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Pheiffer C, Riedel S, Dias S, Adam S. Gestational Diabetes and the Gut Microbiota: Fibre and Polyphenol Supplementation as a Therapeutic Strategy. Microorganisms 2024; 12:633. [PMID: 38674578 PMCID: PMC11051981 DOI: 10.3390/microorganisms12040633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 03/17/2024] [Accepted: 03/18/2024] [Indexed: 04/28/2024] Open
Abstract
Gestational diabetes mellitus (GDM) is an escalating public health concern due to its association with short- and long-term adverse maternal and child health outcomes. Dysbiosis of microbiota within the gastrointestinal tract has been linked to the development of GDM. Modification of microbiota dysbiosis through dietary adjustments has attracted considerable attention as adjunct strategies to improve metabolic disease. Diets high in fibre and polyphenol content are associated with increased gut microbiota alpha diversity, reduced inflammation and oxidative processes and improved intestinal barrier function. This review explores the potential of fibre and polyphenol supplementation to prevent GDM by investigating their impact on gut microbiota composition and function.
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Affiliation(s)
- Carmen Pheiffer
- Biomedical Research and Innovation Platform (BRIP), South African Medical Research Council, Tygerberg, Cape Town 7505, South Africa; (S.R.); (S.D.)
- Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria 0028, South Africa;
- Centre for Cardio-Metabolic Research in Africa (CARMA), Division of Medical Physiology, Faculty of Health Sciences, Stellenbosch University, Tygerberg, Cape Town 7505, South Africa
| | - Sylvia Riedel
- Biomedical Research and Innovation Platform (BRIP), South African Medical Research Council, Tygerberg, Cape Town 7505, South Africa; (S.R.); (S.D.)
- Centre for Cardio-Metabolic Research in Africa (CARMA), Division of Medical Physiology, Faculty of Health Sciences, Stellenbosch University, Tygerberg, Cape Town 7505, South Africa
| | - Stephanie Dias
- Biomedical Research and Innovation Platform (BRIP), South African Medical Research Council, Tygerberg, Cape Town 7505, South Africa; (S.R.); (S.D.)
| | - Sumaiya Adam
- Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria 0028, South Africa;
- Diabetes Research Centre, Faculty of Health Sciences, University of Pretoria, Pretoria 0028, South Africa
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Cahn J, Sundaram A, Balachandar R, Berg A, Birnbaum A, Hastings S, Makansi M, Romano E, Majidi A, McCormick D, Gaffney A. The Association of Childbirth with Medical Debt in the USA, 2019-2020. J Gen Intern Med 2023; 38:2340-2346. [PMID: 37199904 PMCID: PMC10192781 DOI: 10.1007/s11606-023-08214-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 04/13/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND Medical debt affects one in five adults in the USA and may disproportionately burden postpartum women due to pregnancy-related medical costs. OBJECTIVE To evaluate the association between childbirth and medical debt, and the correlates of medical debt among postpartum women, in the USA. DESIGN Cross-sectional. PARTICIPANTS We analyzed female "sample adults" 18-49 years old in the 2019-2020 National Health Interview Survey, a nationally representative household survey. MAIN MEASURES Our primary exposure was whether the subject gave birth in the past year. We had two family-level debt outcomes: problems paying medical bills and inability to pay medical bills. We examined the association between live birth and medical debt outcomes, unadjusted and adjusted for potential confounders in multivariable logistic regressions. Among postpartum women, we also examined the association between medical debt with maternal asthma, hypertension, and gestational diabetes and several sociodemographic factors. KEY RESULTS Our sample included n = 12,163 women, n = 645 with a live birth in the past year. Postpartum women were younger, more likely to have Medicaid, and lived in larger families than those not postpartum. 19.8% of postpartum women faced difficulty with medical bills versus 15.1% who were not; in multivariable regression, postpartum women had 48% higher adjusted odds of medical debt problems (95% CI 1.13, 1.92). Results were similar when examining inability to pay medical bills, and similar differences were seen for privately insured women. Among postpartum women, those with lower incomes and with asthma or gestational diabetes, but not hypertension, had significantly higher adjusted odds of medical debt problems. CONCLUSIONS Postpartum women experience higher levels of medical debt than other women; poorer women and those with common chronic diseases may have an even higher burden. Policies to expand and improve health coverage for this population are needed to improve maternal health and the welfare of young families.
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Affiliation(s)
- Jordan Cahn
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA USA
- Harvard Medical School, Boston, MA USA
| | - Ayesha Sundaram
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA USA
- Harvard Medical School, Boston, MA USA
| | - Roopa Balachandar
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA USA
- Harvard Medical School, Boston, MA USA
| | - Alexandra Berg
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA USA
- Harvard Medical School, Boston, MA USA
| | - Aaron Birnbaum
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA USA
- Harvard Medical School, Boston, MA USA
| | - Stephanie Hastings
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA USA
- Harvard Medical School, Boston, MA USA
| | - Matthew Makansi
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA USA
- Harvard Medical School, Boston, MA USA
| | - Emily Romano
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA USA
- Harvard Medical School, Boston, MA USA
| | - Ariel Majidi
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA USA
- Harvard Medical School, Boston, MA USA
| | - Danny McCormick
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA USA
- Harvard Medical School, Boston, MA USA
| | - Adam Gaffney
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA USA
- Harvard Medical School, Boston, MA USA
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Akinyemi OA, Weldeslase TA, Odusanya E, Akueme NT, Omokhodion OV, Fasokun ME, Makanjuola D, Fakorede M, Ogundipe T. Profiles and Outcomes of Women with Gestational Diabetes Mellitus in the United States. Cureus 2023; 15:e41360. [PMID: 37546039 PMCID: PMC10399637 DOI: 10.7759/cureus.41360] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2023] [Indexed: 08/08/2023] Open
Abstract
Introduction Gestational diabetes mellitus (GDM) is a major contributor to adverse pregnancy outcomes both in the United States and globally. As the prevalence of obesity continues to rise, the incidence of GDM is anticipated to increase as well. Despite the significant impact of GDM on maternal and neonatal health, research examining the independent associations between GDM and adverse outcomes remains limited in the U.S. context. Objective This study aims to address this knowledge gap and further elucidate the relationship between GDM and maternal and neonatal health outcomes. Method We performed a retrospective study using data from the United States Vital Statistics Records, encompassing deliveries that occurred between January 2015 and December 2019. Our analysis aimed to establish the independent association between GDM and various adverse maternal and neonatal outcomes. The multivariate analysis incorporated factors such as maternal socioeconomic demographics, preexisting comorbidities, and conditions during pregnancy to account for potential confounders and elucidate the relationship between GDM and the outcomes of interest. Result Between 2015 and 2019, there were 1,212,589 GDM-related deliveries, accounting for 6.3% of the 19,249,237 total deliveries during the study period. Among women with GDM, 46.4% were Non-Hispanic Whites, 11.4% were Non-Hispanic Blacks, 25.7% were Hispanics, and 16.5% belonged to other racial/ethnic groups. The median age of women with GDM was 31 years, with an interquartile range of 27-35 years. The cesarean section rate among these women was 46.5%. GDM was identified as an independent predictor of adverse maternal and neonatal outcomes, including cesarean section (OR=1.40; 95% CI: 1.39-1.40), maternal blood transfusion (OR=1.15; 95% CI: 1.12-1.18), intensive care unit admission (OR=1.16; 95% CI: 1.10-1.21), neonatal intensive care unit admission (OR=1.53; 95% CI: 1.52-1.54), assisted ventilation (OR=1.37; 95% CI: 1.35-1.39), and low 5-minute Apgar score (OR=1.01; 95% CI: 1.00-1.03). Conclusion GDM serves as an independent risk factor for adverse maternal and neonatal outcomes, emphasizing the importance of early detection and management in pregnant women.
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Affiliation(s)
- Oluwasegun A Akinyemi
- Health Policy and Management, University of Maryland School of Public Health, College Park, USA
- Surgery, Howard University, Washington DC, USA
| | | | - Eunice Odusanya
- Obstetrics and Gynecology, Howard University College of Medicine, Washington DC, USA
| | - Ngozi T Akueme
- Dermatology, University of Medical Sciences Teaching Hospital (UNIMEDTH), Ondo State, NGA
| | | | - Mojisola E Fasokun
- Epidemiology and Public Health, University of Alabama at Birmingham, Birmingham, USA
| | | | - Mary Fakorede
- Family Medicine, Howard University College of Medicine, Washington DC, USA
- Psychiatry, Ladoke Akintola University, Ogbomoso, NGA
| | - Temitayo Ogundipe
- Community and Family Medicine, Howard University Hospital, Washington DC, USA
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Formoso G, Bianchi C, Burlina S, Manicardi E, Sculli MA, Resi V, Sciacca L. Knowledge, attitude, and practice of the 2009 Institute of Medicine (IOM) recommendations on the nutritional management of diabetes in pregnancy: an online national survey. Acta Diabetol 2022; 59:1597-1607. [PMID: 36053391 PMCID: PMC9581811 DOI: 10.1007/s00592-022-01950-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/22/2022] [Indexed: 11/17/2022]
Abstract
AIMS As recommended by the Institute of Medicine (IOM), health practitioners should encourage a healthy nutrition and adequate weight gain during pregnancy in order to ensure favorable pregnancy and fetal outcomes, and to prevent diseases later in life for both mother and child. The purpose of this online survey was to determine the knowledge, attitude, and practice of the 2009 IOM recommendations among healthcare professionals managing nutritional therapy in pregnancies complicated by diabetes in Italy. METHODS A cross-sectional survey was conducted by using an online self-administered questionnaire undertaken between October and December 2021. RESULTS Of the 220 participants 89% were diabetologists/endocrinologists/internal medicine specialists and 11% dietitians/nutritionists. The survey found that the 53% of respondents provide a personalized diet to pregnant women with diabetes, while 32% a standard diet plan and only 15% healthy dietary advice. The 69% of the participants investigated for appropriate gestational weight gain, mainly based on pre-pregnancy BMI (96%), gestational weight gain (GWG) at first prenatal visit (80%) and presence of twin pregnancy (58%). Maternal weight gain was evaluated at each regularly scheduled prenatal visit and compared with IOM recommendations for the 87% of healthcare professionals. Diet plan was periodically re-evaluated and/or modified (90% of participants), based on inadequate maternal weight gain and/or fetal growth abnormalities (78%), trimester transition (53%), changes in physical activity and/or a "feel hungry" (50%). CONCLUSIONS This survey reported the knowledge and attitude of IOM guidelines and the nutritional knowledge and practice of Italian professionals on the nutritional management of diabetes in pregnancy. The application of these recommendations seemed more feasible in clinics/team dedicated to "Diabetes in Pregnancy".
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Affiliation(s)
- Gloria Formoso
- Interassociative Diabetes and Pregnancy Study Group, Italian Association of Diabetologists (AMD), Italian Society of Diabetology (SID), Rome, Italy.
- Department of Medicine and Aging Sciences, Center for Advanced Studies and Technology (CAST, Ex CeSIMet) G. d'Annunzio University Chieti-Pescara, Chieti, Italy.
| | - Cristina Bianchi
- Interassociative Diabetes and Pregnancy Study Group, Italian Association of Diabetologists (AMD), Italian Society of Diabetology (SID), Rome, Italy
- Metabolic Diseases and Diabetes Unit, University Hospital of Pisa, Pisa, Italy
| | - Silvia Burlina
- Interassociative Diabetes and Pregnancy Study Group, Italian Association of Diabetologists (AMD), Italian Society of Diabetology (SID), Rome, Italy
- Department of Medicine, DIMED, University of Padova, Padova, Italy
| | - Elisa Manicardi
- Interassociative Diabetes and Pregnancy Study Group, Italian Association of Diabetologists (AMD), Italian Society of Diabetology (SID), Rome, Italy
- Diabetes Unit, Primary Health Care, Local Health Authority of Reggio Emilia-IRCCS, Reggio Emilia, Italy
| | - Maria Angela Sculli
- Interassociative Diabetes and Pregnancy Study Group, Italian Association of Diabetologists (AMD), Italian Society of Diabetology (SID), Rome, Italy
- Endocrinology and Diabetes, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy
| | - Veronica Resi
- Interassociative Diabetes and Pregnancy Study Group, Italian Association of Diabetologists (AMD), Italian Society of Diabetology (SID), Rome, Italy
- Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Laura Sciacca
- Interassociative Diabetes and Pregnancy Study Group, Italian Association of Diabetologists (AMD), Italian Society of Diabetology (SID), Rome, Italy
- Department of Clinical and Experimental Medicine, Endocrinology Section, University of Catania, Catania, Italy
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More Is Not Always Better. Obstet Gynecol 2022; 140:710-711. [DOI: 10.1097/aog.0000000000004973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Zahid S, Hashem A, Minhas AS, Bennett WL, Honigberg MC, Lewey J, Davis MB, Michos ED. Trends, Predictors, and Outcomes of Cardiovascular Complications at Delivery Associated With Gestational Diabetes: A National Inpatient Sample Analysis (2004-2019). J Am Heart Assoc 2022; 11:e026786. [PMID: 36300664 PMCID: PMC9673632 DOI: 10.1161/jaha.122.026786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background Gestational diabetes (GD) is associated with increased risk of long-term cardiovascular complications. However, data on acute peripartum cardiovascular complications are not well established. Hence, we aimed to investigate the association of GD with acute cardiovascular outcomes at the time of delivery admission. Methods and Results We used data from the National Inpatient Sample (2004-2019). International Classification of Diseases, Ninth Revision (ICD-9) or Tenth Revision (ICD-10) codes were used to identify delivery hospitalizations and GD diagnosis. A total of 63 115 002 weighted hospitalizations for deliveries were identified, of which 3.9% were among individuals with GD (n=2 435 301). The prevalence of both GD and obesity increased during the study period (P trends<0.01). Individuals with GD versus those without GD had a higher prevalence of obesity, hypertension, and dyslipidemia. After adjustment for age, race or ethnicity, comorbidities, insurance, and income, GD remained independently associated with cardiovascular complications including preeclampsia (adjusted odds ratio [aOR], 1.97 [95% CI, 1.96-1.98]), peripartum cardiomyopathy (aOR, 1.15 [1.08-1.22]), acute kidney injury (aOR, 1.16 [1.11-1.21]), stroke (aOR, 1.15 [1.09-1.23]), and arrhythmias (aOR, 1.48 [1.46-1.50]), compared with no GD. Moreover, delivery hospitalizations among individuals with GD were associated with increased length (3 versus 2 days, P<0.01) and cost of hospitalization ($4909 versus $3682, P<0.01). Even in the absence of preeclampsia, GD was associated with elevated cardiovascular risk. Conclusions Individuals with GD had a higher risk of preeclampsia, peripartum cardiomyopathy, acute kidney injury, stroke, and arrhythmias during delivery hospitalizations. As rates of GD are increasing globally, efforts to improve preconception cardiometabolic health and prevent GD may represent important strategies to improve peripartum maternal outcomes and mitigate long-term cardiovascular risk.
