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Tzotzis L, Hooper ME, Douglas A, Kurz E, Atchan M, Spiller S, Davis D. The needs and experiences of women with gestational diabetes mellitus from minority ethnic backgrounds in high-income nations: A systematic integrative review. Women Birth 2023; 36:205-216. [PMID: 36038477 DOI: 10.1016/j.wombi.2022.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 08/11/2022] [Accepted: 08/13/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) represents a growing challenge worldwide, with significant risks to both the mother and baby that extend beyond the duration of the pregnancy and immediate post-partum period. Women from ethnic minority groups who access GDM care in high-income settings face particular challenges. The aim of this systematic integrative review is to explore the experiences and needs of women with GDM from select ethnic groups in high-income healthcare settings. METHODS For the purposes of this systematic integrative review, a comprehensive search strategy explored the electronic databases CINAHL, Medline, Web of Science, and Scopus were searched for primary studies that explored the needs and experiences of women with gestational diabetes from select ethnic minority groups living in high-income nations. The ethnicity of the women in the study included: East, South and Southeast Asian, Indian subcontinent, Aboriginal/First Nations, Torres Strait Islander, Pacific Islander, Māori, Middle Eastern, African, or South/Latina American. Studies were assessed with the Crowe Critical Appraisal Tool and findings were synthesised with thematic analysis. RESULTS This review included 15 qualitative studies, one mixed method, and one cross-sectional study. Six high-income nations were represented. The voices and experiences of 843 women who originated from at least one ethnic minority group are represented. Four major themes were constructed: psychological impact of GDM, GDM care and education, GDM and sociocultural impact, and GDM and lifestyle changes. DISCUSSION AND CONCLUSION Limitations exist in the provision of culturally appropriate care to support the management of GDM in women from select ethnic groups in high-income healthcare settings. Women require care that is culturally appropriate, considering the individual needs and cultural practices of the woman. Engaging a woman's partner and family ensures good support is provided. Culturally appropriate care needs to be co-designed with communities so that women are at the centre of their care, avoiding a one-size-fits-all approach.
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Affiliation(s)
- Louise Tzotzis
- School of Nursing, Midwifery and Public Health, University of Canberra, Australia
| | - Mary-Ellen Hooper
- School of Nursing, Midwifery and Public Health, University of Canberra, Australia
| | - Angela Douglas
- School of Rehabilitation and Health Sciences, University of Canberra, Australia
| | - Ella Kurz
- School of Nursing, Midwifery and Public Health, University of Canberra, Australia
| | - Marjorie Atchan
- School of Nursing, Midwifery and Public Health, University of Canberra, Australia
| | | | - Deborah Davis
- School of Nursing, Midwifery and Public Health, University of Canberra, Australia; ACT Government Health Directorate, Australia.
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Li F, Liu L, Hu Y, Marx CM, Liu W. Efficacy and safety of metformin compared to insulin in gestational diabetes: a systemic review and meta-analysis of Chinese randomized controlled trials. Int J Clin Pharm 2022; 44:1102-1113. [PMID: 35834091 DOI: 10.1007/s11096-022-01438-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 06/01/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Metformin is widely used for the treatment of gestational diabetes. Although some meta-analyses are conducted on the efficacy and safety of metformin, none of them are focused on the Chinese population. The efficacy and safety of metformin in the Chinese GDM population are unknown. AIM The study aimed to compare metformin to insulin regarding the safety and efficacy in Chinese GDM patients using randomized controlled trials (RCTs) conducted in China. METHOD Chinese databases (Wanfang, CNKI, VIP, and CBM), PubMed, Embase, Cochrane library, and Scopus were searched for RCTs. The last search date was October 18, 2021. RESULTS Fifty RCTs (4663 patients) were included in this study after screening. Six outcomes were analyzed. In the main analysis, metformin had lower risk of respiratory distress syndrome (RDS, OR, 0.28; 95% CI 0.16-0.51; P < 0.0001), premature birth (OR, 0.42; 95% CI 0.21-0.85, P = 0.02), and neonatal hypoglycemia (OR, 0.34; 95% CI 0.24-0.48; P < 0.00001) compared to insulin. Moreover, the metformin group is better than the insulin group concerning all other outcomes such as maternal glycemic control and glycated hemoglobin. Subgroup analysis confirmed that metformin has better outcomes than all types of insulin except for RDS, premature birth, 2 h postprandial blood glucose, and glycated hemoglobin. CONCLUSION Metformin is considered to be a safe and effective alternative to insulin for the management of GDM if patients refuse insulin due to any reasons in China.
