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Concept: Gestational diabetes

151

 What is the association between potato consumption before pregnancy and the risk of gestational diabetes mellitus (GDM)?

Concepts: Pregnancy, Diabetes mellitus, Diabetes, Obstetrics, Gestational diabetes, American Diabetes Association, Glycemic index

149

This study assessed indicators of the need for insulin therapy and the effect of treatment on pregnancy outcomes in Japanese patients with gestational diabetes mellitus (GDM). All patients diagnosed with GDM were hospitalized for three days. Plasma glucose profiles in patients under strict dietary management and the characteristics of GDM patients with high daily glucose levels were investigated. Patients who failed to achieve glycemic targets were treated with insulin. Indicators of the need for insulin treatment were investigated. Pregnancy outcomes in patients prescribed dietary management and patients prescribed insulin treatment were compared. The study included 112 patients with GDM. GDM patients with high daily glucose levels in the hospital exhibited significantly higher 1-h and 2-h plasma glucose levels in oral glucose tolerance tests (OGTTs) at diagnosis. In our hospital, 102 GDM patients with singleton pregnancies were followed until delivery; 32 (31.3%) were treated with insulin. Univariate analysis identified significant associations of insulin requirement with family history of diabetes and with 1-h and 2-h OGTT values at diagnosis. Multivariate analysis showed that the 1-h OGTT plasma glucose level at diagnosis was an independent predictor of the need for insulin. In perinatal outcomes, insulin treatment was associated with low birth weight.

Concepts: Pregnancy, Insulin, Diabetes mellitus, Blood sugar, Obstetrics, Glucose tolerance test, Insulin resistance, Gestational diabetes

140

Gestational diabetes mellitus (GDM), one of the common metabolic disorders of pregnancy, leads to functional alterations in various cells including stem cells as well as some abnormalities in fetal development. Perivascular stem cells (PVCs) have gained more attention in recent years, for the treatment of various diseases. However, the effect of GDM on PVC function has not been investigated. In our study, we isolated PVCs from umbilical cord of normal pregnant women and GDM patients and compared their phenotypes and function. There is no significant difference in phenotypic expression, response to bFGF exposure and adipogenic differentiation capacity between normal PVCs and GDM-PVCs. However, when compared with normal PVCs, early passage GDMPVCs displayed decreased initial rates of cell yield and proliferation as well as a reduced ability to promote wound closure. These results suggest that maternal metabolic dysregulation during gestation can alter the function of endogenous multipotent stem cells, which may impact their therapeutic effectiveness.

Concepts: Pregnancy, Embryo, Prenatal development, Fetus, Diabetes mellitus, Developmental biology, Obstetrics, Gestational diabetes

126

Cold-induced thermogenesis is known to improve insulin sensitivity, which may become increasingly relevant in the face of global warming. The aim of this study was to examine the relation between outdoor air temperature and the risk of gestational diabetes mellitus.

Concepts: Insulin, Diabetes mellitus type 2, Diabetes mellitus, Obesity, Diabetes, Insulin resistance, Metabolic syndrome, Gestational diabetes

74

Being overweight is an important risk factor for Gestational Diabetes Mellitus (GDM), but the underlying mechanisms are not understood. Weight change between pregnancies has been suggested to be an independent mechanism behind GDM. We assessed the risk for GDM in second pregnancy by change in Body Mass Index (BMI) from first to second pregnancy and whether BMI and gestational weight gain modified the risk.

Concepts: Pregnancy, Diabetes mellitus, Obesity, Diabetes, Mass, Obstetrics, Body mass index, Gestational diabetes

73

The effectiveness of exercise training for preventing excessive gestational weight gain (GWG) and gestational diabetes mellitus (GDM) is still uncertain. As maternal obesity is associated with both GWG and GDM, there is a special need to assess whether prenatal exercise training programs provided to obese women reduce the risk of adverse pregnancy outcomes. Our primary aim was to assess whether regular supervised exercise training in pregnancy could reduce GWG in women with prepregnancy overweight/obesity. Secondary aims were to examine the effects of exercise in pregnancy on 30 outcomes including GDM incidence, blood pressure, blood measurements, skinfold thickness, and body composition.

