Cases Of Gestational Diabetes Research Articles

Early pregnancy HbA1c as the first screening test for gestational diabetes: results from three prospective cohorts

More than 90% of gestational diabetes cases are estimated to occur in low-income and middle-income countries (LMICs). Most current guidelines recommend an oral glucose tolerance test (OGTT) at 24-28 weeks of gestation. The OGTT is burdensome, especially in LMICs, resulting in a high proportion of women not being screened. We aimed to develop a simple and effective screening strategy for gestational diabetes. STRiDE, a prospective cohort study, was set up in seven centres in south India and seven centres in western Kenya, and included pregnant women aged 18-50 years of age and at less than 16 weeks of gestation (<20 weeks in Kenya), confirmed by dating ultrasound. We assessed the efficacy of early pregnancy HbA1c (venous and capillary point-of-care), either alone or as part of a composite risk score with age, BMI, and family history of diabetes, in predicting gestational diabetes at 24-28 weeks of gestation, in two LMICs (India and Kenya) and in a UK multi-ethnic population from the PRiDE study. A key secondary outcome was to assess whether an early pregnancy composite risk score can reduce the need for OGTTs. Gestational diabetes was diagnosed using current WHO criteria. Between Feb 15, 2016, Dec 13, 2019, we enrolled 3070 participants in India and 4104 in Kenya. 4320 participants were included from the PRiDE cohort. Gestational diabetes prevalence by OGTT at 24-28 weeks was 19·2% in India, 3·0% in Kenya, and 14·5% in the UK. Early pregnancy HbA1c was independently associated with incidence of gestational diabetes at 24-28 weeks of gestation. Adjusted risk ratios were 1·60 (95% CI 1·19-2·16) in India, 3·49 (2·8-4·34) in Kenya, and 4·72 (3·82-5·82) in the UK. Composite risk score models that combined venous or point-of-care HbA1c with age, BMI, and family history of diabetes best predicted testing positive for gestational diabetes. A population-specific, two-threshold screening strategy of rule-in and rule-out gestational diabetes using early pregnancy composite risk score could reduce the requirement of OGTTs by 50-64%. For the HbA1c-alone model, the thresholds were 5·4% (rule in) and 4·9% (rule out) in India, 6·0% (rule in) and 5·2% (rule out) in Kenya, and 5·6% (rule in) and 5·2% (rule out) in the UK. Early pregnancy HbA1c offers a simple screening test for gestational diabetes, allowing those at highest risk to receive early intervention and greatly reduce the need for OGTTs. This can also be carried out using point-of-care HbA1c in LMICs. UK Medical Research Council and the Indian Department of Biotechnology.

Beyond the individual: Socio-ecological factors impacting activity after gestational diabetes mellitus.

The risk of Type 2 Diabetes is 10 times higher after a pregnancy with Gestational Diabetes. Physical activity can independently reduce this risk, yet engagement with physical activity remains low after Gestational Diabetes. Therefore, the present study aimed to explore the barriers and facilitators to the uptake of physical activity after Gestational Diabetes in the United Kingdom, using a socio-ecological approach. The paper was written following the Standards for Reporting Qualitative Research. Patient and Public Involvement contributed to the study's conceptualisation and design. Participants were recruited through an audit of Gestational Diabetes cases at a local Teaching Hospital in 2020. Twelve participants took part in semi-structured one-to-one interviews. Reflexive thematic analysis was used to generate themes in iterative rounds of refinement. The final themes were then organised using the socio-ecological model. Participants were all over 31 years old, predominantly self-identified as White British and were all in employment but were evenly spread across UK-based deprivation deciles. Ten themes were generated and organised according to the four levels of the socio-ecological model: intrapersonal (beliefs about activity, recovering from birth), social (health care professionals, family and partner, role as a mother), organisational (access and cost, environment, childcare and work) and community (connecting women with recent Gestational Diabetes). Many of the amenable barriers and facilitators to physical activity were beyond the intrapersonal level, based on higher levels of the socio-ecological model (social, organisational and community). Multi-level interventions are needed to effectively address all barriers.

