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gestational diabetes: weight gain during pregnancy and its relationship to pregnancy outcomes

Chinese Medical Journal 2019年第2期132卷 154-160页

作者： Bao-Hua Gou Hui-Min Guan Yan-Xia Bi Bing-Jie Ding Department of Gynaecology and Obstetrics Beijing Friendship HospitalCapital Medical UniversityBeijing 100050China Department of Clinical Nutrition Beijing Friendship HospitalCapital Medical UniversityBeijing 100050China

Background:Weight gain during pregnancy reflects the mother's nutritional status.However, it may be affected by nutritional therapy and exercise interventions used to control blood sugar in gestational diabetes mellitus (GDM).This study aimed to evaluate weight gain during gestation and pregnancy outcomes among women with GDM.Methods:A retrospective study involving 1523 women with GDM was conducted between July 2013 and July 2016.Demographic data, gestational weight gain (GWG), blood glucose, glycated-hemoglobin level, and maternal and fetal outcomes were extracted from medical records.Relationships between GWG and pregnancy outcomes were investigated using multivariate logistic regression.Results:In total, 451 (29.6%) women showed insufficient GWG and 484 (31.8%) showed excessive GWG.Excessive GWG was independently associated with macrosomia (adjusted odds ratio [aOR] 2.20, 95% confidence interval [CI] 1.50-3.52, Pgestational age (aOR 2.06, 95% CI 1.44-2.93, Pgestational age (aOR 0.49, 95% CI 0.25-0.97, P=0.040), neonatal hypoglycemia (aOR 3.80, 95% CI 1.20-12.00, P=0.023), preterm birth (aOR 0.45, 95% CI 0.21-0.96, P=0.040), and cesarean delivery (aOR 1.45, 95% CI 1.13-1.87, P=0.004).Insufficient GWG increased the incidence of preterm birth (aOR 3.53, 95% CI 1.96-6.37, P<0.001).Conclusions:Both excessive and insufficient weight gain require attention in women with GDM.Nutritional therapy and exercise interventions to control blood glucose should also be used to control reasonable weight gain during pregnancy to decrease adverse pregnancy outcomes.

关键词： gestational diabetes mellitus Weight gain Pregnancy outcomes

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Optimal gestational Weight Gain for Women with gestational Diabetes Mellitus—China,2011–2021

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China CDC weekly 2023年第9期5卷 189-193,I0001-I0007页

作者： Jinlang Lyu Yin Sun Yuelong Ji Nana Liu Suhan Zhang Hang Lin Yaxin Wang Xuanjin Yang Shuai Ma Na Han Yang Mi Dan Zheng Zhifen Yang Hongping Zhang Yan Jiang Liangkun Ma Haijun Wang School of Public Health Peking UniversityBeijing MunicipalityChina Peking Union Medical College Hospital Beijing MunicipalityChina Chinese Academy of Medical Sciences and Peking Union Medical College Beijing MunicipalityChina Tongzhou Maternal and Child Health Hospital Beijing MunicipalityChina Northwest Women’s and Children’s Hospital Xi'an CityShaanxi ProvinceChina Guiyang Maternal and Child Health Hospital Guiyang CityGuizhou ProvinceChina The Fourth Hospital of Hebei Medical University Shijiazhuang CityHebei ProvinceChina Wenzhou People’s Hospital Wenzhou CityZhejiang ProvinceChina People’s Hospital of Dong’e County Liaocheng CityShandong ProvinceChina.

Summary What is already known about this topic?Joint effects of gestational weight gain(GWG)and hyperglycemia on adverse pregnancy outcomes suggest that lower optimal GWG is optimal for women with gestational diabetes mellitus(GDM).However,there is still a lack of guidelines.What is added by this report?Optimal weekly GWG range after diagnosis of GDM for underweight,normal-weight,overweight,and obese women was 0.37–0.56 kg/week,0.26–0.48 kg/week,0.19–0.32 kg/week,and 0.12–0.23 kg/week,respectively.What are the implications for public health practice?The findings may be used to inform prenatal counseling regarding optimal gestational weight gain for women with gestational diabetes mellitus,and suggest the need for weight gain management.

