Gestational Diabetes Mellitus Cases Research Articles

PREVALENCE AND FETO-MATERNAL OUTCOMES IN GESTATIONAL DIABETES MELLITUS AT A TERTIARY CARE HSOPITAL

Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with the onset or first recognition during pregnancy with or without remission after the end of pregnancy. Worldwide prevalence of GDM is reported between 1.4 – 14 percent. The data regarding prevalence and outcomes of GDM will help in planning and allocation of resources and the preventive strategies at the hospital and community level. There are few studies conducted in this region describing the prevalence, associated risk factors, maternal and neonatal outcomes associated with GDM. This was retrospective study conducted at a tertiary care hospital in India. Data was obtained from January 2018 to January 2019. Women between 24-28 weeks of gestation were included in the study. The information collected included the following parameters: age, residence status, gravid status, family history of diabetes or history of diabetes in first degree relative, past history of GDM. Neonatal outcomes like stillbirths, macrosomia, hyperbilirubinemia were recorded. Most common age of presentation of GDM was 26-30 years. Gravida < 3 accounted for most of the cases. Urban residents accounted for 55.8% of the cases. Most of the cases of GDM had at least one risk factor like history of hypertension or diabetes mellitus. Most common adverse maternal outcome was cephalopelvic disproportion followed by Casearean section and least common was abruptio placentae. Most common adverse fetal outcome was hyperbilirubinemia followed by macrosomia and least common was stillbirth. Early diagnosis and appropriate treatment of GDM will help in preventing maternal and fetal adverse outcomes and delay development of diabetes in high-risk individuals. The prevalence of GDM is going to increase in the near future exponentially, hence there is need for various community-based prevalence studies in different geographical regions of India to determine the exact prevalence and regional differences of GDM.

Glycated Haemoglobin: Is it a Better Reference Method than Oral Glucose Tolerance Test for the Diagnosis of Gestational Diabetes Mellitus?

Introduction: Insulin resistance during pregnancy is associated with adverse effects on foetal and maternal health, including macrosomia, congenital malformations, perinatal mortality and pre-eclampsia. A 100 g Oral Glucose Tolerance Test (OGTT) is recommended by World Health Organisation (WHO) as the diagnostic test for Gestational Diabetes Mellitus (GDM). However, the inconvenience caused to the pregnant females due to time consuming and cumbersome multi-invasive procedure for performing OGTT has prompted the exploration of an alternative method. Aim: To ascertain whether Glycated Haemoglobin (HbA1c) can be used instead of OGTT for diagnosis of GDM. Materials and Methods: It was a case-control study which was conducted for one year from June 2012 to May 2013. In this study, 200 pregnant females with gestational age from 22-40 weeks underwent Fasting Blood Sugar (FBS), Glucose Challenge Test (GCT) with 50 g glucose load, OGTT and HbA1c investigations. Results: The mean HbA1c of Group 1 with GDM was 5.29±0.68% and mean HbA1c of Group 2 without GDM was 4.83±0.46%. At the HbA1c cut-off of ≥5.85%, 18% of GDM patients were identified with specificity of 97%. A higher HbA1c cut-off of ≥5.95% showed sensitivity and specificity of 16.3% and 70%, respectively. An arbitrary cut-off of ≥5.85% would have diagnosed only 18% of patients with GDM with reasonable specificity. According to this study, 88% of GDM cases stayed undiagnosed by HbA1c at a cut-off of ≥5.85%. Hence, it can play only a supplemental role to OGTT in diagnosing GDM. Conclusion: On the basis of the present study, HbA1c can be used as a supplemental investigation in addition to OGTT for confirmation of GDM in pregnant females. Only drawback was the lack of fixed HbA1c cut-off for diagnosing GDM.

