Presence Of Gestational Diabetes Research Articles

Establishing a risk score for prediction of intrapartum cesarean delivery among older women: A retrospective cohort study

ObjectiveTo determine risk factors and to develop a risk prediction score for intrapartum cesarean delivery (CD) in women over 40 years old. Study designA retrospective cohort study, in a single university-affiliated tertiary medical center. All women aged 40 years or more who planned a trial of labor between 2012 and 2022. Women who opted for an elective CD and those with non-viable fetuses were excluded. Maternal and neonatal characteristics of women who delivered vaginally were compared to those who underwent an intrapartum CD. Risk factors were examined using univariate and multivariate analysis. A score was developed to predict the need for intrapartum CD. We assessed a receiver operating characteristic curve to evaluate the performance of our model. Main outcome measureAn unplanned intrapartum cesarean section. ResultsDuring the study period, 122,583 women delivered at our center, of whom 6122 (4.9 %) aged 40 years or more attempted a trial of labor. Of them, 428 (7 %) underwent intrapartum CD. Several independent risk factors were identified, including nulliparity, regional anesthesia, induction of labor, use of antibiotics during labor, multiple gestation, previous cesarean delivery, and the presence of gestational diabetes or preeclampsia. A risk score model, employing a cut-off of 7, demonstrated successful prediction of intrapartum CD, with an area under the curve of 0.86. ConclusionThe score model for intrapartum CD can be used by caregivers to offer a more informed consultation to women aged 40 years or more deciding on the mode of delivery.

Toxic manifestations of alpelisib in endocrinology. Description of the clinical case

Breast cancer (BC) is a serious disease and is considered an important health problem worldwide. The prevalence of the disease in women according to Rosstat was 64,951 cases in the Russian Federation in 2020 (21.7% among all types of cancer). Hormone-dependent estrogen receptor-positive (HR+), human epidermal growth factor receptor type 2 negative (HER2-) metastatic breast cancer (mBC) accounts for 70% of all cases. About 40% of patients with ER+/HER2- mBC have mutations in the PIK3CA gene, leading to hyperactivation of the alpha isoform (p110α) of phosphatidylinositol 3-kinase (PI3K). Hormonal therapy with or without cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitor is considered the standard treatment for patients with ER+/HER2- mBC. However, acquired resistance to this therapy remains a problem. Innovative methods for the treatment of breast cancer are the use of targeted therapeutic agents aimed at direct inhibition of the PI3K pathway in combination with hormone therapy. Alpelisib is a PI3Kα-specific inhibitor. Hyperglycemia is the most common side effect of alpelisib treatment. Currently, there is a consensus on the prevention and correction of hyperglycemia in patients receiving therapy with alpelisib, which recommends that before starting therapy, in order to diagnose carbohydrate metabolism disorders and assess the risk of developing hyperglycemia, determine in all patients: the level of glycated hemoglobin (HbA1c), glucose fasting plasma (FPG), body mass index (BMI). And also to evaluate such risk factors as the presence of a family history of type 2 diabetes mellitus (DM 2), the presence of gestational diabetes in the patient's history, or the fact of the birth of children weighing more than 4 kilograms.Recently, new combinations of drugs have been actively used to treat disorders of carbohydrate metabolism, such as pioglitazone + metformin. This paper discusses the mechanism of action of PI3K inhibitors, new therapeutic combinations and their undesirable effects, and presents therapeutic experience.

Placental macrophage responses to viral and bacterial ligands and the influence of fetal sex.

Bacterial and viral infections of the placenta are associated with inflammation and adverse pregnancy outcomes. Hofbauer cells (HBCs) are fetal-origin macrophages in the placenta, proposed to protect the fetus from vertical pathogen transmission. We performed quantitative proteomics on term HBCs under resting conditions and following exposure to bacterial and viral pathogen-associated molecular patterns (PAMPs), and investigated the contribution of fetal sex. Resting HBCs expressed proteins pertinent to macrophage function, including chemokines, cytokines, Toll-like receptors, and major histocompatibility complex class I and II molecules. HBCs mounted divergent responses to bacterial versus viral PAMPs but exhibited protein expression changes suggestive of a more pro-inflammatoryphenotype. A comparison between male and female HBCs showed that the latter mounted a stronger and wider response. Here, we provide a comprehensive understanding of the sex-dependent responses of placental macrophages to infectious triggers, which were primarily associated with lipid metabolism in males and cytoskeleton organization in females.

