Gestational Diabetes and Subsequent Growth Patterns of Offspring: The National Collaborative Perinatal Project

Our objective was to test the hypothesis that intrauterine exposure to gestational diabetes [GDM] predicts childhood growth independent of the effect on infant birthweight. We conducted a prospective analysis of 28,358 mother-infant pairs who enrolled in the National Collaborative Perinatal Project between 1959 and 1965. The offspring were followed until age 7. Four hundred and eighty-four mothers (1.7%) had GDM. The mean birthweight was 3.2 kg (range 1.1–5.6 kg). Maternal characteristics (age, education, race, family income, pre-pregnancy body mass index and pregnancy weight gain) and measures of childhood growth (birthweight, weight at ages 4, and 7) differed significantly by GDM status (all P < 0.05). As expected, compared to their non-diabetic counterparts, mothers with GDM gave birth to offspring that had higher weights at birth. The offspring of mothers with GDM were larger at age 7 as indicated by greater weight, BMI and BMI z-score compared to the offspring of mothers without GDM at that age (all P < 0.05). These differences at age 7 persisted even after adjustment for infant birthweight. Furthermore, the offspring of mothers with GDM had a 61% higher odds of being overweight at age 7 compared to the offspring of mothers without GDM after adjustment for maternal BMI, pregnancy weight gain, family income, race and birthweight [OR = 1.61 (95%CI:1.07, 1.28)]. Our results indicate that maternal GDM status is associated with offspring overweight status during childhood. This relationship is only partially mediated by effects on birthweight.     

加强妊娠糖尿病管理对围产结局影响的相关研究

目的:探讨加强妊娠期糖尿病筛查与管理对围产结局的影响。方法:选择已确诊的妊娠期糖尿病患者124例,按孕期未进行管理26例为病例组Ⅰ(入院及诊断较迟),已系统管理的98例为病例组Ⅱ,分析其临床资料进行统计学处理。结果:病例组Ⅰ围产病率明显高于病例组Ⅱ;妊高征(2χ=7.113 6,P=0.007 6)、酮症酸中毒(2χ=5.858 7,P=0.015 5)、巨大儿(2χ=4.172 3,P=0.041 1)、胎儿窘迫(2χ=8.212 6,P=0.004 2)、新生儿窒息(2χ=8.901 6,P=0.002 8)均有明显的差异。结论:妊娠期糖尿病严重危害着母儿健康,加强妊娠期糖尿病系统化管理能有效地降低围产病率。     

血管内皮生长因子及其受体与可溶性血管内皮生长因子受体-1对妊娠期糖尿病与围生儿结局的预测价值

目的探讨妊娠期糖尿病(GDM)孕妇血清中血管内皮生长因子(VEGF)及其受体(VEGFR)所介导的胎盘血管病变与围生儿结局间的关系,以及血清中可溶性血管内皮生长因子受体(sVEGFR)-1水平,对VEGF-VEGFR轴发挥的生物学效应。 方法选取2011年1月至12月在本中心被诊断为GDM、孕龄为24～28孕周的孕妇100例纳入GDM组;选择同期在相同医院常规产前检查、相同孕龄的50例正常孕妇,纳入对照组。采集两组孕妇血样,测量糖化指标：空腹血糖(FPG)值,糖化血红蛋白(HbA1c)与VEGF。GDM组经常规干预治疗后,再采集血样测定FPG值,HbA1c及VEGF,并与对照组进行统计学分析。分娩后,收集胎盘,分析胎盘组织中VEGFR蛋白表达。根据GDM组孕妇分娩后的围生儿结局,将其分别纳入GDM围生儿异常组(n＝34)与GDM围生儿正常组(n＝66)(本研究遵循的程序符合本院人体试验委员会所制定的伦理学标准,得到该委员会批准,分组征得受试对象本人的知情同意,并与之签署临床研究知情同意书)。 结果①GDM组孕妇血清VEGF水平、HbA1c及FPG值均明显高于对照组,差异有统计学意义(P<0.05)。②GDM组孕妇经干预治疗后,孕晚期FPG明显降低(P<0.05),HbA1c与对照组比较,差异无统计学意义(P>0.05),血清VEGF水平仍保持较高水平。③GDM组孕妇血清VEGF与sVEGFR-1水平呈负相关(r＝－0.497,P<0.01)。④与GDM组孕妇所分娩围生儿的血清VEGF水平显著高于对照组孕妇所分娩围生儿,且差异有统计学意义(P<0.05)。⑤采用多因素非条件logistic回归法对GDM组与对照组孕妇血清VEGF表达水平的分析结果显示,VEGF是GDM围生儿结局异常的危险因子(OR＝5.196, 95% CI: 1.845～14.610,P<0.001)。⑥采用Western印迹法测定胎盘组织中VEGFR蛋白表达量显示,GDM围生儿异常组较GDM围生儿正常组显著升高,差异有统计学意义(P<0.05)。 结论①GDM孕妇血清VEGF升高是其围生儿结局的一个不利因素,血清VEGF水平高可作为GDM不良围生儿结局的预测指标。②血循环中sVEGFR-1可通过竞争结合方式中和VEGF,抑制其下游信号传递。血清低sVEGFR-1水平可作为GDM病变中VEGF-VEGFR轴过度活跃的生物标记。     

