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Aims: To assess the association of uric acid (UA) with the risks of postpartum type 2 diabetes and prediabetes among women with prior gestational diabetes mellitus (GDM).Methods: We performed a cross-sectional study of 1262 GDM women at 1-5 years after delivery using the baseline data from the Tianjin Gestational Diabetes Mellitus Prevention Program. Logistic regression models were used to estimate the association of different levels of serum UA with the risks of type 2 diabetes and prediabetes.Results: The multivariable-adjusted odds ratios (ORs) across quartiles of serum UA were 1.00, 1.23 (95% confidence interval [CI] 0.55-2.78), 2.05 (95% CI 0.96-4.39), and 3.17 (95% CI 1.54-6.55) (Ptrend < 0.001) for type 2 diabetes, and 1.00, 1.50 (95% CI 1.03-2.19), 2.28 (95% CI 1.58-3.30), and 2.88 (95% CI 1.99-4.17) (Ptrend < 0.001) for prediabetes, respectively. Restricted cubic splines models showed positive linear associations of serum UA as a continuous variable with the risks of type 2 diabetes and prediabetes. This positive association was significant when stratified by healthy weight and overweight participants.Conclusions: Serum UA levels have a graded positive association with the risks of type 2 diabetes and prediabetes among Chinese with a history of GDM. [ABSTRACT FROM AUTHOR]

Aims: To investigate the risk of postpartum metabolic syndrome in women with GDM compared with those without GDM in a Chinese population.Methods: Tianjin GDM observational study included 1263 women with a history of GDM and 705 women without GDM. Multivariate logistic regression was used to assess risks of postpartum metabolic syndrome between women with and without GDM. Postpartum metabolic syndrome was diagnosed by two commonly used criteria.Results: During a mean 3.53 years of follow up, 256 cases of metabolic syndrome were identified by using the NCEP ATPIII criteria and 244 cases by using the IDF criteria. Multivariable-adjusted odds ratios of metabolic syndrome in women with GDM compared with those without GDM were 3.66 (95% confidence interval [CI] 2.02-6.63) for NCEP ATPIII criteria and 3.90 (95% CI 2.13-7.14) for IDF criteria. Women with GDM had higher multivariable-adjusted odds ratios of central obesity, hypertriglyceridemia, and high blood pressure than women without GDM. The multivariable-adjusted odds ratios of low HDL cholesterol and hyperglycemia were not significant between women with and without GDM, however, the multivariable-adjusted odds ratio of hyperglycemia became significant when we used the modified criteria.Conclusions: The present study indicated that women with prior GDM had significantly higher risks for postpartum metabolic syndrome, as well as its individual components. [ABSTRACT FROM AUTHOR]

Aims: To examine associations between the indicators of socio-economic status (SES) and gestational diabetes mellitus (GDM).Methods: From 2010 to 2012, 17 659 women underwent glucose challenge test (GCT) and oral glucose tolerance test if GCT ≥ 7.8 mmol/L at 24-28 gestational weeks in 6 urban districts of Tianjin, China. Binary logistic regression was used to obtain adjusted odds ratio (OR) of SES for GDM, as defined by education attainment and family monthly income.Results: A total of 1264 women (7.2%) were found to have GDM. If the women with low-middle income and high school or below used as the reference group, the middle-high income group and the high income group were associated with decreased risks of GDM (OR: 0.85, 95%CI: 0.71-1.00 & 0.80, 0.65-0.98) while tertiary education attainment was associated with decreased risk of GDM (0.75, 0.58-0.97). Women with higher income and/or higher education attainment tended to have a decreased risk of GDM (P for trend: 0.0105). All these significant ORs were attenuated to be non-significant by adjustment for pre-pregnancy body mass index (BMI), but not by adjustment for gestational weight gain (GWG).Conclusions: In urban Tianjin, indicators of high SES were associated with decreased risk of GDM via decreased pre-pregnancy BMI. [ABSTRACT FROM AUTHOR]