关键词： diagnosis gestational pregnancy

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Risk Factors for gestational Diabetes Mellitus(GDM)in Subsequent Pregnancy Among Women Without GDM History in China:A Multicenter Retrospective Study

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Maternal-Fetal Medicine 2023年第1期5卷 9-15页

作者： Geng Song Yumei Wei Juan Juan Rina Su Jianying Yan Mei Xiao Xianlan Zhao Meihua Zhang Yuyan Ma Haiwei Liu Jingxia Sun Kejia Hu Huixia Yang Department of Obstetrics and Gynecology Peking University First HospitalBeijing 100034China Beijing Key Laboratory of Maternal Fetal Medicine of gestational Diabetes Mellitus Beijing 100034China Department of Obstetrics and Gynecology Fujian Province Maternal and Child Health HospitalFuzhou 350005China Department of Obstetrics and Gynecology Maternal and Child Health Hospital of Hubei ProvinceWuhan 430064China Department of Obstetrics and Gynecology Zhengzhou University First Affiliated HospitalZhengzhou 450052China Department ofObstetrics and Gynecology Taiyuan Maternal and Child Health HospitalTaiyuan 030012China Department of Obstetrics and Gynecology Shandong University Qilu HospitalJinan 250063China Department of Obstetrics and Gynecology Hainan General HospitalHaikou 570311China Department of Obstetrics and Gynecology First Affiliated Hospital of Harbin Medical UniversityHarbin 150007China Department of Obstetrics and Gynecology Beijing Shunyi District HospitalBeijing 101312China

Objective:This study aimed to determine the likelihood of gestational diabetes mellitus(GDM)in subsequent pregnancy among women without GDM history and to identify risk factors for GDM in subsequent pregnancy.Methods:This retrospective cohort study involved participants who delivered twice in same hospital of 18 research centers when delivered the second baby from January 2018 to December 2018.Finally 6204 women were enrolled and 5180 women without GDM history were analyzed further.Women were categorized as non-GDM or GDM based on the blood glucose values of the subsequent pregnancy,and the characteristics and GDM risk of these groups were compared.A univariate analysis of potential risk factors was performed using the Chi-squared test and/ort-test for qualitative or quantitative variables,respectively.Associations withP values<0.1 were chosen to be included in the multivariate binary logistic regression model.Results:In primary analysis of 6204 women,the incidence of GDM in subsequent pregnancy is 48.9%(490/1002)in women with GDM history and 16.1%(835/5202)in women without GDM history.In a further analysis for 5180 women without GDM at index pregnancy,compared with the non-GDM group,the GDM group had a significantly higher age,prepregnancy body mass index,and blood glucose value at each oral glucose tolerance test(OGTT)timepoint(fasting,1 h and 2 h)during the index and subsequent pregnancies,as well as higher weight retention during the interval between the two pregnancies(P<0.001).Age above 35 years in subsequent pregnancy(odds ratio(OR)=1.540,95%confidence interval(CI)=1.257-1.886,P<0.001),macrosomia in index pregnancy(OR=1.749,95%CI=1.277-2.395,P=0.001),OGTT blood glucose values in index pregnancy(fasting,OR=2.487,95%CI=1.883-3.285,P<0.001;1 h,OR=1.142,95%CI=1.051-1.241,P=0.002;2 h,OR=1.290,95%CI=1.162-1.432,P<0.001)and weight retention(OR=1.052,95%CI=1.035-1.068,P<0.001)were independent risk factors for GDM in subsequent pregnancy.Conclusion:For women without GDM history,GDM risk factors including age,macros

关键词： Diabetes gestational Without GDM history Risk factors Subsequent pregnancy.

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Effect of gestational Diabetes Mellitus on the Growth, Development, and Stem Cells of Offspring

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Maternal-Fetal Medicine 2023年第1期5卷 31-35页

作者： Meihua Zhang Munan Ma Jinping Wang Yijun Wang Xinrui Yang Songtao Fu Maternity Department Taiyuan Maternal and Child Health HospitalTaiyuanShanxi 030001China Department of Biochemistry&Molecular Biology Shanxi Medical UniversityTaiyuanShanxi 030001China Birth Defects and Regenerative Medicine Laboratory Department of Biochemistry&Molecular BiologyShanxi Medical UniversityTaiyuanShanxi 030001China Biomedicine and Health Graduate Education Innovation Center TaiyuanShanxi 030001China

