Glycemic Variability and Mean Weekly Glucose in the Evaluation and Treatment of Blood Glucose in Gestational Diabetes Mellitus; Evidence for Lower Neonatal Complications

Carbohydrate is the macronutrient that has the greatest impact on blood glucose response. Limited data are available on how carbohydrate distribution throughout the day affects blood glucose in women with gestational diabetes mellitus (GDM). We aimed to assess how a high-carbohydrate morning-intake (HCM) versus a low-carbohydrate-morning-intake (LCM), affect glycemic variability and glucose control. In this randomized crossover study continuous glucose monitoring (CGM) was performed in 12 women with diet treated GDM (75 g, 2-h OGTT ≥ 8.5 mmol/L), who went through 2 × 3 days of HCM and LCM. A within-subject-analysis showed a significantly higher mean amplitude of glucose excursions (MAGE) (0.7 mmol/L, p = 0.004) and coefficient of variation (CV) (5.1%, p = 0.01) when comparing HCM with LCM, whereas a significantly lower mean glucose (MG) (−0.3 mmol/L, p = 0.002) and fasting blood glucose (FBG) were found (−0.4 mmol/L, p = 0.01) on the HCM diet compared to the LCM diet. In addition, insulin resistance, expressed as Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), decreased significantly during HCM. Results indicate that a carbohydrate distribution of 50% in the morning favors lower blood glucose and improvement in insulin sensitivity in women with GDM, but in contrary gives a higher glycemic variability.

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Safe threshold of capillary blood glucose for predicting early future neonatal hypoglycaemia in babies born to mothers with gestational diabetes mellitus, an observational, retrospective cohort study

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-03973-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Esther H. G. Park ◽

Frances O’Brien ◽

Fiona Seabrook ◽

Jane Elizabeth Hirst

Keyword(s):

Diabetes Mellitus ◽

Cohort Study ◽

Blood Glucose ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Capillary Blood ◽

Capillary Blood Glucose ◽

Neonatal Hypoglycaemia

Abstract Background There is increasing pressure to get women and babies home rapidly after birth. Babies born to mothers with gestational diabetes mellitus (GDM) currently get 24-h inpatient monitoring. We investigated whether a low-risk group of babies born to mothers with GDM could be defined for shorter inpatient hypoglycaemia monitoring. Methods Observational, retrospective cohort study conducted in a tertiary maternity hospital in 2018. Singleton, term babies born to women with GDM and no other risk factors for hypoglycaemia, were included. Capillary blood glucose (BG) testing and clinical observations for signs of hypoglycaemia during the first 24-h after birth. BG was checked in all babies before the second feed. Subsequent testing occurred if the first result was < 2.0 mmol/L, or clinical suspicion developed for hypoglycaemia. Neonatal hypoglycaemia, defined as either capillary or venous glucose ≤ 2.0 mmol/L and/or clinical signs of neonatal hypoglycaemia requiring oral or intravenous dextrose (lethargy, abnormal feeding behaviour or seizures). Results Fifteen of 106 babies developed hypoglycaemia within the first 24-h. Maternal and neonatal characteristics were not predictive. All babies with hypoglycaemia had an initial capillary BG ≤ 2.6 mmol/L (Area under the ROC curve (AUC) 0.96, 95% Confidence Interval (CI) 0.91–1.0). This result was validated on a further 65 babies, of whom 10 developed hypoglycaemia, in the first 24-h of life. Conclusion Using the 2.6 mmol/L threshold, extended monitoring as an inpatient could have been avoided for 60% of babies in this study. Whilst prospective validation is needed, this approach could help tailor postnatal care plans for babies born to mothers with GDM.

