Gestational Diabetes Research Articles

Gestational Diabetes Mellitus and Subsequent Risks of Diabetes and Cardiovascular Diseases: the Life Course Perspective and Implications of Racial Disparities.

Gestational diabetes mellitus (GDM) is one of the most common pregnancy complications worldwide and the prevalence is continuously rising globally. Importantly, GDM is not an isolated complication of pregnancy. Growing evidence suggests that individuals with GDM, compared to those without GDM, have an increased risk of subsequent type 2 diabetes (T2D) and cardiovascular diseases (CVD). Substantial racial and ethnic disparities exist in the risk of GDM. However, the role of race and ethnicity in the progression from GDM to T2D and CVD remains unclear. The purpose of the current review is to summarize recent research about GDM and its life-course impacts on cardiometabolic health, including 1) the peak time of developing T2D and CVD risks after GDM, 2) the racial and ethnic disparities in the risk cardiometabolic diseases after GDM, 3) the biological plausibility and underlying mechanisms, and 4) recommendations for screening and prevention of cardiometabolic diseases among individuals with GDM, collectively to provide an updated review to guide future research. Growing evidence has indicated that individuals with GDM had greater risks of T2D (7.4 to 9.6 times), hypertension (78% higher), and CDV events (74% higher) after GDM than their non-GDM counterparts. More recently, a few studies also suggested that GDM could slightly increase the risk of mortality. Available evidence suggests that key CVD risk factors such as blood pressure, plasma glucose, and lipids levels are all elevated as early as < 1year postpartum in individuals with GDM. The risk of T2D and hypertension is likely to reach a peak between 3-6years after the index pregnancy with GDM compared to normal glycemia pregnancy. Cumulative evidence also suggests that the risk of cardiometabolic diseases including T2D, hypertension, and CVD events after GDM varies by race and ethnicity. However, whether the risk is higher in certain racial and ethnic groups and whether the pattern may vary by the postpartum cardiometabolic outcome of interest remain unclear. The underlying mechanisms linking GDM and subsequent T2D and CVD are complex, often involving multiple pathways and their interactions, with the specific mechanisms varying by individuals of different racial and ethnic backgrounds. Diabetes and CVD risk screening among individuals with GDM should be initiated early during postpartum and continue, if possible, frequently. Unfortunately, adherence to postpartum glucose testing with either obstetrician or primary care providers remained poor among individuals with GDM. A life-course perspective may provide critical information to address clinical and public health gaps in postpartum screening and interventions for preventing T2D and CVD risks in individuals with GDM. Future research investigating the racial- and ethnic-specific risk of progression from GDM to cardiometabolic diseases and the role of multi-domain factors including lifestyle, biological, and socio-contextual factors are warranted to inform tailored and culture-appropriate interventions for high-risk subpopulations. Further, examining the barriers to postpartum glucose testing among individuals with GDM is crucial for the effective prevention of cardiometabolic diseases and for enhancing life-long health.

Early screening and diagnosis of gestational diabetes mellitus (GDM) and its impact on perinatal outcomes

AimsTo compare the maternal and neonatal outcomes following early diagnosis compared with routine diagnosis of gestational diabetes (GDM). MethodsIn this observational study, 3494 women were categorised by weeks of gestation at GDM diagnosis: early GDM (≤20 weeks) and routine GDM (>20 weeks). The early GDM group was further divided by treatment commencement as immediate (<12 weeks) and delayed (12–20 weeks) and by diagnostic fasting blood glucose as higher- FBG (5.3–6.0 mmol/L) and lower-FBG group (FBG 5.1–5.2 mmol/L). Primary outcomes were large for gestational age (LGA) and small for gestational age (SGA). Generalized linear models used to calculate risk ratios and adjusted for confounding. ResultsRisk ratios (RR) for LGA and SGA were similar for early versus routine diagnosis, and immediate versus delayed treatment. The higher-FBG immediate treatment group had a lower risk of newborn respiratory distress (RR 0.52, 95 %CI 0.34, 0.81) and emergency caesarean (RR 0.55, 95 %CI 0.34, 0.88) compared to the higher-FBG delayed treatment group. Among the lower-FBG group, no such benefits were seen. ConclusionsFasting glucose levels modified the effects of early treatment of GDM where a higher-FBG with immediate treatment appears to reduce perinatal complications, but treating women with lower-FBG early has no benefits.