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Affiliation(s)
- Fang Li
- Department of Pharmacy, Beijing You An Hospital, Capital Medical University, Beijing, 100069, China
| | - Ligang Liu
- College of Pharmacy, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Yang Hu
- College of Pharmacy, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Carrie McAdam Marx
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Wei Liu
- Department of Pharmacy, Beijing You An Hospital, Capital Medical University, Beijing, 100069, China.
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Faure MC, Khoueiry R, Quanico J, Acloque H, Guerquin MJ, Bertoldo MJ, Chevaleyre C, Ramé C, Fournier I, Salzet M, Dupont J, Froment P. In Utero Exposure to Metformin Reduces the Fertility of Male Offspring in Adulthood. Front Endocrinol (Lausanne) 2021; 12:750145. [PMID: 34745014 PMCID: PMC8565088 DOI: 10.3389/fendo.2021.750145] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 09/17/2021] [Indexed: 12/11/2022] Open
Abstract
Metformin is a drug used for the treatment of type 2 diabetes and disorders associated with insulin resistance. Metformin is also used in the treatment of pregnancy disorders such as gestational diabetes. However, the consequences of foetal exposure to metformin on the fertility of exposed offspring remain poorly documented. In this study, we investigated the effect of in utero metformin exposure on the fertility of female and male offspring. We observed that metformin is detectable in the blood of the mother and in amniotic fluid and blood of the umbilical cord. Metformin was not measurable in any tissues of the embryo, including the gonads. The effect of metformin exposure on offspring was sex specific. The adult females that had been exposed to metformin in utero presented no clear reduction in fertility. However, the adult males that had been exposed to metformin during foetal life exhibited a 30% reduction in litter size compared with controls. The lower fertility was not due to a change in sperm production or the motility of sperm. Rather, the phenotype was due to lower sperm head quality - significantly increased spermatozoa head abnormality with greater DNA damage - and hypermethylation of the genomic DNA in the spermatozoa associated with lower expression of the ten-eleven translocation methylcytosine dioxygenase 1 (TET1) protein. In conclusion, while foetal metformin exposure did not dramatically alter gonad development, these results suggest that metabolic modification by metformin during the foetal period could change the expression of epigenetic regulators such as Tet1 and perturb the genomic DNA in germ cells, changes that might contribute to a reduced fertility.
