Gestational diabetes and gestational hypertension -
The prevalence rate of GDM in the Middle East and some North African countries has reached Increased insulin resistance and pancreatic β-cell dysfunction are the major pathogenesis of GDM, which may already exist before pregnancy, especially in obese populations 2.
GDM is associated with adverse pregnancy outcomes. Studies have found that the incidence of PE is significantly increased in GDM 16 , However, whether GDM is independently associated with the occurrence of PE or because of the effects of their common risk factors, especially obesity, remains controversial.
PE is the main cause of maternal and fetal mortality and morbidity 19 , GDM complicated by PE further increases perinatal adverse events 21 — 24 , future maternal risk of chronic hypertension, cardiovascular disease, and diabetes 25 — 27 ; offspring body mass index BMI also steadily increases over time Identifying factors associated with occurrence of PE in women with GDM, especially those that are controllable, is important for improving pregnancy outcomes.
This review describes the relationship between GDM and PE, factors associated with occurrence of PE in women with GDM, and impact of GDM on PE in twin pregnancy and in pregnant women with polycystic ovary syndrome PCOS.
It also explores possible impact mechanisms and predictive markers to improve pregnancy outcomes. HAPO is a large international prospective blinded cohort study involving 23, pregnant women in 15 centers from nine countries, assessing the relationship between blood glucose below diabetes levels and pregnancy outcomes.
The HAPO study found that the occurrence of PE is positively associated with blood glucose level even after adjusting for clinical center, age, BMI, height, smoking status, alcohol consumption, family history of diabetes, gestational age at OGTT, and urinary tract infection Following the IADPSG diagnostic criteria, secondary analysis showed that non-obese women with GDM was also associated with PE after adjusting for the above confounding factors, but the association was lower than obesity Population-based retrospective cohort studies in several countries also showed GDM was independently associated with the occurrence of PE 17 , 30 — According to a retrospective cohort study in Sweden, obesity is the main confounding factor 32 ; however, another retrospective cohort study in France suggested that obesity is not related with the occurrence of PE in women with GDM Different diagnostic criteria for GDM have had little impact on the occurrence of PE A few studies suggest that GDM is not associated with the occurrence of PE after removing the effect of pre pregnancy BMI and other factors 42 — A retrospective cohort study in Germany showed that there was no independent correlation between GDM and PE, regardless of obesity before pregnancy, and it was unknown whether it was related to the strict control of blood glucose levels In studies conducted in Australia and Japan 42 , 43 , cases included those within the diagnostic criteria of IADPSG but not up to their own national standards, so blood glucose levels were relatively low, which may have affect the results.
Based on these previous findings Table 1 , most studies support that GDM was independently associated with the occurrence of PE in singleton pregnancy. In addition, GDM is also a major risk factor for recurrent 47 and new postnatal PE in the absence of a PE history The history of GDM in first pregnancy is also a risk factor for PE in the second pregnancy Table 1.
The independent association of gestational diabetes mellitus with preeclampsia. PE also affects the occurrence of GDM; a retrospective cohort study in Korea showed that a history of PE in first pregnancy is a risk factor for the development of GDM in subsequent pregnancies However, a retrospective study in Chile suggested that the history of PE in previous pregnancies is negatively associated with the occurrence of GDM in the next pregnancy Whether PE associated with the occurrence of GDM should be further confirmed in large sample studies.
BMI is a common index used to evaluate nutritional status, even among pregnant women. Obesity is a common risk factor for GDM and PE, an individual participant data meta-analysis of European, North American and Australian cohorts showed that obesity increased the risk of GDM by three times and the risk of PE by two times Both obesity and GDM are independent associated with PE 16 , 31 , 32 , and the combination of the two has a greater impact than either one alone 16 , A Sweden population-based retrospective cohort study that included the data of 13, women with GDM who needed treatment, analyzed the impact of pre pregnancy BMI on PE, and showed the highest risk of GDM with obesity, but without significant interaction between obesity and GDM.
In addition, obesity had less effect on PE in women with GDM comparing with women without GDM, which may be the result of insulin resistance in both GDM and obesity Most studies suggested that pre pregnancy BMI was independently associated with the occurrence of PE in women with GDM 23 , 53 — In a retrospective cohort study, maternal obesity, early GDM diagnosis and poor glycemic control were the three independent factors related to PE in women with GDM, of which obesity was the highest risk Only one population-based retrospective study in France suggested that the incidence of PE in women with GDM was not associated with pre pregnancy BMI The reason for this result may be related to the drug treatment and blood glucose control; furthermore, aspirin was not excluded as a confounding factor In a prospective observational study, considering the level of blood glucose control and treatment methods, obesity was only related to PE in insulin treatment group with poor blood glucose control, but not in diet treatment group regardless of blood glucose control and insulin treatment group with good blood glucose control Thus, the effect of pre pregnancy BMI on PE in women with GDM may be also related to blood glucose level and treatment methods.
GWG, another commonly used indicator for nutritional status during pregnancy, is related to pregnancy complications 59 , The average weekly weight gain in the middle and third stages of gestation should be 0.
Although GWG is significantly elevated in women with GDM combined with PE 23 , 53 , most studies considered that the overall excess GWG had no independent correlation with the occurrence of PE 23 , 36 , 53 , 63 — 65 ; the same result was reported for obese women with GDM A recent retrospective cohort study of 1, women with GDM in China reported different conclusions, after adjusting for maternal age, pre pregnancy BMI, maternal education, in vitro fertilization, fasting, and 2 h glucose, the risk of the total excess GWG developing to PE is 2.
It has also been suggested that weight gain in early pregnancy is associated with the occurrence of PE Since we were unable to determine whether pregnant women would develop GDM at the beginning of pregnancy, the management of weight after GDM diagnosis was more significant.
A retrospective cohort study conducted in the US evaluated the effect of GWG on pregnancy outcome after the diagnosis of GDM; however, GWG after the diagnosis of GDM was not related to the occurrence of PE adjusted for black, pre pregnancy BMI, and chronic hypertension. Recent prospective cohort study in China suggested that a unit increase in GWG level after GDM diagnosis is not related with the occurrence of PE, but in women with excessive GWG before GDM diagnosis, both adequate and excessive GWG after GDM diagnosis increased the incidence of PE Both insufficient weight gain after diagnosis of GDM and total insufficient GWG are not associated with the occurrence of PE 36 , 65 , 67 — 69 ; however, in obese women with GDM, total insufficient GWG is negatively associated with the occurrence of PE A meta-analysis of GWG and GDM pregnancy outcomes showed that excessive GWG is associated with an increased risk of pregnancy-induced hypertension, but PE was not analyzed separately Further clinical studies are required to evaluate whether GWG affects PE occurrence in women with GDM, especially after the diagnosis of GDM.
A Chinese study found that among women with GDM, with weight gain within the receiver operating characteristic target, the incidence of pregnancy-induced hypertension is lower than that of women with weight gain within the IOM target In an Australian study, for the GWG of women with GDM, 2 kg was subtracted from that of the IOM target, which did not improve the prognostic outcome GWG not only affects the occurrence of PE in women with GDM, but also perinatal outcomes in those complicated by PE.
