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Background: To investigate the causal link between early-life exposures and long-term health consequences, we established the Tianjin Birth Cohort (TJBC), a large-scale prospective cohort in northern China. Methods: TJBC aims to enroll 10,000 families with follow-ups from pregnancy until children’s six year-old. Pregnant women and their spouses were recruited through a three-tier antenatal healthcare system at early pregnancy, with follow-ups at mid-pregnancy, late pregnancy, delivery, 42 days after delivery, 6 months after delivery, and each year until 6 years old. Antenatal/neonatal examination, biological samples and questionnaires were collected. Results: From August 2017 to January 2019, a total of 3,924 pregnant women have already been enrolled, and 1,697 women have given birth. We observed the prevalence of gestational diabetes mellitus as 18.1%, anemia as 20.4%, and thyroid hypofunction as 2.0%. In singleton live births, 5.6% were preterm birth (PTB), 3.7% were low birth weight, and 7.3% were macrosomia. Based on current data, we also identified maternal/paternal factors which increased the risk of PTB, including paternal age (OR 1.07; 95% CI, 1.01–1.14 for each year increase), vaginal bleeding during pregnancy (OR 2.82; 95% CI, 1.54–5.17) and maternal early-pregnancy BMI (OR 1.08; 95% CI, 1.01–1.15 for each kg/m2 increase). Conclusion: TJBC has the strength of collecting comprehensive maternal, paternal, and childhood information. With a diverse range of biological samples, we are also engaging with emerging new technologies for multi-omics research. The study would provide new insight into the causal link between macro/micro-environmental exposures of early life and short/long-term health consequences.

Aims/Introduction We investigated the association between leukocyte counts and glucose challenge test (GCT) level during pregnancy. Materials and Methods We collected prenatal information of women who had their first clinic visit in early pregnancy. Women underwent GCT at 24–28 gestational weeks, and a result of ≥7.8 mmol/L was considered positive. Participants were divided into quartiles of leukocyte counts, and association with GCT results and positive rate were analyzed by logistic regression. Results Among 20,707 pregnant women, the median of leukocyte counts was higher in the positive group than the normal group (8.5 × 109/L vs 8.2 × 109/L, P 9.70 × 109/L) was significantly associated with positive GCT results (adjusted odds ratio 1.378, 95% confidence interval 1.246–1.524), and the linear relationship between increased risk of positive result and increasing leukocyte quartiles persisted (P for linear trend, There was a linear trend in glucose challenge test results and positive rate with increasing leukocyte quartiles. Elevated leukocyte counts in early pregnancy were independently and linearly associated with the risk of positive glucose challenge test levels, indicating that inflammation might play an important role in the development of gestational diabetes mellitus.

Background: Gestational diabetes mellitus (GDM) is a major macrosomia risk factor. Variations in the catechol-O-methyltransferase (COMT; rs4680) genotypes are associated with heightened susceptibility to environmental exposures and nutritional conditions. However, macrosomia risks associated with COMT genetics, epigenetics, and the interaction between genetic and epigenetics among children with and without exposure to GDM are unknown. Methods: Data from women/children pairs (n = 1087) who participated in the Tianjin Gestational Diabetes Birth Cohort were used to examine the odds of being born with macrosomia associated with COMT-genotypes, 55 CpG sites located on the COMT gene, and genetic and epigenetic interactions. Odds of macrosomia associated with COMT genetic, epigenetic, genetic and epigenetic interactions, and moderations with GDM were tested using adjusted logistic regression models. Results: Overall, 16.1% (n = 175) of children were born with macrosomia. Models showed that children with at least one copy of the minor allele (A) had higher odds of macrosomia (odds ratio, 1.82; 95% confidence interval 1.25–2.64) compared with children with the GG-genotype. After false discovery rate corrections, none of the 55 CpG sites located on the COMT gene was associated with odds of macrosomia. The genetic and epigenetic associations were not modified by exposure to GDM. Conclusion: Findings suggest carriers of the COMT GG-genotype had lower odds of macrosomia, and this association was not modified by epigenetics or exposure to GDM.

AIMS Aim of this study is to assess dyslipidemia risk between children exposed to maternal gestational diabetes mellitus (GDM) and those not exposed. METHODS We recruited 1144 mother-child pairs (572 GDM and 572 non-GDM women matched by their offspring's age and sex). The age of offspring ranged from 3 to 9 years old. We used general linear models to compare mean values of different lipid profiles among children born to mothers with and without GDM. Logistic regression models were used to assess associations of maternal GDM with abnormal lipid profiles in offspring. RESULTS After adjustment for maternal and children's characteristics, children born to mothers with GDM had lower mean values of high-density-lipoprotein (HDL) cholesterol (1.40 ± 0.01 vs. 1.50 ± 0.01; p

We present a generic and accurate method to transfer part-level labels from annotated 3D shapes to images or annotated images to 3D shapes. The label transfer problem is formulated as a Conditional random field (CRF) model, in which a novel local correspondence encoding term encoding the probability of label assignment of each pixel as a label histogram serves as the likelihood of the labels. With the aid of local correspondence encoding, highly accurate part-level label transfer results can be easily achieved. Our method works well for the bi-directional label transfer between 3D shapes and images, suitable to image-guided 3D shape segmentation, 3D shape-guided image segmentation, and has also found various applications. We thoroughly evaluate our method and demonstrate its superiority over the state-of-the-art methods through experiments on benchmark datasets.

OBJECTIVE Several studies assessed maternal gestational diabetes mellitus (GDM) with the risk of childhood high blood pressure, and the results were inconsistent. We investigated the association between maternal GDM and hypertension risk in offspring during early childhood. METHODS We performed a large study in 1,156 mother–child pairs (578 GDM and 578 non-GDM matched by their offspring’s age and sex). Maternal GDM was diagnosed according to the World Health Organization criteria. Childhood height, weight, and blood pressure were measured using standardized methods. Age-, sex-, and height-specific blood pressure Z score, childhood hypertension, and high blood pressure were evaluated according to the reference range of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. RESULTS After adjustment for maternal and children’s characteristics, children born to mothers with GDM during pregnancy had higher mean values of systolic blood pressure Z score (0.09 vs. −0.17), and higher prevalence of hypertension (6.4% vs. 3.5%) and high blood pressure (15.6% vs. 9.3%) in comparison with their counterparts born to mothers without GDM during pregnancy (all P values CONCLUSIONS Maternal GDM was associated with an increased risk of hypertension in the offspring. Controlling maternal GDM may be important for preventing childhood hypertension in the affected offspring.

