As the utilization of metformin for gestational diabetes mellitus (GDM) treatment continues to rise, a substantial segment of these patients will ultimately necessitate insulin during their therapeutic journey. Hence, assessing patients' clinical and laboratory attributes becomes invaluable in determining their likelihood of responding favorably to metformin medication. This discernment aids in selecting an optimal management approach, wherein the patients most likely to benefit significantly from metformin are identified, while alternative therapies like insulin are considered for individuals with a lower probability of treatment response.

This was a cross-sectional analytical-descriptive study of individuals with GDM. Initially, the subject's laboratory results and demographic information were submitted. Following that, metformin was administered to all subjects along with counseling on maintaining a healthy diet and lifestyle. Following a 4-week interval, the patients were reassessed and divided into two groups based on their response to metformin medication and then analyzed.

807 people participated in this study, of which 329 people (40.8%) responded to treatment and the failure rate of metformin treatment was 59.2%. This research revealed that the predictive factors of response to metformin medication were, respectively, the amount of 1-hour oral glucose tolerance test (OGTT) (OR = 62.66), 2-hour postprandial plasma glucose (OR = 54.04), 2-hour OGTT (OR = 17.37), followed by the history of abortion (OR = 14.88), the number of pregnancies (gravida 3 and more) (OR = 5.06) and history of infertility (OR = 2.6).

The current study's findings indicated that to enhance GDM care, metformin prescriptions should be prescribed to patients depending on their clinical characteristics and laboratory results.

Centella asiatica (L.) Urban has been utilized in wound healing remedies for nearly 3000 years. Asiatic acid (AA), a pentacyclic triterpenoid characterized by ursane-type skeleton, serves as principal bioactive constituent of Centella asiatica, exhibits remarkable therapeutic potential across a spectrum of health conditions. Pharmacological investigations have revealed that AA exerts direct regulatory effects on a multitude of enzymes, receptors, inflammatory mediators, and transcription factors. This article systematically examines the therapeutic applications of AA and its derivatives in the management of neurodegenerative diseases, cancer, cardiovascular disorders, and infections. Additionally, recent advancements in the structural modification of AA are summarized, offering new insights for the development of low-toxicity, effective AA-based therapeutics and diagnostic agents. However, several challenges remain, including the paucity of clinical trials, uncertainties in dosage and treatment regimens, limited data on long-term safety and side effects, and poor bioavailability. Addressing these limitations is crucial for advancing AA-based therapies and ensuring their clinical applicability.

Gestational diabetes mellitus (GDM) is a common complication of pregnancy that has short- and long-term adverse effects. Therefore, further exploration of the pathophysiology of GDM and related biomarkers is important. In this study, we performed a systematic review and meta-analysis to investigate the associations between metabolites in blood detected via metabolomics techniques and the risk of GDM and to identify possible biomarkers for predicting the occurrence of GDM. We retrieved case‒control and cohort studies of metabolomics and GDM published in PubMed, Embase, and Web of Science through March 29, 2024; extracted metabolite concentrations, odds ratios (ORs), or relative risks (RRs); and evaluated the integrated results with metabolites per-SD risk estimates and 95% CIs for GDM. We estimated the results via the random effects model and the inverse variance method. Our study is registered in PROSPERO (CRD42024539435). We included a total of 28 case‒control and cohort studies, including 17,370 subjects (4,372 GDM patients and 12,998 non-GDM subjects), and meta-analyzed 67 metabolites. Twenty-five of these metabolites were associated with GDM risk. Some amino acids (isoleucine, leucine, valine, alanine, aspartate, etc.), lipids (C16:0, C18:1n-9, C18:1n-7, lysophosphatidylcholine (LPC) (16:0), LPC (18:0), and palmitoylcarnitine), and carbohydrates and energy metabolites (glucose, pyruvate, lactate, 2-hydroxybutyrate, 3-hydroxybutyrate) were discovered to be associated with increased GDM risk (hazard ratio 1.06-2.77). Glutamine, histidine, C14:0, and sphingomyelin (SM) (34:1) were associated with lower GDM risk (hazard ratio 0.75-0.84). These findings suggest that these metabolites may play essential roles in GDM progression, and serve as biomarkers, contributing to the early diagnosis and prediction of GDM.

Nonalcoholic fatty liver disease (NAFLD) has emerged as the prevailing chronic liver disease in the pediatric population due to the global obesity pandemic. Evidence shows that prenatal and postnatal exposure to maternal abnormalities leads to a higher risk of pediatric NAFLD through persistent alterations in developmental programming. Gestational diabetes mellitus (GDM) is a hyperglycemic syndrome which has become the most prevalent complication in pregnant women. An increasing number of both epidemiologic investigations and animal model studies have validated adverse and long-term outcomes in offspring following GDM exposure in utero. Similarly, GDM is considered a crucial risk factor for pediatric NAFLD. This review aimed to summarize currently published studies concerning the inductive roles of GDM in offspring NAFLD development during childhood and adolescence. Dysregulations in hepatic lipid metabolism and gut microbiota in offspring, as well as dysfunctions in the placenta are potential factors in the pathogenesis of GDM-associated pediatric NAFLD. In addition, potentially effective interventions for GDM-associated offspring NAFLD are also discussed in this review. However, most of these therapeutic approaches still require further clinical research for validation.

Gestational diabetes mellitus (GDM) is associated with a risk of giving birth to neonates large for gestational age (LGA). Giving birth to a LGA child increases the risk of maternal and perinatal complications. In Sweden, the blood glucose level required for GDM diagnosis has been lowered, resulting in an increased number of women receiving a GDM diagnosis.

The study aimed to determine whether the change in diagnostic criteria for GDM impacted the incidence of LGA and the assessment of additional maternal and perinatal complications.

This retrospective cohort study involved 1237 women diagnosed with GDM. Among them, 92 delivered infants with LGA, 31 delivered infants small for gestational age (SGA), and 1111 delivered infants appropriate for gestational age (AGA). The primary outcome was to compare the incidence of LGA in the different cohorts based on the year they gave birth. Women without GDM at the same periods and their offspring were also analysed.

The incidence of LGA decreased following the change in diagnostic criteria for GDM (OR 0.43; CI 95 %, 0.27-0.68), a result that remained consistent after adjusting for known risk factors (aOR 0.44; CI 95 %, 0.27-0.7).

Lowering blood glucose cut-off values was associated with reduced risk of LGA. Compared to the group of mothers without GDM, the intervention did not appear to account for the lower incidence of LGA. Instead, the results suggest a dilution effect, indicating that mothers included after the change were healthier, exhibiting milder diabetes and, therefore, showed improved outcomes.

NCT04794283.

The utilization of targeted metabolomics technology promises to facilitate the identification of novel metabolic markers in women with gestational diabetes mellitus (GDM), which may in turn facilitate a more comprehensive investigation of the underlying mechanisms of gestational diabetes GDM.

In this study, we used targeted metabolomics to identify serum metabolites from women with or without GDM. The differential metabolites were categorized and analysed using pathway analyses, correlated with maternal glucose level, and assessed as predictors of GDM by receiver operating characteristics analysis.

