Prevalence Of Gestational Diabetes Research Articles

Narcolepsy with cataplexy and pregnancy: a case-control study.

This was a retrospective case-control study in 25 patients with narcolepsy with cataplexy and 75 women in the control group. Patients completed the questionnaire by Maurovich-Horvat etal. (J. Sleep Res., 2013, 22: 496-512). We personally interviewed 25 patients with narcolepsy with cataplexy using the administered questionnaire regarding conception, pregnancy, delivery, perinatal and breastfeeding periods. Patients with narcolepsy with cataplexy reported 59 pregnancies versus 164 in the control group. In 16 cases (27.1%), a disease before pregnancy was present compared with eight cases (4.9%) in the control group (P<0.001); among them, extrinsic asthma was reported 11 times in the narcolepsy with cataplexy group (P<0.005). Patients with narcolepsy with cataplexy more often had a single pregnancy compared with controls (P<0.05). Gestational diabetes was more frequent in patients with narcolepsy with cataplexy (P<0.05). Induced deliveries were higher in controls (P<0.009). No differences were found between the groups in terms of duration of pregnancies and complications during and after delivery, as during the puerperium. Neonates from patients had heavier birth weight (P<0.015). The breastfeeding period was longer in patients (P<0.01). Modafinil and methylphenidate were the drugs administered in six pregnancies. No significant differences in depression during pregnancy and during puerperium were found between patients and controls. This is the first case-control study in women with narcolepsy with cataplexy related to pregnancy, delivery, childbirth and puerperium. Data suggest that patients have pregnancy outcomes similar to controls. The prevalence of gestational diabetes was higher in women with narcolepsy with cataplexy. Caesarean sections, complications during delivery and normal perinatal period for infants were similar in both groups. Breastfeeding was longer in patients.

Strategy to improve the burden of gestational diabetes in African women: Rwandan perspective

The global prevalence of gestational diabetes (GDM) in pregnant 20-49 year old women has increased to 16.9%, although data from Africa on GDM are scarce, and risk exposure to pregnant women is unknown. Among the 288 pregnant women screened in Rwanda, 8.3% of women with FPG &gt;126 mg/dL (&gt;6.9 mmol/L) had GDM. Age &gt;41 years (45.8% vs. 18.9%; p&lt;0.001), first-family history of T2D (29.2% vs. 3.4%; p&lt;0.001) and gravidity ≥3 pregnancies (79.2% vs. 29.2%; p=0.05) were associated with GDM. Gestational diabetes is a high risk factor for T2D, and increases the risk to T2D for women and their offspring later in life. Thus, improving maternal and child cardiometabolic health in Africa is needed through integrated gestational diabetes screening, and cost-effective sustainable strategies to build healthcare staff capacity, and to prioritize relevant evidence-based research and healthcare.Keywords: Gestational diabetes, Rwanda, Africa, Women

Prevalence of gestational diabetes mellitus in Europe: A meta-analysis.

Estimates of the prevalence of gestational diabetes vary widely. It is important to have a clear understanding of the prevalence of this condition to be able to plan interventions and health care provision. This paper describes a meta-analysis of primary research data reporting the prevalence of gestational diabetes mellitus in the general pregnant population of developed countries in Europe. Four electronic databases were systematically searched in May 2016. English language articles reporting gestational diabetes mellitus prevalence using universal screening in general pregnant population samples from developed countries in Europe were included. All papers identified by the search were screened by one author, and then half screened independently by a second author and half by a third author. Data were extracted by one author. Values for the measures of interest were combined using a random effects model and analysis of the effects of moderator variables was carried out. A total of 3258 abstracts were screened, with 40 studies included in the review. Overall prevalence of gestational diabetes mellitus was 5.4% (3.8-7.8). Maternal age, year of data collection, country, area of Europe, week of gestation at testing, and diagnostic criteria were found to have a significant univariate effect on GDM prevalence, and area, week of gestation at testing and year of data collection remained statistically significant in multivariate analysis. Quality category was significant in multivariate but not univariate analysis. This meta-analysis shows prevalence of GDM that is at the upper end of previous estimates in Europe.

