Tag: gestational diabetes

Categories : Metabolic Disorders Obstetrics & GynaecologyTags :

Metformin Trial Offers Hope for Women with Gestational Diabetes

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A significant step forward has been taken in the management of gestational diabetes mellitus after a clinical trial involving pregnant women provided new hope for expectant mothers suffering the condition. The findings from the trial are published in the Journal of American Medical Association.

Gestational diabetes affects almost 3 million pregnant women worldwide every year. It is a condition characterised by elevated blood sugar levels during pregnancy, posing increased health risks for both mothers and their babies.

The EMERGE, randomised, placebo-controlled trial, was conducted by the University of Galway and involved more than 500 pregnant women.

The trial results showed that:

  • Women assigned to metformin were 25% less likely to need insulin, and when insulin was necessary, it was started later in the pregnancy.
  • Fasting and post-meal glycaemic values in the mother were significantly lower in the metformin exposed group at weeks 32 and 38.
  • Women receiving metformin gained less weight throughout the trial and maintained this weight difference at the 12-week post-delivery visit.
  • Importantly, delivery occurred at the same mean gestational age (39.1 weeks) in both groups. There was no evidence of any increase in preterm birth (defined as birth before 37 weeks) among those who received metformin.
  • Infants born to mothers who received metformin weighed, on average, 113g less at birth, with significantly fewer infants classified as large at birth, or weighing over 4kg.
  • While there was a slight reduction in infant length (0.7cm), there were no other significant differences in baby measurements.
  • There were slightly more babies who were small at birth but this did not reach statistical significance.

The study also revealed no differences in adverse neonatal outcomes, including the need for intensive care treatment for new-borns, respiratory support, jaundice, congenital anomalies, birth injuries or low sugar levels.

Additionally there were no variations in rates of labour induction, caesarean delivery, maternal haemorrhage, infection or blood pressure issues during or after birth.

Professor Fidelma Dunne managed the trial, and presented the results at the 59th Annual Meeting of the European Association for the Study of Diabetes in Hamburg, Germany.

Professor Dunne said, “While there is convincing evidence that improved sugar control is associated with improved pregnancy outcomes, there was uncertainty about the optimal management approach following a diagnosis of gestational diabetes.

“In our pursuit of a safe and effective treatment option we explored an alternative approach – administering the drug metformin. A previous trial compared metformin to insulin and found it to be effective, yet concerns remained, especially regarding preterm birth and infant size.”

To address concerns comprehensively, the team at University of Galway conducted a ground-breaking placebo-controlled-trial, filling a critical gap in the gestational diabetes treatment landscape.

  • 535 pregnant women took part, with 268 receiving metformin and 267 a placebo.
  • 98% of women remained in the trial until delivery, with 88% completing the 12-week post-delivery follow up assessment.
  • Only 4.9% of women discontinued medication due to side effects, highlighting the safety of the interventions.

Professor Dunne said, “Traditionally, gestational diabetes has been managed initially through dietary advice and exercise, with insulin introduced if sugar levels remain sub optimal. While effective in reducing poor pregnancy outcomes, insulin use is associated with challenges, including low sugars in both the mother and infant which may require neonatal intensive care, excess weight gain for mothers, and higher caesarean birth rates.” Professor Dunne added: “The results from the EMERGE study are a significant step forward for women with gestational diabetes. Metformin has emerged as an effective alternative for managing gestational diabetes, offering new hope for expectant mothers and healthcare providers worldwide.”

Source: University of Galway

Categories : Metabolic Disorders Obstetrics & GynaecologyTags :

Dimming the Lights Could Help Reduce Gestational Diabetes Risk

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Researchers at Northwestern Medicine suggest that pregnant persons should dim the lights in their home and turn off or at least dim their screens (computer monitors and smartphones) a few hours before bedtime to reduce the risk of gestational diabetes mellitus.

