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1.
BJOG ; 127(3): 345-354, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31749274

RESUMO

OBJECTIVES: To describe the population of women having bariatric surgery and compare the pregnancy outcomes for women having bariatric surgery with a non-bariatric surgery population having a first and second pregnancy. DESIGN: Population-based record linkage study. SETTING: New South Wales (NSW), Australia. POPULATION: All women aged 15-45 years with a hospital record in NSW (2002-2014) and all women giving birth in NSW (1994-2015; n = 1 606 737 women). METHODS: Pregnancy and birth outcomes were compared between first and second pregnancies using repeated-measures logistic regression and paired Student's t-tests. Bariatric and non-bariatric groups were also compared. MAIN OUTCOME MEASURES: Maternal diabetes, preterm birth (<37 weeks of gestation) and large for gestational age. RESULTS: There was a 13-fold increase in hospitalisations for primary bariatric surgery during 2002-2014. Compared with the general birthing population, women who had bariatric surgery experienced higher rates of hypertension, diabetes, and preterm birth. Among women who had bariatric surgery between a first and second pregnancy, there were reduced rates of hypertension (OR 0.39, 95% CI 0.29-0.53), spontaneous preterm birth (OR 0.37, 95% CI 0.16-0.86), infants that were large for gestational age (OR 0.63, 95% CI 0.44-0.88), and the admission of infants to a special care nursery or neonatal intensive care (OR 0.64, 95% CI 0.46-0.90) in the second pregnancy. Rates for small-for-gestational age and gestational diabetes following surgery were 8.3 and 11.4%, respectively CONCLUSIONS: Bariatric surgery between a first and second pregnancy was associated with reductions in obesity-related adverse pregnancy outcomes. Bariatric surgery performed for the management of obesity in accordance with current clinical criteria is associated with improved pregnancy outcomes in a subsequent pregnancy. TWEETABLE ABSTRACT: Bariatric surgery for obesity may improve pregnancy and birth outcomes in a subsequent pregnancy.


Assuntos
Cirurgia Bariátrica , Diabetes Gestacional , Obesidade , Nascimento Prematuro/epidemiologia , Sistema de Registros/estatística & dados numéricos , Adulto , Austrália/epidemiologia , Cirurgia Bariátrica/métodos , Cirurgia Bariátrica/estatística & dados numéricos , Peso ao Nascer , Cesárea/estatística & dados numéricos , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/epidemiologia , Feminino , Humanos , Recém-Nascido , Armazenamento e Recuperação da Informação , Obesidade/epidemiologia , Obesidade/cirurgia , Paridade , Gravidez , Resultado da Gravidez/epidemiologia
3.
Pan Afr Med J ; 34: 18, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31762887

RESUMO

Introduction: The purpose of this study was to describe the diagnostic, prognostic and therapeutic features of gestational diabetes at the Sylvanus Olympio University Hospital Center. Methods: We conducted a retrospective descriptive study over a period of 5 years from 1st January 2013 to 31st December 2017. It involved 125 pregnant women who had given birth in the Department of Internal Medicine and in the Gyneco-Obstetric Department. Results: The average age of patients was 30.84±4.17 years. The most common risk factors were overweight and obesity (57.7%), a family history of diabetes (33.3%), a history of spontaneous miscarriage (26.6%), a history of fetal death in utero (15.5%) and a history of gestational diabetes (8.8%). Gestational diabetes screening was performed using fasting blood glucose test and 75g oral glucose-tolerance test. Diagnosis was made in the first quarter in 55.6% of cases, in the second quarter in 33.3% and in the third quarter in 11.1%. Insulin therapy was necessary in 24.4% of cases and a healthy meal-plan alone in 66.6%. Sixty-six point seven percent (66.7%) of women had given birth by cesarean section and 33.3% vaginally. Maternal complications at birth included: arterial hypertension (22.2%), preeclampsia (17.7%) and premature ruptured membranes (2.2%). Newborn complications included macrosomia (48.9%), prematurity (11.1%), hypoglycaemia (11.1%), malformations (4.4%) and stillborn child (4.4%). Eighty-eight point nine percent (88.9%) of newborns had Apgar score greater than 7 and more than 48% were macrosomes. Conclusion: Gestational diabetes leads to maternofetal complications. Systematic screening is essential even in the absence of risk factors for optimal patient management.


