scholarly journals Cardiometabolic and mental health in women with early gestational diabetes mellitus: A prospective cohort study

2021 ◽  
Author(s):  
Dan Yedu Quansah ◽  
Justine Gross ◽  
Leah Gilbert ◽  
Amelie Pauchet ◽  
Antje Horsch ◽  
...  
Keyword(s):  
Mental Health ◽  
Risk Factors ◽  
Weight Gain ◽  
Gestational Diabetes ◽  
Gestational Weight Gain ◽  
Gestational Age ◽  
Prospective Cohort ◽  
Gestational Weight ◽  
Pregnancy And Postpartum ◽  
History Of

Abstract Context Early diagnosis and treatment of gestational diabetes (GDM) may reduce adverse obstetric and neonatal outcomes, especially in high-risk women. However, there is a lack of data for other outcomes. Objective We compared cardiometabolic and mental health outcomes in women with early (eGDM) and classical (cGDM) GDM. Methods This prospective cohort included 1185 women with cGDM and 76 women with eGDM. eGDM had GDM-risk factors (BMI >30kg/m 2, family history of diabetes, history of GDM, ethnicity), were tested at <20 weeks gestational age and diagnosed using ADA prediabetes criteria. Women underwent lifestyle adaptations. Obstetric, neonatal, mental, cardiometabolic outcomes were assessed during pregnancy and postpartum. Results eGDM had lower gestational weight gain than cGDM (10.7±6.2 vs 12.6±6.4, p=0.03), but needed more medical treatment (66% vs 42%, p<0.001). They had similar rates of adverse maternal and neonatal outcomes, except for increased large-for-gestational-age infants (25% vs 15%, p=0.02). Mental health during pregnancy and postpartum did not differ between groups. eGDM had more atherogenic postpartum lipid profile than cGDM (p≤0.001). In eGDM, the postpartum prevalence of metabolic syndrome (MetS) was 1.8-times, prediabetes was 3.1-times and diabetes was 7.4-times higher than cGDM (MetS-waist circumference-based: 62% vs 34%/MetS-BMI-based: 46% vs 24%; prediabetes: 47.5% vs 15.3%; diabetes: 11.9% vs 1.6%, all p<0.001). These differences remained unchanged after adjusting for GDM-risk factors. Conclusion Compared to cGDM, eGDM was not associated with differences in mental health, but with increased adverse cardiometabolic outcomes, independent of GDM-risk factors and gestational weight gain. This hints to a pre-existing risk-profile in eGDM.

scholarly journals Gestational Weight Gain Influences Neonatal Outcomes in Women With Obesity and Gestational Diabetes

2021 ◽  
Author(s):  
Ana M Ramos-Levi ◽  
Gemma Rodriguez-Carnero ◽  
Cristina Garcia-Fontao ◽  
Antia Fernandez-Pombo ◽  
Paula Andújar-Plata ◽  
...  
Keyword(s):  
Weight Gain ◽  
Birth Weight ◽  
Gestational Diabetes ◽  
Gestational Weight Gain ◽  
Gestational Age ◽  
Perinatal Outcomes ◽  
Large For Gestational Age ◽  
Gestational Weight ◽  
Increased Risk ◽  
The Impact

Abstract Background. Obesity and gestational diabetes mellitus (GDM) are associated to increased risk of perinatal complications and obesity in the offspring. However, the impact of gestational weight gain (GWG) on maternal and fetal outcomes has led to controversial results. Research design and methods. Retrospective study of 220 women with GDM and pre-pregnancy body mass index (BMI) ≥ 30 kg/m2. Pregnant women were classified according to the Institute of Medicine (IOM) recommendations regarding prior BMI and GWG. We evaluated the impact of GWG on birth weight and perinatal outcomes. Results. Mean maternal age was 34.7±5.3 years. Pre-pregnancy obesity was classified as grade I in 55.3% of cases, grade II in 32.0%, and grade III in 12.7%. GWG was adequate (5-9kg) in 24.2%, insufficient (< 5kg) in 41.8% and excessive (> 9kg) in 34.2%. Birthweight was within normal range in 81.9%, 3.6% were small for gestational age (SGA) and 14.4% were large for gestational age (LGA). Insufficient GWG was associated to a higher rate of SGA offspring, excessive GWG was associated to LGA and adequate GWG to normal birth weight. Conclusion. GWG in women with pre-pregnancy obesity and GDM impacts neonatal birthweight. Insufficient GWG is associated to SGA and excessive GWG is associated to LGA. Women with adequate GWG according to IOM guidelines obtained better perinatal outcomes.

scholarly journals eHealth as the Next-Generation Perinatal Care: An Overview of the Literature (Preprint)

2017 ◽  
Author(s):  
Josephus FM van den Heuvel ◽  
T Katrien Groenhof ◽  
Jan HW Veerbeek ◽  
Wouter W van Solinge ◽  
A Titia Lely ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Weight Gain ◽  
Gestational Diabetes ◽  
Gestational Weight Gain ◽  
Literature Search ◽  
Perinatal Care ◽  
Patient Empowerment ◽  
Fetal Monitoring ◽  
Gestational Weight

