Background Early-onset GDM often requires pharmacological treatment and is associated with advers... more Background Early-onset GDM often requires pharmacological treatment and is associated with adverse perinatal outcomes, but data is insufficient regarding the best methods to identify high-risk women requiring early GDM screening. The aim of this study was to analyze the diagnostic accuracy of HbA 1c in the prediction of (1) plasma glucose concentrations > 90th percentile in an oral glucose tolerance test (OGTT) at 12-16 weeks' gestation; and (2) pharmacologically treated early-or late-onset GDM. Methods HbA 1c was measured at 8-14 weeks' gestation in a population-based cohort of 1394 Finnish women recruited for the Early Diagnosis of Diabetes in Pregnancy (EDDIE) study between 3/2013 and 12/2016. Information on maternal risk factors were collected at recruitment. Subsequently, a 2-hour 75 g OGTT was performed at 12-16 weeks' gestation (OGTT1), and if normal, repeated at 24-28 weeks' gestation (OGTT2). Early-and late-onset GDM were diagnosed using the same nationally endorsed cutoffs for fasting, 1 hand 2 h-plasma glucose: â„5.3, â„ 10.0mmol/l, and/or â„ 8.6mmol/l, respectively. In total, 52/1394 (3.7%) women required metformin or insulin treatment for GDM, including 39 women with early-onset GDM diagnosed at OGTT1 and 13 women with late-onset GDM diagnosed at OGTT2. Results Maternal early-pregnancy HbA 1c â„ 35mmol/mol (â„ 5.4%) was the best cutoff to predict fasting or post-load plasma glucose > 90th percentile in OGTT1, but its diagnostic accuracy was low [AUC (95% CI) 0.65 (0.62 to 0.69), sensitivity 0.55 (0.49 to 0.60) and specificity 0.67 (0.64 to 0.70)] both alone and in combination with other maternal risk factors. However, HbA 1c â„ 35mmol/mol correlated positively with plasma glucose concentrations at all time points of OGTT1 and predicted pharmacologically treated GDM diagnosed at OGTT1 or OGTT2; AUC (95% CI) 0.75 (0.68 to 0.81), sensitivity 0.75 (0.61 to 0.86), specificity 0.64 (0.61 to 0.66). Conclusions In our population-based cohort, early-pregnancy HbA 1c â„ 35mmol/mol was positively associated with fasting and post-load plasma glucose concentrations in an OGTT at 12-16 weeks' gestation and predicted
Preeclampsia (PE) is a major obstetric complication that is challenging to predict. Currently, th... more Preeclampsia (PE) is a major obstetric complication that is challenging to predict. Currently, there are limited tools to assess placental health/function in crucial gestational periods for diagnosis and early prediction. The glycoprotein fibronectin (FN) is augmented in PE placentae, and associated with reduced activity of JMJD6, an oxygen sensor that regulates placental FN processing. Evidence implicates placenta-derived small extracellular vesicles (sEVs) in the pathogenesis of pregnancy-associated disorders. Herein, we examined the utility of FN and JMJD6 in placental sEVs as putative markers for early-and late-onset preeclampsia (E-PE and L-PE). Maternal plasma was obtained from venous blood collected longitudinally during pregnancy (10-14, 16-22, 26-32 weeks of gestation and at delivery) in normotensive term control, pre-term control, L-PE, E-PE and gestational hypertensive individuals. Placenta-derived sEVs were isolated and their FN and JMJD6 content and JMJD6 activity were measured. In women that went on to develop preeclampsia, FN content of circulating placental sEVs was significantly elevated as early as 10-14 weeks of gestation and remained augmented until the time of delivery. This was accompanied by a depletion in JMJD6 content. Multivariate receiver operating characteristic analysis revealed high predictive power for FN and JMJD6 as early markers of E-PE and L-PE. In vitro, hypoxia or JMJD6 loss promoted FN accumulation in sEVs that was reverted upon restoring cellular iron balance with the natural compound, Hinokitiol. Elevated FN, along with diminished JMJD6 in circulating placental sEVs serves as an early molecular signature for the detection of different hypertensive disorders of pregnancy and their severity.