Developmental origins of type 2 diabetes: a perspective from China

There has been a marked increase in the prevalence of diabetes in Asia, including China, over the last few decades. While the increased prevalence of diabetes has often been attributed to the nutritional transition associated with recent economic development, emerging data suggest that early-life exposures also play a major role in shaping developmental trajectories, and contributes to alter an individual's susceptibility to diabetes and other non-communicable diseases (NCDs). Early-life exposures such as in utero exposure to undernutrition has been consistently linked with later risk of diabetes and obesity. Furthermore, in utero exposure to maternal hyperglycemia, maternal obesity and excess gestational weight gain are all linked with increased childhood obesity and later risk of diabetes. Emerging data have also highlighted the potential link between early-feeding practices, the role of one-carbon metabolism in metabolic programming and endocrine disrupting chemicals (EDCs) with later risk of diabetes. These different developmental exposures may all be highly relevant to the current epidemic of diabetes in China. For example, the prevalence of gestational diabetes has increased markedly over the last two decades, and may contribute to the diabetes epidemic by driving macrosomia, childhood obesity and later risk of diabetes. In order to address the current burden of diabetes, a lifecourse perspective, incorporating multisectoral efforts from public health policy down to the individuals, will be needed. Several major initiatives have been launched in China as part of its national plans for NCD prevention and treatment, and the experience from these efforts would be invaluable.

The Effect of Prepartum Adiposity and Lipolysis on Gestational and Postnatal Oxylipids Biosynthesis

