Effect of dietary myo-inositol supplementation in pregnancy on the incidence of maternal gestational diabetes mellitus and fetal outcomes: a randomized controlled trial

Abstract

Objective: To test the hypothesis that dietary myo-inositol may improve insulin resistance and the development of gestational diabetes mellitus (GDM) in women at high risk of this disorder.

Design: A prospective, randomized, double-blind, placebo controlled clinical trial, pilot study.

Participants: Non-obese singleton pregnant women with an elevated fasting glucose in the first or early second trimester were studied throughout pregnancy.

Intervention: Supplementation with myo-inositol or placebo during pregnancy.

Main outcome measure: Development of GDM on a 75?g oral glucose tolerance test at 24–28 weeks’ gestation. Secondary outcome measures were increased in BMI, need for maternal insulin therapy, macrosomia, polyhydramnios, neonatal birthweight and hypoglycemia.

Results: Thirty-six women were allocated to receive myo-inositol and 39 placebo. The incidence of GDM in mid-pregnancy was significantly reduced (p?=?0.001) in women randomized to receive myo-inositol compared to placebo (relative risk 0.127). Women randomized to receive myo-inositol also required less insulin therapy, delivered at a later gestational age, had significantly smaller babies with fewer episodes of neonatal hypoglycemia.

Conclusions: Myo-inositol supplementation in pregnancy reduced the incidence of GDM in women at high risk of this disorder. The reduction in incidence of GDM in the treatment arm was accompanied by improved outcomes.     

Obstetric outcome of second trimester antenatal bleeding

Objective: To evaluate the clinical significance of vaginal bleeding in pregnant women between 14th and 22th gestational weeks.

Methods: This retrospective case–control study was conducted between September 2010 and December 2013. Two-hundred nineteen pregnant women with vaginal bleeding between 14th and 22th gestational weeks were compared with 325 pregnant women without vaginal bleeding for their maternal and early neonatal outcomes.

Results: Mean gestational age and birth weight of study group were significantly different from those of the control group respectively (37.9?±?2.8 versus 38.9?±?1.4 and 3071?±?710 versus 3349?±?446 for groups p?<?0.001). Vaginal bleeding between 14th and 22th gestational weeks had increased risk of having preterm birth (PB) and preterm premature rupture of membranes (PPROM) (OR: 10.8, 95% CI: [4.5–26.1]; OR: 12.0, 95% CI: [3.5–40.6], respectively). Gestational diabetes mellitus (GDM) and polyhydramnios ratio in the study group was significantly higher than the control respectively (4.1% versus 1.2%, p?=?0.031; 1.9% versus 0%, p?=?0.025).

Conclusion: Pregnant women with vaginal bleeding was a significantly risk factor for PB, PPROM, GDM, and polyhydramnios. Consequently, these pregnancies should be closely followed up for maternal and fetus complications.     

Serum chemerin level during the first trimester of pregnancy and the risk of gestational diabetes mellitus

Objective: To investigate the association between chemerin level in the first trimester of pregnancy and the risk of gestational diabetes mellitus.

Methods: The blood samples of 212 women at 8–12?weeks of gestation were collected. After screening for gestational diabetes mellitus (GDM), 19 women with GDM and 20 women randomly selected from 144 women with normal glucose tolerance (NGT) were included in the study. Blood samples were collected from these women. Triglycerides, glucose, total cholesterol, and HDL cholesterol, LDL cholesterol, insulin and chemerin were measured. Gestational weight gain and body mass index was assessed.

Results: Serum levels of chemerin were significantly elevated during late gestation, and the risk of GDM was positively associated with maternal serum chemerin in the first trimester.

Conclusion: Serum chemerin level during the first trimester of pregnancy has the potential to predict risk of GDM.     

Does the presence of polycystic ovary syndrome increase the risk of obstetrical complications in women with gestational diabetes?

