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1.
Rev Saude Publica ; 53: 100, 2019.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31800911

RESUMO

OBJECTIVE: To evaluate the clinical factors, as well as weight gain, in a group of pregnant women, associating them with fetal macrosomia in a public institution in Antioquia, Colombia, from 2010-2017. METHODS: A case-control study, using secondary information registries. Cases were defined using newborn weight of ≥ 4000g, while controls were defined as newborn weight between 3000-3999g. A proportion ratio (PR) was established to evaluate factors associated with macrosomia, and a generalized linear model (GLM) of Poisson regression with robust variance was used to evaluate the aspects that best explained macrosomia in the neonate. RESULTS: 122 pregnant women participated in the study, of which 611 were cases and 61 were controls. Of the participants, 44.3% had pre-pregnancy overweight and 48.4% had excess gestational weight gain. Statistically significant differences were found between the groups in the following variables: pre-pregnancy BMI (p = 0.004), gestational weight gain (p = 0.000), gestational diabetes (p = 0.000), and type of delivery (p = 0.004). According to the regression model, a macrosomic newborn is 3.5 times more likely in women with excessive gestational weight gain (95%CI 1.78-7.18) and twice more likely in women who have gestational diabetes (95%CI 1.51-2.76). Of women with pre-pregnancy excess weight, 63% had excess gestational weight gain. CONCLUSIONS: Within this cohort, pre-pregnancy BMI, excess weight gain in pregnancy, and the presence of gestational diabetes were associated with an increased risk of neonatal macrosomia. pre-pregnancy BMI and weight gain in pregnancy are modifiable risk factors that are responsive to nutrition interventions, which can minimize adverse perinatal outcomes.


Assuntos
Macrossomia Fetal/etiologia , Ganho de Peso na Gestação/fisiologia , /complicações , Adulto , Índice de Massa Corporal , Estudos de Casos e Controles , Colômbia , Estudos Transversais , Diabetes Gestacional/fisiopatologia , Feminino , Humanos , Recém-Nascido , Modelos Lineares , Masculino , Gravidez , Fatores de Risco , Fatores Socioeconômicos , Adulto Jovem
2.
BMJ ; 367: l6398, 2019 12 04.
Artigo em Inglês | MEDLINE | ID: mdl-31801789

RESUMO

OBJECTIVE: To evaluate the associations between maternal diabetes diagnosed before or during pregnancy and early onset cardiovascular disease (CVD) in offspring during their first four decades of life. DESIGN: Population based cohort study. SETTING: Danish national health registries. PARTICIPANTS: All 2 432 000 liveborn children without congenital heart disease in Denmark during 1977-2016. Follow-up began at birth and continued until first time diagnosis of CVD, death, emigration, or 31 December 2016, whichever came first. EXPOSURES FOR OBSERVATIONAL STUDIES: Pregestational diabetes, including type 1 diabetes (n=22 055) and type 2 diabetes (n=6537), and gestational diabetes (n=26 272). MAIN OUTCOME MEASURES: The primary outcome was early onset CVD (excluding congenital heart diseases) defined by hospital diagnosis. Associations between maternal diabetes and risks of early onset CVD in offspring were studied. Cox regression was used to assess whether a maternal history of CVD or maternal diabetic complications affected these associations. Adjustments were made for calendar year, sex, singleton status, maternal factors (parity, age, smoking, education, cohabitation, residence at childbirth, history of CVD before childbirth), and paternal history of CVD before childbirth. The cumulative incidence was averaged across all individuals, and factors were adjusted while treating deaths from causes other than CVD as competing events. RESULTS: During up to 40 years of follow-up, 1153 offspring of mothers with diabetes and 91 311 offspring of mothers who did not have diabetes were diagnosed with CVD. Offspring of mothers with diabetes had a 29% increased overall rate of early onset CVD (hazard ratio 1.29 (95% confidence interval 1.21 to 1.37); cumulative incidence among offspring unexposed to maternal diabetes at 40 years of age 13.07% (12.92% to 13.21%), difference in cumulative incidence between exposed and unexposed offspring 4.72% (2.37% to 7.06%)). The sibship design yielded results similar to those of the unpaired design based on the whole cohort. Both pregestational diabetes (1.34 (1.25 to 1.43)) and gestational diabetes (1.19 (1.07 to 1.32)) were associated with increased rates of CVD in offspring. We also observed varied increased rates of specific early onset CVDs, particularly heart failure (1.45 (0.89 to 2.35)), hypertensive disease (1.78 (1.50 to 2.11)), deep vein thrombosis (1.82 (1.38 to 2.41)), and pulmonary embolism (1.91 (1.31 to 2.80)). Increased rates of CVD were seen in different age groups from childhood to early adulthood until age 40 years. The increased rates were more pronounced among offspring of mothers with diabetic complications (1.60 (1.25 to 2.05)). A higher incidence of early onset CVD in offspring of mothers with diabetes and comorbid CVD (1.73 (1.36 to 2.20)) was associated with the added influence of comorbid CVD but not due to the interaction between diabetes and CVD on the multiplicative scale (P value for interaction 0.94). CONCLUSIONS: Children of mothers with diabetes, especially those mothers with a history of CVD or diabetic complications, have increased rates of early onset CVD from childhood to early adulthood. If maternal diabetes does have a causal association with increased CVD rate in offspring, the prevention, screening, and treatment of diabetes in women of childbearing age could help to reduce the risk of CVD in the next generation.


