Gestational Diabetes Research Articles

Clinical Value of Circ-PNPT1 on Adverse Pregnancy Outcomes of Patients with Gestational Diabetes Mellitus.

Several circular RNAs are associated with important pathophysiological characteristics of gestational diabetes mellitus (GDM). This study intended to measure the expression of circ-PNPT1 in sera of GDM patients and to expound on its values on pregnancy outcomes. Totally 104 GDM patients and 71 healthy controls were recruited. The expression pattern of serum circ-PNPT1 was measured by reverse transcription-quantitative polymerase chain reaction. The diagnostic efficacy of circ-PNPT1 and fasting blood glucose (FBG) on GDM was evaluated by receiver operating characteristic (ROC) analysis. Parameters of glycolipid metabolism were determined using automatic biochemical analyzers. The correlation between circ-PNPT1 and glycolipid metabolism parameters was analyzed using Pearson analysis. GDM patients were divided into a high expression group and a low expression group based on the median value of circ-PNPT1 expression. Curves of adverse neonatal outcomes were drawn by Log Rank analysis. GDM patients exhibited higher circ-PNPT1 expression than healthy controls. The area under the ROC curve of circ-PNPT1 diagnosing GDM was 0.9184 and the cut-off value was 1.435 (90.38% sensitivity, 85.92% specificity). Serum circ-PNPT1 expression was positively correlated with FBG, total cholesterol, and triglyceride in GDM patients. Neonates born to GDM patients with high circ- PNPT1 expression were prone to adverse outcomes. Circ-PNPT1 was highly-expressed in the sera of GDM patients. Circ-PNPT1 affected glycolipid metabolism and its expression had certain reference values on adverse pregnancy outcomes.

MiR-142-5p mediated Nrf2 dysregulation in gestational diabetes mellitus and its impact on placental angiogenesis

Gestational diabetes mellitus (GDM) presents significant risks during pregnancy, including adverse perinatal outcomes and placental dysfunction. Impaired angiogenesis, involving crucial factors like Vascular Endothelial Growth Factor (VEGF), contributes to these complications. The Nrf2/Keap1 pathway, crucial for vascular redox homeostasis, has been linked to GDM-associated angiogenesis dysregulation. This study aimed to investigate the molecular mechanisms underlying placental Nrf2 regulation, focusing on angiomiRs, key regulators of angiogenesis in GDM. Computational analysis identified miR-142-5p targeting Nrf2 mRNA. Expression levels of miR-142-5p were assessed in GDM placenta and correlated with Nrf2 expression. Experimental validation utilized human trophoblastic cell lines (BeWo) exposed to hyperglycemic conditions, assessing the effects of anti-miR-142 transfection on Nrf2 expression and angiogenic marker levels. miR-142-5p expression was significantly downregulated in GDM placenta, correlating positively with Nrf2 expression. In BeWo cells exposed to hyperglycemia, anti-miR-142 transfection notably increased Nrf2 expression alongside angiogenic marker levels, confirming the computational predictions. Our findings highlight the pivotal role of miRNAs in GDM-associated impaired angiogenesis by modulating Nrf2 expression. Understanding these molecular mechanisms provides insights into potential therapeutic targets for improving pregnancy outcomes in GDM cases.

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

Background and AimsThere have been limited studies on the application of a diabetes-specific formula in gestational diabetes mellitus (GDM), the role of which has not been well studied. We explored the effect of a diabetes-specific formula on blood glucose levels, insulin use and pregnancy outcomes in GDM patients. MethodsIn this randomized controlled study, 112 GDM patients were randomly assigned to the intervention group (56) and the control group (56). Both groups received individualized dietary counseling. The intervention group consumed a soy-protein-based, high-monounsaturated-fatty-acid, and multi-fiber diabetes-specific formula as milk replacement for breakfast and an extra meal after dinner. All participants were followed up every two weeks until delivery. The blood glucose levels, insulin use and pregnancy outcomes between the groups were compared. ResultsCompared to the control group, the intervention group had significantly lower 2h postprandial blood glucose levels after breakfast (5.84±0.56 vs. 6.15±0.44mmol/L, p=0.008), and exhibited higher postprandial time in range values (83.80% vs. 78.95%, p=0.045). The intervention group used insulin later (33 vs. 28 weeks, p=0.015) and for fewer days (36 vs 78 days, p=0.024), but no differences in the proportion, dose or frequency of insulin use between the groups. There were no significant differences in pregnancy outcomes between the groups. ConclusionsThe diabetes-specific formula significantly decreased postprandial blood glucose levels and improved postprandial glycemic control in GDM patients. Moreover, it delayed the initiation of insulin use and reduced the duration of insulin therapy. Our findings may offer a potential new approach for achieving better personalized blood glucose control in GDM patients. Registration number of Clinical TrialNCT03957603 (registered at ClinicalTrials.gov).