Assuntos
Cesárea/estatística & dados numéricos , Diabetes Gestacional/diagnóstico , Resultado da Gravidez , Adulto , Índice de Apgar , Diabetes Gestacional/terapia , Feminino , Teste de Tolerância a Glucose , Hospitais Universitários , Humanos , Recém-Nascido , Programas de Rastreamento/métodos , Obesidade/epidemiologia , Gravidez , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
4.
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
5.
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
6.
Int J Nanomedicine ; 14: 7851-7860, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31632005

RESUMO

Background: Gestational diabetes mellitus is a commonly occurring metabolic disorder during pregnancy, affecting >4% of pregnant women. It is generally defined as the intolerance of glucose with the onset or initial diagnosis during pregnancy. This illness affects the placenta and poses a threat to the baby as it affects the supply of proper oxygen and nutrients. Purpose: Due to the high percentage of affected pregnant women, it should be mandatory to evaluate glucose levels during pregnancy and there is a need for a continuous monitoring system. Methods: Herein, the investigators modified the interdigitated (di)electrodes (IDE) sensing surface to detect the glucose on covalently immobilized glucose oxidase (GOx) with the graphene. The characterization of graphene and gold nanoparticle (GNP) was performed by high-resolution microscopy. Results: Sensitivity was found to be 0.06 mg/mL and to enhance the detection, GOx was complexed with GNP. GNP-GOx was improved the sensitive detection twofold from 0.06 to 0.03 mg/mL, and it also displayed higher levels of current changes at all the concentrations of glucose that were tested. High-performance of the above IDE sensing system was attested by the specificity, reproducibility and higher sensitivity detections. Further, the linear regression analysis indicated the limit of detection to be between 0.02 and 0.03 mg/mL. Conclusion: This study demonstrated the potential strategy with nanocomposite for diagnosing gestational diabetes mellitus.


Assuntos
Diabetes Gestacional/diagnóstico , Eletricidade , Glucose Oxidase/metabolismo , Glucose/análise , Ouro/química , Grafite/química , Nanocompostos/química , Eletrodos , Feminino , Humanos , Limite de Detecção , Modelos Lineares , Nanopartículas Metálicas/química , Nanopartículas Metálicas/ultraestrutura , Nanocompostos/ultraestrutura , Gravidez , Sensibilidade e Especificidade , Propriedades de Superfície
7.
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
8.
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
9.
Diabetes Metab Syndr ; 13(4): 2353-2356, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31405642

RESUMO

For the effective management and screening of patients with diabetes, lipid profile has been a useful mean. Here, we hypothesized that biochemical analyses of blood serum in pregnant women with GDM will develop an insight on the pathogenesis of the disease and possibly uncover new biomarkers. In order to test our hypothesis, antenatal pregnant women (n = 300) were selected for blood samples including 176 with positive clinical/family history and 124 with negative clinical/family history of GDM during the early second trimester (14-18 weeks of gestation). All the subjects were followed up to the early third trimester (24-28 weeks of gestation) for second sampling until the onset of GDM. Lipid profile data shows that mean values of triglycerides, total cholesterol, low density lipids and very low density lipids were significantly higher (p < 0.05) and mean HDL was significantly lower in early second trimester in those patients who subsequently developed GDM during late third trimester when compared with those who didn't develop GDM. Inflammatory biomarker such as High-sensitivity C-reactive protein (hs-CRP) levels were also found to be significantly higher by 69% increase in patients who developed GDM later in third trimester in comparison with those who didn't develop. About 32% patients who finally developed GDM belonged to positive clinical/family history group. The results of our study indicate that abnormal serum cholesterol; triglycerides, HDL, LDL, VLDL and hs-CRP play a vital in pathophysiology of gestational diabetes. Early diagnosis of GDM based on these biochemical markers will help decrease adverse neonatal and maternal outcomes.


