Gestational Diabetes Research Articles (Page 1)

Antenatal corticosteroids (ACS) can improve the outcomes of preterm infants and have been widely adopted as the standard practice in managing pregnancies at high risk of preterm delivery between 22+0 and 33+6 weeks. Due to their significant benefit for the majority of pregnant women, several guidelines also state that maternal diabetes is not a contraindication for the use of ACS. However, no such evidence has been obtained from diabetic pregnancies. The Chinese Neonatal Network (CHNN), a national multicenter cohort study, recruited 31,915 very preterm infants (VPIs) from 79 NICUs. The outcomes were mortality and morbidity in hospital. Logistic regression models were employed to calculate the odds ratios (ORs) and its 95% confidence intervals (CIs) to estimate the associations between ACS and these outcomes. Stratification and sensitivity analyses were conducted to test the robustness of the results in different population. A total of 4337 VPIs born to diabetic mothers enrolled in the present study: 3605 VPIs were exposed to ACS and 732 were not. ACS was associated with a lower risk in the combined outcome (death or any severe morbidity) (adjusted OR [aOR] 0.66, 95% CI 0.54-0.79), in-hospital death (aOR 0.55, 95% CI 0.41-0.73), severe bronchopulmonary dysplasia (BPD, aOR 0.69, 95% CI 0.55-0.85), low Apgar score (aOR 0.76, 95% CI 0.61-0.96), respiratory distress syndrome (RDS, aOR 0.79, 95% CI 0.66-0.94), or the need for invasive ventilation (aOR 0.62, 95% CI 0.52-0.73). However, a significantly higher risk of maternal chorioamnionitis (aOR 2.09, 95% CI 1.61-2.72) was observed in the ACS group. Similar results were observed in stratification and sensitivity analyses. Conclusions:In VPIs of diabetic mothers, ACS exposure was associated with lower mortality and reduced risks of BPD, low Apgar score, RDS, and invasive ventilation, but with higher odds of maternal chorioamnionitis. What is Known: • Antenatal corticosteroids (ACS) are standard care for reducing neonatal morbidity and mortality in pregnancies at high risk of preterm birth between 22+0 and 33+6 weeks. • However, recommendations for ACS use in pregnant women with diabetes at risk of preterm delivery remain inconsistent due to limited evidence. What is New: • This large, national multicenter cohort study provides the first specific evidence that ACS administration in diabetic pregnancies is associated with significantly lower risks of neonatal mortality, bronchopulmonary dysplasia, respiratory distress syndrome, and the need for invasive ventilation. • Our findings support the benefit of ACS in this understudied population, demonstrating a favorable risk-benefit profile.

Monitoring maternal and fetal health during pregnancy is crucial for preventing adverse outcomes. While tests such as ultrasound scans offer high accuracy, they can be costly and inconvenient. Telehealth solutions and more accessible body shape information provide pregnant women with a convenient way to monitor their health. This study explores the potential of 3D body scan data, captured during the 18-24 gestational weeks, to predict adverse pregnancy outcomes and estimate clinical parameters. We developed a novel algorithm with two parallel streams which are used for extract body shape features: one for supervised learning to extract sequential abdominal level circumference information, and the other for unsupervised learning to extract global shape descriptors, alongside a branch incorporating shape-related demographic data. Our results demonstrated that 3D body shapes can support the prediction of preterm labor and gestational diabetes mellitus (GDM), as well as the estimation of fetal weight. Compared to other machine learning models, our algorithm achieved the best performance, with prediction accuracies exceeding 89% and fetal weight estimation accuracy of 72.22% within a 10% error margin, outperforming the conventional anthropometric measurements-based method by 18.18%.

