A prospective study of gestational diabetes mellitus risk in relation to physical activity before...
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153 POSTPRANDIAL GLUCOSE PROFILE CHARACTERISTICS IN DIABETIC PREGNANCIES AVI BEN HAROUSH 1 , YARIV YOGEV 2 , ODED LANGER 2 , RONY CHEN 1 , LOIS BRUSTMAN 2 , BARAK ROSENN 2 , MOSHE HOD 1 , 1 Rabin Medical Center, Perinatal Division, Department of Obstetrics and Gynecology, Petach-Tikva, Israel 2 St. Luke’s Roosevelt Hospital Center, Department of Obstetrics and Gynecology, New York, NY OBJECTIVE: Paucity of information exists regarding the characteristics of postprandial (PP) glucose profile in pregnancy, and there is controversy regarding the time to perform this evaluation (60 or 120 min). We sought to investigate PP glucose profile in diabetic pregnancies. STUDY DESIGN: Subjects were connected to Continuous Glucose Monitoring System (CGMS) for 72 consecutive hours. CGMS measures, in subcutaneous tissue, interstitial glucose levels within a range of 40-400 mg/dL every 5 minutes for a total of 288 measurements/daily. Women were instructed to record meal times during this period. From each recording we calculated the time and value of PP glucose peak and the time interval required to return to preprandial glucose value. We also assessed possible differences in PP glucose profile between breakfast, lunch, and dinner. RESULTS: 71 women participated in the study, 26 with gestational diabetes (GDM) treated by diet only, 25 with insulin-treated GDM, and 20 with type 1 diabetes. The time interval from meal to peak PP glucose levels and the time interval required to return to preprandial value were significantly different between the groups (Table). Similar PP glucose peak time was obtained for breakfast, lunch, and dinner in all study groups (P = 0.44). CONCLUSION: The time interval for PP glucose peak in all types of diabetic pregnancies is approximately 90 minutes after meals throughout the day. This information should be considered in the glucose testing regimen for diabetes in pregnancy. 154 A PROSPECTIVE STUDY OF GESTATIONAL DIABETES MELLITUS RISK IN RELATION TO PHYSICAL ACTIVITY BEFORE AND DURING PREGNANCY JENNIFER DEMPSEY 1 , TANYA SORENSEN 2 , MICHELLE WILLIAMS 1 , I-MIN LEE 3 , RAYMOND MILLER 1 , EDWARD DASHOW 4 , DAVID LUTHY 2 , 1 Swedish Medical Center, Center for Perinatal Studies, Seattle, WA 2 Swedish Medical Center, Obstetrics & Gynecology, Seattle, WA 3 Harvard School of Public Health, Department of Epidemiology, Boston, MA 4 Tacoma General Hospital, Perinatal Services, Tacoma, WA OBJECTIVE: A small body of evidence supports the thesis that physical activity is associated with a reduced risk of gestational diabetes mellitus (GDM), but inferences have been hampered by recall and selection bias. We examined the relationship between recreational physical activity performed before and during pregnancy and the risk of GDM in a prospective cohort study. STUDY DESIGN: Between 1996 and 2000, 909 normotensive, non-diabetic women who delivered infants in our centers were questioned in early gestation about type, intensity, frequency, and duration of physical activity performed during the year before and 7 days prior to the interview during pregnancy. RESULTS: 42 women (4.6%) in this cohort developed GDM. Women who participated in any physical activity during the year before experienced a 56% reduction in risk (relative risk [RR] = 0.44; 95% confidence interval [CI]: 0.21, 0.91), as compared with those who were inactive. Women who spent $4.2 hours/week engaged in physical activity were 76% less likely to develop GDM (RR = 0.24; 95% CI: 0.10, 0.64), and those who expended $21.1 MET-hours/ week experienced a 74% reduction in risk (RR = 0.26; 95% CI: 0.10, 0.65), as compared with inactive women. Physical activity performed during pregnancy was also associated with reductions in GDM risk, though these associations did not reach statistical significance. Women who engaged in physical activity during both time periods experienced a 69% reduction in risk (RR = 0.31; 95% CI: 0.12, 0.79). CONCLUSION: Our findings suggest that public health efforts to increase maternal physical activity may contribute to substantial reductions in GDM risk. 155 PLASMA LIPID CONCENTRATIONS IN EARLY PREGNANCY AND RISK OF PREECLAMPSIA DANIEL ENQUOBAHRIE 1 , MICHELLE WILLIAMS 1 , CAROLE BUTLER 2 , IHUNNAYA FREDERICK 1 , DAVID LUTHY 3 , 1 Swedish Medical Center, Center for Perinatal Studies, Seattle, WA 