Kesha Baptiste-Roberts

Risk Factors for Type 2 Diabetes Among Women with Gestational Diabetes: A Systematic Review

We conducted a systematic review of studies examining risk factors for the development of type 2 diabetes among women with previous gestational diabetes. Our search strategy yielded 14 articles that evaluated 9 categories of risk factors of type 2 diabetes in women with gestational diabetes: anthropometry, pregnancy-related factors, postpartum factors, parity, family history of type 2 diabetes, maternal lifestyle factors, sociodemographics, oral contraceptive use, and physiologic factors. The studies provided evidence that the risk of type 2 diabetes was significantly higher in women having increased anthropometric characteristics with relative measures of association ranging from 0.8 to 8.7 and women who used insulin during pregnancy with relative measures of association ranging between 2.8 and 4.7. A later gestational age at diagnosis of gestational diabetes, >24 weeks gestation on average, was associated with a reduction in risk of development of type 2 diabetes with relative measures of association ranging between 0.35 and 0.99. We concluded that there is substantial evidence for 3 risk factors associated with the risk of type 2 diabetes in women having gestational diabetes.

Short stature and the risk of adiposity, insulin resistance, and type 2 diabetes in middle age: The Third National Health and Nutrition Examination Survey (NHANES III), 1988-1994

OBJECTIVE—To investigate the association between stature-related measurements (height, leg length, and leg length–to–height ratio) and adiposity, insulin resistance, and glucose intolerance. RESEARCH DESIGN AND METHODS—We conducted a cross-sectional analysis of a nationally representative sample of 7,424 adults aged 40–74 years, from the Third National Health and Nutrition Examination Survey (1988–1994). The main outcome measures were percent body fat, homeostasis model assessment of insulin resistance (HOMA-IR), and glucose intolerance based on the World Health Organization’s 1985 criteria for an oral glucose tolerance test. RESULTS—Shorter height and leg length, and lower leg length–to–height ratio, were associated with higher percent body fat, especially in women. Lower leg length–to–height ratio was associated with greater insulin resistance estimated by HOMA-IR. In multinomial regression models adjusting for potential confounders, including percent body fat, the relative prevalence of type 2 diabetes per 1-SD lower values in height, leg length, and leg length–to–height ratio were 1.10 (95% CI 0.94–0.29), 1.17 (0.98–1.39), and 1.19 (1.02–1.39), respectively. CONCLUSIONS—Our study supports the hypothesis that adult markers of prepubertal growth, especially leg length–to–height ratio, are associated with adiposity, insulin resistance, and type 2 diabetes in the general U.S. population.

Family history of diabetes, awareness of risk factors, and health behaviors among African Americans

OBJECTIVES We examined the role of family history of diabetes in awareness of diabetes risk factors and engaging in health behaviors. METHODS We conducted a cross-sectional analysis of 1122 African American adults without diabetes who were participants in Project DIRECT (Diabetes Interventions Reaching and Educating Communities Together). RESULTS After adjustment for age, gender, income, education, body mass index, and perceived health status, African Americans with a family history of diabetes were more aware than those without such a history of several diabetes risk factors: having a family member with the disease (relative risk [RR]=1.09; 95% confidence interval [CI]=1.03, 1.15), being overweight (RR=1.12; 95% CI=1.05, 1.18), not exercising (RR=1.17; 95% CI=1.07, 1.27), and consuming energy-dense foods (RR=1.10; 95% CI=1.00, 1.17). Also, they were more likely to consume 5 or more servings of fruits and vegetables per day (RR=1.31; 95% CI=1.02, 1.66) and to have been screened for diabetes (RR=1.21; 95% CI=1.12, 1.29). CONCLUSIONS African Americans with a family history of diabetes were more aware of diabetes risk factors and more likely to engage in certain health behaviors than were African Americans without a family history of the disease.

Oral hypoglycaemic agents during pregnancy: The evidence for effectiveness and safety

With the increase in obesity and sedentary lifestyles, the incidence of diabetes among reproductive-aged women is rising globally. Providers are expected to care for a growing number of women with gestational diabetes (GDM) in the coming decades. Traditionally, insulin has been considered the standard for management of GDM, when diet and exercise fail to achieve tight maternal glucose control without the risk of transfer of insulin across the placenta. Understanding the effectiveness and safety of the use of oral diabetes agents during pregnancy for both maternal and neonatal outcomes as an alternative management option is essential to the care of women with GDM and their offspring. In this review, our objectives were to (1) summarise the available evidence on the efficacy these medications, (2) review available data on adverse effect, (3) discuss current gaps in research, outlining limitations in current study designs that deserve attention and (4) summarise key points for the practicing clinician.

