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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Endocrinology & Metabolism".

Deadline for manuscript submissions: closed (26 July 2025) | Viewed by 5894

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Special Issue Editor

Dr. Vendula Bartakova

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Guest Editor

Department of Pathophysiology, Faculty of Medicine, Masaryk University, 62500 Brno, Czech Republic
Interests: diabetes; gestational diabetes; diabetes in pregnancy; diabetic nephropathy; metabolic syndrome; genetics of diabetes

Special Issue Information

Dear Colleagues,

Gestational diabetes mellitus (GDM) is rising in prevalance worldwide and is a potential metabolic risk for mother and child in their future life. Diagnosis is usually achieved in the second trimester of pregnancy by the IADPSG criteria and many scientists try to suggest/find specific markers to precise the diagnosis as soon as possible. Also, the treatment of gestational diabetes is not unified; diet is the best start, although some patients need more therapy in the form of insulin or metformin. One serious problem is the finding that about one-half of women with GDM do not present for repeated oral glucose tolerance tests after delivery.

In this Special Issue, we welcome authors to submit papers on the clinical advancements in diagnosis, treatment and compliance, as well as new knowledge about the metabolic risk of mothers and their offsprings after GDM pregnancy.

Dr. Vendula Bartakova
Guest Editor

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Keywords

gestational diabetes mellitus
oral glucose tolerance test
treatment
pregnancy
peripartal outcomes

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Published Papers (7 papers)

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Research

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21 pages, 705 KB

Open AccessArticle

Diabetes Risk Perception in Women with a Recent History of Gestational Diabetes Mellitus: A Secondary Analysis from a Belgian Randomized Controlled Trial (MELINDA Study)

by Yana Vanlaer, Caro Minschart, Ine Snauwaert, Nele Myngheer, Toon Maes, Christophe De Block, Inge Van Pottelbergh, Pascale Abrams, Wouter Vinck, Liesbeth Leuridan, Sabien Driessens, Jaak Billen, Christophe Matthys, Annick Bogaerts, Annouschka Laenen, Chantal Mathieu and Katrien Benhalima

J. Clin. Med. 2025, 14(14), 4998; https://doi.org/10.3390/jcm14144998 - 15 Jul 2025

Viewed by 435

Abstract

Background/Objectives: To evaluate diabetes risk perception in women with prior gestational diabetes mellitus (GDM) and prediabetes in early postpartum. Methods: Secondary analysis of a multi-center randomized controlled trial assessing the effectiveness of a mobile-based postpartum lifestyle intervention in women with prediabetes after GDM. Data were collected from the Risk Perception Survey for Developing Diabetes at baseline (6–16 weeks postpartum) and one year post-randomization. Logistic regression was used to analyze the difference between the intervention and control groups on diabetes risk estimation. Results: Among 165 women with prediabetes in early postpartum (mean age: 32.1 years, mean BMI: 27.3 kg/m²), 58.9% (96) adequately estimated their diabetes risk (moderate or high chance) at baseline. These women smoked less often [2.06% (2) vs. 10.3% (7), p = 0.034], reported less anxiety (11.6 ± 3.0 vs. 12.6 ± 3.5, p = 0.040), and reported fewer symptoms of depression [30.9% (21) vs. 15.6% (15), p = 0.023] compared to women who underestimated their risk. At one year, 58.3% (95) of all women adequately estimated their diabetes risk. In the intervention group, 50.6% (41) adequately estimated their risk at baseline, increasing to 56.8% (46) by the end of the intervention after one year (p = 0.638). In the control group, a higher proportion of women adequately estimated their risk at baseline [67.1% (55), (p = 0.039)], which decreased to 59.8% (49) at one year (p = 0.376), with no significant difference in risk perception between the groups at one year (p = 0.638). Conclusions: Almost 60% of this high-risk population adequately estimated their diabetes risk, with no significant impact of the lifestyle intervention on risk perception. Full article

(This article belongs to the Special Issue Gestational Diabetes: Cutting-Edge Research and Clinical Practice)

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15 pages, 527 KB

Open AccessArticle

Some Levels of Plasma Free Fatty Acids and Amino Acids in the Second Trimester Are Linked to Gestational Diabetes and Are Predictive of Persisting Impaired Glucose Tolerance After Delivery

by Vendula Bartáková, Anna Pleskačová, Lukáš Pácal, Monika Skrutková Langmajerová, Jindra Smutná, Katarína Chalásová, Veronika Eclerová, Zdeněk Glatz, Kateřina Kaňková and Josef Tomandl

