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SUMMARY OBJECTIVE: The aim of this study was to analyze the second-trimester levels of vitronectin and plasminogen activator inhibitor-1 in gestational diabetes mellitus. METHODS: This study was conducted between September 2020 and December 2020 at the University of Health Sciences, Bursa Yuksek Ihtisas Research and Training Hospital, Department of Obstetrics and Gynecology. A total of 30 pregnant women with gestational diabetes mellitus and 60 healthy controls between 24 and 27/6 weeks of gestation were included. The inclusion criteria were as follows: being between 18 and 45 years old and 24-27/6 gestational weeks, having singleton pregnancy, diagnosed with gestational diabetes mellitus by using a two-step challenge test. The exclusion criteria of this study were as follows: chronic inflammatory or infectious disease, fasting blood glucose>126 mg/dL, intolerance to glucose tolerance testing, abnormal liver or kidney function tests, as well as pregnancy with pre-gestational diabetes history of adverse perinatal outcomes. Serum vitronectin and plasminogen activator inhibitor-1 levels were measured using the enzyme-linked immunosorbent assay method. RESULTS: Vitronectin and plasminogen activator inhibitor-1 levels were higher in the gestational diabetes mellitus group compared with controls [91.85 (23.08) vs. 80.10 (39.18) ng/mL, for vitronectin and 6.50 (1.05) vs. 4.35(1.0) ng/mL, for plasminogen activator inhibitor-1 (for both p<0.001)]. vitronectin >84.7 ng/mL was found to predict gestational diabetes mellitus with a sensitivity of 70% and specificity of 63.3%. Moreover, vitronectin had a significant positive correlation with fasting blood glucose (r=0.476, p<0.001), postprandial blood glucose (r=0.489, p<0.001), HbA1c (r=0.713, p<0.001), and plasminogen activator inhibitor-1 (r=0.586, p<0.001). CONCLUSION: This study revealed that second-trimester vitronectin and plasminogen activator inhibitor-1 are increased in gestational diabetes mellitus and vitronectin could be a candidate for the prediction of gestational diabetes mellitus.
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Objectives: Various physiological mechanisms counteract insulin resistance (IR) during normal pregnancy. Psychological stress is a known, independent risk factor for developing IR. Pregnancy-specific psychological stress may cause IR and increase the risk of overt diabetes. Hence, the study aims to evaluate maternal psychological stress using multiple stress markers and their association with changes in IR during pregnancy and postpartum. Materials and Methods: Anthropometric measurements such as height, weight and skinfold thickness were measured using standard techniques. The stress markers were assessed using perceived stress scales (K10 questionnaire), a physiological marker of stress (Heart rate variability [HRV] measures) and biochemical stress markers (Saliva, hair cortisol levels). IR was estimated using homeostasis model assessment-estimated IR (HOMA-IR). The association of stress markers with IR was studied among fifty healthy pregnant women during pregnancy and postpartum. Results: The psychological stress scores and saliva cortisol were significantly higher during pregnancy than postpartum (P = 0.000). A comparison of cardiac autonomic function as assessed by HRV measures shows that high frequency in normalised units (HFnu) was significantly higher during the postnatal period than in the prenatal period (P = 0.000). High frequency (HF) spectral power in absolute units was also significantly higher (P = 0.002) in the postpartum period (2612.30 ± 432.24) when compared with the prenatal period (1446.10 ± 299.15). Low frequency in normalised units (LFnu), low frequency (LF)/HF ratio was significantly higher during the prenatal period than in the postnatal period (P = 0.000). As assessed by HOMA-IR values, IR was significantly higher during the prenatal period than postpartum (P = 0.04). There was a significant positive correlation between prenatal psychological stress scores, HRV parameters (LFnu, LF/HF) and postnatal IR. Conclusion: Pregnancy is associated with higher psychological stress levels and IR than postpartum. Furthermore, the maternal cardiac autonomic marker could predict postnatal IR among healthy pregnant women.
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Background: The prevalence of hyperglycemia first detected during pregnancy is showing an escalating increase in recent years contributed by the increasing obesity prevalence, advanced maternal age at delivery, and the universal screening protocol during the first antenatal visit. There exists a very little data on the role of HbA1c in pregnancy and the results remain inconsistent. There is a need to define diagnostic criteria to predict the adverse perinatal outcomes in gestational diabetes mellitus (GDM). Aims and Objectives: This study was aimed to assess the role of HbA1c as a prognostic indicator of third trimester mean blood glucose in GDM pregnancies and in predicting the birth of large for gestational age (LGA) babies. Materials and Methods: 200 pregnant women with GDM and 200 pregnant women without GDM and their neonates participated in this analytical cross-sectional study. Maternal age, height, weight, BMI, and neonatal birth weight were recorded. Third trimester maternal HbA1c level was analyzed by high-performance liquid chromatography. The association between HbA1c and LGA births was analyzed. Results: The mean HbA1c levels and percentage of LGA births were high in GDM group. Multiple logistic regression analysis showed association between high HbA1c values and LGA births in GDM. A Receiver operating characteristic curve was drawn to derive the optimal cut-off value, sensitivity, and specificity of HbA1c in predicting birth of LGA neonates in GDM. Conclusion: This study shows that high third trimester HbA1c levels in GDM increase the risk of LGA births. Further studies are needed to define standard cut-off values of glycated Hb in each trimester of pregnancy.
