Gestational Diabetic Mothers Research Articles

Altered Right Portal and Umbilical Vein Doppler Parameters in Fetal Macrosomia Resulting from Pregestational andGestational Diabetic Mothers: A Prospective Case-Control Study

Objective: To evaluate the blood flow of the umbilical vein and right portal vein in macrosomic fetuses of diabetic mothers and investigate the effect of maternal insulin treatment on these blood flows. Material and Methods: This prospective case-control study was conducted between March 2019 and December 2019. Fetuses of the 49 pregestational and gestational diabetic mothers who had an abdominal circumference percentile above 97% were evaluated as macrosomic and formed the study group. The study group was divided into two subgroups: patients treated with insulin and those who did not. In the control group, 48 non-diabetic pregnant women with matched gestational weeks whose fetuses are at the 10-90% percentile were included. Time-averaged maximum blood velocity (TAMXV) values of the right portal vein and the free loop of the umbilical vein were measured. Results: The median right portal vein TAMXV value and umbilical vein TAMXV value were found to be significantly higher in diabetic pregnancies (16.25 cm/s, and 15.28 cm/s, respectively) than in the control group (12.76 cm/s, and 13.38 cm/s, respectively, p<0.001). Umbilical and right portal vein flows were similar in macrosomic fetuses of diabetic mothers who were treated with insulin or those who did not. While umbilical vein flow in macrosomic fetuses increased as the gestational age progressed (p=0.028), it was observed steadily in normally growing fetuses. Conclusion: The umbilical and right portal vein flows are higher in macrosomic fetuses of diabetic mothers than in appropriately grown fetuses. Maternal insulin treatment does not affect fetal umbilical vein and right portal vein blood flow in macrosomic fetuses.

CD68 expression in the placenta of gestational diabetic mothers: A case-control study.

Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with the onset or first recognition during pregnancy and is the most common metabolic complication of pregnancy. Significant maternal and fetal complications can result from undiagnosed or inadequately treated GDM. To investigate the difference in the expression of the CD-68 marker in the Hofbauer cells (HCs) and their distribution within the villi in the placentas of diabetic and non-diabetic mothers. Sixty placentas were included in the study, 30 as controls and 30 from mothers with diagnosed GDM as cases. Full-thickness cross sections of placentas were obtained. Tissue processing was done, followed by haematoxylin and eosin (H&E). A study of CD68 markers (placental macrophages) was done using standard protocols of immunohistochemistry. Frequencies and percentages of Hofbauer cells (HCs) found in case and control placental tissue were calculated. Student's t-test was used to compare two groups using SPSS 13.0 software. When P is 0.0001, differences were considered statistically significant. We studied the distribution and number of fetal macrophages (CD68+) in diabetic and non-diabetic placentas. The immunostained CD68+ cell count was identified to be significantly higher in the GDM placenta. In relation to fetal blood vessels in the villus stroma of the GDM placenta in comparison to control, CD68+ cells were found more frequently. This study shows a significant increase in the number of Hofbauer cells in the placenta of mothers with GDM in comparison to control (P < 0.0001). An increase in macrophages in these placentae might be related to the protective mechanism against inflammation. Further studies are required to investigate the mechanism in detail.

Frequency and Pattern of Congenital Heart Defects in Infant of Diabetic Mother at Tertiary Care Hospital

Objective: This study was conducted to evaluate the frequency and pattern of congenital heart defects in the infant of pregestational and gestational diabetic mothers presenting at NICU and the causality department of NICH Karachi Pakistan. Methods: It was a cross-sectional study conducted at NICH Karachi, from July to Oct 2022. Infants born to diabetic mothers were enrolled in the study and the frequency and pattern of congenital heart diseases were determined by echocardiography which was performed by a pediatric cardiologist who has had expertise in his field for more than 10 years. Results: A total of 147 infants were enrolled in the study with the majority of them being 0 to 15 days of age (n=138, 93.9%) and were male gender (n=88, 59.9%). Nearly a quarter of mothers had pre-gestational diabetes (n=35, 23.8%) while 112 (76.2%) mothers had gestational diabetes. Out of 147, 67 (45.57%) infants had congenital heart defects. The most common heart defect was PFO (n=35, 23%) followed by PDA (n=22, 14.9%), VSD (n=8, 5.4%), ASD (n=4, 2.7%), HCM (n=4, 2.7%), TOF (n=4, 2.7%) and TGA (n=2, 1.36%). A significant difference was seen for ASD (p&lt;0.001), VSD (p&lt;0.001), TGA (p=0.011), HCM (p&lt;0.001), and TOF (p&lt;0.001) in congenital heart defect among infants born to mother having pre-gestational diabetes and gestational diabetes. Conclusion: This study analyzed that nearly half of the infants born to diabetic mothers had congenital heart defects. Thus, it highlights a need for the development of postnatal screening programs for CHD in our population for managing this problem timely. To reduce morbidity and mortality, early CHD diagnosis with screening echocardiography is advised.

