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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
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.
Tidsskr Nor Laegeforen ; 139(18)2019 Dec 10.
Artigo em Norueguês | MEDLINE | ID: mdl-31823575

RESUMO

BACKGROUND: The aim was to investigate the prevalence of gestational diabetes and pregnancy outcomes in women with gestational diabetes in Nordland and Troms counties. MATERIAL AND METHOD: We included all 1 067 women with type 1 diabetes, type 2 diabetes and gestational diabetes among 34 915 births at four hospitals in Nordland and Troms counties from 2004 to 2015. Prevalence of diabetes was calculated based on ICD-10 codes in patient records for women with diabetes in Nordland and Troms counties, and compared with national prevalence figures from the Medical Birth Registry of Norway. Prevalence of pre-eclampsia, macrosomia (birth weight > 4 500 grams) and caesarian section was calculated for all women with diabetes and all those giving birth in the same region. RESULTS: Prevalence of type 1 diabetes and type 2 diabetes remained stable. Prevalence of gestational diabetes increased from 1.0 % to 4.0 % in Nordland and Troms counties and from 1.0 % to 3.8 % nationally. Prevalence of pre-eclampsia among all women with diabetes fell from 18.8 % in 2004-06 to 12.4 % in 2013-15. In women with diabetes, the prevalence of pre-eclampsia was 4.6 times higher, that of macrosomia was 3.5 times higher, and the proportion of caesarian sections was 2.3 times higher than in the background population. INTERPRETATION: Prevalence of gestational diabetes increased in Nordland and Troms counties, as it did nationally. Prevalence of pre-eclampsia among pregnant women with diabetes fell, but prevalence of pre-eclampsia, macrosomia and caesarean section was higher than in the background population.


Assuntos
Diabetes Mellitus Tipo 2 , Diabetes Gestacional , Cesárea , Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Gestacional/epidemiologia , Feminino , Humanos , Noruega/epidemiologia , Gravidez , Resultado da Gravidez , Prevalência
5.
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
6.
BMC Public Health ; 19(1): 1287, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31615456

RESUMO

BACKGROUND: Gestational diabetes (GDM) is a known risk factor for type 2 diabetes mellitus (T2DM), and women with a history of GDM have a 7-fold increased risk of developing the disease. Achieving a healthy weight post-delivery is key in reducing the risk of future diabetes in these women. The aim of this trial is to investigate the use of an interactive smartphone application (APP) to restore women to optimal weight following delivery. METHODS: This will be an open-label randomized controlled trial. Two hundred women with gestational diabetes will be randomized to receive the intervention or standard care following delivery. Participants will be reviewed at 6 weeks and 4 months post-delivery. The intervention is an APP serving as a platform for weight, diet and physical activity tracking. The APP provides 3-5 min educational videos suggesting suitable lifestyle adjustments relevant to postnatal period such as breast feeding, diet and exercise. Lastly, the APP will allow real-time interaction between users and the team of dietitians, physiotherapists and occupational therapists to encourage restoration of optimal weight. Women in the control arm will be informed about the increased risk of developing T2DM and advised to maintain a healthy weight. Primary outcome measure is the restoration of participants' booking weight if booking BMI ≤ 23, or weight loss of at least 5% from booking weight if booking BMI > 23 over the 4 month period. Secondary outcome measures will assess serum metabolic and inflammatory markers, quality of life via questionnaires and cost-effectiveness of the intervention at each follow-up visit. DISCUSSION: This will be the first randomised controlled trial investigating the use of a smartphone application for postpartum weight loss in women with gestational diabetes. The major ethnic groups in our study population represent the majority of ethnic groups in Asia, amongst which the prevalence of diabetes is high. If shown to be effective, this APP may be used in wider clinical settings to improve postpartum weight loss and reduce the risk of developing T2DM in these women. TRIAL REGISTRATION: This study was registered on clintrials.gov on the 30th of October 2017, under the trial registration number: NCT03324737 .