Gestational diabetes is associated with increased lipolysis and adipose tissue (AT) inflammation, which impair insulin signaling during the second half of pregnancy and in early lactation. Prevalence of gestational diabetes is high in overweight and obese women; similarly, dairy cows with high adiposity exhibit a surge in AT lipolysis and inflammatory responses during the last trimester of gestation that lead to AT insulin resistance. Oxidized FA (oxylipids) can modulate inflammatory responses during lipolysis. Linoleic acid (LNA) and arachidonic acid (AA) derived oxylipids, including hydroxy‐octadecadienoic acids (HODE), oxo‐octadecadienoic acids (oxoODE), and hydroxy‐eicosatetraenoic acids (HETE), were recently identified as potential biomarkers for early detection of insulin resistance. However, the effects of adiposity and lipolysis rate during late gestation and early lactation on oxylipid biosynthesis including FA substrate availability is currently unknown. We hypothesized that periparturient profiles of serum and AT concentrations of PUFA and oxylipids are dependent on body adiposity and lipolytic rate. Blood and subcutaneous AT samples were collected from multiparous Holstein cows with high (HA; n=5) or low (LA; n=4) adiposity scores at −27±7 (FO) and −10±5 (CU) d prepartum and at 8±3 d postpartum (PP). Targeted lipidomic analysis was performed on plasma and AT using HPLC‐MS/MS. We report that circulating free FA (FFA) concentrations increased as parturition approached, and peaked at PP. Across time, HA increased the concentration of circulating FFA compared to LA, reflecting a significant effect of adiposity on lipolytic rate during the periparturient period. Serum concentrations of AA and eicosapentanoic acid (EPA) were decreased at CU, compared to the other timepoints for all cows. Across time, serum AA and docosahexanoic acid (DHA) concentrations were decreased in HA compared to LA. AT content of AA and DHA, as well as LNA content in AT and serum, were unchanged throughout the study and were not influenced by adiposity. There were effects of both adiposity and timepoint on oxylipid concentrations. In AT, 13‐HODE, 5‐HETE, and 11‐HETE were increased at PP compared to FO and CU. Compared to LA, HA had decreased AT concentrations of 9‐HODE,13‐HODE, 5‐HETE, and 15‐HETE. Serum concentration of 9‐oxoODE was increased at PP and was positively correlated with serum FFA concentration (r=0.52. P=0.01), but was unaffected by adiposity. These data demonstrate that prepartum adiposity may limit the availability of serum PUFA, such as DHA, which serve as substrates for anti‐inflammatory oxylipids. Furthermore, lipolysis during late gestation and the onset of lactation may enhance AT biosynthesis and systemic release of HODE and HETE into circulation.Support or Funding InformationUSDA‐NIFA grants 2014‐68004‐21972 and 2015‐67015‐23207Michigan Alliance for Animal Agriculture Effect of adiposity and sampling time point across late gestation and early lactation on fatty add composition and oxylipid profile of subcutaneous adipose tissue and serum (mean + SEM) of dairy cows. Adiposity Sampling Metabolite Low (LA) High (HA) SEM P Far off (FO) Close‐up (CU) Postpartum (PP) SEM P Serum free fatty acids (FFA) mEq/L FFA 0.43 0.63 0.05 &lt;0.01 0.27a 0.34b 0.98c 0.06 &lt;0.01 Serum fatty acids μmol/L Linoleic 341.5 222.6 78.8 NS 205.2 187 454 81.8 NS Arachidonic 42.2 20 10.5 0.02 22.2a 17.4a 53.8b 16.1 0.01 EPA 2.5 0.9 0.8 NS 0.7a 0.5a 2.7b 0.4 0.01 DHA 0.8 0.4 0.1 0.03 0.7 0.4 0.7 0.2 NS Adipose tissue fatty acids μmol/mg Linoleic acid 1340 1110 360 NS 1570 420 1720 500 NS Arachidonic acid 43.5 46.2 17 NS 43.9 9.3 52.4 16 NS EPA 0.83 0.43 0.3 NS 0.9 0.14 1.12 0.4 NS DHA 0.17 0.24 0.1 NS 0.23 0.31 0.07 0.2 NS Adipose tissue oxylipids nM/mg 9‐HODE 1.52 0.63 0.63 0.01 0.59 0.67 1.9 0.5 NS 9‐oxoODE 0.97 0.62 0.35 NS 0.49 1.01 0.87 0.26 NS 13‐HODE 2.42 0.71 0.84 0.05 0.77a 0.95a 2.97b 0.7 0.05 13‐oxoODE 0.62 0.62 0.47 NS 0.32 0.5 1.09 0.38 NS 5‐HETE 0.6 0.33 0.12 0.05 0.24a 0.56b 0.6b 0.12 0.05 11‐HETE 0.16 0.09 0.04 0.03 0.1a 0.08a 0.2b 0.04 0.04 15‐HETE 0.29 0.04 0.08 0.01 0.06a 0.12b 0.42c 0.08 0.01 20‐HETE 0.007 0.007 0.01 NS 0.007 0.007 0.006 0.004 NS Serum oxylipids nM/mL 9‐HODE 140.47 141.5 68.44 NS 210.98 111.45 101.65 60.4 NS 9‐oxoODE 82.3 67.6 36.76 NS 79.64a 87.41a 131b 41.3 0.02 13‐HODE 302 309.67 119.44 NS 364.14 301.73 252.77 98.5 NS 13‐oxoODE 31.97 19.18 2.09 NS 36.47 10.58 23.45 15.66 NS 5‐HETE 13.38 20.59 11.04 NS 12.62 29.75 5.55 10.58 NS 11‐HETE 8.65 7.98 4.69 NS 7.48 9.02 8.43 4.09 NS 15‐HETE 10.31 8.64 5.36 NS 10.72 11.8 5.82 4.87 NS 20‐HETE 26.45 28.45 1.7 NS 5.16 32.55 6.65 16.44 NS EPA=eicosapentaenoic acid; DHA=docosahexaenoic acid; HODE=hydroxyoctadecadienoic acid; oxoODE=oxooctadecadienoic acid; HETE= hydroxyeicosatetraenoic acid. Means in same row with different letter differ between sampling timepoint, P &lt; 0.05. NS= non‐significant effect, P &gt; 0.05.

Risk of Diabetes Treated in Early Adulthood After Growth Hormone Treatment of Short Stature in Childhood.

Growth hormone (GH) is known to be diabetogenic, but the risk of diabetes in individuals treated with GH in childhood has been little evaluated, and conflicting results have been obtained. To investigate the prevalence of diabetes and gestational diabetes in a population-based cohort of patients treated with GH for short stature in childhood in France. Participants were a population-based cohort of 5100 children with idiopathic isolated GH deficiency, idiopathic short stature, or short stature in children born short for gestational age who started GH treatment between 1985 and 1996. Data on the delivery of diabetes drugs in 2009 and 2010 were obtained from the French national health insurance database. Cases in patients and controls were identified from diabetes drugs deliveries. The prevalence of diabetes was calculated and compared with that in the general population, determined on the basis of data from the same source, with the same definition. At a mean age of 30 years, no difference in the prevalence of treated diabetes (oral drugs or insulin) was found between subjects treated with GH and the general population in France, regardless of sex. Similarly, the risk of insulin-treated gestational diabetes was similar in patients and in the reference population. No difference in the risk of diabetes was found between GH-treated patients and the reference population. These results are reassuring, but further studies with a longer follow-up are required to evaluate the risk of diabetes with age in these patients.