BACKGROUND Unrestricted by time and place, electronic health (eHealth) provides solutions for patient empowerment and value-based health care. Women in the reproductive age are particularly frequent users of internet, social media, and smartphone apps. Therefore, the pregnant patient seems to be a prime candidate for eHealth-supported health care with telemedicine for fetal and maternal conditions. OBJECTIVE This study aims to review the current literature on eHealth developments in pregnancy to assess this new generation of perinatal care. METHODS We conducted a systematic literature search of studies on eHealth technology in perinatal care in PubMed and EMBASE in June 2017. Studies reporting the use of eHealth during prenatal, perinatal, and postnatal care were included. Given the heterogeneity in study methods, used technologies, and outcome measurements, results were analyzed and presented in a narrative overview of the literature. RESULTS The literature search provided 71 studies of interest. These studies were categorized in 6 domains: information and eHealth use, lifestyle (gestational weight gain, exercise, and smoking cessation), gestational diabetes, mental health, low- and middle-income countries, and telemonitoring and teleconsulting. Most studies in gestational diabetes and mental health show that eHealth applications are good alternatives to standard practice. Examples are interactive blood glucose management with remote care using smartphones, telephone screening for postnatal depression, and Web-based cognitive behavioral therapy. Apps and exercise programs show a direction toward less gestational weight gain, increase in step count, and increase in smoking abstinence. Multiple studies describe novel systems to enable home fetal monitoring with cardiotocography and uterine activity. However, only few studies assess outcomes in terms of fetal monitoring safety and efficacy in high-risk pregnancy. Patients and clinicians report good overall satisfaction with new strategies that enable the shift from hospital-centered to patient-centered care. CONCLUSIONS This review showed that eHealth interventions have a very broad, multilevel field of application focused on perinatal care in all its aspects. Most of the reviewed 71 articles were published after 2013, suggesting this novel type of care is an important topic of clinical and scientific relevance. Despite the promising preliminary results as presented, we accentuate the need for evidence for health outcomes, patient satisfaction, and the impact on costs of the possibilities of eHealth interventions in perinatal care. In general, the combination of increased patient empowerment and home pregnancy care could lead to more satisfaction and efficiency. Despite the challenges of privacy, liability, and costs, eHealth is very likely to disperse globally in the next decade, and it has the potential to deliver a revolution in perinatal care.

scholarly journals Effects of prenatal exposure factors on birth outcomes through mediation of favorable fetal growth conditions using structural equation modeling

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0249664
Author(s):  
Aweke A. Mitku ◽  
Temesgen Zewotir ◽  
Delia North ◽  
Prakash Jeena ◽  
Rajen N. Naidoo
Keyword(s):  
Risk Factors ◽  
Weight Gain ◽  
Gestational Weight Gain ◽  
Birth Outcomes ◽  
Prenatal Exposure ◽  
Fetal Growth ◽  
Gestational Age ◽  
Structural Equation ◽  
Growth Conditions ◽  
Gestational Weight

Background Birth weight, birth length, and gestational age are major indicators of newborn health. Several prenatal exposure factors influence the fetal environment. The aim of the study was to investigate the effect of prenatal exposure factors, including socio-demographic, behavioural, dietary, physical activity, clinical and environmental on birth outcomes through the mediation of Favourable Fetal Growth Conditions (FFGC). Methods Data was obtained from six hundred and fifty-six Mother and Child in the Environment birth cohort study in Durban, South Africa from 2013 to 2017. We adopted structural equation models which evaluate the direct and indirect effects by allowing multiple simultaneous equations to incorporate confounding and mediation. Results A significant direct and indirect effect of FFGC on newborn weight, length, and gestational age was seen. Gestational weight gain and maternal body mass index in the first trimester exerted a mediation effect between maternal behavioural risk factors and FFGC. Similarly, the level of physical activity during pregnancy was associated with decreased gestational weight gain. The effects of maternal characteristics on newborn weight, length, and gestational age were largely indirect, operating through FFGC as a latent variable. Conclusions Gestational weight gain and maternal pre-gestational BMI were observed to mediate the association between prenatal behavioural risk factors and favourable fetal growth conditions. Trial registration Retrospectively registered from 01 March 2013.

scholarly journals Gestational diabetes mellitus, pre-pregnancy body mass index, and gestational weight gain as risk factors for increased fat mass in Brazilian newborns

PLoS ONE ◽  
2019 ◽  
Vol 14 (8) ◽  
pp. e0221971 ◽  
Author(s):  
Laísa R. S. Abreu ◽  
Meghan K. Shirley ◽  
Natália P. Castro ◽  
Verônica V. Euclydes ◽  
Denise P. Bergamaschi ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Body Mass Index ◽  
Weight Gain ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Gestational Weight Gain ◽  
Body Mass ◽  
Fat Mass ◽  
Gestational Weight

