Gestational Diabetes Research Articles

Evaluation Of Maternal And Fetal Findings In Patients With Pemphigoid Gestationis.

To evaluate the maternal and fetal outcomes of 12 pregnant women diagnosed with pemphigoid gestationis, in conjunction with a review of the literature. A retrospective review was conducted on the medical records of 12 patients diagnosed with pemphigoid gestationis who presented between January 2014 and January 2024. Twelve pregnant patients with pemphigoid gestationis were included in the study. The disease manifested during the first pregnancy in six patients. Mean maternal age was 30 years, mean gestational age at delivery was 33 weeks, and mean birth weight was 2146 g. Neonatal lesions were identified in two neonates. Intrauterine growth restriction, starting at an average of 33 weeks of gestation, was observed in four patients. Oligohydramnios was noted in two patients, hypertension in one patient, placental abruption in one patient, and gestational diabetes mellitus in one patient. During pregnancy, five patients were treated with oral steroids, six patients with intravenous steroids, and nine patients with topical steroids. Neonatal intensive care unit admission occurred in six neonates, and maternal intensive care unit admission was required for one patient. Patients with pemphigoid gestationis are at significant risk for severe maternal morbidity and adverse fetal outcomes in both the antepartum and postpartum periods. Early diagnosis of vesiculobullous lesions and close monitoring as high-risk pregnancies through a multidisciplinary approach are recommended.

Early Prediction of Gestational Diabetes Mellitus and Insulin Therapy Requirement Using First-Trimester PAPP-A and Free β-hCG MoMs Levels: A Retrospective Case–Control Study

Objectives: To evaluate the association between gestational diabetes mellitus (GDM), including insulin-dependent GDM with pregnancy-associated plasma protein-A (PAPP-A) multiples of the median (MoM) and free beta human chorionic gonadotropin (free β-hCG) MoM levels, and to assess their potential as predictive risk factors. Methods: This retrospective study included 2588 women with singleton pregnancies who underwent combined first-trimester screening, along with the 50 g glucose challenge test (GCT) and a 100 g oral glucose tolerance test (OGTT) between 24 and 28 weeks of gestation. Patients were initially divided into four groups based on the glucose screening results, and PAPP-A and free β-hCG MoMs were compared between these groups. GDM cases managed by diet were then compared with those requiring insulin therapy. Results: Of the study population, 132 women (5.10%) were diagnosed with GDM, 112 (84.8%) managed their glycemia with dietary changes, while 20 (15.2%) required insulin therapy. PAPP-A levels were significantly lower in the GDM group compared to the control group (p < 0.001). In addition, the insulin-dependent GDM group had significantly lower PAPP-A levels than the diet-controlled group (p < 0.001). No significant differences were observed in the free β-hCG MoM levels between the groups (p = 0.292). Receiver operating characteristic analysis identified 0.815 as the optimal PAPP-A cut-off value for predicting GDM, with a sensitivity of 61.4%, specificity of 61.6%, and an area under the curve (AUC) of 0.649 (95% CI: 0.595–0.703). For insulin-dependent GDM, the same threshold yielded an AUC of 0.621 (95% CI: 0.563–0.679), with a sensitivity of 58.6% and a specificity of 59.7%. Conclusions: Low serum PAPP-A MoM levels are significantly associated with the development of GDM, including insulin-dependent cases. Although PAPP-A alone may not be a definitive predictive marker for GDM, low levels could support the recommendation for early screening as part of a broader diagnostic approach.

Renal function and risk of gestational diabetes mellitus: the potential mediating role of carnitine metabolites.

