Dataset Information

Long-term maternal cardiometabolic outcomes 22 years after gestational diabetes mellitus.

ABSTRACT:

Aims/introduction

Women with gestational diabetes mellitus are at increased risk for type 2 diabetes. We characterized the association between maternal glycemia during pregnancy with long-term outcomes.

Methods and methods

In this prospective nested case-cohort study, participants were recalled for follow up with detailed evaluation including oral glucose tolerance test at 8, 15 and 22 years. Logistic regression was used to estimate the risk of developing impaired glucose tolerance/type 2 diabetes and metabolic syndrome at follow up. The association between maternal glycemia at pregnancy and follow up was evaluated by linear regression. We also charted trajectory of β-cell function during follow up.

Results

The analysis included 121 women with a mean follow-up period of 22.5 years, and a mean age of 50.3 years. Gestational diabetes was associated with an adjusted odds ratio of 2.48 (95% confidence interval 1.03-5.99) for combined diabetes/impaired glucose tolerance at follow up (P = 0.04). Women with a pre-pregnancy body mass index ≥23 had an odds ratio of 5.43 (95% confidence interval 1.87-15.72) for metabolic syndrome at follow up, compared with those with body mass index <23 (P = 0.002). Both fasting and 2-h glucose during pregnancy were strongly associated with glycemic indices at follow up (P-value <0.001-0.016). Gestational diabetes was associated with impaired β-cell function that remained relatively stable after the index pregnancy.

Conclusions

Chinese women with a history of gestational diabetes have a high prevalence of impaired glucose tolerance/type 2 diabetes at 22-year follow up. Glucose levels during mid-pregnancy are strongly associated with those of middle age.

SUBMITTER: Tutino GE

PROVIDER: S-EPMC7378443 | biostudies-literature | 2020 Jul

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Long-term maternal cardiometabolic outcomes 22 years after gestational diabetes mellitus.

Tutino Greg E GE Tam Claudia Ht CH Ozaki Riza R Yuen Lai Yuk LY So Wing Yee WY Chan Michael Hm MH Ko Gary Tc GT Yang Xilin X Chan Juliana Cn JC Tam Wing Hung WH Ma Ronald Cw RC

Journal of diabetes investigation 20200220 4

<h4>Aims/introduction</h4>Women with gestational diabetes mellitus are at increased risk for type 2 diabetes. We characterized the association between maternal glycemia during pregnancy with long-term outcomes.<h4>Methods and methods</h4>In this prospective nested case-cohort study, participants were recalled for follow up with detailed evaluation including oral glucose tolerance test at 8, 15 and 22 years. Logistic regression was used to estimate the risk of developing impaired glucose toleranc ...[more]

PMID: 31912653

Similar Datasets

Project description:OBJECTIVES: To assess the maternal and fetal complications of pregnancy in mothers with gestational diabetes mellitus (GDM) compared with non-diabetic patients who delivered in the hospital during the study period. METHODS: The outcome of pregnancy in 220 Saudi patients with GDM identified from the delivery register/hospital database and matched for age, parity and body mass index with 220 non-diabetic controls were studied retrospectively from their case files. Patients with multiple pregnancies and abnormal presentation of the fetus were excluded from the study. RESULTS: The GDM patients were treated with either diet alone or with additional insulin in some patients who required better control of their blood sugar levels. Patients with GDM had a significantly higher incidence of pre-eclampsia (p<0.0001); preterm delivery (p=0.0226); induction of labor (p<0.0001); cesarean section (p=0.0019); higher mean birth weight (p<0.0001) of babies; large for gestational age infants (p=0.0011); macrosomia (p=0.0186); and admission to the neonatal intensive care unit (p=0.0003), compared with the control group. However, the rates of Apgar score <7 at 5 minutes, respiratory distress syndrome, neonatal hypoglycemia, hyperbilirubinemia and the need for phototherapy were similar in both groups of patients. Congenital anomalies and perinatal mortality rates were not significantly different in the two groups. CONCLUSION: GDM is recognized to be associated with increased rates of adverse maternal and neonatal outcomes, which are supported by the findings of this study. Even the mild form of GDM seems to have significant consequences for women and their offspring and is recommended to be aggressively treated. Evidence suggests that early diagnosis and strict control of blood sugar levels throughout the pregnancy can significantly reduce maternal and fetal complications. A multicenter, randomized controlled trial, based on universally accepted criteria for GDM screening test, standardized diagnostic OGTT and management of all patients with GDM versus the standard obstetric management of the control is warranted.

