The effect of gestational diabetes mellitus on maternal and child health

Introduction: Gestational diabetes mellitus (GDM) affects 1 in 7 pregnancies globally. Development of GDM can be influenced by antenatal factors, such as maternal BMI, metabolic syndrome and poor mental health. Furthermore, previous research suggests that GDM increases the risk of diabetes and coronary heart disease to the mother and child and is associated with impaired neurodevelopment in the child. Therefore, greater understanding of the lifestyle factors which influence GDM development, the trajectory of cardiovascular risk factor appearance in women and children and assessing neurodevelopment in the child will aid intervention strategies that can significantly reduce the risk of chronic disease later in life. Methods: This thesis includes a comprehensive series of systematic reviews and meta-analyses to identify the cardiovascular risk factors seen in women with a history of GDM and their offspring exposed to GDM in utero. To complement the review series, an observational followup study of the Screening Tests to Predict Poor Outcomes of Pregnancy (STOP) cohort was undertaken with women and children being recruited at 3 years postpartum. The original STOP study recruited 1,363 nulliparous women from 2015 to 2018 primarily from the Lyell McEwin Hospital in South Australia. This hospital services patients from the Northern Adelaide region which statistically has some of the worst chronic health outcomes in metropolitan Australia due to significant socioeconomic disadvantage in the community. The follow-up study consisted of hemodynamic and metabolic assessments that were undertaken to determine the prevalence of cardiometabolic risk factors three years postpartum in women with a history of GDM 3 years later, and to determine whether the children also exhibited any cardiovascular risk factors or measures of poor neurodevelopment at 3 years of age. Results: The systematic review and meta-analysis series identified that women who have a history of GDM have an increase in blood pressure, BMI lipids, serum glucose, and serum insulin and are at a higher risk of metabolic syndrome than those without a history of GDM. Children exposed to GDM in utero exhibited higher blood pressure, BMI z-score, blood glucose and risk of metabolic syndrome than those who were not exposed to GDM in utero. Women with a history of GDM who breastfed had reduced serum glucose and reduced risk of type II diabetes mellitus than those who did not. In the original STOP study, there was no difference in history of depression in women who developed GDM compared to those who did not. The latter comprised women with uncomplicated pregnancies, and one or more of the following complications: gestational hypertension, preeclampsia, and delivery of a preterm infant and/or a small for gestational age infant. A total of 281 women-children dyads attended a 3 year follow-up appointment. There were no significant differences in cardiometabolic variables between women with a history of GDM and those without a history of GDM at 3 years postpartum, nor in their offspring exposed to GDM in utero compared to unexposed offspring, when adjusted for BMI and socioeconomic index (SEI). Breastfeeding for at least 6 months postpartum provided some protection against cardiovascular risk factors in all women in the cohort at 3 years postpartum but this was attenuated by maternal BMI in first trimester and socioeconomic index. Anthropometric and hemodynamic outcomes were not different between children who were breastfed for at least 6 months compared to those who were not. Within the group of women with at least one pregnancy complication in their index pregnancy and their in utero exposed children, breastfeeding or being breastfed until at least 6 months old, was some protection against cardiovascular risk factors. Children who were exposed to GDM in utero had significantly reduced communication, gross motor and problem-solving skills than those who were not exposed to GDM in utero, even after adjustment for maternal history of depression during pregnancy. Three year old females who were exposed to GDM in utero appeared to be less able at problem solving than exposed males. Conclusion: Based on the systematic review and meta-analyses conducted, women with a history of GDM are likely to exhibit an increase in conventional cardiovascular risk factors later in life. However, in our smaller cohort, this was not completely evident in women with a history of GDM at 3 years postpartum. Much of this association is largely mediated by covariates including SEI in this socioeconomically disadvantaged community. Breastfeeding may confer some protection to women with GDM but further studies are warranted to assess this association. Exposure to GDM in utero promotes an increase in some cardiovascular risk factors in the literature but this was not evident in our cohort. However, children who were exposed to GDM in utero appear to have impaired neurodevelopment. Interventions in preconception and in early pregnancy that target obesity may significantly reduce the risk of GDM and associated cardiovascular risk factors in the early years after delivery for both women and their children.Thesis (Ph.D.) -- University of Adelaide, Adelaide Medical School, 202