Renal function may play a crucial role in the development of gestational diabetes mellitus (GDM). However, prospective studies on this topic are scarce and the mechanisms remain unclear. To assess the associations of early-pregnancy renal function with GDM and the mediating role of carnitine metabolites. The study was based on the Tongji-Huaxi-Shuangliu Birth Cohort. Renal function was assessed before 15 weeks of gestation. GDM was diagnosed at 24-28 weeks of gestation by a 2-h oral glucose tolerance test. Multivariable logistic regression was utilized to estimate the associations of renal function indicators with GDM. Plasma carnitine metabolites in early pregnancy were quantified using ultrahigh-performance liquid chromatography-tandem mass spectrometry. Mediation analyses were applied to assess the mediating effects of carnitines. The mean age of 6,770 participants was 26.6 ± 3.7 years. Serum uric acid, uric acid to creatinine ratio, and estimated glomerular filtration rate (eGFR) were positively associated with GDM, and the odds ratios (ORs) were 1.23 (95% confidence interval, CI, 1.11, 1,36), 1.31 (1.19, 1.45), and 1.15 (1.04, 1.27) for each 1 standard deviation (SD) increment. Increased creatinine, creatinine to weight ratio, and cystatin C were associated with lower GDM risk with ORs of 0.88 (0.80, 0.97), 0.88 (0.78, 0.99), and 0.89 (0.80, 0.98) for each log-SD increment. Serum creatinine-, creatinine to weight ratio-, and eGFR-related carnitine score played positive mediating roles, and the mediation proportions were 43.1%, 81.9%, and 56.7%, respectively. Renal function should be monitored for GDM, and the potential roles of carnitine metabolites require further evaluation and validation.

The association between gestational diabetes and fear of childbirth: a longitudinal register study

BackgroundGestational diabetes mellitus is a common condition known to be associated with pregnancy complications, larger fetus size and depression, and may therefore lead to increased concerns linked to childbirth. We sought to determine whether gestational diabetes mellitus is linked to fear of childbirth, and whether the possible association is mediated by depressive symptoms.MethodsThis study includes women who gave birth at the Kuopio University Hospital between 2019–2022 and had reported their level of fear of childbirth after gestational week 28 (n = 3293). Two outcome measures of fear of childbirth were used: self-rated intensity on a visual analogue scale, and obstetrician-confirmed diagnosis. Gestational diabetes mellitus was diagnosed based on plasma glucose concentrations in fasting state (≥ 5.3 mmol/l) and after a 75 g glucose load (one hour: ≥ 10.0 mmol/l, two hours: ≥ 8.6 mmol/l). The Edinburgh Postnatal Depression Scale (EPDS) was used to assess depressive symptoms in the third trimester. We performed logistic and linear regression analyses while adjusting for possible confounding factors and examined the controlled direct effect by including depressive symptoms in the model.ResultsGestational diabetes mellitus was associated with increased risk of fear of childbirth diagnosis (OR = 1.42, 95% CI 1.11─1.73) and higher levels of fear of childbirth (B = 0.31, 95% CI 0.09─0.53), but the associations were attenuated and no longer significant after further adjustments for body mass index and health behaviors (OR = 1.22, 95% CI 0.91─1.5; B = 0.11, 95% CI -0.13─0.35). Inclusion of depressive symptoms in the model attenuated the non-significant estimates further.ConclusionsThe observed association between fear of childbirth and gestational diabetes mellitus in previous studies may result from the lack of adjustments for confounding factors.

Immune changes in pregnancy: associations with pre-existing conditions and obstetrical complications at the 20th gestational week—a prospective cohort study

BackgroundPregnancy is a complex biological process and serious complications can arise when the delicate balance between the maternal and semi-allogeneic fetal immune systems is disrupted or challenged. Gestational diabetes mellitus (GDM), pre-eclampsia, preterm birth, and low birth weight pose serious threats to maternal and fetal health. Identification of early biomarkers through an in-depth understanding of molecular mechanisms is critical for early intervention.MethodsWe analyzed the associations between 47 proteins involved in inflammation, chemotaxis, angiogenesis, and immune system regulation, maternal and neonatal health outcomes, and the baseline characteristics and pre-existing conditions of the mother in a prospective cohort of 1049 pregnant women around the 20th gestational week. We used Bayesian linear regression models to examine the impact of risk factors on biomarker levels and Bayesian cause-specific parametric proportional hazards models to analyze the effect of biomarkers on maternal and neonatal outcomes. We evaluated the predictive value of baseline characteristics and 47 proteins using machine-learning models and identified the most predictive biomarkers using Shapley additive explanation scores.ResultsAssociations were identified between specific inflammatory markers and several conditions, including maternal age and pre-pregnancy body mass index, chronic diseases, complications from prior pregnancies, and COVID-19 exposure. Smoking during pregnancy affected GM-CSF and 9 other biomarkers. Distinct biomarker patterns were observed for different ethnicities. Within obstetric complications, IL-6 inversely correlated with pre-eclampsia risk, while birth weight to gestational age ratio was linked to markers including VEGF and PlGF. GDM was associated with IL-1RA, IL-17D, and eotaxin-3. Severe postpartum hemorrhage correlated with CRP, IL-13, and proteins of the IL-17 family. Predictive modeling yielded area under the receiver operating characteristic curve values of 0.708 and 0.672 for GDM and pre-eclampsia, respectively. Significant predictive biomarkers for GDM included IL-1RA and eotaxin-3, while pre-eclampsia prediction yielded the highest predictions when including MIP-1β, IL-1RA, and IL-12p70.ConclusionsOur study provides novel insights into the interplay between preexisting conditions and immune dysregulation in pregnancy. These findings contribute to our understanding of the pathophysiology of obstetric complications and the identification of novel biomarkers for early intervention(s) to improve maternal and fetal health.