Notably, we detected 46 differential metabolites (24 upregulated and 22 downregulated) between GDM and normal pregnancy, which were catalogued into amino acids, peptides and analogues, and organic acids and derivatives, and others. Pathway analysis showed that amino acid metabolites were abnormally active. In addition, most of the metabolites were closely related to maternal glucose level. Of these, two metabolites were associated with fasting blood glucose, 22 correlated with 1-h postprandial plasma glucose and 13 were related to 2-h postprandial plasma glucose. Next, we identified metabolites that could better diagnose GDM with the area under the receiver operating characteristics above 0.75, including 2-hydroxybutyric acid, itaconic acid, O-acetylcarnitine, glutathione disulfide, P-cresolsulfate, 2-furoic acid, l-asparagine, d-biotin, choline and homovanillic acid.

We identified abnormal serum metabolites caused by GDM, which may contribute to our understanding of the pathomechanisms of GDM.

Natural disasters can lead to more adverse pregnancy outcomes (APO). It is unclear if the extended COVID-19 pandemic has impacted APOs and pre-existing conditions among perinatal populations with increased risk of severe maternal morbidity and mortality.A retrospective chart review was conducted of hospital records and birth certificates in the largest birth hospital in Louisiana from 2017 to 2022. Amongst 27,877 births (50.9% White, 38.3% Black, 28.9 ± 5.6 years), gestational diabetes (GDM) was lowest in pre-pandemic conceptions (11.0%, June 2017-May 2019) and rose to 16.4% early pandemic (October 2019-February 2020) but leveled off at 12.2% in peak (March 2020-February 2021) and late pandemic (March 2021-September 2021). Individuals who conceived in early and peak pandemic were 47% (95% CI 33, 63) and 11% (95% CI 2, 20) more likely to develop GDM respectively, compared to pre-pandemic conceptions. Individuals who delivered during early (aRR: 1.54, 95% CI 1.33-1.78), peak (aRR: 1.48, 95% CI 1.32-1.65), and late (aRR: 1.62, 95% CI 1.41, 1.85) pandemic were more likely to develop preeclampsia and HELLP syndrome compared to pre-pandemic conceptions. Individuals were also 17% (95% CI 5, 32) more likely to enter pregnancy with chronic hypertension in peak pandemic compared to pre-pandemic. In paired analysis (n = 3390), individuals with a pandemic conception that occurred early pandemic had a higher risk of developing GDM compared to their pre-pandemic pregnancy (aOR 3.26, 95% CI 1.52, 6.97). Supporting birthing individuals amongst significant stressful events, especially in early gestation, is critical for preventing APOs and severe maternal morbidity and mortality.

Fetal thymus size has recently been recognized as a sensitive parameter linked to pregnancy complications. This study investigates whether maternal diabetes affects fetal thymus size, potentially offering a means to identify at-risk fetuses before birth.

This study was designed as a case-control study conducted from September 2023 to November 2024 in Iran. The study samples included 112 diabetic women (gestational diabetes or pre-pregnancy diabetes) as the case group and 112 healthy pregnant women attending the same hospital as the control group. Data were collected using a researcher-designed demographic questionnaire, and fetal thymus size was measured via abdominal ultrasound. Fetal thymus size is calculated using the thymic-thoracic ratio (TTR) and the thymus circumference.

A statistically significant difference was observed between the two groups regarding body mass index (BMI), an obstetric and demographic variable. The thymic-thoracic ratio (TTR) and the thymus circumference in diabetic pregnancies were statistically significantly lower than in the control group (p = 0.000). Odds ratios (95% CI) for the TTR index were 0.61 (CI 95%: 0.48 to 0.78), and thymus circumference was 0.95 (CI 95%: 0.93 to 0.97).

The present study indicated that a reduction in fetal thymus size may be associated with diabetes in pregnant women. However, it remains to be determined whether ultrasound evaluation of fetal thymus size can help predict perinatal outcomes in diabetic women.

Gestational diabetes mellitus (GDM) affects up to 14% of pregnancies globally, with insulin resistance (IR) playing a critical but often underappreciated role in its pathogenesis. Yet the specific impact of insulin at IR levels on mitochondrial function and pyroptosis in first-trimester trophoblasts remains unclear. Metformin use in GDM pregnancies is rising, but its impact on placental mitochondrial function is uncertain. This study aimed to investigate the impact of IR, a key feature of GDM, on mitochondrial dysfunction and pyroptosis in trophoblasts and to evaluate the protective effects of metformin.

Dual staining assays using TUNEL and caspase-1, and enzyme-linked immunosorbent assay were conducted to assess pyroptosis and pyroptosis-related inflammatory markers in placentas from 42 GDM patients and 39 controls. In vitro, HTR-8/SVneo trophoblast cells were treated with IR-level insulin concentrations, and a concentration gradient of metformin to evaluate the mitochondrial damage, pyroptosis, and cell viability.

There was a significant increase in pyroptosis in GDM placenta, as well as pyroptosis-related inflammatory markers, IL-1β and IL-18. Placental IL-1β and IL-18 levels were strongly correlated with IR indices, especially in GDM cases. Moreover, IR-level insulin concentrations induced mitochondrial dysfunction and activated the NLRP3 inflammasome, triggering pyroptosis in HTR-8/SVneo trophoblasts. Metformin, particularly at therapeutic doses (10-100 µM), mitigated IR-induced mitochondrial damage by promoting mitochondrial biogenesis and reducing pyroptosis via suppressing the ROS/TXNIP/NLRP3 pathway. Metformin-treated cells exhibited enhanced mitochondrial respiration, restored membrane potential homeostasis, and reduced oxidative stress.

IR, independent of hyperglycemia, drives placental inflammation and trophoblastic injury via pyroptosis. Targeting the ROS/TXNIP/NLRP3 pathway with metformin or other therapeutic agents offers potential therapeutic value in managing IR-related complications in GDM.

Gestational Diabetes Mellitus (GDM) is one of the most common medical complications during pregnancy. In the Gulf region, the prevalence of GDM is higher than in other parts of the world. Thus, there is a need for the early detection of GDM to avoid critical health conditions in newborns and post-pregnancy complexities of mothers.

In this article, we propose a machine learning (ML)-based techniques for early detection of GDM. For this purpose, we considered clinical measurements taken during the first trimester to predict the onset of GDM in the second trimester.

The proposed ensemble-based model achieved high accuracy in predicting the onset of GDM with around 89% accuracy using only the first trimester data. We confirmed biomarkers, i.e., a history of high glucose level/diabetes, insulin and cholesterol, which align with the previous studies. Moreover, we proposed potential novel biomarkers such as HbA1C %, Glucose, MCH, NT pro-BNP, HOMA-IR- (22.5 Scale), HOMA-IR- (405 Scale), Magnesium, Uric Acid. C-Peptide, Triglyceride, Urea, Chloride, Fibrinogen, MCHC, ALT, family history of Diabetes, Vit B12, TSH, Potassium, Alk Phos, FT4, Homocysteine Plasma LC-MSMS, Monocyte Auto.

We believe our findings will complement the current clinical practice of GDM diagnosis at an early stage of pregnancy, leading toward minimizing its burden on the healthcare system.Source code is available in GitHub at: https://github.com/H-Zaky/GD.git.

About 15% of all pregnancies end in pregnancy loss. As most studies have focused on maternal factors little is known regarding the influence of paternal factors on the chance of successful pregnancy.

This cohort study aims to assess the chance of biochemical pregnancy, clinical pregnancy, and live-born children in couples where the male partner has diabetes mellitus (DM).