Diagnostic accuracy of Diabetes in Pregnancy Study Group of India criteria for the screening of gestational diabetes mellitus in primary care setting

Introduction: Although the Diabetes in Pregnancy Study Group of India (DIPSI) criterion is recommended by the Government of India guidelines, there is lack of consensus on a universal criterion for diagnosis of gestational diabetes. This has led to a wide variation of pregnant women being diagnosed with gestational diabetes mellitus (GDM). The WHO 1999 and International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria are widely used globally and in India as well. The objective of this study was to evaluate the diagnostic accuracy of DIPSI criteria in comparison to WHO 1999 and IADPSG criteria for diagnosis of GDM. Materials and Methods: A community-based study was conducted for a period of 1 year. Oral glucose tolerance test was done on 506 pregnant women identified through house-to-house survey. The proportion of GDM cases by WHO, IADPSG, and DIPSI criteria was calculated. The diagnostic accuracy of DIPSI criteria was assessed by calculating sensitivity, specificity, and predictive values taking WHO and IADSPG criteria as gold standard. Results: The prevalence of GDM was 14.2% by WHO criteria, 13% by DIPSI criteria, and 27.3% by IADPSG criteria; 10.3% were diagnosed by all the three criteria. The sensitivity and specificity of DIPSI criteria when the WHO criteria was taken as the gold standard was found to be 86.1% and 99.08%. The sensitivity and specificity of DIPSI criteria when the IADPSG criteria was taken as gold standard was found to be 44.93% and 98.91%, respectively. Conclusion: The prevalence of GDM is found to be much higher by IADPSG criteria as compared to the WHO and DIPSI criteria. The single-step approach DIPSI criteria have good diagnostic accuracy and can be used in epidemiological studies and are feasible for diagnosis of GDM in primary care settings.

The Effects of Hyperemesis Gravidarum on the Oral Glucose Tolerance Test Values and Gestational Diabetes.

This study is aimed at determination whether pregnant women who develop hyperemesis gravidarum in the first trimester have a tendency to develop gestational diabetes mellitus (GDM). It is also aimed at identification of effects of hyperemesis gravidarum and GDM on prenatal and neonatal status in case they were detected together. Hyperemesis gravidarum diagnose was based on the following signs and symptoms. To diagnose GDM, first trimester fasting blood glucose measurement and subsequent blood glucose monitoring and 75-g oral glucose tolerance test (OGTT) were performed in the second trimester. A total of 949 singleton pregnant women (95 with and 852 without hyperemesis gravidarum) who met our criteria were included in the study. In the first trimester, plasma blood glucose and positive GDM screening were found to be significantly higher in the hyperemesis gravidarum group compared to the control group (p=0.042 and p<0.001, respectively). However, actual GDM cases were similar between both groups. The positive predictive value was significantly lower in the hyperemesis gravidarum group (28.5% vs. 72.7%, p=0.003). In the second trimester, the prevalence of GDM was 6.6% in the hyperemesis gravidarum group and 7.3% in the control group, with no significant difference (p=0.218) between-groups. In this study, hyperemesis gravidarum was found to cause changes in maternal metabolism in the first trimester of pregnancy due to limited calorie intake and fasting; in the presence of hyperemesis gravidarum, it should be known that the positive predictive value of first trimester gestational diabetes screening may decrease and the diagnosis of pseudo-GDM may increase.

Study of placental morphometric anatomy in mothers with gestational diabetes mellitus and inৎluence of gestational diabetes mellitus on the fetal weight

The placenta is an organ which is an indicator of maternal and fetal disorders. Gestational Diabetes mellitus complicates 2-5% of all pregnancy. Therefore our work was an analysis of changes in placental morphometric anatomy in mothers of gestational diabetes mellitus and the influence of gestational diabetes mellitus on the fetal weight. Sixty-two placentas of full-term pregnancy collected from labour room/operation theatre of Gynaecology and obstetrics, department of government medical college and super facility hospital Azamgarh, Uttar Pradesh. Out of sixty-two placentas, 31 are from mothers with no known history of preexisting gestational diabetes mellitus cases as controls and 31 collected from mothers with gestational diabetes mellitus. We found mean placental weight, mean placental area, mean placental volume, mean no of cotyledons significantly more in placentas of gestational diabetic mothers. Mean fetal weight of gestational diabetic mothers were more in comparison with controls. Mean transverse diameter of placentas of the diabetic mothers were more than mean transverse diameter of placentas of the non-diabetic mothers, statistically significant. Mean longitudinal diameter also more in placentas of diabetic mothers, not statistically significant. Mean thickness at the centre more in placentas of diabetic mothers, statistically significant. Mean thickness mid-way between centre and margin and mean thickness at margin more in diabetic placentas, not statistically significant. Gestational diabetic mothers had more round-shaped placentas. Marginal insertion of umbilical cord presents more in placentas of gestational diabetic mothers.

