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Aim: Understanding the factors determining marine community variations is important for biogeography and conservation. Beta diversity is a metric for mapping species composition variations between communities and regionalizing biota. Ecoregions are commonly used for regionalization, but their empirical testing has been limited. Our aim is to map marine species composition variations in the Western Atlantic, identify variables related to these variations, and regionalize areas based on community distribution. Additionally, we test whether currently proposed ecoregions represent unique biota units and specific environmental conditions. Location: Western Atlantic Ocean. Taxon: Vertebrates, invertebrates and algae. Methods: We constructed a large marine biodiversity database, including vertebrates, invertebrates, and algae, totalling over 4 million records. We used the generalized dissimilarity model (GDM) to identify variables most related to species composition variations and map beta‐diversity variations. We employed an unsupervised classifier for community regionalization. To test if the ecoregion regionalization boundaries are corroborated by species distribution data, we used the Sørensen index. To assess if ecoregions correspond to environmental units, we checked if areas had distinct environmental conditions using a PCA of 134 marine environmental variables. Results: The GDM explained a high variation in species composition, 61% in the complete database. Analysing vertebrates, invertebrates and algae separately also yielded relatively high results: 46%, 54%, and 33%, respectively. Coastal areas differed from open sea areas in composition. Environmental variables combined better explained beta diversity than isolated variables. The regionalization based on GDM was not congruent with ecoregion boundaries. Moreover, ecoregions showed no distinction in species composition or environmental conditions. Main Conclusions: This study's regionalization is crucial for marine biodiversity conservation, focusing on understanding species composition patterns between coastal and open sea areas to develop tailored conservation strategies. Despite sampling limitations, the study advances marine biogeography knowledge by analysing over 4 million species records and 134 environmental variables. This comprehensive approach enhances understanding marine species distribution and diversity and aiding the development of effective conservation measures. [ABSTRACT FROM AUTHOR]

Objective: Gestational diabetes mellitus (GDM) is a prevalent complication during pregnancy associated with numerous adverse outcomes. There is emerging evidence suggesting the potential of probiotics as a therapeutic measure for GDM; however, existing studies have yielded contradictory results. This meta-analysis assessed the efficacy of probiotics on blood glucose management and pregnancy outcomes in patients with GDM. Methods: A comprehensive search of the PubMed, Embase, and Cochrane databases was conducted up to August 22, 2023, to identify relevant studies. The primary outcomes focused on fasting blood glucose (FBG), fasting serum insulin (FSI), homeostasis model assessment of insulin resistance (HOMA-IR), and quantitative insulin sensitivity check index (QUICKI). The secondary outcomes included various maternal and neonatal outcomes. Results: This meta-analysis included 15 randomized controlled trials (RCTs), encompassing 1006 patients with GDM. The results showed that, compared to a placebo, probiotics demonstrated a significant reduction in FBG (MD − 2.58, 95% CI − 4.38 to − 0.79, p < 0.01), FSI (MD − 2.29, 95% CI − 3.40 to − 1.18, p < 0.01), HOMA-IR (MD − 0.56, 95% CI − 0.81 to − 0.32, p < 0.01), and birth weight (MD − 101.20, 95% CI − 184.62 to − 17.77, p = 0.02). Furthermore, it resulted in fewer neonatal intensive care unit (NICU) admissions (RR 0.60, 95% CI 0.40–0.89, p = 0.01), instances of hyperbilirubinemia (RR 0.31, 95% CI 0.16–0.61, p < 0.01), and elevated QUICKI (MD 0.01, 95% CI 0.00–0.01, p < 0.01). No significant impact was observed in the other analyzed outcomes. Conclusions: In conclusion, probiotics improve FBG, FSI, and HOMA-IR, and reduce the occurrence of neonatal hyperbilirubinemia, NICU admissions, and birth weight in the offspring of patients with GDM. However, the quality of the evidence, as per the GRADE approach, varies from high to low, necessitating further studies to consolidate these findings. [ABSTRACT FROM AUTHOR]

ABSTRACT: Objectives: To estimate the prevalence of gestational diabetes mellitus (GDM) and compare adverse pregnancy outcomes with respect to treatment modalities in a peri-urban teaching hospital in Telangana. Methods: A prospective study was conducted on GDM cases delivered from January 2019 to March 2020. GDM was diagnosed using a two-step procedure of screening using IADPSG criteria. Women diagnosed with GDM were divided into four groups – diet group, metformin group, metformin plus insulin group and insulin group based on the treatment modalities. Adverse pregnancy outcomes of the women managed with different treatment modalities were recorded. Results: Good glycaemic control (FBS, P = 0.04, 2 hrs PLBS, P = 0.01) was achieved in diet and metformin groups. Incidence of Gestational hypertension (P = 0.01) and preeclampsia (P = 0.01) were found to be higher in the insulin group when compared to the metformin and insulin group, metformin group and diet group. No difference was noted with respect to polyhydramnios, preterm birth, premature rupture of membranes, induction labour and caesarean delivery rates between the treatment groups. Apgar score at 5 min of <7 (P = 0.02), neonatal intensive care unit admissions for >24 hrs (P = 0.03) and neonatal hypoglycaemia (P = 0.01) were found to be higher in insulin-required groups. Rates of shoulder dystocia, stillbirth, early neonatal death within 1 week and respiratory distress did not vary significantly between the treatment groups. Conclusion: Universal screening of women for GDM and multidisciplinary management of women once diagnosed tend to lessen maternal and fetal complications. Metformin can be an effective, cheaper and non-invasive alternative to insulin in the management of GDM. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to assess the impact of the change of 1-hour postprandial glycemic target from < 6.7 mmol/L (120 mg/dL) to < 7.8 mmol/L (140 mg/dL) on gestational diabetes mellitus (GDM) treatment and pregnancy outcomes. Material and methods: In a retrospective analysis of 1021 GDM patients from the Department of Metabolic Diseases, University Hospital in Cracow, Poland, we compared insulin therapy regimens and pregnancy outcomes between women admitted in 2014-2016 (before the change) and in 2018-2019 (after it). Results: A total of 377 patients were admitted between 2014 and 2016 (TIGHT group) and 644 between 2018 and 2019 (LESS TIGHT group). Women from the LESS TIGHT group were older (32 vs 30 years, p < 0.001) and gained less weight during pregnancy (7.0 vs 9.0 kg, p < 0.001). There was no change in the frequency of any insulin therapy (51.6% vs 56.1%, p = 0.168). In the LESS TIGHT group, the basal insulin-only model was used more frequently (32.5% vs 10.2%, p < 0.001), while the prandial insulin and basal-bolus model less frequently (23.6% vs 42.6% and 21.4% vs 36.7%, p < 0.001, respectively) than in the TIGHT group. There were no differences in the frequency of cesarean sections, preterm births, Hbd of delivery, mean birth weight or prevalence of perinatal complications. Conclusions: Less tight glycemic targets in women with GDM, compared to tighter targets, were associated with less frequent use of prandial insulin, with insulin therapy often limited to basal administration. The change in glycemic targets did not affect the prevalence of adverse pregnancy outcomes, providing evidence supporting new recommendations. [ABSTRACT FROM AUTHOR]

Gestational diabetes mellitus (GDM) is a common disorder in the clinic, which may lead to severe detrimental outcomes both for mothers and infants. However, the underlying mechanisms for GDM are still not clear. In the present study, we performed label‐free proteomics using placentas from GDM patients and normal controls. Vitronectin caused our attention among differentially expressed proteins due to its potential role in the pathological progression of GDM. Vitronectin was increased in the placentas of GDM patients, which was confirmed by Western blot analysis. Vitronectin represses insulin signal transduction in trophoblast cells, whereas the knockdown of vitronectin further potentiates insulin‐evoked events. Neutralization of CD51/61 abolishes the repressed insulin signal transduction in vitronectin‐treated trophoblast cells. Moreover, vitronectin activates JNK in a CD51/61‐depedent manner. Inhibition of JNK rescues impaired insulin signal transduction induced by vitronectin. Overall, our data indicate that vitronectin binds CD51/61 in trophoblast cells to activate JNK, and thus induces insulin resistance. In this regard, increased expression of vitronectin is likely a risk factor for the pathological progression of GDM. Moreover, blockade of vitronectin production or its receptors (CD51/61) may have therapeutic potential for dealing with GDM. [ABSTRACT FROM AUTHOR]

Objective: GDM has conventionally been defined as any degree of glucose intolerance with onset or first recognition during pregnancy warranting early recognition and management to improve maternal foetal outcomes. In India alone, GDM complicates almost four million pregnancies every year, depicting a large proportion of population at high risk for adverse perinatal morbidity and mortality. This makes it prudent to recommend universal screening for GDM for all women especially amongst SE Asian ethnicity. Methods: This prospective, observational twin-centre study was carried out to observe maternal and foetal outcomes in two groups diagnosed as having GDM by two different criteria: 50 pregnant women were diagnosed with GDM by IADPSG criteria by performing a 75 g OGTT in a fasting state at 24–28 weeks. GDM was diagnosed if fasting ≥ 92 mg/dl or 1 h ≥ 180 mg/dl or 2 h ≥ 153 mg/dl — labelled as Group 1 — 50 pregnant women were diagnosed with GDM using DIPSI criteria by performing the single-step non-fasting 75 gm oral glucose challenge at 24–28 weeks. GDM was diagnosed with plasma glucose values ≥ 140 mg/dL at 2 h post glucose — labelled as Group 2 Both the groups were followed prospectively till the delivery of new born for assessment of immediate maternal and foetal outcomes. Results: There was no statistical difference in foetal and maternal outcomes in groups. Conclusions: Single-step DIPSI criteria can be used for screening and diagnosis of GDM for its simplicity, feasibility, economy and convenience. It has the potential to be applied to the entire obstetric population from India as well as the Indian subcontinent, meeting the needs of the developing world where the complicated three-step IADPSG can be challenging. [ABSTRACT FROM AUTHOR]

