INTRODUCTION

Administration of antenatal corticosteroids (ACS) between 24 and 36 weeks of gestation is recommended to pregnant women at risk of preterm delivery to decrease the risk of respiratory distress syndrome, intra-ventricular hemorrhage and neonatal death. However, it may worsen glycemic profile primarily in those with gestational diabetes mellitus (GDM).

To determine the effects of ACS on maternal glycemia in Filipino women with GDM and to analyze the factors associated with insulin use or increased insulin requirement.

A retrospective study of the medical records of Filipino women with GDM who were admitted and received ACS treatment (betamethasone) between 24- and 36-weeks age of gestation (AOG) for fetal lung maturity from 2017-2019. Clinical characteristics (age, parity, completed ACS dose, AOG at ACS administration and mode of delivery) and glycemic control were retrieved and compared before and after ACS treatment. Data collection began the day or on the day before steroids were given and continued until discharge or delivery.

Included were 42 pregnant women with GDM. Of these, 28 women with GDM were treated by diet alone (Group A) while 14 women with GDM were started on insulin in addition to diet (Group B). After betamethasone therapy was initiated, only three (Group A1; n=3/28) patients had good glycemic control with diet alone and the rest were given insulin treatment (Group A2; n=25/28). In this subpopulation of Group A2, insulin requirement within 24 hours after ACS was at 0.3 units per kg of body weight. There was a steady increase with maximum requirement observed on day 4 and decreased thereafter to 0.33 units per kg of body weight on day 5. For GDM women in Group B, only three maintained their insulin dose (Group B1; n=3/14) while 11 (Group B2; n=11/14) women with GDM previously on insulin, required further increase in insulin from day 1-2 reaching 140% increase in insulin dose on day 2. Thereafter, there was a gradual decrease of insulin dose almost returning to initial dose on day 5.

Insulin initiation was observed among GDM diet-controlled mothers (Group A) who were given ACS therapy at ≥31 weeks age of gestation. Age, parity, family history of diabetes and mode of delivery did not have significant effects on insulin use nor increased insulin requirement. Fasting capillary glucose (FCG) and one-hour post-prandial capillary glucose (PPCG) were elevated within 24 hours after administration of corticosteroid (betamethasone) in 60%-70% of our population. The FCG values remained elevated on day 2-3 in about 70% of patients. While the first hour PPCG was elevated in 85% of patients on day 2 and remained elevated in 70% of women on day 3-4, it reached 53% on day 5. Insulin requirement among Group B2 reached to 140% increase in insulin dose on day 2 followed by a gradual decrease of insulin dose almost returning to initial dose on day 5.

ACS administration caused maternal hyperglycemia in Filipino women with GDM during the first 24 hours and lasting up to five days. Both fasting glucose and post-prandial glucose were elevated, hence intensified monitoring of maternal glucose levels and temporary addition or increase of insulin doses may be necessary. The timing (≥31 weeks AOG) of administration of ACS on GDM women was associated with subsequent insulin initiation but only on patients initially controlled on diet alone.

OBJECTIVES

This study aimed to determine the maternal and fetal effects of hyperglycemia, and to compare the clinical outcomes between pregnant teenagers and adult women with gestational diabetes mellitus (GDM).

This was a retrospective cohort study among pregnant women who tested positive for GDM by 75-gram oral glucose tolerance test (OGTT). Data was collected from the 1st of January 2015 to the 31st of December 2019. Maternal and fetal outcomes and the factors associated with maternal and neonatal outcomes among teenage women and adult women with GDM were studied.

A total of 254 charts of women with GDM were reviewed. Overall, adverse maternal outcomes were found in 94.12% and 90% of teenage and adults, respectively; and were almost more likely among primigravida (OR=3.984, CI=1.32-12, p=0.014). The study also showed less probability of having adverse maternal outcomes among multipara and grand multipara women (OR=0.2545, CI=0.08-0.79, P=0.018 and OR=0.1091, CI=0.03-0.45, p=0.002) respectively. Adverse neonatal outcomes were more likely among women who had prior delivery of macrosomic baby (OR=21.9091, CI=1.28-3.73, P=0.033). No adverse fetal outcome records were seen among teenage mothers, while adult women had 5.45% incidence.

