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1.
BJOG ; 127(1): 123, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31654609
2.
Sci Total Environ ; 699: 134390, 2020 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-31525546

RESUMO

BACKGROUND: Evidence concerning the effect of ambient air pollution exposure on gestational diabetes mellitus (GDM) is limited. No published studies have examined maternal weekly air pollution exposure and GDM, and the possible effect modification by folic acid supplementation has not been assessed. OBJECTIVES: To evaluate the association between air pollution exposure and GDM at trimester and weekly levels, and to explore the potential effect modification by folic acid supplementation. METHODS: A total of 5421 pregnant women were recruited during 2011-2014 in Guangzhou, China. Daily PM2.5, PM10, SO2 and NO2 levels were collected from 10 monitoring stations. Individual's exposure during pregnancy was estimated using inverse-distance weighting approach. Binary logistic regression was used to examine the trimester-specific association between air pollution exposure and GDM. Distributed lag models (DLMs) were applied to estimate maternal weekly air pollution exposure and GDM. Stratified analyses by folic acid supplementation and interaction test were performed. RESULTS: The GDM incidence was 11.69%. An interquartile range (IQR) increase in first trimester SO2 was associated with increased GDM risk in the single pollutant model, the adjusted odds ratio (aOR) and 95% confidence interval (CI) was 1.22 (1.02-1.47). In DLMs, an IQR increase in SO2 during 4th to 10th gestational weeks was associated with increased GDM risk, with the strongest effect in the 7th gestational week. When stratified by maternal folic acid supplementation, first trimester exposure to SO2 was associated with increased GDM risk among women taking folic acid supplements (aOR = 1.25, 95% CI: 1.03-1.53) and P value for interaction was 0.13. No significant effects were observed for PM2.5, PM10 and NO2. CONCLUSION: First trimester exposure to SO2 was associated with increased GDM risk, especially during the 4th to 10th gestational weeks. The effect might be stronger among women taking folic acid supplements.


Assuntos
Poluição do Ar/estatística & dados numéricos , Diabetes Gestacional/epidemiologia , Exposição Materna/estatística & dados numéricos , Adulto , Poluentes Atmosféricos , China/epidemiologia , Exposição Ambiental , Feminino , Humanos , Material Particulado , Gravidez
3.
BJOG ; 127(1): 116-122, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31553136

RESUMO

OBJECTIVE: To estimate the risk for adverse perinatal outcomes for women who met the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria but not the two-step criteria for gestational diabetes mellitus (GDM). DESIGN: Population-level cross-sectional study. SETTING: Ontario, Canada. POPULATION: A total of 90 140 women who underwent a 75-g oral glucose tolerance test. METHODS: Women were divided into those who met the diagnostic thresholds for GDM by two-step criteria and were therefore treated, those who met only the IADPSG criteria for GDM and so were not treated, and those who did not have GDM by either criteria. MAIN OUTCOME MEASURES: Hypertensive disorders of pregnancy, preterm delivery, primary caesarean section, large-for-gestational-age, shoulder dystocia and neonatal intensive care unit admission. RESULTS: Women who met the IADPSG criteria had an increased risk for all adverse perinatal outcomes compared with women who did not have GDM. Women with GDM by two-step criteria also had an increased risk of most outcomes. However, their risk for large-for-gestational-age neonates and for shoulder dystocia was actually lower than that of women who met IADPSG criteria. CONCLUSION: Women who met IADPSG criteria but who were not diagnosed with GDM based on the current two-step diagnostic strategy, and were therefore not treated, had an increased risk for adverse perinatal outcomes compared with women who do not have GDM. The current strategy for diagnosing GDM may be leaving women who are at risk for adverse events without the dietary and pharmacological treatments that could improve their pregnancy outcomes. TWEETABLE ABSTRACT: Women who meet IADPSG criteria for GDM have an increased risk for adverse perinatal outcomes compared with women without GDM.


Assuntos
Diabetes Gestacional/epidemiologia , Resultado da Gravidez/epidemiologia , Cesárea/estatística & dados numéricos , Estudos Transversais , Feminino , Macrossomia Fetal/epidemiologia , Teste de Tolerância a Glucose/estatística & dados numéricos , Humanos , Hipertensão Induzida pela Gravidez/epidemiologia , Terapia Intensiva Neonatal/estatística & dados numéricos , Ontário/epidemiologia , Gravidez , Fatores de Risco , Saúde da População Rural , Saúde da População Urbana
4.
Zhonghua Fu Chan Ke Za Zhi ; 54(12): 833-839, 2019 Dec 25.
Artigo em Chinês | MEDLINE | ID: mdl-31874473

