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Gestational Diabetes: Current Knowledge and Therapeutic Prospects
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Gestational Diabetes: Current Knowledge and Therapeutic Prospects

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Endocrinology & Metabolism".

Deadline for manuscript submissions: 30 September 2024 | Viewed by 5247

Special Issue Editor

Dr. Francesco Corrado

E-Mail Website
Guest Editor
Department of Obstetrics and Gynaecology, Policlinico Universitario Gazzi, University of Messina, 98124 Messina, Italy
Interests: pregnancy; gestational diabetes; reproductive physiopathology; prenatal diagnostics

Special Issue Information

Dear Colleagues,

Although gestational diabetes is a well known and widely treated topic, the knowledge of the various aspects of this pathology is always enriched with new details. Therefore, deepening the latest developments in the various related fields, such as screening, diagnosis, perinatal outcome, possibilities of prevention and treatment, and follow-up information, is always useful for maintaining an updated knowledge of this pathology.

This Special Issue aims to provide a comprehensive review on this topic by collecting papers from an expert panel of authors.

Dr. Francesco Corrado
Guest Editor

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Keywords

  • gestational diabetes mellitus
  • diabetes in pregnancy
  • glucose intolerance in pregnancy
  • perinatal outcome
  • follow-up

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Published Papers (4 papers)

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Research

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21 pages, 364 KiB  
Article
Serum Levels of Adipolin and Adiponectin and Their Correlation with Perinatal Outcomes in Gestational Diabetes Mellitus
by Mihai Muntean, Vladut Săsăran, Sonia-Teodora Luca, Laura Mihaela Suciu, Victoria Nyulas and Claudiu Mărginean
J. Clin. Med. 2024, 13(14), 4082; https://doi.org/10.3390/jcm13144082 - 12 Jul 2024
Viewed by 629
Abstract
Objectives: This study aimed to investigate the serum level of adipolin and adiponectin in healthy pregnant women and pregnant women with gestational diabetes mellitus (GDM) during the second trimester, the prepartum period, and in the newborns of these patients. Methods: A [...] Read more.
Objectives: This study aimed to investigate the serum level of adipolin and adiponectin in healthy pregnant women and pregnant women with gestational diabetes mellitus (GDM) during the second trimester, the prepartum period, and in the newborns of these patients. Methods: A total of 55 women diagnosed with GDM and 110 healthy pregnant women were included in this study. Pearson’s and Spearman’s correlation coefficients were calculated to determine the association of adipolin and adiponectin with anthropometric markers of obesity (body mass index (BMI), mid-upper arm circumference (MUAC), tricipital skinfold thickness (TST)), inflammation markers (neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), C-reactive protein (CRP)), and maternal glucose homeostasis parameters (fasting glucose, insulin, C peptide, glycosylated hemoglobin A1c (HbA1c), Insulin Resistance—Homeostatic Model Assessment (IR HOMA)). Results: There were no statistical differences between the adipolin value in patients with GDM compared to healthy patients (p = 0.65 at diagnosis and p = 0.50 prepartum) and in newborns from mothers with GDM compared to healthy mothers (p = 0.24). Adipolin levels are significantly higher in patients with GDM who gave birth via cesarean section (p = 0.01). In patients with GDM, the adipolin level correlates positively with HgA1c in the prepartum period. We found a positive correlation between the maternal adipolin values at diagnosis and prepartum and neonatal adipolin (respectively: r = 0.556, p = 0.001; r = 0.332, p = 0.013). Adiponectin levels were significantly lower in patients with GDM at diagnosis and prepartum (p = 0.0009 and p = 0.02), but their levels increased prepartum (5267 ± 2114 ng/mL vs. 6312 ± 3150 ng/mL p = 0.0006). Newborns of mothers with GDM had lower adiponectin levels than newborns of healthy mothers (p < 0.0001). The maternal adiponectin value correlates negatively with maternal BMI, MUAC, and IR HOMA in both groups at diagnosis and prepartum. There were no differences between the groups in terms of cesarean rate (p > 0.99). The relative risk of occurrence of adverse events in patients with GDM compared to healthy ones was 2.15 (95% CI 1.416 to 3.182), and the odds ratio for macrosomia was 4.66 (95% CI 1.591 to 12.69). Conclusions: There was no difference in adipolin levels between mothers with GDM and healthy mothers during the second trimester and the prepartum period. Adipolin is known to enhance insulin sensitivity and reduce inflammation, but unlike adiponectin, it does not appear to contribute to the development of GDM. Full article
(This article belongs to the Special Issue Gestational Diabetes: Current Knowledge and Therapeutic Prospects)
10 pages, 431 KiB  
Article
Placental Expression of Glucose and Zinc Transporters in Women with Gestational Diabetes
by Łukasz Ustianowski, Michał Czerewaty, Kajetan Kiełbowski, Estera Bakinowska, Maciej Tarnowski, Krzysztof Safranow and Andrzej Pawlik
J. Clin. Med. 2024, 13(12), 3500; https://doi.org/10.3390/jcm13123500 - 14 Jun 2024
Viewed by 386
Abstract
Background/Objectives: Gestational diabetes (GDM) is a metabolic disorder with altered glucose levels diagnosed in pregnant women. The pathogenesis of GDM is not fully known, but it is thought to be caused by impaired insulin production and insulin resistance induced by diabetogenic factors. [...] Read more.
Background/Objectives: Gestational diabetes (GDM) is a metabolic disorder with altered glucose levels diagnosed in pregnant women. The pathogenesis of GDM is not fully known, but it is thought to be caused by impaired insulin production and insulin resistance induced by diabetogenic factors. The placenta may play an important role in the development of GDM. Glucose transporters (GLUTs) are responsible for the delivery of glucose into the foetal circulation. Placental zinc transporters regulate insulin and glucagon secretion, as well as gluconeogenesis and glycolysis. The aim of this study was to investigate the placental expression of GLUT3, GLUT4, GLUT7 and SLC30A8 in women with GDM. Furthermore, we evaluated whether the expression profiles of these transporters were correlated with clinical parameters. Methods: This study included 26 patients with GDM and 28 patients with normal glucose tolerance (NGT). Results: The placental expression of GLUT3 was significantly reduced in the GDM group, while the placental expression of GLUT4, GLUT7 and SLC30A8 was significantly upregulated in the GDM group. GLUT3 expression correlated significantly with body mass index (BMI) increase during pregnancy and body mass increase during pregnancy, while GLUT4 expression correlated negatively with BMI at birth. Conclusions: These results suggest the involvement of GLUT3 and GLUT4, GLUT7 and SLC30A8 in the pathogenesis of GDM. Full article
(This article belongs to the Special Issue Gestational Diabetes: Current Knowledge and Therapeutic Prospects)
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Review