Assuntos
Doenças Cardiovasculares/epidemiologia , Diabetes Mellitus/fisiopatologia , Diabetes Gestacional/fisiopatologia , Exposição Materna/efeitos adversos , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Adulto , Doenças Cardiovasculares/etiologia , Dinamarca/epidemiologia , Feminino , Seguimentos , Humanos , Masculino , Gravidez , Efeitos Tardios da Exposição Pré-Natal/etiologia , Adulto Jovem
3.
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
4.
BMC Health Serv Res ; 19(1): 662, 2019 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-31514743

RESUMO

BACKGROUND: Pre-gestational and gestational diabetes mellitus are common complications in pregnancy affecting one in six pregnancies. The maternity services are under significant strain managing the increasing number of complex pregnancies. This has an impact on patients' experience of antenatal care. Therefore, there is a clear need to address pregnancy care. One possible solution is to use home-based digital technology to reduce clinic visits and improve clinical monitoring. METHODS: The aim of this study was to evaluate the antenatal services provided to pregnant women with diabetes who were monitored at the joint metabolic and obstetric clinic at the Southern Health and Social Care Trust in Northern Ireland. RESULTS: The questionnaires were completed by sixty-three women, most of whom had gestational diabetes mellitus. Most of the participants were between 25 and 35 years of age (69.8%), had one or more children (65.1%) and spent over 2 h attending the clinics (63.9%); 78% of women indicated that their travel time to and from the clinic appointment was over 15 min. Over 70% of women used smartphones for health-related purposes. However, only 8.8% used smartphones to manage their health or diabetes. Less than 25% of the women surveyed expressed concerns about using digital technology from home to monitor various aspects of their health in pregnancy. CONCLUSIONS: Overall, pregnant women who had or developed diabetes in pregnancy experience frequent hospital visits and long waiting times in the maternity clinics. Most of these pregnant women are willing to self-manage their condition from home and to be monitored remotely by the healthcare staff.


Assuntos
Diabetes Gestacional/terapia , Maternidades , Monitorização Fisiológica/métodos , Complicações na Gravidez/terapia , Autogestão , Telemedicina , Adulto , Diabetes Gestacional/fisiopatologia , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Irlanda do Norte , Gravidez , Complicações na Gravidez/fisiopatologia , Autogestão/estatística & dados numéricos
5.
Diabetes Metab Syndr ; 13(4): 2533-2539, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31405673

RESUMO

AIM: A large percentage of gestational diabetes (GDM) are undiagnosed, and prevalence of postpartum type 2 diabetes (T2DM) is unknown, especially in developing countries. This study assessed barriers to GDM diagnosis and postpartum follow-up; to determine educational needs. MATERIALS AND METHODS: This was a clinical observational study of records and procedures of antenatal services at two hospitals. Laboratory and medical records were reviewed for availability of data on anthropometrics, blood glucose, gestational age, urinalysis, and lipid profile for GDM register. Antenatal clinic protocol was observed for GDM diagnosis. BMI was derived and data were analyzed using SPSS version 20. RESULTS: Critical barriers attributable to health systems included lack of screening for blood sugar as part of routine antenatal protocol, and lack of GDM registers at both facilities. There was 6.5% registration of pregnancies in first trimester, 22% pre-pregnancy obesity, and 2.6% high blood pressure. Positive glucosuria cases were not followed-up for GDM diagnosis. CONCLUSIONS: There is neither concerted effort to diagnose GDM, nor systematic records of screening and postpartum follow-up. The gap in diabetology knowledge and practice calls for re-training of antenatal healthcare professionals. GDM screening checklist needs to be established and positive results entered into GDM registers for proper management during and after delivery.