This study aimed to investigate how pre-meal whey protein (WP) supplementation throughout the third trimester of pregnancy affects glycaemic and metabolic outcomes in women with gestational diabetes mellitus (GDM). The hypothesis was that WP, when administered as a pre-meal 30 min before breakfast daily, lowers glycaemic variability (primary outcome: CV%). In a double-blinded, randomised, placebo-controlled, parallel trial, 62 women with GDM were randomised to receive 20 g WP isolate/day or placebo 30 min before breakfast throughout the third trimester. Participants were randomly assigned ( www.randomiser.org ) to WP or placebo using a computer-generated list. Allocation was concealed with sealed strips. Participants, caregivers, investigators and outcome assessors were masked, except the dietitian providing dietary guidance. Eligibility criteria included GDM, normotension and age ≥18 years. Exclusion criteria included special dietary regimens ≥1 month, daily protein supplements, food allergies, glucose-metabolism-affecting drugs, twin pregnancies, polycystic ovary syndrome, severe comorbidity, hyperemesis or non-breakfast eaters. The study included laboratory visits, home-based measurements under controlled-living and free-living conditions during the early and late third trimester, and follow-up at delivery. Glucose levels were assessed using continuous glucose monitoring. A total of 29 women were randomised to placebo and 33 were randomised to WP, with 25 in the placebo group and 30 women in the WP group completing the study. In the WP group, the 1 h postprandial glucose following breakfast was -20% (95% CI -28%, -11%) lower in the early and -15% (95% CI -24%, -5%) lower in the late third trimester compared with the placebo group under controlled conditions. Similarly, the 1 h postprandial glucose was -14% (95% CI -23%, -4%) lower in the early and -8% (95% CI -18%, 3%) lower in the late third trimester under free-living conditions. Glycaemic variability was lower in the WP group under controlled-living conditions. The mean amplitude of glycaemic excursions (MAGE) was lower during both the early and late third trimester, and the SD and CV% were lower during the early third trimester (all p<0.05). Time in range (proportion of time spent with glucose levels 3.5-7.8 mmol/l) was lower during free-living in the late third trimester (p=0.05). Pre-meal WP improves glycaemic management and reduces glucose variability in women with GDM under controlled-living and free-living conditions. Future research should evaluate whether WP can delay or prevent pharmacological treatments such as insulin initiation. ClinicalTrials.gov NCT04767880 FUNDING: Department of Clinical Medicine, Aarhus University and Arla Foods Ingredients Group P/S (Agr-2020-731-12107).

Gestational diabetes mellitus is commonly observed in pregnant women and is associated with an increased risk of adverse outcomes for both mother and child, not only during pregnancy but also in the long term thereafter. The present study aimed to develop a predictive nomogram for gestational diabetes mellitus in pregnant women. This multicenter prospective cohort study enrolled 1,398 pregnant women from five major obstetric hospitals in Vietnam's Mekong Delta. GDM was diagnosed based on the 2017 American Diabetes Association criteria. Using Bayesian Model Averaging, the optimal prediction model was identified in the primary cohort (n = 978) and used to construct a nomogram for individualized risk estimation. Model performance was validated in an independent cohort (n = 420), with assessment of discrimination (AUC), calibration (Brier score), and clinical utility (decision curve analysis). The prevalence of GDM was 18.0% (95%CI: 16.0-20.1). The final model included maternal age (OR per year: 1.09; 95%CI: 1.06-1.13), history of macrosomia (OR: 6.04; 95%CI: 2.76-13.19), body mass index (OR per kg/m²: 1.62; 95%CI: 1.25-2.10), and weight gain during pregnancy (OR per kg: 1.12; 95%CI: 1.06-1.18). The model demonstrated good discriminative ability and calibration in the primary cohort (AUC = 0.74, 95%CI: 0.69-0.78; Brier score = 0.123), and acceptable performance in the validation cohort (AUC = 0.70; 95%CI: 0.63-0.77; Brier score = 0.139). The nomogram showed good calibration and yielded higher net benefit across a wide range of risk thresholds (0.1-0.4) in decision curve analysis, indicating strong clinical utility. A nomogram incorporating four routinely assessed clinical parameters offers good predictive accuracy for gestational diabetes mellitus. This model may facilitate early identification and targeted intervention for high-risk pregnant women in both resource-limited and clinical settings.

Background: Obesity is a common comorbidity among women of childbearing age. With increasing obesity, more females are considering bariatric surgery (BS) as a form of weight loss. The effect of successful bariatric surgery (sBS) on maternal cardiovascular outcomes remains to be elucidated. Methods: Patients were extracted from the National Inpatient Sample database. We mainly stratified patients into two groups-BS candidates and sBS. We matched patients by age, race, and cardiovascular risk factors using propensity-score matching. The primary outcome was a composite and defined as major adverse cardiovascular events (MACE). Secondary outcomes included preeclampsia, gestational diabetes, and extended length of hospital stay (eLOS). The study also evaluated two other groups of interest-patients that had BS with outcomes other than success (oBS) and any patient with a history of BS. Results: Of 5,892 patients with BS, 2,966 patients had sBS. 115,490 patients were BS candidates. BS candidate patients had increased MACE relative to sBS patients. Additionally, they had higher rates of preeclampsia, gestational diabetes, and eLOS relative to BS candidate patients, even after matching. oBS patients also had decreased rates of MACE, heart failure, preeclampsia, gestational diabetes, and eLOS compared with BS candidates after matching. Lastly, to further demonstrate the beneficial effects of BS, patients with a history of BS had similar outcomes, including improved MACE, compared with patients without BS. Conclusion: sBS was associated with a reduction in MACE. The significant reduction in MACE highlights the importance of considering BS as an option if conventional weight loss measures fail.