2 University of Washington, Dept. of Epidemiology, Seattle, WA 3 Pediatrix/Obstetrix Medical Group, Seattle, WA OBJECTIVE: We investigated the relationship between early pregnancy plasma lipid concentrations and risk of preeclampsia. STUDY DESIGN: In a prospective cohort study, maternal blood samples were collected at 13 weeks’ gestation on average. From the cohort, we selected 57 women who developed preeclampsia and 510 who remained normotensive. Plasma lipid concentrations were measured enzymatically by standardized assays. Logistic regression procedures were used to calculate adjusted odds ratios (OR) and 95% confidence intervals (95% CI). RESULTS: Women who subsequently developed preeclampsia had 10.38%, 13.64%, and 15.54% higher concentrations of low-density lipoprotein (LDL) cholesterol, triglycerides, and LDL/HDL ratios, respectively, than controls (P < 0.05). High-density lipoprotein (HDL) cholesterol concentrations were 7.0% lower in cases than controls (P < 0.05). After adjustment, there was a 2.90- fold increase in risk of preeclampsia among women with total cholesterol >205mg/dL (95% CI 1.12-5.99) and a 3.25-fold increase in risk of preeclampsia among women with triglyceride $133 mg/dL (95% CI 1.41-6.69). A linear increase in preeclampsia risk was observed with increasing tertiles of LDL cholesterol, triglyceride concentrations, and LDL/HDL ratio (all P for trend < 0.05). Increasing tertiles of HDL cholesterol concentrations were associated with a decrease in preeclampsia risk (P for trend < 0.05). CONCLUSION: We showed that early pregnancy dyslipidemia is associated with increased risk of preeclampsia. This association may be significant in understanding the pathologic process of preeclampsia and may help in prevention and/or early diagnosis of the disorder. 156 ZINC PROTOPORPHYRIN/HEME RATIOS IN INFANTS BORN TO WOMEN WITH DIABETES KAREN LESSER 1 , SARAH SCHOEL 1 , JOHN WIDNESS 2 , PAMELA KLING 3 , 1 University of Arizona, Obstetrics and Gynecology, Tucson, AZ 2 University of Iowa, Pediatrics, Iowa City, IA 3 University of Wisconsin, Madison, WI OBJECTIVE: The purposes of this study are to determine if fetal cord blood erythrocyte zinc protoporphyrin/heme (ZnPP/H) ratios are elevated in neonates of pregnant women with diabetes and if these levels correlate with maternal glycemic control. STUDY DESIGN: Fetal umbilical cord blood was collected at healthy term deliveries (n = 85, normal group) and at deliveries of neonates of women with insulin-dependent diabetes (n = 41, diabetes group). Women with diabetes all received at least one dose of insulin during the pregnancy and included those with preexisting diabetes and gestational diabetes. Fetal cord blood was analyzed for zinc protoporphyrin/heme ratio. Maternal glycemic control during pregnancy was assessed by infant birth weight, by pregnancy daily glucose diabetic log, and by maternal glycosylated hemoglobin levels. RESULTS: Zinc protoporphyrin/heme ratios were higher in the offspring of women with diabetes (119.8 ± 10.3 mM/M) than normal controls (71.0 ± 2.7 mM/M) (P < 0.0001). In the group with diabetes, large for gestational age (LGA) infants exhibited higher zinc protoporphyrin/heme ratios (173.1 ± 35.8 mM/M) than infants appropriate for gestational age (AGA) (104.9 ± 6.9 mM/M) (P < 0.03). Eight women with diabetes met the goal for mean third-trimester glucose less than 105 mg/dL (5.8 mmol/L). The mean zinc protoporphyrin/heme ratio of these subjects (96.1 ± 17.6 mM/M) was less than the group with poor glycemic control (140.3 ± 16.7 mM/M) (P < 0.05). Zinc protoporphyrin/heme ratios in the diabetes group did not correlate with maternal glycosylated hemoglobin (R 2 = 0.129, P = 0.16). CONCLUSION: Fetal cord blood zinc protoporphyrin/heme ratios are increased in the offspring of women with diabetes. Cord zinc protoporphyrin levels were also higher when maternal glycemic control was poorer. However, glycosylated hemoglobin did not correlate to cord zinc protoporphyrin ratios. Type 1 Diet- treated GDM Insulin- treated GDM P Preprandial value (mg/dL) 102 ± 14 83 ± 18 101 ± 46 .008 PP peak time (min) 92 ± 40 82 ± 31 81 ± 38 .006 PP peak value (mg/dL) 182 ± 58 131 ± 29 149 ± 48 .001 Time to preprandial value (min) 128 ± 33 134 ± 32 111 ± 30 .02 December 2003 Am J Obstet Gynecol S106 SMFM Abstracts
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Transcript of A prospective study of gestational diabetes mellitus risk in relation to physical activity before...