Adverse maternal and neonatal outcomes were not significantly higher in the teenage GDM population compared to adult GDM. However, diagnosing and managing GDM among these groups would be beneficial considering their life expectancy and the need for a lifelong preventive program to avoid future development of Type 2 DM (T2DM) and its complications.

Objective: The objective of the study was to determine the effectiveness of myoinositol (MI) supplementation in the prevention of gestational diabetes mellitus (GDM) among high-risk patients. Materials and Methods: Comprehensive and systemic online searches were performed on PubMed, MEDLINE, Ovid, and Cochrane. Cross-referencing from related articles was also done. Only studies published in English were included in the study. We selected all randomized controlled trials on MI and singleton pregnant women with high risk for GDM. Data Collection and Analysis: Five randomized controlled trials were evaluated by two independent reviewers. For each comparison, the quality of evidence was assessed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Cochrane Collaboration tool. Review Manager 5.3 was used to generate the risk of bias evaluation and the analysis of the results. Main Results: The present study identified five randomized controlled trials involving 871 participants. The comparison of the studies showed a statistically significant reduction in the incidence of GDM in MI supplementation versus the control group (odds ratio [OR] = 0.32, 95% confidence interval [CI] = 0.19–0.53, P = 0.0001, Z = 4.36) by 68%. Similarly, there is a greater reduction in the incidence of fetal macrosomia among patients in the MI group than the controlled group (OR = 0.24, 95% CI = 0.07–0.78; P = 0.02, Z = 2.36) by 78%. However, there was no difference in terms of incidence of gestational hypertension (OR = 0.61, 95% CI = 0.19–2.01; P = 0.42, Z = −0.81), cesarean section (OR = 0.89, 95% CI = 0.65–1.22; P = 0.47, Z = 0.72), and neonatal hypoglycemia (OR = 0.35, 95% CI = 0.01–8.80; P = 0.53, Z = 0.63) outcomes. Conclusion MI supplementation taken at 4 g daily would decrease the incidence of GDM and fetal macrosomia. There was no statistically significant reduction in the risk of gestational hypertension, cesarean section, and neonatal hypoglycemia in the supplementation of MI.
Cesarean section ; fetal macrosomia ; gestational diabetes mellitus ; gestational hypertension ; myoinositol ; neonatal hypoglycemia