Introduction: Cytokines are key players in the development of both type 1 diabetes (T1D) and card... more Introduction: Cytokines are key players in the development of both type 1 diabetes (T1D) and cardiovascular disease (CVD). Offspring of women with T1D are known to have an increased risk of early-onset CVD. We studied whether an increased risk of CVD can be observed in the cytokine profile among young adult offspring of women with T1D. Methods: This cross-sectional case-control study included 67 offspring of women with T1D (cases) and 79 control participants (controls). At an age of 18-23 years, they participated in a clinical assessment including laboratory tests and questionnaires. Cytokine levels were analyzed from venous blood samples after 10 h
Aims/hypothesis The aim of this study was to assess the interaction between genetic risk and life... more Aims/hypothesis The aim of this study was to assess the interaction between genetic risk and lifestyle intervention on the occurrence of gestational diabetes mellitus (GDM) and postpartum diabetes. Methods The RADIEL study is an RCT aimed at prevention of GDM and postpartum diabetes through lifestyle intervention. Participants with a BMI â„30 kg/m2 and/or prior GDM were allocated to intervention and control groups before pregnancy or in early pregnancy. The study visits took place every 3 months before pregnancy, once in each trimester, and at 6 weeks and 6 and 12 months postpartum. We calculated a polygenic risk score (PRS) based on 50 risk variants for type 2 diabetes. Results Altogether, 516 participants provided genetic and GDM data. The PRS was associated with higher glycaemic levels (fasting glucose and/or HbA1c) and a lower insulin secretion index in the second and third trimesters and at 12 months postpartum, as well as with a higher occurrence of GDM and glycaemic abnormalit...
Objective. Assess the impact of Gestational Diabetes Mellitus (GDM) and obesity on neonatal and m... more Objective. Assess the impact of Gestational Diabetes Mellitus (GDM) and obesity on neonatal and maternal pregnancy outcomes. Methods. Cross-sectional data (3343 pregnancies) from seven European centres were included in a multilevel analysis of the association between GDM/obesity and caesarean section, macrosomia and neonatal morbidities. Results. Comparison of databases identified reporting differences between countries due to the inclusion of true population based samples or pregnancies from specialised tertiary centres, resulting in higher prevalences of GDM for some countries. The analysis showed that obesity and GDM were independent risk factors of perinatal complications. Only BMI had a dose-dependent effect on the risk of macrosomia and caesarean section. Both obesity (BMI > 30 kg/m 2) and GDM were independent risk factors of neonatal morbidities. Conclusions. Obesity and GDM were independent risk factors of perinatal complications. The effect of the worldwide obesity and diabetes epidemic is extending to the next generation.
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Background Offspring of mothers with type 1 diabetes have an increased risk for acquiring early o... more Background Offspring of mothers with type 1 diabetes have an increased risk for acquiring early onset cardiovascular disease (CVD). Arterial stiffness, measured as pulse wave velocity (PWV), is a non-invasive biomarker for CVD risk assessment. Our aim is to determine whether PWV is increased in young adult offspring of mothers with type 1 diabetes. Methods This is a caseâcontrol study carried out in the hospital district of Helsinki and Uusimaa, Finland. 75 offspring of mothers with type 1 diabetes (cases) and 84 offspring of mothers without diabetes (controls), aged 18â23 years, were enrolled in this study. All participants attended clinical assessments, including questionnaires and laboratory tests. Carotid-femoral PWV (cfPWV), carotid-radial PWV (crPWV), and PWV ratio were measured from each participant using the Complior Analyse mechanotransducer (Alam Medical, France). Studentâs t-test and chi-squared test were used to assess differences between the groups. Stata 17.0, StataCor...