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Background: Adverse perinatal outcome has always been a devastating experience for the mother. Advanced maternal age and other risk factors are independent risk factor for perinatal outcome. Therefore, aim of study is to compare the effect of these factor in different study group. Aims and Objectives: Case–control study has been conducted to evaluate obstetrics outcome, maternal morbidity, and perinatal outcome in patients with bad obstetric history. Materials and Methods: A prospective observational case–control study has been conducted in two groups; GROUP A: BOH group (n = 44) and GROUP B: Controls (n = 88) who fulfilled inclusion criteria in Department of Obstetrics and Gynaecology, GMERS Medical college, Sola during the period of August 2018 to August 2020. Statistical analysis was done by descriptive statistics and qualitative and quantitative method. Results: Incidence of hypertension in Group A was 25%, while in Group B incidence was 6.8%. Incidence of hypertension was 4.5 times higher in Group A than B which was statistically significant (P < 0.05). Incidence of PROM, gestational diabetes mellitus, thyroid dysfunction was higher in Group A than Group B. Higher incidence of preterm delivery found in Group A than in Group B which was statistically significant (P < 0.05). Conclusion: Among all BOH group, cases with previous history of preterm delivery, still birth, recognition of prior learning, and HTD were the major risk factors which could be responsible for adverse obstetric and perinatal outcome.
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Purpose: Gestational diabetes mellitus (GDM) is fairly common in India. There is an interplay of various factors like androgens, sex hormone?binding globulin (SHBG), estrogen, and progesterone on the tear film in pregnancy. Diabetes mellitus in itself affects the lacrimal function unit (LFU) and ocular surface. This study was therefore performed to assess the effect of the various factors on the tear film function and ocular surface in GDM using different diagnostic tests. Methods: Case–control study includes 49 subjects after calculating the sample size. Cases of newly diagnosed GDM in their second or third trimester of pregnancy without any ocular or systemic comorbidities. The following standard tests were performed, namely, ocular surface disease index (OSDI) scoring, Schirmer’s test, tear film breakup time (TBUT), and ocular surface staining (SICCA). Results: The two study groups did not differ significantly in terms of age, gestational age, and presenting symptoms. None of the patients had diabetic retinopathy, and the ocular surface was unaffected in both groups. There was a significant difference in the Schirmer’s II test (P = 0.01) between the groups, while Schirmer’s I (P = 0.06) and TBUT (P = 0.07) were not significant. Conclusion: Our study suggests that GDM patients can potentially suffer from DES despite the lack of symptoms and may be the basis for conducting larger studies to justify routine screening of GDM for DES in order to improve the quality of life of pregnant women
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Background & objectives: Gestational or preexisting diabetes is one of the risk factors of pre-eclampsia. Both are responsible for higher maternal and fetal complications. The objective was to study clinical risk factors of pre-eclampsia and biochemical markers in early pregnancy of women with diabetes mellitus (DM)/gestational diabetes mellitus (GDM) for the development of pre-eclampsia. Methods: The study group comprised pregnant women diagnosed with GDM before the 20 wk of gestation and DM before pregnancy and the control group had age-, parity- and period of gestation-matched healthy women. Sex hormone-binding globulin (SHBG), insulin-like growth factor-I (IGF-I) and 25-hydroxy vitamin D [25(OH)D] levels and the polymorphism of these genes was evaluated at recruitment. Results: Out of 2050 pregnant women, 316 (15.41%) women (296 had GDM and 20 DM before pregnancy) were included in the study group. Of these, 96 women (30.38%) in the study group and 44 (13.92%) controls developed pre-eclampsia. Multivariate logistic regression analysis indicated those who belonged to the upper middle and upper class of socio-economic status (SES) were likely to be at 4.50 and 6.10 times higher risk of developing pre-eclampsia. The risk of getting pre-eclampsia among those who had DM before pregnancy and pre-eclampsia in their previous pregnancy was about 2.34 and 4.56 times higher compared to those who had no such events, respectively. The serum biomarkers [SHBG, IGF-I and 25(OH)D] were not found to be useful in predicting pre-eclampsia in women with GDM. To predict risk of development of pre-eclampsia, the fitted risk model by backward elimination procedure was used to calculate a risk score for each patient. Receiver operating characteristic (ROC) curve for pre-eclampsia showed that area under the curve was 0.68 (95% confidence interval: 0.63-0.73); P<0.001. Interpretation & conclusions: The findings of this study suggested that pregnant women with diabetes were at a higher risk for pre-eclampsia. SES, history of pre-eclampsia in previous pregnancy and pre-GDM were found to be the risk factors.
