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da Silva LBG, Zajdenverg L, Keating E, Silvestre MPS, dos Santos BMB, Saunders C. Effect of Prenatal Care on Perinatal Outcomes of Pregnant Women with Diabetes Mellitus: A Systematic Review. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2024; 97:49-65. [PMID: 38559460 PMCID: PMC10964819 DOI: 10.59249/wpty4075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Objective: to evaluate the effect of prenatal care (PC) on perinatal outcomes of pregnant women with diabetes mellitus (DM). Methods: systematic review developed according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2020 guidelines and conducted through the population, intervention, control, and outcomes (PICO) strategy. Clinical trials and observational studies were selected, with adult pregnant women, single-fetus pregnancy, diagnosis of DM, or gestational DM and who had received PC and/or nutritional therapy (NT). The search was carried out in PubMed, Scopus, and BIREME databases. The quality of the studies was evaluated using the tools of the National Heart, Lung and Blood Institute-National Institutes of Health (NHLBI-NIH). Results: We identified 5972 records, of which 15 (n=47 420 pregnant women) met the eligibility criteria. The most recurrent outcomes were glycemic control (14 studies; n=9096 participants), hypertensive disorders of pregnancy (2; n=39 282), prematurity (6; n=40 163), large for gestational age newborns (4; n=1556), fetal macrosomia (birth weight >4kg) (6; n=2980) and intensive care unit admission (4; n=2022). Conclusions: The findings suggest that PC interferes with the perinatal outcome, being able to reduce the risks of complications associated with this comorbidity through early intervention, especially when the NT is an integral part of this assistance.
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Affiliation(s)
- Letícia B. G. da Silva
- Josué de Castro Institute of Nutrition, Federal
University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | - Elisa Keating
- Department of Biochemistry, Faculty of Medicine of
Porto, University of Porto, Porto, Portugal
| | | | - Beatriz M. B. dos Santos
- Multidisciplinary Residency Program at the Federal
University of Rio de Janeiro Maternity School, Rio de Janiero, RJ, Brazil
| | - Cláudia Saunders
- Josué de Castro Institute of Nutrition, Federal
University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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2
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Alwash SM, Huda MM, McIntyre HD, Mamun AA. Time trends and projections in the prevalence of gestational diabetes mellitus in Queensland, Australia, 2009-2030: Evidence from the Queensland Perinatal Data Collection. Aust N Z J Obstet Gynaecol 2023; 63:811-820. [PMID: 37435791 DOI: 10.1111/ajo.13734] [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: 01/28/2023] [Accepted: 06/26/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is the fastest-growing type of diabetes in Australia. We aimed to assess the time trends during 2009-2018 and projections of GDM in Queensland, Australia up to 2030. MATERIALS AND METHODS The study data were from the Queensland Perinatal Data Collection (QPDC) and included data on 606 662 birth events with the births reported from at least 20 weeks gestational age or birth weight at least 400 g. Bayesian regression model was used to assess the trends in the prevalence of GDM. RESULTS The prevalence of GDM increased from 5.47 to 13.62% from 2009 to 2018 (average annual rate of change, AARC = +10.71%). If the trend remains the same, the projected prevalence will increase to 42.04% (95% uncertainty interval = 34.77-48.96) by 2030. Observing AARC across different subpopulations, we found that the trend of GDM increased markedly among women living in inner regional areas (AARC = +12.49%), were non-Indigenous (AARC = +10.93%), most disadvantaged (AARC = +11.84%), aged either of two age groups (AARC = +18.45% and + 15.17% for <20 years and 20-24 years, respectively), were with obesity (AARC = +11.05%) and smoked during pregnancy (AARC = +12.26%). CONCLUSIONS Overall, the prevalence of GDM has sharply increased in Queensland, and if this trend continues, about 42% of pregnant women will experience GDM by 2030. The trends vary across different subpopulations. Therefore, targeting the most vulnerable subpopulations is vital to prevent the development of GDM.
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Affiliation(s)
- Sura M Alwash
- Poche Centre for Indigenous Health, The University of Queensland, Brisbane, Queensland, Australia
| | - M Mamun Huda
- Poche Centre for Indigenous Health, The University of Queensland, Brisbane, Queensland, Australia
- ARC Centre of Excellence for Children and Families Over the Life Course, The University of Queensland, Brisbane, Queensland, Australia
| | - H David McIntyre
- Mater Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Abdullah A Mamun
- Poche Centre for Indigenous Health, The University of Queensland, Brisbane, Queensland, Australia
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3
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Dyck RF, Pahwa P, Karunanayake C, Osgood ND. The Contribution of Gestational Diabetes to Diabetes Risk Among First Nations and Non-First Nations Women in Saskatchewan: Results From the DIP: ORRIIGENSS Project. Can J Diabetes 2023; 47:509-518. [PMID: 37150508 DOI: 10.1016/j.jcjd.2023.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 03/23/2023] [Accepted: 04/28/2023] [Indexed: 05/09/2023]
Abstract
OBJECTIVES Our aim in this study was to determine the risk for diabetes mellitus (DM) among Saskatchewan First Nations (FN) and non-FN women with prior gestational DM (GDM). METHODS Using Ministry of Health administrative databases, we conducted a retrospective cohort study of DM risk by GDM occurrence among FN and non-FN women giving birth from 1980 to 2009 and followed to March 31, 2013. We determined frequencies and odds ratios (ORs) of DM in women with/without prior GDM after stratifying by FN status, while adjusting for other DM determinants. Survival curves of women until DM diagnosis were obtained by prior GDM occurrence and stratified by ethnicity and total parity. RESULTS De-identified data were obtained for 202,588 women. Of those who developed DM, 2,074 of 10,114 (20.5%) had previously experienced GDM (811 of 3,128 [25.9%]) FN and 1,263 of 6,986 [18.1%] non-FN). Cumulative survival of women with prior GDM until DM was higher for FN than for non-FN women (82% vs 46%), but prior GDM was a stronger predictor of DM within the non-FN cohort (prior GDM vs no GDM: OR, 9.64 for non-FN; OR, 7.05 for FN). Finally, higher total parity interacted with prior GDM to increase DM risk in both groups. With prior GDM and parity ≥3, 93% of FN and 57% of non-FN women subsequently developed DM. CONCLUSIONS GDM is a leading determinant of T2DM among FN and non-FN women, amplified by higher parity. This contributes to earlier onset diabetes, affecting subsequent pregnancies and increasing risk for chronic diabetic complications. It may also factor into higher type 2 DM rates observed in FN women compared with men.
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Affiliation(s)
- Roland F Dyck
- Department of Medicine, Canadian Center for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
| | - Punam Pahwa
- Department of Medicine, Canadian Center for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Chandima Karunanayake
- Department of Medicine, Canadian Center for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Nathaniel D Osgood
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Department of Computer Science, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Tzotzis L, Hooper ME, Douglas A, Kurz E, Atchan M, Spiller S, Davis D. The needs and experiences of women with gestational diabetes mellitus from minority ethnic backgrounds in high-income nations: A systematic integrative review. Women Birth 2023; 36:205-216. [PMID: 36038477 DOI: 10.1016/j.wombi.2022.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 08/11/2022] [Accepted: 08/13/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) represents a growing challenge worldwide, with significant risks to both the mother and baby that extend beyond the duration of the pregnancy and immediate post-partum period. Women from ethnic minority groups who access GDM care in high-income settings face particular challenges. The aim of this systematic integrative review is to explore the experiences and needs of women with GDM from select ethnic groups in high-income healthcare settings. METHODS For the purposes of this systematic integrative review, a comprehensive search strategy explored the electronic databases CINAHL, Medline, Web of Science, and Scopus were searched for primary studies that explored the needs and experiences of women with gestational diabetes from select ethnic minority groups living in high-income nations. The ethnicity of the women in the study included: East, South and Southeast Asian, Indian subcontinent, Aboriginal/First Nations, Torres Strait Islander, Pacific Islander, Māori, Middle Eastern, African, or South/Latina American. Studies were assessed with the Crowe Critical Appraisal Tool and findings were synthesised with thematic analysis. RESULTS This review included 15 qualitative studies, one mixed method, and one cross-sectional study. Six high-income nations were represented. The voices and experiences of 843 women who originated from at least one ethnic minority group are represented. Four major themes were constructed: psychological impact of GDM, GDM care and education, GDM and sociocultural impact, and GDM and lifestyle changes. DISCUSSION AND CONCLUSION Limitations exist in the provision of culturally appropriate care to support the management of GDM in women from select ethnic groups in high-income healthcare settings. Women require care that is culturally appropriate, considering the individual needs and cultural practices of the woman. Engaging a woman's partner and family ensures good support is provided. Culturally appropriate care needs to be co-designed with communities so that women are at the centre of their care, avoiding a one-size-fits-all approach.