Previous studies found conflicting results about the associations between the exposure to hyperglycemiain uteroand the later risks of childhood overweight and obesity. The aim of the present study is to compare the children’s BMI growth between offspring exposed to maternal gestational diabetes mellitus (GDM) and those not exposed and assess the associations between maternal GDM and their offspring’s overweight and obesity risk. We performed a large observational study in 1156 women and their offspring (578 GDM and 578 non-GDM mother–child pairs, matched by their offspring’s gender and age). Maternal GDM was diagnosed according to the World Health Organization criteria. Childhood height, weight, waist circumference, body fat and skinfold were measured using standardized methods. After adjustment for maternal and children’s characteristics, children born to mothers with GDM during pregnancy had higher mean values of Z scores for BMI-for-age, Z scores for weight-for-age, waist circumferences, body fat, subscapular skinfold and suprailiac skinfold, in comparison with their counterparts born to mothers with normal glucose during pregnancy (allPvalues

IntroductionTo evaluate the single association of postpartum β-cell dysfunction and insulin resistance (IR), as well as different combinations of postpartum β-cell dysfunction, IR, obesity, and a history of gestational diabetes mellitus (GDM) with postpartum type 2 diabetes risk.Research design and methodsThe study included 1263 women with prior GDM and 705 women without GDM. Homeostatic model assessment was used to estimate homeostatic model assessment of β-cell secretory function (HOMA-%β) and homeostatic model assessment of insulin resistance (HOMA-IR).ResultsMultivariable-adjusted ORs of diabetes across quartiles of HOMA-%β and HOMA-IR were 1.00, 1.46, 2.15, and 6.25 (ptrend trend Conclusionsβ-cell dysfunction or IR was significantly associated with postpartum diabetes. IR and β-cell dysfunction, together with obesity and a history of GDM, had the highest ORs of postpartum diabetes risk.

Accurate understanding of sources and mixing state of black carbon (BC) aerosol is essential for assessing its impacts on air quality and climatic effect. Here, a winter campaign (December 2017–January 2018) was conducted in the North China Plain (NCP) to evaluate the sources, coating composition, and radiative effect of BC under the background of emission reduction since 2013. Results show that liquid fossil fuel source (i.e., traffic emission) and solid fuel source (i.e., biomass and coal burning) contributed 69 % and 31 % to the total BC mass, respectively, using a multiwavelength optical approach combined with the source-based aerosol absorption Ångström exponent values. The air quality model indicates that local emission was the dominant contributor to BC at the measurement site on average, however, emissions in the NCP exerted a critical role for high BC episode. Six classes of BC-containing particles were identified, including (1) BC coated by organic carbon and sulphate (52 % of total BC-containing particles), (2) BC coated by Na and K (24 %), (3) BC coated by K, sulphate, and nitrate (17 %), (4) BC associated with biomass burning (6 %), (5) Pure-BC (1 %), and (6) others (1 %). Different BC sources had distinct impacts on those BC-containing particles. A radiative transfer model estimated that the amount of BC detected can produce an atmospheric forcing of +18.0 W m−2 and a heating rate of 0.5 K day−1. Results presented herein highlight that further reduction of solid fuel combustion-related BC may be a more effective way to mitigate regional warming in the NCP, although larger BC contribution was from liquid fossil fuel source.

Black carbon (BC) aerosol plays a vital role in disturbing the balance of ecosystem and climate stability of Tibetan Plateau (TP). An intensive campaign was carried out from 14th March to 12th May 2018 in the southeastern margin of TP to investigate the sources of BC and their radiative effects. To do so, an improved aethalometer model was used to distinguish and apportion BC into fossil fuel combustion source and biomass burning source. To minimize the uncertainty associated with the aethalometer model, a receptor model coupling multi-wavelength absorption with chemical species was used to retrieve the site-dependent Ångström exponent (AAE) and BC mass absorption cross-section (MAC). The results show that the AAEs and BC MACs at wavelength of 880 nm were 0.9 and 12.3 m2 g−1 for fossil fuel source and 1.7 and 10.4 m2 g−1 for biomass burning, respectively. Based on these parameters, the fossil fuel source-related BC (BCfossil) was estimated 43 % of the total BC and the rest 57 % was from biomass burning (BCbiomass) during the campaign. The results from a regional chemical dynamical model reveal that high BCbiomass was contributed from the northeastern India and northern Burma, and the Southeast Asia can explain 40 % of BCbiomass. The high BCfossil was mainly identified from the southeast of sampling site. A radiative transfer model estimated that the atmospheric directive radiative forcing of BC was +4.6 ± 2.4 W m−2 on average, including +2.5 ± 1.8 W m−2 from BCbiomass, and +2.1 ± 0.9 W m−2 from BCfossil, which correspond to and heating rates of 0.07 ± 0.05 and 0.06 ± 0.02 K day−1, respectively. Our study will be useful for improving our understanding in BC sources on the TP and their climatic effect.

OBJECTIVE: To investigate the association of daily branched-chain amino acids (BCAAs) intake with the risks of obesity and insulin resistance in children of mothers with gestational diabetes mellitus (GDM). METHODS: Daily BCAAs intake was calculated using a validated food frequency questionnaire in 996 children of mothers with GDM. The odds ratios (ORs) (95% confidence intervals) of childhood obesity and insulin resistance were obtained using logistic regression models. RESULTS: The multivariable-adjusted ORs for overweight and insulin resistance increased across quartiles of daily BCAAs intake (P for trend < 0.05). Multivariable-adjusted ORs for each 1 standard deviation increase in BCAAs intake were 1.37 (1.16–1.62) for overweight, and 1.19 (1.02–1.38) for insulin resistance. After additional adjustment of children’s daily total energy intake, the OR was still significant for overweight risk but no longer significant for insulin resistance. There were positive associations of daily leucine, isoleucine and valine intake with the risks of overweight and insulin resistance. CONCLUSIONS: Daily BCAAs intake was associated with increased risks of overweight and insulin resistance in children of mothers with GDM, but this association was not fully independent of children’s daily energy intake. Restriction in dietary BCAAs may help prevent childhood obesity and insulin resistance.

OBJECTIVES: To investigate the association of daily branch chained amino acid intake with the risks of obesity and insulin resistance in children. METHODS: 996 children of mothers with gestational diabetes mellitus were included. Daily BCAA intake was calculated using a validated food frequency questionnaire. Logistic regression models were used to obtain the odd ratios (ORs) (95% confidence intervals [CI]) of childhood obesity and insulin resistance associated with different levels of daily BCAA intake. RESULTS: The multivariable-adjusted ORs across quartiles of daily BCAA intake were 1.00, 2.19, 2.06 and 2.81 (P for trend

OBJECTIVE: The purpose of this study was to estimate the associations of genetically determined maternal blood glucose levels with obesity-related outcomes among children from pregnancies with and without gestational diabetes mellitus (GDM). METHODS: A total of 1,114 mothers with (N = 560) and without (N = 554) GDM and their children were included in the present study. A maternal genetic risk score (GRS) for blood glucose was constructed on the basis of 17 single-nucleotide polymorphisms identified from a recent genome-wide association study. RESULTS: It was found that maternal GRS for blood glucose showed different associations with offspring risk of overweight and obesity, as well as adiposity measures (all P (for interaction) < 0.05). Among mothers without GDM, genetically determined maternal blood glucose levels were associated with an 89% higher risk of overweight in their children (95% CI: 42%−152% per SD increase in GRS, P = 1.40 × 10(−5)) and a 120% higher risk of obesity (44%−235%, P = 2.61 × 10(−4)) after adjustment for covariates. In addition, higher maternal GRS for blood glucose was associated with children’s increased obesity-related traits (all P < 0.05). However, no significant associations were observed among children of mothers with GDM. CONCLUSIONS: This study indicates that GDM status may modify the relation between genetically determined glucose levels and obesity risk among children.

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 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.

