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1.
Ann Palliat Med ; 10(9): 9692-9701, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34628895

RESUMO

BACKGROUND: Gestational diabetes mellitus (GDM) increases the incidence of adverse outcomes in pregnant women. Individual diet intervention (IDI) was developed in our center through collaboration with nutritionists to treat GDM and prevent further complications. We then aimed to analyze the effects of IDI on the level of blood glucose and pregnancy outcomes in pregnant women with GDM. METHODS: We retrospectively enrolled pregnant women with GDM between April 2016 and March 2020. Participants in the control group received routine GDM care, and those in the study group received extra IDI on the basis of routine GDM care. Demographic and clinical characteristics of participating pregnant women were retrospectively collected. The study outcomes were the status of blood glucose control after 6 weeks of IDI or conventional intervention and pregnancy outcomes. Univariable and multivariable logistic regression analyses were sequentially performed to determine the predictors of proper blood glucose control and risk factors of adverse pregnancy outcomes in the study population. RESULTS: A total of 817 pregnant women who had been diagnosed as GDM were enrolled in this study, including 435 admitted between April 2016 to March 2018 who received conventional medication and 382 who were admitted between April 2018 to March 2020 and received IDI. Generally, there was no significant difference in baseline characteristics between study and control groups. Glycated hemoglobin (HbA1c) level after intervention was statistically lower in the study group than in the control group (5.6±0.9 vs. 5.5±0.7, P=0.006). Multivariable logistic regression analysis revealed that IDI was a predictor of proper blood glucose control in GDM participants (P=0.003). There were more cesarean sections and cases of macrosomia in the control group than the study group, showing statistical difference (35.9% vs. 28.5%, P=0.026; 8.7% vs. 4.7%, P=0.023, respectively). According to multivariable logistic regression analysis, IDI was identified as playing a protective role against cesarean section in GDM participants (P=0.034) and it could reduce the incidence of macrosomia in GDM participants (P=0.028). CONCLUSIONS: This novel pattern of IDI may not only help stabilize blood glucose levels in pregnant women with GDM, but also reduce the incidence of adverse outcomes to a certain extent.


Assuntos
Diabetes Gestacional , Glicemia , Cesárea , Feminino , Teste de Tolerância a Glucose , Humanos , Gravidez , Resultado da Gravidez , Estudos Retrospectivos
2.
Ann Palliat Med ; 10(9): 9752-9764, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34628901

RESUMO

BACKGROUND: A meta-analysis was conducted on the correlation between intestinal flora and gestational diabetes mellitus (GDM) to provide a theoretical basis for the treatment of GDM. METHODS: The PubMed, Embase, MEDLINE, Ovid, Springer, and Web of Science databases were searched from the establishment of the databases to December 31, 2020, to retrieve randomized control trials (RCTs) involving GDM patients. The Cochrane Handbook for Systematic Reviews of Intervention 5.0.2 was used to assess the bias risk of the included articles, and Rev Man 5.3 was used for the meta-analysis. RESULTS: A total of 7 studies were included in the meta-analysis, comprising 665 study participants. The meta-analysis results showed that the GDM patients in the experimental group had a lower level of Bifidobacterium [MD (mean difference) =-2.49; 95% confidence interval (CI): -3.54 to -1.45; Z=4.66; P<0.00001], Lactobacillus [MD =-1.69; 95% CI: -1.84 to -1.53; Z=20.66; P<0.00001], Bacteroides [MD =-1.17; 95% CI: -1.45 to -0.89; Z=8.15; P<0.00001], Bacteroidetes [MD =-1.22; 95% CI: -1.71 to -0.72; Z=4.81; P<0.00001], and a higher level of Enterobacter [MD =1.79; 95% CI: 1.13 to 2.45; Z=5.3; P<0.00001], Enterococcus [MD =1, 29; 95% CI: 0.98 to 1.6; Z=8.06; P<0.00001], Fusobacterium [MD =0.03; 95% CI: -0.13 to 0.19; Z=0.37; P=0.71], tumor necrosis factor alpha (TNF-α) [MD =113.66; 95% CI: 52.01 to 175.31; Z=3.61; P=0.0003], interleukin (IL)-17 [MD =37.92; 95% CI: 29.74 to 46.1; Z=9.09; P<0.00001], and IL-6 [MD =66.38; 95% CI: 33.6 to 99.15; Z=3.97; P<0.0001] than those in the control group; however, no statistically significant difference was found in relation to Fusobacterium between the experimental group and the control group. DISCUSSION: Intestinal microecological changes are closely related to the occurrence of GDM in our study, which manifested as a decrease in the level of probiotics, an increase in the level of intestinal bacteria and other strains, and an increase in the level of inflammatory factors. Thus, special attention should be paid to changes in patients' intestinal flora to prevent GDM.


