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Al-Hasani W, Ranasinghe R, Rogers H, Spanier W, Spears K, Gayle C, Long L, Dimitriadis GK, Hunt KF, Vincent RP. Clinical utility of point-of-care glucose testing in the assessment of gestational diabetes: Prospective cohort study. BJOG 2024; 131:1270-1278. [PMID: 38497098 DOI: 10.1111/1471-0528.17811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 02/19/2024] [Accepted: 03/03/2024] [Indexed: 03/19/2024]
Abstract
OBJECTIVE To assess the clinical utility of point-of-care (POC) capillary blood glucose (CBG) testing in the assessment of gestational diabetes mellitus (GDM) during oral glucose tolerance test (OGTT). DESIGN Prospective cohort study. SETTING Antenatal clinics at King's College Hospital. POPULATION Women screened for GDM between March and June 2020. METHODS The CBG was measured using the POC StatStrip® test and the venous plasma glucose (VPG) was measured by Roche analyser (Cobas 8000 c702). GDM was diagnosed based on the 2015 National Institute for Health and Clinical Excellence (NICE) Clinical Guideline criteria. The two methods were compared statistically using Analyse-It 5.40.2. MAIN OUTCOME MEASURES Diagnostic sensitivity, specificity, positive and negative predictive values (PPV and NPV) for the POC StatStrip® test, compared with VPG measured by reference laboratory method. RESULTS A total of 230 women were included. The number and percentage of women with glucose concentrations above the GDM threshold using the POC StatStrip® test versus laboratory VPG measurement was 15 (6.5%) versus eight (3.4%) at fasting and 105 (45.6%) versus 72 (31.1%) at 2 h, respectively. The sensitivity and specificity values (and 95% CIs) for the POC StatStrip® test were 88% (52%-99%) and 97% (93%-98%) at fasting and 97% (91%-99%) and 79% (71%-84%) at 2 h, respectively. However, the specificity and the NPV for the POC StatStrip® test for concentrations of ≤5.0 mmol/L at fasting or <7.5 mmol/L at 2 h were 100%, and the sensitivity and the PPV for concentrations of >9.5 mmol/L at 2 h were 100%. CONCLUSIONS In our cohort the POC measurement of CBG cannot entirely replace the laboratory method for the OGTT; however, it can be used to rule out/rule in GDM for glucose concentrations of ≤5.0 mmol/L at fasting or <7.5/>9.5 mmol/L at 2 h.
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Affiliation(s)
- Wiaam Al-Hasani
- Department of Clinical Biochemistry (Synnovis), King's College Hospital NHS Foundation Trust, London, UK
| | - Ruvini Ranasinghe
- Department of Clinical Biochemistry (Synnovis), King's College Hospital NHS Foundation Trust, London, UK
| | - Helen Rogers
- Department of Diabetes, King's College Hospital NHS Foundation Trust, London, UK
| | - William Spanier
- Department of Clinical Biochemistry (Synnovis), King's College Hospital NHS Foundation Trust, London, UK
| | - Katie Spears
- Department of Diabetes, King's College Hospital NHS Foundation Trust, London, UK
| | - Carol Gayle
- Department of Diabetes, King's College Hospital NHS Foundation Trust, London, UK
| | - Lisa Long
- Department of Obstetrics, King's College Hospital NHS Foundation Trust, London, UK
| | - Georgios K Dimitriadis
- Department of Endocrinology, King's College Hospital NHS Foundation Trust, London, UK
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Katharine F Hunt
- Department of Diabetes, King's College Hospital NHS Foundation Trust, London, UK
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Royce P Vincent
- Department of Clinical Biochemistry (Synnovis), King's College Hospital NHS Foundation Trust, London, UK
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
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Alexandre-Heymann L, Boudreau V, Bélanger N, Mostkowska A, Bonhoure A, Lavoie A, Rabasa-Lhoret R, Coriati A. Feasibility and accuracy of at-home glucose tolerance tests for cystic fibrosis related diabetes screening. J Cyst Fibros 2024:S1569-1993(24)00777-X. [PMID: 38942723 DOI: 10.1016/j.jcf.2024.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 06/04/2024] [Accepted: 06/11/2024] [Indexed: 06/30/2024]
Abstract
BACKGROUND Adult people living with Cystic Fibrosis (CF) undergo annual screening for CF-related diabetes. These tests represent a burden and can lead to undesirable effects resulting in low adherence. The objectives of this study were to 1) compare gold-standard in-hospital oral glucose tolerance testing (OGTT) with at-home options, and 2) evaluate acceptability of at-home options. METHODS A total of 34 adults living with CF undertook 3 types of OGTTs in standardized conditions within two weeks: 1) in a hospital using a 75 g glucose beverage, 2) at home with the same glucose beverage, and 3) at home using a standardized quantity of candy. Glucose levels were measured prior to the OGTT, after 1 and 2 hours. Concordance of glucose measurement, side effects and general appreciation were assessed across the three options. RESULTS Mean blood glucose was comparable among the three tests. Glucose tolerance categorization (normal, impaired glucose tolerance, or diabetes) was concordant with the hospital reference test in 59 % of participants for the glucose beverage and 75 % for the candies. Side effects were mild with all types of OGTTs, and 94 % of participants preferred the home options. Among the at-home OGTTs, the glucose beverage was preferred to the candy option. CONCLUSIONS Home-based OGTT could be an alternative to gold standard hospital-based OGTT testing, improving adherence to annual testing and reducing costs. However, the discrepancy between various OGTT testing methods could lead to diagnosis dilemma. This approach should be tested on a larger sample size.