Objective: During the COVID-19 pandemic, the screening approach to the diagnosis of gestational diabetes mellitus (GDM) was subject to emergency simplifications. We aimed at assessing the effectiveness of two of these temporary pandemic protocols—namely the Australian and UK, and to examine the insights they gave into the effectiveness of the more standard WHO-outlined GDM diagnosis protocol. Methods: We performed a retrospective analysis of 432 GDM patients attending the outpatient clinic at the University Hospital of Cracow, Poland throughout 2020. Results: When applying the UK criteria, 272 (63.0%) of 432 GDM cases would be missed. Women with missed-GDM by UK criteria were slightly older, had lower BMI, and had lower use of insulin. The frequency of child perinatal complications was lower in the missed GDM group (7.6% vs. 18.9%, p = 0.042) when compared to the non-missed cases group. When applying the Australian criteria, 86 of 432 (19.9%) GDM cases would be missed. Women with missed-GDM by the Australian criteria had lower BMI and less commonly used insulin than the women not missed. There were no differences in the frequency of child and maternal complications. Conclusions: Modifications proposed from the UK and Australia resulted in varying decreases and delays in GDM diagnoses, but with no apparent harm to mothers and offspring. More studies are required to investigate the impact of the simplification of GDM diagnosis on pregnancy outcomes. [ABSTRACT FROM AUTHOR]

Gestational diabetes mellitus (GDM) triggers alterations in the maternal microbiome. Alongside metabolic shifts, microbial products may impact clinical factors and influence pregnancy outcomes. We investigated maternal microbiome-metabolomic changes, including over 600 metabolites from a subset of the "Choosing Healthy Options in Carbohydrate Energy" (CHOICE) study. Women diagnosed with GDM were randomized to a diet higher in complex carbohydrates (CHOICE, n = 18, 60% complex carbohydrate/25% fat/15% protein) or a conventional GDM diet (CONV, n = 16, 40% carbohydrate/45% fat/15% protein). All meals were provided. Diets were eucaloric, and fiber content was similar. CHOICE was associated with increases in trimethylamine N-oxide, indoxyl sulfate, and several triglycerides, while CONV was associated with hippuric acid, betaine, and indole propionic acid, suggestive of a healthier metabolome. Conversely, the microbiome of CHOICE participants was enriched with carbohydrate metabolizing genes and beneficial taxa such as Bifidobacterium adolescentis, while CONV was associated with inflammatory pathways including antimicrobial resistance and lipopolysaccharide biosynthesis. We also identified latent metabolic groups not associated with diet: a metabolome associated with less of a decrease in fasting glucose, and another associated with relatively higher fasting triglycerides. Our results suggest that GDM diets produce specific microbial and metabolic responses during pregnancy, while host factors also play a role in triglycerides and glucose metabolism. [ABSTRACT FROM AUTHOR]

Background: Phytochemicals are non-nutritive bioactive compounds with beneficial effects on the metabolism of glucose. This study aimed to clarify the possible causal effect of the pre-pregnancy dietary phytochemical index (DPI) on gestational diabetes mellitus (GDM). Methods: In this prospective cohort study 1,856 pregnant women aged 18–45 years who were in their first trimester, were recruited and followed up until delivery. The dietary intakes of participants were examined using an interviewer-administered validated 168-item semi-quantitative food frequency questionnaire (FFQ). Inverse probability weighting (IPW) of propensity scores (PS), estimated from the generalized boosted model (GBM) were used to obtain a adjusted risk ratio (aRR) for potential confounders. Results: During the follow-up period, 369 (19.88%) women were diagnosed with GDM. DPI scores ranged from 6.09 to 89.45. There was no association between DPI scores and GDM (aRR: 1.01, 95% confidence interval [CI]: 0.92, 1.08; p trend = 0.922). When comparing DPI quartile 4 (most pro-phytochemical content) to quartile 1 (few phytochemical contents), there was no significant difference between them (aRR: 0.97; 95% CI: 0.75, 1.25; p = 0.852). Also, there was no significant difference between DPI quartile 3 and quartile 1 (aRR: 1.04; 95% CI: 0.81, 1.34; p = 0.741) as well as DPI quartile 2 and quartile 1 (aRR: 0.92; 95% CI: 0.71, 1.21; p = 0.593). Conclusions: Although this data did not support the association between pre-pregnancy DPI scores and GDM, further cohort studies to ascertain the causal association between them are warranted. [ABSTRACT FROM AUTHOR]

Objective: This study is a Narrative Review that aims at investigating the implications of obesity, excessive gestational weight gain (GWG) and gestational diabetes mellitus (GDM). Additionally, this Review seeks to explore the effectiveness of nutrition, and/or exercise interventions during pregnancy on reducing GWG and preventing GDM. Materials and Methods: The search in literature included studies that identified obesity, GWG, GDM and associated risks during pregnancy. Also, SR and MA focusing on interventions including diet, or physical activity (PA), or combined (i.e., lifestyle interventions) and their impact on metabolic risk during pregnancy, were identified through searches in PubMed, Cochrane Database of Systematic Reviews (CDSRs), and Scopus. Results: The study findings suggest that lifestyle interventions during pregnancy may be effective in reducing excessive GWG. Regarding the prevention of GDM, results from studies evaluating lifestyle interventions vary. However, significant and less controversial results were reported from studies assessing the efficacy of exercise interventions, particularly in high-risk pregnant women. Conclusions: Lifestyle interventions during pregnancy may reduce excessive GWG. Exercise during pregnancy may prevent GDM, especially in high-risk pregnant women. Future research is warranted to tailor lifestyle interventions for optimal effectiveness during pregnancy. [ABSTRACT FROM AUTHOR]

AimConducted a one-day outpatient service for GDM patients, analyzed the relationship between stress adaptation disorder and insulin resistance in GDM patients after intervention, and tried to provide some new clues for the prevention and treatment of GDM, provide some theoretical basis for the multidisciplinary diagnosis and treatment model of GDM patients.Methods240 GDM women were included in this study, 120 women were included in one-day diabetes clinic management for GDM women as GDM Intervention Group, and 120 GDM women receiving regular dietary education as GDM Control Group. One-day diabetes clinic management including disease knowledge and dietary education, sports education and blood sugar monitoring and personalized issues and follow-up visits, and intervention time lasting for 1 month.ResultsAfter intervention, the concentration of 2-h postprandial blood glucose, and HOMA-IR were decreased in GDM Intervention Group, while weekly weight gain rate and insulin application rate were significantly lower than GDM Control Group (all p

Alkylphenols (APs) may cause gestational diabetes mellitus (GDM) in pregnant women by impairing glucose metabolism through endocrine disruption. However, the current literature has limited epidemiological evidence on the association between APs exposure and the risk of GDM, especially the lack of evidence on joint exposure. Thus, we evaluated the effect of exposure to APs during early pregnancy on the risk of GDM. The study involved 2035 pregnant women from Guangxi Zhuang Birth Cohort (GZBC) in China. Poisson regression model, restricted cubic spline (RCS), Bayesian kernel machine regression (BKMR), and quantile g-computation (Qgcomp) were conducted to evaluate the effects of serum APs levels on the risk of GDM in pregnant women. For each Ln-unit increase in the serum nonylphenol (NP) of pregnant women, the adjusted relative risk (RR) for GDM risk was 1.12 (95 % CI: 1.00, 1.24). After sex stratification, the effect was more pronounced among pregnant women carrying female fetuses（RR=1.22; 95 % CI: 1.09, 1.38). The serum 4-t-octylphenol (4-T-OP) of the medium-exposure (adjusted RR = 3.25: 95 % CI: 1.30, 8.12) and high-exposure groups (adjusted RR = 2.90: 95 % CI: 1.15, 7.31) were related to a significantly increased risk of GDM in pregnant women carrying female fetuses only when compared to the low-exposure group. A reverse U-shaped nonlinear association was found between 4-n-octylphenol (4-N-OP) and 4-n-nonylphenol (4-N-NP) concentrations and GDM risk, and it was more susceptible in pregnant women carrying female fetuses. The Qgcomp and BKMR models showed that exposure to APs mixtures was correlated with an elevated risk of GDM in pregnant women carrying female fetuses (adjusted OR = 1.90: 95 % CI: 1.07, 3.38). Exposure to APs during early pregnancy may have potential fetal sex-specific effects on the risk of GDM, with pregnant women carrying female fetuses being more susceptible.

