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Field C, Grobman WA, Yee LM, Johnson J, Wu J, McNeil B, Mercer B, Simhan H, Reddy U, Silver RM, Parry S, Saade G, Chung J, Wapner R, Lynch CD, Venkatesh KK. Community-level social determinants of health and pregestational and gestational diabetes. Am J Obstet Gynecol MFM 2024; 6:101249. [PMID: 38070680 PMCID: PMC11184512 DOI: 10.1016/j.ajogmf.2023.101249] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/20/2023] [Accepted: 12/04/2023] [Indexed: 01/02/2024]
Abstract
BACKGROUND Individual adverse social determinants of health are associated with increased risk of diabetes in pregnancy, but the relative influence of neighborhood or community-level social determinants of health is unknown. OBJECTIVE This study aimed to determine whether living in neighborhoods with greater socioeconomic disadvantage, food deserts, or less walkability was associated with having pregestational diabetes and developing gestational diabetes. STUDY DESIGN We conducted a secondary analysis of the prospective Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-To-Be. Home addresses in the first trimester were geocoded at the census tract level. The exposures (modeled separately) were the following 3 neighborhood-level measures of adverse social determinants of health: (1) socioeconomic disadvantage, defined by the Area Deprivation Index and measured in tertiles from the lowest tertile (ie, least disadvantage [T1]) to the highest (ie, most disadvantage [T3]); (2) food desert, defined by the United States Department of Agriculture Food Access Research Atlas (yes/no by low income and low access criteria); and (3) less walkability, defined by the Environmental Protection Agency National Walkability Index (most walkable score [15.26-20.0] vs less walkable score [<15.26]). Multinomial logistic regression was used to model the odds of gestational diabetes or pregestational diabetes relative to no diabetes as the reference, adjusted for age at delivery, chronic hypertension, Medicaid insurance status, and low household income (<130% of the US poverty level). RESULTS Among the 9155 assessed individuals, the mean Area Deprivation Index score was 39.0 (interquartile range, 19.0-71.0), 37.0% lived in a food desert, and 41.0% lived in a less walkable neighborhood. The frequency of pregestational and gestational diabetes diagnosis was 1.5% and 4.2%, respectively. Individuals living in a community in the highest tertile of socioeconomic disadvantage had increased odds of entering pregnancy with pregestational diabetes compared with those in the lowest tertile (T3 vs T1: 2.6% vs 0.8%; adjusted odds ratio, 2.52; 95% confidence interval, 1.41-4.48). Individuals living in a food desert (4.8% vs 4.0%; adjusted odds ratio, 1.37; 95% confidence interval, 1.06-1.77) and in a less walkable neighborhood (4.4% vs 3.8%; adjusted odds ratio, 1.33; 95% confidence interval, 1.04-1.71) had increased odds of gestational diabetes. There was no significant association between living in a food desert or a less walkable neighborhood and pregestational diabetes, or between socioeconomic disadvantage and gestational diabetes. CONCLUSION Nulliparous individuals living in a neighborhood with higher socioeconomic disadvantage were at increased odds of entering pregnancy with pregestational diabetes, and those living in a food desert or a less walkable neighborhood were at increased odds of developing gestational diabetes, after controlling for known covariates.
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Affiliation(s)
- Christine Field
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH (Drs Field and Grobman, Mr Wu, and Drs Lynch and Venkatesh).
| | - William A Grobman
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH (Drs Field and Grobman, Mr Wu, and Drs Lynch and Venkatesh)
| | - Lynn M Yee
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL (Dr Yee)
| | - Jasmine Johnson
- Department of Obstetrics and Gynecology, Indiana University, Indianapolis, IN (Dr Johnson)
| | - Jiqiang Wu
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH (Drs Field and Grobman, Mr Wu, and Drs Lynch and Venkatesh)
| | | | - Brian Mercer
- Department of Obstetrics and Gynecology, Case Western Reserve University, Cleveland, OH (Dr Mercer)
| | - Hyagriv Simhan
- Department of Obstetrics and Gynecology, and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA (Dr Simhan)
| | - Uma Reddy
- Department of Obstetrics and Gynecology, Columbia University, New York, NY (Drs Reddy and Wapner)
| | - Robert M Silver
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT (Dr Silver)
| | - Samuel Parry
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA (Dr Parry)
| | - George Saade
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX (Dr Saade)
| | - Judith Chung
- Department of Obstetrics and Gynecology, University of California, Irvine School of Medicine, Irvine, CA (Dr Chung)
| | - Ronald Wapner
- Department of Obstetrics and Gynecology, Columbia University, New York, NY (Drs Reddy and Wapner)
| | - Courtney D Lynch
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH (Drs Field and Grobman, Mr Wu, and Drs Lynch and Venkatesh)
| | - Kartik K Venkatesh
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH (Drs Field and Grobman, Mr Wu, and Drs Lynch and Venkatesh)
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ElSayed NA, Aleppo G, Bannuru RR, Bruemmer D, Collins BS, Ekhlaspour L, Hilliard ME, Johnson EL, Khunti K, Lingvay I, Matfin G, McCoy RG, Perry ML, Pilla SJ, Polsky S, Prahalad P, Pratley RE, Segal AR, Seley JJ, Stanton RC, Gabbay RA. 15. Management of Diabetes in Pregnancy: Standards of Care in Diabetes-2024. Diabetes Care 2024; 47:S282-S294. [PMID: 38078583 PMCID: PMC10725801 DOI: 10.2337/dc24-s015] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Field C, Bank TC, Spees CK, Germann K, Landon MB, Gabbe S, Grobman WA, Costantine MM, Venkatesh KK. Association between glycemic control and group B streptococcus colonization among pregnant individuals with pregestational diabetes. Am J Reprod Immunol 2023; 90:e13779. [PMID: 37766411 DOI: 10.1111/aji.13779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/25/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
PROBLEM Pregestational diabetes increases the risk of group B streptococcus (GBS) colonization in pregnancy. Whether glycemic control is associated with differences in this risk is unknown. We examined the association between glycemic control and GBS colonization among pregnant individuals with pregestational diabetes. METHOD OF STUDY A retrospective cohort of pregnant individuals with pregestational diabetes at a tertiary care center. The exposure was glycemic control, measured as hemoglobin A1c (A1c) at >20 weeks and assessed categorically at thresholds of <6.5% and <6.0%, and secondarily, as a continuous percentage. The outcome was maternal GBS colonization. Multivariable logistic regression was used and adjusted for age, parity, race, and ethnicity as a social determinant, body mass index, type of diabetes, and gestational age at A1c assessment. RESULTS Among 305 individuals (33% Type 1, 67% type 2), 45.0% (n = 140) were colonized with GBS. Individuals with an A1c < 6.5% were half as likely to be colonized with GBS compared with those with a A1c ≥ 6.5% (38.8% vs. 53.9%; adjusted odds ratio, AOR: 0.55; 95% CI: 0.33-0.91). Results were unchanged at an A1c threshold of <6.0% (35.7% vs. 48.5%; AOR: 0.60; 95% CI: 0.36-0.98). Individuals with a higher A1c as a continuous measure (%) were more likely to be colonized (AOR: 1.57 per 1%; 95% CI: 1.25-1.97). CONCLUSIONS Pregnant individuals with pregestational diabetes with worse glycemic control were at an increased risk of GBS colonization. Further study is needed to understand if improved glycemic control leads to lower risk of GBS colonization.
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Affiliation(s)
- Christine Field
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio, USA
| | - T Caroline Bank
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio, USA
| | - Colleen K Spees
- School of Health & Rehabilitation Sciences, The Ohio State University, Columbus, Ohio, USA
| | | | - Mark B Landon
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio, USA
| | - Steven Gabbe
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio, USA
| | - William A Grobman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio, USA
| | - Maged M Costantine
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio, USA
| | - Kartik K Venkatesh
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio, USA
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Roble AK, Gundappa R, Sheik Abdirahman F, Abdi AM. Determinants of Adverse Birth Outcomes in Public Hospitals of the Somali Region, Eastern Ethiopia: A Multicenter Unmatched Case-Control Study. Clin Med Insights Pediatr 2023; 17:11795565231195253. [PMID: 37641685 PMCID: PMC10460620 DOI: 10.1177/11795565231195253] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 07/31/2023] [Indexed: 08/31/2023] Open
Abstract
Background Pregnancy outcomes that differ from normal live births are known as adverse pregnancy outcomes. Adverse pregnancy outcomes also have significant effects on the infant's family and society. There is limited data on adverse outcomes in eastern Ethiopia, particularly in the Somali region. Objectives This study aimed to assess the determinants of adverse birth outcomes in the Somali Region Hospitals. Design A hospital-based unmatched case-control study was conducted to conduct this study. Methods A hospital-based unmatched case-control study was conducted between June and July 2021 in pregnant women who attended public hospitals in the Somali region. A total of 327 (109 cases and 218 controls) participants were included in this study. Women who gave birth with at least 1 adverse birth outcome were considered cases, and those who gave birth with normal birth outcomes were considered controls. Cases were recruited consecutively, and controls were selected using systematic sampling methods. Data was gathered using interviews, record reviews, using the pretested standard tools. The data were entered into EpiData version 3.1 and analyzed with SPSS version 22. Multivariable regression analysis with an adjusted odds ratio and a 95% confidence interval was used to identify the factors associated with adverse birth outcomes. Finally, P-values less than .05 were used to identify significantly associated predictors. Results In the current study, rural residency [AOR = 2.80; 95%CI:(1.61-4.87)] lack of ANC follow-up [AOR = 3.27; 95%CI: (1.77-6.02)], pregnancy-induced hypertension [AOR = 3.28; 95%CI: (1.74-6.17)] being anemic mothers [AOR = 3.51; 95%CI: (2.02-6.07)] and khat chewing [AOR = 4.54; 95%CI: (2.12-9.70)] were identified as determinants of adverse birth outcome. Conclusions In the current study, rural residency, lack of ANC, being anemic in indexed pregnancies, pregnancy-induced hypertension, and khat chewing were determinants of adverse birth outcomes. Therefore, efforts should be made to enhance ANC follow-up, iron and folic acid supplementation, early treatments of pregnancy-induced hypertension, and information on the risk of chewing khat.
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Affiliation(s)
- Abdurahman Kedir Roble
- School of Nursing and Midwifery, College of Medicine and Health Science, Jigjiga University, Jigjiga, Ethiopia
| | - Raghu Gundappa
- School of Nursing and Midwifery, College of Medicine and Health Science, Jigjiga University, Jigjiga, Ethiopia
| | - Fahima Sheik Abdirahman
- School of Nursing and Midwifery, College of Medicine and Health Science, Jigjiga University, Jigjiga, Ethiopia
| | - Abdurehman Mohamed Abdi
- School of Medicine, College of Medicine and Health Science, Jigjiga University, Jigjiga, Ethiopia
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Moore KR, Stotz SA, Terry MA, Seely EW, Gonzales K, Marshall G, Nadeau KJ, Akers A, Garcia-Reyes Y, Charron-Prochownik D. Respecting tribal voices in the development of a gestational diabetes risk reduction preconception counseling program for American Indian/Alaska Native adolescent females: a qualitative study. BMC Pregnancy Childbirth 2023; 23:552. [PMID: 37528363 PMCID: PMC10392008 DOI: 10.1186/s12884-023-05850-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/12/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND American Indians and Alaska Natives (AI/AN) are disproportionately affected by adolescent obesity, adolescent pregnancy and gestational diabetes mellitus (GDM). GDM is associated with increased risk for perinatal death, obesity, and subsequent type 2 diabetes (T2D) for the offspring. Moreover, mothers with GDM are also at increased risk for T2D post-partum. Yet few lifestyle interventions exist to reduce GDM risk prior to pregnancy. We describe the process of adapting an existing validated preconception counseling intervention for AI/AN adolescent girls at-risk for GDM and their mothers. Perspectives and recommendations were gathered from a diverse array of stakeholders to assure the new program called Stopping GDM was culturally responsive and developed with tribal voices and perspectives represented. METHODS We conducted focus groups and individual interviews with multiple AI/AN stakeholders (n = 55). Focus groups and interviews were digitally recorded, transcribed verbatim, and analyzed using a thematic content approach to construct cross-cutting themes across the focus groups and interviews. RESULTS Four key themes emerged reflecting issues important to planning a reproductive health intervention: 1) Limited awareness, knowledge, and health education resources about GDM; 2) The importance of acknowledging traditional AI/AN values and the diversity of traditions and culture among AI/AN tribes; 3) The need to cultivate healthy decision-making skills and empower girls to make safe and healthy choices; and 4) Lack of communication about reproductive health between AI/AN mothers and daughters and between AI/AN women and health care professionals. CONCLUSION Findings have been used to inform the cultural tailoring and adaptation of an existing preconception counseling program, originally designed for non-AI/AN adolescent girls with diabetes, for AI/AN adolescents at-risk for GDM in future pregnancies.