Nanostructured Lipid Carrier-Mediated Transdermal Delivery System of Glibenclamide for Gestational Diabetes: Pharmacokinetic and Pharmacodynamic Evaluation.

Gestational diabetes mellitus (GDM) poses significant risks during pregnancy for both mother and fetus. Adherence to oral antidiabetic medications, like glibenclamide (GB), can be challenging, necessitating novel drug delivery methods. Nanostructured lipid carriers (NLC) offer a promising approach by efficiently permeating the skin due to their small size and lipid-based composition. This study aimed to develop and evaluate transdermal patches loaded with glibenclamide NLCs to treat GDM. Glibenclamide NLCs were prepared using hot homogenization with ultrasonication and melt dispersion method. A central composite design was utilized to optimize the formulations. Transdermal patches containing optimized NLCs were developed using HPMC K 100 and Eudragit L polymers. The patches were evaluated for various parameters, and their pharmacokinetic and pharmacodynamic studies were carried out to assess their safety and efficacy. Optimized NLCs efficiently permeated rat skin. Cell viability studies indicated the nontoxicity of the formulations. NLC-loaded transdermal patches (F2 and F7) showed drug release of 1098 μg/cm2 and 1001.83 μg/cm2 in 24 h, with a 2.5-fold higher flux and permeation coefficient than the GB patch. Pharmacokinetic analysis revealed Tmax of 8 and 10 h and Cmax of 7127 ng/ml and 7960 ng/ml for F2 and F7, respectively, ensuring sustained drug action. AUC0-α was 625681 ng/ml·h and 363625 ng/ml·h for F2 and F7, respectively, indicating improved bioavailability. Transdermal patches incorporating NLCs hold promise for enhancing glibenclamide's therapeutic efficacy in GDM treatment. Improved skin permeation, sustained drug release, and enhanced bioavailability make NLC-based transdermal patches a potential alternative with better patient compliance.

Exploring the molecular underpinnings of macrosomia in gestational diabetes mellitus: The role of EGFR signaling and placental syncytiotrophoblast.

Macrosomia, which is frequently associated with gestational diabetes mellitus (GDM), is linked to maternal glycemic control during gestation. When GDM is complicated by macrosomia (GDMM), the placenta exhibits increased mass, underscoring its role as a critical nexus for maternal-fetal nutrient exchange. Despite this recognized correlation, the underlying mechanisms propelling placental hypertrophy have remained elusive. Our study leveraged single-cell RNA transcriptome sequencing of GDMM placental tissues to pinpoint the specific syncytiotrophoblast (SCT) subsets that regulate placental dimensions. Notably, we observed pronounced upregulation of the epidermal growth factor receptor (EGFR) and its corresponding ligands, with a particular emphasis on the autoregulatory cascade involving the glycoprotein hormone alpha subunit (CGA), EGFR, and the transcription factor GATA binding protein 2 (GATA2), as well as perturbations in hormonal homeostasis within the SCT. Furthermore, our cell interaction analysis revealed an enhanced interplay between myeloid cells and SCT3, augmenting the EGFR signaling pathway. These molecular exchanges underscore the pivotal role of the placental immune microenvironment in the etiology of macrosomia, shedding light on the pathophysiology of GDMM and paving the way for novel therapeutic approaches.