Assuntos
Biomarcadores/sangue , Proteína C-Reativa/análise , Diabetes Gestacional/diagnóstico , Lipídeos/sangue , Programas de Rastreamento/métodos , Triglicerídeos/sangue , Adolescente , Adulto , Glicemia/análise , Diabetes Gestacional/sangue , Diabetes Gestacional/epidemiologia , Diagnóstico Precoce , Feminino , Seguimentos , Idade Gestacional , Hemoglobina A Glicada/análise , Humanos , Paquistão/epidemiologia , Placentação , Gravidez , Prognóstico , Fatores de Risco , Adulto Jovem
10.
Diabetes Metab Syndr ; 13(4): 2775-2784, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31405707

RESUMO

Gestational diabetes mellitus (GDM) is one of the most common complication of pregnancy and can lead to significant perinatal mortalities as well as long term risk of comorbidities for both mother and her offspring. This systematic review aimed to explore whether combined diet and exercise interventions are associated with improved glycemic control and/or improved maternal and newborn outcomes in women with GDM when compared to dietary interventions. A search on combined diet and exercise interventions during pregnancy in women with GDM was performed in 3 electronic databases: PubMed (NCBI), ScienceDierct, and the Cochrane Library. Evaluated outcomes were fasting blood glucose levels, postprandial blood glucose levels, glycated hemoglobin percentages, total weight gain during pregnancy, proportion of caesarean delivery, proportion of patients needing insulin, neonatal birth weight, proportion of macrosomia, neonatal hypoglycemia, and preterm birth. This systematic review identified eight randomized, controlled trials involving 592 pregnant women and 350 infants. The risk of bias of the included trials ranged from high to low. The combined diet and exercise interventions reduced fasting and postprandial blood glucose levels when compared to dietary interventions. No significant differences were reported in the selected trials regarding total weight gain during pregnancy, cesarean section, neonatal birth weight, macrosomia, neonatal hypoglycemia, and preterm birth between diet plus exercise and diet groups. The combination of diet and exercise interventions help to control postprandial blood glucose concentration in women diagnosed with GDM, but did not change either maternal or newborn outcomes. REGISTRATION: PROSPERO CRD42018109896.


Assuntos
Diabetes Gestacional/terapia , Dieta , Exercício , Hiperglicemia/prevenção & controle , Hipoglicemia/prevenção & controle , Glicemia/análise , Diabetes Gestacional/diagnóstico , Feminino , Humanos , Hiperglicemia/sangue , Hipoglicemia/sangue , Recém-Nascido , Gravidez , Prognóstico
11.
J Diabetes Res ; 2019: 3264184, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31428654

RESUMO

Background: Women with previous gestational diabetes mellitus (GDM) have evidence of postpartum ß-cell dysfunction, which increases their risk of developing type 2 diabetes (T2DM) later in life. Elevated levels of circulating cell-free preproinsulin (INS) DNA correlate with dying ß-cells in both mice and humans. The aim of this study was to determine if cell-free circulating INS DNA levels are higher in women with previous GDM who develop T2DM. Methods: We used droplet digital (dd) PCR to measure the levels of cell-free circulating methylated and unmethylated INS DNA in plasma from 97 women with normal glucose tolerance (NGT), 12 weeks following an index GDM pregnancy. Women were assessed for up to 10 years for the development of T2DM. Results: In the follow-up period, 22% of women developed T2DM. Compared with NGT women, total cell-free INS DNA levels were significantly higher in women who developed T2DM (P = 0.02). There was no difference in cell-free circulating unmethylated and methylated INS DNA levels between NGT women and women who developed T2DM (P = 0.09 and P = 0.07, respectively). Conclusions: In women with a previous index GDM pregnancy, postpartum levels of cell-free circulating INS DNA are significantly higher in those women who later developed T2DM.


