Li-Juan Lv

Continuous Glucose Monitoring Effects on Maternal Glycemic Control and Pregnancy Outcomes in Patients With Gestational Diabetes Mellitus: A Prospective Cohort Study

CONTEXT Clinical evidence on the consequential effects of continuous glucose monitoring (CGM) on pregnancy outcomes in women with gestational diabetes mellitus (GDM) is scarcely available. OBJECTIVE Our objective was to evaluate the effectiveness of CGM on maternal glycemic control and pregnancy outcomes in patients with GDM . PATIENTS In total, 340 Chinese pregnant women with GDM were allocated to either the routine care group (n = 190) or the CGM group (n =150). DESIGN AND SETTING This was a prospective cohort study in the Department of Obstetrics of GuangDong Women and Children Hospital in China. Recruitment started in April 2011 and stopped in August 2012. INTERVENTIONS A 72-hour CGM system was used as a supplementary tool for glucose monitoring in the CGM group. PRIMARY OUTCOME MEASUREMENTS: The parameters of glycemic variability included mean blood glucose, the SD of blood glucose, mean amplitude of glycemic excursions (MAGEs), and the mean of daily differences. The maternal outcomes (preeclampsia and cesarean delivery) and composite neonatal outcomes were analyzed. RESULTS The SD of blood glucose, MAGEs, and mean of daily differences values were significantly lower in the CGM group compared with those of the routine care group (P < .001). Subjects in the CGM group were at lower risk of preeclampsia and primary cesarean delivery compared with the routine care group (P < .05). The mean infant birth weight of women in the CGM group was lower than infants of women in the routine care group (P < .001). The MAGE was associated with birth weight (β = 0.196, P < .001), and it was an independent factor for preeclampsia (odds ratio, 3.66; 95% confidence interval 2.16-6.20) and composite neonatal outcome (odds ratio, 1.34; 95% confidence interval 1.01-1.77). CONCLUSIONS The use of supplementary CGM combined with routine antenatal care can improve the glycemic control and pregnancy outcomes of patients with GDM.

Clustering of metabolic risk factors and adverse pregnancy outcomes: a prospective cohort study.

The relative contributions of a cluster of metabolic risk factors to pregnancy complications are not fully understood. We investigated the correlation between clustering of metabolic risk factors and adverse pregnancy outcomes.

Metabolic risk factors clustering and adverse pregnancy outcomes: a prospective cohort study

The relative contributions of a cluster of metabolic risk factors to pregnancy complications are not fully understood. We investigated the correlation between clustering of metabolic risk factors and adverse pregnancy outcomes.

Prehypertension During Normotensive Pregnancy and Postpartum Clustering of Cardiometabolic Risk Factors: A Prospective Cohort Study.

The nonstratification of blood pressure (BP) levels may underestimate future cardiovascular risk in pregnant women who present with BP levels in the range of prehypertension (120–139/80–89 mm Hg). We prospectively evaluated the relationship between multiple antepartum BP measurements (from 11+0 to 13+6 weeks’ gestation to term) and the occurrence of postpartum metabolic syndrome in 507 normotensive pregnant women after a live birth. By using latent class growth modeling, we identified the following 3 distinctive diastolic BP (DBP) trajectory groups: the low-J-shaped group (34.2%; DBP from 62.5±5.8 to 65.0±6.8 mm Hg), the moderate-U-shaped group (52.6%; DBP from 71.0±5.9 to 69.8±6.2 mm Hg), and the elevated-J-shaped group (13.2%; DBP from 76.2±6.7 to 81.8±4.8 mm Hg). Notably, the elevated-J-shaped trajectory group had mean DBP and systolic BP levels within the range of prehypertension from 37+0 and 26+0 weeks of pregnancy, respectively. Among the 309 women who completed the ≈1.6 years of postpartum follow-up, the women in the elevated-J-shaped group had greater odds of developing postpartum metabolic syndrome (adjusted odds ratio, 6.55; 95% confidence interval, 1.79–23.92; P=0.004) than the low-J-shaped group. Moreover, a parsimonious model incorporating DBP (membership in the elevated-J-shaped group but not in the DBP prehypertension group as identified by a single measurement) and elevated levels of fasting glucose (>4.99 mmol/L) and triglycerides (>3.14 mmol/L) at term was developed, with good discrimination and calibration for postpartum metabolic syndrome (c-statistic, 0.764; 95% confidence interval, 0.674–0.855; P<0.001). Therefore, prehypertension identified by DBP trajectories throughout pregnancy is an independent risk factor for predicting postpartum metabolic syndrome in normotensive pregnant women.

