Gestational Diabetes Mellitus In China Research Articles

Camp-style lifestyle modification program (CAMP) for diabetes prevention among rural women with prior GDM: study protocol for a three-arm cluster hybrid type 2 randomized controlled trial

BackgroundIntensive lifestyle interventions were effective to reduce the risk of type 2 diabetes mellitus (T2DM) for women with gestational diabetes mellitus (GDM) history. However, reaching these mothers and maintaining participation in lifestyle interventions is suboptimal in real-world settings. Effective, feasible and sustainable new lifestyle interventions are needed. The objectives of this three-arm trial are to (1) compare diabetes risk outcomes of an evidence-based intensive lifestyle modification (ILSM) intervention, a camp-style lifestyle modification program (CAMP) intervention, and usual care among women with GDM history; and (2) evaluate the comparative efficacy of the CAMP versus ILSM intervention on implementation outcomes.MethodsA three-arm cluster randomized clinical trial (RCT) using a hybrid type 2 implementation design will be conducted in two counties in Hunan province in China. Six towns from each county will be randomly selected and assigned to CAMP, ILSM, and the usual care group (25 women from each of 12 towns, 100 women in each arm). The ILSM includes six biweekly in-person sessions and 3-month telephone health consultations, while the CAMP consists of a 2-day camp-based session and 3-month health consultations via a popular social media platform. Both interventions share the same session content, including six lifestyle skills. Efficacy (T2DM risk score and behavioral, anthropometric, psychosocial, and glycemic variables) and implementation outcomes (recruitment, acceptability, feasibility, fidelity, and cost-effectiveness) will be collected at baseline, 6-month, and 12-month. Pre-planned ANOVA F-test and generalized estimating equations will be included to test time-by-arm interactions.DiscussionThe CAMP intervention is expected to have better reach, better attendance, and comparable effectiveness in reducing the risk of T2DM, thus improving postpartum care for GDM in China. The delivery of a concentrated format supplemented with technology-based support may provide an efficient and effective delivery model for implementing maternal health promotion programs in primary care settings.Trial registrationRegistered in the Chinese Clinical Trial Registry (ChiCTR2200058150) on 31st March 2022.

Accuracy of Fasting Blood Glucose and Body Mass Index in Predicting Gestational Diabetes Mellitus in China.

Research suggests that lowering maternal morbidities associated with gestational diabetes mellitus (GDM) can be achieved with earlier risk group identification. Therefore, the purpose of this study was to examine potential markers for identifying first-trimester pregnant women who are at high risk for developing GDM. This was a retrospective cohort study. The pertinent maternal clinical data were retrieved prior to 13+6 weeks of gestation, and a binary logistic regression analysis was used to identify potential GDM predictors. The predictive accuracy was evaluated using the area below the receiver operating characteristics curves. In comparison to the control group, the GDM group had significantly higher mean values for age, body mass index (BMI), mean fasting blood glucose (FBG), and hemoglobin (p < 0.05). The Pearson's correlation coefficients indicated that the first-trimester FBG was significantly positively correlated with the second-trimester FBG. Higher FBG and BMI values were associated with an increased risk of developing GDM (odds ratio [OR] = 3.04, 95% confidence interval [CI] = 2.03-4.55 and OR = 1.18, 95% CI = 1.12-1.25). In terms of predicting GDM, the FBG parameter demonstrated the greatest area under the curve values (0.66), followed by the BMI parameter (0.69). For GDM prediction, the cut-off value for FBG was 4.32 mM, whereas that for BMI was 23.7 kg/m2. The first-trimester FBG and BMI could be utilized to predict gestational diabetes.

Dietary Intakes of Women with Gestational Diabetes Mellitus and Pregnancy Outcomes: A Prospective Observational Study.