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Affiliation(s)
- Laure Alexandre-Heymann
- Institut de Recherches Cliniques de Montréal, 110 av. des Pins Ouest, Montréal, QC, H2W1R7, Canada
| | - Valérie Boudreau
- Institut de Recherches Cliniques de Montréal, 110 av. des Pins Ouest, Montréal, QC, H2W1R7, Canada
| | - Noémie Bélanger
- Institut de Recherches Cliniques de Montréal, 110 av. des Pins Ouest, Montréal, QC, H2W1R7, Canada; Département de Nutrition, Faculté de Médecine, Université de Montréal, 2405 Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T1A8, Canada
| | - Agata Mostkowska
- Département de Nutrition, Faculté de Médecine, Université de Montréal, 2405 Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T1A8, Canada; Centre de Recherche de l'Hôpital Sacré-Cœur de Montréal, CIUSSS-NIM, 5400 boulevard Gouin Ouest, Montréal, QC, H4J1C5, Canada
| | - Anne Bonhoure
- Institut de Recherches Cliniques de Montréal, 110 av. des Pins Ouest, Montréal, QC, H2W1R7, Canada
| | - Annick Lavoie
- Département de Médecine, Service de Pneumologie, Centre Hospitalier de l'Université de Montréal (CHUM), 1000 rue Saint-Denis, Montréal, QC, H2×0C1, Canada
| | - Rémi Rabasa-Lhoret
- Institut de Recherches Cliniques de Montréal, 110 av. des Pins Ouest, Montréal, QC, H2W1R7, Canada; Département de Nutrition, Faculté de Médecine, Université de Montréal, 2405 Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T1A8, Canada; Département de Médecine, Faculté de Médecine, Université de Montréal, 2900 Boulevard Edouard Montpetit, Montreal, QC, H3T1J4, Canada.
| | - Adèle Coriati
- Institut de Recherches Cliniques de Montréal, 110 av. des Pins Ouest, Montréal, QC, H2W1R7, Canada; Département de Nutrition, Faculté de Médecine, Université de Montréal, 2405 Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T1A8, Canada; Centre de Recherche de l'Hôpital Sacré-Cœur de Montréal, CIUSSS-NIM, 5400 boulevard Gouin Ouest, Montréal, QC, H4J1C5, Canada
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Veerasetty NK, Venkatachalam J, Subbaiah M, Arikrishnan K, Soni B. Determinants of health literacy and its impact on glycemic control among women with gestational diabetes mellitus in a tertiary care hospital, Puducherry - A cross-sectional analytical study. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2024; 13:119. [PMID: 38726069 PMCID: PMC11081463 DOI: 10.4103/jehp.jehp_762_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 12/05/2023] [Indexed: 05/12/2024]
Abstract
BACKGROUND Health literacy is vital during pregnancy, as maternal health knowledge and behavior have a significant impact on the health of both mother and child. Hence, this study aimed to assess the health literacy status of pregnant women diagnosed with gestational diabetes mellitus (GDM), as well as its associated factors and impact on glycemic control. MATERIALS AND METHODS The facility-based Cross-sectional analytical study was conducted among 200 pregnant women with GDM in a tertiary care hospital. The eligible participants were consecutively selected for the study. The study was conducted from September 2022 to March 2023. A validated semi-structured questionnaire, the Health Literacy Questionnaire (HLQ) for GDM, was used to measure health literacy status. Stata V.17 software was used for data analysis. RESULTS Out of 200 pregnant women with GDM, the mean (SD) age of the participants is 29.5 (±5.5) years. It was observed that 164 (82%) of the participants had adequate health literacy, whereas 36 (18%) had inadequate health literacy about Gestational Diabetes. Adequate health literacy (HL) was observed among 88.5% of women with controlled blood sugar and 55.1% of women with uncontrolled blood sugar. Results of multivariate logistic regression analysis revealed that pregnant mothers' educational status (PR: 1.8; 95% CI: 1.2-2.5) and glycemic control (PR: 1.4; 95% CI (1.2-1.7) were associated with adequate HL. CONCLUSIONS In conclusion, this study supports the association between adequate HL and glycemic control in pregnant women with GDM. Addressing this gap is essential for healthcare officials and planners to implement programs that promote women's HL during pregnancy, with a focus on low-educated groups.
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Affiliation(s)
| | - J. Venkatachalam
- Department of Preventive and Social Medicine, JIPMER, Puducherry, India
| | - Murali Subbaiah
- Department of Obstetrics and Gynecology, JIPMER, Puducherry, India
| | | | - Bhanushree Soni
- Department of Preventive and Social Medicine, JIPMER, Puducherry, India
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Zhang S, Zhao W, Zeng J, He Z, Wang X, Zhu Z, Hu R, Liu C, Wang Q. Wearable non-invasive glucose sensors based on metallic nanomaterials. Mater Today Bio 2023; 20:100638. [PMID: 37128286 PMCID: PMC10148187 DOI: 10.1016/j.mtbio.2023.100638] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/01/2023] [Accepted: 04/14/2023] [Indexed: 05/03/2023] Open
Abstract
The development of wearable non-invasive glucose sensors provides a convenient technical means to monitor the glucose concentration of diabetes patients without discomfortability and risk of infection. Apart from enzymes as typical catalytic materials, the active catalytic materials of the glucose sensor are mainly composed of polymers, metals, alloys, metal compounds, and various metals that can undergo catalytic oxidation with glucose. Among them, metallic nanomaterials are the optimal materials applied in the field of wearable non-invasive glucose sensing due to good biocompatibility, large specific surface area, high catalytic activity, and strong adsorption capacity. This review summarizes the metallic nanomaterials used in wearable non-invasive glucose sensors including zero-dimensional (0D), one-dimensional (1D), and two-dimensional (2D) monometallic nanomaterials, bimetallic nanomaterials, metal oxide nanomaterials, etc. Besides, the applications of wearable non-invasive biosensors based on these metallic nanomaterials towards glucose detection are summarized in detail and the development trend of the wearable non-invasive glucose sensors based on metallic nanomaterials is also outlook.
