Gestational Diabetes Mellitus Mothers Research Articles

Hypertrophic Cardiomyopathy Risk Factors in Infants of diabetic mothers

Abstract Background Diabetes mellitus (DM) is a systemic chronic metabolic disorder characterized by increased insulin resistance and/or β- cell defects. Maternal DM significantly affects the fetal heart and fetal–placental circulation in both structure and function. Cardiac defects, myocardial hypertrophy are three times more prevalent in infants of diabetic mothers (IDMs). Objective Assess the frequency of hypertrophic cardiomyopathy (HCM) among infants of diabetic mothers and its relationship to the maternal glycemic control and the birth weight for the gestational age. Patients and Methods This was a cross-sectional study conducted on (50) neonates with gestational age ≥ 35 weeks born to diabetic mothers recruited from the delivery room and Neonatal Observation Unit, Obstetrics and Gynecology Hospital, Ain shams university. Detailed history was taken for the duration of maternal diabetes, glycemic control and any associated complications and the level of hemoglobin A1C (HbA1C) was assessed for all the enrolled mothers. Neonates were subjected to full clinical examination and echocardiographic evaluation in the first week of life. Results Forty % of mothers had gestational diabetes mellitus (GDM), (20%) were pre-gestational diabetes type 1 and 40% were pre-GDM type 2. There were 18 infants (36%) had HCM. HCM was highly statistically significant (p-value < 0.001) more in cases with high maternal HbA1C (8.3 ± 0.9). The frequency of HCM among infants of pre-GDM mothers (15 patients, 50%) was significantly higher (p-value = 0.012) when compared to infants of GDM mothers (3 patients, 15%). But the frequency of HCM was equal in infants of pre-GDM type I mothers and those of pre-GDM type 2 mothers. HCM was more common with large for gestational age (LGA) infants (10 cases 55.6% of infants with HCM were LGA). Conclusion HCM is more frequent among infants of mothers with pre-GDM type 1 than infants of GDM. Poor maternal glycemic control and large for gestational age are associated with higher frequency of HCM among those infants.

Maternal gestational diabetes mellitus associates with altered gut microbiome composition and head circumference abnormalities in male offspring

The impact of gestational diabetes mellitus (GDM) on maternal or infant microbiome trajectory remains poorly understood. Utilizing large-scale longitudinal fecal samples from 264 mother-baby dyads, we present the gut microbiome trajectory of the mothers throughout pregnancy and infants during the first year of life. GDM mothers had a distinct microbiome diversity and composition during the gestation period. GDM leaves fingerprints on the infant's gut microbiome, which are confounded by delivery mode. Further, Clostridium species positively correlate with a larger head circumference at month 12 in male offspring but not females. The gut microbiome of GDM mothers with male fetuses displays depleted gut-brain modules, including acetate synthesis I and degradation and glutamate synthesis II. The gut microbiome of female infants of GDM mothers has higher histamine degradation and dopamine degradation. Together, our integrative analysis indicates that GDM affects maternal and infant gut composition, which is associated with sexually dimorphic infant head growth.

IJCM_52A: Profile and outcome of gestational diabetes mellitus in a tertiary care teaching hospital

Background: Gestational Diabetes Mellitus (GDM) is a Glucose tolerance disorder first diagnosed during pregnancy. WHO recommend that all pregnant women or at least women with predisposing risk factors should be screened at the beginning of the 3rd trimester of pregnancy with the Oral Glucose Tolerance Test (OGTT). Here, blood glucose level is screened 2hrs after giving a 75g oral glucose load. This is recommended for both screening and diagnosis. Not many studies have been done regarding the outcome of GDM mothers in India. Objective: 1. To describe the Obstetric profile of the mothers 2. To assess the outcome of GDM among the Mothers 3. To determine the neonatal outcome of GDM. Methodology: Study setting: The study was carried out at Kasturba Medical College Hospital, Attavar, and District Lady Goschen Hospital, Mangalore. Study design: Hospital based retrospective study. Study population: Pregnant women admitted to above mentioned hospitals with GDM and the new born. Inclusion criteria: All women diagnosed with GDM and have delivered in District Lady Goschen Hospital or KMCH Attavar. Sample size was 266. Results: Our study concluded that 24.8% of the women with GDM also had Pregnancy Induced Hypertension, which is comparable to the study done in Qatar where they found 19.2% of the women with GDM suffered from PIH. We also found that 15.8% of the women suffered from Pre-Eclampsia, over twice the percentage of people surveyed in the Qatari study. However the amount of babies suffering from Macrosomia was only 6.8% as opposed to 10.3% according to the aforementioned study and 19.3% as was found in a study in Poznan, Poland. Conclusion: No significant association was found between obstetric profile and antenatal & postpartum complications.