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Affiliation(s)
- Kelly R Moore
- Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Sarah A Stotz
- Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Martha Ann Terry
- School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ellen W Seely
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kelly Gonzales
- School of Public Health, Oregon Health & Science University - Portland State University, Portland, OR, USA
| | | | - Kristen J Nadeau
- Children's Hospital Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | | | | | - Denise Charron-Prochownik
- University of Pittsburgh School of Nursing, Pittsburgh, PA, USA.
- Department of Health Promotion and Development, Professor Nursing and School of Public Health, School of Nursing, University of Pittsburgh, 440 Victoria Bldg, Pittsburgh, USA.
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Wilkie G, Melnik V, Brainard L, Antonioli S, Baltich Nelson B, Leung K, Leftwich H. Continuous glucose monitor use in type 2 diabetes mellitus in pregnancy and perinatal outcomes: a systematic review and meta-analysis. Am J Obstet Gynecol MFM 2023; 5:100969. [PMID: 37061044 DOI: 10.1016/j.ajogmf.2023.100969] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/03/2023] [Accepted: 04/09/2023] [Indexed: 04/17/2023]
Abstract
OBJECTIVE This study aimed to assess whether continuous glucose monitor use in type 2 diabetes mellitus in pregnancy is associated with improved perinatal outcomes. DATA SOURCES We searched Ovid MEDLINE, Scopus, ClinicalTrials.gov, and Cochrane library from inception through May 9, 2022. STUDY ELIGIBILITY CRITERIA We included all studies that compared continuous glucose monitor use with fingerstick glucose monitoring in women with type 2 diabetes mellitus. METHODS The initial search yielded 2463 unique citations that were screened in Covidence by 2 independent reviewers. Study types included randomized controlled trials, cohort studies, and cross-sectional studies. Our outcomes of interest were macrosomia or large-for-gestational-age infants, hemoglobin A1c, cesarean delivery, hypertensive disorders of pregnancy including preeclampsia, gestational age at delivery, and neonatal hypoglycemia. RESULTS Three randomized controlled trials met the inclusion criteria. We performed random-effects meta-analyses of estimates from 2 studies without risk of significant bias and reported summary adjusted odds ratios and 95% confidence intervals. Meta-analysis of 56 women with continuous glucose monitor use and 53 control women without continuous glucose monitor use showed that there was no difference in the incidence of large-for-gestational-age infants between continuous glucose monitor users and standard-of-care controls (odds ratio, 0.78; 95% confidence interval, 0.34-1.78) with an I2 of 0%. In addition, there was no difference in the development of preeclampsia between continuous glucose monitor users and standard-of-care controls (odds ratio, 1.63; 95% confidence interval, 0.34-7.22) with an I2 of 0%. CONCLUSION Continuous glucose monitor use was not associated with improved perinatal outcomes as assessed by large-for-gestational-age infants and preeclampsia. This review is limited by the small amount of data available for this population, and further research is needed.
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Affiliation(s)
- Gianna Wilkie
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Massachusetts Chan Medical School, Worcester, MA (Dr Wilkie, Ms Leung, and Dr Leftwich).
| | - Veronika Melnik
- University of Massachusetts Chan Medical School, Worcester, MA (Ms. Melnik, Ms. Brainard, Ms. Antonioli, and Ms. Nelson)
| | - Lydia Brainard
- University of Massachusetts Chan Medical School, Worcester, MA (Ms. Melnik, Ms. Brainard, Ms. Antonioli, and Ms. Nelson)
| | - Sophia Antonioli
- University of Massachusetts Chan Medical School, Worcester, MA (Ms. Melnik, Ms. Brainard, Ms. Antonioli, and Ms. Nelson)
| | - Becky Baltich Nelson
- University of Massachusetts Chan Medical School, Worcester, MA (Ms. Melnik, Ms. Brainard, Ms. Antonioli, and Ms. Nelson)
| | - Katherine Leung
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Massachusetts Chan Medical School, Worcester, MA (Dr Wilkie, Ms Leung, and Dr Leftwich)
| | - Heidi Leftwich
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Massachusetts Chan Medical School, Worcester, MA (Dr Wilkie, Ms Leung, and Dr Leftwich)
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Delker E, Ramos GA, Bandoli G, LaCoursiere DY, Ferran K, Gallo LC, Oren E, Gahagan S, Allison M. Associations Between Preconception Glycemia and Preterm Birth: The Potential Role of Health Care Access and Utilization. J Womens Health (Larchmt) 2023; 32:274-282. [PMID: 36796052 PMCID: PMC9993162 DOI: 10.1089/jwh.2022.0256] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
Background: Preconception diabetes is strongly associated with adverse birth outcomes. Less is known about the effects of elevated glycemia at levels below clinical cutoffs for diabetes. In this study, we estimated associations between preconception diabetes, prediabetes, and hemoglobin A1c (HbA1c) on the risk of preterm birth, and evaluated whether associations were modified by access to or utilization of health care services. Materials and Methods: We used data from Add Health, a US prospective cohort study with five study waves to date. At Wave IV (ages 24-32), glucose and HbA1c were measured. At Wave V (ages 32-42), women with a live birth reported whether the baby was born preterm. The analytic sample size was 1989. Results: The prevalence of preterm birth was 13%. Before pregnancy, 6.9% of women had diabetes, 23.7% had prediabetes, and 69.4% were normoglycemic. Compared to the normoglycemic group, women with diabetes had 2.1 (confidence interval [95% CI]: 1.5-2.9) times the risk of preterm birth, while women with prediabetes had 1.3 (95% CI: 1.0, 1.7) times the risk of preterm birth. There was a nonlinear relationship between HbA1c and preterm birth such that risk of preterm birth emerged after HbA1c = 5.7%, a standard cutoff for prediabetes. The excess risks of preterm birth associated with elevated HbA1c were four to five times larger among women who reported unstable health care coverage and among women who used the emergency room as usual source of care. Conclusion: Our findings replicate prior research showing strong associations between preconception diabetes and preterm birth, adding that prediabetes is also associated with higher risk. Policies and interventions to enhance access and utilization of health care among women before pregnancy should be examined.
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Affiliation(s)
- Erin Delker
- Department of Public Health, San Diego State University, Joint Doctoral Program in Public Health, San Diego, California, USA
- Department of Pediatrics, University of California, San Diego, La Jolla, California, USA
| | - Gladys A. Ramos
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Diego, La Jolla, California, USA
| | - Gretchen Bandoli
- Department of Pediatrics, University of California, San Diego, La Jolla, California, USA
| | - D. Yvette LaCoursiere
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Diego, La Jolla, California, USA
| | - Karen Ferran
- School of Public Health, San Diego State University, San Diego, California, USA
| | - Linda C. Gallo
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Eyal Oren
- Division of Preventive Medicine, University of California San Diego, La Jolla, California, USA
| | - Sheila Gahagan
- Department of Pediatrics, University of California, San Diego, La Jolla, California, USA
| | - Matthew Allison
- Division of Preventive Medicine, University of California San Diego, La Jolla, California, USA
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Ferry P, Dunne FP, Meagher C, Lennon R, Egan AM, Newman C. Attendance at pre-pregnancy care clinics for women with type 1 diabetes: A scoping review. Diabet Med 2023; 40:e15014. [PMID: 36408687 PMCID: PMC10099966 DOI: 10.1111/dme.15014] [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: 06/18/2022] [Accepted: 11/15/2022] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Type 1 diabetes mellitus occurs in one in every 275 pregnancies and can result in increased morbidity and mortality for both mother and baby. Several pregnancy complications can be reduced or prevented by attendance at pre-pregnancy care (PPC). Despite this, less than 40% of pregnant women with pre-gestational diabetes receive formal PPC. The aim of this scoping review is to identify the barriers to PPC attendance among women with type 1 diabetes. METHODS We conducted a scoping review by searching five databases (Ebsco, Embase, Ovid and PubMed for literature and the ProQuest for any grey/unpublished literature) for studies in English between 2000 and 2022. Studies that evaluated attendance at PPC for women with type 1 diabetes were included. RESULTS There are multiple barriers to PPC attendance, and many of these barriers have been unchanged since the 1990s. Identified barriers can be grouped under patient-centered and clinician-centered headings. Patient factors include knowledge and awareness, unplanned pregnancies, negative perceptions of healthcare and communication issues, unclear attendance pathways and logistical issues including time off work and childcare. Clinician factors include physician knowledge, time constraints and lack of comfort discussing pregnancy/contraception. CONCLUSION This review highlights the ongoing problem of poor attendance at PPC and identifies key barriers to be addressed when developing and implementing PPC programs for women with type 1 diabetes.
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Affiliation(s)
- Pauline Ferry
- School of Nursing and Midwifery, National University of Ireland, Galway, Ireland
- Women and Infants' Services, Letterkenny University Hospital, Donegal, Ireland
| | - Fidelma P Dunne
- School of Medicine, National University of Ireland, Galway, Ireland
- Department of Diabetes and Endocrinology, Galway University Hospital, Galway, Ireland
| | - Catherine Meagher
- School of Nursing and Midwifery, National University of Ireland, Galway, Ireland
| | - Roisin Lennon
- Advanced Nurse Practitioner, Women and Infants' Services, Sligo University Hospital, Galway, Ireland
| | - Aoife M Egan
- Division of Endocrinology, Mayo Clinic, Rochester, Minnesota, USA
| | - Christine Newman
- School of Medicine, National University of Ireland, Galway, Ireland
- Department of Diabetes and Endocrinology, Galway University Hospital, Galway, Ireland
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Field C, Lynch CD, Fareed N, Joseph JJ, Wu J, Thung SF, Gabbe SG, Landon MB, Grobman WA, Venkatesh KK. Association of community walkability and glycemic control among pregnant individuals with pregestational diabetes mellitus. Am J Obstet Gynecol MFM 2023; 5:100898. [PMID: 36787839 DOI: 10.1016/j.ajogmf.2023.100898] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 02/13/2023]
Abstract
BACKGROUND Neighborhood walkability is a community-level social determinant of health that measures whether people who live in a neighborhood walk as a mode of transportation. Whether neighborhood walkability is associated with glycemic control among pregnant individuals with pregestational diabetes remains to be defined. OBJECTIVE This study aimed to evaluate the association between community-level neighborhood walkability and glycemic control as measured by hemoglobin A1c (A1C) among pregnant individuals with pregestational diabetes. STUDY DESIGN This was a retrospective analysis of pregnant individuals with pregestational diabetes enrolled in an integrated prenatal and diabetes care program from 2012 to 2016. Participant addresses were geocoded and linked at the census-tract level. The exposure was community walkability, defined by the US Environmental Protection Agency National Walkability Index (score range 1-20), which incorporates intersection density (design), proximity to transit stops (distance), and a mix of employment and household types (diversity). Individuals from neighborhoods that were the most walkable (score, 15.26-20.0) were compared with those from neighborhoods that were less walkable (score <15.26), as defined per national Environmental Protection Agency recommendations. The outcomes were glycemic control, including A1C <6.0% and <6.5%, measured both in early and late pregnancy, and mean change in A1C across pregnancy. Modified Poisson regression and linear regression were used, respectively, and adjusted for maternal age, body mass index at delivery, parity, race and ethnicity as a social determinant of health, insurance status, baseline A1C, gestational age at A1C measurement in early and late pregnancy, and diabetes type. RESULTS Among 417 pregnant individuals (33% type 1, 67% type 2 diabetes mellitus), 10% were living in the most walkable communities. All 417 individuals underwent A1C assessment in early pregnancy (median gestational age, 9.7 weeks; interquartile range, 7.4-14.1), and 376 underwent another A1C assessment in late pregnancy (median gestational age, 30.4 weeks; interquartile range, 27.8-33.6). Pregnant individuals living in the most walkable communities were more likely to have an A1C <6.0% in early pregnancy (15% vs 8%; adjusted relative risk, 1.46; 95% confidence interval, 1.00-2.16), and an A1C <6.5% in late pregnancy compared with those living in less walkable communities (13% vs 9%; adjusted relative risk, 1.33; 95% confidence interval, 1.08-1.63). For individuals living in the most walkable communities, the median A1C was 7.5 (interquartile range, 6.0-9.4) in early pregnancy and 5.9 (interquartile range, 5.4-6.4) in late pregnancy. For those living in less walkable communities, the median A1C was 7.3 (interquartile range, 6.2-9.2) in early pregnancy and 6.2 (interquartile range, 5.6-7.1) in late pregnancy. Change in A1C across pregnancy was not associated with walkability. CONCLUSION Pregnant individuals with pregestational diabetes mellitus living in more walkable communities had better glycemic control in both early and late pregnancy. Whether community-level interventions to enhance neighborhood walkability can improve glycemic control in pregnancy requires further study.