Preterm birth is a major adverse perinatal outcome and may act as a mediator linking maternal disease to impaired infant growth and neurodevelopment. However, the mediating role of preterm birth has not been well explored in relation to maternal diseases. This study aimed to investigate whether preterm birth mediates the association between maternal diseases and infant outcomes including Body Mass Index, the Neonatal Behavioral Neurological Assessment, and the Gesell Development Schedule. This study recruited a total of 2000 mother-child pairs from the Pediatric Healthcare Centre at the Third Xiangya Hospital. Maternal diseases, including gestational diabetes mellitus, pregnancy-induced hypertension, anaemia, hypothyroidism, hyperthyroidism, and thrombocytopenia, were assessed through hospital records and parental questionnaires verified against medical records. Infant outcomes were evaluated by trained pediatric nurses blinded to maternal conditions, using anthropometric measurements (Body Mass Index) and standardized neurodevelopmental tools (Neonatal Behavioral Neurological Assessment and Gesell Development Schedule). Mediation analysis with 1,000-sample bootstrapping was applied to quantify the indirect effects of preterm birth. Preterm birth significantly mediated the association between Pregnancy-Induced Hypertension and Neonatal Behavioral Neurological Assessment (Indirect effect = -0.653, 95% CI: -0.98 - -0.36, p < 0.001). Preterm birth also significantly mediated the relationship between Gestational Diabetes Mellitus and Body Mass Index (Indirect effect = - 0.046, 95% CI: -0.08 - -0.01, p = 0.01). Preterm birth may act as a mediator between maternal diseases and infant growth and neurodevelopmental outcomes. The results support the feasibility and value of using mediation analysis in maternal-infant research. Findings highlight the importance of early prenatal screening, prevention, and management of preterm birth in pregnancies complicated by maternal disease. Future research is warranted to employ longitudinal neurodevelopmental monitoring in affected infants.

STUDY AIMS: A history of gestational diabetes mellitus is a known risk factor for developing type 2 diabetes in the future. Therefore, screening for persistent dysglycaemia in the postpartum period is of utmost importance. However, follow-up rates tend to be low. The aim of this study was to investigate postpartum screening adherence at a tertiary care centre and to identify factors contributing to persistent dysglycaemia. METHODS: A cohort of women with gestational diabetes mellitus diagnosed between 2015 and 2018 at the department of Obstetrics and Gynaecology, University Hospital Bern, Switzerland, was retrospectively studied. Ethnicity, parity, pre-pregnancy BMI, family history of diabetes mellitus, first trimester glycosylated haemoglobin (HbA1c), 75 g oral glucose tolerance test during pregnancy and in the postpartum period were analysed. Postpartum dysglycaemia was defined as overt diabetes (fasting plasma glucose ≥7.0 mmol/l and/or 2 hours plasma glucose ≥11.1 mmol/l for the 75 g oral glucose tolerance test), impaired glucose tolerance (2 hours plasma glucose 7.8–11.0 mmol/l) or impaired fasting glucose (plasma glucose 5.6–6.9 mmol/l). Parametric and non-parametric tests as well as multivariate regression were used. ROC analyses were performed to assess the prognostic accuracy of HbA1c and oral glucose tolerance test results at predicting postpartum dysglycaemia. RESULTS: We included 489 women with gestational diabetes mellitus in our study. Of these, 217 (44.4%) returned for postpartum testing and 59/217 (27.2%) had an abnormal oral glucose tolerance test. Ethnicity was found to be a factor in adherence to follow-up. Specifically, women of African origin showed a significantly higher compliance than Asian or Caucasian women (61.8% vs 47.8% vs 34.5%, respectively; p = 0.04). The multivariate analysis revealed that obesity (OR: 3.64, 95% CI: 1.41–9.37) and first trimester HbA1c &gt;5.7% (OR: 3.67, 95% CI: 1.28–10.52) are significantly associated with an increased risk of postpartum dysglycaemia. CONCLUSION: Our study indicates that adherence to postpartum screening after gestational diabetes mellitus is low but in line with the existing experience. This is of particular concern as 1 of 4 women undergoing postpartum screening show some sort of disturbed glucose metabolism. In particular, women with higher first trimester HbA1c and/or obesity may warrant closer observation and motivation for testing as the risk for persistent metabolic disorders is increased.