Glycated hemoglobin in early pregnancy as a predictor of gestational diabetes mellitus

Introduction: The prevalence of Gestational diabetes mellitus (GDM) is high in Asian subcontinent. As per current guidelines, the routine screening for GDM is at 24 to 28 weeks of gestation.30 to 50% of GDM cases may remain undiagnosed until such period of screening. This study aims to investigate HbA1C levels at as early as 12 weeks of pregnancy as a predictor of GDM. Materials and Methods: This prospective study included 100 patients enrolled at their first antenatal visit, or before 12 weeks of gestational age, who attended OPD. At the time of enrolment for HbA1c and routine antenatal investigations were done. A 75 gm GTT was done at 22 to 26 weeks of gestation. HbA1c cutoff was taken as ?5.7 & ?6.4 and patients having value ?5.7 were taken as abnormal. Subjects with HbA1c ?6.5, overt diabetes, hemoglobinopathies, anaemia, chronic renal diseases and multiple pregnancies were excluded from the study. Results: It is found that women >28 years had higher levels of hbA1C in comparison to patients Conclusion: The study concludes that women with higher HbA1c (?5.7) were more likely to develop GDM than those women with lower HbA1C (?5.7). HbA1c can be done routinely in early pregnancy (1st trimester). Women with higher HbA1c (?5.7) can benefit from early interventions early in pregnancy thereby prevent GDM and adverse perinatal and pregnancy outcomes. Keywords: Early pregnancy, Glycated hemoglobin, GDM, Maternal age.

A Clinical Analysis of the Diagnosis and Treatment of Fetal Sacrococcygeal Teratomas.

ObjectiveThe present study aims to discuss the clinical features, treatment, and prognosis of fetal sacrococcygeal teratomas (SCTs) to improve the standard of diagnosis and treatment.MethodsThe clinical data of 15 pregnant females with fetal SCT, admitted to Fujian Maternity and Child Health Hospital from January 2013 to January 2020, were retrospectively analyzed with respect to clinical characteristics, imaging features, complications, treatment options, and pregnancy outcomes.ResultsThe 15 cases of fetal SCT were all detected by color ultrasonography. There were two cases of cystic tumors and 13 cases of solid cystic tumors. In terms of tumor blood supply, there was one case without blood flow signal, eight cases with little blood flow signal, and six cases with abundant blood flow. At the time of delivery, there were two cases with a tumor diameter less than 5 cm, five cases with a diameter of 5−10 cm, and eight cases with a diameter of more than 10 cm. In terms of tumor shape and location, there were two cases of type I, ten cases of type II, and three cases of type III. There were six cases with an increased fetal heart to chest ratio, four cases of fetal edema, three cases of placental edema, four cases of excessive amniotic fluid, one case of insufficient amniotic fluid, three cases of fetal distress, one case of stillbirth, two cases of gestational diabetes mellitus, two cases of mirror syndrome, and two cases of postpartum hemorrhage. According to the pathological diagnosis, there were seven cases of mature teratoma, seven cases of immature teratoma, and one case of mixed germ cell tumor. There were six cases of induced delivery, nine cases of cesarean section, one case of premature birth, and two cases of mild neonatal asphyxia.ConclusionFetal SCT was generally diagnosed by prenatal ultrasonography. The tumor blood supply, growth rate, size, nature of the tumor, clinical type, pathology, and maternal-fetal complications are all closely correlated with the prognosis. The timing and manner of the termination of pregnancy should be determined on the basis of the pregnant female, the fetus, and the tumor.