We performed a nationwide cohort study. Couples undergoing assisted reproductive technology treatment from 2006 to 2019 were included. The exposed cohorts comprised embryo transfers in couples with paternal type 1 DM (T1DM), type 2 DM (T2DM), or mixed type DM (TMDM). The unexposed cohort included embryo transfers in couples without paternal DM.

A total of 101,875 embryo transfers were included. Of these, 503 males had T1DM, 225 males had T2DM, 263 males had TMDM, and 100,884 did not have DM. For paternal T1DM, the adjusted OR for achieving a biochemical pregnancy, clinical pregnancy, and live-born child were 0.97 (95% CI 0.77-1.23), 1.08 (95% CI 0.65-1.79), and 0.75 (95% CI 0.49-1.14), respectively. For paternal T2DM, the adjusted OR for achieving a biochemical pregnancy, clinical pregnancy, and live-born child were 0.80 (95% CI 0.56;1.16), 0.67 (95% CI 0.32-1.41), and 1.03 (95% CI 0.48-2.20), respectively. For the paternal TMDM, the adjusted OR for achieving a biochemical pregnancy, clinical pregnancy and livebirth were 0.95 (95% CI 0.67-1.33), 1.31 (95% CI 0.56-2.92), and 1.19 (95% CI 0.59-2.38), respectively.

Paternal DM was not associated with a statistically significant decreased chance of biochemical pregnancy, clinical pregnancy, or live birth.

Diabetes mellitus (DM) is a persistent condition characterized by high levels of glucose in the blood due to irregularities in the secretion of insulin, its action, or both. The disease was believed to be incurable until insulin was extracted, refined, and produced for sale. In DM, insulin delivery devices and insulin analogs have improved glycemic management even further. Sulfonylureas, biguanides, alpha-glucosidase inhibitors, and thiazolidinediones are examples of newer-generation medications having high efficacy in decreasing hyperglycemia as a result of scientific and technological advancements. Incretin mimetics, dual glucose-dependent insulinotropic polypeptide, GLP-1 agonists, PPARs, dipeptidyl peptidase-4 inhibitors, anti-CD3 mAbs, glucokinase activators, and glimins as targets have all performed well in recent clinical studies. Considerable focus was placed on free FA receptor 1 agonist, protein tyrosine phosphatase-1B inhibitors, and Sparc-related modular calcium-binding protein 1 which are still being studied. Theranostics, stem cell therapy, gene therapy, siRNA, and nanotechnology are some of the new therapeutic techniques. Traditional Chinese medicinal plants will also be discussed. This study seeks to present a comprehensive analysis of the latest research advancements, the emerging trends in medication therapy, and the utilization of delivery systems in treating DM. The objective is to provide valuable insights into the application of different pharmaceuticals in the field of diabetes mellitus treatment. Also, the therapeutic approach for diabetic patients infected with COVID-19 will be highlighted. Recent clinical and experimental studies evidence the Egyptian experience. Finally, as per the knowledge of the state of the art, our conclusion and future perspective will be declared.

Gestational diabetes (GDM) is associated with adverse outcomes including a large-for-gestational age (LGA) baby, which in turn is associated with downstream childhood obesity. Appropriate timing of GDM screening is important for prompt initiation and optimization of medical management, potentially mitigating the risk of those outcomes. The present study explored the association between the timing of GDM screening and macrosomia, LGA, shoulder dystocia and caesarean section.

This retrospective cohort study linked primary care prenatal data and intrapartum data from a provincial hospital administrative database. Women with singleton pregnancies who received prenatal care between July 1, 2019 and December 31, 2022 and who also delivered within that timeframe were included in the study.

198 participants were linked between the databases. Among participants for whom GDM risk could be calculated (n = 180), 30.6 % had late GDM screening. Unadjusted logistic regression models showed that late screening for GDM was associated with higher likelihood of LGA (OR = 2.89; 95 % CI = 1.19-7.04; p = 00.019). Adjusted models showed that the best predictor of macrosomia, LGA, and shoulder dystocia was excess gestational weight gain (GWG) (OR = 3.26, CI = 1.17-9.10, p = 0.024; OR 3.00, 95 % CI 0.91-9.93, p = 00.072; and OR = 3.52, CI = 0.83-14.84, p = 00.087 respectively); the best predictor of caesarean section was pre-pregnancy BMI (OR = 2.86; CI = 1.12 = 7.27; p = 0.028).

Almost one-third of participants had screening later than recommended, and late screening for GDM was associated with a higher likelihood of LGA. Linking longitudinal prenatal primary care data to hospital administrative data creates opportunities for future studies pertaining to prenatal care, potentially resulting in improvements in the care provided to vulnerable populations experiencing disproportionate rates of pre-pregnancy obesity and excess GWG.

To investigate the value of serum ferritin (SF) in conjunction with glycated hemoglobin (HbA1c) for the early prediction of gestational diabetes mellitus (GDM) and to provide insights that could enhance health care standards for women and newborns.

A retrospective cohort study was conducted involving 650 pregnant women who received regular prenatal check-ups at our institution from January 2019 to April 2024. Participants were categorized into four groups based on their SF concentration quartiles during the 11th to 13th weeks of gestation. Logistic regression analyses were conducted to assess the predictive value of early GDM risk factors, with the lowest quartile group serving as a reference.

The incidence rate of GDM rose progressively with increasing SF concentrations at 11-13 weeks of gestation, with rates of 18.79%, 21.25%, 24.38%, and 25.45% respectively. Notably, the incidence rate in the highest quartile group (quartile 4) was significantly higher compared to the lowest (quartile 1), with an odds ratio of 1.48 and a 95% confidence interval of 1.12 to 1.93. Additionally, the predictive model incorporating both SF concentration and HbA1c (Model 2) outperformed the model with SF alone (Model 1), indicating a heightened predictive accuracy for GDM when these two biomarkers are used in combination.

The findings of this study highlight the potential utility of SF and HbA1c as early predictors of GDM risk, especially when employed in combination.

Gestational diabetes mellitus (GDM) is a common pregnancy complication associated with adverse maternal and fetal outcomes. Recent studies suggest a role for dual-specificity phosphatase 9 (DUSP9) in insulin resistance and metabolic dysregulation, though its specific contribution to GDM remains unclear. This study aims to investigate the function of DUSP9 in GDM pathophysiology and its underlying molecular mechanisms.

We analyzed DUSP9 expression in umbilical cord blood and placental tissues from GDM patients (n = 16) and healthy controls (n = 14) using RT-qPCR and western blot assays. In vitro, functional assays were conducted on high glucose-induced HTR-8/SVneo trophoblast cells to evaluate the effects of DUSP9 knockdown on cell viability, apoptosis, and insulin signaling. In vivo, a GDM mouse model was constructed, and lentivirus-mediated shRNA was used to downregulate DUSP9 expression. Furthermore, metabolic parameters, including insulin resistance indices, lipid metabolism, and placental apoptosis were assessed, along with the phosphorylation status of key proteins in the IRS1/PI3K/AKT pathway.