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Affiliation(s)
- Salman Zahid
- Sands‐Constellation Heart Institute, Rochester General HospitalRochesterNY
| | - Anas Hashem
- Sands‐Constellation Heart Institute, Rochester General HospitalRochesterNY
| | - Anum S. Minhas
- Division of CardiologyJohns Hopkins University School of MedicineBaltimoreMD
| | - Wendy L. Bennett
- Division of General Internal MedicineJohns Hopkins University School of MedicineBaltimoreMD
| | - Michael C. Honigberg
- Cardiology Division, Department of MedicineMassachusetts General HospitalBostonMA
| | - Jennifer Lewey
- Division of Cardiology, Department of MedicineUniversity of PennsylvaniaPhiladelphiaPA
| | | | - Erin D. Michos
- Division of CardiologyJohns Hopkins University School of MedicineBaltimoreMD
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Mnatzaganian G, Woodward M, McIntyre HD, Ma L, Yuen N, He F, Nightingale H, Xu T, Huxley RR. Trends in percentages of gestational diabetes mellitus attributable to overweight, obesity, and morbid obesity in regional Victoria: an eight-year population-based panel study. BMC Pregnancy Childbirth 2022; 22:95. [PMID: 35105311 PMCID: PMC8809044 DOI: 10.1186/s12884-022-04420-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 12/20/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is the fastest growing type of diabetes in Australia with rates trebling over the past decades partially explained by rising obesity rates and maternal age among childbearing women. Percentage of GDM attributable to obesity has been documented, mostly focusing on metropolitan populations. In parts of regional (areas outside capital cities) and rural Australia where overweight, obesity and morbid obesity are more prevalent, intertwined with socioeconomic disadvantage and higher migrant communities, trends over time in adjusted percentages of GDM attributed to obesity are unknown. METHODS In this population-based retrospective panel study, women, without pre-existing diabetes, delivering singletons between 2010 and 2017 in a tertiary regional hospital that serves 26% of Victoria's 6.5 million Australian population were eligible for inclusion. Secular trends in GDM by body mass index (BMI) and age were evaluated. The percentage of GDM that would have been prevented each year with the elimination of overweight or obesity was estimated using risk-adjusted regression-based population attributable fractions (AFp). Trends in the AFp over time were tested using the augmented Dickey-Fuller test. RESULTS Overall 7348 women, contributing to 10,028 births were included. The age of expecting mothers, their BMI, proportion of women born overseas, and GDM incidence significantly rose over time with GDM rising from 3.5% in 2010 to 13.7% in 2017, p < 0.001, increasing in all BMI categories. The incidence was consistently highest among women with obesity (13.8%) and morbid obesity (21.6%). However, the highest relative increase was among women with BMI < 25 kg/m2, rising from 1.4% in 2010 to 7.0% in 2017. Adjusting for age, country of birth, socioeconomic status, comorbidities, antenatal and intrapartum factors, an estimated 8.6% (confidence interval (CI) 6.1-11.0%), 15.6% (95% CI 12.2-19.0%), and 19.5% (95% CI 15.3-23.6%) of GDM would have been prevented by eliminating maternal overweight, obesity, and morbid obesity, respectively. However, despite the rise in obesity over time, percentages of GDM attributable to overweight, obesity, and morbid obesity significantly dropped over time. Scenario analyses supported these findings. CONCLUSIONS Besides increasing prevalence of obesity over time, this study suggests that GDM risk factors, other than obesity, are also increasing over time.
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Affiliation(s)
- George Mnatzaganian
- Rural Department of Community Health, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia.
- The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.
| | - Mark Woodward
- The George Institute for Global Health, Imperial College, London, UK
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - H David McIntyre
- Obstetric Medicine, Mater Health Services, University of Queensland, Brisbane, Queensland, Australia
| | - Liangkun Ma
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, China
| | - Nicola Yuen
- Department of Women's & Children's Services, Bendigo Health, Bendigo, Victoria, Australia
| | - Fan He
- Rural Department of Community Health, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
- John Richards Centre for Rural Ageing Research, La Trobe Rural Health School, La Trobe University, Albury-Wodonga, Victoria, Australia
| | - Helen Nightingale
- Rural Department of Nursing and Midwifery, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Tingting Xu
- Department of Health Policy and Management, School of Public Health, Capital Medical University, Beijing, China
| | - Rachel R Huxley
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Faculty of Health, Deakin University, Melbourne, Australia
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Maternal and fetal characteristics in pregnancies complicated with gestational diabetes. GINECOLOGIA.RO 2022. [DOI: 10.26416/gine.35.1.2022.6131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Switzer C, Tikhonov I, Khromava A, Pool V, Lévesque LE. Safety and use of tetanus-diphtheria-acellular pertussis-5 (Tdap5) vaccine during pregnancy: findings from 11 years of reporting to a pregnancy registry. Hum Vaccin Immunother 2021; 17:5325-5333. [PMID: 34965196 PMCID: PMC8903913 DOI: 10.1080/21645515.2021.1915038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 04/05/2021] [Indexed: 10/26/2022] Open
Abstract
The "Adacel (Tdap5) Pregnancy Registry" was used to identify 1182 women who received the tetanus, diphtheria, acellular pertussis [5 components] (Tdap5) vaccine during pregnancy from 2005 to 2016. To evaluate the safety and use of prenatal Tdap5, we calculated the rate of maternal, obstetrical, pregnancy and neonatal outcomes following Tdap5 pregnancy exposure and assessed vaccine uptake by year and trimester of exposure. The most commonly reported maternal adverse events included injection site reactions (2.6%; 95% Confidence Interval 1.8%, 3.7%), nervous system events (1.3%; 0.8%, 2.1%) and musculoskeletal events (1.1%; 0.6%, 1.9%). The most commonly reported complications of pregnancy were hypertension/preeclampsia (5.5%; 3.3%, 8.9%) and gestational diabetes (2.5%; 1.1%, 5.3%), while those for labor and delivery were premature labor (2.9%; 1.4%, 5.7%) and premature membrane rupture (1.5%; 0.4%, 3.8%). These rates were similar to, or lower than those reported for the general population of pregnant women. Among pregnancies with known birth outcomes (N = 275), 90.4% (86.2%, 93.4%) resulted in a live birth, 5.9% (3.6%, 9.5%) in spontaneous abortion, 3.0% (1.4%, 5.8%) in stillbirth, and 0.7% (0.0%, 2.8%) in ectopic pregnancies. Most newborns had normal APGAR scores and birth weights (98.1% and 93.0%, respectively), and only two reported a congenital anomaly (0.7%; 0.0%, 2.8%). An influx of reports in 2012 with third trimester Tdap5 exposure coincided with the 2012 updated Advisory Committee on Immunization Practices recommendations. This analysis did not identify any safety concerns across the continuum of maternal, obstetrical, pregnancy, and neonatal outcomes in women who received Tdap5 vaccination during pregnancy.
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Affiliation(s)
- Charlotte Switzer
- Global Pharmacovigilance and Epidemiology, Sanofi Pasteur, Toronto, Ontario, Canada
| | - Ilia Tikhonov
- Global Pharmacovigilance and Epidemiology, Sanofi Pasteur, Swiftwater, Pennsylvania, USA
| | - Alena Khromava
- Epidemiology and Benefit-Risk, Sanofi Pasteur, Toronto, Ontario, Canada
| | - Vitali Pool
- Medical Affairs, Sanofi Pasteur, Swiftwater, PA, USA
| | - Linda E. Lévesque
- Epidemiology and Benefit-Risk, Sanofi Pasteur, Toronto, Ontario, Canada
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Ergin A, Türkay Ü, Özdemir S, Taşkın A, Terzi H, Özsürmeli M. Age at menarche: risk factor for gestational diabetes. J OBSTET GYNAECOL 2021; 42:680-686. [PMID: 34415226 DOI: 10.1080/01443615.2021.1929116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This study examines the relationship between the age at menarche and gestational diabetes mellitus (GDM). This retrospective study included subjects who were diagnosed with GDM at a pregnancy polyclinic in Kocaeli, Turkey between 2014 and 2018. The mean ages at menarche were 12.6 and 13.03 years in the GDM group and control group, respectively. The analysis results showed that pre-pregnancy cycle duration, age at menarche and pre-pregnancy BMI are statistically significant in terms of the development of gestational diabetes. (p < .05).In our study showed that the risk of GDM was found to be 2.3 times higher in pregnant women with a menarche age of <12 years. If the pre-pregnancy BMI value is more than 25 kg/cm2, the risk of GDM was found to be approximately 2 times higher. The study indicated that age at menarche, cycle duration, and BMI were risk factors for GDM. IMPACT STATEMENTWhat is already known on this subject? GDM has a lasting health impact on both the mother and the foetus. While several risk factors have previously been identified for GDM such as family history, obesity, advanced maternal age, significant gaps remain in our understanding of the risk factor and pathogenesis. Recent studies suggested that earlier menarche was significantly associated with an increased risk of GDM.What do the results of this study add? There might be ethnic differences on the relationship between the GDM and menarche age. There is no study examining the relationship between the age of menarche and GDM in Turkey. In presented study, we determined the risk factors of GDM including the age of menarche, cycle duration and BMI.What are the implications of these findings for clinical practice and / or further research? Therefore, a comprehensive evaluation of the menstrual history by healthcare professionals is important for future pregnancy risks. It is important to understand risk factors for GDM and to establish preventive strategies among high-risk populations. In addition, this study will shed light on future epidemiological and cohort studies.
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Affiliation(s)
- Ayla Ergin
- Faculty of Health Sciences, Midwifery Department, Kocaeli University, Kocaeli, Turkey
| | - Ünal Türkay
- Department of Obstetrics and Gynecology, Derince Education and Research Hospital, T.C. Ministry of Health Kocaeli Health Sciences University, Kocaeli, Türkiye
| | - Suzi Özdemir
- Faculty of Health Sciences, Midwifery Department, Kocaeli University, Kocaeli, Turkey
| | - Ayşe Taşkın
- Department of Obstetrics and Gynecology, Derince Education and Research Hospital, T.C. Ministry of Health Kocaeli Health Sciences University, Kocaeli, Türkiye
| | - Hasan Terzi
- Department of Obstetrics and Gynecology, Derince Education and Research Hospital, T.C. Ministry of Health Kocaeli Health Sciences University, Kocaeli, Türkiye
| | - Mehmet Özsürmeli
- Department of Obstetrics and Gynecology, Derince Education and Research Hospital, T.C. Ministry of Health Kocaeli Health Sciences University, Kocaeli, Türkiye
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Phelan S, Jelalian E, Coustan D, Caughey AB, Castorino K, Hagobian T, Muñoz-Christian K, Schaffner A, Shields L, Heaney C, McHugh A, Wing RR. Protocol for a randomized controlled trial of pre-pregnancy lifestyle intervention to reduce recurrence of gestational diabetes: Gestational Diabetes Prevention/Prevención de la Diabetes Gestacional. Trials 2021; 22:256. [PMID: 33827659 PMCID: PMC8024941 DOI: 10.1186/s13063-021-05204-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 03/17/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is associated with several maternal complications in pregnancy, including preeclampsia, preterm labor, need for induction of labor, and cesarean delivery as well as increased long-term risks of type 2 diabetes, metabolic syndrome, and cardiovascular disease. Intrauterine exposure to GDM raises the risk for complications in offspring as well, including stillbirth, macrosomia, and birth trauma, and long-term risk of metabolic disease. One of the strongest risk factors for GDM is the occurrence of GDM in a prior pregnancy. Preliminary data from epidemiologic and bariatric surgery studies suggest that reducing body weight before pregnancy can prevent the development of GDM, but no adequately powered trial has tested the effects of a maternal lifestyle intervention before pregnancy to reduce body weight and prevent GDM recurrence. METHODS The principal aim of the Gestational Diabetes Prevention/Prevención de la Diabetes Gestacional is to determine whether a lifestyle intervention to reduce body weight before pregnancy can reduce GDM recurrence. This two-site trial targets recruitment of 252 women with overweight and obesity who have previous histories of GDM and who plan to have another pregnancy in the next 1-3 years. Women are randomized within site to a comprehensive pre-pregnancy lifestyle intervention to promote weight loss with ongoing treatment until conception or an educational control group. Participants are assessed preconceptionally (at study entry, after 4 months, and at brief quarterly visits until conception), during pregnancy (at 26 weeks' gestation), and at 6 weeks postpartum. The primary outcome is GDM recurrence, and secondary outcomes include fasting glucose, biomarkers of cardiometabolic disease, prenatal and perinatal complications, and changes over time in weight, diet, physical activity, and psychosocial measures. DISCUSSION The Gestational Diabetes Prevention /Prevención de la Diabetes Gestacional is the first randomized controlled trial to evaluate the effects of a lifestyle intervention delivered before pregnancy to prevent GDM recurrence. If found effective, the proposed lifestyle intervention could lay the groundwork for shifting current treatment practices towards the interconception period and provide evidence-based preconception counseling to optimize reproductive outcomes and prevent GDM and associated health risks. TRIAL REGISTRATION ClinicalTrials.gov NCT02763150 . Registered on May 5, 2016.
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Affiliation(s)
- Suzanne Phelan
- Department of Kinesiology & Public Health, Center for Health Research, California Polytechnic State University, San Luis Obispo, CA USA
| | - Elissa Jelalian
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI USA
| | - Donald Coustan
- Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Providence, RI USA
| | - Aaron B. Caughey
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR, USA
| | | | - Todd Hagobian
- Department of Kinesiology & Public Health, Center for Health Research, California Polytechnic State University, San Luis Obispo, CA USA
| | - Karen Muñoz-Christian
- Department of World Languages and Cultures, California Polytechnic State University, San Luis Obispo, CA USA
| | - Andrew Schaffner
- Statistics Department, California Polytechnic State University, San Luis Obispo, CA USA
| | - Laurence Shields
- Dignity Health, Marian Regional Medical Center, Santa Maria, CA USA
| | - Casey Heaney
- Department of Kinesiology & Public Health, Center for Health Research, California Polytechnic State University, San Luis Obispo, CA USA
| | - Angelica McHugh
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, USA
| | - Rena R. Wing
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, USA
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12
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Bazargan-Hejazi S, Ruiz M, Ullah S, Siddiqui G, Bangash M, Khan S, Shang W, Moradi P, Shaheen M. Racial and ethnic disparities in chronic health conditions among women with a history of gestational diabetes mellitus. Health Promot Perspect 2021; 11:54-59. [PMID: 33758756 PMCID: PMC7967138 DOI: 10.34172/hpp.2021.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 12/04/2020] [Indexed: 11/09/2022] Open
Abstract
Background: This study aims to examine and determine the role of race/ethnicity in chronic conditions in women diagnosed with gestational diabetes mellitus (GDM) during any of their previous pregnancies. Methods: We used the National Health and Nutrition Examination Survey (NHANES) from2007-2016 to identify women who self-reported prior GDM and chronic disease diagnoses such as cardiovascular disease, hypertension, depression, and type 2 diabetes mellitus (T2DM).We used bivariate analysis using the chi-square test (χ²) and multiple logistic regressions to perform statistical test for associations, taking into consideration design and sample weight. Results: Among participants with prior GDM diagnoses, black women had a 74.4% prevalence of chronic disease, followed by Whites, 58.5% Hispanics, 58.0%, and Asians, 51.9% (P=0.009).Black women with prior GDM diagnoses had 2.4 odds of having chronic conditions compared to Whites (adjusted odds ratio [AOR]=2.40, 95% confidence interval [CI] = 1.28-4.50). In addition, they had higher odds of being former smokers (AOR=1.73, 95% CI=1.01-2.96),current smokers (AOR=1.96, 95% CI=1.06-3.61), having a body mass index (BMI) of 25-29.9(AOR=2.55, 95% CI=1.10-5.87), or a BMI ≥30 (AOR=4.09, 95% CI = 2.05-8.17) compared to their White counterparts. Hispanic women had lower odds of being diagnosed with GDM and associated chronic diseases. Conclusion: Black women with GDM were disproportionally affected and at higher risk to be diagnosed with chronic conditions. Smoking and obesity were strongly associated with chronic disease diagnoses. Our findings also suggest a 'Hispanic Paradox', requiring further study. These findings inform primary care clinicians and Obstetricians, and Gynecologists of at-risk patients who could benefit from lifestyle modification recommendations and counseling.
