Diabetic Pregnant Women Research Articles

Maternal Hyperglycemia and Neonatal Hypoglycemia Following Betamethasone Administration in Diabetic Women

To determine the incidence and duration of maternal hyperglycemia following betamethasone administration in diabetic pregnant women, and the incidence of neonatal hypoglycemia in those delivered within 7 days of betamethasone.

Relation of insulin like growth factor and glycocylated hemoglobin at different gestational periods of pregnancy in diabetic pregnant women

Background: Diabetes mellitus complicating pregnancy is one of the most common antenatal complications that are associated with significant perinatal mortality and morbidity. Insulin like growth factor-1 (IGF-1) has been implicated with micro-vascular complications during pregnancy. Glycosylated hemoglobin (HbA1c) is a reliable index, used to evaluate the glycemic control at the last 8 weeks.Aim: To find the relation between the level of insulin like growth factor and HbA1c at different gestational periods of pregnancy in diabetic pregnant women.Methods: The study was carried out on 190 pregnant women. They were 134 pregnant women with abnormal carbohydrate metabolism and 56 healthy pregnant women. Those of abnormal carbohydrate metabolism were also classified into two groups, those with gestational diabetes mellitus (70) and those with pregestational diabetes mellitus (64). IGF-1 and HbA1c levels were measured in the studied pregnant women at the second and third trimesters of pregnancy.Results: IGF-1 concentrations was found to be higher in patients with GDM when compared with those of PGDM and the control groups, in both 2nd and 3rd trimesters with a significant (P <0.001) difference among subgroups. HbA1c concentrations were found to be significantly (P< 0.001) higher in pregnant women with GDM and PGDM than in the control group. There was a significant (r=0.27, P<0.001) weak correlation between IGF-1 and HbA1c in both 2nd and 3rd trimesters.Conclusion: Both, IGF-1 and HbA1c levels elevate in pregnant women with GDM and PGDM, such rise is manifested by a weak positive correlation between the concentrations of the two parameters.Recommendation: It is useful to study the role of IGF-1 therapy in pregnant with diabetes mellitus especially those with vasculopathy.

Gestational and pregestational diabetes in pregnant women with cystic fibrosis

As cystic fibrosis transmembrane regulator (CFTR) modulator therapies offer greater longevity and improved health quality, women living with cystic fibrosis (CF) are increasingly pursuing pregnancy. Maternal risks for pregnant women with CF largely depend on a woman’s baseline pulmonary and pancreatic function, and the majority of CF pregnancies will successfully end in live births.Diabetes, either gestational or pre-existing cystic fibrosis-related diabetes (CFRD), is highly prevalent in women with CF, affecting 18 to 62% of pregnancies in recent CF center reports. In addition to the rising incidence of CFRD with age, gestational diabetes is also more common in women with CF due to lower insulin secretion, higher insulin resistance, and increased hepatic glucose production as compared to pregnant women without CF. Diabetes occurring during pregnancy has important implications for maternal and fetal health. It is well established in women without CF that glycemic control is directly associated with risks of fetal malformation, neonatal-perinatal mortality, cesarean delivery and need for neonatal intensive care. Small studies in women with CF suggest that pregnancies affected by diabetes have an increased risk of preterm delivery, lower gestational age, and lower fetal birth weight compared to those without diabetes.Women with CF preparing for pregnancy should be counseled on the risks of diabetes and should undergo routine screening for CFRD with oral glucose tolerance testing (OGTT) if not already completed in the past six months. Glycemic control in those with pre-gestational CFRD should be optimized prior to conception. Insulin is preferred for the management of diabetes in pregnant women with CF via multiple daily injections or insulin pump therapy, and continuous glucose monitors (CGM) can be useful in mitigating hypoglycemia risks. Women with CF face many unique challenges impacting diabetes care during pregnancy and would benefit from support by a multidisciplinary care team, including nutrition and endocrinology, to ensure healthy pregnancies.