Although total excessive GWG is a protective factor for preterm birth, middle trimester excessive GWG is a risk factor for large gestational age and late trimester excessive GWG is a risk factor for severe PE and cesarean section In conclusion, although GWG has no greater impact than pre pregnancy BMI on PE in women with GDM, it is a controllable factor during pregnancy.
There is no consensus on the screening and diagnosis of GDM in early pregnancy. Screening is usually recommended in the first trimester or during prenatal care to exclude the presence of diabetes in high-risk women 10 , 11 , Opinions also differ on whether early- or later-onset GDM affects PE.
This may be related to the heterogeneity in diagnostic criteria for early-onset GDM and different time definitions and sample sizes.
Furthermore, several studies have reported the same conclusion 55 , 75 — In early-onset GDM, metformin or insulin treatment is more needed 75 , 78 , 79 , it is uncertain whether it will affect the occurrence of PE.
However, women with early-onset GDM have more risk factors for PE, such as older age, multiple pregnancy, and higher pre pregnancy BMI 80 , Others suggest a significantly increased incidence of PE in women with early-onset GDM 81 — In another prospective cohort study evaluating the risk of PE in women with GDM, the risk of PE in GDM diagnosed within 20 weeks of pregnancy was 8-fold, even after adjusting for pre pregnancy BMI, OGTT and control blood glucose levels Whether early- or later- onset GDM affects the occurrence of PE needs to be verified by large sample prospective trials.
However, for the high-risk population with GDM, early screening and active treatment may reduce the risk of PE 85 , The HAPO study showed that PE is linearly positively associated with the maternal glucose level, for every 1-standard deviation increase in OGTT blood glucose fasting, 1 h, and 2 h , with the odds ratio of PE between 1.
The risk of PE in women with GDM increases with increasing levels of glucose impairment at diagnosis 88 , However, optimizing glycemic treatment can reduce the occurrence of PE 23 , 90 , 91 , and poor glycemic control is related to the occurrence of PE 54 , 56 — Whether the blood glucose level at OGTT or the blood glucose control level can independently predict the occurrence of PE is unclear.
As previously reported, blood glucose control is an independent risk factor for PE 56 , 57 , and OGTT blood glucose levels are not associated with the occurrence of PE 56 , 57 , However, others reported that although optimizing blood glucose treatment can reduce the risk of PE, it is not an independent influencing factor, but the OGTT fasting blood glucose level is independent and significantly correlated with the occurrence of PE Accordingly, two other studies also support the finding that OGTT blood glucose levels are an independent risk factor for the development of PE 93 , A Chinese retrospective cohort study reported that the blood glucose level at OGTT and after treatment of GDM did not independently predict the occurrence of PE, while the fasting blood glucose level at OGTT is an important risk factor for such In conclusion, blood glucose levels should be more strictly controlled in women with severely-impaired glucose tolerance.
It is controversial whether HbA1c level in the second trimester of pregnancy is related to the occurrence of PE, the secondary analysis of HAPO and a retrospective study showed that the HbA1c level during OGTT was related to the occurrence of PE 99 , However, two retrospective studies showed that HbA1c level in the second trimester of pregnancy was not associated with PE 54 , A higher HbA1c level 5.
The risk of PE in women with GDM is also related to blood glucose variability. Women with poor blood glucose monitoring compliance are more susceptible to PE than women with good compliance Continuous blood glucose monitoring is helpful for detecting all postprandial blood glucose peaks and recording the impact of diet.
It is conducive for the timely adjustment of the treatment plan and for reducing blood glucose variations. The incidence of PE is significantly lower than that in women whose blood glucose alone is monitored, and the mean amplitude of glycemic excursions is also an independent risk factor for PE Blood glucose variability may affect the occurrence of PE by increasing oxidative stress.
However, a prospective study with a small sample size showed that the glycemic variability in the third trimester of non-insulin dependent GDM was not associated with the incidence of PE Age, parity and race are uncontrollable factors, which are also related to the occurrence of PE in GDM women.
More studies suggested that advanced age was not independent associated the occurrence with PE in women with GDM 23 , 54 , Only a retrospective study considered that advanced age was an independent risk factor for PE in women with GDM In a randomized controlled trial, nulliparity was independently associated with the occurrence of PE in women with GDM 57 , another retrospective study reached the same conclusion Other studies showed that parity was not associated with PE in women with GDM 23 , 54 , Ethnicity also has an impact on the occurrence of PE in women with GDM.
In the retrospective study in US, there was no difference in the incidence of PE among different ethnicity, including Mexican American, Caucasian and African American The same conclusion was reached in the retrospective study of Fiji, that is ethnicity had no effect on the occurrence of PE in women with GDM Table 2 summarizes whether the above factors are independently associated with the occurrence of PE in women with GDM.
Table 2. Factors independent affecting the incidence of preeclampsia in women with gestational diabetes mellitus.
The first treatment of GDM is lifestyle intervention, including diet and daily activities. Insulin is the most traditionally-preferred drug; oral hypoglycemic drugs, glibenclamide and metformin, are also used in some countries 2.
Considering that these drugs can cross the placenta, the American Diabetes Association does not recommend them as first-line drugs for GDM Two randomized controlled trials showed that intervention with GDM including dietary recommendations, blood glucose monitoring, and insulin treatment significantly reduced the risk of PE 90 , 91 , and a meta-analyses revealed similar conclusions Lifestyle intervention mainly includes diet and exercise, the diet should contain sufficient macronutrients and micronutrients, carbohydrates with low glycemic index are recommended 2.
A randomized controlled trial showed that a Mediterranean Diet, supplemented with extra-virgin olive oil and pistachios, can reduce the incidence of adverse pregnancy events of GDM, the incidence of PE in women with GDM was not different from that without GDM However, omega-3 fatty acids supplementation had no effect on the incidence of PE in women with GDM Inositol is considered as a food supplement, randomized controlled trials and meta-analysis believe that it can prevent the occurrence of GDM, but it cannot prevent the occurrence of pregnancy induced hypertension in high-risk groups of GDM — Meta-analysis showed that there was a significant negative association between smoking during pregnancy and incidence of PE , but smoking during pregnancy did not reduce the incidence of PE in women with GDM in a retrospective cohort study Moderate exercises during pregnancy are helpful to control pregnancy weight and blood glucose for women with GDM, but it has no effect on the occurrence of PE , Although women with GDM who require insulin treatment tend to have higher blood glucose at OGTT — , there was no significant difference in the incidence of PE compared to that in women on diet treatment alone 23 , 39 , — This may be related to the better management in the insulin treatment group ; even the incidence of PE in women with GDM treated with insulin is consistent with those with normal glucose tolerance If insulin treatment reaches the established blood glucose control level, the risk of PE in GDM with obesity is not different from that in normal weight For the use of glibenclamide and insulin in GDM, more comparisons were reported on blood glucose control and neonatal outcomes, and less on PE.
A retrospective cohort study in California showed that the incidence of PE in a glibenclamide-treated group was twice that in an insulin-treated group, and the risk was still 2.
Another randomized controlled trial study found that there was no difference in the incidence of PE between glibenclamide- and insulin-treated groups The same result was found even among women with GDM with significantly increased oral glucose stimulation test and fasting hyperglycemia A randomized controlled trial of pregnant women in 10 hospitals in New Zealand and Australia compared the pregnancy outcomes between the administration of metformin and insulin for GDM.
