Performance of early pregnancy HbA1c for predicting gestational diabetes mellitus and adverse pregnancy outcomes in obese European women

Aims: To investigate the performance of early pregnancy HbA1c for predicting gestational diabetes mellitus (GDM) and adverse pregnancy outcomes in obese women. Methods: Post hoc analysis using data from the Vitamin D And Lifestyle Intervention for GDM prevention trials conducted across 9 European countries (2012–2014). Pregnant women (BMI ≥ 29 kg/m2) underwent a baseline HbA1c and oral glucose tolerance tests at \u3c 20 weeks, 24–28 weeks, and 35–37 weeks. Women with GDM were referred for treatment. Results: Among the 869 women tested, the prevalence of GDM was 25.9% before 20 weeks, with a further 8.6% at 24–28 weeks. The areas under the curves for HbA1c at the two time points were 0.55 (0.50–0.59) and 0.54 (0.47–0.61), respectively. An early HbA1c ≥ 5.7% (39 mmol/mol) (N = 111) showed low sensitivity (18.2%) with 89.1% specificity for GDM before 20 weeks, at 24–28 weeks (sensitivity of 8.0% and specificity of 88.6% after excluding early GDM), and throughout gestation (sensitivity of 15.9% and specificity of 89.4%). The ≥ 5.7% (39 mmol/mol) threshold was significantly associated with concurrent GDM before 20 weeks (adjusted OR (aOR) 2.77(1.39–5.51)) and throughout gestation (aOR 1.72 (1.02–2.89)), but not adverse pregnancy outcomes. Conclusions: Early pregnancy HbA1c is of limited use for predicting either GDM or adverse outcomes in overweight/obese European women

Beliefs, barriers and preferences of European overweight women to adopt a healthier lifestyle in pregnancy to minimize risk of developing gestational diabetes mellitus: an explorative study

Introduction: Overweight and obese women are at high risk of developing gestational diabetes mellitus (GDM). Lifestyle programs might help curb the GDM risk. We explored beliefs, perceived barriers and preferences regarding lifestyle changes among overweight European pregnant women to help inform the development of future high quality lifestyle interventions. Methods: An explorative mixed methods, two-staged study was conducted to gather information from pregnant European women (BMI≥25kg/m2). In three European countries (Belgium, Netherlands, United Kingdom) interviews were conducted, followed by questionnaires in six other European countries (Austria, Denmark, Ireland, Italy, Poland, Spain). Content analysis, descriptive and chi square statistics were applied (p<0.05). Results: Women preferred to obtain detailed information about their personal risk. The health of their baby was major motivating factor. Perceived barriers for physical activity included pregnancy-specific issues such as tiredness and experiencing physical complaints. Insufficient time was a barrier more frequently reported by women with children. Abstaining from snacking was identified as a challenge for the majority of women, especially for those without children. Women preferred to obtain support from their partner, as well as health professionals and valued flexible lifestyle programs. Conclusions: Healthcare professionals need to inform overweight pregnant women about their personal risk, discuss lifestyle modification and assist in weight management. Lifestyle programs should be tailored to the individual, taking into account barriers experienced by overweight first-time mothers and multipara women

Epidemiology of gestational diabetes mellitus according to IADPSG/WHO 2013 criteria among obese pregnant women in Europe

Aims/hypothesis: Accurate prevalence estimates for gestational diabetes mellitus (GDM) among pregnant women in Europe are lacking owing to the use of a multitude of diagnostic criteria and screening strategies in both high-risk women and the general pregnant population. Our aims were to report important risk factors for GDM development and calculate the prevalence of GDM in a cohort of women with BMI ≥29 kg/m2 across 11 centres in Europe using the International Association of the Diabetes and Pregnancy Study Groups (IADPSG)/WHO 2013 diagnostic criteria. Methods: Pregnant women (n = 1023, 86.3% European ethnicity) with a BMI ≥29.0 kg/m2 enrolled into the Vitamin D and Lifestyle Intervention for GDM Prevention (DALI) pilot, lifestyle and vitamin D studies of this pan-European multicentre trial, attended for an OGTT during pregnancy. Demographic, anthropometric and metabolic data were collected at enrolment and throughout pregnancy. GDM was diagnosed using IADPSG/WHO 2013 criteria. GDM treatment followed local policies. Results: The number of women recruited per country ranged from 80 to 217, and the dropout rate was 7.1%. Overall, 39% of women developed GDM during pregnancy, with no significant differences in prevalence across countries. The prevalence of GDM was high (24%; 242/1023) in early pregnancy. Despite interventions used in the DALI study, a further 14% (94/672) had developed GDM when tested at mid gestation (24–28 weeks) and 13% (59/476) of the remaining cohort at late gestation (35–37 weeks). Demographics and lifestyle factors were similar at baseline between women with GDM and those who maintained normal glucose tolerance. Previous GDM (16.5% vs 7.9%, p = 0.002), congenital malformations (6.4% vs 3.3%, p = 0.045) and a baby with macrosomia (31.4% vs 17.9%, p = 0.001) were reported more frequently in those who developed GDM. Significant anthropometric and metabolic differences were already present in early pregnancy between women who developed GDM and those who did not. Conclusions/interpretation: The prevalence of GDM diagnosed by the IADPSG/WHO 2013 GDM criteria in European pregnant women with a BMI ≥29.0 kg/m2 is substantial, and poses a significant health burden to these pregnancies and to the future health of the mother and her offspring. Uniform criteria for GDM diagnosis, supported by robust evidence for the benefits of treatment, are urgently needed to guide modern GDM screening and treatment strategies

