Increased inositol phosphoglycan P-type in the second trimester in pregnant women with type 2 and gestational diabetes mellitus

Insulin therapy is still the gold standard in diabetic pregnancy. Insulin lispro protamine suspension is an available basal insulin analogue.Aim. To study pregnancy outcomes of women with type 2 and gestational diabetes mellitus when insulin lispro protamine suspension or human NPH insulin was added to medical nutrition therapy and/or short-acting insulin.Methods. In this retrospective study, for maternal outcome we recorded time and mode of delivery, hypertension, glycaemic control (fasting blood glucose and HbA1c), hypoglycemias, weight increase, and insulin need. For neonatal outcome birth weight and weight class, congenital malformations was recorded and main neonatal complications. Two-tail Student'st-test and chi-square test were performed when applicable; significantP<0.05.Results. Eighty-nine pregnant women (25 with type 2 diabetes and 64 with gestational diabetes mellitus; 53 under insulin lispro protamine suspension and 36 under human NPH insulin) were recruited. Maternal and neonatal outcomes were quite similar between the two therapeutic approaches; however, insulin need was higher in NPH. At the end of pregnancy, eight women with gestational diabetes continued to use only basal insulin analogue.Conclusions. Pregnancy outcome in type 2 and gestational diabetes mellitus with insulin lispro protamine suspension was similar to that with NPH insulin, except for a lower insulin requirement.

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Circulating progranulin levels in women with gestational diabetes mellitus and healthy controls during and after pregnancy

Acta Endocrinologica ◽

10.1530/eje-12-0060 ◽

2012 ◽

Vol 167 (4) ◽

pp. 561-567 ◽

Cited By ~ 9

Author(s):

Jelena Todoric ◽

Ammon Handisurya ◽

Thomas Perkmann ◽

Bernhard Knapp ◽

Oswald Wagner ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Gestational Diabetes ◽

Glucose Tolerance ◽

Gestational Diabetes Mellitus ◽

Pregnant Women ◽

Post Partum ◽

Oral Glucose ◽

Positive Correlation

ObjectiveProgranulin (PGRN) was recently introduced as a novel marker of chronic inflammatory response in obesity and type 2 diabetes capable of directly affecting the insulin signaling pathway. This study aimed to investigate the role of PGRN in gestational diabetes mellitus (GDM), which is regarded as a model for early type 2 diabetes.MethodsPGRN serum levels were measured in 90 pregnant women (45 GDM and 45 normal glucose tolerance (NGT)). In addition, PGRN was measured during a 2-h, 75 g oral glucose tolerance test in 20 pregnant women (ten GDM and ten NGT) and in 16 of them post partum (ten GDM and six NGT).ResultsPGRN concentrations were significantly higher in pregnant women compared with post partum levels (536.79±31.81 vs 241.53±8.86, P<0.001). Multivariate regression analyses showed a strong positive correlation of PGRN with estrogen and progesterone. The insulinogenic index, a marker of early insulin secretion, displayed a positive correlation with PGRN, both during and after pregnancy (R=0.47, P=0.034; R=0.63, P=0.012). HbA1c and the oral glucose insulin sensitivity index showed significant post partum associations with PGRN (R=0.43, P=0.049; R=−0.65, P=0.009).ConclusionsPGRN concentrations are markedly lower after pregnancy regardless of the gestational glucose tolerance state. PGRN levels per se do not discriminate between mild GDM and NGT in pregnant women. Therefore, the development of GDM appears to be due to impaired β-cell function that is not related to PGRN effect.

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Self-Reported Eating Speed and Incidence of Gestational Diabetes Mellitus: the Japan Environment and Children’s Study

Nutrients ◽

10.3390/nu12051296 ◽

2020 ◽

Vol 12 (5) ◽

pp. 1296 ◽

Cited By ~ 1

Author(s):

Jia-Yi Dong ◽

Satoyo Ikehara ◽

Takashi Kimura ◽

Meishan Cui ◽

Yoko Kawanishi ◽

...