Isolated Protein S Deficiency Presenting in Neonatal Inferior Vena Cava as Right Atrial Thrombus: A Case Report

Critically ill neonates are at the greatest risk of developing thromboembolic disease. Multiple risk factors have been identified, one of which is isolated Protein S deficiency-a rare cause. The free form of Protein S plays a role in anticoagulation, and its deficiency can manifest as deep venous thrombosis, pulmonary emboli, and superficial thrombophlebitis. Hereby, the authors present a case report of a two-day-old female neonate, born to a gestational diabetic mother, who was initially managed for hypoglycaemia and polycythaemia. On day 4 of life, the baby was shifted to the mother’s side. Twenty-four hours later, she developed late-onset neonatal sepsis with disseminated intravascular coagulation and required management with a mechanical ventilator, Intravenous (IV) antibiotics, and inotropic support. Echocardiography (ECHO) revealed a thrombus (8.9×6.8 mm) attached to the septum of the right atrium, extending from the Inferior Vena Cava (IVC). Treatment with Low Molecular Weight Heparin (LMWH) was initiated, and a follow-up ECHO after three months showed complete resolution of the thrombus. Interval analysis revealed isolated Protein S deficiency with normal Protein C levels. The present report emphasises the importance of interval analysis in identifying causes of Neonatal Thrombotic Events (NTE). Early diagnosis and management can reduce associated morbidity and mortality.

Perinatal Outcome among Women with Gestational Diabetes Mellitus

Background &amp; Objectives: Diabetes in pregnancy is associated with an increased risk of complications in both the mother and the fetus. Early diagnosis by the screening of pregnant women between 24 to 28 weeks of gestation with proper control of diabetes is important to reduce the adverse effects in perinatal outcomes. This study aims to know the perinatal outcome among neonates of diabetic mothers in comparison with those of non-diabetic mothers. Methods: A case control study was carried out at Maternity Teaching Hospital in Erbil City, Kurdistan Region, Iraq over 6 months’ period, from 1st April 2019 to 1st 0f January 2020. A convenient sample size of 100 participants of diabetic mothers compared with 100 non-diabetic mothers with ? 34 weeks of gestation till one week post-delivery, perinatal outcome including gestational age, mode of delivery, admission to neonatal care unit, birth weight, gender, early neonatal death, intrauterine death, the intrauterine fetal restriction was measured in both groups. Results: Among majority of gestational diabetic mothers regarding to maternal age 33.5% were aged between 18-35 years, 16.5% were older than 35, the most common complications in gestational diabetes group which were statistically significant were hypoglycemia, polycythemia and respiratory distress( 17.5%, 13% and 20% respectively) , neonatal macrosomia were revealed in 22.5% of gestational diabetes mellitus neonates and only 10% in non- gestational diabetes mellitus revealed, Conclusion: Morbidities like hypoglycemia, macrosomia, polycythemia, and respiratory distress syndrome are more common among babies of diabetic mothers when compared to those of non-diabetic mothers, and they are the most common complications that were observed.

Predicting resolution of hypoglycemia with and without dextrose infusion in newborn infant of gestational diabetic mothers.