OBJECTIVE: This study aims to develop and evaluate a predictive nomogram for early assessment risk factors of gestational diabetes mellitus (GDM) during early pregnancy term, so as to help early clinical management and intervention. METHODS: A total of 824 pregnant women at Zhongnan Hospital of Wuhan University and Maternal and Child Health Hospital of Hubei Province from 1 February 2020 to 30 April 2020 were enrolled in a retrospective observational study and comprised the training dataset. Routine clinical and laboratory information was collected; we applied least absolute shrinkage and selection operator (LASSO) logistic regression and multivariate ROC risk analysis to determine significant predictors and establish the nomogram, and the early pregnancy files (gestational weeks 12-16, n = 392) at the same hospital were collected as a validation dataset. We evaluated the nomogram via the receiver operating characteristic (ROC) curve, C-index, calibration curve, and decision curve analysis (DCA). RESULTS: We conducted LASSO analysis and multivariate regression to establish a GDM nomogram during the early pregnancy term; the five selected risk predictors are as follows: age, blood urea nitrogen (BUN), fibrinogen-to-albumin ratio (FAR), blood urea nitrogen-to-creatinine ratio (BUN/Cr), and blood urea nitrogen-to-albumin ratio (BUN/ALB). The calibration curve and DCA present optimal predictive power. DCA demonstrates that the nomogram could be applied clinically. CONCLUSION: An effective nomogram that predicts GDM should be established in order to help clinical management and intervention at the early gestational stage.

BackgroundPer- and polyfluoroalkyl substances (PFAS) are persistent synthetic chemicals and are commonly found in everyday items. PFAS have been linked to disrupting glucose homeostasis, however, whether they are associated with gestational diabetes mellitus (GDM) risk remains inconclusive. We examined prospective associations of PFAS concentrations measured twice in pregnancy with GDM risk.MethodsIn the PETALS pregnancy cohort, a nested case-control study which included 41 GDM cases and 87 controls was conducted. PFAS analytes were measured in blood serum collected in both early and mid-pregnancy (mean [SD]: 13.9 [2.2] and 20.2 [2.2] gestational weeks, respectively), with cumulative exposure calculated by the area-under-the-curve (AUC) to integrate both the PFAS concentration and the timing of the exposure. Individual adjusted weighted unconditional logistic regression models examined seven PFAS in association with GDM risk. P-values were corrected using the false-discovery-rate (FDR). Mixture models were analyzed with Bayesian kernel machine regression (BKMR).ResultsPFDA, PFNA and PFOA were individually associated with higher GDM risk per interquartile range (IQR) in early pregnancy (OR [95% CI]: 1.23 [1.09, 1.38]), 1.40 [1.24, 1.58]), and 1.15 [1.04, 1.27], respectively), mid-pregnancy (1.28 [1.15, 1.43], 1.16 [1.05, 1.28], and 1.20 [1.09, 1.33], respectively), and with cumulative exposure (1.23 [1.09, 1.38], 1.21 [1.07, 1.37], and 1.19 [1.09, 1.31], respectively). PFOS in mid-pregnancy and with cumulative exposure was associated with increased GDM risk (1.41 [1.17, 1.71] and 1.33 [1.06, 1.58], respectively). PFUnDA in early pregnancy was associated with lower GDM risk (0.79 [0.64, 0.98]), whereas mid-pregnancy levels were associated with higher risk (1.49 [1.18, 1.89]). PFHxS was associated with decreased GDM risk in early and mid-pregnancy (0.48 [0.38, 0.60] and 0.48 [0.37, 0.63], respectively) and with cumulative exposure (0.49 [0.38,0.63]). PFPeA was not associated with GDM. Similar conclusions were observed in BKMR models; however, overall associations in these models were not statistically significant.ConclusionsHigher risk of GDM was consistently observed in association with PFDA, PFNA, and PFOA exposure in both early and mid-pregnancy. Results should be corroborated in larger population-based cohorts and individuals of reproductive age should potentially avoid known sources of PFAS.

Abstract Background Gestational diabetes mellitus (GDM) is a complication of pregnancy associated with numerous adverse outcomes. There may be a potential link between GDM and arsenic (As) exposure, but this hypothesis remains controversial. This meta-analysis summarizes the latest studies evaluating the association between As and GDM. Methods A comprehensive search of the PubMed, Embase, and Scopus databases up to September 2023 was performed. The pooled estimates with 95% CIs were presented using forest plots. Estimates were calculated with random effects models, and subgroup and sensitivity analyses were conducted to address heterogeneity. Results A total of 13 eligible studies involving 2575 patients with GDM were included in this meta-analysis. The results showed that women exposed to As had a significantly increased risk of GDM (OR 1.47, 95% CI: 1.11 to 1.95, P = 0.007). Subgroup analyses suggested that the heterogeneity might be attributed to the years of publication. In addition, sensitivity analysis confirmed the robust and reliable results. Conclusions This analysis suggested that women exposed to As have a greater risk of GDM. However, the significant heterogeneity across studies requires careful interpretation. Registration The PROSPERO registration ID is CRD42023461820.

Abstract Background This study aimed to evaluate the cost-effectiveness of a telehealth coaching intervention to prevent gestational diabetes mellitus (GDM) and to calculate the breakeven point of preventing GDM. Methods Data to inform the economic evaluation model was sourced directly from the large quaternary hospital in Brisbane, where the Living Well during Pregnancy (LWdP) program was implemented, and further supplemented with literature-based estimates where data had not been directly collected in the trial. A cost-effectiveness model was developed using a decision tree framework to estimate the potential for cost savings and quality of life improvement. A total of 1,315 pregnant women (49% with a BMI 25-29.9, and 51% with a BMI ≥ 30) were included in the analyses. Results The costs of providing routine care and routine care plus LWdP coaching intervention to pregnant women were calculated to be AUD 20,933 and AUD 20,828, respectively. The effectiveness of the LWdP coaching program (0.894 utility) was slightly higher compared to routine care (0.893). Therefore, the value of the incremental cost-effectiveness ratio (ICER) was negative, and it indicates that the LWdP coaching program is a dominant strategy to prevent GDM in pregnant women. We also performed a probabilistic sensitivity analysis using Monte Carlo simulation through 1,000 simulations. The ICE scatter plot showed that the LWdP coaching intervention was dominant over routine care in 93.60% of the trials using a willingness to pay threshold of AUD 50,000. Conclusion Findings support consideration by healthcare policy and decision makers of telehealth and broad-reach delivery of structured lifestyle interventions during pregnancy to lower short-term costs associated with GDM to the health system.

Background and Objectives: The relationship between pregnancy complications and the risk of gynecological and breast cancer remains inconclusive, with limited research available. This study aimed to determine whether pregnancy complications, including preeclampsia, gestational diabetes mellitus (GDM), large for gestational age (LGA), or intrauterine growth restriction (IUGR) are associated with the development of endometrial cancer (EC), ovarian cancer (OC), or breast cancer (BC). Materials and Methods: This was a population-based case–control study linked to the National Health Insurance Research Database from 2008 to 2020, using ICD codes to identify parous gynecological cases (n = 6714). The propensity score matching method was used to match control groups (n = 1,153,346). Multivariable logistic regression models were used to determine the association between EC, OC, BC risk and pregnancy complications. Results: In adjusted multivariable logistic regression models, women with a history of preeclampsia did not have a significantly increased risk of endometrial, ovarian, or breast cancer compared to controls. Although women with GDM complications had a significantly increased risk of breast cancer, the increased risk of EC or OC was not significant. The risk of BC in women with a history of IUGR or LGA was not significant, whereas risk statistics for EC or OC in women with a history of IUGR or LGA could not be shown because of the small sample size. Conclusions: GDM is associated with BC risk. Future studies should aim to determine whether there is a causal relationship. Therefore, cancer screening is warranted in women with GDM.

Background/Objectives: Limited evidence links maternal macronutrient intake to gestational diabetes mellitus (GDM) risk. Therefore, we evaluated these intakes both before and during pregnancy, comparing macronutrient data against the European Food and Safety Authorities’ (EFSA) Dietary Reference Values (DRVs). Methods: Data were prospectively collected from the Greek BORN2020 epidemiologic pregnant cohort, which included 797 pregnant women, of whom 14.7% were diagnosed with GDM. A multinomial logistic regression model assessed the association between macronutrient intake and GDM, adjusting for maternal, lifestyle, and pregnancy-related factors. Results: Women with GDM had higher maternal age (34.15 ± 4.48 vs. 32.1 ± 4.89 years), higher pre-pregnancy BMI (median 23.7 vs. 22.7 kg/m2), and were more likely to smoke during mid-gestation (17.95% vs. 8.82%). Pre-pregnancy energy intake exceeding EFSA recommendations was associated with increased GDM risk (aOR = 1.99, 95%CI: 1.37–2.86). During mid-gestation, higher dietary fiber intake (aOR = 1.05, 95%CI: 1.00–1.10), higher protein intake (aOR = 1.02, 95% CI: 1.00–1.04), and higher protein percentage of energy intake (aOR = 1.08, 95%CI: 1.01–1.17) were all significantly associated with increased GDM risk. Changes from pre-pregnancy to pregnancy showed significant increases in dietary fiber intake (aOR = 1.07, 95%CI: 1.04–1.10), protein (aOR = 1.00, 95%CI: 1.00–1.01), fat (aOR = 1.00, 95%CI: 1.00–1.01), vegetable protein (aOR = 1.01, 95%CI: 1.00–1.03), animal protein (aOR = 1.00, 95%CI: 1.00–1.01), and monounsaturated fatty acid (MUFA) intake (aOR = 1.01, 95%CI: 1.00–1.02), all of which were associated with increased GDM risk. Conclusions: Energy intake above upper levels set by EFSA, as well as increased protein, MUFA, and fiber intake, although beneficial in balanced intakes, may negatively affect gestation by increasing GDM likelihood when consumed beyond requirements.

