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Lefever E, Vliebergh J, Mathieu C. Improving the treatment of patients with diabetes using insulin analogues: current findings and future directions. Expert Opin Drug Saf 2021; 20:155-169. [PMID: 33249944 DOI: 10.1080/14740338.2021.1856813] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Introduction: The aim of insulin replacement in insulin-deficient people (type 1 diabetes, pancreatic causes of diabetes, long-standing type 2 diabetes) is to approximate the physiologic insulin action profile as closely as possible. However, short-acting human insulins start too slow and act too long, causing postprandial hyperglycemia and delayed hypoglycemia, while the insulin action profile of long-acting human insulins is too variable in duration and strength of action, leading to insufficient basal insulin covering and peak insulin levels after injection causing early nocturnal hypoglycemia. Insulin analogues were designed to overcome these shortcomings. In insulin-resistant people (type 2 diabetes), insulin analogues contribute to more efficient and safer insulin supplementation. Areas covered: In this review, we describe the unmet needs for insulin therapy, the currently available short- and long-acting insulin analogues and some considerations on cardiovascular outcomes, use in special populations, and cost-effectiveness. Finally, we discuss what is new in the field of insulin analogues. Expert opinion: The development of insulin analogues is an important step in diabetes treatment. Despite many patients meeting their glycemic targets with the newest analogues, hypoglycemic episodes remain a major problem. More physiologic insulin regimens, with glucose-sensitive or organ-targeting insulin analogues may be the answer to these issues.
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Affiliation(s)
- Eveline Lefever
- Department of Endocrinology, University Hospitals Leuven , Leuven, Belgium
| | - Joke Vliebergh
- Department of Endocrinology, University Hospitals Leuven , Leuven, Belgium
| | - Chantal Mathieu
- Department of Endocrinology, University Hospitals Leuven , Leuven, Belgium
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102
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Al Subhi SK, Al Kindi RM, Al Rawahi A, Al Seyabi IS, Al Mukhaini A. Prevalence of Gestational Diabetes Mellitus Using the Latest World Health Organization Diagnostic Criteria among Omani Women in Muscat, Oman. Oman Med J 2021; 36:e215. [PMID: 33437538 PMCID: PMC7797029 DOI: 10.5001/omj.2021.08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 06/29/2020] [Indexed: 12/12/2022] Open
Abstract
Objectives In 2013, the World Health Organization (WHO) recommended new criteria for diagnosing gestational diabetes mellitus (GDM). Our study aimed to compare the incidence of GDM and its complications among Omani pregnant women using the new diagnostic criteria compared to previous criteria published in 1999. Methods This retrospective cohort study was conducted between January and December 2016 at the Bawshar Specialized Polyclinic in Muscat, Oman. A total of 613 Omani women were included in the study. Baseline maternal characteristics such as age, body mass index, parity, and socioeconomic status were recorded in addition to maternal and neonatal outcomes. Results Based on the current diagnostic criteria, the incidence of GDM was 48.5% (n = 297); however, this dropped to 26.4% (n = 162) when applying the old criteria. Moreover, rates of maternal complications including polyhydramnios (5.6% vs. 4.6%), pregnancy-induced hypertension (3.2% vs. 1.5%), and preterm delivery (3.2% vs. 1.5%) were slightly higher among women with GDM diagnosed using the latest criteria. However, these differences were not statistically significant. Neonatal complications were also slightly more frequent among the first group, without any significant differences. Conclusions The incidence of GDM among Omani women rose dramatically when utilizing the latest WHO diagnostic criteria, owing to a lower fasting blood glucose cut-off value. In addition, a comparison of the frequencies of maternal and neonatal complications supports the validity of the new criteria. These findings should be taken into consideration by decision-makers in Oman when planning antenatal and postnatal services.
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Affiliation(s)
- Saada K Al Subhi
- Department of Obstetrics and Gynecology, Directorate General of Health Services, Bawshar Specialized Polyclinic, Muscat, Oman
| | - Rahma M Al Kindi
- Department of Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University Hospital, Muscat, Oman
| | | | - Iman S Al Seyabi
- Department of Obstetrics and Gynecology, Directorate General of Health Services, Bawshar Specialized Polyclinic, Muscat, Oman
| | - Ameena Al Mukhaini
- Family Medicine Residency Training Program, Oman Medical Specialty Board, Muscat, Oman
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103
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Jethwani P, Saboo B, Jethwani L, Chawla R, Maheshwari A, Agarwal S, Jaggi S. Use of insulin glargine during pregnancy: A review. Diabetes Metab Syndr 2021; 15:379-384. [PMID: 33540243 DOI: 10.1016/j.dsx.2021.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 01/09/2021] [Accepted: 01/11/2021] [Indexed: 11/18/2022]
Abstract
BACKGOUND AND AIMS Hyperglycemia during pregnancy is increasing globally. Insulin therapy is considered the standard of care for its optimum management. Insulin glargine, in spite of widespread use in non-pregnant adults, lacks randomized controlled trial evidence as safe basal insulin during pregnancy. Aim of this review is to discuss major available evidences and recommendations on the use of insulin glargine during pregnancy. METHODS Evidences related to use of insulin glargine during pregnancy, including animal studies, placental transfer studies, case reports as well as observational studies were retrieved using PUBMED & Google scholar. Recommendations regarding use of insulin glargine during pregnancy by international and Indian organizations were reviewed. RESULTS Trans-placental transfer studies show that insulin glargine does not cross placenta when used at therapeutic concentrations. Although there are no randomized controlled trials on insulin glargine in pregnancy, it's use during pregnancy is not associated with any adverse maternal or neonatal outcomes as shown in many case reports and observational studies (both prospective and retrospective). It's use during pregnancy is hence considered safe by many organizations across the globe. CONCLUSIONS Insulin glargine can be continued safely during pregnancy in women who are already taking it prior to pregnancy and have achieved good glycemic control with it. However we require preferably randomized controlled trials or large prospective observational studies to establish it as first line or preferred basal insulin for management of hyperglycemia during pregnancy.
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Affiliation(s)
| | - B Saboo
- Diacare- Diabetes Care & Hormone Clinic, Ahmedabad, India
| | | | - R Chawla
- North Delhi Diabetes Centre, Rohini, New Delhi, India
| | - A Maheshwari
- Sri Harikamal Diabetes Clinic & Research Centre, Vikas Nagar, Lucknow, India
| | - S Agarwal
- Dept. of Medicine, Ruby Hall Clinic, Pune, India
| | - S Jaggi
- Lifecare Diabetes Centre, New Delhi, India
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Vasile FC, Preda A, Ștefan AG, Vladu MI, Forțofoiu MC, Clenciu D, Gheorghe IO, Forțofoiu M, Moța M. An Update of Medical Nutrition Therapy in Gestational Diabetes Mellitus. J Diabetes Res 2021; 2021:5266919. [PMID: 34840988 PMCID: PMC8616668 DOI: 10.1155/2021/5266919] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/25/2021] [Accepted: 11/09/2021] [Indexed: 12/16/2022] Open
Abstract
Gestational diabetes mellitus (GDM) is a serious and frequent pregnancy complication that can lead to short and long-term risks for both mother and fetus. Different health organizations proposed different algorithms for the screening, diagnosis, and management of GDM. Medical Nutrition Therapy (MNT), together with physical exercise and frequent self-monitoring, represents the milestone for GDM treatment in order to reduce maternal and fetal complications. The pregnant woman should benefit from her family support and make changes in their lifestyles, changes that, in the end, will be beneficial for the whole family. The aim of this manuscript is to review the literature about the Medical Nutrition Therapy in GDM and its crucial role in GDM management.
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Affiliation(s)
| | - Agnesa Preda
- University of Medicine and Pharmacy of Craiova, Craiova, Dolj, Romania
- Clinical County Emergency Hospital, Craiova, Dolj, Romania
| | - Adela Gabriela Ștefan
- Department of Diabetes Nutrition and Metabolic Diseases, Calafat Municipal Hospital, Calafat, Dolj, Romania
| | - Mihaela Ionela Vladu
- University of Medicine and Pharmacy of Craiova, Craiova, Dolj, Romania
- Clinical Municipal Hospital “Philanthropy”, Craiova, Romania
| | - Mircea-Cătălin Forțofoiu
- University of Medicine and Pharmacy of Craiova, Craiova, Dolj, Romania
- Clinical Municipal Hospital “Philanthropy”, Craiova, Romania
| | - Diana Clenciu
- University of Medicine and Pharmacy of Craiova, Craiova, Dolj, Romania
- Clinical Municipal Hospital “Philanthropy”, Craiova, Romania
| | - Ioan Ovidiu Gheorghe
- University of Medicine and Pharmacy of Craiova, Craiova, Dolj, Romania
- Public Health Department Gorj, Romania
| | - Maria Forțofoiu
- University of Medicine and Pharmacy of Craiova, Craiova, Dolj, Romania
- Clinical Municipal Hospital “Philanthropy”, Craiova, Romania
| | - Maria Moța
- University of Medicine and Pharmacy of Craiova, Craiova, Dolj, Romania
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Risk stratification and screening for coronary artery disease in asymptomatic patients with diabetes mellitus: Position paper of the French Society of Cardiology and the French-speaking Society of Diabetology. Arch Cardiovasc Dis 2020; 114:150-172. [PMID: 33309203 DOI: 10.1016/j.acvd.2020.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/07/2020] [Accepted: 07/09/2020] [Indexed: 01/09/2023]
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Egan AM, Dow ML, Vella A. A Review of the Pathophysiology and Management of Diabetes in Pregnancy. Mayo Clin Proc 2020; 95:2734-2746. [PMID: 32736942 DOI: 10.1016/j.mayocp.2020.02.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 01/24/2020] [Accepted: 02/18/2020] [Indexed: 12/13/2022]
Abstract
Diabetes is a common metabolic complication of pregnancy and affected women fall into two subgroups: women with pre-existing diabetes and those with gestational diabetes mellitus (GDM). When pregnancy is affected by diabetes, both mother and infant are at increased risk for multiple adverse outcomes. A multidisciplinary approach to care before, during, and after pregnancy is effective in reducing these risks. The PubMed database was searched for English language studies and guidelines relating to diabetes in pregnancy. The following search terms were used alone and in combination: diabetes, pregnancy, gestational diabetes, GDM, prepregnancy, and preconception. A date restriction was not applied. Results were reviewed by the authors and selected for inclusion based on relevance to the topic. Additional articles were identified by manually searching reference lists of included articles. Using data from this search we herein summarize the evidence relating to pathophysiology and management of diabetes in pregnancy. We discuss areas of controversy including the method and timing of diagnosis of GDM, and choice of pharmacologic agents to treat hyperglycemia during pregnancy. Therefore, this review is intended to serve as a practical guide for clinicians who are caring for women with diabetes and their infants.
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Affiliation(s)
- Aoife M Egan
- Department of Endocrinology, Mayo Clinic, Rochester, MN.
| | - Margaret L Dow
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN
| | - Adrian Vella
- Department of Endocrinology, Mayo Clinic, Rochester, MN
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107
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Liu B, Cai J, Xu Y, Long Y, Deng L, Lin S, Zhang J, Yang J, Zhong L, Luo Y, Zhou Y, Zhang Y, Li Z, Chen H, Wang Z. Early Diagnosed Gestational Diabetes Mellitus Is Associated With Adverse Pregnancy Outcomes: A Prospective Cohort Study. J Clin Endocrinol Metab 2020; 105:5902969. [PMID: 32898218 DOI: 10.1210/clinem/dgaa633] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 09/06/2020] [Indexed: 11/19/2022]
Abstract
CONTEXT The significance of an early diagnosis of gestational diabetes mellitus (GDM) with oral glucose tolerance test (OGTT) has not been determined. OBJECTIVE The objective of this work is to investigate GDM diagnosed by early and standard OGTTs and determine adverse maternal and neonatal outcomes associated with early GDM diagnosis. RESEARCH DESIGN AND METHODS The Early Diagnosis of Gestational Diabetes Mellitus study is a prospective cohort study. Each participant in the study underwent 2 OGTTs, an early OGTT at 18 to 20 gestational weeks (gws) and a standard OGTT at 24 to 28 gws. The reproduciblity between early and standard OGTT were analyzed. Maternal and neonatal metabolic disorders and pregnancy outcomes were compared across groups. RESULTS A total of 522 participants completed both the early and standard OGTTs. The glucose values in the early OGTT were not significantly different from those in the standard OGTT (fasting: 4.31 ± 0.41 mmol/L vs 4.29 ± 0.37 mmol/L, P = .360; 1-hour: 7.68 ± 1.71 mmol/L vs 7.66 ± 1.59 mmol/L, P = .826; 2-hour: 6.69 ± 1.47 mmol/L vs 6.71 ± 1.39 mmol/L, P = .800). The reproducibility of early and standard OGTT results was 74.9%. Pregnant women in the GDM group had higher glycated hemoglobin, C-peptide, and homeostasis model assessment of insulin resistance in the late gestational period. Neonates born to mothers in the GDM group were at a higher risk of being large for gestational age (odds ratio [OR]: 3.665; 95% CI, 1.006-11.91) and were also more prone to neonatal hyperinsulinemia (OR: 3.652; 95% CI, 1.152-10.533). CONCLUSION Early-onset GDM diagnosed by OGTT at 18 to 20 gws is associated with maternal and neonatal metabolic disorders and adverse pregnancy outcomes. Further randomized controlled trials on the therapeutic efficacy for early-onset GDM will confirm the significance of early screening for GDM.
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Affiliation(s)
- Bin Liu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
| | - Jian Cai
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
| | - Yun Xu
- Department of Endocrinology, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
| | - Yuhang Long
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
| | - Langhui Deng
- Department of Laboratory Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
| | - Suiwen Lin
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
| | - Jinxin Zhang
- Department of Medical Statistic and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, PR China
| | - Jianbo Yang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
| | - Lieqiang Zhong
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
| | - Yanmin Luo
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
| | - Yi Zhou
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
| | - Ying Zhang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
| | - Zhuyu Li
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
| | - Hanqing Chen
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
| | - Zilian Wang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
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Rudland VL, Price SAL, Hughes R, Barrett HL, Lagstrom J, Porter C, Britten FL, Glastras S, Fulcher I, Wein P, Simmons D, McIntyre HD, Callaway L. ADIPS 2020 guideline for pre-existing diabetes and pregnancy. Aust N Z J Obstet Gynaecol 2020; 60:E18-E52. [PMID: 33200400 DOI: 10.1111/ajo.13265] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 09/14/2020] [Indexed: 02/07/2023]
Abstract
This is the full version of the Australasian Diabetes in Pregnancy Society (ADIPS) 2020 guideline for pre-existing diabetes and pregnancy. The guideline encompasses the management of women with pre-existing type 1 diabetes and type 2 diabetes in relation to pregnancy, including preconception, antepartum, intrapartum and postpartum care. The management of women with monogenic diabetes or cystic fibrosis-related diabetes in relation to pregnancy is also discussed.