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Background: Gestational diabetes mellitus (GDM) is one of the most common complications of pregnancy and associated with adverse outcomes of pregnancy for mother and baby. GDM exposes fetus to hyperglycemia and it leads to macrosomia, birth trauma, shoulder dystocia, neonatal hypoglycemia, hyperbilirubinemia, hypocalcemia, polycythemia, and respiratory distress syndrome. Aim and Objectives: The objective of this study is to analyze maternal and neonatal outcomes of pregnancy in women with GDM. Materials and Methods: This study was carried out prospectively in the department of obstetrics and gynecology, tertiary care hospital, Gujarat, over a period of December 2020–December 2021. Total 104 patients were diagnosed with GDM and included in this study. Exclusion criteria include pregnant women with pre-existing diabetes, pregnancy with more than one fetus, other chronic disease, still birth, on medication that might affect glucose metabolism (steroids, anti-psychotic medications, etc.), not willing to participate. A detailed history of all patients was taken. Results: Out of 990 patients, 104 (10.5%) pregnant women were found to have GDM. Adverse maternal outcomes were polyhydramnios (38.4%), antepartum haemorrhage (1.9%), postpartum hemorrhage (4.8%), sepsis (1.9%), wound infection (1.9%), and urinary tract infection (10.6%). Most common neonatal complication was hypoglycemia (29.8%), prematurity (16.3%), and macrosomia (10.5%). Conclusion: The increasing prevalence of risk factors related to GDM; it is likely that GDM in pregnant women will give adverse outcomes. The antenatal screening for GDM is key for early diagnosis and treatment during antennal visit and that will improve maternal and fetal outcome. Management of GDM can prevent development of future diabetes mellitus in women.
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Background: Gestational diabetes mellitus (GDM) is a type of insulin resistance that develops in the second trimester of pregnancy. This type of diabetes ends after delivery. GDM poses serious health hazards to both the mother and the baby. Pathology behind this carbohydrate intolerance is insulin resistance. The previous studies have pointed out that this insulin resistance is due to oxidative stress caused by free radicals. Free radicals can be generated by iron. Since pregnancy is a condition where iron requirement rises, universal iron supplementation is given. According to the previous studies, excess iron can cause free-radical mediated injury leading on to diabetes. Supplementation of a prooxidant irrespective of body iron stores may be more harmful than beneficial. Hemoglobin and PCV are two hematological parameters that reflect body iron stores. Aims and Objectives: The aim of the study was to compare hemoglobin and PCV values in pregnant woman with and without GDM. Materials and Methods: A case–control study was done in the obstetric department of a tertiary care center in south India from August 2010 to December 2010.The study included 85 cases and 85 controls. Cases were pregnant women at 24–28 weeks of gestation with gestational diabetes who attended the obstetric OPD during the study period. GDM was diagnosed as per ADA guidelines. Controls were pregnant women at 24–28 weeks gestation without GDM as per ADA guidelines. Data for the study were collected using a preformed tested questionnaire. All subjects were provided with iron supplementation according to the national programme. Estimation of hemoglobin and PCV was done with 2 ml of blood sample obtained by venepuncture using an automated analyzer. The association of elevated hemoglobin and PCV with the risk of developing GDM was tested using Chi-square analysis. P ? 0.05 was taken as statistically significant. Results: Hemoglobin in cases and controls showed a significant difference by Chi-square analysis (P = 0.004). PCV in cases was significantly higher than in controls by Chi-square analysis (P = 0.003). Conclusion: The study found a statistically significant association between higher maternal hemoglobin level and PCV with GDM.
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Gestational diabetes mellitus (GDM) and preeclampsia (PE) are most common pregnancy complications with similar risk factors and path physiological changes. When a pregnant woman has high blood pressure, protein in her urine, and often swelling in fingers and toes that doesn't go away, she might have preeclampsia .it is a serious problem that needs to be watched closely and managed by her doctor .high blood pressure can cause harm to both the woman and her unborn baby.it might lead to the baby being born early and also could cause seizures or a stroke in the women with diabetes have high blood pressure more often than women without diabetes From previous studies suggests that the incidence of PE commonly increased in women with GDM. and GDM complicated by PE further increases the adverse effect on maternal and new born babies health. This study provides the prevalence of PE in GDM and its adverse maternal outcomes