The environment in salons provides hairdressers the opportunity to discuss sexual exploits which ... more The environment in salons provides hairdressers the opportunity to discuss sexual exploits which may promote unhealthy sexual behaviour and increase the risk of sexually transmitted infections (STIs). The aim of the study was to determine sexual practices and knowledge and experience of STIs among hairdressers. The study was carried out in Ibadan, Southwest Nigeria. A total of 1700 hairdressers were selected by cluster sampling technique. Predictors of risky sexual behaviour, knowledge and experience of STIs were identified. Their mean age was 27.0 ± 8.1 years, 860 (50.6%) were single. Majority of them, 1453(85.5%) had ever had sex. The mean age at sexual debut was 15.9 years. Mean knowledge score of STIs was 14.0 out of 25. Only 158(9.3%) experienced symptoms of STIs in the last 12 months. Among singles, senior secondary education was a predictor of ever had sex (odds ratio [OR]: 2.20, 95% confidence interval [CI]: 1.53-3.13), good knowledge of STIs (OR: 2.04, 95% CI: 1.45-2.83) and experience of STIs in the last 12 months (OR: 2.20, 95% CI: 1.53-3.13). Hairdressers, especially singles, are a vulnerable group at risk of reproductive health morbidities. There is a need to focus reproductive health interventions on this occupational group.
The pre-pregnancy BMI and the third trimester HbA(1c) levels increased in Finnish parturients wit... more The pre-pregnancy BMI and the third trimester HbA(1c) levels increased in Finnish parturients with Type 1 diabetes during 1989-2008. The aim of the present study was to investigate whether these trends have been accompanied by increases in blood pressure or hypertensive complications. Hypertension trends were analysed using the definitions of hypertension of both the American College of Obstetricians and Gynecologists and the American Diabetes Association. The associations of hypertension, as defined by the latter criteria, with perinatal complications were also studied. The records of a cohort of 1007 consecutive patients with Type 1 diabetes with a singleton live childbirth during 1989-2010 at the Helsinki University Central Hospital were studied. The frequencies of hypertensive pregnancy complications did not change, but the mean diastolic blood pressure increased in normotensive parturients in all trimesters. The proportion of patients with systolic blood pressure > 130 mmHg or diastolic blood pressure > 80 mmHg in the first, second and third trimesters of pregnancy increased from 25 to 33%, from 26 to 35% and from 57 to 71%, respectively. Systolic blood pressure of 131-139 mmHg or diastolic blood pressure of 81-89 mmHg in the third trimester was associated with umbilical artery pH < 7.15. Blood pressure of patients with Type 1 diabetes during pregnancy is increasing. A growing proportion of women with Type 1 diabetes exceed the American Diabetes Association's definition of hypertension during pregnancy.
Paralleling the increasing trends of maternal obesity, gestational diabetes (GDM) has become a gl... more Paralleling the increasing trends of maternal obesity, gestational diabetes (GDM) has become a global health challenge with significant public health repercussions. In addition to short-term adverse outcomes, such as hypertensive pregnancy disorders and fetal macrosomia, in the long term, GDM results in excess cardiometabolic morbidity in both the mother and child. Recent data suggest that women with GDM are characterized by notable phenotypic and genotypic heterogeneity and that frequencies of adverse obstetric and perinatal outcomes are different between physiologic GDM subtypes. However, as of yet, GDM treatment protocols do not differentiate between these subtypes. Mapping the genetic architecture of GDM, as well as accurate phenotypic and genotypic definitions of GDM, could potentially help in the individualization of GDM treatment and assessment of long-term prognoses. In this narrative review, we outline recent studies exploring genetic risk factors of GDM and later type 2 di...