To compare obstetric and perinatal outcomes between assisted reproductive technologies (ART)-conceived and spontaneously conceived twin pregnancies using a nationwide Korean cohort. This retrospective cohort study used Korean National Health Insurance Service data from October 2017 to December 2021. Twin pregnancies were identified via International Statistical Classification of Diseases and Related Health Problems, 10th revision codes and classified by conception type based on embryo transfer procedure codes. Outcomes included miscarriage, preeclampsia, placenta previa, gestational diabetes mellitus (GDM), emergency cesarean section (CS), intrauterine growth restriction (IUGR), and macrosomia. Multivariable logistic regression was used to calculate adjusted odds ratios (aOR), controlling for maternal age and comorbidities. Subgroup analyses stratified by maternal age were also performed. Among 36,013 twin pregnancies, those conceived via ART exhibited significantly higher risks of obstetric complications, including placenta previa (aOR, 1.81; 95% confidence interval [CI], 1.57-2.08), preeclampsia (aOR, 1.31; 95% CI, 1.17-1.47), GDM (aOR, 1.32; 95% CI, 1.22-1.43), emergency CS (aOR, 1.21; 95% CI, 1.08-1.34), and IUGR (aOR, 1.18; 95% CI, 1.07-1.31). In age-stratified analyses, the risks were more pronounced in women aged ≥35 years (preeclampsia: aOR, 1.38; 95% CI, 1.19-1.61; emergency CS: aOR, 1.22; 95% CI, 1.06-1.42) compared with those aged <35 years (preeclampsia: aOR, 1.26; 95% CI, 1.05-1.50; emergency CS: aOR, 1.17; 95% CI, 1.00-1.37). Twin pregnancies conceived via ART are associated with significantly increased risks of obstetric and perinatal complications compared with spontaneous conceptions. Given the growing utilization of ART, these findings underscore the importance of individualized prenatal care and vigilant perinatal monitoring in ART-conceived twin pregnancies, particularly among women of advanced maternal age.

Objectives: Gestational diabetes mellitus (GDM), particularly when combined with overweight or obesity, is associated with adverse neonatal outcomes such as high birth weight and increased adiposity. We determined the effect of a preconception lifestyle intervention initiated before and continued throughout pregnancy on neonatal, birth-related, and body composition outcomes at birth and 6–8 weeks of age in children of participants in the BEFORE THE BEGINNING randomized controlled trial. Methods: People (N = 167) at increased risk of GDM and planning pregnancy were randomly allocated 1:1 to intervention or control. The intervention included time-restricted eating and exercise training. Time-restricted eating involved consuming all energy within ≤10 h/day, ≥5 days per week, and the amount of exercise was set using a heart rate-based physical activity metric (Personal Activity Intelligence, PAI), with the goal of ≥100 weekly PAI points. The main outcome of interest in this report was the proportion of infants with birth weight &gt; 4.0 kg. Results: Among 106 live births, 21% (11/53) of infants in the intervention group and 28% (15/53) in the control group had birth weight &gt; 4 kg (p = 0.367). Mean birth weight did not differ significantly between groups (mean difference −159.3 g, 95% confidence interval −375.7 to 57.2, p = 0.148). No significant between-group differences were found for additional neonatal, birth-related, or early postnatal body composition outcomes. Conclusions: In this secondary analysis, we found no evidence of effects of a preconception lifestyle intervention on the risk of macrosomia or neonatal body composition.

Establishment of an accurate prediction system for gestational diabetes mellitus based on the characteristics of metabolic kinetics in early pregnancy: a prospective two-center cohort study in population according to IOM criteria.

Excess gestational weight gain (GWG) occurs in up to 70% of women who birth. Excess GWG increases the risk of adverse outcomes in both mother and baby including gestational diabetes, pre-eclampsia, postpartum weight retention, large for gestational age babies, and adiposity among children. Antenatal lifestyle interventions can limit excess GWG. However, successful translation of interventions into routine antenatal care are seldom, and interventions involving midwives are uncommon. Following a successful feasibility study, the main aims of this study are to determine if the Delivering Optimal weighT gain advice in pregnancy (DOT) intervention is acceptable to midwives, acceptable and accessible to pregnant women, leads to improved pregnancy outcomes and reduces health inequities for Māori. This is a mixed-methods case study in Te Tai Tokerau (Northland), Aotearoa New Zealand where 37.4% of the total, and half the birthing population are Māori. Independent Lead Maternity Carer midwives (15-20) will be trained to deliver the DOT intervention to 150-200 pregnant women aged ≥ 18 years. Women with pre-existing health conditions requiring specialist obstetric or dietetic care identified at the first antenatal visit will be excluded. The DOT intervention is goal-based and utilises the Starting the Conversation: Diet questionnaire. It is delivered over three visits, the first before 15 weeks gestation then 3-4 weekly. Routinely recorded clinical data including self-reported ethnicity, gravidity and parity, estimated date of delivery, anthropometry, blood pressure, antenatal blood tests, date and mode of delivery and infant birth weight will be collated. Costs associated with intervention delivery will be identified. The primary outcome measures are recruitment and retention. The secondary outcome measures are the cost of intervention delivery, rate of GWG, and birth weight. The acceptability of, and accessibility to, the intervention (enablers and barriers) will be explored qualitatively. Quantitative variables will be summarised using standard statistical methods. The rate of GWG will be described using linear mixed effect models. Qualitative data will be analysed thematically. A key goal of this research is to improve the repeatedly documented poor and inequitable health outcomes for Māori. A case study, unlike a RCT, will enable the context of the study to be considered. ACTRN12623001228673 with the Australian New Zealand Clinical Trials Registry: 29 November 2023.

