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1.
Int J Mol Sci ; 22(3)2021 Jan 26.
Artigo em Inglês | MEDLINE | ID: mdl-33530554

RESUMO

The aim of this review is to highlight the influence of the Mediterranean Diet (MedDiet) on Gestational Diabetes Mellitus (GDM) and Gestational Weight Gain (GWG) during the COVID-19 pandemic era and the specific role of interleukin (IL)-6 in diabesity. It is known that diabetes, high body mass index, high glycated hemoglobin and raised serum IL-6 levels are predictive of poor outcomes in coronavirus disease 2019 (COVID-19). The immunopathological mechanisms of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection include rising levels of several cytokines and in particular IL-6. The latter is associated with hyperglycemia and insulin resistance and could be useful for predicting the development of GDM. Rich in omega-3 polyunsaturated fatty acids, vitamins, and minerals, MedDiet improves the immune system and could modulate IL-6, C reactive protein and Nuclear Factor (NF)-κB. Moreover, polyphenols could modulate microbiota composition, inhibit the NF-κB pathway, lower IL-6, and upregulate antioxidant enzymes. Finally, adhering to the MedDiet prior to and during pregnancy could have a protective effect, reducing GWG and the risk of GDM, as well as improving the immune response to viral infections such as COVID-19.


Assuntos
/sangue , Diabetes Gestacional/prevenção & controle , Dieta Mediterrânea , Interleucina-6/sangue , Animais , Diabetes Gestacional/sangue , Diabetes Gestacional/epidemiologia , Feminino , Ganho de Peso na Gestação , Humanos , Estilo de Vida , Obesidade/sangue , Obesidade/epidemiologia , Obesidade/prevenção & controle , Gravidez
2.
Artigo em Inglês | MEDLINE | ID: mdl-33374764

RESUMO

Gestational diabetes mellitus (GDM) increases the risk of adverse pregnancy outcomes in any pregnancy and recurrence rates are high in future pregnancies. This study aims to investigate the effect of self-reported history of previous GDM on behaviors in a future pregnancy. This is an interim cross-sectional analysis of the pregnant women who participated in the Mutaba'ah Study between May 2017 and March 2020 in the United Arab Emirates. Participants completed a baseline self-administered questionnaire on sociodemographic and pregnancy-related information about the current pregnancy and previous pregnancies. Regression models assessed the relationships between self-reported history of GDM and pre-pregnancy and pregnancy behaviors in the current pregnancy. Out of 5738 pregnant parous women included in this analysis, nearly 30% (n = 1684) reported a history of GDM in a previous pregnancy. Women with a history of previous GDM were less likely to plan their current pregnancies (adjusted odds ratio (aOR): 0.84, 95% confidence interval (CI) 0.74-0.96) and more likely to be worried about childbirth (aOR: 1.18, 95% CI 1.03-1.36). They had shorter interpregnancy intervals between their previous child and current pregnancy (aOR: 0.88, 95% CI 0.82-0.94, per SD increase). There were no significant differences between women with and without a history of GDM in supplement use, sedentary behavior, or physical activity before and during this current pregnancy. Nearly a third of parous pregnant women in this population had a history of GDM in a previous pregnancy. Pregnant women with a previous history of GDM were similar to their counterparts with no history of GDM in the adopted pre-pregnancy and prenatal health behaviors. More intensive and long-term lifestyle counseling, possibly supported by e-health and social media materials, might be required to empower pregnant women with a history of GDM. This may assist in adopting and maintaining healthy prenatal behaviors early during the pregnancy or the preconception phase to minimize the risk of GDM recurrence and the consequential adverse maternal and infant health outcomes.


Assuntos
Diabetes Gestacional , Comportamentos Relacionados com a Saúde , Resultado da Gravidez , Adulto , Estudos Transversais , Diabetes Gestacional/epidemiologia , Diabetes Gestacional/prevenção & controle , Exercício Físico , Feminino , Humanos , Estilo de Vida , Paridade , Gravidez , Comportamento Sedentário , Emirados Árabes Unidos
3.
Artigo em Inglês | MEDLINE | ID: mdl-33353136

RESUMO

Gestational diabetes mellitus (GDM) has become an epidemic and has caused a tremendous healthy and economic burden in China, especially after the "two-child policy" put into effect on October 2015. The prevalence of GDM has continued to increase during the past few decades and is likely to see a further rise in the future. The public health impact of GDM is becoming more apparent in China and it might lead to the development of chronic non-communicable diseases in the long-term for both mothers and their children. Early identification of high-risk individuals could help to take preventive and intervention measures to reduce the risk of GDM and adverse perinatal outcomes. Therefore, a focus on prevention and intervention of GDM in China is of great importance. Lifestyle interventions, including dietary and physical exercise intervention, are effective and first-line preventive strategies for GDM prevention and intervention. The GDM One-day Care Clinic established in 2011, which educates GDM patients on the basic knowledge of GDM, dietary intervention, physical exercise, weight management, and blood glucose self-monitoring methods, sets a good model for group management of GDM and has been implemented throughout the hospitals as well as maternal and child health centers in China. The current review focus on the prevalence, risk factors, as well as prevention and lifestyle intervention of GDM in China for better understanding of the latest epidemiology of GDM in China and help to improve maternal and neonatal pregnancy outcomes and promote long-term health for women with GDM.


