Diabetic Retinopathy in Parous Women With and Without Previous Gestational Diabetes Mellitus: A Nationwide Register-Based Cohort Study.

The association between gestational diabetes mellitus (GDM) and incident kidney disease, the mediating effects of diabetes and hypertension, and the impact of severity of metabolic dysfunction during pregnancy on the risk of incident kidney disease were investigated in this study. This Danish, nationwide, register-based cohort study included all women giving birth between 1997 and 2018. Outcomes included chronic kidney disease (CKD) and acute kidney disease, based on diagnosis codes. Cox regression analyses explored the association between GDM and kidney disease. A proxy for severity of metabolic dysfunction during pregnancy was based on GDM diagnosis and insulin treatment during GDM in pregnancy and was included in the models as an interaction term. The mediating effects of subsequent diabetes and hypertension prior to kidney disease were quantified using mediation analyses. Data from 697,622 women were used. Median follow-up was 11.9 years. GDM was associated with higher risk of CKD (adjusted hazard ratio [aHR] 1.92; 95% CI 1.67-2.21), whereas acute kidney disease was unrelated to GDM. The proportions of indirect effects of diabetes and hypertension on the association between GDM and CKD were 75.7% (95% CI 61.8-89.6) and 30.3% (95% CI 25.2-35.4), respectively, as assessed by mediation analyses. The CKD risk was significantly increased in women with insulin-treated GDM and no subsequent diabetes compared with women without GDM (aHR 2.35; 95% CI 1.39-3.97). The risk of CKD was significantly elevated after GDM irrespective of subsequent development of diabetes and hypertension. Furthermore, women with severe metabolic dysfunction during pregnancy had the highest CKD risk.

<p> </p> <p><em>Objective</em></p> <p>To investigate associations between previous gestational diabetes mellitus (GDM) and incident psychiatric morbidity. Additionally, to explore the role of subsequent diabetes mellitus development in psychiatric morbidity risk.</p> <p><em>Research design and methods</em></p> <p>A nationwide register-based cohort study including all women delivering in Denmark from 1997 to 2018 was conducted. GDM exposure was based on diagnosis code, whereas psychiatric morbidity outcome was based on diagnosis codes and psychopharmacological medication use. Multiple Cox regression and mediation analyses were performed.</p> <p><em>Results</em></p> <p>In a study population of 660,017 women, previous GDM was associated with increased risks of depression based on diagnosis code and/or medication use (adjusted hazard ratio [aHR] 1.22 [95% CI 1.18–1.27]), any psychiatric diagnosis (aHR 1.20 [95% CI 1.13–1.27]), and any psychopharmacological medication use (aHR 1.21 [95% CI 1.17–1.25]). Moreover, risks of depressive and anxiety disorders, as well as antidepressant and antipsychotic medication use were increased, with aHRs ranging from 1.14 [95% CI 1.05–1.25] to 1.32 [95% CI 1.22–1.42]. No associations were found regarding substance use disorders, psychotic disorders, bipolar disorders, postpartum psychiatric disease, and anxiolytic medication use. Psychiatric morbidity risk was higher in women with than without subsequent diabetes development. However, GDM history only impacted risk estimates in women without subsequent diabetes. Subsequent diabetes mediated 35-42% of the associations between GDM and psychiatric morbidity.</p> <p><em>Conclusions</em></p> <p>GDM was associated with increased psychiatric morbidity risk. Subsequent diabetes development played a significant role in the future psychiatric morbidity risk after GDM, although it only partly explained the association.</p>