Examining childhood and adulthood stressors as risk factors for gestational diabetes mellitus in working pregnant individuals: A prospective cohort study

AimsThis study aimed to examine the individual and joint associations of adverse childhood experiences (ACEs) and maternal work and non-work related stressors with the risk of gestational diabetes mellitus (GDM). MethodsWorking pregnant individuals (n = 1163) from a United States (U.S.) prospective cohort conducted in South Carolina between 2016 and 2021 were included in the study. ACEs were assessed at study enrollment before 20 gestational weeks (GW), while maternal stressors were assessed in late pregnancy and GDM diagnosis occurred between 24 and 30 GW. Multivariable logistic regressions were performed to assess associations of ACEs and maternal stressors with GDM. ResultsChildhood abuse, an ACE subdomain, was associated with an elevated but statistically insignificant risk of GDM (adjusted OR = 1.47; 95 % CI: 0.85–2.53). Only maternal work stressors were associated with an increased risk of GDM (adjusted OR = 2.11; 95 % CI: 1.17–3.79) and the association became much stronger among those with childhood abuse experiences (adjusted OR = 3.80; 95 % CI:1.68–8.60). ConclusionAmong U.S. working pregnant individuals, having work stressors during pregnancy was associated with an elevated risk of developing GDM, particularly among those who had childhood experience of abuse.

The Impact of Gestational Diabetes Mellitus on Minipuberty in Girls

Minipuberty is the second phase of physiological activation of the reproductive axis, playing a role in the postnatal development of sexual organs. The course of female minipuberty was found to be affected by low maternal vitamin D status and hypothyroidism during pregnancy. The aim of the current study was to assess the hormonal profile and the size of sexual organs in daughters of mothers with gestational diabetes mellitus. The study included three matched groups of infant girls: daughters of healthy women without metabolic disorders during pregnancy (group 1), daughters of women with poorly controlled gestational diabetes mellitus (group 2), and daughters of women with gestational diabetes mellitus adequately controlled during pregnancy (group 3). Urinary levels of gonadotropins, salivary levels of estradiol, testosterone, DHEA-S and progesterone, ovarian volume, uterine length and breast diameter were measured from postnatal month 1 to postnatal month 18. Concentrations of FSH, LH and estradiol were higher, while concentration of progesterone was lower in group 2 than in the remaining groups. There were no between-group differences in concentrations of testosterone and DHEA-S. Levels of LH, FSH, estradiol and progesterone correlated with maternal whole-blood levels of glycated hemoglobin. Group 2 was also characterized by the longest detection periods for LH and estradiol. Ovarian volume, uterine length and breast diameter were greater in group 1 than in the remaining two groups. Over the entire observation period, there were no differences in hormone levels and sizes of the sexual organs between groups 1 and 3. The obtained results suggest that poorly controlled, but not well controlled, gestational diabetes mellitus affects the course of female minipuberty.

Exposure to alkylphenols during early pregnancy and the risk of gestational diabetes mellitus: Fetal sex-specific effects