RESUMO

Objective: To examine the association of pre-pregnancy obesity, excessive gestational weight gain (GWG) and gestational diabetes mellitus (GDM) with the risk of large for gestational age (LGA), and assess the dynamic changes in population attributable risk percent (PAR%) for having these exposures. Methods: A retrospective cohort study was conducted to collect data on pregnant women who received regular health care and delivered in Beijing Obstetrics and Gynecology Hospital from January to December in 2011, 2014 and 2017, respectively. Information including baseline characteristics, metabolic indicators during pregnancy, pregnancy complications, and pregnancy outcomes were collected. Multivariate logistic regression model was constructed to assess their association with LGA delivery. Adjusted relative risk and prevalence of these factors were used to calculate PAR%and evaluate the comprehensive risk. Results: (1)The number of participants were 11 132, 13 167 and 4 973 in 2011, 2014 and 2017, respectively. Corresponding prevalence of LGA were 15.19% (1 691/11 132), 14.98% (1 973/13 167) and 16.21% (806/4 973). No significant change in the prevalence of LGA was observed across all years investigated (all P>0.05). (2)According to results from multivariate logistic regression model, advanced maternal age, multiparity, pre-pregnancy overweight or obesity, GWG,GDM and serum triglyceride level≥1.7 mmol/L in the first trimester were associated with high risk of LGA (all P<0.05). Among these factors, pre-pregnancy overweight or obesity, excessive GWG and multiparity were common risk factors of LGA. GDM was not associated with risk of LGA in 2017 database. (3) Dynamic change of PAR% in these years were notable. PAR% of GWG for LGA decreased (32.6%, 27.2% and 22.2% in 2011, 2014 and 2017, respectively), while PAR% of pre-pregnancy overweight or obesity showed an upward trend (4.2%, 3.3% and 8.4%). In addition, PAR% of multiparity increased as well (3.5%, 6.3% and 15.9%). (4) Further analysis showed that excessive GWG in the first and second trimesters contributed the most (20.2% and 19.0% in 2014 and 2017). Conclusions: Excessive GWG, pre-pregnancy overweight or obesity and multiparity are the important risk factors what contribute to LGA. PAR% of excessive GWG for LGA decrease in recent years. However, GWG in the first and second trimesters is a critical factor of LGA. Appropriate weight management in pre-pregnancy, the first or second trimester is the key point to reduce the risk of LGA.


Assuntos
Diabetes Gestacional/epidemiologia , Macrossomia Fetal/epidemiologia , Obesidade/complicações , Peso ao Nascer , Índice de Massa Corporal , China/epidemiologia , Feminino , Macrossomia Fetal/etiologia , Idade Gestacional , Humanos , Obesidade/epidemiologia , Sobrepeso/complicações , Sobrepeso/epidemiologia , Gravidez , Complicações na Gravidez/epidemiologia , Estudos Retrospectivos , Ganho de Peso
5.
Zhonghua Fu Chan Ke Za Zhi ; 54(11): 741-746, 2019 Nov 25.
Artigo em Chinês | MEDLINE | ID: mdl-31752456

RESUMO

Objective: To explore the characteristics of maternal glucose and lipid metabolism in twin pregnancies complicated by gestational diabetes mellitus (GDM). Methods: The clinical features of twin and singleton pregnancies complicated by GDM, which delivered in Peking University First Hospital from January 1st, 2012 to December 31st, 2017 were retrospectively analyzed. A total of 286 twin pregnancies with GDM (GDM-T group) were collected, and 572 singleton pregnancies complicated by GDM (GDM-S group) which were matched by delivery time in a ratio of 1∶2 among all singleton pregnancies with GDM. The characteristics of maternal glucolipid metabolism in the second trimesters of pregnancy was compared between two groups. Results: (1) Compared with GDM-S group, the maternal delivery age were lower [(32±4), (33±4) years] and prepregnancy body mass index (BMI) were higher [(24±4), (23±4) kg/m(2)] in GDM-T group, the differences were statistically significant (all P<0.05). The incidence of chronic hypertension was found no significant difference (P=0.581). (2) The 3 points of glucose values in 75 g oral glucose tolerance test (OGTT) and OGTT-area under curve (AUC) had no significant difference between GDM-T and GDM-S group.When compared with GDM-S group, the maternal glycosylated hemoglobin levels [(5.41±0.35)%, (5.32±0.28)%], the insulin resistance index (4.07±0.77, 2.63±1.50) and the proportion of insulin use (7.7%, 4.4%) were all significantly higher in GDM-T group (all P<0.05). The values of triglyceride [(3.4±1.4), (2.6±1.2) mmol/L], total cholesterol [(6.3±1.1), (6.0±1.0) mmol/L], low density lipoprotein cholesterol [(3.3±0.9), (3.1±0.8) mmol/L] were significantly higher and values of high density lipoprotein cholesterol [(1.7±0.4), (2.0±0.5) mmol/L] were significantly lower in GDM-T group than GDM-S group (all P<0.05). (3) There was no significant difference in the incidence of gestational hypertension between the two groups (P>0.05). When compared with GDM-S group, the incidences of preeclampsia and small for gestational age were both significantly higher (13.3% vs 2.4%; 28.7% vs 1.7%) and the incidence of large for gestational age was significantly lower in GDM-T group (4.5% vs 15.2%; all P<0.05). Conclusions: The insulin resistance is aggravated in twin pregnancies and the characteristics of lipid metabolism are different between singleton and twin pregnant women complicated by GDM, and there are more complications in twin GDM pregnancies.


