Gestational Diabetic Women Research Articles

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

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

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

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

Effect of Self-care Program Guided by PRECEDE–PROCEED Model on Maternal and Fetal Outcomes among Gestational Diabetic Women

Effect of Self-care Program Guided by PRECEDE–PROCEED Model on Maternal and Fetal Outcomes among Gestational Diabetic Women

Effect of Roy’s Adaptation Model Based Intervention on Healthy Behaviors and Quality of Life among Gestational Diabetic Women

Effect of Roy’s Adaptation Model Based Intervention on Healthy Behaviors and Quality of Life among Gestational Diabetic Women

Gestational Diabetes in Women with Fetal Spina Bifida Repair-Influence of Perioperative Management.

Background/Objectives: Fetal spina bifida (fSB) is the most common neural tube defect, and intrauterine repair has become a valid treatment option for selected cases. If fSB repair is offered, the ideal time for surgery is from 24 to 26 gestational weeks (GWs). The preoperative steroids for lung maturation and preoperative tocolytics that are administered are known to increase the prevalence of gestational diabetes (GD), which normally occurs in about 10-15% of all pregnant women. This study assessed the prevalence, possible influencing factors, and consequences on the course of pregnancy regarding GD in this cohort. Methods: Between 2010 and 2022, 184 fSB cases were operated. Those patients operated on after 24 0/7 GWs received steroids before surgery. All the patients received tocolysis, and an oral glucose tolerance test was performed between 26 and 28 GWs at least 7 days after steroid administration. In 2020, we established an early postoperative mobilization protocol. The perioperative management procedures of those patients with and without GD were compared to each other, and also, the patients treated according to the early mobilization protocol were compared to the remaining cohort. Results: Nineteen percent were diagnosed with GD. Corticosteroids were administered in 92%. Neither the corticoid administration nor the interval between the administration and glucose tolerance test was different in patients with or without GD. Further, 99.5% received postoperative tocolytics for at least 48 h. The women with GD had significantly longer administration of tocolytics. The length of stay (LOS) was higher in those patients with GD. The gestational age (GA) at delivery was significantly lower in the cohort with GD. In the early mobilized group, we found a significantly higher GA at delivery (37.1 GWs vs. 36.2 GWs, p = 0.009) and shorter LOS (p < 0.001), and their GD rate was lower (10% vs. 20%), although not statistically significant. Conclusions: The GD incidence in the women after fSB repair was higher than in the usual pregnant population. Early mobilization, rapid tocolytics decrease, and shorter LOS could benefit the pregnancy course after fSB repair and may decrease the risk for GD in this already high-risk cohort without increasing the risk for preterm delivery.

Effect of Vitamin-D on Glycemic Parameters and Adiponectin in gestational diabetes.

To determine the effect of Vitamin-D-supplementation on glycemic parameters: glucose levels in blood, insulin, HbA1c, HOMA-IR, and adiponectin in women with gestational diabetes. An experimental study was executed at PGMI/LGH of Lahore from June 2020 to June 2021, with 34 Vitamin-D-deficient women who had gestational diabetes (20-26 weeks). All were aged between 21-32 years, randomly and equally divided into controls and cases. Cases received 200,000 IU Vitamin-D-dose. Fasting blood was collected before as well as after treatment from each participant. Spectrophotometry and peroxidase method were used to estimate HbA1c and glucose concentrations respectively. Insulin, adiponectin, and Vitamin-D were assessed by ELISA. To verify data normality, the Shapiro-Wilk test was applied and to prove group comparison Mann-Whitney U, Wilcoxon signed-rank, and Sample-t tests were used via IBM-SPSS version-21. No difference in blood glucose was found between controls and cases before treatment (p=0.858), while post-treatment, significant reduction found in cases (p=0.019). Before treatment, no difference was noticed in insulin levels of both groups (p=0.44), however, post-treatment, a significant decline was expressed in cases (p=0.001). No difference was found in HOMA-IR between controls and cases before treatment (p=0.14) but post-treatment, significant reduction was observed in cases (p=0.001). Non-significant difference was noted in HbA1c before (p=0.664) and after (p=0.169) treatment in both groups. Non-significant upsurge in adiponectin was observed in cases before (p=0.544) and after (p=0.194) treatment. Vitamin-D supplementation significantly improves glycemic control in gestational diabetic women, however, its effect on adiponectin was non-significant.

