Physical activity and dietary habits during pregnancy: effects on glucose tolerance

Objectives.?We designed this study to assess the potential effects of physical activity and dietary habits on glucose tolerance during pregnancy.

Methods.?This is an observational study involving 268 women who underwent a 50-g oral glucose challenge test (GCT) at 27?±?6.9 week of gestation. Plasma glucose level at 1-h GCT?≥140 mg/dl was used to define abnormal glucose tolerance (AGT). Physical activity was evaluated using the short form of the International Physical Activity Questionnaire (IPAQ), while for dietary habits we used a food frequency questionnaire linked to a computerised program.

Results.?One hundred five women had AGT (AGT+) and 163 had normal glucose tolerance (AGT?). There was no difference between the two groups in demographic and clinical data, with the exception of pre-pregnancy BMI and weight gain both higher in AGT+ women. Also, all parameters referring to physical activity energy and diet (Kcal and diet components) were not statistically different between the two groups. After a multivariate analysis, only pre-pregnancy BMI (F-value 9.264, p?=?0.002) remained an independent predictor of 1-h plasma glucose.

Conclusions.?Our study suggests that high pre-pregnancy BMI confers a substantially high risk of AGT, independently of lifestyle during pregnancy.     

The effect of maternal body condition score before and during pregnancy on the glucose tolerance of adult sheep offspring

This study investigates the effects of diet-induced changes in maternal body condition on glucose tolerance in sheep. Welsh Mountain ewes were established, by dietary manipulation, at a body condition score of 2 (lower body condition [LBCS], n = 17) or >3 (higher body condition [HBCS], n = 19) prior to and during pregnancy. Birth weight and postnatal growth were similar in LBCS and HBCS offspring. In young adulthood, LBCS offspring had increased fasting glucose levels (3.8 +/- 0.07 vs 3.6 +/- 0.05 mM, P < .05), poorer glucose tolerance (2274 +/- 22.6 vs 2161 +/- 33 min/mM, P < .01), and reduced insulin secretion (0.58 +/- 0.05 vs 0.71 +/- 0.07 nM/min, P = .07). Increased fasting glycemia, mild glucose intolerance, and impaired initial insulin secretory response, as observed in LBCS offspring, are indictors of increased diabetes risk in humans. These findings suggest that altered maternal body composition and an imbalance between the fetal and postnatal environment influence offspring glucose tolerance.     

Longitudinal changes in glucose metabolism during pregnancy in obese women with normal glucose tolerance and gestational diabetes mellitus

OBJECTIVE: This study prospectively evaluated the longitudinal changes in insulin sensitivity, insulin response, and endogenous (primarily hepatic) glucose production and suppression during insulin infusion in women with normal glucose tolerance (control) and gestational diabetes mellitus before and during a planned pregnancy. STUDY DESIGN: Eight control subjects and 7 subjects in whom gestational diabetes mellitus developed were evaluated with an oral glucose tolerance test, an intravenous glucose tolerance test, and hyperinsulinemic-euglycemic clamp with infusion of [6,6 (2)H2 ]glucose before conception and at 12 to 14 and 34 to 36 weeks' gestation. Insulin response was estimated as the area under the curve during the intravenous glucose tolerance test. Basal endogenous glucose production was estimated from isotope tracer dilution during steady state with [6,6 (2)H2 ]glucose and suppression during insulin infusion. Insulin sensitivity to glucose was defined as the glucose infusion rate required to maintain euglycemia during steady-state insulin infusion. Body composition was estimated with hydrodensitometry. Data were analyzed with 2-way analysis of variance with repeated measures for 2 groups. RESULTS: There were increases in first-phase (P =.006) and second-phase (P =. 0001) insulin responses in both groups with advancing gestation, but the increase in second-phase response was significantly greater (P =. 02) in the gestational diabetes mellitus group than in the control group. Basal glucose production increased significantly (P =.0001) with advancing gestation, and there was resistance to suppression during insulin infusion in both groups (P =.0001). There was less suppression of endogenous glucose production however, in the gestational diabetes mellitus group than in the control group (P =. 01). Insulin sensitivity decreased with advancing gestation in both groups (P =.0001), and there was lower insulin sensitivity in the gestational diabetes mellitus group than in the control group (P =. 04). Significant decreases in insulin sensitivity with time (P =. 0001) and between groups (P =.03) remained when the data were adjusted for differences in insulin concentration or residual hepatic glucose production. CONCLUSION: Obese women in whom gestational diabetes mellitus develops have a significant increase in insulin response but decreases in insulin sensitivity and suppression of hepatic glucose production during insulin infusion with advancing gestation with respect to a matched control group. These metabolic abnormalities in glucose metabolism are the hallmarks of type 2 diabetes, for which these women are at increased risk in later life.     