Objective.?To determine whether women with both polycystic ovary syndrome (PCOS) and gestational diabetes mellitus (GDM) have an increased risk of obstetric complications compared with women with GDM alone.

Methods.?A retrospective cohort study of maternal/fetal outcomes in women with GDM and PCOS was compared with women with GDM alone. Outcomes were compared using Fisher's exact test for categorical variables and t-test for continuous variables. Logistic regression models allowed for the calculation of odds ratios and 95% confidence intervals (CIs) for each outcome, adjusted for confounding.

Results.?One hundred seventy one women were included in the study. Significantly more women with both GDM and PCOS had pregnancy-induced hypertension/preeclampsia (15.9% vs. 3.9%, p?=?0.019, OR?=?4.62, 95% CI?=?1.38–15.41). Multiple logistic regression revealed that this increase persisted after controlling for body mass index (p?=?0.028, OR?=?4.43, 95% CI?=?1.17–16.72) and parity (p?=?0.050, OR?=?3.45, 95% CI?=?1.00–11.92). Women with GDM and PCOS tended to have more preterm deliveries (25.0% vs. 11.8%, p?=?0.063). More infants of women with GDM and PCOS required phototherapy treatment for hyperbilirubinemia (25.0% vs. 7.9%, p?=?0.0066, OR?=?3.90, 95% CI?=?1.52–9.98). Logistic regression revealed that this association persisted after controlling for preterm delivery (OR?=?3.18, 95% CI?=?1.14–8.82, p?=?0.026).

Conclusions.?Mothers with both disorders should be monitored more carefully and counseled regarding their increased risk of both maternal and fetal complications.     

Pregnancy outcome and placental pathology differences in term gestational diabetes with and without hypertensive disorders

Objective: To compare pregnancy outcome and placental pathology in pregnancies complicated by gestational diabetes mellitus (GDM A1 and A2), with and without hypertensive disorders.

Methods: Pregnancy outcome and placental pathology from term deliveries of women complicated with GDM with (GDM?+?H) and without (GDM???H) hypertensive disorders were compared. Results of the GDM?+?H group were compared also with the non-diabetic patients but with hypertensive disorders (non-GDM?+?H). Composite neonatal outcome was defined as one or more of early complications: respiratory distress or need of ventilation support, sepsis, phototherapy, transfusion, seizure, hypoxic-ischemic encephalopathy. Placental lesions were categorized to lesions related to maternal and fetal vascular supply abnormalities, and maternal and fetal inflammatory responses.

Results: Of the 192 women with GDM, the GDM?+?H group (n?=?41) were more obese, p?<?0.001, with higher rate of placental maternal and fetal vascular supply lesions, p?=?0.008, p?=?0.03, respectively, but similar neonatal outcome, compared to the GDM???H (n?=?151) group. Compared to the non-GDM?+?H group (n?=?41), the GDM?+?H group had higher birth weights, similar neonatal outcome and similar rate of placental vascular lesions.

Conclusions: Higher rate of placental maternal and fetal vascular supply lesions express underlying placental pathology in women with diabetes and hypertensive disorders, similar to women without DM and with hypertensive complications.     

Prediction of gestational diabetes mellitus by first trimester serum secreted frizzle-related protein-5 levels

Objective: The main aim of this study was to investigate the first trimester maternal serum secreted frizzle-related protein-5 (Sfrp-5) levels and to evaluate the predictive value on the subsequently developed gestational diabetes mellitus (GDM).

Methods: A total of 40 pregnant women who subsequently developed GDM and 44 age- and pre-pregnancy BMI-matched healthy pregnant women were enrolled in this prospective case-control study. First trimester serum Sfrp-5 levels were evaluated to determine if there is an association with the onset of GDM, by using logistic regression analysis.

Results: Decreased first trimester serum Sfrp-5 levels (OR?=?14.332, 95%CI: 4.166–49.301, p?<?0.001) were found to be significantly associated with the increased risk of GDM. There were no statistically significant differences in serum Sfrp-5 levels between the diet- and insulin-treated GDM groups and also serum Sfrp-5 levels were not found to be predictive for adverse perinatal outcomes (p?>?0.05).