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Affiliation(s)
- Shahrzad Bazargan-Hejazi
- Department Psychiatry, College of Medicine, Charles R. Drew University of Medicine and Science and UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Maria Ruiz
- College of Medicine, Charles R. Drew University of Medicine and Science, CA, USA
- UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Shakir Ullah
- Khyber Medical College, Pakistan, & College of Medicine at Charles Drew University of Medicine and Science, CA. USA
| | - Gazala Siddiqui
- Department of Obstetrics and Gynecology, University of Texas at Houston, Texas, USA
| | - Maria Bangash
- Southern California University of Health and Sciences, CA, USA
| | | | - Wendy Shang
- College of Science and Health, Biomedical Science, Charles R. Drew University of Medicine and Science, Ca, USA
| | - Parissa Moradi
- Department of Obstetrics and Gynecology, Charles R. Drew University of Medicine and Science, Ca, USA
| | - Magda Shaheen
- College of Medicine, Charles R. Drew University of Medicine and Science, CA, USA
- UCLA David Geffen School of Medicine, Los Angeles, CA, USA
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13
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Harrison RK, Cruz M, Wong A, Davitt C, Palatnik A. The timing of initiation of pharmacotherapy for women with gestational diabetes mellitus. BMC Pregnancy Childbirth 2020; 20:773. [PMID: 33308193 PMCID: PMC7731563 DOI: 10.1186/s12884-020-03449-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 11/22/2020] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND The decision to initiate pharmacotherapy is integral in the care for pregnant women with gestational diabetes mellitus (GDM). We sought to compare pregnancy outcomes between two threshold percentages of elevated glucose values prior to initiation of pharmacotherapy for GDM. We hypothesized that a lower threshold at pharmacotherapy initiation will be associated with lower rates of adverse perinatal outcomes. METHODS This was a retrospective cohort study of women with GDM delivering in a single tertiary care center. Pregnancy outcomes were compared using bivariable and multivariable analyses between women who started pharmacotherapy (insulin or oral hypoglycemic agent) after a failed trial of dietary modifications at two different ranges of elevated capillary blood glucose (CBG) values: Group 1 when 20-39% CBG values were above goal; Group 2 when ≥40% CBG values were above goal. The primary outcome was a composite GDM-associated neonatal adverse outcome that included: macrosomia, large for gestational age (LGA), shoulder dystocia, hypoglycemia, hyperbilirubinemia requiring phototherapy, respiratory distress syndrome, stillbirth, and neonatal demise. Secondary outcomes included cesarean delivery, preterm birth (< 37 weeks), neonatal intensive care unit (NICU) admission, and small for gestational age (SGA). RESULTS A total of 417 women were included in the study. In univariable analysis, the composite neonatal outcome was statistically significantly higher in Group 2 compared to Group 1 (47.9% vs. 31.4%, p = 0.001). In addition, rates of preterm birth (15.7% vs 7.4%, p = 0.011), NICU admission (11.7% vs 4.0%, p = 0.006), and LGA (21.2% vs 9.1% p = 0.001) were higher in Group 2. In contrast, higher rates of SGA were noted in Group 1 (8.0% vs. 2.9%, p = 0.019). There was no difference in cesarean section rates. These findings persisted in multivariable analysis after adjusting for confounding factors (composite neonatal outcome aOR = 0.50, 95%CI [0.31-0.78]). CONCLUSIONS Initiation of pharmacotherapy for GDM when 20-39% of CBG values are above goal, compared to ≥40%, was associated with decreased rates of adverse neonatal outcomes attributable to GDM. This was accompanied by higher rates of SGA among women receiving pharmacotherapy at the lower threshold. Additional studies are required to identify the optimal threshold of abnormal CBG values to initiate pharmacotherapy for GDM.
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Affiliation(s)
- Rachel K Harrison
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI, 53226, USA.
| | - Meredith Cruz
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI, 53226, USA
| | - Ashley Wong
- Medical College of Wisconsin, 8701 W. Watertown Plank Rd, Milwaukee, WI, 53226, USA
| | - Caroline Davitt
- Medical College of Wisconsin, 8701 W. Watertown Plank Rd, Milwaukee, WI, 53226, USA
| | - Anna Palatnik
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI, 53226, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
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14
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Sheiner E. Gestational Diabetes Mellitus: Long-Term Consequences for the Mother and Child Grand Challenge: How to Move on Towards Secondary Prevention? FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2020; 1:546256. [PMID: 36993989 PMCID: PMC10041873 DOI: 10.3389/fcdhc.2020.546256] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 10/12/2020] [Indexed: 03/28/2023]
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15
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Pheiffer C, Dias S, Adam S. Intimate Partner Violence: A Risk Factor for Gestational Diabetes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17217843. [PMID: 33114711 PMCID: PMC7663316 DOI: 10.3390/ijerph17217843] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/14/2020] [Accepted: 10/19/2020] [Indexed: 12/30/2022]
Abstract
The early detection and management of gestational diabetes mellitus (GDM) is an important public health goal. GDM, which is defined as a glucose intolerance that develops during pregnancy, affects about 14% of pregnancies globally, and without effective treatment, it is associated with adverse short- and long-term maternal and neonatal outcomes. Risk-factor screening is an acceptable and affordable strategy to enable risk stratification and intervention. However, common biological risk factors such as overweight or obesity, excessive gestational weight gain, and family history of diabetes often have poor predictive ability, failing to identify a large proportion of women at risk of developing GDM. Accumulating evidence implicate psychosocial factors in contributing to GDM risk. As such, intimate partner violence (IPV), through its contributing effects on maternal stress and depression, presents a plausible risk factor for GDM. Experiencing IPV during pregnancy may dysregulate the hypothalamus-pituitary-adrenal (HPA) axis, leading to increased cortisol secretion and insulin resistance. These effects may exacerbate the insulin-resistant environment characteristic of pregnancy, thus increasing GDM risk. This review explores the relationship between IPV and GDM. We highlight studies that have linked IPV with GDM and propose a biological mechanism that connects IPV and GDM. Recommendations for IPV screening strategies to prevent GDM are discussed.
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Affiliation(s)
- Carmen Pheiffer
- Biomedical Research and Innovation Platform (BRIP), South African Medical Research Council, P.O. Box 19070, Tygerberg, Cape Town 7505, South Africa;
- Division of Medical Physiology, Faculty of Health Sciences, Stellenbosch University, P.O. Box 19063, Tygerberg, Cape Town 7505, South Africa
- Correspondence: ; Tel.: +27-21-938-0292
| | - Stephanie Dias
- Biomedical Research and Innovation Platform (BRIP), South African Medical Research Council, P.O. Box 19070, Tygerberg, Cape Town 7505, South Africa;
| | - Sumaiya Adam
- Department of Obstetrics and Gynecology, University of Pretoria, Private Bag X169, Pretoria 0001, South Africa;
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16
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Shen J, Chen J, Zheng Z, Zheng J, Liu Z, Song J, Wong SY, Wang X, Huang M, Fang PH, Jiang B, Tsang W, He Z, Liu T, Akinwunmi B, Wang CC, Zhang CJP, Huang J, Ming WK. An Innovative Artificial Intelligence-Based App for the Diagnosis of Gestational Diabetes Mellitus (GDM-AI): Development Study. J Med Internet Res 2020; 22:e21573. [PMID: 32930674 PMCID: PMC7525402 DOI: 10.2196/21573] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/23/2020] [Accepted: 07/27/2020] [Indexed: 02/06/2023] Open
Abstract
Background Gestational diabetes mellitus (GDM) can cause adverse consequences to both mothers and their newborns. However, pregnant women living in low- and middle-income areas or countries often fail to receive early clinical interventions at local medical facilities due to restricted availability of GDM diagnosis. The outstanding performance of artificial intelligence (AI) in disease diagnosis in previous studies demonstrates its promising applications in GDM diagnosis. Objective This study aims to investigate the implementation of a well-performing AI algorithm in GDM diagnosis in a setting, which requires fewer medical equipment and staff and to establish an app based on the AI algorithm. This study also explores possible progress if our app is widely used. Methods An AI model that included 9 algorithms was trained on 12,304 pregnant outpatients with their consent who received a test for GDM in the obstetrics and gynecology department of the First Affiliated Hospital of Jinan University, a local hospital in South China, between November 2010 and October 2017. GDM was diagnosed according to American Diabetes Association (ADA) 2011 diagnostic criteria. Age and fasting blood glucose were chosen as critical parameters.
For validation, we performed k-fold cross-validation (k=5) for the internal dataset and an external validation dataset that included 1655 cases from the Prince of Wales Hospital, the affiliated teaching hospital of the Chinese University of Hong Kong, a non-local hospital. Accuracy, sensitivity, and other criteria were calculated for each algorithm. Results The areas under the receiver operating characteristic curve (AUROC) of external validation dataset for support vector machine (SVM), random forest, AdaBoost, k-nearest neighbors (kNN), naive Bayes (NB), decision tree, logistic regression (LR), eXtreme gradient boosting (XGBoost), and gradient boosting decision tree (GBDT) were 0.780, 0.657, 0.736, 0.669, 0.774, 0.614, 0.769, 0.742, and 0.757, respectively. SVM also retained high performance in other criteria. The specificity for SVM retained 100% in the external validation set with an accuracy of 88.7%. Conclusions Our prospective and multicenter study is the first clinical study that supports the GDM diagnosis for pregnant women in resource-limited areas, using only fasting blood glucose value, patients’ age, and a smartphone connected to the internet. Our study proved that SVM can achieve accurate diagnosis with less operation cost and higher efficacy. Our study (referred to as GDM-AI study, ie, the study of AI-based diagnosis of GDM) also shows our app has a promising future in improving the quality of maternal health for pregnant women, precision medicine, and long-distance medical care. We recommend future work should expand the dataset scope and replicate the process to validate the performance of the AI algorithms.
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Affiliation(s)
- Jiayi Shen
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China.,Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jiebin Chen
- College of Information Science and Technology, Jinan University, Guangzhou, China
| | - Zequan Zheng
- International School, Jinan University, Guangzhou, China
| | - Jiabin Zheng
- International School, Jinan University, Guangzhou, China
| | - Zherui Liu
- College of Information Science and Technology, Jinan University, Guangzhou, China
| | - Jian Song
- School of International Studies, Sun Yat-sen University, Guangzhou, China
| | - Sum Yi Wong
- International School, Jinan University, Guangzhou, China
| | - Xiaoling Wang
- School of Journalism and Communication, Jinan University, Guangzhou, China
| | - Mengqi Huang
- School of Journalism and Communication, Jinan University, Guangzhou, China
| | - Po-Han Fang
- International School, Jinan University, Guangzhou, China
| | | | - Winghei Tsang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Zonglin He
- International School, Jinan University, Guangzhou, China
| | - Taoran Liu
- Faculty of Economics and Business, University of Groningen, Groningen, Netherlands
| | - Babatunde Akinwunmi
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, United States.,Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Harvard University, Boston, MA, United States
| | - Chi Chiu Wang
- Department of Obstetrics & Gynaecology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Casper J P Zhang
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong
| | - Jian Huang
- Multidisciplinary, Collaborative Research Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, St Mary's Campus, Imperial College London, London, United Kingdom
| | - Wai-Kit Ming
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
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17
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Alenzi EO. Cost-effectiveness analysis of polycystic ovary syndrome management and the risk of gestational diabetes in pregnant women: a decision-tree model. Expert Rev Pharmacoecon Outcomes Res 2020; 21:995-999. [PMID: 32892665 DOI: 10.1080/14737167.2020.1819796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND This study estimated the cost-effectiveness of metformin to reduce the risk of gestational diabetes mellitus (GDM) in pregnant women with polycystic ovary syndrome (PCOS) from the US health-care payer perspective. METHODS A decision tree was developed to simulate the progression of PCOS in a hypothetical cohort of 10,000 pregnant women diagnosed with PCOS and two scenarios were tested. Normal glucose regulation without developing GDM, average cost-effectiveness ratios (ACER), and the incremental cost-effectiveness ratios (ICERs) were the outcome measures assessed through pregnancy. Evidence from randomized clinical trials and other published literature were used to assess disease progression and its associated health-care costs. Sensitivity analyses that varied key model parameters were conducted. RESULTS Management of PCOS with metformin was associated with lowest ACER ($669.78 per normal glucose regulation without GDM) as compared to 'no intervention' strategy. Metformin use is the most cost-effective strategy to manage PCOS during pregnancy with average cost savings of $7,593,372.97 and an average effect gain of 2271 of normal glucose regulation without GDM among pregnant women with PCOS. Sensitivity analyses determined that the results are robust. CONCLUSIONS Management of PCOS during pregnancy may be a cost-effective strategy to reduce GDM risk and its associated complications.
