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Song Y, Zhai X, Bai Y, Liu C, Zhang L. Progress and indication for use of continuous glucose monitoring in patients with diabetes in pregnancy: a review. Front Endocrinol (Lausanne) 2023; 14:1218602. [PMID: 37680884 PMCID: PMC10482265 DOI: 10.3389/fendo.2023.1218602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 08/07/2023] [Indexed: 09/09/2023] Open
Abstract
Gestational diabetes mellitus is one of the most common endocrine diseases that occur during pregnancy. Disorders of blood glucose metabolism during pregnancy can increase the risk of adverse pregnancy outcomes, such as pregnancy-related hypertension, preeclampsia, eclampsia, miscarriage, macrosomia, and neonatal hypoglycemia. Continuous glucose monitoring (CGM) can safely and effectively monitor blood glucose changes in patients with gestational hyperglycemia, thereby reducing adverse pregnancy outcomes. Hence, this article aimed to provide a comprehensive review of the progress and indications for using CGM in pregnant patients with diabetes. CGM can reduce blood glucose fluctuations and the occurrence of serious hypoglycemia and hyperglycemia events and can provide time in range (TIR). TIR is an important indicator of blood glucose level. Patients with a higher TIR during pregnancy have better gestational outcomes.
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Affiliation(s)
| | | | | | | | - Le Zhang
- Department of Endocrinology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
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Jotic A, Milicic T, Lalic K, Lukic L, Macesic M, Stanarcic Gajovic J, Stoiljkovic M, Gojnic Dugalic M, Jeremic V, Lalic NM. Evaluation of Glycaemic Control, Glucose Variability and Hypoglycaemia on Long-Term Continuous Subcutaneous Infusion vs. Multiple Daily Injections: Observational Study in Pregnancies With Pre-Existing Type 1 Diabetes. Diabetes Ther 2020; 11:845-858. [PMID: 32060738 PMCID: PMC7136374 DOI: 10.1007/s13300-020-00780-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION We evaluated the effectiveness of long-term continuous subcutaneous insulin infusion (CSII) compared with multiple daily insulin (MDI) injections for glycaemic control and variability, hypoglycaemic episodes and maternal/neonatal outcomes in pregnant women with pre-existing type 1 diabetes (pT1D). METHODS Our observational cohort study included 128 consecutive pregnant women with pT1D, who were treated from 1 January 2010 to 31 December 2017. Of 128 participants, 48 were on CSII and 80 were on MDI. Glycaemic control was determined by glycated haemoglobin (HbA1c) (captured in preconception and each trimester of pregnancy). Glucose variability (GV) was expressed as the coefficient of variation (CV) [calculated from self-monitoring of blood glucose (SMBG) values], and hypoglycaemia was defined as glucose values < 3.9 mmol/l. The data on maternal and neonatal outcomes were collected from obstetrical records. RESULTS Duration of the treatment was 8.8 ± 5.3 years in the CSII and 12.6 ± 8.0 years in the MDI group. The CSII lowered HbA1c in preconception (7.1 ± 0.1 vs. 7.9 ± 0.2%, p = 0.03) and the first (6.9 ± 0.1 vs. 7.7 ± 0.2%, p = 0.02), second (6.6 ± 0.1 vs. 7.2 ± 0.1%, p = 0.003) and third (6.5 ± 0.1 vs. 6.8 ± 0.1%, p = 0.02) trimesters significantly better than MDI. Significantly lower CV was observed only for fasting glycaemia in the first trimester (17.1 vs 28.4%, p < 0.001) in favour of CSII. Moreover, the CSII group had significantly lower mean hypoglycaemic episodes/week/patient only during the first trimester (2.0 ± 1.7 vs 4.8 ± 1.5, p < 0.01). In early pregnancy, the majority of women on CSII had less hypoglycaemia than on MDI (0-3: 79.1 vs. 29.1%; 4-6: 18.8 vs. 65.8%; ≥ 7: 2.1 vs. 5.1%, p < 0.01, respectively). We found no difference in the incidence of adverse maternal/neonatal outcomes. CONCLUSIONS Treatment with CSII resulted in a favourable reduction of HbA1c in the preconception period and each trimester in pregnancy. Moreover, long-term CSII treatment demonstrated more stable metabolic control with less GV of fasting glycaemia and fewer hypoglyacemic episodes only during early pregnancy.
