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Negrea MC, Oriot P, Courcelles A, Gruson D, Alexopoulou O. Performance of glycated hemoglobin A1c for the diagnosis of gestational diabetes mellitus during the SARS-CoV-2 pandemic in Belgium (2020-2021). Eur J Obstet Gynecol Reprod Biol 2023; 289:36-41. [PMID: 37625287 DOI: 10.1016/j.ejogrb.2023.08.368] [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: 05/17/2023] [Revised: 07/29/2023] [Accepted: 08/18/2023] [Indexed: 08/27/2023]
Abstract
OBJECTIVES During the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, health care access was restricted. To reduce the risk of maternal SARS-CoV-2 infection, simplified screening recommendations for gestational diabetes mellitus (GDM) have been suggested, leading to glycated hemoglobin A1c (HbA1c) being proposed as an alternative to the oral glucose tolerance test (OGTT). This study aimed to assess the optimal HbA1c cutoff to confirm GDM diagnosis according to IADPSG/WHO2013 guidelines. METHODS In this retrospective study, 3361 pregnancies were followed at the hospital of Mouscron and the Cliniques Universitaires St Luc in Brussels (2020-2021). GDM was universally screened in the third trimester of gestation. The ROC curve was used to evaluate the diagnostic performance of HbA1c with OGTT as the reference. Sensitivity, specificity and likelihood ratios for different HbA1c thresholds were calculated. RESULTS In total, 312 women were selected due to HbA1c analysis in addition to OGTT, and 149 had GDM. The area under the ROC curve for GDM detection by HbA1c was 0.73 (95% CI 0.68-0.79, p < 0.0001). The cutoff value chosen as a possible threshold was HbA1c 5.5% (37 mmol/mol). The sensitivity, specificity, positive and negative likelihood ratios for this cutoff were 12.0%, 99.4%, 20 and 0.88, respectively. The Fagan nomogram test showed a posttest GDM probability of approximately 70%, corresponding to a 10-fold higher pretest probability. An HbA1c ≥ 5.5% (37 mmol/mol) would have avoided OGTT in 18% of women with GDM. These women with an HbA1c ≥ 5.5% had significantly higher rates of family history of diabetes, older age, higher BMI and higher blood glucose levels (fasting, 1 h and 2 h) at OGTT. CONCLUSION Our results are consistent with the literature concerning the diagnostic ability of GDM through HbA1c ≥ 5.5%.
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Affiliation(s)
| | - Philippe Oriot
- Department of Diabetology, Mouscron Hospital Centre, Mouscron, Belgium.
| | - Aude Courcelles
- Department of Laboratory Medicine, Mouscron Hospital Centre, Mouscron, Belgium
| | - Damien Gruson
- Department of Laboratory Medicine, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Orsalia Alexopoulou
- Endocrinology and Nutrition, Cliniques Universitaires Saint-Luc - Université Catholique de Louvain, Brussels, Belgium
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Gerbier E, Favre G, Maisonneuve E, Ceulemans M, Winterfeld U, Dao K, Schmid CPR, Jenkinson SP, Niznik B, Baud D, Spoendlin J, Panchaud A. Antidiabetic Medication Utilisation before and during Pregnancy in Switzerland between 2012 and 2019: An Administrative Claim Database from the MAMA Cohort. J Diabetes Res 2023; 2023:4105993. [PMID: 37206113 PMCID: PMC10191745 DOI: 10.1155/2023/4105993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 05/21/2023] Open
Abstract
Background The incidence of diabetes mellitus (both pregestational and gestational) is increasing worldwide, and hyperglycemia during pregnancy is associated with adverse pregnancy outcomes. Evidence on the safety and efficacy of metformin during pregnancy has accumulated resulting in an increase in its prescription in many reports. Aims We aimed to determine the prevalence of antidiabetic drug use (insulins and blood glucose-lowering drugs) before and during pregnancy in Switzerland and the changes therein during pregnancy and over time. Methods We conducted a descriptive study using Swiss health insurance claims (2012-2019). We established the MAMA cohort by identifying deliveries and estimating the last menstrual period. We identified claims for any antidiabetic medication (ADM), insulins, blood glucose-lowering drugs, and individual substances within each class. We defined three groups of pattern use based on timing of dispensation: (1) dispensation of at least one ADM in the prepregnancy period and in or after trimester 2 (T2) (pregestational diabetes); (2) dispensation for the first time in or after T2 (GDM); and (3) dispensation in the prepregnancy period and no dispensation in or after T2 (discontinuers). Within the pregestational diabetes group, we further defined continuers (dispensation for the same group of ADM) and switchers (different ADM group dispensed in the prepregnancy period and in or after T2). Results MAMA included 104,098 deliveries with a mean maternal age at delivery of 31.7. Antidiabetic dispensations among pregnancies with pregestational and gestational diabetes increased over time. Insulin was the most dispensed medication for both diseases. Between 2017 and 2019, less than 10% of pregnancies treated for pregestational diabetes continued metformin rather than switching to insulin. Metformin was offered to less than 2% of pregnancies to treat gestational diabetes (2017-2019). Conclusion Despite its position in the guidelines and the attractive alternative that metformin represents to patients who may encounter barriers with insulin therapy, there was reluctance to prescribe it.