Assuntos
Diabetes Gestacional , Estilo de Vida , Criança , China/epidemiologia , Diabetes Gestacional/epidemiologia , Diabetes Gestacional/prevenção & controle , Exercício Físico , Feminino , Humanos , Gravidez , Prevalência
5.
Zhonghua Liu Xing Bing Xue Za Zhi ; 41(6): 829-833, 2020 Jun 10.
Artigo em Chinês | MEDLINE | ID: mdl-32564544

RESUMO

Objective: To prospectively explore the associations between total and different types of physical activities and gestational diabetes mellitus (GDM) in the first trimester of pregnant women, in Beijing. Methods: Data of 909 participants from the Chinese Pregnant Women Cohort study were extracted and studied. Four types of physical activities, including household/care-giving, occupational, sports/exercise and outdoor ways of transportation (walking/cycling/E-biking) in early pregnancy were studied by using the pregnancy physical activity questionnaire (PPAQ). All the participants were followed up and related data on GDM collected. Logistic regressions were conducted for data analysis on the associations of interests. Results: A total of 206 pregnant women (22.7%) were diagnosed with GDM. After adjusting for age, pre-pregnancy BMI, family history of diabetes and other types of physical activities, results from the logistic regression showed that women with moderate level of household/care-giving activities were with the lower odds on GDM (OR=0.654, 95%CI: 0.436-0.980). Women who had met the guideline of exercise were less likely to have GDM (OR=0.518, 95%CI: 0.287-0.934). There was no significant association appeared between total physical, occupational and outdoor ways of transportation (walking/cycling/E-biking) activities with GDM. Conclusions: Sports/exercise and household/care-giving activities in early pregnancy appeared important on GDM prevention. Pregnant women are encouraged to wisely arranging their sports/exercise activities and engaging in moderate household/care-giving activities in the first trimester of pregnancy, to prevent GDM.


Assuntos
Diabetes Gestacional/epidemiologia , Exercício Físico , Primeiro Trimestre da Gravidez , Pequim/epidemiologia , Estudos de Coortes , Diabetes Gestacional/prevenção & controle , Feminino , Humanos , Gravidez
6.
Cochrane Database Syst Rev ; 6: CD012394, 2020 06 11.
Artigo em Inglês | MEDLINE | ID: mdl-32526091

