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• Women with PCOS and pre-gestational DM are more likely to develop pregnancy complications. • These complications include pregnancy induced hypertension, preeclampsia, and placenta previa. • Women with PCOS who had pregestational diabetes were also at increased risk of preterm delivery and delivery by cesarean section. • The impact of pre-existing DM on the relationship between PCOS and pregnancy outcomes should be considered when planning care for these patients. To evaluate the effect of pregestational diabetes mellitus (DM) on the likelihood of experiencing adverse pregnancy, delivery, and neonatal outcomes in pregnant women with polycystic ovary syndrome (PCOS). A retrospective population-based study using data from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (HCUP-NIS) database was performed. All deliveries between 2004 and 2014, inclusively, were studied using ICD-9 codes. Within the study period, 14,882 women had a diagnosis of PCOS, of which 673 (4.7%) had a diagnosis of pregestational diabetes. Chi-squared tests were used for comparison of demographics. Multivariate logistic regression analysis was performed to calculate unadjusted and adjusted odds ratios (aORs) and corresponding 95% confidence intervals (CI), controlling for confounding effects. IRB approval was not required, given data was anonymous and publicly available. Women with PCOS and pre-gestational DM were more likely to develop pregnancy complications, including pregnancy induced hypertension (aOR 1.55; CI 1.25–1.92), preeclampsia (aOR 1.45; CI 1.04–2.02), preeclampsia or eclampsia superimposed on pre-existing hypertension (aOR 1.85; CI 1.29–2.66), and placenta previa (aOR 2.53; CI 1.06–6.01), after controlling for confounding demographics. Women with PCOS who had pregestational diabetes were at increased risk of preterm delivery (aOR 1.40; CI 1.09–1.80), and delivery by cesarean section (aOR 1.50; CI 1.23–1.84). Results demonstrated no difference in the rate of women who gave birth to small for gestational age (SGA) infants, the rate of intrauterine fetal demises (IUFD), and the rate of infants with congenital anomalies between the two groups. The impact of pre-existing DM on the relationship between PCOS and pregnancy outcomes should be considered when counselling and planning care for pregnant women affected by these conditions. This emphasizes the importance of optimal perinatal care in diabetic women with PCOS as they are at higher risk of obstetric complications. [ABSTRACT FROM AUTHOR]

This study compared glycosylated hemoglobin (HbA1c) levels in the first and second trimesters of pregnancy and assessed maternal and neonatal outcomes according to HbA1c variations among women with pregestational diabetes. This retrospective, multicenter Korean study involved mothers with diabetes who had given birth in 17 hospitals. A total of 292 women were divided into three groups based on HbA1c levels during the first and second trimesters: women with HbA1c levels maintained at <6.5% (well-controlled [WC] group); women with HbA1c ≥ 6.5% (poorly-controlled [PC] group); and women with HbA1c ≥ 6.5% in the first trimester but <6.5% in the second trimester (improved-control [IC] group). The PC group had the highest pregnancy-associated hypertension (PAH) incidence, while the incidence did not significantly differ between the WC and IC groups. The receiver operating characteristic (ROC) curve indicated that HbA1c in the second trimester could predict PAH with a cut-off value of 5.7%. The PC versus WC versus IC group showed statistically significantly higher neonatal birthweight and significantly higher rates of large for gestational age (LGA); however, those were not significantly different between the WC and IC groups. HbA1c levels in the second trimester could predict LGA, with a cut-off value of 5.4%. Therefore, the second trimester HbA1c levels were significantly associated with both maternal and neonatal outcomes. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this systematic review and meta-analysis was to evaluate fetal cardiac function in fetuses of mothers with diabetes compared to those of mothers without diabetes using 2D-STE. Methods: Embase, MEDLINE, and CENTRAL were searched for observational studies on 2D-STE fetal left and right ventricular global longitudinal strain and strain rate that included singleton, non-anomalous pregnancies complicated by pregestational or gestational diabetes mellitus compared to uncomplicated pregnancies. The strain values were pooled per 4 weeks of gestation for meta-analysis using random-effects models. Results: Fifteen studies met the criteria, including 990 fetuses of diabetic mothers and 1,645 control fetuses. The study design was cross-sectional in fourteen studies and longitudinal in one study. Gestational age, type of diabetes, ultrasound device, and 2D-STE software varied between the studies. Glycemic control and type of treatment were often lacking. In fetuses of diabetic mothers versus healthy mothers, left ventricular strain was significantly decreased (7 studies), increased (1 study), or not significantly different (7 studies). Right ventricular strain was decreased (7 studies), increased (1 study), or not different (2 studies). Left ventricular strain rate was decreased (3 studies), increased (1 study), or not different (2 studies). Right ventricular strain rate was increased (1 study) or not different (2 studies). Conclusion: Fetuses of mothers with diabetes show evidence of systolic dysfunction, which is more visible in the right ventricle. Contradictory results are probably due to suboptimal study designs and variation in gestational age, diabetes severity, image acquisition, and software. Large prospective longitudinal studies are needed to assess fetal myocardial function with 2D-STE in pregestational diabetes mellitus type 1 and 2 and gestational diabetes mellitus pregnancies. The influence of glycemic control, BMI, and treatment should be evaluated. [ABSTRACT FROM AUTHOR]

Aims: To investigate whether systemic inflammatory indices and the last trimester APRI score change in PGDM and to evaluate the relationship between these alterations and perinatal outcomes. Methods: A total of 240 pregnant women, 120 of whom were pregestational diabetic (40 with T1DM and 80 with T2DM), were analyzed. In each trimester, WBC, NEU, LNF, PLT, NLR, dNLR, PLR, PNR, and SII values, and in the last trimester MON, PMR, SIRI, AST values, and APRI score were recorded and compared between PGDM and control cohorts. Results: The first trimester WBC, NEU, and LNF values were higher and the PNR values were lower, the second trimester LNF value was higher and the NLR was lower, the third trimester APRI score was higher in the PGDM group. In diabetic pregnant women, the optimal cut‐off value of NEU for predicting LBW in the first trimester was 6.965 × 10⁹/L (62.5% sensitivity and 61.6% specificity), while the optimal cut‐off value of the last trimester APRI score for predicting preterm delivery was 0.072 (61.9% sensitivity and 61.6% specificity). In predicting NICU, the optimal cut‐off value for second trimester NLR was found to be 3.973 (70% sensitivity and 70% specificity) in the T1DM group, while the optimal cut‐off values for first and second trimester LNF were 2.395 × 10⁹/L (75% sensitivity and 71.1% specificity) and 2.23 × 10⁹/L (75% sensitivity and 68.4% specificity) in the T2DM group, respectively. Conclusions: In routine clinical practice, the first trimester NLR and last trimester APRI score may be used as additional tools for predicting perinatal outcomes in pregnancies affected by PGDM. [ABSTRACT FROM AUTHOR]

Aims/hypothesis: Dietary patterns characterised by high intakes of vegetables may lower the risk of pre-eclampsia and premature birth in the general population. The effect of dietary patterns in women with type 1 diabetes, who have an increased risk of complications in pregnancy, is not known. The aim of this study was to investigate the relationship between dietary patterns and physical activity during pregnancy and maternal complications and birth outcomes in women with type 1 diabetes. We also compared dietary patterns in women with and without type 1 diabetes. Methods: Diet was assessed in the third trimester using a validated food frequency questionnaire in participants followed prospectively in the multi-centre Environmental Determinants of Islet Autoimmunity (ENDIA) study. Dietary patterns were characterised by principal component analysis. The Pregnancy Physical Activity Questionnaire was completed in each trimester. Data for maternal and birth outcomes were collected prospectively. Results: Questionnaires were completed by 973 participants during 1124 pregnancies. Women with type 1 diabetes (n=615 pregnancies with dietary data) were more likely to have a 'fresh food' dietary pattern than women without type 1 diabetes (OR 1.19, 95% CI 1.07, 1.31; p=0.001). In women with type 1 diabetes, an increase equivalent to a change from quartile 1 to 3 in 'fresh food' dietary pattern score was associated with a lower risk of pre-eclampsia (OR 0.37, 95% CI 0.17, 0.78; p=0.01) and premature birth (OR 0.35, 95% CI 0.20, 0.62, p<0.001). These associations were mediated in part by BMI and HbA1c. The 'processed food' dietary pattern was associated with an increased birthweight (β coefficient 56.8 g, 95% CI 2.8, 110.8; p=0.04). Physical activity did not relate to outcomes. Conclusions/interpretation: A dietary pattern higher in fresh foods during pregnancy was associated with sizeable reductions in risk of pre-eclampsia and premature birth in women with type 1 diabetes. [ABSTRACT FROM AUTHOR]

