scholarly journals Myoinositol plus α-lactalbumin supplementation, insulin resistance and birth outcomes in women with gestational diabetes mellitus: a randomized, controlled study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Rosario D’Anna ◽  
Francesco Corrado ◽  
Saverio Loddo ◽  
Giuseppe Gullo ◽  
Loretta Giunta ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Insulin Resistance ◽  
Folic Acid ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Clinical Outcomes ◽  
Fetal Growth ◽  
Treated Group ◽  
Abdominal Circumference ◽  
Reduce Insulin Resistance

AbstractTo verify whether myo-inositol plus α-lactalbumin may reduce insulin resistance and excessive fetal growth in women with gestational diabetes mellitus. In a 12-month period, 120 women with a diagnosis of gestational diabetes mellitus were consecutively enrolled with an allocation of 1:1 in each group and randomly treated with myo-inositol plus α-lactalbumin plus folic acid (treated group) or folic acid (control group) for 2 months. Primary outcome was the variation of insulin resistance through the study evaluated by HOMA-IR. Secondary outcome was the evaluation, through the study, of fetal growth by ultrasound measurements of abdominal circumference centiles and estimated fat thickness. Some clinical outcomes were also considered. After 2 months, in the treated group, a significant reduction in insulin resistance (HOMA values 3.1 ± 1.4 vs 6.1 ± 3.4, p = 0.0002) and fetal growth was shown (Abdominal circumference centiles 54.9 ± 23.5 vs 67.5 ± 22.6, P = 0.006). Among clinical outcomes, a significant decrease in the rate of women who needed insulin (6.7% vs 20.3%, p = 0.03) and of pre-term birth (0 vs 15.2%, p = 0.007) was evidenced. A combination of myo-inositol and α-lactalbumin may reduce insulin resistance and excessive fetal growth.Clinical trial registration: ClinicalTrials.gov, http://www.clinicaltrials.gov, NCT 03763669, first posted date 04/12/2018; last posted date December 06/12/2018.

scholarly journals Combined Effect of Maternal Vitamin D Deficiency and Gestational Diabetes Mellitus on Trajectories of Ultrasound-Measured Fetal Growth: A Birth Cohort Study in Beijing, China

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Zheng Liu ◽  
Hui Liu ◽  
Xiangrong Xu ◽  
Shusheng Luo ◽  
Jue Liu ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Birth Cohort ◽  
Fetal Growth ◽  
Reference Population ◽  
Abdominal Circumference ◽  
Birth Cohort Study ◽  
Increased Risk ◽  
Beijing China

Objective. Few studies have examined whether maternal 25(OH)D deficiency and gestational diabetes mellitus (GDM) jointly affect fetal growth. We aimed to examine the separate and combined effects of maternal 25(OH)D deficiency and GDM on trajectories of fetal growth. Methods. We established a birth cohort (2016-2017) with 10,913 singleton pregnancies in Tongzhou Maternal and Child Health Hospital of Beijing, China. Maternal 25(OH)D deficiency (serum 25OHD concentration<20.0 ng/mL) was detected, and GDM was diagnosed at 24~28 gestational weeks. Fetal growth was assessed by longitudinal ultrasound measurements of estimated fetal weight (EFW) and abdominal circumference (AC) from 28 gestational weeks to delivery, both of which were standardized as gestational-age-adjusted Z-score. A k-means algorithm was used to cluster the longitudinal measurements (trajectories) of fetal growth. Logistic regression models were used for estimating exposure-outcome associations and additive interactions. Results. We identified two distinct trajectories of fetal growth, and the faster one resembling the 90th centile curve in the reference population was classified as excessive fetal growth. Maternal 25(OH)D deficiency and GDM were independently associated with an increased risk of excessive fetal growth. The combination of maternal 25(OH)D deficiency and GDM was associated with an increased risk of excessive fetal growth assessed by EFW Z-score (odds ratio (OR): 1.36; 95% confidence interval (CI): 1.15~1.62) and AC Z-score (OR (95% CI): 1.32 (1.11~1.56)), but the relative excess risks attributable to interaction were nonsignificant (P>0.05). Conclusion. Maternal 25(OH)D deficiency and GDM may jointly increase the risk of excessive fetal growth. Interventions for pregnancies with GDM may be more beneficial for those with 25(OH)D deficiency than those without regarding risk of excessive fetal growth, if confirmed in a large sample.

