scholarly journals Is improvement in the Healthy Food Intake Index (HFII) related to a lower risk for gestational diabetes?

2017 ◽  
Vol 117 (8) ◽  
pp. 1103-1109 ◽  
Author(s):  
Jelena Meinilä ◽  
Anita Valkama ◽  
Saila B. Koivusalo ◽  
Beata Stach-Lempinen ◽  
Kristiina Rönö ◽  
...  
Keyword(s):  
Food Intake ◽  
Gestational Diabetes ◽  
Lower Risk ◽  
First Trimester ◽  
Tolerance Test ◽  
Healthy Food ◽  
Oral Glucose ◽  
Fat Percentage ◽  
Exact Test ◽  
The Mean

AbstractThe aim was to analyse whether changes in the Healthy Food Intake Index (HFII) during pregnancy are related to gestational diabetes (GDM) risk. The 251 pregnant women participating had a pre-pregnancy BMI≥30 kg/m2 and/or a history of GDM. A 75 g oral glucose tolerance test (OGTT) was performed during the first and second trimesters of pregnancy for assessment of GDM. A normal OGTT result at first trimester was an inclusion criterion for the study. FFQ collected at first and second trimesters served for calculating the HFII. A higher HFII score reflects higher adherence to the Nordic Nutrition Recommendations (NNR) (score range 0–17). Statistical methods included Student’s t test, Mann–Whitney U test, Fisher’s exact test and linear and logistic regression analyses. The mean HFII at first trimester was 10·1 (95 % CI 9·7, 10·4) points, and the mean change from the first to the second trimester was 0·35 (95 % CI 0·09, 0·62) points. The range of the HFII changes varied from –7 to 7. The odds for GDM decreased with higher HFII change (adjusted OR 0·83 per one unit increase in HFII; 95 % CI 0·69, 0·99; P=0·043). In the analysis of the association between HFII-sub-indices and GDM, odds for GDM decreased with higher HFII-Fat change (fat percentage of milk and cheese, type of spread and cooking fats) but it was not significant in a fully adjusted model (P=0·058). Dietary changes towards the NNR during pregnancy seem to be related to a lower risk for GDM.

scholarly journals Significant seasonal variations in the rate of women diagnosed with gestational diabetes: A observational single centre study of 28,128 women

2021 ◽  
Author(s):  
Matthew Cauldwell ◽  
Yolande VanDerI'isle ◽  
Ingrid Watt-Coote ◽  
Philip Steer
Keyword(s):  
Gestational Diabetes ◽  
Glucose Tolerance Test ◽  
Tolerance Test ◽  
Oral Glucose ◽  
Test Design ◽  
Single Centre ◽  
June July August ◽  
Single Centre Study ◽  
The Mean ◽  
June July

Objective To test the hypothesis that there is seasonal variation in the rates of gestational diabetes (GDM) diagnosed using a 2 hour oral glucose tolerance test. Design Monthly assessment of the percentage of women screened from 1st April 2016 to the 31st December 2020 who were diagnosed as having gestational diabetes Setting London Teaching Hospital Population 28,128 women receiving antenatal care between April 1st 2016 and 31 December 2020. Methods Retrospective study of prospectively collected data. Main Outcome Measures Proportion of women screened diagnosed as having gestational diabetes. Results The mean (SD) percentage of women diagnosed with GDM was 14.78 (2.24) in summer (June, July, August) compared with 11.23 (1.62) in winter (p < 0.001), 12.13 (1.94) in spring (p = 0.002), and 11.88 (2.67) in autumn (p = 0.003). There was a highly significant positive correlation of the percentage testing positive for GDM with the mean maximum monthly temperature (R2 = 0.248, p < 0.001). There was a statistically significant 33.8% increase in the proportion of GDM diagnoses from June 2020 onwards, possibly related to a reduction in exercise secondary to the Covid-19 pandemic. Conclusions There is a 23.3% higher rate of GDM diagnoses in the warmer summer months. There has been a 33.8% rise in GDM diagnoses associated with the Covid-19 pandemic.

scholarly journals The Effects of Hyperemesis Gravidarum on the Oral Glucose Tolerance Test Values and Gestational Diabetes

2021 ◽  
Vol 122 (4) ◽  
pp. 285-293
Author(s):  
Burak Bayraktar ◽  
Meric Balikoglu ◽  
Miyase Gizem Bayraktar ◽  
Ahkam Goksel Kanmaz
Keyword(s):  
Blood Glucose ◽  
Gestational Diabetes ◽  
Glucose Tolerance Test ◽  
Hyperemesis Gravidarum ◽  
First Trimester ◽  
Tolerance Test ◽  
Control Group ◽  
Oral Glucose ◽  
Second Trimester ◽  
Oral Glucose Tolerance

