Risk Factors For Gestational Diabetes Mellitus Research Articles

Prevalence and risk factors for gestational diabetes in Jambi, Indonesia

The most common time for gestational diabetes mellitus (GDM), which affects anywhere from 1% to 40% of pregnant women, is between the 24th and 28th week of pregnancy. One of the provinces in Indonesia, Jambi, was the focus of this study, which aimed to characterize the incidence and risk factors of GDM. One hundred twenty-two women without GDM and twelve women with GDM participated in this case control research. Oral glucose tolerance tests were used to diagnose gestational diabetes mellitus (GDM) in women who were assessed between 24 and 28 weeks of gestation. Data Collection in this research used questionnaire about woman’s social demographics, history GDM, parity, family support, and social support. Multivariate analysis is used to measure the relationship between variables. The results of the study showed a huigh prevalence of GDM of 37,6%. The identified risk factors were hypertension (OR=2,121;CI95%=1,405-3,203), family history of DM (OR=1,610;CI95%=1,333-1,946),BMI>30 kg/m2(OR=1,465;CI95%=1,243-1,727) and history of GDM previous pregnancy (OR=2,857;CI95%=0,839-9,727). We conclude that a GDM risk factor score is required so that health services can utilize these indicators as gold standards for screening GDM, due to the large heterogeneity in GDM risk factors.

7833 Gestational Diabetes Mellitus (GDM): A Weighted Spectrum of Clinical Outcomes

Abstract Disclosure: M. Moazzami: None. N. Venkatesan: None. K.S. Rajagopalan: None. A.V. Vella: None. A. Egan: None. Gestational diabetes mellitus (GDM) affects approximately 10% of pregnancies, with rates almost doubling in minority subgroups. Higher body mass index (BMI) is a significant GDM risk factor, and BMI ≥ 25kg/m2 is often used as a criterion in risk factor-based screening programs. However, up to 60% of individuals with GDM have a normal BMI, and it is unclear if this offers protection against associated adverse outcomes. Furthermore, many prior studies fail to address the fact that those of Asian descent require a lower BMI cut-off, given their different distribution of body fat. Our study evaluated GDM pregnancy outcomes using BMI as a risk indicator. We compared individuals with BMIs < 25 kg/m2, 25-30 kg/m2, and > 30 kg/m2. For individuals that self-identified as Asian, we adjusted BMI categories: <23 kg/m2 for normal weight, 23-30 kg/m2 for overweight, and >30 kg/m2 for obese. We identified 2212 subjects diagnosed with GDM via universal screening and Carpenter and Coustan criteria at our institution from 2018 - 22. In total, 508 (23.0%) were normal weight, 611 (27.6%) overweight, and 1093 (49.4%) obese. The average maternal age was 31 years. Higher proportions identified as Hispanic and non-White race in overweight and obese categories. Maternal adverse outcomes were higher in obese compared to overweight or normal BMI categories (cesarian delivery: normal 26.7 v overweight 28.3 v obese 22.7%, p<0.001; hypertensive disorders: normal 13.2 v overweight 12.5 v obese 22.7%, p <0.001). Pharmacological therapy was required in 50% with obesity versus 24.8% in normal, and 28.7% in overweight categories (p<0.001). While there were no differences in live birth rates across categories, infants born to mothers with obesity had a higher birthweight (normal 3.30 v overweight 3.38 v obese 3.45kg, p<0.001) and were more likely to have neonatal hypoglycemia (normal 28.7 v overweight 25.5 v obese 43.8%, p<0.001) and require intensive care unit admission (normal 8.4 v overweight 5.5 v obese 12.7%, p<0.001). Attendance at postpartum glucose testing varied across BMI categories with lower attendance in mothers with obesity followed by normal weight BMI (normal 40.75 v overweight 45.99 v obese 36.2%, p<0.001). Compared to overweight individuals, those with normal weight exhibited higher rates of postpartum glucose intolerance (12.4 v 6.9%, p =0.002). However, those with obesity had the highest rates of glucose intolerance (20.7%, p<0.0002). Individuals with normal weight had the highest rates of breastfeeding (normal 95.9 v overweight 92.8 v obese 91.4% p=0.006). This study highlights the nuanced relationship between BMI and pregnancy outcomes in GDM. While maternal obesity was associated with the poorest outcomes, those with normal BMI were not protected compared to overweight individuals, and experience higher rates of postpartum glucose intolerance. Presentation: 6/2/2024