Project description:ObjectiveThe aim of this study was to evaluate the association of mild gestational diabetes mellitus (GDM) and obesity with metabolic and cardiovascular markers 5 to 10 years after pregnancy.Study designThis was a secondary analysis of 5- to 10-year follow-up study of a mild GDM treatment trial and concurrent observational cohort of participants ineligible for the trial with abnormal 1-hour glucose challenge test only. Participants with 2-hour glucose tolerance test at follow-up were included. The primary exposures were mild GDM and obesity. The outcomes were insulinogenic index (IGI), 1/homeostatic model assessment of insulin resistance (HOMA-IR), and cardiovascular markers vascular endothelial growth factor, (VEGF), vascular cell adhesion molecule 1 (VCAM-1), cluster of differentiation 40 ligand (CD40L), growth differentiation factor 15 (GDF-15), and suppression of tumorgenesis 2 (ST-2). Multivariable linear regression estimated the association of GDM and obesity with biomarkers.ResultsOf 951 participants in the parent study, 642 (68%) were included. Lower 1/HOMA-IR were observed in treated and untreated GDM groups, compared with non-GDM (mean differences, -0.24 and -0.15; 95% confidence intervals [CIs], -0.36 to -0.12 and -0.28 to -0.03, respectively). Lower VCAM-1 (angiogenesis) was observed in treated GDM group (mean difference, -0.11; 95% CI, -0.19 to -0.03). GDM was not associated with IGI or other biomarkers. Obesity was associated with lower 1/HOMA-IR (mean difference, -0.42; 95% CI, -0.52 to -0.32), but not other biomarkers.ConclusionPrior GDM and obesity are associated with more insulin resistance but not insulin secretion or consistent cardiovascular dysfunction 5 to 10 years after delivery.Key points· Mild GDM increases the risk of insulin resistance 5 to 10 years postpartum but not pancreatic dysfunction.. · Obesity increases the risk of insulin resistance 5 to 10 years postpartum but not pancreatic dysfunction.. · Neither mild GDM nor obesity increased the risk of cardiovascular dysfunction 5 to 10 years postpartum..

Project description:IntroductionGestational diabetes mellitus (GDM) is associated with a myriad of maternal and fetal complications that severely compromise the mother and child's future health. Dietary interventions are effective in reducing the risk of GDM. However, when diagnosed with GDM in 2nd and 3rd the effectiveness of these interventions on maternal and fetal health remains unexplored. Therefore, this review critically examines existing literature for short- and long-term maternal and fetal outcomes of dietary interventions followed after GDM diagnosis.MethodologyAn extensive literature search through Scopus, PubMed, and Web of Science was conducted to include original, full-text articles published in English between 2013 and April 2024. All randomized controlled trials, case-control, prospective cohort studies, and longitudinal follow-up trials that recruited GDM mothers following dietary interventions upon diagnosis were included. However, pre-pregnancy interventional, retrospective, and prospective studies reporting maternal and fetal outcomes in healthy pregnant women were excluded. This review followed the Narrative Review Checklist by the Academy of Nutrition & Dietetics, Elsevier.ResultsWe reviewed the effects of eight popular dietary interventions on various short and long-term materno-fetal outcomes in women recently diagnosed with GDM. Dietary interventions such as Mediterranean, Dietary Approaches to Stop Hypertension (DASH), and low-GI positively affected both short and long-term maternal and fetal outcomes. In contrast, fasting during Ramadan negatively affected maternal and fetal outcomes. Studies with low-carb, high-protein, and calorie restriction reported mixed findings for materno-fetal outcomes. Although certain dietary interventions have shown beneficial effects in the past literature, their findings were limited by small sample size, short intervention duration, and inconsistencies in the outcomes and population studied, compromising the quality of evidence. Further, we observed a scarcity of studies exploring the effect of dietary interventions followed during 2nd and 3rd trimesters after being diagnosed with GDM on long-term materno-fetal outcomes.ConclusionDietary interventions followed during 2nd and 3rd trimesters after the diagnosis of GDM may be crucial for preventing short and long-term materno-fetal complications; however, there is a lack of strong evidence to support this notion. Future studies are recommended to monitor the long-term materno-fetal outcomes of GDM.

Project description:Background and objectives: Gestational diabetes mellitus (GDM) is known to be associated with pregnancy complications but there is limited evidence about the strength of these associations in recent clinical practice, especially after the introduction of strict guidelines for the management of pregnancies with GDM in a multidisciplinary team setting. The objectives of our study were to first compare the rates of complications in pregnancies with GDM with those that had pre-existing diabetes mellitus and those without diabetes; and second, to derive measures of effect size expressed as odds ratios after adjustment for confounding factors to assess the independent association of GDM in prediction of these pregnancy complications. Materials and Methods: This was a prospective cohort study undertaken at a large maternity unit in the United Kingdom between January 2010 and June 2022. We included singleton pregnancies that were booked at our unit at 11-13 weeks' gestation. Multivariate regression analysis was carried out to determine the risks of complications in pregnancies with GDM after adjusting for pregnancy characteristics. Risks were expressed as odds ratio (OR) (95% confidence intervals [CI]) and expressed graphically in forest plots. Results: The study population included 53,649 singleton pregnancies including 509 (1%) with pre-existing DM, 2089 (4%) with GDM and 49,122 (95%) pregnancies without diabetes. Multivariate regression analysis demonstrated that there was a significant independent contribution from GDM in the prediction of adverse outcomes, including maternal complications such as preterm delivery, polyhydramnios, preeclampsia and delivery of large for gestational age neonates and elective caesarean section (CS); and neonatal complications including admission to neonatal intensive care unit, hypoglycaemia, jaundice and respiratory distress syndrome. Conclusions: GDM is associated with an increased rate of pregnancy complications compared to those without diabetes, even after adjustment for maternal and pregnancy characteristics. GDM does not increase the risk of stillbirth, hypoxic ischaemic encephalopathy or neonatal death.

Dataset Information

Long-term maternal cardiometabolic outcomes 22 years after gestational diabetes mellitus.

Aims/introduction

Methods and methods

Results

Conclusions

Publications

Long-term maternal cardiometabolic outcomes 22 years after gestational diabetes mellitus.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets