Awareness of gestational diabetes mellitus foetal-maternal risks: an Italian cohort study on pregnant women

Assessment of the Level of Knowledge About Risk Factors, Prevention, and Treatment of Gestational Diabetes Mellitus in a Community Sample From Saudi Arabia

Introduction Gestational diabetes mellitus (GDM) is a common disease affecting pregnant females, and it carries a major risk of short and long-term health problems for both mothers and their offspring. Multiple factors like advanced maternal age, obesity, and unhealthy lifestyle can increase the risk of GDM. The current guidelines recommend screening all pregnant females for risk factors during the first trimester with subsequent testing of the blood glucose level at 24 weeks gestation. Lack of awareness about GDM is a main contributing factor in the delay in screening and diagnosis of GDM with subsequent fetal and maternal complications. This study aims to identify the level of knowledge about GDM among the adult population in the Kingdom of Saudi Arabia (KSA). Material and methods A descriptive cross-sectional questionnaire-based study was conducted to identify the level of knowledge about risk factors, prevention, and treatment of GDM in a community sample from Saudi Arabia. A self-administered electronic questionnaire was designed, tested for validity and reliability, and distributed through social media platforms. It consisted of 18 questions asking about the socio-demographic characteristics, the type of hospital in which the participant receives their medical care, whether the participant heard about GDM or not, and if they know someone with GDM, in addition to questions to assess the level of knowledge about risk factors, complications, prevention, and treatment of GDM. The total score of knowledge was calculated. The multivariate regression analysis test was employed to analyze the relationship between various demographic variables and the level of knowledge about GDM among the study population. A p-value of 0.05 or less was considered statistically significant. Results A total of 539 (100%) participants completed the questionnaire: 263 (48.8%) of them were in the age category (18-25 years), 440 (81.6%) of them were females, 307 (57%) had a bachelor's degree, 275 (51%) were single, 454 (84.2%) had heard about GDM, and 258 (47.9%) of them have or know someone with GDM. The total score of knowledge revealed excellent, good, fair, and poor levels among 334 (62%), 140 (26%), 49 (9%), and 16 (3%) of participants, respectively. The multivariable linear regression model revealed that participants who received health care from governmental hospitals heard about GDM and had or knew someone with GDM were positively associated with a higher level of knowledge. Conclusions The findings revealed that among participants, 62% showed excellent knowledge about GDM, although, the other 38% had non-optimal levels of knowledge. Awareness campaigns are recommended to improve the level of knowledge about this disease, its risk factors, treatment, and complications.

Assessment of Women's Awareness of the Effects of Gestational Diabetes Mellitus on the Mother and Fetus in Saudi Arabia: A Cross-Sectional Study

Introduction Gestational diabetes mellitus (GDM) is a form of glucose intolerance that arises during pregnancy, affecting a significant portion of women. It has immediate and long-term effects on both the mother and fetus, including complications like preeclampsia, premature delivery, and an increased risk of cesarean sections. A cross-sectional study among Saudi Arabia's general population, which included 979 women aged between 18 and 60, found varying levels of awareness of GDM, emphasizing the need for more research on awareness levels regarding GDM in Saudi Arabia and more educational campaigns to improve awareness. Objectives The study evaluates the knowledge of pregnant women about GDM and its implications for the mother and fetus. It investigates the relationship between knowledge levels and demographic factors like age, education, and socioeconomic status, aiming to identify knowledge gaps regarding this health issue and develop targeted educational initiatives. Methodology This was a cross-sectional study that included 979 women and was conducted using a Google Forms (Google Inc., Mountainview, CA) questionnaire. The questionnaire covered demographics and explored the knowledge level of women about the impact of GDM on the mother and fetus. Statistical analysis was implemented by IBM SPSS software version 27.0 (IBM Corp., Armonk, NY), with a 5% significance level. Ethical approval was sought, emphasizing anonymous data collection. We did not collect any identifying or private information from participants, and all responses were kept confidential. Results A study of 979 women revealed that their knowledge of GDM was significantly influenced by their age, gestational age, and the number of prior deliveries (p-value < 0.05). The total mean knowledge score for women's correct responses stood at 7.62 (±4.49). The study found that a majority of women, exceeding 60%, accurately answered certain questions about GDM, such as its association with heightened risks, neonatal intensive care unit (NICU) admissions, cesarean section likelihood, high birth weight, and preeclampsia. However, less than 30% could answer yes to questions that indicated that GDM could increase the risk of shoulder dystocia, hypoglycemia at birth, premature rupture of membranes, postpartum hemorrhage, and vacuum delivery. Conclusion There is a need for targeted educational initiatives, particularly focusing on knowledge gaps that women are lacking regarding GDM. Age and prior deliveries were identified as significant determinants of knowledge levels.

