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![Offspring 4-year BMI z-score by maternal pre-conception weight status and glucometabolic status in pregnancy and at delivery. Stratification of maternal groups was performed in enrolled mother-child pairs with offspring 4-year BMI z-scores according to the (A) pre-conception BMI group of 352 mothers, (B) positive or negative testing for GDM in 246 obese women, and (C) HbA 1c at delivery in 151 obese, GDM-negative women. Data are shown as median (horizontal lines within the boxes), 25th and 75th centile (lower and upper boundaries of the boxes), 1.5 times the interquartile range (whisker ends), and outliers (circles). Numerical values and dots within the boxes represent unadjusted mean 4-year BMI z-score of offspring. Differences between groups were tested using Student's t test. a According to the International Association of Diabetes and Pregnancy Study Groups criteria [18]. b](profile/Martha-Schutzmeier/publication/328590623/figure/fig2/AS:687249377226753@1540864428524/Offspring-4-year-BMI-z-score-by-maternal-pre-conception-weight-status-and-glucometabolic.jpg)
Offspring 4-year BMI z-score by maternal pre-conception weight status and glucometabolic status in pregnancy and at delivery. Stratification of maternal groups was performed in enrolled mother-child pairs with offspring 4-year BMI z-scores according to the (A) pre-conception BMI group of 352 mothers, (B) positive or negative testing for GDM in 246 obese women, and (C) HbA 1c at delivery in 151 obese, GDM-negative women. Data are shown as median (horizontal lines within the boxes), 25th and 75th centile (lower and upper boundaries of the boxes), 1.5 times the interquartile range (whisker ends), and outliers (circles). Numerical values and dots within the boxes represent unadjusted mean 4-year BMI z-score of offspring. Differences between groups were tested using Student's t test. a According to the International Association of Diabetes and Pregnancy Study Groups criteria [18]. b
Source publication
Background:
Maternal pre-conception obesity is a strong risk factor for childhood overweight. However, prenatal mechanisms and their effects in susceptible gestational periods that contribute to this risk are not well understood. We aimed to assess the impact of late-pregnancy dysglycemia in obese pregnancies with negative testing for gestational...
Citations
... One study focused on maternal risk for T2DM and child's cognitive abilities (74). Another assessed the relationship between late-pregnancy dysglycemia in obese pregnant women and childhood weight gain (75). One study investigated maternal obesity before pregnancy and child cognitive development (76), and one study examined the effects of maternal preeclampsia and gestational hypertension on childhood and adolescent behavioural problems (77). ...
Background
Recent research in life course epidemiology has demonstrated the importance of evaluating how prepregnancy and pregnancy exposures affect later life developmental outcomes. In this scoping review, we identified and described completed or ongoing pregnancy and prepregnancy cohorts to assess gaps in the maternal exposures and child outcomes measured in these initiatives and inform future research investments.
Methods
We developed a systematic search that included text and MeSH terms and was tailored for four biomedical citation databases. We applied the Arskey and O’Malley scoping review methodology. We selected a scoping review methodology to provide a comprehensive overview of pregnancy and prepregnancy cohorts and their characteristics. Two reviewers independently conducted the title, abstract, full-text screening, and data charting; a third reviewer resolved discrepancies. The results were summarised in narrative form.
Results
We reviewed 147 manuscripts that presented findings from 56 pregnancy and two prepregnancy cohorts, 23 of which were ongoing. Half of the pregnancy cohorts were based in Europe. The most commonly described maternal exposures were nutrition, anthropometric measures, non-communicable diseases (NCDs), and demographic factors. Children’s mental, behavioural, neurodevelopmental, and physical outcomes were the most commonly measured outcomes. Fewer studies evaluated infectious disease, biomarkers, and environmental or workplace exposures. No cohorts examined vaccine or climate-related exposures during pregnancy. About half of the cohorts collected samples from pregnant women or the fetus and a third from children, with blood being the most common sample type. Most studies did not indicate how data or samples could be accessed.
Conclusions
This comprehensive overview of pregnancy and prepregnancy cohorts provides a foundation for cross-cohort coordination. Infectious disease, vaccine, environmental, and climate related exposures and microbiome, immune function, and economic outcomes remain underrepresented in pregnancy and prepregnancy cohorts.
... The global prevalence of GDM reached 16.7% in 2021 [2], primarily due to rising pregnancies at advanced maternal age and in obese women. GDM poses a significant challenge to maternal and infant health [3][4][5]. While most women with GDM return to normal glycemia after delivery, 14.6% to 43% develop glucose intolerance within 6-12 weeks postpartum [6][7][8]. ...