Assuntos
Continuidade da Assistência ao Paciente/normas , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Gestacional/fisiopatologia , Pessoal de Saúde/educação , Período Pós-Parto , Guias de Prática Clínica como Assunto/normas , Adulto , Biomarcadores/análise , Feminino , Seguimentos , Humanos , Nigéria/epidemiologia , Gravidez , Prevalência , Prognóstico
6.
Pediatr Cardiol ; 40(7): 1460-1467, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31324952

RESUMO

This study was aimed at determining if the myocardial performance index (MPI) is altered in well-controlled gestational diabetics and if so whether it is predictive of adverse perinatal outcome. In a prospective cross-sectional study, 54 consecutive women with well-controlled gestational diabetes controlled on insulin or metformin in the third trimester were recruited and matched with 54 women with normal pregnancies (control group). Using Doppler echocardiography, the MPI was calculated. Sonographic biophysical and placental resistance Doppler markers in both groups were also determined. An abnormal outcome was defined as any of the following: stillbirth; neonatal death; neonatal intensive care admissions; tachypnea with pulmonary edema; neonatal cord pH < 7.15; 5-min Apgar score < 7, polycythemia; and nucleated red blood cells > 10/100 white blood cell counts, hypoglycemia. The MPI was significantly higher in the diabetic group compared to controls (p < 0.0001). Rate of adverse outcome was 22% in the diabetic group. The diabetic group with adverse outcomes had significantly elevated MPI values compared to the diabetic group with normal outcomes. There were 26 diabetics controlled on metformin and 28 controlled on insulin. The adverse outcome rate was slightly higher in the IDDM group compared to the non-insulin-dependent group but was not statistically significant. The main adverse outcomes were low Apgars (18%), hypoglycemia (22%), polycythemia (13%) and low pH in 7%. All control births had normal outcomes. MPI served as an independent predictor of adverse outcome. The MPI z-score had a good diagnostic accuracy as evidenced by the area under the ROC curve of 0.83. An MPI z-score exceeding 4.55 conferred a 90% sensitivity and 74% specificity, with 77% of outcomes correctly classified with a likelihood ratio of 3.5. The MPI is impaired in fetuses in well-controlled gestational diabetes, with fetuses with an adverse outcome having significantly higher MPI values compared to the fetuses with normal outcome in the diabetic group. MPI has the potential to improve fetal surveillance in gestational diabetes.


Assuntos
Diabetes Gestacional/fisiopatologia , Coração Fetal/fisiopatologia , Adulto , Estudos de Casos e Controles , Estudos Transversais , Ecocardiografia Doppler , Feminino , Coração Fetal/diagnóstico por imagem , Humanos , Recém-Nascido , Gravidez , Resultado da Gravidez , Terceiro Trimestre da Gravidez , Estudos Prospectivos , Ultrassonografia Pré-Natal
7.
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
8.
Diabetes Res Clin Pract ; 154: 82-89, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31271809

RESUMO

AIMS: Obesity increases risk of gestational diabetes mellitus (GDM) and GDM increases risk of macrosomia but their inter-relations for increased risk of macrosomia remain uncertain. We aimed to examine associations between prepregnancy overweight and macrosomia, and synergistic effects between prepregnancy overweight and GDM on macrosomia. METHODS: From 2010 to 2012, 19,622 women in urban Tianjin, China, underwent a 50-g 1-h glucose challenge test (GCT) at 24-28 gestational weeks and followed by a 75-g 2-h oral glucose tolerance test (OGTT) if the GCT value was ≥ 7.8 mmol/L. GDM was defined according to International Association of Diabetes and Pregnancy Study Group's criteria. Overweight was defined as body mass index ≥ 24.0 kg/m2. Logistic regression was performed to obtain odds ratios (ORs) and 95% confidence intervals (CIs). Additive interaction between prepregnancy overweight and GDM was used to test synergistic effects. RESULTS: In the cohort, 1791 (9.1%) and 1726 (8.8%) of the women delivered a macrosomic infant or a large-for-gestational-age (LGA) infant, respectively. Prepregnancy overweight was associated with increased risk of macrosomia and LGA with adjusted ORs being 2.29 (95%CI: 2.07-2.54) and 2.27 (2.05-2.52), respectively. Copresence of prepregnancy overweight and GDM greatly enhanced the adjusted ORs of overweight alone (ORs for macrosomia and LGA: 2.17, 1.94-2.42 & 2.21,1.98-2.47) and GDM alone (ORs for macrosomia and LGA: 2.01,1.48-2.72 & 2.14, 1.60-2.87) for macrosomia and LGA to 5.29 (4.07-6.87) for macrosomia and 4.72 (3.66-6.10) for LGA, with significant additive interactions. CONCLUSIONS: Prepregnancy overweight increased the risks of macrosomia and LGA independently and synergistically with GDM.


