Investigation of a lifestyle change strategy for high-risk women with a history of gestational diabetes

Fifty-nine women with recent gestational diabetes participated in a randomized controlled trial to assess the feasibility and efficacy of a pragmatic diabetes risk reduction intervention. Intervention participants achieved improvements in energy, total and saturated fats, and carbohydrate intake, but no change in physical activity. Recruitment was challenging and below expectations.     

Prevalence of type 2 diabetes among women with a previous history of gestational diabetes mellitus

We compared the prevalence of diabetes in women who experienced gestational diabetes mellitus (GDM) with that in the general population and identified risk factors for the development of diabetes.The analysis included 868 subjects (620 GDM and 248 single positive (SP) for one of the diagnostic criteria). The post-partum examinations included 2 h 75 g oral glucose tolerance tests, lipid profiles, anthropometric measurements, and documentation of medical history, diet, and lifestyle. All participants were followed up at 6 weeks after parturition and subsequent follow-ups were conducted annually. General population subjects were identified from the 2001 Korean National Health and Nutrition Survey and age-matched for case–control analysis.Eleven (4.4%) and 71 (11.5%) subjects in the SP and GDM groups, respectively, developed diabetes, while 22 (2.5%) subjects in the general population group presented with diabetes. The risk of developing diabetes was 3.5 times greater for GDM subjects than for general population subjects, after adjusting for confounding factors. A multiple logistic regression model revealed that GDM, a family history of diabetes, and waist circumference were independently associated with the development of diabetes.We concluded that GDM women in Korea are at high risk of diabetes irrespective of the absence of putative risk factors.     

Prevalence of non-alcoholic fatty liver disease and factors associated with it in Indian women with a history of gestational diabetes mellitus

Aims/IntroductionThis study aims to evaluate the prevalence of and factors associated with non‐alcoholic fatty liver disease (NAFLD) in Indian women with prior gestational diabetes mellitus (GDM) diagnosed using International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria.Materials and MethodsThis cross‐sectional study (2018–2019) enrolled women with and without prior GDM. Study participants underwent detailed assessments, including relevant medical, obstetric and demographic details; 75‐g oral glucose tolerance test with glucose and insulin estimation at 0, 30 and 120 min; and other relevant biochemical and anthropometric measurements. NAFLD status was defined by ultrasonography.ResultsWe evaluated a total of 309 women (201 and 108 with and without prior GDM, respectively) at a mean age of 31.9 ± 5.0 years and median of 16 months (interquartile range 9–38 months) following the index delivery. The prevalence of NAFLD was significantly higher in women with prior GDM (62.7% vs 50.0%, P = 0.038; grade 2 and 3 disease, 13.9% vs 6.5%). On logistic regression analysis (fully adjusted model), the odds of NAFLD were 2.11‐fold higher in women with prior GDM (95% confidence interval 1.16–3.85, P = 0.014). Overweight/obesity, metabolic syndrome, prediabetes and homeostasis model of assessment of insulin resistance (a measure of insulin resistance) were positively associated with NAFLD, whereas the Matsuda index (a measure of insulin sensitivity) showed a negative association with NAFLD.ConclusionsThe prevalence of NAFLD is high in women with prior GDM. Such women also have a high burden of cardiometabolic risk factors. Future studies should evaluate the intermediate and long‐term hepatic and cardiovascular risk, and the impact of lifestyle interventions in reducing morbidity in such women.     

Chemerin expression in Chinese pregnant women with and without gestational diabetes mellitus

