Ewa Wender-Ożegowska

Threshold values of maternal blood glucose in early diabetic pregnancy--prediction of fetal malformations.

Background.  The prevention of congenital malformations in the newborns of diabetic mothers still constitutes one of the main problems in this group of patients.

Long‐term effects of diabetes during pregnancy on the offspring

Background: Many epidemiological and experimental studies have proven that some adult diseases might have their origin in fetal life. It has been also hypothesized that intra‐uterine environment in pregnancy complicated with diabetes might influence the development of obesity, type 2 diabetes, and cardiovascular diseases in the offspring.

Effect of physical activity and/or healthy eating on GDM risk: The DALI Lifestyle Study

Context Lifestyle approaches for preventing gestational diabetes mellitus (GDM) have produced mixed results. Objective The aim of the present study was to compare the effectiveness of 3 lifestyle interventions [healthy eating (HE), physical activity (PA), and both HE and PA (HE+PA)] with usual care (UC) in reducing GDM risk. Design The present study was a multicenter randomized controlled trial conducted from 2012 to 2014 [the DALI (vitamin D and lifestyle intervention for GDM prevention) lifestyle study]. Setting The study occurred at antenatal clinics across 11 centers in 9 European countries. Patients Consecutive pregnant women at <20 weeks of gestation with a body mass index (BMI) of ≥29 kg/m2 and without GDM using the International Association of Diabetes and Pregnancy Study Group criteria (n = 436). For the intervention, women were randomized, stratified by site, to UC, HE, PA, or HE+PA. The women received 5 face-to-face and ≤4 telephone coaching sessions using the principles of motivational interviewing. A gestational weight gain (GWG) <5 kg was targeted. The coaches received standardized training and an intervention toolkit tailored to their culture and language. Main Outcome Measures The endpoints were the GWG at 35 to 37 weeks and the fasting glucose and insulin sensitivity [homeostasis model assessment insulin resistance (HOMA-IR)] at 24 to 28 weeks. Results We randomized 108 women to HE+PA, 113 to HE, 110 to PA, and 105 to UC. In the HE+PA group, but not HE or PA alone, women achieved substantially less GWG than did the controls (UC) by 35 to 37 weeks (-2.02; 95% confidence interval, -3.58 to -0.46 kg). Despite this reduction, no improvements were seen in fasting or postload glucose levels, insulin concentrations, or HOMA-IR. The birthweights and large and small for gestational age rates were similar. Conclusions The combined HE+PA intervention was able to limit GWG but did not reduce fasting glycemia. Thus, lifestyle changes alone are unlikely to prevent GDM among women with a BMI of ≥29 kg/m2.

Relation of salivary antioxidant status and cytokine levels to clinical parameters of oral health in pregnant women with diabetes.

OBJECTIVE Both pregnancy and diabetes are thought to predispose to the impairment of oral health. As saliva contributes to oral homeostasis, we have characterised its properties and flow rate in pregnant women with or without diabetes. DESIGN Unstimulated whole mixed saliva was collected from 63 women in the first trimester of pregnancy and analysed for the concentration of selected antioxidants, cytokines, and growth factors. RESULTS Pregnant women with diabetes were found to have markedly increased indexes of caries activity, plaque formation, gingival and periodontal status, as well as increased salivary antioxidant capacity and pro-inflammatory cytokine levels. These changes were more pronounced in patients with long-term disease and systemic diabetic complications, but only partly correlated with the level of blood glycated haemoglobin. Of the cytokines examined, salivary VEGF and HGF concentrations in diabetic pregnant women correlated in a positive and negative manner, respectively, with the prevalence of caries. Moreover, VEGF levels in this group correlated inversely with the probing depth and clinical attachment levels. All such associations did not occur in healthy individuals. In contrast, the salivary pH and flow rate correlated inversely with several parameters of caries and plaque formation irrespectively of whether the pregnant women were diabetic or not. CONCLUSIONS Diabetes in pregnant women significantly changes saliva properties, which may contribute to accelerated deterioration of the oral status in this population.

Plasma anhydro-d-glucitol (1,5-AG) as an indicator of hyperglycaemic excursions in pregnant women with diabetes

Aims  To evaluate the use of the plasma 1,5‐anhydro‐d‐glucitol (1,5‐AG) level as a possible marker for glucose excursions in pregnant women with diabetes.