Exploring Lifestyle and Dietary Patterns in Pregnancy and Their Impact on Health: A Comparative Analysis of Two Distinct Groups 10 Years Apart

The significance of dietary patterns during pregnancy is highlighted by accumulating evidence, emphasizing their pivotal role in promoting a healthy pregnancy for both the mother and the child. This study aimed to assess the current dietary patterns of pregnant women, compare the energy and nutrient intake of two distinct groups with a 10-year interval, and identify changes in dietary patterns. EPIC FFQ was applied, and its data were interpreted with the FETA program version 6 (CAMB/PQ/6/1205). By means of principal component analysis, three different food patterns were identified in each study group: vegetarian, balanced, and traditional (2013); and prudent, vegetarian, and modern (2023). Analyzing the relationship between food groups and gestational weight, we found that gestational weight gain in 2013 was positively correlated with eggs and egg dishes and milk and milk products, whereas in 2023, gestational weight gain was positively correlated with fats and oils, non-alcoholic beverages, and the modern pattern. Additionally, in 2023, pre-gestational BMI correlated positively with eggs and egg dishes. The balanced pattern emerged as a predictor for a lower likelihood of inadequate gestational weight gain in both groups. Furthermore, normal and overweight pregnant women showed a reduced likelihood of excessive gestational weight gain.

Awareness of Gestational Diabetes Mellitus Among Women in the Al-Baha Region, Saudi Arabia

Background Gestational diabetes mellitus (GDM) is a condition characterized by impaired glucose tolerance that develops during pregnancy. The prevalence of GDM is increasing globally, including in the Al-Baha region of Saudi Arabia. However, there needs to be more data on the awareness of women in this region regarding GDM and its associated risks. This research aimed to evaluate the level of awareness among women in the Al-Baha region regarding GDM. Methodology This study followed an observational cross-sectional design conducted from April 2023 to December 2023. A simple random sampling technique was used to select 457 participants from the resident women of reproductive age in the Al-Baha region. Data were collected through a self-administered questionnaire that assessed knowledge and awareness of GDM risk factors, assessment, therapy, and implications. The questionnaire included a 12-item section evaluating GDM awareness, with correct answers receiving a score of 1. Descriptive statistics were used to analyze the data with Statistical Product and Service Solutions (SPSS, version 28) (IBM SPSS Statistics for Windows, Armonk, NY). Results The majority of participants fell into the age group of more than 36 years (n=207, 45.3%), with a significant proportion having completed university/diploma education (n=282, 61.7%), and most of them worked outside the health sector (n=283, 61.9%). Approximately 27.8% correctly identified that the number of pregnancies does not increase the chance of developing GDM. Only (n=48, 10.5%) accurately identified the usual time for diagnosing GDM in the absence of risk factors, which is between weeks 24 and 28 of pregnancy. Similarly, 26.0% (119 participants) correctly recognized a history of a previous pregnancy with a child weighing more than 4.5 kg as a factor that increases the suspicion of developing GDM in the future. However, it is important to note that the majority of participants (n=311, 68.1%) had a poor level of awareness regarding GDM. Conclusion The findings revealed that the overall level of knowledge about GDM was poor, with less than 10% of participants demonstrating adequate awareness. The study also highlighted that over 80% of the participants were unaware of GDM.

Maternal gestational weight gain and adverse pregnancy outcomes in non-diabetic women

OBJECTIVE

This study investigated the relationship between maternal gestational weight gain (GWG) and the risk of adverse pregnancy outcomes in gestational diabetes mellitus (GDM)-negative pregnant women.