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Affiliation(s)
- Sheng Zhang
- Ningbo Innovation Center, Zhejiang University, Ningbo, 315100, China
- School of Mechanical Engineering, Zhejiang University, Hangzhou, 310027, China
- NingboTech University, Ningbo, 315100, China
- Faculty of Science and Engineering, University of Nottingham Ningbo China, Ningbo, 315100, China
| | - Wenjie Zhao
- Ningbo Innovation Center, Zhejiang University, Ningbo, 315100, China
- School of Mechanical Engineering, Zhejiang University, Hangzhou, 310027, China
| | - Junyan Zeng
- Ningbo Innovation Center, Zhejiang University, Ningbo, 315100, China
- School of Mechanical Engineering, Zhejiang University, Hangzhou, 310027, China
| | - Zhaotao He
- Ningbo Innovation Center, Zhejiang University, Ningbo, 315100, China
- School of Mechanical Engineering, Zhejiang University, Hangzhou, 310027, China
| | - Xiang Wang
- Faculty of Science and Engineering, University of Nottingham Ningbo China, Ningbo, 315100, China
| | - Zehui Zhu
- Ningbo Innovation Center, Zhejiang University, Ningbo, 315100, China
| | - Runqing Hu
- NingboTech University, Ningbo, 315100, China
| | - Chen Liu
- Ningbo Innovation Center, Zhejiang University, Ningbo, 315100, China
- Faculty of Science and Engineering, University of Nottingham Ningbo China, Ningbo, 315100, China
- Corresponding author. Ningbo Innovation Center, Zhejiang University, Ningbo, 315100, China.
| | - Qianqian Wang
- Ningbo Innovation Center, Zhejiang University, Ningbo, 315100, China
- NingboTech University, Ningbo, 315100, China
- Corresponding author. Ningbo Innovation Center, Zhejiang University, Ningbo, 315100, China.
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Munk Scheuer C, Duevang Tvarnø C, Gils C, Dahl Ravn J, David McIntyre H, Møller Jensen D, Damm P, Kepp Bruun Lauenborg J, Dalsgaard Clausen T, Overgaard M. The impact of inter-laboratory glucose bias on the diagnosis of gestational diabetes mellitus: Comparison of common automated central laboratory methods. Clin Chim Acta 2023:117414. [PMID: 37263535 DOI: 10.1016/j.cca.2023.117414] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 05/07/2023] [Accepted: 05/27/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND AND AIMS The diagnosis of gestational diabetes mellitus (GDM) is based exclusively on glucose measurements, which are highly influenced by pre-analytical and analytical factors. Therefore, poor agreement across laboratories may affect the prevalence of GDM. We aimed to determine the inter-laboratory bias of glucose measurements and the impact on GDM prevalence. MATERIAL AND METHODS A prospective cohort study of women (n=110) referred for second-trimester GDM diagnostics using a 75 g oral glucose tolerance test. Maternal glucose was assessed from venous plasma at fasting, 1 h and 2 h. Venous blood were collected in Fluoride Citrate tubes and frozen. Samples were analyzed at five central laboratories using four different automated glucose Hexokinase methods and GDM prevalence was evaluated according to WHO2013 diagnostic criteria. RESULTS Maximum inter-laboratory bias was 0.19, 0.30 and 0.27 mmol/L in fasting, 1 h and 2 h samples, respectively. GDM prevalence ranged 30.0-41.1% across laboratories. CONCLUSION Inter-laboratory bias for mean venous glucose was low and within desirable limits. Nonetheless, the impact on GDM prevalence was considerable, which may inappropriately affect clinical practice.
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Affiliation(s)
- Cathrine Munk Scheuer
- Shared first authorship; Department of Gynaecology and Obstetrics, University of Copenhagen, Nordsjællands Hospital. Dyrehavevej 29, DK-3400 Hillerød.
| | - Casper Duevang Tvarnø
- Shared first authorship; Department of Gynaecology, Obstetrics and Paediatrics, Nykøbing Falster Sygehus, Denmark. Fjordvej 15, DK-4800 Nykøbing Falster.
| | - Charlotte Gils
- Department of Clinical Biochemistry, Odense University Hospital, Denmark. J.B. Winsløws Vej 4, DK-5000 Odense C.
| | - Julie Dahl Ravn
- Department of Clinical Biochemistry, Odense University Hospital, Denmark. J.B. Winsløws Vej 4, DK-5000 Odense C.
| | - H David McIntyre
- Mater Research, Faculty of Medicine, The University of Queensland, Australia. Raymond Terrace, Level 3 Aubigny Place, South Brisbane QLD 4101, Australia.