Gestational diabetes mellitus (GDM) is associated with increased risk of developing type 2 diabetes and cardiovascular disease (CVD). Here we explore whether the associations are mediated by development of type 2 diabetes and other CVD risk factors. The Exploring Long-term Outcomes following PrEgnancy affected by GDM (ELOPE-GDM) study is a population-based matched cohort study, containing 43 572 records of women diagnosed with GDM matched with 174 288 records of non-GDM women. We used Cox proportional hazards models to assess the risk of GDM on CVD, ischemic heart disease (IHD) and stroke/TIA and quantified the proportions of these effects mediated by the progression to type 2 diabetes, hypertension or dyslipidaemia using causal mediation analysis. There were significant associations between GDM and CVD; (adjusted HR 1.58 (95% CI 1.27-1.97)), IHD (1.83 (1.35-2.49)) and stroke/TIA (1.43 (1.06-1.95)). There were strong associations between GDM and developing type 2 diabetes (OR 13.90 (95% CI 13.19-14.51)), hypertension (1.87 (1.781-1.92)), dyslipidaemia (1.80 (1.76-1.84)) or any of these postpartum mediators (1.67 (1.63-1.71)). However, most of the effect of GDM on CVD was not attributed to the overall mediating effects of type 2 diabetes (36% (95% CI 8%-64%)), hypertension (15% (5%-24%)), dyslipidaemia (37% (18%-55%)) or a combination of these conditions (32% (11%-53%)) which developed after pregnancy. These findings emphasise the need for comprehensive cardio metabolic screening following a pregnancy affected by GDM.

Mesenchymal stem cells (MSCs) derived from the placenta, fetal membranes, or umbilical cord may be used to study the pathophysiology of gestational diabetes mellitus (GDM). The phenotype of MSCs may reflect fetal programming in response to the maternal milieu of a GDM pregnancy. Altered fetal programming is linked to high rates of obesity and type 2 diabetes mellitus (T2DM) in the offspring of mothers with GDM. This review discusses recent findings characterizing the phenotype of GDM-exposed MSCs (GDM-MSCs) which enhance our understanding of the mechanisms of fetal programming. It also considers how MSCs may be used as markers of long-term offspring health to test the benefit of putative interventions and highlights the need for further translational studies to clearly link the MSC phenotype to clinical parameters and interventions.

Gestational diabetes has been associated with risk of neurodevelopmental disorders (NDD). An improved understanding of this association can inform prevention strategies and elucidate underlying mechanisms. To determine associations between prenatal glucose intolerance and NDD and examine differences by gestational timing and child sex. This population-based case-control study examined data from electronic health records from mother-child pairs in an integrated health system in northern California. Children born January 1, 2011, to December 31, 2018, and their mothers were eligible; children were followed up for outcomes through 2023. Data were analyzed from February 2024 to March 2025. Gestational diabetes was determined from routine prenatal test results and categorized as diagnosed early (less than 24 weeks), standard (24 to 28 weeks), or late (more than 28 weeks) in gestation. Prenatal subclinical impaired glucose tolerance (IGT) was defined by elevated glucose screening tests and neither GDM diagnosis nor treatment. Autism spectrum disorder (ASD) and developmental delay were determined from medical records. Adjusted odds ratios (aOR) for associations between prenatal exposures and NDD were estimated using multivariable logistic regression models, adjusted for child sex, birth year, maternal age, race and ethnicity, education, parity, gestational age at prenatal care entry, and prepregnancy body mass index. Effect modification was evaluated by GDM diagnosis timing and sex. A total of 4546 mother-child pairs (median [IQR]) age of diagnosis: ASD, 3.0 [2.0-5.0] years; developmental delay, 2.0 [1.0-3.0] years; 2697 male children [59.3%]) were included in the study, of which 403 mothers (8.9%) had GDM and 64 (1.4%) had IGT; 683 children [15.0%] had ASD, 2054 [45.2%] had developmental delay, and 1809 [39.8%] were controls. GDM was not associated with increased odds of ASD (aOR, 1.15 [95% CI, 0.83-1.60]) or developmental delay (aOR, 1.24 [95% CI, 0.98-1.57]) overall. In sex-stratified analyses, GDM was associated with increased odds of ASD only among females (females: aOR, 2.05 [95% CI, 1.15-3.56]; males: aOR, 0.93 [95% CI, 0.62-1.37]; P for interaction = .04). When assessed by timing, early GDM was associated with increased odds of ASD among females (aOR, 3.23 [95% CI, 1.11-8.91]) but not among males (aOR, 0.78 [95% CI, 0.38-1.56]; P for interaction = .02). There were no associations between standard or late GDM and ASD in either sex. Prenatal IGT was associated with increased odds of developmental delay among females only (females: aOR, 3.25 [95% CI, 1.34-8.68]; males: aOR, 1.07 [95% CI, 0.50-2.39]; P for interaction = .08). In this case-control study, GDM was associated with NDD in a gestational timing- and sex-specific manner. IGT associations with NDD were also sex-specific, adding to a body of research demonstrating influences of prenatal IGT on child outcomes.