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Affiliation(s)
- Aleksandra Jotic
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Dr. Subotića 13, 11000, Belgrade, Serbia.
- Faculty of Medicine, University of Belgrade, Dr. Subotića 8, 11000, Belgrade, Serbia.
| | - Tanja Milicic
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Dr. Subotića 13, 11000, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Dr. Subotića 8, 11000, Belgrade, Serbia
| | - Katarina Lalic
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Dr. Subotića 13, 11000, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Dr. Subotića 8, 11000, Belgrade, Serbia
| | - Ljiljana Lukic
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Dr. Subotića 13, 11000, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Dr. Subotića 8, 11000, Belgrade, Serbia
| | - Marija Macesic
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Dr. Subotića 13, 11000, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Dr. Subotića 8, 11000, Belgrade, Serbia
| | - Jelena Stanarcic Gajovic
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Dr. Subotića 13, 11000, Belgrade, Serbia
| | - Milica Stoiljkovic
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Dr. Subotića 13, 11000, Belgrade, Serbia
| | - Miroslava Gojnic Dugalic
- Faculty of Medicine, University of Belgrade, Dr. Subotića 8, 11000, Belgrade, Serbia
- Clinic for Gynecology and Obstetrics, Clinical Center of Serbia, Visegradska 26, 11000, Belgrade, Serbia
| | - Veljko Jeremic
- Department for Operations Research and Statistics, Faculty of Organizational Sciences, University of Belgrade, Belgrade, Serbia
| | - Nebojsa M Lalic
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Dr. Subotića 13, 11000, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Dr. Subotića 8, 11000, Belgrade, Serbia
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Sina M, Cade TJ, Flack J, Nolan CJ, Rajagopal R, Wong V, Burcher L, Barry A, Gianatti E, McCarthy A, McNamara C, Mickelson M, Hughes R, Jones T, Latino C, McIntyre D, Price S, Simmons D. Antenatal models of care for women with gestational diabetes mellitus: Vignettes from an international meeting. Aust N Z J Obstet Gynaecol 2020; 60:720-728. [DOI: 10.1111/ajo.13144] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 01/30/2020] [Indexed: 01/01/2023]
Affiliation(s)
- Maryam Sina
- Western Sydney University Sydney New South WalesAustralia
| | | | - Jeff Flack
- Bankstown Hospital SydneyNew South WalesAustralia
| | | | | | - Vincent Wong
- Liverpool Hospital Sydney New South WalesAustralia
| | - Linda Burcher
- Flinders Medical Centre Adelaide South AustraliaAustralia
| | - Alison Barry
- Mater Medical Research Institute Brisbane QueenslandAustralia
| | | | - Ana McCarthy
- Lyell McEwin Hospital Adelaide South AustraliaAustralia
| | - Catharine McNamara
- Deakin University, Burwood, Victoria and The Mercy Hospital for Women Heidelberg VictoriaAustralia
| | | | - Ruth Hughes
- University of Otago Christchurch New Zealand
| | - Tara Jones
- Goulburn Valley Health SheppartonVictoriaAustralia
| | - Cathy Latino
- Fiona Stanley Hospital Perth Western AustraliaAustralia
| | - David McIntyre
- Mater Medical Research Institute Brisbane QueenslandAustralia
| | - Sarah Price
- University of Melbourne Melbourne Victoria Australia
| | - David Simmons
- Western Sydney University Sydney New South WalesAustralia
- Campbelltown Hospital SydneyNew South WalesAustralia
