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Zhang X, Liao Q, Wang F, Li D. Association of gestational diabetes mellitus and abnormal vaginal flora with adverse pregnancy outcomes. Medicine (Baltimore) 2018; 97:e11891. [PMID: 30142788 PMCID: PMC6112872 DOI: 10.1097/md.0000000000011891] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 07/07/2018] [Indexed: 12/26/2022] Open
Abstract
Gestational diabetes mellitus (GDM) is associated with adverse perinatal outcomes. This study aimed to examine the association between GDM and abnormal vaginal flora, and the association between abnormal vaginal flora and adverse pregnancy outcomes.This was a prospective study of pregnant women who visited Xuanwu Hospital of the Capital Medical University (Beijing, China) between February and October 2015. All women were screened for GDM according to the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) recommendations. Vaginal secretions were sampled at 28 to 30 and 37 to 40 weeks. Microorganisms were examined.The women were 28.3 ± 2.6 years and their body mass index was 22.8 ± 1.4 kg/m. GDM was associated with higher frequencies of vulvovaginal candidiasis (22.6% vs 9.7%, P < .001), premature rupture of membranes (PROM) (22.6% vs 11.5%, P = .004), premature delivery (16.1% vs 5.5%, P = .02), chorioamnionitis/puerperal infection (19.4% vs 4.5%, P < .001), macrosomia (9.7% vs 4.0%, P = .04), neonatal hypoglycemia (5.4% vs 1.0%, P = .02), and neonatal referral (15.1% vs 6.5%, P = .008). Among healthy women, abnormal flora was associated with PROM (19.4% vs 7.5%, P = .02) and chorioamnionitis/puerperal infection (11.9% vs 0.8%, P < .001). Among women with GDM, abnormal flora was associated with PROM (32.1% vs 10.0%, P < .001), premature delivery (17.7% vs 6.3%, P = .04), and chorioamnionitis/puerperal infection (32.8% vs 2.5%, P < .001).The vaginal infection rate was higher in patients with GDM compared with healthy pregnant women. GDM and abnormal vaginal flora were both associated with adverse pregnancy outcomes. The vaginal Lactobacillus species were different between the 2 groups, which could contribute to the adverse outcomes.
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Affiliation(s)
- Xinhong Zhang
- Department of Obstetrics and Gynecology, Xuanwu Hospital, Capital Medical University
| | - Qinping Liao
- Department of Obstetrics and Gynecology, Xuanwu Hospital, Capital Medical University
- Department of Obstetrics and Gynecology, Beijing Tsinghua Changgung Hospital, Beijing 102218, China
| | - Fengying Wang
- Department of Obstetrics and Gynecology, Xuanwu Hospital, Capital Medical University
| | - Dan Li
- Department of Obstetrics and Gynecology, Xuanwu Hospital, Capital Medical University
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Characteristics of different risk factors and fasting plasma glucose for identifying GDM when using IADPSG criteria: a cross-sectional study. BMC Pregnancy Childbirth 2018; 18:225. [PMID: 29898685 PMCID: PMC6001029 DOI: 10.1186/s12884-018-1875-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 05/31/2018] [Indexed: 11/10/2022] Open
Abstract
Background The Swedish National Board of Health and Welfare (SNBHW) recommended the new diagnostic criteria for GDM based upon Hyperglycaemia and Adverse Pregnancy Outcomes (HAPO) study thresholds. Due to limited knowledge base, no recommendations were made on GDM screening. The aim of this study is to evaluate test characteristics of risk factors and fasting blood glucose as screening tests for diagnosing GDM using diagnostic thresholds based upon HAPO study 1.75/2.0 (model I/II respectively) odds ratio for adverse pregnancy outcomes. Methods This cross-sectional, population-based study included all pregnant women who attended maternal health care in Örebro County, Sweden between the years 1994–96. A 75 g OGTT with capillary fasting and 2-h blood glucose was offered to all pregnant women at week 28–32. Risk factors and repeated random glucose samples were collected. Sensitivity, specificity and predictive values of blood glucose were calculated. Results Prevalence of GDM was 11.7% with model I and 7.2% with the model II criteria. Risk factors showed 28%, (95% CI 24–32) and 31%, (95% CI 25–37) sensitivity for model I and II respectively. A fasting cut off ≥4.8 mmol/l occurred in 24% of women with 91%, (95% CI 88–94) sensitivity and 85%, (95% CI 83–86) specificity using model I while a fasting cut off ≥5.0 mmol/l occurred in 14% with 91%, (95% CI 87–94) sensitivity and 92%, (95% CI 91–93) specificity using model II. Conclusion Risk factor screening for GDM was found to be poorly predictive of GDM but fasting glucose of 4.8–5.0 mmol/l showed good test characteristics irrespective of diagnostic model and results in a low rate of OGTTs.
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Joint position statement on universal screening for GDM in Europe by FIGO, EBCOG and EAPM. Eur J Obstet Gynecol Reprod Biol 2018; 228:329-330. [PMID: 29895471 DOI: 10.1016/j.ejogrb.2018.05.037] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 05/25/2018] [Indexed: 11/21/2022]
Abstract
Hyperglycaemia in Pregnancy (HIP) is a global issue as it increases risks for both the mother and child. There remains considerable disparity in clinical practice and national policies for HIP screening. FIGO, EBCOG and EAPM have joined forces to address this disparity in clinical care and reduce the burden of inter-generational Non-Communicable disease.
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Radwan H, Hashim M, Shaker Obaid R, Hasan H, Naja F, Al Ghazal H, Jan Jan Mohamed H, Rizk R, Al Hilali M, Rayess R, Izzaldin G. The Mother-Infant Study Cohort (MISC): Methodology, challenges, and baseline characteristics. PLoS One 2018; 13:e0198278. [PMID: 29851999 PMCID: PMC5978878 DOI: 10.1371/journal.pone.0198278] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 05/16/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The United Arab Emirates (UAE) exhibits alarming high prevalence of Non-Communicable Diseases (NCDs) and their risk factors. Emerging evidence highlighted the role of maternal and early child nutrition in preventing later-onset NCDs. The objectives of this article are to describe the design and methodology of the first Mother and Infant Study Cohort (MISC) in UAE; present the baseline demographic characteristics of the study participants; and discuss the challenges of the cohort and their respective responding strategies. METHODS The MISC is an ongoing two-year prospective cohort study which recruited Arab pregnant women in their third trimester from prenatal clinics in Dubai, Sharjah and Ajman. Participants will be interviewed six times (once during pregnancy, at delivery, and at 2, 6, 12 and 24months postpartum). Perinatal information is obtained from hospital records. Collected data include socio-demographic characteristics, lifestyle, dietary intake and anthropometry; infant feeding practices, cognitive development; along with maternal and infant blood profile and breast milk profile. RESULTS The preliminary results reported that 256 completed baseline assessment (mean age: 30.5±6.0 years; 76.6% multiparous; about 60% were either overweight or obese before pregnancy). The prevalence of gestational diabetes was 19.2%. Upon delivery, 208 women-infant pairs were retained (mean gestational age: 38.5±1.5 weeks; 33.3% caesarean section delivery; 5.3% low birthweight; 5.7% macrosomic deliveries). Besides participant retention, the main encountered challenges pertained to cultural complexity, underestimation the necessary start-up time, staff, and costs, and biochemical data collection. CONCLUSIONS Despite numerous methodological, logistical and sociocultural challenges, satisfactory follow-up rates are recorded. Strategies addressing challenges are documented, providing information for planning and implementing future birth cohort studies locally and internationally.
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Affiliation(s)
- Hadia Radwan
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, Research Institute of Medical and Health Sciences(RIMHS), University of Sharjah, Sharjah, United Arab Emirates
| | - Mona Hashim
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, Research Institute of Medical and Health Sciences(RIMHS), University of Sharjah, Sharjah, United Arab Emirates
| | - Reyad Shaker Obaid
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, Research Institute of Medical and Health Sciences(RIMHS), University of Sharjah, Sharjah, United Arab Emirates
| | - Hayder Hasan
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, Research Institute of Medical and Health Sciences(RIMHS), University of Sharjah, Sharjah, United Arab Emirates
| | - Farah Naja
- Department of Nutrition and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Hessa Al Ghazal
- Family Health Promotion Center, Sharjah, United Arab Emirates
| | | | - Rana Rizk
- Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
- Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie (INSPECT-LB), The Lebanese University, Beirut, Lebanon
| | - Marwa Al Hilali
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, Research Institute of Medical and Health Sciences(RIMHS), University of Sharjah, Sharjah, United Arab Emirates
| | - Rana Rayess
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, Research Institute of Medical and Health Sciences(RIMHS), University of Sharjah, Sharjah, United Arab Emirates
| | - Ghamra Izzaldin
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, Research Institute of Medical and Health Sciences(RIMHS), University of Sharjah, Sharjah, United Arab Emirates
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Reyes-Muñoz E, Sandoval-Osuna NL, Reyes-Mayoral C, Ortega-González C, Martínez-Cruz N, Ramírez-Torres MA, Arce-Sánchez L, Lira-Plascencia J, Estrada-Gutiérrez G, Montoya-Estrada A. Sensitivity of fasting glucose for gestational diabetes mellitus screening in Mexican adolescents based on International Association of Diabetes and Pregnancy Study Groups criteria: a diagnostic accuracy study based on retrospective data analysis. BMJ Open 2018; 8:e021617. [PMID: 29654051 PMCID: PMC5905784 DOI: 10.1136/bmjopen-2018-021617] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 02/24/2018] [Accepted: 03/02/2018] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To evaluate fasting plasma glucose (FPG) as a screening test for gestational diabetes mellitus (GDM) among Mexican adolescents using International Association of Diabetes and Pregnancy Study Groups criteria. DESIGN Retrospective cohort study. SETTING Level-three medical institution in Mexico City. PARTICIPANTS The study population comprised 1061 adolescent women aged 12-19 years with singleton pregnancies, who underwent a 75 g oral glucose tolerance test (OGTT) between 11 and 35 weeks of gestation. PRIMARY AND SECONDARY OUTCOME MEASURES The sensitivity (Sn), specificity (Sp), positive and negative predictive values (PPV and NPV, respectively), and positive and negative likelihood ratios LR (+) and LR (-), respectively) with 95% CIs for selected FPG cut-off values were compared. Secondary measures were perinatal outcomes in women with and without GDM. RESULTS GDM was present in 71 women (6.7%, 95% CI 5.3% to 8.4%). The performances of FPG at thresholds of ≥80 (4.5 mmol/L), 85 (4.7 mmol/L) and 90 mg/dL (5.0 mmol/L) were as follow (95% CI): Sn: 97% (89% to 99%), 94% (86% to 97%) and 91% (82% to 95%); Sp: 50% (47% to 53%), 79% (76% to 81%) and 97% (95% to 97%); PPV: 12% (9% to 15%), 23% (18% to 28%) and 64% (54% to 73%); NPV: 99% (98.5% to 99.9%) for all three cut-offs; LR (+): 1.9 (1.8 to 2.1), 4.3 (3.8 to 5.0) and 26.7 (18.8 to 37.1) and LR (-): 0.06 (0.02 to 0.23), 0.07 (0.03 to 0.19) and 0.09 (0.04 to 0.19), respectively. No significant differences in perinatal outcomes were found between adolescents with and without GDM. CONCLUSIONS An FPG cut-off of ≥90 mg/dL (5.0 mmol/L) is ideal for GDM screening in Mexican adolescent women. An FPG threshold of 90 mg/dL would miss 6 (8.5%) women with GDM, pick up 34 (3.4%) women without GDM and avoid 962 (90.7%) OGTTs.