Introduction: Molar incisor hypomineralization (MIH) is a type of enamel defect of the first molars and incisors in the permanent dentition affecting one in eight children worldwide. The results of the analysis s of publications on the topic of fetal MRG programming reveled the need for a more detailed study of the causes of its occurrence, depending on the influence of antenatal and perinatal factors. The data were collected from two electronic databases, PubMed and e-library.ru, using key words, inclusion- and exclusion criteria with no time limits. The selection process consisted of two stages. Initially, publications were screened based on their titles and abstracts to determine their relevance to the review. Secondly, the authors thoroughly examined the full text of the articles. Any discrepancies were resolved through group discussions among the authors until a consensus was reached. Of the initially identified 157 studies, 29 were included in the qualitative synthesis. The findings revealed several antenatal factors associated with MIH. These factors include anemia during pregnancy, complications of the third trimester, gestational diabetes, viral diseases, three ultrasound examinations in the third trimester, preeclampsia, alcohol consumption, psychological stress, etc. In addition, several intranatal factors were found to be linked to MIH. These factors include hypoxia at birth, prolonged labor, premature labor, low birth weight, labor induction, complications during childbirth, Caesarean section, etc. The current evidence suggests that a wide range of antenatal and perinatal factors are associated with MIH. High quality research with sufficient sample size and sound data analysis is warranted to strengthen the evidence that could be used for development of population-level prevention strategies.

Climate change is a growing threat to human health, particularly in regions facing overlapping environmental hazards and social inequities. Puerto Rico-a U.S. territory with a colonial history-offers a unique case for examining how multiple disasters, including Hurricane Maria, ongoing earthquakes, and the COVID-19 pandemic, interact with structural vulnerabilities to affect maternal and child health. Despite increasing attention to climate-related health outcomes, little is known about the reproductive health impacts of cumulative disaster exposure in colonial contexts. We used U.S. National Vital Statistics System data (2017-2021) to assess associations between disaster exposure and six maternal and newborn outcomes: preterm birth, low birthweight, term low birthweight, gestational hypertension, gestational diabetes, and excessive weight gain. Disaster exposure was defined based on the timing of hurricanes and the pandemic, using a three-month lag period. We analyzed data from Puerto Rico and used Florida and Texas as comparison sites. Multivariable log-binomial regression models estimated adjusted prevalence ratios. Effect modification was tested for (1) region within Puerto Rico and (2) colonial status, comparing Puerto Rico (territory) to Florida and Texas (states). Simulations were conducted to account for potential live-birth bias. Across 104,560 births in Puerto Rico, disaster periods were consistently associated with worse maternal health outcomes. For example, during the late post-hurricane period, gestational diabetes increased (RR = 1.19, 95% CI: 1.08, 1.31), while term low birthweight surprisingly appeared to decline (RR = 0.90, 95% CI: 0.83, 0.98). Associations with newborn health were mixed and may have been underestimated due to sharp declines in live births after disasters. Simulations suggested stronger disaster-related risks than observed in primary analyses. Effect modification by region and colonial status showed inconsistent but notable differences, particularly elevated maternal health risks in certain regions of Puerto Rico and compared to U.S. states. Our findings suggest that multiple disasters negatively affect reproductive health in Puerto Rico and that structural factors, including colonialism, may exacerbate these impacts. Public health responses must account for cumulative disaster exposure and systemic inequities to better support maternal and child health in marginalized settings, especially as climate change continues to intensify.

