Gestational Diabetes Pregnant Women Research Articles

Cardiovascular (reverse) remodelling induced by pregnancy: looking at the right side of the heart

Abstract Introduction Many studies have focused on pregnancy-induced left ventricular remodelling, overlooking the changes in right cardiac chambers. Purpose To characterize the right cardiovascular (CV) remodelling and reverse remodelling (RR) induced by pregnancy and postpartum, respectively, and the impact of CV risk (CVR) factors on these processes. Methods This prospective cohort was recruited at two tertiary centers from 2019 to 2022, including 51 healthy and 79 obese and/or hypertensive and/or with gestational diabetes and/or smoking habits pregnant women (cardiovascular risk [CVR] group). Women were evaluated by transthoracic echocardiography at the 1st trimester (1T) and 3rd trimester (3T) of pregnancy, as well as one-month (PP1), six-months (PP2), and one-year postpartum (PP3). Generalized linear mixed-effects models were used for the analysis of right CV remodelling and RR and to evaluate the impact of CVR factors on these processes. Results This study included 130 pregnant women, 60.8% primiparous, with a median age of 33 years. Despite all echocardiographic results being within the normality range, we describe the progression of right heart adaptations throughout pregnancy and postpartum (Table 1), namely: 1) Similar enlargement of the right atrium (RA) and right ventricle (RV) dimensions throughout pregnancy, recovering at PP2 except for RA in the CVR group; 2) Preserved RV systolic function throughout pregnancy in both groups, while the postpartum hemodynamic normalization triggers a reduction of (TAPSE) and tricuspid S' wave velocity; 3) Reduced RA strain in both groups during pregnancy, more evident in CVR group, which had a slower postpartum recovery; 4) Preserved RV global longitudinal strain (GLS) throughout follow-up time, being significantly reduced in 3T of CVR group and recovering at PP2; 5) Reduction of tricuspid E/A ratio from 1T to 3T in both groups with an early recovery at PP1, being these values significantly higher in the healthy group, and 6) Steady pulmonary artery systolic pressure (PASP) values throughout follow-up time, showing consistently higher values in the CVR group. Conclusion This study describes the subclinical right cardiac functional and structural changes within the physiological range, which recover 6 months after delivery. CVR factors impact the magnitude of the subclinical RV diastolic function changes, PASP and myocardial deformation (strain) without any impact on classic RV systolic function.

The effect of glycemic levels on Doppler indices and pregnancy outcome in pregestational and gestational diabetic pregnant women

Background Gestational diabetes mellitus (GDM) is characterized as a condition where there is a varying degree of intolerance to glucose, which occurs or is initially identified throughout pregnancy. Aim To evaluate the impact of glycemic control on Doppler indices of uterine, umbilical, and middle cerebral arteries (MCA) in pregestational and GDM women and to correlate alterations in maternal levels of glucose, glycosylated hemoglobin (HbA1c) and Doppler indices related to pregnancy outcome. Patients and methods This prospective comparative cross-sectional work was performed on 84 diabetic patients aged from 20 to 43 years old, pregnant women with singleton living fetus, at booking, gestational age (GA) 24–28 weeks gestation. The participants categorized into two groups equal: group A: Pregestational diabetes and group B: GDM. Results There was an insignificant correlation between mean HbA1c % and BMI, GA, and doppler velocimetry mean results pulsatility index (PI) of uterine artery (UtA), PI of umbilical artery (UA) and PI of MCA. Pregestational diabetic pregnant women was a significantly positive association with UtA PI. There was insignificant association with Age, UA PI, Middle cerebral artery PI, fasting blood sugar, 2 h postprandial blood sugar, HbA1c (%). Gestational Diabetic pregnant women had insignificant associations with age, UtA PI, UA PI, MSA PI, fasting blood sugar, 2 h postprandial blood sugar, HbA1c. Ultrasound findings, amniotic fluid index, weight, PI of UtA, PI of UA. Conclusion Pregestational and GDM were not correlated with irregularities in Doppler indices of uterine, umbilical, and MCA.