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Affiliation(s)
- Victoria L Rudland
- Department of Diabetes and Endocrinology, Westmead Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Sarah A L Price
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Diabetes, Royal Women's Hospital, Melbourne, Victoria, Australia.,Mercy Hospital for Women, Melbourne, Victoria, Australia.,Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Ruth Hughes
- Department of Obstetrics and Gynaecology, University of Otago, Christchurch, New Zealand
| | - Helen L Barrett
- Department of Endocrinology, Mater Health, Brisbane, Queensland, Australia.,Mater Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Janet Lagstrom
- Green St Specialists Wangaratta, Wangaratta, Victoria, Australia.,Denis Medical Yarrawonga, Yarrawonga, Victoria, Australia.,Corowa Medical Clinic, Corowa, New South Wales, Australia.,NCN Health, Numurkah, Victoria, Australia
| | - Cynthia Porter
- Geraldton Diabetes Clinic, Geraldton, Western Australia, Australia
| | - Fiona L Britten
- Department of Obstetric Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Mater Private Hospital and Mater Mother's Private Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Sarah Glastras
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Diabetes, Endocrinology and Metabolism, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Ian Fulcher
- Liverpool Hospital, Sydney, New South Wales, Australia
| | - Peter Wein
- Mercy Hospital for Women, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - David Simmons
- Western Sydney University, Sydney, New South Wales, Australia.,Campbelltown Hospital, Sydney, New South Wales, Australia
| | - H David McIntyre
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Mater Health, Brisbane, Queensland, Australia
| | - Leonie Callaway
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Women's and Children's Services, Metro North Hospital and Health Service District, Brisbane, Queensland, Australia.,Women's and Newborn Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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109
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Belay DM, Bayih WA, Alemu AY, Sinshaw AE, Mekonen DK, Ayele AS, Belayneh WH, Tegared HA, Birihane BM. Adverse birth outcome and associated factors among diabetic pregnant women in Ethiopia: Systematic review and meta-analysis. PLoS One 2020; 15:e0241811. [PMID: 33170888 PMCID: PMC7654793 DOI: 10.1371/journal.pone.0241811] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 10/20/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The magnitude of adverse birth outcome among diabetic pregnant women is high in low-and-middle income countries, like Ethiopia. Precise epidemiological evidence is necessary to plan, evaluate and improve effective preventive measures. This systematic review and meta-analysis is the first to estimate the pooled prevalence of adverse birth outcome and associated factors among diabetic pregnant women in Ethiopia. METHODS PubMed, Cochrane Library, Google Scholar, SCOPUS, Web of Science and PsycINFO, and article found in University online repository were accessed. Observational studies such as cross-sectional, case-control and prospective cohort reported using English language was involved. I2 statistic was used to check heterogeneity. Egger's test and funnel plot were used to measure publication bias. Weighted inverse variance random effects model was also performed. RESULTS Seven studies with 1,225 study participants were retrieved to estimate the pooled prevalence of adverse birth outcome and associated factors. The pooled prevalence of adverse birth outcome among diabetic pregnant women was 5.3% [95% CI; 1.61, 17.41]. Fasting blood glucose level above 100 mg/dl [Adjusted Odds ratio (AOR) = 10.51; 95% Confidence Interval (CI) = 5.90, 15.12], two hour post prandial glucose level above 120 mg/dl [AOR = 8.77; 95% CI = 4.51, 13.03], gestational age <37 completed week [AOR = 9.76; 95% CI = 5.29, 14.23], no ANC follow-up [AOR = 10.78; 95% CI = 6.12, 15.44], history of previous adverse outcomes [AOR = 3.47; 95% CI = 1.04, 5.90], maternal age < 30 years [AOR = 3.47; 95% CI = 1.04, 5.90], and illiteracy [AOR = 2.89; 95% CI = 0.81,4.97)] were associated factors of adverse birth outcome. CONCLUSIONS The pooled prevalence of adverse birth outcomes among diabetic pregnant women in Ethiopia was high. Child born from mothers who were illiterate, maternal age < 30 years, gestational age < 37 completed weeks, history of previous adverse birth outcomes and no ANC follow-up increased the risk of adverse birth outcome. TRIAL REGISTRATION It is registered in PROSPERO data base: (PROSPERO 2020: CRD42020167734).
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Affiliation(s)
- Demeke Mesfin Belay
- Department of Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Wubet Alebachew Bayih
- Department of Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Abebaw Yeshambel Alemu
- Department of Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Aklilu Endalamaw Sinshaw
- Department of Pediatrics and Child Health Nursing, School of Health Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Demewoz Kefale Mekonen
- Department of Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Amare Simegn Ayele
- Department of Midwifery, Reproductive health, Debre Tabor University, Debre Tabor, Ethiopia
| | - Wasihun Hailemichael Belayneh
- Department of Medical Laboratory, Molecular Biology and Immunology, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Henoke Andualem Tegared
- Department of Medical Laboratory, Molecular Biology and Immunology, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Biniam Minuye Birihane
- Department of Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Nosova EV, O'Malley G, Dassau E, Levy CJ. Leveraging technology for the treatment of type 1 diabetes in pregnancy: A review of past, current, and future therapeutic tools. J Diabetes 2020; 12:714-732. [PMID: 32125763 DOI: 10.1111/1753-0407.13030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 03/01/2020] [Indexed: 12/16/2022] Open
Abstract
The significant risks associated with pregnancies complicated by type 1 diabetes (T1D) were first recognized in the medical literature in the mid-twentieth century. Stringent glycemic control with hemoglobin A1c (HbA1c) values ideally less than 6% has been shown to improve maternal and fetal outcomes. The management options for pregnant women with T1D in the modern era include a variety of technologies to support self-care. Although self-monitoring of blood glucose (SMBG) and multiple daily injections (MDI) are often the recommended management options during pregnancy, many people with T1D utilize a variety of different technologies, including continuous glucose monitoring (CGM), continuous subcutaneous insulin infusion (CSII), and CSII including automated delivery or suspension algorithms. These systems have yielded invaluable diagnostic and therapeutic capabilities and have the potential to benefit this understudied higher-risk group. A recent prospective, multicenter study evaluating pregnant patients with T1D revealed that CGM significantly improves maternal glycemic parameters, is associated with fewer adverse neonatal outcomes, and minimizes burden. Outcome data for CSII, which is approved for use in pregnancy and has been utilized for several decades, remain mixed. Current evidence, although limited, for commercially available and emerging technologies for the management of T1D in pregnancy holds promise for improving patient and fetal outcomes.
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Affiliation(s)
- Emily V Nosova
- Division of Endocrinology, Diabetes and Bone Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Grenye O'Malley
- Division of Endocrinology, Diabetes and Bone Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Eyal Dassau
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts, USA
| | - Carol J Levy
- Division of Endocrinology, Diabetes and Bone Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Gortazar L, Goday A, Flores-Le Roux JA, Sarsanedas E, Payà A, Mañé L, Pedro-Botet J, Benaiges D. Trends in prevalence of pre-existing diabetes and perinatal outcomes: a large, population-based study in Catalonia, Spain, 2006-2015. BMJ Open Diabetes Res Care 2020; 8:8/1/e001254. [PMID: 33106331 PMCID: PMC7592254 DOI: 10.1136/bmjdrc-2020-001254] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 06/17/2020] [Accepted: 07/13/2020] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION This study aims to assess trends in the prevalence of pre-existing diabetes and whether the risk of adverse perinatal outcomes decreased in women between 2006 and 2015 in Catalonia, Spain. RESEARCH DESIGN AND METHODS A population-based study of 743 762 singleton deliveries between 2006 and 2015 in Catalonia, Spain, was conducted using data from the Spanish Minimum Basic Data Set. Cases of type 1 diabetes (T1DM) and 'type 2 diabetes and other pre-existing diabetes' ('T2DM and other PGD') were identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes. Crude and age-adjusted annual prevalences were calculated. Poisson regression model was used to assess trends in prevalence and perinatal outcomes during the study period. RESULTS Overall prevalences of pre-existing diabetes, T1DM and 'T2DM and other PGD' were 0.52% (95% CI 0.51 to 0.54), 0.17% (95% CI 0.17 to 0.18) and 0.35% (95% CI 0.33 to 0.36), respectively. From 2006 to 2015, rates increased for pre-existing diabetes (from 0.43 (95% CI 0.39 to 0.48) to 0.56% (0.50 to 0.62), p<0.001), T1DM (from 0.14 (0.11 to 0.17) to 0.20% (0.17 to 0.23), p<0.001) and 'T2DM and other PGD' (from 0.29 (0.25 to 0.33) to 0.36% (0.31 to 0.40), p<0.001). Pre-eclampsia rose in women with pre-existing diabetes (from 4.38% to 8.97%, adjusted p<0.001), T1DM (from 3.85% to 12.88%, p=0.005) and 'T2DM and other PGD' (from 4.63% to 6.78%, adjusted p=0.01). Prevalence of prematurity, cesarean section and small for gestational age remained stable in all diabetes groups. However, the prevalence of macrosomia fell in women with pre-existing diabetes (from 18.18% to 11.9%, adjusted p=0.011) and 'T2DM and other PGD' (from 14.71% to 11.06%, non-adjusted p=0.022, adjusted p=0.305) and large for gestational age decreased in all diabetes groups (from 39.73% to 30.25% in pre-existing diabetes, adjusted p=0.004). CONCLUSIONS The prevalence of pre-existing diabetes increased significantly in Catalonia between 2006 and 2015. Despite improvements in outcomes related to excessive birth weight, pre-eclampsia rates are rising and overall perinatal outcomes in women with pre-existing diabetes continue to be markedly worse than in the population without diabetes.
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Affiliation(s)
- Lucia Gortazar
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Albert Goday
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Juana Antonia Flores-Le Roux
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Eugènia Sarsanedas
- Health Information Management Department, Hospital del Mar, Barcelona, Spain
| | - Antonio Payà
- Department of Gynaecology and Obstetrics, Hospital del Mar, Barcelona, Spain
| | - Laura Mañé
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Juan Pedro-Botet
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - David Benaiges
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
- Consorci Sanitari de l'Alt Penedès Garraf, Vilafranca del Penedès, Spain
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112
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Korvesi VM, Chouvarda I, Mastorakos G, Goulis DG. Implementation of the Endocrine Society clinical practice guidelines for gestational diabetes mellitus to a knowledge tool. Eur J Clin Invest 2020; 50:e13291. [PMID: 32446282 DOI: 10.1111/eci.13291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/29/2020] [Accepted: 05/14/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Despite the production of clinical practice guidelines (CPGs) in many medical areas, their use is not sufficiently adopted in clinical practice. Incorporation of CPGs in knowledge tools (KnowT) or decision support systems (DSS) for routine use can improve healthcare providers' compliance to CPGs. MATERIALS AND METHODS Clinical practice guidelines for gestational diabetes mellitus (GDM) were searched for, collected and compared. The CPG that met pre-specified criteria ([a] published by a European or American organization between 2010 and 2018, [b] being developed a systematic way and [c] having statements of "level of evidence" and "strength of recommendation") was chosen for implementation (Endocrine Society, 2013). Its recommendations were deconstructed, re-organized and reconstructed as an algorithm (in the form of a flowchart), which was integrated into a KnowT. Content completeness and evaluation of CPG by the Guideline Implementability Appraisal tool (GLIA) were performed as well. The primary objective was the development of a clinical algorithm in the field of GDM and its integration into a KnowT. The secondary objective was to demonstrate the completeness of the CPG content and evaluate its implementability in the KnowT. RESULTS Endocrine Society 2013 CPG was restructured as a flowchart, and a KnowT was constructed with the use of the "Openlabyrinth" software. The completeness of the content was confirmed, and GLIA appraisal demonstrated its implementability. CONCLUSION Endocrine Society 2013 CPG for GDM is a complete set of recommendations. Its structure makes possible the design of a clinical algorithm and its implementation into a KnowT.
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Affiliation(s)
- Vasiliki M Korvesi
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioanna Chouvarda
- Lab of Computing, Medical Informatics and Biomedical Imaging Technologies, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Mastorakos
- Unit of Endocrinology, Diabetes mellitus and Metabolism, Faculty of Medicine, Aretaieion Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Valensi P, Henry P, Boccara F, Cosson E, Prevost G, Emmerich J, Ernande L, Marcadet D, Mousseaux E, Rouzet F, Sultan A, Ferrières J, Vergès B, Van Belle E. Risk stratification and screening for coronary artery disease in asymptomatic patients with diabetes mellitus: Position paper of the French Society of Cardiology and the French-speaking Society of Diabetology. DIABETES & METABOLISM 2020; 47:101185. [PMID: 32846201 DOI: 10.1016/j.diabet.2020.08.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Key Words] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/07/2020] [Accepted: 07/09/2020] [Indexed: 01/09/2023]
Affiliation(s)
- Paul Valensi
- Unit of Endocrinology Diabetology Nutrition, AP-HP, Jean Verdier hospital, CINFO, CRNH-IdF, Paris 13 University, Sorbonne Paris Cité, Bondy, France
| | - Patrick Henry
- Department of Cardiology, Inserm U942, Lariboisiere Hospital, Assistance Publique - Hôpitaux de Paris, University of Paris, Paris, France.
| | - Franck Boccara
- AP-HP, Hôpitaux de l'Est Parisien, Hôpital Saint-Antoine, Department of Cardiology, Sorbonne Université-Inserm UMR S_938, Centre de Recherche Saint-Antoine, Paris, France
| | - Emmanuel Cosson
- AP-HP, Avicenne Hospital, Paris 13 University, Sorbonne Paris Cité, Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, Bobigny, France; Paris 13 University, Sorbonne Paris Cité, UMR U557 Inserm/U11125 INRAE/CNAM/Université Paris13, Unité de Recherche Epidémiologique Nutritionnelle, Bobigny, France
| | - Gaetan Prevost
- Department of Endocrinology, Diabetes and Metabolic Diseases, Normandie Univ, UNIROUEN, Rouen University Hospital, Centre d'Investigation Clinique (CIC-CRB)-Inserm 1404, Rouen University Hospital, 76000 Rouen, France
| | - Joseph Emmerich
- Service de Médecine Vasculaire, Groupe Hospitalier Paris Saint-Joseph, Université de Paris, Inserm UMR1153-CRESS, 75674 Paris cedex 14, France
| | - Laura Ernande
- Service des explorations fonctionnelles, Hôpital Henri Mondor, AP-HP et Inserm U955, Université Paris-Est Créteil, France
| | - Dany Marcadet
- Centre Coeur et Santé Bernoulli - Cardiologie du sport et Réadaptation Cardiaque, 3, rue Bernoulli, 75008 Paris, France
| | - Elie Mousseaux
- Radiology Department, Hôpital Européen Georges Pompidou & Inserm U 970; Assistance Publique - Hôpitaux de Paris, University of Paris, French Society of Cardiovascular Imaging (SFICV), Paris, France
| | - François Rouzet
- Nuclear Medicine Department, Bichat Hospital, AP-HP Paris - Université de Paris, Laboratory for Vascular Translational Science, Inserm, UMR 1148, 75018 Paris, France
| | - Ariane Sultan
- Physiologie et Médecine Expérimentale du Coeur et des Muscles (PHYMEDEX), U1046 Inserm, UMR9214 CNRS, Université de Montpellier, 34295 Montpellier; Département Endocrinologie, Nutrition, Diabète, Equipe Nutrition, Diabète, CHRU Montpellier, 34090 Montpellier, France
| | - Jean Ferrières
- Department of Cardiology and UMR Inserm 1027, Toulouse Rangueil University Hospital, Toulouse University School of Medicine, Toulouse, France
| | - Bruno Vergès
- Service Endocrinologie-Diabétologie, CHU Dijon - Inserm LNC-UMR 1231, Dijon, France
| | - Eric Van Belle
- Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Institut Coeur Poumon, Centre Hospitalier Universitaire de Lille, Lille, France; Inserm, U1011, Institut Pasteur de Lille, EGID, Lille, France; Department of Medicine, Université de Lille, Lille, France
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Goyal A, Gupta Y, Singla R, Kalra S, Tandon N. American Diabetes Association "Standards of Medical Care-2020 for Gestational Diabetes Mellitus": A Critical Appraisal. Diabetes Ther 2020; 11:1639-1644. [PMID: 32564336 PMCID: PMC7376815 DOI: 10.1007/s13300-020-00865-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Gestational diabetes mellitus (GDM) is a major public health problem, affecting about one in every six pregnancies globally. The guidelines provided by the American Diabetes Association (ADA) on diagnosis and management of hyperglycemia in pregnancy are widely followed. We aim to provide a critical appraisal of the recently published ADA guidance document, highlighting its strength and limitations with regard to the diagnosis of GDM. METHODS AND RESULTS We reviewed the recent ADA recommendations for the diagnosis and management of hyperglycemia in pregnancy. A periodic update in keeping with the emerging evidence, an inclusive diagnostic approach which increases generalizability, and a clear proposed approach for prenatal testing and postpartum follow-up are strengths of the ADA guidance document. On the other hand, its limitations are a lack of clarity on the applicability of diagnosis of GDM during early pregnancy, use of scientifically inaccurate terms such as "prediabetes" in the context of pregnancy and "overt diabetes prior to gestation" in the definition of GDM, and inconsistent use of terminology between successive publications. Certain issues which merit attention in future publications include a need for uniform global definition of GDM, demarcation of overt diabetes in pregnancy as a distinct entity, clarity on the diagnosis of GDM during early pregnancy, and clear delineation of timelines and appropriate testing strategy for the first prenatal visit. CONCLUSIONS This article provides a critical appraisal of the recently published ADA guidance document with regard to the diagnosis of GDM. We also share our perspective on issues warranting attention in the future publications. Experts from various professional organizations should aim for a consensus document which can resolve existing controversies in this field, and help clinicians and researchers achieve better health for women in their care.
