Pregestational Diabetes Mellitus Research Articles

Obstetricians’ Utilization of Risk Factors for High-Risk Pregnancy to Predict Complicated Pregnancies: How Are Obstetricians Using Risk Factors for High-Risk Pregnancy?

Purpose: The aim of this study was to analyze how obstetricians use risk factors for high-risk pregnancies to predict complicated pregnancies.Methods: Twenty-four obstetricians were surveyed using a questionnaire that included 75 high-risk pregnancy factors identified by the Korean Society of Obstetrics and Gynecology. These factors are used to predict 11 types of complicated pregnancies: preterm labor, preterm premature rupture of membranes, incompetent internal os of the cervix, placenta previa, placenta abruptio, postpartum hemorrhage, preeclampsia/eclampsia, oligohydramnios, polyhydramnios, gestational diabetes mellitus, and intrauterine growth restriction.Results: Obstetricians utilized 65 of the 75 identified high-risk factors to predict 11 types of pregnancy complications. They identified twin pregnancy as the most significant risk factor, followed by chronic hypertension, a history of preterm birth, pregestational diabetes mellitus, advanced maternal age over 40, and a history of preeclampsia and eclampsia. Twin pregnancies were associated with all 11 complicated pregnancies. Ten of the 75 risk factors were not used for predicting complications.Conclusion: This study demonstrated that obstetricians recognized twin pregnancy as a strong risk factor associated with complications of pregnancy. Based on the results of this paper, we expect prediction models for complicated pregnancies to be developed in the future.

Maternal diabetes and risk of attention-deficit/hyperactivity disorder in offspring in a multinational cohort of 3.6 million mother-child pairs.

Previous studies report an association between maternal diabetes mellitus (MDM) and attention-deficit/hyperactivity disorder (ADHD), often overlooking unmeasured confounders such as shared genetics and environmental factors. We therefore conducted a multinational cohort study with linked mother-child pairs data in Hong Kong, New Zealand, Taiwan, Finland, Iceland, Norway and Sweden to evaluate associations between different MDM (any MDM, gestational diabetes mellitus (GDM) and pregestational diabetes mellitus (PGDM)) and ADHD using Cox proportional hazards regression. We included over 3.6 million mother-child pairs between 2001 and 2014 with follow-up until 2020. Children who were born to mothers with any type of diabetes during pregnancy had a higher risk of ADHD than unexposed children (pooled hazard ratio (HR) = 1.16, 95% confidence interval (CI) = 1.08-1.24). Higher risks of ADHD were also observed for both GDM (pooled HR = 1.10, 95% CI = 1.04-1.17) and PGDM (pooled HR = 1.39, 95% CI = 1.25-1.55). However, siblings with discordant exposure to GDM in pregnancy had similar risks of ADHD (pooled HR = 1.05, 95% CI = 0.94-1.17), suggesting potential confounding by unmeasured, shared familial factors. Our findings indicate that there is a small-to-moderate association between MDM and ADHD, whereas the association between GDM and ADHD is unlikely to be causal. This finding contrast with previous studies, which reported substantially higher risk estimates, and underscores the need to reevaluate the precise roles of hyperglycemia and genetic factors in the relationship between MDM and ADHD.

Association between gestational diabetes and cardiovascular disease within 24 months postpartum

