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ABSTRACT To investigate the effect of D‐chiro inositol (DCI) supplementation on perinatal outcomes in pregnant women at high risk of gestational diabetes mellitus (GDM), we conducted a prospective, randomized, placebo‐controlled study. Eligibility criteria included women aged ≥ 35 years old, with a pre‐pregnancy body mass index ≥ 24 kg/m2, having a family history of type 2 diabetes, having a history of GDM, polycystic ovary syndrome, or a history of delivering macrosomia infants. Participants who were recruited at a gestational age of 12–16 weeks, were randomly to receive either DCI 500 mg twice daily or to receive a placebo for 12 weeks. Outcome measured included the occurrence of GDM and other perinatal outcomes. Between 2020 and 2022, 276 participants were enrolled, with 139 in the DCI Group and 137 in the Control Group. Occurrence of GDM was significantly lower in the DCI group compared to that in placebo group (24.8% vs. 38.1%, p = 0.027). A significant difference was observed in the 1‐h glycemia during the oral glucose tolerance test (OGTT) (8.35 ± 1.55 vs. 8.81 ± 1.85, p = 0.043), however, no significant differences in the fasting glucose level or 2‐h glycemia between the two groups. The mean birth weight of newborns in the control group was significantly heavier than in the DCI group (3487.9 ± 437.7 g vs. 3341.6 ± 420.1 g, p = 0.011). Therefore, DCI supplementation in early pregnancy can reduce the occurrence of GDM in women at high risk.Trial Registration: ClinicalTrials.gov identifier: NCT 04801485 [ABSTRACT FROM AUTHOR]

Aims Methods Results Conclusion Gestational diabetes mellitus (GDM) affects an increasing number of women each year. Research involving partners of women with GDM, such as fathers is limited, however, understanding their perspectives and involvement in GDM management could enhance health outcomes for both women and their families. This study aims to explore the impact and experiences of GDM on fathers in the perinatal period.Qualitative, individual, semi‐structured interviews were conducted with individuals whose partners either currently had GDM or had been diagnosed with GDM within the past 3 years. All participants identified as biological fathers. Data were transcribed and analysed using reflexive thematic analysis.Nine fathers participated in the study. Analysis resulted in four themes that explored fathers' experiences of GDM during the perinatal period: ‘navigating a GDM diagnosis’, ‘partnering in management and health’, ‘finding a place within the GDM journey’ and ‘the lasting impact of GDM’.Fathers encountered wide‐ranging impacts of their partners' GDM. Fathers provided both practical and emotional support to their partners. Engaging fathers in discussions at diagnosis and in management could facilitate the maintenance of positive health behaviour changes postpartum, potentially reducing the risk of type 2 diabetes for both parents. [ABSTRACT FROM AUTHOR]

Aim: Gestational Diabetes Mellitus (GDM), a common pregnancy complication characterized by glucose intolerance, is increasingly recognized as a risk factor for Neonatal Respiratory Distress Syndrome (NRDS). This study aimed to systematically review and quantify the association between GDM and NRDS. Methods: A comprehensive search was conducted in PubMed, Scopus, Embase, and Web of Science from their inception through July 30, 2024, to identify relevant studies. A total of 44 studies, including 50 datasets and over 6.2 million participants, were included in the analysis. Meta-analyses were performed using random-effects models to estimate pooled odds ratios (ORs) and assess heterogeneity among studies. Subgroup analyses were conducted based on study design, gestational age, diagnostic methods, and geographical regions. Results: Our meta-analysis demonstrated a statistically significant association between GDM and an increased risk of NRDS in newborns (OR 1.9; 95%CI 1.5–2.3). A sub-group analysis based on studies participants showed significant association in both GDM-based (OR, 2.0; 95%CI, 1.5–2.7) and NRSD-based studies (OR, 1.7; 95%CI, 1.3–2.3). This association was consistent across other various subgroups, including both term and preterm pregnancies and across different continents. Sensitivity analysis confirmed the robustness of these findings, and cumulative meta-analysis showed a steady increase in the strength of the association over time. Conclusion: Our findings highlight GDM as a significant risk factor for NRDS, underscoring the need for early detection and effective management of GDM to reduce adverse neonatal outcomes. However, limitations such as residual confounding, high heterogeneity among studies, and evidence of publication bias should be considered when interpreting these results. Future research should address these issues by including diverse populations and accounting for key confounders to better understand the GDM-NRDS relationship and explore targeted interventions to mitigate the risk in infants born to mothers with GDM. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion To evaluate the association between the consumption of ultra‐processed foods (UPFs) and outcomes of self‐monitoring of blood glucose in pregnant woman with gestational diabetes mellitus (GDM) and the occurrence of hypoglycemia in their newborns.Prospective cohort study of pregnant woman with GDM who were followed up from the second trimester of pregnancy in high‐risk prenatal care until the immediate postpartum period. Dietary intake was assessed using 24‐h recalls and analyzed according to the Nova Classification. The glycemic profile was assessed by self‐monitoring of fasting and postprandial capillary glycemia (pregnant) and by capillary glycemia in the first 48 h of life (neonate). Multilevel binary logistic regression models were used to assess the relationship between increasing UPF intake, considering the highest tertile of UPF consumption, and women's glycemic control and the occurrence of neonatal hypoglycemia.UPFs provided 15% of calories consumed; 33.3% (n = 30) and 52.3% (n = 45) of the women had hyperglycemia in the second and third trimesters of pregnancy, respectively. After adjustment it was observed that UPF consumption had no significant association with maternal glycemic control but it showed a positive association with the occurrence of neonatal hypoglycemia (odds ratio [OR] 1.144, 95% confidence interval [CI] 1.037–1.262, p = 0.007).These data reinforce the need to address food processing during high‐risk prenatal care in order to help reduce the negative impacts of UPF consumption on the mother–infant dyad. [ABSTRACT FROM AUTHOR]

Gut microbiome dysbiosis is associated with gestational diabetes mellitus (GDM), and its modulation represents a promising approach for enhancing glycemic control. In this study, we aimed to discover specific alterations in the gut microbiome through lifestyle management. We performed metagenome sequencing on fecal samples and measured short-chain fatty acid (SCFA) in plasma samples from 27 well-controlled GDM pregnancies before and after glycemic control. At the same time, 38 normal glucose tolerance (NGT) samples served as controls. Additionally, we employed two-sample Mendelian Randomization (MR) to validate our findings against Genome-Wide Association Study (GWAS) database. Our dynamic analysis revealed Bifidobacterium genus increased in GDM patients after intervention. The MR analysis confirmed that the family of Bifidobacteriaceae (OR 0.929, 95% CI, 0.886–0.975; P = 0.003) was the only negatively associated family with GDM. Further analysis indicated the increased abundance of Bifidobacterium species were negatively correlated with glycemic traits (Spearman rho mean − 0.32 ± 0.34) but positively correlated with plasma SCFA levels (Spearman rho mean 0.24 ± 0.19). Functional analysis revealed that the quorum-sensing pathway had the strongest effect on the ability of Bifidobacterium to promote glucose homeostasis (Spearman rho = -0.34), suggesting its role in regulating intestinal microbiota. Finally, the multivariable MR analysis demonstrated that two pathways, COLANSYN PWY and PWY 7323, responsible for cell surface compound synthesis in gram-negative bacteria, mediated 14.83% (P = 0.017) and 16.64% (P = 0.049) of the protective effects of Bifidobacteriaceae against GDM, respectively. In summary, Bifidobacterium is an effective gut microbiota regulator for GDM-related glucose homeostasis. [ABSTRACT FROM AUTHOR]

Background & Objective: To analyze whether there is an association between pre-pregnancy lipid parameters and gestational diabetes mellitus (GDM) in women undergoing assisted reproductive technologies (ART), a group especially at risk for GDM, and if so, which parameter is associated the strongest. Methods: Data was collected at the Reproductive and Genetic Hospital CITIC-Xiangya in Changsha, China from January 2017 to December 2018. The measured lipid parameters include LDL (low-density lipoprotein), HDL (high-density lipoprotein), TC (total cholesterol), and TG (triglycerides). Results: 119 (15.5%) of the 767 patients developed GDM. On average, women who developed GDM were older, had a higher BMI, LDL, TC, and TG, and lower HDL. After adjusting for confounders, LDL and HDL showed a significant association with GDM (p < 0.05), but TC and TG did not. Binary LDL/HDL and TC/HDL ratios showed the strongest association with GDM incidence (OR 1.957 [95%CI 1.258–3.044] and 1.942 [1.243–3.034] respectively). Subgroup analysis showed that an elevated LDL/HDL ratio also increased GDM risk in subgroups with a typically lower prevalence of GDM, such as young women with a low BMI and low blood pressure. Both lipid ratios (LDL/HDL and TC/HD) show strong interactions with baseline age, fasting plasma glucose, and LH. Conclusions: In this cohort of Chinese women undergoing ART, pre-pregnancy LDL/HDL and TC/HDL were associated with GDM the strongest from the lipid parameters and could be useful to estimate GDM risk even before ART treatments and pregnancy. Clinical trial number: NCT03503006 registered on the 21st of March 2018 (on clinicaltrials.gov). https://clinicaltrials.gov/study/NCT03503006?locStr=Changsha,%20Hunan,%20China&country=China&state=Hunan&city=Changsha&cond=ivf&rank=2. [ABSTRACT FROM AUTHOR]