Background: Nutritional therapy is the basis of diabetes treatment. Non-compliance with dietary recommendations is a common obstacle in the treatment of diabetes, with attenuated taste perception being one of many potential responsible factors. We investigated the impact of gestational diabetes mellitus (GDM) and type 1 diabetes (T1D) on two sensory modalities—saccadic eye movement and gustatory sense. Methods: In this prospective cohort study, we included 91 participants—28 women with GDM, 26 nonpregnant women with T1D and 37 non-diabetic non-pregnant women. We performed gustatory sense examination (GSE) with test strips for taste modalities and saccadic eye movement examination (SEME) and compared obtained results between study groups. This study was started prior to the requirement for registration of interventional cohort studies. Results: The mean age of participants was 29.4 ± 5.2 years. Women from the GDM group were older (31.0 [interquartile ranges (IQR): 29.0–35.8] vs. 28.0 [IQR: 22.5–34.8] and 28.0 [IQR: 25.3–30.0] years, p = 0.003) and had higher pre-pregnancy body mass index (BMI) compared to women with T1D and controls (26.2 [IQR: 20.8–28.5] vs. 22.6 [IQR: 20.9–24.4] and 20.9 [IQR: 19.1–22.3] kg/m2, p = 0.001). The total gustatory score was lower in women with GDM and T1D than controls with no significant difference between the GDM and T1D groups (68.8% [56.3%–75.0%], 67.5% [55.0%–76.3%], and 80.0% [70.0%–85.0%], respectively, p < 0.001). Saccadic latency was borderline higher in GDM than in the control group (189.5 ms [162.8–214.3] vs. 167.5 ms [154.5–186.3], p = 0.054) and duration was shorter in GDM than in T1D group (50.0 ms [47.0–53.0] vs. 54.5 ms [48.0–60.3], p = 0.041), with no differences in saccadic amplitude, mean and peak velocity between the studied groups. Conclusions: The gustatory sense was attenuated to a similar degree in nonpregnant women with T1D and those with GDM, when compared to non-diabetic non-pregnant women. This partially explains the phenomenon of cravings and affects compliance to dietary recommendations. Gustatory testing could be a potential measure to improve the metabolic control of diabetes and reducing the risk of maternal and neonatal complications of pregnancy. More studies in diverse populations of T1D patients are needed to assess the effectiveness of saccadometry in screening for diabetic neuropathy.

Objective: To assess the effectiveness of HbA1c as an indicator of Gestational Diabetes mellitus(GDM). Study Design: Prospective Cases Control study. Setting: Fauji Foundation Hospital Rawalpindi. Period: March 2022 to Oct 2022. Methods: All pregnant females older than 18 years of age having pregnancy confirmed by gynecologist in 1st trimester were included. A 5ml blood sample was obtained from each case to evelaute the HbA1c level. Oral glucose tolerance test (OGTT) was performed on both groups at conception to 12 weeks (1st trimester) as well as at 12 to 24 weeks of gestation (2nd trimester) to evaluate correlation between OGTT and HbA1c test. All the females suffering from GDM were taken in cases group and comparatively in equal number non GDM pregnant women were taken in control group. All the relevant information was collected via study proforma and SPSS version 26 was used for analysis. Results: The number of females suffering from GDM was 45 in number and we took 45 pregnant females as control group. Average level of HbA1c in women with GDM (test group) was higher than in women with Non-GDM (control group). Patients having age groups 35-39 showing greater prevalence of gestational diabetes with 73.2% sensitivity and 66.7% specificity at a cut-off value of 5.6% (31 mmol/ mol) for GDM diagnosis. Conclusion: The findings reveal significantly elevated HbA1c levels during both the first and second trimesters in individuals diagnosed with GDM, with a test specificity of 95%. This underscores its ability to accurately pinpoint individuals who truly have GDM. However, HbA1c is observed as a valuable diagnostic tool for the early detection of GDM. [ABSTRACT FROM AUTHOR]

Objective: To analyze of efficacy of metformin in pregnant women with POCS regarding occurrence of gestational diabetes mellitus. To analyze parity distribution for efficacy of metformin regarding occurrence of gestational diabetes mellitus in pregnant women with POCS. Study Design: Descriptive Cases Series. Setting: Sheikh Zaid Hospital, Lahore. Period: July 1, 2019 to December 31, 2019. Methods: Till delivery 200 pregnant ladies were followed up to see if they developed GDM or not. A pre-prepared form was used to record metformin efficacy frequency and GDM in pregnant ladies with PCOS. For efficacy and parity (qualitative variables), percentages and frequencies were got calculated using SPSS.16. Results: Thirty two (16%) women got '0' parity. Forty four (22%) got '1'parity. Fifty (25%) got '2' parity. Forty two (21%) got '3'parity.While thirty two women (16%) got '4' parity. Twenty two (78.57%) was efficacy for nulliparous patients. Thirty three (76.74%) was efficacy for primiparous patients. One hundred nine (84.50%) was efficacy for multiparous patients. Insignificant difference was noted as p was more than 0.05. In one hundred sixty six (83%) women metformin efficacy got achieved. Conclusion: Multiparous patients with PCOS showed relatively more efficacy (84.50%) of metformin against gestational diabetes mellitus while twenty five percent pregnant women with PCOS with a thorough use of metformin delivered two live neonates. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the history of gestational diabetes mellitus and other risk factors in women presenting with Type-2 diabetes mellitus at a tertiary care hospital. Methods: This cross-sectional study was carried out at Baqai Institute of Diabetology & Endocrinology (BIDE), Baqai Medical University (BMU), Karachi-Pakistan from July 2019 to May 2022. Women with Type-2 diabetes mellitus (T2DM) visiting outpatient department of BIDE with a previous history of GDM were recruited. Details were obtained on predesigned questionnaire after taking informed written consent. Results: A total of 378 women who had a prior history of GDM were included. Mean age (years) was 43.53±10.17. Mostly women were obese (BMI = 30.53±6.08) and have sedentary lifestyle. Mean HbA1c (%) was 9.08±2.24. This study found family history of T2DM and hypertension were common risk factors in women with GDM history. Mostly, women were diagnosed as GDM during 2nd trimester 153(42%) and was mainly seen in multiparous women (occur in 4th and above pregnancy). We found hypertension as common complication during pregnancy. Around 46% women developed T2DM within one year of GDM diagnosis, and 29.6% between one to five years. Conclusion: Majority of women with GDM developed T2DM within five years of diagnosis. The potential associated risk factors were age, family history of diabetes, insulin use during pregnancy, trimester of GDM diagnosis, and hypertension during pregnancy. Awareness and life style modifications along with regular post-partum follow up with screening for T2DM should be part of GDM management to prevent or delay the occurrence of this serious complication. [ABSTRACT FROM AUTHOR]

Introduction: Gestational diabetes mellitus (GDM) is associated with a higher risk of adverse maternal outcomes, but its effects on maternal and perinatal outcomes of twin pregnancies remain conflicting. Methods: This retrospective cohort study included all primipara who delivered twin pregnancies at a single tertiary perinatal center between January 1, 2016 and December 31, 2022. Excluded were those who had a single pregnancy, twin pregnancies with pre-existing diabetes, missing information on GDM screening, a delivery before gestational 28 weeks, complications related to monochorionic placentation, multifetal reduction, fetal anomalies, and monochorionic monoamniotic twins. Maternal outcomes included preterm birth, pre-eclampsia, hypothyroidism, preterm premature rupture of membranes (PROM), placental abruption, severe postpartum hemorrhage, and oligohydramnios. Neonatal outcomes included small-for-gestational-age (SGA), large-for-gestational-age (LGA), birthweight, Apgar score, neonatal intensive care unit (NICU) admission, extrauterine growth restriction (EUGR), and neonatal hypoglycemia. Results: A total of 3269 twins were delivered, with 897 women (27.4%) diagnosed with GDM during pregnancies; moreover, 72 (8.0%) of these women received insulin treatment. The GDM group showed a significantly higher maternal age at delivery (≥35 years), as well as incidences of overweight and obesity. These factors also elevated the odds of insulin treatment in GDM women with twin pregnancies (OR = 1.881, 95% CI = 1.073–3.295, P = 0.027; OR = 2.450, 95% CI = 1.422–4.223, P < 0.001; OR = 4.056, 95% CI = 1.728–9.522, P < 0.001, respectively). Chronic hypertension prior to pregnancy was identified as a risk factor for GDM during twin pregnancies (OR = 1.896, 95% CI = 1.290–2.785, P < 0.001), although it did not increase the proportion of women requiring insulin treatment (P = 0.808). Aside from a higher incidence of preterm birth before 37 weeks in insulin-treated GDM twins (OR = 2.096, 95% CI = 1.017–4.321, P = 0.045), there were no significant difference in other maternal outcomes (preterm birth before 34 weeks, pre-eclampsia, hypothyroidism, PROM, placental abruption, placenta previa, severe postpartum hemorrhage, and oligohydramnios) between the GDM group and non-GDM group, and between insulin-treated GDM and non-insulin-treated GDM. The rate of newborns with birthweight <1500 g was significantly lower among twins born to GDM women, but the prevalence of EUGR was notably higher. Additionally, the risk of EUGR was elevated in insulin-treated GDM twins (OR = 3.170, 95% CI = 1.639,6.131, P < 0.001). No significant differences were observed between the GDM group and non-GDM group, or between insulin-treated GDM and non-insulin-treated GDM group in terms of mean birthweight, newborn sex ratio, and incidences of other adverse neonatal outcomes, including gestational age at delivery, LGA, birth weight <2500 g, and 1-min and 5-min Apgar scores. Conclusion: Maternal age ≥35 years, overweight or obesity, and chronic hypertension are significant risk factors for GDM during twin pregnancies. Women with GDM during twin pregnancies may achieve similar outcomes compared to those without GDM. However, the women with GDM during twin pregnancies receiving insulin therapy may have a higher risk of preterm birth and EUGR. [ABSTRACT FROM AUTHOR]