Although the incidence of PE in the metformin-treated group was lower than that in the insulin-treated group, the difference was not statistically significant In other studies, metformin also had no effect on the incidence of PE — However, the metformin-treated group had less weight gain after treatment , No relevant data exist on whether metformin is advantageous in obese women with GDM.
A recent meta-analysis evaluated the efficacy of metformin, glibenclamide, and insulin in the treatment of GDM. Metformin showed a trend of reducing PE compared with insulin, but there was no significant difference. The incidence of PE in the glibenclamide-treated group was slightly higher than that in insulin-treated group; however, there was also no significant difference Metformin may prevent PE by reducing the production of anti angiogenic factors, improving endothelial dysfunction and changing cell homeostasis and energy allocation , it is expected to become an ideal drug for preventing PE in women with GDM.
With the increase in maternal age and application of assisted reproductive technology, the incidence of twin pregnancy has been increasing , Population-based retrospective cohort studies across different time periods — and — in Canadians show a higher incidence of PE in twin pregnancies than in singletons, with or without GDM 35 , Retrospective case control studies in China and Australia also show a significantly higher incidence of PE in women with GDM with twin pregnancies than that in women with singletons , The two population-based cohort studies in Canadians derived different conclusions on whether GDM is associated with PE in twin pregnancy.
Early studies show that the risk of PE in twin pregnancy women with GDM is still 1. However, recent studies suggest that GDM was not associated with PE in twin pregnancy after adjusting for maternal age, smoking, parity, race, pre pregnancy BMI, and auxiliary factors This difference may be related to the fact that early studies did not adjust for pre pregnancy BMI, because obesity significantly increases the risk of PE The conclusions of other studies revealed inconsistencies; some suggested that the incidence of PE in twin pregnant women with GDM was significantly higher than that without GDM , , , and GDM was independent associated with PE in twin pregnancy , , while others suggested no significant difference between the two groups , Whether GDM is independent associated with PE in twin pregnancy requires further validation; overall, GDM has less impact on PE in twin pregnancy than in singleton pregnancy 35 , 40 , Women with PCOS have increased insulin resistance and hyperandrogenemia , PCOS increases the incidence of GDM and PE, and the results are independent of obesity and assisted reproductive technology — A meta-analysis showed that pregnant women with PCOS had a 2.
The incidence of PE is significantly higher in women with GDM combined with PCOS than in those without PCOS — The risk was fold after adjusting for factors such as age, pre pregnancy BMI, and parity — Only one study believes that there was no correlation between PCOS and PE in women with GDM after adjusting for confounding factors A Chinese prospective study found no difference in the incidence of PE between women with GDM with PCOS and those without PCOS, although the result was affected by factors such as small sample size and early intervention Pregnant women with PCOS combined with GDM tend to be older and have higher pre pregnancy BMI — It is necessary to determine whether GDM associated with PE in pregnant women with PCOS.
A prospective, double-blind, multicenter trial including pregnant women with PCOS in Norway revealed that there was no statistical correlation between early GDM and PE occurrence Similarly, two other studies were added to the earlier one, which increased the number of pregnant women with PCOS to The results still show that GDM did not increase the incidence of PE in pregnant women with PCOS, regardless of whether GDM occurred early or later Another prospective study in China found that the incidence of PE in PCOS pregnant women with GDM is significantly higher than that in pregnant women without GDM but did not analyze whether it was independent associated with PE Thus, the effect of GDM on PE in pregnant women with PCOS is less than the effect of PCOS on PE in women with GDM.
Although GDM is associated with PE, the exact mechanism underlying the two disease associations is unclear. The pathophysiological process of PE involves two stages, early insufficient trophoblast invasion leads to incomplete spiral artery remodeling, which causes placental ischaemia and oxidative stress.
The diseased placenta progressively secretes elevated amounts of anti-angiogenic factors [soluble fms-like tyrosine kinase-1 sFlt1 and soluble endoglin] that cause maternal inflammation and vascular endothelial dysfunction, and finally lead to systemic diseases 1 , Hyperglycemia can induce trophoblast inflammation and autophagy, inhibit trophoblast migration and invasion — Neutrophils in GDM are over-activated and release excessive neutrophil extracellular traps NETs , Excessive NETs hinder the blood circulation in the villous space, resulting in placental ischemia, which is related to the occurrence of PE — Oxidative stress increases in women with GDM — , hyperglycemia can induce oxidative stress through a variety of ways, including the formation of advanced glycation end products AGEs The production of reactive oxygen species increases during oxidative stress, resulting in a decrease in circulating nitric oxide NO level and bioavailability , which leads to vasodilation dysfunction.
AGEs are significantly increased in women with GDM , and can promote the occurrence of PE by inducing oxidative stress and inflammation — Moreover, the pro-inflammatory cytokines serum tumor necrosis factor-α TNF-α and Interleukin-6 IL-6 have been found increased in the circulation of women with GDM , , which are associated with endothelial dysfunction , and also increased in women with PE , Genetic variants are also associated with PE in women with GDM, the MIRArsCC genotype, HNF1αgene p.
Obesity is the main influencing factor of PE in women with GDM in this paper. There are many of same pathophysiological changes between obesity and GDM, but obesity was concluded to be associated with greater oxidative stress and inflammation including the imbalance of fat factors , which are related to the occurrence of PE.
Hyperinsulinemia and insulin resistance caused by obesity before pregnancy are related to the migration of cytotrophoblast and the reduction of uterine spiral artery remodeling, which is more likely to lead to placental ischemia The mechanism of gestational diabetes mellitus affecting the occurrence of preeclampsia is shown in Figure 1.
Figure 1. The mechanism of gestational diabetes mellitus affecting the occurrence of preeclampsia. Hyperglycemia inhibits trophoblast migration and invasion by inducing trophoblast inflammation and autophagy, which can lead to uterine spiral artery remodeling deficiency.
Neutrophils in GDM are over-activated and release excessive neutrophil extracellular traps resulting intervillous space occlusion. The two factors cause placental ischemia and hypoxia, resulting in the imbalance of anti-angiogenic factors, which can lead to vascular endothelial injury.
In addition, increased oxidative stress in GDM leads to decreased nitric oxide synthesis and activity, resulting in vasodilation dysfunction.
The increased inflammatory factors further aggravate the vascular endothelial injury. The clinical symptoms of preeclampsia eventually appeared, including hypertension and multiple organ injury. Obesity exaggerates all pathways affecting PE. Multiple biochemical markers have been studied to predict the occurrence of GDM and PE, and CRP, TNF-α, IL-6, and B-type natriuretic peptides are common predictive markers , , but none are used as practical clinical markers.
It is also significantly elevated in the blood of women with GDM complicated with PE However, whether it can early identify the risk of PE in women with GDM needs further research. In conclusion, there are no practical markers to predict the occurrence of PE in women with GDM, and we need to explore the pathophysiology of GDM and PE further.
In most studies, GDM is independently associated with PE in singleton pregnancy, and pre pregnancy BMI and blood glucose levels are closely related with the occurrence of PE. Therefore, optimizing the treatment and management of GDM can reduce the incidence of PE.
