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Alecrim MDJ, Mattar R, Torloni MR. Pregnant women's experience of undergoing an oral glucose tolerance test: A cross-sectional study. Diabetes Res Clin Pract 2022; 189:109941. [PMID: 35690268 DOI: 10.1016/j.diabres.2022.109941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/25/2022] [Accepted: 06/02/2022] [Indexed: 11/22/2022]
Abstract
AIMS The oral glucose tolerance test (OGTT) is routinely performed in most pregnancies; however, there are few studies which document the experience of taking this test. We assessed the experience of pregnant women during an OGTT. METHODS This cross-sectional study included 152 women (24-32 weeks' gestation) and assessed their knowledge, anxiety (Spielberg anxiety inventory test-STAI), and physical pain (0-10 visual analog scale) during the OGTT. The Friedman test was used to compare pain scores over time. RESULTS 61 (40%) participants did not know why they were doing the OGTT and 73 (48%) women had high state-anxiety levels (STAI ≥ 41 points, 20-80 scale). Participants had mild to moderate pain scores immediately after the first and second blood draws (3.9 ± 2.7 and 3.8 ± 2.3, respectively) that decreased significantly after the third blood draw (2.8 ± 2.4, P < 0.001). Nearly half (n = 71, 47%) of the participants were very or extremely bothered with having to drink the glucose solution. CONCLUSIONS The OGTT was associated with high levels of anxiety and mild to moderate physical pain. Ingestion of the glucose solution was perceived as the most difficult part of the test. Good strategies can help to mitigate some of these negative experiences while undergoing an OGTT.
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Affiliation(s)
- Maria de J Alecrim
- Department of Obstetrics, São Paulo Federal University, Rua Napoleão de Barros, 875, São Paulo, SP 04024-002, Brazil.
| | - Rosiane Mattar
- Department of Obstetrics, São Paulo Federal University, Rua Napoleão de Barros, 875, São Paulo, SP 04024-002, Brazil.
| | - Maria R Torloni
- Department of Obstetrics, São Paulo Federal University, Rua Napoleão de Barros, 875, São Paulo, SP 04024-002, Brazil; Evidence Based Health Care Post-Graduate Program, Department of Medicine, São Paulo Federal University, Rua Botucatu 740, 3° andar, São Paulo, SP 04023-900, Brazil.
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Grønvall L, Skjeldestad FE. Changed definition of disease and broader screening criteria had little impact on prevalence of gestational diabetes mellitus. Acta Obstet Gynecol Scand 2022; 101:581-588. [PMID: 34699074 PMCID: PMC9564809 DOI: 10.1111/aogs.14276] [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: 06/28/2021] [Revised: 08/31/2021] [Accepted: 09/27/2021] [Indexed: 12/01/2022]
Abstract
INTRODUCTION There are major controversies in screening for gestational diabetes mellitus (GDM). The present study evaluates the impact of the 2017 revised guidelines for GDM screening and a changed definition of GDM in Norway. MATERIAL AND METHODS We used a case-series design and included women with no pre-pregnancy diabetes mellitus, who gave birth after gestational week 29 to a singleton fetus at the University Hospital of North Norway, Tromsø, or at a local maternity ward in Troms county, during the first 6 months of 2013 (before group, n = 676) and 2018 (after group, n = 673). Data were collected from antenatal records, maternal health information sheets, and electronic medical records (Partus). We assessed the screening criteria age, parity, pre-pregnancy BMI, and ethnicity. Primary outcomes were change in size of the population eligible for GDM screening, screening adherence, and prevalence of GDM, and follow up of GDM (treatment and obstetric risk assessment at gestational week 36). Statistical analyses were done using IBM SPSS with chi-squared test. A p value less than 0.05 was considered statistically significant. RESULTS The proportion of women eligible for GDM screening increased from 46.4% in the before group to 67.6% in the after group (+45%) (p < 0.01). However, screening adherence among eligible women was only 28.3% and 49.2% in the before and after groups, respectively (p < 0.01). Among screened women, 16.9% (15/89) and 10.7% (24/224), respectively, were diagnosed with GDM, resulting in an overall estimated prevalence of 2.2% (15/676) and 3.6% (24/673). Among women diagnosed with GDM, 13.3% received no follow up in 2013 and this proportion was 20.8% in 2018. The remaining women underwent obstetric risk assessment at gestational week 36 as advised in the guidelines. CONCLUSIONS The introduction of broader screening criteria and a more liberal case definition increased the population eligible for GDM screening by 45%. The higher proportion of women screened resulted in an insignificant higher prevalence of GDM. Screening adherence was poor in both study groups. Stakeholders for obstetric care need to consolidate quality measures and revisit the screening algorithm.
