Occurrence Of Gestational Diabetes Research Articles

The association between the Helicobacter pylori infection and the occurrence of gestational diabetes: a systematic review and meta-analysis

BackgroundThis meta-analysis aims to establish a more precise association between gestational diabetes mellitus (GDM) incidence and H. pylori infection by amalgamating findings from prior case–control and cohort studies.MethodsTo identify relevant studies, we conducted a comprehensive search using the Excerpta Medica Database (Embase), PubMed (Medline), Web of Science (ISI), and Scopus from January 1990 to November 2022. The screening process involved reviewing the entire text, abstracts, and titles of retrieved articles. Subsequently, data extraction was performed from the selected articles, and their quality was assessed using the Newcastle–Ottawa Scale checklist. Version 17 of STATA software was utilized for the analysis, with relative risks (RR) calculated along with their 95% confidence intervals (CI) to quantify the impact of the included studies.ResultsThis meta-analysis included eight observational and analytical studies. The combined risk of gestational diabetes mellitus (GDM) in pregnant women with H. pylori infection was found to be 1.97 times higher compared to pregnant women without infection (RR: 1.97; 95% CI 1.57–2.47; I2 = 0.00%; P = 0.84).ConclusionPregnant women with H. pylori infection are at an increased risk of developing gestational diabetes.

Contribution of the Triglycerides-Glucose Index (TyG) in the Assessment of Insulin Resistance in Pregnant Women During an OGTT Test

The Triglyceride-Glucose (TyG) index is a marker used to assess insulin resistance which is associated with the occurrence of gestational diabetes. The aim of this study is to determine the benefit of the TyG within the diagnosis of insulin resistance in pregnant women in an orally induced hyperglycaemia test. This study was conducted at the Department of Biochemistry, at Aristide le Dantec University Hospital in collaboration with the department of gynaecology. Women with fasting blood glucose < 0.92 g/L at 12 weeks of age benefited from the OGTT 75 test following the WHO protocol. The TyG index was calculated using the formula: Ln [fasting triglyceridemia (mg/dL) × fasting blood glucose (mg/dL)]/2. Data were analysed using SPSS v.26 and a p< value of 0.05 was considered statistically significant. A total of 102 patients were included in the study with a mean age of 29± to 5.9 years. The OGTT 75 test was positive in 24 women (23.5%) with a predominance in the third trimester (19.4%). TyG values were significantly higher in women with gestational diabetes (8.76, ±0.5vs8.2±, 0.5; p<0.0001), in contrast to the HOMA index (6.43, ±16.8, ±1.15±, 0.9; p=0.138). The AUC of the ROC curve for the TyG-H0, TyG-H1 and TyG-H2 indices were 0.808 (95% CI)=0.70-0.92), 0.808 (95% CI)=0.698-0.918), 0.818 (95% CI)=0.70-0.93, respectively. For the HOMA-IR index, the AUC was 0.799 (95% CI = 0.69-0.91). The cut-off value for the TyG-H<sub>1</sub> index was 9.5 with a sensitivity and specificity of 79.2% and 71.8%, respectively. The TyG index is a better way to assess the level of insulin resistance in pregnant women than using the HOMA index, especially after the first hour of a glucose load of 75g.

The Impact of Vitamin D Deficiency on Gestational Diabetes Mellitus Risk: A Retrospective Study.

Background Nowadays, there has been growing attention to vitamin D deficiency's impact on women of reproductive age, both during pregnancy and the preconception period.Because of its possible impact on female reproductive ability, vitamin D deficiency may have multiple implications for maternal and fetal health. Currently, the correlation between vitamin D deficiency and gestational diabetes mellitus (GDM) isgaining attention, mainly due to contradictory findings in the literature. Methods We conducted a single-center, retrospective study involving data from 106 pregnant women to establish a possible link between vitamin D deficiency and GDM risk. We analyzed variables such as vitamin D status, the occurrence of gestational diabetes, and body mass index to identify significant statistical correlations among them. Results Within our study group, the average vitamin D level was 19.5 ± 7.8 ng/mL. Regarding vitamin D status, 59 (55.7%) pregnant women had vitamin D deficiency, 36 (34%) had vitamin D insufficiency, and 11 (10.4%) had optimal vitamin D levels. GDM was diagnosed in 18 cases, representing 17%. After the statistical analysis, we found a positive correlation between gestational diabetes and vitamin D deficiency (chi-square = 4.472, p = 0.049).However, we did not find a significant correlation between gestational diabetes and optimal vitamin D status. Conclusions Pregnant women with vitamin D deficiency are at an increased risk of developing GDM and may benefit from vitamin D supplementation. We believe that further research is necessary to have a comprehensive understanding of vitamin D's effects on pregnancy.