Assuntos
Diabetes Mellitus Tipo 2/prevenção & controle , Diabetes Gestacional/epidemiologia , Aplicativos Móveis , Smartphone , Programas de Redução de Peso/métodos , Adulto , Protocolos Clínicos , Feminino , Humanos , Gravidez , Singapura/epidemiologia
7.
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
8.
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
9.
Int J Gynaecol Obstet ; 147(3): 404-412, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31479156

RESUMO

OBJECTIVE: To characterize the demographics, comorbidities, management, and outcomes of pregnant women with pre-gestational and gestational diabetes (GDM), including overt and true GDM, taking into account HIV infection and the influence of exposure to oral hypoglycemic agents (OHAs). METHODS: A review of medical records of 1071 diabetic pregnancies (between 2012 and 2018) at a tertiary hospital in South Africa. RESULTS: Of the women, 43% had GDM, 19% had type 1 diabetes (T1DM), and 38% had type 2 diabetes (T2DM). Each group had a mean initial body mass index (BMI) >25 kg/m2 . Despite poor initial HbA1c for pre-gestational groups, over 90% of the cohort achieved glycemic control by the time of delivery. The rate of prematurity was 30.9%. Perinatal mortality (PNM) was 5.1% for the pre-gestational group and 1.8% for GDM. Of the cohort, 23.9% was HIV infected. PNM was higher in the HIV-infected pregnancies (9.4%) than non-HIV exposed pregnancies (1.8%, P<0.001). The macrosomia rate was higher in the glibenclamide-exposed group than the insulin-alone group (12.2% vs 0%, P=0.025). CONCLUSION: Obesity is a significant predictor for macrosomia and was high in all groups. In a low-/middle-income country setting with a high prevalence of HIV and high usage of OHAs as an alternative to insulin therapy, HIV might be associated with higher PNM and glibenclamide with increased rates of macrosomia, which warrants further exploration.


Assuntos
Diabetes Gestacional/epidemiologia , Infecções por HIV/epidemiologia , Gravidez em Diabéticas/epidemiologia , Adulto , Estudos de Coortes , Estudos Transversais , Feminino , Macrossomia Fetal/epidemiologia , Macrossomia Fetal/etiologia , Humanos , Recém-Nascido , Doenças do Recém-Nascido/epidemiologia , Doenças do Recém-Nascido/etiologia , Recém-Nascido Prematuro , Mortalidade Perinatal , Gravidez , Estudos Retrospectivos , África do Sul/epidemiologia , Adulto Jovem
10.
Diabetes Res Clin Pract ; 155: 107811, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31401151

RESUMO

AIMS: To evaluate the effects of pre-gestational diabetes mellitus (PGDM) and gestational diabetes mellitus (GDM) on macrosomia and birth defects. METHODS: Existing birth registry data from the Perinatal Data System in Upstate New York was analysed. 650,914 women with a singleton term pregnancy (≥37 weeks) aged 18-55 years from 2004 to 2016 were included. RESULTS: The prevalence of macrosomia in infants born to women with PGDM and GDM were 26.0% and 16.4%, respectively, higher than that in the controls (11.2%). Compared with the controls (0.8%), the PGDM and GDM groups had higher prevalence of any birth defect (1.8% and 1.0%). The PGDM group had the highest prevalence of cyanotic heart disease (0.6%). Moreover, the PGDM group had higher prevalence of cleft lip and palate, cleft palate alone, hypospadias and limb reduction defect compared to the GDM and control groups (p < 0.05). However, these birth defects in the GDM group were similar to those in the controls. Both the PGDM and GDM groups had significantly elevated odds of macrosomia, cyanotic heart disease and any birth defect than controls. The PGDM group had higher odds of cleft lip and palate, cleft palate alone, hypospadias and limb reduction defect. CONCLUSIONS: Using the Perinatal Data System database, PGDM and GDM, especially PGDM, was associated with higher prevalence of macrosomia, cyanotic heart disease and any birth defect in singleton term pregnancy in Upstate New York. PGDM, not GDM had higher prevalence of cleft lip and palate, cleft palate alone, hypospadias and limb reduction defect.