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Objective:To study the impacts of pre-pregnancy body mass index (BMI), gestational diabetes mellitus (GDM) and gestational weight gain (GWG) on perinatal outcomes and mode of delivery.Methods:From November 2016 to December 2017, single-pregnancy women in early pregnancy (<13 weeks) regularly checked-up at our hospital were enrolled in this prospective cohort study and followed up until delivery. They were assigned into four groups according to pre-pregnancy BMI: obese group (≥28.0 kg/m 2), overweight group(24.0-<28.0 kg/m 2), normal group (18.5-<24.0 kg/m 2) and underweight group(<18.5 kg/m 2). A 75-g oral glucose tolerance test was performed at 24-28 weeks of pregnancy to screen for GDM. The optimal GWG was 11.0-16.0 kg for underweight group, 8.0-14.0 kg for normal group, 7.0-11.0 kg for overweight group and 5.0-9.0 kg for obesity group. The effects of pre-pregnancy BMI, GDM and GWG on perinatal outcomes and delivery mode were evaluated using multivariate logistic regression methods. Results:A total of 802 pregnant women were included. The incidences of pre-pregnancy overweight and obesity were 21.8% and 8.9%, respectively. The incidence of GDM was 14.1%. 57.2% of the participants experienced excessive GWG. The incidences of macrosomia, low birth weight and premature birth were 7.1%, 2.7% and 2.2%, respectively. The incidence of Cesarean delivery (C-section) was 37.7%. Pre-pregnancy obesity [adjusted odds ratio ( AOR)=4.355, 95% confidence interval ( CI) 1.900-9.980] and excessive GWG ( AOR=3.799, 95% CI 1.796-8.034) were independent risk factors for macrosomia. Excessive GWG was a protective factor for low birth weight ( AOR=0.279, 95% CI 0.084-0.928) and inadequate GWG was a risk factor for low birth weight ( AOR=10.954, 95% CI 3.594-33.382) and premature birth ( AOR=8.796, 95% CI 2.628-29.438). Compared with the normal group, overweight group had an increased risk of C-section ( AOR=1.817, 95% CI 1.119-2.949). Compared with pregnant women without pre-pregnancy overweight/obesity, GDM nor excessive GWG, any combination of two of the above-mentioned three factors increased the risks of macrosomia ( AOR=3.908, 95% CI 1.630-9.370) and C-section ( AOR=2.269, 95% CI 1.325-3.886). The risks of macrosomia and C-section were the highest when all three factors existed. Conclusions:Pre-pregnancy obesity and excessive GWG are independent risk factors for macrosomia and pre-pregnancy overweight is a risk factor of C-section. Exposure to any two of the three factors (pre-pregnancy overweight/obesity, GDM and excessive GWG) increases risks of macrosomia and C-section and the highest risk is observed when all three factors are present.
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Objective:To analyze the clinical value of relative expression of peroxisome proliferators-activated receptors mRNA (PPAR mRNA) and protein in placental tissues of pregnant women with gestational diabetes mellitus (GDM) .Methods:52 pregnant women (the study group) with GDM who were admitted to our hospital from Jan. 2019 to Nov. 2020 and 50 normal pregnant women (the control group) who underwent physical examination and gave birth during the same period were selected. Serum samples were collected to detect the islet cell function. Placental tissue samples of the two groups of pregnant women were collected after delivery to measure the content of PPARγmRNA and protein in placental tissues and adipose tissues. The correlations between PPARγ in placental, adipose tissues of GDM pregnant women with islet cell function were analyzed.Results:The HOMA-IR level of the study group was higher than that of the control group [ (3.45±1.06) % vs (1.40±0.43) %], and the HOMA-β level [ (126.59±23.59) % vs (153.12±27.34) %] was lower than that of the control group ( P<0.05). The PPARγ mRNA [ (1.65±0.21) vs (0.93±0.16) ] and PPARγ protein content [ (1.89±0.51) vs (1.02±0.23) ] of placenta tissue in the study group were higher than those in the control group ( P<0.05), the PPARγmRNA [ (0.49±0.12) vs (1.15±0.26) ] and PPARγ protein content [ (0.43±0.11) % vs (0.96±0.22) %] in adipose tissue were lower than those of the control group ( P<0.05). Adipose tissue PPARγ mRNA and PPARγ protein were negatively correlated with HOMA-IR ( r=-0.45, -0.33), and positively correlated with HOMA-β ( r=0.47, 0.43) ( P<0.05) ; placental tissue PPARγ mRNA and PPARγ protein were positively correlated with HOMA-IR ( r=0.40, 0.37), and negatively correlated with HOMA-β ( r=-0.44, -0.35) ( P<0.05) . Conclusion:The levels of PPARγ mRNA and PPARγ protein are low expressed in adipose tissue of GDM patients, and highly expressed in placental tissues, and PPARγ expression is significantly correlated with HOMA-IR and HOMA-β, which can provide new clinical treatment for GDM Target and direction.
