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 65,817 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The metabolic syndrome consists of a combination of risk factors that include abdominal obesity, atherogenic dyslipidaemia, hypertension and insulin resistance. It increases the risk of cardiovascular disease and type 2 diabetes. The increased risk of cardiovascular disease is higher in women than in men. The first manifestation of metabolic syndrome may occur in pregnancy presenting as gestational diabetes or preeclampsia. Both conditions are associated with increased insulin resistance. Also metabolic syndrome is more common in polycystic ovarian syndrome. It has been suggested that there is a metabolic syndrome resulting from the menopause due to estrogen deficiency, as many of the risk factors are more prevalent in postmenopausal women. Also estrogen replacement improves insulin sensitivity and reduces the risk of diabetes. The key elements in managing the metabolic syndrome are weight reduction, increasing physical activity and diet modification. If blood pressure, lipid and glycaemic control are not achieved through these interventions then pharmacological therapy will be required.
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PMID:Metabolic syndrome and the menopause. 1838 Sep 57

Gestational diabetes mellitus (GDM), defined as carbohydrate intolerance of any degree first recognized during pregnancy, complicates approximately 4% of all pregnancies in the United States. Several factors can increase one's risk of developing GDM, including obesity, family history of type 2 diabetes mellitus (T2DM), and race/ethnicity. Conversely, a history of GDM can increase the risk of developing not only T2DM but also cardiovascular disease (CVD) independent of a diagnosis of T2DM. Several investigations have explored GDM relationships with CVD risk factors, CVD surrogate markers, and clinically evident CVD. These studies have included evaluations of biochemical parameters, such as inflammatory and endothelial biomarkers; endothelial dysfunction, such as that seen in impaired brachial artery flow-mediated vasodilation; and vascular dysfunction, manifest as cardiac dysfunction or in diseases such as hypertension. This article will review these studies and examine factors considered to be responsible for promoting CVD in women with a history of GDM, such as T2DM and metabolic syndrome and its components. In addition, studies evidencing CVD in women with a history of GDM will be explored.
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PMID:Late cardiovascular consequences of gestational diabetes mellitus. 1953 66

Excess bodyweight is the sixth most important risk factor contributing to the overall burden of disease worldwide. In excess of a billion adults and 10% of all children are now classified as overweight or obese. The main adverse consequences of obesity are the metabolic syndrome, cardiovascular disease and type 2 diabetes and a diminished average life expectancy. It has been argued that the complex pathological processes underlying obesity reflect environmental and genetic interactions, and individuals from disadvantaged communities seem to have greater risks than more affluent individuals partly because of fetal and postnatal programming interactions. Abundant evidence indicates that the obesity epidemic reflects progressive secular and age-related decreases in physical activity, together with passive over-consumption of energy dense foods despite neurobiological processes designed to regulate energy balance. The difficulty in treating obesity, however, highlights the deficits in our current understanding of the pathophysiology which underlies the initiation and chronic nature of this disorder. Large population based studies in Europe and North America in healthy women and in women with gestational diabetes have demonstrated that there are clear relationships between maternal and fetal nutrient supply, fetal growth patterns and the subsequent risk of obesity and glucose intolerance in childhood and adult life. In this review we discuss the impact of fetal nutrition on the biology of the developing adipocyte and brain and the growing evidence base supporting an intergenerational cycle of obesity.
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PMID:The early origins of later obesity: pathways and mechanisms. 1953 65

It has long been recognized that the diagnosis of gestational diabetes mellitus (GDM) identifies a population of young women at high risk of developing Type 2 diabetes (T2DM) in the future. In recent years, however, a series of studies have revealed that antepartum glucose tolerance screening, a standard element of current obstetrical care instituted for the purpose of detecting GDM, may provide previously-unrecognized insight into a woman's future risk of metabolic and vascular disease. Indeed, it has emerged that in fact any degree of abnormal glucose tolerance detected on antepartum screening (i.e. not just GDM) predicts an increased future risk of pre-diabetes and diabetes, one that is proportional to the severity of dysglycemia observed in pregnancy. In addition, in the years following the index pregnancy, women with a history of GDM exhibit an enhanced cardiovascular risk profile and ultimately an increased incidence of cardiovascular disease (CVD), risks that may similarly extend to women with milder gestational glucose intolerance as well. Thus, by providing a unique window to a woman's risk potential for future metabolic and vascular disease, glucose tolerance testing in pregnancy, as currently practiced, may offer an opportunity for the early identification of high-risk individuals prior to the onset of clinical disease. Ultimately, the insight so derived may inform strategies for postpartum surveillance, risk factor modification, and disease prevention that may eventually lead to a reduction in the burden of T2DM and CVD in women.
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PMID:Glucose tolerance status in pregnancy: a window to the future risk of diabetes and cardiovascular disease in young women. 1960 32