RESUMO

BACKGROUND: The prevalence of gestational diabetes mellitus (GDM) is increasing, with approximately 15% of pregnant women affected worldwide, varying by country, ethnicity and diagnostic thresholds. There are associated short- and long-term health risks for women and their babies. OBJECTIVES: We aimed to summarise the evidence from Cochrane systematic reviews on the effects of interventions for preventing GDM. METHODS: We searched the Cochrane Database of Systematic Reviews (6 August 2019) with key words 'gestational diabetes' OR 'GDM' to identify reviews pre-specifying GDM as an outcome. We included reviews of interventions in women who were pregnant or planning a pregnancy, irrespective of their GDM risk status. Two overview authors independently assessed eligibility, extracted data and assessed quality of evidence using ROBIS and GRADE tools. We assigned interventions to categories with graphic icons to classify the effectiveness of interventions as: clear evidence of benefit or harm (GRADE moderate- or high-quality evidence with a confidence interval (CI) that did not cross the line of no effect); clear evidence of no effect or equivalence (GRADE moderate- or high-quality evidence with a narrow CI crossing the line of no effect); possible benefit or harm (low-quality evidence with a CI that did not cross the line of no effect or GRADE moderate- or high-quality evidence with a wide CI); or unknown benefit or harm (GRADE low-quality evidence with a wide CI or very low-quality evidence). MAIN RESULTS: We included 11 Cochrane Reviews (71 trials, 23,154 women) with data on GDM. Nine additional reviews pre-specified GDM as an outcome, but did not identify GDM data in included trials. Ten of the 11 reviews were judged to be at low risk of bias and one review at unclear risk of bias. Interventions assessed included diet, exercise, a combination of diet and exercise, dietary supplements, pharmaceuticals, and management of other health problems in pregnancy. The quality of evidence ranged from high to very low. Diet Unknown benefit or harm: there was unknown benefit or harm of dietary advice versus standard care, on the risk of GDM: risk ratio (RR) 0.60, 95% CI 0.35 to 1.04; 5 trials; 1279 women; very low-quality evidence. There was unknown benefit or harm of a low glycaemic index diet versus a moderate-high glycaemic index diet on the risk of GDM: RR 0.91, 95% CI 0.63 to 1.31; 4 trials; 912 women; low-quality evidence. Exercise Unknown benefit or harm: there was unknown benefit or harm for exercise interventions versus standard antenatal care on the risk of GDM: RR 1.10, 95% CI 0.66 to 1.84; 3 trials; 826 women; low-quality evidence. Diet and exercise combined Possible benefit: combined diet and exercise interventions during pregnancy versus standard care possibly reduced the risk of GDM: RR 0.85, 95% CI 0.71 to 1.01; 19 trials; 6633 women; moderate-quality evidence. Dietary supplements Clear evidence of no effect: omega-3 fatty acid supplementation versus none in pregnancy had no effect on the risk of GDM: RR 1.02, 95% CI 0.83 to 1.26; 12 trials; 5235 women; high-quality evidence. Possible benefit: myo-inositol supplementation during pregnancy versus control possibly reduced the risk of GDM: RR 0.43, 95% CI 0.29 to 0.64; 3 trials; 502 women; low-quality evidence. Possible benefit: vitamin D supplementation versus placebo or control in pregnancy possibly reduced the risk of GDM: RR 0.51, 95% CI 0.27 to 0.97; 4 trials; 446 women; low-quality evidence. Unknown benefit or harm: there was unknown benefit or harm of probiotic with dietary intervention versus placebo with dietary intervention (RR 0.37, 95% CI 0.15 to 0.89; 1 trial; 114 women; very low-quality evidence), or probiotic with dietary intervention versus control (RR 0.38, 95% CI 0.16 to 0.92; 1 trial; 111 women; very low-quality evidence) on the risk of GDM. There was unknown benefit or harm of vitamin D + calcium supplementation versus placebo (RR 0.33, 95% CI 0.01 to 7.84; 1 trial; 54 women; very low-quality evidence) or vitamin D + calcium + other minerals versus calcium + other minerals (RR 0.42, 95% CI 0.10 to 1.73; 1 trial; 1298 women; very low-quality evidence) on the risk of GDM. Pharmaceutical Possible benefit: metformin versus placebo given to obese pregnant women possibly reduced the risk of GDM: RR 0.85, 95% CI 0.61 to 1.19; 3 trials; 892 women; moderate-quality evidence. Unknown benefit or harm:eight small trials with low- to very low-quality evidence showed unknown benefit or harm for heparin, aspirin, leukocyte immunisation or IgG given to women with a previous stillbirth on the risk of GDM. Management of other health issues Clear evidence of no effect: universal versus risk based screening of pregnant women for thyroid dysfunction had no effect on the risk of GDM: RR 0.93, 95% CI 0.70 to 1.25; 1 trial; 4516 women; moderate-quality evidence. Unknown benefit or harm: there was unknown benefit or harm of using fractional exhaled nitrogen oxide versus a clinical algorithm to adjust asthma therapy on the risk of GDM: RR 0.74, 95% CI 0.31 to 1.77; 1 trial; 210 women; low-quality evidence. There was unknown benefit or harm of pharmacist led multidisciplinary approach to management of maternal asthma versus standard care on the risk of GDM: RR 5.00, 95% CI 0.25 to 99.82; 1 trial; 58 women; low-quality evidence. AUTHORS' CONCLUSIONS: No interventions to prevent GDM in 11 systematic reviews were of clear benefit or harm. A combination of exercise and diet, supplementation with myo-inositol, supplementation with vitamin D and metformin were of possible benefit in reducing the risk of GDM, but further high-quality evidence is needed. Omega-3-fatty acid supplementation and universal screening for thyroid dysfunction did not alter the risk of GDM. There was insufficient high-quality evidence to establish the effect on the risk of GDM of diet or exercise alone, probiotics, vitamin D with calcium or other vitamins and minerals, interventions in pregnancy after a previous stillbirth, and different asthma management strategies in pregnancy. There is a lack of trials investigating the effect of interventions prior to or between pregnancies on risk of GDM.


Assuntos
Diabetes Gestacional/prevenção & controle , Revisões Sistemáticas como Assunto , Dieta para Diabéticos , Suplementos Nutricionais , Exercício Físico , Ácidos Graxos Ômega-3/administração & dosagem , Feminino , Humanos , Hipoglicemiantes/uso terapêutico , Inositol/uso terapêutico , Metformina/uso terapêutico , Gravidez , Probióticos/administração & dosagem , Complexo Vitamínico B/uso terapêutico , Vitamina D , Vitaminas/administração & dosagem
7.
PLoS One ; 15(5): e0232250, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32401778

RESUMO

AIMS: Type 2 diabetes mellitus (T2DM) and gestational diabetes (GDM) are globally on the rise, accompanied by comorbidities and associated health costs. Increased physical activity, healthy nutrition, and weight loss have shown the potential to prevent T2DM/GDM. Despite this, reaching vulnerable groups remains a key challenge. The aim of this scoping review was to identify barriers and facilitating factors in the prevention of T2DM/GDM in vulnerable groups. METHODS: We conducted a systematic literature search in May 2018, updated in September 2019, in several databases (e.g. PubMed, Embase) to identify barriers and facilitating factors in the prevention of T2DM/GDM in vulnerable groups. Two reviewers independently screened the results. Extracted data was charted, categorized, and summarized. RESULTS: We included 125 articles. Ninety-eight studies were extracted, and eight categories of barriers and facilitating factors were formed. The most common categories of barriers were limited knowledge, family/friends, and economic factors, and the most common categories of facilitating factors were family/friends, social support, and knowledge. CONCLUSION: This scoping review identified various barriers and facilitating factors in vulnerable groups. Preventive interventions should consider these barriers and facilitating factors in developing preventive interventions or in adapting existing ones.


