[Show abstract][Hide abstract] ABSTRACT: Background & Aims: Breastfeeding improves glucose tolerance in the early postpartum period of women with prior gestational diabetes GDM, but it is unclear whether future risk of metabolic al-terations, like type 2 diabetes, is reduced. The aim of this study was to investigate the effect of lac-tation, three years after pregnancy, on glucose and lipid metabolism in women with prior gesta-tional diabetes. Materials & Methods: A population of women with prior gestational diabetes (Carpenter and Coustan Criteria) was evaluated with comparison of results for "lactating" [BF] versus "nonlactating women" [non BF]. Breast feeding was defined [BF] if lasting? 4 weeks. In each woman a 75-g oral glucose tolerance test (OGTT) was performed to analyze the glucose tolerance, insulin sensitivity/resistance and b-cell function. Fasting serum was used to study their lipid pro-file (total cholesterol, high-density lipoprotein [HDL] cholesterol, low-density lipoprotein [LDL] cholesterol, and triglycerides), apolipoprotein B, apolipoprotein A1, homocysteine, fibrinogen, hs-CRP, uric acid, microalbuminuria. Statistics: Paired and Un-paired t-test, Mann-Whitney and χ 2 tests were used, as appropriate. Results: A total of 81 women were evaluated (62 [BF] and 19 [non BF]). Maternal age (37.1 ± 4.6 vs 37.4 ± 4.9 years), body mass index (26.3 ± 5.6 vs 26.4 ± 5.3 kg/m 2), parity (1.9 ± 0.8 vs 1.7 ± 0.8) and length of follow-up (32.2 ± 20.2 vs 32.1 ± 20,0) were not different between the two groups. No effect was visible on glucose tolerance, HOMA-IR and other b-cell func-tion indexes as well as hs-CRP (not significantly lower in non BF), uric acid, total cholesterol, HDL and LDL cholesterol. Levels of significance were only reached for "HOMA-IS" [BF] 1.0 ± 0.7 vs [non BF] 0.6 ± 0.4, p = 0.04) and triglycerides [BF] 83.8 ± 46.7 vs [non BF] 123.2 ± 94.0 mg/dl, p = 0.02). Conclusions: Breastfeeding does not improve the glucose tolerance of our women with prior GDM three years after delivery, even though lower levels of triglycerides and improved insulin sensitiv-ity are still visible.
Journal of Diabetes Mellitus 10/2014; 4(4):257-263. DOI:10.4236/jdm.2014.44037
[Show abstract][Hide abstract] ABSTRACT: This study monitored blood glucose profiles in normotolerant breastfeeding women, with and without previous gestational diabetes, in real life in order to identify normal blood glucose fluctuations during breastfeeding.
Two groups were studied: (1) 18 women with recent gestational diabetes mellitus but normotolerant postpartum (pGDM-N group) and (2) 15 women normotolerant both during pregnancy and postpartum (pN-N group). All participants underwent continuous glucose monitoring during which they recorded their main daily activities and three standardized events: "suckling," "meal," and "meal and suckling." Other than these three events, these women were essentially on an "ad lib" diet. Data were expressed as median and SD values. Student's t test and Fisher's test were used to compare mean, variances, and percentages. Differences were significant with P<0.05. Clustering analysis was used to determine the normal range of glucose values.
The two groups were matched for age, follow-up duration, and monitoring measurements but not for body mass index. Blood glucose levels and variances were higher in the pGDM-N group, particularly during daytime and the three standardized events, and were not related to body mass index. Suckling had no direct effect on glucose profile during both the non-fed and the fed state. Blood glucose levels that best represent the normal breastfeeding population were between 50 and 126 mg/dL (from 2.8 to 7.0 mmol/L).
Three months after delivery, normotolerant women with recent gestational diabetes had higher daily blood glucose levels than women who were always normotolerant, with no direct effect of suckling. The blood glucose profiles of healthy subjects could be representative of the normal range of the population during breastfeeding.