Assuntos
Ácidos Nucleicos Livres/sangue , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Gestacional , Insulina/genética , Período Pós-Parto/sangue , Adulto , Biomarcadores/sangue , Estudos de Casos e Controles , Ácidos Nucleicos Livres/análise , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/genética , Diabetes Gestacional/sangue , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/patologia , Feminino , Seguimentos , Teste de Tolerância a Glucose , Humanos , Insulina/sangue , Resistência à Insulina/genética , Reação em Cadeia da Polimerase/métodos , Gravidez , Prognóstico , Fatores de Risco
12.
Acta Diabetol ; 56(11): 1159-1167, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31396699

RESUMO

AIMS: In 2010, Italian health professionals rapidly implemented the one-step screening for gestational diabetes mellitus (GDM) based on a 75 g OGTT, to comply with the diagnostic criteria proposed by the International Association of Diabetes and Pregnancy Study Groups (IADPSG). The change was promoted by the two main Italian scientific societies of diabetology, Associazione Medici Diabetologi (AMD) and Società Italiana di Diabetologia (SID), and it took just a few months for the Istituto Superiore di Sanità, together with several scientific societies, to revise the criteria and include them in the National Guidelines System. Over the last 9 years, the implementation of these guidelines has shown some benefits and some drawbacks. METHODS: In order to evaluate the critical issues arisen from the implementation of the current Italian guidelines for the diagnosis of GDM, the studies published on this topic have been reviewed. The search was performed using the following keywords: "gestational diabetes" AND "diagnostic criteria" OR screening AND Ital*. The study is an expert opinion paper, based on the relevant scientific literature published between 2010 and 2019. The databases screened for the literature review included PubMed, MEDLINE, and Scopus. RESULTS: The implementation of the Guidelines for Screening and Diagnosis of GDM in Italy present some strengths and some weaknesses. One of the positive aspects is that high-risk women are required to perform an OGTT early in pregnancy. By contrast, there are several aspects in need of improvement: (1) In spite of the current indications, only a minority of high-risk women perform OGTT early in pregnancy; (2) several low-risk women are screened for GDM; (3) in some low-risk women affected by GDM, the diagnosis might be missed with the application of the current guidelines; (4) there is a lack of homogeneity in the risk assessment data from different regions. CONCLUSIONS: In order to improve the current Italian GDM guidelines, some practical solutions have been suggested.


Assuntos
Diabetes Gestacional/diagnóstico , Guias de Prática Clínica como Assunto , Adulto , Feminino , Humanos , Itália , Programas de Rastreamento/normas , Gravidez
13.
BMC Pregnancy Childbirth ; 19(1): 252, 2019 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-31324151

RESUMO

BACKGROUND: Gestational diabetes mellitus (GDM) is associated with adverse perinatal outcomes. Screening for GDM and applying adequate interventions may reduce the risk of adverse outcomes. However, the diagnosis of GDM depends largely on tests performed in late second trimester. The aim of the present study was to bulid a simple model to predict GDM in early pregnancy in Chinese women using biochemical markers and machine learning algorithm. METHODS: Data on a total of 4771 pregnant women in early gestation were used to fit the GDM risk-prediction model. Predictive maternal factors were selected through Bayesian adaptive sampling. Selected maternal factors were incorporated into a multivariate Bayesian logistic regression using Markov Chain Monte Carlo simulation. The area under receiver operating characteristic curve (AUC) was used to assess discrimination. RESULTS: The prevalence of GDM was 12.8%. From 8th to 20th week of gestation fasting plasma glucose (FPG) levels decreased slightly and triglyceride (TG) levels increased slightly. These levels were correlated with those of other lipid metabolites. The risk of GDM could be predicted with maternal age, prepregnancy body mass index (BMI), FPG and TG with a predictive accuracy of 0.64 and an AUC of 0.766 (95% CI 0.731, 0.801). CONCLUSIONS: This GDM prediction model is simple and potentially applicable in Chinese women. Further validation is necessary.