Prevalence of vaginal candidiasis and associated factors in pregnant women with diabetes

Background/aims Vaginal candidiasis is commonly experienced by women with diabetes, but its prevalence is not well documented in Zimbabwe. This study aimed to assess the prevalence of vaginal candidiasis and factors associated with diabetic treatment adherence in pregnant women with diabetes. Methods This cross-sectional study was conducted on a consecutive sample of 157 participants from a central hospital in Harare, Zimbabwe. A structured questionnaire and physical examination of the perineum were used to collect data. All procedures were conducted in privacy. Diagnosis of vaginal candidiasis was made clinically. Data were analysed using the Chi-squared test, with P<0.05 being significant. Results The prevalence of vaginal candidiasis was 19.7%. There was a significant association between monthly family income (P=0.041), parity (P=0.029) and number of living children (P=0.049) and the presence of vaginal candidiasis. Women with poor adherence to diabetic therapy were 3.95 times more likely to have vaginal candidiasis (P=0.002). Conclusions Individualised health education on glycaemic control and good perineal hygiene remains key in the prevention of vaginal candidiasis among diabetic pregnant women.

ASSESSMENT OF THE EFFECT OF VITAMIN D SUPPLEMENTATION ON IMPROVING GLYCAEMIC CONTROL IN DIABETIC VITAMIN D-DEFICIENT PREGNANT WOMEN

The study is conducted to assess the effect of vitamin D supplementation in diabetic vitamin D-Deficient pregnant women on the improvement of blood sugar levels. One hundred sixty pregnant women in age ranged 18-40 years were randomized into Group I & Group II. Group I am consisting of 80 patients were supplemented with 60,000 I.U of vitamin D3 and Group II were offered routine antenatal care as per institutional protocol. Mean age was 28.1 years and 28.4 years, weight was 73.5 Kgs and 74.1 kgs, height was 156.2 cms and 157.4 cms, BMI (Kg/m2) was 30.1 and 29.5, primigravida was seen in 35 and 42, multigravida in 45 and 38, overt DM in 12 and 10, H/O GDM in previous pregnancy was seen in 16 and 8 and family history of DM was seen in 36 and 24 in Group I and Group II respectively. 35 patients in Group I and 26 in Group II were on insulin which increased to 40 in Group I and 30 in Group II on post- intervention. 32 patients in Group I and 25 in Group II required metformin which increased to 36 in Group I and 28 in Group II. The difference was comparable (P> 0.05) between both Groups. Vitamin D supplementation had no effect on decreasing insulin resistance or improving the blood sugar levels in diabetic pregnant women suffering from deficiency of vitamin D.

Ancestry-Matched and Cross-Ancestry Genetic Risk Scores of Type 2 Diabetes in Pregnant Women and Fetal Growth: A Study in an Ancestrally Diverse Cohort.

Maternal genetic variants associated with offspring birth weight and adult type 2 diabetes (T2D) risk loci show some overlap. Whether T2D genetic risk influences longitudinal fetal weight and the gestational timing when these relationships begin is unknown. We investigated the associations of T2D genetic risk scores (GRS) with longitudinal fetal weight and birth weight among 1,513 pregnant women from four ancestral groups. Women had up to five ultrasonography examinations. Ancestry-matched GRS were constructed separately using 380 European- (GRSeur), 104 African- (GRSafr), and 189 East Asian- (GRSeas) related T2D loci discovered in different population groups. Among European Americans, the highest quartile GRSeur was significantly associated with 53.8 g higher fetal weight (95% CI 19.2-88.5) over the pregnancy. The associations began at gestational week 24 and continued through week 40, with a 106.8 g (95% CI 6.5-207.1) increase in birth weight. The findings were similar in analysis further adjusted for maternal glucose challenge test results. No consistent association was found using ancestry-matched or cross-ancestry GRS in non-Europeans. In conclusion, T2D genetic susceptibility may influence fetal growth starting at midsecond trimester among Europeans. Absence of similar associations in non-Europeans urges the need for further genetic T2D studies in diverse ancestries.

Prevalence of asymptomatic bacteriuria among Thai diabetic pregnant women.