Pregnancy Outcomes and Maternal Characteristics in Women with Pregestational and Gestational Diabetes: A Population-Based Study in Spain, 2016–2022

Background/Objectives: The objective of this study was to compare trends in the incidence of deliveries and in obstetric interventions and outcomes in women with and without type 1 diabetes (T1DM), type 2 diabetes (T2DM), and gestational diabetes (GDM). Methods: This was an observational study using the Spanish National Hospital Discharge Database (2016–2022). Results: A total of 1,995,953 deliveries were recorded between 2016 and 2022 (6495 mothers with T1DM, 5449 with T2DM, and 124,172 with GDM). The incidence of T1DM and GDM increased over time, although it remained stable in women with T2DM. Women with T2DM were more likely to have obstetric comorbid conditions (72.93%) than women with GDM (63.04%), women with T1DM (59.62%), and women who did not have diabetes (45.3%). Pre-eclampsia, previous cesarean delivery, and arterial hypertension were the most prevalent conditions in all types of diabetes. The highest frequency of cesarean delivery was recorded for women with T1DM (55.04%), followed by women with T2DM (44.94%), and those with GDM (28.13%). The probability of cesarean delivery was 2.38, 1.79, and 1.19 times greater for T1DM, T2DM, and GDM, respectively, than for women who did not have diabetes. The adjusted rate for severe maternal morbidity was significantly higher for women with T1DM (RR 2.31; 95%CI 2.02–2.63) and T2DM (RR 1.58; 95%CI 1.34–1.87) than for women without diabetes. Conclusions: The incidence of deliveries in women with T2DM remained unchanged between 2016 and 2022; the incidence of deliveries increased in women with T1DM and GDM. The prevalence of comorbidity and obstetric factors increased over time in women with T1DM and GDM.

Association between obesity in women with multiple gestations and adverse obstetric outcomes: a study of an American population database with over 136,000 unique deliveries.

The purpose of this study is to compare obese and non-obese women with multiple pregnancies to determine the effects on pregnancy, delivery, and neonatal outcomes. We conducted a retrospective population-based study utilizing data collected between 2004 and 2014 inclusively, from the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample. A total of 137,303 multiple pregnancies were analyzed; 130,542 (95%) were non-obese, while 6761 (5%) were obese. An initial analysis was performed to identify the prevalence of obesity in women with multiple pregnancies. Subsequently, chi-square tests and binary logistic regression analyses were conducted to assess the association between obesity and multiple gestation in the context of obstetric complications. There was a statistically significant increase in the prevalence of obesity for women with multiple gestations (p < 0.0001). The obese group was at higher risk of pregnancy-induced hypertension (adjusted odd's ratio [aOR] = 1.89, 95% confidence interval [CI] = 1.77-2.02), gestational hypertension (aOR = 1.84, CI = 1.65-2.05), preeclampsia (aOR = 1.68, CI = 1.55-1.81), preeclampsia or eclampsia superimposed on pre-existing hypertension (aOR = 1.86, CI = 1.58-2.20), gestational diabetes mellitus (aOR = 2.65, CI = 2.44-2.87), and placenta previa (aOR = 0.57, CI = 0.39-0.85). They were more likely to have preterm premature rupture of membranes (aOR = 1.19, CI = 1.06-1.34), chorioamnionitis (aOR = 1.24, CI = 1.03-1.51), caesarean deliveries (aOR = 1.28, CI = 1.18-1.38), wound complications (aOR = 1.65, CI = 1.31-2.08), and transfusions (aOR = 0.77, CI = 0.67-0.89). They were less likely to have small for gestational age neonates (aOR = 0.88, CI = 0.79-0.97), though more likely to have neonates with congenital anomalies (aOR = 1.56, CI = 1.16-2.10). Obesity and multiple gestations are independent risk factors for adverse obstetric outcomes. Combined, when analyzed in a large population, obesity in multiple gestation increases the risk of maternal, delivery, and neonatal complications.

