Effects of a Lifestyle Intervention to Prevent Deterioration in Glycemic Status Among South Asian Women With Recent Gestational Diabetes: A Randomized Clinical Trial.
Tandon Nikhil,Gupta Yashdeep,Kapoor Deksha,Lakshmi Josyula K,Praveen Devarsetty,Bhattacharya Amritendu,Billot Laurent,Naheed Aliya,de Silva Asita,Gupta Ishita,Farzana Noshin,John Renu,Ajanthan Saumiyah,Divakar Hema,Bhatla Neerja,Desai Ankush,Pathmeswaran Arunasalam,Prabhakaran Dorairaj,Joshi Rohina,Jan Stephen,Teede Helena,Zoungas Sophia,Patel Anushka,
JAMA network open
Importance:Women with recent gestational diabetes (GDM) have increased risk of developing type 2 diabetes. Objective:To investigate whether a resource-appropriate and context-appropriate lifestyle intervention could prevent glycemic deterioration among women with recent GDM in South Asia. Design, Setting, and Participants:This randomized, participant-unblinded controlled trial investigated a 12-month lifestyle intervention vs usual care at 19 urban hospitals in India, Sri Lanka, and Bangladesh. Participants included women with recent diagnosis of GDM who did not have type 2 diabetes at an oral glucose tolerance test (OGTT) 3 to 18 months postpartum. They were enrolled from November 2017 to January 2020, and follow-up ended in January 2021. Data were analyzed from April to July 2021. Interventions:A 12-month lifestyle intervention focused on diet and physical activity involving group and individual sessions, as well as remote engagement, adapted to local context and resources. This was compared with usual care. Main Outcomes and Measures:The primary outcome was worsening category of glycemia based on OGTT using American Diabetes Association criteria: (1) normal glucose tolerance to prediabetes (ie, impaired fasting glucose or impaired glucose tolerance) or type 2 diabetes or (2) prediabetes to type 2 diabetes. The primary analysis consisted of a survival analysis of time to change in glycemic status at or prior to the final patient visit, which occurred at varying times after 12 months for each patient. Secondary outcomes included new-onset type 2 diabetes and change in body weight. Results:A total of 1823 women (baseline mean [SD] age, 30.9 [4.9] years and mean [SD] body mass index, 26.6 [4.6]) underwent OGTT at a median (IQR) 6.5 (4.8-8.2) months postpartum. After excluding 160 women (8.8%) with type 2 diabetes, 2 women (0.1%) who met other exclusion criteria, and 49 women (2.7%) who did not consent or were uncontactable, 1612 women were randomized. Subsequently, 11 randomized participants were identified as ineligible and excluded from the primary analysis, leaving 1601 women randomized (800 women randomized to the intervention group and 801 women randomized to usual care). These included 600 women (37.5%) with prediabetes and 1001 women (62.5%) with normoglycemia. Among participants randomized to the intervention, 644 women (80.5%) received all program content, although COVID-19 lockdowns impacted the delivery model (ie, among 644 participants who engaged in all group sessions, 476 women [73.9%] received some or all content through individual engagement, and 315 women [48.9%] received some or all content remotely). After a median (IQR) 14.1 (11.4-20.1) months of follow-up, 1308 participants (81.2%) had primary outcome data. The intervention, compared with usual care, did not reduce worsening glycemic status (204 women [25.5%] vs 217 women [27.1%]; hazard ratio, 0.92; [95% CI, 0.76-1.12]; P = .42) or improve any secondary outcome. Conclusions and Relevance:This study found that a large proportion of women in South Asian urban settings developed dysglycemia soon after a GDM-affected pregnancy and that a lifestyle intervention, modified owing to the COVID-19 pandemic, did not prevent subsequent glycemic deterioration. These findings suggest that alternate or additional approaches are needed, especially among high-risk individuals. Trial Registration:Clinical Trials Registry of India Identifier: CTRI/2017/06/008744; Sri Lanka Clinical Trials Registry Identifier: SLCTR/2017/001; and ClinicalTrials.gov Identifier: NCT03305939.
