Presence Of Gestational Diabetes Research Articles

CERVICAL RIPENING BALLOON AS A METHOD OF PREINDUCTION - ONE CENTER STUDY.

SUMMARY – Cervical ripening can be promoted in many ways, but mechanical methods are among the oldest. Like all other methods, this one also has its pros and cons. Disadvantages compared to pharmacological methods include some maternal discomfort upon manipulation of the cervix, a theoretical increase in the risk of maternal and neonatal infection from the introduction of a foreign body, potential disruption of a low-lying placenta, and increase in the need of oxytocin induction of labor. The aim of the study was to evaluate the effect of using cervical ripening balloon in preinduction on the mode of delivery. This was a longitudinal, cohort, intervention, non-randomized one center study. Inclusion criteria were term pregnancies with gestational diabetes, oligohydramnios, intrauterine growth restriction, gestational hypertension/preeclampsia and pregnancies after 41 weeks of pregnancy. Preinduction of labor was performed in term pregnancies at Sestre milosrdnice University Hospital Center. Results in the first 150 women having undergone labor preinduction with cervical ripening balloon were included. Two-sided p values <0.05 were considered significant. Statistical analysis was done using SPSS Version 20.0. The study included 150 women; one woman was excluded from further analyses due to conversion of fetal presentation (head to breech). Indications for labor preinduction were as follows: gestational diabetes, oligohydramnios, intrauterine growth restriction, gestational hypertension/preeclampsia and pregnancies after 41 weeks of pregnancy. Women with normal vaginal delivery (96/149) had lower rates of gestational diabetes and oligohydramnios and used epidural analgesia more frequently. Women with dystocia (32/53) had a significantly longer labor duration and higher neonatal birth weight. In multivariate analysis, multiparity, greater cervical dilatation after balloon removal and use of epidural analgesia were associated with a decreased risk of cesarean section, while the presence of gestational diabetes and oligohydramnios was associated with an increased risk of cesarean section. We found this preinduction method safe and efficient, with a potential to increase the rate of vaginal deliveries.

Risk factors for overweight and obesity in children aged 2-6 years.

Understanding risk factors that may vary culturally can help improve preventive strategies for obesity. This is the first cross-sectional study aimed to determine the risk factors for overweight/obesity in children aged 2-6 years in a central Anatolian city in Turkey. A total of 1582 children (1351 healthy, 231 overweight/obese) aged 2-6 years were included from the Anthropometry of Turkish Children aged 0-6 years database. Age, gender, birth weight, birth order, mother's age, mother's body mass index (BMI), weight gain of mothers during pregnancy, presence of gestational diabetes, breastfeeding duration, history of formula feeding, mother's and father's education, mother's job, monthly income, smoking at home and physical activity, sleep duration and duration of television (TV) watching of the children were evaluated as independent risk factors. Logistic regression analyses were performed to investigate risk factors for overweight/obesity. Having a high family income compared to bad [odds ratio (OR)=1.96; 95% confidence interval (CI): 1.237-3.106], increased the time of watching TV during the weekend (OR=1.094; 95% CI: 1.032-1.159), and similar physical activity level according to their peers compared to less (OR=2.957; 95% CI: 1.056-8.282) were found to be significantly associated with a higher risk of overweight/obesity in children aged 2-6 years old. The early childhood period seems to be important in the establishment of healthy behavioral patterns, especially limitation of TV watching and encouragement of physical activity. Obesogenic environment in families with high incomes need to be revealed.

Environmental Factors and the Risk of Type 1 Diabetes Mellitus-A Case-Control Study

Introduction: An interaction between genetic susceptibility and environmental factors is assumed to be elaborate in the etiology of type 1 diabetes mellitus (T1DM). Autoimmunity may be induced in first years of life, suggesting that environmental agents encountered early in life could be triggers of the disease process. Aim: The aim of the study was therefore to investigate the associations of T1DM with several environmental factors. Methods: A case-control study was conducted in Minia University Maternity and Children Hospital, Minia governorate, Egypt. One hundred and ten children aged from 2-16 years old who were diagnosed with T1DM and 110 age and sex-matched controls were included. Data regarding environmental factors during gestation, neonatal period, and early years of life were collected by a structured questionnaire. Results: On multivariable logistic regression analysis, maternal age >35 years at delivery, the presence of gestational diabetes, pre-eclampsia and taking medications during pregnancy were significantly associated with the occurrence of T1DM. Also, viral infection in early life, low birth weight children (<2500 grams) and those who suffered from neonatal diseases (respiratory distress, jaundice, and infection) were 4.71 and 2.17 folds increased therisk of T1DM. Consumption of cow's milk during the1st year of life was a significant predictor for developing T1DM with OR 3.83 (1.64-8.96), However, vitamin D supplement and increased duration of breast feeding were significant protective factors. Conclusion: in the present study, certain environmental risk factors were associated with the development of T1DM.