妊娠期糖尿病对双胎妊娠围产结局的影响

目的探讨妊娠期糖尿病(gestational diabetes mellitus,GDM)对双胎妊娠结局的影响,为促进GDM双胎妊娠的健康提供临床科学依据。方法收集2017年1月-2017年12月在福建省妇幼保健医院建档、住院分娩合并GDM的双胎妊娠孕产妇101例,随机抽取同期血糖正常的双胎妊娠孕产妇104例作为对照组,比较分析两组的母儿并发症。结果观察组孕产妇双胎不同一性发生率低于对照组(P<0.05)。观察组受孕方式、双胎绒毛膜性、分娩方式、早产、胎膜早破、妊娠期高血压疾病(hypertensive disorders complicating pregnancy,HDCP)、前置胎盘、胎盘早剥、产后出血、新生儿窒息、新生儿高胆红素血症新生儿低血糖、新生儿畸形发生率与对照组比较,差异无统计学意义(均P>0.05)。结论GDM孕妇经规范管理治疗后没有增加双胎妊娠不良围产结局。     

Ophthalmic Pathology in the Offspring of Pregnant Women with Gestational Diabetes Mellitus

Maternal and Child Health Journal - Gestational diabetes (GD) occurs in 5.8% to 25.1% of pregnant women. This disorder has been linked with intrauterine growth delays, congenital anomalies, and...     

Seasonality of preterm birth in the Collaborative Perinatal Project: demographic factors

Marked circannual variation in the incidence of preterm birth, adjusted for the normal seasonal fertility rate, was observed in data from the Collaborative Perinatal Project collected at 12 urban university centers during 1959-1966 (p less than 10(-5). The variation in monthly preterm birth rates ranged from a trough of 64% in May to a peak of 144% in September. This is considerably greater seasonal variation than found in most previous studies, which used differing definitions of prematurity. The seasonal trend was present for maternal age groups 22-26 years (p less than 0.005) and greater than 26 years (p less than 0.005), for Bureau of the Census socioeconomic index 3.6-4.9 (p less than 10(-4) and greater than 4.9 (p less than 0.01), for those living in northern states (p less than 10(-4), for married gravidas (p less than 10(-6), for blacks (p less than 0.05) and whites (p less than 0.001), but not for those less than age 22, those with socioeconomic index less than 3.6, those living in southern states, and those not married. Thus, preterm birth was seasonal in the population studied, and the seasonal factor was more evident in demographic groups less predisposed to deliver preterm. These findings may have implications for the pathogenesis of a portion of premature deliveries, and should be considered in the design of studies related to the pathogenesis of preterm birth.     

妊娠期糖尿病早期干预对孕产妇及围产儿结局的影响

目的 探讨妊娠期糖尿病早期干预对孕产妇及围产儿结局的影响.方法 选择汕头市妇幼保健院2004年6月-2007年6月期间确诊为妊娠期糖尿病并在经各种干预治疗措施后血糖水平控制理想的孕妇60例作为观察组,对同期未及时进行控制治疗或未进行产前检查,入院时才确诊的妊娠期糖尿病孕妇60例作为对照组,观察两组孕产妇及围产儿的结局.结果 对照组孕妇产科并发症、围产儿并发症发生率高于观察组(P＜0.05).结论 对妊娠期糖尿病病人的早期干预,是提高妊娠质量、降低并发症和保障母婴健康的关键.     

