Body mass index correlates positively with insulin resistance and secretion but inversely with insulin sensitivity in gestational diabetes

Background. To assess fasting C-peptide and insulinindices using homeostatic model assessment (HOMA)in gestational diabetes mellitus (GDM).Methods. Gestational diabetes mellitus (n = 64, age:27.02 ± 0.53 years, BMI: 26.3 ± 0.5 kg/m2; mean ±SEM) and normal glucose tolerance NGT (n = 56, age:26.11 ± 0.55 years, BMI: 24.4 ± 0.4 kg/m2; mean ±SEM) screened according to WHO 2013 criteria. Glucosewas measured by oxidase method whereas fastinginsulin and C-peptide by ELISA. HOMA-IR, HOMA-B andHOMA-%S were calculated. Results. C-peptide was found higher in GDM comparedto NGT without any significant difference (P = 0.465).Fasting insulin (P = 0.063) and HOMA-IR (P < 0.001)were significantly higher while HOMA-B (P = 0.015)and HOMA-%S (P = 0.012) were significantly lower inGDM than those of NGT. BMI, bad obstetric history,multiparity and blood glucose were higher (P ≤ 0.05)in GDM while age, duration of gestation, family historyof DM did not differ (P = NS). C-peptide (0.185 ± 0.06vs 0.331 ± 0.44; P < 0.05), fasting insulin (4.88 ± 0.74vs 10.37 ± 0.74; P < 0.01) and HOMA-IR (1.04 ± 0.14 vs2.48 ± 0.18; P < 0.011) as well as HOMA-B were foundlower in GDM having BMI < 23 kg/m2 than those ofGDM with BMI ≥ 23. Conversely, HOMA-%S (115.52 ±14.63 vs 50.62 ± 3.39; P < 0.011) was higher in thesubgroup with BMI < 23 than the rest. Fasting bloodglucose (FBG) (P < 0.01) and fasting insulin (P < 0.05)were independent predictors for GDM. Conclusions. Fasting C-peptide did not differ betweenGDM and NGT. BMI was positively related with resistanceand secretion of insulin but inversely with sensitivity.HOMA model analyses revealed decreased insulinsensitivity and secretory capacity in GDM than NGT

Dodatnia korelacja wskaźnika masy ciała z insulinoopornością i wydzielaniem insuliny i odwrotna z wrażliwością na insulinę w cukrzycy ciążowej

WSTĘP: Badania przeprowadzono w celu oceny stężenia peptydu C i wskaźników insulinowych w modelu homeostazy (HOMA) u kobiet z cukrzycą ciążową (GDM). METODY: Kobiety z cukrzycą ciążową (n = 64, wiek: 27,02 ± 0,53 roku, BMI: 26,3 ± 0,5 kg/m2; średnia ± SEM) i prawidłową tolerancją glukozy (NGT) (n = 56, wiek: 26,11 ± 0,55 roku, BMI: 24,4 ± 0,4 kg/m2; średnia ± SEM) zdiagnozowanymi zgodnie z kryteriami Światowej Organizacji Zdrowia 2013. Stężenie glukozy mierzono metodą oksydazową, natomiast stężenie insuliny na czczo i peptydu C metodą ELISA. Obliczono wskaźniki HOMA-IR, HOMA-B i HOMA-%S. WYNIKI: Stwierdzono, że stężenie peptydu C było wyższe u kobiet z GDM w porównaniu z kobietami z NGT, jednak różnica nie była istotna statystycznie (p = 0,465). Stężenie insuliny na czczo (p = 0,063) i wskaźnik HOMA-IR (p < 0,001) były istotnie wyższe, podczas gdy wskaźniki HOMA-B (p = 0,015) i HOMA- -%S (p = 0,012) były istotnie niższe w grupie z GDM niż u osób z NGT. Wskaźnik BMI i stężenie glukozy we krwi były wyższe, a obciążony wywiad położniczy i wielorództwo występowały częściej (p ≤ 0,05) w grupie GDM, natomiast wiek, czas trwania ciąży, dodatni wywiad rodzinny w kierunku cukrzycy nie różniły się między grupami (p = NS). Stężenie peptydu C (0,185 ± 0,06 v. 0,331 ± 0,44; p < 0,05), insulinemia na czczo (4,88 ± 0,74 v. 10,37 ± 0,74; p < 0,01) oraz wskaźniki HOMA-IR (1,04 ± 0,14 v. 2,48 ± 0,18; p < 0,011) oraz HOMA-B były niższe u kobiet z GDM, których wskaźnik BMI wynosił < 23 kg/m2 niż u osób z GDM z wyższymi wartościami wskaźnika BMI (≥ 23), natomiast wskaźnik HOMA-%S (115,52 ± 14,63 v. 50,62 ± 3,39; p < 0,011) był wyższy w podgrupie z BMI < 23. Stężenie glukozy we krwi na czczo (fasting blood glucose, FBG) (p < 0,01) i stężenie insuliny na czczo (p < 0,05) były niezależnymi predyktorami GDM. WNIOSKI: Stężenia peptydu C na czczo nie różniły się między grupami GDM i NGT. Wskaźnik BMI był dodatnio związany z insulinoopornością i wydzielaniem insuliny, ale odwrotnie związany z wrażliwością na insulinę. Analiza modelu HOMA wykazała zmniejszoną wrażliwość na insulinę i czynność wydzielniczą w GDM w porównaniu z NGT

Omega 3 fatty acids on child growth, visual acuity and neurodevelopment.