BackgroundCardiovascular disease is the leading cause of death among women in the United States. It is well established that gestational diabetes mellitus (GDM) is associated with an overall lifetime increased risk of cardiometabolic disease, even among those without intercurrent type 2 diabetes. However, the association between GDM and short-term risk of cardiovascular disease (CVD) is unclear. Establishing short-term risks of CVD for patients with GDM has significant potential to inform early screening and targeted intervention strategies to reduce premature cardiovascular morbidity among women. ObjectiveWe aimed to estimate the risk of cardiovascular disease diagnoses in the first 24 months postpartum among patients with GDM compared with patients without GDM. Study DesignOur longitudinal population-based study included pregnant individuals with deliveries during 2007-2019 in the Maine Health Data Organization's All Payer Claims Data. We excluded records with gestational age <20 weeks and deliveries with non-Maine residence, multifetal gestation, those without insurance in the month of delivery or the 3 months before pregnancy, those with implausible time to next pregnancy (<60 days), pre-gestational diabetes mellitus, and any pre-pregnancy diagnosis of the cardiovascular conditions being examined postpartum. GDM and CVD (heart failure, ischemic heart disease, arrhythmia/cardiac arrest, cardiomyopathy, cerebrovascular disease/stroke, and new chronic hypertension) were identified by ICD 9/10 diagnosis codes. Cox proportional hazards models were used to estimate hazard ratios (HR), adjusting for potential confounding factors. We assessed whether the association between GDM and chronic hypertension was mediated by intercurrent diabetes mellitus. ResultsOf the 84,746 pregnancies examined, the cumulative risk of CVD within 24 months postpartum for those with GDM vs. without GDM was 0.13% vs. 0.20% for heart failure, 0.16% vs. 0.14% for ischemic heart disease, 0.60% vs. 0.44% for cerebrovascular disease/stroke, 0.22% vs. 0.16% for arrhythmia/cardiac arrest, 0.20% vs. 0.20% for cardiomyopathy, and 4.19% vs. 1.83% for new chronic hypertension. After adjusting for potential confounders, those with GDM have an increased risk of new chronic hypertension (adjusted hazard ratio (aHR) 1.56 (95% CI 1.32-1.86)) within the first 24 months postpartum as compared to those without GDM. There was no association between GDM and ischemic heart disease (aHR 0.75 (95% CI 0.34-1.65)), cerebrovascular disease/stroke (aHR 1.13 (95% CI 0.78-1.66)), arrhythmia/cardiac arrest (aHR 1.16 (95% CI 0.59-2.29)), or cardiomyopathy (aHR 0.75 (95% CI 0.40-1.41)) within the first 24 months postpartum. Those with GDM appeared to have a decreased risk of heart failure within 24 months postpartum, aHR 0.45 (95% CI (0.21-0.98)). Our mediation analyses estimated that 28% of the effect of GDM on new chronic hypertension was mediated through intercurrent diabetes mellitus. ConclusionPatients with GDM have a significantly increased risk of new chronic hypertension as early as 24 months postpartum. The majority of this effect was not due to the development of diabetes mellitus. Our findings suggest that all women with GDM need careful monitoring and screening for new chronic hypertension in the first 2 years postpartum.

Idiopathic intracranial hypertension and obstetric and neonatal outcomes: A 1:20 matched study from a population database.

Idiopathic intracranial hypertension (IIH), also known as pseudotumor cerebri, is a common pathology in reproductive-aged women, although data regarding pregnancy outcomes are scarce. In the present study, we aimed to compare pregnancy and perinatal outcomes between women who suffered from IIH to those who did not. A retrospective cohort study using the Healthcare Cost and Utilization Project, Nationwide Inpatient Sample. All pregnant women who delivered or had a maternal death in the US (2004-2014) were included. Women with an ICD-9 diagnosis of IIH before or during pregnancy were matched to controls without IIH according to age, race, insurance type, and income quartile, in a 1:20 ratio. Pregnancy, delivery, and neonatal outcomes were compared between the two groups. Overall, 9 096 788 deliveries were identified. Of these, 1454 women (0.016%) had a diagnosis of IIH (study group) and were compared to 29 080 women without IIH (control group). Women with IIH, compared to those without, were more likely to be obese (body mass index >30 kg/m2) and suffer from pregestational diabetes mellitus and chronic hypertension (P < 0.001, all). After adjusting for confounders, patients in the IIH group, compared to those without, had a higher rate of pregnancy-induced hypertension (aOR 1.82, 95% CI: 1.57-2.1, P < 0.001), pre-eclampsia (aOR 1.98, 95% CI: 1.61-2.45, P < 0.001), preterm delivery (aOR 1.88, 95% CI: 1.59-2.23, P < 0.001), CD (aOR 2.41, 95% CI: 2.12-2.73, P < 0.001), wound complications (aOR 3.2, 95% CI: 1.89-5.42, P < 0.001), and congenital anomalies (aOR 2.18, 95% CI: 1.4-3.4, P < 0.001). Women with IIH had a higher incidence of obstetrical complications, including preterm deliveries, hypertensive disorders of pregnancy, and congenital anomalies.