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Hirst JE, Loerup L, Mackillop L, Farmer A, Kenworthy Y, Bartlett K, Velardo C, Kevat DA, Tarassenko L, Levy JC. Digital blood glucose monitoring could provide new objective assessments of blood glucose control in women with gestational diabetes. Diabet Med 2016; 33:1598-1599. [PMID: 26606543 DOI: 10.1111/dme.13035] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- J E Hirst
- Nuffield Department of Obstetrics and Gynaecology, University of Oxford, Oxford, UK
| | - L Loerup
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - L Mackillop
- Nuffield Department of Obstetrics and Gynaecology, University of Oxford, Oxford, UK
- Oxford University Hospitals, NHS Trust, Oxford, UK
| | - A Farmer
- Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Y Kenworthy
- Nuffield Department of Obstetrics and Gynaecology, University of Oxford, Oxford, UK
| | - K Bartlett
- Oxford University Hospitals, NHS Trust, Oxford, UK
| | - C Velardo
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - D A Kevat
- Oxford University Hospitals, NHS Trust, Oxford, UK
| | - L Tarassenko
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - J C Levy
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford University Hospitals, NHS Trust, Oxford, UK
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5
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Starikov RS, Inman K, Chien EKS, Anderson BL, Rouse DJ, Lopes V, Coustan DR. Can hemoglobin A1c in early pregnancy predict adverse pregnancy outcomes in diabetic patients? J Diabetes Complications 2014; 28:203-7. [PMID: 24268941 DOI: 10.1016/j.jdiacomp.2013.10.004] [Citation(s) in RCA: 16] [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: 05/19/2013] [Revised: 09/18/2013] [Accepted: 10/08/2013] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To examine the association of elevated early pregnancy hemoglobin A1c (HbA1c) levels with adverse pregnancy outcomes in women with preexisting diabetes mellitus. STUDY DESIGN Retrospective cohort study of 330 women with preexisting diabetes enrolled in a Diabetes in Pregnancy Program at an academic institution between 2003 and 2011 who had an early HbA1c determination. The frequencies of composite maternal adverse pregnancy outcomes (birth at<37 weeks, preeclampsia, and medically indicated birth <39 weeks), and composite fetal adverse pregnancy outcomes [shoulder dystocia, Apgar scores<7 at 5 minutes, small for gestational age (SGA), large for gestational age (LGA), and stillbirth] were compared between HbA1c categories (<6.5, 6.5-7.4, 7.5-8.4 and ≥ 8.5%). RESULTS There was no statistically significant difference between composite adverse maternal pregnancy outcomes and composite adverse fetal pregnancy outcomes as well as other individual outcomes between different HbA1c categories. Of the vaginally delivered women in our cohort, the 37 patients with HbA1c levels of ≥ 8.5% had a significantly higher frequency of fetal shoulder dystocia than the 62 with HbA1c levels of < 8.5% (24.2 vs. 1.6%, P = 0.002). Neonates of patients with HbA1c ≥ 8.5% were more likely to have low five minute Apgar scores than neonates of patients with HbA1c < 8.5%, but this was of borderline statistical significance (7.4% vs. 0.5%, P = 0.05). CONCLUSION In patients with preexisting diabetes mellitus, HbA1c levels of ≥ 8.5% during early pregnancy are not useful in predicting most adverse outcomes, although there may be an increased risk for shoulder dystocia.
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Affiliation(s)
- Roman S Starikov
- Obstetrics and Gynecology, Division of MFM, Women & Infants Hospital of RI, Providence, RI 02905; The Warren Alpert Medical School of Brown University, Providence, RI 02806.
