Weight gain in early pregnancy and risk of gestational diabetes mellitus among Latinas

Aim

To evaluate the association between gestational weight gain (GWG) in early pregnancy and incidence of abnormal glucose tolerance (AGT) and gestational diabetes mellitus (GDM) among Latinas.

Plasma adiponectin concentrations in early pregnancy and subsequent risk of gestational diabetes mellitus

Low plasma adiponectin has been identified as a risk factor for type 2 diabetes. Our objective was to determine the extent to which low maternal plasma adiponectin is predictive of gestational diabetes mellitus (GDM), a condition that is biochemically and epidemiologically similar to type 2 diabetes. We used a prospective, nested case-control study design to compare maternal plasma adiponectin concentrations in 41 cases with 70 controls. Subjects were selected from a population of 968 women who provided blood samples in early pregnancy. Plasma adiponectin was determined using an ELISA. Adiponectin concentrations were statistically significantly lower in women with GDM than controls (4.4 vs. 8.1 micro g/ml, P < 0.001). Approximately 73% of women with GDM, compared with 33% of controls, had adiponectin concentrations less than 6.4 micro g/ml. After adjusting for confounding, women with adiponectin concentrations less than 6.4 micro g/ml experienced a 4.6-fold increased risk of GDM, as compared with those with higher concentrations (95% confidence interval, 1.8-11.6). Our findings are consistent with other reports suggesting an association between hypoadiponectemia and risk of type 2 diabetes. Our findings extend the literature to include GDM. Studies designed to examine the effect of dietary and pharmacological mediators of adiponectin concentrations in pregnant and nonpregnant subjects are warranted.     

孕早期糖化血红蛋白与妊娠糖尿病的关系

目的探讨孕早期HbA1C与妊娠糖尿病（GDM）的关系。方法对185位孕妇在孕早期检测HbA1C并分组,在孕中晚期行口服葡萄糖负荷试验进行GDM的诊断。对各组数据进行分析、比较。结果当HbA1c〈5．0％,5．0％～5．5％,5．5％～6．0％,6．00～6．5％,≥6．5％,各组相对应的GDM发病率分别为5％,9％,15％,44％,100％。各组与GDM的OR值及95％CI分别是0．51（0．30～0．91）、1．00、1．80（1．47～1．96）、4．12（3．68～4．93）、12．08（10．90～15．69）。当HbA1c≥6．0％,GDM的发病率明显升高。结论孕早期HbA1c与GDM有关,当HbA1c≥6．0％时,GDM发病率明显升高。     

Relationship of hypothyroxinemia to gestational diabetes mellitus during early pregnancy

正Objective To investigate the relationship of hypothyroxinemia to gestational diabetes mellitus during early pregnancy.Methods A total of 11 365 cases of women with early singleton pregnancies were collected from Chongqing Health Center for Women and Children.The screening of thyroid function was performed.The postload glucose concentrations and the risks of gestational     

Early pregnancy lipid concentrations and the risk of gestational diabetes mellitus

The objective of this study was to determine if early pregnancy maternal plasma lipid concentrations are elevated in women who later developed gestational diabetes mellitus (GDM) as compared with women who do not. Women, recruited prior to 16 weeks gestation, were followed until delivery. Maternal plasma lipid concentrations were measured in samples collected at 13 weeks gestation on average. Generalized linear models were used to estimate relative risks (RR) and 95% confidence intervals (95% CI). 5.5% of the cohort (47/851) developed GDM. Elevated triglyceride (TG) was positively associated with GDM risk (p for trend <0.001). After adjusting for maternal pre-pregnancy adiposity and other confounders, women with TG concentrations > or =137 mg/dl experienced a 3.5-fold increased risk of GDM (95% CI: 1.1-10.5) as compared with women who had concentrations <96 mg/dl. We noted a linear component of trend in risk of GDM with increasing plasma TG. Each 20mg/dl increase in TG was associated with a 10% increase in GDM risk (RR=1.1; 95% CI: 1.0-1.3). Associations between GDM risk and plasma concentrations of other lipids (i.e., total cholesterol, high-density lipoprotein, and low-density lipoprotein) were not evident. Larger prospective studies are needed to confirm our findings and to identify modifiable determinants of pregnancy-associated dyslipidemia.     

Association between sleep duration in early pregnancy and risk of gestational diabetes mellitus: a prospective cohort study

