Maternal Diabetes In Pregnancy Research Articles

Maternal diabetes in pregnancy and developmental programming of neurodevelopment disorders: An inflammatory Hypothesis

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The role of maternal DNA methylation in pregnancies complicated by gestational diabetes.

Diabetes in pregnancy is associated with adverse pregnancy outcomes and poses a serious threat to the health of mother and child. Although the pathophysiological mechanisms that underlie the association between maternal diabetes and pregnancy complications have not yet been elucidated, it has been suggested that the frequency and severity of pregnancy complications are linked to the degree of hyperglycemia. Epigenetic mechanisms reflect gene-environment interactions and have emerged as key players in metabolic adaptation to pregnancy and the development of complications. DNA methylation, the best characterized epigenetic mechanism, has been reported to be dysregulated during various pregnancy complications, including pre-eclampsia, hypertension, diabetes, early pregnancy loss and preterm birth. The identification of altered DNA methylation patterns may serve to elucidate the pathophysiological mechanisms that underlie the different types of maternal diabetes during pregnancy. This review aims to provide a summary of existing knowledge on DNA methylation patterns in pregnancies complicated by pregestational type 1 (T1DM) and type 2 diabetes mellitus (T2DM), and gestational diabetes mellitus (GDM). Four databases, CINAHL, Scopus, PubMed and Google Scholar, were searched for studies on DNA methylation profiling in pregnancies complicated with diabetes. A total of 1985 articles were identified, of which 32 met the inclusion criteria and are included in this review. All studies profiled DNA methylation during GDM or impaired glucose tolerance (IGT), while no studies investigated T1DM or T2DM. We highlight the increased methylation of two genes, Hypoxia-inducible Factor-3α (HIF3α) and Peroxisome Proliferator-activated Receptor Gamma-coactivator-Alpha (PGC1-α), and the decreased methylation of one gene, Peroxisome Proliferator Activated Receptor Alpha (PPARα), in women with GDM compared to pregnant women with normoglycemia that were consistently methylated across diverse populations with varying pregnancy durations, and using different diagnostic criteria, methodologies and biological sources. These findings support the candidacy of these three differentially methylated genes as biomarkers for GDM. Furthermore, these genes may provide insight into the pathways that are epigenetically influenced during maternal diabetes and which should be prioritized and replicated in longitudinal studies and in larger populations to ensure their clinical applicability. Finally, we discuss the challenges and limitations of DNA methylation analysis, and the need for DNA methylation profiling to be conducted in different types of maternal diabetes in pregnancy.

The relationship between maternal dietary patterns during pregnancy in women with gestational diabetes mellitus and infant appetitive feeding behaviour at 6\xa0months

Early dietary exposure may influence infant appetitive feeding behaviour, and therefore their later health. Maternal diabetes in pregnancy is associated with an increased risk of obesity in the offspring. We, therefore, examined third-trimester dietary patterns of women with gestational diabetes, their offspring’s appetitive feeding behaviour at 6 months of age, and relationships between these. We used data from a prospective cohort of women with gestational diabetes and assessed maternal dietary patterns at 36 weeks’ gestation using principal component analysis; infant appetitive feeding behaviour at 6 months of age using the Baby Eating Behaviour Questionnaire; and relationships between these using general linear modelling and chi-square tests. In 325 mother-infant dyads, we identified three distinct maternal dietary patterns: ‘Junk,’ ‘Mixed,’ and ‘Health-conscious.’ The maternal ‘Health-conscious’ pattern was inversely associated with ‘enjoyment of food’ in their sons (β − 0.24, 95% CI − 0.36 to − 0.11, p = 0.0003), but not daughters (β − 0.02, 95% CI − 0.12 to 0.08, p = 0.70), and was positively associated with ‘slowness in eating,’ (β 0.13, 95% CI 0.02 to 0.24, p = 0.01). Third-trimester dietary patterns in women with gestational diabetes may have sex-specific effects on infant appetitive feeding behaviour at 6 months of age.

