Objective Based on the methodology of evidence-based medicine, we explored the prognosis of a patient with gestational diabetes mellitus (GDM). Methods We searched ACP Journal Club (1991 to October 2006), The Cochrane Library (Issue 4, 2006), MEDLINE (1990 to October 2006) and Chinese Biomedicine database (CBM). Cohort studies, case-control studies and case series studies involving the prognosis of patients with GDM were collected. The available evidence was critically appraised. Results During the period from 6 weeks to 28 years after delivery, the incidence of type 2 diabetes mellitus appeared to vary from 2.6% to 70%. Patients with GDM suffered from an increased incidence of spontaneous premature delivery, hypertension, metabolic syndrome and vaginal infection. Conclusion Patients with GDM appears to be more liable to overt diabetes mellitus, and to suffer fromspontaneous premature delivery, hypertension, metabolic syndrome and vaginal infection than women with normal glucose tolerance during pregnancy. Further studies of the long-term follow-up data from GDM trials are needed.
ObjectiveTo explore the relationship between the diet during pregnancy and gestational diabetes mellitus (GDM), and analyze the effect of GDM on weight gain, outcome and complication of mother and infant. MethodsWe selected 128 GDM pregnant women and 267 non-GDM pregnant women who were investigated by semi-quantitative food frequency method during September 2009 to March 2011. Then, we collected relevant information and the data were analyzed by t-test and chi-square test. ResultsThere were statistically significant differences between the two groups in total calorie, carbohydrate, fat and protein intakes per day (P<0.05). In general, the rates of insufficient weight gain and excessive weight gain during pregnancy in the GDM group were significantly higher than the non-GDM group (P<0.05), while proper weight gain rate was significantly lower (P<0.01). The risk of hydramnion, intrahepatic cholestasis and pregnancy-induced hypertension in the GDM group was significantly higher than the non-GDM group (P<0.05), while there was no significant difference between the two groups in premature delivery, cesarean section or premature membrane ruptures (P>0.05). Apgar scores were significantly different at minute 1 and 5 between the infants in the two groups (P<0.05). The incidence of fetal death, malformation, mild neonatal asphyxia and fetal macrosomia in the GDM group was significantly higher than the non-GDM group (P<0.05). No significant differences between the two groups in low birth weight infant, cord entanglement and fetal distress were detected (P>0.05). ConclusionGDM can lead to high incidence of poor outcome and complication. It is vital to strengthen the examination and keep balanced dietary structure, in order to reduce the complication and improve the health of mother and child.
ObjectiveTo establish a model of fetal hyperglycemia and explore the effects of hyperglycemia on alveolar cell apoptosis,proliferation and the development of lung structure in neonatal rats. MethodsForty SD pregnant rats were randomly divided into a hyperglycemia group (STZ group) and a normal pregnancy group (N group)(n=20 in each group). The rats in STZ group and N group were intraperitoneally injected streptozotocin(STZ,40 mg/kg) or the same bulk of citrate buffer respectively at the 4.5 days after gestation. Blood glucose concentration of the pregnant rats was measured before injection,at the 6.5,11.5,16.5 and 20.5 days after gestation,respectively. The weight,survival rate,lung weight,septal thickness,radical alveolar count,alveolar cell apoptosis and proliferation of neonatal rats were recorded after birth immediately (D0) and at 7 days (D7). ResultsCompared with N group,the blood glucose level increased after intraperitoneal injection of STZ in STZ group (P<0.05). The Survival rate of STZ group was lower than that of N group at D0 and D7 (P=0.00). The neonatal weight,lung weight,septal thickness of STZ group were lower compared with those of N group at D0(P<0.05). However,there was no significant difference between two groups in radical alveolar count. The alveolar apoptosis index of STZ group was higher than that of N group at D0 [(11.8±1.1)% vs. (3.4±0.7)%,P=0.00]. Alveolar cell proliferation significantly increased in STZ group compared with N group at D0 and D7 (P<0.05). ConclusionsThe fetal hyperglycemia model is successfully established by intraperitoneal injection of STZ 40 mg/kg. Fetal hyperglycemia can increase mortality,alveolar cell proliferation and apoptosis,and affect the development of lung structure of neonatal rats.