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Affiliation(s)
- Ebtihag O Alenzi
- Department of Community Medicine Faculty of Medicine, Northern Border University, Arar, Saudi Arabia
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18
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Ghaffari N, Gonzalez JM, Rosenstein MG. Does the 1-step method of gestational diabetes mellitus screening improve pregnancy outcomes? Am J Obstet Gynecol MFM 2020; 2:100199. [PMID: 33345916 DOI: 10.1016/j.ajogmf.2020.100199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 07/15/2020] [Accepted: 08/02/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND Despite considerate debate, the best method of diagnosing gestational diabetes mellitus remains unknown. A commonly used method of gestational diabetes mellitus screening in the United States is the 2-step method, which includes screening with a 50-gram, 1-hour glucose challenge followed by a 100-gram, 3-hour diagnostic oral glucose tolerance test. The International Association of Diabetes and Pregnancy Study Group has recommended the 1-step method using a 75-gram, 2-hour oral glucose tolerance test. The International Association of Diabetes and Pregnancy Study Group thresholds have been predicted to increase the rates of gestational diabetes mellitus, yet little is known about the effect on pregnancy outcomes, especially in the United States. OBJECTIVE This study aimed to determine whether adoption of the 1-step method of gestational diabetes mellitus screening leads to improved obstetrical outcomes at a single academic institution. STUDY DESIGN This is a retrospective cohort study of patients who delivered before and after a switch from the 2-step method to the 1-step International Association of Diabetes and Pregnancy Study Group method in July 2015. Women with a due date of January 1, 2012 through October 1, 2015 were diagnosed with gestational diabetes mellitus using the 2-step method with Carpenter and Coustan criteria. After a 6-month transition period, outcomes from women with a due date of May 1, 2016 through February 1, 2018, when the 1-step International Association of Diabetes and Pregnancy Study Group criteria were used to diagnose gestational diabetes mellitus, were evaluated. Women with gestational diabetes mellitus were managed similarly throughout the study period. The primary outcome was the incidence of primary cesarean delivery. Maternal and neonatal outcomes were compared using chi-square and t tests, and multivariable logistic regression was used to control for changes in the population. RESULTS With the adoption of the International Association of Diabetes and Pregnancy Study Group method, the rates of gestational diabetes mellitus more than doubled, to 23.3% from 9.2% (P<.001). The rates of primary cesarean delivery increased with the International Association of Diabetes and Pregnancy Study Group criteria (22.2% vs 19.4%, P=.001), and the incidence of shoulder dystocia was not significantly different (1.1% vs 0.8%, P=.07). The rate of preeclampsia decreased during the time the 1-step method was in use (8.2% vs 10.9%, P<.001). The rate of macrosomia was not different using a definition of ≥4500 g (0.99% vs 0.86%, P=.5) but was reduced when using a definition of ≥4000 g (8.0% vs 6.0%, P<.001). The rate of neonatal intensive care unit admission did not change significantly. Controlling for maternal age, body mass index, race or ethnicity, chronic hypertension, and parity, the adjusted odds of a diagnosis of gestational diabetes mellitus increased 3-fold (adjusted odds ratio, 3.3; 95% confidence interval, 2.90-3.66) with 1-step testing, the adjusted odds of a shoulder dystocia increased (adjusted odds ratio, 1.48; 95% confidence interval, 0.97-2.25), and the adjusted odds of preeclampsia decreased (adjusted odds ratio, 0.64; 95% confidence interval, 0.55-0.74). There was no change in the adjusted odds of primary cesarean delivery (adjusted odds ratio, 1.05; 95% confidence interval, 0.94-1.17). CONCLUSION Although the rates of gestational diabetes mellitus increased 3-fold with the adoption of the International Association of Diabetes and Pregnancy Study Group method, the rates of primary cesarean delivery, shoulder dystocia, and birthweight ≥4500 g did not decrease in our population. The incidence of preeclampsia decreased; our analysis suggests that this was not because of the increased diagnosis of gestational diabetes mellitus. In our patient population, a large increase in the rates of gestational diabetes mellitus did not lead to an improvement in several clinically meaningful obstetrical outcomes.
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Affiliation(s)
- Neda Ghaffari
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA.
| | - Juan M Gonzalez
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA
| | - Melissa G Rosenstein
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA
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19
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Sorbye LM, Cnattingius S, Skjaerven R, Klungsoyr K, Wikström AK, Kvalvik LG, Morken NH. Interpregnancy weight change and recurrence of gestational diabetes mellitus: a population-based cohort study. BJOG 2020; 127:1608-1616. [PMID: 32534460 DOI: 10.1111/1471-0528.16364] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To estimate recurrence risk of gestational diabetes mellitus (GDM) by interpregnancy weight change. DESIGN Population-based cohort study. SETTING AND POPULATION Data from the Swedish (1992-2010) and the Norwegian (2006-2014) Medical Birth Registries on 2763 women with GDM in first pregnancy, registered with their first two singleton births and available information on height and weight. METHODS Interpregnancy weight change (BMI in second pregnancy minus BMI in first pregnancy) was categorised in six groups by BMI units. Relative risks (RRs) of GDM recurrence were obtained by general linear models for the binary family and adjusted for confounders. Analyses were stratified by BMI in first pregnancy (<25 and ≥25 kg/m2 ). MAIN OUTCOME MEASURE GDM in second pregnancy. RESULTS Among overweight/obese women (BMI ≥25), recurrence risk of GDM decreased in women who reduced their BMI by 1-2 units (relative risk [RR] 0.80, 95% CI 0.65-0.99) and >2 units (RR 0.72, 95% CI 0.59-0.89) and increased if BMI increased by ≥4 units (RR 1.26, 95% CI 1.05-1.51) compared wth women with stable BMI (-1 to 1 units). In normal weight women (BMI <25), risk of GDM recurrence increased if BMI increased by 2-4 units (RR 1.32, 95% CI 1.08-1.60) and ≥4 units (RR 1.61, 95% CI 1.28-2.02) compared with women with stable BMI. CONCLUSION Interpregnancy weight loss reduced risk of GDM recurrence in overweight/obese women. Weight gain between pregnancies increased recurrence risk for GDM in both normal and overweight/obese women. Our findings highlight the importance of weight management in the interconception window in women with a history of GDM. TWEETABLE ABSTRACT Interpregnancy weight loss reduces recurrence of gestational diabetes mellitus in overweight/obese women.
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Affiliation(s)
- L M Sorbye
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Norwegian National Advisory Unit on Women's Health, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - S Cnattingius
- Department of Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - R Skjaerven
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - K Klungsoyr
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Division for Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
| | - A-K Wikström
- Department of Medicine, Karolinska University Hospital, Stockholm, Sweden.,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - L G Kvalvik
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Department of Biomedicine, University of Bergen, Bergen, Norway
| | - N-H Morken
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
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20
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Moran PS, Wuytack F, Turner M, Normand C, Brown S, Begley C, Daly D. Economic burden of maternal morbidity - A systematic review of cost-of-illness studies. PLoS One 2020; 15:e0227377. [PMID: 31945775 PMCID: PMC6964978 DOI: 10.1371/journal.pone.0227377] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 12/17/2019] [Indexed: 02/07/2023] Open
Abstract
Aim To estimate the economic burden of common health problems associated with pregnancy and childbirth, such as incontinence, mental health problems, or gestational diabetes, excluding acute complications of labour or birth, or severe acute adverse maternal outcomes. Methods Searches for relevant studies were carried out to November 2019 in Medline, Embase, CINAHL, PsycINFO and EconLit databases. After initial screening, all results were reviewed for inclusion by two authors. An adapted version of a previously developed checklist for cost-of-illness studies was used for quality appraisal. All costs were converted to 2018 Euro using national consumer price indices and purchasing power parity conversion factors. Results Thirty-eight relevant studies were identified, some of which reported incremental costs for more than one health problem (16 gestational diabetes, 13 overweight/obesity, 8 mental health, 4 hypertensive disorders, 2 nausea and vomiting, 2 epilepsy, 1 intimate partner violence). A high level of heterogeneity was observed in both the methods used, and the incremental cost estimates obtained for each morbidity. Average incremental costs tended to be higher in studies that modelled a hypothetical cohort of women using data from a range of sources (compared to analyses of primary data), and in studies set in the United States. No studies that examined the economic burden of some common pregnancy-related morbidities, such as incontinence, pelvic girdle pain, or sexual health problems, were identified. Conclusion Our findings indicate that maternal morbidity is associated with significant costs to health systems and society, but large gaps remain in the evidence base for the economic burden of some common health problems associated with pregnancy and childbirth. More research is needed to examine the economic burden of a range of common maternal health problems, and future research should adopt consistent methodological approaches to ensure comparability of results.
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Affiliation(s)
- Patrick S. Moran
- School of Nursing and Midwifery, Trinity College, Dublin, Ireland
- * E-mail:
| | | | | | - Charles Normand
- Centre for Health Policy and Management, Trinity College, Dublin, Ireland
- Cicely Saunders Institute, King’s College, London, United Kingdom
| | - Stephanie Brown
- General Practice and Primary Health Care Academic Centre, University of Melbourne, Melbourne, Australia
- Murdoch Children’s Research Institute, Melbourne, Australia
| | - Cecily Begley
- School of Nursing and Midwifery, Trinity College, Dublin, Ireland
| | - Deirdre Daly
- School of Nursing and Midwifery, Trinity College, Dublin, Ireland
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Glaharn P, Chumworathayi B, Kongwattanakul K, Sutthasri N, Wiangyot P. Proportion of abnormal second 50-g glucose challenge test in gestational diabetes mellitus screening using the two-step method in high-risk pregnant women. J Obstet Gynaecol Res 2019; 46:229-236. [PMID: 31814200 DOI: 10.1111/jog.14172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 11/13/2019] [Indexed: 11/28/2022]
Abstract
AIMS To determine the merit of repeating 50-g glucose challenge test (50-g GCT) at 24-28 weeks of gestation in high-risk pregnant women and the prevalence of early- and late-onset gestational diabetes mellitus (GDM). METHODS This study was conducted in 1447 pregnant women, 344 of them were at risks for GDM undergoing screening by two-step method at first visit. Data were not completely collected in 47 women leaving only 297 for analyses. Fifty-six of 297 pregnant women were diagnosed as early-onset GDM (18.8%) and the other 241 pregnant women were consequently screened at 24-28 weeks of gestation to identify late-onset GDM. Screening data were retrieved, including risks, laboratory test results, baseline characteristics and diagnostic outcomes. Proportion of abnormal second 50-g GCT and the prevalence of late-onset GDM were estimated. RESULTS The prevalence of late-onset GDM was 17.8%. Among groups of normal 50-g GCT, abnormal 50-g GCT and abnormal 1 oral glucose tolerance test (OGTT) value at first test, the proportions of abnormal 50-g GCT at second test were 38.3%, 59.5% and 79.3%, and the prevalence of late-onset GDM among each group were 18.8%, 8.3% and 41.4%, consecutively. This lead to prevalence of GDM in this high-risk group of 33.3% and overall among 1447 women was 7.9%. CONCLUSION There were high proportions of abnormal 50-g GCT at second test in the groups with abnormal 50-g GCT and abnormal 1 OGTT value at first test (59.5% and 79.3%). Authors suggested doing OGTT without repeating 50-g GCT in these groups coming at 24-28 weeks of gestation.
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Affiliation(s)
- Pianpun Glaharn
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Bandit Chumworathayi
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Kiattisak Kongwattanakul
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Nutwara Sutthasri
- Nursing Department, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Phimwimon Wiangyot
- Nursing Department, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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Zhang M, Zhou Y, Zhong J, Wang K, Ding Y, Li L, Pan X. Quality appraisal of gestational diabetes mellitus guidelines with AGREE II: a systematic review. BMC Pregnancy Childbirth 2019; 19:478. [PMID: 31805878 PMCID: PMC6896264 DOI: 10.1186/s12884-019-2597-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 11/13/2019] [Indexed: 01/25/2023] Open
Abstract
Background Several societies and associations have produced and disseminated clinical practice guidelines (CPGs) for gestational diabetes mellitus (GDM). However, the quality of such guidelines has not been appraised so far. This study aims to evaluate the quality of CPGs for GDM published in the last decade using the AGREE II instrument. Methods A systematic search of the National Institute for Health and Care Excellence, New Zealand Guidelines Group, Scottish Intercollegiate Guidelines Network, Medlive, American Diabetes Association, Canadian Diabetes Association, International Diabetes Federation, as well as PubMed, Web of Science, Embase, China National Knowledge Infrastructure, Wanfang Chinese Periodical Database, and VIP Chinese Periodical Database was conducted from inception to June 2018. The quality was assessed by four trained researchers independently, using the AGREE IIinstrument. Results A total of 13 guidelines, published from 2009 to 2018, were finally included. Among them, 11 guidelines were evidence-based guidelines, and 2 were expert consensus. Scores for each of the six AGREE II domains(Median ± IQR) were 94 ± 11, 89 ± 53, 58 ± 37, 100 ± 6, 79 ± 48, 100 ± 71 and 67% ± 42%, and guidelines based on expert consensus generally scored lower than evidence-based guidelines (Z = -2.201, p = 0.028). Overall score of 10 guidelines were 5 points and above, and four guidelines were 7 points. Among six domains, two domains: Scope and Purpose, and Clarity of Presentation, had high scores; however, the domains of Rigor of Development, Stakeholder Involvement and Editorial Independence received lower scores. Conclusions In general, the methodological quality of GDM guidelines is high, and evidence-based guidelines are superior to expert consensus. However, the domains of Rigor of Development, Stakeholder Involvement and Editorial Independence still need improvement. A systematic approach in the development of these guidelines and updating timely is needed. In some regions, more attention for guideline adaptation is recommended.
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Affiliation(s)
- Mengxing Zhang
- JBI Evidence Based Nursing Cooperation Center, School of Nursing, Fudan University, Shanghai, China
| | - Yingfeng Zhou
- JBI Evidence Based Nursing Cooperation Center, School of Nursing, Fudan University, Shanghai, China.
| | - Jie Zhong
- JBI Evidence Based Nursing Cooperation Center, School of Nursing, Fudan University, Shanghai, China
| | - Kairong Wang
- JBI Evidence Based Nursing Cooperation Center, School of Nursing, Fudan University, Shanghai, China
| | - Yan Ding
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Li Li
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
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Wang Y, Luo BR. The association of body composition with the risk of gestational diabetes mellitus in Chinese pregnant women: A case-control study. Medicine (Baltimore) 2019; 98:e17576. [PMID: 31626126 PMCID: PMC6824814 DOI: 10.1097/md.0000000000017576] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Studies have found that the measurement of body composition can be used to identify the gestational diabetes mellitus (GDM) risk in pregnant women. However, few studies focused on the relationship between body composition and GDM development in low GDM risk population. Thus, the objective of this study was to examine the association between body composition and the development of GDM in pregnant women with low risk of gestational diabetes.A retrospective case-control study was conducted. We reviewed the medical records of 3965 pregnant women who had body composition measurement from March, 2016 to May, 2018 in our hospital. Their sociodemographic, clinical data, and body composition information were collected from medical record. Multiple logistic regression analyses were used.A total of 2698 subjects were eligible for the study. The mean age of the gravidas was 30.95 ± 4.01 years old. Of all gravidas, 462 had gestational diabetes. Percentage body fat was the strongest risk factor for gestational diabetes after adjusting pre-pregnancy body mass index (BMI) (odds ratio = 1.786, 95% confidence interval = 1.112-2.866, P = .02). The age and extracellular water/intracellular water ratio were independently associated with gestational diabetes.Percentage body fat was the strongest risk factor for gestational diabetes after adjusting pre-pregnancy BMI. Assessment of body composition may provide important guidance to identify gestational diabetes in pregnant women with low gestational diabetes risk.