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Affiliation(s)
- Alpesh Goyal
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Yashdeep Gupta
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India.
| | - Rajiv Singla
- Department of Endocrinology and Metabolism, Kalpavriksh Superspecialty Center, New Delhi, India
| | - Sanjay Kalra
- Department of Endocrinology and Metabolism, Bharti Hospital, Karnal, India
| | - Nikhil Tandon
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
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115
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Mijatovic J, Louie JCY, Buso MEC, Atkinson FS, Ross GP, Markovic TP, Brand-Miller JC. Effects of a modestly lower carbohydrate diet in gestational diabetes: a randomized controlled trial. Am J Clin Nutr 2020; 112:284-292. [PMID: 32537643 DOI: 10.1093/ajcn/nqaa137] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 05/15/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Lower carbohydrate diets have the potential to improve glycemia but may increase ketonemia in women with gestational diabetes (GDM). We hypothesized that modestly lower carbohydrate intake would not increase ketonemia. OBJECTIVE To compare blood ketone concentration, risk of ketonemia, and pregnancy outcomes in women with GDM randomly assigned to a lower carbohydrate diet or routine care. METHODS Forty-six women aged (mean ± SEM) 33.3 ± 0.6 y and prepregnancy BMI 26.8 ± 0.9 kg/m2 were randomly assigned at 28.5 ± 0.4 wk to a modestly lower carbohydrate diet (MLC, ∼135 g/d carbohydrate) or routine care (RC, ∼200 g/d) for 6 wk. Blood ketones were ascertained by finger prick test strips and 3-d food diaries were collected at baseline and end of the intervention. RESULTS There were no detectable differences in blood ketones between completers in the MLC group compared with the RC group (0.1 ± 0.0 compared with 0.1 ± 0.0 mmol/L, n = 33, P = 0.31, respectively), even though carbohydrate and total energy intake were significantly lower in the intervention group (carbohydrate 165 ± 7 compared with 190 ± 9 g, P = 0.04; energy 7040 ± 240 compared with 8230 ± 320 kJ, P <0.01, respectively). Only 20% of participants in the MLC group met the target intake compared with 65% in the RC group (P <0.01). There were no differences in birth weight, rate of large-for-gestational-age infants, percent fat mass, or fat-free mass between groups. CONCLUSIONS An intervention to reduce carbohydrate intake in GDM did not raise ketones to clinical significance, possibly because the target of 135 g/d was difficult to achieve in pregnancy. Feeding studies with food provision may be needed to assess the benefits and risks of low-carbohydrate diets. This trial was registered at www.anzctr.org.au as ACTRN12616000018415.
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Affiliation(s)
- Jovana Mijatovic
- School of Life and Environmental Sciences, The University of Sydney, Sydney, Australia.,Boden Collaboration Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Jimmy Chun Yu Louie
- School of Biological Sciences, The University of Hong Kong, Hong Kong, China
| | - Marion E C Buso
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
| | - Fiona S Atkinson
- School of Life and Environmental Sciences, The University of Sydney, Sydney, Australia.,Charles Perkins Centre, The University of Sydney, Sydney, Australia
| | - Glynis P Ross
- Boden Collaboration Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Royal Prince Alfred Hospital, Sydney Local Health District, Camperdown, Australia
| | - Tania P Markovic
- Boden Collaboration Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Royal Prince Alfred Hospital, Sydney Local Health District, Camperdown, Australia
| | - Jennie C Brand-Miller
- School of Life and Environmental Sciences, The University of Sydney, Sydney, Australia.,Charles Perkins Centre, The University of Sydney, Sydney, Australia
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116
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Antoniou MC, Gilbert L, Gross J, Rossel JB, Fumeaux CJF, Vial Y, Puder JJ. Main Fetal Predictors of Adverse Neonatal Outcomes in Pregnancies with Gestational Diabetes Mellitus. J Clin Med 2020; 9:jcm9082409. [PMID: 32731425 PMCID: PMC7465343 DOI: 10.3390/jcm9082409] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/12/2020] [Accepted: 07/14/2020] [Indexed: 12/04/2022] Open
Abstract
The objectives of this study were to (a) assess the utility of fetal anthropometric variables to predict the most relevant adverse neonatal outcomes in a treated population with gestational diabetes mellitus (GDM) beyond the known impact of maternal anthropometric and metabolic parameters and (b) to identify the most important fetal predictors. A total of 189 patients with GDM were included. The fetal predictors included sonographically assessed fetal weight centile (FWC), FWC > 90% and <10%, and fetal abdominal circumference centile (FACC), FACC > 90% and < 10%, at 29 0/7 to 35 6/7 weeks. Neonatal outcomes comprising neonatal weight centile (NWC), large and small for gestational age (LGA, SGA), hypoglycemia, prematurity, hospitalization for neonatal complication, and (emergency) cesarean section were evaluated. Regression analyses were conducted. Fetal variables predicted anthropometric neonatal outcomes, prematurity, cesarean section and emergency cesarean section. These associations were independent of maternal anthropometric and metabolic predictors, with the exception of cesarean section. FWC was the most significant predictor for NWC, LGA and SGA, while FACC was the most significant predictor for prematurity and FACC > 90% for emergency cesarean section. In women with GDM, third-trimester fetal anthropometric parameters have an important role in predicting adverse neonatal outcomes beyond the impact of maternal predictors.
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Affiliation(s)
- Maria-Christina Antoniou
- Pediatric Service, Department Woman Mother Child, University Hospital of Lausanne, 1011 Lausanne, Switzerland
- Correspondence: ; Tel.: +41-79-55-61-663 or +41-21-314-48-773
| | - Leah Gilbert
- Obstetric Service, Department Woman Mother Child, University Hospital of Lausanne, 1011 Lausanne, Switzerland; (L.G.); (J.G.); (J.-B.R.); (Y.V.); (J.J.P.)
| | - Justine Gross
- Obstetric Service, Department Woman Mother Child, University Hospital of Lausanne, 1011 Lausanne, Switzerland; (L.G.); (J.G.); (J.-B.R.); (Y.V.); (J.J.P.)
- Service of Endocrinology, Diabetes and Metabolism, University Hospital of Lausanne, 1011 Lausanne, Switzerland
| | - Jean-Benoît Rossel
- Obstetric Service, Department Woman Mother Child, University Hospital of Lausanne, 1011 Lausanne, Switzerland; (L.G.); (J.G.); (J.-B.R.); (Y.V.); (J.J.P.)
| | - Céline Julie Fischer Fumeaux
- Clinic of Neonatology, Department Woman Mother Child, University Hospital of Lausanne, 1011 Lausanne, Switzerland;
| | - Yvan Vial
- Obstetric Service, Department Woman Mother Child, University Hospital of Lausanne, 1011 Lausanne, Switzerland; (L.G.); (J.G.); (J.-B.R.); (Y.V.); (J.J.P.)
| | - Jardena Jacqueline Puder
- Obstetric Service, Department Woman Mother Child, University Hospital of Lausanne, 1011 Lausanne, Switzerland; (L.G.); (J.G.); (J.-B.R.); (Y.V.); (J.J.P.)
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Chawla R, Madhu SV, Makkar BM, Ghosh S, Saboo B, Kalra S. RSSDI-ESI Clinical Practice Recommendations for the Management
of Type 2 Diabetes Mellitus 2020. Int J Diabetes Dev Ctries 2020. [PMCID: PMC7371966 DOI: 10.1007/s13410-020-00819-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Rajeev Chawla
- North Delhi Diabetes Centre Rohini, New Delhi, India
| | - S. V. Madhu
- Centre for Diabetes, Endocrinology & Metabolism, UCMS-GTB Hospital, Delhi, India
| | - B. M. Makkar
- Dr Makkar’s Diabetes & Obesity Centre Paschim Vihar, New Delhi, India
| | - Sujoy Ghosh
- Department of Endocrinology & Metabolism, Institute of Post Graduate Medical Education & Research, Kolkata, West Bengal India
| | - Banshi Saboo
- DiaCare - A Complete Diabetes Care Centre, Ahmedabad, India
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, Haryana India
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Rosta K, Al-Bibawy K, Al-Bibawy M, Temsch W, Springer S, Somogyi A, Ott J. Vaginal Progesterone Has No Diabetogenic Potential in Twin Pregnancies: A Retrospective Case-Control Study on 1686 Pregnancies. J Clin Med 2020; 9:jcm9072249. [PMID: 32679847 PMCID: PMC7408737 DOI: 10.3390/jcm9072249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/01/2020] [Accepted: 07/13/2020] [Indexed: 01/02/2023] Open
Abstract
Background: In this study, we aimed to investigate the incidence of gestational diabetes mellitus (GDM) in women who carried twin pregnancies and received vaginal progesterone. Methods: In this retrospective cohort study, 203 out of 1686 women with twin pregnancies received natural progesterone (200 mg/day between gestational weeks 16 + 0 and 36 + 0) vaginally for ≥ 4 weeks. The control group consisted of 1483 women with twin pregnancies without progesterone administration. Pearson’s Chi squared test, Fisher’s exact test, and Student’s t-test was used to compare differences between the control and the progesterone-treated groups. A multivariate binary logistic regression was performed to assess relative independent associations on the dependent outcome of GDM incidence. Results: Vaginal progesterone treatment in twin pregnancies had no significant influence on developing GDM (p = 0.662). Higher pre-pregnancy BMI (OR 1.1; p < 0.001), GDM in previous pregnancy (OR 6.0; p < 0.001), and smoking during pregnancy (OR 1.6; p = 0.014) posed an increased risk for developing GDM. Conclusion: In twin pregnancies, the use of vaginal progesterone for the prevention of recurrent preterm delivery was not associated with an increased risk of GDM.
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Affiliation(s)
- Klara Rosta
- Department of Obstetrics and Gynecology, Clinical Division of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, Vienna 1090, Austria; (K.R.); (K.A.-B.); (M.A.-B.); (S.S.)
| | - Katharina Al-Bibawy
- Department of Obstetrics and Gynecology, Clinical Division of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, Vienna 1090, Austria; (K.R.); (K.A.-B.); (M.A.-B.); (S.S.)
| | - Maria Al-Bibawy
- Department of Obstetrics and Gynecology, Clinical Division of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, Vienna 1090, Austria; (K.R.); (K.A.-B.); (M.A.-B.); (S.S.)
| | - Wilhelm Temsch
- Center for Medical Statistic and Informatic and Intelligent Systems, Medical University of Vienna, Vienna 1090, Austria;
| | - Stephanie Springer
- Department of Obstetrics and Gynecology, Clinical Division of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, Vienna 1090, Austria; (K.R.); (K.A.-B.); (M.A.-B.); (S.S.)
| | - Aniko Somogyi
- 2nd Department of Internal Medicine, Semmelweis University, 1085 Budapest, Hungary;
| | - Johannes Ott
- Department of Obstetrics and Gynecology, Clinical Division of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, Vienna 1090, Austria; (K.R.); (K.A.-B.); (M.A.-B.); (S.S.)
- Correspondence: ; Tel.: +43-140-4002-8160
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Impact of dietary counseling on the perception of diet in patients with gestational diabetes mellitus. Diabetol Int 2020; 12:151-160. [PMID: 33786270 DOI: 10.1007/s13340-020-00454-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 07/01/2020] [Indexed: 12/13/2022]
Abstract
Aims/introduction Medical nutrition therapy is the cornerstone of gestational diabetes mellitus (GDM) treatment. Patients with GDM should receive dietary counseling regarding diet and exercise. Materials and methods To study patients' perception level of diet and their level of understanding after dietary counseling, we analyzed 225 reports of dietary counseling of patients with GDM prepared by dieticians. We also assessed the patients' level of understanding after dietary counseling by asking questions regarding the counseling content. The answers to the questions were aggregated, and substantially similar answers were grouped and categorized. Results The dieticians' suggestions were well understood by the patients. Moreover, the patients also identified their previous incorrect eating habits, such as excessive carbohydrate restriction or inappropriate fruit intake. Although distributed frequent meals were recommended by the dieticians, few patients actually practiced this for various reasons. Some patients were apparently influenced by dietary information from the mass media. Conclusion Dietary counseling was regarded as helpful and acceptable to most patients with GDM in our hospital, and many suggestions were recognized as informative for modification of previous dietary habits. By providing the results of the questionnaire survey to the dieticians, they can improve the quality of their counseling, which is expected to result in better individual care of the patients.
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120
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Thayer SM, Lo JO, Caughey AB. Gestational Diabetes: Importance of Follow-up Screening for the Benefit of Long-term Health. Obstet Gynecol Clin North Am 2020; 47:383-396. [PMID: 32762924 DOI: 10.1016/j.ogc.2020.04.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Gestational diabetes mellitus (GDM) is the most common obstetric metabolic disorder. Long-term health consequences, including type 2 diabetes, metabolic syndrome, and cardiovascular disease, are common with GDM. Postpartum glucose screening is recommended for women with a prior GDM pregnancy. Rates of postpartum screening compliance remain low. Interventions ranging from appointment reminder systems to personalized chronic disease education are being used, emphasizing future chronic disease risk for patients with a history of GDM. With these practice changes, clinicians can more thoroughly engage in the early identification, intervention, and prevention of chronic disease for women with a history of GDM.
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Affiliation(s)
- Sydney M Thayer
- Department of Obstetrics and Gynecology, Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239, USA.
| | - Jamie O Lo
- Department of Obstetrics and Gynecology, Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239, USA
| | - Aaron B Caughey
- Department of Obstetrics and Gynecology, Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239, USA
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Lee KW, Ching SM, Hoo FK, Ramachandran V, Chong SC, Tusimin M, Ang FE, Mohd Nordin N, Devaraj NK. Factors associated with poor-to-moderate quality of life among pregnant women with gestational diabetes mellitus: a cross-sectional study in Malaysia. Qual Life Res 2020; 29:2725-2736. [PMID: 32430781 DOI: 10.1007/s11136-020-02532-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE This study aimed to identify factors associated with poor-to-moderate quality of life (QOL) among women with gestational diabetes mellitus (GDM) in two tertiary hospitals in Malaysia. METHODS A cross-sectional study was conducted among 526 pregnant women with GDM in two tertiary hospitals in Malaysia. Diabetes-related QOL was assessed using the Asian Diabetes Quality of Life Scale (AsianDQoL). Socio-demographic characteristics, glucose monitoring treatments for GDM, past obstetric history, concurrent medical problems and a family history of diseases were captured from patient records. A multiple logistic regression was used for analysis. RESULTS A total of 526 respondents with GDM entered the analysis. The median age of the respondents was 32 (interquartile range = 7) while 82.3% were Malay women. More than half of the respondents (69.5%) received an oral hypoglycaemic agent (OHA), and/or diet modification in controlling their GDM. The study reported that 23.2% of the respondents had poor-to-moderate QOL. Those with a family history of depression and/or anxiety (adjusted Odds ratio [AOR] 6.934, 95% confidence interval [CI] 2.280-21.081), and a family history of GDM (AOR 1.814, 95% CI 1.185-2.778) were at higher odds of suffering from poor-to-moderate QOL compared to those without a family history. Similarly, those who received insulin, with or without OHA, and/or are on diet modification (AOR 1.955, 95% CI 1.243-3.074) were at higher odds of suffering from poor-to-moderate QOL compared to those receiving OHA and/or diet modification. CONCLUSION Nearly one-quarter of Malaysian women with GDM have poor-to-moderate QOL. GDM women with a family history of depression and/or anxiety, family history of GDM, and those who received insulin, with or without OHA, and/or are on diet modification were associated with poor-to-moderate QOL. TRIAL REGISTRATION NMRR-17-2264-37814.