Background: Although the association between HHEX, IGF2BP2, and FTO polymorphisms and the risk of GDM has been investigated in several studies, the findings have been inconsistent across different populations. The study aimed to investigate the association between genetic polymorphisms and GDM risk in a Chinese population. Methods: 502 control volunteers and 500 GDM patients were enrolled. IGF2BP2 rs11705701 and rs4402960, FTO rs9939609, and HHEX rs1111875 and rs5015480 were all genotyped using the SNPscan™ genotyping assay. The independent sample t-test, logistic regression, and chi-square test were used to assess the variations in genotype and allele and their relationships with the risk of GDM. The blood glucose level, gestational week of delivery, and newborn weight were compared using a one-way ANOVA. Results: After adjusting for confounding factors, the results show that the rs1111875 heterozygous (OR=1.370; 95% CI: 1.040-1.805; P = 0.025) and overdominant (OR=1.373; 95% CI: 1.049-1.796; P = 0. 021) models are significantly associated with an increased risk of GDM, especially for the age ≥ 30 years group: heterozygote (OR=1.646; 95% CI: 1.118-2.423; P =0.012) and overdominant (OR=1.553; 95% CI: 1.064-2.266; P = 0.022) models. In the age ≥ 30 years, the rs5015480 overdominant model (OR=1.595; 95% CI: 1.034-2.459; P = 0.035) and the rs9939609 heterozygote model (OR=1.609; 95% CI: 1.016-2.550; P =0.043), allele (OR=1. 504; 95% CI: 1.006-2.248; P = 0.047), dominant model (OR=1.604; 95% CI: 1.026-2.505; P = 0.038), and overdominant model (OR=1.593; 95% CI: 1.007-2.520; P = 0.047) were associated with a significantly increased risk of GDM; Additionally, people with the TC genotype of rs1111875 had a substantially higher 1-hour blood glucose level than TT genotype (P < 0.05). The results of the meta-analysis showed that the A allele of rs11705701 was associated with an increased risk of diabetes mellitus (P < 0.05). Conclusion: The study indicates that the TC genotype of rs1111875 is linked to a higher risk of GDM, particularly in women aged 30 years or older. Additionally, rs5015480 and rs9939609 were significantly associated with GDM in the same age group. These SNPs may therefore be more closely linked to GDM in older mothers. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to analyze the correlation between gestational diabetes mellitus and postpartum metabolic indicators and inflammatory factors, and explore the role of inflammatory factors, so as to provide evidence for the early prevention of postpartum CVD risk in gestational diabetes mellitus. Methods: This prospective study was based on the pregnant women cohort study established in Peking University International Hospital from December 2017 to March 2019. A total of 120 women were enrolled sequentially, including 60 cases of gestational diabetes mellitus (GDM group) and 60 cases of non-gestational diabetes mellitus (non-GDM group) after 4-7 years. The general information, inflammatory factors and metabolic indicators of the women were collected and analyzed. Results: (1)The TyG and siMS levels in the GDM group were higher than those in the non-GDM group (p<0.05, respectively). The interleukin-6(IL-6) levels in the GDM group were higher than those in the non-GDM group and the difference was statistically significant (p<0.05). (2) The results of linear regression analysis showed that GDM was associated with postpartum GLU0min (β=0.94, 95%CI: 0.27-1.60, p<0.05), GLU120min (β=2.76, 95%CI: 1.57-3.94, p<0.05) and HbA1c (β=0.49, 95%CI: 0.27-1.60, p<0.05). At the same time, GDM was significantly correlated with postpartum metabolic indicators triglyceride-glucose (TyG) index (β=0.31, 95%CI: 0.01-0.61, p<0.05) and siMS score (β=0.45, 95%CI: 0.03-0.88, p<0.05).The results of linear regression analysis showed that GDM was significantly correlated with IL-6 (β=0.91, 95%CI: 0.02-1.79, p<0.05). (3) Logistic regression analysis showed that GDM was an independent risk factor for postpartum abnormal metabolism (OR=10.62, 95%CI: 1.66-68.17, p<0.05), and an independent risk factor for postpartum high low-density lipoprotein cholesterolemia (OR=3.38, 95%CI: 1.01-11.56, p<0.05). (4) The IL-6 had a mediating effect in the association between GDM and postpartum TyG and siMS, with the mediating effect sizes being 20.59% and 30.77%, respectively. Conclusion: This study revealed that GDM history can lead to abnormal glucose and lipid metabolism indexes in postpartum women, affect the levels of postpartum CVD-related metabolic indicators. Meanwhile, IL-6 shows a mediating role, providing important clinical evidence for the prevention and control of CVD in such high-risk populations and the improvement of cardiovascular health. [ABSTRACT FROM AUTHOR]

Objectives: To describe the impacts of four Veterans Health Administration (VA) Quality Enhancement Research Initiative (QUERI) projects implementing an evidence‐based lifestyle intervention known as the Diabetes Prevention Program (DPP). Data Sources and Study Setting: 2012–2024 VA administrative and survey data. Study Design: This is a summary of findings and impacts from four effectiveness‐implementation projects focused on in‐person and/or online DPP across VA sites. Data Collection/Extraction Methods: Patient demographics, participation data, and key findings and impacts were summarized across reports from the VA Diabetes‐Mellitus Quality Enhancement Research Initiative (QUERI‐DM) Diabetes Prevention Program (VA DPP) Trial, QUERI‐DM Online DPP Trial, the Enhancing Mental and Physical Health of Women through Engagement and Retention (EMPOWER) QUERI DPP Project, and EMPOWER 2.0 QUERI Program. Principal Findings: Between 2012 and 2024, four VA QUERI studies enrolled 963 Veterans in DPP across 16 VA sites. All participants had overweight/obesity with one additional risk factor for type 2 diabetes (i.e., prediabetes, elevated risk score, or history of gestational diabetes) and 56% (N = 536) were women. In addition to enhancing the reach of and engagement in diabetes prevention services among Veterans, these projects resulted in three key impacts as follows: (1) informing the national redesign of VA MOVE! including recommendations to increase the number of MOVE! sessions and revise guidelines across 150+ VA sites, (2) enhancing the national evidence base to support online DPP delivery options with citations in national care guidelines outside VA, and (3) demonstrating the importance of gender‐tailoring of preventive care services by and for women Veterans to enhance engagement in preventive services. Conclusions: Over the past decade, the evolution of VA QUERI DPP projects increased the reach of and engagement in diabetes prevention services among Veterans, including women Veterans who have been harder to engage in lifestyle change programs in VA, and resulted in three key impacts informing type 2 diabetes and obesity prevention efforts within and outside of VA. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Objective Methods Results Conclusions The maternal population residing in rural areas, tribal lands or near the United States‐Mexico border are at high risk for adverse pregnancy complications, notably gestational diabetes mellitus (GDM). Few studies have considered the socioeconomic status (SES) attributes of neighbourhoods on maternal health during gestation. Given that the national and global rate of GDM is rising, this analysis moves beyond individual‐level factors and investigates the role of neighbourhood deprivation on GDM risk.To investigate the relationship between neighbourhood deprivation and risk of GDM using Arizona state birth records.This population‐based study of singleton live births (N = 481,113) utilised birth certificates from 2014 to 2020 from the AzPEARS study. Using American Community Survey (5‐year data) linked to 2010 US Census tracts, a composite neighbourhood deprivation index (NDI) score (continuous and quartiles) was derived from 8 socioeconomic indicators. Risk ratios (RR) and 95% confidence intervals (95% CI) were used to examine the association between NDI and GDM risk, adjusting for maternal age, maternal education, race/ethnicity, parity, rurality, and birth year.The state‐wide incidence of GDM was 7.8% (n = 37,636) with variation by neighbourhoods (4% to 12%). GDM risk was highest for Native Americans (17.6%), Asian/Pacific Islanders (13.7%) and Hispanic/Latinas (8.3%). Compared to mothers living in areas with the lowest quartile of NDI, mothers living in neighbourhoods with the highest deprivation had an adjusted risk ratio of 1.21 for developing GDM (95% CI 1.18, 1.26).We observed that neighbourhood deprivation was positively associated with a higher risk of GDM for each increase in quartile. These results suggest that NDI, a proxy for neighbourhood socioeconomic status, may contribute to GDM risk. Identifying high‐risk neighbourhoods for place‐based interventions targeting the most vulnerable birthing populations may be an effective strategy in the prevention of GDM. [ABSTRACT FROM AUTHOR]

Continuous glucose monitoring (CGM) has led to a paradigm shift in the management of pregnant women with type 1 diabetes (T1D), with improved glycaemic control, less hypoglycaemia and fewer pregnancy complications. Data on CGM use in pregnant women with type 2 diabetes (T2D) are limited. A large randomized controlled trial (RCT) on CGM use in people with T2D in pregnancy is ongoing. Small studies on CGM use in women with gestational diabetes (GDM) have suggested improved glycaemic control and better qualification when insulin is needed. However, none of these studies was powered to evaluate pregnancy outcomes. Several large RCTs are ongoing in women with GDM. In addition to CGM, other technologies, such as advanced hybrid closed‐loop (AHCL) systems have further improved glycaemic management in people with T1D. AHCL therapy adapts insulin delivery via a predictive algorithm integrated with CGM and an insulin pump. A large RCT with the AHCL CamAPS® FX demonstrated a 10% increase in time in range compared to standard insulin therapy in a pregnant population with T1D. Recently, an RCT of an AHCL system not approved for use in pregnancy (780G MiniMed) has also demonstrated additional benefits of AHCL therapy compared to standard insulin therapy, with improved time in range overnight, less hypoglycaemia and improved treatment satisfaction. More evidence is needed on the impact of AHCL therapy on maternal and neonatal outcomes and on which glycaemic targets with CGM should be used in pregnant women with T2D and GDM. We review the current evidence on the use of CGM and AHCL therapy in pregnancy. Continuing Medical Education: Please visit https://health.learning.wiley.com/courses/dom-26s7 to complete an accredited learning activity for this article and receive 2.0 AMA PRA Category 1 Credit™. [ABSTRACT FROM AUTHOR]