Correlation between low serum vitamin D levels and Gestational Diabetes Mellitus among pregnant women in the rural area attending tertiary care center

Background: Diabetes mellitus with the first onset in pregnancy is known as gestational diabetesmellitus (GDM) which is a common complication of pregnancy. Maternal vitamin D status has beenassociated with gestational diabetes mellitus (GDM) but the evidence is inconsistent. Duringpregnancy, this deficiency is even more critical. It appears that vitamin D insufficiency duringpregnancy may be associated with maternal hazards. Methods: This study included 200 pregnantwomen. 100 women already diagnosed with GDM were taken as cases and 100 normal pregnantwomen were taken as control. All the patients included were subjected to detailed history taking.BMI matched in cases and controls. Blood samples were taken from both cases and control ant sentfor Vitamin-D level, HbA1c, fasting blood glucose, and 2hrs postprandial glucose test. Results:Overall 78% of Indian women are vitamin D deficient in the present study. The mean maternalserum vitamin D levels were 9.25±6.07 in GDM cases and in the controls the mean is 18.11±7.86.The difference was statistically significant reflecting that the mean serum vitamin D was decreasedin women with GDM. Vitamin D levels correlated significantly with the fasting blood glucose, thefasting serum insulin, and the HbA1c levels, the P-value in all these correlations were <0.0001.Conclusions: Low maternal serum vitamin d levels were associated with gestational diabetesmellitus. There is a statistically significant negative correlation between glycemic control and vitaminD levels in serum in the whole study population.

Associations between urinary phenol mixtures and gestational diabetes mellitus: A case-control study in Oklahoma

Background: Previous studies have examined environmental phenol exposures as risk factors for gestational diabetes mellitus (GDM), but have focused on associations with individual chemicals. As methods have emerged to better assess simultaneous exposure to multiple chemicals, the association between phenol mixtures and GDM remains undetermined. In the present study, we utilized Bayesian kernel machine regression (BKMR) to investigate the relationship between phenol mixtures and GDM.Methods: A case-control study of 64 GDM cases and 237 controls was conducted among obstetric patients at the University of Oklahoma Medical Center, August 2009 to May 2010. Concentrations of bisphenol A (BPA), benzophenone-3, triclosan, 2,4-dichlorophenol, 2,5-dichlorophenol, butylparaben, methylparaben, and propylparaben were quantified in mid-pregnancy spot urine samples. Multivariable logistic regression was performed to assess associations between continuous measures of individual specific-gravity adjusted phenol concentrations and GDM while controlling for age, race and pre-pregnancy body mass index. Probit implementation of BKMR with hierarchical variable selection was used to evaluate the adjusted mean difference in GDM probability for each component of the phenol mixtures, while taking the correlation among the mixture components into account.Results: We observed that benzophenone-3 was positively associated with GDM [adjusted odds ratio (aOR per interquartile range (IQR) = 1.48 (95% Confidence Interval (CI) 1.11, 1.98)] when analyzing individual phenols using logistic regression. In contrast, BPA was negatively associated with GDM (aOR 0.63 (95% CI 0.41, 0.98)). In Probit-BKMR analysis, an IQR increase in Z score-transformed benzophenone-3 was associated with an increase in the probability of GDM (0.19, 95% Credible Interval: -0.09, 0.48), holding other phenols fixed at their medians, but the credible interval crossed zero. The BKRM analyses did not identify associations with the other phenol concentrations while accounting for correlation among the mixture components.Conclusion: Our results highlight the importance of addressing chemical mixtures in studies of perinatal environmental exposures.