Objective To guide blood glucose management during pregnancy and reduce the incidence of long-term complications of the fetus by exploring the long-term growth condition of offspring of pregnant women with gestational diabetes mellitus. Methods A total of 180 cases full-term newborns of pregnant women with gestational diabetes mellitus from December 25th, 2011 to December 25th, 2012 were selected as the diabetes group. Another 200 newborns of pregnant women without any complications were randomly collected as the control group. Birth weight, gestational age, sex, blood glucose, and 24-, 48-, 72- and 120-hour transcutaneous bilirubin value after the birth of the newborns were recorded; weight, height, body mass index (BMI), triglycerides, total cholesterol, high density lipoprotein (HDL), low density lipoprotein, blood pressure and fasting plasma glucose quota between the two groups were contrasted when the children were three years old. Results There were no significant difference in the birth weight, gestational age and sex between the diabetic and the control group. The blood glucose levels of the newborns in the diabetic group was significantly lower than that in the control group (P<0.05). The 24-, 48-, 72- and 120-hour transcutaneous bilirubin values of the newborns in the diabetic group were significantly higher than those of the control group (P<0.05). The weight, height and BMI of the three years old offspring in the diabetic group were significantly higher than those in the control group (P<0.05). There were no significant difference in triglycerides, total cholesterol, HDL, Low density lipoprotein, fasting plasma glucose quota, and systolic blood pressure between the diabetic group and the control group (P>0.05), but the diastolic blood pressure in the diabetic group was much higher than that in the control group (P<0.05). Conclusion The impact of gestational diabetes mellitus on offspring of pregnant women was not only in the fetus and newborn period, but also in the future, which should be timely intervened.
ObjectiveTo systematically review the prevalence rate of gestational diabetes mellitus in Chinese population.MethodsPubMed, EMbase, The Cochrane Library, CNKI, WanFang Data and VIP databases were electronically searched to collect relevant literature of the prevalence rate of gestational diabetes in Chinese population from inception to October 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using R 3.4.1 software.ResultsA total of 27 studies were included involving 183 338 peoples, of whom 23 834 were diagnosed as gestational diabetes mellitus by oral glucose tolerance test (75g). The prevalence rate was 13% (95%CI 10 to 16). The prevalence rate of gestational diabetes mellitus in north area was 13% (95%CI 9 to 19), central area was 11% (95%CI 2 to 39), east area was 15% (95%CI 12 to 19), south area was 12% (95%CI 11 to 14), northwest area was 5% (95%CI 3 to 8) and southwest area was 4% (95%CI 3 to 4). The prevalence rate of gestational diabetes mellitus during January 2005 to December 2012 was 11% (95%CI 7 to 16), during December 2012 to June 2016 was 17% (95%CI 14 to 20). The prevalence of specialist hospitals was 9% (95%CI 6 to 14), and which of comprehensive hospital was 14% (95%CI 11 to 18). The prevalence of gestational diabetes screening at 24 to 28 weeks gestation remained at 13% (95%CI 10 to 17).ConclusionThe prevalence rate of gestational diabetes mellitus is high in China. The prevalence rate of gestational diabetes mellitus in north China, central China and east China is significantly higher than that in southern China, northwest China and southwest China. The prevalence rate during 2012-2016 is significantly higher than that in 2005 to 2012. Improvement of lifestyle and living standard should be considered be closely related with that. The prevalence of comprehensive hospitals is higher than specialist hospitals. It is related to the China’s economic conditions, medical care situations and the medical habits of patients.
