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Article ; Online: The Effect of Maternal Diet and Physical Activity on the Epigenome of the Offspring.

Panagiotidou, Anastasia / Chatzakis, Christos / Ververi, Athina / Eleftheriades, Makarios / Sotiriadis, Alexandros

2024 Volume 15, Issue 1

Abstract: The aim of this review was to examine the current literature regarding the effect of maternal lifestyle interventions (i.e., diet and physical activity) on the epigenome of the offspring. PubMed, Scopus and Cochrane-CENTRAL were screened until 8 July ... ...

Abstract	The aim of this review was to examine the current literature regarding the effect of maternal lifestyle interventions (i.e., diet and physical activity) on the epigenome of the offspring. PubMed, Scopus and Cochrane-CENTRAL were screened until 8 July 2023. Only randomized controlled trials (RCTs) where a lifestyle intervention was compared to no intervention (standard care) were included. Outcome variables included DNA methylation, miRNA expression, and histone modifications. A qualitative approach was used for the consideration of the studies' results. Seven studies and 1765 mother-child pairs were assessed. The most common types of intervention were dietary advice, physical activity, and following a specific diet (olive oil). The included studies correlated the lifestyle and physical activity intervention in pregnancy to genome-wide or gene-specific differential methylation and miRNA expression in the cord blood or the placenta. An intervention of diet and physical activity in pregnancy was found to be associated with slight changes in the epigenome (DNA methylation and miRNA expression) in fetal tissues. The regions involved were related to adiposity, metabolic processes, type 2 diabetes, birth weight, or growth. However, not all studies showed significant differences in DNA methylation. Further studies with similar parameters are needed to have robust and comparable results and determine the biological role of such modifications.
MeSH term(s)	Female ; Pregnancy ; Humans ; Epigenome ; Diet ; MicroRNAs/genetics ; Obesity ; Exercise
Chemical Substances	MicroRNAs
Language	English
Publishing date	2024-01-06
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2527218-4
ISSN	2073-4425 ; 2073-4425
ISSN (online)	2073-4425
ISSN	2073-4425
DOI	10.3390/genes15010076
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Article ; Online: Gestational Diabetes Mellitus Pharmacological Prevention and Treatment.

Chatzakis, Christos / Cavoretto, Paolo / Sotiriadis, Alexandros

Current pharmaceutical design

2021 Volume 27, Issue 36, Page(s) 3833–3840

Abstract: Gestational diabetes mellitus (GDM) is one of the most common medical complications of pregnancy and is defined as glucose intolerance that first emerges or is first recognized during pregnancy. Several factors increase the risk of a pregnant woman ... ...

Abstract	Gestational diabetes mellitus (GDM) is one of the most common medical complications of pregnancy and is defined as glucose intolerance that first emerges or is first recognized during pregnancy. Several factors increase the risk of a pregnant woman developing gestational diabetes mellitus, and several interventions have been tested for the prevention of GDM development. The most common pharmacological interventions that have been assessed are metformin administration, probiotics administration, and vitamin D administration. However, no intervention appears to be universally superior to placebo/no intervention for the prevention of GDM. Administration of insulin is the preferred medication for treating hyperglycemia in gestational diabetes mellitus. Metformin and glyburide are not regarded as first-line agents, as both cross the placenta to the fetus. Even though there are sufficient data indicating that administration of metformin is safe and effective in women with GDM, there are very limited data concerning the long-term effects of metformin on the offspring. Furthermore, glyburide should be used with caution, as it increases the risk of neonatal hypoglycemia. Some studies also show that it increases the risk of macrosomia. Overall, oral agents may be a therapeutic option in women with GDM after a discussion of the known risks and the need for more long-term safety data in the offspring. The present review aims to highlight the current scientific status regarding the prevention and treatment of GDM.
MeSH term(s)	Diabetes, Gestational/drug therapy ; Diabetes, Gestational/prevention & control ; Female ; Glyburide ; Humans ; Hypoglycemic Agents/therapeutic use ; Insulin ; Metformin/therapeutic use ; Pregnancy
Chemical Substances	Hypoglycemic Agents ; Insulin ; Metformin (9100L32L2N) ; Glyburide (SX6K58TVWC)
Language	English
Publishing date	2021-01-18
Publishing country	United Arab Emirates
Document type	Journal Article ; Review
ZDB-ID	1304236-1
ISSN	1873-4286 ; 1381-6128
ISSN (online)	1873-4286
ISSN	1381-6128
DOI	10.2174/1381612827666210125155428
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Article: The Impact of a Single Supervised Exercise Session in the Third Trimester of Pregnancy on the Physical Activity Levels of Pregnant Women-A Pilot Study.