Assuntos
Diabetes Gestacional , Programas de Rastreamento/métodos , Primeiro Trimestre da Gravidez/sangue , Medição de Risco/métodos , Adulto , Glicemia/análise , Índice de Massa Corporal , China/epidemiologia , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/epidemiologia , Feminino , Teste de Tolerância a Glucose/métodos , Humanos , Idade Materna , Valor Preditivo dos Testes , Gravidez , Prognóstico , Fatores de Risco
14.
PLoS Med ; 16(7): e1002857, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31335871

RESUMO

BACKGROUND: Pregnant women with metabolic risk factors are at high risk of complications. We aimed to assess whether a Mediterranean-style diet reduces adverse pregnancy outcomes in high-risk women. METHODS AND FINDINGS: We conducted a multicentre randomised trial in 5 maternity units (4 in London and 1 in Birmingham) between 12 September 2014 and 29 February 2016. We randomised inner-city pregnant women with metabolic risk factors (obesity, chronic hypertension, or hypertriglyceridaemia) to a Mediterranean-style diet with high intake of nuts, extra virgin olive oil, fruits, vegetables, nonrefined grains, and legumes; moderate to high consumption of fish; low to moderate intake of poultry and dairy products; low intake of red and processed meat; and avoidance of sugary drinks, fast food, and food rich in animal fat versus usual care. Participants received individualised dietary advice at 18, 20, and 28 weeks' gestation. The primary endpoints were composite maternal (gestational diabetes or preeclampsia) and composite offspring (stillbirth, small for gestational age, or admission to neonatal care unit) outcomes prioritised by a Delphi survey. We used an intention-to-treat (ITT) analysis with multivariable models and identified the stratification variables and prognostic factors a priori. We screened 7,950 and randomised 1,252 women. Baseline data were available for 593 women in the intervention (93.3% follow-up, 553/593) and 612 in the control (95.6% follow-up, 585/612) groups. Over a quarter of randomised women were primigravida (330/1,205; 27%), 60% (729/1,205) were of Black or Asian ethnicity, and 69% (836/1,205) were obese. Women in the intervention arm consumed more nuts (70.1% versus 22.9%; adjusted odds ratio [aOR] 6.8, 95% confidence interval [CI] 4.3-10.6, p ≤ 0.001) and extra virgin olive oil (93.2% versus 49.0%; aOR 32.2, 95% CI 16.0-64.6, p ≤ 0.001) than controls; increased their intake of fish (p < 0.001), white meat (p < 0.001), and pulses (p = 0.05); and reduced their intake of red meat (p < 0.001), butter, margarine, and cream (p < 0.001). There was no significant reduction in the composite maternal (22.8% versus 28.6%; aOR 0.76, 95% CI 0.56-1.03, p = 0.08) or composite offspring (17.3% versus 20.9%; aOR 0.79, 95% CI 0.58-1.08, p = 0.14) outcomes. There was an apparent reduction in the odds of gestational diabetes by 35% (aOR 0.65, 95% CI 0.47-0.91, p = 0.01) but not in other individual components of the composite outcomes. Mothers gained less gestational weight (mean 6.8 versus 8.3 kg; adjusted difference -1.2 Kg, 95% CI -2.2 to -0.2, p = 0.03) with intervention versus control. There was no difference in any of the other maternal and offspring complications between both groups. When we pooled findings from the Effect of Simple, Targeted Diet in Pregnant Women With Metabolic Risk Factors on Pregnancy Outcomes (ESTEEM) trial with similar trials using random effects meta-analysis, we observed a significant reduction in gestational diabetes (odds ratio [OR] 0.67, 95% CI 0.53-0.84, I2 = 0%), with no heterogeneity (2 trials, 2,397 women). The study's limitations include the use of participant reported tools for adherence to the intervention instead of objective biomarkers. CONCLUSIONS: A simple, individualised, Mediterranean-style diet in pregnancy did not reduce the overall risk of adverse maternal and offspring complications but has the potential to reduce gestational weight gain and the risk of gestational diabetes. TRIAL REGISTRATION: ClinicalTrials.gov NCT02218931.


