Likelihood Of Gestational Diabetes Mellitus Research Articles

Remnant cholesterol, but not other cholesterol parameters, is associated with gestational diabetes mellitus in pregnant women: a prospective cohort study

ObjectiveNo evidence has been found of a relationship between remnant cholesterol (RC) and the likelihood of gestational diabetes mellitus (GDM) in pregnant women. The aim of our study was to investigate the link between serum RC at 12–14 weeks of gestation and the risk of GDM.MethodsThis was a secondary analysis with data from a prospective cohort study in Korea. A total of 590 single pregnant women attending two hospitals in Korea, up to 14 weeks gestation, from November 2014 to July 2016 were included in the study. The formula used to calculate RC in detail was RC (mg/dL) = TC (mg/dL)-HDL-c (mg/dL)-LDL-c (mg/dL). Logistic regression models were employed to examine the relationship between RC and GDM and explore the association between other lipoprotein cholesterol parameters and the risk of GDM. Furthermore, receiver operating characteristic (ROC) analysis was performed to assess the ability of RC to identify GDM. Additionally, sensitivity and subgroup analyses were conducted.ResultsThe mean age of participants was 32.06 ± 3.80 years. The median of RC was 34.66 mg/dL. 37 pregnant women (6.27%) were eventually diagnosed with GDM. Multivariate adjusted logistic regression analysis showed that RC was positively associated with the risk of GDM (OR = 1.458, 95% CI 1.221, 1.741). There was no significant association between other lipoprotein cholesterols (including TC, LDL-c, HDL-c) and the risk of GDM. The area under the ROC curve for RC as a predictor of GDM was 0.8038 (95% CI 0.7338–0.8738), and the optimal RC cut-off was 24.30 mg/dL. Our findings were demonstrated to be robust by performing a series of sensitivity analyses.ConclusionSerum RC levels at 12–14 weeks of gestation are positively associated with GDM risk in pregnant women. RC in early pregnancy is an early warning indicator of GDM in pregnant women, especially those with normal HDL-c, LDL-c, and TC that are easily overlooked. There is a high risk of developing GDM in pregnant women whose RC is more than 24.30 mg/dL. This study may help optimize GDM prevention in pregnant women and facilitate communication between physicians, pregnant patients, and their families.

Circulating endocannabinoid levels in pregnant women with gestational diabetes mellitus: a case–control study

BackgroundThe role of the Endocannabinoids (ECs) in insulin resistance, and their association with visceral obesity and metabolic profile have been studied extensively. Since the association between ECs and metabolic factors in Gestational Diabetes Mellitus (GDM) are not clear, we aimed to evaluate the levels of N-Arachidonoylethanolamide (AEA) and 2-Arachidonoylglycerol (2-AG) and their association with C-reactive protein (CRP), glycemic indices, blood pressure, and anthropometric indices in pregnant women with GDM.MethodsThe present case–control study was conducted among 96 singleton pregnant women aged 18–40 years, including 48 healthy pregnant women (control group) and 48 women with a positive diagnosis of GDM (case group). Odds Ratios (ORs) and 95% Confidence Intervals (CIs) for GDM were checked according to endocannabinoids and anthropometric indices using Multivariable Logistic Regression.ResultsAEA was significantly associated with increased risk of GDM in models 1, 2 and 3 (OR = 1.22, 95% CI: 1.06–1.41; OR = 1.54, 95% CI: 1.19–1.97; OR = 1.46, 95% CI:1.11–1.91). A positive but no significant association was found for AEA in model 4 (OR = 1.38,95% CI: 0.99–1.92). Similar to AEA, 2-AG was also positively associated with the likelihood of GDM in Models 1, 2, and 3 but the association attenuated to null in model 4 (OR = 1.25; 95% CI: 0.94- 1.65).ConclusionsOur findings showed that levels of ECs were significantly higher in pregnant women with GDM compared to healthy ones. Also, ECs levels were associated with the likelihood of GDM, independent of BMI and weight gain.

