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Anness AR, Foster M, Osman MW, Webb D, Robinson T, Khalil A, Walkinshaw N, Mousa HA. Do maternal haemodynamics have a causal influence on treatment for gestational diabetes? J OBSTET GYNAECOL 2024; 44:2307883. [PMID: 38389317 DOI: 10.1080/01443615.2024.2307883] [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: 10/03/2023] [Accepted: 01/04/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Arterial stiffening is believed to contribute to the worsening of insulin resistance, and factors which are associated with needing pharmacological treatment of gestational diabetes (GDM), such as maternal obesity or advanced age, are associated with impaired cardiovascular adaptation to pregnancy. In this observational study, we aimed to investigate causal relationships between maternal haemodynamics and treatment requirement amongst women with GDM. METHODS We assessed maternal haemodynamics in women with GDM, comparing those who remained on dietary treatment with those who required pharmacological management. Maternal haemodynamics were assessed using the Arteriograph® (TensioMed Ltd, Budapest, Hungary) and the NICOM® non-invasive bio-reactance method (Cheetah Medical, Portland, Oregon, USA). A graphical causal inference technique was used for statistical analysis. RESULTS 120 women with GDM were included in the analysis. Maternal booking BMI was identified as having a causative influence on treatment requirement, with each unit increase in BMI increasing the odds of needing metformin and/or insulin therapy by 12% [OR 1.12 (1.02 - 1.22)]. The raw values of maternal heart rate (87.6 ± 11.7 vs. 92.9 ± 11.90 bpm, p = 0.014) and PWV (7.8 ± 1.04 vs. 8.4 ± 1.61 m/s, p = 0.029) were both significantly higher amongst the women requiring pharmacological management, though these relationships did not remain significant in causal logistic regression. CONCLUSIONS Maternal BMI at booking has a causal, rather than simply associational, relationship on the need for pharmacological treatment of GDM. No significant causal relationships were found between maternal haemodynamics and the need for pharmacological treatment.
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Affiliation(s)
- Abigail R Anness
- Maternal and Fetal Medicine Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Michael Foster
- Department of Computer Science, University of Sheffield, Sheffield, UK
| | - Mohammed W Osman
- Maternal and Fetal Medicine Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - David Webb
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
| | | | - Asma Khalil
- Fetal Medicine Unit, St. George's University Hospital (University of London), UK
| | - Neil Walkinshaw
- Department of Computer Science, University of Sheffield, Sheffield, UK
| | - Hatem A Mousa
- Maternal and Fetal Medicine Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
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2
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Saban M, Rovira G, Curriá MI. Risk factors associated with the need for insulin in patients with gestational diabetes in a reference hospital in Buenos Aires, Argentina: retrospective cohort study. REVISTA COLOMBIANA DE OBSTETRICIA Y GINECOLOGIA 2023; 74:136-142. [PMID: 37523686 PMCID: PMC10419874 DOI: 10.18597/rcog.3883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 04/28/2023] [Indexed: 08/02/2023]
Abstract
Objectives To describe the clinical and sociodemographic characteristics of pregnant women diagnosed with gestational diabetes mellitus (GDM) and to assess factors potentially associated with out-of-target glycemic control and the need for insulin. Materials and methods Retrospective descriptive cohort. Women with GDM delivered at a reference hospital between January 2018 and September 2020 were included; women delivered in a different institution were excluded. Measured variables were age, body mass index (BMI) at the start of pregnancy, family history of diabetes, gestational age at the time of diagnosis, blood glucose levels at baseline and following oral glucose tolerance test, fructosamine, Hba1c, and insulin therapy use. A descriptive exploratory analysis of factors associated with poor glycemic control was conducted using uni and multivariate analyses. Results Of the patients with GDM, 44 % were out of target for blood glucose with lifestyle and dietary measures. The exploratory analyses revealed a potential increase in the risk of poor glycemic control associated with initial blood glucose level on OGTT (raw OR: 3.57; 95 % CI: 2.1 - 6.1), BMI > 25 kg/m2 (OR: 1.97, 95 % CI: 1.15 - 3.34), and more advanced gestational age at the time of diagnosis as a protective factor against the need for insulin therapy (OR: 0.45, 95 % CI: 0.27- 0.75). However, these associations were not confirmed in the multivariate analysis. Conclusions A baseline blood glucose value greater than 95 mg/dl and BMI of more than 25 kg/m2 could be associated with poor glycemic control in women with GDM. Studies that assess these variables and control for confounding factors are needed in order to identify the factors associated with insulin requirement in pregnant women.
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Affiliation(s)
- Melina Saban
- Hospital Británico, Ciudad Autónoma de Buenos Aires (Argentina)..
| | - Gabriela Rovira
- Hospital Británico, Ciudad Autónoma de Buenos Aires (Argentina)..
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3
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Zaccara TA, Mikami FCF, Paganoti CF, Francisco RPV, Costa RA. Predicting insulin use among women with gestational diabetes diagnosed in oral glucose tolerance test. BMC Pregnancy Childbirth 2023; 23:410. [PMID: 37268897 DOI: 10.1186/s12884-023-05746-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/30/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is one of the most common complications affecting pregnant women. While most women will achieve adequate glycemic levels with diet and exercise, some will require pharmacological treatment to reach and maintain glucose levels between the desired thresholds. Identifying these patients early in pregnancy could help direct resources and interventions. METHODS This retrospective cohort of women with GDM diagnosed with an abnormal 75g-OGTT presents data from 869 patients (724 in the diet group and 145 in the insulin group). Univariate logistic regression was used to compare the groups, and multivariable logistic regression was used to identify independent factors associated with the need for insulin. A log-linear function was used to estimate the probability of requiring pharmacological treatment. RESULTS Women in the insulin group had higher pre-pregnancy BMI index (29.8 vs 27.8 kg/m2, odds ratio [OR] 1.06, 95% confidence interval [CI] 1.03-1.09), more frequent history of previous GDM (19.4% vs. 7.8%, OR 2.84, 95% CI 1.59-5.05), were more likely to have chronic hypertension (31.7% vs. 23.2%, OR 1.54, 95% CI 1.04-2.27), and had higher glucose levels at all three OGTT points. Multivariable logistic regression final model included age, BMI, previous GDM status, and the three OGTT values as predictors of insulin requirement. CONCLUSIONS We can use regularly collected data from patients (age, BMI, previous GDM status, and the three OGTT values) to calculate the risk of a woman with GDM diagnosed in OGTT needing insulin. Identifying patients with a greater risk of requiring pharmacological treatment could help healthcare services to better allocate resources and offer closer follow-up to high-risk patients.
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Affiliation(s)
- Tatiana A Zaccara
- Departamento de Obstetrícia e Ginecologia da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, SP, Brazil.
| | - Fernanda C F Mikami
- Divisão de Clínica Obstétrica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, SP, Brazil
| | - Cristiane F Paganoti
- Divisão de Clínica Obstétrica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, SP, Brazil
| | - Rossana P V Francisco
- Departamento de Obstetrícia e Ginecologia da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, SP, Brazil
| | - Rafaela A Costa
- Departamento de Obstetrícia e Ginecologia da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, SP, Brazil
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Liao LD, Ferrara A, Greenberg MB, Ngo AL, Feng J, Zhang Z, Bradshaw PT, Hubbard AE, Zhu Y. Development and validation of prediction models for gestational diabetes treatment modality using supervised machine learning: a population-based cohort study. BMC Med 2022; 20:307. [PMID: 36104698 PMCID: PMC9476287 DOI: 10.1186/s12916-022-02499-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 07/27/2022] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Gestational diabetes (GDM) is prevalent and benefits from timely and effective treatment, given the short window to impact glycemic control. Clinicians face major barriers to choosing effectively among treatment modalities [medical nutrition therapy (MNT) with or without pharmacologic treatment (antidiabetic oral agents and/or insulin)]. We investigated whether clinical data at varied stages of pregnancy can predict GDM treatment modality. METHODS Among a population-based cohort of 30,474 pregnancies with GDM delivered at Kaiser Permanente Northern California in 2007-2017, we selected those in 2007-2016 as the discovery set and 2017 as the temporal/future validation set. Potential predictors were extracted from electronic health records at different timepoints (levels 1-4): (1) 1-year preconception to the last menstrual period, (2) the last menstrual period to GDM diagnosis, (3) at GDM diagnosis, and (4) 1 week after GDM diagnosis. We compared transparent and ensemble machine learning prediction methods, including least absolute shrinkage and selection operator (LASSO) regression and super learner, containing classification and regression tree, LASSO regression, random forest, and extreme gradient boosting algorithms, to predict risks for pharmacologic treatment beyond MNT. RESULTS The super learner using levels 1-4 predictors had higher predictability [tenfold cross-validated C-statistic in discovery/validation set: 0.934 (95% CI: 0.931-0.936)/0.815 (0.800-0.829)], compared to levels 1, 1-2, and 1-3 (discovery/validation set C-statistic: 0.683-0.869/0.634-0.754). A simpler, more interpretable model, including timing of GDM diagnosis, diagnostic fasting glucose value, and the status and frequency of glycemic control at fasting during one-week post diagnosis, was developed using tenfold cross-validated logistic regression based on super learner-selected predictors. This model compared to the super learner had only a modest reduction in predictability [discovery/validation set C-statistic: 0.825 (0.820-0.830)/0.798 (95% CI: 0.783-0.813)]. CONCLUSIONS Clinical data demonstrated reasonably high predictability for GDM treatment modality at the time of GDM diagnosis and high predictability at 1-week post GDM diagnosis. These population-based, clinically oriented models may support algorithm-based risk-stratification for treatment modality, inform timely treatment, and catalyze more effective management of GDM.
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Affiliation(s)
- Lauren D Liao
- Division of Biostatistics, School of Public Health, University of California, Berkeley, CA, USA
| | - Assiamira Ferrara
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Mara B Greenberg
- Department of Obstetrics and Gynecology, Kaiser Permanente Northern California, Oakland, CA, USA.,Regional Perinatal Service Center, Kaiser Permanente Northern California, Santa Clara, CA, USA
| | - Amanda L Ngo
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Juanran Feng
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Zhenhua Zhang
- Department of Civil and Environmental Engineering, Stanford University, Palo Alto, CA, USA
| | - Patrick T Bradshaw
- Division of Epidemiology, School of Public Health, University of California, Berkeley, CA, USA
| | - Alan E Hubbard
- Division of Biostatistics, School of Public Health, University of California, Berkeley, CA, USA
| | - Yeyi Zhu
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA. .,Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.
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Alvarez-Silvares E, Bermúdez-González M, Vilouta-Romero M, García-Lavandeira S, Seoane-Pillado T. Prediction of insulin therapy in women with gestational diabetes: a systematic review and meta-analysis of observational studies. J Perinat Med 2022; 50:608-619. [PMID: 35313096 DOI: 10.1515/jpm-2021-0247] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 02/20/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To identify antenatal risk factors that may predict the need for insulin treatment upon diagnosis of gestational diabetes (GDM), that is, to identify the specific characteristics of women diagnosed with GDM who did not achieve good glycemic control through lifestyle modifications. METHODS We performed a comprehensive literature search in PubMed, Science Direct, Ebsco, and Scielo for studies evaluating the associations between antenatal factors and the need for insulin treatment published until January 28th, 2021. Random-effects models were used to estimate risk ratios and their 95% confidence interval. The quality of studies was assessed using the Newcastle-Ottawa Scale. Random-effects models were used to estimate outcomes, and effects reported as risk ratio and their 95% confidence interval. The systematic review and meta-analysis were registered in the International Prospective Register of Systematic Reviews. RESULTS Eighteen observational studies were selected, reporting 14,951 women with GDM of whom 5,371 received insulin treatment. There were statistically significant associations between the need for insulin treatment and BMI ≥ 30 (RR:2.2; 95%CI: 1.44-3.41), family history of type 2 diabetes mellitus (RR:1.74; 95%CI: 1.56-1.93), prior personal history of GDM (RR:2.10; 95%CI: 1.56-2.82), glycated hemoglobin value at GDM diagnosis (RR:2.12; 95%CI: 1.77-2.54), and basal glycemia obtained in the diagnostic curve (RR: 1.2; 95%CI: 1.12-1.28). Nulliparity and maternal age were not determinants factor. There was moderate-to-high heterogeneity among the included studies. CONCLUSIONS the strong causal association between BMI ≥ 30, family history of type 2 diabetes mellitus, prior history of GDM and glycosylated hemoglobin with the need for insulin treatment was revealed.
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Maternal AA/EPA Ratio and Triglycerides as Potential Biomarkers of Patients at Major Risk for Pharmacological Therapy in Gestational Diabetes. Nutrients 2022; 14:nu14122502. [PMID: 35745231 PMCID: PMC9231064 DOI: 10.3390/nu14122502] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/08/2022] [Accepted: 06/13/2022] [Indexed: 02/04/2023] Open
Abstract
Gestational diabetes mellitus (GD) is characterized by glycemic and lipid metabolism alterations in an environment of low-grade inflammation. Our trial aimed to assess the effect of nutraceutical supplements (omega-3 fatty acids, anthocyanins, and alpha-cyclodextrins) in GD patients and evaluate the role of anthropometric, metabolic, and inflammatory parameters as biomarkers to identify subjects who require pharmacological hypoglycemic treatment during gestation. Pregnant women with GD at 24-28 weeks of gestation were enrolled in a double-blind trial and randomized to receive either nutraceutical supplements or a placebo for 12 weeks. No statistically significant differences were observed between the two groups in blood and urine measurements of metabolic, inflammatory, and antioxidant parameters. In the whole cohort, pre-pregnancy BMI and anthropometric measurements were significantly different in patients who required pharmacological intervention. These patients showed higher triglycerides, CRP, and insulin levels and gave birth to newborns with significantly higher weights. Subjects with a greater AA/EPA ratio had higher PAF levels and gave birth four days earlier. In conclusion, one-to-one nutritional coaching and poor compliance with nutraceutical supplementation might have outweighed the impact of this intervention. However, triglyceride concentration and the AA/EPA ratio seems to be a biomarker for higher inflammatory levels and GD candidates for pharmacological treatment. An adequate assumption of omega-3 in women with GD, either by a controlled diet or by nutraceutical supplementation, reduces the need for pharmacological therapy.