<p> </p> <p><em>Objective</em></p> <p>To investigate associations between previous gestational diabetes mellitus (GDM) and incident psychiatric morbidity. Additionally, to explore the role of subsequent diabetes mellitus development in psychiatric morbidity risk.</p> <p><em>Research design and methods</em></p> <p>A nationwide register-based cohort study including all women delivering in Denmark from 1997 to 2018 was conducted. GDM exposure was based on diagnosis code, whereas psychiatric morbidity outcome was based on diagnosis codes and psychopharmacological medication use. Multiple Cox regression and mediation analyses were performed.</p> <p><em>Results</em></p> <p>In a study population of 660,017 women, previous GDM was associated with increased risks of depression based on diagnosis code and/or medication use (adjusted hazard ratio [aHR] 1.22 [95% CI 1.18–1.27]), any psychiatric diagnosis (aHR 1.20 [95% CI 1.13–1.27]), and any psychopharmacological medication use (aHR 1.21 [95% CI 1.17–1.25]). Moreover, risks of depressive and anxiety disorders, as well as antidepressant and antipsychotic medication use were increased, with aHRs ranging from 1.14 [95% CI 1.05–1.25] to 1.32 [95% CI 1.22–1.42]. No associations were found regarding substance use disorders, psychotic disorders, bipolar disorders, postpartum psychiatric disease, and anxiolytic medication use. Psychiatric morbidity risk was higher in women with than without subsequent diabetes development. However, GDM history only impacted risk estimates in women without subsequent diabetes. Subsequent diabetes mediated 35-42% of the associations between GDM and psychiatric morbidity.</p> <p><em>Conclusions</em></p> <p>GDM was associated with increased psychiatric morbidity risk. Subsequent diabetes development played a significant role in the future psychiatric morbidity risk after GDM, although it only partly explained the association.</p>

To investigate associations between previous gestational diabetes mellitus (GDM) and incident psychiatric morbidity, and to explore the role of subsequent diabetes development in psychiatric morbidity risk. A nationwide register-based cohort study including all women delivering in Denmark from 1997 to 2018 was conducted. GDM exposure was based on diagnosis code, whereas psychiatric morbidity outcome was based on diagnosis code and psychopharmacological medication use. Multiple Cox regression and mediation analyses were performed. In a study population of 660,017 women, previous GDM was associated with increased risk of depression based on diagnosis code and/or medication use (adjusted hazard ratio [aHR] 1.22 [95% CI 1.18-1.27]), any psychiatric diagnosis (aHR 1.20 [95% CI 1.13-1.27]), and any psychopharmacological medication use (aHR 1.21 [95% CI 1.17-1.25]). Moreover, risk of depressive and anxiety disorders, as well as antidepressant and antipsychotic medication use, was increased, with aHRs ranging from 1.14 (95% CI 1.05-1.25) to 1.32 (95% CI 1.22-1.42). No associations were found regarding substance use disorders, psychotic disorders, bipolar disorders, postpartum psychiatric disease, or anxiolytic medication use. Psychiatric morbidity risk was higher in women with versus without subsequent diabetes development. However, GDM history affected risk estimates only in women without subsequent diabetes. Subsequent diabetes mediated 35-42% of the associations between GDM and psychiatric morbidity. GDM was associated with increased psychiatric morbidity risk. Subsequent diabetes development played a significant role in future psychiatric morbidity risk after GDM, although it only partly explained the association.

<p dir="ltr">OBJECTIVE</p><p dir="ltr">This study investigated the association between gestational diabetes mellitus (GDM) and incident kidney disease, the mediating effects of diabetes and hypertension, and the impact of severity of metabolic dysfunction during pregnancy on the risk of incident kidney disease.</p><p dir="ltr">RESEARCH DESIGN AND METHODS</p><p dir="ltr">This Danish nationwide register-based cohort study included all women giving birth between 1997 and 2018. Outcomes included chronic kidney disease (CKD) and acute kidney disease based on diagnosis codes. Cox regression analyses explored the association between GDM and kidney disease. A proxy for severity of metabolic dysfunction during pregnancy was based on GDM diagnosis and insulin treatment during GDM-pregnancy and included in the models as interaction term. The mediating effects of subsequent diabetes and hypertension prior to kidney disease were quantified using mediation analyses.</p><p dir="ltr">RESULTS</p><p dir="ltr">We included 697,622 women. Median follow-up was 11.9 years. GDM associated with higher risk of CKD (adjusted hazard ratio [aHR] 1.92 [95% CI 1.67–2.21]) whereas acute kidney disease was unrelated to GDM. There were indirect effects of diabetes and hypertension on the association between GDM and CKD; 75.7% (95% CI 61.8–89.6) and 30.3% (95% CI 25.2–35.4), respectively, as assessed by mediation analyses. The CKD risk was significantly increased in women with insulin-treated GDM and no subsequent diabetes compared to women without GDM (aHR 2.35 [95% CI 1.39–3.97]).</p><p dir="ltr">CONCLUSIONS</p><p dir="ltr">The risk of CKD was significantly elevated after GDM irrespective of subsequent development of diabetes and hypertension. Furthermore, women with severe metabolic dysfunction during pregnancy had the highest CKD risk. </p>