The PREDG study: A randomised controlled trial testing whether an educational intervention can prevent gestational weight gain in women with obesity

The PREDG trial was designed to study the influence of an educative program on gestational weight gain in women with pregestational obesity. Randomized controlled clinical trial (https://www.isrctn.com/ISRCTN61793947) in 169 women with pregestational obesity (BMI ≥30kg/m2). Women were randomized to participate in a group education program in nutrition and physical activity or conventional follow-up in a specialized Unit of Obesity and Pregnancy. The nutritional intervention was adjusted to prepregnancy BMI and to the physical activity intensity. Quality was based on the Mediterranean diet. Macronutrients were distributed as follows: 50% carbohydrates, 20% protein and 30% fat. Adequate gestational weight gain was defined between 5 and 9kg (IOM 2009). Mean gestational weight gain was compared between groups by using the T Student test and frequencies of adequate gestational weight gain were compared by using ꓫ2. Gestational weight gain was lower in the intervention group: 8 (4-11) vs 9.2 (6-13) kg, p 0.026. Gestational weight gain was below 9kg in 24 of 39 (61.5%) women of the intervention vs 10 of 41 (24.4%) of the control group (p 0.001). Regarding obstetric complications, there were 15 (8.3%) cases of gestational diabetes with no differences between the groups. There were 14 of 85 (18.2%) cases of gestational hypertension or preeclampsia in the intervention group compared with 26 of 84 (32.5%) in the control group (p 0.040). With reference to neonatal weight, there were 7 of 82 (8.5%) large for gestational age neonates in the intervention group compared with 15 of 79 (19.2%) in the control group (p 0.050). A group-based educative and structured intervention results in an adequate weight gain and lower rates of gestational hypertension, preeclampsia and large for gestational age neonates in pregnant women with obesity.

Comparison of Neurodevelopmental Status in Early Infancy of Infants of Women With and Without Gestational Diabetes Mellitus.

To study the neurodevelopmental status of offsprings of mothers with gestational diabetes (OGDM) aged 3½ mo. This cross-sectional study was conducted at a tertiary hospital, New Delhi which included infants aged 3½ mo (+1 wk) who were either offsprings of women with gestational diabetes (cases) or infants of mothers without gestational diabetes mellitus presenting to tertiary care public hospital in India from January, 2018 through March, 2019, with enrollment of infants done between 10 April, 2018 and 30 March, 2019. The development quotient (DQ) using Developmental Assessment Scales for Indian Infants (DASII) was calculated as Motor DQ, Mental DQ and a composite DQ. The mean motor DQ of the enrolled infants was 101.7 (12.02); it was significantly lower for OGDM than controls [101 (1.41) vs. 109.5 (10.6); P <0.001]. The mean mental DQ of the enrolled infants was 88.9 (12.0); it was significantly lower for OGDM than the control group [84 (9.89 vs. 88 (8.48); P = 0.03]. The total development quotient for the enrolled infants was 95.3 (11.3). The total development quotient for study group was significantly lower than the control group [92.5 (5.65) vs. 98.75 (9.54); P = 0.001]. The mean motor, mental total DQ of offsprings of mothers with GDM were significantly lower than those born to mothers without GDM. Hence follow up, early intervention should be considered for this high risk group.

Cardiovascular risk management following gestational diabetes and hypertensive disorders of pregnancy: a narrative review.

Cardiovascular risk management following gestational diabetes and hypertensive disorders of pregnancy: a narrative review.

Gestational Diabetes Mellitus (GDM) Screening In Pregnant Women and Diabetes in The Elderly Getasan

Type 1 and type 2 diabetes are influenced by genetic and environmental factors causing a decrease in β cell function resulting in hyperglycemia. Patients with hyperglycemia are at risk for chronic complications. The elderly have the potential to suffer from diabetes mellitus due to the age factor and the decreased ability of the body's metabolism. Whereas in pregnant women any hyperglycemia is considered gestational diabetes mellitus (GDM), regardless of diabetes occurring before or during the current pregnancy GDM is diabetes diagnosed in the second trimester or later. This study aims to map cases of diabetes and gestational diabetes. This research is a non-experimental study with a survey method approach without intervention that is descriptive analytic research results of 48 people with a total of 14 men and 5 pregnant women out of a total of 34 female respondents. Examination results for supporting examinations obtained the results of 8 glucose samples with levels 200 mg/dl and those who had diabetes mellitus based on HbA1c examination were 6 people aged 45-65 years and as many as 3 people aged over 65 years. Respondents who had diabetes mellitus were 2 men and 4 women and none of the pregnant women had gestational diabetes. This research has an impact on the people who take part in this activity, one of which is getting education on how to maintain a healthy quality of life in old age and for those who enter the diabetes mellitus screening group, it is continued in the process of care and assistance by the Getasan Health Center.