METHODS

We did a retrospective cohort study between 1 July 2017, and 1 January 2020, at Women's Hospital, Zhejiang University School of Medicine. Firstly, pregnant women were divided into subgroups according to the entire GWG (inadequate GWG, adequate GWG, and excessive GWG) and GDM status (positive and negative) during pregnancy. Secondly, the whole population of pregnant women with GDM was used as a reference to evaluate the relationship between GWG and adverse pregnancy outcomes in GDM-negative pregnant women. Lastly, subgroup analysis was conducted based on pre-pregnancy body mass index (pp-BMI).

RESULTS

A total of 30,910 pregnant women were analysed. Included pregnancy women were divided into three groups based on GWG: 7569 (24.49%) pregnancy women had inadequate GWG, 13088 (42.34%) had adequate GWG, and 10,253 (33.17%) had excessive GWG. In addition to preterm birth and small for gestational age (SGA), the incidence of macrosomia and large for gestational age (LGA) continues to increase from inadequate GWG to excessive GWG groups. Pregnant women without GDM who have excessive GWG are at higher risk of macrosomia and LGA than pregnant women with GDM. Moreover, this risk increased with increasing pp-BMI. Pregnant women without GDM with inadequate GWG were at risk of preterm birth regardless of pp-BMI. Only those with inadequate GWG and pp-BMI < 18.5 kg/m2 had an increased risk of SGA.

CONCLUSIONS

In conclusion, inappropriate GWG is strongly associated with adverse pregnancy outcomes, even if they do not have GDM. Therefore, this population should receive attention and management before and during pregnancy.Impact StatementWhat is already known on this subject? Several studies have focused on the GDM population and the risk of adverse pregnancy outcomes, but few have focused on GDM-negative populations. This is because GDM-negative women are perceived to be "safe," leading to less focus on themselves, which can lead to subsequent excessive weight gain during pregnancy. Whether this factor increases the risk of adverse pregnancy outcomes in this population remains unknown.What do the results of this study add? Our study found an inverse relationship between GWG and GDM. Therefore, our study focuses on this group of GDM-negative pregnant women. Their excessive weight gain increases the risk of adverse pregnancy outcomes, even higher than GDM pregnant women.What are the implications of these findings for clinical practice and/or further research? GWG is associated with adverse pregnancy outcomes. Therefore, pregnant women without GDM also need increased attention and management of their weight before and during pregnancy. Prenatal care providers can utilise tools such as diet, exercise counselling, weight tracking, and setting weight gain goals to reduce inappropriate weight gain and mitigate its adverse effects on pregnancy outcomes.

Comprehension and Understanding of Gestational Diabetes Mellitus Among Pregnant Women Attending Primary Health Care Facilities in Jeddah, Saudi Arabia

Background and objective Gestational diabetes mellitus (GDM) is a form of diabetes that develops during pregnancy and can negatively affect both the mother and the fetus. This study aimed to assess the knowledge and awareness of GDM among pregnant women in primary care centers. By enhancing their understanding of the risks and symptoms of GDM, we can potentially mitigate adverse outcomes. Methods A cross-sectional study was conducted in the National Guard's primary healthcare facilities in Jeddah, Saudi Arabia. The study employed a validated 12-item questionnaire to collect data from 489 participants. The questionnaire items covered the identification of risk factors, diagnostic approach, treatment options, and complications related to GDM, considering maternal and fetal health implications. Results The study participants had a mean age of 30.9 years. Among these participants, 53.6% demonstrated a thorough understanding of GDM, 35.2% had moderate knowledge scores, and 11.2% had low knowledge scores. Higher levels of awareness were strongly associated with higher levels of education, gravidity, and prior knowledge of GDM. Conclusion The study highlights the importance of early detection and management strategies for GDM during pregnancy to minimize its negative impacts. The findings suggest the need for individually tailored antenatal education programs by healthcare professionals that address the needs of different populations. This is particularly relevant for women with lower education levels and those who are pregnant for the first time or have no prior knowledge of GDM.