BACKGROUND: Gestational diabetes mellitus (GDM) brings health issues for both mothers and offspring, and GDM prevention is as important as GDM management. It was shown that a history of GDM was significantly associated with a higher maternal risk for GDM recurrence. The incidence of GDM recurrence was unclear because of the incidence of second-child was low before 2016 in China. We aim to investigate the prevalence of GDM recurrence and its associated high-risk factors which may be useful for the prediction of GDM recurrence in China. METHODS: A retrospective study was conducted which enrolled participants who underwent regular prenatal examination and delivered twice in the same hospital of 18 research centers. All participants were enrolled from January 2018 to October 2018, where they delivered the second baby during this period. A total of 6204 women were enrolled in this study, and 1002 women with a history of GDM were analyzed further. All participants enrolled in the study had an oral glucose tolerance test (OGTT) result at 24 to 28 weeks and were diagnosed as GDM in the first pregnancy according to the OGTT value (when any one of the following values is met or exceeded to the 75-g OGTT: 0 h [fasting], ≥5.10 mmol/L; 1 h, ≥10.00 mmol/L; and 2 h, ≥8.50 mmol/L). The prevalence of GDM recurrence and development of type 2 diabetes mellitus were calculated, and its related risk factors were analyzed. RESULTS: In 6204 participants, there are 1002 women (1002/6204,16.15%) with a history of GDM and 5202 women (5202/6204, 83.85%) without a history of GDM. There are significant differences in age (32.43 ± 4.03 years vs. 33.00 ± 3.34 years vs. 32.19 ± 3.37 years, P  < 0.001), pregnancy interval (4.06 ± 1.44 years vs. 3.52 ± 1.43 years vs. 3.38 ± 1.35 years, P  = 0.004), prepregnancy body mass index (BMI) (27.40 ± 4.62 kg/m2vs. 23.50 ± 3.52 kg/m2vs. 22.55 ± 3.47 kg/m2, P < 0.001), history of delivered macrosomia (22.7% vs. 11.0% vs. 6.2%, P < 0.001) among the development of diabetes mellitus (DM), recurrence of GDM, and normal women. Moreover, it seems so important in the degree of abnormal glucose metabolism in the first pregnancy to the recurrence of GDM and the development of DM. There are significant differences in OGTT levels of the first pregnancy such as area under the curve of OGTT value (18.31 ± 1.90 mmol/L vs. 16.27 ± 1.93 mmol/L vs. 15.55 ± 1.92 mmol/L, P < 0.001), OGTT fasting value (5.43 ± 0.48 mmol/L vs. 5.16 ± 0.49 mmol/L vs. 5.02 ± 0.47 mmol/L, P < 0.001), OGTT 1-hour value (10.93 ± 1.34 mmol/L vs. 9.69 ± 1.53 mmol/L vs. 9.15 ± 1.58 mmol/L, P < 0.001), OGTT 2-hour value (9.30 ± 1.66 mmol/L vs. 8.01 ± 1.32 mmol/L vs. 7.79 ± 1.38 mmol/L, P < 0.001), incidence of impaired fasting glucose (IFG) (fasting plasma glucose ≥5.6 mmol/L) (31.3% vs. 14.6% vs. 8.8%, P < 0.001), and incidence of two or more abnormal OGTT values (68.8% vs. 39.7% vs. 23.9%, P < 0.001) among the three groups. Using multivariate analysis, the factors, such as age (1.07 [1.02-1.12], P = 0.006), prepregnancy BMI (1.07 [1.02, 1.12], P  = 0.003), and area under the curve of OGTT in the first pregnancy (1.14 [1.02, 1.26], P  = 0.02), have an effect on maternal GDM recurrence; the factors, such as age (1.28 [1.01-1.61], P  = 0.04), pre-pregnancy BMI (1.26 [1.04, 1.53], P = 0.02), and area under the curve of OGTT in the first pregnancy (1.65 [1.04, 2.62], P = 0.03), have an effect on maternal DM developed further. CONCLUSIONS The history of GDM was significantly associated with a higher maternal risk for GDM recurrence during follow-up after the first pregnancy. The associated risk factors for GDM recurrence or development of DM include age, high pre-pregnancy BMI, history of delivered macrosomia, the OGTT level in the first pregnancy, such as the high area under the curve of OGTT, IFG, and two or more abnormal OGTT values. To prevent GDM recurrence, women with a history of GDM should do the preconception counseling before preparing next pregnancy.
Adult ; Blood Glucose/metabolism* ; China/epidemiology* ; Diabetes Mellitus, Type 2/epidemiology* ; Diabetes, Gestational ; Female ; Fetal Macrosomia ; Glucose Intolerance ; Humans ; Male ; Pregnancy ; Retrospective Studies

Gestational diabetes mellitus (GDM) is a growing public health problem worldwide that threatens both maternal and fetal health. Identifying individuals at high risk for GDM and diabetes after GDM is particularly useful for early intervention and prevention of disease progression. In the last decades, a number of studies have used metabolomics, genomics, and proteomic approaches to investigate associations between biomolecules and GDM progression. These studies clearly demonstrate that various biomarkers reflect pathological changes in GDM. The established markers have potential use as screening and diagnostic tools in GDM and in postpartum diabetes research. In the present review, we summarize recent studies of metabolites, single-nucleotide polymorphisms, microRNAs, and proteins associated with GDM and its transition to postpartum diabetes, with a focus on their predictive value in screening and diagnosis.
Pregnancy ; Female ; Humans ; Diabetes, Gestational/genetics* ; Proteomics ; Postpartum Period ; Biomarkers/metabolism* ; MicroRNAs/genetics* ; Diabetes Mellitus, Type 2