Chatzakis, Christos / Mastorakos, George / Demertzidou, Eleftheria / Theodoridou, Anatoli / Dinas, Konstantinos / Sotiriadis, Alexandros

Clinics and practice

2023 Volume 13, Issue 5, Page(s) 1227–1235

Abstract: Background: Despite the numerous beneficial effects of physical exercise during pregnancy, the levels of physical activity remain low. The aim of the study is to investigate the impact of a single supervised physical exercise session on the overall ... ...

Abstract	Background: Despite the numerous beneficial effects of physical exercise during pregnancy, the levels of physical activity remain low. The aim of the study is to investigate the impact of a single supervised physical exercise session on the overall physical activity levels of pregnant women. Methods: During the third trimester, pregnant women attending our outpatient clinic were requested to assess their physical activity levels using the International Physical Activity Questionnaire (IPAQ). Additionally, they were invited to participate in a supervised 30 min mild-moderate-intensity aerobic exercise session (stationary bike ergometer) under the guidance of medical personnel. Subsequently, physical activity levels were reevaluated at the time of delivery. Results: Prior to the intervention, 3 out of 50 (6%) women engaged in mild-moderate physical activity for 150 min per week, while 20 out of 50 (40%) women participated in mild-moderate activity for 15-30 min, twice a week. Following the intervention, these percentages increased to 10 out of 50 (20%) and 31 out of 50 (62%), respectively ( Conclusions: This pilot study suggests that a single exercise session supervised by medical personnel may significantly improve the low physical activity levels observed in pregnant women.
Language	English
Publishing date	2023-10-03
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2605724-4
ISSN	2039-7283 ; 2039-7275
ISSN (online)	2039-7283
ISSN	2039-7275
DOI	10.3390/clinpract13050110
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Article ; Online: Pregnancy outcomes in the different phenotypes of gestational diabetes mellitus based on the oral glucose tolerance test. A systematic review and meta-analysis.

Chatzakis, Christos / Eleftheriades, Anna / Demertzidou, Eleftheria / Dinas, Konstantinos / Vlahos, Nikolaos / Sotiriadis, Alexandros / Eleftheriades, Makarios

Diabetes research and clinical practice

2023 Volume 204, Page(s) 110913

Abstract: Aims: To assess the prevalence variation in pregnancy outcomes of the different phenotypes of gestational diabetes mellitus (GDM).: Materials: Cohort, cross sectional and case control studies grouping together pregnant women with GDM, based on the ... ...