The IRELAnD study—investigating the role of early low-dose aspirin in diabetes mellitus: a double-blinded, placebo-controlled, randomized trial

Although aspirin therapy is being increasingly advocated with the intention of risk modification for a wide range of pregnancy complications, women with prepregnancy diabetes mellitus are commonly excluded from clinical trials. The primary aim of this study was to examine the effect of aspirin therapy on a composite measure of adverse perinatal outcome in pregnancies complicated by pregestational diabetes mellitus. A double-blinded, placebo-controlled randomized trial was conducted at 6 university-affiliated perinatology centers. Women with type 1 diabetes mellitus or type 2 diabetes mellitus of at least 6 months' duration were randomly allocated to 150-mg daily aspirin or placebo from 11 to 14 weeks' gestation until 36 weeks. Established vascular complications of diabetes mellitus, including chronic hypertension or nephropathy, led to exclusion from the trial. The primary outcome was a composite measure of placental dysfunction (preeclampsia, fetal growth restriction, preterm birth <34 weeks' gestation, or perinatal mortality). The planned sample size was 566 participants to achieve a 35% reduction in the primary outcome, assuming 80% statistical power. Secondary end points included maternal and neonatal outcomes and determination of insulin requirements across gestation. Data were centrally managed using ClinInfo and analyzed using SAS 9.4. The 2 treatment groups were compared using t tests or chi-square tests, as required, and longitudinal data were compared using a repeated-measures analysis. From February 2020 to September 2022, 191 patients were deemed eligible, 134 of whom were enrolled (67 randomized to aspirin and 67 to placebo) with a retrospective power of 64%. A total of 101 (80%) women had type 1 diabetes mellitus and 25 (20%) had type 2 diabetes mellitus. Reaching the target sample size was limited by the impact of the COVID-19 pandemic. Baseline characteristics were similar between the aspirin and placebo groups. Treatment compliance was very high and similar between groups (97% for aspirin, 94% for placebo). The risk of the composite measure of placental dysfunction did not differ between groups (25% aspirin vs 21% placebo; P=.796). Women in the aspirin group had significantly lower insulin requirements throughout pregnancy compared with the placebo group. Insulin requirements in the aspirin group increased on average from 0.7 units/kg at baseline to 1.1 units/kg by 36 weeks' gestation (an average 83% within-patient increase), and increased from 0.7 units/kg to 1.3 units/kg (a 181% within-patient increase) in the placebo group, over the same gestational period (P=.002). Serial hemoglobin A1c levels were lower in the aspirin group than in the placebo group, although this trend did not reach statistical significance. In this multicenter, double-blinded, placebo-controlled randomized trial, aspirin did not reduce the risk of adverse perinatal outcome in pregnancies complicated by prepregnancy diabetes mellitus. Compared with the placebo group, aspirin-treated patients required significantly less insulin throughout pregnancy, indicating a beneficial effect of aspirin on glycemic control. Aspirin may exert a plausible placenta-mediated effect on pregestational diabetes mellitus that is not limited to its antithrombotic properties.

Universal Fetal Echocardiography for Pregestational Diabetes Mellitus: A Cost-Effectiveness Analysis.