Associations between maternal BMI as well as glucose tolerance and adverse pregnancy outcomes in women with polycystic ovary syndrome

This retrospective, cohort study examined the association between maternal pre-pregnancy body mass index (BMI), independent of glucose tolerance and adverse pregnancy outcomes in women with polycystic ovary syndrome (PCOS), for which there are few previous studies. Medical records from 2012 to 2015 at Guangzhou Women and Children’s Medical Center, China were reviewed for women previously diagnosed with PCOS with normal 2-h 75-g oral glucose tolerance test (OGTT) results (n?=?1249). The separate and joint effects of maternal BMI and glucose levels on pregnancy outcomes were assessed. Maternal pre-pregnancy BMI was associated with hypertensive disorders of pregnancy (HDP) (OR: 1.22, 95% CI: 1.02–1.45), preterm birth (OR: 1.49, 95% CI: 1.08–2.17), and large for gestational age (LGA) (OR: 1.69, 95% CI: 1.16–2.20). Elevated fasting glucose and maternal pre-pregnancy BMI were jointly associated with increased risks of HDP, preterm birth, and LGA. Therefore, among women with PCOS and normal glucose tolerance, maternal pre-pregnancy BMI is an independent risk factor of adverse pregnancy outcomes.     

Emotional, physical and sexual violence against women before or during pregnancy

The objective of this study was to determine the prevalence of emotional, sexual or physical violence reported by women delivered at the University Hospital Geneva, a tertiary care university teaching hospital, where about 3000 women are delivered each year. This study showed that prevalence of violence against women is high, and is severely underestimated by health case providers.     

Prevalence of physical and sexual abuse before and during pregnancy among Swedish couples

BACKGROUND: To estimate the prevalence of threats and actual acts of physical and sexual abuse during pregnancy. METHODS: Two hundred and seven pregnant Swedish women married to or cohabiting with Swedish men were randomly selected from three antenatal clinics in the city of G?teborg, Sweden. A standardized questionnaire was used for personal interviews about the women's experience of physical and sexual abuse by a husband or a boyfriend at some point in the past, during the last year and during current pregnancy. RESULTS: Twenty-seven point five percent of the women reported that they had been exposed to physical violence at some point in the past by their husband/boyfriend. Twenty-four and a half percent of the women had experienced some form of threat, physical or sexual violence during the last year. At some time (once or more) during their current pregnancy, the proportions of women who had been exposed to the following categories of violence, were as follows: 14.5%-symbolic violence, 14.5%-threats of mild violence, 2.9%-threats of moderate violence, 2.9%-threats of serious violence, 11%-mild violence, 4.3%-minor violence, 2.4%-moderate violence, 4.3%-serious violence and 3.3%-sexual violence. CONCLUSIONS: This study demonstrates that a considerable number of women had experienced threats, physical and sexual abuse during pregnancy. There is an obvious need for screening of experience of domestic violence among pregnant women to enhance the safety of women and their unborn babies.     

肥胖妊娠期妇女的糖耐量减低与糖尿病

妊娠期糖代谢的生理变化容易使妊娠期妇女发生糖耐量的减低，所以近年来妊娠期妇女糖代谢的异常受到诸多关注。因为妊娠期妇女糖耐量的减低不仅影响到母体，引起其代谢紊乱或者发展为妊娠期糖尿病，而且影响胎儿发育，以致发生胎儿的先天性畸形，发育异常，死亡率增加等一系列问题。如果在肥胖这个高危因素作用下，将会加重妊娠期妇女糖耐量减低的程度，甚至使其发展为妊娠期糖尿病的几率大大增加。着重对肥胖影响母体糖耐量的相关研究进行综述。     

肥胖妊娠期妇女的糖耐量减低与糖尿病

妊娠期糖代谢的生理变化容易使妊娠期妇女发生糖耐量的减低,所以近年来妊娠期妇女糖代谢的异常受到诸多关注.因为妊娠期妇女糖耐量的减低不仅影响到母体,引起其代谢紊乱或者发展为妊娠期糖尿病,而且影响胎儿发育,以致发生胎儿的先天性畸形,发育异常,死亡率增加等一系列问题.如果在肥胖这个高危因素作用下,将会加重妊娠期妇女糖耐量减低的程度,甚至使其发展为妊娠期糖尿病的几率大大增加.着重对肥胖影响母体糖耐量的相关研究进行综述.     

Oral glucose tolerance test is a poor predictor of hyperglycemia during pregnancy

In an effort to assess the efficacy of the oral glucose tolerance test to detect patients with gestational diabetes mellitus who require therapeutic measures to maintain normoglycemia, we compared the results of an oral glucose tolerance test with those of a home glucose profile consisting of three postprandial glucose values in 250 pregnant women. The OGTT overestimated the occurrence of hyperglycemia by 28%, while the home glucose profile underestimated the occurrence of hyperglycemia by 5%. Pregnancy outcome was not significantly different between spontaneously normoglycemic women and those who required therapy. One cannot effectively identify the ten percent largest infants in the population by screening for gestational diabetes.     