Assuntos
Diabetes Mellitus Tipo 2/prevenção & controle , Diabetes Gestacional/prevenção & controle , Prevenção Primária/métodos , Diabetes Mellitus Tipo 2/economia , Diabetes Mellitus Tipo 2/psicologia , Diabetes Gestacional/economia , Diabetes Gestacional/psicologia , Feminino , Humanos , Gravidez , Prevenção Primária/economia , Prevenção Primária/estatística & dados numéricos
8.
Endocrinol. diabetes nutr. (Ed. impr.) ; 67(5): 342-350, mayo 2020. graf
Artigo em Inglês | IBECS | ID: ibc-191310

RESUMO

Gestational diabetes mellitus (GDM) increases the risk of adverse events in pregnancy and jeopardizes long-term health of the mother and offspring. There is currently no consensus as to what screening strategies improve the efficiency of GDM diagnosis. Which criteria should be used? Is the one-step or two-step procedure better? There is no agreement as to what the best dietary approach in the treatment of GDM is. In addition, different nutritional interventions have been studied in the prevention of GDM. The Mediterranean diet seems to be effective in preventing GDM and other maternofoetal outcomes. We review herein our experience using the one-step criteria for GDM screening; the treatment and prevention strategies used; and the overall impact of nutrition on maternofoetal health


La diabetes gestacional (DG) incrementa el riesgo de tener eventos adversos durante el embarazo, y también afecta a la salud materna y de la descendencia a largo plazo. En la actualidad no existe un consenso sobre qué estrategia de cribado es más eficaz para el diagnóstico de la DG. ¿Qué criterios se deberían utilizar? ¿Es mejor hacerlo en un solo paso o en 2? Tampoco existe un acuerdo universal sobre cuál es el mejor tratamiento nutricional ni qué intervención nutricional es la más adecuada para su prevención. La dieta mediterránea parece ser las más efectiva en la prevención no solo de la DG, sino que también de otros eventos adversos materno-fetales. En este artículo revisamos la experiencia de nuestro grupo en la aplicación de los criterios diagnósticos de un solo paso para la DG; las estrategias empleadas en el tratamiento y prevención de la DG, y del impacto global que tiene la alimentación sobre la salud materno-fetal


Assuntos
Humanos , Feminino , Gravidez , Adulto , Diabetes Gestacional/prevenção & controle , Diabetes Gestacional/terapia , Programas de Nutrição , Técnicas de Diagnóstico Endócrino/normas , Vigilância Nutricional , Dieta Mediterrânea , Estilo de Vida , Sobrepeso
9.
Diabetes Res Clin Pract ; 162: 108111, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32194215

RESUMO

AIM: To perform a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the effect of probiotics in pregnancy on the incidence of gestational diabetes (GDM) and fasting plasma glucose (FPG). METHODS: A MEDLINE, EMBASE, Scopus and Cochrane search (up to May 30th, 2019) was performed to identify RCTs of comparison of probiotics with placebo/active comparators in pregnant women. Principal endpoints were the incidence of GDM and the change of FPG. Other maternal and fetal outcomes were secondary endpoints. Mantel-Haenszel Odds Ratio with 95% CI (MH-OR) was calculated for dichotomous outcomes, whereas standardized differences in means was calculated for continuous variables. (PROSPERO registration CRD42019139889). FINDINGS: A total of 17 RCTs, all versus placebo, was identified. The overall quality of the trials was satisfactory. No effect of probiotics on incidence of GDM (MH-OR: 0.77[0.51,1.16], p = 0.21,I2:62%) was observed, with a small but significant reduction of FPG (mean difference -1.01 [-1.96, -0.06]mg/dl, p = 0.02, I2:46%). Among secondary endpoints, a significant reduction of maternal insulin (both in women with or without diabetes) was observed in the probiotics group. INTERPRETATION: Probiotics during pregnancy do not reduce the incidence of GDM, with a very little (statistically but not clinically significant) reduction of fasting plasma glucose.