We first observed that DUSP9 expression was significantly upregulated in the umbilical cord blood and placental tissues of GDM patients compared to healthy controls (p < 0.01). Using high glucose-induced HTR-8/SVneo trophoblast cells to mimic GDM conditions, we found that downregulation of DUSP9 increased cell viability and inhibited apoptosis (p < 0.01). Mechanistically, co-immunoprecipitation and pull-down assays demonstrated that DUSP9 directly interacts with insulin receptor substrate 1 (IRS1) and inhibits HG-mediated IRS1 phosphorylation at Tyr632, impairing downstream insulin signaling (p < 0.01). In vivo, a GDM mouse model revealed elevated DUSP9 expression, along with significant metabolic dysfunction, including insulin resistance and increased placental apoptosis (p < 0.01). Lentivirus-mediated knockdown of DUSP9 in these mice ameliorated insulin resistance, improved lipid metabolism, and reduced placental apoptosis by improving fasting glucose and insulin levels, lipid profiles, and decreased apoptotic markers (p < 0.01). Moreover, DUSP9 knockdown in these mice promoted activation of the IRS1/PI3K/AKT signaling pathway (p < 0.01).

DUSP9 contributes to GDM progression by inhibiting the IRS1/PI3K/AKT pathway, leading to insulin resistance and metabolic dysfunction. The knockdown of DUSP9 ameliorates key pathological features of GDM, including insulin resistance, impaired lipid metabolism, and placental apoptosis, suggesting that targeting DUSP9 may represent a potential therapeutic strategy for GDM.

To explore the impact of seasonal variations on the risks of hypertensive disorders of pregnancy (HDP) and gestational diabetes mellitus (GDM) in women who undergo in vitro fertilization (IVF) treatment.

We retrospectively included a total of 21,469 women who achieved singleton delivery during their first cycles of IVF, the risks of HDP and GDM were compared in different seasonal groups according to the time of embryo transfer and the time of oocyte retrieval.

After adjustment via multivariable logistic regression, women who underwent embryo transfer in spring with the expected date of confinement in winter had a higher risk of HDP (4.9% vs. 3.8%; adjusted odds ratio (aOR), 1.34; 95% confidence interval (CI), 1.09-1.64; P = 0.005) than those underwent embryo transfer in winter with the expected date of confinement in autumn. There were no seasonal variations in the risk of HDP according to the time of oocyte retrieval or in the risk of GDM regardless of the time of embryo transfer or the time of oocyte retrieval. After subgroup analysis, the seasonal variations in the risk of HDP remained in frozen embryo transfer (FET) cycles but not in fresh embryo transfer (FreET) cycles.

The risk of HDP was increased in women who underwent embryo transfer in spring compared to those who underwent embryo transfer in winter. The risk of HDP is more likely to be affected by the season at the time of embryo transfer in FET cycles compared to FreET cycles.

This study investigates the association of blood cell components and blood cell-derived inflammatory indices in early pregnancy with the development of gestational diabetes mellitus (GDM).

This research is part of the Qazvin maternal and neonatal metabolic study (QMNMS) conducted in Iran from 2018 to 2021. Pregnant women with gestational age ≤ 14 weeks were enrolled in the study. The association of blood cells and inflammatory indices, including neutrophil-to-lymphocyte ratio (NLR), systemic inflammatory response index (SIRI), systemic immune inflammation index (SII), and aggregate systemic inflammatory response index (AISI), in early pregnancy with subsequent GDM development was examined using multivariate logistic regression. This analysis was adjusted for age, pre-pregnancy body mass index (BMI), weight gain, and GDM history in previous pregnancies (Model 1), as well as for these factors in addition to the homeostatic model assessment for insulin resistance (HOMA-IR) (Model 2). The correlation of blood cells and inflammatory indices with insulin resistance was assessed through Spearman partial correlation, adjusted for the same risk factors.

The final analysis included 612 participants, among whom GDM developed in 96 participants (15.7%). Neutrophil, platelet, and lymphocyte counts showed significant correlations with HOMA-IR (r = 0.14, r = 0.22, and r = 0.17, respectively; P < 0.01 for all). In univariate analysis, the highest quartile of neutrophil count was associated with a 5.9 times higher risk of GDM development (95% CI 2.6-13.2, P < 0.001). In multivariate logistic regression, neutrophil count quartiles remained significant predictors of GDM development, with relative risks of 3.7, 4.4, and 8.2 for the 2nd, 3rd, and 4th neutrophil quartiles compared to the 1st quartile (P < 0.001). While platelet count was initially associated with GDM development (RR = 2.6, 95% CI 1.3-5.1, P = 0.028), this association was no longer significant after adjusting for HOMA-IR. Neither lymphocyte nor monocyte counts were linked to GDM development. Additionally, inflammatory indices, such as NLR, SIRI, SII, and AISI, did not provide additional predictive value for GDM development.

Neutrophil count is an independent predictor of GDM development, and its role in GDM development is not influenced by early pregnancy insulin resistance. Moreover, novel inflammatory indices offer no additional predictive benefit for GDM.

Gestational diabetes mellitus (GDM), which refers to diabetes mellitus or abnormal glucose tolerance of any degree occurring during pregnancy, is a distinct type within the diabetes classification. 25-hydroxyvitamin D deficiency has been associated with an increased risk of maternal glycaemia, insulin resistance and gestational diabetes. There is no consensus on the definition of vitamin D deficiency, but most scientists define vitamin D deficiency as less than 20 ng/mL (50 nmoL/L) of 25-hydroxyvitamin D. Vitamin D deficiency is common in women during pregnancy. Vitamin D can regulate the course of gestational diabetes, which may be related to regulation of insulin gene transcription, insulin secretion, intracellular and cytosolic calcium balance, inhibition of oxidative stress and inflammatory responses and alteration of glucose metabolism. This is a review article that aims to analyze the possible mechanism of vitamin D regulation of GDM, which provides a theoretical basis for clinical researchers in the future management of patients with GDM.

We here investigated whether lactation during puerperium could help to reverse the diabetogenic effect of gestation and further explored the lipid profiling changes upon breastfeeding.

Thirty-five women diagnosed with GDM were recruited, and fasting plasma samples were collected at ~6 weeks postpartum. Maternal metabolic parameters were determined, and an untargeted lipidomic analysis was performed. The relationship between underlying lipidomic responses and lactation was explored.

Improved glucose homeostasis and insulin sensitivity were observed in GDM women who adopted breastfeeding during the puerperium. Further lipidomics analysis revealed prominent correlations between lipid constitution changes and breastfeeding in women with GDM. A total of 766 lipid species were identified, 33 of which were found to be significantly altered in response to lactation. Significant associations between dysregulated lipids and maternal metabolic parameters were also shown. Subsequently, we identified a panel of three lipids that were strongly associated with breastfeeding, from which we constructed a predictive model with higher discriminating power.

We generally revealed that lactation during puerperium appears to have favorable effects on diabetogenic risk factors for GDM women. We also discovered that lipidomic changes related to lactation could elucidate the mother's recovery from GDM pregnancy.

