Nondiabetic Women Research Articles

Association of vitamin D deficiency and insulin resistance in nondiabetic obese women: role of parathyroid hormone

Association of vitamin D deficiency and insulin resistance in nondiabetic obese women: role of parathyroid hormone

A comparative study of BMI and eGFR in pre- and post-menopausal women with and without diabetes

Background: Obesity is a most important disorder associated with menopause. The mechanisms of the increase in body weight after menopause are not clearly understood. Earlier studies reported that the changes in sex hormone levels at menopause may have adverse effects on kidney function. The renoprotection activity of female sex hormones seems to decrease after menopause. Aim and Objectives: In this study, it was aimed to evaluate body mass index (BMI) and estimated glomerular filtration rate (eGFR) along with fasting blood glucose, follicle-stimulating hormone (FSH), and estradiol in healthy pre- and postmenopausal women with or without diabetes. Materials and Methods: A total of 92 subjects including 37 non-diabetic, 15 diabetic premenopausal women, and 25 diabetic and 15 non-diabetic postmenopausal women were included in the study. For all the subjects, BMI was calculated using height (cm) and weight (kg) and recorded as kg/m2. Fasting blood samples were collected for glucose estimation by GOD/POD method, serum creatinine by Jaffe’s method, and FSH and estradiol were estimated by ELISA method using commercial kits. A simplified MDRD equation was used to estimate GFR (mL/min/1.73 m2) = 186 × [serum creatinine] − 1.154 × [age] − 0.203 (× 0.742 if female). Values were reported as mean + standard deviation. The data were analyzed by one-way ANOVA with Tukey‒Kramer post hoc test using SPSS version 20 and P < 0.05 was taken as statistically significant at 95% confidence interval. Results: Results of the study showed that BMI was higher and eGFR was significantly reduced in postmenopausal women with and without diabetes compared to premenopausal women with or without diabetes. Conclusion: The study was concluded that the observed increased BMI and reduced eGFR in postmenopausal women need lifestyle changes to control BMI and measures to improve kidney function are to be considered to improve quality of life in postmenopausal women.

Relationship of serum adiponectin levels with lipid profile in diabetic and non-diabetic pregnant women

Relationship of serum adiponectin levels with lipid profile in diabetic and non-diabetic pregnant women

Effect of Vitamin D Supplementation on Serum 25-Hydroxyvitamin D and Homeostatic Model of Insulin Resistance Levels in Healthy Pregnancy: A Systematic Review and Meta-Analysis.

Progressive insulin resistance is a physiological condition during pregnancy that can lead to gestational diabetes. Given the association between low blood vitamin D levels and insulin resistance, the present meta-analysis evaluated the effect of vitamin D supplementation on serum 25-hydroxyvitamin D (25[OH]D) and the homeostatic model of insulin resistance (HOMA-IR) levels in non-diabetic pregnant women. A comprehensive literature search was conducted using electronic databases and gateways such as Cochrane Library, Medline, Google Scholar, Science Direct, Web of Sciences, Embase, and Scopus. Articles up to 2020 in both English and Persian were included in the study. The effect of vitamin D supplementation on 25(OH)D and HOMA-IR was determined based on the differences in mean changes from baseline to post-intervention. Weighted mean and 95% confidence intervals (CI) were pooled using a random-effects model. Data were analyzed using STATA software. Four studies, including six trials with 380 participants, reported that vitamin D supplementation increased 25(OH)D (mean change: 13.72, 95% CI: 7.28-20.17) and decreased HOMA-IR (mean change: 1.46, 95% CI: 0.56-2.37) levels compared with the placebo group. A high weekly dose of vitamin D further reduced HOMA-IR levels (adjusted R2=77.99, I2 residuals=80.49%, P=0.047). There was no significant association between the dose of vitamin D and 25(OH)D (P=0.974). Intervention duration was not associated with an increase in 25(OH)D (P=0.102), nor with a decrease in HOMA-IR (P=0.623). Vitamin D supplementation increased 25(OH)D and decreased HOMA-IR levels in non-diabetic pregnant women. Vitamin D in high doses further reduced HOMA-IR, but did not affect 25(OH)D concentrations.