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Affiliation(s)
- Louise Tzotzis
- School of Nursing, Midwifery and Public Health, University of Canberra, Australia
| | - Mary-Ellen Hooper
- School of Nursing, Midwifery and Public Health, University of Canberra, Australia
| | - Angela Douglas
- School of Rehabilitation and Health Sciences, University of Canberra, Australia
| | - Ella Kurz
- School of Nursing, Midwifery and Public Health, University of Canberra, Australia
| | - Marjorie Atchan
- School of Nursing, Midwifery and Public Health, University of Canberra, Australia
| | | | - Deborah Davis
- School of Nursing, Midwifery and Public Health, University of Canberra, Australia; ACT Government Health Directorate, Australia.
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Umaefulam V, Premkumar K. Enablers and barriers to diabetic retinopathy eye care among first nations and Métis women. Diabet Med 2023; 40:e14995. [PMID: 36308051 DOI: 10.1111/dme.14995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 09/03/2022] [Accepted: 10/19/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Diabetes is increasingly prevalent in Indigenous women and increases their risk of developing diabetic retinopathy, an eye complication of diabetes and a common cause of vision loss in Canada, especially among adults. Early detection is the most effective approach to prevent vision loss and reduce the impact of diabetic retinopathy. OBJECTIVE This study examined enablers and barriers that influence the diabetes eye care behaviour of First Nations and Métis women with diabetes and at risk of diabetes. METHODS We conducted a descriptive qualitative study with 35 First Nations and Métis women with diabetes or at risk of diabetes in Saskatoon, Canada. Data were collected via four sharing circle discussions and were analysed using thematic analysis. RESULTS The study findings showed that understanding of diabetes eye care access and cost, and unsupportive interactions with health care practitioners, were barriers to diabetic retinopathy care behaviour. Conversely, the presence of eye complications, participants' resolve to manage diabetes, self-efficacy and fear due to experiences of family members with diabetes enabled diabetes eye care. CONCLUSIONS Our study advances knowledge in socio-cultural factors influencing diabetic retinopathy care behaviour among First Nations and Métis women living with and at risk of diabetes. The study shows the need for further public health and health system interventions to address barriers and support Indigenous peoples with or at risk of diabetes to make informed health decisions.
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Affiliation(s)
- Valerie Umaefulam
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Kalyani Premkumar
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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6
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Kuyoro O, McLaren RA, Narayanamoorthy S, Weedon J, Minkoff H. The ability of a low value on an early GCT to identify women not needing repeat testing in the second trimester. J Matern Fetal Neonatal Med 2022; 35:10086-10092. [PMID: 35749288 DOI: 10.1080/14767058.2022.2089553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To evaluate the predictive value of a low early glucose challenge test (GCT) in ruling out a subsequent diagnosis of gestational diabetes in the second trimester. METHODS This was a retrospective cohort study of women at a single clinic who had a normal early GCT between 2016 and 2020. Patients who did not have repeat screening in the late second trimester were excluded. Demographic data were extracted from the record. The primary outcome was a normal GCT or glucose tolerance test in the late second trimester. Logistic regression and receiver operator curves (ROC) were performed to assess the ability of the early GCT value to predict subsequent normal glucose screening. RESULTS Of the 532 pregnant persons with normal early GCT, 62 (11.7%) were subsequently diagnosed with gestational diabetes in the second trimester. None of the patients (N = 56), who had a GCT value less than 80 mg/dL were diagnosed with gestational diabetes in the second trimester. The prediction of subsequent normal screening using the early GCT on a ROC plot produced an area under the curve (AUC) of 0.67, 95% CI (0.60-0.74). Adding age, prior history of gestational diabetes and family history of diabetes mellitus to the prediction, only improved the AUC to 0.75, 95% CI (0.66, 0.82). CONCLUSION Early GCT value was a fair predictor for normal second trimester glucose testing for gestational diabetes. However, high-risk patients with an early GCT value of less than 80 mg/dL may be able to forego repeat second trimester screening.
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Affiliation(s)
- Olutunmike Kuyoro
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY, USA
| | - Rodney A McLaren
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY, USA
| | | | - Jeremy Weedon
- Department of Epidemiology & Biostatistics, SUNY Downstate, School of Public Health, Brooklyn, NY, USA
| | - Howard Minkoff
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY, USA.,Department of Obstetrics and Gynecology and The School of Public Health, SUNY Downstate Medical Center, Brooklyn, NY, USA
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7
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Coetzee A, Hall DR, Conradie M. Hyperglycemia First Detected in Pregnancy in South Africa: Facts, Gaps, and Opportunities. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2022; 3:895743. [PMID: 36992779 PMCID: PMC10012101 DOI: 10.3389/fcdhc.2022.895743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 04/01/2022] [Indexed: 06/19/2023]
Abstract
This review contextualizes hyperglycemia in pregnancy from a South-African perspective. It aims to create awareness of the importance of hyperglycemia in pregnancy in low-middle-income countries. We address unanswered questions to guide future research on sub-Saharan African women with hyperglycemia first detected in pregnancy (HFDP). South African women of childbearing age have the highest prevalence of obesity in sub-Saharan Africa. They are predisposed to Type 2 diabetes (T2DM), the leading cause of death in South African women. T2DM remains undiagnosed in many African countries, with two-thirds of people living with diabetes unaware. With the South African health policy's increased focus on improving antenatal care, women often gain access to screening for non-communicable diseases for the first time in pregnancy. While screening practices and diagnostic criteria for gestational diabetes mellitus (GDM) differ amongst geographical areas in South Africa (SA), hyperglycemia of varying degrees is often first detected in pregnancy. This is often erroneously ascribed to GDM, irrespective of the degree of hyperglycemia and not overt diabetes. T2DM and GDM convey a graded increased risk for the mother and fetus during and after pregnancy, with cardiometabolic risk accumulating across the lifespan. Resource limitations and high patient burden have hampered the opportunity to implement accessible preventative care in young women at increased risk of developing T2DM in the broader public health system in SA. All women with HFDP, including those with true GDM, should be followed and undergo glucose assessment postpartum. In SA, studies conducted early postpartum have noted persistent hyperglycemia in a third of women after GDM. Interpregnancy care is advantageous and may attain a favourable metabolic legacy in these young women, but the yield of return following delivery is suboptimal. We review the current best evidence regarding HFDP and contextualize the applicability in SA and other African or low-middle-income countries. The review identifies gaps and shares pragmatic solutions regarding clinical factors that may improve awareness, identification, diagnosis, and management of women with HFDP.
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Affiliation(s)
- Ankia Coetzee
- Department of Medicine, Division of Endocrinology Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - David R. Hall
- Department of Obstetrics and Gynecology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Magda Conradie
- Department of Medicine, Division of Endocrinology Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
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8
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Elamurugan K, Esmaeilisaraji L, Strain J, Ziraldo H, Root A, MacDonald H, Meekis C, Hummelen R, Ysseldyk R. Social Inequities Contributing to Gestational Diabetes in Indigenous Populations in Canada: A Scoping Review. Can J Diabetes 2022; 46:628-639.e1. [DOI: 10.1016/j.jcjd.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 03/31/2022] [Accepted: 05/12/2022] [Indexed: 10/18/2022]
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9
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Tools for Supporting the MCH Workforce in Addressing Complex Challenges: A Scoping Review of System Dynamics Modeling in Maternal and Child Health. Matern Child Health J 2022; 26:176-203. [PMID: 35188621 PMCID: PMC9482604 DOI: 10.1007/s10995-022-03376-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2022] [Indexed: 11/17/2022]
Abstract
Objectives System Dynamics (SD) is a promising decision support modeling approach for growing shared understanding of complex maternal and child health (MCH) trends. We sought to inventory published applications of SD to MCH topics and introduce the MCH workforce to these approaches through examples to support further iteration and use. Methods We conducted a systematic search (1958–2018) for applications of SD to MCH topics and characterized identified articles, following PRISMA guidelines. Pairs of experts abstracted information on SD approach and MCH relevance. Results We identified 101 articles describing applications of SD to MCH topics. Approach: 27 articles present qualitative diagrams, 10 introduce concept models that begin to quantify dynamics, and 67 present more fully tested/analyzed models. Purpose: The most common purposes described were to increase understanding (n = 55) and support strategic planning (n = 26). While the majority of studies (n = 53) did not involve stakeholders, 40 included what we considered to be a high level of stakeholder engagement – a strength of SD for MCH. Topics: The two Healthy People 2020 topics addressed most frequently were early and middle childhood (n = 30) and access to health services (n = 26). The most commonly addressed SDG goals were “End disease epidemics” (n = 26) and “End preventable deaths” (n = 26). Conclusions for Practice While several excellent examples of the application of SD in MCH were found, SD is still underutilized in MCH. Because SD is particularly well-suited to studying and addressing complex challenges with stakeholders, its expanded use by the MCH workforce could inform an understanding of contemporary MCH challenges. Supplementary Information The online version contains supplementary material available at 10.1007/s10995-022-03376-8.