Assuntos
Diabetes Gestacional/prevenção & controle , Dieta Mediterrânea , Ganho de Peso na Gestação , Adulto , Técnica Delfos , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/etiologia , Diabetes Gestacional/fisiopatologia , Metabolismo Energético , Inglaterra , Feminino , Humanos , Fenômenos Fisiológicos da Nutrição Materna , Metanálise como Assunto , Estado Nutricional , Valor Nutritivo , Gravidez , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
15.
BMC Pregnancy Childbirth ; 19(1): 249, 2019 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-31311547

RESUMO

BACKGROUND: In April 2012 our institution chose to switch from a two- step criteria for Gestational Diabetes Mellitus (GDM) screening, to the International Association of Diabetes in Pregnancy Study Group (IADSPG) criteria. This shift led to an increased prevalence of GDM in our pregnant population. We designed a study in order to estimate the magnitude of the increase in GDM prevalence before and after the switch in screening strategy. As a secondary objective we wanted to evaluate if there was a significant difference between the two periods in the percentage of maternal and neonatal complications such as gestational hypertensive disorders (GHD), primary cesarean section (pCS), preterm birth, large for gestational age (LGA) newborns, macrosomia, shoulder dystocia, 5' Apgar score less than to 7 at birth, neonatal intensive care unit (NICU) transfer and neonatal hypoglycemia. METHODS: We selected retrospectively 3496 patients who delivered between January 2009 and December 2011 who were screened with the two-step criteria (group A), and compared them to 2555 patients who delivered between January 2013 and December 2014 and who were screened with IADPSG criteria (Group B). We checked patients' electronic files to establish GDM status, baseline characteristics (age, body mass index, nationality, parity) and the presence of maternal and neonatal complications. RESULTS: GDM prevalence increased significantly from group A (3.4%; 95%CI 2.8-4.06%) to group B (16.28%; 95%CI 14.8 -17.7%). In group B there were significantly more non-Belgian and primiparous patients. There was no statistically significant difference in maternal and neonatal complications between the two groups, even after adjustment for nationality and parity. There was a non-significant reduction of the proportion of macrosomic and of LGA babies. CONCLUSIONS: In our population the introduction of IADPSG screening criteria has increased the prevalence of GDM without having a statistically significant impact on pregnancy outcomes.


Assuntos
Diabetes Gestacional , Programas de Triagem Diagnóstica , Doenças do Recém-Nascido/epidemiologia , Programas de Rastreamento , Complicações do Trabalho de Parto/epidemiologia , Adulto , Bélgica/epidemiologia , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/epidemiologia , Programas de Triagem Diagnóstica/normas , Programas de Triagem Diagnóstica/estatística & dados numéricos , Feminino , Humanos , Recém-Nascido , Doenças do Recém-Nascido/classificação , Masculino , Programas de Rastreamento/métodos , Programas de Rastreamento/organização & administração , Complicações do Trabalho de Parto/classificação , Gravidez , Resultado da Gravidez/epidemiologia , Cuidado Pré-Natal/métodos , Cuidado Pré-Natal/normas , Prevalência , Estudos Retrospectivos
16.
J Pregnancy ; 2019: 7578403, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31275653

RESUMO

Aim: To identify the involvement of leanness and impaired insulin secretion with Japanese gestational diabetes mellitus (GDM). Method: A cross-sectional study was conducted comprising 219 at-risk pregnant women who underwent a 75g glucose tolerance test at a single institute in Tokyo, Japan. We identified GDM and normal glucose tolerance (NGT). The cut-off value of the homeostasis model assessment insulin resistance (HOMA-IR) for detecting GDM was determined. The GDM group was divided into subgroups according to insulin resistance based on the cut-off value of HOMA-IR. We compared the prepregnancy body mass index (BMI) and homeostasis model assessment of ß-cell function (HOMA-ß) between the group comprising low insulin resistance (LIR) and the group comprising high insulin resistance (HIR). Results: Seventy GDM cases and 149 NGT cases were identified. By using receiver operating characteristic curve analysis, the HOMA-IR cut-off value was determined to be 1.41. Twenty-five GDM cases (36%) were classified as LIR and forty-five GDM cases (64%) were classified as HIR. The background including indications for having 75gOGTT and the gestational age having 75gOGTT did not differ between groups. The BMI of the LIR group was significantly lower than that of the HIR group (20.9±2.8 vs. 24.4 ± 5.5, p<0.01), and the HOMA-ß of the LIR group was significantly lower than that of the HIR group (95.5±30.3 vs. 146.0±70.1, p<0.01). A positive linear correlation was found between BMI and HOMA-ß in cases of GDM (r=0.27, p=0.02). Conclusion: Leanness with impaired insulin secretion is deeply involved in Japanese gestational diabetes mellitus.