Anti-Tumor Necrosis Factor Therapy and the Risk of Gestational Diabetes in Pregnant Women With Inflammatory Bowel Disease.

Anti-tumor necrosis factor (anti-TNF) therapy may improve insulin sensitivity, and its impact during pregnancy remains unclear. We aimed to assess the risk of gestational diabetes mellitus (GDM) associated with anti-TNF treatment among pregnant women with inflammatory bowel disease (IBD). This nationwide cohort study included patients with IBD in Korea from 2010 to 2021. Anti-TNF exposure was identified from the last menstrual period (LMP) to LMP + 140 days. The development of GDM was assessed from LMP + 141 days to delivery. We performed overlap weighting to balance the covariates and used a generalized linear mixed model to measure the risk ratio (RR) and 95% confidence intervals (CIs). The anti-TNF group was compared with the unexposed group, as well as with the immunosuppressant, 5-aminosalicylate, and untreated groups. A total of 3,695 pregnancies in women with IBD were identified, of which 338 (9.2%) were exposed to anti-TNFs. GDM was found in 7.1% of the pregnancies exposed to anti-TNFs as compared with 11.0% of those unexposed. The crude and weighted RRs for GDM risk were 0.64 (95% CI 0.43-0.96) and 0.68 (95% CI 0.55-0.84), respectively. The weighted RR when compared with the immunosuppressant, 5-aminosalicylate, and untreated groups was 0.70 (95% CI 0.41-1.18), 0.71 (95% CI 0.52-0.95), and 0.85 (95% CI 0.59-1.24), respectively. This nationwide cohort reported a decreased risk of GDM among patients who used anti-TNFs during early pregnancy compared with those unexposed. GDM risk may become a consideration in the decision-making process when choosing treatment options for pregnant women with a risk factor for GDM.

The Relationship Between Vitamin B12 and Gestational Diabetes in Pregnant Women With and Without Gestational Diabetes Mellitus

The Relationship Between Vitamin B12 and Gestational Diabetes in Pregnant Women With and Without Gestational Diabetes Mellitus

The Effect of Vitamin D Supplementation on the Risk of Gestational Diabetes in Pregnant Women Over the Age of 18 Without a Diabetes or Gestational Diabetes Diagnosis

The Effect of Vitamin D Supplementation on the Risk of Gestational Diabetes in Pregnant Women Over the Age of 18 Without a Diabetes or Gestational Diabetes Diagnosis

Enhancing Maternal Health: Physiotherapy Rehabilitation Approaches for Gestational Diabetes in Pregnant Women: A Narrative Review

Enhancing Maternal Health: Physiotherapy Rehabilitation Approaches for Gestational Diabetes in Pregnant Women: A Narrative Review

Determinant Role of Toll-like Receptor 4 (TLR4) on Angiotensin II in Isolated Umbilical Arteries from Normal and Gestational Diabetes Pregnant Women.

Gestational diabetes mellitus (GDM) is a common condition that occurs during pregnancy and results in cesarean section, pre-eclampsia, and neonatal morbidity. Angiotensin II is a potent vasoconstrictor and an important determinant of uteroplacental perfusion. Toll-like receptor 4 (TLR4) was found to contribute to diabetes progression. This study aimed to determine how TLR4 activation affects the contraction mediated by angiotensin II type 1 receptor in the isolated umbilical arteries of normal and GDM women. Angiotensin II was applied with either a TLR4 agonist or TLR4 antagonists to isolated arteries from normal and GDM umbilical cords. The changes in the angiotensin II response were expressed as the maximal contraction percentage and pD2 values. The mRNA expression levels of TLR4 and angiotensin II type 1 receptor gene were measured via quantitative real-time polymerase chain reaction analysis. This study displayed an increased sensitivity to angiotensin II in the arteries of the GDM group compared with the normal group. The TLR4 agonist showed a synergistic effect with angiotensin II, while the TLR4 antagonists were not strongly determinant. In the GDM group, the TLR4 mRNA level is slightly higher than in the normal pregnancy group; however, no statistical difference was noted. Toll-like receptor 4 may determine the vasoconstrictive effect of angiotensin II in normal and GDM umbilical arteries. Some studies showed a similar interaction as supportive. However, comprehensive animal and/or human studies are promising.