J. Clin. Med. 2025, 14(13), 4744; https://doi.org/10.3390/jcm14134744 - 4 Jul 2025

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Abstract

Background/Objectives: Gestational diabetes mellitus (GDM) represents an increased metabolic risk in future life for both mother and child. We hypothesize free fatty acids (FFAs) and amino acids (AAs) disturbances in plasma during second trimester might be indicating high risk of persisting glucose intolerance (PGI). The aim of study was to determine plasma FFAs and AAs during pregnancy in women with normal pregnancy and GDM and also in post-GDM women with PGI after delivery and to find potential association of altered FFAs and AAs profile with adverse peripartal outcomes and PGI after GDM. Material and Methods: A total of 54 pregnant women were included in the study. Of those 34 participants had GDM. PGI was diagnosed by oGTT up to one year after delivery. Plasma FFAs were determined using GC-FID and plasma AAs levels were determined using CE-MS method. Results: Decreased levels of tetradecanoic acid and several AAs were found in GDM group during pregnancy. Oleic and docosahexaenoic acid correlated positively while almost all AAs negatively correlated with oGTT values in the pregnancy (all p < 0.05, Spearman). Logistic regression model (using AAs, FFAs and BMI) identified higher citrulline and glutamate levels and lower tetradecenoic acid and choline as the best predictors for postpartum PGI. Some differences in AA levels were detected in women with macrosomic babies. Conclusions: Data support a possible link between GDM development and PGI after delivery and selected metabolite levels. The predictive potential of plasma FFAs and AAs levels on a diabetes risk in future life requires further validation. Full article

(This article belongs to the Special Issue Gestational Diabetes: Cutting-Edge Research and Clinical Practice)

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25 pages, 818 KB

Open AccessFeature PaperArticle

Mental Health and Metabolic Outcomes in Early Postpartum in Women with Prediabetes After Gestational Diabetes: A Secondary Analysis of the MELINDA Trial

by Yana Vanlaer, Caro Minschart, Karolijn Van den Keybus, Nele Myngheer, Toon Maes, Christophe De Block, Niels Bochanen, Inge Van Pottelbergh, Pascale Abrams, Wouter Vinck, Liesbeth Leuridan, Sabien Driessens, Jaak Billen, Christophe Matthys, Annick Bogaerts, Annouschka Laenen, Chantal Mathieu and Katrien Benhalima

J. Clin. Med. 2025, 14(10), 3592; https://doi.org/10.3390/jcm14103592 - 21 May 2025

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Abstract

Aims: To examine the association between depressive symptoms and metabolic profile in women with prior gestational diabetes mellitus (GDM) and early postpartum prediabetes, and to explore whether a mobile-based lifestyle intervention affected mental health outcomes. Methods: Secondary, exploratory analysis of a multi-centric randomized controlled trial (MELINDA), evaluating a mobile-based lifestyle intervention versus standard follow-up (control group) in women with prediabetes after GDM. The analysis included 166 participants who completed the Center for Epidemiologic Studies–Depression (CES-D) questionnaire [score of ≥16 being suggestive for (sub)clinical depression] at baseline (6–16 weeks postpartum) and one year post-randomization. Results: At one year, 26.5% of women (n = 44) reported depressive symptoms, with no significant difference between the intervention and control groups (30.5% vs. 22.6%, p = 0.293). Women with depressive symptoms (symptomatic women) were younger (30.9 ± 4.9 vs. 32.5 ± 3.8 years, p = 0.033) and were less often highly educated (61.4% vs. 80.3%, p = 0.028). At baseline, symptomatic women had a higher rate of metabolic syndrome (38.6% vs. 21.9%, p = 0.044), higher LDL-cholesterol [3.2 ± 0.8 vs. 2.8 ± 0.8 mmol/L, p = 0.009], lower quality of life (lower SF-36 scores, p < 0.050) and a higher level of anxiety based on the STAI-6 questionnaire (14.5 ± 3.6 vs. 11.2 ± 2.6, p < 0.001). These differences persisted at one year postpartum with worse metabolic profile, more anxiety and lower quality of life in symptomatic women. Conclusions: Depressive symptoms are common in women with prediabetes in early postpartum after GDM and are associated with a persistent worse metabolic profile, increased anxiety and lower quality of life postpartum. The mobile-based lifestyle intervention did not improve mental health. Full article

(This article belongs to the Special Issue Gestational Diabetes: Cutting-Edge Research and Clinical Practice)

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15 pages, 1500 KB

Open AccessArticle

Potential Glycobiomarkers in Maternal Obesity and Gestational Diabetes During Human Pregnancy

by Anna Farkas, Andrea Suranyi, Balint Kolcsar, Zita Gyurkovits, Zoltan Kozinszky, Sandor G. Vari and Andras Guttman

