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Quaresima P, Visconti F, Chiefari E, Puccio L, Foti DP, Venturella R, Vero R, Brunetti A, Di Carlo C. Barriers to Postpartum Glucose Intolerance Screening in an Italian Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E2853. [PMID: 30558120 PMCID: PMC6313594 DOI: 10.3390/ijerph15122853] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 12/09/2018] [Accepted: 12/11/2018] [Indexed: 01/17/2023]
Abstract
Background: Gestational diabetes mellitus (GDM) is a strong risk factor for type 2 diabetes mellitus (T2D) and the postpartum period is crucial for early treatment in at-risk women. However, despite recommendations, only a fraction of women undergo a postpartum screening for glucose intolerance (ppOGTT). The present study aims to verify the reason(s) for poor adherence in our population. Research design and methods: This retrospective study includes 451 women in which GDM was diagnosed between 2015⁻2016. During 2017, we verified by phone interview how many women underwent ppOGTT at 6⁻12 weeks postpartum, as recommended by the Italian guidelines. The non-compliant women were asked about the reason(s) for failing to screen. The non-parametric Mann-Whitney test and the 2-tailed Fisher exact test were used to compare continuous and categorical features, respectively, among women performing or non-performing ppOGTT. Results: Out of 451 women with GDM diagnosis, we recorded information from 327. Only 97 (29.7%) performed ppOGTT. The remaining 230 women (70.3%) provided the following explanation for non-compliance: (1) newborn care (30.4%); (2) misunderstood importance (28.3%); (3) oversight (13.0%); (4) unavailability of test reservation in the nearest centers (10.4%); (5) normal glycemic values at delivery (8.3%); (6) discouragement by primary care physician (5.6%). Conclusions: In our population, most women with recent GDM failed to perform ppOGTT. Our results indicated that the prominent barriers could potentially be overcome.
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Affiliation(s)
- Paola Quaresima
- Unit of Obstetrics and Gynecology, Department of Medical and Surgical Sciences, University "Magna Græcia'' of Catanzaro, Viale Europa, 88100 Catanzaro, Italy.
| | - Federica Visconti
- Unit of Obstetrics and Gynecology, Department of Medical and Surgical Sciences, University "Magna Græcia'' of Catanzaro, Viale Europa, 88100 Catanzaro, Italy.
| | - Eusebio Chiefari
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, Viale Europa, 88100 Catanzaro, Italy.
| | - Luigi Puccio
- Complex Operative Structure Endocrinology-Diabetology, Hospital Pugliese-Ciaccio, 88100 Catanzaro, Italy.
| | - Daniela P Foti
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, Viale Europa, 88100 Catanzaro, Italy.
| | - Roberta Venturella
- Unit of Obstetrics and Gynecology, Department of Medical and Surgical Sciences, University "Magna Græcia'' of Catanzaro, Viale Europa, 88100 Catanzaro, Italy.
| | - Raffaella Vero
- Complex Operative Structure Endocrinology-Diabetology, Hospital Pugliese-Ciaccio, 88100 Catanzaro, Italy.
| | - Antonio Brunetti
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, Viale Europa, 88100 Catanzaro, Italy.
| | - Costantino Di Carlo
- Unit of Obstetrics and Gynecology, Department of Medical and Surgical Sciences, University "Magna Græcia'' of Catanzaro, Viale Europa, 88100 Catanzaro, Italy.
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Jelsma JGM, van Poppel MNM, Smith BJ, Cinnadaio N, Bauman A, Tapsell L, Cheung NW, van der Ploeg HP. Changing psychosocial determinants of physical activity and diet in women with a history of gestational diabetes mellitus. Diabetes Metab Res Rev 2018; 34. [PMID: 28843034 DOI: 10.1002/dmrr.2942] [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: 01/06/2017] [Revised: 07/04/2017] [Accepted: 07/17/2017] [Indexed: 11/05/2022]
Abstract
BACKGROUND To investigate how a behavioural lifestyle intervention influences psychosocial determinants of physical activity and dietary behaviours in a population at risk of type 2 diabetes (T2DM). METHODS Fifty-nine women with a body mass index of ≥25 kg/m2 and a history of gestational diabetes mellitus (GDM) participated in a randomized controlled study. The intervention group (n = 29) received 2 face-to-face and 5 telephone lifestyle-counselling sessions with a health professional. The control group (n = 30) received care as usual. At baseline and 6 months, psychosocial determinants related to physical activity and diet were measured with a self-administrated questionnaire. Linear regression analyses were applied to test for intervention effects. RESULTS The intervention was effective in improving social support (β = 3.5, P < 0.001; β = 2.1, P = 0.02), modifying self-efficacy (β = -2.2, P = 0.02; β = -4.3, P < 0.001), and reducing barriers (β = -3.5, P = 0.01; β = -3.8, P = 0.01) for, respectively, physical activity and diet from baseline to 6-month follow-up in the intervention group compared with the control group. The intervention reduced the following barriers to a physically active lifestyle: lack of energy and lack of motivation. Physical activity barriers like lack of time and lack of childcare were unchanged. The intervention reduced the following barriers to a healthy diet: lack of time, costs, having unhealthy snacks at home, and having cravings for sweets. CONCLUSION This lifestyle intervention influenced psychosocial determinants relevant for overweight women with a history of gestational diabetes mellitus (GDM) in prevention of T2DM.