In their study published in the American Journal of Obstetrics and Gynecology Maternal Fetal Medicine, women who developed gestational diabetes mellitus in the multi-site study had greater light exposure in the three hours before sleep onset. They did not differ in their light exposure during daytime or sleep or in their activity levels compared to those who did not develop it.

“Our study suggests that light exposure before bedtime may be an under-recognised yet easily modifiable risk factor of gestational diabetes,” said lead study author Dr Minjee, Northwestern Medicine neurologist.

While exposure to light at night before bedtime may be linked to impaired glucose regulation in non-pregnant adults, little is known about the effect of evening light exposure during pregnancy on the risk of developing gestational diabetes.

This is believed to be one of the first multi-site studies to examine light exposure before sleep on the risk of developing gestational diabetes, a serious health complication for mother and child.

‘Alarming’ global rise in gestational diabetes

Gestational diabetes is on the rise in the U.S. and globally. About 4.5% of first-time pregnant women with a baby born between 2011 and 2013 developed gestational diabetes, which has been increasing on average 3.4% per three-year period until 2019. In 2020, the rate of gestational diabetes was 7.8% of all births in the US.

“It’s alarming,” Kim said. “Gestational diabetes is known to increase obstetric complications, and the mother’s risk of diabetes, heart disease and dementia. The offspring also are more likely to have obesity and hypertension as they grow up.”

Data show that women who have gestational diabetes are nearly 10 times more likely to develop type 2 diabetes mellitus compared to those do not have glucose issues during pregnancy, Kim said.

Bright light exposure prior to sleep can come from bright indoor lighting and from device screens.

“We don’t think about the potential harm of keeping the environment bright from the moment we wake up until we go to bed,” Kim said. “But it should be pretty dim for several hours before we go to bed. We probably don’t need that much light for whatever we do routinely in the evening.”

Scientists don’t know which source of bright light causes the problem, but it might all add up, Kim said.

“Try to reduce whatever light is in your environment in those three hours before you go to bed,” Kim said. “It’s best not to use your computer or phone during this period. But if you have to use them, keep the screens as dim as possible,” Kim said, suggesting people use the night light option and turn off the blue light.

If pregnant persons develop gestational diabetes with the first pregnancy, they are more likely to have it with the next pregnancy.

Pre-sleep light exposure increases heart rate, with knock-on effects

Pre-sleep light exposure may affect glucose metabolism through sympathetic overactivity, meaning the heart rate goes up before bed when it should go down. “It seems there is inappropriate activation of the fight or flight response when it is time to rest,” Kim said.

Data shows the sympathetic overactivity may lead to cardiometabolic disease, which is a cluster of conditions including abdominal obesity, insulin resistance, increased blood pressure and an imbalance of lipids, all leading to cardiovascular disease.

The study of 741 women in their second trimester was conducted at eight clinical U.S. sites between 2011 and 2013. The participants’ light exposure was measured by an actigraph worn on their wrists. The women were measured during the second trimester of pregnancy, the time when they receive routine screening for gestational diabetes.

After adjusting separately for age, BMI, race/ethnicity, education, commercial insurance, employment schedule, season, sleep duration, sleep midpoint, sleep regularity index, and daytime light exposure, pre-sleep light exposure remained significantly associated with gestational diabetes.

The growing rate of gestational diabetes has been partially attributed to increasing body mass index and the older age of pregnant persons.

“But even after adjusting for BMI and age, gestational diabetes is still rising,” Kim said. “We have a lot to prove, but my personal worry is that light may be silently contributing to this problem without most people realising the potential harm.”

Losing body weight and exercising also reduce the risk of developing gestational diabetes, which are important but take some effort.

Turning down lights is an easy fix

“Turning down the lights is an easy modification you can make,” Kim said.

“Now I’m the light police at home,” Kim said. “I see all this light I never thought about before. I try to dim the light as much as possible. Just for evening activities such as dinner and bathing the kids, you don’t need bright light.”

“This study highlights the importance of reducing light exposure in the hours before bedtime” said senior author Kathryn Reid, research professor of neurology at Feinberg.