Prevalence and Complications of Pregestational and Gestational Diabetes in Saudi Women: Analysis from Riyadh Mother and Baby Cohort Study (RAHMA).

The objectives of this study were to estimate the burden of diabetes and to explore the adverse pregnancy outcomes associated with pregestational diabetes mellitus (pre-GDM) and gestational diabetes mellitus (GDM) among the Saudi pregnant population. In this subcohort, we compared the maternal and the neonatal outcomes of diabetic women with pre-GDM and GDM to the outcomes of nondiabetic mothers who delivered during the same period. From the total cohort, 9723 women participated in this study. Of the participants, 24.2% had GDM, 4.3% had pre-GDM, and 6951 were nondiabetic. After adjustment for confounders, women with GDM had increased odds of delivering a macrosomic baby (OR: 1.6; 95% CI: 1.2–2.1). Women with pre-GDM were more likely to deliver by Cesarean section (OR: 1.65; CI: 1.32–2.07) and to have preterm delivery < 37 weeks (OR: 2.1; CI: 1.5–2.8). Neonates of mothers with pre-GDM were at increased risk of being stillbirth (OR: 3.66; CI: 1.98–6.72), at increased risk of admission to NICU (OR: 2.21; CI: 1.5–3.27), and at increased risk for being macrosomic (OR: 2.40; CI: 1.50–3.8). The prevalence of GDM and pre-GDM in the Saudi pregnant population is among the highest in the world. The conditions are associated with high maternal and neonatal morbidities and mortalities.

"Why screen if we cannot follow-up and manage?" Challenges for gestational diabetes screening and management in low and lower-middle income countries: results of a cross-sectional survey.

BackgroundThe prevalence of gestational diabetes (GDM) in low and lower middle income countries (LLMIC) is increasing. Despite its associated short and long term complications for mothers and their newborns, there is a lack of knowledge about how to detect and manage GDM. The objective of our study was to identify the challenges that first line healthcare providers in LLMIC face in screening and management of GDM.MethodsWe conducted a cross-sectional survey of key informants from 40 low and lower-middle income countries in Africa, South-Asia and Latin-America by sending out questionnaires to 182 gynecologists, endocrinologists and medical doctors. Sixty-seven respondents from 26 LLMIC provided information on the challenges they encounter. Data was thematically analyzed and revealed eight overarching themes, including guidelines; human resources; access; costs; availability of services, equipment and drugs; patient and community factors; and collaboration and communication.ResultsUnavailability of guidelines combined with lack of knowledge about GDM on the part of both providers and patients poses a substantial barrier to detection and management of GDM, leading to deficiencies in screening and counseling. Limited access to regular monitoring and follow-up care as a result of distance and costs, in particular with respect to additional expenses related to specific tests and changes in diet were identified as important challenges. Services were not available at all levels nor was adequate testing equipment. Patient factors included lack of motivation and compliance with the recommended therapy. Respondents also highlighted the lack of communication and collaboration between different specialists and treatment delays as a result of patients being seen by multiple providers.ConclusionsProviders from LLMIC face various challenges related to screening and managing GDM. Policy makers need to address these challenges by strengthening their health care system as a whole and by assuring that non-communicable diseases are better integrated into the existing packages of free or subsidized maternal health care.