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Affiliation(s)
- Judith G M Jelsma
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU University Medical Center Amsterdam, The Netherlands
| | - Mireille N M van Poppel
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU University Medical Center Amsterdam, The Netherlands
- Institute of Sport Science, University of Graz, Graz, Austria
| | - Ben J Smith
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Nancy Cinnadaio
- School of Medicine, IIlawarra Health and Medical Research Institute, University of Wollongong, New South Wales, Australia
| | - Adrian Bauman
- Sydney School of Public Health, University of Sydney, New South Wales, Australia
| | - Linda Tapsell
- School of Medicine, IIlawarra Health and Medical Research Institute, University of Wollongong, New South Wales, Australia
| | - N Wah Cheung
- Department of Diabetes and Endocrinology, Westmead Hospital, New South Wales, Australia
| | - Hidde P van der Ploeg
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU University Medical Center Amsterdam, The Netherlands
- Sydney School of Public Health, University of Sydney, New South Wales, Australia
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Chamberlain CR, Oldenburg B, Wilson AN, Eades SJ, O'Dea K, Oats JJN, Wolfe R. Type 2 diabetes after gestational diabetes: greater than fourfold risk among Indigenous compared with non-Indigenous Australian women. Diabetes Metab Res Rev 2016; 32:217-27. [PMID: 26385131 DOI: 10.1002/dmrr.2715] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 07/06/2015] [Accepted: 07/28/2015] [Indexed: 01/28/2023]
Abstract
BACKGROUND Gestational diabetes is associated with a high risk of type 2 diabetes. However, progression rates among Indigenous women in Australia who experience high prevalence of gestational diabetes are unknown. METHODS This retrospective cohort study includes all births to women at a regional hospital in Far North Queensland, Australia, coded as having 'gestational diabetes' from 1 January 2004 to 31 December 2010 (1098 births) and receiving laboratory postpartum screening from 1 January 2004 to 31 December 2011 (n = 483 births). Women who did not receive postpartum screening were excluded from the denominator. Data were linked between hospital electronic records, routinely collected birth data and laboratories, with sample validation by reviews of medical records. Analysis was conducted using Cox-proportional regression models. RESULTS Indigenous women had a greater than fourfold risk of developing type 2 diabetes within 8 years of having gestational diabetes, compared with non-Indigenous women (hazards ratio 4.55, 95% confidence interval 2.63-7.88, p < 0.0001). Among women receiving postpartum screening tests, by 3, 5 and 7 years postpartum, 21.9% (15.8-30.0%), 25.5% (18.6-34.3%) and 42.4% (29.6-58.0%) Indigenous women were diagnosed with type 2 diabetes after gestational diabetes, respectively, compared with 4.2% (2.5-7.2%), 5.7% (3.3-9.5%) and 13.5% (7.3-24.2%) non-Indigenous women. Multivariate analysis showed an increased risk of developing type 2 diabetes among women with an early pregnancy body mass index ≥25 kg/m(2) , only partially breastfeeding at hospital discharge and gestational diabetes diagnosis prior to 17 weeks gestation. CONCLUSIONS This study demonstrates that, compared with non-Indigenous women, Indigenous Australian women have a greater than fourfold risk of developing type 2 diabetes after gestational diabetes. Strategies are urgently needed to reduce rates of type 2 diabetes by supporting a healthy weight and breastfeeding and to improve postpartum screening among Indigenous women with gestational diabetes. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Catherine R Chamberlain
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Brian Oldenburg
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Alyce N Wilson
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Sandra J Eades
- Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Kerin O'Dea
- School of Population Health, University of South Australia, Adelaide, SA, Australia
| | - Jeremy J N Oats
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Rory Wolfe
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Li X, Xu Q, Jiang T, Fang S, Wang G, Zhao J, Zhang H, Chen W. A comparative study of the antidiabetic effects exerted by live and dead multi-strain probiotics in the type 2 diabetes model of mice. Food Funct 2016; 7:4851-4860. [DOI: 10.1039/c6fo01147k] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
A comparative study of the anti-diabetic effects exerted by live and dead multi-strain probiotics in the type 2 diabetes model of mice.