Manganese exposure and perinatal health: a systematic review of literature.

Manganese is essential for adequate feto-maternal health; however, an inverted U-shaped relation has been found between maternal manganese status and pregnancy complications. This systematic review summarizes the effect of maternal manganese exposure and perinatal health. We adopted a systematic approach to retrieve the recent literature. After applying the inclusion/exclusion criterion, a total of 20 studies were included in this review. Results found a non-significant relationship between maternal manganese exposure and risk of gestational diabetes mellitus (GDM), while only three studies reported the association between higher manganese levels and risk of preterm birth. Also, inconsistent results were found regarding higher manganese status and risk of low birth weight. This review reported no association between higher maternal manganese status andrisk of GDM. Nevertheless, the paucity of literature related to small for gestational age and pre-eclampsia prohibits a conclusion. Further studies are required for evaluation of environmental manganese exposure and maternal manganese status.

Evaluating causal associations of chronotype with pregnancy and perinatal outcomes and its interactions with insomnia and sleep duration: a mendelian randomization study

BackgroundObservational studies suggested chronotype was associated with pregnancy and perinatal outcomes. Whether these associations are causal is unclear. Our aims are to use Mendelian randomization (MR) to explore (1) associations of evening preference with stillbirth, miscarriage, gestational diabetes, hypertensive disorders of pregnancy, perinatal depression, preterm birth and offspring birthweight; and (2) differences in associations of insomnia and sleep duration with those outcomes between chronotype preferences.MethodsWe conducted two-sample MR using 105 genetic variants reported in a genome-wide association study (N = 248,100) to instrument for lifelong predisposition to evening- versus morning-preference. We generated variant-outcome associations in European ancestry women from UK Biobank (UKB, N = 176,897), Avon Longitudinal Study of Parents and Children (ALSPAC, N = 6826), Born in Bradford (BiB, N = 2940) and the Norwegian Mother, Father and Child Cohort Study (MoBa, N = 57,430), and extracted equivalent associations from FinnGen (N = 190,879). We used inverse variance weighted (IVW) as main analysis, with weighted median and MR-Egger as sensitivity analyses. Relying on the individual participant data from UKB, ALSPAC, BiB and MoBa, we also conducted IVW analyses of insomnia and sleep duration on the pregnancy and perinatal outcomes, stratified by genetically predicted chronotypes.ResultsIn IVW and sensitivity analyses, we did not find robust evidence of associations of chronotype with the outcomes. Insomnia was associated with a higher risk of preterm birth among evening preference women (odds ratio 1.61, 95% confidence interval: 1.17, 2.21), but not among morning preference women (odds ratio 0.87, 95% confidence interval: 0.64, 1.18), with an interaction P-value = 0.01. There was no evidence of interactions between insomnia and chronotype on other outcomes, or between sleep duration and chronotype on any outcomes.ConclusionsThis study raises the possibility of a higher risk of preterm birth among women with insomnia who also have an evening preference. Our findings warrant replications due to imprecise estimates.

Design and analysis of a telemonitoring system for high-risk pregnant women in need of special care or attention

BackgroundHigh-risk pregnancies, characterized by underlying health issues or unusual circumstances, pose increased risks to both maternal and neonatal health during pregnancy and childbirth. Global guidelines emphasize the importance of early identification, monitoring, and intervention to mitigate these risks.MethodWe decided to design and implement a telemonitoring system for remotely monitoring and managing pregnancies in women with conditions such as hypertension, diabetes, or high-risk pregnancy. When a high-risk pregnant mom is discharged from the hospital, the Healthcare Center or Integrated Healthcare Services Center in her area is immediately notified via SMS to ensure her condition is monitored remotely. In addition to sending notifications, the patient’s medical record, post-discharge care recommendations, drug prescription, re-visit time, and contact details are also sent to them via the application. The high-risk pregnant mom is followed up and all her information is recorded in the application for further use. To evaluate the usability of the proposed telemonitoring system, we conducted a laboratory study involving 92 participants, including pregnant mothers’ care experts at hospitals, healthcare center experts, midwives at integrated healthcare services centers, and midwifery department experts with varying levels of digital skills. Participants performed activities related to the application’s services, while their satisfaction was measured using the QUIS 7.0 questionnaires covering multiple aspects of usability, including user interface, system capabilities, and online help, with ratings on a Likert scale.ResultThe usability evaluation revealed that the average satisfaction score across all usability dimensions was above 8, demonstrating a satisfactory level of system usage from all user perspectives. Additionally, the close alignment of mean and median scores, along with standard deviations below 1 for several dimensions, indicated consistent positive feedback among users.ConclusionOur telemonitoring system demonstrates promise for enhancing the management of high-risk pregnancies, facilitating better health outcomes for mothers and infants through effective remote monitoring and support. The usability test results underscore the platform’s effectiveness and user satisfaction, contributing valuable insights for future improvements in high-risk pregnancy care.