AimsAs cohort studies of the impact of sleep duration during early pregnancy on gestational diabetes mellitus (GDM) are lacking, our study aimed to explore the association between sleep duration in the first trimester and GDM in one region of mainland China.MethodsFor this prospective cohort study, sleep duration data were collected from 3692 pregnant women at the first prenatal care appointment before 14 weeks of gestation. Multivariable log-binomial regression models were used to analyze the association of sleep duration with GDM after adjusting for demographic characteristics, health status (such as family history of diabetes, history of GDM, prepregnancy body mass index, gestational weight gain) and lifestyle habits (such as physical activity, dietary intakes).ResultsOur cohort included 166 (4.5%) short sleepers and 505 (14%) long sleepers. Shorter sleep duration was more likely to be observed in women aged ≥35 years who were multiparous, and had previous pregnancy, insufficient gestational weight gain, engaged in more vigorous physical activity, drank alcohol, were vegan and/or never took folic-acid supplements. Compared with normal sleepers (29%), the prevalence of GDM was significantly higher in short sleepers (38%; P = 0.01), but not in long sleepers (31%; P = 0.224). In the multivariable model, women with short sleep durations during early pregnancy had a 32% greater risk of GDM [adjusted risk ratio (aRR): 1.32, 95% CI: 1.06–1.63], whereas long sleepers did not (aRR: 1.09, 95% CI: 0.94–1.26).ConclusionShort sleep duration during early pregnancy is associated with an increased risk of GDM. This suggests that more attention should be paid to controlling the development of GDM in pregnant women with insufficient sleep.     

Dietary pattern in pregnancy and risk of gestational diabetes mellitus (GDM)

Aim

Among the most common metabolic disorders during pregnancy is gestational diabetes mellitus (GDM). This research was conducted to examine the dietary pattern in women with GDM.

Retinal vasculature and 5-year metabolic syndrome among women with gestational diabetes mellitus

BackgroundWomen with gestational diabetes mellitus (GDM) are at greater risk of metabolic syndrome (MetS). We studied the association between second-trimester retinal microvasculature and 5-year MetS incidence in women with GDM.MethodsA total of 142 mothers with GDM were recruited and followed up 5 years after delivery. Retinal photography was performed at 26–28 weeks gestation and metabolic outcomes were assessed at the 5-year postpartum follow-up visit. GDM and MetS were defined based on World Health Organization (WHO) guidelines and Adults Treatment Panel (ATP) III guidelines, respectively. Modified-Poisson regression was applied to study the association between second-trimester retinal microvasculature and incident 5-year maternal MetS, after adjusting for major confounders. Area under the curve (AUC) was calculated based on the final model.ResultsOur prospective cohort reported a 9.2% incidence rate of 5-year MetS among women with GDM. After adjusting for maternal age, ethnicity, college degree, pre-pregnancy BMI and fasting glucose at 26–28 week gestation, each 10 μm widening in retinal venular caliber was associated with an increased relative risk of 1.6 (95% confidence interval [CI]: 1.0, 2.8) in incident MetS. In addition to traditional risks of pre-pregnancy BMI and fasting glucose level at 26–28 week gestation, retinal venular caliber mildly increased the prediction of 5-year maternal MetS by 1.8%.ConclusionsSecond-trimester retinal venular widening was associated with incident 5-year maternal MetS in women with GDM. Our study suggests that mother with GDM at risk of future MetS development may have already presented retinal microvascular abnormalities during pregnancy.     

多囊卵巢综合征与妊娠糖尿病

多囊卵巢综合征(PCOS)是女性最常见的内分泌紊乱疾病,而妊娠糖尿病(GDM)是妊娠期最常见的代谢紊乱性疾病,众多研究表明,PCOS患者妊娠后发生糖尿病的几率明显增高.胰岛素抵抗、肥胖以及血浆内脂素(visfatin)、视黄醇结合蛋白4浓度升高等是联系两者的可能机制.通过改变生活方式、减重及应用二甲双胍等,可以明显改善...     

The association between weight gain at different stages of pregnancy and risk of gestational diabetes mellitus

Aims/IntroductionWomen with excessive gestational weight gain (GWG) are at a higher risk for complications during pregnancy, such as preeclampsia. However, the association between excessive GWG and gestational diabetes mellitus (GDM) remains unclear.Materials and MethodsWe retrospectively reviewed 8,352 women from our obstetric database with singleton pregnancies who gave birth after 28 completed weeks of gestation between January 1, 2012, and December 31, 2016, excluding pregnancies complicated by fetal anomalies, fetal death, and overt diabetes. Diagnosis of GDM was based on the criteria recommended by the International Association of Diabetes and Pregnancy Study Groups. We used two classification methods to define excessive GWG: a weight gain above the 90th percentile of the population, or exceeding the upper range recommended by the Institute of Medicine, stratified by pre‐pregnancy body mass index. Statistical analysis was performed using multiple logistic regression to determine the association between excessive GWG and the risk of GDM.ResultsOverall, 1,129 women (13.5%) were diagnosed with GDM. There was no difference in GWG between women with and without GDM in the first trimester and before GDM screening. Women with GDM had significantly less GWG in the second trimester, after GDM screening, and throughout the whole gestation than women without GDM. No correlation was found between excessive GWG in the first and second trimesters, before GDM screening, and the later development of GDM.ConclusionsOur results indicate that excessive GWG prior to GDM screening is not associated with an increased risk of GDM.     