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Affiliation(s)
- Enrique Reyes-Muñoz
- Department of Gynecological and Perinatal Endocrinology, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Norma Lidia Sandoval-Osuna
- Division of Obstetrics and Gynecology, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Christian Reyes-Mayoral
- Division of Obstetrics and Gynecology, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Carlos Ortega-González
- Department of Endocrinology, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Nayeli Martínez-Cruz
- Department of Endocrinology, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - María Aurora Ramírez-Torres
- Department of Endocrinology, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Lidia Arce-Sánchez
- Department of Endocrinology, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Josefina Lira-Plascencia
- Research Unit in Adolescent Medicine, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Guadalupe Estrada-Gutiérrez
- Direction of Research, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Araceli Montoya-Estrada
- Department of Gynecological and Perinatal Endocrinology, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
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Yan Y, Liu Z, Liu D. Heterogeneity of glycometabolism in patients with gestational diabetes mellitus: Retrospective study of 1,683 pregnant women. J Diabetes Investig 2017; 8:554-559. [PMID: 27863107 PMCID: PMC5497052 DOI: 10.1111/jdi.12595] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 10/05/2016] [Accepted: 11/06/2016] [Indexed: 01/14/2023] Open
Abstract
AIMS/INTRODUCTION To evaluate the glycometabolism and outcomes of gestational diabetes mellitus (GDM) patients according to the International Association of Diabetes and Pregnancy Study Group (IADPSG) criteria in China. MATERIALS AND METHODS According to the results of a 75-g oral glucose tolerance test, 1,683 pregnant women were divided into three groups: (i) an increment GDM group (patients meet the IADPSG criteria, but not the previous Chinese criteria); (ii) a stock GDM group (patients meet both criteria); and (iii) a normal glucose tolerance group. Their glycometabolism outcomes, prepregnancy and postpartum body mass index were compared, as were maternal-fetal outcomes. RESULTS The IADPSG and previous Chinese criteria diagnosed 12.4% and 5.5% of women with GDM. Pairwise comparison showed significant differences in 1-h plasma glucose, 2-h plasma glucose, HbA1c values and area under curve of glucose among all groups (P < 0.01). The fasting plasma glucose and postpartum body mass index of the stock group were significantly higher than those of the other two groups (P < 0.01). The incidences of hypertensive disorder complicating pregnancy and cesarean section of the normal glucose tolerance group were significantly lower than those of the other two groups (P < 0.001). No significant differences in patient age, prepregnancy body mass index, duration of pregnancy, prevalence of premature labor, premature rupture of membranes, neonatal jaundice, neonatal asphyxia or Ponderal Index were observed, but significant differences in macrosomia and neonatal hypoglycemia were observed (P < 0.05). CONCLUSIONS The IADPSG criteria doubled the number of GDM patients. The cases of the increment patients were mild. The IADPSG criteria should be discussed fully before implementation in China.
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Affiliation(s)
- Yan Yan
- Department of ObstetricsShanghai First Maternity and Infant HospitalTongji UniversityShanghaiChina
| | - Zhou Liu
- Department of Obstetrics and GynecologyShanghai Zhoupu HospitalShanghaiChina
| | - Daqing Liu
- Department of Obstetrics and GynecologyShanghai Seventh People's HospitalShanghaiChina
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Petrović O, Belci D. A critical appraisal and potentially new conceptual approach to screening and diagnosis of gestational diabetes. J OBSTET GYNAECOL 2017; 37:691-699. [PMID: 28467229 DOI: 10.1080/01443615.2017.1306692] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The aim of this article was a critical appraisal of current GDM screening and diagnosis status as well as a presentation of a potentially new approach to this perinatologic and public health problem of increasing clinical significance. Medline, EMBASE and Cochrane databases were searched. Most professional organisations recommend universal screening at 24-28 weeks of gestation, while some of them state that selective screening could also be recommended. Expert opinions regarding GDM diagnosis significantly differ throughout the world. Authors call for an open and broad professional and scientific discussion and suggest a combination of screening and diagnosis procedures in a form of one-step 1-h screening method, creation of regional GDM diagnostic criteria and standardisation of outcome-based randomised control trials. They also advise introduction of a conceptually new approach, where the risk of hyperglycaemia rather than insisting on GDM diagnosis itself should be detected.
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Affiliation(s)
- Oleg Petrović
- a Department of Gynaecology and Obstetrics, Perinatal Unit , University Hospital Centre Rijeka , Rijeka , Croatia
| | - Dragan Belci
- b Department of Gynaecology , General Hospital Pula , Pula , Croatia
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Kuo CH, Chen SC, Fang CT, Nien FJ, Wu ET, Lin SY, Chuang LM, Lee CN, Li HY. Screening gestational diabetes mellitus: The role of maternal age. PLoS One 2017; 12:e0173049. [PMID: 28296923 PMCID: PMC5351872 DOI: 10.1371/journal.pone.0173049] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 02/14/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Using a specific cutoff of fasting plasma glucose (FPG) to screen gestational diabetes mellitus (GDM) can reduce the use of oral glucose tolerance tests (OGTT). Since the prevalence of GDM increases with age, this screening method may not be appropriate in healthcare systems where women become pregnant at older ages. Therefore, we aimed to develop a screening algorithm for GDM that takes maternal age into consideration. METHODS We included 945 pregnant women without history of GDM who received 75g OGTT to diagnose GDM in 2011. Screening algorithms using FPG with or without age were developed. Another 362 pregnant women were recruited in 2013-2015 as the validation cohort. RESULTS Using FPG criteria alone, more GDM diagnoses were missed in women ≥35 years than in women <35 years (13.2% vs. 5.8%, p <0.001). Among GDM women ≥35 years, 63.6% had FPG <92 mg/dL (5.1 mmol/L). Use of the algorithm with an "age plus FPG" cutoff could reduce the use of OGTT (OGTT%) from 77.6% to 62.9%, while maintaining good sensitivity (from 91.9% to 90.2%) and specificity (from 100% to 100%). Similar reduction in OGTT% was found in the validation cohort (from 86.4% to 76.8%). In the simulation, if the percentage of women ≥35 years were 40% or more, the screening algorithm with an "age plus FPG" cutoff could further reduce OGTT% by 11.0%-18.8%. CONCLUSIONS A screening algorithm for GDM that takes maternal age into consideration can reduce the use of OGTT when women become pregnant at older ages.
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Affiliation(s)
- Chun-Heng Kuo
- Department of Internal Medicine, New Taipei City Hospital, New Taipei City, Taiwan
| | - Szu-Chi Chen
- Department of Internal Medicine, New Taipei City Hospital, New Taipei City, Taiwan
| | - Chi-Tai Fang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Feng-Jung Nien
- Department of Internal Medicine, National Taiwan University Hospital, Yun-lin branch, Yun-lin, Taiwan
| | - En-Tzu Wu
- Department of Obstetrics and Gynecology, Dianthus MFM Clinic, Taiwan
| | - Shin-Yu Lin
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
| | - Lee-Ming Chuang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chien-Nan Lee
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
- * E-mail: (HYL); (CNL)
| | - Hung-Yuan Li
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- * E-mail: (HYL); (CNL)
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Abstract
Gestational diabetes mellitus (GDM) is the most common medical complication of pregnancy. It is associated with maternal and neonatal adverse outcomes. Maintaining adequate blood glucose levels in GDM reduces morbidity for both mother and baby. There is a lack of uniform strategies for screening and diagnosing GDM globally. This review covers the latest update in the diagnosis and management of GDM. The initial treatment of GDM consists of diet and exercise. If these measures fail to achieve glycemic goals, insulin should be initiated. Insulin analogs are more physiological than human insulin, and are associated with less risk of hypoglycemia, and may provide better glycemic control. Insulin lispro, aspart, and detemir are approved to be used in pregnancy. Insulin glargine is not approved in pregnancy, but the existing studies did not show any contraindications. The use of oral hypoglycemic agents; glyburide and metformin seems to be safe and effective in pregnancy.
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Affiliation(s)
- Eman M Alfadhli
- Department of Internal Medicine, Endocrine Section, Taibah University Medical College, Al-Madinah Al-Munawwarah, Kingdom of Saudi Arabia. Fax. +966 (14) 8443195. E-mail.
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Satodiya M, Takkar N, Goel P, Kaur J. Comparison of One-Step Versus Two-Step Screening for Diagnosis of GDM in Indian Population: A Randomized Controlled Trial. J Obstet Gynaecol India 2016; 67:190-195. [PMID: 28546666 DOI: 10.1007/s13224-016-0955-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 11/11/2016] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To compare the incidence, maternal and fetal outcomes of gestational diabetes mellitus using one step versus two steps as a screening procedure. METHODOLOGY A prospective randomized trial involving screening of 1000 pregnant women for gestational diabetes mellitus was conducted. Women were divided in two groups (500 each). Group A comprised of patients screened with two-step approach (ACOG recommendation), and group B comprised of women screened by one-step method (IADPSG criteria). Women diagnosed with 'gestational diabetes' were followed in an antenatal clinic, and incidence of GDM and maternal and fetal outcome between two groups were analyzed using SPSS. RESULTS The incidence of GDM was almost double using one-step versus two-step approach which was 19.2 and 11.8%, respectively. Maternal outcomes were comparable in both the groups except the risk of preterm delivery which was 2.5 times more in group A than group B (odds ratio = 2.43 95% CI 1.01-5.79). Further, fetal outcomes were also comparable except neonatal hypoglycemia which was seen in 29.31% in group A versus 7.4% in group B. In the group B, 15 patients (15.8%) with GDM (based on FBS ≥ 92 mg/dl at first ANC visit) showed clinical symptoms and blood sugars in hypoglycemic range on MNT requiring resumption of normal diet. CONCLUSION The incidence of GDM using IADPSG criteria was almost double versus ACOG criteria. Maternal and fetal outcomes were comparable except in 15.8% women diagnosed as GDM (using FBS ≥ 92 mg/dl at first ANC visit as per IADPSG) and suffered from hypoglycemia. A large trial is being proposed before these criteria are adopted.
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Affiliation(s)
- Mohit Satodiya
- Department of Obstetrics and Gynecology, Govt. Medical College and Hospital, D Block, Level IV, GMCH, Sector 32, Chandigarh, 160030 India
| | - Navneet Takkar
- Department of Obstetrics and Gynecology, Govt. Medical College and Hospital, D Block, Level IV, GMCH, Sector 32, Chandigarh, 160030 India
| | - Poonam Goel
- Department of Obstetrics and Gynecology, Govt. Medical College and Hospital, D Block, Level IV, GMCH, Sector 32, Chandigarh, 160030 India
| | - Jasbinder Kaur
- Department of Biochemistry, Govt. Medical College and Hospital, Chandigarh, 160030 India
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Shahbazian H, Nouhjah S, Shahbazian N, Jahanfar S, Latifi SM, Aleali A, Shahbazian N, Saadati N. Gestational diabetes mellitus in an Iranian pregnant population using IADPSG criteria: Incidence, contributing factors and outcomes. Diabetes Metab Syndr 2016; 10:242-246. [PMID: 27350363 DOI: 10.1016/j.dsx.2016.06.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 06/11/2016] [Indexed: 12/16/2022]
Abstract
AIMS Different approaches for screening and diagnosis of gestational diabetes mellitus(GDM) have great impact on all process of management of gestational diabetes and its future complications. The aims of this study were to evaluate rate, risk factors and outcomes of GDM based on International Association of Diabetes and Pregnancy Study Groups diagnostic criteria. MATERIALS In a prospective study pregnant women attended 5 clinics in Ahvaz, screened for gestational diabetes mellitus using IADPSG criteria and followed up delivery from August 2014 to February 2015. At the first prenatal visit women underwent the fasting blood sugar test. A 75-g oral glucose tolerance test (OGTT) was performed for 750 mothers between 24 and 32 weeks of gestation. Logistic regression test for calculating the odds ratios and 95% confidence intervals was used. RESULTS The mean age of participants was 28.43±5.52years. The overall rate of GDM in our study was 29.9% (224/750). Incidence of gestational diabetes was associated with age group≥35years [OR=1.92(95% CI, 1.19-3.09)], family history of diabetes [OR=2.47(95% CI, 1.33-4.59)], previous GDM [OR=3.12(1.35-7.19)], BMI≥25 [OR=1, 71(1.10-2.67)] Using logistic regression. The most common maternal complication in studied women was cesarean section followed by hypertension and preeclampsia. CONCLUSION About one third of studied women diagnosed as GDM according to the IADPSG criteria. Risk factors of GDM were maternal age, family history of diabetes, Previous GDM, overweight and obesity before pregnancy, the same reported factors with 2 steps approach. Higher rate of GDM using this criterion may increase concern about healthcare costs and workloads.