The Impact of Food Insecurity on Maternal and Neonatal Outcomes

Purpose: The purpose of this study was to examine the relationship between food security status and pregnancy outcomes. Methods: This was a single-center cross-sectional cohort study of postpartum women in Indianapolis, IN. A validated 10 question Household Food Security Survey module was used to assess food security for patients who spoke English, Spanish, or Haitian-Creole. Correlating with the USDA definitions of food security, total scores were “high,” “marginal,” “low,” and “very low.” Scores were analyzed as inadequate (marginal, low, or very low) vs. adequate (high) food security. If a score fell within any category but “adequate” food security, patients were provided with information on community resources. Prenatal and postpartum data were abstracted via chart review, collecting: standard demographics, language, parity, diagnosis of diabetes, diagnosis of hypertensive disorder(s), pre-pregnancy weight, weight at time of delivery, BMI at time of delivery, gestational age at delivery, Edinburgh Postnatal Depression Scale (EPDS) score, and delivery mode. Neonatal variables included: weight and sex. The primary outcome was occurrence of gestational diabetes (GDM). These outcomes were compared between patients who had adequate vs. inadequate food security. Logistic regression was used to examine the association between food insecurity and each of the dichotomous outcomes. Linear regression was used to model the relationship between sex-specific birthweight z-scores and food insecurity. All adjusted models included language and maternal age. The Indiana University institutional review board approved the study (IRB# 14116). Results: Two hundred six surveys were completed from June 2022 through December 2022. Ninety-three participants (45.4%, 95% CI 38.4-52.4%) were categorized as inadequate food security. The incidences of marginal, low, and very low food security were similar with 31, 30, and 28 participants, respectively. Race/ethnicity and language were different between adequate and inadequate groups (p=0.006 and <0.001 respectively). The incidence of GDM was 7.9% and was not different for those with inadequate food security (OR 0.96 95% CI 0.33-2.68). Food insecurity was protective against delivery via C-section (aOR 0.50 95% CI 0.25-0.98). Food insecurity increases odds of EPDS > 9 (aOR 4.32 95% CI 1.41-16.2). Conclusions: Inadequate food security status is highly prevalent in our patient population and was associated with racial/ethnic minority status and non-English speaking populations. Inadequate food security was found to be associated with a decreased odds of cesarean delivery and higher odds of postpartum depression.

Correlation between PAPP-A serum levels in the first trimester of pregnancy with the occurrence of gestational diabetes, a multicenter cohort study

ObjectiveThis study aimed to investigate the association between first-trimester Pregnancy-associated plasma protein A (PAPP-A) levels and subsequent gestational diabetes mellitus (GDM) development.MethodThe study was conducted on 5854 pregnant women who attended routine prenatal care. Maternal biomarkers, including PAPP-A and free beta hCG, were measured for all women in a referral laboratory and converted to MoM values. Pregnant women were divided into two groups, based on the serum concentration of PAPP-A, (PAPP-A > 0.4 (normal) and PAPP-A < 0.4 (low)). Data on the screening test for GDM and pregnancy outcomes were collected and analyzed with appropriate tests.ResultOf the 5854 pregnant women, 889 (15.19%) developed GDM. The maternal PAPP-A MoM concentrations were significantly lower in GDM cases compared to controls. Indeed, gestational age at delivery and birth weight were significantly lower (p < 0.001) in PAPP-A MoM < 0.4, and the rate of intrauterine growth restriction (IUGR) was significantly higher (p < 0.001). ROC analysis revealed that the sensitivity and specificity of MoM concentration for predicting GDM were 53.3% and 51.9%, respectively.ConclusionLower maternal PAPP-A in early pregnancy can lead to glucose intolerance and increase the risk of subsequent GDM development. In addition, decreased serum concentration of PAPP-A is significantly correlated to lower birth weight and IUGR.