Corrigendum to “Performance of early pregnancy HbA1c for predicting gestational diabetes mellitus and adverse pregnancy outcomes in obese European women” [Diab. Res. Clin. Pract. 168 (2020) 108378](S0168822720306318)(10.1016/j.diabres.2020.108378)

The authors regret that a few lines in Tables 1 and 2 were formatted incorrectly in the published version of the article with numbers all appearing in one line instead of being in separate lines. The correctly formatted tables are shown below. The authors would like to apologise for any inconvenience caused

The Predictive Value of miR-16, -29a and -134 for Early Identification of Gestational Diabetes:A Nested Analysis of the DALI Cohort

Early identification of gestational diabetes mellitus (GDM) aims to reduce the risk of adverse maternal and perinatal outcomes. Currently, no circulating biomarker has proven clinically useful for accurate prediction of GDM. In this study, we tested if a panel of small non-coding circulating RNAs could improve early prediction of GDM. We performed a nested case-control study of participants from the European multicenter 'Vitamin D and lifestyle intervention for GDM prevention (DALI)' trial using serum samples from obese pregnant women (BMI 65 29 kg/m2) entailing 82 GDM cases (early- and late- GDM), and 41 age- and BMI-matched women with normal glucose tolerance (NGT) throughout pregnancy (controls). Anthropometric, clinical and biochemical characteristics were obtained at baseline (<20 weeks of gestation) and throughout gestation. Baseline serum microRNAs (miRNAs) were measured using quantitative real time PCR (qPCR). Elevated miR-16-5p, -29a-3p, and -134-5p levels were observed in women, who were NGT at baseline and later developed GDM, compared with controls who remained NGT. A combination of the three miRNAs could distinguish later GDM from NGT cases (AUC 0.717, p = 0.001, compared with fasting plasma glucose (AUC 0.687, p = 0.004)) as evaluated by area under the curves (AUCs) using Receiver Operator Characteristics (ROC) analysis. Elevated levels of individual miRNAs or a combination hereof were associated with higher odds ratios of GDM. Conclusively, circulating miRNAs early in pregnancy could serve as valuable predictive biomarkers of GDM

Traumapotilaan golden hour Kainuun ensihoidossa : Tutkimus traumapotilaan golden hour:n toteutumisesta sekä siihen vaikuttavista tekijöistä Kainuun ensihoidossa

