What we have learned about treating mild gestational diabetes mellitus

Rice, Madeline Murguia; Landon, Mark B.

doi:10.1053/j.semperi.2016.03.006

Cited by 8 publications

(8 citation statements)

References 38 publications

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“…LGA, macrosomia, first C-section, and hospital length above 3 days [8][9][10][11]. Regardless of the inconsistency in perinatal outcomes evaluated in reviews or even in randomized trials [45], the literature supports our findings.…”

Section: The Independent Risk Factors For Hip-related Adverse Outcomessupporting

confidence: 71%

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Maternal factors associated with hyperglycemia in pregnancy and perinatal outcomes: a Brazilian reference center cohort study

Nicolosi

Vernini

Costa

et al. 2020

Diabetol Metab Syndr

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Background: While sufficient evidence supporting universal screening is not available, it is justifiable to look for specific risk factors for gestational diabetes mellitus (GDM) or hyperglycemia in pregnancy (HIP). The objective of this study is to identify independent risk factors for HIP and its adverse perinatal outcomes in a Brazilian public referral center. Methods: We included 569 singleton pregnant women who were split into three groups by glucose status: GDM (n = 207), mild gestational hyperglycemia (MGH; n = 133), and control (n = 229). Women who used corticosteroids or had a history of DM were excluded. HIP comprised both GDM and MGH, diagnosed by a 100 g-or 75 g-oral glucose tolerance test (OGTT) and a glucose profile at 24-28 weeks. Maternal characteristics were tested for their ability to predict HIP and its outcomes. Bivariate analysis (RR; 95% CI) was used to identify potential associations. Logistic regression (RR adj ; 95% CI) was used to confirm the independent risk factors for HIP and its perinatal outcomes (p < 0.05). Results: Age ≥ 25 years [1.83, 1.12-2.99], prepregnancy BMI ≥ 25 kg/m 2 [2.88, 1.89-4.39], family history of DM [2.12, 1.42-3.17] and multiparity [2.07, 1.27-3.37] were independent risk factors for HIP. Family history of DM [169, 1.16-2.16] and hypertension [2.00, 1.36-2.98] were independent risk factors for C-section. HbA1c ≥ 6.0% at birth was an independent risk factor for LGA [1.99, 1.05-3.80], macrosomia [2.43, 1.27-4.63], and birthweight Z-score > 2.0 [4.17, 1.57-11.10]. Conclusions: MGH presents adverse pregnancy outcomes similar to those observed in the GDM group but distinct from those observed in the control (no diabetes) group. In our cohort, age ≥ 25 years, prepregnancy BMI ≥ 25 kg/m 2 , family history of DM, and multiparity were independent risk factors for HIP, supporting the use of selective screening for this condition. These results should be validated in populations with similar characteristics in Brazil or other lowand middle-income countries.

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Section: The Independent Risk Factors For Hip-related Adverse Outcomessupporting

confidence: 71%

“…Milder forms of hyperglycemia that do not meet the diagnostic criteria for GDM but have adverse effects on the mother and offspring have been identified [8]. Over three decades ago, our public referral center found an association between the glucose profile (GP) test and the oral glucose tolerance test (OGTT) for the diagnosis of GDM.…”

mentioning

confidence: 99%

Maternal factors associated with hyperglycemia in pregnancy and perinatal outcomes: a Brazilian reference center cohort study

Nicolosi

Vernini

Costa

et al. 2020

Diabetol Metab Syndr

View full text Add to dashboard Cite

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“…LGA and macrosomia, 19 the long-term beneficial impacts of GDM treatment remains controversial. [20][21][22] Mothers from our cohort were carefully followed up, and those with GDM were treated in accordance with established clinical practices.…”