To evaluate the cost effectiveness of universal fetal echocardiogram for patients with pregestational diabetes mellitus by first-trimester hemoglobin A1c (Hb A1c) level. We developed a cost-effectiveness model comparing two strategies of screening for critical fetal congenital heart disease among patients with diabetes: universal fetal echocardiogram and fetal echocardiogram only after abnormal findings on detailed anatomy ultrasonogram. We excluded ventricular septal defect, atrial septal defects, and bicuspid aortic valve from the definition of critical fetal congenital heart disease. Probabilities and costs were derived from the literature. We used individual models to evaluate different scenarios: first-trimester Hb A1c lower than 6.5%, Hb A1c 6.5-9.0%, and Hb A1c higher than 9.0%. Primary outcomes included fetal death, neonatal death, and false-positive and false-negative results. A cost-effectiveness threshold was set at $100,000 per quality-adjusted life-year. Univariable sensitivity analyses were performed to investigate the drivers of the model. Universal fetal echocardiogram is not cost effective except for when first-trimester Hb A1c level is higher than 9.0% (incremental cost-effectiveness ratio $638,100, $223,693, and $67,697 for Hb A1c lower than 6.5%, 6.5-9.0%, and higher than 9.0%, respectively). The models are sensitive to changes in the probability of congenital heart disease at a given Hb A1c level, as well as the cost of neonatal transfer to a higher level of care. Universal fetal echocardiogram became both cost saving and more effective when the probability of congenital heart disease reached 14.48% (15.4 times the baseline risk). In the Monte Carlo simulation, universal fetal echocardiogram is cost effective in 22.7%, 48.6%, and 62.3% of scenarios for each of the three models, respectively. For pregnant patients with first-trimester Hb A1c levels lower than 6.5%, universal fetal echocardiogram was not cost effective, whereas, for those with first-trimester Hb A1c levels higher than 9.0%, universal fetal echocardiogram was cost effective. For those with intermediate Hb A1c levels, universal fetal echocardiogram was cost effective in about 50% of cases; therefore, clinical judgment based on individual patient values, willingness to pay to detect congenital heart disease, and resource availability needs to be considered.

Antenatal steroids and neonatal outcomes in late preterm births with pregestational diabetes

AbstractObjectiveTo evaluate if antenatal steroid use was associated with a lower rate of respiratory complications in neonates born late preterm to patients with pregestational diabetes mellitus (PGDM).MethodsThis was a retrospective cohort study of live, singleton, non‐anomalous, late preterm births complicated by PGDM using data from the Centers for Disease Control and National Vital Statistics System from 2017 to 2021. The primary (assisted ventilation use &gt;6 h) and secondary neonatal outcomes (immediate assisted ventilation, Apgar score, neonatal intensive care unit [NICU] admission, and surfactant use) were compared between births that received steroids and those that did not. Multivariable analyses were performed to adjust for differences in demographic and clinical characteristics.ResultsThere were 24 323 late preterm births with PGDM, of which 4613 received antenatal steroids and 19 710 did not receive steroids. After adjusting for the differences among the two groups, the need for assisted neonatal ventilation for more than 6 h (adjusted odds ratio [aOR] 1.69, 95% confidence interval [CI] 1.53–1.86), immediate assisted neonatal ventilation (aOR 1.67, 95% CI 1.55–1.80), NICU admission (aOR 1.95, 95% CI 1.81–2.10), and surfactant use (aOR 1.68, 95% CI 1.40–2.02) were higher in the births that received steroids compared with those that did not. These findings did not differ when examining outcomes at each gestational week of delivery between 34 weeks 0 days and 36 weeks 6 days.ConclusionsAntenatal steroid use in late preterm births complicated with PGDM was associated with worse immediate respiratory neonatal outcomes. Our findings support current recommendations against the use of steroids in the late preterm period in pregnancies with PGDM.

Influence of aspirin on obstetric outcomes in women with pre-gestational diabetes mellitus: a South-Western Sydney cohort study

Aim To investigate the effect of aspirin on obstetric outcomes in women with pre-gestational diabetes mellitus (PGDM). Method Retrospective audit of pregnant women with PGDM from two centres in South-Western Sydney was conducted. Women were categorised into the aspirin group (prescribed aspirin before 16 weeks, gestation) and non-aspirin group (not prescribed aspirin or prescribed aspirin at or after 16 weeks, gestation). The outcomes examined were pre-eclampsia, pre-term delivery and birthweight percentile. Results Of 494 women, 52 (10.5%) were in the aspirin group. Pre-eclampsia developed in 57 (12.0%) women. There was no association between aspirin use and pre-eclampsia (8 (15.4%) vs 49 (11.1%), P = 0.2). Aspirin use was not associated with difference in birthweight percentile and rate of pre-term deliveries when adjusted for maternal age, gravidity and other comorbidities. Conclusion There was no difference in the rates of pre-eclampsia, pre-term delivery, or birthweight percentile between women with PGDM in aspirin group compared to women in non-aspirin group.

