The Effects of Breastfeeding and Gestational Diabetes Mellitus on Body Mass Composition and the Levels of Selected Hormones after Childbirth.

Breastfeeding may have a positive effect on glucose metabolism and insulin sensitivity, which may reduce the risk of developing diabetes following gestational diabetes mellitus (GDM). This study aimed to evaluate the effect of breastfeeding and GDM on the body mass composition of the studied women, the levels of leptin, ghrelin, adiponectin, resistin, and insulin, and weight loss during the 6-8-week postpartum period and 1 year after childbirth. MATERIALS AND METHODS: The study group included 42 women with a singleton pregnancy, diagnosed with GDM between the 24th and 28th week of gestation. The control group consisted of 28 non-diabetic women with a singleton pregnancy. This study was carried out at 6-8 weeks as well as at 1 year postpartum. The women were subjected to body weight measurements and body composition analysis performed using a professional body composition analyzer TANITA DC-430 S MA. Waist circumference and subcutaneous fat was measured. Blood for laboratory tests was taken in the morning, on an empty stomach. RESULTS: It was shown that, regardless of diabetes, exclusive breastfeeding had a significant impact on weight loss at 6-8 weeks postpartum (p = 0.014785) and lower insulin levels (p = 0.047). However, there was no effect of breastfeeding on the women's anthropometric measurements or hormone levels one year after delivery, except for the thickness of subcutaneous adipose tissue, which was significantly lower in breastfeeding women (p = 0.03). One year after delivery, breastfeeding women had a lower BMI (p = 0.0014), less-thick subcutaneous adipose tissue (p < 0.001), and a lower risk of obesity (p = 0.016). There were also higher insulin and ghrelin levels in both breastfeeding and non-breastfeeding women (p < 0.001), and lower resistin levels in non-breastfeeding women (p = 0.004). Women who had diabetes during pregnancy had a significantly reduced waist circumference and subcutaneous fat thickness after one year (p < 0.001 and p = 0.05, respectively). CONCLUSIONS: Having diabetes during pregnancy did not significantly affect the results of anthropometric measurements and hormone levels noted at 6-8 weeks after delivery (the only exception was the thickness of subcutaneous fat tissue, which was greater in women without GDM). This may indicate normalization of carbohydrate metabolism after childbirth; however, the observation period is too short to elucidate long-term metabolic effects. This suggests the need for further research related to GDM and breastfeeding.

Maternal endothelin-1 and cyclic guanosine monophosphate concentrations in pregnancies complicated by pregravid and gestational diabetes mellitus.

BACKGROUND/AIMS: Pregnancy complicated by diabetes is associated with increased risk of unfavorable obstetric outcomes. A common abnormality in diabetes is endothelial dysfunction resulting in an altered pattern of vasoactive substance production by the endothelial cells. The aim of study was to assess serum endothelin-1 (ET-1) and cyclic guanosine monophosphate (cGMP) in pregnant women with pregravid (PGDM) or gestational diabetes (GDM). METHODS: At the time of delivery, serum ET-1, cGMP, glycated hemoglobin (A1c), fructosamine and non-fasting glucose were measured in 19 PGDM, 23 GDM and 18 controls. RESULTS: ET-1 and cGMP were similar in all groups. In GDM there was a positive association between A1c and ET-1 (r = 0.437; p < 0.05) and cGMP (r = 0.542; p < 0.02). In the controls, but not in PGDM and GDM, we found a positive correlation between ET-1 and cGMP (r = 0.634; p < 0.005). In women with diabetes, an optimal (A1c <6%) or inadequate (A1c >6%) metabolic control of diabetes did not influence ET-1 or cGMP levels. CONCLUSIONS: In women with PGDM and GDM, serum ET-1 and cGMP were similar to the levels observed in healthy pregnant women. However, the physiological balance between vasoconstrictor and vasodilator substances might be defective in pregnancies complicated by diabetes.