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Objective:To investigate the effect of single nucleotide variation of osteoprotegerin (OPG) gene on the occurrence of osteoporosis (OP) in patients with gestational diabetes mellitus (GDM) .Methods:From Apr. 2018 to Apr. 2022, 276 pregnant women with GDM who underwent prenatal examination and gave birth in Linyi People’s Hospital were collected for analysis, general data were collected and bone mineral density was tested. According to the bone mineral density test results, they were divided into normal group and OP group. The OPG genotype was tested, and the general information, OPG genotype and allele frequency of the two groups were compared. The differences in bone mineral density among different genotypes of OPG were compared, and the genotypes affecting the risk of OP in GDM patients were analyzed.Results:There was no significant difference in the general data of the two groups of patients (all P>0.05). The allelic distribution of the rs3134069 and rs2073618 loci of the OPG gene in the two groups of patients conformed to the Hardy-Weinberg equilibrium law (all P>0.05). There was a statistically significant difference in the frequency of the AC genotype at rs3134069 between the two groups ( χ2=7.75, P=0.005). Taking patients with the AA genotype as a reference, patients with the AC genotype had a lower risk of developing OP ( OR=0.15, 95% CI: 0.03-0.59). There was a statistically significant difference in the frequency of CC genotype at rs2073618 between the two groups ( χ2=11.30, P=0.001). Taking patients with GG genotype as a reference, patients with CC genotype had a higher risk of developing OP ( OR=7.42, 95% CI: 2.19-27.18). Comparing rs3134069 and rs2073618 loci, there was no significant difference in bone mineral density at each part of the three genotypes (all P>0.05). The multivariate Logistic regression model showed that the AC genotype of rs3134069 ( OR=0.18, 95% CI: 0.03-0.70, P=0.029) was a protective factor for the induction of OP, while GC genotype of rs2073618 ( OR=6.86, 95% CI: 1.57-27.15, P=0.007) were the risk factors for OP in GDM patients. Conclusion:The CC genotype of rs2073618 is significantly positively correlated with the susceptibility to OP in GDM patients.
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Melatonin receptor 1B (MT2, encoded by the MTNR1B gene), a high-affinity receptor for melatonin, is associated with glucose homeostasis including glucose uptake and transport. The rs10830963 variant in the MTNR1B gene is linked to glucose metabolism disorders including gestational diabetes mellitus (GDM); however, the relationship between MT2-mediated melatonin signaling and a high birth weight of GDM infants from maternal glucose abnormality remains poorly understood. This article aims to investigate the relationship between rs10830963 variants and GDM development, as well as the effects of MT2 receptor on glucose uptake and transport in trophoblasts. TaqMan-MGB (minor groove binder) probe quantitative real-time polymerase chain reaction (qPCR) assays were used for rs10930963 genotyping. MT2 expression in the placenta of GDM and normal pregnant women was detected by immunofluorescence, western blot, and qPCR. The relationship between MT2 and glucose transporters (GLUTs) or peroxisome proliferator-activated receptor γ (PPARγ) was established by western blot, and glucose consumption of trophoblasts was measured by a glucose assay kit. The results showed that the genotype and allele frequencies of rs10830963 were significantly different between GDM and normal pregnant women (P<0.05). The fasting, 1-h and 2-h plasma glucose levels of G-allele carriers were significantly higher than those of C-allele carriers (P<0.05). Besides, the protein and messenger RNA (mRNA) expression of MT2 in the placenta of GDM was significantly higher than that of normal pregnant women (P<0.05). Melatonin could stimulate glucose uptake and GLUT4 and PPARγ protein expression in trophoblasts, which could be attenuated by MT2 receptor knockdown. In conclusion, the rs10830963 variant was associated with an increased risk of GDM. The MT2 receptor is essential for melatonin to raise glucose uptake and transport, which may be mediated by PPARγ.
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Female , Humans , Pregnancy , Blood Glucose/metabolism , Diabetes, Gestational/metabolism , Glucose/metabolism , Melatonin/metabolism , Polymorphism, Genetic , PPAR gamma , Receptor, Melatonin, MT2/geneticsABSTRACT
Resumo Introdução O diabetes mellitus gestacional é definido como qualquer grau de intolerância à glicose, diagnosticado pela primeira vez durante a gestação, podendo ou não persistir após o parto. Sua prevalência ainda é conflitante, mas os riscos oferecidos a mãe e feto são diversos. Objetivo Identificar as respostas positivas de mulheres sobre um diagnóstico de diabetes recebido na gestação e relacioná-lo a características sociodemográficas e do pré-natal, além de descrever as orientações recebidas frente ao diagnóstico. Método Estudo com característica transversal que utiliza dados da Pesquisa Nacional de Saúde 2013, conforme o autorrelato de diagnóstico de diabetes gestacional. Realizou-se análise bivariada e cálculo das prevalências e razões de prevalência, com intervalo de confiança de 95% (IC95%), considerando plano de amostragem complexa. Resultados O diagnóstico de diabetes mellitus gestacional no período pré-natal foi relatado por 106 mulheres, com uma prevalência ponderada de 6,6% (IC95% 5,0-8,5). Verificou-se associação entre o relato de diagnóstico na gestação com maior idade e cor não branca. A maioria das mulheres diagnosticadas recebeu orientações quanto aos riscos da doença, mas poucas foram encaminhadas para consulta com especialista. Conclusão Os resultados detalhados da PNS fornecem estimativas populacionais sobre a magnitude da doença e possibilitam identificar o conjunto de fatores associados ao DMG.