The effects of gestational diabetes mellitus (GDM) on offspring include macrosomia, hypoglycemia, respiratory distress syndrome, cardiovascular disease, neural and mental injury, etc. The effects of GDM on the health status of offspring are sustained although pregnancy has ended. It has been proposed that fetal reprogramming causes long-term consequences to metabolic health in offspring. An intrauterine high-glucose environment may lead to changes in the multi-differentiation proficiency of intracorporal stem cells, showing decreased proliferation and osteogenic ability, increased adipogenic ability, accelerated apoptosis, and occurrence of premature failure. This environment also reduces the mobilization of bone marrow stem cells, whereas it increases that of medullary cells. This results in pro-inflammatory conditions and sustained inflammation in the body, thereby increasing the risk of obesity, cardiovascular and neurological disorders, and metabolic abnormalities. Stem cells derived from the amniotic membrane, umbilical cord, or placenta may be a reliable predictor of the long-term effects of GDM on offspring. The levels of blood glucose during pregnancy should be effectively controlled to reduce harm to the neonate.

关键词： Diabetes gestational Growth and development Offspring Stem cells

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Single-cell transcriptomic profiling of non-hematopoietic circulating cells in mid-gestational mouse embryos

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Journal of Genetics and Genomics 2021年第6期48卷 508-511页

作者： Yanyan Li Yanjuan Chen Xiaona Zheng Yun Gao Yuxuan Zheng Zongcheng Li Han He Fuchou Tang Bing Liu Yu Lan Key Laboratory for Regenerative Medicine of Ministry of Education Institute of HematologySchool of MedicineJinan UniversityGuangzhouGuangdong 510632China Integrated Chinese and Western Medicine Postdoctoral Research Station Jinan UniversityGuangzhouGuangdong 510632China Biomedical Institute for Pioneering Investigation via Convergence College of Life SciencesPeking UniversityBeijing 100871China State Key Laboratory of Experimental Hematology Institute of HematologyFifth Medical Center of Chinese PLA General HospitalBeijing 100071China

The circulatory system is indispensable for an animal’s normal physiology.In addition to well-characterized hematopoietic cells,several types of circulating non-hematopoietic cells have been identified in adult mice(... 详细信息

关键词： hematopoietic gestational circulating

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Exploration of the shared pathophysiological mechanisms of gestational diabetes and large for gestational age offspring

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World Journal of Diabetes 2019年第6期10卷 333-340页

作者： Sofia Nahavandi Sarah Price Priya Sumithran Elif Ilhan Ekinci The Royal Children’s Hospital Melbourne Parkville VIC 3052 Australia Department of Endocrinology Austin Health Repatriation Campus Heidelberg West Melbourne VIC 3081 Australia Department of Medicine Austin Health and the University of Melbourne (Austin Campus) Parkville Melbourne VIC 3084 Australia

gestational diabetes mellitus (GDM) and large for gestational age (LGA) offspring are two common pregnancy complications. Connections also exist between the two conditions, including mutual maternal risk factors for the conditions and an increased prevalence of LGA offspring amongst pregnancies affected by GDM. Thus, it is important to elucidate potential shared underlying mechanisms of both LGA and GDM. One potential mechanistic link relates to macronutrient metabolism. Indeed, derangement of carbohydrate and lipid metabolism is present in GDM, and maternal biomarkers of glucose and lipid control are associated with LGA neonates in such pregnancies. The aim of this paper is therefore to reflect on the existing nutritional guidelines for GDM in light of our understanding of the pathophysiological mechanisms of GDM and LGA offspring. Lifestyle modification is first line treatment for GDM, and while there is some promise that nutritional interventions may favourably impact outcomes, there is a lack of definitive evidence that changing the macronutrient composition of the diet reduces the incidence of either GDM or LGA offspring. The quality of the available evidence is a major issue, and rigorous trials are needed to inform evidence-based treatment guidelines.