Vitamin D Combined with Exercise During Pregnancy Promotes Neonatal Health in Gestational Diabetes Mellitus Mothers

Vitamin D Combined with Exercise During Pregnancy Promotes Neonatal Health in Gestational Diabetes Mellitus Mothers

Metabolic Profile of Offspring of Mothers with Gestational Diabetes Mellitus.

Gestational diabetes mellitus (GDM) is defined as diabetes diagnosed in the second or third trimester of pregnancy that was not clearly overt diabetes before gestation. Unrecognized and untreated GDM confers significantly greater maternal and fetal risk, which is largely related to the degree of hyperglycemia. The specific risks of diabetes in pregnancy include but are not limited to, spontaneous abortion, pre-eclampsia, fetal anomalies, macrosomia, neonatal hypoglycemia, hyperbilirubinemia, and respiratory distress syndrome. Additionally, GDM is also implicated in long-term metabolic derangements in the offspring in the form of obesity/overweight, hypertension, dysglycemia, insulin resistance, and dyslipidemias later in life. To determine the prevalence of anthropometric and metabolic derangements in children between 1 and 5 years of age, born to women with GDM. This hospital-based cross-sectional study was conducted between November 2019 and November 2021 at our Pediatric Endocrine Clinic. Women were diagnosed as having GDM based on the American Diabetes Association Criteria (2019). History regarding the treatment of the GDM (diet only/diet and medical treatment) and detailed physical examination, including anthropometry and blood pressure, were recorded. Blood samples were collected from children for the estimation of their metabolic profile. Overweight, obesity, and severe obesity were present in 18 (11.3%), 2 (1.3%), and 2 (1.3%) children, respectively. Hypertension was found in 21 (19.4%) children. Elevated LDL, triglyceride, and total cholesterol were seen in 3 (1.9%), 84 (52.5%), and 1 (0.6%) children, respectively. Impaired fasting glucose (IFG) was found in 6 (3.8%) children, while 27 (16.9%) subjects were found to be having impaired glucose tolerance after OGTT. Insulin resistance was found in 30 (18.8%) children. GDM mothers with a higher BMI tended to have children with a higher BMI (correlation coefficient, r = .414, P < .001). Higher serum triglyceride levels (r = -0.034, P = 0.672) were recorded in children, irrespective of the BMI of their mothers. There was no significant correlation of maternal BMI with blood pressure (r = -0.134, P = 0.091) or with HOMA-IR (r = 0.00, P = 0.996) in children. However, mothers with a higher BMI had children with statistically higher fasting blood glucose (r = +0.339, P = <0.001) as well as blood glucose 2 hours after OGTT (r = +0.297, P = <0.001). This positive correlation of maternal BMI with the glucose metabolism of their offspring was observed for both male and female genders. Children of women with GDM had a higher BMI, and the mode of treatment for GDM did not lead to differences in childhood BMI. The higher BMI of a GDM mother is associated with altered glucose metabolism in their offspring. Deranged levels of triglyceride across the gender were not found to be statistically significant. This has implications for future metabolic and cardiovascular risks in targeting this group for intervention studies to prevent obesity and disorders of glucose metabolism as one potential strategy to prevent adverse metabolic health outcomes.