Dietary quality and mindful eating among pregnant women with and without gestational diabetes

Objective: The incidence of gestational diabetes mellitus (GDM) is increasing in parallel with maternal obesity. The main components of treatment are monitoring blood glucose levels with medical nutrition therapy and lifestyle modification in order to prevent short- and long-term materno-fetal complications. This study aimed to compare the diet quality and mindful eating among pregnant women with and without GDM. Methods: This case-control study included 68 pregnant women. Each participant was face-to-face interviewed using a structured questionnaire to obtain socio-demographic information, general health information, nutritional habits, and registered three days of food record. Mindful Eating Questionnaire (MEQ) and Healthy Eating Index (HEI) were applied in order to assess mindful eating and diet quality, respectively. Results: Mean pre-pregnancy body mass index of women was 27.42+5.44 kg/m2, 66.7% of the gestational diabetes group and 29.4% of the control group was obese. Differences in HEI adequacy subgroup scores between the groups were significant. Mean MEQ scores were 2.85±0.34 and 3.13±0.44 in pregnant women with gestational diabetes and control cases, respectively (r=0.61, p=0003, p&lt;0.05). Conclusion: Our results showed that pregnant women with gestational diabetes had lower mindful eating and diet quality scores.

Abstract P240: Higher Body Mass Index is Associated With Lower Placental Expression of EPYC: Results From a Genome-Wide Transcriptomic Study in the Gen3G Cohort

Background: Elevated maternal body mass index (BMI) in pregnancy is associated with adverse maternal and fetal outcomes. Identification of alterations in the placental transcriptome may elucidate molecular markers of the biological pathways underlying these associations. Methods: We investigated the association of first trimester maternal BMI with the placental transcriptome in Gen3G, a large population-based pregnancy cohort. We completed RNA sequencing of 449 placental samples and performed differential gene expression analysis of over 15,000 genes (Limma Voom). We used maternal BMI as a continuous variable, with estimates reported as change in normalized gene expression per 1-unit increase in BMI (kg/m2), as well as a categorical variable (participants with normal weight (N=270) vs. obesity (N=82)), with RNA expression estimates reported as log2 fold changes. We adjusted models for maternal age, fetal sex, gestational age and 6 surrogate variables inferred from the expression data to adjust for batch effects and other unmeasured sources of variability. We accounted for multiple testing using False Discovery Rate (FDR). Sensitivity analyses were performed by removing cases of gestational diabetes and hypertensive disorders in pregnancy. Results: At enrollment in early pregnancy, participants had a mean ± SD age of 28.2 ± 4.4 years and measured BMI of 25.4 ± 5.5 kg/m 2 ; 57% of participants were categorized in normal weight, 22% in overweight and 18% in obesity BMI categories. Maternal BMI was significantly associated with decreased expression of EPYC , a gene that regulates fibrillogenesis (slope= -0.14, FDR-adjusted P=1.68x10 -5 for continuous BMI; log2 fold change= -1.71, FDR-adjusted P=1.06x10 -2 for obesity vs. normal weight). Both sensitivity analyses with the removal of gestational diabetes and hypertensive disorders revealed similar associations for EPYC . Conclusions: We identified an association between elevated maternal BMI and downregulation of EPYC expression in the placenta. Additional studies are required to examine the role of placental EPYC expression in maternal and fetal health.