Oral hypoglycemic drugs, including metformin and glibenclamide, showed no significant difference in the occurrence of PE compared with insulin, despite a decreasing trend for metformin. The effects of GWG on PE, especially after the diagnosis of GDM and early-onset GDM, are controversial, and thus warrant further prospective studies.
Twin pregnancy and PCOS significantly increased the occurrence of PE in women with GDM. However, GDM has less effect on PE in twin pregnancy and pregnant women with PCOS.
The prevalence of GDM is significantly increased, which also increases the incidence of PE. Therefore, identifying the controllable factors affecting PE of GDM is important for improving pregnancy outcomes.
GDM may affecting the occurrence of PE by inducing placental ischemia, increasing oxidative stress and inflammation. Understanding the pathophysiological mechanism of GDM affecting the occurrence of PE is helpful to find effective markers and preventive measures, which needs further studies.
YY collected material and wrote the first draft. NW contributed to design of the study and provided critical feedback. All authors contributed to the article and agree to be accountable for the content of the work. This study was funded by the National Natural Science Foundation of China No.
LK , and the Virtual Simulation Experiment Teaching Project of China Medical University No. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers.
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AGEs, advanced glycation end products; BMI, body mass index; CRP, C-reactive protein; GDM, gestational diabetes mellitus; GWG, gestational weight gain; HAPO, Hyperglycemia and Adverse Pregnancy Outcome; HbA1c, glycosylated hemoglobin; IADPSG, International Association of Diabetes and Pregnancy Study Groups; IL-6, interleukin-6; IOM, Institute of Medicine; NAM, National Academy of Medicine; NETs, sneutrophil extracellular traps; NO, nitric oxide; OGTT, oral glucose tolerance test; PCOS, polycystic ovary syndrome; PE, preeclampsia; PlGF, placental growth factor; sFlt1, soluble fms-like tyrosine kinase-1; TNF-α, tumor necrosis factor; WHO, World Health Organization.
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J Perinat Med. Do very obese women who have bariatric surgery and substantial weight loss have a reduced risk of GDM and GH? Can some of the newer drugs for treating obesity or diabetes reduce risk of GDM if used even during pregnancy?
Are they safe? The CVD death rates have not declined in recent years among women 50 years of age or younger 36 , Traditional CVD risk factors are the primary determinants of CVD among younger women 38 — A high percentage of women have had complications of GDM or GH during 1 or more of their pregnancies 1 , Obesity, diabetes, and hypertension have been increasing over time 42 — This is an epidemic in great need of control 45 , Author affiliations: Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania Lewis H.
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J Am Coll Cardiol. Abbreviations: BP, blood pressure; CVD, cardiovascular disease; GDM, gestational diabetes mellitus; GH, gestational hypertension. Oxford University Press is a department of the University of Oxford.
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Chris L. Bryson, George N. Ioannou, Stephen Riabetes. Gestational diabetes and Jypertension hypertension are common, and their relation is not well understood. The authors conducted a population-based case-control study using — Washington State birth certificate and hospital discharge records to investigate this relation. Gestational diabetes was more common in each case group 3.Video
Is Pregnancy Diabetes or Gestational Diabetes harmful for baby? - Complication - touch-kiosk.infoma MurthyChris L. Bryson, Gestationap N. Duabetes, Stephen J. Gestational diabetes hypertensioj pregnancy-induced hypertension are hypeetension, and Gdstational relation is not gwstational Gestational diabetes and gestational hypertension.
Hypertensioj authors conducted a population-based Gestarional study using — Washington State birth certificate and hospital discharge records to geztational this relation. Gestational diabetes was more common Gestattional each case group 3.
Received for publication March 24, ; Herbal appetite suppressant for publication June Gestationl, Hypertensive disorders of pregnancy complicate gestationnal percent of all pregnancies High-speed fiber internet can result in a variety of maternal and fetal complications, including seizures, stroke, hepatic failure, hypettension failure, intrauterine growth retardation, ane distress, premature delivery, and hypertejsion 1.
The pathophysiology of pregnancy-induced Effective ways to reduce cellulite is Gfstational understood, but gestationla is likely multifactorial; several lines hyperteension evidence suggest hypfrtension glucose hypertenwion and insulin Gut health tips have a role in the Gfstational of these diseases 2.
Like pregnancy-induced hypertension, gestational diabetes mellitus is also relatively diabees and affects 3—5 percent hypertenslon pregnancies, resulting in a variety of complications that primarily affect anf fetus, including macrosomia, stillbirth, adn, and respiratory distress syndrome hyertension.
The relation between pregnancy-induced hypertension Tart cherry juice for acid reflux gestational diabetes is not Gesttaional understood 4 — dibaetes ; several studies suggest an association between Gestationap diseases 4 — 7 Getsational, 10 Tart cherry juice for acid reflux, anrbut others do not 89.
Whether the association between gestational diabetes and nad various Tart cherry juice for acid reflux of pregnancy-induced hypertension is ajd same or varies between types gestatioal pregnancy-induced hypertension is also Fat oxidation enzymes unknown.
To our gestatinal, there have been no diaberes, population-based studies with sufficient dlabetes to delineate gestattional relation diabettes gestational diabetes Gestational diabetes and gestational hypertension each subtype of pregnancy-induced hypertension in the same study or to investigate interactions Gestatuonal gestational diabetes hypertensikn known predictors of pregnancy-induced hypertension.
A better understanding of aand association between these conditions may gestatiohal to more effective strategies for prenatal care jypertension may ultimately allow gestarional a better understanding of their pathophysiology. Therefore, we conducted a population-based case-control study to better Gestationl the hypetension between Tart cherry juice for acid reflux diabetes and the bestational of pregnancy-induced hypertension eclampsia, severe preeclampsia, mild preeclampsia, and gestational diabetee in a sample of wnd delivering infants in Washington State.
Anonymous diabeetes data Gsetational this case-control Gestationzl were gestationall from Gestationaal electronic Washington Hpyertension Events Records Database Hypertennsion records of mothers who gestatiohal infants in Washington State between anv This statewide database links more Tart cherry juice for acid reflux 95 percent of Gestationap Washington State birth certificate data hypeertension maternal yhpertension infant Citrus bioflavonoids and anti-aging benefits Classification of Diseases diabeges, Ninth Gestationxl ICD-9 records of delivery hospitalization from the Hypertensoon Hospital Discharge Reporting System CHARS 12providing birth certificate data and ICD-9 discharge diagnosis data.
Subjects were excluded from gesgational analysis if yhpertension had Omega- for mental health history of pregestational hypertension ICD-9 codes — The study was restricted to women for whom body mass index was available for analysis.
Cases Gestationxl pregnancy-induced hypertension getational identified hypertesion ICD-9 codes. Four separate case groups testational created Gesattional on these codes: eclampsia ICD-9 diabftes All yestational identified during the study period were diabetew.
Controls were randomly sampled from diwbetes year of the study gestationall were frequency matched to the cases by year of birth. There wereGestational diabetes and gestational hypertension possible controls Holistic skin care tips which this sample was Creatine for muscle growth. The presence of gestational diabetes diabeetes ascertained from diabetee hospital Tart cherry juice for acid reflux records Hjpertension code Covariates that were used to Gestationap for confounding and examine for interaction with gestational diabetes were identified from prior studies gesttional — gestatilnal and included age, parity, ethnicity, body mass index, and adequacy of gestationa, care.
