1
|
Mussa J, Meltzer S, Bond R, Garfield N, Dasgupta K. Trends in National Canadian Guideline Recommendations for the Screening and Diagnosis of Gestational Diabetes Mellitus over the Years: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1454. [PMID: 33557155 PMCID: PMC7913952 DOI: 10.3390/ijerph18041454] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 01/29/2021] [Accepted: 02/01/2021] [Indexed: 11/16/2022]
Abstract
Canada's largest national obstetric and diabetology organizations have recommended various algorithms for the screening of gestational diabetes mellitus (GDM) over the years. Though uniformity across recommendations from clinical practice guidelines (CPGs) is desirable, historically, national guidelines from Diabetes Canada (DC) and the Society of Obstetricians and Gynaecologists of Canada (SOGC) have differed. Lack of consensus has led to variation in screening approaches, rendering precise ascertainment of GDM prevalence challenging. To highlight the reason and level of disparity in Canada, we conducted a scoping review of CPGs released by DC and the SOGC over the last thirty years and distributed a survey on screening practices among Canadian physicians. Earlier CPGs were based on expert opinion, leading to different recommendations from these organizations. However, as a result of the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study, disparities between DC and the SOGC no longer exist and many Canadian physicians have adopted their recent recommendations. Given that Canadian guidelines now recommend two different screening programs (one step vs. two step), lack of consensus on a single diagnostic threshold continues to exist, resulting in differing estimates of GDM prevalence. Our scoping review highlights these disparities and provides a step forward towards reaching a consensus on one unified threshold.
Collapse
Affiliation(s)
- Joseph Mussa
- Department of Medicine, McGill University, Montreal, QC H4A 3J1, Canada; (J.M.); (S.M.); (R.B.); (N.G.)
- Centre for Outcomes Research and Evaluation of the RI-MUHC, 5252 boul de Maisonneuve Ouest, Office 3E.09, Montreal, QC H4A 3S5, Canada
| | - Sara Meltzer
- Department of Medicine, McGill University, Montreal, QC H4A 3J1, Canada; (J.M.); (S.M.); (R.B.); (N.G.)
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC H4A 3J1, Canada
| | - Rachel Bond
- Department of Medicine, McGill University, Montreal, QC H4A 3J1, Canada; (J.M.); (S.M.); (R.B.); (N.G.)
| | - Natasha Garfield
- Department of Medicine, McGill University, Montreal, QC H4A 3J1, Canada; (J.M.); (S.M.); (R.B.); (N.G.)
| | - Kaberi Dasgupta
- Department of Medicine, McGill University, Montreal, QC H4A 3J1, Canada; (J.M.); (S.M.); (R.B.); (N.G.)
- Centre for Outcomes Research and Evaluation of the RI-MUHC, 5252 boul de Maisonneuve Ouest, Office 3E.09, Montreal, QC H4A 3S5, Canada
| |
Collapse
|
2
|
Moses RG, Wong VCK, Lambert K, Morris GJ. Fasting target for hyperglycaemia in pregnancy. Aust N Z J Obstet Gynaecol 2016; 56:530-531. [PMID: 27144374 DOI: 10.1111/ajo.12473] [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: 12/15/2015] [Accepted: 04/04/2016] [Indexed: 11/27/2022]
Abstract
Knowledge of the fasting plasma glucose of healthy women may assist in the setting of treatment targets for women with hyperglycaemia in pregnancy (HIP). This study examines the pregnancy glucose tolerance test results of 3344 women without HIP collected over a three-year period. The median fasting plasma glucose was 4.4 mmol/L with an interquartile range of 4.2-4.6 mmol/L and a 5th to 95th centile of 3.8-4.9 mmol/L. As the diagnostic fasting glucose level for HIP is ≥5.1 mmol/L, these data support a treatment target of ≤5.0 mmol/L.