Assuntos
Peso ao Nascer , Diabetes Gestacional/fisiopatologia , Macrossomia Fetal/etiologia , Sobrepeso/complicações , Complicações na Gravidez/etiologia , Adulto , China/epidemiologia , Feminino , Macrossomia Fetal/diagnóstico , Macrossomia Fetal/epidemiologia , Idade Gestacional , Teste de Tolerância a Glucose , Humanos , Recém-Nascido , Gravidez , Complicações na Gravidez/diagnóstico , Estudos Prospectivos , Fatores de Risco
9.
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
10.
Fertil Steril ; 111(6): 1076-1091, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31155115

RESUMO

Fetal programming may influence childhood and adult life, determining the risk of specific diseases. During earlier stages of pregnancy, the transfer of maternal thyroid hormones to the fetus is vital for adequate neurologic development. The presence of severe maternal thyroid dysfunction, particularly severe iodine deficiency, is devastating, leading to irreversible neurologic sequelae. Moreover, mild maternal thyroid conditions, such as a mild-to-moderate iodine deficiency, may also lead to milder neurologic and behavioral conditions later during the life of the offspring. Maternal dysglycemia due to pregestational or gestational diabetes mellitus is another common situation in which fetal development encounters a hostile environment. Hyperglycemia in utero may trigger metabolic conditions in the offspring, including abnormalities of glucose tolerance and weight excess. Physicians assisting pregnant women have to be aware about these conditions, because they may go unnoticed if not properly screened. Because an early diagnosis and appropriate management may prevent most of the possible negative consequences for the progeny, the prevention, early diagnosis, and proper management of these endocrine conditions should be offered to all women undergoing pregnancy. Here, we comprehensively review the current evidence about the effects of maternal thyroid dysfunction and maternal dysglycemia on the cognitive function and carbohydrate metabolism in the offspring, two prevalent conditions of utmost importance for the child's health and development.


Assuntos
Saúde da Criança , Filho de Pais Incapacitados , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 2/complicações , Diabetes Gestacional , Sistema Endócrino/fisiopatologia , Efeitos Tardios da Exposição Pré-Natal , Doenças da Glândula Tireoide/complicações , Fatores Etários , Criança , Comportamento Infantil , Desenvolvimento Infantil , Pré-Escolar , Cognição , Diabetes Mellitus Tipo 1/diagnóstico , Diabetes Mellitus Tipo 1/fisiopatologia , Diabetes Mellitus Tipo 1/terapia , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/fisiopatologia , Diabetes Mellitus Tipo 2/terapia , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/fisiopatologia , Diabetes Gestacional/terapia , Suscetibilidade a Doenças , Metabolismo Energético , Feminino , Nível de Saúde , Humanos , Lactente , Recém-Nascido , Masculino , Saúde Materna , Sistema Nervoso/crescimento & desenvolvimento , Gravidez , Medição de Risco , Fatores de Risco , Doenças da Glândula Tireoide/diagnóstico , Doenças da Glândula Tireoide/fisiopatologia , Doenças da Glândula Tireoide/terapia
11.
Endocrinology ; 160(8): 1907-1925, 2019 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-31237608

RESUMO

Fetal exposure to gestational diabetes mellitus (GDM) and poor postnatal diet are strong risk factors for type 2 diabetes development later in life, but the mechanisms connecting GDM exposure to offspring metabolic health remains unclear. In this study, we aimed to determine how GDM interacts with the postnatal diet to affect islet function in the offspring as well as characterize the gene expression changes in the islets. GDM was induced in female rats using a high-fat, high-sucrose (HFS) diet, and litters from lean or GDM dams were weaned onto a low-fat (LF) or HFS diet. Compared with the lean control offspring, GDM exposure reduced glucose-stimulated insulin secretion in islets isolated from 15-week-old offspring, which was additively worsened when GDM exposure was combined with postnatal HFS diet consumption. In the HFS diet-fed offspring of lean dams, islet size and number increased, an adaptation that was not observed in the HFS diet-fed offspring of GDM dams. Islet gene expression in the offspring of GDM dams was altered in such categories as inflammation (e.g., Il1b, Ccl2), mitochondrial function/oxidative stress resistance (e.g., Atp5f1, Sod2), and ribosomal proteins (e.g., Rps6, Rps14). These results demonstrate that GDM exposure induced marked changes in gene expression in the male young adult rat offspring that cumulatively interact to worsen islet function, whole-body glucose homeostasis, and adaptations to HFS diets.


Assuntos
Diabetes Gestacional/fisiopatologia , Ilhotas Pancreáticas/fisiologia , Animais , Peso Corporal , Dieta Hiperlipídica , Feminino , Expressão Gênica , Glucose/metabolismo , Ilhotas Pancreáticas/patologia , Masculino , Gravidez , Ratos , Ratos Sprague-Dawley , Sacarose/administração & dosagem
12.
Int J Gynaecol Obstet ; 146(3): 326-332, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31242319

