Multiple Micronutrient Supplementation during Pregnancy and Increased Birth Weight and Skinfold Thicknesses in the Offspring: The Cambridge Baby Growth Study

Multiple micronutrient supplementation (MMS) in pregnancy has previously been associated with positive effects on fetal growth, but its value in high-income countries remains controversial. In this study, we investigated effects of pregnancy MMS on offspring size at birth and adiposity, along with risks of various maternal outcomes of pregnancy, using the prospective Cambridge Baby Growth Study. Maternal MMS was reported in 528 out of 970 women who completed pregnancy questionnaires. Gestational diabetes (GDM) was assessed using results from 75 g oral glucose tolerance tests at week 28 of pregnancy. Offspring size at birth was assessed using standard anthropometric measurements and adiposity using skinfold calipers. MMS was associated with increased risk of developing GDM (risk ratio = 1.86 (1.13–3.08), p = 0.02), as well as increased offspring size at birth in terms of weight (p = 0.03), head circumference (p = 0.04), and flank, and subscapular and triceps skinfold thicknesses (p = 0.04, 0.03, and 0.003, respectively). There was no association with quadriceps skinfold thickness (p = 0.2), suggesting that the increased adiposity was partially regionalized. In women who underwent oral glucose tolerance testing, nearly all of these associations were attenuated by adjusting for GDM. These results suggest that the increased offspring size at birth, including (regionalized) adiposity associated with pregnancy, and MMS may be partially related to the development of GDM.

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Role of positive glucose challenge test only versus oral glucose tolerance test in pregnancy outcome: a comparative study

Journal of Pathology of Nepal ◽

10.3126/jpn.v9i2.25256 ◽

2019 ◽

Vol 9 (2) ◽

pp. 1545-1549

Author(s):

Neha Homagai ◽

Nirajan Mainali ◽

Sikha Rijal

Keyword(s):

Glucose Tolerance ◽

Oral Glucose Tolerance Test ◽

Glucose Tolerance Test ◽

Challenge Test ◽

Tolerance Test ◽

Oral Glucose ◽

Oral Glucose Tolerance ◽

Glucose Challenge Test ◽

Increased Risk ◽

Glucose Challenge

Background: Gestational diabetes mellitus is defined as any degree of glucose intolerance which is first recognized during pregnancy and is associated with a number of adverse perinatal outcomes, such as neonatal hypoglycemia, macrosomia with an increased risk of shoulder dystocia and the need for neonatal intensive care. Maternal complications include pre-eclampsia and an increased risk of caesarean delivery. The objective of this study was to compare maternal and perinatal outcomes in pregnant women with positive and negative oral glucose tolerance test following positive glucose challenge test. Materials and Methods: This is a prospective observational hospital based study of 120 patients admitted in Nobel Medical College Teaching Hospital, Biratnagar with glucose challenge test positive pregnancy for delivery. Oral glucose tolerance test was performed in all the glucose challenge test positive pregnant and compared with various maternal parameters and newborn’s conditions. Results: Among 120 patients included in the study, 28 (30.4%) cases were oral glucose tolerance test. Pregnancy induced hypertension was present in 12 cases. Hyperbilirubinemia was present in 42, hypoglycemia in 32, respiratory distress in 44, birth asphyxia in 15 and macrosomia in 6 cases. Conclusions: Pregnancy induced hypertension and hyperbilirubinemia were found to be significantly higher in OGTT positive cases so early detection of GDM screening via is advisable

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Does multiple sclerosis affect glucose tolerance?

Multiple Sclerosis Journal ◽

10.1177/1352458513515957 ◽

2013 ◽

Vol 20 (9) ◽

pp. 1273-1276 ◽

Cited By ~ 18

Author(s):

I Wens ◽

U Dalgas ◽

N Deckx ◽

N Cools ◽

BO Eijnde

Keyword(s):

Multiple Sclerosis ◽

Glucose Tolerance ◽

Oral Glucose Tolerance Test ◽

Glucose Tolerance Test ◽

Fasting Glucose ◽

Tolerance Test ◽

Oral Glucose ◽

Healthy Controls ◽

Oral Glucose Tolerance ◽

Increased Risk

Based on current literature, it is not clear if multiple sclerosis (MS) patients are at increased risk to develop impaired glucose tolerance (IGT). Eighty-one MS patients and 45 healthy controls (HC) performed an oral glucose tolerance test. IGT was defined as a fasting glucose concentration of 6.1–6.9 mmol/l and two-hour post-load glucose of 7.8–11.1 mmol/l. The prevalence of impaired fasting glucose concentrations (17% vs 2%) and IGT (11% vs 0%) was higher in MS patients than HC. Accordingly, the areas under the glucose and insulin curves were higher in MS patients. The current study demonstrates an elevated IGT-prevalence in MS.

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Kockázatalapú praediabetesszűrés egy vidéki családorvosi praxisban – orális glükóztolerancia-teszt vagy glikált hemoglobin?