Collapse
|
3
|
Moses RG, Wong VCK, Lambert K, Morris GJ, San Gil F. The prevalence of hyperglycaemia in pregnancy in Australia. Aust N Z J Obstet Gynaecol 2016; 56:341-5. [PMID: 26914693 DOI: 10.1111/ajo.12447] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 01/09/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND The Australasian Diabetes in Pregnancy Society (ADIPS) has recently endorsed the World Health Organization (WHO) terminology and classification of hyperglycaemia in pregnancy. The prevalence is likely to increase, but no prospective data are available for a representative Australian population. AIMS To determine the prevalence of hyperglycaemia in pregnancy (HIP) using results from both the public and private sectors in a population that has a similar ethnicity to the overall Australian population. MATERIAL AND METHODS The results of all pregnancy oral glucose tolerance tests (POGTT) in the public sector and by a dominant private pathology provider in a major city have been prospectively collected for a three-year period and analysed using the ADIPS (WHO) criteria. RESULTS The prevalence of hyperglycaemia in pregnancy (HIP) was 13.1% with diabetes mellitus in pregnancy (DIP) being 0.4% and gestational diabetes mellitus (GDM) being 12.7%. CONCLUSION The new criteria will diagnose about one-third more women with GDM than the previous ADIPS criteria. This will have resource and health implications. Focussed local health economic data will be important.
Collapse
|
4
|
Scifres CM, Abebe KZ, Jones KA, Comer DM, Costacou T, Freiberg MS, Simhan HN, Day NL, Davis EM. Gestational Diabetes Diagnostic Methods (GD2M) Pilot Randomized Trial. Matern Child Health J 2014; 19:1472-80. [DOI: 10.1007/s10995-014-1651-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
5
|
Nielsen KK, Kapur A, Damm P, de Courten M, Bygbjerg IC. From screening to postpartum follow-up - the determinants and barriers for gestational diabetes mellitus (GDM) services, a systematic review. BMC Pregnancy Childbirth 2014; 14:41. [PMID: 24450389 PMCID: PMC3901889 DOI: 10.1186/1471-2393-14-41] [Citation(s) in RCA: 170] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 01/06/2014] [Indexed: 12/25/2022] Open
Abstract
Background Gestational diabetes mellitus (GDM) – a transitory form of diabetes first recognised during pregnancy complicates between < 1% and 28% of all pregnancies. GDM has important short and long-term health consequences for both the mother and her offspring. To prevent adverse pregnancy outcomes and to prevent or delay future onset of type 2 diabetes in mother and offspring, timely detection, optimum treatment, and preventive postpartum care and follow-up is necessary. However the area remains grossly under-prioritised. Methods To investigate determinants and barriers to GDM care from initial screening and diagnosis to prenatal treatment and postpartum follow-up, a PubMed database search to identify quantitative and qualitative studies on the subject was done in September 2012. Fifty-eight relevant studies were reviewed. Results Adherence to prevailing GDM screening guidelines and compliance to screening tests seems sub-optimal at best and arbitrary at worst, with no clear or consistent correlation to health care provider, health system or client characteristics. Studies indicate that most women express commitment and motivation for behaviour change to protect the health of their unborn baby, but compliance to recommended treatment and advice is fraught with challenges, and precious little is known about health system or societal factors that hinder compliance and what can be done to improve it. A number of barriers related to health care provider/system and client characteristics have been identified by qualitative studies. Immediately following a GDM pregnancy many women, when properly informed, desire and intend to maintain healthy lifestyles to prevent future diabetes, but find the effort challenging. Adherence to recommended postpartum screening and continued lifestyle modifications seems even lower. Here too, health care provider, health system and client related determinants and barriers were identified. Studies reveal that sense of self-efficacy and social support are key determinants. Conclusions The paper identifies and discusses determinants and barriers for GDM care, fully recognising that these are highly dependent on the context.
Collapse
Affiliation(s)
- Karoline Kragelund Nielsen
- Department of International Health, Immunology and Microbiology, University of Copenhagen, Oester Farimagsgade 5, Building 9, Copenhagen DK-1014, K, Denmark.