The objective of this scoping review was to investigate the effectiveness and limitations of risk prediction models for postpartum glucose intolerance in women with gestational diabetes mellitus (GDM). The aim was to provide valuable insights for healthcare professionals in the development of robust risk prediction models.
A comprehensive literature search was conducted across multiple databases, including PubMed, EBSCO, Web of Science Core Collection, Ovid Full-Text Medical Journal Database, ProQuest, Elsevier ClinicalKey, China National Knowledge Infrastructure, China Biology Medicine, and WanFang Database, spanning from January 1990 to July 2023. To assess the quality of the included models, the Predictive Model Risk of Bias Assessment Tool (PROBAST) was employed.
Fourteen relevant studies were identified and included in the final review, all focusing on model development. The discrimination ability of the included models ranged from 0.725 to 0.940, indicating satisfactory prediction accuracy. However, a notable limitation was that nine of these models (64.3%) did not provide clear guidelines on the selection of potential predictors. Furthermore, only six models (42.86%) underwent internal validation, with none undergoing external validation. A high risk of bias was observed across the included models. Logistic regression, Cox regression, and machine learning were the primary methods employed in the construction of these models.
The risk prediction models included in this review demonstrated favorable prediction accuracy. However, due to variations in construction methodologies, direct comparison of their performance is challenging. These models exhibited certain shortcomings, such as inadequate handling of missing data and a lack of internal and external validation, resulting in a high risk of bias. Therefore, it is recommended that these models be updated and externally validated. The development of prospective, multi-center studies is encouraged to construct predictive models with low risk of bias and high clinical applicability, ultimately guiding evidence-based clinical practice.
... A recent study revealed that HbA1c ≥5.7% during pregnancy indicated impaired b-cell function and pathophysiological dysfunction of glucose disposal (36). Late-pregnancy HbA1c at or above 5.7% in obese non-GDM pregnancies posed long-term health risks to the offspring and mother (16,37). When the cut-off value for HbA1c in this study was set at 5.7%, we also found that high HbA1c was an independent risk factor for pre-eclampsia and gestational hypertension in women with GDM. ...
Background
Metabolic diseases during pregnancy result in negative consequences for mothers. Pre-pregnancy body mass index (BMI) and late-pregnancy glycated-hemoglobin (HbA1c) are most important factors independently affecting the risk of gestational diabetes mellitus (GDM). However how both affect the combined risk of other metabolic diseases in women with GDM is unclear. The study aims to investigate the influence of pre-pregnancy BMI and pregnancy glycemic levels on other gestational metabolic diseases in women with GDM.
Methods
Pregnancies with GDM from January 2015 to December 2018 in the Xi’an longitudinal mother-child cohort study (XAMC) were retrospectively enrolled. Those without other metabolic diseases by the time of oral glucose tolerance test (OGTT) detection were finally recruited and divided into four groups by pre-pregnancy BMI (Underweight <18.5kg/m ² ; Normal weight 18.5-23.9 kg/m ² ; Overweight 24.0-27.9 kg/m ² ; Obesity ≥28.0 kg/m ² , respectively) or two groups by HbA1c in late pregnancy (normal HbA1c<5.7%; high HbA1c≥5.7%). Multivariate logistic regression analysis was used to identify risk factors. Interaction between pre-pregnancy BMI (reference group 18.5-23.9 kg/m ² ) and HbA1c (reference group <5.7%) was determined using strata-specific analysis.
Results
A total of 8928 subjects with GDM were included, 16.2% of which had a composite of metabolic diseases. The pre-pregnancy overweight and obesity, compared with normal BMI, were linked to the elevated risk of the composite of metabolic diseases, particularly pre-eclampsia (both P <0.001) and gestational hypertension (both P <0.001). Meanwhile, patients with high HbA1c had an obvious higher risk of pre-eclampsia ( P < 0.001) and gestational hypertension ( P = 0.005) compared to those with normal HbA1c. In addition, there were significant interactions between pre-pregnancy BMI and HbA1c ( P < 0.001). The OR of pre-pregnancy BMI≥ 28 kg/m ² and HbA1c≥ 5.7% was 4.46 (95% CI: 2.85, 6.99; P < 0.001). The risk of other metabolic diseases, except for pre-eclampsia ( P = 0.003), was comparable between the two groups of patients with different HbA1c levels at normal pre-pregnancy BMI group. However, that was remarkably elevated in obese patients ( P = 0.004), particularly the risk of gestational hypertension ( P = 0.004).