Diabetic pregnant women are susceptible to urinary tract infection, which can result in preterm labor and a low birth weight of the neonate. This was a prospective observational study. In total, 110 diabetic pregnant women between 12-20 weeks of gestation were recruited. Asymptomatic bacteriuria (ASB) was diagnosed when the urinalysis presented a white blood cell (WBC) count ≥ 5 WBCs per high power field (HPF). Urine culture was later performed. Most of the diabetic pregnant women were classified as GDM A1. The prevalence of ASB was 7.2% (8/110 cases). Klebsiella aerogenes was found in only one case from urine culture. ASB was commonly found in the pregnant women with a high BMI, with statistical significance. The prevalence of ASB in the diabetic pregnant women was 7.2%. Urinalysis should be considered for diabetic pregnant women with a high body mass index.

PREGNANCY OUTCOMES IN WOMEN WITH GESTATIONAL DIABETES COMPARED WITH THE GENERAL OBSTETRIC POPULATION

Background: Gestational diabetes mellitus (GDM) is the most prevalent metabolic disorder during pregnancy. It is described as the vulnerability to impaired glucose tolerance of multiple severities, usually during pregnancy. Objective: To compare pregnancy outcome in pregnant women with gestational diabetes mellitus and pregnant women in general population. Patients and Methods: A prospective non-intervention observational study was conducted in Obstetrics and Gynecology Department, Faculty of Medicine, Al-Azhar University, Samanoud General Hospital and Private Clinics during the period from October 2017 to October 2020. This study included 200 primigravida singleton pregnant women between 24 weeks and 28 weeks of gestation divided into two equal groups: case group included pregnant women attended for their routine antenatal care and discovered to have gestational diabetes and control group included normal healthy pregnant women attended for their routine antenatal care. Results: Fetal weight was significantly higher among study group than controls. Fetal complications in the form of Large for Gestational Age (LGA), premature, shoulder dystocia, hypoglycemia and hyperbilirubinemia were significantly higher among study group than controls. Neonatal Intensive Care Unit (NICU) admission was significantly higher among study group was (14%) than controls (3%). Conclusion: Increased maternal and fetal morbidity is linked with maternity gestational diabetes. Early screening, diagnosis, closer monitoring, and intervention were also important to minimize short and long-term maternal and fetal adverse effects, in particular in populations that are high-risk.

Sexual function between women with gestational diabetes and low risk pregnant women in third trimester of pregnancy

Sexual function between women with gestational diabetes and low risk pregnant women in third trimester of pregnancy

Evaluation of quality of life in diabetic pregnant women

AimsGestational diabetes is the most common clinical complication during pregnancy. Women with gestational diabetes face many problems in their personal, family and social lives that affect their quality of life. The aim of this study was to evaluate the quality of life of diabetic pregnant women. MethodsThis study was a descriptive study and the study population was all diabetic pregnant women referred to health centers in Kermanshah, Iran in 2019−2020. The studied variables were collected using a short form of quality of life questionnaire (WHOQOL-BREF-26 items). Then, with the help of SPSS software version 25, data analysis was performed based on frequency table and independent t-test. Results101 pregnant women with gestational diabetes were studied. Their mean age was 33.06 ± 05.05 years. The quality of life of all mothers participating in the study was above average. The average quality of life and psychological domains, social and environmental relationships of mothers were higher in people with higher incomes and employment, and also the average quality of life and psychological domains, social and environmental relationships were higher in mothers who had less than 6 months. ConclusionsThe majority of mothers were overweight (BMI = 25−29.9) and obese (BMI ≥ 30), which is one of the most important risk factors for gestational diabetes. Given the importance of quality of life of pregnant mothers, health policy makers are asked to provide more training for pregnant mothers on nutrition and increased physical activity to prevent gestational diabetes and improve their quality of life.

Pregnancy in Diabetics: Clinicobiological Features and Evolution

Background: The association between diabetes and pregnancy is a real public health problem due to the inherent maternal and fetal complications.Aims: To study the clinical and biological features of diabetic pregnancies.Methods: We conducted a retrospective descriptive study including pregnant diabetic women followed at the National Institute of Nutrition of Tunis.Results: We included 100 patients with a mean age of 32.87±5.3 years. In preconception, 63.6% of patients were overweight and had poorly balanced diabetes (HbA1c> 7%). The mean weight gain throughout the pregnancy was 8.62 ± 5.39 kg. Pregnancy was planned in 18% of cases.Significant improvement in HbA1c was observed in the second trimester. The average daily insulin dose increased from 0.68 u/kg/day in the first trimester to 0.87 u/kg/day in the third trimester (p <0.001). Full term delivery occurred in 72% of cases.The majority (93.3%) of our patients gave birth by caesarean section. Macrosomia was observed in 24% of cases. The main neonatal complications were neonatal respiratory distress and hypoglycemia in 26.7% and 20.5% of cases, respectively. Five newborns had deformities.Conclusion: Diabetic pregnancy is associated with an increased risk of maternal and fetal complications. An action on modifiable factors, before conception, could significantly improve its prognosis.

