Non-diabetic Pregnant Women Research Articles

Metformin has no effect on median birth weight score in pregnant non-diabetic women with BMI >35

Metformin has no effect on median birth weight score in pregnant non-diabetic women with BMI >35

Comparison of Growth Parameters, Apgar score, the Blood Zinc, Magnesium, Calcium and Phosphor between Gestational Diabetic and Non-Gestational Diabetic Pregnant Women: a Prospective Cohort Study

Background: Due to little attention to the combined effect of diabetes and pregnancy on mother an infants microelements in literatures. This study aimed to compare newborns growth parameters, Apgar score, the cord blood zinc, magnesium, calcium and phosphor between pregnant women with and without gestational diabetes mellitus. Materials and Methods: This prospective cohort study was conducted in Hamadan city, Iran, during 2013-14. Gestational diabetes considered as exposure and 20 women with gestational diabetes were individually matched with the 20 non-diabetic pregnant women in terms of the variables age, number of pregnancies, and type of delivery were included in this study. The cord blood and mother vein blood samples were taken immediately after delivery. Results: The mean of newborn's head circumference was 34.85±0.9 cm and 33.90±0.97 cm in mothers with gestational diabetes and non- diabetic mothers respectively (P<0.05). The mean of cord blood calcium was 9.81±0.6 mg/dl in the exposed group and 10.23±0.4 mg/dl in the control group (P<0.05) and these figures for zinc were 79.05±13.1 mg/dl in the exposed group and 86.96±11.6 mg/dl in the control group (P<0.05). Conclusion: This prospective cohort study showed the imbalance of some micronutrient in cord blood of mothers with gestational diabetes in comparison to non-diabetic mothers. Therefore in pregnant women with gestational diabetes should be more attention to be paid the concentrations of microelements.

Self-weighing and simple dietary advice for overweight and obese pregnant women to reduce obstetric complications without impact on quality of life: a randomised controlled trial.

To determine the effect of serial weighing and dietary advice compared with standard antenatal care on obstetric outcomes. Randomised controlled clinical trial. Australian tertiary obstetric hospital. Three hundred and eighty-two overweight or obese non-diabetic pregnant women at less than 20 weeks gestation with a singleton pregnancy. Women were randomised to targeted, serial self-weighing and simple dietary advice, (intervention), or standard antenatal care (control). The primary outcome was a reduction in a composite of obstetric complications: gestational hypertension, pre-eclampsia, diabetes, assisted or caesarean birth, shoulder dystocia, severe perineal trauma, postpartum haemorrhage and maternal high dependency care. Secondary outcomes were gestational weight gain at 36 weeks' gestation, quality of life (QOL) and maternal serum levels of 28-week leptin, adiponectin and C-reactive protein (CRP). There was no difference in the rate of the primary composite outcome of obstetric complications: 124/184 (67% control), 124/187 (66% intervention) [relative risk 0.98 (95% confidence interval (CI) 0.85-1.14)]. There was no difference in mean gestational weight gain [-0.9 kg (95% CI -2.0, 0.25)], QOL or leptin, adiponectin or CRP levels between intervention and control groups. This low-cost, pragmatic intervention failed to prevent obstetric complications or modify maternal biochemistry or gestational weight gain in overweight or obese pregnant women. Participation in the study did not impair participants' QOL. Serial self-weighing and dietary advice failed to reduce obstetric complications in overweight pregnant women.

Seroprevalence of toxoplasmosis in diabetic pregnant women in southwestern of Iran.