Abstract	Aims: To assess the prevalence variation in pregnancy outcomes of the different phenotypes of gestational diabetes mellitus (GDM). Materials: Cohort, cross sectional and case control studies grouping together pregnant women with GDM, based on the results of oral glucose tolerance test(OGTT) and reporting pregnancy outcomes in each group, were included. The primary outcomes were (i)large for gestational age and ii)hypertensive disorders of pregnancy (HDP). The secondary outcomes included (i)insulin treatment, ii)admission to neonatal intensive care unit, iii)preterm birth, iv)small for gestational age and v)caesarean section. The pooled proportions of the outcomes of interest were calculated for each phenotype. Results: 8 studies (n = 20.928 women with GDM) were included. The pooled prevalence of LGA, HDP and insulin treatment were 20 %, 8 % and 24 % respectively in women with abnormal fasting plasma glucose,10 %, 6 % and 9 % respectively in women with abnormal post-load plasma glucose and 14 %,14 % and 30 % in women with abnormal combined plasma glucose. Conclusions: Pregnant women with abnormal fasting plasma glucose, present with the highest prevalence of LGA, while those with abnormal combined plasma glucose, present with the highest prevalence of HDP. Pregnant women with abnormal post-load plasma glucose present with the lowest need for insulin treatment.
MeSH term(s)	Pregnancy ; Female ; Infant, Newborn ; Humans ; Diabetes, Gestational/diagnosis ; Diabetes, Gestational/drug therapy ; Diabetes, Gestational/epidemiology ; Pregnancy Outcome/epidemiology ; Glucose Tolerance Test ; Blood Glucose ; Cesarean Section ; Cross-Sectional Studies ; Premature Birth/epidemiology ; Phenotype ; Insulins
Chemical Substances	Blood Glucose ; Insulins
Language	English
Publishing date	2023-09-22
Publishing country	Ireland
Document type	Meta-Analysis ; Systematic Review ; Journal Article ; Review
ZDB-ID	632523-3
ISSN	1872-8227 ; 0168-8227
ISSN (online)	1872-8227
ISSN	0168-8227
DOI	10.1016/j.diabres.2023.110913
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Article ; Online: Pregnancy physical activity questionnaire: Translation and cross-cultural adaptation of a Greek version.

Mitrogiannis, Ioannis / Chatzakis, Christos / Skentou, Chara / Koutalia, Nikoleta / Makrydimas, Stylianos / Efthymiou, Athina / Makrydimas, George

European journal of obstetrics, gynecology, and reproductive biology

2023 Volume 291, Page(s) 156–161

Abstract: Objective: The aim of this study was to translate and adapt the Pregnancy Physical Activity Questionnaire (PPAQ) into Greek culture.: Study design: The procedure followed to translate the PPAQ included the stages: forward translation, synthesis, ... ...

Abstract	Objective: The aim of this study was to translate and adapt the Pregnancy Physical Activity Questionnaire (PPAQ) into Greek culture. Study design: The procedure followed to translate the PPAQ included the stages: forward translation, synthesis, backward translation and an expert committee review. Members of the research team discussed ambiguities, discordances and equivalence at each stage. Then, the pre-final Greek version of the PPAQ was pre-tested on 46 pregnant women; a quantitative and qualitative analysis was conducted. Results: Few modifications were done to the original PPAQ, in order to ensure cultural adaptation and clinical implementation. Appropriate changes to the international metric units were done. In addition, two items have been modified to achieve relevance with Greek culture. Two items were merged into one and three items were splitted, which maintained their initial meaning. Those changes were made to match the energy expenditure compendium update for physical activities. Participants at the pre-test had a mean age of 34,23 years, response time to the questionnaire varied between 5 and 10 min and there were no missing data. No difficulties or misunderstandings were reported by the participants during pre-testing. Thus, the research team agreed on the pre-final PPAQ Greek version. Conclusion: The final PPAQ Greek version indicated transcultural equivalence to the original PPAQ in English. It is also a unique questionnaire for assessing physical activity in Greek pregnant women and will be a useful tool in clinical routine.
MeSH term(s)	Female ; Pregnancy ; Humans ; Cross-Cultural Comparison ; Pregnant Women ; Exercise/physiology ; Language ; Surveys and Questionnaires ; Reproducibility of Results
Language	English
Publishing date	2023-10-18
Publishing country	Ireland
Document type	Journal Article
ZDB-ID	190605-7
ISSN	1872-7654 ; 0301-2115 ; 0028-2243
ISSN (online)	1872-7654
ISSN	0301-2115 ; 0028-2243
DOI	10.1016/j.ejogrb.2023.10.022
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Article ; Online: Emergency cerclage in singleton pregnancies with painless cervical dilatation: A meta-analysis.