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Affiliation(s)
- Hajieh Shahbazian
- Health Research Institute, Diabetes Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Sedigheh Nouhjah
- Health Research Institute, Diabetes Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Nahid Shahbazian
- Obstetrics and Gynecology Department, Fertility Infertility and Perinatology Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Shayesteh Jahanfar
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Seyed Mahmoud Latifi
- Health Research Institute, Diabetes Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Armaghan Aleali
- Health Research Institute, Diabetes Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Nasrin Shahbazian
- Health Research Institute, Diabetes Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Najmieh Saadati
- Obstetrics and Gynecology Department, Fertility Infertility and Perinatology Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Dozio E, Briganti S, Delnevo A, Vianello E, Ermetici F, Secchi F, Sardanelli F, Morricone L, Malavazos AE, Corsi Romanelli MM. Relationship between soluble receptor for advanced glycation end products (sRAGE), body composition and fat distribution in healthy women. Eur J Nutr 2016; 56:2557-2564. [DOI: 10.1007/s00394-016-1291-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 08/02/2016] [Indexed: 01/01/2023]
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63
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Agarwal MM. Gestational diabetes mellitus: Screening with fasting plasma glucose. World J Diabetes 2016; 7:279-89. [PMID: 27525055 PMCID: PMC4958688 DOI: 10.4239/wjd.v7.i14.279] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 05/30/2016] [Accepted: 06/27/2016] [Indexed: 02/05/2023] Open
Abstract
Fasting plasma glucose (FPG) as a screening test for gestational diabetes mellitus (GDM) has had a checkered history. During the last three decades, a few initial anecdotal reports have given way to the recent well-conducted studies. This review: (1) traces the history; (2) weighs the advantages and disadvantages; (3) addresses the significance in early pregnancy; (4) underscores the benefits after delivery; and (5) emphasizes the cost savings of using the FPG in the screening of GDM. It also highlights the utility of fasting capillary glucose and stresses the value of the FPG in circumventing the cumbersome oral glucose tolerance test. An understanding of all the caveats is crucial to be able to use the FPG for investigating glucose intolerance in pregnancy. Thus, all health professionals can use the patient-friendly FPG to simplify the onerous algorithms available for the screening and diagnosis of GDM - thereby helping each and every pregnant woman.
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Ali AD, Mehrass AAKO, Al-Adhroey AH, Al-Shammakh AA, Amran AA. Prevalence and risk factors of gestational diabetes mellitus in Yemen. Int J Womens Health 2016; 8:35-41. [PMID: 26869814 PMCID: PMC4734826 DOI: 10.2147/ijwh.s97502] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
PURPOSE Gestational diabetes mellitus (GDM) continues to be a significant health disorder triggering harmful complications in pregnant women and fetuses. Our knowledge of GDM epidemiology in Yemen is largely based on very limited data. The aim of this study was, therefore, to determine the prevalence and risk factors of GDM among pregnant women in Dhamar governorate, Yemen. PATIENTS AND METHODS A total of 311 subjects were randomly selected for this cross sectional survey. Health history data and blood samples were collected using a pretested questionnaire. To determine the prevalence of GDM, the fasting and random blood glucose techniques were applied according to the recommendations of the American Diabetes Association, using alternative methods that are more convenient to the targeted population. Poisson's regression model incorporating robust sandwich variance was utilized to assess the association of potential risk factors in developing GDM. RESULTS The prevalence of GDM was found to be 5.1% among the study population. Multivariate analysis confirmed age ≥30 years, previous GDM, family history of diabetes, and history of polycystic ovary syndrome as independent risk factors for GDM prevalence. However, body mass index ≥30 kg/m(2) and previous macrosomic baby were found to be dependent risk factors. CONCLUSION This study reports new epidemiological information about the prevalence and risk factors of GDM in Yemen. Introduction of proper maternal and neonatal medical care and health education are important in order to save the mother and the baby.
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Affiliation(s)
| | | | | | | | - Adel A Amran
- Department of Physiology, Faculty of Medicine and Health Sciences, Thamar University, Dhamar, Yemen
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Ryser Rüetschi J, Jornayvaz FR, Rivest R, Huhn EA, Irion O, Boulvain M. Fasting glycaemia to simplify screening for gestational diabetes. BJOG 2016; 123:2219-2222. [PMID: 26810795 DOI: 10.1111/1471-0528.13857] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Recommendations in Switzerland on screening for gestational diabetes endorse the International Association of Diabetes in Pregnancy Study Group consensus. As universal testing is time consuming and glucose loading is unpleasant, the recommendations include a simplification, not performing the glucose loading in women with fasting glycaemia <4.4 mmol/l. Our objective was to evaluate the diagnostic performance of this simplified strategy, compared with the complete test, in our population with a low prevalence of gestational diabetes. DESIGN We collected 2298 complete 75-g glucose tolerance tests. We simulated stopping the test, so avoiding the glucose loading and further glycaemia, if fasting glycaemia was <4.4 or ≥5.1 mmol/l. SETTING AND POPULATION Unselected pregnant women from Geneva and Basel, at 24-28 weeks of gestation. METHODS We calculated the sensitivity, and the percentage of women who would avoid the complete test with the strategy based on fasting glycaemia. RESULTS The prevalence of gestational diabetes was 10.9% in our population. Among 251 women with gestational diabetes, fasting glycaemia was ≥5.1 mmol/l in 119 women (47.4%), between 4.4 and <5.1 mmol/l in 78 women (31.1%) and <4.4 mmol/l in 54 women (21.5%). Proceeding with the complete test only in women with fasting glycaemia between 4.4 and <5.1 mmol/l will result in a sensitivity of 78.5%. This strategy would avoid glucose loading in 63.8% of women. CONCLUSIONS Screening with fasting glycaemia is an attractive alternative to universal screening with the complete 75-g glucose tolerance test. This strategy is, however, slightly less sensitive than previously reported in higher-risk populations. TWEETABLE ABSTRACT Fasting glycaemia can be considered as an alternative to the complete test for gestational diabetes screening.
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Affiliation(s)
- J Ryser Rüetschi
- Department of Gynaecology and Obstetrics, University Hospitals of Geneva, Geneva, Switzerland
| | - F R Jornayvaz
- Department of Endocrinology, Diabetes, Hypertension and Nutrition, University Hospitals of Geneva, Geneva, Switzerland
| | | | - E A Huhn
- Department of Obstetrics and Gynaecology, University Hospital of Basel, Basel, Switzerland
| | - O Irion
- Department of Gynaecology and Obstetrics, University Hospitals of Geneva, Geneva, Switzerland
| | - M Boulvain
- Department of Gynaecology and Obstetrics, University Hospitals of Geneva, Geneva, Switzerland
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Gopalakrishnan V, Singh R, Pradeep Y, Kapoor D, Rani AK, Pradhan S, Bhatia E, Yadav SB. Evaluation of the prevalence of gestational diabetes mellitus in North Indians using the International Association of Diabetes and Pregnancy Study groups (IADPSG) criteria. J Postgrad Med 2016; 61:155-8. [PMID: 26119433 PMCID: PMC4943402 DOI: 10.4103/0022-3859.159306] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective: Currently, there is controversy regarding the diagnosis of gestational diabetes mellitus (GDM) as per the newer International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria. We studied the prevalence and associations of GDM in North Indians, diagnosed by the IADPSG criteria. Patients and Methods: We conducted a cross-sectional study on 332 pregnant women, predominantly belonging to lower and middle socioeconomic strata. The women were screened for GDM between 24 weeks and 28 weeks of gestation by 75g oral glucose tolerance test (OGTT) and GDM diagnosed by the IADPSG criteria. Results: The prevalence of GDM was 41.9% [95% Confidence interval (CI) 36.6-47.2%]. Amongst the women diagnosed to have GDM, 91.4% had abnormal fasting plasma glucose (FPG), while 1-h and 2-h post-glucose (PG) levels were abnormal in 18.7% and 17.3% of women, respectively. No maternal factors were significantly associated with GDM. Birth weight of the neonates was similar in women with GDM as compared to those with normal glucose tolerance. In the entire group, fasting glucose levels were associated with the weight of the patient while 1-h PG levels were associated with weight, height, socioeconomic score, and parity. Conclusions: There is a very high prevalence rate of GDM using the IADPSG criteria in North Indian women of low and middle socioeconomic strata. Further studies are needed to assess the utility of applying these criteria in settings with limited resources.
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Affiliation(s)
| | | | | | | | | | | | | | - S B Yadav
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Mandò C, Calabrese S, Mazzocco MI, Novielli C, Anelli GM, Antonazzo P, Cetin I. Sex specific adaptations in placental biometry of overweight and obese women. Placenta 2015; 38:1-7. [PMID: 26907375 DOI: 10.1016/j.placenta.2015.12.008] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 11/30/2015] [Accepted: 12/14/2015] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Placental biometry at birth has been shown to predict chronic disease in later life. We hypothesized that maternal overweight/obesity, a state of low-grade inflammation and risk factor for adverse pregnancy outcome, could negatively influence placental development and that differences would be sex-specific. METHODS 696 women (537 normal-weight, NW; 112 overweight, OW; 47 obese, OB) with singleton uncomplicated pregnancies were prospectively enrolled at term delivery. Gestational age, maternal (age, height, pre-pregnancy BMI, gestational weight gain -GWG, hemoglobin, hematocrit and glycemia), fetal (weight, length, ponderal index, cranial circumference) and placental (weight, diameters) data were collected. Placental area, thickness and efficiency (fetal/placental weight ratio, F/P) were calculated. RESULTS GWG was within standard recommendations in OB, while OW exceeded it. Placental weight was significantly higher in OW versus NW, but not in OB, leading to significantly higher placental thickness and lower F/P in this group. In the total population, a significant interaction effect between maternal BMI and fetal sex on placental weight and efficiency was found. Indeed, differences in placental parameters were present only in female offspring. DISCUSSION In our population of OW and OB uncomplicated pregnancies only OW women, presenting GWG over standard recommendations, had thicker and less efficient placentas. We also reported different placental adaptation depending on fetal sex, with significant changes only in female fetuses. This may be part of a female-specific strategy aiming to ensure survival if another adverse event occurs. Customized counseling according to maternal BMI and fetal sex should be evaluated in clinical care.
