Search Results (227)

Background/Objectives: A number of initiatives have refocused attention from obesity to adiposity-related organ dysfunction. In this prospective observational study, we examined this paradigm postpartum. Methods: At King’s College Hospital, London, UK, we invited for review by six months postpartum, consecutive women with GDM (N = 1442, September 2023–August 2025) and without GDM (N = 646, January 2025–August 2025). Those with excess adiposity (BMI ≥ 30 kg/m² and waist-to-height ratio > 0.5) were assessed for organ dysfunction, using criteria from a recent Commission: anovulation, metabolism or renal clusters, raised blood pressure, or elevated end-diastolic left ventricular filling pressure. Multiple regression determined predictors of adiposity-related organ dysfunction, the prevalence of which was calculated as a range (highest estimate: absolute organ dysfunction prevalence; lowest estimate: adiposity-adjusted, as highest estimate minus prevalence of organ dysfunction in women without excess adiposity). Results: Of those invited for review, 1086/1442 (75.3%) GDM and 562/646 (87.0%) non-GDM women attended, at median 5.8 months after birth (interquartile range 4.8–6.7). Excess adiposity was observed in 385/1086 (35.5%) GDM and 117/562 (20.8%) non-GDM women, among whom organ dysfunction was seen in 61.0% GDM (235/385), 51.3% non-GDM (60/117). 35.9% (408/1137) of women without excess adiposity. Organ dysfunction attributable to excess adiposity was estimated to be 22.9% (58.8% minus 35.9%), and was poorly predicted by the multivariable model (AUC 0.64, 95%CI 0.60–0.69). Conclusions: Among women with prior GDM, organ dysfunction attributable to excess adiposity affects at least 20% of those with excess adiposity postpartum, and is not currently predictable. Full article

Gestational diabetes mellitus (GDM) has witnessed a persistent rise in the prevalence over the past few decades, imposing a substantial burden on global health and economies. GDM exerts both short-term and long-term effects on neuropsychiatric systems of the mothers and their progeny. This review catalogs the neurodevelopmental and neuropsychiatric disorders in GDM women and their offspring and summarizes the possible relationships as well as the underlying mechanisms, which would enhance our understanding of the neuropsychiatric disorders related to GDM, offering information on personalized strategies for patients. Full article

Background: Gestational diabetes mellitus (GDM) is one of the most common metabolic complications of pregnancy, and its prevalence continues to rise worldwide. Dietary management is the cornerstone of therapy, yet adherence may impose a substantial everyday burden. This study aimed to assess perceived burden and practical challenges related to following a diabetic diet in women with GDM. Methods: A cross-sectional anonymous online questionnaire study was conducted among 109 women with a current or past diagnosis of GDM within the previous five years. The survey addressed self-reported difficulties in maintaining normal blood glucose levels, adherence to a diabetic diet, perceived increases in grocery expenses, time required for meal preparation, dietary preferences, and family attitudes toward the diet. Associations between categorical variables were analyzed using contingency tables and the contingency coefficient. Results: Women with insulin-treated GDM (GDM2) reported more difficulties maintaining normal blood glucose levels than women treated with diet and physical activity alone (GDM1) (p = 0.014). Educational level was associated with perceived financial burden (p = 0.013) and meal preparation time (p = 0.003). These patterns likely reflect both differences in economic resources and the extent of dietary changes undertaken, rather than uniform differences in nutritional awareness. Pregnancy status was associated with dietary preferences, as non-pregnant respondents more often reported liking diabetic-diet meals than pregnant respondents (p = 0.037). Overall, 53.2% of respondents reported that a diabetic diet made daily functioning more difficult, mainly due to increased time and financial demands. Conclusions: Dietary management of GDM is associated with a meaningful perceived burden, especially among women requiring insulin therapy and those facing financial and time constraints. Understanding these subjective challenges may support more individualized dietary counseling and patient-centered care. Full article