RESUMO

OBJECTIVE: To investigate whether glycated albumin, fructosamine, and hemoglobin A1c (HbA1c) are associated with neonatal complications in newborns of pregnant women with gestational diabetes mellitus (GDM). METHODS: Between November 2016 and September 2017, women with a singleton pregnancy and GDM were enrolled in a prospective study in an obstetric Portuguese referral center. Glycemic markers were compared between mothers of newborns with and without complications. Multivariable logistic regression models and corresponding areas under the receiver operating characteristic curve (AUC) were used. RESULTS: A total of 85 women participated in the study. Raised levels of glycated albumin and fructosamine were associated with at least one neonatal complication (OR- [odds ratio] estimate: 1.33, P=0.015; OR: 1.24, P=0.027, respectively) and with respiratory disorders at birth (OR 1.41, P=0.004; OR 1.26, P=0.014, respectively). HbA1c was not associated with these outcomes. All biomarkers were associated with large-for-gestational age (LGA) status (OR 1.61, P<0.001; OR 1.45, P<0.001; OR 3.62, P=0.032 for glycated albumin, fructosamine, and HbA1c, respectively). All had similar AUC for at least one neonatal complication (0.82; 0.81; 0.79, respectively). For newborn respiratory disorders, AUCs were 0.83, 0.81, and 0.76, respectively, and for LGA status were 0.81, 0.79, and 0.71, respectively. CONCLUSION: Raised values of glycated albumin and fructosamine were associated with particular perinatal complications in newborns of mothers with GDM, better discriminating mothers of newborns with and without complications than HbA1c.


Assuntos
Diabetes Gestacional/fisiopatologia , Frutosamina/metabolismo , Hemoglobina A Glicada/metabolismo , Doenças do Recém-Nascido/etiologia , Albumina Sérica/metabolismo , Adulto , Biomarcadores/metabolismo , Glicemia/metabolismo , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Macrossomia Fetal/etiologia , Humanos , Recém-Nascido , Modelos Logísticos , Gravidez , Estudos Prospectivos , Curva ROC
13.
Adv Exp Med Biol ; 1176: 81-88, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31069723

RESUMO

Hypercoagulability and altered lipid metabolism, which are observed in normal pregnancy, can be enhanced in diabetes mellitus. The aim of the study was to evaluate the influence of glycemic control on coagulation and lipid metabolism in women with pregestational (PGDM) and gestational (GDM) diabetes treated with insulin. There were 50 patients with PGDM and 101 patients with GDM enrolled into the study. Serum lipid and coagulation parameters were assessed at 18-22, 25-28, and 31-34 weeks of pregnancy and were compared within the diabetic groups with reference to the effectiveness of glycemia control. We found that poor glycemic control was associated with shortened activated partial thromboplastin time (APTT) and increased activity of antithrombin III (ATIII) in both diabetic groups and with a higher plasminogen activator inhibitor (PAI-1) content level in the GDM group. Poorly controlled PGDM was associated with higher levels of total cholesterol and high-density cholesterol (HDL) in the second trimester and triglycerides in the third trimester. In patients with poorly controlled GDM, a higher concentration of HDL was observed in third trimester, whereas a higher triglyceride level was found in both second and third trimesters. Positive correlations between total cholesterol and APTT and between triglyceride and APTT and ATIII were found in the poorly controlled PGDM group. We conclude that poor glycemic control of diabetic pregnancy impacts both lipid metabolism and the blood coagulation system.


Assuntos
Coagulação Sanguínea , Diabetes Gestacional , Metabolismo dos Lipídeos , Coagulação Sanguínea/fisiologia , Colesterol/sangue , Diabetes Gestacional/fisiopatologia , Feminino , Humanos , Metabolismo dos Lipídeos/fisiologia , Gravidez , Triglicerídeos/sangue
14.
Pharm Biol ; 57(1): 250-254, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30957612

RESUMO

CONTEXT: In vitro and in vivo research has shown that curcumin can alleviate diabetes and the relevant complications. OBJECTIVE: To investigate the effect of curcumin on gestational diabetes (GD). MATERIALS AND METHODS: C57 BL/KsJdb/+(db/+) mice and C57 BL/KsJ+/+ mice (10-12 weeks old) were divided into four groups (n = 15): normal pregnancy (C57 BL/KsJ+/+), GD (C57 BL/KsJdb/+), GD plus low dose curcumin (50 mg/kg, orally gavage every day) and GD plus high dose curcumin (100 mg/kg, orally gavage every day). The tolerance of glucose and insulin were measured on gestation day 10. Body weight at birth and litter size of offspring were investigated, and the expression of oxidative stress factors [thiobarbituric acid reactive substance (TBARS), glutathione (GSH), superoxide dismutase (SOD) and catalase (CAT)] and AMP-activated protein kinase (AMPK), phospho-AMPK, histone deacetylases 4 (HDAC4), pHDAC4 and glucose-6-phosphatase (G6Pase) in the livers were analyzed by ELISA and Western blot on gestation day 20. RESULTS: High dose curcumin could partly ameliorate the intolerance of glucose and insulin, and completely restore the litter size and the body weight of GD mice through decreased TBARS expression (p < 0.05) and increased GSH, SOD and CAT expression (p < 0.05). Enhanced AMPK activation, accompanied with decreased HDAC4 and G6Pase expression (p < 0.05) were partly contributed to the alleviation of GD mediated by curcumin. CONCLUSIONS: Although further detailed mechanism needs to be deciphered, curcumin can be considered as an alternative treatment for gestational diabetes.