Title-Efficacy of metformin as monotherapy in gestational and pre-gestational diabetic pregnant women

Title-Efficacy of metformin as monotherapy in gestational and pre-gestational diabetic pregnant women

The association of plasma pancreastatin levels with insulin resistance in patients with gestational diabetes mellitus

Introduction Gestational diabetes mellitus (GDM) occurs on the background of increased insulin resistance. We aimed to investigate the levels of plasma pancreastatin (PST) levels and its association with metabolic, demographic, and anthropometric parameters in gestational diabetic and normal glucose-tolerant pregnant women. Materials and methods A total of 165 pregnant women in the 24th–28th week of pregnancy were enrolled in this cross-sectional study. PST levels were measured using ELISA method. Results Median PST levels were similar between GDM (n = 62, 37.6%) and normal glucose-tolerant control group (n = 103, 62.4%). In the GDM group, PST level showed a significant positive correlation with fasting insulin and the homeostasis model assessment of insulin resistance (HOMA-IR). In binary logistic regression analysis, PST levels did not predict the presence of GDM significantly. Conclusion Positive correlation of PST with fasting insulin and HOMA-IR suggests that PST could be associated with insulin resistance. Further studies are needed as regards to the role of PST in GDM pathogenesis.

Relationship Between Genetic Variant Of OXTR (Rs53576) And MTNR1B (Rs1387153) And Symptoms Of Psychological Stress In Females With Gestational Diabetes Mellitus.

To assess the association of oxytocin receptor (rs53576) and melatonin hormone receptor 1B (rs1387153) gene single nucleotide polymorphisms with psychological symptoms in women with gestational diabetes mellitus. The case-control study was conducted from May 1 to June 1, 2022, at the Department of Physiology, University of Karachi, in collaboration with the Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, and the Department of Obstetrics and Gynaecology, Jinnah Postgraduate Medical Centre, Karachi. Fifty gestational diabetic pregnant women and ninety healthy pregnant women were recruited. Sanger sequencing was performed to assess the genotypic frequency and polymorphic variation of all subjects. Perceived stress scale and diabetes-related distress scale were used to assess the stress levels. Data was analysed using SPSS 23. Of the 140 subjects, 90 (64.3%) were controls with mean age 24.96±4.35 years, and 50 (35.7%) were cases with mean age 28.78±5.25 (p<0.05). Mean body weight and mean gestational age were not significantly different between the groups (p>0.05). Melatonin hormone receptor 1B rs1387153 frequency was significantly different between the groups (p<0.05). Among the cases, a significant mean difference for regimen distress scores between AA and GG was observed for oxytocin receptor rs53576 (p=0.04). A significant mean difference in sum of PSS, diabetes-related stress, total diabetes- related stress and emotional distress was noted between CC and TT genotypes for melatonin hormone receptor 1B rs1387153 (p=0.001). MTNR1B rs1387153 genotypes were associated with perceived stress, diabetes-related stress, diabetic distress, and emotional burden, while OXTR rs53576 genotypes were associated with regimen distress in GDM women.

Cardiovascular risk factors during pregnancy impact the postpartum cardiac and vascular reverse remodeling.