Background and Objectives: Gestational diabetes mellitus (GDM) is a complex pregnancy condition that carries substantial risks for adverse pregnancy outcomes. Following the implementation of universal diagnostic criteria in our clinical practice, this study was undertaken to assess their applicability and to determine whether locally conducted clinical studies are beneficial before adopting globally applicable criteria. By retrospectively analyzing parameters relevant to GDM from medical records, we aimed to determine the suitability of existing diagnostic criteria for our population, taking into account distinct socioeconomic, demographic, and genetic factors, and to assess the validity of alternative criteria. Materials and Methods: We used data from 2183 pregnant women who underwent 75 g-OGTT between 24 and 28 weeks of pregnancy. Results of the plasma glucose (PG) measurements were used to assign women into four diagnostic groups: diagnosed and treated by IADPSG criteria, diabetes mellitus in pregnancy identified according to WHO-2006 criteria, identified according to CDA-2013 criteria, and identified according to Tomic et al. criteria, based on a study on our population. Pregnancy outcomes were extracted from medical records. Results: The prevalence of GDM was 18.7% by IADPSG criteria, comparable to published data. Adverse pregnancy outcomes were consistently more frequent in GDM groups across all diagnostic systems (46.6–80% versus 33.9–35.9% in non-GDM). Maternal BMI ≥ 25 kg/m² was also associated with having large-for-gestational-age (LGA) neonates, contributing to the influence of hyperglycemia. Excessive gestational weight gain was a predictor of complications such as macrosomia and cesarean delivery. Conclusions: Before adopting universal GDM diagnostic criteria, population-specific studies are valuable to balance detection rates and clinical accuracy. Full article

Background: Gestational weight gain (GWG) is commonly used as an indicator of nutritional adequacy during pregnancy and a marker for pregnancy outcomes. This study aims to report the prevalence and extent of GWG inadequacy among Saudi women and to examine the effects of GWG inadequacy on pregnancy outcomes. Methods: This study was conducted as part of the Riyadh Mother and Baby Multicenter Cohort Study; it included 6984 women with singleton pregnancies. Adverse pregnancy outcomes—including hypertension, gestational diabetes (GDM), cesarean section (CS), low birth weight (LBW), Neonatal Intensive Care Unit admission (NICU), and macrosomia—were compared between women with adequate and inadequate GWG, based on the Institute of Medicine (IOM) guidelines. Results: Of the participants, 2221 women (31.8%) had adequate GWG for prepregnancy BMI, 2959 (42.4%) had inadequate GWG, and 1804 (25.8%) had excessive GWG. Women with normal prepregnancy BMI and inadequate GWG had significantly increased odds of delivering LBW infants (adjusted odds ratio (AOR) = 1.61, 95% CI: 1.17–2.20). Inadequate GWG also decreased the odds of emergency cesarean delivery among women with obesity (AOR = 0.75, 95% CI: 0.56–0.97) and lowered the likelihood of NICU admission for infants of obese women (AOR = 0.59, 95% CI: 0.36–0.97). Women with prepregnancy obesity experienced the highest rate of adverse outcomes; however, the prevalence of all adverse outcomes decreased as the degree of weight gain inadequacy increased. Conversely, underweight women had the highest percentage of LBW, with this percentage increasing as weight gain inadequacy increased. Conclusions: The effects of inadequate GWG vary depending on maternal prepregnancy BMI and the specific outcome assessed. For women with obesity, reduced weight gain during pregnancy may be beneficial. In contrast, inadequate GWG is associated with a higher incidence of LBW in women with normal prepregnancy BMI and underweight women. Full article