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10
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Ahmed MA, Bailey HD, Pereira G, White SW, Wong K, Shepherd CCJ. Trends and burden of diabetes in pregnancy among Aboriginal and non-Aboriginal mothers in Western Australia, 1998-2015. BMC Public Health 2022; 22:263. [PMID: 35139837 PMCID: PMC8827280 DOI: 10.1186/s12889-022-12663-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 01/21/2022] [Indexed: 12/13/2022] Open
Abstract
Background Diabetes in pregnancy (DIP), which includes pre-gestational and gestational diabetes, is more prevalent among Aboriginal women. DIP and its adverse neonatal outcomes are associated with diabetes and cardiovascular disease in the offspring. This study investigated the impact of DIP on trends of large for gestational age (LGA) in Aboriginal and non-Aboriginal populations, and added to the limited evidence on temporal trends of DIP burden in these populations. Methods We conducted a retrospective cohort study that included all births in Western Australia between 1998 and 2015 using linked population health datasets. Time trends of age-standardised and crude rates of pre-gestational and gestational diabetes were estimated in Aboriginal and non-Aboriginal mothers. Mixed-effects multivariable logistic regression was used to estimate the association between DIP and population LGA trends over time. Results Over the study period, there were 526,319 births in Western Australia, of which 6.4% were to Aboriginal mothers. The age-standardised annual rates of pre-gestational diabetes among Aboriginal mothers rose from 4.3% in 1998 to 5.4% in 2015 and remained below 1% in non-Aboriginal women. The comparable rates for gestational diabetes increased from 6.7 to 11.5% over the study period in Aboriginal women, and from 3.5 to 10.2% among non-Aboriginal mothers. LGA rates in Aboriginal babies remained high with inconsistent and no improvement in pregnancies complicated by gestational diabetes and pre-gestational diabetes, respectively. Regression analyses showed that DIP explained a large part of the increasing LGA rates over time in Aboriginal babies. Conclusions There has been a substantial increase in the burden of pre-gestational diabetes (Aboriginal women) and gestational diabetes (Aboriginal and non-Aboriginal) in recent decades. DIP appears to substantially contribute to increasing trends in LGA among Aboriginal babies. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12663-6.
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Affiliation(s)
- Marwan Awad Ahmed
- Telethon Kids Institute, University of Western Australia, P.O. Box 855, West Perth, Western Australia, 6872, Australia. .,School of Population and Global Health, The University of Western Australia, Perth, Australia.
| | - Helen D Bailey
- Telethon Kids Institute, University of Western Australia, P.O. Box 855, West Perth, Western Australia, 6872, Australia
| | - Gavin Pereira
- Telethon Kids Institute, University of Western Australia, P.O. Box 855, West Perth, Western Australia, 6872, Australia.,Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia.,Centre for Fertility and Health (CeFH), Norwegian Institute of Public Health, Oslo, Norway
| | - Scott W White
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, WA, Australia.,Maternal Fetal Medicine Service, King Edward Memorial Hospital, Subiaco, WA, Australia
| | - Kingsley Wong
- Telethon Kids Institute, University of Western Australia, P.O. Box 855, West Perth, Western Australia, 6872, Australia.,Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Carrington C J Shepherd
- Telethon Kids Institute, University of Western Australia, P.O. Box 855, West Perth, Western Australia, 6872, Australia.,Curtin Medical School, Faculty of Health Sciences, Curtin University, Perth, Australia.,Ngangk Yira Research Centre, Murdoch University, Perth, WA, Australia
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Cao J, Peng Q. NLRP3 Inhibitor Tranilast Attenuates Gestational Diabetes Mellitus in a Genetic Mouse Model. Drugs R D 2022; 22:105-112. [PMID: 35124792 PMCID: PMC8885922 DOI: 10.1007/s40268-022-00382-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2022] [Indexed: 12/16/2022] Open
Abstract
Background and Objective Methods Results Conclusions
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Affiliation(s)
- Jing Cao
- Department of Endocrinology, Tianjin First Central Hospital, No. 24 Fukang Road, Nankai District, Tianjin, 300192, China.
| | - Qian Peng
- School of Medicine, Nankai University, Nankai District, Tianjin, China
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Mackenzie ML, Yuan Y, Shen Y, Toth EL, Bell RC, Oster RT. Pregnancy and development of diabetes in First Nations and non-First Nations women in Alberta, Canada. Diabet Med 2021; 38:e14372. [PMID: 32745272 DOI: 10.1111/dme.14372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 05/26/2020] [Accepted: 07/27/2020] [Indexed: 12/12/2022]
Abstract
AIM To conduct a retrospective population-based study to examine the risk of developing diabetes after delivery in First Nations and non-First Nations women in Alberta. METHODS Delivery records (1999-2014) were linked to provincial administrative data, which allowed for a maximum follow-up of 16 years after delivery. Prevalence of pregnancy risk factors were compared by First Nations status. Hazard ratios for diabetes after delivery by First Nations status, high pre-pregnancy body weight (≥91 kg) and gestational diabetes status were estimated using the Cox proportional hazards model. RESULTS Age-adjusted prevalence of gestational diabetes (7.9% vs 4.6%; P<0.0001), high pre-pregnancy body weight (18.8% vs 10.2%; P<0.0001) and diabetes after delivery (3.9% vs 1.1%; P<0.0001) were higher in First Nations women than in non-First Nations women. Development of diabetes after delivery was higher with First Nations status (hazard ratio 3.0, 95% CI 2.6-3.4), high pre-pregnancy body weight (hazard ratio 3.6, 95% CI 3.3-4.0) and gestational diabetes status (hazard ratio 19.2, 95% CI 17.9-20.6). The highest risk was within First Nations women with high pre-pregnancy body weight and gestational diabetes (hazard ratio 54.8, 95% CI 45.2-66.5) compared to women without these three risk factors. Reduced prenatal visits per pregnancy (8.4 vs 10.7; P<0.0001) and delayed first prenatal visit (time to delivery 23.7 vs 26.7 weeks; P<0.0001) were observed in First Nations women compared to non-First Nations women. CONCLUSION First Nations women are at greater risk of developing diabetes after pregnancy, with gestational diabetes being the strongest predictor. Strategies that target the specific needs of First Nations women before, during and after pregnancy are required.
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Affiliation(s)
- M L Mackenzie
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Y Yuan
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Y Shen
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - E L Toth
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - R C Bell
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - R T Oster
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
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McIntyre HD, Kapur A, Divakar H, Hod M. Gestational Diabetes Mellitus-Innovative Approach to Prediction, Diagnosis, Management, and Prevention of Future NCD-Mother and Offspring. Front Endocrinol (Lausanne) 2020; 11:614533. [PMID: 33343512 PMCID: PMC7744927 DOI: 10.3389/fendo.2020.614533] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 11/04/2020] [Indexed: 12/20/2022] Open
Abstract
Gestational diabetes mellitus (GDM) is the commonest medical complication of pregnancy. The association of GDM with immediate pregnancy complications including excess fetal growth and adiposity with subsequent risk of birth trauma and with hypertensive disorders of pregnancy is well recognized. However, the associations with wide ranges of longer-term health outcomes for mother and baby, including the lifetime risks of obesity, pre-diabetes, and diabetes and cardiovascular disease have received less attention and few health systems address these important issues in a systematic way. This article reviews historical and recent data regarding prediction of GDM using demographic, clinical, and biochemical parameters. We evaluate current and potential future diagnostic approaches designed to most effectively identify GDM and extend this analysis into a critical evaluation of lifestyle and nutritional/pharmacologic interventions designed to prevent the development of GDM. The general approach to management of GDM during pregnancy is then discussed and the major final focus of the article revolves around the importance of a GDM diagnosis as a future marker of the risk of non-communicable disease (NCD), in particular pre-diabetes, diabetes, and cardiovascular disease, both in mother and offspring.