To investigate anti-Toxoplasma gondii IgG and IgM antibodies in diabetic pregnant women in Ahvaz, southwest of Iran this experiment was performed. In current study the sera of 110 diabetic pregnant women as well as 110 non diabetic pregnant women referred to the hospitals affiliated with the Ahvaz Jundishapur University of Medical Sciences were assessed for anti-T. gondii IgG and IgM antibodies by ELISA and IFA methods. The ELISA assessments showed that 47 (42.7%) and 3 (2.7%) of diabetic women were positive for IgG and IgM antibodies, respectively. However, in the control group, 24 individuals (21.81%) were positive for IgG antibody but no detection for IgM antibody. According to IFA method, 46 (41.8%) and 3 (2.7%) of diabetic women were positive for IgG and IgM antibodies, respectively, while in control group, 21 individuals (19.09%) were positive for IgG antibody. In this method, IgM antibody was negative for all samples of control group (0%). In both methods, the values obtained in the case group were significantly higher than those in the control group (p<0.05). Prevalence of anti-Toxoplasma IgG and IgM antibodies in diabetic pregnant women was higher than that in non-diabetic pregnant women. It seems that screening tests for seeking patients and teaching the transmission routes should be considered as prenatal cares for diabetic women.

Glycosylated hemoglobin values in nondiabetic pregnant women in the third trimester and adverse fetal outcomes: An observational study.

Objective:The objective of the study is to estimate the level of glycosylated hemoglobin (HbA1c) for a safe fetal outcome and to estimate the relation between this level and various adverse fetal outcomes. Materials andMethodology:Primigravidas who are diagnosed as not having gestational diabetes mellitus as per the glucose challenge test done at 24 weeks with a cutoff value up to 140 mg/dl are followed up at 30–34 weeks for the estimation of HbA1c in the blood and further till the time of delivery and postnatal period for the fetal outcomes. Data were collected based on detailed patient interview, clinical examination, and laboratory investigations. Data were analyzed to obtain the mean value of HbA1c in the third trimester. Fetal outcomes were analyzed with the HbA1c value using Chi-square test.Results:The HbA1c values in the third trimester of pregnancy in this study ranged from 4.5% to 6%.Discussion:Unfavorable outcomes were found the least in the 4.5%–5%. The average plasma blood glucose corresponding to HbA1c value of 5% is 101 mg/dl. The majority of the newborn were admitted for observation for transient tachypnea (49.5%) and hyperbilirubinemia (16.5%) requiring phototherapy, hypocalcemia requiring calcium supplements (12.6%), hypoglycemia requiring glucose (7.8%), and persistent tachypnea of newborn (5.8%) and all the outcomes correlated significantly with HbA1c values.Conclusion:Hence, HbA1c can be utilized for the monitoring of glycemic level and as screening test.

Vitamin D Deficiency and Gestational Diabetes Mellitus in Egyptian Women

Background: Although recent meta-analyses indicates a consistent significant inverse relation of serum 25 (OH) D and the prevalence of gestational diabetes mellitus (GDM), the mechanism is unclear and conflicting opinions continue to be reported. Objectives: The objectives are: 1) comparison of vitamin D status in diabetic and non-diabetic pregnant women; 2) trying to determine the level of vitamin D associated with GDM, and its sensitivity and specificity; 3) determination of the relation of hypovitaminosis D with insulin resistance. Subjects and Methods: One hundred consecutive pregnant women (<28 weeks gestational period) from the attendants of the out-patient clinic at our hospital were diagnosed for GDM by glucose tolerance test (GTT) (75 g 2 h). Among them, 40 patients met the inclusion criteria for this study (group I). As a comparative group, another 40 pregnant ladies were included, 20 of them (group II) had pre-gestational type II DM, and the other 20 (group III) had normal glucose tolerance (NGT) as a control. For all the participants, we estimated fasting blood glucose, fasting serum insulin, homeostasis model assessment of (HOMA-IR and HOMA-B), quantitative insulin sensitivity check index (QUICKI), and serum 25-OH vit D. The ROC curve analysis was used to determine the optimal threshold value of vit D in relation to DM. Results: Compared to the control group, the diabetic patients showed a statistically significant increase in the levels of fasting glucose, 1-hour postprandial glucose, 2-hour post prandial glucose, fasting insulin, and HOMA-IR, (P=0.000 for all). None of the diabetic patients showed optimal vit D level. Vit D insuficiency (10 - 29 ng/ml) was found in 32.5% of patients in group I, 55% in group II, and 50% in group III. Vit D deficiency (<10 ng/ml) was found in 67.5% of patients in group I, 45% in group II, and 0% in group III. Significant negative correlation was found for vit D with fasting insulin and FBS. The AUC for 25 OH vit D was 97%, CI was 95% and p-value was 0.0001. The sensitivity, specificity, and positive and negative predictive values of 25 OH vit D in GDM versus control persons were 97%, 90%, 95.1%, 94.7% respectively at a cut-off level <22 ng/ml. Conclusions: Although it might seem premature to draw a sharp relation between hypovitaminosis D and GDM, this study showed the importance of vit D in GDM, the need for supplementation below 22 ng/ml, and the role of hypovitaminosis D in increasing insulin resistance. Further randomized studies with vit D supplementation are recommended.

