High Risk For Gestational Diabetes Research Articles

Improving treatment of women with schizophrenia: a review of the recent literature

Effective clinical management of women with schizophrenia is therapeutically challenging. While there have been recent advances in the understanding of neurobiological, hormonal, and female reproductive cycle factors that play a decisive role in the development and progression of schizophrenia in women, this knowledge has not yet been fully translated into treatment practice. The aim was to apply the best evidence available to optimally treat women with schizophrenia at various periods of the lifespan. A narrative review was conducted of recent advances (2018–2023) in aspects of schizophrenia in women that demand sex-specific treatment. Sex steroids impact antipsychotic absorption, distribution, metabolism, elimination, passage through the blood-brain barrier, and blood flow rate to the brain. For these reasons, premenopausal women with schizophrenia, as compared to male age peers, require lower doses of most antipsychotic drugs and suffer comparatively more adverse events (metabolic, sexual, and cardiovascular) at similar doses. Apart from pharmacologic treatment, women have specific reproductive planning needs and need protection from sexual exploitation and domestic abuse. In addition, when pregnant, schizophrenia women show a high risk of gestational diabetes and pre-eclampsia/eclampsia that requires prevention. Prevention is also needed against long-term health hazards for their offspring. Another period of therapeutic challenge specific to women is menopause. The collected evidence points to women-specific recommendations for both biological and psychosocial treatment strategies for schizophrenia.

The Mediating Role of Physical Activity Self‐Efficacy in Predicting Moderate‐Intensity Physical Activity in Pregnant People at High Risk for Gestational Diabetes

IntroductionGestational diabetes mellitus (GDM) is a common medical complication in pregnancy. Moderate‐intensity physical activity during pregnancy can lower the risk of GDM. However, the relationship between moderate‐intensity physical activity and correlated factors among pregnant people at high risk for GDM remains unknown.MethodsA cross‐sectional study was conducted in China. Two hundred fifty‐two participants completed the Pregnancy Physical Activity Questionnaire, Pregnancy Physical Activity Self‐Efficacy Scale, Physical Activity Knowledge Questionnaire, Physical Activity Social Support Scale, 7‐item Generalized Anxiety Disorder Scale, Edinburgh Postnatal Depression Scale, and a sociodemographic data sheet. Structural equation modeling was used to explore the direct and indirect associations between the study variables.ResultsA total of 51.6% of the participants did not meet the current physical activity guidelines. Only physical activity self‐efficacy was significantly correlated with moderate‐intensity physical activity. Physical activity self‐efficacy mediated the relationship between moderate‐intensity physical activity and knowledge of physical activity, social support for physical activity, and anxiety symptoms. Furthermore, knowledge of physical activity was also associated with improved moderate‐intensity physical activity mediated by reduced anxiety symptoms and increased physical activity self‐efficacy.ConclusionOur study revealed a high prevalence of not meeting current physical activity guidelines among pregnant people at high risk for GDM. Physical activity self‐efficacy played an important mediating role in predicting moderate‐intensity physical activity. Future studies should focus on enhancing self‐efficacy to improve moderate‐intensity physical activity for pregnant people at high risk for GDM.

DHA, nutrient intake, and maternal characteristics as predictors of pregnancy outcomes in a randomised clinical trial of DHA supplementation

To investigate the relationships among docosahexaenoic acid (DHA) intake, nutrient intake, and maternal characteristics on pregnancy outcomes in a phase III randomised clinical trial designed to determine the effect of a DHA dose of 1000mg/day compared to 200mg/day on early preterm birth (<34 weeks gestation). A secondary aim of the phase III randomised trial was to explore the relationships among pregnancy outcomes (maternal red blood cell phospholipid (RBC-PL) DHA at delivery, preterm birth, gestational age at delivery, labor type, birth anthropometric measures, low birth weight, gestational diabetes, pre-eclampsia, and admission to a neonatal intensive care unit) in participants (n=1100). We used Bayesian multiple imputation and linear and logistic regression models to conduct an analysis of five general classes of predictor variables collected during the trial: a) DHA intake, b) nutrient intake from food and supplements, c) environmental exposure to tobacco and alcohol, d) maternal demographics, and e) maternal medical history. DHA supplementation lowered the risk of preterm birth and NICU admission, and increased gestation and birth weight as observed in the primary analysis. Higher maternal RBC-PL-DHA at delivery was associated with DHA supplementation and formal education of a bachelor's degree or higher. DHA supplementation and maternal age were associated with a higher risk of gestational diabetes. Total vitamin A intake was associated with longer gestation, while fructose and intake of the long chain omega-6 fatty acid, arachidonic acid, were associated with shorter gestation. Risk of preterm birth was associated with a history of low birth weight, preterm birth, pre-eclampsia, and NICU admission. Bayesian models provide a comprehensive approach to relationships among DHA intake, nutrient intake, maternal characteristics, and pregnancy outcomes. We observed previously unreported relationships between gestation duration and fructose, vitamin A, and arachidonic acid that could be the basis for future research. ClinicalTrials.gov (NCT02626299); December 10, 2015.

