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Hong JGS, Mohd. Noor AF, Tan PC. Three Days Compared to One Day Per Week of Self-Monitoring of Blood Glucose in Mild Gestational Diabetes: A Randomized Trial. J Clin Med 2022; 11:3770. [PMID: 35807057 PMCID: PMC9267312 DOI: 10.3390/jcm11133770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/17/2022] [Accepted: 06/28/2022] [Indexed: 12/04/2022] Open
Abstract
Background: The International Diabetes Federation estimates that 16.2% of livebirths in 2017 were affected by hyperglycemia in pregnancy, with 85.1% due to gestational diabetes mellitus (GDM). Daily blood glucose monitoring compared with alternate day testing in mild GDM is associated with similar pregnancy outcomes. Data are sparse on the ideal frequency for self-monitoring of blood glucose (SMBG) in mild GDM for glycemic control. A higher HbA1c at late pregnancy is associated with adverse pregnancy outcomes. We sought to evaluate three days compared to one day per week of four-point self-monitoring of blood glucose (SMBG) in gestational diabetes mellitus (GDM) controlled by lifestyle changes for glycemic control. Methods: This randomized trial was conducted from February−December 2018. A total of 106 women with lifestyle-controlled GDM were randomized to three days (SMBG3) or one day (SMBG1) per week of four-point (fasting and two-hours post-meal) SMBG. The primary outcome was the change in the HbA1c level at recruitment and 36-weeks gestation within and across trial arms. The student t-test was used for between-arm analyses and a paired t-test for within-arm analyses. Results: The HbA1c level through pregnancy increased significantly in both trial arms: mean increase of 0.21% ± 0.26%, p < 0.001 (SMBG3), and 0.19% ± 0.24%, p < 0.001 (SMBG1), but the 0.02% difference across trial arms was not significant (p = 0.79). Maternal weight gain (3.1 ± 2.1 kg vs. 3.3 ± 3.0 kg, p = 0.72), cesarean delivery (24/52 (48%) vs. 23/53 (43%), RR 1.06, 95% CI: 0.69−1.62, p = 0.77), neonatal birthweight (3.1 ± 0.4 kg vs. 3.0 ± 0.4 kg, p = 0.53) and neonatal intensive care unit admission (4/52 (8%) vs. 3/53 (6%), RR 1.36, 95% CI: 0.32−5.78, p = 0.68) were not significantly different for SMBG3 vs. SMBG1, respectively. Other maternal and neonatal secondary outcomes were not significantly different. Conclusion: In mild GDM, three days compared to one day per week showed a similar HbA1c levels change at 36-weeks gestation. Maternal and neonatal outcomes were also not significantly different. Less frequent monitoring of SMBG as a standard of care in mild GDM deserves further study and consideration.
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Affiliation(s)
| | | | - Peng Chiong Tan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universiti Malaya, Jalan Profesor Diraja Ungku Aziz, Kuala Lumpur 50603, Malaysia; (J.G.S.H.); (A.F.M.N.)
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Tew MP, Tan PC, Saaid R, Hong JGS, Omar SZ. Metformin in gestational diabetes mellitus: A double-blind placebo-controlled randomized trial. Int J Gynaecol Obstet 2021; 156:508-515. [PMID: 33890319 DOI: 10.1002/ijgo.13718] [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: 02/09/2021] [Revised: 03/22/2021] [Accepted: 04/19/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate the impact of preemptive metformin on the level of glycosylated hemoglobin (HbA1c) at 36 weeks of pregnancy in women with gestational diabetes mellitus controlled by diet change (GDMA1). METHODS A randomized, double-blind, placebo-controlled trial was performed in a university hospital. Women with GDMA1 were recruited at 16-30 weeks of pregnancy and randomized to oral metformin 500 mg twice daily or identical placebo tablets to delivery. Level of HbA1c was taken at recruitment and at 36 weeks of pregnancy. The primary outcome was the change in level of HbA1c at recruitment and 36 weeks of pregnancy. RESULTS Data from 106 participants were analyzed. The level of HbA1c during pregnancy increased significantly with a mean increase of 0.20% ± 0.31% (P < 0.001; metformin) versus 0.27% ± 0.31% (P < 0.001; placebo). An increment of 0.07% across trial arms was not significant (P = 0.310). Mean birth weight was significantly lower in the metformin group (2.81 ± 0.41 kg vs 2.98 ± 0.37 kg; P = 0.030). Rates of macrosomia (≥3.5 kg; 0/53 [0%] vs 4/53 [8%]; P = 0.123) and low birth weight (<2.5 kg; 11/53 [21%] vs 5/53 [9%]; P = 0.102) were not significantly different. CONCLUSION Preemptive metformin did not prevent the level of HbA1c at 36 weeks of pregnancy from rising nor significantly reduce the increase of HbA1c. Mean birth weight was significantly lower in the metformin arm with a non-significant trend to low birth weight, which is concerning. ISRCTN ISRCTN10845466.