IMPACT OF GESTATIONAL DIABETES MELLITUS ON HEMATOLOGICAL PARAMETERS, LIVER FUNCTION, RENAL FUNCTION, AND LIPID PROFILE IN ANTENATAL WOMEN AT A TERTIARY CARE HOSPITAL

Objective: Gestational diabetes mellitus (GDM) is a condition in which glucose intolerance is first recognized during pregnancy. It affects a substantial percentage of pregnancies globally, with a significant prevalence in India. Iron supplementation is often recommended to prevent anemia, but caution is advised in GDM due to the potential inflammatory effects. Elevated hemoglobin (Hb) levels, associated with excess iron, may increase the risk of GDM. This study aims to investigate the differences in Hb and various other blood parameters between controlled and uncontrolled GDM mothers attending antenatal OPD for a regular check-up. Methods: This cross-sectional study was conducted among 100 women diagnosed with GDM at a tertiary care hospital in Western Tamil Nadu after obtaining ethical clearance and informed consent from the participants. Routine blood investigations, like a complete hemogram, HbA1C, renal and liver function tests, and lipid profiles, were recorded. Participants were categorized based on HbA1C values (&lt;6.5 as normal, &gt;6.5 as abnormal). Differences in blood parameters between the two groups were statistically analyzed. Results: The study found no significant differences in age, weight, height, or BMI between the controlled and uncontrolled GDM groups. Mean HbA1c levels were 5.58±0.41 and 6.98±1.23 in controlled and uncontrolled GDM groups, respectively. Comparing hematological parameters, the controlled GDM group exhibited higher mean red blood cell (RBC) levels (4.6±0.69 vs. 4.12±0.92) but lower Hb levels (12.25±2.26 vs. 11.01±3.59) than the uncontrolled GDM group. There were no significant differences in platelet, lymphocyte, and MCH levels. Urea, triglycerides, and globulin levels were higher in the uncontrolled GDM group, but all values remained within normal limits. Conclusion: Elevated Hb levels were associated with uncontrolled GDM, indicating a potential risk factor. The study underscores the importance of monitoring iron levels in GDM patients. In addition, heightened white blood cell counts and altered hematological parameters suggest an inflammatory component in uncontrolled GDM. Further research is warranted to explore these associations and their clinical implications for managing GDM effectively.

Clinical profile and risk factors of symptomatic and asymptomatic hypoglycemia in neonates admitted to NICU in a tertiary care center: A cross-sectional study

Objective: To investigate the clinical profile and risk factors of symptomatic and asymptomatic hypoglycemia in neonates admitted to a neonatal intensive care unit in a tertiary care center. Methods: The prospective observational study was conducted in a tertiary care center in the Specialty Department of Pediatric. 196 Newborn babies with blood glucose levels &lt; 45 mg/dL were examined with a simple random sampling method between December 2019 and November 2021. Maternal and neonatal risk factors and clinical signs were recorded and compared between symptomatic and asymptomatic cases. Results: The proportion of symptomatic hypoglycemia neonates bom to gestational diabetes mellitus mothers was significantly higher (23.4% vs. 8.4%)(P&lt;0.05). Small for gestational age, low birth weight, respiratory distress syndrome, hypothermia, and endocrine disorders were risk factors. The death rate in asymptomatic hypoglycemia neonates was significantly higher (58% vs. 39%) (P&lt;0.05). Conclusions: The study indicates that maternal gestational diabetes mellitus is associated with symptomatic hypoglycemia and asymptomatic hypoglycemia is associated with neonatal mortality. It is important to take vigilance and timely interventions to address associated symptoms, particularly poor feeding, in the management of neonatal hypoglycemia.

Maternal overweight and obesity and its association with metabolic changes and fetal overgrowth in the absence of gestational diabetes mellitus: A prospective cohort study.