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Affiliation(s)
- Kai Wei Lee
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia
| | - Siew Mooi Ching
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia. .,Malaysian Research Institute On Ageing, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia.
| | - Fan Kee Hoo
- Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia
| | - Vasudevan Ramachandran
- Malaysian Research Institute On Ageing, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia
| | - Seng Choi Chong
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia
| | - Maiza Tusimin
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia
| | - Faith En Ang
- Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia
| | - Noraihan Mohd Nordin
- Department of Obstetrics and Gynaecology, Hospital Kuala Lumpur, 50586, Kuala Lumpur, Malaysia
| | - Navin Kumar Devaraj
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia
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Comparison of criteria of International Association of Diabetes and Pregnancy Study Groups (IADPSG) with National Institute for Health and Care Excellence (NICE) for diagnosis of gestational diabetes mellitus. Arch Gynecol Obstet 2020; 302:47-52. [PMID: 32388777 DOI: 10.1007/s00404-020-05564-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 04/25/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Different screening procedures and diagnostic criteria are being followed in the same as well as in different countries with no single standard criteria established for diagnosis of GDM. So far, there are no studies in the Indian population comparing IADPSG with NICE criteria. OBJECTIVE To compare International Association of Pregnancy and Study Groups (IADPSG) criteria with the National Institute for Health and Care Excellence (NICE) for diagnosis of gestational diabetes mellitus and its influence on maternal and perinatal outcomes. METHOD This prospective observational study was conducted in the Department of Obstetrics and Gynaecology of a tertiary care institute in South India from March 2017 to October 2018. Six-hundred and eighty women with or without risk factors for GDM were recruited in the study and screened for GDM based on IADPSG and NICE criteria. Women with preexisting diabetes mellitus or with fasting plasma glucose ≥ 126 mg/dl were excluded. RESULTS The overall prevalence of GDM in our study was 27.2% by either IADPSG/NICE criteria. In this study, 25.1% women and 11.6% women were diagnosed as GDM using IADPSG and NICE criteria, respectively. The level of agreement between the two diagnostic criteria was found to be poor in our study and was statistically significant (kappa = 0.429, p < 0.001). Women testing IADPSG-positive NICE-negative had a higher risk of GHTN, abortions, PROM, preterm delivery, caesarean section and congenital anomalies, meconium-stained liquor, and low Apgar scores at 1 min when compared to non GDM group. In addition, except for preterm delivery, women diagnosed as GDM by both IADPSG and NICE criteria had adverse outcomes such as preeclampsia, urinary tract infection, and polyhydramnios. Women diagnosed as GDM in IADPSG-negative NICE-positive had no significant adverse maternal or perinatal outcomes. CONCLUSIONS IADPSG criteria appear to be more robust than NICE criteria for diagnosis of GDM. Women with substantial risk of maternal and perinatal outcomes are better identified by IADPSG criteria who would have been missed if NICE criteria was used.
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Kawasaki M, Arata N, Sakamoto N, Osamura A, Sato S, Ogawa Y, Yasuhi I, Waguri M, Hiramatsu Y. Risk factors during the early postpartum period for type 2 diabetes mellitus in women with gestational diabetes. Endocr J 2020; 67:427-437. [PMID: 31969529 DOI: 10.1507/endocrj.ej19-0367] [Citation(s) in RCA: 11] [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] [Indexed: 11/23/2022] Open
Abstract
For women with gestational diabetes mellitus (GDM), the evaluation of glucose tolerance (GT) in the early postpartum period is universally recommended. Nevertheless, few studies have evaluated the risk factors for T2DM on the basis of GT data obtained during the early postpartum period. We aimed to identify the risk factors for type 2 diabetes mellitus (T2DM) by evaluating GT in the first 12 weeks postpartum (12wPP) in women with GDM and to categorize the risk using a combination of the principal risk factors. This retrospective multicenter observational study included 399 East Asian women with GDM who underwent a 75-g oral glucose tolerance test (OGTT) within 12wPP, which was repeated annually or biennially and used to identify the postpartum development of T2DM. Forty-three women (10.8%) developed T2DM during a median follow-up period of 789 ± 477 days. The independent risk factors for T2DM were pre-pregnancy obesity (BMI ≥25 kg/m2), early postpartum impairment in glucose tolerance (IGT), and an early postpartum glycated hemoglobin (HbA1c) ≥5.7%. The odds ratios (95% confidence intervals) for T2DM were 3.2 (1.3-7.8) in women with either early postpartum IGT or pre-pregnancy obesity, 9.2 (3.0-28.3) in those with early postpartum IGT, pre-pregnancy obesity, and HbA1c <5.7%, and 51.4 (16.1-163.9) in those with early postpartum IGT, pre-pregnancy obesity, and HbA1c ≥5.7%, compared with those without obesity or IGT. T2DM risk in East Asian women with GDM should be stratified according to pre-pregnancy obesity and early postpartum IGT, and these patients should be followed up and receive appropriate care for their risk category.
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Affiliation(s)
- Maki Kawasaki
- Department of Health Policy, National Center for Child Health and Development, Tokyo 157-0074, Japan
- Department of Molecular Endocrinology and Metabolism, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8510, Japan
| | - Naoko Arata
- Division of Maternal Medicine, Center for Maternal-Fetal, Neonatal, and Reproductive Medicine, National Center for Child Health and Development, Tokyo 157-0074, Japan
| | - Naoko Sakamoto
- Department of Epidemiologic Research, Faculty of Nursing, Toho University, Tokyo 143-8540, Japan
| | - Anna Osamura
- Division of Diabetes, Metabolism and Endocrinology, Department of Medicine, Showa University School of Medicine, Tokyo 142-8666, Japan
| | - Siori Sato
- Division of Maternal Medicine, Center for Maternal-Fetal, Neonatal, and Reproductive Medicine, National Center for Child Health and Development, Tokyo 157-0074, Japan
| | - Yoshihiro Ogawa
- Department of Molecular and Cellular Metabolism, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8510, Japan
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Ichiro Yasuhi
- Department of Obstetrics and Gynecology, National Hospital Organization Nagasaki Medical Center, Omura, Nagasaki 856-8562, Japan
| | - Masako Waguri
- Department of Obstetric Medicine, Osaka Women's and Children's Hospital, Izumi, Osaka 594-1101, Japan
| | - Yuji Hiramatsu
- Okayama City General Medical Center, Okayama 700-0962, Japan
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Vesentini G, Barbosa AMP, Damasceno DC, Marini G, Piculo F, Matheus SMM, Hallur RLS, Nunes SK, Catinelli BB, Magalhães CG, Costa R, Abbade JF, Corrente JE, Calderon IMP, Rudge MVC. Alterations in the structural characteristics of rectus abdominis muscles caused by diabetes and pregnancy: A comparative study of the rat model and women. PLoS One 2020; 15:e0231096. [PMID: 32243473 PMCID: PMC7122752 DOI: 10.1371/journal.pone.0231096] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 03/16/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVE In the present study, we compared the effect of diabetic pregnancy on the rectus abdominis muscle (RAM) in humans and rats. We hypothesized that our animal model could provide valuable information about alterations in the RAM of women with Gestational Diabetes (GDM). METHOD Newborns female rats (n = 10/group) were administered streptozotocin (100 mg/kg body weight) subcutaneously and were mated on reaching adulthood, to develop the mild hyperglycemic pregnant (MHP) rat model. At the end of pregnancy, the mothers were sacrificed, and the RAM tissue was collected. Pregnant women without GDM (non-GDM group; n = 10) and those diagnosed with GDM (GDM group; n = 8) and undergoing treatment were recruited, and RAM samples were obtained at C-section. The RAM architecture and the distribution of the fast and slow fibers and collagen were studied by immunohistochemistry. RESULTS No statistically significant differences in the maternal and fetal characters were observed between the groups in both rats and women. However, significant changes in RAM architecture were observed. Diabetes in pregnancy increased the abundance of slow fibers and decreased fast fiber number and area in both rats and women. A decrease in collagen distribution was observed in GDM women; however, a similar change was not observed in the MHP rats. CONCLUSION Our results indicated that pregnancy- associated diabetes- induced similar structural adaptations in the RAM of women and rats with slight alterations in fiber type number and area. These findings suggest that the MHP rat model can be used for studying the effects of pregnancy-associated diabetes on the fiber structure of RAM.
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Affiliation(s)
- Giovana Vesentini
- Perinatal Diabetes Research Center, University Hospital, Botucatu Medical School, Univ Estadual Paulista_UNESP, Botucatu, São Paulo, Brazil
- Department of Gynecology and Obstetrics, São Paulo State University (UNESP), Botucatu Medical School, Botucatu, São Paulo, Brazil
| | - Angélica M. P. Barbosa
- Perinatal Diabetes Research Center, University Hospital, Botucatu Medical School, Univ Estadual Paulista_UNESP, Botucatu, São Paulo, Brazil
- Department of Physiotherapy and Occupational Therapy, São Paulo State University (UNESP), School of Philosophy and Sciences, Marilia, São Paulo, Brazil
| | - Débora C. Damasceno
- Department of Gynecology and Obstetrics, São Paulo State University (UNESP), Botucatu Medical School, Botucatu, São Paulo, Brazil
| | - Gabriela Marini
- Perinatal Diabetes Research Center, University Hospital, Botucatu Medical School, Univ Estadual Paulista_UNESP, Botucatu, São Paulo, Brazil
- Department of Gynecology and Obstetrics, São Paulo State University (UNESP), Botucatu Medical School, Botucatu, São Paulo, Brazil
- Department of Health Sciences, Universidade Sagrado Coração, Bauru, São Paulo, Brazil
| | - Fernanda Piculo
- Perinatal Diabetes Research Center, University Hospital, Botucatu Medical School, Univ Estadual Paulista_UNESP, Botucatu, São Paulo, Brazil
- Department of Gynecology and Obstetrics, São Paulo State University (UNESP), Botucatu Medical School, Botucatu, São Paulo, Brazil
| | - Selma M. M. Matheus
- Perinatal Diabetes Research Center, University Hospital, Botucatu Medical School, Univ Estadual Paulista_UNESP, Botucatu, São Paulo, Brazil
- Department of Anatomy, São Paulo State University (UNESP), Institute of Biosciences, Botucatu, São Paulo, Brazil
| | - Raghavendra L. S. Hallur
- Perinatal Diabetes Research Center, University Hospital, Botucatu Medical School, Univ Estadual Paulista_UNESP, Botucatu, São Paulo, Brazil
- Department of Gynecology and Obstetrics, São Paulo State University (UNESP), Botucatu Medical School, Botucatu, São Paulo, Brazil
| | - Sthefanie K. Nunes
- Perinatal Diabetes Research Center, University Hospital, Botucatu Medical School, Univ Estadual Paulista_UNESP, Botucatu, São Paulo, Brazil
- Department of Gynecology and Obstetrics, São Paulo State University (UNESP), Botucatu Medical School, Botucatu, São Paulo, Brazil
| | - Bruna B. Catinelli
- Perinatal Diabetes Research Center, University Hospital, Botucatu Medical School, Univ Estadual Paulista_UNESP, Botucatu, São Paulo, Brazil
- Department of Gynecology and Obstetrics, São Paulo State University (UNESP), Botucatu Medical School, Botucatu, São Paulo, Brazil
| | - Claudia G. Magalhães
- Perinatal Diabetes Research Center, University Hospital, Botucatu Medical School, Univ Estadual Paulista_UNESP, Botucatu, São Paulo, Brazil
- Department of Gynecology and Obstetrics, São Paulo State University (UNESP), Botucatu Medical School, Botucatu, São Paulo, Brazil
| | - Roberto Costa
- Perinatal Diabetes Research Center, University Hospital, Botucatu Medical School, Univ Estadual Paulista_UNESP, Botucatu, São Paulo, Brazil
- Department of Gynecology and Obstetrics, São Paulo State University (UNESP), Botucatu Medical School, Botucatu, São Paulo, Brazil
| | - Joelcio F. Abbade
- Perinatal Diabetes Research Center, University Hospital, Botucatu Medical School, Univ Estadual Paulista_UNESP, Botucatu, São Paulo, Brazil
- Department of Gynecology and Obstetrics, São Paulo State University (UNESP), Botucatu Medical School, Botucatu, São Paulo, Brazil
| | - José E. Corrente
- Perinatal Diabetes Research Center, University Hospital, Botucatu Medical School, Univ Estadual Paulista_UNESP, Botucatu, São Paulo, Brazil
- Department of Biostatistics, São Paulo State University (UNESP), Bioscience Institute, Botucatu, São Paulo, Brazil
| | - Iracema M. P. Calderon
- Perinatal Diabetes Research Center, University Hospital, Botucatu Medical School, Univ Estadual Paulista_UNESP, Botucatu, São Paulo, Brazil
- Department of Gynecology and Obstetrics, São Paulo State University (UNESP), Botucatu Medical School, Botucatu, São Paulo, Brazil
| | - Marilza V. C. Rudge
- Perinatal Diabetes Research Center, University Hospital, Botucatu Medical School, Univ Estadual Paulista_UNESP, Botucatu, São Paulo, Brazil
- Department of Gynecology and Obstetrics, São Paulo State University (UNESP), Botucatu Medical School, Botucatu, São Paulo, Brazil
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Jokelainen M, Stach-Lempinen B, Rönö K, Nenonen A, Kautiainen H, Teramo K, Klemetti MM. Oral glucose tolerance test results in early pregnancy: A Finnish population-based cohort study. Diabetes Res Clin Pract 2020; 162:108077. [PMID: 32057964 DOI: 10.1016/j.diabres.2020.108077] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 01/21/2020] [Accepted: 02/10/2020] [Indexed: 12/16/2022]
Abstract
AIMS To analyze early-pregnancy oral glucose tolerance test (OGTT) results and differences between early- and late-pregnancy OGTT results in a population-based cohort. METHODS From 3/2013 to 12/2016, pregnant women in South Karelia, Finland, were invited to undergo a 2-hour 75 g OGTT at 12-16 weeks' gestation (OGTT1) and, if normal, repeat testing at 24-28 weeks (OGTT2). Early and late gestational diabetes (GDM) were diagnosed using the same nationally endorsed criteria (fasting [FPG], 1- or 2-hour plasma glucose ≥5.3, ≥10.0 or ≥8.6 mmol/L, respectively). RESULTS In OGTT1 (n = 1401), the mean (SD) FPG, 1- and 2-hour values were 4.85 (0.34), 6.63 (1.73) and 5.60 (1.28) mmol/L, respectively. Early GDM was diagnosed in 209 (14.9%). In OGTT2 (n = 1067), late GDM was diagnosed in 114 (10.6%). In women without GDM (n = 953), the mean FPG values were higher and post-load values lower in OGTT1 vs. OGTT2. No interaction effects of gestational timepoint and maternal BMI on OGTT results were detected, except for the 2-hour value. In women with late GDM, both mean FPG and post-load values were lower in OGTT1 vs. OGTT2. Results were similar employing the IADPSG GDM criteria. CONCLUSIONS Our findings suggest that gestational-age specific OGTT thresholds for early GDM diagnosis need to be generated.