Associations between maternal anthropometric characteristics and infant birth weight in Iranian population.

Objective:To examine the (1) normal ranges of anthropometric and insulin resistance/sensitivity indices (homeostatic model assessment for insulin resistance, homeostatic model assessment for insulin sensitivity, and quantitative insulin sensitivity check index) for Iranian pregnant women and their newborns and (2) associations between maternal anthropometric and metabolic values and infants’ birth weights among Iranian women.Methods:Anthropometric and metabolic values of 163 singleton non-diabetic pregnant women in Tehran, Iran (2014) were collected before and during pregnancy and at delivery. Linear regression, multivariable regression, and Student t tests were used to evaluate correlations between birth weight and maternal variables.Results:Linear regression modeling suggested that maternal serum glucose (p = 0.2777) and age (p = 0.6752) were not associated with birth weight. Meanwhile, maternal weight and body mass index before pregnancy (p = 0.0006 and 0.0204, respectively), weight at delivery (p = 0.0036), maternal height (p = 0.0118), and gestational age (p = 0.0016) were positively associated with birth weight, while serum insulin (p = 0.0300) and homeostatic model assessment for insulin resistance (p = 0.0334) were negatively associated with infant’s birth weight. Using multivariate modeling, we identified severalconfounders: parity (multipara mothers delivered heavier babies compared to first-time mothers) explained as much as 24% of variation in birth weight (p = 0.005), maternal height explained 20.7% (p = 0.014), gestational age accounted for 19.7% (p = 0.027), and maternal body mass index explained 19.1% (p = 0.023) of the variation in the infant’s birth weight. Maternal serum insulin and infant’s sex were not observed to be associated with birth weight (p = 0.342 and 0.669, respectively) in the overall model.Conclusion:Overweight/obese women may experience higher incidence of delivering larger babies. Multivariable regression analyses showed that maternal body mass index and height, parity, and gestational age are associated with newborn’s birth weight.

Insulin Resistance in Pregnancy Is Correlated with Decreased Insulin Receptor Gene Expression in Omental Adipose: Insulin Sensitivity and Adipose Tissue Gene Expression in Normal Pregnancy

Aims: To determine correlations of insulin sensitivity to gene expression in omental and subcutaneous adipose tissue of non-obese, non-diabetic pregnant women. Methods: Microarray gene profiling was performed on subcutaneous and omental adipose tissue from 14 patients and obtained while fasting during non-laboring Cesarean section, using Illumina HumanHT-12 V4 Expression BeadChips. Findings were validated by real-time PCR. Matusda-Insulin sensitivity index (IS) and homeostasis model assessment of insulin resistance (HOMA-IR) were calculated from glucose and insulin levels obtained from a frequently sampled oral glucose tolerance test, and correlated with gene expression. Results: Of genes differentially expressed in omental vs. subcutaneous adipose, in omentum 12 genes were expressed toward insulin resistance, whereas only 5 genes were expressed toward insulin sensitivity. In particular, expression of the insulin receptor gene (INSR), which initiates the insulin signaling cascade, is strongly positively correlated with IS and negatively with HOMA-IR in omental tissue (r = 0.84). Conclusion: Differential gene expression in omentum relative to subcutaneous adipose showed a pro-insulin resistance profile in omentum. A clinical importance of omental adipose is observed here, as downregulation of insulin receptor in omentum is correlated with increased systemic insulin resistance.