Conclusions: Decreased first trimester serum Sfrp-5 levels are significantly associated with the increased risk of GDM.     

Risk factors and outcomes of macrosomia in China: a multicentric survey based on birth data

Objective: To investigate the risk factors and outcomes of macrosomia in China.

Methods: This was a multicenter, retrospective cohort study conducted in China. 178?709 singletons weighing ≥?2500?g with gestational ages of 37–44 weeks were included. We compared the macrosomia group (with birth weight (BW)?≥?4000?g) with the nornosomic control group (weighting 2500–3999?g).

Results: The total prevalence of macrosomia was 8.70%. The strongest risk factors correlated with macrosomia were maternal obesity and gestational diabetes mellitus (GDM). The risks of obstetric and neonatal complications increased when infants had a BW of ≥4000?g.

Conclusions: Obesity and GDM are the most prominent risk factors for macrosomia, and macrosomia is associated with adverse maternal and neonate outcomes. Therefore, monitoring and controlling maternal weight and blood glucose could decrease the prevalence of macrosomia or improve its poor outcomes.     

Pregnancy outcomes in women aged 35 years or older with gestational diabetes – a registry-based study in Finland

Objective: To compare pregnancy outcomes of women ≥35 years to women <35 years with and without gestational diabetes.

Methods: The data include 230?003 women <35 years and 53?321 women ≥35 years and their newborns from 2004 to 2008. In multivariate modeling, the main outcome measures were preterm delivery (<28, 28–31 and 32–36 weeks' gestation), Apgar scores <7 at 5?min, small for gestational age (SGA), fetal death, asphyxia, preeclampsia, admission to neonatal intensive care unit (NICU), shoulder dystocia and large for gestational age (LGA).

Results: In comparison to women <35 with normal glucose tolerance, preeclampsia (OR 1.57, CI 1.30–1.88), admission to the NICU (OR 3.30, CI 2.94–3.69) and shoulder dystocia (OR 2.12, CI 1.05–4.30) were highest in insulin-treated women ≥35 years. In women ≥35, diet- and insulin-treated gestational diabetes mellitus (GDM) increased the rates of preeclampsia, shoulder dystocia and admission to NICU (OR 3.07 CI 2.73–3.45). The effect of advanced maternal age was observed in very preterm delivery (<28 weeks), fetal death, preeclampsia and NICU. The increase in preeclampsia was statistically significant.

Conclusions: GDM at advanced age is a high risk state and, more specifically, the risk caused by age and GDM appear to be increasing in preeclampsia.     

Management of fetal death after 20 weeks of gestation complicated by placenta previa

Objective.?To determine the frequency and risk factors associated with neonatal chemical hypoglycemia in neonates of mothers with type 2 diabetes and gestational diabetes mellitus (GDM).

Research Design and Methods.?A retrospective cohort study of women with type 2 diabetes or GDM and their singleton neonates. The primary outcome measure was the presence of neonatal chemical hypoglycemia (capillary plasma equivalent glucose <45?mg/dl) within 1?h of birth. Statistical methods included bivariate and multivariate analyses.

Results.?242 mother infant dyads were identified. Sixty-eight (28%) were treated with diet, 110 (46%) with glyburide, and 64 (26%) with insulin. The incidence of neonatal chemical hypoglycemia was 18% (44/242). The incidence was significantly higher in those requiring pharmacotherapy (25% vs. 3%, p?p?=?0.58). The frequency of neonatal chemical hypoglycemia was statistically associated with birth weight, macrosomia and ponderal index (p?Conclusion.?Neonatal chemical hypoglycemia occurs more frequently in infants from women with type 2 diabetes and GDM treated with glyburide or insulin. An increased neonatal ponderal index is a strong predictor of significant neonatal chemical hypoglycemia.     

