Diabetes & Women's Health Study: long term health implications of GDM

糖尿病

• 批准号: 10684578
• 负责人: Edwina Yeung
• 金额: $ 0.35万
• 依托单位: EUNICE KENNEDY SHRIVER NATIONAL INSTITUTE OF CHILD HEALTH & HUMAN DEVELOPMENT
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10684578
• 关键词: Adult; Alcohol consumption; American; Behavior; Beta Cell; Biochemical Markers; Biological; Birth; Blood; Cardiometabolic Disease; Cardiovascular Diseases; Caring; Cell physiology; Clinical; Clinical Nutrition; Collaborations; Complications of Diabetes Mellitus; Consumption; Data; Data Collection; Deterioration; Development; Diabetes Mellitus; Diet; Diet Modification; Dietary Factors; Early identification; Enrollment; Environmental Risk Factor; Etiology; Fatty Liver; Fatty acid glycerol esters; Genetic; Genetic Markers; Genetic Risk; Gestational Diabetes; Goals; Health; Hybrids; Individual; Intake; Joints; Journals; Lactation; Life Style; Liver; Longitudinal Studies; Measures; Non-Insulin-Dependent Diabetes Mellitus; Nurses' Health Study; Nutrient; Outcome; Participant; Pathway interactions; Personal Satisfaction; Physical activity; Population; Postpartum Period; Pregnancy; Pregnancy Complications; Pregnancy in Diabetics; Prevention; Process; Prolonged Lactations; Publishing; Recording of previous events; Renal function; Research; Risk; Risk Factors; Saliva; Structure of nail of toe; Suggestion; Thyroid Function Tests; Thyroid Hormones; Update; Urine; Woman; Women' s Health; Work; base; cardiometabolic risk; cardiometabolism; clinically relevant; cohort; comorbidity; design; diabetes risk; dietary; glucose metabolism; high risk; impaired glucose tolerance; improved; indexing; innovation; kidney dysfunction; member; modifiable risk; novel; offspring; prospective; public health intervention; sugar; sweetened beverage