scholarly journals Gestational Diabetes Mellitus: Predictive Value of Fetal Growth Measurements by Ultrasonography at 22–24 Weeks: A Retrospective Cohort Study of Medical Records

Nutrients ◽  
2020 ◽  
Vol 12 (12) ◽  
pp. 3645
Author(s):  
Danyao Jin ◽  
Janet Wilson Rich-Edwards ◽  
Chunyi Chen ◽  
Yue Huang ◽  
Yinping Wang ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Fetal Growth ◽  
Medical Records ◽  
Generalized Estimating Equations ◽  
Abdominal Circumference ◽  
Fetal Head ◽  
Femur Length ◽  
Fetal Size

Early intervention of gestational diabetes mellitus (GDM) is effective in reducing pregnancy disorders. Fetal growth, measured by routine ultrasound scan a few weeks earlier before GDM diagnosis, might be useful to identify women at high risk of GDM. In the study, generalized estimating equations were applied to examine the associations between ultrasonic indicators of abnormal fetal growth at 22–24 weeks and the risk of subsequent GDM diagnosis. Of 44,179 deliveries, 8324 (18.8%) were diagnosed with GDM between 24 and 28 weeks. At 22–24 weeks, fetal head circumference (HC) < 10th, fetal femur length (FL) < 10th, and estimated fetal weight (EFW) < 10th percentile were associated with 13% to 17% increased risks of maternal GDM diagnosis. Small fetal size appeared to be especially predictive of GDM among women who were parous. Fetal growth in the highest decile of abdominal circumference (AC), HC, FL and EFW was not associated with risk of subsequent GDM. The observed mean difference in fetal size across gestation by GDM was small; there was less than 1 mm difference for AC, HC, and FL, and less than 5 g for EFW before 24 weeks. Despite similar mean fetal growth among women who were and were not later diagnosed with GDM, mothers with fetuses in the lowest decile of HC, FL and EFW at 22–24 weeks tended to have higher risk of GDM.

scholarly journals Early Onset Acceleration of Fetal Growth in Gestational Diabetes Mellitus: Deciding About When and Whom to Screen for Preventing Fetal Macrosomia

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A353-A353
Author(s):  
Maria Mirabelli ◽  
Eusebio Chiefari ◽  
Paola Quaresima ◽  
Federica Visconti ◽  
Daniela Foti ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Fetal Growth ◽  
Early Onset ◽  
Abdominal Circumference ◽  
Fetal Macrosomia ◽  
Screening Strategies ◽  
Initial Acceleration ◽  
Current Screening

