Elisabeth Reinhardt Mathiesen

Aims: Moderate‐to‐vigorous physical activity (MVPA) and adequate, high‐quality sleep are important for cardiometabolic health in women with recent gestational diabetes mellitus (GDM) but are likely reduced during early motherhood. These behaviours may be associated; however, device‐measured sleep data and studies of these associations remain scarce in this population. This cross sectional study characterised MVPA and sleep patterns and examined their associations in women with recent GDM. Methods: In the Face‐it trial, 185 women provided device‐measured MVPA and sleep data 1 year after delivery. Sleep variables included duration and efficiency, reflecting sleep quantity and quality. Duration was categorised as 8 h/night. Associations with MVPA were analysed using linear mixed‐effects models with site as a random intercept, adjusted for potential confounders. Results: Two‐thirds (61.6%) met WHO recommendations for moderate‐intensity physical activity (PA), whereas few (3.2%) met recommendations for vigorous‐intensity PA. Most met recommendations for sleep duration (87.6%) and sleep efficiency (83.8%). Compared to 6–8 h/night, there was no difference in MVPA among those sleeping 8 h/night were associated with less MVPA (β = −13.5, 95% CI = −23.0, −4.0, p = 0.006). Sleep efficiency was positively associated with MVPA (β = 0.6, 95% CI = 0.1, 1.1, p = 0.018). Conclusions: The association between high‐quality sleep and greater MVPA suggests that PA and sleep may not only independently be relevant to cardiometabolic health but may also be associated in women with recent GDM.

Aims/hypothesis: Women with previous gestational diabetes mellitus (GDM) have an increased risk of developing both type 1 and type 2 diabetes. However, predicting the risk on a personal level is challenging. Polygenic scores (PGSs), which capture an individual's genetic susceptibility to disease, may improve risk prediction. We aimed to examine the utility of PGSs for type 1 diabetes (T1D-PGS) and type 2 diabetes (T2D-PGS) to predict overt diabetes in women with previous GDM, with a median follow-up time of 30 years after index pregnancy. Methods: We conducted an observational study including 370 women diagnosed with GDM between 1978 and 1996. Development of type 1 and type 2 diabetes was identified using national registry data comprising ICD-10 diagnosis codes on diabetes until 2019, combined with a glucose tolerance test performed in 2000–2002. The predictive ability of T1D-PGS and T2D-PGS and clinical risk factors during index pregnancy for type 1 and type 2 diabetes, including maternal age at delivery, pre-pregnancy BMI, fasting plasma glucose, insulin treatment and family history of diabetes, was evaluated using receiver operating characteristic area under the curve (AUC). Results: During a median follow-up of 30 years, 200 (54.1%) women were diagnosed with diabetes: 30 (8.1%) with type 1 diabetes, 157 (42.4%) with type 2 diabetes and 13 (3.5%) carried monogenic diabetes variants. The mean T1D-PGS was higher in women with type 1 diabetes compared with those without (13.6 vs 11.5, p p =0.16). The T1D-PGS and clinical risk factors during pregnancy were discriminative of type 1 diabetes with AUCs of 0.788 and 0.839, respectively, while a combined model yielded an AUC of 0.887. The T2D-PGS and clinical risk factors during pregnancy yielded AUCs of 0.539 and 0.745, respectively. The combined model had an AUC of 0.752. Conclusions/interpretation: In women with previous GDM, the T1D-PGS showed good predictive ability for the development of type 1 diabetes, especially when combined with clinical risk factors during pregnancy, and may have potential to guide targeted follow-up and early treatment interventions. The T2D-PGS showed no predictive ability for type 2 diabetes.

Purpose of Review To address the clinical dilemma of how best to counsel women with type 2 diabetes (T2D) using glucagon-like peptide-1 receptor agonists (GLP-1RA) regarding pregnancy. Recent Findings Animal studies raise concern for fetal loss, malformations and adverse fetal growth after GLP-1RA exposure. Nonetheless, three cohort studies and one prospective study including 2,994 women with T2D exposed to GLP-1RA in early pregnancy indicate no increased risk of malformations compared with unexposed pregnancies, and observational data in 168 GLP-1RA exposed pregnancies are reassuring regarding miscarriage and fetal growth. Summary Women with T2D are advised to use contraception and to discontinue GLP-1RAs two months before planned pregnancy. Despite concerns in animal studies, GLP-1RA exposure in early T2D pregnancy has not been associated with increased risk of malformations. If a woman with T2D inadvertently becomes pregnant while using GLP-1RA, the existing human evidence does not support a recommendation of terminating pregnancy.