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Affiliation(s)
- H. David McIntyre
- Mater Research, The University of Queensland, South Brisbane, QLD, Australia
| | - Anil Kapur
- World Diabetes Foundation, Bagsvaerd, Denmark
| | | | - Moshe Hod
- Mor Women’s Health Care Center, Tel Aviv, Israel
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Congenital Anomalies of the Kidney and Urinary Tract (CAKUT): An Emerging Relationship With Pregestational Diabetes Mellitus Among First Nations and Non-First Nations People in Saskatchewan-Results From the DIP: ORRIIGENSS Project. Can J Diabetes 2020; 45:346-354.e1. [PMID: 33308984 DOI: 10.1016/j.jcjd.2020.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 10/06/2020] [Accepted: 10/06/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Because congenital anomalies of the kidneys and urinary tract (CAKUT) represent a frequent cause of end stage renal disease (ESRD) in the young, we explored the epidemiology of CAKUT and the role of diabetes in pregnancy. METHODS This was a retrospective cohort study of CAKUT, by maternal diabetes status, from among all 1980‒2009 births in Saskatchewan First Nations (FN) and non-First Nations (non-FN) people. We determined frequencies, predictors and complications of CAKUT, as well as cumulative survival (to 2014) of affected persons until ESRD and death. RESULTS Of the 411,055 babies (204,167 mothers) in the Saskatchewan maternal-infant database, 2,540 had CAKUT (391 FN and 2,149 non-FN). Overall annual CAKUT incidence was 0.63% for non-FN and 0.57% for FN (p=0.082), but 5-year CAKUT incidence only increased among FN (0.40% in 1980‒1984 and 0.76% in 2005‒2009, p<0.0001) and was highest among offspring of FN mothers with pregestational diabetes (pre-G/DM) (0% before 1995, 2.51% in 2000‒2004 and 1.66% in 2005-2009). Pre-G/DM, but not gestational diabetes mellitus (GDM), was an independent predictor of CAKUT in non-FN (odds ratio, 1.79; 95% confidence interval, 1.20 to 2.69), and in FN interacting with maternal history of stillbirth (odds ratio, 7.90; 95% confidence interval, 1.14 to 54.6). ESRD was >100-fold more likely among offspring with CAKUT compared with all other offspring and was responsible for 40% of ESRD cases in young FN and non-FN people. CONCLUSIONS In Saskatchewan, pre-G/DM is an emerging cause of CAKUT, accounting for 40% of ESRD cases in FN/non-FN children and young adults. Because pre-G/DM‒related CAKUT is potentially preventable with optimal glycemic management, increased recognition of this serious complication is required.
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Dyck RF, Karunanayake C, Pahwa P, Stang M, Osgood ND. Epidemiology of Diabetes in Pregnancy Among First Nations and Non-First Nations Women in Saskatchewan, 1980‒2013. Part 2: Predictors and Early Complications; Results From the DIP: ORRIIGENSS Project. Can J Diabetes 2020; 44:605-614. [PMID: 32033918 DOI: 10.1016/j.jcjd.2019.11.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 10/08/2019] [Accepted: 11/05/2019] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Because of disparities in incidence of diabetes in pregnancy (DIP) among First Nations (FN) and non-First Nations (non-FN) women in Saskatchewan, we compared predictors and early maternal/child complication rates of gestational diabetes (GDM) and pre-GDM between the 2 populations from 1980 to 2013. METHODS Using Ministry of Health administrative databases, we examined overall GDM and pre-GDM predictors among a cohort of FN and non-FN women using logistic regression models. We compared early birth complications by ethnicity and DIP status using chi-square analysis. RESULTS Deidentified data were obtained for 69,176 FN and 344,410 non-FN pregnancies. Important GDM and pre-GDM predictors for FN and non-FN pregnancies were increasing maternal age, a previous high birthweight (HBW) or stillborn infant, and, most importantly, previous maternal GDM. Both GDM and pre-GDM were over 2.3-fold as likely to occur among FN in multivariable analysis. FN and non-FN pregnancies with GDM and pre-GDM had higher rates of prematurity, shoulder dystocia, caesarean section, HBW and stillborn and infant death than those with no DIP. The largest rate disparities between FN and non-FN with DIP occurred with stillborn, HBW and shoulder dystocia. CONCLUSIONS Along with previously recognized predictors of GDM and pre-GDM, FN ethnicity was an independent determinant of DIP in Saskatchewan from 1980 to 2013. Early mother/child birth complications were increased in both FN and non-FN with DIP, but more so in FN. Effective DIP prevention strategies, and improvements in preconception, prenatal and perinatal care, are required to remove ethnicity-based disparities in DIP rates and outcomes.
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Affiliation(s)
- Roland F Dyck
- Department of Medicine, Canadian Center for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Department of Community Health and Epidemiology, University of Saskatchewan, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
| | - Chandima Karunanayake
- Department of Medicine, Canadian Center for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Punam Pahwa
- Department of Medicine, Canadian Center for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Department of Community Health and Epidemiology, University of Saskatchewan, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - MaryRose Stang
- Ministry of Health, Government of Saskatchewan, University of Saskatchewan, Regina, Saskatchewan, Canada
| | - Nathaniel D Osgood
- Department of Community Health and Epidemiology, University of Saskatchewan, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Department of Computer Science, University of Saskatchewan, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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16
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Dyck RF, Karunanayake C, Pahwa P, Stang M, Osgood ND. Epidemiology of Diabetes in Pregnancy Among First Nations and Non-First Nations Women in Saskatchewan, 1980‒2013. Part 1: Populations, Methodology and Frequencies (1980‒2009); Results From the DIP: ORRIIGENSS Project. Can J Diabetes 2020; 44:597-604. [PMID: 31987766 DOI: 10.1016/j.jcjd.2019.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 09/23/2019] [Accepted: 10/16/2019] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Because of the immediate and long-term consequences of diabetes in pregnancy (DIP) for mother and child, we compared frequencies of gestational diabetes (GDM) and pre-GDM between First Nations (FN) and non-FN people in Saskatchewan from 1980 to 2009. METHODS Using Ministry of Health administrative databases, we conducted a retrospective cohort study of GDM and pre-GDM rates within all FN and non-FN pregnancies in Saskatchewan. Annual crude and 10-year age-adjusted incidence of GDM and pre-GDM were determined as were maternal age-specific rates of DIP. RESULTS De-identified data were obtained for 69,176 FN and 344,410 non-FN pregnancies. The crude annual incidence of GDM rose from 1.0% to 6.6% among FN and from 0.4% to 3.6% among non-FN between 1980 and 2009. The crude annual incidence of pre-GDM rose from 0.7% to 2.0% among FN and from 0.4% to 0.9% among non-FN over the same period. The 10-year age-standardized incidence of GDM increased from 3.53% in 1980-1989 to 8.37% in 2000-2009 for FN, and from 1.55% to 3.13% for non-FN. For pre-GDM, the corresponding increases were from 1.65% to 3.26% for FN and from 0.5% to 0.91% for non-FN. Both GDM and pre-GDM rates increased with increasing maternal age, reaching 10.9% and 8.0% of FN pregnancies, and 7.7% and 1.1% of non-FN pregnancies, respectively, for mothers >40 years old. CONCLUSIONS The proportion of pregnancies complicated by DIP increased steadily among FN and non-FN women in Saskatchewan in 1980‒2009, but the incidence of GDM and pre-GDM is 2- to 3-fold higher among FN.