Telomere length is not a main factor for the development of islet autoimmunity and type 1 diabetes in the TEDDY study

The Environmental Determinants of Diabetes in the Young (TEDDY) study enrolled 8676 children, 3–4 months of age, born with HLA-susceptibility genotypes for islet autoimmunity (IA) and type 1 diabetes (T1D). Whole-genome sequencing (WGS) was performed in 1119 children in a nested case–control study design. Telomere length was estimated from WGS data using five tools: Computel, Telseq, Telomerecat, qMotif and Motif_counter. The estimated median telomere length was 5.10 kb (IQR 4.52–5.68 kb) using Computel. The age when the blood sample was drawn had a significant negative correlation with telomere length (P = 0.003). European children, particularly those from Finland (P = 0.041) and from Sweden (P = 0.001), had shorter telomeres than children from the U.S.A. Paternal age (P = 0.019) was positively associated with telomere length. First-degree relative status, presence of gestational diabetes in the mother, and maternal age did not have a significant impact on estimated telomere length. HLA-DR4/4 or HLA-DR4/X children had significantly longer telomeres compared to children with HLA-DR3/3 or HLA-DR3/9 haplogenotypes (P = 0.008). Estimated telomere length was not significantly different with respect to any IA (P = 0.377), IAA-first (P = 0.248), GADA-first (P = 0.248) or T1D (P = 0.861). These results suggest that telomere length has no major impact on the risk for IA, the first step to develop T1D. Nevertheless, telomere length was shorter in the T1D high prevalence populations, Finland and Sweden.

Physical activity and sedentary behaviours during pregnancy are associated with neonatal size at birth

Background. Pregnancy is a crucial time to examine modifiable maternal behaviours associated with neonatal outcomes so that preventative measures can be taken against childhood obesity. Objectives. This study aimed to examine the pathways through which maternal physical activity impacted neonatal size and body composition. Methods. A subsample of participants who had objectively measured physical activity data were included from a pregnancy cohort study. Sociodemographic data were collected at the first visit during pregnancy. Gestational weight gain (GWG) was calculated at each visit, and the presence of gestational diabetes, hypertension and HIV were assessed. Physical activity was measured using a hip-worn triaxial accelerometer, at 14 - 18 weeks’ and 29 - 33 weeks’ gestation. At delivery, gestational age, birthweight and length were measured and neonatal body composition was analysed. A structural equation model (SEM) was run with either weight-to-length ratio (WLR) or fat mass index (FMI) as the outcome. Results. A total of 84 participants were included in this study, and a subsample of neonates (n=45) also had FMI data. Most (66%) mothers presented as overweight or obese at their first visit, and gained on average 0.35 (19) kg per week. The SEM showed that only gestational age at delivery and sedentary time were positively associated with WLR. Step count was directly associated with GWG (ß=-0.02, p=0.01), and with gestational age (ß=0.16, p=0.04), and was therefore indirectly associated with decreased fetal abdominal circumference. Conclusion. This study showed that increasing daily step count and decreasing sedentary behaviour could have beneficial effects on maternal health as well as delivery outcomes and neonatal size.

Comparison of the key modifiable factors in the first 1000 days predicting subsequent overweight and obesity in pre-school children in Tehran: a case-control study.

The identification of paediatric obesity predictors in the early stages of life is warranted, as it can influence the development of effective strategies to prevent metabolic disorders. In this case-control study, we assessed nine risk factors for paediatric obesity, namely a birth weight > 4000 g, an exclusive breast-feeding period < 4 months, the introduction of solid food at < 4 months, maternal overweight or obesity before pregnancy, maternal smoking during pregnancy, the presence of gestational diabetes, paternal overweight and obesity and paternal smoking. In order to identify the most relevant predictors of paediatric obesity, we employed a multiple logistic regression model with R2 Cox Snell by adjusting confounders. In the randomly selected 509 preschool children from Tehran, children exposed to gestational diabetes had the maximum predicted probability of obesity (4·36 (1·94, 9·80) %) among the analysed risk factors %. The introduction of solid food at < 4 months of age increased the risk of obesity by 2·98 (1·77, 4·97 %). The OR of childhood obesity was associated with maternal overweight and obesity (2·72(1·60-4·60) %), maternal smoking (2·21 (1·18, 4·11) %) and excessive gestational weight gain (1·89 (1·23, 2·91) %). Paternal smoking and high birth weight increased the risk of paediatrics obesity > 1·8 times (1·15-2·94) and > 1·5 times (1·015-2·43), respectively. There was no association between the paternal BMI, the exclusive breast-feeding time and the risk of paediatric obesity. Among early risk factors, probably gestational diabetes can be considered as the most important predictor for the risk of paediatric obesity.