Assuntos
Diabetes Gestacional/prevenção & controle , Glucose/metabolismo , Probióticos/uso terapêutico , Feminino , Humanos , Gravidez , Probióticos/farmacologia , Ensaios Clínicos Controlados Aleatórios como Assunto
10.
Curr Diab Rep ; 20(2): 6, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-32008111

RESUMO

PURPOSE OF REVIEW: Lifestyle interventions (such as diet and physical activity) successfully limit excessive gestational weight gain and can reduce some adverse maternal events; however, benefit is variable and cost-effectiveness remains unclear. We aimed to review published cost-effectiveness analyses of lifestyle interventions compared with usual care on clinically relevant outcome measures. Five international and six grey-literature databases were searched from 2007 to 2018. Articles were assessed for quality of reporting. Data were extracted from healthcare and societal perspectives. Costs were adapted to the common currencies of Australia and the United Kingdom by adjusting for resource utilization, healthcare purchase price and changes in costs over time. Included studies were economic analyses of lifestyle interventions aiming to limit weight-gain during pregnancy and/or reduce risk of gestational diabetes, for women with a BMI of 25 or greater in pre- or early-pregnancy. RECENT FINDINGS: Of the 538 articles identified, six were retained for review: one modelling study and five studies in which an economic analysis was performed alongside a randomized-controlled trial. Outcome measures included infant birth-weight, fasting glucose, insulin resistance, gestational weight-gain, infant respiratory distress syndrome, perceived health, cost per case of adverse outcome avoided and quality-adjusted life years (QALYs). Interventions were cost-effective in only one study. Although many studies have investigated the efficacy of lifestyle interventions in pregnancy, few have included cost-effectiveness analyses. Where cost-effectiveness studies were undertaken, results were inconsistent. Secondary meta-analysis, taxonomy and framework research is now required to determine the effective components of lifestyle interventions and to guide future cost-effectiveness analyses.


Assuntos
Diabetes Gestacional/terapia , Ganho de Peso na Gestação , Comportamentos Relacionados com a Saúde , Sobrepeso/terapia , Análise Custo-Benefício , Diabetes Gestacional/economia , Diabetes Gestacional/etiologia , Diabetes Gestacional/prevenção & controle , Dieta Saudável , Exercício Físico , Feminino , Humanos , Recém-Nascido , Estilo de Vida , Sobrepeso/complicações , Gravidez , Complicações na Gravidez/etiologia , Complicações na Gravidez/prevenção & controle , Complicações na Gravidez/terapia , Resultado da Gravidez , Qualidade de Vida , Medição de Risco , Fatores de Risco
11.
Diabetes Res Clin Pract ; 160: 107998, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31911249

RESUMO

Women with previous gestational diabetes mellitus (GDM) are at increased risk of developing diabetes after pregnancy (DAP), especially 5-10 years postpartum. Two well-known diabetes prevention trials demonstrated a significant reduction in DAP incidence using metformin and troglitazone; however, since their publication, several novel classes of anti-hyperglycemic agents have emerged. This review aimed to conduct a systematic literature search for new evidence in support of pharmacotherapy in DAP prevention and to analyze the results based on special considerations for women of reproductive potential. The only studies whose primary outcome was DAP incidence were those examining metformin, the thiazolidinediones troglitazone and pioglitazone, and the dipeptidyl peptidase-4 inhibitor vildagliptin. Metformin was effective in DAP reduction and was well tolerated, but participants were on average 12 years beyond their GDM pregnancy. Troglitazone was also shown to prevent DAP, but was withdrawn from the market due to hepatotoxicity. There was no comparator arm in the pioglitazone study, which limits its interpretability. The vildagliptin study was underpowered. There are ongoing trials with glucagon-like peptide 1 receptor agonists and sodium-glucose cotransporter 2 inhibitors, but none with diabetes incidence as a primary outcome. This review highlights the limited evidence base for pharmacological prevention of DAP.


Assuntos
Diabetes Gestacional/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Metformina/uso terapêutico , Adulto , Diabetes Gestacional/prevenção & controle , Feminino , Humanos , Hipoglicemiantes/farmacologia , Metformina/farmacologia , Gravidez , Estudos Prospectivos
12.
Curr Pharm Des ; 26(10): 1119-1125, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31969089

RESUMO

This review aims to focus the links existing between several aspects of the mother-child dyad in the intricate playground of obesity and Metabolic Syndrome (MetS), including its hepatic component, the Non- Alcoholic Fatty Liver Disease (NAFLD). In recent years human and animal model studies have shown that dietary interventions in mothers and offspring can be successful in reducing the risk of NAFLD development. Evidences also concern the new concept of a real intergenerational transmission of predisposition to metabolic disorders. Certain genes, such as SIRT1 and PNPLA3, and some epigenetic modifications, including micro RNAs function, seem to be responsible for fetal reprogramming in the setting of maternal obesity. These modifiers appear to be potential therapeutic targets to reduce the risk of future metabolic dysfunctions. Controlling antepartum hyperglycemia, preventing gestational diabetes, and avoiding excessive weight gain during pregnancy can help reduce the relentless epidemic of childhood obesity and NAFLD. Also, the composition of the intestinal microbiota seems to be related to the development of metabolic disorders in the offspring. Several studies show that breastfed infants have a microbial signature different from formula-fed infants. Much interestingly, prolonged breastfeeding is beneficial not only for the newborn and his health in adult life, but also for the mothers' health. Maternal benefits include reducing the risk of developing chronic diseases, such as diabetes mellitus, myocardial infarction and NAFLD as well. In conclusion, all above mechanisms appear to intervene synergistically and may act as modifiable risk factors for infant and mother NAFLD.