The impact of health coaching on the prevention of gestational diabetes in overweight/obese pregnant women: a quasi-experimental study

BackgroundPrevious studies have demonstrated that excessive gestational weight gain (GWG) increases the risk of gestational diabetes mellitus (GDM). This study aimed to determine the effect of using health coaching on the prevention of GDM in overweight pregnant women.MethodsIn this quasi-experimental study, 64 eligible overweight women at 12–14 gestational weeks were randomly divided into 2 groups: the coaching group and the control group (usual care group). The intervention group received 8 weeks of the phone coaching program, which integrated GWG and physical activity to reduce the incidence of GDM. The Pregnancy Physical Activity Questionnaire (PPAQ) was used to assess physical activity during pregnancy. The occurrence of gestational diabetes was determined based on the 75-g 2-hour oral glucose tolerance test (OGTT) at 24–28 weeks of gestation. The primary outcome was the incidence of GDM, and the secondary outcomes included physical activity, GWG, and neonatal and maternal birth outcomes.ResultsThe incidence of GDM in the control and intervention groups was 24.1% and 22.6%, respectively. The relative risk (RR) was 0.93 (95% CI, 0.37–2.34; P = 0.887). The post survey results indicated that GWG decreased more considerably in the coaching than in the control group between pre-trial (T0) and post-trial (T1), (MD; -2.49 with 95% CI, -4.38 to -0.60; P < 0.011). Moreover, the total GWG (between pre-pregnancy and birth) diminished more remarkably in the coaching than in the control group, (MD; -2.83 with 95% CI, -5.08 to -0.58; P < 0.014). However, the score of self-efficacy and concern about PPAQ Metabolic Equivalent of Task (METs) did not differ between the coaching and control groups.ConclusionsThe findings and implications of this research could significantly contribute to maternal health and gestational diabetes prevention. Additional support from a midwife coach resulted in better GWG. More studies are needed to assess the impact of health coaching as a component of usual care and its long-term effect on maternal and neonatal outcomes.

Impact of Selected Eicosanoids in Normal and Pathological Pregnancies.

Pregnancy is a physiological state in which the female body undergoes a series of changes and adaptations to provide the best possible conditions for the growth and development of the forming baby. The internal adaptations that take place lead to the production of inflammation, which is necessary for the initial and final stages of pregnancy (embryo implantation and induction of labor). Gestational diabetes mellitus is considered to be the most common pathology during this period. However, many more serious health complications can arise, which include pre-eclampsia, fetal stunting, and preterm labor. The purpose of this study was to analyze the impact of the levels of individual eicosanoids on the course of normal pregnancy and the possibility of pathologies including gestational diabetes and pre-eclampsia. Sixty-nine pregnant women who were overweight or obese before and during pregnancy were studied. Eicosanoids were extracted as appropriate and then determined using liquid chromatography. The levels of eicosanoids studied in pregnant women differed not only according to the week of pregnancy but also in relation to individual anthropometric and biochemical parameters. There was a significant correlation between being overweight and having a high BMI before pregnancy-as well as biochemical parameters of lipid and carbohydrate profiles-and the occurrence of pathological conditions in pregnancy. Eicosanoids are involved in the pathology of pregnancy associated with the occurrence of gestational diabetes and pre-eclampsia. Salicylic acid may find use in the treatment of pregnant women exposed to both phenomena, as well as in overweight and obese women found before pregnancy. Diets rich in natural salicylates, methods of administration, and pharmacotherapy and dosage need further study. Some of the mediators (lipoxin, prostaglandin and leucotrien) may be new diagnostic markers in pregnancy pathology and intervention pathways in the future.