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent chronic liver disorder in both children and adults. Pediatric MASLD, however, is not simply an early form of adult disease, as it exhibits distinct developmental, histological, and metabolic features. Emerging evidence suggests that these characteristics arise from a complex, multi-hit continuum that begins in utero. Maternal obesity, gestational diabetes, and poor diet quality during pregnancy have been associated with greater hepatic steatosis in offspring, raising the possibility that intrauterine exposure to dyslipidemia, hyperglycemia, and elevated free fatty acid flux may contribute to early hepatic lipid deposition. After birth, feeding behaviors such as a prolonged breastfeeding appear protective, whereas formula feeding, especially high added-sugar formulations, may accelerate rapid weight gain and increase susceptibility to later steatosis. Early childhood diets high in added sugars, saturated fats, and ultra-processed foods may further promote hepatic lipogenesis and inflammation and interact with underlying genetic susceptibility. Given the heterogeneity of available human cohort studies and mechanistic model systems, this narrative review summarizes converging evidence from prenatal, postnatal, and early childhood nutritional exposures and their relationship to offspring hepatic lipid accumulation, emphasizing early-life windows for intervention to reduce the burden of pediatric MASLD. Full article

Perineal tears are common during vaginal delivery and are associated with significant maternal morbidity. While chorioamnionitis and intrapartum fever are known to affect labor dynamics and perineal tissue integrity, their relationship with perineal trauma in spontaneous vaginal deliveries has not been established. This study aimed to evaluate the prevalence of perineal tears among women with intrapartum fever who delivered spontaneously. This retrospective cohort study included women who underwent spontaneous vaginal delivery during 2013–2021 in Israel. The study group comprised women diagnosed with intrapartum fever (≥38 °C), while afebrile women served as controls in a 1:2 ratio matched by age (<35 or ≥35 years) and gestational age (preterm/term). Perineal tears were classified according to the Royal College of Obstetricians and Gynaecologists (RCOG) criteria. Multivariable logistic regression was performed to adjust for statistically significant variables including obesity, induction of labor, epidural analgesia, amniotomy, delivery week, gestational diabetes, birth number, duration of the second stage of labor, and episiotomy. The cohort included 373 women with intrapartum fever and 746 controls. The overall rate of perineal tears was similar between febrile and afebrile women (42% vs. 40%; adjusted odds ratio [aOR] 0.99, 95% confidence interval [CI] 0.72–1.36). However, the rate of obstetric anal sphincter injury (OASIS) was lower among women with intrapartum fever (0.5% vs. 2.0%; aOR 0.10, 95% CI 0.02–0.52). Intrapartum fever was associated with higher rates of postpartum hemorrhage, manual exploration of the uterus, endometritis, anemia, and blood transfusion. Bacterial cultures were positive in 31% of febrile women, predominantly Escherichia coli and Group B Streptococcus, without association with perineal trauma. Alltogether, Intrapartum fever did not increase the risk of perineal tears in spontaneous vaginal deliveries and was paradoxically associated with a lower rate of OASIS. Further studies are warranted to explore the underlying physiological mechanisms linking temperature and perineal tissue resilience. Full article

Over 100 million pregnant people worldwide remain at risk of COVID-19. We compared the prevalence of severe COVID-19 in pregnancy and in people of reproductive age, and the risk of adverse pregnancy/neonatal outcomes in those with/without COVID-19 during gestation. In the Canadian Mother–Child Cohort, two sub-cohorts were identified using medical services, prescription medication fillings, hospitalizations, and COVID-19 surveillance testing programs data (28 February 2020–2021). The first included all pregnant people with at least one completed trimester of pregnancy during the study period, stratified on COVID-19 status. The second included all non-pregnant people (aged 15–45) with a positive COVID-19 test during the same period. COVID-19 severity was categorized based on hospital admissions before the end of pregnancy. Associations between COVID-19 during pregnancy and adverse perinatal outcomes were quantified using log-binomial regressions. A total of 150,345 pregnant people (3464 (2.3%) had COVID-19), and 112,073 non-pregnant people with COVID-19 were included. Maternal age at the time of COVID-19 diagnosis/positive test was statistically significantly lower among pregnant individuals compared to those who were not pregnant (96% had less than 40 years vs. 80%, p < 0.001). In pregnancy, COVID-19 was associated with the risk of spontaneous abortions (adjRR 1.76, 95%CI 1.37, 2.25), gestational diabetes (adjRR 1.52, 95%CI 1.18, 1.97), prematurity (adjRR 1.30, 95%CI 1.01, 1.67), and NICU (adjRR 1.32, 95%CI 1.10, 1.59); COVID-19 treatment with medications reduced risks. Severe COVID-19 was more prevalent in pregnancy and was associated with higher risks of adverse maternal/neonatal outcomes. As some countries are pulling back preventive strategies for COVID-19, this study highlights the importance of continued surveillance during pregnancy to prevent adverse pregnancy outcomes. Full article