Impact of the COVID-19 lockdown on the O'Sullivan test and gestational diabetes mellitus diagnosis in pregnant Spanish women

ObjectiveTo analyze the impact of COVID-19 lockdown on serum glucose levels of pregnant women. DesignA retrospective analysis of O'Sullivan test in pregnant women who underwent COVID-19 lockdown compared to controls. SitePoniente Primary Health Care center in Córdoba (Spain). Participants235 pregnant women from 23+0 to 25+0 weeks of gestation without diabetes mellitus. InterventionsGestational diabetes mellitus screening with O'Sullivan test and 3-h oral glucose tolerance test. Main measurementsPregnant women who underwent gestational diabetes mellitus screening with O'Sullivan test before (control group) and during COVID-19 Lockdown (Lockdown group) in Córdoba (Spain) were investigated. Lockdown group was divided in early and late lockdown. An additional, control group from data of the same months of the Lockdown in the previous year were recorded to discarded seasonally (adjusted seasonally control) this group was also divided in early and late seasonally adjusted.A logistic regression model for O'Sullivan test has been performed to analyze potential cofounders. Kolgomorov–Smirnov and Kruskal–Wallis test comparing pregnant women who underwent COVID-19 lockdown with the two types of controls. ResultsStatistically significant differences were found in serum glucose after O'Sullivan test between lockdown group and control group (123.51±26.02mg/dL and 112.86±31.28mg/dL; p=0.017). When early lockdown group and control group were compared no differences were found (119.64±26.18mg/dL vs. 112.86±31.28mg/dL; p>0.05) whereas differences were observed in late lockdown group and control group (127.22±25.59mg/dL vs. 112.86±31.28mg/dL; p=0.009). Statistical trends were also found between lockdown group and seasonally adjusted group and between lockdown and late seasonally adjusted group (p=0.089). A higher proportion of positive O'Suvillan pregnant women who were subsequently diagnosed with GDM were found in lockdown group compared to the seasonally adjusted control group (60% vs. 26.06% respectively; p<0.05). ConclusionsThe COVID-19 lockdown was associated with an increase in serum glucose levels after the O'Sullivan test as well as a higher GDM diagnosis risk in pregnant women. The findings of our study emphasize the essential requirement for comprehensive maternal services and the accessibility to community's health assets during future lockdown scenarios to pregnant women.

Postpartum dysglycaemia after early gestational diabetes: Follow-up of women in the TOBOGM randomised controlled trial

AimTo evaluate the incidence and predictors of postpartum dysglycaemia among high-risk women who develop early gestational diabetes (eGDM) prior to 20 weeks’ gestation. MethodsThis is a sub-study of the Treatment of Booking Gestational Diabetes (TOBOGM) Study, a randomised controlled trial of early or deferred treatment for women with risk factors for diabetes diagnosed with eGDM, using current WHO criteria. Overt diabetes in pregnancy was excluded. A repeat oral glucose tolerance test (oGTT) was recommended at 6–12 weeks postpartum. ResultsOf 793 participants, 352 (44.4%) underwent a postpartum oGTT. Baseline characteristics of participants with and without an oGTT were similar. Ninety-two (26.1%) had postpartum dysglycaemia: 11 (3.1%) diabetes, 31 (8.8%) impaired fasting glucose (IFG), 39 (11.1%) impaired glucose tolerance (IGT), and 11 (3.1%) combined IFG/IGT. Participants with postpartum dysglycaemia were more likely to have had past GDM, lower body mass index, more gestational weight gain, and higher 1 and 2-hour glucose concentrations on the early pregnancy oGTT. On logistic regression, higher 1 and 2-hour glucose concentration, previous GDM and greater gestational weight gain were independently associated with postpartum dysglycaemia. ConclusionThere is a high incidence of postpartum dysglycaemia among high-risk women with eGDM.

Unique cardiometabolic factors in women that contribute to modified cardiovascular disease risk.

Major risk factors of cardiovascular disease (CVD) include hypertension, obesity, diabetes mellitus and metabolic syndrome; all of which are considered inflammatory conditions. Women are disproportionately affected by inflammatory conditions, with sex differences emerging as early as adolescence. Hormonal fluctuations associated with reproductive events such as menarche, pregnancy and menopause, are hypothesized to promote a pro-inflammatory state in women. Moreover, women who have experienced inflammatory-type conditions such as polycystic ovarian syndrome (PCOS), gestational diabetes or pre-eclampsia, have a cardiometabolic phenotype that pre-disposes to increased risk of myocardial infarction, stroke and coronary heart disease. Women with no notable CVD risk factors are often relatively protected from CVD pre-menopause; but overtake men in risk of major cardiovascular events when the cardiovascular protective effects of oestrogen begin to wane. Sex differences and female-specific factors have long been considered challenging to study and this has led to an underrepresentation of females in clinical trials and lack of female-specific data from pre-clinical studies. However, there is now a clear prerogative to include females at all stages of research, despite inherent complexities and potential variability in data. This review explores recent advancements in our understanding of CVD in women. We summarise the underlying factors unique to women that can promote CVD risk factors, ultimately contributing to CVD burden and the emerging therapies aimed to combat this.