Alkylphenols (APs) may cause gestational diabetes mellitus (GDM) in pregnant women by impairing glucose metabolism through endocrine disruption. However, the current literature has limited epidemiological evidence on the association between APs exposure and the risk of GDM, especially the lack of evidence on joint exposure. Thus, we evaluated the effect of exposure to APs during early pregnancy on the risk of GDM. The study involved 2035 pregnant women from Guangxi Zhuang Birth Cohort (GZBC) in China. Poisson regression model, restricted cubic spline (RCS), Bayesian kernel machine regression (BKMR), and quantile g-computation (Qgcomp) were conducted to evaluate the effects of serum APs levels on the risk of GDM in pregnant women. For each Ln-unit increase in the serum nonylphenol (NP) of pregnant women, the adjusted relative risk (RR) for GDM risk was 1.12 (95 % CI: 1.00, 1.24). After sex stratification, the effect was more pronounced among pregnant women carrying female fetuses（RR=1.22; 95 % CI: 1.09, 1.38). The serum 4-t-octylphenol (4-T-OP) of the medium-exposure (adjusted RR = 3.25: 95 % CI: 1.30, 8.12) and high-exposure groups (adjusted RR = 2.90: 95 % CI: 1.15, 7.31) were related to a significantly increased risk of GDM in pregnant women carrying female fetuses only when compared to the low-exposure group. A reverse U-shaped nonlinear association was found between 4-n-octylphenol (4-N-OP) and 4-n-nonylphenol (4-N-NP) concentrations and GDM risk, and it was more susceptible in pregnant women carrying female fetuses. The Qgcomp and BKMR models showed that exposure to APs mixtures was correlated with an elevated risk of GDM in pregnant women carrying female fetuses (adjusted OR = 1.90: 95 % CI: 1.07, 3.38). Exposure to APs during early pregnancy may have potential fetal sex-specific effects on the risk of GDM, with pregnant women carrying female fetuses being more susceptible.

Gestational Diabetes Mellitus - Neonatal and Maternal Outcomes in Women Treated with Insulin or Diet: A Propensity Matched Analysis

AimsPregnant women worldwide face the risk of developing gestational diabetes mellitus (GDM), if left untreated, can cause complications. The study explores factors influencing the choice between diet control and insulin therapy for pregnant women with GDM. It aims to understand how these choices impact maternal and neonatal outcomes. MethodsIn this quasi-experimental study, clinicians determined treatment (diet control or insulin) for 1030 individuals with GDM at a private practice from 2010 to 2020 based on baseline characteristics. Propensity scores (PS), reflecting the probability of treatment allocation, were derived through multiple logistic regression. ResultsAfter PS matching, 386 individuals were paired from two study groups. The insulin-treated group exhibited a 4.43 times higher risk of neonatal hypoglycemia than the diet group. Insulin-treated individuals, stratified by PS, revealed that the high-risk quartile had significantly higher mean insulin requirements and a doubled dose at full term compared to the lower-risk quartiles. The mean insulin dose did not significantly differ in the first three quartiles, but the last quartile showed a significant increase (p = 0.008), particularly for individuals with PS exceeding 0.70, indicating a higher insulin dose requirement for effective glucose control. ConclusionThis study reveals that individuals with a bad obstetrics history, a family history of diabetes, obesity, and elevated glycemic values necessitate higher insulin doses. This insight improves clinicians' decision-making in diagnosis and treatment planning, enhancing the precision of medical practices.

P12 Post-streptococcal reactive arthritis and panniculitis in pregnancy: a case report