Chronic hypertension in pregnancy: are outcomes the same in patients on antihypertensives?*

Objective To investigate differences in maternal and fetal outcomes among pregnant patients with chronic hypertension requiring antihypertensives for adequate control versus those who do not require antihypertensives. Study design Single-site retrospective cohort study including pregnant patients with chronic hypertension from 2015-2018. Two groups included those who required antihypertensives versus those who did not. Primary outcome is composite morbidity: pregnancy loss after 20 weeks, IUGR, maternal death, maternal stroke or TIA, pulmonary edema, renal failure, hypertensive emergency, HELLP syndrome, placental abruption or delivery before 34 weeks. Secondary outcomes included development of severe features, indication for preterm labor less than 37 weeks, incidence of severe range blood pressures, and neonatal outcomes. Student t, chi square, and Kruskal-Wallis tests where appropriate. Logistic regression used to account for potential confounders. Results Study cohort included 117 on antihypertensives and 114 not on antihypertensives. Use of antihypertensives was associated with the composite primary outcome (Odds ratio [OR], 3.88; 95% confidence interval [CI], 1.66–9.78). Use of antihypertensive medications was also associated with increased risk of prenatal diagnosis of IUGR, delivery prior to 34 weeks, development of severe features, severe blood pressure during pregnancy, earlier mean gestational age at delivery, lower mean birth weight, and higher risk of NICU admission. Logistic regression analysis showed that the association between medication requirement and our composite primary outcome persisted even after adjustment for age, BMI, and presence of gestational diabetes. Conclusion Our findings show an association between the requirement of antihypertensive medication use a significantly higher risk of composite primary outcome, prenatal diagnosis of IUGR, delivery prior to 34 weeks, and the development of severe features.

Distinct Metabolomic Profile Because of Gestational Diabetes and its Treatment Mode in Women with Overweight and Obesity.

Whether the presence of gestational diabetes (GDM) and its treatment mode influence the serum metabolic profile in women with overweight or obesity was studied. The serum metabolic profiles of 352 women with overweight or obesity participating in a mother-infant clinical study were analyzed with a targeted NMR approach (at 35.1 median gestational weeks). GDM was diagnosed with a 2-hour 75-g oral glucose tolerance test. The metabolomic profile of the women with GDM (n = 100) deviated from that of women without GDM (n = 252). Differences were seen in 70 lipid variables, particularly higher concentrations of very low-density lipoprotein particles and serum triglycerides were related to GDM. Furthermore, levels of branched-chain amino acids and glycoprotein acetylation, a marker of low-grade inflammation, were higher in women with GDM. Compared with women with GDM treated with diet only, the women treated with medication (n = 19) had higher concentrations of severalizes of VLDL particles and their components, leucine, and isoleucine, as well as glycoprotein acetylation. A clearly distinct metabolic profile was detected in GDM, which deviated even more if the patient was receiving medical treatment. This suggests a need for more intense follow-up and therapy for women with GDM during pregnancy and postpartum to reduce their long-term adverse health risks.