153 POSTPRANDIAL GLUCOSE PROFILE CHARACTERISTICS IN DIABETICPREGNANCIES AVI BEN HAROUSH1, YARIV YOGEV2, ODED LANGER2,RONY CHEN1, LOIS BRUSTMAN2, BARAK ROSENN2, MOSHE HOD1,1Rabin Medical Center, Perinatal Division, Department of Obstetrics andGynecology, Petach-Tikva, Israel 2St. Luke’s Roosevelt Hospital Center,Department of Obstetrics and Gynecology, New York, NY
OBJECTIVE: Paucity of information exists regarding the characteristics ofpostprandial (PP) glucose profile in pregnancy, and there is controversyregarding the time to perform this evaluation (60 or 120 min). We sought toinvestigate PP glucose profile in diabetic pregnancies.
STUDY DESIGN: Subjects were connected to Continuous GlucoseMonitoring System (CGMS) for 72 consecutive hours. CGMS measures, insubcutaneous tissue, interstitial glucose levels within a range of 40-400 mg/dLevery 5 minutes for a total of 288 measurements/daily. Women were instructedto record meal times during this period. From each recording we calculated thetime and value of PP glucose peak and the time interval required to return topreprandial glucose value. We also assessed possible differences in PP glucoseprofile between breakfast, lunch, and dinner.
RESULTS: 71 women participated in the study, 26 with gestational diabetes(GDM) treated by diet only, 25 with insulin-treated GDM, and 20 with type 1diabetes. The time interval from meal to peak PP glucose levels and the timeinterval required to return to preprandial value were significantly differentbetween the groups (Table). Similar PP glucose peak time was obtained forbreakfast, lunch, and dinner in all study groups (P = 0.44).
CONCLUSION: The time interval for PP glucose peak in all types ofdiabetic pregnancies is approximately 90 minutes after meals throughout theday. This information should be considered in the glucose testing regimen fordiabetes in pregnancy.
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155 PLASMA LIPID CONCENTRATIONS IN EARLY PREGNANCY AND RISKOF PREECLAMPSIA DANIEL ENQUOBAHRIE1, MICHELLE WILLIAMS1,CAROLE BUTLER2, IHUNNAYA FREDERICK1, DAVID LUTHY3, 1SwedishMedical Center, Center for Perinatal Studies, Seattle, WA 2University ofWashington, Dept. of Epidemiology, Seattle, WA 3Pediatrix/ObstetrixMedical Group, Seattle, WA
OBJECTIVE: We investigated the relationship between early pregnancyplasma lipid concentrations and risk of preeclampsia.
STUDY DESIGN: In a prospective cohort study, maternal blood sampleswere collected at 13 weeks’ gestation on average. From the cohort, we selected 57women who developed preeclampsia and 510 who remained normotensive.Plasma lipid concentrations were measured enzymatically by standardizedassays. Logistic regression procedures were used to calculate adjusted odds ratios(OR) and 95% confidence intervals (95% CI).
RESULTS: Women who subsequently developed preeclampsia had 10.38%,13.64%, and 15.54% higher concentrations of low-density lipoprotein (LDL)cholesterol, triglycerides, and LDL/HDL ratios, respectively, than controls(P < 0.05). High-density lipoprotein (HDL) cholesterol concentrations were7.0% lower in cases than controls (P < 0.05). After adjustment, there was a 2.90-fold increase in risk of preeclampsia among women with total cholesterol>205mg/dL (95% CI 1.12-5.99) and a 3.25-fold increase in risk of preeclampsiaamong women with triglyceride $133 mg/dL (95% CI 1.41-6.69). A linearincrease in preeclampsia risk was observed with increasing tertiles of LDLcholesterol, triglyceride concentrations, and LDL/HDL ratio (all P for trend< 0.05). Increasing tertiles of HDL cholesterol concentrations were associatedwith a decrease in preeclampsia risk (P for trend < 0.05).
CONCLUSION: We showed that early pregnancy dyslipidemia is associatedwith increased risk of preeclampsia. This association may be significant inunderstanding the pathologic process of preeclampsia and may help inprevention and/or early diagnosis of the disorder.
156 ZINC PROTOPORPHYRIN/HEME RATIOS IN INFANTS BORN TOWOMEN WITH DIABETES KAREN LESSER1, SARAH SCHOEL1, JOHNWIDNESS2, PAMELA KLING3, 1University of Arizona, Obstetrics andGynecology, Tucson, AZ 2University of Iowa, Pediatrics, Iowa City, IA3University of Wisconsin, Madison, WI
OBJECTIVE: The purposes of this study are to determine if fetal cord blooderythrocyte zinc protoporphyrin/heme (ZnPP/H) ratios are elevated inneonates of pregnant women with diabetes and if these levels correlate withmaternal glycemic control.