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7
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Akgöl S, Budak MŞ, Oğlak SC, Ölmez F, Dilek ME, Kartal S. Can maternal abdominal fat thickness predict antenatal insulin therapy in patients with gestational diabetes mellitus? J Obstet Gynaecol Res 2021; 48:634-639. [PMID: 34931403 DOI: 10.1111/jog.15128] [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: 08/05/2021] [Revised: 11/13/2021] [Accepted: 12/05/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE This study aimed to investigate the effectiveness of abdominal subcutaneous fat thickness (ASFT) in predicting antenatal insulin therapy (AIT) in patients with gestational diabetes mellitus (GDM). METHODS A prospective study was conducted on patients with regulated blood sugar levels (n = 50) and those with unregulated blood sugar (n = 50) although medical nutrition therapy (MNT) was initiated and then AIT was applied. Using receiver operator characteristic (ROC) curve analysis, appropriate ASFT cut-off point values were found for the prediction of cases that required AIT after MNT in GDM pregnancies. RESULTS Patients with GDM who needed AIT had a significantly higher ASFT value compared to those with GDM who did not need AIT. The optimal ASFT cutoff was 21.7 mm in predicting cases that required AIT after MNT (sensitivity, specificity, negative, and positive predictive values were 68.0%, 64.0%, 65.8%, and 66.6%, respectively). The risk of AIT increased 3.77-fold in those with ASFT > 21.7 mm in GDM pregnancies (p = 0.001). CONCLUSION The ASFT value was significantly higher in cases with GDM, with blood glucose levels not regulated despite MNT and AIT being then needed, compared to patients with blood glucose levels regulated by MNT, and who did not need AIT. Also, patients requiring AIT can be determined with moderate to high sensitivity and specificity using a cut-off value of ASFT > 21.7 mm. The ASFT > 21.7 mm cut-off point was seen to be more effective than BMI ≥ 30 kg/m2 in the determination of cases where AIT is required.
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Affiliation(s)
- Sedat Akgöl
- Department of Obstetrics and Gynecology, Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey
| | - Mehmet Şükrü Budak
- Department of Obstetrics and Gynecology, Private Can Hospital, Izmir, Turkey
| | - Süleyman Cemil Oğlak
- Department of Obstetrics and Gynecology, Health Sciences University, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
| | - Fatma Ölmez
- Department of Obstetrics and Gynecology, Health Sciences University, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Emin Dilek
- Department of Internal Medicine, Health Sciences University, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
| | - Serhat Kartal
- Department of Radiology, Health Sciences University, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
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Tamagawa M, Kasuga Y, Saisho Y, Tanaka Y, Hasegawa K, Oishi M, Endo T, Sato Y, Ikenoue S, Tanaka M, Ochiai D. Predictors of later insulin therapy for gestational diabetes diagnosed in early pregnancy. Endocr J 2021; 68:1321-1328. [PMID: 34108310 DOI: 10.1507/endocrj.ej21-0118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Interventions for gestational diabetes mellitus (GDM), diagnosed in early pregnancy, have been a topic of controversy. This study aimed to elucidate factors that predict patients with GDM diagnosed before 24 gestational weeks (early GDM: E-GDM) who require insulin therapy later during pregnancy. Furthermore, we identified patients whose impaired glucose tolerance should be strictly controlled from early gestation onward. Women diagnosed with GDM were categorized based on the gestational age at diagnosis into E-GDM (n = 388) or late GDM (L-GDM, diagnosed after 24 weeks, n = 340) groups. Clinical features were compared between the groups, and the predictors for insulin therapy was evaluated in the E-GDM group. There were no significant between-group differences in terms of perinatal outcomes (e.g., gestational weeks at delivery, fetal growth, hypertensive disorder of pregnancy), with the exception of the Apgar score at 5 min. Moreover, there was no significant difference in the frequency of insulin therapy during pregnancy between the two groups. Using multiple logistic regression analysis, pre-pregnancy body mass index (BMI) ≥25 kg/m2, a family history of diabetes, and higher fasting plasma glucose (FPG), 1 h-plasma glucose (PG), and 2 h-PG values increased insulin therapy risk during pregnancy in the E-GDM group. Furthermore, since E-GDM patients with abnormal levels of FPG, as well as 1 h-PG or 2 h-PG, and those with pre-pregnancy BMI ≥25 kg/m2 and a family history of diabetes had a higher risk of later insulin therapy during pregnancy, they may require more careful follow-up in the perinatal period.
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Affiliation(s)
- Masumi Tamagawa
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Yoshifumi Kasuga
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Yoshifumi Saisho
- Department of Internal Medicine, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Yuya Tanaka
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Keita Hasegawa
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Maki Oishi
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Toyohide Endo
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Yu Sato
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Satoru Ikenoue
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Mamoru Tanaka
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Daigo Ochiai
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, 160-8582, Japan
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Martine-Edith G, Johnson W, Hunsicker E, Hamer M, Petherick ES. Associations between maternal characteristics and pharmaceutical treatment of gestational diabetes: an analysis of the UK Born in Bradford (BiB) cohort study. BMJ Open 2021; 11:e053753. [PMID: 34732497 PMCID: PMC8572403 DOI: 10.1136/bmjopen-2021-053753] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES To identify the maternal characteristics associated with pharmaceutical treatment of gestational diabetes mellitus (GDM). DESIGN Prospective birth cohort study. SETTING Bradford, UK. PARTICIPANTS 762 women from the Born in Bradford (BiB) cohort who were treated for GDM in a singleton pregnancy. BiB cohort participants were recruited from 2007 to 2010. All women booked for delivery were screened for GDM between 26 and 28 weeks of gestation using a 75 g 2-hour oral glucose tolerance test (OGTT). OUTCOME MEASURE GDM treatment type: lifestyle changes advice (lifestyle changes), lifestyle changes advice with supplementary insulin (insulin) and lifestyle changes advice with supplementary metformin (metformin). RESULTS 244 (32%) women were prescribed lifestyle changes advice alone while 518 (68%) were offered supplemental pharmaceutical treatment. The odds of receiving pharmaceutical treatment relative to lifestyle changes advice alone were increased for mothers who were obese (OR 4.6, 95% CI 2.8 to 7.5), those who smoked (OR 2.6, 95% CI 1.2 to 5.5) and had higher fasting glucose levels at OGTT (OR 2.1, 95% CI 1.6 to 2.7). The odds of being prescribed pharmaceutical treatment rather than lifestyle changes advice were lower for Pakistani women (OR 0.7, 95% CI 0.4 to 1.0)) than White British women. Relative to insulin treatment, metformin was more likely to be offered to obese women than normal weight women (relative risk ratio, RRR 3.2, 95% CI 1.3 to 7.8) and less likely to be prescribed to women with higher fasting glucose concentrations at OGTT (RRR 0.3, 95% CI 0.2 to 0.6). CONCLUSIONS In the BiB cohort, GDM pharmaceutical treatment tended to be prescribed to women who were obese, White British, who smoked and had more severe hyperglycaemia. The characteristics of metformin-treated mothers differed from those of insulin-treated mothers as they were more likely to be obese but had lower glucose concentrations at diagnosis.
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Affiliation(s)
- Gilberte Martine-Edith
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - William Johnson
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | | | - Mark Hamer
- Institute of Sport, Exercise and Health, Division Surgery Interventional Science, University College London, London, UK
| | - Emily S Petherick
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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Sampaio Y, Porto LB, Lauand TCG, Marcon LP, Pedrosa HC. Gestational diabetes and overt diabetes first diagnosed in pregnancy: characteristics, therapeutic approach and perinatal outcomes in a public healthcare referral center in Brazil. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2021; 65:79-84. [PMID: 33166439 PMCID: PMC10528695 DOI: 10.20945/2359-3997000000310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 09/26/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To describe the clinical characteristics, management, and fetal outcomes of patients diagnosed with gestational diabetes mellitus (GDM) or overt diabetes (OD) during pregnancy who followed up at a public healthcare referral center in Brazil. METHODS A retrospective cohort study based on the medical records of women diagnosed with dysglycemia during pregnancy between January 2015 and July 2017 was conducted. RESULTS Out of 224 pregnant women evaluated, 70% were overweight/obese. GDM was observed in 78.6% of pregnant women, while 21.4% presented with OD. Approximately 59% of patients could be diagnosed with GDM or OD by fasting plasma glucose (FPG) alterations alone. Exclusive diet therapy was used in 50.9% of patients. The need for insulin therapy was higher in OD patients (60.4%) than in GDM patients (38.1%) (p = 0.006). Women who needed insulin (n = 96) had a mean initial dose of 0.33 IU/kg (±0.27) and a final value of 0.39 IU/kg (±0.34). The cesarean rate was 74.3%. The fetal outcomes evaluated were macrosomia (2.15%), large for gestational age (LGA) fetus (15.83%), intensive care unit (ICU) need (4.32%), Apgar score ≤7 (6.47%), hypoglycemia (14.39%) and jaundice (16.55%). CONCLUSION Patients with GDM and OD presented with several similar clinical features. Approximately half of the patients presented with adequate glycemic control only with diet management. Patients with OD presented a higher need for insulin therapy. Although overweight and obesity were frequent within both groups, they could possibly explain many of our findings.
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Affiliation(s)
- Yanara Sampaio
- Unidade de Endocrinologia e Centro de Pesquisa, Hospital Regional de Taguatinga, Secretaria de Saúde do Distrito Federal, Taguatinga, Brasília, DF, Brasil
| | - Lara Benigno Porto
- Unidade de Endocrinologia e Centro de Pesquisa, Hospital Regional de Taguatinga, Secretaria de Saúde do Distrito Federal, Taguatinga, Brasília, DF, Brasil,
| | - Thais Cabral Gomes Lauand
- Unidade de Endocrinologia e Centro de Pesquisa, Hospital Regional de Taguatinga, Secretaria de Saúde do Distrito Federal, Taguatinga, Brasília, DF, Brasil
| | - Larissa Pereira Marcon
- Unidade de Endocrinologia e Centro de Pesquisa, Hospital Regional de Taguatinga, Secretaria de Saúde do Distrito Federal, Taguatinga, Brasília, DF, Brasil
| | - Hermelinda Cordeiro Pedrosa
- Unidade de Endocrinologia e Centro de Pesquisa, Hospital Regional de Taguatinga, Secretaria de Saúde do Distrito Federal, Taguatinga, Brasília, DF, Brasil
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Eleftheriades M, Chatzakis C, Papachatzopoulou E, Papadopoulos V, Lambrinoudaki I, Dinas K, Chrousos G, Sotiriadis A. Prediction of insulin treatment in women with gestational diabetes mellitus. Nutr Diabetes 2021; 11:30. [PMID: 34601490 PMCID: PMC8487424 DOI: 10.1038/s41387-021-00173-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 05/24/2021] [Accepted: 08/11/2021] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION The identification of pregnant women with Gestational Diabetes Mellitus (GDM) who will require insulin therapy, may modify their management to closer monitoring and probable early interventions. The aim of the study was to develop a predictive model for the necessity of insulin treatment in women with GDM. MATERIALS AND METHODS This was a prospective cohort study. Data from 775 women diagnosed with GDM per the IADPSG criteria were analyzed using logistic regression and a machine learning algorithm, the Classification and Regression Trees (CART). Potential predictors routinely recorded at follow-up visits were tested and used for the development of the model. The resultant model was externally validated using the data from two different perinatology clinics. RESULTS Preconceptional maternal BMI and morning fasting blood glucose levels at baseline and at 1 h during an Oral Glucose Tolerance Test (OGTT) were independent significant predictors for the treatment modality of GDM. Baseline blood glucose greater than 98 mg/dl and preconceptional maternal Body Mass Index (BMI) between 26 and 31 kg/height2 increased substantially the probability of insulin therapy (odds ratio [OR] 4.04, 95% confidence interval [CI] CI 2.65-6.17 and 2.21, 95%CI 1.42-3.43, respectively). The area under the curve (AUC) for the internal and external validation of the predictive model was 0.74 and 0.77, respectively. CONCLUSIONS A simple model based on maternal characteristics and the values of an OGTT can predict the need for insulin treatment with accuracy. Overweight women with an abnormal baseline blood glucose at OGTT are at high likelihood for insulin treatment. KEY MESSAGE Fifteen to 30% of women with Gestational Diabetes Mellitus (GDM) require insulin therapy. Overweight women with baseline blood glucose greater than 98 mg/dl at OGTT are at increased risk for insulin treatment and close monitoring and increased physical exercise are required.