CHARACTERIZATION OF THE LIPID SPECTRUM IN LATE PRETERM AND TERM INFANTS BORN LARGE TO GESTATIONAL AGE FROM OBESE MOTHERS

Introduction. Today, up to 35% of pregnant women are overweight or obese. Maternal obesity or excessive weight gain during pregnancy increases the risk of developing metabolic syndrome and cardiovascular disease in the offspring. The development of early and long-term adverse effects may occur through the mechanisms of intrauterine lipotoxicity, including inflammatory changes and oxidative stress and / or glucometabolic changes. The aim. Determine the lipid spectrum in late preterm and term infants born large to gestational age from obese mothers. Materials and methods. A single-center study included 54 newborns born at the Poltava Perinatal Center during 2019 from singleton pregnancies in women with a body mass index ≥ 35 kg / m2 without type 2 diabetes or type 1 diabetes. 1 group consisted of children (n=23), large to gestational age (&gt; 90 percentiles), and 2 - children (n=27) in the range of 10-90 percentiles. Total cholesterol, high-density lipoproteins, low-density lipoproteins, triglycerides, and atherogenic factor were determined. Research results. The mean high-density lipoproteins in late preterm infants was significantly lower than in term born infants (0.71 ± 0.17 mmol / L vs. 1.05 ± 0.34 mmol / L), and the mean was significantly higher in infants with normal birth weight (3.49 ± 0.44 vs. 2.56 ± 0.67). After correction for a number of factors (gestational age and the presence of gestational diabetes in the mother) overweight in the newborn was significantly associated with high-density lipoproteins (OR 0.008, p = 0.002) and atherogenic factor (OR 2.96, p = 0.021). Conclusion. Overweight in infants born from obese mothers is accompanied by a significant increase atherogenic factor and the development of dyslipoproteinemia due to a decrease in the high-density lipoproteins fraction. It is necessary to improve the supervision of children who were born large to gestation age, from the first months of life.

Frequency and Factors Associated With Dental Caries In Pregnant Females Visiting Antenatal Clinic of Public Sector Hospital of Karachi, Pakistan

Objective: To assess the frequency and factors associated with dental caries in pregnant women attending antenatal clinic of a public sector hospital of Karachi, Pakistan. Methods: A descriptive cross-sectional study was conducted at the Sindh Institute of Oral Health Sciences, Jinnah Sindh Medical University, Karachi from July 2019-March 2020. Pregnant women of age 18-45 years visiting antenatal clinic were included. The dental examination was carried out to assess the dental caries in accordance with the WHO diagnosis criteria. Frequency of dental caries along with factors like age, socioeconomic status, educational status, occupation, BMI, residence, family structure, gestational hypertension, and gestational diabetes were noted. . Results: Of 375 pregnant women, mean age was 30.32 ±4.37 years. Most of the women were from low socio-economic class 237 (63.2%), uneducated 231 (61.6%) and belonged from rural areas 196 (52.3%). Frequency of dental caries was found to be 108 (28.8%). In multivariate logistic regression model, uneducated females (aOR=9.53, 95% CI=3.93-23.10), rural area residents (aOR=19.73, 95% CI= 7.50-51.88), presence of gestational diabetes (aOR=8.86, 95% CI=3.78-20.73) and presence of gestational hypertension (aOR=4.33, 95% CI=2.01-8.92) remained statistically significant (p<0.05). Conclusion: A higher frequency of dental caries was observed in pregnant women attending antenatal clinics. The significant factors that remained associated with dental caries in final multivariate model were education, residence, gestational hypertension and gestational diabetes mellitus.

Which way is better to deliver the very heavy baby: mode of delivery, maternal and neonatal outcome.

Currently there are no existing data regarding the maternal and neonatal outcomes for nulliparous women delivering neonates with birthweight above 4500g. We aim to evaluate birth outcome among these subset of parturients. A retrospective study of nulliparous delivering a singleton fetus weighing ≥ 4500g in two tertiary medical centers between 2007 and 2018. Women who chose to undergo a trial of labor (TOL) were compared to those who underwent elective cesarean delivery (CD). Overall, 121 women were included. Seventy eight (65.4%) women elected a TOL while 43 (34.6%) had elective CD. Of women who chose TOL, 46 (59%) delivered with unassisted vaginal delivery, 28 (36%) by intrapartum CD, and 4 (5%) by assisted vaginal delivery, reaching TOL success rate of 64% (50/78). The rates of shoulder dystocia and anal sphincter injury in vaginal deliveries were 5/50 (10%) and 2/50 (4%) respectively. Successful TOL was negatively associated with the presence of gestational diabetes [5 (18%) vs. 0 (0%), OR 0.8 (95% CI 0.7-0.9), p = 0.005], and was positively associated with maternal height (median 170cm vs. 165cm, p = 0.002), epidural analgesia [42 (84%) vs. 16 (57%), OR 3.5 (95% CI 1.2-9.8), p = 0.009] and spontaneous onset of labor (38 (76%) vs. 10 (36%), OR 5.7 (95% CI 2.1-15.6), p = 0.001. Neonates born after TOL were more commonly complicated by meconium aspiration syndrome as compared to no TOL (9 (11%) vs. 0 (0%), OR 1.1 (95% CI 1.04-1.22, p = 0.02). Only maternal height was independently associated with successful TOL (aOR 6.9 (95% CI 1.03-46.3, p = 0.04). Maternal and neonatal adverse composite outcomes were associated with gestational hypertensive disorders (10 (50%) vs. 5 (5%). OR 19.2 (5.5-67.4), p < 0.001) and with delivery before 40weeks (9 (57%) vs, 86 (82%), OR 3.5 (95% CI 1.2-10.6, p = 0.02), respectively. Trial of vaginal delivery in nulliparous with fetuses ≥ 4500g was associated with a high failure rate, with only two thirds of parturients achieving successful vaginal delivery. Nevertheless, neonatal outcomes mostly did not differ according to the mode of delivery. Maternal height was the only factor associated with successful vaginal delivery.