[Does type 2 diabetes predispose to osteoporotic bone fractures?]. / Czy cukrzyca typu 2 predysponuje do osteoporotycznych zlaman kosci?

Chronic complications of diabetes are associated mainly with changes in major and small arterial vessels as well as in peripheral and autonomic fibers of the nervous system. For years it has been suggested that DM2 does not predispose to osteoporosis because bone mineral density (BMD) in DM2 patients is commonly normal or even increased. However, results of recent large cross-sectional studies have indicated that patients with DM2 have significantly increased risk of bone fractures, predominantly hip fractures (by 70%). Results of these studies suggest that the increased risk of fractures in DM2 is independent of BMD. In this group of patients is frequently associated the loss of vision caused by diabetic eye disease, peripheral neuropathy, arterial hypertension, orthostatic hypotonia (caused by autonomic neuropathy or/and by concomitant antihypertensive treatment), and ischemic disease of the brain, heart and lower extremities--conditions that predispose to falls. There are no specific methods of prophylaxis and treatment of osteoporosis associated with diabetes; therefore they should be based on widely accepted principles as in non-diabetic populations. It seems that in DM2 patients the most purposeful strategy could be the popularization of healthy attitudes aiming the elimination of unfavorable dietetic and environmental factors, such as low physical activity, smoking, and low vitamin D intake, as well as education against falls.

The Impact of Health Locus of Control and Anxiety on Self-Monitored Blood Glucose Concentration in Women with Gestational Diabetes Mellitus.

BACKGROUND: The purpose of this study was to evaluate the associations between health locus of control (HLC), anxiety, and glycemic control from the time of diagnosis of gestational diabetes (GDM) to the end of pregnancy. METHODS: The study group comprised 165 women with GDM. Baseline HLC (∼27 weeks of gestation) was assessed by the Multidimensional HLC Scale. The level of anxiety was measured at baseline and follow-up (37 weeks of gestation) by the State-Trait Anxiety Inventory. Using questionnaires, we collected information about the level of fear related to measuring blood glucose several times per day, dietary regimen, and insulin therapy, as well as fear for the baby and its health, patient's own health, and having diabetes in the next pregnancy. Glycemic control was evaluated by self-monitored fasting and postprandial blood glucose levels. RESULTS: Baseline state anxiety was significantly higher than trait anxiety. From baseline to follow-up, the state anxiety and percentage of women with increased fear for their infant's health, diabetic diet, self-monitoring of blood glucose, and insulin injection significantly decreased. In comparison to women with blood glucose in the low tertile, those with blood glucose in the high tertile had significantly higher scores in the chance HLC subscale and a similar level of state anxiety. Blood glucose was positively correlated with the chance HLC score. CONCLUSIONS: Chance HLC beliefs seem to be associated with poorer glycemic outcomes in women with GDM. Our results suggest the need for further efforts to reduce the GDM-associated state anxiety.

Association between depression, parameters of adiposity and genetic polymorphisms of pro-inflammatory cytokines: IL-1α, IL-1ß, IL-2 and IL-6 in subjects over 55 years old.

BACKGROUND: During the last few decades, adiposity has become a relatively common phenomenon worldwide. The available data on the effects of pro-inflammatory factors in both depression and adiposity has been attracting great attention. AIM: We sought to assess the prevalence of -889C>T IL-1α, -31T>C and -511C>T IL-1ß, -330T>G IL-2 and -174G>C IL-6 genes and their association with adiposity and depression in Polish subjects. METHODS: A cohort study was conducted in 2013/2014, covering a sample of 297 individuals (217 female and 80 male). Anthropometric data was handled using the BIA analysis method, while for genotyping PCR-RFLP techniques were used. RESULTS: A positive correlation between depression and anthropometric parameters: adipose tissue (in kg) and adipose tissue (in %) (R=0.135 and p=0.02, R=0.114 and p<0.05, respectively) was found. No association between studied polymorphisms and depression was observed. CONCLUSION: Although it was not possible to demonstrate any influence of the studied polymorphisms as the genetic modulator of depression, authors believe that the presented data are noticeable and may provide the basis for future studies on larger groups.