<p dir="ltr">OBJECTIVE</p><p dir="ltr">This study investigated the association between gestational diabetes mellitus (GDM) and incident kidney disease, the mediating effects of diabetes and hypertension, and the impact of severity of metabolic dysfunction during pregnancy on the risk of incident kidney disease.</p><p dir="ltr">RESEARCH DESIGN AND METHODS</p><p dir="ltr">This Danish nationwide register-based cohort study included all women giving birth between 1997 and 2018. Outcomes included chronic kidney disease (CKD) and acute kidney disease based on diagnosis codes. Cox regression analyses explored the association between GDM and kidney disease. A proxy for severity of metabolic dysfunction during pregnancy was based on GDM diagnosis and insulin treatment during GDM-pregnancy and included in the models as interaction term. The mediating effects of subsequent diabetes and hypertension prior to kidney disease were quantified using mediation analyses.</p><p dir="ltr">RESULTS</p><p dir="ltr">We included 697,622 women. Median follow-up was 11.9 years. GDM associated with higher risk of CKD (adjusted hazard ratio [aHR] 1.92 [95% CI 1.67–2.21]) whereas acute kidney disease was unrelated to GDM. There were indirect effects of diabetes and hypertension on the association between GDM and CKD; 75.7% (95% CI 61.8–89.6) and 30.3% (95% CI 25.2–35.4), respectively, as assessed by mediation analyses. The CKD risk was significantly increased in women with insulin-treated GDM and no subsequent diabetes compared to women without GDM (aHR 2.35 [95% CI 1.39–3.97]).</p><p dir="ltr">CONCLUSIONS</p><p dir="ltr">The risk of CKD was significantly elevated after GDM irrespective of subsequent development of diabetes and hypertension. Furthermore, women with severe metabolic dysfunction during pregnancy had the highest CKD risk. </p>

BackgroundGestational diabetes mellitus (GDM) is a common pregnancy complication characterized by insulin resistance. A link has been suggested between insulin resistance and breast cancer, which is the most common cancer in women. Hence, women with previous GDM may be at increased risk of developing breast cancer, yet, the existing evidence is conflicting. This study explored the association between GDM and incident breast cancer, including age at cancer diagnosis. Additionally, we investigated the potential impact of severity of insulin resistance during pregnancy and of subsequent diabetes development on the breast cancer risk.MethodsWe conducted a nationwide, register-based cohort study including all women giving birth in Denmark from 1997 to 2018. We defined GDM and breast cancer based on ICD-10 codes. Premenopausal and postmenopausal breast cancer was pragmatically defined as age at outcome < 50 years and ≥ 50 years, respectively. A proxy for severity of insulin resistance during pregnancy was based on insulin treatment; subsequent diabetes was defined as presence of ICD-10 codes and/or antidiabetic medication after pregnancy. The statistical analyses included Cox regression, logistic regression and t-test.ResultsOf 708,121 women, 3.4% had GDM. The median follow-up period was 11.9 years (range 0-21.9). The overall breast cancer risk was comparable in women with and without previous GDM (adjusted hazard ratio 0.96 [95% CI 0.83–1.12]). Premenopausal and postmenopausal breast cancer risk also did not differ; however, women with previous GDM had a breast cancer diagnosis at younger age (42.6 vs. 43.5 years, p-value 0.01). All-cause mortality was similar regardless of GDM history. Severity of insulin resistance during pregnancy and subsequent diabetes did not affect breast cancer risk.ConclusionsThis large, population-based cohort study showed no higher risk of incident breast cancer in women with previous GDM compared to women without previous GDM after a median of almost 12 years of follow-up. This was evident irrespective of menopausal state. The breast cancer risk was not influenced by the severity of insulin resistance during pregnancy and by subsequent diabetes development. Regardless of GDM history, attention towards prevention, early detection and treatment of breast cancer should be prioritized.