Macrosomia Risk Factors and Perinatal Outcomes: A 1-year Cohort Study

AIM: This study aims to identify possible risk factors and concurrently investigates how macrosomia impacts mothers and neonates. STUDY DESIGN: The study is a retrospective cohort of data obtained in a large tertiary obstetrics and neonatal unit over 1 year, from anuary 1, 2019 to December 31, 2019. Data of all deliveries conducted at the institution were accessed. In addition, singleton and term pregnancies were included for further analysis. Multiple pregnancies, premature births, stillbirths, non-vertex presentations, and being lost to follow-up served as exclusion criteria. A database of the cases was constructed and data regarding maternal constitutional parameters, mode of delivery, shoulder dystocia, perineal trauma, and postpartum hemorrhage were collected. Further on, pregnancies were divided accordingly into two groups: Macrosomic fetuses (&gt;4000 g) and non-macrosomic fetuses (&lt;4000 g). The two groups were compared to assess possible macrosomia risk factors and maternal-neonatal outcomes. Statistical analysis is done using the Mann–Whitney-U and Chi-square tests. Significance was set as p &lt; 0.05. RESULTS: A total of 3408 deliveries met the inclusion criteria of the study. The macrosomia rate is 10.3%. The mean age (30.1 ± 5.17 years vs. 28.9 ± 8.4 years, p &lt; 0.05) and, body mass index (29.2 ± 3.54 vs. 26.1 ± 2.78, p &lt; 0.05) was significantly higher in the macrosomia group. Women that gained more than 12.5 kg have nearly twice the odds of delivering a big baby (odds ratio [OR] 1.86, confidence interval [CI] 1.47–2.36, p &lt; 0.001). No statistically significant differences were noted regarding cases of gestational diabetes (p = 0.56). Cesarean sections were preferred to vaginal deliveries in the macrosomic group (39.3% vs. 29.7%, OR 1.53, CI 1.2–1.9, p = 0.001). The risk of undergoing an emergency procedure is 6-fold higher in pregnancies with macrosomic newborns (20.5% vs. 13.6%, OR 6.1, CI 4.45–8.36, p &lt; 0.001). Both episiotomy rate (40.45% vs. 31.9%, OR 1.44, CI 1.15–1.81, p = 0.001) and lacerations (3.13 % vs. 1.44%, OR 2.21, CI 1.13–4.33, p = 0.02) were higher in the macrosomic group. CONCLUSION: The study concludes that macrosomia is associated with an increase in maternal and neonatal adverse outcomes.

Association of Serum Leptin with Gestational Diabetes Mellitus

Background: It has been stated that leptin has a role in glucose regulation as it decreases the insulin resistance and regulates the insulin mediated glucose metabolism. As the body need more glucose, more secretion of insulin which stimulates adipose tissues to secrete more leptin which causes the release of cytokines which decreases insulin sensitivity and develop insulin resistance. The aim of the current study was to find out the association of serum leptin with gestational diabetes mellitus in current setting. Methods: A case control study was conducted at the Gynecology department of Abbasi Shaheed Hospital Karachi during April to September 2022. A self-designed proforma was used, consisting of 4 parts consisting of demographic variables, general physical examination and laboratory findings. Blood sample was collected during 24th to 28th week of gestation for testing fasting blood sugar, OGTT and then ELISA was done. Statistical Package for Social Science (SPSS) version-20 was used to analyze the data. p-value ≤0.05 was considered as significant. Results: The mean age of the study participants was 27.42 ± 0.39 and 24.96 ± 0.51 in cases and controls respectively. The basal metabolic index (BMI) was higher among the cases of gestational diabetes as compared to normal controls. Likewise, oral glucose tolerance test results showed higher levels of blood glucose than the normal controls during all steps of the test. The comparison of serum insulin and serum leptin during pregnancy and after delivery in cases of gestational diabetes showed a decrease in both serum insulin and serum leptin levels with significant p-value (p-value ≤0.05). Conclusion: Leptin is the contributory factor of insulin resistance and leads to gestational diabetes mellitus. Both serum insulin and serum leptin levels were having strong significant association with gestational diabetes mellitus. Keywords: Gestational diabetes mellitus, Serum Leptin, Hyperinsulinemia

ODP166 Autoantibody Positivity and Random C-peptide Profile in Young Ethnic South Indian Population with Diabetes Mellitus

