Patrick Campbell

A new study is underlining the increased risk of vision problems among children born to mothers with diabetes.

With data from nearly 2.5 million individuals born from 1977-2016, investigators determined children born to mothers with diabetes were at a 39% greater risk of high refractive error before the age of 25 years.

“In this nationwide population-based cohort study, we observed that children born to mothers with either pre-gestational or gestational diabetes were at an increased risk of developing high refractive error in general, as well as specific types of high refractive error, persisting from the neonatal period to early adulthood. Children born to mothers with diabetic complications had the highest risk of high refractive error,” wrote investigators.

Using data from multiple Danish health registries, a team of investigators from China and Denmark designed the current study as a cohort study of 2,470,580 individuals born in Denmark from 1977-2016. With follow-up lasting as long as 25 years, investigators planned to use Cox regression to assess associations between maternal diabetes and the risk of high RE in offspring from birth until the age of 25 years.

Investigators noted Cox regressions models were adjusted for multiple confounding factors, including sociodemographic information and other clinical factors.

Of the 2,470,580 live births included in the study, 2.3% (n=56,419) were born to mothers with diabetes. Overall, 0.9% (n=22,235) were born to mothers with type 1 diabetes, 0.3% (n=7412) were born to mothers with type 2 pre-gestational diabetes, and 1.1% (n=27,176) were north to mothers with gestational diabetes. Initial analysis indicated 20,248 offspring were diagnosed with high refractive error during the follow-up period, including 553 offspring of mothers with diabetes and 19, 695 offspring of mothers without diabetes.

Upon analysis, results indicated prenatal exposure to maternal diabetes was associated with a 39% greater risk of high refractive error before the age of 25 (HR, 1.39 [95% CI, 1.28-1.51], 

 <.001). Investigators pointed out an increased risk was observed for incidence of hypermetropia (HR, 1.37 [95% CI 1.24-1.51], 

 <.001), myopia (HR, 1.34 [95% CI 1.08-1.66], 

=.007), and astigmatism (HR, 1.58 [95% CI 1.29-1.92], 

 <.001). Additionally, results suggested the increased risk associated with exposure to maternal diabetes was more apparent in offspring born to mothers with diabetic complications, with a more than 2-fold (HR, 2.05 [95% CI, 1.60-2.64], 

 <.001) increase in risk compared to those born to mothers without diabetes and an 18% greater risk when compared to those born to mothers with diabetes but no complications (HR, 1.18 [95% CI, 1.02-1.37], 

“Although the 39% increased risk is a relatively low effect size, from a public health perspective, considering the high global prevalence of REs, any tiny improvement in this low-risk preventable factor will contribute to a huge reduction in absolute numbers of these eye conditions,” wrote investigators.

This study, “Association of maternal diabetes during pregnancy with high refractive error in offspring: a nationwide population-based cohort study,” was published in 

This article was originally published on Endocrinology Network®. 

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An analysis of registry data from more than 2.4 million births in Denmark suggests those born to mothers with diabetes were 39% more likely to experience high refractive error before turning 25 years old.

Vision problems for children born to mothers with diabetes

New research Is sounding the alarm on increased rates of 

Conducted by investigators from Northwestern University, Kaiser Permanente, and the Centers for Disease Control and Prevention, the cross-sectional analysis of data from 12.6 million singleton births suggests the rate of gestational diabetes has increased from 47.6 per 1000 live births in 2011 to 63.5 per 1000 live births in 2019, with increases in prevalence observed across all racial and ethnic subgroups included in the analysis.

“Given that gestational diabetes is associated with increased short-term and long-term risks for individuals and their offspring, the observed trends and disparities may portend a greater burden of future cardiometabolic disease,” wrote investigators.

With the increased risk of Cardiometabolic conditions associated with gestational diabetes widely recognized, a team of investigators led by Sadiya Khan, MD, MSc, assistant professor at Northwestern University Feinberg School of Medicine, conducted the present study to develop a greater understanding of contemporary trends in the rate of gestational diabetes among individuals at first live births between 2011 and 2019. To do so, investigators designed their study as a serial cross-sectional analysis of information from the National Center for Health Statistics (NCHS).