Effects of a low glycemic index or low glycemic load diet on pregnant women at high risk of gestational diabetes: A meta-analysis of randomized controlled trials

AimsTo evaluate the effect of low glycemic index or low glycemic load diets on maternal and neonatal outcomes at high risk of gestational diabetes mellitus (GDM). Data synthesisSeveral databases (PubMed, Cochrane Library, Web of Science, Embase, OVID, Clinical Trials. gov, China National Knowledge Infrastructure, China Biomedical Database, and Wanfang Database) were searched from January 1990 to January 2022 (updated to November 2022). Randomized controlled trials of low glycemic index diets interventions for women at high risk of GDM were included. From 2131 articles initially were screened, after eliminating duplicates, 1749 titles and abstracts were analyzed. 71 documents that met the inclusion criteria were selected and 3 documents were obtained through searching the reference lists. After reading the full text, 10 studies were retained. Two authors evaluated the studies, extracted data and conducted quality assessment independently. A total of 10 studies with 2304 patients met the inclusion criteria. Compared with the control group, a low glycemic index diet could control the range of weight gain (WMD -1.01, 95% CI -1.41 to -0.61), decrease the incidence of excessive weight gain (OR 0.69, 95% CI 0.54–0.87), lessen the incidence of large-for-gestational-age infants (OR 0.32, 95% CI 0.16–0.62) and reduce the incidence of preterm infants (OR 0.45, 95% CI 0.29–0.71). ConclusionA low glycemic index or low glycemic load diet could control maternal weight gain, reduce the incidence of excessive weight gain, and decrease the incidence of large-for-gestational-age infants and preterm infants in group with high risk of GDM. ProsperoCRD42022322697.

0309 Light exposure before bedtime in pregnancy is associated with a higher risk of gestational diabetes

Abstract Introduction Evidence suggests a link between mistimed light exposure and impaired glucose regulation among nonpregnant adults, yet little is known about the magnitude and significance of evening light exposure during pregnancy. This study examined the relationship between evening light exposure before sleep, during pregnancy, and the incidence of gestational diabetes mellitus (GDM). Methods In this prospective cohort study conducted at 8 U.S. clinical sites, nulliparous women wore a wrist actigraphy monitor and completed a daily sleep diary for seven days between 160 and 216 weeks’ gestation. The primary exposure variable was time spent above 10 lux (dim light) during the three hours preceding sleep onset (“TAT10 pre-sleep”), averaged over valid days of recording and categorized to tercile groups (“High”, “Medium”, “Low”). Primary outcome variable was the incidence of GDM. Associations of TAT10 pre-sleep groups with baseline characteristics, sleep and activity variables were examined with Chi-squared and Kruskal-Wallis rank sum tests. Univariate and multiple logistic regression models were used to characterize the relationship between pre-sleep light exposure and GDM. Results 901 eligible women consented to participate; 758 submitted valid actigraphy recordings. Excluding women with pre-gestational diabetes and those with unknown gestational diabetes status, 741 were included in the analysis. Greater pre-sleep light exposure was associated with an increased risk of GDM (odds ratio [95% confidence interval]: 5.49 [1.8–23.84] in high and 4.05 [1.27–17.94] in medium vs 1 [reference] in low group). Women in the high group had more daytime light and were less likely to be late (midpoint &amp;gt; 5AM) or fragmented (wake after sleep onset ≥ 75th percentile) sleepers. Sleep duration, mean activity level, and light during sleep were not different between groups. After adjusting separately for age, body mass index, race/ethnicity, sleep duration, sleep midpoint, education, employment schedule, season, and daytime light exposure, pre-sleep light exposure remained significantly associated with GDM. Conclusion Increased evening light exposure in pregnancy may be an under-recognized, potentially modifiable risk factor for GDM. Future research should investigate light-targeted interventions as a potential preventive strategy for GDM. Support (if any) R01HL105549, nuMoM2b Network

The impact of gestational weight gain on pregnancy outcomes among Saudi women delivered at maternal and child hospital, Al Ahsa, Saudi Arabia, 2022

