Gestational Diabetes Mellitus: Perspectives on Lifestyle Changes during Pregnancy and Post-partum, Physical Activity and the Prevention of Future Type 2 Diabetes

2008 ◽  
Vol 14 (3) ◽  
pp. 85 ◽  
Author(s):  
Frances Doran
Keyword(s):  
Physical Activity ◽  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Post Partum ◽  
Oral Glucose ◽  
The Impact

This paper reports on a mixed methods study which sought to explore the role of physical activity in relation to the management of gestational diabetes mellitus (GDM); the impact of a diagnosis of GDM on a woman?s life; follow-up support and factors that both hinder and support women to engage in physical activity post-partum in order to reduce their risk of developing future type 2 diabetes. Thirty-eight women who had a pregnancy complicated by GDM completed surveys. In-depth interviews were then conducted with a subset of eight women who completed these surveys, to further explore their experiences. Women reported making changes to their lifestyle to improve diet and engage in physical activity during pregnancy. These changes were harder to sustain after the baby was born. In this study few women underwent the recommended six-weekly oral glucose tolerance testing, and post-partum follow-up support was virtually non-existent. There is a clear role for health promotion across a number of sectors to support sustained behaviour change in this high-risk group of women. Factors are identified that could enhance follow-up support, particularly for lifestyle change.

scholarly journals Circulating progranulin levels in women with gestational diabetes mellitus and healthy controls during and after pregnancy

2012 ◽  
Vol 167 (4) ◽  
pp. 561-567 ◽  
Author(s):  
Jelena Todoric ◽  
Ammon Handisurya ◽  
Thomas Perkmann ◽  
Bernhard Knapp ◽  
Oswald Wagner ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Gestational Diabetes ◽  
Glucose Tolerance ◽  
Gestational Diabetes Mellitus ◽  
Pregnant Women ◽  
Post Partum ◽  
Oral Glucose ◽  
Positive Correlation

ObjectiveProgranulin (PGRN) was recently introduced as a novel marker of chronic inflammatory response in obesity and type 2 diabetes capable of directly affecting the insulin signaling pathway. This study aimed to investigate the role of PGRN in gestational diabetes mellitus (GDM), which is regarded as a model for early type 2 diabetes.MethodsPGRN serum levels were measured in 90 pregnant women (45 GDM and 45 normal glucose tolerance (NGT)). In addition, PGRN was measured during a 2-h, 75 g oral glucose tolerance test in 20 pregnant women (ten GDM and ten NGT) and in 16 of them post partum (ten GDM and six NGT).ResultsPGRN concentrations were significantly higher in pregnant women compared with post partum levels (536.79±31.81 vs 241.53±8.86, P<0.001). Multivariate regression analyses showed a strong positive correlation of PGRN with estrogen and progesterone. The insulinogenic index, a marker of early insulin secretion, displayed a positive correlation with PGRN, both during and after pregnancy (R=0.47, P=0.034; R=0.63, P=0.012). HbA1c and the oral glucose insulin sensitivity index showed significant post partum associations with PGRN (R=0.43, P=0.049; R=−0.65, P=0.009).ConclusionsPGRN concentrations are markedly lower after pregnancy regardless of the gestational glucose tolerance state. PGRN levels per se do not discriminate between mild GDM and NGT in pregnant women. Therefore, the development of GDM appears to be due to impaired β-cell function that is not related to PGRN effect.

scholarly journals Gestational Diabetes Mellitus and the Risks of Overall and Type-Specific Cardiovascular Diseases: A Population- and Sibling-Matched Cohort Study

2021 ◽  
Author(s):  
Yongfu Yu ◽  
Melissa Soohoo ◽  
Henrik Toft Sørensen ◽  
Jiong Li ◽  
Onyebuchi A. Arah
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Cohort Study ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Cox Regression ◽  
Maternal History ◽  
History Of ◽  
The Impact

<b>OBJECTIVE</b> <p>To evaluate associations between gestational diabetes mellitus (GDM) and various incident cardiovascular disease (CVD) endpoints, considering the effects of mediating role of type 2 diabetes and shared environmental/familial factors.</p> <p><b>RESEARCH DESIGN AND METHODS</b></p> <p>This population-based cohort study included 1002486 parous women in Denmark during 1978-2016. We used Cox regression to (i) examine the associations of GDM with overall and type-specific CVDs using full-cohort and sibling-matched analysis; (ii) quantify the impact of type 2 diabetes after GDM using mediation analysis; and (iii) assess whether these associations were modified by pre-pregnancy obesity or maternal history of CVD.</p> <p><b>RESULTS</b></p> <p>Women with a history of GDM had a 40% increased overall CVD risk (hazard ratio [HR]: 1.40, 95% confidence interval [CI]: 1.35-1.45). Sibling-matched analyses yielded similar results(HR, 1.44; 95%CI, 1.28-1.62). Proportion of association between GDM and overall CVD explained by subsequent type 2 diabetes was 23.3%(15.4%-32.8%). We observed increased risks of specific CVDs, including 65% increased stroke risk and more than two-fold risks for myocardial infarction, heart failure, and peripheral artery disease. The elevated overall risks were more pronounced among women with GDM and pre-pregnancy obesity or maternal history of CVD. </p> <p><b>CONCLUSIONS</b></p> <p>A history of GDM was associated with increased risks of overall and specific CVDs. Increased risks were partly explained by subsequent type 2 diabetes and the need to identify other pathways remains important. Continuous monitoring of women with a history of GDM, especially those with pre-pregnancy obesity or maternal history of CVD, may provide better opportunities to reduce their cardiovascular risk.</p>