ObjectivesThe aim of this study was to determine the effect of obesity, gestational diabetes mellitus (GDM) on circulating chemerin concentrations and chemerin gene expression of adipotissue in pregnancy women.Material and methodsTotally 42 normal glucose tolerant (NGT) women and 48 women with GDM were included in this study. Their clinical features and biochemical parameters were analyzed. The NGT and GDM women were subgrouped by prepregnancy BMI as normal-weight group, overweight group, and obese group, respectively. Serum chemerin and tumor necrosis factor α (TNF-α) of these individuals were determined by ELISA methods, and subcutaneous adipose tissues’ mRNA expressions of chemerin and CMKLR1 (encoding the receptor of chemerin) were analyzed by real-time PCR.ResultsSerum chemerin in obese-NGT group and normal-weight-GDM group was significantly higher than that of normal-weight-NGT group. Chemerin and CMKLR1 mRNA expression of subcutaneous adipose tissue was lower in the obese-NGT group than normal-weight-NGT group. There was no significant difference of CMKLR1 mRNA expression between normal-weight-NGT and normal-weight-GDM group. Serum chemerin significantly and positively correlated with triglycerides (TG) and homeostasis model assessment of insulin resistance (HOMA-IR) assessed both by uni- and multivariate.ConclusionsGestational obesity, GDM may contribute to the elevating serum chemerin. Serum chemerin in pregnancy was associated with insulin resistance and triglycerides. Chemerin gene may play a role both in obese and GDM patients. CMKLR1 might exert its action only in obese individuals, not in GDM patients before delivery.     

Barriers and interventions for postpartum reclassification of glycemic status in women with gestational diabetes mellitus: A scoping review

Background and aimsOur aim was to summarize, analyze and disseminate the current state of knowledge about the barriers and facilitators in postpartum reclassification that women who have had gestational diabetes face.MethodsData collection was carried out from January to March 2021 in PubMed, Scopus, Web of Science (WoS), Embase and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases.ResultsOf the 361 studies initially retrieved in the search, 32 articles published between 2010 and 2020 were selected because they were within our objective.ConclusionMultiple barriers and interventions were found regarding the reclassification of the glycemic status of women who had Gestational Diabetes during pregnancy. Therefore, further studies are needed to achieve a better intervention for this condition.     

妊娠糖尿病:产后管理减少发生2型糖尿病的风险

妊娠糖尿病(GDM)不仅增加围产期孕妇和胎儿患病的风险,而且增加孕妇产后发生2型糖尿病(T2DM)的风险.GDM发展为T2DM有很多危险因素,关键是重视对GDM妇女产后随访和血糖的筛查,以及产后的各种干预措施如健康的生活方式、母乳喂养和必要时药物干预.这对减少Tr2DM发生的风险有重要意义.     

Changing psychosocial determinants of physical activity and diet in women with a history of gestational diabetes mellitus

Background

To investigate how a behavioural lifestyle intervention influences psychosocial determinants of physical activity and dietary behaviours in a population at risk of type 2 diabetes (T2DM).

Methods

Fifty‐nine women with a body mass index of ≥25 kg/m² and a history of gestational diabetes mellitus (GDM) participated in a randomized controlled study. The intervention group (n = 29) received 2 face‐to‐face and 5 telephone lifestyle‐counselling sessions with a health professional. The control group (n = 30) received care as usual. At baseline and 6 months, psychosocial determinants related to physical activity and diet were measured with a self‐administrated questionnaire. Linear regression analyses were applied to test for intervention effects.

Results

The intervention was effective in improving social support (β = 3.5, P < 0.001; β = 2.1, P = 0.02), modifying self‐efficacy (β = ‐2.2, P = 0.02; β = ‐4.3, P < 0.001), and reducing barriers (β = ‐3.5, P = 0.01; β = ‐3.8, P = 0.01) for, respectively, physical activity and diet from baseline to 6‐month follow‐up in the intervention group compared with the control group. The intervention reduced the following barriers to a physically active lifestyle: lack of energy and lack of motivation. Physical activity barriers like lack of time and lack of childcare were unchanged. The intervention reduced the following barriers to a healthy diet: lack of time, costs, having unhealthy snacks at home, and having cravings for sweets.

Conclusion

This lifestyle intervention influenced psychosocial determinants relevant for overweight women with a history of gestational diabetes mellitus (GDM) in prevention of T2DM.     