Evaluating pregnancy outcomes in women with uterine fibroids treated with high-intensity focused ultrasound: insights from a single-institution study

ObjectiveThis study aims to assess the safety and effectiveness of High-Intensity Focused Ultrasound (HIFU) ablation on pregnancy outcomes among women with uterine fibroids wishing to conceive, focusing specifically on short-term pregnancy outcomes immediately following HIFU treatment.MethodsA retrospective analysis was conducted on 210 women who underwent HIFU treatment (Group I) at our institution between January 2018 and December 2022 and subsequently conceived. Pregnancy outcomes were compared with two control groups: 510 patients who delivered vaginally (Group II) and 278 who underwent cesarean sections (Group III) during the same period. Statistical analyses included multivariable logistic regression to adjust for confounding factors. The study only considered outcomes related to the immediate pregnancy following HIFU treatment and did not include data on subsequent pregnancies or long-term effects.ResultsThe natural conception rate post-HIFU was 93.81% (197/210), with a miscarriage rate of 19.05% (40/210). Group I had significantly lower rates of gestational diabetes mellitus (8.24%) and precipitate labor (0%) compared to Group II but higher rates of mild anemia (31.18%) and adherent placenta (10.59%). Compared to Group III, Group I had lower rates of gestational diabetes mellitus (8.24% vs. 20.86%) and moderate anemia (4.71% vs. 16.55%) but a higher incidence of premature rupture of membranes (18.82%). Neonates in Group I had lower birth weights compared to Groups II and III (p < 0.05), with no cases of low birth weight in Group I. Multivariable analysis identified fibroid location as a predictor of preterm birth, while maternal age and mode of delivery influenced the risk of incomplete uterine rupture.ConclusionHIFU ablation is a safe and effective fertility-preserving treatment for women with uterine fibroids, demonstrating favorable short-term pregnancy outcomes. It does not increase perinatal risks, but its impact on pregnancy duration and certain complications suggests that careful patient selection and management are crucial. Future studies should investigate the long-term effects of HIFU on subsequent pregnancies.

Gestational Diabetes Mellitus, Breastfeeding, and Progression to Type 2 Diabetes: Why Is It So Hard to Achieve the Protective Benefits of Breastfeeding? A Narrative Review

Women diagnosed with gestational diabetes mellitus (GDM) face a significantly heightened risk of developing type 2 diabetes mellitus (T2DM) later in life. Breastfeeding (BF) has been identified as a potential strategy to delay or prevent T2DM; however, women with GDM often encounter barriers in initiating and maintaining adequate BF practices compared to those with uncomplicated pregnancies. This paradox prompts an exploration into the causes of these BF challenges and considers the possibility of reverse causation: Does prolonged and intensive BF mitigate the risk of subsequent glucose dysregulation and T2DM? Alternatively, do women with compromised insulin secretion and sensitivity, who are predisposed to T2DM, struggle to sustain intensive BF practices? This narrative review aims to explore the interplay between GDM, BF, and T2DM development by examining the different factors that present BF challenges among women with GDM. Understanding these dynamics is crucial for establishing realistic BF expectations and developing effective clinical and public health strategies to support BF in this high-risk population.

