Influence of Pre-Pregnancy Underweight Body Mass Index on Fetal Abdominal Circumference, Estimated Weight, and Pregnancy Outcomes in Gestational Diabetes Mellitus

Pregnancy Outcomes in Women With and Without Gestational Diabetes Mellitus According to The International Association of the Diabetes and Pregnancy Study Groups Criteria

To investigate the relationship of different types of gestational diabetes mellitus (GDM) and pregnancy outcomes. A total of 4090 cases, who received prenatal examination and delivered in Peking University First Hospital and performed a 75 g oral glucose tolerance test (75 g OGTT) at 24-28 gestational weeks, from January. 1(st), 2011 to Jul 31(st), 2012 , were divided into 2 groups. Normal blood glucose group:the result of OGTT (fasting plasma glucose, 1 hour glucose and 2 hour glucose ) was normal; Gestational diabetes mellitus group (GDM group): the result of OGTT was abnormal at any time point. GDM group were separated into A, B and C. GDM A means fasting plasma glucose annormal but others were normal, GDM B:fasting plasma glucose, 1 hour and/or 2 hour glucose abnormal, GDM C:fasting plasma glucose normal. To analyse the effect of different number of abnormal result of OGTT on pregnancy outcomes, GDM group were divided into I, II and III.GDMI means one abnormal blood glucose of OGTT result, GDM II: two abnormal blood glucose and GDM III:three abnormal blood glucose. We analyzed the pregnant outcomes of each group. (1) Among the 4090 cases, 858 cases (21.98%) were diagnosed as GDM (GDM group), and 82 cases (9.6%, 82/858) were treated with insulin.other 3232 cases with normal blood glucose (normal blood glucose group). In GDM group, the rate of cesarean section (51.9%, 445/858), premature delivery (8.4%, 72/858) and LGA (5.9%, 51/858) were respectively significantly higher than those of normal blood glucose group [ (43.5%, 1406/3232), (5.8%, 189/3232) and(4.2%, 137/3232)] (P < 0.05). But, there was no statistically significant differences for the rate of macrosomia (P > 0.05) between the GDM group(6.8%, 58/858) and normal blood glucose group (6.2%, 199/3232) . (2) In the GDM group, GDM A was 317 cases (36.9%), GDM B 239 cases (27.8%), GDM C 302 cases (35.2%). The incidence of Macrosomia and LGA in GDM B was significantly higher than that in GDM C and normal blood glucose group (P < 0.05). Comparing with GDM A , there was no statistically significance in GDM B and GDM C (P > 0.05). (3) In GDM group, GDMIwas 521 cases (60.7%), GDM II203 cases (15.6%), GDM III 134 cases (23.7%). Compared with the normal blood glucose group, GDM III had a significantly higher incidence of macrosomia and LGA and cesarean section(P < 0.01);and GDM IIhad only a significantly higher incidence of cesarean section(P < 0.01). (4) Among the 4090 cases, there were 1118 patients (27.3%) whose fasting blood glucose was below 4.4 mmol/L, of which 55 cases were diagnosed as GDM. There were 4 premature infants and 1 macrosomia. The GDM group with more than FBG ≥ 5.1 mmol/L had a higher incidence of adverse pregnancy outcomes, it suggested that we should pay more attention and take actively intervented; the pregnant woman is not recommended for 75g OGTT detection when fasting blood glucose was below 4.4 mmol/L because of the low rate of GDM and adverse pregnancy outcomes among them.