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Affiliation(s)
- Yan Wang
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education
| | - Bi-Ru Luo
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education
- Department of Nursing, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
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Dall TM, Yang W, Gillespie K, Mocarski M, Byrne E, Cintina I, Beronja K, Semilla AP, Iacobucci W, Hogan PF. The Economic Burden of Elevated Blood Glucose Levels in 2017: Diagnosed and Undiagnosed Diabetes, Gestational Diabetes Mellitus, and Prediabetes. Diabetes Care 2019; 42:1661-1668. [PMID: 30940641 PMCID: PMC6702607 DOI: 10.2337/dc18-1226] [Citation(s) in RCA: 124] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 03/07/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This study was conducted to update national estimates of the economic burden of undiagnosed diabetes, prediabetes, and gestational diabetes mellitus (GDM) in the United States for year 2017 and provide state-level estimates. Combined with published estimates for diagnosed diabetes, these updated statistics provide a detailed picture of the economic costs associated with elevated blood glucose levels. RESEARCH DESIGN AND METHODS This study estimated medical expenditures exceeding levels occurring in the absence of diabetes or prediabetes and the indirect economic burden associated with reduced labor force participation and productivity. Data sources analyzed included Optum medical claims for ∼5.8 million commercially insured patients continuously enrolled from 2013 to 2015, Medicare Standard Analytical Files containing medical claims for ∼2.8 million Medicare patients in 2014, and the 2014 Nationwide Inpatient Sample containing ∼7.1 million discharge records. Other data sources were the U.S. Census Bureau, Centers for Disease Control and Prevention, and Centers for Medicare & Medicaid Services. RESULTS The economic burden associated with diagnosed diabetes (all ages), undiagnosed diabetes and prediabetes (adults), and GDM (mothers and newborns) reached nearly $404 billion in 2017, consisting of $327.2 billion for diagnosed diabetes, $31.7 billion for undiagnosed diabetes, $43.4 billion for prediabetes, and nearly $1.6 billion for GDM. Combined, this amounted to an economic burden of $1,240 for each American in 2017. Annual burden per case averaged $13,240 for diagnosed diabetes, $5,800 for GDM, $4,250 for undiagnosed diabetes, and $500 for prediabetes. CONCLUSIONS Updated statistics underscore the importance of reducing the burden of prediabetes and diabetes through better detection, prevention, and treatment.
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Vesco KK, Sharma AJ, Bulkley J, Kimes T, Callaghan WM, England LJ, Hornbrook MC. Association of glucose levels in pregnancy with use of health care services. Diabetes Res Clin Pract 2019; 152:146-155. [PMID: 31063853 PMCID: PMC6703164 DOI: 10.1016/j.diabres.2019.04.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 01/30/2019] [Accepted: 04/18/2019] [Indexed: 12/16/2022]
Abstract
AIMS To determine whether women with abnormal gestational diabetes (GDM) screening test results short of frank GDM have increased health-services utilization compared to women with normal results. METHODS We conducted a retrospective-cohort study among 29,999 women enrolled in Kaiser Permanente Northwest who completed GDM screening (two-step method: 1-h, 50-g glucose-challenge test (GCT); 3-h, 100-g oral-glucose-tolerance test (OGTT)). Test results were categorized as normal GCT (referent, n = 25,535), normal OGTT (n = 2246), abnormal OGTT but not GDM (n = 1477), and GDM (n = 741). Rate ratios (RRs) were calculated for utilization measures and analyses were age- and BMI-adjusted. RESULTS Compared to women with normal GCT, rates for obstetrical ultrasound, noninvasive and invasive antenatal testing, and ambulatory visits to the obstetrics department were significantly greater among women with abnormal OGTT (RRs 1.2 [95%CI 1.1, 1.4], 1.3 [1.1, 1.4], 1.7 [1.3, 2.3], and 1.1 [1.1, 1.1], respectively) and GDM (RRs 1.8, 1.8, 2.0, and 1.3, respectively). Women with abnormal OGTT results were more likely to visit a dietician than women with normal GCT; RRs ranged from 4.0 [3.3, 4.9] for women with abnormal GCT but normal OGTT to 72.1 [64, 81] for women with GDM. CONCLUSIONS Health-services utilization increased with severity of glucose result, even among women without GDM.
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Affiliation(s)
- Kimberly K Vesco
- Kaiser Permanente Center for Health Research, Portland, OR, USA.
| | - Andrea J Sharma
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA; U.S. Public Health Service Commissioned Corps, Atlanta, GA, USA
| | - Joanna Bulkley
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Terry Kimes
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - William M Callaghan
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lucinda J England
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Farahvar S, Walfisch A, Sheiner E. Gestational diabetes risk factors and long-term consequences for both mother and offspring: a literature review. Expert Rev Endocrinol Metab 2019; 14:63-74. [PMID: 30063409 DOI: 10.1080/17446651.2018.1476135] [Citation(s) in RCA: 116] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 05/09/2018] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Established risk factors for gestational diabetes mellitus (GDM) include ethnicity, obesity, and family history of diabetes. Untreated GDM patients have higher rates of maternal and perinatal morbidity. GDM is an independent risk factor for future longer-term risk of type 2 diabetes mellitus (T2DM), metabolic syndrome, cardiovascular morbidity, malignancies, ophthalmic, psychiatric, and renal disease in the mother. Offspring risk long-term adverse health outcomes, including T2DM, subsequent obesity, impacted neurodevelopmental outcome, increased neuropsychiatric morbidity, and ophthalmic disease. AREAS COVERED We critically review data from retrospective, prospective, and meta-analysis studies pertaining to established GDM risk factors, complications during pregnancy and birth (both mother and offspring), and long-term consequences (both mother and offspring). EXPERT COMMENTARY Many of the adverse consequences of GDM might be avoided with proper management and treatment. Patients belonging to high-risk ethnic groups, and/or with body mass index ≥ 25 kg/m2, and/or known history of diabetes in first-degree relatives may benefit from universal screening and diagnostic criteria proposed by the International Association of Diabetes and Pregnancy Study Group (IADPSG). The IADPSG one-step method has several advantages, including simplicity of execution, greater patient-friendliness, and higher diagnostic accuracy. Additionally, evidence suggests that the recent increased popularity of bariatric surgery will help to decrease GDM rates over next 5 years. Similarly, metformin may be useful for treating and preventing obstetrical complications in confirmed GDM patients.
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Affiliation(s)
- Salar Farahvar
- a Department of Obstetrics and Gynecology, Faculty of Health, Sciences, Soroka University Medical Center, Ben-Gurion , University of the Negev , Beer Sheva , Israel
| | - Asnat Walfisch
- a Department of Obstetrics and Gynecology, Faculty of Health, Sciences, Soroka University Medical Center, Ben-Gurion , University of the Negev , Beer Sheva , Israel
| | - Eyal Sheiner
- a Department of Obstetrics and Gynecology, Faculty of Health, Sciences, Soroka University Medical Center, Ben-Gurion , University of the Negev , Beer Sheva , Israel
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Egbe TO, Tsaku ES, Tchounzou R, Ngowe MN. Prevalence and risk factors of gestational diabetes mellitus in a population of pregnant women attending three health facilities in Limbe, Cameroon: a cross-sectional study. Pan Afr Med J 2018; 31:195. [PMID: 31086639 PMCID: PMC6488967 DOI: 10.11604/pamj.2018.31.195.17177] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 10/25/2018] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION There are few studies regarding gestational diabetes mellitus (GDM) in the South West Region of Cameroon. We aimed at determining the prevalence and risk factors of GDM in three health facilities in the Limbe health district, Cameroon. METHODS A cross-sectional study was carried out in one secondary, and two primary healthcare facilities in Limbe, Cameroon during the period 1st November 2016 to 31st January 2017. We administered a pretested questionnaire on 200 consenting pregnant women at 24-28 weeks' gestation. We carried out a 2-hr oral glucose tolerance test after fasting overnight. GDM was diagnosed when ≥1 plasma glucose (PG) test result was abnormal according to the IADPSG criteria (FPG ≥92 mg/dL, PG 1-hr 180mg/L, PG 2-hr 153 mg/dL). Data analysis was with Epi-InfoTM version 3.5.4. Associations were analyzed with the Pearson's chi squared and Fischer's exact test where appropriate. Statistical significance was set at p < 0.05. RESULTS The prevalence of GDM was 20.5% and respondents' mean age was 27.8 (SD 5.7) years. Majority, 13.5% participants had abnormal FPG alone, while 3.5% had any two abnormal values. GDM was associated with: advanced maternal age (OR 3.4: 95% CI 1.7-7.0; P<0.001), BMI≥30 kg/m2 (OR 6.2 : 95% CI 2.9-13.1, P<0.001), past history of unexplained stillbirth (OR 5.7: 95% CI 2.5-12.9, P<0.001) and history of macrosomia (OR 8.5:95% CI 3.8-19, P<0.001). CONCLUSION With the high prevalence of GDM, identification of its associated factors has the potential to be a target of intervention to prevent poor obstetrical outcomes.
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Affiliation(s)
- Thomas Obinchemti Egbe
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, University of Buea, Cameroon
| | | | - Robert Tchounzou
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, University of Buea, Cameroon
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Park Y, Hernandez-Diaz S, Bateman BT, Cohen JM, Desai RJ, Patorno E, Glynn RJ, Cohen LS, Mogun H, Huybrechts KF. Continuation of Atypical Antipsychotic Medication During Early Pregnancy and the Risk of Gestational Diabetes. Am J Psychiatry 2018; 175:564-574. [PMID: 29730938 PMCID: PMC5988929 DOI: 10.1176/appi.ajp.2018.17040393] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Some atypical antipsychotics are associated with metabolic side effects, which are risk factors for gestational diabetes. The authors examined the risk of developing gestational diabetes associated with the continuation of treatment with aripiprazole, ziprasidone, quetiapine, risperidone, and olanzapine during pregnancy compared with discontinuation of these antipsychotic drugs. METHOD Nondiabetic pregnant women who were linked to a live-born infant and enrolled in Medicaid (2000-2010) and who received one or more prescriptions dispensed for an antipsychotic drug during the 3 months before pregnancy were included in the analyses. Among 1,543,334 pregnancies, some expectant mothers at baseline were receiving treatment with aripiprazole (N=1,924), ziprasidone (N=673), quetiapine (N=4,533), risperidone (N=1,824), or olanzapine (N=1,425). For each antipsychotic drug, women with two or more dispensings ("continuers") were compared with women with no dispensings ("discontinuers") during the first half of pregnancy. A generalized linear model and propensity-score stratification were used to obtain absolute and relative risks of developing gestational diabetes, with adjustment for confounders. RESULTS Women who continued antipsychotic treatment during pregnancy generally had higher comorbidity and longer baseline antipsychotic use. The crude risk of developing gestational diabetes among continuers compared with discontinuers, respectively, was 4.8% and 4.5% for aripiprazole, 4.2% and 3.8% for ziprasidone, 7.1% and 4.1% for quetiapine, 6.4% and 4.1% for risperidone, and 12.0% and 4.7% for olanzapine. The adjusted relative risks were 0.82 (95% CI=0.50-1.33) for aripiprazole, 0.76 (95% CI=0.29-2.00) for ziprasidone, 1.28 (95% CI=1.01-1.62) for quetiapine, 1.09 (95% CI=0.70-1.70) for risperidone, and 1.61 (95% CI=1.13-2.29) for olanzapine. CONCLUSIONS Compared with women who discontinued use of an atypical antipsychotic medication before the start of pregnancy, women who continued treatment with olanzapine or quetiapine had an increased risk of gestational diabetes that may be explained by the metabolic effects associated with these two drugs.
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Affiliation(s)
- Yoonyoung Park
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Sonia Hernandez-Diaz
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Brian T. Bateman
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA,The Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Jacqueline M. Cohen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Rishi J. Desai
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Elisabetta Patorno
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Robert J. Glynn
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Lee S. Cohen
- Center for Women’s Mental Health, Perinatal and Reproductive Psychiatry Program, Massachusetts General Hospital, Boston, MA
| | - Helen Mogun
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Krista F. Huybrechts
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
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Broekhuizen K, Simmons D, Devlieger R, van Assche A, Jans G, Galjaard S, Corcoy R, Adelantado JM, Dunne F, Desoye G, Harreiter J, Kautzky-Willer A, Damm P, Mathiesen ER, Jensen DM, Andersen LL, Lapolla A, Dalfra MG, Bertolotto A, Wender-Ozegowska E, Zawiejska A, Hill D, Snoek FJ, Jelsma JGM, Bosmans JE, van Poppel MNM, van Dongen JM. Cost-effectiveness of healthy eating and/or physical activity promotion in pregnant women at increased risk of gestational diabetes mellitus: economic evaluation alongside the DALI study, a European multicenter randomized controlled trial. Int J Behav Nutr Phys Act 2018. [PMID: 29540227 PMCID: PMC5853142 DOI: 10.1186/s12966-018-0643-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Gestational diabetes mellitus (GDM) is associated with perinatal health risks to both mother and offspring, and represents a large economic burden. The DALI study is a multicenter randomized controlled trial, undertaken to add to the knowledge base on the effectiveness of interventions for pregnant women at increased risk for GDM. The purpose of this study was to evaluate the cost-effectiveness of the healthy eating and/or physical activity promotion intervention compared to usual care among pregnant women at increased risk of GDM from a societal perspective. Methods An economic evaluation was performed alongside a European multicenter-randomized controlled trial. A total of 435 pregnant women at increased risk of GDM in primary and secondary care settings in nine European countries, were recruited and randomly allocated to a healthy eating and physical activity promotion intervention (HE + PA intervention), a healthy eating promotion intervention (HE intervention), or a physical activity promotion intervention (PA intervention). Main outcome measures were gestational weight gain, fasting glucose, insulin resistance (HOMA-IR), quality adjusted life years (QALYs), and societal costs. Results Between-group total cost and effect differences were not significant, besides significantly less gestational weight gain in the HE + PA group compared with the usual care group at 35–37 weeks (−2.3;95%CI:-3.7;-0.9). Cost-effectiveness acceptability curves indicated that the HE + PA intervention was the preferred intervention strategy. At 35–37 weeks, it depends on the decision-makers’ willingness to pay per kilogram reduction in gestational weight gain whether the HE + PA intervention is cost-effective for gestational weight gain, whereas it was not cost-effective for fasting glucose and HOMA-IR. After delivery, the HE + PA intervention was cost-effective for QALYs, which was predominantly caused by a large reduction in delivery-related costs. Conclusions Healthy eating and physical activity promotion was found to be the preferred strategy for limiting gestational weight gain. As this intervention was cost-effective for QALYs after delivery, this study lends support for broad implementation. Trial registration ISRCTN ISRCTN70595832. Registered 2 December 2011. Electronic supplementary material The online version of this article (10.1186/s12966-018-0643-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Karen Broekhuizen
- Department of Health Sciences and EMGO+ Institute for Health and Care Research, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - David Simmons
- Western Sydney University, Campbelltown, NSW, Australia.,Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, England
| | - Roland Devlieger
- Department of Development and Regeneration: Pregnancy, Fetus and Neonate, Gynaecology and Obstetrics, University Hospitals, Katholieke Universiteit Leuven, Leuven, Belgium
| | - André van Assche
- Department of Development and Regeneration: Pregnancy, Fetus and Neonate, Gynaecology and Obstetrics, University Hospitals, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Goele Jans
- Department of Development and Regeneration: Pregnancy, Fetus and Neonate, Gynaecology and Obstetrics, University Hospitals, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Sander Galjaard
- Department of Development and Regeneration: Pregnancy, Fetus and Neonate, Gynaecology and Obstetrics, University Hospitals, Katholieke Universiteit Leuven, Leuven, Belgium.,Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Rosa Corcoy
- Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Juan M Adelantado
- Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,CIBER Bioengineering, Biomaterials and Nanotechnology, Instituto de Salud Carlos III, Zaragoza, Spain
| | - Fidelma Dunne
- Galway Diabetes Research Centre and College of Medicine Nursing and Health Sciences, National University of Ireland, Galway, Ireland
| | - Gernot Desoye
- Department of Obstetrics and Gynecology, Medizinische Universitaet Graz, Graz, Austria
| | - Jürgen Harreiter
- Gender Medicine Unit, Endocrinology and Metabolism, Dept. Internal Medicine III, Medical University of Vienna, 1090, Vienna, Austria
| | - Alexandra Kautzky-Willer
- Gender Medicine Unit, Endocrinology and Metabolism, Dept. Internal Medicine III, Medical University of Vienna, 1090, Vienna, Austria
| | - Peter Damm
- Center for Pregnant Women with Diabetes, Departments of Endocrinology and Obstetrics, Rigshospitalet, Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Elisabeth R Mathiesen
- Center for Pregnant Women with Diabetes, Departments of Endocrinology and Obstetrics, Rigshospitalet, Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Dorte M Jensen
- Department of Endocrinology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Liselotte L Andersen
- Department of Endocrinology, Odense University Hospital, Odense, Denmark.,Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | | | | | | | | | | | - David Hill
- Recherche en Santé Lawson SA, Bronschhofen, Switzerland
| | - Frank J Snoek
- Department of Medical Psychology, EMGO+-Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands.,Department of Medical Psychology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Judith G M Jelsma
- Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Centre, 1081, BT, Amsterdam, The Netherlands
| | - Judith E Bosmans
- Department of Health Sciences and EMGO+ Institute for Health and Care Research, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Mireille N M van Poppel
- Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Centre, 1081, BT, Amsterdam, The Netherlands.,Institute of Sport Science, University of Graz, 8010, Graz, Austria
| | - Johanna M van Dongen
- Department of Health Sciences and EMGO+ Institute for Health and Care Research, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands. .,Department of Health Sciences and EMGO+ Institute for Health and Care Research, Faculty of Earth & Life Sciences, VU University Amsterdam, De Boelelaan 1085, 1081, HV, Amsterdam, The Netherlands.