Unraveling gestational diabetes in Ethiopia: Insights from a cross-sectional study on prevalence and risk factors among Sidama’s pregnant population

BackgroundGestational diabetes mellitus (GDM) is a chronic condition characterized by glucose intolerance during pregnancy and is particularly common in low- and middle-income countries, where it poses significant health risks to both mothers and their fetuses. Research on this topic in Ethiopia has been limited, especially regarding the World Health Organization’s 2013 guidelines for universal screening. This study aims to evaluate the prevalence of GDM and identify its influencing factors among women attending antenatal clinics in the Sidama regional state. MethodsA cross-sectional study in the Sidama Region included 685 pregnant women who underwent a two-hour Oral Glucose Tolerance Test for universal screening and diagnosis of gestational diabetes mellitus (GDM). The prevalence of GDM was evaluated using descriptive statistics and multivariate analysis with the adjusted odds ratio (AOR) at a 95% confidence interval and a significance level of 0.05. ResultsThe study, comprising 685 participants, attained a 92.4 % response rate, indicating a 16.1 % prevalence of GDM overall and an average post-glucose load level of 0.99 mmole/L. Factors such as living in urban areas (AOR = 1.69, 95 % CI (1.011, 2.82)), being widowed (AOR = 2.23,95 % CI (1.00,5.08)), history of previous abortions (AOR = 2.59,95 %CI(1.50,4.50)), prior caesarean section(AOR = 0.14,95 % CI (0.07,0.27)), gravidity (AOR = 0.77,95 % CI (0.64,0.94)), parity (AOR = 1.93, 95 % CI (1.54, 2.42)), and HIV/AIDS status (AOR = 4.06, 95 % CI (2.18, 7.58)) were independently associated with GDM. ConclusionThe study revealed a gestational diabetes mellitus (GDM) prevalence of 16.1% in the Sidama region of Ethiopia, consistent with findings from other recent studies across the country. It also identified several key independent risk factors for GDM, including urban residency, widowhood, prior abortions or cesarean deliveries, HIV status, gravidity, and parity. The results emphasize the critical need for targeted interventions and continuous monitoring of GDM among pregnant women, particularly in regions with high prevalence. To enhance maternal health outcomes in Ethiopia and beyond, it is crucial to incorporate these findings into comprehensive healthcare strategies.

Mendelian randomization analysis of the association between childhood overweight or obesity and gestational diabetes mellitus.

To investigate the association between childhood overweight or obesity and gestational diabetes mellitus (GDM). Data were sourced from the Genome-Wide Association Studies database on childhood body mass index (BMI), with 39 620 samples and 8 173 382 single-nucleotide polymorphisms (SNPs), and GDM, with 143 441 samples, including 12 332 GDM cases and 20 149 608 SNPs. Mendelian randomization (MR) was conducted, including inverse variance weighting (IVW), MR-Egger regression, and the weighted median method. Statistical heterogeneity among SNPs was assessed using Cochran's Q test. MR-Egger's intercept, the MR-Pleiotropy RESidual Sum and Outlier (PRESSO) test, and funnel plots were used to evaluate pleiotropy. The leave-one-out method tested the robustness of the IVW results by excluding individual SNPs. Fifteen SNPs highly related to childhood BMI were identified. IVW analysis indicated that higher childhood BMI is a significant risk factor for GDM (odds ratio 1.50 [95% confidence interval 1.20-1.87]; p < 0.001). The direction of the β value derived from the weighted median method analysis was consistent with that from the IVW analysis. Cochran's Q test showed statistical heterogeneity among SNPs highly related to childhood BMI (p = 0.001), thus prioritizing IVW analysis results. The MR-Egger regression intercept, MR-PRESSO test, and funnel plot analyses demonstrated no horizontal pleiotropy among SNPs highly related to childhood BMI. The leave-one-out analysis indicated that the MR analysis results were largely unchanged after the exclusion of individual SNPs. Elevated childhood BMI is associated with an increased risk of developing GDM, underscoring the need to address childhood obesity as a preventive strategy. Effective interventions to reduce childhood obesity could be crucial in mitigating this risk.

Anti-Tumor Necrosis Factor Therapy and the Risk of Gestational Diabetes in Pregnant Women With Inflammatory Bowel Disease.

