Diabetes, Gestational

ARLINGTON, Va., Oct. 24, 2024 /PRNewswire/ -- Today, the American Diabetes Association® (ADA) and Blue Cross and Blue Shield of Minnesota announced a new endeavor to address disparities in maternal health care delivery, with an emphasis on the impact of gestational diabetes (GDM)—diabetes that occurs during pregnancy. A new professional education series will seek to eliminate provider biases and encourage implementation of the ADA's Standards of Care in Diabetes (Standards of Care) to optimize maternal and infant health outcomes. GDM affects up to 9% of pregnancies in the U.S. and carries health risks for both mothers and children during pregnancy and after birth. Women who are Black, Hispanic, Native American, or Asian, or who are socioeconomically disadvantaged, are far more likely than their more advantaged peers to suffer from GDM and its adverse effects. "Gestational diabetes not only increases the risk of adverse pregnancy outcomes, but also creates a greater risk of developing overt diabetes later in life, damaging both short- and long-term health," said Bukata Hayes, vice president of racial and health equity and chief equity officer at Blue Cross and Blue Shield of Minnesota. "That it more deeply impacts birthers that are Black, Latine, Indigenous, Asian Pacific Islander or are socioeconomically disadvantaged, emphasizes the work we need to do to ensure everyone has access to quality and affordable culturally concordant care." Together, the ADA and Blue Cross and Blue Shield of Minnesota will create a nationally available educational series of webinars and webcasts for health care and allied professionals. The series will focus on: Understanding the root causes of maternal health disparities on women and their children who are residents of marginalized communities. Identifying and eliminating provider bias. The latest clinical guidance from the ADA's Standards of Care. The role of allied professionals and non-traditional community-based resources to provide wrap-around care needed for women and their children to thrive. The series is supported by a $750,000 educational grant from Blue Cross and Blue Shield of Minnesota and offers up to 4.5 continuing education credits. The initial series is expected to launch during American Diabetes Month® in November 2024 through the ADA's Institute of Learning. "Maternal health care teams, including doulas, midwives, and other health care professionals, are at the heart of culturally respectful, effective care delivery. Through this partnership, we're able to offer additional support and the latest evidence-based care recommendations as these teams work to improve health outcomes for those most deeply affected," said Charles "Chuck" Henderson, the ADA's chief executive officer. About the American Diabetes Association The American Diabetes Association (ADA) is the nation's leading voluntary health organization fighting to end diabetes and helping people thrive. For 84 years, the ADA has