[Show abstract][Hide abstract] ABSTRACT: Hypertensive disorders in pregnancy can be chronic, pregestational or just diagnosed before the 20th week, or newly diagnosed in the second half of pregnancy. Any type of hypertension is more frequent in diabetic pregnancies with a different distribution among different types of diabetes. Most of the evidence is for pre-eclampsia associated with a marked increase in primary caesarean section, preterm birth and more need for neonatal intensive care. Different risk factors and pregnancy outcomes would support the hypothesis that pre-eclampsia and gestational hypertension might be largely separate entities, but this position is not unanimously accepted. Chronic hypertension increases with age and duration of diabetes, predicting increased rates of prematurity and neonatal morbidity, especially when associated with superimposed pre-eclampsia. Long-term consequences are observed in women whose pregnancy was complicated by hypertension such as chronic hypertension and cardiovascular diseases.
Best Practice & Research: Clinical Endocrinology & Metabolism 08/2010; 24(4):635-51. DOI:10.1016/j.beem.2010.05.003 · 4.60 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In 2008, ADA provided new standards of care and recommendations including therapeutic actions favourably affecting health outcomes of patients with diabetes. In this context, Continuous Subcutaneous Insulin Infusion (CSII) becomes a great flexible therapeutic alternative, because of glucose sensors' availability, theoretical support and improved therapeutic decisions. However, there are no conclusive studies on the benefits of CSII in pregnancy. In particular, '80' randomized and controlled trials describe the pregnancy outcomes of few type 1 and type 2 diabetic patients. A recent Cochrane review, including 61 pregnancies concluded that there is no sufficient evidence to support any sort of insulin administration in diabetic pregnancy. Similar conclusions were reported by another review and a meta-analysis of 6 randomized and controlled trials on 213 subjects. No better results were obtained by recent retrospective studies. Doubts exist about CSII timing (before/and or after conception). Poor results are due to the inadequate patients selection, education, and abilities. Multi -centre studies are needed to verify the real utility of insulin pump during pregnancy, considering risks, costs and benefits including quality of life, in order to outline recommendations for an appropriate use. This review article also discussed some recent patents related to the field.
Recent Patents on Endocrine Metabolic & Immune Drug Discovery 06/2009; 3(2):150-153. DOI:10.2174/187221409788452327
[Show abstract][Hide abstract] ABSTRACT: Hypertension is one of the major complications of pregnancy. Its impact in type 2 diabetic pregnant women could be understimated because it is generally evaluated by retrospective studies and as one of the outcome measures.
Our aims were: 1) to evaluate the prevalence of hypertensive disease between type 2 diabetic and normal pregnancies; 2) to relate hypertensive disease to body weight in type 2 diabetic pregnancies; 3) to assess the impact of different types of hypertension on pregnancy outcome in type 2 diabetic women.
Seventy-six type 2 diabetic (23 normal-weight, 26 overweight and 27 obese) and sixty normal (43, 15 and 2 respectively; x (2) 0.0001) pregnancies, matched for age and smoking habit. Hypertension was defined as >/=140/90 mmHg and classified in chronic, gestational and pre-eclampsia.
Student's t-test, chi (2), simple, and/or multiple and logistic regression analysis were used when appropriate. Odds ratio was calculated for hypertension. p significant <0.05.
The overall prevalence of hypertension was 40.8% (18.4% chronic, 17.1% gestational and 5.3% pre-eclampsia) in type 2 diabetic pregnancies and 10% (8.3% gestational and 1.7% pre-eclampsia) in normal pregnancies (p<0.0001), with an odds ratio of 6.2. All the types of hypertension, significantly chronic, contributed to the higher prevalence. Only in diabetic pregnancies, hypertension was associated with a higher pregestational BMI; whenever BMI increased, chronic and gestational hypertension increased by contrast of pre-eclampsia (chi (2), 0.02). Hypertensive disorders did not affect maternal-fetal outcome.
The prevalence of hypertension was 40.8% in type 2 diabetic pregnant women whilst it was 10.0% in non diabetic controls. All hypertensive disorders, significantly chronic, were more frequent. Increasing BMI was a crucial factor for chronic and gestational but not for pre-eclampsia. Hypertensive diseases did not seem to affect pregnancy outcome.