scholarly journals Gestational Diabetes Mellitus and Maternal Immune Dysregulation: What We Know So Far

2021 ◽  
Vol 22 (8) ◽  
pp. 4261
Author(s):  
Colm J. McElwain ◽  
Fergus P. McCarthy ◽  
Cathal M. McCarthy
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Immune Dysregulation ◽  
Adverse Outcomes ◽  
Low Grade ◽  
Adaptive Immune ◽  
Adaptive Immune Cells ◽  
Visceral Adipose ◽  
Increased Susceptibility

Gestational diabetes mellitus (GDM) is an obstetric complication that affects approximately 5–10% of all pregnancies worldwide. GDM is defined as any degree of glucose intolerance with onset or first recognition during pregnancy, and is characterized by exaggerated insulin resistance, a condition which is already pronounced in healthy pregnancies. Maternal hyperglycaemia ensues, instigating a ‘glucose stress’ response and concurrent systemic inflammation. Previous findings have proposed that both placental and visceral adipose tissue play a part in instigating and mediating this low-grade inflammatory response which involves altered infiltration, differentiation and activation of maternal innate and adaptive immune cells. The resulting maternal immune dysregulation is responsible for exacerbation of the condition and a further reduction in maternal insulin sensitivity. GDM pathology results in maternal and foetal adverse outcomes such as increased susceptibility to diabetes mellitus development and foetal neurological conditions. A clearer understanding of how these pathways originate and evolve will improve therapeutic targeting. In this review, we will explore the existing findings describing maternal immunological adaption in GDM in an attempt to highlight our current understanding of GDM-mediated immune dysregulation and identify areas where further research is required.

scholarly journals Pregnancy course and outcome peculiarities in women with gestational diabetes mellitus

2018 ◽  
Vol 26 (1) ◽  
pp. 96-105 ◽  
Author(s):  
S. V. Yankina ◽  
N. V. Shatrova ◽  
S. V. Berstneva ◽  
D. N. Pavlov
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Pregnant Women ◽  
Adverse Outcomes ◽  
Chronic Pyelonephritis ◽  
Oral Glucose ◽  
Threatened Miscarriage ◽  
Perinatal Center ◽  
Adverse Pregnancy

Gestational diabetes mellitus (GDM) is a serious medical and social problem, because it greatly increases the frequency of adverse pregnancy outcomes for mother and fetus. The frequency of GDM in the general population of different countries varies from 1% to 14% and average 7%, in Russia this figure is estimated at 4.5%. Aim. To evaluate the prevalence of GDM in Ryazan Regional clinical perinatal center for the last 3 years and examine its influence on the course and outcome of pregnancy. Materials and Methods. The analysis of the birth history data and exchange cards of 1690 pregnant women from 2015 to 2017 at Ryazan Regional clinical perinatal center. Results. GDM was diagnosed in 193 women (prevalence – 11.4%), with 62 pregnant women on the basis of the results of oral glucose tolerance test performed in the period of 24-30 weeks. It was established that the course of pregnancy and delivery in patients with GDM was characterized by a high percentage of complications (late gestosis – 18.1%, anemia – 11.3%, swelling – 11.9%, early toxicosis – 4.6%, poly-hydramnios – 12.4%, chronic pyelonephritis – 5.1% and threatened miscarriage – 3.6%). Pregnancy outcome study revealed that the majority – 60.6% of pregnancies ended in natural births. Preterm birth was noted in 15% of cases, of which 2 cases were of perinatal fetal death. The frequency of delivery by cesarean section – 39.4%. The frequency of childbirth large fetus was 21.8%, higher than in women with normal blood glucose levels. Conclusions. The prevalence of GDM in Ryazan Regional clinical perinatal center for the last 3 years was 11.4%. Complications during pregnancy were observed in 153 women (79.2%) of with GDM. The most frequent complications were; late gestosis, pregnancy anemia, edema, early toxemia, polyhydramnios, chronic pyelonephritis, and threatened miscarriage. In pregnant women with GDM, adverse outcomes of pregnancy were more common than in women with normoglycemia. Significant differences were obtained in the frequency of premature birth, macrosomia of the fetus and asphyxia during childbirth.

scholarly journals Burden, associated risk factors and adverse outcomes of gestational diabetes mellitus in twin pregnancies in Al Ain, UAE