Successful pregnancy is one of the better indicators of quality of life for women who are of child-bearing age with restored fertility after kidney transplantation. Our objective was to evaluate whether pregnancy represented a risk factor for worsening of renal function or for cardiovascular disease among renal transplant recipients. From 1976 to 2007, we followed 30 successful pregnancies in 27 renal recipients in our hospital; three women had two twin gestations. We compared this population with 27 women with renal transplants who were not pregnant. They were of similar ages at transplantation (pregnant 31.1 +/- 5.4 years vs not pregnant 31.3 +/- 5.4 years, P = NS) and similar evolution time between kidney transplantation and pregnancy (51.5 +/- 36 months vs 47.2 +/- 41 months respective; P = NS). There were no acute rejection episodes or graft losses. Renal function measured by serum creatinine and MDRD4 at the end of pregnancy was lower among the pregnant compared with the control group: mainly, 1.1 +/- 0.2 mg/dL versus 0.9 +/- 0.2 mg/dL (P = .05), and 66 +/- 20 mL/min/1.73 m(2) versus 80 +/- 26 mL/min/1.73 m(2) (P = .03). At 1 and 10 years, renal function was similar among the groups. Ten pregnant women developed preeclampsia (37%) and three, gestational diabetes mellitus (11%). There was one major cardiovascular event (4%; acute myocardial infarction) among the pregnant group, whereas there were two in the control group (7.4%; stroke and severe hypertensive retinopathy). One death occurred in each group secondary to cardiovascular complications. Our results showed that successful pregnancy after renal transplantation did not represent a long-term risk factor to worsen renal function and or produce severe cardiovascular complications. Therefore, pregnancy should be promoted. for young women with renal transplants that show excellent function.
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PMID:Renal allograft function and cardiovascular risk in recipients of kidney transplantation after successful pregnancy. 1971 32

In women with previous gestational diabetes (pGDM), the risk of developing Type 2 diabetes is greatly increased, to the point that GDM represents an early stage in the natural history of Type 2 diabetes. In addition, in the years following the index pregnancy, women with pGDM exhibit an increased cardiovascular risk profile and an increased incidence of cardiovascular disease. This paper will review current knowledge on the metabolic modifications that occur in normal pregnancy, underlining the mechanism responsible for GDM, the link between these alterations and the associated long-term maternal complications. In women with pGDM, accurate follow-up and prevention strategies (e.g., weight control and regular physical exercise) are needed to reduce the subsequent development of overt diabetes and other metabolic abnormalities related to cardiovascular disease. Therefore, our paper will provide arguments in favor of performing follow-up programs aimed at modifying risk factors involved in the pathogenesis of Type 2 diabetes and cardiovascular disease.
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PMID:Gestational diabetes mellitus: an opportunity to prevent type 2 diabetes and cardiovascular disease in young women. 2008 33

Nearly 20 years ago, it was discovered that low birthweight was associated with an increased risk of adult diabetes and cardiovascular disease (CVD). This led to the hypothesis that exposure to undernutrition in early life increases an individual's vulnerability to these disorders, by 'programming' permanent metabolic changes. Implicit in the programming hypothesis is that improving the nutrition of girls and women could prevent common chronic diseases in future generations. Research in India has shown that low birthweight children have increased CVD risk factors, and a unique birth cohort in Delhi has shown that low infant weight, and rapid childhood weight gain, increase the risk of type 2 diabetes. Progress has been made in understanding the role of specific nutrients in the maternal diet. In the Pune Maternal Nutrition Study, low maternal vitamin B12 status predicted increased adiposity and insulin resistance in the children, especially if the mother was folate replete. It is not only maternal undernutrition that causes problems; gestational diabetes, a form of foetal overnutrition (glucose excess), is associated with increased adiposity and insulin resistance in the children, highlighting the adverse effects of the 'double burden' of malnutrition in developing countries, where undernutrition and overnutrition co-exist. Recent intervention studies in several developing countries have shown that CVD risk factors in the offspring can be improved by supplementing undernourished mothers during pregnancy. Results differ according to the population, the intervention and the post-natal environment. Ongoing studies in India and elsewhere seek to understand the long-term effects of nutrition in early life, and how best to translate this knowledge into policies to improve health in future generations.
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PMID:Maternal nutrition: effects on health in the next generation. 2009 Jan 13