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Affiliation(s)
- Mervi Jokelainen
- Obstetrics and Gynaecology, South Karelia Central Hospital, Valto Käkelän katu 1, 53130 Lappeenranta, Finland; Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2, 00029 HUS Helsinki, Finland.
| | - Beata Stach-Lempinen
- Obstetrics and Gynaecology, South Karelia Central Hospital, Valto Käkelän katu 1, 53130 Lappeenranta, Finland.
| | - Kristiina Rönö
- Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2, 00029 HUS Helsinki, Finland.
| | - Arja Nenonen
- Laboratory Center, South Karelia Central Hospital, Valto Käkelän katu 1, 53130 Lappeenranta, Finland.
| | - Hannu Kautiainen
- Folkhälsan Research Centre, Haartmaninkatu 8, 000290 Helsinki, Finland; Primary Health Care Unit, Kuopio University Hospital, P.O. Box 100, FI 70029 KYS Kuopio, Finland.
| | - Kari Teramo
- Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2, 00029 HUS Helsinki, Finland.
| | - Miira M Klemetti
- Obstetrics and Gynaecology, South Karelia Central Hospital, Valto Käkelän katu 1, 53130 Lappeenranta, Finland; Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2, 00029 HUS Helsinki, Finland; Medical and Clinical Genetics, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 8, 000290 Helsinki, Finland; Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 60 Murray Street, M5T 3L9 Toronto, Ontario, Canada.
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Simon A, Pratt M, Hutton B, Skidmore B, Fakhraei R, Rybak N, Corsi DJ, Walker M, Velez MP, Smith GN, Gaudet LM. Guidelines for the management of pregnant women with obesity: A systematic review. Obes Rev 2020; 21:e12972. [PMID: 31943650 PMCID: PMC7064940 DOI: 10.1111/obr.12972] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 09/27/2019] [Accepted: 10/02/2019] [Indexed: 02/06/2023]
Abstract
Multiple clinical practice guidelines (CPGs) have been established for pregnant women with obesity. The quality and consistency of recommendations remain unknown. The objective of this study is to conduct a systematic review to synthesize and appraise evidence from CPGs, available worldwide, for pregnant women affected by obesity. An experienced information specialist performed a rigorous search of the literature, searching MEDLINE, Embase, grey literature, and guideline registries to locate CPGs that reported on pregnancy care relating to obesity. CPGs related to antenatal care of pregnant women with obesity (pre-pregnancy body mass index [BMI] ≥ 30 kg/m2 ) in low-risk (eg, care provider = family physician or midwife) or high-risk settings (eg, obstetrician or maternal fetal medicine) were included. CPGs were appraised for quality with independent data collection by two raters. Information was categorized into five domains: preconception care. care during pregnancy, diet and exercise during pregnancy, care immediately before, during, and after delivery, and postpartum care. The literature search yielded 2614 unique citations. Following screening of abstracts and full texts, 32 CPGs were included, with quality ranging between 0 and 100 on the AGREE II tool. The strongest evidence related to nutritional advice, exercise, and pregnancy risk counselling. Guidance was limited for timing of screening tests, antenatal visits and delivery, ideal postpartum care, and management of adverse pregnancy outcomes. Most guidelines in this population are not evidence based. Research is needed to bridge knowledge gaps pertaining to fetal antenatal surveillance, management of adverse outcomes and postpartum care, and enhance consistency across CPGs.
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Affiliation(s)
- Alexandre Simon
- OMNI Research Group, Clinical Epidemiology ProgramOttawa Hospital Research InstituteOttawaOntarioCanada
| | - Misty Pratt
- Knowledge Synthesis Group, Clinical Epidemiology ProgramOttawa Hospital Research InstituteOttawaOntarioCanada
| | - Brian Hutton
- Knowledge Synthesis Group, Clinical Epidemiology ProgramOttawa Hospital Research InstituteOttawaOntarioCanada
- Public Health and Preventive MedicineUniversity of Ottawa School of EpidemiologyOttawaOntarioCanada
| | - Becky Skidmore
- Knowledge Synthesis Group, Clinical Epidemiology ProgramOttawa Hospital Research InstituteOttawaOntarioCanada
| | - Romina Fakhraei
- OMNI Research Group, Clinical Epidemiology ProgramOttawa Hospital Research InstituteOttawaOntarioCanada
- Public Health and Preventive MedicineUniversity of Ottawa School of EpidemiologyOttawaOntarioCanada
| | - Natalie Rybak
- OMNI Research Group, Clinical Epidemiology ProgramOttawa Hospital Research InstituteOttawaOntarioCanada
| | - Daniel J. Corsi
- OMNI Research Group, Clinical Epidemiology ProgramOttawa Hospital Research InstituteOttawaOntarioCanada
- Public Health and Preventive MedicineUniversity of Ottawa School of EpidemiologyOttawaOntarioCanada
| | - Mark Walker
- OMNI Research Group, Clinical Epidemiology ProgramOttawa Hospital Research InstituteOttawaOntarioCanada
- Public Health and Preventive MedicineUniversity of Ottawa School of EpidemiologyOttawaOntarioCanada
- Department of Obstetrics, Gynecology& Newborn CareUniversity of OttawaOttawaOntarioCanada
| | - Maria P. Velez
- Department of Obstetrics and GynecologyQueen's UniversityKingstonOntarioCanada
- Department of Public Health SciencesQueen's UniversityKingstonOntarioCanada
| | - Graeme N. Smith
- Department of Obstetrics and GynecologyQueen's UniversityKingstonOntarioCanada
| | - Laura M. Gaudet
- OMNI Research Group, Clinical Epidemiology ProgramOttawa Hospital Research InstituteOttawaOntarioCanada
- Public Health and Preventive MedicineUniversity of Ottawa School of EpidemiologyOttawaOntarioCanada
- Department of Obstetrics, Gynecology& Newborn CareUniversity of OttawaOttawaOntarioCanada
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Yerlikaya-Schatten G, Trimmal L, Rosicky I, Husslein P, Schatten C, Eppel D, Eppel W, Tura A, Göbl CS. Effects of gum chewing on glycaemic control in women with gestational diabetes mellitus: A randomized controlled trial. Impact of chewing on hyperglycaemia in women with GDM. Eur J Obstet Gynecol Reprod Biol 2020; 247:61-65. [PMID: 32070847 DOI: 10.1016/j.ejogrb.2020.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 02/02/2020] [Accepted: 02/04/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND The amount of chewing might be relevant in reducing hyperglycaemia in diabetic patients. The study assessed the impact of enhanced chewing on glycaemic control in women with gestational diabetes mellitus (GDM). METHODS As an open-label, mono-centre randomized controlled trial, 59 women with recent diagnosis of GDM were included. They received either routine care or additional chewing gum intervention. SMBG was performed for five days. RESULTS No significant impact on mean values of postprandial glucose levels were observed. The estimated mean differences (intervention vs. control group) were: 4.9 mg/dl, 98.4 %CI -7.2-17.1 (breakfast); -4.5 mg/dl, 98.4 %CI -15.1-6.0 (lunch); -3.8 mg/dl, 98.4 %CI -15.9 to 8.4 (dinner). OGTT levels at 60 and 120 min. were associated with glucose levels after breakfast. CONCLUSION In conclusion, no significant differences in blood glucose levels were observed between the groups and therefore major effects of chewing on hyperglycaemia in women with GDM could be excluded. TRIAL REGISTRATION ClinicalTrials.gov; NCT03961542, Date of registration: 20.01.2019. Retrospectively registered.
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Affiliation(s)
- Gülen Yerlikaya-Schatten
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Vienna, Austria.
| | - Lisa Trimmal
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Vienna, Austria.
| | - Ingo Rosicky
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Vienna, Austria.
| | - Peter Husslein
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Vienna, Austria.
| | - Christian Schatten
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Vienna, Austria.
| | - Daniel Eppel
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Vienna, Austria.
| | - Wolfgang Eppel
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Vienna, Austria.
| | - Andrea Tura
- CNR Institute of Neuroscience, Padova, Italy.
| | - Christian S Göbl
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Vienna, Austria.
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Zhong L, Long Y, Wang S, Lian R, Deng L, Ye Z, Wang Z, Liu B. Continuous elevation of plasma asprosin in pregnant women complicated with gestational diabetes mellitus: A nested case-control study. Placenta 2020; 93:17-22. [PMID: 32090964 DOI: 10.1016/j.placenta.2020.02.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 01/21/2020] [Accepted: 02/03/2020] [Indexed: 02/08/2023]
Abstract
INTRODUCTION To investigate the expression of asprosin, a novel insulin resistance-related factor, in plasma and placenta of pregnant women with and without gestational diabetes mellitus (GDM). METHODS This is a nested case-control study within the prospective study named Early Diagnosis of Gestational Diabetes Mellitus (EDoGDM). Forty pregnant women with GDM and forty control cases with normal glucose tolerance (NGT) were recruited in the present study. Asprosin levels were tested by ELISA in maternal plasma at 18-20 and 24-28 gestational weeks and before delivery, as well as in umbilical plasma. Asprosin concentrations were compared between GDM and NGT groups, and the relationship between asprosin and other parameters were analyzed. Expression of asprosin in placenta was examined by Western blot and immunohistochemistry. RESULTS Asprosin was elevated in plasma of GDM pregnant women and their offspring, after adjusted by maternal and neonatal clinical characteristics and lipid profiles. Asprosin was expressed in placenta from both GDM and NGT pregnant women. DISCUSSION Protein asprosin is expressed in human placenta and is elevated in the plasma of pregnant women complicated with GDM and their offspring. As an insulin resistance-related factor increased before 20 gestational weeks, asprosin may play a role as a potential early biomarker of GDM.
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Affiliation(s)
- Lieqiang Zhong
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, PR China.
| | - Yuhang Long
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, PR China.
| | - Songzi Wang
- Department of Laboratory Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, PR China.
| | - Rong Lian
- Department of Microbiology, Zhongshan Medical School, Sun Yat-sen University, Guangzhou, 510000, PR China.
| | - Langhui Deng
- Department of Laboratory Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, PR China.
| | - Zhixin Ye
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, PR China.
| | - Zilian Wang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, PR China.
| | - Bin Liu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, PR China.
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Wali AS, Rafique R, Iftikhar S, Ambreen R, Yakoob MY. High proportion of overt diabetes mellitus in pregnancy and missed opportunity for early detection of diabetes at a tertiary care centre in Pakistan. Pak J Med Sci 2020; 36:S38-S43. [PMID: 31933605 PMCID: PMC6943103 DOI: 10.12669/pjms.36.icon-suppl.1723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Objectives To determine the frequency of diabetes in pregnancy (DIP), namely pre-gestational, gestational (GDM) and overt diabetes mellitus (DM) in women registered for delivery. Methods A retrospective chart review of antenatal women registered between January 01 to August 31, 2017 was performed. Gestational age, diagnosis of DIP, glucose levels at diagnosis and other relevant data was extracted. The effect of various fasting blood glucose (FBG) thresholds for diagnosis of DIP was assessed. Results DIP was diagnosed in 21.8% women (pre-gestational: 2%, GDM: 81.2%, overt: DM: 16.8%). In early registrants, 30.2% were detected through screening. However, 55.3% of women registered late. Women with pre-gestational DM were older, had more miscarriages, and greater personal and family history of diabetes versus GDM and overt DM. Raising the diagnostic threshold of FBG from 92 mg/dl to 95 mg/dl missed three women (0.1%) and to 105 mg/dl, missed six women (0.2%). Conclusion We observed a high proportion of overt DM. In early registrants, almost one third of DIP was diagnosed in the first half of pregnancy, an opportunity missed in late registrants. Altering diagnostic thresholds of DIP affected only a small proportion of women.
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Affiliation(s)
- Aisha Syed Wali
- Aisha Syed Wali, FCPS. Sheikh Saeed Memorial Hospital, Indus Health Network, Karachi, Pakistan
| | - Raheela Rafique
- Raheela Rafique, MBBS. Sheikh Saeed Memorial Hospital, Indus Health Network, Karachi, Pakistan
| | - Sundus Iftikhar
- Sundus Iftikhar, MS. Indus Hospital Research Center, Indus Health Network, Karachi, Pakistan
| | - Rakhshinda Ambreen
- Rakhshinda Ambreen, BDS. Indus Hospital Research Center, Indus Health Network, Karachi, Pakistan
| | - Mohammad Yawar Yakoob
- Mohammad Yawar Yakoob, DS. Indus Hospital Research Center, Indus Health Network, Karachi, Pakistan
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130
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Sert UY, Ozgu-Erdinc AS. Gestational Diabetes Mellitus Screening and Diagnosis. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1307:231-255. [PMID: 32314318 DOI: 10.1007/5584_2020_512] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
An ideal screening test for gestational diabetes should be capable of identifying not only women with the disease but also the women with a high risk of developing gestational diabetes mellitus (GDM). Screening and diagnosis are the main steps leading to the way of management. There is a lack of consensus among healthcare professionals regarding the screening methods worldwide. Different study groups advocate a variety of screening methods with the support of evidence-based comprehensive data. Some of the organizations suggest screening for high risk or all pregnant women, while others prefer to offer definitive testing without screening. Glycemic thresholds are also not standardized to decide GDM among different guidelines. Prevalence rates of GDM vary between populations and with the choice of glucose thresholds for both screening and definitive tests. One-step or two-step methods have been used for GDM diagnosis. However, screening includes selecting patients with historical risk factors, 50 g 1-h glucose challenge test, fasting plasma glucose, random plasma glucose, and hemoglobin A1c with different cutoffs. In this chapter, screening and diagnosis methods of GDM accepted by different study groups will be discussed which will be followed by the evaluation of different glycemic thresholds. Then the advantages and disadvantages of used methods will be explained and the chapter will finish with an evaluation of the current international guidelines.
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Affiliation(s)
- U Yasemin Sert
- Ministry of Health-Ankara City Hospital, Universiteler Mahallesi Bilkent Cad, Ankara, Turkey
| | - A Seval Ozgu-Erdinc
- Ministry of Health-Ankara City Hospital, Universiteler Mahallesi Bilkent Cad, Ankara, Turkey.
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131
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Quaresima P, Visconti F, Chiefari E, Mirabelli M, Borelli M, Caroleo P, Foti D, Puccio L, Venturella R, Di Carlo C, Brunetti A. Appropriate Timing of Gestational Diabetes Mellitus Diagnosis in Medium- and Low-Risk Women: Effectiveness of the Italian NHS Recommendations in Preventing Fetal Macrosomia. J Diabetes Res 2020; 2020:5393952. [PMID: 33015192 PMCID: PMC7520011 DOI: 10.1155/2020/5393952] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/04/2020] [Accepted: 09/09/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Screening strategies for gestational diabetes mellitus (GDM) earlier than 24-28 weeks of gestation should be considered to prevent adverse pregnancy outcomes. Nonetheless, there is uncertainty about which women would benefit most from early screening and which screening strategies should be offered to women with GDM. The Italian National Healthcare Service (NHS) recommendations on selective screening for GDM at 16-18 weeks of gestation are effective in preventing fetal macrosomia in high-risk (HR) women, but the appropriateness of timing and effectiveness of these recommendations in medium- (MR) and low-risk (LR) women are still controversial. Patients and Methods. We retrospectively enrolled 769 consecutive singleton pregnant women who underwent both anomaly scan at 19-21 weeks of gestation and screening for GDM at 16-18 and/or 24-28 weeks of gestation, in agreement with the NHS recommendations and risk stratification criteria. Comparison of maternal characteristics, fetal biometric parameters at anomaly scan (head circumference (HC), biparietal diameter (BPD), abdominal circumference (AC), femur length (FL), estimated fetal weight (EFW)), and neonatal birth weight (BW) percentile among risk groups was examined. RESULTS 219 (28.5%) women were diagnosed with GDM, while 550 (71.5%) were normal glucose-tolerant women. Out of 164 HR women, only 62 (37.8%) underwent the recommended early screening for GDM at 16-18 weeks of gestation. AC and EFW percentiles, as well as neonates' BW percentiles, were significantly higher in HR women diagnosed with GDM at 24-28 weeks of gestation with respect to normal glucose-tolerant women, as well as MR and LR women who tested positive for GDM. Comparative analysis between MR and LR women with GDM and women with normal glucose tolerance revealed significant differences in both AC and EFW percentiles (P < 0.05), while there was no significant difference in neonatal BW percentiles. CONCLUSION In MR and LR women with GDM, a mild acceleration of fetal growth can be detected at the time of anomaly scan. However, in these at-risk categories, the NHS recommendations for screening and treatment of GDM at 24-28 weeks of gestation are still effective in normalizing BW and preventing fetal macrosomia, thus supporting a risk factor-based selective screening program for GDM.