Abstract The precise time into pregnancy at which women are screened for gestational diabetes mellitus (GDM) is crucial for determining the benefits of diagnosis. However, this issue remains a source of intense debate among guidance authorities and there is no consensus about when and whom to screen. Since 2010, the IADPSG recommends universal screening with 75g OGTT at 24–28 weeks’ gestation (WG), due to evidence of a positive linear correlation between maternal blood glucose levels around 28 WG and risk of fetal macrosomia. Nonetheless, emerging evidence indicates that initial acceleration of fetal growth (FG) related to GDM, predicting fetal macrosomia, is already underway at 20 WG, thereby suggesting that screening strategies for GDM earlier than the recommended 24–28 WG should be reconsidered (1). By exploiting the routine 19–21 WG obstetrical assessment of FG (anomaly scan), along with the risk stratification system endorsed by the Italian NHS, which offers, in addition to the usual GDM screening test at 24–28 WG, an early 75g OGTT at 16–18 WG to women who are classified as at high risk (HR) for GDM (i.e. previous GDM, pre-gravid obesity, or FPG at first prenatal visit between 5.6–6.9 mmol/L), we aimed to verify whether an early onset acceleration of FG related to GDM would be observed in our pregnant population, and if reversion could occur with current screening recommendations. For this, 769 consecutive women in singleton pregnancies, subjected to both anomaly scan and GDM screening, were retrospectively enrolled at our Institution between Jan 2018-Feb 2020. At a mean time of 20.8 WG, the percentiles of estimated fetal weight (EFW) and abdominal circumference (AC) were significantly higher in women who tested positive for GDM at late screening than in women with normal glucose tolerance (NGT). However, while no differences in the birthweight (BW) percentiles of neonates born to non-HR women diagnosed with GDM at 24–28 WG, with respect to NGT women were observed (p=0.416), neonates born to HR women diagnosed with GDM at 24–28 WG (due to refusal to comply with early screening advices) were significantly heavier (p&lt;0.001). In contrast, both the EFW and AC percentiles, as well as the BW percentiles, were significantly lower in infants born to HR women diagnosed with GDM at 16–18 WG with respect to their late diagnosis counterparts (EFW p=0.001, AC p=0.002, BW p=0.048), and not dissimilar to those of NGT women (EFW p=0.824, AC p=0.873, BW p=0.242). These results were confirmed by regression analysis, while adjusting for maternal confounders. Although an initial acceleration of FG related to GDM can be detected at anomaly scan in non-HR women, reversion occurs with current screening recommendations. Earlier screening strategies should be reserved to HR women, as the acceleration of FG related to GDM in these cases is less responsive to treatment delays. (1) Ref: Li et al. Lancet Diabetes Endocrinol. 2020;8(4):292–300.

scholarly journals Fetuin-A and fetal growth in gestational diabetes mellitus

2020 ◽  
Vol 8 (1) ◽  
pp. e000864 ◽  
Author(s):  
Wen-Juan Wang ◽  
Lin Zhang ◽  
Tao Zheng ◽  
Guang-Hui Zhang ◽  
Kun Du ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Insulin Resistance ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Cord Blood ◽  
Fetal Growth ◽  
Birth Length ◽  
Postnatal Life ◽  
Fetuin A ◽  
Igf I

ObjectiveFetuin-A is a glycoprotein produced by hepatocytes and has been associated with insulin resistance and bone growth in postnatal life. Gestational diabetes mellitus (GDM) is a condition characterized by insulin resistance. It is unclear whether GDM may affect cord blood fetuin-A levels and whether fetuin-A is associated with fetal growth.Research design and methodsIn a nested case–control study of 153 matched pairs of neonates of mothers with GDM and euglycemic pregnancies in the Shanghai Birth Cohort, we evaluated cord blood fetuin-A in association with GDM and fetal growth.ResultsComparing the newborns of GDM versus euglycemic mothers, cord blood fetuin-A concentrations were similar (mean±SD: 783.6±320.0 vs 754.8±281.9 µg/mL, p=0.53), while insulin-like growth factor (IGF)-I (76.6±27.8 ng/mL vs 68.1±25.1 ng/mL, p=0.008) and IGF-II (195.3±32.5 ng/mL vs 187.5±30.8 ng/mL, p=0.042) concentrations were higher. Cord blood fetuin-A was not correlated with insulin, IGF-I or IGF-II. Cord blood fetuin-A was negatively correlated with birth weight (r=−0.19, p=0.025) and birth length (r=−0.24, p=0.005) z scores in GDM pregnancies, while there were no significant correlations in euglycemic pregnancies (tests for interaction: p=0.014 for birth length, p=0.013 for birth length). Adjusting for maternal and neonatal characteristics, the differential associations remained.ConclusionsGDM was not associated with cord blood fetuin-A levels. Fetuin-A was negatively associated with fetal growth in GDM but not in euglycemic pregnancies. This novel observation suggests a GDM-conditional negative correlation of fetuin-A with fetal growth.

scholarly journals Plasma retinol-binding protein 4 in the first and second trimester and risk of gestational diabetes mellitus in Chinese women: a nested case-control study

2020 ◽  
Vol 17 (1) ◽  
Author(s):  
Chuyao Jin ◽  
Lizi Lin ◽  
Na Han ◽  
Zhiling Zhao ◽  
Zheng Liu ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Insulin Resistance ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Binding Protein ◽  
First Trimester ◽  
Retinol Binding Protein ◽  
Second Trimester ◽  
Retinol Binding Protein 4 ◽  
Plasma Retinol