912: Chronic Hypertension in Pregnancy: Are outcomes the same in patients who require antihypertensives?

The objective of this study is to investigate differences in maternal and fetal outcomes among pregnant patients with chronic hypertension requiring antihypertensives for adequate control versus those who do not require antihypertensives. Single-site retrospective cohort study including pregnant patients with chronic hypertension from December 2012 - December 2018. Patients were divided into two groups, those who required antihypertensives versus those who did not. The primary outcome was composite maternal morbidity which included: pregnancy loss after 20 weeks, IUGR, maternal death, maternal stroke or TIA, pulmonary edema, renal failure, hypertensive emergency, HELLP syndrome, placental abruption or delivery before 34 weeks. Secondary outcomes included neonatal outcomes and the occurrence of severe range blood pressures during pregnancy. Student t, chi square, and Kruskal-Wallis tests were used where appropriate. Adjusted odds ratios were calculated using logistic regression to account for potential confounders. Our study cohort included 117 patients in the antihypertensive group and 114 in the no antihypertensive group. Requiring antihypertensives for blood pressure control was associated with the composite primary outcome (Odds ratio [OR], 3.88; 95% confidence interval [CI], 1.66- 9.78). All individual outcomes included in the composite outcome were more common in the antihypertensive group including IUGR (OR 2.85, 95% CI: 1.01-9.21) and delivery less than 34 weeks (OR 7.17 95% CI: 2.01-38.7). Logistic regression analysis found that the association persisted even after adjustment for age, BMI, and presence of gestational diabetes. Current recommendations for treating hypertension in pregnancy with medications divide hypertensive patients into two unique groups. In our study, those who require antihypertensives during pregnancy more often experienced adverse outcomes than patients who did not. Future studies should focus on whether treatment/surveillance of patients on antihypertensives should differ from those who are not on antihypertensives.

Trial of labor after cesarean in older women who never delivered vaginally

ObjectiveMaternal age is an established determinant of successful trial of labor after cesarean (TOLAC). While an increasing proportion of parturients are aged 40 years and older, and previously underwent a cesarean section, little data regarding TOLAC success for this age group is available. This study assessed TOLAC success, and its associated characteristics, among women >40 years who never delivered vaginally. Study designA retrospective case-control study of all women who never delivered vaginally aged ≥40 years with a history of previous cesarean delivery, who delivered at our hospital during 2006-2017. Maternal, neonatal, and delivery characteristics were compared between women with successful and unsuccessful TOLAC. ResultsOf 335 older women who never delivered vaginally with a history of one cesarean delivery, 61 (18.2 %) elected TOLAC (18.2 %); the median age was 41[40–42] years and the inter-delivery interval 34 [25–50] months. Overall, 38/61 (62.3 %) had a successful TOLAC. Women with successful TOLAC had a higher rate of a non-recurrent indication for cesarean delivery in their previous cesarean delivery (42.1 % vs. 13.0 %, P = 0.01), whereas dysfunctional labor at previous delivery was more common in the failed TOLAC group (47.8 % vs. 15.8 %, P = 0.007). Failed TOLAC was associated with the presence of gestational diabetes (13.0 % vs. 0 %, P = 0.02) and having a comorbidity (47.8 % vs. 21.0 %, P = 0.02). Induction of labor at TOLAC was more common in the failed TOLAC group (34.8 % vs. 2.6 %, P < 0.001). Birthweight was higher in the failed TOLAC group (3330 vs. 3107 g, P = 0.04), as well as the birthweight difference between deliveries (212 g vs. 82 g, P = 0.03). Neonatal and maternal outcomes were comparable between groups, except for longer length of stay (5 vs. 4 days, P = 0.04) in the failed TOLAC group. In a multivariable logistic regression analysis, only two factors were independently associated with TOLAC failure: previous cesarean delivery due to dysfunctional labor (OR [95 % CI]: 13.40 (1.29, 138.71), P = 0.03) and higher inter-delivery birthweight difference (OR [95 % CI]: 1.18 (1.11, 1.39), P = 0.02). ConclusionsTOLAC in older women who never delivered vaginally is associated with a moderate success rate. The indication for cesarean delivery at the first delivery and inter-delivery birthweight difference were identified as having strong predictive value for TOLAC outcome.