Risk Factors for Gestational Diabetes Mellitus (GDM) in Subsequent Pregnancy Among Women Without GDM History in China: A Multicenter Retrospective Study

Abstract Objective This study aimed to determine the likelihood of gestational diabetes mellitus (GDM) in subsequent pregnancy among women without GDM history and to identify risk factors for GDM in subsequent pregnancy. Methods This retrospective cohort study involved participants who delivered twice in same hospital of 18 research centers when delivered the second baby from January 2018 to December 2018. Finally 6204 women were enrolled and 5180 women without GDM history were analyzed further. Women were categorized as non-GDM or GDM based on the blood glucose values of the subsequent pregnancy, and the characteristics and GDM risk of these groups were compared. A univariate analysis of potential risk factors was performed using the Chi-squared test and/or t-test for qualitative or quantitative variables, respectively. Associations with P values <0.1 were chosen to be included in the multivariate binary logistic regression model. Results In primary analysis of 6204 women, the incidence of GDM in subsequent pregnancy is 48.9% (490/1002) in women with GDM history and 16.1% (835/5202) in women without GDM history. In a further analysis for 5180 women without GDM at index pregnancy, compared with the non-GDM group, the GDM group had a significantly higher age, prepregnancy body mass index, and blood glucose value at each oral glucose tolerance test (OGTT) timepoint (fasting, 1 h and 2 h) during the index and subsequent pregnancies, as well as higher weight retention during the interval between the two pregnancies (P<0.001). Age above 35 years in subsequent pregnancy (odds ratio (OR)=1.540, 95% confidence interval (CI) = 1.257–1.886, P<0.001), macrosomia in index pregnancy (OR=1.749, 95% CI=1.277–2.395, P=0.001), OGTT blood glucose values in index pregnancy (fasting, OR=2.487, 95% CI=1.883–3.285, P<0.001; 1 h, OR=1.142, 95% CI=1.051–1.241, P=0.002; 2 h, OR=1.290, 95% CI=1.162–1.432, P<0.001) and weight retention (OR=1.052, 95% CI=1.035–1.068, P<0.001) were independent risk factors for GDM in subsequent pregnancy. Conclusion For women without GDM history, GDM risk factors including age, macrosomia history, OGTT value, and weight retention, these can be evaluated before a subsequent pregnancy. Early warning and interventions are needed for women at high risk.

1378-P: Are Nutritional Habits Equally Associated with the Risk of Gestational Diabetes and Gestational Glucose Intolerance?

Objective: The aim of this study is to investigate the relationships between the nutritional characteristics of pregnant women and the risk of gestational diabetes mellitus (GDM) and Gestational Glucose Intolerance (GGIT). Materials and Method: Women were investigated for GDM during the 24th to 28th weeks of pregnancy. According to the two-step diagnostic approach, women with normal glucose tolerance (normal), those with only 1 high glucose (GGIT) and those with at least 2 high values (GDM) in OGTT were included in the study. There was 60 pregnant women in each group (mean age 31.6±5.4; range 19-46 years). Demographic and clinical characteristics of the participants were questioned and a 3-day food consumptions record were evaluated with BEBIS program. Results: The mean weight, BMI and daily fiber intake in GDM group were significantly higher than the normal group. In the GDM and GGIT groups, the mean age, weight, daily carbohydrate (CHO) and protein intakes, and family history of diabetes were higher than those with normal group. Moreover, in the GDM group, daily fat intake was also significantly higher than the normal and GGIT groups. According to the separate models of logistic regression analysis; the age; daily protein, CHO and fat consumptions; having the first pregnancy and higher pre-pregnancy BMI (>25 kg/m2) were associated with increased likelihood of GDM. Similarly, the age, daily protein consumption, history of giving birth to a macrosomic baby and current smoking were positively linked with the risk of GGIT. Conclusion: Women’s nutritional habits (excessive CHO, fat and especially protein consumptions), phenotypic characteristics, family history of diabetes and poor obstetric history are similarly related to the risk of developing GDM and GGIT. Our results showed that in all women, particularly in those at high-risk for GDM who are planning pregnancy, a special attention should be given to general health and balanced diet, starting from pre-pregnancy. Disclosure M. Yabaci: None. I. Satman: None. C. Idiz: None. F. Turker: None. A. Yuksel: None. B. Omer: None. B. Demirel: None. E. Ozer: None. Funding Istanbul University

Maternal exposure to fine particulate matter from a large coal mine fire is associated with gestational diabetes mellitus: A prospective cohort study