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Affiliation(s)
- Xiangfei Li
- State Key Laboratory of Food Science and Technology
- School of Food Science and Technology
- Jiangnan University
- Wuxi 214122
- P. R. China
| | - Qi Xu
- State Key Laboratory of Food Science and Technology
- School of Food Science and Technology
- Jiangnan University
- Wuxi 214122
- P. R. China
| | - Tian Jiang
- Jiangsu Wecare Biotechnology Co
- Ltd
- Wujiang 215200
- P. R. China
| | - Shuguang Fang
- Jiangsu Wecare Biotechnology Co
- Ltd
- Wujiang 215200
- P. R. China
| | - Gang Wang
- State Key Laboratory of Food Science and Technology
- School of Food Science and Technology
- Jiangnan University
- Wuxi 214122
- P. R. China
| | - Jianxin Zhao
- State Key Laboratory of Food Science and Technology
- School of Food Science and Technology
- Jiangnan University
- Wuxi 214122
- P. R. China
| | - Hao Zhang
- State Key Laboratory of Food Science and Technology
- School of Food Science and Technology
- Jiangnan University
- Wuxi 214122
- P. R. China
| | - Wei Chen
- State Key Laboratory of Food Science and Technology
- School of Food Science and Technology
- Jiangnan University
- Wuxi 214122
- P. R. China
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Chang Y, Chen X, Cui H, Zhang Z, Cheng L. Follow-up of postpartum women with gestational diabetes mellitus (GDM). Diabetes Res Clin Pract 2014; 106:236-40. [PMID: 25271112 DOI: 10.1016/j.diabres.2014.08.020] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Revised: 08/01/2014] [Accepted: 08/29/2014] [Indexed: 12/25/2022]
Abstract
AIM The incidence of type 2 diabetes in postpartum women with gestational diabetes mellitus (GDM) is high, and blood glucose screening for postpartum women is recommended. Follow-up procedures for women with GDM in the postnatal period need to be improved. We investigated the incidence of GDM and the follow-up of women with GDM in Tianjin, China. METHODS Postpartum women who delivered at Tianjin Obstetrics and Gynecology Hospital from January 1st, 2008 to December 31st, 2010 were interviewed by telephone about their blood glucose screening. Thirty obstetricians were interviewed to evaluate awareness about the importance of follow-up. RESULTS The incidence rate of GDM increased from 6.9% in 2008, to 8.8% in 2009, and 9.9% in 2010. A total of 2152 women were interviewed, including 282 women (13.1%) screened for blood glucose. The top three reasons for failed blood glucose screening included: not being informed by their physicians, believing that GDM would disappear after delivery, and being occupied with the baby. Methods for GDM screening included testing of random blood glucose levels, fasting blood glucose levels, oral glucose tolerance, and glycosylated hemoglobin. Of the 30 obstetricians interviewed, 25 were aware of the need for blood glucose screening for women with GDM after delivery, but only 15 of them had informed their patients. CONCLUSION In China, most women with GDM are not screened for type 2 diabetes after delivery. Standard clinical procedures that will enable and encourage all women to return for glucose screening following GDM are needed.