Neonatal Outcomes in Single Agent vs. Combination Therapy in Management of Maternal Diabetes in Pregnancy [26A

INTRODUCTION: To determine if there are decreased rates of neonatal hypoglycemia when type 2 diabetes mellitus (T2DM) is treated with combined insulin and oral hypoglycemic agent compared to insulin, oral hypoglycemic agent, or diet alone. METHODS: We performed an IRB approved, retrospective chart review of 357 women with a diagnosis of T2DM who delivered at our center from 1/2012 to 12/2017. Patients were managed by with diet alone, insulin alone, oral hypoglycemic agent alone, or combined insulin and oral hypoglycemic agent. Primary outcome was neonatal hypoglycemia, defined by the pediatric care providers in discharge diagnoses. Secondary outcomes included birth weight, NICU admission, neonatal death and composite neonatal outcome score (CNOS) that included respiratory failure, respiratory distress syndrome (RDS), death at delivery, ventilator use, admission to NICU, shoulder dystocia, and perinatal death. RESULTS: Of the 357 women included in the study, 11% who were treated with diet alone, 8.2% who were treated with insulin alone, 9.6% who were treated with oral agent alone and 8.7% who were treated with both insulin and oral agent delivered infants that were diagnosed with neonatal hypoglycemia (P=.90). Neonatal death was observed in 3.6% (4/112) of women treated with diet alone, whereas no neonatal death was observed in the other treatment groups (P=.04). There was no significant relationship between treatment type and the CNOS. CONCLUSION: Maternal use of combined insulin and oral hypoglycemic agent for T2DM in pregnancy did not improve, or worsen, neonatal hypoglycemia and other neonatal outcomes. However, neonatal death was more common in diet controlled diabetes.

Maternal diabetes in early pregnancy, and psychotic experiences and depressive symptoms in 10-year-old offspring: A population-based birth cohort study

Epidemiological studies have suggested that maternal diabetes in pregnancy increases the risk of schizophrenia in offspring. A recent cohort study observed that maternal diabetes in early pregnancy is also associated with psychotic experiences in the general adolescent population. However, it remains unclear whether maternal diabetes in early pregnancy is specifically associated with psychotic experiences, or is generally associated with broader mental health problems, including depressive symptoms in adolescence. The present study investigated the longitudinal associations between maternal diabetes in early pregnancy, and psychotic experiences and depressive symptoms in 10-year-old offspring. Our data were derived from the Tokyo Early Adolescence Survey, a population-based survey of early adolescents (N = 4478) and their primary caregivers. Diabetes in early pregnancy was determined by records in the mother's Maternal and Child Health Handbook, documented during the pregnancy. Psychotic experiences and depressive symptoms were established through self-report by the offspring at 10 years of age. Diabetes in early pregnancy was associated with an increased risk of hallucination in the offspring (auditory hallucination [odds ratio {OR} 4.33, 95% confidence interval {CI} 1.12–16.75]; visual hallucination [OR 6.58, 95% CI 1.69–25.66]), even after adjusting for depressive symptoms and other covariates. However, the association between maternal diabetes and delusional thoughts was not significant and diabetes in early pregnancy was not associated with adolescent depressive symptoms. Our investigation suggests that maternal diabetes in early pregnancy may specifically affect the risk of hallucinatory experiences in adolescent offspring.

Differential Effects of Birth Weight on Early-Onset Type 2 Diabetes in Adolescents and Young Adults