PDB14 - Gestational Diabetes Screening for Chinese Women: A Cost-Effectiveness Analysis

The prevalence of gestational diabetes (GDM) is growing in China, and it is associated with a boosted risk of complications for the mother and neonate, such as pre-eclampsia, intrauterine death, stillbirth, post-partum type 2 diabetes, and macrosomia. GDM is also related with birth trauma, hypoglycemia, hyperbilirubinemia, respiratory distress, long-term obesity and childhood diabetes. Early determination and treatment of GDM can significantly diminish the incidence of these complications. The diagnostic criteria for GDM, however, remain questionable whether it is cost-effective or not. The objective of this study is to investigate the cost effectiveness of new American Diabetes Association (ADA) guideline on GDM screening in China. A decision analytic model was built to compare new GDM criteria (ADA 2011) and old criteria in China. All probabilities, costs, and benefits were derived from the literature. Base case, sensitivity analyses, and a Monte Carlo simulation were performed. Screening with the 75g-OGTT was more expensive and effective. In a 1-way sensitivity analysis, the ADA 2011 diagnostic approach remained cost-effective even triple of patients were diagnosed and treated for gestational diabetes mellitus. ADA 2011 diagnostic approach, however, was no longer cost-effective when long-term maternal and neonatal outcomes were not considered. Screening at 24-28 weeks’ gestational age under the ADA 2011 guidelines with the 2h OGTT is expensive but cost effective in improving long-term maternal and neonatal outcomes.

Prevention and Care Programs Addressing the Growing Prevalence of Diabetes in China.

According to a 2010 national survey, 11 % of adults in China have diabetes, affecting 109.6 million individuals. The high prevalence of diabetes has been attributed to the aging of the population, the rapid adoption of energy-dense foods, and a reduction in physical activity. Collectively, these secular changes have created an obesogenic environment that can unmask diabetes in subjects with a genetic predisposition. The growing prevalence of maternal obesity, gestational diabetes, childhood obesity, and early-onset disease can lead to premature morbidity and mortality. Rising to meet these public health challenges, researchers in China have conducted randomized studies to demonstrate the benefits of lifestyle modification in preventing diabetes (the Da Qing Study), as well as that of team-based integrated care, using multiple strategies including peer support and information technology, in order to reduce hospitalizations, cardiovascular-renal complications, and premature deaths. With growing evidence supporting the benefits of these diabetes prevention and management programs, the next challenge is to use policies and systems to scale up the implementation of these programs through raising awareness, building capacity, and providing resources to reduce the human and socioeconomic burden of diabetes.

Prevalence of gestational diabetes among Chinese and South Asians: A Canadian population-based analysis

BackgroundThere is considerable geographic variation in gestational diabetes mellitus (GDM) rates. We used data from two Canadian provinces, British Columbia (BC) and Alberta (AB), to determine the impact of ethnicity on GDM prevalence and neonatal outcomes. Research Design and MethodsAll deliveries between 04/01/2004 and 03/31/2010 in AB (n=249,796) and BC (n=248,217) were analyzed. We calculated GDM prevalence among Chinese, South-Asian, and the general population (predominantly Caucasian) women. ResultsOverall GDM prevalence was 4.8% (n=12,036) in AB and 7.2% (n=17,912) in BC. In both provinces, the prevalence of GDM was significantly higher in Chinese (AB:11%; BC:13.5%) and South Asian women (AB:8.4%;BC:13.9%) compared to the general population (AB:4.2%; BC: 5.8%). Chinese women were significantly older (AB:32.7; BC:33.0years) compared to the general population (AB:29.1; BC:30.1years). The odds of GDM relative to the general-population were 2-fold higher for South Asians in both provinces and almost 3-fold higher for Chinese in BC. Among GDM cases, compared to the general population, Chinese and South Asian infants were less likely to be LGA, more likely to be SGA, and had similar neonatal mortality rates. ConclusionsCompared to the general population, GDM prevalence is higher in Chinese and South Asian Canadians. Increased maternal age is a major contributor to higher prevalence of GDM in Chinese women. GDM rates were higher in both ethnic and general population women in BC compared to AB, suggesting that in addition to differences in ethnic distribution, differences in diagnostic practices are likely contributing to observed geographic differences in GDM prevalence.

Reported prevalence of gestational diabetes in Scotland: The relationship with obesity, age, socioeconomic status, smoking and macrosomia, and how many are we missing?