Assuntos
Diabetes Gestacional/etiologia , Hipertensão Induzida pela Gravidez/etiologia , Gravidez de Gêmeos , Glicemia/análise , Feminino , Teste de Tolerância a Glucose , Humanos , Gravidez , Estudos Retrospectivos
6.
Medicine (Baltimore) ; 98(42): e17576, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626126

RESUMO

Studies have found that the measurement of body composition can be used to identify the gestational diabetes mellitus (GDM) risk in pregnant women. However, few studies focused on the relationship between body composition and GDM development in low GDM risk population. Thus, the objective of this study was to examine the association between body composition and the development of GDM in pregnant women with low risk of gestational diabetes.A retrospective case-control study was conducted. We reviewed the medical records of 3965 pregnant women who had body composition measurement from March, 2016 to May, 2018 in our hospital. Their sociodemographic, clinical data, and body composition information were collected from medical record. Multiple logistic regression analyses were used.A total of 2698 subjects were eligible for the study. The mean age of the gravidas was 30.95 ±â€Š4.01 years old. Of all gravidas, 462 had gestational diabetes. Percentage body fat was the strongest risk factor for gestational diabetes after adjusting pre-pregnancy body mass index (BMI) (odds ratio = 1.786, 95% confidence interval = 1.112-2.866, P = .02). The age and extracellular water/intracellular water ratio were independently associated with gestational diabetes.Percentage body fat was the strongest risk factor for gestational diabetes after adjusting pre-pregnancy BMI. Assessment of body composition may provide important guidance to identify gestational diabetes in pregnant women with low gestational diabetes risk.


Assuntos
Constituição Corporal , Diabetes Gestacional/epidemiologia , Ganho de Peso na Gestação , Medição de Risco/métodos , Adulto , Estudos de Casos e Controles , China/epidemiologia , Diabetes Gestacional/etiologia , Diabetes Gestacional/fisiopatologia , Feminino , Humanos , Incidência , Gravidez , Estudos Retrospectivos , Fatores de Risco
7.
J Assoc Physicians India ; 67(10): 70-72, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31571457

RESUMO

Guidelines to diagnose Gestational Diabetes Mellitus (GDM) have changed a number of times from O'Sullivan and Mahan, Carpenter and Coustan, World Health Organization, American Diabetes Association to that of International Association of Diabetes in Pregnancy Study Group (IADPSG). The IADPSG guideline was based on Hyperglycaemia and Adverse Pregnancy Outcome (HAPO) study which was performed in caucasian population only and thus literally cannot be considered as international. Recently a study commented that this guideline needs revision for standardization of this strategy for diagnosing GDM. Based on a prospective study, Diabetes in Pregnancy Study Group India (DIPSI) recommended A single step procedure of diagnosing GDM with 2hr PG > 140 mg/dl after 75g of oral glucose administered irrespective of the last meal timing. This guideline has been approved by the Ministry of Health Government of India, WHO, IDF and Federation of Gynaecologists and Obstetricians Society (FIGO). National Institute of Clinical Excellence (NICE) also recognises cut off value, 2hr PG > 140 mg/dl based on a study in multi ethnic population of UK. Hence, we can safely conclude, A Single Step procedure has settled the criteria for diagnosing GDM.


