Recurrence of Gestational Diabetes Mellitus A systematic review

Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA.
Diabetes care (Impact Factor: 8.42). 06/2007; 30(5):1314-9. DOI: 10.2337/dc06-2517
Source: PubMed


The purpose of this study was to examine rates and factors associated with recurrence of gestational diabetes mellitus (GDM) among women with a history of GDM.
We conducted a systematic literature review of articles published between January 1965 and November 2006, in which recurrence rates of GDM among women with a history of GDM were reported. Factors abstracted included recurrence rates, time elapsed between pregnancies, race/ethnicity, diagnostic criteria, and, when available, maternal age, parity, weight or BMI at the initial and subsequent pregnancy, weight gain at the initial or subsequent pregnancy and between pregnancies, insulin use, gestational age at diagnosis, glucose tolerance test levels, baby birth weight and presence of macrosomia, and breast-feeding.
Of 45 articles identified, 13 studies were eligible for inclusion. After the index pregnancy, recurrence rates varied between 30 and 84%. Lower rates were found in non-Hispanic white (NHW) populations (30-37%), and higher rates were found in minority populations (52-69%). Exceptions to observed racial/ethnic variations in recurrence were found in cohorts that were composed of a significant proportion of both NHW and minority women or that included women who had subsequent pregnancies within 1 year. No other risk factors were consistently associated with recurrence of GDM across studies. The rates of future preexisting diabetes in pregnancy, socioeconomic status, postpartum diabetes screening rates after the index pregnancy, and the average length of time between pregnancies were generally not reported.
Recurrence of GDM was common and may vary most significantly by NHW versus minority race/ethnicity.

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    • "An increase in GDM prevalence in Europe of ~10% using the new diagnostic criteria as compared to 2-6% appreciated through classic criteria was reported. Numerous risk factors have been incriminated for the occurrence of GDM (Kim et al., 2007), but only maternal obesity and excess weight gain can be corrected. The estimate of the real prevalence of GDM and the identification of some susceptible to influence risk factors provide useful data for the establishment of prevention programs. "
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    ABSTRACT: An increase in prevalence of gestational diabetes mellitus (GDM) was observed using new diagnostic criteria. We evaluated the prevalence of GDM in a population of pregnant women (109 women with gestational age of 24-28 weeks) and risk factors for GDM, such as maternal obesity and weight gain. The evaluation of each patient included an oral glucose tolerance test (OGTT) using the new diagnostic criteria of the International Association of Diabetes and Pregnancy Study Groups (IADPSG) for GDM, 2D ultrasounds and the registration of risk factors. The prevalence of GDM in the age group >= 30 years was 11.9%, which is comparable to the results of other studies. The relative risk (RR) for GDM was 1.738 (95% CI 0.630-4.795) in women over 30 years and 3.782 (95% CI 1.127-12.686) in women over 35. Weight gain in the group with GDM was significantly higher than in the group that included pregnant women without GDM (p < 0.01). Considering the high risk of GDM with excessive gestational weight gain, educational nutrition programs should be established for the fertile-age population, not only to prevent obesity but also to prevent excessive weight gain during pregnancy.
    Preview · Article · Jan 2015 · Archives of Biological Sciences
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    • "Gestational diabetes mellitus (GDM) is characterised as any degree of glucose intolerance with first recognition during pregnancy. It is the most common type of diabetes found in pregnancy, affecting up to 14% of all pregnancies (Kim et al. 2007); the prevalence of GDM is increasing worldwide, in part due to the increased rates of obesity (Ferrara 2007). Of clinical significance, there are short-and long-term consequences for both mother and infant (Dabelea et al. 2000, Sobngwi et al. 2003), enhancing the susceptibility to a number of chronic diseases including obesity, diabetes, cardiovascular disease and certain cancers later in life. "
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    ABSTRACT: Maternal peripheral insulin resistance and increased inflammation are two features of pregnancies complicated by gestational diabetes mellitus (GDM). The nucleotide oligomerization domain (NOD) intracellular molecules recognise a wide range of microbial products as well as other intracellular danger signals, thereby initiating inflammation through activation of nuclear factor-κB. The aim of this study was to determine whether NOD1 and NOD2 are increased in adipose tissue from women with GDM. The effect of NOD1 and NOD2 activation on inflammation and the insulin signalling pathway was also assessed. NOD1, but not NOD2, expression was higher in omental and subcutaneous adipose tissue obtained from women with GDM when compared to women with normal glucose tolerance (NGT). In both omental and subcutaneous adipose tissue from NGT and GDM women, the NOD1 ligand iE-DAP significantly induced the expression and secretion of the pro-inflammatory cytokine IL-6 and chemokine IL-8; COX-2 gene expression and subsequent prostaglandin production; the expression and secretion of the extracellular matrix remodelling enzyme matrix metalloproteinase (MMP)-9; and the gene expression and secretion of the adhesion molecules ICAM-1 and VCAM-1. There was no effect of the NOD2 ligand MDP on any of the endpoints tested. The effects of the NOD1 ligand iE-DAP were mediated via NF-κB as the NF-κB inhibitor BAY 11-7082 significantly attenuated iE-DAP induced expression and secretion of pro-inflammatory cytokines, COX-2 gene expression and subsequent prostaglandin production, MMP-9 expression and secretion, and ICAM-1 and VCAM-1 gene expression and secretion. In conclusion, the present findings describe an important role for NOD1 in the development of insulin resistance and inflammation in pregnancies complicated by GDM.
    Preview · Article · May 2014 · Journal of Endocrinology
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    • "The rate of pregnancy outcomes also differs between Caucasian and Asian ethnicity. For example, preterm birth and macrosomia (Wong et al., 2008), recurrence of GDM in subsequent pregnancies (Kim et al., 2007) and later development of type 2 diabetes (Baptiste-Roberts et al., 2009) are all seen with higher frequency among Asian women with GDM. These facts strengthen the hypothesis that any approaches for the prevention and management of GDM may have greater impact in Asian populations. "
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    ABSTRACT: Abstract This review aims to evaluate the effectiveness of low glycemic index (GI) dietary intervention for the treatment of gestational diabetes mellitus (GDM), specifically from the Asian perspective. A systematic review of the literature using multiple databases without time restriction was conducted. Three studies were retrieved based upon a priori inclusion criteria. While there was a trend towards improvement, no significant differences were observed in overall glycemic control and pregnancy outcomes in GDM women. However, a tendency for lower birth weight and birth centile if the intervention began earlier was noted. Low GI diets were well accepted and had identical macro-micronutrient compositions as the control diets. However, due to genetic, environment and especially food pattern discrepancies between Western countries and Asians, these results may not be contributed to Asian context. Clearly, there are limited studies focusing on the effect of low GI dietary intervention in women with GDM, particularly in Asia.
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