Summary Aims Women with prior gestational diabetes mellitus (GDM) or high genetic susceptibility are prone to development of type 2 diabetes. We examined whether a lifestyle intervention modified the genetic effect on changes in glycemic markers among women with prior GDM. Research design and methods This study included 560 women with prior GDM from a randomized controlled trial, the Tianjin Gestational Diabetes Mellitus Prevention Program, who were assigned into an intervention arm (improved physical activity and healthy dietary intakes) or a control arm. We assessed associations of GDM related genetic variants in/near the CDKAL1 (rs7754840) and MTNR1B (rs10830962) genes with changes in fasting levels of glucose and insulin, β-cell function (HOMA-B) and insulin resistance (HOMA-IR) at 1 year and 2 years after the baseline. Results We found significant interactions between CDKAL1 variant rs7754840 and lifestyle intervention on changes in fasting insulin and HOMA-IR at 1 year (P for interactions = 0.008 and 0.006, respectively). The GDM-increasing C allele was associated with a 0.07-unit greater increase in fasting insulin (P = 0.048) and HOMA-IR (P = 0.045) in the control group, while opposite-directional associations were observed in the intervention group; women with the C allele seemed to decrease more in these glycemic markers than the non-C-carriers (both P ≤ 0.06). The interactions between the CDKAL1 genetic variant and lifestyle intervention on changes in fasting insulin (P = 0.035) and HOMA-IR (P = 0.024) remained significant over the 2-year period, even though the effects of lifestyle intervention were attenuated at 2-year. The MTNR1B variant rs10830962 did not show interaction with lifestyle intervention on changes in the glycemic markers. Conclusions Healthy lifestyle intervention may be beneficial for women with the GDM predisposing CDKAL1 genetic variant in improvement of insulin resistance. Trial registration number ClinicalTrials.gov NCT01554358 . URL of registration https://clinicaltrials.gov/ct2/show/NCT01554358 .

ObjectivesAbdominal obesity is more closely associated with diabetes than general obesity in adults, however, it is unknown which kind of obesity is more closely associated with abnormal glucose metabolism in children.Research design and methodsWe recruited 973 children (aged 3.08±1.06) of mothers with prior gestational diabetes mellitus (GDM). Children’s height, weight, waist circumstance, fasting glucose and insulin were measured using standardized methods. Logistic regression models were used to assess the single and joint associations of general and abdominal obesity with the risks of hyperglycemia (the upper quartile of fasting glucose), insulin resistance (the upper quartile of homeostatic model assessment of insulin resistance (HOMA-IR)), and β-cell dysfunction (the lower quartile of HOMA-%β).ResultsCompared with normal weight children, children with general overweight/obesity had higher levels of HOMA-IR and HOMA-%β, higher ORs for hyperglycemia (1.56, 95% CI 1.06 to 2.30) and insulin resistance (3.44, 95% CI 2.32 to 5.09), but a lower OR for β-cell dysfunction (0.65, 95% CI 0.41 to 1.04). Children with abdominal obesity had an increased risk of insulin resistance (2.54, 95% CI 1.71 to 3.76) but not hyperglycemia and β-cell dysfunction compared with children with normal waist circumstance. In the joint analyses, general overweight children with and without abdominal obesity had an increased risk of hyperglycemia and insulin resistance compared with normal weight children.ConclusionsGeneral obesity was more closely associated with abnormal glucose metabolism than abdominal obesity in children of mothers with GDM.

The objective of this study was to investigate the risk of postpartum metabolic syndrome in women with GDM compared with those without GDM in a Chinese population. 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. 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. The present study indicated that women with prior GDM had significantly higher risks for postpartum metabolic syndrome, as well as its individual components. Disclosure G. Hu: None. W. Li: None. J. Leng: None. Y. Shen: None. S. Zhang: None. H. Liu: None. W. Li: None. L. Wang: None. H. Tian: None. J. Chen: None. L. Qi: None. X. Yang: None. Z. Yu: None. J. Tuomilehto: Advisory Panel; Self; Novo Nordisk A/S. Board Member; Self; AstraZeneca. Research Support; Self; Bayer AG. Funding European Foundation for the Study of Diabetes; Chinese Diabetes Society; Lilly Program for Collaborative Diabetes Research between China and Europe; Tianjin Women’s and Children’s Health Center; Tianjin Public Health Bureau; National Institute of Diabetes and Digestive and Kidney Diseases (R01DK100790 to G.H.); National Institute of General Medical Sciences (U54GM104940 to G.H.)

Abdominal obesity is more closely associated with diabetes than general obesity in adults, however, it is unknown which kind of obesity is more closely associated with abnormal glucose metabolism in children. We recruited 973 children of mothers with prior gestational diabetes mellitus (GDM). Children’s height, weight, waist circumstance, fasting glucose and insulin were measured using standardized methods. Logistic regression models were used to assess the single and joint associations of general and abdominal obesity with the risks of hyperglycemia (the upper quartile of fasting glucose), insulin resistance (the upper quartile of HOMA-IR), and β-cell dysfunction (the lower quartile of HOMA-% β). Compared with normal weight children, children with general overweight/obesity had higher levels of HOMA-IR and HOMA-%β, higher odds ratios for hyperglycemia (1.56, 95% confidence intervals [CIs] 1.06-2.30) and insulin resistance (3.44, 95% CI 2.32-5.09), and a lower odds ratio for β-cell dysfunction (0.65, 95% CI 0.41-1.04). Children with abdominal obesity had increased insulin resistance (2.54, 95% CI 1.71-3.76) but not hyperglycemia and β-cell dysfunction compared with normal weight children. In the joint analyses, children with general overweight only or with both general and abdominal obesity but not with abdominal obesity only had increased hyperglycemia and insulin resistance compared with normal weight children. General obesity was more closely associated with major abnormal glucose metabolism than abdominal obesity in children of mothers with GDM. Disclosure J. Lu: None. Y. Gu: None. L. Wang: None. W. Li: None. S. Zhang: None. H. Liu: None. J. Leng: None. J. Liu: None. S. Wang: None. L. Hou: None. A. Baccarelli: None. G. Hu: None. Funding Tianjin Women’s and Children’s Health Center; Tianjin Public Health Bureau; European Foundation for the Study of Diabetes/Chinese Diabetes Society; Lilly Program for Collaborative Research between China and Europe; National Institute of Diabetes and Digestive and Kidney Diseases (R01DK100790 to G.H.); National Institute of General Medical Sciences (U54GM104940 to G.H.)

