scholarly journals The effects of insulin therapy on maternal blood pressure and weight in women with gestational diabetes mellitus

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tiange Sun ◽  
Fanhua Meng ◽  
Shufei Zang ◽  
Yue Li ◽  
Rui Zhang ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Insulin Therapy ◽  
Lifestyle Intervention ◽  
Intervention Group ◽  
Maternal Blood ◽  
Maternal Weight ◽  
Short Term ◽  
Family History Of Diabetes ◽  
History Of ◽  
Maternal Blood Pressure

Abstract Background Although insulin therapy achieves effective glycemic control, it may aggravate hyperinsulinemia. Nonetheless the benefits of insulin as first-line treatment for women with GDM are controversial. This work aimed to investigate the effect of insulin on maternal GDM. Methods This retrospective cohort study recruited 708 women with GDM of whom 616 underwent lifestyle intervention and 92 were prescribed insulin therapy. Differences in variables between the two groups were analyzed by univariate analysis and multivariate analysis. Propensity score matching was used to control for age, pre-pregnancy BMI, time and BP at GDM diagnosis, and family history of diabetes and hypertension. Paired sample test was applied to evaluate the changes in BP after intervention in the two groups of women. Results There was no significant difference in mode of delivery, newborn weight or incidence of macrosomia between women prescribed insulin and those who adopted lifestyle modifications. Insulin therapy was associated with a slight increase in maternal weight compared with the lifestyle intervention group and was attributed to short-term treatment (about 12 weeks). In addition, insulin therapy remarkably increased maternal blood pressure, an effect that persisted after matching age, pre-pregnancy BMI, time and BP at GDM diagnosis, and family history of diabetes and hypertension. Between commencing insulin therapy and delivery, systolic blood pressure significantly increased by 6mmHg (P = 0.015) and diastolic blood pressure by 9 mmHg (P < 0.001). Increase in BP was significantly higher in the insulin group compared with the lifestyle intervention group (P < 0.001). Logistic regression analysis with enter selection confirmed that insulin therapy was closely correlated with development of gestational hypertension (GH). Conclusions This work suggested that short-term insulin therapy for GDM was associated with a slight increase in maternal weight but a significant risk of increasing maternal blood pressure.

scholarly journals Associations of maternal blood pressure-raising polygenic risk scores with fetal weight

2021 ◽  
Author(s):  
Tsegaselassie Workalemahu ◽  
Mohammad L. Rahman ◽  
Marion Ouidir ◽  
Jing Wu ◽  
Cuilin Zhang ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Maternal Blood ◽  
Fetal Weight ◽  
Risk Scores ◽  
Polygenic Risk ◽  
Maternal Blood Pressure

The Importance of Mercury Speciation in the Association of Mercury Exposure During Pregnancy with Elevated Maternal Blood Pressure

Epidemiology ◽  
2009 ◽  
Vol 20 ◽  
pp. S220
Author(s):  
Ellen M Wells ◽  
Carl P Verdon ◽  
Jeff Jarrett ◽  
Kathleen L Caldwell ◽  
Frank Witter ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Maternal Blood ◽  
Mercury Exposure ◽  
Mercury Speciation ◽  
Exposure During Pregnancy ◽  
Maternal Blood Pressure

Norepinephrine as an Alternative in Hypotension Prophylaxis During Cesarean Sectionunder Spinal Anesthesia

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mohamed I Shahin ◽  
Ayman M Kamaly ◽  
Mohamed Saleh ◽  
Ashraf E El-Agamy
Keyword(s):  
Blood Pressure ◽  
Spinal Anesthesia ◽  
Cesarean Delivery ◽  
Hypotensive Effect ◽  
Maternal Blood ◽  
Cesarean Sections ◽  
Fluid Loading ◽  
Elective Cesarean ◽  
Spinal Hypotension ◽  
Maternal Blood Pressure

Abstract Background Spinal anesthesia is the preferred method for elective cesarean sections (C.S.) due to considerable risks regarding airway management associated with physiological changes of pregnancy. Hypotension is reported to occur in up to 80% of spinal anesthesia cases. Many approaches have been investigated to prevent spinal hypotension, e.g., fluid loading, vasopressors, or both. Thus we compare the administration of intermittent I.V. boluses of norepinephrine and ephedrine to guard against the hypotensive effect of spinal anesthesia during cesarean delivery. Patients and Methods 120 female patients undergoing electiveC.S.were randomly divided into “group-E” for Ephedrine and “group-N” for Norepinephrine. Results Compared with ephedrine, norepinephrine maintained maternal blood pressure and uterine artery blood flow. Further, it was associated with lower numbers of hypotension and hypertension episodes and less frequency of bradycardia and tachycardia during cesarean delivery. Conclusion Norepinephrine can be used as an alternative vasopressor to maintain maternal blood pressure during spinal anesthesia for cesarean delivery, with no adverse effect on neonatal outcome.

Abstract P121: Comparative Effectiveness Study of the Diabetes Prevention Program in Families: Preliminary Results

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Jennifer Wessel ◽  
Erin O'Kelly-Phillips ◽  
Kelly Palmer ◽  
Chandan Saha ◽  
Tamara Hannon ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Prevention Program ◽  
Diabetes Prevention ◽  
Intervention Group ◽  
Diabetes Prevention Program ◽  
Comparative Effectiveness Study ◽  
Develop Type ◽  
History Of ◽  
Family Based

The prevalence of gestational diabetes (GDM) is increasing substantially and currently affects up to 14% of pregnancies. As many as 70% of women with GDM will develop type 2 diabetes (T2D) in the next 10 years. Moreover as many as 40% of children exposed to in-utero diabetes will develop obesity and T2D. The Diabetes Prevention Program (DPP) is an evidence-based lifestyle intervention that has been shown to lower T2D risk by 58% in high-risk adults. Family based lifestyle interventions that target either children, parents or both have reported mixed results. We modified the DPP curriculum to use with families (DPPF) and recruited mothers with a history of GDM and their children 8-15 years old. We randomized n=130 families to test which method of delivering the DPPF (mothers only (M) or mothers and their children (M+C)) is more effective at lowering families T2D risk. Baseline characteristics of women were similar among each intervention group (n=65 M and n=65 M+C, respectively): age (38±8 vs 39±11, P=0.5), ethnicity (Black 55% vs 55%, White 20% vs 17%, Latino 20% vs 27%, other 5% vs 2%, P=0.6), body mass index (BMI, 37±8 vs 38±7, P=0.24), systolic blood pressure (SBP, 121±11 vs 122±13, P=0.8), diastolic blood pressure (DBP, 103±26 vs 105±21, P=0.6), HbA1c (5.6±0.4 vs 5.7±0.3, p=0.2). The majority of women self-reported low levels of physical activity (PA): moderate PA (2 days or less per week, 42% vs 26%, P=0.06) or vigorous PA (2 days or less per week, 38% vs 25%, P=0.1), and high levels of sedentary activities (3 or more hours per day, 49% vs 58%, P=0.2). For diet related obesogenic behaviors women self-reported high levels of eating meals while watching TV (3 days or more per week, 58% vs 74%, P=.06) and eating at restaurants (3 days or more per week, 28% vs 41%, P=0.1). Follow-up is ongoing and currently n=32 families have completed the 3-month follow-up. Preliminary analyses of mothers show decreases in HbA1c (-.01±.3 vs -.1±.2), SBP (-9.7±30 vs -3.1±8), DBP (-8±19 vs -1±9) but not BMI (0.07±1.6 vs 0.04±1.2); however results were not significantly different by intervention group.

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