Pregnant Women's Perception and Knowledge of the Impact of Obesity on Prenatal Outcomes-A Cross-Sectional Study

The prevalence of obesity and overweight has been rapidly increasing and is significantly higher among adult females in the Arab States. The aim of the present study was to explore pregnant Emirati women's perception of their weight, their knowledge of the healthy gestational weight gain, and the possible weight-related pregnancy complications. A total of 526 self-administered questionnaires were obtained with a response rate of 72%. The majority (81.8%, n = 429) entered pregnancy as overweight or obese. The percentage of pregnant women who underestimated their weight category was 12.1% in normal weight participants, 48.9% in overweight participants, and 73.5% in obese participants (p < 0.001). The overweight and obese participants were 13 times more likely to underestimate their weight status and 3.6 times more likely to correctly select their healthy gestational weight gain. Women's awareness of pregnancy-related complications due to weight varied from 80.3% for diabetes to 44.5% for fetal complications; their awareness of breastfeeding difficulty was the lowest at 2.5%. Moreover, there was a misconception about personal BMI and the appropriate range for gestational weight gain (GWG). Healthy lifestyle counselling urgently needs to be addressed in preventative health programs such as pre-marital and preconception counselling.

How much do pregnant women know about the importance of oral health in pregnancy? Questionnaire-based survey

BACKGROUND

Although pregnancy is a physiological process it causes hormonal changes that can also affect the oral cavity. Pregnancy increases the risk of gum disease inflammation and tooth caries which could affect the health of the developing baby. Proper oral health is crucial both for mother and her babies and is related with mothers' awareness of this connection. The aim of this study was the self-assessment of women's both oral health and oral health literacy as well as mothers' awareness of the connection of oral health and pregnancy.

MATERIAL AND METHODS

In the study anonymous questionnaire was prepared and provided to be filled in by 200 mothers at the age from 19 to 44 y.o. who gave birth in the gynecological clinic. The questionnaire included demographic, and concerning the areas of oral health before and during pregnancy and after the childbirth questions.

RESULTS

Only 20% of the investigated women underwent the oral examination before the pregnancy and the next 38.5% underwent it intentionally when the pregnancy had been confirmed. As much as 24% of women pointed out lack of awareness of the importance of proper oral hygiene during pregnancy. 41.5% of investigated women declared complaints during the pregnancy concerning teeth or gums and 30.5% underwent dental treatment; 68%, brushed their teeth properly-twice a day; 32% of women observed deterioration of oral health state during the pregnancy. The knowledge of the importance of oral health during pregnancy presented by the majority of mothers was relatively proper, which was strongly connected with higher education status and living in big cities. A significant correlation between higher birth weight and more frequent daily tooth brushing was observed. Both higher frequency of problems concerning the oral cavity and dental treatment during pregnancy were significantly related to the younger age of mothers.

CONCLUSIONS

The knowledge of women concerning of oral health on the management of pregnancy and development of fetus is still insufficient. Gynecologists should inquire pregnant women if they have done dental examination, and provide wider education about importance of oral health in pregnancy.

Risk of Subsequent Preeclampsia by Maternal Country of Birth: A Norwegian Population-Based Study

In this nationwide population-based study, we investigated the associations of preeclampsia in the first pregnancy with the risk of preeclampsia in the second pregnancy, by maternal country of birth using data from the Medical Birth Registry of Norway and Statistics Norway (1990-2016). The study population included 101,066 immigrant and 544,071 non-immigrant women. Maternal country of birth was categorized according to the seven super-regions of the Global Burden of Disease study (GBD). The associations between preeclampsia in the first pregnancy with preeclampsia in the second pregnancy were estimated using log-binomial regression models, using no preeclampsia in the first pregnancy as the reference. The associations were reported as adjusted risk ratios (RR) with 95% confidence intervals (CI), adjusted for chronic hypertension, year of first childbirth, and maternal age at first birth. Compared to those without preeclampsia in the first pregnancy, women with preeclampsia in the first pregnancy were associated with a considerably increased risk of preeclampsia in the second pregnancy in both immigrant (n = 250; 13.4% vs. 1.0%; adjusted RR 12.9 [95% CI: 11.2, 14.9]) and non-immigrant women (n = 2876; 14.6% vs. 1.5%; adjusted RR 9.5 [95% CI: 9.1, 10.0]). Immigrant women from Latin America and the Caribbean appeared to have the highest adjusted RR, followed by immigrant women from North Africa and the Middle East. A likelihood ratio test showed that the variation in adjusted RR across all immigrant and non-immigrant groups was statistically significant (p = 0.006). Our results suggest that the association between preeclampsia in the first pregnancy and preeclampsia in the second pregnancy might be increased in some groups of immigrant women compared with non-immigrant women in Norway.