Conclusion
Pre-pregnancy overweight/obesity and late-pregnancy high HbA1c increased the risk of other gestational metabolic diseases of women with GDM. Monitoring and controlling late-pregnancy HbA1c was effective in reducing metabolic diseases, particularly in those who were overweight/obese before conception.
... In der Mutter-Kind-Kohorte PEACHES lagen bei mehr als 1/3 der Schwangeren mit Adipositas bei der Geburt hohe Werte für das glykierte Hämoglobin (HbA1c ≥ 5,7 %) vor, die eine Dysglykämie im 3. Trimenon reflektierten, obwohl zuvor ein Gestationsdiabetes (GDM) ausgeschlossen worden war [8,9]. Bei den Nachkommen dieser Schwangeren fand sich im Alter von 4 Jahren ein höherer Body-Mass-Index(BMI)-z-Score der Kinder [10]. ...
... Generationsübergreifende sog. Programmierungszusammenhänge wurden inzwischen anhand tierexperimenteller Studien und epidemiologischer Datensätze untersucht [10,13,[15][16][17]. ...
... There is also emerging evidence of a dose-dependent effect of maternal hyperglycaemia upon offspring obesity, with risk increasing proportionately with maternal glucose concentrations in pre-gestational and gestational diabetes [11,14]. This dosedependent effect is also evident in pregnancies with lower levels of hyperglycaemia in pregnancy, below the diagnostic thresholds for gestational diabetes [18,19], with elevated obesity rates in affected offspring, even after adjustment for maternal BMI. A sibling study suggests that the effect of maternal hyperglycaemia upon offspring obesity risk is likely to be primarily a developmental effect [15]. ...
... Although type 1, type 2 and gestational diabetes have distinct mechanistic causes, they all demonstrate similar associations with childhood obesity, broadly proportionate to the severity of hyperglycaemia in pregnancy [11,14,18,19]. This suggests that there is a common pathway to childhood obesity, regardless of diabetes aetiology. ...
... Preventing maternal diabetes would be the optimal approach, but there is currently no clear way to prevent gestational diabetes, as trials of lifestyle interventions in pregnancy have had variable results [66,67]. Effective treatment of gestational diabetes is a helpful contribution to reducing child obesity [19]. The Programming of Enhanced Adiposity Risk in Childhood-Early Screening (PEACHES) study identified that offspring obesity risk was lower in women treated for gestational diabetes, compared with untreated women with hyperglycaemia [19]. ...
Diabetes in pregnancy affects 20 million women per year and is associated with increased risk of obesity in offspring, leading to insulin resistance and cardiometabolic disease. Despite the substantial public health ramifications, relatively little is known about the pathophysiological mechanisms underlying obesity in these high-risk children, which creates a barrier to successful intervention. While maternal glucose itself is undeniably a major stimulus upon intrauterine growth, the degree of offspring hyperinsulinism and disturbed lipid metabolism in mothers and offspring are also likely to be implicated in the disease process. The aim of this review is to summarise current understanding of the pathophysiology of childhood obesity after intrauterine exposure to maternal hyperglycaemia and to highlight possible opportunities for intervention. I present here a new unified hypothesis for the pathophysiology of childhood obesity in infants born to mothers with diabetes, which involves self-perpetuating twin cycles of pancreatic beta cell hyperfunction and altered lipid metabolism, both acutely and chronically upregulated by intrauterine exposure to maternal hyperglycaemia.
Graphical Abstract
... Women who enter pregnancy with a healthy body mass index (BMI between 18.5 and 24.9 kg/m 2 ) are at a lower risk for adverse pregnancy outcomes such as pre-eclampsia, gestational diabetes, large or small for gestational age (LGA or SGA), and stillbirths (4)(5)(6)(7). Poor maternal nutrition also has long-term implications for the offspring health by placing them at increased risk of diabetes, hypertension, hypercholesterolemia and heart disease later in life (8)(9)(10)(11)(12). ...
Background
There is limited evidence from prospective cohorts in low-resource settings on the long-term impact of pre-pregnancy body mass index (PPBMI) and gestational weight gain (GWG) on postpartum weight retention (PPWR) and maternal and child body composition.
Objectives
We examined the associations between PPBMI and timing of GWG on PPWR at 1, 2, and 6–7 years and maternal and child percent body fat at 6–7 years.