Assuntos
Diabetes Gestacional , Microbioma Gastrointestinal , Feminino , Humanos , Gravidez
3.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao ; 43(4): 551-557, 2021 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-34494525

RESUMO

Objective To explore the performance of mobile health platform for standardized management of pregnant women with gestational diabetes mellitus(GDM). Methods A randomized controlled trial was conducted,in which 295 women with GDM were randomized into two groups(traditional management group and mobile health management group)by a computer-generated sequence.The traditional management group accepted standardized GDM management,and the mobile health management group was supplemented by mobile health management based on the standardized management.The glycemic control rate and the incidences of low birth weight,macrosomia,preterm birth,premature rupture of membranes,postpartum hemorrhage after cesarean section,neonatal asphyxia,malformation,and admission to the neonatal intensive care unit were compared between the two groups. Results The glycemic control rate in mobile health management group was significantly higher than that in the traditional management group [(67.22±22.76)% vs.(60.69±21.28)%,P=0.004].The incidences of low birth weight,macrosomia,preterm birth,premature rupture of membranes,postpartum hemorrhage after cesarean section,neonatal asphyxia,malformation,and admission to the neonatal intensive care unit demonstrated no significant differences between groups(all P > 0.05). Conclusions Mobile health applied in standardized management is conducive to the glycemic control of GDM women,whereas it does not significantly improve the pregnancy outcomes.Due to the short time of intervention,the effects of mobile health on pregnancy outcomes need further study.


Assuntos
Diabetes Gestacional , Nascimento Prematuro , Telemedicina , Cesárea , Diabetes Gestacional/terapia , Feminino , Macrossomia Fetal , Humanos , Recém-Nascido , Gravidez , Resultado da Gravidez
4.
BMC Public Health ; 21(1): 1616, 2021 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-34479526

RESUMO

BACKGROUND: Women with prior gestational diabetes mellitus (GDM) are at high risk of developing type 2 diabetes; however, this risk can be reduced by engaging in positive health behaviours e.g. healthy diet and regular physical activity. As such behaviours are difficult to obtain and maintain there is a need to develop sustainable behavioural interventions following GDM. We aimed to report the process of systematically developing a health promotion intervention to increase quality of life and reduce diabetes risk among women with prior GDM and their families. We distil general lessons about developing complex interventions through co-production and discuss our extensions to intervention development frameworks. METHODS: The development process draws on the Medical Research Council UK Development of complex interventions in primary care framework and an adaptation of a three-stage framework proposed by Hawkins et al. From May 2017 to May 2019, we iteratively developed the Face-it intervention in four stages: 1) Evidence review, qualitative research and stakeholder consultations; 2) Co-production of the intervention content; 3) Prototyping, feasibility- and pilot-testing and 4) Core outcome development. In all stages, we involved stakeholders from three study sites. RESULTS: During stage 1, we identified the target areas for health promotion in families where the mother had prior GDM, including applying a broad understanding of health and a multilevel and multi-determinant approach. We pinpointed municipal health visitors as deliverers and the potential of using digital technology. In stage 2, we tested intervention content and delivery methods. A health pedagogic dialogue tool and a digital health app were co-adapted as the main intervention components. In stage 3, the intervention content and delivery were further adapted in the local context of the three study sites. Suggestions for intervention manuals were refined to optimise flexibility, delivery, sequencing of activities and from this, specific training manuals were developed. Finally, at stage 4, all stakeholders were involved in developing realistic and relevant evaluation outcomes. CONCLUSIONS: This comprehensive description of the development of the Face-it intervention provides an example of how to co-produce and prototype a complex intervention balancing evidence and local conditions. The thorough, four-stage development is expected to create ownership and feasibility among intervention participants, deliverers and local stakeholders. TRIAL REGISTRATION: ClinicalTrials.gov NCT03997773 , registered retrospectively on 25 June 2019.