• Pregnancy overweight was associated with a 2.3-fold risk of macrosomia and large-for-gestational age (LGA) infants. • Gestational diabetes (GDM) and prepregnancy overweight had a synergistic effect on the risk of macrosomia and LGA. • Our findings highlight the importance to maintain normal body weight before pregnancy for perinatal health. Obesity increases risk of gestational diabetes mellitus (GDM) and GDM increases risk of macrosomia but their inter-relations for increased risk of macrosomia remain uncertain. We aimed to examine associations between prepregnancy overweight and macrosomia, and synergistic effects between prepregnancy overweight and GDM on macrosomia. From 2010 to 2012, 19,622 women in urban Tianjin, China, underwent a 50-g 1-h glucose challenge test (GCT) at 24–28 gestational weeks and followed by a 75-g 2-h oral glucose tolerance test (OGTT) if the GCT value was ≥ 7.8 mmol/L. GDM was defined according to International Association of Diabetes and Pregnancy Study Group's criteria. Overweight was defined as body mass index ≥ 24.0 kg/m2. Logistic regression was performed to obtain odds ratios (ORs) and 95% confidence intervals (CIs). Additive interaction between prepregnancy overweight and GDM was used to test synergistic effects. In the cohort, 1791 (9.1%) and 1726 (8.8%) of the women delivered a macrosomic infant or a large-for-gestational-age (LGA) infant, respectively. Prepregnancy overweight was associated with increased risk of macrosomia and LGA with adjusted ORs being 2.29 (95%CI: 2.07–2.54) and 2.27 (2.05–2.52), respectively. Copresence of prepregnancy overweight and GDM greatly enhanced the adjusted ORs of overweight alone (ORs for macrosomia and LGA: 2.17, 1.94–2.42 & 2.21,1.98–2.47) and GDM alone (ORs for macrosomia and LGA: 2.01,1.48–2.72 & 2.14, 1.60–2.87) for macrosomia and LGA to 5.29 (4.07–6.87) for macrosomia and 4.72 (3.66–6.10) for LGA, with significant additive interactions. Prepregnancy overweight increased the risks of macrosomia and LGA independently and synergistically with GDM. [ABSTRACT FROM AUTHOR]

Aims: Very few studies have assessed the association of fasting and 2h glucose, and HbA1c during pregnancy with postpartum diabetes risk among women with prior gestational diabetes mellitus (GDM). We assessed the association of fasting glucose, 2h glucose and HbA1c at 26-30 gestational weeks with postpartum diabetes risk among women with prior GDM.Methods: A cohort study in 1263 GDM women at 1-5 years after delivery was performed. Cox proportional hazards regression models were used to evaluate the association of fasting and 2h plasma glucose, and HbA1c at 26-30 gestational weeks with the risk of diabetes at postpartum.Results: The multivariable-adjusted (age, pre-pregnancy body mass index, weight gain during pregnancy, current body mass index, family history of diabetes, marital status, education, family income, smoking status, passive smoking, leisure-time physical activity, alcohol drinking, and intake of energy, saturated fat, and dietary fiber) hazard ratios of postpartum diabetes were 1.61 (95% confidence interval [CI]: 1.36-1.91) for each 1 mmol/l increase in fasting glucose during pregnancy, 1.63 (95% CI: 1.45-1.84) for each 1 mmol/l increase in 2h glucose during pregnancy, 2.11 (95% CI: 1.50-2.97) for each 1 unit (%) increase in HbA1c during pregnancy. When fasting glucose, 2h glucose and HbA1c during pregnancy were entered multivariable-adjusted model simultaneously, 2h glucose and HbA1c but not fasting glucose remained to be significant and positive predictors for postpartum diabetes.Conclusions: For women with prior GDM, 2h plasma glucose and HbA1c during pregnancy are independent predictors of postpartum diabetes, but fasting plasma glucose during pregnancy is not. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To evaluate the association of maternal fasting glucose levels at 4-12 gestational weeks with anthropometry in the offspring from birth to 12 months in Tianjin, China. DESIGN AND METHODS: A total of 57,454 pregnant women underwent a fasting glucose test during the first trimester, and their children had body weight/length measured from birth to 12 months of age. RESULTS: Maternal fasting glucose concentrations at 4-12 gestational weeks were positively associated with Z scores for birth weight, birth length, birth weight for length, and birth body mass index (BMI). Infants born to mothers with fasting glucose concentrations >=126mg/dL (7.0mmol/l) had had the highest mean Z scores for birth weight, birth length, birth weight for length and birth BMI for gestational age, and the lowest mean Z scores for weight and length for age at months 3, 6, 9, and 12, the smallest changes in Z scores for weight for age, weight for length, and BMI for age from birth to month 3, and largest changes in Z scores for weight for age, and BMI for age after 6 months. CONCLUSIONS: Higher maternal fasting glucose during pregnancy was associated with larger birth weight and birth length, less weight gain and length gain in the first 3 months of life, and more weight gain in months 6-12 of life. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To evaluate the association of maternal fasting glucose levels at 4–12 gestational weeks with anthropometry in the offspring from birth to 12 months in Tianjin, China. Design and methods: A total of 57,454 pregnant women underwent a fasting glucose test during the first trimester, and their children had body weight/length measured from birth to 12 months of age. Results: Maternal fasting glucose concentrations at 4–12 gestational weeks were positively associated with Z scores for birth weight, birth length, birth weight for length, and birth body mass index (BMI). Infants born to mothers with fasting glucose concentrations ≥126mg/dL (7.0mmol/l) had had the highest mean Z scores for birth weight, birth length, birth weight for length and birth BMI for gestational age, and the lowest mean Z scores for weight and length for age at months 3, 6, 9, and 12, the smallest changes in Z scores for weight for age, weight for length, and BMI for age from birth to month 3, and largest changes in Z scores for weight for age, and BMI for age after 6 months. Conclusions: Higher maternal fasting glucose during pregnancy was associated with larger birth weight and birth length, less weight gain and length gain in the first 3 months of life, and more weight gain in months 6–12 of life. [Copyright &y& Elsevier]