Aims The aim of this study was to evaluate whether maternal type 1 diabetes influences skin autof... more Aims The aim of this study was to evaluate whether maternal type 1 diabetes influences skin autofluorescence (SAF), used as a marker of accumulated advanced glycation end products (AGEs), in young adult offspring. Methods This cross-sectional case-control study included 78 offspring of women with type 1 diabetes (cases) and 85 control participants (controls). Cases were born between 1st January 1996 and 31st December 2000, at the Department of Obstetrics and Gynecology, Helsinki University Hospital, and controls were born during the same period in the Hospital District of Helsinki and Uusimaa, Finland. All study participants, aged 18 to 23 years, were invited to participate in a clinical assessment including laboratory tests and questionnaires. SAF was assessed from all participants using the AGE reader. Results The mean SAF value did not differ between the cases (1.61 [0.37]) arbitrary units [AU]) and the controls (1.64 [0.41] AU) (p=0.69). After adjusting for HbA1c, body fat percentage, smoking, and season the mean SAF value did not differ between the cases and the controls (p=0.49) but differed between men and women (p=0.008), without any interaction observed (p=0.78). Conclusions No differences in SAF values were observed between the young adult offspring of women with type 1 diabetes and offspring born to mothers without diabetes. Surprisingly, young adult women showed higher SAF values than men in both case and control groups.Avancerade glykolyserade slutprodukter (fr. engelskan, advanced glycation end products, AGEs) Àr en heterogen grupp av proteiner, vilka syntetiserats genom en icke-enzymatisk reaktion med glukosmolekyler. Eftersom produktionen av AGEs bevisligen har en stark association med Äldern samt med vissa metaboliska tillstÄnd (typ 2-diabetes och metaboliskt syndrom), tror forskare att AGEs kunde tillÀmpas som en framtida biomarkör för att förutspÄ uppkomsten av Äldersrelaterade komplikationer. Utöver att AGEs Àr starkt associerat med de sedvanliga kardiovaskulÀra riskfaktorerna (Älder, typ 2-diabetes, rökning, metaboliskt syndrom, njursvikt), har man Àven nyligen kunnat bevisa att AGEs kan förutspÄ risken att insjukna i typ 2-diabetes, kardiovaskulÀra sjukdom samt mortalitet i den allmÀnna befolkningen. Eftersom AGEs kan mÀtas icke-invasivt frÄn huden genom optisk avbildning (skin autofluorescence, SAF), framstÄr detta som en lovande biomarkör för att förutspÄ risker för metaboliska komplikationer. Eftersom barn till typ 1-diabetes graviditeter har en större benÀgenhet att insjukna i typ 2-diabetes och metabolt syndrom, ville vi undersöka ifall man kunde anvÀnda AGEs för att förutspÄ den förhöjda risken. I kontrast med vÄr hypotes, visade vÄra forskningsresultat att typ 1-diabetes graviditet inte pÄverkar pÄ AGEs nivÄer i barnen och kan sÄledes inte anvÀndas för att minska risken för att insjukna i typ 2-diabetes och övervikt
Background: Dr. Priscilla White, a pioneer in the care of diabetes (DM) in pregnancy, recognized ... more Background: Dr. Priscilla White, a pioneer in the care of diabetes (DM) in pregnancy, recognized that the prognosis of pregnancy is not identical in all women with type 1 DM. To improve the prediction of risks, she published in 1949 a classification system for pregnant women with DM according to the age at onset, the duration of DM and the presence of diabetic vascular complications. Since then, great advances in diabetes care and obstetrics have been made, but adverse outcomes remain increased in type 1 DM pregnancies compared with background populations. Pregnancy-related metabolic and hemodynamic changes superimposed on the diabetic metabolic milieu and the diabetes-affected vasculature contribute to many of these complications. The increasing prevalence of obesity in women of reproductive age may result in additional obstetric challenges. Aims. To analyze the trends in pre-pregnancy body mass index (BMI), glycemic control and blood pressure (BP) levels and their relations to obs...