Altered Right Portal and Umbilical Vein Doppler Parameters in Fetal Macrosomia Resulting from Pregestational andGestational Diabetic Mothers: A Prospective Case-Control Study

Objective: To evaluate the blood flow of the umbilical vein and right portal vein in macrosomic fetuses of diabetic mothers and investigate the effect of maternal insulin treatment on these blood flows. Material and Methods: This prospective case-control study was conducted between March 2019 and December 2019. Fetuses of the 49 pregestational and gestational diabetic mothers who had an abdominal circumference percentile above 97% were evaluated as macrosomic and formed the study group. The study group was divided into two subgroups: patients treated with insulin and those who did not. In the control group, 48 non-diabetic pregnant women with matched gestational weeks whose fetuses are at the 10-90% percentile were included. Time-averaged maximum blood velocity (TAMXV) values of the right portal vein and the free loop of the umbilical vein were measured. Results: The median right portal vein TAMXV value and umbilical vein TAMXV value were found to be significantly higher in diabetic pregnancies (16.25 cm/s, and 15.28 cm/s, respectively) than in the control group (12.76 cm/s, and 13.38 cm/s, respectively, p<0.001). Umbilical and right portal vein flows were similar in macrosomic fetuses of diabetic mothers who were treated with insulin or those who did not. While umbilical vein flow in macrosomic fetuses increased as the gestational age progressed (p=0.028), it was observed steadily in normally growing fetuses. Conclusion: The umbilical and right portal vein flows are higher in macrosomic fetuses of diabetic mothers than in appropriately grown fetuses. Maternal insulin treatment does not affect fetal umbilical vein and right portal vein blood flow in macrosomic fetuses.

Association Between Plasma Asprosin Levels and Gestational Diabetes Mellitus.

This study sought to investigate whether asprosin can be used in the diagnosis of GDM or for diagnostic purposes in high-risk pregnancies, along with a review of other parameters that may be associated with serum asprosin levels. The study investigated the association between gestational diabetes mellitus (GDM) and asprosin levels. A total of 93 participants; 30 patients with GDM, 33 healthy pregnant women with normal glucose tolerance (NGT), and 30 healthy non-diabetic women (control group) at the Endocrinology and Metabolic Diseases outpatient clinic of a tertiary care university hospital were enrolled in the study. Patients with GDM and NGT were examined in terms of GDM between the 24th and 28th week of pregnancy (2nd trimester). Patient data were collected during routine examinations, and asprosin levels were measured using the ELISA method. All participants underwent testing for measurements of serum hemoglobin, insulin, C-peptide, fasting plasma glucose, and glycated hemoglobin (HbA1c) levels following a fasting period of at least eight hours. Asprosin levels were higher in pregnant women with NGT and with GDM versus controls (Control-NGT asprosin, p = 0.001; Control-GDM asprosin, p = 0.001). Pregnant women with GDM had higher asprosin levels than those with NGT (p = 0.001). In detecting GDM in pregnant women, an asprosin cutoff value of >31.709 ng/mL yielded a sensitivity of 93.3%, specificity of 90.9%, positive predictive value of 90.3%, and negative predictive value of 93.75% (p < 0.001). Serum asprosin levels can potentially be used as a marker in the diagnosis of GDM.

Interaction of sex and diabetes on the association between hemoglobin glycation index, hemoglobin A1c and serum uric acid

BackgroundHemoglobin glycation index (HGI), which is calculated by blood glucose and hemoglobin A1c(HbA1c), reflects the individual discrepancy in HbA1c. This study aimed to investigate the association between HGI/HbA1c and serum uric acid(SUA) stratified by sex and diabetes.MethodsThe study recruited 33772 participants who underwent physical examinations between April 2016 and August 2021 in Beijing Chao-Yang Hospital. A random subsample of 3000 subjects was utilized to calculate the formula of HGI and data of the remaining 30772 participants were used for analysis. HGI and HbA1c were categorized according to quartiles (Q1, Q2, Q3, Q4), using Q1 as the reference. We used multiple linear regression and restricted cubic splines for data analysis.Results30772 participants with a mean age of 44.4 years old were included in the analysis, 48.6% (N = 14944) of which were female and 7.7% (N = 2363) with diabetes. Associations of HGI, HbA1c and SUA were modified by sex and diabetes. The relationship between SUA levels and HGI was positive in women without diabetes, with one unit increase in HGI associating with an 11.3 μmol/L increase in SUA (P < 0.001) after adjusting for other confounders. On average, each one-unit increase in HbA1c was associated with a 14.3 μmol/L decrease in SUA in women with diabetes, a 14.9 μmol/L decrease in SUA in men with diabetes, and a 16.5 μmol/L increase in SUA in women without diabetes (all P < 0.001). The SUA levels in men without diabetes showed a bell-shaped relation with HbA1c, increasing as the HbA1c rose to around 5.7% and then falling with a further increase of HbA1c (P < 0.001).ConclusionsSUA levels were inversely correlated with HbA1c in diabetic patients, also in men with prediabetes (HbA1c ≥ 5.7%), but positively correlated with HbA1c and HGI in women without diabetes. Glycemic control may help to reduce the risk of hyperuricemia in non-diabetes women.