Assuntos
Proteínas Quinases Ativadas por AMP/efeitos dos fármacos , Curcumina/farmacologia , Diabetes Mellitus Experimental/tratamento farmacológico , Diabetes Gestacional/tratamento farmacológico , Proteínas Quinases Ativadas por AMP/metabolismo , Animais , Western Blotting , Catalase/metabolismo , Curcumina/administração & dosagem , Diabetes Mellitus Experimental/fisiopatologia , Diabetes Gestacional/fisiopatologia , Relação Dose-Resposta a Droga , Ensaio de Imunoadsorção Enzimática , Feminino , Glucose/metabolismo , Glutationa/metabolismo , Insulina/metabolismo , Tamanho da Ninhada de Vivíparos/efeitos dos fármacos , Camundongos , Camundongos Endogâmicos C57BL , Estresse Oxidativo/efeitos dos fármacos , Gravidez , Superóxido Dismutase/metabolismo
15.
J Obstet Gynaecol ; 39(6): 768-773, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31007102

RESUMO

This study aims to investigate associations between glycated haemoglobin (HbA1c), glycated albumin (GA) and fructosamine with neonatal birthweight in gestational diabetes mellitus (GDM). The prospective cohort consisted of 82 women with GDM and their newborns, enrolled between November 2016 and September 2017. Considering neonatal birthweight and birthweights ≥90th percentile for gestational age as outcomes, linear and logistic regression models were used, respectively. Fructosamine (R2=0.62) and GA (R2=0.61) performed very similarly between them and best than HbA1c (R2=0.58). The added value of GA or fructosamine to HbA1c resulted in increase in models' performances. GA attained the best discriminative ability regarding large-for-date status babies (AUC = 0.80, OR-estimate 1.58, p=.001) followed by fructosamine (AUC = 0.78, OR-estimate 1.42, p=.001) and HbA1c (AUC = 0.69, OR-estimate 3.09, p=.070). GA and fructosamine, besides from providing additional information to HbA1c, when used separately perform better than the traditional biomarker in predicting neonatal birthweight and large-for-date babies in pregnant women with GDM. Impact statement What is already known on this subject? HbA1c is the standard glycaemic indicator used in GDM. Its association with birthweight and large-for-date status has been previously reported. However, it has become increasingly questionable whether it is a suitable glycaemic marker in pregnancy. There is a growing interest in other non-traditional shorter-term glycaemic indicators, such as GA and fructosamine. Nevertheless, few studies exist and almost all are retrospective and with ethnically homogeneous study populations composed by pregnant women not only with GDM but also type 1 and type 2 diabetes mellitus. What do the results of this study add? Our prospective multi-ethnic cohort composed solely on pregnant women with GDM and their infants show that even though all of the aforementioned biomarkers are associated with birthweight and large-for-date status in GDM when used separately, GA and fructosamine seem to perform better than HbA1c. When used with HbA1c, they improve the predicting performance of the traditional marker. What are the implications of these findings for future clinical practice and/or further research? These findings suggest that GA and fructosamine can provide important additional or substitute information to HbA1c in GDM, namely in predicting birthweight and large-for-date status babies. Larger studies are needed to confirm if this non-traditional biomarkers can change clinical practice.


Assuntos
Peso ao Nascer , Diabetes Gestacional/fisiopatologia , Frutosamina/sangue , Hemoglobina A Glicada/análise , Albumina Sérica/análise , Adulto , Estudos de Coortes , Diabetes Gestacional/sangue , Grupos Étnicos , Feminino , Humanos , Recém-Nascido , Pessoa de Meia-Idade , Portugal , Gravidez , Estudos Prospectivos
16.
Diabetes Care ; 42(5): 718-726, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31010942

RESUMO

Pregnancy has been equated to a "stress test" in which placental hormones and growth factors expose a mother's predisposition toward metabolic disease, unleashing her previously occult insulin resistance (IR), mild ß-cell dysfunction, and glucose and lipid surplus due to the formidable forces of pregnancy-induced IR. Although pregnancy-induced IR is intended to assure adequate nutrition to the fetus and placenta, in mothers with obesity, metabolic syndrome, or those who develop gestational diabetes mellitus, this overnutrition to the fetus carries a lifetime risk for increased metabolic disease. Norbert Freinkel, nearly 40 years ago, coined this excess intrauterine nutrient exposure and subsequent offspring developmental risk "fuel-mediated teratogenesis," not limited to only excess maternal glucose. Our attempts to better elucidate the causes and mechanisms behind this double-edged IR of pregnancy, to metabolically characterize the intrauterine environment that results in changes in newborn body composition and later childhood obesity risk, and to examine potential therapeutic approaches that might target maternal metabolism are the focus of this article. Rapidly advancing technologies in genomics, proteomics, and metabolomics offer us innovative approaches to interrogate these metabolic processes in the mother, her microbiome, the placenta, and her offspring that contribute to a phenotype at risk for future metabolic disease. If we are successful in our efforts, the researcher, endocrinologist, obstetrician, and health care provider fortunate enough to care for pregnant women have the unique opportunity to positively impact health outcomes not only in the short term but in the long run, not just in one life but in two-and possibly, for the next generation.