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Affiliation(s)
- Min P Tew
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Malaya, Lembah Pantai, Kuala Lumpur, Malaysia
| | - Peng C Tan
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Malaya, Lembah Pantai, Kuala Lumpur, Malaysia
| | - Rahmah Saaid
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Malaya, Lembah Pantai, Kuala Lumpur, Malaysia
| | - Jesrine G S Hong
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Malaya, Lembah Pantai, Kuala Lumpur, Malaysia
| | - Siti Z Omar
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Malaya, Lembah Pantai, Kuala Lumpur, Malaysia
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Sim YE, Sia AL, Tan CW, Sng BL. Implications of diabetes in obstetric anaesthesia. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2019. [DOI: 10.1016/j.tacc.2018.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Eken M, Çınar M, Şenol T, Özkaya E, Karateke A. Six-year incidence and some features of cases of brachial plexus injury in a tertiary referral center. Turk J Obstet Gynecol 2015; 12:71-74. [PMID: 28913046 PMCID: PMC5558379 DOI: 10.4274/tjod.80388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 06/12/2015] [Indexed: 12/29/2022] Open
Abstract
Objective: To present some features and incidence of cases of brachial plexus injury in deliveries at the Department of Obstetrics and Gynecology of Zeynep Kamil Maternity and Children’s Training and Research Hospital, from January 2010 through December 2014. Materials and Methods: In total, 38.896 deliveries in the Department of Obstetrics and Gynecology of Zeynep Kamil Maternity and Children’s Training and Research Hospital, from January 2010 through December 2014 were screened from a prospectively collected database. We recorded gravidity, parity, body mass index, maternal diabetes, labor induction, gestational age at delivery, operative deliveries, malpresentations, prolonged second stage of deliveries, shoulder dystocies, clavicle and humerus fructures, estimated fetal weight, biparietal diameter, abdominal circumference, femur length, fetal sex, route of delivery, maternal age, and fetal anomalies. Results: There were 28 (72/100.000) cases of brachial plexus injury among 38.896 deliveries. In the 6-year study period, there were 18.363 deliveries via c-section, whereas 20.533 were vaginal deliveries. Conclusion: Sonographic fetal weight estimation and clinical examination performed by experienced obstetricians, and active appropriate management of shoulder dystocias seemed to attenuate the incidence of brachial plexus injury in the at risk population in our tertiary referral center.
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Affiliation(s)
- Meryem Eken
- Zeynep Kamil Women and Children's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Mehmet Çınar
- Zeynep Kamil Women and Children's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Taylan Şenol
- Zekai Tahir Maternity and Womens Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, Ankara, Turkey
| | - Enis Özkaya
- Zeynep Kamil Women and Children's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Ateş Karateke
- Zeynep Kamil Women and Children's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
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Timmerman E, Pajkrt E, Snijders RJM, Bilardo CM. High macrosomia rate in healthy fetuses after enlarged nuchal translucency. Prenat Diagn 2014; 34:103-8. [DOI: 10.1002/pd.4262] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 10/15/2013] [Accepted: 10/17/2013] [Indexed: 11/08/2022]
Affiliation(s)
- E. Timmerman
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology; Academic Medical Centre Amsterdam; The Netherlands
| | - E. Pajkrt
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology; Academic Medical Centre Amsterdam; The Netherlands
| | - R. J. M. Snijders
- Prenatal Screening Foundation Northeast of the Netherlands; Groningen The Netherlands
| | - C. M. Bilardo
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology; University Medical Centre; Groningen The Netherlands
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Souka AP, Papastefanou I, Pilalis A, Michalitsi V, Panagopoulos P, Kassanos D. Performance of the ultrasound examination in the early and late third trimester for the prediction of birth weight deviations. Prenat Diagn 2013; 33:915-20. [DOI: 10.1002/pd.4161] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Revised: 04/19/2013] [Accepted: 05/18/2013] [Indexed: 11/10/2022]
Affiliation(s)
- Athena P. Souka