Anti-tumor necrosis factor (anti-TNF) therapy may improve insulin sensitivity, and its impact during pregnancy remains unclear. We aimed to assess the risk of gestational diabetes mellitus (GDM) associated with anti-TNF treatment among pregnant women with inflammatory bowel disease (IBD). This nationwide cohort study included patients with IBD in Korea from 2010 to 2021. Anti-TNF exposure was identified from the last menstrual period (LMP) to LMP + 140 days. The development of GDM was assessed from LMP + 141 days to delivery. We performed overlap weighting to balance the covariates and used a generalized linear mixed model to measure the risk ratio (RR) and 95% confidence intervals (CIs). The anti-TNF group was compared with the unexposed group, as well as with the immunosuppressant, 5-aminosalicylate, and untreated groups. A total of 3,695 pregnancies in women with IBD were identified, of which 338 (9.2%) were exposed to anti-TNFs. GDM was found in 7.1% of the pregnancies exposed to anti-TNFs as compared with 11.0% of those unexposed. The crude and weighted RRs for GDM risk were 0.64 (95% CI 0.43-0.96) and 0.68 (95% CI 0.55-0.84), respectively. The weighted RR when compared with the immunosuppressant, 5-aminosalicylate, and untreated groups was 0.70 (95% CI 0.41-1.18), 0.71 (95% CI 0.52-0.95), and 0.85 (95% CI 0.59-1.24), respectively. This nationwide cohort reported a decreased risk of GDM among patients who used anti-TNFs during early pregnancy compared with those unexposed. GDM risk may become a consideration in the decision-making process when choosing treatment options for pregnant women with a risk factor for GDM.

Glycated CD59 is a potential biomarker for gestational diabetes mellitus.

To explore the diagnostic value of glycated CD59 (gCD59) in gestational diabetes mellitus (GDM). A total of 707 pregnant women who underwent the first visit in the obstetric outpatient clinic of the Affliated Suqian Hospital of Xuzhou Medical University from January 2022 to July 2023 were included, and were grouped according to the International Association of the Diabetes and Pregnancy Study Groups(IADPSG) diagnostic criteria, and finally 113 cases in the GDM group and 559 cases in the normal glucose tolerance (NGT) group were included, and the concentration of gCD59 was determined by enzyme-linked immunosorbent assay (ELISA). The baseline data characteristics of the two groups were compared, the risk factors for GDM were explored by multivariate binary logistic analysis, and the diagnostic value of gCD59 in predicting GDM was explored by receiver operating characteristic (ROC) curve analysis. The level of gCD59 in the GDM group was significantly higher than that in the NGT group (1.49 SPU vs 0.87 SPU). Multivariate regression analysis showed that gCD59, diastolic blood pressure (DBP) and thyroid stimulating hormone (TSH) were independent risk factors for GDM.The area under the curve (AUC) of gCD59 for the diagnosis of GDM was 0.681 (95% CI: 0.583-0.717), with a sensitivity of 71.7% and a specificity of 58.3%. In combination with fasting glucose, gCD59 effectively diagnosed GDM with higher AUC of 0.871 (95% CI: 0.708-1.000). gCD59 is an independent risk factor for GDM and a good biomarker for the diagnosis of GDM.

Trends in the Incidence of Gestational Diabetes Mellitus Among the Medicaid Population Before and During the COVID-19 Pandemic.

Importance: Although there are many regional and national studies on the trends in the incidence of gestational diabetes mellitus (GDM), the trends in the incidence of GDM among the Medicaid population are lacking, especially before and during coronavirus disease of 2019 (COVID-19). Objective: To investigate the trends in the incidence of GDM before and during COVID-19 pandemic (2016-2021) among the Louisiana Medicaid population. Design, Setting, and Participants: This study included 111,936, Louisiana Medicaid pregnant women of age 18-50 between January 1, 2016, to December 31, 2021. Main Outcomes and Measures: Pregnancies, GDM, and pre-pregnancy diabetes cases were identified by using the Tenth Revisions of the International Classification of Disease code. The annual incidence of GDM and annual prevalence of pre-pregnancy diabetes were calculated for each age and race subgroup. Results: The age-standardized incidence of GDM increased from 10.2% in 2016 to 14.8 in 2020 and decreased to 14.0% in 2021. The age-standardized prevalence of pre-pregnancy diabetes increased from 2.8% in 2016 to 3.4% in 2018 and decreased to 2.3% in 2021. The age-standardized rate of GDM was the highest among Asian women (23.0%), then White women (15.5%), and African American women (13.9%) (p for difference <0.001). The COVID-19 pandemic saw an increase in the incidence of GDM, with a rise in prominent GDM risk factors, such as obesity and sedentary behaviors, suggesting an association. Conclusion and Relevance: The incidence of GDM significantly increased during the COVID-19 pandemic. Potential reasons might include increased sedentary behavior and increased prevalence of obesity. GDM is a major public health issue, and the prevention of GDM is particularly essential for the Louisiana Medicaid population owing to the high prevalence of GDM-related risk factors in this population.