Background: Sleep problems are prevalent among individuals diagnosed with gestational diabetes mellitus (GDM), significantly impacting their overall quality of life. Objective: This study sought to adopt a person-centered methodology to unveil the latent profiles of sleep quality and identify factors influencing sleep patterns in patients with GDM. Methods: The cross-sectional study gathered sociodemographic features, clinical information, sleep problems (Pittsburgh Sleep Quality Index), personality traits (Type D Personality Scale), social support (Perceived Social Support Scale), and self-efficacy (General Self-efficacy Scale). Latent profile analysis was conducted to identify profiles of sleep quality, while multinomial logistic regression was employed to ascertain the factors influencing these identified profiles. Results: Among the 431 participants, 423 (98.1%) completed the questionnaire, with 53.0% reporting moderate-to-poor sleep quality. This study identified 4 distinct profiles of sleep quality among patients with GDM: the "good sleep quality" group (47.0%), the "poor sleep quality—long sleep duration" group (10.0%), the "moderate sleep quality" group (25.3%), and the "poor sleep quality—short sleep duration" group (17.7%). Individuals with type D personality were associated with the "poor sleep quality—long sleep duration" [odds ratio (OR) = 3.21, P =.005], "moderate sleep quality" (OR = 2.65, P =.003), and "poor sleep quality—short sleep duration" group (OR = 2.31, P =.018). Individuals with a history of GDM were associated with "poor sleep quality—long sleep duration" group (OR = 3.46, P =.005). Conclusions: The research revealed significant classification characteristics of sleep quality in patients with GDM, offering valuable insights for tailoring interventions to address distinct subcategories of sleep-related issues. [ABSTRACT FROM AUTHOR]

Gestational diabetes (GD) is a condition characterized by elevated blood sugar levels during pregnancy. GD poses various health risks, such as serious birth injuries, the need for cesarean delivery, and the necessity of newborn care. Monitoring glucose levels is essential for ensuring safe delivery and reducing the risks to both the mother and fetus. Various sensors are readily available for monitoring glucose levels, and researchers are continually working to develop highly sensitive glucose sensors. This research aimed to develop a gold nanourchin (AuNU)‐hybrid biosensor for quantifying glucose on a multi‐point electrode sensor. Glucose oxidase (GOx) was attached to the AuNU and seeded on the sensing surface using an amine linker. The current‐potential (1–2 V at 0.1 V sweep) was recorded for the GOx–glucose interaction, with a limit of detection of 560 μM and a regression coefficient (R2) of 0.9743 [y = 0.9106x − 0.9953] on the linear curve. The sensitivity was estimated to be 3.5 mAcm−2M−1. Furthermore, control experiments with galactose, sucrose, and fructose did not yield an increase in current‐potential, confirming specific glucose detection. This experiment helps in monitoring glucose levels to manage conditions associated with GD. [ABSTRACT FROM AUTHOR]

Background: Polycystic ovary syndrome (PCOS) is a metabolic and reproductive disorder. Current research findings present conflicting views on the effects of different PCOS phenotypes on outcomes in pregnancy and for newborns. Methods: This research study followed the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA). A thorough search of literature was carried out using the Cochrane Menstrual Disorders and Subfertility Group trials register, Web of Science, and EMBASE databases from their start to December 2023. The search focused on studies examining the links between hyperandrogenic and non-hyperandrogenic PCOS phenotypes and risks in pregnancy and neonatology. Odds ratios (ORs) and 95% confidence intervals (CIs) were computed using either a fixed-effects or random-effects model. Results: Our analysis incorporated 10 research studies. Expectant mothers with a hyperandrogenic PCOS subtype had increased ORs for gestational diabetes mellitus (GDM) and preeclampsia (PE) compared to those with a non-hyperandrogenic PCOS subtype, with respective values of 2.14 (95% CI, 1.18–3.88, I2 = 0%) and 2.04 (95% CI, 1.02–4.08, I2 = 53%). Nevertheless, no notable differences were detected in ORs for outcomes like preterm birth, live birth, miscarriage, cesarean delivery, pregnancy-induced hypertension, small for gestational age babies, large for gestational age newborns, and neonatal intensive care unit admissions between pregnant women with hyperandrogenic PCOS phenotype and those without. Conclusions: This meta-analysis highlights that the presence of hyperandrogenism heightens the risks of GDM and PE within the PCOS population. Healthcare providers ought to be aware of this connection for improved patient management. [ABSTRACT FROM AUTHOR]

Background: Gestational diabetes mellitus (GDM) occurs in approximately 9% of pregnancies, and proper glycemic control is of utmost importance in the prevention of GDM-associated obstetric complications. Flash glucose monitoring (FGM), a subtype of continuous glucose monitoring (CGM), offers intermittent blood glucose scanning and is considered a propitious alternative to the standard method of self-monitoring of blood glucose (SMBG). Aim: The aim of this review was to systematically assess the efficacy and acceptability of FGM in in pregnancies complicated by GDM. Methods: A systematic literature search was performed in the PubMed, MEDLINE, Scopus, and Cochrane databases. The review was conducted following the PRISMA guidelines, and the study protocol has been registered in the PROSPERO database with the registration number CRD42024545874. Results: A total of 872 articles were initially identified, 141 publications underwent an in-depth full-text analysis, resulting in 133 studies being excluded from further assessment. Eventually, eight studies were included in the analysis. Conclusions: The analysis revealed that FGM is a safe and efficient method of glycemic control in GDM. The majority of the studies consider its accuracy comparable to SMBG. Furthermore, FGM is well accepted by patients with numerous advantages in user-friendliness over SMBG. [ABSTRACT FROM AUTHOR]

Pregnancy is a critical period marked by intricate physiological changes and maintaining maternal and fetal well-being is paramount. Inositols, a group of naturally occurring sugar alcohols, have gained attention for their potential benefits during pregnancy. This abstract provides a comprehensive review of the current literature on using inositols, primarily myo-inositol (MI) and D-chiro-inositol (DCI) in pregnancy. Inositols are crucial in cellular signal transduction and insulin sensitivity, making them integral to various physiological processes. Several studies suggest that inositols may contribute to preventing and managing gestational diabetes mellitus (GDM). MI, in particular, has shown promise in improving insulin sensitivity and mitigating insulin resistance, thereby influencing glucose metabolism. As our understanding of inositol's role in pregnancy deepens, it may emerge as a valuable supplement to enhance maternal and fetal health outcomes. [ABSTRACT FROM AUTHOR]

Introduction: The use of vitamin D-calcium supplementation for treating gestational diabetes remains unclear. This meta-analysis aims to evaluate the efficacy of vitamin D-calcium supplementation in the treatment of gestational diabetes. Methods: Several databases including PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases were systemically searched from inception to August 2023, and we included the randomized controlled trials (RCTs) assessing the effect of vitamin D-calcium supplementation on the metabolic profile of gestational diabetes. Results: We included five eligible RCTs and 306 pregnant women in this meta-analysis. Compared with control group in pregnant women with gestational diabetes, vitamin D-calcium supplementation was associated with remarkably decreased fasting plasma glucose (SMD=-0.67; 95% CI=-0.93 to −0.41; p <0.00001), serum insulin (SMD=-1.09; 95% CI=-1.89 to −0.29; p =.007) and LDL (SMD=-0.35; 95% CI=-0.63 to −0.06; p =.02), but demonstrated no impact on total cholesterol (SMD=-0.05; 95% CI=-0.81 to 0.71; p =.90) or triglycerides (SMD=-0.14; 95% CI=-0.86 to 0.58; p =.70). Conclusions: Vitamin D-calcium supplementation is effective to improve metabolic profile for the treatment of gestational diabetes. [ABSTRACT FROM AUTHOR]

Objective: Anthropometric measurement provides a simple, noninvasive approach to evaluate obesity in pregnant women. We aimed to develop a predictive model utilizing anthropometric index for gestational diabetes mellitus (GDM), the most common obesity-related complications during pregnancy. Methods: A prospective cohort of 4709 women was enrolled in Qingdao, China. Logistic regression model was constructed to determine the association of body mass index (BMI), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT) in the first trimester (<14 weeks' gestation) with GDM. The discrimination ability for GDM was assessed using areas under the receiver operating characteristic (ROC) curve (AUC). Delong tests were performed to compare AUC values between different measures. Results: The GDM incidence was 19.50%. GDM risk increased with VAT during early pregnancy, and the risk increased by 117% (OR = 2.17, 95% CI: 1.23–2.83) to 326% (OR = 4.26, 95% CI: 2.29–7.91) in pregnant women with the second quartile or above after adjusting for confounders (all p<.05). Combined index using VAT and BMI demonstrated superior predictive power for GDM compared with BMI alone (p<.05), but didn't differ from VAT (p>.05). Overall, VAT was positively correlated with GDM occurrence, outperforming BMI, WHR, WHtR and SAT in the predicative model. A first-trimester VAT cutoff of 27.05 mm might be promising for GDM risk stratification. Conclusions: First-trimester routine ultrasound screening may facilitate earlier identification and intervention of GDM. Pregnant women with VAT above the optimal threshold (27.05 mm) might benefit from targeted GDM monitoring. [ABSTRACT FROM AUTHOR]

Objective: Gestational diabetes mellitus (GDM) is associated with several adverse maternal and neonatal outcomes. Previous studies reported a link between altered sleep and risk of GDM. This systematic review aims to collate evidence on the association between impaired sleep quality and duration, and the risk of GDM. Methods: PubMed, Embase, Web of Science, and Scopus databases were searched up to January 20, 2024. Studies reporting the association between impaired sleep quality and duration and risk of GDM were included. Sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI). Random-effects meta-analysis was performed, and the results were reported as hazard ratio (HR) with 95% confidence interval (CI). Results: 19 studies were included. Meta-analysis revealed a significant increase in the risk of GDM in pregnant women with poor sleep quality (i.e. <5 PSQI) (HR: 1.50, 95% CI: 1.26 − 1.78, p <.001). Sleep duration of <7 h (HR: 1.56, 95% CI.: 1.20 − 2.01, p <.001), and >8 h (HR: 2.32, 95% CI.: 1.19 − 4.50, p =.01) were also associated with a significantly higher incidence of GDM. Conclusion: Sleep quality and duration emerge as critical risk factors of GDM. Healthcare practitioners should consider targeted interventions to improve sleep hygiene as a potential measure for GDM prevention. [ABSTRACT FROM AUTHOR]