THE ASSOCIATION OF GESTATIONAL WEIGHT GAIN AND ADVERSE PREGNANCY OUTCOMES IN WOMEN WITH GESTATIONAL DIABETES MELLITUS

2019 ◽  
Vol 25 (11) ◽  
pp. 1137-1150 ◽  
Author(s):  
Qianyue Xu ◽  
Zhijuan Ge ◽  
Jun Hu ◽  
Shanmei Shen ◽  
Yan Bi ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Weight Gain ◽  
Gestational Diabetes ◽  
Glucose Tolerance ◽  
Gestational Diabetes Mellitus ◽  
Gestational Weight Gain ◽  
Gestational Age ◽  
Large For Gestational Age ◽  
Institute Of Medicine ◽  
Gestational Weight

Objective: To explore the association of excessive gestational weight gain (GWG) defined by the Institute of Medicine (IOM) targets and adverse perinatal outcomes in gestational diabetes mellitus (GDM) pregnancies, and whether a modified target might be related to a lower rate of adverse perinatal outcomes for GDM. Methods: This retrospective cohort study involved 1,138 women of normal glucose tolerance (NGT) and 1,200 women with GDM. Based on the IOM target, pregnancies were classified to appropriate GWG (aGWG), inadequate GWG, and excessive GWG (eGWG). Modified GWG targets included: upper limit of IOM target minus 1 kg (IOM-1) or 2 kg (IOM-2), both upper and lower targets minus 1 kg (IOM-1-1) or 2 kg (IOM-2-2). Results: The proportions of women achieving eGWG were 26.3% in NGT and 31.2% in GDM ( P = .036); in comparison, for aGWG NGT, the risks of large for gestational age (LGA) were significantly higher in eGWG NGT (adjusted odds ratio [OR] 1.47; 95% confidence interval [CI] 1.02 to 2.13), aGWG GDM (adjusted OR 1.42; 95% CI 1.03 to 1.95), and eGWG GDM (adjusted OR 2.70; 95% CI 1.92 to 3.70). GDM pregnancies gaining aGWG based on the modified GWG targets (IOM-2, IOM-1-1, and IOM-2-2) had a lower prevalence of LGA and macrosomia delivery than that for similar pregnancies using the original IOM target (all P<.05). Conclusion: For aGWG GDM according to the IOM target, adhering to a more stringent weight control was associated with decreased adverse outcomes. A tighter IOM target might help to reduce the prevalence of adverse pregnancy outcomes. Abbreviations: aGWG = appropriate gestational weight gain; BG = blood glucose; BMI = body mass index; CI = confidence interval; eGWG = excessive gestational weight gain; GDM = gestational diabetes mellitus; GW = gestational weeks; GWG = gestational weight gain; HbA1c = hemoglobin A1c; iGWG = inadequate gestational weight gain; IOM = Institute of Medicine; LGA = large for gestational age; NGT = normal glucose tolerance; NICU = neonatal intensive care unit; OGTT = oral glucose tolerance test; OR = odds ratio; PARp = partial population attributable risks; SGA = small for gestational age

Abstract P078: Gestational Weight Gain Modifies the Effect of the Circadian Rhythms Related MTNR1B Genotype on Postpartum Glycemic Changes: A Longitudinal Study in Women With Prior Gestational Diabetes

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Hoirun Nisa ◽  
Junhong Leng ◽  
Tao Zhou ◽  
Huikun Liu ◽  
Weiqin Li ◽  
...  
Keyword(s):  
Weight Gain ◽  
Circadian Rhythms ◽  
Gestational Diabetes ◽  
Gestational Weight Gain ◽  
Genetic Variant ◽  
Chinese Women ◽  
Gestational Weight ◽  
Excessive Gestational Weight Gain ◽  
History Of ◽  
Melatonin Receptor 1B

Context: Gestational diabetes mellitus (GDM) affects postpartum glucose metabolism and future risk of type 2 diabetes. Pregnancy and GDM are related to disturbed circadian rhythms and sleeping, which are determined by genetic variations in genes such as Melatonin receptor 1B ( MTNR1B ). Objective: We prospectively assessed whether the circadian rhythms related MTNR1B genotype was related to on 1-5 years of postpartum glycemic changes among women with a history of GDM, and whether gestational weight gain modified such associations. Design: The established circadian rhythms-associated MTNR1B genetic variant (rs10830963) was genotyped in 1025 Chinese women with a history of GDM. Body weight and glycemic traits during and after pregnancy were longitudinally collected. Results: The frequency of MTNR1B rs10830963 was not different among the three categories of gestational weight gain (inadequate, adequate, and excessive). We found women carrying different MTNR1B genotype showed distinct postpartum changes in 2-h glucose (OGTT) – 0.36, 0.20, and -0.19 mmol/L per additional copy of the G allele in women with inadequate, adequate, and excessive gestational weight gain, respectively ( p for interaction=0.028). The corresponding changes in fasting glucose were 0.14, 0.13, and 0.01, though the modification effects of gestational weight gain on the genetic association was marginal ( p for interaction= 0.067). Conclusions: Our findings suggest that gestational weight gain may modify the circadian rhythms related MTNR1B genetic variant on long term glycemic changes, highlighting the significance of gestational weight management in diabetes prevention among women with GDM.

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