Background: Type 2 diabetes mellitus (T2DM) is increasingly diagnosed in adolescents and young adults. However, the impact of birth weight (BW) on this early onset T2DM is not well quantified. Methods: A longitudinal study of Southwestern American Indians, aged ≥ 5 years, was conducted from 1965-2007. Subjects who had a recorded BW and at least one research exam that included an OGTT were followed until they developed T2DM or their last exam before the age of 40 years, whichever came first. Age-sex-adjusted incidence rate of T2DM was computed and Poisson regression models were used to estimate the effect of BW on the incidence of T2DM, adjusted for sex, BMI z-score (fitted as time-varying), and maternal variables, such as the presence of diabetes during pregnancy. The effect of BW on T2DM was non-proportional over time, and in some regression models, the effect was non-linear (quadratic). Therefore, all analyses were stratified by decade of age at follow-up and BW was analyzed as quintiles. Results: Among 4,275 subjects (52% females, median BW 3.45 kg), there were 728 incident cases of T2DM over a median follow-up of 20.6 years (7.5 cases per 1000 person-years). Incidence rates, stratified by decade of age at follow-up, were greater in females and in older age groups. In multivariable regression analyses, the effect of BW on T2DM risk varied by age group, showing a quadratic (U-shaped) effect at 10-19 years (P<0.05) and a negative linear effect at older age intervals (20-29 years, P=0.015; 30-39 years, P<0.001). We could not reliably estimate risk at 0-9 years because of few cases. Female sex, greater BMI z-score, and the presence of maternal diabetes in pregnancy added to the effect of BW on T2DM risk in all age groups. Conclusions: Both low and high BWs increased the risk of T2DM in adolescence, but only the effect of low BW persisted into young adulthood. Effects of female sex, accelerated growth, or being the offspring of a diabetic pregnancy added to the effect of BW on the risk of early onset T2DM. Disclosure M.T. Olaiya: None. M. Sinha: None. R.L. Hanson: None. S. Kobes: None. R. Nelson: None. W.C. Knowler: None.

Expression of apoptosis-regulatory genes in the hippocampus of rat neonates born to mothers with diabetes.

Diabetes during pregnancy impairs the development of the central nervous system (CNS) and causes cognitive and behavioral abnormalities in offspring. However, the exact mechanism by which the maternal diabetes affects the development of the brain remains to be elucidated. The aim of the present study was to investigate the effects of maternal diabetes in pregnancy on the expression of Bcl-2 and Bax genes and the numerical density of degenerating dark neurons (DNs) in the hippocampus of offspring at the first postnatal two weeks. Wistar female rats were maintained diabetic from a week before pregnancy through parturition and male offspring was sacrificed at P0, P7, and P14. Our findings demonstrated a significant down-regulation in the hippocampal expression of Bcl-2 in the diabetic group newborns (P<0.05). In contrast, the mRNA expression of Bax was markedly up-regulated in the offspring born to diabetic dams at all of studied time-points (P<0.05). Moreover, we found a striking increase in the numerical density of DNs in the various subfields of hippocampus of diabetic group pups (P<0.05). The results of the present study revealed that maternal hyperglycemia during gestational period may result in disturbances in the expression of Bcl-2 and Bax genes as two important genes in neuronal apoptosis regulation and induces the production of DNs in the developing hippocampus of neonatal rats. These disturbances may be a reason for the cognitive, structural, and behavioral anomalies observed in offspring born to diabetic mothers. Furthermore, the control of maternal glycaemia by insulin administration in most cases normalized these negative impacts.

Synaptogenesis in the Cerebellum of Offspring Born to Diabetic Mothers.

There is increasing evidence that maternal diabetes mellitus during the pregnancy is associated with a higher risk of neurodevelopmental and neurofunctional anomalies including motor dysfunctions, learning deficits, and behavioral problems in offspring. The cerebellum is a part of the brain that has long been recognized as a center of movement balance and motor coordination. Moreover, recent studies in humans and animals have also implicated the cerebellum in cognitive processing, sensory discrimination, attention, and learning and memory. Synaptogenesis is one of the most crucial events during the development of the central nervous system. Synaptophysin (SYP) is an integral membrane protein of synaptic vesicles and is considered to be a marker for synaptic density and synaptogenesis. Here, we review the manuscripts focusing on the negative impacts of maternal diabetes in pregnancy on the expression or localization of SYP in the developing cerebellar cortex. We believe that the alteration in synaptogenesis or synapse density may be part of the cascade of events through which diabetes in pregnant women affects the newborn's cerebellum.