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Affiliation(s)
- Christine Field
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Ohio State University, Columbus, OH (Drs Field and Lynch, Mr Wu, and Drs Thung, Gabbe, Landon, Grobman, and Venkatesh).
| | - Courtney D Lynch
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Ohio State University, Columbus, OH (Drs Field and Lynch, Mr Wu, and Drs Thung, Gabbe, Landon, Grobman, and Venkatesh)
| | - Naleef Fareed
- Department of Biomedical Informatics, Ohio State University College of Medicine, Columbus, OH (Dr Fareed)
| | - Joshua J Joseph
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Ohio State University College of Medicine, Columbus, OH (Dr Joseph)
| | - Jiqiang Wu
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Ohio State University, Columbus, OH (Drs Field and Lynch, Mr Wu, and Drs Thung, Gabbe, Landon, Grobman, and Venkatesh)
| | - Stephen F Thung
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Ohio State University, Columbus, OH (Drs Field and Lynch, Mr Wu, and Drs Thung, Gabbe, Landon, Grobman, and Venkatesh)
| | - Steven G Gabbe
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Ohio State University, Columbus, OH (Drs Field and Lynch, Mr Wu, and Drs Thung, Gabbe, Landon, Grobman, and Venkatesh)
| | - Mark B Landon
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Ohio State University, Columbus, OH (Drs Field and Lynch, Mr Wu, and Drs Thung, Gabbe, Landon, Grobman, and Venkatesh)
| | - William A Grobman
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Ohio State University, Columbus, OH (Drs Field and Lynch, Mr Wu, and Drs Thung, Gabbe, Landon, Grobman, and Venkatesh)
| | - Kartik K Venkatesh
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Ohio State University, Columbus, OH (Drs Field and Lynch, Mr Wu, and Drs Thung, Gabbe, Landon, Grobman, and Venkatesh)
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ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, Collins BS, Hilliard ME, Isaacs D, Johnson EL, Kahan S, Khunti K, Leon J, Lyons SK, Perry ML, Prahalad P, Pratley RE, Seley JJ, Stanton RC, Gabbay RA, on behalf of the American Diabetes Association. 2. Classification and Diagnosis of Diabetes: Standards of Care in Diabetes-2023. Diabetes Care 2023; 46:S19-S40. [PMID: 36507649 PMCID: PMC9810477 DOI: 10.2337/dc23-s002] [Citation(s) in RCA: 654] [Impact Index Per Article: 654.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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11
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ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, Collins BS, Hilliard ME, Isaacs D, Johnson EL, Kahan S, Khunti K, Leon J, Lyons SK, Perry ML, Prahalad P, Pratley RE, Jeffrie Seley J, Stanton RC, Gabbay RA, on behalf of the American Diabetes Association. 15. Management of Diabetes in Pregnancy: Standards of Care in Diabetes-2023. Diabetes Care 2023; 46:S254-S266. [PMID: 36507645 PMCID: PMC9810465 DOI: 10.2337/dc23-s015] [Citation(s) in RCA: 106] [Impact Index Per Article: 106.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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12
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Olerich KLW, Souter VL, Fay EE, Katz R, Hwang JK. Cesarean delivery rates and indications in pregnancies complicated by diabetes. J Matern Fetal Neonatal Med 2022; 35:10375-10383. [PMID: 36202395 DOI: 10.1080/14767058.2022.2128653] [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: 01/20/2023]
Abstract
OBJECTIVE Rates of pregestational (PGDM) and gestational diabetes (GDM), and their associated pregnancy complications, are rising. Pregnancies complicated by diabetes have increased cesarean delivery (CD) rates; however, there are limited data regarding the current rates of, and contributing factors to, these deliveries. The Robson Ten Group Classification System (TGCS) is a clinically relevant, standardized framework that can be used to evaluate and analyze cesarean rates. The objective of this study was to evaluate rates of, and indications for, intrapartum, unplanned CD among pregnancies complicated by diabetes, compared to normoglycemic (NG) pregnancies, in a large United States birth cohort. METHODS This retrospective cohort study used chart-abstracted data on births between 24 and 42 weeks' gestation at 17 hospitals that contributed to the Obstetrical Care Outcome Assessment Program database between 01/2016 and 03/2019. The CD rate for NG pregnancies, and pregnancies complicated by gestational and PGDM was calculated and compared using the Robson TGCS. The indications for intrapartum CD in patients with term, singleton, vertex gestations without a prior cesarean were then analyzed. Univariate and multivariate logistic regression models were used to compare the cesarean rate and indications for CD, between the diabetic groups and the NG group. Results were adjusted for maternal age, BMI, neonatal birth weight, and insurance status, as well as clustering by hospital. RESULTS A total of 86,381 pregnant people were included in the study cohort. Of these 76,272 (88.3%) were NG, 8591 (9.9%) had GDM, and 1518 (1.8%) had PGDM. Compared to NG patients, overall cesarean rates were higher in patients with GDM (40.3% vs. 29.7%; aOR 1.25, 95%CI 1.18-1.31) and PGDM (60.0% vs. 29.7%; aOR 2.53, 95%CI 2.04-3.13). This finding remained true when the cohort was restricted to term, singleton, vertex laboring patients without a prior cesarean; compared to NG patients, the cesarean rate was higher in patients with GDM (17.4% vs. 12.2%, aOR 1.37, 95%CI 1.29-1.45) and PGDM (26.0% vs. 12.2%, aOR 2.55, 95%CI 2.00-3.25). The cesarean rate for fetal indications was similar in the GDM (5.7%) and NG (4.4%) groups, while those patients with PGDM had a significantly higher rate (10.4%; aOR 2.01, 95%CI 1.43-2.83). Similarly, the rate of cesarean for labor dystocia in patients with PGDM was significantly higher than in NG patients (16.9% vs. 7.0%, and aOR 2.28, 95%CI 1.66-3.13) while patients with GDM had an intermediate rate (10.6% vs. 7.0%, aOR 1.49, 95%CI 1.40-1.57). CONCLUSIONS The CD rate is significantly higher in pregnancies complicated by diabetes, particularly pregestational, compared to NG pregnancies. Despite controlling for maternal factors and birth weight, pregnancies complicated by diabetes are more likely to undergo an unplanned intrapartum cesarean secondary to labor dystocia than their NG counterparts, but only pregnancies complicated by PGDM have an increased risk of cesarean for fetal indications. More research is needed to understand whether this higher cesarean rate is due to factors intrinsic to diabetes in laboring patients or is due to a difference in the way clinicians manage diabetics in labor.
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Affiliation(s)
- Kelsey L W Olerich
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Washington, Seattle, WA, USA
| | | | - Emily E Fay
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Washington, Seattle, WA, USA
| | - Ronit Katz
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - Joseph K Hwang
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Washington, Seattle, WA, USA
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13
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Alnoman A, Peeva M, Badeghiesh AM, Baghlaf HA, Dahan MH. Pregnancy, delivery and neonatal outcomes among women with diabetic retinopathy. J Matern Fetal Neonatal Med 2022; 35:10621-10628. [PMID: 36404423 DOI: 10.1080/14767058.2022.2148095] [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: 11/22/2022]
Abstract
OBJECTIVES Diabetic retinopathy is a common microvascular complication of diabetes. Despite that, there are few studies in the literature to address pregnancy, delivery, or neonatal outcomes among women with diabetic retinopathy. METHODS We conducted a retrospective study using the Health Care Cost and Utilization Project-Nationwide Inpatient Sample Database over 11 years from 2004 to 2014. A delivery cohort was created using ICD-9 codes. ICD-9 code 250 or 249 was used to extract the cases of maternal diabetic retinopathy. A multivariant logistic regression model was used to adjust for statistically significant variables (p-value ≤ .05). RESULTS There were a total of 9,096,788 deliveries during the study period. Of those, 86 615 pregnant women were found to have Diabetes Mellites (DM). Diabetic retinopathy was present in 1233 of the patients with DM. Diabetic retinopathy increased the likelihood of developing pregnancy-induced HTN (p < .0001), Preeclampsia (p < .0001), and Preeclampsia and eclampsia superimposed on preexisting HTN (p < .0001). In addition, in women with DM, the presence of diabetic retinopathy increased the risk of Preterm delivery (p = .002), cesarean section (p < .0001), requiring transfusion (p < .0001), and undergoing hysterectomy (p = .001), and were less likely to have a spontaneous vaginal delivery (p < .0001). However, the presence of diabetic retinopathy in women with DM did not increase the risk of the fetus being small at delivery, having intrauterine fetal demise, or congenital anomalies. CONCLUSION Women with diabetic retinopathy should be counseled about their increased risk of pregnancy-induced HTN, preeclampsia, premature delivery, cesarean section, transfusion, and hysterectomy.
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Affiliation(s)
- Abdullah Alnoman
- Division of Maternal-Fetal Medicine, Obstetrics and Gynaecology, McGill University, Montreal, Canada.,Department of Obstetrics and Gynecology, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Ahmad M Badeghiesh
- Department of Obstetrics and Gynecology, King Abdulaziz University, Jeddah, Saudi Arabia.,Division of Reproductive Endocrinology and Infertility, Obstetrics and Gynaecology, Western University, London, Canada
| | - Haitham A Baghlaf
- Division of Maternal-Fetal Medicine, Obstetrics and Gynaecology, McGill University, Montreal, Canada.,Division of Maternal-Fetal Medicine, Obstetrics and Gynaecology, University of Tabuk, Tabuk, Saudi Arabia
| | - Michael H Dahan
- Division of Reproductive Endocrinology and Infertility, MUHC Reproductive Center, McGill University, Montreal, Canada
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14
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Wilkie GL, Delpapa E, Leftwich HK. Screening test characteristics and comparison of diabetes outcomes among pregnant patients with prediabetes. J OBSTET GYNAECOL 2022; 42:3498-3502. [PMID: 36448554 DOI: 10.1080/01443615.2022.2151344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
This study sought to compare test characteristics of hemoglobin A1c, oral glucose tolerance test and fasting plasma glucose for the development of gestational diabetes among women with prediabetes. Diabetes outcomes were compared by screening test used for prediabetes diagnosis among a retrospective cohort of pregnant patients between 2017-2021. During the study, 8132 patients received diabetes screening and 14.0% met criteria for prediabetes. By screening test, 75.1% were screened with hemoglobin A1c, 10.0% with fasting plasma glucose and 14.9% with a 75-g oral glucose tolerance test. Hemoglobin A1c had the highest positive predictive value (67.2%). Use of hemoglobin A1c was significantly more likely to identify women with GDM than oral glucose tolerance test (aOR 3.94, 95% CI 2.30-6.73). In this study cohort, hemoglobin A1c was able to identify patients that were more likely to develop GDM in an at-risk population.IMPACT STATEMENTWhat is already known on this subject? Prediabetes is becoming more common in the general population; however little is known about prediabetes in pregnancy. Women with prediabetes in pregnancy appear to be at increased risk of developing gestational diabetes mellitus, however there is minimal information about various screening tests performance in pregnancy for detection of prediabetes and subsequent gestational diabetes.What do the results of this study add? The results of this study compare three commonly used screening tests for screening for diabetes. When identifying women with prediabetes, they are at increased risk for developing gestational diabetes mellitus if identified by hemoglobin A1c.What are the implications of these findings for clinical practice and/or further research? The clinical implication of this study is that women can be screened with hemoglobin A1c in early pregnancy for both overt diabetes, but also may be identified as high risk with prediabetes. Among women with prediabetes by hemoglobin A1c, they remain at high risk for developing gestational diabetes mellitus.
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Affiliation(s)
- Gianna L. Wilkie
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Massachusetts Memorial HealthCare and University of Massachusetts Medical School, Worcester, MA, USA
| | - Ellen Delpapa
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Massachusetts Memorial HealthCare and University of Massachusetts Medical School, Worcester, MA, USA
| | - Heidi K. Leftwich
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Massachusetts Memorial HealthCare and University of Massachusetts Medical School, Worcester, MA, USA
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15
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Verbeke E, Luyten J. Future Offspring Costs in Economic Evaluation. PHARMACOECONOMICS 2022; 40:141-147. [PMID: 34713421 DOI: 10.1007/s40273-021-01102-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/06/2021] [Indexed: 06/13/2023]
Abstract
Economic evaluation guidelines increasingly prescribe inclusion of all future costs. We point at an important dimension of future costs that is systematically neglected. Healthcare can affect future offspring, either through affecting the patient's fertility or through determining future offspring's health. As we show, the future costs associated with these changes can be substantial and will vary across interventions and demographic groups. However, systematic inclusion of these future offspring costs would raise many problems on its own. Based on the population ethics concept of necessitarianism, we suggest that only those future costs that spring from 'necessary' future lives should be included in future cost calculations, while all costs associated with 'potential' future lives can be ignored. This approach allows excluding most future offspring costs and avoids skewed cost-effectiveness outcomes of interventions with fertility effects, while taking into account the economic implications of preventing disease in future generations that will exist by necessity. Overall, future generations expose a substantial gap in today's Health Technology Assessment (HTA) methodology and further discussion of the issues they raise is needed.