Background/Objectives: Diabetes mellitus (DM) in pregnancy, including type 1 (T1DM), type 2 (T2DM), and gestational DM (GDM), represents an increasing health burden due to its maternal and fetal complications. Despite the increment in the global prevalence estimates of DM in pregnancy, in Romania, it has not been comprehensively described. This study aimed to analyze the prevalence and dynamics of DM in pregnancy in Romania between 2014 and 2024, using national databases, and to identify prevention strategies for reducing maternal and fetal complications. Methods: Data were obtained from the Romanian National Public Health Institute through two distinct sources: Database 1, consisting of reports from public and medical units associated with the National Health Insurance House and Database 2, based on the reports from general practitioners. Pregnancies complicated by DM were assessed by type, age group, and environmental settlement. Additional data were extracted on pregnancies with insufficient prenatal care and those of socially vulnerable individuals. Results: From 2014 to 2024, the prevalence of DM in pregnancy in Romania was consistently lower than European and global estimates, ranging from 1.01‰ to 3.08‰ in Database 1 and from 0.84‰ to 5.88‰ in Database 2, respectively. GDM accounted for the majority of cases, accounting for 65–88% of reported DM in pregnancy. The highest incidence was observed in the 20–39 years age group, with a growing proportion in women aged ≥40 years. Urban-rural disparities decreased over the decade, with rural cases reaching parity by 2024. Vulnerable populations included adolescents, women with insufficient prenatal care, and those with social risk factors, predominantly from rural areas. Conclusions: Although the reported prevalence of DM in pregnancy in Romania is lower than international figures, the true burden is likely underestimated. GDM remains the leading type of DM in pregnancy, mirroring global trends. Strengthening the reporting system, standardizing diagnostic criteria, and targeting high-risk groups through preconceptional counselling, lifestyle interventions, advanced monitoring technologies, and improving social support through the involved authorities are crucial steps to reduce maternal and fetal morbidity. Full article

Background: Over the past several decades, the prevalence of gestational diabetes mellitus (GDM) has risen markedly worldwide, posing serious threats to both maternal and child health by increasing adverse pregnancy outcomes and long-term metabolic risks. Developing effective risk prediction tools for early detection and intervention has become the most important clinical priority in this field. The current GDM prediction models primarily rely on non-modifiable factors, for example age and body mass index, while modifiable factors such as lifestyle and health literacy, although strongly associated with GDM, have not been fully utilized in risk assessment. This study sought to establish and validate a nomogram prediction model combining modifiable and non-modifiable risk factors, with the goal of identifying high-risk Chinese pregnant women with GDM at an early stage and promoting targeted prevention and personalized prenatal management. Methods: A multicenter study was conducted across 7 maternal health institutions in Southern China (2021–2023), enrolling 806 singleton pregnant women (14–23⁺⁶ weeks). The collected data included sociodemographic, clinical history, and modifiable factors collected through validated questionnaires: dietary quality, physical activity level, sleep quality, and nutrition and health literacy. GDM was diagnosed via 75 g oral glucose tolerance test at 24–28 weeks. Predictive factors were identified through multi-variable logistic regression. A nomogram model was developed (70% modeling group) and validated (30% validation group). Receiver operator characteristic curves, calibration curves, and decision curve analysis were used to evaluate the prediction ability, the degree of calibration, and the clinical benefit of the model, respectively. Results: The finalized risk prediction model included non-modifiable factors such as maternal age, pre-pregnancy weight, and maternal polycystic ovary syndrome, as well as modifiable factors including dietary quality, physical activity level, sleep quality, nutrition and health literacy. The application of the nomogram in the modeling group and the validation groups showed that the model had high stability, favorable predictive ability, good calibration effect and clinical practicality. Conclusions: Overall, the integrated model demonstrates significant clinical utility as it facilitates the prompt identification of individuals at heightened risk and offers actionable targets for personalized interventions. In terms of future implementation, this model can be integrated into prenatal care as a rapid scoring table during early pregnancy consultations or incorporated into mobile health applications. This approach fosters precise prevention strategies for GDM in maternal health by emphasizing nutrition and health literacy, supplemented by coordinated adjustments in diet, physical activity, and sleep. Full article