The aim of this review is to evaluate the effects of omega-3 long chain polyunsaturated fatty acids (n-3 LCPUFA) supplementation in pregnant and lactating women and infants during postnatal life, on the visual acuity, psychomotor development, mental performance and growth of infants and children. Eighteen publications (11 sets of randomized control clinical trial [RCTs]) assessed the effects of the n-3 LCPUFA supplementation during pregnancy on neurodevelopment and growth, in the same subjects at different time points; 4 publications (2 data sets from RCTs) addressed physiological responses to n-3 LCPUFA supplementation during pregnancy & lactation and 5 publications (3 data sets from RCTs) exclusively during lactation. Some of these studies showed beneficial effects of docosahexaenoic acid (DHA) supplementation during pregnancy and/or lactation especially on visual acuity outcomes and some on long-term neurodevelopment; a few, showed positive effects on growth. There were also 15 RCTs involving term infants who received infant formula supplemented with DHA, which met our selection criteria. Many of these studies claimed a beneficial effect of such supplementation on visual, neural, or developmental outcomes and no effects on growth. Although new well designed and conducted studies are being published, evidence from RCTs does not demonstrate still a clear and consistent benefit of n-3 LCPUFA supplementation during pregnancy and/or lactation on term infants growth, neurodevelopment and visual acuity. These results should be interpreted with caution due to methodological limitations of the included studies

Type 2 diabetes linked FTO gene variant rs8050136 is significantly associated with gravidity in gestational diabetes in a sample of Bangladeshi women: Meta-analysis and case-control study.

ObjectiveGestational diabetes mellitus (GDM) is a growing public health concern that has not been extensively studied. Numerous studies have indicated that a variant (rs8050136) of the fat mass-associated gene, FTO, is associated with both GDM and Type 2 diabetes mellitus(T2DM). We conducted a meta-analysis on the association between the FTO single nucleotide polymorphism (SNP) rs8050136 and T2DM, followed by a case-control study on the association of the said SNP and GDM in a sample of Bangladeshi women.MethodA total of 25 studies were selected after exploring various databases and search engines, which were assessed using the Newcastle-Ottawa Scale (NOS). The MetaGenyo web tool was used to conduct this meta-analysis. A case-control study was performed on 218 GDM patients and 284 controls to observe any association between FTO rs8050136 and GDM. Genotyping was performed using the tetra-primer amplification refractory mutation system-polymerase chain reaction (T-ARMS) method, and statistical analyses were performed using various statistical softwares.ResultsIn the meta-analysis 26231 cases and 43839 controls were examined. Pooled association analyses revealed a statistically significant relationship between the FTO rs8050136 polymorphism and an elevated risk of T2DM under all genetic models (PConclusionOur meta-analysis revealed a significant association between SNP rs8050136 of FTO with T2DM, and this variant was substantially associated with an increased risk of GDM in a sample of Bangladeshi multigravida women

Adaptation and Integration of Psychosocial Stimulation, Maternal Mental Health and Nutritional Interventions for Pregnant and Lactating Women in Rural Bangladesh.

Supporting caregivers' mental wellbeing and ability to provide psychosocial stimulation may promote early childhood development. This paper describes the systematic approach of developing an integrated stimulation intervention, identifying the feasibility and challenges faced throughout the period. We developed an integrated curriculum by culturally adapting three interventions (Reach Up, Thinking Healthy, and general nutrition advice) and piloted this curriculum (Mar-April 2017) in courtyard groups sessions and individual home visits with pregnant women (n = 11) and lactating mothers (of children <24 months) (n = 29). We conducted qualitative interviews with the participants (n = 8) and the community health workers who delivered the intervention (n = 2). Most participants reported willingness to attend the sessions if extended for 1 year, and recommended additional visual cues and interactive role-play activities to make the sessions more engaging. Participants and community health workers found it difficult to understand the concept of "unhealthy thoughts" in the curriculum. This component was then revised to include a simplified behavior-focused story. Community health workers reported difficulty balancing the required content of the integrated curriculum but were able to manage after the contents were reduced. The revised intervention is likely feasible to deliver to a group of pregnant and lactating mothers in a low-resource setting

Adaptation and Integration of Psychosocial Stimulation, Maternal Mental Health and Nutritional Interventions for Pregnant and Lactating Women in Rural Bangladesh.