Source: Northwestern University

Categories : Metabolic Disorders Obstetrics & GynaecologyTags :

Obesity and Diabetes in Pregnancy may Raise Child’s ADHD Risk

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A recent study has found that children born to women with gestational diabetes and obesity may have twice the risk of developing attention-deficit/hyperactivity disorder (ADHD) compared to those born to mothers without obesity. The findings, published in the Journal of Clinical Endocrinology & Metabolism, also found found that in women with a healthy weight gain during pregnancy, this risk increase was not seen.

ADHD is a growing problem. According to data from 2016-2019, 6 million children aged 3–17 years have received an ADHD. Maternal obesity is a major risk factor for ADHD in children, and roughly 30% of women have obesity at their first doctor’s visit during pregnancy, rising to 47% in women with gestational diabetes. Excessive weight gain during pregnancy in this population is a risk factor for children developing ADHD.

“Our study found pregnant women with obesity and gestational diabetes had children with long-term mental health disorders such as ADHD,” said Verónica Perea, MD, PhD, of the Hospital Universitari Mutua Terrassa in Barcelona. “We did not find this association when these women gained a healthy amount of weight during pregnancy.”

Studying 1036 children born to women with gestational diabetes, the researchers found that 13% of these children were diagnosed with ADHD. When compared to mothers without obesity, the researchers found children of women with gestational diabetes and obesity were twice as likely to have ADHD compared to those born to mothers without obesity.

Notably, this association was only seen in women with gestational diabetes, obesity and excessive weight gain during pregnancy. There was no increased risk of ADHD in children of women with gestational diabetes and obesity if the amount of weight these women gained during pregnancy was within the normal range.

“It’s important for clinicians to counsel their patients on the importance of healthy weight gain during pregnancy,” Perea said.

Source: The Endocrine Society

Categories : Metabolic DisordersTags :

Using The 5:2 Diet for Weight Loss in Gestational Diabetes

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In a welcome finding, researchers have found that women who have had gestational diabetes can use the popular 5:2 diet for weight loss to help prevent the onset of type 2 diabetes.   

It can be a challenge to lose weight and keep it off, especially for mothers with a new baby. The study by the University of South Australia suggests that the popular 5:2 or intermittent fasting diet is as effective as a conventional energy-restricting diet, giving women greater choice and flexibility for weight loss.

The 5:2 diet allows five days of normal eating each week while substantially restricting calories over two days a week, as opposed to a typical diet that requires moderate energy restrictions daily.

A fifth of pregnancies are affected by gestational diabetes, which carries a ten-fold risk of developing type 2 diabetes later in life, exacerbated even further by being overweight.

A welcome finding for a growing problem
The study’s lead researcher, Dr Kristy Gray, said women looking to lose weight will welcome the finding: “Gestational diabetes is the fastest growing type of diabetes in Australia, affecting 15% of pregnancies.

“Healthy eating and regular physical activity are recommended to manage gestational diabetes, with continuous energy restriction diets – or diets that cut calories by 25–30% being the most common strategy for weight loss and diabetes prevention.

“The trouble is, however, that new mums often put themselves last – they’re struggling with fatigue and juggling family responsibilities – so when it comes to weight loss, many find it hard to stick to a low-calorie diet.

“The 5:2 diet may provide a less overwhelming option. As it only cuts calories over two days, some women may find it easier to adopt and adhere to, as opposed to a consistently low-calorie diet requiring constant management.

“Our research shows that the 5:2 diet is just as effective at achieving weight loss as a continuous energy-restricted diet in women who have had gestational diabetes, which is great, because it provides women with greater choice and control,” she said, adding that women should seek advice from health professionals before starting the diet.

The research investigated the effects of both the 5:2 diet (five days eating normally and two days eating 500 calories) and a continuous energy-restricted diet (1500 calories per day) on weight loss and diabetes risk markers in women with a previous diagnosis of gestational diabetes. Both diets cut energy intake by about 25% a week.

The study was published in the American Journal of Clinical Nutrition.

Source: University of South Australia