Aims/IntroductionGestational diabetes mellitus (GDM) is defined as ‘carbohydrate intolerance of varying degrees of severity with onset or first recognition during pregnancy,’ and is associated with increased fetal and maternal risks. The aims of the present study were to investigate the prevalence of GDM in Scotland over 32 years (1981–2012), and using the data from 2012, to assess how GDM related to maternal body mass index, maternal age, parity, smoking, Scottish Index of Multiple Deprivation, infant gender and macrosomia status.Materials and Methods GDM prevalence along with anthropometric, obstetric and demographic data were collected on a total of 1,891,097 women with a delivery episode between 1 January 1981 and 31 December 2012 using data extracted from the Scottish Morbidity Record 02. Univariate and multivariate logistic regression analysis was undertaken to investigate their association with GDM.ResultsA ninefold increase in GDM prevalence was observed from 1981 to 2012 (P < 0.001). GDM prevalence in 2012 was 1.9%. Maternal body mass index, age, parity status, Scottish index of multiple deprivation and fetal macrosomia were positively associated with GDM. Reported smoking status at booking was inversely associated with GDM. Multivariable analysis showed that fetal macrosomia was not associated with GDM status.ConclusionsThe present study confirmed that the reporting of GDM is low in Scotland, and that GDM is associated with maternal body mass index, maternal age, multiparity and social deprivation. GDM was negatively associated with smoking and requires further investigation. The lack of association between GDM and macrosomia (following multivariate analysis) might reflect the screening processes undertaken in Scotland.

Maternal hyperglycemia during labor and related immediate post-partum maternal and perinatal outcomes at the Yaoundé Central Hospital, Cameroon.

BackgroundData on the prevalence and complications of gestational diabetes are very scarce in Cameroon. The aim of this study was to evaluate the uptake of screening for gestational diabetes and assess the immediate post-partum outcome of hyperglycemic parturient mothers and perinatal outcome of their babies.MethodsA prospective cohort study was held at the Maternity of the Yaoundé Central Hospital from March to June 2013. One hundred volunteer women in labor without overt diabetes mellitus and having fasted for 8 to 12 h were recruited. No intervention was given. A clinical examination was done and capillary glucose recorded. Parturient women were categorized into two groups (hyperglycemic and non-hyperglycemic subjects) based on glycemia results interpreted according to the International Association of Diabetes and Pregnancy Study Groups. Mothers’ clinical examination was repeated and neonates examined immediately after delivery. Perinatal outcomes associated with maternal hyperglycemia during labor were assessed using relative risks. A p value <0.05 was considered statistically significant.ResultsOne hundred women with a mean age of 27 (SD 6) years were recruited. Of them, 22 (22 %) had already been screened for gestational diabetes at baseline. Thirty-one (31 %) were diagnosed with hyperglycemia during labor, and this condition was highly associated with macrosomia in neonates (RR = 8.9, 95 % CI 2.70–29.32; p < 0.001). Other complications associated with maternal hyperglycemia during labor were perineal tears, cesarean section, and intrauterine fetal death, though the association was not statistically significant.ConclusionsThe main finding of this study is that maternal hyperglycemia during labor is highly associated with macrosomia in neonates. About a third of mothers were concerned with hyperglycemia during labor, and gestational diabetes was insufficiently screened in this series.

Self-Care Behaviors of Mothers with Gestational Diabetes Treated with Insulin Based on the Theory of Planned Behavior

Background & aim: The prevalence of gestational diabetes during pregnancy is one of the major maternal and fetal complications. Self-care behavior could be an effective method to control gestational diabetes induced by pregnancy. The theory of planned behavior (TPB) is one of the popular conceptual frameworks for the study of human action and the prediction and understanding of particular behaviors, including self-care behavior. With this background in mind, this study was performed to evaluate the predictive factors for self-care behaviors based on TPB in patients with gestational diabetes treated with insulin.Methods:This descriptive and analytical study was performed on 60 women with gestational diabetes treated with insulin referring to diabetes clinic of Ommolbanin Hospital in Mashhad, Iran in 2014. The samples were randomly selected and evaluated based on a researcher-made questionnaire of awareness, gestational diabetes self-care behaviors, the variables of the theory of planned behavior theory (TPB) (attitude, subjective norm, perceived behavioral control, and behavioral intention), and fasting blood glucose and two-hour postprandial blood glucose tests. Data analysis was performed in SPSS V.16 using descriptive and inferential statistics (correlation, multiple regression analysis, ANOVA, Kruskal-Wallis, and independent t-tests).Results: A direct relationship was observed between intention and perceived behavioral control indices and self-care behaviors. Moreover, attitude affected self-care behaviors through both intention and perceived behavioral control. With regard to total effects of the variables, perceived behavioral control was the second predictive factor for self-care after behavioral intention.Conclusion: TPB emphasizes on behavioral intention and perceived behavioral control, which could be used as a framework to design educational interventions for promotion of gestational diabetes self-care behaviors in mothers.