Predictors of postpartum glucose metabolism disorders in women with gestational diabetes mellitus

Background and aimsPostpartum glucose metabolism disorders are a common problem in women with gestational diabetes mellitus (GDM). They are often underdiagnosed since many patients do not attend the postpartum screening. This study aims to assess predictors of postpartum glucose metabolism disorders and type 2 diabetes mellitus (T2DM) after GDM.Material and methodsRetrospective study in women with GMD who underwent postpartum screening for glucose metabolism disorders (n = 2688). Logistic regression was used in the statistical analysis.Results24.6% of women had postpartum glucose metabolism disorder. In multivariate analysis, pre-pregnancy body mass index (BMI) 25–30 kg/m² (OR 1.46, 95%CI 1.05 to 2.02) or BMI ≥30 kg/m² (OR 2.62, 95%CI 1.72 to 3.96), diagnosis of GDM before 20 weeks of pregnancy (OR 2.33, 95%CI 1.57 to 3.46), fasting plasma glucose after diagnosis of GDM ≥90 mg/dl (OR 2.12, 95%CI 1.50 to 2.98), postprandial glucose ≥100 mg/dl (OR 1.47, 95%CI 1.09 to 2.99), and HbA1c in the third trimester of pregnancy ≥5.3% (2.04, 95%CI, 1.52 to 2.75) were independent predictors for any postpartum glucose metabolism disorder.Conclusionpostpartum screening for T2DM should be performed in all women with GDM, and it is especially important not to lose follow-up in those with one or more predictive factors.     

Maternal and neonatal outcomes in women with recurrent gestational diabetes mellitus

Background and aimsThe aim of the study was to evaluate the maternal and neonatal outcomes in women with recurrent gestational diabetes mellitus (GDM), compared to women with GDM.MethodsThis prospective observational cohort study was done on multiparous women with GDM attending the two tertiary care hospitals. Subjects were divided into two groups, recurrent GDM and GDM. Demographics, clinical variables, and maternal and neonatal outcomes were recorded between the two groups. The postpartum glycemic status was determined at six months.ResultsThere were 36 (20.2%) women with recurrent GDM and 142 (79.8%) women with GDM. Women with recurrent GDM were older (32.4 ± 6.2 versus 29.8 ± 5.6 years), had higher frequency of obesity, and insulin resistance than women with GDM. Women with recurrent GDM had poor glycemia at diagnosis as compared to GDM. Although the glycemic goals achieved were comparable but women with recurrent GDM have increased frequency of gestational hypertension, preeclampsia, and need for cesarean section. Women with recurrent GDM significantly had higher frequency of large for gestational age (LGA) and macrosomic neonates. Postpartum diabetes at six months was significantly higher in women with recurrent GDM.ConclusionWomen with recurrent GDM are at increased risk of adverse maternal and perinatal outcomes despite achieving optimal glycemic goals and also at the most significant risk of postpartum diabetes.     

Prevalence and predictors of postpartum glucose intolerance in Italian women with gestational diabetes mellitus

Aims

To determine the prevalence of both prediabetes and type 2 diabetes mellitus (T2DM) by postpartum oral glucose tolerance test (ppOGTT) in Italian women diagnosed with gestational diabetes mellitus (GDM), and identify antepartum predictors of glucose intolerance.

Methods

Retrospective study of 454 Caucasian women that underwent a 75 g OGTT between 6 and 12 weeks postpartum in Calabria (Southern Italy) between 2004 and 2012. Prediabetes and T2DM were diagnosed according to the American Diabetes Association (ADA) criteria. Data were examined by univariate analysis and multiple regression analysis.

Results

290 women (63.9%) were normal, 146 (32.1%) had prediabetes (85 impaired fasting glycemia; 61 impaired glucose tolerance), and 18 (4.0%) had T2DM. Of the continuous variables, pre-pregnancy body mass index (BMI), age at pregnancy, fasting plasma glucose (FPG) at gravid OGTT, and week at diagnosis of GDM were associated with prediabetes and T2DM, whereas the parity was associated with T2DM only. For categorical traits, pre-pregnancy BMI ≥25 and previous diagnosis of polycystic ovary syndrome (PCOS) emerged as the strongest predictors of prediabetes whereas the strongest predictors of T2DM were FPG ≥100 mg/dl (5.6 mmol/l) at GDM diagnosis and pre-pregnancy BMI ≥25. Moreover, FPG at GDM screening was a good predictor of T2DM after receiver-operating-characteristic analysis.