The Association between Grand Multiparity and Adverse Neonatal Outcomes: A Retrospective Cohort Study from Ha'il, Saudi Arabia.

Inconsistent evidence exists regarding the association of grand multiparity with adverse neonatal outcomes. This study aims to compare specific adverse outcomes in grand multiparas (those with five or more births at twenty or more weeks of gestation, regardless of fetal outcome) compared to those with lower parity (those with less than five births at twenty or more weeks of gestation, regardless of fetal outcome). A retrospective cohort study was undertaken at the Maternity and Children Hospital in Ha'il region, Saudi Arabia. After calculating the required sample size, data were collected from consenting participants with a viable singleton delivery. Socio-demographic variables, select maternal characteristics, and adverse neonatal outcomes (admission to the neonatal intensive care unit, low birth weight, prematurity, and APGAR score less than 7 in the first 5 min) were compared between grand multiparas and women with lower parity. Two hundred ninety-four participants were recruited (ninety-eight grand multiparas and one hundred ninety-six of lower parity). There was a statistically significant difference between the two groups in relation to age, level of education, body mass index, and the occurrence of gestational diabetes. Out of the studied adverse neonatal outcomes after the adjustment for maternal age between the two groups, no statistically significant difference in the adverse neonatal outcomes was found between the two groups. Grand multiparity does not incur an additional risk of adverse neonatal outcomes compared to women of lower parity. Furthermore, increasing maternal age and comorbid conditions might have a more detrimental effect on neonatal outcomes than grand multiparity per se.

Gestational diabetes mellitus and COVID-19: The epidemic during the pandemic.

During the global coronavirus disease 2019 (COVID-19) pandemic, people worldwide have experienced an unprecedented rise in psychological distress and anxiety. In addition to this challenging situation, the prevalence of diabetes mellitus (DM), a hidden epidemic, has been steadily increasing in recent years. Lower-middle-income countries have faced significant barriers in providing accessible prenatal care and promoting a healthy diet for pregnant women, and the pandemic has made these challenges even more difficult to overcome. Pregnant women are at a higher risk of developing complications such as hyper-tension, preeclampsia, and gestational diabetes, all of which can have adverse implications for both maternal and fetal health. The occurrence of gestational diabetes has been on the rise, and it is possible that the pandemic has worsened its prevalence. Although data is limited, studies conducted in Italy and Canada suggest that the pandemic has had an impact on gestational diabetes rates, especially among women in their first trimester of pregnancy. The significant disruptions to daily routines caused by the pandemic, such as limited exercise options, indicate a possible link between COVID-19 and an increased likelihood of experiencing higher levels of weight gain during pregnancy. Notably, individuals in the United States with singleton pregnancies are at a significantly higher risk of excessive gestational weight gain, making this association particularly important to consider. Although comprehensive data is currently lacking, it is important for clinical researchers to explore the possibility of establishing correlations between the stress experienced during the pandemic, its consequences such as gestational gain weight, and the increasing incidence of gestational DM. This knowledge would contribute to better preventive measures and support for pregnant individuals during challenging times.

Effects of Antenatal Lifestyle Interventions in Pregnant Women with Normal Body Mass Index.

We aimed to explore the effect of lifestyle interventions on improving lifestyle behaviors on gestational weight gain in pregnant women with normal body mass index (BMI). The study was conducted in Maternal and Child Health Hospital of Hubei Province (Wuhan, China) between June 2020 and April 2022. A total of 355 pregnant women (<12 weeks of pregnancy) were enrolled and finally completed the program. Participants were divided into the intervention and control groups. The intervention group received an individualized lifestyle intervention focusing on healthy lifestyle, like diet, exercise, and weight monitoring as four sessions at 16-18, 20-24, 28-30 and 34 weeks' gestation. Participants in the control group received routine antenatal care. The weight of both group was recorded from pregnancy until 6-8 weeks postpartum. The participants in the intervention group with normal pre-pregnancy BMI (n = 178) had lower GWG, excessive GWG, hypertension, and neonate birth weight compared to the control group (n = 177, P<0.01). There were no statistically significant differences in the occurrence of gestational diabetes, premature labor, delivery mode, preterm birth, small for gestational age, macrosomia, number of neonates referred to the NICU, and postpartum weight retention. Even though lifestyle intervention in pregnant women with normal BMI has a relatively limited effect, attention should still be paid to reasonable weight gain during pregnancy and the potential long-term impact of the intervention remains to be assessed.