Adherence to Healthy Prepregnancy Lifestyle and Risk of Adverse Pregnancy Outcomes: A Prospective Cohort Study

ABSTRACTObjectiveTo quantify the association between a combination of modifiable prepregnancy lifestyle factors and the risk of adverse pregnancy outcomes (APOs).DesignProspective cohort study.SettingThe Japan Environment and Children's Study.PopulationA total of 79 703 pregnant Japanese women without chronic disease.MethodsMaternal lifestyle before pregnancy was assessed using a self‐administered questionnaire. A healthy lifestyle score (HLS, 0–5 points) was calculated based on adherence to five prepregnancy healthy lifestyle factors: healthy weight, high‐quality diet, regular physical activity, not smoking, and not drinking alcohol. Relative risks (RRs) and 95% credible intervals (CrIs) were estimated using a Bayesian log‐binomial regression model.Main Outcome MeasuresComposite APOs, defined as the development of any APO, including gestational diabetes, hypertensive disorders of pregnancy, preterm birth, low birth weight, and small‐for‐gestational‐age, transcribed from medical records.ResultsA total of 13 894 women (17.4%) experienced one or more APOs. HLS was inversely associated with the risk of APOs in a dose–response manner. Women with an HLS of 5 points had a 33% (RR 0.67; 95% CrI, 0.61–0.74) lower risk of APOs than those with the lowest HLS (0–1 points). The population attributable fraction of five healthy lifestyle factors was 10.3%. A 1‐point increase of HLS could have reduced APO cases by 6.6%.ConclusionsA higher HLS was associated with a lower risk of APOs, suggesting that adopting a healthy lifestyle before pregnancy may reduce the risk of APOs, which can increase the risk of future chronic diseases in both mother and child.

Factors Affecting Mother‐Infant Bonding in Women with Gestational Diabetes Mellitus: A Cross‐Sectional Study

ABSTRACTObjectiveTo explore the impact of psychological and social factors on mother‐infant bonding in women with gestational diabetes mellitus (GDM) living in the United Kingdom.DesignA cross‐sectional online survey study conducted between November 2022 and January 2023 administered to women who self‐reported current or past (within the previous 1 year) GDM.MethodsThe survey comprised demographic and validated self‐report measures for depression, anxiety, eating disorders, perceived social support, pregnancy and birth experience, and breastfeeding. Mother‐infant bonding was measures using the Maternal Antenatal Attachment Scale for women who were currently pregnant with GDM (antenatal) and the Maternal Postnatal Attachment Scale for women with past GDM (postnatal).ResultsN = 149 women (n = 37 antenatal, and n = 112 postnatal) completed the survey. Higher anxiety and depression symptoms and managing GDM using metformin and insulin were associated with poorer mother‐infant bonding for women in both antenatal and postnatal periods. Higher social support was associated with higher mother‐infant bonding scores in women in both the antenatal and postnatal period.ConclusionThe experience of GDM may be amplifying the known risk factors for impaired mother‐infant bonding. Targeted psychological support for women with GDM may be necessary to ensure that their emotional well‐being is addressed as part of comprehensive perinatal care.

Determining how the gestational changes, including low hemoglobin influence the hba1c and estimated average glucose relationship

ABSTRACT Background: Gestational Diabetes Mellitus (GDM) affects up to 14% of pregnancies globally, with accurate glycemic control critical for preventing adverse outcomes. While HbA1c is a standard marker for long-term glucose control, its reliability in pregnant women with anemia is debated. This study explores the association between anemia and glycemic indicators (Glycosylated hemoglobin HbA1c, Random plasma glucose (rPG), and Estimated average glucose (eAG) in pregnant women with GDM. Additionally, it examined the correlation between average glucose levels or eAG, measured by random plasma glucose rPG, and HbA1C. Methods: A prospective case-control study was carried out over eight months at the Departments of Chemical Pathology and Obstetrics and Gynecology, Dow University of Health Sciences (DUHS). Pregnant women in their second trimester after being diagnosed for GDM through oral glucose tolerance test were classified into anemic (hemoglobin &lt; 10.5 g/dL) and non-anemic groups. Blood samples were collected and analyzed for HbA1c, hemoglobin, and random plasma glucose levels. Data were processed using SPSS (version-26) different variables compared by using independent t-test and correlation analyses at a significance level of p &lt; 0.05. Results: Mean values for eAG, HbA1C, and rPG were 174.22 ± 24.489 mg/dl, 8.342 ± 1.6152%, and 166.21 ± 21.478 mg/dl, respectively. Anemia was associated with significantly higher HbA1C (p &lt; 0.001), eAG (p &lt; 0.001), and rPG (p = 0.004). A strong positive correlation was observed between eAG and rPG (r = 0.958, p &lt; 0.01), while eAG showed a moderate correlation with HbA1C (r = 0.501, p &lt; 0.01). In contrast, the correlation between HbA1C and rPG was weaker (r = 0.331, p &lt; 0.01). Conclusion: eAG proved to be a good indicator for assessing glycemic control in pregnant non-anemic women with GDM. Anemia significantly affected glycemic metrics, leading to higher HbA1C and glucose levels.

