Objective. The reported incidence of type 2 diabetes mellitus (T2DM) after gestational diabetes (GDM) varies widely. The purpose of this meta-analysis was to define the incidence rate of T2DM among women with a history of GDM and to examine what might modulate the rate. Research Design and Methods. We searched PubMed and Embase for terms related to T2DM after GDM up to January 2019. Large cohort studies with sample size ≥300 and follow-up duration of at least one year were included. Data from selected studies were extracted, and meta-analysis was performed using the random-effects model. Subgroups analyses were based on the sample size of gestational diabetes, geographic region, maternal age, body-mass index, diagnostic criteria, and duration of follow-up. Results. Twenty-eight studies involving 170,139 women with GDM and 34,627 incident cases of T2DM were identified. The pooled incidence of T2DM after GDM was 26.20 (95% CI, 23.31 to 29.10) per 1000 person-years. Women from Asia and those with older age and higher body mass index seem to experience higher risk of developing T2DM. The incidence rate of T2DM was lowest when applying IADPSG (7.16 per 1000 person-years) to diagnose GDM. The risk of developing T2DM after GDM increased linearly with the duration of follow-up. The increments per year of follow-up were estimated at 9.6‰. The estimated risks for T2DM were 19.72% at 10 years, 29.36% at 20 years, 39.00% at 30 years, 48.64% at 40 years, and 58.27% at 50 years, respectively. Conclusions. The findings of very high incidence of T2DM after GDM add an important insight into the trajectory of the development of T2DM in the long-term postpartum periods, which could provide evidence for consultant and might motivate more women with GDM to screen for T2DM. This trial is registered with PROSPERO identifier CRD42019128980.
Unexplained recurrent spontaneous abortion (URSA) is an alloimmune disease associated with the failure of fetal-maternal immunologic tolerance in which the regulatory T lymphocytes (Treg) play a pivotal role. It is well known that Forkhead box P3 (Foxp3) is a crucial regulatory factor for the development and function of Treg cells. It has also been established that deficiency of the Foxp3 gene suppresses the regulatory function of Treg cells. To determine if functional polymorphisms at the Foxp3 loci are associated with URSA in humans, we genotyped four common polymorphisms of Foxp3 gene in 146 unrelated URSA patients and 112 healthy women. The results showed that rs3761548A/C and rs2232365A/G polymorphisms were significantly associated with URSA. Additionally, we found that the allelic distribution of rs5902434 del/ATT in URSA group was slightly different from that in the control group. We conclude that functional polymorphisms of the Foxp3 gene may confer an important susceptibility to URSA in the Chinese Han population, probably by altering Foxp3 function and/or its expression.
BackgroundGestational diabetes mellitus (GDM) is one of the most common complications during pregnancy, and it has both short- and long-term adverse effects on the health of mothers and fetuses. To investigate the effect of exercise during pregnancy on the occurrence of GDM among normal-weight pregnant women.MethodsWe searched for studies published between January 1994 and June 2017 that appeared in the Web of Science, Scopus, ClinicalTrials.gov or Cochrane library databases. Randomized controlled trials that investigated the preventive effect of exercise on GDM in normal-weight women were included. Interventions including any confounding factors (e.g., dietary) were excluded. We extracted maternal characteristics, the diagnostic criteria of GDM, and basic information for intervention and obstetric outcomes. The primary outcome was the occurrence of GDM, and the secondary outcomes included gestational weight gain, gestational age at birth, birth weight, and the odds of cesarean section. A meta-analysis was conducted based on calculations of pooled estimates using the random-effects model.ResultsEight studies were included in this systematic review and meta-analysis. Exercise during pregnancy was shown to decrease the occurrence of GDM [RR = 0.58, 95% CI (0.37, 0.90), P = 0.01 and RR = 0.60, 95% CI (0.36, 0.98), P = 0.04 based on different diagnosis criteria, respectively] in normal-weight women. Regarding secondary outcomes, exercise during pregnancy can decrease gestational weight gain [MD = − 1.61, 95% CI (− 1.99, − 1.22), P<0.01], and had no significant effects on gestational age at birth [MD = − 0.55, 95% CI (− 1.57, 0.47), P = 0.29], birth weight [MD = − 18.70, 95% CI (− 52.49, 15.08), P = 0.28], and the odds of caesarean section [RR = 0.88, 95% CI (0.72, 1.08), P = 0.21], respectively.ConclusionsExercise during pregnancy can ostensibly decrease the occurrence of GDM without reducing gestational age at delivery and increasing the odds of cesarean section in normal-weight women.Electronic supplementary materialThe online version of this article (10.1186/s12884-018-2068-7) contains supplementary material, which is available to authorized users.
Rapid diagnosis or prognosis of PPH, in combination with early usage of the Bakri postpartum balloon is more effective for the management of PPH.
Context The significance of an early diagnosis of gestational diabetes mellitus(GDM) with oral glucose tolerance test (OGTT) has not been determined. Objective To investigate GDM diagnosed by early and standard OGTTs and determine adverse maternal and neonatal outcomes associated with early GDM diagnosis. Research design and methods The Early Diagnosis of Gestational Diabetes Mellitus study is a prospective cohort study. Each participant in the study undertook two OGTTs, an early OGTT in 18-20 gestational weeks(gws) and a standard OGTT in 24–28 gws. The reproduciblity between early and standard OGTT were analysed. Maternal and neonatal metabolic disorders and pregnancy outcomes were compared across groups. Results A total of 522 participants completed both the early and standard OGTTs. The glucose values in the early OGTT were not significantly different from those in the standard OGTT (Fasting: 4.31±0.41 mmol/L vs. 4.29±0.37 mmol/L, P=0.360; 1hour: 7.68±1.71 mmol/L vs. 7.66±1.59 mmol/L, P=0.826; 2hour: 6.69±1.47mmol/L vs. 6.71±1.39mmol/L, P=0.800). The reproducibility of early and standard OGTT results was 74.9%. Pregnant women in the GDM group had higher Hemoglobin A1c(HbA1c), C-peptide, and homeostasis model assessment-insulin resistance (HOMA-IR) in late gestational period. Neonates born to mothers in the GDM group were at a higher risk of being large for gestational age (OR: 3.665, 95%CI: 1.006-11.91) and were also more prone to neonatal hyperinsulinemia (OR: 3.652, 95%CI: 1.152-10.533). Conclusion Early onset GDM diagnosed by OGTT at 18-20 gws is associated with maternal and neonatal metabolic disorders and adverse pregnancy outcomes. Further randomized control trials on the therapeutic efficacy for early onset GDM will confirm the significance of early screen for GDM.
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