Exposure to maternal diabetes is considered one of the factors during foetal development, leading not only to several complications during pregnancy but also to an increased risk of chronic diseases in later life and exerting a lasting impact on the health of offspring. Animal models play a role in establishing a clear cause-and-effect relationship between prenatal exposure to maternal diabetes and the enduring well-being of offspring, helping to control for variables that could distort the results. This study aims to systematically analysis long-term offspring complications associated with maternal diabetes, drawing insights from both human and animal studies. Analysis expands knowledge about possible new directions of scientific research concerning the prevention and treatment of hyperglycemia in pregnancy through a detailed analysis of the mechanisms of its influence on fetal development. [ABSTRACT FROM AUTHOR]

Background: Diabetic retinopathy (DR) may worsen during pregnancy, but its course in the postpartum remains poorly understood. Understanding the natural history of DR during and after pregnancy can help determine when sight‐threatening DR treatment should be administered. Methods: A prospective longitudinal cohort study recruited pregnant women with pre‐existing type 1 (T1D) or type 2 diabetes from two tertiary Diabetes Antenatal Clinics in Melbourne, Australia. Eye examination results in early pregnancy, late pregnancy, and up to 12‐months postpartum were compared to determine DR changes. Two‐field fundus photographs and optical coherence tomography scans were used to assess DR severity. Results: Overall, 105 (61.4%) women had at least two eye examinations during the observation period. Mean age was 33.5 years (range 19–51); 54 women (51.4%) had T1D; 63% had HbA1c <7% in early pregnancy. DR progression rate was 23.8% (95% CI 16.4–32.6). Having T1D (RR 4.96, 95% CI 1.83–13.46), pre‐existing DR in either eye (RR 4.54, 95% CI 2.39–8.61), and elevated systolic blood pressure (adjusted RR 2.49, 95% CI 1.10–5.66) were associated with increased risk of progression. Sight‐threatening progression was observed in 9.5% of women. Among the 19 eyes with progression during pregnancy, 15 eyes remained stable, three eyes progressed, and only one eye regressed in the postpartum. Conclusions: Nearly 1 in 4 women had DR progression from conception through to 12‐months postpartum; almost half of these developing sight‐threatening disease. DR progression occurring during pregnancy was found to predominantly remain unchanged, or worsen, after delivery, with very few eyes spontaneously improving postpartum. [ABSTRACT FROM AUTHOR]

Background: Type 1 diabetes mellitus (T1DM) is associated with adverse maternal and fetal outcomes. Continuous glucose monitoring (CGM) during pregnancy is associated with better glycemic control in women with T1DM. However, no clear benefits have been demonstrated in reducing adverse feto-maternal outcomes in pregnant women with T1DM. Design and Methods: This is a retrospective, single-center study of pregnant women with T1DM to evaluate the impact of CGM use on glycemic control and feto-maternal outcomes in pregnant women with T1DM. Results: Of 265 women with T1DM, 92 (34.7%) used CGM, and 173 (65.3%) were managed with capillary blood glucose (CBG) monitoring. The mean (SD) age and BMI at the first visit were 29.4 (4.7) years and 27.2 (5.2) kg/m2, respectively. The mean (SD) HbA1c at the first-trimester visit was 63 (1) mmol/mol, and in the last trimester was 51 (1%). There was no difference in the mean changes in HbA1c between the two groups. Women using CGM had lower insulin requirements (1.02 + 0.37 vs. 0.87 + 0.04 units/kg, p = 0.01). The two groups had no significant differences in maternal or fetal outcomes. Conclusion: CGM use in pregnant T1DM women is not associated with improved fetomaternal outcomes. [ABSTRACT FROM AUTHOR]

Objective: To evaluate if antenatal steroid use was associated with a lower rate of respiratory complications in neonates born late preterm to patients with pregestational diabetes mellitus (PGDM). Methods: This was a retrospective cohort study of live, singleton, non‐anomalous, late preterm births complicated by PGDM using data from the Centers for Disease Control and National Vital Statistics System from 2017 to 2021. The primary (assisted ventilation use >6 h) and secondary neonatal outcomes (immediate assisted ventilation, Apgar score, neonatal intensive care unit [NICU] admission, and surfactant use) were compared between births that received steroids and those that did not. Multivariable analyses were performed to adjust for differences in demographic and clinical characteristics. Results: There were 24 323 late preterm births with PGDM, of which 4613 received antenatal steroids and 19 710 did not receive steroids. After adjusting for the differences among the two groups, the need for assisted neonatal ventilation for more than 6 h (adjusted odds ratio [aOR] 1.69, 95% confidence interval [CI] 1.53–1.86), immediate assisted neonatal ventilation (aOR 1.67, 95% CI 1.55–1.80), NICU admission (aOR 1.95, 95% CI 1.81–2.10), and surfactant use (aOR 1.68, 95% CI 1.40–2.02) were higher in the births that received steroids compared with those that did not. These findings did not differ when examining outcomes at each gestational week of delivery between 34 weeks 0 days and 36 weeks 6 days. Conclusions: Antenatal steroid use in late preterm births complicated with PGDM was associated with worse immediate respiratory neonatal outcomes. Our findings support current recommendations against the use of steroids in the late preterm period in pregnancies with PGDM. Synopsis: Antenatal steroid use in late preterm births complicated by pregestational diabetes was associated with increased risk of short‐term adverse neonatal respiratory outcomes. [ABSTRACT FROM AUTHOR]

An infant of a diabetic mother is defined as a newborn born to a mother who has diabetes during pregnancy. The term diabetic mother refers to pregnant women with diabetes diagnosed either before (type 1 or 2 diabetes) or during pregnancy (gestational diabetes). Rising incidence of type 1 and type 2 diabetes in young women and increasing maternal age at conception account for the higher risk of birth complications and adverse maternal and infant outcomes. Infants of diabetic mothers (IDMs) because of mother’s diabetes are prone to developing complications and the most common include: large birth weight and complications resulting from it (i.e. birth injuries, perinatal asphyxia), cardiovascular and respiratory insufficiency (poor tolerance of labor stress), neonatal hypoglycemia and it’s complications, delayed lung maturity (fetal hyperinsulinism and the opposite function of insulin to cortisol), cardiomegaly and hypertrophy of the intraventricular septum (functional narrowing of the outflow of the left ventricle and cardiac failure), congenital malformations (most often of the central nervous system and heart). Less common complications in IDMs are: persistent pulmonary hypertension, hyperbilirubinemia, renal vein thrombosis, small left colon syndrome, intrauterine death, polycythemia, and a predisposition to obesity, insulin resistance and diabetes later in life. This article presents current knowledge about pathological conditions and the recommended management for IDMs.

Diabetes is the most common medical disorder in pregnancy in UAE affecting between 7.9% to 37.7% of women. Recommendations for Metformin use in pregnant diabetics vary between societies. Through this study, we explored the effectiveness and safety of metformin monotherapy in women with diabetes during pregnancy and analyzed the clinico-demographic profile of cases with successful metformin use. This is a retrospective study conducted in Abdulla Bin Omran Hospital, RAK between January 2018 and December 2019 including women with GDM and PGDM requiring pharmacological treatment for blood sugar control. The effectiveness of metformin was assessed with Glycemic control FBG, 1HPG, and 2HPG levels at definite intervals and pregnancy outcomes. Clinicodemographic profiles for the successful use of Metformin were analyzed. Descriptive, inferential, and regression model analyses were done by using SPSS version 24. This included 271 patients with GDM and 56 with PGDM(total 327). Metformin was as effective as insulin for the control of blood glucose in both GDM and PGDM. Insulin is more effective in control of FBG abnormalities but is associated with higher preterm labor rates(p=.0009). Women with higher BMI (=40) and FBG levels at diagnosis are significantly more likely to need supplemental insulin(p= .00008 and .0001). This is not associated with factors like age, parity, ethnicity, class1 or class-2 obesity. There were no abnormalities or differences in babies at a 2-year follow-up. Metformin is a safe and effective option for both PGDM and GDM in carefully selected patients without any adverse effect on offspring. [ABSTRACT FROM AUTHOR]