Introduction: The role of dietary intake on maternal glucose is uncertain. This study described the dietary characteristics of women with gestational diabetes mellitus (GDM) and examined the differences in dietary characteristics based on GDM diagnosis. Methods: This study recruited GDM women (n =45; age =31.1±5.1 years old) from health clinics in Seremban. Dietary intake, glycemic index (GI) and glycemic load (GL) were assessed using a semi-quantitative food frequency questionnaire (SFFQ) during first and second trimester of pregnancy. GDM diagnosis was made at 28 weeks gestation with the following cut-off for FPG ≥ 5.1 or 2hPG ≥ 7.8 mmol/L following oral glucose tolerance test. Results: Women with GDM had a reasonable intake of protein and fat but consumed high-carbohydrate at second trimester and high-sugar diet at both trimesters. Fibre, iron and calcium from the food sources did not meet the recommended nutrient intakes for pregnancy. About 75.6% (n = 34) GDM women had high 2hPG (9.3 ± 1.5 mmol/L) with a normal FPG (4.7 ± 0.7 mmol/L). While dietary characteristics were not significantly different, women with a higher 2hPG tended to take a higher proportion of protein at first trimester and a higher dietary GI, serving of rice, and sugars and creamer at second trimester than high FPG. Conclusion: Suboptimal maternal nutrition in women with GDM are of particular concern. Dietary characteristics of women with high fasting and 2-hour glucose were comparable but not optimal. The needs of tailored nutritional intervention are evident in women known to be at high risk of GDM.
Gestational diabetes mellitus (GDM) ;

BACKGROUND: We aimed to identify the postpartum metabolic factors that were associated with the development of diabetes in women with a history of gestational diabetes mellitus (GDM). In addition, we examined the role of the oral glucose tolerance test (OGTT) in the prediction of future diabetes. METHODS: We conducted a prospective study of 179 subjects who previously had GDM but did not have diabetes at 2 months postpartum. The initial postpartum examination including a 75-g OGTT and the frequently sampled intravenous glucose tolerance test (FSIVGTT) was performed 12 months after delivery, and annual follow-up visits were made thereafter. RESULTS: The insulinogenic index (IGI30) obtained from the OGTT was significantly correlated with the acute insulin response to glucose (AIRg) obtained from the FSIVGTT. The disposition indices obtained from the OGTT and FSIVGTT were also significantly correlated. Women who progressed to diabetes had a lower insulin secretory capacity including IGI30, AIRg, and disposition indices obtained from the FSIVGTT and OGTT compared with those who did not. However, the insulin sensitivity indices obtained from the OGTT and FSIVGTT did not differ between the two groups. Multivariate logistic regression analysis showed that the 2-hour glucose and disposition index obtained from the FSIVGTT were significant postpartum metabolic risk factors for the development of diabetes. CONCLUSION: We identified a crucial role of β-cell dysfunction in the development of diabetes in Korean women with previous GDM. The 2-hour glucose result from the OGTT is an independent predictor of future diabetes. Therefore, the OGTT is crucial for better prediction of future diabetes in Korean women with previous GDM.
Diabetes Mellitus, Type 2 ; Diabetes, Gestational ; Female ; Follow-Up Studies ; Glucose ; Glucose Tolerance Test ; Humans ; Insulin ; Insulin Resistance ; Logistic Models ; Postpartum Period ; Pregnancy ; Prospective Studies ; Risk Factors