Assuntos
Saúde Materna , Hepatopatia Gordurosa não Alcoólica , Animais , Aleitamento Materno , Diabetes Gestacional/prevenção & controle , Feminino , Microbioma Gastrointestinal , Ganho de Peso na Gestação , Humanos , Hiperglicemia/prevenção & controle , Lactente , Recém-Nascido , Síndrome Metabólica/prevenção & controle , Mães , Hepatopatia Gordurosa não Alcoólica/prevenção & controle , Obesidade Pediátrica/prevenção & controle , Gravidez
13.
Br J Nutr ; 123(5): 516-528, 2020 03 14.
Artigo em Inglês | MEDLINE | ID: mdl-31771683

RESUMO

Glucose intolerance during pregnancy - a major driver of gestational diabetes mellitus (GDM) - has significant short- and long-term health consequences for both the mother and child. As GDM prevalence continues to escalate, there is growing need for preventative strategies. There is limited but suggestive evidence that myo-inositol (MI) and probiotics (PB) could improve glucose tolerance during pregnancy. The present study tested the hypothesis that MI and/or PB supplementation would reduce the risk of glucose intolerance during pregnancy. Female C57BL/6 mice were randomised to receive either no treatment, MI, PB (Lactobacillus rhamnosus and Bifidobacterium lactis) or both (MIPB) for 5 weeks. They were then provided with a high-fat diet for 1 week before mating commenced and throughout mating/gestation, while remaining on their respective treatments. An oral glucose tolerance test occurred at gestational day (GD) 16·5 and tissue collection at GD 18·5. Neither MI nor PB, separately or combined, improved glucose tolerance. However, MI and PB both independently increased adipose tissue expression of Ir, Irs1, Akt2 and Pck1, and PB also increased Pparγ. MI was associated with reduced gestational weight gain, whilst PB was associated with increased maternal fasting glucose, total cholesterol and pancreas weight. These results suggest that MI and PB may improve insulin intracellular signalling in adipose tissue but this did not translate to meaningful differences in glucose tolerance. The absence of fasting hyperglycaemia or insulin resistance suggests this is a very mild model of GDM, which may have affected our ability to assess the impact of these nutrients.


Assuntos
Suplementos Nutricionais , Intolerância à Glucose/terapia , Inositol/administração & dosagem , Complicações na Gravidez/terapia , Probióticos/uso terapêutico , Tecido Adiposo/metabolismo , Animais , Glicemia/metabolismo , Diabetes Gestacional/etiologia , Diabetes Gestacional/prevenção & controle , Dieta Hiperlipídica , Modelos Animais de Doenças , Feminino , Intolerância à Glucose/sangue , Teste de Tolerância a Glucose , Insulina/sangue , Resistência à Insulina , Camundongos , Camundongos Endogâmicos C57BL , Gravidez , Complicações na Gravidez/sangue
14.
Am J Clin Nutr ; 111(1): 122-130, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31625576

RESUMO

BACKGROUND: Previous studies have shown conflicting findings regarding the relation of vitamin D status and supplementation during pregnancy with gestational diabetes mellitus (GDM). Most of these studies hypothesized that 25-hydroxyvitamin D [25(OH)D] concentrations were associated with GDM risk and glucose metabolism based on linear association models. OBJECTIVES: We aimed to estimate the associations of 25(OH)D concentrations and vitamin D supplementation with GDM risk and glucose metabolism and determine the threshold concentrations of 25(OH)D that could significantly affect glucose metabolism and GDM risk. METHODS: In a prospective birth cohort study, we collected information about sociodemographic characteristics, health status, and lifestyle from 4984 pregnant women. Vitamin D supplementation and 25(OH)D concentrations were assessed in the second trimester. Data from the 75-g oral-glucose-tolerance test were obtained at 24-28 weeks of gestation. RESULTS: A total of 922 (18.5%) women were diagnosed with GDM. Compared with women with 25(OH)D concentrations <25 nmol/L, the GDM risk was significantly lower in women with 25(OH)D concentrations ranging from 50 to 75 nmol/L (RR: 0.74; 95% CI: 0.58, 0.95) and >75 nmol/L (RR: 0.40; 95% CI: 0.22, 0.70). The curve-fitting models suggested a significant large reduction in GDM risk, fasting plasma glucose, and area under the curve of glucose with increasing 25(OH)D concentrations only for concentrations >50 nmol/L. Consistently, GDM risk was significantly reduced only in women who took 400-600 IU vitamin D/d (RR: 0.83; 95% CI: 0.70, 0.97) with a mean 25(OH)D concentration of 50 nmol/L but not in women taking vitamin D sometimes with a mean 25(OH)D concentration of 40 nmol/L. CONCLUSIONS: GDM risk was significantly reduced only in pregnant women with 25(OH)D concentrations >50 nmol/L. Pregnant women taking 400-600 IU vitamin D/d with mean 25(OH)D concentrations of 50 nmol/L had a lower risk of GDM.