Suomen ensimmÀinen neuvola syntyi vajaat sata vuotta sitten siirtolaisten kansoittamaan helsinkil... more Suomen ensimmÀinen neuvola syntyi vajaat sata vuotta sitten siirtolaisten kansoittamaan helsinkilÀislÀhiöön. Uusi konsepti (1)-kaikille avoimet ovet, sosiaali-ja terveyspalvelujen integraatio ja yhden luukun periaate-oli vÀlitön menestys. Muutamassa vuodessa alueen lapsikuolleisuus laski viidesosaan (2), ja pian joka kylÀssÀ oli oma neuvola. Tarinan jatko on jokaisen suomalaislÀÀkÀrin tuntemaa kansanterveystyön historiaa. Ajatus kaikkien Àitien ja lasten terveydenhoidosta on yhÀ ajankohtainen. Terveydenhuollon ammattilaiset ovat nostaneet esiin oman aikamme kaupunkiköyhÀlistön, paperittomien, terveydenhoidon inhimilliset ja eettiset ulottuvuudet (3). PelissÀ on vielÀkin enemmÀn: kaikkien
Background Early-onset GDM often requires pharmacological treatment and is associated with advers... more Background Early-onset GDM often requires pharmacological treatment and is associated with adverse perinatal outcomes, but data is insufficient regarding the best methods to identify high-risk women requiring early GDM screening. The aim of this study was to analyze the diagnostic accuracy of HbA 1c in the prediction of (1) plasma glucose concentrations > 90th percentile in an oral glucose tolerance test (OGTT) at 12-16 weeks' gestation; and (2) pharmacologically treated early-or late-onset GDM. Methods HbA 1c was measured at 8-14 weeks' gestation in a population-based cohort of 1394 Finnish women recruited for the Early Diagnosis of Diabetes in Pregnancy (EDDIE) study between 3/2013 and 12/2016. Information on maternal risk factors were collected at recruitment. Subsequently, a 2-hour 75 g OGTT was performed at 12-16 weeks' gestation (OGTT1), and if normal, repeated at 24-28 weeks' gestation (OGTT2). Early-and late-onset GDM were diagnosed using the same nationally endorsed cutoffs for fasting, 1 hand 2 h-plasma glucose: â„5.3, â„ 10.0mmol/l, and/or â„ 8.6mmol/l, respectively. In total, 52/1394 (3.7%) women required metformin or insulin treatment for GDM, including 39 women with early-onset GDM diagnosed at OGTT1 and 13 women with late-onset GDM diagnosed at OGTT2. Results Maternal early-pregnancy HbA 1c â„ 35mmol/mol (â„ 5.4%) was the best cutoff to predict fasting or post-load plasma glucose > 90th percentile in OGTT1, but its diagnostic accuracy was low [AUC (95% CI) 0.65 (0.62 to 0.69), sensitivity 0.55 (0.49 to 0.60) and specificity 0.67 (0.64 to 0.70)] both alone and in combination with other maternal risk factors. However, HbA 1c â„ 35mmol/mol correlated positively with plasma glucose concentrations at all time points of OGTT1 and predicted pharmacologically treated GDM diagnosed at OGTT1 or OGTT2; AUC (95% CI) 0.75 (0.68 to 0.81), sensitivity 0.75 (0.61 to 0.86), specificity 0.64 (0.61 to 0.66). Conclusions In our population-based cohort, early-pregnancy HbA 1c â„ 35mmol/mol was positively associated with fasting and post-load plasma glucose concentrations in an OGTT at 12-16 weeks' gestation and predicted
Preeclampsia (PE) is a major obstetric complication that is challenging to predict. Currently, th... more Preeclampsia (PE) is a major obstetric complication that is challenging to predict. Currently, there are limited tools to assess placental health/function in crucial gestational periods for diagnosis and early prediction. The glycoprotein fibronectin (FN) is augmented in PE placentae, and associated with reduced activity of JMJD6, an oxygen sensor that regulates placental FN processing. Evidence implicates placenta-derived small extracellular vesicles (sEVs) in the pathogenesis of pregnancy-associated disorders. Herein, we examined the utility of FN and JMJD6 in placental sEVs as putative markers for early-and late-onset preeclampsia (E-PE and L-PE). Maternal plasma was obtained from venous blood collected longitudinally during pregnancy (10-14, 16-22, 26-32 weeks of gestation and at delivery) in normotensive term control, pre-term control, L-PE, E-PE and gestational hypertensive individuals. Placenta-derived sEVs were isolated and their FN and JMJD6 content and JMJD6 activity were measured. In women that went on to develop preeclampsia, FN content of circulating placental sEVs was significantly elevated as early as 10-14 weeks of gestation and remained augmented until the time of delivery. This was accompanied by a depletion in JMJD6 content. Multivariate receiver operating characteristic analysis revealed high predictive power for FN and JMJD6 as early markers of E-PE and L-PE. In vitro, hypoxia or JMJD6 loss promoted FN accumulation in sEVs that was reverted upon restoring cellular iron balance with the natural compound, Hinokitiol. Elevated FN, along with diminished JMJD6 in circulating placental sEVs serves as an early molecular signature for the detection of different hypertensive disorders of pregnancy and their severity.