Supporting caregivers' mental wellbeing and ability to provide psychosocial stimulation may promote early childhood development. This paper describes the systematic approach of developing an integrated stimulation intervention, identifying the feasibility and challenges faced throughout the period. We developed an integrated curriculum by culturally adapting three interventions (Reach Up, Thinking Healthy, and general nutrition advice) and piloted this curriculum (Mar-April 2017) in courtyard groups sessions and individual home visits with pregnant women (n = 11) and lactating mothers (of children <24 months) (n = 29). We conducted qualitative interviews with the participants (n = 8) and the community health workers who delivered the intervention (n = 2). Most participants reported willingness to attend the sessions if extended for 1 year, and recommended additional visual cues and interactive role-play activities to make the sessions more engaging. Participants and community health workers found it difficult to understand the concept of "unhealthy thoughts" in the curriculum. This component was then revised to include a simplified behavior-focused story. Community health workers reported difficulty balancing the required content of the integrated curriculum but were able to manage after the contents were reduced. The revised intervention is likely feasible to deliver to a group of pregnant and lactating mothers in a low-resource setting

Effects of the COVID-19 pandemic on caregiver mental health and the child caregiving environment in a low-resource, rural context.

Early child development has been influenced directly and indirectly by the COVID-19 pandemic, and these effects are exacerbated in contexts of poverty. This study estimates effects of the pandemic and subsequent population lockdowns on mental health, caregiving practices, and freedom of movement among female caregivers of children 6-27 months (50% female), in rural Bangladesh. A cohort (N = 517) was assessed before and during the pandemic (May-June, 2019 and July-September, 2020). Caregivers who experienced more food insecurity and financial loss during the pandemic reported larger increases in depressive symptoms (0.26 SD, 95% CI 0.08-0.44; 0.21 SD, 0.04-0.40) compared to less affected caregivers. Stimulating caregiving and freedom of movement results were inconsistent. Increases in depressive symptoms during the pandemic may have consequences for child development

Success Factors for Community Health Workers in Implementing an Integrated Group-Based Child Development Intervention in Rural Bangladesh.

Community Health Workers (CHWs) can effectively implement maternal and child health interventions, but there is paucity of evidence on how to integrate child stimulation into these interventions, and their delivery at scale. In rural Bangladesh, CHWs implemented an intervention integrating psychosocial stimulation, nutrition, maternal mental health, water, sanitation, hygiene (WASH) and lead exposure prevention. In each of 16 intervention villages, one CHW worked with 20 households. CHWs bi-weekly held group meetings or alternated group meetings and home visits with pregnant women and lactating mothers. We assessed the intervention through five focus groups, four interviews and one group discussion with CHWs and their supervisors to explore success factors of implementation. CHWs' training, one-on-one supervision and introduction by staff to their own community, and adoption of tablet computers as job aids, enabled successful session delivery to convey behavioral recommendations. CHWs reported difficulties delivering session due to the complexity of behavioral recommendations and struggled with age-specific intervention material. Young children's attendance in group sessions generated distractions that undermined content delivery. We identified ways to minimize the difficulties to strengthen intervention-delivery during implementation, and scale-up. Iterative revisions of similarly integrated interventions based on qualitative evaluation findings could be delivered feasibly by CHWs and allow for implementation at scale

Exploration of Attendance, Active Participation, and Behavior Change in a Group-Based Responsive Stimulation, Maternal and Child Health, and Nutrition Intervention

Delivery of interventions through group sessions allows for in-depth discussions and creates opportunities for group members to work together to identify and solve common problems. However, low attendance may limit impact. We explored factors affecting attendance, active participation, and behavior change in an integrated group-based child development and maternal and child health intervention in Bangladesh. Community health workers (CHWs) facilitated two sessions a month including material on child stimulation; water, sanitation, and hygiene; nutrition, maternal depression, and lead exposure prevention. Sessions were conducted with 320 pregnant women and mothers with children younger than 24 months, in 16 villages in Kishoreganj district. After 4 and 9 months of intervention, we conducted focus group discussions and in-depth interviews with mothers (n = 55 and n = 48) to identify determinants of attendance and behavior change, and to examine potential for intervention scale-up. Recruiting family members to assist with childcare resulted in improved attention during sessions. Adopting a storytelling format for presentation of session materials resulted in more engaged participation during courtyard sessions. Session attendance and behavior change, especially purchasing decisions, were difficult for participants without the support of male heads of the household. Selecting a rotating leader from among the group members to remind group members to attend sessions and support CHWs in organizing the sessions was not successful. Facilitating self-appraisals and planning for water and sanitation allowed participants to identify areas for improvement and track their progress. Key determinants of a participant's attendance were identified, and the resulting intervention shows promise for future implementation at scale