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Affiliation(s)
- Eva Gerbier
- Service of Pharmacy, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
- Materno-Fetal and Obstetrics Research Unit, Department “Woman-Mother-Child”, Lausanne University Hospital, 1011 Lausanne, Switzerland
| | - Guillaume Favre
- Materno-Fetal and Obstetrics Research Unit, Department “Woman-Mother-Child”, Lausanne University Hospital, 1011 Lausanne, Switzerland
| | - Emeline Maisonneuve
- Materno-Fetal and Obstetrics Research Unit, Department “Woman-Mother-Child”, Lausanne University Hospital, 1011 Lausanne, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, 3012 Bern, Switzerland
| | - Michael Ceulemans
- Teratology Information Service, Pharmacovigilance Centre Lareb, 's-Hertogenbosch, 5237 MH Hertogenbosch, Netherlands
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, 3000 Leuven, Belgium
- L-C&Y, KU Leuven Child and Youth Institute, 3000 Leuven, Belgium
| | - Ursula Winterfeld
- Swiss Teratogen Information Service and Clinical Pharmacology Service, Lausanne University Hospital, 1011 Lausanne, Switzerland
| | - Kim Dao
- Swiss Teratogen Information Service and Clinical Pharmacology Service, Lausanne University Hospital, 1011 Lausanne, Switzerland
| | - Christian P. R. Schmid
- Christian P.R. Schmid, CSS Institute for Empirical Health Economics, 6002 Lucerne, Switzerland
- Department of Economics, University of Bern, 3012 Bern, Switzerland
| | - Stephen P. Jenkinson
- Institute of Primary Health Care (BIHAM), University of Bern, 3012 Bern, Switzerland
| | - Bartlomiej Niznik
- Institute of Primary Health Care (BIHAM), University of Bern, 3012 Bern, Switzerland
| | - David Baud
- Materno-Fetal and Obstetrics Research Unit, Department “Woman-Mother-Child”, Lausanne University Hospital, 1011 Lausanne, Switzerland
| | - Julia Spoendlin
- Hospital Pharmacy, University Hospital Basel, Basel, Switzerland
- Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Alice Panchaud
- Service of Pharmacy, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, 3012 Bern, Switzerland
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Evolution of maternal and neonatal outcomes before and after the adoption of the IADPSG/WHO guidelines in Belgium: A descriptive study of 444,228 pregnancies. Heliyon 2022; 8:e09251. [PMID: 35497044 PMCID: PMC9038558 DOI: 10.1016/j.heliyon.2022.e09251] [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] [Received: 11/24/2021] [Revised: 02/11/2022] [Accepted: 04/01/2022] [Indexed: 12/03/2022] Open
Abstract
Objectives To appraise adverse pregnancy outcomes after the adoption of IADPSG/WHO guidelines in Belgium. Methods A retrospective study of the Center for Perinatal Epidemiology registry was conducted. Demographic changes and adverse pregnancy outcomes were compared between a pre- and post-guideline period in women with and without hyperglycemia in pregnancy (HIP). Adjusted odds ratios with a 95% confidence interval (CI) were used to compare maternal and neonatal outcomes controlling for potential confounders (maternal age, body mass index (BMI), hypertension, parity, and multiple births). Results The prevalence of HIP increased (6.0%–9.2%). In the overall population regardless of glycemic status, gestational weight gain (12.3 ± 5.7 vs 11.9 ± 5.8; p < 0.001), hypertension (0.92; 95% CI, 0.89–0.94; p < 0.001), and neonatal intensive care unit/special care nursery (0.89; 95% CI, 0.87–0.91; p < 0.001) decreased despite increasing maternal age and pre-pregnancy BMI. Emergency cesarean section rates (1.07; 95% CI, 1.05–1.09; p < 0.001) increased, but not in the HIP population (1.02; 95% CI, 0.95–1.10; ns). The overall incidence of preterm birth (1.09; 95% CI, 1.06–1.12; p < 0.001), stillbirth (1.10; 95% CI, 1.01–1.21; p < 0.05), and perinatal mortality (1.10; 95% CI, 1.01–1.19; p < 0.05) increased, except in the HIP population (1.03; 95% CI, 0.95–1.11; ns), (1.04; 95% CI, 0.74–1.47; ns) and (1.09; 95% CI, 0.80–1.49; ns), respectively. The overall incidence of small- for-gestational-age remained unchanged (0.99; 95%CI, 0.97–1.01; ns) regardless of glycemic status. In the HIP population, large-for-gestational age (0.90; 95% CI, 0.84–0.95; p < 0.001) and macrosomia (0.84; 95% CI, 0.78–0.92; p < 0.001) decreased. Conclusion After the implementation of IADPSG/WHO guidelines, the prevalence of HIP increased by 53.7% and the incidence of major HIP-related pregnancy complications appears to be lower. However, we cannot conclude that the reduction of LGA-macrosomia is due to a better management of diabetes or due to greater recruitment of women with mild HIP associated with a lower risk of obstetrical complications.