Polyphenol Intake in Pregnant Women on Gestational Diabetes Risk and Neurodevelopmental Disorders in Offspring: A Systematic Review

The intake of foods containing polyphenols can have a protective role to avoid comorbidities during pregnancy and, at the same time, promote transgenerational health. This review aims to describe the effect of polyphenol intake through supplements or polyphenol-rich foods during pregnancy on the incidence and evolution of gestational diabetes mellitus (GDM), as well as the link with the neurodevelopment of the fetus. Using PRISMA procedures, a systematic review was conducted by searching in biomedical databases (PubMed, Cinahl and Scopus) from January to June 2022. Full articles were screened (n = 419) and critically appraised. Fourteen studies were selected and were divided into two different thematic blocks considering (i) the effect of polyphenols in GDM and (ii) the effect of GDM to mental disorders in the offspring. A positive relationship was observed between the intake of polyphenols and the prevention and control of cardiometabolic complications during pregnancy, such as GDM, which could be related to thwarted inflammatory and oxidative processes, as well as neuronal factors. GDM is related to a greater risk of suffering from diseases related to neurodevelopment, such as attention deficit hyperactivity disorder, autism spectrum disorder and learning disorder. Further clinical research on the molecule protective mechanism of polyphenols on pregnant women is required to understand the transgenerational impact on fetal neurodevelopment.     

Perinatal Outcomes of Southeast Asians with Pregnancies Complicated by Gestational Diabetes Mellitus or Preeclampsia

To examine risks for adverse perinatal outcomes among Southeast Asian women with pregnancies complicated by gestational diabetes mellitus (GDM) or preeclampsia. Perinatal outcomes of singleton births of Cambodian (3,489), Laotian (2,038), Vietnamese (11,605), Japanese (3,083) and non-Hispanic White women (33,088) were analyzed using Washington state linked birth certificate and hospitalization discharge records (1993-2006). Both Cambodian (aOR = 1.68) and Laotian (aOR = 1.71) women with GDM had increased odds of macrosomia when compared with Japanese women with GDM. Southeast Asian women with GDM had reduced odds of macrosomia when compared with White women. Southeast Asian women with preeclampsia had increased odds for preterm delivery when compared with Japanese and White women with preeclampsia. Research is needed to understand why Southeast Asian women with GDM are more likely to have better perinatal outcomes when compared with White women. Vigilant monitoring and culturally sensitive care for Southeast Asian women with preeclampsia is needed.     

Influence of Diet and Lifestyle on the Development of Gestational Diabetes Mellitus and on Perinatal Results

GDM is a multifactorial disease, so there is controversy regarding the mechanisms involved in its pathogenesis. We speculate whether lifestyle and eating habits influenced the appearance and pathogenesis of GDM. To explore this issue, the aim of the present study was to analyze maternal diet and lifestyle characteristics in early pregnancy and their influence on the development of GDM. The study included 103 pregnant women who completed a questionnaire on nutritional knowledge, lifestyle and eating habits. Perinatal and biochemical outcomes as well as pregestational lifestyle and eating habits were compared between normoglycemic women and those who developed GDM. The results obtained showed that women who developed GDM had erroneous knowledge regarding nutrition. Consumption of white bread (p = 0.018), added sugars (p = 0.037), legumes (p = 0.025), fish (p = 0.014), butter (p = 0.010) and the performance of less physical activity (p = 0.024) correlated with glucose intolerance in pregnant women. In conclusion, we found a relationship between dietary and lifestyle habits at the beginning of pregnancy and the later diagnosis of GDM.     

Long-term follow-up of participants in the Collaborative Perinatal Project: tracking the next generation

This report describes the methods used in conducting a long-term follow-up study and the factors associated with the successful location of subjects. In 1987–91, we selected, from among the women who were born in 1959–66 as members of the Philadelphia and Providence cohorts of the Collaborative Perinatal Project (CPP), 391 who were preterm at birth, 413 who were small-for-gestational age (SGA) and 978 who were term and appropriately grown; 1314 were from Philadelphia and 468 from Providence. Tracing was accomplished using original CPP records, telephone directories, voter registration and driver's licence records, birth certificate files and credit bureaux. A total of 61% of the women were located, 55% at Philadelphia and 77% at Providence. After adjustment, the odds ratio for ease of location, compared with women who were term and appropriately grown, was 0.85 [95% CI 0.66–1.11] for women who were preterm and 1.02 [0.78–1.34] for women who were SGA. In Philadelphia, African–American women were more likely than white women to be located, but in Providence, African–American women were less likely than white women to be located. Women whose own mothers were older at the time of their birth were more likely to be located, as were those who had more siblings followed in the CPP. Compared with women who did not complete their original CPP examinations at ages 4 and 7 years, those whose original CPP follow-up was more complete were more likely to be located. These findings demonstrate that long-term follow up in a US urban setting can be accomplished, and that successful location was not associated with birth status.     