Insulin Blood Levels in Gestational Diabetes Mellitus in Relation to Ethnicity and Age in the Kingdom of Bahrain: A Cross-Sectional Study.

Gestational diabetes mellitus (GDM) is one of the most common complications of pregnancy. It may be attributed to certain placental hormones during pregnancy which render insulin less effective. Our study aimed to focus on the levels of insulin in gestational diabetic women in the Kingdom of Bahrain as compared with non-diabetic pregnant women. Furthermore, we studied the correlation between insulin levels by ethnicity and age of the pregnant women. Methods: A cross-sectional study was conducted on 75 pregnant participants: 41 with GDM (test group) and 34 without GDM (control group). Insulin levels were determined in patients with GDM and compared to non-diabetic pregnant women. A comparison between Bahraini and non-Bahraini women was carried out in two different age groups: below and above 30 years of age. P values < 0.05 were considered significant. The results showed higher mean values of fasting blood glucose (FBG), random blood glucose (RBG), and insulin levels in the test group when compared to the control group. There was no significant difference in FBG, RBG, and insulin levels among Bahraini women with GDM and non-Bahraini women (Indian, Pakistani. Bengali, and Filipino) with GDM. Age, less than 30 vs more than 30 years, had no significant effect on women with GDM. Insulin levels were higher in pregnant women with GDM irrespective of their ethnicity or age. The lack of blood glucose control in GDM even in the presence of high insulin secretion may suggest loss of insulin effectiveness due to other factors such as stress and lactogenic placental hormones.

Effect of Instructional Package on Knowledge and Self-care Practices among Gestational Diabetic Women.

Effect of Instructional Package on Knowledge and Self-care Practices among Gestational Diabetic Women.

Effect of Instructional Package on Knowledge and Attitudes among Gestational Diabetic Women.

Effect of Instructional Package on Knowledge and Attitudes among Gestational Diabetic Women.

A comparison of the breast milk microbiota from women diagnosed with gestational diabetes mellitus and women without gestational diabetes mellitus

BackgroundHuman breast milk (HBM) is a contributing factor in modulating the infant’s gut microbiota, as it contains bacteria that are directly transferred to the infant during breastfeeding. It has been shown that children of women diagnosed with gestational diabetes mellitus (GDM) have a different gut microbiota compared to children of women without GDM. Our hypothesis is therefore that women with GDM have a different HBM microbiota, which may influence the metabolic function and capacity of the child later in life. The aim of this study was to investigate whether women with GDM have a different breast milk microbiota 1–3 weeks postpartum compared to women without GDM.MethodsIn this case-control study, a total of 45 women were included: 18 women with GDM and 27 women without GDM. A milk sample was collected from each participant 1 to 3 weeks postpartum and the bacterial composition was examined by 16 S rRNA gene sequencing targeting the V4 region.ResultsHigh relative abundances of Streptococcus and Staphylococcus were present in samples from both women with and without GDM. No difference could be seen in either alpha diversity, beta diversity, or specific taxa between groups.ConclusionOur results did not support the existence of a GDM-associated breast milk microbiota at 1–3 weeks postpartum. Further research is needed to fully understand the development of the gut microbiota of infants born to mothers with GDM.

Risk of gestational diabetes in women with PCOS based on body mass index: The Japan Environment and Children's Study.

Women with polycystic ovary syndrome (PCOS), which is the most common endocrine disorder in women of reproductive age, have a potentially increased risk of gestational diabetes mellitus (GDM). To examine the impact of PCOS on GDM based on maternal body mass index (BMI) using data from a large birth cohort study in Japan. Prospective observational study using data from the Japan Environment and Children's Study (JECS). Singleton pregnancies in the JECS during 2011-2014 were included. Mothers with HbA1c levels of ≥6.5% in the first trimester and history of DM or steroid use during pregnancy were excluded. Participants were categorized according to their pre-pregnancy BMIs: G1 (<18.5 kg/m2), G2 (18.5-19.99 kg/m2), G3 (20.0-22.99 kg/m2), G4 (23.0-24.99 kg/m2), and G5 (≥25.0 kg/m2). The impact of PCOS on early (Ed) and late-onset (Ld) GDM for each group was estimated using a multiple logistic regression model. We included 92774 participants, comprising 2012 PCOS(+) cases. GDM occurrence was higher in women with PCOS (p<0.001). PCOS had no effect on GDM in G1, G2, and G3. In G4, PCOS increased the risk of Ed GDM (adjusted odds ratio [aOR]: 3.27, 95% confidence interval [CI]: 1.29-8.29). In G5, PCOS increased the risk of both Ed (aOR: 2.48, 95% CI: 1.53-4.02) and Ld GDM (aOR: 1.94, 95% CI: 1.23-3.07). The impact of PCOS on GDM occurrence depended on the pre-pregnancy BMIs, which may facilitate personalized preconception counseling among women with PCOS.