The impact of preconceptional obesity on trajectories of maternal lipids during gestation.

Growing challenges of maternal obesity necessitate to focus metabolic management on alternative factors than glycaemia. The objective is to assess longitudinal changes in lipids and inflammatory parameters during pregnancies stratified by pregestational BMI. Therefore, 222 pregnant women (normal-weight BMI < 25: n = 91 (41%), overweight BMI 25–29.9: n = 69 (31%), obese BMI ≥ 30: n = 62 (28%)) underwent a detailed metabolic characterization including fasting lipids and glucometabolic parameters at <21st gestational week (GW) with follow-up assessments at further three visits (24–28th GW, 32–34th GW, >36th GW). Overweight and obesity was related to dyslipidemia already at baseline, i.e. elevated triglycerides (TG, p < 0.001), decreased high-density-lipoprotein-C (p = 0.009) and increased ultrasensitive-c-reactive-protein (usCRP, p < 0.001) independent of gestational diabetes prevalence. Trajectories of lipids during pregnancy progress revealed an unexpected less pronounced increase in TG, low-density-lipoprotein-C and total-cholesterol in overweight/obese women. usCRP remained associated with higher BMI throughout pregnancy showing no time-dependent longitudinal changes. Newborns of obese/overweight women were affected by higher birth-weight percentiles. Regarding lipids only maternal TG showed tendency for relation to prevalence of large-for-gestational-age offspring, particularly at the end of pregnancy (p = 0.048). Overweight and obese women show significant differences in trajectories of lipids during pregnancy that distinguish them from normal-weight women. Further studies should evaluate if targeting lipid metabolism could improve clinical management of maternal obesity.

Detemir potential applications in the treatment of diabetes during pregnancy: proven benefits and perspectives

In recent years there is notable growing prevalence of gestational and overt diabetes in pregnant women while rate of obstetric complications, neonatal morbidity, perinatal mortality in women with diabetes is maintained at the high level as compared with common population. Furhermore no doubt that fetal programming and genetic factors induce the formation of various longterm complications in infants of diabetic mothers. There is a strong evidence that the risk of obstetric complications can be reduced by achieving adequate glycemic control, which is frequently still an elusive goal. Improved pharmacokinetic and pharmacodynamic profiles of the insulin analogs (including minimal action variability) allow to achieve a better glycemic control with lower risk of hypoglycemias compared to human insulin. The clinical benefits of detemir have been confirmed in clinical trials in pregnant women with diabetes. Detemir is the only long-acting insulin analog that has been evaluated in prospective studies in pregnant women and proved a satisfactory safety profile and the ability to achieve a lower level of fasting glycemia and advanced maturity of the fetus at delivery.

Prevalence of gestational diabetes and risk of complications before and after initiation of a general systematic two-step screening strategy in Germany (2012–2014)

AimsInformation on the prevalence of gestational diabetes mellitus is scarce on national and international level. On July 1st, 2013, a general two-step screening was implemented in Germany harmonizing gestational diabetes diagnoses. We aim to provide prevalence estimates for gestational diabetes and pregnancy-related complications for the large region of North Rhine for the 12 months before and after introduction of the general screening. MethodsRoutine care data covering all outpatient diagnoses of more than 150,000 pregnancies per 12-month period in women aged 15–55 years was used to determine cases of gestational diabetes. Gestational diabetes diagnosis and pregnancy-related complications were assessed according to the International Statistical Classification of Diseases and Related Health Problems (ICD-10). Relative Risks for pregnancy-related complications were calculated in pregnancies with and without gestational diabetes. ResultsBefore the screening, diagnosis of gestational diabetes was made in 6.02% of pregnancies and in 6.81% after this date (other types of diabetes mellitus: 1.67% and 1.76% respectively). The prevalence of GDM increased with age and was highest at age 36–40 years (8.45%). The relative increase in prevalence after introduction of the screening was highest in the age group≤25 years (24.9%). The frequency of pregnancy-related complications such as hypertension, pre-eclampsia, cesarean section was increased in pregnancies with gestational diabetes in comparison to those without independent of observation period. ConclusionsWe found a high prevalence of gestational diabetes, which has relatively increased by 13.12% after the introduction of the general screening.