The Influence of Exercise Characteristics Before and During Pregnancy on Gestational Diabetes Mellitus

Background: Although exercise is recommended for preventing gestational diabetes mellitus (GDM), the situation has remained unclear regarding the characteristics and timing of the proper exercise. Objectives: The aim of the present study was to compare exercise characteristics including volume, frequency, intensity and energy expenditure before and during pregnancy in diabetic and non-diabetic pregnant women. Patients and Methods: Participants of the study included 137 pregnant women (80 diabetics and 57 non-diabetics) who were selected based on the inclusion criteria. Exercise activities of the participants were evaluated by interviews. Statistical tests of Mann-Whitney and Chi-square were used for data analysis. Results: Participating in regular exercise activities was significantly higher in the non-diabetics compared to the diabetics during all stages including 8 and 1 years before pregnancy and during the 1st and 2nd trimesters of pregnancy (P < 0.05). However among the diabetics and non-diabetics who regularly exercised, there was no significant difference in terms of exercise characteristics (frequency, intensity, duration and energy cost). Conclusions: Regular participation in exercise activities before and during pregnancy especially during the second trimester is important for preventing GDM. However, in few cases, similar exercise characteristics were found among diabetics and non-diabetics.

The Impact of Genetic Variants for Different Physiological Characterization of Type 2 Diabetes Loci on Gestational Insulin Signaling in Nondiabetic Pregnant Chinese Women.

We investigate the impact of genetic variants on transiently upregulated gestational insulin signaling. We recruited 1152 unrelated nondiabetic pregnant Han Chinese women (age 28.5 ± 4.1 years; body mass index [BMI] 21.4 ± 2.6 kg/m(2)) and gave them oral glucose tolerance tests. Matsuda index of insulin sensitivity, homeostatic model assessment of insulin resistance, indices of insulin disposition, early-phase insulin release, fasting state, and 0 to 120 minute's proinsulin to insulin conversion were used to dissect insulin physiological characterization. Several variants related to β-cell function were genotyped. The genetic impacts were analyzed using logistic regression under an additive model. By adjusting for maternal age, BMI, and the related interactions, the genetic variants in ABCC8, CDKAL1, CDKN2A, HNF1B, KCNJ11, and MTNR1B were detected to impact gestational insulin signaling through heterogeneous mechanisms; however, compared with that in nonpregnant metabolism, the genetic effects seem to be eminently and heavily influenced by maternal age and BMI, indicating possible particular mechanisms underlying gestational metabolism and diabetic pathogenesis.

Depression and anxiety in pregnant women with diabetes or mild hyperglycemia.

A number of physical and psychological changes that occur during pregnancy can stimulate the development of psychological disorders such as anxiety and depression. The study evaluated psychological aspects related to maternal depression and anxiety in pregnant women with diabetes mellitus or hyperglycemia, contrasting the results with those of non-diabetic pregnant women. In a prospective and longitudinal approach, two questionnaires were applied and validated for use in Brazil, the Beck depression inventory and the State-Trait Anxiety Inventory. The questionnaires were applied to pregnant women at the first prenatal visit or at the time of disease diagnosis (T1) and reapplied at admission for delivery (T2). Regardless of the degree of hyperglycemia, both at first and in the second stage most women had severe anxiety trait. In early pregnancy (T1), however, severe state anxiety was more frequent in women with hyperglycemia than in those from the NG group. Most pregnant women showed moderate state anxiety over their pregnancy, regardless of glycemic status. In early pregnancy, however, severe state anxiety was more prevalent in hyperglycemic women than in those with normal glycemic status. Most women showed moderate trait anxiety and mild depression in both early and late pregnancy, irrespective of glycemic status. The incidence of severe state anxiety in early pregnancy is more frequent in women with diabetes or hyperglycemia, but their levels of trait anxiety and depression are not affected by glycemic status.