Xylooligosaccharides (XOS) ameliorate insulin resistance (IR) in gestational diabetes mellitus (GDM) probably by propagating Akkermansia muciniphila (Akk). This study aimed to investigate the effects and mechanisms of XOS, Akk and combination on IR in GDM mice/pseudo-germ-free (PGF) mice. Female mice were fed with AIN-93 (n = 19) and high fat diet (HFD) (n = 206). After 4 weeks, HFD-fed mice were further allotted to HFD, GDM, GDM + XOS, GDM + Akk, GDM + XOS + Akk, GDM + PGF, GDM + PGF + XOS, GDM + PGF + Akk, and GDM + PGF + XOS + Akk groups (n ≥ 19). GDM was induced by intraperitoneally injecting streptozotocin and PGF was established by intragastrically administrating antibiotic cocktails. XOS (500 mg/kg·BW) or/and Akk (4 × 108 CFU) were gavaged once a day for 10 days. Fasting blood glucose (FBG), insulin, oral glucose tolerance test (OGTT) and insulin signaling pathway were determined. Gut microbiota were detected by 16S rRNA sequencing and absolute quantities of Akk by qRT-PCR. Intestinal tissues were stained by Hematoxylin-Eosin and Periodic acid-Schiff-Alcian blue staining. Occludin and Zonula occludens-1 (ZO-1) in intestine, Natural killer group 2 member D (NKG2D) on intestinal epithelial lymphocytes (IELs) and NKG2D ligands (NKG2DL) on intestinal epithelial cells (IECs) were detected by Western blotting. In GDM mice, XOS, Akk and XOS + Akk reduced (p < 0.05) the area under the curve of OGTT (AUC), insulin and homeostasis model assessment of insulin resistance (HOMA-IR), and increased (p < 0.05) protein kinase B (Akt) phosphorylation in liver and insulin receptor substrate 1 (IRS-1) phosphorylation in muscle. Furthermore, XOS + Akk reduced (p < 0.05) FBG and increased (p < 0.05) Akt phosphorylation in muscle and IRS-1 phosphorylation in liver. XOS, Akk and XOS + Akk reshaped gut microbiota with XOS + Akk exhibiting the greatest effectiveness. XOS increased (p < 0.05) Akk and clearance of gut microbiota abolished such effect. XOS, Akk and XOS + Akk reduced (p < 0.05) the small intestine Chiu's score and the colon Dieleman's scores, increased (p < 0.05) ZO-1 and Occludin, and reduced (p < 0.05) NKG2D on IELs and NKG2DLs (H60, MULT-1, Rae-1ε) on IECs. Moreover, XOS + Akk reduced (p < 0.05) MULT-1 in duodenum. Collectively, XOS and Akk synergistically ameliorate IR by reshaping gut microbiota, improving intestinal barrier and regulating NKG2D/NKG2DL signaling in GDM mice.

To investigate the effects of a self-management-cluster-based pregnancy care model (SMB-CPCM) on the psychological status and delivery outcomes of pregnant women with gestational diabetes mellitus (GDM).

A total of 120 pregnant women with GDM who had been filed and had regular obstetric examinations in a tertiary-level hospital in Bengbu City between 1 April 2023 and 1 April 2024 were included in the study using the convenience sampling method. Sixty women each were grouped into a study group and a control group using the randomised numeric table method. The study group implemented the SMB-CPCM and the control group used the conventional pregnancy healthcare model. We compared the differences in self-management ability, blood glucose concentration, delivery outcome, and psychological status.

Self-management ability scores were higher in both groups following the intervention than before the intervention (P<0.001), and the increase was more notable in the study group (t=9.237, P<0.001). Anxiety scale (63.31±4.73, 48.29±4.20) and depression self-assessment scale scores(60.70±3.49, 41.69±4.76) in the study group were lower after the intervention than before the intervention(t=13.322, 18.115, P<0.001). Following the intervention, fasting blood glucose(5.39±0.42, 4.92±0.45) and postprandial 2-h blood glucose(6.70±0.71, 5.92±0.64) exhibited a reduction compared to the pre-intervention period (P<0.001). Furthermore, this decline was more pronounced in the study group (t=4.267, 4.584, P<0.001). The study group demonstrated an elevated spontaneous delivery rate compared to the control group (χ2 =5.168, P<0.05). Additionally, the rates of gestational hypertension (χ2 =4.941), pre-term labour (χ2 =3.890), and macrosomia (χ2 =4.050) were reduced in the study group when compared to the control group (P<0.05).

SMB-CPCM can effectively control the blood glucose levels of pregnant women with GDM and improve their self-management ability, psychological status, and delivery outcomes. SMB-CPCM shows a good prospect in the management of gestational diabetes and is worth promoting. Future research can explore the impact of SMB-CPCM on long-term health outcomes of pregnant women with diabetes, so as to comprehensively evaluate its clinical value.

This study explores a hybrid approach to maternal-fetal care for gestational diabetes (GD), integrating virtual visits seamlessly with in-clinic assessments. We assessed the feasibility, time efficiency, patient satisfaction, and clinical outcomes to facilitate wider adoption of maternal-fetal telemedicine.

We conducted a 4-week prospective study involving 20 women with GD at ≥32 weeks of pregnancy, alternating between remote and in-clinic weekly visits. Remote assessments began with women self-measuring vital signs and using a digital urine dipstick. The remote encounter started with a midwife performing anamnesis and remotely connecting women to the fetal nonstress test. A physician concluded the meeting with remote sonographic assessment of amniotic fluid maximal vertical pocket that together with the nonstress test provided the modified biophysical assessment as well as a video encounter and ongoing glycemic control assessment. We assessed the feasibility of remote visits, compared visit durations, evaluated women's satisfaction using the Telehealth Usability Questionnaire, examined glucose documentation adherence during hybrid care compared with the following period until birth, and assessed GD-related clinical outcomes.

Remote visits had a success rate of 97.4% (38 of 39), with significantly shorter durations compared with in-clinic visits (median 59.0 min vs. 159.0 min, P < 0.001). Women expressed high satisfaction (6.6 of 7), and adherence with recording fasting glucose values during the study period was significantly higher than the following period until birth (92.2% vs. 61.8%, P = 0.001). Notably, none required induction of labor for glycemic control imbalance, and there were no cases of macrosomia, shoulder dystocia, or neonatal hypoglycemia.

The hybrid approach to maternal-fetal care for GD demonstrated feasibility, safety, time efficiency, improved patient satisfaction, and enhanced glycemic control adherence.

Aims/Background Gestational diabetes mellitus (GDM) is a common complication during pregnancy. This retrospective study investigates the correlation between umbilical blood flow index and maternal-fetal outcomes in pregnant women with GDM, aiming to contribute to evidence-based risk assessment and management strategy in this high-risk obstetric population. Methods This retrospective study recruited 119 pregnant women with GDM who were admitted to the Yichang Central People's Hospital, between January 2022 and January 2024. Based on the umbilical blood flow index, the study participants were divided into a normal umbilical blood flow (UBF) index group (n = 56) and a high UBF index group (n = 63). Colour Doppler ultrasound was used to assess umbilical blood flow, and relevant data on maternal, fetal, and neonatal outcomes were obtained from the hospital's electronic medical records. Results We observed that, compared to the normal UBF index group, the high UBF index group exhibited significantly higher rates of adverse pregnancy outcomes, including the cesarean section (p = 0.022), preterm delivery (p = 0.020), gestational hypertension (p = 0.019), neonatal hypoglycemia (p = 0.015), as well as increased incidence of neonatal complications such as respiratory distress syndrome (p = 0.009), neonatal jaundice (p = 0.022), neonatal intensive care unit (NICU) admission (p = 0.015), lower 5-minute Apgar scores (p = 0.013), and neonatal sepsis (p = 0.005). Furthermore, significant differences were observed in fetal biometric parameters and placental morphology between the two groups (fetal weight: p = 0.003; estimated fetal weight percentile: p = 0.017; femur length: p = 0.018; placental weight: p = 0.019; placental volume: p = 0.021). Additionally, correlation analyses indicated significant associations between umbilical blood flow index and maternal and fetal outcomes (p < 0.05). Conclusion We observed a significant correlation between umbilical blood flow indices and maternal and fetal outcomes in pregnant women with gestational diabetes mellitus, implying its utility as a non-invasive parameter for risk stratification and personalized management in this high-risk obstetric population.