Background: The pregnant women who gain the excessive weight outside the recommendation of Institute of Medicine (IOM) during pregnancy lead to adverse pregnancy outcome. Women with excessive gestational weight gain have high risk of gestational diabetes, gestational hypertension, preeclampsia, cesarean section, macrosomia, preterm delivery and birth weight. The aim of this study was to assess the prevalence of excessive gestational weight gain and to identify its association with adverse pregnancy outcomes among Saudi women delivered at Maternity and Child hospital (MCH) , Al Ahsa Materials and Methods: It was a cross-sectional chart review study. All pregnant women who were admitted in the postnatal ward in MCH after delivery were the study population. A sample size of 250 was calculated using online software (OpenEpi).Convenience sampling was used, as we want to reach all the women who are admitted to the ward after delivery. A special data sheet was prepared based on similar previous study and modified to meet our study objectives. The data were computerized, processed and analyzed using SPSS version 24.Descriptive statistics were presented using counts, proportions (%), mean ±, standard deviation whatever appropriate. The association of the weight gain and pregnancy outcome was tested by chi square test. A P -value cut off point of 0.05 or less was used to determine statistical significance. Results: The data of 250 women could be collected during the study period. The mean age of the participants was 28.34 years ± Std. Dev. 9.24 years. As far as the BMI is concerned more than thirty seven percent (37.6%) of the participants were of normal weight while 22% and 33.3% were overweight and obese respectively. Only 7.2% of the participants were underweight. The mean Wight gain by the underweight pregnant women was 11.29Kg while those with normal weight were 10.5Kg. The pregnant women who were overweight gained a mean weight of 12.85kg and those who were obese gained 13.47kg.. Recurrent UTI was significantly higher among the normal weight pregnant women with weight gain of 10.53Kg than those of under weight with weight gain of11.59 kg , overweight with weight gain of 12.85 kg and obese with weight gain of13.47kg(40.54% vs.2.7% vs.26.13% vs,30.62%, P=0.023).Vaginal infection(P=0.023), vaginal infection plus UTI (0.0.023) were significantly more associated with excess weight gain during pregnancy. Gestational diabetes(P=0.013), preeclamsia (P=0.013)was significantly more prevalent among the obese pregnant women However the pregnancy induced hypertension was more prevalent among normal weight with weight gain of10.53Kg (P-0.013).Normal delivery was significantly more common among the normal weight with weight gain of10.53Kg than (P-0.013) , delivery by induction (P=0.013) and the delivery by caeserian section was significantly more among the obese pregnant women with weight gain of 13.47kg The obese pregnant women with weight gain of 13.47kg were significantly associated with the preterm delivery (P=0.034).

Maternal hypertensive disorders during pregnancy and the risk of offspring diabetes mellitus in childhood, adolescence, and early adulthood: a nationwide population-based cohort study

BackgroundMaternal hypertensive disorders during pregnancy (HDP) have been suggested to contribute to the development of offspring cardiovascular disease later in life, but empirical evidence remains inconsistent. This study was aimed to assess the association of maternal overall and type-specific HDPs with diabetes in offspring from childhood to early adulthood.MethodsUsing Danish national health registers, a total of 2,448,753 individuals born in Denmark from 1978 to 2018 were included in this study. Maternal HDP included chronic hypertension, gestational hypertension, and preeclampsia. The outcome of interest was diabetes in offspring (including type 1, type 2, and gestational diabetes). The follow-up of offspring started at birth and ended at the first diagnosis of diabetes, emigration from Denmark, death, or time end on 31 December 2018, whichever came first. Cox proportional hazards regression was used to evaluate the hazard ratios (HRs) with 95% confidence intervals (CIs) of the association between maternal HDP and diabetes (including type 1, type 2, and gestational diabetes) in offspring from birth to young adulthood (up to 41 years), with the offspring’s age as the time scale.ResultsDuring a follow-up of up to 41 (median: 19.3) years, 1247 offspring born to mothers with HDP and 23,645 offspring born to mothers without HDP were diagnosed with diabetes. Compared with offspring born to mothers without HDP, those born to mothers with HDP had an increased risk for overall diabetes (HR=1.27, 95% CI=1.20–1.34), as well as for type 2 diabetes (HR=1.57, 95% CI=1.38–1.78) and gestational diabetes (HR=1.37, 95% CI=1.25–1.49). We did not observe obvious increased risk for type 1 diabetes (HR=1.08, 95% CI=0.98–1.18). Offspring of mothers with gestational hypertension (HR=1.37, 95% CI=1.00–1.88) or preeclampsia (HR=1.62, 95% CI=1.41–1.87) had higher risks of type 2 diabetes. The strongest association was observed for severe preeclampsia, with a 2-fold risk of type 2 diabetes (HR=2.00, 95% CI=1.42–2.82). The association between maternal HDP and type 1 diabetes did not reach statistical significance, except for maternal gestational hypertension (HR=1.41, 95%CI=1.17–1.71). In addition, we found that offspring born to mothers with any subtypes of maternal HDP had higher risk of gestational diabetes, and the corresponding HRs (95%CIs) for chronic hypertension, gestational hypertension, and preeclampsia were 1.60 (1.06–2.41), 1.29 (1.04–1.59), and 1.38 (1.24–1.53), respectively. We also observed stronger associations among offspring of mothers with HDP and comorbid diabetes (HR=4.64, 95%CI=3.85–5.60) than offspring of mothers with HDP or diabetes alone.ConclusionsOffspring of mothers with HDP, especially mothers with comorbid diabetes, had an increased risk of diabetes later in their life. Our findings suggest that timely and effective prevention of HDP in women of childbearing age should be taken into consideration as diabetes prevention and control strategies for their generations.