Histopathological changes in the placentas of pregnant women with Gestational Diabetes Mellitus

Objectives: Placental damage might be the primary underlying cause of the high rates of fetal adverse outcomes in cases with gestational diabetes mellitus (GDM). Histopathological changes were considered to be associated with GDM in the literature. However, there are also studies showing no changes in the placenta in some gestational diabetic women. The pathophysiology of these placental alterations remains elusive. Therefore, this study aimed to examine the histopathological changes in the placentas of patients with GDM and compare them with the placentas of the healthy control group.&#x0D; Material and methods: This experimental non-randomized case-control study was conducted with 40 GDM patients and 40 healthy pregnant women at Dicle University Faculty of Medicine between March 2023 and December 2023. Placental tissues obtained following cesarean delivery were subjected to routine tissue processing. Placental samples were stained with hematoxylin-eosin and examined histopathologically using a light microscope.&#x0D; Results: When histopathological findings were compared between the GDM and control groups, villous degeneration, congestion in blood vessels, fibrinoid accumulation, inflammation and intervillous hemorrhage were higher in the GDM group than in the control group (p&lt;0.001).&#x0D; Conclusion: The intricate relationship between GDM and placental pathology underscores the profound impact of metabolic changes on placental structure and function throughout pregnancy. Understanding these pathological changes is crucial for elucidating the progression of GDM and its implications for maternal and fetal health, highlighting the importance of comprehensive placental analysis in managing pregnancies complicated by GDM.&#x0D; Keywords: Gestational diabetes, hematoxylin-eosin staining, histopathological examination

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

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

Dietary intakes of branch chained amino acids and obesity risk among Chinese gestational diabetes women.

Epidemiological studies have assessed the correlation between daily dietary branch chain amino acid (BCAA) intakes and the risk of obesity, however, the findings from these studies were inconsistent and investigations among GDM women were few. The present study was to investigate the associations of daily BCAA intakes with the risks of overweight and abdominal obesity among women with prior gestational diabetes mellitus (GDM) postpartum. We performed a cross-sectional study of 1,263 women with prior GDM at 1-5 years post-delivery. Logistic regression models were used to estimate the associations of daily dietary intakes of BCAAs with the risks of overweight and abdominal obesity. The multivariable-adjusted odds ratios (ORs) across quartiles of daily BCAA intakes postpartum were 1.42 (95% confidence interval [CI] 1.02-1.97), 1.00 (reference), 1.21 (95% CI 0.88-1.68), and 1.31 (95% CI 0.95-1.81) for general overweight, and 1.38 (95% CI 0.99-1.90), 1.00, 1.19 (95% CI 0.86-1.64), and 1.43 (95% CI 1.04-1.98) for abdominal obesity, respectively. Women with the lowest quartile of daily BCAA intakes significantly increased the risks of general overweight (OR 1.49; 95 %CI 1.06-2.09) and abdominal obesity (OR 1.50; 95 %CI 1.08-2.11) compared with women at quartile 2 of daily BCAA intakes after further adjustment of daily energy intake. The present study indicated that daily lower BCAA intakes were associated with increased risks of general overweight and abdominal obesity among women with prior GDM.

Effect of Lifestyle Coaching Program on Health-Related Behavior and Blood Glucose Level among Gestational Diabetic Women

Effect of Lifestyle Coaching Program on Health-Related Behavior and Blood Glucose Level among Gestational Diabetic Women

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

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

The Degree of Prepregnancy Vitamin D Deficiency Is Not Associated With Gestational Diabetes in Women Undergoing ART.