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Affiliation(s)
- Evelyn Verbeke
- Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium.
| | - Jeroen Luyten
- Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium
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Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc22-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc22-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc22-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc22-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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18
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Scott R, Oliver N, Thomas M, Agha-Jaffar R. Pregnancy and contraception in women with Pre-Gestational diabetes in secondary Care- A questionnaire study. Diabetes Res Clin Pract 2021; 182:109124. [PMID: 34740741 DOI: 10.1016/j.diabres.2021.109124] [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: 08/20/2021] [Revised: 10/10/2021] [Accepted: 10/31/2021] [Indexed: 11/24/2022]
Abstract
AIMS To establish the knowledge of women with pre-gestational diabetes about of the risks of diabetes in pregnancy, and investigate their pregnancy plans, contraceptive choices, and preparedness for pregnancy. METHODS Women of reproductive age attending diabetes clinics across a single busy metropolitan NHS Trust were invited to fill in a questionnaire about pregnancy and contraception. The electronic health records of those women were also reviewed. RESULTS Ninety-six women completed the questionnaire. The majority of respondents (94%) had Type 1 Diabetes. Only 3% of women met the criteria of 'prepared for pregnancy'. Low efficacy contraception was used by 32% of women. Most women were only aware of a few risks to the mother and fetus in pregnancy, though the majority of women were aware of the importance of good glycaemic control before pregnancy. Previous pregnancies, or attendance at pre-conception counselling, did not improve participant knowledge. CONCLUSIONS Many women with diabetes of reproductive age are poorly prepared for pregnancy, but many are also using less effective contraceptive methods. These areas should be addressed if the poor pregnancy outcome in women with diabetes are to be improved, possibly through the development of an evidenced-based structured education course to target pre-conception and contraception.
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Affiliation(s)
- R Scott
- Department of Diabetes & Endocrinology, St Mary's Hospital, Imperial College Healthcare NHS Trust, Praed Street, London W2 1NY, England; Faculty of Medicine, 10(th) Floor Commonwealth Building, Hammersmith Hospital Campus, Imperial College London, Du Cane Road, London W12 0NN, England.
| | - N Oliver
- Department of Diabetes & Endocrinology, St Mary's Hospital, Imperial College Healthcare NHS Trust, Praed Street, London W2 1NY, England; Faculty of Medicine, 10(th) Floor Commonwealth Building, Hammersmith Hospital Campus, Imperial College London, Du Cane Road, London W12 0NN, England.
| | - M Thomas
- Faculty of Medicine, 10(th) Floor Commonwealth Building, Hammersmith Hospital Campus, Imperial College London, Du Cane Road, London W12 0NN, England
| | - R Agha-Jaffar
- Department of Diabetes & Endocrinology, St Mary's Hospital, Imperial College Healthcare NHS Trust, Praed Street, London W2 1NY, England; Faculty of Medicine, 10(th) Floor Commonwealth Building, Hammersmith Hospital Campus, Imperial College London, Du Cane Road, London W12 0NN, England.
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Perceptions and Practice of Preconception Care by Healthcare Workers and High-Risk Women in South Africa: A Qualitative Study. Healthcare (Basel) 2021; 9:healthcare9111552. [PMID: 34828600 PMCID: PMC8618283 DOI: 10.3390/healthcare9111552] [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: 10/25/2021] [Revised: 11/07/2021] [Accepted: 11/08/2021] [Indexed: 12/26/2022] Open
Abstract
Preconception care is biomedical, behavioural, and social health interventions provided to women and couples before conception. This service is sometimes prioritised for women at high risk for adverse pregnancy outcomes. Evidence revealed that only very few women in Africa with severe chronic conditions receive or seek preconception care advice and assessment for future pregnancy. Thus, this study aimed to explore the perceptions and practice of preconception care by healthcare workers and high-risk women in Kwa-Zulu-Natal, South Africa. This exploratory, descriptive qualitative study utilised individual in-depth interviews to collect data from 24 women at high risk of adverse pregnancy outcomes and five healthcare workers. Thematic analysis was conducted using Nvivo version 12. Five main themes that emerged from the study include participants’ views, patients’ access to information, practices, and perceived benefits of preconception care. The healthcare workers were well acquainted with the preconception care concept, but the women had inconsistent acquaintance. Both groups acknowledge the role preconception care can play in the reduction of maternal and child mortality. A recommendation is made for the healthcare workers to use the ‘One key’ reproductive life plan question as an entry point for the provision of preconception care.
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20
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Martin RB, Duryea EL, Ambia A, Ragsdale A, Mcintire D, Wells CE, Spong CY, Dashe JS, Nelson DB. Congenital Malformation Risk According to Hemoglobin A1c Values in a Contemporary Cohort with Pregestational Diabetes. Am J Perinatol 2021; 38:1217-1222. [PMID: 34087946 DOI: 10.1055/s-0041-1730435] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The study aimed to evaluate the association between hemoglobin A1c values and likelihood of fetal anomalies in women with pregestational diabetes. STUDY DESIGN Women with pregestational diabetes who delivered at a single institution that serves a nonreferred population from May 1, 2009 to December 31, 2018 were ascertained. Hemoglobin A1c values were obtained at the first prenatal visit. Women who delivered a singleton live- or stillborn infant with a major malformation as defined by European Surveillance of Congenital Anomalies criteria were identified. In infants with multiple system anomalies, each malformation was considered separately. Hemoglobin A1c values were analyzed categorically by using Mantel-Haenszel method and continuously with linear regression for trend for fetal anomalies. RESULTS A total of 1,676 deliveries to women with pregestational diabetes were delivered at our institution, and hemoglobin A1c was assessed in 1,573 deliveries (94%). There were 129 deliveries of an infant with at least one major malformation, an overall anomaly rate of approximately 8%. Mean hemoglobin A1c concentration was significantly higher in pregnancies with anomalous infants, 9.3 ± 2.1% versus 8.0 ± 2.1%, and p <0.001. There was no difference in gestational age at the time hemoglobin A1c was obtained, 13 ± 8.3 versus 14 ± 8.7 weeks. Hemoglobin A1c was associated with increased probability of a congenital malformation. This reached 10% with a hemoglobin A1c concentration of 10%, and 20% with a hemoglobin A1c of 13%. Similar trends were seen when examining risk of anomalies by organ system with increasing hemoglobin A1c levels, with the greatest increase in probability for both cardiac and genitourinary anomalies. CONCLUSION In women with pregestational diabetes, hemoglobin A1c is strongly associated with fetal anomaly risk. Data from a contemporary cohort may facilitate counseling and also highlight the need for preconceptual care and glycemic optimization prior to entry to obstetric care. KEY POINTS · Infants of diabetic mothers had an 8% major anomaly rate.. · HbA1c of 10% in pregnancy associated with 10% anomaly rate.. · HbA1c of 13% in pregnancy associated with 20% anomaly rate.. · Preconceptual care is important to reduce prevalence..
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Affiliation(s)
- Robert B Martin
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Elaine L Duryea
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Anne Ambia
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Alexandra Ragsdale
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Donald Mcintire
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Chet Edward Wells
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Catherine Y Spong
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jodi S Dashe
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - David B Nelson
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
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Braveman P, Dominguez TP, Burke W, Dolan SM, Stevenson DK, Jackson FM, Collins JW, Driscoll DA, Haley T, Acker J, Shaw GM, McCabe ERB, Hay WW, Thornburg K, Acevedo-Garcia D, Cordero JF, Wise PH, Legaz G, Rashied-Henry K, Frost J, Verbiest S, Waddell L. Explaining the Black-White Disparity in Preterm Birth: A Consensus Statement From a Multi-Disciplinary Scientific Work Group Convened by the March of Dimes. FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3:684207. [PMID: 36303973 PMCID: PMC9580804 DOI: 10.3389/frph.2021.684207] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/06/2021] [Indexed: 11/30/2022] Open
Abstract
In 2017–2019, the March of Dimes convened a workgroup with biomedical, clinical, and epidemiologic expertise to review knowledge of the causes of the persistent Black-White disparity in preterm birth (PTB). Multiple databases were searched to identify hypothesized causes examined in peer-reviewed literature, 33 hypothesized causes were reviewed for whether they plausibly affect PTB and either occur more/less frequently and/or have a larger/smaller effect size among Black women vs. White women. While definitive proof is lacking for most potential causes, most are biologically plausible. No single downstream or midstream factor explains the disparity or its social patterning, however, many likely play limited roles, e.g., while genetic factors likely contribute to PTB, they explain at most a small fraction of the disparity. Research links most hypothesized midstream causes, including socioeconomic factors and stress, with the disparity through their influence on the hypothesized downstream factors. Socioeconomic factors alone cannot explain the disparity's social patterning. Chronic stress could affect PTB through neuroendocrine and immune mechanisms leading to inflammation and immune dysfunction, stress could alter a woman's microbiota, immune response to infection, chronic disease risks, and behaviors, and trigger epigenetic changes influencing PTB risk. As an upstream factor, racism in multiple forms has repeatedly been linked with the plausible midstream/downstream factors, including socioeconomic disadvantage, stress, and toxic exposures. Racism is the only factor identified that directly or indirectly could explain the racial disparities in the plausible midstream/downstream causes and the observed social patterning. Historical and contemporary systemic racism can explain the racial disparities in socioeconomic opportunities that differentially expose African Americans to lifelong financial stress and associated health-harming conditions. Segregation places Black women in stressful surroundings and exposes them to environmental hazards. Race-based discriminatory treatment is a pervasive stressor for Black women of all socioeconomic levels, considering both incidents and the constant vigilance needed to prepare oneself for potential incidents. Racism is a highly plausible, major upstream contributor to the Black-White disparity in PTB through multiple pathways and biological mechanisms. While much is unknown, existing knowledge and core values (equity, justice) support addressing racism in efforts to eliminate the racial disparity in PTB.
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Affiliation(s)
- Paula Braveman
- School of Medicine, University of California, San Francisco, San Francisco, CA, United States
- *Correspondence: Paula Braveman
| | - Tyan Parker Dominguez
- USC Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States
| | - Wylie Burke
- University of Washington School of Medicine, Seattle, WA, United States
| | - Siobhan M. Dolan
- Albert Einstein College of Medicine, New York, NY, United States
| | | | | | - James W. Collins
- Northwestern University School of Medicine, Chicago, IL, United States
| | - Deborah A. Driscoll
- University of Pennsylvania School of Medicine, Philadelphia, PA, United States
| | - Terinney Haley
- School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Julia Acker
- School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Gary M. Shaw
- Stanford University School of Medicine, Stanford, CA, United States
| | - Edward R. B. McCabe
- David Geffen School of Medicine at University of California, Los Angeles, CA, United States
| | | | - Kent Thornburg
- School of Medicine, Oregon State University, Portland, OR, United States
| | | | - José F. Cordero
- University of Georgia College of Public Health, Athens, GA, United States
| | - Paul H. Wise
- Stanford University School of Medicine, Stanford, CA, United States
| | - Gina Legaz
- March of Dimes, White Plains, NY, United States
| | | | | | - Sarah Verbiest
- University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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22
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Alrais M, Ward C, Cornthwaite JAA, Chen HY, Chauhan SP, Sibai BM, Fishel Bartal M. Type 2 diabetes and neonatal hypoglycemia: role of route of delivery and insulin infusion. J Matern Fetal Neonatal Med 2021; 35:7445-7451. [PMID: 34344270 DOI: 10.1080/14767058.2021.1949452] [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: 10/20/2022]
Abstract
OBJECTIVE To compare the rate of neonatal hypoglycemia among newborns delivered by individuals with Type 2 diabetes mellitus (T2DM) in two clinical scenarios: who attempted vaginal delivery vs. had a planned cesarean delivery (CD); who had intrapartum insulin infusion vs. who did not. METHODS This was a retrospective cohort study of individuals with insulin-treated T2DM who had non-anomalous singleton pregnancy and delivered at a single tertiary center (March 2012 and May 2018). Individuals with chronic renal failure, proliferative retinopathy, or major congenital anomalies were excluded. The primary outcome was neonatal hypoglycemia (blood glucose < 40 mg/dl <24 h of age or < 50 mg/dl >24 h of age). Secondary outcomes included neonatal outcomes. Multivariable Poisson regression models with robust error variance were used to examine the association between groups and the primary outcome. Adjusted relative risk (aRR) and 95% confidence intervals (CI) were calculated. RESULTS Of 233 individuals with T2DM, 215 (92.2%) met the inclusion criteria, of whom 95 (44%) attempted vaginal delivery and 120 (56%) had a planned CD. Individuals who labored had a higher gestational age at delivery (36.6 vs. 35.8 weeks, p = .005), and higher blood glucose levels upon admission (125 vs 103, p < .001) compared to those with a planned CD. After adjustment for potential confounders, there was no difference in risk of neonatal hypoglycemia between the groups (41.2 vs 44.1%, aRR 1.05, 95% CI = 0.75-1.45). Among those who attempted vaginal delivery, 34 (35.8%) required insulin infusion. There was no difference in the risk of neonatal hypoglycemia (aRR = 0.79, 95% CI = 0.45-1.37) between newborns delivered by individuals who required insulin infusion and those who did not. CONCLUSION Over 40% of newborns delivered by individuals with insulin-dependent T2DM had hypoglycemia; however, there was no significant difference in the risk of hypoglycemia, irrespective of the route of delivery and the use of insulin infusion.