ObjectiveTo examine the expression levels of miR-144-3p in the plasma of patients with gestational diabetes mellitus (GDM) and to construct a nomogram for predicting and evaluating factors influencing adverse pregnancy outcomes (APO) in GDM based on plasma miR-144-3p levels.MethodsThis study included 442 pregnant women, comprising 216 diagnosed with GDM (GDM group) and 226 with normal glucose tolerance (NGT group). Plasma miR-144-3p levels in both groups were measured using reverse transcription real-time polymerase chain reaction (RT-qPCR). The diagnostic performance of plasma miR-144-3p for GDM was assessed by receiver operating characteristic (ROC) curve analysis. During pregnancy, the GDM group was followed, and outcomes were categorized into two groups: 132 with favorable pregnancy outcomes (FPO) and 84 with APO. A random number table method was applied to divide the GDM group into a training set (n=151) and a validation set (n=65) using a 7:3 ratio. Differences in variables across pregnancy outcome subgroups in the training set were examined. Univariate and multivariate logistic regression analyses were performed to identify risk factors for APO in GDM. Based on these factors, a nomogram prediction model was developed to estimate the risk of APO in GDM. The model’s performance was evaluated using area under the curve (AUC) analysis, calibration curve analysis, and decision curve analysis (DCA).ResultsThe expression of miR-144-3p was significantly higher in the GDM group than in the NGT group (p < 0.05). miR-144-3p showed an AUC of 0.877, with a sensitivity of 81.09% and a specificity of 91.20% for diagnosing GDM. No statistically significant differences were observed in general clinical characteristics between the training and validation sets. In the training set, gestational weight gain (GWG), the number of OGTT abnormalities, glycaemic control (GC), and miR-144-3p expression varied significantly between the APO and FPO subgroups (p < 0.05). Multivariate logistic regression analysis identified increased GWG, the number of OGTT abnormalities, poor GC, and higher miR-144-3p levels as independent risk factors for APO in GDM. The AUC of the nomogram based on these variables was 0.881 in the training set and 0.855 in the validation set. Calibration curves indicated good agreement between predicted and actual outcomes in both sets. The DCA showed a clear net clinical benefit and stable predictive utility.ConclusionElevated plasma miR-144-3p levels in pregnant women with GDM may contribute to the occurrence of APO. The number of OGTT abnormalities and glycaemic control were also identified as independent risk factors. A nomogram incorporating miR-144-3p and these clinical indicators displays strong predictive accuracy and provides a practical tool for assessing APO risk in GDM.

The increasing prevalence of gestational diabetes mellitus (GDM) necessitates risk stratification directing limited antenatal resources to those at greatest risk. Recent evidence demonstrates that an early pregnancy glycated hemoglobin (HbA1c ≥5.9% (41 mmol/mol) predicts adverse pregnancy outcomes. To determine the optimal HbA1c threshold for adverse pregnancy outcomes in GDM in a treated multiethnic cohort and whether this differs in women diagnosed <24 vs ≥24 weeks' gestation (early vs standard GDM). This was a retrospective cohort study undertaken at the Royal Prince Alfred Hospital Diabetes Antenatal Clinic, Australia, between 1991 and 2011. Pregnant women (N = 3098) underwent an HbA1c (single-laboratory) measurement at the time of GDM diagnosis. Maternal clinical and pregnancy outcome data were collected prospectively. The association between baseline HbA1c and adverse pregnancy outcomes in early vs standard GDM. HbA1c was measured at a median of 17.6 ± 3.3 weeks' gestation in early GDM (n = 844) and 29.4 ± 2.6 weeks' gestation in standard GDM (n = 2254). In standard GDM, HbA1c >5.9% (41 mmol/mol) was associated with the greatest risk of large-for-gestational-age (odds ratio [95% confidence interval] = 2.7 [1.5-4.9]), macrosomia (3.5 [1.4-8.6]), cesarean section (3.6 [2.1-6.2]), and hypertensive disorders (2.6 [1.1-5.8]). In early GDM, similar HbA1c associations were seen; however, lower HbA1c correlated with the greatest risk of small-for-gestational-age (P trend = 0.004) and prevalence of neonatal hypoglycemia. Baseline HbA1c >5.9% (41 mmol/mol) identifies an increased risk of large-for-gestational-age, macrosomia, cesarean section, and hypertensive disorders in standard GDM. Although similar associations are seen in early GDM, higher HbA1c levels do not adequately capture risk-limiting utility as a triage tool in this cohort.

Background: Gestational diabetes mellitus (GDM) is associated with significant maternal and fetal complications, including preterm delivery, macrosomia, and neonatal hypoglycemia. Elevated serum ferritin levels, a marker of inflammation and oxidative stress, may exacerbate these risks. This study was aims to determine if serum ferritin elevation is a marker of adverse maternal and fetal outcome in pregnancies complicated by GDM. Method: A case control study was conducted in the Department of Obstetrics and Gynecology, Dhaka Medical College, Dhaka from September 2020 to August 2021. 42 pregnant women at 2nd 3rd trimester attended for antenatal care diagnosed as GDM was selected as cases and 42 non-diabetic pregnant women matching with cases by age and gestational age was selected as control are included this study. GDM was diagnosed by oral glucose tolerance test (OGTT). The serum ferritin level of these patients was measured. Results: Elevated serum ferritin was significantly associated with GDM (p&lt;0.05). GDM women had higher rates of obesity (p=0.005), preterm delivery (30.9% vs. 16.6%) and term delivery was less in case group (69.05%) than controls (83.33%) . In neonates of GDM mothers macrosomia rates were 26.19% in case group and 14.3% in control group. Hypoglycemia was 16.6%, respiratory distress 11.9% and NICU admissions 21.4% (p&lt;0.05 vs controls). Conclusion: Elevated serum ferritin is a strong predictor of adverse maternal and neonatal outcomes in GDM pregnancies. These findings suggest that ferritin could serve as a biomarker for identifying high-risk pregnancies. Incorporating ferritin screening into antenatal care may facilitate early risk stratification and targeted interventions.