Is there any difference in insulin resistance status between cases of benign and malignant ovarian neoplasms? A study on surrogate markers of insulin resistance in Indonesian non-diabetic women.

The association between insulin resistance (IR) and ovarian neoplasm is little known. The present study attempted to investigate the difference in clinicopathological characteristics, metabolic parameters, and IR prevalence between benign and malignant ovarian neoplasms. The cross-sectional study involved 52 non-diabetic women with benign (n=27) and malignant (n=25) diagnoses in a tertiary hospital in Indonesia. Fasting insulin level (FIL), homeostatic model assessment of IR and β-cell dysfunction (HOMA-IR and HOMA-β), fasting IR index (FIRI), and quantitative insulin sensitivity check index (QUICKI) were used as surrogate markers to evaluate IR. Parametric and nonparametric statistical tests were employed to analyze the different parameters between the two groups. Pearson or Spearman's rank test assessed the correlation between markers and clinical variables. Results revealed that patients with benign neoplasms were younger than those with malignant neoplasms (38.63 vs. 47.40 years; P=0.003) and had a higher median body mass index (BMI) than their counterparts (22.98 vs. 18.61 kg/m2; P=0.014). Different characteristics between benign and malignant neoplasm cases were found in menopausal status, ovary side affected, systolic blood pressure, and BMI classes. Endometrial cysts and mucinous carcinoma were the most often diagnosed benign and malignant neoplasms. Malignant neoplasms had a lower median HOMA-β score than benign neoplasms (49.33 vs. 75.79; P=0.011), indicating more severe β-cell dysfunction. No significant difference was observed in the prevalence of IR between benign and malignant ovarian neoplasms for the following values of each marker: FIL (25.9% vs. 12.0%), HOMA-IR (37.0% vs. 28.0%), FIRI (51.9% vs. 48.0%) and QUICKI (81.5% vs. 92.0%). The indicators of FIL, HOMA-IR, HOMA-β, FIRI, and QUICKI correlated with each other and confirmed the reliability of these surrogate markers for measuring IR status in ovarian neoplasms. In brief, benign ovarian neoplasms tended to have more IR when compared with malignant ovarian neoplasms. However, this difference was not statistically significant.

Bariatric surgery normalizes diabetes risk index by one month post-operation.

The Diabetes risk index (DRI) is a composite of NMR-measured lipoproteins and branched chain amino acids predictive of diabetes mellitus development. Bariatric surgery is indicated in patients with severe obesity, many of whom are at high-risk for developing diabetes. Substantial weight loss occurs following bariatric surgery and sustained weight loss likely contributes to reductions in the development of diabetes and cardiovascular disease. However, some evidence suggests that bariatric surgical procedures themselves may contribute to reducing risk of these conditions independent of weight loss. We aimed to investigate DRI and its association with reductions in body weight and adiposity over one year following bariatric surgery. We examined 51 severely obese premenopausal women without diabetes. DRI, BMI, body weight and waist measurements were made before and at 1, 6 and 12months after Roux-en-Y Gastric Bypass (RYGB) or Sleeve Gastrectomy. Values were compared to healthy women with normal BMI (18.5-24.9kg/m2; n = 15). Non-diabetic women with severe obesity (BMI 44.7 ± 6.2kg/m2) exhibited significantly elevated DRI scores prior to surgery versus controls (35 [26, 39] vs 12 [1, 20]; p < 0.0001). At 1month after surgery, BMI decreased 5.1 ± 1.1kg/m2, but DRI decreased so that it no longer differed from that of normal BMI controls (1.9 [1, 17] vs control 12 [1, 20]; p = 0.35). Subjects continued to lose weight, whereas DRI remained similar, throughout follow-up with DRI 1.0 [1, 7] at 12months. Changes in DRI did not correlate with changes in BMI, body weight or waist circumference at any time during follow-up. There was no difference in change in DRI between surgical procedures or pre-operative metabolic syndrome status. Our analysis of DRI scores supports the capacity of bariatric surgery to reduce risk of developing diabetes in severely obese individuals. Our findings suggest that bariatric surgical techniques may have inherent effects that improve cardiometabolic risk independent of reductions in body weight or adiposity.