Assuntos
Diabetes Gestacional/epidemiologia , Macrossomia Fetal/complicações , Complicações na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Adolescente , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , New York , Gravidez , Prevalência , Ganho de Peso , Adulto Jovem
11.
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
12.
J Med Life ; 12(2): 160-167, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31406518

RESUMO

The prevalence of gestational diabetes mellitus (GDM) is increasing in Iran. Collection of patients' data is commonly conducted through using medical records. However, for providing a structured reporting based on the information needs, a minimum data set is a fast, inexpensive, and suitable method. For exchanging high-quality data between different healthcare centers and health monitoring organization, the data are required to be uniformly collected and registered. The present study aims at designing an MDS for creating the registry of GDM. The present study is an applied one, conducted in two stages, with a qualitative Delphi method in 2018. In the first stage of the study, it was attempted to extract the data elements of mothers with GDM, through reviewing the related studies and collecting these patients' data from the medical records. Then, based on the results of the first stage, a questionnaire including demographic, clinical, and pharmaceutical data was distributed among 20 individuals including gynecologists, pharmacists, nurses, and midwives. The validity of the questionnaire was examined by a team of experts and its reliability was examined by using Cronbach's alpha. Data analysis was conducted using descriptive statistics (frequency, percentage, and mean) and excel. An MDS of gestational diabetes mellitus was developed. This MDS divided into three categories: administrative, clinical, and pharmaceutical with 4, 18, and 2 sections and 35, 199, and 12 data elements, respectively. Determining the minimum data sets of GDM will be an effective step toward integrating and improving data management of patients with GDM. Moreover, it will be possible to store and retrieve the data related to these patients.


Assuntos
Análise de Dados , Diabetes Gestacional/epidemiologia , Sistema de Registros , Adulto , Técnica Delfos , Feminino , Humanos , Irã (Geográfico)/epidemiologia , Pessoa de Meia-Idade , Gravidez , Reprodutibilidade dos Testes , Inquéritos e Questionários , Adulto Jovem
13.
BMC Pregnancy Childbirth ; 19(1): 272, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31370816

RESUMO

BACKGROUND: Gestational diabetes mellitus (GDM) is a common cause of maternal morbidity, and can lead to the development of diabetes later in life. Pre-pregnancy body weight is associated with the change in body mass index (BMI) between a first and second pregnancy. Compared with long-term change in BMI between pregnancies, the most accessible follow-up point to investigate BMI change is 6 weeks after the initial pregnancy. The present study aimed to assess the association between weight retention at 6 weeks postpartum and the risk of GDM in a subsequent pregnancy. METHODS: We recruited 6429 singleton pregnancies into this retrospective cohort study. For each pregnancy, we calculated weight retention at 6 weeks postpartum after the first pregnancy, the interpregnancy BMI change between pregnancies, and the gestational weight gain in the second pregnancy. Risk was represented by the odds ratio (OR) and 95% confidence intervals (CIs). We then determined the relationship between postpartum weight retention at 6 weeks after the initial pregnancy, and the interpregnancy change in BMI between pregnancies. Analyses were stratified by BMI during the first pregnancy. RESULTS: Compared to women with a stable BMI (- 1 to 1), interpregnancy BMI gains were associated with an increased risk of GDM in the second pregnancy. Risk increased significantly for women with a BMI below and above 25 during the first pregnancy, although the increase was greater in the women with a BMI < 25. The risk of GDM in the second pregnancy was higher in women with inadequate weight gain during the second gestation. The weight retention at 6 weeks postpartum, where there was a gain of > 3 BMI units was significantly more related to weight gain more than when there was 1 BMI unit gain between pregnancies (P < 0.05) and associated with an increased incidence of GDM in the second pregnancy (OR = 2.95, 95% CI: 1.95 ~ 4.45). Women who showed a change in BMI that was > 3 units at 6 weeks postpartum after the first pregnancy showed an increased risk for BMI subsequently (OR = 1.42, 95% CI: 1.08~1.87). CONCLUSIONS: Women who gained more than 3 BMI units at 6 weeks postpartum were associated with an increased risk of BMI in a subsequent pregnancy. Six weeks postpartum provides a new early window of opportunity to identify risk factors for a subsequent pregnancy and allows us to implement primary prevention strategies.