WITHDRAWN: Myoinositol supplementation for the prevention of gestational diabetes in at-risk patients. Systematic review and meta-analysis

Gestational diabetes (GD) is associated with an increase in maternal and fetal morbidity. The risk factors involved have been clearly identified but no prevention strategies have yet provided robust evidence of their efficacy. Myoinositol has insulin sensitization properties and is of potential interest in the treatment of the disorder. The aim of this work was to assess the efficacy of myoinositol supplementation during pregnancy to prevent GD in patients with known risk factors. A systematic literature review was performed on studies comparing the effects of myoinositol supplementation and placebo on the occurrence of GD in at-risk pregnant women. The main judgement criterion was diagnosis of GD between 24 and 28 gestational weeks by an oral glucose tolerance test. The secondary judgement criteria were the occurrence of maternal fetal complications and the need to initiate insulin treatment to manage GD. Nine studies were included in the meta-analysis. The results showed a significantly higher risk of GD in patients on placebo than in those receiving myoinositol (RR​=​2.58, CI 95%: 1.68 to 3.97, p​<​0.0001) but wide variations between studies (I2​=​71.94%, p​<​0.001). And the risk of prematurity was significantly greater in the children of mothers on placebo (RR: 2.15, IC 95%: 1.32 to 3.20, p​=​0.002). Myoinositol supplementation taken from the beginning of pregnancy reduces the incidence of GD and could be of interest at a dose of 4​g/day as a prevention strategy for patients with identified risk factors.

PREVALENCE OF HYPERTENSIVE DISORDERS AMONG PREGNANT WOMEN ATTENDING ANTENATAL CARE IN SELECTED PUBLIC HOSPITALS IN ADDIS ABABA, ETHIOPIA

Purpose: This study sought to assess the prevalence of hypertension in pregnancy and associated risk factors among women attending antenatal care clinics in selected Pubic Hospitals in Addis Ababa, Ethiopia.&#x0D; Materials and Methods: The research employed a cross-sectional descriptive study design. Study population was pregnant women who attended ANC care in selected hospital. The respondents were randomly selected from Tikur Anbesa specialized, Zewuditu Memorial and St. Paul’s Millennium medical college hospitals. Respondents for interview were selected using systematic random sampling at an interval of nine until a sample size of 297 was reached. The study used an adopting both quantitative and qualitative data collection methods. Quantitative data was collected using structured questionnaires from pregnant women attending antenatal care clinics while qualitative data was collected using key informant interview schedules and Focused Group Discussion guides with Nurses in charge of antenatal care clinics and primary respondents respectively. Key informants and focused group discussants were purposively selected. Descriptive data was analysed using Statistical Package for Social Sciences version 20.0 with the aid of Microsoft Excel program to generate frequency tables, graphs and pie-charts. Qualitative data was analysed using thematic analysis and results triangulated with quantitative data as direct quotes or narrations. Inferential statistics were calculated using Chi-Square tests done at 95% confidence interval and a margin of error of 0.05 to establish the association between variables. Information generated were presented in the text in the form of tables, bar graphs and pie charts.&#x0D; Results: The study results revealed that the prevalence of pregnancy induced hypertension in Addis Ababa was 21.9%. Socio-demographic factors such as age (p=0.030), occupation (p=0.031), income (p=0.0014), highest level of education (p=0.001) and health insurance (p=0.001) were significantly associated with occurrence of hypertension in pregnancy. Rreproductive and obstetric factors such as age at first pregnancy (p=0.001), gravidity (p=0.046), parity (p=0.001), history of obesity (p=0.001) and occurrence of gestational diabetes (p=0.002) were significantly associated with hypertension in pregnancy. More than a half (51.9%) of respondents had negative attitude towards hypertensive disorder in pregnancy. The level of attitude (p=0.040) was significantly associated with occurrence of hypertension in pregnancy.&#x0D; Unique contribution to theory, practice and policy: The study recommends that the management of the 3 health facilities together with other stakeholders in health empower women to start income generating projects to increase their financial access to antenatal care services consequently reduces hindrances that may lead to pregnancy complications such as hypertensive disorders in pregnancy.