Tutkimuksen tarkoituksena oli kuvailla Kainuun ensihoidon laatua traumapotilaiden hoidossa. Opinnäytetyömme on tehty yhteistyössä Kainuun sosiaali- ja terveydenhuollon kuntayhtymän ensihoidon kanssa. Tutkimuksen tavoitteena oli hyödyntää tutkimusta Kainuun ensihoidossa traumapotilaiden hoidon kehittämisessä. Tutkimuksemme on toteutettu kvantitatiivisena ja retrospektiivisena tutkimuksena. Aineiston keräämiseen käytimme valmista tiedonkeruupohjaa, johon keräsimme 391 ensihoitotehtävän tiedot. Analysoimme tutkimuksen tulokset Excel- ja SPSS-ohjelmilla. Tutkimuksen perusteella 50 % (N= 196) traumapotilaista pääsi kultaisen tunnin aikana lopulliseen hoitopaikkaan. Keskimäärin ensihoitajilla kului kohteessa 21 minuuttia, joka on yli suositellun 10 minuutin. Tutkimuksen mukaan 15 %:lla (N= 58) ensihoitotehtävistä kuljetus päästiin aloittamaan 10 minuutin sisällä. Tutkimuksessa kävi ilmi, että mitä enemmän kohteessa tehtiin hoitotoimenpiteitä, sitä pidempi kohteessa oloaika oli. Tutkimuksessa kävi ilmi, että ensihoitotehtävien kokonaisajasta suurin osa kului matkalla potilaan luokse ja potilaan kuljettamiseen hoitolaitokseen. Tämä selittyy Kainuun alueen pitkillä välimatkoilla. Ensihoitotehtävien kokonaisaika kasvoi huomattavasti, mikäli potilas jatkokuljetettiin Kainuun keskussairaalasta yliopistolliseen sairaalaan Ouluun. Ensihoitotehtävillä, joissa potilas jatkokuljetettiin, aikaa kului merkittävästi keskussairaalassa potilaan tilan stabilointiin ennen jat-kokuljetuksen aloittamista. Tutkimme myös vaikuttaako ensihoitotehtävien kokonaisaikaan eri viranomaisjohtajuudet. Tutkimuksen perusteella voidaan todeta, että poliisijohtoisilla ensihoitotehtävillä kohteessa oloaika oli keskimäärin kaikista lyhyin. Opinnäytetyötämme voidaan hyödyntää ensihoidon laadun kehittämiseksi Kainuun ensihoidossa sekä henkilöstön ammattitaidon ylläpitämiseksi. Tutkimustuloksia voidaan käyttää simulaatiokoulutuksen suunnittelun tukena, jolloin tunnistetaan mahdolliset kehittämishaasteet ensihoitajien toiminnassa. Traumapotilaiden lopullinen hoito tapahtuu aina sairaalassa, jossa on mahdollista saada mm. leikkaushoitoa. Jotta traumapotilas saa parasta mahdollista hoitoa, tulee ensihoidossa pyrkiä mahdollisimman nopeaan kuljetukseen, jolla pyritään turvaamaan traumapotilaan nopea sairaalahoitoon pääsy.Purpose of this study was to describe the quality of emergency care in Kainuu in trauma patients care. Our thesis is made in co-operation with emergency care centre of Kainuu. Objective of the study was to exploit research in developing of care for trauma patients in emergency care of Kainuu. Our study is implemented as a quantitative and retrospective research. For collecting the material, we used ready data collection sheet which we gathered the information of 391 alarms. We analyzed the result of the research by using Excel- and SPSS-programs. Based on the study 50% (N= 196) of trauma patients were transported in the final sequel care facility during the golden hour. Paramedics spent approximately 21 minutes on scene which is over than the recommended 10 minutes. According to the study in 15% (N= 58) of the alarms transportation was achieved to start within 10 minutes. The study showed that the on-scene time was the longer the more procedures were accomplished in the destination. The study also showed that most of the time on the alarms were spent by travelling to the patient and transporting the patient to care facility. This is explained by the long distances of the area of Kainuu. The total time of alarms was highly increased if the patient was sequel transported from central Hospital of Kainuu to University Hospital in Oulu. In alarms which the patient was sequel transported, significant amount of time was spent in central Hospital stabilizing the patient before continuing the transport. We also investigated if authority leaderships affect to the total time spent on alarms. The study lightened out that in those alarms which was lead by police, the on-scene time was averagely shortest. Our thesis can be utilized in developing the quality of emergency care in Kainuu and maintaining the professionality of personnel. Results of the study can be used as a support of simulation education which allows to identify the possible developing challenges in the action of paramedics. The final care of trauma patients always occurs at hospital where multiple procedures are availa-ble. To guarantee that the patient receives best care, must emergency care always strive to quick transportation which secures that patients gets quickly the care they need

Less sedentary time is associated with a more favourable glucose-insulin axis in obese pregnant women : a secondary analysis of the DALI study

Background/objectives Obese pregnant women are at high risk of developing gestational diabetes mellitus (GDM), which might be reduced by sufficient physical activity (PA) and reduced sedentary time (ST). We assessed whether PA and ST are longitudinally associated with the glucose-insulin axis in obese pregnant women. Subjects/methods In this secondary analysis of the DALI (vitamin D And Lifestyle Intervention for gestational diabetes mellitus prevention) study, pregnant women, <20 weeks gestation, with a pre-pregnancy body mass index (BMI) ≥ 29 kg/m2, without GDM on entry were included. Time spent in moderate-to-vigorous PA (MVPA) and ST were measured objectively with accelerometers at <20 weeks, 24–28 weeks and 35–37 weeks of gestation. Fasting glucose (mmol/l) and insulin (mU/l), insulin resistance (HOMA-IR) and first-phase and second-phase insulin release (Stumvoll first and second phase) were assessed at the same time. Linear mixed regression models were used to calculate between-participant differences and within-participant changes over time. Analyses were adjusted for gestational age, randomisation, pre-pregnancy BMI, education and age. MVPA, Insulin, HOMA-IR and Stumvoll first and second phase were log-transformed for analyses due to skewness. Results 232 women were included in the analysis. Concerning differences between participants, more ST was associated with higher fasting glucose (Estimate: 0.008; 95% CI: 0.002, 0.014), fasting insulin (0.011; 0.002, 0.019), HOMA-IR (0.012; 0.004, 0.021) and Stumvoll first and second phase (0.008; 0.001, 0.014 and 0.007; 0.001, 0.014). Participants with more MVPA had lower Stumvoll first and second phase (−0.137; −0.210, −0.064 and −0.133; −0.202, −0.063). Concerning changes over time, an increase in ST during gestation was associated with elevated Stumvoll first and second phase (0.006; 0.000, 0.011). Conclusions As the glucose-insulin axis is more strongly associated with ST than MVPA in our obese population, pregnant women could be advised to reduce ST in addition to increasing MVPA. Moreover, our findings suggest that behaviour change interventions aiming at GDM risk reduction should start in early or pre-pregnancy