driven discovery and research to prevent, manage, treat, and ultimately cure diabetes. There are 136 million Americans living with diabetes or prediabetes. Through advocacy, program development, and education, we're fighting for them all. To learn more or to get involved, visit us at diabetes.org or call 1-800-DIABETES (800-342-2383). Join the fight with us on Facebook (American Diabetes Association), Spanish Facebook (Asociación Americana de la Diabetes), LinkedIn (American Diabetes Association), and Instagram (@AmDiabetesAssn). Contact: [email protected] SOURCE American Diabetes Association WANT YOUR COMPANY'S NEWS FEATURED ON PRNEWSWIRE.COM? 440k+ Newsrooms & Influencers 9k+ Digital Media Outlets 270k+ Journalists Opted In GET STARTED

引言 近年来，全球肥胖率不断攀升，肥胖已成为严重威胁人类可持续发展的公共卫生问题。与此同时，育龄女性的肥胖流行率亦呈现与普通人群同步增长的态势，成为该群体面临的最普遍健康问题之一【1】。大量观察性研究已证实母亲肥胖与多种不良妊娠结局及并发症的关联，如子痫前期、妊娠期糖尿病、胎膜早破等。对于子代，母亲肥胖可增加早产、巨大儿及出生缺陷的风险；从长远角度考量，母亲肥胖还会对子代健康产生持久的负面影响，增加子代罹患心血管代谢性疾病、神经发育异常，甚至癌症的风险【2,3】。值得注意的是，观察性研究往往受到混杂因素、过度显著性偏倚和选择性报告等问题的影响，导致观察到的效应量被夸大【4】。截至目前，针对该领域的相关证据尚缺乏全面而系统的综合评估。 2024年10月11日，山东大学生殖医学与子代健康全国重点实验室陈子江/赵涵/赵世刚研究团队在Nature Human Behaviour发表了题为 Maternal adiposity and perinatal and offspring outcomes: an umbrella review的研究论文【5】。该研究以伞形评价的方式系统性地梳理了母亲肥胖对围产期及子代健康 (涵盖出生缺陷、心血管代谢及生殖健康、神经发育及精神健康、癌症) 的影响，并对证据有效性和强度进行了全面评估。伞形评价作为一种继系统评价和荟萃 (meta) 分析之后的更高级别的循证医学分析方法，能够系统地收集并评估多个系统综述或meta分析中的现有证据，从而得出更为可靠和全面的结论。 该团队系统检索了PubMed、Web of Science及Cochrane Library三大权威数据库，对8068篇文献进行严格筛选，最终纳入了共计194项观察性meta分析、10项孟德尔随机化研究；同时对8329篇文献进行严格筛选，最终纳入78项干预性meta分析进行伞形评价。研究团队通过一系列统计学标准 (包括meta分析P值、样本量大小、小样本研究效应、95%预测区间等) 对每一项观察性meta分析的证据水平强度和可信度进行了细致评估，并据此将它们划分为五个证据等级：Convincing (class I)、Highly Suggestive (class II)、Suggestive (class III)、Weak (class IV) 及Not Significant (NS)。 文献筛选流程图（Credit: Nature Human Behaviour） 结果显示，有17项 (占比8.8%) 观察性meta分析被评为最高证据等级Convincing (class I)，这些研究强有力地支持了母亲肥胖与12个不良围产期并发症及子代健康结局之间的关联，发现母亲肥胖可增加引产后剖宫产、新生儿1分钟Apgar评分低于7分、婴儿期死亡、产前抑郁发生风险，其子代患先天性心脏病、脊柱裂、脑瘫、女儿青春期提前以及注意力缺陷多动障碍的风险也大大增加。同时，这些高级别证据还支持母亲肥胖程度与子代脂肪质量及体脂比之间呈正相关关系。 受最高等级 (Convincing) 证据支持的不良结局（Credit: Nature Human Behaviour） 对于这12个受最高证据等级(Convincing)支持的不良健康结局，研究团队利用干预性meta分析和孟德尔随机化研究的结果来辅助验证观察性研究的结论。干预性meta分析证实了母亲孕前或孕期减重措施在降低产前抑郁风险方面的有效性，但在改善新生儿Apgar评分或调整子代脂肪质量及体脂比方面则未见显著成效，说明母亲肥胖带来的负面健康影响并不是都能通过孕前或孕期减重干预来改善的。此外，孟德尔随机化研究证实了母亲肥胖与子代体重及体脂之间的因果关系，这一结论支持观察性研究的结果；但孟德尔随机化研究并未发现母亲肥胖与先天缺陷之间的关联。 更大比例的观察性meta分析 (17.5%，34项)，被评为Highly Suggestive (class II)。这些meta分析支持母亲肥胖与妊娠期糖尿病、子痫前期、剖宫产、早产、死产、巨大儿、子代BMI增高、收缩压增高、子代患I型糖尿病等结局的关联。此外，12.9% (25项) 的观察性meta分析被评为Suggestive (class III)，涉及胎膜早破、肩难产、过期产、产后出血等不良妊娠结局，子代自闭症、唇腭裂、智力发育异常、白血病等缺陷。30.9% (60项) 的观察性meta分析仅被评为Weak (class IV)；剩余29.9% (58项) 未显示出显著关联。 Convincing和Highly Suggestive证据支持母亲肥胖与36种不良结局的关联（Credit: Nature Human Behaviour） 为确保研究结论的稳健性，研究团队还进行了一系列敏感性分析，分别探讨了原始研究设计类型 (即队列研究、病例对照研究、横断面研究) 及原始研究方法学质量 (依据NOS量表评估) 对证据等级评估结果的影响。结果显示，在仅纳入队列研究或仅纳入高质量原始研究时，原先被评为Convincing (class I) 的观察性meta分析依然稳固地保持了其最高证据等级，证实了结果的可靠性和稳健性。 综上所述，本研究通过伞形评价的方式，系统地总结并评估了母亲肥胖与围产期及子代结局之间的现有证据。值得注意的是，现有的孟德尔随机化研究仍然不足，特别是在涉及子代结局方面。