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Affiliation(s)
- Makarios Eleftheriades
- 2nd Department of Obstetrics and Gynecology Aretaieio Hospital, National and Kapodistrian University of Athens - Faculty of Medicine, Athens, Greece.
| | - Christos Chatzakis
- 2nd Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece
| | - Eftychia Papachatzopoulou
- 2nd Department of Obstetrics and Gynecology Aretaieio Hospital, National and Kapodistrian University of Athens - Faculty of Medicine, Athens, Greece
| | - Vassilis Papadopoulos
- University of Patras Medical School, Department of Obstetrics and Gynecology, Patras, Greece
| | - Irene Lambrinoudaki
- 2nd Department of Obstetrics and Gynecology Aretaieio Hospital, National and Kapodistrian University of Athens - Faculty of Medicine, Athens, Greece
| | - Konstantinos Dinas
- 2nd Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece
| | - George Chrousos
- University Research Institute of Maternal and Child Health and Precision Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Alexandros Sotiriadis
- 2nd Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece
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You SY, Han K, Lee SH, Kim MK. Nonalcoholic fatty liver disease and the risk of insulin-requiring gestational diabetes. Diabetol Metab Syndr 2021; 13:90. [PMID: 34446090 PMCID: PMC8393465 DOI: 10.1186/s13098-021-00710-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 08/14/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) is one of the most common chronic liver diseases; however, there has been little research into its impact on gestational diabetes mellitus (GDM). METHODS This study included 308,095 women registered in the Korean National Health Insurance Service database, who delivered between 2011 and 2015 and received a health examination within 52 weeks before pregnancy. Insulin-requiring GDM was defined as no insurance claims for diabetes mellitus and a fasting blood glucose level of < 126 mg/dL before pregnancy, and initiation of insulin treatment during pregnancy. A fatty liver index (FLI) was calculated using body mass index, waist circumference, and blood triglyceride and γ-glutamyl transferase levels. FLI scores < 30 ruled out hepatic steatosis, while FLI scores ≥ 60 indicated NAFLD. RESULTS The prevalence of NAFLD was 0.8% (2355/308,095) and 1984 (0.6%) subjects developed insulin-requiring GDM. FLIs of 30-59 and ≥ 60 were significantly associated with increased risk of insulin-requiring GDM (odds ratio [OR] 3.50; 95% confidence interval [CI] 2.99-4.10; OR 4.19; 95% CI 3.37-5.23), respectively. Further exploration of the association of FLI with GDM across FLI decile categories revealed a steady increase in OR across the categories. The association was more prominent among those without metabolic syndrome. CONCLUSION NAFLD in women is an independent risk factor for insulin-requiring GDM.
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Affiliation(s)
- Sang Youn You
- College of Medicine, The Catholic University of Korea, Seoul, 06591, South Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, 06978, South Korea
| | - Seung-Hawn Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, #222 Banpo-daero, Seocho-gu, Seoul, 06591, South Korea.
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, 06591, South Korea.
| | - Mee Kyoung Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, Yeouido St. Mary's Hospital, The Catholic University of Korea, #10 63-ro, Yeongdeungpo-gu, Seoul, 07345, South Korea.
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Paganoti CDF, da Costa RA, Oliveira AMDSS, Hoshida MS, Francisco RPV. Adiponectin does not improve the prediction of insulin need in pregnant women with gestational diabetes mellitus. ENDOCRINE AND METABOLIC SCIENCE 2021. [DOI: 10.1016/j.endmts.2021.100095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
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Identification of Diagnostic CpG Signatures in Patients with Gestational Diabetes Mellitus via Epigenome-Wide Association Study Integrated with Machine Learning. BIOMED RESEARCH INTERNATIONAL 2021; 2021:1984690. [PMID: 34104645 PMCID: PMC8162250 DOI: 10.1155/2021/1984690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 04/01/2021] [Accepted: 05/06/2021] [Indexed: 12/13/2022]
Abstract
Background Gestational diabetes mellitus (GDM) is the most prevalent metabolic disease during pregnancy, but the diagnosis is controversial and lagging partly due to the lack of useful biomarkers. CpG methylation is involved in the development of GDM. However, the specific CpG methylation sites serving as diagnostic biomarkers of GDM remain unclear. Here, we aimed to explore CpG signatures and establish the predicting model for the GDM diagnosis. Methods DNA methylation data of GSE88929 and GSE102177 were obtained from the GEO database, followed by the epigenome-wide association study (EWAS). GO and KEGG pathway analyses were performed by using the clusterProfiler package of R. The PPI network was constructed in the STRING database and Cytoscape software. The SVM model was established, in which the β-values of selected CpG sites were the predictor variable and the occurrence of GDM was the outcome variable. Results We identified 62 significant CpG methylation sites in the GDM samples compared with the control samples. GO and KEGG analyses based on the 62 CpG sites demonstrated that several essential cellular processes and signaling pathways were enriched in the system. A total of 12 hub genes related to the identified CpG sites were found in the PPI network. The SVM model based on the selected CpGs within the promoter region, including cg00922748, cg05216211, cg05376185, cg06617468, cg17097119, and cg22385669, was established, and the AUC values of the training set and testing set in the model were 0.8138 and 0.7576. The AUC value of the independent validation set of GSE102177 was 0.6667. Conclusion We identified potential diagnostic CpG signatures by EWAS integrated with the SVM model. The SVM model based on the identified 6 CpG sites reliably predicted the GDM occurrence, contributing to the diagnosis of GDM. Our finding provides new insights into the cross-application of EWAS and machine learning in GDM investigation.
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Du R, Li L. Estimating the Risk of Insulin Requirement in Women Complicated by Gestational Diabetes Mellitus: A Clinical Nomogram. Diabetes Metab Syndr Obes 2021; 14:2473-2482. [PMID: 34103956 PMCID: PMC8179754 DOI: 10.2147/dmso.s310866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/22/2021] [Indexed: 12/02/2022] Open
Abstract
PURPOSE This study sought to develop a nomogram for the prediction of insulin requirement in a Chinese population with gestational diabetes mellitus (GDM). MATERIALS AND METHODS We performed a retrospective cohort study involving 626 Chinese women with GDM, of whom 188 were treated with insulin. "Least absolute shrinkage and selection operator" regression was used to optimize the independent predictors of insulin requirement during pregnancies complicated with GDM. Cox proportional hazards regression analysis was performed to establish a prediction model incorporating the selected predictors, and the nomogram was constructed to achieve individual prediction. The C-index, calibration plot and decision curve analysis were used to validate the model. RESULTS Maternal age, family history of type 2 diabetes mellitus in a first-degree relative, a prior GDM history, fasting plasma glucose, hemoglobin A1c, gestational age, and body mass index values at the time of GDM diagnosis were the risk factors for insulin treatment. The model displayed medium predictive power with a C-index of 0.77 (95% confidence interval: 0.73-0.81) and relatively good calibration accuracies. The decision curve demonstrated a positive net benefit with a threshold between 0.09 and 0.70. CONCLUSION The findings suggest that our nomogram, incorporating seven indicators, is useful in predicting individualized survival probabilities of insulin requirement.
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Affiliation(s)
- Runyu Du
- Department of Endocrinology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, People’s Republic of China
| | - Ling Li
- Department of Endocrinology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, People’s Republic of China
- Correspondence: Ling Li Department of Endocrinology, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, Liaoning Province, 110004, People’s Republic of ChinaTel +86 18940251181Fax +86 24-25944460 Email
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Wang T, Yin W, Huang Y, Zhang Q. Identification of Significant Predictors for the Need of Insulin Therapy and Onset of Postpartum Impaired Glucose Tolerance in Gestational Diabetes Mellitus Patients. Diabetes Metab Syndr Obes 2021; 14:2609-2617. [PMID: 34140790 PMCID: PMC8203192 DOI: 10.2147/dmso.s309618] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 04/21/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) during pregnancy can greatly increase the risk for a number of adverse prenatal and postpartum consequences, including postpartum impaired glucose tolerance (IGT). Determining the need for insulin therapy is critical for controlling the glycemic level in GDM patients. The study contains two major purposes: 1) to identify the potential predictors for the need of insulin therapy in GDM patients; 2) to identify the factors that are related to the onset of postpartum IGT. MATERIALS AND METHODS Here, we performed a retrospective study on 112 GDM patients in China to identify the significant predictors for the need of insulin therapy and onset of postpartum IGT in patients with GDM. RESULTS Age and gestational weeks at GDM diagnosis, pregestational BMI, family history of diabetes mellitus (DM), plasma glucose levels assessed by 75-g OGTT at both the 1-hour and 2-hour time points (PG-1h and PG-2h) and HbA1c level were all significantly different between the patients that received insulin therapy and those did not. During postpartum, family history of DM, PG-1h PG-2h and HbA1c level were found to be significantly different between the patients with normal glucose tolerance and those with IGT. CONCLUSION Our results reveal a number of factors that are closely associated with the need of insulin therapy and onset of postpartum IGT, especially the PG-1h and PG-2h levels. These findings will provide valuable indications on selection of treatment strategy for GDM and GDM-induced postpartum IGT.
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Affiliation(s)
- Ting Wang
- Department of Reproductive Medicine Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People’s Republic of China
- Department of Reproductive Medicine Center, The First People’s Hospital of Foshan(Affiliated FoShan Hospital of Sun Yat-sen University), Foshan, People’s Republic of China
| | - Wei Yin
- Department of Obstetrics, Guangzhou Women and Children’s Center, Guangzhou, People’s Republic of China
| | - Yonghan Huang
- Department of Reproductive Medicine Center, The First People’s Hospital of Foshan(Affiliated FoShan Hospital of Sun Yat-sen University), Foshan, People’s Republic of China
| | - Qingxue Zhang
- Department of Reproductive Medicine Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People’s Republic of China
- Correspondence: Qingxue Zhang Email
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Kim HY, Kim J, Noh E, Ahn KH, Cho GJ, Hong SC, Oh MJ, Kim HJ. Prepregnancy hemoglobin levels and gestational diabetes mellitus in pregnancy. Diabetes Res Clin Pract 2021; 171:108608. [PMID: 33310123 DOI: 10.1016/j.diabres.2020.108608] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 11/15/2020] [Accepted: 12/01/2020] [Indexed: 12/16/2022]
Abstract
AIM To identify the influence of prepregnancy hemoglobin levels on gestational diabetes mellitus. MATERIALS AND METHODS Korean women who had given birth between January 1st, 2006 and December 31st, 2015 and who had undergone a biannual national health screening examination within 6 months prior to pregnancy were enrolled. Subjects were divided into three groups according to their hemoglobin levels. Multivariate logistic regression analysis was used to estimate the adjusted odds ratio and 95% confidence interval for GDM. RESULTS Of the 366,122 participants, GDM developed in 14,799 (4%) women. More specifically, GDM developed in 3.6% of women with prepregnancy anemia (hemoglobin < 11 g/dL), 3.57% with normal hemoglobin levels, and 4.47% with hemoglobin levels higher than 13 g/dL. We did not find any association between prepregnancy anemia and the risk of developing GDM (OR 1.002 [95% CI 0.90-1.11]). After adjusting for potential confounding factors (adjusted odds ratio 1.41; 95% CI 1.29-1.54), high hemoglobin levels were associated with insulin requiring GDM. CONCLUSIONS Our study identified an association between high prepregnancy hemoglobin levels and GDM risk.
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Affiliation(s)
- Ho Yeon Kim
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jinsil Kim
- Korea University Guro Hospital Smart Healthcare Center, Seoul, Republic of Korea
| | - Eunjin Noh
- Korea University Guro Hospital Smart Healthcare Center, Seoul, Republic of Korea
| | - Ki Hoon Ahn
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Geum Joon Cho
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea.
| | - Soon-Cheol Hong
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Min-Jeong Oh
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hai-Joong Kim
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea
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Kim MK, Han K, You SY, Kwon HS, Yoon KH, Lee SH. Prepregnancy smoking and the risk of gestational diabetes requiring insulin therapy. Sci Rep 2020; 10:13901. [PMID: 32807828 PMCID: PMC7431589 DOI: 10.1038/s41598-020-70873-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 08/03/2020] [Indexed: 12/04/2022] Open
Abstract
The relationship between maternal smoking and gestational diabetes mellitus (GDM) is inconclusive. We investigated whether prepregnancy smoking is a risk factor for insulin-requiring GDM in Korean women. Using the National Health Insurance Service database, 325,297 women who delivered between 2011 and 2015 and who received a health examination within 52 weeks before pregnancy were included. Insulin-requiring GDM was defined as no claims for diabetes mellitus and a fasting blood glucose level of < 126 mg/dL before pregnancy, and initiation of insulin treatment during pregnancy. Smoking status was identified in a self-reported questionnaire completed during the health examination. There were 2,114 women (0.65%) with GDM who required insulin therapy. Compared with nonsmokers, the fully adjusted odd ratios (ORs) of former smokers and current smokers for insulin-requiring GDM were 1.55 (95% confidence interval [CI] 1.27–1.90) and 1.73 (1.42–2.09), respectively. The ORs (95% CIs) of insulin-requiring GDM among women who reported ≤ 2, 2–≤ 4, 4–≤ 6, 6–≤ 8, 8–≤ 10, and > 10 pack-years of smoking were 1.50 (1.22–1.84), 1.71 (1.31–2.22), 1.60 (1.13–2.26), 1.97 (1.14–3.40), 2.34 (1.22–4.51), and 2.29 (1.25–4.22), respectively, compared with nonsmokers (P for trend < 0.001). This association was similar in women with or without obesity and abdominal obesity. In conclusions, women who smoke have a significantly higher risk of GDM requiring insulin therapy, which may be proportional to the cumulative exposure to smoking. Cessation of smoking should be emphasized in women of childbearing age for the prevention of GDM.