J. Clin. Med. 2025, 14(5), 1626; https://doi.org/10.3390/jcm14051626 - 27 Feb 2025

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Abstract

Introduction: Obesity is a rapidly growing common health problem worldwide that can lead to the development of gestational diabetes mellitus (GDM). However, GDM not only affects women with obesity but can also develop at any time, even after the OGTT test; therefore, an increasing number of complications related to GDM can be seen in both mothers and their children. It is necessary to discover biomarkers capable of indicating the development of GDM or complications during/after pregnancy. Since the N-glycosylation motif of human IgG has been described to change under many physiological and pathological conditions, it is a promising target for biomarker research. In our study, the effects of obesity and GDM were investigated on human serum IgG N-linked glycosylation patterns during human pregnancy. Materials and Methods: The study participants were categorized into four groups according to their body mass index (BMI) and GDM status: normal weight as control, obese (BMI > 30 kg/m²), normal weight with GDM, and obese with GDM. The released N-glycan components of IgG were separated with capillary electrophoresis and detected using a laser-induced fluorescence detector. Results: The result revealed several differences between the N-glycosylation patterns of the four study groups. Of this, 17 of the 20 identified structures differed significantly between the groups. The ratios of sialylated to non-sialylated structures were not changed significantly, but the core fucosylation level showed a significant decrease in the GDM and obese GDM groups compared to the control subjects. The lowest degree of core fucosylation was observed in the GDM group. Conclusions: The findings indicate that obesity in isolation does not have a significant impact on the IgG N-glycosylation pattern in pregnancy. Conversely, alterations in the N-glycan profile of antibodies may serve as biomarkers for the diagnosis of GDM in mothers with a normal BMI, although more evidence is needed. By incorporating glycan-based biomarkers into clinical practice, healthcare providers can improve early detection, personalize management strategies, and potentially mitigate adverse pregnancy outcomes associated with obesity and GDM. Full article

(This article belongs to the Special Issue Gestational Diabetes: Cutting-Edge Research and Clinical Practice)

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Review

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20 pages, 429 KB

Open AccessFeature PaperReview

Doppler Evaluation of Fetal Cardiac Function in Gestational Diabetes Mellitus: A Scoping Review Providing Insights into Hemodynamic and Structural Alterations

by Sophia Tsokkou, Ioannis Konstantinidis, Alkis Matsas, Evaggelia Karopoulou and Theodora Papamitsou

J. Clin. Med. 2025, 14(16), 5622; https://doi.org/10.3390/jcm14165622 - 8 Aug 2025

Viewed by 382

Abstract

Introduction: Gestational diabetes mellitus (GDM) is a form of hyperglycemia that develops during pregnancy and poses risks to both the mother and fetus. In other words, it is a glucose intolerance disorder first recognized during pregnancy, specifically in the second and third trimesters, with approximately 7–14% of pregnancies worldwide being affected. Methodology: A systematic literature search was conducted across three major well-established databases; PubMed, Scopus, and ScienceDirect. The search was conducted with the aim of identifying the most suitable studies for the evaluation of fetal cardiac function using Doppler ultrasound techniques in pregnancies affected by GDM. Results: Following a comprehensive full-text assessment, 186 papers were excluded, mainly due to discrepancies in the population, unsuitable study design, publishing type, or unavailability of full-text access. Ultimately, 12 studies met all the inclusion criteria and were incorporated into the scoping review. From the studies included it was found that the conventional pulsed-wave Doppler was the most frequently used modality, assessing parameters such as the E/A ratios, myocardial performance index (MPI), and the isovolumic relaxation time (IVRT). The advanced techniques of choice included tissue Doppler imaging (TDI), speckle-tracking echocardiography (STE), dual-gate Doppler, and automated MPI. Conclusions: Doppler ultrasound techniques, particularly the advanced modalities like TDI and STE, provide valuable insights into fetal cardiac function in GDM pregnancies. Their integration into routine prenatal surveillance may enhance the early detection of cardiac dysfunction and inform timely clinical interventions. Full article

(This article belongs to the Special Issue Gestational Diabetes: Cutting-Edge Research and Clinical Practice)

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16 pages, 630 KB

Open AccessReview

The Role of Probiotics in Preventing Gestational Diabetes: An Umbrella Review

by Simone Cosmai, Sara Morales Palomares, Cristina Chiari, Daniela Cattani, Stefano Mancin, Alberto Gibellato, Alessandra Valsecchi, Marco Sguanci, Fabio Petrelli, Giovanni Cangelosi, Diego Lopane and Beatrice Mazzoleni