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Affiliation(s)
- Lina Grønvall
- Research Group Epidemiology of Chronic DiseasesInstitute of Community MedicineUiT the Arctic University of NorwayTromsøNorway
| | - Finn Egil Skjeldestad
- Research Group Epidemiology of Chronic DiseasesInstitute of Community MedicineUiT the Arctic University of NorwayTromsøNorway
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Lachmann EH, Fox RA, Dennison RA, Usher‐Smith JA, Meek CL, Aiken CE. Barriers to completing oral glucose tolerance testing in women at risk of gestational diabetes. Diabet Med 2020; 37:1482-1489. [PMID: 32144795 PMCID: PMC8641378 DOI: 10.1111/dme.14292] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/03/2020] [Indexed: 01/26/2023]
Abstract
AIM Complications of gestational diabetes (GDM) can be mitigated if the diagnosis is recognized. However, some at-risk women do not complete antenatal diagnostic oral glucose tolerance testing (OGTT). We aimed to understand reasons contributing to non-completion, particularly to identify modifiable factors. METHODS Some 1906 women attending a tertiary UK obstetrics centre (2018-2019) were invited for OGTT based on risk-factor assessment. Demographic information, test results and reasons for non-completion were collected from the medical record. Logistic regression was used to analyse factors associated with non-completion. RESULTS Some 242 women (12.3%) did not complete at least one OGTT, of whom 32.2% (n = 78) never completed testing. In adjusted analysis, any non-completion was associated with younger maternal age [≤ 30 years; odds ratio (OR) 2.3, 95% confidence interval (CI) 1.6-3.4; P < 0.001], Black African ethnicity (OR 2.7, 95% CI 1.2-5.5; P = 0.011), lower socio-economic status (OR 0.9, 95% CI 0.8-1.0; P = 0.021) and higher parity (≥ 2; OR 1.8, 95% CI 1.1-2.8; P = 0.013). Non-completion was more likely if testing indications included BMI ≥ 30 kg/m2 (OR 1.7, 95% CI 1.1-2.4; P = 0.009) or family history of diabetes (OR 2.2, 95% CI 1.5-3.3; P < 0.001) and less likely if the indication was an ultrasound finding (OR 0.4, 95% CI 0.2-0.9; P = 0.035). We identified a common overlapping cluster of reasons for non-completion, including inability to tolerate test protocol (21%), social/mental health issues (22%), and difficulty keeping track of multiple antenatal appointments (15%). CONCLUSIONS There is a need to investigate methods of testing that are easier for high-risk groups to schedule and tolerate, with fuller explanation of test indications and additional support for vulnerable groups.
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Affiliation(s)
- E. H. Lachmann
- School of Clinical MedicineUniversity of CambridgeNIHR Cambridge Comprehensive Biomedical Research CentreCambridgeUK
| | - R. A. Fox
- School of Clinical MedicineUniversity of CambridgeNIHR Cambridge Comprehensive Biomedical Research CentreCambridgeUK
| | - R. A. Dennison
- The Primary Care UnitDepartment of Public Health and Primary CareUniversity of CambridgeCambridgeUK
| | - J. A. Usher‐Smith
- The Primary Care UnitDepartment of Public Health and Primary CareUniversity of CambridgeCambridgeUK
| | - C. L. Meek
- Institute of Metabolic ScienceCambridgeUK
- Department of Clinical BiochemistryCambridge University HospitalsAddenbrooke’s HospitalCambridgeUK
- Wolfson Diabetes and Endocrinology ClinicCambridge University HospitalsAddenbrooke’s HospitalCambridgeUK
- Department of ChemistryPeterborough City HospitalPeterboroughUK
| | - C. E. Aiken
- University Department of Obstetrics and GynaecologyUniversity of CambridgeNIHR Cambridge Comprehensive Biomedical Research CentreCambridgeUK
- Department of Obstetrics and GynaecologyRosie HospitalCambridge University HospitalsCambridgeUK
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de Wit L, Bos DM, van Rossum AP, van Rijn BB, Boers KE. Repeated oral glucose tolerance tests in women at risk for gestational diabetes mellitus. Eur J Obstet Gynecol Reprod Biol 2019; 242:79-85. [PMID: 31569028 DOI: 10.1016/j.ejogrb.2019.09.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 09/16/2019] [Accepted: 09/20/2019] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Pregnant women with a negative oral glucose tolerance test (OGTT) between 24-28 weeks as part of risk-based screening for gestational diabetes mellitus (GDM) may develop clinical signs or symptoms suggestive for GDM in the third trimester. We aimed to determine the additional yield of repeating an OGTT to detect missed GDM in this group and assess patient characteristics and indications associated with a positive second OGTT. STUDY DESIGN We conducted a retrospective cohort study of women with a negative OGTT between 24-28 weeks of pregnancy in two hospitals in the Netherlands. Patient characteristics, pregnancy outcomes, OGTT results and indications were compared between women with normal (non-GDM) and abnormal (GDM) results of the second OGTT, using the WHO 1999 criteria (fasting glucose ≥7.0 