The Diabetes & Womens Health Study, based on an innovative hybrid design combining new prospective data collection with historical data, aims to understand pathways and determinants underlying the progression from gestational diabetes (GDM) to type 2 diabetes (T2DM) and complications such as cardiovascular diseases. GDM is a common pregnancy complication. Women who develop impaired glucose tolerance and/or GDM in pregnancy are at substantially increased risk for T2DM in the years following pregnancy. Determinants underlying the transition from GDM to T2DM are not well studied and available studies are limited. There is limited information about the genetic and environmental factors that impact this transition in particular. Further, there is limited research aimed at following women with GDM long term through later adulthood for the development of T2DM and co-morbidities. These critical data gaps serve as the impetus for this study with the overall goal of investigating genetic factors and their interactions with risk factors amenable to clinical or public health intervention in relation to the transition of GDM to T2DM. A secondary goal of the study is to evaluate feasibility of investigating the long-term impact of GDM and other intrauterine factors on the health and wellbeing of offspring. Data collection for this study builds upon two large existing cohorts: the Nurses' Health Study II (NHS-II) and the Danish National Birth Cohort (DNBC). The overall design of the study was published in 2014 (Zhang et al. Acta Obstetricia et Gynecologica Scandinavica). The DWH Study data collection was completed in 2016 and initial work focused on long-term comorbidities of GDM and potentially modifiable pathways. We recently published the cohort profile for the study which describes the study, the main findings, and opportunities for collaboration (Zhang BMJ Open 2019). Using data from the two independent populations within the DWH Study, the NHS-II and DNBC, we identified eight novel GDM SNPs (Ding et al. Diabetologia, 2018). These findings offer the potential to improve our understanding of the etiology of GDM, and particularly of biological mechanisms related to beta cell function. Further we have identified that in independent populations of white women with a history of GDM within the DWH study, a higher genetic risk score (GRS) for type 2 diabetes was significantly associated with a higher risk of T2D. The findings were largely consistent between the two populations. We also found suggestive evidence that the GRS association may be stronger among women with poorer dietary quality after the index pregnancy than among women with a better dietary quality. Using data from the DWH Study, we have demonstrated that GDM may be an early indicator of subsequent subclinical renal dysfunction (Rawal et al. Diabetes Care, 2018). Our findings suggest that in women with a history of GDM, deterioration of renal function may potentially precede the development of overt diabetes, although clinically relevant outcomes such as elevated UACR may manifest only after progression to diabetes. We have also shown that women with GDM during pregnancy were at an increased risk for fatty liver 9-16 years postpartum (Donnelly 2019 Journal of Diabetes). GDM may serve as another risk indicator for early identification and prevention of liver fat accumulation. We also examined for potentially modifiable risk-factors associated with long-term health among women with a history of GDM. In Danish women with a history of GDM, our findings suggest a positive association between a longer duration of lactation and higher levels of thyroid hormone 916 years postpartum, even among women with a single lifetime pregnancy (Panuganti et al. Nutrients, 2018). We identified lactation as a novel potential modifiable factor for thyroid function, and with replication, these findings may add thyroid function to the wide-array of long-term cardiometabolic outcomes associated with increased lactation duration. In addition, we demonstrated that prolonged lactation duration was related to lower risk of type 2 diabetes (Ley et al. Diabetes Care, 2020) and improved cardio-metabolic risk profiles (Ley et al. BMJ Diabetes Research and Care, 2020) among women with a history of GDM. We also investigated modifiable dietary factors among women with GDM. We found that that among Danish women with a history of GDM, a population at high risk for cardiometabolic diseases, artificially sweetened beverage intake was not associated with either improvements or determents in cardiometabolic complications (Hinkle et al. American Journal of Clinical Nutrition 2019). Although high-risk individuals are recommended to consume artificially sweetened beverage instead of sugar sweetened beverages as a means of reducing sugar intake and risk for cardio-metabolic diseases, we did not observe significant improvements or determinants in cardiometabolic health with higher artificially sweetened beverage intake in this population. in addition, we observed moderate alcohol consumption among U.S. women with a history of GDM was related to lower risk of type 2 diabetes (Hinkle et al. JAMA Network Open, 2021). Taken all these together, findings from the study suggested that the greater long-term risk for type 2 diabetes and comorbidity may be mitigated through modification of diet, lifestyle and behavior factors. The study team is in the process of examining the joint impacts of modifiable risk factors and genetic factors on long-term risk of type 2 diabetes and cardiovascular diseases among women following pregnancies complicated by GDM.