| | - Kyle Inman
- Obstetrics and Gynecology, Division of MFM, Women & Infants Hospital of RI, Providence, RI 02905; The Warren Alpert Medical School of Brown University, Providence, RI 02806
| | - Edward K S Chien
- Obstetrics and Gynecology, Division of MFM, Women & Infants Hospital of RI, Providence, RI 02905; The Warren Alpert Medical School of Brown University, Providence, RI 02806
| | - Brenna L Anderson
- Obstetrics and Gynecology, Division of MFM, Women & Infants Hospital of RI, Providence, RI 02905; The Warren Alpert Medical School of Brown University, Providence, RI 02806
| | - Dwight J Rouse
- Obstetrics and Gynecology, Division of MFM, Women & Infants Hospital of RI, Providence, RI 02905; The Warren Alpert Medical School of Brown University, Providence, RI 02806
| | - Vrishali Lopes
- The Warren Alpert Medical School of Brown University, Providence, RI 02806; Division of Research, Department of Obstetrics and Gynecology, Women & Infants Hospital of RI
| | - Donald R Coustan
- Obstetrics and Gynecology, Division of MFM, Women & Infants Hospital of RI, Providence, RI 02905; The Warren Alpert Medical School of Brown University, Providence, RI 02806
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Abstract
Blood glucose monitoring has evolved over the last century. The concept of adequate glycemic control and minimum glycemic variability requires an ideal, accurate and reliable glucose monitoring system. The search for an ideal blood glucose monitoring system still continues. This review explains the various blood glucose monitoring systems with special focus on the monitoring systems like self- monitored blood glucose (SMBG) and continuous glucose monitoring system (CGMS). It also focuses on the newer concepts of blood glucose monitoring and their incorporation in routine clinical management of diabetes mellitus.
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Affiliation(s)
- Kranti Shreesh Khadilkar
- Department of Endocrinology, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India
| | - Tushar Bandgar
- Department of Endocrinology, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India
| | - Vyankatesh Shivane
- Department of Endocrinology, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India
| | - Anurag Lila
- Department of Endocrinology, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India
| | - Nalini Shah
- Department of Endocrinology, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India
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Dalfrà MG, Chilelli NC, Di Cianni G, Mello G, Lencioni C, Biagioni S, Scalese M, Sartore G, Lapolla A. Glucose Fluctuations during Gestation: An Additional Tool for Monitoring Pregnancy Complicated by Diabetes. Int J Endocrinol 2013; 2013:279021. [PMID: 24319455 PMCID: PMC3844274 DOI: 10.1155/2013/279021] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 09/19/2013] [Accepted: 09/30/2013] [Indexed: 01/12/2023] Open
Abstract
Continuous glucose monitoring (CGM) gives a unique insight into magnitude and duration of daily glucose fluctuations. Limited data are available on glucose variability (GV) in pregnancy. We aimed to assess GV in healthy pregnant women and cases of type 1 diabetes mellitus or gestational diabetes (GDM) and its possible association with HbA1c. CGM was performed in 50 pregnant women (20 type 1, 20 GDM, and 10 healthy controls) in all three trimesters of pregnancy. We calculated mean amplitude of glycemic excursions (MAGE), standard deviation (SD), interquartile range (IQR), and continuous overlapping net glycemic action (CONGA), as parameters of GV. The high blood glycemic index (HBGI) and low blood glycemic index (LBGI) were also measured as indicators of hyperhypoglycemic risk. Women with type 1 diabetes showed higher GV, with a 2-fold higher risk of hyperglycemic spikes during the day, than healthy pregnant women or GDM ones. GDM women had only slightly higher GV parameters than healthy controls. HbA1c did not correlate with GV indicators in type 1 diabetes or GDM pregnancies. We provided new evidence of the importance of certain GV indicators in pregnant women with GDM or type 1 diabetes and recommended the use of CGM specifically in these populations.