Assuntos
Diabetes Mellitus Tipo 2 , Diabetes Gestacional , Diabetes Gestacional/prevenção & controle , Feminino , Promoção da Saúde , Humanos , Gravidez , Qualidade de Vida , Estudos Retrospectivos
5.
J Coll Physicians Surg Pak ; 31(9): 1015-1019, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34500513

RESUMO

OBJECTIVES: To determine the diagnostic accuracy of HOMA-IR, and QUICKI in diagnosing gestational diabetes mellitus (GDM) considering oral glucose tolerance test (OGTT) as gold standard. STUDY DESIGN: Cross-sectional analytical study. PLACE AND DURATION OF STUDY: Department of Chemical Pathology, Armed Forces Institute of Pathology, Rawalpindi from September 2020 to February 2021. METHODOLOGY: Pregnant women with gestational age between 24 to 28 weeks, who reported to Endocrine Clinic of AFIP for OGTT, were included in the study. OGTT was performed by following ADA guidelines. Sample for fasting insulin was collected along with first fasting sample of OGTT. HOMA-IR and QUICKI were calculated simultaneously. Percentage was used for qualitative variable while median (IQR 25th-75th) was applied for quantitative variables. OGTT was used as gold standard for calculation of diagnostic accuracy of HOMA-IR and QUICKI. RESULTS: Out of 182 patients, 74 (40.6%) were found to have GDM on OGTT while 108 (59.4%) had normal OGTT. Women with GDM (n=74) had median values of fasting insulin 15.9 (IQR 11.2-17.77), HOMA-IR 3.5 (IQR 2.6-4.1) and QUICKI 0.31 (IQR 0.30-0.33) as compared to median values of fasting insulin 8.0 (IQR 5.9-10.3), HOMA-IR 1.60 (IQR 1.12-2.03) and QUICKI 0.35 (IQR 0.34-0.37) in patients (n=108) with normal response to OGTT, (p <0.001). On logistic regression analysis, there was a strong association of HOMA-IR and QUICKI with gestational diabetes mellitus (p <0.001, accuracy 84.6%). HOMA-IR at cutoff of ≤2 had 94.5% sensitivity, 72.2% specificity, 70% PPV, 95.1% NPV, and 81.31% overall diagnostic accuracy with 0.913 AUC. QUICKI at cutoff of 0.34 had 86.4% sensitivity, 83.3% specificity, 78.0% PPV, 90.0% NPV, and 84.61% overall diagnostic accuracy with 0.905 AUC. CONCLUSION: Fasting insulin and HOMA-IR were significantly higher while QUICKI was lower in patients of GDM as compared to non-GDM pregnant patients at 24 to 28 weeks of gestation. Being more convenient for patients, it has the potential to be used as screening tool for gestational diabetes. Key Words: HOMA IR, QUICKI, Gestational diabetes mellitus, Insulin.


Assuntos
Diabetes Gestacional , Resistência à Insulina , Glicemia , Estudos Transversais , Diabetes Gestacional/diagnóstico , Feminino , Teste de Tolerância a Glucose , Humanos , Lactente , Insulina , Gravidez
7.
J Agric Food Chem ; 69(36): 10749-10759, 2021 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-34474557

RESUMO

Gestational diabetes mellitus (GDM) not only has a bad effect on the development of infants but also causes variations in breastmilk composition. This study aims to investigate the changes in the protein profile of colostrum between mothers with GDM and healthy mothers (H) by sequential windowed acquisition of all theoretical fragment ion proteomics techniques. A total of 1295 proteins were detected, with 192 proteins being significantly different between GDM and H. These significantly different proteins were enriched with the carbohydrate and lipid metabolism pathway as well as immunity. Some proteins had an AOC value of 1, such as apolipoprotein E and lipoprotein lipase. In addition, we identified 42 glycated and 93 glycosylated peptides in colostrum without any enrichment, with glycated peptides being upregulated and glycosylated peptides being downregulated in colostrum with GDM. These results help us to better understand the GDM-induced changes in proteomes and glycated and glycosylated level and provide guidance on infant formula adjustment for infants from mothers with GDM.


Assuntos
Diabetes Gestacional , Colostro , Feminino , Humanos , Leite Humano , Gravidez , Proteoma , Proteômica
8.
Zhongguo Dang Dai Er Ke Za Zhi ; 23(9): 969-974, 2021.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-34535215

RESUMO

With the increase of the incidence of pre-pregnancy diabetes mellitus and gestational diabetes mellitus, the number of infants of diabetic mothers (IDMs) are increasing year by year. IDMs may be associated with poor perinatal outcomes and may have a negative impact on neurodevelopment, but there are relatively few studies on the neurodevelopmental outcomes of IDMs. This article reviews the relevant literature and summarizes the neurodevelopmental outcomes of IDMs from the aspects of sensory and perception, motor, language, intellectual development, neuropsychiatric disorders, neurological examination and drug effect, so as to provide reference for clinical work. Citation.