Hybrid approach using fuzzy sets and extreme learning machine for classifying clinical datasets

Data mining techniques play a major role in developing computer aided diagnosis systems and expert systems that will aid a physician in clinical decision making. In this work, a classifier that combines the relative merits of fuzzy sets and extreme learning machine (FELM) for clinical datasets is proposed. The three major subsystems in the FELM framework are preprocessing subsystem, fuzzification subsystem and classification subsystem. Missing value imputation and outlier elimination are handled by the preprocessing subsystem. The fuzzification subsystem maps each feature to a fuzzy set and the classification subsystem uses extreme learning machine for classification. Cleveland heart disease (CHD), Statlog heart disease (SHD) and Pima Indian diabetes (PID) datasets from the University of California Irvine (UCI) machine learning repository have been used for experimentation. The CHD and SHD datasets have been experimented with two class labels one indicating the absence and the other indicating the presence of heart disease. The CHD dataset has also been experimented with five class labels, one class label indicating the absence of heart disease and the other four class labels indicating the severity of heart disease namely low risk, medium risk, high risk and serious. The PID data set has been experimented with two class labels one indicating the absence and the other indicating the presence of gestational diabetes. The classifier has achieved an accuracy of 93.55% for CHD data set with two class labels; 73.77% for CHD data set with five class labels; 94.44% for SHD data set and 92.54% for PID dataset.

ASSOCIATION OF CARDIAC STRUCTURAL AND FUNCTIONAL ABNORMALITIES WITH GESTATIONAL DIABETES

Introduction: Pregnancy leads to changes in the cardiovascular system. Gestational diabetes relates to maternal and fetus later development of chronic cardiovascular diseases. We perform an exploratory analysis to assess the prevalence of cardiac structural and functional abnormalities in pregnant women with gestational diabetes. Methods: We enrolled 20 consecutive pregnant women with gestational diabetes and 30 healthy pregnant women as controls. Participants with age less than 18 years, previous gestational diabetes, hypertension, cardiac diseases, lung diseases, or medications other than vitamins were excluded. A comprehensive echocardiography protocol was performed in all participants, including 2D views, M-mode technique, flow assessment, and tissue Doppler imaging to acquire cardiac structural and functional parameters. A cross-sectional analysis was performed to assess relations of gestational diabetes with echocardiography-derived parameters. Results: Women with gestational diabetes had higher weight compared to normal pregnant participants, but the cardiovascular risk profile was similar in both groups. LV mass index was significantly higher in women with gestational diabetes when compared to normal pregnant controls, but the other echocardiography-derived parameters were similar in both groups. Gestational diabetes had significant predictive power on higher values of LV mass index, consistent after adjustment for anthropometrics, risk factors, and gynecological history. Conclusion: The presence of gestational diabetes has a consistent independent relation with higher values of LV mass index, but not with other measurements of LV systolic and diastolic function. Myocardial hypertrophy appears to be an early marker of gestational diabetes-related cardiac injury.

Leptin levels at birth and infant growth: the EPOCH study.

To examine the association of cord blood leptin with body mass index (BMI) growth velocity from birth to 12 months of age among infants exposed and not exposed to over-nutrition in utero (defined as maternal overweight/obesity or presence of gestational diabetes). 185 infants enrolled in the Exploring Perinatal Outcomes among Children study (76 exposed and 109 not exposed) had leptin and insulin measured in cord blood. Longitudinal weight and length measures in the first 12 months of life (average 4 per participant) obtained from medical records were used to compute BMI growth rates. Mixed models were used to examine associations of cord blood leptin with growth. Compared with unexposed infants, those exposed had significantly higher cord blood insulin (8.64 v. 6.97 uU/ml, P<0.01) and leptin levels (8.89 v. 5.92 ng/ml, P=0.05) as well as increased birth weights (3438.04 v. 3306.89 g, P=0.04). There was an inverse relationship between cord leptin levels and BMI growth from birth to 12 months of age (P=0.005); however, exposure to over-nutrition in utero did not significantly modify this association (P=0.59). We provide support of a possible operational feedback mechanism by which lower cord blood leptin levels are associated with faster infant growth in the first year of life. Our data do not tend to support the hypothesis that this mechanism is altered in infants exposed to over-nutrition in utero; however our sample is too small to provide sufficient evidence. Larger epidemiological studies are needed to elucidate the mechanisms responsible for increased propensity for obesity in exposed offspring.