Context: The prevalence of type 2 diabetes (T2DM) in pregnancy is increasing rapidly worldwide. Consequently, there is a need to gain more knowledge about pregnant women with T2DM. Objective: The current study aimed to assess the prevalence of cardiometabolic risk factors and comorbidities in women with T2DM before and during pregnancy, and to evaluate associations with adverse obstetric and perinatal outcomes. A comparison between women with preexisting T2DM (P-T2DM) and women with T2DM first recognized during pregnancy (N-T2DM) was also performed. Design: A retrospective Danish national population-based cohort study, including all pregnancies in women with T2DM, giving birth to a live infant after 24 weeks of gestation, from 2004 until 2019. Results: The population included 1297 pregnancies in women with T2DM (1207 P-T2DM, 90 N-T2DM). Before pregnancy, 20.4% smoked, 13.4% had chronic hypertension, 12.5% had dyslipidemia, and 63.1% had obesity. Only 58.6% of women with P-T2DM entered pregnancy with hemoglobin A1c (HbA1c) < 53 mmol/mol (7.0%). During pregnancy, 73.4% had an excessive weight gain, and 21.6% attained a median HbA1c < 38 mmol/mol (5.6%). Preeclampsia was observed in 9.1% of women, preterm delivery in 19.0%, and large-for-gestational-age birthweight in 32.2% of infants. Obstetric and perinatal outcomes were similar in women with P-T2DM and N-T2DM. All modifiable exposures were associated with one or more severe adverse outcomes. Conclusion: Cardiometabolic risk factors are prevalent in pregnant women with T2DM and are associated with severe adverse outcomes for mother and child.

OBJECTIVE: To evaluate the risk of treatment of sight-threatening diabetic retinopathy (DR) defined as panretinal photocoagulation for proliferative DR or anti–vascular endothelial growth factor injections for diabetic macular edema (DME) during and after pregnancy compared with nonpregnant control participants. RESEARCH DESIGN AND METHODS: This was a matched cohort study of women with type 1 diabetes who gave birth in 2013–2022 and who had DR levels recorded in the national Danish Registry of Diabetic Retinopathy during and after pregnancy. Control participants consisted of nonpregnant women with type 1 diabetes, individually matched by baseline DR level. Data were collected from relevant national registers from 36 months before pregnancy until 36 months after. RESULTS: We included 1,041 pregnant women and 1,041 matched control participants. At baseline, the median duration (interquartile range [IQR]) of diabetes was 13 (6, 19) and 10 (5, 17) years for cases and control participants. Median baseline HbA1c (IQR) was 57 (50, 67) compared with 64 (55, 79) mmol/mol (7.4% vs. 8%), and DR was present in 42.7% of both groups. During and after pregnancy, treatment of proliferative DR with panretinal photocoagulation occurred to a similar extent in both groups (pregnant women vs. control participants: during treatment: 1.2% vs. 1.1%, respectively, OR 1.18 [95% CI 0.53, 2.66]); and after treatment: 2.7% vs. 2.9%, respectively, OR 0.93 [95% CI 0.55, 1.57]). Treatment of DME was rare in both groups. Progression to proliferative DR was not higher in the pregnant group (adjusted hazard ratio 0.64 [95% CI 0.32, 1.31]). CONCLUSIONS: In this nationwide register study of women with type 1 diabetes, pregnant women and retinopathy-matched, nonpregnant control participants had a similar risk of developing sight-threatening DR requiring treatment during and within 36 months after pregnancy.

Aims: This study investigated the prevalence and concordance of cardiometabolic risk markers among couples after a gestational diabetes mellitus (GDM)‐affected pregnancy. It also examined whether selected demographic, socioeconomic and health behavioural factors could explain within‐couple associations. Materials and Methods: A cross‐sectional study design was used. We included health examinations and questionnaire data from couples assessed 12 weeks after a pregnancy affected by GDM. We determined the prevalence and concordance of cardiometabolic risk markers (overweight or obesity, high waist circumference, metabolic syndrome, impaired fasting glucose [≥6.1 mmol/L], and stage 1 hypertension or more [≥130 mmHg/≥80 mmHg], along with health behaviour [dietary quality and physical activity]). Results: A total of 196 couples were included. Overweight or obesity was present in 63.3% of women and 71.9% of partners, with concordance observed in 50.5% of couples. By comparison, 78.6% of women and 55.1% of partners had high waist circumferences, which was concordant in 48.5% of couples. Metabolic syndrome was identified in 9.2% of women and 24.0% of partners, suggesting a higher occurrence among partners with concordance in 5.1% of couples. Impaired fasting glucose was observed in 7.7% of women and 9.2% of partners, with concordance in 1.5% of couples. Stage 1 hypertension or more was observed in 31.1% of the women, 55.6% of the partners and concordant in 8.2% of couples. Cardiometabolic risk markers were associated within couples. Conclusions: Detecting GDM in women may serve as an opportunity to identify partners at risk, underscoring the potential of couple‐based or family‐focused interventions.