Assuntos
Diabetes Gestacional , Gravidez em Diabéticas , Feminino , Humanos , Incidência , Lactente , Mães , Gravidez
9.
Environ Sci Pollut Res Int ; 28(40): 55915-55924, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34490580

RESUMO

Recently, there is growing evidence that ambient temperature and seasonal changes are related to the incidence of gestational diabetes mellitus (GDM). Thereby, this study was conducted to evaluate the association between seasonal changes and ambient temperature and GDM. We conducted a systematic search in PubMed, ISI Web of Science, Scopus, Google Scholar, and Cochrane Collaboration for human studies available until the end of 2020. We used the following keywords to identify relevant articles: "Diabetes, Gestational" (MeSH), "Glucose Tolerance Test" (MeSH), "Glucose intolerance" (MeSH), "Pregnancy outcome" (MeSH), "Birth outcome", "Seasons" (MeSH), "Weather" (MeSH), "Ambient Temperature," "Climate Change" (MeSH). Meta-analyses by using STATA software were conducted for analyzing data. Due to the high heterogeneity between included studies, a random-effects model was used. Subgroup analysis, meta-regression, and sensitivity analysis were used to define a source of heterogeneity. We found 13 studies related to the association between ambient temperature and season changes and GDM, which 11 of them were included in meta-analyses. Despite inconsistencies in outcome assessment across studies, we found a significant positive association between seasons of GDM screening and risk of GDM (pooled OR=1.12; 95% CI (1.03, 1.21)). The funnel plot and Egger's test showed that there was no significant publication bias among these studies (p=0.51). In general, season changes showed a significant positive relationship with prevalence of GDM. However, due to the unknown exact mechanism on this association, further studies should be conducted.


Assuntos
Diabetes Gestacional , Clima , Diabetes Gestacional/epidemiologia , Feminino , Humanos , Gravidez , Estações do Ano
10.
Artigo em Inglês | MEDLINE | ID: mdl-34518156

RESUMO

INTRODUCTION: To investigate associations between genetic variants related to beta-cell (BC) dysfunction or insulin resistance (IR) in type 2 diabetes (T2D) and bile acids (BAs), as well as the risk of gestational diabetes mellitus (GDM). RESEARCH DESIGN AND METHODS: We organized a case-control study of 230 women with GDM and 217 without GDM nested in a large prospective cohort of 22 302 Chinese women in Tianjin, China. Two weighted genetic risk scores (GRSs), namely BC-GRS and IR-GRS, were established by combining 39 and 23 single nucleotide polymorphisms known to be associated with BC dysfunction and IR, respectively. Regression and mediation analyses were performed to evaluate the relationship of GRSs with BAs and GDM. RESULTS: We found that the BC-GRS was inversely associated with taurodeoxycholic acid (TDCA) after adjustment for confounders (Beta (SE)=-0.177 (0.048); p=2.66×10-4). The BC-GRS was also associated with the risk of GDM (OR (95% CI): 1.40 (1.10 to 1.77); p=0.005), but not mediated by TDCA. Compared with individuals in the low tertile of BC-GRS, the OR for GDM was 2.25 (95% CI 1.26 to 4.01) in the high tertile. An interaction effect of IR-GRS with taurochenodeoxycholic acid (TCDCA) on the risk of GDM was evidenced (p=0.005). Women with high IR-GRS and low concentration of TCDCA had a markedly higher OR of 14.39 (95% CI 1.59 to 130.16; p=0.018), compared with those with low IR-GRS and high TCDCA. CONCLUSIONS: Genetic variants related to BC dysfunction and IR in T2D potentially influence BAs at early pregnancy and the development of GDM. The identification of both modifiable and non-modifiable risk factors may facilitate the identification of high-risk individuals to prevent GDM.