Telemonitoring System Oriented towards High-Risk Pregnant Women

A high-risk pregnancy is one in which pathological problems or abnormal conditions are latent during pregnancy and childbirth, increasing dangers to the mother's or the infant's health. Based on international standards and studies, most of the harms and risks to both the mother and the infant can be detected, treated, and prevented through proper pregnancy monitoring, as well as through appropriate and timely diagnosis. In this paper, we present the analysis, design, development, and usability assessment of a telemonitoring system focused on the remote monitoring and control of pregnancy in women suffering from hypertension, diabetes, or high-risk pregnancy. Our system is composed of two mobile web applications. One of these is designed for the medical area, allowing remote monitoring of the patient's pregnancy, and the other one is directed towards the patient, who enters the alarm symptom data, hypertension data, diabetes data, and clinical analyses, allowing the detection of a risk situation on time. Furthermore, we performed a usability assessment of our system based on a laboratory study with seven doctors and seven patients to evaluate the users' satisfaction. Our telemonitoring system shows a satisfactory/favorable opinion from the users' perspectives based on the obtained results.

Obstetric and Neonatal Outcomes in Mild Idiopathic Polyhydramnios

Background: Idiopathic polyhydramnios is a controversial clinical condition, as data on perinatal outcomes are conflicting and vary depending on the severity of the condition. The aim of the present study was to compare obstetric and neonatal outcomes between pregnant women with mild idiopathic polyhydramnios and a control population. Methods: A retrospective cohort study was performed at a single university hospital comparing the obstetrics and neonatal outcomes of pregnancies with mild idiopathic polyhydramnios (n = 109) and control pregnancies (n = 2550). Results: Cesarean section (CS) was significantly increased in the group with polyhydramnios compared to controls (46% vs. 32%, respectively, p = 0.047) due to a higher rate of emergency CS in the polyhydramnios group (p = 0.041) because of abnormal cardiotocography (7.3% vs. 2.9%; p = 0.018) or labor dystocia (8.2% vs. 2.9%; p = 0.006). No statistically significant difference was found in the Apgar score, in the rate of neonatal hypoxia, or in the incidence of macrosomia between groups. In four cases, additional diagnoses of anomalies were made after birth, with a rate of 3.2%, which is comparable to the general population. Conclusion: Besides an increased risk of CS, patients with mild idiopathic polyhydramnios should be reassured regarding maternal and feto-neonatal outcomes. The management of pregnancies with stable mild idiopathic polyhydramnios should not differ from uncomplicated pregnancies, except for the need for increased labor surveillance.

How Do the Different Types of Maternal Diabetes during Pregnancy Influence Offspring Outcomes?

Background/Aim of the study: Exposure to maternal diabetes is considered one of the most common in utero insults that can result in an increased risk of complications later in life with a permanent effect on offspring health. In this study, we aim to assess the level of risk associated with each type of maternal diabetes on obesity, glucose intolerance, cardiovascular diseases (CVD), and neurodevelopmental disorders in offspring. Methods: We conducted a systematic review of the literature utilizing PubMed for studies published between January 2007 and March 2022. Our search included human cohorts and case control studies following offspring exposed at least to two different types of maternal diabetes clearly identified during pregnancy. Collected outcomes included prevalence, incidence, odds ratio, hazard ratio and risk ratio. Results: Among 3579 published studies, 19 cohorts were eligible for inclusion in our review. The risks for overweight, obesity, type 2 diabetes (T2D), glucose intolerance, metabolic syndrome, and CVD were increased for all types of maternal diabetes during pregnancy. The risk of overweight or obesity in infancy and in young adults was similar between gestational diabetes mellitus (GDM) and type 1 diabetes (T1D). The risk for T2D or abnormal glucose tolerance was double for offspring from GDM mothers compared to offspring from T1D mothers. In contrast, the risk for T1D in offspring at any age until young adulthood was increased when mothers had T1D compared to GDM and T2D. The risk for CVD was similar for all types of maternal diabetes, but more significant results were seen in the occurrence of heart failure and hypertension among offspring from T2D mothers. The risk of autism spectrum disorders and attention deficit/hyperactivity disorders was mainly increased after in utero exposure to preexisting T1D, followed by T2D. Conclusions: Offspring of diabetic mothers are at increased risk for multiple adverse outcomes with the highest risk detected among offspring from T2D mothers. Future work warrants large multiethnic prospective cohort studies that aim to identify the risks associated with each type of maternal diabetes separately.