Analysis of Risk Factors Associated with Gestational Diabetes Mellitus: A Retrospective Case-Control Study.

Gestational diabetes mellitus (GDM) is a complication of abnormal glucose tolerance during pregnancy, with incidence is on the rise. There are inconsistent results on the risks of GDM and it has not been reported in our region. The purpose of this study is to explore the risk factors of GDM. A total of 383 pregnant women were analyzed, including 67 (17.5%) pregnant women with GDM and 316 (82.5%) with normal glucose tolerance (NGT). The relationship of personal history, family history and reproductive history of pregnant women, the levels of alpha-fetoprotein (AFP), human chorionic gonadotropin (HCG), inflammatory markers in blood cell analysis at the first prenatal examination, and fetal ultrasound indices and the risk of GDM were analyzed. The fetal biparietal diameter, head circumference, and femur length were negatively correlated with HCG level, but not inflammatory markers. The proportion of pregnant women aged ≥30 years old, body mass index (BMI) in early pregnancy≥24.0 kg/m2, history of polycystic ovary syndrome (PCOS), cesarean section, adverse pregnancy, and oral contraceptive use, and pregnant women who conceived through assisted reproduction in GDM group were higher than those in NGT group. Logistic regression analysis showed that age of pregnant woman ≥30 years old (≥30 vs <30 years old, odds ratio (OR): 2.142, 95% confidence interval (CI): 1.183-3.878, p=0.012), BMI≥24.0 kg/m2 (≥24.0 kg/m2 vs 18.5-23.9 kg/m2, OR: 1.887, 95% CI: 1.041-3.420, p=0.036), history of adverse pregnancy (yes vs no, OR: 1.969, 95% CI: 1.022-3.794, p=0.043), and history of oral contraceptive use (yes vs no, OR: 2.868, 95% CI: 1.046-7.863, p=0.041) were associated with GDM. Age of pregnant woman ≥30 years old, BMI≥24.0 kg/m2, history of adverse pregnancy and oral contraceptive use were independent risk factors for GDM.

Sleep conditions and sleep hygiene behaviors in early pregnancy are associated with gestational diabetes mellitus: A propensity-score matched study.

To explore the influence of sleep conditions and sleep hygiene behaviors in early pregnancy on gestational diabetes mellitus (GDM) development. This 1:1 propensity-score matched study included 1,216 pregnant women divided into GDM and control groups based on diagnosis via the oral glucose tolerance test at 24-28 gestational weeks. Sleep conditions and hygiene behaviors were evaluated using structural questionnaires, including the Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, and Sleep Hygiene Practice Scale. Univariate and multivariate logistic regression analyses and Spearman's correlation were conducted to identify the associations. After adjusting for baseline clinical characteristics, women with GDM were more likely to have poor sleep quality (adjusted odds ratio [AOR] = 1.585, 95% confidence interval [CI]: 1.261-1.992) and higher scores for subjective sleep quality, latency, duration, efficiency, and sleep disturbances (all P < 0.01). Mild sleepiness (AOR = 1.311, 95% CI: 1.012-1.699) and worrying about not being able to fall asleep (AOR = 1.123, 95% CI: 1.005-1.255) were more likely to occur in the GDM group. Sleep quality and hygiene behaviors such as sleep-irrelevant activities, staying in bed after waking up, weekend catch-up sleep, and overeating before bedtime were significantly correlated with gestational diabetes variables. Poor sleep conditions and specific sleep hygiene behaviors in early pregnancy may be independent risk factors for GDM. This suggests that sleep assessment and behavior education can be used as new approaches for the early implementation of surveillance and prevention of GDM.

Exposure to Low-Level Air Pollution and Hyperglycemia Markers during Pregnancy: A Repeated Measure Analysis.