Assuntos
Diabetes Gestacional/diagnóstico , Feminino , Teste de Tolerância a Glucose , Humanos , Hiperglicemia , Índia , Gravidez , Estudos Prospectivos
8.
Se Pu ; 37(8): 897-903, 2019 Aug 08.
Artigo em Chinês | MEDLINE | ID: mdl-31642261

RESUMO

The global increase in the prevalence of gestational diabetes mellitus(GDM)in recent years has prompted the study of the effect of GDM on the metabolism between mother and fetus. In this study, the metabolomic investigation of the umbilical cord blood of mothers presenting GDM was performed using liquid chromatography-mass spectrometry (LC-MS), orthogonal projections to latent structures discriminant analysis (OPLS-DA), and network analysis to assess GDM-related metabolic biomarkers. The results showed that arachidonic acid (AA) played an important role in the key metabolic network while further pathway analysis suggested that GDM induced unsaturated fatty acid metabolic disorder. This study provides the underlying metabolic mechanism of GDM-induced metabolic abnormalities between mother and fetus.


Assuntos
Diabetes Gestacional/metabolismo , Sangue Fetal/metabolismo , Metabolômica , Ácido Araquidônico , Biomarcadores/sangue , Cromatografia Líquida , Feminino , Humanos , Espectrometria de Massas , Gravidez
9.
Zhonghua Fu Chan Ke Za Zhi ; 54(10): 654-659, 2019 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-31648440

RESUMO

Objective: To explore the relationship between hemoglobin (Hb) level during the first trimester of pregnancy and gestational diabetes mellitus (GDM). Methods: A total of 1 276 participants, who underwent scheduled prenatal examination and normal singleton delivery at the Fifth People's Hospital of Shanghai and Hospital of Intergrated Chinese and Western Medicine in Minhang District, from January 2016 to May 2018 were included. There were 99 cases of GDM (GDM group) and 1 177 cases of normal (control group) pregnant women.Based on the serum Hb level during the first trimester of pregnancy, participants were divided into three groups, 236 cases of low Hb level group (Hb<110 g/L), 868 cases of normal Hb level group (110 g/L≤Hb<130 g/L), and 172 cases of high Hb level group (Hb≥130 g/L). Maternal clinical data were collected, including Hb level during the first trimester of pregnancy, three-point blood glucose (BG) of oral glucose tolerance test (OGTT) and fasting insulin during the second trimester of pregnancy. Homeostasis model assessment of insulin resistance index (HOMA-IR) and homeostasis model assessment of pancreatic ß cell function index (HOMA-ß) were used to evaluate insulin resistance and pancreatic ß cell function. Results: (1) Hb level during the first trimester of pregnancy in GDM group was significantly higher than that in control group [(123±10),(119±11) g/L, P<0.05]. There were no significant difference in gravidity, parity, index of liver and renal function (all P>0.05). (2) Pre-pregnancy body mass index (BMI), 1-hour BG and 2-hour BG of OGTT were significantly increased in the high Hb level group during the first trimester of pregnancy, which were (23±4) kg/m(2), (7.3±2.0) mmol/L, and (6.5±1.4) mmol/L (P<0.05), respectively. The pre-pregnancy BMI, 1-hour BG and 2-hour BG of the normal or low Hb level group were (22±3) kg/m(2), (6.7±1.6) mmol/L, (6.1±1.2) mmol/L; (22±3) kg/m(2), (6.5±1.5) mmol/L, (5.9±1.1) mmol/L, respectively. There were no statistically significant difference in levels of fasting blood glucose, fasting insulin, HOMA-IR and HOMA-ß within 3 groups (all P>0.05). (3) In the high Hb level group, prevalence of pregnancy overweight or obesity and GDM were the highest, which were 37.2%(64/172) and 15.1%(26/172), respectively; the differences were statistically significant (all P<0.05). (4) The serum Hb level in the first trimester was positively related with pre-pregnancy BMI (r=0.130, P<0.05), 1-hour BG (r=0.129, P<0.05), 2-hour BG (r=0.134, P<0.05), fasting insulin (r=0.096, P<0.05), and HOMA-IR (r=0.101, P<0.05).Logistic regression indicated that Hb≥130 g/L during the first trimester of pregnancy was an independent risk factor for GDM (OR=2.799, 95%CI: 1.186-6.604; P<0.05). Conclusion: The high level of Hb (Hb≥130 g/L) during the first trimester of pregnancy is associated with GDM.