Pregnant women with cardiovascular risk (CVR) factors are highly prone to develop cardiovascular disease later in life. Thus, recent guidelines suggest extending the follow-up period to 1 yr after delivery. We aimed to evaluate cardiovascular remodeling during pregnancy and determine which CVR factors and potential biomarkers predict postpartum cardiac and vascular reverse remodeling (RR). Our study included a prospective cohort of 76 healthy and 54 obese and/or hypertensive and/or with gestational diabetes pregnant women who underwent transthoracic echocardiography, pulse-wave velocity (PWV), and blood collection at the 1st trimester (1T) and 3rd trimester (3T) of pregnancy as well as at the 1st/6th/12th mo after delivery. Generalized linear mixed-effects models was used to evaluate the extent of RR and its potential predictors. Pregnant women develop cardiac hypertrophy, as confirmed by a significant increase in left ventricular mass (LVM). Moreover, ventricular filling pressure (E/e') and atrial volume increased significantly during gestation. Significant regression of left ventricular (LV) volume, LVM, and filling pressures was observed as soon as 1 mo postpartum. The LV global longitudinal strain worsened slightly and recovered at 6 mo postpartum. PWV decreased significantly from 1T to 3T and normalized at 1 mo postpartum. We found that arterial hypertension, smoking habits, and obesity were independent predictors of increased LVM during pregnancy and postpartum. High C-reactive protein (CRP) and low ST2/IL33-receptor levels are potential circulatory biomarkers of worse LVM regression. Arterial hypertension, age, and gestational diabetes positively correlated with PWV. Altogether, our findings pinpoint arterial hypertension as a critical risk factor for worse RR and CRP, and ST2/IL33 receptors as potential biomarkers of postpartum hypertrophy reversal.NEW & NOTEWORTHY This study describes the impact of cardiovascular risk factors (CVR) in pregnancy-induced remodeling and postpartum reverse remodeling (up to 1 yr) by applying advanced statistic methods (multivariate generalized linear mixed-effects models) to a prospective cohort of pregnant women. Aiming to extrapolate to pathological conditions, this invaluable "human model" allowed us to demonstrate that arterial hypertension is a critical CVR for worse RR and that ST2/IL33-receptors and CRP are potential biomarkers of postpartum hypertrophy reversal.

The effect of hepatitis B virus on the risk of pregnancy outcomes: a systematic review and meta-analysis of cohort studies

BackgroundThe effect of HBV on neonatal and maternal outcomes can create a basis for more accurate clinical decision-making. So, the aim of this meta-analysis is to detrmine the effect of chronic hepatitis B virus on the risk of pregnancy outcomes by combining cohort studies.MethodsInternational databases in this meta-analysis included the Cumulated Index to Nursing and Allied Health Literature (CINAHL), SPORT Discuss via the EBSCO interface, PubMed (Medline), Scopus, Web of Science, Embase, which were searched up to April 2023. All cohort studies reporting the risk ratio (RR) with a 95% confidence interval (CI) were included in the study. The quality assessment was done based on the Newcastle–Ottawa Scale (NOS).ResultsFinally, thirty-five cohort studies were selected for meta-analysis. Outcomes of interest included pre-eclampsia, gestational diabetes, abortion, preterm birth, infant death, and other related outcomes. Results showed that the pooled RR for incident gestational diabetes in pregnant women with choronic hepatitis B infection was 1.16 (RR: 1.16; 95% CI 1.13–1.18; I-square: 92.89%; P value: 0.00). Similarly, the association between the presence of hepatitis B infection in pregnant women and the occurrence of pre-eclampsia was 1.10 (RR: 1.10; 95% CI 1.04–1.16; I-square: 92.06%; P value: 0.00). The risk of preterm delivery in pregnant women with hepatitis B infection was 1.17 times that of pregnant women without hepatitis B infection (RR: 1.17; 95% CI 1.14–1.20; I-squared: 94.32%; P value: 0.00).ConclusionThis meta-analysis found that hepatitis B infection during pregnancy may be associated with an increased risk of gestational diabetes, preterm delivery, pre-eclampsia, and eclampsia. However, confirmation of this association, as well as the specific biological pathways involved in the association between HBV infection and pregnancy outcomes, requires further investigation.

Comprehensive Assessment of Knowledge, Attitudes, and Practices, alongside Predictive Factors, Affecting Optimal Management of Gestational Diabetes in Pregnant Women across Multicenter Sites in Lebanon

Gestational diabetes mellitus (GDM) is a growing public health concern at a global level. Educating pregnant women is critical if we are to control this disease and prevent its adverse consequences. This cross-sectional study aimed to assess the knowledge, attitude, and practice of Lebanese pregnant women with regards to GDM and identify predictors of good practice. A total of 187 pregnant women with a mean age of 27 years were recruited from private gynecology clinics in different regions of Lebanon. A well-structured questionnaire was used to collect data relating to knowledge, attitude, and practice scores. Analysis revealed poor knowledge, good attitude, and average practice levels with regards to GDM among the participants. Based on our findings, it was observed that pregnant women who were in their first trimester exhibited greater adherence to practices when compared to those who were in their third trimester. Age was inversely associated with the practice of pregnant women, whereas the presence of comorbidities reduced the probability of attaining adequate practical scores. Our findings highlight the need for institutionalizing therapeutic education practices, particularly group education, to equip pregnant women with appropriate management skills, attitudes, and practices to prevent GDM.