Prenatal Breastfeeding Counseling Intervention in Women with Pre-Gestational Diabetes Mellitus—A Randomized Controlled Trial

Background: Data on breastfeeding rates and targeted interventions in women with pre-gestational diabetes mellitus are inconclusive. The aim of the study was to evaluate breastfeeding rates up to one year postpartum and whether targeted counseling towards the end of pregnancy can impact breastfeeding rates and duration. An additional goal was to evaluate whether counseling affected women’s perceptions regarding breastfeeding. Methods: Women with pre-gestational diabetes mellitus were cluster-randomized between 32 and 36 weeks of gestation, either to face-to-face instruction with a certified lactation consultant or to receive written information on breastfeeding. Thirty-eight women without diabetes served as controls and were given written information on breastfeeding. All women filled out a questionnaire regarding intended breastfeeding duration, exclusivity, and perceptions, before intervention and at three, six, and twelve months post-partum. Results: Fifty-two women with pre-gestational diabetes mellitus consented to participate. All completed the questionnaires, 26 in each group. At three, six, and twelve months postpartum, rates of any breastfeeding were around 60%, 50%, and 30%, respectively. Approximately one-third breastfed exclusively in each group at three and six months. No significant difference in breastfeeding rates was noted between face-to-face instruction, written information, and controls. End-of-pregnancy counseling improved confidence in breastfeeding knowledge and confidence in being able to manage blood glucose. Conclusions: Breastfeeding rates in pre-gestational diabetes mellitus were comparable to those of women without diabetes and were unchanged by mode of instruction at the end of pregnancy. However, targeted diabetes-oriented breastfeeding instruction at the end of pregnancy improved knowledge and confidence among women with pre-gestational diabetes mellitus.

Corin—the early marker of preeclampsia in pregestational diabetes mellitus

Corin—the early marker of preeclampsia in pregestational diabetes mellitus

Antepartum Fetal Surveillance and Optimal Timing of Delivery in Diabetic Women: A Narrative Review.

Antepartum fetal surveillance (AFS) is essential for pregnant women with diabetes to mitigate the risk of stillbirth. However, there is still no universal consensus on the optimal testing method, testing frequency, and delivery timing. This review aims to comprehensively analyze the evidence concerning AFS and the most advantageous timing for delivery in both gestational and pregestational diabetes mellitus cases. This review's methodology involved an extensive literature search encompassing international diabetes guidelines and scientific databases, including PubMed, MEDLINE, Google Scholar, and Scopus. The review process meticulously identified and utilized pertinent articles for analysis. Within the scope of this review, a thorough examination revealed five prominent international guidelines predominantly addressing gestational diabetes. These guidelines discuss the utility and timing of fetal well-being assessments and recommendations for optimal pregnancy resolution timing. However, the scarcity of clinical trials directly focused on this subject led to a reliance on observational studies as the basis for most recommendations. Glucose control, maternal comorbidities, and the medical management received are crucial in making decisions regarding AFS and determining the appropriate delivery timing.

Relationship between serum NLRP3 along with its effector molecules and pregnancy outcomes in women with hyperglycemia