ObjectivesTo systematically review the efficacy of telemedicine on blood glucose level and pregnancy outcomes in patients with gestational diabetes mellitus.MethodsThe Cochrane Library, PubMed, Web of Science, CINAHL, Scopus, CBM, CNKI, WanFang Data and VIP databases were electronically searched to collect randomized controlled trials (RCTs) on efficacy of telemedicine on blood glucose and pregnancy outcomes in patients with gestational diabetes from inception to January 1st, 2019. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, and then meta-analysis was performed by RevMan 5.3 software.ResultsA total of 10 RCTs involving 1 267 patients were included. The results of meta-analysis showed that there were no statistical significances in fasting blood glucose (MD=−0.34, 95%CI −1.62 to 0.93, P=0.60), HbA1c (MD=−0.22, 95%CI −0.61 to 0.17, P=0.27), gestational age at delivery (MD=0.03, 95%CI −0.13 to 0.19, P=0.72), premature rate (OR=0.52, 95%CI 0.26 to 1.01, P=0.05), caesarean delivery rate (OR=0.87, 95%CI 0.57 to 1.31, P=0.51), infant birth weight (MD=13.01, 95%CI −45.75 to 71.78, P=0.66), large for gestational age rate (OR=1.16, 95%CI 0.83 to 1.62, P=0.40), pre- eclampsia/pregnancy induced hypertension rate (OR=1.04, 95%CI 0.52 to 2.09, P=0.91), neonatal hypoglycaemia rate (OR=1.21, 95%CI 0.75 to 1.95, P=0.44) and neonatal jaundice rate (OR=1.09, 95%CI 0.59 to 2.00, P=0.78) between telemedicine management and outpatient follow-up of gestational diabetes mellitus. However, the telemedicine management group had lower 2h postprandial blood glucose (MD=−3.45, 95%CI −5.53 to −1.37, P=0.001).ConclusionsThe current evidence shows that telemedicine management of gestational diabetes mellitus achieves similar efficacy and safety in blood glucose level and pregnancy outcomes as outpatient follow-up. Due to limited quality and quantity of the included studies, more high quality studies are required to verify the above conclusions.
ObjectiveTo systematically review the effects of assisted reproductive technology in single pregnancy on the incidence of gestational diabetes.MethodsPubMed, EMbase, The Cochrane Library, Web of Science, CNKI, WanFang Data, VIP and CBM databases were electronically searched to collect cohort studies on the correlation between assisted reproductive technology (ART) and gestational diabetes mellitus (GDM) incidence in single pregnancy from inception to June 2019. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Meta-analysis was then performed by using RevMan 5.3 software.ResultsA total of 16 cohort studies involving 2 017 573 cases of single pregnancy were included. The results of meta-analysis showed that compared with the natural pregnancy group, the incidence of GDM was higher in the ART group (RR=1.54, 95%CI 1.30 to 1.83, P<0.000 01). In East Asia and Non-East Asia, the incidence of GDM in the ART group was higher than that in the natural pregnancy group (East Asia: RR=1.55, 95%CI 1.26 to 1.92, P<0.000 01; Non-East Asia: RR=1.49, 95%CI 1.18 to 1.89. P<0.000 1).ConclusionsCurrent evidence shows that the incidence of GDM may increase in single pregnancy with ART compared with natural pregnancy. Due to limited quantity and quality of the included studies, more high quality studies are required to verify above conclusions.
ObjectiveTo systematically review the preventive effect of breastfeeding intensity and duration on progression to pre-diabetes mellitus (DM) and DM among females with prior gestational diabetes mellitus (GDM).MethodsPubMed, Web of Science, CNKI, and WanFang Data databases were electronically searched to collect cohort studies on the correlation of GDM and breastfeeding from inception to January 8th, 2021. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Meta-analysis was then performed using Stata 16.0 software.ResultsA total of 29 cohort studies were included. The results of the meta-analysis showed that breastfeeding could lower the risk of pre-DM (RR=0.64, 95%CI 0.57 to 0.71, P<0.001) and DM (RR=0.75, 95%CI 0.66 to 0.86, P<0.001) among females with prior GDM. Subgroup analysis showed that breastfeeding exhibited protective effects against pre-DM after 0 to 6 months as well as 6 to 12 months. Both breastfeeding for 0 to 6 months and over 12 months could decrease the risk of DM. These effects became prominent with the extension of the follow-up period. However, no significant association was observed between breastfeeding and recurrence of GDM (RR=0.72, 95%CI 0.47 to 1.09, P=0.14).ConclusionsBreastfeeding may be a major contributor in protecting against pre-DM and DM among females with prior GDM history. Due to limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusions.