Assuntos
Diabetes Gestacional/prevenção & controle , Vitamina D/análogos & derivados , Adulto , Glicemia/metabolismo , China , Diabetes Gestacional/sangue , Diabetes Gestacional/metabolismo , Suplementos Nutricionais/análise , Feminino , Teste de Tolerância a Glucose , Humanos , Gravidez , Estudos Prospectivos , Fatores de Risco , Vitamina D/administração & dosagem , Vitamina D/sangue , Adulto Jovem
15.
Acta Obstet Gynecol Scand ; 99(3): 333-340, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31654523

RESUMO

INTRODUCTION: Gestational diabetes is on the rise and demographics are changing in many countries due to increased migration. Simultaneously, the treatment of gestational diabetes in our clinic has shifted towards metformin with substantially less insulin treatment. The aim was to study the impact of these changes on metabolic control and pregnancy outcome by comparing women diagnosed with gestational diabetes during 2012-2013 and 2016-2017. MATERIAL AND METHODS: Our universal Oral Glucose Tolerance Test screening program for gestational diabetes diagnosed 199 women with singleton pregnancies during 2012-2013 and 203 during 2016-2017. Treatment and achieved metabolic control in the two different time periods were compared. Pregnancy outcome data related to gestational diabetes were retrieved from case notes and compared between the different time periods. RESULTS: When comparing results from 2016-2017 with 2012-2013 there was no difference in maternal weight or weight gain. There was a higher frequency of heredity (52.6 vs 35.4%; P = 0.001) and non-Scandinavian ethnicity (46.5 vs 33.8%; P = 0.011).The frequency of smoking during pregnancy was significantly lower (2.6 vs 7.7%; P = 0.023) There was an improved metabolic control as measured by median glucose in 2016-2017 compared with 2012-2013 (5.8 vs 6.2 mmol/L; P < 0.001). Insulin was less frequently used in 2016-2017 than in 2012-2013 (32.5 vs 44.7%; P = 0.012). There was a significant increase in the use of metformin (14.8 vs 0%; P < 0.001). There were no differences regarding the frequency of large-for-gestational-age infants (8.2% vs 7.3%; P = 0.762) or macrosomia (16.3 vs 15.1%; P = 0.745), median birthweight (3510 vs 3521; P = 0.879), frequency of cesarean section (28.1 vs 27.8%; P = 0.951) or Apgar scores at 10 minutes (10 [3-10] vs 10 [7-10]; P = 0.290). CONCLUSIONS: In an increasing but changing population of gestational diabetes women in our region, with more hereditary and non-Scandinavian origins, but with fewer smokers, metabolic control has improved with maintained favorable pregnancy outcomes, with more frequent use of metformin and substantially less use of insulin treatment.


Assuntos
Diabetes Gestacional/epidemiologia , Cuidado Pré-Natal , Adulto , Demografia , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/mortalidade , Diabetes Gestacional/prevenção & controle , Feminino , Humanos , Hipoglicemiantes/administração & dosagem , Recém-Nascido , Estudos Longitudinais , Gravidez , Resultado da Gravidez , Suécia/epidemiologia
17.
Curr Diabetes Rev ; 16(6): 538-545, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31544699

RESUMO

BACKGROUND: Gestational Diabetes Mellitus (GDM) is a health problem that is increasing around the world. INTRODUCTION: Prevention of GDM, rather than treatment, could have several benefits in terms of both health and economic cost. Even a slight reduction in maternal glucose in non-diabetic women, particularly in women at high risk for GDM, may have significant benefits for pregnancy results and the future health of off-springs. Probiotics are a relatively new intervention, which are assessed by mothers' metabolism, and can reduce blood sugar levels, prevent gestational diabetes and reduce the maternal and fetal complications resulting from it. The aim of this study was to review the studies on the prevention of gestational diabetes and assess the potential beneficial effects of probiotics on gestational diabetes and their possible mechanism of action. METHODS: Articles compiled through clinical trials indexed in PubMed, Science Direct, Cochran, and Medlib between 2000 and 2017, with the keywords probiotics, prevention, and gestational diabetes mellitus were selected. RESULTS: Considering the potential of probiotics in the modulation of gut microbiota, naturalization increases intestinal permeability, regulation of pro-inflammatory mediators' secretion and thereby controlling local and systemic inflammation results in decreasing intestinal permeability, enhancing the immune system. It likely has the ability to prevent or control diabetes during pregnancy although confirmatory studies are still needed. CONCLUSION: Experimental and clinical evidence support the supposition that the modulation of the gut microbiota via probiotic microorganisms could be effective in the prevention of gestational diabetes mellitus.