Assuntos
Glicemia/análise , Diabetes Gestacional/diagnóstico , Intolerância à Glucose/diagnóstico , Teste de Tolerância a Glucose , Hemoglobinas/análise , Resistência à Insulina , Primeiro Trimestre da Gravidez/sangue , Adulto , Grupo com Ancestrais do Continente Asiático , Glicemia/metabolismo , Índice de Massa Corporal , China/epidemiologia , Diabetes Gestacional/sangue , Diabetes Gestacional/epidemiologia , Feminino , Humanos , Incidência , Gravidez , Fatores de Risco
10.
Medicine (Baltimore) ; 98(43): e17258, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31651836

RESUMO

Increasing studies demonstrated that genetic susceptibility attributes to the development of gestational diabetes mellitus (GDM). The polymorphisms of the ß-3 adrenergic receptor(ß-3AR) gene have been found to be of great importance in bodyweight elevation and dyslipidaemias. We aimed to determine the influence of ß-3AR polymorphisms on the GDM risk. Thus, we performed a case-control study including 136 GDM cases and 138 controls to evaluate the relation between the rs201607471 and susceptibility to GDM. Likelihood ratios X analysis showed the distribution of the genotype frequency (rs201607471 in ß-3AR gene) was accorded with the Hardy-Weinberg genetic equilibrium. Although no significant association between rs201607471 alleles and GDM susceptibility (Chi-square test, P > .05), we observed that ß-3AR gene rs201607471 CT genotype was significantly prevalent in GDM (Chi-square test, P < .05). Moreover, we observed that ß-3AR gene rs201607471 C > T was significantly associated with an increased risk of GDM using the recessive model (CC vs CT/TT: P = .026) and the additive model (CC vs CT vs TT: P = .038). These data indicate that ß-3AR rs201607471 may be a helpful susceptibility marker for GDM in Chinese pregnant women.


Assuntos
Grupo com Ancestrais do Continente Asiático/genética , Diabetes Gestacional/genética , Predisposição Genética para Doença/genética , Polimorfismo de Nucleotídeo Único/genética , Receptores Adrenérgicos beta 3/genética , Adulto , Alelos , Estudos de Casos e Controles , Distribuição de Qui-Quadrado , China , Feminino , Frequência do Gene , Genótipo , Humanos , Gravidez , Estudos Retrospectivos , Fatores de Risco
11.
Wei Sheng Yan Jiu ; 48(5): 811-821, 2019 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-31601326

RESUMO

OBJECTIVE: This Meta-analysis of randomized controlled trial( RCT) was conducted to summarize the preventive and therapeutic effects of vitamin D supplementation on gestational diabetes mellitus( GDM). METHODS: The electronic database( CNKI, CBM, VIP, PubMed, Cochrane library, Web of Science) were systematically searched from inception to February 2018, using the keywords vitamin D and gestational diabetes to identify Meta-analysis. RESULTS: A total of 16 RCTs were included. A total of 6 RCTs were included for the prevention of GDM by vitamin D supplementation. Meta-analysis indicated that vitamin D supplementation significantly reduced the level of fasting plasma glucose( FPG)( SMD =-1. 87, 95% CI-3. 39--0. 35) and the incidence of GDM( OR = 0. 42, 95% CI 0. 30-0. 60) in pregnant women. Ten RCTs were included for the treatment of GDM by vitamin D supplementation. Meta-analysis indicated that vitamin D supplementation significantly reduced the level of fasting plasma glucose( FPG)( SMD =-0. 29, 95% CI-0. 56--0. 02) and Fasting Insulin( FINS)( SMD =-0. 42, 95% CI-0. 69--0. 15), also improved the homeostasis model of assessment-estimated insulin resistance( HOMA-IR)( SMD =-0. 53, 95% CI-0. 89--0. 17) and the homeostasis model of assessment-estimated B cell function( HOMA-ß)( SMD =-0. 39, 95% CI-0. 61--0. 18), and increased the quantitative insulin sensitivity check index( QUICKI)( SMD = 0. 87, 95% CI 0. 41-1. 32) in GDM patients. CONCLUSION: supplementation may prevent and treat GDM by an improvement in HOMA-IR, HOMA-IR and QUICKI.


Assuntos
Diabetes Gestacional , Suplementos Nutricionais , Resistência à Insulina , Vitamina D , Glicemia , Feminino , Humanos , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto
13.
Cochrane Database Syst Rev ; 9: CD012544, 2019 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-31476798