In utero metabolomic signatures of refined grain intake and risk of gestational diabetes: A metabolome-wide association study

BackgroundEpidemiologic evidence has linked refined grain intake to a higher risk of gestational diabetes (GDM), but the biological underpinnings remain unclear. ObjectivesWe aimed to identify and validate refined grain-related metabolomic biomarkers for GDM risk. MethodsIn a metabolome-wide association study of 91 cases with GDM and 180 matched controls without GDM (discovery set) nested in the prospective Pregnancy Environment and Lifestyle Study (PETALS), refined grain intake during preconception and early pregnancy and serum untargeted metabolomics were assessed at gestational weeks 10–13. We identified refined grain-related metabolites using multivariable linear regression and examined their prospective associations with GDM risk using conditional logistic regression. We further examined the predictivity of refined grain-related metabolites selected by least absolute shrinkage and selection operator regression in the discovery set and validation set (a random PETALS subsample of 38 individuals with and 336 without GDM). ResultsAmong 821 annotated serum (87.4% fasting) metabolites, 42 were associated with refined grain intake, of which 17 (70.6% in glycerolipids, glycerophospholipids, and sphingolipids clusters) were associated with subsequent GDM risk (all false discovery rate-adjusted P values <0.05). Adding 7 of 17 metabolites to a conventional risk factor-based prediction model increased the C-statistic for GDM risk in the discovery set from 0.71 (95% CI: 0.64, 0.77) to 0.77 (95% CI: 0.71, 0.83) and in the validation set from 0.77 (95% CI: 0.69, 0.86) to 0.81 (95% CI: 0.74, 0.89), both with P-for-difference <0.05. ConclusionsClusters of glycerolipids, glycerophospholipids, and sphingolipids may be implicated in the association between refined grain intake and GDM risk, as demonstrated by the significant associations of these metabolites with both refined grains and GDM risk and the incremental predictive value of these metabolites for GDM risk beyond the conventional risk factors. These findings provide evidence on the potential biological underpinnings linking refined grain intake to the risk of GDM and help identify novel disease-related dietary biomarkers to inform diet-related preventive strategies for GDM.

Gender Differences in Migration

There are about 200 million people on the move in the world, and approximately 50% of them are women. There are no clear migration plans for women leaving as a result of persecution, war, famine, climatic disasters or moving away from contexts of external abuse and even intrafamily violence. Gender-related violence, to which women are exposed in cultural contexts characterized by a patriarchal social organization, is manifested through different ways including, but not limited to, early marriages and genital mutilation, with reproductive health already being seriously impaired at an early age. To this must be added the consideration that low-income countries are not able to deal with chronic degenerative diseases with a multidisciplinary approach such as diabetes. Fragile or non-existent health systems are not prepared for this need, which now affects a third of all deaths from this cause. Compared to Italian mothers, women from high-migration pressure countries had a higher risk of gestational diabetes; in addition, young women of Ethiopian ethnicity are more exposed to increased diabetes risk, in an age- and BMI-dependent way. Gender inequalities are also more evident in migrants for other non-communicable diseases besides diabetes. A major effort is needed in terms of training practitioners and reorganization of basic health services, making them competent in an intercultural sense. Health education of the population as a whole and of women specifically is also needed to contain risk behavior and prevent the early onset of metabolic syndromes in general and of type 2 diabetes in particular.