Conclusions

Our findings confirm the high prevalence of glucose intolerance in the early postpartum period in women with previous GDM. PCOS emerges as a new strong antepartum predictor of prediabetes.     

Follow-up of postpartum women with gestational diabetes mellitus (GDM)

AimThe incidence of type 2 diabetes in postpartum women with gestational diabetes mellitus (GDM) is high, and blood glucose screening for postpartum women is recommended. Follow-up procedures for women with GDM in the postnatal period need to be improved. We investigated the incidence of GDM and the follow-up of women with GDM in Tianjin, China.MethodsPostpartum women who delivered at Tianjin Obstetrics and Gynecology Hospital from January 1st, 2008 to December 31st, 2010 were interviewed by telephone about their blood glucose screening. Thirty obstetricians were interviewed to evaluate awareness about the importance of follow-up.ResultsThe incidence rate of GDM increased from 6.9% in 2008, to 8.8% in 2009, and 9.9% in 2010. A total of 2152 women were interviewed, including 282 women (13.1%) screened for blood glucose. The top three reasons for failed blood glucose screening included: not being informed by their physicians, believing that GDM would disappear after delivery, and being occupied with the baby. Methods for GDM screening included testing of random blood glucose levels, fasting blood glucose levels, oral glucose tolerance, and glycosylated hemoglobin. Of the 30 obstetricians interviewed, 25 were aware of the need for blood glucose screening for women with GDM after delivery, but only 15 of them had informed their patients.ConclusionIn China, most women with GDM are not screened for type 2 diabetes after delivery. Standard clinical procedures that will enable and encourage all women to return for glucose screening following GDM are needed.     

Risk factors for abnormal postpartum glycemic states in women diagnosed with gestational diabetes by the International Association of Diabetes and Pregnancy Study Groups criteria

Aims/IntroductionTo evaluate the rate of postpartum glycemic screening tests (PGST) in women with gestational diabetes mellitus (GDM), and to investigate risk factors for abnormal PGST results.Materials and MethodsWe retrospectively analyzed the obstetric data of 1,648 women with GDM who gave birth after 28 completed weeks of gestation between 1 July 2011 and 31 December 2019 at Taipei Chang Gung Memorial Hospital, Taiwan. GDM was diagnosed by the International Association of Diabetes and Pregnancy Study Groups criteria. PGST was carried out at 6–12 weeks postpartum with a 75‐g, 2‐h oral glucose tolerance test, and the results were classified into normal, prediabetes and diabetes mellitus. Multiple logistic regression was used to assess the associations between various risk factors and abnormal PGST results.ResultsIn total, 493 (29.9%) women underwent PGST and 162 (32.9%) had abnormal results, including 135 (27.4%) with prediabetes and 27 (5.5%) with diabetes mellitus. Significant risk factors for postpartum diabetes mellitus included insulin therapy during pregnancy (adjusted odds ratio [OR] 10.79, 95% confidence interval [CI] 4.07–28.58), birthweight >4,000 g (adjusted OR 10.22, 95% CI 1.74–59.89) and preterm birth <37 weeks’ gestation (adjusted OR 3.33, 95% CI 1.09–10.22); whereas prepregnancy body mass index >24.9 kg/m² (adjusted OR 1.99, 95% CI 1.24–3.21) was the major risk factor for postpartum prediabetes.ConclusionsLess than one‐third of women with GDM underwent PGST, and nearly one‐third of these women had abnormal results. Future efforts should focus on reducing the barriers to PGST in women with GDM.     