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Affiliation(s)
- Chiara Mandò
- Department of Mother and Child, Hospital L. Sacco, Department of Biomedical and Clinical Sciences L. Sacco, and Center for Fetal Research Giorgio Pardi, Università degli studi di Milano, Italy.
| | - Stefania Calabrese
- Department of Mother and Child, Hospital L. Sacco, Department of Biomedical and Clinical Sciences L. Sacco, and Center for Fetal Research Giorgio Pardi, Università degli studi di Milano, Italy
| | - Martina Ilaria Mazzocco
- Department of Mother and Child, Hospital L. Sacco, Department of Biomedical and Clinical Sciences L. Sacco, and Center for Fetal Research Giorgio Pardi, Università degli studi di Milano, Italy
| | - Chiara Novielli
- Department of Mother and Child, Hospital L. Sacco, Department of Biomedical and Clinical Sciences L. Sacco, and Center for Fetal Research Giorgio Pardi, Università degli studi di Milano, Italy
| | - Gaia Maria Anelli
- Department of Mother and Child, Hospital L. Sacco, Department of Biomedical and Clinical Sciences L. Sacco, and Center for Fetal Research Giorgio Pardi, Università degli studi di Milano, Italy
| | - Patrizio Antonazzo
- Department of Mother and Child, Hospital L. Sacco, Department of Biomedical and Clinical Sciences L. Sacco, and Center for Fetal Research Giorgio Pardi, Università degli studi di Milano, Italy
| | - Irene Cetin
- Department of Mother and Child, Hospital L. Sacco, Department of Biomedical and Clinical Sciences L. Sacco, and Center for Fetal Research Giorgio Pardi, Università degli studi di Milano, Italy
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Alfadhli E. Gestational diabetes in Saudi women identified by the International Association of Diabetes and Pregnancy Study Group versus the former American Diabetes Association criteria: a prospective cohort study. Ann Saudi Med 2015; 35:428-34. [PMID: 26657225 PMCID: PMC6074466 DOI: 10.5144/0256-4947.2015.428] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Use of the criteria of the International Association of Diabetes and Pregnancy Study Group (IADPSG) identifies additional cases of gestational diabetes mellitus (GDM) that have a lesser degree of hyperglycemia. The objective of this study was to compare the clinical characteristics and the pregnancy outcomes of GDM cases identified by IADPSG versus those identified by the former American Diabetes Association (ADA) criteria. DESIGN AND SETTINGS Prospective cohort study of Saudi women conducted at the Maternity and Children Hospital, Madinah, Saudi Arabia from October 2011 to August 2012. PATIENTS AND METHODS Consecutive pregnant women treated in the antenatal service performed oral glu.cose tolerance tests between 24 to 28 weeks of gestation. GDM was diagnosed according to IADPSG and the former ADA criteria. The women were divided into three groups by GDM diagnosed by both criteria, additional GDM identified by the IADPSG criteria, and cases with normal glucose tolerance (NGT). Clinical characteristics and pregnancy outcomes were compared. RESULTS Of 277 women who underwent OGTT, 47 (16.9%) were diagnosed by the former ADA criteria and 115 (41.5%) by the IADPSG criteria. The IADPSG criteria identified all women with GDM by the former ADA criteria and an additional 68 cases. The additional GDM cases had the same clinical characteristics as cases diagnosed by both criteria except for lower blood pressure and less frequent glycosuria. On the other hand, they were older, heavier and had a higher frequency of past GDM and history of recurrent abortions than the NGT group. In addition, they had significantly more cesarean deliveries, neonatal hypoglycemia, and a lower Apgar score than the NGT group. LIMITATIONS Relatively small numbers of subjects, which could limit the power of statistical findings. CONCLUSIONS The IADPSG criteria increased GDM frequency. The additional GDM cases identified by IADPSG have the same clinical characteristics and adverse pregnancy outcomes as cases with GDM identified by the older criteria.
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Affiliation(s)
- Eman Alfadhli
- Dr. E. Alfadhli, Department of Medicine,, Taibha University,, PO Box 420,, Madinah, Saudi Arabia, T: 966-44-844-3195, F: 966-44-844-3195,
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Hod M, Kapur A, Sacks DA, Hadar E, Agarwal M, Di Renzo GC, Roura LC, McIntyre HD, Morris JL, Divakar H. The International Federation of Gynecology and Obstetrics (FIGO) Initiative on gestational diabetes mellitus: A pragmatic guide for diagnosis, management, and care . Int J Gynaecol Obstet 2015; 131 Suppl 3:S173-S211. [PMID: 29644654 DOI: 10.1016/s0020-7292(15)30033-3] [Citation(s) in RCA: 516] [Impact Index Per Article: 57.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Moshe Hod
- Division of Maternal Fetal Medicine, Rabin Medical Center, Tel Aviv University, Petah Tikva, Israel
| | - Anil Kapur
- World Diabetes Foundation, Gentofte, Denmark
| | - David A Sacks
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Eran Hadar
- Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mukesh Agarwal
- Department of Pathology, UAE University, Al Ain, United Arab Emirates
| | - Gian Carlo Di Renzo
- Centre of Perinatal and Reproductive Medicine, Department of Obstetrics and Gynecology, University of Perugia, Perugia, Italy
| | - Luis Cabero Roura
- Maternal Fetal Medicine Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | - Jessica L Morris
- International Federation of Gynecology and Obstetrics, London, UK
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5. Diagnosing gestational diabetes mellitus. Int J Gynaecol Obstet 2015. [DOI: 10.1016/s0020-7292(15)30013-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Agarwal MM, Dhatt GS, Othman Y. Gestational diabetes mellitus prevalence: Effect of the laboratory analytical variation. Diabetes Res Clin Pract 2015; 109:493-9. [PMID: 26164090 DOI: 10.1016/j.diabres.2015.06.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 05/17/2015] [Accepted: 06/19/2015] [Indexed: 11/29/2022]
Abstract
AIMS To highlight the effect of laboratory analytic variation, assessed by glucose (a) total analytic laboratory error (TAEL) present in one index laboratory and (b) total recommended allowable error (TAEa) universally applicable to all laboratories, on the prevalence of gestational diabetes mellitus (GDM). METHODS 2337 pregnant women underwent a 75-g oral glucose tolerance test (OGTT) for universal GDM screening. Since the true value of every laboratory result fluctuates within a range, the glucose TAEL and TAEa were used to define a lower and an upper diagnostic threshold (95% confidence interval, CI) for the three glucose OGTT cut-offs of the criteria of the American Diabetes Association, ADA (2003); the Canadian Diabetes Association, CDA (2013) and the International Association of Diabetes and Pregnancy Study Groups, IADPSG (2010). RESULTS For the ADA, CDA and IADPSG criteria, respectively, the GDM prevalence [95% CI, (glucose TAEL) (glucose TAEa)] was 13.3% [(8.0-21.8) (6.3-25.9)], 30% [(17.3-53.1) (14.3-61.3)] and 45.3% [(27.0-71.0) (22.3-79.2)]. Using the lower and higher assigned OGTT glucose thresholds for TAEL, respectively, among the different criteria, either 200 (8.6%)-601 (25.7%) additional or 122 (5.2%)-426 (18.3%) fewer women would be identified with GDM (p<0.0001). CONCLUSIONS Independent of the diagnostic criteria, any reported GDM prevalence can potentially vary between one half to two times even for laboratories meeting recommended quality specifications. To avoid misclassifying women with GDM substantially, individual laboratories can significantly reduce this disparity by improving analytic performance. All physicians must ensure that their laboratory meets acceptable quality standards for optimal patient care.
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Affiliation(s)
- M M Agarwal
- Department of Pathology, College of Medicine, UAE University, Al Ain, United Arab Emirates.
| | - G S Dhatt
- Department of Pathology, Tawam Hospital, Al Ain, United Arab Emirates
| | - Y Othman
- Department of Pathology, Tawam Hospital, Al Ain, United Arab Emirates
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What accounts for ethnic differences in newborn skinfold thickness comparing South Asians and White Caucasians? Findings from the START and FAMILY Birth Cohorts. Int J Obes (Lond) 2015; 40:239-44. [PMID: 26315840 PMCID: PMC4753357 DOI: 10.1038/ijo.2015.171] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 07/06/2015] [Accepted: 08/03/2015] [Indexed: 02/04/2023]
Abstract
Objective: South Asians are a high-risk group for type 2 diabetes and coronary heart disease. We sought to determine ethnic differences in newborn adiposity comparing South Asians (SA) to White Caucasians (Whites). Methods: Seven hundred ninety pregnant women (401 SA, 389 Whites) and their full-term offspring from two birth cohorts in Canada were analyzed. Pregnant women completed a health assessment including a 75-g oral glucose tolerance test to assess for dysglycemia. Birthweight, length, waist and hip circumference, and triceps and subscapular skinfold thickness (a surrogate measure of body adiposity) were measured in all newborns. Multivariate regression was used to identify maternal factors associated with newborn skinfold measurements. Results: South Asian women were younger (30.1 vs 31.8 years, P<0.001), their prepregnancy body mass index was lower (23.7 vs 26.2, P<0.0001) and gestational diabetes was substantially higher (21% vs 13%, P=0.005) compared with Whites. Among full-term newborns, South Asians had lower birthweight (3283 vs 3517 g, P=0.0001), had greater skinfold thickness (11.7 vs 10.6 mm; P=0.0001) and higher waist circumference (31.1 vs 29.9 cm, P=0.0001) compared with Whites. Risk factors for newborn skinfold thickness included South Asian ethnicity (standardized estimate (s.e.): 0.24; P<0.0001), maternal glucose (s.e.: 0.079; P=0.04) and maternal body fat (s.e.: 0.14; P=0.0002). Conclusions: South Asian newborns are lower birthweight and have greater skinfold thickness, compared with White newborns, and this is influenced by maternal body fat and glucose. Interventions aimed at reducing body fat prior to pregnancy and gestational diabetes during pregnancy in South Asians may favorably alter newborn body composition and require evaluation.
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Zhu W, Yang H, Wei Y, Wang Z, Li X, Wu H, Li N, Zhang M, Liu X, Zhang H, Wang Y, Niu J, Gan Y, Zhong L, Wang Y, Kapur A. Comparing the diagnostic criteria for gestational diabetes mellitus of World Health Organization 2013 with 1999 in Chinese population. Chin Med J (Engl) 2015; 128:125-7. [PMID: 25563325 PMCID: PMC4837807 DOI: 10.4103/0366-6999.147858] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
| | - Huixia Yang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing 100034, China
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Benhalima K, Mathieu C, Damm P, Van Assche A, Devlieger R, Desoye G, Corcoy R, Mahmood T, Nizard J, Savona-Ventura C, Dunne F. A proposal for the use of uniform diagnostic criteria for gestational diabetes in Europe: an opinion paper by the European Board & College of Obstetrics and Gynaecology (EBCOG). Diabetologia 2015; 58:1422-9. [PMID: 25952480 DOI: 10.1007/s00125-015-3615-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 04/15/2015] [Indexed: 01/17/2023]
Abstract
Screening and diagnostic criteria for gestational diabetes (GDM) are inconsistent across Europe, and the development of a uniform GDM screening strategy is necessary. Such a strategy would create opportunities for more women to receive timely treatment for GDM. Developing a consensus on screening for GDM in Europe is challenging, as populations are diverse and healthcare delivery systems also differ. The European Board & College of Obstetrics and Gynaecology (EBCOG) has responded to this challenge by appointing a steering committee, including members of the EBCOG and the Diabetic Pregnancy Study Group (DPSG) associated with the EASD, to develop a proposal for the use of uniform diagnostic criteria for GDM in Europe. A proposal has been developed and has now been approved by the Council of the EBCOG. The current proposal is to screen for overt diabetes at the first prenatal contact using cut-off values for diabetes outside pregnancy, with particular efforts made to screen high-risk groups. When screening for GDM is performed at 24 weeks' gestation or later, the proposal is now to use the 75 g OGTT with the new WHO diagnostic criteria for GDM. However, more research is necessary to evaluate the best GDM screening strategy for different populations in Europe. Therefore, no clear recommendation has been made on whether a universal one-step, two-step or a risk-factor-based screening approach should be used. The use of the same WHO diagnostic GDM criteria across Europe will be an important step towards uniformity.