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Searching for Utopia, the Challenge of Standardized Medical Nutrition Therapy Prescription in Gestational Diabetes Mellitus Management: A Critical Review

Seminars in Reproductive Medicine ◽

10.1055/s-0040-1722316 ◽

2021 ◽

Author(s):

Nina Meloncelli ◽

Shelley A. Wilkinson ◽

Susan de Jersey

Keyword(s):

Diabetes Mellitus ◽

Blood Glucose ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Lifestyle Modification ◽

Nutrition Therapy ◽

Medical Nutrition Therapy ◽

Glucose Levels ◽

Blood Glucose Levels ◽

Medical Nutrition

AbstractGestational diabetes mellitus (GDM) is a common pregnancy disorder and the incidence is increasing worldwide. GDM is associated with adverse maternal outcomes which may be reduced with proper management. Lifestyle modification in the form of medical nutrition therapy and physical activity, as well as self-monitoring of blood glucose levels, is the cornerstone of GDM management. Inevitably, the search for the “ultimate” diet prescription has been ongoing. Identifying the amount and type of carbohydrate to maintain blood glucose levels below targets while balancing the nutritional requirements of pregnancy and achieving gestational weight gain within recommendations is challenging. Recent developments in the area of the gut microbiota and its impact on glycemic response add another layer of complexity to the success of medical nutrition therapy. This review critically explores the challenges to dietary prescription for GDM and why utopia may never be found.

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Effects of probiotics on blood glucose, biomarkers of inflammation and oxidative stress in pregnant women with gestational diabetes mellitus: A meta-analysis of randomized controlled trials

Medicina Clínica ◽

10.1016/j.medcli.2019.05.041 ◽

2020 ◽

Vol 154 (6) ◽

pp. 199-206 ◽

Cited By ~ 3

Author(s):

Yuan Chen ◽

Rensong Yue ◽

Boxun Zhang ◽

Zhenhua Li ◽

Jiacheng Shui ◽

...

Keyword(s):

Oxidative Stress ◽

Diabetes Mellitus ◽

Blood Glucose ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Randomized Controlled Trials ◽

Meta Analysis ◽

Controlled Trials ◽

Randomized Controlled ◽

And Oxidative Stress

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Effect of utilizing developed gestational diabetes mellitus guideline on pregnancy and childbirth outcomes

Clinical Nursing Studies ◽

10.5430/cns.v9n1p15 ◽

2020 ◽

Vol 9 (1) ◽

pp. 15

Author(s):

Enas Sabry Fathy Elbeltagy ◽

Nahed Fikry Hassan Khedr ◽

Nadia Youssef Ahmed Abd-Ella

Keyword(s):

Diabetes Mellitus ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Antenatal Care ◽

Pregnant Women ◽

Pregnancy Outcomes ◽

Lifestyle Changes ◽

Neonatal Complications ◽

Pregnancy And Childbirth ◽

Routine Antenatal Care

Background: Gestational Diabetes Mellitus (GDM) is one of the most common medical health problems that may happen during pregnancy and may lead to a range of short and long-term maternal, fetal as well as neonatal complications. However, effective management and education on GDM self-care measures improve pregnancy outcomes for both women and their neonates.Aim: The study was carried out to evaluate the effect of utilizing developed gestational diabetes mellitus guideline on pregnancy and childbirth outcomes.Methods: A quasi-experimental research design was used at Antenatal Clinic of Obstetric and Gynecological Specialty Center at Mansoura University Hospitals, Mansoura city. A purposive sample of 126 pregnant women diagnosed with GDM, assigned to the intervention group (n = 63) who utilized the Gestational Diabetes Mellitus Guideline (GDMG) of care in addition to routine antenatal care and control group (n = 63) who followed routine antenatal care only. Tools: Three tools were used to collect data from participants as A structured interview schedule, maternal assessment record and fetal & neonatal assessment record.Results: The current study findings indicated that, there was a highly statistical significant reduction of body mass index and the mean random blood glucose levels at 34 & 37 weeks’ of pregnancy after intervention in the GDMG group than control groups (p < .001). Also, there was a statistical significant reduction in the occurrence of maternal complications as gestational hypertension, preeclampsia, preterm labor and polyhydramnios in the GDMG group .Similarly, the neonates of the GDMG group had better Apgar scores after birth & lower incidence for developing neonatal complications as prematurity, respiratory distress syndrome and NICU admission.Conclusions and Recommendations: This study showed that, pregnant women with GDM who utilized the GDMG had better maternal & neonatal outcomes than those who did not utilize it. It is recommended to provide a manual GDMG to all pregnant women with GDM for better lifestyle changes & maintaining self-management regimen as well as better pregnancy outcomes.