This study is aimed at determination whether pregnant women who develop hyperemesis gravidarum in the first trimester have a tendency to develop gestational diabetes mellitus (GDM). It is also aimed at identification of effects of hyperemesis gravidarum and GDM on prenatal and neonatal status in case they were detected together. Hyperemesis gravidarum diagnose was based on the following signs and symptoms. To diagnose GDM, first trimester fasting blood glucose measurement and subsequent blood glucose monitoring and 75-g oral glucose tolerance test (OGTT) were performed in the second trimester. A total of 949 singleton pregnant women (95 with and 852 without hyperemesis gravidarum) who met our criteria were included in the study. In the first trimester, plasma blood glucose and positive GDM screening were found to be significantly higher in the hyperemesis gravidarum group compared to the control group (p=0.042 and p<0.001, respectively). However, actual GDM cases were similar between both groups. The positive predictive value was significantly lower in the hyperemesis gravidarum group (28.5% vs. 72.7%, p=0.003). In the second trimester, the prevalence of GDM was 6.6% in the hyperemesis gravidarum group and 7.3% in the control group, with no significant difference (p=0.218) between-groups. In this study, hyperemesis gravidarum was found to cause changes in maternal metabolism in the first trimester of pregnancy due to limited calorie intake and fasting; in the presence of hyperemesis gravidarum, it should be known that the positive predictive value of first trimester gestational diabetes screening may decrease and the diagnosis of pseudo-GDM may increase.

scholarly journals The Utility of Glycated Hemoglobin, Determined in the Second Trimester of Pregnancy, in Diagnosing Gestational Diabetes

2015 ◽  
Vol 22 (3) ◽  
pp. 233-240
Author(s):  
Monica Vereș ◽  
Doru Ioan Crăiuț ◽  
Johann Trutz ◽  
Aurel Babeș
Keyword(s):  
Gestational Diabetes ◽  
Area Under The Curve ◽  
First Trimester ◽  
Tolerance Test ◽  
Oral Glucose ◽  
Second Trimester ◽  
Mortality And Morbidity ◽  
Average Value ◽  
Study Results ◽  
First Trimester Of Pregnancy

Abstract Background and Aims: Gestational diabetes (GD) identifies a pregnancy with high obstetrical risk due to the possible complications that may appear and which are associated with significant perinatal mortality and morbidity. The role of HbA1c in diagnosing GD is still debatable. Our aim was to evaluate the clinical utility of HbA1c assessed in the second trimester of pregnancy (before performing the oral glucose tolerance test - OGTT) in establishing the macrosomia risk, and also for diagnosing GD. Material and methods: This was an observational study on a group of 165 pregnant women followed from the first trimester of pregnancy in whom we measured HbA1c in the second trimester, before running an OGTT with 100 grams of glucose and who delivered at term (37 - 41 weeks of pregnancy). Finally, HbA1c and OGTT were performed only in 132 women, these being the subjects of our study. Results: The average value of HbA1c was 4.85±1.23%. HbA1c was higher in the group having gestational diabetes (6.58±0.74%) in comparison to the group not having GD (4.52±0,80%). The Receiver Operating Characteristic (ROC) curve for HbA1c determined in the second trimester, for diagnosis of GD, has an area under the curve (AUC) of 0.939. Conclusions: HbA1c value could be considered as a sensitive and specific predictive factor in appreciating the macrosomia risk and could be set as an extra criterion in GD diagnosis.

scholarly journals Maternal hyperinsulinism and glycaemic status in the first trimester of pregnancy are associated with the development of pregnancy-induced hypertension and gestational diabetes

2013 ◽  
Vol 168 (3) ◽  
pp. 413-418 ◽  
Author(s):  
Simon Kayemba-Kay's ◽  
Catherine Peters ◽  
Michael P P Geary ◽  
Nathan R Hill ◽  
David R Mathews ◽  
...  
Keyword(s):  
Gestational Diabetes ◽  
Pregnant Women ◽  
Plasma Insulin ◽  
Fasting Glucose ◽  
First Trimester ◽  
Tolerance Test ◽  
Antenatal Visit ◽  
Oral Glucose ◽  
Pregnancy Induced Hypertension ◽  
Induced Hypertension