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Affiliation(s)
- Ying Chang
- Department of Obstetrics, Tianjin Center Hospital of Obstetrics and Gynecology, Tianjin 300100, China
| | - Xu Chen
- Department of Obstetrics, Tianjin Center Hospital of Obstetrics and Gynecology, Tianjin 300100, China.
| | - Hongyan Cui
- Department of Obstetrics, Tianjin Center Hospital of Obstetrics and Gynecology, Tianjin 300100, China
| | - Zhikun Zhang
- Department of Obstetrics, Tianjin Center Hospital of Obstetrics and Gynecology, Tianjin 300100, China
| | - Lan Cheng
- Department of Obstetrics, Tianjin Center Hospital of Obstetrics and Gynecology, Tianjin 300100, China
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Chasan-Taber L, Marcus BH, Rosal MC, Tucker KL, Hartman SJ, Pekow P, Braun B, Moore Simas TA, Solomon CG, Manson JE, Markenson G. Estudio Parto: postpartum diabetes prevention program for hispanic women with abnormal glucose tolerance in pregnancy: a randomised controlled trial - study protocol. BMC Pregnancy Childbirth 2014; 14:100. [PMID: 24606590 PMCID: PMC3975296 DOI: 10.1186/1471-2393-14-100] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 02/26/2014] [Indexed: 12/13/2022] Open
Abstract
Background Diabetes and obesity have reached epidemic proportions in the U.S. with rates consistently higher among Hispanics as compared to non-Hispanic whites. Among Hispanic women diagnosed with gestational diabetes mellitus (GDM), 50% will go on to develop type 2 diabetes within 5 years of the index pregnancy. Although randomised controlled trials among adults with impaired glucose tolerance have shown that diet and physical activity reduce the risk of type 2 diabetes, such programs have not been tested in high-risk postpartum women. The overall goal of this randomised controlled trial is to test the efficacy of a culturally and linguistically modified, individually-tailored lifestyle intervention to reduce risk factors for type 2 diabetes and cardiovascular disease among postpartum Hispanic women with a history of abnormal glucose tolerance during pregnancy. Methods/Design Hispanic pregnant women who screen positive for GDM will be recruited and randomly assigned to a Lifestyle Intervention (n = 150) or a Health & Wellness (control) Intervention (n = 150). Multimodal contacts (i.e., in-person, telephone, and mailed materials) will be used to deliver the intervention from late pregnancy (29 weeks gestation) to 12 months postpartum. Targets of the intervention are to achieve Institute of Medicine Guidelines for postpartum weight loss; American Congress of Obstetrician and Gynecologist guidelines for physical activity; and American Diabetes Association guidelines for diet. The intervention draws from Social Cognitive Theory and the Transtheoretical Model and addresses the specific cultural and environmental challenges faced by low-income Hispanic women. Assessments will be conducted at enrollment, and at 6-weeks, 6-months, and 12-months postpartum by trained bicultural and bilingual personnel blinded to the intervention arm. Efficacy will be assessed via postpartum weight loss and biomarkers of insulin resistance and cardiovascular risk. Changes in physical activity and diet will be measured via 7-day actigraph data and three unannounced 24-hour dietary recalls at each assessment time period. Discussion Hispanic women are the fastest growing minority group in the U.S. and have the highest rates of sedentary behavior and postpartum diabetes after a diagnosis of GDM. This randomised trial uses a high-reach, low-cost strategy that can readily be translated into clinical practice in underserved and minority populations. Trial registration NCT01679210
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Affiliation(s)
- Lisa Chasan-Taber
- Division of Biostatistics & Epidemiology, Department of Public Health, School of Public Health & Health Sciences, University of Massachusetts, 405 Arnold House, 715 North Pleasant Street, Amherst, MA 01003-9304, USA.
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Diagnostic value of the combined measurement of serum hcy, serum cys C, and urinary microalbumin in type 2 diabetes mellitus with early complicating diabetic nephropathy. ISRN ENDOCRINOLOGY 2013; 2013:407452. [PMID: 24159393 PMCID: PMC3789395 DOI: 10.1155/2013/407452] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Accepted: 08/21/2013] [Indexed: 11/17/2022]
Abstract
Diabetic nephropathy (DN) is a major cause of end-stage kidney disease, and therefore early diagnosis and intervention may help reverse renal damage. One hundred and sixty-eight patients with T2DM and 56 healthy volunteers (control group) were enrolled at Shandong University Qilu Hospital between April 2010 and October 2012. All subjects underwent blood sampling for sera homocysteine (Hcy) and cystatin C (Cys C) assays and a urine microalbumin test. The patients were divided into three groups according to the urine microalbumin excretion rate (UMAER): the simple DM group (SDM group, n = 51), the early-stage DN group (EDN group, n = 60), and the clinical DN and renal failure group (CDN group, n = 57). Correlation analysis was performed to examine the association between sera Hcy and Cys C levels with UMAER. Our findings showed that sera Hcy level, Cys C level, and UMAER increased significantly in the SDM group (P < 0.05, P < 0.01), the EDN group (P < 0.01), and the CDN group (P < 0.01) as compared with the control group. These three biochemical markers also increased significantly with DN progression (P < 0.01). Correlation analysis showed that sera Hcy and Cys C levels were positively correlated with UMAER (r = 0.702, P < 0.01; r = 0.873, P < 0.01). In conclusion, our results showed that sera Hcy and Cys C levels increased consistently with the development and progression of DN as indicated by UMAER. Sera Hcy and Cys C are sensitive biomarkers for the detection of early-stage DN and monitoring its progression.