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Affiliation(s)
- Mesk Alrais
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Clara Ward
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Joycelyn A Ashby Cornthwaite
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Han-Yang Chen
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Suneet P Chauhan
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Baha M Sibai
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Michal Fishel Bartal
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
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23
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Fishel Bartal M, Ward C, Blackwell SC, Ashby Cornthwaite JA, Zhang C, Refuerzo JS, Pedroza C, Lee KH, Chauhan SP, Sibai BM. Detemir vs neutral protamine Hagedorn insulin for diabetes mellitus in pregnancy: a comparative effectiveness, randomized controlled trial. Am J Obstet Gynecol 2021; 225:87.e1-87.e10. [PMID: 33865836 DOI: 10.1016/j.ajog.2021.04.223] [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] [Received: 12/07/2020] [Revised: 04/06/2021] [Accepted: 04/08/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND Insulin detemir, being used increasingly during pregnancy, may have pharmacologic benefits compared with neutral protamine Hagedorn. OBJECTIVE We evaluated the probability that compared with treatment with neutral protamine Hagedorn, treatment with insulin detemir reduces the risk for adverse neonatal outcome among individuals with type 2 or overt type 2 diabetes mellitus (gestational diabetes mellitus diagnosed at <20 weeks' gestation). STUDY DESIGN We performed a multiclinic randomized controlled trial (September 2018 to January 2020), which included women with singleton gestation with type 2 or overt type 2 diabetes mellitus who sought obstetrical care at ≤21 weeks' gestation. Participants were randomized to receive either insulin detemir or neutral protamine Hagedorn by a clinic-stratified scheme. The primary outcome was a composite of adverse neonatal outcomes, including shoulder dystocia, large for gestational age, neonatal intensive care unit admission, respiratory distress (defined as the need of at least 4 hours of respiratory support with supplemental oxygen, continuous positive airway pressure or ventilation at the first 24 hours of life), or hypoglycemia. The secondary neonatal outcomes included gestational age at delivery, small for gestational age, 5-minute Apgar score of <7, lowest glucose level, need for intravenous glucose, respiratory distress syndrome, need for mechanical ventilation or continuous positive airway pressure, neonatal jaundice requiring therapy, brachial plexus injury, and hospital length of stay. The secondary maternal outcomes included hypoglycemic events, hospital admission for glucose control, hypertensive disorder of pregnancy, maternal weight gain, cesarean delivery, and postpartum complications. We used the Bayesian statistics to estimate a sample size of 108 to have >75% probability of any reduction in the primary outcome, assuming 80% power and a hypothesized effect of 33% reduction with insulin detemir. All analyses were intent to treat under a Bayesian framework with neutral priors (a priori assumed a 50:50 likelihood of either intervention being better; National Clinical Trial identifier 03620890). RESULTS There were 108 women randomized in this trial (57 in insulin detemir and 51 in neutral protamine Hagedorn), and 103 women were available for analysis of the primary outcome (n=5 for pregnancy loss before 24 weeks' gestation). Bayesian analysis indicated an 87% posterior probability of reduced primary outcome with insulin detemir compared with neutral protamine Hagedorn (posterior adjusted relative risk, 0.88; 95% credible interval, 0.61-1.12). Bayesian analyses for secondary outcomes showed consistent findings of lower adverse maternal outcomes with the use of insulin detemir vs neutral protamine Hagedorn: for example, maternal hypoglycemic events (97% probability of benefit; posterior adjusted relative risk, 0.59; 95% credible interval, 0.29-1.08) and hypertensive disorders (88% probability of benefit; posterior adjusted relative risk, 0.81; 95% credible interval, 0.54-1.16). CONCLUSION In our comparative effectiveness trial involving individuals with type 2 or overt type 2 diabetes mellitus, use of insulin detemir resulted in lower rates of adverse neonatal and maternal outcomes compared with neutral protamine Hagedorn.
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24
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Redden K, Safarian J, Schoenborn C, Shortall C, Gagnon AJ. Interventions to Support International Migrant Women's Reproductive Health in Western-Receiving Countries: A Systematic Review and Meta-Analysis. Health Equity 2021; 5:356-372. [PMID: 34084988 PMCID: PMC8170723 DOI: 10.1089/heq.2020.0115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose: The reproductive health outcomes of international migrant women differ in comparison with receiving-country-born women, depending on country of birth and immigrant status. Effective interventions to support the reproductive health of international migrant women are not well known. Methods: We conducted a systematic review and meta-analysis of studies between 2010 and 2017 evaluating interventions directly or indirectly affecting the reproductive health (as defined by the World Health Organization) of international migrant women in Western-receiving countries. Results: Sixteen studies representing 5080 migrants were identified. Interventions consisted of linguistically (e.g., translated brochures) or culturally adapted (e.g., cultural narratives) routine care or new interventions. Meta-analysis showed that interventions increased rates of preventive reproductive health activities, including mammography, condom use, and Pap test completion, by almost 18% (95% confidence interval 7.61–28.3) compared with usual care or interventions not adapted to migrant women. Conclusion: Culturally and linguistically adapted care practices congruent with target populations of international migrant women are effective in improving their reproductive health outcomes, particularly their participation in preventative reproductive health activities.
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Affiliation(s)
- Kara Redden
- Ingram School of Nursing, McGill University, Montréal, Canada
| | | | - Claudia Schoenborn
- Research Centre in Health Policies and Health Systems, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
| | - Clare Shortall
- Doctors of the World UK, Part of the Médecins du Monde Network, London, United Kingdom
| | - Anita J Gagnon
- Ingram School of Nursing, McGill University, Montréal, Canada.,Reproductive Outcomes and Migration (ROAM) Collaboration
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25
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Dude AM, Badreldin N, Schieler A, Yee LM. Periconception glycemic control and congenital anomalies in women with pregestational diabetes. BMJ Open Diabetes Res Care 2021; 9:9/1/e001966. [PMID: 33888543 PMCID: PMC8070859 DOI: 10.1136/bmjdrc-2020-001966] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 03/16/2021] [Accepted: 03/21/2021] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION To assess the relationship between periconception glycemic control and congenital anomalies in a contemporary, diverse population of women with pregestational diabetes. RESEARCH DESIGN AND METHODS This is a retrospective cohort study of all pregnant women with pregestational diabetes at a single institution (2003-2017) in the USA. The primary outcome was frequency of major or minor congenital anomalies. Glycemic control was assessed by periconception glycosylated hemoglobin (HbA1c). The association of periconception HbA1c with pregnancy outcomes was assessed using bivariable and multivariable analyses. RESULTS Our sample included 351 women, of which 63.8% had type 2 diabetes. Our study cohort is racially and ethnically diverse, with approximately equal numbers of women identifying as white non-Hispanic, black non-Hispanic and Hispanic, with 3.4% identifying as Asian. Of these 351 women, 52 (14.8%) had a fetus with a congenital anomaly, of whom the majority (n=43) had a major anomaly. Over half (51.1%) of all major anomalies were cardiovascular. Compared with the group with the best glycemic control (HbA1c ≤7.4%), which had an anomaly frequency of 10.2%, the frequency of congenital anomalies increased significantly with each category of worsening glycemic control (HbA1c 7.5%-9.4%: 20.6%, adjusted OR (aOR) 2.35, 95% confidence interval (CI) 1.08 to 5.13; HbA1c 9.5% to 11.4%: 25.8%, aOR 2.86, 95% CI 1.08 to 7.59; HbA1c ≥11.5%: 37.5%, aOR 7.66, 95% CI 2.27 to 25.9). CONCLUSION In a diverse cohort of women with pregestational diabetes, higher periconception HbA1c, especially HbA1c >9.5, was significantly associated with major congenital fetal anomalies. Our study sample is reflective of the current population of pregnant women with diabetes, including women with type 2 diabetes and from racial and ethnic minorities.
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Affiliation(s)
- Annie M Dude
- Department of Obstetrics & Gynecology, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Nevert Badreldin
- Department of Obstetrics & Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Amanda Schieler
- Department of Obstetrics & Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lynn M Yee
- Department of Obstetrics & Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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26
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Syrop CH, Wernimont SA, Fleener DK, Kardos JM, Rubenstein LM, Andrews JI. Redesigned Care Delivery for Insulin-Requiring Diabetes in Pregnancy Improves Perinatal Glycemic Control While Reducing Neonatal Intensive Care Admissions, Length of Stay, and Costs. J Womens Health (Larchmt) 2021; 30:557-568. [PMID: 32833565 PMCID: PMC8182645 DOI: 10.1089/jwh.2020.8290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: We sought to improve perinatal glycemic control and downstream neonatal outcomes through redesigned ambulatory management for women with insulin-requiring diabetes in pregnancy. Methods: To address gaps in perinatal glycemic management of women with insulin-requiring diabetes in pregnancy, redesigned care delivery (RCD) utilized integrated practice unit and minimally disruptive medicine concepts with incorporation of cellular-enabled glucose monitoring. Primary outcomes of RCD (N = 129) included hemoglobin A1c ([HbA1c], within RCD cohort), and gestational age (GA) at delivery, neonatal intensive care (NICU) admission, and NICU length of stay (LOS) compared with a preredesign care cohort (Pre-RCD; N = 122). Secondary outcomes included facility, payer reimbursement, and program costs. Generalized linear models assessed continuous variables while logistic regression methods assessed categorical outcomes. Results: Utilizing RCD, 92% of women with an initial HbA1c <6.5% maintained glycemic control until delivery, and 67.2% with an initial HbA1c ≥6.5% achieved delivery levels <6.5%. NICU admissions and GA-adjusted LOS decreased significantly [Pre-RCD vs. RCD: NICU admissions, 41.0% vs. 27.3%, p < 0.024; NICU LOS (95% confidence interval [CI]), 21.9 (17.1-26.6) vs. 14.6 (9.1-20.1), p = 0.045]. Every 10 days of redesigned management decreased mean NICU LOS by 1 day. Mean payer neonatal reimbursements decreased over $18,000 per delivery (p = 0.08) compared with implementation costs of $1,942 per delivery. Conclusion: Redesigned perinatal diabetes care with remote glucose monitoring demonstrated improved outcomes and value through downstream neonatal outcomes and lower payer costs. Therefore, subsequent dissemination and sustainability of similar programs' improved outcomes will likely require payer support.
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Affiliation(s)
- Craig H. Syrop
- Department of Obstetrics & Gynecology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Sarah A. Wernimont
- Department of Obstetrics & Gynecology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Diedre K. Fleener
- Department of Obstetrics & Gynecology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Joseph M. Kardos
- University of Iowa Health Care, Operational Analysis and Business Intelligence Unit, University of Iowa Health Care, Iowa City, Iowa, USA
| | - Linda M. Rubenstein
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Janet I. Andrews
- Department of Obstetrics & Gynecology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
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27
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Abstract
The societal cost of preterm birth indicates potential economic gains from interventions that reduce the incidence of preterm birth. Changes in the epidemiology of preterm birth and healthcare costs require periodic updates to cost estimates. Previously reported incremental cost estimates for the United States in 2004 were updated. The discounted present value of the excess cost associated with prematurity for the 2016 US birth cohort was estimated to be $25.2 billion: $17.1 billion for medical care of persons born preterm, $2.0 billion for delivery care, $1.3 billion for early intervention and special education, and $4.8 billion in lost productivity due to associated disabilities in adults. The nominal and inflation-adjusted incremental costs per preterm birth increased by 26% and 4%, respectively, during 2004-2016. The aggregate cost decreased by 4%, associated with declines in overall births and the preterm birth rate and changes in the distribution by gestational age.
