Pregnancy
Prediabetes during adolescence linked with adverse pregnancy outcomes

New research shows a link between prediabetes among young people and adverse pregnancy outcomes later in life – findings that could alter how doctors routinely screen or counsel youth on blood glucose levels, and subsequently, minimize potential maternal and neonatal risks.
Prediabetes is a serious health condition that occurs when blood sugar levels are higher than normal but not high enough to be diagnosed as type 2 diabetes, or persistently high blood sugar levels.
The condition can increase the risk for heart disease and stroke, and disproportionally burdens Hispanic, Black, and low-income individuals. According to JAMA Pediatrics, the prediabetes rate among youth in the United States has doubled in the last decade to nearly one in three aged 12 to 19 years.
In a new study, researchers examined the significance of prediabetes prior to conception among adolescents and young adults, a group that is most at risk of unplanned pregnancy and least likely to benefit from preconception health counselling.
“This study is an important step in tying lifecourse cardiometabolic health to optimal pregnancy outcomes,” said Teresa Janevic, PhD, associate professor of Epidemiology at Columbia University Mailman School of Public Health and senior author.
“The findings point to an opportunity to invest in adolescent health to promote later healthy pregnancies.”
The study of more than 14,000 people between ages 10 and 24 years was generated by linking New York City birth registry, hospital discharge, and A1C Registry data between 2009 and 2017 and included individuals who had no history of diabetes and at least one haemoglobin A1c (HbA1c) test prior to first birth.
The researchers found that preconception prediabetes was associated with more than twice the likelihood of gestational diabetes at future first birth. The experts discovered that prediabetes during youth and adolescence could result in an 18 per cent increased risk of hypertensive disorders during pregnancy, such as gestational hypertension and preeclampsia, or preterm delivery.
The study also assessed what level of haemoglobin A1c, a measure of a person’s average blood sugar level over the prior three months, was most predictive of gestational diabetes at first birth among adolescents and young adults.
The optimal threshold was slightly lower for young people than that used for adults (5.6 per cent vs. 5.7 per cent). Overall, the study results support the need to establish clear clinical guidance on how to screen and counsel young people who currently have elevated blood glucose levels without other risk factors, the researchers said.
“The lack of uniform preconception prediabetes treatment guidelines for adolescents may represent a missed opportunity to avert pregnancy-related complications,” said corresponding author Katharine McCarthy, PhD, assistant professor of Population Health Science and Policy, and Obstetrics, Gynecology and Reproductive Science at the Icahn School of Medicine at Mount Sinai.
“Our results support expanded preconception haemoglobin A1c screening as a mechanism to intervene on excess cardiometabolic risk earlier in the life course,” noted the researchers.
The experts will next investigate potential school policies and interventions that could reduce risks for heart and metabolism-related conditions in adolescence, and may benefit pregnancy and health outcomes across the lifespan.
The research was conducted at Columbia Mailman School of Public Health and Mount Sinai School of Medicine and published in JAMA Network Open.
Pregnancy
Pregnant women may reduce key health risk through more light exercise, study finds

Light exercise and less sitting may reduce pregnant women’s risk of serious blood pressure complications, according to a new study.
Researchers have proposed a daily activity and sleep guide that they say was linked to a nearly 30 per cent lower risk of hypertensive disorders of pregnancy.
The suggested pattern includes fewer than eight hours of sedentary time, at least seven hours of light physical activity, around 22 minutes of more intense activity and nearly nine hours of sleep.
The University of Iowa-led study examined the daily behaviours of 470 pregnant women across all stages of pregnancy.
Participants wore monitors that measured physical activity over 24-hour periods and recorded how long they spent asleep.
Hypertensive disorders of pregnancy include chronic high blood pressure, gestational hypertension and pre-eclampsia.
Gestational hypertension is high blood pressure that develops during pregnancy, while pre-eclampsia is a potentially serious condition involving high blood pressure and signs that organs may be affected.
Sedentary behaviour means being mostly inactive, such as sitting or lying down.
Light physical activity can include casual walking, moving around the home or standing.
Moderate to vigorous activity includes movement such as brisk walking, where breathing and heart rate increase.
Kara Whitaker, associate professor in the department of health, sport, and human physiology at Iowa and corresponding author of the study, said: “We are identifying the optimal composition of movement behaviours across the day associated with the lowest risk of developing HDP and the most improved health outcomes.
“This blueprint holds for each and every trimester of pregnancy.”
Study participants were enrolled at sites in Iowa City, Pittsburgh and Morgantown, West Virginia.
The women wore activity and sleep monitors for at least one week during each trimester of pregnancy.
Four in five participants were non-Hispanic white and nearly a quarter lived in rural areas.
The data showed a steep rise in risk among pregnant women who were sedentary for more than 10 hours a day.
Women who increased light physical activity to at least four hours a day reduced their risk of hypertensive disorders of pregnancy to 15 per cent from 30 per cent.
Whitaker said: “Just moving around more seems to have significant health benefits.
“And I think it also may be a more feasible target for women who are pregnant who are not exercising regularly.”
The researchers said they were surprised that longer durations of moderate to vigorous physical activity did not appear to provide additional benefit.
Sleep beyond a certain duration also did not appear to bring major further benefits.
Whitaker said: “Through this study, we are providing evidence that reducing sedentary behaviour and engaging in light physical activity are important, and maybe more important, when it comes to pregnancy and health.”
The findings may be relevant beyond pregnancy because clinical research has shown that women who develop hypertensive disorders of pregnancy are more than twice as likely to develop heart disease later in life.
Cardiovascular disease includes conditions affecting the heart and blood vessels, such as heart disease and stroke.
Whitaker said: “We know that cardiovascular disease is the number one killer of women, and if we can intervene in pregnancy and prevent women from developing a hypertensive disorder of pregnancy, we are putting them on a better trajectory, away from cardiovascular disease and toward more optimal cardiovascular health.”
The study was published online on June 10.
A second study, published online on May 27, looked more closely at the ratio and type of sedentary behaviour and light physical activity linked to a lower risk of hypertensive disorders of pregnancy.
Whitaker is a lead co-author on that study.
Co-authors in the June 10 study include Alex Crisp, Jaemyung Kim, Karina Smith, Donna Santillan, Mark Santillan and Bridget Zimmerman, from Iowa; Jacob Gallagher, from Iowa State University; Melissa Jones, from Oakland University in Michigan; Bethany Barone Gibbs, Katrina Wilhite, Alexis Thrower and Iqra Sheikh, from West Virginia University; and Sabera Rahman, Janet Catov, Christopher Kline and Maisa Feghali, from the University of Pittsburgh.
The National Institutes of Health, the University of Iowa Institute for Clinical and Translational Science, the University of Pittsburgh Clinical and Translational Science Institute and the West Virginia Clinical and Translational Science Institute funded the research.
Pregnancy
£50m initiative aims to tackle disparities in maternal healthcare
Entrepreneur
Liverpool uni secures £18.m for women’s health studio and life-saving tech