Neonicotinoids (NEOs) are well-designed highly selective pesticides that target nicotinic acetylcholine receptors. However, their extensive use, accumulation, and biomagnification pose significant risks to humans. Increasing evidence has suggested that NEOs may affect glucose homeostasis, but little research has linked NEOs exposure to gestational diabetes mellitus (GDM), which is the most common disease in pregnancy. We here aimed to investigate the association between NEOs exposure and GDM occurrence.

100 pregnant women who completed a 75 g oral glucose tolerance test (OGTT) at 24-28 weeks of gestation were enrolled. Urinary concentrations of seven widely used NEOs were quantified using ultra-high performance liquid chromatography multiple reaction monitoring mass spectrometry (UHPLC-MRM-MS/MS). Correlation analysis revealed the associations between NEOs concentrations and glucose homeostasis parameters. The toxic effects of thiamethoxam (TMX) and clothianidin (CLO) were assessed using pregnant mice, and the potential mechanism in impairing glucose disposition regarding brown adipose tissue (BAT) thermogenesis has been elucidated.

Among the 100 urine samples, 88 % were contaminated by NEOs with concentrations ranging from 2.50 to 491.34 nmol/L. TMX and CLO were the most frequently detected NEOs, highly detected in women with GDM. Moreover, we found statistically significant associations between TMX concentrations and 1hBG, and 2hBG. Exposure to mixed NEOs during gestation resulted in elevated glucose levels and impaired insulin sensitivity in normal pregnant and GDM mice models. In addition, we found the metabolic disorders induced by NEOs were linked to the deterioration of BAT thermogenesis in vivo.

In general, we demonstrated that prenatal exposures to NEOs were associated with an increased risk of GDM by deteriorating the thermogenic capacity of BAT.

Gestational diabetes mellitus (GDM) is linked to a greater risk of various maternal and fetal complications, including the possibility of long-term metabolic issues in offspring. Our initial research suggests that the Traditional Chinese Medicine formula, Shenling Guchang prescription (SLGP), may have an impact on the gut microbiota. However, the specific mechanisms through which it affects intestinal barrier inflammation in GDM are still not fully understood. This study explored SLGP's mechanisms in GDM. Firstly, network pharmacology predicted key bioactive constituents targeting toll-like receptor 4 (TLR4)/nuclear factor-kappa B (NF-κB), guiding experimental design. Subsequently, the pregnant female rats were induced with GDM through intraperitoneal streptozotocin injection and then divided into control, model, metformin, and SLGP treatment groups. Blood samples were collected for ELISA analysis to measure levels of inflammatory markers, intestinal tissues were examined histologically using hematoxylin-eosin (HE) staining, and western blot analysis was conducted to evaluate TLR4 and NF-κB expression. Relative to control rats, model group animals exhibited significant increases in the levels of inflammatory markers (IL-1β, IL-6, TNF-α, TGF-β, CRP), as well as enhanced TLR4 and p-NF-κB p65 expression, along with intestinal histopathological changes. Treatment with SLGP notably reduced inflammatory markers and protein expression in the colonic tissue of GDM rats, leading to a decrease in histopathological damage. Overall, SLGP was found to modulate the TLR4/NF-κB pathway, resulting in enhancements in insulin resistance and a reduction in inflammatory responses in GDM rats, thereby providing protection for the intestines. This study demonstrates the potential therapeutic effectiveness of SLGP in addressing intestinal inflammation linked to GDM.

Oxidative stress due to aberrant metabolism is considered as a crucial contributor to diabetes and its complications. Hyperglycemia and hyperlipemia boost excessive reactive oxygen species generation by elevated mitochondrial respiration, increased nicotinamide adenine dinucleotide phosphate oxidase activity, and enhanced pro-oxidative processes, including protein kinase C pathways, hexosamine, polyol, and advanced glycation endproducts, which exacerbate oxidative stress. Oxidative stress plays a significant role in the onset of diabetes and its associated complications by impairing insulin production, increasing insulin resistance, maintaining hyperglycemic memory, and inducing systemic inflammation. A more profound comprehension of the molecular processes that link oxidative stress to diabetes is crucial to new preventive and therapeutic strategies. Therefore, this review discusses the mechanisms underlying how oxidative stress contributes to diabetes mellitus and its complications. We also summarize the current approaches for prevention and treatment by targeting the oxidative stress pathways in diabetes.

The Lingguizhugan decoction (LGZGD) is a promising traditional Chinese medicine for the treatment of gestational diabetes mellitus (GDM). However, its bioactive compounds and therapeutic mechanisms remain unknown. The main chemical composition of LGZGD was analyzed by high-performance liquid chromatography-mass spectrometry (HPLC-MS). Furthermore, the underlying mechanisms of LGZGD against GDM were elucidated through network pharmacology and molecular docking. The therapeutic efficacy and targets of LGZGD were further confirmed via an in vitro GDM model (high glucose [HG]-treated HTR-8/SVneo cells). Four compounds of LGZGD, namely, cinnamaldehyde, glycyrrhizic acid, 2-atractylenolide, and pachymic acid, were detected. A total of 26 targets for LGZGD treating GDM were obtained, which were mainly involved in oxidative stress and the PI3K-AKT signaling pathway. The protein-protein interaction (PPI) network unveiled that AKT1, TLR4, TP53, and NOS3 were hub therapeutic targets. Molecular docking showed that these targets had strong affinity with key compounds. In vitro experiments confirmed that LGZGD treatment promoted HG-induced cell viability, migration, and invasion ability while inhibited the apoptosis rate and oxidative stress. Mechanically, western blot revealed that LGZGD may protect HG-treated cells by activating the PI3K-AKT pathway and suppressing TLR4 expression. Our study preliminarily explored the mechanism of LGZGD in GDM treatment, providing a scientific basis for the clinical application of LGZGD.

The associations of gut microbial metabolites, such as trimethylamine N-oxide (TMAO), its precursors, and phenylacetylglutamine (PAGln), with the risk of gestational diabetes mellitus (GDM) remain unclear.

Serum samples of 201 women with GDM and 201 matched controls were collected and then targeted metabolomics was performed to examine the metabolites of interest. Multivariable conditional logistic regression was applied to investigate the relationship between metabolites and GDM. Meta-analysis was performed to combine our results and four similar articles searched from online databases, and Mendelian randomization (MR) analysis was eventually conducted to explore the causalities.

In the case-control study, after dichotomization and comparing the higher versus the lower group, the adjusted odds ratio and 95% confidence interval of choline and L-carnitine with GDM were 2.124 (1.186-3.803) and 0.293 (0.134-0.638), respectively; but neutral relationships between TMAO, betaine, and PAGln with GDM were observed. The following meta-analysis consistently revealed that L-carnitine was negatively associated with GDM. However, MR analyses showed no evidence of causalities.