关键词： gestational diabetes mellitus Large for gestational age Metabolism Biomarkers Glucose Lipids

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Adiponectin gene polymorphisms and risk of gestational diabetes mellitus:A meta-analysis

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World Journal of Clinical Cases 2019年第5期7卷 572-584页

作者： Lin-Ting Huang Shi-Lan Wu Xin Liao Shu-Juan Ma Hong-Zhuan Tan Department of Epidemiology and Health Statistics Xiangya School of Public Health Central South University

BACKGROUND Adiponectin(ADIPOQ) is an important factor involved in the regulation of both carbohydrate and lipid metabolism. Polymorphisms in the ADIPOQ gene are known to influence an individual's predisposition to metabolic syndrome and type 2 diabetes. Moreover, women with gestational diabetes mellitus(GDM) are at an increased risk of developing type 2 diabetes. Several studies have been conducted previously to assess the association between ADIPOQ polymorphisms and GDM; however, the results of the association are inconclusive.AIM To quantitatively evaluate the association between ADIPOQ +45 T/G, +276 G/T,and-11377 C/G polymorphisms and the risk of GDM.METHODS A systematic search of EMBASE, PubMed, CNKI, Web of Science, and WANFANG DATA was conducted up to October 20, 2018. We calculated merged odds ratios(ORs) with 95% confidence intervals(CIs) using a fixed-effects or random-effects model depending on the between-study heterogeneity to evaluate the association between AIDPOQ +45 T/G, +276 G/T, and-11377 C/G polymorphisms and the risk of GDM. Subgroup analysis was performed by ethnicity. Publication and sensitivity bias analyses were performed to test the robustness of the association. All statistical analyses were conducted using Stata 12.0.RESULTS Nine studies of +45 T/G included 1024 GDM cases and 1059 controls, five studies of +276 G/T included 590 GDM cases and 595 controls, and five studies of-11377 C/G included 722 GDM cases and 791 controls. Pooled ORs indicated that+45 T/G increased GDM risk in Asians(allelic model: OR = 1.47, 95%CI: 1.27-1.70,P = 0.000; dominant model: OR = 1.54, 95%CI: 1.27-1.85, P = 0.000; recessive model: OR=2.00, 95%CI: 1.43-2.85, P = 0.000), not in South Americans(allelic model: OR = 1.21, 95%CI: 0.68-2.41, P = 0.510; dominant model: OR = 1.13, 95%CI:,0.59-2.15, P = 0.710; recessive model: OR = 2.18, 95%CI: 0.43-11.07, P = 0.350).There were no significant associations between +276 G/T(allelic model: OR = 0.88,95%CI: 0.74-1.05, P = 0.158; dominant model: OR = 0.91, 95%CI: 0.65-1.2

关键词： gestational diabetes mellitus Single nucleotide Polymorphism Adiponectin Gene Meta-analysis

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Correlation of serum vitamin D, adipose tissue vitamin D receptor, and peroxisome proliferator-activated receptor γ in women with gestational diabetes mellitus

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Chinese Medical Journal 2019年第21期132卷 2612-2620页

作者： Hui-Yan Wang Guang-Tong She Li-Zhou Sun Hao Lu Yin-Pin Wang Jun Miao Ke-Zhuo Liu Cai-Feng Sun Hui-Hui Ju Department of Obstetrics The First Affiliated Hospital of Nanjing Medical UniversityNanjingJiangsu 210000China Department of Obstetrics Changzhou Woman and Children Health-Care Hospital Affiliated to Nanjing Medical UniversityChangzhouJiangsu 213003China.

Background:gestational diabetes mellitus(GDM)is a common complication during pregnancy.Obesity and overweight are closely related to metabolic diseases and diabetes.However,the role of adipose tissue in the pathogenesis of GDM remains to be studied.The aim of this study was to investigate the correlation of vitamin D(VD)levels,VD receptor(VDR),and peroxisome proliferatoractivated receptor g(PPARg)expression with GDM in overweight or obese women.Methods:One hundred and forty pregnant women with full-term single-birth cesarean-section were selected as the study subjects and grouped(70 GDM women,including 35 non-overweight/non-obese women[group G1]and 35 women with overweight or obesity[group G2];70 pregnant women with normal glucose tolerance,including 35 non-overweight/non-obese women[group N1]and 35 overweight/obese women[group N2]).The levels of serum VD,blood biochemistry,and adiponectin were compared in these women.Subcutaneous adipose tissue was isolated from the abdominal wall incision.VDR and PPARg messenger RNA(mRNA)transcript levels in these adipose tissues were quantified by real-time polymerase chain reaction.The differences between the levels of PPARg protein and phosphorylated PPARg Ser273 were detected by Western blotting.Results:The serum VD level ofGDM women was lower in comparison to that of women with normal glucose tolerance(G1 vs.N1:20.62±7.87 ng/mL vs.25.85±7.29 ng/mL,G2 vs.N2:17.06±6.74 ng/mL vs.21.62±7.18 ng/mL,P<0.05),and the lowest in overweight/obese GDM women.VDR and PPARg mRNA expression was higher in the adipose tissues of GDM women in comparison to that of women with normal glucose tolerance(VDR mRNA:G1 vs.N1:210.00[90.58–311.46]vs.89.34[63.74–159.92],G2 vs.N2:298.67[170.84–451.25]vs.198.28[119.46–261.23],PPARg mRNA:G1 vs.N1:100.72[88.61–123.87]vs.87.52[66.37–100.04],G2 vs.N2:117.33[100.08–149.00]vs.89.90[76.95–109.09],P<0.05),and their expression was the highest in GDM+overweight/obese women.VDR mRNA levels positively correlated with the pre-pregnancy body mass index(BMI),pre-deliver