Maternal ethnicity was anc from the birth gestatiomal and was grouped into four Gestationak White, Black, Hispanic, gestatinoal other.
Body mass index was available Gesyational approximately 60 percent hypertenslon mothers giving birth in Washington Hypfrtension during this period.
Body mass index was categorized into gstational for the purposes of gestarional analysis. Adequacy of prenatal care was determined by calculating the Kotelchuck Tart cherry juice for acid reflux, as Promoting balanced sugar levels previously Hyprrtension index is a composite hypertensiom that summarizes hypertensiion care based hyprrtension both the number Gestafional timing of hypertensjon visits.
Unconditional Gestatonal regression was used to simultaneously control for multiple confounders and to model interactions. Each case group was modeled independently of the others with the same control group.
We assessed the statistical significance of effect modification between gestational diabetes and each of the covariates by using the likelihood ratio test. Age was modeled as a linear variable, while body mass index, parity, and degree of prenatal care were modeled as indicator variables to allow for either linear or nonlinear effects.
In general, women with pregnancy-induced hypertension tended to be younger, be a primigravida, and have a higher body mass index compared with controls table 1.
In addition, they were more likely to receive adequate prenatal care. Gestational diabetes was more common in each of the pregnancy-induced hypertension case groups than in controls table 2with prevalences of 3.
After adjustment for body mass index, age, ethnicity, parity, and adequacy of prenatal care, gestational diabetes was found to be associated with a significant 1.
Ethnicity was found to significantly modify the association between gestational diabetes and subtypes of pregnancy-induced hypertension table 3. Because of the small number of eclamptic cases, the eclampsia and severe pre-eclampsia case groups were combined for this analysis.
In this combined case group, White mothers with gestational diabetes had a 1. Similar increases in the risk of mild pre-eclampsia and gestational hypertension were found among White mothers.
Black mothers with gestational diabetes had a three- to fourfold higher risk of pregnancy-induced hypertension compared with Black mothers without gestational diabetes. This finding reflected the largest increase in risk among the ethnic groups. The amount and timing of prenatal care also modified the association between gestational diabetes and the most severe forms of pregnancy-induced hypertension table 4.
Compared with mothers without gestational diabetes, mothers with gestational diabetes who received less prenatal care less than 80 percent of the expected visits had a higher risk of both eclampsia and preeclampsia than did mothers with gestational diabetes and receiving more prenatal care eclampsia: high care vs.
low care, 0. low care, 1. The risk of gestational hypertension and mild preeclampsia associated with gestational diabetes was also higher among women receiving inadequate prenatal care, although this finding failed to achieve statistical significance. We were unable to find any significant interactions between gestational diabetes and body mass index, age, or parity.
Furthermore, the results of the study were unchanged when the women who refused classification of ethnicity were excluded from analysis data not shown. In this large, population-based study, we found a significantly increased risk of gestational hypertension, mild pre-eclampsia, and severe preeclampsia among women with gestational diabetes.
After adjustment for confounders, the risk of developing these serious disorders was 1. Results also suggest that both ethnicity and prenatal care modify the association between gestational diabetes and pregnancy-induced hypertension.
Our results are consistent with the findings from several prior studies. One cohort study of 10, women in Sweden examined risk factors for gestational hypertension and preeclampsia 6.
These data were collected from a similar birth registry, using ICD-9 codes to classify gestational diabetes and case status, but were restricted to nulliparous women less than age 34 years. A number of other studies have examined the association between gestational diabetes and pregnancy-induced hypertension, although some have been limited by small sample size or limited descriptive information 459 Nonetheless, three of these studies 4510 also found a higher proportion of pregnancy-induced hypertension among women with gestational diabetes compared with women without gestational diabetes.
A prospective study of women participating in a calcium supplementation trial for the prevention of preeclampsia also demonstrated that the degree of abnormal glucose tolerance was associated with preeclampsia We found interactions between ethnicity and gestational diabetes regarding their association with eclampsia and severe preeclampsia; trends were similar for the outcomes of gestational hypertension and mild preeclampsia.
We also found that the association between gestational diabetes and pregnancy-induced hypertension differed among the high and low prenatal care groups. Gestational diabetes was associated with a lower risk of pregnancy-induced hypertension among those women who received more prenatal care. While inadequate prenatal care has been described as increasing the risk of preeclampsia by 30 percent 1618to our knowledge it has not been previously portrayed as modifying the effect of other risk factors for pregnancy-induced hypertension.
Other studies and trials have suggested that aggressive early treatment of high-risk mothers might reduce the risk of preeclampsia 21 — Additionally, it has been suggested that the decreasing incidence rate of eclampsia over the past 20 years is due in part to better prenatal care Alternatively, this association could result from incomplete ascertainment and exclusion of preexisting diabetic and hypertensive disorders or related types of correlated misclassification.
This bias would lead to a relative enrichment of these disorders and misclassification of gestational diabetes and pregnancy-induced hypertension among mothers not receiving adequate prenatal care. If this bias is present, the lack of association between gestational diabetes and eclampsia or severe preeclampsia in the group receiving adequate or better care may reflect the least biased estimate.
Differential misclassification of pregnancy-induced hypertension and gestational diabetes according to degree of prenatal care is also possible; in this instance, women who receive more prenatal care might be more likely to have their gestational diabetes or pregnancy-induced hypertension diagnosed, resulting in a stronger-than-expected association.
However, we found the strongest association between gestational diabetes and pregnancy-induced hypertension for women receiving the least prenatal care in all case groups. Furthermore, the exposure, the outcome, and prenatal care variables were all ascertained from the hospital discharge record of the birth event.
This single point of data acquisition may limit errors that occur in large administrative databases compiled at different time points for different persons and makes this population data cross-sectional, reducing the possibility that recording of these variables was influenced by the frequency of preceding prenatal visits.
Overall, our findings do not prove that prenatal care and the treatment of underlying risk factors, such as diabetes and hypertension, can prevent more severe forms of pregnancy-induced hypertension but rather support the need for further investigation into this observation. This study has several other limitations.
We used administrative data, which may include women incorrectly classified as either 1 having pregnancy-induced hypertension or gestational diabetes when, according to strict criteria, they do not have these diseases or 2 not having case status or gestational diabetes when they would have met diagnostic criteria for these diseases.
Misclassification may occur more frequently with the less severe outcomes of gestational hypertension and mild preeclampsia and, less frequently, with severe preeclampsia and eclampsia.
This misclassification would tend to decrease the observed magnitude of a true relation between gestational diabetes and gestational hypertension or gestational diabetes and mild preeclampsia. Missing data is an expected difficulty arising from use of a large administrative database.
We found that gestational diabetes is associated with severe preeclampsia, mild preeclampsia, and gestational hypertension and that women with gestational diabetes appear to be at a 1.
The risk for pregnancy-induced hypertension associated with gestational diabetes varied among different maternal ethnicity groups and also by degree of prenatal care. These findings contribute to the understanding of these disorders and support the findings of prior studies that suggest an association between gestational diabetes and pregnancy-induced hypertension.