This article discusses a case report of a pregnant woman with diabetes and chronic kidney disease (CKD). The medical team decided to continue the pregnancy while closely monitoring the mother's kidney function and glucose levels. They used an intermittently scanning continuous glucose monitoring system (isCGM) to monitor glucose levels, but also confirmed the readings with a capillary blood glucometer (CBGM) due to discrepancies. The study found a strong correlation between the two methods, but noted that the accuracy of the isCGM was suboptimal, especially for glucose values within a specific range. The article emphasizes the importance of accurate glucose monitoring in managing diabetes during pregnancy complicated by CKD and highlights the need for further research in this area. [Extracted from the article]

Objectives: The association between pregestational diabetes mellitus (PDM) and risk of congenital heart disease (CHD) is well recognized; however, the importance of glycemic control and other coexisting risk factors during pregnancy is less clear. We sought to determine the relative risk (RR) of major CHD (mCHD) among offspring from pregnancies complicated by PDM and the effect of first‐trimester glycemic control on mCHD risk. Methods: We determined the incidence of mCHD (requiring surgery within 1 year of birth or resulting in pregnancy termination or fetal demise) among registered births in Alberta, Canada. Linkage of diabetes status, maximum hemoglobin A1c (HbA1c) at < 16 weeks' gestation and other covariates was performed using data from the Alberta Perinatal Health Program registry. Risk of mCHD according to HbA1c was estimated as an adjusted RR (aRR), calculated using log‐binomial modeling. Results: Of 1412 cases of mCHD in 594 773 (2.37/1000) births in the study period, mCHD was present in 48/7497 with PDM (6.4/1000; RR, 2.8 (95% CI, 2.1–3.7); P < 0.0001). In the entire cohort, increased maternal age (aRR, 1.03 (95% CI, 1.02–1.04); P < 0.0001) and multiple gestation (aRR, 1.37 (95% CI, 1.1–1.8); P = 0.02) were also associated with mCHD risk, whereas maternal prepregnancy weight > 91 kg was not. The stratified risk for mCHD associated with HbA1c ≤ 6.1%, > 6.1–8.0% and > 8.0% was 4.2/1000, 6.8/1000 and 17.1/1000 PDM/gestational diabetes mellitus births, respectively; the aRR of mCHD associated with PDM and HbA1c > 8.0% was 8.5 (95% CI, 5.0–14.4) compared to those without diabetes and 5.5 (95% CI, 1.6–19.4) compared to PDM with normal HbA1c (≤ 6.1%). Conclusions: PDM is associated with a RR of 2.8 for mCHD, increasing to 8.5 in those with HbA1c > 8%. These data should facilitate refinement of referral indications for high‐risk pregnancy screening. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. Linked article: There is a comment on this article by Jiang and Li. Click here to view the Correspondence. [ABSTRACT FROM AUTHOR]

Introduction: Insulin requirement in women with Type 1 diabetes (T1DM) changes throughout pregnancy. The aim of this study was to determine the total change in insulin requirements and the effect of gestational weight gain (GWG) and pre‐gestational BMI on insulin requirements during pregnancy in women with T1DM treated with continuous subcutaneous insulin infusion and continuous glucose monitoring. Methods: This historical cohort study included all consecutive women with T1DM who were monitored during pregnancy at the high‐risk pregnancy clinic at a tertiary medical center during April 2011–April 2019. One Way Repeated Measures ANOVA with Bonferroni adjustment was conducted to compare the effects of gestational age on insulin requirements and a Two Way Repeated Measures ANOVA was employed to test for the interaction between gestational age intervals and maternal BMI and GWG. Results: Data regarding insulin requirements of 185 pregnancies were included in the analyses. There was a significant effect of gestational age on total insulin (Wilks' Lambda = 0.34, F(6,14) = 4.52, p = 0.009), basal insulin (Wilks' Lambda = 0.41, F(6,14) = 3.30, p = 0.031) and bolus insulin (Wilks' Lambda = 0.43, F(6,14) = 3.02, p = 0.041). Total insulin/kg requirements increased by 5.5% from 13–20 weeks to 20–26 weeks, 19% from 20–26 weeks to 26–33 weeks, and 17.4% from 26 to 33 weeks to delivery (p for trend = 0.009). Overall, insulin requirements increased by 42.1% from conception to delivery (p < 0.01). There was no significant main effect of maternal BMI or GWG on insulin requirements. Conclusions: There is a significant increase in insulin requirements per kg during pregnancy in women with T1DM who were treated with an insulin pump. [ABSTRACT FROM AUTHOR]

Background: Diabetes Mellitus (DM) is a common medical disorder that complicates about 16% of pregnancies worldwide. DM may result in significant adverse maternal and fetal outcomes, if not recognised early and properly managed. Objective: To determine the prevalence, perinatal, and maternal outcomes of Diabetes in pregnancy at the University of Maiduguri Teaching Hospital, Nigeria. Methodology: A 5-year retrospective review of women with Diabetes Mellitus in pregnancy carrying a singleton pregnancy managed at the Obstetrics and Gynaecology department of the University of Maiduguri Teaching Hospital, Nigeria. Data was analysed using SPSS version 25 and presented in tables and figures. P-value less than 0.05 was considered statistically significant. Results: A total of 16,390 deliveries were recorded during the period under review out of which 176 women had DM in pregnancy, giving a prevalence of 1.1%. Gestational Diabetes Mellitus (GDM) has a prevalence of 0.7% (accounting for 74.83% of cases). The risk factors for DM in pregnancy were found to be GDM in a previous pregnancy, family history of DM, booking weight greater than 90 kg, or BMI greater than 30Kg/m2. Significantly, women with GDM are more likely to be controlled by diet and exercise only compared to women with Pre-Gestational Diabetes Mellitus (PGDM); P=0.004. The overall risk of preterm delivery was 4.2%, and preterm delivery was significantly higher in PGDM compared to the GDM group (P=0.048). Although not statistically significant, C-section rate (66.7% vs 52.3%), Preeclampsia (5.6% vs 4.75%), congenital anomaly (2.8% vs 1.9%), neonatal SCBU admission (25.0% vs 14.0%), recurrent UTI (2.8% vs 0%), and development of hypoglycaemia (5.6% vs 0.9%) were more common among patients with PGDM compared to those with GDM. While fetal macrosomia, (28.0% vs. 19.4%), shoulder dystocia (3.7% vs 0%), and IUFD (3.7% vs. 2.8%) were commoner in the GDM group compared to the PGDM group; however, the rate of ENND was the same among both groups. Conclusion: The prevalence of DM in pregnancy in this study is low and patients with GDM were more likely to be controlled with dietary therapy compared to patients with PGDM. Preterm delivery is commoner in patients with PGDM.

Abstract Background Maternal pre-gestational diabetes (PGDM), gestational diabetes mellitus (GDM), and overweight/obesity have been associated with increased risks of offspring neurodevelopmental conditions (NDCs) including autism, intellectual disability (ID), and attention deficit/hyperactivity disorder (ADHD). Less is known about whether and how obstetric and neonatal complications (e.g., preterm birth, neonatal asphyxia) could mediate these associations. Methods In this Swedish register-based cohort study, we examined complications during pregnancy, delivery, and the neonatal period as potential mediators of the relationships between maternal metabolic conditions and offspring NDCs. We quantified the extent to which these obstetric and neonatal factors could mediate the associations of maternal metabolic conditions with offspring NDCs by applying parametric regression models for single mediation analyses and weighting-based methods for multiple mediation analyses under counterfactual frameworks. Results The study sample included 2,352,969 singleton children born to 1,299,692 mothers from 1987–2010 who were followed up until December 31, 2016, of whom 135,832 children (5.8%) were diagnosed with at least one NDC. A substantial portion of the association between maternal PGDM and children’s odds of NDCs could be explained by the combined group of obstetric and neonatal complications in the multiple mediation analysis. For instance, these complications explained 44.4% of the relationship between maternal PGDM and offspring ID risk. The proportion of the relationship between maternal overweight/obesity and children’s risk of NDCs that could be explained by obstetric and neonatal complications was considerably smaller, ranging from 1.5 to 8.1%. Some complications considered on their own, including pregnancy hypertensive diseases, preterm birth, neonatal asphyxia, and hematological comorbidities, could explain at least 10% of the associations between maternal PGDM and offspring NDCs. Complications during the neonatal period showed a stronger joint mediating effect for the relationship between PGDM and offspring NDCs than those during pregnancy or delivery. Conclusions Obstetric and neonatal complications could explain nearly half of the association between maternal PGDM and offspring risk of NDCs. The mediating effects were more pronounced for complications during the neonatal period and for specific complications such as pregnancy hypertensive diseases, preterm birth, neonatal asphyxia, and hematological comorbidities. Effective preventive strategies for offspring NDCs should holistically address both the primary metabolic issues related to PGDM and the wide array of potential complications, especially those in the neonatal period. Graphical Abstract