The association of breast feeding for at least six months with hemodynamic and metabolic health of women and their children aged three years: an observational cohort study

Abstract Background Breastfeeding is important for both mother and child in reducing risk of future cardiovascular disease. Therefore, it may be an effective method to improve cardio-metabolic health, particularly those who are exposed to pregnancy complications which increase later CVD risk for both mother and child. The aim of this study is to assess differences in cardiometabolic health at three years postpartum in mothers who breastfed for at least six months and their children compared to those who did not. Methods Women and children from the Screening Tests to Predict Poor Outcomes of Pregnancy (STOP) study (2015–2017) were invited to attend a health check-up at three years postpartum. Women’s breastfeeding status at least six months postpartum was ascertained through their child health record. Anthropometric and hemodynamic measurements were taken from women and their children. A fasting blood sample was taken from women to measure blood glucose and lipids. Results A total of 160 woman-child dyads were assessed in this study. Women who breastfed for at least six months had significantly lower maternal BMI, systolic blood pressure, diastolic blood pressure, mean arterial pressure, central systolic blood pressure, and central diastolic blood pressure than those who did not and this did not change after adjusting for BMI and socioeconomic index in early pregnancy, prenatal smoking and maternal age in early pregnancy. Subgroup analysis on women who had one or more pregnancy complications during the index pregnancy (i.e. preeclampsia, gestational hypertension, delivery of a small for gestational age infant, delivery of a preterm infant, and/or gestational diabetes mellitus) demonstrated that women who breastfed for at least six months had significantly lower maternal systolic and diastolic blood pressures, serum insulin and triglycerides, and higher HDL cholesterol. There were no differences in child anthropometric or hemodynamic variables at three years of age between those children who had been breastfed for at least six months and those who had not. Conclusion Breastfeeding for at least six months may reduce some maternal; cardiovascular risk factors in women at three years postpartum, in particular, in those who have experienced a complication of pregnancy. Trial registration ACTRN12614000985684 (12/09/2014)

Early pregnancy cardio metabolic risk factors and the prevalence of metabolic syndrome 10 years after the first pregnancy.

BackgroundWe aimed to compare risk factors for CVD 10 years postpartum among women who had ≥ 1 compared to no cardio metabolic risk factor in early first pregnancy.MethodsWomen of the SCOPE (Screening fOr Pregnancy Endpoints) study from Adelaide, South Australia were invited to participate in a cardiovascular risk assessment 10 years after the delivery of the first child. Data from 141 women who completed all the assessments are included in the analyses.ResultCompared to women who did not have any cardio metabolic risk factor at 15 ± 1 weeks' gestation during the first pregnancy, those who had ≥ 1 risk factor were 5.5 times more likely to have metabolic syndrome 10 years postpartum (aOR = 5.5, 95% CI 1.8-17.3, p = 0.004). Women who had ≥ 1cardio metabolic risk factor during the first pregnancy were more likely to be obese (p = 0.001), have high total cholesterol levels (p ConclusionCardio metabolic risk factors at the booking visit in the first pregnancy may be useful in identifying young women at risk of future CVD

Additional file 1 of A prospective registry analysis of psychosocial and metabolic health between women with and without metabolic syndrome after a complicated pregnancy

Additional file 1: Supplementary Table 1. Multiple linear regression model estimating difference in PHQ-9 scores between metabolic syndrome status. Supplementary Table 2. Multiple linear regression model estimating difference in GAD-7 scores between metabolic syndrome status

Additional file 1 of The association of breast feeding for at least six months with hemodynamic and metabolic health of women and their children aged three years: an observational cohort study

Additional file 1

Power calculation.

(PNG)</p

Participant characteristics in the prevention of gestational diabetes as evidence for precision medicine: a systematic review and meta-analysis.