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Affiliation(s)
- Roland F Dyck
- Department of Medicine (Canadian Center for Health and Safety in Agriculture), University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
| | - Chandima Karunanayake
- Department of Medicine (Canadian Center for Health and Safety in Agriculture), University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Punam Pahwa
- Department of Medicine (Canadian Center for Health and Safety in Agriculture), University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - MaryRose Stang
- Ministry of Health, Government of Saskatchewan, Regina, Saskatchewan, Canada
| | - Nathaniel D Osgood
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Department of Computer Science, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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17
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Huang Y, Chen X, You ZS, Gu F, Li L, Wang D, Liu J, Li Y, He S. The value of first-trimester platelet parameters in predicting gestational diabetes mellitus. J Matern Fetal Neonatal Med 2020; 35:2031-2035. [PMID: 32594791 DOI: 10.1080/14767058.2020.1774543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: To explore the potential clinical value of platelet parameters in early pregnancy in predicting gestational diabetes mellitus (GDM).Methods: A total of 1188 singleton pregnant women were included in the regular antenatal examination and delivered in the First Affiliated Hospital of Sun Yat-Sen University from January 2016 to December 2018, who had no pre-pregnancy diabetes, no factors leading to elevated blood glucose level, no medical complications and no other obstetrical complications. Blood routine examination was performed at the 11-13+6 gestational weeks. All pregnant women underwent 75 g OGTT directly at the 24-28th gestational weeks. And they were divided into GDM group (n = 192) and non-GDM group (n = 996). Binomial Logistic regression analysis and receiver operating characteristic (ROC) curve were used to evaluate the ability of first-trimester platelet parameters to predict GDM, that is the sensitivity and specificity of platelet parameters at the optimal critical value.Results: There were significant differences in platelet count (PLT), platelet distribution width (PDW), mean platelet volume (MPV), and plateletcrit (PCT) between the GDM group and the normal group (p<.05). After adjusting for the related factors such as maternal age, parity and pregestational body mass index (BMI), the MPV and PCT were correlated with the incidence of GDM (p<.05). The area under the curve (AUC) of MPV was 0.577; 95% confidence interval (CI) 0.533-0.621 and that of PCT was 0.628. 95%CI 0.582-0.674. PLT and PDW were not correlated with GDM.Conclusion: MPV and PCT in early pregnancy are potential indicators in predicting gestational diabetes mellitus.
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Affiliation(s)
- Ying Huang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xi Chen
- Department of Pediatrics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ze Shan You
- Department of Obstetrics and Gynecology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Fang Gu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Li Li
- Department of Obstetrics and Gynecology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Dongyu Wang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jun Liu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yinguang Li
- Department of Obstetrics and Gynecology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shanyang He
- Department of Obstetrics and Gynecology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Freebairn L, Atkinson JA, Qin Y, Nolan CJ, Kent AL, Kelly PM, Penza L, Prodan A, Safarishahrbijari A, Qian W, Maple-Brown L, Dyck R, McLean A, McDonnell G, Osgood ND. 'Turning the tide' on hyperglycemia in pregnancy: insights from multiscale dynamic simulation modeling. BMJ Open Diabetes Res Care 2020; 8:e000975. [PMID: 32475837 PMCID: PMC7265040 DOI: 10.1136/bmjdrc-2019-000975] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 02/15/2020] [Accepted: 04/06/2020] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Hyperglycemia in pregnancy (HIP, including gestational diabetes and pre-existing type 1 and type 2 diabetes) is increasing, with associated risks to the health of women and their babies. Strategies to manage and prevent this condition are contested. Dynamic simulation models (DSM) can test policy and program scenarios before implementation in the real world. This paper reports the development and use of an advanced DSM exploring the impact of maternal weight status interventions on incidence of HIP. METHODS A consortium of experts collaboratively developed a hybrid DSM of HIP, comprising system dynamics, agent-based and discrete event model components. The structure and parameterization drew on a range of evidence and data sources. Scenarios comparing population-level and targeted prevention interventions were simulated from 2018 to identify the intervention combination that would deliver the greatest impact. RESULTS Population interventions promoting weight loss in early adulthood were found to be effective, reducing the population incidence of HIP by 17.3% by 2030 (baseline ('business as usual' scenario)=16.1%, 95% CI 15.8 to 16.4; population intervention=13.3%, 95% CI 13.0 to 13.6), more than targeted prepregnancy (5.2% reduction; incidence=15.3%, 95% CI 15.0 to 15.6) and interpregnancy (4.2% reduction; incidence=15.5%, 95% CI 15.2 to 15.8) interventions. Combining targeted interventions for high-risk groups with population interventions promoting healthy weight was most effective in reducing HIP incidence (28.8% reduction by 2030; incidence=11.5, 95% CI 11.2 to 11.8). Scenarios exploring the effect of childhood weight status on entry to adulthood demonstrated significant impact in the selected outcome measure for glycemic regulation, insulin sensitivity in the short term and HIP in the long term. DISCUSSION Population-level weight reduction interventions will be necessary to 'turn the tide' on HIP. Weight reduction interventions targeting high-risk individuals, while beneficial for those individuals, did not significantly impact forecasted HIP incidence rates. The importance of maintaining interventions promoting healthy weight in childhood was demonstrated.
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Affiliation(s)
- Louise Freebairn
- The Australian Prevention Partnership Centre, Sax Institute, Haymarket, New South Wales, Australia
- School of Medicine, The University of Notre Dame Australia, Darlinghurst, New South Wales, Australia
- Population Health, ACT Health, Woden, Australian Capital Territory, Australia
| | - Jo-An Atkinson
- The Australian Prevention Partnership Centre, Sax Institute, Haymarket, New South Wales, Australia
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Yang Qin
- Computational Epidemiology and Public Health Informatics Laboratory, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Christopher J Nolan
- Endocrinology and Diabetes, ACT Health, Woden, Australian Capital Territory, Australia
- Medical School, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Alison L Kent
- Medical School, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
- Golisano Children's Hospital at URMC, University of Rochester, Rochester, New York, USA
| | - Paul M Kelly
- Population Health, ACT Health, Woden, Australian Capital Territory, Australia
- Medical School, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Luke Penza
- School of Computer, Data and Mathematical Sciences, Western Sydney University, Penrith, New South Wales, Australia
| | - Ante Prodan
- School of Computer, Data and Mathematical Sciences, Western Sydney University, Penrith, New South Wales, Australia
| | - Anahita Safarishahrbijari
- Computational Epidemiology and Public Health Informatics Laboratory, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Weicheng Qian
- Computational Epidemiology and Public Health Informatics Laboratory, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Louise Maple-Brown
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
- Endocrinology Department, Royal Darwin Hospital, Casuarina, Northern Territory, Australia
| | - Roland Dyck
- Department of Medicine, University of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, Canada
| | - Allen McLean
- Computational Epidemiology and Public Health Informatics Laboratory, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Geoff McDonnell
- The Australian Prevention Partnership Centre, Sax Institute, Haymarket, New South Wales, Australia
| | - Nathaniel D Osgood
- Computational Epidemiology and Public Health Informatics Laboratory, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Kapur A, McIntyre HD, Divakar H, Di Renzo GC, Kihara AB, McAuliffe F, Hanson M, Ma RC, Hod M. Towards a global consensus on GDM diagnosis: Light at the end of the tunnel? Int J Gynaecol Obstet 2020; 149:257-261. [PMID: 32333403 DOI: 10.1002/ijgo.13149] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 03/10/2020] [Accepted: 03/27/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Anil Kapur
- World Diabetes Foundation, Bagsvaerd, Denmark
| | - H David McIntyre
- Mater Health and Mater Research University of Queensland, Brisbane, Australia
| | | | - Gian Carlo Di Renzo
- Center of Perinatal and Reproductive Medicine, Department of Obstetrics and Gynecology, University of Perugia, Italy
| | - Anne Beatrice Kihara
- College of Health Sciences, Department of Obstetrics and Gynecology, University of Nairobi, Kenya.,African Federation of Obstetrics and Gynaecology, Khartoum, Sudan
| | - Fionnuala McAuliffe
- Department of Obstetrics and Gynecology, The National Maternity Hospital, Dublin, Ireland
| | - Mark Hanson
- Institute of Developmental Sciences, University of Southampton, UK
| | - Ronald C Ma
- Department of Medicine and Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, China
| | - Moshe Hod
- Helen Schneider Hospital for Women, Rabin Medical Center, Tel Aviv, Israel
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Khajehei M, Assareh H. Temporal trend of diabetes in pregnant women and its association with birth outcomes, 2011 to 2017. J Diabetes Complications 2020; 34:107550. [PMID: 32037288 DOI: 10.1016/j.jdiacomp.2020.107550] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 11/15/2019] [Accepted: 01/23/2020] [Indexed: 01/02/2023]
Abstract
AIM To assess changes in the prevalence of diabetes in pregnant women, and its association with selected birth outcomes (including caesarean section, episiotomy, admission to the special care nursery/neonatal intensive care unit, postpartum haemorrhage and neonatal birth weight) from 2011 to 2017. METHODS In a single-centre, retrospective cohort study, we examined records of pregnant women who attended an Australian tertiary hospital between 2011 and 2017, identifying women with gestational diabetes mellitus and pre-existing diabetes mellitus, and examined trends associated with diabetes and their effects on birth outcomes. RESULTS The average incidence of women with diabetes increased by 9% annually (RR = 0.09, 95% CI = 1.08-1.11), which was 6% greater in women who received antenatal doctor-led care (RR = 1.06, 95% CI = 1.01-1.13), 42% greater in women who had other endocrine diseases (including thyroid, adrenal or pituitary diseases) (RR = 1.42, 95% CI = 1.31-1.53), and 61% greater in women with hypertension during pregnancy (RR = 1.61, 95% CI = 1.47-1.78). The presence of diabetes did not affect the relative risks of caesarean section, episiotomy, postpartum haemorrhage, decreased neonatal birth weight or special care nursery/neonatal intensive care unit admission, after adjustment for demographics and health and care status and behaviours. CONCLUSIONS The rate of diabetes during pregnancy increased from 2011 to 2017. Diabetes did not affect the relative risk of untoward birth outcomes.