Association Between Serum Uric Acid and Pregnancy Outcomes: A Study in Chinese Women

ABSTRACT Objective The study aims to explore the relationship between serum uric acid (UA) levels in the first trimester and pregnancy outcomes. Methods The clinical data of 1381 pregnant women who delivered in the Department of Obstetrics and Gynecology of Beijing Chao-Yang Hospital from June 2021 to July 2022 were collected. All patients were categorized into four groups (Q1-Q4) according to quartiles of UA, using the first quartile of UA as the reference group. Logistic regression analysis was used to observe the correlation between UA and pregnancy outcomes. Restricted cubic spline (RCS) was drawn to observe the dose-response relationship between UA and pregnancy outcomes. Results The numbers of GDM patients in Q1-Q4 were 40 (11.70%), 46 (13.49%), 60 (17.29%) and 83 (23.65%), respectively (p < 0.001). Logistic regression analysis showed that higher quartiles of UA were significantly associated with an increased prevalence of gestational diabetes mellitus (GDM). After adjusting for confounding factors (maternal age, prepregnancy BMI, gestational weight gain, and gestational age), compared with the lowest quartile of UA, the highest quartile of UA had 2.06 times odds of GDM (OR, 2.06; 95% CI, 1.34, 3.18; p = 0.001) in Q4. RCS suggested that the risk of GDM increased slowly until UA levels reached 219.43 µmol/L and then began to increase rapidly afterward (overall p = 0.0037). Conclusions Increased uric acid concentrations in the first trimester are associated with an increased risk of GDM and gestational hypertension.

Hemoglobin concentrations in early pregnancy and their associations with adverse pregnancy outcomes in Western China: a population-based study.

Despite the global standardization of hemoglobin (Hb) testing in early pregnancy, the impact of first trimester Hb concentrations on pregnancy outcomes remains inadequately understood. Also, the early pregnancy Hb concentrations have not been well documented in Western China. Therefore, this study aimed to assess the Hb concentrations during early pregnancy and their associations with adverse pregnancy outcomes in Western China. This cross-sectional study used data from the Chengdu Maternal and Child Health Information System for pregnant women who delivered between January 1, 2019, and December 31, 2023. A total of 454,815 Chinese females aged 15 to 49 years with available first trimester Hb data, including those with singleton or multiple gestations, were included in the analysis. Multivariable logistic regression models were performed to estimate the adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for associations between Hb categories and adverse pregnancy outcomes. The average first trimester Hb concentration was 126.0 (SD 10.5) g/L, with 5.8% of pregnant women experiencing anemia during early pregnancy. Multivariable logistic regression analyses revealed significantly increased odds of developing gestational diabetes mellitus (GDM) and gestational hypertensive disorders (GHD) across increasing Hb concentration categories. Compared to Hb concentrations of 110-119g/L, Hb ≥ 140g/L was associated with elevated risk of GDM (aOR: 1.57, 95% CI: 1.52, 1.62) and GHD (aOR: 1.87, 95% CI: 1.79, 1.96). Moreover, both Hb ≤ 99g/L (aOR: 1.15, 95% CI: 1.03, 1.29) and Hb ≥ 140g/L (aOR: 1.20, 95% CI: 1.13, 1.26) were associated with higher odds of preterm birth compared to Hb concentrations of 110-119g/L. In addition, the restricted cubic spline demonstrated a U-shaped relationship for cesarean delivery, low birthweight and small for gestational age (p < 0.001). However, no significant associations were found between first trimester Hb concentrations and the odds of stillbirth, Apgar score < 7 at 5min, or Apgar score < 7 at 10min (p > 0.05). Our research findings suggest associations between first trimester Hb concentrations and various adverse pregnancy outcomes. We recommend interventions for early pregnancy anemia, particularly moderate to severe cases, and emphasize monitoring females with high Hb concentrations to reduce adverse outcomes.