Aims: To explore associations between adverse pregnancy outcomes and risk of postpartum diabetes and prediabetes among Chinese women with gestational diabetes mellitus (GDM).Methods: A total of 507 women with GDM who participated in a randomized controlled trial were successfully followed up at a median of 9.1  (interquartile range: 7.7-11.3) weeks after delivery and underwent a 75 g 2-h oral glucose tolerance test. GDM was diagnosed according to the International Association of Diabetes and Pregnancy Study Group's criteria. Postpartum diabetes and prediabetes were defined by the World Health Organization's. Generalized logit model was used to obtain odds ratios (OR) and 95% confidence interval (CI) of adverse pregnancy outcomes for postpartum diabetes, prediabetes and abnormal glucose regulation (AGR).Results: Of 507 women with GDM, 3.7% (19) women developed postpartum diabetes, 35.1% (178) women developed postpartum prediabetes. Preterm birth was associated with increased risk of postpartum prediabetes and AGR (adjusted OR: 3.24, 95%CI: 1.48-7.07 & 3.16, 1.46-6.85). Low birth weight was associated with the risk of postpartum prediabetes, diabetes and AGR (adjusted OR: 2.78, 95%CI: 1.13-6.86; 5.21, 1.13-24.02 & 2.99, 1.24-7.21).Conclusions: Preterm birth and low birth weight were predictive of postpartum prediabetes, diabetes or AGR in Chinese women with GDM. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To assess whether lifestyle intervention can reduce type 2 diabetes risk in women with prior GDM in the Tianjin Gestational Diabetes Mellitus (GDM) Prevention Program. Methods: 1180 women who were diagnosed with GDM from 2005 to 2009 were randomly assigned to either a lifestyle intervention (n =586) or a control group (n =594). Major elements of the intervention include six face-to-face meetings with study dietitians in the first year, and two additional sessions and two telephone calls in second year. Results: During the first year, average body weight loss in the first 404 subjects was 1.40kg (2.1%) in the intervention group vs 0.21kg (0.3%) in the control group (P =0.001), and the decrease was more significant among baseline overweight women (body bass index [BMI]≥24kg/m2) in the intervention (2.91kg/4.2%) compared with that in the control group (0.51kg/0.7%) (P <0.001). In addition, women in the intervention group, compared with those in the control group, have decreased BMI, body fat, waist circumference, and plasma insulin levels, and have improved behaviors including increased leisure time activity and dietary fiber intake and decreased sedentary time and fat consumptions. Conclusion: The interim results support the efficacy and feasibility of the lifestyle intervention program. [Copyright &y& Elsevier]