Worldwide, diabetes mellitus represents a growing health problem. If it occurs during pregnancy, it can increase the risk of various abnormalities in early and advanced life stages of exposed individuals due to fetal programming occurring in utero. Studies have determined that maternal conditions interfere with the genotypes and phenotypes of offspring. Researchers are now uncovering the mechanisms by which epigenetic alterations caused by diabetes affect the expression of genes and, therefore, the development of various diseases. Among the numerous possible epigenetic changes in this regard, the most studied to date are DNA methylation and hydroxymethylation, as well as histone acetylation and methylation. This review article addresses critical findings in epigenetic studies involving diabetes mellitus, including variations reported in the expression of specific genes and their transgenerational effects. [ABSTRACT FROM AUTHOR]

Introduction: Our objective was to evaluate the strength of association and diagnostic performance of cerebroplacental ratio (CPR) in predicting the outcome of pregnancies complicated by pre- and gestational diabetes mellitus. Methods: PubMed, Embase, Cochrane, and Google Scholar databases were searched. Inclusion criteria were pregnancies complicated by gestational or pregestational diabetes undergoing ultrasound assessment of CPR. The primary outcome was a composite score of perinatal mortality and morbidity as defined by the original publication. The secondary outcomes included preterm birth gestational age (GA) at birth, mode of delivery, fetal growth restriction (FGR) or small for GA (SGA) newborn, neonatal birthweight, perinatal death (PND), Apgar score <7 at 5 min, abnormal acid-base status, neonatal hypoglycemia, admission to neonatal intensive care unit (NICU). Furthermore, we aimed to perform a number of sub-group analyses according to the type of diabetes (gestational and pregestational), management adopted (diet insulin or oral hypoglycemic agents), metabolic control (controlled vs. non-controlled diabetes), and fetal weight (FGR, normally grown, and large for GA fetuses). Head-to-head meta-analyses were used to directly compare the risk of each of the explored outcomes. For those outcomes found to be significant, computation of diagnostic performance of CPR was assessed using bivariate model. Results: Six studies (2,743 pregnancies) were included. The association between low CPR and adverse composite perinatal outcome was not statistically significant (p = 0.096). This result did not change when stratifying the analysis using CPR cut-off below 10th (p = 0.079) and 5th (p = 0.545) centiles. In pregnancies complicated by GDM, fetuses with a low CPR had a significantly higher risk of birthweight <10th percentile (OR: 5.83, 95% confidence interval [CI] 1.98–17.12) and this association remains significant when using a CPR <10th centile (p < 0.001). Fetuses with low CPR had also a significantly higher risk of PND (OR: 6.15, 95% CI 1.01–37.23, p < 0.001) and admission to NICU (OR 3.32, 95% CI 2.21–4.49, p < 0.001), but not of respiratory distress syndrome (p = 0.752), Apgar score <7 at 5 min (p = 0.920), abnormal acid-base status (p = 0.522), or neonatal hypoglycemia (p = 0.005). These results were confirmed when stratifying the analysis including only studies with CPR <10th centile as a cut-off to define abnormal CPR. However, CPR showed a low diagnostic accuracy for detecting perinatal outcomes. Conclusion: CPR is associated but not predictive of adverse perinatal outcome in pregnancies complicated by gestational diabetes. The findings from this systematic review do not support the use of CPR as a universal screening for pregnancy complication in women with diabetes. [ABSTRACT FROM AUTHOR]

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Aim: Determine the utility of prospective spinal ultrasound in infants of mothers with pregestational diabetes (PGDM) for the diagnosis of closed spinal dysraphism (SDs). Methods: This prospective observational pilot study was completed at a tertiary care center between May 1, 2020 and December 30, 2022. Infants born to mothers with PGDM and with normal spinal physical examinations were included. A total of 25 mother–infant dyads were enrolled in the study and prospectively screened with spinal ultrasound. The study was registered on ClinicalTrials.gov (Identifier‐NCT05033275). Results: Twenty‐five spinal ultrasounds were performed over the course of this study with three (8%) resulting in abnormal findings that required further imaging. Follow‐up with magnetic resonance imaging found one case of tethered cord syndrome. Conclusion: Prospective screening in infants of mothers with PGDM found one case of tethered cord syndrome. This finding suggests that risk stratified screening of mothers with diabetes might be a reasonable approach to care. [ABSTRACT FROM AUTHOR]

Background Common maternal medical comorbidities such as hypertensive disorders, diabetes, tobacco use, and extremes of maternal age, body mass index, and gestational weight gain are known individually to influence the rate of cesarean delivery. Numerous studies have estimated the risk of individual conditions on cesarean delivery.

Holoprosencephaly is a brain abnormality resulting from an incomplete cleavage of the prosencephalon during early embryogenesis. Uncontrolled maternal diabetes mellitus is one of the strongest human teratogens and the most well-known cause of holoprosencephaly. We report a rare case of holoprosencephaly in a male fetus in a preexisting diabetic pregnancy. The diagnosis of the holoprosencephaly was established by ultrasound scan and MRI data. [ABSTRACT FROM AUTHOR]

Congenital heart defects (CHDs) are the most common form of birth defects in humans. They occur in 9 out of 1000 live births and are defined as structural abnormalities of the heart. Understanding CHDs is difficult due to the heterogeneity of the disease and its multifactorial etiology. Advances in genomic sequencing have made it possible to identify the genetic factors involved in CHDs. However, genetic origins have only been found in a minority of CHD cases, suggesting the contribution of non-inherited (environmental) risk factors to the etiology of CHDs. Maternal pregestational diabetes is associated with a three- to five-fold increased risk of congenital cardiopathies, but the underlying molecular mechanisms are incompletely understood. According to current hypotheses, hyperglycemia is the main teratogenic agent in diabetic pregnancies. It is thought to induce cell damage, directly through genetic and epigenetic dysregulations and/or indirectly through production of reactive oxygen species (ROS). The purpose of this review is to summarize key findings on the molecular mechanisms altered in cardiac development during exposure to hyperglycemic conditions in utero. It also presents the various in vivo and in vitro techniques used to experimentally model pregestational diabetes. Finally, new approaches are suggested to broaden our understanding of the subject and develop new prevention strategies. [ABSTRACT FROM AUTHOR]

Background: Maternal pre-gestational diabetes (PGDM), gestational diabetes mellitus (GDM), and overweight/obesity have been associated with increased risks of offspring neurodevelopmental conditions (NDCs) including autism, intellectual disability (ID), and attention deficit/hyperactivity disorder (ADHD). Less is known about whether and how obstetric and neonatal complications (e.g., preterm birth, neonatal asphyxia) could mediate these associations. Methods: In this Swedish register-based cohort study, we examined complications during pregnancy, delivery, and the neonatal period as potential mediators of the relationships between maternal metabolic conditions and offspring NDCs. We quantified the extent to which these obstetric and neonatal factors could mediate the associations of maternal metabolic conditions with offspring NDCs by applying parametric regression models for single mediation analyses and weighting-based methods for multiple mediation analyses under counterfactual frameworks. Results: The study sample included 2,352,969 singleton children born to 1,299,692 mothers from 1987–2010 who were followed up until December 31, 2016, of whom 135,832 children (5.8%) were diagnosed with at least one NDC. A substantial portion of the association between maternal PGDM and children's odds of NDCs could be explained by the combined group of obstetric and neonatal complications in the multiple mediation analysis. For instance, these complications explained 44.4% of the relationship between maternal PGDM and offspring ID risk. The proportion of the relationship between maternal overweight/obesity and children's risk of NDCs that could be explained by obstetric and neonatal complications was considerably smaller, ranging from 1.5 to 8.1%. Some complications considered on their own, including pregnancy hypertensive diseases, preterm birth, neonatal asphyxia, and hematological comorbidities, could explain at least 10% of the associations between maternal PGDM and offspring NDCs. Complications during the neonatal period showed a stronger joint mediating effect for the relationship between PGDM and offspring NDCs than those during pregnancy or delivery. Conclusions: Obstetric and neonatal complications could explain nearly half of the association between maternal PGDM and offspring risk of NDCs. The mediating effects were more pronounced for complications during the neonatal period and for specific complications such as pregnancy hypertensive diseases, preterm birth, neonatal asphyxia, and hematological comorbidities. Effective preventive strategies for offspring NDCs should holistically address both the primary metabolic issues related to PGDM and the wide array of potential complications, especially those in the neonatal period. [ABSTRACT FROM AUTHOR]

