Pregnancy as an opportunity to prevent type 2 diabetes mellitus: FIGO Best Practice Advice.

Gestational diabetes (GDM) impacts approximately 17 million pregnancies worldwide. Women with a history of GDM have an 8-10-fold higher risk of developing type 2 diabetes and a 2-fold higher risk of developing cardiovascular disease (CVD) compared with women without prior GDM. Although it is possible to prevent and/or delay progression of GDM to type 2 diabetes, this is not widely undertaken.

Management of obesity across women's life course: FIGO Best Practice Advice.

Obesity is a chronic, progressive, relapsing, and treatable multifactorial, neurobehavioral disease. According to the World Health Organization, obesity affects 15% of women and has long-term effects on women's health. The focus of care in patients with obesity should be on optimizing health outcomes rather than on weight loss.

Hyperglycemia in Pregnancy and Women's Health in the 21st Century.

Hyperglycemia is the commonest medical condition affecting pregnancy and its incidence is increasing globally in parallel with the twin epidemics of diabetes and obesity. Both pre-pregnancy diabetes and gestational diabetes are associated with short term pregnancy complications, with the risk of immediate complications generally broadly rising with more severe hyperglycemia. In this article we firstly consider these risks and their optimal management during pregnancy and then broaden our scope to consider the long-term implications of hyperglycemia in pregnancy as it relates to overall maternal and offspring health in a life course perspective.

Clinicians' perspectives on gestational diabetes screening during the global COVID-19 pandemic in Australia.

Aim: There is no international consensus for the screening and diagnosis of gestational diabetes mellitus (GDM). In March 2020, modified screening and diagnostic recommendations were rapidly implemented in Queensland, Australia, in response to the COVID-19 pandemic. How clinicians perceived and used these changes can provide insights to support high-quality clinical practice and provide lessons for future policy changes.

Cost-effectiveness of gestational diabetes screening including prevention of type 2 diabetes: application of the GeDiForCE model in Australia.

Aims: Gestational diabetes mellitus (GDM) is associated with an increased risk of perinatal complications and of developing type 2 diabetes mellitus (T2DM). A strategy including universal screening following new evidence-based thresholds recommended by the International Association of Diabetes and Pregnancy Study Groups (IADPSG) combined with antenatal care and postpartum lifestyle management could reduce these risks. This new strategy has been endorsed by the Australasian Diabetes in Pregnancy Society (ADIPS) following evidence that showed previous diagnostic thresholds were too high to prevent perinatal adverse events (PAEs) and subsequent T2DM.

Relationship between obesity and lower rates of breast feeding initiation in regional Victoria, Australia: an 8-year retrospective panel study.

Objectives: Using routinely collected hospital data, this study explored secular trends over time in breast feeding initiation in a large Australian sample. The association between obesity and not breast feeding was investigated utilising a generalised estimating equations logistic regression that adjusted for sociodemographics, antenatal, intrapartum and postpartum conditions, mode of delivery and infant's-related covariates.

Design: Population-based retrospective panel.

Early life predictors of development of blood pressure from childhood to adulthood: Evidence from a 30-year longitudinal birth cohort study.

Background And Aims: The early life predictors of changes in the blood pressures of offspring between childhood and young adulthood have not been well defined. Thus, this study aimed to determine the life course association of offspring's blood pressure with prenatal and early infancy lifestyle, and other factors taking advantage of a large community-based, longitudinal study of a birth cohort in Australia - the MUSP study.

Methods: The systolic and diastolic blood pressure (SBP, DBP) was measured for 3793, 3782, 2628 and 1780 offspring of the Australian longitudinal cohort study at 5, 14, 21 and 30 years of their age, respectively.

Type 2 Diabetes in Pregnancy.

Hyperglycemia is common during pregnancy, involving multisystem adaptations. Pregnancy-induced metabolic changes increase insulin resistance. Pregnancy-induced insulin resistance adds to preexisting insulin resistance.

The International Federation of Gynecology and Obstetrics (FIGO) initiative on pre-eclampsia: A pragmatic guide for first-trimester screening and prevention.

Pre‐eclampsia (PE) is a multisystem disorder that typically affects 2%–5% of pregnant women and is one of the leading causes of maternal and perinatal morbidity and mortality, especially when the condition is of early onset. Globally, 76 000 women and 500 000 babies die each year from this disorder. Furthermore, women in low‐resource countries are at a higher risk of developing PE compared with those in high‐resource countries.

Renal insufficiency among urban populations in Bangladesh: A decade of laboratory-based observations.

Objective: The objective of this study was to describe the age and sex-specific prevalence of renal insufficiency, and observe its trends over a decade at an urban Bangladesh setup.