Altered expression and localization of synaptophysin in developing cerebellar cortex of neonatal rats due to maternal diabetes mellitus

There is sufficient evidence that diabetes during pregnancy is associated with a higher risk of neurodevelopmental anomalies including learning deficits, behavioral problems and motor dysfunctions in the offspring. Synaptophysin (SYP) is an integral membrane protein of synaptic vesicles and is considered as a marker for synaptogenesis and synaptic density. This study aimed to examine the effects of maternal diabetes in pregnancy on the expression and localization of SYP in the developing rat cerebellum. Wistar female rats were maintained diabetic from a week before pregnancy through parturition and male offspring was euthanized at postnatal day (P) 0, 7, and 14. The results revealed a significant down-regulation in the mRNA expression of SYP in the offspring born to diabetic animals at both P7 and P14 (P<0.05 each). One week after birth, there was a significant reduction in the localization of SYP expression in the external granular (EGL) and in the molecular (ML) layers of neonates born to diabetic animals (P<0.05 each). We also found a marked decrease in the expression of SYP in all of the cerebellar cortical layers of STZ-D group pups at P14 (P<0.05 each). Moreover, our results revealed no significant changes in either expression or localization of SYP in insulin-treated group pups when compared with the controls (P≥0.05 each). The present study demonstrated that maternal diabetes has adverse effects on the synaptogenesis in the offspring's cerebellum. Furthermore, the rigid maternal blood glucose control in the most cases normalized these negative impacts.

Health related quality of life in pregnant women with diabetes or mild hyperglycemia

ABSTRACT Background: Diabetes mellitus (DM) is a public health concern spread worldwide. Maternal diabetes in pregnancy increases risk of adverse perinatal and maternal outcomes; therefore; affecting the women´s quality of life (QOL). Objective: To evaluate quality of life in pregnant women with diabetes mellitus, gestational diabetes or mild gestational hyperglycemia. Study Design: This is a prospective and longitudinal study. The sample comprised 105 pregnant women, i.e. 66 Hyperglycemic (HG) and 39 Normoglycemic (NG). The validated WHOQOL–BREF/ QUALITY of LIFE ASSESSMENT questionnaire was applied at the first prenatal appointment or at time of disease diagnosis; and re-applied at delivery admission or at 36-37 weeks’ gestation. Results: Most pregnant women considered good QOL at early pregnancy, but not at late pregnancy. In general, they were satisfied with their quality of life. NG pregnant women were more satisfied than their HG counterparts. At the onset of the gestational period the HG group obtained lower scores in the physical domain than the NG group. At the end of the gestational period, the scores on physical, psychological and environmental domains were significant lower in pregnant women with diabetes or hyperglycemia. Conclusion: The study demonstrated that pregnant women with diabetes or hyperglycemia were compromised in certain aspects of quality of life. Keywords: Pregnancy, Diabetes mellitus, hyperglycemia, life quality, outpatient treatment, hospital

Sex-Differences in the Metabolic Health of Offspring of Parents with Diabetes: A Record-Linkage Study.

Maternal diabetes in pregnancy affects offspring health. The impact of parental diabetes on offspring health is unclear. We investigated the impact of parental diabetes on the metabolic-health of adult-offspring who did not themselves have diabetes. Data from the Generation Scotland: Scottish Family Health Study, a population-based family cohort, were record-linked to subjects’ own diabetes medical records. From F0-parents, we identified F1-offspring of: mothers with diabetes (OMD, n = 409), fathers with diabetes (OFD, n = 468), no parent with diabetes (ONoPD, n = 2489). Metabolic syndrome, body, biochemical measurements and blood-pressures were compared between F1-offspring groups by sex. A higher proportion of female OMD had metabolic syndrome than female OFD or ONoPD (P<0.0001). In female offspring, predictors of metabolic syndrome were: having a mother with diabetes (OR = 1.78, CI 1.03–3.07, [reference ONoPD]), body mass index (BMI, OR = 1.21, CI 1.13–1.30) and age (OR = 1.03, CI 1.01–1.06). In male offspring, predictors of metabolic syndrome were: BMI (OR = 1.18, CI 1.09–1.29) and percent body-fat (OR = 1.12, CI 1.05–1.19). In both sexes, OMD had higher blood-pressures than OFD (P<0.0001). In females, OMD had higher glucose (P<0.0001) and percent body-fat (P<0.0001) compared with OFD or ONoPD. OMD and OFD both had increased waist-measurements (P<0.0001), BMI (P<0.0001) and percent body-fat (P<0.0001) compared with ONoPD. Female OMD and OFD had lower HDL-cholesterol levels (P<0.0001) than female ONoPD. Parental diabetes is associated with higher offspring-BMI and body-fat. In female offspring, maternal diabetes increased the odds of metabolic syndrome, even after adjusting for BMI. Further investigations are required to determine the mechanisms involved.