Objective: To comprehensively assess the dose-response association between dietary glycemic index (GI) and glycemic load (GL) and gestational diabetes mellitus (GDM) risk. Methods: PubMed, Embase, Cochrane Library, Web of Science, CNKI, WanFang, and VIP databases were searched up to May 29, 2024. Studies with at least three exposure categories were included. Dose-response analysis was also performed when covariates were adjusted in the included studies. Results: Thirteen studies involving 39,720 pregnant women were included. A linear relationship was found between GI and the risk of GDM (χ2 = 4.77, Pnon-linearity =.0923). However, association was not significant (χ2 = 0.06, p =.8000). For every unit increase in GI (range 0–30), GDM risk increased by 0.29%. After adjusting for covariates, the linear relationship persisted (χ2 = 4.95, Pnon-linearity =.084) with no significant association (χ2 = 0.08, p =.7775). For GL, a linear relationship was also found (χ2 = 4.17, Pnon-linearity =.1245), but GL was not significantly associated with GDM risk (χ2 = 2.63, p =.1049). The risk of GDM increased by 0.63% per unit increase in GL. After covariate adjustment, a significant association was observed (χ2 = 6.28, p =.0122). Conclusion: No significant association between GI and GDM risk was found. After adjusting for covariates, GL shows a significant association with GDM risk. Our findings emphasize the importance of considering dietary GL in managing the risk of GDM. Future research should continue to explore these relationships with standardized diagnostic criteria and robust adjustment for potential confounders. [ABSTRACT FROM AUTHOR]

Gestational diabetes is an increase in blood sugar levels that appears during pregnancy and disappears after delivery. This study aimed to assess the level of knowledge of pregnant women with gestational diabetes regarding diet and physical activity. We conducted a descriptive observational study using a well-structured questionnaire to evaluate data from 100 pregnant women with gestational diabetes. The average age of pregnant women was 30.92 years, with a notable concentration of participants in the 25-29 age group. The distribution of educational levels shows that secondary school constitutes the largest proportion at 32.0%. A very large percentage of participants agreed on the importance of incorporating vegetables and fiber into their diet while abstaining from processed meats. However, only 30% of participants understood the importance of choosing monounsaturated fats over saturated fats. 80% of our participants recognized the importance of physical activity in managing gestational diabetes. The results underline the need for better information and improved dietary education and physical activity for these patients in order to improve the outcome of these pregnancies at risk of complications. [ABSTRACT FROM AUTHOR]

Objective • Gestational diabetes mellitus (GDM) is a metabolic disorder that occurs in 3–5% of pregnancies. The inflammatory response is essential to the development of GDM. Resistant dextrin is a natural fiber and exhibits an antidiabetic effect against diabetes. We investigate resistant dextrin’s preventive role and underlying mechanism against STZ-induced GDM. Material and method • Female Wistar rats were utilized, and GDM was induced in pregnant rats using STZ. The levels of glycated hemoglobin (HbA1c), resistin, serum-cpeptide, free fatty acid, antioxidant, hepatic glycogen, lipid, inflammatory cytokines, apoptosis, and inflammatory parameters were estimated. mRNA expression of Toll-like receptor 4 (TLR4), myeloid differentiation primary response 88 (MyD88), nuclear factor kappa B (NF-κB) and NOD-like receptor protein 3 (NLRP3) was estimated. We also estimated the histopathology of pancreatic and liver tissue. Result • Body weight, plasma insulin, fetal body weight, and blood glucose levels were all considerably (P < .001) improved by resistant dextrin, while placental weight and blood sugar levels were also decreased. Resistant dextrin significantly (P < .001) suppressed the levels of HbA1c, resistin, serum-cpeptide, and hepatic glycogen and improved the free fatty acid (FFA) level. Resistant dextrin significantly (P < .001) altered the level of adiponectin, leptin, intercellular Adhesion Molecule 1 (ICAM-1), and visfatin; antioxidant parameters such as malonaldehyde (MDA), superoxide dismutase (SOD), catalase (CAT), glutathione (GSH), glutathione peroxidase (GPx), glutathione S-transferase GST, inflammatory cytokines like tumor necrosis factor- α (TNFα), interleukin-4 (IL-4), interleukin-6 (IL-6), interleukin-2 (IL-2), interferon- γ (INF-γ), interleukin-10 (IL-10); apoptosis parameters include Bcl-2, caspase-3, and Bax, respectively. Resistant dextrin significantly (P < .001) suppressed the mRNA expression of NF-κB, MyD88, NLRP3, and TLR4. Resistant dextrin altered the histopathological changes in the pancreas and hepatic tissue. Discussion & Conclusion • In short, resistant dextrin demonstrated a protective effect against STZ-induced GDM by modulating the TLR4/MyD88/NF-κB signaling pathway. [ABSTRACT FROM AUTHOR]

Objective The aim was to find a cost-effective, more practical method to be used in the early gestational weeks as an alternative to the oral glucose tolerance test (OGTT) for predicting gestational diabetes mellitus (GDM). The method selected was adipose tissue measurements made in the first trimester. Material and Methods The study was designed as a prospective, cohort study. Ultrasound images were used to calculate abdominal visceral (VAT) and subcutaneous adipose tissue (SAT) thicknesses of the first trimester pregnant women. Two groups were formed: those who were diagnosed with GDM and those who were not, based on the results of the OGTT performed in the same patients at 24th-28th weeks of gestation. Ultrasonographic records were examined and compared between these two groups using received operator characteristic curves and logistic regression analyses. Results A total of 292 pregnant women were included, of whom 21.2% were diagnosed with GDM. In the group diagnosed with GDM, SAT, VAT and total adipose tissue (TAT) values were significantly higher than the women who did not have GDM. Threshold values for SAT, VAT and TAT were 18 mm, 55 mm and 55 mm. Conclusion First trimester SAT, VAT and TAT measurements of pregnant women with GDM were significantly higher than those without GDM diagnosis. Although our results showed that adipose measurements cannot be an alternative to OGTT; they may be a powerful aid in identify at-risk pregnant women, suggesting to perform an early OGTT in the first trimester. Keywords:Gestational diabetes, subcutaneous adipose tissue, visceral adipose tissue, first trimester screening: [ABSTRACT FROM AUTHOR]

Background: Women with a body mass index (BMI) >35 kg/m2 carry an increased obstetric risk; however, the experience of the Class IV and above obese nulliparous women is less understood. Aims: To describe maternal and perinatal outcomes in nulliparous women of booking BMI > 50 kg/m2. Materials and methods: A cohort study of 48 nulliparous women who delivered between 2015 and 2019 in a tertiary hospital and had a booking BMI > 50 kg/m2. Obstetric outcome data was collated via electronic and written patient records. The relationship between mode of delivery and BMI was assessed using direct logistic regression. Multiple pregnancies and severe congenital malformations (n = 3) were excluded. Results: The mean booking BMI was 53.7 kg/m2 (SD 4.05) and mean maternal age was 30.4 years (SD = 5.7). Comorbidities included asthma (43%), essential hypertension (20%) and diabetes (61%). Antenatally, accuracy was compromised in 80% of morphology scans (n = 35). In the perinatal period, 33 women (68.8%) were induced compared to a spontaneous onset of labour in two (4.1%) women. There were nine elective caesarean sections (CS), five of which were for breech presentation. Of those who intended on vaginal delivery (n = 35), 51% (n = 18) had an emergency CS. In these women, the risk of CS increased by a factor of 1.36 for every one point increase in BMI > 50 kg/m2. The average gestational age was 37.5 weeks (SD 2.4) with 14% (n = 6) experiencing preterm deliveries. The incidence of babies born >90th percentile for gestational age was 15 (34%). Conclusion: Increased BMI impairs maternal and perinatal outcomes and significantly increases the risk of emergency CS. BMI > 50 kg/m2 is associated with higher‐level interventions and obstetric complications. [ABSTRACT FROM AUTHOR]

Background: Under‐identification of Aboriginal and Torres Strait Islander (hereafter referred to as Aboriginal) people can result in inaccurate estimation of health outcomes. Data linkage has improved identification of Aboriginal people in administrative datasets. Aim: To compare three methods of ascertainment of Aboriginal status using only pregnancy data from the Western Australian Midwives Notification System (MNS), to the linked Indigenous Status Flag (ISF) derived by the Department of Health. Materials and Methods: This retrospective population‐based cohort study utilised logistic regression to determine which demographic characteristics were associated with under‐identification, and the effect of ascertainment method on perinatal adverse outcomes. Results: All methods identified a core group of 19 017 (83.0%) Aboriginal women and the ISF identified 2298 (10.0%) women who were not identified using any other method. Under‐ascertainment was lowest when a woman's Aboriginal status was determined by ever being recorded as Aboriginal in the MNS data, and highest when taken as it had been recorded for the birth in question. Maternal age <20 years, smoking during pregnancy, pre‐existing diabetes, a history of singleton preterm birth and being in the lowest 20% of Socio‐Economic Indexes for Areas score were all associated with a higher chance of being identified by the methods using only the MNS. These methods were less likely to identify nulliparous women, and those with maternal age ≥35 years. The method of ascertainment of Aboriginality did not make a significant difference to the adjusted predicted marginal probabilities of adverse perinatal outcomes. Conclusion: Unlinked pregnancy data can be used for epidemiological research in Aboriginal obstetric populations. [ABSTRACT FROM AUTHOR]

Objective: To investigate the association between thyroid peroxidase antibody (TPOAb) positivity in the first trimester and maternal metabolic syndrome in pregnancy. Methods: The study retrospectively reviewed the medical records for 787 pregnant women. Serum-free thyroid hormone, thyroid stimulating hormone, and TPOAb levels were measured in early pregnancy (<13 weeks gestation). Baseline demographics, clinical characteristics, thyroid function, and pregnancy outcomes were compared between women who were TPOAb positive or TPOAb negative in the first trimester. Associations between TPOAb positivity in the first trimester and the occurrence of gestational diabetes mellitus, hypertensive disorders complicating pregnancy (HDCP), maternal metabolic syndrome in pregnancy, and adverse pregnancy outcomes were explored. Results: Data for 787 women with a singleton pregnancy were included in the analyses. In women who were TPOAb positive compared to TPOAb negative in the first trimester, baseline HDL-C was significantly lower (1.51 [1.33, 1.81] vs. 1.62 [1.40, 1.87], p = 0.028), and there was a significantly higher incidence of HDCP (15.8% vs. 6%, p < 0.0001), maternal metabolic syndrome in pregnancy (18.8% vs 6.4%, p < 0.0001) or preeclampsia (7% vs, 2.5%, p = 0.024). There was a significant nonlinear association between TPOAb levels in the first trimester and the incidence of HDCP or maternal metabolic syndrome in pregnancy (both p < 0.001). The logit of the probability of having HDCP or maternal metabolic syndrome in pregnancy increased rapidly at TPOAb (log10) ≤ 1.5 (TPOAb (log10) = 1.07 as reference). After adjusting for confounders (maternal age, pre-pregnancy BMI, gravidity, parity and history of adverse events during pregnancy), there was a significantly higher risk of HDCP (odds ratio [OR], 3.029; 95% confidence interval [CI], 1.586, 5.622, p = 0.001), maternal metabolic syndrome in pregnancy (OR, 2.841; 95% CI, 1.473-5.260, p = 0.001), or preeclampsia (OR 3.315, 95% CI 1.305-7.788, p = 0.008) in women who were TPOAb positive compared to TPOAb negative in the first trimester. Conclusion: TPOAb positivity in the first trimester may increase the risk of HDCP, maternal metabolic syndrome in pregnancy, and preeclampsia, emphasizing the need for universal screening for thyroid disorders and better diagnostic criteria and management strategies for metabolic disorders during pregnancy. [ABSTRACT FROM AUTHOR]