Timing of clamping and factors associated with iron stores in full-term newborns

OBJECTIVETo analyze the impact of timing of clamping and obstetric, biological and socioeconomic factors on the iron stores of full-term newborns.METHODSCross-sectional study between October 2011 and July 2012 in which hematological parameters were evaluated for newborns in Viçosa, MG, Southeastern Brazil. It involved collecting 7 mL of umbilical cord blood from 144 full-term not underweight newborns. The parameters investigated were complete blood count, serum iron, ferritin and C-reactive protein. The time of umbilical cord clamping was measured using a digital timer without interfering in the procedures of childbirth. The birth data were collected from Live Birth Certificates and other information was obtained from the mother through a questionnaire applied in the first month postpartum. Analysis of multiple linear regression was then used to estimate the influence of biological, obstetrics and socioeconomic factors on the ferritin levels at birth.RESULTSThe median ferritin was 130.3 µg/L (n = 129, minimum = 16.4; maximum = 420.5 µg/L), the mean serum iron was 137.9 μg/dL (n = 144, SD = 39.29) and mean hemoglobin was 14.7 g/dL (n = 144, SD = 1.47). The median time of cord clamping was 36 seconds, ranging between 7 and 100. The bivariate analysis detected an association between ferritin levels and color of the child, timing clamping of 60 seconds, type of delivery, the presence of gestational diabetes and per capita family income. In multivariate analysis, the variables per capita income, number of antenatal visits and length at birth accounted for 22.0% of variation in ferritin levels.CONCLUSIONSIron stores at birth were influenced by biological, obstetric and social characteristics. Tackling anemia should involve creating policies aimed at reducing social inequalities, improving the quality of antenatal care, as well as implementing a criterion of delayed clamping of the umbilical cord within the guidelines of labor.

Gestational Diabetes: Risk Factors, Perinatal Complications and Screening Importance in Niger Delta Region of Nigeria: A Public Health Dilemma

Aim: The study identified the incidence of undiagnosed gestational diabetes and its consequences on maternal/neonatal mortality and highlighted screening importance in an African urban setting in the Niger Delta region in Nigeria. Study Design: Randomised study. Place and Duration of Study: Pregnant women attending antenatal clinics in one tertiary, six primary, six secondary, hospitals, and six maternity homes in the Niger delta area of Nigeria between May 2006 to May 2009. Method: A total of 1920 pregnant women were recruited into the study. While 956 received the oral glucose test and formed the study group, 964 declined from continuing in the study, and formed the control group. Results: Women with gestational diabetes were at increased risk for premature rupture of membranes, preterm birth; breech presentation and high birth weight adjusting for maternal age. Conclusion: The presence of gestational diabetes in pregnancy is predictive of poor pregnancy outcome as it remains undetected in conception resulting in unto wards maternal/neonatal complications.

Risk Factors for Eclampsia: A Population-based Study in Washington State, 1987–2007: Coghill AE, Hansen S, Littman AJ. Am J Obstet Gynecol 2011;205:553.e1–7.

Eclampsia is defined as generalized seizure with or without coma (in the absence of other neurologic conditions) with the concomitant onset of hypertension and proteinuria at>20 weeks gestation. Estimates of the incidence for eclampsia vary widely from 1 in 100 to 1 in 4000. The authors of this study evaluated all women with singleton births in Washington State from 1987–2007 through the state's Birth Events Reporting System in an effort to update the previous characterizations of risk factors for eclampsia, taking into account shifts in population demographics (specifically, increased obesity) and to evaluate a more heterogeneous population than prior studies. There were 781 women discharged with a diagnosis of eclampsia during this time period. They were matched with 3124 controls randomly selected from those discharged without a diagnosis of eclampsia. Multivariable logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (CI). Nearly 50% of cases and controls were missing data for key variables such as body mass index (BMI) and level of education. As such, multiple imputation procedures were performed to address missing data. Results were provided as ORs, first without multiple imputation data, then with these data. Risk of eclampsia was greater in nulliparous, compared to parous, women (OR 3.04, 95% CI 2.20–4.19; OR 3.06, 95% CI 2.43–3.87). Being a young mother and an older mother were each associated with elevated risk (age<20 years: OR 1.87, 95% CI 1.29–2.71; OR 2.08, 95% CI 1.61–2.69; age>35 years: OR 1.69, 95% CI 1.13–2.53; OR 1.45, 95% CI 1.07–1.96). Longer birth interval (> 5 years: OR 1.92, 95% CI 1.09–3.37; OR 1.63, 95% CI 1.08–2.46), low socioeconomic status (OR 1.18, 95% CI 0.88–1.59; OR 1.23, 95% CI 1.00–1.49), gestational diabetes (OR 1.79, 95% CI 1.06–3.02; OR 1.72, 95% CI 1.13–2.63), pre-pregnancy obesity (BMI > 30: OR 1.73, 95% CI 1.26–2.37; 1.41, 95% CI 1.09–1.83), and weight gain during pregnancy above or below recommended guidelines (< 25 lb: OR 1.47, 95% CI 1.04–2.07; OR 1.23, 95% CI 0.95–1.61;>35 lb: 1.68, 95% CI 1.23–2.30; OR 1.39, 95% CI 1.09–1.78) were positively associated with eclampsia. Multiparity and smoking were negatively associated with risk. This study confirmed previously known risk factors (maternal age and parity) for eclampsia and identified new risk factors such as presence of gestational diabetes and BMI>30.