The aim of this study was to compare the sex-dependent intergenerational effects of insulin, glibenclamide, and metformin on glucose and lipid metabolism in the offspring born to GDM mice. The murine GDM was induced by high fat diet. The offspring were grouped based on the treatments in maternal mice. ITT and GTT were performed at 4th and 8th weeks of age, respectively. Serum levels of TC, TG, HDL-C, and LDL-C plus hepatic levels of TG and TC, were respectively determined by enzymatic kits. Western blotting was conducted to detect related proteins in the livers from offspring. The dyslipidaemia, hepatic lipid abnormality, and insulin insensitivity caused by GDM were persistently normalised in male adult offspring by the respective therapies of insulin, glibenclamide, and metformin during maternal pregnancy. Specifically, the decreases in plasma TC, TG, and LDL-C levels (29%, 37.8%, and 57.7%, respectively, p ˂.05) and in hepatic lipid contents (TC 31.3% and TG 39.2%, p ˂.05), the increases in hepatic phosphorylation levels of AKT, CPT1A, PPAR-α, and PPAR-γ (57.1%, 91.7%, 68%, and 173.3%, respectively, p ˂.05) and the inhibition of G6Pase, PEPCK, and HMGCS1 (35.7%, 68.8%, and 77.3% respectively, p ˂.05) were still observed in the male offspring born to treated GDM mice from 4th to 8th week of age. Unexpectedly, the aforementioned parameters in female progenies in different groups were not significantly changed compared with controls. Respective treatments in GDM mice during pregnancy with insulin, glibenclamide, and metformin have the long-term persistent effects in male offspring, while female progenies born to untreated dams showed an autonomous inhibition of intergenerational relay of glucose and lipid dysregulation. Our current findings may imply a sex-dependent strategy of medical care for GDM mothers and their offspring. Respective interventions of insulin, glibenclamide, and metformin on dams exerted the persisted effects on male progenies. Therapies of three drugs on dams had the similarly improved effects in offspring. Female offspring autonomously corrected their dysregulated glucose-lipid metabolism caused by gestational diabetes mellitus (GDM) in dams. [ABSTRACT FROM AUTHOR]

Obesity and overweight are common and complex conditions influenced by multiple genetic and environmental factors. Several genetic variants located in the genes involved in clock systems and fat taste perception can affect metabolic health. In particular, the polymorphisms in CLOCK and BMAL1 genes were reported to be significantly related to cardiovascular disease, metabolic syndrome, sleep reduction, and evening preference. Moreover, genetic variants in the CD36 gene have been shown to be involved in lipid metabolism, regulation of fat intake, and body weight regulation. The aim of this study is to evaluate, for the first time, the association between variants in some candidate genes (namely, BMAL1 rs7950226 (G>A), CLOCK rs1801260 (A>G), CLOCK rs4864548 (G>A), CLOCK rs3736544 (G>A), CD36 rs1984112 (A>G), CD36 rs1761667 (G>A)) and overweight/obesity (OB) in pregnant women. A total of 163 normal-weight (NW) and 128 OB participants were included. A significant correlation was observed between A-allele in CLOCK rs4864548 and an increased risk of obesity (OR: 1.97; 95% CI 1.22–3.10, p = 0.005). In addition, we found that subjects carrying the haplotype of rs1801260-A, rs4864548-A, and rs3736544-G are likely to be overweight or obese (OR 1.47, 95% CI 1.03–2.09, p = 0.030), compared with those with other haplotypes. Moreover, a significant relation was observed between third-trimester lipid parameters and genetic variants—namely, CD36 rs1984112, CD36 rs1761667, BMAL1 rs7950226, and CLOCK rs1801260. A multivariate logistic regression model revealed that CLOCK rs4864548 A-allele carriage was a strong risk factor for obesity (OR 2.05, 95% CI 1.07–3.93, p = 0.029); on the other hand, greater adherence to Mediterranean diet (OR 0.80, 95% CI 0.65–0.98, p = 0.038) and higher HDL levels (OR 0.96, 95% CI 0.94–0.99, p = 0.021) were related to a reduced risk of obesity. Interestingly, an association between maternal CLOCK rs4864548 and neonatal birthweight was detected (p = 0.025). These data suggest a potential role of the polymorphisms in clock systems and in fat taste perception in both susceptibility to overweight/obesity and influencing the related metabolic traits in pregnant women. [ABSTRACT FROM AUTHOR]

Gestational diabetes mellitus (GDM) is a common condition in pregnancy, the prevalence of which has increased. Identifying modifiable risk factors for GDM, such as dietary factors, could prevent or delay the onset of the condition. Our goal was to perform a comprehensive meta-analysis of cohort studies, to summarize the current evidence on the relationship between total, animal, and plant protein intake during pregnancy, as well as pre-pregnancy protein intake, and the risk of GDM. A literature search was completed using Scopus, PubMed, Web of Science, and Google Scholar up to January 2023 and references of retrieved relevant articles. Observational studies examining the association between the consumption of dietary protein from different sources in pre-pregnancy or/and during pregnancy and the risk of GDM were included. To combine effect sizes for the comparison between the highest and lowest categories of protein intake, a random effects model was utilized. Dose–response relationships were investigated using a 1-stage random-effects model. 8 observational studies were included in the systematic review and 5 prospective cohort studies in the meta-analysis, involving a total of 24,160 participants and 2450 cases of GDM. The analysis revealed a significant association between total protein intake during pregnancy and an elevated risk of GDM (relative risk (RR): 2.24, 95 % confidence interval (CI): 1.67–3.00, P = 0.000). Conversely, no significant association was found between total protein intake before pregnancy and the risk of GDM. Both animal protein intake before pregnancy (RR: 1.47, 95 % CI: 1.06–2.03, P = 0.021) and during pregnancy (RR; 2.31, 95 % CI: 1.43–3.73, P = 0.001) showed a significant association with GDM. Interestingly, there was no significant association between the consumption of plant protein both before and during pregnancy and the risk of GDM. Further analysis revealed that an additional 5 % energy from total protein and animal protein per day was associated with a 24 % and 32 % before and 114 % and 67 % increased risk of GDM during pregnancy respectively. In conclusion, consumption of animal protein and total protein before pregnancy is associated with an increased risk of GDM, although the association is not significant for total protein. Conversely, plant protein intake is linked to a decreased risk of GDM, however, the results are not significant. The intake of any protein type (plant/animal/total) during pregnancy is associated with an elevated risk of GDM, with this association being statistically insignificant for plant protein. Further cohort studies are required to validate the findings presented in this study. PROSPERO (CRD42023396215). [ABSTRACT FROM AUTHOR]

Background: This study aimed to evaluate the cost-effectiveness of a telehealth coaching intervention to prevent gestational diabetes mellitus (GDM) and to calculate the breakeven point of preventing GDM. Methods: Data to inform the economic evaluation model was sourced directly from the large quaternary hospital in Brisbane, where the Living Well during Pregnancy (LWdP) program was implemented, and further supplemented with literature-based estimates where data had not been directly collected in the trial. A cost-effectiveness model was developed using a decision tree framework to estimate the potential for cost savings and quality of life improvement. A total of 1,315 pregnant women (49% with a BMI 25-29.9, and 51% with a BMI ≥ 30) were included in the analyses. Results: The costs of providing routine care and routine care plus LWdP coaching intervention to pregnant women were calculated to be AUD 20,933 and AUD 20,828, respectively. The effectiveness of the LWdP coaching program (0.894 utility) was slightly higher compared to routine care (0.893). Therefore, the value of the incremental cost-effectiveness ratio (ICER) was negative, and it indicates that the LWdP coaching program is a dominant strategy to prevent GDM in pregnant women. We also performed a probabilistic sensitivity analysis using Monte Carlo simulation through 1,000 simulations. The ICE scatter plot showed that the LWdP coaching intervention was dominant over routine care in 93.60% of the trials using a willingness to pay threshold of AUD 50,000. Conclusion: Findings support consideration by healthcare policy and decision makers of telehealth and broad-reach delivery of structured lifestyle interventions during pregnancy to lower short-term costs associated with GDM to the health system. [ABSTRACT FROM AUTHOR]