Trimester-Specific Weight Gain and Midpregnancy Diastolic Blood Pressure Rebound During Normotensive PregnancyNovelty and Significance

The longitudinal exposure–response relationship between trimester-specific gestational weight gain (GWG) and blood pressure (BP) during pregnancy is not well understood. We retrospectively assessed 1112 uncomplicated, normotensive pregnant women whose body weight and BP were measured from 12+0 to 40+0 weeks of gestation from a hospital-based cohort. By using growth curve modeling, a J-shaped pattern dominated diastolic BP (DBP) changing dynamics, with a midpregnancy drop at 20+0 to 22+0 weeks followed by a rebound. Using group-based trajectory modeling, 3 distinctive trajectories of DBP were identified: high–J shaped (18.5%), moderate–J shaped (48.3%), and low–J shaped (33.1%), as well as 3 distinctive GWG trajectories: high increasing (14.7%), moderate increasing (48.6%) and low increasing (36.8%). A temporal coincidence between the maximal rate of GWG and DBP transition from its nadir to rebound was observed during 20+0 to 22+0 weeks. Moreover, women in the high-increasing GWG group had the highest probability of being in the high–J DBP group. The GWG rate during the late midsecond trimester (22+0 to 26+0 weeks) was consistently associated with an elevated DBP level: for every 200 g/wk increase, the multivariable-adjusted odds ratio was 1.27 (95% confidence interval, 1.13–1.43) for the trajectory shift to the high–J group and 1.20 (95% confidence interval, 1.07–1.35) for the occurrence of diastolic prehypertension after 37+0 weeks. Furthermore, adding a trimester-specific GWG rate (22+0 to 26+0 weeks) contributed to the incremental yield for the prediction of diastolic prehypertension after 37+0 weeks. Our results thus provide the timing and extent of gestational weight control relevant to the optimized BP level during pregnancy.

Prehypertension During Normotensive Pregnancy and Postpartum Clustering of Cardiometabolic Risk FactorsNovelty and Significance

The nonstratification of blood pressure (BP) levels may underestimate future cardiovascular risk in pregnant women who present with BP levels in the range of prehypertension (120–139/80–89 mm Hg). We prospectively evaluated the relationship between multiple antepartum BP measurements (from 11+0 to 13+6 weeks’ gestation to term) and the occurrence of postpartum metabolic syndrome in 507 normotensive pregnant women after a live birth. By using latent class growth modeling, we identified the following 3 distinctive diastolic BP (DBP) trajectory groups: the low-J-shaped group (34.2%; DBP from 62.5±5.8 to 65.0±6.8 mm Hg), the moderate-U-shaped group (52.6%; DBP from 71.0±5.9 to 69.8±6.2 mm Hg), and the elevated-J-shaped group (13.2%; DBP from 76.2±6.7 to 81.8±4.8 mm Hg). Notably, the elevated-J-shaped trajectory group had mean DBP and systolic BP levels within the range of prehypertension from 37+0 and 26+0 weeks of pregnancy, respectively. Among the 309 women who completed the ≈1.6 years of postpartum follow-up, the women in the elevated-J-shaped group had greater odds of developing postpartum metabolic syndrome (adjusted odds ratio, 6.55; 95% confidence interval, 1.79–23.92; P=0.004) than the low-J-shaped group. Moreover, a parsimonious model incorporating DBP (membership in the elevated-J-shaped group but not in the DBP prehypertension group as identified by a single measurement) and elevated levels of fasting glucose (>4.99 mmol/L) and triglycerides (>3.14 mmol/L) at term was developed, with good discrimination and calibration for postpartum metabolic syndrome (c-statistic, 0.764; 95% confidence interval, 0.674–0.855; P<0.001). Therefore, prehypertension identified by DBP trajectories throughout pregnancy is an independent risk factor for predicting postpartum metabolic syndrome in normotensive pregnant women.