ObjectiveTo systematically evaluate the changes in placental protein expressions in gestational diabetes mellitus (GDM) and their correlations with maternal insulin resistance (IR). Methods PubMed, Cochrane Library, Scopus, Web of Science, Embase, China National Knowledge Infrastructure, VIP database, Wanfang Database and CBMdisc were searched for case-control studies published from January 2009 to November 2021, which reported the placental protein expressions in GDM and their correlations with IR. Two researchers independently reviewed the literature, extracted data and evaluated the literature quality. RevMan 5.4 software was used for meta-analysis, and descriptive analysis was performed on data that cannot be combined. ResultsA total of 19 studies were included, comprising 2 012 patients. The results of meta-analysis showed that: the expression level of retinol binding protein 4 (RBP4) [standard mean difference=2.11, 95% confidence interval (CI) (1.64, 2.58), P<0.000 01] and the positive rate of protein tyrosine phosphatase-1B (PTP1B) [relative risk (RR)=1.56, 95%CI (1.29, 1.88), P<0.000 01] were up-regulated, and the positive rate of insulin receptor substrate 1 (IRS-1) [RR=0.69, 95%CI (0.60, 0.78), P<0.000 01] was down-regulated. The protein expression levels of RBP4 (P<0.000 01) and PTP1B (P<0.000 01) were positively correlated with homeostasis model assessment of insulin resistance (HOMA-IR), while the protein expression levels of IRS-1 (P<0.000 01) and APN (P=0.002) were negatively correlated with HOMA-IR, and glucose transporter 4 (GLUT 4) was not correlated with HOMA-IR (P=0.79). Descriptive analysis found that the expression levels or positive rates of adipocytokines (leptin, resistin), oxidative stress markers (xanthione oxidase, malondialdehyde, 8-isoprostaglandin),inflammatory factors (tumor necrosis factor α, Toll-like receptor 4, Galectin-3, Galectin-2, migration inhibitory factor),fetuin-A, forkhead box transcription factor 1, forkhead box transcription factor 3a and estrogen receptor α in GDM placenta were up-regulated and all were positively correlated with HOMA-IR. The expression levels or positive rates of insulin signaling pathway proteins [phosphoinositide 3-kinase (PI3K), protein kinases B (AKT), phospho-protein kinases B (p-AKT), GLUT 4] were down-regulated, PI3K and AKT were negatively correlatedwith HOMA-IR, while p-Akt had no correlation with HOMA-IR. ConclusionsThe dysregulation of placental protein expressions may mediate maternal IR exacerbation, thus promote the occurrence and development of GDM and other pregnancy complications. The causal relationship and regulatory mechanism are still unclear, which need to be further studied.
Objective To systematically review the association between periodontal disease during pregnancy and the risk of gestational diabetes mellitus (GDM). Methods PubMed, Web of Science, CBM and CNKI databases were electronically searched to collect studies on periodontal disease and GDM from inception to October 23, 2021. Two researchers independently screened literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed using RevMan 5.4 software. Results A total of 11 studies were included, involving 2 910 pregnant women. The results of meta-analysis showed that pregnant women with periodontal disease during pregnancy reported more GDM than normal pregnant women (OR=1.81, 95%CI 1.31 to 2.50, P=0.000 3). Conclusion The current evidence suggests that there is a positive association between periodontal disease during pregnancy and the risk of GDM. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.