Nutrient intake for pregnant women with gestational diabetes mellitus (GDM) is important to ensure satisfactory birth outcomes. This study aims to explore the dietary profiles of patients with GDM, compare the results with the Chinese dietary guidelines or Dietary Reference Intakes (DRIs) from China and investigate the relationship between maternal dietary intake and pregnancy outcomes. A total of 221 patients with GDM in the second trimester were included in the cohort. Dietary intake data were collected using a 24-hour recall method for three consecutive days. The pregnancy outcomes of these participants were subsequently monitored. Both univariate logistic regression and multivariate logistic regression analyses were conducted to explore the associations between dietary intake variables or general characteristics variables and adverse pregnancy outcomes. Participants with adverse pregnancy outcomes showed a lower intake of iodine and vitamin D, a lower percentage of dietary energy intake from carbohydrates and a higher percentage of dietary energy intake from fats, compared to participants without adverse pregnancy outcomes. The gestational weight gain and family history of diabetes were associated with an increased risk of adverse pregnancy outcomes. Conversely, regular exercise, the intake of iodine and Vitamin D, and the percentage of dietary energy intake from carbohydrates were associated with a decreased risk. The daily diet of pregnant women with GDM in China did not meet the dietary guidelines or DRIs. The low intake of Vitamin D and iodine, the low dietary carbohydrate ratio, family history of diabetes, lack of exercise, and high gestational weight gain were associated with increased risk of adverse pregnancy outcomes in pregnant women with GDM.

Experiences and self-care of pregnant nurses with gestational diabetes mellitus: a qualitative study

BackgroundPregnant nurses are at high risk of developing gestational diabetes mellitus (GDM), and nurses diagnosed with GDM face challenges in balancing disease management and work, which affects maternal and child health and the quality of care. GDM requires significant changes to lifestyle and physical activity to control blood glucose levels, which is key to reducing adverse pregnancy outcomes. However, few studies have focused on the experiences of pregnant nurses with GDM. This study aimed to gain insight into the experiences of pregnant nurses with GDM in China in terms of their illness, work burdens, and self-care.MethodsThis qualitative study used an interpretative phenomenological analysis. Face-to-face semi-structured in-depth interviews were conducted with pregnant nurses with GDM to investigate their experiences and self-care. The study was performed at Chongqing’s maternal and child health hospital in China. A purposive sampling was used. Nine pregnant nurses diagnosed with GDM were recruited and interviewed.ResultsThe interview data generated four themes and 11 sub-themes. The four themes were ‘the perceptions and feelings of GDM’, ‘experiences of lifestyle changes’, ‘social support needs’, and ‘health expectations and risk perception.’ConclusionMany factors such as the unique occupational environment, overwork, occupational pressure, shift work, family status, and education level may lead to difficulties in managing blood glucose in nurses with GDM. These findings suggest that managers should pay more attention to nurses with GDM and develop personalized medical care and work arrangements. These measures can improve the self-care and well-being of nurses with GDM and promote the health of nurses and their offspring.

Risk factors and glycaemic control in small-for-gestational-age infants born to mothers with gestational diabetes mellitus: a case–control study using propensity score matching based on a large population

BackgroundSmall for gestational age (SGA) poses a significant concern for newborns, being linked to neonatal complications and potential metabolic disorders in adulthood, especially when born to mothers with gestational diabetes...

Knowledge, Attitude and Practice of Patients with Gestational Diabetes Mellitus Regarding Gestational Diabetes Mellitus: A Cross-Sectional Study.

Self-monitoring of blood glucose levels and changes in diet and lifestyle play important roles in the management of gestational diabetes mellitus (GDM). This cross-sectional study enrolled patients with GDM at Hangzhou Women's Hospital, China, between September 1, 2022, and October 26, 2022. A questionnaire was designed that included the following dimensions: demographic/clinical information, knowledge, attitude and practice. Correlations between knowledge, attitude and practice scores were evaluated using Spearman correlation analysis. Factors associated with practice score ≥14/16 were identified using multivariate logistic regression. The analysis included 499 women with GDM and a mean age of 31.22±3.89 years. The average knowledge, attitude and practice score were 11.55±3.04, 34.23±4.06 and 10.7±2.87 points, respectively. Knowledge score was positively correlated with attitude score (r=0.318, P<0.001) and practice score (r=0.351, P<0.001); attitude and practice scores were also positively correlated (r=0.209, P<0.001). Multivariate analysis identified higher knowledge score (odds ratio [OR], 1.138; 95% confidence interval [95% CI], 1.042-1.244; P=0.004) and higher attitude score (OR, 1.137; 95% CI, 1.060-1.219; P<0.001) as independently associated with good practice (ie, practice score ≥14 points). The results provide important insights into the knowledge, attitudes and practices of women with GDM in China regarding GDM and its management. These findings may facilitate the development and implementation of education and training programs to improve the self-management of GDM by women in China.