Assuntos
Diabetes Mellitus Tipo 2 , Diabetes Gestacional , Resistência à Insulina , Ácidos e Sais Biliares , Estudos de Casos e Controles , China/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/genética , Diabetes Gestacional/epidemiologia , Diabetes Gestacional/genética , Feminino , Predisposição Genética para Doença , Humanos , Resistência à Insulina/genética , Gravidez , Estudos Prospectivos
11.
Clin Med (Lond) ; 21(5): e438-e440, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34507926

RESUMO

In pregnancy, women are more likely to develop certain metabolic disturbances as a result of the physiological changes that occur. Diabetic ketoacidosis and hypoglycaemia occur at increased frequency in women with pre-existing and gestational diabetes, and starvation ketoacidosis can present towards the end of pregnancy and can cause severe illness. Peripartum hyponatraemia is increasingly recognised and can be associated with maternal and neonatal morbidity. This review describes these conditions in detail as well as treatment priorities and the impact on both mother and baby.


Assuntos
Diabetes Gestacional , Cetoacidose Diabética , Hipoglicemia , Diabetes Gestacional/epidemiologia , Diabetes Gestacional/terapia , Emergências , Feminino , Humanos , Hipoglicemia/terapia , Lactente , Recém-Nascido , Gravidez
12.
Clin Lab ; 67(9)2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34542985

RESUMO

BACKGROUND: The current study aims to investigate the differences of glycoprotein non-metastatic melanoma protein B (GPNMB) levels between gestational diabetes mellitus (GDM) women and normal blood glucose women during pregnancy to provide the basis for early intervention and treatment of GDM. METHODS: The level of GPNMB was detected using an enzyme-linked immunosorbent assay (ELISA). Pearson's correlation assay was performed to analyze the correlation between serum GPNMB and fasting plasma glucose (FPG) or hemoglobin A1c (HbA1c). The receiver operating characteristic (ROC) curve was carried out to analyze the diagnostic value of serum GPNMB. RESULTS: Our data showed that the serum GPNMB level in GDM group was higher than that in normal blood glucose group at 5 - 12 weeks, 13 - 23 weeks, and 24 - 28 weeks of gestation, but there was no significant difference at 29 - 37 weeks of gestation. Meanwhile, the total level of serum GPNMB in GDM group was significantly higher than that in normal blood glucose group. Further study indicated that serum GPNMB positively correlated with FPG (r = 0.562, p < 0.0001) or HbA1c (r = 0.652, p < 0.0001). ROC analysis showed that serum GPNMB level at 13 - 23 weeks of gestation had a good predictive effect on predicting GDM at 24 weeks of gestation and beyond. When the cutoff value of serum GPNMB level was 2.46 µg/L, the sensitivity and specificity were 80% and 72%, respectively. CONCLUSIONS: The serum GPNMB level at 13 - 23 weeks of gestation is an independent risk factor for GDM in 24 weeks and beyond, and early inhibition with GPNMB may provide a preventive measure in GDM women.


Assuntos
Diabetes Gestacional , Melanoma , Glicemia , Diabetes Gestacional/diagnóstico , Feminino , Hemoglobina A Glicada/análise , Humanos , Melanoma/diagnóstico , Glicoproteínas de Membrana , Gravidez , Receptores Fc
13.
Medicina (Kaunas) ; 57(9)2021 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-34577865

RESUMO

The worldwide epidemic of diabetes mellitus and hyperglycemia in pregnancy (HIP) presents many challenges, some of which are country-specific. To address these specific problems, parochial resolutions are essential. In India, the government, by working in tandem with (a) national groups such as the Diabetes in Pregnancy Study Group of India, and (b) global organizations such as the International Diabetes Federation, has empowered the medical and paramedical staff throughout the country to manage HIP. Additionally, despite their academic university backgrounds, Indian health planners have provided practical guidelines for caregivers at the ground level, who look up to these experts for guidance. This multipronged process has helped to negotiate some of the multiple problems that are indigenous and exclusive to India. This review traces the Indian journey to manage and prevent HIP with simple, constructive, and pragmatic solutions.


Assuntos
Diabetes Gestacional , Hiperglicemia , Diabetes Gestacional/epidemiologia , Feminino , Humanos , Índia/epidemiologia , Negociação , Gravidez
14.
Nutr Diabetes ; 11(1): 28, 2021 09 14.
Artigo em Inglês | MEDLINE | ID: mdl-34521807