PSUN176 Fructosamine as a screening test for gestational diabetes

Abstract Background All organizations use variable glucose criteria for diagnosis of gestational diabetes (GDM). However all involve OGTT. American college of Obstetrics and Gynecology (ACOG) and American Diabetes Association (ADA) recommend 2 step testing; 1) 1 hour glucose level on 50 gm glucose ingestion at any time during the day (1 hour OGTT) and 2) 3 hour OGTT with 100 gm glucose ingestion after overnight fast in pregnant women with glucose &amp;gt; 140 mg/dl during 1 hour. OGTTs require preparation with least daily intake of carbohydrate 150 gm for 3 days before testing. Many women are hesitant getting tested because of nausea, vomiting on glucose ingestion. Thus, none of the tests is convenient. Objective We examined utility of serum Fructosamine level as a screening test for diagnosis of GDM. Methods Random serum glucose and Fructosamine (mcM/l) levels as well as HbA1c (%) were determined at 24-30 weeks in 206 pregnant women, ages 24-40 years along with 1 hour OGTT and then again with 3 hour OGTT in 46 pregnant women with abnormal 1 hour OGTT and 21 age matched non-pregnant women. Continuous glucose monitoring (CGM) for 2 weeks was performed in 5 pregnant women with abnormal 3 hour OGTT and 7 non-pregnant women. Results Fructosamine levels (192± 4) were significantly lower (p&amp;lt;0.01) in nondiabetic pregnant women when compared with age matched non-pregnant women (224 ± 5). Cutoff serum Fructosamine concentration between groups was 205. Glucose and HbA1c were not significantly different amongst groups. Serum Fructosamine levels in 26 pregnant with abnormal 1 hour but normal 3 hour OGTT were &amp;lt;205, similar to nondiabetic pregnant women. Serum Fructosamine concentrations in women with abnormal 3 hour OGTT and normal CGM e.g, 70-140 mg /dl matched levels in nondiabetic pregnant women. Conclusion CGM may be the most accurate test for diagnosis of GDM. Random serum Fructosamine level may be as accurate as CGM and more accurate than both OGTTs. Importantly, it is a simple and convenient test without requiring fast, glucose ingestion or preparation. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

PMON244 Alterations in Nonesterified Free Fatty Acids (NEFA) Trafficking Rather Than Hyperandrogenism Contribute to Variations in Insulin Sensitivity Among Obese Women with Polycystic Ovary Syndrome

Abstract Objectives To compare the metabolic and hormonal features of metabolically unhealthy obese PCOS women (MU-PCOS) vs. metabolically healthy obese PCOS women (MH-PCOS) and determine whether alterations in non-esterified free fatty acids (NEFA) response to hyperinsulinemia contribute to variations in insulin sensitivity between MU-PCOS and MH-PCOS. Design Prospective cross-sectional study. Setting Tertiary-care academic center. Methods Insulin resistance (IR) in the basal state was assessed by HOMA-IR in 125 consecutive obese oligo-ovulatory PCOS women (BMI≥ 30 kg/m2; NIH 1990 or Rotterdam 2003 Phenotype A/B) undergoing an oral glucose tolerance test (oGTT); and IR in the dynamic state assessed by the modified frequently sampled intravenous glucose tolerance test (mFSIVGTT) in a subgroup of 16 non-diabetic obese PCOS women. Main Outcome Measures: Primary outcome measures were: 1) IR in AT was assessed in the basal state by the Adipose Insulin Resistance Index [Adipo-IR]) and dynamically by the mFSIVGTT-derived indices of insulin-mediated NEFA suppression [NEFAnadir, TIMEnadir, and %NEFAsupp]); 2) peak lipolysis rate [SNEFA]; and 3) peak NEFA uptake rate [KNEFA]. Secondary outcome measures were levels of insulin and glucose during oGTT, HOMA-β%, and degree of hyperandrogenism (i.e. mF-G score, free testosterone [T], total T, DHEAS). Results Eighty-five obese PCOS participants undergoing oGTT had a HOMA-IR index of ≥2.5 (MU-PCOS) and 40 had a HOMA-IR of &amp;lt;2.5 (MH-PCOS). MU-PCOS had higher mean HOMA-β%, levels of fasting, 1-hr and 2-hr. glucose and insulin, and peak insulin during the oGTT, and higher prevalence of prediabetes and elevated 1-hr. glucose and a trend towards higher prevalence of type 2 diabetes mellitus (T2DM), than MH-PCOS. Alternatively, measures of HA were similar between the groups. Assessing IR dynamically, subjects were subdivided into MU-PCOS by an insulin sensitivity index [Si] ≤1.7 [mU/L]−1·min−1 (n=8) or MH-PCOS by an Si ≥5.6 [mU/L]−1·min−1 (n=8), matched for age and BMI. MU-PCOS had lower Si and KNEFA, smaller %NEFAsupp, longer TIMEnidar, and higher NEFAnidar and Adipo-IR than MH-PCOS, although fasting plasma NEFA levels and SNEFA were similar. In bivalent analysis, Si correlated strongly and negatively with NEFAnadir, weakly and negatively with TIMEnadir, and positively and strongly with KNEFA and NEFAsupp, in MUO-PCOS only. Conclusion Independent of age and BMI, metabolically unhealthy obese PCOS women, compared with metabolically healthy obese PCOS women, had lower rates of NEFA uptake and altered insulin-mediated plasma NEFA suppression in response to mFSIVGTT-determined endogenous insulin secretion, rather than disparities in HA and rate of lipolysis, mechanism that may contribute to variations in insulin sensitivity among obese PCOS women. Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.