Method: This was a cross-sectional study, in which we observed the Estimated Glomerular Filtration Rate (eGFR) of 218,888 adults, aged ≥19 years, who had submitted their blood specimen to the Clinical Biochemistry Laboratory of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) during the years 2006-2015. We applied CKD-EPI definition in estimating eGFR using their age-and sex-specific serum creatinine concentrations.

Quantitative Proteomics by SWATH-MS Suggest an Association Between Circulating Exosomes and Maternal Metabolic Changes in Gestational Diabetes Mellitus.

Several factors including placental hormones (PH) released from the human placenta have been associated with the development of insulin resistance and gestational diabetes mellitus (GDM). However, circulating levels of PH does not correlate well with maternal insulin sensitivity across gestation, suggesting that other, previously unrecognized, mechanisms may be involved. The levels of circulating exosomes are higher in GDM compared to normal.

Adipose Tissue Exosomal Proteomic Profile Reveals a Role on Placenta Glucose Metabolism in Gestational Diabetes Mellitus.

Context: Molecules produced by adipose tissue (AT) function as an endocrine link between maternal AT and fetal growth by regulating placental function in normal women and women with gestational diabetes mellitus (GDM).

Objective: We hypothesized that AT-derived exosomes (exo-AT) from women with GDM would carry a specific set of proteins that influences glucose metabolism in the placenta.

Design: Exosomes were isolated from omental AT-conditioned media from normal glucose tolerant (NGT) pregnant women (n = 65) and pregnant women with GDM (n = 82).

Human placental exosomes in gestational diabetes mellitus carry a specific set of miRNAs associated with skeletal muscle insulin sensitivity.

There is increasing evidence that miRNAs, which are enriched in nanovesicles called exosomes, are important regulators of gene expression. When compared with normal pregnancies, pregnancies with gestational diabetes mellitus (GDM) are associated with skeletal muscle insulin resistance as well as increased levels of circulating placental exosomes. Here we investigated whether placental exosomes in GDM carry a specific set of miRNAs associated with skeletal muscle insulin sensitivity.

Diastolic blood pressure is a potentially modifiable risk factor for preeclampsia in women with pre-existing diabetes.

Aims: To identify early clinical, modifiable risk factors for preeclampsia present at first antenatal visit and assess the prevalence of pregnancy-related hypertensive disorders in women with pre-existing diabetes treated with tight glycemic and blood pressure (BP) control.

Methods: A population-based cohort study of 494 women with pre-existing diabetes (307 and 187 women with type 1 and type 2 diabetes, respectively), included at their first antenatal visit from 2012 to 2016. The prevalence of chronic hypertension (without diabetic nephropathy or microalbuminuria), gestational hypertension and preeclampsia was recorded.

Clinical management of pregnancy in the obese mother: before conception, during pregnancy, and post partum.

The global epidemic of obesity has led to an increasing number of obese women of reproductive age. Obesity is associated with reduced fertility, and pregnancies complicated by maternal obesity are associated with adverse outcomes, including increased risk of gestational diabetes, pre-eclampsia, preterm birth, instrumental and caesarean births, infections, and post-partum haemorrhage. The medical and obstetric management of obese women is focused on identifying, addressing, and preventing some of these associated complications, and is a daunting challenge given the high percentage of patients with obesity and few therapeutic options proven to improve outcomes in this population.

Effect of birth weight on adulthood renal function: A bias-adjusted meta-analytic approach.

While the association between low birth weight (LBW; <2500 g) and development of adult chronic renal disease (CKD) is inconsistently reported, less information is available regarding association of high birth weight (HBW; ≥4000 g) with CKD. We undertook a systematic review and meta-analysis on studies published before 30 September 2015 and report associations between birth weight and renal function. Blood (glomerular filtration rate (GFR)) and urine (microalbuminuria/albumin excreation rate (AER)/urinary albumin creatinine ratio (ACR)) parameters were used to define CKD.

Association of parental body mass index before pregnancy on infant growth and body composition: Evidence from a pregnancy cohort study in Malaysia.

Background And Objectives: Parental body mass index (BMI) is strongly linked with the development of offspring overweight and obesity. However, there are a limited number of studies focusing on the association of parental body mass index before pregnancy on offspring growth and body composition in early life, particularly in developing countries.

Methods: Data from the University Sains Malaysia (USM) Pregnancy Cohort which consists of 153 mother-offspring pairs were used.

Changing the protocol for gestational diabetes mellitus screening.

Background: Gestational diabetes mellitus (GDM) affects 5-8% of pregnant women in Australia and is linked to adverse maternal and neonatal outcomes. Earlier diagnosis and treatment has been suggested to improve these outcomes.

Aim: To describe the experience of a change in GDM screening policy at a large tertiary hospital.