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Predictors of postpartum glucose tolerance testing in italian women with gestational diabetes mellitus. ISRN ENDOCRINOLOGY 2013; 2013:182505. [PMID: 23956870 PMCID: PMC3730210 DOI: 10.1155/2013/182505] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 06/30/2013] [Indexed: 01/19/2023]
Abstract
Postpartum screening is critical for early identification of type 2 diabetes in women previously diagnosed with gestational diabetes mellitus (GDM). Nevertheless, its rate remains disappointingly low. Thus, we plan to examine the rate of postpartum glucose tolerance test (ppOGTT) for Italian women with GDM, before and after counseling, and identify demographic, clinical, and/or biochemical predictors of adherence. With these aims, we retrospectively enrolled 1159 women with GDM, in Calabria, Southern Italy, between 2004 and 2011. During the last year, verbal and written counseling on the importance of followup was introduced. Data were analyzed by multiple regression analysis. A significant increase of the return rate was observed following introduction of the counseling [adjusted odds ratio (AOR) 5.17 (95% CI, 3.83–6.97), P < 0.001]. Interestingly, previous diagnosis of polycystic ovary syndrome (PCOS) emerged as the major predictor of postpartum followup [AOR 5.27 (95% CI, 3.51–8.70), P < 0.001], even after stratification for the absence of counseling. Previous diagnosis of GDM, higher educational status, and insulin treatment were also relevant predictors. Overall, our data indicate that counseling intervention is effective, even if many women fail to return, whereas PCOS represents a new strong predictor of adherence to postpartum testing.
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Mielke RT, Kaiser D, Centuolo R. Interconception Care for Women With Prior Gestational Diabetes Mellitus. J Midwifery Womens Health 2013; 58:303-12. [DOI: 10.1111/jmwh.12019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Behboudi Gandevani S, Garshasbi A, Shahpari Niri S, Naghizade MM. New criteria for gestational diabetes in Tehran, Iran. IRANIAN JOURNAL OF REPRODUCTIVE MEDICINE 2012; 10:237-42. [PMID: 25242999 PMCID: PMC4165967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Revised: 05/22/2011] [Accepted: 07/20/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is common problem during pregnancy. Diagnostic criteria of this problem are based on foreign population. Because of differences in racial, cultural, and nutritional characteristics, we need to determine these criteria are suitable for Iranian population. OBJECTIVE To determine whether different diagnostic criteria of gestational diabetes mellitus (GDM) are suitable for Iranian population. MATERIALS AND METHODS Prospective study was performed on 617 pregnant women. 1804 subjects referred for 50 g glucose challenge test (GCT) between 24th and 28(th) weeks of gestation. 617 women with abnormal GCT (blood glucose ≥130 mg/dl) underwent 100-g 3-h oral glucose tolerance test (OGTT). The results were classified by three diagnostic criteria: new "Iranian" diagnostic criteria based on the results from the 100-g 3-h OGTT performed in healthy participating women; the Carpenter and Coustan (CC) criteria; and the National Diabetes Data Group (NDDG) criteria. Obstetric and neonatal outcomes were recorded. RESULTS With 89% as the statistical cutoff value for the 100-g 3-h OGTT, the new diagnostic criteria were 92, 179, 153, and 121 mg/dL at 0, 60, 120, and 180 min. The K value was 0.945 for the new criteria vs. the CC criteria and 0.657 for the new criteria vs. the NDDG criteria (p<0.001). In women with GDM, the incidence rates of adverse outcomes by the new and CC criteria were similar, but higher than NDDG criteria (p<0.05). CONCLUSION Carpenter and Coustan criteria are applicable to Iranian pregnant women for diagnosis of GDM.