The ability of pGCD59 to predict adverse pregnancy outcomes: a prospective study of non-diabetic pregnant women in Ireland

AimEven though most pregnancies are uneventful, occasionally complications do occur. Gestational diabetes is linked to an increased risk of adverse pregnancy outcomes. Early identification of women at risk of experiencing adverse outcomes, ideally through a single blood test, would facilitate early intervention. Plasma glycated CD59 (pGCD59) is an emerging biomarker which has shown promise in identifying hyperglycaemia during pregnancy and has been associated with the risk of delivering an LGA infant. The aim of this study was to explore the ability of the first- and second-trimester pGCD59 to predict adverse pregnancy outcomes.MethodsThis was a prospective study of 378 pregnant women. Samples for pGCD59 were taken at the first antenatal visit and at the time of the 2 h 75 g OGTT (24–28 weeks of gestation). Adjusted receiver operating characteristic curves were used to evaluate the ability of pGCD59 to predict maternal and neonatal outcomes.ResultsFirst-trimester pGCD59 levels were higher in women with gestational diabetes who delivered a macrosomic infant (4.2 ± 0.7 vs. 3.5 ± 1.0 SPU, p < 0.01) or an LGA infant (4.3 ± 0.3 vs. 3.6 ± 1.0 SPU, p = 0.01) compared to women with GDM that did not experience these outcomes. Second-trimester pGCD59 levels were higher in women that developed polyhydramnios (2.9 ± 0.4 vs. 2.5 ± 1.1 SPU, p = 0.03). First- and second-trimester pGCD59 predicted pregnancy-induced hypertension with good accuracy (AUC:0.85, 95%CI:0.78–0.91; AUC: 0.80, 95%CI: 0.73–0.88, respectively) and neonatal hypoglycaemia with fair to good accuracy (AUC:0.77, 95%CI: 0.54–0.99, AUC:0.81, 95%CI:0.62–0.99).ConclusionsThis study has shown that pGCD59 has the potential to predict adverse pregnancy outcomes. Prospective studies with a larger number of cases are necessary to fully explore and validate the potential of this emerging biomarker in predicting adverse pregnancy outcomes.

Does the Ketogenic Diet Improve the Quality of Ovarian Function in Obese Women?

Background: Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder in women of reproductive age, the prevalence of which ranges from 8 to 13%. It is characterized by metabolic, reproductive, and psychological alterations. PCOS prevalence is related to body mass index (BMI). Women with BMI < 25 kg/m2 have a prevalence of 4.3%, whereas women with BMI > 30 kg/m2 have a prevalence of 14%. Moreover, women with PCOS have a risk of type 2 diabetes mellitus (T2DM) two-fold higher than controls, independently of BMI. Both PCOS and T2DM are also consequences of lower serum sex-hormone-binding globulin (SHBG) levels, which is currently considered a biomarker of metabolic disorders, in particular T2DM. Aim: To evaluate the effect of the very-low-calorie ketogenic diet (VLCKD) on markers suggested to be predictive of metabolic and ovulatory dysfunction. These comprehend SHBG, anti-Mullerian hormone (AMH), and progesterone levels on day 21 of the menstrual cycle in a cohort of obese non-diabetic women with PCOS and regular menses. Methods: Twenty-five patients (mean age 25.4 ± 3.44 years) with obesity and PCOS underwent VLCKD for 12 weeks. Each of them underwent measurements of anthropometric parameters (body weight, height, and waist circumference) and blood testing to evaluate serum levels of SHBG, AMH, and progesterone before and after 12 weeks of VLCKD. Results: At enrollment, all patients had high BMI, WC, and AMH, whereas SHBG and progesterone levels were low. After VLCKD, the patients showed a significant reduction in BMI, WC, and HOMA index. In particular, 76% of patients (19/25) switched from obesity to overweight, and the HOMA index normalized, reaching values lower than 2.5 in 96% (24/25) of patients. In addition, serum AMH levels significantly decreased, and progesterone and SHBG significantly increased after VLCKD. Conclusions: This is the first study documenting the effects of VLCKD on ovarian reserve and luteal function in women with PCOS. VLCKD could be used to improve metabolic and ovulatory dysfunction in women with PCOS. Further studies are needed to understand the reasons for the AMH reduction.