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Affiliation(s)
- Mee Kyoung Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 07345, South Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, 06978, South Korea
| | - Sang Youn You
- College of Medicine, The Catholic University of Korea, Seoul, 06591, South Korea
| | - Hyuk-Sang Kwon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 07345, South Korea
| | - Kun-Ho Yoon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, #222 Banpo-daero, Seocho-gu,, Seoul, 06591, South Korea.,Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, 06591, South Korea
| | - Seung-Hwan Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, #222 Banpo-daero, Seocho-gu,, Seoul, 06591, South Korea. .,Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, 06591, South Korea.
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Chee C, Hibbert EJ, Lam P, Nanan R, Liu A. Sonographic and other nonglycemic factors can predict large-for-gestational-age infants in diet-managed gestational diabetes mellitus: A retrospective cohort study. J Diabetes 2020; 12:562-572. [PMID: 32250016 DOI: 10.1111/1753-0407.13042] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 03/01/2020] [Accepted: 03/27/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is one of the most common complications of pregnancy. Left untreated or poorly controlled, GDM results in adverse infant outcomes such as large for gestational age (LGA). This study aims to identify nonglycemic maternal and fetal factors predictive of LGA outcomes in pregnancies complicated by diet-managed GDM. METHODS This was a retrospective cohort study of singleton pregnancies complicated by diet-managed GDM from 2004 to 2015. Multiple logistic regression analysis was performed on maternal and perinatal factors to identify risk factors for LGA. In addition, a subset univariate analysis was conducted for pregnancies in which fetal ultrasound abdominal circumference measurements were available at gestational weeks 18 to 22, 24 to 28, and 29 to 33. RESULTS A total of 1064 women were included, delivering 123 LGA infants. Women with higher parity (odds ratio [OR] 1.44; CI, 1.23-1.68; P < .001) and higher prepregnancy body mass index (BMI) (OR 1.09; CI, 1.06-1.12; P < .001) were more likely to have LGA infants. Maternal smoking (OR 0.30; CI, 0.14-0.62; P = .001) and higher gestational age at birth (OR 0.91; CI, 0.84-0.99; P = .018) were associated with reduced risk. Subset univariate analysis showed that fetal abdominal circumference measurements at weeks 24 to 28 and 29 to 33 beyond the 75th percentile (OR 5.92 and 13.74, respectively) and 90th percentile (OR 4.57 and 15.89, respectively) were highly predictive of LGA. CONCLUSIONS Parity, smoking status, maternal BMI, gestational age, and ultrasound fetal abdominal circumference measurements were identified as useful predictors of LGA. Presence of these predictors may prompt closer monitoring of pregnancy and early therapeutic intervention to improve management and reduce the risk of adverse fetal and maternal outcomes.
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Affiliation(s)
- Chermaine Chee
- Discipline of Paediatrics, The University of Sydney Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney, Penrith, New South Wales, Australia
| | - Emily Jane Hibbert
- Department of Endocrinology and Diabetes, Division of Medicine, The University of Sydney Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney, Penrith, New South Wales, Australia
| | - Penny Lam
- Department of Perinatal Ultrasound, Nepean Hospital, Penrith, New South Wales, Australia
| | - Ralph Nanan
- Discipline of Paediatrics, The University of Sydney Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney, Penrith, New South Wales, Australia
- Charles Perkins Centre Nepean, The University of Sydney, Penrith, New South Wales, Australia
| | - Anthony Liu
- Discipline of Paediatrics, The University of Sydney Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney, Penrith, New South Wales, Australia
- Charles Perkins Centre Nepean, The University of Sydney, Penrith, New South Wales, Australia
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Ardilouze A, Bouchard P, Hivert MF, Simard C, Allard C, Garant MP, Ménard J, Ouellet A, Houde G, Pesant MH, Baillargeon JP, Ardilouze JL. Self-Monitoring of Blood Glucose: A Complementary Method Beyond the Oral Glucose Tolerance Test to Identify Hyperglycemia During Pregnancy. Can J Diabetes 2019; 43:627-635. [DOI: 10.1016/j.jcjd.2019.02.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 01/24/2019] [Accepted: 02/13/2019] [Indexed: 10/27/2022]
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Kouhkan A, Baradaran HR, Hosseini R, Arabipoor A, Moini A, Pirjani R, Khajavi A, Khamseh ME. Assisted conception as a potential prognostic factor predicting insulin therapy in pregnancies complicated by gestational diabetes mellitus. Reprod Biol Endocrinol 2019; 17:83. [PMID: 31656196 PMCID: PMC6815419 DOI: 10.1186/s12958-019-0525-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 09/23/2019] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Advanced maternal age, family history of diabetes, pre-gestational obesity, increased level of HbA1c, history of gestational diabetes mellitus (GDM), and poor pregnancy consequences are considered risk factors for antenatal insulin requirement in women with GDM. However, the role of assisted reproductive technology (ART) in increasing the risk of insulin therapy in pregnancies complicated with GDM remained elusive. The current study aimed to determine the role of ART in predicting insulin therapy in GDM women and investigate the clinical and biochemical factors predicting the need for insulin therapy in pregnancies complicated with GDM. METHODS In this prospective cohort study, 236 Iranian women with GDM were diagnosed by one-step oral glucose tolerance test (OGTT) between October 2014 and June 2017. They were mainly assigned to two groups; the first group (n = 100) was designated as ART which was further subdivided into two subgroups as follows: 60 participants who received medical nutrition therapy (MNT) and 40 participants who received MNT plus insulin therapy (MNT-IT). The second group (n = 136) was labeled as the spontaneous conception (SC), consisting of 102 participants receiving MNT and 34 participants receiving MNT in combination with IT (MNT-IT). The demographic, clinical, and biochemical data were compared between groups. Multivariate logistic regression was performed to estimate prognostic factors for insulin therapy. RESULTS A higher rate of insulin therapy was observed in the ART group as compared with the SC group (40% vs. 25%; P < 0.001). Multivariate logistic regression demonstrated that maternal age ≥ 35 years [OR: 2.91, 95% CI: (1.28-6.62)], high serum FBS [1.10: (1.04-1.16)], HbA1c [1.91 (1.09-3.34)], and ART treatment [2.94: (1.24-6.96)] were independent risk factors for insulin therapy in GDM women. CONCLUSIONS Apart from risk factors mentioned earlier, ART may be a possible prognostic factor for insulin therapy in pregnancies complicated with GDM.
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Affiliation(s)
- Azam Kouhkan
- grid.417689.5Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
- 0000 0004 0612 4397grid.419336.aDepartment of Interdisciplinary Research in Diabetes, Obesity and Metabolism, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, 19395-4644, Iran
| | - Hamid Reza Baradaran
- 0000 0004 4911 7066grid.411746.1Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences (IUMS), Firouzeh St., South Vali- Asr Ave., Vali- Asr Sq, Tehran, Iran
- 0000 0004 1936 7291grid.7107.1Ageing Clinical & Experimental Research Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, AB25 2ZD Scotland, UK
| | - Roya Hosseini
- grid.417689.5Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
- grid.417689.5Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Arezoo Arabipoor
- grid.417689.5Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Ashraf Moini
- grid.417689.5Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
- 0000 0001 0166 0922grid.411705.6Department of Gynecology and Obstetrics, Arash Women’s Hospital, Tehran University of Medical Sciences, Tehran, Iran
- 0000 0001 0166 0922grid.411705.6Breast Disease Research Center (BDRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Reihaneh Pirjani
- 0000 0001 0166 0922grid.411705.6Department of Gynecology and Obstetrics, Arash Women’s Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Khajavi
- grid.411600.2Student Research Committee, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad E. Khamseh
- 0000 0004 4911 7066grid.411746.1Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences (IUMS), Firouzeh St., South Vali- Asr Ave., Vali- Asr Sq, Tehran, Iran
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Ducarme G, Desroys du Roure F, Grange J, Vital M, Le Thuaut A, Crespin-Delcourt I. Predictive factors of subsequent insulin requirement for glycemic control during pregnancy at diagnosis of gestational diabetes mellitus. Int J Gynaecol Obstet 2019; 144:265-270. [PMID: 30578686 DOI: 10.1002/ijgo.12753] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 09/12/2018] [Accepted: 12/20/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To determine maternal and biological parameters at diagnosis of gestational diabetes mellitus (GDM) as predictors of antenatal insulin therapy (AIT) for glycemic control. METHODS In this planned secondary analysis of a prospective observational study, we recruited women diagnosed with GDM between July 1, 2014, and October 31, 2015. Maternal and biological parameters were analyzed as predictors of AIT using multivariable logistic regression analyses. Predictive accuracy of a cut-off value for a biological predictor was determined using the area under the receiver operating characteristic curve (AUC) and the Youden index (J). RESULTS Of 200 women included (mean gestational age 22 ± 6 weeks), 72 (36%) required AIT. No maternal characteristic was associated with AIT. Glycated hemoglobin (HbA1c; adjusted odds ratio [aOR] 3.15, 95% CI 1.03-9.69) and elevated 1-hour oral glucose tolerance test (OGTT; aOR 1.23, 95% CI 1.13-1.46) were predictors of AIT. Analyses suggested inaccurate prediction of AIT, with an optimal cut-off HbA1c value of 5.4% (J=0.14; AUC 0.58, 95% CI 0.48-0.67), and an optimal 1-hour plasma glucose OGTT value of 1.77 mg/dL (J=0.24; AUC 0.62, 95% CI 0.50-0.74). CONCLUSION HbA1c at diagnosis of GDM and elevated 1-hour OGTT were independent predictors of AIT for glycemic control. Clinicaltrials.gov: NCT02159378.
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Affiliation(s)
- Guillaume Ducarme
- Department of Obstetrics and Gynecology, Centre Hospitalier Departemental, La Roche sur Yon, France
| | | | - Joséphine Grange
- Department of Obstetrics and Gynecology, Centre Hospitalier Departemental, La Roche sur Yon, France
| | - Mathilde Vital
- Department of Obstetrics and Gynecology, Centre Hospitalier Departemental, La Roche sur Yon, France
| | - Aurélie Le Thuaut
- Clinical Research Center, Centre Hospitalier Departemental, La Roche sur Yon, France
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Ding TT, Xiang J, Luo BR, Hu J. Relationship between the IADPSG-criteria-defined abnormal glucose values and adverse pregnancy outcomes among women having gestational diabetes mellitus: A retrospective cohort study. Medicine (Baltimore) 2018; 97:e12920. [PMID: 30412096 PMCID: PMC6221640 DOI: 10.1097/md.0000000000012920] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
To explore the influence of the 75 g oral glucose tolerance test (OGTT) on pregnancy outcomes and to determine the risk factors for adverse outcomes among women with gestational diabetes mellitus (GDM).This retrospective cohort study was conducted among women who had GDM and were treated between January 1, 2015 and December 31, 2017. The diagnostic criteria for GDM were proposed by the International Diabetes and Pregnancy Research Organization (IADPSG) in 2010. Women with GDM were stratified according to the number of abnormal OGTT values or the presence/absence of adverse pregnancy outcomes. Maternal characteristics, OGTT values, pregnancy outcomes, and the relationship between the latter 2 were analyzed.In total, 3221 pregnant women with GDM were included. The incidence of adverse outcomes was affected by maternal age (28-37 years, in particular; odds ratio [OR], 1.403; 95% confidence interval [CI], 1.037-1.899; P = .028), days of pregnancy (OR, 0.904; 95% CI, 0.894-0.914; P < .001), gestational weight gain (OR, 1.018; 95% CI, 1.000-1.036;, P = .048), and age of menarche (OR, 0.925; 95% CI, 0.863-0.992; P = .029). Both fasting plasma glucose (FPG) and 2-h OGTT were positively correlated with adverse outcomes, of which FPG was more predictive (FPG: OR, 1.143; 95% CI, 1.007-1.297; P = .038; 2-h OGTT: OR, 1.074; 95% CI, 1.018-1.133; P = .009). Meanwhile, higher abnormal OGTT values were associated with significantly increased risks of antenatal insulin treatment, cesarean delivery, premature delivery, gestational hypertension, premature rupture of membranes, preeclampsia, macrosomia, neonatal asphyxia, and full term low weight infants.OGTT values and the number of abnormal glucose are associated with various adverse pregnancy outcomes. Stratified management is recommended for pregnant women with GDM, especially those with fasting hyperglycemia and/or 3 abnormal OGTT values.
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Affiliation(s)
- Ting-ting Ding
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, (Sichuan University), Ministry of Education
- Department of Gynecology and Obstetrics
| | - Jie Xiang
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, (Sichuan University), Ministry of Education
- Department of Gynecology and Obstetrics
| | - Bi-ru Luo
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, (Sichuan University), Ministry of Education
- Department of Nursing
| | - Juan Hu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, (Sichuan University), Ministry of Education
- Department of Emergency, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
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Aviram A, Shtaif B, Gat-Yablonski G, Yogev Y. The association between adipocytokines and glycemic control in women with gestational diabetes mellitus. J Matern Fetal Neonatal Med 2018; 33:177-183. [PMID: 29886799 DOI: 10.1080/14767058.2018.1487944] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objective: To evaluate the relationship between adipocytokines and glycemic control.Study design: Prospective observational trial of gestations with gestational diabetes mellitus (GDM). Fasting glucose (FG), insulin, adiponectin, leptin, chemerin, retinol-binding protein 4 (RBP-4), osteocalcin, and resistin were measured. HomeOstasis model assessment of insulin resistance (HOMA-IR) and QUantitative insulin sensitivity ChecK Index (QUICKI) were calculated. Women who required medications for glycemic control were compared to women using nutritional therapy only.Results: Overall, 75 women were included -26 (34.7%) required medications to achieve good glycemic control. Factors associated with poor control are as follows: low resistin (aOR 0.84), HOMA-IR (aOR 1.96), QUICKI (aOR 0.62), first trimester FG (aOR 1.43), and maternal age (aOR 1.26). HOMA-IR and QUICKI performed highest for prediction. Resistin, first trimester FG, maternal age, and QUICKI had an AUC of 0.878, sensitivity and specificity of 87.5% for the prediction of the need for medications.Conclusions: Low resistin is associated with poor control. A model utilizing maternal age, first trimester fasting glucose, and first visit QUICKI yields good predictability.