The aim of the present study was to investigate the race-specific association between a history of GDM and incidence of type 2 diabetes and evaluate how the risk changed over different years after delivery. We performed two large cohorts - the Coronary Artery Risk Development in Young Adults (CARDIA) cohort with African Americans and whites in the U.S. (188 GDM and 1625 non-GDM women), and the Tianjin GDM Observational Study with Chinese in China (1263 GDM and 705 non-GDM women). The multivariate cox regression model was used to assess the risk of incident diabetes postpartum between women with and without GDM. During a mean follow-up of 13.9 years, 419 women developed type 2 diabetes. After adjustment for multiple confounding factors, Chinese women with GDM had a higher risk of incident diabetes within 5 years postpartum than African Americans with GDM compared with Chinese and African Americans without GDM (Hazard ratio 71.5 in Chinese vs. 11.0 in African Americans). When the risk of incident diabetes was analyzed within 10 years, white women with GDM seemed to have a higher hazard ratio than African American and Chinese women with GDM compared with women without GDM of different race. In comparison to African American women without GDM, different racial women with GDM showed an increased risk of type 2 diabetes within 10 years postpartum, however, white women without GDM had a decreased risk of type 2 diabetes. The largest increased risk of type 2 diabetes over 10 years postpartum appeared in Chinese women with GDM (Hazard ratio 23.9), followed by African American women with GDM (Hazard ratio 4.92), and the smallest was seen in white women with GDM (Hazard ratio 3.57). Chinese women with a history of GDM had the highest risk of incident diabetes postpartum. The different genetic backgrounds and other risk factors among different races might contribute to the racial differences in the incidence of diabetes postpartum among women with GDM. Disclosure Y. Shen: None. L. Hou: None. H. Liu: None. L. Wang: None. J. Leng: None. W. Li: None. G. Hu: None. Funding Tianjin Women’s and Children’s Health Center; Tianjin Public Health Bureau; European Foundation for the Study of Diabetes/Chinese Diabetes Society; Lilly Program for Collaborative Research between China and Europe; National Institute of Diabetes and Digestive and Kidney Diseases (R01DK100790 to G.H.); National Institute of General Medical Sciences (U54GM104940 to G.H.)

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 NCEPATPIII 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. (C) 2019 Elsevier B.V. All rights reserved.

Background: Gestational diabetes mellitus (GDM) is a known risk factor for macrosomia, with recent estimates suggesting that between 15-45% of newborns of mothers with GDM are macrosomic (vs. 12% in non-GDM mothers). This study’s objectives were to explore associations between both maternal GDM and children’s macrosomia and DNA methylation of eight genes selected based on a literature review of candidates potentially involved in GDM and obesogenic pathways ( IGF1 , IGF2 , H19 , ARHGRF11 , MEST , NR3C1 , Adiponectin , and RETN ). Methods: Data were taken from the Tianjin GDM Observational study, in the 4th-largest city in China; subjects were ages 24-49 and diagnosed with GDM between 2005-2009. Baseline surveys were completed from 2009-2011 for 580 enrolled women-child pairs; an additional 580 women-child pairs without GDM and frequency matched on child sex and birth date were enrolled. We examined 572 GDM cases vs. 573 non-GDM controls; of these 177 children were born with macrosomia (114 to women with GDM, p Results: After analysis of 345 CpGs in eight target genes, one CpG was associated with macrosomia (cg14428359) and one with GDM (cg19466922) at FDR < 0.05; both CpGs were located in the gene MEST (3’ and 5’ untranslated regions, respectively). One additional CpG site in the promoter region of MEST (cg05862114) was associated with both GDM and macrosomia before FDR adjustment. All three CpGs were hypomethylated in both children of GDM mothers and macrosomia cases. Conclusions: MEST is a paternally imprinted gene that is highly expressed in fetal and placental tissue, and believed to play an important role in fetal development. It has also been found to have elevated expression in adipose tissue; epigenetic regulation of MEST may play an important role in the link between GDM and macrosomia.

BACKGROUND: A history of gestational diabetes mellitus (GDM) has been related to an elevated risk of type 2 diabetes. The melanocortin-4 receptor (MC4R) genotype has been related to glycemic changes in women with prior GDM. OBJECTIVE: The objective of this study was to analyze whether lifestyle intervention modified the association between the MC4R genotype and changes in insulin sensitivity among women with prior GDM. METHODS: We genotyped MC4R rs6567160 and measured glucose and insulin in fasting plasma samples at baseline and during the first 2 follow-up visits in 1128 women with prior GDM. They were randomly assigned to either a 4-y lifestyle intervention involving both diet and physical activity or a control group from a randomized clinical trial, the Tianjin Gestational Diabetes Mellitus Prevention Program. We analyzed the interaction between the MC4R genotype and lifestyle intervention on changes in insulin resistance. RESULTS: From baseline to 1.28 y, the MC4R genotype was related to changes in fasting insulin, HOMA-IR, and homeostasis model assessment of β cell function (HOMA-B) in the intervention group. Each risk allele (C) of rs6567160 was associated with a 0.08-unit greater decrease in log(insulin), log(HOMA-IR), and log(HOMA-B) (P = 0.02, 0.04, and 0.04, respectively), whereas in the control group, each C allele tended to be associated with a greater increase in HOMA-IR (P = 0.09). We found significant interactions between the MC4R genotype and lifestyle intervention on 1.28-y changes in fasting insulin and HOMA-IR (P = 0.006 and 0.008, respectively), and such interaction remained significant when we analyzed the trajectory of changes in insulin and HOMA-IR from baseline to 2.55 y (both P = 0.03). CONCLUSIONS: The exploratory results from the first 2 follow-up visits indicate that women with prior GDM carrying a diabetes-increasing MC4R genotype (CC or TC) may obtain better improvement than the TT genotype in insulin resistance through lifestyle intervention. This trial was registered at clinicaltrials.gov as NCT01554358.

OBJECTIVE To investigate the association of lactation intensity and duration with postpartum diabetes and prediabetes risks among Chinese women with a history of gestational diabetes (GDM). METHODS We included 1260 women with a history of GDM who participated in the whole population's GDM universal screening survey by using the 1999 World Health Organization's criteria. Lactation intensity and lactation duration were collected by a standardized questionnaire. Postpartum diabetes and prediabetes risk were confirmed by an oral glucose tolerance test. RESULTS During a mean postpartum period of 3.65 years, we identified 114 cases of diabetes and 417 cases of prediabetes. The multivariable-adjusted hazard ratios based on different lactation intensity (exclusive formula, mixed feeding, and exclusive lactation) were 1.00, 0.68, 0.45 for diabetes (Ptrend = 0.008), and 1.00, 0.74, and 0.61 for prediabetes (Ptrend = 0.006), respectively. The multivariable-adjusted hazard ratios associated with different lactation duration (none, 0-6 months, 6-12 months, 12-18 months, and ≥18 months) were 1.00, 0.66, 0.42, 0.66, and 0.25 for diabetes (Ptrend = 0.013), and 1.00, 0.82, 0.62, 0.67, and 0.63 for prediabetes (Ptrend = 0.021), respectively. A restricted cubic spline curve showed a graded inverse association of lactation duration with the risks of diabetes and prediabetes (Ptrend

Zinc transporter 8 genetic variant SLC30A8 has been associated with postpartum risk of type 2 diabetes among women with gestational diabetes mellitus (GDM). Gestational weight gain is one of the strongest risk factors for postpartum hyperglycemia. We assessed the interaction between type 2 diabetes–associated SLC30A8 rs13266634 and gestational weight gain on 1–5 years of postpartum glycemic changes in 1,071 women with prior GDM in a longitudinal study. Compared with gestation of 26–30 weeks, postpartum levels of fasting glucose, oral glucose tolerance test 2-h glucose, and hemoglobin A1c (HbA1c) increased across rs13266634 TT, CT, and CC genotypes in women with excessive gestational weight gain, whereas opposite genetic associations were found in women with inadequate or adequate gestational weight gain. Postpartum changes in fasting glucose per additional copy of the C allele were −0.18, −0.04, and 0.12 mmol/L in women with inadequate, adequate, and excessive gestational weight gain, respectively (P for interaction = 0.002). We also found similar interactions for changes in 2-h glucose and HbA1c (P for interaction = 0.003 and 0.005, respectively). Our data indicate that gestational weight gain may modify SLC30A8 variant on long-term glycemic changes, highlighting the importance of gestational weight control in the prevention of postpartum hyperglycemia in women with GDM.