Objective The study aims to investigate the levels of serum NLRP3 along with its effector molecules (Caspase-1, IL-1β, and IL-18) in the mid-pregnancy in pregnant women with hyperglycemia, and explore the relationship between NLRP3, along with its effector molecules (Caspase-1, IL-1β, and IL-18) and insulin resistance, as well as pregnancy outcomes. Methods The levels of serum NLRP3 along with its effector molecules (Caspase-1, IL-1β, and IL-18) in three groups of pregnant women with gestational diabetes mellitus (GDM), pregestational diabetes mellitus (PGDM) and normal glucose tolerance (NGT) were measured in mid-pregnancy, and their relationship with insulin resistance and pregnancy outcomes was analyzed. The ROC curve was also used to evaluate the predictive value of serum NLRP3 inflammasome and its effector molecules for pregnancy outcomes. Results There were no statistical differences in the general clinical data of the three groups, and the concentrations of serum NLRP3 along with its effector molecules were higher in the GDM and PGDM groups than in the NGT group, and NLRP3 along with its effector molecules were positively correlated with fasting blood glucose, fasting insulin, and insulin resistance index in both groups (r > 0, p < .05). The incidence of preterm delivery, hypertensive disorders of pregnancy, premature rupture of membranes, neonatal hypoglycemia and macrosomia was significantly higher in both groups than in the NGT group (p < .05). The value of the combined serum NLRP3 and its effector molecules in mid-pregnancy to predict adverse pregnancy outcomes was highest, and the AUCs for the combined prediction of late hypertensive disorders of pregnancy, premature rupture of membranes, preterm delivery, neonatal hypoglycemia and macrosomia were 0.84 (95% CI 0.79–0.88, p < .001), 0.81 (95% CI 0.75–0.85, p < .001), 0.76 (95% CI 0.70–0.81, p < .001), 0.76 (95% CI 0.70–0.81, p < .001) and 0.72 (95% CI 0.63–0.81, p < .001), respectively. Conclusions Increased serum NLRP3 along with its effector molecules in pregnant women with hyperglycemia are associated with the levels of insulin resistance and the subsequent development of adverse pregnancy outcomes.

1018 Late preterm antenatal steroids in women with pregestational diabetes mellitus

1018 Late preterm antenatal steroids in women with pregestational diabetes mellitus

Endocrine pathologies and pregnancy: features of medical control of patients

Metabolic changes constantly occur in the mother and her fetus during pregnancy, and the role of hormones in maintaining normal fetal growth and development cannot be overestimated. The scale of endocrine control necessary to maintain physiological functions during pregnancy is clearly demonstrated by the dramatic changes in the hormonal profile and its fluctuations observed from the prenatal to the postpartum period. Differential sensitivity to fluctuations in placental hormones may also play a role in the development of perinatal mental health disorders. Thus, endocrine homeostasis is important for the successful course of pregnancy and its favorable outcome. It is important to note that pregnancy is a period when a woman’s endocrine system undergoes significant changes and adaptations. Endocrine pathologies, such as diabetes mellitus or hypothyroidism, can significantly aggravate this process and increase the risk of various complications. The study is necessary to determine the optimal strategies for medical monitoring and treatment of pregnant women with endocrine disorders. This includes choosing the most appropriate methods for controlling hormone levels, monitoring blood glucose, and ensuring proper medication correction. This article discusses endocrinopathies that occur during pregnancy. Special attention is paid to pregestational diabetes mellitus (PGDM) and gestational diabetes mellitus (GDM), glucose metabolism disorders and methods of screening for GDM. Thyroid diseases associated with human chorionic gonadotropin (HCG) and thyroxine-binding globulin (TBG) levels are also discussed, as well as the effect of these conditions on the euthyroid status.

Evaluation of cardiac contractility of fetuses from pregestational diabetes mellitus pregnancies by three-dimensional ultrasound.

This study aimed to evaluate cardiac contractility in fetuses from pregestational diabetes mellitus pregnancies by three-dimensional ultrasound using spatiotemporal image correlation in rendering mode. A retrospective cross-sectional study was performed on 40 fetuses from nondiabetic pregnancies and 28 pregestational diabetic pregnancies between 20 and 33 weeks and 6 days. Cardiac contractility was assessed by measuring the ventricular myocardial area in diastole subtracted from the ventricular myocardial area in systole. Pregestational diabetic pregnancies had a lower maternal age than nondiabetic pregnancies (26.7 vs. 39.9 years, p=0.019). Cardiaccontractility in fetuses from diabetic and nondiabetic pregnancies was similar (p=0.293). A moderately positive and significant correlation was observed between gestational age and cardiac contractility (r=0.46, p=0.0004). A 1-week increase in gestational age was responsible for a 0.1386 cm2 increase in cardiac contractility. Cardiac contractility as evaluated by three-dimensional ultrasound using spatiotemporal image correlation in rendering mode showed no significant differences across fetuses with and without pregestational diabetes.