孕前及孕期减重干预虽能减少部分母亲肥胖带来的不良健康影响，但并非全部。随着肥胖成为全球流行病，未来亟需进一步的干预性和因果研究以确定母体肥胖对围产期和子代健康的全面影响，帮助制定更有效的疾病预防策略。 参考文献 [1] Creanga, A. A., Catalano, P. M. & Bateman, B. T. Obesity in pregnancy. N. Engl. J. Med. 387, 248–259 (2022). [2] Poston, L. et al. Preconceptional and maternal obesity: epidemiology and health consequences. Lancet Diabetes Endocrinol. 4, 1025–1036 (2016). [3] Razaz, N., Villamor, E., Muraca, G. M., Bonamy, A.-K. E. & Cnattingius, S. Maternal obesity and risk of cardiovascular diseases in offspring: a population-based cohort and sibling-controlled study. Lancet Diabetes Endocrinol. 8, 572–581 (2020). [4] Ioannidis, J. P. A. Why most discovered true associations are inflated. Epidemiology 19, 640–648 (2008). [5] Yang, ZY. et al. Maternal adiposity and perinatal and offspring outcomes: an umbrella review. Nature human behaviour. (2024). https://www.nature.com/articles/s41562-024-01994-6 责编|探索君 排版|探索君 文章来源|“BioArt” End 往期精选 围观 一文读透细胞死亡(Cell Death) | 24年Cell重磅综述（长文收藏版） 热文 Cell | 是什么决定了细胞的大小？ 热文 Nature | 2024年值得关注的七项技术 热文 Nature | 自身免疫性疾病能被治愈吗？科学家们终于看到了希望 热文 CRISPR技术进化史 | 24年Cell综述

TUESDAY, Oct. 1, 2024 -- Preconception prediabetes is associated with increased odds of gestational diabetes among adolescents and young adults, according to a study published online Sept. 24 in JAMA Network Open . Katharine J. McCarthy, Ph.D., from the Icahn School of Medicine at Mount Sinai in New York City, and colleagues conducted a retrospective cohort study using linked 2009 to 2017 birth registry, hospital discharge, and New York City Department of Health A1C Registry data for pregnant individuals aged 10 to 24 years. Eligibility criteria were met by 14,302 individuals: 41.0 percent Hispanic, 29.0 percent Black, 18.1 percent White, 10.6 percent Asian, and 1.3 percent other or unknown race and ethnicity. The researchers found that 79.7 and 20.2 percent of participants had normoglycemia and prediabetes, respectively. Compared with those with normoglycemia, those with preconception prediabetes had more than twice the risk for gestational diabetes (adjusted relative risk [aRR], 2.21) after adjusting for prepregnancy characteristics. Small increases in the likelihood of a hypertensive disorder of pregnancy (aRR, 1.18) and preterm delivery (aRR, 1.18) were seen in association with preconception prediabetes. Increases were seen in the risks for cesarean delivery and macrosomia, but they were not statistically significant. For identifying gestational diabetes among adolescents and young adults, the optimal hemoglobin A1c threshold was 5.6 percent. "Given alarming trends in adolescent obesity and diabetes risk and the high prevalence of unplanned pregnancies in adolescence and young adulthood, our results support expanded preconception screening as a mechanism to intervene on excess cardiometabolic risk earlier in the life course," the authors write. Abstract/Full Text Whatever your topic of interest, subscribe to our newsletters to get the best of Drugs.com in your inbox.