Assuntos
Diabetes Gestacional/epidemiologia , Ganho de Peso na Gestação , /epidemiologia , Adulto , Intervalo entre Nascimentos , Índice de Massa Corporal , Trajetória do Peso do Corpo , Estudos de Coortes , Feminino , Humanos , Razão de Chances , Gravidez , Estudos Retrospectivos , Fatores de Risco
14.
Sci Total Environ ; 695: 133855, 2019 Dec 10.
Artigo em Inglês | MEDLINE | ID: mdl-31421341

RESUMO

BACKGROUND: Personal care products (PCPs), known sources of endocrine disrupting chemicals (EDCs) such as phthalates and parabens, are widely used among women of reproductive age. EDCs have been linked to pregnancy complications such as gestational diabetes (GDM), and PCP use could represent a modifiable source of exposure in this sensitive time window. Yet, to our knowledge, no study has directly evaluated the association between pregnancy use of PCP and late pregnancy glucose levels, established risk factors for complications such as GDM. METHODS: A total of 233 women from the Environment and Reproductive Health (EARTH) Study had data available on 1st and/or 2nd trimester PCP use, assessed through self-reported use over the previous 24 h, and blood glucose levels after the glucose loading test (GLT), taken at late 2nd trimester. Associations between each individual PCP and total PCP with glucose levels were evaluated in multivariable adjusted linear regression models. RESULTS: Both positive and negative differences in glucose levels were observed when comparing users vs. non-users of several PCPs including 2nd trimester use of deodorant (adjusted mean difference: 12.2 mg/dL, 95% CI: -0.6, 24.9); bar soap (6.9 mg/dL, 95% CI: -0.9, 14.7 mg/dL); and liquid soap (-13.3, 95% CI: -26.8, 0.1 mg/dL), and 1st trimester use of sunscreen (-14.6 mg/dL, 95% CI: -27.8, -1.5 mg/dL). Total number of PCPs used in the 2nd trimester was also associated with higher glucose levels, with the largest difference of 20 mg/dL when comparing individuals who used eight vs none PCPs (95% CI: 3-37). CONCLUSIONS: In a pregnancy cohort of women seeking care at a fertility clinic, we found the use of several PCPs to be positively or negatively associated with glucose levels in the late second trimester, which may reflect increased risk of GDM and subsequent perinatal outcomes. These results strengthen the role of product use as a potentially modifiable source of EDCs that may impact glucose levels.


Assuntos
Glicemia , Cosméticos , Poluentes Ambientais , Exposição Materna/estatística & dados numéricos , Autorrelato , Sabões , Adulto , Estudos de Coortes , Diabetes Gestacional/epidemiologia , Feminino , Humanos , Parabenos , Ácidos Ftálicos , Gravidez , Complicações na Gravidez/epidemiologia , Primeiro Trimestre da Gravidez , Segundo Trimestre da Gravidez , Fatores de Risco
15.
Chemosphere ; 237: 124412, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31376695

RESUMO

BACKGROUND: The association between multiple metal concentrations and gestational diabetes mellitus (GDM) is poorly understood. METHODS: A total of 776 women with GDM and an equal number of controls were included in the study. Concentrations of metals in participants' blood (nickel (Ni), arsenic (As), cadmium (Cd), antimony (Sb), thallium (Tl), mercury (Hg), lead (Pb)) were measured using inductively coupled plasma-mass. We used unconditional logistical regression models to estimate the associations between metals and GDM. We also employed weighted quantile sum (WQS) regression and principal components analysis (PCA) to examine metal mixtures in relation to GDM. RESULTS: An increased risk of GDM was associated with As (OR = 1.49, 95% CI: 1.11, 2.01 for the 2nd tertile vs. the 1st tertile) and Hg (OR = 1.43, 95% CI: 1.09, 1.88 for the 3rd tertile vs. the 1st tertile). In WQS analysis, the WQS index was significantly associated with GDM (OR = 1.20, 95% CI: 1.02, 1.41). The major contributor to the metal mixture index was Hg (69.2%), followed by Pb (12.8%), and As (11.3%). Based on PCA, the second principal component, which was characterized by Hg, Ni, and Pb, was associated with an increased risk of GDM (OR = 1.46, 95% CI: 1.02, 2.08 for the highest quartile vs. the lowest quartile). CONCLUSIONS: Our study results suggest that high metal levels are associated with an increased risk of GDM, and this increased risk is mainly driven by Hg and, to a lesser extent, by Ni, Pb, and As.


