Gestational Diabetes Mellitus and Obesity are Related to Persistent Hyperglycemia in the Postpartum Period

Rehder, Patrícia Moretti; Borovac-Pinheiro, Anderson; Araujo, Raquel Oliveira Mena Barreto de; Diniz, Juliana Alves Pereira Matiuck; Ferreira, Nathalia Lonardoni Crozatti; Branco, Ana Claudia Rolim; Dias, Aline de Fatima; Pereira, Belmiro Gonçalves

doi:10.1055/s-0040-1721356

Cited by 8 publications

(9 citation statements)

References 17 publications

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“…GWG is an independent risk factor for the progression of cardio-metabolic complications in both mothers and offspring [ 26 ]. Diabetes is a condition characterized by increased blood glucose levels and glucose intolerance, detected for the first-time during pregnancy (GDM) or before conception (pre-gestational diabetes) [ 27 ]. GDM is a significant health concern occurring in 2–6% of pregnancies, and in the presence of pre-pregnancy obesity, it rises to 17% in industrialized countries [ 25 ].…”

Section: Obstetric Complications In Women With Obesity and Diabetes M...mentioning

confidence: 99%

Impact of Obesity and Diabetes in Pregnant Women on Their Immunity and Vaccination

et al. 2023

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Pregnant women with obesity and diabetes are at increased risk of developing infections and other complications during pregnancy. Several mechanisms are involved in the immunological mechanisms that contribute to reduced immunity in these populations. Both obesity and diabetes are associated with chronic low-grade inflammation that can lead to an overactive immune response. Pregnant women with obesity and diabetes often have an increase in pro-inflammatory cytokines and adipokines, such as TNF-α, IL-6, IL-1β, leptin, and resistin, which are involved in the inflammatory response. Insulin resistance can also affect the functioning of immune cells. Furthermore, both conditions alter the composition of the gut microbiome, which produces a variety of biomolecules, including short-chain fatty acids, lipopolysaccharides, and other metabolites. These substances may contribute to immune dysfunction. In addition to increasing the risk of infections, obesity and diabetes can also affect the efficacy of vaccinations in pregnant women. Pregnant women with obesity and diabetes are at increased risk of developing severe illness and complications from COVID-19, but COVID-19 vaccination may help protect them and their fetuses from infection and its associated risks. Since both obesity and diabetes classify a pregnancy as high risk, it is important to elucidate the impact of these diseases on immunity and vaccination during pregnancy. Research examining the efficacy of the COVID-19 vaccine in a high-risk pregnant population should be of particular value to obstetricians whose patients are hesitant to vaccinate during pregnancy. Further research is needed to better understand these mechanisms and to develop effective interventions to improve immune function in these populations.

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Section: Obstetric Complications In Women With Obesity and Diabetes M...mentioning

confidence: 99%

Impact of Obesity and Diabetes in Pregnant Women on Their Immunity and Vaccination

et al. 2023

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“…Além disso, diabetes gestacional também está relacionado com macrossomia (aumentando risco de trauma, como lesão do plexo braquial), crescimento intrauterino reduzido (em mulheres com doença vascular renal), policetemia, hiperbilirrubinemia, cardiomiopatia, hipoglicemia ou outras anormalidades metabólicas e complicações respiratórias. 6,7…”

Section: Desenvolvimentounclassified

Diabetes gestacional: revisão de literatura / Gestational diabetes: literature review

Ferreira¹,

Sabatini²,

Souza³

et al. 2021

Braz. J. Develop.

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Introdução: O diabetes mellitus gestacional (DMG) se relaciona com várias complicações maternas e fetais. Dentre essas complicações, inclui a pré-eclampsia, necessidade de indução do trabalho de parto e parto cesáreo, a prematuridade, macrossomia e natimorto. Além disso, mulheres com DMG apresentam risco aumentado a longo prazo para desenvolvimento de diabetes mellitus do tipo 2 e, consequentemente, maior risco cardiovascular. Objetivos: O objetivo desse estudo é revisar sobre o manejo de diabetes gestacional, vista que se trata uma doença de alta prevalência e morbidade materno-fetal. Métodos: Os bancos de dados Pubmed, Diretrizes e protocolos hospitalares foram pesquisados eletronicamente utilizando os descritores diabetes gestacional, diabetes e gestação de alto risco nos idiomas inglês e português. Discussão e Conclusão: O diagnóstico e o tratamento do diabetes gestacional são importantes para evitar a morbimortalidade materno-fetal. Dessa forma, revisar o manejo dessa doença se faz necessário em todos âmbitos de atenção.Palavras-chaves :diabetes gestacional,diabetes e gestação de alto risco .