Assuntos
Diabetes Gestacional/etiologia , Secreção de Insulina , Insulina/deficiência , Magreza , Adulto , Biomarcadores/sangue , Índice de Massa Corporal , Estudos Transversais , Diabetes Gestacional/sangue , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/epidemiologia , Feminino , Teste de Tolerância a Glucose , Humanos , Insulina/sangue , Japão/epidemiologia , Gravidez , Estudos Retrospectivos , Fatores de Risco , Sensibilidade e Especificidade
17.
DNA Cell Biol ; 38(10): 1069-1077, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31361511

RESUMO

Long-noncoding RNA AC092159.2, located ∼247 bp upstream of the TMEM18 gene, may play integral roles in metabolic processes, including adipocyte differentiation and glycometabolism. AC092159.2 may be an important regulator of TMEM18, which is an important susceptibility gene related to obesity and type 2 diabetes. We designed a case-control study (including 964 gestational diabetes mellitus [GDM] cases and 1021 controls) to assess the associations of 14 single-nucleotide polymorphisms (SNPs) in AC092159.2 with the GDM risk. Logistic regression analyses showed that rs11127496 A > G, rs12714417 C > T, and rs1320334 A > G conferred a decreased GDM risk in the recessive and additive model, whereas rs11691220 T > C conferred an increased GDM risk in the dominant and additive model. Also, with increasing number of protective alleles of the four SNPs, the risk of GDM was significantly decreased in a dose-dependent manner (ptrend = 0.007). Further function annotation indicated that these four SNPs may fall on the function elements of human pancreatic islets. The genotype-phenotype associations suggested that these SNPs may contribute to GDM by affecting TMEM18 expression. AC092159.2 SNPs (rs11127496 A > G, rs11691220 T > C, rs12714417 C > T, and rs1320334 A > G) may be susceptibility makers for risk of GDM in Chinese females.


Assuntos
Diabetes Gestacional/genética , Ilhotas Pancreáticas/metabolismo , Proteínas de Membrana/genética , Polimorfismo de Nucleotídeo Único , RNA Longo não Codificante/genética , Adulto , Alelos , Grupo com Ancestrais do Continente Asiático , Estudos de Casos e Controles , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/etnologia , Diabetes Gestacional/patologia , Feminino , Regulação da Expressão Gênica , Estudos de Associação Genética , Humanos , Ilhotas Pancreáticas/patologia , Proteínas de Membrana/metabolismo , Modelos Genéticos , Gravidez , RNA Longo não Codificante/metabolismo , Risco
18.
Diabetes Res Clin Pract ; 155: 107800, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31362053

RESUMO

BACKGROUND: Impaired glucose metabolism during pregnancy can result in a significant adverse pregnancy-outcomes. Previous studies have reported the contribution of ART to the impaired glucose tolerance and gestational diabetes mellitus (GDM) in HIV-infected pregnant women. METHODS: PRISMA guideline was followed for this systematic review and meta-analysis. The STATA version 11 was employed to compute the pooled prevalence of GDM using the random effect model and 95% confidence interval. Subgroup analysis was conducted by geographical regions. Visual inspection of the funnel plot and Egger's regression test statistic were used to show the publication bias. RESULTS: A total of 13,517 articles were identified, of which 21 publications met the inclusion criteria. The pooled prevalence of GDM among HIV-infected pregnant women was 4.42% (95% CI: 3.48; 5.35). According to the subgroup analysis, the pooled prevalence of GDM among HIV-infected pregnant women was 7.1% (95%CI: 3.38; 10.76) in Asia, 5.83% (95% CI: 2.61; 9.04) in Europe, 3.58% (95% CI: 2.67; 4.50) in America and 3.19% (95% CI: -2.89; 9.27) in Africa. CONCLUSION: The pooled prevalence of GDM among HIV-infected pregnant women is expectedly high. Therefore, early screening of HIV-infected pregnant women for GDM is vital to reduce its complications related to pregnancy. PROTOCOL REGISTRATION NUMBER: International Prospective Register of Systematic Reviews CRD42018090735.