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Affiliation(s)
- M. G. Dalfrà
- Department of Medicine, Unit of Metabolic Diseases, University of Padua, Via Giustiniani no. 2, 35128 Padua, Italy
| | - N. C. Chilelli
- Department of Medicine, Unit of Metabolic Diseases, University of Padua, Via Giustiniani no. 2, 35128 Padua, Italy
| | - G. Di Cianni
- Department of Endocrinology & Metabolism, Section of Metabolic Diseases & Diabetes, AOUP Pisa, University of Pisa, Ospedale Cisanello, Via Paradisa no. 2, 56124 Pisa, Italy
| | - G. Mello
- Department of Gynecology, Perinatology and Human Reproduction, University of Florence, Viale Giovan Battista Morgagni no. 85, 50134 Florence, Italy
| | - C. Lencioni
- Department of Endocrinology & Metabolism, Section of Metabolic Diseases & Diabetes, AOUP Pisa, University of Pisa, Ospedale Cisanello, Via Paradisa no. 2, 56124 Pisa, Italy
| | - S. Biagioni
- Department of Gynecology, Perinatology and Human Reproduction, University of Florence, Viale Giovan Battista Morgagni no. 85, 50134 Florence, Italy
| | - M. Scalese
- CNR, Institute of Clinical Physiology, Via G. Moruzzi no. 1, 56124 Pisa, Italy
| | - G. Sartore
- Department of Medicine, Unit of Metabolic Diseases, University of Padua, Via Giustiniani no. 2, 35128 Padua, Italy
| | - A. Lapolla
- Department of Medicine, Unit of Metabolic Diseases, University of Padua, Via Giustiniani no. 2, 35128 Padua, Italy
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Bakiner O, Bozkirli E, Ozsahin K, Sariturk C, Ertorer E. Risk Factors That can Predict Antenatal Insulin Need in Gestational Diabetes. J Clin Med Res 2013; 5:381-8. [PMID: 23976911 PMCID: PMC3748663 DOI: 10.4021/jocmr1515w] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2013] [Indexed: 12/12/2022] Open
Abstract
Background This study was undertaken to assess the association between insulin need in gestational diabetes mellitus (GDM) and clinical features and laboratory parameters. Factors that can predict insulin need are also identified. Methods Cases with GDM were included retrospectively from records. Cases which failed to achieve target blood glucose levels with medical nutrition therapy (MNT) and need insulin treatment were recorded. Risk factors which can predict antenatal insulin treatment (AIT) were identified as follows; the presence of diabetes in a first degree relative, body mass index prior to pregnancy, number of parity, history of GDM, macrosomic baby delivery (> 4,000 g), age, gestational week at time of diagnosis, body mass index during diagnosis, weight gain untill diagnosis, mean systolic and diastolic blood pressure, HbA1C level during diagnosis, and fasting plasma glucose on diagnostic oral glucose tolerance test. Presence of a statistical significance between those patient features and AIT was assessed. Independent predictors for AIT were evaluated. Results A total of 300 cases were recruited from records, 190 cases (63.3%) were followed only with MNT until delivery and 110 cases (36.7%) were initiated AIT. The association between AIT and patient factors like presence of diabetes in the pedigree, week of gestation at which GDM was diagnosed, BMI during diagnosis, HbA1C levels, and fasting plasma glucose during diagnosis was found (P = 0.03; 0.008; 0.049; 0.001 and 0.001respectively). Multivariant analysis showed that fasting plasma glucose levels during diagnosis and HbA1C levels were independent risk factors for AIT. Fasting plasma glucose values that can predict AIT were identified > 89.5 mg/dL with 72.7% sensitivity and 62.6% spesifity (P < 0.001). Positive predictive value was 73% (P < 0.001). Also, HbA1C levels that can predict AIT was found to be > 5.485% with 65.3% sensitivity and 66.7% spesifitiy(P < 0.001) with a positive predictive value 68% (P < 0.001). Conclusions Independent predictors for AIT were found as fasting plasma glucose on OGTT and HbA1c levels during diagnosis in GDM. Cases with fasting plasma glucose ≥ 89.5 mg/dL or HbA1C ≥ 5.485% should be closely followed for AIT in specified centers.