Epidemiologic evidence has emerged showing an association between exposure to air pollution and increased risks of gestational diabetes mellitus (GDM). This study examines the effect of low-level air pollution exposure on a subclinical biomarker of hyperglycemia (i.e., HbA1c) in pregnant people without diabetes before conception. We measured HbA1c in 577 samples repeatedly collected from 224 pregnant people in Rochester, NY, and estimated residential concentrations of PM2.5 and NO2 using high-resolution spatiotemporal models. We observed a U-shaped trajectory of HbA1c during pregnancy with average HbA1c levels of 5.13 (±0.52), 4.97 (±0.54), and 5.43 (±0.40)% in early-, mid-, and late pregnancy, respectively. After adjustment for the U-shaped trajectory and classic GDM risk factors, each interquartile range increase in 10 week NO2 concentration (8.0 ppb) was associated with 0.09% (95% CI: 0.02 to 0.16%) and 0.18% (95% CI: 0.08 to 0.28%) increases in HbA1c over the entire pregnancy and in late pregnancy, respectively. These associations remained robust among participants without GDM. Using separate distributed lag models, we identified a period between 8th and 14th gestational weeks as critical windows responsible for increased levels of HbA1c measured at 14th, 22nd, and 30th gestational weeks. Our results suggest that low-level air pollution contributes to hyperglycemia in medically low-risk pregnant people.

Vitamin D and Gestational Diabetes Mellitus in the IEU OpenGWAS Project: A Two-Sample Bidirectional Mendelian Randomization Study.

Gestational diabetes mellitus (GDM) is one of the most prevalent pregnancy problems, and there is still debate over the relationship between vitamin D and GDM. Our objective is to investigate the correlation between vitamin D and GDM by employing Mendelian randomization (MR) with summary data obtained from genome-wide association studies (GWAS). Data on exposures and outcomes, namely vitamin D, vitamin D insufficiency, and GDM, were acquired from the IEU OpenGWAS Project. Bidirectional MR analysis was performed utilizing the inverse variance weighted (IVW) method as the principal analytical approach. The complementary approaches employed in this study encompassed weighted median, simple mode, weighted mode, and MR-Egger regression. A series of sensitivity analysis were conducted in order to assess the reliability of the obtained results. The data were acquired from the IEU OpenGWAS Project. Following the application of the three assumptions of MR, 13 single nucleotide polymorphisms (SNPs) were included in the MR analysis for vitamin D levels and vitamin D deficiency on GDM, and 10 and 26 SNPs were included for GDM on vitamin D levels and deficiency, respectively. The findings from the IVW analysis revealed a significant positive correlation between vitamin D levels and GDM (OR = 1.057, 95% CI: 1.011-1.104, p = 0.015). Conversely, a negative correlation was seen between vitamin D deficiency and GDM (OR = 0.979, 95% CI: 0.959-0.999, p = 0.039). The results of the reverse MR study revealed no evidence of reverse causation between GDM and vitamin D. The findings from multiple MR approaches were in line with the direction of IVW analysis. Sensitivity analysis revealed no evidence of heterogeneity, pleiotropy, or outliers, suggesting the robustness of the results. There exists a causal association between vitamin D and GDM, whereby vitamin D levels serve as a risk factor for GDM.

Functional genetic variants and susceptibility and prediction of gestational diabetes mellitus

The aetiological mechanism of gestational diabetes mellitus (GDM) has still not been fully understood. The aim of this study was to explore the associations between functional genetic variants screened from a genome-wide association study (GWAS) and GDM risk among 554 GDM patients and 641 healthy controls in China. Functional analysis of single nucleotide polymorphisms (SNPs) positively associated with GDM was further performed. Univariate regression and multivariate logistic regression analyses were used to screen clinical risk factors, and a predictive nomogram model was established. After adjusting for age and prepregnancy BMI, rs9283638 was significantly associated with GDM susceptibility (P < 0.05). Moreover, an obvious interaction between rs9283638 and clinical variables was detected (Pinteraction < 0.05). Functional analysis confirmed that rs9283638 can regulate not only target gene transcription factor binding, but it also regulates the mRNA levels of SAMD7 (P < 0.05). The nomogram model constructed with the factors of age, FPG, 1hPG, 2hPG, HbA1c, TG and rs9283638 revealed an area under the ROC curve of 0.920 (95% CI 0.902–0.939). Decision curve analysis (DCA) suggested that the model had greater net clinical benefit. Conclusively, genetic variants can alter women's susceptibility to GDM by affecting the transcription of target genes. The predictive nomogram model constructed based on genetic and clinical variables can effectively distinguish individuals with different GDM risk factors.