From the NCHS, investigators identified 12,610,235 individuals aged 15-44 years with singleton live birth from 2011-2019. For the purpose of analysis, these patients were stratified into the following groups: Hispanic/Latina, non-Hispanic Asian/Pacific Island, non-Hispanic Black, and non-Hispanic White. Of note, the Hispanic/Latina group included those identifying Central and South American, Cuban, Mexican, and Puerto Rican and the non-Hispanic Asian/Pacific Islander group included those identifying as Asian Indian, Chinese, Filipina, Japanese, Korean, and Vietnamese.

The primary outcomes of interest for the analysis were the age-standardized rates of gestational diabetes per 1000 live births and respective mean annual percent change and rate ratios of gestational diabetes among the aforementioned groups and subgroups relative to those in the non-Hispanic White group.

The 12,610,235 individuals included in the analysis had a mean age of 26.5 (SD, 5.8) years, 21% were Hispanic/Latina, 8% were non-Hispanic Asian/Pacific Islander, 14% were non-Hispanic Black, and 56% were non-Hispanic White. Overall, the age-standardized gestational diabetes rates increased from 47.6 (95% CI, 47.1-48.0) per 1000 live births in 2011 to 63.5 (95% CI, 63.1-64.0) per 1000 live births in 2019, which represents a mean annual percent change of 3.7% (95% CI, 2.8-4.6%) per year.

In analyses of subgroups based on race, increases were observed across all groups from 2011 to 2019. Investigators noted rates were greatest among Asian Indian patients, with a rate of 129.1 (95% CI, 100.7-104.7) per 1000 live births. Investigators also pointed out rates were greatest among Puerto Rican (75.8 per 1000 live births [95% CI, 71.8-79.9]) patients than any other Hispanic/Latina subgroup.

, Camille Powe, MD, and Ebony Carter, MD, MPH, express their concern over the rising rates of gestational diabetes and potential racial and ethnic barriers to care.

“The study by Shah et aldocuments a concerning trend of increasing gestational diabetes rates over the past decade, as well as persistent racial and ethnic inequities in gestational diabetes prevalence. Because of the strong links between glucose intolerance during pregnancy and future diabetes, these observations ominously foreshadow a potential future increase in diabetes incidence” wrote Powe and Carter.

This article was originally published in Endocrinology Network®. 

A recent study published in JAMA details increasing rates of gestational diabetes among first-time mothers in the US from 2011-2019, with rates increasing across all racial/ethnic subgroups examined in the 12 million person analysis.

Gestational diabetes rising among new mothers

The US Preventive Services Task Force (USPSTF) has released an updated recommendation statement reaffirming their previous guidance on screening for 

Journal of the American Medical Association

, the recommendation statement reaffirms the guidance released by the USPSTF in 2014, which included a B recommendation for screening for gestational diabetes at 24 weeks of gestation or after to improve maternal and fetal outcomes and maintained there was insufficient evidence to conclude a net benefit exists from screening before 24 weeks of gestation.

“While we know certain risk factors can increase a pregnant person’s chance of developing gestational diabetes, there is limited evidence on the effectiveness of screening before 24 weeks,” said Task Force member Michael Cabana, MD, MPH, a professor of pediatrics and chair of the Department of Pediatrics at the Albert Einstein College of Medicine, 

. “The Task Force is calling for more research to determine whether earlier screening could be beneficial for some pregnant people.”

 investigators provide the evidence-base used in their latest recommendations statement. The article, which is further summarized in the slideshow below, details a systematic review and meta-analysis of data related to gestational diabetes screenings published within the MEDLINE, EMBASE, and CINAHL databases from 2010 through May 2020 and from ClinicalTrials.gov and reference lists through June 2021.

Screening for Gestational Diabetes US Preventive Services Task Force Recommendation Statement

Screening for Gestational Diabetes Updated Evidence Report and Systematic Review for the US Preventive Services Task Force

This article was originally published on Endocrinology Network®.