Neonatal hypoglycemia (NH) may lead to significant neurological impairment if left untreated. Infants of gestational diabetic mothers (IGDM) are at increased risk of early NH and need to be screened. However, it is challenging to predict management with or without intravenous dextrose once hypoglycemia is identified. We evaluated the association between hypoglycemia risk scores at 1-hour of life and the need for intravenous dextrose for hypoglycemia resolution in IGDM. This was a retrospective cohort study of IGDM born at a gestational age ≥35 weeks from January 2015 to December 2017. NH was the disease of interest. The outcomes were the association of hypoglycemia risk score (HRS) with and without intravenous dextrose for hypoglycemia resolution. Each infant's hypoglycemia risk score (HRS) was calculated using data extracted from the maternal and neonatal electronic medical records. Resolution of hypoglycemia with and without intravenous dextrose was compared between the low HRS (0-1) group and the high HRS (2-5) group. Sixty-five infants were included in the study with a mean gestational age of 38.2 ± 1 weeks for low HRS and 38.0 ± 2 weeks for high HRS. While more children with high HRS were delivered by cesarean section (p = 0.04), hypoglycemia resolved more frequently without intravenous dextrose in infants with low HRS (p = 0.03). IGDM is at increased risk of NH. The resolution of hypoglycemia without dextrose infusion is frequently associated with low HRS at 1-hour of life. Early identification using HRS of IGDM whose hypoglycemia will resolve with or without intravenous dextrose may help clinicians triage newborns to either stay in the nursery or transfer for more invasive care.

Study of pathological changes in placentas of gestational diabetes mellitus and its association with fetal outcome

GDM is associated with an adverse fetal and neonatal outcome that often presents with macrosomia, birth trauma, neonatal hypoglycemia, and respiratory distress syndrome. The inclusion of GDM into 'the great obstetrical syndromes' emphasizes the role of the placenta in interactions between the maternal and fetal unit. &#x0D; The aim: To study pathological changes in the placentas of gestational diabetes mellitus and its association with fetal outcome.&#x0D; Materials and methods: The Prospective study was conducted among pregnant women above the age of 18 years diagnosed with gestational diabetes attending the hospital. All patients are subjected to complete physical examination along with obstetric examination. All the routine investigations, including the complete blood counts, blood picture, RBS, RFT, LFT, OGTT, CUE and, ultrasonography with doppler, histopathological examination of the placenta after delivery.&#x0D; Results: The weight of the babies born to GDM mothers and normal mothers were compared, and the GDM mother's baby weighed higher, meaning diabetes has an effect on the baby's weight which was statistically significant. Comparison of the placenta was made for cases and controls; the result suggested all the morphological parameters placenta - weight (p&lt;0.001), diameter (p&lt;0.001), area (p&lt;0.002) and thickness (p&lt;0.001) were statistically significant. The complications reported were respiratory complications, hypoglycemia, hyperbilirubinemia, meconium staining, polycythemia, sepsis and hypocalcemia. Babies of gestational diabetic mothers have a higher risk of developing neonatal complications than non-diabetic mothers. Villous oedema, villous fibrosis, syncytial knots, and fibrinoid necrosis is seen on histopathological examination was &lt;0.05, and hence there was a significant difference between these findings in both the groups.&#x0D; Conclusions: GDM is associated with the adverse fetal and neonatal outcome that often presents with respiratory complications, hypoglycemia, hyperbilirubinemia, meconium staining, polycythemia, sepsis and hypocalcemia. Including GDM into 'the great obstetrical syndromes' emphasizes the role of the placenta in interactions between the maternal and fetal unit

Vitamin D status and levels of pro-inflammatory cytokines in newborns born to mothers with endocrine diseases