The association between visceral adipose thickness and gestational diabetes mellitus in the first trimester

Objective: To investigate the association between visceral adipose tissue (VAT) thickness in early pregnancy and the risk of gestational diabetes mellitus (GDM). Methods: Based on the Qingdao Women and Children Health Cohort, pregnant women in the first trimester (11-13+6 weeks of gestation) were enrolled in this cohort study between May 2019 and October 2022. The VAT was measured in first trimester and determined as the distance from the inner margin of the rectus abdominis muscle to the anterior wall of the great artery using multi-functional color ultrasound. The 75 g oral glucose tolerance test (OGTT) results were followed up at 24-28 weeks and the participants were divided into GDM group and non-GDM group. The pregnant women were divided into 4 groups according to the VAT quartile. Log-binomial model and linear regression model were used to analyze the association between VAT and GDM/blood glucose. Results: A total of 3 686 pregnant women were included in this study, the mean age of participants was (30.56±4.05) years and 722 were diagnosed with GDM, with an incidence of 19.6%. The log-binomial regression model results showed that compared with VAT thickness Q1 (VAT<14.70 mm), the GDM risk in Q3 (21.65≤VAT≤29.69 mm) and Q4 (VAT ≥29.70 mm) increased by 34% [RR(95%CI): 1.34 (1.08-1.67)], and 61% [RR(95%CI): 1.61 (1.30-2.00)], respectively. Among women with gestational age<35 years old, compared with VAT thickness Q1, the risk of GDM increased by 42% in Q3 [RR(95%CI): 1.42 (1.22-1.65)] and 70% [RR(95%CI): 1.70 (1.46-1.98)] in Q4, whereas no associations were found in women with gestational age ≥35 years old (P>0.05). The association between VAT and GDM risk was only found in pregnant women with pre-pregnancy BMI <24.0 kg/m2, and the GDM risk increased by 57% [RR(95%CI): 1.57 (1.22-2.04)] in Q3 and 65% [RR(95%CI): 1.65 (1.24-2.19)] in Q4 compare with Q1. The results of multiple linear regression analysis showed that VAT was positively correlated with fasting blood glucose, 1-hour blood glucose after 75 g OGTT and 2-hours blood glucose after 75 g OGTT (all Pfor trend<0.001). Conclusion: High VAT thickness in early pregnancy is an independent risk factor for GDM, and the GDM risk increases with the raising of VAT depth.

Co-designing The Healthy Gut Diet for Preventing Gestational Diabetes: Co-design methods and process outcomes.

Gestational diabetes mellitus (GDM) is a common and costly condition of pregnancy. The Healthy Gut Diet for Preventing Gestational Diabetes study is a novel randomised controlled trial that aims to prevent GDM through a diet that modulates the gut microbiota for pregnant women with GDM risk factors. Despite increasing interest in co-designing interventions with consumers (lived experience experts), co-design methods and outcomes are often poorly reported. The present study aims to report on the co-design process used to develop The Healthy Gut Diet intervention. Co-design occurred across three online workshops with consumer participants (women with a lived experience of GDM, n = 11), researchers (n = 6) and workshop co-facilitators (including a consumer co-facilitator, n = 2). The workshops explored women's preferences for the mode and length of education sessions, as well as the types of information and supportive resources women wanted to receive, and undertook a "behaviour diagnosis" to understand barriers and enablers to the target behaviours (eating for gut health). The final intervention is reported according to the Template for Intervention Description and Replication. A co-designed dietary intervention (The Healthy Gut Diet), delivered via telehealth, with a suite of educational and supportive resources that integrates published behaviour change techniques, was developed. Generally, the co-design process was reported as a positive experience based on participant feedback and evidenced by no participant dropouts over the 3-month study period. Co-design is recognised as a process that creates a partnership between lived experience experts and researchers who can engage and empower research recipients and improve health behaviours.

Clinical and pathological characteristics of gestational diabetes mellitus with different insulin resistance

AimsTo elucidate the clinical and pathological characteristics of gestational diabetes mellitus (GDM) with high and low insulin resistance. MethodsIn total, 1393 GDM and 1001 non-GDM singleton deliveries were included in this study. Insulin resistance subtypes were classified according to the HOMA2-IR value. Clinical data were analyzed using SPSS 26.0. Placenta samples were collected for pathological analysis. ResultsMaternal age and fasting glucose were identified as independent risk factors for GDM with high insulin resistance (p < 0.01), while fasting glucose was the sole risk factor for GDM with low insulin resistance (p < 0.001). Fetal distress was associated with both of GDM subtypes (both p < 0.01), while anemia, fetal growth restriction, large for gestational age and intrahepatic cholestasis in pregnancy were related to specific GDM insulin resistance subtype. In addition, GDM with high insulin resistance showed an increase of syncytial knots with down-regulation of PI3K/AKT signaling, while GDM with low insulin resistance showed normal syncytial knot counts and up-regulation of PI3K/AKT signaling. ConclusionsOur findings provide novel perspectives to the clinical and pathological comprehensions of GDM with high and low insulin resistance, which might facilitate the mechanism study of GDM and its precision pregnancy management.