Previous studies indicated an association between fetal overgrowth and maternal obesity independent of gestational diabetes mellitus (GDM). However, the underlying mechanisms beyond this possible association are not completely understood. This study investigates metabolic changes and their association with fetal and neonatal biometry in overweight and obese mothers who remained normal glucose-tolerant during gestation. In this prospective cohort study 893 women who did not develop GDM were categorized according to their pregestational body mass index (BMI): 570 were normal weight, 220 overweight and 103 obese. Study participants received a broad metabolic evaluation before 16 weeks and were followed up until delivery to assess glucose levels during the oral glucose tolerance test (OGTT) at mid-gestation as well as fetal biometry in ultrasound and pregnancy outcome data. Increased maternal BMI was associated with an adverse metabolic profile at the beginning of pregnancy, including a lower degree of insulin sensitivity (as assessed by the quantitative insulin sensitivity check index) in overweight (mean difference: -2.4, 95% CI -2.9 to -1.9, p < 0.001) and obese (mean difference: -4.3, 95% CI -5.0 to -3.7, p < 0.001) vs normal weight women. Despite not fulfilling diagnosis criteria for GDM, overweight and obese mothers showed higher glucose levels at fasting and during the OGTT. Finally, we observed increased measures of fetal subcutaneous tissue thickness in ultrasound as well as higher proportions of large-for-gestational-age infants in overweight (18.9%, odds ratio [OR] 1.74, 95% CI 1.08-2.78, p = 0.021) and obese mothers (21.0%, OR 1.99, 95% CI 1.06-3.59, p = 0.027) vs normal weight controls (11.8%). The risk for large for gestational age was further determined by OGTT glucose (60 min: OR 1.11, 95% CI 1.02-1.21, p = 0.013; 120 min: OR 1.13, 95% CI 1.02-1.27, P = 0.025, for the increase of 10 mg/dL) and maternal triglyceride concentrations (OR 1.11, 95% CI 1.01-1.22, p = 0.036, for the increase of 20 mg/dL). Mothers affected by overweight or obesity but not GDM had a higher risk for fetal overgrowth. An impaired metabolic milieu related to increased maternal BMI as well as higher glucose levels at mid-gestation may impact fetal overgrowth in women still in the range of normal glucose tolerance.

Systematic review and bibliometric analysis of the metabolome found in human breast milk from healthy and gestational diabetes mellitus mothers

Systematic review and bibliometric analysis of the metabolome found in human breast milk from healthy and gestational diabetes mellitus mothers

Lipid profile in women of different ethnicity with gestational diabetes: Relationship with fetal growth.

Pregnancy complicated by gestational diabetes mellitus (GDM) is characterized by excessive insulin resistance that impairs the metabolism of glucose and lipids. the aim of the study was to examine lipid profiles during pregnancy of women with GDM, and its impact on fetal growth in a multiethnic population. The study included 322 pregnant women of different ethnicity with GDM attending a clinical unit specializing in metabolic diseases. The area under the curve for the 75-g oral glucose tolerance test and glycated hemoglobin were significantly different among all groups. At the time of being diagnosed with GDM, Asian and African mothers had significantly lower levels of total and low-density liprotein cholesterol than European mothers (P < 0.001). The trend for high-density liprotein cholesterol was similar. Triglycerides levels in the Asian group (193.6 ± 65.5 mg/dL) were higher than in the African group (133.2 ± 49.6 mg/dL, P < 0.001), whereas the European group presented intermediate values (175.8 ± 58.8 mg/dL), which differed significantly only versus the African group (P < 0.001). Pre-partum lipid profiles showed a trend quite similar to that observed at diagnosis. The newborn's birthweight was significantly different, with that of African women (3,437 ± 503 g) being the highest, followed by that of European women (3,294 ± 455 g) and of Asian women (3,006 ± 513 g). The rates of macrosomia showed a trend with higher values in the African group (13.5%), followed by the European group (5.7%, P = 0.1162), whereas that of the Asian group was zero (P = 0.0023 vs African). Our data show that lipid profiles in women with GDM differ by ethnicity. The impact of lipid profile on fetal growth is limited and uninfluenced by ethnicity.

A comparative study of short-term post caesarean section complications in normal versus gestational diabetic mothers

Background: There are variegated complications following caesarean section that may compel the mothers to stay longer in hospital with sufferings or to carry a long period of morbidity at home. Unfortunately, these complications are more in gestational diabetes mellitus (GDM). This study was designed to compare post-operative complications following caesarean sections in normal and GDM Mothers. Methods: This study was conducted in the Department of Obstetrics and Gynecology, 250 bedded general hospital, Naogaon, Bangladesh, from January 2022 to June 2023. In this study 74 participants were included consecutively. Among these, 37 mothers had GDM and 37 had normal pregnancies as control. After caesarean section, data regarding sociodemographic, obstetric and surgical profile were recorded and analyzed. Results: The mean age of the participants in GDM group was 31.32±5.56 years and in normal pregnant group was 29.24±5.56 years. Post-operative pain were almost same in both groups. Mean time of PO mobilization was 25.2 hours in GDM group and 20.2 hours in normal group. 16 patients in GDM group had PO complications and 6 in normal mothers. Among the complications SSI and UTI were more common in GDM group. No mortality was recorded. Average hospital stay were 5.9 days and 4.9 days in GDM and normal patients. Conclusions: Some post-operative complications are more common in GDM mothers. So, good glycemic control, appropriate surgical technique and proper post-operative care are needed to reduce post-operative morbidity and hospital stay.