Awareness of euglycaemic diabetic ketoacidosis during pregnancy prevents recurrence of devastating outcomes: a case report of two pregnancies in one patient

BackgroundEuglycaemic diabetic ketoacidosis (DKA) during pregnancy is a life-threatening obstetric emergency. It requires early identification and prompt action. Obstetricians’ knowledge about symptoms, diagnostic pitfalls and management during pregnancy and delivery need to be improved. We report a case of a young diabetic woman developing severe euglycaemic DKA in two consecutive pregnancies; the first pregnancy resulted in the most deviating outcome (i.e., intrauterine death), while the second pregnancy resulted in the delivery of a healthy newborn. Thus, the novelty of the case presented here is the possibility to demonstrate how the management of DKA in pregnancy can dramatically change outcomes.Case presentationWe report a case of a young diabetic woman in whom DKA was concealed by hyperemesis and oesophageal reflux. This woman presented to our delivery unit with severe euglycaemic DKA during her first pregnancy. While the mother’s condition could be successfully stabilized, the foetus died shortly after admission. Two years later, the same woman presented with similar problems. Repeated episodes of mild euglycaemic DKA could be successfully managed with consequent interdisciplinary treatment and close observation, leading to a good pregnancy outcome, i.e., the birth of a healthy child.ConclusionAwareness of euglycaemic DKA needs to be increased to reduce the risk of severe complications during pregnancies in diabetic women. This case report demonstrates that increased awareness of DKA with immediate recognition and a successful multidisciplinary approach are mandatory for an positive pregnancy outcomes.

Study of the prevalence of toxoplasmosis in pregnant women with diabetes type 1 and type 2 using serological and molecular methods in Abadan and Khoramshahr Counties, Southwest of Iran

BackgroundHerein we assessed the sero-molecular prevalence of Toxoplasma infection in diabetic pregnant women, southwestern Iran. MethodsTotally, 264 sera were collected from diabetic pregnant women for detection of specific IgM, IgG and IgG avidity. DNA from buffy coats were used for B1-nested PCR. ResultsIn ELISA, out of 264 pregnant women with diabetes, 79 (29.92%) were showed positive. Of these, 75 (28.4%) were IgG +/ IgM _ and 4 (1.5%) were IgG +/IgM +. By IgG avidity, all cases with only IgG titers had high avidity, while 4 patients positive for both IgG and IgM had low avidity. Based on nested-PCR method, of 79 seropositive samples, 16 (20.25%) and among the 185 seronegative ones, 5 (2.7%) were positive. Molecular positive cases were most frequent (13.69%) in T1DM patients. ConclusionRemarkable positive cases were revealed in this sero-molecular study, implicating proper management particularly for those in early pregnancy.

Observation on the Preventive Effect of Delivery Nursing on Full-term Neonatal Complications in Diabetic Pregnant Women

Observation on the Preventive Effect of Delivery Nursing on Full-term Neonatal Complications in Diabetic Pregnant Women

Vaccination against COVID-19 infection: the need of evidence for diabetic and obese pregnant women