Environmental Exposure to Toxic Metals and Gestational Diabetes Mellitus: A Systematic Review and Meta-Analysis

Background: Exposure to toxic metals have been inconsistently associated with the risk of gestational diabetes mellitus (GDM). We aimed to perform a systematic review and meta-analysis of epidemiological studies to examine the associations of exposure to arsenic, cadmium, lead, and mercury with GDM. Methods: PubMed, Web of Science, and Embase were searched for epidemiological studies reporting associations of arsenic, cadmium, lead, and mercury with risk of GDM up to 1 September, 2020. A random-effects model was used to calculate the pooled odds ratios (ORs) and 95% confidence intervals (CIs). Findings: Eleven studies, including 2867 GDM cases among 34760 participants, met the inclusion criteria. The pooled OR for the highest versus lowest category of arsenic was 1·36 (95% CI: 1·06, 1·75) for GDM. No significant associations between exposure to cadmium, lead, and mercury and risk of GDM were observed, with corresponding ORs of 1·16 (95% CI: 0·93, 1·44), 1·17 (95% CI: 0·78, 1·74), 1·26 (95% CI: 0·87, 1·82), respectively. In subgroup analysis, exposure to cadmium was associated with an increased risk of GDM among studies with measurement of urinary cadmium (OR, 1·28; 95% CI: 1·08, 1·51). Interpretations: This meta-analysis suggested a positive association between exposure to arsenic and risk of GDM. In addition, urinary cadmium was associated with an increased risk of GDM. Improved understanding of the effects of toxic metals on GDM may promote early identification of women with increased risk of GDM. Funding: This research was funded by the China postdoctoral Science Foundation (2019M662646) and the National Key R&D Program of China (2019YFC1605102). Declaration of Interests: All other authors declare no competing interests.

Association between maternal alcohol use during pregnancy and gestational diabetes mellitus: a meta-analysis

Maternal alcohol use and gestational diabetes mellitus (GDM) have been serious public health issues worldwide. This study aimed to investigate the association between maternal alcohol use during pregnancy and risk of GDM via a meta-analysis. PubMed, ScienceDirect, and Cochrane Library databases were systematically searched up to March 25, 2020. Observational studies on associations between maternal alcohol use during pregnancy and risk of GDM were retrieved. The pooled odds ratios (ORs) and their 95% confidence intervals (CIs) for with versus without alcohol use during pregnancy were calculated using a random-effect model. The publication bias was assessed by Begg’s rank correlation test. A total of 7 observational studies (185,235 participants, including 8368 GDM cases) were included in this meta-analysis. Compared with women without any use of alcohol during pregnancy, the pooled OR for women with alcohol use was 0.74 (95% CI 0.50–1.10). In subgroup analysis, the pooled OR was 0.79 (95% CI 0.60–1.05) and 0.71 (95% CI 0.28–1.80), respectively, for individual study with and without adjusting for body mass index. Our findings suggest that there is no discernible association between maternal alcohol use during pregnancy and risk of GDM. However, given other possible pregnancy complications and adverse birth outcomes induced by alcohol use, women who have been pregnant and are planning to become pregnant should quit drinking.

Maternal Arsenic Exposure and Gestational Diabetes: A Systematic Review and Meta-Analysis.

Gestational diabetes mellitus (GDM) is a metabolic complication associated with adverse outcomes for mother and fetus. Arsenic (As) exposure has been suggested as a possible risk factor for its development. The aim of this meta-analysis was to provide a comprehensive overview of published evidence on the association between As and GDM. The systematic search from PubMed, MEDLINE, and Scopus was limited to full-length manuscripts published in peer-reviewed journals up to April 2020, identifying fifty articles. Ten studies met the inclusion criteria, nine for quantitative synthesis with a total of n = 1984 GDM cases. The overall pooled risk was 1.56 (95% Confidence Interval - CI = 1.23, 1.99) with moderate heterogeneity (χ2 = 21.95; I2% = 64). Several differences among the included studies that may account for heterogeneity were investigated. Stratification for exposure indicator confirmed a positive association for studies assessing urine As. A slightly higher risk was detected pooling studies based in Asia rather than in North America. Stratification for GDM diagnostic criteria showed higher risks when diagnosis was made according to the Canadian Diabetes Association (CDA-SOGC) or World Health Organization (WHO) criteria, whereas a lower risk was observed when adopting the American Diabetes Association (ADA) criteria. These results provide additional evidence for a possible association between As exposure and GDM, although the data need to be interpreted with caution due to heterogeneity.