| | | | | | | | | |
Collapse
|
6
|
Moses RG, Morris GJ, Petocz P, San Gil F, Garg D. The impact of potential new diagnostic criteria on the prevalence of gestational diabetes mellitus in Australia. Med J Aust 2011; 194:338-40. [DOI: 10.5694/j.1326-5377.2011.tb03001.x] [Citation(s) in RCA: 138] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Accepted: 01/16/2011] [Indexed: 11/17/2022]
|
7
|
Persson M, Winkvist A, Mogren I. Surprisingly low compliance to local guidelines for risk factor based screening for gestational diabetes mellitus - A population-based study. BMC Pregnancy Childbirth 2009; 9:53. [PMID: 19917091 PMCID: PMC2784436 DOI: 10.1186/1471-2393-9-53] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2008] [Accepted: 11/16/2009] [Indexed: 11/26/2022] Open
Abstract
Background Screening for gestational diabetes mellitus (GDM) is routine during pregnancy in many countries in the world. The screening programs are either based on general screening offered to all pregnant women or risk factor based screening stipulated in local clinical guidelines. The aims of this study were to investigate: 1) the compliance with local guidelines of screening for GDM and 2) the outcomes of pregnancy and birth in relation to risk factors of GDM and whether or not exposed to oral glucose tolerance test (OGTT). Methods This study design was a population-based retrospective cross-sectional study of 822 women. A combination of questionnaire data and data collected from medical records was applied. Compliance to the local guidelines of risk factor based screening for GDM was examined and a comparison of outcomes of pregnancy and delivery in relation to risk factor groups for GDM was performed. Results Of the 822 participants, 257 (31.3%) women fulfilled at least one criterion for being exposed to screening for GDM according to the local clinical guidelines. However, only 79 (30.7%) of these women were actually exposed to OGTT and of those correctly exposed for screening, seven women were diagnosed with GDM. Women developing risk factors for GDM during pregnancy had a substantially increased risk of giving birth to an infant with macrosomia. Conclusion Surprisingly low compliance with the local clinical guidelines for screening for GDM during pregnancy was found. Furthermore, the prevalence of the risk factors of GDM in our study was almost doubled compared to previous Swedish studies. Pregnant women developing risk factors of GDM during pregnancy were found to be at substantially increased risk of giving birth to an infant with macrosomia. There is a need of actions improving compliance to the local guidelines.
Collapse
Affiliation(s)
- Margareta Persson
- Department of clinical science, Obstetrics and gynecology, Umeå University, Sweden.
| | | | | |
Collapse
|
8
|
Moses RG, Barker M, Winter M, Petocz P, Brand-Miller JC. Can a low-glycemic index diet reduce the need for insulin in gestational diabetes mellitus? A randomized trial. Diabetes Care 2009; 32:996-1000. [PMID: 19279301 PMCID: PMC2681032 DOI: 10.2337/dc09-0007] [Citation(s) in RCA: 127] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE A low-glycemic index diet is effective as a treatment for individuals with diabetes and has been shown to improve pregnancy outcomes when used from the first trimester. A low-glycemic index diet is commonly advised as treatment for women with gestational diabetes mellitus (GDM). However, the efficacy of this advice and associated pregnancy outcomes have not been systematically examined. The purpose of this study was to determine whether prescribing a low-glycemic index diet for women with GDM could reduce the number of women requiring insulin without compromise of pregnancy outcomes. RESEARCH DESIGN AND METHODS All women with GDM seen over a 12-month period were considered for inclusion in the study. Women (n = 63) were randomly assigned to receive either a low-glycemic index diet or a conventional high-fiber (and higher glycemic index) diet. RESULTS Of the 31 women randomly assigned to a low-glycemic index diet, 9 (29%) required insulin. Of the women randomly assigned to a higher-glycemic index diet, a significantly higher proportion, 19 of 32 (59%), met the criteria to commence insulin treatment (P = 0.023). However, 9 of these 19 women were able to avoid insulin use by changing to a low-glycemic index diet. Key obstetric and fetal outcomes were not significantly different. CONCLUSIONS Using a low-glycemic index diet for women with GDM effectively halved the number needing to use insulin, with no compromise of obstetric or fetal outcomes.
Collapse
Affiliation(s)
- Robert G Moses
- Illawarra Diabetes Service, South Eastern Sydney and Illawarra Area Health Service, Wollongong, New South Wales, Australia.
| | | | | | | | | |
Collapse
|
9
|
Gayet-Ageron A, Poncet B, Guerre P, Rocher L, Dureau-Drevard E, Colin C, Orgiazzi J, Berland M, Touzet S. Specific information about the WHO guidelines for gestational diabetes screening improves clinical practices. J Eval Clin Pract 2008; 14:36-42. [PMID: 18211641 DOI: 10.1111/j.1365-2753.2007.00783.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVE To evaluate the impact of specific information on World Health Organization (WHO) guidelines for gestational diabetes mellitus (GDM) screening on clinical practices and to estimate its acceptance by women. METHODS A non-randomized interventional study, comparing two periods, that is, before (period I) and after (period II) the implementation of the WHO guidelines during year 2000 in three obstetrical units, using reminders, meetings and pre-printed prescription sheets. Women were interviewed on GDM screening acceptance. RESULTS A total of 333 pregnant women were included in period I and 345 in period II. The proportion of women who were screened significantly increased between period I and period II (0.9% in period I, 59.1% in period II, P < 10(-3)). The screening test was realized in accordance with guidelines for 80% of women in period II. The acceptability of the test by women was estimated at 98%. Furthermore, 90% of them would accept to be screened again during another pregnancy. DISCUSSION Specific information about WHO screening guidelines improves doctor practices. Moreover, the high rate of acceptance by women is an argument to promote more widespread WHO screening for GDM during pregnancy.