- Fetal Medicine Unit, 3rd Department of Obstetrics and Gynaecology; University of Athens, ‘Attikon’ University Hospital; Athens Greece
- Fetal Medicine Unit, Leto Maternity Hospital; Athens Greece
| | - Ioannis Papastefanou
- Fetal Medicine Unit, 3rd Department of Obstetrics and Gynaecology; University of Athens, ‘Attikon’ University Hospital; Athens Greece
| | - Athanasios Pilalis
- Fetal Medicine Unit, 3rd Department of Obstetrics and Gynaecology; University of Athens, ‘Attikon’ University Hospital; Athens Greece
- Fetal Medicine Unit, Leto Maternity Hospital; Athens Greece
| | - Vasiliki Michalitsi
- Fetal Medicine Unit, 3rd Department of Obstetrics and Gynaecology; University of Athens, ‘Attikon’ University Hospital; Athens Greece
| | - Perikles Panagopoulos
- Fetal Medicine Unit, 3rd Department of Obstetrics and Gynaecology; University of Athens, ‘Attikon’ University Hospital; Athens Greece
| | - Dimitrios Kassanos
- Fetal Medicine Unit, 3rd Department of Obstetrics and Gynaecology; University of Athens, ‘Attikon’ University Hospital; Athens Greece
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Pilalis A, Souka AP, Papastefanou I, Michalitsi V, Panagopoulos P, Chrelias C, Kassanos D. Third trimester ultrasound for the prediction of the large for gestational age fetus in low-risk population and evaluation of contingency strategies. Prenat Diagn 2012; 32:846-53. [DOI: 10.1002/pd.3918] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Revised: 04/23/2012] [Accepted: 05/13/2012] [Indexed: 12/26/2022]
Affiliation(s)
- Athanasios Pilalis
- Fetal Medicine Unit, 3 Department of Obstetrics and Gynaecology; University of Athens, ‘Attikon’ University Hospital; Athens Greece
- Leto Maternity Hospital; Fetal Medicine Unit; Athens Greece
| | - Athena P. Souka
- Fetal Medicine Unit, 3 Department of Obstetrics and Gynaecology; University of Athens, ‘Attikon’ University Hospital; Athens Greece
- Leto Maternity Hospital; Fetal Medicine Unit; Athens Greece
| | - Ioannis Papastefanou
- Fetal Medicine Unit, 3 Department of Obstetrics and Gynaecology; University of Athens, ‘Attikon’ University Hospital; Athens Greece
| | - Vasiliki Michalitsi
- Fetal Medicine Unit, 3 Department of Obstetrics and Gynaecology; University of Athens, ‘Attikon’ University Hospital; Athens Greece
| | - Perikles Panagopoulos
- 3 Department of Obstetrics and Gynaecology; University of Athens, ‘Attikon’ University Hospital; Athens Greece
| | - Charalambos Chrelias
- 3 Department of Obstetrics and Gynaecology; University of Athens, ‘Attikon’ University Hospital; Athens Greece
| | - Dimitrios Kassanos
- Fetal Medicine Unit, 3 Department of Obstetrics and Gynaecology; University of Athens, ‘Attikon’ University Hospital; Athens Greece
- 3 Department of Obstetrics and Gynaecology; University of Athens, ‘Attikon’ University Hospital; Athens Greece
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Dodd JM, Catcheside B, Scheil W. Can shoulder dystocia be reliably predicted? Aust N Z J Obstet Gynaecol 2012; 52:248-52. [PMID: 22428758 DOI: 10.1111/j.1479-828x.2012.01425.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Accepted: 02/07/2012] [Indexed: 12/01/2022]
Abstract
AIMS To evaluate factors reported to increase the risk of shoulder dystocia, and to evaluate their predictive value at a population level. METHODS The South Australian Pregnancy Outcome Unit's population database from 2005 to 2010 was accessed to determine the occurrence of shoulder dystocia in addition to reported risk factors, including age, parity, self-reported ethnicity, presence of diabetes and infant birth weight. Odds ratios (and 95% confidence interval) of shoulder dystocia was calculated for each risk factor, which were then incorporated into a logistic regression model. Test characteristics for each variable in predicting shoulder dystocia were calculated. RESULTS As a proportion of all births, the reported rate of shoulder dystocia increased significantly from 0.95% in 2005 to 1.38% in 2010 (P = 0.0002). Using a logistic regression model, induction of labour and infant birth weight greater than both 4000 and 4500 g were identified as significant independent predictors of shoulder dystocia. The value of risk factors alone and when incorporated into the logistic regression model was poorly predictive of the occurrence of shoulder dystocia. CONCLUSIONS While there are a number of factors associated with an increased risk of shoulder dystocia, none are of sufficient sensitivity or positive predictive value to allow their use clinically to reliably and accurately identify the occurrence of shoulder dystocia.