RESUMO

BACKGROUND: Gestational diabetes mellitus (GDM) is a common medical condition that complicates pregnancy and causes adverse maternal and fetal outcomes. At present, most treatment strategies focus on normalisation of maternal blood glucose values with use of diet, lifestyle modification, exercise, oral anti-hyperglycaemics and insulin. This has been shown to reduce the incidence of adverse outcomes, such as birth trauma and macrosomia. However, this involves intensive monitoring and treatment of all women with GDM. We propose that using medical imaging to identify pregnancies displaying signs of being affected by GDM could help to target management, allowing low-risk women to be spared excessive intervention, and facilitating better resource allocation. OBJECTIVES: We wanted to address the following question: in women with gestational diabetes, does the use of fetal imaging plus maternal blood glucose concentration to indicate the need for medical management compared with glucose concentration alone reduce the risk of adverse perinatal outcomes? SEARCH METHODS: We searched Cochrane Pregnancy and Childbirth's Trials Register (29 January 2019), ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform (ICTRP) (both on 29 January 2019), and reference lists of retrieved studies. SELECTION CRITERIA: Randomised controlled trials, including those published in abstract form only. Studies using a cluster-randomised design and quasi-randomised controlled trials were both eligible for inclusion, but we didn't identify any. Cross-over trials were not eligible for inclusion in our review.We included women carrying singleton pregnancies who were diagnosed with GDM, as defined by the trials' authors. The intervention of interest was the use of fetal biometry on imaging methods in addition to maternal glycaemic values for indicating the use of medical therapy for GDM. The control group was the use of maternal glycaemic values alone for indicating the use of such therapy. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trials for inclusion and assessed risk of bias. Two review authors extracted data and checked them for accuracy. MAIN RESULTS: Three randomised controlled trials met the inclusion criteria for our systematic review - the studies randomised a total of 524 women.We assessed the three included studies as being at a low to moderate risk of bias; the nature of the intervention made it difficult to achieve blinding of participants and personnel and none of the trial reports contained information about methods of allocation concealment (and were therefore assessed as being at an unclear risk of selection bias).In all studies, the intervention was the use of fetal biometry on ultrasound to identify fetuses displaying signs of fetal macrosomia, and the use of this information to indicate the use of medical anti-hyperglycaemic treatments. Those pregnancies were subject to more stringent blood glucose targets than those without signs of fetal macrosomia.Maternal outcomesThe use of fetal biometry in addition to maternal blood glucose concentration (compared with maternal blood glucose concentration alone) may make little or no difference to the incidence of caesarean delivery (risk ratio (RR) 0.81, 95% confidence interval (CI) 0.59 to 1.10; 2 trials, 428 women; low-certainty evidence). We are unclear about the results for hypertensive disorders of pregnancy (RR 0.80, 95% CI 0.34 to 1.89; 2 trials, 325 women) due to very low-certainty evidence. The included trials did not report on development of type 2 diabetes in the mother or maternal hypoglycaemia.Fetal and neonatal outcomesThe use of fetal biometry may make little or no difference to the incidence of neonatal hypoglycaemia (RR 0.90, 95% CI 0.57 to 1.42; 3 trials, 524 women; low-certainty evidence). Very low-certainty evidence means that we are unclear about the results for large-for-gestational age (RR 0.81, 95% CI 0.38 to 1.74; 3 trials, 524 women); shoulder dystocia (RR 0.33, 95% CI 0.01 to 7.98; 1 trial, 96 women); a composite measure of perinatal morbidity or mortality (RR 1.00, 95% CI 0.21 to 4.71; 1 study, 96 women); or perinatal mortality (RR 0.33, 95% CI 0.01 to 7.98; 1 trial, 96 women). AUTHORS' CONCLUSIONS: This review is based on evidence from three trials involving 524 women. The trials did not report some important outcomes of interest to this review, and the majority of our secondary outcomes were also unreported. The available evidence ranged from low- to very low-certainty, with downgrading decisions based on limitations in study design, imprecision and inconsistency.There is insufficient evidence to evaluate the use of fetal biometry (in addition to maternal blood glucose concentration values) to assist in guiding the medical management of GDM, on either maternal or perinatal health outcomes, or the associated costs.More research is required, ideally larger randomised studies which report the maternal and infant short- and long-term outcomes listed in this review, as well as those outcomes relating to financial and resource implications.


Assuntos
Biometria/métodos , Diabetes Gestacional/terapia , Macrossomia Fetal/prevenção & controle , Complicações na Gravidez/prevenção & controle , Feminino , Humanos , Insulina/uso terapêutico , Gravidez , Resultado da Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto
14.
Arch Endocrinol Metab ; 63(5): 524-530, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31482958