Introduction. Vitamin deficiency states are found in 50–80% of pregnant women. Vitamin D deficiency is hazardous because it significantly increases the risk of complications during pregnancy, childbirth, as well as its effect on the child’s condition. Aim. To analyse the relationships between vitamin D status and levels of pro-inflammatory cytokines (IL-1β, IL-6) in children born to mothers with endocrine pathology.Materials and methods. Clinical-anthropometric and laboratory examination included 218 newborns: 98 (45.0%) infants of obese mothers, 32 (14.7%) infants of gestational diabetic mothers with underlying obesity, 22 (10.1%) infants of gestational diabetic mothers, 31 (14.2%) infants of mothers with type I diabetes mellitus and 35 (16.0%) infants of mothers without obesity and signs of impaired glucose tolerance.Results. Severe calcidiol deficiency is more often recorded in infants born to mothers with obesity, gestational diabetes mellitus and type I diabetes mellitus than in infants born to mothers without endocrine pathology. Serum IL-1β level was 2.6 times higher in newborns born to mothers with obesity than in the newborns from the control group — 14.6 (4.7; 36.5) and 5.6 (1.5; 13. 8) pg/ml, respectively (p = 0.04), 2.8 times higher in those born to women with gestational diabetes mellitus with underlying obesity —15.7 (6.5; 54.3) pg/ml (p = 0.02), 4.5 times higher in those born to mothers with gestational diabetes — 25.4 (5.0; 40.5) pg/ml (p = 0.035), and 6.1 times higher in those born to mothers with type I diabetes — 34.3 (3.8; 61.3) pg/ml (p = 0.01). Newborns born to mothers with type 1 diabetes mellitus had a higher serum IL-6 level as compared to the control group — 48.2 (21.3; 75.6) and 20.2 (5.1; 53.2) pg/ml (p = 0.006).Conclusion. Overweight and impaired glucose tolerance in the mother negatively affect the vitamin D sufficiency status, and if a fetus experiences vitamin D deficiency, provoke excessive production of pro-inflammatory cytokines in newborns.

Nutritional assessment of birth outcomes of gestational diabetic mothers in Gaza Strip, Palestine

Introduction: Gestational diabetes mellitus (GDM) is the most prevalent metabolic disorder during pregnancy. Numerous studies have dealt with risk factors of GDM, while others studied the health complications associated with GDM. This study aimed to investigate the association between GDM and nutritional birth outcomes in Gaza Strip, Palestine. Materials and Methods: The study utilized the case−control design where 44 GDM mothers and 44 non-GDM mothers were recruited. The study was conducted at the obstetric departments at Al-Shifa Maternity Hospital in Gaza and Mubarak Maternity Hospital in Khan Yunis. Data collection included anthropometric measurement and hematological indicators and other pertinent information through a structured questionnaire. Results: The result reported that the mean age of GDM pregnant women and non-GDM was 31 ± 11.5 and 23 ± 6.75 years, respectively. 13.6% had anemia, 20.5% had previous delivery of macrosomic baby, 15.9% had hypertension, and 11.4% were obese. In addition, 63.6% of GDM mothers had a family history of diabetes and 18.2% had a family history of GDM. 43.2% of GDM mothers delivered by cesarean section (CS) and 13.6% of GDM mothers had a premature delivery. Assessment of dietary intake indicated that 40.9% of GDM mothers have breakfast regularly. The neonatal median birth weight was 3.22 kg for babies of GDM mothers and 3.30 kg for babies of non-GDM mothers, and the median length was 52 cm versus 50 cm; 6.8% of neonates of GDM mothers had low Apgar score. Neonates of GDM mothers expressed significantly lower blood sugar (P = 0.039), lower albumin (P = 0.037), and higher soluble surface receptors – surface transferrin receptor (P = 0.017), but there were no statistically significant differences in the other hematological parameters. Conclusion: The study reflected a significant association between GDM and lower blood glucose, serum albumin, and iron status. Furthermore, the study reflected a significant association between GDM and CS delivery and neonatal hypoglycemia. The study emphasized the need to integrate clinical nutrition services in maternity departments and antenatal clinics and encourage physical activities during pregnancy. The following core competencies are addressed in this article: Patient care and procedural skills, Medical knowledge.

Comparison of hearing screening outcomes in newborns of gestational diabetic and non-diabetic mothers: a prospective, controlled study

Objectives To investigate whether Gestational diabetes mellitus (GDM) is related to presumptive hearing impairment in newborns. Study design The newborns were divided into two groups. The first group included the children of gestational diabetic pregnancies (DPs), and the second group, the children of non-gestational diabetic pregnancies (NDPs). Transient evoked otoacoustic emissions (TEOAE) and automated Auditory Brainstem Response (aABR) tests were applied as hearing screening tests. Results Twenty (40.8%) newborns in the DPs group and 5 (7.7%) newborns in the NDPs group failed the first hearing screening test (p = .001). The number of newborns with bilateral failed hearing screening tests was higher in the DPs group at the first screening (75% vs. 20%, p = .04). Fifteen (75.0%) of 20 newborns in the DPs group and 1 (20.0%) of 5 newborns in the NDPs group failed the second TEOAE hearing screening test (p = .04). Conclusion The possibility of presumptive hearing impairment is higher in the newborns of mothers with gestational diabetes compared to the newborns of non-diabetic mothers.