ObjectiveTo evaluate the relationships across a range of glucose and insulin measures at 12 weeks of gestation with the development of pregnancy-induced hypertension (PIH), gestational diabetes mellitus (GDM) and birth size.Materials and methodsProspective study of pregnant women booking before 15th week of gestation. At the first antenatal visit, standard measures of height, weight, blood pressure (BP) and social status were recorded, and blood sample was drawn for measurements of fasting glucose and plasma insulin. Oral glucose tolerance test with 75 g glucose load was performed after overnight fast. Odds ratios (ORs) with 95% CI were calculated to determine the risk of developing PIH or GDM depending on quartiles of blood glucose or tertiles of plasma insulin levels.ResultsOne thousand six hundred and fifty pregnant women were included in the study. Of them, 1484 delivered a live infant of whom 70 were preterm, 166 did not complete the study, 155 mothers developed PIH (10.4%), 18 were diagnosed with GDM (1.2%) and four had both PIH and GDM. At 12 weeks of gestation, women who became hypertensive were heavier (P<0.001), with higher BMI (P<0.001) than controls. Both systolic (P<0.001) and diastolic BPs (P<0.001) were already higher in women who developed PIH. Fasting insulin concentrations were higher in PIH group (P<0.002). Fasting glucose level >6.8 mmol/l was associated with the likelihood of delivering a macrosomic baby (OR 3.1 (95% CI: 1.21–8.0); P=0.02); the effect was heightened in multiparous mothers (OR 4.0 (95% CI: 1.4–11.1); P=0.01). Fasting plasma insulin had, however, no effect on size at birth in this study.ConclusionsOur data suggest that women who develop PIH may be metabolically challenged at early stages of pregnancy with hyperinsulinism, insulin insensitivity and slightly higher BP.

scholarly journals Association between dietary inflammatory potential and risk of developing gestational diabetes: a prospective cohort study

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Sanaz Soltani ◽  
Azadeh Aminianfar ◽  
Hossein Hajianfar ◽  
Leila Azadbakht ◽  
Zahra Shahshahan ◽  
...  
Keyword(s):  
Cohort Study ◽  
Gestational Diabetes ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Cox Regression ◽  
First Trimester ◽  
Tolerance Test ◽  
Oral Glucose ◽  
Dietary Intakes ◽  
Maternal Weight

Abstract Background Limited and inconsistent data are available regarding the relationship between the dietary inflammatory potential (DIP) and risk of gestational diabetes mellitus (GDM). Objective The present prospective study aimed to evaluate the association between DIP score during the first trimester of pregnancy and risk of developing GDM among Iranian women. Methods In this prospective cohort study, 812 pregnant women aged 20–40 years, who were in their first trimester, were recruited and followed up until week 24–28 of gestation. Dietary intakes of study subjects were examined using an interviewer-administered validated 117-item semi-quantitative food frequency questionnaire (FFQ). DIP score was calculated from 29 available food parameters based on earlier literature. The results of a fasting plasma glucose concentration and a 50-g, 1-h oral glucose tolerance test, between the 24th and 28th week of gestation, were used to diagnose GDM. The risk of developing GDM across quartiles of DIP score was estimated using Cox regression in several models. Results At study baseline, mean (SD) age and BMI of study participants were 29.4 (±4.84) y and 25.14 (±4.08) kg/m2, respectively. No significant association was found between DIP score and risk of GDM in the crude model (RR: 1.01; 95% CIs: 0.71–1.45). When we adjusted for age the association did not alter (RR: 1.04; 95% CIs: 0.72–1.48). Even after further adjustment for maternal weight gain we failed to find a significant association between DIP score and risk of GDM (RR: 0.97; 95% CIs: 0.66–1.41). Conclusion We found no significant association between DIP and risk of developing GDM. Further longitudinal studies among other populations are needed to elucidate the association between DIP score and GDM.

scholarly journals Who Should Return for an Oral Glucose Tolerance Test? A Proposed Clinical Pathway Based on Retrospective Analysis of 332 Children

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A455-A455
Author(s):  
Sarah Wing-yiu Poon ◽  
Wilfred Hing-sang Wong ◽  
Anita Man-ching Tsang ◽  
Grace Wing-kit Poon ◽  
Joanna Yuet-ling Tung
Keyword(s):  
Family History ◽  
High Risk ◽  
Clinical Pathway ◽  
Lower Risk ◽  
Glucose Tolerance Test ◽  
Tolerance Test ◽  
Oral Glucose ◽  
Oral Glucose Tolerance ◽  
History Of ◽  
The Mean