The 18-month efficacy of an Intensive LifeStyle Modification Program (ILSM) to reduce type 2 diabetes risk among rural women: a cluster randomized controlled trial

BackgroundMany lifestyle interventions have demonstrated efficacy up to one-year follow-up, yet maintaining improvements at longer-term follow-up is a well-recognized worldwide challenge, especially in underserved areas. The purpose of this study is to compare the 18-month efficacy of an Intensive LifeStyle Modification Program to usual care in reducing the risk for type 2 diabetes (T2D) among women with a history of gestational diabetes mellitus (GDM).MethodsWe conducted a two-arm, cluster randomized controlled trial among women with a history of GDM in China. A total of 16 towns (clusters) in two distinct rural areas in south-central China were randomly selected (8 towns per area) and assigned (1:1) to the intervention (Intensive LifeStyle Modification Program) or control (usual care) group with stratification in the two rural areas. The strategies for maintaining intervention effects were used (including setting recursive goals and providing a supportive environment, etc.) under the guidance of social cognitive theory. The primary outcome was a change in T2D risk; secondary outcomes included glycemic, weight-related, behavioral, and psychological variables. All outcomes were collected at baseline, 6, and 18 months. All participants entered the intention-to-treat analysis. Data were analyzed via generalized estimation equation models (accounting for clusters) at the individual level, with subgroup analysis included in the model.ResultsThe sample included 320 women from 16 clusters (20 women per cluster). At 18 months, the intervention group demonstrated a significant improvement in T2D risk score, fasting blood glucose, body mass index (BMI), waist circumference, intention to eat low glycemic index food, perceived stress, quality of life in psychological and environmental domains, and social support over time (p < 0.05) based on the intention-to-treat analysis set. Subgroup analysis showed a significant interaction effect on T2D risk score in subgroups of different BMI, waist circumference, and blood glucose (p < 0.05).ConclusionsOver 18 months, the Intensive LifeStyle Modification Program reduced T2D risk among rural women with a history of GDM in China. Women who were overweight, had high abdominal adiposity, or had blood glucose intolerance benefited more from this intervention. This program serves as a potential diabetes prevention model for women with a history of GDM in low-resource settings worldwide.Trial registrationRegistered on Chinese Clinical Trial Registry (ChiCTR1800015023) on 1st March 2018, http://www.chictr.org.cn/showproj.aspx?proj=25569

Passive Smoking and Risk of Gestational Diabetes Mellitus among Nonsmoking Women: A Prospective Cohort Study in China.

Background: Increasing evidence has shown that active smoking can increase the risk of gestational diabetes mellitus (GDM), but the effect of passive smoking is still unknown. Women in pregnancy are vulnerable to secondhand smoke. This study explored the association of passive smoking with GDM in China. Method: A total of 3083 nonsmoking pregnant women living in Beijing were recruited into a prospective cohort study. Sociodemographic and passive smoking data were collected with structured questionnaires during face-to-face interviews. Glucose levels were measured by physicians according to standard protocols. Multivariate logistic regression was performed for the association estimation after accounting for potential confounders. Result: In total, 562 of the 3083 participants developed GDM (18.23%); 779 participants (25.27%) reported exposure to passive smoking. After adjusting for age, BMI, ethnicity, education, occupation, and parity, passive smoking conferred an approximately 1.4-fold risk increase in GDM (adjusted odds ratio (OR) = 1.37, 95% confidence interval (CI): (1.11, 1.70)). The adjusted ORs with 95% CIs for passive smoking levels of <1, 1–6, and ≥7 times per week were 1.21 (0.94, 1.55), 1.81 (1.22, 2.69), and 1.70 (1.02, 2.84), respectively. An obvious passive-smoking–GDM association was observed among only nulliparous women (adjusted OR = 1.45, 95% CI: (1.14, 1.85)). Conclusion: Frequent exposure to secondhand smoke could increase the risk of GDM among nonsmoking pregnant women. Parity status might modify their association. Public policies should be advocated to prevent passive smoking among this population.

Development and psychometric evaluation of self-management scale for pregnant woman with gestational diabetes mellitus in China.