Background: Previous articles on the relationship between vitamin D and gestational diabetes mellitus (GDM) were inconsistent. Their relationship has been observed primarily through observational studies, and the causality of this association has not been established. Methods: A two-sample Mendelian randomization (MR) research was conducted to test the causal association between vitamin D and GDM, utilizing publically available statistics from genome-wide association studies (GWAS). This study obtained genetic variants from GWAS including vitamin D (N = 373,045,10,783,672 Single Nucleotide Polymorphisms SNPs), and GDM (5687 cases and 117,892 controls). The major technique was the inverse variance weighted approach (IVW), although there were other approaches as well, such as MR-Egger regression, weighted median, weighted mode, and simple mode. Additionally, we conducted sensitivity analyses to detect any potential diversity and horizontal pleiotropy. Results: The study suggested that there was no causal link between vitamin D and GDM (all methods p > 0.05). For heterogeneity, MR egger Q value was 113.7, p < 0.05; IVW Q value was 114.7, p < 0.05. Therefore, random- effects IVW approach was applied. Regarding pleiotropy, the MR Egger regression intercept was 0.0046, which was close to zero with a p value of 0.452, suggesting the absence of pleiotropy. Conclusions: We observed no assosiation between genetically predicted vitamin D and the risk of GDM, implying that insufficient vitamin D may do not confer an increased susceptibility to GDM. [ABSTRACT FROM AUTHOR]

Objective: Gestational diabetes mellitus (GDM) is associated with metabolic abnormalities such as an altered serum lipid profile. This study investigated the influence of polymorphisms in the lipid metabolism-related cholesteryl ester transfer protein gene (CETP) on the metabolic parameters of pregnant women with GDM. Methods: This prospective case-control study included 665 women with GDM and 1,044 women with uncomplicated pregnancies. The PCR-restriction fragment length polymorphism method was used to genotype rs708272 and rs1800775 single nucleotide polymorphisms (SNPs). Lipid and glucose metabolic parameters were assessed. Genetic associations with related traits were analyzed. Results: Genotype distributions of rs708272 and rs1800775 in patients with GDM were similar to those in normal controls. However, the two CETP SNPs were associated with altered plasma total cholesterol (TC), high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol (LDL-C) concentrations in patients with GDM and in control pregnant women. Additional subgroup analysis demonstrated that the rs708272 polymorphism was associated with variations in triglyceride (TGs), TC, LDL-C, and apolipoprotein B (ApoB) levels in patients with overweight or obesity GDM, whereas both polymorphisms were associated with glucose metabolic traits (plasma insulin, glucose, or insulin) and the insulin resistance index in patients with GDM without obesity. Conclusions: In patients with GDM, the rs708272 polymorphism was associated with atherogenic lipid levels (TG, TC, LDL-C, and ApoB), whereas the rs708272 and rs1800775 polymorphisms were associated with glucose metabolism and insulin resistance parameters, which were influenced by the body mass index. These results suggest that genetic associations with atherogenic metabolic factors may increase the risk of adverse outcomes in mothers with GDM and their offspring. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study is to explore the relationship between Life's Essential 8 (LE8) and the risk of gestational diabetes among US adults. Method: We used National Health and Nutrition Examination Surveys 2007–2018 data to perform this study. LE8 scores comprised 4 health behaviors (diet, physical activity, nicotine exposure, and sleep duration) and 4 health factors (BMI, non-high-density lipoprotein [HDL] cholesterol, blood glucose, and blood pressure). Then, LE8 were categorized into low CVH (0 to 49 scores), moderated CVH (50 to 79 scores), and high CVH (80 to 100 scores). Weighted multivariate Logistic regression analysis model were used to estimate the relationship between LE8 and gestational diabetes. Result: A total of 3,189 participants were included, and the portion of gestational diabetes was 15.33%, 11.46%, 7.71% in low CVH, moderate CVH, and high CVH, respectively. Adjustment for covariates, we found that high CVH (OR: 0.49, 95%CI: 0.29–0.83, p = 0.01) was associated with decreased of gestational diabetes, not moderate CVH (OR: 0.78, 95%CI: 0.50–1.20, p = 0.25). This inverse associations were dose-response dependent (p-nonlinear = 0.982). This inverse associations were significant in subgroup. Significant interaction between CVH and family diabetes with the risk of gestational diabetes was found (P for interaction = 0.04). High CVH (OR: 0.357, 95%CI: 0.176–0.724, p = 0.005) could significantly decrease the risk of gestational diabetes in the population with family diabetes. The results were generally robust in sensitivity analyses after excluding of ASCVD participants. Conclusion: The high CVH could decrease the risk of gestational diabetes, especially in the population of family diabetes. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to assess the relationship of increased body mass index (BMI) with pregnancy complications. Study Design: We obtained data for a retrospective cohort of singleton live births using an electronic birth certificate database from 2010 to 2022. Institutional review board exemption was obtained. BMI was assessed as a continuous variable and a categorical variable with groups of BMI 18.5-29.9 kg/m2, 40-49.9 kg/m2, and ≥50 kg/m2 compared to patients with BMI 30-39.9 kg/m2. Primary outcomes were pregnancy and maternal outcomes. Secondary outcomes were neonatal outcomes. ANOVA and χ2 were used to compare continuous and categorical variables respectively, and logistic regression was used to obtain adjusted odds ratios for primary and secondary outcomes. Results: There were 223,837 patients with singleton live births with mean BMI 27.86 kg/m2. 54,385 (24.3%) had BMI 30-39.9 kg/m2, 13,299 (5.9%) had BMI 40-49.9 kg/m2, and 1,958 (0.87%) had BMI ≥50 kg/m2. Patients with BMI > 50 kg/m2 have a higher likelihood of APGAR scores <7 (aOR 1.38, 95% CI 1.05-1.83), and NICU admission or transfer out of facility (aOR 1.17, 95% CI 1.02-1.34). In the nulliparous subgroup analysis, For patients with BMI >50 kg/m2, there was a higher odds of preterm birth <37 weeks (aOR 1.57, 95% CI 1.23-2.00) and preterm birth <34 weeks (aOR 1.51 95% CI 1.00-2.30. There is also an increased odds of cesarean section in both of these BMI groups (aOR 1.68 95% CI 1.57-1.79 and aOR 2.30 95% CI 1.94-2.72). Conclusion: BMI ≥ 50 kg/m2 was significantly associated with increased pregnancy complications. KEY POINTS: Patients with BMI > 50 kg/m2 have a higher likelihood of having pregestational diabetes, gestational diabetes, chronic hypertension, gestational hypertension, and preterm birth < 37 weeks. Increasing obesity in Central New York is leading to worsened pregnancy outcomes. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to determine the likelihood of hyperglycemia postpartum in women with gestational diabetes mellitus (GDM) and to identify the predictors. Methods: The retrospective cohort study involved 1 527 GDM patients who delivered at Peking University First Hospital from 1 January 2021, to 31 December 2021. According to the blood glucose level of postpartum oral glucose tolerance test (OGTT), women were divided into a normal glucose tolerance (NGT) group and a hyperglycemia group, and their characteristics and risk factors of hyperglycemia were compared. Results: The prevalence of hyperglycemia was 33.9% (184/543) at 6–12 weeks postpartum. Compared with the NGT group, the fasting plasma glucose (FPG) of hyperglycemia group increased significantly during pregnancy and postpartum, the OGTT 1h postprandial glucose (PG) and 2hPG increased in the second trimester of pregnancy, the triglyceride (TG) increased in the first trimester of pregnancy and postpartum, the triglyceride glucose (TyG) index increased in the first trimester of pregnancy and postpartum, and the total cholesterol (TCHO) and low density lipoprotein cholesterol (LDL-C) decreased in the second trimester (p < 0.05). Fasting plasma glucose (FPG) in the first trimester [odds ratio (OR) = 3.583, p < 0.001], OGTT 2hPG in the second trimester (OR = 1.604, p < 0.001), the TyG index in the first trimester (OR = 1.863, p = 0.045) and FPG in third trimester (OR = 1.985, p = 0.024) were independent risk factors for postpartum hyperglycemia. Conclusions: Approximately one-third of women with GDM have hyperglycemia 6–12 weeks after delivery. FPG and the TyG index in the first trimester, OGTT 2hPG in the second trimester and FPG in third trimester are risk factors for postpartum hyperglycemia. [ABSTRACT FROM AUTHOR]