Orvosi Hetilap ◽

10.1556/650.2019.31573 ◽

2019 ◽

Vol 160 (50) ◽

pp. 1976-1983

Author(s):

Henrietta Galvács ◽

János Szabó ◽

Zoltán Balogh

Keyword(s):

Diabetes Mellitus ◽

High Risk ◽

Glucose Tolerance ◽

Oral Glucose Tolerance Test ◽

Glucose Tolerance Test ◽

Glycated Haemoglobin ◽

Tolerance Test ◽

Oral Glucose ◽

Oral Glucose Tolerance ◽

Increased Risk

Abstract: Introduction and aim: The aim of this study was to implement a two-stage diabetes screening programme in a severely disadvantaged municipality. In the first stage, diabetes risk assessment was carried out in the 18 to 75 age group, followed by screening of the high risk population for potential carbohydrate metabolism disorders using laboratory tests. Method: Stage 1: assessment of diabetes risk with the FINDRISC questionnaire; Stage 2: identification of carbohydrate metabolism status by oral glucose tolerance test and glycated haemoglobin test in patients with elevated or high risk of diabetes. Results: 406 individuals completed the FINDRISC questionnaire. Elevated or high risk for diabetes was confirmed in 129 individuals (31.77%). There was significant correlation between increased risk and age (p<0.001) and between increased risk and body mass index (p<0.001). Based on the oral glucose tolerance test, 28.3% and 9.43% of the patients were diagnosed with pre-diabetes and diabetes mellitus, respectively. According to the glycated haemoglobin test, the incidences of prediabetes and diabetes were 50.94% and 11.32%, respectively. The strongest predictors of prediabetes/diabetes mellitus was the age (p = 0.047). The correlation between prediabetes/diabetes mellitus and smoking (p = 0.635) and physical activity (p = 0.975) was the weakest. The results showed that the glycated hemoglobin value increased by mean 0.2% by metabolic syndromes patients. Conclusions: Our results highlight the necessity for improving preventative care. Based on the risks of significant mortality and disability due to diabetes, prevention and early diagnosis must be prioritised in primary care. In addition to the oral glucose tolerance test, measurement of glycated haemoglobin is also indicated, while keeping in mind the limitations of its diagnostic value. Evaluating for glycated hemoglobin results, it is also worth looking for the presence of metabolic syndrome. Orv Hetil. 2019; 160(50): 1976–1983.

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Folic acid supplementation during pregnancy and associations with offspring size at birth and adiposity: a cohort study

BMC Research Notes ◽

10.1186/s13104-021-05575-y ◽

2021 ◽

Vol 14 (1) ◽

Author(s):

Clive J. Petry ◽

Ken K. Ong ◽

Ieuan A. Hughes ◽

David B. Dunger

Keyword(s):

Folic Acid ◽

Gestational Diabetes ◽

Folic Acid Supplementation ◽

Diabetes Risk ◽

Offspring Size ◽

Growth Study ◽

Acid Supplementation ◽

Multiple Micronutrient ◽

Size At Birth ◽

In Pregnancy

Abstract Objective Previously we observed that maternal multiple micronutrient supplementation in pregnancy was associated with increased offspring size at birth and adiposity, as well as with maternal gestational diabetes risk, in the Cambridge Baby Growth Study. In this study we therefore investigated whether folic acid supplementation specifically is associated with similar changes, to test the hypothesis that folic acid supplementation mediates such changes. Results The majority of mothers who reported supplementing with folic acid in pregnancy (n = 776 in total, 526 of which took multiple micronutrient preparations) did so either from pre- (n = 139) or post-conception (n = 637) largely for all or just the first half of pregnancy. A minority of mothers (n = 198) reported not supplementing with folic acid. Folic acid supplementation in pregnancy was not associated with birth weight [β’ = − 0.003, p = 0.9], height [β’ = − 0.013, p = 0.6], head circumference [β’ = 0.003, p = 0.09] or adiposity (ponderal index [β’ = 0.020, p = 0.5], skinfolds thicknesses [β’ = − 0.029 to + 0.008, p = 0.4–0.9]). Neither was it associated with the development of maternal gestational diabetes (risk ratio 1.2 [0.6‒2.2], p = 0.6). These results suggest that folic acid supplementation in pregnancy did not mediate the previously observed increases in offspring size at birth and adiposity, or the raised gestational diabetes risk, in response to supplementation with multiple micronutrients.

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Perinatal Outcomes in Obese Women with One Abnormal Value on 3-Hour Oral Glucose Tolerance Test

American Journal of Perinatology ◽

10.1055/s-0041-1740005 ◽

2021 ◽

Author(s):

Victoria R. Greenberg ◽

Lisbet S. Lundsberg ◽

Uma M. Reddy ◽

William A. Grobman ◽

Corette B. Parker ◽

...