Maternal risk factors for abnormal placental growth: The national collaborative perinatal project

BackgroundPrevious studies of maternal risk factors for abnormal placental growth have focused on placental weight and placental ratio as measures of placental growth. We sought to identify maternal risk factors for placental weight and two neglected dimensions of placental growth: placental thickness and chorionic plate area.MethodsWe conducted an analysis of 24,135 mother-placenta pairs enrolled in the National Collaborative Perinatal Project, a prospective cohort study of pregnancy and child health. We defined growth restriction as < 10th percentile and hypertrophy as > 90th percentile for three placental growth dimensions: placental weight, placental thickness and chorionic plate area. We constructed parallel multinomial logistic regression analyses to identify (a) predictors of restricted growth (vs. normal) and (b) predictors of hypertrophic growth (vs. normal).ResultsBlack race was associated with an increased likelihood of growth restriction for placental weight, thickness and chorionic plate area, but was associated with a reduced likelihood of hypertrophy for these three placental growth dimensions. We observed an increased likelihood of growth restriction for placental weight and chorionic plate area among mothers with hypertensive disease at 24 weeks or beyond. Anemia was associated with a reduced likelihood of growth restriction for placental weight and chorionic plate area. Pre-pregnancy BMI and pregnancy weight gain were associated with a reduced likelihood of growth restriction and an increased likelihood of hypertrophy for all three dimensions of placental growth.ConclusionMaternal risk factors are either associated with placental growth restriction or placental hypertrophy not both. Our findings suggest that the placenta may have compensatory responses to certain maternal risk factors suggesting different underlying biological mechanisms.

Association of prenatal physical activity and gestational weight gain: results from the first baby study.

BACKGROUND In response to increasing rates of excessive gestational weight gain (GWG) and evidence of postpartum weight retention and long-term overweight and obesity, the Institute of Medicine (IOM) revised their guidelines for GWG in 2009. Prenatal physical activity is recommended, although its role in preventing excessive GWG is unclear. We sought to understand the association between prenatal physical activity and GWG in a longitudinal cohort. METHODS During a baseline survey at 34 weeks, women (n = 3,006) reported their height, prepregnancy weight, and physical activity during pregnancy. GWG was self-reported at 1-month postpartum. Multivariable logistic regression adjusting for age, race/ethnicity, education, poverty status, marital status, gestational age at the time of delivery, and smoking was used to model the association between adequate physical activity during pregnancy and exceeding the IOM recommendations for GWG. FINDINGS Overweight women were most likely to exceed the IOM recommendations for GWG (78.7%), followed by obese women and normal weight women (65.0% and 42.4%, respectively). The majority of women participated in some physical activity during pregnancy, with 41.2% engaging in 60 to 149 minutes and 32.1% engaging in at least 150 minutes of physical activity per week. In adjusted analysis, meeting the physical activity guidelines was associated with a 29% (confidence interval, 0.57-0.88) lower odds of exceeding the IOM recommendations for GWG compared with inactive women. CONCLUSIONS Findings of high rates of excessive GWG, especially among women with overweight and obesity, are concerning given the associated health burdens. The association of guideline-concordant physical activity with appropriate GWG suggests this is an important target for future interventions.

Neighborhood and weight-related health behaviors in the Look AHEAD (Action for Health in Diabetes) Study

BackgroundPrevious studies have shown that neighborhood factors are associated with obesity, but few studies have evaluated the association with weight control behaviors. This study aims to conduct a multi-level analysis to examine the relationship between neighborhood SES and weight-related health behaviors.MethodsIn this ancillary study to Look AHEAD (Action for Health in Diabetes) a trial of long-term weight loss among individuals with type 2 diabetes, individual-level data on 1219 participants from 4 clinic sites at baseline were linked to neighborhood-level data at the tract level from the 2000 US Census and other databases. Neighborhood variables included SES (% living below the federal poverty level) and the availability of food stores, convenience stores, and restaurants. Dependent variables included BMI, eating patterns, weight control behaviors and resource use related to food and physical activity. Multi-level models were used to account for individual-level SES and potential confounders.ResultsThe availability of restaurants was related to several eating and weight control behaviors. Compared to their counterparts in neighborhoods with fewer restaurants, participants in neighborhoods with more restaurants were more likely to eat breakfast (prevalence Ratio [PR] 1.29 95% CI: 1.01-1.62) and lunch (PR = 1.19, 1.04-1.36) at non-fast food restaurants. They were less likely to be attempting weight loss (OR = 0.93, 0.89-0.97) but more likely to engage in weight control behaviors for food and physical activity, respectively, than those who lived in neighborhoods with fewer restaurants. In contrast, neighborhood SES had little association with weight control behaviors.ConclusionIn this selected group of weight loss trial participants, restaurant availability was associated with some weight control practices, but neighborhood SES was not. Future studies should give attention to other populations and to evaluating various aspects of the physical and social environment with weight control practices.