Features of mental state and reproductive function in dynamics inmentally ill women with infertility

Women suffering from a mental disorder are faced with the problem of pregnancy and the realisation of their reproductive rights throughout their lives. The presence of a mental disorder largely determines the onset, course and outcome of pregnancy. A deterioration in mental health is often accompanied by an impairment of menstrual and reproductive function, and an improvement contributes to their recovery.Objective: to analyse individual indicators of reproductive function in women with various mental disorders and infertility in dynamics according to the follow-up data.Material and methods. The study included 120 women with various mental disorders and infertility, who were observed for 2 years by a psychiatrist and a gynaecologist on the background of treatment of the existing disorders.Results. In 70% of cases, mentally ill women have primary infertility, with idiopathic infertility predominating (63.3%), especially in the context of secondary infertility (77.8%; p&lt;0.05). Treatment of infertility by gynaecologists and mental disorders by psychiatrists leads to the normalization of the menstrual cycle and the onset of pregnancy. Pregnancy is usually accompanied by obstetric and somatic complications (fetal growth retardation and miscarriage, placental disorders, hypertension, oedema, lipid metabolism disorders, gestational diabetes mellitus). Reproductive function is impaired mostly in patients with schizophrenia and affective disorders, they account for 80.8% of observed infertility. Fertility is lowest in patients with paranoid schizophrenia: pregnancy occurred in 12.9% of patients, none of them gave birth. In schizoaffective disorder, 43.75% of women became pregnant, but only 20% gave birth. In bipolar affective disorder (BAD) type I, pregnancy occurred in 87.5% of patients (of which 57.1% resulted in a childbirth), in bipolar disorder type II – in 43.75% (of which 42.8% resulted in a childbirth), and in recurrent depressive disorder – in 60% (of which 50% resulted in a childbirth). In these disorders, the duration of infertility correlates with the duration of the disease (p&lt;0.05). In neurotic disorders, fertility suffers to a lesser extent: pregnancy with recovery or significant improvement of the mental condition occurred in 75–100% of cases, but only 66.7% of cases resulted in a child birth. Childbirth was mainly performed by caesarean section.Conclusion. Reproductive function in mentally ill women depends largely on the type of mental disorder, the characteristics of its course, the efficacy of psychopharmacotherapy, the quality of remission and the degree of social and family adaptation, which must be taken into account in the diagnosis and treatment of infertility.

The influence of fetal sex on antenatal maternal glucose and insulin dynamics

The ‘Developmental Origins of Health and Disease’ (DOHaD) hypothesis postulates that exposures during critical periods of development and growth, including maternal hyperglycemia, can have significant consequences for short- and long-term health in offspring. The influence of fetal status on maternal (patho)physiology is less well understood but gaining attention. Fetal sex specifically may be an independent risk factor for a range of adverse pregnancy outcomes, including increased gestational diabetes mellitus (GDM) frequency with male fetuses in multi-ethnic populations. Fetal sex has been thought to modulate maternal glucose metabolism, including insulin dynamics, through complex genetic and hormonal interactions. Mechanisms have not been fully elucidated, however, but may relate to sexual dimorphism in maternal-fetal-placental interactions. We review current evidence on the potential influence of fetal sex on maternal glucose and insulin dynamics, and fetal outcomes.

Pregnancy in Inflammatory Bowel Disease: Data from a Real-World Cohort in Germany

Background: Inflammatory bowel disease (IBD) frequently manifests at a young age, during the peak fertility years. Understanding the risks of negative pregnancy outcomes associated with IBD is crucial for effective pregnancy management and support. Additionally, it is essential to provide patients with the necessary knowledge to make informed choices and foster their confidence in navigating pregnancy while maintaining effective disease management. Although IBD frequently appears during the peak fertility years, knowledge about managing pregnancy in the context of IBD remains limited and often inaccurate among both physicians and patients. Our study aims to assess the complications occurring during pregnancy in patients with IBD, considering the level of disease activity, and to evaluate the standard of care provided to patients with chronic inflammatory conditions through a cohort analysis. Methods: Patients with IBD who had children were included in this single-center mixed-method (retrospective and prospective) study. Clinical data, disease progression, course of pregnancy, and complications were examined in women. Outcomes for children of men with IBD were also analyzed. To supplement the data, a survey addressing various pregnancy-related topics, including all patients from the university outpatient clinic for IBD, was conducted over a period of six months. Results: A total of 410 patients were screened retrospectively between 2010 and 2021. In total, 134 patients who had children were included in the study: 51.4% (n = 69) had Crohn’s disease, 44% (n = 59) had ulcerative colitis, and 4.6% (n = 6) had unclassified inflammatory bowel disease. Of the women, 85% (n = 34) were in remission for at least three months before pregnancy, 14.6% (n = 6) experienced an acute flare-up during pregnancy, and 10.3% (n = 4) and 7.7% (n = 3) had active disease at the time of delivery and during breastfeeding, respectively. Patients with IBD who were in remission before pregnancy did not experience a higher risk of pregnancy complications (no cases of pre-eclampsia or placental abruption were reported in this group). However, the rates of gestational diabetes and fever during pregnancy were 10% for those in remission, compared to 25% for those with active disease. Conclusions: Patients with IBD in remission did not present an increased risk of pregnancy complications. However, our survey indicates that those with active disease at conception were more likely to experience complications such as gestational diabetes and fever. These findings underscore the importance of adequate patient education regarding the safety of various IBD medications during pregnancy in order to avoid pregnancy-related complications.