A comparison study of maternal and perinatal outcomes with gestational diabetes mellitus, impaired glucose tolerance, and normal glucose tolerance

Gestational diabetes mellitus (GDM) and impaired glucose tolerance (IGT), which are growing health concerns globally, are the most common metabolic and endocrine perinatal issues. It is a contentious entity with competing policies and procedures. Most physicians in the United States employ a two-step procedure, starting with a 50-g non-fasting oral glucose challenge test at 24 to 28 weeks and moving on to a 100-g fasting test for women who receive a positive screening result. Instead, doctors use the Diabetes in Pregnancy Study Group India (DIPSI) technique and conduct just a 75-g, two-hour fasting oral glucose tolerance test. The prospective observational study was approved by the hospital's institutional ethics committee and was conducted from April 2020 to September 2021 at the department of obstetrics and gynecology at Stanley Medical College Hospital in Chennai, Tamil Nadu, India. The patients were chosen in accordance with the inclusion criteria, which called for first-trimester pregnant women without diabetes mellitus. Both oral and written consent were also obtained. DIPSI performed the screening. The WHO standards have been updated to be a one-step process with a single glycemic value. According to the results of this study, GDM is linked to harmful consequences that might affect both the mother and the foetus. The short- and long-term consequences in both the mother and the newborn can be greatly reduced with early detection and timely therapy of this illness. In this study, birth weights ranging from 2.5 to 3.5 kg were the same for GDM and IGT moms. IGT mothers should also be followed up on, and we should be more watchful at birth, even though we monitor GDM mothers.

Impaired Angiogenic Function of Fetal Endothelial Progenitor Cells via PCDH10 in Gestational Diabetes Mellitus.

Maternal hyperglycemia, induced by gestational diabetes mellitus (GDM), has detrimental effects on fetal vascular development, ultimately increasing the risk of cardiovascular diseases in offspring. The potential underlying mechanisms through which these complications occur are due to functional impairment and epigenetic changes in fetal endothelial progenitor cells (EPCs), which remain less defined. We confirm that intrauterine hyperglycemia leads to the impaired angiogenic function of fetal EPCs, as observed through functional assays of outgrowth endothelial cells (OECs) derived from fetal EPCs of GDM pregnancies (GDM-EPCs). Notably, PCDH10 expression is increased in OECs derived from GDM-EPCs, which is associated with the inhibition of angiogenic function in fetal EPCs. Additionally, increased PCDH10 expression is correlated with the hypomethylation of the PCDH10 promoter. Our findings demonstrate that in utero exposure to GDM can induce angiogenic dysfunction in fetal EPCs through altered gene expression and epigenetic changes, consequently increasing the susceptibility to cardiovascular diseases in the offspring of GDM mothers.

Galectin-10 Expression in Placentas of Women with Gestational Diabetes.

Galectins are known to play an important role in immunoregulatory processes and autoimmune diseases. Galectin-10 is a cytoplasmic protein of human eosinophils and is involved in various eosinophilic diseases. Since increased galectin expression is already detected in the placentas of mothers with gestational diabetes mellitus (GDM), this study focuses on the specific role of galectin-10 and hints at consequences for the diagnosis and therapeutic options of GDM. It is hypothesized that the difference in galectin-10 expression will raise the pathophysiological understanding of gestational diabetes. The study population consists of 80 women: 40 healthy mothers and 40 women suffering from gestational diabetes mellitus. The expression of galectin-10 was analyzed in the syncytiotrophoblast (SCT) and the decidua of the placenta via immunohistochemistry and immunofluorescence double staining. The immunoreactivity score (IRS) was used for evaluation. The results in this study were significant for an overexpression of galectin-10 in GDM placentas compared with the control group. The syncytiotrophoblast showed overexpression in the nucleus and the cytoplasm, whereas expression of galectin-10 in the decidua was significant in the cytoplasm only. This study identified the expression changes in galectin-10 in placental tissue between healthy and GDM mothers and intensified the understanding of gestational diabetes. Assuming that gestational diabetes mellitus is involved in inflammatory processes, galectin-10 might play a role in the development and maintenance of GDM. Further investigation is required to strengthen these findings.