Concepts: Pregnancy, Nutrition, Embryo, Fetus, Diabetes mellitus, Obesity, Obstetrics, Gestational diabetes

34

Women who developed gestational diabetes mellitus represent a high-risk population for hypertension later in life. The role of diet in the progression of hypertension among this susceptible population is unknown. We conducted a prospective cohort study of 3818 women with a history of gestational diabetes mellitus in the Nurses' Health Study II as part of the ongoing Diabetes & Women’s Health Study. These women were followed-up from 1989 to 2011. Incident hypertension was identified through self-administered questionnaires that were validated previously by medical record review. Adherence scores for the alternative Healthy Eating Index 2010, the alternative Mediterranean diet, and the Dietary Approaches to Stop Hypertension were computed for each participant. Cox proportional hazard models were used to evaluate the associations between dietary scores and hypertension while adjusting for major risk factors for hypertension. We documented 1069 incident hypertension cases during a median of 18.5 years of follow-up. After adjustment for major risk factors for hypertension, including body mass index, alternative Healthy Eating Index 2010, alternative Mediterranean diet, and Dietary Approaches to Stop Hypertension scores were significantly inversely associated with the risk of hypertension; hazard ratio and 95% confidence interval comparing the extreme quartiles (highest versus lowest) were 0.76 (0.61-0.94;Pfor linear trend =0.03) for AHEI score, 0.72 (0.58-0.90;Pfor trend =0.01) for Dietary Approach to Stop Hypertension score, and 0.70 (0.56-0.88;Pfor trend =0.002) for alternative Mediterranean diet score. Adherence to a healthful dietary pattern was related to a lower subsequent risk of developing hypertension among women with a history of gestational diabetes mellitus.

Concepts: Health, Epidemiology, Nutrition, Proportional hazards models, Diabetes mellitus, Obesity, Gestational diabetes, Diabetic diet

28

To evaluate the effect of metformin and insulin in glycemic control and compare pregnancy outcome in women with gestational diabetes mellitus (GDM).

Concepts: Pregnancy, Clinical trial, Diabetes mellitus, Obesity, Diabetes, Obstetrics, Insulin resistance, Gestational diabetes

27

MiR-98 expression was up-regulated in kidney in response to early diabetic nephropathy in mouse and down-regulated in muscle in type 2 diabetes in human. However, the expression prolife and functional role of miR-98 in human gestational diabetes mellitus (GDM) remained unclear. Here, we investigated its expression and function in placental tissues from GDM patients and the possible molecular mechanisms. The results showed that miR-98 was up-regulated in placentas from GDM patients compared with normal placentas. MiR-98 over-expression increased global DNA methylational level and miR-98 knockdown reduced global DNA methylational level. Further investigation revealed that miR-98 could inhibit Mecp2 expression by binding the 3'-untranslated region (UTR) of methyl CpG binding protein 2 (Mecp2), and then led to the expression dysregulation of canonical transient receptor potential 3 (Trpc3), a glucose uptake related gene. More importantly, in vivo analysis found that the expression level of Mecp2 and Trpc3 in placental tissues from GDM patients, relative to the increase of miR-98, was diminished, especially for GDM patients over the age of 35 years. Collectively, up-regulation of miR-98 in the placental tissues of human GDM is linked to the global DNA methylation via targeting Mecp2, which may imply a novel regulatory mechanism in GDM.

Concepts: DNA, Protein, Insulin, Diabetes mellitus type 2, Diabetes mellitus, Glucose, Diabetes, Gestational diabetes

27

The Clinical Use Physical Activity Questionnaire for Pregnancy (CPAQpreg) is proposed as a rapid, simple and accurate method to identify pregnant women whose levels of physical activity fail to meet those recommended by the Royal College of Obstetricians and Gynaecologists (RCOG).(1) METHODS: A pilot validation of CPAQpreg was performed at Leeds General Infirmary, UK. Each participant completed CPAQpreg and the Pregnancy Physical Activity Questionnaire (PPAQ). PPAQ has previously been validated for use in pregnancy but is both time consuming and difficult to interpret.(2) Total amounts of physical activity (MET minutes/week(-1)) were calculated for each questionnaire and subdivided by intensity; moderate, vigorous and combined (moderate+vigorous). Each participant was classified as active or inactive in accordance with RCOG physical activity guidance.

Concepts: Pregnancy, Childbirth, Uterus, Obstetrics, Gestational diabetes, Abortion, Ectopic pregnancy, Royal College of Obstetricians and Gynaecologists