First trimester biomarkers for prediction of gestational diabetes mellitus

PurposeTo develop a first trimester prediction model for gestational diabetes mellitus (GDM) using obesity, placental, and inflammatory biomarkers. MethodsWe used a first trimester dataset of the ASPRE study to evaluate clinical and biochemical biomarkers. All biomarkers levels (except insulin) were transformed to gestational week-specific medians (MoMs), adjusted for maternal body mass index (BMI), maternal age, and parity. The MoM values of each biomarker in the GDM and normal groups were compared and used for the development of a prediction model assessed by area under the curve (AUC). ResultsThe study included 185 normal and 20 GDM cases. In the GDM group, compared to the normal group BMI and insulin (P = 0.003) were higher (both P < 0.003). The MoM values of uterine artery pulsatility index (UtA-PI) and soluble (s)CD163 were higher (both P < 0.01) while pregnancy associated plasma protein A (PAPP-A), placental protein 13 (PP13), and tumor-necrosis factor alpha (TNFα) were lower (all P < 0.005). There was no significant difference between the groups in placental growth factor, interleukin 6, leptin, peptide YY, or soluble mannose receptor (sMR/CD206). In screening for GDM in obese women the combination of high BMI, insulin, sCD163, and TNFα yielded an AUC of 0.95, with detection rate of 89% at 10% false positive rate (FPR). In non-obese women, the combination of sCD163, TNFα, PP13 and PAPP-A yielded an AUC of 0.94 with detection rate of 83% at 10% FPR. ConclusionA new model for first trimester prediction of the risk to develop GDM was developed that warrants further validation.

Early triglyceride and glucose index as a risk marker for gestational diabetes mellitus.

To assess the risk of gestational diabetes mellitus (GDM) according to the triglyceride and glucose (TyG) index values during the first trimester of pregnancy in Latin American women. Pregnant women were enrolled at their first prenatal visit at the Obstetric Division in the University Hospital "Dr. José E. González". Triglycerides and fasting plasma glucose (FPG) were collected to determine the TyG index. GDM diagnosis was performed by a single-step 2-hour 75-g oral glucose tolerance test. Generalized linear models were used to determine risk ratios; pregnancy outcomes at delivery were collected from the hospital medical records. A total of 164 pregnant women were included. GDM was present in 29 (17.7%) women. No significant differences in age, first-trimester body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters), family history of diabetes, and TyG index were observed between GDM cases and the reference group without GDM. The adjusted analysis showed no association between TyG and GDM (risk ratio [RR] 1.03, 95% confidence interval [CI] 0.57-1.88]). Higher TyG index values between women with and without a diagnosis of GDM in the second trimester were observed. No significant differences were identified in pregnancy outcomes, although a trend was observed for hyperbilirubinemia in women with first-trimester TyG index values greater than 8.7. Our findings do not support the use of the TyG index for GDM prediction in Latin American women.

Gestational diabetes mellitus yesterday, today and tomorrow: A 13 year italian cohort study