10.1001/jamanetworkopen.2022.0773
Relationship between the Dietary Inflammatory Index Score and Cytokine Levels in Chinese Pregnant Women during the Second and Third Trimesters.
Nutrients
The impact of dietary inflammatory potential on serum cytokine concentrations in second and third trimesters of Chinese pregnant women is not clear. A total of 175 pregnant women from the Tianjin Maternal and Child Health Education and Service Cohort (TMCHESC) were included. The dietary inflammatory index (DII) was calculated based on 24-h food records. Serum tumor necrosis factor-α (TNF-α), interleukin 1β (IL-1β), IL-6, IL-8, IL-10, C-reactive protein (CRP), and monocyte chemoattractant protein-1 (MCP-1) levels in the second and third trimesters were measured. The mean DII scores (mean ± SD) were -0.07 ± 1.65 and 0.06 ± 1.65 in the second and third trimesters, respectively. In the third trimester, IL-1β ( = 0.039) and MCP-1 ( = 0.035) levels decreased and then increased with increasing DII scores. IL-10 concentrations decreased in pregnant women whose DII scores increased between the second and third trimesters ( = 0.011). Thiamin and vitamin C were negatively correlated with MCP-1 (β = -0.879, and β = -0.003) and IL-6 (β = -0.602, and β = -0.002) levels in the third trimester. In conclusion, the DII score had a U-shaped association with cytokine levels during the third trimester. Changes in DII scores between the second and third trimesters of pregnancy were correlated with cytokine levels during the third trimester.
10.3390/nu15010194
Association of Dietary Inflammatory Index with Serum IL-6, IL-10, and CRP Concentration during Pregnancy.
Pieczyńska Joanna,Płaczkowska Sylwia,Pawlik-Sobecka Lilla,Kokot Izabela,Sozański Rafał,Grajeta Halina
Nutrients
: The mother's diet has a direct impact on fetal development and pregnancy, and can also be important in the course of the body's inflammatory response. An anti-inflammatory diet can be a promising way to counter an excessive inflammatory response in pregnancy. : The aim of the study was to examine the association between the dietary inflammatory index (DII) and the pregnant women's serum interleukin 6 (IL-6) and 10 (IL-10) and C-reactive protein (CRP) concentration in the course of normal and complicated pregnancy. : The study included 45 Polish pregnant women recruited to the study. The DII, a literature-based dietary index to assess the inflammatory properties of diet, was estimated based on a seven-day 24-h recall and an food frequency questionnaire (FFQ) in each trimester of pregnancy. At the same time as the nutritional interviews, blood samples were collected for the determination of IL-6, IL-10, and CRP concentrations. The studied group was divided into subgroups with normal and complicated pregnancy and depending on the DII median. : With the development of pregnancy, the DII score slightly decreased in subsequent trimesters: -1.78 in the first trimester, -2.43 in the second trimester, and -2.71 in the third trimester ( = 0.092). Independent of the trimester of pregnancy and the occurrence of pregnancy complications, the DII score did not affect the differences in the serum concentrations of IL-6, IL-10, and CRP, with the exception of CRP level in the second trimester in women with complicated pregnancy (subgroup with DII < median had a lower CRP level than subgroup with DII > median). In the first and third trimesters, there was a weak but significant positive correlation between the DII score and CRP concentration. During the second trimester, in the group with normal pregnancy and DII below the median, a significant negative correlation between the DII score and the serum IL-6 and IL-10 concentration was noted as well as in the third trimester for IL-6. : The anti-inflammatory potential of a pregnant woman's diet increases slightly with pregnancy development; however, its value has no permanent significant association with the level of CRP, IL-6, and IL-10.
10.3390/nu12092789
[Association between the dietary inflammatory index, interleukin-6 of late pregnant women and birth weight].