Abstract Introduction Reactive arthritis is an inflammatory condition that can occur following an infection, commonly caused by bacterial pathogens such as Streptococcus. Pregnancy introduces unique challenges in managing autoimmune and inflammatory conditions due to the need to balance maternal and foetal health. This case report highlights the diagnosis and management of post-streptococcal reactive arthritis and panniculitis in a 16-week pregnant patient, focusing on the use of steroids and the resulting impact on her gestational diabetes Case description A 25-year-old woman, 16 weeks pregnant with no known comorbidities, presented with bilateral ankle pain and swelling for the last two weeks, preceded by an episode of tonsillitis. Initially, the pain was localised to her right ankle and left wrist, then involved her left ankle. She was treated with antibiotics for presumed cellulitis, and a doppler ultrasound ruled out deep vein thrombosis. Examination revealed swollen, inflamed ankles with limited range of motion due to pain. The rest of the examination was unremarkable. This was her second pregnancy and had no complications in her first pregnancy. Routine investigations were done; her C-reactive protein (CRP) was 126 and erythrocyte sedimentation rate (ESR) was 56, with a normal white cell count. Autoimmune workup, including rheumatoid factor (RF), antinuclear antibodies (ANA), and HLA-B27, was negative, but her anti-streptolysin O (ASO) titer was borderline positive. She was diagnosed with post-streptococcal reactive arthritis. After discussing the risks and benefits of NSAID use in the second trimester, we started her on prednisolone 20 mg with a tapering plan. The patient showed clinical improvement, but upon tapering the steroids to 5 mg daily, she developed well-demarcated erythema with desquamation and epidermal changes over both ankles. The left ankle was tender on the medial side, but the right was non-tender. Her angiotensin-converting enzyme (ACE) levels were negative, and calcium levels were normal. Her steroid dose was increased again to 20 mg with a slow tapering plan. She also developed gestational diabetes mellitus and was started on insulin by the diabetes team. Her foetal scan was reassuring and was under obstetrician. A dermatology team reviewed her and suggested the rash was likely panniculitis, which had improved significantly with steroids, so a biopsy was not performed. With careful management, her symptoms resolved, and she successfully discontinued steroid therapy as planned. Discussion This case highlights the complex nature of managing post-streptococcal reactive arthritis and panniculitis in a pregnant patient. The initial presentation with a sore throat and subsequent development of arthritis and panniculitis, along with raised inflammatory markers and a positive ASO titer, strongly suggested reactive arthritis triggered by a recent streptococcal infection. Given the foetal risk from NSAIDs, steroid therapy was chosen for its safety profile in pregnancy. While steroid therapy provided symptomatic relief, it led to gestational diabetes, requiring careful monitoring and adjustment of the patient’s diabetic management. The emergence of panniculitis during steroid tapering added another layer of complexity, necessitating collaboration with dermatology specialists for a revised approach. The dermatological team agreed with the recommendation of slow tapering of steroids, which were crucial in managing this complication. This case highlights the importance of a multidisciplinary approach and close monitoring to ensure optimal outcomes for both the mother and the developing foetus. Key learning points • The diagnosis of post-streptococcal reactive arthritis should be considered in pregnant patients presenting with joint inflammation and a recent history of infection. Prompt recognition and appropriate treatment are essential to prevent long-term joint damage. • Careful monitoring of glycaemic control is crucial when initiating steroid therapy in pregnant patients, as it may lead to uncontrolled diabetes and can cause foetal problems. Close collaboration between obstetric and endocrine specialists is necessary to optimise diabetes management while minimising foetal risks. • Collaboration with dermatology specialists can aid in the management of complications such as panniculitis during steroid tapering in pregnant patients. A multidisciplinary approach ensures comprehensive care and improves outcomes for both the mother and the developing foetus.

The Effects of Vitamin D Supplementation on Glycemic Indices, Lipid Profile and Blood Pressure of Pregnant Women with Vitamin D Deficiency: A Single Arm Clinical Trial

Introduction: Vitamin D Deficiency (VDD) is a global problem among pregnant women in many populations. There is an association between VDD and some pregnancy outcomes, as well as gestational diabetes mellitus (GDM) and pre-eclampsia. We aimed to evaluate the effect of vitamin D supplementation on metabolic status (Fasting Blood Sugar (FBS), insulin, Homeostasis model of assessment-insulin resistance (HOMA-IR) and lipid profile) and blood pressure (BP) among pregnant women with VDD. Methods: A clinical trial was carried out on 30 pregnant women with VDD referring to the Gynecology &amp; Obstetrics Clinic of Baqiyatallah Hospital, Tehran, Iran. The present study had two phases of vitamin D3 supplementation (50000 IU / week for 12 weeks and then 50000 IU / month for three months). Serum total cholesterol, triglyceride, Low Density Lipoprotein (LDL), High Density Lipoprotein (HDL), 25-hydroxyvitamin D (25(OH) D) level, insulin, Fasting Blood Sugar (FBS) and both systolic and diastolic blood pressure were measured. Homeostasis model of assessment-insulin resistance (HOMA-IR) was also determined. Results: The results showed that mean levels of Insulin (p=0.010), HOMA-IR (p=0.020), 25(OH) D level (p=0.001), cholesterol (p=0.001), triglyceride (p=0.001) and LDL (p=0.001) significantly increases during study period. However, Diastolic and systolic blood pressure, FBS, and HDL levels did not change significantly over time. Conclusion: The results of this investigation showed that weekly and monthly vitamin D3 supplementation in pregnant women with VDD had beneficial effects on glycemic status, lipid profile and blood pressure.