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Affiliation(s)
- Paola Quaresima
- Unit of Obstetrics and Gynecology, Department of Medical and Surgical Sciences, University “Magna Græcia” of Catanzaro, Viale Europa, 88100 Catanzaro, Italy
| | - Federica Visconti
- Unit of Obstetrics and Gynecology, Department of Medical and Surgical Sciences, University “Magna Græcia” of Catanzaro, Viale Europa, 88100 Catanzaro, Italy
| | - Eusebio Chiefari
- Department of Health Sciences, University “Magna Græcia” of Catanzaro, Viale Europa, 88100 Catanzaro, Italy
| | - Maria Mirabelli
- Department of Health Sciences, University “Magna Græcia” of Catanzaro, Viale Europa, 88100 Catanzaro, Italy
| | - Massimo Borelli
- UMG School of PhD Programmes Life Sciences and Technologies, University “Magna Græcia” of Catanzaro, Italy
- Department of Chemical and Pharmaceutical Sciences, University of Trieste, Italy
| | - Patrizia Caroleo
- Complex Operative Structure Endocrinology-Diabetology, Hospital Pugliese-Ciaccio, Viale Pio X, 88100 Catanzaro, Italy
| | - Daniela Foti
- Department of Health Sciences, University “Magna Græcia” of Catanzaro, Viale Europa, 88100 Catanzaro, Italy
| | - Luigi Puccio
- Complex Operative Structure Endocrinology-Diabetology, Hospital Pugliese-Ciaccio, Viale Pio X, 88100 Catanzaro, Italy
| | - Roberta Venturella
- Unit of Obstetrics and Gynecology, Department of Medical and Surgical Sciences, University “Magna Græcia” of Catanzaro, Viale Europa, 88100 Catanzaro, Italy
| | - Costantino Di Carlo
- Unit of Obstetrics and Gynecology, Department of Medical and Surgical Sciences, University “Magna Græcia” of Catanzaro, Viale Europa, 88100 Catanzaro, Italy
| | - Antonio Brunetti
- Department of Health Sciences, University “Magna Græcia” of Catanzaro, Viale Europa, 88100 Catanzaro, Italy
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Chawla R, Madhu SV, Makkar BM, Ghosh S, Saboo B, Kalra S. RSSDI-ESI Clinical Practice Recommendations for the Management of Type 2 Diabetes Mellitus 2020. Indian J Endocrinol Metab 2020; 24:1-122. [PMID: 32699774 PMCID: PMC7328526 DOI: 10.4103/ijem.ijem_225_20] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Rajeev Chawla
- North Delhi Diabetes Centre, Rohini, New Delhi, India
| | - S. V. Madhu
- Centre for Diabetes, Endocrinology and Metabolism, UCMS-GTB Hospital, New Delhi, India
| | - B. M. Makkar
- Dr. Makkar's Diabetes and Obesity Centre, Paschim Vihar, New Delhi, India
| | - Sujoy Ghosh
- Department of Endocrinology and Metabolism, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Banshi Saboo
- DiaCare - A Complete Diabetes Care Centre, Ahmedabad, Gujarat, India
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, Haryana, India
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Mensah GP, ten Ham‐Baloyi W, van Rooyen D(R, Jardien‐Baboo S. Guidelines for the nursing management of gestational diabetes mellitus: An integrative literature review. Nurs Open 2020; 7:78-90. [PMID: 31871693 PMCID: PMC6918019 DOI: 10.1002/nop2.324] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 05/03/2019] [Accepted: 05/08/2019] [Indexed: 12/13/2022] Open
Abstract
Aims and objectives An integrative literature review searched for, selected, appraised, extracted and synthesized data from existing available guidelines on the nursing management of gestational diabetes mellitus as no such analysis has been found. Background Early screening, diagnosis and management of gestational diabetes mellitus are important to prevent or reduce complications during and postpregnancy for both mother and child. A variety of guidelines exists, which assist nurses and midwives in the screening, diagnosis and management of gestational diabetes mellitus. Design An integrative literature review. Methods The review was conducted in June 2018 following an extensive search of available guidelines according to an adaptation of the stages reported by Whittemore and Knafl (2005, Journal of Advanced Nursing, 52, 546). Thus, a five-step process was used, namely formulation of the review question, literature search, critical appraisal of guidelines identified, data extraction and data analysis. All relevant guidelines were subsequently appraised for rigour and quality by two independent reviewers using the AGREE II tool. Content analysis was used analysing the extracted data. Results Following extraction and analysis of data, two major themes were identified from eighteen (N = 18) guidelines. These were the need for early screening and diagnosis of gestational diabetes mellitus and for nursing management of gestational diabetes mellitus (during pregnancy, intra- and postpartum management). Various guidelines on the nursing management of gestational diabetes mellitus were found; however, guidelines were not always comprehensive, sometimes differed in their recommended practices and did not consider a variety of contextual barriers to the implementation of the recommendations. Conclusion Critically, scrutiny of the guidelines is required, both in terms of the best evidence used in their development and in terms of the feasibility of implementation for its context. Relevance to clinical practice This study provides a summary of best practices regarding the diagnosis, screening and nursing management of gestational diabetes mellitus that provide guidance for nurse-midwives on maternal and postpartum follow-up care for women at risk or diagnosed with gestational diabetes mellitus.
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Affiliation(s)
| | | | | | - Sihaam Jardien‐Baboo
- Department of Nursing ScienceNelson Mandela UniversityPort ElizabethSouth Africa
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134
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Management of Gestational Diabetes Mellitus. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1307:257-272. [PMID: 32548833 DOI: 10.1007/5584_2020_552] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Once a woman is diagnosed with gestational diabetes mellitus (GDM), two strategies are considered for management; life-style modifications and pharmacological therapy. The management of GDM aims to maintain a normoglycemic state and to prevent excessive weight gain in order to reduce maternal and fetal complications. Lifestyle modifications include nutritional therapy and exercise. Calorie restriction with a low glycemic index diet is recommended to avoid postprandial hyperglycemia and to reduce insulin resistance. Blood glucose levels, HbA1c levels, and ketonuria are monitored to analyze the efficacy of conservative management. Pharmacological treatment is initiated if conservative strategies fail to provide expected glucose levels during follow-ups.Insulin has been the first choice for the treatment of diabetes during pregnancy. Recently, metformin has been used more commonly in diabetic pregnant women in cases when insulin cannot be prescribed, after its safety has been proven. However, a high percentage of women, which may be up to 46% may require additional insulin to maintain expected blood glucose levels. The evidence on the long-term safety of other oral anti-diabetics has been lacking yet.Women with diet-controlled GDM can wait for spontaneous labor expectantly in case there are no obstetric indications for birth. However, in women with GDM under insulin therapy or with poor glycemic control, elective induction at term is recommended by authorities.The women who have GDM during pregnancy should be counseled about their increased risks of impaired glucose tolerance, type 2 diabetes mellitus, hypertensive disorders, cardiovascular diseases, and metabolic syndrome.
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135
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Wu L, Song Y, Zhang Y, Liang B, Deng Y, Tang T, Ye YC, Hou HY, Wang CC. Novel Genetic Variants of PPARγ2 Promoter in Gestational Diabetes Mellitus and its Molecular Regulation in Adipogenesis. Front Endocrinol (Lausanne) 2020; 11:499788. [PMID: 33551986 PMCID: PMC7862745 DOI: 10.3389/fendo.2020.499788] [Citation(s) in RCA: 4] [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: 03/23/2020] [Accepted: 11/25/2020] [Indexed: 11/13/2022] Open
Abstract
Peroxisome proliferator-activated receptor γ2 (PPARγ2) is a nuclear hormone receptor of ligand-dependent transcription factor with a key role in adipogenesis and insulin sensitization in diabetes mellitus. In this study, we investigated genetic variants in PPARγ2 promoter, its association with gestational diabetes mellitus (GDM), and its molecular regulation. PPARγ2 promoter and start codon (-2,091 to +82 bp) from 400 pregnancies with GDM and 400 gestational-age matched control pregnancies were sequenced. Association and linkage disequilibrium of the identified polymorphisms with GDM was determined. ChIP-seq, gene silencing, and dual-luciferase reporter assays were performed to confirm transcription factor binding sites and promoter activity of the variants. Transfection experiments were carried out to determine the effects of variants on gene expression and adipogenesis. Among 15 variants identified, 7 known variants were not significantly associated with the risk of GDM (odds ratio: 0.710-1.208, 95% confidence interval: 0.445-0.877 to 1.132-1.664, P > 0.05) while linkage disequilibrium was significant (D' > 0.7, R2 > 0.9). However, T-A-A-T-G haplotype was not significantly associated with GDM (χ2 = 2.461, P = 0.117). Five rare variants and 3 novel variants (rs948820149, rs1553638909, and rs1553638903) were only found in GDM. Transcription factor glucocorticoid receptor β (GRβ) bound to -807A/C (rs948820149) and knockdown of GRβ suppressed PPARγ2 promoter activity. This mutation significantly down-regulated PPARγ2 expression and alleviated adipogenesis. In conclusion, a novel -807A/C in PPARγ2 promoter was identified in Chinese women with GDM and the mutation affected GRβ binding and transcription of PPARγ2 for adipogenesis.
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Affiliation(s)
- Ling Wu
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Yi Song
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Yuan Zhang
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Bo Liang
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Yan Deng
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Tao Tang
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Yan Chou Ye
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Hong Ying Hou
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Chi Chiu Wang
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- Development and Reproduction Laboratory, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- Chinese University of Hong Kong-Sichuan University Joint Laboratory in Reproductive Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- *Correspondence: Chi Chiu Wang,
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Morris MA, Hutchinson J, Gianfrancesco C, Alwan NA, Carter MC, Scott EM, Cade JE. Relationship of the Frequency, Distribution, and Content of Meals/Snacks to Glycaemic Control in Gestational Diabetes: The myfood24 GDM Pilot Study. Nutrients 2019; 12:nu12010003. [PMID: 31861337 PMCID: PMC7019496 DOI: 10.3390/nu12010003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 12/13/2019] [Accepted: 12/16/2019] [Indexed: 12/16/2022] Open
Abstract
This study examines nutritional intakes in Gestational diabetes mellitus piloting the myfood24 tool, to explore frequency of meals/snacks, and daily distribution of calories and carbohydrates in relation to glycaemic control. A total of 200 women aged 20-43 years were recruited into this prospective observational study between February 2015 and February 2016. Diet was assessed using myfood24, a novel online 24-h dietary recall tool. Out of 200 women 102 completed both ≥1 dietary recalls and all blood glucose measurements. Blood glucose was self-measured as part of usual care. Differences between groups meeting and exceeding glucose targets in relation to frequency of meal/snack consumption and nutrients were assessed using chi-squared and Mann-Whitney tests. Women achieving a fasting glucose target <5.3 mmol/L, compared to those exceeding it, consumed three meals (92% vs. 78%: p = 0.04) and three snacks (10% vs. 4%: p = 0.06) per day, compared with two or less; and in relation to evening snacks, consumed a higher percentage of daily energy (6% vs. 5%: p = 0.03) and carbohydrates (8% vs. 6%: p = 0.01). Achieving glycaemic control throughout the day was positively associated with snacking (p = 0.008). Achieving glucose targets was associated with having more snacks across the day, and may be associated with frequency and distribution of meals and nutrients. A larger study is required to confirm this.
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Affiliation(s)
- Michelle A. Morris
- Leeds Institute for Data Analytics, School of Medicine, Level 11 Worsley Building, University of Leeds, Leeds LS2 9JT, UK
- Correspondence: ; Tel.: +44-113-343-0883
| | - Jayne Hutchinson
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds LS2 9JT, UK; (J.H.); (C.G.); (M.C.C.); (J.E.C.)
| | - Carla Gianfrancesco
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds LS2 9JT, UK; (J.H.); (C.G.); (M.C.C.); (J.E.C.)
- Sheffield Diabetes and Endocrine Centre, Sheffield Teaching Hospitals NHS Trust, Sheffield S10 2JF, UK
| | - Nisreen A. Alwan
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK;
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Michelle C. Carter
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds LS2 9JT, UK; (J.H.); (C.G.); (M.C.C.); (J.E.C.)
| | - Eleanor M. Scott
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds LS2 9JT, UK;
| | - Janet E. Cade
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds LS2 9JT, UK; (J.H.); (C.G.); (M.C.C.); (J.E.C.)
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137
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Kim W, Park SK, Kim YL. Gestational diabetes mellitus diagnosed at 24 to 28 weeks of gestation in older and obese Women: Is it too late? PLoS One 2019; 14:e0225955. [PMID: 31841546 PMCID: PMC6913988 DOI: 10.1371/journal.pone.0225955] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 11/16/2019] [Indexed: 12/15/2022] Open
Abstract
Aim/Background The prevalence of elderly pregnancy and maternal obesity is increasing worldwide. In old and obese women, metabolic derangement affecting fetal growth might be present earlier than the diagnosis of gestational diabetes mellitus (GDM) or even before pregnancy. We thus investigated whether GDM diagnosed at 24–28 weeks of gestation had already affected fetal abdominal growth and, if so, whether elderly pregnancy and/or maternal obesity aggravate fetal abdominal obesity. Methods We retrospectively reviewed the medical records of 7820 singleton pregnant women who had been universally screened using a 50-g glucose challenge test (GCT) at 24–28 weeks of gestation, and underwent a 3-h 100-g oral glucose tolerance test (OGTT) if GCT were ≥140mg/dl. GDM and normal glucose tolerance (NGT) were diagnosed using the Carpenter-Coustan criteria. Fetal abdominal obesity was investigated by assessing the fetal abdominal overgrowth ratios (FAORs) of the ultrasonographically estimated gestational age (GA) of abdominal circumference per actual GA by the last menstruation period, biparietal diameter or femur length, respectively. Fetal abdominal overgrowth was defined as FAOR ≥ 90th percentile. The subjects were divided into four study groups: group 1 (age < 35 years and pre-pregnancy body mass index [BMI] < 25 kg/m2), group 2 (age < 35 years and ≥ 25), group 3 (age ≥ 35 years and BMI < 25), and group 4 (age ≥ 35 years and ≥ 25). Results The overall prevalence of GDM was 5.1%, with old and obese group 4 exhibiting the highest prevalence (22.4%). FAORs were significantly higher in the fetus of those with GDM than in the NGT subjects. But, in the subgroup analysis, only old and nonobese group 3 and old and obese group 4 with GDM exhibited significantly higher FAORs than the NGT subjects. Also, risk of fetal abdominal overgrowth was increased in group 3 and 4 subjects with GDM but not in young and nonobese group 1 GDM. The risk of fetal abdominal overgrowth significantly increased with maternal age >35 years, pre-pregnancy BMI >20kg/m2, and HbA1c >37.7 mmol/mol (5.6%). In multivariate analyses, maternal age and HbA1c were significantly associated with FAORs. Conclusion GDM diagnosed at 24–28 weeks of gestation already affected fetal abdominal obesity in older and/or obese women, but not in younger and nonobese women. Our data suggest that selective screening and appropriate intervention of GDM earlier than 24–28 weeks of gestation might be necessary for high-risk old and/or obese women.