Assuntos
Diabetes Gestacional/metabolismo , Macrossomia Fetal/etiologia , Obesidade/metabolismo , Complicações na Gravidez/metabolismo , Distinções e Prêmios , Peso ao Nascer/fisiologia , Diabetes Gestacional/fisiopatologia , Feminino , Humanos , Lactente , Recém-Nascido , Resistência à Insulina/fisiologia , Síndrome Metabólica/complicações , Síndrome Metabólica/metabolismo , Obesidade/complicações , Gravidez
17.
Matern Child Health J ; 23(5): 603-612, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30949932

RESUMO

Objectives Complications of pregnancy such as gestational diabetes mellitus (GDM) forewarn future chronic illness and disability, and demonstrate the need for a life course approach to prevention. Our study had two aims: (1) to elucidate how experiences reported by patients and providers converge to facilitate or impede follow-up care after GDM, and (2) to elicit recommendations for system-level changes to enhance prevention across key care transitions. Methods We conducted in-depth interviews with 30 GDM patients and 29 providers of maternity, specialty and primary care in an urban safety hospital network, and used a three-tiered thematic analysis to interpret their narratives. Results Findings reveal that a 'perfect storm' gathers on the path to prevention across stages of care. At diagnosis, patients feel profound anxiety about the debilitating effects of type 2 diabetes mellitus in their communities, providers choose reassurance over risk communication, and both focus primarily on the birth of a healthy baby. Providers report that clinical teams often lack coordination, and confuse patients with a barrage of often-inconsistent advice. In the postpartum period, providers juggle competing clinical priorities and mothers juggle overwhelming demands; for both, the recommended 2-h oral glucose tolerance test is too arduous for women and providers to do as prescribed. Finally, the transition from maternity to primary care is complicated by communication barriers between clinicians and patients, and between maternity and primary care providers. Conclusions for Practice Respondents propose systems innovations to open communication between provider specialties in order to bridge the chasm between reproductive care and life course prevention.


Assuntos
Complicações do Diabetes/complicações , Diabetes Mellitus Tipo 2/prevenção & controle , Pessoal de Saúde/psicologia , Adulto , Boston , Complicações do Diabetes/fisiopatologia , Diabetes Mellitus Tipo 2/fisiopatologia , Diabetes Gestacional/fisiopatologia , Feminino , Teste de Tolerância a Glucose/métodos , Pessoal de Saúde/tendências , Humanos , Entrevistas como Assunto/métodos , Cuidado Pós-Natal/normas , Período Pós-Parto , Gravidez , Pesquisa Qualitativa
18.
Saudi Med J ; 40(4): 353-359, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30957128

RESUMO

OBJECTIVES: To investigate the cord blood levels of adipokine and to assess their association with the fetal insulin resistance and fetal outcomes in newborns of gestational diabetic women (GDM). Methods: This cross-sectional study was performed in 40 GDM women and 40 healthy pregnant women (HPW) in the Department of Obstetrics and Gynecology at Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) hospital in Puducherry, India, during the period from May 2016 to December 2017. Cord blood samples were collected at delivery from GDM and HPW groups. Cord plasma biochemical parameters such as insulin, C-peptide, adiponectin, leptin, resistin, and visfatin concentrations were measured. Leptin/adiponectin ratio (L/A), homeostasis model assessment of insulin resistance (HOMA2-IR), insulin sensitivity (HOMA2-%S) and beta cell function (HOMA2-%B) were calculated. The pregnancy outcomes such as birth weight (BW), Ponderal index and Apgar scores of the baby were measured. Results: The BW and Ponderal index of the baby were found to be significantly higher in GDM newborns compared to HPW newborns. Cord plasma insulin, C-peptide, HOMA2 -IR, visfatin, leptin, and L/A ratio were significantly higher whereas adiponectin level was lower in GDM compared to HPW. A significant positive correlation was observed between L/A ratio and fetal HOMA2-IR. Conclusion: Altered adipokine levels with increased L/A ratio was observed among the new-borns of Indian gestational diabetic mothers. There was an association between increased L/A ratio, insulin resistance and increased Ponderal index among the new-borns.


