Gestational diabetes mellitus (GDM) is characterized by glucose intolerance in pregnant women without a previous diagnosis of diabetes. While the etiology of GDM remains elusive, the close association of GDM with increased maternal adiposity and advanced gestational age implicates insulin resistance as a culpable factor for the pathogenesis of GDM. Pregnancy is accompanied by the physiological induction of insulin resistance in the mother secondary to maternal weight gain. This effect serves to spare blood glucose for the fetus. To overcome insulin resistance, maternal β-cells are conditioned to release more insulin into the blood. Such an adaptive response, termed β-cell compensation, is essential for maintaining normal maternal metabolism. β-cell compensation culminates in the expansion of β-cell mass and augmentation of β-cell function, accounting for increased insulin synthesis and secretion. As a result, a vast majority of mothers are protected from developing GDM during pregnancy. In at-risk pregnant women, β-cells fail to compensate for maternal insulin resistance, contributing to insulin insufficiency and GDM. However, gestational β-cell compensation ensues in early pregnancy, prior to the establishment of insulin resistance in late pregnancy. How β-cells compensate for pregnancy and what causes β-cell failure in GDM are subjects of investigation. In this mini-review, we will provide clinical and preclinical evidence that β-cell compensation is pivotal for overriding maternal insulin resistance to protect against GDM. We will highlight key molecules whose functions are critical for integrating gestational hormones to β-cell compensation for pregnancy. We will provide mechanistic insights into β-cell decompensation in the etiology of GDM. 

Beta-Cell Compensation and Gestational Diabetes

Pregnant women with GDM affected by COVID-19 seem to be at higher risk of adverse maternal and neonatal outcomes, especially those with overweight or obesity. Good glycemic control seems to be the most effective measure in reducing the risk of GDM and severe COVID-19. For such purposes, the Mediterranean diet, micronutrient supplementation, and physical activity are considered the first line of treatment. Failure to achieve glycemic control leads to the use of insulin, and this clinical scenario has been shown to be associated with an increased risk of adverse maternal and neonatal outcomes. In this review, we explore the current evidence pertaining to the pathogenesis of SARS-CoV-2 leading to the main complications caused by COVID-19 in patients with GDM. We also discuss the incidence of complications caused by COVID-19 in pregnant women with GDM according to their treatment.

/pdf/covid-19-and-gestational-diabetes-the-role-of-nutrition-and-14pjkvvq.pdf

COVID-19 and Gestational Diabetes: The Role of Nutrition and Pharmacological Intervention in Preventing Adverse Outcomes

To evaluate the frequency of cardiovascular (CV) risk factors in psoriatic arthritis (PsA) patients. The study included 97 PsA patients and 30 control. Lipid profile and serum homocysteine level were assessed. The endothelium-dependent vasodilation (EDVD) evaluated. The QRISK-3 scale was used to assess CV risk. Disease activity PsA (DAPSA) and psoriasis area and severity index (PASI) were recorded. Reduced EDVD (<10 %) was significantly more frequent in PsA compared to control (75.3 % vs. 6.7 %, p < 0.001), with significant differences in lipid profile (p < 0.001), homocysteine (p < 0.001), QRISK (p < 0.001), CRP (p < 0.001), DAPSA (p < 0.001), and disease duration (p < 0.001) between PsA patients with reduced and normal EDVD. Average CV risk was 7.7 times higher than in control, and the classical risk factors did not account for the reduced EDVD. Linear regression analysis identified disease duration (β 0.5; OR 1.65, p < 0.001) and disease activity (β 0.09; OR 1.09, p < 0.001) as significant predictors of CV risk in PsA patients. The predictive accuracy of DAPSA (sensitivity 69 %, specificity 86.4 %, 95 % CI: 0.7–0.9; p < 0.001) and disease duration (sensitivity 91 %, specificity 55 %, 95 % CI: 0.95–1; p < 0.001) for CV risk was determined. A heightened CV risk in PsA patients is highlightened independent of traditional risk factors. The significance of disease activity and disease duration as robust predictors of CV risk in PsA patients is emphasized. The data on hyperhomocysteinemia and its association with endothelial dysfunction emphasize the intricate link between PsA, homocysteine levels, and increased CV risk. 