AimsTo describe all cases of gestational diabetes mellitus (GDM) managed at the Italian Hospital of San Daniele del Friuli from 2006 to 2018, after the establishment of a dedicated multidisciplinary team. MethodsData on mothers, pregnancies, and newborns have been recorded since the team establishment. The associations of maternal, pregnancy, and delivery characteristics with complications of pregnancy and delivery and adverse birth outcomes were assessed. Results894 cases of GDM were observed, representing 6.8% of all deliveries. More than 20% of women were non-Italian, 5.3% had a previous macrosomic child, 12.5% previous diabetes or GDM, 27.3% family history of diabetes. On average, women had 4 visits at the clinic; mean glycated hemoglobin was 5.3%; starting body mass index (BMI) 26.2 and weight gain 10.3 kg. Cesarean sections were 21.8%. Pre-eclampsia was the most common pregnancy complication (4.7%). 6.0% of newborns were macrosomic and there were 3 fetal deaths. Only 26.3% of women had a post-partum oral glucose tolerance test. Initial BMI, weight gain, nationality, family history of diabetes or previous diabetes-related pregnancy complications were associated with pregnancy complications or adverse outcomes. ConclusionsWe identified factors to be targeted for preventing GDM complications. Further efforts should be directed at post-partum.

Exposure to elevated per- and polyfluoroalkyl substances in early pregnancy is related to increased risk of gestational diabetes mellitus: A nested case-control study in Shanghai, China

BackgroundLong-chain per- and polyfluoroalkyl substances (PFASs) and their short-chain alternatives have been produced and used extensively in China. However, it is unclear whether these compounds contribute to the risk of gestational diabetes mellitus (GDM) in women residing in contaminated areas. ObjectiveThe study was performed to explore the association between PFASs varying in chain length and the risk of developing GDM. MethodA nested case-control study was conducted in a prospective cohort of 2,460 pregnant women between July 1, 2017, and January 31, 2019 in Shanghai, China. Twelve PFASs of interest were measured using ultra-performance liquid chromatography/quadrupole time-of-flight mass spectrometry (UPLC-Q/TOF MS) in the sera of pregnant women at 16–20 weeks. GDM was diagnosed by an oral glucose tolerance test administered over 24–28 gestational weeks. The cases and controls were matched by maternal age. The relationship between maternal serum PFAS level and GDM risk was determined by conditional logistic and linear regression analyses. ResultsA total of 165 GDM cases and 330 controls were enrolled in the study cohort. The frequencies of detection of PFHpA, PFDS, and PFOSA were all ≤80%. Hence, they were excluded from any further risk analysis. Perfluorooctane sulfonate (PFOS) and perfluorooctanoic acid (PFOA) were detected at relatively high serum levels (medians 6.57 ng/mL and 8.07 ng/mL, respectively). The serum levels of perfluorobutanesulfonic acid (PFBS) and perfluorododecanoic acid (PFDoA) were significantly higher in the GDM group than they were in the control group (P = 0.02 and P < 0.01, respectively) according to a nonparametric Wilcoxon rank sum test. A quartile analysis showed that the odds ratio of GDM would significantly increase at the highest PFBS and PFDoA levels. In the core model, the adjusted ORs were 2.02 (95% CI = 1.04–3.79) and 13.00 (95% CI = 4.74–24.59), respectively, after adjusting for maternal age, sampling time, parity and body mass index [BMI]). ConclusionElevated maternal serum PFBS and PFDoA levels in early pregnancy may be associated with a substantially higher GDM risk.

Effect of maternal perceived stress during pregnancy on gestational diabetes mellitus risk: A prospective case-control study

Background and aimsA variety of risk factors have been reported for the development of gestational diabetes mellitus (GDM). But limited review on the role of antenatal perceived stress necessitated the design of the present study to evaluate the association between GDM and perceived stress during pregnancy. MethodsA prospective case-control study was carried out among 100 GDM cases and 273 matched controls, attending regular antenatal clinic at two private hospitals of Karnataka. Data was collected by personal interviews using a standard questionnaire. Perceived stress was assessed using the Cohen 10-item Perceived Stress Scale. Score of ≥20 was identified as high stress. Statistical Package for the Social Sciences version 15 was used for analysis. ResultsExposure rates for high maternal perceived stress among cases during pregnancy were noted. The odds of GDM were 13 folds higher among those with high antenatal stress (≥20) compared to those with low (<20) (p < 0.001) perceived stress. No correlation between maternal antenatal stress and blood glucose following OGTT was noted. ConclusionsThe study identified high perceived stress during pregnancy as a potential risk factor for GDM.

