Gestational diabetes: Implications for fetal growth, intervention timing, and treatment options

Mirabelli, Maria; Chiefari, Eusebio; Tocci, Vera; Greco, Emanuela A.; Foti, Daniela; Brunetti, Antonio

doi:10.1016/j.coph.2021.06.003

Cited by 49 publications

(58 citation statements)

References 53 publications

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“…In most of our GDM cases, dietary changes and physical activity sufficed as treatment, which is in accordance to previously published literature 40 , and only a small fraction (3 patients) required insulin treatment. Potentially, nutritional and/or pharmacological interventions might have restricted maternal weight gain and, thus, affected GPC-4 levels at 35–37 weeks.…”

Section: Discussionsupporting

confidence: 90%

Glypican-4 in pregnancy and its relation to glucose metabolism, insulin resistance and gestational diabetes mellitus status

Deischinger

Harreiter

Leitner

et al. 2021

Sci Rep

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Glypican-4 (GPC-4) is an adipokine that enhances insulin receptor signaling. Plasma concentrations were found to be elevated in patients with prediabetes but reduced in type 2 diabetes mellitus. No study on Glypican-4 in pregnancy and pregnancy-related insulin resistance has been published yet. GPC-4 levels were investigated in 59 overweight women throughout their pregnancy at the Medical University of Vienna. GPC-4 levels, fasting insulin, fasting glucose, estradiol, liver and renal parameters, and markers of bone development were assessed before the < 21st week of gestation (GW), and at GW 35–37. GPC-4 levels increased from < 21 GW (mean = 2.38 pg/ml, SD = 0.68 pg/ml) to GW 35–37 (mean = 2.96 pg/ml, SD = 0.77 pg/ml, p < 0.001). At the same time, GPC-4 levels correlated negatively with estimated glomerular filtration rate (eGFR), serum protein and serum albumin levels and were positively related to creatinine and uric acid levels at GW 35–37. Concerning glucose metabolism, GPC-4 levels were inversely related to ISSI-2, fasting insulin and HOMA-IR, however, not significantly different between women with normal glucose tolerance (NGT) and GDM (p = 0.239). In conclusion, GPC-4 levels rose significantly during pregnancy, correlated negatively with fasting insulin and HOMA-IR but might not be related to gestational diabetes mellitus status.

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Section: Discussionsupporting

confidence: 90%

Glypican-4 in pregnancy and its relation to glucose metabolism, insulin resistance and gestational diabetes mellitus status

Deischinger

Harreiter

Leitner

et al. 2021

Sci Rep

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“…It is well known that both the fetal glucose homeostasis and the trajectory of intrauterine growth are consequences of intricate connections between the fetal endocrine system and placental function, which is affected by uterine blood flow and maternal health and nutrition, especially in elderly primiparas 36 . Nevertheless, maternal hyperglycemia was the strongest predictor of FAO in GDM subjects 12 , 28 , 37 because fetal energy requirement for metabolism and growth is met mainly by glucose from mother 38 .…”

Section: Discussionmentioning

confidence: 99%

Fetal abdominal overgrowth is already present at 20–24 gestational weeks prior to diagnosis of gestational diabetes mellitus

Kim

Park

Kim

2021

Sci Rep

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Fetal abdominal obesity (FAO) was detected at the time of gestational diabetes mellitus (GDM) diagnosis at 24–28 gestational weeks (GW) in older (≥ 35 years) and/or obese (≥ body mass index 25 kg/m2) women and persisted until delivery. We investigated whether FAO is already present at 20–24 GW. Medical records of 7820 singleton pregnancy including 384 GDM were reviewed. Fetal abdominal overgrowth was assessed by the fetal abdominal overgrowth ratios (FAORs) of the ultrasonographically estimated gestational age (GA) of abdominal circumference per actual GA by the last menstruation period, biparietal diameter or femur length, respectively. FAO was defined as FAOR ≥ 90th percentile. FAORs measured at 20–24 GW in older and/or obese but not in young and non-obese GDM subjects were significantly higher than those in NGT subjects. Relative to NGT subjects without FAO at 20–24 GW, odds ratios for exhibiting FAO at GDM diagnosis and large for gestational age in GDM with FAO at 20–24 GW were 10.15 and 5.57, and their primary cesarean delivery rate was significantly higher than those in GDM without FAO (44% vs. 29%). Earlier diagnosis and active interventions of GDM well before 20–24 GW might be necessary to prevent FAO in the older and/or obese women.

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“…In accordance with previous facts, up-to-date results of available meta-analyses on the effects of antidiabetic pharmaceuticals estimated that if we look to the majority of adverse neonatal outcomes, metformin was ranked to be the superior treatment over insulin or glyburide, whereas the lower risk of adverse maternal outcomes was primarily linked to glyburide administration [14]. These divergent effects require additional caution in their use [8].…”

Section: Introductionmentioning

confidence: 61%

“…Most of these have been particularly positively linked to considerable maternal weight fluctuations in GDM [7]. Although today it has become very clear that timely screening and diagnosis (even before 20 weeks gestation) of GDM in at-risk women is more than required for clinically desirable maternal and fetal outcomes [8], in this context, new predictive and diagnostic biomarkers for GDM represent a critical state-of-the-art topic [9].…”

Section: Introductionmentioning

confidence: 99%

Pharmacotherapy of Gestational Diabetes Mellitus: Current Recommendations

Radenković¹,

Jakovljevic²

2022

Gestational Diabetes Mellitus - New Developments

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The incidence of gestational diabetes mellitus (GDM) is still rising, and this pathological condition is strongly associated with some serious adverse pregnancy outcomes. Therefore, GDM must be timely recognized and adequately managed. Treatment of GDM is aimed to maintain normal glycemia and it should involve regular glucose monitoring, dietary modification, lifestyle changes, moderate physical activity, and pharmacotherapy, when necessary. As for the pharmacotherapy, needed in approximately one-third of GDM women, insulin administration is the first choice of pharmacological treatment, although oral hypoglycemic drugs, for example, metformin (a biguanide agent) or glyburide (a second-generation sulfonylurea drug), could be indicated, too. Metformin is considered as a reasonable and safe first-line alternative to insulin. If comparing two oral agents, metformin seems to be safer than glyburide, since glyburide was found to be linked to neonatal hypoglycemia and higher birth weight, which can for example increase the hazard for shoulder dystocia and a necessity for Cesarean delivery. Finally, it should be underlined that many pregnant women turn to complementary and alternative medicine for health maintenance or symptom relief, including traditional herbal medicine and the use of supplements. Given the previous facts, this chapter will address current pharmacotherapy options and challenges related to GDM treatment.

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Gestational diabetes: Implications for fetal growth, intervention timing, and treatment options

Cited by 49 publications

References 53 publications

Glypican-4 in pregnancy and its relation to glucose metabolism, insulin resistance and gestational diabetes mellitus status

Glypican-4 in pregnancy and its relation to glucose metabolism, insulin resistance and gestational diabetes mellitus status

Fetal abdominal overgrowth is already present at 20–24 gestational weeks prior to diagnosis of gestational diabetes mellitus

Pharmacotherapy of Gestational Diabetes Mellitus: Current Recommendations

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