Predictive factors for the development of diabetes in women with previous gestational diabetes mellitus

Gestational diabetes mellitus (GDM) is a common complication of pregnancy associated with a higher risk of developing type 2 diabetes (T2DM) in the future. Postpartum diabetes screening is important to identify glucose intolerance and introduce diabetes prevention support. However, screening uptake is suboptimal, including in China where the prevalence of GDM is high. There is limited evidence on the barriers and facilitators to screening uptake among Chinese women. To explore the barriers and facilitators of postpartum diabetes screening uptake among Chinese women with GDM to inform the development of an intervention to increase screening attendance. Women with current or previous GDM were recruited from social network platforms and pregnancy groups in China. Data were collected using semi-structured interviews and analysed using Framework Analysis to identify themes related to the barriers and facilitators for screening uptake. Twenty-four women with current (n = 4) or previous (n = 20) GDM participated. The postpartum glucose screening attendance rate was 35% among those with previous GDM. Screening uptake was influenced by: risk awareness of T2DM and its complications, interactions with healthcare providers (HCPs), screening-related factors (understanding and beliefs, accessibility and acceptability of the test) and motivation to maintain personal health, which was influenced by fear of T2DM, lack of symptoms, confidence in self management without support, and prioritisation of the child's needs. Postpartum screening uptake after GDM could be boosted through raising risk awareness, more constructive communication from HCPs, increasing the acceptability and accessibility of screening procedures, and addressing psychological factors related to attendance.

This retrospective cohort study was designed to examine the prevalence and risk factors of gestational diabetes mellitus (GDM) in Manitoba. A total of 324,605 deliveries by 165,969 women were reported to Manitoba Health in the years 1985-2004. Data on maternal ages, delivery dates, GDM, self-declared First Nation (FN) status, rural or urban residence and previous GDM were collected for the study. Data were analyzed using multivariate logistic regression models. The prevalence of GDM during the 20-year period was 2.9%, which was 2.3% in 1985-1989 and 3.7% in 1999-2004 (P < 0.01). The trend of increase in the prevalence of GDM continued after major modifications on the screening and diagnostic criteria for GDM in 1998. The prevalence of GDM in FN women was 3-times greater than that in non-FN women. Higher prevalence of GDM was detected in FN pregnant women living in rural areas compared to those in urban areas (P < 0.01), which was opposite for non-FN pregnant women living in rural and urban areas. The prevalence of GDM in pregnant women > or =35 yr was 2.3-fold higher than that in those < 35 yr (P < 0.01). The recurrent rate of GDM was 44.4%. Adjusted odds ratios of GDM for FN status, advanced age, a history of GDM and rural living were 2.2, 2.4, 25.1 and 0.8, respectively. The prevalence of GDM is increased in Manitoba. FN status, advanced age and a history of GDM, but not rural living, are independent predictors for GDM.