Keyword(s):

Diabetes Mellitus ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Pregnant Women ◽

Dietary Factors ◽

Cancer Type ◽

Odds Ratios ◽

Prospective Association

There is little evidence linking eating speed to gestational diabetes mellitus (GDM) incidence. We therefore aimed to evaluate the prospective association of eating speed with GDM incidence. Overall, 97,454 pregnant women were recruited between January 2011 and March 2014. Singleton pregnant women who did not have GDM, heart disease, stroke, cancer, type 1 diabetes, and/or type 2 diabetes at the time of study enrollment were eligible. Each woman was asked about her eating speed at that time via a questionnaire. Odds ratios of GDM in relation to eating speed were obtained using logistic regression. Among the 84,811 women eligible for analysis, 1902 cases of GDM were identified in medical records. Compared with women who reported slow eating speed, the age-adjusted odds ratios (95% confidence interval) of GDM for women who reported medium, relatively fast, or very fast eating speed were 1.03 (0.90, 1.18), 1.07 (0.94, 1.23), and 1.28 (1.05, 1.58), respectively. Adjustment for demographic, lifestyle-related, and dietary factors including dietary fat, dietary fiber, and energy intakes yielded similar results. The association was attenuated and no longer significant after further adjustment for pre-pregnancy body mass index. The mediation analysis showed that being overweight accounted for 64% of the excess risk of GDM associated with eating speed. In conclusion, women who reported very fast eating speed, compared with those reporting slow eating speed, were associated with an increased incidence of GDM, which may be largely mediated by increased body fat.

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Air pollution and gestational diabetes mellitus: evidence from cohort studies

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2019-000937 ◽

2020 ◽

Vol 8 (1) ◽

pp. e000937 ◽

Cited By ~ 2

Author(s):

Xingyao Tang ◽

Jian-Bo Zhou ◽

Fuqiang Luo ◽

Yipeng Han ◽

Yoriko Heianza ◽

...

Keyword(s):

Diabetes Mellitus ◽

Particulate Matter ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Air Pollutants ◽

Evidence Base ◽

Second Trimester ◽

Increased Risk ◽

Particulate Matter 2.5

Exposure to different air pollutants has been linked to type 2 diabetes mellitus, but the evidence for the association between air pollutants and gestational diabetes mellitus (GDM) has not been systematically evaluated. We systematically retrieved relevant studies from PubMed, Embase, and the Web of Science, and performed stratified analyses and regression analyses. Thirteen studies were analyzed, comprising 1 547 154 individuals from nine retrospective studies, three prospective studies, and one case–control study. Increased exposure to particulate matter ≤2.5 µm in diameter (PM2.5) was not associated with the increased risk of GDM (adjusted OR 1.03, 95% CI 0.99 to 1.06). However, subgroup analysis showed positive correlation of PM2.5 exposure in the second trimester with an increased risk of GDM (combined OR 1.07, 95% CI 1.00 to 1.13). Among pollutants other than PM2.5, significant association between GDM and nitrogen dioxide (NO2) (OR 1.05, 95% CI 1.01 to 1.10), nitrogen oxide (NOx) (OR 1.03, 95% CI 1.01 to 1.05), and sulfur dioxide (SO2) (OR 1.09, 95% CI 1.03 to 1.15) was noted. There was no significant association between exposure to black carbon or ozone or carbon monoxide or particulate matter ≤10 µm in diameter and GDM. Thus, systematic review of existing evidence demonstrated association of exposure to NO2, NOx, and SO2, and the second trimester exposure of PM2.5 with the increased risk of GDM. Caution may be exercised while deriving conclusions from existing evidence base because of the limited number and the observational nature of studies.

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Cost effectiveness of different screening strategies for gestational diabetes mellitus screening: study protocol of a randomized community non-inferiority trial

Diabetology & Metabolic Syndrome ◽

10.1186/s13098-019-0493-z ◽

2019 ◽

Vol 11 (1) ◽

Author(s):

Fahimeh Ramezani Tehrani ◽

Keyword(s):

Diabetes Mellitus ◽

Health Care ◽

Cost Effectiveness ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Pregnant Women ◽