Association of History of Spontaneous or Induced Abortion With Subsequent Risk of Gestational Diabetes

Gestational diabetes (GD) is one of the most common and important complications of pregnancy. Identifying pregnant women who are at high risk of GD is crucial for implementing early prevention and intervention. To examine whether a history of spontaneous abortion (SAB) or induced abortion is associated with increased risk of GD in subsequent pregnancies. This retrospective cohort study was conducted at a tertiary hospital in Shanghai, China. Pregnant women who received routine antenatal care between January 2014 and December 2019 were included. Data analysis was performed from December 2020 to June 2021. Maternal history of abortion, including SAB and induced abortion, were extracted from medical records. GD was diagnosed with a 75-g diagnostic oral glucose tolerance test. A multivariable-adjusted log-binomial analysis was used to estimate relative risks (RRs) and 95% CIs of GD associated with history of abortion. Among the 102 259 included pregnant women (mean [SD] age, 29.8 [3.8] years), 14 579 (14.3%) experienced only SAB, 17 935 (17.5%) experienced only induced abortion, and 4017 (3.9%) experienced both SAB and induced abortion. A total of 12 153 GD cases were identified, and the prevalence of GD was 11.9% (12 153 of 102 259 women) in this cohort. Pregnant women who experienced only SAB (RR, 1.25; 95% CI, 1.18-1.31) or both SAB and induced abortion (RR, 1.15; 95% CI, 1.05-1.27) were at higher risk of developing GD. The association of SAB history with GD occurred in a number-dependent manner. Compared with pregnant women with no history of abortion, the RR for GD increased by 18% (RR, 1.18; 95% CI, 1.11-1.26) for pregnant women with 1 SAB, by 41% (RR, 1.41; 95% CI, 1.27-1.57) for those with 2 SABs, and by 43% (RR, 1.43; 95% CI, 1.22-1.67) for those more than 2 SABs. However, no association between history of induced abortion and GD was observed. This study found that a history of SAB was associated with increased risk of GD in subsequent pregnancies. Further research is needed to clarify this association and explore the potential biological mechanisms underlying the association.

Myo-inositol nutritional supplement for prevention of gestational diabetes (EMmY): a randomised, placebo-controlled, double-blind pilot trial with nested qualitative study

ObjectivesTo determine the feasibility and acceptability of conducting a randomised trial on the effects of myo-inositol in preventing gestational diabetes in high-risk pregnant women.DesignA multicentre, double-blind, placebo-controlled, pilot randomised trial...

Maternal first trimester iron status and its association with obstetric and perinatal outcomes.

To assess the following in singleton pregnant women: (1) associations between first trimester iron deficiency and obstetric and perinatal outcomes, (2) overall first trimester iron status and (3) post-treatment iron status after intensified iron supplementation. A prospective cohort study was conducted with linkage of first trimester hemoglobin and plasma ferritin with obstetric and perinatal data from a hospital database. Blood sample data were obtained from a Danish University Hospital. The cohort was divided into groups according to ferritin and hemoglobin: (1) iron-deficient anemic (ferritin < 30ng/mL and Hb < 110g/L), (2) iron-deficient non-anemic (ferritin < 30ng/mL and Hb ≥ 110g/L), and (3) iron-replete non-anemic (ferritin 30-200ng/mL and Hb ≥ 110g/L). Obstetric and perinatal outcomes in each iron-deficient group were compared to the iron-replete non-anemic group using multivariable logistic regression. The effect of 4weeks intensified iron supplementation on hemoglobin and ferritin was assessed by groupwise comparisons. The cohort comprised 5763 singleton pregnant women, of which 14.2% had non-anemic iron deficiency, and 1.2% had iron-deficiency anemia. Compared to iron-replete non-anemic women, iron-deficient anemic women had a higher risk of gestational diabetes (aOR 3.8, 95% CI 1.4-9.0), and iron-deficient non-anemic women had a higher risk of stillbirth (aOR 4.0, 95% CI 1.0-14.3). In group 1 and 2, 81.5% and 67.7% remained iron-deficient after intensified iron supplementation. Iron-deficiency anemia was associated with gestational diabetes, and non-anemic iron deficiency with stillbirth, although risk estimates were imprecise due to few events. Iron deficiency was present in 15.4% and often persisted despite 4weeks intensified iron supplementation.

Independent effect of gestational weight gain and prepregnancy obesity on pregnancy outcomes among Saudi women: A sub-cohort analysis from Riyadh mother and baby cohort study (RAHMA)