| | - Dorte Møller Jensen
- Steno Diabetes Center Odense, Odense University Hospital, Denmark Kløvervænget 10, DK-5000 Odense C; Department of Gynecology and Obstetrics, Odense University Hospital, Denmark. J.B. Winsløws Vej 4, DK-5000 Odense C; Department of Clinical Research, University of Southern Denmark, Denmark. J.B. Winsløws Vej 19.3, DK-5000 Odense C.
| | - Peter Damm
- Center for Pregnant Women with Diabetes, Department of Obstetrics, Rigshospitalet, Denmark. Blegdamsvej 9, DK-2100 Copenhagen East; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. Blegdamsvej 3b 33.5. DK-2200 Copenhagen.
| | - Jeannet Kepp Bruun Lauenborg
- Department of Gynaecology, Obstetrics and Paediatrics, Nykøbing Falster Sygehus, Denmark. Fjordvej 15, DK-4800 Nykøbing Falster; Department of Gynaecology and Obstetrics, Copenhagen University Hospital Herlev, Denmark. Borgmester Ib Juuls Vej 11, DK-2730 Herlev.
| | - Tine Dalsgaard Clausen
- Department of Gynaecology and Obstetrics, University of Copenhagen, Nordsjællands Hospital. Dyrehavevej 29, DK-3400 Hillerød; Center for Pregnant Women with Diabetes, Department of Obstetrics, Rigshospitalet, Denmark. Blegdamsvej 9, DK-2100 Copenhagen East.
| | - Martin Overgaard
- Department of Clinical Biochemistry, Odense University Hospital, Denmark. J.B. Winsløws Vej 4, DK-5000 Odense C; Department of Clinical Research, University of Southern Denmark, Denmark. J.B. Winsløws Vej 19.3, DK-5000 Odense C.
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Scheuer CM, Andersen MH, Mathiesen ER, Ringholm L, Müller CL, Truong JM, Lie-Olesen MM, Overgaard M, McIntyre HD, Jensen DM, Damm P, Clausen TD. Regional divergence and time trends in the prevalence of gestational diabetes mellitus: a national Danish cohort study. Acta Diabetol 2023; 60:379-386. [PMID: 36539623 PMCID: PMC9931790 DOI: 10.1007/s00592-022-02013-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022]
Abstract
AIMS To evaluate the prevalence and time trends of gestational diabetes mellitus (GDM) across the five regions of Denmark with uniform national guidelines for screening and diagnosing GDM. METHODS This register-based national cohort study included 287,684 births from 2013 to 2017. Trends in GDM prevalence over time and differences between the five regions were evaluated. Crude and adjusted odd ratios (ORs) for GDM were calculated including potential confounding clinical risk factors as age, BMI, educational level, marital status, parity, country of origin and assisted reproduction. RESULTS From 2013 to 2017, GDM prevalence in Denmark increased by 7% per year (OR 1.07, 95% CI 1.06-1.09, P < 0.001). GDM prevalence varied considerably between regions and ranged from 3.0 to 5.9% in 2017, corresponding to a maximal regional difference of 97%. In crude analyses, the risk of GDM in 2017 was significantly different in four of five regions compared to the remaining regions (OR ranging from 0.60 to 1.55), and these differences persisted after adjusting for confounding clinical risk factors (adjusted OR: 0.59-1.45). CONCLUSION The prevalence of GDM increased over time in all Danish regions with substantial regional divergence. Up to a 97%, difference in GDM prevalence was observed between Danish regions, which was not explained by available clinical risk factors. This occurred despite national guidelines and raises the question of whether regional variations in screening efficacy, diagnostic procedures or inequality in clinical health care access may explain the observed differences.
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Affiliation(s)
- Cathrine M Scheuer
- Department of Gynaecology and Obstetrics, Nordsjællands Hospital, Hillerød, Denmark.
