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Pre-Gestational Diabetes
Pre-Gestational Diabetes
Pre-Gestational Diabetes
http://main.diabetes.org/site/R?
i=CcKLVT2ni5UsLHCbVf1bmw
Alex Fong, Allison Serra, Tiffany Herrero, Deyu Pan, Dotun Ogunyemi
Pre-gestational versus gestational diabetes: A population based study on clinical and demographic differences ☆
Journal of Diabetes and its Complications, Volume 28, Issue 1, 2014, 29–34
http://dx.doi.org/10.1016/j.jdiacomp.2013.08.009
Fig. 4. Age-adjusted prevalence of PGDM and GDM by race/ethnicity.
Alex Fong, Allison Serra, Tiffany Herrero, Deyu Pan, Dotun Ogunyemi
Pre-gestational versus gestational diabetes: A population based study on clinical and demographic differences ☆
Journal of Diabetes and its Complications, Volume 28, Issue 1, 2014, 29–34
http://dx.doi.org/10.1016/j.jdiacomp.2013.08.009
Risk of birth defects associated with
pregestational diabetes
• Reviewed all pregnancies in Emilia-Romagna region between
1997-2010
• Malformations in 62/2269 diabetic pregnancies vs.
162/10,648 non-diabetic (1:5 cases/controls)
– Prevalence ratio of 1.79 (controls were age-matched)
– Prevalence ratio was 0.94 for probable type 1 patients and 4.89 for
Fig.
probable
42
Fig. Age-adjusted
Age-adjusted
Fig. 3 Prevalence type
prevalence
incidenceofof
of pre-gestational 2diabetes
PGDM
patients
and GDM bydiabetes
pre-gestational race/ethnicity.
and gestational diabetes over time.
compared to gestational diabetes in pregnancy by age range.
Alex Fong , Allison Serra , Tiffany Herrero , Deyu Pan , Dotun Ogunyemi
Alex Fong , Allison Serra , Tiffany Herrero , Deyu Pan , Dotun Ogunyemi
AlexPre-gestational
Fong , Allisonversus
Serragestational
, Tiffany Herrero
diabetes:,ADeyu Pan ,based
population Dotun Ogunyemi
study on clinical and demographic differences
Pre-gestational versus gestational diabetes: A population based study on clinical and demographic differences
Pre-gestational versus
Journal of Diabetes gestational
and its diabetes:
Complications, Volume 28,AIssue
population based
1, 2014, 29 - 34 study on clinical and demographic differences
Journal of Diabetes and its Complications, Volume 28, Issue 1, 2014, 29 - 34
http://dx.doi.org/10.1016/j.jdiacomp.2013.08.009
Journal of Diabetes and its Complications, Volume 28, Issue 1, 2014, 29 - 34
http://dx.doi.org/10.1016/j.jdiacomp.2013.08.009
Vinceti M et al. Risk of birth defects associated with maternal pregestational diabetes.
http://dx.doi.org/10.1016/j.jdiacomp.2013.08.009
Eur J Epidemiol 29:411-18
A: Risk of a major or minor congenital anomaly according to the number of SDs of GHb above
normal, measured periconceptionally.
Decoding the oxidative stress hypothesis in diabetic embryopathy through proapoptotic kinase signaling
American Journal of Obstetrics and Gynecology, Volume 212, Issue 5, 2015, 569–579
http://dx.doi.org/10.1016/j.ajog.2014.11.036
Figure 2. Oxidative stress-induced proapoptotic PKC signalingMaternal diabetes-induced oxidative stress activates PKC α, βII, δ,
while it inhibits PKCε, ξ. Activated PKCα induces lipid peroxidation, which in turn aggravates oxidative stress, and induces apopto...
Figure 2. Oxidative stress-induced proapoptotic PKC signalingMaternal diabetes-induced oxidative stress activates PKC α, βII, δ,
while it inhibits PKCε, ξ. Activated PKCα induces lipid peroxidation, which in turn aggravates oxidative stress, and induces apopto...
Figure 2. Oxidative stress-induced proapoptotic PKC signalingMaternal diabetes-induced oxidative stress activates PKC α, βII, δ,
Figure 2. Oxidative stress-induced proapoptotic PKC signalingMaternal diabetes-induced oxidative stress activates PKC α, βII, δ,
while it inhibits PKCε,Fangξ. Activated PKCαGabbay-Benziv
induces lipid peroxidation, which in turn aggravates oxidative stress, and induces apopto...
while it inhibits PKCε, ξ. Activated PKCα induces lipid peroxidation, which in turn aggravates oxidative stress, and induces apopto...