Incretin and glucagon levels in adult offspring exposed to maternal diabetes in pregnancy.

Fetal exposure to maternal diabetes is associated with increased risk of type 2 diabetes mellitus (T2DM) later in life. The pathogenesis of T2DM involves dysfunction of the incretin hormones, glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP), as well as hyperglucagonemia. Our aim was to investigate circulating plasma levels of GLP-1, GIP, and glucagon during the oral glucose tolerance test (OGTT) in adult offspring of women with diabetes in pregnancy. We conducted a follow-up study of 567 offspring, aged 18-27 years. We included two groups exposed to maternal diabetes in utero: offspring of women with diet-treated gestational diabetes mellitus (O-GDM; n = 163) or type 1 diabetes (O-T1DM; n = 146). Two reference groups were included: offspring of women with risk factors for GDM, but normoglycemia during pregnancy (O-NoGDM; n = 133) and offspring from the background population (O-BP; n = 125). The subjects underwent a 75-g OGTT with venous samples at 0, 30, and 120 minutes. Fasting plasma levels of GLP-1 were lower in the two diabetes-exposed groups compared to O-BP (O-GDM, P = .040; O-T1DM, P = .008). Increasing maternal blood glucose during OGTT in pregnancy was associated with reduced postprandial suppression of glucagon in the offspring. Lower levels of GLP-1 and higher levels of glucagon during the OGTT were present in offspring characterized by overweight or prediabetes/T2DM at follow-up, irrespective of exposure status. Lower levels of fasting GLP-1 and impaired glucagon suppression in adult offspring exposed to maternal diabetes during pregnancy are diabetogenic traits that may contribute to glucose intolerance in these persons, but further investigations are needed.

Maternal diabetes in pregnancy and offspring cognitive ability: sibling study with 723,775 men from 579,857 families

Aims/hypothesisThe aim of this study was to investigate the association between maternal diabetes in pregnancy and offspring cognitive ability and also to assess whether the association was due to intrauterine mechanisms or shared familial characteristics.MethodsWe linked national registers and conducted a prospective cohort study of singleton Swedish-born men to explore associations between maternal pregnancy diabetes and educational achievement at age 16 years, the age of completing compulsory education in Sweden (n = 391,545 men from 337,174 families, graduating in 1988–1997 and n = 326,033 men from 282,079 families, graduating in 1998–2009), and intelligence quotient (IQ) at the mandatory conscription examination at 18 years of age (n = 664,871 from 543,203 families).ResultsAmong non-siblings, maternal diabetes in pregnancy was associated with lower offspring cognitive ability even after adjustment for maternal age at birth, parity, education, early-pregnancy BMI, offspring birth year, gestational age and birthweight. For example, in non-siblings, the IQ of men whose mothers had diabetes in their pregnancy was on average 1.36 points lower (95% CI −2.12, −0.60) than men whose mothers did not have diabetes. In comparison, we found no such association within sibships (mean difference 1.70; 95% CI −1.80, 5.21).Conclusions/interpretationThe association between maternal diabetes in pregnancy and offspring cognitive outcomes is likely explained by shared familial characteristics and not by an intrauterine mechanism.

Risk factors for congenital hypothyroidism in Egypt: results of a population case-control study (2003–2010)

BACKGROUND AND OBJECTIVESAlthough the prevention of the neuropsychological consequences of congenital hypothyroidism (CH) through the use of replacement therapy represents an important public health success, knowledge about the modifiable risk factors could reduce the number of infants affected by this disease. This study was carried out to identify risk factors for CH at Fayoum Governorate, Egypt.DESIGN AND SETTINGSThis was a population-based case-control study, which started in 2003 and was carried out for 8 years through Fayoum center of the Egyptian Ministry of Health and Population screening program for CH.METHODSThis study was a population-based case-control study carried out by using national project for CH. One control was enrolled for each new CH infant; 320 cases and 320 controls were enrolled in 8 years. Maternal and neonatal influences were investigated.RESULTSA statistically significant association of CH was observed with birth defects, female gender, gestational age >40 weeks, and gestational diabetes. An increased risk for CH was detected in twins by a multivariate analysis.CONCLUSIONOur results suggest a multifactorial origin of CH in which genetic (high frequency of additional malformations) and environmental factors (especially maternal diabetes) play a role in the development of the disease.