| | - Maria H Andersen
- Department of Gynaecology and Obstetrics, Nordsjællands Hospital, Hillerød, Denmark
| | - Elisabeth R Mathiesen
- Department of Endocrinology and Metabolism, Center for Pregnant Women with Diabetes, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lene Ringholm
- Department of Endocrinology and Metabolism, Center for Pregnant Women with Diabetes, Copenhagen, Denmark
| | - Clara L Müller
- Department of Gynaecology and Obstetrics, Nordsjællands Hospital, Hillerød, Denmark
| | - Jun-Mei Truong
- Department of Gynaecology and Obstetrics, Nordsjællands Hospital, Hillerød, Denmark
| | | | - Martin Overgaard
- Department of Clinical Biochemistry, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - H David McIntyre
- Mater Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Dorte M Jensen
- Steno Diabetes Center Odense, 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
| | - Peter Damm
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Obstetrics, Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark
| | - Tine D Clausen
- Department of Gynaecology and Obstetrics, Nordsjællands Hospital, Hillerød, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Ravel V, Jayaseelan V, Rengaraj S, Lakshminarayanan S, Kannusamy S, Susindhran B. Adherence to medical nutrition therapy and it's challenges among antenatal women with gestational diabetes mellitus in South India- A sequential explanatory mixed-method study. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:28. [PMID: 37034861 PMCID: PMC10079207 DOI: 10.4103/jehp.jehp_930_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/08/2022] [Indexed: 06/19/2023]
Abstract
BACKGROUND Globally, one in ten pregnant women have diabetes; out of which, 90% contribute to gestational diabetes mellitus (GDM). Medical Nutrition Therapy (MNT) is the cornerstone for GDM treatment yet adherence to MNT among the masses is not adequately monitored as part of the routine antenatal services. The study aimed to estimate the proportion of adherence to MNT and determine the factors related toadherence among antenatal women with GDM. This study also explores the facilitators, barriers, and possible suggestions for improving adherence. MATERIALS AND METHODS This facility-based sequential explanatory mixed-method study was conducted among 341 antenatal women with GDM at, Puducherry. The study was conducted in 2021. Dietary adherence was evaluated using Perceived Dietary Adherence Questionnaire and based on the scores obtained they were selected for in-depth interviews to explore the facilitators and barriers. Collected data wereanalysed by Chi-square test using STATA version 16. RESULTS Out of 341 participants, the proportion of participants adherent to MNT was 135 (39.6%) with 95% CI of 34%-44%. Thepredictors for poor adherence were unemployment (PR: 0.65; 95%CI: 0.48-0.88) and good adherence was antenatal women in the 2nd trimester (PR: 1.541; 95%CI: 1.18-2.025). Barrierstonon-adherence were financial crisis, lack of awareness ofthe need for MNT, and joint family pressure. CONCLUSIONS About two-thirds of antenatal women with GDM are non-adherent to MNT. Unemployment and period of gestation were found to be theirdeterminants. Appropriate action has to be implemented for improving the adherence rate.
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Affiliation(s)
- Vanessa Ravel
- Department of Preventive and Social Medicine, JIPMER, Puducherry, India
| | | | | | | | | | - Balaji Susindhran
- Department of Preventive and Social Medicine, JIPMER, Puducherry, India
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8
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Mak C, Papassotiriou I, Zierk J, Kohse KP, Greaves RF, Geaghan SMD, Lang T, Loh TP. Emerging technologies in paediatric laboratory medicine. J LAB MED 2021. [DOI: 10.1515/labmed-2021-0097] [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] Open
Affiliation(s)
- Chloe Mak
- Department of Pathology , Princess Margaret Hospital , Hong Kong , P.R. China
| | - Ioannis Papassotiriou
- Department of Clinical Biochemistry , “Aghia Sophia” Children’s Hospital , Athens , Greece
| | - Jakob Zierk
- Department of Pediatrics and Adolescent Medicine , University Hospital Erlangen , Erlangen , Germany
| | - Klaus P. Kohse
- Faculty of Medicine and Health Sciences , University of Oldenburg , Oldenburg , Germany
- Institute for Laboratory Diagnostics and Microbiology, Klinikum , Oldenburg , Germany
| | - Ronda F. Greaves
- Victorian Clinical Genetics Services , Murdoch Children’s Research Institute , Melbourne , VIC , Australia
| | - Sharon M. D. Geaghan
- Department of Pathology , Pediatrics Division, Stanford University School of Medicine , Stanford , CA , USA
| | - Tim Lang
- Department of Clinical Biochemistry , University Hospital of North Durham , Durham , UK
| | - Tze Ping Loh
- Department of Laboratory Medicine , National University Hospital , Singapore , Singapore
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Screening for Gestational Diabetes Mellitus in Early Pregnancy: What Is the Evidence? J Clin Med 2021; 10:jcm10061257. [PMID: 33803650 PMCID: PMC8003050 DOI: 10.3390/jcm10061257] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/12/2021] [Accepted: 03/16/2021] [Indexed: 12/12/2022] Open
Abstract
The incidence of gestational diabetes mellitus (GDM) is increasing worldwide. This has a significant effect on the health of the mother and offspring. There is no doubt that screening for GDM between 24 and 28 weeks is important to reduce the risk of adverse pregnancy outcomes. However, there is no consensus about diagnosis and treatment of GDM in early pregnancy. In this narrative review on the current evidence on screening for GDM in early pregnancy, we included 37 cohort studies and eight randomized controlled trials (RCTs). Observational studies have shown that a high proportion (15–70%) of women with GDM can be detected early in pregnancy depending on the setting, criteria used and screening strategy. Data from observational studies on the potential benefit of screening and treatment of GDM in early pregnancy show conflicting results. In addition, there is substantial heterogeneity in age and BMI across the different study populations. Smaller RCTs could not show benefit but several large RCTs are ongoing. RCTs are also necessary to determine the appropriate cut-off for HbA1c in pregnancy as there is limited evidence showing that an HbA1c ≥6.5% has a low sensitivity to detect overt diabetes in early pregnancy.