Abstract The islet cell autoantibody and beta-cell reserve profiles of young-onset diabetes patients in India are not only heterogeneous but also differ from those in the rest of the world. We sought to assess 3 standard islet cell autoantibodies and random C-peptide in the young ethnic South Indian population with diabetes mellitus attending the Endocrinology OPD of our tertiary care. A total of 190 young diabetes patients aged between 12-30 years were screened for inclusion in the study. Known cases of gestational diabetes and those on diabetogenic drugs were excluded. Additionally, those with clinical features suggestive of pancreatic diabetes or maturity-onset diabetes of young (MODY), or any diabetes-associated syndromic disorders were also excluded. Finally, 138 eligible young diabetes patients were included in the study. The islet cell autoantibodies against glutamic acid decarboxylase (GAD), insulinoma-associated protein-2 (IA-2), zinc transporter (ZnT8)was measured by sandwich ELISA technique using a human GAD ELISA kit (Euroimmun, Germany), human IA2 ELISA kit (Euroimmun, Germany), human ZnT8 ELISA kit (RSR diagnostics, USA) respectively. Random C-peptide was measured with chemiluminescence immunoassay analyser Advia Centaur XP. Diagnosis of T1DM was based on the requirement of immediate insulin replacement therapy for hyperglycemia with or without acute-onset ketosis with random C-peptide (&amp;lt;0.6 ng/ml) with /without any of islet cell antibodies. Diagnosis of T2DM is based on the history of control of hyperglycemia with oral hypoglycemic agents with documentation of adequate beta-cell reserve (random C-peptide ≥ 0.6 ng/ml) while maintaining euglycemia. Based on the patient characteristics, treatment profile, islet cell antibody status, and beta-cell reserve as assessed by random C-peptide levels, 82 were classified as T1DM, and 48 were classified as T2DM. The rest 8 patients were categorized as unclassified diabetes. GAD antibody was seen in 54(66%) of 82 T1DM patients. Islet cell autoantibody negativity was documented in 21(26%) of T1DM patients. IA-2 and ZnT8 antibodies contributed to an additional 7(8%) to islet cell antibody positivity in T1DM patients. IA-2 antibody positivity was low and random C-peptide was undetectable in many cases of T1DM in our study and is probably due to prolonged duration of diabetes in many T1DM patients. Autoantibody positivity was seen in 4(8%) T2DM patients. These patients need to be followed up for possible evolution of latent autoimmune diabetes in adults.

Correlation of body composition in early pregnancy on gestational diabetes mellitus under different body weights before pregnancy.

The prediction of gestational diabetes mellitus (GDM) by body composition-related indicators in the first trimester was analyzed under different body mass index (BMI) values before pregnancy. This was a retrospective analysis of pregnant women who were treated, had documented data, and received regular perinatal care at the Third Affiliated Hospital of Zhengzhou University from January 1, 2021, to December 31, 2021. Women with singleton pregnancies who did not have diabetes before pregnancy were included. In the first trimester (before the 14th week of pregnancy), bioelectric impedance assessment (BIA) was used to analyze body composition-related indicators such as protein levels, mineral levels, fat volume, and the waist-hip fat ratio. The Pearman's correlation coefficient was used to evaluate the linear relationship between the continuous variables and pre-pregnancy body mass index (BMI). In the univariate body composition analysis, the association with the risk of developing GDM was included in a multivariate analysis using the relative risk and 95% confidence interval obtained from logarithmic binomial regression, and generalized linear regression was used for multivariate regression analysis. Furthermore, the area under the curve (AUC) was calculated by receiver operating characteristic (ROC) curves. The optimal cutoff value of each risk factor was calculated according to the Youden Index. In a retrospective study consisting of 6698 pregnant women, we collected 1109 cases of gestational diabetes. Total body water (TBW), protein levels, mineral levels, bone mineral content (BMC), body fat mass (BFM), soft lean mass (SLM), fat-free mass (FMM), skeletal muscle mass (SMM), percent body fat (PBF), the waist-hip ratio (WHR), the visceral fat level (VFL), and the basal metabolic rate (BMR) were significantly higher in the GDM group than in the normal group (P<0.05). Under the pre-pregnancy BMI groupings, out of 4157 pregnant women with a BMI <24 kg/m2, 456 (10.97%) were diagnosed with GDM, and out of 2541 pregnant women with a BMI ≥24 kg/m2, 653 (25.70%) were diagnosed with GDM. In the generalized linear regression model, it was found that in all groups of pregnant women, pre-pregnancy BMI, age, gestational weight gain (GWG) in the first trimester, and weight at the time of the BIA had a certain risk for the onset of GDM. In Model 1, without adjusting for confounders, the body composition indicators were all positively correlated with the risk of GDM. In Model 3, total body water, protein levels, mineral levels, bone mineral content, soft lean mass, fat-free mass, skeletal muscle mass, and the basal metabolic rate were protective factors for GDM. After Model 4 was adjusted for confounders, only the waist-hip ratio was positively associated with GDM onset. Among pregnant women with a pre-pregnancy BMI <24 kg/m2, the body composition-related indicators in Model 2 were all related to the onset of GDM. In Model 3, total body water, soft lean mass, fat-free mass, and the basal metabolic rate were negatively correlated with GDM onset. In the body composition analysis of among women with a pre-pregnancy BMI ≥ 24 kg/m2, only Model 1 and Model 2 were found to show positive associations with GDM onset. In the prediction model, in the basic data of pregnant women, the area under the receiver operating characteristic curve predicted by gestational weight gain for GDM was the largest (0.795), and its cutoff value was 1.415kg. In the body composition results, the area under the receiver operating characteristic curve of body fat mass for predicting GDM risk was larger (0.663) in all pregnant women. Through this retrospective study, it was found that the body composition-related indicators were independently associated with the onset of GDM in both the pre-pregnancy BMI <24 kg/m2 and pre-pregnancy BMI ≥24 kg/m2 groups. Body fat mass, the visceral fat level, and the waist-hip ratio had a higher correlation with pre-pregnancy BMI. Total body water, protein levels, mineral levels, bone mineral content, soft lean mass, fat-free mass, skeletal muscle mass, and the basal metabolic rate were protective factors for GDM after adjusting for some confounders. In all pregnant women, the waist-hip ratio was found to be up to 4.562 times the risk of GDM development, and gestational weight gain had the best predictive power for GDM. Gestational weight gain in early pregnancy, body fat mass, and the waist-hip ratio can assess the risk of GDM in pregnant women, which can allow clinicians to predict the occurrence of GDM in pregnant women as early as possible and implement interventions to reduce adverse perinatal outcomes.