J. Clin. Med. 2025, 14(14), 5168; https://doi.org/10.3390/jcm14145168 - 21 Jul 2025

Viewed by 661

Abstract

Background/Objectives: Gestational diabetes (GD), which affects approximately 15% of pregnancies worldwide, poses significant risks to both maternal and fetal health, underscoring the need for effective prevention and management strategies. This umbrella review aims to evaluate the role of probiotics in the prevention of GD. Methods: The review was conducted in accordance with the Joanna Briggs Institute (JBI) Manual for Evidence Synthesis. A comprehensive literature search was performed in November 2024 across four databases: PubMed/Medline, Cochrane Library, Embase, and CINAHL. A total of 307 articles were identified, of which 6 met the inclusion criteria and were included in the final synthesis. Results: Probiotic supplementation was associated with a significant reduction in the incidence of GD in selected populations, particularly in women with a body mass index (BMI) < 26, age < 30 years [Relative Risk (RR): 0.58], and p < 0.05 in the other studies included, alongside improvements in several metabolic parameters. However, consistent benefits on maternal or neonatal complications were not observed but a 33% reduction in GD was confirmed (RR 0.67). The combination of probiotics with healthy lifestyle behaviors appeared to exert a stronger protective effect against GD and its potential complications. Conclusions: This umbrella review suggests that probiotics—particularly multi-strain formulations—may have a potential role in reducing the risk of GD in certain populations. However, the findings across the included studies are inconsistent and sometimes conflicting. While probiotics are generally considered safe and have recognized benefits for metabolic health, their efficacy as an adjunct intervention for GD prevention remains not fully clear. Further well-designed research is needed to clarify which specific probiotic interventions may be effective and to better guide clinical practice. Full article

(This article belongs to the Special Issue Gestational Diabetes: Cutting-Edge Research and Clinical Practice)

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Other

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17 pages, 3140 KB

Open AccessSystematic Review

Assessment of Environmental Risk Factors for Gestational Diabetes Mellitus: A Ten-Year Systematic Review and Meta-Analysis

by Sophia Tsokkou, Stefanos-Timoleon Tzintros, Ioannis Konstantinidis, Antonios Keramas, Maria-Nefeli Georgaki, Eleni Stamoula and Alkis Matsas

J. Clin. Med. 2025, 14(5), 1646; https://doi.org/10.3390/jcm14051646 - 28 Feb 2025

Cited by 1 | Viewed by 1999

Abstract

Background/Objectives: It is estimated that gestational diabetes mellitus (GDM) affects approximately 14% of pregnant women. This is due to the inability of the body to produce enough insulin for gestation. With greater appearance during the second and third trimesters, GDM has a multifactorial cause including hypertension, cardiovascular issues (CVD), family history both or either type two diabetes mellitus (T2DM) or GDM, obesity, advanced maternal age, and polycystic ovarian syndrome (PCOS). However, it has been suggested that except for genetic predisposition, environmental factors can increase the risk of GDM development to a great extent. The aim of this systematic review and meta-analysis is the examination of different environmental contributors that play a significant role in the development of GDM. Methods: The databases used were PubMed and ScienceDirect. The inclusion criteria were a 10-year duration (2014–2024), English language, research articles, and only humans included. Afterwards, tables were created to summarize the most important information from each article. Forest and funnel plots were created to assess the possibility of a greatly significant difference between each environmental contributor. Results: Initially, 9361 articles were found. After the automation tools were applied, 706 were left. The total number of articles used in the study after the screening process was 26. Through the systematic review analysis, the following risk factors were stated to play a contributing role with GDM: extreme temperatures (both high and low), organophosphorus flame retardants (OFRs), bisphenol A (BPA), selenium (Se), metallic elements, urinary antimony (Sb), trace elements, thiamine and riboflavin, and fine particulate matter PM_2.5. Conclusions: Through this meta-analysis, it can be concluded that there is statistical significance for fine particulate matter PM_2.5, especially in the first (p < 0.001) and second (p < 0.001) trimesters, proving the acknowledged connection between PM_2.5 and GDM pathogenesis during pregnancy. Apart from that, fetal sex can play an important role in the development of GDM, as there is the greatest risk in males (p < 0.001), whereas no correlation between maternal smoking habit and bisphenol A with GDM was found. In conclusion, it can be stated that environmental factors can have a great impact on the development of GDM during the gestational period, but more studies must be carried out to reinforce our outcomes. Full article

(This article belongs to the Special Issue Gestational Diabetes: Cutting-Edge Research and Clinical Practice)

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