Metabolic profiling in infants of mothers with diabetes or hyperglycaemia during pregnancy

regnancy-related diabetes is a growing public health concern, with up to 40000 cases in the UK each year. Intrauterine exposure to diabetes is associated with greater risks of adverse metabolic sequelae in later life. 1 Two recent meta-analyses examine the relationship between maternal diabetes in pregnancy and offspring BMI and blood pressure in childhood. Offspring of mothers with diabetes had 0.28kg/m 2 higher mean BMI and 1.88mmHg greater systolic BP compared to controls. 2,3 These differences may have important clinical implications. 4,5 Maternal diabetes is also associated with an increased risk of glucose intolerance and type 2 diabetes (T2D) in offspring. 6,7 These risks are elevated in both preexisting and gestational diabetes and are independent of the effects of maternal obesity. 1,8,9 Risks are also additional to genetic predisposition. The comparison of siblings born before and after their mother develops diabetes provides particularly compelling evidence as this minimises the possible impact of genetic and environmental influences, but examines the effect of intrauterine exposure to diabetes. In the Pima Indian population, children born after their mother developed diabetes were shown to have higher systolic BP, HbA1c, BMI and nearly four times the odds of developing T2D compared to siblings born before their mother developed diabetes. 10,11 In a large prospective Swedish study, young men whose mothers had diabetes during pregnancy had on average 0.94kg/m 2 greater BMI than brothers born before their mother developed diabetes. 12 An altered phenotype is also evident in off

Infants Born to Mothers with Diabetes in Pregnancy at the Population Level in Manitoba: More Questions than Answers

ObjectiveReport some novel associations seen between maternal diabetes in pregnancy (DIP) and infant morbidity over the first year of life. MethodsA retrospective population based cohort of infants born at 34 to 41 weeks of gestational age (GA) was assembled; using individual and area-level income for socio-economic status (SES). Neonatal morbidity was measured as diagnoses received during the birth stay. First year outcomes were neonatal readmissions (up to 28 days) and postneonatal admissions (29 to 365 days). Logistic regression controlled for confounders. ResultsThere were 25 312 infants: 6.1% preterm, 32.4% low SES, and 4.8% had mothers with DIP. During the newborn period maternal DIP increased the odds of nonrespiratory morbidity (odds ratio [OR] 8.1; 95% confidence interval [CI] 6.9–9.5), need for phototherapy (OR 2.3; 95% CI 1.8–2.9) and neonatal intensive care unit admission (OR 2.8; 95% CI 2.4–3.4) and had an unclear relationship with respiratory outcomes. Maternal DIP did not demonstrate a significant association with neonatal admissions. Maternal DIP increased the odds of postneonatal admissions (OR 1.2; 95% CI 1.0–1.5) but not in the respiratory subgroup (OR 1.0; 95% CI 0.7–1.3). ConclusionsMaternal DIP is a significant risk factor for infant morbidity that persists over the first year of life. Its consistent lack of an association with respiratory morbidity in this cohort suggests an interaction with SES and merits further investigation.

Associations of Existing Diabetes, Gestational Diabetes, and Glycosuria with Offspring IQ and Educational Attainment: The Avon Longitudinal Study of Parents and Children