Background To describe the study design, methodology and baseline characteristics of the Dongguan Eye Study. Design Population-based, cross-sectional study Participants A total of 8952 rural-dwelling residents aged 40 years or older in Hengli, Dongguan. Methods The Dongguan Eye Study was conducted from September 2011 to February 2012. The interview covered demographic data, socio-economic status and health- and vision-related quality of life. Physical measurements included height, weight, waist and hip circumference, heart rate and blood pressure. Laboratory tests included fasting blood glucose, haemoglobin A1c, oral glucose tolerance, serum total cholesterol, triglycerides, high-density lipoprotein-cholesterol, low-density lipoprotein-cholesterol, serum creatinine, blood urea nitrogen and uric acid. Ophthalmic examinations included visual acuity and autorefraction testing, intraocular pressure measurement, slit-lamp examination, ocular biometry, gonioscopy, fundus photography, retinal nerve fibre layer imaging and visual field testing. Main Outcome Measures Prevalence and risk factors for visual impairment, blindness, eye diseases and their associations with systemic medical indicators or health-related lifestyles, as well as epidemiological data on diabetic subjects. Methodology, response rates and baseline characteristics are presented. Results Of the 11 357 individuals eligible for the Dongguan Eye Study, 8952 (78.82%) subjects participated. All participants were self-identified Han Chinese. The average age was 54.0 years, 59.9% were female, 48.4% were farmers and 77.2% had elementary or junior middle school educational levels. The average body mass index and waist–hip ratio were 24.6 ± 3.9 kg/m2 and 0.9 ± 0.2. Conclusions Data from the Dongguan Eye Study provide information concerning the prevalence, risk factors and impacts of eye diseases in rural residents undergoing urbanization in southern China.

Aims The aim of the present study was to investigate the race-specific association between a history of gestational diabetes mellitus (GDM) and incidence of type 2 diabetes and evaluate how the risk changed over different years after delivery. Methods We performed two large cohorts - the Coronary Artery Risk Development in Young Adults (CARDIA) cohort and the Tianjin GDM Observational Study. The multivariate cox regression model was used to assess the risk of incident postpartum diabetes between women with and without prior GDM. Results During a mean follow-up of 13.8 years, 405 women developed type 2 diabetes. After adjustment for multiple confounding factors, Chinese women with GDM had a higher risk of incident diabetes within 5 years postpartum than African Americans with GDM compared with Chinese and African Americans without GDM (Hazard ratio 71.5 in Chinese vs. 9.29 in African Americans). When the risk of incident diabetes was analyzed within 10 years, white women with GDM seemed to have a higher hazard ratio than African American and Chinese women with GDM compared with non-GDM women of different races. In comparison to African American women without GDM, the highest risk of type 2 diabetes over 10 years postpartum appeared in Chinese women with GDM, followed by African American women with GDM, and the smallest risk was seen in white women with GDM. Conclusions Different genetic backgrounds and other risk factors among women of different races might contribute to the racial differences in the incidence of diabetes postpartum among women with GDM.

Previous studies found conflicting results about the associations between the exposure to maternal hyperglycemia in utero and the later risks of childhood overweight and obesity. The aim of the present study was to compare the children’s body mass index (BMI) growth between offspring exposed to maternal gestational diabetes mellitus (GDM) and those not exposed, and assess the associations between maternal GDM and their offspring’s overweight and obesity risk. We performed a large observational study in 1156 women and their offspring (578 GDM and 578 non-GDM mother-child pairs, matched by their offspring’s gender and age). The mean values of children were 5.86 years (range 3-9 years old). After adjustment for maternal and children’s characteristics, children born to mothers with GDM during pregnancy had higher mean values of Z scores for BMI-for-age, Z-scores for weight-for-age, waist circumferences, body fat, subscapular skinfold, and suprailiac skinfold, in comparison with their counterparts born to mothers with normal glucose (all P values Disclosure J. Wang: None. L. Wang: None. S. Zhang: Employee; Self; American Diabetes Association. Advisory Panel; Self; Company/ABC. H. Liu: None. J. Leng: None. W. Li: None. T. Zhang: None. N. Li: None. W. Li: None. A. Baccarelli: None. L. Hou: None. G. Hu: None.

The objective of this study was to compare risks of postpartum type 2 diabetes (T2D) and prediabetes in Chinese women with and without gestational diabetes (GDM) during pregnancy. Tianjin GDM observational study included 1263 women with a history of GDM and 7women without GDM who participated in the whole population’s GDM universal screening survey by using World Health Organization (WHO)’s criteria. Postpartum T2D and prediabetes were defined according to the American Diabetes Association (ADA) criteria after a standard oral glucose tolerance test. Cox proportional hazards regression was used to assess risks of postpartum T2D and prediabetes between women with and without GDM. During a mean follow-up of 3.53 years postpartum, 90 T2D and 599 prediabetes were identified. Multivariable-adjusted hazard ratios (HR) associated with GDM were 76.1 (95% CI 23.6-246) for T2D, and 25.4 (95% CI 18.2-35.3) for prediabetes. When a mean of follow-up extended to 4.40 years, 121 T2D and 616 prediabetes were identified. Women with prior GDM had a 13.0-fold increased risk (adjusted HR: 95% CI 5.54-30.6) for diabetes and 2.15-fold risk (95% CI 1.76-2.62) for prediabetes than women without GDM. The positive associations between GDM and the risks of postpartum T2D and prediabetes were significant and persistent across stratum by age at delivery (i.e., < 30 years vs. >= 30 years) and overall body adiposity status (i.e., normal vs. overweight). The present study among Chinese women indicated that women with prior GDM had a significantly increased risk for early postpartum T2D and prediabetes, with the risk being highest at the first 3 years postpartum, compared with those without GDM. Disclosure Y. Shen: None. P. Wang: None. L. Wang: None. S. Zhang: Employee; Self; American Diabetes Association. Advisory Panel; Self; Company/ABC. H. Liu: None. W. Li: None. N. Li: None. W. Li: None. J. Leng: None. J. Wang: None. H. Tian: None. C. Zhang: None. X. Yang: None. Z.M. Yu: None. G. Hu: None.