Problem: Pregestational diabetes increases the risk of group B streptococcus (GBS) colonization in pregnancy. Whether glycemic control is associated with differences in this risk is unknown. We examined the association between glycemic control and GBS colonization among pregnant individuals with pregestational diabetes. Method of study: A retrospective cohort of pregnant individuals with pregestational diabetes at a tertiary care center. The exposure was glycemic control, measured as hemoglobin A1c (A1c) at >20 weeks and assessed categorically at thresholds of <6.5% and <6.0%, and secondarily, as a continuous percentage. The outcome was maternal GBS colonization. Multivariable logistic regression was used and adjusted for age, parity, race, and ethnicity as a social determinant, body mass index, type of diabetes, and gestational age at A1c assessment. Results: Among 305 individuals (33% Type 1, 67% type 2), 45.0% (n = 140) were colonized with GBS. Individuals with an A1c < 6.5% were half as likely to be colonized with GBS compared with those with a A1c ≥ 6.5% (38.8% vs. 53.9%; adjusted odds ratio, AOR: 0.55; 95% CI: 0.33–0.91). Results were unchanged at an A1c threshold of <6.0% (35.7% vs. 48.5%; AOR: 0.60; 95% CI: 0.36–0.98). Individuals with a higher A1c as a continuous measure (%) were more likely to be colonized (AOR: 1.57 per 1%; 95% CI: 1.25–1.97). Conclusions: Pregnant individuals with pregestational diabetes with worse glycemic control were at an increased risk of GBS colonization. Further study is needed to understand if improved glycemic control leads to lower risk of GBS colonization. [ABSTRACT FROM AUTHOR]

Background: The objective of this study was to assess the ascending and descending aorta area measurements by three-dimensional (3D) ultrasound using spatiotemporal image correlation (STIC) in the rendering mode comparing these measurements with pregestational diabetic mothers and assessing the reproducibility of the method. Methods: We carried out a retrospective cross-sectional study with 58 normal and nine fetuses from pregestational diabetic mothers between 20 and 33 + 6 weeks of gestation. Fetal heart volumes were acquired at the level of four-chamber view to obtain the reconstructed planes for the ascending and descending aorta areas in the rendering mode. Linear regression was performed to assess the correlation between the fetal aorta areas and gestational age (GA). To assess the intra- and interobserver reproducibility, we used the concordance correlation coefficient (CCC). Results: The mean ascending and descending aorta areas were 0.12 (0.02–0.48) and 0.11 (0.04–0.39) cm2 in normal fetuses, respectively. There was a moderate positive correlation between GA and ascending aorta area measurements (0.005676*GA – 0.01283; r = 0.53, P < 0.0001) and strong positive correlation between GA and descending aorta area (0.01095*GA – 0.1581; r = 0.68, P < 0.0001). We observed a weak intra- and interobserver reproducibility with CCC ranging from 0.05 to 0.91. The mean difference in the ascending and descending aorta area measurements of normal and fetuses of pregestational diabetic mothers was −0.03 cm2 (P = 0.276) and −0.03 cm2 (P = 0.231), respectively. Conclusion: The fetal ascending and descending aorta area measurements obtained by 3D ultrasound using STIC in the rendering mode increased with GA in normal fetuses. The method showed weak intra- and interobserver reproducibility. [ABSTRACT FROM AUTHOR]

Abstract Studies have consistently shown a significant increase in the risk of congenital heart defects in the offspring of diabetic mothers compared with those of nondiabetic pregnancies. Evidence points that all types of pregestational diabetes have the capacity of generating cardiac malformations in a more accentuated manner than in gestational diabetes, and there seems to be an increased risk for all congenital heart defects phenotypes in the presence of maternal diabetes. Currently, the application of some therapies is under study in an attempt to reduce the risks inherent to diabetic pregnancies; however, it has not yet been possible to fully prove their effectiveness. The present review aims to better understand the mechanisms that govern the association between pregestational diabetes and congenital heart defects and how maternal diabetes interferes with fetal cardiac development, as there is still a long way to go in the investigation of this complex process.

Background: The objective of this study was to assess the ascending and descending aorta area measurements by three-dimensional (3D) ultrasound using spatiotemporal image correlation (STIC) in the rendering mode comparing these measurements with pregestational diabetic mothers and assessing the reproducibility of the method. Methods: We carried out a retrospective cross-sectional study with 58 normal and nine fetuses from pregestational diabetic mothers between 20 and 33 + 6 weeks of gestation. Fetal heart volumes were acquired at the level of four-chamber view to obtain the reconstructed planes for the ascending and descending aorta areas in the rendering mode. Linear regression was performed to assess the correlation between the fetal aorta areas and gestational age (GA). To assess the intra- and interobserver reproducibility, we used the concordance correlation coefficient (CCC). Results: The mean ascending and descending aorta areas were 0.12 (0.02–0.48) and 0.11 (0.04–0.39) cm2 in normal fetuses, respectively. There was a moderate positive correlation between GA and ascending aorta area measurements (0.005676*GA – 0.01283; r = 0.53, P < 0.0001) and strong positive correlation between GA and descending aorta area (0.01095*GA – 0.1581; r = 0.68, P < 0.0001). We observed a weak intra- and interobserver reproducibility with CCC ranging from 0.05 to 0.91. The mean difference in the ascending and descending aorta area measurements of normal and fetuses of pregestational diabetic mothers was −0.03 cm2 (P = 0.276) and −0.03 cm2 (P = 0.231), respectively. Conclusion: The fetal ascending and descending aorta area measurements obtained by 3D ultrasound using STIC in the rendering mode increased with GA in normal fetuses. The method showed weak intra- and interobserver reproducibility.

Objective: The aim of the study was to evaluate fetal thymus size by sonography in diabetic pregnancies and its relationship with diabetes type. Methods: In this prospectively designed case–control study, fetal thymus transverse diameter and circumference of the fetal thymus were measured. Also, TTR (thymic‐thoracic ratio) was assessed in 288 healthy and 105 diabetic pregnancies. Patients were divided into subgroups as diet‐controlled gestational diabetes (GDMA1, n = 40), insulin‐dependent (GDMA2, n = 42), and pregestational diabetes mellitus (PGDM, n = 23). GDM was diagnosed between 24 and 28 weeks of gestation with a 75 g oral glucose tolerance test. Measurements were compared to the healthy control group. Pairwise comparisons with Bonferroni correction determined which type of diabetes was independently associated with a small fetal thymus. Results: All 3 maternal diabetes categories had smaller fetal thymus size than controls (p < 0.05). TTR were lowest in PGDM (p < 0.05). Conclusion: Gestational diabetes is associated with smaller fetal thymus size. Pregestational diabetes may be associated with a smaller fetal thymus compared to diet‐controlled GDM. Also, the thymus size may be even smaller in those with poor blood glucose regulation. [ABSTRACT FROM AUTHOR]

Abstract Background Women with diabetes first diagnosed during pregnancy (overt diabetes) may be at the same risk level of adverse outcomes as those with known pregestational diabetes. We compared pregnancy outcomes between these groups. Methods We evaluated pregnant women with type 2 diabetes, pregestational or overt diabetes, attending high risk antenatal care in two public hospitals in Southern Brazil, from May 20, 2005 to June 30, 2021. Outcomes were retrieved from electronic medical records. Risk of adverse outcomes, expressed as relative risk (RR) and 95% confidence interval (CI), were calculated using Poisson regression with robust estimates. Results Of 618 women, 33% were labelled as having overt diabetes and 67%, pregestational diabetes. Baseline maternal characteristics were similar: there was a slight, non-clinically relevant, difference in maternal age (33 ± 5.7 years in women with pregestational diabetes vs. 32 ± 6.0 years in women with overt diabetes, p = 0.004); and women with overt diabetes reported smoking almost twice compared to those with pregestational diabetes (12.3% vs. 6.5%, p = 0.024). There were no relevant differences between the groups regarding pregnancy outcomes, although there was a trend of higher neonatal intensive care admission in the group of women with pregestational diabetes (45.2% vs. 36.1%, p = 0.051). Conclusions Overt diabetes was diagnosed in one third of this cohort of pregnant women with hyperglycemia. Their pregnancy outcomes were similar to those of women with pregestational diabetes and were mostly related to maternal demographic characteristics and metabolic control. A call to action should be made to identify women of childbearing age at risk for pre-pregnancy diabetes; to detect hyperglycemia before conception; and to implement timely preconception care to all women with diabetes.