AimTo develop a self‐management scale and evaluate its validity for pregnant woman with GDM in China.DesignA cross‐sectional survey design.MethodsThis study was conducted through three phases. The item pools of the scale were developed through literature review and expert interview. Content validity was assessed by an expert panel. Structure validity was evaluated through exploratory factor analysis. In the end, internal consistency reliability was tested.ResultsThe self‐management scale includes four dimensions, including self‐management consciousness, pregnancy management, blood glucose management and resource utilization, with a total of 35 items. In the scale, the Cronbach's α was 0.95. The split‐half reliability of the overall scale is 0.79. And the test‐retest reliability was 0.91. The content validity was 0.94.ConclusionsThe scale is significantly valid and reliable, and it can be used to evaluate the self‐management ability of pregnant woman with GDM in China.

Comprehensive Management of Gestational Diabetes Mellitus in China

Comprehensive Management of Gestational Diabetes Mellitus in China

Prevalence, Prevention, and Lifestyle Intervention of Gestational Diabetes Mellitus in China.

Gestational diabetes mellitus (GDM) has become an epidemic and has caused a tremendous healthy and economic burden in China, especially after the “two-child policy” put into effect on October 2015. The prevalence of GDM has continued to increase during the past few decades and is likely to see a further rise in the future. The public health impact of GDM is becoming more apparent in China and it might lead to the development of chronic non-communicable diseases in the long-term for both mothers and their children. Early identification of high-risk individuals could help to take preventive and intervention measures to reduce the risk of GDM and adverse perinatal outcomes. Therefore, a focus on prevention and intervention of GDM in China is of great importance. Lifestyle interventions, including dietary and physical exercise intervention, are effective and first-line preventive strategies for GDM prevention and intervention. The GDM One-day Care Clinic established in 2011, which educates GDM patients on the basic knowledge of GDM, dietary intervention, physical exercise, weight management, and blood glucose self-monitoring methods, sets a good model for group management of GDM and has been implemented throughout the hospitals as well as maternal and child health centers in China. The current review focus on the prevalence, risk factors, as well as prevention and lifestyle intervention of GDM in China for better understanding of the latest epidemiology of GDM in China and help to improve maternal and neonatal pregnancy outcomes and promote long-term health for women with GDM.

Economic burden of IADPSG gestational diabetes diagnostic criteria in China: propensity score matching analysis from a 7-year retrospective cohort

IntroductionThe International Association of Diabetes and Pregnancy Study Group (IADPSG) criteria for gestational diabetes mellitus (GDM) increased the morbidity significantly, but the cost and effectiveness of its application are still...

Barriers and facilitators of self-monitoring of blood glucose engagement among women with gestational diabetes mellitus in China: A mixed-methods study

BackgroundSelf-monitoring of blood glucose (SMBG) is a crucial tool for maintaining glycemic control in women with gestational diabetes mellitus (GDM). However, to date, little is known about the current status of SMBG engagement among women with GDM in China. ObjectiveTo describe the current status of SMBG engagement among women with GDM in China and identify its barriers and facilitators. Design and settingA mixed-methods design was conducted, comprising a cross-sectional survey and semi-structured interviews. The research data were collected in two tertiary hospitals in Hunan province, China. ParticipantsA total of 323 women with GDM completed the survey from March 2018 to October 2018, and 11 of them participated in the interviews. FindingIn total, 35.6% of the participants actively engaged in SMBG. The participants who had an advanced maternal age (95% CI 0.253–0.947), did not own glucose meters (95% CI 0.054–0.364), did not receive SMBG-related information from health professionals (95% CI 0.232–.987), or received less SMBG information in general (95% CI 0.137–0.52) were less likely to engage in SMBG. Insufficient SMBG information and low awareness of SMBG were also summarized as the main barriers in the interview findings. Facilitators of SMBG engagement included SMBG-related social support (95% CI 1.573–6.135) and health concerns related to themselves and the unborn infant. ConclusionAbout one-third of Chinese women with GDM engaged in SMBG. An accurate and complete description of how SMBG should be performed is needed from health professionals. Strategies to obtain more SMBG-related social support and a greater emphasis on health concerns are recommended to increase SMBG engagement among women with GDM in China.