Introduction: Cytokines are key players in the development of both type 1 diabetes (T1D) and card... more Introduction: Cytokines are key players in the development of both type 1 diabetes (T1D) and cardiovascular disease (CVD). Offspring of women with T1D are known to have an increased risk of early-onset CVD. We studied whether an increased risk of CVD can be observed in the cytokine profile among young adult offspring of women with T1D. Methods: This cross-sectional case-control study included 67 offspring of women with T1D (cases) and 79 control participants (controls). At an age of 18-23 years, they participated in a clinical assessment including laboratory tests and questionnaires. Cytokine levels were analyzed from venous blood samples after 10 h
Aims/hypothesis The aim of this study was to assess the interaction between genetic risk and life... more Aims/hypothesis The aim of this study was to assess the interaction between genetic risk and lifestyle intervention on the occurrence of gestational diabetes mellitus (GDM) and postpartum diabetes. Methods The RADIEL study is an RCT aimed at prevention of GDM and postpartum diabetes through lifestyle intervention. Participants with a BMI â„30 kg/m2 and/or prior GDM were allocated to intervention and control groups before pregnancy or in early pregnancy. The study visits took place every 3 months before pregnancy, once in each trimester, and at 6 weeks and 6 and 12 months postpartum. We calculated a polygenic risk score (PRS) based on 50 risk variants for type 2 diabetes. Results Altogether, 516 participants provided genetic and GDM data. The PRS was associated with higher glycaemic levels (fasting glucose and/or HbA1c) and a lower insulin secretion index in the second and third trimesters and at 12 months postpartum, as well as with a higher occurrence of GDM and glycaemic abnormalit...
Objective. Assess the impact of Gestational Diabetes Mellitus (GDM) and obesity on neonatal and m... more Objective. Assess the impact of Gestational Diabetes Mellitus (GDM) and obesity on neonatal and maternal pregnancy outcomes. Methods. Cross-sectional data (3343 pregnancies) from seven European centres were included in a multilevel analysis of the association between GDM/obesity and caesarean section, macrosomia and neonatal morbidities. Results. Comparison of databases identified reporting differences between countries due to the inclusion of true population based samples or pregnancies from specialised tertiary centres, resulting in higher prevalences of GDM for some countries. The analysis showed that obesity and GDM were independent risk factors of perinatal complications. Only BMI had a dose-dependent effect on the risk of macrosomia and caesarean section. Both obesity (BMI > 30 kg/m 2) and GDM were independent risk factors of neonatal morbidities. Conclusions. Obesity and GDM were independent risk factors of perinatal complications. The effect of the worldwide obesity and diabetes epidemic is extending to the next generation.
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Background Offspring of mothers with type 1 diabetes have an increased risk for acquiring early o... more Background Offspring of mothers with type 1 diabetes have an increased risk for acquiring early onset cardiovascular disease (CVD). Arterial stiffness, measured as pulse wave velocity (PWV), is a non-invasive biomarker for CVD risk assessment. Our aim is to determine whether PWV is increased in young adult offspring of mothers with type 1 diabetes. Methods This is a caseâcontrol study carried out in the hospital district of Helsinki and Uusimaa, Finland. 75 offspring of mothers with type 1 diabetes (cases) and 84 offspring of mothers without diabetes (controls), aged 18â23 years, were enrolled in this study. All participants attended clinical assessments, including questionnaires and laboratory tests. Carotid-femoral PWV (cfPWV), carotid-radial PWV (crPWV), and PWV ratio were measured from each participant using the Complior Analyse mechanotransducer (Alam Medical, France). Studentâs t-test and chi-squared test were used to assess differences between the groups. Stata 17.0, StataCor...