Purpose To evaluate the level of soluble endoglin (sEng) in pregnant women with pregestational diabetes mellitus (DM) and to assess its predictive value for preeclampsia development. Methods Ninety pregnant women were enrolled in the study forming five comparison groups: type 1 DM (not planned, n = 20; planned, n = 20), type 2 DM (diet, n = 15; insulin therapy, n = 20), and the control group (n = 15). The primary outcome was clinically confirmed preeclampsia. Maternal serum concentrations of sEng were measured at 11+0–13+6 and 30+0–33+6 weeks. Results sEng level was elevated in all patients with pregestational DM compared to the control group. Its plasma concentration increased with gestational age and in case of preeclampsia development. In patients with type 1 DM, serum sEng level did not depend on the presence of preeclampsia. This is evidence of severe metabolic disorder and endothelial dysfunction in these patients. The addition of sEng level to logistic models considering established risk factors (body mass index + age + HbA1c level) in the first and third trimesters significantly improved their performance for preeclampsia prediction. Conclusions Eng level may become an important marker for early prediction of preeclampsia in women with pregestational DM.

ABSTRACT Objective: Pregnancy complicated by type 2 diabetes is rising, while data on type 2 diabetes first diagnosed in pregnancy (overt diabetes) are scarce. We aimed to describe the frequency and characteristics of pregnant women with overt diabetes, compare them to those with known pregestational diabetes, and evaluate the potential predictors for the diagnosis of overt diabetes. Subjects and methods: A retrospective cohort study including all pregnant women with type 2 diabetes evaluated in two public hospitals in Porto Alegre, Brazil, from May 20, 2005, to June 30, 2021. Classic and obstetric factors associated with type 2 diabetes risk were compared between the two groups, using machine learning techniques and multivariable analysis with Poisson regression. Results: Overt diabetes occurred in 33% (95% confidence interval: 29%-37%) of 646 women. Characteristics of women with known or unknown type 2 diabetes were similar; excessive weight was the most common risk factor, affecting ~90% of women. Age >30 years and positive family history of diabetes were inversely related to a diagnosis of overt diabetes, while previous delivery of a macrosomic baby behaved as a risk factor in younger multiparous women; previous gestational diabetes and chronic hypertension were not relevant risk factors. Conclusion: Characteristics of women with overt diabetes are similar to those of women with pregestational diabetes. Classic risk factors for diabetes not included in current questionnaires can help identify women at risk of type 2 diabetes before they become pregnant.

Automated insulin delivery (AID) systems have established benefits in terms of glycemic control, health outcomes, and quality of life and are strongly recommended for people with type 1 diabetes outside of pregnancy. While evidence for use of investigational AID systems during pregnancy is promising, data and guidance are still needed regarding use of commercially available systems during pregnancy. Unfortunately, none of the hybrid closed-loop (HCL) systems that are currently available in the United States have glucose targets that are as aggressive as pregnancy glycemic targets, none have a pregnancy-specific algorithm, and none are approved for use during pregnancy. As such, any use of these systems during pregnancy is considered off-label in the United States and would be "assisted" by provider/user techniques. Despite these limitations, many women conceive while using clinically available HCL systems and may be hesitant to cease use during pregnancy. Achievement of strict pregnancy glycemic targets can be difficult, and it is conceivable that selective off-label use of clinically available HCL systems in some women could lead to improved glycemia. We herein offer expert guidance based on clinical experience and available case reports on how to identify appropriate candidates for HCL therapy in pregnancy, how to counsel pregnant women with diabetes on the potential risks and benefits of HCL therapy during pregnancy, and how to manage commercially available systems off-label throughout gestation in an assisted HCL approach. [ABSTRACT FROM AUTHOR]

Heart rate variability assessment of neonates of pregestational diabetic mothers have shown alterations in the autonomic nervous system (ANS). The objective was to study the effect of maternal pregestational diabetes on ANS at the fetal stage by combining cardiac and movement parameters using a non‐invasive fetal magnetocardiography (fMCG) technique. This is an observational study with 40 participants where fetuses from a group of 9 Type 1, 19 Type 2 diabetic, and 12 non‐diabetic pregnant women were included. Time and frequency domain fetal heart rate variability (fHRV) and coupling of movement and heart rate acceleration parameters related to fetal ANS were analyzed. Group differences were investigated using analysis of covariance to adjust for gestational age (GA). When compared to non‐diabetics, the Type 1 diabetics had a 65% increase in average ratio of very low‐frequency (VLF) to low‐frequency (LF) bands and 63% average decrease in coupling index after adjusting for GA. Comparing Type 2 diabetics to non‐diabetics, there was an average decrease in the VLF (50%) and LF bands (63%). Diabetics with poor glycemic control had a higher average VLF/LF (49%) than diabetics with good glycemic control. No significant changes at p < 0.05 were observed in high‐frequency (HF) frequency domain parameters or their ratios, or in the time domain. Fetuses of pregestational diabetic mothers exhibited some differences in fHRV frequency domain and heart rate‐movement coupling when compared to non‐diabetics but the effect of fHRV related to fetal ANS and sympathovagal balance were not as conclusive as observed in the neonates of pregestational diabetic mothers. [ABSTRACT FROM AUTHOR]

Pregestational diabetes is a risk factor for congenital anomalies, including heterotaxy syndrome, a rare birth defect characterized by the abnormal arrangement of organs relative to the left-right (L-R) body axis. To provide insight into the underlying mechanism by which diabetes induces heterotaxy, we here analyzed the L-R axis of mouse embryos of diabetic dams. Various Pitx2 expression patterns indicative of disruption of L-R axis formation were apparent in such embryos. Expression of Nodal at the node, which triggers a Nodal - Pitx2 expression cascade in lateral plate mesoderm, showed marked regression associated with L-R axis malformation. This regression was similar to that apparent in Wnt3a −/− embryos, and canonical Wnt signalling was indeed found to be downregulated in embryos of diabetic dams. RNA sequencing revealed dysregulation of glycolysis in embryos of diabetic dams, and high glucose lowered intracellular pH in the primitive streak, leading to the suppression of Wnt signalling and the regression of Nodal expression. Of note, maternal vitamin A intake increased the incidence of L-R axis defects in embryos of diabetic dams, with dysregulation of retinoic acid metabolism being apparent in these embryos and in Wnt3a −/− embryos. Our results shed light on the mechanisms underlying embryopathies associated with maternal diabetes and suggest the importance of diet for prevention of heterotaxy. • Various Pitx2 expression patterns are apparent in mouse embryos of diabetic dams. • High-glucose exposure lowers intracellular pH in the primitive streak of embryos. • Lowering of pH downregulates Wnt signalling and induces L-R axis malformation. • Maternal vitamin A intake increases the incidence of L-R axis defects. [ABSTRACT FROM AUTHOR]

Worldwide, diabetes mellitus represents a growing health problem. If it occurs during pregnancy, it can increase the risk of various abnormalities in early and advanced life stages of exposed individuals due to fetal programming occurring in utero. Studies have determined that maternal conditions interfere with the genotypes and phenotypes of offspring. Researchers are now uncovering the mechanisms by which epigenetic alterations caused by diabetes affect the expression of genes and, therefore, the development of various diseases. Among the numerous possible epigenetic changes in this regard, the most studied to date are DNA methylation and hydroxymethylation, as well as histone acetylation and methylation. This review article addresses critical findings in epigenetic studies involving diabetes mellitus, including variations reported in the expression of specific genes and their transgenerational effects.