Methods
We used data from the PRECONCEPT study (NCT01665378) that included prospectively collected data on 864 mother–child pairs from preconception through 6–7 years postpartum. The key outcomes were PPWR at 1, 2, and 6–7 years, and maternal and child percent body fat at 6–7 years that was measured using bioelectric impedance. Maternal conditional GWG (CGWG) was defined as window-specific weight gains (< 20wk, 21-29wk, and ≥ 30wk), uncorrelated with PPBMI and all prior body weights. PPBMI and CGWG were calculated as standardized z-scores to allow for relative comparisons of a 1 standard deviation (SD) increase in weight gain for each window. We used multivariable linear regressions to examine the associations, adjusting for baseline demographic characteristics, intervention, breastfeeding practices, diet and physical activity.
Results
Mean (SD) PPBMI and GWG were 19.7 (2.1) kg/m² and 10.2 (4.0) kg, respectively. Average PPWR at 1, 2, and 6–7 years was 1.1, 1.5 and 4.3 kg, respectively. A one SD increase in PPBMI was associated with a decrease in PPWR at 1 year (β [95% CI]: −0.21 [−0.37, −0.04]) and 2 years (−0.20 [−0.39, −0.01]); while a one SD in total CGWG was associated with an increase in PPWR at 1 year (1.01 [0.85,1.18]), 2 years (0.95 [0.76, 1.15]) and 6–7 years (1.05 [0.76, 1.34]). Early CGWG (< 20 weeks) had the greatest association with PPWR at each time point as well as with maternal (0.67 [0.07, 0.87]) and child (0.42 [0.15, 0.69]) percent body fat at 6–7 years.
Conclusion
Maternal nutrition before and during pregnancy may have long-term implications for PPWR and body composition. Interventions should consider targeting women preconception and early in pregnancy to optimize maternal and child health outcomes.
... Adequate energy and nutrient intake during pregnancy is essential to prevent excessive or suboptimal weight gain and related adverse outcomes. Excessive gestational weight gain and obesity are associated with the development of maternal diabetes and child overweight [137], while higher rates of low birthweight and neonatal/intrauterine mortality can result from inadequate weight gain [130,138]. Maternal diet should be supplemented as necessary during pregnancy with protein, fat and vitamins (e.g. ...
Obesity is a chronic metabolic disease that has become one of the leading causes of disability and death in the world, affecting not only adults but also children and adolescents. In Iraq, one third of the adult population is overweight and another third obese. Clinical diagnosis is accomplished by measuring body mass index (BMI) and waist circumference (a marker for intra-visceral fat and higher metabolic and cardiovascular disease risk). A complex interaction between behavioral, social (rapid urbanization), environmental and genetic factors underlies the etiology of the disease. Treatment options for obesity may include a multicomponent approach, involving dietary changes to reduce calorie intake, an increase in physical activity, behavioral modification, pharmacotherapy and bariatric surgery. The purpose for these recommendations is to develop a management plan and standards of care that are relevant to the Iraqi population and that can prevent/manage obesity and obesity-related complications , for the promotion of a healthy community. ARTICLE HISTORY
... Common adverse pregnancy outcomes in GDM include preeclampsia, preterm delivery, surgical delivery, obstructed shoulder delivery, fetal overgrowth, neonatal hypoglycemia, jaundice, and perinatal mortality [3][4][5]. In addition, maternal diabetes may be an important factor in obesity and increased incidence of diabetes in themselves or the next generation [4,6]. However, the most common factors for GDM include being overweight or obese, family history of diabetes, hypothyroidism, sleep apnea, and polycystic ovary syndrome [7][8][9]. ...
Observational studies suggest that the potential role of magnesium remains controversial in gestational diabetes mellitus (GDM). This meta-analysis aims to consolidate the available information from observational studies that have focused on the relationship between magnesium levels and GDM. A systematic and comprehensive literature search was conducted in PubMed, Embase, Web of Science, CNKI, and Wanfang databases. Data were extracted independently by two investigators. Standardized mean differences (SMD) and 95% confidence intervals (CIs) were used to summarize the circulating magnesium levels (CI). This meta-analysis included a total of 17 studies involving 2858 participants including 1404 GDM cases and 1454 healthy controls, which showed that magnesium levels were significantly lower in GDM compared to healthy controls (SMD: − 0.35; 95% CI: − 0.62, − 0.07, P = 0.013). Likewise, the same phenomenon was observed in the third trimester (SMD = − 1.07; 95% CI: − 1.84 to − 0.29, P = 0.007). Other subgroup analyses revealed that this trend of decreasing magnesium concentration was only observed in Europeans (SMD = − 0.64; 95% CI: − 0.90, − 0.38, P < 0.0001). This meta-analysis revealed that serum magnesium levels were lower in patients with GDM than in healthy pregnant women, and this discrepancy was most pronounced in European populations and during the third trimester. Nevertheless, current evidence suggests that circulating magnesium deficiency is associated with gestational diabetes; the challenge for the future is to further elucidate the possible benefits of preventing gestational diabetes through magnesium supplementation.