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Affiliation(s)
| | - Ahia Garshasbi
- Department of Obstetrics and Gynecology, Shahed University, Tehran, Iran.
| | - Sara Shahpari Niri
- Department of Obstetrics and Gynecology, Shahed University, Tehran, Iran.
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Missed opportunities for diabetes prevention: post-pregnancy follow-up of women with gestational diabetes mellitus in England. Br J Gen Pract 2012; 61:e611-9. [PMID: 22152832 DOI: 10.3399/bjgp11x601316] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Women with gestational diabetes mellitus (GDM) should be followed-up to exclude ongoing diabetes and for prevention of type 2 diabetes. The National Institute for Health and Clinical Excellence (NICE) diabetes in pregnancy guideline recommends checking fasting plasma glucose (FPG) at 6 weeks postpartum (short term), and annually thereafter (long term). AIM To examine the reported practice regarding GDM follow-up. DESIGN AND SETTING Nationwide postal survey in England 2008-2009. METHOD Questionnaires were distributed to a consultant diabetologist and obstetrician in all maternity units, and to a random sample of general practices (approximately 1 in 5). RESULTS Response rates were: 60% (915/1532) GPs, 93% (342/368) specialists; 80% of GPs and 98% of specialists reported women with GDM had short-term follow-up. More GPs (55%) than specialists (13%) used a FPG test to exclude ongoing diabetes; 26% of GPs versus 89% of specialists thought the hospital was responsible for ordering the test. Twenty per cent of GPs had difficulty in discovering women had been diagnosed with GDM in secondary care. Seventy-three per cent of specialists recommended long-term follow-up; only 39% of GPs recalled women with GDM for this. A minority of GPs and specialists had joint follow-up protocols. CONCLUSION Follow-up of GDM in England diverged from national guidance. Despite consensus that short-term follow-up occurred, primary and secondary care doctors disagreed about the tests and responsibility for follow-up. There was lack of long-term follow-up. Agreement about the NICE guideline, its promotion and effective implementation by primary and secondary care, and the systematic recall of women with GDM for long-term follow-up is required.
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Tovar A, Chasan-Taber L, Eggleston E, Oken E. Postpartum screening for diabetes among women with a history of gestational diabetes mellitus. Prev Chronic Dis 2011; 8:A124. [PMID: 22005617 PMCID: PMC3221566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION To make recommendations for future clinical, public health, and research practices for women with abnormal glucose tolerance during pregnancy, we reviewed the latest evidence regarding rates of postpartum diabetes screening and types of screening tests. METHODS We searched PubMed for journal articles published from January 2008 through December 2010 that reported on postpartum screening and studies designed to prevent progression to type 2 diabetes among women with gestational diabetes mellitus (GDM). Two authors independently reviewed titles and abstracts from 265 articles. RESULTS From 34% to 73% of women with GDM completed postpartum glucose screening. Predictors of higher screening rates included older age, nulliparity, and higher income or education. Screening rates varied by race/ethnicity; Asian women were more likely to be screened than were other racial/ethnic minorities. Women who received prenatal care, who were treated with insulin during pregnancy, or who completed a 6-week postpartum visit were also more likely to receive screening. A moderate proportion of women screened had type 2 diabetes (1.2%-4.5%) or prediabetes (12.2%-36.0%). CONCLUSION Rates of postpartum screening among women with a history of GDM are low; only half of women in most populations are screened. Our findings can inform future screening initiatives designed to overcome barriers to screening for both providers and patients. Well-designed lifestyle interventions specific to women with a history of abnormal glucose tolerance during pregnancy and also studies to determine the efficacy and safety of pharmacological interventions will be important to help prevent progression to diabetes among these high-risk women.
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Affiliation(s)
- Alison Tovar
- John Hancock Research Center on Physical Activity, Nutrition, and Obesity Prevention, Friedman School of Nutrition Science and Policy, Tufts University
| | | | - Emma Eggleston
- Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts. Dr Eggleston is also affiliated with the Brigham and Women's Hospital, Boston, Massachusetts
| | - Emily Oken
- Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts
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Kerlan V. Post-partum et contraception chez les femmes ayant eu un diabète gestationnel. ACTA ACUST UNITED AC 2010; 39:S289-98. [DOI: 10.1016/s0368-2315(10)70055-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Kerlan V. Postpartum and contraception in women after gestational diabetes. DIABETES & METABOLISM 2010; 36:566-74. [DOI: 10.1016/j.diabet.2010.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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