BackgroundIn 2014, the Hazelwood coal mine fire was an unprecedented event that resulted in a six-week period of poor air quality in the Latrobe Valley in regional Australia. We aimed to determine whether maternal exposure to fine particulate matter in coal mine fire smoke was associated with selected obstetric complications, including gestational diabetes mellitus, hypertensive disorders of pregnancy and abnormal placentation. MethodsWe defined a complete cohort of pregnant women with births >20 weeks in the Latrobe Valley from March 1, 2012–Dec 31, 2015 utilising administrative perinatal data. Average and peak fine particulate matter (PM2.5) was assigned to residential address at delivery using a chemical transport model. Maternal, meteorological and temporal variables were included in final log-binomial regression models. Results3612 singleton pregnancies were included in the analysis; 766 were exposed to the smoke event. Average maternal PM2.5 exposure was 4.4 μg/m3 (SD 7.7; IQR 2.12). Average peak PM2.5 exposure was 44.9 μg/m3 (SD 57.1; IQR 35.0). An interquartile range increase in peak PM2.5 was associated with a 16% increased likelihood of gestational diabetes mellitus (95%CI 1.09, 1.22; <0.0001). Whereas, an interquartile range increase in average PM2.5 was associated with a 7% increased likelihood of gestational diabetes mellitus (95%CI 1.03, 1.10; <0.0001). Second trimester exposure was of critical importance. No association for hypertensive disorders or abnormal placentation was observed. Conclusionthis is the first study to examine obstetric complications relating to a discrete smoke event. These findings may guide the public health response to future similar events.

Influence of environmental temperature on risk of gestational diabetes.

Cold-induced thermogenesis is known to improve insulin sensitivity, which may become increasingly relevant in the face of global warming. The aim of this study was to examine the relation between outdoor air temperature and the risk of gestational diabetes mellitus. We identified all births in the Greater Toronto Area from 2002 to 2014 using administrative health databases. Generalized estimating equations were used to examine the relation between the mean 30-day outdoor air temperature before the time of gestational diabetes mellitus screening and the likelihood of diagnosis of gestational diabetes mellitus based on a validated algorithm using hospital records and physician service claims. Over the 12-year period, there were 555 911 births among 396 828 women. Prevalence of gestational diabetes mellitus was 4.6% among women exposed to extremely cold mean outdoor air temperatures (≤ -10°C) in the 30-day period before screening and increased to 7.7% among those exposed to hot mean 30-day temperatures (≥ 24°C). Each 10°C increase in mean 30-day temperature was associated with a 1.06 (95% confidence interval [CI] 1.04-1.07) times higher odds of gestational diabetes mellitus, after adjusting for maternal age, parity, neighbourhood income quintile, world region and year. A similar effect was seen for each 10°C rise in outdoor air temperature difference between 2 consecutive pregnancies for the same woman (adjusted odds ratio 1.06, 95% CI 1.03-1.08). In our setting, there was a direct relation between outdoor air temperature and the likelihood of gestational diabetes mellitus. Future climate patterns may substantially affect global variations in the prevalence of diabetes, which also has important implications for the prevention and treatment of gestational diabetes mellitus.

Excessive fruit consumption during the second trimester is associated with increased likelihood of gestational diabetes mellitus: a prospective study

This study aimed to investigate the association between fruit consumption during the second trimester and the occurrence of gestational diabetes mellitus (GDM). A prospective study with 772 female participants was conducted in China from April 2013 to August 2014. Dietary intake was assessed in face-to-face and telephone interviews using a 3-day food record. GDM was ascertained using a standard 75 g 2 hour oral glucose tolerance test. Multivariable logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) after adjustment for various confounders. Of the 772 participants, 169 were diagnosed with GDM during the period under study. Greater total fruit consumption during the second trimester was associated with a higher likelihood of GDM (highest vs. lowest quartile: adjusted OR4.82, 95% CI 2.38 to 9.76). Fruits with a moderate or high glycaemic index (GI) were positively associated with the occurrence of GDM. Fruit subgroups were also categorised by polyphenol content, and tropical-fruit and citrus-fruit consumption was found to be positively related to the occurrence of GDM. These findings suggest that the excessive consumption of fruit, especially fruit with moderate or high GI values, tropical-fruit and citrus-fruit, increases the likelihood of GDM.