Factors associated with fetal macrosomia.

ABSTRACTOBJECTIVE To evaluate the clinical factors, as well as weight gain, in a group of pregnant women, associating them with fetal macrosomia in a public institution in Antioquia, Colombia, from 2010-2017.METHODS A case-control study, using secondary information registries. Cases were defined using newborn weight of ≥ 4000g, while controls were defined as newborn weight between 3000–3999g. A proportion ratio (PR) was established to evaluate factors associated with macrosomia, and a generalized linear model (GLM) of Poisson regression with robust variance was used to evaluate the aspects that best explained macrosomia in the neonate.RESULTS 122 pregnant women participated in the study, of which 611 were cases and 61 were controls. Of the participants, 44.3% had pre-pregnancy overweight and 48.4% had excess gestational weight gain. Statistically significant differences were found between the groups in the following variables: pre-pregnancy BMI (p = 0.004), gestational weight gain (p = 0.000), gestational diabetes (p = 0.000), and type of delivery (p = 0.004). According to the regression model, a macrosomic newborn is 3.5 times more likely in women with excessive gestational weight gain (95%CI 1.78-7.18) and twice more likely in women who have gestational diabetes (95%CI 1.51-2.76). Of women with pre-pregnancy excess weight, 63% had excess gestational weight gain.CONCLUSIONS Within this cohort, pre-pregnancy BMI, excess weight gain in pregnancy, and the presence of gestational diabetes were associated with an increased risk of neonatal macrosomia. pre-pregnancy BMI and weight gain in pregnancy are modifiable risk factors that are responsive to nutrition interventions, which can minimize adverse perinatal outcomes.

Assessment of Ventricular Outflow Tract in Macrosomic Neonates

Introduction: Fetal macrosomia is encountered in up to 10% of all deliveries. It occurs in 15-45% of diabetic pregnancies. Factors associated with fetal macrosomia include genetics; duration of gestation; presence of gestational diabetes; high pre-pregnancy body mass index (BMI); excessive gestational weight gain and diabetes mellitus. Macrosomia is reportedly associated with neonatal morbidity, neonatal injury, maternal injury, and cesarean delivery. Moreover, shoulder dystocia, brachial plexus injury, skeletal injuries, meconium aspiration, prenatal asphyxia, hypoglycemia, and fetal death. All types of maternal diabetes are risk factors for macrosomia and can affect the foetal cardiac development in the form of Hypertrophic cardiomyopathy and congenital cardiac malformation. Aim of work: To evaluate the cardiac changes and ventricular outflow tracts in macrosomic neonates clinically and by 2D transthoracic echocardiography. Patients and Methods: This prospective study was carried out in NICU of Sayed Galal University Hospital on fifty macrosomic neonates’ thorough detailed history, clinical examination, Chest X-ray, important laboratory investigation, two dimensional M-mode and Doppler echocardiographic examination. Results: The fifty macrosomic neonates consisted of 29 males (58%) and 21 females (42%) with mean age ± SD of 2.16±0.84 days (range, 1-5 days). Statistically, significant relation between inter ventricular septum diastole (IVSD) (mm) according to HbA1c level, increase IVSD with increase HbA1c level, and show statistically significant relation between inter ventricular septum diastole (mm) and LTVOTO. When IVSD increase the incidence of LVOTO increase While TABSE decrease with the increase in IVSD. It also showed significant negative correlation between IVSD and MPI and PAP. Conclusion: Elevated maternal HbA1c level can lead hypertrophic cardiomyopathy mainly septal hypertrophy, which increased incidence of ventricular outflow tract obstruction. These echocardiographic findings (TAPSE and MPI) seem to be a better index of the cardiac outcome of macrosomic neonates than other clinical, laboratory or radiological parameters. Recommendations: Early echocardiographic examination for early detection of myocardial dysfunction or cardiac defect is essential in all macrosomic neonates andIDM even those without audible murmur, especially so if not improving with proper intervention. Echocardiographic indices especially TAPSE and Tei index for all macrosomic neonates to detect early cardiac changes in particular left ventricular dysfunction.