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Affiliation(s)
- Amir Aviram
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.,Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Biana Shtaif
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.,The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Galia Gat-Yablonski
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.,The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.,Felsenstein Medical Research Center, Petah Tikva, Israel
| | - Yariv Yogev
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
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Barnes RA, Ross GP, Jalaludin BB, Flack JR. Initial group dietary education compared to individual education in gestational diabetes mellitus management: Do outcomes differ? Diabetes Res Clin Pract 2018; 140:88-96. [PMID: 29605560 DOI: 10.1016/j.diabres.2018.03.039] [Citation(s) in RCA: 4] [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: 11/01/2017] [Revised: 03/14/2018] [Accepted: 03/22/2018] [Indexed: 11/27/2022]
Abstract
AIMS To assess the effectiveness of Initial Group versus Initial Individual GDM dietary education in terms of insulin requirements and pregnancy outcomes. METHODS A retrospective audit of clinical data was conducted where English speaking women who received initial education in a group setting (01-2-2012 to 01-2-2014) (Group), were compared to women who received initial individual education with a dietitian (1-2-2010 to 31-1-2012) (Individual), all followed by one individual dietitian appointment. The same dietary information was provided in both settings. Data collected included: attendance rates, insulin requirements, maternal weight gain, and rates of adverse birth outcomes. Data were compared by t-test or Chi-squared test. Multivariable logistic regression analysis was conducted to determine independent predictors of insulin therapy. RESULTS Of 743 women; (362 Group and 381 Individual), Group women had a lower HbA1c at GDM diagnosis 5.3 ± 0.6% versus 5.5 ± 0.5% (34 ± 6.6 mmol/mol versus 37 ± 5.5 mmol/mol p < 0.0001). There were no other differences in baseline characteristics. More Group women required insulin (42.0% versus 34.6%, p = 0.048). Group education was found to be an independent predictor of insulin therapy (OR = 1.9 [1.29, 2.75] p < 0.001). CONCLUSIONS Despite adjusting for all known potential confounders, unlike Individual education, Group education remained a significant predictor of insulin therapy (but resulted in similar therapeutic and pregnancy outcomes to Individual education).
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Affiliation(s)
- Robyn A Barnes
- Department of Diabetes and Endocrinology, Bankstown-Lidcombe Hospital, 68 Eldridge Rd, Bankstown, NSW 2200, Australia; School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia.
| | - Glynis P Ross
- Department of Diabetes and Endocrinology, Bankstown-Lidcombe Hospital, 68 Eldridge Rd, Bankstown, NSW 2200, Australia; Faculty of Medicine, University of Sydney, Sydney, NSW, Australia.
| | - Bin B Jalaludin
- Healthy People and Places Unit, South Western Sydney Local Health District, Liverpool, Australia; Ingham Institute for Medical Research, University of New South Wales, Liverpool, NSW 2170, Australia.
| | - Jeff R Flack
- Department of Diabetes and Endocrinology, Bankstown-Lidcombe Hospital, 68 Eldridge Rd, Bankstown, NSW 2200, Australia; Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; School of Medicine, Western Sydney University, Sydney, NSW, Australia.
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26
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Nishikawa T, Ono K, Hashimoto S, Kinoshita H, Watanabe T, Araki H, Otsu K, Sakamoto W, Harada M, Toyonaga T, Kawakami S, Fukuda J, Haga Y, Kukidome D, Takahashi T, Araki E. One-hour oral glucose tolerance test plasma glucose at gestational diabetes diagnosis is a common predictor of the need for insulin therapy in pregnancy and postpartum impaired glucose tolerance. J Diabetes Investig 2018; 9:1370-1377. [PMID: 29624902 PMCID: PMC6215946 DOI: 10.1111/jdi.12848] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 03/19/2018] [Accepted: 03/25/2018] [Indexed: 12/15/2022] Open
Abstract
Aims/Introduction Gestational diabetes mellitus (GDM) is a risk for adverse perinatal outcomes, and patients with a history of GDM have an increased risk of impaired glucose tolerance (IGT). Here, we carried out two non‐interventional and retrospective studies of GDM patients in Japan. Materials and Methods In the first study, we enrolled 529 GDM patients and assessed predictors of the need for insulin therapy. In the second study, we enrolled 185 patients from the first study, and assessed predictors of postpartum IGT. Results In the first study, gestational weeks at GDM diagnosis and history of pregnancy were significantly lower, and pregestational body mass index, family history of diabetes mellitus, 1‐ and 2‐h glucose levels in a 75‐g oral glucose tolerance test (OGTT), the number of abnormal values in a 75‐g OGTT, and glycated hemoglobin were significantly higher in participants receiving insulin therapy. In the second study, 1‐ and 2‐h glucose levels in a 75‐g OGTT, the number of abnormal values in a 75‐g OGTT, glycated hemoglobin, and ketone bodies in a urine test were significantly higher in participants with OGT. Logistic regression analysis showed that gestational weeks at GDM diagnosis, 1‐h glucose levels in a 75‐g OGTT and glycated hemoglobin were significant predictors of the need for insulin therapy, and 1‐h glucose levels in a 75‐g OGTT at diagnosis and ketone bodies in a urine test were significant predictors for postpartum IGT. Conclusions Antepartum 1‐h glucose levels in a 75‐g OGTT was a predictor of the need for insulin therapy in pregnancy and postpartum IGT.
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Affiliation(s)
- Takeshi Nishikawa
- Department of Diabetes and Endocrinology, National Hospital Organization, Kumamoto Medical Center, Kumamoto, Japan
| | - Keiko Ono
- Department of Diabetes and Endocrinology, National Hospital Organization, Kumamoto Medical Center, Kumamoto, Japan
| | - Shoko Hashimoto
- Department of Diabetes and Endocrinology, National Hospital Organization, Kumamoto Medical Center, Kumamoto, Japan
| | - Hiroyuki Kinoshita
- Department of Diabetes and Endocrinology, National Hospital Organization, Kumamoto Medical Center, Kumamoto, Japan
| | - Takuro Watanabe
- Department of Diabetes and Endocrinology, National Hospital Organization, Kumamoto Medical Center, Kumamoto, Japan
| | - Hirotaka Araki
- Department of Diabetes and Endocrinology, National Hospital Organization, Kumamoto Medical Center, Kumamoto, Japan
| | - Kae Otsu
- Department of Diabetes and Endocrinology, National Hospital Organization, Kumamoto Medical Center, Kumamoto, Japan
| | - Wakana Sakamoto
- Department of Diabetes and Endocrinology, National Hospital Organization, Kumamoto Medical Center, Kumamoto, Japan
| | - Masahiro Harada
- Department of Diabetes and Endocrinology, National Hospital Organization, Kumamoto Medical Center, Kumamoto, Japan
| | | | | | | | - Yoshio Haga
- Amakusa Central General Hospital, Amakusa, Japan
| | - Daisuke Kukidome
- Faculty of Life Sciences, Department of Metabolic Medicine, Kumamoto University, Kumamoto, Japan
| | - Takeshi Takahashi
- Department of Diabetes and Endocrinology, National Hospital Organization, Kumamoto Medical Center, Kumamoto, Japan
| | - Eiich Araki
- Faculty of Life Sciences, Department of Metabolic Medicine, Kumamoto University, Kumamoto, Japan
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Ares J, Martín-Nieto A, Díaz-Naya L, Tartón T, Menéndez-Prada T, Ragnarsson CS, Delgado-Álvarez E, Menéndez-Torre E. Gestational Diabetes Mellitus (GDM): Relationship Between Higher Cutoff Values for 100 g Oral Glucose Tolerance Test (OGTT) and Insulin Requirement During Pregnancy. Matern Child Health J 2018; 21:1488-1492. [PMID: 28105546 DOI: 10.1007/s10995-017-2269-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Objectives To study if there is any relationship about higher cutoff values for 100 g oral glucose tolerance test and the need for insulin in women diagnosed with gestational diabetes. Materials and Methods This is a retrospective population-based study of 201 women diagnosed with Gestational Diabetes Mellitus (GDM) between January 2012 and June 2014 in the area of Oviedo, Asturias, Spain. According to diagnostic criteria recommended by GEDE, NDDG, gestational diabetes is diagnosed if two or more plasma glucose levels meet or exceed the following threshold: fasting glucose of 105 mg/dl, 1-h 190 mg/dl, 2-h 165 mg/dl, or 3-h 145 mg/dl. We aim to know if there is any relationship between higher cutoffs and insulin requirement. Results 36 out of 201 patients (17.91%) needed insulin to achieve the targets of blood glucose control. There were no differences in mean maternal age and birthweights. Fasting blood glucose levels were significantly higher in women with further need for insulin than those who only needed diet and exercise (p < 0.001). Also, blood glucose levels 2 h after the oral glucose intake were statistically different between the two groups (p 0.032). AUC for fasting glucose value was the highest according to ROC curve. Conclusions Fasting cutoff vales for 100 g oral glucose tolerance test are consistently higher in women diagnosed with Gestational Diabetes that further needed insulin to achieve adequate blood glucose control. The positive predictive value of fasting glucose value 105 mg/dl on OGTT was 81.1%, whereas for the cut-off 95 mg/dl it was 54.0%.
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Affiliation(s)
- Jessica Ares
- Endocrinology and Nutrition Department, Hospital Universitario Central de Asturias España, Asturias, Spain.
| | - Alicia Martín-Nieto
- Endocrinology and Nutrition Department, Hospital Universitario Central de Asturias España, Asturias, Spain
| | - Lucía Díaz-Naya
- Endocrinology and Nutrition Department, Hospital Universitario Central de Asturias España, Asturias, Spain
| | - Teresa Tartón
- Endocrinology and Nutrition Department, Hospital Universitario Central de Asturias España, Asturias, Spain
| | - Teresa Menéndez-Prada
- Endocrinology and Nutrition Department, Hospital Universitario Central de Asturias España, Asturias, Spain
| | - Cecilia S Ragnarsson
- Endocrinology and Nutrition Department, Hospital Universitario Central de Asturias España, Asturias, Spain
| | - Elías Delgado-Álvarez
- Endocrinology and Nutrition Department, Hospital Universitario Central de Asturias España, Asturias, Spain
| | - Edelmiro Menéndez-Torre
- Endocrinology and Nutrition Department, Hospital Universitario Central de Asturias España, Asturias, Spain
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Souza ACRLA, Costa RA, Paganoti CF, Rodrigues AS, Zugaib M, Hadar E, Hod M, Francisco RPV. Can we stratify the risk for insulin need in women diagnosed early with gestational diabetes by fasting blood glucose? J Matern Fetal Neonatal Med 2018; 32:2036-2041. [PMID: 29301456 DOI: 10.1080/14767058.2018.1424820] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The objective of this study is to evaluate risk factors and propose a model for the prediction of insulin requirement during the treatment of early-diagnosed gestational diabetes mellitus (GDM). RESEARCH DESIGN AND METHODS Retrospective cohort analysis of all pregnant women who were diagnosed with GDM by abnormal fasting blood glucose at the first prenatal visit. According to the requirement for insulin therapy to achieve good glycemic control (insulin or diet group), women were compared regarding clinical and laboratory variables. The performance of these variables in predicting insulin need for GDM treatment was identified by a logistic regression model, and a nomogram was created based on the model to facilitate clinical interpretation. RESULTS In total, 408 women were included for analysis. Among them, 135 (33%) needed insulin therapy. In the logistic regression model, maternal age, prepregnancy body mass index, fasting blood glucose (FBG) value, prior GDM, and family history of diabetes were significant independent variables for the prediction of insulin need. CONCLUSIONS The need for insulin therapy in women with early diagnosis of GDM can be predicted by a logistic regression model, which can be converted to a clinically usable nomogram that could help to properly address follow-up strategies for GDM treatment in regions where health resources are limited.