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Juma Alkaabi ◽  
Raya Almazrouei ◽  
Taoufik Zoubeidi ◽  
Fatema M. Alkaabi ◽  
Fatima Rashid Alkendi ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Adverse Outcomes ◽  
Fetal Outcomes ◽  
Al Ain ◽  
Adverse Pregnancy ◽  
Associated Risk Factors ◽  
The City ◽  
Twin Pregnancies

Abstract Background Gestational diabetes mellitus (GDM) in singleton pregnancies represent a high-risk scenario. The incidence, associated factors and outcomes of GDM in twin pregnancies is not known in the UAE. Methods This was five years retrospective analysis of hospital records of twin pregnancies in the city of Al Ain, Abu Dhabi, UAE. Relevant data with regards to the pregnancy, maternal and birth outcomes and incidence of GDM was extracted from two major hospitals in the city. Regression models assessed the relationship between socio-demographic and pregnancy-related variables and GDM, and the associations between GDM and maternal and fetal outcomes at birth. Results A total of 404 women and their neonates were part of this study. The study population had a mean age of 30.1 (SD: 5.3), overweight or obese (66.5%) and were majority multiparous (66.6%). High incidence of GDM in twin pregnancies (27.0%). While there were no statistical differences in outcomes of the neonates, GDM mothers were older (OR: 1.09, 95% CI: 1.06–1.4) and heavier (aOR: 1.02, 95% CI: 1.00 -1.04). They were also likely to have had GDM in their previous pregnancies (aOR: 7.37, 95% CI: 2.76–19.73). The prognosis of mothers with twin pregnancies and GDM lead to an independent and increased odds of cesarean section (aOR: 2.34, 95% CI: 1.03–5.30) and hospitalization during pregnancy (aOR: 1.60, 95% CI: 1.16–2.20). Conclusion More than a quarter of women with twin pregnancies were diagnosed with GDM. GDM was associated with some adverse pregnancy outcomes but not fetal outcomes in this population. More studies are needed to further investigate these associations and the management of GDM in twin pregnancies.

scholarly journals Maternal and Perinatal Outcome in Gestational Diabetes Mellitus Compared to Pregestational Diabetes Mellitus

2019 ◽  
Vol 9 (2) ◽  
pp. 127-132
Author(s):  
Faryal Mustary ◽  
TA Chowdhury ◽  
Ferdousi Begum ◽  
Nusrat Mahjabeen
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Pregnant Women ◽  
Perinatal Outcome ◽  
Birth Asphyxia ◽  
Adverse Outcomes ◽  
Intrauterine Death ◽  
Perinatal Complications ◽  
Pregestational Diabetes

Background: Diabetes mellitus is the most frequently encountered endocrine disorder in pregnancy and is associated with adverse outcomes if remain undiagnosed or untreated. This study was done to compare the maternal and perinatal outcome of pregestational diabetes mellitus (PGDM) with that of gestational diabetes (GDM). Methods: This observational analytical study with group comparison was carried out in the Department of Obstetrics and Gynaecology, BIRDEM General Hospital, Dhaka from July 2015 to June 2016. This study was conducted on two groups of pregnant women: group A (PGDM) and group B (GDM). A total of 100 cases were selected and in each group 50 pregnant women were enrolled. Singleton pregnancy and age 18 to 45 years were included. Pregnancy with hypertension, heart disease, renal disease and other metabolic disorders were excluded. Results: In this study mean gestational age of the study subjects were 35.72 ± 2.61 weeks and 36.58 ± 2.34 weeks in PGDM and GDM groups. History of GDM [34.0% vs 16.0%], intrauterine death (IUD) [14.0% vs 2.0%] and abortion [22.0% vas 6.0%] were significantly higher among PGDM patients than GDM patients. Regarding present pregnancy complications, polyhydramnios [32.0% vs 14.0%], preterm delivery [38.0% vs 20.0%], vulvovaginitis [28.0% vs 12.0%] and premature rupture of membrane (PROM) [24.0% vs 8.0%] were significantly higher in PGDM than GDM patients. Wound infection was significantly high in PGDM groups [35.7% vs 11.1%] among the patients delivered by lower uterine Cesarean section (LUCS). Regarding perinatal complications, hypoglycemia [22.0% vs 8.0%], birth asphyxia [24.0% vs 8.0%], RDS [24.0% vs 8.0%] were significantly higher among PGDM comparing GDM patients. Conclusion: The maternal and perinatal outcomes of pregestational diabetes mellitus were less favorable than those of gestational diabetes mellitus. Birdem Med J 2019; 9(2): 127-132

scholarly journals Gestational diabetes mellitus causes dyslipidemia in late trimester: mini review