The Ohio Gestational Diabetes Postpartum Care Learning Collaborative: Development of a Quality Improvement Initiative to Improve Systems of Care for Women

Objectives To improve clinical practice and increase postpartum visit Type 2 diabetes mellitus (T2DM) screening rates in women with a history of gestational diabetes mellitus (GDM). Methods We recruited clinical sites with at least half of pregnant patients enrolled in Medicaid to participate in an 18-month quality improvement (QI) project. To support clinical practice changes, we developed provider and patient toolkits with educational and clinical practice resources. Clinical subject-matter experts facilitated a learning network to train sites and promote discussion and learning among sites. Sites submitted data from patient chart reviews monthly for key measures that we used to provide rapid-cycle feedback. Providers were surveyed at completion regarding toolkit usefulness and satisfaction. Results Of fifteen practices recruited, twelve remained actively engaged. We disseminated more than 70 provider and 2345 patient toolkits. Documented delivery of patient education improved for timely GDM prenatal screening, reduction of future T2DM risk, smoking cessation, and family planning. Sites reported toolkits were useful and easy to use. Of women for whom postpartum data were available, 67 % had a documented postpartum visit and 33 % had a postpartum T2DM screen. Lack of information sharing between prenatal and postpartum care providers was are barriers to provision and documentation of care. Conclusions for Practice QI and toolkit resources may improve the quality of prenatal education. However, postpartum care did not reach optimal levels. Future work should focus on strategies to support coordination of care between obstetrical and primary care providers.

     

Maternal and Perinatal Outcomes During the COVID-19 Epidemic in Pregnancies Complicated by Gestational Diabetes

IntroductionGestational diabetes (GDM) is one of the most common complications in pregnancy, with a prevalence that continues to rise. At the time of the COVID-19 epidemic, immediate reorganisation and adjustment of the system was needed. Telemedicine support was offered in order to provide high-quality treatment to pregnant women. However, the success of the treatment is unknown. We therefore aimed to evaluate COVID-19 epidemic effects on pregnancy outcomes in GDM.MethodsThe maternal outcomes (insulin treatment, gestational weight gain, caesarean section, hypertensive disorders) and perinatal outcomes (rates of large and small for gestational age, preterm birth and a composite child outcome) of women visiting a university hospital diabetes clinic from March to December 2020 were compared with those treated in the same period in 2019.ResultsWomen diagnosed with GDM during the COVID-19 epidemic (n=417), were diagnosed earlier (23.9 [11.7–26.0] vs. 25.1 [21.8–26.7] gestational week), had higher fasting glucose (5.2 [5.0–5.4] vs. 5.1 [4.8–5.3] mmol/l) and earlier pharmacological therapy initiation, and had achieved lower HbA1c by the end of followup (5.1% (32.2 mmol/mol) [4.9% (30.1 mmol/mol)–5.4% (35.0 mmol/mol)] vs. 5.2% (33.3 mmol/mol) [5.0% (31.1 mmol/mol) – 5.4%·(35.5 mmol/mol)], p<0.001) compared to a year before (n=430). No significant differences in perinatal outcomes were found.ConclusionsAlthough GDM was diagnosed at an earlier gestational age and higher fasting glucose concentration was present at the time of diagnosis, the COVID-19 epidemic did not result in worse glucose control during pregnancy or worse pregnancy outcomes in Slovenia.     

Dietary Patterns during Pregnancy Are Associated with Risk of Gestational Diabetes Mellitus