BACKGROUND/AIMS: The purpose of this study was to compare maternal and neonatal outcomes in Korean women with type 2 diabetes and nondiabetic controls. METHODS: We performed a retrospective survey of 200 pregnancies in women with type 2 diabetes (n = 100) and nondiabetic controls (n = 100) who delivered from 2003 to 2010 at Cheil General Hospital & Women’s Healthcare Center, Korea. We compared maternal characteristics as well as maternal and neonatal outcomes between groups matched by age, pre-pregnancy weight, body mass index, parity, and gestational age at delivery. RESULTS: The number of infants that were small for gestational age and the rate of major congenital malformations were not significantly different. However, women with type 2 diabetes showed a slightly higher risk for primary caesarean section (35.0% vs. 18.0%, p = 0.006) as well as pre-eclampsia (10.0% vs. 2.0%, p = 0.017), infections during pregnancy (26.0% vs. 2.0%, p < 0.001), neonatal weight (3,370 ± 552.0 vs. 3,196 ± 543.3, p = 0.025), large for gestational age (22.0% vs. 9.0%, p = 0.011), and macrosomia (15.0% vs. 5.0%, p = 0.018) compared to nondiabetic controls. CONCLUSIONS: Maternal and neonatal outcomes for women with type 2 diabetes were worse than those for nondiabetic controls. Diabetic women have a higher risk for primary caesarean section, pre-eclampsia, infections during pregnancy, large neonatal birth weight, large for gestational age, and macrosomia.
Birth Weight ; Body Weight ; Cesarean Section ; Delivery of Health Care ; Diabetes Mellitus, Type 2 ; Female ; Gestational Age ; Hospitals, General ; Humans ; Infant ; Korea ; Parity ; Pre-Eclampsia ; Pregnancy ; Pregnancy Outcome ; Retrospective Studies

Gestational diabetes mellitus (GDM), defined as any degree of glucose intolerance with onset or first recognition during pregnancy, is characterized by underlying maternal defects in the β-cell response to insulin during pregnancy. Women with a previous history of GDM have a greater than 7-fold higher risk of developing postpartum diabetes compared with women without GDM. Various risk factors for postpartum diabetes have been identified, including maternal age, glucose levels in pregnancy, family history of diabetes, pre-pregnancy and postpartum body mass index, dietary patterns, physical activity, and breastfeeding. Genetic studies revealed that GDM shares common genetic variants with type 2 diabetes. A number of lifestyle interventional trials that aimed to ameliorate modifiable risk factors, including diet, exercise, and breastfeeding, succeeded in reducing the incidence of postpartum diabetes, weight retention, and other obesity-related morbidities. The present review summarizes the findings of previous studies on the incidence and risk factors of postpartum diabetes and discusses recent lifestyle interventional trials that attempted to prevent postpartum diabetes.
Body Mass Index ; Breast Feeding ; Diabetes Mellitus, Type 2* ; Diabetes, Gestational* ; Diet ; Epidemiology ; Female ; Glucose ; Glucose Intolerance ; Humans ; Incidence ; Insulin ; Life Style ; Maternal Age ; Motor Activity ; Postpartum Period ; Pregnancy ; Risk Factors

Vitamin D is an important secosteroid hormone in skeletal and non-skeletal systems. Vitamin D has relevance to muscle and immune function, hypertension, diabetes mellitus, cancer, and pregnancy because vitamin D receptors (VDR) are present in many non-skeletal tissues. Vitamin D acts on target tissues via the binding of its active form to VDR. As vitamin D affects not only bone metabolism but also glucose metabolism, vitamin D deficiency may affect the development of gestational diabetes mellitus and fetal growth. Although vitamin D deficiency is prevalent during pregnancy, there are conflicting reports on the effect of vitamin D deficiency on pregnancy complications, such as fetal growth restriction and gestational diabetes. This article reviews published papers on the effects of vitamin D on gestational diabetes and fetal growth.
Diabetes Mellitus ; Diabetes, Gestational* ; Female ; Fetal Development ; Glucose ; Hypertension ; Metabolism ; Pregnancy ; Pregnancy Complications ; Receptors, Calcitriol ; Vitamin D Deficiency ; Vitamin D* ; Vitamins*