Assuntos
Adipocinas/sangue , Diabetes Gestacional/sangue , Diabetes Gestacional/fisiopatologia , Sangue Fetal/metabolismo , Resistência à Insulina , Resultado da Gravidez , Índice de Apgar , Biomarcadores/sangue , Peso ao Nascer , Peptídeo C/sangue , Estudos Transversais , Diabetes Gestacional/diagnóstico , Feminino , Humanos , Índia , Recém-Nascido , Insulina/sangue , Leptina/sangue , Nicotinamida Fosforribosiltransferase/sangue , Gravidez , Resistina/sangue
19.
Diabetologia ; 62(6): 915-925, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30840112

RESUMO

AIMS/HYPOTHESIS: Offspring of obese women are at increased risk of features of the metabolic syndrome, including obesity and diabetes. Lifestyle intervention in pregnancy might reduce adverse effects of maternal obesity on neonatal adiposity. METHODS: In the Vitamin D And Lifestyle Intervention for Gestational Diabetes Mellitus (GDM) Prevention (DALI) lifestyle trial, 436 women with a BMI ≥29 kg/m2 were randomly assigned to counselling on healthy eating (HE), physical activity (PA) or HE&PA, or to usual care (UC). In secondary analyses of the lifestyle trial, intervention effects on neonatal outcomes (head, abdominal, arm and leg circumferences and skinfold thicknesses, estimated fat mass, fat percentage, fat-free mass and cord blood leptin) were assessed using multilevel regression analyses. Mediation of intervention effects by lifestyle and gestational weight gain was assessed. RESULTS: Outcomes were available from 334 neonates. A reduction in sum of skinfolds (-1.8 mm; 95% CI -3.5, -0.2; p = 0.03), fat mass (-63 g; 95% CI -124, -2; p = 0.04), fat percentage (-1.2%; 95% CI -2.4%, -0.04%; p = 0.04) and leptin (-3.80 µg/l; 95% CI -7.15, -0.45; p = 0.03) was found in the HE&PA group, and reduced leptin in female neonates in the PA group (-5.79 µg/l; 95% CI -11.43, -0.14; p = 0.05) compared with UC. Reduced sedentary time, but not gestational weight gain, mediated intervention effects on leptin in both the HE&PA and PA groups. CONCLUSIONS/INTERPRETATION: The HE&PA intervention resulted in reduced adiposity in neonates. Reduced sedentary time seemed to drive the intervention effect on cord blood leptin. Implications for future adiposity and diabetes risk of the offspring need to be elucidated. TRIAL REGISTRATION: ISRCTN70595832.


Assuntos
Diabetes Gestacional/metabolismo , Obesidade/metabolismo , Comportamento Sedentário , Adiposidade/fisiologia , Animais , Animais Recém-Nascidos , Diabetes Gestacional/fisiopatologia , Exercício/fisiologia , Feminino , Humanos , Estilo de Vida , Obesidade/fisiopatologia , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto , Análise de Regressão
20.
Diabetes Res Clin Pract ; 150: 202-210, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30880095

RESUMO

AIM: To determine, in a multi-ethnic cohort, the association of first-trimester HbA1c levels with the development of pregnancy complications. METHODS: A prospective study between April 2013-October 2016. Participants were stratified in five ethnic groups. Women had an HbA1c measurement added to their first antenatal bloods. Primary outcome was macrosomia and secondary outcomes included preeclampsia and large-for-gestational age (LGA). A multivariate logistic regression analysis was performed to adjust for potential confounders in determining the association between different HbA1c cut-off points and obstetric outcomes on each ethnic group. RESULTS: 1,882 pregnancies were included. Analysis was limited to the three main ethnic groups: Caucasian (54.3%), South-Central Asian (19%) and Latin-American (12.2%). There was no association between HbA1c levels and obstetric outcomes among Caucasians. In Latin-Americans, an HbA1c ≥ 5.8% (40 mmol/mol) was associated with higher risk of macrosomia, whereas an HbA1c ≥ 5.9% (41 mmol/mol) was associated with LGA. In South-Central Asian, an HbA1c ≥ 5.7% (39 mmol/mol) was associated with increased risk of macrosomia and a continuous graded relationship between HbA1c levels and preeclampsia and LGA was detected starting at HbA1c levels of 5.4% (36 mmol/mol). CONCLUSION: First-trimester HbA1c levels perform as a suitable predictor of pregnancy complications in South-Central Asian and Latin-American women whereas in Caucasian no significant associations were found.


Assuntos
Diabetes Gestacional/fisiopatologia , Grupos Étnicos/estatística & dados numéricos , Macrossomia Fetal/epidemiologia , Hemoglobina A Glicada/análise , Doenças do Recém-Nascido/epidemiologia , Complicações na Gravidez/epidemiologia , Primeiro Trimestre da Gravidez , Adulto , Feminino , Macrossomia Fetal/sangue , Humanos , Incidência , Recém-Nascido , Doenças do Recém-Nascido/sangue , Gravidez , Complicações na Gravidez/sangue , Resultado da Gravidez , Estudos Prospectivos , Espanha/epidemiologia
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