AimThe recent availability of vaccines against COVID-19 has sparked national and international debate on the feasibility of administering them to pregnant and lactating women, given that these vaccines have not been tested to assess their safety and efficacy in such women. As concerns the risks of COVID-induced disease, published data show that pregnant women who develop COVID-19 have fewer symptoms than patients who are not pregnant, but they are more likely to need hospitalization in intensive care, and neonatal morbidity. Aim of the present perspective paper is to analyze the current literature regarding the use of the vaccine against COVID-19 infection, in terms of safety and protection, in high risk pregnant women as those affected by diabetes and obesity.MethodsAnalysis of literature about vaccination against COVID-19 infection in pregnancy.ResultsThe main health organizations and international scientific societies, emphasize that—although data regarding the use of COVID vaccines during pregnancy and lactation are still lacking—vaccination should not be contraindicated. It should be considered for pregnant women at high risk of exposure to COVID-19. For such women, the potential benefits and risks should be assessed by the healthcare professionals caring for them. A recent prospective study to test the immunogenicity and reactogenicity of vaccination with COVID-19 mRNA in pregnant and lactating women, has showed that SARS-CoV-2 mRNA vaccination triggers a robust humoral immunity in pregnant and lactating women; there was also evidence of an immune transfer to their newborn.ConclusionsWe urgently need data on the effect of COVID-19 vaccination, in terms of maternal and fetal outcomes and vaccine related symptoms in high risk women during pregnancy and breastfeeding. It is important to run campaigns to promote vaccination, in particular in pregnant women at high risk to have severe COVID infection as those diabetics and/or obese.

Validation of a Claims-based Algorithm to Identify Pregestational Diabetes Among Pregnant Women in the United States.

Identifying pregestational diabetes in pregnant women using administrative claims databases is important for studies of the safety of antidiabetic treatment in pregnancy, but limited data are available on the validity of case-identifying algorithms. The purpose of this study was to evaluate the validity of an administrative claims-based algorithm to identify pregestational diabetes. Using a cohort of pregnant women nested within the Medicaid Analytic Extract (MAX) database, we developed an algorithm to identify pregestational type 1 and type 2 diabetes, distinct from gestational diabetes. Within a single large healthcare system in the Boston area, we identified women who delivered an infant between 2000 and 2010 and were covered by Medicaid, and linked their electronic health records to their Medicaid claims within MAX. Medical records were reviewed by two physicians blinded to the algorithm classification to confirm or rule out pregestational diabetes, with disagreements resolved by discussion. We calculated positive predictive values with 95% confidence intervals using the medical record as the reference standard. We identified 49 pregnancies classified by the claims-based algorithm as pregestational diabetes that were linked to the electronic health records and had records available for review. The PPV for any pregestational diabetes was 92% [95% confidence interval (CI) 82%, 97%], type 2 diabetes 87% (68%, 95%), and type 1 diabetes 57% (37%, 75%). The claims-based algorithm for pregestational diabetes and type 2 diabetes performed well; however, the PPV was low for type 1 diabetes.

Relation between Different Types of Treatment and Glycemic Control in Diabetic Pregnant Women

Gestational diabetes mellitus (GDM) is a common medical condition associated with pregnancy. GDM is defined as hyperglycemia that is diagnosed during pregnancy and is not clearly overt diabetes that existed prior to pregnancy. The sample of the study was sixty diabetic pregnant women who came for follow up at obstetrics and gynecology department in TMC in Tripoli medical center during the year 2016. The patients divided according to the type of treatments they received into three groups; A: Patients who took Oral hypoglycemic agents (OHA), B: Patients who took insulin, C: Patents who took both drugs (OHA and insulin), Glycemic control was assessed using HBA1c level, FBS and RBS. This study shows that about 70% of the patients who took OHA had type 1 diabetes and 30% had type 2 diabetes. About 77.8% of patients who took insulin had type 2 diabetes and 22.2% had type 1 diabetes. And 73.2% of the patients who were treated with the combination of drugs had type 2 diabetes and 26.8% had type 1 diabetes. The current study demonstrates that 80% of patients who took OHA had good control, 33.3% of patients who took insulin had good control and 53.7% of patients who took both drugs had good control. Regarding the fasting blood sugar of the patients, the result illustrates the following; High level was reported in 20% of OHA group, 33.3% of insulin group and 31.7% of both drugs group. On the birth weight, the macrosomia (>4kg) was more in insulin group (33.3%) than other groups (10% of OHA and 31.7% of both drugs group). GDM is a condition that should be treated and prevented, as uncontrolled GDM can affect the mother and the fetal growth.