This work was supported in part by resources at VA Puget Sound, Seattle, Washington. Bryson was a VA Health Services Research and Development fellow while this work was conducted. Correspondence Dr.
Risk of pregnancy-induced hypertension associated with gestational diabetes, Washington State, — Walker JJ. Lancet ; : —5. Solomon CG, Seely EW. Brief review: hypertension in pregnancy: a manifestation of the insulin resistance syndrome?
Hypertension ; 37 : —9. Kjos SL, Buchanan TA. Gestational diabetes mellitus. N Engl J Med ; : — Suhonen L, Teramo K. Hypertension and pre-eclampsia in women with gestational glucose intolerance. Acta Obstet Gynecol Scand ; 72 : — Jensen DM, Sorensen B, Feilberg-Jorgensen N, et al.
: Gestational diabetes and gestational hypertension| Gestational diabetes | Liver detoxification techniques Med. Gestationa, CAS PubMed Google Gsetational Anderson MS, Bluestone JA. doi: Kajantie E, Osmond C, Eriksson JG. This study did not evaluate LGA and SGA for women with both HDP and GDM. |
| ACKNOWLEDGMENTS | Xiong, X. A Preventing premature aging Gestational diabetes and gestational hypertension study Gsetational an OR of 3. We also observed an increased risk of dibaetes diabetes among Gestational diabetes and gestational hypertension exposed to maternal overall and any subtypes of HDP, compared with those who were not exposed to maternal HDP. Similarly, two other studies were added to the earlier one, which increased the number of pregnant women with PCOS to Association of Concomitant Gestational Hypertensive Disorders and Gestational Diabetes With Cardiovascular Disease. |
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Association between fetal congenital heart defects and maternal risk of hypertensive disorders of pregnancy in the same pregnancy and across pregnancies. Circulation , 39— Sliwa, K. Possible joint pathways of early pre-eclampsia and congenital heart defects via angiogenic imbalance and potential evidence for cardio-placental syndrome. Heart J. Waters, T. Maternal and neonatal morbidity for women who would be added to the diagnosis of GDM using IADPSG criteria: A secondary analysis of the hyperglycemia and adverse pregnancy outcome study. Download references. This study is supported in part by Taiwan Ministry of Health and Welfare Clinical Trial Center MOHWTDU-B , MOST Clinical Trial Consortium for Stroke MOST Clinical Trial Consortium for Stroke MOST B , China Medical University Hospital DMR , and Tseng-Lien Lin Foundation, Taichung, Taiwan. School of Nursing and Graduate Institute of Nursing, China Medical University, Shui-Nan Campus, Jingmao Rd. Department of Public Health, China Medical University, Taichung, Taiwan. Department of Pharmacy and Master Program, Tajen University, Pingtung, Taiwan. Department of Nursing, Central Taiwan University of Science and Technology, Taichung, Taiwan. Department of Obstetrics and Gynecology, China Medical University Hospital, Taichung, Taiwan. Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan. Department of Health Services Administration, China Medical University, Taichung, Taiwan. Department of Food Nutrition and Health Biotechnology, Asia University, Taichung, Taiwan. Department of Nursing, China Medical University Hospital, Taichung, Taiwan. You can also search for this author in PubMed Google Scholar. The study was conceptualized by Y. and J. and F. analyzed and curated the data. were involved in validation. and Y. were involved with the resources and supervision. wrote the original draft. All authors were involved in the investigation and methodology of the study. All authors reviewed and edited the manuscript. finalized the revision. Correspondence to Ya-Ling Tzeng. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Open Access This article is licensed under a Creative Commons Attribution 4. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. Reprints and permissions. Lin, YW. Population-based study on birth outcomes among women with hypertensive disorders of pregnancy and gestational diabetes mellitus. Sci Rep 11 , Download citation. Received : 10 February Accepted : 09 August Published : 30 August Anyone you share the following link with will be able to read this content:. Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative. By submitting a comment you agree to abide by our Terms and Community Guidelines. If you find something abusive or that does not comply with our terms or guidelines please flag it as inappropriate. Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily. Skip to main content Thank you for visiting nature. nature scientific reports articles article. Download PDF. Subjects Gestational diabetes Hypertension. Introduction Hypertensive disorders of pregnancy HDP and gestational diabetes mellitus GDM are common disorders that may contribute to complications in pregnant women and newborns. Results Demographics characteristics of study groups Age distributions were similar among the three study groups, with a mean age of approximately 33 years; Table 1 Demographics and comorbidities in women with hypertension during pregnancy HDP , women with HDP and gestational diabetes mellitus GDM , and comparison group. Full size table. Figure 1. Full size image. Discussion It is well known that pregnant women with HDP or GDM are at elevated risks of subsequent adverse maternal and neonatal health conditions. Congenital malformations are associated with preterm delivery Studies have associated GDM and hypertensive disorders with congenital defects, including congenital heart defects 47 , 48 , 49 , 50 , particularly in women with preterm preeclampsia 51 , 52 , Methods Data sources The Department of Health Insurance in Taiwan is a government-managed system established in through integration of 11 public insurance programs to create a universal insurance system, which is compulsory for all residents. Figure 2. Flow chart for establishing study cohorts. Data availability The data that support the findings of this study were obtained from National Health Insurance Research database NHIRD of the Ministry of Health and Welfare, established by the National Health Research Institutes of Taiwan. References Kharakwal, S. Google Scholar Berhe, A. Article Google Scholar Butalia, S. Article PubMed Google Scholar Nguyen, C. Article PubMed PubMed Central Google Scholar DeSisto, C. 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Download references. This study was supported by intramural funding, provided by the E-Da Hospital EDAHP, EDAHP and EDAHI Department of Pediatrics, E-Da Hospital, I-Shou University, No. School of Medicine for International Students, College of Medicine, I-Shou University, No. Department of Obstetrics and Gynecology, E-Da Hospital, I-Shou University, No. You can also search for this author in PubMed Google Scholar. YHH and CCT conceived the idea. YTS, SJT, MCY, and LCC collected the data. HPK, YTS, YHH, CCT, and SJT analyzed and organized the data. YHH and CCT performed the result analysis and discussion. HPK drafted the manuscript. YHH and CCT reviewed and edited the manuscript. All authors reviewed and approved the final manuscript. Correspondence to Yun-Hsiang Hung or Ching-Chung Tsai. The Institutional Review Board of the E-DA Hospital approved this study EMRP— , which utilized data from the Taiwan National Health Insurance Research Database. The database encrypts patients' identity data, and the study solely utilized encrypted data without any direct contact with study participants. Therefore, the need for informed consent was waived by the Institutional Review Board of the E-DA Hospital. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Open Access This article is licensed under a Creative Commons Attribution 4. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. Reprints and permissions. Kek, HP. et al. The joint effect of gestational diabetes mellitus and hypertension contribute to higher risk of diabetes mellitus after delivery: a nationwide population-based study. BMC Pregnancy Childbirth 23 , Download citation. Received : 24 February Accepted : 04 July Published : 26 July Anyone you share the following link with will be able to read this content:. Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative. Skip to main content. Search all BMC articles Search. Download PDF. Abstract Background Gestational diabetes mellitus GDM and pregnancy-induced hypertension PIH are known risk factors for postpartum diabetes mellitus DM and hypertension, respectively. Methods A cohort study was conducted using data from the Taiwan National Health Insurance Research Database TNHIRD. Results The GDM cohort had a higher risk of developing DM, hypertension, and metabolic syndrome than the normal cohort, with hazard ratios of 7. Conclusion The cohort of patients with both GDM and PIH had the highest impact on developing postpartum DM compared with either condition alone cohort. Background Gestational diabetes mellitus GDM is a form of diabetes that manifests during pregnancy; it is characterized by high blood glucose levels that were absent or well-controlled before pregnancy. Note: The analysis of gestational diabetes was restricted to female offspring who had been pregnant; Adjusted for calendar year of birth, maternal age, maternal country of origin, maternal residence at birth, maternal cohabitation at birth, maternal educational level, maternal income categories at birth, maternal pre-pregnancy BMI, maternal smoking status during pregnancy, singleton status, maternal diabetes history before childbirth, paternal diabetes history before childbirth, parity, and sex of offspring. Associations between maternal HDP of pregnancy and diabetes in offspring, according to the timing of the maternal HDP diagnosis. Note: Adjusted for calendar year of birth, maternal age, maternal country of origin, maternal residence at birth, maternal cohabitation at birth, maternal educational level, maternal income categories at birth, maternal pre-pregnancy BMI, maternal smoking status during pregnancy, singleton status, maternal diabetes history before childbirth, paternal diabetes history before childbirth, parity, and sex of offspring. Subgroup analyses showed that the positive association between maternal HDP and offspring diabetes was largely similar in each subgroup by baseline characteristics Additional file 1 : Table S4. Sensitivity analyses restricted to offspring born after for maternal smoking adjustment, excluded offspring of mothers who diagnosed multiple types of HDP in one pregnancy, additionally adjusted for paternal hypertension, or adjusted for maternal obesity before childbirth, restricted analysis to offspring born after for the capture of diabetes diagnoses in same period in different registers, to offspring born before for the redefined preeclampsia concept, additionally adjusting for low birth weight, and excluded those diabetic patients identified through age from the main analysis, yielded similar results to the primary analyses Additional file 1 : Tables S However, we uncovered no association between maternal HDP and type 1 diabetes in offspring. The occurrence of maternal HDP, either gestational hypertension or preeclampsia, was associated with an increased risk of offspring type 2 diabetes. An increased risk of type 1 diabetes was solely observed in offspring exposed to gestational hypertension. In addition, offspring exposed to any subtypes of maternal HDP would have increased risks of gestational diabetes. We also observed stronger associations among offspring born to mothers with HDP and comorbid diabetes. To our knowledge, limited studies comprehensively evaluated the effect of maternal HDP on offspring diabetes [ 8 , 23 ]. However, the significant heterogeneity between studies I 2 : In addition, the abovementioned studies only assessed the effect of maternal type-specific HDP on offspring overall diabetes. In our study, we comprehensively assessed the association of maternal HDP and its subtypes preeclampsia, chronic hypertension, and gestational hypertension with diabetes in offspring from birth to young adulthood up to 41 years old and found an increased risk of diabetes in offspring born to mothers with overall or type-specific HDP. We also found that the offspring of mothers with either gestational hypertension or preeclampsia had an increased risk of offspring type 2 diabetes. Consistent with our findings, a study composed of older adults born in — from the Helsinki Birth Cohort Study reported that offspring exposed to maternal gestational hypertension in utero had a 1. The inconsistent findings abovementioned might be attributed to the baseline characteristics of the study populations, duration of follow-up, statistical power, adjusted covariates, and identification of diabetes. In the present study, based on data from several national registers of Denmark, we ascertained and verified diabetes with high reliability [ 24 ]. Type 2 diabetes, usually refers to as adult-onset disease, is partially determined by the accumulation of risk factors during early development [ 25 ]. Earlier studies in s have reported that preeclampsia was associated with offspring type 1 diabetes [ 12 , 13 ]. However, a case-control designed register study including 14, type 1 diabetes cases onset at ages 0—14 years from the Swedish Childhood Diabetes Register and 55, matched controls from the Swedish Total Population Register born from to [ 14 ], as well as the present population-based register study, covered a contemporary considerable time span of birth cohorts, showed no association of maternal preeclampsia with offspring type 1 diabetes. The inconsistent findings might be explained by new and more active pregnancy treatments, which might eliminate some of the adverse effects of preeclampsia. Simultaneously, we observed obvious increased risk for type 1 diabetes in the offspring of mothers with gestational hypertension for the first time. The differences in the association between maternal HDP and type-specific diabetes in offspring may be owing to the effects of various future risk factors and differential pathogenesis for type 1 organ-specific immune destruction of the pancreatic β-islets [ 26 ] and type 2 diabetes insulin resistance [ 27 ]. Further studies on the underlying mechanisms and other potential risk factors throughout life for offspring type 1 diabetes are warranted. We also observed an increased risk of gestational diabetes among offspring exposed to maternal overall and any subtypes of HDP, compared with those who were not exposed to maternal HDP. Evidence suggested that women with high blood pressure before or during pregnancy tended to have an increased risk of gestational diabetes [ 28 ], and several common pathogenic pathways might be underlying the association including insulin resistance [ 29 , 30 ], endothelial dysfunction [ 31 , 32 ], and inflammation markers [ 33 , 34 ]. Offspring exposed to higher levels of glucose spectrum in utero are more likely to be insulin resistant and limited β-cell compensation [ 35 , 36 ]. Such modulation in girls might increase the propensity to develop gestational diabetes. The underlying mechanisms between maternal HDP and diabetes in offspring are not fully elucidated. Maternal HDP has been suggested to be associated with non-specific systemic inflammatory reaction and circulating cortisol levels overexposure, which further result in hypoxia and fetal malnutrition [ 37 , 38 ]. Evidence showed that perturbed maternal-fetal environment was associated with the development of adult diabetes according to the modulation of epigenetic regulation of gene expression [ 25 ]. Methylation presence has been identified among women with preeclampsia [ 39 ], and in cord blood [ 40 ], which could decrease the numbers of stem cells involved in islet cell development, with an increased risk for abnormal insulin secretion, resistance to insulin, and type 2 diabetes in offspring [ 39 ]. Thus, epigenetic changes might have an essential role in the association between maternal HDP and diabetes in offspring. We found that mothers with both HDP and diabetes history tended to have a higher risk of offspring diabetes, compared with offspring born to mothers without HDP and diabetes history. Further research on the added effects of coexisting maternal HDP and maternal diabetes history on offspring diabetes is required to evaluate the burden of multimorbidity through pregnancy. This study has several strengths. First, we used the large population-based cohort study based on the Danish national registries, which covered all Danish residents with a long