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Affiliation(s)
- Marjan Khajehei
- Women's and Newborn Health, Westmead Hospital, Australia; University of New South Wales, Sydney, Australia; University of Sydney, Sydney, Australia.
| | - Hassan Assareh
- University of New South Wales, Sydney, Australia; Agency for Clinical Innovation, NSW Health, Australia.
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Wood A, MacKay D, Fitzsimmons D, Derkenne R, Kirkham R, Boyle JA, Connors C, Whitbread C, Welsh A, Brown A, Shaw JE, Maple-Brown L. Primary Health Care for Aboriginal Australian Women in Remote Communities after a Pregnancy with Hyperglycaemia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17030720. [PMID: 31979123 PMCID: PMC7037226 DOI: 10.3390/ijerph17030720] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 01/20/2020] [Accepted: 01/20/2020] [Indexed: 01/24/2023]
Abstract
Background: Hyperglycaemia in pregnancy contributes to adverse outcomes for women and their children. The postpartum period is an opportune time to support women to reduce cardiometabolic and diabetes risk in subsequent pregnancies. Aims: To identify strengths and gaps in current care for Aboriginal women after a pregnancy complicated by hyperglycaemia. Methods: A retrospective review of the 12 month postpartum care provided by primary health centres in remote Australia in 2013–2014 identified 195 women who experienced hyperglycaemia in pregnancy (gestational diabetes (GDM) (n = 147), type 2 diabetes (T2D) (n = 39), and unclear diabetes status (n = 9)). Results: Only 80 women (54%) with GDM had postpartum glycaemic checks. Of these, 32 women were diagnosed with prediabetes (n = 24) or diabetes (n = 8). Compared to women with GDM, women with T2D were more likely to have their weight measured (75% vs. 52%, p <0.01), and smoking status documented as “discussed” (65% vs. 34%, p < 0.01). Most women (97%) accessed the health centre at least once in the 12 month postpartum period but, during these visits, only 52% of women had service provision, either structured or opportunistic, related to diabetes. Conclusion: High rates of dysglycaemia among women screened for T2D after GDM in the 12 month postpartum period highlight the need for increased screening and early intervention to prevent the development of T2D and its complications. Whilst a clear strength was high postpartum attendance, many women did not attend health services for diabetes screening or management.
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Affiliation(s)
- Anna Wood
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT 0810, Australia; (A.W.)
- Endocrinology Department, Division of Medicine, Royal Darwin Hospital, Darwin, NT 0810, Australia
| | - Diana MacKay
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT 0810, Australia; (A.W.)
- Endocrinology Department, Division of Medicine, Royal Darwin Hospital, Darwin, NT 0810, Australia
| | - Dana Fitzsimmons
- Northern Territory Department of Health, Darwin, NT 8000, Australia
| | - Ruth Derkenne
- Northern Territory Department of Health, Darwin, NT 8000, Australia
| | - Renae Kirkham
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT 0810, Australia; (A.W.)
| | - Jacqueline A. Boyle
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT 0810, Australia; (A.W.)
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia
| | | | - Cherie Whitbread
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT 0810, Australia; (A.W.)
| | - Alison Welsh
- Northern Territory Department of Health, Darwin, NT 8000, Australia
| | - Alex Brown
- South Australia Health and Medical Research Institute, Adelaide, SA 5000, Australia
- Faculty of Health and Medical Science, University of Adelaide, Adelaide, SA 5005, Australia
| | - Jonathan E. Shaw
- Aboriginal Health Domain, Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia;
| | - Louise Maple-Brown
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT 0810, Australia; (A.W.)
- Endocrinology Department, Division of Medicine, Royal Darwin Hospital, Darwin, NT 0810, Australia
- Correspondence:
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Mishra S, Rao CR, Bhadoria AS, Mohanty S, Kishore S, Chaudhary AS. Life-cycle approach for prevention of gestational diabetes mellitus. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2019. [DOI: 10.1016/j.cegh.2018.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Naumann RB, Austin AE, Sheble L, Lich KH. System dynamics applications to injury and violence prevention: a systematic review. CURR EPIDEMIOL REP 2019; 6:248-262. [PMID: 31911889 DOI: 10.1007/s40471-019-00200-w] [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] [Indexed: 10/27/2022]
Abstract
Purpose of review System dynamics (SD) is an approach to solving problems in the context of dynamic complexity. The purpose of this review was to summarize SD applications in injury prevention and highlight opportunities for SD to contribute to injury prevention research and practice. Recent findings While SD has been increasingly used to study public health problems over the last few decades, uptake in the injury field has been slow. We identified 18 studies, mostly conducted in the last 10 years. Applications covered a range of topics (e.g., road traffic injury; overdose; violence), employed different types of SD tools (i.e., qualitative and quantitative), and served a variety of research and practice purposes (e.g., deepen understanding of a problem, policy analysis). Summary Given the many ways that SD can add value and complement traditional research and practice approaches (e.g., through novel stakeholder engagement and policy analysis tools), increased investment in SD-related capacity building and opportunities that support SD use are warranted.
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Affiliation(s)
- Rebecca B Naumann
- Department of Epidemiology and Injury Prevention Research Center, University of North Carolina at Chapel Hill
| | - Anna E Austin
- Department of Maternal and Child Health and Injury Prevention Research Center, University of North Carolina at Chapel Hill
| | - Laura Sheble
- School of Information Sciences, Wayne State University.,Duke Network Analysis Center, Social Science Research Institute, Duke University
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Sunjaya AF, Sunjaya AP. Comparing outcomes of nutrition therapy, insulin and oral anti-diabetics in managing diabetes mellitus in Pregnancy: Retrospective study and review of current guidelines. Diabetes Metab Syndr 2019; 13:104-109. [PMID: 30641679 DOI: 10.1016/j.dsx.2018.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 08/21/2018] [Indexed: 11/21/2022]
Abstract
AIMS This study aims to evaluate the glycemic profile and outcomes of Indonesian diabetic pregnant mothers based on their methods of therapy and review current international as well as national guidelines on management of diabetes in pregnancy. MATERIALS AND METHODS Data was obtained from medical records of Hermina-Podomoro Hospital. Subjects were grouped based on therapy - nutrition therapy only, insulin and oral anti-diabetics group. RESULTS Forty-five subjects were obtained with an average age of 31-years. Around thirty-five percent of patients were given nutrition therapy only, 55.6% were using insulin and 8.8% were using oral anti-diabetics. Oral anti-diabetics users showed worse glycemic profile among the three groups. Six-patients suffered from IUFD with the highest proportion found in oral anti-diabetics users. CONCLUSION The above results show the negative impacts of DM on pregnant mothers and the unborn. Caution is advised on the use of oral anti-diabetics as it may increase the risk of infant mortality. Increased monitoring and prenatal services for DM patients are essential in achieving blood glucose targets.
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Affiliation(s)
- Angela F Sunjaya
- Faculty of Medicine, Tarumanagara University Jl. Letjen S. Parman No.1, Jakarta, Indonesia
| | - Anthony P Sunjaya
- Faculty of Medicine, Tarumanagara University Jl. Letjen S. Parman No.1, Jakarta, Indonesia.
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Zilberman-Kravits D, Meyerstein N, Abu-Rabia Y, Wiznitzer A, Harman-Boehm I. The Impact of a Cultural Lifestyle Intervention on Metabolic Parameters After Gestational Diabetes Mellitus A Randomized Controlled Trial. Matern Child Health J 2018; 22:803-811. [PMID: 29411251 DOI: 10.1007/s10995-018-2450-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES The prevalence of type 2 diabetes in Israel is increasing in all ethnic groups but most markedly in the Bedouin population. We aimed to assess the effects of a lifestyle change intervention on risk markers for type 2 diabetes after gestational diabetes mellitus (GDM). METHODS One hundred eighty Jewish and Bedouin post-GDM women were randomly assigned to a lifestyle intervention group (IG) or a control group (CG) starting 3-4 months after delivery. The IG participated in healthy lifestyle sessions led by a dietician and a sports instructor for 24 months after delivery. The IG participants had three individual 45-min counseling sessions and four 90-min group meetings (10 women each). The dietary and exercise recommendations were culturally adapted. The primary outcome of the study was HOMA-IR. We monitored clinical and chemical biomarkers 1 and 2 years after delivery. RESULTS After 1 and 2 years of intervention, the metabolic measures improved substantially. The intervention reduced the insulin, glucose and HOMA-IR levels in the IG compared with those in the CG (p < 0.001). CONCLUSIONS This novel culturally tailored lifestyle intervention program significantly improved the metabolic and morphometric indices measured 1 and 2 years after delivery. These results highlight and underscore the importance of effective lifestyle change education following GDM.