Objective: To create an objective framework to classify gestational diabetes mellitus diagnosed by routine antenatal 75 g diabetes testing results to provide an alternative to current treatment-based classification. Methods: A framework was created to classify gestational diabetes according to the severity of glycemic abnormalities after routine antenatal 75 g GTT (classes 1 through 4, determined by fasting and post-test glycemic abnormalities). A retrospective cohort chart review was used to correlate clinically how often diet therapy alone maintained glycemic targets throughout pregnancy in each class. Chi-square analysis was used to assess inter-class differences in the success of diet therapy alone maintaining glycemic targets throughout pregnancy. Results: Seventy-four of 228 (33%), 35/228 (15%), 76/228 (33%), and 43/228 (19%) of the study population were classified as Class 1, 2, 3, or 4, respectively. Of eighty-nine patients who maintained glycemic targets throughout pregnancy with diet alone 51/89 (57%) were Class 1, 20/89 (22.5%) were Class 2, 11/89 (12.5%) were Class 3, and 7/89 (8%) were Class 4. Chi-square analysis showed statistically significant inter-class differences in the likelihood of diet therapy alone maintaining glycemic targets throughout pregnancy. Conclusion: In this framework classifying gestational diabetes according to the severity of glycemic abnormalities after routine antenatal 75 g GTT (an objective proxy for disease severity), the higher the assigned class, the less likely that diet therapy alone maintained glycemic targets throughout pregnancy (a clinical proxy for disease severity). [ABSTRACT FROM AUTHOR]

Objective: To evaluate the relative cost-effectiveness of starting antenatal fetal surveillance at 32 vs. 36 weeks, in medication-treated gestational diabetes. Methods: We performed a 2017–2022 retrospective cohort study of patients with medication-treated GDM who underwent BPPs. Patients diagnosed before 24 weeks, those delivered before 32 weeks, and those without BPPs or delivery data were excluded. Demographic and outcome data were abstracted by chart review. We performed a cost-effectiveness analysis regarding two outcomes: stillbirth, and decision to alter delivery timing following abnormal BPPs. Results: A total of 652 pregnancies were included. Patients were 49% privately insured, 25% publicly insured, and 26% uninsured. We assumed that each BPP cost $145. In total, 1,284 BPPs occurred after 36 weeks, costing $186,180, and 2,041 BPPs occurred between 32 and 36 weeks, costing an additional $295,945. Twelve deliveries resulted from abnormal BPPs, all after 36 weeks. No stillbirths occurred. The cost to attempt to avoid one stillbirth was $40,177 across all patients. In our sample, starting surveillance at 36 weeks would have theoretically avoided all stillbirths, with cost savings per avoided stillbirth of $51,572 for privately insured patients, $14,123 for publicly insured patients, and $17,799 for patients without insurance. Conclusion: Based on this population with no stillbirths and no BPPs dictating delivery before 36 weeks, surveillance after 36 weeks may be safe and cost-effective. Our findings reflect opportunities for shared decision making and potential practice change, with greatest impact for low socioeconomic status patients and those without insurance. [ABSTRACT FROM AUTHOR]

Objective: To evaluate neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), neutrophil-to-monocyte ratio (NMR), and other hemogram-derived inflammatory parameters measured in the early second trimester and their association with the risk of gestational diabetes mellitus (GDM). Methods: This case-control study was conducted with 105 women with GDM and 205 healthy pregnant women, matched for maternal age at a 1:2 ratio with the cases at two regional maternity hospitals between January 2021 and August 2022. The inflammatory blood cell indices were tested in the early second trimester, and the patient's characteristics and the course of the pregnancy were analyzed. Logistic regression was used to determine the association between hematological parameters and the risk of GDM. Data were analyzed using SPSS, version 25.0 (SPSS, Chicago, IL). Results: The final analysis included 310 pregnant women. The GDM group showed a higher pre-pregnancy BMI compared to the healthy controls (p <.01). There was no difference in NMR, PLR, and NLR between the groups (p =.63,.54, and.39, respectively). GDM was only positively associated with MLR (p =.02). After adjusting for potential confounding risk factors including maternal age, parity, and BMI, the multivariate regression analysis showed a higher level of MLR, with a cutoff point of 0.312, was independently associated with the risk of GDM (OR = 2.15, 95%CI 1.51–4.31, p =.03). However, ROC analysis showed that the AUC value of MLR was poor (0.670). Conclusions: We found that MLR, an inflammatory combined index derived from whole blood counts, may potentially serve as a predictor of GDM in the early second trimester. [ABSTRACT FROM AUTHOR]

Aims: To derive accurate estimates of risk of maternal and neonatal complications in women with gestational diabetes mellitus (GDM) and to investigate the association of the effect size of these risks on subgroups of GDM managed with dietary modification, metformin and insulin therapy. Methods: This was a large retrospective cohort study undertaken at a large maternity unit in the United Kingdom between January 2010 and June 2022. We included singleton pregnancies that booked at our unit at 11-13 weeks' gestation. The rates of maternal and neonatal complications in pregnancies with GDM that were managed by a multidisciplinary team (MDT) in the specialist high-risk clinic were compared to those in non-diabetic pregnancies. We stratified pregnancies with GDM into those that were managed with diet, metformin and insulin to pregnancies without diabetes. Logistic regression analysis was carried out to determine risks of pregnancy complications in pregnancies with GDM and its treatment subgroups. Risks were expressed as absolute risks (AR) and odds ratio (OR) (95% confidence intervals [CI]). Forest plots were used to graphically demonstrate risks. Results: The study population included 51,211 singleton pregnancies including 2089 (4.1%) with GDM and 49,122 (95.9%) controls without diabetes. In pregnancies with GDM, there were 1247 (59.7%) pregnancies managed with diet, 451 (21.6%) with metformin and 391 (18.7%) who required insulin for maintaining euglycaemia. Pregnancies with GDM had higher maternal age, body mass index (BMI), higher rates of Afro-Caribbean and South Asian racial origin and higher rates of chronic hypertension. In pregnancies with GDM compared to non-diabetic controls, there was an increased rate of preterm delivery, delivery of LGA neonate, polyhydramnios, preeclampsia, need for IOL, elective and emergency CS and PPH whereas the rate of delivery of SGA neonates and likelihood of an unassisted vaginal delivery were lower. In pregnancies with GDM, there is significantly increased risk of maternal and neonatal complications in those that require insulin compared to those that are managed on dietary modification alone. Conclusions: There is a linear association between the risk of adverse outcomes and the severity of GDM with those on insulin treatment demonstrating an increased association with complications compared to those that have milder disease requiring only dietary modification. [ABSTRACT FROM AUTHOR]

Background: The fetal stage is pivotal for growth and development, making it susceptible to the adverse effects of prenatal metal(loid)s exposure. This study evaluated the influence of gestational diabetes mellitus (GDM) on the placental transfer efficiency (PTE) of metal(loid)s and thus assessed the associated risks of prenatal metal(loid)s exposure. Materials and method: Designed as a case-control study, it incorporated 114 pregnant participants: 65 without complications and 49 diagnosed with GDM. We utilized inductively coupled plasma mass spectrometry to quantify seven metal(loid)s - manganese (Mn), cobalt (Co), nickel (Ni), copper (Cu), gallium (Ga), arsenic (As), and cadmium (Cd) - in both maternal venous blood and umbilical cord blood. Result: We compared metal(loid)s concentrations and their PTE in the maternal and cord blood between the two groups. Notably, Cu, Ga, As, and Co levels in the umbilical cord blood of the GDM group (657.9 ± 167.2 μg/L, 1.23 ± 0.34 μg/L, 5.19 ± 2.58 μg/L, 1.09 ± 2.03 μg/L) surpassed those of the control group, with PTE of Co showing a marked increase in GDM group (568.8 ± 150.4 μg/L, 1.05 ± 0.31 μg/L, 4.09 ± 2.54 μg/L, 0.47 ± 0.91 μg/L), with PTE of Co showing a marked increase in GDM group (p < 0.05). The PTE of Ni exhibited a reduction in the GDM group relative to the control group, yet this decrease did not reach statistical significance. Conclusion: This study indicates that GDM can influence the placental transfer efficiency of certain metal(loid)s, leading to higher concentrations of Co, Cu, Ga, and As in the umbilical cord blood of the GDM group. The marked increase in the PTE of Co suggests a potential link to placental abnormal angiogenesis due to GDM. [ABSTRACT FROM AUTHOR]

Objective: To investigate the associations of body mass index (BMI) change and large for gestational age (LGA) among prepregnancy normal-weight women with and without gestational diabetes mellitus (GDM). Methods: The retrospective study including 9515 normal-weight pregnant women (1331 women with GDM and 8184 without GDM) was conducted in Fujian Maternity and Child Health Hospital in 2020. The BMI change was calculated as gestational weight gain in kilograms by maternal height in meters. The binary logistic regression, stratified analyses, restricted cubic spline models and additive interaction analysis were adopted to reveal the relationship between BMI change and LGA. Results: Pregnant women with GDM had a lower level of BMI change but a higher incidence of LGA compared with those without GDM. After adjustment for covariates variables, we found that the risk of LGA was associated with the highest quartile of BMI change (OR = 1.89, 95%CI:1.27–2.8 for GDM and OR = 1.48,95%CI:1.27–1.75 for non-GDM). There were significant linear relationships of BMI change and LGA with the inflection point of 5.096 and 5.401 kg/m2 in GDM and non-GDM groups. Significant additive interaction was observed between parity and BMI change level concerning LGA. A significant difference in BMI change and gestational weight gain (GWG) for LGA prediction was detected. Conclusion: Higher BMI changes were significantly associated with a higher risk of LGA in pregnant women with or without GDM in a linear dose-response relationship, with the threshold around 5.096 and 5.401 kg/m2, respectively. These suggested that BMI changes may be a useful predictor for the incidence of LGA in singleton pregnant women. [ABSTRACT FROM AUTHOR]

