or HOMA-IR levels. Among the pregnant women with gestational diabetes, the relative quantity of hsa_circ_0002268 (PHACTR1) was approximately 120% higher than among healthy pregnant women: 0.046 [0.022-0.096] vs. 0.021 [0.007-0.047], respectively, (p = 0.0029). Elevated levels of hsa_circ_0002268 (PHACTR1) might be specific to the Polish population of pregnant women with GDM, making it useful as a potential molecular biomarker in the management of GDM in Poland.

Oral Glucose Tolerance Test for Universal screening for Gestational Diabetes Mellitus.

BACKGROUND: Gestational Diabetes Mellitus increased almost 30% in many countries, including underdeveloped countries and same in Nepal. Hospital-based studies in Nepal reported Gestational Diabetes Mellitus cases, with prevalence 2.48% in 2010 to 4.47% in 2019 emphasising on necessity of universal screening for Gestational Diabetes Mellitus. METHODS: As part of implementation of Electronic Decision support System for Antenatal Care, in formative study clinical vignettes on Gestational Diabetes Mellitus case presented to six healthcare providers ( Incharges, Auxiliary Nurse, Midwives and Lab Assistants) from 3 primary healthcare facilities in Kavre and Dolakha districts, Nepal from October-December 2019. 19 Auxiliary Nurse, Midwives from 19 HCF of 4 districts (Kavre, Dolakha, Sindhuli, and Sindhupalchok, including where clinical vignette were applied trained to perform Oral Glucose Tolerance Test for 4 hours. In-depth Interviews conducted with 16 Auxiliary Nurse, Midwives (8 trained and 8 peer coached from selected 4 HCF to explore their perception and experiences of conducting Oral Glucose Tolerance Test and continuing it for future. Clinical vigenttes compared with PEN protocol and IDIs analyzed thematically. RESULTS: Only 4/6 HCPs made probable diagnosis of Gestational Diabetes Mellitus. 217 Oral Glucose Tolerance Test performed, 24 found to have Gestational Diabetes Mellitus. In-depth Interviews showed Auxiliary Nurse, Midwives enthusiasts on implementing tests for Gestational Diabetes Mellitus and to continue what has been learnt in training. Some challenges; clients hesitate to stay 2 hours at facilities due to unavailability of transport and household work. Oral Glucose Tolerance Test trained Auxiliary Nurse, Midwives seem more confident in counselling and conducting Oral Glucose Tolerance Test than those peer coached. CONCLUSIONS: Administering Oral Glucose Tolerance Test seemed feasible in HCF settings despite some challenges. Training and continuing logistics supply from municipality level seems promising.

Diagnosis and Treatment of Hyperglycemia in Pregnancy: Type 2 Diabetes Mellitus and Gestational Diabetes.

Hyperglycemia in pregnancy due to pre-existing Type 2 diabetes mellitus (T2DM) and gestational diabetes mellitus (GDM) is rising globally with increasing rates of risk factors for metabolic disease. This review summarizes current evidence and recommendations from national and international guidelines for diagnosis and management of T2DM and GDM to optimize maternal and neonatal outcomes.

Gestational diabetes mellitus as a risk factor for future Type-2 diabetes mellitus: An experience from a tertiary care diabetes hospital, Karachi - Pakistan.

Objective: To evaluate the history of gestational diabetes mellitus and other risk factors in women presenting with Type-2 diabetes mellitus at a tertiary care hospital. Methods: This cross-sectional study was carried out at Baqai Institute of Diabetology & Endocrinology (BIDE), Baqai Medical University (BMU), Karachi-Pakistan from July 2019 to May 2022. Women with Type-2 diabetes mellitus (T2DM) visiting outpatient department of BIDE with a previous history of GDM were recruited. Details were obtained on pre-designed questionnaire after taking informed written consent. Results: A total of 378 women who had a prior history of GDM were included. Mean age (years) was 43.53±10.17. Mostly women were obese (BMI = 30.53±6.08) and have sedentary lifestyle. Mean HbA1c (%) was 9.08±2.24. This study found family history of T2DM and hypertension were common risk factors in women with GDM history. Mostly, women were diagnosed as GDM during 2nd trimester 153(42%) and was mainly seen in multiparous women (occur in 4th and above pregnancy). We found hypertension as common complication during pregnancy. Around 46% women developed T2DM within one year of GDM diagnosis, and 29.6% between one to five years. Conclusion: Majority of women with GDM developed T2DM within five years of diagnosis. The potential associated risk factors were age, family history of diabetes, insulin use during pregnancy, trimester of GDM diagnosis, and hypertension during pregnancy. Awareness and life style modifications along with regular post-partum follow up with screening for T2DM should be part of GDM management to prevent or delay the occurrence of this serious complication.

Association of VDR gene variant rs2228570-FokI with gestational diabetes mellitus susceptibility in Arab women.

Gestational diabetes mellitus (GDM) has been linked with adverse pregnancy outcomes. Vitamin D receptor (VDR) gene variants have been associated with diabetes mellitus susceptibility and related complications. This study assessed the association between VDR gene polymorphism (rs2228570) and GDM risk among pregnant Arab women. A total of 368 pregnant Saudi women who were screened for GDM at 24-28 weeks of gestation and genotyped for the VDR gene variant (rs2228570) were included in this cross-sectional study. Circulatory insulin levels, fasting blood glucose (FBG), glycated hemoglobin (HbA1c), and vitamin D (25(OH)D) were measured. There were 108 women with GDM and 260 women without GDM. The genotype frequency of women with GDM was CC 60.2 %, CT 33.3 %, TT 6.9 %, and CT + TT 39.8 %; for non-GDM women, were CC 61.1 %, CT 31.5 %, TT 6.9 %, and CT + TT 38.4 %. No association was found between the VDR gene variant (rs2228570-FokI) and GDM susceptibility after adjustment for covariates. Serum 25(OH)D had a significant inverse association with FBG (r = -0.49, p = 0.01) and HbA1c (r = -0.45, p = 0.03) among carriers of the TT-genotype. Furthermore, a significant inverse correlation was observed between serum 25(OH)D and HOMA-ß (r = -0.20, p = 0.035) in individuals with the T-allele. Among pregnant Saudi women, glycemic indices appear to be influenced by vitamin D, suggesting a possible role it may play in mitigating the metabolic changes associated with GDM, particularly among individuals with specific genetic backgrounds. In our study population, rs2228570-FokI did not appear to be a significant contributor to GDM risk.