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Meena G, Venkatachalam J, Chinnakali P, Olickal JJ, Kumar KV, Subramanian S, Dasari P. Glycemic control and its associated factors among women with gestational diabetes mellitus in a tertiary care Centre, Puducherry, South India. J Family Med Prim Care 2021; 10:491-495. [PMID: 34017776 PMCID: PMC8132810 DOI: 10.4103/jfmpc.jfmpc_1465_20] [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: 07/17/2020] [Revised: 09/17/2020] [Accepted: 11/24/2020] [Indexed: 12/02/2022] Open
Abstract
Background: Worldwide, one in ten pregnancies is related with diabetes; 87.6% of which are gestational diabetes mellitus (GDM). Maternal hyperglycaemia affects the successful progression of pregnancy. Objectives: To determine the proportion and the factors associated with poor glycaemic control among women with gestational diabetes. Methods: This hospital-based cross-sectional study was conducted in a tertiary care hospital, Puducherry, South India from September to October 2019. Pregnant women diagnosed as GDM and on treatment for at least one month were approached consecutively for the study. A fasting blood sugar (FBS) ≥92 mg/dl and postprandial blood sugar (PPBS) 1 hour ≥180 mg/dl or PPBS 2 hour ≥153 mg/dl were considered as poor glycaemic control. Results: A total of 301 women with GDM were included and the mean (SD) age was 27 (5) years. Of total, 29 (10%) reported GDM during their previous pregnancy and 95 (32%) got diagnosed before reaching the tertiary care hospital. Lifestyle modifications (77%) were the most common mode of management for GDM. Of total, 116 (38.5%; 95% CI 33%-44.3%) had poor glycaemic control. Multigravida women (46.9%) and those on pharmacological treatment for GDM had poor glycaemic control. Conclusion: One-third of women with GDM at a tertiary care centre had poor glycaemic control. Therefore, a novel approach to improve awareness about GDM control both among pregnant women and the medical fraternity is needed.
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Affiliation(s)
- Garima Meena
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Jayaseelan Venkatachalam
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Palanivel Chinnakali
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Jeby J Olickal
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Karthiga V Kumar
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Sadhana Subramanian
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Papa Dasari
- Department of Obstetrics and Gynaecology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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11
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Nevander S, Landberg E, Blomberg M, Ekman B, Lilliecreutz C. Comparison of Venous and Capillary Sampling in Oral Glucose Testing for the Diagnosis of Gestational Diabetes Mellitus: A Diagnostic Accuracy Cross-Sectional Study Using Accu-Chek Inform II. Diagnostics (Basel) 2020; 10:diagnostics10121011. [PMID: 33255868 PMCID: PMC7760160 DOI: 10.3390/diagnostics10121011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/23/2020] [Accepted: 11/23/2020] [Indexed: 11/16/2022] Open
Abstract
Gestational diabetes mellitus (GDM) is a common complication with negative impacts on mother and child. The primary aim of this study was to examine whether plasma glucose cutoffs for GDM diagnosis based on venous sampling can be replaced by cutoffs based on capillary sampling. A prospective cross-sectional study was performed at an antenatal care clinic including 175 pregnant women undergoing an oral glucose tolerance test (OGTT). Duplicate samples were collected by capillary and venous puncture while fasting and 1 h and 2 h after an OGTT. Both samples were analyzed on Accu-Chek Inform II. The cutoffs for a GDM diagnosis using capillary samples were corrected from 5.1 to 5.3 mmol/L for the fasting sample, from 10.0 to 11.1 mmol/L for the 1 h sample, and from 8.5 to 9.4 mmol/L for the 2-h sample using half of the dataset. Applying these cutoffs to the remaining dataset resulted in a sensitivity, specificity, and accuracy of 85.0%, 95.0%, and 90.3%, respectively, with a positive predictive value (PPV) of 83%, an negative predictive value (NPV) of 96%, and a positive negative likelihood ratio (LHR) of 16.4 using capillary sampling for the GDM diagnosis at fasting and 2-h after. Corrected cutoffs and capillary samples can be used for the diagnosis of GDM with maintained diagnostic accuracy using Accu-Chek Inform II.
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Affiliation(s)
- Sofia Nevander
- Department of Obstetrics and Gynecology, Linköping University, SE-581 85 Linköping, Sweden; (M.B.); (C.L.)
- Department of Biomedical and Clinical Sciences, Linköping University, SE-581 85 Linköping, Sweden;
- Correspondence: ; Tel.: +46-(705)-397-979
| | - Eva Landberg
- Department of Biomedical and Clinical Sciences, Linköping University, SE-581 85 Linköping, Sweden;
- Department of Clinical Chemistry, Linköping University, SE-581 85 Linköping, Sweden
| | - Marie Blomberg
- Department of Obstetrics and Gynecology, Linköping University, SE-581 85 Linköping, Sweden; (M.B.); (C.L.)
- Department of Biomedical and Clinical Sciences, Linköping University, SE-581 85 Linköping, Sweden;
| | - Bertil Ekman
- Department of Endocrinology, Linköping University, SE-581 85 Linköping, Sweden;
- Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 85 Linköping, Sweden
| | - Caroline Lilliecreutz
- Department of Obstetrics and Gynecology, Linköping University, SE-581 85 Linköping, Sweden; (M.B.); (C.L.)