Background/Objectives: Canada’s Food Guide 2019 includes advice such as “Cook more often” and “Eat meals with others”, which are considered healthy eating practices. However, mothers with a history of gestational diabetes mellitus (GDM) may face specific barriers to adopting healthy eating practices. This study aimed to compare eating practices between mothers with (GDM+) and without (GDM−) a history of GDM, and to explore the associations between eating practices, diet quality, and the anthropometric and cardiometabolic profile of these mothers. Methods: The cross-sectional study was conducted in Quebec (Canada) between 2012 and 2017. Eating practices were assessed using a self-administered questionnaire. Diet quality was evaluated by the Healthy Eating Food Index 2019 through a validated food frequency questionnaire. Weight, height, and waist circumference were measured, and body composition was obtained by absorptiometry. Results: Data from 105 GDM+ and 38 GDM− mothers were analyzed (mean age 37.5 years ± 4.9). GDM+ mothers were more likely to prepare a greater proportion of dinners (≥1 per week) using pre-prepared or processed foods than GDM− mothers (49.0% vs. 34.2%; p = 0.016). Among GDM+ mothers, those who prepared ≥1 dinners per week using pre-prepared or processed foods showed lower adherence to the “Whole-grain foods” (1.1 ± 0.8 vs. 1.9 ± 1.2; p = 0.002) and “Sodium” (4.9 ± 2.0 vs. 5.8 ± 2.0, p = 0.013) recommendations, had a higher percentage of total body fat (37.5% ± 7.6 vs. 34.0% ± 7.7; p = 0.041), a higher waist circumference (91.6 cm ± 13.9 vs. 87.1 cm ± 16.3; p = 0.030), and a higher glycated hemoglobin (5.6% ± 0.5 vs. 5.5% ± 0.3; p = 0.025) than those who used less pre-prepared or processed foods. Conclusions: GDM+ mothers were more likely than GDM− mothers to prepare dinners using pre-prepared or processed foods, an eating practice associated with less favorable components of diet quality and some altered anthropometric and cardiometabolic variables. Further investigation into the factors influencing cooking from scratch within this population is warranted.

Background: Diabetes during pregnancy is a major risk factor for congenital heart disease (CHD), particularly septal defects and ventricular hypertrophy. Hemoglobin A1c (HbA1c) and the Oral Glucose Tolerance Test are screening measures used to diagnose and control diabetes in pregnancy. This retrospective study compares gestational and pre-gestational diabetes and CHD outcomes, the effects of glycemic control, diabetic treatment, and other maternal factors. Methods: Medical records of 217 infant-mother dyads from 2020-2024 were analyzed. Maternal HbA1C levels from the first and second trimesters were recorded. Fetal and postnatal echocardiograms were reviewed to identify CHD. An abnormal postnatal echocardiogram during the first three months of life was deemed to have CHD. Data was analyzed using descriptive statistics, logistic regression, and an ROC was calculated on HbA1C for the predictive value on CHD. Results: CHD was diagnosed in 21.7% of infants. Mean gestational age was 36 weeks 5 days (24-41 weeks) and mean maternal age was 32.6 years (18-45 years). Mean birth weight was 3096 grams (640-5465 grams). CHD was more common in those with pre-gestational diabetes than gestational diabetes 26.4% vs 15.6%; p = 0.055. The most frequent CHDs were atrial septal defect (44.7%), patent ductus arteriosus (36%), left ventricular hypertrophy (27.6%), and ventricular septal defect (22.3%). Among mothers, the classes of diabetes were type 2 diabetes (45%), gestational diabetes (44%), prediabetes (8.8%) and type 1 diabetes (2.3%). Logistic regression analysis showed that higher first-trimester HbA1c levels was significantly associated with an increased odd of CHD; OR 1.42 (CI: 1.10–1.86); p = 0.009. Second-trimester HbA1c levels were not significantly associated with CHD; p &gt; 0.05. A decreasing trend in HbA1c and gestational age was significant for CHD, OR 0.81 (CI: 0.68-0.95); p = 0.012. The ROC curve for HbA1c resulted with an AUC of 0.67 (CI: 0.53-0.81); p = 0.015. Conclusion: Poor first-trimester glycemic control is significantly associated with an increased odds of CHD in infants born to diabetic mothers including gestational diabetes. Increasing gestational age and decreasing HbA1c trends are protective factors, emphasizing the importance of early pregnancy diabetes management. HbA1c levels are moderately predictive of CHD.