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Affiliation(s)
- Jodie M Dodd
- Discipline of Obstetrics and Gynaecology, Robinson Institute, The University of Adelaide, 72 King William Road, North Adelaide, SA 5006, Australia.
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Belfort MA, White GL, Vermeulen FM. Association of fetal cranial shape with shoulder dystocia. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2012; 39:304-309. [PMID: 21630363 DOI: 10.1002/uog.9066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To evaluate whether fetal cranial shape is related to shoulder dystocia. METHODS We compared shoulder dystocia cases (n = 18) with controls (normal vaginal deliveries, n = 18) in a retrospective matched-pairs observational study. Subjects were matched for known maternal and fetal risk factors and then evaluated for fetal biometric differences, which were measured by ultrasound near delivery. We tested multivariable risk models to predict shoulder dystocia by logistic regression. RESULTS Cases had a smaller estimated occipitofrontal diameter (OFD) (P = 0.02) and a larger biparietal diameter/estimated OFD ratio (P = 0.003). A multivariable model including estimated fetal weight, estimated OFD, maternal weight and diabetes mellitus had sensitivity and specificity of 86% and 95%, respectively, and positive and negative likelihood ratios of 18.9 and 0.15, respectively. Estimated OFD significantly increased the predictive value of the model. CONCLUSION A small estimated OFD is a risk factor for shoulder dystocia in the presence of other significant risk factors. A multivariable model including estimated OFD can predict shoulder dystocia in a clinically useful range.
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Affiliation(s)
- M A Belfort
- Baylor College of Medicine, Department of Obstetrics and Gynecology, Houston, TX 77030, USA.
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Salem W, Adler AI, Lee C, Smith GCS. Maternal waist to hip ratio is a risk factor for macrosomia. BJOG 2011; 119:291-7. [DOI: 10.1111/j.1471-0528.2011.03167.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Yehuda I, Nagtalon‐Ramos J, Trout K. Fetal Growth Scans and Amniotic Fluid Assessments in Pregestational and Gestational Diabetes. J Obstet Gynecol Neonatal Nurs 2011; 40:603-14; quiz 614-6. [DOI: 10.1111/j.1552-6909.2011.01283.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Chaves EGS, Franciscon PDM, Nascentes GAN, Paschoini MC, Silva APD, Borges MDF. Estudo retrospectivo das implicações maternas, fetais e perinatais em mulheres portadoras de diabetes, em 20 anos de acompanhamento no Hospital Escola da Universidade Federal do Triângulo Mineiro. ACTA ACUST UNITED AC 2010; 54:620-9. [DOI: 10.1590/s0004-27302010000700006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Accepted: 09/14/2010] [Indexed: 11/22/2022]
Abstract
OBJETIVOS: Avaliar implicações do diabetes melito (DM) na morbimortalidade materno-fetal, segundo experiência da Universidade Federal do Triângulo Mineiro. MATERIAIS E METODOS: Procedeu-se à análise retrospectiva dos prontuários de gestantes diabéticas assistidas entre 1990 e 2009 focando dados e complicações maternas e neonatais. RESULTADOS: A última gestação de 93 diabéticas foi avaliada, sendo 34 com DM tipo 1, em que se observou maior ocorrência de tocotrauma (p = 0,023) e retinopatia (p = 0,023). Vinte e uma pacientes tinham DM tipo 2; suas necessidades de insulina aumentaram progressivamente (p < 0,01) e observou-se maior prevalência de tabagismo (p = 0,004). Trinta e oito tiveram diabetes gestacional e iniciaram acompanhamento do diabetes em idade gestacional mais tardia (p < 0,001), tiveram mais antecedentes de macrossomia fetal (p = 0,028) e maior prevalência de fatores de risco cardiovascular. CONCLUSÕES: Não obstante melhora do controle glicêmico durante a gestação, nenhum dos grupos atingiu alvos glicêmicos ideais. Ainda assim, a maioria das gestações em diabéticas, conduzidas em nosso meio, evoluiu favoravelmente.
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