BackgroundGestational weight gain (GWG) and prepregnancy obesity are garnering more attention as determining factors of pregnancy outcomes when it comes to the wellbeing of both the mother and her baby. This study was conducted to describe the pattern of GWG among participants of Riyadh Mother and Baby Multicenter Cohort Study (RAHMA) and to investigate the detrimental effects of excessive GWG and prepregnancy obesity on pregnancy outcomes.MethodsRAHMA is a multicentre cohort study conducted in three hospitals in Riyadh, Saudi Arabia. Participants were categorized according to the Institute of Medicine into inadequate, adequate, and excessive GWG, and stratified by body mass index (BMI) into under/normal weight, overweight, and obese. To examine the independent effect of maternal prepregnancy obesity and GWG, a multivariate regression model was used and adjusted odds ratio (AOR) and 95% Confidence Interval (CI) for each outcome were calculated.ResultsA total of 7029 participants were included in this study; 31.8% had adequate GWG, 25.9% had excessive GWG and 42.3% had inadequate GWG, while 29.7% had normal BMI, 33.3% were overweight, 34.8% were obese, and 2.2% were underweight. Excessive GWG was independently associated with increased risk of hypertensive events, (AOR = 1.77, 95% CI 1.20–2.63). Obesity was associated with higher risk of gestational diabetes (AOR 2.11, 95% CI 1.76–2.53), hypertensive events (AOR 2.06, 95% CI 1.48–3.01), and delivery by emergency caesarean section (AOR = 1.63, 95% CI 1.35–1.97). Infants of obese women had increased odds of macrosomia (AOR 3.11, 95% CI 1.94–4.99) and lower odds of low birth weight (AOR = 0.68, 95% CI 0.53–0.88).ConclusionIn comparison to excessive GWG, which increases the risk of hypertensive events during pregnancy, prepregnancy obesity is associated with more adverse outcomes including GDM, hypertensive events in pregnancy and emergency CS.

Gestational diabetes – an obstetric, neonatal and postnatal challenge

In recent decades, the demographics of pregnant women have changed, with an increase of women giving birth at an older age and which, associated with the increase of obesity, has led to a rise in the prevalence of gestational diabetes mellitus (GDM). This has become a global concern and, from a public health perspective, it has huge implications for the mother and the baby. This longitudinal and transversal re­tro­spec­tive study was conducted at the Department of Obstetrics and Gynecology of the “Regina Maria” Hospital – Private Health Network, Bucharest, and included 200 preg­nant women who gave birth between 1 July 2021 and 30 June 2022. The patients selected were grouped into two major categories: the study group (100 pregnant wo­men with gestational diabetes), and the control group (100 preg­nant women without gestational diabetes). The total num­ber of births in this period was 3807 (out of which 404 pa­tients had gestational diabetes, representing 10.61%). The women were selected based on the following cri­te­ria: the glucose tolerance test with 75 g of modified glu­cose, with clinical exploration (age, Body Mass Index [BMI], he­re­di­tary antecedents, associated pathology, type of preg­nan­cy), paraclinical and ultrasound. We included in our study pa­tients of different ages and with different BMI. Women who gave birth to twins or more, with pre-preg­nan­cy dia­be­tes or with unavailable or incomplete case data were ex­clu­ded from the study. The data used were collected from the patients’ observation documents, birth and operation re­cords, and from the Medis medical information system. Microsoft Excel was used to analyze the data. The aim of the study is to show that having a normal BMI lowers the risks of gestational diabetes, and that patients with obesity have a higher risk of gestational diabetes. We want to demonstrate that there are direct correlations between clinical and pa­ra­cli­ni­cal changes and maternal and fetal complications for pregnant women with gestational diabetes, and that ha­ving a good glycemic control is of great importance for the amelioration of pregnancy complications and perinatal con­ditions.

The influence of obesity and diet quality on fetal growth and perinatal outcome.

.Background: maternal obesity is associated with an increase of both maternal and fetal complications as macrosomia. Aim: to assess the quality of diet in a cohort of pregnant women in terms of Mediterranean diet (MD) adherence and to examine the association between diet quality, obesity, weight gain and fetal growth and perinatal complications. Methods: Mediterranean Diet Adherence Screener (MEDAS) was applied to assess diet quality in 542 pregnant women. Fetal biometric measurements at third-trimester ultrasound were collected and perinatal outcomes were recorded. Results: only 35 % of pregnant women presented a good quality of diet, in terms of adherence to MD. Diet quality significantly increased with lower values of body mass index (BMI) and higher maternal age. Higher BMI was significantly associated with a higher abdominal circumference and estimated fetal weight at the third trimester, a higher risk of hypertension disorder, induction of labor and a higher birthweight. A statistically significant association between diet quality and ultranosographic measures or perinatal outcome was not found. However, a higher weight gain across gestation was significantly associated with a higher risk of gestational diabetes, a higher gestational age at delivery and a higher birthweight. Conclusion: most of our pregnant women did not showed a great diet quality, but there was no evidence that diet quality affected pregnancy complications. On the contrary, pre-pregnancy BMI was related to fetal and neonatal growth and obstetric outcomes, similarly to weight gain across gestation.