2019 ◽  
Vol 9 (1) ◽  
pp. 453
Author(s):  
Poonguzhalai S. ◽  
Kalyanikutty K. P.
Keyword(s):  
Diabetes Mellitus ◽  
Lipid Metabolism ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Gestational Age ◽  
Significant Risk ◽  
Normal Pregnancy ◽  
Adverse Outcomes ◽  
Peripheral Tissues ◽  
Management Protocol

The incidence of gestational diabetes mellitus (GDM) is increasing rapidly worldwide. Many women with gestational diabetes mellitus are likely to have type 2 diabetes. With the extensive management protocol for GDM we are able to obtain a good glycaemic control but still excess morbidity prevails among GDM pregnancy compared to normal pregnancy. This may be due to the dysfunction of lipid metabolism. Changes in carbohydrate and lipid metabolism occur during pregnancy to ensure a continuous supply of nutrients to the growing fetus despite intermittent maternal food intake. Exaggerated reduction in insulin sensitivity in the peripheral tissues combined with peripheral adipose tissue lipolysis in GDM pregnancy than normal pregnancy results in increased maternal lipoprotein concentrations and elevated lipoprotein triglyceride content. An altered lipid profile on the maternal side would modulate the quantity and quality of lipids being transferred to the fetus. Hypertriacylglycerolemia in gestational diabetes mellitus has been related to a significant risk of having neonates that are large for gestational age and it is considered as a major cause of preeclampsia in the late gestational age. So, the recent researchers emphasize on targeting lipid metabolism in pregnant women with GDM to avoid the adverse outcomes of pregnancy.

scholarly journals Gestational diabetes mellitus is associated with adverse outcomes in twin pregnancies

2019 ◽  
Vol 220 (1) ◽  
pp. 102.e1-102.e8 ◽  
Author(s):  
Liran Hiersch ◽  
Howard Berger ◽  
Rania Okby ◽  
Joel G. Ray ◽  
Michael Geary ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Adverse Outcomes ◽  
Twin Pregnancies

scholarly journals Insulin-Like Growth Factor Axis in Pregnancy and Gestational Diabetes Mellitus

2019 ◽  
pp. 807-816 ◽  
Author(s):  
K. ANDERLOVÁ ◽  
A. CINKAJZLOVÁ ◽  
P. ŠIMJÁK ◽  
J. KLOUČKOVÁ ◽  
H. KRATOCHVÍLOVÁ ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Growth Factor ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Pregnant Women ◽  
Insulin Like Growth Factor ◽  
Igf System ◽  
Visceral Adipose ◽  
Regulation Of Growth ◽  
Igfbp 3

The insulin-like growth factor (IGF) is involved in the regulation of growth and metabolism. The aim of this study was to determine selected parameters of IGF system at systemic and local levels [subcutaneous (SAT) and visceral adipose tissue (VAT)] to assess its possible role in gestational diabetes mellitus (GDM). 37 pregnant women (21 with GDM and 16 without GDM) and 15 age-matched non-pregnant females were included in the study. Blood samples were taken in 28-32 and 36-38 weeks of gestation and 6-12 months after delivery. SAT and VAT samples were obtained during delivery or surgery. Compared with non-pregnant women, serum IGF-1 and IGFBP-3 were increased in both groups of pregnant women. IGF-2 was elevated only in GDM women from 36 weeks of gestation culminating 6 months after delivery (p=0.003). Serum IGFBP-3 was increased and IGFBP-4 decreased in GDM women vs. pregnant women without GDM during the whole study (IGFBP-3: p˂0.001 for GDM vs. non-GDM; IGFBP-4: p=0.004 for GDM vs. non-GDM). Pregnant women with GDM had decreased mRNA expression of IGF-1, IGF-1R and IGF-2R and IGFBP-4 in VAT and IGF-1R in SAT compared to pregnant women without GDM. Changes in local activity of IGF are associated with the development of GDM.

scholarly journals Maternal Body Mass Index and Ethnicity in Relation to The Adverse Outcomes of Large for Gestational Age and Gestational Diabetes Mellitus in a Retrospective Cohort of Australian Pregnant Women.