follow-up duration of up to 41 years, thus providing sufficient power and minimizing the possibility of selection and recall bias to obtain reliable statistical estimates. Second, we comprehensively assessed the association of maternal HDP and its different subtypes on diabetes in offspring from birth to young adulthood. Third, the availability of maternal and birth baseline characteristics and socioeconomic factors from the several Danish registration systems enables us to adjust for a wide range of important covariables. However, several limitations should be noted. First, although we have adjusted for a large number of important confounding factors, residual confounding caused by unmeasured confounders in childhood or adulthood, such as smoking status, alcohol intake, physical activity, sleep quality, and body mass index, may influence our findings. However, further adjustment for paternal hypertension in sensitivity analyses yielded similar results as the primary analyses, which suggested that the observed associations are unlikely to be completely attributable to unmeasured confounders. Second, there might be potential misclassification in the diagnosis of maternal HDP and offspring diabetes. In addition, due to the periods captured in the different registries and unavailable specific codes for type 1 and type 2 diabetes among offspring born from to , potential misclassification might exist for subtypes of diabetes. However, we performed sensitivity analyses restricted to offspring born after , excluded those diabetic patients identified through age from the main analysis, respectively, and found similar results to the primary analyses. Third, as our study was conducted in Denmark, the generality of our findings to other countries should be made cautiously. In conclusion, our study provides evidence that offspring born to mothers with HDP, especially mothers with comorbid diabetes, had higher risk of diabetes later in life, especially for type 2 diabetes and gestational diabetes. Maternal HDP did not increase the risk of offspring type 1 diabetes, except for gestational hypertension. These findings emphasize the importance and necessity of screening HDP status in women of childbearing age to identify and control maternal HDP early, thereby reducing the risk of diabetes in their offspring. Data collected for this study and additional related documents will be available to others by contacting the corresponding author Prof. Yongfu Yu, Email: yu fudan. Phipps EA, Thadhani R, Benzing T, Karumanchi SA. Pre-eclampsia: pathogenesis, novel diagnostics and therapies. Nat Rev Nephrol. Article PubMed PubMed Central Google Scholar. Webster K, Fishburn S, Maresh M, Findlay SC, Chappell LC, Guideline C. Diagnosis and management of hypertension in pregnancy: summary of updated NICE guidance. Article PubMed Google Scholar. Kuehn BM. Hypertensive disorders in pregnancy are on the rise. Stuart JJ, Tanz LJ, Missmer SA, Rimm EB, Spiegelman D, James-Todd TM, et al. Hypertensive disorders of pregnancy and maternal cardiovascular disease risk factor development: an observational cohort study. Ann Intern Med. Honigberg MC, Zekavat SM, Aragam K, Klarin D, Bhatt DL, Scott NS, et al. Long-term cardiovascular risk in women with hypertension during pregnancy. J Am Coll Cardiol. Wang YX, Arvizu M, Rich-Edwards JW, Wang L, Rosner B, Stuart JJ, et al. Hypertensive disorders of pregnancy and subsequent risk of premature mortality. Thomas C, Hypponen E, Power C. Prenatal exposures and glucose metabolism in adulthood - are effects mediated through birth weight and adiposity? Diabetes Care. Imterat M, Wainstock T, Landau D, Walfisch A, Sheiner E. Maternal chronic hypertension elevates the risk for long-term selected endocrine and metabolic morbidity in the offspring, particularly childhood obesity. Child Obes. Barker DJP. The fetal and infant origins of disease. Eur J Clin Investig. Article CAS Google Scholar. Kajantie E, Osmond C, Eriksson JG. Gestational hypertension is associated with increased risk of type 2 diabetes in adult offspring: the Helsinki birth cohort study. Am J Obstet Gynecol. Libby G, Murphy DJ, McEwan NF, Greene SA, Forsyth JS, Chien PW, et al. Pre-eclampsia and the later development of type 2 diabetes in mothers and their children: an intergenerational study from the Walker cohort. Article CAS PubMed Google Scholar. Dahlquist G, Kallen B. Maternal-child blood group incompatibility and other perinatal events increase the risk for early-onset type 1 insulin-dependent diabetes mellitus. Dahlquist GG, Patterson C, Soltesz G. Perinatal risk factors for childhood type 1 diabetes in Europe. The EURODIAB substudy 2 study group. Waernbaum I, Dahlquist G, Lind T. Perinatal risk factors for type 1 diabetes revisited: a population-based register study. Schmidt M, Schmidt SAJ, Adelborg K, Sundboll J, Laugesen K, Ehrenstein V, et al. The Danish health care system and epidemiological research: from health care contacts to database records. Clin Epidemiol. National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy. Report of the National High Blood Pressure Education Program Working Group on high blood pressure in pregnancy. Article Google Scholar. Magee LA, Pels A, Helewa M, Rey E, von Dadelszen P, Canadian Hypertensive Disorders of Pregnancy Working Group. Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy: executive summary. J Obstet Gynaecol Can. Arendt LH, Henriksen TB, Lindhard MS, Parner ET, Olsen J, Ramlau-Hansen CH. Hypertensive disorders of pregnancy and genital anomalies in boys: a Danish nationwide cohort study. Feltbower RG, McKinney PA, Campbell FM, Stephenson CR, Bodansky HJ. Type 2 and other forms of diabetes in year olds: a hospital based study in Leeds, UK. Arch Dis Child. Article CAS PubMed PubMed Central Google Scholar. Anna LG, Sian E. Defining the genetic aetiology of monogenic diabetes can improve treatment. Expert Opin Pharmacother. World Health Organization. Hong LS, Limited R, Bournemouth. Lexis expansion-age-at-risk adjustment for survival analysis; Google Scholar. Bi SL, Zhang LZ, Huang LJ, Li YL, Liang YY, Huang MS, et al. Long-term effects of preeclampsia on metabolic and biochemical outcomes in offspring: what can be expected from a meta-analysis? Obes Rev. Green A, Sortso C, Jensen PB, Emneus M. Validation of the Danish National Diabetes Register. It might lead to the baby being born early and also could cause seizures or a stroke a blood clot or a bleed in the brain that can lead to brain damage in the woman during labor and delivery. Women with diabetes have high blood pressure more often than women without diabetes. Listen to this Podcast: Gestational Diabetes. People with diabetes who take insulin or other diabetes medications can develop blood sugar that is too low. Low blood sugar can be very serious, and even fatal, if not treated quickly. Seriously low blood sugar can be avoided if women watch their blood sugar closely and treat low blood sugar early. Women who had gestational diabetes or who develop prediabetes can also learn more about the National Diabetes Prevention Program National DPP , CDC-recognized lifestyle change programs. To find a CDC-recognized lifestyle change class near you, or join one of the online programs. Gestational Diabetes and Pregnancy [PDF — 1 MB] View, download, and print this brochure about gestational diabetes and pregnancy. Skip directly to site content Skip directly to search. Español Other Languages. Gestational Diabetes and Pregnancy. Español Spanish. |
BMC Gfstational Gestational diabetes and gestational hypertension 21Gestational diabetes and gestational hypertension number: 59 Cite this article. Metrics details. Maternal hypertebsion disorders gestationxl pregnancy HDP have been suggested to contribute to the gestatonal of offspring Immune system defense mechanisms disease later in life, but empirical evidence remains inconsistent. This study was aimed to assess the association of maternal overall and type-specific HDPs with diabetes in offspring from childhood to early adulthood. Using Danish national health registers, a total of 2, individuals born in Denmark from to were included in this study. Maternal HDP included chronic hypertension, gestational hypertension, and preeclampsia.
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