Study of Growth Process of Infants in Healthy and Gestational Diabetes Mothers in Rafsanjan City in 2017

Introduction: Gestational diabetes (GDM) can affect neonatal developmental indicators. The aim of this study was to evaluate and compare the growth process of infants less than 2 years of age with GDM and healthy mothers in Rafsanjan City. Methods: This cross-sectional study was performed on 208 neonates under 2 years of age from healthy mothers (104 neonates) and GDM mothers (104 neonates) in Rafsanjan City in 2017. Weight, height and head circumference were measured at birth, 6, 12 and 18 months. Fasting serum glucose above 126 mg/dl after 8 hours of fasting was considered as GDM. Data analysis was performed using SPSS 16 software and independent t-test, Chi-square and repeated measures analysis. Significant level was considered 0.05. Results: The mean age of GDM mothers was 31.8±5.3 and healthy mothers were 29.2±5.5 years. Cesarean delivery was reported in 73.1% of mothers with GDM and in 57.7% of healthy mothers (P = 0.020). Changes in weight, height and head circumference in the two groups at birth, 6 months, 12 months and 18 months after birth had an increasing process that was higher in infants of mothers with GDM (P &lt;0.001). Conclusion: The process of weight, height and head circumference changes in infants born to mothers with GDM was higher.

Morbidity and mortality among infants of diabetic mothers admitted to a neonatal care unit in Karbala pediatric teaching hospital.

This study aimed to determine the morbidity and mortality patterns among infants of diabetic mothers admitted to the neonatal care unit in Karbala pediatric teaching hospital. The study enrolled fifty diabetic infants (pregestational and gestational) admitted to the ward from the 1st of October 2013 to the 30th of January 2014. Data on delivery mode, gestational age, birth weight, other associated morbidities, investigation results, therapy, length of hospital stay, and outcome were collected and compared to infants of non-diabetic mothers admitted during the same period. A retrospective analysis of maternal data was performed. 62% of infants were born to mothers with gestational diabetes, and 38% were born to mothers with pre-gestational diabetes. 86% were born by caesarian section, of which 35% were by emergency cesarean section. The mean gestational age of infants of diabetic mothers was 37w1d±1.88, and 29 (64%) had macrosomia. The most typical morbidities were hypoglycemia (significantly higher in infants of diabetic mothers (IDMs) than infants of non-diabetic mothers) and hyperbilirubinemia in 36 (72%) and 24 (48%), respectively. There was no difference in morbidity patterns between infants of pregestational and gestational diabetic mothers except for macrosomia, and transient tachypnea of newborns was higher in gestational diabetes. The mortality rate was not significantly higher in IDMs. Diabetes during pregnancy has a serious effect on neonates and their mothers. The commenced morbidities in IDMs were hypoglycemia, macrosomia, and hyperbilirubinemia, so strict control of blood glucose level during pregnancy and education of diabetic women is essential before and during gestation.

Evaluation of H19, Mest, Meg3, and Peg3 genes affecting growth and metabolism in umbilical cord blood cells of infants born to mothers with gestational diabetes and healthy mothers in Rafsanjan City, Iran.

Hyperglycemia during the first trimester leads to an increased risk of innate malformations as well as death at times close to delivery dates. The methylated genes include those from paternal H19 and PEG3 and those from maternal MEST and MEG3 that are necessary for the growth and regulation of the human fetus and its placenta. The aim of this study was to evaluate and compare the expression of these genes in the cord blood of healthy infants born to mothers with gestational diabetes mellitus (GDM) and healthy mothers.This case-control study was conducted on the cord blood of 40 infants born to mothers with GDM and 35 infants born to healthy mothers. Mothers were identified by measuring oral glucose tolerance in the 24th-26th week of pregnancy. Cord blood was obtained post-delivery, and cord blood mononuclear cells were immediately extracted, using Ficoll solution. Then, RNA extraction and cDNA synthesis were performed, and gene expression of MEG3, PEG3, H19, and MEST was assessed through quantitative real-time PCR.Findings show that the expression levels of MEG3, PEG3, H19, and MEST genes were significantly decreased in mononuclear cord blood cells of infants born to mothers with GDM when compared to those of the healthy control group.These findings reveal that the reduction of imprinted genes in mothers with GDM is most likely due to changes in their methylation by an epigenetic process. Considering the importance of GDM due to its high prevalence and its side effects both for mother and fetus, recognizing their exact mechanisms is of high importance. This has to be studied more widely.

