ObjectiveWe compared the increases in the prevalence of gestational diabetes mellitus (GDM) based on the 1999 World Health Organization (WHO) criteria and its risk factors in Tianjin, China, over a 12-year period. We also examined the changes in the prevalence using the criteria of International Association of Diabetes and Pregnancy Study Group (IADPSG).MethodsIn 2010-2012, 18589 women who registered within 12 weeks of gestation underwent a glucose challenge test (GCT) at 24-28 gestational weeks. Amongst them, 2953 women with 1-hour plasma glucose ≥7.8 mmol/L underwent a 75-gram 2-hour oral glucose tolerance test (OGTT) and 781 women had a positive GCT but absented from the standard OGTT. An adjusted prevalence of GDM was calculated for the whole cohort of women by including an estimate of the proportion of women with positive GCTs who did not have OGTTs but would have been expected to have GDM. Logistic regression was used to obtain odds ratios and 95% confidence intervals using the IADPSG criteria. The prevalence of GDM risk factors was compared to the 1999 survey.ResultsThe adjusted prevalence of GDM by the 1999 WHO criteria was 8.1%, a 3.5-fold increase as in 1999. Using the IADPSG criteria increased the adjusted prevalence further to 9.3%. Advanced age, higher pre-pregnancy body mass index, Han-nationality, higher systolic blood pressure (BP), a family history of diabetes, weight gain during pregnancy and habitual smoking were risk factors for GDM. Compared to the 1999 survey, the prevalence of overweight plus obesity had increased by 1.8 folds, age≥30 years by 2.3 folds, systolic BP by 2.3 mmHg over the 12-year period.ConclusionsIncreasing prevalence of overweight/obesity and older age at pregnancy were accompanied by increasing prevalence of GDM, further increased by change in diagnostic criteria.

This study aimed to examine the effect of lifestyle intervention on the risk of gestational diabetes mellitus (GDM). We searched PubMed, Springer and other databases to retrieve articles published in English and Chinese up to 30 September 2015. The inclusion criteria were randomized controlled trials evaluating the effects of lifestyle intervention on risk of GDM. Exclusion criteria were studies with prepregnancy diabetes mellitus or interventions with nutrient supplements. Random-effect and fixed-effect model analyses were used to obtain pooled relative risks and 95% confidence intervals (CIs) of diet and physical activity on the risk of GDM. Subgroup analyses were performed to check the consistency of effect sizes across groups where appropriate. We identified 29 randomized controlled trials with 11,487 pregnant women, addressing the effect of lifestyle intervention on the risk of GDM. In the pooled analysis, either diet or physical activity resulted in an 18% (95%CI 5-30%) reduction in the risk of GDM (P = 0.0091). Subgroup analysis showed that such intervention was effective among women with intervention before the 15th gestational week (relative risk: 0.80, 95%CI 0.66-0.97), but not among women receiving the intervention afterwards. We conclude that lifestyle modification during pregnancy, especially before the 15th gestational week, can reduce the risk of GDM. © 2016 World Obesity.

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BackgroundThere are no randomised controlled trials to demonstrate whether lifestyle modifications can improve pregnancy outcomes of gestational diabetes mellitus (GDM) diagnosed by the International Association of Diabetes and Pregnancy Study Group’s (IADPSG) criteria. We tested the effectiveness of lifestyle modifications implemented in a 3-tier’s shared care (SC) on pregnancy outcomes of GDM.MethodsBetween December 2010 and October 2012, we randomly assigned 700 women with IADPSG-defined GDM but without diabetes at 26.3 (interquartile range: 25.4-27.3) gestational weeks in Tianjin, China, to receive SC or usual care (UC). The SC group received individual consultations and group sessions and performed regular self-monitoring of blood glucose compared to one hospital-based education session in the UC group. The outcomes were macrosomia defined as birth weight ≥ 4.0 kg and the pregnancy-induced hypertension (PIH).ResultsWomen in the SC (n = 339) and UC (n = 361) groups delivered their infants at similar gestational weeks. Birth weight of infants in the SC group was lower than that in the UC group (3469 vs. 3371 grams, P = 0.021). The rate of macrosomia was 11.2% (38/339) in the SC group compared to 17.5% (63/361) in the UC group with relative risk (RR) of 0.64 (95% CI: 0.44-0.93). The rate of PIH was 8.0% (27/339) in the SC compared to 4.4% (16/361) in the UC with RR of 1.80 (0.99-3.28). Apgar score at 1 min < 7 was lower but preeclampsia was higher in the SC than in the UC.ConclusionsLifestyle modifications using a SC system improved pregnancy outcomes in Chinese women with GDM.Trial registrationClinicaltrials.gov; NCT01565564.Electronic supplementary materialThe online version of this article (doi:10.1186/s12967-014-0290-2) contains supplementary material, which is available to authorized users.