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Bilous RW, Jacklin PB, Maresh MJ, Sacks DA. Resolving the Gestational Diabetes Diagnosis Conundrum: The Need for a Randomized Controlled Trial of Treatment. Diabetes Care 2021; 44:858-864. [PMID: 33741696 PMCID: PMC8578931 DOI: 10.2337/dc20-2941] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 01/16/2021] [Indexed: 02/03/2023]
Abstract
The diagnosis of and criteria for gestational diabetes mellitus (GDM) continue to divide the scientific and medical community, both between and within countries. Many argue for universal adoption of the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria and feel that further clinical trials are unjustified and even unethical. However, there are concerns about the large increase in number of women who would be diagnosed with GDM using these criteria and the subsequent impact on health care resources and the individual. This Perspective reviews the origins of the IADPSG consensus and points out some of its less well-known limitations, particularly with respect to identifying women at risk for an adverse pregnancy outcome. It also questions the clinical and cost-effectiveness data often cited to support the IADPSG glycemic thresholds. We present the argument that adoption of diagnostic criteria defining GDM should be based on response to treatment at different diagnostic thresholds of maternal glycemia. This will likely require an international multicenter trial of treatment.
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Affiliation(s)
- Rudolf W Bilous
- School of Medical Education, Newcastle University, Newcastle upon Tyne, U.K
| | - Paul B Jacklin
- Royal College of Obstetricians and Gynaecologists, London, U.K
| | - Michael J Maresh
- Department of Obstetrics, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, U.K
| | - David A Sacks
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
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Cosson E, Vicaut E, Sandre-Banon D, Gary F, Pharisien I, Portal JJ, Banu I, Bianchi L, Cussac-Pillegand C, Dina R, Chiheb S, Valensi P, Carbillon L. Early screening for gestational diabetes mellitus is not associated with improved pregnancy outcomes: an observational study including 9795 women. DIABETES & METABOLISM 2019; 45:465-472. [DOI: 10.1016/j.diabet.2018.11.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 10/29/2018] [Accepted: 11/15/2018] [Indexed: 01/09/2023]
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Zhu B, Yin P, Ma Z, Ma Y, Zhang H, Kong H, Zhu Y. Characteristics of bile acids metabolism profile in the second and third trimesters of normal pregnancy. Metabolism 2019; 95:77-83. [PMID: 30959040 DOI: 10.1016/j.metabol.2019.04.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 03/19/2019] [Accepted: 04/03/2019] [Indexed: 12/15/2022]
Abstract
PURPOSE Bile acids are a group of cholesterol metabolites functioning as key regulators of glucose, lipid, and energy metabolism. Their homeostatic control is essential to the physiology of the normal pregnancy. Abnormalities of bile acids regulation in pregnancy lead to intrahepatic cholestasis of pregnancy, a serious condition associated with a number of fetal and maternal morbidities. Dysregulation of glucose and lipids is also tied to perturbations in bile acid concentrations. Changes in bile acid metabolic profiles in the second and third trimesters of pregnancy have been incompletely explored. We seek to establish pregnancy-specific normative ranges for a number of bile acids in women in the second and third trimesters and explore changes in their concentrations in the period from 12 to 40 weeks gestation. PROCEDURE In this cross-sectional study, a total of 782 normal pregnant women were enrolled including n = 290 in the second trimester (12-28 weeks) and n = 492 in the third trimester (29-40 weeks). The concentrations of 14 bile acids were measured by liquid chromatography and mass spectrometry (LC-MS) and compared at various time points. Reference intervals of these bile acids were calculated using standard statistical techniques. RESULTS A reference interval profile of 14 bile acids from a cohort of 782 normal pregnant women was developed. Significant differences in concentration were found between the second trimester and the third trimester. Unconjugated bile acids dominate the bile acid profile in the second trimester, while conjugated bile acids, especially (taurine-conjugated) dominate in the third trimester. 28-31 weeks gestation was the notable change period of bile acid metabolism. CONCLUSION This study establishes pregnancy-specific reference intervals for bile acids in the second and third trimesters. As bile acid composition changes with gestational age, this study establishes a foundation for trimester-specific clinical interpretation of bile acid metabolic profiles in pregnant women.