Background/Objectives: The objective of this study was to assess the diagnostic accuracy of the Triglyceride-Glucose (TyG) index for screening gestational diabetes mellitus (GDM) at 24–28 weeks of gestation, to determine its optimal diagnostic threshold, and to compare its predictive performance with conventional lipid ratios (LDL/HDL, TG/HDL, and TC/HDL). Materials and Methods: We retrospectively analyzed 440 pregnant women with singleton pregnancies who underwent a 75 g oral glucose tolerance test (OGTT) between January and July 2025. The TyG index and lipid ratios were calculated, and their associations with GDM were evaluated. Subgroup analyses were conducted to assess the efficacy of the TyG index in predicting GDM, using logistic regression to estimate odds ratios (ORs) with 95% confidence intervals (CIs), and receiver operating characteristic (ROC) curve analysis along with restricted cubic spline modeling to evaluate diagnostic performance and determine the optimal cutoff value. Results: The overall prevalence of GDM, as defined by the IADPSG (International Association of the Diabetes and Pregnancy Study Groups) criteria, was 22.7%. The median TyG index was significantly higher in the GDM group compared with the non-GDM group (9.1 vs. 8.9, p = 0.001). The TyG index was a significant predictor of GDM (p < 0.05), with each one-unit increase associated with significantly higher odds of GDM (OR = 12.29), after adjusting for covariates. ROC analysis demonstrated an AUC of 0.716 (95% CI: 0.627–0.793, p < 0.001) for the TyG index, and the optimal cut-off value was identified as 9.35, yielding a sensitivity of 38.5% and a specificity of 96.5% and a negative predictive value of 83.7%. Subgroup analyses indicated that the TyG index had limited discriminative ability for predicting GDM in both the post-load and insulin-requiring groups. Among conventional lipid ratios, TG/HDL demonstrated the highest predictive performance (AUC = 0.587), while LDL/HDL (AUC = 0.483) and TC/HDL (AUC = 0.509) demonstrated low predictive accuracy. Compared with conventional lipid ratios, the TyG index demonstrated superior predictive performance. Conclusions: A higher TyG index was positively associated with the development of GDM and showed better predictive ability than conventional lipid ratios. However, its low sensitivity limits its use as a standalone diagnostic tool, suggesting it may be most useful when combined with other clinical parameters. Full article

Background/Objectives: The classification of patients with diabetes into phenotypes with distinct risks and therapeutic needs is crucial for individualized care. We recently introduced a clustering model for gestational diabetes mellitus (GDM). This study aims to further characterize the proposed clusters and to identify cluster-specific differences in glucometabolic parameters during early pregnancy in an independent cohort. The metabolic profiles and dietary habits of GDM clusters will be compared with those of a normal glucose-tolerant (NGT) control group. Methods: 1088 women (195 who developed GDM and 893 who remained NGT) underwent a broad risk evaluation at early pregnancy. GDM patients were further categorized into the three proposed GDM subtypes (CL1 to CL3). Results: Among GDM patients, 7.7% were classified as CL1, 35.9% as CL2, and 56.4% as CL3. CL1 showed higher age, pregestational BMI, and increased glucose concentrations both at fasting and during the diagnostic oral glucose tolerance test. CL2 was characterized by elevated BMI and fasting glucose, while CL3 showed higher glucose concentrations after the oral glucose load, with BMI levels comparable to NGT mothers. Women in the CL1 group exhibited impaired insulin sensitivity and β-cell function at early pregnancy and showed elevated lipid levels. Compared to NGT women, a positive family history of diabetes was more prevalent in CL1 and CL3, but not in CL2. Dietary patterns were similar across all groups. Conclusions: Our study showed distinct alterations in glucometabolic parameters already at early pregnancy among GDM subtypes. Patients in CL1 exhibited the most unfavorable risk constellation and could benefit from lifestyle changes and nutrition therapy in early pregnancy, despite showing similar dietary patterns as the NGT group. Full article