Standard Care ◽

First Trimester ◽

Trial Registration ◽

Second Trimester

Abstract Background There is lack of ideal and comprehensive economic evaluations of various GDM strategies. The aim of this study is to the compare efficacy and cost-effectiveness of five different methods of screening for gestational diabetes mellitus (GDM). Methods This study is a randomized community non-inferiority trial among 30,000 pregnant women in five different geographic regions of Iran, who were randomly assigned to one of the five GDM screening methods. All first trimester pregnant women, seeking prenatal care in governmental health care systems, who met our eligibility criteria were enrolled. The criteria suggested by the International-Association-of-Diabetes-in-Pregnancy-Study-Group, the most intensive approach, were used as reference. We used the non-inferiority approach to compare less intensive strategies to the reference one. Along with routine prenatal standard care, all participants were scheduled to have two phases of GDM screening in first and second-trimester of pregnancy, based on five different pre-specified protocols. The screening protocol included fasting plasma glucose in the first trimester and either a one step or a two-step screening method in the second trimester of pregnancy. Pregnant women were classified in three groups based on the results: diagnosed with preexisting pre-gestational overt diabetes; gestational diabetes and non-GDM women. Each group received packages for standard-care and all participants were followed till delivery; pregnancy outcomes, quality of life and cost of health care were recorded in detail using specific standardized questionnaires. Primary outcomes were defined as % birth-weight > 90th percentile and primary cesarean section. In addition, we assessed the direct health care direct and indirect costs. Results This study will enable us to compare the cost effectiveness of different GDM screening protocols and intervention intensity (low versus high). Conclusion Results which if needed, will also enable policy makers to optimize the national GMD strategy as a resource for enhancing GDM guidelines. Trial registration Name of the registry: Iranian Registry of Clinical Trials. Trial registration number: IRCT138707081281N1. Date of registration: 2017-02-15. URL of trial registry record: https://www.irct.ir/trial/518

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FGF21 Serum Levels in the Early Second Trimester Are Positively Correlated With the Risk of Subsequent Gestational Diabetes Mellitus: A Propensity-Matched Nested Case-Control Study

Frontiers in Endocrinology ◽

10.3389/fendo.2021.630287 ◽

2021 ◽

Vol 12 ◽

Author(s):

Zhiheng Wang ◽

Min Yuan ◽

Chengjie Xu ◽

Yang Zhang ◽

Chunmei Ying ◽

...

Keyword(s):

Diabetes Mellitus ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Pregnant Women ◽

Case Control Study ◽

Case Control ◽

Fibroblast Growth Factor 21 ◽

Second Trimester ◽

Nested Case Control ◽

Control Study

BackgroundAs an important endocrine hormone regulating glucose metabolism, fibroblast growth factor 21 (FGF21) is increased in individuals with gestational diabetes mellitus (GDM) after 24 gestational weeks. However, it is unknown whether the increase in FGF21 precedes the diagnosis of GDM.MethodsIn this nested case-control study, 133 pregnant women with GDM and 133 pregnant women with normal glucose tolerance (NGT) were identified through propensity score matching, and serum FGF21 levels were measured at 14 to 21 gestational weeks, before GDM is routinely identified. The differences in FGF21 levels were compared. The association between FGF21 and the occurrence of GDM was evaluated using logistic regression models with adjustment for confounders.ResultsThe serum FGF21 levels of the GDM group at 14 to 21 gestational weeks were significantly higher than those of the NGT group overall (P < 0.001), with similar results observed between the corresponding BMI subgroups (P < 0.05). The 2nd (OR 1.224, 95% CI 0.603–2.485), 3rd (OR 2.478, 1.229–5.000), and 4th (OR 3.419, 95% CI 1.626–7.188) FGF21 quartiles were associated with greater odds of GDM occurrence than the 1st quartile after multivariable adjustments.ConclusionsThe serum FGF21 levels in GDM groups increased in the early second trimester, regardless of whether participants were stratified according to BMI. After adjusting for confounding factors, the FGF21 levels in the highest quartile were associated with more than three times higher probability of the diagnosis of GDM in the pregnancy as compared to levels in the first quartile.