Birth weight predicts the risk of gestational diabetes mellitus and pregravid obesity.

OBJECTIVES: It has been suggested that birth weight may determine metabolic abnormalities later in life. The aim of the current study was to assess the association between birth weight and future risk of gestational diabetes mellitus (GDM) and pregravid obesity in a homogenous sample of Caucasian Polish women. METHODS: In this retrospective study, we collected the medical reports of 787 women with GDM and 801 healthy pregnant women. We analyzed the following data: birth weight, age, pregravid weight, prior GDM, prior macrosomia, parity, and family history of diabetes. RESULTS: Birth weight was inversely associated with the risk of GDM; for each decrease in birth weight of 500 g, the risk increased by 11% (odds ratio [OR], 1.11; 95% confidence interval [CI], 1.02-1.21). Birth weight was a strong predictor of GDM independent of other risk factors (OR, 1.19; 95% CI, 1.09-1.31), and it was positively correlated with pregravid weight (R = 0.21; P < 0.00001). An increase in birth weight of 500 g substantially increased the risk of overweight and obesity (OR, 1.17; 95% CI, 1.01-1.34 and OR, 1.35; 95% CI 1.11-1.64, respectively). Each of the traditional risk factors for GDM were also strong predictors of pregravid obesity: age (P < 0.0001), prior GDM (P < 0.01), prior macrosomia (P < 0.0001), multiparity (P < 0.0001), and maternal (but not paternal) history of diabetes (P < 0.0001). CONCLUSIONS: Among Caucasian Polish women, the risk of GDM is associated with low birth weight, and pregravid obesity is associated with high birth weight. Traditional risk factors for GDM, including maternal (but not paternal) history of diabetes, are also risk factors for pregravid obesity.

Are short women at risk for gestational diabetes mellitus?

OBJECTIVE: The aim of the study was to assess the influence of height variations on the risk of gestational diabetes mellitus (GDM). RESEARCH DESIGN AND METHODS: We analyzed the medical records of 1830 Caucasian women with GDM and 1011 healthy pregnant women. The following data were collected: age, prior macrosomia, prior GDM, parity, history of type 2 diabetes in first-degree relatives, weight before pregnancy, weight gain during pregnancy, glucose level at the first obstetric visit, results of the glucose challenge test and oral glucose tolerance test (OGTT), HbA1c, and method for treatment of GDM. RESULTS: Women with GDM were significantly shorter than the healthy controls (165.7+/-5.6 vs 163.8+/-6.6 cm; P<0.001). The differences in height were not significant between GDM women who required insulin therapy and those treated with diet alone (P=0.12). All the studied variables, including height, were independently associated with GDM. Even after adjustment for confounding variables, height was still associated with GDM (odds ratio 0.958, 95% confidence interval: 0.94-0.97; P<0.00001). In women with GDM diagnosed by 75-g OGTT, we found a significant inverse association of height adjusted for age and pregravid weight with 2-h glucose level (beta=-0.12; P<0.0001). CONCLUSIONS: Caucasian women with GDM are shorter than pregnant women without GDM regardless of the diagnostic criteria used or the severity of glucose intolerance. Although height is an independent predictor for GDM, its predictive value for identifying women at risk is relatively low and should not be considered in selective screening for this disease.

The prevalence of 6 weeks postpartum abnormal glucose tolerance in Caucasian women with gestational diabetes.