Abstract Background Gestational diabetes mellitus is defined as any degree of glucose intolerance that is first diagnosed during pregnancy and may or may not persist after delivery. Its prevalence is still conflicting, but the risks offered to mother and fetus are diverse. Objective To identify the positive responses of women about a diagnosis of diabetes received during pregnancy and to relate it to sociodemographic and prenatal characteristics, in addition to describing the orientations received regarding the diagnosis. Method A cross-sectional study that uses data from the 2013 National Health Survey according to the self-reported gestational diabetes diagnosis. A bivariate analysis was performed, and prevalence and prevalence rates with a 95% confidence interval (95% CI) were calculated, considering a complex sampling plan. Results The diagnosis of prenatal gestational diabetes mellitus was reported by 106 women, with a weighted prevalence of 6.6% (95% CI 5.0-8.5). There was an association between the diagnosis report in older pregnancy and non-white color. Most diagnosed women received guidance on the risks of the disease, but few were referred for specialist consultation. Conclusion The detailed results of the PNS provide population estimates of the magnitude of the disease and make it possible to identify the set of factors associated with GDM.
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Abstract Objective This study aimed to investigate the mid-pregnancy blood glucose levels of women with singleton or twin pregnancies. Method The relationship between blood glucose levels and Gestational Diabetes Mellitus (GDM) was studied in women with different pre-pregnancy Body Mass Index (BMI), and the effect of GDM on twin pregnancy outcomes was analyzed. Women with twin (n= 1,985) and singleton (n= 1,985) pregnancies were categorized into underweight (BMI < 18.5 kg/m2, n= 597), normal weight (BMI: 18.5-23.9 kg/m2, n= 2,575), and overweight/obese (BMI ≥ 24 kg/m2, n= 798) groups. Results The incidence of GDM was 21.01% in women with twin pregnancies. Among the women with GDM in twin pregnancies, 38.37% had at least two abnormal blood glucose levels. The incidence of these parameters increased with preconception BMI, and the incidence of twin pregnancies was higher than that of singleton pregnancies (p < 0.001). In the normal weight and overweight/obese group, the oral glucose tolerance test glucose level and incidence of GDM were higher in women with twin than singleton pregnancies (p < 0.05). For twin pregnancies, the prevalence of selective fetal growth restriction was higher and anemia was lower in the GDM group than in the non-GDM group (all p < 0.05). Conclusion Therefore, a greater emphasis should be placed on BMI before conception, and well-controlled GDM does not increase adverse pregnancy outcomes for twin pregnancies.
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Resumen OBJETIVO: Determinar la frecuencia del alelo Ala en una muestra de mujeres mexicanas con diabetes mellitus gestacional y asociar su repercusión en la glucemia. MATERIALES Y MÉTODOS: Estudio ambispectivo, observacional, transversal y correlacional efectuado en una cohorte de pacientes con diabetes gestacional atendidas entre los meses de enero a junio del 2014 en el Hospital Militar de Especialidades de la Mujer y Neonatología de la Secretaría de la Defensa Nacional en la Ciudad de México. Se evaluó el polimorfismo mediante amplificación de un fragmento de ADN mediante la reacción en cadena de la polimerasa (PCR) y su secuenciación. RESULTADOS: Se estudiaron 81 pacientes; 3 de ellas con el alelo Ala, con concentraciones de glucosa menores y antecedente de más abortos en comparación con las mujeres sin el alelo Ala. CONCLUSIONES: La coexistencia del alelo Ala en mujeres embarazadas con diagnóstico de diabetes mellitus gestacional pudiera tener un efecto protector en contra de la hiperglucemia en el embarazo y el riesgo de aborto.
Abstract OBJECTIVE: To determine the frequency of peroxisomal proliferator-activated receptor gamma (PPARg) polymorphism of proline substituted with an alanine in amino acid 12 (Pro12Ala), in women with gestational diabetes mellitus and associate its impact with glycemia. MATERIALS AND METHODS: An ambispective, observational, cross-sectional and correlational study was carried out in a cohort of women with gestational diabetes that included 81 pregnant women treated at the Military Hospital for Women's Specialties and Neonatology of the Ministry of National Defense in the city from Mexico. Polymorphism was evaluated by amplification of a DNA fragment by PCR Polymerase Chain Reaction and its sequencing. RESULTS: The results indicated that 13.5% of the women carriers of the Ala allele also had lower blood glucose values and a history with a higher number of abortions compared to women without the Ala allele. CONCLUSIONS: The presence of the Ala allele in pregnant women with gestational diabetes mellitus could have a protective effect against hyperglycemia in pregnancy and a risk of abortion.