Chatzakis, Christos / Efthymiou, Athina / Sotiriadis, Alexandros / Makrydimas, George

Acta obstetricia et gynecologica Scandinavica

2020 Volume 99, Issue 11, Page(s) 1444–1457

Abstract: Introduction: Emergency cerclage is the most common active intervention in pregnant women with cervical insufficiency. This meta-analysis aimed to compare the effectiveness of emergency cerclage vs expectant management on maternal and perinatal outcomes, ...

Abstract	Introduction: Emergency cerclage is the most common active intervention in pregnant women with cervical insufficiency. This meta-analysis aimed to compare the effectiveness of emergency cerclage vs expectant management on maternal and perinatal outcomes, and to assess the current status of evidence. Material and methods: A search was conducted from 1 June 2019 until 1 September 2019 and eligible studies were identified in the MEDLINE, Scopus, Cochrane and US clinical trials registry without limitations concerning the publication dates and languages. Randomized controlled trials (RCTs), non-RCTs and observational studies comparing emergency cerclage with no cerclage/expectant management, in women presenting with painless cervical dilatation were included. Results: The electronic search yielded 3607 potential studies, of which 38 were fully reviewed and 12 observational studies (1021 participants) were included. Cerclage was superior to expectant management for the primary outcomes of preterm birth before 28 and 32 gestational weeks, OR 0.25 (95% CI 0.16-0.39, five studies, N = 392, I Conclusions: Emergency cerclage in pregnant women with painless cervical dilatation seems to decrease preterm births, prolong the pregnancy, and decrease the neonatal deaths and fetal losses, but does not increase the risk of chorioamnionitis and premature rupture of membranes. Despite the extremely favorable estimates for cerclage, the results should be viewed with caution because, as a result of the lack of randomized control trials, the quality of evidence is low to very low.
MeSH term(s)	Cerclage, Cervical ; Emergencies ; Female ; Humans ; Infant ; Infant Mortality ; Infant, Newborn ; Intensive Care, Neonatal ; Pregnancy ; Premature Birth/etiology ; Premature Birth/prevention & control ; Treatment Outcome ; Uterine Cervical Incompetence/physiopathology ; Uterine Cervical Incompetence/surgery ; Watchful Waiting
Language	English
Publishing date	2020-09-16
Publishing country	United States
Document type	Comparative Study ; Journal Article ; Meta-Analysis ; Systematic Review
ZDB-ID	80019-3
ISSN	1600-0412 ; 0001-6349
ISSN (online)	1600-0412
ISSN	0001-6349
DOI	10.1111/aogs.13968
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Article: STORK: Collaborative Online Monitoring of Pregnancies Complicated with Gestational Diabetes Mellitus.

Chatzakis, Christos / Floros, Dimitris / Liberis, Anastasios / Gerede, Aggeliki / Dinas, Konstantinos / Pitsianis, Nikos / Sotiriadis, Alexandros

Healthcare (Basel, Switzerland)

2022 Volume 10, Issue 4

Abstract: Background: A novel digital platform, named STORK, was developed in the COVID-19 pandemic when clinic visits were restricted. A study of its clinical use during the pandemic was conducted. The study aims to advance the state of the art in monitoring and ... ...

Abstract	Background: A novel digital platform, named STORK, was developed in the COVID-19 pandemic when clinic visits were restricted. A study of its clinical use during the pandemic was conducted. The study aims to advance the state of the art in monitoring and care of pregnancies complicated with gestational diabetes mellitus (GDM) via online collaboration between patients and care providers. Methods: This study involved 31 pregnant women diagnosed with GDM and 5 physicians. Statistical comparisons were made in clinic-visit frequency and adverse outcomes between the STORK group and a historical control group of 32 women, compatible in size, demographics, anthropometrics and medical history. Results: The average number of submitted patient measurements per day was 3.6±0.4. The average number of clinic visits was 2.9±0.7 for the STORK group vs. 4.1±1.1 for the control group (p<0.05). The number of neonatal macrosomia cases was 2 for the STORK group vs. 3 for the control group (p>0.05); no other adverse incidents. Conclusions: The patient compliance with the pilot use of STORK was high and the average number of prenatal visits was reduced. The results suggest the general feasibility to reduce the average number of clinic visits and cost, with enhanced monitoring, case-specific adaptation, assessment and care management via timely online collaboration.
Language	English
Publishing date	2022-03-31
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2721009-1
ISSN	2227-9032
ISSN	2227-9032
DOI	10.3390/healthcare10040653
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Article ; Online: Prevalence of preeclampsia and uterine arteries resistance in the different phenotypes of gestational diabetes mellitus.