RESUMO

BACKGROUND/OBJECTIVE: Previous studies have consistently demonstrated that maternal weight status both before and during pregnancy is associated with infant birthweight. However, a fundamental limitation across this literature remains that previous studies have not evaluated the concomitant impact of paternal weight at conception, owing to the paucity of studies in which fathers were assessed prior to pregnancy. Thus, we established a cohort of preconception couples to prospectively evaluate the associations of maternal and paternal weight prior to pregnancy with infant birthweight at delivery. METHODS: In this prospective observational cohort study, 1292 newly-married women and their partners in Liuyang, China, were assessed at median of 23.3 weeks before a singleton pregnancy, thereby enabling concomitant assessment of preconception maternal and paternal body mass index (BMI) in relation to infant birthweight. RESULTS: Mean birthweight was 3294 ± 450 g with 147 neonates (11.4%) born large-for-gestational-age (LGA) and 94 (7.3%) small-for-gestational-age (SGA). After adjustment for maternal and paternal factors prior to conception (age, education, smoking, BMI, household income), length of gestation, total gestational weight gain, gestational diabetes, preeclampsia, and infant sex, it was noted that infant birthweight increased by 42.2 g (95% CI 29.5-54.8; p < 0.0001) per unit increase in maternal pregravid BMI and 10.7 g (95% CI 0.5-20.9; p = 0.04) per unit increase in paternal pregravid BMI. Maternal pregravid BMI explained 6.2% of the variance in birthweight whereas paternal BMI explained only 0.7%. Independent predictors of LGA delivery were maternal pregravid BMI (aOR = 1.91, 95% CI 1.50-2.44), maternal age (aOR = 1.48, 95% CI 1.09-2.00), and gestational weight gain (aOR = 1.80, 95% CI 1.40-2.30). Paternal pregravid BMI was not independently associated with LGA or SGA. CONCLUSION: Paternal BMI prior to conception is associated with infant birthweight but only modestly so, in contrast to the dominant impact of maternal weight.


Assuntos
Peso ao Nascer , Peso Corporal , Pai/estatística & dados numéricos , Mães/estatística & dados numéricos , Adulto , Índice de Massa Corporal , China/epidemiologia , Estudos de Coortes , Diabetes Gestacional/epidemiologia , Feminino , Macrossomia Fetal/epidemiologia , Idade Gestacional , Ganho de Peso na Gestação , Humanos , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Masculino , Gravidez , Estudos Prospectivos , Adulto Jovem
15.
Eur J Endocrinol ; 185(5): 755-763, 2021 Oct 11.
Artigo em Inglês | MEDLINE | ID: mdl-34524975

RESUMO

Aim: To assess whether in women with gestational diabetes mellitus (GDM), postpartum plasma glycated CD59 (pGCD59) levels predict conversion to glucose intolerance diagnosed with an oral glucose tolerance test (OGTT). Methods: Blood levels of pGCD59 were measured in a case-control study of 105 women with GDM who underwent a 75 g OGTT 3 months postpartum. The 35 postpartum glucose intolerant cases were individually matched for age, BMI, ethnic origin, and parity with 70 women with GDM but normal postpartum OGTT (controls). The GDM cohort (105) was also matched with 105 normal glucose tolerant women during pregnancy. pGCD59 was measured by ELISA in standard peptide units (SPU). Results: Mean pGCD59 postpartum was significantly higher in cases than in controls (1.5 ± 0.6 SPU vs 1.0 ± 0.6 SPU, P < 0.001). The area under the receiving operating characteristic curve (AUC) in cases vs controls was 0.72 (95% CI: 0.62-0.83) for postpartum pGCD59 and 0.50 (95% CI: 0.36-0.61) for postpartum HbA1c. A 0.5-unit increase in postpartum pGCD59 was associated with an odds ratio (OR) of 3.3 (95% CI: 1.82-6.16, P < 0.001) for glucose intolerance postpartum. A pGCD59 cut-off postpartum of 0.9 SPU had a sensitivity of 85.7% (95% CI: 69.7-95.2%), specificity of 47.8% (95% CI: 35.6-60.2%), positive predictive value of 45.4% (95% CI: 33.1-58.2%), and negative predictive value of 86.8% (95% CI: 71.9-95.6%). pGCD59 in pregnancy was a poor predictor for glucose intolerance postpartum (AUC of 0.61 (95% CI: 0.50-0.72)). Conclusion: pGCD59 might identify women at low risk for glucose intolerance postpartum and could help to avoid an OGTT.