Profile of insulin resistance of pregnant women at late third trimester in Nigeria: A descriptive cross-sectional report.

Exaggerated level of insulin resistance (IR) is associated with poor pregnancy outcomes. Identifying affected women may forestall these outcomes. There are few reports on IR and its predictors among pregnant women in Nigeria. To determine the profile of IR, using the homeostatic model assessment of insulin resistance (HOMA-IR), and its predictors among parturient Nigerian women in third trimester. A cross-sectional baseline data of healthy pregnant women in third trimester, consecutively recruited into a cohort study that evaluated IR and neonatal outcomes at a tertiary maternity. Sociodemographic and clinical data were obtained. Fasting venous blood was analyzed for glucose and insulin and HOMA-IR was calculated. We consecutively recruited 401 healthy pregnant women between 28 and 41 weeks [means ± SD = 37.4 ± 0.8 weeks]; mean age 31.52 ± 4.3 years (range: 20-41 years). Median (IQR) HOMA-IR was 1.15 (0.63, 1.96; range: 0.02-11.73). Binary multivariable logistic regression showed overweight- [aOR (95% CI) = 3.29 (1.18, 9.13)], hyperglycemia- [aOR (95% CI) = 2.98 (1.19, 6.90)], and hypertension as independent predictors of IR [aOR (95% CI) = 2.85 (1.18, 6.90)]. Among nondiabetic Nigerian pregnant women in late third trimester, IR was independently associated with overweight, hypertension, and hyperglycemia. Control of adiposity is a potential target for control of IR and consequently its outcomes.

Outcome of Gestational Diabetes during Pregnancy and at Delivery

Gestational diabetes (GDM) is a state of intolerance to glucose that initiates or is first diagnosed during gestation. About 1-14% of all pregnancies are complicated by GDM. The pregnancy-related morbidity and mortality in gestational diabetes is lower than in overt diabetes; however, if left untreated, it is significantly higher than in nondiabetic women. Treating GDM is important because appropriate treatment reduces side effects on the mother and newborn. GDM during pregnancy has a number of adverse short- and long-term consequences for both the mother and the fetus. Aim: To establish the relationship between gestational diabetes and complications related to pregnancy and childbirth. Study Design: A prospective cohort study. Place and Duration: The study was conducted at the Karachi Aga Khan University Hospital in the Department of Obstetrics and Gynecology from 22 November, 2018 to 22 May 2019, six months after the approval of the study. Methods: 130 patients, 65 patients in the GDM group and 65 patients in the non-GDM group were enrolled in the study. Demographic data were presented as standard deviation and mean as well as simple descriptive statistics, while qualitative variables as percentage and frequency. Chi-square test was applied for comparison of the incidence of complications related to pregnancy and childbirth. P&lt;0.05 was considered statistically significant. Relative risk was calculated. Results: 130 total patients, including 65 patients in GDM group and 65 patients in non GDM group were included. Mean age in GDM and non GDM group was 29.27±2.79 years and 28.49±3.40 years. Outcome of pregnancy in GDM and non GDM group showed that 27 (41.5%) and 18 (27.7%) had pregnancy induced hypertension, 07 (10.8%) and 03 (4.6%) had pre-eclampsia, 29 (44.6%) and 07 (10.8%) had polyhydramnios, 04 (6.2%) and 02 (3.1%) had antepartum hemorrhage, 01 (1.5%) and 06 (9.2%) had premature rupture of membrane, 11 (16.9%) and 09 (13.8%) had preterm labour, 13 (20%) and 04 (6.2%) had urinary tract infection. Outcome of pregnancy in GDM and non GDM group showed 51 (78.5%) and 33 (50.8%) had induction of labour, 17 (26.2%) and 14 (21.5%) had low birth weight, 14 (51%) and 03 (4.6%) had macrosomia, 02 (3.1%) and 01 (1.5%) had birth injury and 10 (15.4%) and 11 (16.9%) had NICU admission. Conclusion: Gestational diabetes (GDM) is the utmost communal medicinal complication of pregnancy. It has negative consequences for the mother and the newborn baby. Maintaining glycemia in GDM decreases the morbidity of both baby and mother. Keywords: Gestational diabetes mellitus, delivery outcome, pregnancy outcome, maternal and fetal outcomes.

Weight Gain during and after Pregnancy in Women with Gestational Diabetes Mellitus-A Preliminary Study.