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Affiliation(s)
- Katrien Benhalima
- Department of Endocrinology, UZ Gasthuisberg, KU Leuven, Herestraat 49, 3000, Leuven, Belgium,
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Hussain Z, Yusoff ZM, Sulaiman SAS. Evaluation of knowledge regarding gestational diabetes mellitus and its association with glycaemic level: A Malaysian study. Prim Care Diabetes 2015; 9:184-190. [PMID: 25132140 DOI: 10.1016/j.pcd.2014.07.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Revised: 07/02/2014] [Accepted: 07/14/2014] [Indexed: 01/11/2023]
Abstract
AIMS The aim of this study was to evaluate the knowledge about GDM and its corresponding relation with glycaemic level in GDM patients. METHOD A cross-sectional study was conducted in antenatal clinic of Hospital Pulau Pinang, Malaysia from June 2013 to December 2013 using Gestational Diabetes Mellitus Knowledge Questionnaire (GDMKQ) on the sample of 175 GDM patients. Three most recent fasting plasma glucose (FPG) values (mmol/l) were taken from patients profiles and mean was calculated. RESULTS A total of 166 patients were included in final analysis. A total mean knowledge score of 166 patients was 10.01±3.63 and total mean FPG value was 5.50±1.13. Knowledge had a significant negative association with FPG (r=- 0.306, P<0.01). Among different knowledge domains, highest mean score was seen for diet/food values domain and lowest for management of GDM. Educational level seems to be the most significant predictor of GDM knowledge and glycaemic control. Highest mean knowledge score and lowest mean glycaemic levels were recorded for patients aged 25-29 years, Malay ethnicity, working women and family history of DM. CONCLUSION Higher Knowledge about GDM is related to better glycaemic control. New educational strategies should be developed to improve the lower health literacy.
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Affiliation(s)
- Zahid Hussain
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Malaysia.
| | - Zuraidah Mohd Yusoff
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Malaysia
| | - Syed Azhar Syed Sulaiman
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Malaysia
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Agarwal MM, Dhatt GS, Othman Y. Gestational diabetes: differences between the current international diagnostic criteria and implications of switching to IADPSG. J Diabetes Complications 2015; 29:544-9. [PMID: 25837380 DOI: 10.1016/j.jdiacomp.2015.03.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 02/19/2015] [Accepted: 03/09/2015] [Indexed: 12/17/2022]
Abstract
AIMS To highlight the differences between eight international expert panel diagnostic criteria (either current or outdated but in use) for the diagnosis of gestational diabetes mellitus (GDM) and implications of switching to the International Association of Diabetes in Pregnancy Study Groups (IADPSG) criterion. METHODS 2337 pregnant women underwent a 75-g oral glucose tolerance test as part of a universal screening protocol. The GDM prevalence and number of women classified differently were compared between the criteria of the American Diabetes Association (2003); Australasian Diabetes in Pregnancy Society (1998); the Canadian Diabetes Association, CDA (2003 & 2013); the European Association for the Study of Diabetes (1996); IADPSG (2010); the New Zealand Society for the Study of Diabetes (2004) and the World Health Organization (1999). RESULTS The prevalence varied from 9.2% to 45.3% with the different criteria. The IADPSG compared a) best with CDA 2013 [356(15.2%) women classified differently, (kappa, k=68.3%)] and b) worst with CDA 2003 [843 (36.1%) women classified differently, (k=21.8%)]; p<0.001.Switching to IADPSG from the original criteria would increase the prevalence 1.5-4.9 times. CONCLUSIONS In 2015, the various international guidelines for GDM continue to show major discrepancies in the prevalence and the women classified dissimilarly. A consensus on a single global guideline would be a giant leap forward.
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Affiliation(s)
- M M Agarwal
- Department of Pathology, College of Medicine, UAE University, Al Ain, United Arab Emirates.
| | - G S Dhatt
- Department of Pathology, Tawam hospital, Al Ain, United Arab Emirates
| | - Y Othman
- Department of Pathology, Tawam hospital, Al Ain, United Arab Emirates
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Alfadhli EM, Osman EN, Basri TH, Mansuri NS, Youssef MH, Assaaedi SA, Aljohani BA. Gestational diabetes among Saudi women: prevalence, risk factors and pregnancy outcomes. Ann Saudi Med 2015; 35:222-30. [PMID: 26409797 PMCID: PMC6074454 DOI: 10.5144/0256-4947.2015.222] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The prevalence of gestational diabetes (GDM) has increased recently worldwide, mainly due to adoption of the International Association of Diabetes and Pregnancy Study Group (IADPSG) criteria. The objectives of this study were to determine the prevalence of GDM in Saudi women and to assess risk factors and pregnancy outcomes using the IADPSG criteria. DESIGN AND SETTING A prospective descriptive study of pregnant Saudi women presenting at the Maternity and Children Hospital, Medina, Saudi Arabia, between October 2011 and June 2014. METHODS Fasting plasma glucose, glycated hemoglobin, and random plasma glucose concentrations were obtained for all participants at the first antenatal visit. In women with normal results, screening for GDM was performed at 24 to 28 weeks of gestation, with a 75-g oral glucose tolerance test (OGTT). Women who had GDM were treated with diet, exercise, and insulin as needed. Pregnancy outcomes were recorded after delivery. Multiple logistic regression was used to assess possible risk factors for GDM. RESULTS Early screenings showed abnormal glucose in 211 of 954 women (22.1%). In 445 women, the OGTT showed GDM in 183 women (39.4%). GDM cases identified by OGTT and by early screening increased the rate of GDM to 51% (292 women). Older maternal age, higher body mass index, higher blood pressure, past GDM, history of delivering a malformed child, and family history of diabetes were the main risk factors for GDM. GDM increased the risk of neonatal hypoglycemia (OR 9.353), low Apgar score (OR 5.546), and induction of labor (OR 2.33). The newborns of GDM mothers had a higher birth weight: 3043 g vs. 2890 g in the non-GDM group (P=.004). Other maternal and neonatal outcomes were not significantly different between the two groups. CONCLUSION The prevalence of GDM is high among Saudi women. Timely and effective treatment reduces perinatal morbidity and improves outcomes.
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Affiliation(s)
- Eman Mohammed Alfadhli
- Dr. Eman Alfadhli, Department of Medicine,, Taibha University,, PO Box 420 Madinah, Saudi Arabia, T: 966-44-844-3195 F: 966-44-844-3195,
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78
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Celen S, Yildiz Y, Kahyaoglu S, Kaymak O, Ozel M, Timur H, Danisman N. Cost-effectivity analysis of one-step versus two-step screening for gestational diabetes. Eurasian J Med 2015; 44:84-7. [PMID: 25610215 DOI: 10.5152/eajm.2012.20] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Accepted: 04/11/2012] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE Early diagnosis of gestational diabetes mellitus (GDM) is important for both maternal and fetal health. The literature has varying recommendations about one-step and two-step tests for GDM screening and diagnosis. The present study aimed to investigate the difference in the cost and duration of hospital stay of a one-step procedure compared to a two-step procedure, which is routinely performed in our hospital. MATERIALS AND METHODS The two-step procedure was performed in 2,724 pregnant women, and the one-step procedure was performed in 185 pregnant women. The one-step and two-step screening procedures for gestational diabetes were compared with respect to the duration of hospital stay and cost. RESULTS The test cost per woman was 0.75 TL less in the one-step procedure; however, the duration of the one-step test was 18.6 min longer, and the number of blood sampling procedures was 1.08 times higher. CONCLUSION The one-step method may be preferred over the two-step (or glucose challenge) test due to its diagnostic value and lower cost.
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Affiliation(s)
- Sevki Celen
- Department of High Risk Pregnancy, Zekai Tahir Burak Women's Health and Research Hospital, Ankara, Turkey
| | | | - Serkan Kahyaoglu
- Department of High Risk Pregnancy, Zekai Tahir Burak Women's Health and Research Hospital, Ankara, Turkey
| | - Oktay Kaymak
- Department of High Risk Pregnancy, Zekai Tahir Burak Women's Health and Research Hospital, Ankara, Turkey
| | - Murat Ozel
- Department of High Risk Pregnancy, Zekai Tahir Burak Women's Health and Research Hospital, Ankara, Turkey
| | - Hakan Timur
- Department of High Risk Pregnancy, Zekai Tahir Burak Women's Health and Research Hospital, Ankara, Turkey
| | - Nuri Danisman
- Department of High Risk Pregnancy, Zekai Tahir Burak Women's Health and Research Hospital, Ankara, Turkey
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79
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Agarwal MM, Shah SM, Al Kaabi J, Saquib S, Othman Y. Gestational diabetes mellitus: Confusion among medical doctors caused by multiple international criteria. J Obstet Gynaecol Res 2014; 41:861-9. [DOI: 10.1111/jog.12661] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 11/05/2014] [Indexed: 12/20/2022]
Affiliation(s)
- Mukesh M. Agarwal
- Department of Pathology; UAE University; Al Ain United Arab Emirates
| | - Syed M. Shah
- Department of Public Health; UAE University; Al Ain United Arab Emirates
| | - Juma Al Kaabi
- Department of Internal Medicine; College of Medicine; UAE University; Al Ain United Arab Emirates
| | - Shabnam Saquib
- Department of Obstetrics and Gynecology; Dubai Hospital; Dubai United Arab Emirates
| | - Yusra Othman
- Department of Pathology; Tawam Hospital; Al Ain United Arab Emirates
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80
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Duran A, Sáenz S, Torrejón MJ, Bordiú E, Del Valle L, Galindo M, Perez N, Herraiz MA, Izquierdo N, Rubio MA, Runkle I, Pérez-Ferre N, Cusihuallpa I, Jiménez S, García de la Torre N, Fernández MD, Montañez C, Familiar C, Calle-Pascual AL. Introduction of IADPSG criteria for the screening and diagnosis of gestational diabetes mellitus results in improved pregnancy outcomes at a lower cost in a large cohort of pregnant women: the St. Carlos Gestational Diabetes Study. Diabetes Care 2014; 37:2442-50. [PMID: 24947793 DOI: 10.2337/dc14-0179] [Citation(s) in RCA: 222] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The use of the new International Association of the Diabetes and Pregnancy Study Groups criteria (IADPSGC) for the diagnosis of gestational diabetes mellitus (GDM) results in an increased prevalence of GDM. Whether their introduction improves pregnancy outcomes has yet to be established. We sought to evaluate the cost-effectiveness of one-step IADPSGC for screening and diagnosis of GDM compared with traditional two-step Carpenter-Coustan (CC) criteria. RESEARCH DESIGN AND METHODS GDM risk factors and pregnancy and newborn outcomes were prospectively assessed in 1,750 pregnant women from April 2011 to March 2012 using CC and in 1,526 pregnant women from April 2012 to March 2013 using IADPSGC between 24 and 28 weeks of gestation. Both groups received the same treatment and follow-up regimes. RESULTS The use of IADPSGC resulted in an important increase in GDM rate (35.5% vs. 10.6%) and an improvement in pregnancy outcomes, with a decrease in the rate of gestational hypertension (4.1 to 3.5%: -14.6%, P < 0.021), prematurity (6.4 to 5.7%: -10.9%, P < 0.039), cesarean section (25.4 to 19.7%: -23.9%, P < 0.002), small for gestational age (7.7 to 7.1%: -6.5%, P < 0.042), large for gestational age (4.6 to 3.7%: -20%, P < 0.004), Apgar 1-min score <7 (3.8 to 3.5%: -9%, P < 0.015), and admission to neonatal intensive care unit (8.2 to 6.2%: -24.4%, P < 0.001). Estimated cost savings was of €14,358.06 per 100 women evaluated using IADPSGC versus the group diagnosed using CC. CONCLUSIONS The application of the new IADPSGC was associated with a 3.5-fold increase in GDM prevalence in our study population, as well as significant improvements in pregnancy outcomes, and was cost-effective. Our results support their adoption.