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Ganer Herman H, Dekalo A, Jubran L, Schreiber L, Bar J, Kovo M. Obstetric outcomes and placental findings in gestational diabetes patients according to maternal prepregnancy weight and weight gain. J Matern Fetal Neonatal Med 2018; 32:1682-1687. [DOI: 10.1080/14767058.2017.1416078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Hadas Ganer Herman
- Department of Obstetrics and Gynecology, the Edith Wolfson Medical Center, Holon, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ann Dekalo
- Department of Obstetrics and Gynecology, the Edith Wolfson Medical Center, Holon, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lora Jubran
- Department of Obstetrics and Gynecology, the Edith Wolfson Medical Center, Holon, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Letizia Schreiber
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Pathology, The Edith Wolfson Medical Center, Holon, Israel
| | - Jacob Bar
- Department of Obstetrics and Gynecology, the Edith Wolfson Medical Center, Holon, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Kovo
- Department of Obstetrics and Gynecology, the Edith Wolfson Medical Center, Holon, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Xiao Y, Chen R, Chen M, Luo A, Chen D, Liang Q, Cai Y, Chen L, Zhao X. Age at menarche and risks of gestational diabetes mellitus: a meta-analysis of prospective studies. Oncotarget 2017; 9:17133-17140. [PMID: 29682210 PMCID: PMC5908311 DOI: 10.18632/oncotarget.23658] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 10/29/2017] [Indexed: 11/25/2022] Open
Abstract
Background Accumulating evidence suggests that early menarche is associated with adult obesity, which in turn may increase the risk of insulin resistance and hyperglycemia. However, the relation of menarcheal age with gestational diabetes mellitus (GDM) remains inconsistent across studies. The objective of this meta-analysis was to evaluate the association between age at menarche and GDM risk. Materials and Methods We searched Medline (PubMed), Embase, Web of Knowledge and the Cochrane library through the end of May 2017. We pooled summary relative risks (RR) with 95% confidence intervals (CIs). Stata 12.0 software was used to analyse the data. Results Five prospective studies were eligible for inclusion. The results of meta-analysis showed that women in the early menarcheal age group (at < 12 years of age) had a higher risk of GDM compared with those in the "not early" menarcheal age group (at ≥ 13 years of age) (pooled RR = 1.31, 95% CI: 1.05, 1.56) with moderate heterogeneity (I2 = 47.5%, P = 0.107). However, there was no obvious protection of late menarche (at ≥ 15 years of age) versus median menarche (at 13 years of age) (pooled RR = 1.12, 95% CI: 0.92, 1.32; I2 = 0%). Conclusions The findings support an association between earlier age at menarche and increased risk of GDM. Age at menarche may help identify women with increased risk of developing GDM. However, considering the potential limitations in this study, further larger prospective studies are warranted to verify our findings.
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Affiliation(s)
- Ya Xiao
- School of Traditional Chinese Medicine, Jinan University, Guangzhou, 510632, China
| | - Ruixue Chen
- School of Traditional Chinese Medicine, Jinan University, Guangzhou, 510632, China
| | - Minghao Chen
- Reproductive center, Guangdong Women and Children Hospital, Guangzhou, 511400, China
| | - Anling Luo
- School of Basic Medicine, Jinan University, Guangzhou, 510632, China
| | - Dayi Chen
- School of Basic Medicine, Jinan University, Guangzhou, 510632, China
| | - Qiuer Liang
- School of Traditional Chinese Medicine, Jinan University, Guangzhou, 510632, China
| | - Yunfei Cai
- School of Traditional Chinese Medicine, Jinan University, Guangzhou, 510632, China
| | - Liguo Chen
- School of Traditional Chinese Medicine, Jinan University, Guangzhou, 510632, China
| | - Xiaoshan Zhao
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, 510515, China
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32
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Ognean L, Boanta O, Visa G, Grosu F, Şofariu C, Gafencu M, Matei C, Iurian S. HYDROCEPHALY, SCHIZENCEPHALY, SPONDYLOCOSTAL DYSPLASIA, AND HYPOPARATHYROIDISM IN AN INFANT OF A DIABETIC MOTHER. ACTA ENDOCRINOLOGICA (BUCHAREST, ROMANIA : 2005) 2017; 13:494-501. [PMID: 31149221 PMCID: PMC6516547 DOI: 10.4183/aeb.2017.494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CONTEXT Diabetes mellitus is the most frequent chronic complication in pregnancy and continues to contribute to increased perinatal morbidity and mortality in newborns. Macrosomia, respiratory distress syndrome, metabolic and electrolytic disturbances, and increased rates of congenital structural defects are well-known neonatal complications associated with maternal diabetes, even if well-controlled. CASE REPORT A macrosomic infant born from an insulin-dependent mother, with uncontrolled diabetes and lack of adequate prenatal care, prenatally diagnosed with hydrocephaly showed a complicated postnatal course. Initial respiratory distress syndrome and transient hypoglycemia, rapidly corrected under treatment, were followed by persistent hypocalcemia and hyperphosphatemia due to hypoparathyroidism and evolving hydrocephaly. Ventriculoperitoneal shunting was followed by resolution of hypocalcemia, but seizures associated with schizencephaly and recurrent respiratory tract infections, aggravated by spondylocostal dysplasia, concurred to infant's demise at the age of 5 months. CONCLUSIONS The reported case is rare due to multiple aspects: persistent hypoparathyroidism, uncommon association of schizencephaly, and even rarely association with spondylocostal dysplasia, all these conditions requiring a multidisciplinary therapeutic approach. Also, the reported case is evocative for challenges associated with infants born from diabetic mothers.
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Affiliation(s)
- L. Ognean
- “Lucian Blaga” University, Faculty of Medicine, Dept. of Neonatology, Sibiu, Romania
| | - O. Boanta
- “Lucian Blaga” University, Faculty of Medicine, Dept. of Neonatology, Sibiu, Romania
| | - G. Visa
- Clinical Hospital of Pediatrics, Dept. of Neurology, Sibiu, Romania
| | - F. Grosu
- “Lucian Blaga” University, Faculty of Medicine, Dept. of Radiology, Sibiu, Romania
| | - C. Şofariu
- Clinical Hospital of Pediatrics, Children's Neurological Diseases Research Center and Telemedicine (CEFORATEN), Sibiu, Romania
| | - M. Gafencu
- “Victor Babes” University of Medicine and Pharmacy, Dept. of Pediatrics, Timisoara, Romania
- “Louis Turcanu” Emergency Children, Peritoneal Dialysis, Hospital, Timisoara, Romania
| | - C. Matei
- “Lucian Blaga” University, Faculty of Medicine, Dept. of Neurosurgery, Sibiu, Romania
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Nicklas JM, Zera CA, Lui J, Seely EW. Patterns of gestational diabetes diagnosis inside and outside of clinical guidelines. BMC Pregnancy Childbirth 2017; 17:11. [PMID: 28061829 PMCID: PMC5219746 DOI: 10.1186/s12884-016-1191-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 12/09/2016] [Indexed: 11/24/2022] Open
Abstract
Background Hospital discharge codes are often used to determine the incidence of gestational diabetes mellitus (GDM) at state and national levels. Previous studies demonstrate substantial variability in the accuracy of GDM reporting, and rarely report how the GDM was diagnosed. Our aim was to identify deliveries coded as gestational diabetes, and then to determine how the diagnosis was assigned and whether the diagnosis followed established guidelines. Methods We identified which deliveries were coded at discharge as complicated by GDM at the Brigham and Women’s Hospital in Boston, MA for the year 2010. We reviewed medical records to determine whether the codes were appropriately assigned. Results Of 7883 deliveries, coding for GDM was assigned with 98% accuracy. We identified 362 cases assigned GDM delivery codes, of which 210 (58%) had oral glucose tolerance test (OGTT) results available meeting established criteria. We determined that 126 cases (34%) received a GDM delivery code due to a clinician diagnosis documented in the medical record, without an OGTT result meeting established guidelines for GDM diagnosis. We identified only 15 cases (4%) that were coding errors. Conclusions Thirty four percent of women assigned GDM delivery codes at discharge had a medical record diagnosis of GDM but did not meet OGTT criteria for GDM by established guidelines. Although many of these patients may have met guidelines if guideline-based testing had been conducted, our findings suggest that clinician diagnosis outside of published guidelines may be common. There are many ramifications of this approach to diagnosis, including affecting population-level statistics of GDM prevalence and the potential impact on some women who may be diagnosed with GDM erroneously.
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Affiliation(s)
- Jacinda M Nicklas
- Division of General Internal Medicine, University of Colorado School of Medicine, 12348 E. Montview Blvd, C263, Aurora, CO, 80045, USA.
| | - Chloe A Zera
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Janet Lui
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, MA, 02115, USA
| | - Ellen W Seely
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, MA, 02115, USA
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Nouhjah S, Shahbazian H, Shahbazian N, Jahanshahi A, Jahanfar S, Cheraghian B. Incidence and Contributing Factors of Persistent Hyperglycemia at 6-12 Weeks Postpartum in Iranian Women with Gestational Diabetes: Results from LAGA Cohort Study. J Diabetes Res 2017; 2017:9786436. [PMID: 28491872 PMCID: PMC5405388 DOI: 10.1155/2017/9786436] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 01/19/2017] [Accepted: 01/29/2017] [Indexed: 12/31/2022] Open
Abstract
Background. A history of gestational diabetes is an important predictor of many metabolic disturbances later in life. Method. Life after gestational diabetes Ahvaz Study (LAGAs) is an ongoing population-based cohort study. Up to February 2016, 176 women with gestational diabetes underwent a 75 g oral glucose tolerance test (OGTT) at 6-12 weeks postpartum in Ahvaz (southwestern of Iran). Gestational diabetes was diagnosed according to the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria and the American Diabetes Association (ADA) criteria applied for diagnosis of postpartum prediabetes and diabetes. Univariate and multivariate regression analysis were done. Results. Overall incidence of early postpartum glucose intolerance was 22.2% (95% CI, 16.3-29.0), 17.6% prediabetes (95% CI, 12.3-24.1) and 4.5% diabetes (95% CI, 2.0-8.8%). Independent risk factors for glucose intolerance were FPG ≥ 100 at the time of OGTT (OR 3.86; 95% CI; 1.60-9.32), earlier diagnosis of GDM (OR 0.92; 95% CI; 0.88-0.97), systolic blood pressure (OR 1.02; 95% CI; 1.002-1.04), and insulin or metformin therapy (OR 3.14; 95% CI; 1.20-8.21). Conclusion. Results determined a relatively high rate of glucose intolerance at 6-12 weeks after GDM pregnancy. Early postpartum screening of type 2 diabetes is needed particularly in women at high risk of type 2 diabetes.
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Affiliation(s)
- Sedigheh Nouhjah
- Diabetes Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Hajieh Shahbazian
- Diabetes Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- *Hajieh Shahbazian:
| | - Nahid Shahbazian
- Department of Obstetrics and Gynecology, Fertility, Infertility and Perinatology Research Center, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Alireza Jahanshahi
- Diabetes Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Internal Medicine Ward, Golestan Teaching Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Shayesteh Jahanfar
- School of Health Sciences, Central Michigan University, Building 2212, Room 2239, Mount Pleasant, MI 48859, USA
| | - Bahman Cheraghian
- Department of Epidemiology and Biostatistics, Faculty of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Abstract
Gestational diabetes mellitus (GDM) is linked with several acute maternal health risks and long-term development of type 2 diabetes, metabolic syndrome, and cardiovascular disease. Intrauterine exposure to GDM similarly increases offspring risk of early-life health complications and later disease. GDM recurrence is common, affecting 40 to 73% of women, and augments associated maternal/fetal/child health risks. Modifiable and independent risk factors for GDM include maternal excessive gestational weight gain and prepregnancy overweight and obesity. Lifestyle interventions that target diet, activity, and behavioral strategies can effectively modify body weight. Randomized clinical trials testing the effects of lifestyle interventions during pregnancy to reduce excessive gestational weight gain have generally shown mixed effects on reducing GDM incidence. Trials testing the effects of postpartum lifestyle interventions among women with a history of GDM have shown reduced incidence of diabetes and improved cardiovascular disease risk factors. However, the long-term effects of interpregnancy or prepregnancy lifestyle interventions on subsequent GDM remain unknown. Future adequately powered and well-controlled clinical trials are needed to determine the effects of lifestyle interventions to prevent GDM and identify pathways to effectively reach reproductive-aged women across all levels of society, before, during, and after pregnancy.