AIMS: To evaluate the incidence of impaired glucose tolerance (IGT), impaired fasting glucose (IFG) and diabetes in 318 Caucasian women with gestational diabetes (GDM) at 6 weeks postpartum. METHODS: All women had 75g OGTT and the following data were collected: age, height, weight, results of the challenge 50g and diagnostic 75g OGTT, and glycated hemoglobin (HbA1c). RESULTS: 13.5% of women had abnormal glucose tolerance, including 1.3% of diabetes, 2.5% of IFG and 7.5% of IGT. None of the prepregnancy independent variables, such as age, body mass index, prior GDM, prior macrosomia, family history of type 2 diabetes and multiparity was a predictor for the abnormal OGTT. In contrast, pregnancy-related risk factors, like gestational week at GDM diagnosis (P=0.001), glucose values in the challenge (P=0.007) and diagnostic (P=0.02) OGTTs and HbA1c (P=0.01) were significantly associated with the persistence of glucose intolerance after delivery. CONCLUSION: The incidence of postpartum abnormal glucose tolerance in Caucasian women with GDM was 13.5% and was associated with an early diagnosis of GDM, severity of hyperglycemia and requirement for insulin therapy. The diagnosis of GDM should initiate a lifelong monitoring of glucose tolerance to minimize the risk of developing overt diabetes.

Factors influencing risk of macrosomia in women with gestational diabetes mellitus undergoing intensive diabetic care.

AIMS: The aim of study was to assess the impact of intensive diabetic care, defined as target values for fasting glucose of 60-90mg/dl and 1-h postprandial glucose of below 130mg/dl, on neonatal birth weight in relation to risk indicators for fetal macrosomia in women with gestational diabetes mellitus (GDM). METHODS: In women with (N=543) and without GDM (N=1011) age, height, weight, previous GDM, history of macrosomia, family history of type 2 diabetes, parity and weight gain during pregnancy were recorded. RESULTS: Neonatal birth weight and frequency distribution of macrosomia and infants with small for gestational age did not differ between women with and without GDM. Neonatal birth weight was strongly associated with traditional risk predictors for GDM, such like prior macrosomia (OR 5.03; 95%CI 3.36-7.53), prior GDM (OR 2.52; 95%CI 1.37-4.64) and prepregnancy body mass index (BMI)>23kg/m(2) (OR 1.82; 95%CI 1.27-2.63). CONCLUSIONS: Neonatal birth weight and the incidence of macrosomia were similar in comparison of pregnancies with and without GDM. In the population of Caucasian women the strongest single predictors for macrosomia were prior macrosomia, BMI>23kg/m(2) and prior GDM.

Low predictive value of traditional risk factors in identifying women at risk for gestational diabetes.

BACKGROUND: There is no worldwide agreement on the best way to screen for gestational diabetes mellitus (GDM), and different diagnostic methods have been developed in order to identify women at risk. The aim of this study was to evaluate the prevalence and predictive value of the traditional risk indicators for GDM in a large group of Caucasian women. METHODS: We evaluated the frequency distribution of age, body mass index (BMI), prior macrosomia, prior GDM, and family history of diabetes of 1,414 pregnant women with GDM and 1,011 healthy pregnant women. RESULTS: The distribution of risk factors in both groups was different and significantly higher in GDM women. The cut-off value for age was 28 years, and 23 kg/m2 for BMI. The accumulation of two or more risk factors was frequent in GDM, but not in healthy women. By multiple logistic regression, there were significant interactions between independent variables of interest and GDM (OR: 3.19; p<0.001; sensitivity: 57.9%, specificity: 69.8%). The strongest predictors were prior GDM (OR: 4.35;95% CI: 2.42-7.82) and a family history of diabetes (OR: 3.03; 95% CI: 2.47-3.72); less predictive were age (OR: 1.69;95% CI: 1.44-1.99), BMI (OR: 1.50; 95% CI: 1.28-1.77), and prior macrosomia (OR: 1.64; 95% CI: 1.19-2.26). CONCLUSIONS: Selective screening based on traditional risk factors for GDM had relatively low sensitivity, and identified <60% of Caucasian women at risk. The cut-off value for BMI as a risk indicator (23 kg/m2) was lower than that proposed by guidelines about screening for GDM.