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Affiliation(s)
- Alejandra Duran
- Endocrinology and Nutrition Department, Universidad Complutense de Madrid, Madrid, Spain Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Sofía Sáenz
- Endocrinology and Nutrition Department, Universidad Complutense de Madrid, Madrid, Spain
| | - María J Torrejón
- Clinical Laboratory Department, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
| | - Elena Bordiú
- Endocrinology and Nutrition Department, Universidad Complutense de Madrid, Madrid, Spain Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Laura Del Valle
- Endocrinology and Nutrition Department, Universidad Complutense de Madrid, Madrid, Spain
| | - Mercedes Galindo
- Endocrinology and Nutrition Department, Universidad Complutense de Madrid, Madrid, Spain
| | - Noelia Perez
- Gynecology and Obstetrician Department, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
| | - Miguel A Herraiz
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain Gynecology and Obstetrician Department, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
| | - Nuria Izquierdo
- Gynecology and Obstetrician Department, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
| | - Miguel A Rubio
- Endocrinology and Nutrition Department, Universidad Complutense de Madrid, Madrid, Spain Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Isabelle Runkle
- Endocrinology and Nutrition Department, Universidad Complutense de Madrid, Madrid, Spain Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Natalia Pérez-Ferre
- Endocrinology and Nutrition Department, Universidad Complutense de Madrid, Madrid, Spain
| | - Idalia Cusihuallpa
- Endocrinology and Nutrition Department, Universidad Complutense de Madrid, Madrid, Spain
| | - Sandra Jiménez
- Endocrinology and Nutrition Department, Universidad Complutense de Madrid, Madrid, Spain
| | | | - María D Fernández
- Endocrinology and Nutrition Department, Universidad Complutense de Madrid, Madrid, Spain
| | - Carmen Montañez
- Endocrinology and Nutrition Department, Universidad Complutense de Madrid, Madrid, Spain
| | - Cristina Familiar
- Endocrinology and Nutrition Department, Universidad Complutense de Madrid, Madrid, Spain
| | - Alfonso L Calle-Pascual
- Endocrinology and Nutrition Department, Universidad Complutense de Madrid, Madrid, Spain Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
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Trujillo J, Vigo A, Reichelt A, Duncan BB, Schmidt MI. Fasting plasma glucose to avoid a full OGTT in the diagnosis of gestational diabetes. Diabetes Res Clin Pract 2014; 105:322-6. [PMID: 25037441 DOI: 10.1016/j.diabres.2014.06.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 05/31/2014] [Accepted: 06/02/2014] [Indexed: 12/11/2022]
Abstract
AIMS To evaluate the performance of fasting plasma glucose (FPG) in determining the need for a full oral glucose tolerance test (OGTT) to diagnose gestational diabetes (GDM) by the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria. METHODS A multicenter cohort study of 4926 pregnant women 20 years or older consecutively enrolled in prenatal care clinics of the Brazilian National Health Service from 1991 to 1995. All women underwent a single 2 h 75 g OGTT by weeks 24-28 of pregnancy and were followed to detect adverse pregnancy outcomes. RESULTS A FPG cut-off value of 80 mg/dl indicated that only 38.7% of all women needed to undergo a complete OGTT, while detecting 96.9% of all GDM cases. When the 85 mg/dl cut-off was used, the corresponding percentages were 18.7% and 92.5%, respectively. The fraction of women labeled with GDM who had adverse pregnancy outcomes was nearly identical when using FPG strategies and universal full testing. CONCLUSIONS Using a FPG cut-off to diagnose GDM and to determine the need for post-load OGTT measurements is a valid strategy to diagnose GDM by IADPSG criteria. This approach may improve feasibility of applying IADPSG diagnostic criteria by reducing costs and increasing convenience.
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Affiliation(s)
- J Trujillo
- Post Graduate Studies Program in Epidemiology, School of Medicine, Rio Grande do Sul Federal University, Rua Ramiro Barcelos 2600, sala 414, 90035-003, Porto Alegre, RS, Brazil.
| | - A Vigo
- Post Graduate Studies Program in Epidemiology, School of Medicine, Rio Grande do Sul Federal University, Rua Ramiro Barcelos 2600, sala 414, 90035-003, Porto Alegre, RS, Brazil
| | - A Reichelt
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - B B Duncan
- Post Graduate Studies Program in Epidemiology, School of Medicine, Rio Grande do Sul Federal University, Rua Ramiro Barcelos 2600, sala 414, 90035-003, Porto Alegre, RS, Brazil
| | - M I Schmidt
- Post Graduate Studies Program in Epidemiology, School of Medicine, Rio Grande do Sul Federal University, Rua Ramiro Barcelos 2600, sala 414, 90035-003, Porto Alegre, RS, Brazil
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McIntyre HD, Colagiuri S, Roglic G, Hod M. Diagnosis of GDM: a suggested consensus. Best Pract Res Clin Obstet Gynaecol 2014; 29:194-205. [PMID: 25242583 DOI: 10.1016/j.bpobgyn.2014.04.022] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 04/13/2014] [Indexed: 01/27/2023]
Abstract
Despite recent attempts at building consensus, an internationally consistent definition of gestational diabetes mellitus (GDM) remains elusive. Within and between countries, there is disagreement between obstetric, medical, and endocrine groups as to the diagnosis and management of GDM. The current article aims to discuss the background to the controversy of GDM diagnosis and to address issues related to the detection and treatment of GDM in low-, middle-, and high-resource settings. The criteria recommended by the International Association of the Diabetes and Pregnancy Study Groups (IADPSG), the American Diabetes Association (ADA), and the World Health Organization (WHO) are endorsed. We also wish to put into perspective the importance of GDM, both during and after pregnancy, in terms of its relationship to overall women's health.
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Affiliation(s)
- Harold David McIntyre
- University of Queensland and Mater Health Services, South Brisbane, QLD 4101, Australia
| | - Stephen Colagiuri
- Boden Institute of Obesity, Nutrition & Exercise, G89 Medical Foundation Building K25, Sydney Medical School, The University of Sydney, NSW 2000, Australia.
| | - Gojka Roglic
- Department of Management of Noncommunicable Chronic Diseases, World Health Organization, Geneva, Switzerland.
| | - Moshe Hod
- Division of Maternal Fetal Medicine, Helen Schneider Hospital for Women, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Petah-Tiqva 49100, Israel.
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83
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Weile LKK, Kahn JG, Marseille E, Jensen DM, Damm P, Lohse N. Global cost-effectiveness of GDM screening and management: current knowledge and future needs. Best Pract Res Clin Obstet Gynaecol 2014; 29:206-24. [PMID: 25225056 DOI: 10.1016/j.bpobgyn.2014.06.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 06/15/2014] [Indexed: 11/30/2022]
Abstract
Gestational diabetes mellitus (GDM) is an increasing cause of morbidity in women and their offspring. Screening and intervention can reduce perinatal and most likely also long-term diabetes consequences. There have been many economic studies, but not recently systematically compared. We conducted a systematic search and abstraction of cost-effectiveness and cost-utility studies from 2002 to 2014. We standardized all findings to 2014 US dollars. We found that cost-effectiveness ratios varied widely. Most variation was found to be due to differences in geographic setting, diagnostic criteria and intervention approaches, and outcomes (e.g., inclusion or exclusion of long-term type 2 diabetes risk and associated costs). We concluded that incorporation of long-term benefits of GDM screening and treatment has huge impact on cost-effectiveness estimates. Based on the large methodological heterogeneity and varying results in the existing body of evidence, we find it unreasonable to outline any global recommendations. For future economic studies, we recommend inclusion of long-term outcomes and adaptation to local preferences, as well as examination of the impact of the diagnostic criteria recently proposed by the International Association of Diabetes in Pregnancy Study Groups (IADPSG).
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Affiliation(s)
- Louise K K Weile
- Dept of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark.
| | - James G Kahn
- Philip R. Lee Institute for Health Policy Studies, Global Health Sciences, and Global Health Economics Consortium, University of California, San Francisco, USA.
| | - Elliot Marseille
- Health Strategies International and UCSF Global Health Economics Consortium, Oakland, USA.
| | - Dorte M Jensen
- Dept of Endocrinology, Odense University Hospital, Odense, Denmark.
| | - Peter Damm
- Centre for Pregnant Women with Diabetes, Dept. of Obstetrics, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Nicolai Lohse
- Dept of Anaesthesiology and Intensive Care, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
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84
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Al-Rubeaan K, Al-Manaa HA, Khoja TA, Youssef AM, Al-Sharqawi AH, Siddiqui K, Ahmad NA. A community-based survey for different abnormal glucose metabolism among pregnant women in a random household study (SAUDI-DM). BMJ Open 2014; 4:e005906. [PMID: 25138813 PMCID: PMC4139649 DOI: 10.1136/bmjopen-2014-005906] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To assess the prevalence and risk factors of gestational diabetes mellitus (GDM) in a population known to have a high prevalence of abnormal glucose metabolism. METHODS A household random population-based cross-sectional study of 13,627 women in the childbearing age, who were subjected to fasting plasma glucose if they were not known to have been diagnosed before with any type of diabetes. GDM cases were diagnosed using the International Association of Diabetes and Pregnancy Study Group (IAPSG) criteria. RESULTS The overall GDM prevalence was 36.6%, categorised into 32.4% new cases and 4.2% known cases. Another 3.6% had preconception type 1 or 2 diabetes. GDM cases were older and had a significantly higher body mass index, in addition to a higher rate of macrocosmic baby and history of GDM. Monthly income, educational level, living in urban areas and smoking were not found to be significantly different between normal and GDM cases. The most important and significant risk factors for GDM were history of GDM, macrosomic baby, obesity and age >30 years. However, hypertension, low high-density lipoprotein, family history of diabetes and increased triglycerides did not show any significant effect on GDM prevalence in this cohort. CONCLUSIONS This society is facing a real burden of abnormal glucose metabolism during pregnancy, where almost half of the pregnant women are subjected to maternal and neonatal complications. Early screening of pregnant women, especially those at a high risk for GDM, is mandatory to identify and manage those cases.