mmol/L or 2 -h post load ≥7.8 mmol/L). We used receiver operating characteristic (ROC) curve analysis to determine cut-offs for fasting and 2 -h glucose values of the index OGTT that were associated with a positive OGTT in the third trimester. RESULTS Of 3147 women at risk for GDM, 183 underwent a second OGTT in the third trimester following their regular OGTT at 24-28 weeks. In 43 women (23.5%) GDM was diagnosed based on the second OGTT. A history of GDM was associated with subsequent GDM diagnosis, with an odds ratio of 2.6 (95% CI 1.0-6.3). Both fasting and 2 -h post load glucose values of the index OGTT were significantly higher in women with abnormal OGTT results later in pregnancy. Index OGTT glucose value cut-offs of 4.8 mmol/L (fasting) and 6.5 mmol/L (2 -h) had positive predictive values of 0.32 and 0.47 for a positive OGTT in the third trimester, and negative predictive values of 0.83 and 0.90, respectively. Fetal growth as a clinical symptom for GDM was the most frequent indication for repeating the OGTT, resulting in the diagnosis of GDM in 22.7% of women tested for this indication. CONCLUSION Repeating an OGTT after initial negative screening results in additional GDM diagnoses. In case of clinical signs, especially in women with additional risk factors such as a history of GDM or higher index OGTT glucose values, repeating an OGTT could be considered.
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Affiliation(s)
- L de Wit
- Department of Obstetrics & Gynecology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
| | - D M Bos
- Department of Obstetrics & Gynecology, University Medical Center Leiden, Leiden University, Leiden, the Netherlands.
| | - A P van Rossum
- Department of Clinical Chemistry and Hematology, Haaglanden Medical Center Bronovo, the Hague, the Netherlands.
| | - B B van Rijn
- Department of Obstetrics & Gynecology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; Department of Obstetrics and Prenatal Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
| | - K E Boers
- Department of Obstetrics & Gynecology, Haaglanden Medical Center Bronovo, the Hague, the Netherlands.
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Tsirou E, Grammatikopoulou MG, Theodoridis X, Gkiouras K, Petalidou A, Taousani E, Savvaki D, Tsapas A, Goulis DG. Guidelines for Medical Nutrition Therapy in Gestational Diabetes Mellitus: Systematic Review and Critical Appraisal. J Acad Nutr Diet 2019; 119:1320-1339. [PMID: 31201104 DOI: 10.1016/j.jand.2019.04.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 04/02/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Medical nutrition therapy is the cornerstone of gestational diabetes mellitus treatment. However, guidelines often present contradictory guidance to health care practitioners. OBJECTIVE To systematically review and critically appraise medical nutrition therapy guidelines for treating patients with gestational diabetes mellitus. DESIGN We searched Medline, the Cochrane Library, Guidelines International Network, and Google Scholar to retrieve clinical practice guidelines (CPGs) for medical nutrition therapy in gestational diabetes mellitus from professional or governmental organizations, published in English, between January 1, 2007, and November 24, 2018. CPGs were reviewed and appraised using the Appraisal of Guidelines, Research, and Evaluation II instrument. RESULTS Of 1,286 retrieved articles, 21 CPGs fulfilled the inclusion criteria. CPGs of the Academy of Nutrition and Dietetics, Diabetes Canada, and Malaysia Health Technology Assessment Section received the greatest overall scores and the highest scores concerning rigor of recommendations development. Many CPGs failed to involve multidisciplinary teams in their development, including patients, and often, dietitians. Applicability of the recommendations was low, lacking facilitators and tools to enhance implementation. Many CPGs demonstrated low editorial independence by failing to disclose funding and competing interests. More medical nutrition therapy recommendations were incorporated in the Academy of Nutrition and Dietetics and Malaysia Health Technology Assessment Section CPGs. The Malaysia Health Technology Assessment Section, Diabetes Canada, Academy of Nutrition and Dietetics, and Endocrine Society guidelines were recommended by the review panel herein without modifications. Overall, the CPGs suggested the consumption of adequate protein and the selection of foods with low glycemic index, divided into three main meals and two to four snacks. Weight gain recommendations were mostly based on the Institute of Medicine body mass index thresholds. CONCLUSIONS With few exceptions, the main developmental limitations of the appraised CPGs involved low rigor of recommendations development, lack of multidisciplinary stakeholder involvement, low applicability, and inadequate editorial independence. This indicates a need for developing more clear, unbiased, practical, and evidence-based CPGs.