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Affiliation(s)
- Ana C R L A Souza
- a Departamento de Obstetrícia e Ginecologia da Faculdade de Medicina da Universidade de São Paulo , Sao Paulo , Brazil
| | - Rafaela A Costa
- b Divisão de Clínica Obstétrica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , Sao Paulo , Brazil
| | - Cristiane F Paganoti
- b Divisão de Clínica Obstétrica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , Sao Paulo , Brazil
| | - Agatha S Rodrigues
- b Divisão de Clínica Obstétrica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , Sao Paulo , Brazil
| | - Marcelo Zugaib
- a Departamento de Obstetrícia e Ginecologia da Faculdade de Medicina da Universidade de São Paulo , Sao Paulo , Brazil
| | - Eran Hadar
- c Helen Schneider Hospital for Women, Rabin Medical Center and the Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Moshe Hod
- c Helen Schneider Hospital for Women, Rabin Medical Center and the Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Rossana P V Francisco
- a Departamento de Obstetrícia e Ginecologia da Faculdade de Medicina da Universidade de São Paulo , Sao Paulo , Brazil
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Santos P, Hefele JG, Ritter G, Darden J, Firneno C, Hendrich A. Population-Based Risk Factors for Shoulder Dystocia. J Obstet Gynecol Neonatal Nurs 2017; 47:32-42. [PMID: 29221671 DOI: 10.1016/j.jogn.2017.11.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2017] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE To re-examine the risk factors for shoulder dystocia given the increasing rates of obesity and diabetes in pregnant women. DESIGN Retrospective observational study. SETTING Five hospitals located in Wisconsin, Florida, Maryland, Michigan, and Alabama. PARTICIPANTS We evaluated 19,236 births that occurred between April 1, 2011, and July 25, 2013. METHODS Data were collected from electronic medical records and used to evaluate the risk of shoulder dystocia. Data were analyzed using a generalized linear mixed model, which controlled for clustering due to site. RESULTS When insulin was prescribed, gestational diabetes was associated with an increased risk of shoulder dystocia (odds ratio = 2.10, 95% confidence interval [1.01, 4.37]); however, no similar association was found with regard to gestational diabetes treated with glycemic agents or through diet. Use of epidural anesthesia was associated with an increased risk for shoulder dystocia (odds ratio = 3.47, 95% confidence interval [2.72, 4.42]). Being Black or Hispanic, being covered by Medicaid or having no insurance, infant gestational age of 41 weeks or greater, and chronic diabetes were other significant risk factors. CONCLUSION With the changing characteristics of pregnant women, labor and birth clinicians care for more pregnant women who have an increased risk for shoulder dystocia. Our findings may help prospectively identify women with the greatest risk.
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Insulin therapy in women with pregestational type 2 diabetes and its relevance to maternal and neonatal complications. Int J Diabetes Dev Ctries 2016. [DOI: 10.1007/s13410-016-0541-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Barnes RA, Wong T, Ross GP, Jalaludin BB, Wong VW, Smart CE, Collins CE, MacDonald-Wicks L, Flack JR. A novel validated model for the prediction of insulin therapy initiation and adverse perinatal outcomes in women with gestational diabetes mellitus. Diabetologia 2016; 59:2331-2338. [PMID: 27393136 DOI: 10.1007/s00125-016-4047-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 06/15/2016] [Indexed: 11/27/2022]
Abstract
AIMS/HYPOTHESIS Identifying women with gestational diabetes mellitus who are more likely to require insulin therapy vs medical nutrition therapy (MNT) alone would allow risk stratification and early triage to be incorporated into risk-based models of care. The aim of this study was to develop and validate a model to predict therapy type (MNT or MNT plus insulin [MNT+I]) for women with gestational diabetes mellitus (GDM). METHODS Analysis was performed of de-identified prospectively collected data (1992-2015) from women diagnosed with GDM by criteria in place since 1991 and formally adopted and promulgated as part of the more detailed 1998 Australasian Diabetes in Pregnancy Society management guidelines. Clinically relevant variables predictive of insulin therapy by univariate analysis were dichotomised and included in a multivariable regression model. The model was tested in a separate clinic population. RESULTS In 3317 women, seven dichotomised significant independent predictors of insulin therapy were maternal age >30 years, family history of diabetes, pre-pregnancy obesity (BMI ≥30 kg/m(2)), prior GDM, early diagnosis of GDM (<24 weeks gestation), fasting venous blood glucose level (≥5.3 mmol/l) and HbA1c at GDM diagnosis ≥5.5% (≥37 mmol/mol). The requirement for MNT+I could be estimated according to the number of predictors present: 85.7-93.1% of women with 6-7 predictors required MNT+I compared with 9.3-14.7% of women with 0-1 predictors. This model predicted the likelihood of several adverse outcomes, including Caesarean delivery, early delivery, large for gestational age and an abnormal postpartum OGTT. The model was validated in a separate clinic population. CONCLUSIONS/INTERPRETATION This validated model has been shown to predict therapy type and the likelihood of several adverse perinatal outcomes in women with GDM.
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Affiliation(s)
- Robyn A Barnes
- Diabetes Centre, Bankstown-Lidcombe Hospital, 68 Eldridge Road, Bankstown, NSW, 2200, Australia.
| | - Tang Wong
- Diabetes Centre, Bankstown-Lidcombe Hospital, 68 Eldridge Road, Bankstown, NSW, 2200, Australia
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Glynis P Ross
- Diabetes Centre, Bankstown-Lidcombe Hospital, 68 Eldridge Road, Bankstown, NSW, 2200, Australia
- Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
| | - Bin B Jalaludin
- Epidemiology Department, Healthy People and Places Unit, South Western Sydney Local Health District, Liverpool, Australia
- Ingham Institute for Medical Research, University of New South Wales, Liverpool, NSW, Australia
| | - Vincent W Wong
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- Liverpool Diabetes Collaborative Research Unit, Ingham Institute of Applied Science, Liverpool, NSW, Australia
| | - Carmel E Smart
- Department of Paediatric Endocrinology and Diabetes, John Hunter Children's Hospital, Newcastle, NSW, Australia
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia
| | - Clare E Collins
- Priority Research Centre in Physical Activity and Nutrition, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia
| | - Lesley MacDonald-Wicks
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia
| | - Jeff R Flack
- Diabetes Centre, Bankstown-Lidcombe Hospital, 68 Eldridge Road, Bankstown, NSW, 2200, Australia
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- School of Medicine, Western Sydney University, Sydney, NSW, Australia
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Are There Benefits for Gestational Diabetes Mellitus in Treating Lower Levels of Hyperglycemia Than Standard Recommendations? Can J Diabetes 2016; 40:548-554. [PMID: 27423765 DOI: 10.1016/j.jcjd.2016.05.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 05/02/2016] [Accepted: 05/10/2016] [Indexed: 01/06/2023]
Abstract
OBJECTIVES The new International Association of Diabetes and Pregnancy Study Groups (IADPSG) recommendations for diagnosis of gestational diabetes mellitus (GDM) are generating discussion regarding their universal adoption. Our centre is currently using stricter GDM diagnostic criteria than those proposed by the IADPSG. Evaluation of complication rates and their predictors in our cohort may provide insight for the care of this high-risk population. Therefore, we determined complication rates and identified antepartum maternal predictors of adverse outcomes in our cohort with mild GDM. METHODS A retrospective cohort study was performed between 2005 and 2011. It included women with and without GDM, which was diagnosed if fasting plasma glucose levels were 5.0 or above or 2-hour post 75 gram oral glucose tolerance test (OGTT) were 7.8 mmol/L or higher. RESULTS A total of 3712 women, with and without diabetes, were included. Rates of macrosomia and pre-eclampsia were significantly higher in the group with GDM but were lower than the rates usually reported. Macrosomia, the need for insulin therapy or caesarean section and postpartum glucose intolerance predictors included prepregnancy body mass index, excessive gestational weight gain and OGTT screening results, although no specific threshold was found. CONCLUSIONS This study provides insight into GDM-related complications rates and the benefits of intervention in a large cohort of women with levels of hyperglycemia lower than those currently recommended for diagnosis of GDM. These findings suggest a continuous association between adverse outcomes and maternal hyperglycemia and highlight the important role of maternal risk factors other than glycemic results in the development of pregnancy-related complications. Milder forms of hyperglycemia that would not be identified by IADPSG guidelines may benefit from treatment.
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Assessment of predictors of insulin therapy in patients with gestational diabetes diagnosed according to the IADPSG criteria. Diabetol Int 2016; 7:440-446. [PMID: 30603297 DOI: 10.1007/s13340-016-0272-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 04/19/2016] [Indexed: 10/21/2022]
Abstract
Aims and introduction It is helpful for both diabetologists and obstetricians to identify patients with gestational diabetes who require insulin therapy for glycemic control during pregnancy. The aim of the present study was to assess potential predictors of insulin requirement in patients with gestational diabetes. Materials and methods One hundred thirteen patients with gestational diabetes [mean age 34.2 ± 4.5 years; pre-gestational body mass index (BMI), 23.6 ± 6.0 kg/m2] were included in this study. The associations between insulin requirement and the following factors were analyzed: clinical maternal characteristics, number of abnormal oral glucose tolerance test (OGTT) values, gestational age at diagnosis, plasma glucose levels measured during the OGTT, glycated hemoglobin (HbA1c) and glycated albumin levels, and serum C-peptide level before breakfast and 1 and 2 h after breakfast. Results Thirty-six patients (32 %) required insulin during pregnancy ("insulin group"); the remaining patients were treated with nutrition therapy ("nutrition group"). The insulin group had a higher pre-gestational BMI, higher fasting glucose level, higher area under the curve (AUC) for serum C-peptide level, higher HbA1c level, and a younger gestational age at diagnosis than the nutrition group (p < 0.05, all). Logistic regression analysis showed that the pre-gestational BMI, AUC for serum C-peptide level, and the HbA1c level were independent predictors for the insulin group (p < 0.05, all). Conclusions The results suggest that a high insulin resistance and HbA1c level may be associated with insulin requirement in patients with gestational diabetes.
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Ye M, Liu Y, Cao X, Yao F, Liu B, Li Y, Wang Z, Xiao H. The utility of HbA1c for screening gestational diabetes mellitus and its relationship with adverse pregnancy outcomes. Diabetes Res Clin Pract 2016; 114:43-9. [PMID: 27103368 DOI: 10.1016/j.diabres.2016.02.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 02/14/2016] [Accepted: 02/17/2016] [Indexed: 12/20/2022]
Abstract
AIMS To evaluate the utility of glycated hemoglobin A1c (HbA1c) for screening gestational diabetes mellitus (GDM) and analyze its association with adverse pregnancy outcomes in a cohort of pregnant women. METHODS Women with singleton pregnancies, who completed a 2h oral glucose tolerance test (OGTT) and HbA1c test at gestational week 24-28 were enrolled in this retrospective study. Clinical information was obtained and statistical analyses were performed to assess the diagnostic value of HbA1c for GDM and the association of HbA1c with adverse pregnancy outcomes. RESULTS Of the 1959 pregnant women enrolled in the study, 413 were diagnosed with GDM. A HbA1c cutoff value <4.8% (29mmol/mol) showed adequate sensitivity to exclude GDM (85.0%) but low specificity (31.8%). While HbA1c cutoff value ≥5.5% (37mmol/mol) presented adequate specificity (95.7%) but low sensitivity (14.8%) in diagnosing GDM. Adoption of HbA1c as a screening test for GDM could eliminate the need for an OGTT in 34.7% women in our study, however, with 6.5% being wrongly diagnosed. HbA1c level was significantly associated with the risk of preterm delivery, neonatal hyperbilirubinemia, and neonatal asphyxia. CONCLUSIONS Whether adoption of HbA1c as a screening test for GDM would benefit pregnant women remains to be determined. However, HbA1c might be a useful tool to predict patients at increased risk of several adverse pregnancy outcomes.
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Affiliation(s)
- Min Ye
- Department of Endocrinology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
| | - Yuanyuan Liu
- Department of Endocrinology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
| | - Xiaopei Cao
- Department of Endocrinology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
| | - Fengjuan Yao
- Department of Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
| | - Bin Liu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
| | - Yanbing Li
- Department of Endocrinology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
| | - Zilian Wang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China.
| | - Haipeng Xiao
- Department of Endocrinology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China.
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Ozler S, Oztas E, Caglar AT, Uygur D, Ergin M, Erel O, Danisman N. Thiol/disulfide homeostasis in predicting adverse perinatal outcomes at 24-28 weeks of pregnancy in gestational diabetes. J Matern Fetal Neonatal Med 2016; 29:3699-704. [PMID: 26769102 DOI: 10.3109/14767058.2016.1141885] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The main aim of this study was to investigate thiol/disulfide homeostasis at 24-28 weeks of pregnancy and to evaluate whether it is predictive for adverse perinatal outcomes or not in gestational diabetes mellitus (GDM). METHODS A total of 110 pregnant women at 24-28 weeks of pregnancy (74 GDM patients and 36 age- and BMI-matched healthy pregnant women) were enrolled in this prospective case-control study. Thiol/disulfide homeostasis was evaluated with a novel spectrophotometric method to determine if there is an association with adverse perinatal outcomes in GDM, by using logistic regression analysis. RESULTS GDM patients, with decreased native thiol levels at 24-28 weeks (OR: 4.890, 95% CI: 1.355-5.764, p = 0.015) and with higher pre-pregnancy BMI (OR: 1.280, 95% CI: 1.072-1.528, p = 0.006), were found to be at increased risk of adverse perinatal outcomes in GDM. There were no statistically significant differences in thiol/disulfide homeostasis between diet- and insulin-treated GDM subgroups. Additionally, 1-h and 2-h glucose levels on 100 g OGTT were found to be predictive for the insulin need in achieving good glycemic control in GDM (OR: 1.022, 95% CI: 1.005-1.038, p = 0.010 and OR: 1.019, 95% CI: 1.004-1.035, p = 0.015). CONCLUSIONS GDM patients, with decreased native thiol levels at 24-28 weeks of pregnancy and with higher pre-pregnancy BMI, have an increased risk of possible adverse perinatal outcomes. Also, increased 1-h and 2-h glucose levels on 100 g OGTT can predict the need for insulin treatment for GDM.