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Affiliation(s)
- Khalid Al-Rubeaan
- University Diabetes Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | | | - Amira M Youssef
- University Diabetes Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ahmad H Al-Sharqawi
- Biostatistics Department, Strategic Center for Diabetes Research, King Saud University, Riyadh, Saudi Arabia
| | - Khalid Siddiqui
- Biochemistry Department, Strategic Center for Diabetes Research, King Saud University, Riyadh, Saudi Arabia
| | - Najlaa A Ahmad
- Biostatistics Department, Strategic Center for Diabetes Research, King Saud University, Riyadh, Saudi Arabia
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85
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Benhalima K, Van Crombrugge P, Verhaeghe J, Vandeginste S, Verlaenen H, Vercammen C, Dufraimont E, De Block C, Jacquemyn Y, Mekahli F, De Clippel K, Devlieger R, Mathieu C. The Belgian Diabetes in Pregnancy Study (BEDIP-N), a multi-centric prospective cohort study on screening for diabetes in pregnancy and gestational diabetes: methodology and design. BMC Pregnancy Childbirth 2014; 14:226. [PMID: 25015413 PMCID: PMC4227277 DOI: 10.1186/1471-2393-14-226] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 07/08/2014] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The International Association of Diabetes and Pregnancy Study Groups (IADPSG) recommends universal screening with a 75 g oral glucose tolerance test (OGTT) using stricter criteria for gestational diabetes (GDM). This may lead to important increases in the prevalence of GDM and associated costs, whereas the gain in health is unclear. The goal of 'The Belgian Diabetes in Pregnancy Study' (BEDIP-N) is to evaluate the best screening strategy for pregestational diabetes in early pregnancy and GDM in an ethnically diverse western European population. The IADPSG screening strategy will be followed, but in addition risk questionnaires and a 50 g glucose challenge test (GCT) will be performed, in order to define the most practical and most cost effective screening strategy in this population. METHODS BEDIP-N is a prospective observational cohort study in 6 centers in Belgium. The aim is to enroll 2563 pregnant women in the first trimester with a singleton pregnancy, aged 18-45 years, without known diabetes and without history of bariatric surgery. Women are universally screened for overt diabetes and GDM in the first trimester with a fasting plasma glucose and for GDM between 24-28 weeks using the 50 g GCT and independently of the result of the GCT, all women will receive a 75 g OGTT using the IADPSG criteria. Diabetes and GDM will be treated according to a standardized routine care protocol. Women with GDM, will be reevaluated three months postpartum with a 75 g OGTT. At each visit blood samples are collected, anthropometric measurements are obtained and self-administered questionnaires are completed. Recruitment began in April 2014. DISCUSSION This is the first large, prospective cohort study rigorously assessing the prevalence of diabetes in early pregnancy and comparing the impact of different screening strategies with the IADPSG criteria on the detection of GDM later in pregnancy. TRIAL REGISTRATION ClinicalTrials.gov: NCT02036619. Registered 14-1-2014.
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Affiliation(s)
- Katrien Benhalima
- Department of Endocrinology and Department of Obstetrics & Gynecology, UZ Gasthuisberg, KU Leuven, Herestraat 49, 3000 Leuven, Belgium.
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86
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Helseth R, Salvesen O, Stafne SN, Mørkved S, Salvesen KA, Carlsen SM. Gestational diabetes mellitus among Nordic Caucasian women: prevalence and risk factors according to WHO and simplified IADPSG criteria. Scandinavian Journal of Clinical and Laboratory Investigation 2014; 74:620-8. [PMID: 24980704 DOI: 10.3109/00365513.2014.928942] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is associated with both maternal and offspring adverse effects. The World Health Organization (WHO) has recently adopted novel GDM criteria. The aim of this study was to evaluate the former WHO and a simplified version of the new International Association for Diabetes in Pregnancy Study Group (IADPSG) criteria as to prevalence of and risk factors for GDM in a Nordic Caucasian population. METHODS A 75 g oral glucose tolerance test was performed in 687 women at 18-22 and 32-36 pregnancy weeks. GDM was defined according to the WHO criteria as fasting plasma glucose ≥ 7.0 mmol/L and/or 2-hour plasma glucose ≥ 7.8 mmol/L and by a simplified version of the IADPSG criteria as either fasting glucose ≥ 5.1 mmol/L and/or 2-h plasma glucose ≥ 8.5 mmol/L. One-hour glucose values were not available and were thus not included in the diagnosis of GDM by IADPSG. Prevalence of GDM during pregnancy and risk factors for GDM at 18-22 weeks were studied in retrospect according to each of the two criteria. RESULTS The total prevalence of GDM during pregnancy was 6.1% (42/687) for the WHO criteria and 7.4% (51/687) for the simplified IADPSG criteria. High maternal age and short stature were independently associated with WHO GDM. Maternal age, fasting insulin and no regular exercise at 18-22 pregnancy weeks associated with simplified IADPSG GDM. CONCLUSIONS Simplified IADPSG criteria moderately increase GDM prevalence compared with the WHO criteria. Risk factors for GDM differ with the diagnostic criteria used.
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Affiliation(s)
- Ragnhild Helseth
- Department of Internal Medicine, Drammen Hospital , Vestre Viken
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87
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Translating the HAPO study into new diagnostic criteria for GDM? From HAPO to IADPSG and back to O'Sullivan. Clin Obstet Gynecol 2014; 56:758-73. [PMID: 24005129 DOI: 10.1097/grf.0b013e3182a8e08e] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The various strategies to diagnose gestational diabetes mellitus (GDM), starting from O'sullivan, followed by numerous opinions and recommendations and up to the recently published International association of diabetes and pregnancy study groups criteria, have been and still are the subject of extensive and ongoing debate, since the 1960s, and holding, fiercely than ever, nowadays. In this review we shall provide an overlook on the history of GDM diagnosis, concentrating on the interpretation of the hyperglycemia and adverse pregnancy outcome results into clinical guidelines, and the pros and cons for changing the criteria for GDM diagnosis.
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88
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Colagiuri S, Falavigna M, Agarwal MM, Boulvain M, Coetzee E, Hod M, Meltzer SJ, Metzger B, Omori Y, Rasa I, Schmidt MI, Seshiah V, Simmons D, Sobngwi E, Torloni MR, Yang HX. Strategies for implementing the WHO diagnostic criteria and classification of hyperglycaemia first detected in pregnancy. Diabetes Res Clin Pract 2014; 103:364-72. [PMID: 24731475 DOI: 10.1016/j.diabres.2014.02.012] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/31/2013] [Indexed: 02/07/2023]
Abstract
The World Health Organization (WHO) has recently released updated recommendations on Diagnostic Criteria and Classification of Hyperglycaemia First Detected in Pregnancy which are likely to increase the prevalence of gestational diabetes mellitus (GDM). Any increase in the number of women with GDM has implications for health services since these women will require treatment and regular surveillance during the pregnancy. Some health services throughout the world may have difficulty meeting these demands since country resources for addressing the diabetes burden are finite and resource allocation must be prioritised by balancing the need to improve care of people with diabetes and finding those with undiagnosed diabetes, including GDM. Consequently each health service will need to assess their burden of hyperglycaemia in pregnancy and decide if and how it will implement programmes to test for and treat such women. This paper discusses some considerations and options to assist countries, health services and health professionals in these deliberations.
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Affiliation(s)
- Stephen Colagiuri
- Boden Institute of Obesity, Nutrition and Exercise, The University of Sydney, Sydney, Australia.
| | - Maicon Falavigna
- Post Graduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Mukesh M Agarwal
- Faculty of Medicine, UAE University, Al Ain, United Arab Emirates
| | - Michel Boulvain
- Service d'Obstétrique Maternité HUG, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Edward Coetzee
- Department Obstetrics & Gynaecology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Moshe Hod
- Helen Schneider Hospital for Women, Rabin Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Petah-Tiqva, Tel-Aviv, Israel
| | - Sara J Meltzer
- Department of Medicine, McGill University, Montreal, Canada; Department of Obstetrics and Gynaecology, McGill University, Montreal, Canada
| | - Boyd Metzger
- Northwestern University, Feinberg School of Medicine, Chicago, United States
| | - Yasue Omori
- Tokyo Women's Medical University, Diabetes Center, Ebina General Hospital, Tokyo, Japan
| | - Ingvars Rasa
- Rīga East Clinical University Hospital, Rīga Stradiņš University, Rīga, Latvia
| | - Maria Inês Schmidt
- Post Graduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Veerasamy Seshiah
- Diabetes Research Institute, Dr Balaji Diabetes Care Centre, Chennai, India
| | - David Simmons
- Institute of Metabolic Science, Cambridge University Hospitals, National Health Services Foundation Trust, Cambridge, United Kingdom
| | - Eugene Sobngwi
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Cameroon; Institute of Health and Society, Newcastle University, Newcastle, United Kingdom
| | | | - Hui-xia Yang
- Peking University First Hospital, Beijing, China
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89
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Reece EA, Moore TR. Reply: To PMID 23123381. Am J Obstet Gynecol 2014; 210:280-1. [PMID: 24035984 DOI: 10.1016/j.ajog.2013.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 09/09/2013] [Indexed: 11/19/2022]
Affiliation(s)
- E Albert Reece
- Vice President for Medical Affairs, University of Maryland, John Z. and Akiko K. Bowers Distinguished Professor and Dean, University of Maryland School of Medicine, 655 West Baltimore Street, Room 14-029, Baltimore, MD 21202-1559.
| | - Thomas R Moore
- Professor and Chairman, Department of Reproductive Medicine, Division of Perinatal Medicine, University of California, San Diego, School of Medicine, 200 West Arbor Dr., #8433, San Diego, CA 92103-8433.
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90
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Liao S, Mei J, Song W, Liu Y, Tan YD, Chi S, Li P, Chen X, Deng S. The impact of the International Association of Diabetes and Pregnancy Study Groups (IADPSG) fasting glucose diagnostic criterion on the prevalence and outcomes of gestational diabetes mellitus in Han Chinese women. Diabet Med 2014; 31:341-51. [PMID: 24152069 DOI: 10.1111/dme.12349] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 09/26/2013] [Accepted: 09/27/2013] [Indexed: 02/04/2023]
Abstract
AIMS The International Association of Diabetes and Pregnancy Study Groups (IADPSG) proposed that a one-time value of fasting plasma glucose of 5.1 mmol/l or over at any time of the pregnancy is sufficient to diagnose gestational diabetes. We evaluated the repercussions of the application of this threshold in pregnant Han Chinese women. METHODS This is a retrospective study of 5360 (72.3% of total) consecutively recruited pregnant Han Chinese women in one centre from 2008 to 2011. These women underwent a two-step gestational diabetes diagnostic protocol according to the previous American Diabetes Association criteria. The IADPSG fasting plasma glucose criterion was used to reclassify these 5360 women. The prevalence, clinical characteristics and obstetric outcomes were compared among the women classified as having gestational diabetes by the previous American Diabetes Association criteria (approximately 90% were treated), those reclassified as having gestational diabetes by the single IADPSG fasting plasma glucose criterion (untreated), but not as having gestational diabetes by the previous American Diabetes Association criteria, and those with normal glucose tolerance. RESULTS There were 626 cases of gestational diabetes defined by the previous American Diabetes Association criteria (11.7%) and these cases were associated with increased risks of maternal and neonatal outcomes when compared with the women with normal glucose tolerance. With the IADPSG fasting plasma glucose criterion, another 1314 (24.5%) women were reclassified as having gestational diabetes. Gestational diabetes classified by the IADPSG fasting plasma glucose criterion was associated with gestational hypertension (P = 0.0094) and neonatal admission to nursery (P = 0.035) prior to adjustment for maternal age and BMI, but was no longer a predictor for adverse pregnancy outcomes after adjustment. CONCLUSION The simple IADPSG fasting plasma glucose criterion increased the Chinese population with gestational diabetes by 200%. The increased population with gestational diabetes was not significantly associated with excess obstetric and neonatal morbidity.