Assuntos
Diabetes Gestacional/diagnóstico , Diabetes Gestacional/epidemiologia , Intolerância à Glucose/epidemiologia , Infecções por HIV/complicações , Complicações Infecciosas na Gravidez/etiologia , Diabetes Gestacional/virologia , Feminino , HIV/isolamento & purificação , Infecções por HIV/virologia , Humanos , Programas de Rastreamento , Gravidez , Complicações Infecciosas na Gravidez/patologia , Prevalência , Estudos Prospectivos
19.
Nutrients ; 11(8)2019 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-31357598

RESUMO

Nutrition therapy provides the foundation for treatment of gestational diabetes (GDM), and has historically been based on restricting carbohydrate (CHO) intake. In this paper, randomized controlled trials (RCTs) are reviewed to assess the effects of both low- and higher CHO nutrition approaches in GDM. The prevailing pattern across the evidence underscores that although CHO restriction improves glycemia at least in the short-term, similar outcomes could be achievable using less restrictive approaches that may not exacerbate IR. The quality of existing studies is limited, in part due to dietary non-adherence and confounding effects of treatment with insulin or oral medication. Recent evidence suggests that modified nutritional manipulation in GDM from usual intake, including but not limited to CHO restriction, improves maternal glucose and lowers infant birthweight. This creates a platform for future studies to further clarify the impact of multiple nutritional patterns in GDM on both maternal and infant outcomes.


Assuntos
Diabetes Gestacional/dietoterapia , Dieta com Restrição de Carboidratos , Carboidratos da Dieta/administração & dosagem , Obesidade/dietoterapia , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/epidemiologia , Diabetes Gestacional/fisiopatologia , Dieta com Restrição de Carboidratos/efeitos adversos , Carboidratos da Dieta/efeitos adversos , Carboidratos da Dieta/metabolismo , Feminino , Ganho de Peso na Gestação , Humanos , Incidência , Fenômenos Fisiológicos da Nutrição Materna , Estado Nutricional , Obesidade/diagnóstico , Obesidade/epidemiologia , Obesidade/fisiopatologia , Gravidez , Prevalência , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Resultado do Tratamento
20.
East Mediterr Health J ; 25(4): 282-289, 2019 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-31210349

RESUMO

Background: Gestational diabetes mellitus (GDM) is defined as impaired glucose tolerance with onset during the second or third trimester of pregnancy. Aims: The purpose of this study was to investigate the prevalence of pregnant women who were not screened for gestational diabetes mellitus and compare the maternal and fetal outcomes of women who had undergone GDM screening. Methods: Women who refused to attend the gestational diabetes screening test (n = 162) at a maternity hospital in Ankara, Turkey, between October 2014 and January 2015 were included in this prospective cohort study. The control group (matched for age and body mass index) was recruited from women who agreed to have the gestational diabetes screening test (n = 194). Results: Just 12% of pregnant women did not attend gestational diabetes screening test; these women were at higher risk for idiopathic polyhydramnios (P = 0.026). Prevalence of GDM was 8.8% (n = 17) in the control group and 30.9% (n = 50) in those who refused GDM screening. The maternal and fetal outcomes of GDM patients were similar in both groups. Women who did not attend GDM screening test had increased risk for mild idiopathic polyhydramnios in late gestation. Conclusions: Fasting and postprandial plasma glucose screening can replace gestational diabetes mellitus screening in women who refuse to have the glucose load test.


Assuntos
Análise Química do Sangue/métodos , Glicemia/análise , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/epidemiologia , Adolescente , Adulto , Índice de Massa Corporal , Diabetes Gestacional/sangue , Jejum/fisiologia , Feminino , Humanos , Poli-Hidrâmnios/epidemiologia , Período Pós-Prandial/fisiologia , Gravidez , Prevalência , Estudos Prospectivos , Turquia , Adulto Jovem
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