Section: Discussionmentioning

confidence: 99%

Placental lipoprotein lipase DNA methylation alterations are associated with gestational diabetes and body composition at 5 years of age

et al. 2017

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Gestational diabetes mellitus (GDM) is associated with obesity in childhood. This suggests that consequences of in utero exposure to maternal hyperglycemia extend beyond the fetal development, possibly through epigenetic programming. The aims of this study were to assess whether placental DNA methylation (DNAm) marks were associated with maternal GDM status and to offspring body composition at 5 years old in a prospective birth cohort. DNAm levels were measured in the fetal side of the placenta in 66 samples (24 from GDM mothers) using bisDNA-pyrosequencing. Anthropometric and body composition (bioimpedance) were measured in children at 5 years of age. Mann-Whitney and Spearman tests were used to assess associations between GDM, placental DNAm levels at the lipoprotein lipase (LPL) locus and children's weight, height, body mass index (BMI), body fat, and lean masses at 5 years of age. Weight, height, and BMI z-scores were computed according to the World Health Organization growth chart. Analyses were adjusted for gestational age at birth, child sex, maternal age, and pre-pregnancy BMI. LPL DNAm levels were positively correlated with birth weight z-scores (r D 0.252, P D 0.04), and with midchildhood weight z-scores (r D 0.314, P D 0.01) and fat mass (r D 0.275, P D 0.04), and negatively correlated with lean mass (r D ¡0.306, P D 0.02). We found a negative correlation between LPL DNAm and mRNA levels in placenta (r D ¡0.459; P < 0.001), which highlights the regulation of transcriptional activity by these epivariations. We demonstrated that alterations in fetal placental DNAm levels at the LPL gene locus are associated with the anthropometric profile in children at 5 years of age. These findings support the concept of fetal metabolic programming through epigenetic changes.

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“…Current management guidelines recommend “universal screening” for GDM at 24–28 weeks of gestation by oral glucose tolerance tests [7–9]. In patients with positive screening, two randomized trials show beneficial results for both the mother and the offspring, with treatment [10]. The management of this disorder either with dietary intervention, self-monitoring of blood glucose or with insulin therapy, significantly reduced the risks of fetal overgrowth, shoulder dystocia, cesarean delivery, and hypertensive disorders [7, 11, 12].…”

Section: Introductionmentioning

confidence: 99%

Oral extracellular vesicles in early pregnancy can identify patients at risk of developing gestational diabetes mellitus

et al. 2019

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Aim To isolate and characterize oral extracellular vesicles from gingival crevicular fluid at 11–14 weeks and evaluate their capacity to identify patients at risk of developing gestational diabetes mellitus. Methods A case-control study was conducted, including patients who developed gestational diabetes mellitus (n = 11) and healthy pregnant controls (n = 23). Obstetric and periodontal histories were recorded at 11–14 weeks of gestation, and samples of gingival crevicular fluid obtained. Extracellular vesicles were isolated from gingival crevicular fluid by ExoQuick. Nanoparticle tracking analysis, ELISA and transmission electron microscopy were used to characterize extracellular vesicles. Results Total extracellular vesicles isolated from gingival crevicular fluid were significantly higher in patients who developed gestational diabetes mellitus later in pregnancy compared to normoglycemic pregnant women (6.3x10 9 vs 1.7 x10 10 , p value = 0.0026), and the concentration of the extracellular vesicles delivered an area under the ROC curve of 0.81. The distribution size of extracellular vesicles obtained using ExoQuick was around 148 ± 57 nm. There were no significant differences in the periodontal status between cases and controls. The exosome transmembrane protein CD63 was also detected in the extracellular vesicles of gingival crevicular fluid. Conclusion We were able to isolate extracellular vesicles from gingival crevicular fluid using a method that is suitable to be applied in a clinical setting. Our results provide an insight into the potential capacity of first trimester oral extracellular vesicles as early biomarkers for the prediction of gestational diabetes mellitus in pre-symptomatic women.

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What we have learned about treating mild gestational diabetes mellitus

Cited by 8 publications

References 38 publications

Maternal factors associated with hyperglycemia in pregnancy and perinatal outcomes: a Brazilian reference center cohort study

Maternal factors associated with hyperglycemia in pregnancy and perinatal outcomes: a Brazilian reference center cohort study

Placental lipoprotein lipase DNA methylation alterations are associated with gestational diabetes and body composition at 5 years of age

Oral extracellular vesicles in early pregnancy can identify patients at risk of developing gestational diabetes mellitus

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