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Affiliation(s)
- Dana Zilberman-Kravits
- Nursing Department, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Yitshak Rager, 8410501, Beer Sheva, Israel.
| | - Naomi Meyerstein
- Department of Physiology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Yones Abu-Rabia
- Diabetes Unit, Soroka University Medical Center, Beer Sheva, Israel
| | - Arnon Wiznitzer
- Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women at the Rabin Medical Center, Petah Tikva, Israel
| | - Ilana Harman-Boehm
- Department of Internal Medicine and Diabetes Unit, Soroka University Medical Center, Beer Sheva, Israel
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Reid J, Anderson A, Cormack D, Reid P, Harwood M. The experience of gestational diabetes for indigenous Māori women living in rural New Zealand: qualitative research informing the development of decolonising interventions. BMC Pregnancy Childbirth 2018; 18:478. [PMID: 30518341 PMCID: PMC6282285 DOI: 10.1186/s12884-018-2103-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 11/19/2018] [Indexed: 01/18/2023] Open
Abstract
Background Although early detection and management of excess rates of gestational diabetes mellitus (GDM) among Indigenous women can substantially reduce maternal and offspring complications, current interventions seem ineffective for Indigenous women. While undertaking a qualitative study in a rural community in Northland, New Zealand about the complexities of living with diabetes, we observed a common emotional discourse about the burden of diabetic pregnancies. Given the significance of GDM and our commitment to give voice to Indigenous Māori women in ways that could potentially inform solutions, we aimed to explore the phenomenon of GDM among Māori women in a rural context marked by high area-deprivation. Method A qualitative and Kaupapa Māori methodology was utilised. A sub-sample of women (n = 10) from a broader study designed to improve type 2 diabetes mellitus (T2DM) who had experienced GDM or pre-existing diabetes during pregnancy and/or had been exposed to diabetes in utero were interviewed. Participants in the broader study were recruited via the local primary care clinic. Experiences of GDM, in relation to their current T2DM, was sought. Narrative data was analysed for themes. Results Intergenerational experiences informed perceptions that GDM was an inevitable heritable illness that “just runs in the family.” The cumulative effects of deprivation and living with GDM compounded the complexities of participant’ lives including perceptions of powerlessness and mental health deterioration. Missed opportunities for health services to detect and manage diabetes had ongoing health consequences for the women and their offspring. Positive relationships with healthcare providers facilitated management of GDM and helped women engage with self-management. Conclusion Māori women living with T2DM were clear that health providers had failed to intervene in ways that would have potentially slowed or prevented progression of GDM to T2DM. Participants revealed missed opportunities for appropriate diagnostic testing, treatment and health promotion programmes for GDM. Poor collaboration between health services and social services meant psychosocial issues were rarely addressed and the cycle of intergenerational poverty and disadvantage prevailed. These data highlight opportunities for extended case management to include whānau (family) engagement, input from social services, and evidence-based medicine and/or long-term management and prevention of T2DM. Electronic supplementary material The online version of this article (10.1186/s12884-018-2103-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jennifer Reid
- c/- Te Kupenga Hauora Māori, Medical and Health Sciences, University of Auckland, 261 Morrin Rd, Glen Innes, Auckland, 1072, New Zealand.
| | - Anneka Anderson
- c/- Te Kupenga Hauora Māori, Medical and Health Sciences, University of Auckland, 261 Morrin Rd, Glen Innes, Auckland, 1072, New Zealand
| | - Donna Cormack
- c/- Te Kupenga Hauora Māori, Medical and Health Sciences, University of Auckland, 261 Morrin Rd, Glen Innes, Auckland, 1072, New Zealand.,Te Rōpū Rangahau Hauora A Eru Pōmare, University of Otago, 23A Mein St, Newtown, Wellington, 6021, New Zealand
| | - Papaarangi Reid
- c/- Te Kupenga Hauora Māori, Medical and Health Sciences, University of Auckland, 261 Morrin Rd, Glen Innes, Auckland, 1072, New Zealand
| | - Matire Harwood
- c/- Te Kupenga Hauora Māori, Medical and Health Sciences, University of Auckland, 261 Morrin Rd, Glen Innes, Auckland, 1072, New Zealand.,National Hauora Coalition, Units 3-4, 485B Rosebank Rd, Avondale, Auckland, 1026, New Zealand
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Fabienke R, Hod M, Kapur A. Take home message: Start where life begins and follow the life-course approach. Diabetes Res Clin Pract 2018; 145:214-215. [PMID: 29475021 DOI: 10.1016/j.diabres.2018.02.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 02/06/2018] [Indexed: 11/20/2022]
Affiliation(s)
| | - Moshe Hod
- Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anil Kapur
- Chairman World Diabetes Foundation, Bagsvaerd, Denmark
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28
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Sadikot S, Purandare CN, Cho NH, Hod M. FIGO-IDF joint statement and declaration on hyperglycemia in pregnancy. Diabetes Res Clin Pract 2018; 145:1-4. [PMID: 30001825 DOI: 10.1016/j.diabres.2018.02.031] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 02/22/2018] [Indexed: 11/22/2022]
Affiliation(s)
| | | | - Nam H Cho
- International Diabetes Federation (IDF), South Korea
| | - Moshe Hod
- FIGO Committee on Pregnancy and Non Communicable Disease, Israel
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29
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Kapur A, Divakar H, Seshiah V. Perspectives on diagnostic strategies for hyperglycemia in pregnancy - Dealing with the barriers and challenges in South Asia. Diabetes Res Clin Pract 2018; 145:88-92. [PMID: 29408685 DOI: 10.1016/j.diabres.2018.01.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 01/24/2018] [Indexed: 10/18/2022]
Abstract
Estimates indicate that south Asia accounts for over two fifths of the global burden of hyperglycemia in pregnancy (HIP) and the ongoing nutritional and epidemiological transition may make the situation worse. Given their higher risk, all women of south Asian decent require to be tested for HIP. With approximately 37 million births annually in the region requires that 37 million women be tested annually; thereby placing a huge burden on the fragile inadequately resourced health systems in the region with poor awareness and lack of trained manpower. Recommendation for testing must therefore be pragmatic, feasible, convenient and cost effective. Diabetes in pregnancy study group India (DIPSI) has proposed a simple testing protocol that is endorsed by the Indian National Guideline on GDM, and by the FIGO guideline on HIP for use in South Asia. This testing protocol has received widespread support in the region. Despite the many challenges it is encouraging to note that in the four large countries in the region - Bangladesh, India, Pakistan and Sri Lanka which account for over 80% of the estimated burden of HIP in south Asia, large scale credible programs have been initiated to address the identified barriers.
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Affiliation(s)
- Anil Kapur
- World Diabetes Foundation, Gentofte, Denmark.
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30
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Liu X, Zhang L, Li J, Meng G, Chi M, Li T, Zhao Y, Wu Y. A nested case-control study of the association between exposure to polybrominated diphenyl ethers and the risk of gestational diabetes mellitus. ENVIRONMENT INTERNATIONAL 2018; 119:232-238. [PMID: 29980046 DOI: 10.1016/j.envint.2018.06.029] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 05/31/2018] [Accepted: 06/22/2018] [Indexed: 05/12/2023]
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is rapidly increasing worldwide. Exposure to endocrine-disrupting chemicals such as polybrominated diphenyl ethers (PBDEs) is thought to be a contributor to GDM, independent of diet and physical activity. OBJECTIVE The prospective association between PBDEs body burden in early pregnancy and GDM risk was investigated. METHODS A nested case-control study of 439 pregnant women was conducted between 2013 and 2015 in Beijing, China. Seven predominant PBDE congeners were measured in first trimester maternal serum by gas chromatography-high resolution mass spectrometry. Pregnant women were screened for GDM at 24-28 weeks of gestation using the oral glucose tolerance test. GDM was defined based on the diagnostic criteria set by China Ministry of Health. Conditional logistic and linear regression were used to estimate the association between PBDEs exposure and GDM risk, and PBDEs exposure and glucose level, respectively. RESULTS A total of 77 (17.5%) women developed GDM in this study. Median concentrations of PBDEs were higher in women with GDM. Analyses parameterizing PBDE concentrations as continuous variables suggested significant associations between BDE-153, -154, -183 and GDM risk with an estimated odds ratio of 4.04 (95%CI: 1.92, 8.52), 1.88 (95%CI: 1.15, 3.09) and 1.91 (95%CI: 1.31, 2.08), respectively. In the quartile analyses, a significant increase in the odds ratio of GDM was associated with the highest levels of BDE-153 (OR = 3.42 95%CI: 1.49, 7.89) and BDE-183 (OR = 3.70, 95%CI: 1.58, 8.65), whereas, BDE-154 demonstrated an inverted U-shaped association with GDM. In addition, BDE-153 and -154 were significantly positively associated with fasting glucose, and both 1 h and 2 h glucose level (p < 0.05). CONCLUSIONS These results suggest that exposure to PBDEs disturbs maternal glucose homeostasis and increases the risk of GDM. These findings should be replicated in future studies with a larger population and wider range of exposure.