Etiology Of Neonatal Peritonitis Treated at The University Hospital Joseph Ravoahangy Andrianavalona, Antananarivo

Neonatal peritonitis is burdened with high morbidity and mortality despite progress in pediatric intensive care. The causal pathologies are multiple. Their knowledge is an important tool for improving care. The objective of our study is to determine the causes of neonatal peritonitis treated in our center. This is a retrospective, descriptive study of 72 months. The inclusion criteria were newborns less than 28 days old operated for peritonitis. The parameters studied were age, gender, perinatal history, site of perforation, causal pathologies. Eighteen patients were collected. The average age was 8 days, with extremes of 3 and 25 days. There was a male predominance with a sex ratio of 8. In the prenatal history, 1 case of gestational diabetes and 2 cases of gravidic hypertension were found. The average birth weight was 2730 g with extremes of 2500 g and 3500 g. The site of perforation was at the small intestine (7 cases), the colon (5 cases) and the stomach (4 cases) and there were 2 cases of multiple perforation. Ulcerative-necrotizing enterocolitis and mechanical causes represented the two main etiologies, each representing 44.44% of cases. Mechanical etiologies which represent 44% of cases could have been prevented by early management of the causal pathologies.

Therapeutic options for pre-gravidary training in women with a history of combined infertility

The objective: to substantiate and evaluate the improvement of pre-gravida preparation in women with a history of combined infertility factors. Materials and methods. We examined 102 women who were diagnosed with two factors of infertility simultaneously – infertility of tubal origin and infertility associated with anovulation caused by hyperprolactinemia and polycystic ovary syndrome. All patients were divided into groups according to the three-month pre-gravida preparation regimen: the 1st group (52 women) received basic pre-gravida preparation (dydrogesterone, folic acid, metformin) in combination with diet; the 2d group 2 (50 patients) – an improved scheme of pre-gravida preparation (dydrogesterone, methyl tetrahydrofolate, potassium iodide, vitamin D3, a complex of myo-inositol and D-chiro-inositol) in combination with diet. The reliability of relative values was evaluated by the Fisher angular transformation method. Results. In women of the 1st group the number of cases of gestational diabetes (30.8 %) was slightly higher than in patients of the 2nd group (20.0 %), the frequency of fetal macrosomia was significantly higher (19.2 % and 10.0 % persons, respectively). The incidence of early miscarriage in persons of the 2d group was significantly lower (40.0 %) than in the 1st group (69.2 %), the risk of late miscarriage was twice lower (14.0 % and 26.9 %, respectively). Conclusions. The proposed complex of pre-gravida preparation in the women with a combined form of infertility (tubal infertility and infertility associated with anovulation), which includes inositol, contributes to a greater reduction in the incidence of obstetric and perinatal complications.

Treatment with low-dose prednisone in refractory obstetric antiphospholipid syndrome: A retrospective cohort study and meta-analysis.