Chatzakis, Christos / Sotiriadis, Alexandros / Demertzidou, Eleftheria / Eleftheriades, Anna / Dinas, Konstantinos / Vlahos, Nikolaos / Eleftheriades, Makarios

Diabetes research and clinical practice

2022 Volume 195, Page(s) 110222

Abstract: Aims: This study aims to investigate the different phenotypes of Gestational Diabetes Mellitus (GDM), in correlation to preeclampsia and uterine arteries resistance.: Materials: This is a prospective cohort study including women with and without GDM ... ...

Abstract	Aims: This study aims to investigate the different phenotypes of Gestational Diabetes Mellitus (GDM), in correlation to preeclampsia and uterine arteries resistance. Materials: This is a prospective cohort study including women with and without GDM per the IADPSG criteria. Three phenotypes of GDM emerged, women with only abnormal fasting (AF) glucose levels, women with only abnormal post-load (AP) glucose levels at 60' and/or 120' and women with abnormal combined (AC) fasting and post-load glucose values. All women underwent uterine arteries doppler examination in the three trimesters and assessed for preeclampsia development. Linear regression was used to express the trajectories of uterine arteries resistance throughout the pregnancy. Results: 6928 pregnant women were included, 5274 without GDM and 1654 with GDM. 546, 781 and 327 of GDM pregnancies presented with AF, AP and AC phenotypes respectively. Prevalence of preeclampsia was 17.9%, 26.8% and 30% in the AF, AP and AC phenotypes respectively (p < 0.001). In women who developed preeclampsia, AC phenotype presented with statistically different trajectory of Uterine Arteries Pulsatility Index Percentiles b = 0.129 than women without GDM and women with AP GDM phenotype b = -0.015 and b = -0.016 respectively. Conclusions: The combined abnormal phenotype presents with the highest rate of preeclampsia and the most distinct pattern of uterine arteries resistance.
MeSH term(s)	Pregnancy ; Female ; Humans ; Diabetes, Gestational/epidemiology ; Diabetes, Gestational/diagnosis ; Pre-Eclampsia/epidemiology ; Prospective Studies ; Prevalence ; Uterine Artery/diagnostic imaging ; Glucose Tolerance Test ; Glucose ; Blood Glucose
Chemical Substances	Glucose (IY9XDZ35W2) ; Blood Glucose
Language	English
Publishing date	2022-12-15
Publishing country	Ireland
Document type	Journal Article
ZDB-ID	632523-3
ISSN	1872-8227 ; 0168-8227
ISSN (online)	1872-8227
ISSN	0168-8227
DOI	10.1016/j.diabres.2022.110222
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Article ; Online: Decreased flow-mediated dilation in gestational diabetes in pregnancy and post-partum. A systematic review and meta-analysis.

Chatzakis, Christos / Koletsos, Nikolaos / Tirta, Maria / Dinas, Konstantinos / Gkaliagkousi, Eugenia / Sotiriadis, Alexandros

Diabetes/metabolism research and reviews

2022 Volume 39, Issue 2, Page(s) e3600

Abstract: Aims: Gestational diabetes mellitus (GDM) is a common medical complication during pregnancy. Endothelial dysfunction is considered an early step in the progression of atherosclerosis that may contribute to subclinical target organ damage. This meta- ... ...

