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All Journal Scientific Journal of Pediatrics Sriwijaya Journal of Internal Medicine Sriwijaya Journal of Neurology
Vania Delma
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Biochemistry, Genetics & Molecular Biology Dentistry Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Nursing Public Health

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The Impact of Gestational Diabetes on Long-Term Cognitive Function: A Prospective Cohort Study with Neuroimaging Correlates in Bandung, Indonesia Miranda Aisah; Lestini Wulansari; Vania Delma; Reza Andrianto; Zahra Amir; Dedi Sucipto; Agnes Mariska; Saurie Hernandez
Sriwijaya Journal of Neurology Vol. 2 No. 1 (2024): Sriwijaya Journal of Neurology
Publisher : Phlox Institute: Indonesian Medical Research Organization

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59345/sjn.v1i2.91

Abstract

Introduction: Gestational diabetes mellitus (GDM) is a growing public health concern with potential long-term consequences for both mother and child. Emerging evidence suggests that GDM may impact maternal cognitive function, but the underlying mechanisms remain unclear. This prospective cohort study investigates the association between GDM and long-term cognitive function in mothers, exploring potential neuroimaging correlates. Methods: Pregnant women were recruited from antenatal clinics in Bandung, Indonesia, between 2018 and 2020. GDM was diagnosed using the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria. Cognitive function was assessed at 6 months, 1 year, and 3 years postpartum using a comprehensive neuropsychological battery. A subset of participants underwent structural and functional magnetic resonance imaging (MRI) at 3 years postpartum. Results: Women with GDM exhibited lower scores on tests of executive function, processing speed, and memory compared to women without GDM at all follow-up assessments. MRI analysis revealed alterations in brain structure and function inwomen with a history of GDM, including reduced gray matter volume in the prefrontal cortex and hippocampus, and altered functional connectivity within the default mode network. Conclusion: GDM is associated with long-term cognitive impairment in mothers, possibly mediated by structural and functional brain changes. These findings highlight the importance of early identification and management of GDM to mitigate potential long-term cognitive consequences.
Non-Invasive Neuromodulation for Drug-Resistant Epilepsy in Children: A Randomized Controlled Trial of Transcranial Magnetic Stimulation (TMS) versus Vagus Nerve Stimulation (VNS) in Jakarta, Indonesia Febria Suryani; Rinna Azrida; Linda Purnama; Vania Delma; Desiree Montesinos
Scientific Journal of Pediatrics Vol. 3 No. 1 (2025): Scientific Journal of Pediatrics
Publisher : Phlox Institute: Indonesian Medical Research Organization

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59345/sjped.v2i2.173

Abstract

Introduction: Drug-resistant epilepsy (DRE) significantly impacts the quality of life in children. While vagus nerve stimulation (VNS) is an established treatment, repetitive transcranial magnetic stimulation (rTMS) offers a non-invasive alternative. This study aimed to compare the efficacy and safety of rTMS versus VNS in a pediatric DRE population in Jakarta, Indonesia. Methods: This was a single-center, randomized, controlled, open-label trial conducted at Private Hospital, Jakarta. Children aged 5-18 years with DRE, defined as failure to achieve seizure freedom despite adequate trials of two appropriate antiepileptic drugs (AEDs), were randomly assigned (1:1) to receive either rTMS or VNS. The primary outcome was the percentage reduction in seizure frequency at 6 months post-intervention compared to baseline. Secondary outcomes included responder rate (≥50% seizure reduction), quality of life (QoL) using the PedsQL, cognitive function (using standardized neuropsychological tests), and adverse events. Results: A total of 60 children were randomized (30 rTMS, 30 VNS). At 6 months, the mean percentage reduction in seizure frequency was significantly greater in the rTMS group (48.5%, SD 15.2%) compared to the VNS group (35.2%, SD 12.8%) (p = 0.001). Responder rates were 63.3% for rTMS and 46.7% for VNS (p = 0.17). PedsQL scores showed a significant improvement in the rTMS group compared to baseline in the psychosocial health summary score (p = 0.005), but not the VNS group (p=0.1). No significant differences were observed in cognitive function between the groups. Adverse events were generally mild and transient in both groups, though VNS was associated with more voice alteration and coughing. Conclusion: rTMS demonstrated superior efficacy in reducing seizure frequency compared to VNS in this Indonesian pediatric DRE population. While VNS is an established method, rTMS may present a non-invasive and potentially more effective therapeutic alternative. Further, larger, multicenter studies are warranted to confirm these findings and explore long-term outcomes.
Cardiovascular Risk Stratification in Pregnant Women with Gestational Diabetes: A Comparative Analysis of Predictive Models in Padang, Indonesia Cinthya Callathea; Vania Delma; Muhammad Rusli; Bjorka Alma; Rinna Azrida
Sriwijaya Journal of Internal Medicine Vol. 3 No. 1 (2025): Sriwijaya Journal of Internal Medicine
Publisher : Phlox Institute: Indonesian Medical Research Organization

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59345/sjim.v2i2.177

Abstract

Introduction: Gestational diabetes mellitus (GDM) significantly increases the risk of both short-term and long-term cardiovascular disease (CVD) in women. Effective risk stratification during pregnancy is crucial for targeted interventions. This study aimed to compare the performance of established cardiovascular risk prediction models in a cohort of pregnant women with GDM in Padang, Indonesia. Methods: A prospective cohort study was conducted involving 350 pregnant women diagnosed with GDM at two major hospitals in Padang, Indonesia, between January 2022 and June 2023. Baseline demographic, clinical, and laboratory data were collected. Three established CVD risk prediction models – the Framingham Risk Score (FRS), the American College of Cardiology/American Heart Association (ACC/AHA) Pooled Cohort Equations (PCE), and a modified version of the PCE adapted for GDM (PCE-GDM) – were applied to calculate individual 10-year CVD risk scores. The primary outcome was the development of any major adverse cardiovascular event (MACE), defined as myocardial infarction, stroke, or cardiovascular death, or new-onset hypertension requiring medication, within one year postpartum. Model performance was assessed using discrimination (c-statistic) and calibration (Hosmer-Lemeshow goodness-of-fit test). Results: The mean age of participants was 32.4 ± 5.1 years. The prevalence of pre-existing hypertension was 8.6%, and the mean pre-pregnancy BMI was 28.5 ± 4.7 kg/m². During the one-year follow-up, 25 (7.1%) women experienced a MACE. The PCE-GDM model demonstrated the best discrimination (c-statistic = 0.82, 95% CI 0.76-0.88), followed by the PCE (c-statistic = 0.75, 95% CI 0.68-0.82), and the FRS (c-statistic = 0.68, 95% CI 0.60-0.76). The PCE-GDM also showed good calibration (χ² = 8.3, p = 0.41), while the FRS and PCE tended to underestimate risk (χ² = 18.5, p = 0.02 and χ² = 15.2, p = 0.06, respectively). Conclusion: The PCE-GDM model, specifically adapted for GDM, showed superior performance in predicting short-term cardiovascular risk compared to traditional models in this Indonesian cohort. These findings highlight the need for GDM-specific risk stratification tools to improve cardiovascular risk management in this vulnerable population.
Co-Authors Agnes Mariska Bjorka Alma Cinthya Callathea Dedi Sucipto Desiree Montesinos Febria Suryani Lestini Wulansari Linda Purnama Miranda Aisah Muhammad Rusli Reza Andrianto Rinna Azrida Saurie Hernandez Zahra Amir