Aims: To explore associations between ceramides in early pregnancy and gestational diabetes mellitus (GDM); and interactions between ceramides and trimethylamine N-oxide (TMAO) metabolites for GDM.Methods: We organized a 1:1 nested case-control study (n = 486) from a prospective cohort of pregnant women. Conditional logistic regression and additive interaction were performed to examine relationships between ceramides and TMAO metabolites for GDM. We defined trimethylamine (TMA) conversion ratio (TMAR) as TMA/its precursors and TMAO conversion ratio (TMAOR) as TMAO/TMA. Copresence of high TMAR and low TMAOR indicated TMA accumulation status.Results: High ceramides 18:0 (per SD), 18:1 (per SD) and low ceramide 24:0 (≤ 3.60 nmol/mL) were associated with increased GDM risk (OR: 1.69, 1.72 & 3.59, respectively). High TMA enhanced the OR of low ceramide 24:0 for GDM from 1.53 (95%CI: 0.88-2.66) to 10.3 (2.83-37.5), high TMAR enhanced it from 1.31 (0.67-2.56) to 24.3 (6.57-89.5) and TMA accumulation enhanced it from 1.42 (0.72-2.77) to 25.5 (6.80-95.7), with all additive interactions being significant. However, the interactions between high ceramide 18 and TMAO metabolites were not significant.Conclusions: High ceramides 18:0, 18:1 and low ceramide 24:0 in early pregnancy were associated with increased GDM risk. Notably, TMA accumulation greatly amplified the risk-promoting effect of low ceramide 24:0 for GDM. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the independent or combined effects of gestational diabetes (GDM) and pre-pregnancy and postpartum BMI on the odds of postpartum diabetes and hyperglycemia.Methods: The study samples included 1263 women with prior GDM and 705 women without GDM. Postpartum 1-7 years diabetes was diagnosed by the standard oral glucose tolerance test.Results: The multivariable-adjusted odds ratios among women with prior GDM, compared with those without it, were 7.52 for diabetes and 2.27 for hyperglycemia. The multivariable-adjusted odds ratios at different postpartum BMI levels (<24, 24-27.9, and ≥ 28 kg/m2) were 1.00, 2.80, and 8.08 for diabetes (Ptrend < 0.001), and 1.00, 2.10, and 4.42 for hyperglycemia (Ptrend < 0.001), respectively. Women with high body fat (≥31.9%) or abdominal obesity (≥85 cm) had a 2.7-6.9-fold higher odds ratio for diabetes or hyperglycemia. Women with both obesity and prior GDM had the highest risk of diabetes or hyperglycemia compared with non-obese women without GDM. Non-obese women with prior GDM had the same risk of diabetes and hyperglycemia as non-GDM women with obesity. When using Cox regression models, the results were very close to those using logistic regression models.Conclusions: Maternal prior GDM and pre-pregnancy or postpartum obesity contribute equally to postpartum diabetes and hyperglycemia risk. [ABSTRACT FROM AUTHOR]

Aims: Obesity increases risk of gestational diabetes mellitus (GDM) and GDM increases risk of macrosomia but their inter-relations for increased risk of macrosomia remain uncertain. We aimed to examine associations between prepregnancy overweight and macrosomia, and synergistic effects between prepregnancy overweight and GDM on macrosomia.Methods: From 2010 to 2012, 19,622 women in urban Tianjin, China, underwent a 50-g 1-h glucose challenge test (GCT) at 24-28 gestational weeks and followed by a 75-g 2-h oral glucose tolerance test (OGTT) if the GCT value was ≥ 7.8 mmol/L. GDM was defined according to International Association of Diabetes and Pregnancy Study Group's criteria. Overweight was defined as body mass index ≥ 24.0 kg/m2. Logistic regression was performed to obtain odds ratios (ORs) and 95% confidence intervals (CIs). Additive interaction between prepregnancy overweight and GDM was used to test synergistic effects.Results: In the cohort, 1791 (9.1%) and 1726 (8.8%) of the women delivered a macrosomic infant or a large-for-gestational-age (LGA) infant, respectively. Prepregnancy overweight was associated with increased risk of macrosomia and LGA with adjusted ORs being 2.29 (95%CI: 2.07-2.54) and 2.27 (2.05-2.52), respectively. Copresence of prepregnancy overweight and GDM greatly enhanced the adjusted ORs of overweight alone (ORs for macrosomia and LGA: 2.17, 1.94-2.42 & 2.21,1.98-2.47) and GDM alone (ORs for macrosomia and LGA: 2.01,1.48-2.72 & 2.14, 1.60-2.87) for macrosomia and LGA to 5.29 (4.07-6.87) for macrosomia and 4.72 (3.66-6.10) for LGA, with significant additive interactions.Conclusions: Prepregnancy overweight increased the risks of macrosomia and LGA independently and synergistically with GDM. [ABSTRACT FROM AUTHOR]