Abstract	Aims: Gestational diabetes mellitus (GDM) is a common medical complication during pregnancy. Endothelial dysfunction is considered an early step in the progression of atherosclerosis that may contribute to subclinical target organ damage. This meta-analysis aimed to systemically review the existing data regarding endothelial dysfunction between women with and without GDM during pregnancy and post-partum using flow-mediated dilation (FMD). Materials and methods: Eligible studies (cohort and observational) published until October 2021 were identified in the MEDLINE, Scopus, Cochrane Library database and grey literature sources were searched. Results: The search yielded 2272 studies, of which 17 were fully reviewed and 12 studies (N = 740 pregnant women) were finally included. Pregnant women with GDM exhibited a significantly lower FMD compared to pregnant women without GDM (pooled mean difference -3.12; 95% CI -5.36 to -0.88). Moreover, in the immediate (1-6 months) post-partum period, women with previous GDM showed lower FMD compared to healthy women without GDM history (pooled mean difference -7.52; 95% CI -9.44 to -5.59), whereas FMD did not differ in the late post-partum period (more than 4 years). Conclusions: Flow-mediated dilation is decreased in women with GDM during pregnancy and in the immediate post-partum period, compared to women without GDM, indicating that the endothelial dysfunction noted during the pregnancy in those women persists in the immediate post-partum period too. Clinical trial registration: PROSPERO CRD42021283113 (www. Clinicaltrials: gov).
MeSH term(s)	Pregnancy ; Female ; Humans ; Diabetes, Gestational ; Dilatation/adverse effects ; Postpartum Period ; Vascular Diseases
Language	English
Publishing date	2022-12-20
Publishing country	England
Document type	Meta-Analysis ; Systematic Review ; Journal Article
ZDB-ID	1470192-3
ISSN	1520-7560 ; 1520-7552
ISSN (online)	1520-7560
ISSN	1520-7552
DOI	10.1002/dmrr.3600
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Article: Uterine Arteries Resistance in Pregnant Women with Gestational Diabetes Mellitus, Diabetes Mellitus Type 1, Diabetes Mellitus Type 2, and Uncomplicated Pregnancies.

Chatzakis, Christos / Eleftheriades, Makarios / Demertzidou, Eleftheria / Eleftheriades, Anna / Koletsos, Nikolaos / Lavasidis, Lazaros / Zikopoulos, Athanasios / Dinas, Konstantinos / Sotiriadis, Alexandros

Biomedicines

2023 Volume 11, Issue 12

Abstract: Background: The examination of the uterine arteries using Doppler in the first trimester of pregnancy serves as a valuable tool for evaluating the uteroplacental circulation. Diabetes mellitus is associated with altered placental implantation and ... ...

Abstract	Background: The examination of the uterine arteries using Doppler in the first trimester of pregnancy serves as a valuable tool for evaluating the uteroplacental circulation. Diabetes mellitus is associated with altered placental implantation and pregnancy-related pathologies, such as preeclampsia. The aim of this study was to compare the uterine arteries' pulsatility indices (UtA PI) in women with diabetes mellitus type 1 (DM1), diabetes mellitus type 2 (DM2), gestational diabetes mellitus (GDM), and uncomplicated pregnancies. Methods: This was a retrospective case-control trial including pregnant women with DM1, DM2, GDM, and uncomplicated pregnancies, presenting for first-trimester ultrasound screening in two tertiary university hospitals between 2013 and 2023. The first-trimester UtA pulsatility index (PI), expressed in multiples of medians (MoMs), was compared between the four groups. Results: Out of 15,638 pregnant women, 58 women with DM1, 67 women with DM2, 65 women with GDM, and 65 women with uncomplicated pregnancies were included. The mean UtA PI were 1.00 ± 0.26 MoMs, 1.04 ± 0.32 MoMs, 1.02 ± 0.31 MoMs, and 1.08 ± 0.33 MoMs in pregnant women with DM1, DM2, GDM, and uncomplicated pregnancies, respectively ( Conclusions: Potential alterations in the implantation of the placenta in pregnant women with diabetes were not displayed in the first-trimester pulsatility indices of the uterine arteries, as there were no changes between the groups.
Language	English
Publishing date	2023-11-21
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2720867-9
ISSN	2227-9059
ISSN	2227-9059
DOI	10.3390/biomedicines11123106
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