Treatment Versus Observation in Early Gestational Diabetes Mellitus: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Early gestational diabetes mellitus (eGDM) refers to elevated blood glucose levels not meeting the criteria for overt diabetes before 20 weeks gestation. Observational studies link eGDM to adverse outcomes, but randomized controlled trial (RCT) evidence on early intervention benefits remains inconclusive. To address this, we performed a systematic review and meta-analysis (SRM) of RCTs on this subject. We searched electronic databases to identify RCTs comparing early treatment versus observation for eGDM. The primary neonatal outcomes analyzed were large-for-gestational-age (LGA) and macrosomia. The primary maternal outcome was pregnancy-related hypertension. Secondary neonatal outcomes included neonatal respiratory distress (NRD), neonatal intensive-care unit (NICU) admission, small-for-gestational-age (SGA), cord-blood C-peptide ≥90th percentile, and neonatal hypoglycemia. Secondary maternal outcomes were cesarean section (CS), emergency CS, labor induction, preeclampsia, and preterm birth. Seven RCTs involving 4,427 pregnancies were analyzed. The studies differed in their timing and methods of inclusion. Six studies used a combination of lifestyle and pharmaceutical interventions, while one relied solely on lifestyle modifications. Early treatment did not reduce LGA [OR 0.84 (95%CI: 0.53-1.32); P=0.44], macrosomia [OR 0.68 (95%CI: 0.43-1.06); P=0.09], or pregnancy-related hypertension [OR 1.04 (95%CI: 0.68-1.57); P=0.87]. Among the secondary outcomes, only NRD was significantly reduced in the treatment arm [OR 0.52 (95%CI: 0.34-0.80); P=0.003]. However, sensitivity analysis, omitting the lifestyle-only study, demonstrated a lower risk of macrosomia with early intervention [OR 0.55 (95%CI: 0.34-0.91); P=0.02]. The SRM demonstrates early intervention does not improve most pregnancy outcomes, except NRD. Sensitivity analysis, excluding the lifestyle-only study, additionally revealed a reduction in macrosomia. The findings must be interpreted cautiously due to the variability in study designs. Replication in well-designed multicenter trials is required before clinical application.

User experience and perceived usability of nurse-led telemonitoring among women with gestational diabetes in Dhulikhel, Nepal

ObjectiveTo assess the usability and acceptability of nurse-led telemonitoring in managing gestational diabetes among Nepalese women.MethodsWe conducted a convergent mixed-method study among 91 pregnant women diagnosed with gestational diabetes at Dhulikhel Hospital, Nepal. Participants received glucometers and blood pressure monitors, along with training and instructions to measure and record their blood pressure and glucose levels at home once a week. Starting from the 28th gestational week, the study nurse reviewed measurements obtained at home during the biweekly telemonitoring follow ups, alternating with hospital visits. We used the System Usability Scale (SUS) to assess perceived usability and conducted in-depth interviews to understand participants’ experiences with telemonitoring and related technologies, including feasibility, acceptability, satisfaction with treatment, usability, as well as any difficulties or unmet needs. The quantitative analysis included descriptive statistics to summarize participant characteristics and System Usability Scale (SUS) responses, while a framework analysis was applied to examine the qualitative data.ResultsThe mean SUS score for telemonitoring services was 72.1 ± 7.6, indicating good usability (a score ≥ 68 indicates good usability). 93% of participants wanted to use the service frequently; 88% found it easy to use; 81% considered it well-integrated with their typical prenatal care. Participants acknowledged the benefits of virtual health visits, such as frequent health monitoring, facilitation of communication with healthcare providers, appointment reminders, added motivation for home monitoring, increased access to health information, and prevention of unnecessary anxiety. Overall, participants expressed satisfaction with the quality and features of the nurse-led telemonitoring for managing gestational diabetes, emphasizing its role in ensuring uninterrupted prenatal care.ConclusionsTelemonitoring is a feasible and acceptable tool to facilitate close monitoring of pregnant women with gestational diabetes in peri-urban hospital settings in Nepal.