Abstract Background To assess the association between plasma retinol-binding protein 4 (RBP4) levels both in the first trimester and second trimester and risk of gestational diabetes mellitus (GDM). Methods Plasma RBP4 levels and insulin were measured among 135 GDM cases and 135 controls nested within the Peking University Birth Cohort in Tongzhou. Multivariable linear regression analysis was conducted to assess the influence of RBP4 levels on insulin resistance. Conditional logistic regression models were used to compute the odds ratio (OR) and 95% confidence interval (CI) between RBP4 levels and risk of GDM. Results The GDM cases had significantly higher levels of RBP4 in the first trimester than controls (medians: 18.0 μg/L vs 14.4 μg/L; P < 0.05). Plasma RBP4 concentrations in the first and second trimester were associated with fasting insulin, homeostasis model assessment for insulin resistance (HOMA-IR), and the quantitative insulin sensitivity check index (QUICKI) in the second trimester (all P < 0.001). With adjustment for diet, physical activity, and other risk factors for GDM, the risk of GDM increased with every 1-log μg/L increment of RBP4 levels, and the OR (95% CI) was 3.12 (1.08–9.04) for RBP4 in the first trimester and 3.38 (1.03–11.08) for RBP4 in the second trimester. Conclusions Plasma RBP4 levels both in the first trimester and second trimester were dose-dependently associated with increased risk of GDM.

scholarly journals 726 Fetal growth by ultrasound prior to the diagnosis of gestational diabetes mellitus in nulliparous women

2021 ◽  
Vol 224 (2) ◽  
pp. S455-S456
Author(s):  
Alexandra Mahdasian-Miller ◽  
Christina Scifres ◽  
David M. Haas ◽  
William A. Grobman ◽  
Robert M. Silver ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Fetal Growth ◽  
Nulliparous Women

Placental Accumulation of Triacylglycerols in Gestational Diabetes Mellitus and Its Association with Altered Fetal Growth are Related to the Differential Expressions of Proteins of Lipid Metabolism

2020 ◽  
Author(s):  
Manoharan Balachandiran ◽  
Zachariah Bobby ◽  
Gowri Dorairajan ◽  
Sajini Elizabeth Jacob ◽  
Victorraj Gladwin ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Fatty Acid ◽  
Lipid Metabolism ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Fetal Growth ◽  
Fatty Acid Synthase ◽  
Regulatory Element ◽  
Acid Oxidation ◽  
Placental Proteins

Abstract Introduction Gestational diabetes mellitus (GDM) exhibit altered placental lipid metabolism. The molecular basis of this altered metabolism is not clear. Altered placental expression of proteins of lipogenesis and fatty acid oxidation may be involved in the placental accumulation of triacylglycerols (TG). The present study was aimed at investigating the differential expressions of placental proteins related to lipid metabolism among GDM women in comparison with control pregnant women (CPW) and to correlate them with maternal and fetal lipid parameters as well as altered fetal growth. Materials and Methods Maternal blood, cord blood, and placental samples were collected from GDM and CPW. The biochemical parameters, glucose, lipid profile and free fatty acids (FFA) were measured. The placental TG content was measured. Differential placental expressions of proteins; phosphatidylinositol-3-kinase (PI3K) p85α, PI3K p110α,liver X receptor alpha (LXRα), sterol regulatory element binding protein1(SREBP1), fatty acid synthase (FAS), stearyl CoA desaturase1 (SCD1), lipoprotein lipase (LPL),Peroxisome proliferator-activated receptor (PPAR)α and PPARγ were analysed by western blotting and immunohistochemistry. Results Placental protein expressions of PI3K p110α, LXRα, FAS, SCD1, and LPL were found to be significantly higher, whereas PPARα and PPARγ were lower in GDM women compared with CPW. The placental TG content and cord plasma FFA were increased in GDM women compared with CPW. The placental TG content positively correlated with Ponderal index of GDM new-borns. Conclusion Differential expressions of placental proteins related to lipid metabolism in GDM might have led to placental TG accumulation. This might have contributed to the fetal overgrowth in GDM.

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