BackgroundGestational diabetes mellitus (GDM) significantly affects the fetal metabolic environment, elevating risks of neonatal hypoglycemia and macrosomia. Metabolomics offers promising avenues for early prediction and diagnosis of GDM and associated adverse offspring outcomes.MethodsThis study analyzed serum samples from pregnant women diagnosed with GDM at 24 to 28 weeks of gestation using untargeted metabolomics. We monitored the health outcomes of their offspring to explore the correlation between initial serum metabolite profiles and subsequent health outcomes, to uncover the predictive markers for hypoglycemia and macrosomia in these offspring.ResultsOut of 200 participants, 154 had normal newborns, 33 had offspring with hypoglycemia, and 19 had offspring with macrosomia. From 448 identified metabolites, 66 showed significant differences in cases of hypoglycemia, and 45 in macrosomia. A panel of serum metabolite biomarkers achieved Area Under the Curve (AUC) values of 0.8712 for predicting hypoglycemia and 0.9434 for macrosomia.ConclusionThe study delineated metabolic disruptions in GDM during 24–28 weeks of gestation and pinpointed biomarkers capable of forecasting adverse neonatal outcomes. These findings could inform GDM management strategies and minimize the incidence of such outcomes.

BackgroundOutside of pregnancy, intuitive eating (IE) is associated with lower body weight, blood glucose, and higher positive mood. However, little was known about the relationship between IE and anxiety-depression in the GDM population. Thus, this study aimed to investigate the association of IE with anxiety and depression, pregnancy weight and pregnancy blood glucose in the first and second GDM visit.MethodsData from 310 pregnant women with GDM from the Fujian Maternal and Child Health Hospital Trial (Approval Number: 2020Y9133) were analyzed. IE was assessed using the Intuitive Eating Scale-2 subscales of Eating for Physiological Reasons rather than Emotional Reasons (EPR), Relying on Hunger and Satiety Cues (RHSC) and Body-Food Choice Consistency (B-FCC). Observations included weight, body mass index (BMI), fasting plasma glucose (FPG) and 2-h postprandial blood glucose; the Hospital Anxiety and Depression Scale (HADS) was used to assess the level of anxiety and depression in pregnant women with GDM. Linear regression analysis was used to assess the correlation between IE and anxiety, depression, pregnancy blood glucose and weight.ResultsThe cross-sectional analysis showed that the EPR eating behavior was negatively correlated with anxiety and depression, and the B-FCC eating behavior was negatively correlated with depression at both the first and second GDM visit; in addition, the B-FCC eating behavior was associated with lower BMI in the third trimester (all p

Risk for atherosclerotic cardiovascular disease (ASCVD) shows considerable heterogeneity both in generally healthy persons and in those with known ASCVD. The foundation of preventive cardiology begins with assessing baseline ASCVD risk using global risk scores based on standard office-based measures. Persons at low risk are generally recommended for lifestyle management only and those at highest risk are recommended for both lifestyle and pharmacologic therapy. Additional "risk enhancing" factors, including both traditional risk factors and novel biomarkers and inflammatory factors can be used to further assess ASCVD risk, especially in those at borderline or intermediate risk. There are also female-specific risk enhancers, social determinants of health, and considerations for high-risk ethnic groups. Screening for subclinical atherosclerosis, especially with the use of coronary calcium screening, can further inform the treatment decision if uncertain based on the above strategies. Persons with pre-existing ASCVD also have variable risk, affected by the number of major ASCVD events, whether recurrent events have occurred recently, and the presence of other major risk factors or high-risk conditions. Current guidelines define high to very high risk ASCVD accordingly. Accurate ASCVD risk assessment is crucial for the appropriate targeting of preventive therapies to reduce ASCVD risk. Finally, the clinician-patient risk discussion focusing on lifestyle management and the risks and benefits of evidence-based pharmacologic therapies to best lower ASCVD risk is central to this process. This clinical practice statement provides the preventive cardiology specialist with guidance and tools for assessment of ASCVD risk with the goal of appropriately targeting treatment approaches for prevention of ASCVD events.

The rapid growth of the vehicle population is a major factor in heavy air pollution and public health issues. Traffic-related air pollutants (TRAPs) on roads are often much higher than ambient values, leading to high exposure levels in vehicles. This research proposes a hybrid forecasting model for early detection and early warning systems (EWS) of road networks during real-world travels. Data is collected from Kannur, Calicut, Palakkad, and Coimbatore using real-time sensors, including surrounding discussion information, activity information, vehicle speed, and stopping events. The study predicts ambient air quality (AAQ) levels on the road network using the Gaussian Dispersion model (GDM) and measures the risk sensitivity of PM10 and PM2.5 in selected regions. This helps formulate powerful prevention strategies and prevent negative health impacts. The air pollution module for predicting concentration has an innovative hybridization model that combines an improved cuckoo search (CS) and differential evolution (DE) algorithm with a stacked LSTM model to increase forecasting accuracy of six major environmental pollution levels. This model predicts the AAQ level and is effective and robust for warning one day before the pollutant event occurs based on the risk level of an ambient air pollutant from the RN.

Abstract Background Both obesity and sleep disorders are common among women during pregnancy. Although prior research has identified a relationship between obesity and sleep disorders, those findings are from women later in pregnancy. Objective To explore the relationships between self‐reported sleep duration, insufficient sleep and snoring with body mass index (BMI) among multiethnic women at risk of gestational diabetes mellitus (GDM)in early pregnancy. Methods Cross‐sectional study of baseline data from women at risk of GDM enrolled in the Treatment of BOoking Gestational diabetes Mellitus (TOBOGM) multicentre trial across 12 Australian/Austrian sites. Participants completed a questionnaire before 20 weeks’ gestation to evaluate sleep. BMI 5 days/month was higher in class II and class III obesity (1.38 (1.03–1.85) and 1.34 (1.01–1.80), respectively), and the risk of snoring increased as BMI increased (1.59 (1.25–2.02), 2.68 (2.07–3.48), 4.35 (3.21–5.88) to 4.96 (3.65–6.74), respectively)). Conclusions Obesity is associated with insufficient sleep among pregnant women at risk of GDM. Snoring is more prevalent with increasing BMI.

Abstract Background Contradictory relationships have been observed between thyroid function and gestational diabetes mellitus (GDM). Previous studies have indicated that pre-pregnancy BMI (pBMI) could modify their relationships. Few studies have illustrated the role of thyroid hormone sensitivity on GDM. We aimed to explore the effect of pre-pregnancy obesity on the association between early pregnancy thyroid hormone sensitivity and GDM in euthyroid pregnant women. Methods This study included 1310 women with singleton gestation. Subjects were classified into pre-pregnancy obese and non-obese subgroups by pBMI levels with a cutoff of 25 kg/m2. Sensitivity to thyroid hormone was evaluated by Thyroid Feedback Quartile-Based Index (TFQI), Chinese-referenced parametric TFQI (PTFQI), TSH Index (TSHI) and Thyrotrophic T4 Resistance Index (TT4RI). The associations between these composite indices and GDM were analyzed using multivariate regression models in the two subgroups, respectively. Results In pre-pregnancy non-obese group, early pregnancy TFQI, PTFQI, TSHI and TT4RI levels were higher in subjects with incident GDM compared to those without GDM (all P

Abstract Background Gestational diabetes mellitus (GDM) is a common pregnancy-related disorder and a well-known risk factor for adverse pregnancy outcomes. There are conflicting findings on the association of GDM with the risk of congenital anomalies (CAs) in offspring. In this study, we aimed to determine study whether maternal GDM is associated with an increased risk of major CAs in offspring. Methods This Finnish Gestational Diabetes (FinnGeDi) register-based study included 6,597 women with singleton pregnancies and a diagnosis of GDM and 51,981 singleton controls with no diabetes identified from the Finnish Medical Birth Register (MBR) in 2009. Data from MBR were combined in this study with the Register of Congenital Malformations, which includes the data of CAs. We used logistic regression to calculate odds ratios (OR) for CAs, together with their 95% confidence intervals (CIs), adjusting for maternal age, parity, pre-pregnancy body mass index (BMI), and maternal smoking status. Results The risk of major CAs was higher in the GDM-exposed (n = 336, 5.09%) than in the non-exposed group (n = 2,255, 4.33%) (OR: 1.18, 95% CI: 1.05–1.33, p = 0.005). The adjusted OR (aOR) was 1.14 (95% CI: 1.00-1.30, p = 0.047). There was a higher overall prevalence of CAs, particularly chromosomal abnormalities (0.52% vs. 0.21%), in the GDM-exposed group (OR: 2.49, 95% Cl: 1.69–3.66, p

Introduction Pregestational smoking increases the risk of gestational diabetes mellitus (GDM) and is a common health problem during pregnancy, with its incidence on the rise worldwide, especially in China. This study is a meta-analysis of passive smoking as a risk factor associated with GDM. Methods Two independent reviewers searched passive smoking and the risk of GDM in PubMed, Medline, Web of Knowledge, Science Direct, China National Knowledge Internet (CNKI) and Wanfang databases (up to May 2023). The authors extracted the study data independently and used the Newcastle–Ottawa scale (NOS) to evaluate the quality of the included articles. A meta-analysis was conducted using a random effects model depending on the size of the heterogeneity. Begg’s and Egger’s tests were performed to assess publication bias. Results The overall relative risk for GDM caused by passive smoking was 1.47 (95% CI: 1.31–1.64), with moderate heterogeneity between studies (I 2 =41.7%, p=0.079). Subgroup and sensitivity analyses were stable, and no evidence of publication bias was found. Conclusions Passive smoking is a risk factor for GDM, even in those who are not active smokers. To eliminate the effects of other confounding factors, larger prospective cohort studies are required to clarify the relationship between passive smoking and the occurrence of GDM.