Objective: The study aims to investigate the levels of serum NLRP3 along with its effector molecules (Caspase-1, IL-1β, and IL-18) in the mid-pregnancy in pregnant women with hyperglycemia, and explore the relationship between NLRP3, along with its effector molecules (Caspase-1, IL-1β, and IL-18) and insulin resistance, as well as pregnancy outcomes. Methods: The levels of serum NLRP3 along with its effector molecules (Caspase-1, IL-1β, and IL-18) in three groups of pregnant women with gestational diabetes mellitus (GDM), pregestational diabetes mellitus (PGDM) and normal glucose tolerance (NGT) were measured in mid-pregnancy, and their relationship with insulin resistance and pregnancy outcomes was analyzed. The ROC curve was also used to evaluate the predictive value of serum NLRP3 inflammasome and its effector molecules for pregnancy outcomes. Results: There were no statistical differences in the general clinical data of the three groups, and the concentrations of serum NLRP3 along with its effector molecules were higher in the GDM and PGDM groups than in the NGT group, and NLRP3 along with its effector molecules were positively correlated with fasting blood glucose, fasting insulin, and insulin resistance index in both groups (r > 0, p <.05). The incidence of preterm delivery, hypertensive disorders of pregnancy, premature rupture of membranes, neonatal hypoglycemia and macrosomia was significantly higher in both groups than in the NGT group (p <.05). The value of the combined serum NLRP3 and its effector molecules in mid-pregnancy to predict adverse pregnancy outcomes was highest, and the AUCs for the combined prediction of late hypertensive disorders of pregnancy, premature rupture of membranes, preterm delivery, neonatal hypoglycemia and macrosomia were 0.84 (95% CI 0.79–0.88, p <.001), 0.81 (95% CI 0.75–0.85, p <.001), 0.76 (95% CI 0.70–0.81, p <.001), 0.76 (95% CI 0.70–0.81, p <.001) and 0.72 (95% CI 0.63–0.81, p <.001), respectively. Conclusions: Increased serum NLRP3 along with its effector molecules in pregnant women with hyperglycemia are associated with the levels of insulin resistance and the subsequent development of adverse pregnancy outcomes. [ABSTRACT FROM AUTHOR]

Background and aim: Globally, the prevalence of gestational diabetes mellitus (GDM) is rising each year, yet its pathophysiology is still unclear. To shed new light on the pathogenesis of gestational diabetes mellitus and perhaps uncover new therapeutic targets, this study looked at the expression levels and correlations of SIRT1, SREBP1, and pyroptosis factors like NLRP3, Caspase-1, IL-1, and IL-18 in patients with GDM. Methods: This study involved a comparative analysis between two groups. The GDM group consisted of 50 GDM patients and the control group included 50 pregnant women with normal pregnancies. Detailed case data were collected for all participants. We utilized real-time quantitative PCR and Western Blot techniques to assess the expression levels of SIRT1 and SREBP1 in placental tissues from both groups. Additionally, we employed an enzyme-linked immunosorbent assay to measure the serum levels of SIRT1, SREBP1, and pyroptosis factors, namely NLRP3, Caspase-1, IL-1β, and IL-18, in the patients of both groups. Subsequently, we analyzed the correlations between these factors and clinical. Results: The results showed that there were significantly lower expression levels of SIRT1 in both GDM group placental tissue and serum compared to the control group (p < 0.01). In contrast, the expression of SREBP1 was significantly higher in the GDM group than in the control group (p < 0.05). Additionally, the serum levels of NLRP3, Caspase-1, IL-1β, and IL-18 were significantly elevated in the GDM group compared to the control group (p < 0.01). The expression of SIRT1 exhibited negative correlations with the expression of FPG, OGTT-1h, FINS, HOMA-IR, SREBP1, IL-1β, and IL-18. However, there was no significant correlation between SIRT1 expression and OGTT-2h, NLRP3, or Caspase-1. On the other hand, the expression of SREBP1 was positively correlated with the expression of IL-1β, Caspase-1, and IL-18, but has no apparent correlation with NLRP3. Conclusions: Low SIRT1 levels and high SREBP1 levels in placental tissue and serum, coupled with elevated levels of pyroptosis factors NLRP3, Caspase-1, IL-1β, and IL-18 in serum, may be linked to the development of gestational diabetes mellitus. Furthermore, these three factors appear to correlate with each other in the pathogenesis of GDM, offering potential directions for future research and therapeutic strategies. [ABSTRACT FROM AUTHOR]

Background: Maternal high blood pressure (BP) was associated with adverse pregnancy outcomes. This study aimed to synthesize evidence on the association between high BP prior to or in early pregnancy with maternal and fetal complications. Methods: We searched the cohort studies assessing the effect of high BP in the Medline, Embase, Web of Science and China National Knowledge Internet databases. A random-effects model was used to estimate the pooled odds ratios (ORs) with 95% confidence intervals (CIs). The protocol was registered in PROSPERRO (CRD 42023414945). Results: 23 eligible studies were identified. High BP prior to or in early pregnancy was associated with higher odds of hypertensive disorders of pregnancy (OR 2.90, 95% CI 1.91–3.89), gestational hypertension (2.56, 2.01–3.12), preeclampsia (3.20, 2.66–3.74), gestational diabetes mellitus (1.71, 1.36–2.06), preterm birth (1.66, 1.39–1.93), stillbirth (2.01, 1.45–2.58) and neonatal intensive care unit admission (1.22, 1.08–1.37). Subgroup analyses indicated that pre-hypertension could significantly increase the odds of these outcomes except for stillbirth, though the odds were lower than hypertension. Conclusions: High BP prior to or in early pregnancy was associated with adverse pregnancy outcomes and this association increased with hypertension severity. The findings emphasized an urgent need for heightened surveillance for maternal BP, especially pre-hypertensive status. [ABSTRACT FROM AUTHOR]

Introduction: The use of metformin for treating gestational diabetes mellitus (GDM) remains controversial because it can pass through the placenta. This meta-analysis aimed to compare the effects of metformin and insulin on maternal and neonatal outcomes in patients with GDM. Methods: We conducted a comprehensive search of the PubMed, Embase, and Cochrane Library databases, focusing on randomized controlled trials (RCTs) that evaluated the impacts of metformin and insulin on both maternal and neonatal outcomes in patients with GDM. Results: Twenty-four RCTs involving 4934 patients with GDM were included in this meta-analysis. Compared with insulin, metformin demonstrated a significant reduction in the risks of preeclampsia (RR 0.61, 95% CI 0.48 to 0.78, p <.0001), induction of labor (RR 0.90, 95% CI 0.82 to 0.98, p =.02), cesarean delivery (RR 0.91, 95% CI 0.85 to 0.98, p =.01), macrosomia (RR 0.67, 95% CI 0.53 to 0.83, p =.0004), neonatal intensive care unit (NICU) admission (RR 0.75, 95% CI 0.66 to 0.86, p <.0001), neonatal hypoglycemia (RR 0.55, 95% CI 0.48 to 0.63, p <.00001), and large for gestational age (LGA) (RR 0.80, 95% CI 0.68 to 0.94, p =.007). Conversely, metformin showed no significant impact on gestational hypertension (RR 0.84, 95% CI 0.67 to 1.06, p =.15), spontaneous vaginal delivery (RR 1.13, 95% CI 1.00 to 1.08, p =.05), emergency cesarean section (RR 0.94, 95% CI 0.77 to 1.16, p =.58), shoulder dystocia (RR 0.65, 95% CI 0.31 to 1.39, p =.27), premature birth (RR 0. 92, 95% CI 0.61 to 1.39, p =.69), polyhydramnios (RR 1.11, 95% CI 0.54 to 2.30, p =.77), birth trauma (RR 0.87, 95% CI 0.54 to 1.39, p =.56), 5-min Apgar score < 7 (RR 1.13, 95% CI 0.76 to 1.68, p =.55), small for gestational age (SGA) (RR 0.93, 95% CI 0.71 to 1.22, p =.62), respiratory distress syndrome (RDS) (RR 0.74, 95% CI 0.50 to 1.08, p =.11), jaundice (RR 1.09, 95% CI 0.95 to 1.25, p =.24) or birth defects (RR 0.80, 95% CI 0.37 to 1.74, p =.57). Conclusions: The findings suggest that metformin can reduce the risk of certain maternal and neonatal outcomes compared with insulin therapy for GDM. However, long-term follow-up studies of patients with GDM taking metformin and their offspring are warranted to provide further evidence. [ABSTRACT FROM AUTHOR]

Introduction: The efficacy of myo-inositol supplementation to treat gestational diabetes remains controversial, and this meta-analysis aims to study the efficacy of myo-inositol supplementation on metabolic status for gestational diabetes. Methods: Several databases including PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases were systemically searched from inception to October 2021, and we included the randomized controlled trials (RCTs) assessing the effect of myo-inositol supplementation on the outcomes of women with gestational diabetes. Gestational diabetes was diagnosed if at least one threshold of glucose concentration was exceeded and the three thresholds included 92, 180, and 153 mg/dl for 0, 1 and 2 h, respectively, after a 75-g, 2-h glucose tolerance test. Results: Four RCTs and 317 patients were included in this meta-analysis. Compared with routine treatment in pregnant women with gestational diabetes, myo-inositol supplementation could lead to remarkably decreased treatment requirement with insulin (odd ratio [OR] = 0.24; 95% confidence interval [CI] = 0.11–0.52; p =.0003) and homeostasis model assessment of insulin resistance (HOMA-IR, standard mean difference [SMD]= −1.18; 95% CI= −1.50 to −0.87; p <.00001), but demonstrated no obvious impact on birth weight (SMD= −0.11; 95% CI= −0.83 to 0.61 g; p =.76), cesarean section (OR = 0.82; 95% CI = 0.46–1.47; p =.51) or the need of NICU (OR = 0.88; 95% CI = 0.03–26.57; p =.94). Conclusions: Myo-inositol supplementation is effective to decrease the need of insulin treatment and HOMA-IR for gestational diabetes. [ABSTRACT FROM AUTHOR]

Maternally inherited diabetes and deafness (MIDD) is a mitochondrial disorder with diverse characteristics, which make early diagnosis difficult. We report a case of 32-year-old woman with diabetes who was admitted due to weight loss and poor glycemic control. She had a history of gestational diabetes at age 26. Pancreatic function was evaluated by oral glucose tolerance. An ophthalmologic examination detected conjunctivitis and refractive errors and hearing tests were normal. The patient had a family of diabetes. Then we tested the patient and her first-degree relatives with a confirmed genetic mutation at position 3243 in the tRNA. After two years of treatment with linagliptin, both glycated hemoglobin and pancreatic function have shown improvement to some extent. Although MIDD is a rare form of diabetes, due to distinctive management and associated comorbidities it is important to diagnose. [ABSTRACT FROM AUTHOR]