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Oleuropein alleviates gestational diabetes mellitus by activating AMPK signaling

Endocrine Connections ◽

10.1530/ec-20-0466 ◽

2020 ◽

Author(s):

Zhiwei Zhang ◽

Hui Zhao ◽

Aixia Wang

Keyword(s):

Oxidative Stress ◽

Diabetes Mellitus ◽

Body Weight ◽

Blood Glucose ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Signaling Pathway ◽

Hepatic Glycogen ◽

Ampk Signaling ◽

Tnf Α

Background: Gestational diabetes mellitus (GDM) has a high incidence rate among pregnant women. The objective of the study was to assess the effect of plant-derived oleuropein in attenuating inflammatory and oxidative stress of GDM. Methods: Oleuropein was administered to GDM mice at the doses of 5 or 10 mg/kg/day. Body weight, blood glucose, insulin and hepatic glycogen levels were recorded. To evaluate the effect of oleuropein in reducing oxidative stress, enzyme-linked immunosorbent assay (ELISA) was used to measure the hepatic oxidative stress markers. The inflammation levels of GDM mice were evaluated by measuring serum levels of IL-6 and TNF-α by ELISA, and mRNA levels of IL-1β, TNF-α and IL-6 by real-time PCR (RT-PCR). The AMP-activated protein kinase (AMPK) signaling pathway was assessed by Western blot. Gestational outcome was analyzed through comparing litter size and birth weight. Results: Oleuropein attenuated the elevated body weight of GDM mice, and efficiently reduced blood glucose, insulin and hepatic glycogen levels. Oxidative stress and inflammation were alleviated by oleuropein treatment. The AMPK signaling was activated by oleuropein in GDM mice. Gestational outcome was markedly improved by oleuropein treatment. Conclusions: Our study suggests that oleuropein is effective in alleviating symptoms of GDM and improving gestational outcome in the mouse model. This effect is achieved by attenuating oxidative stress and inflammation, which is mediated by the activation of the AMPK signaling pathway.

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GESTATIONAL DIABETES MELLITUS

The Professional Medical Journal ◽

10.29309/tpmj/2012.19.04.2258 ◽

2012 ◽

Vol 19 (04) ◽

pp. 462-468

Author(s):

M. IKRAM ◽

SYED HAIDER HASAN ALAM ◽

SHAFQAT MUKHTAR ◽

M. Saeed

Keyword(s):

Diabetes Mellitus ◽

Blood Glucose ◽

Gestational Diabetes ◽

Glucose Tolerance ◽

Gestational Diabetes Mellitus ◽

Glucose Tolerance Test ◽

Fasting Blood Glucose ◽

Tolerance Test ◽

Oral Glucose ◽

Oral Glucose Tolerance

Introduction: Gestational diabetes mellitus is common disorder in pregnancy. It is associated with adverse pregnancy outcome. There is no consensus regarding the optimal approach to screening of gestational diabetes mellitus. The present study has tried toobserve the value of fasting blood glucose in screening of gestational diabetes. Objective: To determine the frequency of patients in whomfasting blood glucose and 100gm glucose tolerance show agreement for screening of gestational diabetes mellitus at 24 -28 wks. Studydesign: Comparative cross sectional study. Settings: The study was conducted at Gynecology and Obstetrics department Shaikh ZayedFederal Post Graduate Institute Lahore. Duration of study with dates: 6 months from 12Nov 2010 to 11 May 2011. Material and method: Thestudy included 135 booked patients with positive family history of diabetes mellitus. All patients underwent fasting blood glucose at 24-28 weeksof gestation, regardless of results of fasting blood glucose on next visit they underwent 100g oral glucose tolerance test (OGTT). The agreementbetween fasting blood glucose and 100g oral glucose tolerance test was calculated in frequency and percentages. Results: The mean age ofwomen in studied population was 27.15±3.70.Out of 135 patients 86.7 %( 117) showed agreement between results of fasting blood glucose and100g OGTT while 13.31 %( 18) showed no agreement between both of the tests. Conclusions: Fasting blood glucose is a good screeningoption for gestational diabetes mellitus along with positive history. It provides a simple, cheap and more practical test for screening of gestationaldiabetes mellitus. However diagnostic confirmation with 100g OGTT should be done.

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