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Affiliation(s)
- Bo Zhu
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China; Clinical Prenatal Diagnosis Center, Women's Hospital, School of Medicine, Zhejiang University, China
| | - Peiyuan Yin
- Key Laboratory of Separation Science for Analytical Chemistry, Dalian Institute of Chemical Physics, Chinese Academy of Sciences, Dalian, China; The First affiliated Hospital of Dalian Medical University, Dalian, China
| | - Zhixin Ma
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China; Clinical Prenatal Diagnosis Center, Women's Hospital, School of Medicine, Zhejiang University, China
| | - Yu Ma
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China; Clinical Prenatal Diagnosis Center, Women's Hospital, School of Medicine, Zhejiang University, China
| | - Hong Zhang
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China; Clinical Prenatal Diagnosis Center, Women's Hospital, School of Medicine, Zhejiang University, China
| | - Hongwei Kong
- Key Laboratory of Separation Science for Analytical Chemistry, Dalian Institute of Chemical Physics, Chinese Academy of Sciences, Dalian, China
| | - Yuning Zhu
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China; Clinical Prenatal Diagnosis Center, Women's Hospital, School of Medicine, Zhejiang University, China.
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Kansu-Celik H, Ozgu-Erdinc AS, Kisa B, Findik RB, Yilmaz C, Tasci Y. Prediction of gestational diabetes mellitus in the first trimester: comparison of maternal fetuin-A, N-terminal proatrial natriuretic peptide, high-sensitivity C-reactive protein, and fasting glucose levels. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2019; 63:121-127. [PMID: 31038593 PMCID: PMC10522132 DOI: 10.20945/2359-3997000000126] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 02/20/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE We investigated the utility of maternal fetuin-A, N-terminal proatrial natriuretic peptide (pro-ANP), high-sensitivity C-reactive protein (hs-CRP), and fasting glucose levels at 11-14 gestation weeks for predicting pregnancies complicated by gestational diabetes mellitus (GDM). SUBJECTS AND METHODS This prospective cohort study included 327 low-risk pregnant women who completed antenatal follow-up at a tertiary research hospital between January and April 2014. Maternal blood samples were collected between 11-14 gestational weeks in the first trimester of pregnancy and then stored at -80 °C until further analyses. During follow-up, 29 (8.8%) women developed GDM. The study population was compared 1:2 with age- and body mass index-matched pregnant women who did not develop GDM (n = 59). Fasting plasma glucose (FPG) levels and serum fetuin-A, pro-ANP, and hs-CRP levels were measured using automated immunoassay systems. RESULTS There was a significant negative correlation between fetuin-A and hs-CRP (CC = -0.21, p = 0.047) and a positive correlation between FPG and hs-CRP (CC = 0.251, p = 0.018). The areas under the receiver operating characteristic curve for diagnosing GDM were 0.337 (p = 0.013), 0.702 (p = 0.002), and 0.738 (p < 0.001) for fetuin-A, hs-CRP, and FPG, respectively. The optimal cut-off values were > 4.65, < 166, and > 88.5 mg/dL for maternal hs-CRP, fetuin-A, and FPG, respectively. CONCLUSION Reduced fetuin-A, elevated hs-CRP, and FPG levels in women in the first trimester can be used for the early detection of GDM. Further research is needed before accepting these biomarkers as valid screening tests for GDM.
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Affiliation(s)
- Hatice Kansu-Celik
- University of Health SciencesZekai Tahir Burak Health Practice Research CenterAnkaraTurkeyUniversity of Health Sciences, Zekai Tahir Burak Health Practice Research Center, Ankara, Turkey
| | - A. Seval Ozgu-Erdinc
- University of Health SciencesZekai Tahir Burak Health Practice Research CenterAnkaraTurkeyUniversity of Health Sciences, Zekai Tahir Burak Health Practice Research Center, Ankara, Turkey
| | - Burcu Kisa
- University of Health SciencesZekai Tahir Burak Health Practice Research CenterAnkaraTurkeyUniversity of Health Sciences, Zekai Tahir Burak Health Practice Research Center, Ankara, Turkey
| | - Rahime Bedir Findik
- University of Health SciencesZekai Tahir Burak Health Practice Research CenterAnkaraTurkeyUniversity of Health Sciences, Zekai Tahir Burak Health Practice Research Center, Ankara, Turkey
| | - Canan Yilmaz
- Gazi University Faculty of MedicineDepartment of Medical BiochemistryAnkaraTurkeyGazi University Faculty of Medicine, Department of Medical Biochemistry, Ankara, Turkey
| | - Yasemin Tasci
- University of Health SciencesZekai Tahir Burak Health Practice Research CenterAnkaraTurkeyUniversity of Health Sciences, Zekai Tahir Burak Health Practice Research Center, Ankara, Turkey
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