The Effect of Glucose Metabolism and Breastfeeding on the Intestinal Microbiota of Newborns of Women with Gestational Diabetes Mellitus

Gestational diabetes mellitus (GDM) is a pregnancy complication in which women without previously diagnosed diabetes develop chronic hyperglycemia during gestation. The diet and lifestyle of the mother during pregnancy as well as lactation have long-term effects on the child’s health and development. Detection of early risk markers of adult-age chronic diseases that begin during prenatal life and the application of complex nutritional interventions at the right time may reduce the risk of these diseases. Newborns adapt to the ectopic environment by developing intestinal immune homeostasis. Adequate initial colonization of bacteria is necessary for sufficient development of intestinal immunity. The environmental determinant of adequate colonization is breast milk. Although a developing newborn is capable of producing an immune response, the effector immune component requires bacterial stimulation. Breast milk stimulates the proliferation of a well-balanced and diverse microbiota, which initially influences the switch from an intrauterine TH2 predominant to a TH1/TH2 balanced response and the activation of T-regulatory cells by breast milk-stimulated specific organisms (Bifidobacteria, Lactobacillus, and Bacteroides). Breastfeeding in newborns of mothers with diabetes mellitus regulates the adequate immune response of the newborn and prevents diseases of the neonatal and postnatal period.

Suppressive Role of Lactoferrin in Overweight-Related Female Fertility Problems

The secretory glycoprotein lactoferrin (LF) is suggested to ameliorate overweight regardless of non-genetic or genetic mechanisms. Although maternal overweight represents a key predictor of offspring growth, the efficacy of LF on fertility problems in overweight and obese mothers remains unknown. To address this issue, we examined the effect of LF ingestion by analyzing overweight mice (Institute of Cancer Research (ICR) mice with high-fat diets; HF mice) and obese mice (leptin-deficient mice with type II diabetes; ob/ob mice). Plasma insulin, leptin, glucose, and cholesterol levels were measured, and thermal imaging and histological analysis were employed. The litter size of HF females was reduced due to miscarriage, which was reversed by LF ingestion. In addition, LF ingestion suppressed overweight prevalence in their offspring. The component analysis of the maternal blood demonstrated that glucose concentration in both HF females and their offspring was normalized by LF ingestion, which further standardized the concentration of insulin, but not leptin. LF ingestion was unable to reverse female infertility in ob/ob mice, although their obesity and uterine function were partially improved. Our results indicate that LF upregulates female fertility by reinforcing ovarian and uterine functions in females that are overweight due to caloric surplus.

Cumulative Lactation and Clinical Metabolic Outcomes at Mid-Life among Women with a History of Gestational Diabetes

Lactation is associated with a lower risk of subsequent cardiometabolic disease among parous women; however, the underlying mechanisms are unknown. Further, the potential protective effects of lactation on cardiometabolic risk markers at mid-life among high-risk women with past gestational diabetes (GDM) are not established. Using data from the Diabetes & Women’s Health Study (2012−2014; n = 577), a longitudinal cohort of women with past GDM from the Danish National Birth Cohort (1996−2002), we assessed associations of cumulative lactation duration (none, <6 months, 6−12 months, ≥12−24 months, and ≥24 months) with clinical metabolic outcomes (including type 2 diabetes [T2D], prediabetes, and obesity) and cardiometabolic biomarkers (including biomarkers of glucose/insulin metabolism, fasting lipids, inflammation, and anthropometrics) 9−16 years after enrollment when women were at mid-life. At follow-up, women were 43.9 years old (SD 4.6) with a BMI of 28.7 kg/m2 (IQR 24.6, 33.0); 28.6% of participants had T2D, 39.7% had prediabetes, and 41.2% had obesity. Relative risks (95% CI) of T2D for 0−6, 6−12, 12−24, and ≥24 months of cumulative lactation duration compared to none were 0.94 (0.62,1.44), 0.88 (0.59,1.32), 0.73 (0.46,1.17), and 0.71 (0.40,1.27), respectively. Cumulative lactation duration was not significantly associated with any other clinical outcome or continuous biomarker. In this high-risk cohort of middle-aged women with past GDM, T2D, prediabetes, and obesity were common at follow-up, but not associated with history of cumulative lactation duration 9−16 years after the index pregnancy. Further studies in diverse populations among women at mid-age are needed to understand associations of breastfeeding with T2D.