- Department of Biomedical and Clinical Sciences, Linköping University, SE-581 85 Linköping, Sweden;
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12
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Maidwell-Smith AA, Doel AM, Bernstein RM, Moore SE. Prevalence estimates of diabetes in pregnancy in a rural, sub-Saharan population. Diabetes Res Clin Pract 2020; 169:108455. [PMID: 32979418 PMCID: PMC7738751 DOI: 10.1016/j.diabres.2020.108455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 08/17/2020] [Accepted: 09/15/2020] [Indexed: 11/19/2022]
Abstract
AIMS To determine the prevalence of Hyperglycaemia first Detected in Pregnancy (HDIP) in a cohort of women from rural Gambia and compare the diagnostic ability of capillary blood glucose (CBG) sampling to identify HIP versus laboratory-based analysis of venous plasma glucose (VPG). METHODS Pregnant women from rural Gambia (N = 251) underwent a 75 g Oral Glucose Tolerance Test (OGTT) at 28-weeks of gestation. Gestational Diabetes Mellitus was assessed as fasting glucose concentration ≥ 5.1-6.9 mmol/L; ≥10.0 mmol/L at 1-h post load; or ≥ 8.5 mmol/L at 2-h post load and Diabetes in Pregnancy as fasting glucose > 7.0 mmol/L. RESULTS A total of 199 and 244 women had VPG and CBG measurements respectively, and 198 women had both. 32 women (16.1%) were diagnosed with HDIP using VPG, mostly based on fasting concentrations. CONCLUSIONS The prevalence of HDIP in rural Gambia was higher than anticipated, emphasising a need for maternal diabetic policy. Based on the current findings, tailored recommendations could include measuring fasting VPG alone when conducting a full OGTT is not feasible. Similarly, CBG may be of value for excluding disease and thereby limiting costly laboratory-based investigations to a select few.
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Affiliation(s)
| | - Andrew M Doel
- Department of Women and Children's Health, King's College London, London, UK
| | - Robin M Bernstein
- Department of Anthropology, University of Colorado, Boulder, CO, USA; Health and Society Program, Institute of Behavioural Science, University of Colorado, Boulder, CO, USA
| | - Sophie E Moore
- Department of Women and Children's Health, King's College London, London, UK; MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Gambia.
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13
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Bogdanet D, O’Shea P, Lyons C, Shafat A, Dunne F. The Oral Glucose Tolerance Test-Is It Time for a Change?-A Literature Review with an Emphasis on Pregnancy. J Clin Med 2020; 9:E3451. [PMID: 33121014 PMCID: PMC7693369 DOI: 10.3390/jcm9113451] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 09/29/2020] [Accepted: 10/22/2020] [Indexed: 02/06/2023] Open
Abstract
Globally, gestational diabetes (GDM) is increasing at an alarming rate. This increase is linked to the rise in obesity rates among women of reproductive age. GDM poses a major global health problem due to the related micro- and macro-vascular complications of subsequent Type 2 diabetes and the impact on the future health of generations through the long-term impact of GDM on both mothers and their infants. Therefore, correctly identifying subjects as having GDM is of utmost importance. The oral glucose tolerance test (OGTT) has been the mainstay for diagnosing gestational diabetes for decades. However, this test is deeply flawed. In this review, we explore a history of the OGTT, its reproducibility and the many factors that can impact its results with an emphasis on pregnancy.
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Affiliation(s)
- Delia Bogdanet
- Department of Medicine, School of Medicine, National University of Ireland Galway, H91TK33 Galway, Ireland; (P.O.); (A.S.); (F.D.)
- Department of Diabetes and Endocrinology, Saolta University Health Care Group (SUHCG), University Hospital Galway, H91YR71 Galway, Ireland
| | - Paula O’Shea
- Department of Medicine, School of Medicine, National University of Ireland Galway, H91TK33 Galway, Ireland; (P.O.); (A.S.); (F.D.)
- Department of Clinical Biochemistry, SUHCG, University Hospital Galway, H91YR71 Galway, Ireland;
| | - Claire Lyons
- Department of Clinical Biochemistry, SUHCG, University Hospital Galway, H91YR71 Galway, Ireland;
| | - Amir Shafat
- Department of Medicine, School of Medicine, National University of Ireland Galway, H91TK33 Galway, Ireland; (P.O.); (A.S.); (F.D.)
| | - Fidelma Dunne
- Department of Medicine, School of Medicine, National University of Ireland Galway, H91TK33 Galway, Ireland; (P.O.); (A.S.); (F.D.)
- Department of Diabetes and Endocrinology, Saolta University Health Care Group (SUHCG), University Hospital Galway, H91YR71 Galway, Ireland
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14
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O'Malley E, Turner MJ. Diagnostic criteria for gestational diabetes mellitus. Aust N Z J Obstet Gynaecol 2020; 60:E16-E17. [PMID: 33043437 DOI: 10.1111/ajo.13214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 06/15/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Eimer O'Malley
- UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Dublin 8, Ireland
| | - Michael J Turner
- UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Dublin 8, Ireland
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15
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Applying Nanomaterials to Modern Biomedical Electrochemical Detection of Metabolites, Electrolytes, and Pathogens. CHEMOSENSORS 2020. [DOI: 10.3390/chemosensors8030071] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Personal biosensors and bioelectronics have been demonstrated for use in out-of-clinic biomedical devices. Such modern devices have the potential to transform traditional clinical analysis into a new approach, allowing patients or users to screen their own health or warning of diseases. Researchers aim to explore the opportunities of easy-to-wear and easy-to-carry sensors that would empower users to detect biomarkers, electrolytes, or pathogens at home in a rapid and easy way. This mobility would open the door for early diagnosis and personalized healthcare management to a wide audience. In this review, we focus on the recent progress made in modern electrochemical sensors, which holds promising potential to support point-of-care technologies. Key original research articles covered in this review are mainly experimental reports published from 2018 to 2020. Strategies for the detection of metabolites, ions, and viruses are updated in this article. The relevant challenges and opportunities of applying nanomaterials to support the fabrication of new electrochemical biosensors are also discussed. Finally, perspectives regarding potential benefits and current challenges of the technology are included. The growing area of personal biosensors is expected to push their application closer to a new phase of biomedical advancement.