Women with previous preeclampsia (PE), gestational hypertension (GH), or gestational diabetes mellitus (GDM) have increased cardiovascular disease (CVD) risk. Physical activity (PA) is an important CVD risk modifier. We aimed to assess PA levels, using a validated objective method, and other modifiable CVD risk factors in women with these previous pregnancy complications. One year postpartum we assessed PA levels for 1week in women with previous PE (n=68), GH (n=26), GDM (n=23), and normotensive pregnancies (n=65), using the ActiGraph-wGT3X-BT™ accelerometer. We assessed adherence to American PA guidelines (≥150min/week of moderate or ≥75min/week of vigorous intensity PA), and time spent in moderate and vigorous PA. We also assessed steps/day, blood pressure and anthropometric indices. Recommended PA levels were achieved in only 50%, 39%, and 35% following PE, GH, and GDM, respectively, not significantly different from controls (52%). Differences in moderate and vigorous PA levels and steps/day between the groups were non-significant, except from lower vigorous PA in women with previous GDM. Elevated blood pressure (systolic BP≥120mmHg and/or diastolic BP≥80mmHg) was more common after PE and GH. Overweight rates were significantly higher in PE, GH, and GDM groups compared to controls. Less than half of women achieved recommended PA levels 1year postpartum. This did not differ significantly between women with previous PE, GH, or GDM compared to controls. Measures to increase PA in postpartum women are warranted, especially in women with pregnancy complications associated with high risk of premature CVD.

Introduction: Adrenal glands are a common site for cancer metastases. However, massive adrenal haemorrhage secondary to adrenal metastasis is rare. We report an unusual case of spontaneous massive retroperitoneal haemorrhage from an adrenal gland metastasis. Case report: A 74-year-old man was admitted with sudden onset of right upper quadrant abdominal pain. He had a 20 pack per year history of cigarette smoking. On examination he was distressed with blood pressure of 85/59mmHg and regular pulse of 90 beats /min. Abdominal examination revealed tenderness and guarding in the right hypochondrium and the right flank. Initial laboratory investigations revealed haemoglobin of 14.4g/dl and haematocrit of 41%. His haemoglobin and haematocrit subsequently dropped to 8.9g/dl and 25.9%, respectively. Computed tomography (CT) scan of the abdomen revealed bilateral adrenal masses (right 5.6cm and left 2.4cm) with right adrenal and extensive retroperitoneal haemorrhage. No signs and symptoms of hypoadrenalism developed and his response to short synacthen test was satisfactory. Phaeochromocytoma was ruled out by normal urinary catecholamine levels (6 samples). Subsequent CT of the chest showed an abnormal lesion in the right upper lobe and 4cm soft subcarinal mass, the histology of which showed squamous cell carcinoma of the lung. Discussion: Clinically significant adrenal haemorrhage secondary to metastases from lung cancer is extremely rare. To the best of our knowledge, there are only 10 reports (15 patients) in the English literature of adrenal haemorrhage secondary to metastases of lung carcinoma. Of the 15 patients, only 7 patients were known to have lung cancer before their presentation with adrenal haemorrhage.

To evaluate the impact of assisted reproductive technology (ART) on the risk of gestational diabetes mellitus (GDM) in single pregnancies. We retrospectively collected clinical and anthropometric data of 219ART- and 256 age- and body mass index (BMI)-matched women with spontaneous conception screened for GDM. The primary outcome was to evaluate GDM prevalence in ART women. There were no differences in age, BMI, and family history of diabetes in the two groups of women. ART-women were more frequently primiparous, whereas the prevalence of previous GDM was higher in SC-women. The prevalence of GDM in thewhole cohort was 36.1% and was higher in ART-women (52.3% vs. 23.4%; p<0.0001). In the whole cohort, on multivariate analysis, family history of diabetes (OR 1.67; 95% CI: 1.03-2.69), previous GDM (OR 7.05; 95% CI: 2.92-17.04), pre-pregnancy obesity (OR 2.72; 95% CI 1.21-6.13), and ART (OR 4.14; 95% CI 2.65-6.48) were independent risk factors for GDM. Among ART-women, age over 40years was associated with GDM. Preterm delivery was more common in ART-women; gestational week at delivery, birth weight, ponderal index, and Apgar score were lower in ART-women than in SC-women, both in the whole cohort and in GDM women. Among women undergoing ART treatment, at least one in two develops GDM. ART appears to be an independent risk factor for GDM in single pregnancies, particularly above the age of 40. ART treatment seems to be associated with an increased rate of preterm delivery and lower neonatal birth weight and Apgar score, especially in GDM women. The study was not registered as it is an observational retrospective evaluation.