OBJECTIVE Counselling patients with gestational diabetes mellitus (GDM) on their individual risk of post-partum type 2 diabetes (T2D) is challenging. This study aimed to develop nomograms for predicting incident risk of post-partum T2D in women with GDM diagnosed by WHO 1998 criteria. METHODS We performed a retrospective cohort study in 1263 Chinese women with GDM, of whom 83 were diagnosed as T2D at 2.3 years post-partum. Multivariate Cox proportional hazards models were used to investigate the independent predictors for post-partum T2D. The results of multivariate analyses were used to formulate nomograms for predicting incident risk of post-partum T2D. The predictive accuracy was evaluated using the area under the receiver operating characteristic curve (AUROC). RESULTS On multivariate analysis, independent predictors of post-partum T2DM in women with GDM included family history of diabetes [hazard ratio (HR) and its 95% confidential interval (95% CI): 2.06 (95% CI: 1.32-3.22)], history of pregnancy-induced hypertension [3.11 (95% CI: 1.86-5.21)], pre-pregnancy BMI [1.00, 1.90 (95% CI: 1.14-3.16), and 3.67 (95% CI: 2.03-6.63) for BMI

AIMS To report the weight loss findings after the first year of a lifestyle intervention trial among women with gestational diabetes mellitus (GDM). METHODS A total of 1180 women with GDM were randomly assigned (1:1) to receive a 4-year lifestyle intervention (intervention group, n = 586) or standard care (control group, n = 594) between August 2009 and July 2011. Major elements of the intervention included 6 face-to-face sessions with study dieticians and two telephone calls in the first year, and two individual sessions and two telephone calls in each subsequent year. RESULTS Among 79% of participants who completed the year 1 trial, mean weight loss was 0.82 kg (1.12% of initial weight) in the intervention group and 0.09 kg (0.03% of initial weight) in the control group (P = .001). In a prespecified subgroup analysis of people who completed the trial, weight loss was more pronounced in women who were overweight (body mass index ≥24 kg/m2 ) at baseline: mean weight loss 2.01 kg (2.87% of initial weight) in the intervention group and 0.44 kg (0.52% of initial weight) in the control group (P < .001). Compared with those in the control group, women in the intervention group had a greater decrease in waist circumference (1.76 cm vs 0.73 cm; P = .003) and body fat (0.50% vs 0.05% increase; P = .001). CONCLUSION The 1-year lifestyle intervention led to significant weight losses after delivery in women who had GDM, and the effect was more pronounced in women who were overweight at baseline.

Context: Gestational diabetes mellitus (GDM) affects postpartum glucose metabolism and future risk of type 2 diabetes. Pregnancy and GDM are related to disturbed circadian rhythms and sleeping, which are determined by genetic variations in genes such as Melatonin receptor 1B ( MTNR1B ). Objective: We prospectively assessed whether the circadian rhythms related MTNR1B genotype was related to on 1-5 years of postpartum glycemic changes among women with a history of GDM, and whether gestational weight gain modified such associations. Design: The established circadian rhythms-associated MTNR1B genetic variant (rs10830963) was genotyped in 1025 Chinese women with a history of GDM. Body weight and glycemic traits during and after pregnancy were longitudinally collected. Results: The frequency of MTNR1B rs10830963 was not different among the three categories of gestational weight gain (inadequate, adequate, and excessive). We found women carrying different MTNR1B genotype showed distinct postpartum changes in 2-h glucose (OGTT) – 0.36, 0.20, and -0.19 mmol/L per additional copy of the G allele in women with inadequate, adequate, and excessive gestational weight gain, respectively ( p for interaction=0.028). The corresponding changes in fasting glucose were 0.14, 0.13, and 0.01, though the modification effects of gestational weight gain on the genetic association was marginal ( p for interaction= 0.067). Conclusions: Our findings suggest that gestational weight gain may modify the circadian rhythms related MTNR1B genetic variant on long term glycemic changes, highlighting the significance of gestational weight management in diabetes prevention among women with GDM.

AIM To investigate the effects of the interaction between glycated haemoglobin (HbA1c) genetic risk score and weight changes during and after pregnancy (postpartum weight reduction and gestational weight gain) on long-term glycaemic changes in the largest cohort of women with a history of gestational diabetes mellitus (GDM). METHODS This was a retrospective cohort using the baseline data from the Tianjin Gestational Diabetes Mellitus Prevention Programme. A genetic risk score was established by combining 10 HbA1c-related single-nucleotide polymorphisms, which were identified by genome-wide association studies. General linear regression models were applied to evaluate the effect of interaction between HbA1c genetic risk score and weight changes during and after pregnancy (postpartum weight reduction and gestational weight gain) on glycaemic changes. RESULTS 'A total of 1156 women with a history of GDM were included in this respective cohort study. Statistical differences in pre-pregnancy weight, pre-delivery weight and postpartum weight were evidenced across different groups of postpartum weight reduction. After adjusting for covariates, statistical significance for changes in HbA1c level was only observed in the postpartum weight reduction

Background: Short height is associated with gestational diabetes mellitus (GDM) but the underlying mechanism remains unknown. This study aims to explore whether short height has a synergistic effect with pre-pregnancy overweight/obesity and undue weight gain on the risk of GDM.Methods: We recruited 19,962 singleton pregnant women from their first antenatal care visit in urban Tianjin, China, between October 2010 to August 2012. At 24–28 weeks of gestation, women underwent a 50-g 1-h glucose challenge test (GCT) followed by a 75-g 2-h oral glucose tolerance test (OGTT) if the GCT result was ≥7.8 mmol/L. GDM was defined by the International Association of Diabetes and Pregnancy Study Group's cut-points. Univariable and multivariable logistic regression analyses were performed to obtain odds ratios (ORs) and 95% confidence intervals (CIs). Restricted cubic spline (RCS) analysis nested in the logistic regression analysis was used to identify a cutoff point of height for GDM. Additive interaction was used to test interactions between short height, pregnancy overweight/obesity and undue weight gain.Results: A total of 1,517 (or 7.6%) women developed GDM. The risk of GDM increased rapidly with a decreasing height from 158 cm and downwards. Using height ≥158 cm as the reference group, women with < 158 cm of height were at increased GDM risk (adjusted OR: 1.44, 95%CI: 1.18–1.75). Maternal overweight/obesity at the first antenatal care visit greatly enhanced the OR of short height for GDM (adjusted OR: 3.78, 95%CI: 2.84–5.03) with significant additive interaction (P < 0.05). However, the interaction between short height and undue weight gain was non-significant (P > 0.05).Conclusions: In Chinese pregnant women in urban Tianjin, height < 158 cm had a synergistic effect with pre-pregnancy overweight/obesity on the risk of GDM.

Aims To compare risks of early postpartum diabetes and prediabetes in Chinese women with and without gestational diabetes mellitus (GDM) during pregnancy. Subjects and methods Tianjin GDM observational study included 1263 women with a history of GDM and 705 women without GDM who participated in the urban GDM universal screening survey by using World Health Organization’s criteria. Postpartum diabetes and prediabetes were identified after a standard oral glucose tolerance test. Cox proportional hazards regression was used to assess risks of postpartum diabetes and prediabetes between women with and without GDM. Results During a mean follow-up of 3.53 years postpartum, 90 incident cases of diabetes and 599 incident cases of prediabetes were identified. Multivariable-adjusted hazard ratios among women with prior GDM, compared with those without it, were 76.1 (95% CI: 23.6–246) for diabetes and 25.4 (95% CI: 18.2–35.3) for prediabetes. When the mean follow-up extended to 4.40 years, 121 diabetes and 616 prediabetes cases were identified. Women with prior GDM had a 13.0-fold multivariable-adjusted risk (95% CI: 5.54-30.6) for diabetes and 2.15-fold risk (95% CI: 1.76-2.62) for prediabetes compared with women without GDM. The positive associations between GDM and the risks of postpartum diabetes and prediabetes were significant and persistent when stratified by younger and older than 30 years at delivery and normal weight and overweight participants. Conclusions The present study indicated that women with prior GDM had significantly increased risks for postpartum diabetes and prediabetes, with the highest risk at the first 3–4 years after delivery, compared with those without GDM.