Comparison of oxidative stress markers in the saliva, gingival crevicular fluid, and serum samples of pregnant women with gestational diabetes and healthy pregnant women.

To compare oxidative stress (OS) markers in the saliva, gingival crevicular fluid (GCF), and serum samples of pregnant women with gestational diabetes (GDM) and healthy pregnant women and to investigate the association between periodontal health/diseases and OS and GDM. Eighty women with GDM and 80 healthy pregnant women were included in the study. Medical and clinical anamnesis was obtained from all the pregnant women included in the study, and their plaque index (PI), gingival index (GI), bleeding on probing (BoP), probing pocket depth (PPD), and clinical attachment level (CAL) measurements were performed. GCF, saliva, and serum samples were collected for the measurements of the local and systemic total antioxidant status (TAS) and total oxidant status (TOS). Clinical periodontal parameters were found to be significantly higher in the GDM group compared to the control group. The serum and saliva TAS, TOS, and TAS/TOS values were significantly lower in the GDM group than in the control group. In the analysis of the GCF samples, the mean TAS and TAS/TOS values were significantly lower and the TOS value was significantly higher in the GDM group than in the control group. The multivariate reduced model indicated that gravidity, salivary TAS/TOS, and GCF TAS were significant independent variables in the development of GDM (p < .05). Our results indicated that the OS of serum, saliva, and GCF samples increased in patients with GDM compared to healthy pregnant women. The role of local OS parameters in GDM may be associated with elevated clinical periodontal parameters.

Antenatal dietary supplementation with myo-inositol for preventing gestational diabetes.