Peixin Yang, E. Albert Reece, Wang, Rinat
Figure 2. Oxidative stress-induced proapoptotic PKC signalingMaternal diabetes-induced oxidative stress activates PKC α, βII, δ,
while it inhibits PKCε, ξ. Activated PKCα
Peixin Yang, E. Albert Reece, Fang Wang, Rinat Gabbay-Benziv induces lipid peroxidation, which in turn aggravates oxidative stress, and induces apopto...
Decoding the oxidative stress
Figure hypothesis
2. Oxidative in diabetic proapoptotic
stress-induced embryopathy through
PKC proapoptotic
signalingMaternal kinase signaling
diabetes-induced oxidative stress activates PKC α, βII, δ,
while it inhibits PKCε, ξ. Activated PKCα
Peixin Yang, E. Albert Reece, Fang Wang, Rinat Gabbay-Benziv induces lipid peroxidation, which in turn aggravates oxidative stress, and induces apopto...
Decoding the oxidative stress
Figure 2. hypothesis
Oxidative in diabetic proapoptotic
stress-induced embryopathy PKCthrough proapoptotic
signalingMaternal kinase signaling
diabetes-induced oxidative stress activates PKC α, βII, δ,
American Journal of Obstetrics and Gynecology, Volume 212, Issue 5, 2015, 569–579
Peixin Yang, while it inhibits
E. Albert PKCε,Fang
Reece, ξ. Activated PKCαGabbay-Benziv
Wang, Rinat induces lipid peroxidation, which in turn aggravates oxidative stress, and induces apopto...
Decoding the oxidative Figurestress
2. hypothesis
Oxidative in diabetic proapoptotic
stress-induced embryopathy PKCthrough proapoptotic
signalingMaternal kinase signaling
diabetes-induced oxidative stress activates PKC α, βII, δ,
American Journal of Obstetrics and Gynecology, Volume 212, Issue 5, 2015, 569–579
Peixin Yang, E. Albert Reece, Fang Wang, Rinat Gabbay-Benziv
http://dx.doi.org/10.1016/j.ajog.2014.11.036
Peixin Yang, while it inhibits
E. Albert PKCε,Fang
Reece, ξ. Activated PKCαGabbay-Benziv
Wang, Rinat induces lipid peroxidation, which in turn aggravates oxidative stress, and induces apopto...
Decoding the oxidative stress hypothesis in diabetic embryopathy through proapoptotic kinase signaling
American Journal of Obstetrics and Gynecology, Volume 212, Issue 5, 2015, 569–579
http://dx.doi.org/10.1016/j.ajog.2014.11.036
Peixin Yang, E. Albert Reece, Fang Wang, Rinat Gabbay-Benziv
Decoding the oxidative stress hypothesis in diabetic embryopathy through proapoptotic kinase signaling
American Journal of Obstetrics and Gynecology, Volume 212, Issue 5, 2015, 569–579
http://dx.doi.org/10.1016/j.ajog.2014.11.036
Decoding the oxidative stress hypothesis in diabetic embryopathy through proapoptotic kinase signaling
Peixin Yang, E. Albert Reece, Fang Wang, Rinat Gabbay-Benziv
Decoding the oxidative stress hypothesis in diabetic embryopathy through proapoptotic kinase signaling
American Journal of Obstetrics and Gynecology, Volume 212, Issue 5, 2015, 569–579
http://dx.doi.org/10.1016/j.ajog.2014.11.036
Decoding the oxidative stress hypothesis in diabetic embryopathy through proapoptotic kinase signaling
American Journal of Obstetrics and Gynecology, Volume 212, Issue 5, 2015, 569–579
http://dx.doi.org/10.1016/j.ajog.2014.11.036
American Journal of Obstetrics and Gynecology,American
Volume 212, Issue 5, 2015, 569–579
Journal of Obstetrics and Gynecology, Volume 212, Issue 5, 2015, 569–579
http://dx.doi.org/10.1016/j.ajog.2014.11.036
http://dx.doi.org/10.1016/j.ajog.2014.11.036
http://dx.doi.org/10.1016/j.ajog.2014.11.036
Risk of major congenital anomalies
• 3% of all births- leading cause of infant
mortality
• 5.7% of offspring of women with type 1 DM
(Norwegian study)
• 6.6% of offspring of women with type 2DM
(British study)
Relative risk (RR) for major congenital abnormalities from 14 studies of women with diabetes
mellitus who did or did not receive preconception care (PCC).
© Association of Physicians
Does preconception care matter?
• PGDM w/o PCC
– 41.4 % pre-term
– 7.3% with birth defects
– 4.4% perinatal death
• PGDM w/ universal PCC
– 8400 pre-term births avoided
– 3725 birth defects prevented
– 1900 perinatal deaths avoided
Preventable health and cost burden of adverse birth outcomes associate with PGDM
in the US
Peterson C, et al. Am J Obstet Gynecol 2015;212:74e1-9.
eklass@medicine.nevada.edu