The environment in salons provides hairdressers the opportunity to discuss sexual exploits which ... more The environment in salons provides hairdressers the opportunity to discuss sexual exploits which may promote unhealthy sexual behaviour and increase the risk of sexually transmitted infections (STIs). The aim of the study was to determine sexual practices and knowledge and experience of STIs among hairdressers. The study was carried out in Ibadan, Southwest Nigeria. A total of 1700 hairdressers were selected by cluster sampling technique. Predictors of risky sexual behaviour, knowledge and experience of STIs were identified. Their mean age was 27.0 ± 8.1 years, 860 (50.6%) were single. Majority of them, 1453(85.5%) had ever had sex. The mean age at sexual debut was 15.9 years. Mean knowledge score of STIs was 14.0 out of 25. Only 158(9.3%) experienced symptoms of STIs in the last 12 months. Among singles, senior secondary education was a predictor of ever had sex (odds ratio [OR]: 2.20, 95% confidence interval [CI]: 1.53-3.13), good knowledge of STIs (OR: 2.04, 95% CI: 1.45-2.83) and experience of STIs in the last 12 months (OR: 2.20, 95% CI: 1.53-3.13). Hairdressers, especially singles, are a vulnerable group at risk of reproductive health morbidities. There is a need to focus reproductive health interventions on this occupational group.
The pre-pregnancy BMI and the third trimester HbA(1c) levels increased in Finnish parturients wit... more The pre-pregnancy BMI and the third trimester HbA(1c) levels increased in Finnish parturients with Type 1 diabetes during 1989-2008. The aim of the present study was to investigate whether these trends have been accompanied by increases in blood pressure or hypertensive complications. Hypertension trends were analysed using the definitions of hypertension of both the American College of Obstetricians and Gynecologists and the American Diabetes Association. The associations of hypertension, as defined by the latter criteria, with perinatal complications were also studied. The records of a cohort of 1007 consecutive patients with Type 1 diabetes with a singleton live childbirth during 1989-2010 at the Helsinki University Central Hospital were studied. The frequencies of hypertensive pregnancy complications did not change, but the mean diastolic blood pressure increased in normotensive parturients in all trimesters. The proportion of patients with systolic blood pressure > 130 mmHg or diastolic blood pressure > 80 mmHg in the first, second and third trimesters of pregnancy increased from 25 to 33%, from 26 to 35% and from 57 to 71%, respectively. Systolic blood pressure of 131-139 mmHg or diastolic blood pressure of 81-89 mmHg in the third trimester was associated with umbilical artery pH < 7.15. Blood pressure of patients with Type 1 diabetes during pregnancy is increasing. A growing proportion of women with Type 1 diabetes exceed the American Diabetes Association's definition of hypertension during pregnancy.
Paralleling the increasing trends of maternal obesity, gestational diabetes (GDM) has become a gl... more Paralleling the increasing trends of maternal obesity, gestational diabetes (GDM) has become a global health challenge with significant public health repercussions. In addition to short-term adverse outcomes, such as hypertensive pregnancy disorders and fetal macrosomia, in the long term, GDM results in excess cardiometabolic morbidity in both the mother and child. Recent data suggest that women with GDM are characterized by notable phenotypic and genotypic heterogeneity and that frequencies of adverse obstetric and perinatal outcomes are different between physiologic GDM subtypes. However, as of yet, GDM treatment protocols do not differentiate between these subtypes. Mapping the genetic architecture of GDM, as well as accurate phenotypic and genotypic definitions of GDM, could potentially help in the individualization of GDM treatment and assessment of long-term prognoses. In this narrative review, we outline recent studies exploring genetic risk factors of GDM and later type 2 di...