The effect of adopting the IADPSG screening guidelines on the risk profile and outcomes of the gestational diabetes population

Objective: To compare characteristics and outcomes of women diagnosed with gestational diabetes mellitus (GDM) by the newer one-step glucose tolerance test and those diagnosed with the traditional two-step method.

Research design and methods: This was a retrospective cohort study of women with GDM who delivered in 2010–2011. Data are reported as proportion or median (interquartile range) and were compared using a Chi-square, Fisher's exact or Wilcoxon rank sum test based on data type.

Results: Of 235 women with GDM, 55.7% were diagnosed using the two-step method and 44.3% with the one-step method. The groups had similar demographics and GDM risk factors. The two-step method group was diagnosed with GDM one week later [27.0 (24.0–29.0) weeks versus 26.0 (24.0–28.0 weeks); p?=?0.13]. The groups had similar median weight gain per week before diagnosis. After diagnosis, women in the one-step method group had significantly higher median weight gain per week [0.67 pounds/week (0.31–1.0) versus 0.56 pounds/week (0.15–0.89); p?=?0.047]. In the one-step method group more women had suspected macrosomia (11.7% versus 5.3%, p?=?0.07) and more neonates had a birth weight >4000?g (13.6% versus 7.5%, p?=?0.13); however, these differences were not statistically significant. Other pregnancy and neonatal complications were similar.

Conclusions: Women diagnosed with the one-step method gained more weight per week after GDM diagnosis and had a non-statistically significant increased risk for suspected macrosomia. Our data suggest the one-step method identifies women with at least equally high risk as the two-step method.     

Measuring the rate of fetal urine production using three-dimensional ultrasound during normal pregnancy and pregnancy-associated diabetes

Abstract

Objective: To establish a nomogram of fetal urine production according to gestational age as a predictor for fetal well-being in normal and diabetic women.

Study design: Prospective observational study included 180 pregnant women classified into two groups: Group I (120 women) without any medical complications and Group II (60 women) with gestational diabetes mellitus (GDM). The fetal bladder is measured by the virtual organ computer-aided analysis VOCAL 3D ultrasound scanner.

Results: There was a significant positive correlation between gestational age and fetal urine production rate (UPR) (the mean UPR rate in normal pregnancy at 25, 30, 35, 40 weeks were 12.3, 14.38, 56.13 and 90.73?ml/h, respectively). There was no significant difference regarding UPR ml/h between women with normal pregnancy and those with controlled GDM (p?=?0.9). There was a statistically significant difference regarding UPR ml/h between women with normal pregnancy and those with uncontrolled GDM (p?=?0.012) and a statistically significant difference between women with controlled GDM and those with uncontrolled GDM (p?=?0.03).

Conclusion: Fetal UPR is considered to be more reliable as an assessment method for fetal well-being and shows significant increase in patients with uncontrolled gestational DM.     

Association between inflammatory potential of diet and odds of gestational diabetes mellitus among Iranian women

Background: The possible relationship between diet-related inflammation and the risk of gestational diabetes mellitus (GDM) requires further investigation, especially in non-Western populations. We examined the association between dietary inflammatory index (DII) scores and GDM in a case-control study conducted in Iran.

Methods: This study included 122 GDM cases and 266 controls hospitalized for acute non-neoplastic diseases. Cases were pregnant women aged 18–40 years, who visited major general hospitals in different regions of Tehran. Pregnant women were screened for gestational diabetes between the 24th and 28th week of gestation with a 50-g, 1-hour glucose challenge test (GCT). Cases were diagnosed positive for GDM. Controls were pregnant women who had normal GCT test. DII scores were computed from dietary intake assessed by a previously validated 147-item food frequency questionnaire. Logistic regression models adjusted age, gestational age, energy, exercise, BMI, smoking exposure, family history of diabetes, and history of multivitamin intake were used to estimate odds ratios (ORs) and 95% confidence intervals (CI).

Results: Subjects with higher DII scores (i.e. indicating a more proinflammatory diet) had a higher odd of GDM with the DII being used as both a continuous (OR?=?1.20; 95% CI?=?0.94–1.54) and as categorical (OR_{tertile 3vs1}?=?2.10; 95% CI?=?1.02–4.34, p-trend?=?.03).

Conclusions: These results indicate that a proinflammatory diet, as evidenced by higher DII scores, is associated with increased odds of GDM among Iranian women.     

Does small for gestational age worsen outcomes in gestational diabetics?*

Objective: Our goal was to determine whether pregnancy outcomes are worse in gestational diabetics with small for gestational age (SGA) than those without.

Methods: This was a retrospective cohort study of 114 199 pregnancies with gestational diabetes mellitus (GDM) in California, 6446 of which were complicated by SGA. SGA was defined as birth weight Results: In the term 37?+?0 to 41?+?6 week GDM cohort the risk of RDS increased from 0.4% to 1.3%, the risk of neonatal demise from 0.02% to 0.09%, the risk of IUFD from 0.1% to 0.4%, the risk of hypoglycemia from 0.4% to 1.0% and the risk of jaundice from 18.0% to 23.3% (p?Conclusions: The presence of SGA in a patient with gestational diabetes is associated with significantly increased risks of adverse outcomes compared to gestational diabetics without SGA including increased risks of RDS, neonatal demise, IUFD, hypoglycemia and jaundice.     

Gestational diabetes mellitus and pregnancy outcomes among Chinese and South Asian women in Canada

Objective: To determine the association between Chinese or South Asian ethnicity and adverse neonatal and maternal outcomes for women with gestational diabetes compared to the general population. Methods: A cohort study was conducted using population-based health care databases in Ontario, Canada. All 35,577 women aged 15–49 with gestational diabetes who had live births between April 2002 and March 2011 were identified. Their delivery hospitalization records and the birth records of their neonates were examined to identify adverse neonatal outcomes and adverse maternal outcomes. Results: Compared to infants of mothers from the general population (55.5%), infants of Chinese mothers had a lower risk of an adverse outcome at delivery (42.9%, adjusted odds ratio 0.63, 95% confidence interval 0.58–0.68), whereas infants of South Asian mothers had a higher risk (58.9%, adjusted odds ratio 1.15, 95% confidence interval 1.07–1.23). Chinese women also had a lower risk of adverse maternal outcomes (32.4%, adjusted odds ratio 0.58, 95% confidence interval 0.54–0.63) compared to general population women (41.2%), whereas the risk for South Asian women was not different (39.4%, adjusted odds ratio 0.94, 95% confidence interval 0.88–1.02) from that of general population women. Conclusions: The risk of complications of gestational diabetes differs significantly between Chinese and South Asian patients and the general population in Ontario. Tailored interventions for gestational diabetes management may be required to improve pregnancy outcomes in high-risk ethnic groups.     

Comparison of placental three-dimensional power Doppler indices and volume in the first and the second trimesters of pregnancy complicated by gestational diabetes mellitus

Objective: To compare the changes of placental three-dimensional power Doppler indices and volume in the first and the second trimesters of pregnancy with gestational diabetes mellitus (GDM).

Methods: This was a prospective case-control study of singleton pregnancies with risk factors for GDM. Data on placental vascular indices including vascularization index (VI), flow index (FI), and vascularization flow index (VFI), as well as placental volume were obtained and analyzed during the first and the second trimesters between pregnant women with and without GDM.