THU307 Landscapes Of MaternalAnd Neonatal Bacterial And Metabolic SignaturesAnd Their Interaction In Gestational Diabetes Mellitus

Abstract Disclosure: L. Ding: None. J. Liu: None. X. Zhai: None. X. Xiao: None. Background: Gestational diabetes mellitus (GDM) is strongly correlated with considerable risks to both the mother and the developing fetus. Although evidence indicates an association between the altered gut microbiota and GDM, the microbial and metabolic mechanisms that link the metabolic state between mothers and offspring are unknown. This study aims to characterize the maternal and neonatal bacterial and metabolic signatures and their interaction in gestational diabetes mellitus. Methods: Sixty-six mothers (39 women with GDM and 27 normal pregnant women) and eighty-nine newborns (44 from GDM mothers and 45 from normal mothers) were included in this study. Using 16S rRNA gene sequencing and untargeted metabolomic methods, we determined the gut microbiota and serum metabolomics both for mothers and newborns. Results: We found that the microbial and metabolic signatures of GDM mothers and newborns were significantly different from those of the Control group (Ctr), respectively. Intriguingly, we identified 14 genera (Phyllobacterium, etc.) that exhibited identical alterations in mothers and newborns between groups. Among the overlapped differential metabolites in mothers and newborns, 23 (Glutamyl-methionine, etc.) showed consistent alterations between groups, while 19 (Cyclotetradecane, etc.) metabolites exhibited opposite alterations. Metabolic KEGG pathway analysis revealed that 6 pathways, including fatty acid metabolism, sphingolipid metabolism, TCA cycle, transsulfuration pathway, bile acid metabolism, and carnitine metabolism were both enriched in mothers and newborns. Significantly, correlation analysis revealed the notable association between pyroglutamic acid and maternal glucose level in Ctr group was disrupted in GDM group (Ctr: r = -0.46, p = 0.02; GDM: r = 0.04, p = 0.82). Simultaneously, pyroglutamic acid was significantly correlated with neonate serum high-density lipoprotein cholesterol level, which was disrupted in newborns of GDM mothers (Ctr: r = 0.33, p = 0.03; GDM: r = -0.05, p = 0.80). Conclusion: Altogether, we demonstrated that GDM could consistently alter the microbiota and serum metabolome in mothers and newborns, which is significantly associated with their metabolic state respectively. These findings indicate that serum metabolites serve as promising targets to intervene in metabolic transmission in GDM, which needs further validation. Presentation: Thursday, June 15, 2023

Women with gestational diabetes mellitus, controlled for plasma glucose level, exhibit maternal and fetal dyslipidaemia that may warrant treatment

AimsTo compare maternal and fetal cord plasma and lipoprotein triglyceride (TG) concentrations in women with Gestational Diabetes Mellitus (GDM), with hyperglycaemia and hypertriglyceridaemia, and healthy women. MethodsFasted maternal blood at 28.6 ± 3.4 (T1) and 36.2 ± 1.0 (T2) [mean ± S.D] weeks of gestation, and cord blood were collected. Plasma lipoprotein fractions underwent compositional analysis. ResultsPlasma glucose did not differ between GDM and healthy women. T1 maternal plasma TG (2.60 ± 0.89 mmol/l versus 1.71 ± 0.69 mmol/l) and plasma apolipoprotein B (1.30 ± 0.48 g/l versus 0.75 ± 0.40 g/l) were higher in GDM compared to healthy. Maternal plasma TG increased over gestation in both groups. T1 plasma VLDL total protein (38 ± 15 mg/dl versus 25 ± 11 mg/dl), total cholesterol (TC) (30 ± 14 mg/dl versus 16 ± 13 mg/dl) and phospholipid (PL) (43 ± 17 mg/dl versus 26 ± 16 mg/dl) were higher in GDM than healthy, and similarly for IDL, suggesting increased lipoprotein particle number. T1 VLDL-TG enrichment was higher in healthy and increased over gestation in GDM women but decreased in healthy. IDL-TG enrichment (TG/TC) increased over gestation in women with GDM and decreased in healthy. Cord blood VLDL, IDL and LDL from GDM had a two-fold higher TG enrichment than healthy pregnancy. ConclusionIncreased maternal lipoprotein number, but not TG enrichment, in GDM mothers may explain TG enrichment of cord lipoproteins.

