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Leung, Siu Lun. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2013. / Includes bibliographical references (leaves 153-190). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts also in Chinese.

In this 15 year follow up study in a Chinese population, we confirmed that maternal gestational diabetic status significantly increased women’s future cardiometabolic risk. Glycaemic levels below the current criteria for a positive screening test for gestational diabetes and for the diagnosis of gestational diabetes still significantly predict women’s future risk. In utero hyperinsulinaemia, which caused by an intrauterine hyperglycaemic environment, was found to predict children’s AGT and adolescents’ overweight and MetS. The results had important implication that the current diagnostic criteria for gestational diabetes may not be discriminative in predicting both the mothers and their children’s future cardiometabolic risk. Although recent research has re-visited and emphasised on the diagnostic criteria of gestational diabetes which best predicted adverse pregnancy outcome, future study should also scrutinise on the optimal glycaemic threshold, either in screening or diagnostic test, that relate to the mothers’ and children offspring’s long term cardiometabolic risk. / Tam, Wing Hung. / Thesis (M.D.)--Chinese University of Hong Kong, 2012. / Includes bibliographical references (leaves 119-146). / Abstract also in Chinese. / LIST OF TABLES --- p.xxii / LIST OF FIGURES --- p.xxv / LIST OF ABBREVIATIONS --- p.xxvi / Chapter Chapter 1 --- Gestational diabetes & future cardiometabolic risk - an overview / Chapter 1.1 --- Historical background --- p.2 / Chapter 1.2 --- Pregnancy physiology vs. gestational diabetes --- p.5 / Chapter 1.3 --- Diabetes mellitus - a global epidemic --- p.6 / Chapter 1.4 --- History of gestational diabetes & progression to Type 2 DM --- p.7 / Chapter 1.5 --- History of gestational diabetes & cardiometabolic risk --- p.8 / Chapter 1.6 --- Type 2 DM among children and adolescents --- p.9 / Chapter 1.7 --- Type 2 DM among offspring of mothers with gestational diabetes --- p.10 / Chapter 1.8 --- Cardiometabolic risk in children exposed to maternal gestational diabetes --- p.12 / Chapter 1.9 --- Long term follow up on mothers & children cohort --- p.12 / Chapter Chapter 2 --- Research methodology / Chapter 2.1 --- Subjects --- p.16 / Chapter 2.2 --- Obstetric and neonatal information --- p.18 / Chapter 2.2.1 --- Maternal glycaemic indices at pregnancy --- p.18 / Chapter 2.2.2 --- Umbilical cord blood C-peptide & insulin levels --- p.18 / Chapter 2.2.3 --- Definition of antenatal variables --- p.19 / Chapter 2.3 --- Follow up assessment of the mothers --- p.19 / Chapter 2.4 --- Follow up assessment of the children and adolescents --- p.22 / Chapter 2.5 --- Definition of abnormal glucose tolerance and metabolic syndrome --- p.24 / Chapter 2.5.1 --- Definition of abnormal glucose tolerance --- p.24 / Chapter 2.5.2 --- Definition of metabolic syndrome in adult --- p.24 / Chapter 2.5.3 --- Definition of metabolic syndrome in adolescent --- p.25 / Chapter 2.6 --- Determination of insulin resistance and pancreatic beta cell function --- p.26 / Chapter 2.6.1 --- Definition of insulin resistance --- p.26 / Chapter 2.6.2 --- Definition of pancreatic beta cell function --- p.26 / Chapter 2.6.3 --- Measurement of insulin resistance and pancreatic β-cell function --- p.27 / Chapter 2.7 --- Statistical analysis --- p.31 / Chapter 2.7.1 --- Statistical programme --- p.31 / Chapter 2.7.2 --- Comparison between group differences --- p.31 / Chapter 2.7.3 --- General Linear Model --- p.32 / Chapter 2.7.4 --- Multivariate logistic regression --- p.33 / Chapter 2.7.5 --- Receiver operating characteristic analysis --- p.37 / Chapter 2.8 --- Ethics approval --- p.41 / Chapter 2.9 --- Funding --- p.42 / Chapter Chapter 3 --- History of gestational diabetes and women’s future cardiometabolic risk / Chapter 3.1 --- Maternal clinical parameters at the index pregnancy --- p.44 / Chapter 3.2 --- Maternal cardiometabolic status at 8 years post-delivery --- p.45 / Chapter 3.3 --- Maternal cardiometabolic status at 15 years post-delivery --- p.49 / Chapter 3.4 --- Prediction of cardiometabolic risk by maternal gestational diabetic status --- p.50 / Chapter 3.4.1 --- Abnormal glucose tolerance and metabolic syndrome at 8 years by maternal gestational diabetic status --- p.52 / Chapter 3.4.2 --- Abnormal glucose tolerance, DM, hypertension and metabolic syndrome at 15 years by maternal gestational diabetic status --- p.52 / Chapter 3.5 --- The role of insulin resistance in predicting women’s DM and metabolic syndrome --- p.55 / Chapter 3.6 --- Discussion --- p.57 / Chapter 3.7 --- Conclusion --- p.62 / Chapter Chapter 4 --- Glycaemic variables measured at mid-gestation of the index pregnancy predict women’s future cardiometabolic risk / Chapter 4.1 --- Glycaemic levels in pregnancy and perinatal outcome --- p.64 / Chapter 4.2 --- Glycaemic levels in pregnancy and women’s future cardiometabolic risk --- p.65 / Chapter 4.2.1 --- Prediction of women’s cardiometabolic risk at 8 and 15-year --- p.66 / Chapter 4.2.2 --- Optimal cut-off levels in predicting women’s future cardio- metabolic risk --- p.69 / Chapter 4.3 --- Discussion --- p.75 / Chapter 4.4 --- Conclusion --- p.78 / Chapter Chapter 5 --- Maternal gestational diabetes and offspring’s cardiometabolic risk / Chapter 5.1 --- Offspring’s cardiometabolic risk at 8 years age --- p.80 / Chapter 5.1.1 --- Baseline characteristics at pregnancy and delivery --- p.80 / Chapter 5.1.2 --- Children’s clinical and biochemical parameters at 8 years age --- p.82 / Chapter 5.2 --- Offspring’s cardiometabolic risk at 15 years age --- p.84 / Chapter 5.2.1 --- Adolescents’ clinical and biochemical parameters at 15 years age --- p.84 / Chapter 5.2.2 --- Clinical parameters of adolescents with abnormal glucose tolerance --- p.84 / Chapter 5.3 --- Discussion --- p.88 / Chapter 5.4 --- Conclusion --- p.90 / Chapter Chapter 6 --- In utero hyperinsulinaemia and offspring’s cardiometabolic risk / Chapter 6.1 --- Umbilical cord blood insulin and C-peptide --- p.92 / Chapter 6.1.1 --- Umbilical cord insulin and C-peptide concentrations in the original cohort --- p.92 / Chapter 6.1.2 --- Determination of in utero hyperinsulinaemia by umbilical cord insulin and C-peptide levels --- p.95 / Chapter 6.2 --- The effect of in utero hyperinsulinaemia on children’s abnormal glucose tolerance at 8 years of age --- p.98 / Chapter 6.2.1 --- Receiver operating characteristic analysis --- p.98 / Chapter 6.2.2 --- Logistic regression analysis --- p.98 / Chapter 6.3 --- The effect of in utero hyperinsulinaemia on adolescents’ cardio- metabolic risk at 15years of age --- p.102 / Chapter 6.3.1 --- Logistic regression analysis --- p.102 / Chapter 6.4 --- Discussion --- p.105 / Chapter 6.5 --- Conclusion --- p.108 / Chapter Chapter 7 --- Summary and conclusion / Chapter 7.1 --- Summary of the thesis --- p.110 / Chapter 7.1.1 --- Women’s long term cardiometabolic risk after a pregnancy with gestational diabetes --- p.110 / Chapter 7.1.2 --- The long term cardiometabolic risk of children born to mothers who had gestational diabetes --- p.111 / Chapter 7.1.3 --- New findings from the studies and their implications --- p.111 / Chapter 7.2 --- Strength and weakness in the study --- p.113 / Chapter 7.2.1 --- Unique cohort from universal screening --- p.113 / Chapter 7.2.2 --- Study design --- p.113 / Chapter 7.2.3 --- Response rate and loss to follow up --- p.114 / Chapter 7.2.4 --- Treatment effect of gestational diabetes --- p.115 / Chapter 7.3 --- Issues of future research --- p.115 / Chapter 7.3.1 --- Follow up study on the HAPO cohort --- p.115 / Chapter 7.3.2 --- Opportunity for international collaboration --- p.117 / Chapter 7.4 --- Conclusion --- p.118 / REFERENCES --- p.119