1171-P: HORMAD1, a Novel Hypoxia-Inducible Factor-1 Target, Is Upregulated in Maternal Overnutrition-Induced Nonalcoholic Steatohepatitis (NASH)/Hepatocellular Carcinoma

We investigated whether overnutrition during pregnancy were associated with the changes in gene expressions, oxygen metabolism, and vascular and hepatic parenchymal remodeling in fetal livers at mid gestational days E14.5 of dams fed a control diet (CD group) or a high-fat diet (HFD group) during pregnancy. Synchrotron-based phase-contrast micro-CT demonstrated embryos of HFD group showed hepatomegaly accompanied with the same size umbilical vein and less portal branching, which might result in liver hypoxia. Correspondingly, fetal livers of HFD group increased the expression of HIF-1alpha. To identify genes and pathways targeted by maternal overnutrition in fetal livers, we assayed mRNA levels with microarray. We identified 430 differentially expressed genes (DEGs) including 146 upregulated- and 284 downregulated genes in fetal livers of HFD group compared with those of CD group. The up-regulated DEGs were significantly enriched in DNA alkylation, bile secretion, and the down-regulated DEGs mainly enriched in neuronal system, cell maturation. Among upregulated DEGs, a cancer/testis antigen HORMAD1 was induced by hypoxia up to 30-fold compared with that in normoxia in primary mouse hepatocytes (PMH), and the genetic inhibition of HIF-1alpha by siRNAs abolished the stimulatory effect of hypoxia on Hormad1 expression. In addition, we found three putative hypoxia response elements within the mouse Hormad1gene. Interestingly, the tumor suppressor WW domain-containing oxidoreductase (WWOX), which inhibits the activity of HIF-1alpha, were remarkably decreased in hypoxia in PMH. Finally, HORMAD1 protein was upregulated in fetal livers and NASH-based HCC in offspring of HFD group at 15 weeks old. Our results suggest that WWOX-HIF-1alpha-HORMAD1 pathway might be involved in the development of NAFLD in offspring of obese and/or diabetic pregnant woman, and be an important therapeutic target of NASH/HCC. Disclosure T. Takiyama: None. Y. Takiyama: Other Relationship; Self; Gilead Sciences, Inc., Research Support; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Mochida Pharmaceutical Co., Ltd., Roche Diabetes Care, Taisho Pharmaceutical Co., Ltd. R. Bessho: None. H. Kitsunai: None. Y. Takeda: None. H. Sakagami: None. T. Sera: None. M. Nakamura: None. S. Horike: None. Y. Nishikawa: None.

948-P: Serum Elabela Is Associated with Inflammatory Abnormalities in Gestational Diabetes Mellitus

Gestational diabetes mellitus (GDM) is a common disease in pregnant women, which mechanisms remain unclear. Apelin-APJ system contributes to the energy homeostasis in middle and terminal pregnancy. Elabela (ELA) is another endogenous ligand of apelin receptor (APJ), which is expressed highly in the placenta. Few studies have focused on the role of ELA in GDM and the association between ELA and inflammatory cytokines. In this study we mainly compare the concentrations of serum Elabela between 33 diabetes pregnant women (GDM group) with 33 healthy pregnant women (control group). The inflammatory biomarkers including IL-1β, IL-6 and TNF-α were measured and evaluated the relationship with ELA. There were significant differences in serum Elabela (P<0.05), fasting plasma glucose (FPG), one-hour glucose, two-hour glucose in the OGTT (P<0.001), HOMA-IR (P<0.001), cytokine IL-1β(P<0.05) between GDM group and control group. ELA had significant correlations with FPG (r=-0.254, P=0.039), fasting insulin (r=-0.258, P=0.036), HOMA-IR (r=-0.275, P=0.026), and IL-1β (r=-0.789, P=0.000). And stepwise multiple linear regression analysis presented IL-1β and FPG most significantly affected the ELA levels. This study showed that decreased ELA levels were significantly associated with increased glucose levels and insulin resistance in GDM, which might be mediated by inflammatory factors, such as IL-1β. Serum ELA levels might be a clinical biomarker for GDM. Disclosure Y. Chen: None. M. Shi: None. H. Zhang: None. Funding National Natural Science Foundation of China (81200595, 81400807)

Factors predictive of glycemic control of pregnant diabetic women

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)