Intravenous glucose tolerance tests in women with twin pregnancy

Carbohydrate metabolism was evaluated in 20 twin gestations and 20 singleton pregnancies. The groups were matched for age, parity, weight, height, and gestational age. Intravenous glucose tolerance tests were performed on all women in the third trimester of pregnancy using a glucose load of 0.5 g/kg body weight. Venous plasma glucose and insulin level were measured and statistically compared. The glucose disappearance rates (K) were not different in the two groups. No significant differences in the mean insulin or glucose responses were found between singleton and twin pregnancies. Thus, twin gestations are not at higher metabolic risk of gestational diabetes than are singleton pregnancies.     

单纯葡萄糖筛查试验异常对妊娠结局和新生儿体质指标的影响

目的 探讨妊娠期单纯葡萄糖筛查试验(GCT)异常对妊娠结局和新生儿体质指标的影响.方法 收集2006年11月至2007年12月于中山大学附属第一医院妇产科住院分娩的孕妇214例,于孕24～28周时行50 g GCT,若服糖后1 h血糖≥7.8 mmol/L,再行75 g口服葡萄糖耐量试验(OGTT),空腹血糖及服糖后1 h、2 h、3 h血糖标准分别为5.3 mmol/L、10.0 mmol/L、8.6 mmol/L和7.8 mmol/L,4项血糖值均未达到上述标准,为OGTT正常.50 g GCT异常、但75 g OGTY正常的116例孕妇及其新生儿为单纯GCT异常组;50 g GCT正常的98例孕妇及其新生儿为GCT正常组.对两组母儿结局进行分析.记录两组新生儿的出生体重、身长、头围、肩周围值;于出生后24 h内以皮尺测定其上臂围,以直尺测定其肱三头肌皮褶厚度及腹壁皮下脂肪厚度.结果 (1)两组母儿结局:单纯GCT异常组孕妇的阴道助产率[10.3%(12/116)]、羊水过多发生率[5.2%(6/116)]、胎膜早破发生率[13.8%(16/116)]、胎儿窘迫发生率[20.7%(24/116)]与GCT正常组[分别为4.1%(4/98)、10.2%(10/98)、17.3%(17/98)、13.3%(13/98)]比较,差异均无统计学意义(P＞0.05);单纯GCT异常组孕妇的剖宫产率[72.4%(84/116)]、阴道顺产率[17.2%(20/116)]、大于胎龄儿出生率[25.9%(30/116)],与GCT正常组[分别为51.0%(50/98)、44.9%(44/98)、6.1%(6/98)]比较,差异均有统计学意义(P＜0.05).(2)新生儿体质指标:单纯GCT异常组新生儿出生体重为(3.4±0.4)kg,与GCT正常组的(3.3±0.4)kg比较,差异有统计学意义(P＜0.05);单纯GCT异常组新生儿身长[(49.9±1.3)cm]、头围[(33.4±1.5)cm]、肩周围[(35.4±2.3)cm]、上臂围[(11.0±0.7)cm]、肱三头肌皮褶厚度[(9.7±1.0)mm]、腹壁皮下脂肪厚度[(7.2±1.2)mm]等体质指标,与GCT正常组[分别为(49.7±1.4)cm、(33.8±1.7)cm、(35.0±2.3)cm、(10.9±0.8)cm、(9.9±1.4)mm、(7.2±1.0)mm]比较,差异均无统计学意义(P＞0.05).结论 单纯GCT异常对新生儿体质指标无影响,但GCT异常的孕妇剖宫产率、大于胎龄儿出生率、新生儿出生体重均高于GCT正常的孕妇.     

Disorders of glucose tolerance among women with pregnancy induced hypertension

OBJECTIVES: Gestational diabetes is observed to coexist with pregnancy induced hypertension. Insulin resistance might be associated with both of these diseases. DESIGN: To assess the association between glucose intolerance and subsequent development of hypertension in pregnancy. MATERIAL AND METHODS: Glucose levels at the time of routine screening for gestational diabetes among 79 women with pregnancy induced hypertension and 79 normotensive women have been compared. RESULTS: Hypertensive women were statistically more often obese, their pregravid BMIs were greater and their pregnancy weight gain was higher. Among hypertensive women gestational diabetes has been more often diagnosed. As compared with normotensive, women developing PIH had significantly higher glucose levels after 50 g and 75 g of glucose load. CONCLUSIONS: Women with pregnancy induced hypertension are at increased risk of gestational diabetes. Even within the normal range, levels of plasma glucose levels were higher among hypertensive women.