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Egan AM, Hod M, Mahmood T, Dunne FP. Perspectives on diagnostic strategies for hyperglycaemia in pregnancy - Dealing with the barriers and challenges: Europe. Diabetes Res Clin Pract 2018; 145:67-72. [PMID: 29902541 DOI: 10.1016/j.diabres.2018.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 06/05/2018] [Indexed: 12/14/2022]
Abstract
Diabetes in pregnancy (DIP) is associated with an increased risk of adverse pregnancy outcomes. Unfortunately guidelines and clinical practices vary significantly and a number of key issues remain under debate. These include: glucose cut-offs for diagnosis; the approaches of universal versus selective screening; appropriate timing of screening; and acceptability of various screening strategies to the population at risk. Economic considerations are also of importance, but unfortunately data outlining the best approach from this viewpoint are limited. In this paper, we review each of these topics and examine associated barriers and challenges associated with various strategies from a European perspective. We also address options which potentially may have a future role in the care of these women including alternative diagnostic biomarkers.
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Affiliation(s)
- Aoife M Egan
- Galway Diabetes Research Centre, School of Medicine, National University of Ireland Galway, Galway, Ireland; Division of Endocrinology, Diabetes and Metabolism, Mayo Clinic School of Medicine, 200 1st Street SW, Rochester, MN 55905, USA.
| | - Moshe Hod
- Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel; European Association of Perinatal Medicine (EAPM), Israel; FIGO Hyperglycemia in Pregnancy (HIP) Working Group, Israel; FIGO Maternal and Offspring Health and NCD Prevention Committee, Israel
| | - Tahir Mahmood
- NHS Fife, Scotland, United Kingdom; European Board and College of Obstetrics and Gynaecology (EBCOG), United Kingdom
| | - Fidelma P Dunne
- Galway Diabetes Research Centre, School of Medicine, National University of Ireland Galway, Galway, Ireland; International Diabetes in Pregnancy Study Groups (IADPSG), United Kingdom
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Tierney M, O'Dea A, Danyliv A, Carmody L, McGuire BE, Glynn LG, Dunne F. Perspectives on the provision of GDM screening in general practice versus the hospital setting: a qualitative study of providers and patients. BMJ Open 2016; 6:e007949. [PMID: 26888724 PMCID: PMC4762147 DOI: 10.1136/bmjopen-2015-007949] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE A novel gestational diabetes mellitus (GDM) screening programme which involved offering screening at the patient's general practitioner (GP) compared with the traditional hospital setting was trialled. This study investigates perspectives of involved stakeholders on the provision of GDM screening at both settings. DESIGN Thematic analysis of the perspectives of stakeholders involved in the receiving and provision of GDM screening in both the GP and hospital settings drawn from focus groups and interviews. PARTICIPANTS 3 groups of participants are included in this research--patient participants, GP screening providers and hospital screening providers. All were recruited from a larger sample who participated in a randomised controlled screening trial. Purposeful sampling was utilised to select participants with a wide variety of perspectives on the provision of GDM screening. SETTING Participants were recruited from a geographical area covered by 3 hospitals in Ireland. RESULTS 4 themes emerged from thematic analysis--namely (1) travel distance, (2) best care provision, (3) sense of ease created and (4) optimal screening. CONCLUSIONS The influence of travel distance from the screening site is the most important factor influencing willingness to attend for GDM screening among women who live a considerable distance from the hospital setting. For patients who live equidistance from both settings, other factors are important; namely the waiting facilities including parking, perceived expertise of screening provider personnel, access to emergency treatment if necessary, accuracy of tests and access to timely results and treatment. Optimal screening for GDM should be specialist led, incorporate expert advice of GDM screening, treatment and management, should be provided locally, offer adequate parking and comfort levels, provide accurate tests, and timely access to results and treatment. Such a service should result in improved rates of GDM screening uptake. TRIAL REGISTRATION NUMBER ISRCTN41202110.