Gestational diabetes mellitus (GDM) is a type of diabetes that presents during pregnancy and usually disappears shortly after a woman gives birth. Better recognition of the risk factors of GDM, combined with more universal screening for the disease in many countries, has led to the increased detection of GDM along with other forms of pregestational diabetes. There is growing evidence that GDM significantly increases the risk of a number of short- and long-term adverse consequences for the fetus and mother, the most significant of which is a predisposition to the development of metabolic syndrome and Type 2 diabetes. Maternal and childhood obesity as well as cardiovascular disease are also potential long-term consequences of GDM. On the other hand, there is a growing body of evidence suggesting that the risk of many of these consequences can be significantly reduced or eliminated by aggressive treatment of GDM. There remains, however, a great deal of controversy over when to begin screening for hyperglycemia in pregnancy and at what level of hyperglycemia should aggressive intervention be initiated.
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PMID:The fetal and maternal consequences of gestational diabetes mellitus. 2195 80

Obesity and diabetes have become globally epidemic. The cause of this unprecedented rise in obesity is multifactorial, with inactivity, excessive calorie intake, and genetic factors implicated. More recent data indicate that exposure to diabetes during pregnancy increases the risk of childhood and adult obesity, diabetes, and cardiovascular disease. Evidence derived from recent randomized controlled trials indicates that gestational diabetes mellitus (GDM) treatment reduces newborn obesity and therefore may contribute to reducing the global prevalence of obesity and metabolic syndrome. Current evidence detailing increases in global prevalence of obesity was reviewed together with data evaluating the effectiveness of treatment of GDM. Development of new protocols for diagnosis and treatment of GDM may reduce population obesity and cardiovascular disease.
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PMID:Fetal exposure to gestational diabetes contributes to subsequent adult metabolic syndrome. 2043 Mar 55

Women who develop gestational diabetes mellitis (GDM) display endothelial dysfunction up to 1 yr after pregnancy, despite a return to normoglycemia. It is unknown whether this dysfunction was preexisting or whether GDM pregnancy leads to long-term endothelial dysfunction. A mouse model that spontaneously develops GDM (Lepr(db/+)) was used to determine whether the endothelial dysfunction that develops during GDM is evident in later life. Heterozygous and wild-type (WT) controls were allowed to litter once, then age to 9-10 mo, and were compared with virgin controls. Vascular function of small mesenteric arteries was assessed using wire myography. Concentration response curves to the thromboxane A(2)mimetic U46619 and the endothelium-dependent vasodilator methacholine were constructed. Superoxide production and peroxynitrite formation was also measured. Mice with previous GDM displayed blood glucose concentrations similar to previously pregnant WT mice (8.0 +/- 0.1 vs. 7.1 +/- 0.3 mmol/l, P > 0.05). Arteries from mice with previous GDM displayed increased sensitivity to U46619 (EC(50) 5.2 +/- 0.7 vs. 45.2 +/- 1.0 nmol/l, P < 0.01) and impaired endothelium-dependent relaxation compared with WT controls (29 +/- 8 vs. 58 +/- 16 percent relaxation, P < 0.05). This was associated with increased superoxide production (93.3 +/- 2.3 vs. 64.6 +/- 1.6 mean fluorescence intensity, P < 0.001) and increased peroxynitrite formation (173.5 +/- 11.0 vs. 57.4 +/- 16.2 mean fluorescence intensity, P < 0.01) compared with virgin controls. In summary, endothelial dysfunction was evident in mice with previous GDM compared with previously healthy pregnant mice or virgin controls. These data suggest that GDM affects endothelial function and may contribute to an increased risk of cardiovascular disease.
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PMID:Previous gestational diabetes impairs long-term endothelial function in a mouse model of complicated pregnancy. 2055 29


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