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Affiliation(s)
- Mélanie C. Faure
- l’Institut National de Recherche Pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), UMR85 Physiologie de la Reproduction et des Comportements/Centre national de la Recherche Scientifique (CNRS), UMR7247/Université François Rabelais de Tours/Institut français du Cheval et de l'Équitation (IFCE), Nouzilly, France
| | - Rita Khoueiry
- Epigenetics Group, International Agency for Research on Cancer (IARC), Lyon, France
| | - Jusal Quanico
- Université Lille 1, INSERM U1192 - Protéomique Réponse Inflammatoire Spectrométrie de Masse (PRISM), Villeneuve d’Ascq, France
| | - Hervé Acloque
- Université Paris-Saclay, INRAE, AgroParisTech, Génétique Animale et Biologie Intégrative (GABI), Jouy-en-Josas, France
| | - Marie-Justine Guerquin
- UMR967 INSERM, Commissariat à l'Énergie Atomique (CEA)/Direction de la Recherche Fondamentale (DRF)/Institut de Radiobiologie Cellulaire et Moléculaire (iRCM)/Service Cellules Souches et Radiation (SCSR)/LDG, Université Paris Diderot, Sorbonne Paris Cité, Université Paris-Sud, Université Paris-Saclay, Laboratory of Development of the Gonads, Fontenay aux Roses, France
| | - Michael J. Bertoldo
- Fertility and Research Centre, School of Women’s and Children’s Health, University of New South Wales, Sydney, NSW, Australia
- School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Claire Chevaleyre
- l’Institut National de Recherche Pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), UMR85 Physiologie de la Reproduction et des Comportements/Centre national de la Recherche Scientifique (CNRS), UMR7247/Université François Rabelais de Tours/Institut français du Cheval et de l'Équitation (IFCE), Nouzilly, France
| | - Christelle Ramé
- l’Institut National de Recherche Pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), UMR85 Physiologie de la Reproduction et des Comportements/Centre national de la Recherche Scientifique (CNRS), UMR7247/Université François Rabelais de Tours/Institut français du Cheval et de l'Équitation (IFCE), Nouzilly, France
| | - Isabelle Fournier
- Université Lille 1, INSERM U1192 - Protéomique Réponse Inflammatoire Spectrométrie de Masse (PRISM), Villeneuve d’Ascq, France
| | - Michel Salzet
- Université Lille 1, INSERM U1192 - Protéomique Réponse Inflammatoire Spectrométrie de Masse (PRISM), Villeneuve d’Ascq, France
| | - Joëlle Dupont
- l’Institut National de Recherche Pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), UMR85 Physiologie de la Reproduction et des Comportements/Centre national de la Recherche Scientifique (CNRS), UMR7247/Université François Rabelais de Tours/Institut français du Cheval et de l'Équitation (IFCE), Nouzilly, France
| | - Pascal Froment
- l’Institut National de Recherche Pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), UMR85 Physiologie de la Reproduction et des Comportements/Centre national de la Recherche Scientifique (CNRS), UMR7247/Université François Rabelais de Tours/Institut français du Cheval et de l'Équitation (IFCE), Nouzilly, France
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Quadir H. Current Therapeutic Use of Metformin During Pregnancy: Maternal Changes, Postnatal Effects and Safety. Cureus 2021; 13:e18818. [PMID: 34804675 PMCID: PMC8592788 DOI: 10.7759/cureus.18818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 10/16/2021] [Indexed: 11/28/2022] Open
Abstract
Metformin is one of the most easily available medications for diabetes and has a relatively low cost. It is not only used in diabetes but is also effective in polycystic ovarian syndrome (PCOS) and obesity. Although insulin is the first choice when it comes to treating pregnant women with gestational diabetes mellitus (GDM), metformin has also been debated as a good choice after modification of diet. As metformin passes through the placenta, it is essential to know its consequence of leading to insulin resistance in the fetus as well as the impact on postnatal development. The use of metformin during GDM has raised many trials demonstrating that outcomes from the use of metformin are similar to those achieved with insulin. Follow-up studies were also conducted that assessed the impact on children exposed to metformin in utero. This review highlights the experimental evidence relating to the use of metformin during pregnancy for different conditions, and its impact on the growth and development of offspring.
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Affiliation(s)
- Huma Quadir
- Internal Medicine/Family Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Neurology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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Laurie JG, McIntyre HD. A Review of the Current Status of Gestational Diabetes Mellitus in Australia-The Clinical Impact of Changing Population Demographics and Diagnostic Criteria on Prevalence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E9387. [PMID: 33333879 PMCID: PMC7765268 DOI: 10.3390/ijerph17249387] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/08/2020] [Accepted: 12/10/2020] [Indexed: 12/12/2022]
Abstract
The current status of gestational diabetes mellitus in Australia reveals an almost quadrupling prevalence over the last decade. A narrative review of the current Australian literature reveals unique challenges faced by Australian maternity clinicians when addressing this substantial disease burden in our diverse population. Rising rates of maternal overweight and obesity, increasing maternal age and the diversity of ethnicity are key epidemiological impactors, overlaid by the 2015 changes in screening and diagnostic parameters. Our vast land mass and the remote location of many at risk women requires innovative and novel ideas for pathways to diagnose and effectively manage women with gestational diabetes mellitus. By modifying and modernizing models of care for women with gestational diabetes mellitus, we have the ability to address accessibility, resource management and our acute response to global events such as the COVID 19 pandemic. With continuing research, education and robust discourse, Australia is well placed to meet current and future challenges in the management of gestational diabetes mellitus.