BACKGROUND: Precision prevention involves using the unique characteristics of a particular group to determine their responses to preventive interventions. This study aimed to systematically evaluate the participant characteristics associated with responses to interventions in gestational diabetes mellitus (GDM) prevention. METHODS: We searched MEDLINE, EMBASE, and Pubmed to identify lifestyle (diet, physical activity, or both), metformin, myoinositol/inositol and probiotics interventions of GDM prevention published up to May 24, 2022. RESULTS: From 10347 studies, 116 studies (n = 40940 women) are included. Physical activity results in greater GDM reduction in participants with a normal body mass index (BMI) at baseline compared to obese BMI (risk ratio, 95% confidence interval: 0.06 [0.03, 0.14] vs 0.68 [0.26, 1.60]). Combined diet and physical activity interventions result in greater GDM reduction in participants without polycystic ovary syndrome (PCOS) than those with PCOS (0.62 [0.47, 0.82] vs 1.12 [0.78-1.61]) and in those without a history of GDM than those with unspecified GDM history (0.62 [0.47, 0.81] vs 0.85 [0.76, 0.95]). Metformin interventions are more effective in participants with PCOS than those with unspecified status (0.38 [0.19, 0.74] vs 0.59 [0.25, 1.43]), or when commenced preconception than during pregnancy (0.21 [0.11, 0.40] vs 1.15 [0.86-1.55]). Parity, history of having a large-for-gestational-age infant or family history of diabetes have no effect on intervention responses. CONCLUSIONS: GDM prevention through metformin or lifestyle differs according to some individual characteristics. Future research should include trials commencing preconception and provide results disaggregated by a priori defined participant characteristics including social and environmental factors, clinical traits, and other novel risk factors to predict GDM prevention through interventions

Balloon Catheters Versus Vaginal Prostaglandins for Labour Induction (CPI Collaborative):An Individual Participant Data Meta-analysis of Randomised Controlled Trials

Since 2010, the rates of induction have risen in Australia (from 25% to 35%) and the United Kingdom (from 20% to 32%). This may be an indication that induction has become more acceptable among women and health providers. In women with unripe cervices, mechanical methods, such as balloon catheters, and pharmacological methods, such as vaginal prostaglandins, are commonly used for cervical ripening to induce labor. Yet, induction poses the risks of cesarean delivery (CD), as well as maternal and neonatal morbidity and mortality. Finding the optimal method to induce labor is important to reduce these risks. The aim of this study was to compare the safety and effectiveness of balloon catheters and vaginal prostaglandins for the induction of labor.This was a meta-analysis using individual patient data from published and unpublished randomized controlled trials that had completed data collection between March 19, 2019, and May 1, 2021. A recent Cochrane review provided additional trials completed before March 19. Eligible trials were those that compared single- or double-balloon catheters with the vaginal prostaglandins, misoprostol, or dinoprostone. The analysis included only women with viable, singleton pregnancies with no exclusion for parity or membrane status. The primary outcomes were CD, a composite of adverse maternal outcomes, and a composite of adverse perinatal outcomes.A total of 12 trials, representing 5460 deliveries, were included in the analysis. Overall, the crude incidence of CD was 27%, the perinatal composite was 13.6%, and the maternal composite was 22.7%. No significant differences in the rate of CD were found between patients who received a balloon catheter and those given vaginal prostaglandin to induce labor (12 trials, 5414 women; adjusted odds ratio [aOR], 1.09; 95% confidence interval [CI], 0.95–1.24). The adverse perinatal composite was lower among those who received balloon catheters (10 trials, 4452 neonates; aOR, 0.80 [95% CI, 0.70–0.92]; I2 = 0%). There were no significant differences for the adverse maternal composite measure (10 trials, 4326 women; aOR, 1.02 [95% CI, 0.89–1.18]; I2 = 0%). Balloon catheters were associated with fewer instrumental vaginal births than vaginal prostaglandins (10 trials, 4888 women; aOR, 0.82 [95% CI, 0.68–1.00]). In a subgroup analysis, there was a lower chance of the adverse perinatal composite with the use of a single-balloon catheter versus vaginal prostaglandins (9 trials, 2683 neonates; aOR, 0.84 [95% CI, 0.71–0.99]).This study found that labor induction with balloon catheters and vaginal prostaglandins was equally effective and had similar rates of CD and adverse composite maternal outcome. However, induction with a balloon catheter was observed to improve perinatal outcomes