Gestational Diabetes Mellitus and its Association with ABO Blood Group Type among Pregnant Women with Pregnancy-Induced Hypertension in Northwest Ethiopia: A Comparative Study

Gestational Diabetes Mellitus and its Association with ABO Blood Group Type among Pregnant Women with Pregnancy-Induced Hypertension in Northwest Ethiopia: A Comparative Study

Administration of a diabetes-specific formula can improve postprandial glycemic control and delay insulin use in gestational diabetes mellitus: a randomized controlled trial from two centers

Administration of a diabetes-specific formula can improve postprandial glycemic control and delay insulin use in gestational diabetes mellitus: a randomized controlled trial from two centers

The role and function of metformin in women’s reproductive health: From pre-pregnancy preparation to breastfeeding

Disorders of carbohydrate metabolism not only reduce the quality of life of patients of reproductive age due to violations of the regularity of menstruation, anovulation and other clinical manifestations, but also affect the stages of pregnancy planning, affect the course of pregnancy and play an important role in the postpartum period. In overweight women, the presence of insulin resistance (IR), as well as existing disorders of carbohydrate metabolism, a conscious approach to pregnancy planning with maintaining targets before and throughout pregnancy is extremely important. The particular importance of a responsible approach is necessary due to the fact that glycemic disorders in both hyperand hypoglycemia are associated with risks on the part of the patient and the unborn child. Infertility, miscarriage, the risk of preeclampsia and eclampsia, as well as a high risk of birth injury (in relation to both mother and child) due to the peculiarities of childbirth with a large fetus are common among patients with impaired carbohydrate metabolism. Among all disorders of carbohydrate metabolism in patients of reproductive age, the most common are such as prediabetes, gestational diabetes mellitus, type 2 diabetes mellitus, all of which are associated with IR. Polycystic ovary syndrome, one of the main pathogenetic links of which is also IR, can be outlined separately. The use of metformin as a drug aimed at reducing IR is pathogenetically justified in such situations, however, despite the evidence of the safety of metformin presented by a large number of studies, there are no unified recommendations on dosage, timing and duration of metformin administration.

The association of higher offspring early-childhood weight gain with prepregnancy metabolic and bariatric surgery.

The objective of this study was to assess maternal gestational outcomes and offspring growth trajectories following prepregnancy metabolic and bariatric surgery (MBS) compared with non-MBS controls. Single-center deliveries between January 2020 and March 2023 with prepregnancy Roux-en-Y gastric bypass (herein referred to as "bypass"), sleeve gastrectomy (herein referred to as "sleeve"), and non-MBS controls were included. Offspring growth trajectories were compared with the World Health Organization child growth standards. Linear mixed models assessed MBS-bypass and MBS-sleeve offspring weight, length, and BMI trajectories with a prepregnancy BMI 27 to 37 kg/m2 and propensity score-matched controls. The study included 440 participants with prepregnancy MBS (MBS-bypass, 185; MBS-sleeve, 225; 76% Hispanic/Latino) and 13,434 non-MBS controls. Gestational weight gain and gestational diabetes mellitus were similar, whereas hypertensive disorders of pregnancy were more common after MBS. The post-MBS offspring had lower birth weight but higher weight gain at 24 months (sleeve, +1.4 kg [95% CI: 1.0-1.9]; bypass, +0.5-0.7 kg [95% CI: 0.0-1.2]) compared with non-MBS groups. Male children had higher weight gain than females. The post-MBS-sleeve but not the post-MBS-bypass offspring had higher BMI z scores. The higher early-life weight gain and sex differences in the post-MBS-sleeve group compared with the post-MBS-bypass group provide a window toward elucidating pathways to mitigate intergenerational metabolic risk transfer.