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Affiliation(s)
- Wonjin Kim
- Department of Internal Medicine, Division of Endocrinology and Metabolism, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea
- Yonsei University College of Medicine, Seoul, Korea
| | - Soo Kyung Park
- Departmentof Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, Maryland, United States of America
| | - Yoo Lee Kim
- Department of Internal Medicine, Division of Endocrinology and Metabolism, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea
- * E-mail: ,
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138
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Zhang M, Zhou Y, Zhong J, Wang K, Ding Y, Li L, Pan X. Quality appraisal of gestational diabetes mellitus guidelines with AGREE II: a systematic review. BMC Pregnancy Childbirth 2019; 19:478. [PMID: 31805878 PMCID: PMC6896264 DOI: 10.1186/s12884-019-2597-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 11/13/2019] [Indexed: 01/25/2023] Open
Abstract
Background Several societies and associations have produced and disseminated clinical practice guidelines (CPGs) for gestational diabetes mellitus (GDM). However, the quality of such guidelines has not been appraised so far. This study aims to evaluate the quality of CPGs for GDM published in the last decade using the AGREE II instrument. Methods A systematic search of the National Institute for Health and Care Excellence, New Zealand Guidelines Group, Scottish Intercollegiate Guidelines Network, Medlive, American Diabetes Association, Canadian Diabetes Association, International Diabetes Federation, as well as PubMed, Web of Science, Embase, China National Knowledge Infrastructure, Wanfang Chinese Periodical Database, and VIP Chinese Periodical Database was conducted from inception to June 2018. The quality was assessed by four trained researchers independently, using the AGREE IIinstrument. Results A total of 13 guidelines, published from 2009 to 2018, were finally included. Among them, 11 guidelines were evidence-based guidelines, and 2 were expert consensus. Scores for each of the six AGREE II domains(Median ± IQR) were 94 ± 11, 89 ± 53, 58 ± 37, 100 ± 6, 79 ± 48, 100 ± 71 and 67% ± 42%, and guidelines based on expert consensus generally scored lower than evidence-based guidelines (Z = -2.201, p = 0.028). Overall score of 10 guidelines were 5 points and above, and four guidelines were 7 points. Among six domains, two domains: Scope and Purpose, and Clarity of Presentation, had high scores; however, the domains of Rigor of Development, Stakeholder Involvement and Editorial Independence received lower scores. Conclusions In general, the methodological quality of GDM guidelines is high, and evidence-based guidelines are superior to expert consensus. However, the domains of Rigor of Development, Stakeholder Involvement and Editorial Independence still need improvement. A systematic approach in the development of these guidelines and updating timely is needed. In some regions, more attention for guideline adaptation is recommended.
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Affiliation(s)
- Mengxing Zhang
- JBI Evidence Based Nursing Cooperation Center, School of Nursing, Fudan University, Shanghai, China
| | - Yingfeng Zhou
- JBI Evidence Based Nursing Cooperation Center, School of Nursing, Fudan University, Shanghai, China.
| | - Jie Zhong
- JBI Evidence Based Nursing Cooperation Center, School of Nursing, Fudan University, Shanghai, China
| | - Kairong Wang
- JBI Evidence Based Nursing Cooperation Center, School of Nursing, Fudan University, Shanghai, China
| | - Yan Ding
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Li Li
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
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Antoniou MC, Gilbert L, Gross J, Rossel JB, Fischer Fumeaux CJ, Vial Y, Puder JJ. Potentially modifiable predictors of adverse neonatal and maternal outcomes in pregnancies with gestational diabetes mellitus: can they help for future risk stratification and risk-adapted patient care? BMC Pregnancy Childbirth 2019; 19:469. [PMID: 31801465 PMCID: PMC6894261 DOI: 10.1186/s12884-019-2610-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 08/22/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) exposes mothers and their offspring to short and long-term complications. The objective of this study was to identify the importance of potentially modifiable predictors of adverse outcomes in pregnancies with GDM. We also aimed to assess the relationship between maternal predictors and pregnancy outcomes depending on HbA1c values and to provide a risk stratification for adverse pregnancy outcomes according to the prepregnancy BMI (Body mass index) and HbA1c at the 1st booking. METHODS This prospective study included 576 patients with GDM. Predictors were prepregnancy BMI, gestational weight gain (GWG), excessive weight gain, fasting, 1 and 2-h glucose values after the 75 g oral glucose challenge test (oGTT), HbA1c at the 1st GDM booking and at the end of pregnancy and maternal treatment requirement. Maternal and neonatal outcomes such as cesarean section, macrosomia, large and small for gestational age (LGA, SGA), neonatal hypoglycemia, prematurity, hospitalization in the neonatal unit and Apgar score at 5 min < 7 were evaluated. Univariate and multivariate regression analyses and probability analyses were performed. RESULTS One-hour glucose after oGTT and prepregnancy BMI were correlated with cesarean section. GWG and HbA1c at the end pregnancy were associated with macrosomia and LGA, while prepregnancy BMI was inversely associated with SGA. The requirement for maternal treatment was correlated with neonatal hypoglycemia, and HbA1c at the end of pregnancy with prematurity (all p < 0.05). The correlations between predictors and pregnancy complications were exclusively observed when HbA1c was ≥5.5% (37 mmol/mol). In women with prepregnancy BMI ≥ 25 kg/m2 and HbA1c ≥ 5.5% (37 mmol/mol) at the 1st booking, the risk for cesarean section and LGA was nearly doubled compared to women with BMI with < 25 kg/m2 and HbA1c < 5.5% (37 mmol/mol). CONCLUSIONS Prepregnancy BMI, GWG, maternal treatment requirement and HbA1c at the end of pregnancy can predict adverse pregnancy outcomes in women with GDM, particularly when HbA1c is ≥5.5% (37 mmol/mol). Stratification based on prepregnancy BMI and HbA1c at the 1st booking may allow for future risk-adapted care in these patients.
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Affiliation(s)
- Maria-Christina Antoniou
- Pediatric Service, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland.
| | - Leah Gilbert
- Obstetric Service, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Justine Gross
- Obstetric Service, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
| | - Jean-Benoît Rossel
- Obstetric Service, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Céline J Fischer Fumeaux
- Pediatric Service, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Yvan Vial
- Obstetric Service, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Jardena J Puder
- Obstetric Service, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
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Abstract
PURPOSE OF REVIEW Currently, the diagnosis of gestational diabetes mellitus (GDM) lacks uniformity. Several controversies are still under debate, especially on the method of screening and diagnosis. This review focuses on recent literature and provides current evidence for the screening and diagnosis of GDM. RECENT FINDINGS Selective screening would miss a significant number of women with GDM. In contrast, universal screening has been shown to be cost-effective, compared with selective screening, and is recommended by many medical societies. For the diagnostic methods for GDM, most observational cohort studies reported that the one-step method is associated with improved pregnancy outcomes and is cost-saving or cost-effective, compared with the two-step method, although these findings should be confirmed in the upcoming randomized controlled trials which compare the performance of one-step and two-step methods. On the other hand, the methods of early screening or diagnosis of GDM are varied, and current evidence does not justify their use during early pregnancy. In conclusion, current evidence favors universal screening for GDM using the one-step method. Early screening for GDM is not favorably supported by the literature.
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Affiliation(s)
- Chun-Heng Kuo
- Department of Internal Medicine, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Hung-Yuan Li
- Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan.
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Affiliation(s)
- Kyu Yeon Hur
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Korea.
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Vitacolonna E, Succurro E, Lapolla A, Scavini M, Bonomo M, Di Cianni G, Di Benedetto A, Napoli A, Tumminia A, Festa C, Lencioni C, Torlone E, Sesti G, Mannino D, Purrello F. Guidelines for the screening and diagnosis of gestational diabetes in Italy from 2010 to 2019: critical issues and the potential for improvement. Acta Diabetol 2019; 56:1159-1167. [PMID: 31396699 DOI: 10.1007/s00592-019-01397-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 07/30/2019] [Indexed: 12/17/2022]
Abstract
AIMS In 2010, Italian health professionals rapidly implemented the one-step screening for gestational diabetes mellitus (GDM) based on a 75 g OGTT, to comply with the diagnostic criteria proposed by the International Association of Diabetes and Pregnancy Study Groups (IADPSG). The change was promoted by the two main Italian scientific societies of diabetology, Associazione Medici Diabetologi (AMD) and Società Italiana di Diabetologia (SID), and it took just a few months for the Istituto Superiore di Sanità, together with several scientific societies, to revise the criteria and include them in the National Guidelines System. Over the last 9 years, the implementation of these guidelines has shown some benefits and some drawbacks. METHODS In order to evaluate the critical issues arisen from the implementation of the current Italian guidelines for the diagnosis of GDM, the studies published on this topic have been reviewed. The search was performed using the following keywords: "gestational diabetes" AND "diagnostic criteria" OR screening AND Ital*. The study is an expert opinion paper, based on the relevant scientific literature published between 2010 and 2019. The databases screened for the literature review included PubMed, MEDLINE, and Scopus. RESULTS The implementation of the Guidelines for Screening and Diagnosis of GDM in Italy present some strengths and some weaknesses. One of the positive aspects is that high-risk women are required to perform an OGTT early in pregnancy. By contrast, there are several aspects in need of improvement: (1) In spite of the current indications, only a minority of high-risk women perform OGTT early in pregnancy; (2) several low-risk women are screened for GDM; (3) in some low-risk women affected by GDM, the diagnosis might be missed with the application of the current guidelines; (4) there is a lack of homogeneity in the risk assessment data from different regions. CONCLUSIONS In order to improve the current Italian GDM guidelines, some practical solutions have been suggested.
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Affiliation(s)
- Ester Vitacolonna
- Diabetes and Pregnancy Study Group, Italian Society of Diabetology (SID), Rome, Italy.
- Diabetes and Pregnancy Study Group, Italian Association of Diabetologists (AMD), Rome, Italy.
- Department of Medicine and Aging, School of Medicine and Health Sciences, "G. d'Annunzio" University, Chieti-Pescara, Chieti, Italy.
| | - Elena Succurro
- Diabetes and Pregnancy Study Group, Italian Society of Diabetology (SID), Rome, Italy
- Diabetes and Pregnancy Study Group, Italian Association of Diabetologists (AMD), Rome, Italy
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Annunziata Lapolla
- Diabetes and Pregnancy Study Group, Italian Society of Diabetology (SID), Rome, Italy
- Diabetes and Pregnancy Study Group, Italian Association of Diabetologists (AMD), Rome, Italy
- Department of Medicine, Diabetology and Dietetics Unit, Padova University, Padua, Italy
| | - Marina Scavini
- Diabetes and Pregnancy Study Group, Italian Society of Diabetology (SID), Rome, Italy
- Diabetes and Pregnancy Study Group, Italian Association of Diabetologists (AMD), Rome, Italy
- Division of Immunology, Transplantation and Infectious Diseases, Diabetes Research Institute (DRI), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Bonomo
- Diabetes and Pregnancy Study Group, Italian Society of Diabetology (SID), Rome, Italy
- Diabetes and Pregnancy Study Group, Italian Association of Diabetologists (AMD), Rome, Italy
- SSD Diabetology, Ca'Granda Niguarda Hospital, Milan, Italy
| | - Graziano Di Cianni
- Diabetes and Pregnancy Study Group, Italian Society of Diabetology (SID), Rome, Italy
- Diabetes and Pregnancy Study Group, Italian Association of Diabetologists (AMD), Rome, Italy
- Diabetes and Metabolic Diseases Unit, Health Local Unit Nord-West Tuscany, Livorno Hospital, Leghorn, Italy
| | - Antonino Di Benedetto
- Diabetes and Pregnancy Study Group, Italian Society of Diabetology (SID), Rome, Italy
- Diabetes and Pregnancy Study Group, Italian Association of Diabetologists (AMD), Rome, Italy
- Department of Clinical and Experimental Medicine, University Hospital of Messina, Messina, Italy
| | - Angela Napoli
- Diabetes and Pregnancy Study Group, Italian Society of Diabetology (SID), Rome, Italy
- Diabetes and Pregnancy Study Group, Italian Association of Diabetologists (AMD), Rome, Italy
- Department of Experimental Medicine, Faculty of Medicine and Dentistry, Sapienza University, Rome, Italy
| | - Andrea Tumminia
- Diabetes and Pregnancy Study Group, Italian Society of Diabetology (SID), Rome, Italy
- Diabetes and Pregnancy Study Group, Italian Association of Diabetologists (AMD), Rome, Italy
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Camilla Festa
- Diabetes and Pregnancy Study Group, Italian Society of Diabetology (SID), Rome, Italy
- Diabetes and Pregnancy Study Group, Italian Association of Diabetologists (AMD), Rome, Italy
- Department of Experimental Medicine, Faculty of Medicine and Dentistry, Sapienza University, Rome, Italy
| | - Cristina Lencioni
- Diabetes and Pregnancy Study Group, Italian Society of Diabetology (SID), Rome, Italy
- Diabetes and Pregnancy Study Group, Italian Association of Diabetologists (AMD), Rome, Italy
- Diabetes Unit, Usl Nord Ovest Tuscany, Lucca, Italy
| | - Elisabetta Torlone
- Diabetes and Pregnancy Study Group, Italian Society of Diabetology (SID), Rome, Italy
- Diabetes and Pregnancy Study Group, Italian Association of Diabetologists (AMD), Rome, Italy
- Internal Medicine, Endocrinology and Metabolism, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Giorgio Sesti
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
- Italian Diabetes and Research Foundation, Italian Society of Diabetology (SID), Rome, Italy
| | - Domenico Mannino
- Diabetes and Pregnancy Study Group, Italian Society of Diabetology (SID), Rome, Italy
- Diabetes and Pregnancy Study Group, Italian Association of Diabetologists (AMD), Rome, Italy
- Section of Endocrinology and Diabetes, Bianchi Melacrino Morelli Hospital, Reggio Calabria, Italy
- Italian Association of Diabetologists (AMD), Rome, Italy
| | - Francesco Purrello
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
- Italian Society of Diabetology (SID), Rome, Italy
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Bettencourt-Silva R, Neves JS, Ferreira MJ, Souteiro P, Belo S, Oliveira AI, Carvalho D, Namora G, Montenegro N, Queirós J. Metformin in overweight and obese women with gestational diabetes: a propensity score-matched study. Endocrine 2019; 66:192-200. [PMID: 31401725 DOI: 10.1007/s12020-019-02043-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 08/02/2019] [Indexed: 12/15/2022]
Abstract
PURPOSE Obesity and gestational diabetes mellitus (GDM) have an independent negative impact in pregnancy outcomes. Excessive gestational weight gain (GWG) represents an additional high-risk condition for adverse outcomes. The aims of this study were to evaluate the potential effect of metformin in GWG in overweight or obese women with GDM, to report our experience and to assess metformin's safety in this population. METHODS Retrospective observational cohort study involving pregnant women with GDM and pregestational overweight or obesity. Demographic, anthropometric, glycemic control data, obstetric, fetal and neonatal outcomes were evaluated. The sample was divided into two groups according to metformin treatment. A propensity score-matched analysis was performed using age, initial body mass index (BMI), trimester at GDM diagnosis and previous history of GDM or macrosomia as covariates. RESULTS Of the 457 enrolled in the study, 177 (38.7%) were treated with metformin. Two groups of 130 well matched patients were balanced regarding baseline characteristics. Women in metformin group had significantly less excessive GWG (29.23% vs. 42.31%, OR 0.56, 95% CI 0.34-0.94, p = 0.028) and more adequate GWG (36.92% vs. 23.08%, OR 1.95, 95% CI 1.14-3.35, p = 0.015). No significant differences were found between both groups regarding glycemic control, rate of insulinization, and obstetric, fetal, and neonatal outcomes. CONCLUSIONS This study highlights metformin as an important and safe tool to prevent excessive GWG and promote adequate GWG in overweight or obese women with GDM, regardless of age, BMI, timing of GDM diagnosis, previous history of GDM or macrosomia.
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Affiliation(s)
- Rita Bettencourt-Silva
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário S. João, Porto, Portugal.
- Faculty of Medicine of University of Porto, Porto, Portugal.
- Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal.
| | - João Sérgio Neves
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário S. João, Porto, Portugal
- Faculty of Medicine of University of Porto, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
| | - Maria João Ferreira
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário S. João, Porto, Portugal
- Faculty of Medicine of University of Porto, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
| | - Pedro Souteiro
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário S. João, Porto, Portugal
- Faculty of Medicine of University of Porto, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
| | - Sandra Belo
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário S. João, Porto, Portugal
- Outpatient Clinic of Obstetrics and Endocrinology, Centro Hospitalar Universitário S. João, Porto, Portugal
- Diabetes and Pregnancy Study Group, Portuguese Society of Diabetology, Porto, Portugal
| | - Ana Isabel Oliveira
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário S. João, Porto, Portugal
- Outpatient Clinic of Obstetrics and Endocrinology, Centro Hospitalar Universitário S. João, Porto, Portugal
| | - Davide Carvalho
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário S. João, Porto, Portugal
- Faculty of Medicine of University of Porto, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
| | - Gabriela Namora
- Faculty of Medicine of University of Porto, Porto, Portugal
- Outpatient Clinic of Obstetrics and Endocrinology, Centro Hospitalar Universitário S. João, Porto, Portugal
- Department of Obstetrics and Gynecology, Centro Hospitalar Universitário S. João, Porto, Portugal
| | - Nuno Montenegro
- Faculty of Medicine of University of Porto, Porto, Portugal
- Outpatient Clinic of Obstetrics and Endocrinology, Centro Hospitalar Universitário S. João, Porto, Portugal
- Department of Obstetrics and Gynecology, Centro Hospitalar Universitário S. João, Porto, Portugal
| | - Joana Queirós
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário S. João, Porto, Portugal
- Outpatient Clinic of Obstetrics and Endocrinology, Centro Hospitalar Universitário S. João, Porto, Portugal
- Diabetes and Pregnancy Study Group, Portuguese Society of Diabetology, Porto, Portugal
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Cosson E, Vicaut E, Sandre-Banon D, Gary F, Pharisien I, Portal JJ, Banu I, Bianchi L, Cussac-Pillegand C, Dina R, Chiheb S, Valensi P, Carbillon L. Early screening for gestational diabetes mellitus is not associated with improved pregnancy outcomes: an observational study including 9795 women. DIABETES & METABOLISM 2019; 45:465-472. [DOI: 10.1016/j.diabet.2018.11.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 10/29/2018] [Accepted: 11/15/2018] [Indexed: 01/09/2023]
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Horsch A, Gilbert L, Lanzi S, Kang JS, Vial Y, Puder JJ. Prospective associations between maternal stress during pregnancy and fasting glucose with obstetric and neonatal outcomes. J Psychosom Res 2019; 125:109795. [PMID: 31421320 DOI: 10.1016/j.jpsychores.2019.109795] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/31/2019] [Accepted: 08/04/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This prospective study investigated associations between maternal stress exposure and maternal psychological stress measures during pregnancy with obstetric and neonatal outcomes. We also tested whether any observed associations would be moderated by increasing glucose levels, as increased glycaemia is also associated with adverse obstetric and neonatal outcomes. METHODS 203 women between 24 and 30 weeks gestation completed validated questionnaires assessing pregnancy-related major events and major life events, maternal perceived stress, and depression, anxiety, and stress symptoms. Glucose was measured using fasting morning blood samples. Instrumental delivery represented an obstetric outcome. Neonatal outcomes included Apgar score, large and small for gestational age weight, cord blood pH, NICU hospitalization, and neonatal hypoglycaemia. RESULTS Regarding the obstetric outcome, pregnancy-related major life events OR = 1.346 (1.016-1.783; p = .016) were related to more incidences of instrumental delivery. Regarding neonatal outcomes, exposure to major life events in the last 12 months was associated with lower cord blood pH values B = -0.155 (-0.059 to -0.002; p = .036) and with more incidences of hypoglycaemia OR = 0.165 (0.012-0.169; p = .04). Maternal psychological stress measures were related to more incidences of instrumental delivery OR = 1.018 (1.003-1.032; p = .013). Maternal stress perception was associated with higher cord blood pH values B = 0.155 (0-0.003; p = .046) and fewer NICU hospitalisations OR = -0.170 (-0.009 to -0.001; p = .019). Some of these associations between life events and stress perceptions with neonatal outcomes were moderated by fasting glucose levels. CONCLUSION Maternal pregnancy events as well as stress, depression and anxiety symptoms have a negative impact on obstetric outcomes and maternal life events are associated with negative neonatal outcomes. Higher fasting glucose levels moderate some of the relationships between stress and neonatal outcomes.
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Affiliation(s)
- Antje Horsch
- Institute of Higher Education in Healthcare Research, University of Lausanne, Lausanne, Switzerland; Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland.
| | - Leah Gilbert
- Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Stefano Lanzi
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital, Lausanne, Switzerland; Division of Angiology, Heart and Vessel Department, Lausanne University Hospital, Switzerland
| | - Ji Seon Kang
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
| | - Yvan Vial
- Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Jardena J Puder
- Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
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Özler S, Oztas E, Guler BG, Alci M, Caglar AT, Danişman N. ARE THE FACTORS AFFECTING ADVERSE PREGNANCY OUTCOMES DIFFERENT IN OBESE GESTATIONAL DIABETES PREGNANT WOMEN RECEIVING DIET OR INSULIN TREATMENT? ACTA ENDOCRINOLOGICA (BUCHAREST, ROMANIA : 2005) 2019; 15:472-481. [PMID: 32377245 PMCID: PMC7200116 DOI: 10.4183/aeb.2019.472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CONTEXT We aimed to examine the factors affecting adverse gestational outcome in gestational diabetes (GDM) patients, who were grouped as obese and normal- weight, having only-diet, or insulin treatments. SUBJECTS AND METHODS The study included 373 patients, treated with diet or insulin. These patients were sub-grouped as obese and non-obese, and examined retrospectively. The variables affecting adverse gestational outcome in obese GDM patients having dietary and/ or insulin treatments were detected with multiple regression analysis. RESULTS The weight gained during pregnancy in the GDM group having insulin treatment was more than the one in only-diet treated GDM group (p=0.004). Pre-pregnancy body mass index, the weight gained during pregnancy, hemoglobin A1C levels in the second and third trimesters, caesarian rates were higher in the insulin-treated obese patients than in the other groups (p<0.001). The odds ratio for fasting blood glucose level in insulin-treated obese GDM group was 1.081 (95% CI =1.004 - 1.163) (p=0.039); and it was 0.982 (95% CI =0.924 - 1.002) (p=0.048) for the weight gained during pregnancy, in only-diet treated obese GDM patients. CONCLUSION The control of weight gained during pregnancy, and of fasting blood glucose levels in obese patients having GDM, is important to decrease adverse gestational outcome.
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Affiliation(s)
- S Özler
- Selçuk University - Perinatology, Turkey
| | | | - B G Guler
- Istinye University, Istanbul, Turkey
| | - M Alci
- Selçuk University - Konya, Turkey
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Intensive glycemic control in gestational diabetes mellitus: a randomized controlled clinical feasibility trial. Am J Obstet Gynecol MFM 2019; 1:100050. [PMID: 33345840 DOI: 10.1016/j.ajogmf.2019.100050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/28/2019] [Accepted: 09/22/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Overweight and obese women with gestational diabetes mellitus are at increased risk for adverse perinatal outcomes, and they are also more likely to have suboptimal glycemic control. However, there is a paucity of data evaluating whether lower glycemic targets could improve outcomes. OBJECTIVE To evaluate the feasibility of intensive glycemic control in overweight and obese women with gestational diabetes mellitus. MATERIALS AND METHODS We randomized 60 overweight or obese women with gestational diabetes mellitus, diagnosed between 12 and 32 weeks' gestation to either intensive (fasting <90 mg/dL, 1 hour postprandial <120 mg/dL) or standard (fasting <95 mg/dL, 1 ho postprandial <140 mg/dL) glycemic targets. Maternal glucose was assessed in 2 ways: blinded continuous glucose monitors, worn for 5 days at 2 time points (at 12-32 weeks and again at 32-36 weeks), and self-monitored glucose measurement 4 times per day. All women underwent standardized dietary counseling, and medical therapy was prescribed as needed to achieve glycemic control. RESULTS Between December 2015 and December 2017, we randomized 60 women to either intensive (n = 30) or standard (n = 30) glycemic control. Baseline characteristics including maternal age, body mass index, and gestational age at diagnosis were similar between the intensive and standard groups. Medical therapy was more common in women in the intensive group than those in the standard group (83 vs 57%, P = .02). Women in the intensive glycemic control group had lower glucose values as assessed by continuous glucose monitors at including 24-hour mean (-8.1; 95% confidence interval, -12.0 to -4.3 mg/dL; P < .0001) and 1-h postprandial (-11.8; 95% confidence interval, -19.7 to -3.9 mg/dL, P = .004) values. Hypoglycemia <60 mg/dL was uncommon and did not differ between groups. CONCLUSION Intensive glycemic targets can be used in overweight and obese women with minimal hypoglycemia, and this approach results in improved glycemic control when compared to standard glycemic targets. Further studies are needed to determine whether intensive glycemic targets can improve maternal and neonatal outcomes in high-risk women with gestational diabetes mellitus. CLINICAL TRIAL IDENTIFIER NCT02530866; clinicaltrials.gov.
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Ozler S, Oztas E, Gumus Guler B, Erel O, Turhan Caglar A, Ergin M, Uygur D, Danisman N. Are serum levels of ADAMTS5, TAS and TOS at 24-28 gestational weeks associated with adverse perinatal outcomes in gestational diabetic women? J OBSTET GYNAECOL 2019; 40:619-625. [PMID: 31526197 DOI: 10.1080/01443615.2019.1634025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We aimed to determine the role of placental A Disintegrin and Metalloproteinase with thrombospondin motifs 5 (ADAMTS5), and maternal serum ADAMTS5, total antioxidant status (TAS), total oxidant status (TOS) and oxidative stress index (OSI) levels at 24-28th gestational weeks in GDM. This study included 57 patients, who had been diagnosed as having GDM at their 24-28th gestational week, and 29 controls. The maternal blood samples were collected at the 24-28th gestational week and ADAMTS5 was studied with the enzyme-linked immunosorbent assay (ELISA) method, whereas an automated colorimetric method was used to study TAS, TOS, and OSI. The level of ADAMTS5 in maternal serum of patients with GDM were significantly lower than the controls (p = .017); whereas TOS and OSI levels were significantly higher (p = .003 and p = .008). Multivariable logistic regression analysis revealed ADAMTS5 and TOS levels were independently associated with adverse perinatal outcomes (p = .004 and p = .018). We found that serum ADAMTS5 levels decreased and TOS level increased in GDM pregnant at 24-28th gestational weeks. In addition, we found that increased levels of serum ADAMTS5 and decreased TOS levels at 24-28th weeks were associated with adverse perinatal outcomes independent of the mode of treatment in GDM.Impact statementWhat is already known on this subject? Gestational diabetes mellitus (GDM) is one of the most common medical complications of pregnancy. The insulin resistance, which starts at the 24-28th gestational weeks, increases during gestation. GDM increases maternal complications like preeclampsia, cesarean rate, cardiovascular disease, obesity, and diabetes after pregnancy; and neonatal complications like macrosomia, hypoglycemia, hyperbilirubinemia, delivery trauma, shoulder dystocia, and adult-onset obesity, and diabetes.What the results of this study add? A significant relationship between ADAMTS5, TOS levels and adverse perinatal outcome. insulin resistance and was observed.What the implications are of these findings for clinical practice and/or further research? Based on this finding, we concluded that increased levels of oxidative stress and decreased ADAMTS5 levels are associated with GDM and predictive for adverse perinatal outcomes. The results of the present study were consistent with the previous reports and indicated that increased oxidative stress in GDM patients are related to adverse perinatal outcomes.
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Affiliation(s)
- Sibel Ozler
- Department of Perinatology, Selcuk University Medical School, Konya, Turkey
| | - Efser Oztas
- Department of Perinatology, Eskisehir City Hospital, Eskisehir, Turkey
| | | | - Ozcan Erel
- Department of Clinical Biochemistry, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | - Ali Turhan Caglar
- Department of Clinical Biochemistry, Aralik State Hospital, Gaziantep, Turkey
| | - Merve Ergin
- Department of Pathology, Etlik Zübeyde Haním Women's Health Education and Research Hospital, Ankara, Turkey
| | - Dilek Uygur
- Department of Clinical Biochemistry, Aralik State Hospital, Gaziantep, Turkey
| | - Nuri Danisman
- Department of Perinatology, Acıbadem Acıbadem University Medical School, Istanbul, Turkey
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Guardo FD, Currò JM, Valenti G, Rossetti P, Di Gregorio LM, Conway F, Chiofalo B, Garzon S, Bruni S, Rizzo G. Non-pharmacological management of gestational diabetes: The role of myo-inositol. JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2019; 17:/j/jcim.ahead-of-print/jcim-2019-0111/jcim-2019-0111.xml. [PMID: 31527297 DOI: 10.1515/jcim-2019-0111] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 07/03/2019] [Indexed: 12/29/2022]
Abstract
Gestational diabetes mellitus (GDM) is the most common metabolic disorder occurring in pregnancy. GDM plays an important role in the current diabetes epidemic: exposure to a high glycemic environment during the early stages of development increases the risk of the fetus to develop type two diabetes mellitus (T2DM) in adult life. Various cardiometabolic risk factors are linked to GDM. A thorough knowledge of the risk factors and genes involved in the development of GDM, along with an understanding of the underlying pathophysiological mechanisms are crucial to properly identify patients at risk of developing this condition. There is growing evidence showing that myo-inositol, combined with an appropriate therapeutic regimen for GDM, can provide additional benefits to the patient. The aim of this review is to analyze the role of inositol isomers - especially myo-inositol (MYO-INS) - in the treatment of patients with GDM.
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Affiliation(s)
- Federica Di Guardo
- Department of General Surgery and Medical Surgical Specialties, Gynecology and Obstetrics Section, University of Catania, Catania, Italy
| | | | - Gaetano Valenti
- Department of General Surgery and Medical Surgical Specialties, Gynecology and Obstetrics Section, University of Catania, Catania, Italy
| | - Paola Rossetti
- Unit of Diabetology and Endocrino-Metabolic Diseases, Hospital for Emergency Cannizzaro, Catania, Italy
| | - Luisa Maria Di Gregorio
- Department of General Surgery and Medical Surgical Specialties, Gynecology and Obstetrics Section, University of Catania, Catania, Italy
| | - Francesca Conway
- Department of Biomedicine and Prevention, Section of Gynecology and Obstetrics, University of Rome Tor Vergata, Rome, Italy
| | - Benito Chiofalo
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, "Regina Elena" National Cancer Institute, Rome, Italy
| | - Simone Garzon
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Simone Bruni
- Division of Obstetrics and Gynecology, Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
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Abstract
In 1989 the St. Vincent Declaration aimed to achieve comparable pregnancy outcomes in diabetic and non-diabetic women. However, currently women with pre-gestational diabetes still feature a higher risk of perinatal morbidity and even increased mortality. This fact is mostly ascribed to a persistently low rate of pregnancy planning and pre-pregnancy care with optimization of metabolic control prior to conception. All women should be experienced in the management of their therapy and on stable glycemic control prior to the conception. In addition, thyroid dysfunction, hypertension as well as the presence of diabetic complications should be excluded before pregnancy or treated adequately in order to decrease the risk for a progression of complications during pregnancy as well as maternal and fetal morbidity. Especially in women with type 1 diabetes mellitus in early pregnancy the risk of hypoglycemia is highest and decreases with the progression of pregnancy due to hormonal changes causing steady increase of insulin resistance. In addition, obesity increases worldwide and contributes to increasing numbers of women at childbearing age with type 2 diabetes mellitus and further deterioration of pregnancy outcomes in diabetic women. Maternal glycemic control should aim to achieve normoglycemia and normal HbA1c levels, possibly without hypoglycemia, but is associated with the development of diabetic embryopathy and fetopathy if dysglycemia occurs. Intensified insulin therapy with multiple daily insulin injections and pump treatment are effective in reaching good metabolic control during pregnancy. Oral glucose lowering drugs (Metformin) may be considered in obese women with type 2 diabetes mellitus to increase insulin sensitivity but should be also prescribed cautiously due to crossing the placenta and lack of long-time follow up data of the offspring.
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