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Affiliation(s)
- Sibel Ozler
- a Department of Perinatology , Zekai Tahir Burak Women's Health Training and Research Hospital , Ankara , Turkey and
| | - Efser Oztas
- a Department of Perinatology , Zekai Tahir Burak Women's Health Training and Research Hospital , Ankara , Turkey and
| | - Ali Turhan Caglar
- a Department of Perinatology , Zekai Tahir Burak Women's Health Training and Research Hospital , Ankara , Turkey and
| | - Dilek Uygur
- a Department of Perinatology , Zekai Tahir Burak Women's Health Training and Research Hospital , Ankara , Turkey and
| | - Merve Ergin
- b Department of Clinical Biochemistry , Faculty of Medicine, Yildirim Beyazit University , Ankara , Turkey
| | - Ozcan Erel
- b Department of Clinical Biochemistry , Faculty of Medicine, Yildirim Beyazit University , Ankara , Turkey
| | - Nuri Danisman
- a Department of Perinatology , Zekai Tahir Burak Women's Health Training and Research Hospital , Ankara , Turkey and
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Zhang Y, Shao J, Li F, Xu X. Factors in Gestational Diabetes Mellitus Predicting the Needs for Insulin Therapy. Int J Endocrinol 2016; 2016:4858976. [PMID: 27478440 PMCID: PMC4958471 DOI: 10.1155/2016/4858976] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 04/01/2016] [Accepted: 05/10/2016] [Indexed: 11/17/2022] Open
Abstract
Objective. To identify factors predicting the need for insulin therapy in pregnancies complicated by gestational diabetes mellitus (GDM). Methods. A total of 1352 patients with GDM diagnosed by the 75-g/2-h oral glucose tolerance test (OGTT) were enrolled in this study. Univariate and multivariate analysis were performed; receiver operating characteristics (ROC) were also drawn. Results. There was a significant difference in factors such as maternal age, pregestational BMI, first visit SBP, first visit DBP, FBG of first visit, FBG at time of OGTT, 75-g OGTT glucose value (fasting, after 1 h and 2 h), and serum HbA1c level at diagnosis between patients with insulin therapy and patients with medical nutrition therapy (MNT) alone. Multivariate analysis showed that higher FBG at time of OGTT, first 75 g OGTT 2 h plasma glucose, and HbA1c concentration at diagnosis lead to more likely need of insulin therapy. Conclusion. The probability of insulin therapy can be estimated in pregnant women with GDM based on fasting and 2 h glucose values during OGTT and HbA1c value at diagnosis of GDM.
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Affiliation(s)
- Ya Zhang
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University, No. 100 Haining Road, Shanghai 200080, China
| | - Jiashen Shao
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University, No. 100 Haining Road, Shanghai 200080, China
| | - Feifei Li
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University, No. 100 Haining Road, Shanghai 200080, China
| | - Xianming Xu
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University, No. 100 Haining Road, Shanghai 200080, China
- *Xianming Xu:
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Watanabe M, Katayama A, Kagawa H, Ogawa D, Wada J. Risk Factors for the Requirement of Antenatal Insulin Treatment in Gestational Diabetes Mellitus. J Diabetes Res 2016; 2016:9648798. [PMID: 27995150 PMCID: PMC5141550 DOI: 10.1155/2016/9648798] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 09/26/2016] [Accepted: 10/23/2016] [Indexed: 11/17/2022] Open
Abstract
Poor maternal glycemic control increases maternal and fetal risk for adverse outcomes, and strict management of gestational diabetes mellitus (GDM) is recommended to prevent neonatal and maternal complications. However, risk factors for the requirement of antenatal insulin treatment (AIT) are not well-investigated in the pregnant women with GDM. We enrolled 37 pregnant women with GDM and investigated the risk for AIT by comparing the patients with AIT (AIT group; n = 10) and without insulin therapy (Diet group; n = 27). The 1-h and 2-h plasma glucose levels and the number of abnormal values in 75 g OGTT were significantly higher in AIT group compared with Diet group. By logistic regression analysis, plasma glucose level at 1-h was significant predictor for AIT and the odds ratios were 1.115 (1.004-1.239) using forward selection method and 1.192 (1.006-1.413) using backward elimination method. There were no significant differences in obstetrical outcomes and neonatal complications. 1-h plasma glucose levels in 75 g OGTT are useful parameters in predicting the requirement for AIT in GDM. Both maternal and neonatal complications are comparable in GDM patients with and without insulin therapy.
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Affiliation(s)
- Mayu Watanabe
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
- Department of Internal Medicine, Japanese Red Cross Society Himeji Hospital, Himeji, Hyogo 670-8540, Japan
- *Mayu Watanabe:
| | - Akihiro Katayama
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Hidetoshi Kagawa
- Department of Internal Medicine, Japanese Red Cross Society Himeji Hospital, Himeji, Hyogo 670-8540, Japan
| | - Daisuke Ogawa
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
- Department of Internal Medicine, Japanese Red Cross Society Himeji Hospital, Himeji, Hyogo 670-8540, Japan
| | - Jun Wada
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
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Ito Y, Shibuya M, Hosokawa S, Motoki Y, Nagata R, Konishi H, Miyazaki T, Matsunaga T, Nomura Y, Mihara T, Ito S, Sugiura K, Terauchi Y. Indicators of the need for insulin treatment and the effect of treatment for gestational diabetes on pregnancy outcomes in Japan. Endocr J 2016; 63:231-7. [PMID: 26606946 DOI: 10.1507/endocrj.ej15-0427] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This study assessed indicators of the need for insulin therapy and the effect of treatment on pregnancy outcomes in Japanese patients with gestational diabetes mellitus (GDM). All patients diagnosed with GDM were hospitalized for three days. Plasma glucose profiles in patients under strict dietary management and the characteristics of GDM patients with high daily glucose levels were investigated. Patients who failed to achieve glycemic targets were treated with insulin. Indicators of the need for insulin treatment were investigated. Pregnancy outcomes in patients prescribed dietary management and patients prescribed insulin treatment were compared. The study included 112 patients with GDM. GDM patients with high daily glucose levels in the hospital exhibited significantly higher 1-h and 2-h plasma glucose levels in oral glucose tolerance tests (OGTTs) at diagnosis. In our hospital, 102 GDM patients with singleton pregnancies were followed until delivery; 32 (31.3%) were treated with insulin. Univariate analysis identified significant associations of insulin requirement with family history of diabetes and with 1-h and 2-h OGTT values at diagnosis. Multivariate analysis showed that the 1-h OGTT plasma glucose level at diagnosis was an independent predictor of the need for insulin. In perinatal outcomes, insulin treatment was associated with low birth weight.
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Affiliation(s)
- Yuzuru Ito
- Department of Endocrinology and Metabolism, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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Meshel S, Schejter E, Harel T, Maslovitz S, Germez N, Elimelech B, Cohen B, Azuri J. Can we predict the need for pharmacological treatment according to demographic and clinical characteristics in gestational diabetes? J Matern Fetal Neonatal Med 2015; 29:2062-6. [PMID: 26515278 DOI: 10.3109/14767058.2015.1077225] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To determine the ability to predict the need for pharmacological treatment in gestational diabetes mellitus (GDM). METHOD A retrospective cohort study. Data were collected from medical records of 1324 GDM patients including demographic data, family history of diabetes, obstetrical history, laboratory results, treatment modality and level of glycemic control. Patients who were identified as pre-gestational diabetes were excluded. RESULTS Overall, 143 (10.8%) GDM patients required pharmacological therapy. Of women who had GDM in their previous pregnancy; only 11.65% achieved desired glycemic control solely by diet treatment. Moreover, 62.5% of patients requiring pharmacological therapy in their previous pregnancy achieved desired level of glycemic control only by diet. Of patients who achieved desired level of glycemic control on diet until the second antenatal visit, 95% continued to maintain desired level glycemic control throughout pregnancy. Pre-pregnancy BMI >30, fasting plasma glucose >95 mg/dL and maternal age above 30 were associated with increase need for pharmacological treatment. One abnormal value in the OGTT and GCT result >2 mg/dL did not predict the need for pharmacological therapy. Primigravida and family history of GDM were not found to be predictors for treatment modality. CONCLUSION Using clinical and demographical data can predict the need for pharmacological treatment for GDM.
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Affiliation(s)
| | | | - Tamar Harel
- a Maccabi Healthcare Services , Tel Aviv , Israel
| | | | - Nurit Germez
- a Maccabi Healthcare Services , Tel Aviv , Israel
| | | | - Bili Cohen
- a Maccabi Healthcare Services , Tel Aviv , Israel
| | - Joseph Azuri
- a Maccabi Healthcare Services , Tel Aviv , Israel
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Elkins D, Taylor JS. Evidence-based strategies for managing gestational diabetes in women with obesity. Nurs Womens Health 2015; 17:420-9; quiz 430. [PMID: 24138661 DOI: 10.1111/1751-486x.12065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Pregnancies complicated by both obesity and gestational diabetes mellitus (GDM) increase the risk of maternal and fetal complications, including but not limited to gestational hypertension, cesarean surgical birth, fetal macrosomia and postpartum hemorrhage. Because of the increased maternal and fetal risks associated with maternal obesity and GDM, the development of evidence-based strategies for screening for and management of GDM and for timing of birth will provide a comprehensive approach needed to optimize outcomes for both women and newborns.
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Morikawa M, Yamada T, Akaishi R, Kojima T, Nishida R, Koyama T, Cho K, Minakami H. Prevalence of hyperglycaemia in singleton versus twin pregnancy. Diabetes Metab Res Rev 2015; 31:198-203. [PMID: 25066690 DOI: 10.1002/dmrr.2586] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 05/29/2014] [Accepted: 07/01/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND There is conflicting information regarding the risk of gestational diabetes mellitus in twin pregnancies. This study was conducted to determine whether the risk of gestational diabetes mellitus is higher in pregnant Japanese women with twin versus singleton pregnancy. METHODS The prevalence of gestational diabetes mellitus was studied in two different populations: 144 589 women registered with the Japan Society of Obstetrics and Gynecology (JSOG cohort) over 3 years between 2007 and 2009 in which patient selection bias was unavoidable; and 430 Japanese women who gave birth at a single centre over 5 years between 2008 and 2012 (single-centre cohort), consisting of 86 women with twins and 344 women with singletons matched for maternal age and prepregnancy body mass index. The gestational diabetes mellitus was diagnosed on the basis of the previous criteria in the JSOG cohort. The gestational diabetes mellitus was screened in a stepwise method and diagnosed on the basis of the new criteria in the single-centre cohort. RESULTS In the single-centre cohort, neither frequency of random glucose level ≥105 mg/dL in the first trimester [9.0% (31/344) vs 5.8% (5/86)], positive result (≥140 mg/dL) on 50 g glucose challenge test in the second trimester [26.5% (90/339) vs 26.7% (23/86)], nor women diagnosed with GDM [8.4% (29/344) vs 9.3% (8/86)] differed between the two groups. The prevalence of hyperglycaemia was higher in singleton than in twin pregnancies in the JSOG cohort (2.6% vs 1.8%, p < 0.001). CONCLUSIONS The risk of gestational diabetes mellitus may be similar between Japanese women with singleton and twin pregnancies. Difference in the risk of hyperglycaemia in the JSOG cohort may have been due to selection bias.
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Affiliation(s)
- Mamoru Morikawa
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Mitra S, Nayak PK, Sahoo J, Mathew A, Padma A, Kamalanathan S, Agrawal S. Predictors for antenatal insulin requirement in gestational diabetes. Gynecol Endocrinol 2014; 30:565-8. [PMID: 24828607 DOI: 10.3109/09513590.2014.911274] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The purpose of this study was to identify pre-gestational and gestational factors predicting subsequent insulin requirement in patients with gestational diabetes mellitus (GDM). Maternal parameters were compared between mothers achieving glycemic control with or without the addition of antenatal insulin therapy (AIT). Insulin was required only in 8/83 (10%) patients for glycemic control. Those who needed insulin had a stronger family history of diabetes and higher first hour plasma glucose along with multiple (>1) abnormal values during oral glucose tolerance test (OGTT) in univariate analysis (p < 0.05). The first hour plasma glucose value of ≥ 9.72 mmol/l predicted requirement of AIT in GDM mothers with a sensitivity of 100% and specificity of 73%. However, only positive family history of diabetes mellitus among first degree relatives and multiple abnormal values in OGTT were independent predictors for antenatal insulin requirement in regression analysis.
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Affiliation(s)
- Subarna Mitra
- Department of Obstetrics & Gynecology, All India Institute of Medical Sciences , Raipur, Chhattisgarh , India
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Thériault S, Forest JC, Massé J, Giguère Y. Validation of early risk-prediction models for gestational diabetes based on clinical characteristics. Diabetes Res Clin Pract 2014; 103:419-25. [PMID: 24447804 DOI: 10.1016/j.diabres.2013.12.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 10/13/2013] [Accepted: 12/18/2013] [Indexed: 12/16/2022]
Abstract
AIMS Gestational diabetes (GDM) is generally diagnosed late in pregnancy, precluding early preventive interventions. This study aims to validate, in a large Caucasian population of pregnant women, models based on clinical characteristics proposed in the literature to identify, early in pregnancy, those at high risk of developing GDM in order to facilitate follow up and prevention. METHODS This is a cohort study including 7929 pregnant women recruited prospectively at their first prenatal visit. Clinical information was obtained by a self-administered questionnaire and extraction of data from the medical records. The performance of four proposed clinical risk-prediction models was evaluated for identifying women who developed GDM and those who required insulin therapy. RESULTS The four models yielded areas under the receiver operating characteristic curve (AUC) between 0.668 and 0.756 for the identification of women who developed GDM, a performance similar to those obtained in the original studies. The best performing model, based on ethnicity, body-mass index, family history of diabetes and past history of GDM, resulted in sensitivity, specificity and AUC of 73% (66-79), 81% (80-82) and 0.824 (0.793-0.855), respectively, for the identification of GDM cases requiring insulin therapy. CONCLUSIONS External validation of four risk-prediction models based exclusively on clinical characteristics yielded a performance similar to those observed in the original studies. In our cohort, the strategy seems particularly promising for the early prediction of GDM requiring insulin therapy. Addition of recently proposed biochemical markers to such models has the potential to reach a performance justifying clinical utilization.