Introduction. Results from studies examining associations of maternal diabetes in pregnancy with offspring cognitive outcomes have been inconclusive. Methods. We used data from the Avon Longitudinal Study of Parents and Children, a UK prospective pregnancy cohort. Outcomes were School Entry Assessment (SEA) scores (age 4, N = 6, 032) and WISC-III IQ (age 8, N = 5, 282–5,307) and General Certificate of Secondary Education (GCSE) results (age 16, N = 7, 615). Results. Existing diabetes, gestational diabetes, and, to a lesser extent, glycosuria were associated with lower offspring SEA scores (age 4), IQ (age 8), and GCSE results (age 16) even when adjusting for offspring sex, maternal age, prepregnancy BMI, smoking in pregnancy, parity, caesarean section, maternal education, and occupational social class. Offspring of mothers with existing diabetes had a threefold risk of achieving no GCSEs graded A*-C, whilst offspring of women with gestational diabetes had, on average, a five point lower IQ compared to offspring of women with no diabetes or glycosuria. Conclusions. Maternal diabetes in pregnancy is consistently associated with lower offspring cognition and educational attainment though confidence intervals were wide. The weaker associations with glycosuria suggest a dose-dependent adverse association with IQ.

Students Views about GDM Education with EPMP (Electronic Patient Management Problem) Method

Introduction: GDM (Gestational diabetes mellitus) education is an important topic in medical science courses. How clinical decision making and management of maternal diabetes in pregnancy, is a term in which in gestational diabetes is concerned. EPMP simulation method is one of the Web based methods and is used to reinforcement student clinical reasoning and evaluation decision making ability in different situation. EPMP has developed a large evolution in usage of simulation method in medical science education with advantages such as complicated branches in problem solving, immediate response to student performance and reassessment of prior selections.Purpose: To determine students views about GDM education with EPMP educational softwareMaterial and method: This study is a cross sectional method. Research samples were community sample included 44 midwifery students in fourth and sixth semesters. Then, pretest and GDM education accomplished with EPMP, an educational software, that designed by researchers .Next, data was gathered regarding to student views with prepared researcher questionnaire consist of 10 questions .Afterwards the data was evaluated with SPSS ver. 19.0.Findings: Study results indicate 91% announce that this method is new method and 84.5% had believed this method is appropriate for reinforcements make a decision power.Conclusion: EPMP method is very appropriate to teach lessons that need to clinical reasoning. This method cause student participates in active learning process and they are away from passive learning process. So it suggests be used to reinforcement student clinical reasoning ability in some of specific lessons.

Maternal Diabetes in Pregnancy: Early and Long-Term Outcomes on the Offspring and the Concept of “Metabolic Memory”

The adverse outcomes on the offspring from maternal diabetes in pregnancy are substantially documented. In this paper, we report main knowledge on impacts of maternal diabetes on early and long-term health of the offspring, with specific comments on maternal obesity. The main adverse outcome on progenies from pregnancy complicated with maternal diabetes appears to be macrosomia, as it is commonly known that intrauterine exposure to hyperglycemia increases the risk and programs the offspring to develop diabetes and/or obesity at adulthood. This “fetal programming”, due to intrauterine diabetic milieu, is termed as “metabolic memory”. In gestational diabetes as well as in macrosomia, the complications include metabolic abnormalities, degraded antioxidant status, disrupted immune system and potential metabolic syndrome in adult offspring. Furthermore, there is evidence that maternal obesity may also increase the risk of obesity and diabetes in offspring. However, women with GDM possibly exhibit greater macrosomia than obese women. Obesity and diabetes in pregnancy have independent and additive effects on obstetric complications, and both require proper management. Management of gestational diabetes mellitus and maternal obesity is essential for maternal and offspring's good health. Increasing physical activity, preventing gestational weight gain, and having some qualitative nutritional habits may be beneficial during both the pregnancy and offspring's future life.

Lung maturation in diabetes in pregnancy: If and when to test

Poorly controlled maternal diabetes in pregnancy may delay fetal pulmonary maturation. However, diabetic women with good glycemic control have fetal lung maturation at the same gestational age as nondiabetic women. With modern ultrasound technology, gestational dates can be accurately assessed in the first or early second trimester. Respiratory distress syndrome is rare in nondiabetic and well-controlled diabetic pregnancies confirmed by early ultrasound to be at or beyond 37 weeks. Early confirmation of dates thus eliminates the need for amniotic fluid assessment of fetal lung maturity prior to elective delivery at or beyond 38 weeks in well-controlled diabetic and nondiabetic women. Poorly controlled diabetic women and pregnancies without early ultrasound verified dates may require amniotic fluid analysis for lung maturity prior to elective delivery.