Effect of the Human Amniotic Membrane on the Umbilical Vein Endothelial Cells of Gestational Diabetic Mothers: New Insight on Inflammation and Angiogenesis.

One of the most relevant diabetes complications is impaired wound healing, mainly characterized by reduced peripheral blood flow and diminished neovascularization together with increased inflammation and oxidative stress. Unfortunately, effective therapies are currently lacking. Recently, the amniotic membrane (AM) has shown promising results in wound management. Here, the potential role of AM on endothelial cells isolated from the umbilical cord vein of gestational diabetes-affected women (GD-HUVECs), has been investigated. Indeed, GD-HUVECs in vivo exposed to chronic hyperglycemia during pregnancy compared to control cells (C-HUVECs) have shown molecular modifications of cellular homeostasis ultimately impacting oxidative and nitro-oxidative stress, inflammatory phenotype, nitric oxide (NO) synthesis, and bioavailability, thus representing a useful model for studying the mechanisms potentially supporting the role of AM in chronic non-healing wounds. In this study, the anti-inflammatory properties of AM have been assessed using a monocyte–endothelium interaction assay in cells pre-stimulated with tumor necrosis factor-α (TNF-α) and through vascular adhesion molecule expression and membrane exposure, together with the AM impact on the nuclear factor kappa-light-chain-enhancer of activated B cell (NF-kB) pathway and NO bioavailability. Moreover, GD-HUVEC migration and tube formation ability were evaluated in the presence of AM. The results showed that AM significantly reduced TNF-α-stimulated monocyte–endothelium interaction and the membrane exposure of the endothelial vascular and intracellular adhesion molecules (VCAM-1 and ICAM-1, respectively) in both C- and GD-HUVECs. Strikingly, AM treatment significantly improved vessel formation in GD-HUVECs and cell migration in both C- and GD-HUVECs. These collective results suggest that AM positively affects various critical pathways in inflammation and angiogenesis, thus providing further validation for ongoing clinical trials in diabetic foot ulcers.

Comprehensive assessment of biventricular myocardial function by two-dimensional speckle tracking echocardiography in infants of gestational diabetic mothers.

No previous research provided a complete biventricular and multidirectional left ventricular (LV) functional assessment by two-dimensional (2D) speckle tracking echocardiography (STE) in infants of gestational diabetic mothers (IGDM) METHODS: A total of 30 consecutive IGDM and 30 infants of healthy mothers were examined between March 2021 and July 2021. Both groups of infants underwent evaluation by neonatologist and 2D transthoracic echocardiography (TTE) implemented with 2D-STE quantification of LV-global longitudinal strain (GLS), LV-global circumferential strain (GCS), LV-global radial strain (GRS) and right ventricular (RV)-GLS, within 3 days of life and at 40 days after birth. Predictors of persistent subclinical myocardial dysfunction, defined as a LVGLS less negative than -20% at 40-day follow-up, in IGDM population, were determined. At 2.2 ± 1.3 days after birth, LV-GLS (- 17.2 ± 1.9 vs. - 23.9 ± 3.8%), LV-GCS (- 17.9 ± 2.7 vs. - 27.3 ± 3.4%), LV-GRS (25.6 ± 3.4 vs. 35.8 ± 3.6%) and RV-GLS (- 17.6 ± 3.6 vs. - 22.6 ± 3.8%) were significantly impaired in IGDM than controls (all p < 0.001). At 36.8 ± 5.2 days of life, LV-GLS was still impaired (less negative than -20%) in 26.6% of IGDM. Maternal third trimester body mass index (BMI) (OR 1.89, 95%CI 1.05-3.39) and third trimester glycosylated hemoglobin (HbA1C) (OR 1.59, 95%CI 1.08-2.19) were independently associated with persistent LV-GLS impairment in IGDM. Maternal BMI ≥ 30 Kg/m2 and HbA1C ≥ 38 mmol/mol showed the maximum of sensitivity and specificity for predicting persistent subclinical myocardial dysfunction in IGDM at 40 days of life. IGDM have diffuse pattern of myocardial dysfunction during perinatal period. This dysfunction may be persistent up to 40 days of life in infants of GDM women with obesity and uncontrolled diabetes.