STUDY DESIGN: Fetal umbilical cord blood was collected at healthy termdeliveries (n = 85, normal group) and at deliveries of neonates of women withinsulin-dependent diabetes (n = 41, diabetes group). Women with diabetes allreceived at least one dose of insulin during the pregnancy and included thosewith preexisting diabetes and gestational diabetes. Fetal cord blood was analyzedfor zinc protoporphyrin/heme ratio. Maternal glycemic control duringpregnancy was assessed by infant birth weight, by pregnancy daily glucosediabetic log, and by maternal glycosylated hemoglobin levels.
RESULTS: Zinc protoporphyrin/heme ratios were higher in the offspringof women with diabetes (119.8 ± 10.3 mM/M) than normal controls(71.0 ± 2.7 mM/M) (P < 0.0001). In the group with diabetes, large forgestational age (LGA) infants exhibited higher zinc protoporphyrin/hemeratios (173.1 ± 35.8mM/M) than infants appropriate for gestational age (AGA)(104.9 ± 6.9 mM/M) (P < 0.03). Eight women with diabetes met the goal formean third-trimester glucose less than 105 mg/dL (5.8 mmol/L). The meanzinc protoporphyrin/heme ratio of these subjects (96.1 ± 17.6 mM/M) was lessthan the group with poor glycemic control (140.3 ± 16.7 mM/M) (P < 0.05).Zinc protoporphyrin/heme ratios in the diabetes group did not correlate withmaternal glycosylated hemoglobin (R2 = 0.129, P = 0.16).
CONCLUSION: Fetal cord blood zinc protoporphyrin/heme ratios areincreased in the offspring of women with diabetes. Cord zinc protoporphyrinlevels were also higher when maternal glycemic control was poorer. However,
Type 1Diet- treated
GDMInsulin- treated
GDM P
Preprandialvalue (mg/dL)
102 ± 14 83 ± 18 101 ± 46 .008
PP peaktime (min)
92 ± 40 82 ± 31 81 ± 38 .006
PP peakvalue (mg/dL)
182 ± 58 131 ± 29 149 ± 48 .001
Time topreprandialvalue (min)
128 ± 33 134 ± 32 111 ± 30 .02
December 2003Am J Obstet Gynecol
S106 SMFM Abstracts
A PROSPECTIVE STUDY OF GESTATIONAL DIABETES MELLITUS RISKIN RELATION TO PHYSICAL ACTIVITY BEFORE AND DURINGPREGNANCY JENNIFER DEMPSEY1, TANYA SORENSEN2, MICHELLEWILLIAMS1, I-MIN LEE3, RAYMOND MILLER1, EDWARD DASHOW4,DAVID LUTHY2, 1Swedish Medical Center, Center for Perinatal Studies,Seattle, WA 2Swedish Medical Center, Obstetrics & Gynecology, Seattle, WA3Harvard School of Public Health, Department of Epidemiology, Boston, MA4Tacoma General Hospital, Perinatal Services, Tacoma, WA
OBJECTIVE: A small body of evidence supports the thesis that physicalactivity is associated with a reduced risk of gestational diabetes mellitus (GDM),but inferences have been hampered by recall and selection bias. We examinedthe relationship between recreational physical activity performed before andduring pregnancy and the risk of GDM in a prospective cohort study.
STUDY DESIGN: Between 1996 and 2000, 909 normotensive, non-diabeticwomen who delivered infants in our centers were questioned in early gestationabout type, intensity, frequency, and duration of physical activity performedduring the year before and 7 days prior to the interview during pregnancy.
RESULTS: 42 women (4.6%) in this cohort developed GDM. Women whoparticipated in any physical activity during the year before experienced a 56%reduction in risk (relative risk [RR] = 0.44; 95% confidence interval [CI]: 0.21,0.91), as compared with those who were inactive. Women who spent $4.2hours/week engaged in physical activity were 76% less likely to develop GDM(RR = 0.24; 95% CI: 0.10, 0.64), and those who expended $21.1 MET-hours/week experienced a 74% reduction in risk (RR = 0.26; 95% CI: 0.10, 0.65), ascompared with inactive women. Physical activity performed during pregnancywas also associated with reductions in GDM risk, though these associations didnot reach statistical significance.Womenwho engaged in physical activity duringboth time periods experienced a 69% reduction in risk (RR = 0.31; 95% CI:0.12, 0.79).
CONCLUSION: Our findings suggest that public health efforts to increasematernal physical activity may contribute to substantial reductions in GDM risk.
glycosylated hemoglobin did not correlate to cord zinc protoporphyrin ratios.