Risk of Adverse Maternal Outcomes in Pregnant Women With Disabilities

Women with disabilities have a higher risk of preterm birth, gestational diabetes, preeclampsia, and cesarean delivery; however, their risk of other obstetric interventions, adverse maternal outcomes, and clinical indications for increased cesarean delivery is unclear. To evaluate risk of a range of obstetric interventions and adverse maternal outcomes, including severe maternal morbidities (SMM) and mortality, among women with and without disabilities. The Consortium on Safe Labor was a retrospective cohort that included comprehensive medical chart review for deliveries between January 2002 and January 2008. Data were collected from 12 clinical sites, which included 19 hospitals across the United States. This secondary analysis was conducted in February to July 2021. Using International Classification of Diseases, Ninth Revision, codes and a validated algorithm to define disability, participants were classified as having physical, intellectual, sensory, or any disability, and compared with women with no documented disability. The relative risk (RR) of 23 obstetric interventions and adverse maternal outcomes, including SMM and mortality, was evaluated. Of the 223 385 women in the study, 9206 (4.1%) were Asian or Pacific Islander, 50 235 (22.5%) were Black, 39 039 (17.5%) were Hispanic, and 110 443 (49.4%) were White, with a mean (SD) age of 27.6 (6.2) years. There were 2074 (0.9%) women with disability and 221 311 (99.1%) without. Among women with disabilities, 1733 (83.5%) were physical, 91 (4.4%) were intellectual, and 250 (12.1%) were sensory. Compared with women with no disability, women with disabilities had higher risk of gestational diabetes, placenta previa, premature rupture of membranes, preterm premature rupture of membranes, and postpartum fever as well as maternal death (adjusted relative risk [aRR], 11.19; 95% CI, 2.40-52.19) and individual SMMs: severe preeclampsia/eclampsia (aRR, 2.15; 95% CI, 1.80-2.56), hemorrhage (aRR, 1.27; 95% CI, 1.09-1.49), and fever (aRR, 1.32; 95% CI, 1.03-1.67), with the highest risk observed for thromboembolism (aRR, 6.08; 95% CI, 4.03-9.16), cardiovascular events (aRR, 4.02; 95% CI, 2.87-5.63), and infection (aRR, 2.69; 95% CI, 1.97-3.67). Women with any disability also had higher risk of interventions, including oxytocin augmentation, operative vaginal delivery, and cesarean delivery (aRR, 1.33; 95% CI, 1.25-1.42), with the cesarean indication less likely to be medically indicated (aRR, 0.79; 95% CI, 0.70-0.89). Risk of adverse outcomes and interventions remained consistent across disability categories. In this study, women with physical, intellectual, and sensory disability during pregnancy were at higher risk of adverse outcomes, including a broad range of SMM and maternal mortality.

Sedentary behaviors and gestational diabetes mellitus: A systematic review.

Sedentary behaviors are activities that expend less energy than 1.5 metabolic equivalents, such as watching TV, sitting. We aim to systematically review the evidence to determine the association of sedentary behavior (SB) with the risk of gestational diabetes mellitus, and the associations of SB with health outcomes in pregnant women with gestational diabetes mellitus (GDM) and women at high risk of gestational diabetes mellitus. Two researchers independently performed a literature search using PubMed, Medline, EMBASE, CINAHL, the Cochrane Library, the Rehabilitation and Sports Medicine Source, and the Sedentary Behavior Research Database for studies published up to January 27, 2021. Randomized controlled trials, quasi-experimental studies, and observational studies were screened and selected if SB was assessed in the context of gestational diabetes mellitus. Two reviewers extracted the relevant information and independently assessed the included studies for quality and bias. Eighteen studies were included, involving 60 804 patients, and the timeline of the original study included was from 2006 to 2021. Our review showed that SB before pregnancy was not associated with the risk of gestational diabetes mellitus, while SB during pregnancy was uncertain about the risk of gestational diabetes mellitus. In addition, there were significant associations between SB time and metabolic outcomes. In addition, SB may cause some adverse maternal and fetal outcomes. SB is likely to be the intermediary variable between occurrence of GDM and adverse maternal and infant outcome, rather than a direct influencing factor. Limited by the quantity and quality of included studies, the above conclusions need to be verified by more high-quality studies.

Maternal Vitamin B12 Status During Pregnancy and Its Association With Outcomes of Pregnancy and Health of the Offspring: A Systematic Review and Implications for Policy in India.