RESUMO

OBJECTIVE: The aim of the study is to describe a portable and convenient software to facilitate the diagnostics of gestational (GDM) and pre-gestational diabetes (PGDM). MATERIALS AND METHODS: An open source software, d-GDM, was developed in Java. The integrated development environment Android Studio was used as the Android operational system. The software for GDM diagnosis uses the criteria endorsed by the International Association of Diabetes and Pregnancy Study Group, modified by the World Health Organization. RESULTS: GDM diagnosis criteria is not simple to follow, therefore, errors or inconsistencies in diagnosis are expected and could delay the appropriate treatment. The d-GDM, was developed to assist GDM diagnosis with precision and consistency diagnostic reports. The open source software can be manipulated conveniently. The operator requires information regarding the gestational period and selects the appropriate glycaemic marker options from the menu. During operation, pressing the button "diagnosticar" on the screen will present the diagnosis and information for the follow up. d-GDM is available in Portuguese or English and can be downloaded from the Google PlayStore. A responsive web version of d-GDM is also available. The usefulness and accuracy of d-GDM was verify by field tests involving 22 subjects and 5 mobile phone brands. The approval regards user-friendliness and efficiency were 95% or higher. The GDM diagnosis were 100% correct, in this pilot test. d-GDM is a user-friendly, free software for diagnosis that was developed for mobile devices. It has the potential to contribute and facilitate the diagnosis of gestational diabetes for healthcare professionals.


Assuntos
Técnicas de Apoio para a Decisão , Diabetes Gestacional/diagnóstico , Aplicativos Móveis , Feminino , Humanos , Gravidez
15.
Eur J Endocrinol ; 181(5): 565-577, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31539877

RESUMO

Design: Gestational diabetes mellitus (GDM) is one of the most common pregnancy complications and its prevalence is constantly rising worldwide. Diagnosis is commonly in the late second or early third trimester of pregnancy, though the development of GDM starts early; hence, first-trimester diagnosis is feasible. Objective: Our objective was to identify microRNAs that best distinguish GDM samples from those of healthy pregnant women and to evaluate the predictive value of microRNAs for GDM detection in the first trimester. Methods: We investigated the abundance of circulating microRNAs in the plasma of pregnant women in their first trimester. Two populations were included in the study to enable population-specific as well as cross-population inspection of expression profiles. Each microRNA was tested for differential expression in GDM vs control samples, and their efficiency for GDM detection was evaluated using machine-learning models. Results: Two upregulated microRNAs (miR-223 and miR-23a) were identified in GDM vs the control set, and validated on a new cohort of women. Using both microRNAs in a logistic-regression model, we achieved an AUC value of 0.91. We further demonstrated the overall predictive value of microRNAs using several types of multivariable machine-learning models that included the entire set of expressed microRNAs. All models achieved high accuracy when applied on the dataset (mean AUC = 0.77). The significance of the classification results was established via permutation tests. Conclusions: Our findings suggest that circulating microRNAs are potential biomarkers for GDM in the first trimester. This warrants further examination and lays the foundation for producing a novel early non-invasive diagnostic tool for GDM.


Assuntos
MicroRNA Circulante/sangue , Diabetes Gestacional/sangue , Diabetes Gestacional/diagnóstico , Tecido Adiposo/química , Adulto , Estudos de Casos e Controles , Diagnóstico Precoce , Feminino , Humanos , Aprendizado de Máquina , MicroRNAs/sangue , Placenta/química , Valor Preditivo dos Testes , Gravidez , Primeiro Trimestre da Gravidez , Reprodutibilidade dos Testes
18.
Vestn Oftalmol ; 135(3): 55-66, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31393448

RESUMO

INTRODUCTION: Pregnancy is a risk factor for progression of diabetic retinopathy (DR). Despite the common opinion about the regression of DR after childbirth, it is possible for the disease to progress aggressively, which can cause loss of visual functions when treated untimely. PURPOSE: To present clinical cases with different course of development of DR in pregnant women with type 1 diabetes mellitus (DM1). MATERIAL AND METHODS: Five pregnant women with DM1 lasting more than 8 years were examined. Glycemic level of all patients was higher than normal (glycated hemoglobin (HbA1c) of more than 6.1%). Ophthalmologic examination was carried out including fundus photography, optical coherence tomography (OCT) of the macular area, Angio-OCT. RESULTS: The most significant factors in the progression of DR in pregnant women are DR1 compensation, severity and stabilization of DR during the preconception period, presence of a concomitant pathology. Timely detection of signs of progression of DR and therapeutic measures taken during pregnancy, in particular laser coagulation, were shown to stabilize the course of the disease and prevent loss of vision in pregnant women with DM1. CONCLUSION: Clinical course of DR in pregnancy can vary between absence of manifestation, stabilization, and progression. Progression of DR during pregnancy is determined by a number of factors including compensation of DM during the preconception period and throughout pregnancy, severity and stabilization of retinopathy during the preconception period, and presence of a concomitant pathology. Timely detection of the signs of DR progression and its treatment, in particular laser coagulation of the retina, can help stabilize the course of the disease during pregnancy. The course of DR may be aggressive in some pregnant women involving progression in the postpartum period, which warrants active monitoring of patients with retinopathy after childbirth.