Maternal and perinatal outcome of pre-eclampsia in patients with gestational diabetes mellitus

Background: Pre-eclampsia is a leading cause of maternal mortality in Bangladesh. The most common problem of the gestational diabetic mother is increased incidence of pre-eclampsia. The aim of the study was to compare the maternal and perinatal outcome of diabetic pregnancy complicated with pre-eclampsia and without preeclampsia.&#x0D; Methods: This was a prospective observational study including 70 gestational diabetes mellitus (GDM) cases with pre-eclampsia and 70 patients with GDM without pre-eclampsia admitted in Obstetrics and Gynaecology Department of BIRDEM General Hospital-2. A detailed history was taken, and relevant data were collected through interview in a structured questionnaire and analyses were done according to objectives of the study.&#x0D; Results: In this study, 82% patients were delivered by Caesarean section in the study group (pre-eclampsia) and 72% patients were delivered by Caesarean section in the control group (p value 0.158). Rate of pre-term delivery was 55% in the studygroup and 32% in the control group (p value &lt;0.001). In the study group percentage of intrauterine growth retardation (IUGR) was 11.4% and in control group proportion of percentage of IUGR was 1.4%. There was oligo-hydramnios in 32% subjects of the study group and 22% of control group (p value 3.32). In the study group 44% babies were low birth weight whereas in control group 8% were low birth weight (p value &lt;0.001).&#x0D; Conclusion: The rates of pre-maturity and low birth weight were significantly higher among patients of GDM with pre-eclampsia in comparison to patients with GDM without pre-eclampsia.&#x0D; BIRDEM Med J 2022; 12(2): 106-110

Descriptive Study On Starvation Ketoacidosis In Covid-19 Obstetric Patients In A Tertiary Hospital in Central Region of Malaysia

PurposeThis study describes the presentation of starvation ketoacidosis in cases of pregnancy related Covid 19 pneumonia and their outcomes toward Cytokine Release Syndrome (CRS), Intensive Care Unit (ICU) admission, overall maternal and fetal outcome.Methods & MaterialsProspective study on all obstetric admissions for Covid 19 pneumonia in a tertiary hospital in central region of Malaysia (Hospital Ampang) from 1st July to 31st August 2021 was done. Starvation ketoacidosis cases as defined as serum bicarbonate less than 20mmol/L, with serum ketone of more than 3mmol/L or urine ketone more than 4+ were selected. Their outcome related to CRS, ICU admission and fetal outcome was monitor. Patients with incomplete data, and other cause of metabolic acidosis were excluded from this study.Results31 patients been isolated to have starvation ketoacidosis based on our study criteria. The median age of our study population was 31 years old. Patients mostly presented in stable condition before the onset of starvation ketoacidosis whereby 23 cases (74.19%) presented with Category 1 to 3 Covid-19 infection and only 8 cases (25.81%) require oxygen (Category 4) on presentation. Starvation ketoacidosis has commonly been observed in gestational diabetes mothers (61.29%) and those with obesity (51.61%). It happened mostly at day 6 to day 10 of covid infection (54.83%) with commonly lower CRP count of less than 50 (61.29%) during onset of acidosis. The mean random blood sugar (RBS) among patients who diagnosed with starvation ketoacidosis was 5.95 mmol/L. Total of 25 from 31 patients (80.64 %) went into CRS, and required oxygen supplementation and 13 patients (41.94%) required ICU care. We also observed 21 out of 31 patients (67.74%) in our sample population whom needed delivery of the fetusConclusionStarvation ketoacidosis in Covid 19 Obstetric patients may precede CRS and ICU admission. The association of starvation ketoacidosis with CRS and ICU admission or worsening Covid 19 pneumonia need to be further evaluated in a bigger study sample. A prompt early multidisciplinary treatment involving Infectious Disease team, Intensive Care team and Obstetric Team could avoid undesirable patient outcome.