Investigating predictive factors in treatment response with metformin in patients with gestational diabetes mellitus: a cross-sectional analytical-descriptive study.

As the utilization of metformin for gestational diabetes mellitus (GDM) treatment continues to rise, a substantial segment of these patients will ultimately necessitate insulin during their therapeutic journey. Hence, assessing patients' clinical and laboratory attributes becomes invaluable in determining their likelihood of responding favorably to metformin medication. This discernment aids in selecting an optimal management approach, wherein the patients most likely to benefit significantly from metformin are identified, while alternative therapies like insulin are considered for individuals with a lower probability of treatment response. This was a cross-sectional analytical-descriptive study of individuals with GDM. Initially, the subject's laboratory results and demographic information were submitted. Following that, metformin was administered to all subjects along with counseling on maintaining a healthy diet and lifestyle. Following a 4-week interval, the patients were reassessed and divided into two groups based on their response to metformin medication and then analyzed. 807 people participated in this study, of which 329 people (40.8%) responded to treatment and the failure rate of metformin treatment was 59.2%. This research revealed that the predictive factors of response to metformin medication were, respectively, the amount of 1-hour oral glucose tolerance test (OGTT) (OR = 62.66), 2-hour postprandial plasma glucose (OR = 54.04), 2-hour OGTT (OR = 17.37), followed by the history of abortion (OR = 14.88), the number of pregnancies (gravida 3 and more) (OR = 5.06) and history of infertility (OR = 2.6). The current study's findings indicated that to enhance GDM care, metformin prescriptions should be prescribed to patients depending on their clinical characteristics and laboratory results.

Gestational Diabetes Mellitus Prevalence and Risk Factors - A Study from a Tertiary Care Centre in North India

Introduction: Type 2 diabetes mellitus (T2DM) and gestational diabetes mellitus (GDM) pose significant global health challenges. The increasing global prevalence of GDM and its associated complications underscores the need for proactive screening and management. The study aimed to evaluate the prevalence of GDM and its associated risk factors in a tertiary care hospital in North India Methodology: A prospective cross-sectional study conducted at Max Super Speciality Hospital, New Delhi, during 2016-2017, enrolled 900 pregnant women (aged 18-50 years) from the antenatal outpatient department (OPD). Primary objective: To assess impaired oral glucose tolerance prevalence (IADPSG criteria) at 24th-28th weeks. The data covered demographic, socioeconomic, obstetric, and medical details. Descriptive statistics were used to summarize the variables. Chi-square or Fisher's tests were applied to categorical data, while continuous data were analysed using independent t-tests. Multiple regression analysis was conducted to identify risk factors. Results: GDM was diagnosed in 7.4% of participants. Prevalence was highest in the age group &gt;35 years (36.2%, p=0.000), and a significant association was found between increasing body mass index (BMI) and GDM (p=0.04). Adverse obstetric history, including previous abortions and GDM in prior pregnancies, increased the risk of GDM. Complications during pregnancy, such as macrosomia (present in 1 patient with GDM and none in non-GDM), foetal distress (9.09% in GDM), and preeclampsia (4.7% in GDM), were higher in women with GDM. Vaginal delivery prevalence was higher in non-GDM, while GDM had a higher rate of caesarean section delivery (p&lt;0.005). Conclusion: The study discloses a 7.4% GDM prevalence in North Indian tertiary care, accentuating rising diabetes trends. Identified risk factors inform antenatal screening, highlighting the need for early GDM management to mitigate complications and prevent future diabetes. Single-centre limitations emphasise the necessity for broader population studies for accurate prevalence rates.

Global Picture of Diabetes &amp; GDM

India is one of the countries with diabetes in the world and has one of the highest rates of GDM in women, affecting more than 5 million women in the country each year [1]. India currently has the second highest number of people with type 2 diabetes in the world at 77 million; Almost half of these patients are women. IDF 2019 estimates that 6 million newborns in India alone are affected by some form of hyperglycemia (HIP) during pregnancy, 90% of which are due to GDM [1]. Therefore, all women should be tested for gestational diabetes, even if they are asymptomatic. Unfortunately, the diagnostic criteria are not the same.