A genome-wide association study of gestational diabetes mellitus in Chinese women

Background Recently, gestational diabetes mellitus (GDM) exhibits an obvious trend of increase in pregnant mothers and usually causes several abnormities or diseases for the offspring. Although several studies have been reported for potential molecular mechanisms, relevant genes or mutated sites have not been intensively investigated in China. Materials and methods In the present study, 218 pregnant mothers (GDM group: 103 individuals and control group: 115 individuals) in China were enrolled to conduct genome-wide association study (GWAS) and pathway analyses for the purpose of related genes associated with GDM in China. Results Our results identified 23 SNPs exhibiting closely association with GDM using multiple tests. Annotation of these 23 SNPs identified four genes (SYNPR, CDH18, CTIF, and PTGIS), which suggests that the four genes may associate with GDM. GO enrichment and KEGG pathway analysis showed that gene SYNPR, CDH18, and PTGIS were enriched or located into the pathways or process associated with glycometabolism (e.g. insulin resistance and glucose tolerance), which further indicates that the three genes may associate with the GDM. Conclusion The identification of these potential genes associating with GDM enriched the potential molecular mechanisms of GDM in Asia and will provide abundant stocks for subsequent clinical verifications for better understanding the molecular mechanisms, diagnosis, drug development and clinical treatment of GDM.

Diagnosis of Gestational Diabetes Mellitus in China: Perspective, Progress and Prospects

Abstract Gestational diabetes mellitus (GDM) is one of the most common complications during pregnancy. Despite extensive research in the past 50 years, the universal approach to diagnose GDM continues to be debated around the world and clinical practices vary from country to country and unit to unit within the same country. As new evidence emerges, the diagnostic criteria of GDM has continuously evolved since the 1990s. In 2011, after the announcement of the landmark International Association of Diabetes and Pregnancy Study Groups diagnostic criteria, many international organizations have accepted and advocated its use. However, there are differences in glucose metabolism among different ethnic groups, and the Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) Study lacked data from mainland China. Whether the criteria developed based on the HAPO study are applicable to China remains to be further validated. In this current review, we will discuss the evolution of GDM diagnostic criteria and guidelines in China, and compare them to that in western countries to figure out the proper recommendations on the diagnosis of GDM among Chinese women.

Passive smoking at home increased the risk of gestational diabetes mellitus in China

Active smoking during pregnancy may increase the risk of gestational diabetes mellitus (GDM), but little is known about the potential association between passive smoking and risk of GDM. The present study investigated the association between passive smoking at home and/or in the workplace and risk of GDM among non-smoking Chinese women. A population-based study including 995 pregnant women taking antenatal care from December 2015 to May 2016 was conducted. Screening was carried out after 24 gestational weeks, during which women were offered a 75-g 2-h oral glucose tolerance test (OGTT). Basic information and self-reported passive smoking were collected by a questionnaire. Passive smoking was classified as passive smoking at home, passive smoking in the workplace, or passive smoking at home and in the workplace. They were further classified by time period, total exposure time, and amount. Logistic regression was used to estimate both crude and adjusted odds ratios (ORs) and 95% confidence intervals (CIs). The prevalence of passive smoking was 78.3%. Compared with women who were non-exposed to passive smoking, a passive smoker has an increased risk of GDM with an adjusted OR (95% CI) of 1.60 (1.09, 2.33). In addition, there was a strong association between passive smoking exposure at home and GDM (adjusted OR 1.59; 95% CI 1.13, 2.24), and significant dose–response relationships in total exposure time and amount of passive smoking at home were observed. However, there is no obvious evidence for the link between passive smoking in the workplace and GDM risk (adjusted OR 1.25; 95% CI 0.87, 1.80). Passive smoking at home was associated with an increased risk of GDM among non-smoking Chinese women. These findings emphasize the importance of preventing passive smoking, especially at home.