Modern determinants of cardiovascular risk factors in patients with psoriatic arthritis: Relation to disease activity and severity

Although there are many regional and national studies on the trends in the incidence of gestational diabetes mellitus (GDM), the trends in the incidence of GDM among the Medicaid population are lacking, especially before and during coronavirus disease of 2019 (COVID-19). 

Trends in the Incidence of Gestational Diabetes Mellitus Among the Medicaid Population Before and During the COVID-19 Pandemic

AimsThe study aimed to evaluate the impact of a simplified screening approach for gestational diabetes (GDM) compared to conventional screening on OGTT rates, GDM prevalence, and perinatal outcomes.MethodA retrospective comparative cohort study included singleton births from 20 weeks’ gestation. Pregnancies without diagnostic glucose results from 13 weeks’ gestation or incomplete screenings were excluded. Simplified screening consisted of a triaging fasting plasma glucose (FPG), where only those with FPG levels between 4.7 and 5.0 mmol/L proceeded to the 2hr 75 g oral glucose tolerance test (OGTT). The study period was divided into conventional screening (1st January 2019–30th June 2020) and simplified screening (1st January 2021–31st December 2021).ResultsOut of 15,138 pregnancies, 12,035 met the inclusion criteria: 7385 underwent conventional and 4650 underwent simplified screening. In the simplified group, 82.9 % avoided an OGTT. The simplified screening group also had a lower GDM prevalence compared to the conventional group ((18.7 % vs. 21.7 %, p < 0.001). Perinatal outcomes, including the rate of large-for-gestational-age infants, were similar between the groups.ConclusionThe simplified GDM screening strategy for significantly reduced OGTTs by over 80% without impacting perinatal outcomes. It suggests that prospective studies are necessary to further evaluate this approach. 

Simplified gestational diabetes screening with a triaging fasting plasma glucose reduces the burden of oral glucose tolerance tests during pregnancy - A large tertiary comparative cohort study.

Gestational diabetes mellitus (GDM) affects a total of 3% to 9% of all pregnancies. It has a high impact on both mother and baby, increases the perinatal risks, and predicts the presence of long-term chronic metabolic complications. The aim of our study is to determine the incidence of GDM in tertiary hospitals in the west part of Romania to lay out the risk factors associated with GDM and to observe the evolution of pregnancy among patients with this pathology by emphasizing the state of birth of the fetus, the birth weight, and the way of birth. We also want to compare the prevalence of GDM in preCOVID-19 (Coronavirus disease) versus COVID-19 years. The study took place between January 2017 and December 2021 at the Municipal Emergency Hospital of Timisoara, Romania. The proportion of births with GDM was significantly increased during the COVID-19 period compared to the preCOVID-19 period (chi2 Fisher exact test, p < 0.001). The period 2020–2021 represents a significant risk factor for GDM births (OR = 1.87, with 95% CI = [1.30, 2.67]). COVID years represent a risk period for developing gestational diabetes, which can be explained by reduced physical activity, anxiety, or modified dietary habits, even if the follow-up period was not impacted.

/pdf/prevalence-of-gestational-diabetes-in-precovid-19-and-covid-3sfhwf2b.pdf

Prevalence of Gestational Diabetes in preCOVID-19 and COVID-19 Years and Its Impact on Pregnancy: A 5-Year Retrospective Study

OBJECTIVE
Cardiovascular atherosclerotic comorbidities represent an important cause of morbidity and mortality in patients diagnosed with psoriatic arthritis. In both atherosclerosis and Psoriatic arthritis, inflammation plays a pivotal role. Psoriatic arthritis is considered as an independent risk factor for the development of atherosclerosis with accelerated evolution. Development of atherosclerosis is initiated by the endothelial cell dysfunction along with inflammation and insulin resistance. The main aim of the study was to evaluate the endothelial function in Psoriatic arthritis patients, and to identify if it is related to the insulin resistance and Psoriatic arthritis disease activity.


PATIENTS AND METHODS
In this case-control study, a group of 32 age and gender matched healthy controls was formed and compared to the group of 32 Psoriatic arthritis patients. We assessed the following parameters: Disease Activity in Psoriatic Arthritis Score, Homeostatic Model Assessment for Insulin Resistance, serum levels of the tumor necrosis factor alpha (TNFα), and the endothelial dysfunction by means of the flow-mediated dilation at brachial artery. The Student's t-test, the Pearson correlation and the ANOVA test were used to perform the statistical analysis of the data obtained; p-value <0.05 was considered as statistically significant.