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Higher mean amplitude of glycaemic excursion in the second trimester of pregnancy is associated with the subsequent development of gestational diabetes mellitus: an observational study

10.22541/au.163843479.99686909/v1 ◽

2021 ◽

Author(s):

Phaik Ling Quah ◽

Kok Hian Tan ◽

Nurul Razali ◽

Nurul Sakinah Razali

Keyword(s):

Diabetes Mellitus ◽

Blood Glucose ◽

Gestational Diabetes ◽

Observational Study ◽

Gestational Diabetes Mellitus ◽

Pregnant Women ◽

Subsequent Development ◽

Mean Amplitude ◽

First Trimester ◽

Second Trimester

Objective: To examine glycaemic variability (GV) and glycaemic control (GC) parameters in early pregnancy with subsequent development of gestational diabetes mellitus (GDM). Design: Longitudinal observational study. Setting: Pregnant women from KK Women and Children’s Hospital in Singapore Participants: 51 study participants in the first trimester (9-13 weeks’ gestational), and 44 participants (18-23 weeks’ gestation) in the second trimester of pregnancy. Methods: Independent t-tests were used to examine the differences in the parameters between participants who developed GDM and those who did not. Main outcome measure: GDM was determined at 24-30 weeks’ gestation using oral glucose tolerance test (OGTT). GV parameters examined were, mean amplitude of glycaemic excursion (MAGE), standard deviation of blood glucose (SDBG) and mean of daily continuous 24 h blood glucose (MBG) and coefficient of variation (CV). GC parameters measured were, J-Index and % time spent in glucose target ranges. Results: In the second trimester of pregnancy, mean amplitude of glycaemic excursions (MAGE) was significantly higher in participants who subsequently developed GDM, compared to those who did not (mean (SD): 3.18(0.68) vs 2.60(0.53), p=0.02). Other study parameters measured in the second trimester of pregnancy were not significantly different between groups. There were no significant associations between all the GV and GC parameters determined from the CGM in the first trimester with subsequent development of GDM (p>0.05). Conclusion: MAGE is an important GV parameter associated to the development of subsequent GDM in pregnant women. The findings highlight the potential value of CGM in gestational glycaemic profiling.

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Higher Parity, Pre-Pregnancy BMI and Rate of Gestational Weight Gain Are Associated with Gestational Diabetes Mellitus in Food Insecure Women

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18052694 ◽

2021 ◽

Vol 18 (5) ◽

pp. 2694

Author(s):

Heng Yaw Yong ◽

Zalilah Mohd Shariff ◽

Barakatun Nisak Mohd Yusof ◽

Zulida Rejali ◽

Yvonne Yee Siang Tee ◽

...

Keyword(s):

Diabetes Mellitus ◽

Weight Gain ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Food Insecurity ◽

Pregnant Women ◽

Household Food Insecurity ◽

Second Trimester ◽

Gestational Weight ◽

Household Food

Food insecurity may exacerbate adverse maternal health outcomes during pregnancy, however, this association has not been well established, particularly in the context of developing countries. This study aimed to identify the associations between household food insecurity and gestational diabetes mellitus (GDM) risk among urban pregnant women. Household food insecurity was assessed using the translated 10-item Radimer/Cornell hunger scale. Logistic regression models were used to estimate the associations between food insecurity status and GDM risk. About 35.6% of women experienced food insecurity, with 25.2% reported household food insecurity, 8.0% individual food insecurity, and 2.4% child hunger. Food insecure women were at significantly higher risk of developing GDM compared to food secure women (AOR = 16.65, 95% CI = 6.17–24.98). The significant association between food insecurity and GDM risk was influenced by pre-pregnancy BMI, parity and rate of GWG at second trimester. Food insecure women with parity ≥ 2 (AOR = 4.21, 95% CI = 1.98–8.92), overweight/obese BMI prior to pregnancy (AOR = 12.11, 95% CI = 6.09–24.10) and excessive rate of GWG in the second trimester (AOR = 9.66, 95% CI = 4.27–21.83) were significantly more likely to develop GDM compared to food secure women. Food insecurity showed strong association with GDM risk in that the association was influenced by maternal biological and physical characteristics. Multipronged interventions may be necessary for food insecure pregnant women who are not only at risk of overweight/obesity prior to pregnancy but also may have excessive gestational weight gain, in order to effectively reduce GDM risk.

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