Abstract Purpose: Fasting plasma glucose (FPG) or oral glucose tolerance test (OGTT) is the traditional diagnostic tool for type 2 diabetes (T2DM). Primary barrier to performing FPG or OGTT in asymptomatic patients is the requirement of fasting, and thus the need for another scheduled visit. For OGTT, at least 2 blood draws would be needed, making the test inconvenient and labour-intensive. These barriers may lead to lower testing rate and possibly under-diagnosis. In a busy clinic setting with increasing number of referrals for children with obesity, a more practical and simpler clinical pathway to stratify those at higher risk of having abnormal OGTT results from the lower risk ones is needed. This study thus aimed to identify simple non-fasting parameters which can be used to formulate a clinical pahtway to stratify subjects according to their risk of abnormal OGTT. Methods: This retrospective study included subjects with overweight or obesity who had undergone OGTT in tertiary paediatric unit from 2012–2018. The optimal haemoglobin A1c (HbA1c) cutoff that predicts abnormal OGTT was evaluated. Other non-fasting parameters, in combination with this HbA1c cutoff, were also explored as predictors of abnormal OGTT. Results: Three hundred and thirty-two subjects (boys: 54.2%, Chinese: 97.3%) were included for analysis, of which, 272 (81.9%) subjects had normal OGTT while 60 (18.0%) subjects had abnormal OGTT (prediabetes or T2DM). The mean age was 15.4 ± 2.3 years and the mean BMI z-score was 2.7 ± 0.6. The mean HbA1c level was significantly higher in the abnormal OGTT group than normal OGTT group (5.6% vs 5.3%, P&lt;0.001). In our cohort, using the ADA criteria for prediabetes with a HbA1c cutoff of ≥ 5.7% only yielded a sensitivity of 41.7% and a specificity of 86% in identifying abnormal OGTT (prediabetes or T2DM), meaning that a substantial proportion of subjects with prediabetes or diabetes will be missed. From Receivers operating characteristic (ROC) curves analysis, optimal HbA1c predicting abnormal OGTT was 5.5% (AUC 0.71; sensitivity of 66.7% and specificity of 71%). When HbA1c ≥ 5.5% was combined with positive family history and abnormal alanine transaminase (ALT) level, the positive predictive value for abnormal OGTT was increased from 33.6% to 61.6%. Conclusion: In our cohort, over 97% were Chinese and close to 60% had family history of T2DM, thus fulfilling the ‘high-risk’ group criteria as suggested by American Diabetes Association to have FPG or OGTT screening. Nevertheless, only 18% of subjects had prediabetes or diabetes based on OGTT results. Our study showed that HbA1c, family history of T2DM and ALT level could be used to derive a clinical pathway to stratify children who have high risk of abnormal OGTT. These high risk individuals can go for further diagnostic tests, while those at lower risk of prediabetes/T2DM can avoid unnecessary tests and additional clinic visits.

scholarly journals Early Identification of the Maternal, Placental, and Fetal Dialog in Gestational Diabetes and Its Prevention

2021 ◽  
Vol 3 (1) ◽  
pp. 1-14
Author(s):  
Amir Naeh ◽  
Esther Maor-Sagie ◽  
Mordechai Hallak ◽  
Rinat Gabbay-Benziv
Keyword(s):  
Gestational Diabetes ◽  
Prediction Models ◽  
Protein A ◽  
First Trimester ◽  
Tolerance Test ◽  
Current Data ◽  
Sex Hormone Binding Globulin ◽  
Oral Glucose ◽  
Adverse Pregnancy ◽  
In Pregnancy

Gestational diabetes mellitus (GDM) complicates between 5 and 12% of pregnancies, with associated maternal, fetal, and neonatal complications. The ideal screening and diagnostic criteria to diagnose and treat GDM have not been established and, currently, diagnostic use with an oral glucose tolerance test occurs late in pregnancy and produces poor reproducibility. Therefore, in recent years, significant research has been undertaken to identify a first-trimester biomarker that can predict GDM later in pregnancy, enable early intervention, and reduce GDM-related adverse pregnancy outcomes. Possible biomarkers include glycemic markers (fasting glucose and hemoglobin A1c), adipocyte-derived markers (adiponectin and leptin), pregnancy-related markers (pregnancy-associated plasma protein-A and the placental growth factor), inflammatory markers (C-reactive protein and tumor necrosis factor-α), insulin resistance markers (sex hormone-binding globulin), and others. This review summarizes current data on first-trimester biomarkers, the advantages, and the limitations. Large multi-ethnic clinical trials and cost-effectiveness analyses are needed not only to build effective prediction models but also to validate their clinical use.

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