Riyadh Mother and Baby Multicenter Cohort Study: The Cohort Profile.

ObjectivesTo assess the effects of non-communicable diseases, such as diabetes, hypertension and obesity, on the mother and the infant.MethodsA multicentre cohort study was conducted in three hospitals in the city of Riyadh in Saudi Arabia. All Saudi women and their babies who delivered in participating hospitals were eligible for recruitment. Data on socio-demographic characteristics in addition to the maternal and neonatal outcomes of pregnancy were collected. The cohort demographic profile was recorded and the prevalence of maternal conditions including gestational diabetes, pre-gestational diabetes, hypertensive disorders in pregnancy and obesity were estimated.FindingsThe total number of women who delivered in participating hospitals during the study period was 16,012 of which 14,568 women participated in the study. The mean age of the participants was 29 ± 5.9 years and over 40% were university graduates. Most of the participants were housewives, 70% were high or middle income and 22% were exposed to secondhand smoke. Of the total cohort, 24% were married to a first cousin. More than 68% of the participants were either overweight or obese. The preterm delivery rate was 9%, while 1.5% of the deliveries were postdate. The stillbirth rate was 13/1000 live birth. The prevalence of gestational diabetes was 24% and that of pre-gestational diabetes was 4.3%. The preeclampsia prevalence was 1.1%. The labour induction rate was 15.5% and the cesarean section rate was 25%.ConclusionPregnant women in Saudi Arabia have a unique demographic profile. The prevalence of obesity and diabetes in pregnancy are among the highest in the world.

Le diabète gestationnel

While the prevalence of gestational diabetes mellitus (GDM) was estimated between 5 and 10% in 2010, the application of new thresholds recommended by IADPSG and adopted in 2010 by CNGOF seems to significantly increase the number of patients affected by this pathology. A prospective single-center French study estimated in 2014 the prevalence of gestational diabetes at 14% with these criteria, making it one of the most frequent complications during pregnancy. However, to date, there is no published study using these criteria to show a benefit to the health of women and children. If a diagnosis of GDM or type 2 diabetes during pregnancy is definitively an important risk factor for maternal as well as newborn and child complications, it is probably not the case for moderate hyperglycemia discovered during pregnancy.

Fasting glycaemia to simplify screening for gestational diabetes.

Recommendations in Switzerland on screening for gestational diabetes endorse the International Association of Diabetes in Pregnancy Study Group consensus. As universal testing is time consuming and glucose loading is unpleasant, the recommendations include a simplification, not performing the glucose loading in women with fasting glycaemia <4.4 mmol/l. Our objective was to evaluate the diagnostic performance of this simplified strategy, compared with the complete test, in our population with a low prevalence of gestational diabetes. We collected 2298 complete 75-g glucose tolerance tests. We simulated stopping the test, so avoiding the glucose loading and further glycaemia, if fasting glycaemia was <4.4 or ≥5.1 mmol/l. Unselected pregnant women from Geneva and Basel, at 24-28 weeks of gestation. We calculated the sensitivity, and the percentage of women who would avoid the complete test with the strategy based on fasting glycaemia. The prevalence of gestational diabetes was 10.9% in our population. Among 251 women with gestational diabetes, fasting glycaemia was ≥5.1 mmol/l in 119 women (47.4%), between 4.4 and <5.1 mmol/l in 78 women (31.1%) and <4.4 mmol/l in 54 women (21.5%). Proceeding with the complete test only in women with fasting glycaemia between 4.4 and <5.1 mmol/l will result in a sensitivity of 78.5%. This strategy would avoid glucose loading in 63.8% of women. Screening with fasting glycaemia is an attractive alternative to universal screening with the complete 75-g glucose tolerance test. This strategy is, however, slightly less sensitive than previously reported in higher-risk populations. Fasting glycaemia can be considered as an alternative to the complete test for gestational diabetes screening.