Gestational diabetes mellitus (GDM) is a common pregnancy complication, particularly in women undergoing assisted reproductive technology (ART). An association of GDM with vitamin D in women conceiving naturally has been described; however, studies have yielded heterogeneous results. To analyze the association between prepregnancy total and free vitamin D and GDM incidence in women undergoing ART. Post hoc analysis of a prospective study at the Reproductive and Genetic Hospital of CITIC-Xiangya in Changsha, China. Total and free vitamin D were measured 1 day before embryo transfer. The patients were screened for GDM using the oral glucose tolerance test. A total of 1593 women were included in the study, among whom 256 (16.1%) developed GDM. According to international guidelines for total 25-hydroxyvitamin D [25(OH)D], 47 (2.9%) patients had sufficient (≥30 ng/mL) levels, while 696 (43.7%) were insufficient (20 to <30 ng/mL) and 850 (54.4%) were deficient (<20 ng/mL). Comparing GDM and non-GDM patients, there was no significant difference in total nor free vitamin D levels (P = .340 and .849). Similarly, analysis of GDM rates by quintiles of total and free 25(OH)D showed no significant association in one-way ANOVA (P = .831 and .799). Multivariate logistic regression, considering age, BMI, and fasting glucose, also did not show a significant influence of the 2 vitamin D forms on GDM incidence (P = .266 and .123 respectively). In this relatively vitamin D deficient/insufficient ART cohort, the degree of neither total nor free vitamin D deficiency before pregnancy was associated with the occurrence of GDM.

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

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

Is there any difference between metabolomic profiles of mothers who progress to gestational diabetes versus healthy women during pregnancy?

Is there any difference between metabolomic profiles of mothers who progress to gestational diabetes versus healthy women during pregnancy?

The Effect of Vitamin D3 Intervention on the Association Among Vitamin D3, Adiponectin, and Body Mass Index in Pregnant Women With Gestational Diabetes.

Vitamin D3 (VD3) deficiency is a strong predictor of gestational diabetes. Therefore, VD3 supplementation during the antenatal period could prevent the development of gestational diabetes via its effects on insulin secretion, insulin sensitivity, body mass index (BMI), and adiponectin production. To observe the effect of VD3 supplementation on adiponectin and BMI and to explore the effect of VD3 supplementation on the association among VD3, adiponectin, and BMI in pregnant women with gestational diabetes. A randomized control trial was performed after receiving consent at Postgraduate Medical Institute, Lahore. Subjects at 20-26 weeks of gestation with gestational diabetes and with a deficiency/insufficiency of VD3 were included. The study excluded those who were smokers, had multiple pregnancies, or had other gestational complications. Subjects were categorized into interventional (VD3 supplementation) and control groups. The institutional ethical committee approved the study. Serum samples were used for enzyme-linked immunosorbent assay estimation of VD3 and adiponectin levels. Statistical Product and Service Solutions (SPSS) (IBM SPSS Statistics for Windows, Version 21.0, Armonk, NY) software was used to analyze data. Student t-tests were applied to compare quantitative variables, and Chi-square tests were utilized to compare qualitative variables. Pearson's correlation and linear regressions were performed to explore the association. At a 95% confidence interval, a p-value of ≤0.05 was taken as significant. With an increase in serum VD3 levels, a decrease in serum adiponectin level was observed in pregnant women with gestational diabetes (interventional group: r = -0.088, p = 0.74); however, after the intervention of VD3 supplementation in the same subjects, an increase in serum adiponectin level was noted with an increase in VD3 (interventional group: r = 0.273, p = 0.28). A significant direct relationship was found between BMI and adiponectin in the same study population (interventional group: r = 0.7, p = 0.001). Interestingly, after the intervention, BMI tends to be less likely to increase adiponectin levels (interventional group: r = 0.09, p = 0.73). Moreover, an inverse association was exhibited between BMI and VD3 levels in all the study groups before intervention (controlgroup: r = -0.07, p = 0.78; interventional group: r = -0.035, p = 0.89) and after intervention (interventional group: r = -0.12, p = 0.65), except in the control group after the intervention span, where BMI mildly raises the VD3 levels (r = -0.12, p = 0.65). BMI increases with an increase in serum adiponectin levels in gestational diabetic women, but after VD3 supplementation, BMI was less likely to influence adiponectin. Also, with an increase in BMI, a decrease in the VD3 in all study groups was observed except in the control group after VD3 supplementation.