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Affiliation(s)
- Norman J Waitzman
- Department of Economics, University of Utah, 260 Central Campus Dr., Salt Lake City, UT, USA.
| | - Ali Jalali
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | - Scott D Grosse
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, GA, USA
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28
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Buschur EO, Polsky S. Type 1 Diabetes: Management in Women From Preconception to Postpartum. J Clin Endocrinol Metab 2021; 106:952-967. [PMID: 33331893 DOI: 10.1210/clinem/dgaa931] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Indexed: 01/11/2023]
Abstract
CONTEXT This review presents an up-to-date summary on management of type 1 diabetes mellitus (T1DM) among women of reproductive age and covers the following time periods: preconception, gestation, and postpartum. EVIDENCE ACQUISITION A systematic search and review of the literature for randomized controlled trials and other studies evaluating management of T1DM before pregnancy, during pregnancy, and postpartum was performed. EVIDENCE SYNTHESIS Preconception planning should begin early in the reproductive years for young women with T1DM. Preconception and during pregnancy, it is recommended to have near-normal glucose values to prevent adverse maternal and neonatal outcomes, including fetal demise, congenital anomaly, pre-eclampsia, macrosomia, neonatal respiratory distress, neonatal hyperbilirubinemia, and neonatal hypoglycemia. CONCLUSION Women with T1DM can have healthy, safe pregnancies with preconception planning, optimal glycemic control, and multidisciplinary care.
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Affiliation(s)
| | - Sarit Polsky
- The University of Colorado Barbara Davis Center, Denver, CO, USA
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29
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Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc21-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc21-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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30
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Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc21-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc21-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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31
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Abstract
The prevalence of diabetes in reproductive age women has been reported to be as high as 6.8%, with pregestational diabetes affecting 2% of all pregnancies. As cases of diabetes in children and adolescents rise, more patients will be entering reproductive age and pregnancy with diagnoses of obesity, prediabetes, type 2 diabetes. Early interventions of diet modification and exercise to maintain healthy weights can delay or even prevent these complications. It is critical for health care providers to emphasize the importance of preconception counseling in this high-risk patient population to reduce the morbidities associated with obesity and diabetes in pregnancy.
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32
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Z. I. I, C. J. N, P. Y. L, N. H. Factors influencing pregnancy planning of multi-ethnic Asian women with diabetes: A qualitative study. PLoS One 2020; 15:e0242690. [PMID: 33270663 PMCID: PMC7714241 DOI: 10.1371/journal.pone.0242690] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 11/09/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction Pregnancy planning varies among women with diabetes. Observing that the literature examining the factors affecting diabetic women’s pregnancy intentions in multi-ethnic Asian populations is limited, we sought to explore these factors to give a better perspective on these women’s pregnancy planning. Methods This qualitative study used individual in-depth interviews to capture the views and experiences of non-pregnant diabetic women of reproductive age in four public health clinics in a southwestern state of peninsular Malaysia from May 2016 to February 2017. The participants were purposively sampled according to ethnicity and were interviewed using a semi-structured topic guide. Interviews were audio-recorded, and transcripts were analysed using thematic analysis. Results From the 33 interviews that were analysed, four important factors influencing participants’ decisions regarding pregnancy planning were identified. Participants’ perception of poor pregnancy outcomes due to advanced age and medical condition was found to have an impact. However, despite these fears and negative relationships with doctors, personal, family and cultural influences supported by religious ‘up to God’ beliefs took centre stage in the pregnancy intention of some participants. Participants demonstrated a variety of understandings of pregnancy planning. They outlined some activities for pregnancy preparation, although many also reported limited engagement with pre-pregnancy care. Conclusions This study emphasised the known dilemma experienced by diabetic women considering their desire for an ideal family structure against their perceived pregnancy risks, heterogeneous religious beliefs and the impact of cultural demands on pregnancy intention. This study urges healthcare providers to increase their engagement with the women in pregnancy planning in a more personalised approach.
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Affiliation(s)
- Irmi Z. I.
- Faculty of Medicine, Department of Primary Care Medicine, University Malaya, Kuala Lumpur, Malaysia
- Faculty of Medicine and Health Sciences, Department of Family Medicine, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Ng C. J.
- Faculty of Medicine, Department of Primary Care Medicine, University Malaya, Kuala Lumpur, Malaysia
- * E-mail:
| | - Lee P. Y.
- Faculty of Medicine and Health Sciences, Department of Family Medicine, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Hussein N.
- Faculty of Medicine, Department of Primary Care Medicine, University Malaya, Kuala Lumpur, Malaysia
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33
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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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Martin RB, Duryea EL, Mcintire DD, Twickler DM, Dashe JS. Fetal Anomaly Detection in Pregnancies With Pregestational Diabetes. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:1917-1923. [PMID: 32323894 DOI: 10.1002/jum.15296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 03/23/2020] [Accepted: 03/25/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To evaluate fetal anomaly detection in pregnancies with pregestational diabetes, according to the gestational age at the time of specialized sonography, use of follow-up sonography, maternal body mass index, and organ system(s) involved. METHODS Women with pregestational diabetes who received prenatal care and delivered a live-born or stillborn neonate at our hospital from October 2011 through April 2017 were ascertained. We included all pregnancies with at least 1 confirmed structural anomaly (EUROCAT classification) who had detailed sonography at 18 weeks' gestation or later. We analyzed detection of anomalous fetuses at the initial detailed sonogram and, if no abnormality was identified, during any follow-up sonograms. Statistical analyses were performed with the χ2 test and Mantel-Haenszel χ2 test for trend. RESULTS Seventy-two anomalous neonates (72 of 1060 [6.8%]) were born. Overall detection was 55 of 72 (76%); 49 of 72 (68%) were detected at the initial detailed sonogram, compared to 6 of 15 (40%) of follow-up examinations (P = .04). Recognition at the initial or follow-up examination was not dependent on gestational age or body mass index category (all P > .05). Of individual organ system anomalies, 67 of 89 (75%) were identified. Detection exceeded 85% for central nervous system, genitourinary, and musculoskeletal abnormalities and 43% for craniofacial anomalies. Sixty-five percent of cardiac anomalies were detected, and 14 of 17 (82%) requiring specialized care in the immediate neonatal period were recognized. CONCLUSIONS Approximately three-fourths of anomalous fetuses were identified, with greater detection at the initial detailed examination. Fetuses with central nervous system, genitourinary, musculoskeletal abnormalities and those with cardiac anomalies requiring specialized cardiac care were more likely to come to attention.
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Affiliation(s)
- Robert B Martin
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Elaine L Duryea
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Donald D Mcintire
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Diane M Twickler
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jodi S Dashe
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Kotirum S, Kiatpongsan S, Kapol N. Systematic review of economic evaluation studies on preconception care interventions. Health Care Women Int 2020; 42:503-517. [PMID: 32940580 DOI: 10.1080/07399332.2020.1817025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Implementation of preconception care interventions have been encouraged for improving maternal and child health outcomes; therefore, evidence on their cost-effectiveness is needed. We conducted the systematic review to examine the efficiency of those interventions by collecting evidence from published economic evaluation studies. Out of 14 included studies, almost all (12/14) were in high-income countries. All studies were not cost-utility analysis with genetic disease screening and diabetes management were the common interventions for evaluating their efficiency during preconception period. Preconception care interventions are likely to be cost-effective, especially in low-income countries which incremental benefits had a greater return than developed nations.
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Affiliation(s)
- Surachai Kotirum
- Department of Community Pharmacy, Faculty of Pharmacy, Silpakorn University, Muang, Nakhon Pathom, Thailand
| | | | - Nattiya Kapol
- Department of Community Pharmacy, Faculty of Pharmacy, Silpakorn University, Muang, Nakhon Pathom, Thailand
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Wahabi HA, Fayed A, Esmaeil S, Elmorshedy H, Titi MA, Amer YS, Alzeidan RA, Alodhayani AA, Saeed E, Bahkali KH, Kahili-Heede MK, Jamal A, Sabr Y. Systematic review and meta-analysis of the effectiveness of pre-pregnancy care for women with diabetes for improving maternal and perinatal outcomes. PLoS One 2020; 15:e0237571. [PMID: 32810195 PMCID: PMC7433888 DOI: 10.1371/journal.pone.0237571] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 07/30/2020] [Indexed: 12/17/2022] Open
Abstract
Background Pre-gestational diabetes mellitus is associated with increased risk of maternal and perinatal adverse outcomes. This systematic review was conducted to evaluate the effectiveness and safety of pre-conception care (PCC) in improving maternal and perinatal outcomes. Methods Databases from MEDLINE, EMBASE, WEB OF SCIENCE, and Cochrane Library were searched, including the CENTRAL register of controlled trials, and CINHAL up until March 2019, without any language restrictions, for any pre-pregnancy care aiming at health promotion, glycemic control, and screening and treatment of diabetes complications in women with type I or type II pre-gestational diabetes. Trials and observational studies were included in the review. Newcastle-Ottawa scale and the Cochrane collaboration methodology for data synthesis and analysis were used, along with the GRADE tool to evaluate the body of evidence. Results The search identified 8500 potentially relevant citations of which 40 reports of 36 studies were included. The meta-analysis results show that PCC reduced congenital malformations risk by 71%, (Risk ratio (RR) 0.29; 95% CI: 0.21–0.40, 25 studies; 5903 women; high-certainty evidence). The results also show that PCC may lower HbA1c in the first trimester of pregnancy by an average of 1.27% (Mean difference (MD) 1.27; 95% CI: 1.33–1.22; 4927 women; 24 studies, moderate-certainty evidence). Furthermore, the results suggest that PCC may lead to a slight reduction in the risk of preterm delivery of 15%, (RR 0.85; 95% CI: 0.73–0.99; nine studies, 2414 women; moderate-certainty evidence). Moreover, PCC may result in risk reduction of perinatal mortality by 54%, (RR 0.46; 95% CI: 0.30–0.73; ten studies; 3071 women; moderate-certainty evidence). There is uncertainty about the effects of PCC on the early booking for antenatal care (MD 1.31; 95% CI: 1.40–1.23; five studies, 1081 women; very low-certainty evidence) and maternal hypoglycemia in the first trimester, (RR 1.38; 95% CI: 1.07–1.79; three studies; 686 women; very low- certainty evidence). In addition, results of the meta-analysis indicate that PCC may lead to 48% reduction in the risk of small for gestational age (SGA) (RR 0.52; 95% CI: 0.37–0.75; six studies, 2261 women; moderate-certainty evidence). PCC may reduce the risk of neonatal admission to intensive care unit (NICU) by 25% (RR 0.75; 95% CI: 0.67–0.84; four studies; 1322 women; moderate-certainty evidence). However, PCC may have little or no effect in reducing the cesarean section rate (RR 1.02; 95% CI: 0.96–1.07; 14 studies; 3641 women; low-certainty evidence); miscarriage rate (RR 0.86; 95% CI: 0.70–1.06; 11 studies; 2698 women; low-certainty evidence); macrosomia rate (RR 1.06; 95% CI: 0.97–1.15; nine studies; 2787 women, low-certainty evidence); neonatal hypoglycemia (RR 0.93; 95% CI: 0.74–1.18; five studies; 880 women; low-certainty evidence); respiratory distress syndrome (RR 0.78; 95% CI: 0.47–1.29; four studies; 466 women; very low-certainty evidence); or shoulder dystocia (RR 0.28; 95% CI: 0.07–1.12; 2 studies; 530 women; very low-certainty evidence). Conclusion PCC for women with pre-gestational type 1 or type 2 diabetes mellitus is effective in improving rates of congenital malformations. In addition, it may improve the risk of preterm delivery and admission to NICU. PCC probably reduces maternal HbA1C in the first trimester of pregnancy, perinatal mortality and SGA. There is uncertainty regarding the effects of PCC on early booking for antenatal care or maternal hypoglycemia during the first trimester of pregnancy. PCC has little or no effect on other maternal and perinatal outcomes.