Effects of household air pollution and healthy lifestyle associated with gestational diabetes mellitus

This study investigated the effect of household air pollution on pregnant women with GDM, and assessed the modifying effect of a healthy lifestyle on this relationship. Household solid fuel exposure was defined as using solid fuels (coal, crop residue, and wood) for cooking and heating. Four individually modifiable lifestyle factors were assessed in early pregnancy: body mass index, diet, sleep, and vitamin D supplementation. Multifactorial logistic regression modeling was used to assess the relationship between household air pollution and GDM. A stratified analysis and additive interaction tested the effects of healthy lifestyle scores. After adjusting for potential confounders, we found that using solid fuels for heating was significantly associated with an increased risk of GDM (adjusted OR = 1.60, 95% CI 1.18–2.18). GDM risk showed a decreasing trend in the medium versus the high score group when compared to the low score group, with a consistent trend regardless of household fuel type used (adjusted OR = 0.39, 95% CI 0.27–0.57) (adjusted OR = 0.12, 95% CI 0.05–0.28), respectively. Importantly, when the healthy lifestyle score increased, exposure to household air pollution was no longer associated with a higher GDM risk. There was a negative additive interaction between exposure to household solid fuels exposure and a healthy lifestyle (FERI: −5.10 [−16.48, −2.04]; AP: −1.29 [−2.80, −0.39]; SI: −0.37 [−0.20, −0.67]). We determined that exposure to household air pollution may be an important GDM risk factor. In addition, A healthy lifestyle may have a protective effect on women with GDM exposed to indoor fuel air pollution.

Creating Perinatal Nursing Care Plans Using ChatGPT: A Pathway to Improve Nursing Care Plans and Reduce Documentation Burden.

Extensive time spent on documentation in electronic health records (EHRs) impedes patient care and contributes to nurse burnout. Artificial intelligence-based clinical decision support tools within the EHR, such as ChatGPT, can provide care plan recommendations to the perinatal nurse. The lack of explicit methodologies for effectively integrating ChatGPT led to our initiative to build and demonstrate our ChatGPT-4 prompt to support nurse care planning. We employed our process model, previously tested with 22 diverse medical-surgical patient scenarios, to generate a tailored prompt for ChatGPT-4 to produce care plan suggestions for an exemplar patient presenting with preterm labor and gestational diabetes. A comparative analysis was conducted by evaluating the output against a "nurse-generated care plan" developed by our team of nurses on content alignment, accuracy of standardized nursing terminology, and prioritization of care. ChatGPT-4 delivered suggestions for nursing diagnoses, interventions, and outcomes comparable to the "nurse-generated care plan." It accurately identified major care areas, avoided irrelevant or unnecessary recommendations, and identified top priority care. Of the 24 labels generated by ChatGPT-4, 16 correctly utilized standardized nursing terminology. This demonstration of the use of our ChatGPT-4 prompt illustrates the potential of leveraging a large language model to assist perinatal nurses in creating care plans. The next steps are improving the accuracy of ChatGPT-4-generated standardized nursing terminology and integrating our prompt into EHRs. This work supports our broader goal of enhancing patient outcomes while mitigating the burden of documentation that contributes to nurse burnout.

Immune Thrombocytopenic Purpura and Maternal and Neonatal Outcomes During Pregnancy: A Systematic Review and Meta-Analysis.