Glucocorticoids have been suggested as a potential therapy in refractory obstetric antiphospholipid syndrome (oAPS). Our aims were to describe a cohort of patients with oAPS treated with low-dose glucocorticoids and to perform a systematic review and meta-analysis evaluating the effects of additional glucocorticoids on the pregnancy outcomes in oAPS patients. Retrospective study that included 11 women diagnosed with primary antiphospholipid syndrome. The meta-analysis was conducted by fitting random effects models and was checked for heterogeneity. All women had suffered from early pregnancy losses and two also had a history of fetal deaths. We studied 47 pregnancies that resulted in 32 abortions (68.1%) and 3 fetal deaths (6.4%). Twenty-six pregnancies were under treatment, mainly LDA and LMWH. Low-dose glucocorticoids were indicated in 13 pregnancies (always in association with LDA and LMWH). There was a decrease in pregnancy loss in those patients treated with LDA and LMWH. Treatment with glucocorticoids significantly increased the rate of successful pregnancy (38.5% abortions in treated vs 85.3% abortions in non-treated pregnancies; p=0.003). After multivariate GEE analysis, only glucocorticoids remained inversely associated with pregnancy loss (OR=0.157, (CI 0.025-0.968, p=0.046)). The meta-analysis showed that glucocorticoids tended to improve the frequency of successful pregnancy (OR= 0.509 (0.252-1.028), p=0.06). Three cases of gestational diabetes and one of preeclampsia were observed in our cohort. The meta-analysis, which mostly included studies using high-dose steroids, showed that glucocorticoids increased not only the frequency of preeclampsia and gestational diabetes, but also the rate of pre-term birth. The efficacy of low-dose glucocorticoids in addition to the standard therapy in patients with refractory oAPS should be confirmed in well-designed clinical trials. However, high doses of steroids significantly increase the frequency of maternal and fetal morbidities, making their use strongly inadvisable.

Association of gene polymorphisms of ACE, AGT, and ARNT-like protein 1 with susceptibility to gestational diabetes

Background and aimsGestational diabetes mellitus is well-defined as glucose intolerance first documented during pregnancy. In this study, we examined the possible associations between I/D polymorphism of the angiotensin-converting enzyme gene, the M235T variant of angiotensinogen gene, and the rs7950226 polymorphism of the ARNT-like protein-1 (BMAL1) gene and the risk for diabetes in Egyptian pregnant women.Subjects and methodsThis study recruited 160 gestational diabetes cases and 165 controls. Genomic DNA was derived from peripheral blood leukocytes and ACE gene (I/D) genotyping was performed using the method of polymerase chain reaction and the polymerase chain reaction-based restriction fragment length polymorphism was used for identifying the M235T variant of AGT gene and the rs7950226 polymorphism of the BMAL1.ResultsThe II, ID, and DD genotypes of the ACE gene have significant differences in cases compared to controls (P = 0.000 and X2 = 81.77). The M235T polymorphism of the AGT gene was increased with gestational diabetes risk. Furthermore, the AA genotype of the BMAL1 rs7950226 gene was significantly related to the gestational diabetes risk (P = 0.000 and X2 = 52.82). Furthermore, the allele frequencies of the three variants have significant variances between cases and control.ConclusionThis study suggested significant associations between ACE (DD), AGT (TT), and BMAL1 rs7950226 (AA) gene polymorphisms with gestational diabetes susceptibility and there was a possibility to identify that II + MM + GG as protective haplotypes and DD + TT + AA as risk haplotypes for gestational diabetes.

Association between AMPKα1 gene polymorphisms and gestational diabetes in the Chinese population: A case‐control study