Gestational diabetes with onset or first recognition during pregnancy is an increasing problem worldwide. Myo-inositol, an isomer of inositol, is a naturally occurring sugar commonly found in cereals, corn, legumes and meat. Myo-inositol is one of the intracellular mediators of the insulin signal and correlates with insulin sensitivity in type 2 diabetes. The potential beneficial effect of improving insulin sensitivity suggests that myo-inositol may be useful for women in preventing gestational diabetes. This is an update of a review first published in 2015. To assess if antenatal dietary supplementation with myo-inositol is safe and effective, for the mother and fetus, in preventing gestational diabetes. We searched the Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, WHO ICTRP (17 March 2022) and the reference lists of retrieved studies. We included published and unpublished randomised controlled trials (RCTs) including cluster-RCTs and conference abstracts, assessing the effects of myo-inositol for the prevention of gestational diabetes in pregnant women. We included studies that compared any dose of myo-inositol, alone or in a combination preparation, with no treatment, placebo or another intervention. Quasi-randomised and cross-over trials were not eligible. We excluded women with pre-existing type 1 or type 2 diabetes. Two review authors independently assessed studies for inclusion, assessed risk of bias and extracted the data. We checked the data for accuracy. We assessed the certainty of the evidence using the GRADE approach. We included seven RCTs (one conducted in Ireland, six conducted in Italy) reporting on 1319 women who were 10 weeks to 24 weeks pregnant at the start of the studies. The studies had relatively small sample sizes and the overall risk of bias was low. For the primary maternal outcomes, meta-analysis showed that myo-inositol may reduce the incidence of gestational diabetes (risk ratio (RR) 0.53, 95% confidence interval (CI) 0.31 to 0.90; 6 studies, 1140 women) and hypertensive disorders of pregnancy (RR 0.34, 95% CI 0.19 to 0.61; 5 studies, 1052 women). However, the certainty of the evidence was low to very low. For the primary neonatal outcomes, only one study measured the risk of a large-for-gestational-age infant and found myo-inositol was associated with both appreciable benefit and harm (RR 1.40, 95% CI 0.65 to 3.02; 1 study, 234 infants; low-certainty evidence). None of the included studies reported on the other primary neonatal outcomes (perinatal mortality, mortality or morbidity composite). For the secondary maternal outcomes, we are unclear about the effect of myo-inositol on weight gain during pregnancy (mean difference (MD) -0.25 kilogram (kg), 95% CI -1.26 to 0.75 kg; 4 studies, 831 women) and perineal trauma (RR 4.0, 95% CI 0.45 to 35.25; 1 study, 234 women) because the evidence was assessed as being very low-certainty. Further, myo-inositol may result in little to no difference in caesarean section (RR 0.91, 95% CI 0.77 to 1.07; 4 studies, 829 women; low-certainty evidence). None of the included studies reported on the other secondary maternal outcomes (postnatal depression and the development of subsequent type 2 diabetes mellitus). For the secondary neonatal outcomes, meta-analysis showed no neonatal hypoglycaemia (RR 3.07, 95% CI 0.90 to 10.52; 4 studies; 671 infants; very low-certainty evidence). However, myo-inositol may be associated with a reduction in the incidence of preterm birth (RR 0.35, 95% CI 0.17 to 0.70; 4 studies; 829 infants). There were insufficient data for a number of maternal and neonatal secondary outcomes, and no data were reported for any of the long-term childhood or adulthood outcomes, or for health service utilisation outcomes. Evidence from seven studies shows that antenatal dietary supplementation with myo-inositol during pregnancy may reduce the incidence of gestational diabetes, hypertensive disorders of pregnancy and preterm birth. Limited data suggest that supplementation with myo-inositol may not reduce the risk of a large-for-gestational-age infant. The current evidence is based on small studies that were not powered to detect differences in outcomes such as perinatal mortality and serious infant morbidity. Six of the included studies were conducted in Italy and one in Ireland, which raises concerns about the lack of generalisability to other settings. There is evidence of inconsistency among doses of myo-inositol, the timing of administration and study population. As a result, we downgraded the certainty of the evidence for many outcomes to low or very low certainty. Further studies for this promising antenatal intervention for preventing gestational diabetes are encouraged and should include pregnant women of different ethnicities and varying risk factors. Myo-inositol at different doses, frequency and timing of administration, should be compared with placebo, diet and exercise, and pharmacological interventions. Long-term follow-up should be considered and outcomes should include potential harms, including adverse effects.

A Smart Architecture Leveraging Fog Computing Fusion and Ensemble Learning for Prediction of Gestational Diabetes

Gestational diabetes (GD) is a growing global concern, underscoring the need for early detection and effective management to prevent adverse health consequences. This paper presents an innovative and reliable architecture to predict gestational diabetes in pregnant women. While reducing the frequency of doctor visits by sending the necessary data via Internet of Things (IoT) technology and receiving the prediction results via a mobile application in real time. The proposed architecture is a fusion of fog computing hardware with ensemble machine learning to enable low-latency, energy-efficient solutions for data processing, and cloud computing. The GD_Fog architecture leverages fused fog computing and load balancing techniques to reduce latency, power consumption, Network bandwidth consumption, and response time, and cloud computing is used based on the concept of use on demand for more reliability while harnessing the power of group learning to improve prediction accuracy. In addition, GD_Fog can be configured for different operating modes to ensure optimal quality of service and prediction accuracy in various fog calculation scenarios, which meet different user requirements. Through extensive testing using real-world data from pregnant women, the framework shows promising results, outperforming the latest methods in accuracy and efficiency. Where the percentage of improvement in prediction accuracy was approximately 6.5% when using ensemble learning, and the improvement in energy use, amounted to approximately 87.01% when using fused fog computing instead of cloud computing. These results confirm the potential of the proposed structure as an invaluable tool for the early detection and effective management of gestational diabetes.