Introduction: Women with gestational diabetes mellitus (GDM) can present with hypoglycaemia during the oral glucose tolerance test (OGTT), which has been associated with adverse perinatal outcomes. Objectives: We studied whether the presence of hypoglycaemia during the OGGT (HdOGTT) was associated with adverse perinatal outcomes. Methods: Retrospective study of a national database of women diagnosed with GDM in the 24–28th week OGTT. Excluded: women with missing OGTT or the primary outcomes data. HdOGGT: any glucose value < 70 mg/dL. Primary outcomes: hypertensive disease of pregnancy, preterm delivery, caesarean section (CSA), small-for-gestational-age, large-for-gestational-age, neonatal hypoglycaemia, respiratory distress syndrome, and intensive care unit admission. Women with and without hypoglycaemia were compared. Predictors of HdOGTT and the association between HdOGTT and the primary outcomes were studied using a multivariate logistic regression analysis. Results: We analysed 7704 women, 10.7% with HdOGTT. Most of them (94.8%) presented fasting hypoglycaemia, and 3.2% had blood glucose values < 54 mg/dL. There were no differences between groups regarding the primary outcomes, except for women with HdOGTT, who had a lower rate of CSA (34.1% vs. 29.0%, p = 0.001), large-for-gestational-age newborns (9.7% vs. 13.8%, p < 0.001), and a higher rate of small-for-gestational-age newborns (11.0% vs. 6.9%, p < 0.001) than those without HdOGTT. Age, BMI, previous miscarriage, and chronic hypertension were associated with lower risk of HdOGTT. HdOGTT was only associated with increased risk of SGA [OR (95% CI): 1.25 (1.00–1.56), p = 0.047] after adjustment for confounders. Conclusions: The prevalence of HdOGTT was 10.7%. Age, BMI, previous miscarriage, and chronic hypertension were associated with lower risk of HdOGTT. HdOGTT was associated with 25% higher risk of SGA newborns. Full article

Background: Reduced tissue sensitivity to insulin, as well as the associated increased risk of gestational diabetes mellitus is genetically controlled and often varies racially and geographically. Roma populations constitute a genetically autonomous society with particularities in their type of sociability, and they are reported to have an increased prevalence of type 2 diabetes mellitus, which is pathophysiologically related to insulin resistance. Objectives: The aim of this study was to investigate the level of insulin sensitivity in pregnancies of Roma mothers compared to controls. Methods: A total of 65 pregnancies were studied during the third trimester, divided between 33 Roma mothers (RP) and 32 mothers of European descent to serve as control volunteers (CP). The presence of gestational diabetes was confirmed according to the WHO diagnostic criteria by a 75 mg oral glucose tolerance test and insulin resistance status by the means of HOMA-IR index. Results: The mean fasting insulin levels as well as the mean HOMA-IR index were statistically significantly higher in the Roma population (p = 0.0013) and (p < 0.001), respectively, regardless of the age and BMI of the participants. Gestational Diabetes Mellitus developed in seven women (10.7%), five of whom were Roma (15.1%) and in two controls (6.2%) (p = 0.247). Conclusions: Increased insulin resistance is observed in Roma pregnancies, so it would be beneficial to provide these women with appropriate counseling focused on healthy diet and lifestyle. Full article