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Affiliation(s)
- Marie Tierney
- School of Medicine and Galway Diabetes Research Centre, National University of Ireland, Galway, Ireland
| | - Angela O'Dea
- School of Medicine and Galway Diabetes Research Centre, National University of Ireland, Galway, Ireland
| | - Andrii Danyliv
- School of Business and Economics, National University of Ireland, Galway, Ireland
| | - Louise Carmody
- School of Medicine and Galway Diabetes Research Centre, National University of Ireland, Galway, Ireland
| | - Brian E McGuire
- School of Psychology and Centre for Pain Research, National University of Ireland, Galway, Ireland
| | - Liam G Glynn
- Discipline of General Practice, National University of Ireland, Galway, Ireland
| | - Fidelma Dunne
- School of Medicine and Galway Diabetes Research Centre, National University of Ireland, Galway, Ireland
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Overington JD, Huang YC, Abramson MJ, Brown JL, Goddard JR, Bowman RV, Fong KM, Yang IA. Implementing clinical guidelines for chronic obstructive pulmonary disease: barriers and solutions. J Thorac Dis 2014; 6:1586-96. [PMID: 25478199 DOI: 10.3978/j.issn.2072-1439.2014.11.25] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 11/20/2014] [Indexed: 01/17/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is a complex chronic lung disease characterised by progressive fixed airflow limitation and acute exacerbations that frequently require hospitalisation. Evidence-based clinical guidelines for the diagnosis and management of COPD are now widely available. However, the uptake of these COPD guidelines in clinical practice is highly variable, as is the case for many other chronic disease guidelines. Studies have identified many barriers to implementation of COPD and other guidelines, including factors such as lack of familiarity with guidelines amongst clinicians and inadequate implementation programs. Several methods for enhancing adherence to clinical practice guidelines have been evaluated, including distribution methods, professional education sessions, electronic health records (EHR), point of care reminders and computer decision support systems (CDSS). Results of these studies are mixed to date, and the most effective ways to implement clinical practice guidelines remain unclear. Given the significant resources dedicated to evidence-based medicine, effective dissemination and implementation of best practice at the patient level is an important final step in the process of guideline development. Future efforts should focus on identifying optimal methods for translating the evidence into everyday clinical practice to ensure that patients receive the best care.
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Affiliation(s)
- Jeff D Overington
- 1 School of Medicine, The University of Queensland, Brisbane, Australia ; 2 Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia ; 3 Lung Foundation Australia, Brisbane, Australia ; 4 Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Australia
| | - Yao C Huang
- 1 School of Medicine, The University of Queensland, Brisbane, Australia ; 2 Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia ; 3 Lung Foundation Australia, Brisbane, Australia ; 4 Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Australia
| | - Michael J Abramson
- 1 School of Medicine, The University of Queensland, Brisbane, Australia ; 2 Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia ; 3 Lung Foundation Australia, Brisbane, Australia ; 4 Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Australia
| | - Juliet L Brown
- 1 School of Medicine, The University of Queensland, Brisbane, Australia ; 2 Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia ; 3 Lung Foundation Australia, Brisbane, Australia ; 4 Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Australia
| | - John R Goddard
- 1 School of Medicine, The University of Queensland, Brisbane, Australia ; 2 Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia ; 3 Lung Foundation Australia, Brisbane, Australia ; 4 Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Australia
| | - Rayleen V Bowman
- 1 School of Medicine, The University of Queensland, Brisbane, Australia ; 2 Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia ; 3 Lung Foundation Australia, Brisbane, Australia ; 4 Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Australia
| | - Kwun M Fong
- 1 School of Medicine, The University of Queensland, Brisbane, Australia ; 2 Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia ; 3 Lung Foundation Australia, Brisbane, Australia ; 4 Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Australia
| | - Ian A Yang
- 1 School of Medicine, The University of Queensland, Brisbane, Australia ; 2 Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia ; 3 Lung Foundation Australia, Brisbane, Australia ; 4 Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Australia