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Affiliation(s)
- Okan Bakiner
- Department of Endocrinology and Metabolism Diseases, Baskent University, Faculty of Medicine, Turkey
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Hirst JE, Tran TS, Do MAT, Rowena F, Morris JM, Jeffery HE. Women with gestational diabetes in Vietnam: a qualitative study to determine attitudes and health behaviours. BMC Pregnancy Childbirth 2012; 12:81. [PMID: 22873351 PMCID: PMC3449178 DOI: 10.1186/1471-2393-12-81] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Accepted: 07/31/2012] [Indexed: 11/10/2022] Open
Abstract
Background Diabetes is increasing in prevalence globally, notably amongst populations from low- and middle- income countries. Gestational Diabetes Mellitus(GDM), a precursor for type 2 diabetes, is increasing in line with this trend. Few studies have considered the personal and social effects of GDM on women living in low and middle-income countries. The aim of this study was determine attitudes and health behaviours of pregnant women with GDM in Vietnam. Methods This was a qualitative study using focus group methodology conducted in Ho Chi Minh City. Pregnant women, aged over 18 years, with GDM were eligible to participate. Women were purposely sampled to obtain a range of gestational ages and severity of disease. They were invited to attend a 1-hour focus group. Questions were semi structured around six themes. Focus groups were recorded, transcribed, translated and cross-referenced. Non-verbal and group interactions were recorded. Thematic analysis was performed using a theoretical framework approach. Results From December 2010 to February 2011, four focus groups were conducted involving 34 women. Median age was 31.5 years (range 23 to 44), median BMI 21.8 kg/m2. Women felt confusion, anxiety and guilt about GDM. Many perceived their baby to be at increased risk of death. Advice to reduce dietary starch was confusing. Women reported being ‘hungry’ or ‘starving’ most of the time, unaware of appropriate food substitutions. They were concerned about transmission of GDM through breast milk. Several women planned not to breastfeed. All felt they needed more information. Current sources of information included friends, magazines, a health phone line or the Internet. Women felt small group sessions and information leaflets could benefit them. Conclusions This study highlights the need for culturally appropriate clinical education and health promotion activities for women with GDM in Vietnam.
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Affiliation(s)
- Jane E Hirst
- Department of Obstetrics & Gynaecology, Sydney Medical School- Northern, University of Sydney, Royal North Shore Hospital, Sydney, NSW, Australia.
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Berger-Kulemann V, Brugger PC, Reisegger M, Klein K, Hachemian N, Koelblinger C, Weber M, Prayer D. Quantification of the subcutaneous fat layer with MRI in fetuses of healthy mothers with no underlying metabolic disease vs. fetuses of diabetic and obese mothers. J Perinat Med 2011; 40:179-84. [PMID: 22117112 DOI: 10.1515/jpm.2011.122] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Accepted: 10/19/2011] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess the age-dependent fetal subcutaneous fat layer (SCFL) of non-diabetic, normal-weight mothers and fetuses of mothers with gestational diabetes (GDM) and normal body weight or obesity. METHODS In a prospective study, we evaluated 115 MRI examinations of fetuses with no history of (maternal) metabolic disease [gestational week (GW) 29 to 39/40] and 50 examinations of mothers with GDM and normal body weight or obesity. The SCFL was measured at predetermined anatomical landmarks. Measurements were correlated with the maternal body mass index (BMI) and glycated hemoglobin A1c (HbA1c)-values in diabetic mothers. RESULTS In fetuses of non-diabetic, normal-weight mothers, measurements showed high consistency within the respective GW and ranged from 2 mm at GW 29 at all measured points, up to 4.5 mm at the trunk and 6.0 mm at the extremities at GW 39/40. In 47/50 fetuses of mothers with GDM, the SCFL was within the range of fetuses of mothers with no metabolic disease. In three patients with GDM and BMI<30, the SCFL-thickness was decreased. No fetuses showed an increased SCFL-thickness. CONCLUSION The SCFL of normally developed fetuses is easily detectable from GW 29 on T1-weighted images (T1-W), and increases with gestational age. The presented data provide physiological benchmarks to evaluate developmental status and may help in the prenatal diagnosis of abnormal growth and macrosomia. In pregnant women with well-controlled GDM, an increase of the SCFL is not expected.
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Current world literature. Curr Opin Obstet Gynecol 2011; 23:135-41. [PMID: 21386682 DOI: 10.1097/gco.0b013e32834506b7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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