Association Between Elevated HbA1c Levels and Urinary Tract Infection Among Diabetic Women

Background: Urinary tract infection is one of the common clinical sequelae of diabetes mellitus. Objectives: This study aimed to determine the effect of poor glycaemic control as determined by glycated hemoglobin (HbA1c) levels on the prevalence of urinary tract infections among diabetic women. Materials and Methods: In this cross-sectional descriptive study, 50 non-pregnant diabetic women attending the diabetes clinic of Nena hospital, Abuja, Nigeria were included as subjects and 25 age and sex-matched apparently healthy individuals were included as controls. Results: Mean HbA1c levels in diabetic women were significantly higher than in healthy controls (7.29 ± 2.4 % vs. 4.5 ± 1.8 %) (P < 0.001). The prevalence of poor glycaemic control was high; 19 (38%) and UTI was significantly more prevalent in DM patients with poor glycaemic control than in subjects with good glycaemic control 14 (77.8%) vs. 4 (22.2%) (P < 0.001). Conclusions: HbA1c values showing poor glycaemic control may be a proxy indicator for screening for UTI among women with diabetes mellitus.

Effect of metformin on early pregnancy loss in women with polycystic ovary syndrome

ObjectiveTo evaluate the effectiveness of metformin therapy in reducing early pregnancy loss in pregnant women with polycystic ovary syndrome (PCOS). Materials and methodsThis is a prospective cohort study conducted in the Obstetric Department of the Gulf Medical College Hospital in Ajman, UAE, for a period of 3 years. This study involved 106 nondiabetic pregnant women with PCOS who became pregnant while using metformin. They were divided into two groups, namely, the group that received metformin throughout pregnancy (metformin group) and the group that discontinued using the drug once pregnancy started (control group). A comparison was made between the two groups of patients with respect to certain basal characteristics (age, body mass index, previous obstetric outcome, serum glucose with free testosterone). Statistical analysis was performed using Chi-square test to compare the differences between the two groups. ResultsThere were 56 patients who received metformin during pregnancy (metformin group) compared with 50 patients who did not receive the treatment (control group). The rate of early pregnancy loss in the metformin group was 8.9% (5/56) compared with 36% (18/50) in the control group (p < 0.001). For patients in the metformin group with a history of previous miscarriage, the rate of pregnancy loss was 45% (35 cases/50 pregnancies). ConclusionMetformin therapy in pregnant women with PCOS was associated with a significant reduction in the rate of early pregnancy loss.

Hemoglobin A1C Values Are Not Affected by Hemoglobin Level in Diabetic and Nondiabetic Pregnant Women [327

Hemoglobin A1C Values Are Not Affected by Hemoglobin Level in Diabetic and Nondiabetic Pregnant Women [327

Influence of the time of day and fasting duration on glucose level following a 1-hour, 50-gram glucose challenge test in pregnant women.

BackgroundPrevious studies have shown that the time of day (TD) of glucose measurement and the fasting duration (FD) influence the glucose levels in adults. Few studies have examined the effects of the TD and FD on the glucose level following a 1-hour, 50-gram glucose challenge test (GCT) in pregnant women in screening for or diagnosing gestational diabetes mellitus (GDM). The objective of this study was to investigate the influence of the TD (morning, afternoon, night) and the FD (the time of the last food ingestion as follows: ≤1 hour, 1–2 hours, and >2 hours) by examining their combined effects on the glucose levels following a 50-gram GCT in pregnant women.Methods and ResultsWe analyzed the data of 1,454 non-diabetic pregnant Taiwanese women in a prospective study. Multiple linear regression and multiple logistic regression were used to estimate the relationships between the 9 TD-FD groups and the continuous and binary glucose levels (cut-off at 140 mg/dL) following a 50-gram GCT, after adjusting for maternal age, nulliparity, pre-pregnancy body mass index, and weight gain. Different TD and FD groups were associated with variable glucose responses to the 50-gram GCT, some of which were significant. The estimate coefficients (β) of the TD-FD groups “night, ≤1 hr” and “night, 1–2 hr” revealed significantly lower glucose concentrations [β (95% confidence interval [CI]): −6.46 (−12.53, −0.38) and −6.85 (−12.50, −1.20)] compared with the “morning, >2 hr” group. The TD-FD groups “afternoon, ≤1 hr” and “afternoon, 1–2 hr” showed significantly lower odds ratios (OR) of a positive GCT; the adjusted ORs (95% CI) were 0.54 (0.31–0.95) and 0.58 (0.35–0.96), respectively.ConclusionsOur findings demonstrate the importance of standardizing the TD and FD for the 1-hour, 50-gram GCT. In screening for and diagnosing GDM, the TD and FD are modifiable factors that should be considered in clinical practice and epidemiological studies.