Abstract Background Finland has the world’s highest incidence of 62.5/100000 of diabetes mellitus type 1 (DM1) with approximately 400 (1%) DM1 pregnancies annually. Pregnancies complicated by DM1 are accompanied with increased risk for perinatal morbidity and mortality. Timing and mode of delivery are based on the risk of complications, yet the data on labor induction is limited. The aim of this study was to compare delivery outcomes in planned vaginal (VD) and planned cesarean deliveries (CD) in late preterm and term DM1 pregnancies, and to evaluate the feasibility of labor induction. Materials and Methods Pregnant women with DM1, live singleton fetus in cephalic presentation ≥34 gestational weeks delivering in Helsinki University Hospital between January 1st 2017 and December 31st 2019 were included. The primary outcome were the rates of adverse maternal and perinatal outcome. The study population was classified according to the 1980-revised White’s classification. Statistical analyses were performed by IBM SPSS Statistics for Windows. Results Two hundred four women were included, 59.8% (n = 122) had planned VD. The rate of adverse maternal outcome was 27.5% (n = 56), similar between the planned modes of delivery and White classes. The rate of perinatal adverse outcome was 38.7% (n = 79), higher in planned CD (52.4% vs. 29.5%;p = 0.001). The most common adverse perinatal event was respiratory distress (48.8% vs. 23.0%;p

Pregestational diabetes mellitus (PGDM) confers an increased risk of adverse maternal and neonatal outcomes [1,2]. Glycaemic control in the medium and long term is commonly evaluated by examining glycosylated haemoglobin (HbA1c) levels. However, the value of HbA1c in pregnancy may be diminished by increased level of red cell turnover characteristic of pregnancy [3,4]. We sought to examine the impact of HbA1c in the first trimester and pre-delivery, and the within-patient change throughout gestation on mode of delivery and birthweight in pregnancies complicated by a pre-pregnancy diagnosis of type I or type II diabetes. A 10-year consecutive cohort of pregnancies complicated by PGDM, from Jan 2010 until Dec 2019, was examined for HbA1c data in the first trimester and within 6 weeks of delivery. Perinatal outcome data, including gestational age at delivery, mode of delivery and birthweight centile, were obtained from hospital records. The Spearman Rank correlation was used to correlate HcA1c levels in the first trimester with birthweight centiles. Non-parametric summaries and rank-based tests, Signed-rank test and Kruskal-Wallis test, were used to compare Hba1c levels. During the 10-year study period, a consecutive cohort of 396 pregnancies that attained a viable gestational age (>24 weeks' gestation) and complicated by pregestational diabetes was identified; representing 81 % of the population of pregestational diabetic pregnancies managed by this service during the study period. The median [IQR] HbA1c levels (mmol/mol) in the first trimester, pre-delivery and the differential across gestation were 51 [19] mmol/mol, 43 [11] mmol/mol and −8 [13] mmol/mol, respectively. A statistically significant reduction in HbA1c levels throughout gestation was observed (p < 0.001). The median [IQR] birthweight centile was 69 [50 – 96]. The distributions in HbA1c levels and birthweight centiles were heavily skewed. No correlation was identified between HbA1c levels and mode of delivery. Neither baseline HbA1c levels, pre-delivery values, nor trends across gestation appear to impact birthweight centile or mode of delivery in PGDM. While optimising glycaemic control can affect the long term health of the mother, these indices cannot be relied upon to reflect the impact of glycaemic control on fetal growth aberrations that influence mode of delivery. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the changes in fetal intracranial structures in pregnant women with pregestational diabetes mellitus (DM) and gestational diabetes mellitus (GDM). Methods: The study was conducted prospectively with patients who were grouped as pregestational DM (n = 110), GDM (n = 110), and control (n = 110). Fetal ultrasonographic measurements of widths of posterior lateral ventricles (PLV), cavum septum pellucidi (CSP), cisterna magna (CM), thalamus and transcerebellar diameter (TCD) were recorded and compared. Results: Fetal PLV, CSP, and CM widths were higher in pregestational DM and GDM groups than in control group, and also higher in pregestational DM group compared to GDM group (p < 0.001). Fetal TCD in the PGDM group was found to be less than both control and GDM groups (p < 0.001). No difference was found between three groups in terms of fetal thalamus size (p = 0.801). Fetal PLV, CSP, and CM values were positively correlated with maternal hyperglycemia, fetal abdominal circumference (AC), and deepest vertical pocket of amniotic fluid (DVP) (p < 0.001). Fetal TCD was negatively correlated with HbA1c and DVP (p = 0.002, p = 0.38, respectively). The optimal cut‐off points to identify pregestational DM and GDM were 5.55 and 5.83 mm for PLV, 5.83 and 6.32 mm for CSP, and 7.26 and 6.62 mm for CM. Conclusion: Maternal hyperglycemia was significantly associated with an increase in the widths of fetal PLV, CSP, and CM and a decrease in fetal TCD. [ABSTRACT FROM AUTHOR]

Aim: To evaluate whether pregnant individuals with pregestational diabetes who live in a food-insecure community have worse glycemic control compared to those who do not live in a food-insecure community.Methods: A retrospective analysis of pregnant individuals with pregestational diabetes enrolled in a multidisciplinary prenatal and diabetes care program. The exposure was community-level food insecurity per the Food Access Research Atlas. The outcomes were hemoglobin A1c (A1c) < 6.0 % in early and late pregnancy, and an absolute decrease in A1c ≥ 2.0 % and mean change in A1c across pregnancy.Results: Among 418 assessed pregnant individuals with pregestational diabetes, those living in a food-insecure community were less likely to have an A1c < 6.0 % in early pregnancy compared to those living in a community without food insecurity [16 % vs. 30 %; adjusted risk ratio (aRR): 0.55; 95 % CI: 0.33-0.92]. Individuals living in a food-insecure community were more likely to achieve a decrease in A1c ≥ 2.0 % [35 % vs. 21 %; aRR: 1.55; 95 % CI: 1.06-2.28] and a larger mean decrease in A1c across pregnancy [mean: 1.46 vs. 1.00; adjusted beta: 0.47; 95 % CI: 0.06-0.87)].Conclusions: Pregnant individuals with pregestational diabetes who lived in a food-insecure community were less likely to enter pregnancy with glycemic control, but were more likely to have a reduction in A1c and achieve similar A1c status compared to those who lived in a community without food insecurity. Whether interventions that address food insecurity improve glycemic control and consequent perinatal outcomes remains to be studied. [ABSTRACT FROM AUTHOR]

Background: Hyperglycemia in pregnancy (HIP) increases the risk of adverse pregnancy outcomes. The increasing prevalence of overweight or obesity and the increasing proportion of pregnant women with advanced maternal age (AMA) in the recent decade may affect its prevalence. We analyzed the secular trend of HIP prevalence in 2008-2017 in Taiwan and investigated the impact of AMA in this study. Methods: This cross-sectional study used data from Health and Welfare Data Science Center. Pregnant women who registered their data in the Birth Certificate Application in 2008-2017 were recruited. Diagnosis of HIP was defined by ICD-9-CM and ICD-10-CM codes. Results: In 2008-2017, 151,306-211,768 pregnant women were recruited in different years. The proportion of women with AMA increased from 15.8% to 32.1%. Meanwhile, the prevalence increased from 0.5% to 0.9% for preexisting diabetes, 0.2% to 0.4% for undiagnosed diabetes, and 11.4% to 14.5% for GDM. Maternal age was significantly associated with the prevalence of HIP. For women aged <30 years, 30-34 years and ≥35 years, the prevalence of preexisting diabetes were 0.51%, 0.75% and 1.24%, respectively (p<0.05); the prevalence of undiagnosed diabetes were 0.18%, 0.24% and 0.37%, respectively (p<0.05); and the prevalence of GDM were 10.57%, 14.77% and 18.13%, respectively (p<0.05). In all age groups, the prevalence of HIP increased over time in 2008-2017. Conclusion: The prevalence of HIP increased in Taiwan in 2008-2017, which may result from the increasing proportion of pregnant women with AMA and the change in the diagnostic criteria for GDM. [ABSTRACT FROM AUTHOR]

Preeclampsia (PE) is one of the leading causes of mortality and morbidity in pregnant women. Pregestational diabetes (PGDM) patients are prone to vascular complications and preeclampsia, whereas vascular exposure to hyperglycemia induces inflammation, vascular remodeling, and arterial stiffness. Corin is a serine protease, converting inactive pro-atrial natriuretic peptide (pro-ANP) into an active form. It also promotes salt and water excretion by activating atrial natriuretic peptide (ANP), and significantly increases trophoblast invasion. The study aimed to determine whether corin may be a predictor of PE in a high-risk group—women with long-term PGDM. The nested case-control prospective study involved 63 patients with long-term pregestational type 1 diabetes (PGDM). In total, 17 patients developed preeclampsia (the study group), whereas 43 patients without PE constituted the control group. To assess corin concentration, blood samples were collected at two time points: between 18th–22nd week of gestation and 28th–32nd week of gestation. PE patients presented significantly higher mid-gestation corin levels, urine protein loss in each trimester, serum creatinine in the third trimester, and lower creatinine clearance in the third trimester. The results of our study indicate that serum corin assessment may play a role in predicting preeclampsia. Thus, it may be included in the PE risk calculator, initially in high-risk groups, such as patients with PGDM. [ABSTRACT FROM AUTHOR]