Maternal levels of L-carnitine were related to the risk of GDM in both the original case-control study and meta-analysis. However, we did not observe any genetic evidence to establish a causal relationship between this metabolite and GDM.

Background: Pregnancy anxiety increases the risk of preterm birth but less is known about the impacts on glucose intolerance during pregnancy, such as gestational diabetes mellitus (GDM). The present study examined the relationship between pregnancy anxiety and the risk of GDM in a prospective cohort Centering and Racial Disparities (CRADLE) study of racially diverse pregnant women in the United States. Methods: This is a prospective analysis among racially diverse pregnant women in the United States who enrolled in the CRADLE study. Pregnancy anxiety was assessed twice using the Pregnancy-Specific Anxiety Scale (PSAS): the baseline survey at <20 gestational weeks (GW) and the second survey at >30 GW. GDM was screened at 24-30 GW and diagnosed based on the Carpenter and Coustan criteria. The associations of baseline PSAS score (>9 [median] versus ≤9) and PSAS score change with GDM risk were estimated using multivariable logistic regressions with adjustment for potential confounders. Results: Among a total of 2,310 women (40.74% Black, 20.91% Hispanic), 154 (6.67%) developed GDM. No association was found between baseline PSAS and GDM (adjusted odds ratio [OR]: 0.99; 95% confidence interval [CI]: 0.70-1.42) after adjusting for confounders. Individuals with an increased PSAS during pregnancy had 52% higher GDM risk (adjusted OR: 1.52, 95% CI: 1.04-2.23) compared with those with no change or decreased scores. Conclusions: Pregnant individuals who increased their pregnancy-specific anxiety level during pregnancy had a higher risk of developing GDM. Clinical Trials Registration Identifier: NCT02640638. Registered with ClinicalTrials.gov December 29, 2015. Study recruitment began February 24, 2016. URL of ClincialTrials.gov registration site: https://clinicaltrials.gov/ct2/show/NCT02640638?term=NCT02640638&draw=2&rank=1.

Studies have shown that chronobiological factors may adversely affect glycemic control in patients with type 2 diabetes mellitus. We assessed the association of chronobiological factors with glycemic control and neonatal birth weight in women with GDM.

A prospective cohort study included 208 women aged 18-45 years with a singleton pregnancy who were randomly selected from among women undergoing follow-up for GDM at the Maternal-Fetal Medicine Unit of a tertiary medical center. Nutrition, sleep, and lifestyle patterns were assessed from onset of GDM until birth along with glycemic control and birth outcomes.

Multivariate analyses on a cohort of 208 women revealed that suboptimal glycemic control was associated with a late breakfast (RR = 2.26; 95% CI 1.09-4.67), increased carbohydrate intake in the evening (RR = 1.19; 95% CI 1.003-1.42), and poor sleep quality (RR = 2.14; 95% CI 1.04-4.41). The adjusted relative risk for neonatal birth weight above the 85th percentile was associated with increased carbohydrate intake in the morning (RR = 1.70; 95% CI 1.30-2.23) and increased carbohydrate intake in the evening (RR = 1.39; 95% CI 1.16-1.67).

Chronobiological factors are associated with suboptimal glycemic control and birth weight above the 85th percentile in women with GDM. The study was registered under ClinicalTrials.gov.org, identifier: NCT02916667.

Diabetes mellitus, a chronic metabolic disorder, poses a significantly public health challenge. Extensive research highlights that contemporary dietary patterns, characterized by excessive intake of sugar, fat, and protein, are major contributors to the onset and progression of diabetes. The central element to this process is the aberrant activation of the advanced glycation end products (AGEs) - receptor for AGEs (RAGE) - oxidative stress axis, which plays a pivotal role in disrupting normal carbohydrate metabolism. This pathway presents a critical target for developing interventions aimed at mitigating diabetes and its complications. In recent years, natural polysaccharides have emerged as promising agents in the prevention and treatment of diabetes, due to their ability to inhibit AGE formation, regulate RAGE expression, and modulate the AGEs-RAGE-oxidative stress axis. In this paper, we explore the pathogenic mechanism of this axis and review the therapeutic potential of natural polysaccharides in managing diabetes and its complications. Our goal is to provide new insights for the effective management of diabetes and its associated health challenges.

Observational studies have highlighted that gestational diabetes mellitus is associated with a higher risk of cardiovascular diseases, but the causality remains unclear. Herein, the causality between genetic predisposition to gestational diabetes mellitus and the risk of cardiovascular diseases was investigated using sex-specific Mendelian randomization analysis.

Linkage disequilibrium score regression analysis and two-sample Mendelian randomization analysis were applied to infer the genetic correlation and causality, respectively. Mediation analysis was conducted using a two-step Mendelian randomization approach. Sensitivity analyses were performed to differentiate causality from pleiotropy. The genome-wide association study summary statistics for gestational diabetes mellitus were obtained from FinnGen consortium, while for cardiovascular diseases were generated based on individual-level genetic data from the UK Biobank.

Linkage disequilibrium score regression analyses revealed that gestational diabetes mellitus had a significant genetic correlation with coronary artery disease and myocardial infarction after Benjamini-Hochberg correction in ever-pregnant women. In Mendelian randomization analyses, odds ratios (95% confidence interval) for coronary artery disease and myocardial infarction were 1.09 (1.01-1.17) and 1.12 (.96-1.31) per unit increase in the log-odds of genetic predisposition to gestational diabetes mellitus in ever-pregnant women, respectively. Further, Type 2 diabetes and hypertension were identified as mediators for the causality of genetic predisposition to gestational diabetes mellitus on coronary artery disease. In sensitivity analyses, the direction of odds ratio for the association between instrumental variables with gestational diabetes mellitus-predominant effects and the risk of coronary artery disease was consistent with the primary results in ever-pregnant women, although not statistically significant.

This study demonstrated a suggestive causal relationship between genetic predisposition to gestational diabetes mellitus and the risk of coronary artery disease, which was mainly mediated by Type 2 diabetes and hypertension. These findings highlight targeting modifiable cardiometabolic risk factors may reduce the risk of coronary artery disease in women with a history of gestational diabetes mellitus.

To explore the relationship between pregnancy complications and maternal near-miss (MNM).

Data were obtained from the Maternal Near-Miss Surveillance System in Hunan Province, China, 2012-2022. The MNM ratio refers to the number of MNM per 1000 live births, and maternal mortality refers to the number of maternal deaths per 100,000 live births. Chi-square trend tests (χ2trend) were used to determine trends in proportions by year. Multivariate logistic regression analysis (method: Forward, Wald, α = 0.05) and adjusted odds ratios (aORs) were used to identify risk factors for MNM.