Background/Aims: Fast-acting insulin analogues (FAIAs) are being used more frequently during pregnancy. Previous studies comparing regular insulin (RI) and FAIA consist primarily of women enrolled with pre-existing diabetes; therefore, we compared pregnancy and neonatal outcomes in women with gestational diabetes. Methods: We retrospectively investigated 197 pregnant women with gestational diabetes mellitus (GDM) requiring insulin treatment for glycemic control. Individuals were divided into 2 groups: RI (n = 55) and FAIA (aspart or lispro; n = 142). Pregnancy outcomes, including caesarean section rate, and neonatal outcomes, including macrosomia and ponderal index, were compared between groups. Results: There were no significant differences in maternal baseline characteristics (age, parity, body mass index and weight gain) between groups or in haemoglobinA_1c before delivery. The frequency of emergency caesarean section (caesarean section after trial of labor) was not significantly different between groups (RI 16.7%, FAIA 24.7%; p = 0.452). There were no differences in frequencies of macrosomia (RI 3.4%, FAIA 6.5%; p = 0.518), ponderal index (RI 2.65 ± 0.5, FAIA 2.71 ± 0.5; p = 0.322), cranial-thoracic circumference ratio (RI 1.07 ± 0.06, FAIA 1.07 ± 0.06; p = 0.386) or neonatal hypoglycemia (RI 5.1%, FAIA 5.8%; p = 1.000). Conclusion: Our data indicate that FAIA achieves similar pregnancy and neonatal outcomes in GDM compared with RI. Considering patient convenience, FAIA may be better to use during pregnancy.

Comparison of risk factors and pregnancy outcomes of gestational diabetes mellitus diagnosed during early and late pregnancy

Pregnant women with gestational diabetes mellitus (GDM) may have adverse pregnancy outcomes, even if their blood glucose level is well-controlled. Aquaporin 3 (AQP3) and adiponectin (APN) serve important roles in fetal growth and development. However, the associations of AQP3 and APN with GDM and pregnancy outcome are not known. Therefore, the present study was performed to evaluate the expression of AQP3 in the placenta and APN in the umbilical artery blood, and the association of the two factors with GDM and pregnancy outcome. The patient cohort was divided into two groups: Pregnant women with GDM; and pregnant women with normal glucose tolerance (NGT). The expression levels of AQP3 in the placenta and APN in the umbilical artery blood were detected. Logistic regression was used to analyze the associations of AQP3 and APN with GDM and pregnancy outcome. The expression levels of AQP3 and AQP3 mRNA in the placenta of the GDM group were decreased compared with that of the NGT group, and the difference was statistically significant (P<0.05). The expression of APN in the umbilical artery blood of the GDM group was also decreased compared with that of the NGT group, and the difference was also statistically significant (P<0.05). Multivariate logistic regression analyses indicated that the AQP3 and APN levels were negatively correlated not only with the risk of developing GDM [AQP3 odds ratio (OR)=5.00 (P<0.01); APN OR=2.98 (P=0.01)], but also with abnormal pregnancy outcome [(AQP3 OR=4.64 (P<0.01); APN OR=5.41 (P<0.01)]. The levels of AQP3 in the placenta and APN in the umbilical cord blood were associated with GDM, and the risk of GDM was increased in pregnant women with decreased AQP3 and APN levels. The AQP3 and APN levels also had an effect on pregnancy outcome. The risk of abnormal pregnancy outcomes, including cesarean section, macrosomia, fetal distress and neonatal asphyxia, was increased in pregnant women with decreased AQP3 and APN levels.