Appropriate gestational weight gain (GWG) favors fewer complications related to pregnancy, delivery, puerperium, and the condition of the fetus and newborn baby. The aim of this study was to evaluate weight gain in women during and after pregnancy, including both women with and without gestational diabetes mellitus (GDM). Materials and methods: The study involved 42 singleton pregnant women diagnosed with GDM between the 24th and 28th week of pregnancy. The control group consisted of 28 nondiabetic women with a singleton pregnancy. The pre-pregnancy BMI, intra-pregnancy weight gain, and postpartum body weight were assessed in the participants. Results: There were no statistically significant differences in the values of intra-pregnancy weight gain. Only diabetic women who were also overweight or obese had a significantly higher percentage of weight gain during pregnancy. The analysis of the percentage of weight gain during the entire pregnancy showed differences only in the group of women with pre-pregnancy BMI over 30. Conclusions: There were no significant differences in total pregnancy or mid-pregnancy weight gain between women with and without GDM. Most of the women had too high or too low total-pregnancy and mid-pregnancy weight gain. Therefore it is necessary to control GWG and educate pregnant women about it.

Relationship between psychological stress and ghrelin concentrations in pregnant women with overweight or obesity

Exposure to, perception of, and response to stress have all been shown to influence appetite and dietary behaviors in non-pregnancy human and animal studies, mediated in part by the appetite stimulating hormone ghrelin. Yet, the impact of prenatal stress on biological pathways associated with appetite in the context of pregnancy is not well understood. The objective of this study was to assess the relationship between these layered dimensions of stress with fasting and postprandial plasma ghrelin concentrations among Hispanic pregnant women with overweight or obesity, a population known to experience heightened levels of stress. Thirty-three non-diabetic Hispanic women with pre-pregnancy body mass index of 25.0–34.9 kg/m2 participated in a crossover study at 28–32 weeks’ gestation. At each visit, participants provided fasting blood and saliva samples, consumed a standardized mixed-meal, and completed a 15-minute task: friendly conversation (control) or the Trier Social Stress Test (experimental stress exposure). Six timed blood and saliva samples were collected up to 2 h from baseline and assayed for ghrelin and cortisol, respectively, and area-under-the-curve (AUC) values were computed. Day-to-day stress levels were assessed by the Perceived Stress Scale. Physiological and psychological stress reactivity was determined by cortisol AUC and change in self-reported affect state, respectively, during the experimental stress visit. Maternal perceived stress was positively associated with ghrelin concentrations in the fasted (β = 0.06, p = 0.02) and postprandial state (β = 0.05, p = 0.02). Mean ghrelin AUC was not significantly different following acute stress versus control. Measures of acute stress reactivity were not associated with ghrelin AUC. Contrary to our hypothesis, among Hispanic pregnant women with overweight and obesity, exposure to an acute stress induction task did not alter postprandial ghrelin concentrations, and changes in individual psychological and physiological stress reactivity did not associate with postprandial ghrelin. However, our findings suggest that maternal report of general perceived stress over the last month is associated with higher fasting and postprandial ghrelin concentrations. Differences in the effects of short-term stress exposure versus day-to-day perception of stress on appetite and food intake in pregnancy deserves further investigation.

Associations between air pollution, residential greenness, and glycated hemoglobin (HbA1c) in the three prospective cohorts of U.S. adults

Background and Aim: While studies suggest impacts of individual environmental exposures on type 2 diabetes (T2D) risk, the biological mechanisms remain poorly characterized. Glycated hemoglobin (HbA1c) is an important biomarker for diagnosing prediabetes and predicting T2D risk. We explored associations between multiple environmental exposures and HbA1c. Methods: HbA1c was assessed in 12,698 non-diabetic women and men in three U.S.-based prospective cohorts: the Nurses’ Health Study (NHS) in 1990, the Nurses’ Health Study II (NHSII) in 1998, and the Health Professionals Follow-up Study (HPFS) in 1993. Residential greenness data within 270m and 1,230m (normalized difference vegetation index, NDVI) was obtained from Landsat. Fine particulate matter (PM₂.₅) and nitrogen dioxide (NO₂) were estimated from nationwide spatiotemporal models. Three-month and one-year average exposures prior to blood draw were assigned to participants’ addresses. We used single and multi-exposure linear regression models, as well as mixture methods such as models with component scores from Principal Components Analysis (PCA), to assess associations with HbA1c. We first applied basic models adjusted for age and year at blood draw, BMI, alcohol use, and neighborhood socioeconomic status (nSES). In fully-adjusted models, we included overall diet quality, race, family history, smoking status, postmenopausal hormone use, population density, and season. We assessed potential modification via stratification. Results: Based on HbA1c thresholds, 19% of participants had prediabetes. In basic models, we observed a small negative association between PM₂.₅ and HbA1c: an IQR increase was associated with a 0.28% (95% CI: 0.54%, 0.02%) lower HbA1c. In fully-adjusted models, we did not find any associations between the individual exposures or the component scores and HbA1c. There was no evidence of differing associations by sex, nSES, or population density. Conclusions: In this study of adults, environmental exposures were not associated with HbA1c. More work is needed to elucidate biological pathways between the environment and prediabetes.