The unexplored role of sedentary time and physical activity in glucose and lipid metabolism-related placental mRNAs in pregnant women who are obese : the DALI lifestyle randomised controlled trial

Objective: We aimed to explore: (i) the association of sedentary time (ST) and physical activity (PA) during pregnancy with the placental expression of genes related to glucose and lipid metabolism in pregnant women who are obese; (ii) maternal metabolic factors mediating changes in these placental transcripts; and (iii) cord blood markers related to the mRNAs mediating neonatal adiposity. Design: Multicentre randomised controlled trial. Setting: Hospitals in nine European countries. Population: A cohort of 112 pregnant women with placental tissue. Methods: Both ST and moderate-to-vigorous PA (MVPA) levels were measured objectively using accelerometry at three time periods during pregnancy. Main outcome measures: Placental mRNAs (FATP2, FATP3, FABP4, GLUT1 and PPAR-γ) were measured with NanoString technology. Maternal and fetal metabolic markers and neonatal adiposity were assessed. Results: Longer periods of ST, especially in early to middle pregnancy, was associated with lower placental FATP2 and FATP3 expression (P 0.05). Additionally, placental FATP2 expression was inversely associated with cord blood triglycerides and free fatty acids (FFAs; P < 0.01). No cord blood marker mediated neonatal adiposity except for cord blood leptin, which mediated the effects of PPAR-γ on neonatal sum of skinfolds (P < 0.05). Conclusions: In early to middle pregnancy, ST is associated with the expression of placental genes linked to lipid transport. PA is hardly related to transporter mRNAs. Strategies aimed at reducing sedentary behaviour during pregnancy could modulate placental gene expression, which may help to prevent unfavourable fetal and maternal pregnancy outcomes. Tweetable abstract: Reducing sedentary behaviour in pregnancy might modulate placental expression of genes related to lipid metabolism in women who are obese

Vitamin D3 Supplementation in Overweight/Obese Pregnant Women:No Effects on the Maternal or Fetal Lipid Profile and Body Fat Distribution—A Secondary Analysis of the Multicentric, Randomized, Controlled Vitamin D and Lifestyle for Gestational Diabetes Prevention Trial (DALI)

Vitamin D deficiency is a common finding in overweight/obese pregnant women and is associated with increased risk for adverse pregnancy outcome. Both maternal vitamin D deficiency and maternal obesity contribute to metabolic derangements in pregnancy. We aimed to assess the effects of vitamin D3 supplementation in pregnancy versus placebo on maternal and fetal lipids. Main inclusion criteria were: women &lt;20 weeks’ gestation, BMI ≥ 29 kg/m2. Eligible women (n = 154) were randomized to receive vitamin D3 (1600 IU/day) or placebo. Assessments were performed &lt;20, 24–28 and 35–37 weeks and at birth. Linear regression models were used to assess effects of vitamin D on maternal and cord blood lipids. In the vitamin D group significantly higher total 25-OHD and 25-OHD3 levels were found in maternal and cord blood compared with placebo. Adjusted regression models did not reveal any differences in triglycerides, LDL-C, HDL-C, free fatty acids, ketone bodies or leptin between groups. Neonatal sum of skinfolds was comparable between the two groups, but correlated positively with cord blood 25-OH-D3 (r = 0.34, p = 0.012). Vitamin D supplementation in pregnancy increases maternal and cord blood vitamin D significantly resulting in high rates of vitamin D sufficiency. Maternal and cord blood lipid parameters were unaffected by Vitamin D3 supplementation.</p

Correction to: The Effects of Lifestyle and/or Vitamin D Supplementation Interventions on Pregnancy Outcomes: What Have we Learned from the DALI Studies? (Current Diabetes Reports, (2019), 19, 12, (162), 10.1007/s11892-019-1282-7)

The original version of this review article unfortunately contained a mistake