糖尿病与女子健康研究基于创新的混合设计，结合了新的前瞻性数据收集与历史数据，旨在了解从损伤糖尿病（GDM）到2型糖尿病（T2DM）的进展的途径和决定因素，以及诸如心血管疾病等并发症。 GDM是常见的妊娠并发症。在怀孕后的几年中，葡萄糖耐受性受损和/或GDM的妇女的T2DM风险大大增加。从GDM到T2DM过渡的基本决定因素没有很好地研究，并且可用的研究受到限制。特别是有关影响这一转变的遗传和环境因素的信息有限。此外，有限的研究旨在跟随长期长期内GDM的妇女进行T2DM和合并症的发展。这些关键的数据差距是这项研究的动力，其总体目标是研究遗传因素及其与GDM过渡到T2DM的临床或公共卫生干预措施的危险因素的相互作用。该研究的第二个目标是评估研究GDM和其他宫内因素对后代健康和福祉的长期影响的可行性。 这项研究的数据收集建立在两个大型现有人群的基础上：护士健康研究II（NHS-II）和丹麦国家出生队列（DNBC）。该研究的整体设计于2014年发表（Zhang等人Acta Obstetricia et Gynecologica Scandinavica）。 DWH研究数据收集于2016年完成，最初的工作着重于GDM的长期合并症和潜在的可修改途径。我们最近发表了该研究的队列概况，该研究描述了研究，主要发现和协作机会（Zhang BMJ Open 2019）。 使用DWH研究中的两个独立人群的数据，NHS-II和DNBC，我们确定了八个新型GDM SNP（Ding等人糖尿病学，2018年）。这些发现提供了我们对GDM病因的理解，尤其是与β细胞功能相关的生物学机制的潜力。此外，我们已经确定，在DWH研究中具有GDM病史的独立人群中，2型糖尿病的遗传风险评分（GRS）较高，与T2D的风险较高显着相关。这两个人群之间的发现在很大程度上是一致的。我们还发现了暗示性的证据，表明在饮食质量妊娠后，与饮食质量更高的女性相比，饮食质量较差的女性中，GRS联想可能更强。 使用DWH研究中的数据，我们证明GDM可能是随后的亚临床肾功能障碍的早期指标（Rawal等人糖尿病护理，2018年）。我们的发现表明，在具有GDM史的女性中，肾功能的恶化可能可能先于明显的糖尿病的发展，尽管临床上相关的结果（例如UACR升高）只有在发展为糖尿病后才能表现出来。我们还表明，怀孕期间GDM的女性在产后9 - 16年的脂肪肝风险增加（Donnelly，2019年糖尿病杂志）。 GDM可以作为早期鉴定和预防肝脏脂肪积累的另一个风险指标。 我们还检查了具有GDM史的女性中与长期健康相关的潜在可修改风险因素。在具有GDM史的丹麦妇女中，我们的发现表明，哺乳期更长的持续时间与产后916年的甲状腺激素水平更高，即使是单一终生怀孕的女性，也有正面的联系（Panuganti等人Nutrients，2018年）。我们将乳酸确定为甲状腺功能的新型潜在可修改因子，并且通过复制，这些发现可能会增加甲状腺功能，从而在与哺乳期持续时间增加的长期心脏代谢结果的广泛阵列中增加。此外，我们证明了延长的哺乳期持续时间与较低的2型糖尿病风险有关（Ley等人的糖尿病护理，2020年）和改善的有GDM史的心脏代谢风险概况（Ley等人，BMJ糖尿病研究与护理，2020年）。我们还研究了GDM女性的可修改饮食因素。我们发现，在具有GDM史的丹麦妇女中，心脏代谢疾病的高风险人口，人为地甜味的饮料摄入量与心脏代谢并发症的改善或阻止均无关（Hinkle等，《美国临床营养杂志2019）。尽管建议高风险的人可以人工甜味的饮料而不是糖甜饮料，以减少糖的摄入量和心脏代谢疾病的风险，但我们并未观察到这种人群中较高的人工甜味饮料摄入量的心脏代谢健康的显着改善或决定因素。此外，我们观察到具有GDM病史的美国女性中等饮酒量与较低的2型糖尿病风险有关（Hinkle等，Jama Network Open，2021年）。研究的结果将所有这些都一起摄取，表明，可以通过改变饮食，生活方式和行为因素来减轻2型糖尿病和合并症的长期风险。研究团队正在研究可修改的危险因素和遗传因素对2型糖尿病和心血管疾病长期风险的关节影响，因为GDM妊娠复杂。

项目成果

Prevalence of Gestational Diabetes and Risk of Progression to Type 2 Diabetes: a Global Perspective.

• DOI: 10.1007/s11892-015-0699-x
• 发表时间: 2016-01
• 期刊: Current diabetes reports
• 影响因子: 4.2
• 作者: Zhu Y;Zhang C
• 通讯作者: Zhang C

Maternal dietary intakes of refined grains during pregnancy and growth through the first 7 y of life among children born to women with gestational diabetes.

• DOI: 10.3945/ajcn.116.136291
• 发表时间: 2017-07
• 期刊: The American journal of clinical nutrition
• 作者: Yeyi Zhu;S. Olsen;P. Mendola;T. Halldorsson;E. Yeung;C. Granström;A. Bjerregaard;Jing Wu;Shristi Rawal;J. Chavarro;F. Hu;Cuilin Zhang