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Affiliation(s)
- S Liao
- Diabetes Center, Sichuan Provincial People's Hospital, Sichuan University, Chengdu, China
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91
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IADPSG criteria for diagnosing gestational diabetes mellitus and predicting adverse pregnancy outcomes. J Perinatol 2014; 34:100-4. [PMID: 24232664 DOI: 10.1038/jp.2013.143] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 09/21/2013] [Accepted: 10/07/2013] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To evaluate the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria versus the American Diabetes Association (ADA) criteria for diagnosing gestational diabetes mellitus (GDM) in China. STUDY DESIGN Overall, 3083 women with a singleton pregnancy underwent a 75-g, 2-h oral glucose tolerance test between 24 and 28 weeks of pregnancy, and both IADPSG and ADA criteria were used for GDM diagnosis. Adverse pregnancy outcomes (APOs), including preterm birth, required Cesarean section, preeclampsia, macrosomia and low birth weight, were recorded and analyzed. RESULT IADPSG and ADA criteria diagnosed 19.9% and 7.98% of women with GDM, respectively (P<0.001). IADPSG criteria has a stronger capacity of predicting APOs than ADA criteria (odds ratio (OR)=1.84, 95% confidence interval (CI): 1.52-2.25 for IADPSG, and OR=1.54, 95% CI: 1.16-2.05 for ADA). CONCLUSION IADPSG criteria increase GDM diagnosis by almost twofold. GDM diagnosed by IADPSG criteria is more associated with APOs, although the economic impact needs further evaluation.
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92
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Agarwal MM, Dhatt GS. Comment on zhu et Al. Fasting plasma glucose at 24-28 weeks to screen for gestational diabetes mellitus: new evidence from china. Diabetes care 2013;36:2038-2040. Diabetes Care 2014; 37:e33. [PMID: 24459162 DOI: 10.2337/dc13-2035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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93
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Zhu WW, Yang HX, Kapur A. Response to comment on zhu et Al. Fasting plasma glucose at 24-28 weeks to screen for gestational diabetes mellitus: new evidence from china. Diabetes care 2013;36:2038-2040. Diabetes Care 2014; 37:e34. [PMID: 24459163 DOI: 10.2337/dc13-2246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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94
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Legardeur H, Girard G, Journy N, Ressencourt V, Durand-Zaleski I, Mandelbrot L. Factors predictive of macrosomia in pregnancies with a positive oral glucose challenge test: Importance of fasting plasma glucose. DIABETES & METABOLISM 2014; 40:43-48. [DOI: 10.1016/j.diabet.2013.01.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2012] [Revised: 01/06/2013] [Accepted: 01/11/2013] [Indexed: 11/29/2022]
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95
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Linnenkamp U, Guariguata L, Beagley J, Whiting DR, Cho NH. The IDF Diabetes Atlas methodology for estimating global prevalence of hyperglycaemia in pregnancy. Diabetes Res Clin Pract 2014; 103:186-96. [PMID: 24300016 DOI: 10.1016/j.diabres.2013.11.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/07/2013] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Hyperglycaemia is one of the most prevalent metabolic disorders occurring during pregnancy. Limited data are available on the global prevalence of hyperglycaemia in pregnancy. The International Diabetes Federation (IDF) has developed a methodology for generating estimates of the prevalence of hyperglycaemia in pregnancy, including hyperglycaemia first detected in pregnancy and live births to women with known diabetes, among women of childbearing age (20-49 years). METHODS A systematic review of the literature for studies reporting the prevalence of gestational diabetes was conducted. Studies were evaluated and scored to favour those that were representative of a large population, conducted recently, reported age-specific estimates, and case identification was based on blood test. Age-specific prevalence data from studies were entered to produce estimates for five-year age groups using logistic regression to smooth curves, with age as the independent variable. The derived age-specific prevalence was adjusted for differences in diagnostic criteria in the underlying data. Cases of hyperglycaemia in pregnancy were derived from age-specific estimates of fertility and age-specific population estimates. Country-specific estimates were generated for countries with available data. Regional and global estimates were generated based on aggregation and extrapolation for 219 countries and territories. Available fertility rates and diabetes prevalence estimates were used to estimate the proportion of hyperglycaemia in pregnancy that may be due to total diabetes in pregnancy - pregnancy in women with known diabetes and diabetes first detected in pregnancy. RESULTS The literature review identified 199 studies that were eligible for characterisation and selection. After scoring and exclusion requirements, 46 studies were selected representing 34 countries. More than 50% of selected studies came from Europe and North America and Caribbean. The smallest number of identified studies came from sub-Saharan Africa. The majority of studies were for high-income countries, although low- and middle-income countries were also represented. CONCLUSION Prevalence estimates of hyperglycaemia in pregnancy are sensitive to the data from which they are derived. The IDF methodology is a transparent, reproducible, and modifiable method for estimating the burden of hyperglycaemia in pregnancy. More data are needed, in particular from developing countries, to strengthen the methodology.
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Affiliation(s)
- U Linnenkamp
- International Diabetes Federation, Brussels, Belgium.
| | - L Guariguata
- International Diabetes Federation, Brussels, Belgium
| | - J Beagley
- International Diabetes Federation, Brussels, Belgium
| | - D R Whiting
- Directorate of Public Health, Medway Council, Chatham, United Kingdom
| | - N H Cho
- Department in Preventive Medicine, Ajou University School of Medicine, Suwon, Republic of Korea
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96
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Anderson V, Ye C, Sermer M, Connelly PW, Hanley AJG, Zinman B, Retnakaran R. Fasting capillary glucose as a screening test for ruling out gestational diabetes mellitus. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2013; 35:515-522. [PMID: 23870775 DOI: 10.1016/s1701-2163(15)30909-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE A common approach to screening for gestational diabetes mellitus (GDM) is the testing of all pregnant women with a one-hour, 50 g glucose challenge test (GCT), followed by a diagnostic oral glucose tolerance test (OGTT) when the GCT is positive (≥ 7.8 mmol/L). As only a small subset of those with a positive GCT will have GDM, many more women undergo the OGTT than may be necessary. In this context, we hypothesized that measurement of fasting capillary glucose (FCG) could provide a strategy for reducing the number of unnecessary OGTTs. Thus, we sought to identify a threshold level of FCG below which GDM could be ruled out following a positive GCT, without need for the OGTT. METHODS Following a positive GCT, 888 women underwent measurement of FCG prior to their OGTT. We evaluated the test characteristics of FCG for identifying the 209 women diagnosed with GDM on the OGTT. RESULTS Fasting capillary glucose was positively associated with each glucose measurement on the OGTT (all P < 0.001) and inversely related to insulin sensitivity and pancreatic beta-cell function (both P < 0.001). As FCG increased, the prevalence of GDM progressively rose (P < 0.001). However, the area under the curve of the receiver-operating characteristic curve for FCG in predicting GDM was modest (0.67). Although using an FCG threshold of 4.8 mmol/L could reduce the number of OGTTs by 28.4%, this approach would miss 18.2% of cases of GDM. CONCLUSION Fasting capillary glucose is associated with glycemia, insulin sensitivity, and pancreatic beta-cell function. However, a single FCG measurement is insufficient for reliably ruling out GDM after an abnormal GCT.
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Affiliation(s)
- Valerie Anderson
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto ON
| | - Chang Ye
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto ON
| | - Mathew Sermer
- Division of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto ON
| | - Philip W Connelly
- Division of Endocrinology, University of Toronto, Toronto ON; Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital Toronto ON
| | - Anthony J G Hanley
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto ON; Division of Endocrinology, University of Toronto, Toronto ON; Department of Nutritional Sciences, University of Toronto, Toronto ON
| | - Bernard Zinman
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto ON; Division of Endocrinology, University of Toronto, Toronto ON; Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto ON
| | - Ravi Retnakaran
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto ON; Division of Endocrinology, University of Toronto, Toronto ON; Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto ON
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97
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Simmons D, Moses RG. Gestational diabetes mellitus: to screen or not to screen?: Is this really still a question? Diabetes Care 2013; 36:2877-8. [PMID: 24065839 PMCID: PMC3781565 DOI: 10.2337/dc13-0833] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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98
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Diet and carbohydrate food knowledge of multi-ethnic women: a comparative analysis of pregnant women with and without Gestational Diabetes Mellitus. PLoS One 2013; 8:e73486. [PMID: 24069200 PMCID: PMC3772003 DOI: 10.1371/journal.pone.0073486] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 07/21/2013] [Indexed: 12/16/2022] Open
Abstract
Background Diet therapy is the cornerstone for the management of gestational diabetes mellitus (GDM). Carbohydrate is the primary nutrient affecting postprandial blood glucose levels. Hence, knowledge of food containing carbohydrates can assist women with GDM optimize glycemic control. Despite that, there is a paucity of research on carbohydrate-related knowledge of women with GDM. The United Arab Emirates (UAE) has one of the highest prevalence of diabetes (19.2%) in the world. This study compared diet and knowledge of carbohydrate-containing foods among pregnant women with and without GDM in the UAE. Methods The sample consisted of multi-ethnic women with GDM (n = 94) and a control group of healthy pregnant women (n = 90) attending prenatal clinics in three hospitals in Al Ain, UAE. Data were collected using a questionnaire and a 24-hour recall. Knowledge of food sources of carbohydrate, dietary patterns, and nutrient intakes of the two groups were compared. Results There were no significant differences in the mean knowledge score of food sources of carbohydrate between women with GDM and that of pregnant women without GDM. Similarly, there were no significant differences in energy and nutrient intakes between the two groups with the exception of percent energy from protein. Women with GDM reported significantly lower intake of fruits and fruit juices (P = 0.012) and higher consumption of milk and yogurt (P = 0.004) compared to that of women without GDM. Twenty-two percent of women with GDM indicated they never visited a dietitian for counseling while 65% reported they visited a dietitian only once or twice during the pregnancy. Predictors of carbohydrate knowledge score were perceived knowledge of diet and GDM and parity among women with GDM and parity and educational level among those without GDM. Conclusion The results of the study highlight the urgent need to provide nutrition education for women with GDM in the UAE.
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Zhu WW, Fan L, Yang HX, Kong LY, Su SP, Wang ZL, Hu YL, Zhang MH, Sun LZ, Mi Y, Du XP, Zhang H, Wang YH, Huang YP, Zhong LR, Wu HR, Li N, Wang YF, Kapur A. Fasting plasma glucose at 24-28 weeks to screen for gestational diabetes mellitus: new evidence from China. Diabetes Care 2013; 36:2038-40. [PMID: 23536582 PMCID: PMC3687275 DOI: 10.2337/dc12-2465] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate the usefulness of a fasting plasma glucose (FPG) at 24-28 weeks' gestation to screen for gestational diabetes mellitus (GDM). RESEARCH DESIGN AND METHODS The medical records and results of a 75-g 2-h oral glucose tolerance test (OGTT) of 24,854 pregnant women without known pre-GDM attending prenatal clinics in 15 hospitals in China were examined. RESULTS FPG cutoff value of 5.1 mmol/L identified 3,149 (12.1%) pregnant women with GDM. FPG cutoff value of 4.4 mmol/L ruled out GDM in 15,369 (38.2%) women. With use of this cutoff point, 12.2% of patients with mild GDM will be missed. The positive predictive value is 0.322, and the negative predictive value is 0.928. CONCLUSIONS FPG at 24-28 weeks' gestation could be used as a screening test to identify GDM patients in low-resource regions. Women with an FPG between ≥4.4 and ≤5.0 mmol/L would require a 75-g OGTT to diagnose GDM. This would help to avoid approximately one-half (50.3%) of the formal 75-g OGTTs in China.
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Affiliation(s)
- Wei-wei Zhu
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
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Heterogeneity of pregnancy outcomes and risk of LGA neonates in Caucasian females according to IADPSG criteria for gestational diabetes mellitus. DIABETES & METABOLISM 2013. [DOI: 10.1016/j.diabet.2012.09.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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