Gestational weight gain targets during the second and third trimesters of pregnancy for women with gestational diabetes mellitus in China

Background/objectivesGestational weight gain (GWG) recommendations for pregnant women with gestational diabetes mellitus (GDM) in China are lacking. The present study aims to examine whether specific GWG targets for women with GDM can improve pregnancy outcomes in comparison with GWG according to the Institute of Medicine (IOM) targets.Subjects/methodsPregnant women diagnosed with GDM were selected from a retrospective cohort study of 8299 singleton pregnant women aged 18–45 years in 2012 (n = 1820). GWG ranges were calculated using a receiver operating characteristic (ROC) curve analysis (ROC targets) and the interquartile range (IR) method (the range from the 25th to 75th percentiles of the GWG among GDM women without adverse pregnancy outcomes, IR targets).ResultsThe incidences of small for gestational age (SGA) births and pregnancy hypertension among women with GDM who gained weight within the ROC targets were lower than the incidences in women who gained weight within the IOM targets (SGA, 7.5% vs. 8.6%; pregnancy hypertension, 12.6% vs. 14.1%; both P < 0.05). GWG was associated with a risk of adverse pregnancy outcomes in the total sample (estimated values ranged from −2.95 to 2.08, all P < 0.05). No statistically significant associations between GWG and adverse pregnancy outcomes were observed in subgroups of pregnant women with appropriate GWGs according to the ROC, IR, and IOM targets. The ROC targets exhibited higher negative predictive values for adverse pregnancy outcomes than the IR and IOM targets.ConclusionThe ROC targets improved pregnancy outcomes and thus represent potential special GWG guidelines for women with GDM in China.

Postpartum follow-up and management of gestational diabetes mellitus: comments on relevant issues in American College of Obstetricians and Gynecologists (ACOG) and America Diabetes Association (ADA) guidelines in 2018

Gestational diabetes mellitus (GDM) is defined as carbohydrate intolerance of variable severity with onset or first recognition during pregnancy. Short- and long-term effects of GDM on both mother and child depend on the severity of the condition and blood sugar level. Currently, relatively standardized guidance on management of GDM in China has greatly improved maternal and infant outcomes. Moreover, standardized postpartum management and monitoring are also essential for the prevention of long-term complications in this population. The guidelines issued by America Diabetes Association (ADA) and American College of Obstetricians and Gynecologists (ACOG) in 2018 recommended that GDM patients should be followed up at 4-12 weeks postpartum for a 75 g oral glucose tolerance test. For those who is normal at the first postpartum follow up, it is necessary to have their blood glucose tested once every 1-3 years. However, for those who is abnormal, medication should also be initiated when necessary in addition to more frequent follow-ups and nutritional intervention and physical exercise. Key words: Diabetes, gestational; Postpartum period; Follow-up studies; Patient care management

Exposure to Air Pollutants and Variation of Blood Glucose Level among Gestational Diabetes Mellitus in China: A Retrospective Cohort Study

Background: Air pollution has been reported to be associated with risk of type 2 diabetes, but few studies were available for the associations with blood glucose level in pregnant women.Objectives: We aimed to examine the effects of exposure to air pollution on blood glucose in GDM patients in a retrospective cohort study.Methods: We identified GDM cases from hospital records among 35,722 women who were pregnant from January 2013 to May 2017.We used generalized additional models to estimate adverse effects of air pollution on fasting blood glucose and OGTT among GDM patients.Results: We identified a total of 1,347 women with GDM. An IQR increase in NO2 exposure during the second trimester was associated with an increment of fasting blood glucose (FBG) level by 0.42mmol/L. Significant associations were observed among women with younger age (&amp;#946;&amp;#61;0.55, p&amp;lt;0.05 for CO), overweight/obesity (&amp;#946;&amp;#61;0.52, p&amp;lt;0.05 for NO2, &amp;#946;&amp;#61;0.70, p&amp;lt;0.05 for CO), lower education (&amp;#946;&amp;#61;1.08, p&amp;lt;0.05 for NO2，&amp;#946;&amp;#61;0.83 for CO), and among manual labor(&amp;#946;&amp;#61;1.12, p&amp;lt;0.05 for NO2) and housewife(&amp;#946;&amp;#61;1.46, p&amp;lt;0.05 for CO). Our estimates for air pollutants (NO2 and CO) and OGTT were generally consistent with the corresponding &amp;#946; values for FBG. No evidence was observed for the association between particle matter, SO2 and Particle Matter exposure and FBG/OGTT level in our study.Conclusions: In the present study, women were at increased risk for higher blood glucose level when exposure to higher residential NO2 and CO during their pregnancy. Women with higher BMI, lower education level were more susceptible to the adverse effects of ambient air pollution.

Development and prospect of research on gestational diabetes mellitus in China

Development and prospect of research on gestational diabetes mellitus in China