Vitamin D status and vitamin D deficiency risk factors among pregnancy of Shanghai in China

BackgroundThere is increasing awareness that vitamin D deficiency in pregnant women may be associated with several adverse effects for the mother and newborn. The risks for vitamin D deficiency are unclear. This study was to assess vitamin D nutritional status and vitamin D deficiency risk factors among pregnant women in Shanghai in China.MethodsThis study is a cross-sectional study conducted in the Sixth Affiliated People’s Hospital of Shanghai Jiao Tong University. A total of 953 healthy pregnant women participated, serological examinations and other variables included serum 25-hydroxyvitamin D [25(OH)D], total blood cholesterol (TCh), high-density lipoprotein (HDL), low-density lipoprotein (LDL), and very-low-density lipoprotein (VLDL) cholesterol, triglycerides at the first antenatal visit (12–14 weeks) pregnancy parity and age, body mass index (BMI) before pregnancy, and completed OGTTs test. Associations between vitamin D deficiency and possible predictors (age group, pre-pregnancy BMI, parity, and gestational hyperlipemia) were assessed with a multinomial logistic regression analysis. And also used to investigate the effects of 25(OH)D and the other variables on the occurrence of gestational diabetes mellitus.ResultsThe mean vitamin D level of pregnancy was 16 (a range from 11 to 21) ng/ml, and severe vitamin D deficiency was 31.8% (303); vitamin D deficiency was 40.7% (388); vitamin D insufficiency was 25.1% (239); normal vitamin D was 2.4%(23). Vitamin D deficiency risk factors were age over 30, parity over 2, overweight, obese, and hyperlipemia. The increasing level of vitamin D nutritional status in pregnancy is significantly related to reducing gestational diabetes mellitus. Vitamin D deficiency is a risk factor for gestational diabetes mellitus.ConclusionsIt is a high prevalence of vitamin D deficiency in Chinese pregnancy in Shanghai. Aging more than 30 years, the parity of more than 2, overweight and obesity, and hyperlipemia are risk factors for vitamin D deficiency. Vitamin D deficiency is a risk factor for gestational diabetes mellitus. Public health strategies to prevent vitamin D deficiency should focus on those risks to promote health pregnancy of Shanghai in China.

Impact of nutrients and Mediterranean diet on the occurrence of gestational diabetes

ABSTRACT Background: The Mediterranean diet (MedDiet) is a dietary pattern effective in terms of prevention of many diseases such as gestational diabetes mellitus (GDM). Recently, many studies have paid attention to nutritional factors during pregnancy as a modifiable contributor to GDM risk. Objective: to investigate associations of nutrients intakes and MedDiet pattern of eating with risk of GDM. Subjects/Methods: This study conducted on N = 120; Pregnant women with GDM (n = 60) and without controls (n = 60). The dietary habits were assessed by a dietary history method and a validated food frequency questionnaire. We calculated a MedDiet score which measures the degree of adherence to a Med Diet. Result: A low Med Diet score was found in pregnant women with and without gestational diabetes in 46.7% and 38.8% of cases, respectively, with no significant difference. Our data showed that the higher the adherence score to the MedDiet, the lower the fasting blood glucose level and the plasma glucose 2 h post load. These findings concerned the two groups studied (P <10−3). We also noted that controls had a significantly higher intake of legumes, vegetables and fish. Monounsaturated fatty acids and saturated fatty acids consumption was significantly higher in the control group (2.3 ± 0.8 vs 1.7 ± 0.7, P < 10−3). GDM subjects consumed significantly more dairy products and cereals (P < 10−3). After adjustment for confounders, no nutrient was associated with the risk of developing gestational diabetes except vitamin D intake (OR 0.29 [0.15−0.54], P < 10−3) which had a protective effect. Conclusion: Our study underlines the importance of adequate vitamin D intake during pregnancy and suggests that the MedDiet may reduce the incidence of gestational diabetes.