Background: Gestational diabetes mellitus is an endocrine and metabolic disorder that appears for the first time during pregnancy and causes varying degrees of short- and/or long-term effects on the mother and child. The etiology of the disease is currently unknown and isobaric tags for relative and absolute quantitation proteomics approach, the present study attempted to identify potential proteins in placental tissues that may be involved in the pathogenesis of GDM and adverse foetal pregnancy outcomes. Methods: Pregnant women with GDM hospitalised were selected as the experimental group, and pregnant women with normal glucose metabolism as the control group. The iTRAQ protein quantification technology was used to screen the differentially expressed proteins between the GDM group and the normal control group, and the differentially expressed proteins were analysed by GO, KEGG, PPI, etc., and the key proteins were subsequently verified by western blot. Results: Based on the proteomics of iTRAQ, we experimented with three different samples of placental tissues from GDM and normal pregnant women, and the total number of identified proteins were 5906, 5959, and 6017, respectively, which were similar in the three different samples, indicating that the results were reliable. Through the Wayne diagram, we found that the total number of proteins coexisting in the three groups was 4475, and 91 differential proteins that could meet the quantification criteria were strictly screened, of which 32 proteins were up-regulated and 59 proteins were down-regulated. By GO enrichment analysis, these differential proteins are widely distributed in extracellular membrane-bounded organelle, mainly in extracellular exosome, followed by intracellular vesicle, extracellular organelle. It not only undertakes protein binding, protein complex binding, macromolecular complex binding, but also involves molecular biological functions such as neutrophil degranulation, multicellular organismal process, developmental process, cellular component organization, secretion, regulated exocytosis. Through the analysis of the KEGG signaling pathway, it is found that these differential proteins are mainly involved in HIF-1 signaling pathway, Glycolysis/Gluconeogenesis, Central carbon metabolism in cancer, AMPK signaling pathway, Proteoglycans in cancer, Protein processing in endoplasmic reticulum, Thyroid cancer, Alcoholism, Glucagon signaling pathway. Discussion: This preliminary study helps us to understand the changes in the placental proteome of GDM patients, and provides new insights into the pathophysiology of GDM. [ABSTRACT FROM AUTHOR]

We aimed to determine the peripheral blood mononuclear cell (PBMC) immune profiles of mid- and late-stage pregnant women to establish a foundation for studying pregnancy-related diseases. Peripheral blood samples were collected from three women each during mid- and late-stage pregnancy, and PBMCs were extracted for single-cell RNA sequencing (scRNA-seq). Peripheral blood samples were also collected for flow cytometry analysis to validate the analytical results. HOPX+ CD4+ T cells, ZNF683+CD8+ T cells, and KLRB1+CD8+ T cells significantly differed in quantitative ratio and gene transcript level between women at mid- and late-stage pregnancy. In late pregnancy, cell-to-cell communication was enhanced and effector CD8+ T cells highly expressed infection-related pathways. A rare T cell subtype, "XIST+ T cells," exhibited high XIST expression, a gene that may be involved in the regulation of immune-related gene transcription and translation, and insulin signaling pathway, during pregnancy. Monocytes exhibited significant proinflammatory and metabolic properties in mid- and late-stage pregnancy, respectively. Natural killer (NK) cells were mainly involved in T- and B-cell-mediated signaling pathways, and in T cell differentiation, in mid-pregnancy. Enhanced innate immunity of NK cells was observed. Moreover, NK cells expressed genes associated with diabetes-related pathways in late-stage pregnancy. To conclude, we present detailed changes in the immune response occurring in pregnant women from mid- to late-stage gestation, revealing significant differences in PBMC subtypes and molecular properties. These findings provide insights into the physiopathological mechanisms of chronic hepatitis B infection, systemic lupus erythematosus, and gestational diabetes mellitus underlying systemic immune responses during mid- and late-stage pregnancy. NEW & NOTEWORTHY: There are significant differences in three subtypes of memory/effector T cells (HOPX+ CD4+ T cells, ZNF683+CD8+ T cells, and KLRB1+CD8+ T cells) between mid- and late pregnancy. In late pregnancy, intercellular interaction was enhanced and effector CD8+ T cells highly expressed infection-related pathways. A rare T cell subtype, "XIST+ T cells," may be involved in the regulation of immune-related gene transcription and translation with a strong female bias. [ABSTRACT FROM AUTHOR]

Summary: Introduction: Robust randomized trials consistently demonstrate little impact from diet and physical activity interventions on gestational weight gain (GWG) and clinical outcomes, although meta‐analyses report some benefit. Our aim was to evaluate the effect of trial quality on treatment effect estimates and review conclusions. Methods: We conducted a systematic review of dietary and/or physical activity interventions for pregnant women with a body mass index ≥18.5 kg/m2. We assessed studies for risk of bias and methodological features impacting reliability. Outcomes included GWG; gestational diabetes mellitus (GDM); pre‐eclampsia; caesarean birth; and birth weight measures. For each outcome, a sequence of meta‐analyses was performed based on intervention group and level of potential bias in the effect estimate. Results: We identified 128 eligible studies. The most robust estimate from a combined diet and physical activity behavioral intervention, with only studies at negligible risk of bias, was a difference in GWG of 1.10 kg (95% CI −1.62 to −0.58; 17,755 women). There was no evidence of an effect on any clinical outcomes. Conclusions: Our findings highlight discrepancies produced by the indiscriminate inclusion of studies with methodological flaws in previous systematic reviews. Regular weighing of pregnant women is futile in the absence of clinical benefit. [ABSTRACT FROM AUTHOR]

Objective: This study investigates the association between a new insulin resistance indicator, the triglyceride‐glucose (TyG) index, and the risk of macrosomia. Design: This is a prospective cohort study. Methods: This study included 1332 women who delivered at Peking University International Hospital between October 2017 and August 2019. Participants were divided equally into three groups based on the TyG index. Logistic regression and restricted cubic spline (RCS) analyses were used to evaluate the relationship between the TyG index and macrosomia and conducted subgroup analyses. The TyG index's ability to predict macrosomia was assessed using the receiver operating characteristic (ROC) curve. Results: Multivariable logistic regression analysis revealed that the TyG index is an independent risk factor for macrosomia (Odds ratio [OR] 1.84, 95% confidence interval [CI] 1.02–3.30, p <.05). RCS analysis indicates that the risk of macrosomia increases with the rise of the TyG index (p for nonlinearity <.001) when the TyG index is >6.53. Subgroup analysis showed a synergistic additive interaction between the TyG index and gestational diabetes mellitus (GDM) of macrosomia. The area under the ROC curve for the predictive model was 0.733 (95% CI 0.684, 0.781), with a sensitivity of 76.4% and specificity of 66.9%. Incorporating the TyG index alongside traditional risk factors notably enhances macrosomia prediction (p <.05). Conclusions: The TyG index independently predicts macrosomia, and exhibits an additive interaction with GDM in its occurrence. Integrating the TyG index with traditional risk factors improves the prediction of macrosomia. Trial Registry: Clinical trials. gov [NCT02966405]. [ABSTRACT FROM AUTHOR]

Introduction: Gestational Diabetes Mellitus (GDM), a common medical complication of pregnancy, is an independent risk factor for obstetric complications and adverse perinatal outcomes. Insulin has been the treatment modality for many years. Recent studies indicate that metformin, an oral hypoglycaemic agent, may be a safe and effective alternative. Aim: To evaluate and compare the effectiveness of metformin and insulin in managing glycaemic control, and assessing maternal and newborn outcomes among women diagnosed with GDM. Materials and Methods: The present prospective cohort study was conducted in the Department of Obstetrics, Fernandez Hospital, Hyderabad, Telangana, India, from December 2020 to November 2021. The study population included women attending antenatal check-ups after meeting the inclusion and exclusion criteria. Those who failed to respond to lifestyle modifications were started on either metformin or insulin as per the attending physician's advice. A total of 369 pregnant women were included in the study. Parameters such as weight gain during pregnancy, need for additional pharmacologic treatment, maternal hypoglycaemia, onset of Hypertensive Disorders of Pregnancy (HDP), gestational age at delivery, mode of delivery and neonatal details such as birth weight, occurrence of Large for Gestational Age (LGA), Appearance, Pulse, Grimace, Activity and Respiration (APGAR) score, birth injuries, neonatal hypoglycaemia, hyperbilirubinemia, respiratory distress, and neonates requiring Neonatal Intensive Care Unit (NICU) admissions were recorded. Data were subjected to statistical analysis. Analysis was performed using Statistical Package for the Social Sciences (SPSS) software version 22.0. A p-value of <0.05 was considered statistically significant. Results: Among the study population, 338 (91.6%) patients were on metformin, while 31 (8.40%) patients were on insulin. The metformin group exhibited good glycaemic control, whereas those on insulin had inadequate glycaemic control (p-value<0.001), a higher incidence of LGA babies (p-value=0.038) and more infants requiring phototherapy (p-value=0.022). Conclusion: The metformin group demonstrated effective control regarding both Fasting Blood Sugar (FBS) levels and postprandial blood glucose levels. Conversely, the group receiving insulin treatment exhibited a higher prevalence of neonates born LGA, a greater need for phototherapy, and inadequate maternal glycaemic control. [ABSTRACT FROM AUTHOR]

Introduction: Gestational diabetes mellitus (GDM) occurs on the background of increased insulin resistance. We aimed to investigate the levels of plasma pancreastatin (PST) levels and its association with metabolic, demographic, and anthropometric parameters in gestational diabetic and normal glucose-tolerant pregnant women. Materials and methods: A total of 165 pregnant women in the 24th–28th week of pregnancy were enrolled in this cross-sectional study. PST levels were measured using ELISA method. Results: Median PST levels were similar between GDM (n = 62, 37.6%) and normal glucose-tolerant control group (n = 103, 62.4%). In the GDM group, PST level showed a significant positive correlation with fasting insulin and the homeostasis model assessment of insulin resistance (HOMA-IR). In binary logistic regression analysis, PST levels did not predict the presence of GDM significantly. Conclusion: Positive correlation of PST with fasting insulin and HOMA-IR suggests that PST could be associated with insulin resistance. Further studies are needed as regards to the role of PST in GDM pathogenesis. [ABSTRACT FROM AUTHOR]