Assuntos
Diabetes Gestacional/sangue , Diabetes Gestacional/epidemiologia , Metais/sangue , Adulto , Estudos de Casos e Controles , China/epidemiologia , Estudos de Coortes , Feminino , Humanos , Modelos Logísticos , Gravidez , Análise de Componente Principal , Fatores de Risco
16.
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
17.
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
18.
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
19.
Diabetes Metab Syndr ; 13(2): 1505-1509, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31336513

RESUMO

AIM: This study was conducted to illustrate the relation between vitamin D deficiency and glycemic parameters. MATERIALS AND METHODS: The study was carried out on 80 pregnant females who were attending obstetrics and gynecology out-patient clinic in el-Shatby hospital in Alexandria university, Egypt. They were divided into 2 groups: group 1 (n = 40) pregnant females diagnosed with gestational diabetes de novo at week 24-28 and group 2 (n = 40) pregnant females of the same age group who were not suffering from any glucose intolerance (control group). Each patient was subjected to detailed history taking, complete physical examination, One step 75 gm Oral glucose tolerance test, insulin, glycated hemoglobin(HbA1c),homeostatic model assessment of insulin resistance(HOMA-IR), 25 hydroxy-vitamin D, serum calcium, phosphorous and parathormone were assessed. RESULTS: A statistically significant higher fasting blood glucose (FBG), HbA1c%, fasting insulin and HOMA-IR was observed in patients with Gestational diabetes mellitus (GDM) versus control (p < 0.001). However, no significant difference was observed as regards Vitamin D levels in patients with GDM and control group. Among patients with GDM, vitamin D was found to correlate negatively with HbA1c (p < 0.001), insulin(p = 0.019) and HOMA-IR(p = 0.034). CONCLUSION: No definite causal relationship was observed between low vitamin D and subsequent occurrence of GDM.however, a significant correlation was found between the degree of vitamin D deficiency and the insulin resistance in patients with GDM.


Assuntos
Biomarcadores/análise , Glicemia/análise , Diabetes Gestacional/epidemiologia , Resistência à Insulina , Deficiência de Vitamina D/fisiopatologia , Adulto , Diabetes Gestacional/metabolismo , Diabetes Gestacional/patologia , Egito , Feminino , Seguimentos , Teste de Tolerância a Glucose , Hemoglobina A Glicada/análise , Humanos , Gravidez , Prognóstico , Estudos Prospectivos
20.
Diabetes Metab Syndr ; 13(2): 895-899, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31336542

RESUMO

AIM: Inflammatory mediators like interleukin-6 (IL-6) and acute phase protein like C-reactive protein (CRP) are supposed to contribute to development of GDM, however clinical data supporting this hypothesis is limited. This study was designed to analyze the association of IL-6 and CRP with development of GDM in Indian females. METHODS: This case control study included pregnant women diagnosed as GDM (n = 53) and those having normal glucose tolerance (n = 50). Serum levels of IL-6 and CRP were analysed and correlated with various clinical parameters. RESULTS: Serum IL-6 levels were significantly high (p < 0.05) in GDM females as compared to control females. IL-6 levels correlated with pre-pregnancy body mass index (BMI), fasting blood sugar (FBS) and postprandial sugar (PPBS). Unlike IL-6, CRP levels did not show significant differences between GDM and control females. However, positive correlation of CRP levels with BMI, FBS and PPBS was observed. CONCLUSION: High IL-6 levels in gestational diabetes may indicate a possible role for inflammation in pathophysiology of GDM.


Assuntos
Biomarcadores/sangue , Proteína C-Reativa/análise , Diabetes Gestacional/sangue , Diabetes Gestacional/epidemiologia , Interleucina-6/sangue , Adulto , Estudos de Casos e Controles , Feminino , Seguimentos , Humanos , Incidência , Índia/epidemiologia , Gravidez , Prognóstico
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