Aims The aim of this study was to evaluate whether maternal type 1 diabetes influences skin autof... more Aims The aim of this study was to evaluate whether maternal type 1 diabetes influences skin autofluorescence (SAF), used as a marker of accumulated advanced glycation end products (AGEs), in young adult offspring. Methods This cross-sectional case-control study included 78 offspring of women with type 1 diabetes (cases) and 85 control participants (controls). Cases were born between 1st January 1996 and 31st December 2000, at the Department of Obstetrics and Gynecology, Helsinki University Hospital, and controls were born during the same period in the Hospital District of Helsinki and Uusimaa, Finland. All study participants, aged 18 to 23 years, were invited to participate in a clinical assessment including laboratory tests and questionnaires. SAF was assessed from all participants using the AGE reader. Results The mean SAF value did not differ between the cases (1.61 [0.37]) arbitrary units [AU]) and the controls (1.64 [0.41] AU) (p=0.69). After adjusting for HbA1c, body fat percentage, smoking, and season the mean SAF value did not differ between the cases and the controls (p=0.49) but differed between men and women (p=0.008), without any interaction observed (p=0.78). Conclusions No differences in SAF values were observed between the young adult offspring of women with type 1 diabetes and offspring born to mothers without diabetes. Surprisingly, young adult women showed higher SAF values than men in both case and control groups.Avancerade glykolyserade slutprodukter (fr. engelskan, advanced glycation end products, AGEs) Àr en heterogen grupp av proteiner, vilka syntetiserats genom en icke-enzymatisk reaktion med glukosmolekyler. Eftersom produktionen av AGEs bevisligen har en stark association med Äldern samt med vissa metaboliska tillstÄnd (typ 2-diabetes och metaboliskt syndrom), tror forskare att AGEs kunde tillÀmpas som en framtida biomarkör för att förutspÄ uppkomsten av Äldersrelaterade komplikationer. Utöver att AGEs Àr starkt associerat med de sedvanliga kardiovaskulÀra riskfaktorerna (Älder, typ 2-diabetes, rökning, metaboliskt syndrom, njursvikt), har man Àven nyligen kunnat bevisa att AGEs kan förutspÄ risken att insjukna i typ 2-diabetes, kardiovaskulÀra sjukdom samt mortalitet i den allmÀnna befolkningen. Eftersom AGEs kan mÀtas icke-invasivt frÄn huden genom optisk avbildning (skin autofluorescence, SAF), framstÄr detta som en lovande biomarkör för att förutspÄ risker för metaboliska komplikationer. Eftersom barn till typ 1-diabetes graviditeter har en större benÀgenhet att insjukna i typ 2-diabetes och metabolt syndrom, ville vi undersöka ifall man kunde anvÀnda AGEs för att förutspÄ den förhöjda risken. I kontrast med vÄr hypotes, visade vÄra forskningsresultat att typ 1-diabetes graviditet inte pÄverkar pÄ AGEs nivÄer i barnen och kan sÄledes inte anvÀndas för att minska risken för att insjukna i typ 2-diabetes och övervikt
Background: Dr. Priscilla White, a pioneer in the care of diabetes (DM) in pregnancy, recognized ... more Background: Dr. Priscilla White, a pioneer in the care of diabetes (DM) in pregnancy, recognized that the prognosis of pregnancy is not identical in all women with type 1 DM. To improve the prediction of risks, she published in 1949 a classification system for pregnant women with DM according to the age at onset, the duration of DM and the presence of diabetic vascular complications. Since then, great advances in diabetes care and obstetrics have been made, but adverse outcomes remain increased in type 1 DM pregnancies compared with background populations. Pregnancy-related metabolic and hemodynamic changes superimposed on the diabetic metabolic milieu and the diabetes-affected vasculature contribute to many of these complications. The increasing prevalence of obesity in women of reproductive age may result in additional obstetric challenges. Aims. To analyze the trends in pre-pregnancy body mass index (BMI), glycemic control and blood pressure (BP) levels and their relations to obs...
Suomen ensimmÀinen neuvola syntyi vajaat sata vuotta sitten siirtolaisten kansoittamaan helsinkil... more Suomen ensimmÀinen neuvola syntyi vajaat sata vuotta sitten siirtolaisten kansoittamaan helsinkilÀislÀhiöön. Uusi konsepti (1)-kaikille avoimet ovet, sosiaali-ja terveyspalvelujen integraatio ja yhden luukun periaate-oli vÀlitön menestys. Muutamassa vuodessa alueen lapsikuolleisuus laski viidesosaan (2), ja pian joka kylÀssÀ oli oma neuvola. Tarinan jatko on jokaisen suomalaislÀÀkÀrin tuntemaa kansanterveystyön historiaa. Ajatus kaikkien Àitien ja lasten terveydenhoidosta on yhÀ ajankohtainen. Terveydenhuollon ammattilaiset ovat nostaneet esiin oman aikamme kaupunkiköyhÀlistön, paperittomien, terveydenhoidon inhimilliset ja eettiset ulottuvuudet (3). PelissÀ on vielÀkin enemmÀn: kaikkien
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