AbstractAimThe aim is to examine the association between seven candidate single nucleotide polymorphisms in AMPKα1 and gestational diabetes in Chinese people.MethodWe used a matched nested case‐control study design, individuals including 334 participants with gestational diabetes and 334 healthy pregnant women. Confirmed 334 gestational diabetes cases and maternal age and district of residence matched controls (1:1) were enrolled. We examined seven candidate single nucleotide polymorphisms in AMPKα1 gene and the risk of gestational diabetes. The associations were estimated in Co‐dominant, Dominant, Recessive, and Alleles models. The odds ratios (ORs) and their 95% confidence intervals (95% CI) were estimated by unconditional logistical regression as a measure of the associations between genotypes and gestational diabetes adjusting for maternal age, prepregnancy body mass index (BMI), fetal sex and parity.ResultAt the gene level, we found that AMPKα1 was associated with gestational diabetes (p = 0.008). After adjusting the covariates and multiple comparison correction, AMPKα1 (rsc1002424, rs10053664, rs13361707) polymorphisms were associated with the risk of gestational diabetes. In addition, gestational diabetes was related to the AAGGA haplotype comprising rs1002424, rs2570091, rs10053664, rs13361707 and rs3805486 in the haplotype models (p = 0.011).ConclusionsThis study provides evidence that the AMPKα1 genotypes (rs1002424 G/A, rs10053664 A/G, rs13361707 A/G) and the haplotype (AAGGA) are relevant genetic factors in a Chinese population with gestational diabetes.

Antenatal management and maternal/fetal outcomes associated with hyperglycaemia in pregnancy (HIP) in Uganda; a prospective cohort study

BackgroundHyperglycaemia in pregnancy (HIP) is associated with complications for both mother and baby. The prevalence of the condition is likely to increase across Africa as the continent undergoes a rapid demographic transition. However, little is known about the management and pregnancy outcomes associated with HIP in the region, particularly less severe forms of hyperglycaemia. It is therefore important to generate local data so that resources may be distributed effectively. The aim of this study was to describe the antenatal management and maternal/fetal outcomes associated with HIP in Ugandan women.MethodsA prospective cohort study of 2917 pregnant women in five major hospitals in urban/semi-urban central Uganda. Women were screened with oral glucose tolerance test (OGTT) at 24–28 weeks of gestation. Cases of gestational diabetes (GDM) and diabetes in pregnancy (DIP) were identified (WHO 2013 diagnostic criteria) and received standard care. Data was collected on maternal demographics, anthropometrics, antenatal management, umbilical cord c-peptide levels, and pregnancy outcomes.ResultsTwo hundred and seventy-six women were diagnosed with HIP (237 classified as GDM and 39 DIP). Women had between one and four fasting capillary blood glucose checks during third trimester. All received lifestyle advice, one quarter (69/276) received metformin therapy, and one woman received insulin. HIP was associated with large birthweight (unadjusted relative risk 1.30, 95% CI 1.00–1.68), Caesarean delivery (RR 1.34, 95% CI 1.14–1.57) and neonatal hypoglycaemia (RR 4.37, 95% CI 1.36–14.1), but not perinatal mortality or preterm birth. Pregnancy outcomes were generally worse for women with DIP compared with GDM.ConclusionHIP is associated with significant adverse pregnancy outcomes in this population, particularly overt diabetes in pregnancy. However pregnancy outcomes in women with milder forms of hyperglycaemia are similar to those with normoglycaemic pregnancies. Intervention strategies are required to improve current monitoring and management practice, and more research needed to understand if this is a cost-effective way of preventing poor perinatal outcomes.

Importance of Antidiabetic Medicinal Plants in the Prevention and Management of Insulin Resistance: Case of Gestational Diabetes in Cameroon

Importance of Antidiabetic Medicinal Plants in the Prevention and Management of Insulin Resistance: Case of Gestational Diabetes in Cameroon

Gestational Diabetes Mellitus (GDM) Related Common Risk Factors and Recurrence among Pregnant Patients: A Multifactorial Cross-Sectional Study

&#x0D; &#x0D; &#x0D; Objective: To determine the frequency of newly diagnosed gestational diabetes mellitus (GDM) and common associated factors in recurrent GDM. Study Design: Cross sectional. Place and Duration of Study: The study was conducted in the department of Obstetrics and Gynecology unit A of Lady Reading Hospital, Peshawar from 27th July 2016 to 27th Jan 2017. Materials and Methods: 336 women meeting the eligibility criteria (18-45 years, of any gestational age with gestational diabetes mellitus history and diagnosed as recurrent gestational diabetes) were included in the study. All patients who were labeled as a case of recurrent gestational diabetes was further investigated for any risk factor associated with its recurrence. Results: The recurrence of Gestational Diabetes was observed in 99 (29.46%) patients, in which 77% of patients had family history positive. Conclusion: Keeping in view the recurrence of gestational diabetes proper screening and medical care for GDM in women during the childbearing years is highly recommended.&#x0D; &#x0D; &#x0D;