Pre-Conception Interventions for Subfertile Couples Undergoing Assisted Reproductive Technology Treatment: Modeling Analysis.

BackgroundApproximately 1 in 7 couples experience subfertility, many of whom have lifestyles that negatively affect fertility, such as poor nutrition, low physical activity, obesity, smoking, or alcohol consumption. Reducing lifestyle risk factors prior to pregnancy or assisted reproductive technology treatment contributes to the improvement of reproductive health, but cost-implications are unknown.ObjectiveThe goal of this study was to evaluate reproductive, maternal pregnancy, and birth outcomes, as well as the costs of pre-conception lifestyle intervention programs in subfertile couples and obese women undergoing assisted reproductive technology.MethodsUsing a hypothetical model based on quantitative parameters from published literature and expert opinion, we evaluated the following lifestyle intervention programs: (1) Smarter Pregnancy, an online tool; (2) LIFEstyle, which provides outpatient support for obese women; (3) concurrent use of both Smarter Pregnancy and LIFEstyle for obese women; (4) smoking cessation in men; and (5) a mindfulness mental health support program using group therapy sessions. The model population was based on data from the Netherlands.ResultsAll model-based analyses of the lifestyle interventions showed a reduction in the number of in vitro fertilization, intracytoplasmic sperm injection, or intrauterine insemination treatments required to achieve pregnancy and successful birth for couples in the Netherlands. Smarter Pregnancy was modeled to have the largest increase in spontaneous pregnancy rate (13.0%) and the largest absolute reduction in potential assisted reproductive technology treatments. Among obese subfertile women, LIFEstyle was modeled to show a reduction in the occurrence of gestational diabetes, maternal hypertensive pregnancy complications, and preterm births by 4.4%, 3.8%, and 3.0%, respectively, per couple. Modeled cost savings per couple per year were €41 (US $48.66), €360 (US $427.23), €513 (US $608.80), €586 (US $695.43), and €1163 (US $1380.18) for smoking cessation, mindfulness, Smarter Pregnancy, combined Smarter Pregnancy AND LIFEstyle, and LIFEstyle interventions, respectively.ConclusionsAlthough we modeled the potential impact on reproductive outcomes and costs of fertility treatment rather than collecting real-world data, our model suggests that of the lifestyle interventions for encouraging healthier behaviors, all are likely to be cost effective and appear to have positive effects on reproductive, maternal pregnancy, and birth outcomes. Further real-world data are required to determine the cost-effectiveness of pre-conception lifestyle interventions, including mobile apps and web-based tools that help improve lifestyle, and their effects on reproductive health. We believe that further implementation of the lifestyle app Smarter Pregnancy designed for subfertile couples seeking assistance to become pregnant is likely to be cost-effective and would allow reproductive health outcomes to be collected.

Gestational weight gain and pregnancy outcome in women with excessive pre-pregnancy body mass index

Aim: To evaluate the effects of gestational weight gain on perinatal outcomes in woman with excessive pre-gravid body mass index. Material and Methods: The study group consisted of 197 overweight or obese women who delivered full-term newborns at the 1st Department of Obstetrics and Gynecology, Medical University of Warsaw. Group A included 89 (45.2%) women with inadequate or adequate weight gain. Group B included 108 patients (54.8%) with excessive weight gain during pregnancy. Results: No significant differences in the occurrence of gestational diabetes, hypertension or intrahepatic cholestasis between the analyzed groups were observed. Excessive weight gain was positively correlated with the incidence of cesarean delivery (67.6% vs 32.4%, p=0.009), newborns’ birthweight (3627g±519 vs 3406g±521, p=0.009) and the risk of low for gestational age infants (26.9% vs 12.4%, p=0.01). The highest risk of low for gestational age new born was related to gestational weight gain of about 15 kg. Appropriate preconception counselling for overweight and obese women may reduce the risk of low for gestational age infants.