Management of Gestational Diabetes Mellitus: Knowledge, Attitudes, and Practices of Obstetric Doctors in Benghazi, Libya

Abstract Introduction Gestational diabetes mellitus (GDM) adversely affects the mother and fetus. Its diagnosis and management are of great importance to prevent complications. Mothers with GDM are at great risk of developing type 2 diabetes, and metabolic changes can persist for 3 years postdelivery. We assessed the knowledge and practice of obstetricians working at Benghazi Medical Centre (BMC) regarding gestational diabetes. Materials and Methods A cross-sectional descriptive study was conducted at the obstetric department of BMC; we included all postgraduate doctors in July 2021 in the study. The questionnaire included demographic data and questions related to knowledge regarding the definition of GDM, diagnosis, and complications to the mother and fetus. It also included practices toward GDM, including screening, management, follow-up, and postpartum screening for diabetes. Results The total number of doctors who agreed to participate was 102, and the response rate was 72.9%. The mean age of the participants was 35.4 ± 7.2 years; most of the studied group were females 97 (95.1%), 76 (74.5%) were senior house officers, 16 (15.7%) were mid-grades, and 10 (9.8%) were seniors. Most working obstetricians, 76 (74.5%), had less than 10 years of experience. One hundred (98%) participants heard about GDM, and only 39 (38.2%) correctly defined GDM. Regarding the threshold for fasting glucose to diagnose GDM, only 11 (10.8%) gave a right answer of 92 mg/dL. Most participants had a good knowledge of GDM risk factors and complications. Regarding follow-up, only 35 (34.3%) participants provided the correct answer, and only 27 (26.5%) mentioned insulin as the medical treatment of choice. Conclusion Although most of our studied group had contact with GDM patients, most needed basic knowledge regarding definition, diagnosis, and screening. Different opinions regarding diagnostic thresholds and management practices were observed. We recommended the establishment of a gestational diabetes clinic with the cooperation of endocrinologists and obstetricians, as well as local guidelines.

Prevalence and Association of Stress with Gestational Diabetes Mellitus among Pregnant Women in a Rural Area of Maharashtra: A Community-based Cross-sectional Study

Abstract Aim: Gestational diabetes mellitus (GDM) is a major public health problem. There is a scarcity of knowledge regarding the association of stress with GDM. Our objective was to determine the prevalence and association of stress with GDM among pregnant women in a rural area of Maharashtra. Methods: A community-based cross-sectional study was conducted among 965 pregnant women from the rural field practice area of the Department of Community Medicine, MGIMS, Sevagram. After taking written informed consent, a pretested semistructured questionnaire was administered. Diabetes in Pregnancy Study Group India recommendation was used (2-h plasma glucose &gt; 140 mg/dL with 75 g oral glucose load to diagnose GDM irrespective of the duration of the last meal). Kessler Psychological Distress Scale (K10) was administered to assess the stress (anxiety and depression). Results: The K10 scale showed that 3.11% of participants were moderately affected, and 3.01% had mild symptoms of anxiety and depression. Only 1.14% of pregnant women had severe mental disorders. The participants with normal to mild depression (K10 score &lt; 25) had 90% less chance (odds ratio: 0.10; 95% confidence interval: 0.05–0.23) of becoming GDM than participants with moderate to severe depression (K10 score &gt; 25), which was statistically significant (P &lt; 0.001). Conclusion: Our study highlighted that normal to mild stress had a lesser chance of getting GDM than moderate to severe stress during pregnancy, indicating that stress is a positive risk factor of GDM. Hence, it is advisable to screen for stress during pregnancy.