Keyword(s):

Glucose Tolerance ◽

Oral Glucose Tolerance Test ◽

Glucose Tolerance Test ◽

Perinatal Outcomes ◽

Tolerance Test ◽

Oral Glucose ◽

Obese Women ◽

Oral Glucose Tolerance ◽

Increased Risk ◽

The One

Objective This study aimed to determine if one abnormal value of four on the diagnostic 3-hour oral glucose tolerance test (OGTT) is associated with adverse perinatal outcomes in obese women. Study Design This is a secondary analysis of a prospective study of nulliparous women in eight geographic regions. Women with body mass index <30 kg/m2 and pregestational diabetes mellitus (GDM) were excluded. Four groups were compared: (1) normal 50-g 1-hour glucose screen, (2) elevated 1-hour glucose screen with normal 100-g 3-hour diagnostic OGTT, (3) elevated 1-hour glucose screen and one of four abnormal values on 3-hour OGTT, and (4) GDM. Using multivariable logistic regression adjusting for covariates, the women in the groups with dysglycemia were compared with those in the normal screen group for maternal and neonatal outcomes. Results Among 1,713 obese women, 1,418 (82.8%) had a normal 1-hour glucose screen, 125 (7.3%) had a normal 3-hour diagnostic OGTT, 72 (4.2%) had one abnormal value on their diagnostic OGTT, and 98 (5.7%) were diagnosed with GDM. The one abnormal value group had increased risk of large for gestational age (LGA) neonates (adjusted odds ratio [aOR] = 2.24, 95% confidence interval [CI]: 1.31–3.82), cesarean delivery (aOR = 2.19, 95% CI: 1.34–3.58), and hypertensive disorders of pregnancy (aOR = 2.19, 95% CI: 1.32–3.63) compared with normal screens. The one abnormal value group also had an increased risk of preterm birth <37 weeks (aOR = 2.63, 95% CI: 1.43–4.84), neonatal respiratory support (aOR = 2.38, 95% CI: 1.23–4.60), and neonatal hyperbilirubinemia (aOR = 2.00, 95% CI: 1.08–3.71). There was no association between one abnormal value with shoulder dystocia and neonatal hypoglycemia. Conclusion For obese women, one abnormal value on the 3-hour OGTT confers increased perinatal adverse outcomes. These women should be studied further to determine if nutrition counseling and closer fetal monitoring improve outcomes even in the absence of a diagnosis of GDM. Key Points

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Abstract 75: Cardiomyocyte-specific Conditional Deletion of GSK-3β Leads to Global Metabolic Defects and Cardiac Dysfunction in a HFD Induced Obesity Model

Circulation Research ◽

10.1161/res.119.suppl_1.75 ◽

2016 ◽

Vol 119 (suppl_1) ◽

Author(s):

Hind Lal ◽

Firdos Ahmad ◽

Vipin K Verma ◽

Samvruta Tumuluru ◽

Shan Parikh ◽

...

Keyword(s):

Glucose Tolerance ◽

Glucose Intolerance ◽

Cardiac Dysfunction ◽

Mass Composition ◽

Oral Glucose ◽

Oral Glucose Tolerance ◽

Therapeutic Benefits ◽

Increased Risk ◽

Gsk 3Β

Obesity has reached epidemic proportions worldwide and is associated with increased risk of cardiovascular and metabolic disease, resulting in enhanced morbidity and mortality. Indeed, the primary cause of mortality in patients with diabetes is cardiovascular disease, accounting for 50-80% of deaths. Numerous studies have implicated GSK-3β in the pathogenesis of insulin resistance, metabolic syndrome and diabetes. However, these studies are primarily relies on non-isoform specific inhibitors. We and others have reported not only isoform-specific functions of GSK-3 but also their distinct roles in various tissues. At present, all available inhibitors of GSK-3 are non-isoform-specific; therefore it’s impossible to assess the isoform-specific functions by employing these agents. The primary goal of present study was to determine the role of cardiac GSK-3β in obesity-induced metabolic perturbations and cardiac dysfunction. An oral glucose tolerance test (GTT) was performed on cardiomyocyte-specific GSK-3β KO (GSK-3β KO) and controls. At baseline, GSK-3β KO and controls displays a comparable lean mass, fat mass and oral glucose tolerance. To determine the functional role of cardiac GSK-3β in obesity-induced glucose intolerance, GSK-3β KO and controls were subjected to HFD for 24 wks and an oral GTT assay was performed on fasting mice (6h). The hyperglycemic response was significantly increased in the obese GSK-3β KO mice in comparison to obese WT mice. Importantly, body weight and food consumption were comparable between groups confirming that observed glucose intolerance in GSK-3β KO were not confounded by variable body mass composition. Furthermore, HFD leads to accelerated cardiac dysfunction in GSK-3β KO hearts compared to controls as reflected by significantly reduced ejection fraction (EF) and functional shortening. In summary, these data suggest that cardiac-specific deletion of GSK-3β lead to systemic glucose intolerance and cardiac dysfunction. These findings suggest that cardiac GSK-3β is required for the maintenance of global metabolic homeostasis and cardiac function in diabetic hearts and strategies to maintain GSK-3β activity may lead to therapeutic benefits for the disease.

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