Abstract Background Per- and polyfluoroalkyl substances (PFAS) are persistent synthetic chemicals and are commonly found in everyday items. PFAS have been linked to disrupting glucose homeostasis, however, whether they are associated with gestational diabetes mellitus (GDM) risk remains inconclusive. We examined prospective associations of PFAS concentrations measured twice in pregnancy with GDM risk. Methods In the PETALS pregnancy cohort, a nested case–control study which included 41 GDM cases and 87 controls was conducted. PFAS analytes were measured in blood serum collected in both early and mid-pregnancy (mean [SD]: 13.9 [2.2] and 20.2 [2.2] gestational weeks, respectively), with cumulative exposure calculated by the area-under-the-curve (AUC) to integrate both the PFAS concentration and the timing of the exposure. Individual adjusted weighted unconditional logistic regression models examined seven PFAS in association with GDM risk. P-values were corrected using the false-discovery-rate (FDR). Mixture models were analyzed with Bayesian kernel machine regression (BKMR). Results PFDA, PFNA and PFOA were individually associated with higher GDM risk per interquartile range (IQR) in early pregnancy (OR [95% CI]: 1.23 [1.09, 1.38]), 1.40 [1.24, 1.58]), and 1.15 [1.04, 1.27], respectively), mid-pregnancy (1.28 [1.15, 1.43], 1.16 [1.05, 1.28], and 1.20 [1.09, 1.33], respectively), and with cumulative exposure (1.23 [1.09, 1.38], 1.21 [1.07, 1.37], and 1.19 [1.09, 1.31], respectively). PFOS in mid-pregnancy and with cumulative exposure was associated with increased GDM risk (1.41 [1.17, 1.71] and 1.33 [1.06, 1.58], respectively). PFUnDA in early pregnancy was associated with lower GDM risk (0.79 [0.64, 0.98]), whereas mid-pregnancy levels were associated with higher risk (1.49 [1.18, 1.89]). PFHxS was associated with decreased GDM risk in early and mid-pregnancy (0.48 [0.38, 0.60] and 0.48 [0.37, 0.63], respectively) and with cumulative exposure (0.49 [0.38,0.63]). PFPeA was not associated with GDM. Similar conclusions were observed in BKMR models; however, overall associations in these models were not statistically significant. Conclusions Higher risk of GDM was consistently observed in association with PFDA, PFNA, and PFOA exposure in both early and mid-pregnancy. Results should be corroborated in larger population-based cohorts and individuals of reproductive age should potentially avoid known sources of PFAS.

During pregnancy, insulin resistance and impaired insulin secretion may lead to the development of Gestational Diabetes Mellitus (GDM). Although a higher Body Mass Index (BMI) is often cited as a risk factor for the development of GDM, lean pregnant women are also at risk of developing GDM based on evidence from several studies. It is proposed that insulin deficiency (more than insulin resistance) leads to the development of GDM in women with low BMI (BMI

BackgroundGestational diabetes mellitus (GDM) is a prevalent condition where diabetes is diagnosed during pregnancy, affecting both maternal and fetal outcomes. Retinol-binding protein 4 (RBP4) is a circulating adipokine which belongs to the lipocalin family and acts as a specific carrier protein that delivers retinol (vitamin A) from the liver to the peripheral tissues. Growing data indicate that circulating RBP4 levels may positively correlate with GDM. Thus, this systematic review and meta-analysis aimed to investigate the potential relationship between circulating RBP4 levels and GDM when measured at various stages of pregnancy.MethodsMEDLINE, CINAHL, EMCARE, EMBASE, Scopus, and Web of Science databases were searched to identify studies comparing pregnant women with and without GDM, whose circulating RBP4 levels were measured in at least one pregnancy trimester. Findings were reported using standardized mean difference (SMD) and random-effects models were used to account for variability among studies. Furthermore, the risk of bias was assessed using the RoBANS tool.ResultsOut of the 34 studies identified, 32 were included in the meta-analysis (seven with circulating RBP4 levels measured in the first trimester, 19 at 24–28 weeks, and 14 at >28 weeks of pregnancy). RBP4 levels were statistically higher in the GDM group than in controls when measured during all these pregnancy stages, with the noted RBP4 SMD being 0.322 in the first trimester (95% CI: 0.126–0.517; p 28 weeks of gestation (95% CI: 0.252–1.498; p = 0.006; 870 GDM cases vs. 1942 non-GDM controls). Significant study heterogeneity was noted for all three pregnancy timepoints.ConclusionThe present findings indicate consistently higher circulating RBP4 levels in GDM cases compared to non-GDM controls, suggesting the potential relevance of RBP4 as a biomarker for GDM. However, the documented substantial study heterogeneity, alongside imprecision in effect estimates, underscores the need for further research and standardization of measurement methods to elucidate whether RBP4 can be utilized in clinical practice as a potential GDM biomarker.Systematic review registrationPROSPERO (CRD42022340097: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022340097).

Aim: Women with twin pregnancies have an increased risk of gestational diabetes mellitus (GDM). Assisted reproductive technology (ART) and pre-pregnancy smoking were both associated with GDM. However, the relationships between pre-pregnancy smoking and ART and GDM in twin pregnancies were unclear. Herein, this study aims to explore the roles of pre-pregnancy smoking and ART in GDM among women with twin pregnancies. Methods: Data of women with twin pregnancies were extracted from the National Vital Statistics System (NVSS) database in 2016–2020 in this retrospective cohort study. Univariate and multivariate logistic regression analyses were used to explore the associations between pre-pregnancy smoking and ART and GDM in women with twin pregnancies. The evaluation index was odds ratios (ORs) with 95% confidence intervals (CIs). Subgroup analysis of age and BMI was also performed. Results: A total of 19,860 (9.15%) women had GDM in our study. After adjusting for covariates, we found that receiving ART was associated with high odds of GDM [OR = 1.41, 95% CI (1.34–1.48)], while pre-pregnancy smoking combined with ART was associated with higher odds of GDM [OR = 1.66, 95% CI (1.14–2.42)]. In addition, these relationships were also found in women who aged ≥ 35 years old [OR = 1.98, 95% CI (1.14–3.44)] and with BMI ≥ 25 kg/m2 [OR = 1.69, 95% CI (1.11–2.55)]. Conclusion: Pre-pregnancy smoking may further increase the risk of GDM from ART in women with twin pregnancies. In clinical, women who are ready to receive ART treatment are recommend to quit smoking, which may reduce the risk of GDM and prevent adverse pregnancy outcomes. [ABSTRACT FROM AUTHOR]

Models of care for women with gestational diabetes mellitus (GDM) have evolved in an ad hoc way and do not meet women's needs. GDM affects 50,000 Australian women per annum with prevalence quadrupling in the last ten years. Many health services are struggling to provide a quality service. People with diabetes are calling for care that focuses on their wellbeing more broadly. To examine the holistic (emotional, social, economic, and spiritual) care needs of women with GDM. Qualitative and mixed-methods studies capturing the healthcare experiences of women with GDM were searched for in CINAHL, Medline, Web of Science and Scopus. English-language studies published between 2011 and 2023 were included. Quality of studies was assessed using Crowe Critical Appraisal Tool and NVIVO was used to identify key themes and synthesise data. Twenty-eight studies were included, representing the experiences of 958 women. Five themes reflect women's holistic needs through their journey from initial diagnosis to postpartum: psychological impact, information and education, making change for better health, support, and care transition. The biomedical, fetal-centric model of care neglects the woman's holistic wellbeing resulting in high levels of unmet need. Discontinuity between tertiary and primary services results in a missed opportunity to assist women to make longer term changes that would benefit themselves (and their families) into the future. The provision of holistic models of care for this cohort is pivotal to improving clinical outcomes and the experiences of women with GDM. [ABSTRACT FROM AUTHOR]