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Buckley BS, Harreiter J, Damm P, Corcoy R, Chico A, Simmons D, Vellinga A, Dunne F. Gestational diabetes mellitus in Europe: prevalence, current screening practice and barriers to screening. A review. Diabet Med 2012; 29:844-54. [PMID: 22150506 DOI: 10.1111/j.1464-5491.2011.03541.x] [Citation(s) in RCA: 241] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Gestational diabetes mellitus is a potentially serious condition that affects many pregnancies and its prevalence is increasing. Evidence suggests early detection and treatment improves outcomes, but this is hampered by continued disagreement and inconsistency regarding many aspects of its diagnosis. METHODS The Vitamin D and Lifestyle Intervention for Gestational Diabetes Mellitus Prevention (DALI) research programme aims to promote pan-European standards in the detection and diagnosis of gestational diabetes and to develop effective preventive interventions. To provide an overview of the context within which the programme will be conducted and its findings interpreted, systematic searching and narrative synthesis have been used to identify and review the best available European evidence relating to the prevalence of gestational diabetes, current screening practices and barriers to screening. RESULTS Prevalence is most often reported as 2-6% of pregnancies. Prevalence may be lower towards the Northern Atlantic seaboard of Europe and higher in the Southern Mediterranean seaboard. Screening practice and policy is inconsistent across Europe, hampered by lack of consensus on testing methods, diagnostic glycaemic thresholds and the value of routine screening. Poor clinician awareness of gestational diabetes, its diagnosis and local clinical guidelines further undermine detection of gestational diabetes. CONCLUSIONS Europe-wide agreement on screening approaches and diagnostic standards for gestational diabetes could lead to better detection and treatment, improved outcomes for women and children and a strengthened evidence base. There is an urgent need for well-designed research that can inform decisions on best practice in gestational diabetes mellitus screening and diagnosis.
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Affiliation(s)
- B S Buckley
- School of Medicine, National University of Ireland, Galway, Ireland.
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Persson M, Winkvist A, Mogren I. Surprisingly low compliance to local guidelines for risk factor based screening for gestational diabetes mellitus - A population-based study. BMC Pregnancy Childbirth 2009; 9:53. [PMID: 19917091 PMCID: PMC2784436 DOI: 10.1186/1471-2393-9-53] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2008] [Accepted: 11/16/2009] [Indexed: 11/26/2022] Open
Abstract
Background Screening for gestational diabetes mellitus (GDM) is routine during pregnancy in many countries in the world. The screening programs are either based on general screening offered to all pregnant women or risk factor based screening stipulated in local clinical guidelines. The aims of this study were to investigate: 1) the compliance with local guidelines of screening for GDM and 2) the outcomes of pregnancy and birth in relation to risk factors of GDM and whether or not exposed to oral glucose tolerance test (OGTT). Methods This study design was a population-based retrospective cross-sectional study of 822 women. A combination of questionnaire data and data collected from medical records was applied. Compliance to the local guidelines of risk factor based screening for GDM was examined and a comparison of outcomes of pregnancy and delivery in relation to risk factor groups for GDM was performed. Results Of the 822 participants, 257 (31.3%) women fulfilled at least one criterion for being exposed to screening for GDM according to the local clinical guidelines. However, only 79 (30.7%) of these women were actually exposed to OGTT and of those correctly exposed for screening, seven women were diagnosed with GDM. Women developing risk factors for GDM during pregnancy had a substantially increased risk of giving birth to an infant with macrosomia. Conclusion Surprisingly low compliance with the local clinical guidelines for screening for GDM during pregnancy was found. Furthermore, the prevalence of the risk factors of GDM in our study was almost doubled compared to previous Swedish studies. Pregnant women developing risk factors of GDM during pregnancy were found to be at substantially increased risk of giving birth to an infant with macrosomia. There is a need of actions improving compliance to the local guidelines.
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Affiliation(s)
- Margareta Persson
- Department of clinical science, Obstetrics and gynecology, Umeå University, Sweden.
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