Higher prevalence of gestational diabetes mellitus following assisted reproduction technology treatment

Do mothers following assisted reproduction technology (ART) treatment have increased likelihood of gestational diabetes mellitus (GDM) compared with non-ART mothers after controlling for maternal factors and plurality? ART mothers had 28% increased likelihood of GDM compared with non-ART mothers. Advanced maternal age and multiple pregnancies are independently associated with increased likelihood of GDM. Given the average age of mothers having ART treatment is higher than non-ART mothers and the higher multiple pregnancy rate following ART treatment, ART treatment might be expected to be associated with increased risk of GDM. A population retrospective cohort study of 400 392 mothers who gave birth in Australia between 2007 and 2009, using the Australian National Perinatal Data Collection from five states (Australian Capital Territory, Queensland, Tasmania, Victoria and Western Australia) where a code for ART treatment is available. The study included 13 732 ART mothers and 386 660 non-ART mothers. The prevalence of GDM was compared between ART and non-ART mothers. Logistic regressions were used to assess the association between ART treatment and GDM. Odds ratio (OR), adjusted OR (AOR) and 95% confidence interval (CI) were calculated. A larger proportion of ART mothers were aged ≥40 years compared with non-ART counterpart (11.7 versus 3.4%, P < 0.01). The prevalence of GDM was 7.6% for ART mothers and 5.0% for non-ART mothers (P < 0.01). Mothers who had twins had higher prevalence of GDM than those who gave births to singletons (8.8 versus 7.5%, P = 0.06 for ART mothers; and 7.3 versus 5.0%, P < 0.01 for non-ART mothers). Overall, ART mothers had a 28% increased likelihood of GDM compared with non-ART mothers (AOR 1.28, 95% CI 1.20-1.37). Of mothers who had singletons, ART mothers had higher odds of GDM than non-ART mothers (AOR 1.26, 95% CI 1.18-1.36). There was no significant difference in the likelihood of GDM among mothers who had twins between ART and non-ART (AOR 1.18, 95% CI 0.94-1.48). For mothers aged <40 years, the younger the maternal age, the higher the odds of GDM for ART singleton mothers compared with non-ART singleton mothers. It was not possible to investigate which ART procedure is associated with increased risk of GDM and how the risk could have been minimized. The information on BMI and smoking during pregnancy was not stated for a large proportion of mothers. These limitations may have reduced the validity of the study. In agreement with other studies, our data suggest that the underlying cause of subfertility and some particular ART procedures might have played an important role in the increased likelihood of GDM. Together with the public education on not delaying motherhood, minimizing multiple pregnancies by applying single embryo transfer may diminish the excess risk of GDM related to ART treatment.

Sleep Disturbances and Their Relationship to Glucose Tolerance in Pregnancy

OBJECTIVETo explore relationships among sleep disturbances, glucose tolerance, and pregnancy outcomes.RESEARCH DESIGN AND METHODSFour validated sleep questionnaires were administered to 169 pregnant women at the time of 50-g oral glucose tolerance testing (OGTT) during the second trimester. Pregnancy outcomes were analyzed in 108 women with normal glucose tolerance (NGT).RESULTSOf the participants, 41% had excessive daytime sleepiness (Epworth Sleepiness Scale [ESS] >8); 64% had poor sleep quality; 25% snored frequently; 29% had increased risk of sleep-disordered breathing (SDB); 52% experienced short sleep (SS); 19% had both increased SDB risk and SS (SDB/SS); and 14% had daytime dysfunction. Reported sleep duration inversely correlated with glucose values from 50-g OGTT (r = −0.21, P < 0.01). Each hour of reduced sleep time was associated with a 4% increase in glucose levels. Increased likelihood of gestational diabetes mellitus (GDM) was found in subjects with increased SDB risk (odds ratio 3.0 [95% CI 1.2–7.4]), SS (2.4 [1.0–5.9]), SDB/SS (3.4 [1.3–8.7]), and frequent snoring (3.4 [1.3–8.8], after adjustment for BMI). Among NGT subjects, preterm delivery was more frequent in those with increased ESS (P = 0.02), poor sleep quality (P = 0.02), and SS (P = 0.03). Neonatal intensive care unit admissions were associated with increased ESS (P = 0.03), SDB/SS (P = 0.03), and daytime dysfunction (P < 0.01) in mothers.CONCLUSIONSPregnant women experience significant sleep disturbances that are associated with increased risk of GDM and unfavorable pregnancy outcomes. Pregnant women with increased SDB risk, frequent snoring, and sleep duration of <7 h/night have increased risk of developing GDM.