关键词： gestational diabetes mellitus Overweight Obesity Serum vitamin D Vitamin D receptor Peroxisome proliferatoractivated receptor gamma

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Maternal serum level of resistin is associated with risk for gestational diabetes mellitus:A meta-analysis

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World Journal of Clinical Cases 2019年第5期7卷 585-599页

作者： Shi-Min Hu Meng-Shi Chen Hong-Zhuan Tan Department of Epidemiology and Health Statistics Xiangya School of Public Health Central South University

BACKGROUND Resistin is most likely involved in the pathogenesis of gestational diabetes mellitus(GDM), but the existing findings are inconsistent.AIM To review the literature investigating the associations of the risk of GDM with serum level of resistin.METHODS A systematic literature search was performed using MEDLINE, EMBASE, and Web of Science(all databases). This meta-analysis included eligible studies that:(1) investigated the relationship between the risk of GDM and serum resistin;(2)included GDM cases and controls without GDM;(3) diagnosed GDM according to the oral glucose-tolerance test;(4) were performed in humans;(5) were published as full text articles in English; and(6) provided data with median and quartile range, median and minimum and maximum values, or mean and standard deviation. The pooled standardized mean difference(SMD) and 95%confidence interval(CI) were calculated to estimate the association between the risk of GDM and serum resistin. To analyze the potential influences of need for insulin in GDM patients and gestational age at blood sampling, we performed a subgroup analysis. Meta-regression with restricted maximum likelihood estimation was performed to assess the potentially important covariate exerting substantial impact on between-study heterogeneity.RESULTS The meta-analysis for the association between serum resistin level and GDM risk included 18 studies(22 comparisons) with 1041 cases and 1292 controls. The total results showed that the risk of GDM was associated with higher serum resistin level(SMD = 0.250, 95%CI: 0.116, 0.384). The "after 28 wk" subgroup, "no need for insulin" subgroup, and "need for insulin" subgroup indicated that higher serum resistin level was related to GDM risk("after 28 wk" subgroup: SMD =0.394, 95%CI: 0.108, 0.680; "no need for insulin" subgroup: SMD = 0.177, 95%CI:0.018, 0.336; "need for insulin" subgroup: SMD = 0.403, 95%CI: 0.119, 0.687). The"before 14 wk" subgroup, "14-28 wk" subgroup, and "no information of need for insulin" subgroup showed a nonsignif

关键词： Resistin gestational diabetes mellitus Meta-analysis gestational age

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gestational diabetes: A clinical update

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World Journal of Diabetes 2015年第8期6卷 1065-1072页

作者： Ulla Kampmann Lene Ring Madsen Gitte Oeskov Skajaa Ditte Smed Iversen Niels Moeller Per Ovesen Department of Endocrinology and Internal Medicine Aarhus University Hospital Department of Obstetrics and Gynecology Aarhus University Hospital

gestational diabetes mellitus(GDM)is increasing in prevalence in tandem with the dramatic increase inthe prevalence of overweight and obesity in women of childbearing age.Much controversy surrounds the diagnosis and management of gestational diabetes,emphasizing the importance and relevance of clarity and consensus.If newly proposed criteria are adopted universally a significantly growing number of women will be diagnosed as having GDM,implying new therapeutic challenges to avoid foetal and maternal complications related to the hyperglycemia of gestational diabetes.This review provides an overview of clinical issues related to GDM,including the challenges of screening and diagnosis,the pathophysiology behind GDM,the treatment and prevention of GDM and the long and short term consequences of gestational diabetes for both mother and offspring.

关键词： gestational diabetes Diagnostic criteria Treatment Complications

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