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Affiliation(s)
- Suzanne Phelan
- Department of Kinesiology, California Polytechnic State University
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Shahbazian H, Nouhjah S, Shahbazian N, Jahanfar S, Latifi SM, Aleali A, Shahbazian N, Saadati N. Gestational diabetes mellitus in an Iranian pregnant population using IADPSG criteria: Incidence, contributing factors and outcomes. Diabetes Metab Syndr 2016; 10:242-246. [PMID: 27350363 DOI: 10.1016/j.dsx.2016.06.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 06/11/2016] [Indexed: 12/16/2022]
Abstract
AIMS Different approaches for screening and diagnosis of gestational diabetes mellitus(GDM) have great impact on all process of management of gestational diabetes and its future complications. The aims of this study were to evaluate rate, risk factors and outcomes of GDM based on International Association of Diabetes and Pregnancy Study Groups diagnostic criteria. MATERIALS In a prospective study pregnant women attended 5 clinics in Ahvaz, screened for gestational diabetes mellitus using IADPSG criteria and followed up delivery from August 2014 to February 2015. At the first prenatal visit women underwent the fasting blood sugar test. A 75-g oral glucose tolerance test (OGTT) was performed for 750 mothers between 24 and 32 weeks of gestation. Logistic regression test for calculating the odds ratios and 95% confidence intervals was used. RESULTS The mean age of participants was 28.43±5.52years. The overall rate of GDM in our study was 29.9% (224/750). Incidence of gestational diabetes was associated with age group≥35years [OR=1.92(95% CI, 1.19-3.09)], family history of diabetes [OR=2.47(95% CI, 1.33-4.59)], previous GDM [OR=3.12(1.35-7.19)], BMI≥25 [OR=1, 71(1.10-2.67)] Using logistic regression. The most common maternal complication in studied women was cesarean section followed by hypertension and preeclampsia. CONCLUSION About one third of studied women diagnosed as GDM according to the IADPSG criteria. Risk factors of GDM were maternal age, family history of diabetes, Previous GDM, overweight and obesity before pregnancy, the same reported factors with 2 steps approach. Higher rate of GDM using this criterion may increase concern about healthcare costs and workloads.
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Affiliation(s)
- Hajieh Shahbazian
- Health Research Institute, Diabetes Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Sedigheh Nouhjah
- Health Research Institute, Diabetes Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Nahid Shahbazian
- Obstetrics and Gynecology Department, Fertility Infertility and Perinatology Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Shayesteh Jahanfar
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Seyed Mahmoud Latifi
- Health Research Institute, Diabetes Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Armaghan Aleali
- Health Research Institute, Diabetes Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Nasrin Shahbazian
- Health Research Institute, Diabetes Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Najmieh Saadati
- Obstetrics and Gynecology Department, Fertility Infertility and Perinatology Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Lin PC, Hung CH, Chan TF, Lin KC, Hsu YY, Ya-Ling Tzeng. The risk factors for gestational diabetes mellitus: A retrospective study. Midwifery 2016; 42:16-20. [PMID: 27705836 DOI: 10.1016/j.midw.2016.09.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 07/15/2016] [Accepted: 09/21/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To investigate the risk factors for developing GDM among Taiwanese pregnant women. DESIGN A retrospective cohort and case-control study. SETTING At a medical centre in Southern Taiwan. PARTICIPANTS The hospitalised pregnant women who were diagnosed with either GDM or normal glucose tolerance (NGT) between 1997 and 2011. The glucose tolerance test results were interpreted according to criteria established by the National Diabetes Data Group for GDM. Participants were divided into either a GDM group (case group) or a normal glucose tolerance (NGT) group (control group) in order to determine the risk factors for GDM. MEASUREMENTS With a retrospective chart review, data regarding demographics, a family history of diabetes, history of gestation, and physiological index for pre- and postpregnancy periods were collected. χ2 tests and independent t tests were used to examine the correlations between demographic characteristics and GDM. Stepwise multivariate logistic regression was used to determine the factors associated with GDM. FINDINGS The results of the comparison between the GDM group (n=106) and the NGT group (n=406) showed that the risk factors for GDM were maternal age, education, a family history of diabetes, and prepregnancy body mass index (BMI). KEY CONCLUSION AND IMPLICATION FOR PRACTICE Older age, lower levels of education, a family history of diabetes, and higher prepregnancy BMI were significant risk factors for GDM. In addition to performing risk factor assessment, health care providers should proactively promote the importance of GDM screening to pregnant women at their first antenatal visit.
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Affiliation(s)
- Pei-Chao Lin
- School of Nursing, Kaohsiung Medical University, No. 100, Shih-Chuan 1st Rd., Kaohsiung City 80708, Taiwan.
| | - Chich-Hsiu Hung
- School of Nursing, Kaohsiung Medical University, No. 100, Shih-Chuan 1st Rd., Kaohsiung City 80708, Taiwan.
| | - Te-Fu Chan
- Department of Obstetrics and Gynecology, Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, No. 100, Shih-Chuan 1st Rd., Kaohsiung City 80708, Taiwan; Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, No. 100, Tz-You 1st Rd., Kaohsiung City 80756, Taiwan.
| | - Kuan-Chia Lin
- Institute of Hospital and Health Care Administration, Community Medicine Research Center, National Yang-Ming University, No. 155, Linong Street Sec. 2, Taipei City 11221, Taiwan.
| | - Yu-Yun Hsu
- Department of Nursing, and Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, 1 University Road, Tainan City, 70101, Taiwan.
| | - Ya-Ling Tzeng
- School of Nursing and Graduate Institute of Nursing, China Medical University, No. 91, Hsueh-Shih Rd., Taichung City 40402, Taiwan.
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Haghighat N, Hu M, Laurent O, Chung J, Nguyen P, Wu J. Comparison of birth certificates and hospital-based birth data on pregnancy complications in Los Angeles and Orange County, California. BMC Pregnancy Childbirth 2016; 16:93. [PMID: 27121857 PMCID: PMC4848813 DOI: 10.1186/s12884-016-0885-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 04/21/2016] [Indexed: 11/10/2022] Open
Abstract
Background The incidence of both gestational diabetes mellitus and preeclampsia is on the rise; however, these pregnancy complications may not be systematically reported. This study aimed to examine differences in reporting of preeclampsia and gestational diabetes between hospital records and birth certificate data, and to determine if such differences vary by maternal socioeconomic status indicators. Methods We obtained over 70,000 birth records from 2001 to 2006 from the perinatal research database of the Memorial Care system, a network of four hospitals in Los Angeles and Orange Counties, California. Memorial birth records were matched to corresponding state birth certificate records and analyzed to determine differential rates of reporting of preeclampsia and diabetes. Additionally, the influence of maternal socioeconomic factors on the reported incidence of such adverse pregnancy outcomes was analyzed. Socioeconomic factors of interest included maternal education levels, race, and type of health insurance (private or public). Results It was found that the birth certificate data significantly underreported the incidence of both preeclampsia (1.38 % vs. 3.13 %) and diabetes (1.97 % vs. 5.56 %) when compared to Memorial data. For both outcomes of interest, the degree of underreporting was significantly higher among women with lower education levels, among Hispanic women compared to Non-Hispanic White women, and among women with public health insurance. Conclusion The Memorial Care database is a more reliable source of information than birth certificate data for analyzing the incidence of preeclampsia and diabetes among women in Los Angeles and Orange Counties, especially for subpopulations of lower socioeconomic status.
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Affiliation(s)
- Nekisa Haghighat
- Program in Public Health, College of Health Sciences, University of California, Anteater Instruction & Research Bldg (AIRB) # 2034, 653 East Peltason Drive, Irvine, CA, 92697-3957, USA
| | - Maogui Hu
- Program in Public Health, College of Health Sciences, University of California, Anteater Instruction & Research Bldg (AIRB) # 2034, 653 East Peltason Drive, Irvine, CA, 92697-3957, USA
| | - Olivier Laurent
- Program in Public Health, College of Health Sciences, University of California, Anteater Instruction & Research Bldg (AIRB) # 2034, 653 East Peltason Drive, Irvine, CA, 92697-3957, USA
| | - Judith Chung
- Maternal-Fetal Medicine, School of Medicine, University of California, Irvine, CA, USA
| | - Peter Nguyen
- VA Long Beach Healthcare System, Long Beach, CA, USA
| | - Jun Wu
- Program in Public Health, College of Health Sciences, University of California, Anteater Instruction & Research Bldg (AIRB) # 2034, 653 East Peltason Drive, Irvine, CA, 92697-3957, USA.
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39
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Transcription Factor 7-Like 2 (TCF7L2) rs7903146 Polymorphism as a Risk Factor for Gestational Diabetes Mellitus: A Meta-Analysis. PLoS One 2016; 11:e0153044. [PMID: 27058589 PMCID: PMC4825985 DOI: 10.1371/journal.pone.0153044] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 03/22/2016] [Indexed: 12/13/2022] Open
Abstract
Background There are racial and ethnic differences in the prevalence of gestational diabetes mellitus (GDM). Prior meta-analyses included small samples and very limited non-Caucasian populations. Studies to determine the relationship between transcription factor 7 like-2 (TCF7L2) rs7903146 polymorphism and risk of GDM in Hispanics/Latinos are recently available. The present meta-analysis was to estimate the impact of allele variants of TCF7L2 rs7903146 polymorphism on GDM susceptibility in overall population and racial/ethnic subgroups. Methods Literature was searched in multiple databases including PubMed, Web of Science, EMBASE (Ovid SP), Airiti Library, Medline Complete, and ProQuest up to July 2015. Allelic frequency for TCF7L2 rs7903146 polymorphism in GDM and control subjects was extracted and statistical analysis was performed using Comprehensive Meta-Analysis (CMA) 2.0 statistical software. The association between TCF7L2 rs7903146 polymorphism and GDM risk was assessed by pooled odd ratios (ORs) using five gene models (dominant, recessive, homozygote, heterozygote, and allele). Stratified analysis based on race/ethnicity was also conducted. The between-study heterogeneity and contribution of each single study to the final result was tested by Cochran Q test and sensitivity analyses, respectively. Publication bias was evaluated using Egger’s linear regression test. Results A total of 16 studies involving 4,853 cases and 10,631 controls were included in this meta-analysis. Significant association between the T-allele of rs7903146 and GDM risk was observed under all genetic models, dominant model (OR = 1.44, 95% CI = 1.19–1.74), recessive model (OR = 1.35, 95% CI = 1.08–1.70), heterozygous model (OR = 1.31, 95% CI = 1.12–1.53), homozygous model (OR = 1.67, 95% CI = 1.31–2.12), and allele model (OR = 1.31, 95% CI = 1.12–1.53). Stratified analysis by race/ethnicity showed a statistically significant association between rs7903146 polymorphism and susceptibility to GDM under homozygous genetic model (TT versus CC) among whites, Hispanics/Latinos and Asians. Sensitivity analysis showed that the overall findings were robust to potentially influential decisions of the 16 studies included. No significant evidence for publication bias was observed in this meta-analysis for overall studies and subgroup studies. Conclusions This meta-analysis showed that the T allele of TCF7L2 rs7903146 polymorphism was associated with susceptibility of GDM in overall population in white, Hispanic/Latino and Asian sub-groups. Asians with homozygous TT allele of rs7903146 polymorphism have highest risk of GDM (OR = 2.08) followed by Hispanics/Latinos (OR = 1.80) and whites (OR = 1.51). The highest and lowest frequency of T allele of rs7903146 was found in Malaysia and South Korea, respectively. Future studies are needed to profile genetic risk for GDM among high risk Asian and Pacific Islander subgroups.
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Global architecture of gestational diabetes research: density-equalizing mapping studies and gender analysis. Nutr J 2016; 15:36. [PMID: 27044432 PMCID: PMC4820855 DOI: 10.1186/s12937-016-0154-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 03/29/2016] [Indexed: 12/25/2022] Open
Abstract
Objective Gestational diabetes mellitus (GDM) is associated with substantial morbidity for mothers and their offspring. While clinical and basic research activities on this important disease grow constantly, there is no concise analysis of global architecture of GDM research. Hence, it was the objective of this study to assess the global scientific performance chronologically, geographically and in relation to existing research networks and gender distribution of publishing authors. Study design On the basis of the New Quality and Quantity Indices in Science (NewQIS) platform, scientometric methods were combined with modern visualizing techniques such as density equalizing mapping, and the Web of Science database was used to assess GDM-related entries from 1900 to 2012. Results Twelve thousand five hundred four GDM-related publications were identified and analyzed. The USA (4295 publications) and the UK (1354 publications) dominated the field concerning research activity, overall citations and country-specific Hirsch-Index, which quantified the impact of a country’s published research on the scientific community. Semi-qualitative indices such as country-specific citation rates ranked New Zealand and the UK at top positions. Annual collaborative publications increased steeply between the years 1990 and 2012 (71 to 1157 respectively). Subject category analysis pointed to a minor interest of public health issues in GDM research. Gender analysis in terms of publication authorship revealed a clear dominance of the male gender until 2005; then a trend towards gender equity started and the activity of female scientists grew visibly in many countries. The country-specific gender analysis revealed large differences, i.e. female scientists dominated the scientific output in the USA, whereas the majority of research was published by male authors in countries such as Japan. Conclusion This study provides the first global sketch of GDM research architecture. While North-American and Western-European countries were dominating the GDM-related scientific landscape, a disparity exists in terms of research output between developed and low-resource countries. Since GDM is linked to considerable mortality and morbidity of mothers and their offspring and constitutes a tremendous burden for the healthcare systems in underserved countries, our findings emphasize the need to address disparities by fostering research endeavors, public health programs and collaborative efforts in these nations.
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Ogunleye OK, Davidson KD, Gregg AR, Egerman RS. Perinatal outcomes after adopting 1- versus 2-step approach to diagnosing gestational diabetes. J Matern Fetal Neonatal Med 2016; 30:186-190. [DOI: 10.3109/14767058.2016.1166201] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Law A, McCoy M, Lynen R, Curkendall SM, Gatwood J, Juneau PL, Landsman-Blumberg P. Costs of Newborn Care Following Complications During Pregnancy and Delivery. Matern Child Health J 2016; 19:2081-8. [PMID: 25707488 DOI: 10.1007/s10995-015-1721-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this study is examine the impact of pregnancy and delivery complications on the healthcare costs of newborns during the first 3 months of life. We conducted a retrospective cohort study of newborns born to women ages 15-49 using de-identified medical and pharmacy claims from the Truven Health MarketScan Commercial Claims and Encounters database incurred between January 1, 2007 and December 31, 2011. Total healthcare costs and resource utilization were examined and compared for the first 3 months of life between cohorts of newborns either with or without evidence of categorized maternal complications. Incremental costs were also determined using multivariable analysis for the conditions found to be the most prevalent in the study population. A total of 137,040 infants were studied, 75.4% of which were born to mothers who had experienced at least one complication during pregnancy or delivery. Fetal abnormalities (26.2%), early or threatened labor (16.6%), and hemorrhage (10.8%) were the most frequently observed complications. Diabetes (8.0%) and hypertension (7.7%) were also common, with the majority of other conditions present in 1% or less of the study population. Adjusted analyses found significant differences for seven conditions where incremental costs ranged from $987 to $10,287. Complications are common during pregnancy and delivery and some complications may lead to increased healthcare costs for newborns immediately following birth.