Assuntos
Diabetes Gestacional/prevenção & controle , Efeitos Tardios da Exposição Pré-Natal/prevenção & controle , Probióticos/uso terapêutico , Diabetes Gestacional/etiologia , Diabetes Gestacional/microbiologia , Feminino , Microbioma Gastrointestinal/fisiologia , Trato Gastrointestinal/efeitos dos fármacos , Trato Gastrointestinal/microbiologia , Humanos , Inflamação/microbiologia , Inflamação/prevenção & controle , Gravidez , Probióticos/farmacologia
18.
Exp Clin Endocrinol Diabetes ; 128(3): 199-205, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29890554

RESUMO

OBJECTIVE: This study was to analyze the efficacy of metformin intervention in preventing gestational diabetes mellitus (GDM). METHODS: A systematic review and meta-analysis of clinical trials or observational studies of metformin intervention in preventing symptoms of GDM during pregnancy were performed. Medline, Embase, and Cochrane Library were searched through to now. The main evaluated primary outcomes were incident of GDM, miscarriage, preterm delivery, and neonatal mortality. The evaluated secondary outcomes were mean difference of gestational age at birth and birth weight between metformin group and control group. RESULTS: We included 6 studies including 3 randomized clinical trials (RCTs), 2 observational studies, and 1 non-RCT in our meta-analysis. A total of 643 patients were enrolled for a follow-up study with continued metformin therapy (n=341) or not (n=302) during pregnancy. Metformin therapy reduced the proportion of patients developing GDM (log Odds Ratio: -1.27; 95%CI: -2.24 to -0.30) but had no significant effect on reducing the proportion of abortion, preterm delivery, and neonatal death in pregnant women with polycystic ovary syndrome (PCOS). Also, it did not cause a significant difference in gestational age at birth and birth weight in metformin group versus control/placebo group. CONCLUSIONS: Metformin was associated with less frequent GDM development than control diets, suggesting that it is the appropriate intervention to be prescribed to prevent GDM in patients with PCOS.


Assuntos
Diabetes Gestacional/prevenção & controle , Hipoglicemiantes/farmacologia , Metformina/farmacologia , Avaliação de Resultados em Cuidados de Saúde , Síndrome do Ovário Policístico/tratamento farmacológico , Adulto , Feminino , Humanos , Gravidez
19.
J Matern Fetal Neonatal Med ; 33(5): 743-751, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30558466

RESUMO

Objective: To identify the effects of different dietary inositol stereoisomers on insulin resistance and the development of gestational diabetes mellitus (GDM) in women at high risk for this disorder.Design: A preliminary, prospective, randomized, placebo controlled clinical trial.Participants: Nonobese singleton pregnant women with an elevated fasting glucose in the first or early second trimester were studied throughout pregnancy.Intervention: Supplementation with myo-inositol, d-chiro-inositol, combined myo- and d-chiro-inositol or placebo.Main outcome measure: Development of GDM on a 75 grams oral glucose tolerance test at 24-28 weeks' gestation. Secondary outcome measures were increase in BMI, need for maternal insulin therapy, macrosomia, polyhydramnios, neonatal birthweight and hypoglycemia.Results: The group of women allocated to receive myo-inositol alone had a lower incidence of abnormal oral glucose tolerance test (OGTT). Nine women in the control group (C), one of the myo-inositol (MI), five in d-chiro-inositol (DCI), three in the myo-inositol/D-chiro-inositol group (MI/DCI) required insulin (p = .134). Basal, 1-hour, and 2 hours glycemic controls were significantly lower in exposed groups (p < .001, .011, and .037, respectively). The relative risk reduction related to primary outcome was 0.083, 0.559, and 0.621 for MI, DCI, and MI/DCI groups.Conclusions: This study compared the different inositol stereoisomers in pregnancy to prevent GDM. Noninferiority analysis demonstrated the largest benefit in the myo-inositol group. The relevance of our findings is mainly related to the possibility of an effective approach in GDM. Our study confirmed the efficacy of inositol supplementation in pregnant women at risk for GDM.


Assuntos
Diabetes Gestacional/prevenção & controle , Inositol/uso terapêutico , Complexo Vitamínico B/uso terapêutico , Adulto , Suplementos Nutricionais , Feminino , Humanos , Isomerismo , Gravidez , Resultado da Gravidez , Estudos Prospectivos
20.
J Formos Med Assoc ; 119(2): 577-586, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30952480

RESUMO

It is estimated that there were 1.73-2.20 million people with diabetes in Taiwan in 2014-2015. The executive summary briefly introduced recommendations from the Diabetes Association of Republic of China (DAROC) clinical practice guidelines for diabetes care- 2018. We described the diagnostic criteria for diabetes, pre-diabetes and gestational diabetes, and the screening methods for diabetes in asymptomatic subjects. Treatment goals for adults with diabetes, older adults with diabetes, children and adolescents with type 1 diabetes, women with gestational diabetes and inpatients were recommended. For people with type 2 diabetes, we suggested an algorithm including lifestyle modification, weight control, as well as the consideration and selection of anti-diabetic medications. Besides, we also recommended laboratory tests for metabolic monitoring, examinations for the screening of diabetic complications and the suggested testing intervals for these tests and examinations.


Assuntos
Diabetes Mellitus/diagnóstico , Diabetes Mellitus/terapia , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/prevenção & controle , Diagnóstico Diferencial , Feminino , Humanos , Programas de Rastreamento , Gravidez , Sociedades Médicas , Taiwan
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