Assessment of Barriers toward Initiating Insulin among Gestational Diabetes Pregnant Women, Diabetes Center, Hera’a General Hospital, Makkah

Background: Gestational diabetes mellitus (GDM) is one of the most common pathologies in pregnancy. Unfortunately, both clinicians and patients are often reluctant to begin insulin therapy, a phenomenon that has been known as psychological insulin resistance (PIR). Objectives: To assess the barriers of initiating insulin among GDM pregnant women. Patients and Methods: An observational cross-sectional study was conducted in the GDM clinic, Diabetes Center in Hera’a General Hospital, Makkah, Saudi Arabia in a period of 4 months. A self-administered validated questionnaire was adopted. It included socio-demographic data of women, perceived (personal, social, pharmacological, occupational and misconception) barriers towards insulin therapy and possible solutions to overcome these barriers. Results: A total of 164 pregnant women with gestational diabetes were included in the study. The age of 36.4% of them exceeded 35 years. Among personal barriers, preferring other treatment methods over insulin (56.4%) and unaware of insulin dose control method (45.4%) were commonly reported. Regarding family barriers, 23.6% reported past family experience of insulin-related complications. Concerning side effects, fear of hypoglycemia (59.4%) and fear of weight gain (50.9%) were most frequently reported barriers against use of insulin. Regarding misconceptions about insulin injections, 26% believed that insulin is addictive; the injection will continue for life. Among work-related barriers, irregular eating times during working hours and long working hours (55.2%) were barriers for insulin use. Facilitating access to healthcare services (94%), engage the patient in decision-making and development of the treatment plan (91.6%), activate virtual clinics and social media for remote follow-up (86.6%) and organize social support groups for pregnant women who use insulin to share their experiences were the most frequently reported possible solutions to initiate and commit to insulin therapy. Conclusion: Various barriers were identified against initiation of insulin therapy in the management of gestational diabetes; mostly due to personal factors, misconception and work-related factors. Prompt actions are needed to overcome these barriers.

Reliability of Estimation of HBA1C for Diagnosing Gestational Diabetes

Gestation Diabetes mellitus is a condition that, if left untreated, can have adverse effects not only on the mother but also on the unborn child. Even though the oral glucose tolerance test (OGTT), which is the typical method of screening for gestational diabetes in pregnant women and has been widely used and recognised for a number of decades, there is still a need for a test that is both more accurate and simpler to administer in order to diagnose GDM. This is the case despite the fact that the standard method involves an OGTT Subjects and Methods: In this prospective observational study, OGTT and HbA1c were performed in 400 antenatal women between 24 and 28 weeks of gestation; the pregnant women were followed up thereafter. Repeat OGTT and HbA1c were done in women with GDM at 6 weeks postpartum. Results: Among the 400 women, 52 were diagnosed with GDM, for an incidence of 9%. The mean HbA1c level in women with GDM was 6.2 – 0.6%, whereas it was 5.4 – 0.5% in those with normoglycemia. Women with GDM had a higher incidence of pregnancy-related complications compared with normoglycemic women. An HbA1c cutoff of 5.3% had a sensitivity of 95.6% and a specificity of 51.6% for the diagnosis of GDM and would have avoided OGTT in approximately half of antenatal women, while missing 5% of the women. However, those with an abnormal HbA1c will require a confirmatory OGTT, as 50% of normoglycemic women would be misclassified as having GDM by this approach. On repeat testing postpartum, two of 52 women (4.4%) had overt diabetes mellitus, whereas five (11.1%) had impaired glucose tolerance. Conclusions: Although HbA1c cannot replace OGTT in the diagnosis of GDM, it can be used as a screening test, avoiding OGTT in approximately 50% of women, if a cutoff of 5.3% is used. The findings of all of these trials make it abundantly evident that the HbAlc test is superior than the traditional OGTT in a number of important respects. The great reproducibility of the HbAlc assay, improved instrumentation and standardisation of the HbAlc assay, less biological variability, and the fact that it is not affected by short-term changes in lifestyle are all factors that contribute to these advantages. It is possible to use it as a primary screening test for all pregnant women due to the fact that the patient does not need to prepare significantly for the test and that it takes less time. If, on the other hand, the HbAlc result is discovered to be greater than the reference range, then it is absolutely necessary to perform a confirmatory test in order to establish a diagnosis of GDM. It is anticipated that HbAlc will be able to function as a diagnostic marker in the not-too-distant future. Keywords: GDM; HbAlc.