Orientador: Débora Cristina Damasceno / Coorientador: kleber Eduardo de Campos / Banca: Gustavo Tadeu Volpato / Banca: Patricia Bauer / Resumo: Frente à dificuldade de localização de artigos abordando o termo exercício físico e hormônios sexuais, este estudo tem como objetivo apresentar uma revisão de literatura sobre o efeito do exercício físico nos hormônios sexuais durante a gestação para conscientizar os leitores da área sobre a importância de se realizar mais estudos com a intervenção do exercício físico para diferentes tipos de doenças, incluindo Diabetes mellitus, com relação aos hormônios sexuais. Foi realizada uma revisão de literatura utilizando dois conjuntos de palavras-chave: 1) diabetes, exercise, sex female hormone, pregnancy; 2) diabetes, physical activity, sex female hormone, pregnancy. A pesquisa foi investigada no site do base de dados do National Center of Biotechnology Information (NCBI - PUBMED). Para o primeiro conjunto de palavras-chave, foram encontrados 95 artigos, sendo o primeiro trabalho publicado em 1996. No segundo conjunto, 32 artigos foram encontrados, sendo o primeiro publicado em 1969. Nenhum dos artigos encontrados apresentou relação entre os termos exercício físico e hormônios sexuais. Concluímos que, após revisão de literatura, o exercício físico tem relevância para a aplicação clínica como parte integral do tratamento do diabete e deve ser encorajado. No entanto é necessário seguir as recomendações médicas para a prática do exercício antes e durante a gestação de mulheres diabéticas. Além disso, esta revisão de literatura mostrou que nenhum dos artigos encontrados abordava hormônios sexuais (FHS, LH, estrógeno e progesterona) na gravidez/prenhez diabética / Abstract: Due to difficulty to find papers about exercise and sex female hormones, this study aimed to present literature update of the exercise effect on the sex female hormones during pregnancy to explain the researchers about the importance to carry out more studies using exercise intervention for different types of diseases, including Diabetes mellitus, related to sex female hormones. A literature update was accomplished using two groups of key words: 1) diabetes, exercise, sex female hormone, pregnancy; 2) diabetes, physical activity, sex female hormone, pregnancy. The research was investigated in the site of the database of National Center of Biotechnology Information (NCBI - PUBMED). For the first group of key-words, 95 papers were found, where the first papers was published in 1996. In the second group, 32 papers were found, where the first papers was published in1969. None of the paper found presented relationship between exercise and sex female hormone. After literature update we concluded that the physical exercise has relevance for the clinical application as integral part of the treatment of the diabetes and it should be encouraged. However it is necessary to follow the medical recommendations before for the practice of the exercise and during the diabetic women's gestation. Besides, this literature update showed that none of the papers approached sex female hormones (FHS, LH, estrogen and progesterone) in the diabetic pregnancy / Mestre

Lee, Man Yuen. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2011. / Includes bibliographical references (leaves 191-215). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese.