Assessment of Ventricular Outflow Tract in Macrosomic Neonates

Introduction: Fetal macrosomia is encountered in up to 10% of all deliveries. It occurs in 15-45% of diabetic pregnancies. Factors associated with fetal macrosomia include genetics; duration of gestation; presence of gestational diabetes; high pre-pregnancy body mass index (BMI); excessive gestational weight gain and diabetes mellitus. Macrosomia is reportedly associated with neonatal morbidity, neonatal injury, maternal injury, and cesarean delivery. Moreover, shoulder dystocia, brachial plexus injury, skeletal injuries, meconium aspiration, prenatal asphyxia, hypoglycemia, and fetal death. All types of maternal diabetes are risk factors for macrosomia and can affect the foetal cardiac development in the form of Hypertrophic cardiomyopathy and congenital cardiac malformation. Aim of work: To evaluate the cardiac changes and ventricular outflow tracts in macrosomic neonates clinically and by 2D transthoracic echocardiography. Patients and Methods: This prospective study was carried out in NICU of Sayed Galal University Hospital on fifty macrosomic neonates’ thorough detailed history, clinical examination, Chest X-ray, important laboratory investigation, two dimensional M-mode and Doppler echocardiographic examination. Results: The fifty macrosomic neonates consisted of 29 males (58%) and 21 females (42%) with mean age ± SD of 2.16±0.84 days (range, 1-5 days). Statistically, significant relation between inter ventricular septum diastole (IVSD) (mm) according to HbA1c level, increase IVSD with increase HbA1c level, and show statistically significant relation between inter ventricular septum diastole (mm) and LTVOTO. When IVSD increase the incidence of LVOTO increase While TABSE decrease with the increase in IVSD. It also showed significant negative correlation between IVSD and MPI and PAP. Conclusion: Elevated maternal HbA1c level can lead hypertrophic cardiomyopathy mainly septal hypertrophy, which increased incidence of ventricular outflow tract obstruction. These echocardiographic findings (TAPSE and MPI) seem to be a better index of the cardiac outcome of macrosomic neonates than other clinical, laboratory or radiological parameters. Recommendations: Early echocardiographic examination for early detection of myocardial dysfunction or cardiac defect is essential in all macrosomic neonates andIDM even those without audible murmur, especially so if not improving with proper intervention. Echocardiographic indices especially TAPSE and Tei index for all macrosomic neonates to detect early cardiac changes in particular left ventricular dysfunction.

Maternal socioeconomic factors and the risk of premature birth and low birth weight in Cyprus: a case\u2013control study

BackgroundPrematurity and low birth weight are significant predictors of perinatal morbidity and mortality and are influenced by the overall health and socioeconomic status of the pregnant mother. Although Cyprus is characterized by the highest prematurity rate in Europe (13.1% in 2014), the relationship between maternal health and socioeconomic characteristics with prematurity and low birth weight has never been investigated. We aimed to investigate the association of maternal demographic, clinical and socioeconomic characteristics with premature delivery and low neonatal birth weight in Cyprus.MethodsIn a case-control design, questionnaire data were collected from 348 women who gave birth prematurely (cases) and 349 women who gave birth at term (controls). Information was obtained on gestation duration and birth weight as well as maternal demographic, socioeconomic and clinical profiles, including parameters such as smoking, body mass index, alcohol consumption, presence of gestational diabetes and mental health factors.ResultsPremature delivery was associated with greater maternal age (OR: 1.12, 95% CI: 1.06–1.18), absence of gestational diabetes (OR: 0.53, 95% CI: 0.30–0.97), long working hours (OR: 3.77, 95% CI: 2.08–6.84) and emotional stress (OR: 8.5, 95% CI: 3.03–23.89). Within the cases group, emotional stress was also associated with lower birth-weight (β: -323.68 (95% CI: -570.36, − 77.00).ConclusionsThe findings of this study demonstrate the positive association of maternal psychological factors, working conditions as well as maternal age with prematurity and low birth weight in Cyprus. Additional, prospective, studies are needed in the country to further investigate these associations and inform public health intervention measures.