... The early proposal by Pedersen [54] implicating intrauterine hyperglycemia in pregnancy in offspring obesity and T2DM risk has gained support in recent decades through epidemiological and prospective birth studies. Human observational studies have shown an increased birthweight and neonatal fat mass [55,56], abdominal adiposity [57], and overweight and obesity in those offspring exposed to maternal hyperglycemia and GDM [58][59][60][61][62][63]. A seminal study of sibships in the Akimal O' odam (Pima) population comparing offspring born before and after a diagnosis of maternal diabetes revealed an increased risk of childhood obesity with maternal diabetes exposure independent of shared genetics and environment [64]. ...
Gestational diabetes mellitus (GDM) has historically been perceived as a medical complication of pregnancy that also serves as a harbinger of maternal risk of developing type 2 diabetes mellitus (T2DM) in the future. In recent decades, a growing body of evidence has detailed additional lifelong implications that extend beyond T2DM, including an elevated risk of ultimately developing cardiovascular disease. Furthermore, the risk factors that mediate this lifetime cardiovascular risk are evident not only after delivery but are present even before the pregnancy in which GDM is first diagnosed. The concept thus emerging from these data is that the diagnosis of GDM enables the identification of women who are already on an enhanced track of cardiometabolic risk that starts early in life. Studies of the offspring of pregnancies complicated by diabetes now suggest that the earliest underpinnings of this cardiometabolic risk profile may be determined in utero and may first manifest clinically in childhood. Accordingly, from this perspective, GDM is now seen as a chronic metabolic disorder that holds implications across the life span of both mother and child.
... Нині спостерігають збільшення поширеності ГЦД на тлі надмірної маси тіла та ожиріння [4]. З'ясовано роль кількох чинників ризику розвитку ГЦД, таких як ожиріння, наявність цукрового діабету 2 типу в родині, вік матері [5], але значення інших чинників ризику остаточно не встановлено. ...
У світі спостерігається підвищення частоти гестаційного цукрового діабету (ГЦД) на тлі різкого зростання надмірної маси тіла та ожиріння. Гестаційний цукровий діабет має негативні найближчі та віддалені наслідки для здоров’я жінок та їхнього потомства. З’ясовано роль кількох чинників ризику розвитку ГЦД, таких як ожиріння, наявність цукрового діабету 2 типу в родині, вік матері. Однак значення інших чинників ризику остаточно не визначено. Оскільки ГЦД асоціюється з посиленням резистентності до інсуліну в периферичних тканинах, розглядають можливу участь дефіциту вітаміну D у патогенезі ГЦД. Мета роботи — дослідити взаємозв’язок між дефіцитом вітаміну D у сироватці крові впродовж першого триместру вагітності та ризиком розвитку ГЦД в третьому триместрі. Матеріали та методи. Проведено проспективне дослідження за участю 68 вагітних, обстежених у першому триместрі (6 — 13 тиж вагітності), з них 52 взяли участь у скринінгу ГЦД у третьому триместрі (24 — 28 тиж вагітності). Визначали рівень вітаміну D у сироватці крові, біохімічні, антропометричні параметри. Використовували метод логістичної регресії для аналізу зв’язків між дефіцитом вітаміну D і виникненням ГЦД. Результати. Дефіцит вітаміну D (< 20 нг/мл) у першому триместрі зареєстровано у 42 (61,8 %) вагітних. У третьому триместрі в 14 (26,9 %) вагітних діагностовано ГЦД за результатами перорального тесту на толерантність до глюкози, з них у 11 вагітних, які мали дефіцит вітаміну D у першому триместрі. Ризик ГЦД був статистично значущо вищим у жінок з дефіцитом вітаміну D порівняно з вагітними з нормальним його рівнем (відносний ризик — 6,67; p < 0,001, 95 % довірчий інтервал — 3,56 — 15,57). Цей ризик значно підвищувався після внесення поправок на вік, кількість вагітностей, величину індексу маси тіла, наявність цукрового діабету у родині (відносний ризик — 10,4; p < 0,001, 95 % довірчий інтервал — 2,82 — 39,76). Висновки. Дефіцит вітаміну D у першому триместрі статистично значущо збільшує ризик виникнення ГЦД.