2021 ◽  
Author(s):  
Catherine Knight-Agarwal ◽  
Jani Rati ◽  
Meisa Al-Foraih ◽  
Dionne Eckley ◽  
Carrie Ka Wai Lui ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Body Mass Index ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Body Mass ◽  
Gestational Age ◽  
Retrospective Cohort ◽  
Adverse Outcomes ◽  
Large For Gestational Age ◽  
Maternal Body Mass Index

Abstract Background: The prevalence of maternal overweight and obesity has been increasing. This research explored the association between maternal body mass index and ethnicity in relation to the adverse outcomes of large for gestational age and gestational diabetes mellitus. Method: A retrospective cohort study was undertaken with 27 814 Australian women of various ethnicities, who gave birth to a singleton infant between 2008 and 2017. Variables were examined using logistic regression. Results: A significantly higher proportion of large for gestational age infants were born to overweight and obese women compared to those who were classified as underweight and healthy weight. Asian-born women with a body mass index of ≥ 40kg/m2 had an adjusted odds ratio of 9.926 (3.859 - 25.535) for birthing a large for gestational age infant whereas Australian-born women had an adjusted odds ratio of 2.661 (2.256 - 3.139) for the same outcome. Women born in Australia were at high risk of birthing a large for gestational age infant in the presence of insulin controlled gestational diabetes mellitus, but this risk was not significant for those with the diet-controlled type. Asian-born women did not present an elevated risk of birthing a large for gestational infant, in either the diet controlled, or insulin controlled gestational diabetes mellitus groups. Conclusion: Large for gestational age and gestational diabetes mellitus are adverse pregnancy outcomes that can lead to significant maternal and neonatal morbidity. Women who are overweight or obese, and considering a pregnancy, are encouraged to seek culturally appropriate nutrition and weight management advice during the periconception period.

scholarly journals Prevalence of Gestational Diabetes Mellitus, Maternal and Neonatal outcomes in a Peripheral Hospital in North India

2017 ◽  
Vol 5 (6) ◽  
pp. 2343 ◽  
Author(s):  
Naiyma Choudhary ◽  
Mohd Rasheed ◽  
Vivek Aggarwal
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Gestational Hypertension ◽  
Adverse Outcomes ◽  
Neonatal Outcomes ◽  
North India ◽  
Peripheral Hospital ◽  
Medical Entity ◽  
Maternal And Neonatal Outcomes

Background: Gestational diabetes mellitus (GDM) is a well-known medical entity which should be diagnosed at the earliest to prevent adverse maternal and neonatal outcomes due to hyperglycemia.Methods: This study was done in patients attending antenatal OPD in a peripheral hospital in North India. A total of 569 patients diagnosed as GDM were included in the study out of 6321 who attended the antenatal clinic.Results: The prevalence of gestational diabetes mellitus was found to be 9%. Gestational hypertension was seen in 29.35% of patients. The percent of babies who were admitted to NICU was 29.35%.Conclusions: These results stress the need for early detection and treatment of GDM to prevent adverse outcomes.

scholarly journals Consumption of multiple sources of protein is associated with gestational diabetes mellitus in the Chinese population

2021 ◽  
Author(s):  
Wei-Qin Wang ◽  
Vic Shao-Chih Chiang ◽  
Jing-Yuan Wen ◽  
Ji-Fen Hu ◽  
Rong-Xian Xu
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Pregnant Women ◽  
Dairy Products ◽  
Chinese Population ◽  
Adverse Outcomes ◽  
Smoking History ◽  
Oral Glucose ◽  
Multiple Sources

Background: Gestational diabetes mellitus (GDM) is a hyperglycemic state during pregnancy that results in disruptions of insulin sensitivity and secretion. It affects 7% of all pregnancies and lead to adverse maternal and offspring outcomes. GDM has many risk factors, such as ethnicity special, hereditary. However Nutritional factors offer key strategies against GDM, but this is less characterized for the Chinese population. Methods: A case control study of GDM pregnant women (n=49, 29.88+/-3.92 years of age) and healthy pregnant women (n=77, 27.63+/-4.83 years of age) from 1st Affiliated Hospital of Fujian Medical University were studied. Diagnosis was made using oral glucose tolerance test. Dietary data were collected using food frequency questionnaires. Data for use of dietary supplements, occupation, education, income, meal expenditure and smoking history were also recorded. Results: No differences were found between GDM and control subjects for their age, education, occupation, monthly income, grocery expenditure and smoking (p>0.05). GDM subjects were associated with higher quantities of dairy products (p<0.05) and seafood (p<0.01) intake. There were also higher number of GDM subjects using protein powder supplementation (p<0.05). Conclusions: Dietary recommendation guidelines for pregnant Chinese women should consider possible risks with excessive consumption of dairy products, seafood and protein powder. They should also assess the quality of the nutrition factor, other dietary interactions and their nutritional status further to minimize adverse outcomes caused by GDM .

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