Introduction/Background: Gestational diabetes mellitus (GDM) is the most common metabolic complication during pregnancy. It increases the risk for endothelial dysfunction, hypertension and cardiovascular diseases in the mother and the child in later life. Endothelin-1 (ET-1) is a potent vasoconstrictor that promotes endothelial dysfunction and contributes to cardiovascular diseases. Research Question/Hypothesis: We hypothesise that ET-1 is a key mediator of fetal endothelial dysfunction in GDM. Methods/Approach: We obtained maternal and fetal vessels from human placentas of patients with insulin-treated GDM (iGDM) (n=10), diet-treated GDM (dGDM) (n=8) and normoglycemic controls (n=30). Groups were defined by oral glucose tolerance test and clinical data of mothers and newborns. Vascular function of fetal arteries was analyzed in a Mulvany Myograph. Fetal placental arteries from patients of all groups were incubated with the selective endothelin receptor A antagonist BQ123 and the selective endothelin receptor B antagonist BQ788. The impact of ET-1 on vascular function was studied in a concentration-dependent manner. Gene expression was quantified by real-time PCR in fetal vessels of the cotyledon base and maternal spiral arteries. ET-1 peptide levels in the venous fetal placental serum were quantified with a human ET-1 ELISA. Results/Data: ET-1-mediated vasoconstriction was shown in fetal placental arteries from the chorionic base in all study groups. At higher concentrations, ET-1-mediated vasoconstriction was significantly lower in patients with iGDM compared to normoglycemic controls. No differences in mRNA expression of pre-pro ET-1 gene (EDN1), endothelin-converting enzyme 1 (ECE1), endothelin receptor A (EDNRA) and endothelin receptor B (EDNRB) were found between study groups. Notably, mRNA expression of EDNRB was higher compared to EDNRA expression in fetal placental vessels of all groups. Significantly increased levels of ET-1 were detected in venous fetal placental serum in dGDM patients compared to control. The ET-1-mediated vasoconstriction was blocked by BQ123 and BQ788 in GDM patients and controls. The relative contribution of EDNRB to ET-1-mediated vasoconstriction is significantly higher in GDM patients, compared to normoglycemic controls. Conclusions: In conclusion, we could demonstrate that GDM impairs ET-1-mediated vasoconstriction in fetal placental vessels. This may contribute to the endothelial dysfunction in patients with GDM.

Background: Gestational diabetes mellitus (GDM) is the most common metabolic disorder in pregnancy and a major risk factor for endothelial dysfunction, hypertension, and future cardiovascular diseases in both mother and child. In Germany, treatment is limited to dietary management and insulin. Although metformin is widely used as first-line therapy for type 2 diabetes, it is not approved for GDM monotherapy in Germany due to limited data on fetal safety. As it improves insulin sensitivity and endothelial function and reduces oxidative stress in type 2 diabetes, metformin may have protective effects in fetal vessels with GDM. Aims/Hypothesis: We hypothesize that metformin influences fetal endothelial function and mitigates GDM-associated endothelial dysfunction. Methods and Material: Maternal and fetal placental vessels were collected from normoglycemic pregnancies (NG, n=25), insulin-treated GDM (iGDM, n=13), and diet-controlled GDM (dGDM, n=10). Clinical characteristics was recorded. Vessels were incubated for 24 hours in a normoglycemic medium with or without metformin. Endothelial function was assessed using a Mulvany myograph. Human umbilical vein endothelial cells (HUVECs) were isolated and treated with metformin (± VEGF), followed by RNA extraction and qPCR analysis. Results: iGDM patients had a significantly higher body mass index than NG and dGDM groups. Vessels from iGDM patients displayed impaired insulin-induced vasorelaxation, suggesting early endothelial dysfunction. Metformin-treated NG and iGDM vessels showed reduced contractile responses to serotonin and potassium. Insulin-mediated relaxation was significantly diminished in metformin-treated NG and iGDM vessels (p&lt;0.0001). Notably, nitric oxide synthase (NOS) inhibition with L-NAME had a stronger effect in metformin-treated NG vessels (p=0.0022), suggesting increased eNOS activity. This effect was absent in GDM vessels. In HUVECs, VEGF induced KLF2 and PGC1α expression, while co-treatment with metformin attenuated the KLF2 response. Conclusion: Metformin significantly alters vascular responses in fetal placental vessels from normoglycemic and GDM pregnancies. It did not enhance insulin-mediated vasorelaxation, but increased sensitivity to NOS inhibition suggesting higher eNOS activity in normoglycemic tissue. These findings support an impact of metformin on vascular function in fetal placental vessels with gestational diabetes mellitus.