Gut microbiota mediates the alleviative effect of polar lipids-enriched milk fat globule membrane on obesity-induced glucose metabolism disorders in peripheral tissues in rat dams.

Obesity during pregnancy and lactation not only increases the incidence of metabolic disorders and gestational diabetes in mothers, but also programs adiposity and related metabolic diseases in offspring. The aim of this study was to investigate the effects of milk polar lipids on gut microbiota and glucose metabolism in high-fat diet (HFD)-fed rat dams. Sprague Dawley (SD) female rats were fed a HFD for 8 weeks to induce obesity, followed by HFD with or without oral administration of polar lipids-enriched milk fat globule membrane (MFGM-PL) at 400 mg/kg BW during pregnancy and lactation. At the end of lactation, fresh fecal samples of dams were collected, the gut microbiota was assessed, and the insulin-signaling protein expression in peripheral tissues (adipose tissue, liver and skeletal muscle) were measured. MFGM-PL supplementation attenuated body weight gain, ameliorated serum lipid profiles and improved insulin sensitivity in obese dams at the end of lactation. 16 S rDNA sequencing revealed that MFGM-PL increased the community richness and diversity of gut microbiota. The composition of gut microbiota was also changed after MFGM-PL supplementation as shown by an increase in the ratio of Bacteroidetes/Firmicutes and the relative abundance of Akkermansia, as well as a decrease in the relative abundance of Ruminococcaceae. The functional prediction of microbial communities by PICRUSt analysis showed that there were 7 KEGG pathways related to carbohydrate metabolism changed after MFGM-PL supplementation to HFD dams, including glycolysis/gluconeogenesis and insulin signaling pathway. Furthermore, MFGM-PL improved insulin signaling in the peripheral tissues including liver, adipose tissue and skeletal muscle. MFGM-PL supplementation during pregnancy and lactation improves the glucose metabolism disorders in HFD-induced obese dams, which may be linked to the regulation of gut microbiota induced by MFGM-PL.

Evaluation of the selected parameters of the fetal diastolic functions in normally grown or macrosomic fetuses of gestational diabetic mothers with poor glycaemic control.

This study aimed to investigate whether the third trimester fetal cardiac diastolic function measured by selected conventional Doppler indices is affected in appropriate-for-gestational-age or macrosomic fetuses of gestational diabetic mothers with poor glycaemic control. This cross-sectional study included 93 pregnant women divided into two groups. Group 1 included 45 appropriate-for-gestational-age or macrosomic fetuses from gestational diabetic mothers with poor glycaemic control (study group). Group 2 included 48 appropriate-for-gestational-age fetuses from gestational age-matched healthy mothers (control group). Functional fetal cardiac parameters and fetoplacental Doppler parameters were measured. Data were compared between the two groups. Maternal characteristics did not differ significantly between the study and the control group. There were no significant differences in the early and late velocity, early/late velocity ratio of both mitral and tricuspid valves, the fetal pulmonary vein pulsatility index, and the ductus venosus pulsatility index between the study and the control group. Moreover, the rate of abnormal Doppler findings in pulmonary vein (pulmonary vein pulsatility index >95th centile), ductus venosus (ductus venosus pulsatility index >95th centile), and peripheral vessels (umbilical artery pulsatility index >95th centile, middle cerebral artery pulsatility index <5th centile, cerebra-placental index >95th centile) were comparable in both groups. The third trimester fetal diastolic functions measured by selected conventional Doppler techniques do not seem to be altered in appropriate-for-gestational-age or macrosomic fetuses of gestational diabetic mothers who have poor glycaemic control.

DNA methylation analysis of cord blood samples in neonates born to gestational diabetes mothers diagnosed before 24 gestational weeks

IntroductionGenome-wide methylation analyses of gestational diabetes mellitus (GDM) diagnosed after 24 gestational weeks (late GDM (L-GDM)) using cord blood have been reported. However, epigenetic changes in neonates born to mothers...