Orientador: Marilza Vieira Cunha Rudge / Coorientador: Silvana Andrea Molina Lima / Banca: Wilza Spiri / Banca: Maria Yolanda Makuch / Resumo: O objetivo deste estudo foi avaliar a qualidade de vida em gestantes diabéticas, em uso de insulina, que realizaram o acompanhamento pré-natal hospitalar ou ambulatorial no serviço especializado de diabete e gravidez. Trata-se de um estudo coorte única concorrente, desenvolvido no Centro de Investigação do Diabete Perinatal do Hospital das Clínicas da Faculdade de Medicina de Botucatu. A coleta de dados foi realizada no período de janeiro de 2011 a março de 2013, mediante aplicação de um questionário de avaliação de qualidade de vida a todas gestantes portadoras de diabete melito prévio à gestação (Tipo 1e 2) ou diabete melito gestacional, em uso de insulina, que foram submetidas a acompanhamento ambulatorial ou hospitalar. De acordo com World Health Organization Quality Of Life, adaptado para o português-WHOQOL-BREF, a maioria das gestantes dos grupos ambulatorial e hospitalar considerou a qualidade de vida como boa no início da gestação (Momento 1) e no final da gestação (Momento 2), sendo ainda maior a avaliação de qualidade de vida no grupo hospitalar. Em relação à condição de saúde, a maioria das gestantes do grupo ambulatorial estava satisfeita no início da gestação (Momento 1) e no final da gestação (Momento 2). Já no grupo hospitalar, apenas 36,3% (momento 1) e 33,3% (momento 2) estavam satisfeitas. Considerando os locais de atendimento, a evolução dos escores dos domínios (físico, psicológico, social e meio ambiente), nos momentos 1 e 2, não apresentaram diferenças significativas entre si. Pode-se concluir que, neste estudo, aplicação do WHOQOL-BREF, ao longo da gestação, evidenciou que as gestantes diabéticas apresentaram boa qualidade de vida, independente do tipo de acompanhamento / Abstract: The arm of this study is asssessing quality of life in diabetic pregnant women taking insulin, which conducted the hospital prenatal care or outpatient service specializing in diabetes and pregnancy. It is a single cohort competitor followed by 09 months, developed the Specialized Service of Diabetes and Pregnancy, Faculty of Medicine of Botucatu. The data collection was conducted from January 2011 to March 2013 through a questionnaire for assessing quality of life to all pregnant women with diabetes prior to pregnancy (Type 1, 2) or DMG, taking insulin, which underwent ambulatory or hospital monitoring. According World Health Organization Quality of Life in brazilian version- WHOQOL - BREF, most of the pregnant patient and hospital groups considered the quality of life as good in early pregnancy (Time 1) and at the end of pregnancy (Time 2), and further assessment of quality of life in the hospital group. Regarding health status, most mothers in the outpatient group was met at the beginning of pregnancy (Time 1) and at the end of pregnancy (Time 2). In the hospital group, only 36.3% (First moment) and 33.3% (Second moment) were satisfied. Considering the local service, the evolution of the domain scores (physical, psychological, social and environmental), at times 1 and 2, no significant differences between them. Can conclude that in this study, applying the WHOQOL-BREF, throughout gestation, showed that diabetic patients had a good quality of life independent of the type of monitoring / Mestre

published_or_final_version / abstract / toc / Obstetrics and Gynaecology / Doctoral / Doctor of Philosophy

Daughters of gestational diabetes (GDM) affected pregnancies are at greater risk for the development of type 2 diabetes mellitus (DM) later in life. Adiponectin is an early marker of DM risk. Dietary fat quality has been proposed to be involved in the development of insulin resistance. Plasma fatty acids are a marker of recent dietary exposure. The objectives of this research were to determine whether differences in adiponectin exist in daughters of GDM pregnancies, and to describe how dietary fatty acids impact adiponectin concentrations. Fasting adiponectin and plasma fatty acids were examined for 180 adolescent daughters born to mothers with and without GDM. No differences were observed in adiponectin between study groups, however; a significant difference was detected upon comparison of daughters from mothers who were presently diabetic with those from healthy mothers. The association between fatty acids and adiponectin varied by visceral adiposity. Adiponectin was inversely associated with monounsaturated and omega-3 (n-3) fatty acids in the high waist group. Further knowledge on the interactions between fatty acids, desaturase activity and adiponectin would be helpful in planning early interventions for individuals at risk for diabetes.