Collapse
Affiliation(s)
- Angèle Gayet-Ageron
- Pôle Information médicale Evaluation Recherche, Hospices Civils de Lyon, and Université Lyon 1, Lyon, France
| | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Cosson E, Benchimol M, Carbillon L, Pharisien I, Pariès J, Valensi P, Lormeau B, Bolie S, Uzan M, Attali JR. Universal rather than selective screening for gestational diabetes mellitus may improve fetal outcomes. DIABETES & METABOLISM 2006; 32:140-6. [PMID: 16735962 DOI: 10.1016/s1262-3636(07)70260-4] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIM The benefit of treating gestational diabetes mellitus (GDM) has recently been shown. The aim of this study was to compare offspring and maternal health benefits from selective or universal screening for GDM. METHODS The incidence of outcomes was compared in three series of pregnant women: 1) the 159 consecutive women with GDM out of the 1909 women who delivered between October 2000 and September 2001: during this period screening for GDM was based on risk factors (risk factor-GDM); 2) the 265 consecutive women with GDM out of the 2111 women who delivered during the year 2002: during this period screening for GDM was universal (universal-GDM); 3) 1255 women with no GDM during year 2002 (controls). RESULTS After adjustment for age, pregravid body mass index, parity, and ethnicity, the risk of large for gestational age (Odds ratio 2.19[95% confidence interval 1.36-3.54], P < 10(-3)), delivery before 37 weeks of gestation (OR 2.44 [95CI 1.32-4.51], P = 0.004), jaundice (OR 3.31[95CI 1.58-6.93], P = 0.002), hospitalization in the department of pediatrics (OR 2.35 [95CI 1.53-3.61], P < 10(-3)) was higher in the GDM-risk factor group than in the control group, whereas it was similar in the universal-GDM group and the control group. Compared with the control group, the risk of anticipated delivery and hospital stay > 4 days after delivery was increased in the GDM-risk factor group (OR 2.69[1.88-3.84], P < 10(-3); and OR 2.6 [1.82-3.71], P < 10(-3) respectively) and the universal-GDM group (OR 1.54 [1.15-2.07] P = 0.004; and OR 1.49 [1.13-1.97], P = 0.005 respectively). CONCLUSION This observational study suggests that universal rather than selective screening for GDM may improve outcomes. Universal screening might reduce delay of diagnosis and care.
Collapse
Affiliation(s)
- E Cosson
- Department of Endocrinology-Diabetology-Nutrition, Jean Verdier Hospital, AP-HP, Paris XIII University, Bondy, France.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Koren G. Glyburide is Safe for Gestational Diabetes Mellitus. Can Pharm J (Ott) 2005. [DOI: 10.1177/171516350513800614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
12
|
Abstract
OBJECTIVE To assess the relationship between leg length and glucose tolerance in pregnancy. RESEARCH DESIGN AND METHODS The leg length and leg-to-height percentage were prospectively determined on 161 glucose-tolerant women during pregnancy and 61 women with gestational diabetes mellitus (GDM). RESULTS Women with GDM were a mean of 2.8 cm shorter than women who were glucose tolerant, due entirely to their leg lengths being a mean of 3.2 cm shorter. With respect to the 2-h result on the glucose tolerance test (GTT), there were negative correlations for height (r = -0.161, P = 0.017), leg length (r = -0.266, P < 0.0005), and the leg-to-height percentage (r = -0.294, P < 0.0005). The correlation between the leg-to-height percentage and the 2-h result on the GTT remained significant after adjustment for age (r = -0.252, P < 0.0005) and for age and BMI (r = -0.224, P = 0.001). CONCLUSIONS Women with GDM are shorter than glucose-tolerant women and have a lower leg-to-height percentage. Consideration of short stature as a risk factor for GDM is not valid without taking into account the leg-to-height percentage.
Collapse
Affiliation(s)
- Robert G Moses
- Diabetes Service, Illawarra Area Health Service, Wollongong, New South Wales, Australia.
| | | |
Collapse
|