Adipokines in early and mid-pregnancy and subsequent risk of gestational diabetes: a longitudinal study in a multiracial cohort

IntroductionSeveral adipokines are implicated in the pathophysiology of gestational diabetes mellitus (GDM), however, longitudinal data in early pregnancy on many adipokines are lacking. We prospectively investigated the association of a...

Relationship between serum cystatin C level and pregnancy complications and abnormal glucose tolerance at 6-week postpartum in patients with gestational diabetes mellitus

This study aimed to investigate the relationship between serum cystatin C level and pregnancy complications and abnormal glucose tolerance at 6-week postpartum in patients with gestational diabetes mellitus (GDM). Clinical data of 298 cases of GDM delivered in Taizhou People’s Hospital from January 2017 to June 2018 were retrospectively analyzed. According to the level of cystatin C before delivery, they were divided into normal group (≤ 1.1 mg/L) and elevated group (> 1.1 mg/L). The general situation, complications of pregnancy, and the incidence of abnormal glucose tolerance at 6 weeks after delivery were compared between the two groups. According to concomitant gestational hypertension in late pregnancy, the patients were divided into group A (GDM with hypertensive disorder complicating pregnancy (HDCP)) and group B (GDM without HDCP). The differences of age, parity, body mass index (BMI) and mean arterial pressure (MAP) in the first trimester of pregnancy, levels of cystatin C, creatinine, urinary microalbumin, and glycosylated hemoglobin in 24-week gestation and before delivering were compared between the two groups. There was no significant difference in age and parity between the normal group and the elevated group (p > 0.05). The levels of BMI (25.06 ± 3.46 vs 26.34 ± 3.65 kg/m2), creatinine (38.76 ± 16.52 vs 59.75 ± 17.82 mmol/L), and urinary microalbumin (37.11 ± 49.20 vs 61.25 ± 43.52 mg/L) and the incidence of premature delivery (9.35% vs 17.8%), premature rupture of membranes (11.22% vs 20.94%), and abnormal glucose tolerance at 6-week postpartum (18.69% vs 42.93%) in the normal group of cystatin C were significantly lower than that in the elevated group of cystatin C (p 0.05). The clinical characteristics of group A (GDM with HDCP) and group B (GDM without HDCP) were compared. The results showed that the levels of age, BMI, and mean arterial pressure (MAP) were significantly different (p < 0.001). The results of binary logistic regression analysis showed that the significance value of MAP was 0.005 after controlling age factors, which indicated that MAP was an independent risk factor of GDM with HDCP, and the OR value of MAP was 1.420 (1.109–1.817). The increase of cystatin C in patients with GDM does not increase the risk of HDCP, but it does increase the risks of premature delivery, PROM, and abnormal glucose tolerance at 6-week postpartum. Cystatin C is a biological index that may be valuable in predicting the occurrence of these diseases in GDM patients. The independent risk factor of GDM complicating HDCP is MAP.

Proteome profiling of gestational diabetes mellitus at 16-18 weeks revealed by LC-MS/MS.

BackgroundThe practices used to diagnose gestational diabetes mellitus (GDM) could only be carried out around the time of detectable symptoms, and predictive capacity is little.MethodsLC‐MS/MS was conducted to explore overview proteomics for GDM complicated pregnant woman at 16‐18 gestation weeks, while normal pregnant for control. Enzyme‐linked immunosorbent assay was further applied in an independent cohort of 15 GDM cases and 15 controls for verification.ResultsThe results indicated that 24 protein expression levels were significantly changed in GDM group samples, and inflammation, oxidative stress, insulin resistance, blood coagulation, and lipid homeostasis were associated with GDM. The abnormal expression of CRP and IGFBP2 was verified in the first‐trimester maternal plasma in women who subsequently developed GDM.ConclusionsThis study not only identified 24 potential predictive biomarkers for GDM also provided a global overview of protein rearrangements induced by GDM.