A nested case-control study on the association of gut virome in early pregnancy and gestational diabetes mellitus

BackgroundRecent studies have increasingly shown the connection between gut microbiome and gestational diabetes mellitus (GDM). However, no studies have explored the relationship between the gut virome and GDM, and the underlying mechanism remains unknown.MethodsWe performed a nested case-control study within a follow-up cohort, enrolling 51 patients with GDM and 51 healthy controls. Shotgun metagenomics sequencing was used to explore gut virome profiles during early pregnancy.ResultsDiversity analysis revealed no difference in the overall gut virome composition between two groups, however, we found greater abundance of Escherichia phage SH2026Stx1 (Q = 0.23), Enterobacteria phage mEp043 c-1 (Q = 0.21), crAssphage cr50_1 (Q = 0.21), Enterobacteria phage phi80 (Q = 0.21), and Escherichia phage HK106 (Q = 0.23) in GDM patients. Cross-kingdom correlation analysis showed the negative correlation between the gut bacterium Eubacterium eligens and three bacteriophages (Escherichia phage SH2026Stx1, Enterobacteria phage mEp043 c-1, and Escherichia phage HK106) in GDM group (r &amp;lt; 0, P &amp;lt; 0.05). Based on gut microbial features and clinical indicators, we constructed a new prediction model using random forest method for GDM with good predictive performance (AUC of 0.893, 95% CI: 0.736 ∼ 0.990).ConclusionThis study is the first to investigate the relationship between the gut virome and GDM as well as the cross-kingdom correlation between gut viruses and bacteria in GDM. Our findings could enhance strategies for preventing and treating GDM from the perspective of gut microbiome, offering valuable insights into its pathogenesis.

Effect of exercise during pregnancy on offspring development through ameliorating high glucose and hypoxia in gestational diabetes mellitus

BACKGROUND Gestational diabetes mellitus (GDM) women require prenatal care to minimize short- and long-term complications. The mechanism by which exercise during pregnancy affects organ development and whether glucose transporter (GLUT) 1 plays a role in GDM offspring organ development remains unknown. AIM To determine the effect of exercise during pregnancy on the cardiac, hepatic and renal development of GDM mother’s offspring. METHODS Placenta samples were collected from humans and mice. GDM mouse models were created using streptozotocin along with a GDM with exercise group. The hearts, livers and kidneys of 3- and 8-week-old offspring were collected for body composition analysis and staining. The effects of high glucose levels and hypoxia were investigated using HTR8/SVneo. Transwell and wound-healing assays were performed to assess cell migration. Immunofluorescence accompanied with TUNEL and Ki67 staining was used to explore apoptosis and proliferation. RESULTS Exercise during pregnancy downregulated the GLUT1 and hypoxia inducible factor-1α expression in placenta from individuals with GDM. Cobalt chloride-induced hypoxia and high glucose levels also significantly decreased migration and apoptosis of HTR8/SVneo cells. In addition, exercise reduced inflammatory cell infiltration in the liver and decreased the tubular vacuolar area in the kidneys of offspring. CONCLUSION GDM affects the growth and development of organs in offspring. Exercise during pregnancy can reverse adverse effects of GDM on the development of the heart, liver, and kidney in offspring.

Impact of gestational diabetes mellitus on women's sexual function: a systematic review and meta-analysis.