Prevalence of gestational diabetes mellitus risk factors in singleton pregnancies obtained by assisted reproductive technology: An observational, retrospective, real-world study from a pregnancy registry

AIMSSeveral studies showed that Assisted Reproductive Technology (ART) could affect gestational diabetes mellitus (GDM) onset. The aim of this study was to estimate the prevalence of GDM risk factors in a cohort of women with singleton pregnancy obtained by ART and complicated by GDM. Maternal and neonatal outcomes were explored. METHODSWe retrospectively collected data of pregnancies of women with singleton pregnancy obtained by ART and complicated by GDM consecutively cared for at a specialized center for diabetes and pregnancy care. Prevalence and combination of GDM risk factors, their combinations and maternal-fetal outcomes were estimated. RESULTSOverall, our cohort included 50 women (mean age of 40.4 ± 4.7 years, mean pre-pregnancy BMI 26.3 ± 6.2 kg/m2). The most frequent GDM traditional risk factors were age ≥ 35 years (94 %), family history of diabetes (44 %), overweight (29 %) and obesity (19 %). Combining risk factors, 5 groups were identified with 1, 2, 3, 4, or 5 risk factors with a prevalence respectively of 28 %, 46 %, 20 %, 4 %, and 2 %. Examining features of the above groups, pre-pregnancy weight (p < 0.0001) and pre-pregnancy BMI (p < 0.0001) statistically significant differed in the 5 groups, increasing with higher numbers of risk factors. Regarding neonatal outcomes only neonatal hypoglycemia (p = 0.03) differed significantly among the groups, with higher percentages in women with higher numbers of combined risk factors. CONCLUSIONPrevalence of GDM traditional risk factors in singleton ART pregnancies complicated by GDM is considerable. Such pregnancies need appropriate clinical attention because of the risk of adverse outcomes.

Association of Serum Homocysteine with Gestational Diabetes Mellitus (GDM): A Case-Control Study

Gestational diabetes mellitus (GDM) is associated with an increased risk of maternal and fetal mortality and morbidity. There is an increasing trend in the prevalence of GDM in Bangladesh. The role of homocysteine (Hcy) as an independent risk factor of GDM has not been extensively studied. The aim of this study was to evaluate the association of serum homocysteine levels in gestationaldiabetes mellitus. It was a case-control study among pregnant women attending the inpatient and outpatient departments of Obstetrics and Gynecology,BSMMU, Shahbag Dhaka, from April 2020 to March 2021. A total of 80 singleton pregnant women between 18-35 years of age were included in this study in their 24-40 weeks of gestation. Among them, 40 diagnosed women with GDM were considered as the cases and the rest of the 40 matched healthy pregnant women were selected as controls matching for age and gestational age.The overall average Hcy levels in the cases and controls were 5.48±1.3 μmol/L and 4.06±0.98 μmol/L, respectively. Both in the late second trimester and the third-trimester serum Hcy levels were significantly higher in the GDM cases than non-GDM healthy pregnant women (p&lt;0.05). Considering Hcy level of 6.38 μmol/L as the cut-off value, GDM was 4.75 times more likely in pregnant women with elevated serum Hcy level (≥6.38) than those with &lt; 6.38 μmol/L (OR=4.75; 95% CI = 0.941-23.985). There was a significant positive correlation of serum Hcy level with both fasting blood sugar level (r = +0.600, p&lt;0.001) and 2 hrs after 75g glucose level (r = +0.438, p&lt;0.001). Elevated level of serum homocysteine was found associated with GDM. Bangabandhu Sheikh Mujib Med. Coll. J. 2024;3(1):32-37

Early age at menarche and the risk of gestational diabetes mellitus: a cohort study.

To evaluate whether there is an association between age at menarche (AAM) and the risk of gestational diabetes mellitus (GDM). A retrospective cohort study was conducted, including 5390 pregnant women who were screened for GDM at Alexandra Hospital in Athens, Greece over a 15-year period (2000-2014). Maternal age, pre-pregnancy body mass index (BMI), height, family history of type 2 diabetes mellitus, parity, educational and smoking status, and AAM were recorded. The results were expressed as odds ratios (OR) with a 95% confidence interval (95% CI). Pregnant women with GDM experienced earlier menarche compared to normoglycemic women (12.9 ± 1.5 vs 13.1 ± 1.6, p < 0.001, respectively). The OR for a woman with AAM <12 years to develop GDM was 1.08 (95% CI 1.03-1.14), while the OR to be obese was 1.70 (95% CI 1.50-1.90). The multivariate logistic regression analysis showed that AAM is a risk factor for GDM. However, that effect was lost after adjusting for BMI. Early AAM may be associated with an increased risk of GDM. Therefore, it can be used to identify high-risk women and implement preconception interventions for GDM prevention. Future studies should be conducted to confirm these findings.