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“…(15)(16)(17) T2DM is expected to persist post-delivery, whereas GDM characteristically resolves (within 24-48 hours) postpartum. (18)(19)(20) Women, with GDM, however, remain at very high risk of future T2DM. (18,19) The early detection and optimal management of T2DM has long-term benefit and is referred to as the so called "legacy effect".…”

Section: Introduction [4239]mentioning

confidence: 99%

“…(18)(19)(20) Women, with GDM, however, remain at very high risk of future T2DM. (18,19) The early detection and optimal management of T2DM has long-term benefit and is referred to as the so called "legacy effect". (21)(22)(23) Landmark studies support the hypothesis that progression to T2DM is preventable in women with GDM.…”

Section: Introduction [4239]mentioning

confidence: 99%

Early postpartum HbA1c after hyperglycemia first detected in pregnancy - imperfect but not without value

Coetzee

Hall

Vyver

et al. 2023

Preprint

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Background: South African women of childbearing age are disproportionally affected by obesity and at significant risk of Type 2 Diabetes Mellitus (T2DM). Unless pregnant, they do not readily undergo screening for T2DM. With a local focus on improved antenatal care, hyperglycemia is often first detected in pregnancy (HFDP). This may erroneously be attributed to Gestational Diabetes Mellitus (GDM) in all without considering T2DM. Glucose evaluation following pregnancy is essential for early detection and management of women with T2DM in whom persistent hyperglycemia is to be expected. Conventional testing with an oral glucose tolerance test (OGTT) is cumbersome, prompting investigation for alternate solutions. Aim: To compare the diagnostic performance of HbA1c to the current gold standard OGTT in women with HFDP 4-12 weeks post-delivery. Methods: Glucose homeostasis was assessed with OGTT and HbA1c in 167 women with HFDP, 4-12 weeks after delivery. Glucose status was based on American Diabetes Association criteria. Results: Glucose homeostasis was assessed at 10 weeks (IQR 7-12) after delivery. A total of 52/167 (31%) participants had hyperglycemia, 34 (20%) had prediabetes, and 18 (11%) had T2DM. For patients with prediabetes, fasting plasma glucose (FPG) and 2 hour plasma glucose (2hPG) were diagnostic in 12 patients, whereas in two-thirds (22/34) only one time point was diagnostic. FPG and 2hPG values were both in the prediabetes diagnostic range in six women with T2DM. Based on FPG, 15 women with persistent hyperglycemia (11 with prediabetes and four with T2DM) would have been missed (15/52; 29%). The HbA1c accurately classified 85% of the 52 participants with gold standard OGTT defined hyperglycemia and 15 of 18 women with postpartum persistent T2DM. When compared to an OGTT, a single HbA1c of 6.5% (48mmol/mol) postpartum demonstrated a sensitivity of 83% and specificity of 97% for the identification of T2DM. Conclusion: HbA1c may improve access to postpartum testing in overburdened clinical settings where the required standards of OGTT cannot be guaranteed. HbA1c is a valuable test to detect women who will benefit most from early intervention but cannot unequivocally replace OGTT.

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Gestational Diabetes Mellitus and Obesity are Related to Persistent Hyperglycemia in the Postpartum Period

Cited by 8 publications

References 17 publications

Impact of Obesity and Diabetes in Pregnant Women on Their Immunity and Vaccination

Impact of Obesity and Diabetes in Pregnant Women on Their Immunity and Vaccination

Diabetes gestacional: revisão de literatura / Gestational diabetes: literature review

Early postpartum HbA1c after hyperglycemia first detected in pregnancy - imperfect but not without value

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