The presence of gestational diabetes is associated with an increased detection of anti-HLA-class II antibodies in the maternal circulation

Introduction: Similar like preeclampsia, gestational diabetes (GD) is characterized by an abnormal inflammatory response in the maternal circulation. Therefore, GD may be associated with temporary reduced immune tolerance towards alloantigens for the time of pregnancy. The aim of this study was to assess anti-HLA-class-I and-II antibodies as markers for an aberrant immunostimulation in women with GD compared to women with normal term delivery and women in the presence of fetal distress. As these antibodies may cross the placental barrier and cause the activation and IL-6 release from fetal monocytes, we estimated the percentage of IL-6 positive monocytes in the fetal circulation of these patient groups (1,2).

The Presence of Gestational Diabetes is Associated with Increased Detection of Anti‐HLA‐class II Antibodies in the Maternal Circulation

Gestational diabetes (GD) may be associated with temporarily reduced immune tolerance toward alloantigens for the time of pregnancy. The aim of this study was to assess anti-HLA-class I and -II antibodies as markers for an aberrant immunostimulation in women with GD. The percentage of anti-HLA-class I and -II antibodies was estimated in women with GD, normal term delivery and fetal distress, which was confirmed by demonstrating low cord blood pH for this patient group. These antibodies may cross the placental barrier and cause interleukin-6 (IL-6) release from fetal monocytes by cross-linking monocytes with antibody-loaded cells. Therefore we estimated the percentage of IL-6-positive monocytes in the fetal circulation of these three patient groups. We found a significantly increased percentage of anti-HLA-class II in the circulation of women with GD. In comparison with women with normal term delivery, a significantly increased percentage of IL-6-positive monocytes was detected for women with GD and for women with fetal distress. Significantly decreased cord blood pH were detected for neonates born in the presence of fetal distress but not for neonates born in the presence of GD. Our results suggest that GD is associated with an increased humoral immune response against HLA-class II antigens.

Nutritional Intake and Placental Size in Gestational Diabetic Pregnancies—a Preliminary Observation

A disproportionately large placenta may represent an adaptive response to adverse intrauterine conditions. Both maternal nutritional intake and presence of gestational diabetes (GDM) have been found to affect relative placental growth. As dietary modification is part of the standard management in GDM women, the observed increase in placental size in these women may be partly due to dietary modification. In this study, we set out to examine the relationship between dietary intake and placental size in GDM pregnancies. Food diaries for five consecutive days for 52 women diagnosed with GDM were obtained to assess their nutritional intake in terms of total calories, carbohydrate, protein and fat. Spearman's correlations were calculated for nutritional intake and various factors that may correlate with placental weight. There was a significant inverse relationship ( P=0.021) between placental weight and protein intake. No correlations with the other two nutritional components could be demonstrated. Maternal nutritional intake was not correlated with infant birthweight. It is possible that dietary modulations improve GDM pregnancy outcome, not only by improving glycaemic controls but also by affecting placental growth by altering the proportion of protein intake.

Factors associated with fetal growth and body composition as measured by ultrasound

Objective: This study seeks to determine which parental demographic and metabolic factors best correlate with fetal growth and body composition as estimated by ultrasound. Study Design: Thirty-one gravid patients had ultrasound estimates of fetal anthropometry in mid-third trimester. These measurements included estimated fetal weight, abdominal subcutaneous fat, and/or thigh subcutaneous fat thickness. Independent variables included diagnosis of gestational diabetes, parental demographic factors, neonatal sex, and late gestation estimates of carbohydrate metabolism. Results: In the multivariate stepwise model the strongest predictor of ultrasound estimated fetal weight was basal hepatic glucose production, followed by late gestation insulin sensitivity (total R2 = 0.27). The strongest predictors of abdominal subcutaneous fat thickness were weight gain and presence of gestational diabetes (total R2 = 0.25). Conclusion: Measures of maternal carbohydrate metabolism, rather than fat mass, explain sonographic measurements of fetal weight. We speculate that factors other than maternal carbohydrate metabolism further explain the variances of fetal adiposity. (Am J Obstet Gynecol 2001;185:1416-20.)