Comparison of Anthropometric Measurements of Infants Born to Bahraini Mothers with and Without Gestational Diabetes Mellitus (GDM)

Gestational Diabetes Mellitus is a major cause of morbidity and mortality to both mother and fetus. It is defined as the development of hyperglycemia during pregnancy in women who were not previously diagnosed with Diabetes Mellitus (DM) (1). Diagnosis usually occurs during the 24th to 28th weeks of gestation (1). The prevalence of GDM varies worldwide and was reported to be in Bahrain in 2012 at 10.1% of pregnancies, which was increased from 7.2% in 2002 (6). For this study, a total sample of 10,865 patients was used, dating from May 2016 to January 2020. The sample size is set in King Hamad University Hospital (KHUH), Kingdom of Bahrain. They were chosen based on inclusion and exclusion criteria. The data collected included the GDM status of the mother (GDM or Non-GDM), gestational age of the fetus (weeks), birth weight (grams) of the fetus, length (centimeters) of the fetus, head circumference (centimeters) of the fetus and placental weight (grams) upon delivery. In our study, the results showed an increase in anthropometric measurements in infants born to GDM mothers. 10 out of 200 (5%) neonates had a macrocosmic birth weight in GDM infants. However, when comparing to the birth weight, p= 0.940 was found, showing a non-significant difference between both groups. There was a faster acceleration in head circumference in neonates born to mothers with GDM, and there was no significant difference in average head circumference between both groups. Moreover, 153 out of 200 (76%) of the GDM group had a placental weight of more than 500 grams, whereas 179 out of 200 (89.5%) of the non-GDM group had a placental weight of more than 500 grams. GDM is a common yet serious complication encountered throughout pregnancy, most commonly via routine screening. One of the commonly observed outcomes of GDM in pregnancy is increased fetal growth through various mechanisms, which can result in an increased risk of neonatal morbidity and mortality. This study helps to reaffirm that routine screening of GDM is required, and perhaps placental weight is another factor to be taken into consideration after further study as an indicator of fetal growth and GDM progression.

FACTORS ASSOCIATED WITH BREASTFEEDING INTENTION AMONG GESTATIONAL DIABETES MELLITUS MOTHERS

Breastfeeding knowledge, self-efficacy, attitude and breastfeeding intention affect breastfeeding rates, especially in mothers with Gestational Diabetes Mellitus (GDM) who are associated with having poor breastfeeding outcomes. Therefore, this study is aimed to investigate whether breastfeeding knowledge, attitude, self-efficacy, and sociodemographic factors are associated with breastfeeding intention among GDM pregnant mothers attending health clinics in Selangor. Validated questionnaires including Breastfeeding Self-Efficacy Scale Short Form (BSES-SF), Knowledge and Attitude, Breastfeeding Questionnaire (KA-BFQ), and Infant Feeding Intention (IFI) were self-administered to assess maternal knowledge, attitude, self-efficacy, and intention towards breastfeeding. Pearson’s Chi Square and independent t-test were used to investigate factors associated with breastfeeding intention among GDM mothers. Multiple linear regression was executed to explore determinants of breastfeeding intention among the studied population. A total of 124 pregnant women with GDM visiting chosen public health clinics in Selangor were recruited for this study. Findings revealed the scores (Mean ± SD) for breastfeeding knowledge 25.66 ± 8.736, breastfeeding attitude 81 ± 11.5, and breastfeeding self-efficacy 48.5 ± 12. About 84.7% (n = 105) had the intention to breastfeed with a mean score of 11 ± 5.25. Further analysis depicted significant associations between breastfeeding intention with a family history of diabetes (AOR = 3.551, 95% CI: 1.127 to 11.185, p-value = 0.030) and breastfeeding knowledge (AOR = 1.107, 95% CI: 1.036 to 1.182, p-value = 0.003). This study concluded that mothers with GDM had fair breastfeeding knowledge, good attitude, high self-efficacy, and high intention in breastfeeding. These findings highlight the need to develop culture-specific interventions in improving breastfeeding knowledge particularly to enhance breastfeeding intention among GDM mothers.