Women with previous gestational diabetes mellitus (GDM) have an increased risk for later development of type 2 diabetes. During pregnancy, GDM affects the cardio-metabolic protein profile; however, it is unknown how GDM affects the cardio-metabolic protein profile in the long term and if it is associated with type 2 diabetes after GDM. We hypothesise that the cardio-metabolic protein profile is affected long term and is associated with the development of type 2 diabetes after GDM. A case-control follow-up study based on the Odense GDM Follow-Up Study (OGFUS) cohort, which included women with previous GDM (n = 128) and matched controls without previous GDM (n = 70). Blood samples from a follow-up assessment 8-10 years after delivery were analysed using a 29-plex panel of apolipoproteins, transport and inflammation/immune proteins using multiple-reaction-monitoring mass spectrometry. Apolipoprotein A-I, D and M were significantly lower in women with previous GDM compared to controls (all p < 0.001), while apolipoprotein L-I, H, vitamin D binding protein, CRP, vitronectin, transthyretin and complement factors 3 and B were significantly higher (p = 0.008, p < 0.001, p < 0.001, p < 0.001, p < 0.001, p = 0.005, respectively). All associations remained significant after adjustment for multiple testing except CRP, whereas apolipoprotein D, vitronectin and complement factors 3 and B were associated with the development of type 2 diabetes in women with previous GDM (p = 0.02, p = 0.001, p < 0.001, p = 0.004, respectively). The cardio-metabolic protein profile 8-10 years after pregnancy is altered in women with previous GDM. Apolipoprotein D, vitronectin and complement factors 3 and B are candidate risk markers of type 2 diabetes after GDM pregnancy.

Background: The increasing number of infertile couples has led to the growing popularity of assisted reproductive technologies as a means of achieving desired pregnancy. It is known that assisted reproductive technologies are an independent risk factor for a serious pregnancy complication—gestational diabetes mellitus. The multifactorial and polygenic nature of gestational diabetes mellitus, as well as its high prevalence following in vitro fertilization, make this issue of particular interest for research. Aim: To investigate the prevalence of gestational diabetes mellitus in pregnancies achieved through in vitro fertilization, its pathogenetic features, and possible risk factors. Methods: Scientific publications from eLibrary and PubMed databases were analyzed, focusing on the prevalence, risk factors, and pathogenetic features of gestational diabetes mellitus after assisted reproductive technologies. Outpatient and inpatient medical records of 116 women with singleton pregnancies from 2018 to 2022 were analyzed retrospectively and prospectively. The main group included 77 (66%) patients with in vitro fertilization pregnancies and confirmed gestational diabetes mellitus; the reference group included 39 (34%) in vitro fertilization patients without gestational diabetes mellitus. Results: The prevalence of gestational diabetes mellitus among pregnant women after in vitro fertilization is significantly higher than in the general pregnant population and, according to various sources, reaches up to 12.6%. Gestational diabetes mellitus is a polygenic multifactorial disease, with epigenetic influences acting as triggers in the presence of specific gene polymorphism associations. A high pregestational body mass index was identified as a risk factor for gestational diabetes mellitus after in vitro fertilization, whereas the number of in vitro fertilization attempts and the follicle-stimulating hormone to luteinizing hormone ratio did not significantly affect its development in this cohort. The etiology of infertility may be a risk factor for gestational diabetes mellitus according to some data, but in our study, no statistically significant differences were found between groups based on infertility cause (p 0.05). Conclusion: Understanding the pathogenetic features, identifying, and timely modifying potential risk factors for gestational diabetes mellitus among pregnant women following in vitro fertilization will allow for timely correction of carbohydrate metabolism disorders, as women with gestational diabetes mellitus are at high risk for pregnancy complications and the subsequent development of type 2 diabetes mellitus.