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Affiliation(s)
- Hayfaa A. Wahabi
- Research Chair for Evidence-Based Healthcare and Knowledge Translation, King Saud University, Riyadh, Saudi Arabia
- Department of Family and Community Medicine, King Saud University Medical City and College of Medicine, Riyadh, Saudi Arabia
| | - Amel Fayed
- College of Medicine, Clinical Department, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
- High Institute of Public Health, Alexandria University, Alexandria, Egypt
- * E-mail:
| | - Samia Esmaeil
- Research Chair for Evidence-Based Healthcare and Knowledge Translation, King Saud University, Riyadh, Saudi Arabia
| | - Hala Elmorshedy
- College of Medicine, Clinical Department, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
- High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | - Maher A. Titi
- Research Chair for Evidence-Based Healthcare and Knowledge Translation, King Saud University, Riyadh, Saudi Arabia
- Patient Safety Unit, Quality Management Department, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Yasser S. Amer
- Research Chair for Evidence-Based Healthcare and Knowledge Translation, King Saud University, Riyadh, Saudi Arabia
- Clinical Practice Guidelines Unit, Quality Management Department, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Rasmieh A. Alzeidan
- Cardiac Science Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdulaziz A. Alodhayani
- Department of Family and Community Medicine, King Saud University Medical City and College of Medicine, Riyadh, Saudi Arabia
| | - Elshazaly Saeed
- Prince Abdulla bin Khaled Coeliac Disease Research Chair, King Saud University, Riyadh, Saudi Arabia
| | | | - Melissa K. Kahili-Heede
- John A. Burns School of Medicine, Health Sciences Library, University of Hawaii at Manoa, Honolulu, HI, United States of America
| | - Amr Jamal
- Research Chair for Evidence-Based Healthcare and Knowledge Translation, King Saud University, Riyadh, Saudi Arabia
- Department of Family and Community Medicine, King Saud University Medical City and College of Medicine, Riyadh, Saudi Arabia
| | - Yasser Sabr
- Department of Obstetrics and Gynecology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Practical considerations for pregnant women with diabetes and severe acute respiratory syndrome coronavirus 2 infection. Am J Obstet Gynecol MFM 2020; 2:100210. [PMID: 32838276 PMCID: PMC7430221 DOI: 10.1016/j.ajogmf.2020.100210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 07/26/2020] [Accepted: 08/05/2020] [Indexed: 01/08/2023]
Abstract
Epidemiologic data available so far suggest that individuals with diabetes, especially when not well controlled, are at a greater risk than the general population for severe acute respiratory syndrome coronavirus 2 morbidity such as acute respiratory distress syndrome, multiorgan failure, and mortality. Given the significant correlation between severity of coronavirus disease 2019 and diabetes mellitus and the lack of pregnancy-specific recommendations, we aim to provide some guidance and practical recommendations for the management of diabetes in pregnant women during the pandemic, especially for general obstetricians-gynecologists and nonobstetricians taking care of these patients.
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38
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LaManna JB, Quelly SB, Stahl M, Giurgescu C. A Florida public health-based endocrine clinic for low-income pregnant women with diabetes. Public Health Nurs 2020; 37:729-739. [PMID: 32761865 DOI: 10.1111/phn.12783] [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: 04/27/2020] [Revised: 06/18/2020] [Accepted: 07/19/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To evaluate pregnancy outcomes of low-income women with diabetes-complicated pregnancies who received care from an embedded, public health-based endocrine specialty clinic (ESC) in Florida. DESIGN This program evaluation used retrospective chart data to analyze client characteristics, pre-program and during-program glycemic control, and pregnancy outcomes of women enrolled in a prenatal ESC. SAMPLE Ninety-two low-income, pregnant women with type 1/type 2 diabetes or gestational diabetes (GDM) comprised this racially/ethnically diverse sample. VARIABLES/ANALYSIS Neonatal outcomes included frequencies of prematurity, hypoglycemia, hyperbilirubinemia, and birth weight-for-gestational-age categories. Differences in maternal HbA1C at program entry and mean HbA1C during ESC care were determined by a Wilcoxon and paired sample t test. RESULTS HbA1C levels during ESC care (6.9 ± 1.4) were less than program entry HbA1C levels (7.9 ± 1.8) for women with pregestational diabetes (Z = -3.364, p = .001). Among women with GDM, mean HbA1C values during ESC care (5.5 ± 0.4) did not significantly differ (t(51) = -0.532, p > .05) from program entry HbA1C levels (5.5 ± 0.5), suggestive of glycemic goal achievement. No neonatal hypoglycemia or hyperbilirubinemia cases were observed in both groups. Approximately 11% of births were preterm, and 16% of neonates were large-for-gestational-age. CONCLUSIONS A public health-based ESC for low-income pregnant women with diabetes may positively affect pregnancy outcomes.
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Affiliation(s)
- Jacqueline B LaManna
- University of Central Florida College of Nursing, Orlando, FL, USA.,Florida Department of Health, Melbourne, FL, USA
| | - Susan B Quelly
- University of Central Florida College of Nursing, Orlando, FL, USA
| | - Maria Stahl
- Florida Department of Health, Melbourne, FL, USA
| | - Carmen Giurgescu
- University of Central Florida College of Nursing, Orlando, FL, USA
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Dedov II, Shestakova MV, Mayorov AY, Shamkhalova MS, Nikonova TV, Sukhareva OY, Pekareva EV, Ibragimova LI, Mikhina MS, Galstyan GR, Tokmakova AY, Surkova EV, Laptev DN, Kononenko IV, Egorova DN, Klefortova II, Sklyanik IA, Yarek-Martynova IY, Severina AS, Martynov SA, Vikulova OK, Kalashnikov VY, Gomova IS, Lipatov DV, Starostina EG, Ametov AS, Antsiferov MB, Bardymova TP, Bondar IA, Valeeva FV, Demidova TY, Klimontov VV, Mkrtumyan AM, Petunina NA, Suplotova LA, Ushakova OV, Khalimov YS, Ruyatkina LA. Diabetes mellitus type 1 in adults. DIABETES MELLITUS 2020. [DOI: 10.14341/dm12505] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Tatiana P. Bardymova
- Irkutsk State Medical Academy of Postgraduate Education – Branch Campus of the Russian Medical Academy of Continuing Professional Education
| | | | | | | | - Vadim V. Klimontov
- Research Institute of Clinical and Experimental Lymphology – Branch of the Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences
| | - Ashot M. Mkrtumyan
- Moscow State University of Medicine and Dentistry named after A.I. Evdokimov
| | - Nina A. Petunina
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
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40
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Dedov II, Shestakova MV, Mayorov AY, Shamkhalova MS, Sukhareva OY, Galstyan GR, Tokmakova AY, Nikonova TV, Surkova EV, Kononenko IV, Egorova DN, Ibragimova LI, Shestakova EA, Klefortova II, Sklyanik IA, Yarek-Martynova IY, Severina AS, Martynov SA, Vikulova OK, Kalashnikov VY, Bondarenko IZ, Gomova IS, Starostina EG, Ametov AS, Antsiferov MB, Bardymova TP, Bondar IA, Valeeva FV, Demidova TY, Mkrtumyan AM, Petunina NA, Ruyatkina LA, Suplotova LA, Ushakova OV, Khalimov YS. Diabetes mellitus type 2 in adults. DIABETES MELLITUS 2020. [DOI: 10.14341/dm12507] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Tatiana P. Bardymova
- Irkutsk State Medical Academy of Postgraduate Education – Branch Campus of the Russian Medical Academy of Continuing Professional Education
| | | | | | | | - Ashot M. Mkrtumyan
- Moscow State University of Medicine and Dentistry named after A.I. Evdokimov
| | - Nina A. Petunina
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
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41
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Lynch TA, Westen E, Li D, Katzman PJ, Malshe A, Drennan K. Stillbirth in women with diabetes: a retrospective analysis of fetal autopsy reports. J Matern Fetal Neonatal Med 2020; 35:2091-2098. [PMID: 32567445 DOI: 10.1080/14767058.2020.1779213] [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] [Indexed: 12/24/2022]
Abstract
Introduction: Diabetes in pregnancy is associated with an increased rate of stillbirth. There are a wide variety of factors that have been implicated including placental insufficiency, hypoxia, hyperinsulinemia and impaired cardiac function. Furthermore, there is evidence that diabetic pregnancies have an increased rate of fetal cardiomyopathy as compared to non-diabetic pregnancies. Prior studies have indicated that this association can also be an etiology for diabetic stillbirth. The purpose of this study was to determine if diabetic pregnancies have an increased risk of fetal cardiomyopathy identified on fetal autopsy as compared to non-diabetic women with a stillbirth in a cohort of pregnancies that had evaluation with a fetal autopsy.Materials and methods: Retrospective cohort study of women with a stillbirth who consented to fetal autopsy at an academic medical center from 2011 to 2017. Stillbirth was defined as an intrauterine fetal demise at ≥20 weeks' gestation. Women with diabetes defined as pre-gestational diabetes type 1, pre-gestational diabetes type 2, and gestational diabetes were compared to women without diabetes. Primary outcome was fetal cardiomyopathy. Other etiologies for stillbirth were also evaluated and classified according to the Stillbirth Collaborative Research Network (SCRN) initial causes of fetal death. Fisher exact test, χ2 test, and Mann Whitney U tests were performed as appropriate, with p < .05 considered significant. Generalized linear models were performed for fetal organ weights controlling for gestational age of delivery, maternal chronic hypertension, delivery body mass index, and birthweight.Results: A total of 78 women elected to have fetal autopsy examinations during the study period. Of these, 75 had complete information available for review. A total of 60 women did not have diabetes and 15 women had diabetes. Of pregnancies complicated by diabetes, 11 had insulin dependent diabetes and 4 had non-insulin dependent diabetes. Fetal cardiomyopathy was diagnosed on autopsy for 7 (46.7%) of pregnancies with diabetes and 2 (3.3% of pregnancies without diabetes (RR 14.00 [95% CI 3.23-60.65], p < .001). These associations were still significant even when analyzing only those pregnancies without fetal congenital heart disease (7 [46.7%] diabetic pregnancies with cardiomyopathy versus 1 [2.0%] nondiabetic pregnancy with cardiomyopathy, RR 23.80 [95% CI 3.17-178.46], p < .001). There was no difference between diabetic and non-diabetic pregnancies in regards to other causes for stillbirth. Stillbirths in pregnancies with diabetes also had larger fetal heart, liver, and adrenal weights on fetal autopsy.Conclusion: Women with diabetes have 14 times the risk of fetal cardiomyopathy identified at fetal autopsy as compared to women without diabetes. As the prediction and prevention of diabetic stillbirth is limited, information on potential causes of stillbirth may help future research identify those pregnancies at the greatest risk for adverse outcome.
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Affiliation(s)
- Tara A Lynch
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Elizabeth Westen
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Dongmei Li
- Department of Clinical and Translational Research, Department of Obstetrics and Gynecology, Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Philip J Katzman
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Amol Malshe
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Kathryn Drennan
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Rochester Medical Center, Rochester, NY, USA
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Kapur A, Hod M. Maternal health and non-communicable disease prevention: An investment case for the post COVID-19 world and need for better health economic data. Int J Gynaecol Obstet 2020; 150:151-158. [PMID: 32401348 PMCID: PMC9087486 DOI: 10.1002/ijgo.13198] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 05/05/2020] [Indexed: 01/13/2023]
Abstract
An integrated approach to population health, disease surveillance, and preventive care will dominate the health agenda in the post COVID‐19 world. Because of their huge burden and the vulnerability imposed during a health crisis, prevention and care of non‐communicable diseases (NCDs) will need to be prioritized even further. Maternal and child health are inextricably linked with NCDs and their risk factors. The intergenerational impact of poor maternal nutrition and health conditions during pregnancy, particularly NCD‐related pregnancy complications, can be considered as a multiplier of the ongoing pandemic of NCDs. The economic cost of poor maternal health and NCD‐related pregnancy complications is likely very high, but is not adequately researched or documented in the context of long‐term population health. Interventions to address NCDs in pregnancy have beneficial effects on short‐term pregnancy outcomes; but even more importantly, identifying “at‐risk” mothers and offspring opens up the opportunity for targeted early preventive action. Preventive actions to address obesity, hypertension, type 2 diabetes, and cardiovascular diseases have a common lifestyle approach—identifying any one of these problems in pregnancy provides an opportunity to address them all. Cost–benefit analyses that only focus on the short‐term and on one condition do not capture the full value of downstream, long‐term benefits for population health. This requires urgent attention from FIGO. Integrated action on maternal health and non‐communicable disease prevention is an investment for future population health that requires more health economic data.