Risk Factors for Preeclampsia in Pregnant Women with Pregestational Diabetes

Purpose: To estimate the incidence of preeclampsia in pregnant women with pregestational diabetes and to identify risk factors for preeclampsia. Material and methods: A retrospective cohort study of pregnant women with pregestational diabetes was conducted and compared with a random sample of non-diabetic pregnant women from the population served in the period from January 2017 to August 2019 at the Obstetrics Service of the Women's Hospital. By means of multiple logistic regression the risk factors for preeclampsia were estimated. Results: 10% and 90% of the cases were type 1 and type 2 diabetes mellitus respectively. The incidence of preeclampsia in pregestational diabetes mellitus was 22.5%. Chronic hypertension (OR: 28, CI95%4.8,164) for global PE, nulliparity (OR:6.8, CI95%1.6,36.2) for PE with SF, metabolic disorder (OR:8.4, CI95%1.3,54) for early-onset PE. Conclusions: Chronic hypertension, nulliparity, and metabolic disorder were risk factors for preeclampsia in pregnant women with pregestational diabetes.

Neonatal birth weight percentile following the use of sensor-augmented pump therapy in women with pre-gestational diabetes

AimsTo assess the effect of using sensor-augmented pump therapy (SAP) during pregnancy on neonatal birth weight percentile and other neonatal and pregnancy outcomes. MethodsThis retrospective cohort study included consecutive women with pregestational diabetes mellitus (PGDM) treated with an insulin pump and sensor that enabled the SAP feature during pregnancy. SAP use was defined as utilization of either low-glucose suspend (LGS) or predictive LGS technology. Utilization of SAP was according to physician discretion. Differences in neonatal birth weight percentile and in other neonatal and pregnancy outcomes were compared between those who did and not use SAP. OutcomesOf 142 women, 136 had type 1 diabetes, 5 type 2 diabetes and one diabetes due to pancreatectomy. 83 women used SAP and 59 did not. For the neonates of the mothers of the respective groups, the median birth weight percentiles were similar (79 and 80, pV = 0.96), as were the other neonatal outcomes assessed. The rate of cesarean section was higher in the SAP group. However, after adjusting for maternal age, BMI, and a history of severe hypoglycemic events before pregnancy, the relation between mode of delivery and the use of SAP was no longer statistically significant. ConclusionIn women with PGDM treated with an insulin pump and sensor, SAP use during pregnancy was not associated with higher neonatal birth weight percentile or the occurrences of other adverse neonatal or pregnancy outcomes.

Antidiabetic Therapy during Pregnancy: The Prescription Pattern in Italy.

Pregestational and gestational diabetes mellitus are relevant complications of pregnancy, and antidiabetic drugs are prescribed to obtain glycemic control and improve perinatal outcomes. The objective of this study was to describe the prescription pattern of antidiabetics before, during and after pregnancy in Italy and to evaluate its concordance with the Italian guideline on treatment of diabetes mellitus. A multi-database cross-sectional population study using a Common Data Model was performed. In a cohort of about 450,000 women, the prescribing profile of antidiabetics seemed to be in line with the Italian guideline, which currently does not recommend the use of oral antidiabetics and non-insulin injection, even if practice is still heterogeneous (up to 3.8% in the third trimester used oral antidiabetics). A substantial variability in the prescription pattern was observed among the Italian regions considered: the highest increase was registered in Tuscany (4.2%) while the lowest was in Lombardy (1.5%). Women with multiple births had a higher proportion of antidiabetic prescriptions than women with singleton births both in the preconception period and during pregnancy (1.3% vs. 0.7%; 3.4% vs. 2.6%) and used metformin more frequently. The consumption of antidiabetics in foreign women was higher than Italians (second trimester: 1.8% vs. 0.9%, third trimester: 3.6% vs. 1.8%).