The 1-year lifestyle intervention led to significant weight losses after delivery in women who had GDM, and the effect was more pronounced in women who were overweight at baseline.

The benefits of concurrent newborn hearing and genetic screening have not been statistically proven due to limited sample sizes and outcome data. To fill this gap, we analyzed outcomes of newborns with genetic screening results. Methods: Newborns in China were screened for 20 hearingloss-related genetic variants from 2012 to 2017. Genetic results were categorized as positive, at-risk, inconclusive, or negative. Hearing screening results, risk factors, and up-to-date hearing status were followed up via phone interviews. Results: Following up 12,778 of 1.2 million genetically screened newborns revealed a higher rate of hearing loss by three months of age among referrals from the initial hearing screening (60% vs. 5.0%, P < 0.001) and a lower rate of lost-to-follow-up/documentation (5% vs. 22%, P < 0.001) in the positive group than in the inconclusive group. Importantly, genetic screening detected 13% more hearing-impaired infants than hearing screening alone and identified 2,638 (0.23% of total) newborns predisposed to preventable ototoxicity undetectable by hearing screening. Conclusion: Incorporating genetic screening improves the effectiveness of newborn hearing screening programs by elucidating etiologies, discerning high-risk subgroups for vigilant management, identifying additional children who may benefit from early intervention, and informing at-risk newborns and their maternal relatives of increased susceptibility to ototoxicity.

OBJECTIVETo examine the relative contributions of b-cell dysfunction and insulin resistance to postpartum diabetes risk among obese and nonobese women with prior gestational diabetes mellitus (GDM). RESEARCH DESIGN AND METHODSWe performed a cross-sectional survey 1-5 years after 1,263 women who had GDM gave birth. Polytomous logistic regression models were used to assess the associations of b-cell dysfunction (the lower quartile of HOMA-%b), insulin resistance (the upper quartile of HOMA-IR), decreased insulin sensitivity (the lower quartile of HOMA-%S), and different categories of BMI with prediabetes and diabetes risk. RESULTSb-Cell dysfunction, insulin resistance, and decreased insulin sensitivity all were significantly associated with hyperglycemic status across normal weight, overweight, and obese groups, and the patterns of insulin resistance and decreased insulin sensitivity were similar. BMI was inversely associated with b-cell dysfunction and positively associated with insulin resistance across normal glucose, prediabetes, and diabetes categories. Compared with women with normal glucose and weight, obese women with normal glucose had increased b-cell secretory function (odds ratio [OR] 0.09 [95% CI 0.02-0.37]) and insulin resistance ). Normal weight diabetic women displayed the most b-cell dysfunction .3]), whereas obese diabetic women displayed the highest insulin resistance ). CONCLUSIONS

Gestational diabetes mellitus (GDM) accounts for approximately 7% of all pregnancies in the United States and China. 1,2 Women with GDM are at an increased risk of adverse pregnancy outcomes, such as giving birth to babies with greater birth weight and primary cesarean delivery. 3 Maternal GDM also exerts a long-term influence on the offspring, which was named "metabolic imprinting" by some researchers. 4 Previous studies indicated that offspring of mothers with GDM were predisposed to metabolic syndrome and its components. 4-12 However, the results about the association between maternal GDM and offspring's risk for hypertension were controversial. Several studies have indicated that offspring of mothers with GDM had higher mean values of systolic blood pressure (SBP) or diastolic blood pressure (DBP) than children of mothers without GDM mothers. 11-14 Other studies reported no difference in the levels of SBP and DBP between the 2 groups. 7,8 However, most of these previous studies are largely limited by small samples sizes (20-130 GDM cases) and different diagnosis methods of maternal GDM, and whether maternal GDM means a higher risk of pediatric hypertension remains uncertain. Moreover, the extent to which childhood hypertension associated with maternal GDM could be explained by other confounders remains unclear. To elucidate these issues, we compared childhood blood pressure levels and the risk of hypertension