BackgroundVitamins B12 and folate participate in the one-carbon metabolism cycle and hence regulate fetal growth. Though vitamin B12 deficiency is widely prevalent, the current public health policy in India is to supplement only iron and folic acid for the prevention of anaemia. Prompted by our research findings of the importance of maternal vitamin B12 status for a healthy pregnancy, birth and offspring health outcomes, we evaluated available literature evidence using a systematic review approach, to inform policy.MethodsA systematic search was performed for relevant Indian studies in the MEDLINE/PubMed and IndMed databases. We selected studies reporting maternal vitamin B12 status (dietary intake or blood concentrations), and/or metabolic markers of vitamin B12 deficiency (homocysteine, methylmalonic acid) or haematological indices during pregnancy and their associations with outcomes of pregnancy, infancy or in later life. Intervention trials of vitamin B12 during pregnancy were also included. Quality of evidence was assessed on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.ResultsOf the 635 articles identified, 46 studies met the inclusion criteria (cohort studies-26, case-control studies-13, RCT’s -7). There is a high prevalence of vitamin B12 deficiency in Indian women during pregnancy (40-70%) (3 studies). Observational studies support associations (adjusted for potential sociodemographic confounders, maternal body size, postnatal factors) of lower maternal B12, higher homocysteine or an imbalance between vitamin B12-folate status with a higher risk of NTDs (6 studies), pregnancy complications (recurrent pregnancy losses, gestational diabetes, pre-eclampsia) (9 studies), lower birth weight (10 studies) and adverse longer-term health outcomes in the offspring (cognitive functions, adiposity, insulin resistance) (11 studies). Vitamin B12 supplementation (7 RCT’s) in pregnancy showed a beneficial effect on offspring neurocognitive development and an effect on birth weight was inconclusive. There is a high quality evidence to support the role of low maternal vitamin B12 in higher risk for NTD and low birth weight and moderate-quality evidence for higher risk of gestational diabetes and later life adverse health outcomes (cognitive functions, risk for diabetes) in offspring.ConclusionIn the Indian population low maternal vitaminB12 status, is associated with adverse maternal and child health outcomes. The level of evidence supports adding vitamin B12 to existing nutritional programs in India for extended benefits on outcomes in pregnancy and offspring health besides control of anaemia.Systematic Review Registration[website], identifier [registration number]

Adverse maternal and perinatal pregnancy outcomes related to very advanced maternal age in primigravida and multigravida in the Netherlands: A population‐based cohort

The age at which women give birth is rising steadily in the western world. Advanced maternal age has been associated with adverse pregnancy outcomes. We assessed the association between advanced maternal age and the risk of adverse maternal and perinatal outcome in primigravid and multigravid women. The study was a population-based cohort study and included women giving birth between January 2000 and December 2018 using data from the Dutch perinatal registration of Perined. Women were divided into age groups. We compared outcomes between women of 40-44, 45-49, and over 50years old (the study groups) with women of 25-29years old (reference group), stratified for parity. We employed multivariable regression to correct for possible confounders including methods of conception, multiple pregnancies, ethnicity, and socio-economic status. Our primary outcomes were maternal and perinatal mortality. Secondary outcomes included common maternal and perinatal complications, as well as cesarean section rate. A cohort of 3700326 women gave birth during the study period. Of these women, 3.2% were above 40years of age. Maternal mortality was rare in all groups, but significantly higher in multigravid women over 50years old. Perinatal mortality was significantly higher in all pregnancies of women over 40years old, but not for primigravida over 50years old. The most notable results with the steepest increase were in maternal complications. Both primigravida and multigravida over 40years old were at a two times higher risk of perinatal mortality, cesarean section, gestational diabetes, hypertensive disorders, and a low Apgar score after 5minutes. The risk for women over 45 was almost tripled for perinatal mortality and gestational diabetes and six times higher for cesarean section. Women over 50years old had a seven times higher risk of cesarean section, a four times higher risk of gestational diabetes, postpartum hemorrhage, and neonatal intensive care unit admission, and a 10 times higher risk of hypertensive disorders. The risk of adverse maternal and perinatal outcomes for women over 40years old surges as age increases. A novel aspect was the consistent increased risks not only for primigravid women but also for multigravida.

Schizophrenia during pregnancy.

A diagnosis of schizophrenia has significant implications for women of childbearing age, pregnant or considering a pregnancy, ranging from sexual health, psychopharmacological treatment, to the occurrence of negative pregnancy and foetal outcomes. We provide a short narrative review of recent papers focusing on these issues. Although pregnancy rates have been increasing in women with a diagnosis of schizophrenia, they also tend to have altogether fewer pregnancies and fewer live births than women without this diagnosis, and also higher rates of induced abortions.Use of antipsychotics in pregnancy has also increased, and evidence suggests lack of significant contraindications for their use in this period. However, drug levels monitoring may be recommended across the three trimesters, as levels may change in relation to pregnancy-related physiology.Monitoring of physical health is an increasingly crucial issue, given higher risk of gestational diabetes, negative obstetric and infant outcomes in these women. There is an urgent need to generate valid and reproducible research that could help implement appropriate treatment protocols and relapse-prevention approaches, and interventions based on strong pharmaceutical targets for the benefit of pregnant women with a diagnosis of schizophrenia, their families and their children.