Immune thrombocytopenic purpura (ITP) affects 1-3 out of every 10000 pregnancies, posing significant risks to both mothers and newborns. The condition often requires careful management to prevent severe hemorrhagic events. PubMed, Embase, Scopus, and Web of Science searched for relevant literature until June 2024. A meta-analysis was performed to evaluate the effect of ITP on maternal and fetal outcomes. The results showed that antepartum hemorrhage occurred in 0.17 (95% CI = 0.12-0.25) of patients and postpartum hemorrhage occurred in 0.11 (95% CI = 0.07-0.16) of pregnant women with ITP. About 0.63 (95% CI = 0.50-0.74) of pregnant women needed treatment for ITP. The cesarean section (CS) rate was 0.48 (95% CI = 0.34-0.61), and the occurrence of preterm labor was 0.14 (95% CI = 0.07-0.24). A total of 0.32 of neonates had thrombocytopenia (95% CI = 0.18-0.52). The difference between the platelet count of those diagnosed with ITP before pregnancy and those diagnosed after pregnancy was significant (MD=-31.50, 95% CI=51.29-11.72, p<0.01). This meta-analysis highlights the significant impact of ITP on pregnancy, estimating risks of bleeding, CS, gestational diabetes, preterm labor, and neonatal thrombocytopenia. These findings underscore the need for vigilant monitoring and tailored management of pregnant women with ITP.

Glycated albumin in pregnancy correlates negatively with body mass index and contributes to the risk of gestational diabetes mellitus

ObjectivesThe aims of our study were to establish a reference interval for glycated albumin (GA) in gestational week 30, to investigate whether GA can replace or reduce the need for oral glucose tolerance test (OGTT) in pregnancy, and to reassess the usefulness of body mass-index (BMI), age and fasting glucose in detection of gestational diabetes (GDM). Designand methods: We measured GA in 486 healthy pregnant women. Reference interval was calculated using the central 95% of the results. ROC curves were created to assess the ability of GA, fasting glucose and BMI separately to detect GDM, and logistic regression analysis was used to estimate risk of developing GDM given the level of the same markers. Finally, multiple logistic regression analysis based on GA, fasting glucose and BMI was used to find a strategy of predicting a patient’s risk of GDM. ResultsThe reference interval for GA at week 30 of gestation is 6.8-10.3%. The analysis has a low AUC (0.53) with respect to detecting GDM. It increases slightly to 0.64 when corrected for BMI, as GA is inversely correlated to BMI. Combining GA with fasting glucose and BMI at gestational weeks 16-20 could raise the AUC to 0.80. ConclusionGA cannot be recommended to replace OGTT for the diagnosis of GDM. Nor can it be used to identify women at risk of developing GDM. GA combined with fasting glucose and BMI in early pregnancy could be a useful model to estimate risk of GDM.

Challenging the American College of Obstetricians and Gynecologists' Clinical Practice Update on Screening for Pre-existing Diabetes and Early Gestational Diabetes.

A recent American College of Obstetricians and Gynecologists Clinical Practice Update continues to recommend targeted (as opposed to universal) screening for pregestational diabetes, no longer recommends screening for early gestational diabetes mellitus (GDM), and provides updated guidelines for immediate postpartum testing for diabetes in patients with GDM. Here, we present data that the targeted screening paradigm, which has repeatedly been shown to fail in practice because of its complexity, no longer makes sense in the context of the high and rising prevalence of diabetes and diabetic risk factors, and we argue that the time has come for universal early pregnancy screening for pregestational diabetes. Furthermore, the recommendation against early screening for GDM is based on 2021 U.S. Preventive Services Task Force guidance, which in turn is based almost entirely on a single underpowered study that excluded individuals at highest risk and does not account for more recent research showing benefits of early diagnosis and treatment. Universal early pregnancy screening for pregestational diabetes may also help to identify patients at risk who will benefit from early GDM diagnosis and treatment and may provide rationale for prioritizing postpartum diabetes testing.