Background and Objectives: Gestational diabetes mellitus (GDM) may impact both maternal and fetal/neonatal health. The identification of prognostic indicators for GDM may improve risk assessment and selection of patient for intensive monitoring. The aim of this study was to find potential predictors of adverse pregnancy outcome in GDM and normoglycemic patients by comparing the levels of different biochemical parameters and the values of blood cell count (BCC) between GDM and normoglycemic patients and between patients with adverse and good outcome. Materials and Methods: Prospective clinical study included 49 patients with GDM (study group) and 44 healthy pregnant women (control group) who underwent oral glucose tolerance test (OGTT) at gestational age of 24-28 weeks. At the time of OGTT peripheral blood was taken for the determination of glucose levels, insulin, glycated hemoglobin, lipid status, homeostatic model assessment, BCC, iron and zinc metabolism, liver function, kidney function and inflammatory status. Each group was divided into two subgroups-normal and poor pregnancy outcome. Results: Higher RBC, hemoglobin concentration, hematocrit value, fasting glucose, uric acid and fibrinogen were found in GDM patients compared to control group. In GDM patients with poor pregnancy outcome values of fibrinogen, ALT, sedimentation rate, granulocyte and total leukocyte counts were elevated, while the serum level of zinc was significantly lower. Higher level of fibrinogen was found in normoglycemic patients with adverse pregnancy outcomes. ROC curve was constructed in order to assess fibrinogen's biomarker potential. The established AUC value for diagnostic ROC was 0.816 (p < 0.001, 95% CI 0.691-0.941), while the AUC value for assessing fibrinogen's potential to predict poor pregnancy outcome in GDM was 0.751 (p = 0.0096, 95% CI 0.561-0.941). Conclusions: The results of our study demonstrated that the best prognostic potential in GDM showed inflammation related parameters, identifying fibrinogen as a parameter with both diagnostic and prognostic ability.

Diabetes and Pregnancy

ObjectiveTo evaluate the impact of carbohydrate quantity and quality on maternal and pregnancy outcomes in gestational diabetes mellitus. MethodsUsing a pre-defined search strategy, two researchers systematically searched MEDLINE, CINAHL Plus, and PubMed for randomized controlled trials comparing low-carbohydrate, low-glycaemic index, or low-glycaemic load diets with usual care in gestational diabetes mellitus. Mean differences and risk ratios were extracted. ResultsThirteen studies with 877 participants were included. Low-carbohydrate diet did not significantly differ from usual care for fasting blood glucose (3 studies; mean difference: 1.60 mmol/L; 95 % confidence interval: −1.95, 5.15), insulin requirement (2 studies; risk ratio: 1.01; 95 % confidence interval: 0.31, 3.05), birthweight (4 studies; mean difference: −0.23 kg; 95 % confidence interval: −1.90, 1.45), caesarean delivery (5 studies; risk ratio: 1.11; 95 % confidence interval: 0.66, 1.85), macrosomia (3 studies; risk ratio: 0.35; 95 % confidence interval: 0.00, 2130.64), large-for-gestational-age (2 studies; risk ratio: 0.46; 95 % confidence interval: 0.03, 7.20), and small-for-gestational-age infants (2 studies; risk ratio: 0.94; 95 % confidence interval: 0.00, 231.18). Low-glycaemic index diet did not significantly differ from usual care for the above outcomes either. However, low-glycaemic load diet reduced macrosomia risk (2 studies; risk ratio: 0.51; 95 % confidence interval: 0.43, 0.59). ConclusionsLow-carbohydrate and low-glycaemic index diets do not differ from usual care for most maternal and foetal outcomes in gestational diabetes mellitus. But low-glycaemic load diet may reduce macrosomia risk.

Objective: To evaluate the predictive value of umbilical artery half peak systolic velocity deceleration time (UA hPSV-DT) for composite adverse perinatal outcomes (CAPO) in pregnancies complicated by gestational diabetes mellitus (GDM). Methods: In this prospective observational study, 120 singleton pregnancies in the third trimester were enrolled: 30 insulin-regulated GDM (IRGDM), 30 diet-regulated GDM (DRGDM), and 60 healthy controls. UA hPSV-DT and standard Doppler indices were measured using a standardized protocol by a single perinatologist. An abnormal UA hPSV-DT was defined as <5th percentile for gestational age. Maternal metabolic parameters, fetal biometry, and neonatal outcomes were recorded. The primary outcome was CAPO, defined as the presence of one or more adverse perinatal events. Results: Median UA hPSV-DT values were significantly lower in IRGDM (171 ms) and DRGDM (184 ms) compared with controls (227 ms) (p = 0.006). Abnormal UA hPSV-DT occurred in 43.3% of GDM cases and was associated with higher estimated fetal weight and abdominal circumference percentiles, increased amniotic fluid, elevated OGTT values, higher HbA1c, and more frequent insulin therapy (p < 0.01 for all). In GDM pregnancies, CAPO occurred in 73.1% of the abnormal UA hPSV-DT group versus 11.8% of the normal group (p < 0.001). ROC analysis identified a cut-off of < 181 ms for predicting CAPO (AUC 0.741, 70.3% sensitivity, 66.7% specificity). Conclusions: UA hPSV-DT is a novel, reproducible Doppler parameter that independently predicts adverse perinatal outcomes in GDM pregnancies, even when conventional UA Doppler indices are normal. Incorporating UA hPSV-DT into routine surveillance may improve risk stratification and guide management to optimize perinatal outcomes.