Twenty-four-hour urinary protein excretion in uncomplicated singleton pregnancy

Twenty-four-hour urinary total protein excretion is an essential parameter used for evaluation of renal function and early detection of gestational complications. However, data on reference ranges of 24-hour urinary total protein excretion in normal pregnancy are scarce. This study aimed to determine reference ranges for 24-hour urinary total protein excretion in a population with uncomplicated singleton pregnancies using a standard method for urinary total protein. In addition, the values of 24-hour urinary total protein were stratified by maternal age and prepregnancy body mass index. This study was based on a prospective cohort study in Shenzhen, China. The pregnant women were enrolled at their first prenatal clinical visit. All the participants were instructed to collect 24-hour urine samples during the following successive gestational periods: 6+0 to 13+6, 14+0 to 27+6, and 28+0 to 41+6 weeks. Total urinary protein excretion was analyzed by a colorimetric method. Ultimately, the study encompassed a total of 4844 pregnant women with uncomplicated pregnancies. The nonparametric percentile method was used to determine reference ranges for 24-hour urinary total protein excretion during different trimesters in women with uncomplicated pregnancies (excluding those with previous kidney disorders, gestational or chronic hypertension, preeclampsia, and pregestational diabetes mellitus, among others). The 24-hour urinary total protein levels expressed as medians and percentiles (5th, 95th) for each trimester were as follows: 72.0 (28.4, 165.0), 88.0 (34.0, 185.0), and 108.0 (37.5, 258.0) mg in the first, second, and third trimesters, respectively. A significant increase in 24-hour urinary total protein excretion was observed throughout pregnancy (all P values <.001). Moreover, 24-hour urinary total protein levels were higher in the older (≥35 years) than in the younger (<35 years) group from mid-gestation. Specifically, the median (interquartile range) 24-hour urinary total protein levels by age were 72.2 (50.6-100.0) vs 70.5 (50.5-100.0) mg, 85.8 (62.0-117.0) vs 96.0 (68.0-127.8) mg, and 106.6 (76.0-146.2) vs 114.7 (81.5-153.6) mg in the first, second, and third trimesters, respectively. In addition, 24-hour proteinuria was significantly increased in higher-weight (overweight or obese) subgroups compared with lower-weight (underweight or normal-weight) subgroups (all P values <.05). Our study provides reference values for 24-hour urinary total protein excretion with apparently uncomplicated pregnancies. Understanding these changes in low-risk pregnancies is essential for optimizing maternal management.

Risk of Breast Cancer After Diabetes in Pregnancy: A Population-based Cohort Study

ObjectivesDiabetes is associated with an increased risk of several cancers, including postmenopausal breast cancer. The evidence for higher breast cancer risk after diabetes in pregnancy is conflicting. We compared the incidence of breast and other cancers between pregnant women with and without diabetes. MethodsThis work was a propensity-matched, retrospective, cohort study using population-based health-care databases from Ontario, Canada. Those deliveries with gestational diabetes mellitus (GDM) and pregestational diabetes mellitus (pregestational DM) were identified and matched to deliveries without diabetes mellitus (non-DM). Deliveries from each diabetes cohort were matched 1:2 on age, parity, year of delivery, and propensity score to non-DM deliveries. Matched subjects were followed from delivery for incidence of breast cancer as a primary outcome, and other site-specific cancers as secondary outcomes. We performed Cox proportional hazards regression to compare rates of breast cancer between matched groups. ResultsOver a median 8 (interquartile range 4 to 13) years of follow up, compared with non-DM deliveries, the incidence of breast cancer was significantly lower for GDM but similar for pregestational DM deliveries (hazard ratio [HR] 0.90, 95% confidence interval [CI] 0.82 to 0.98; and HR 0.92, 95% CI 0.80 to 1.07, respectively). GDM was associated with a significantly higher incidence of pancreatic and hepatocellular cancer, and pregestational DM was associated with a higher incidence of thyroid, hepatocellular, and endometrial cancers. ConclusionsDiabetes in pregnancy does not have a higher short-term risk of subsequent breast cancer, but there may be a higher incidence of other cancers.