Results: Of the 155 pregnant women enrolled, 31 developed GDM and 124 did not. VI and VFI were significantly lower in the GDM group during the first and second trimesters (VI: p?=?.023, and VFI: p?=?.014 in the first trimester; VI: p?=?.049, and VFI: p?=?.031 in the second trimester). However, the placental volume was similar in both the groups during the first trimester, while it was significantly increased in the GDM group during the second trimester (p?=?.022). There were no significant differences in FI and uterine artery pulsatility index between the two groups. After adjustments in multivariate logistic regression analysis, significant differences were observed in the first trimester VFI (adjusted odds ratio (OR) 0.76, 95% confidence interval (CI) 0.61–0.93), second trimester VFI (adjusted or 0.83, 95%CI 0.71–0.96), and second trimester placental volume (adjusted or 1.03, 95%CI 1.01–1.05).

Conclusions: Placental vascular indices can provide an insight into placental vascularization in GDM during early pregnancy. VFI rather than placental volume may be a sensitive sonographic marker in the first trimester of GDM placentas.     

Outcomes of vacuum-assisted vaginal deliveries of mothers with gestational diabetes mellitus

Objective: To evaluate the outcomes of vacuum-assisted vaginal deliveries (VAD) among neonates of mothers with gestational diabetes mellitus (GDM).

Study design: Retrospective cohort study of women with singleton gestation ≥37?+?0 weeks of gestation who underwent VAD at a single, tertiary, medical center (2007–2014). Women with GDM and their neonates were compared to women without diabetes and their neonates. Composite neonatal outcome was defined as ≥1 of the following: shoulder dystocia, 5-min Apgar score <7, asphyxia, seizure, subgaleal, subarachnoid or subdural hemorrhage, fracture of the clavicle, humerus or skull, or Erb’s palsy.

Results: Overall, 251 (5.2%) women with GDM were compared with 4534 (94.8%) women without GDM. Women with GDM were older, delivered earlier, with higher rates of mild preeclampsia and induction of labor. Their neonates had higher mean birth weight percentile, and higher rates of hypoglycemia, phototherapy, fracture of the humerus (3.2 versus 1.1%, aOR 2.95, 95%CI 1.38–6.30), and subarachnoid hemorrhage (1.2 versus 0.3%, aOR 4.56, 95%CI 1.28–16.26). No difference was found with regards to the composite neonatal outcome (9.2 versus 11.1%, p?=?.34).

Conclusions: GDM is associated with a higher risk for certain birth injuries in VAD at ≥37?+?0 weeks of gestation, yet the overall risk of adverse neonatal outcomes is comparable to women without GDM.     

Fear of childbirth and emergency caesarean section in low-risk nulliparous women: a prospective cohort study

Abstract

Objective: To assess the association between fear of childbirth (FOC) and emergency caesarean section.

Design: A prospective cohort study of low-risk nulliparous women at term.

Setting: Nine obstetric departments in Denmark, May 2004–July 2005.

Population: A total of 2598 nulliparous women in spontaneous labor with a single fetus in cephalic presentation at term.

Methods: Self-reported FOC was assessed at 37 weeks of gestation by the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) version A and at admission to the labor ward by the Delivery Fear Scale (DFS). Mode of delivery was recorded by the attending staff. Logistic regression analyses were used to estimate unadjusted and adjusted odds ratios (OR).

Main outcome measures: Risk of emergency caesarean section in women who feared childbirth.

Results: FOC (W-DEQ sum score ≥85 and DFS sum score ≥70) was not associated with emergency caesarean section: adjusted OR?=?0.81 (95% CI: 0.48–1.36) and OR?=?0.97 (95% CI: 0.55–1.71), respectively.

Conclusion: In this prospective observational study, women with FOC did not have an increased risk of emergency caesarean section compared to women with no such fear.     

Does pregnancy interval after laparoscopic sleeve gastrectomy affect maternal and perinatal outcomes?

Background: Obesity is a global health epidemic and is associated with many maternal and neonatal complications. Laparoscopic sleeve gastrectomy (LSG) is among the surgical treatments for obesity. The appropriate timing of pregnancy following LSG remains controversial and few studies have evaluated this public health issue.

Objective: To evaluate the effect of pregnancy timing after LSG on maternal and perinatal outcomes.