Our study included 780,359 women with 731,185 live births, a total of 2461 MNMs, and 52 maternal deaths were identified. The MNM ratio was 3.37‰ (95%CI: 3.23-3.50), and the maternal mortality was 7.11 per 100,000 live births (95%CI: 5.18-9.04). Coagulation/hematological dysfunction was the most common cause of MNM (75.66%). From 2012 to 2022, the proportion of coagulation/hematological dysfunction among MNM increased from 49.14% in 2012 to 86.39% in 2022, which was the only cause of MNM that showed an increased trend (χ2trend = 7.43, P = 0.01). Results of multivariate logistic regression analysis showed that 10 pregnancy complications were risk factors for MNM: hemorrhage disorder (aOR = 21.50, 95%CI: 19.64-23.54), infections (aOR = 1.91, 95%CI: 1.64-2.22), hypertension (aOR = 4.50, 95%CI: 4.08-4.98), heart disease (aOR = 14.96, 95%CI: 11.51-19.44), embolic disease (aOR = 171.70, 95%CI: 94.08-313.36), liver disease (aOR = 1.54, 95%CI: 1.25-1.90), anaemia (aOR = 4.72, 95%CI: 4.29-5.19), renal disease (aOR = 5.44, 95%CI: 4.00-7.40), pulmonary disease (aOR = 14.85, 95%CI: 8.33-26.50), and connective tissue disease (aOR = 5.15, 95%CI: 3.06-8.66).

The MNM ratio was relatively low in Hunan Province. Several pregnancy complications increased the risk of MNM. It is helpful for clinical counseling and public health policies, which may contribute to preventing MNM.

Gestational diabetes mellitus (GDM) is a common complication during pregnancy and increases the risk of metabolic diseases in offspring. We hypothesize that the poor intrauterine environment in pregnant women with GDM may lead to chromosomal DNA damage and telomere damage in umbilical cord blood cells, providing evidence of an association between intrauterine programming and increased long-term metabolic disease risk in offspring.

We measured telomere length (TL), serum telomerase (TE) activity, and oxidative stress markers in umbilical cord blood mononuclear cells (CBMCs) from pregnant women with GDM (N=200) and healthy controls (Ctrls) (N=200) and analysed the associations of TL with demographic characteristics, biochemical indicators, and blood glucose levels.

The length of telomeres in umbilical CBMCs in the GDM group was significantly shorter than that in the Ctrl group (P<0.001), and the shortening of telomeres in male infants in the GDM group was more significant than that in the Ctrl group (P<0.001) after adjustment for Pre-pregnancy body mass index (PBMI), Pregnancy weight gain (PGW), and Triglyceride (TG) as confounding factors. In addition, the TE expression level in the GDM group was lower after adjustment. There was no statistically significant difference in oxidative stress hydroxydeoxyguanosine (8-OHdG), malondialdehyde (MDA) and superoxide dismutase (SOD) between the two groups. TL was positively correlated with TE activity, and both were negatively correlated with blood glucose levels. There was no correlation between TL and Gestational age (GA), PBMI, PGW, or TG levels.

The poor intrauterine environment in pregnant women with GDM increases telomere attrition and reduces TE activity, which may be potential genetic risk factors for an increased risk of metabolic diseases in offspring later in life due to intrauterine reprogramming.

Gestational diabetes mellitus (GDM) is a metabolic disorder associated with adverse maternal and neonatal outcomes. While GDM is diagnosed by oral glucose tolerance testing between 24-28 weeks, earlier prediction of risk of developing GDM via circulating biomarkers has the potential to risk-stratify women and implement targeted risk reduction before adverse obstetric outcomes. This scoping review aims to collate biomarkers associated with GDM development, associated perinatal outcome and medication requirement in GDM.

The Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for scoping reviews was used to guide the study.

This review searched for articles on PubMed, Embase, Scopus, Cochrane Central Register of Controlled Trials, the Cumulative Index to Nursing and Allied Health Literature and the Web of Science from January 2013 to February 2023.

The eligibility criteria included analytical observational studies published in English, focusing on pregnant women with maternal plasma or serum biomarkers collected between 6 and 24 weeks of gestation. Studies were excluded if they evaluated drug effects, non-GDM diabetes types or involved twin pregnancies, microbiota, genetic analyses or non-English publications.

Two independent reviewers extracted data. One reviewer extracted data from papers included in the scoping review using Covidence. From the 8837 retrieved records, 137 studies were included.

A total of 278 biomarkers with significant changes in individuals with GDM compared with controls were identified. The univariate predictive biomarkers exhibited insufficient clinical sensitivity and specificity for predicting GDM, perinatal outcomes, and the necessity of medication. Multivariable models combining maternal risk factors with biomarkers provided more accurate detection but required validation for use in clinical settings.

This review recommends further research integrating novel omics technology for building accurate models for predicting GDM, perinatal outcome, and the necessity of medication while considering the optimal testing time.

Recent findings highlighted the potential of long non-coding RNAs (lncRNAs) as novel indicators of gestational diabetes mellitus (GDM), as they demonstrate altered expression in metabolic disorders, oxidative stress (OS) and inflammation (IFM). The aim of this study was to evaluate the diagnostic potential and prognostic significance of the OS/IFM-related lncRNAs H19, MALAT1 and MEG3 in GDM and their correlations with redox status-related parameters. The relative quantification of selected lncRNAs from peripheral blood mononuclear cells (PBMCs) of GDM patients and controls (n = 50 each) was performed by qPCR. The expression levels were tested for correlations with metal ion concentrations, NRF2 expression, activities of glutathione reductase (GR), superoxide dismutase (SOD), catalase (CAT), serum thiol content, protein carbonyl level and thiobarbituric acid reactive substances. MALAT1 and H19 were significantly downregulated in GDM patients (p = 0.0095 and p = 0.012, respectively). A correlation was observed between H19 expression and zinc levels in both GDM patients and controls. MALAT1 expression positively correlated with NFE2L2 levels in GDM patients (p = 0.026), while H19 exhibited a positive correlation with GR activity in controls (p = 0.018) and an inverse correlation with SOD activity (p = 0.048). Our data show the disturbance of OS/IFM-lncRNAs in GDM pathogenesis and illustrate the biomarker potential of the analyzed lncRNAs, as well as of certain redox status parameters.

Gestational Diabetes Mellitus (GDM), a common pregnancy complication characterized by glucose intolerance, is increasingly recognized as a risk factor for Neonatal Respiratory Distress Syndrome (NRDS). This study aimed to systematically review and quantify the association between GDM and NRDS.

A comprehensive search was conducted in PubMed, Scopus, Embase, and Web of Science from their inception through July 30, 2024, to identify relevant studies. A total of 44 studies, including 50 datasets and over 6.2 million participants, were included in the analysis. Meta-analyses were performed using random-effects models to estimate pooled odds ratios (ORs) and assess heterogeneity among studies. Subgroup analyses were conducted based on study design, gestational age, diagnostic methods, and geographical regions.

Our meta-analysis demonstrated a statistically significant association between GDM and an increased risk of NRDS in newborns (OR 1.9; 95%CI 1.5-2.3). A sub-group analysis based on studies participants showed significant association in both GDM-based (OR, 2.0; 95%CI, 1.5-2.7) and NRSD-based studies (OR, 1.7; 95%CI, 1.3-2.3). This association was consistent across other various subgroups, including both term and preterm pregnancies and across different continents. Sensitivity analysis confirmed the robustness of these findings, and cumulative meta-analysis showed a steady increase in the strength of the association over time.

Our findings highlight GDM as a significant risk factor for NRDS, underscoring the need for early detection and effective management of GDM to reduce adverse neonatal outcomes. However, limitations such as residual confounding, high heterogeneity among studies, and evidence of publication bias should be considered when interpreting these results. Future research should address these issues by including diverse populations and accounting for key confounders to better understand the GDM-NRDS relationship and explore targeted interventions to mitigate the risk in infants born to mothers with GDM.