Investigating the Relationship Between Serum C-Reactive Protein, Ferritin levels, and Gestational Diabetes in Pregnant Women Living in Qazvin City

Background: This study aimed to compare the serum levels of C-reactive protein (CRP) and ferritin in the first trimester of pregnancy between normal and abnormal pregnant women (complicated with gestational diabetes) to determine if these chemicals have any predictive value in the diagnosis of gestational diabetes. Methods: This prospective cohort study was carried out on 300 pregnant women attending the Prenatal Clinic of Kosar Hospital, Qazvin City, Iran, during 2017-2018. Based on Carpenter and Constant criteria, the pregnant women undertook an oral glucose tolerance test with 75 g glucose to diagnose gestational diabetes. We also measured the serum levels of CRP and ferritin in all the women in the first trimester. The obtained data were analyzed using SPSS software version 24. P&lt;0.05 was considered statistically significant Results: A total of 40 pregnant women were found to have gestational diabetes. The levels of CRP and ferritin were slightly higher in women with gestational diabetes, although this increase was not statistically significant. Regarding the receiver operating characteristic curve, body mass index (BMI) could predict the incidence of gestational diabetes (72.5% sensitivity, 53.1% specificity, P=0.023). The higher BMI and CRP levels in the first trimester were also significantly associated with macrosomia, which could predict macrosomia with 75% sensitivity, 73.6% specificity for BMI (P=0.005), and 87.5% sensitivity, 58.1% specificity for BMI. Conclusion: There was no correlation between CRP and ferritin levels and gestational diabetes in the first trimester of pregnancy. BMI before pregnancy was the only variable related to gestational diabetes. Increased values of both CRP and BMI were associated with fetal macrosomia

FETAL SONOGRAPHIC PARAMETERS BETWEEN GESTATIONAL DIABETIC AND NORMAL PREGNANT WOMEN.

Background– Gestational diabetes mellitus (GDM) is dened as intolerance of glucose seen during pregnancy and is associated with fetal and maternal morbidity. The aim of our study was to measure various fetal sonographic parameters such as fetal biometry, fetal liver length (FLL), amniotic uid deepest pocket (AFDP), placental thickness, inter ventricular (IV) septum thickness, Wharton's jelly area and fetal abdominal fat thickness (FAFT) during 21-24 weeks of gestation and comparison of these parameters between Gestational diabetic and normal pregnant women. Tot Methods: al patients selected in our study were 100 in number, of which 50 had GDM and 50 were normal pregnant women. Fetal standard biometry with additional parameters were measured on transabdominal scan from 21-24 weeks. Fetal sonographic measurements and patients characteristics were measured and compared between two groups. P-value was evaluated along with mean, standard deviation, mean difference and condence interval Patient characteristics and standard fetal Results: biometric parameters were comparable except for femur length (FL), mean femur length was signicantly greater in GDM women compared to normal pregnant women (39.20 ± 0.70 vs. 38.36 ± 1.20, p = 0.001). Mean values in GDM vs. normal pregnent women were, fetal placental thickness in mm ( 42.28 ± 2.09 vs. 33.24 ± 1.70, p = 0.001), amniotic uid maximum vertical pocket in mm (54.96 ± 1.24 vs. 44.46 ± 1.06, p = 0.001), fetal abdomen fat layer thickness in mm (3.59 ± 0.17 vs. 3.46 ± 0.15, p = 0.001), inter ventricular septum thickness in mm (3.71 ± 0.13 vs. 3.63 ± 0.16, p = 0.001), fetal liver length in mm (36.48± 1.15 vs. 31.86 ± 0.90, p = 0.001), Wharton jelly area in mm2 (115.26 ± 1.96 vs. 109.34 ± 4.81, p = 0.001), Fetal sonographic Conclusion: parameters are signicantly increased in GDM women compared to normal pregnant women even before 24 weeks. Measurements of these parameters in routine practice could be used to monitor fetal growth and hence can prevent fatal complications.