Incidence, risk factors, and pregnancy outcomes of gestational diabetes mellitus using one-step versus two-step diagnostic approaches: A population-based cohort study in Isfahan, Iran

Association between GCK gene polymorphism and gestational diabetes mellitus and its pregnancy outcomes

Background: Gestational Diabetes Mellitus (GDM) is a condition characterized by glucose intolerance with onset or first recognition during pregnancy. It affects approximately 7% of all pregnancies and is primarily associated with increased insulin resistance and inadequate compensatory insulin secretion. GDM poses significant risks for both maternal and neonatal health, including complications such as preeclampsia, macrosomia, neonatal hypoglycemia, and an increased likelihood of developing type 2 diabetes mellitus later in life. Elevated maternal HbA1c levels in the third trimester have been linked to increased risks of complications such as preterm delivery, vulvovaginitis, polyhydramnios, and neonatal issues including hypoglycemia and macrosomia. Monitoring HbA1c levels during pregnancy, alongside blood glucose, may provide valuable insights into managing euglycemia and reducing the risks of these complications. This study aims to evaluate the impact of third-trimester HbA1c levels on pregnancy outcomes, focusing on both maternal and fetal health in women with controlled and uncontrolled serum HbA1c levels. Methods: This cohort-type observational study was conducted at the Department of Gynaecology and Obstetrics, BIRDEM-II General Hospital, Dhaka, from July 2019 to June 2020. The study included pregnant women diagnosed with Gestational Diabetes Mellitus (GDM) attending the outpatient department or admitted to the hospital. Participants were categorized into two groups based on third-trimester HbA1c levels: those with HbA1c &gt;6.0% (uncontrolled group) and those with HbA1c ≤ 6.0% (controlled group). A sample size of 100 was determined by consecutive purposive sampling, with 50 participants in each group. During the third trimester, 5 cc of venous blood was collected from each participant for HbA1c and blood glucose level testing. Participants were monitored for fetomaternal outcomes during the follow-up period, which lasted until the puerperium. Data were collected using a pre-structured form, and the researcher personally gathered all information to ensure accuracy. After data collection, the information was carefully reviewed, and inconsistencies were corrected. Results: This prospective cohort study conducted at BIRDEM-II General Hospital, Dhaka, aimed to investigate the impact of third-trimester HbA1c levels on pregnancy outcomes in Gestational Diabetes Mellitus (GDM) patients. The study included 100 participants, categorized into controlled (HbA1c ≤ 6%) and uncontrolled (HbA1c &gt; 6%) groups. The results demonstrated that poor glycemic control was significantly linked to increased rates of polyhydramnios, preterm delivery, macrosomia, and neonatal complications including hypoglycemia, hyperbilirubinemia, and respiratory distress syndrome (RDS). Additionally, newborns in the poorly controlled group had significantly higher rates of NICU admission, incubator care, and resuscitation at birth. However, there was no significant difference in mode of delivery or maternal complications between the two groups. These findings suggest that poor HbA1c control in the third trimester is linked to adverse maternal and fetal outcomes in GDM pregnancies. Conclusion: The study found that GDM patients with HbA1c &gt;6.0% in the third trimester had higher rates of complications such as polyhydramnios, preterm delivery, macrosomia, hypoglycemia, hyperbilirubinemia, RDS, NICU admissions, incubator care, and resuscitation at birth, compared to those with HbA1c ≤6.0%. However, differences in vulvovaginitis, oligohydramnios, PPH, and UTIs were not statistically significant. Central Medical College Journal Vol 9 No 1 January 2025 Page: 31-36