scholarly journals Gestational Diabetes Mellitus and the Risks of Overall and Type-Specific Cardiovascular Diseases: A Population- and Sibling-Matched Cohort Study

2021 ◽  
Author(s):  
Yongfu Yu ◽  
Melissa Soohoo ◽  
Henrik Toft Sørensen ◽  
Jiong Li ◽  
Onyebuchi A. Arah
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Cohort Study ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Cox Regression ◽  
Maternal History ◽  
History Of ◽  
The Impact

<b>OBJECTIVE</b> <p>To evaluate associations between gestational diabetes mellitus (GDM) and various incident cardiovascular disease (CVD) endpoints, considering the effects of mediating role of type 2 diabetes and shared environmental/familial factors.</p> <p><b>RESEARCH DESIGN AND METHODS</b></p> <p>This population-based cohort study included 1002486 parous women in Denmark during 1978-2016. We used Cox regression to (i) examine the associations of GDM with overall and type-specific CVDs using full-cohort and sibling-matched analysis; (ii) quantify the impact of type 2 diabetes after GDM using mediation analysis; and (iii) assess whether these associations were modified by pre-pregnancy obesity or maternal history of CVD.</p> <p><b>RESULTS</b></p> <p>Women with a history of GDM had a 40% increased overall CVD risk (hazard ratio [HR]: 1.40, 95% confidence interval [CI]: 1.35-1.45). Sibling-matched analyses yielded similar results(HR, 1.44; 95%CI, 1.28-1.62). Proportion of association between GDM and overall CVD explained by subsequent type 2 diabetes was 23.3%(15.4%-32.8%). We observed increased risks of specific CVDs, including 65% increased stroke risk and more than two-fold risks for myocardial infarction, heart failure, and peripheral artery disease. The elevated overall risks were more pronounced among women with GDM and pre-pregnancy obesity or maternal history of CVD. </p> <p><b>CONCLUSIONS</b></p> <p>A history of GDM was associated with increased risks of overall and specific CVDs. Increased risks were partly explained by subsequent type 2 diabetes and the need to identify other pathways remains important. Continuous monitoring of women with a history of GDM, especially those with pre-pregnancy obesity or maternal history of CVD, may provide better opportunities to reduce their cardiovascular risk.</p>

scholarly journals Continuing Challenges in The Medical Management of Gestational Diabetes Mellitus

EMJ Diabetes ◽  
2020 ◽  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
High Risk ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Diabetes In Pregnancy ◽  
In Pregnancy

The management of gestational diabetes mellitus (GDM) involves screening (or universal testing), a diagnostic oral glucose tolerance test, patient counselling/education, gestational weight management and medical nutrition therapy, and self-monitoring of blood glucose levels with regular glycaemia reviews. This is in addition to pharmacological treatment, often insulin therapy, if glycaemia is above target. Females with GDM receive more frequent ultrasound testing to assess fetal growth, and birth is planned and not usually allowed to go much past term. A range of challenges continue to arise in GDM management including screening approaches and diagnostic criteria, dealing with the increasing numbers of females diagnosed, weight and glycaemic targets, the long-term safety of oral antihyperglycaemic agents for the offspring, particularly metformin, and adjunct medication for complication prevention. GDM management involves additional complexities including differentiating between those with likely undiagnosed Type 2 diabetes mellitus (diabetes in pregnancy), how to manage females with high glucose early in pregnancy less than diabetes in pregnancy, and identifying females with rare causes, for example monogenic diabetes or new Type 1 diabetes mellitus in pregnancy. While the management of GDM has evolved from identifying females at high risk of progressing to Type 2 diabetes mellitus, to greater focus on improving pregnancy outcomes, females with prior GDM and their offspring have the highest need for follow-up and prevention strategies. To date, follow-up and intervention remains limited for this high-risk group for both diabetes and cardiovascular disease. Follow-up in these females is particularly important for the next pregnancy, especially as GDM prevention from the second trimester onwards remains another continuing challenge.

scholarly journals Nomograms for incident risk of post-partum type 2 diabetes in Chinese women with prior gestational diabetes mellitus

2018 ◽  
Vol 90 (3) ◽  
pp. 417-424 ◽  
Author(s):  
Weiqin Li ◽  
Junhong Leng ◽  
Huikun Liu ◽  
Shuang Zhang ◽  
Leishen Wang ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Chinese Women ◽  
Post Partum
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