SummaryObjective To compare pregnancy outcomes of women with gestational diabetes mellitus (GDM) newly defined by the International Association of Diabetes and Pregnancy Study Group (IADPSG)'s criteria vs GDM cases missed by a shift from the 1999 World Health Organization (WHO)'s criteria to the IADPSG's. Methods From 2010 to 2012, we recruited 17 808 women who registered within 12 weeks of gestation in Tianjin, China. All women underwent a 50-g 1-h glucose challenge test (GCT) at 24–28 weeks of gestation and further underwent a 75-g 2-h oral glucose tolerance test (OGTT) if the GCT result was ≥7·8 mmol/l. Women were divided into four groups, i.e., GDM defined by both criteria, GDM defined by the IADPSG's only, GDM defined by the 1999 WHO's only and non-GDM by either of them. Large for gestational age (LGA), macrosomia, pregnancy-induced hypertension (PIH) and preterm birth were compared among the four groups. Logistic regression was used to control for confounders. Results The use of IADPSG's and the 1999 WHO's criteria detected that 7·7% (n = 1378) and 6·8% (n = 1206) of women had GDM, respectively, with 429 GDM newly identified and 257 women missed by a shift from the 1999 WHO's to the IADPSG's. The IADPSG's newly defined GDM had significantly increased risks of LGA (adjusted OR: 2·23, 95%CI: 1·36–3·64) and macrosomia (2·65, 95%CI: 1·50–4·66) than the 1999 WHO's only defined GDM cases. Conclusions A shift of the 1999 WHO's criteria to the IADPSG's diagnosed more GDM cases who had worse pregnancy outcomes than those cases missed.

Objective. To examine the association of maternal glycemia during pregnancy and after delivery with anthropometry in the offspring of mothers with gestational diabetes mellitus (GDM).Methods. A total of 1,263 GDM mothers and their children finished the health survey at 1–5 years after delivery.Results. Offspring of GDM mothers who were diagnosed with diabetes during pregnancy had higher prevalence of overweight, higher mean weight for heightZscores, and higher mean BMI for ageZscores at 1–5 years old than the offspring of GDM mothers who were diagnosed with impaired glucose tolerance (IGT) during pregnancy. Offspring of GDM mothers who developed diabetes 1–5 years after delivery had higher mean values ofZscores for weight for height and BMI for age at 1–5 years old than the offspring of GDM mothers who had normal glucose or prediabetes after delivery.Conclusions. Offspring of GDM mothers who were diagnosed with diabetes during pregnancy or after delivery had an increased risk of childhood overweight or weight gain at 1–5 years old compared with children of GDM mothers with IGT during pregnancy or with normal glucose or prediabetes after delivery.

The genetic variants near the Melanocortin-4 receptor gene (MC4R), a key protein regulating energy balance and adiposity, have been related to obesity and glucose metabolism. We aimed to assess whether the MC4R genotype affected longitudinal changes in body weight and glucose metabolism biomarkers among women with prior gestational diabetes mellitus (GDM). The MC4R genotype, postpartum weight reduction, and glycemic changes between after delivery and pregnancy were assessed in a cohort of 1208 Chinese women who had experienced GDM. The adiposity-increasing allele (C) of the MC4R variant rs6567160 was associated with greater postpartum increase of HbA1c (β = 0.08%; P = 0.03) and 2-hour OGTT glucose concentrations (β = 0.25 mmol/L; P = 0.02). In addition, we found an interaction between the MC4R genotype and postpartum weight reduction on changes in fasting plasma glucose (P-interaction = 0.03). We found that the MC4R genotype was associated with postpartum glycemic changes; and the association with fasting glucose were significantly modified by postpartum weight reduction in women who had experienced GDM.

To examine the association of connecting peptide (C-peptide) and the risks of postpartum diabetes and pre-diabetes among women with prior gestational diabetes.A cross-sectional study of 1263 women with prior gestational diabetes was carried out at 1-5years after delivery in Tianjin, China. Logistic regression was used to assess the associations of C-peptide and the risks of diabetes and pre-diabetes.The multivariable-adjusted odds ratios based on different levels of C-peptide (0-33%, 34-66%, 67-90%, and90% as C-peptide cutpoints) were 1.00, 1.93 (95% confidence interval [CI] 0.85-4.39), 2.49 (95% CI 1.06-5.87), and 3.88 (95% CI 1.35-11.1) for diabetes (P for trend0.0001), and 1.00, 1.66 (95% CI 1.18-2.36), 2.38 (95% CI 1.56-3.62) and 2.35 (95% CI 1.27-4.37) for pre-diabetes (P for trend0.0001), respectively. Restricted cubic splines models showed a positive linear association of C-peptide as a continuous variable with the risks of type 2 diabetes and pre-diabetes. The positive association was significant when stratified by healthy weight and overweight participants.We found a positive association between serum C-peptide levels and the risks of diabetes and pre-diabetes among Chinese women with prior gestational diabetes. Our finding suggested that elevated C-peptide levels may be a predictor of diabetes and pre-diabetes.

To estimate the prevalence of hyperuricemia and its major risk factors among Chinese preschool children. A cross-sectional survey was carried out in six central urban districts of Tianjin from March to June 2015. A cluster sampling was employed to obtain a random sample of preschool children. A total of 4073 children aged from 3 to 6 years participated in this survey. Logistic regression was used to obtain odds ratios and 95% confidence intervals. The overall mean serum uric acid concentrations was 243.0 ± 53.2 μmol/L, corresponding to a mean concentrations of 247.3 ± 53.7 μmol/L among boys and 238.3 ± 52.4 μmol/L among girls. The overall prevalence of serum uric acid ≥ 310 μmol/L among children was 10.1%. Boys, obesity, diastolic blood pressure, and serum triglyceride concentrations were associated with the increased risk of hyperuricemia in univariable models, although the statistically significant association between diastolic blood pressure, serum triglyceride concentrations and hyperuricemia disappeared in multivariable models. The prevalence of hyperuricemia among children aged from 3 to 6 years was relatively high. Several metabolic syndrome components were associated with the risk of hyperuricemia.

We investigated the association of physical activity, TV watching time, sleeping time with the risks of obesity and hyperglycemia among 1263 offspring aged 1–5 years of mothers with gestational diabetes (GDM) in a cross-sectional study. Logistic regression models were used to obtain the odd ratios (ORs) (95% confidence intervals [CI]) of childhood obesity and hyperglycemia associated with different levels of indoor activity, outdoor activity, TV watching, and sleeping time. The multivariable-adjusted ORs of obesity based on different levels of TV watching time (0, trend = 0.003), respectively. The multivariable-adjusted ORs of hyperglycemia based on different levels of indoor activity (trend = 0.034), respectively. The multivariable-adjusted ORs of hyperglycemia associated with different levels of sleeping time (trend = 0.003), respectively. The present study indicated a positive association of TV watching with the risk of obesity, and an inverse association of either indoor activity or sleeping time with the risk of hyperglycemia among offspring born to GDM mothers in Tianjin, China.