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Affiliation(s)
- Josephine G Laurie
- Department of Obstetric Medicine, Mater Mothers’ Hospital Brisbane, Queensland and Mater Clinical Unit, The University of Queensland, South Brisbane, QLD 4101, Australia
| | - H. David McIntyre
- Department of Obstetric Medicine, Mater Mothers’ Hospital Brisbane, Queensland and Mater Research Institute, The University of Queensland, South Brisbane, QLD 4101, Australia;
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MacKay D, Kirkham R, Freeman N, Murtha K, Van Dokkum P, Boyle J, Campbell S, Barzi F, Connors C, O'Dea K, Oats J, Zimmet P, Wenitong M, Sinha A, Hanley AJ, Moore E, Peiris D, McLean A, Davis B, Whitbread C, McIntyre HD, Mein J, McDermott R, Corpus S, Canuto K, Shaw JE, Brown A, Maple-Brown L. Improving systems of care during and after a pregnancy complicated by hyperglycaemia: A protocol for a complex health systems intervention. BMC Health Serv Res 2020; 20:814. [PMID: 32867837 PMCID: PMC7461356 DOI: 10.1186/s12913-020-05680-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 08/21/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Many women with hyperglycaemia in pregnancy do not receive care during and after pregnancy according to standards recommended in international guidelines. The burden of hyperglycaemia in pregnancy falls disproportionately upon Indigenous peoples worldwide, including Aboriginal and Torres Strait Islander women in Australia. The remote and regional Australian context poses additional barriers to delivering healthcare, including high staff turnover and a socially disadvantaged population with a high prevalence of diabetes. METHODS A complex health systems intervention to improve care for women during and after a pregnancy complicated by hyperglycaemia will be implemented in remote and regional Australia (the Northern Territory and Far North Queensland). The Theoretical Domains Framework was used during formative work with stakeholders to identify intervention components: (1) increasing workforce capacity, skills and knowledge and improving health literacy of health professionals and women; (2) improving access to healthcare through culturally and clinically appropriate pathways; (3) improving information management and communication; (4) enhancing policies and guidelines; (5) embedding use of a clinical register as a quality improvement tool. The intervention will be evaluated utilising the RE-AIM framework at two timepoints: firstly, a qualitative interim evaluation involving interviews with stakeholders (health professionals, champions and project implementers); and subsequently a mixed-methods final evaluation of outcomes and processes: interviews with stakeholders; survey of health professionals; an audit of electronic health records and clinical register; and a review of operational documents. Outcome measures include changes between pre- and post-intervention in: proportion of high risk women receiving recommended glucose screening in early pregnancy; diabetes-related birth outcomes; proportion of women receiving recommended postpartum care including glucose testing; health practitioner confidence in providing care, knowledge and use of relevant guidelines and referral pathways, and perception of care coordination and communication systems; changes to health systems including referral pathways and clinical guidelines. DISCUSSION This study will provide insights into the impact of health systems changes in improving care for women with hyperglycaemia during and after pregnancy in a challenging setting. It will also provide detailed information on process measures in the implementation of such health system changes.