A new comprehensive diabetes health literacy scale: Development and psychometric evaluation

BackgroundThe prevalence of diabetes is close to reaching an epidemic level, and health literacy has recently emerged as a concept that can influence the health outcomes of patients with diabetes. Health literacy was once defined from the perspective of basic reading and understanding skills, but this has now become more comprehensive to include the abilities and skills to assess, understand, appraise, communicate, and use health information. Nevertheless, there is no instrument reflecting the comprehensive health literacy relevant to diabetes. ObjectivesThe aims of this study were to develop a comprehensive Diabetes Health Literacy Scale and to evaluate its psychometric properties. DesignAn instrument-development study was applied that comprised three steps: conceptualization, item generation and content validity, and field testing of the psychometric properties. SettingsA convenience sample of 462 participants was recruited from December 2016 to September of 2017 at outpatient clinics in 2 Korean university hospitals. ParticipantsThe inclusion criteria for participants were being aged at least 19 years, articulate in the Korean language, and diagnosed with diabetes, while the presence of gestational diabetes was applied as an exclusion criterion. Approximately half of the participants were female (51.1%). The participants were aged 54.5 (SD, 11.0) years, 67.1% of them were taking an oral hypoglycemic agent, and 21.9% of them had well-controlled blood-glucose levels. MethodsThe content validity, factorial structure validity, convergent validity, criterion validity, internal consistent reliability, and test–retest reliability of the Diabetes Health Literacy Scale were evaluated. Data were analyzed using exploratory and confirmatory factor analyses, Pearson’s correlation, Cronbach’s alpha, and the intraclass correlation coefficient. ResultsThe content validity was assessed by five experts. Exploratory and confirmatory factor analyses yielded a three-factor solution. Convergent validity was demonstrated using measures of diabetes knowledge and self-efficacy. Criterion validity was demonstrated with generic health-literacy questions. Internal consistency reliability and test–retest reliability were found to be acceptable, as indicated by a Cronbach’s alpha of 0.91 and an intraclass correlation coefficient of 0.89, respectively. ConclusionsThe Diabetes Health Literacy Scale is a new instrument that measures comprehensive aspects of informational, numeracy, and communicative health literacy. It is a short instrument, comprising only 14 items scored on a 5-point Likert scale. The instrument exhibits good psychometric properties for four validity metrics (content, structural, convergent, and criterion validity) and two reliability metrics (internal consistency and test–retest reliability). These findings indicate that the instrument can be applied in both research and clinical practice.

Glycemic profile assessment during betamethasone administration in women with gestational diabetes mellitus

AimBetamethasone's effect on glucose homeostasis in the presence of gestational diabetes has not been adequately investigated. Materials-methodsWe assessed the glycemic profile of 99 women with gestational diabetes (52 on insulin, 47 on medical nutrition therapy) who were given betamethasone during hospitalization for at risk pregnancies. ResultsIn insulin-treated women the increase in total daily insulin dose significantly linked to betamethasone dose (p = 0.014). In women on diet, the need for insulin was positively related to betamethasone dose, age and gestational age >34th week (all p < 0.05). ConclusionParsimonious betamethasone use might still be beneficial with a milder effect on glycemia.

Comparative study of the intestinal microbiota in children from Mexican mothers with or without gestational diabetes

Pregnancy includes the development of an individual, from fertilization to labor. This development is influenced by genetic and environmental modifications during the intrauterine period, which continues until the first 1000 days of life. Important lapse in health and disease programming. The presence of gestational diabetes (GDM) favors the development of metabolic diseases in adult life and has an 18% prevalence in Mexico. The diversity of the intestinal microbiota is affected by maternal diabetes status, and this could contribute to the abundance of different phylas that contribute to the generation of new associated diseases. The aim of this study was to compare the fecal microbiota of children between 3 months and 3 years of age born to mothers with and without GDM. Anthropometric measures and fecal sample were collected from 29 patients (without GDM=24; GDM=5). The V4 region of bacterial 16S rRNA gene was sequenced by Illumina MiSeq. There were no significant differences between the birth weight of the infant and the weeks of gestation. Our data showed differences in composition of the microbiota in the study groups. We observed a decrease in Firmicutes, in addition with an increase in Bacteroidetes and Proteobacterias in GDM group. Also, LefSe analysis indicated a significant increment in Desulfovibrionaceae in this group compared with the control group. These results suggest the presence of dysbiosis in child from gestational diabetic mothers.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.