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Affiliation(s)
- Sébastien Thériault
- CHU de Québec Research Center, 10 rue de l'Espinay, Quebec City, QC, Canada G1L 3L5, and Département de biologie moléculaire, biochimie médicale et pathologie, Faculté de médecine, Université Laval, 1050 avenue de la Médecine, Quebec City, QC, Canada G1V 0A6
| | - Jean-Claude Forest
- CHU de Québec Research Center, 10 rue de l'Espinay, Quebec City, QC, Canada G1L 3L5, and Département de biologie moléculaire, biochimie médicale et pathologie, Faculté de médecine, Université Laval, 1050 avenue de la Médecine, Quebec City, QC, Canada G1V 0A6
| | - Jacques Massé
- CHU de Québec Research Center, 10 rue de l'Espinay, Quebec City, QC, Canada G1L 3L5, and Département de biologie moléculaire, biochimie médicale et pathologie, Faculté de médecine, Université Laval, 1050 avenue de la Médecine, Quebec City, QC, Canada G1V 0A6
| | - Yves Giguère
- CHU de Québec Research Center, 10 rue de l'Espinay, Quebec City, QC, Canada G1L 3L5, and Département de biologie moléculaire, biochimie médicale et pathologie, Faculté de médecine, Université Laval, 1050 avenue de la Médecine, Quebec City, QC, Canada G1V 0A6.
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Markedly different rates of incident insulin treatment based on universal gestational diabetes mellitus screening in a diverse HMO population. Am J Obstet Gynecol 2013; 209:440.e1-9. [PMID: 23816844 DOI: 10.1016/j.ajog.2013.06.044] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2013] [Revised: 05/02/2013] [Accepted: 06/25/2013] [Indexed: 11/23/2022]
Abstract
OBJECTIVE We sought to evaluate population gestational diabetes mellitus (GDM) screening results and risk for incident insulin treatment. STUDY DESIGN Among 64,687 pregnant women universally screened for GDM from 1995 through 2010 in 2 regions of a large US health plan, we stratified women requiring insulin treatment during their pregnancy by GDM screening results (50-g glucose challenge test [GCT]), followed by a 3-hour, 100-g oral glucose tolerance test if GCT was positive. Women with GCT >200 mg/dL were evaluated separately. RESULTS Overall, 2% of all pregnant women required insulin treatment, ranging from 0.1% (normal GCT) to 49.9% (GCT >200 mg/dL; P for trend < .0001). Women with GCT >200 mg/dL had a much higher rate of insulin treatment than women with GDM (odds ratio, 3.7; 95% confidence interval, 3.1-4.4). Risk factors for higher insulin treatment rates with GDM or GCT >200 mg/dL included obesity, race/ethnicity, and diagnosed ≤16 weeks' gestation. CONCLUSION Our results indicate women with GCT >200 mg/dL could be reasonably treated as GDM without requiring additional oral glucose tolerance test for diagnosis.
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Bakiner O, Bozkirli E, Ozsahin K, Sariturk C, Ertorer E. Risk Factors That can Predict Antenatal Insulin Need in Gestational Diabetes. J Clin Med Res 2013; 5:381-8. [PMID: 23976911 PMCID: PMC3748663 DOI: 10.4021/jocmr1515w] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2013] [Indexed: 12/12/2022] Open
Abstract
Background This study was undertaken to assess the association between insulin need in gestational diabetes mellitus (GDM) and clinical features and laboratory parameters. Factors that can predict insulin need are also identified. Methods Cases with GDM were included retrospectively from records. Cases which failed to achieve target blood glucose levels with medical nutrition therapy (MNT) and need insulin treatment were recorded. Risk factors which can predict antenatal insulin treatment (AIT) were identified as follows; the presence of diabetes in a first degree relative, body mass index prior to pregnancy, number of parity, history of GDM, macrosomic baby delivery (> 4,000 g), age, gestational week at time of diagnosis, body mass index during diagnosis, weight gain untill diagnosis, mean systolic and diastolic blood pressure, HbA1C level during diagnosis, and fasting plasma glucose on diagnostic oral glucose tolerance test. Presence of a statistical significance between those patient features and AIT was assessed. Independent predictors for AIT were evaluated. Results A total of 300 cases were recruited from records, 190 cases (63.3%) were followed only with MNT until delivery and 110 cases (36.7%) were initiated AIT. The association between AIT and patient factors like presence of diabetes in the pedigree, week of gestation at which GDM was diagnosed, BMI during diagnosis, HbA1C levels, and fasting plasma glucose during diagnosis was found (P = 0.03; 0.008; 0.049; 0.001 and 0.001respectively). Multivariant analysis showed that fasting plasma glucose levels during diagnosis and HbA1C levels were independent risk factors for AIT. Fasting plasma glucose values that can predict AIT were identified > 89.5 mg/dL with 72.7% sensitivity and 62.6% spesifity (P < 0.001). Positive predictive value was 73% (P < 0.001). Also, HbA1C levels that can predict AIT was found to be > 5.485% with 65.3% sensitivity and 66.7% spesifitiy(P < 0.001) with a positive predictive value 68% (P < 0.001). Conclusions Independent predictors for AIT were found as fasting plasma glucose on OGTT and HbA1c levels during diagnosis in GDM. Cases with fasting plasma glucose ≥ 89.5 mg/dL or HbA1C ≥ 5.485% should be closely followed for AIT in specified centers.
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Affiliation(s)
- Okan Bakiner
- Department of Endocrinology and Metabolism Diseases, Baskent University, Faculty of Medicine, Turkey
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Spaulonci CP, Bernardes LS, Trindade TC, Zugaib M, Francisco RPV. Randomized trial of metformin vs insulin in the management of gestational diabetes. Am J Obstet Gynecol 2013; 209:34.e1-7. [PMID: 23524173 DOI: 10.1016/j.ajog.2013.03.022] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Revised: 02/06/2013] [Accepted: 03/16/2013] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To evaluate glycemic control in women receiving metformin or insulin for gestational diabetes, and to identify factors predicting the need for supplemental insulin in women initially treated with metformin. STUDY DESIGN Women with gestational diabetes who failed to achieve glycemic control with diet and exercise were randomized to receive metformin (n = 47) or insulin (n = 47). Criteria for inclusion were singleton pregnancy, diet, and exercise for a minimum period of 1 week without satisfactory glycemic control, absence of risk factors for lactic acidosis, and absence of anatomic and/or chromosome anomalies of the conceptus. Patients who were lost to prenatal follow-up were excluded. RESULTS Comparison of mean pretreatment glucose levels showed no significant difference between groups (P = .790). After introduction of the drug, lower mean glucose levels were observed in the metformin group (P = .020), mainly because of lower levels after dinner (P = .042). Women using metformin presented less weight gain (P = .002) and a lower frequency of neonatal hypoglycemia (P = .032). Twelve women in the metformin group (26.08%) required supplemental insulin for glycemic control. Early gestational age at diagnosis (odds ratio, 0.71; 95% confidence interval, 0.52-0.97; P = .032) and mean pretreatment glucose level (odds ratio, 1.061; 95% confidence interval, 1.001-1.124; P = .046) were identified as predictors of the need for insulin. CONCLUSION Metformin was found to provide adequate glycemic control with lower mean glucose levels throughout the day, less weight gain and a lower frequency of neonatal hypoglycemia. Logistic regression analysis showed that gestational age at diagnosis and mean pretreatment glucose level were predictors of the need for supplemental insulin therapy in women initially treated with metformin.
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Katon J, Reiber G, Williams MA, Yanez D, Miller E. Antenatal haemoglobin A1c and risk of large-for-gestational-age infants in a multi-ethnic cohort of women with gestational diabetes. Paediatr Perinat Epidemiol 2012; 26:208-17. [PMID: 22471680 PMCID: PMC7442536 DOI: 10.1111/j.1365-3016.2012.01266.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Gestational diabetes mellitus (GDM) is a risk factor for delivering a large-for-gestational-age (LGA) infant. Haemoglobin A1c (A1C) is an indicator of glycaemic control. The objective of this study was to test whether higher A1C quartile at the time of diagnosis of GDM is associated with increased risk of delivering a LGA or macrosomic infant. Women with singleton pregnancies treated for GDM at a large diabetes and pregnancy programme located in Charlotte, North Carolina, were eligible for inclusion in this retrospective cohort study. Clinical information, including A1C at diagnosis, treatment, prior medical and obstetric history, and birth data were abstracted from medical records. LGA was defined as birthweight >90th percentile for gestational age and sex and macrosomia as birthweight >4000 g. Logistic regression was used to analyse the association of A1C at GDM diagnosis with risk of delivering LGA or macrosomic infants. This study included 502 women. Prevalences of LGA and macrosomia were 4% and 6% respectively. After adjustment there was no detectable trend of increased risk for LGA (P for trend = 0.12) or macrosomia (P for trend = 0.20) across increasing quartiles of A1C at GDM diagnosis. A1C at GDM diagnosis may not be linearly associated with LGA or macrosomia, possibly because of the mediating effect of strict glycaemic control in this clinical setting.
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Affiliation(s)
- Jodie Katon
- Departments of Epidemiology Health Services Biostatistics, University of Washington VA Puget Sound Health Care System, Seattle, WA 98195, USA.
| | - Gayle Reiber
- Department of Epidemiology, University of Washington,Department of Health Services, University of Washington,VA Puget Sound Health Care System, Seattle, WA
| | | | - David Yanez
- Department of Biostatistics, University of Washington
| | - Edith Miller
- Carolinas Medical Center Diabetes and Pregnancy Program, Carolinas Medical Center, Charlotte, NC, USA
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WONG VW, JALALUDIN B. Gestational diabetes mellitus: Who requires insulin therapy? Aust N Z J Obstet Gynaecol 2011; 51:432-6. [DOI: 10.1111/j.1479-828x.2011.01329.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Katon J, Williams MA, Reiber G, Miller E. Antepartum A1C, maternal diabetes outcomes, and selected offspring outcomes: an epidemiological review. Paediatr Perinat Epidemiol 2011; 25:265-76. [PMID: 21470266 PMCID: PMC7179576 DOI: 10.1111/j.1365-3016.2011.01195.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Between 1989 and 2004, the prevalence of gestational diabetes mellitus (GDM) in the United States increased by 122%. Glycated haemoglobin, as measured by haemoglobin A1C (A1C), can potentially identify pregnant women at high risk for adverse outcomes associated with GDM including macrosomia and post-partum glucose intolerance. Our objective was to systematically review the literature with respect to A1C levels during pregnancy and associated maternal and offspring outcomes. We used MEDLINE to identify relevant publications from 1975 to 2009. We included articles if they met the following criteria: original full text articles in English; primary exposure of antepartum A1C; women with GDM at baseline or who developed GDM during the study; primary outcome of GDM, insulin use, post-partum abnormal glucose or type 2 diabetes (T2DM), birthweight, macrosomia or large for gestational age. Case series and case reports were excluded. Twenty studies met our criteria. A1C at GDM diagnosis was positively associated with post-partum abnormal glucose. Women with post-partum T2DM or impaired glucose tolerance had mean A1C at GDM diagnosis higher than those with normal post-partum glucose (P ≤ 0.002) and a 1% increase in A1C at GDM diagnosis was associated with 2.36 times higher odds of post-partum abnormal glucose 6 weeks after delivery [95% confidence interval 1.19, 4.68]. The association of A1C and birthweight varied substantially between studies, with correlation coefficients ranging from 0.11 to 0.51. A1C, a less burdensome and costly measure than an oral glucose tolerance test, appears to be an attractive measure for identifying women at high risk of adverse outcomes associated with GDM.
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Affiliation(s)
- Jodie Katon
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA 98195, USA.
| | - Michelle A. Williams
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA
| | - Gayle Reiber
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA,,Department of Health Services, University of Washington School of Public Health, Seattle, WA, USA
| | - Edith Miller
- Carolinas Medical Center Diabetes and Pregnancy Program, Charlotte NC, USA
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Jovanovic L, Savas H, Mehta M, Trujillo A, Pettitt DJ. Frequent monitoring of A1C during pregnancy as a treatment tool to guide therapy. Diabetes Care 2011; 34:53-4. [PMID: 20921215 PMCID: PMC3005444 DOI: 10.2337/dc10-1455] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE No guidelines for A1C measurement exist for women with gestational diabetes mellitus (GDM). The aim of this study was to document the rate of A1C decline in women with GDM. RESEARCH DESIGN AND METHODS Women with GDM in the Santa Barbara County Endocrine Clinic are managed with a carbohydrate-restricted diet and self-monitored blood glucose before and 1-h postprandial. Insulin is started if the preprandial glucose concentration is ≥90 mg/dl and/or a 1-h postprandial glucose concentration is ≥120 mg/dl. Capillary A1C was tested weekly using the DCA2000+ analyzer. RESULTS Twenty-four women with GDM (aged 29.0 ± 7.3 years) with initial A1C ≥7.0% were recruited. Baseline A1C was 8.8 ± 1.8%. Mean A1C decline was 0.47% per week (range 0.10-1.15%); the maximum was 4.3% in 4 weeks. CONCLUSIONS This study documents rapid decline in A1C during pregnancy and the utility of weekly A1C to guide therapy.
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Affiliation(s)
- Lois Jovanovic
- Sansum Diabetes Research Institute, Santa Barbara, California, USA.
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