妊娠糖尿病孕妇骨代谢状况的研究

目的探讨妊娠糖尿病（GDM）孕妇与正常孕妇骨代谢特点的异同。方法比较67例妊娠糖尿病患者（GDM组）与13例正常糖耐量孕妇（NGT组）血钙、磷、ALP、250HD、CTx、24h尿钙、跟骨超声（SOS）等骨代谢指标的异同。然后将GDM组患者分为A、B两组,分别给予低、高两种不同剂量钙和维生素D干预至分娩前,比较两组治疗前后上述指标的差异。结果GDM组血钙、磷为（2．3±0．1）mmol／L、（1．3±0．2）mmol／L,NGT组血钙、磷分别为（2．2±0．1）mmol／L,（1．1±0．1）mmol／L（P〈0．05）;GDM组和NGT组24h尿钙均升高;GDMB组24h尿钙治疗前为（11．0±6．9）mmol／L,治疗后为（8．2±4．3）mmol／L,明显下降（P〈0．05）。结论GDM孕妇骨代谢特点和NGT孕妇基本相同,24h尿钙均显著增加。GDM可能导致血钙、磷轻度增加。补充足量的钙剂和维生素D可使尿钙丢失减少。     

Screening for gestational diabetes mellitus and its prevalence in Bangladesh

Background

The prevalence of gestational diabetes mellitus (GDM) has important health complications for both mother and child and is increasing all over the world. Although prevalence estimates for GDM are not new in developed and many developing countries, data are lacking for many low-income countries like Bangladesh.

Objective

To evaluate the prevalence of GDM in Bangladesh.

Research design and methods

This cross-sectional study included 3447 women who consecutively visited the antenatal clinics with an average gestation age of 26 weeks. GDM was defined according to WHO criteria (fasting plasma glucose [FPG] ≥7.0 mmol/L or 2-h ≥7.8 mmol/L) and the new ADA criteria (FPG ≥5.3 mmol/L or 2-h ≥8.6 mmol/L OGTT). We also calculated overt diabetes as FPG ≥7.0 mmol/L.

Results

Prevalence of GDM was 9.7% according to the WHO criteria and 12.9% according to the ADA criteria in this study population. Prevalence of overt diabetes was 1.8%. Women with GDM were older, higher educated, had higher household income, higher parity, parental history of diabetes, and more hypertensive, compared with non-GDM women.

Conclusion

This study demonstrates a high prevalence of GDM in Bangladesh. These estimates for GDM may help to formulate new policies to prevent and manage diabetes.     

Risk factors of gestational diabetes mellitus using results of a prospective population-based study in Iranian pregnant women

Aims

Early identification of at-risk groups is an important step in preventing gestational diabetes and its subsequent side effects. This study aimed to evaluate the risk factors of gestational diabetes based on the International Association of Diabetes and Pregnancy Study Groups criteria in Ahvaz.

An immunological and genetic study of patients with gestational diabetes mellitus

The aim of the study was to evaluate the frequency of islet cell (ICA) and insulin (IAA) antibodies and of HLA antigen typing in a group of subjects diagnosed with gestational diabetes mellitus (GDM) in a screening-diagnostic program during pregnancy. ICA, complement-fixing (CF) ICA and other autoantibodies, absolute number and percentage of lymphocyte subpopulations, and HLA antigens were evaluated in 68 women with GDN and compared with those of matched controls. ICA were found in 2 (2.9%) and IAA in 1 (1.5%). Both ICA-positive women had CF-ICA; one of them was receiving insulin therapy, while the other was on a special diet. No correlations were found between ICA and IAA, nor between IAA and insulin treatment. As far as lymphocyte subsets were concerned, we found a significant increase in the absolute number of total and activated (CD3+HLA-DR+) T lymphocytes and a significant increase in the absolute number and percentage of suppressor/cytotoxic T lymphocytes (CD8) and NK lymphocytes (CD57) in GDM patients compared with normal pregnant controls. Concerning frequency for HLA A, B, C, DR antigens in the GDM population, only Cw₇ was found to be significantly increased and A₁₀ significantly decreased in comparison with controls. Our study suggests that GDM is a heterogeneous disorder in which few patients present with the immunologic and genetic markers of type 1 diabetes.