IADPSG and WHO 2013 Gestational Diabetes Mellitus Criteria Identify Obese Women With Marked Insulin Resistance in Early Pregnancy

Implementation of the International Association of Diabetes and Pregnancy Study Groups (IADPSG) and the World Health Organization 2013 (WHO 2013) recommendations leads to an increased prevalence of gestational diabetes mellitus (GDM) due to more stringent criteria and early screening of women at high risk for diabetes in pregnancy (DIP) (1,2). IADPSG members now recommend that their GDM criteria should not be used in early pregnancy but have not provided alternative criteria (3). We have compared the characteristics of overweight/obese women early in pregnancy, with and without GDM using the new criteria, to assess whether those testing positive are metabolically distinct. Pregnant women with a BMI ≥29.0 kg/m2 underwent a 75-g oral glucose tolerance test in early pregnancy as part of enrollment into the DALI (Vitamin D And Lifestyle Intervention for GDM prevention) pilot and lifestyle Pan-European multicenter trials (4). GDM and DIP were diagnosed using WHO 2013 criteria. A high rate of GDM (237/1,035 or 22.9%: DIP 0.5%; total hyperglycemia in early pregnancy 23.4%) was found at a …

Multiple daily injections of insulin versus continuous subcutaneous insulin infusion for pregnant women with type 1 diabetes.

The aim was to evaluate the outcome of pregnancies with type 1 diabetes (T1DM) treated from the first trimester with continuous subcutaneous insulin infusion (CSII) or multiple daily injections (MDI).

Maternal hyperglycemia according to IADPSG criteria as a predictor of perinatal complications in women with gestational diabetes: a retrospective observational study

Abstract Objective: We investigated the association between abnormal maternal glucose levels according to International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria and perinatal complications. Materials and methods: Retrospective observational study of data of 492 women in singleton pregnancy and gestational diabetes (GDM) diagnosed according to WHO criteria. Perinatal outcome and maternal characteristics were compared between normo- and hyperglycemic patients using IADPSG criteria and odds ratios calculated for particular outcomes. Results: Maternal fasting hyperglycemia (≥5.1 mmol/L) was associated with significantly higher proportion of birth weight ≥ 4000 g (19.3% versus 9.7%, p = 0.004, OR: 2.2; 95% CI: 1.3–3.8), gestational insulin therapy (27.7% versus 9.1%, p < 0.001, OR: 3.8; 95% CI: 2.3–6.5), poor long-term metabolic control (HbA1c at diagnosis ≥ 6.5% [48 mmol/mol]: 19.9% versus 4.6%, p < 0.001, OR: 5.2; 95% CI: 2.5–10.9). Pre-pregnancy obesity (BMI ≥ 30 kg/m2, 26.0% versus 11.9%, p < 0.001, OR: 2.6; 95% CI: 1.6–4.3) and positive family history of diabetes (45.2% versus 30.8%, p < 0.002, OR: 1.8; 95% CI: 1.3–2.7) was more frequent in women with fasting hyperglycemia. Two-hour post-load hyperglycemia was only associated with increased prevalence of gestational hypertension (5.1% versus 11.4%, p = 0.046). Conclusions: Women with fasting but not 2-h hyperglycemia according to IADPSG criteria are at significantly elevated risk of perinatal complications.

Components of metabolic syndrome in women after gestational diabetes.

OBJECTIVES The aim of the study was to evaluate the risk of occurrence of metabolic syndrome (MS) in females who suffered from gestational diabetes mellitus (GDM). PATIENTS AND METHODS 495 letters were sent to patients with a history of GDM treated in the Department between 1993-2002. One hundred and fifty-three (30.9%) patients who responded positively formed the study group. Out of them 74 had already been treated for diabetes mellitus, and glucose intolerance was found in 5 subjects. Seventy-four patients had been subjected to a 75 g Oral Glucose Tolerance Test, as well as the control group that consisted of 155 subjects, in whom GDM during pregnancy was excluded. In all patients lipid parameters, blood pressure, height, weight and waist circumference were measured and body mass index (BMI) was calculated. Metabolic syndrome was diagnosed according to the modified NCEP-ATP III criteria from 2005 (3 of 5 had to be fulfilled). RESULTS Patients from the study group were older than from the control group (p <0.05), higher was their BMI at the time of the index pregnancy, as well as after the observation time (p <0.0001). Metabolic syndrome was developed in 47 (30.7%) patients of the study group and 8 (5.2%) patients from the control group (p <0.001). The study group presented all components of MS significantly more often than the control group--in both groups, we found respectively: abnormal waist circumference--57% vs. 37.6% (p <0.005), hypertension--18.9% vs. 1.9% (p <0.001), elevated fasting glycemia--79.1% vs. 1.9%, hypertriglyceridemia--21.6% vs. 2.6% (p <0.0001), and decreased concentrations of high-density lipoprotein cholesterol--11.1% vs. 2.6% (p <0.005). CONCLUSIONS Patients who suffered from GDM are at high risk for carbohydrate disturbances and metabolic syndrome in the following year. Therefore, they should be under continuous medical surveillance that would enable early detection and treatment of the metabolic disturbances.

Maternal endothelial dysfunction and its association with abnormal fetal growth in diabetic pregnancy

Diabet. Med. 28, 692–698 (2011)