Assuntos
Antígenos CD59/análise , Diabetes Gestacional/sangue , Intolerância à Glucose/sangue , Período Pós-Parto/sangue , Adulto , Área Sob a Curva , Glicemia , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Intolerância à Glucose/etiologia , Hemoglobina A Glicada/análise , Humanos , Paridade , Valor Preditivo dos Testes , Gravidez , Estudos Prospectivos , Sensibilidade e Especificidade , Adulto Jovem
16.
Nutrients ; 13(7)2021 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-34371966

RESUMO

Medical nutrition therapy is an integral part of gestational diabetes mellitus (GDM) management; however, the prescription of optimal energy intake is often a difficult task due to the limited available evidence. The present pilot, feasibility, parallel, open-label and non-randomized study aimed to evaluate the effect of a very low energy diet (VLED, 1600 kcal/day), or a low energy diet (LED, 1800 kcal/day), with or without personalized exercise sessions, among women with GDM in singleton pregnancies. A total of 43 women were allocated to one of four interventions at GDM diagnosis: (1) VLED (n = 15), (2) VLED + exercise (n = 4), (3) LED (n = 16) or (4) LED + exercise (n = 8). Primary outcomes were gestational weight gain (GWG), infant birth weight, complications at delivery and a composite outcomes score. Secondary outcomes included type of delivery, prematurity, small- for-gestational-age (SGA) or large-for-gestational-age (LGA) infants, macrosomia, Apgar score, insulin use, depression, respiratory quotient (RQ), resting metabolic rate (RMR) and middle-upper arm circumference (MUAC). GWG differed between intervention groups (LED median: 12.0 kg; VLED: 5.9 kg). No differences were noted in the type of delivery, infant birth weight, composite score, prevalence of prematurity, depression, RQ, Apgar score, MUAC, or insulin use among the four groups. Regarding components of the composite score, most infants (88.4%) were appropriate-for-gestational age (AGA) and born at a gestational age of 37-42 weeks (95.3%). With respect to the mothers, 9.3% experienced complications at delivery, with the majority being allocated at the VLED + exercise arm (p < 0.03). The composite score was low (range 0-2.5) for all mother-infant pairs, indicating a "risk-free" pregnancy outcome. The results indicate that adherence to a LED or VLED induces similar maternal, infant and obstetrics outcomes.


Assuntos
Restrição Calórica , Diabetes Gestacional/dietoterapia , Peso ao Nascer , Exercício Físico , Estudos de Viabilidade , Feminino , Idade Gestacional , Ganho de Peso na Gestação , Humanos , Recém-Nascido , Complicações do Trabalho de Parto , Projetos Piloto , Gravidez , Resultado da Gravidez
17.
Ann Intern Med ; 174(8): JC93, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34339223

RESUMO

SOURCE CITATION: Hillier TA, Pedula KL, Ogasawara KK, et al. A pragmatic, randomized clinical trial of gestational diabetes screening. N Engl J Med. 2021;384:895-904. 33704936.


Assuntos
Diabetes Gestacional , Diabetes Gestacional/diagnóstico , Feminino , Humanos , Programas de Rastreamento , Gravidez , Pesquisa
18.
Nutrients ; 13(7)2021 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-34371987

RESUMO

It was previously observed that in a population of a high-income country, dietary multiple micronutrient supplementation in pregnancy was associated with an increased risk of gestational diabetes (GDM) and increased offspring size at birth. In this follow-up study, we investigated whether similar changes are observed with dietary iron supplementation. For this we used the prospective Cambridge Baby Growth Study with records of maternal GDM status, nutrient supplementation, and extensive offspring birth size measurements. Maternal iron supplementation in pregnancy was associated with GDM development (risk ratio 1.67 (1.01-2.77), p = 0.048, n = 677) as well as offspring size and adiposity (n = 844-868) at birth in terms of weight (ß' = 0.078 (0.024-0.133); p = 0.005), head circumference (ß' = 0.060 (0.012-0.107); p = 0.02), body mass index (ß' = 0.067 (0.014-0.119); p = 0.01), and various skinfold thicknesses (ß' = 0.067-0.094; p = 0.03-0.003). In a subset of participants for whom GDM statuses were available, all these associations were attenuated by adjusting for GDM. Iron supplementation also attenuated the associations between multiple micronutrient supplementation and these same measures. These results suggest that iron supplementation may mediate the effects associated with multiple micronutrient supplementation in pregnancy in a high-income country, possibly through the increased risk of developing GDM.


