Intrapartum and early postpartum glycemic profiles in women with gestational diabetes mellitus:an observational study

Background: Data on the glycemic profile of pregnant women with gestational diabetes mellitus (GDM) during the perinatal period are sparse. This study described the intrapartum and early postpartum glucose profiles among pregnant women with GDM, and analyzed factors potentially affecting glycemic parameters during the period.Methods: This was a prospective observational study conducted from March 2020 to November 2021. Pregnant women with GDM receiving lifestyle interventions alone during pregnancy and matched women with non-diabetic pregnancies (NDPs) were enrolled from among patients admitted to the obstetrics department for childbirth. Glucose monitoring was performed via a flash glucose monitoring (FGM) system on admission, and glucose readings during labor and early postpartum were analyzed. The clinical characteristics and FGM-based parameters of participants in the two groups were compared.Results: A total of 124 participants (mean age: 29.5 ± 3.5 years, 92 [74.2%] primipara) were included in the final analysis. A total of 17,571 glucose readings were retrieved. There were no significant differences in clinical characteristics between the GDM (n = 60) and NDP (n = 64) groups. The average glucose level was 92.2 mg/dL, and the level was higher in the GDM group (95.5 ± 12.1 mg/dLvs. 89.1 ± 13.4 mg/dL,P = 0.008) during the intrapartum and early postpartum periods. The data were split into the intrapartum period (from the start of labor to delivery of the placenta) and the early postpartum period (within 24 h after placental delivery) for analysis. During intrapartum, women with GDM exhibited glycemic profiles and fluctuations similar to those in the NDP group. However, women with GDM had higher postpartum glucose levels (97.7 ± 13.4 mg/dLvs. 90.8 ± 15.3 mg/dL,P = 0.009), a longer time spent >140 mg/dL (8.7 ± 9.3%vs. 5.9 ± 10.3%,P = 0.011), and greater glycemic fluctuations than those with NDP. Postpartum hyperglycemia in GDM might be associated with high parity and postprandial glucose abnormalities in GDM screening tests.Conclusion: Compared to those with normoglycemia, pregnant women with GDM receiving lifestyle interventions alone had similar intrapartum glucose profiles but higher early postpartum glucose levels and greater glucose variability, providing evidence for modification of the current perinatal glucose monitoring strategy for GDM.Trial Registration: ChiCTR.org.cn, ChiCTR2000030972.

Effects of L-arginine supplementation on glycemic profile: Evidence from a systematic review and meta-analysis of clinical trials

Background:The effects of l-arginine supplementation on indices of glycemic control and the role of many factors influencing this intervention have been controversial in clinical trials.Objective:This meta-analysis was performed to assess the effects of l-arginine supplementation on indices of glycemic control,including fasting blood glucose(FBG),hemoglobin A1c(HbA1c),serum insulin and homeostatic model assessment of insulin resistance(HOMA-IR)levels in randomized controlled trials(RCTs).Search strategy:This study conducted a systematic review of RCTs published in PubMed,Scopus,Web of Science,Cochrane Library and Embase,up to 5 May,2018.Inclusion criteria:Studies were included in this meta-analysis if they were RCTs with parallel design and reported sufficient data on participants before and after intervention,and outcomes of glycemic profile parameters in both the arginine supplementation and control groups.Data extraction and analysis:The screening of titles and abstracts was performed independently by two reviewers.Selected articles were considered if they met the study’s inclusion criteria.The quality of included studies was assessed by using the Cochrane Collaboration modified tool.From 710 articles retrieved in the initial search,only 10 trials were suitable for pooling the effects of arginine supplementation on serum glucose,insulin,HOMA-IR and HbA1c levels,with effect sizes of nine,eight,five and five,respectively.Results:Pooled random-effect analysis revealed that l-arginine supplementation could significantly decrease FBG level(weighted mean difference[WMD]:3.35 mg/dL;95%confidence interval[CI]=[−6.55,−0.16];P=0.04)and serum insulin level(WMD:−2.19μIU/mL;95%CI=[−3.70,−0.67];P=0.005).However,the effects of l-arginine supplementation on HOMA-IR and HbA1c were not significant.Results of subgroup analysis showed that supplementation with l-arginine could significantly decrease serum insulin levels when the dosage of l-arginine is>6.5 g/d(WMD:−3.49μIU/mL;95%CI=[−5.59,−1.38];P=0.001),when the duration of supplementation is≤12.8 weeks(WMD:−3.76;95%CI=[−6.50,−0.98];P=0.008),when the participants are not diabetic patients(WMD:−2.54μIU/mL;95%CI=[−4.50,−0.50];P=0.01)and when the baseline serum level of insulin was>20μIU/mL(WMD:−3.98;95%CI=[−6.31,−1.65];P=0.001).Conclusion:Although the results of this study confirmed that supplementation with l-arginine could have significant effects on some glycemic profile indices of participants in clinical trials,the clinical importance of this reduction may not be meaningful.