During the last decades, gestational diabetes mellitus (GDM) prevalence has been on the rise. While insulin remains the gold standard treatment for GDM, metformin use during pregnancy is controversial. This review aimed to comprehensively assess the available data on the efficacy and safety of metformin during pregnancy, both for the mother and the offspring. Metformin has been validated for maternal efficacy and safety, achieving comparable glycemic control with insulin. Additionally, it reduces maternal weight gain and possibly the occurrence of hypertensive disorders. During the early neonatal period, metformin administration does not increase the risk of congenital anomalies or other major adverse effects, including lower APGAR score at 5 min, neonatal intensive care unit admissions, and respiratory distress syndrome. Several studies have demonstrated a reduction in neonatal hypoglycemia. Metformin has been associated with an increase in preterm births and lower birth weight, although this effect is controversial and depends on the indication for which it was administered. Evidence indicates possible altered fetal programming and predisposition to childhood obesity and metabolic syndrome during adulthood after use of metformin in pregnancy. With critical questions still requiring a final verdict, ongoing research on the field must be conducted. [ABSTRACT FROM AUTHOR]

Aim: Gestational diabetes mellitus (GDM) affects a significant number of women worldwide and has been associated with lifelong health consequences for their offspring, including increased susceptibility to obesity, insulin resistance, and type II diabetes. Recent studies have suggested that aberrant expression of the long non-coding RNA Meg3 in the liver may contribute to impaired glucose metabolism in individuals. In this study, we aimed to investigate whether intrauterine exposure to hyperglycemia affects glucose intolerance in puberty by mediating the overexpression of LncMeg3 in the liver. Methods: To test our hypothesis, we established an animal model of intrauterine hyperglycemia to mimic GDM. The progeny was observed for phenotypic changes, and intraperitoneal glucose tolerance tests, insulin tolerance tests, and pyruvate tolerance tests were conducted to assess glucose and insulin tolerance. We also measured LncMeg3 expression in the liver using real-time quantitative PCR and examined differential methylation areas (DMRs) in the Meg3 gene using pyrophosphoric sequencing. To investigate the role of LncMeg3 in glucose tolerance, we conducted Meg3 intervention by vein tail and analyzed the changes in the phenotype and transcriptome of the progeny using bioinformatics analysis. Results: We found that intrauterine exposure to hyperglycemia led to impaired glucose and insulin tolerance in the progeny, with a tendency toward increased fasting blood glucose in fat offspring at 16 weeks (P = 0.0004). LncMeg3 expression was significantly upregulated (P = 0.0061), DNMT3B expression downregulated (P = 0.0226), and DNMT3A (P = 0.0026), TET2 (P = 0.0180) expression upregulated in the liver. Pyrophosphoric sequencing showed hypomethylation in Meg3-DMRs (P = 0.0005). Meg3 intervention by vein tail led to a decrease in the percentage of obese and emaciated offspring (emaciation: 44% vs. 23%; obesity: 25% vs. 15%) and attenuated glucose intolerance. Bioinformatics analysis revealed significant differences in the transcriptome of the progeny, particularly in circadian rhythm and PPAR signaling pathways. Conclusion: In conclusion, our study suggests that hypomethylation of Meg3-DMRs increases the expression of the imprinted gene Meg3 in the liver of males, which is associated with impaired glucose tolerance in GDM-F1. MEG3 interference may attenuate glucose intolerance, which may be related to transcriptional changes. Our findings provide new insights into the mechanisms underlying the long-term effects of intrauterine hyperglycemia on progeny health and highlight the potential of Meg3 as an intervention target for glucose intolerance. [ABSTRACT FROM AUTHOR]

Background: The metabolic changes that ultimately lead to gestational diabetes mellitus (GDM) likely begin before pregnancy. Cannabis use might increase the risk of GDM by increasing appetite or promoting fat deposition and adipogenesis. Objectives: We aimed to assess the association between preconception cannabis use and GDM incidence. Methods: We analysed individual‐level data from eight prospective cohort studies. We identified the first, or index, pregnancy (lasting ≥20 weeks of gestation with GDM status) after cannabis use. In analyses of pooled individual‐level data, we used logistic regression to estimate study‐type‐specific odds ratios (OR) and 95% confidence intervals (CI), adjusting for potential confounders using random effect meta‐analysis to combine study‐type‐specific ORs and 95% CIs. Stratified analyses assessed potential effect modification by preconception tobacco use and pre‐pregnancy body mass index (BMI). Results: Of 17,880 participants with an index pregnancy, 1198 (6.7%) were diagnosed with GDM. Before the index pregnancy, 12.5% of participants used cannabis in the past year. Overall, there was no association between preconception cannabis use in the past year and GDM (OR 0.97, 95% CI 0.79, 1.18). Among participants who never used tobacco, however, those who used cannabis more than weekly had a higher risk of developing GDM than those who did not use cannabis in the past year (OR 2.65, 95% CI 1.15, 6.09). This association was not present among former or current tobacco users. Results were similar across all preconception BMI groups. Conclusions: In this pooled analysis of preconception cohort studies, preconception cannabis use was associated with a higher risk of developing GDM among individuals who never used tobacco but not among individuals who formerly or currently used tobacco. Future studies with more detailed measurements are needed to investigate the influence of preconception cannabis use on pregnancy complications. [ABSTRACT FROM AUTHOR]

Gestational diabetes mellitus (GDM) is a risk factor for both mother and fetus/neonate during and after the pregnancy. Inconsistent protocols and cumbersome screening procedures warrant the search for new and easily accessible biomarkers. We investigated a potential of serum N-glycome to differentiate between healthy pregnant women (n = 49) and women with GDM (n = 53) using a lectin-based microarray and studied the correlation between the obtained data and parameters of glucose and lipid metabolism. Four out of 15 lectins used were able to detect the differences between the control and GDM groups in fucosylation, terminal galactose/N-acetylglucosamine (Gal/GlcNAc), presence of Galα1,4Galβ1,4Glc (Gb3 antigen), and terminal α2,3-sialylation with AUC values above 60%. An increase in the Gb3 antigen and α2,3-sialylation correlated positively with GDM, whereas the amount of fucosylated glycans correlated negatively with the content of terminal Gal/GlcNAc. The content of GlcNAc oligomers correlated with the highest number of blood analytes, indices, and demographic characteristics, but failed to discriminate between the groups. The presence of terminal Gal residues correlated positively with the glucose levels and negatively with the LDL levels in the non-GDM group only. The results suggest fucosylation, terminal galactosylation, and the presence of Gb3 antigen as prediction markers of GDM. [ABSTRACT FROM AUTHOR]

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Objective: With the prevalence of obesity, growing age of first pregnancy, highly processed high-calorie diet, consumption of saturated fats as well as sedentary and stressful life, the prevalence of gestational diabetes mellitus (GDM) is increasing. We aimed to determine the predictive role of pre-pregnancy serum uric acid levels and the occurrence of GDM during pregnancy. Methods: This study was a descriptive-analytical study that was performed retrospectively through case–control. The Subjects of this study were women over 18 years of age who were 24–28 weeks pregnant. All subjects of this study were evaluated for GDM based on the ADA guideline and were divided into case and control groups. All data relating to the period of 6 months before pregnancy of the study participants including blood uric acid level, blood pressure, etc. were collected and analyzed. Results: In this study, 454 normal individuals without GDM and 478 others with GDM were examined. The mean serum uric acid showed to be 4.47 ± 1.33 mg/dl in patients with GDM but 3.7 ± 1.25 mg/dl in patients without GDM (p value = 0.001). The results of the regression test showed that the incidence of GDM in people with blood uric acid levels of 4.1–5, 5.1–6, and more than 6 mg/dl is 2.46, 3.42, and 4.9 times higher in people with uric acid levels less than 3 mg/dl, respectively. Conclusion: The present study identified that serum uric acid levels in the period of 6 months before pregnancy can be used as an independent predictor marker for future GDM. [ABSTRACT FROM AUTHOR]

Gestational diabetes mellitus (GDM), a prevalent complication during the gestation period, has been linked to impaired proliferation and migration of trophoblasts causing placental maldevelopment. We previously found that lncRNA X‐inactive specific transcript (XIST) played an essential role in GDM progression. Here, we investigated the precise biological functions as well as the upstream and downstream regulatory mechanisms of XIST in GDM. We found that XIST and forkhead box O1 (FOXO1) were conspicuously upregulated and miR‐497‐5p and methyltransferase‐like 14 (METTL14) were downregulated in the placentas of GDM patients. XIST silencing facilitated proliferation and migration and inhibited cell apoptosis and cell cycle arrest in HG‐cultured HTR8/SVneo cells. METTL14 inhibited XIST expression through m6A methylation modification. XIST overexpression abrogated the positive effect of METTL14 overexpression on HG‐cultured HTR8/SVneo cell progression. MiR‐497‐5p and FOXO1 are downstream regulatory genes of XIST in HTR8/SVneo cells. Reverse experiments illustrated that XIST mediated HTR8/SVneo cell functions by regulating the miR‐497‐5p/FOXO1 axis. Additionally, XIST silencing augmented glucose tolerance and alleviated fetal detrimental changes in GDM rats. To conclude, METTL14‐mediated XIST silencing facilitated proliferation and migration and inhibited cell apoptosis and cell cycle arrest in HG‐cultured HTR8/SVneo cells via the miR‐497‐5p/FOXO1 axis, thereby alleviating GDM progression in rats. [ABSTRACT FROM AUTHOR]