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13 pages, 780 KiB  
Review
Antepartum Fetal Surveillance and Optimal Timing of Delivery in Diabetic Women: A Narrative Review
by Alan Braverman-Poyastro, Blanca Vianey Suárez-Rico, Héctor Borboa-Olivares, Salvador Espino y Sosa, Johnatan Torres-Torres, Lidia Arce-Sánchez, Nayeli Martínez-Cruz and Enrique Reyes-Muñoz
J. Clin. Med. 2024, 13(2), 313; https://doi.org/10.3390/jcm13020313 - 5 Jan 2024
Cited by 1 | Viewed by 2613
Abstract
Antepartum fetal surveillance (AFS) is essential for pregnant women with diabetes to mitigate the risk of stillbirth. However, there is still no universal consensus on the optimal testing method, testing frequency, and delivery timing. This review aims to comprehensively analyze the evidence concerning [...] Read more.
Antepartum fetal surveillance (AFS) is essential for pregnant women with diabetes to mitigate the risk of stillbirth. However, there is still no universal consensus on the optimal testing method, testing frequency, and delivery timing. This review aims to comprehensively analyze the evidence concerning AFS and the most advantageous timing for delivery in both gestational and pregestational diabetes mellitus cases. This review’s methodology involved an extensive literature search encompassing international diabetes guidelines and scientific databases, including PubMed, MEDLINE, Google Scholar, and Scopus. The review process meticulously identified and utilized pertinent articles for analysis. Within the scope of this review, a thorough examination revealed five prominent international guidelines predominantly addressing gestational diabetes. These guidelines discuss the utility and timing of fetal well-being assessments and recommendations for optimal pregnancy resolution timing. However, the scarcity of clinical trials directly focused on this subject led to a reliance on observational studies as the basis for most recommendations. Glucose control, maternal comorbidities, and the medical management received are crucial in making decisions regarding AFS and determining the appropriate delivery timing. Full article
(This article belongs to the Special Issue Gestational Diabetes: Current Knowledge and Therapeutic Prospects)
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Other

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15 pages, 561 KiB  
Systematic Review
Early HbA1c Levels as a Predictor of Adverse Obstetric Outcomes: A Systematic Review and Meta-Analysis
by Laura Mañé, Humberto Navarro, Juan Pedro-Botet, Juan José Chillarón, Silvia Ballesta, Antonio Payà, Verónica Amador, Juana Antonia Flores-Le Roux and David Benaiges
J. Clin. Med. 2024, 13(6), 1732; https://doi.org/10.3390/jcm13061732 - 17 Mar 2024
Viewed by 1275
Abstract
Background: The objective was to assess the association between early HbA1c levels and pregnancy complications and whether this relationship is affected when HbA1c thresholds are greater than or less than 39 mmol/mol (5.7%). Methods: Electronic searches of the MEDLINE and EMBASE [...] Read more.
Background: The objective was to assess the association between early HbA1c levels and pregnancy complications and whether this relationship is affected when HbA1c thresholds are greater than or less than 39 mmol/mol (5.7%). Methods: Electronic searches of the MEDLINE and EMBASE databases up to October 2022 were conducted. We included retrospective and prospective observational studies. The inclusion criteria were as follows: HbA1c measurements taken at <20 weeks’ gestation, singleton pregnancy, and no pre-existing diabetes mellitus. Results: We assessed the certainty of the evidence with the GRADE system. We determined the proportion of patients in each group who met the criteria for obstetrical outcomes and pooled data into two subgroups according to the HbA1c threshold: <39 mmol/mol or >39 mmol/mol (5.7%). Sixteen studies with a total of 43,627 women were included. An association between elevated early HbA1c levels and pre-eclampsia, large for gestational age (LGA), macrosomia, and preterm delivery (RR 2.02, 95% CI 1.53–2.66; RR 1.38, 95% CI 1.15–1.66; RR 1.40, 95% CI 1.07–1.83; and RR 1.67, 95% CI 1.39–2.0, respectively) was shown, with a moderate–high grade of certainty. According to the subgroup analysis of all studies, LGA, pre-eclampsia, and labour induction were associated with elevated HbA1c levels only in studies using an HbA1c threshold >39 mmol/mol (5.7%). The association between HbA1c levels and premature birth was statistically significant in studies using both higher and lower HbA1c thresholds. Conclusions: Women with high early HbA1c levels below the range of diabetes presented an increased risk of pregnancy complications such as macrosomia, LGA, and pre-eclampsia. An early HbA1c threshold of >39 mmol/mol (5.7%) showed the strongest association with pregnancy complications. Full article
(This article belongs to the Special Issue Gestational Diabetes: Current Knowledge and Therapeutic Prospects)
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