OBJECTIVE To examine the relative contributions of β-cell dysfunction and insulin resistance to postpartum diabetes risk among obese and nonobese women with prior gestational diabetes mellitus (GDM). RESEARCH DESIGN AND METHODS We performed a cross-sectional survey 1–5 years after 1,263 women who had GDM gave birth. Polytomous logistic regression models were used to assess the associations of β-cell dysfunction (the lower quartile of HOMA-%β), insulin resistance (the upper quartile of HOMA-IR), decreased insulin sensitivity (the lower quartile of HOMA-%S), and different categories of BMI with prediabetes and diabetes risk. RESULTS β-Cell dysfunction, insulin resistance, and decreased insulin sensitivity all were significantly associated with hyperglycemic status across normal weight, overweight, and obese groups, and the patterns of insulin resistance and decreased insulin sensitivity were similar. BMI was inversely associated with β-cell dysfunction and positively associated with insulin resistance across normal glucose, prediabetes, and diabetes categories. Compared with women with normal glucose and weight, obese women with normal glucose had increased β-cell secretory function (odds ratio [OR] 0.09 [95% CI 0.02–0.37]) and insulin resistance (OR 17.4 [95% CI 9.47–31.9]). Normal weight diabetic women displayed the most β-cell dysfunction (OR 13.6 [95% CI 4.06–45.3]), whereas obese diabetic women displayed the highest insulin resistance (OR 45.8 [95% CI 18.5–113]). CONCLUSIONS For women with prior GDM, β-cell dysfunction had more pronounced contribution to postpartum diabetes among nonobese subjects, whereas insulin resistance contributed more to postpartum hyperglycemia among obese subjects.

Aims There is some confusion regarding which anthropometric measurement of adiposity should be used to indicate diabetes, especially for Asians. The present study was to evaluate different indicators of adiposity (BMI, waist circumference and body fat) with Type 2 diabetes risk among women with prior gestational diabetes mellitus. Methods We performed a cross-sectional survey in 1263 women with gestational diabetes at 1–5 years after delivery. Logistic regression models were used to estimate the association of BMI, waist circumference and body fat with Type 2 diabetes risk. Results BMI, waist circumference and body fat were all associated with an increased risk of Type 2 diabetes among women with prior gestational diabetes (all Ptrend

Objective To evaluate the effects of prepregnancy BMI and weight change from prepregnancy to postpartum on postpartum type 2 diabetes (T2D) risk among women with gestational diabetes (GDM). Methods A retrospective cohort study in 1,263 GDM women at 1-5 years after delivery was performed. Cox proportional hazards regression models were used to evaluate the association of prepregnancy BMI and weight change with T2D and prediabetes risks. Results The multivariable-adjusted hazard ratios based on different levels of prepregnancy BMI (

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 ( Conclusions Maternal prior GDM and pre-pregnancy or postpartum obesity contribute equally to postpartum diabetes and hyperglycemia risk.

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/m 2 ) in the intervention (2.91kg/4.2%) compared with that in the control group (0.51kg/0.7%) ( P Conclusion The interim results support the efficacy and feasibility of the lifestyle intervention program.

Alanine aminotransferase (ALT) predicts type 2 diabetes but it is uncertain whether it also predicts gestational diabetes mellitus (GDM). We recruited 17359 Chinese women with ALT measured in their first trimester. At 24–28 weeks of gestation, all women underwent a 50-gram 1-hour glucose challenge test (GCT) followed by a 75-gram 2-hour oral glucose tolerance test if GCT result was ≥7.8 mmol/L. Restricted cubic spline analysis was used to examine full-range risk associations of ALT levels with GDM. Relative excess risk due to interaction, attributable proportion due to interaction and synergy index were used to estimate additive interaction between high ALT and overweight/obesity for GDM. Finally, 1332 (7.7%) women had GDM. ALT levels were positively associated with GDM risk without a clear threshold. Using ALT levels

Aims: We aimed to examine the association of gestational hypertension and chronic hypertension at the inter-conception examination with type 2 diabetes risk among women with a history of gestational diabetes. Methods: We conducted a population-based study among 1261 women who had a history of gestational diabetes at 1-5 years after delivery in Tianjin, China. Logistic regression or Cox regression was used to assess the associations of gestational hypertension and chronic hypertension at the inter-conception examination with pre-diabetes and type 2 diabetes risks. Results: Gestational diabetic women who had a history of gestational hypertension but did not use antihypertensive drugs during pregnancy had a 3.94-fold higher risk (95% CI: 1.94-8.02) of developing type 2 diabetes compared with those who were normotensive in index pregnancy. Compared with gestational diabetic women who had normal blood pressure at the inter-conception examination, hypertensive women at the inter-conception examination were 3.38 times (95% CI: 1.66-6.87) and 2.97 times (95% CI: 1.75-5.05) more likely to develop diabetes and prediabetes, respectively. The odds ratios of type 2 diabetes and prediabetes associated with each 5 mmHg increase in systolic blood pressure were 125 (95% CI: 1.03-1.51) and 120 (95% CI: 1.06-135). Each 5 mmHg increase in diastolic blood pressure contributed to a 1.49-fold higher risk (95% CI: 1.18-1.88) for type 2 diabetes and a 1.42-fold higher risk (95% CI: 1.22-1.65) for prediabetes. Conclusions: For women with prior gestational diabetes, gestational hypertension and chronic hypertension at the inter-conception examination were risk factors for type 2 diabetes. (C) 2016 Elsevier Inc. All rights reserved.

Polycystic ovary syndrome (PCOS) is a common condition in reproductive-aged women and a major female-specific risk factor of obesity, impaired glucose tolerance, and diabetes.We examined whether the genetic variation predisposing to PCOS affected glycemic changes in women with prior gestational diabetes mellitus (GDM) and whether such an effect was modified by changes in body adiposity, especially during and after pregnancy.This is a longitudinal study in Tianjin, China. We genotyped 7 genome-wide association study-identified PCOS single nucleotide polymorphisms and assessed gestational weight gain and changes in glycemic traits and weight at 1 to 5 years postpartum in 1133 women with prior GDM.The main outcome measure was postpartum glycemic changes.The PCOS genetic risk score significantly interacted with postpartum weight reduction on changes in fasting glucose and 2-h glucose (P for interaction = .032 and .007; respectively) after multivariable adjustment. In women with postpartum weight reduction of ≥ 5 kg/y, the genetic risk score was associated with decreased fasting and 2-h glucose, whereas an opposite genetic effect was found in women who lost less weight. The association between postpartum weight reduction and glycemic improvement was more significant among women with a higher genetic risk score.In a large cohort of Chinese women with a history of GDM, our data for the first time indicate that the genetic predisposition to PCOS may interact with postpartum weight reduction on long-term glycemic changes, emphasizing the importance of postpartum weight management in prevention of diabetes in this subgroup of women.

Aims Very few studies have assessed the association of fasting and 2 h glucose, and HbA1c during pregnancy with postpartum diabetes risk among women with prior gestational diabetes mellitus (GDM). We assessed the association of fasting glucose, 2 h 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 2 h 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 2 h glucose during pregnancy, 2.11 (95% CI: 1.50–2.97) for each 1 unit (%) increase in HbA1c during pregnancy. When fasting glucose, 2 h glucose and HbA1c during pregnancy were entered multivariable-adjusted model simultaneously, 2 h glucose and HbA1c but not fasting glucose remained to be significant and positive predictors for postpartum diabetes. Conclusions For women with prior GDM, 2 h plasma glucose and HbA1c during pregnancy are independent predictors of postpartum diabetes, but fasting plasma glucose during pregnancy is not.