The cascade integration model based on machine learning to predict gestational diabetes

Abstract Machine learning has significant superiority in disease prediction and auxiliary clinical decisions due to its powerful data analysis and exploration capabilities. Making accurate predictions about gestational diabetes mellitus (GDM) with clinical data is not always an easy task. In previous work, GDM was predicted using machine learning models and integrated learning models such as Stacking. This work improves on previous work by developing a new integrated learning model building approach for better exploiting the benefits of machine learning models. Initially, the clinical data set is normalized. Then, according to the principle of removing the redundant features of each machine learning model, the first nine high-importance features of the five single models are filtered respectively. Finally, the GDM Cascade integration prediction model is constructed and compared with the Blending model and Stacking model, it is obvious that the proposed model construction method has superior performance and the AUC value reaches 0.9536.&amp;#xD;

Association between Gestational Bisphenol A Exposure and Maternofoetal Outcomes: A Cohort Study in a Single Tertiary Hospital in Klang Valley

A growing body of literature has documented the adverse effects of bisphenol A (BPA) exposure on pregnancy and birth outcomes. Regardless, how gestational BPA exposure affects mother-newborn pairs in Malaysia is yet to be explored. Hence, this study aimed to investigate urinary BPA levels of pregnant women living in Klang Valley and their associations with adverse obstetric and birth outcomes. This cross-sectional study involved pregnant women in their third trimester attending antenatal clinic in Hospital Al Sultan Abdullah (HASA), UiTM Puncak Alam, who planned to have their delivery in HASA. Information on maternal age, parity, education, household income, gestational age, and obstetric complications, such as Gestational Diabetes Mellitus (GDM), preeclampsia, preterm labour, and foetal growth restriction (FGR) were collected. Maternal urine samples were also obtained and evaluated using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Additionally, the neonatal outcomes including mode of delivery, gestational age, birth weight and need for NICU admission were documented. Our LC-MS/MS analysis showed that BPA was present in all the urine samples, with levels varying from 4.42 to 30.86 ng/mL. The median level was 15.96 ng/mL. Urinary BPA level has no significant correlation with gestational hypertension (GHTN), preterm labour and low birth weight babies. Babies who need NICU admission were born to mothers who exhibited significantly different urinary BPA levels compared to those whose babies were not admitted (p=0.049). Finding from this study suggestive of further investigation on level of gestational urinary BPA with NICU admission, ideally with a larger sample size to validate these results.

The Linkage of Grand Multiparity with Associated Risks During Pregnancy and Childbirth: A Cross-Sectional Study at Tertiary Care Hospital

Objective: To investigate the risk factors associated with grand multiparityn during pregnancy and childbirth. Study Design: Cross-sectional study. Place and Duration of Study: Gynaecology and Obstetrics Department, Pakistan Emirates Military Hospital, Rawalpindi, Pakistan from Dec 2022 to Oct 2023. Methodology: Three hundred twenty-two (n=322) women from the Pakistan Emirates Military Hospital, labor ward, Rawalpindi, Pakistan, gynecology and obstetrics department participated in this research. Primiparous, Multiparous, and grand multiparous females were included in the study for various demographic, maternal, and neonatal factors. Results: Primiparous women were higher in number than multiparous and GMP women [202(62.7%), 109(33.8%), and 11(3.4%), respectively). Among the risk factors associated with GMP, there was a greater incidence of miscarriage, i.e., 59.1% in GMP, and Gestational diabetes (27.2% in GMP) and spontaneous preterm delivery (45.4% in GMP) were the two most common problems linked with pregnancy in GMP women. The primary neonatal consequence observed was low birth weight (32.1% in PM), with a prevalence of 32.1%. However, the percentage of infants with an APGAR score below 7 at 5 minutes was higher in the GMP (36.3%). Conclusion: When compared to other parity groups, grand multiparous Pakistani women face the same risks of maternal and newborn problems. In GMP, advanced age may have a significant impact on pregnancy outcomes. Nonetheless, grand multiparty may not be outlawed, given that women receive adequate prenatal care.