Assessing Outpatients’ Knowledge, Attitude, and Practice Toward Managing Diabetes in Saudi Arabia

Introduction: When it comes to non-communicable diseases like diabetes, inadequate knowledge, attitude, and practice are often linked to poor health outcomes. This study aims to assess the patients’ knowledge, attitude, and practice (KAP) of diabetes in the outpatient department of a university teaching hospital in Saudi Arabia. Methodology: In this cross-sectional study, diabetes type 2 patients attending outpatient departments at a university teaching hospital, Riyadh, were assessed regarding their knowledge, attitude, and practice toward diabetes using a validated KAP scale. Descriptive and inferential analysis was done to determine the factors associated with KAP score using SPSS version 26.0 software (SPSS Inc., Chicago, IL, U.S.). Results: Males made up 69.7% of the sample (n = 165), while 56.9% were between the ages of 41 and 75. The level of knowledge and practice had “good” in 37.6%, and 47.9%, respectively, but level of attitude had “positive” in 30.9% of patients. The association between knowledge tier and gender (p0.014) and insurance status (p0.008), respectively, was shown to be significant. However, the attitude tier was only significantly associated with gender (P = .003). The practice tier also showed a significant age association (P = .049). As regards, the mean scores for diabetes-related knowledge were higher only among insured participants (P = .03) than for other participants’ sociodemographic factors. Meanwhile, the mean attitude scores were also higher among males (P = .006) than for other sociodemographic characteristics. A comparison of the participants’ sociodemographic characteristics found no statistically significant variations in practice scores. Conclusion: Unfortunately, this study found that outpatient diabetes patients had insufficient knowledge, practice, and a negative attitude toward diabetes type 2. This imposes a great burden on healthcare workers and hence the healthcare system to improve patient scores via diabetes education programs or pharmacist-led patient counseling initiatives.

Long-Term Outcomes of in Utero Ramadan Exposure: A Systematic Literature Review

Health outcomes of in utero Ramadan exposure have been reported in a systematic literature review; however, the available literature on long-term effects were not fully covered. Our study aims to specifically review the long-term outcomes of in utero Ramadan exposure. We searched for original research articles analyzing any long-term outcome of in utero Ramadan exposure, excluding maternal and perinatal outcomes. Sixteen studies from 8304 non-duplicate search results were included. Most studies suggest negative consequences from in utero Ramadan exposure on health, as well as on economic outcomes later in adulthood. Higher under-five mortality rate, higher mortality under three months, and under one year, shorter stature, lower body mass index, increased incidence of vision, hearing and learning disabilities, lower mathematics, writing and reading scores, as well as a lower probability to own a home were associated with Ramadan exposure during conception or the first trimester of pregnancy. Furthermore, age and sex seem to play a pivotal role on the association. Existing studies suggest that in utero Ramadan exposure may adversely impact long-term health and economic well-being. However, evidence is limited. Meanwhile, increasing awareness of the potential risks of Ramadan fasting during pregnancy should be raised among pregnant women and clinicians and other antenatal care workers should promote better maternal healthcare.

An Audit of Pre-Pregnancy Maternal Obesity and Diabetes Screening in Rural Regional Tasmania and Its Impact on Pregnancy and Neonatal Outcomes

Maternal obesity in pregnancy, a growing health problem in Australia, adversely affects both mothers and their offspring. Gestational diabetes mellitus (GDM) is similarly associated with adverse pregnancy and neonatal complications. A low-risk digital medical record audit of antenatal and postnatal data of 2132 pregnant mothers who gave birth between 2016–2018 residing in rural-regional Tasmania was undertaken. An expert advisory group guided the research and informed data collection. Fifty five percent of pregnant mothers were overweight or obese, 43.6% gained above the recommended standards for gestational weight gain and 35.8% did not have an oral glucose tolerance test. The audit identified a high prevalence of obesity among pregnant women and low screening rates for gestational diabetes mellitus associated with adverse maternal and neonatal pregnancy outcomes. We conclude that there is a high prevalence of overweight and obesity among pregnant women in rural regional Tasmania. Further GDM screening rates are low, which require addressing.