Serum uric acid in early pregnancy and risk of gestational diabetes mellitus: A cohort study of 85,609 pregnant women

AimsHigher serum uric acid (UA) has been associated with increased risk of Type 2 diabetes mellitus. This cohort study examined whether there are any associations between serum UA in early pregnancy and the subsequent risk of gestational diabetes mellitus (GDM).MethodsThis cohort study was conducted in Shanghai, China, and included 85,609 pregnant women. Generalised additive models were used to estimate the associations of serum UA with risk of GDM.ResultsThe prevalence of GDM was 14.0% (11,960/85,609). Non-linear associations between serum UA and GDM risk were observed and these associations varied by gestational ages. Only elevated serum UA levels at 13–18 weeks gestation was associated with substantially increased risk of GDM. Analysis by UA quintiles at 13–18 weeks gestation showed the odds ratios for GDM were 1.11 (95%CI, 1.03–1.20) for the second, 1.27 (95%CI, 1.17–1.37) for the third, 1.37 (95%CI, 1.27–1.48) for the fourth and 1.70 (95%CI, 1.58–1.84) for the fifth quintile of serum UA in comparison with the first quintile. Stratified analysis showed the associations of serum UA with GDM were stronger among pregnant women aged 35 years or older.ConclusionWe found higher serum UA at 13–18 gestational weeks was a risk factor for GDM. Our findings provide new evidence for the role of serum UA in the prevention and early intervention of GDM, and highlighted the need for monitoring serum UA at 13–18 gestational weeks.     

Serum resistin in gestational diabetes mellitus and early postpartum

OBJECTIVES: To observe the alterations in serum resistin in gestational diabetes (GDM) and the early postpartum period, and compare this to nondiabetic pregnancies in order to evaluate the role of serum resistin in gestational diabetes mellitus. DESIGN: A cross-sectional study. PATIENTS: Twenty women with normal pregnancy and 20 with gestational diabetes. MEASUREMENTS: Serum resistin concentration was assayed by ELISA. RESULTS: Serum resistin concentration was significantly higher in women with GDM than in controls before delivery. Serum levels of resistin significantly decreased after delivery in both the GDM group and controls (P < 0.001 for both). There was a trend of higher serum resistin in women with GDM than in controls. Differences existed on days 1 (P < 0.001) and 3 (P = 0.013), but not by day 5 (P = 0.052) after delivery. CONCLUSIONS: Elevated serum resistin level was observed in women with gestational diabetes, suggesting that it is important in the pathology of the disease.     

Metabolic syndrome at follow-up in women with and without gestational diabetes mellitus in index pregnancy

We prospectively studied 262 women with prior gestational diabetes mellitus (GDM) and 66 control women to compare their prevalence of metabolic syndrome and its relationship with insulin secretion and sensitivity. A 75-g oral glucose tolerance test was scheduled 5 years after delivery along with lipid profile, anthropometrics, and blood pressure measurement. Metabolic syndrome was defined according to the National Cholesterol Education Program 2001, and insulin sensitivity and secretion were estimated with the homeostasis model assessment. Women with prior GDM had similar insulin sensitivity and lower insulin secretion than control women. In comparison with control women, women with prior GDM had higher blood pressure, waist circumference, very low-density lipoprotein cholesterol, and oral glucose tolerance test blood glucose values but, with the exception of fasting hyperglycemia, did not have an increased prevalence of metabolic syndrome or its components. The multivariate prediction of metabolic syndrome and its components was similar with age and current homeostasis model assessment-insulin secretion and resistance indexes or with age, obesity, and GDM. The main predictor was current insulin resistance in the first case and obesity in the second, obesity being the best predictor overall. We conclude that in our population and at midterm follow-up, women with prior GDM have a decreased insulin secretion and display a higher prevalence of fasting hyperglycemia but not the full-blown picture of metabolic syndrome. Obesity, a surrogate index of insulin resistance, is the best predictor of metabolic syndrome at follow-up.     

Racial and ethnic disparities in diabetes risk after gestational diabetes mellitus

Aims/hypothesis  

To investigate racial/ethnic disparities in diabetes risk after gestational diabetes mellitus (GDM).     

Plasma cystatin-C and risk of developing gestational diabetes mellitus

AimsCystatin-C, a low molecular weight protein, is effectively applied to evaluate the risk of developing renal insufficiency, cardiovascular disorders, neural defects, and inflammatory states. However, the role of this biomarker to monitor different pregnancy-related complications remains controversial.Materials and methodsIn the present study, we compared serum cystatin-C concentration between pregnant women with gestational diabetes mellitus (GDM) and healthy pregnant women to assess value of this biomarker to predict presence of GDM in these women. The study consisted of 60 consecutive pregnant women (30 women suffered GDM and 30 healthy pregnant women) enrolled in Afzalipour hospital in Kerman, Iran in 2012. Fasting blood sample was collected to perform measurements on plasma glucose, lipids, serum creatinine, and C-cystatin. Serum cystatin-C level was quantified using ELISA techniques.ResultsUnadjusted comparison of cystatin-C level between the two study group showed no significant discrepancy between them so that the level of this biomarker in GDM group was 593.00 ± 204.81 mg/L and in healthy group was 531.67 ± 87.52 mg/L (P = 0.137); while in multivariable linear model with the presence of associated variables, GDM was a main determinant for increased level of cystatin-C (standardized beta of 0.355, P-value of 0.014).ConclusionGestational age was also identified to be another indicator of elevated cystatin-C. In final, our study showed that cystatin-C can be a reliable, useful and promising marker of GDM appearance in pregnant women.