Study design: We performed a retrospective observational study of 23 pregnant women who underwent LSG at a tertiary hospital in Turkey. Women who became pregnant within 18 months of undergoing LSG were included in the early pregnancy after LSG group, and those who became pregnant after 18 months were included the late pregnancy after LSG group. Maternal and perinatal outcomes were evaluated, including gestational diabetes mellitus (GDM), pregnancy-associated hypertensive disorders, preterm birth, mode of delivery, small and large for gestational age births (small for gestational age (SGA), large for gestational age (LGA)), birth injury, and congenital malformations.

Results: Body mass index (BMI) at conception was higher in the early pregnancy after LSG group than in the late pregnancy after LSG group (30.48 versus 27.25, respectively; p?=?.03). Pregnancy interval after LSG did not impact maternal–fetal complications or mode of delivery. After a 75?g oral glucose tolerance test (OGTT) for GDM, 75% (n?=?6) of the early pregnancy group presented with early dumping syndrome, compared to only 13.3% (n?=?2) of the late pregnancy after LSG group (p?=?.009).

Conclusions: LSG may reduce obesity-related gestational complications, such as GDM and LGA. The interval between LSG and conception did not impact maternal or neonatal outcomes. Screening for GDM can result in dumping syndrome in pregnancies after LSG.     

Obstetric and perinatal outcome in women with twin pregnancy and gestational diabetes

Objective: The aim of this study was to evaluate pregnancy complications and obstetric and perinatal outcomes in women with twin pregnancy and GDM. Study Design: An observational multicentre retrospective study was performed and 534 pregnant woman and 1068 twins infants allocated into two groups, 257 with GDM and 277 controls, were studied. Main Outcome Measures: Pregnant women characteristics, hypertensive complications, preterm delivery rate, mode of delivery and birthweight were analysed. Results: Pregnant women with GDM were older (p?<?0.001) and had higher body mass index (p?<?0.001) than controls. GDM was associated with higher risk of prematurity in twin pregnancy (odds ratio 1.64, 95% confidence interval [1.14–2.32], p?=?0.005). This association was based on the association with other pregnancy complications. Birthweight Z-scores were significantly higher in the GDM group (p?=?0.02). The rate of macrosomia was higher in the GDM group (p?=?0.002) and small for gestational age (SGA) babies were significantly less frequent (p?=?0.03). GDM was an independent predictor of macrosomia (p?=?0.006). Conclusion: The presence of GDM in twin pregnancy was associated with a higher risk of hypertensive complications, prematurity and macrosomia, but significantly reduces the risk of SGA infants. Prematurity was related to the presence of other associated pregnancy complications.     

Lipoprotein-associated phospholipase A2 and AGEs are associated with cardiovascular risk factors in women with history of gestational diabetes mellitus

Objective: Although most women with gestational diabetes mellitus (GDM) return to normal glucose tolerance after delivery, they have increased risk of cardiometabolic diseases. This study aimed to evaluate the relationships between plasma levels of Lp-pla2 and AGEs and cardiometabolic risk factors in women with GDM.

Methods: 190 women with GDM (cases) and 80 healthy women (controls) were enrolled. Demographic and clinical data were collected and analyzed about 2 years after the delivery.

Results: Of the 190 cases, 19 (10%), 38 (20%) and 10 (5%) had type 2 diabetes mellitus, metabolic syndrome and hypertension after delivery, respectively. There were significant differences in variables between cases and controls: Lp-pla2 (pg/mL) 1991.5?±?905.3 versus 1527.0?±?799.8; AGEs (ng/mL) 403.0?±?208.6 versus 321.8?±?150.3. The plasma Lp-pla2 and AGEs levels were positively correlated with metabolic indexes in women with previous GDM.

Conclusion: Women with GDM have increased risk of cardiometabolic disease. AGEs and Lp-pla2 could be utilized as novel biomarkers to identify at an early stage of women with increased risk of metabolic and cardiovascular disease.