Efficacy of Prophylactic Use of Metformin in Prevention of Gestational Diabetes Mellitus in Nondiabetic Obese Pregnant Women

Background & Objective: Maternal obesity can increases pregnancy consequences like postpartum hemorrhage, preeclampsia, need for cesarean section, neonatal death, and fetal macrosomia. In this study, the efficacy of prophylactic use of metformin to prevent gestational diabetes mellitus in nondiabetic pregnant women with obesity was examined.Materials & Methods: This study was a clinical trial. Totally, 340 pregnant women who were in the first trimester were referred to the gynecology clinic of Motahhari hospital in Urmia after ensuring the absence of underlying diseases such as diabetes, hypertension, kidney, liver, and cardiovascular disease, without a history of allergy to metformin, in case of a singleton pregnancy, and Body Mass Index (BMI) above 30 were allocated to two equal groups. The intervention group was given 1000 mg of metformin, and the control group was given a placebo. Demographic information, including age, gravity, parity, live birth, birth, and maternal weight, previous delivery method, abortion, delivery method with its cause, polyhydramnios, NICU hospitalization, gestational age, mortality, and neonatal anomalies was also recorded. The results were analyzed using SPSS version 26.Results: In the control group, 15 mothers (9.4%) out of 160 people, and in the intervention group, 13 mothers (8.1%) had gestational diabetes (P < /i>=0.692). In the intervention group, the mean insulin dose was 10.8 ±3 units; in the control group, the mean insulin dose was 21.2±15.7 units (P=0.048). Twenty patients (6.7%) out of 297 obese patients and 8 patients (34.8%) in the morbid obesity group had diabetes (P < /i><0.001). In the control group, the mean weight of mothers was 8.04±2.5 kg; in the intervention group, it was 5.2±2.3 kg during pregnancy (P < /i><0.001). Gestational diabetes, delivery method, death one week after birth, preterm birth, polyhydramnios, and intensive care unit were similar in the two groups. Conclusion: Metformin in pregnant women with a BMI>30 deals with low maternal weight, reduced birth weight, and reduced insulin dose in diabetic mothers.

Canagliflozin combined with metformin versus metformin monotherapy for endocrine and metabolic profiles in overweight and obese women with polycystic ovary syndrome: A single-center, open-labeled prospective randomized controlled trial.

ObjectivesCanagliflozin (CANA), a kind of sodium-glucose cotransporter-2 (SGLT-2) inhibition, study in which the role of CANA monotherapy in polycystic ovary syndrome (PCOS) has been investigated, and it could become a novel option in the PCOS treatment. Nevertheless, trials focused on SGLT-2 combination therapy’s efficacy, and safety in PCOS patients are limited. This randomized controlled trial compared the efficacy and safety of CANA and metformin (MET) combination therapy and MET monotherapy in endocrine and metabolic profiles of overweight and obese women with polycystic ovary syndrome (PCOS).MethodsFifty-one overweight or obese non-diabetic PCOS women between 18 and 40 years old were enrolled. Patients were randomly allocated to receive either CANA/MET or MET treatment. The CANA/MET group received CANA 100 mg once daily plus MET 1000 mg twice daily, while the MET group received MET 1000 mg twice daily for three months. Changes in menstrual pattern, anthropometric parameters, gonadal parameters, glucose and lipid homeostasis, and adverse events (AEs) were evaluated.ResultsCompared with the MET group, women have a significantly lower level of total testosterone (TT), area under the curve for glucose (AUCGlu), and area under the curve for insulin (AUCIns) to AUCGlu ratio in the combination group. There were no significant differences in menstrual frequency, body weight, body mass index, follicle-stimulating hormone, luteinizing hormone, free androgen index, sex hormone-binding globulin, androstenedione, fasting blood glucose, fasting insulin, AUCIns, homeostasis model assessment-insulin resistance (HOMA-IR), triglycerides, total cholesterol, low-density lipoprotein cholesterol, apolipoprotein A1 (Apo A1), apolipoprotein B (Apo B), and APO B/A1 ratio. AEs were seen in 57.70% (15/26) and 68.00% (17/25) of patients in the CANA/MET and MET groups, respectively.ConclusionsIn overweight and obese women with PCOS, CANA and MET combination therapy may be similar to MET monotherapy in improving menstrual frequency, weight control, hyperandrogenemia, and relieving insulin resistance. CANA/MET may have more benefits in reducing TT, AUCGlu, and the AUCIns/AUCGlu ratio within three months than MET monotherapy.Trial registration ClinicalTrials.gov, NCT04973891.