Assuntos
Peso ao Nascer/efeitos dos fármacos , Suplementos Nutricionais , Ferro na Dieta/efeitos adversos , Fenômenos Fisiológicos da Nutrição Materna/efeitos dos fármacos , Micronutrientes/efeitos adversos , Adiposidade/efeitos dos fármacos , Adulto , Índice de Massa Corporal , Diabetes Gestacional/induzido quimicamente , Diabetes Gestacional/fisiopatologia , Feminino , Seguimentos , Humanos , Recém-Nascido , Ferro na Dieta/administração & dosagem , Masculino , Micronutrientes/administração & dosagem , Gravidez , Estudos Prospectivos , Pregas Cutâneas
19.
BMJ Open ; 11(8): e046048, 2021 08 02.
Artigo em Inglês | MEDLINE | ID: mdl-34341040

RESUMO

INTRODUCTION: Women with gestational diabetes mellitus (GDM) have a higher risk of developing type 2 diabetes mellitus compared with women who never had GDM. Consequently, the question of structured aftercare for GDM has emerged. In all probability, many women do not receive care according to the guidelines. In particular, the process and interaction between obstetrical, diabetic, gynaecological, paediatric and general practitioner care lacks clear definitions. Thus, our first goal is to analyse the current aftercare situation for women with GDM in Germany, for example, the participation rate in aftercare diabetes screening, as well as reasons and attitudes stated by healthcare providers to offer these services and by patients to participate (or not). Second, we want to develop an appropriate, effective and patient-centred care model. METHODS AND ANALYSIS: This is a population-based mixed methods study using both quantitative and qualitative research approaches. In various working packages, we evaluate data of the GestDiab register, of the Association of Statutory Health Insurance Physicians of North Rhine and the participating insurance companies (AOK Rheinland/Hamburg, BARMER, DAK Gesundheit, IKK classic, pronova BKK). In addition, quantitative (postal surveys) and qualitative (interviews) surveys will be conducted with randomly selected healthcare providers (diabetologists, gynaecologists, paediatricians and midwives) and affected women, to be subsequently analysed. All results will then be jointly examined and evaluated. ETHICS AND DISSEMINATION: The study was approved by the ethics committee of the Faculty of Medicine, Heinrich-Heine-University Düsseldorf (Ethics Committee No.: 2019-738). Participants of the postal surveys and interviews will be informed in detail about the study and the use of data as well as the underlying data protection regulations before voluntarily participating. The study results will be disseminated through peer-reviewed journals, conferences and public information. TRIAL REGISTRATION NUMBER: DRKS00020283.


Assuntos
Diabetes Mellitus Tipo 2 , Diabetes Gestacional , Assistência ao Convalescente , Criança , Diabetes Mellitus Tipo 2/terapia , Diabetes Gestacional/terapia , Feminino , Alemanha , Humanos , Gravidez , Inquéritos e Questionários
20.
Artigo em Inglês | MEDLINE | ID: mdl-34348919

RESUMO

INTRODUCTION: Fatty acid (FA) concentrations have previously been associated with gestational diabetes mellitus (GDM). However, few studies on GDM have examined FA profiles in early pregnancy or before diagnosis. This study aimed to compare early pregnancy plasma FA profiles of women with and without GDM diagnoses as well as their reported dietary consumption. RESEARCH DESIGN AND METHODS: The subjects comprised 853 women from the prospective study: Pregnant Women in Iceland II (PREWICE II), attending their 11-14 weeks ultrasound appointment in 2017-2018. During the visit, blood samples were collected for plasma FA analysis, and dietary habits were assessed using a short food frequency questionnaire. Information on GDM diagnoses was then later extracted from medical records. Differences in FA profile between GDM cases and non-cases were evaluated using the Mann-Whitney U test. RESULTS: GDM was diagnosed in 127 women (14.9%). Concentrations of saturated fatty acids, monounsaturated fatty acids, polyunsaturated fatty acids (PUFA) n-6, PUFA n-3 and total FA were higher in the women who later developed GDM compared with those who did not (p≤0.05). The medians for total FA were 2898 µg/mL for the women with GDM and 2681 µg/mL for those without GDM. Mean adjusted difference for total FA between the groups was 133 µg/mL (95% CI 33 to 233). Similar results were observed in prepregnancy normal-weight women and overweight women/women with obesity. Overall diet quality in early pregnancy appeared to be lower among the women later diagnosed with GDM. CONCLUSION: We found that plasma FA profiles in early pregnancy were different for women later diagnosed with GDM compared with those who were not, independent of the women's body mass index.


Assuntos
Diabetes Gestacional , Índice de Massa Corporal , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/epidemiologia , Dieta , Ácidos Graxos , Ácidos Graxos Insaturados , Feminino , Humanos , Gravidez
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