Maternal dietary patterns before and during pregnancy play important roles in the development of gestational diabetes mellitus (GDM). We aimed to identify dietary patterns during pregnancy that are associated with GDM risk in pregnant U.S. women. From a 24 h dietary recall of 253 pregnant women (16–41 years) included in the National Health and Nutrition Examination Survey (NHANES) 2003–2012, food items were aggregated into 28 food groups based on Food Patterns Equivalents Database. Three dietary patterns were identified by reduced rank regression with responses including prepregnancy body mass index (BMI), dietary fiber, and ratio of poly- and monounsaturated fatty acids to saturated fatty acid: “high refined grains, fats, oils and fruit juice”, “high nuts, seeds, fat and soybean; low milk and cheese”, and “high added sugar and organ meats; low fruits, vegetables and seafood”. GDM was diagnosed using fasting plasma glucose levels ≥5.1 mmol/L for gestation <24 weeks. Multivariable logistic regression models were used to estimate adjusted odds ratio (AOR) and 95% confidence intervals (CIs) for GDM, after controlling for maternal age, race/ethnicity, education, family poverty income ratio, marital status, prepregnancy BMI, gestational weight gain, energy intake, physical activity, and log-transformed C-reactive protein (CRP). All statistical analyses accounted for the appropriate survey design and sample weights of the NHANES. Of 249 pregnant women, 34 pregnant women (14%) had GDM. Multivariable AOR (95% CIs) of GDM for comparisons between the highest vs. lowest tertiles were 4.9 (1.4–17.0) for “high refined grains, fats, oils and fruit juice” pattern, 7.5 (1.8–32.3) for “high nuts, seeds, fat and soybean; low milk and cheese” pattern, and 22.3 (3.9–127.4) for “high added sugar and organ meats; low fruits, vegetables and seafood” pattern after controlling for maternal sociodemographic variables, prepregnancy BMI, gestational weight gain, energy intake and log-transformed CRP. These findings suggest that dietary patterns during pregnancy are associated with risk of GDM after controlling for potential confounders. The observed connection between a high consumption of refined grains, fat, added sugars and low intake of fruits and vegetables during pregnancy with higher odds for GDM, are consistent with general health benefits of healthy diets, but warrants further research to understand underlying pathophysiology of GDM associated with dietary behaviors during pregnancy.     

妊娠糖尿病治疗对妊娠结局的影响

目的 观察妊娠糖尿病的治疗对妊娠结局的影响.方法 对妊娠糖尿病病例进行比较分析.结果 产妇剖宫产率显著较低,母婴并发症显著较低.结论 积极治疗妊娠糖尿病可减少母婴并发症和剖宫产率.     

产前干预性治疗妊娠期糖尿病的预后对比研究

目的:对妊娠期糖尿病患者产前干预性治疗进行对比研究,以期改善患者病情,降低母婴死 亡率。方法:对近8年本院收治的71例患者依据分娩前血糖控制情况分为观察组与对照组,回顾性 对比分析产妇与新生儿的预后。结果:对照组孕期并发症、围生儿不良预后及因难产行剖宫产率均明 显高于观察组;胰岛素治疗可有效控制血糖。结论:针对高危人群,可于首次产前检查时行糖筛查试 验;饮食疗法效果不佳的患者及时使用胰岛素可获理想疗效。     

Prenatal Exposure to Persistent Organochlorines and Childhood Obesity in the U.S. Collaborative Perinatal Project

Background: In some previous studies, prenatal exposure to persistent organochlorines such as 1,1,-dichloro-2,2-bis(p-chlorophenyl)ethylene (p,p´-DDE), polychlorinated biphenyls (PCBs), and hexachlorobenzene (HCB) has been associated with higher body mass index (BMI) in children.Objective: Our goal was to evaluate the association of maternal serum levels of β-hexachlorocyclohexane (β-HCH), p,p´-DDE, dichlorodiphenyltrichloroethane (p,p´-DDT), dieldrin, heptachlor epoxide, HCB, trans-nonachlor, oxychlordane, and PCBs with offspring obesity during childhood.Methods: The analysis was based on a subsample of 1,915 children followed until 7 years of age as part of the U.S. Collaborative Perinatal Project (CPP). The CPP enrolled pregnant women in 1959–1965; exposure levels were measured in third-trimester maternal serum that was collected before these organochlorines were banned in the United States. Childhood overweight and obesity were defined using age- and sex-specific cut points for BMI as recommended by the International Obesity Task Force.Results: Adjusted results did not show clear evidence for an association between organochlorine exposure and obesity; however, a suggestive finding emerged for dieldrin. Compared with those in the lowest quintile (dieldrin, < 0.57 μg/L), odds of obesity were 3.6 (95% CI: 1.3, 10.5) for the fourth and 2.3 (95% CI: 0.8, 7.1) for the highest quintile. Overweight and BMI were unrelated to organochlorine exposure.Conclusions: In this population with relatively high levels of exposure to organochlorines, no clear associations with obesity or BMI emerged.Citation: Cupul-Uicab LA, Klebanoff MA, Brock JW, Longnecker MP. 2013. Prenatal exposure to persistent organochlorines and childhood obesity in the U.S. Collaborative Perinatal Project. Environ Health Perspect 121:1103–1109; http://dx.doi.org/10.1289/ehp.1205901