Assuntos
Diabetes Mellitus Tipo 1 , Retinopatia Diabética , Diabetes Gestacional , Feminino , Hemoglobina A Glicada , Humanos , Gravidez , Retina , Tomografia de Coerência Óptica
19.
Zhonghua Yu Fang Yi Xue Za Zhi ; 53(8): 817-823, 2019 08 06.
Artigo em Chinês | MEDLINE | ID: mdl-31378042

RESUMO

Objective: To explore the association between the exposure to major air pollutants in pre-pregnancy and early pregnancy (peri-conceptional period) and gestational diabetes mellitus (GDM). Methods: From March 2015 to April 2018, 4 817 pregnancies were recruited at three prenatal check-ups hospital in Hefei (Hefei First People's Hospital, Hefei. Maternal and Child Care Hospital and the First Affiliated Hospital of Anhui Medical University), China. Questionnaire was used to collect the demographic data, the health status and lifestyle of pregnant women. GDM was diagnosed according to the Chinese Guidelines for the Prevention and Treatment of Type 2 Diabetes (2017 Edition). Logistic regression was used to investigate the association of exposure to major air pollutants (PM(2.5), PM(10), SO(2), CO and NO(2)) during different periods of pre-pregnancy (12 weeks before pregnancy) and first trimester (12 weeks after last menstruation) and duration of exposure to high levels of pollutants with GDM. Results: The mean±SD of the age of subjects was (29.14±4.19) years old and the prevalence of GDM was 21.4% (n=1 030). The results of multivariate logistic regression analysis showed that after adjusting for confounding factors, the risk of GDM increased gradually with the prolonged exposure time of high-concentration pollutants compared with pregnant women who were not exposed to high pollution during the pre-pregnancy (χ(2)=61.28, P(trend)<0.001) with the OR (95%CI) values for exposure time of 1, 2, and 3 months about 1.42 (1.10-1.84), 1.73 (1.29-2.33), and 2.51 (1.75-3.59), respectively. In the pre-pregnancy period, in every 10 µg/m(3) increase of PM(2.5) and PM(10), the OR (95%CI) values of GDM were 1.14 (1.08-1.20) and 1.13 (1.08-1.19), respectively; for each increase of 1 µg/m(3) and 0.10 mg/m(3) of SO(2) and CO, the OR (95% CI) values of GDM were 1.03 (1.01-1.05) and 1.07 (1.01-1.13), respectively. For every 1 µg/m(3) increase in the average concentration of SO(2) in the first trimester, the OR (95%CI) value of GDM was 1.02 (1.01-1.05). Conclusion: PM(2.5), PM(10), SO(2) and CO exposure during the pre-pregnancy and SO(2) exposure in first trimester were positively correlated with the risk of GDM.


Assuntos
Poluição do Ar/efeitos adversos , Diabetes Gestacional/epidemiologia , Adulto , China/epidemiologia , Feminino , Humanos , Material Particulado/efeitos adversos , Gravidez , Estudos Prospectivos
20.
Acta Clin Croat ; 58(1): 37-41, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31363323

RESUMO

Gestational diabetes involves disorder of glucose metabolism first diagnosed in pregnancy. Obese women undoubtedly have more often complications in reproductive age, such as fertility difficulties, spontaneous and recurrent miscarriages, premature births, and various obstetric and surgical complications related to the course of pregnancy, delivery and puerperium. Children of obese pregnant women are more likely to develop obesity in childhood and adulthood. We analyzed the outcome of 51 pregnancies in obese pregnant women and 50 pregnant women with normal body mass index. All women in both groups were diagnosed with gestational diabetes by the IADPSG criteria. We analyzed gestational age at delivery and mode of delivery, gestational weight gain, presence of concomitant diagnosis of gestational or chronic hypertension, difference in birth weight, and prevalence of hypertrophic newborns. There was no significant difference in gestational age at pregnancy termination and in the mode of delivery. There was a significant difference in gestational weight gain, number of pregnant women with hypertension, neonatal birth weight and number of hypertrophic children. Based on the data presented, we conclude that obesity is an unfavorable factor for pregnancy outcome. It also influences birth weight and fetal hypertrophy, as well as gestational weight gain.


Assuntos
Peso ao Nascer , Diabetes Gestacional/epidemiologia , Resultado da Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Adulto , Índice de Massa Corporal , Cesárea/estatística & dados numéricos , Feminino , Idade Gestacional , Humanos , Gravidez , Complicações na Gravidez/epidemiologia , Ganho de Peso
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