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ObjectiveTo investigate the effect of Zuoguiwan on pancreatic islet function in offspring of gestational diabetes mellitus （GDM） maternal rat model and explore the mechanisms of Zuoguiwan in improving pancreatic islet function based on postpartum pancreatic regeneration. MethodHealthy female SD rats with normal blood glucose levels were paired with male rats in a 2∶1 ratio and housed together. Pregnancy was confirmed based on vaginal plugs or vaginal smears. The pregnant rats were divided into the following groups： normal group， model group， insulin group （insulin Detemir， 20 U·kg-1）， low-dose Zuoguiwan group （1.89 g·kg-1）， and high-dose Zuoguiwan group （3.78 g·kg-1）. The GDM rat model was induced using streptozotocin in rats except for those in the normal group. The model was confirmed by blood glucose testing in the maternal rats. Except for the normal and model groups， the other groups received daily administration of corresponding treatments. At 21 days after birth， fasting blood glucose （FBG） and fasting serum insulin （FINS） levels were measured in 6 offspring from each group. The homeostasis model assessment of insulin resistance （HOMA-IR） was calculated， and an oral glucose tolerance test （OGTT） was performed on additional 12 offspring from each group. Blood samples were taken from the abdominal aorta of the offspring at postnatal day 22， and enzyme-linked immunosorbent assay （ELISA） was used to measure insulin， glucagon （GC）， pancreatic polypeptide （PPY）， and somatostatin （SS） levels in the serum. Hematoxylin-eosin （HE） staining was performed to observe pathological changes in the pancreatic tissue of the offspring. Immunofluorescence （IF） was used to observe the area and structure of the pancreatic islets. Western blot was used to detect the expression of key proteins involved in the development and functional expression of pancreatic β-cells， namely pancreatic and duodenal homeobox factor 1 （Pdx1）， Nkx6.1， and Glucose transporter 2 （Glut2）. ResultCompared with the normal group， the model group showed significant increases in FBG and FINS levels， and HOMA-IR （P<0.01）. Compared with the model group， the insulin group showed significant decreases in FBG levels and HOMA-IR （P<0.01）， the low-dose Zuoguiwan group showed a significant decrease in FBG levels （P<0.05）， and the high-dose Zuoguiwan group showed significant decreases in FBG and FINS levels， and HOMA-IR （P<0.01）. Compared with the normal group， the model group showed significant increases in OGTT 60-min blood glucose levels and AUC index （P<0.05， P<0.01）. Compared with the model group， the high-dose Zuoguiwan group showed significant decreases in OGTT60-min blood glucose levels and area under the curve（AUC） index （P<0.05， P<0.01）. HE staining of pancreatic tissue showed that compared with the normal group， the model group had a reduced number of islets and a loose arrangement of acinar cells. Compared with the model group， the groups with drug treatment showed increased number of islets and a compact arrangement of acinar cells. Compared with the normal group， the model group had significantly increased levels of insulin， GC， PPY， and SS in the serum （P<0.01）. Compared with the model group， the low-dose and high-dose Zuoguiwan groups and the insulin group showed significantly decreased serum levels of insulin， GC， PPY， and SS （P<0.05， P<0.01）. IF results showed that compared with the normal group， the model group had a significantly lower positive rate of insulin （P<0.05）. Compared with the model group， the low-dose and high-dose Zuoguiwan groups showed a significant increase in the positive rate of insulin （P<0.05）. There was no significant difference in the positive rate of GC among the groups. In terms of the proportion of insulin and GC in individual islets， compared with the normal group， the model group showed a significant decrease in the proportion of insulin （P<0.01） and a significant increase in the proportion of GC （P<0.01）. Compared with the model group， the low-dose and high-dose Zuoguiwan groups showed significantly increased proportion of insulin （P<0.01） and significantly decreased proportion of GC （P<0.01）. Compared with the normal group， the model group showed significantly decreased expression levels of Pdx1， Nkx6.1， and Glut2 proteins in the pancreatic tissue of GDM offspring （P<0.05）. Compared with the model group， the insulin group and the low-dose Zuoguiwan group showed significant increases in the expression levels of Pdx1 and Nkx6.1 proteins in the pancreatic tissue of GDM offspring （P<0.05）， and the low-dose and high-dose Zuoguiwan groups showed significant increases in the expression levels of Glut2 protein （P<0.05）. ConclusionZuoguiwan can promote pancreatic islet development in offspring of GDM maternal rat model， improve pancreatic islet morphology and function， and alleviate insulin resistance. Its mechanism of action may be related to the regulation of Pdx1， Nkx6.1， and Glut2 protein expression in the pancreatic tissue of offspring.
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@#Introduction: There is limited evidence on dietary patterns and the risk of type 2 diabetes (T2D) in women with a history of gestational diabetes mellitus (GDM) compared to their non-GDM counterparts, especially in the Asian population. The pilot study investigated dietary patterns in women with a history of GDM (HGDM) and without a history of GDM (non-HGDM), and the association with T2D risk. Methods: This comparative cross-sectional study involved 64 women (32 HGDM, 32 non-HGDM). Food intake was assessed using a validated food frequency questionnaire. Principal component analysis derived the dietary patterns. T2D risk score was determined using the Finnish Diabetes Risk Score tool. Results: HGDM group had significantly higher proportion of first-degree family history of diabetes; higher risk of T2D and better diabetes knowledge; lower gestational weight gain and postpartum weight retention; and consumed more fast food than nonHGDM. ‘Rice-noodle-pasta-meat’ dietary pattern was significantly associated with increased T2D risk after adjusting for age (β=0.272, p=0.032). ‘Bread-cereals-fast food-meat’ dietary pattern was positively and significantly associated with T2D risk after adjusting for confounders, including age, education level, family history of diabetes, diabetes knowledge score, gestational weight gain, and postpartum weight retention (β=0.251, p=0.012). Conclusion: Dietary patterns high in bread, cereals and cereal products, fast food and meat, as well as rice, noodle, pasta and meat were associated with an elevated T2D risk. A more extensive study is warranted to establish the association between dietary patterns and risk of T2D, focusing on women with a history of GDM.