415. Medication use in gestational diabetes

Introduction In the United Arab Emirates,the prevalence of Gestational Diabetes is reported as 28–37% using the IADPSG criteria for diagnosis. In our hospital the population has a 39% occurrence of Gestational Diabetes. Those diagnosed with Gestational Diabetes are commenced on a Diabetic Diet and advised to increase their physical activity as the first step in their management. If glycaemic control is not achieved medication is prescribed. A choice of Insulin versus Metformin is given. Objectives Determining the proportion of women requiring medication for Gestational Diabetes. Documenting the medication used in the majority of cases and the dosage required. Methods Retrospective case note analysis using the electronic medical records of all women with Gestational Diabetes delivered in Corniche Hospital from 1st January 2014–31st December 2015. Results A total of 1,481 women were identified as having Gestational Diabetes during the study period. The proportion of women managed with a Diabetic Diet was 45%, while those who required medication to optimize glycaemic control was 55%. Of which 87% commenced Metformin, and 14% required additional insulin. Also, 13% were on Insulin alone as they declined Metformin or could not tolerate it due to side effects. Characteristics of this population were an average age of 33 years, multiparity and a BMI more than 30. The average gestation at which medication was offered was 28 weeks. Pregnancy outcomes of all these groups were similar. Conclusions As the demographics of our pregnant population change to incorporate an increasing maternal age, increased parity and a higher BMI. The requirement for medication use in Gestational Diabetes will continue to increase.

Rolul vitaminei D în dezvoltarea fetală şi în apariţia diabetului gestaţional

Rolul vitaminei D în dezvoltarea fetală şi în apariţia diabetului gestaţional

Research digest: updates on diabetes in pregnancy

Pregnancy is well known to be a metabolic and vascular stress test, potentially providing an early clue to future health risks for women who succumb to specific pregnancy complications. For example, the occurrence of gestational diabetes and pre-eclampsia predict higher risks of diabetes and cardiovascular disease, respectively. Gestational diabetes is particularly worrying since the risk for incident type 2 diabetes in these women has been shown to be substantially raised, sufficiently so to warrant yearly screening for diabetes, whereas cardiovascular risks in women suffering pre-eclampsia seem more modest. In the past, and still in many centres, diabetes screening in the first few months after birth in these women takes the form of oral glucose tolerance testing (OGTT), an approach that is less pragmatic than either fasting glucose or the even simpler HbA1c. However, other cardiometabolic risk factors are not routinely tested in these women.

Determinants of maternal vitaminD concentrations in Slovenia : Aprospective observational study.

To analyze the vitaminD status of pregnant women in Slovenia and the factors influencing it. The study was performed in Maribor University Medical Centre (location 46°N). Maternal serum 25-hydroxy-vitaminD (25(OH)D) in 4 groups of 100 pregnant women in 4 different seasons of the year was measured at the time of delivery. Data on life style, eating habits, sunbathing and intake of vitaminD supplements during pregnancy were obtained using aquestionnaire. Information on maternal outcome was acquired from medical records. Duration of sunlight and average temperature in the month preceding delivery were calculated from meteorological data. The average maternal 25(OH)D concentration ranged from 28.5± 17.1 nmol/l in March to 54.8± 24.1 nmol/l in June (p< 0.001). Severe vitaminD deficiency, i.e. <25 nmol/l 25(OH)D was present in 23.6% of women overall. In multiple regression analysis supplements containing vitaminD (β= 0.225, p< 0.001) and duration of intentional exposure to sunlight (β= 0.192, p= 0.026) were associated with maternal 25(OH)D status. Significantly lower vitaminD levels were observed in women who had a cesarean section (t= 2.053, p= 0.041) and those with premature delivery (t= 2.296, p= 0.022). VitaminD levels were not associated with the occurrence of gestational diabetes, gestational hypertension or infections during pregnancy. Ahigh prevalence of vitaminD deficiency was detected at the end of pregnancy, especially in the months following autumn and winter and in women who did not take supplements containing vitaminD.