The latest recommendation statement reaffirms the USPSTF's 2014 guidance, which included a B recommendation for screening for gestational diabetes at 24 weeks of gestation or after.

New USPSTF recommendations reaffirm previous guidance on screening for gestational diabetes

A study funded by the Physicians Committee for Responsible Medicine suggests implanting a plant-based diet could help lower the impact of menopausal symptoms in older women.

A 12-week, randomized, controlled trial assessing the impact of a plant-based diet rich in soy, results of the study indicate adherence to such a diet could reduce moderate-to-severe hot flashes by 84% and nearly 60% of women randomized to this approach became totally free of moderate-to-severe hot flashes.

"This is a game-changer for women aged 45 and over, most of whom we now know can get prompt relief from the most severe and troubling menopause symptoms without drugs," said lead researcher Neal Barnard, MD, president of the Physicians Committee and adjunct professor at the George Washington University School of Medicine, in a 

statement from the Physicians Committee for Responsible Medicine

With vasomotor menopausal symptoms a significant burden on the quality of life among many aging women, the Women's Study for the Alleviation of Vasomotor Symptoms (WAVS) trial was designed to assess compare the effects of implementing a low-fat, vegan diet or no dietary changes on the frequency and severity of hot flashes. Enrolling postmenopausal women reporting at least 2 hot flashes per day, investigators invited more than 7000 patients to take part in the trial. Of these, 155 were interviewed by telephone and a group of 38 met study criteria, underwent randomization in a 1:1 ratio, and were included in the study.

To be included in the study, patients needed to be between 40-65 years of age, without menses in the preceding 12 months, and have experienced their last period within the preceding 10 years. Exclusion criteria included use of hormonal medications, explanation for hot flashes other than natural menopause, use of weight-loss medications, history of drug use, and current consumption of a low-fat, vegan diet.

For the purpose of analysis, frequency and severity of hot flashes were recorded using a mobile phone application and vasomotor, psychosocial, physical, and sexual symptoms were assessed using the Menopause-Specific Quality of Life Questionnaire (MENQOL). Patients were given a self-calibrating scale to track body weight on a day-to-day basis. Potential associations were assessed using t-tests and chi-squared/McNemar tests.

At the end of the trial, data indicated total hot flashes decreased by 79% among those in the intervention group and by 49% among those in the control group (

=.01). Further analysis suggested the frequency of moderate-to-severe hot flashes was decreased by 84% in the intervention group compared to 42% in the control group (

Additionally, investigators noted 59% of patients in the intervention group reported being free of moderate and severe hot flashes from 0-12 weeks (

=.002). In contrast, no change was observed for this variable among those in the control group (between-group 

 <.0001). Investigators also pointed out the MENQOL indicated significantly greater reductions in vasomotor (

=.01) domains in the intervention group compared to the control group.

"Previous studies have shown that soy could be beneficial, so we decided to put a diet change to the test," said study author Hana Kahleova, MD, PhD, director of clinical research for the Physicians Committee for Responsible Medicine, in the aforementioned statement. “We believe that the combination is what is important. By the end of the study, the majority of women on a plant-based diet rich in soy reported that they no longer experienced moderate-to-extreme hot flashes at all and that they experienced significant improvements in their quality of life.”

Investigators noted multiple limitations within their study for clinicians to consider when interpreting results. These limitations included the possibility of a placebo effect, a relatively small sample size, limited intervention period prohibited assessment of long-term effects, and the COVID-19 pandemic necessitating use of telemedicine mediums, among others.

The Women’s Study for the Alleviation of Vasomotor Symptoms (WAVS): a randomized, controlled trial of a plant-based diet and whole soybeans for

 postmenopausal women,” was published in 

A 12-week trial found implementing a dietary approach using a low-fat, vegan diet could help reduce the incidence of moderate-to-severe hot flashes in postmenopausal women.

Patrick Campbell

Articles

Vision problems for children born to mothers with diabetes

Gestational diabetes rising among new mothers

New USPSTF recommendations reaffirm previous guidance on screening for gestational diabetes

Low-fat, vegan diet may reduce vasomotor symptoms