There are limited data on follow-up, treatment, and maternal and fetal outcomes in women with prediabetes before or at the beginning of pregnancy. The aim of this study was to comprehensively characterize women with prediabetes compared to women with type 2 diabetes mellitus. This was a retrospective cohort data from a single medical center treating women with pregestational prediabetes mellitus (PDM). Women were compared to pregestational overt type 2 diabetes mellitus (T2DM). Data were collected from 120 women in the PDM group and 86 women in the T2DM group. Baseline characteristics were comparable, albeit women in the PDM group arrived at medical attention significantly later, 55% after 15 weeks gestation. Women with PDM needed significantly less treatment to achieve glycemic control and glycated hemoglobin remained lower throughout pregnancy. Maternal and fetal outcomes were similar between groups, although significantly higher rates of macrosomia and neonatal jaundice were observed in the T2DM group. The lack of clear guidelines causes a delay in the first prenatal visit of women with PDM. Comparable pregnancy outcomes may tip the balance toward acceptance of early treatment. Establishing clear guidelines will enable primary caregivers to refer prediabetic women sooner for lifestyle modifications and treatment if needed. [ABSTRACT FROM AUTHOR]

To evaluate the changes of fetal epicardial fat thickness (EFT) in pregnancies with pregestational diabetes mellitus (PGDM) and gestational diabetes mellitus (GDM) and to identify the diagnostic effectiveness of fetal EFT in differentiating PGDM and GDM from normal pregnancies. The study was conducted with pregnant women who admitted to perinatology department between October 2020 and August 2021. Patients were grouped as PGDM (n = 110), GDM (n = 110), and control (n = 110) for comparison of fetal EFT. EFT was measured in all three groups at 29 weeks of gestation. Demographic characteristics and ultrasonographic findings were recorded and compared. The mean fetal EFT was significantly higher in PGDM (1.47 ± 0.083 mm, p <.001) and GDM (1.40 ± 0.082 mm, p <.001) groups compared to control group (1.19 ± 0.049 mm) and was also significantly higher in PGDM group than GDM group (p <.001). Fetal EFT was significantly positively correlated with maternal age, fasting, 1st hour, 2nd hour glucose values, HbA1c, fetal abdominal circumference, and deepest vertical pocket of amniotic fluid (p <.001). Fetal EFT value of 1.3 mm diagnosed PGDM patients with a sensitivity of 97.3% and a specificity of 98.2%. Fetal EFT value of 1.27 mm diagnosed GDM patients with a sensitivity of 94% and a specificity of 95%. Fetal EFT is greater in pregnancies with diabetes than in normal pregnancies, and also greater in PGDM than in GDM. In addition, fetal EFT is strongly correlated with maternal blood glucose levels in diabetic pregnancies. [ABSTRACT FROM AUTHOR]

Background: Pregnancy in women with diabetes mellitus is associated with an increased risk of congenital malformations, obstetric complications and neonatal morbidity. The current study was aimed to assess the effect of different types of diabetes mellitus without vascular changes on maternal and fetal outcomes. Methods: This was a cross sectional study done at Zagazig university hospital and included 50 cases of gestational and pregestational diabetic pregnant women in third trimester of pregnancy (28wks to 40wks) attending at Zagazig University hospitals in the period from March until September 2019. Patients divided into 2 groups: Group I: included 25 pregnant women with pregestational diabetes mellitus (Type 1and Type 2 DM) without vascular changes, Group II: included 25 pregnant women with gestational diabetes mellitus. Fasting &2 h postprandial blood glucose level, HbA1c, Complete general and abdominal examination, Obstetric Ultrasonography was done for all patients. Results: There was no statistical significant difference in positive family history of diabetes and previous history of congenital fetal malformation, Intra Uterine Fetal Death and gestational diabetes mellitus between the studied groups. There was no statistical significant difference in gestational age at delivery and mode of delivery between the two groups. Conclusion: We concluded that either diabetes was gestational or pregestational there was no statistical difference between maternal and fetal outcomes. Optimal control of blood glucose resulted in lower neonatal and maternal complications. Further studies on large geographical scale and larger sample size are required to support our conclusion. [ABSTRACT FROM AUTHOR]

Background: Previous studies found consistent associations between pregestational diabetes and birth defects. Given the different biological mechanisms for type 1 (PGD1) and type 2 (PGD2) diabetes, we used National Birth Defects Prevention Study (NBDPS) data to estimate associations by diabetes type. Methods: The NBDPS was a study of major birth defects that included pregnancies with estimated delivery dates from October 1997 to December 2011. We compared self‐reported PGD1 and PGD2 for 29,024 birth defect cases and 10,898 live‐born controls. For case groups with ≥5 exposed cases, we estimated adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for the association between specific defects and each diabetes type. We calculated crude ORs (cORs) and 95% CIs with Firth's penalized likelihood for case groups with 3–4 exposed cases. Results: Overall, 252 (0.9%) cases and 24 (0.2%) control mothers reported PGD1, and 357 (1.2%) cases and 34 (0.3%) control mothers reported PGD2. PGD1 was associated with 22/26 defects examined and PGD2 was associated with 29/39 defects examined. Adjusted ORs ranged from 1.6 to 70.4 for PGD1 and from 1.6 to 59.9 for PGD2. We observed the strongest aORs for sacral agenesis (PGD1: 70.4, 32.3–147; PGD2: 59.9, 25.4–135). For both PGD1 and PGD2, we observed elevated aORs in every body system we evaluated, including central nervous system, orofacial, eye, genitourinary, gastrointestinal, musculoskeletal, and cardiac defects. Conclusions: We observed positive associations between both PGD1 and PGD2 and birth defects across multiple body systems. Future studies should focus on the role of glycemic control in birth defect risk to inform prevention efforts. [ABSTRACT FROM AUTHOR]

Rates of pregestational (PGDM) and gestational diabetes (GDM), and their associated pregnancy complications, are rising. Pregnancies complicated by diabetes have increased cesarean delivery (CD) rates; however, there are limited data regarding the current rates of, and contributing factors to, these deliveries. The Robson Ten Group Classification System (TGCS) is a clinically relevant, standardized framework that can be used to evaluate and analyze cesarean rates. The objective of this study was to evaluate rates of, and indications for, intrapartum, unplanned CD among pregnancies complicated by diabetes, compared to normoglycemic (NG) pregnancies, in a large United States birth cohort. This retrospective cohort study used chart-abstracted data on births between 24 and 42 weeks' gestation at 17 hospitals that contributed to the Obstetrical Care Outcome Assessment Program database between 01/2016 and 03/2019. The CD rate for NG pregnancies, and pregnancies complicated by gestational and PGDM was calculated and compared using the Robson TGCS. The indications for intrapartum CD in patients with term, singleton, vertex gestations without a prior cesarean were then analyzed. Univariate and multivariate logistic regression models were used to compare the cesarean rate and indications for CD, between the diabetic groups and the NG group. Results were adjusted for maternal age, BMI, neonatal birth weight, and insurance status, as well as clustering by hospital. A total of 86,381 pregnant people were included in the study cohort. Of these 76,272 (88.3%) were NG, 8591 (9.9%) had GDM, and 1518 (1.8%) had PGDM. Compared to NG patients, overall cesarean rates were higher in patients with GDM (40.3% vs. 29.7%; aOR 1.25, 95%CI 1.18–1.31) and PGDM (60.0% vs. 29.7%; aOR 2.53, 95%CI 2.04–3.13). This finding remained true when the cohort was restricted to term, singleton, vertex laboring patients without a prior cesarean; compared to NG patients, the cesarean rate was higher in patients with GDM (17.4% vs. 12.2%, aOR 1.37, 95%CI 1.29–1.45) and PGDM (26.0% vs. 12.2%, aOR 2.55, 95%CI 2.00–3.25). The cesarean rate for fetal indications was similar in the GDM (5.7%) and NG (4.4%) groups, while those patients with PGDM had a significantly higher rate (10.4%; aOR 2.01, 95%CI 1.43–2.83). Similarly, the rate of cesarean for labor dystocia in patients with PGDM was significantly higher than in NG patients (16.9% vs. 7.0%, and aOR 2.28, 95%CI 1.66–3.13) while patients with GDM had an intermediate rate (10.6% vs. 7.0%, aOR 1.49, 95%CI 1.40–1.57). The CD rate is significantly higher in pregnancies complicated by diabetes, particularly pregestational, compared to NG pregnancies. Despite controlling for maternal factors and birth weight, pregnancies complicated by diabetes are more likely to undergo an unplanned intrapartum cesarean secondary to labor dystocia than their NG counterparts, but only pregnancies complicated by PGDM have an increased risk of cesarean for fetal indications. More research is needed to understand whether this higher cesarean rate is due to factors intrinsic to diabetes in laboring patients or is due to a difference in the way clinicians manage diabetics in labor. [ABSTRACT FROM AUTHOR]