Study of Risk Factors and Foeto-maternal Outcome of Gestational Diabetes Mellitus

Introduction: Gestational diabetes mellitus (GDM) is a common pregnancy complication with complex disease mechanism. Several risk factors may contribute to its onset. Based on recent evidence up-to 15% of all pregnancies may be affected by GDM. Untreated GDM is a severe threat to maternal and neonatal health Objectives: To determine the risk factors and foeto- maternal outcome of GDM. Methods: This prospective observational study was conducted on patients who were admitted in Obstetrics &amp; Gynaecology department of CMH, Bogura from June 2020 to May 2021 with the diagnosis of GDM. Data were collected from the patients as well as from the antenatal records in a preformed questionnaire and risk factors and outcomes measured. Results: A total of 679 patients were admitted during the period of 1 year from June 2020 to May 2021. Among them 50 patients were admitted with GDM. The prevalence of GDM was 7.36%. GDM risks were higher in women aged between 25-29 years and in those with maternal overweight and obesity (58%). Newborns of GDM mother had an increased risk of hypoglycemia (10%), macrosomia (20%), respiratory distress syndrome (8 %) and 42% required NICU admission. Most of the patients (92%) needed cesarean section. Conclusion: Pre-pregnancy BMI and family history of diabetes in first degree relatives and high parity were the predominant risk factor of GDM in this study. GDM patients are of increase risk of delivery by cesarean section, preterm birth, Newborns of GDM mother are at risk of RDS (Respiratory distress syndrome), macrosomia and neonatal hypoglycemia. JAFMC Bangladesh. Vol 18, No 2 (December) 2022: 46-50

Comparison Between Maternal Blood Glucose and Fetal Cord Insulin Level Among Gestational Diabetes Mellitus Women

Introduction: Offspring of gestational diabetes mellitus (GDM) mothers are at high risk of developing insulin resistance, type 2 diabetes mellitus (T2 DM), and cardiovascular complications later in life. So, screening maternal blood glucose during pregnancy and identifying high-risk infants immediately after birth is necessary to prevent the potential long-term implications. Aim: To correlate the maternal fasting and post-prandial blood glucose withfetal insulin level. Materials and methods:A case-control study, was conducted at Chettinad Hospital and Research Institute, India, between May 2019 to May 2020. A 75-gram OGTT was performed among pregnant women between 24 to 28 weeks of pregnancy for diagnosing GDM according to American Diabetes Association (ADA) guidelines. 94 GDM mothers and Non-GDM mothers and theirnew-bornswere taken up for this study. 2.5ml of maternal venous blood was collected in a vacutainer containing sodium fluoride and EDTA as an anticoagulant for FBS and PPBS estimation. Some mothers on induction of labor were posted for emergency LSCS (for failed induction and non - progression of labor) and some had normal vaginal deliveries. Plasma FBS and PPBS estimation in the mother’s blood sample was assayed by the Hexokinase method in Siemen'sDimension RxLMachine immediately after centrifugation. 2.5ml of umbilical cord blood was collected in a vacutainer without an anticoagulant after the 2nd stage of labor. 0.5 ml of cord blood serum was separated and stored at -80°C in an eppendorf for later estimation of insulin by CLIA method in Beckman Coulter – Access 2 Immunoassay System. Independent students’ t-tests and Pearson’s correlation were used as statistical methods. p-value &lt;0.05 is considered significant. Results: There is a positive correlation and significant difference between maternal FBS, PPBS, and fetal insulin levels in the GDM group (p-value 0.008, r-value 0.272 and p-value 0.005, r-value 0.286) compared to the Non-GDM group (p-value -0.087, r-value 0.243 and p-value 0.018, r-value 0.212). Conclusion: Significant hyperinsulinemia was noted in the offspring of the GDM group compared to the NON-GDM group.Those hyper-insulinemic babies are at very high risk of developing obesity, metabolic syndrome, and type 2 DM in the future and possess a threat to society.