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Background There is a lack of research evidence on the association between sugar-sweetened beverage (SSB) consumption and gestational diabetes mellitus (GDM) in China. Objective To explore the association between frequency of SSB consumption before pregnancy and risk of GDM in pregnant women in Shaanxi Province, and to provide a scientific basis for targeted interventions to control maternal blood glucose. Methods The recruitment to the China Birth Cohort study started in October 2020. Pregnant women at 6-16 weeks who had their first prenatal examination at five hospitals in Shaanxi Province were recruited. A maternal health questionnaire was used to collect basic information about pregnant women. A semi-quantitative food frequency questionnaire was used to collect the consumption of carbonated beverages, fruit and vegetable juice beverages, coffee beverages, and milk tea beverages in one year before pregnancy, which were summed to obtain the SSB consumption. Pregnant women were divided into three groups according to SSB consumption, namely <1 serving·week−1, 1-4 servings·week−1, and ≥5 servings·week−1. GDM was confirmed by oral glucose tolerance test (OGTT) between 24-28 weeks of gestation. A binary logistic regression model was applied to explore the association between SSB consumption and risk of GDM. Multiple linear regression was applied to investigate the associations between SSB consumption (per 1-serving·d−1 increase) and OGTT fasting plasma glucose, 1-hour glucose, and 2-hour glucose. Results A total of 3811 pregnant women were finally enrolled in this study, of which 752 developed GDM, with an incidence rate of 19.7%. The incidence rates of GDM in pregnant women with SSB consumption frequency of <1 serving·week−1, 1-4 servings·week−1, and ≥5 servings·week−1 were 18.0%, 21.1%, and 26.8%, respectively. After adjusting for maternal age, pre-pregnancy body mass index (BMI), education, number of children born, family history of diabetes, smoking, alcohol consumption, physical activity level, and total energy intake, the risk of GDM increased by 26% (OR=1.26, 95%CI: 1.05, 1.50) in the 1-4 servings·week−1 group and by 76% (OR=1.76, 95%CI: 1.31, 2.38) in the ≥5 servings·week−1 group compared to the <1 serving·week−1 SSB consumption group, respectively. Further stratified analysis revealed no interaction effect (Pinteraction>0.05) between SSB consumption and maternal age, pre-pregnancy BMI, or first labor or not. For each additional SSB consumption per day, the risk of GDM increased by 94% (OR=1.94, 95%CI: 1.37, 2.75); and the maternal OGTT 1-hour glucose and 2-hour glucose increased by 0.33 mmol·L−1 and 0.18 mmol·L−1, respectively (P<0.05), and no significant increase in fasting plasma glucose was found (P>0.05). Conclusion Higher SSB consumption before pregnancy increases the risk of GDM in pregnant women.
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Objective @#To examine the association between dietary patterns during pregnancy and gestational diabetes mellitus (GDM), so as to provide the evidence for guiding the establishment of healthy and balanced dietary patterns and reducing the prevalence of GDM.@*Methods@#Pregnant women who underwent oral glucose tolerance tests in Hangzhou Obstetrics and Gynecological Hospital from 2020 to 2021 were enrolled, and their demographic information were collected using questionnaires. Pregnant women's diets during the past three months were collected using Food Frequency Questionnaires (FFQs), and dietary patterns were extracted using principal component analysis. In addition, the association between dietary patterns and risk of GDM was examined using a multivariable logistic regression model.@*Results@# A total of 1 689 pregnant women were included, with a median age of 28.53 (interquartile range, 2.47) years and a median gestational age of 26.00 (interquartile range, 2.00) weeks. Five dietary patterns were identified according to pregnant women's types of diets, including meat-based diets, dessert-fruit-refined grain diets, plant-based diets, eggs-milk-nut diets and whole-grain diets, with a cumulative contribution rate of 58.76%. The prevalence of GDM was 24.57% (415 cases) among the study subjects. Multivariable logistic regression analysis showed that pregnant women with scores in the highest quartile (Q4) of the meat-based diets had an increased risk of GDM (OR=1.372, 95%CI: 1.043-2.055) relative to those with scores in the lowest quartile (Q1), and pregnant women with Q4 scores of the dessert-fruit-refined grain diets had an increased risk of GDM (OR=1.743, 95%CI: 1.397-2.432) relative to those with Q1 scores, while pregnant women with Q4 scores of the plant-based diets had a reduced risk of GDM (OR=0.382, 95%CI: 0.346-0.613) relative to those with Q1 scores.@*Conclusion@#A plant-based dietary pattern may reduce the risk of GDM, while meat-based and dessert-fruit-refined grain dietary patterns may increase the risk of GDM.