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Affiliation(s)
- Amy Law
- Bayer HealthCare Pharmaceuticals, Whippany, NJ, USA,
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Verburg PE, Tucker G, Scheil W, Erwich JJHM, Dekker GA, Roberts CT. Seasonality of gestational diabetes mellitus: a South Australian population study. BMJ Open Diabetes Res Care 2016; 4:e000286. [PMID: 27843556 PMCID: PMC5073586 DOI: 10.1136/bmjdrc-2016-000286] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 08/31/2016] [Accepted: 09/20/2016] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To investigate whether there is a seasonal variation in the incidence of gestational diabetes mellitus (GDM). RESEARCH DESIGN AND METHODS This retrospective cohort study of 60 306 eligible South Australian live-born singletons during 2007-2011 recorded in the South Australian Perinatal Statistics Collection (SAPSC) examined the incidence of GDM in relation to estimated date of conception (eDoC). Fourier series analysis was used to model seasonal trends. RESULTS During the study period, 3632 (6.0%) women were diagnosed with GDM. Seasonal modeling showed a strong relation between GDM and eDoC (p<0.001). Unadjusted and adjusted models (adjusted for maternal age, body mass index (BMI), parity, ethnicity, socioeconomic status, and chronic hypertension) demonstrated the presence of a peak incidence occurring among pregnancies with eDoC in winter (June/July/August), with a trough for eDoc in summer (December/January/February). As this was a retrospective study, we could only use variables that had been collected as part of the routine registration system, the SAPSC. CONCLUSIONS This study is the first population-based study to demonstrate a seasonal variation for GDM. Several maternal lifestyle and psychosocial factors associated with seasonality and GDM may be influential in the pathophysiologic mechanisms of GDM. Ambient temperature, physical activity, nutrient intake, and vitamin D levels may affect maternal physiology, and fetal and placental development at the cellular level and contribute to the development of GDM. The mechanisms underlying these possible associations are not fully understood and warrant further investigation.
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Affiliation(s)
- Petra E Verburg
- Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Graeme Tucker
- Epidemiology Branch, SA Health, Adelaide, South Australia, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Wendy Scheil
- Epidemiology Branch, SA Health, Adelaide, South Australia, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Jan Jaap H M Erwich
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Gus A Dekker
- Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
- Department of Obstetrics and Gynaecology, Lyell McEwin Hospital, Elizabeth Vale, South Australia, Australia
| | - Claire T Roberts
- Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
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Liu T, Li J, Xu F, Wang M, Ding S, Xu H, Dong F. Comprehensive analysis of serum metabolites in gestational diabetes mellitus by UPLC/Q-TOF-MS. Anal Bioanal Chem 2015; 408:1125-35. [DOI: 10.1007/s00216-015-9211-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Revised: 11/18/2015] [Accepted: 11/23/2015] [Indexed: 01/22/2023]
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Cho GJ, An JJ, Choi SJ, Oh SY, Kwon HS, Hong SC, Kwon JY. Postpartum Glucose Testing Rates Following Gestational Diabetes Mellitus and Factors Affecting Testing Non-compliance from Four Tertiary Centers in Korea. J Korean Med Sci 2015; 30:1841-6. [PMID: 26713061 PMCID: PMC4689830 DOI: 10.3346/jkms.2015.30.12.1841] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 09/01/2015] [Indexed: 01/03/2023] Open
Abstract
The purpose of this study was to investigate postpartum glucose testing rates in patients with gestational diabetes mellitus (GDM) and to determine factors affecting testing non-compliance in the Korean population. This was a retrospective study of 1,686 patients with GDM from 4 tertiary centers in Korea and data were obtained from medical records. Postpartum glucose testing was conducted using a 2-hr 75-g oral glucose tolerance, fasting glucose, or hemoglobin A1C test. Test results were categorized as normal, prediabetic, and diabetic. The postpartum glucose testing rate was 44.9% (757/1,686 patients); and of 757 patients, 44.1% and 18.4% had pre-diabetes and diabetes, respectively. According to the multivariate analysis, patients with a high parity, larger weight gain during pregnancy, and referral from private clinics due to reasons other than GDM treatment were less likely to receive postpartum glucose testing. However, patients who had pharmacotherapy for GDM were more likely to be screened. In this study, 55.1% of patients with GDM failed to complete postpartum glucose testing. Considering the high prevalence of diabetes (18.4%) at postpartum, clinicians should emphasize the importance of postpartum diabetes screening to patients with factors affecting testing noncompliance.
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Affiliation(s)
- Geum Joon Cho
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
| | - Jung-Joo An
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Suk-Joo Choi
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo-young Oh
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Han-Sung Kwon
- Department of Obstetrics and Gynecology, Konkuk University School of Medicine, Seoul, Korea
| | - Soon-Cheol Hong
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
| | - Ja-Young Kwon
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
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Whiteman VE, Salemi JL, Mejia De Grubb MC, Ashley Cain M, Mogos MF, Zoorob RJ, Salihu HM. Additive effects of Pre-pregnancy body mass index and gestational diabetes on health outcomes and costs. Obesity (Silver Spring) 2015; 23:2299-308. [PMID: 26390841 DOI: 10.1002/oby.21222] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 06/11/2015] [Accepted: 06/19/2015] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Pre-pregnancy obesity and gestational diabetes mellitus (GDM) are increasingly prevalent independent risk factors for maternal and infant morbidities. However, there is a paucity of information on their joint effects on health outcomes and healthcare costs. METHODS A population-based retrospective cohort study was conducted in Florida using a validated statewide database covering 1,057,647 infants born between 2004 and 2009. Using generalized linear modeling, joint associations between levels of pre-pregnancy body mass index (BMI) and GDM and maternal complications of pregnancy, adverse birth outcomes, and healthcare costs were examined. The relative excess risk due to interaction was used to describe the direction and magnitude of the BMI-GDM interaction on the additive scale. RESULTS Increasing pre-pregnancy BMI conferred increasing odds of adverse consequences, as did GDM, and the BMI-GDM interaction was greater than additive for 9 of 14 outcomes. The cost for infants born to women with GDM/obesity-III was 34% higher during the first year compared with those born to women with normal BMI and without GDM. The costs of maternal and infant inpatient care associated with overweight/obesity and GDM totaled over $351 million. CONCLUSIONS These findings provide further evidence of the importance of lifestyle modifications to decrease rates of obesity and risk factors from GDM.
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Affiliation(s)
- Valerie E Whiteman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Jason L Salemi
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Maria C Mejia De Grubb
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Mary Ashley Cain
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Mulubrhan F Mogos
- Department of Community and Health Systems, School of Nursing, University of Indiana, Indianapolis, Indiana, USA
| | - Roger J Zoorob
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Hamisu M Salihu
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, College of Medicine, University of South Florida, Tampa, Florida, USA
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas, USA
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Abstract
OBJECTIVE To evaluate whether the addition of glyburide to diet therapy modifies pregnancy outcomes in women with mild gestational diabetes. METHODS Women with at least two abnormal values on a 3-hour, 100-g oral glucose tolerance test according to National Diabetes Data Group criteria and fasting values less than 105 mg/dL between 24 and 30 weeks of gestation were randomized to blinded glyburide or placebo study drug. All women were placed on a 35-kcal/kg diet and recorded four times daily capillary glucose measurements. The study drug was titrated based on weekly maternal capillary glucose values with targets of less than 95 mg/dL (5.3 mmol/L) and 120 mg/dL (6.7 mmol/L) for fasting and 2-hour postprandial glucose measurements, respectively. The primary study outcome was a 200-g birth weight decrement in neonates of women treated with glyburide. The sample size estimate for this outcome was 334 total randomized women with a one-to-one allocation. RESULTS A total of 395 women were enrolled at a single center between September 2008 and October 2012. Women treated with glyburide had a significantly greater decline in fasting glucose values over the course of therapy. However, there was no difference in the primary study outcome. Specifically, the mean birth weight was 33 g lower in the group treated with glyburide (P=.52). Although not powered to examine all outcomes associated with gestational diabetes, treatment with glyburide did not affect need for operative delivery, shoulder dystocia, clavicular fracture, Erb's palsy, or neonatal hypoglycemia. Four women in each group required insulin. CONCLUSION The addition of glyburide to diet therapy significantly improved maternal glycemic control over time when compared with placebo. However, adding glyburide to diet did not decrease birth weight or improve maternal or neonatal outcomes in women with mild gestational diabetes. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, www.clinicaltrials.gov, NCT00744965. LEVEL OF EVIDENCE I.
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Cho GJ, Kim LY, Sung YN, Kim JA, Hwang SY, Hong HR, Hong SC, Oh MJ, Kim HJ. Secular Trends of Gestational Diabetes Mellitus and Changes in Its Risk Factors. PLoS One 2015; 10:e0136017. [PMID: 26292282 PMCID: PMC4546365 DOI: 10.1371/journal.pone.0136017] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Accepted: 07/30/2015] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the secular trends of incidence of gestational diabetes mellitus (GDM) and insulin treatment for GDM in a Korean population and to determine the factors that contribute to the trends in the incidence of GDM. STUDY DESIGN We used data collected by the Health Insurance Review & Assessment Service of Korea and analyzed data from women who had given birth from 2006 to 2010. We evaluated the trends in the incidence of GDM and GDM requiring insulin treatment and the changes in risk factors. RESULTS There were 1,824,913 births during the study period, which included 129,666 cases of GDM, an incidence of 7.11% over this period. The incidence of GDM increased from 3.86% in 2007 to 11.83% in 2010, with a continuous increase after adjustment for age. However, the number of GDM cases that required insulin treatment decreased significantly from 13.87% in 2007 to 5.94% in 2010. The proportion of patients who were at an older age and multiparity, 2 GDM risk factors, increased during the study period. CONCLUSIONS In Korea, the incidence of GDM, especially mild GDM, increased dramatically during the period from 2006 to 2010. Further efforts are needed to monitor this trend and to identify associated factors.
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Affiliation(s)
- Geum Joon Cho
- Department of Obstetrics and Gynecology, College of Medicine, Korea University, Seoul, Korea
| | - Log Young Kim
- The Health Insurance Review & Assessment Service of Korea, Seoul, Korea
| | - Ye Na Sung
- The Health Insurance Review & Assessment Service of Korea, Seoul, Korea
| | - Jee Ae Kim
- The Health Insurance Review & Assessment Service of Korea, Seoul, Korea
| | - Soon Young Hwang
- Department of Biostatistics, College of Medicine, Korea University, Seoul, Korea
| | - Hye-Ri Hong
- Department of Obstetrics and Gynecology, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Soon-Cheol Hong
- Department of Obstetrics and Gynecology, College of Medicine, Korea University, Seoul, Korea
| | - Min-Jeong Oh
- Department of Obstetrics and Gynecology, College of Medicine, Korea University, Seoul, Korea
| | - Hai-Joong Kim
- Department of Obstetrics and Gynecology, College of Medicine, Korea University, Seoul, Korea
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Bashshur RL, Shannon GW, Smith BR, Woodward MA. The empirical evidence for the telemedicine intervention in diabetes management. Telemed J E Health 2015; 21:321-54. [PMID: 25806910 PMCID: PMC4432488 DOI: 10.1089/tmj.2015.0029] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 02/17/2015] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE The research presented here assesses the scientific evidence for the telemedicine intervention in the management of diabetes (telediabetes), gestational diabetes, and diabetic retinopathy. The impetus derives from the confluence of high prevalence of these diseases, increasing incidence, and rising costs, while telemedicine promises to ameliorate, if not prevent, type 2 diabetes and its complications. MATERIALS AND METHODS A purposeful review of the literature identified relevant publications from January 2005 to December 2013. These were culled to retain only credible research articles for detailed review and analysis. The search yielded approximately 17,000 articles with no date constraints. Of these, 770 appeared to be research articles within our time frame. A review of the abstracts yielded 73 articles that met the criteria for inclusion in the final analysis. Evidence is organized by research findings regarding feasibility/acceptance, intermediate outcomes (e.g., use of service, and screening compliance), and health outcomes (control of glycemic level, lipids, body weight, and physical activity.) RESULTS Definitions of telediabetes varied from study to study vis-à-vis diabetes subtype, setting, technology, staffing, duration, frequency, and target population. Outcome measures also varied. Despite these vagaries, sufficient evidence was obtained from a wide variety of research studies, consistently pointing to positive effects of telemonitoring and telescreening in terms of glycemic control, reduced body weight, and increased physical exercise. The major contributions point to telemedicine's potential for changing behaviors important to diabetes control and prevention, especially type 2 and gestational diabetes. Similarly, screening and monitoring for retinopathy can detect symptoms early that may be controlled or treated. CONCLUSIONS Overall, there is strong and consistent evidence of improved glycemic control among persons with type 2 and gestational diabetes as well as effective screening and monitoring of diabetic retinopathy.
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Affiliation(s)
- Rashid L. Bashshur
- E-Health Center, University of Michigan Health System, Ann Arbor, Michigan
| | - Gary W. Shannon
- Department of Geography, University of Kentucky, Lexington, Kentucky
| | - Brian R. Smith
- E-Health Center, University of Michigan Health System, Ann Arbor, Michigan
| | - Maria A. Woodward
- Departments of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
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Son KH, Lim NK, Lee JW, Cho MC, Park HY. Comparison of maternal morbidity and medical costs during pregnancy and delivery between patients with gestational diabetes and patients with pre-existing diabetes. Diabet Med 2015; 32:477-86. [PMID: 25472691 PMCID: PMC4407911 DOI: 10.1111/dme.12656] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/01/2014] [Indexed: 12/16/2022]
Abstract
AIMS To evaluate the effects of gestational diabetes and pre-existing diabetes on maternal morbidity and medical costs, using data from the Korea National Health Insurance Claims Database of the Health Insurance Review and Assessment Service. METHODS Delivery cases in 2010, 2011 and 2012 (459 842, 442 225 and 380 431 deliveries) were extracted from the Health Insurance Review and Assessment Service database. The complications and medical costs were compared among the following three pregnancy groups: normal, gestational diabetes and pre-existing diabetes. RESULTS Although, the rates of pre-existing diabetes did not fluctuate (2.5, 2.4 and 2.7%) throughout the study, the rate of gestational diabetes steadily increased (4.6, 6.2 and 8.0%). Furthermore, the rates of pre-existing diabetes and gestational diabetes increased in conjunction with maternal age, pre-existing hypertension and cases of multiple pregnancy. The risk of pregnancy-induced hypertension, urinary tract infections, premature delivery, liver disease and chronic renal disease were greater in the gestational diabetes and pre-existing diabetes groups than in the normal group. The risk of venous thromboembolism, antepartum haemorrhage, shoulder dystocia and placenta disorder were greater in the pre-existing diabetes group, but not the gestational diabetes group, compared with the normal group. The medical costs associated with delivery, the costs during pregnancy and the number of in-hospital days for the subjects in the pre-existing diabetes group were the highest among the three groups. CONCLUSIONS The study showed that the rates of pre-existing diabetes and gestational diabetes increased with maternal age at pregnancy and were associated with increases in medical costs and pregnancy-related complications.
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Affiliation(s)
- K H Son
- Department of Thoracic and Cardiovascular Surgery, Gachon University Gil Medical Centre, Gachon UniversityIncheon, Korea
| | - N-K Lim
- Division of Cardiovascular and Rare Disease, Korea National Institute of HealthChungbuk, Korea
| | - J-W Lee
- Division of Cardiovascular and Rare Disease, Korea National Institute of HealthChungbuk, Korea
| | - M-C Cho
- Department of Internal Medicine, College of Medicine, Chungbuk National UniversityChungju, Korea
| | - H-Y Park
- Division of Cardiovascular and Rare Disease, Korea National Institute of HealthChungbuk, Korea
- Correspondence to: Hyun-Young Park. E-mail:
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