Gestational diabetes mellitus (GDM) is a prevalent pregnancy complication with well-established adverse effects on maternal and fetal health. However, research on its impact on sexual health is inconsistent. Currently, there is no comprehensive review on sexual function in pregnant women with GDM. The purpose of this study is to systematically gather and synthesize the available evidence, addressing this important research gap. This systematic review and meta-analysis utilized a comprehensive literature search strategy and incorporated the following databases: the Cochrane Library, Scopus, PubMed, Web of Science, SID, and Google Scholar. The search was conducted until February 21, 2024. The quality of the cross-sectional and case‒control studies included in the current study was evaluated via the modified and standard Newcastle‒Ottawa scale. The certainty of the evidence was evaluated via the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework. A meta-regression was conducted to examine the variables that influence total sexual function. Additionally, sequential analysis was performed to determine the required information size for the meta-analysis. The systematic search process yielded a total of 370 studies. The final analysis included six studies. The meta-analysis findings revealed that compared with controls, women with GDM had significantly lower total scores for sexual function (SMD - 1.80, 95% CI -3.44 to -0.15, p = 0.03), sexual desire (SMD - 5.14, 95% CI -8.14 to -2.14, p < 0.001), arousal (SMD - 0.58, 95% CI -0.95 to -0.21, p = 0.002), lubrication (MD -0.41, 95% CI -0.59 to -0.22, p < 0.001) and satisfaction (SMD - 3.82, 95% CI -6.08 to -1.57, p < 0.001). However, the analysis did not reveal statistically significant differences in sexual pain, or orgasm between the GDM and control groups. The meta-regression analysis revealed that older age in the control group was associated with poorer sexual function. Compared with control women, pregnant women diagnosed with GDM have lower sexual function. Further research with larger sample sizes is necessary to enhance the robustness of the evidence, given the low level of certainty. Healthcare providers should focus on the sexual well-being of women with GDM and create tailored interventions to address their specific needs.

A prospective multicenter birth cohort in China: pregnancy health atlas.

The China Prospective Multi-Center Birth Cohort Study was launched in 2022. In collaboration with medical centers in 12 cities, it aims to establish a high-quality, multidimensional cohort comprising 20,000 natural pregnancy and assisted reproductive families. As of June 26, 2024, 12,911 pregnant women have participated in this study, and 161,122 biological samples have been collected. These samples cover four critical periods (early pregnancy, mid-pregnancy, late pregnancy, and postpartum) and comprise 10 different types such as serum, plasma, and urine. The study has collected comprehensive information from early pregnancy to newborns. The participants have an average age of 29.76years, an average height of 160.46cm, an average pre-pregnancy BMI of 23.11, and an average BMI of 27.25 before delivery. The cohort includes individuals from 26 ethnic groups, with 25 minority groups comprising 5.03% of the population. Guizhou Province exhibits the highest percentage of ethnic minorities at 24.96% and Guangdong Province owns the highest proportion (12.22%)of women with two or more children. The prevalence of thalassemia in Guangdong Province is seven times higher than in other provinces. Among pregnant women over 35years old, the prevalence of gestational diabetes mellitus is twice that of women under 35. Additionally, the prevalence of preeclampsia in women with assisted reproductive pregnancies is more than twice that of those with natural pregnancies. The study extensively collected diverse data and biological samples, making this cohort an ideal candidate for DOHaD field and multi-omics research.

Early continuous glucose monitoring-derived glycemic patterns are associated with subsequent insulin resistance and gestational diabetes mellitus development during pregnancy.

Gestational diabetes mellitus (GDM) and insulin resistance (IR) increase the risk of adverse pregnancy outcomes. We aimed to examine the relationship of interstitial glucose assessed by continuous glucose monitoring (CGM) at early gestation, and the subsequent development of IR and GDM, and to determine 24-h interstitial glucose centile distributions in women with normal (non-IR and non-GDM) and suboptimal glycemic status (IR and/or GDM). CGM measurements were taken for 3-10days at 18-24weeks' gestation, followed by fasting serum insulin and oral glucose tolerance testing at 24-28weeks' gestation. IR and GDM were determined by the updated Homeostasis Model Assessment of IR score of ≥ 1.22 and 2013 World Health Organization criteria, respectively. Risks of IR and GDM were estimated using modified Poisson models, and hourly interstitial glucose centiles determined using Generalized Additive Models for Location, Scale and Shape. This prospective cohort study involved 167 pregnant women in Singapore, with a mean age of 31.7years, body mass index of 22.9kg/m2, and gestation of 20.3weeks. 25% of women exhibited IR and 18% developed GDM. After confounders adjustment, women with suboptimal glycemic control, indicated by higher mean daily glucose (risk ratio 1.42; 95% confidence interval 1.16, 1.73), glucose management indicator (1.08; 1.03, 1.12), and J-index (1.04; 1.02, 1.06), as well as those with greater glycemic variability, indicated by higher standard deviation (1.69; 1.37, 2.09), coefficient of variation (1.03; 1.00, 1.06), and mean amplitude of glycemic excursions (1.4; 1.14, 1.35) derived from CGM in early gestation were associated with higher risks of developing IR in later gestation. These associations were similarly observed for the development of GDM. Centile curves showed that, compared to those with normal glycemic status, women with suboptimal glycemic status had higher glucose levels, with greater fluctuations throughout 24h. In pregnant women who subsequently developed IR and GDM, interstitial glucose levels assessed by CGM were elevated and varied greatly. This supports the potential use of CGM to screen for glycemic changes early in pregnancy.