Does gestational diabetes result in cochlear damage?

Glucose metabolism has a significant impact on inner-ear physiology. Therefore, hearing may be affected in gestational diabetes. A matched case-control study was performed to evaluate 27 patients with gestational diabetes and 31 non-diabetic pregnant women with similar demographic characteristics. A medical history was taken for each participant, and otological inspections and high-frequency audiometry tests were performed. There were no significant differences in average pure tone air-bone hearing thresholds between the groups (p > 0.05). However, evaluation of high-frequency hearing thresholds indicated significantly increased auditory thresholds at 10 kHz and 12 kHz for right ears and at 8, 10, 12 and 14 kHz for left ears in the gestational diabetes group (p < 0.001). An investigation into cochlear damage in gestational diabetic patients showed significant high-frequency hearing loss. Further studies are needed to validate these findings in different ethnic groups and geographical populations.

The impact of maternal lipid levels of non-diabetic pregnant women on fetal weight

The impact of maternal lipid levels of non-diabetic pregnant women on fetal weight

The factors effective on the macrosomic deliveries of non-diabetic pregnant women

The factors effective on the macrosomic deliveries of non-diabetic pregnant women

Diyabetik olmayan gebelerde maternal lipid seviyelerinin fetal ağırlık üzerine etkisi

Diyabetik olmayan gebelerde maternal lipid seviyelerinin fetal ağırlık üzerine etkisi

Leptin, fetal growth and insulin resistance in non-diabetic pregnancies

BackgroundInterrogation of the association between leptin, insulin resistance and fetal growth may provide a biological link for the fetal programming of later metabolic health. AimsOur aim was to clarify the relationship between maternal and fetal leptin, insulin resistance and fetal growth. Study designMaternal leptin, glucose and insulin were measured in early pregnancy and at 28weeks and the HOMA index calculated. At 34weeks, ultrasound scan assessed fetal weight and adiposity (abdominal wall width). At delivery birthweight was recorded and cord blood analyzed for fetal c-peptide and leptin. Analysis was performed using a multivariate linear regression model. Subjects574 non-diabetic pregnant women. Outcome measuresFetal growth and maternal and fetal insulin resistance. ResultsOn multivariate analysis a relationship was identified between maternal and fetal leptin concentrations at each time point and maternal body mass index. Maternal leptin was related to insulin resistance in early pregnancy (β=0.15, p=0.02) and at 28week gestation (β=0.27, p<0.001). Fetal insulin resistance correlated with maternal leptin in early pregnancy (β=0.17, p=0.004); at 28weeks (β=0.12, p=0.05), and with leptin in cord blood (r=0.28, p<0.001).Fetal weight at 34weeks was related to maternal leptin in early pregnancy (β=0.16, p=0.02). Both maternal and fetal leptin correlated with infant size at birth (β=0.12, p=0.07 in early pregnancy, β=0.21, p=0.004 in cord blood), independent of all other outcome measures. ConclusionOur findings have confirmed that in a non-diabetic cohort there is a link between maternal and fetal leptin and insulin resistance. We also established a link between maternal leptin in early pregnancy and both fetal and neonatal size. These results add to the growing body of evidence suggesting a role for leptin in the fetal programming of childhood obesity and metabolic dysfunction.