RESULTS
Compared to the patients in the control group, TNFα and Homeostatic Model Assessment for Insulin Resistance were increased (p-value <0.001), and flow-mediated dilation at brachial artery was decreased (p-value <0.001) in the disease group. In Psoriatic arthritis patients, significant correlations were found between Disease Activity in Psoriatic Arthritis Score and Homeostatic Model Assessment for Insulin Resistance (r=0.8143, p-value <0.001), and between Disease Activity in Psoriatic Arthritis Score and flow-mediated dilation at brachial artery % (r= -0.8376, p-value <0.001). Psoriatic arthritis patients treated with Methotrexate exhibited reduced values of Disease Activity in Psoriatic Arthritis Score and Homeostatic Model Assessment for Insulin Resistance and increased values of flow-mediated dilation at brachial artery, when compared with the untreated patients.


CONCLUSIONS
Endothelial dysfunction is present in Psoriatic arthritis patients and has a significant correlation with both, the course of the disease and the insulin resistance.

Endothelial dysfunction in psoriatic arthritis patients: correlations between insulin resistance and disease activity.

BACKGROUND Maldevelopment of the fetal bowel can result in the rare condition of intestinal atresia, which results in congenital bowel obstruction. This report describes a case of prenatal diagnosis of fetal ileal atresia at 22 weeks' gestation. CASE REPORT Here, we present a 24-year old woman who was 22 weeks into her first pregnancy when she underwent routine fetal ultrasound. She was diagnosed with gestational diabetes mellitus. Her body mass index was normal and she had normal weight gain. The ultrasonographic examination performed revealed a hyperechoic bowel and a small dilatation of the bowel. The couple was counselled for possible intestinal atresia and its postnatal implications. At 33 weeks of gestation, polyhydramnios appeared, and the intestinal distension was much more pronounced, with hyperechoic debris in the intestinal lumen (succus-entericus). After birth, surgery was performed and we concluded the patient had type II atresia, which was surgically treated. CONCLUSIONS This report has highlighted the importance of antenatal ultrasound in detecting fetal abnormalities, and has shown that rare conditions such as intestinal atresia can be accurately diagnosed and successfully managed. Surgical correction, if implemented promptly after stabilizing the general condition, can have a relatively good prognosis. Coexisting fetal ileal atresia and gestational diabetes mellitus are rare occurrences, which can make each condition even more difficult to treat.

Importance of Prenatal Diagnosis of Ileal Atresia in Gestational Diabetes Cases.

Gestational diabetes (GDM) is considered to be the most common metabolic problem of pregnancy, which, if not recognized and treated on time, can lead to devastating effects on both the mother's health and the health of the fetus and the newborns. Many studies have revealed that the children born of GDM mothers or grandmothers have higher chances of developing diabetes type I or type II later in their life. Early identification of risk factors can help prevent the appearance of severe GDM and its complications witnessed both in the child and the mother. Obesity is one of the major risk factors that should not be ignored, and obese females should first undergo weight reduction plans in case of planned pregnancies. Other risk factors include a family history of DM arterial hypertension, significant weight gain during pregnancy, short sleep duration, women's exposure to stressful environments, changes in alpha and beta microbiota, and air pollution. Proper care should be provided to females of reproductive age both before and during pregnancy to avoid complications. Awareness programs for healthy lifestyles and diets, oral hygiene maintenance guides, and regular health check-ups can all be considered as a key to a healthy society. Expanding the analysis of gut microbiota in individuals at a heightened risk of GDM can hold particular value, especially during the preconception phase. The alterations in gut microbiota can serve as crucial factors in enhancing lifestyle modifications prior to conception. Further studies are required in this direction to decrease the prevalence of GDM, and efficient measures should be implemented before the consequences appear.

Prevention is better than cure: identifying and dealing with the key features involved in the prevention of gestational diabetes - A bird's eye view.

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Prevalence of Gestational Diabetes in preCOVID-19 and COVID-19 Years and Its Impact on Pregnancy: A 5-Year Retrospective Study

Endothelial dysfunction in psoriatic arthritis patients: correlations between insulin resistance and disease activity.

Importance of Prenatal Diagnosis of Ileal Atresia in Gestational Diabetes Cases.

Prevention is better than cure: identifying and dealing with the key features involved in the prevention of gestational diabetes - A bird's eye view.