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Affiliation(s)
- Anil Kapur
- World Diabetes Foundation, Bagsvaerd, Denmark.,Pregnancy and Non-Communicable Diseases Committee, FIGO, London, UK
| | - Moshe Hod
- Pregnancy and Non-Communicable Diseases Committee, FIGO, London, UK.,Mor Women's Health Care Center, Tel Aviv, Israel
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Abstract
Telemedicine involves the use of technology to provide services to patients and share medical information. Telemedicine's use has increased as technology has advanced. It allows for medicine to be practiced from a distance to reach patients in rural or underserved areas. Telemedicine has widespread uses in high-risk obstetrics, including management of diabetes, diagnosis and management of hypertensive disorders of pregnancy, screening for fetal malformations with teleultrasound, delivering care to underserved areas, and more. The use of telemedicine to provide care to patients and information to health care providers at a distance has been well accepted by the patients and providers.
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Affiliation(s)
- Julie R Whittington
- University of Arkansas for Medical Sciences, 4301 West Markham Street, Slot 518, Little Rock, AR 72205, USA.
| | - Everett F Magann
- Department of OB/GYN, MFM Division, 4301 West Markham Street, Slot 518, Little Rock, AR 72205, USA
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44
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Tinker SC, Gilboa SM, Moore CA, Waller DK, Simeone RM, Kim SY, Jamieson DJ, Botto LD, Reefhuis J. Specific birth defects in pregnancies of women with diabetes: National Birth Defects Prevention Study, 1997-2011. Am J Obstet Gynecol 2020; 222:176.e1-176.e11. [PMID: 31454511 DOI: 10.1016/j.ajog.2019.08.028] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 08/19/2019] [Accepted: 08/19/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Diabetes is associated with an increased risk for many birth defects and is likely to have an increasing impact on birth defect prevalence because of the rise in diabetes in the United States in recent decades. One of the first analyses in which specific birth defects were assessed for their relationship with both pregestational and gestational diabetes used data from the initial 6 years of the National Birth Defects Prevention Study. That analysis reported strong associations for pregestational diabetes with several birth defects, but few exposures among some of the less common birth defects led to unstable estimates with wide confidence intervals. Since that analysis, the study continued to collect data for another 8 years, including information on approximately 19,000 additional cases and 6900 additional controls. OBJECTIVE Our objective was to use data from the National Birth Defects Prevention Study, the largest population-based birth defects case-control study in the United States, to provide updated and more precise estimates of the association between diabetes and birth defects, including some defects not previously assessed. STUDY DESIGN We analyzed data on deliveries from October 1997 through December 2011. Mothers of case and control infants were interviewed about their health conditions and exposures during pregnancy, including diagnosis of pregestational (type 1 or type 2) diabetes before the index pregnancy or gestational diabetes during the index pregnancy. Using logistic regression, we separately assessed the association between pregestational and gestational diabetes with specific categories of structural birth defects for which there were at least 3 exposed case infants. For birth defect categories for which there were at least 5 exposed case infants, we calculated odds ratios adjusted for maternal body mass index, age, education, race/ethnicity, and study site; for defect categories with 3 or 4 exposed cases, we calculated crude odds ratios. RESULTS Pregestational diabetes was reported by 0.6% of mothers of control infants (71 of 11,447) and 2.5% of mothers of case infants (775 of 31,007). Gestational diabetes during the index pregnancy was reported by 4.7% of mothers of control infants (536 of 11,447) and 5.3% of mothers of case infants (1,653 of 31,007). Pregestational diabetes was associated with strong, statistically significant odds ratios (range, 2.5-80.2) for 46 of 50 birth defects considered. The largest odds ratio was observed for sacral agenesis (adjusted odds ratio, 80.2; 95% confidence interval, 46.1-139.3). A greater than 10-fold increased risk was also observed for holoprosencephaly (adjusted odds ratio, 13.1; 95% confidence interval, 7.0-24.5), longitudinal limb deficiency (adjusted odds ratio, 10.1; 95% confidence interval, 6.2-16.5), heterotaxy (adjusted odds ratio, 12.3; 95% confidence interval, 7.3-20.5), truncus arteriosus (adjusted odds ratio, 14.9; 95% confidence interval, 7.6-29.3), atrioventricular septal defect (adjusted odds ratio, 10.5; 95% confidence interval, 6.2-17.9), and single ventricle complex (adjusted odds ratio, 14.7; 95% confidence interval, 8.9-24.3). For gestational diabetes, statistically significant odds ratios were fewer (12 of 56) and of smaller magnitude (range, 1.3- 2.1; 0.5 for gastroschisis). CONCLUSION Pregestational diabetes is associated with a markedly increased risk for many specific births defects. Because glycemic control before pregnancy is associated with a reduced risk for birth defects, ongoing quality care for persons with diabetes is an important opportunity for prevention.
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Affiliation(s)
- Sarah C Tinker
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA.
| | - Suzanne M Gilboa
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Cynthia A Moore
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - D Kim Waller
- UTHealth, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX
| | - Regina M Simeone
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Shin Y Kim
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Denise J Jamieson
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA
| | - Lorenzo D Botto
- Division of Medical Genetics, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT
| | - Jennita Reefhuis
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
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Tsakiridis I, Mamopoulos A, Athanasiadis A, Kourtis A, Dagklis T. Management of pregestational diabetes mellitus: a comparison of guidelines. J Matern Fetal Neonatal Med 2020; 35:423-432. [PMID: 31992099 DOI: 10.1080/14767058.2020.1719481] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Pregestational diabetes is associated with adverse maternal and neonatal outcomes. The aim of this study was to summarize and compare evidence-based recommendations on pregestational diabetes and to focus especially on issues related to the management of this entity.Materials and methods: A descriptive review of three recently published national guidelines on pregestational diabetes was conducted: the American Diabetes Association on "Diabetes in Pregnancy: Standards of Medical Care in Diabetes - 2019," the National Institute for Health and Care Excellence on "Diabetes in pregnancy: management from preconception to the postnatal period" and the American College of Obstetricians and Gynecologists on "Pregestational Diabetes Mellitus." These guidelines were compared according to recommendations on management, during the preconception, antenatal, intrapartum and postpartum period.Results: There were many similar recommendations regarding the preconception counseling, the antepartum assessment by specialists, the glycemic control target levels, the pharmacologic treatment and the postpartum period among the three guidelines. On the other hand, the American Diabetes Association makes no recommendations regarding fetal monitoring and obstetric management during pregnancy and the intrapartum period, while there are several similarities between the other two guidelines.Conclusions: The adoption of an international consensus based on evidence - based guidelines will increase the awareness of the healthcare professionals on the management of pregestational diabetes, leading that way to more favorable perinatal outcomes.
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Affiliation(s)
- Ioannis Tsakiridis
- Third Department of Obstetrics and Gynaecology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Apostolos Mamopoulos
- Third Department of Obstetrics and Gynaecology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Apostolos Athanasiadis
- Third Department of Obstetrics and Gynaecology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anargyros Kourtis
- Third Department of Obstetrics and Gynaecology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Themistoklis Dagklis
- Third Department of Obstetrics and Gynaecology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Perceptions and Behaviors Related to Contraceptive Use in the Postpartum Period Among Women With Pregestational Diabetes Mellitus. J Obstet Gynecol Neonatal Nurs 2020; 49:154-166. [PMID: 31951814 DOI: 10.1016/j.jogn.2019.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2019] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To describe perceptions and behaviors related to contraception and preconception care and to test the association between these perceptions and contraceptive use in the postpartum period among women with pregestational diabetes mellitus. DESIGN Cross-sectional, descriptive survey. SETTING Three high-risk obstetric clinics in the Southeastern United States. PARTICIPANTS Fifty-five women who were 18 years or older with pregestational Type 1 or Type 2 diabetes mellitus. METHODS Between 4 and 8 weeks after birth, we used investigator-developed items and psychometrically validated scales to measure participants' perceptions and behaviors related to contraception and preconception care. We dichotomized use of contraception in the postpartum period as procedure/prescription or nonprescription/no method. We used multiple logistic regression to test the hypothesis that perceptions are associated with contraceptive use. RESULTS When data were collected 4 to 8 weeks after birth, almost half (49%, n = 27) of the participants had resumed sexual activity; however, most (95%, n = 52) did not want another pregnancy in the next 18 months. Fifty-six percent (n = 31) of participants used procedure/prescription contraception, and 44% (n = 24) used nonprescription/no method. Those who perceived contraception use and preconception care to be beneficial were more likely to use procedure/prescription contraception (adjusted odds ratio = 1.52; 95% confidence interval [1.07, 2.17]). CONCLUSION When caring for women in the postpartum period, providers should be mindful that women's perceptions of the benefits of contraception and preconception care may have implications for whether their use aligns with their reproductive goals and optimizes outcomes for future pregnancies.
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Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee (https://doi.org/10.2337/dc20-SPPC), a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc20-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Roeckner JT, Bennett S, Mitta M, Sanchez-Ramos L, Kaunitz AM. Pregnancy outcomes associated with an abnormal 50-g glucose screen during pregnancy: a systematic review and Meta-analysis. J Matern Fetal Neonatal Med 2020; 34:4132-4140. [PMID: 31893960 DOI: 10.1080/14767058.2019.1706473] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Objective: To assess the association between an abnormal 1-h 50-g glucose challenge test (GCT) followed by a normal 3-h 100-g glucose tolerance test (GTT) on fetal macrosomia and other adverse outcomes.Data sources: MEDLINE, Cochrane, clinicaltrials.gov, and Google Scholar were searched from inception to March 2019.Methods of study selection: Any studies reporting adverse perinatal and/or maternal outcomes in women with an abnormal 50-g 1-h glucose challenge test (GCT) followed by a normal 3-h, 100-g glucose tolerance test (GTT) were included. Studies were critically appraised by three independent reviewers. Outcomes included fetal macrosomia, cesarean delivery, preeclampsia, birth weight, neonatal hypoglycemia, shoulder dystocia, NICU admission, respiratory morbidity, and low Apgar score. A random-effects model was employed to calculate pooled odds ratios (OR) for each outcome with their 95% confidence intervals (CI) and 95% predictive intervals (PI).Tabulation, integration, and results: We identified 30 studies comprising 18,067 patients with a normal 3-h GTT after an abnormal 1-h GCT (study group) and 117,091 patients with a normal 1-h, 50-g GCT (comparison group). Patients in the study group had an increased risk of macrosomia (OR 1.68, 95% CI 1.48-1.91, 27 studies, 132,027 patients), cesarean delivery (OR 1.39, 95% CI 1.30-1.48, 24 studies, 128,495 women), preeclampsia (OR 1.48, 95% CI 1.15-1.91, 17 studies, 110,930 patients), hypoglycemia (OR 1.43, CI 1.07-1.91) and shoulder dystocia (OR 1.52, 95% CI 1.09-2.12, 9 studies, 41,229 patients). Neonatal birth weight was significantly higher in the study group. The incidence of NICU admission, low Apgar score, and respiratory morbidity was similar in the two groups. Controlling for body mass index and 1-h glucose screen cut off did not alter these results.Conclusion: Even in the absence of gestational diabetes, patients who fail the GCT test are at mildly increased risk of maternal and neonatal morbidity including macrosomia, cesarean delivery, preeclampsia, and shoulder dystocia.
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Affiliation(s)
- Jared T Roeckner
- Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Stevie Bennett
- Department of Obstetrics and Gynecology, College of Medicine, University of Florida, Jacksonville, FL, USA
| | - Melanie Mitta
- Department of Obstetrics and Gynecology, College of Medicine, University of Florida, Jacksonville, FL, USA
| | - Luis Sanchez-Ramos
- Department of Obstetrics and Gynecology, College of Medicine, University of Florida, Jacksonville, FL, USA
| | - Andrew M Kaunitz
- Department of Obstetrics and Gynecology, College of Medicine, University of Florida, Jacksonville, FL, USA
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Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc20-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc20-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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50
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Marshall C, Britton L. Delivering family planning and preconception care to women with diabetes: Implementation challenges and promising strategies. HEALTHCARE (AMSTERDAM, NETHERLANDS) 2019; 8:100386. [PMID: 31668425 DOI: 10.1016/j.hjdsi.2019.100386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 09/27/2019] [Accepted: 10/04/2019] [Indexed: 02/08/2023]
Abstract
Diabetes is increasingly prevalent among women of reproductive age and during pregnancy. The American Diabetes Association, which has called for improvements in the patient-centeredness of care, recommends preconception counseling and care for women of reproductive age with diabetes. However, data suggests this care is not sufficiently delivered. In this article, we describe demographic shifts in the need for preconception care and outline several changes at the clinical encounter as well as the health system- and community-levels that can help improve the delivery of diabetes-specific preconception care.
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Affiliation(s)
- Cassondra Marshall
- School of Public Health, University of California, Berkeley, 2121 Berkeley Way, Berkeley, CA, 94720, USA.
| | - Laura Britton
- School of Nursing, Columbia University, 560 W 168th St, New York City, New York, 10032, USA
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