The University of Liverpool has secured £1.8m to test a device for postpartum bleeding and launch a new women’s health studio.
The PPH Butterfly is designed to help control postpartum haemorrhage, which is severe bleeding after childbirth and a leading cause of maternal death worldwide.
The funding will support research into how the device can be used in clinical practice and generate evidence to inform its wider adoption.
The university has launched the Women’s Health Innovation Studio, known as the WIN Studio, alongside the project.
The £1.8m initiative is predominantly funded by the National Institute for Health and Care Research, which is providing £1.5m, with additional support from the university.
The PPH Butterfly project will involve a multi-centre clinical trial across the UK and a global feasibility study looking at how practical it would be to use the device in different healthcare settings.
The WIN Studio is led by Andrew Weeks, professor of international maternal health care at the University of Liverpool and a senior investigator at the National Institute for Health and Care Research, and Dr Teesta Dey, a tenure track fellow in the department of women’s and children’s health.
Dr Dey will also lead the PPH Butterfly project.
Its work will cover conditions linked to female biology, including endometriosis, menopause and pregnancy-related complications.
It will also support technologies for diseases that affect women differently or disproportionately, even when they are not usually classed as gender-specific conditions.
Dr Dey said: “Women’s health has often been marginalised within healthcare systems and innovation markets, resulting in treatments, devices and care models that fail to adequately account for women’s specific needs. WIN Studio seeks to change this status quo and reconfigure how health technologies are conceived and delivered.
“The funding from NIHR for this £1.8m project is precisely the kind of innovation the WIN Studio exists to foster: clinically urgent, women-centred, and with the potential to save lives at scale.”
The studio recently hosted an event at Liverpool Women’s University Hospital as part of the Liverpool City Region Combined Authority’s Innovation Investment Fortnight.
Seven innovations are currently undergoing clinical testing through the studio, with three developed internally.
The studio will work closely with NHS University Hospitals Liverpool Group and provide clinical, regulatory and commercial support to people developing women’s health technologies.
It will also involve patients and members of the public in shaping research priorities and product development.
Its wider programme includes collaborations involving clinicians, engineers, economists, academics and policymakers.
The project team says the PPH Butterfly is a simple, low-cost device designed to control severe bleeding quickly and with minimal training.
According to the team, postpartum haemorrhage causes around 70,000 deaths globally each year, equal to about one death every seven minutes.
The device previously received £1.1m in funding from the National Institute for Health and Care Research.
The latest £1.5m grant will support a randomised UK trial, in which participants are allocated to different treatment groups by chance, and a global feasibility assessment.
Weeks said: “In an area where women face deep health inequalities, WIN Studio has a vital role to play. By working in partnership with the NHS, local government and communities, we can ensure that research leads to real-world impact.
“Liverpool has a highly integrated ecosystem of academic, clinical and commercial expertise. By bringing these together under a single platform, the WIN Studio aims to act as a national exemplar for equitable health innovation. Transforming the way medical technologies are developed is essential to addressing gender disparities in healthcare outcomes.”
Another product supported by the university, the LifeStart Trolley, has already reached commercialisation.
The small mobile resuscitation trolley allows newborn care to be carried out at the bedside while the baby’s umbilical cord remains intact, enabling delayed cord clamping.
Delayed cord clamping means waiting before cutting the cord so blood can continue flowing from the placenta to the baby after birth.
Clinical trials conducted around 10 years ago found that life-saving care could be provided successfully at the bedside using the trolley.
It was later commercialised by Inspiration Healthcare and is now used in more than 70 UK maternity units and in 36 countries, including Norway, Italy and the US.
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