Increased gallbladder emptying and reduced GLP-1 response in pregnancy with and without gestational diabetes mellitus.

Gestational diabetes mellitus (GDM) has been associated with reduced postprandial glucagon-like peptide 1 (GLP-1) responses. As pregnancy induces changes in gallbladder motility and bile acids stimulate GLP-1 secretion, we investigated postprandial gallbladder emptying and GLP-1 responses in women with GDM. Women with and without GDM underwent two 240-min mixed meal tests; one during third trimester of pregnancy and one 3-6 months postpartum. We evaluated ultrasonography-assessed gallbladder emptying, plasma concentrations of glucometabolic hormones including GLP-1, paracetamol absorption (proxy for gastric emptying) and circulating factors known to affect gallbladder dynamics. Fifteen women with GDM and 15 pregnant women with normal glucose tolerance (NGT) (baseline median age 31 (interquartile range 29;33) versus 32 (28;33) years, body mass index (BMI) 27.2 (24.7;30.7) versus 28.4 (26.2;31.0) kg/m2, HbA1c 30 (29;32) versus 30 (28;31) mmol/mol) were included. No differences in postprandial gallbladder emptying or GLP-1 responses were observed between women with and without GDM, neither during pregnancy nor postpartum. Pregnancy increased fasting gallbladder volumes by 69 (30;122)% and 103 (59;156)% and postprandial gallbladder emptying by 77 (28;236)% and 99 (37;190)% compared with postpartum in women with and without GDM, respectively. Postprandial GLP-1 responses were reduced by 60 (3;82)% and 81 (11;90)% during pregnancy compared with postpartum in women with and without GDM, respectively. Pregnancy-induced changes in gallbladder motility seem to play no or a limited role in previously reported GDM-associated reduced postprandial GLP-1 responses as gallbladder emptying was greater and postprandial GLP-1 response was lower in pregnancy than postpartum regardless of GDM status.

A prospective observational study on maternal diet pre- and post-GDM diagnosis and pregnancy outcomes in individuals with/without GDM.

To investigate (1) the association between maternal dietary choices during the first and second trimesters and the diagnosis of gestational diabetes mellitus (GDM), (2) the association between a GDM diagnosis and dietary choices during pregnancy, and (3) the differences in pregnancy outcomes between individuals with and without GDM. A prospective cohort study. Pregnant individuals with singleton pregnancy aged 19 ∼ 44 years, without severe pregnancy complications were enrolled in the study. Dietary data were collected at three time points during routine antenatal appointments: 8 ∼ 12 weeks gestation(n = 993), 20 ∼ 24 weeks gestation(n = 732), and 32 ∼ 36 weeks gestation(n = 536). GDM diagnosis and pregnancy outcomes were collected during follow-up from the electronic medical record (EMR). A total of 93 participants (12.9%) were diagnosed with GDM. Livestock and poultry meat intake during the second trimester were associated with an increased risk of developing GDM (aOR 1.371, 95%CI 1.070-1.756, P = 0.013), and a GDM diagnosis may lead to decreased intake of cereals and its products (P = 0.001), potatoes and its products (P < 0.001), and fruit (P = 0.002) and increased intake of fish, shrimp and shellfish (P = 0.001), eggs (P = 0.015), and milk and milk products (P = 0.011) in the third trimester. Individuals with GDM related to lower risk of excessive gestational weight gain (aOR 0.384, 95%CI 0.188-0.646, P = 0.001) but may increase the risk of fetal macrosomia (aOR 3.873, 95%CI 1.364-10.996, P = 0.011). Understanding maternal dietary choices around GDM diagnosis is crucial for accurate nutritional assessment and effective education programs. While our findings suggest dietary changes may occur post-diagnosis, further research is needed to confirm these patterns and the potential benefits of early dietary counseling for individuals with GDM.