Wei sheng yan jiu = Journal of hygiene research
OBJECTIVE:To explore the relationship between dietary inflammatory index(DII), serum interleukin-6(IL-6) of late pregnant women and infant birth weight. METHODS:This study was conducted in late pregnant women who received antenatal care at the Maternal and Children& apos; s Hospital of Baiyun and Yuexiu District in Guangzhou, China between September 2010 and February 2011. Tree consecutive 24-h diet recalls, pre-pregnancy body mass index, maternal education level and etc were collected. DII score was calculated based on data of dietary surveys. Participant were dived into anti-inflammatory group(T1), neutral group(T2) and pro-inflammatory group(T3) according to the tertiles of DII score. Maternal and infant anthropometric profile(n=456) and level of maternal serum IL-6(n=308) were measured. Structrural equation modeling(SEM) was used to explore the relationship between DII, IL-6 and birth weight. RESULTS:In 456 women, the mean DII score was 0. 02±1. 08. Women performed anti-inflammatory diet had higher intake of grain and potato, vegetables, energy, fiber, minerals, vitamins and unsaturated fatty acids, but lower intakes of fruits, diary, fat(% energy) and protein from animal food(P& lt; 0. 05). Average infant birth weight and level of maternal serum IL-6 were(3238. 1±376. 4)g and 4. 05(2. 02, 10. 14) pg/mL respectively. DII of pregnant women was positively correlated with maternal serum IL-6(r=0. 144, P& lt; 0. 05), and IL-6 was negatively correlated with birth weight(r=-0. 184, P& lt; 0. 05). SEM indicated that maternal serum IL-6 may be a mediator in the association between DII and birth weight. CONCLUSION:The diet of pregnant women may change the serum level of IL6, and then affect infant birth weight.
10.19813/j.cnki.weishengyanjiu.2021.03.019
Familial clustering of type 2 diabetes in Korean women with gestational diabetes mellitus.
Rhee Sang Youl,Kim Joo Young,Woo Jeong-Taek,Kim Young Seol,Kim Sung-Hoon
The Korean journal of internal medicine
BACKGROUND/AIMS:This study was conducted to examine the relationship between family history of type 2 diabetes (T2DM) and risk of developing gestational diabetes mellitus (GDM) in Korean women. METHODS:We performed a 100-g oral glucose tolerance test in 858 pregnant women who had abnormal glucose tolerance in 50-g oral glucose challenge. In addition, we reviewed the incidence of T2DM in the parents and siblings and analyzed the association between the familial history of T2DM and the risk of GDM. RESULTS:Of the 858 subjects, 427 were normal, and 431 were diagnosed with GDM. Compared with women with no family history of T2DM, women with first degree family history of T2DM displayed higher risk of T2DM (odd ratio: parent only 1.91, sibling only 6.24, any 2.27). CONCLUSIONS:The risk of developing GDM was significantly increased in Korean women with a family history of T2DM in first-degree relatives.
10.3904/kjim.2010.25.3.269
Prevention of type 2 diabetes mellitus in women with previous gestational diabetes mellitus.
The Korean journal of internal medicine
Gestational diabetes mellitus (GDM), defined as any degree of glucose intolerance with onset or first recognition during pregnancy, is characterized by underlying maternal defects in the β-cell response to insulin during pregnancy. Women with a previous history of GDM have a greater than 7-fold higher risk of developing postpartum diabetes compared with women without GDM. Various risk factors for postpartum diabetes have been identified, including maternal age, glucose levels in pregnancy, family history of diabetes, pre-pregnancy and postpartum body mass index, dietary patterns, physical activity, and breastfeeding. Genetic studies revealed that GDM shares common genetic variants with type 2 diabetes. A number of lifestyle interventional trials that aimed to ameliorate modifiable risk factors, including diet, exercise, and breastfeeding, succeeded in reducing the incidence of postpartum diabetes, weight retention, and other obesity-related morbidities. The present review summarizes the findings of previous studies on the incidence and risk factors of postpartum diabetes and discusses recent lifestyle interventional trials that attempted to prevent postpartum diabetes.
10.3904/kjim.2016.203