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Affiliation(s)
- D MacKay
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- Royal Darwin Hospital, Darwin, Australia
| | - R Kirkham
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - N Freeman
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - K Murtha
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - P Van Dokkum
- Baker Heart & Diabetes Institute Central Australia, Alice Springs, Australia
| | - J Boyle
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - S Campbell
- College of Nursing and Midwifery, Charles Darwin University, Cairns, Australia
| | - F Barzi
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - C Connors
- Top End Health Service, Northern Territory Department of Health, Darwin, Australia
| | - K O'Dea
- Population School of Health Research, University of South Australia, Adelaide, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - J Oats
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - P Zimmet
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, Australia
| | - M Wenitong
- Apunipima Cape York Health Council, Bungalow, Australia
| | - A Sinha
- Cairns and Hinterland Hospital and Health Service, Cairns, Australia
| | - A J Hanley
- Department of Nutritional Sciences, Faculty of Medicine and the Dalla Lana School of Public Health, The University of Toronto, Toronto, Canada
| | - E Moore
- Aboriginal Medical Services Alliance Northern Territory, Darwin, Australia
| | - D Peiris
- The George Institute for Global Health, Sydney, Australia
| | - A McLean
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- Cairns and Hinterland Hospital and Health Service, Cairns, Australia
| | - B Davis
- Cairns and Hinterland Hospital and Health Service, Cairns, Australia
| | - C Whitbread
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- Royal Darwin Hospital, Darwin, Australia
| | - H D McIntyre
- Mater Medical Research Institute, University of Queensland, Brisbane, Australia
| | - J Mein
- Wuchopperen Health Service, Cairns, Australia
| | - R McDermott
- Centre for Chronic Disease Prevention, Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Australia
| | - S Corpus
- Danila Dilba Health Service, Darwin, Australia
| | - K Canuto
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - J E Shaw
- Aboriginal Health Domain, Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - A Brown
- South Australian Health and Medical Research Institute, Adelaide, Australia
- Faculty of Health and Medical Science, University of Adelaide, Adelaide, Australia
| | - L Maple-Brown
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia.
- Royal Darwin Hospital, Darwin, Australia.
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Jorquera G, Echiburú B, Crisosto N, Sotomayor-Zárate R, Maliqueo M, Cruz G. Metformin during Pregnancy: Effects on Offspring Development and Metabolic Function. Front Pharmacol 2020; 11:653. [PMID: 32625081 PMCID: PMC7311748 DOI: 10.3389/fphar.2020.00653] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 04/22/2020] [Indexed: 12/14/2022] Open
Abstract
Maternal obesity during pregnancy and gestational diabetes mellitus (GDM) are both associated with of several postnatal diseases in the offspring, including obesity, early onset hypertension, diabetes mellitus, and reproductive alterations. Metformin is an oral drug that is being evaluated to treat GDM, obesity-associated insulin resistance, and polycystic ovary syndrome (PCOS) during pregnancy. The beneficial effects of metformin on glycemia and pregnancy outcomes place it as a good alternative for its use during pregnancy. In this line of thought, improving the metabolic status of the pregnant mother by using metformin should avoid the consequences of insulin resistance on the offspring's fetal and postnatal development. However, some human and animal studies have shown that metformin during pregnancy could amplify these alterations and be associated with excessive postnatal weight gain and obesity. In this minireview, we discuss not only the clinical and experimental evidence that supports the benefits of using metformin during pregnancy but also the evidence showing a possible negative impact of this drug on the offspring's development.
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Affiliation(s)
- Gonzalo Jorquera
- Centro de Neurobiología y Fisiopatología Integrativa (CENFI), Instituto de Fisiología, Facultad de Ciencias, Universidad de Valparaíso, Valpararaíso, Chile
| | - Bárbara Echiburú
- Laboratory of Endocrinology and Metabolism, West Division, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Nicolás Crisosto
- Laboratory of Endocrinology and Metabolism, West Division, Faculty of Medicine, University of Chile, Santiago, Chile.,Unit of Endocrinology, Clínica Las Condes, Santiago, Chile
| | - Ramón Sotomayor-Zárate
- Centro de Neurobiología y Fisiopatología Integrativa (CENFI), Instituto de Fisiología, Facultad de Ciencias, Universidad de Valparaíso, Valpararaíso, Chile
| | - Manuel Maliqueo
- Laboratory of Endocrinology and Metabolism, West Division, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Gonzalo Cruz
- Centro de Neurobiología y Fisiopatología Integrativa (CENFI), Instituto de Fisiología, Facultad de Ciencias, Universidad de Valparaíso, Valpararaíso, Chile
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