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16
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Bruns DE, Metzger BE, Sacks DB. Diagnosis of Gestational Diabetes Mellitus Will Be Flawed until We Can Measure Glucose. Clin Chem 2020; 66:265-267. [PMID: 32040567 DOI: 10.1093/clinchem/hvz027] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 11/27/2019] [Indexed: 01/21/2023]
Affiliation(s)
- David E Bruns
- Department of Pathology, University of Virginia School of Medicine, Charlottesville, VA
| | - Boyd E Metzger
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - David B Sacks
- Department of Laboratory Medicine, NIH Clinical Center, Bethesda, MD
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17
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Liu J, Xu W, Zhu A, Kang H, Cao Y, Long F. Reusable optofluidic point-of-care testing platform with lyophilized specific antibody for fluorescence detection of cholylglycine in serum. Mikrochim Acta 2020; 187:439. [PMID: 32653962 DOI: 10.1007/s00604-020-04424-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 06/30/2020] [Indexed: 02/07/2023]
Abstract
A reusable optofluidic point-of-care testing platform (OPOCT) was successfully constructed through integrating evanescent wave fluorescence technology into an all-fiber-based optofluidic system. The compact design of the OPOCT allows it to be portable and suitable for on-site sensitive determination of biomarkers in serum without complicated and costly procedures. The sensitivity of 90.9 pM for antibody determination is observed thanks to the high transmission efficiency of excitation light and fluorescence in the OPOCT. The affinity constant between cholylglycine (CG) and anti-CG antibody was quantified using this platform based on the proposed theory. Using the lyophilized fluorescence-labeled specific antibody and reusable fiber optic biosensor, the OPOCT is applied to the one-step sensitive determination of CG in serum, which eliminates the dearth associated with liquid reagent handling, disposable biosensors, and user intervention. A limit of detection of 0.025 μg/mL for CG is obtained, which is far more than adequate for meeting diagnostic requirements. The matrix effect of serum samples on the evanescent wave-based optofluidic biosensor can be effectively reduced by simple dilution of serum samples. The performance of the OPOCT also compared favorably with that of a commercial turbidimetric inhibition immunoassay through analyzing multiple serum samples. This platform is ready to expand to measure any other biomarker by using its specific antibody. The simplicity, sensitivity, cost-effectiveness, and robustness of the OPOCT enable the early diagnosis of disease and making a timely clinical decision. Graphical abstract .
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Affiliation(s)
- Jiayao Liu
- School of Environment and Natural Resources, Renmin University of China, Beijing, 100874, China
| | - Wenjuan Xu
- School of Environment and Natural Resources, Renmin University of China, Beijing, 100874, China
| | - Anna Zhu
- State Key Laboratory of NBC Protection for Civilian, Academy of Military Sciences PLA China, Beijing, 102205, China
| | - Haoxiang Kang
- Beijing MDTK Biotechnology Corporation, Beijing, 102206, China
| | - Yu Cao
- Beijing MDTK Biotechnology Corporation, Beijing, 102206, China
| | - Feng Long
- School of Environment and Natural Resources, Renmin University of China, Beijing, 100874, China.
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18
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Affiliation(s)
- Sarah A L Price
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Robert G Moses
- Diabetes Services, University of Wollongong, West Wollongong, New South Wales, Australia
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19
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High Prevalence of Gestational Diabetes Mellitus in Rural Tanzania-Diagnosis Mainly Based on Fasting Blood Glucose from Oral Glucose Tolerance Test. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17093109. [PMID: 32365670 PMCID: PMC7246425 DOI: 10.3390/ijerph17093109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/22/2020] [Accepted: 04/24/2020] [Indexed: 12/16/2022]
Abstract
Gestational diabetes mellitus (GDM) is associated with poor pregnancy outcomes and increased long-term risk of metabolic diseases for both mother and child. In Tanzania, GDM prevalence increased from 0% in 1991 to 19.5% in 2016. Anaemia has been proposed to precipitate the pathogenesis of GDM. We aimed to examine the prevalence of GDM in a rural area of Tanzania with a high prevalence of anaemia and to examine a potential association between haemoglobin concentration and blood glucose during pregnancy. The participants were included in a population-based preconception, pregnancy and birth cohort study. In total, 538 women were followed during pregnancy and scheduled for an oral glucose tolerance test (OGTT) at week 32-34 of gestation. Gestational diabetes mellitus was diagnosed according to the WHO 2013 guidelines. Out of 392 women screened, 39% (95% CI: 34.2-44.1) had GDM, the majority of whom (94.1%) were diagnosed based solely on the fasting blood sample from the OGTT. No associations were observed between haemoglobin or ferritin and glucose measurements during pregnancy. A very high prevalence of GDM was found in rural Tanzania. In view of the laborious, costly and inconvenient OGTT, alternative methods such as fasting blood glucose should be considered when screening for GDM in low- and middle-income countries.
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20
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O'Malley EG, Reynolds CME, Turner MJ. Letter to the editor - Brief Communication. Eur J Obstet Gynecol Reprod Biol 2020; 249:106. [PMID: 32029286 DOI: 10.1016/j.ejogrb.2020.01.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 01/23/2020] [Accepted: 01/29/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Eimer G O'Malley
- UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Dublin 8, Ireland.
| | - Ciara M E Reynolds
- UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Dublin 8, Ireland
| | - Michael J Turner
- UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Dublin 8, Ireland
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