Prehypertension During Normotensive Pregnancy and Postpartum Clustering of Cardiometabolic Risk FactorsNovelty and Significance: A Prospective Cohort Study

The nonstratification of blood pressure (BP) levels may underestimate future cardiovascular risk in pregnant women who present with BP levels in the range of prehypertension (120–139/80–89 mm Hg). We prospectively evaluated the relationship between multiple antepartum BP measurements (from 11+0 to 13+6 weeks’ gestation to term) and the occurrence of postpartum metabolic syndrome in 507 normotensive pregnant women after a live birth. By using latent class growth modeling, we identified the following 3 distinctive diastolic BP (DBP) trajectory groups: the low-J-shaped group (34.2%; DBP from 62.5±5.8 to 65.0±6.8 mm Hg), the moderate-U-shaped group (52.6%; DBP from 71.0±5.9 to 69.8±6.2 mm Hg), and the elevated-J-shaped group (13.2%; DBP from 76.2±6.7 to 81.8±4.8 mm Hg). Notably, the elevated-J-shaped trajectory group had mean DBP and systolic BP levels within the range of prehypertension from 37+0 and 26+0 weeks of pregnancy, respectively. Among the 309 women who completed the ≈1.6 years of postpartum follow-up, the women in the elevated-J-shaped group had greater odds of developing postpartum metabolic syndrome (adjusted odds ratio, 6.55; 95% confidence interval, 1.79–23.92; P=0.004) than the low-J-shaped group. Moreover, a parsimonious model incorporating DBP (membership in the elevated-J-shaped group but not in the DBP prehypertension group as identified by a single measurement) and elevated levels of fasting glucose (>4.99 mmol/L) and triglycerides (>3.14 mmol/L) at term was developed, with good discrimination and calibration for postpartum metabolic syndrome (c-statistic, 0.764; 95% confidence interval, 0.674–0.855; P<0.001). Therefore, prehypertension identified by DBP trajectories throughout pregnancy is an independent risk factor for predicting postpartum metabolic syndrome in normotensive pregnant women.

Prehypertension During Normotensive Pregnancy and Postpartum Clustering of Cardiometabolic Risk Factors

The nonstratification of blood pressure (BP) levels may underestimate future cardiovascular risk in pregnant women who present with BP levels in the range of prehypertension (120–139/80–89 mm Hg). We prospectively evaluated the relationship between multiple antepartum BP measurements (from 11+0 to 13+6 weeks’ gestation to term) and the occurrence of postpartum metabolic syndrome in 507 normotensive pregnant women after a live birth. By using latent class growth modeling, we identified the following 3 distinctive diastolic BP (DBP) trajectory groups: the low-J-shaped group (34.2%; DBP from 62.5±5.8 to 65.0±6.8 mm Hg), the moderate-U-shaped group (52.6%; DBP from 71.0±5.9 to 69.8±6.2 mm Hg), and the elevated-J-shaped group (13.2%; DBP from 76.2±6.7 to 81.8±4.8 mm Hg). Notably, the elevated-J-shaped trajectory group had mean DBP and systolic BP levels within the range of prehypertension from 37+0 and 26+0 weeks of pregnancy, respectively. Among the 309 women who completed the ≈1.6 years of postpartum follow-up, the women in the elevated-J-shaped group had greater odds of developing postpartum metabolic syndrome (adjusted odds ratio, 6.55; 95% confidence interval, 1.79–23.92; P=0.004) than the low-J-shaped group. Moreover, a parsimonious model incorporating DBP (membership in the elevated-J-shaped group but not in the DBP prehypertension group as identified by a single measurement) and elevated levels of fasting glucose (>4.99 mmol/L) and triglycerides (>3.14 mmol/L) at term was developed, with good discrimination and calibration for postpartum metabolic syndrome (c-statistic, 0.764; 95% confidence interval, 0.674–0.855; P<0.001). Therefore, prehypertension identified by DBP trajectories throughout pregnancy is an independent risk factor for predicting postpartum metabolic syndrome in normotensive pregnant women.