Pregravid physical activity, dietary intake, and glucose intolerance during pregnancy.

OBJECTIVES To ascertain prepregnancy physical activity and dietary intake from a sample of women in early pregnancy and estimate the effect of prepregnancy lifestyle behaviors on the 1-hour glucose challenge test (GCT). METHODS We conducted a prospective analysis of a racially diverse urban-based sample of 152 pregnant women in the first trimester who were participants in the Parity, Inflammation and Diabetes (PID) study. Dietary intake before pregnancy was assessed using a modified version of the Block Rapid Food Screener, and leisure time physical activity before pregnancy was assessed using the Baecke questionnaire. Test results from a nonfasting oral GCT conducted between 26 and 28 weeks were abstracted from the medical record. Participants were classified as having a positive GCT if the blood glucose measurement was ≥140 mg/dL and as negative with a blood glucose measurement <140 mg/dL. We constructed a series of multiple logistic regression models, adjusting for potential confounders to determine if prepregnancy dietary intake and leisure activity were associated with response to the GCT. RESULTS Women with higher prepregnancy leisure activity scores were 68% less likely to have a 1-hour GCT response ≥140mg/dL. However, there was no association between dietary intake and response to the GCT. CONCLUSIONS Our data suggest that prevention of an abnormal GCT result should include practices to encourage women of reproductive age to engage in leisure physical activity in advance of planning a pregnancy.

The Natural Course of Microalbuminuria among African Americans with Type 2 Diabetes: A 3-Year Study

BACKGROUND The natural course of microalbuminuria in African Americans (AA) with type 2 diabetes is not well established. METHOD Longitudinal analysis of 186 African Americans with type 2 diabetes enrolled in Project Sugar, a randomized controlled trial of primary care-based interventions to improve diabetes control. RESULTS Mean age was 59.4 years and 85% were female. Mean estimated glomerular filtration rate and urinary albumin-to-creatinine ratio were 75.90 mL/min/1.73 m(2) and 1.62, respectively. Thirty-nine patients had macroalbuminuria and significantly higher systolic blood pressure compared with those with microalbuminuria (P=.01). Sixty patients had microalbuminuria, 19 progressed to macroalbuminuria, and none regressed. Progression was associated significantly with systolic blood pressure >or=115 mm Hg and requirement for blood pressure medication in the univariate model. In the multivariate model, the degree of albumin-to-creatinine ratio (odds ratio 35.51, 95% confidence interval, 2.21-571.65) and need for blood pressure medication (odds ratio 8.96, 95% confidence interval, 1.35-59.70) were independently associated with progression. No association was observed with the use of specific antihypertensive agent. CONCLUSION This study suggests that African Americans with type 2 diabetes and microalbuminuria experience irreversible disease that not infrequently progresses to overt proteinuria. The degree of microalbuminuria and blood pressure are key determinants in this process and should be primary targets in treating this population regardless of the antihypertensive class used.

Gross placental measures and childhood growth

Objectives. We hypothesised that the gross placental measures would be positively associated with childhood growth. Methods. We analysed data on 23,967 mother–infant pairs enrolled in the Collaborative Perinatal Project. In race-stratified regression models, the main outcomes were birthweight and z-score body-mass index (BMI) at ages 4 and 7. Results. Some placental measures were significantly associated with z-score BMI at age 7: in Blacks, placental weight (β = 0.0004/g; 95%CI: 0.0001, 0.0008), chorionic plate area (β = 0.0007; 95%CI: 0.0001, 0.0012) and largest diameter (β = 0.013; 95%CI: 0.004, 0.026); and in Whites placental weight (β = 0.0004/g; 95%CI: 0.0001, 0.0003) and largest diameter (Model 3: β = 0.020; 95%CI: 0.007, 0.032). Tested as group, placental measures significantly predicted z-score BMI at age 7 (all p values < 0.005). Conclusions. Placental structure independently predicts birthweight and childhood growth. Strategies to improve placental structure might favourably influence birthweight and childhood development.