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Affiliation(s)
- Xin Liu
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang, China; The Key Laboratory of Food Safety Risk Assessment, Ministry of Health and China National Center for Food Safety Risk Assessment, Beijing, China; School of Food Science and Technology, Nanchang University, Nanchang, China
| | - Lei Zhang
- The Key Laboratory of Food Safety Risk Assessment, Ministry of Health and China National Center for Food Safety Risk Assessment, Beijing, China
| | - Jingguang Li
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang, China; The Key Laboratory of Food Safety Risk Assessment, Ministry of Health and China National Center for Food Safety Risk Assessment, Beijing, China; School of Food Science and Technology, Nanchang University, Nanchang, China.
| | - Guimin Meng
- Beijing Fengtai Hospital Obstetrics and Gynecology, Beijing, China
| | - Min Chi
- School of Food Science and Technology, Nanchang University, Nanchang, China
| | - Tiantian Li
- Department of Environmental Health Risk Assessment, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yunfeng Zhao
- The Key Laboratory of Food Safety Risk Assessment, Ministry of Health and China National Center for Food Safety Risk Assessment, Beijing, China
| | - Yongning Wu
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang, China; The Key Laboratory of Food Safety Risk Assessment, Ministry of Health and China National Center for Food Safety Risk Assessment, Beijing, China; School of Food Science and Technology, Nanchang University, Nanchang, China
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31
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Ho J, Bachman-Carter K, Thorkelson S, Anderson K, Jaggi J, Brown C, Nelson AK, Curley C, King C, Atwood S, Shin S. Glycemic control and healthcare utilization following pregnancy among women with pre-existing diabetes in Navajo Nation. BMC Health Serv Res 2018; 18:629. [PMID: 30097012 PMCID: PMC6086058 DOI: 10.1186/s12913-018-3434-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 07/30/2018] [Indexed: 11/13/2022] Open
Abstract
Background Native American communities experience greater burden of diabetes than the general population, including high rates of Type 2 diabetes among women of childbearing age. Diabetes in pregnancy is associated with risks to both the mother and offspring, and glycemic control surrounding the pregnancy period is of vital importance. Methods A retrospective chart review was conducted at a major Navajo Area Indian Health Service (IHS) hospital, tracking women with pre-existing diabetes who became pregnant between 2010 and 2012. Logistic regression was performed to find patient-level predictors of our desired primary outcome—having hemoglobin A1c (HbA1c) consistently < 8% within 2 years after pregnancy. Descriptive statistics were generated for other outcomes, including glycemic control and seeking timely IHS care. Results One hundred twenty-two pregnancies and 114 individuals were identified in the dataset. Baseline HbA1c was the only covariate which predicted our primary outcome (OR = 1.821, 95% CI = 1.184–2.801). Examining glycemic control among pregnancies with complete HbA1c data (n = 59), 59% were controlled before, 85% during, and 34% after pregnancy. While nearly all women received care in the immediate postpartum period, only 49% of women visited a primary care provider and 71% had HbA1c testing in the 2 years after pregnancy. Conclusions This is the first analysis of outcomes among women with diabetes in pregnancy in Navajo Nation, the largest reservation and tribal health system in the United States. Our findings demonstrate the positive impact of specialized prenatal care in achieving glycemic control during pregnancy, while highlighting the challenges in maintaining glycemic control and continuity of healthcare after pregnancy.
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Affiliation(s)
- Julius Ho
- Department of Medicine, Johns Hopkins School of Medicine, 1800 Orleans St, Baltimore, MD, 21298, USA
| | | | - Shelley Thorkelson
- Northern Navajo Medical Center, Indian Health Service, Shiprock, NM, USA
| | - Kristi Anderson
- Northern Navajo Medical Center, Indian Health Service, Shiprock, NM, USA
| | - Jennifer Jaggi
- Gallup Indian Medical Center, Indian Health Service, Gallup, NM, USA
| | - Chris Brown
- Division of Global Health Equity, Brigham and Women's Hospital, 210 East Aztec Avenue, Gallup, NM, 87301, USA.,Community Outreach and Patient Empowerment, 210 East Aztec Avenue, Gallup, NM, 87301, USA
| | - Adrianne Katrina Nelson
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Ave., Boston, MA, 02115, USA
| | - Cameron Curley
- Division of Global Health Equity, Brigham and Women's Hospital, 210 East Aztec Avenue, Gallup, NM, 87301, USA.,Community Outreach and Patient Empowerment, 210 East Aztec Avenue, Gallup, NM, 87301, USA
| | - Caroline King
- Division of Global Health Equity, Brigham and Women's Hospital, 210 East Aztec Avenue, Gallup, NM, 87301, USA.,Community Outreach and Patient Empowerment, 210 East Aztec Avenue, Gallup, NM, 87301, USA
| | - Sid Atwood
- Division of Global Health Equity, Brigham and Women's Hospital, 210 East Aztec Avenue, Gallup, NM, 87301, USA
| | - Sonya Shin
- Division of Global Health Equity, Brigham and Women's Hospital, 210 East Aztec Avenue, Gallup, NM, 87301, USA. .,Community Outreach and Patient Empowerment, 210 East Aztec Avenue, Gallup, NM, 87301, USA. .,Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Ave., Boston, MA, 02115, USA.
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32
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FIGO-IDF joint statement and declaration on hyperglycemia in pregnancy. Int J Gynaecol Obstet 2018; 142:127-130. [DOI: 10.1002/ijgo.12497] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Fleischer NL, Liese AD, Hammond R, Coleman-Jensen A, Gundersen C, Hirschman J, Frongillo EA, Ma X, Mehta N, Jones SJ. Using systems science to gain insight into childhood food security in the United States: Report of an expert mapping workshop. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2018. [DOI: 10.1080/19320248.2017.1364194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Nancy L. Fleischer
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
- Center for Social Epidemiology and Population Health, Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Angela D. Liese
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | | | | | - Craig Gundersen
- National Soybean Research Laboratory, University of Illinois, Urbana, Illinois, USA
| | - Jay Hirschman
- Food and Nutrition Service, US Department of Agriculture (retired), Alexandria, Virginia, USA
| | - Edward A. Frongillo
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Xiaoguang Ma
- Department of Nutrition and Food Hygiene, School of Public Health, Zhejiang University, Hangzhou, Zhejiang, China
| | - Neil Mehta
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Sonya J. Jones
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
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Koh K, Reno R, Hyder A. Designing an Agent-Based Model Using Group Model Building: Application to Food Insecurity Patterns in a U.S. Midwestern Metropolitan City. J Urban Health 2018. [PMID: 29536416 PMCID: PMC5906389 DOI: 10.1007/s11524-018-0230-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Recent advances in computing resources have increased interest in systems modeling and population health. While group model building (GMB) has been effectively applied in developing system dynamics models (SD), few studies have used GMB for developing an agent-based model (ABM). This article explores the use of a GMB approach to develop an ABM focused on food insecurity. In our GMB workshops, we modified a set of the standard GMB scripts to develop and validate an ABM in collaboration with local experts and stakeholders. Based on this experience, we learned that GMB is a useful collaborative modeling platform for modelers and community experts to address local population health issues. We also provide suggestions for increasing the use of the GMB approach to develop rigorous, useful, and validated ABMs.
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Affiliation(s)
- Keumseok Koh
- Division of Environmental Health Sciences, College of Public Health, The Ohio State University, 241-3C, 1841 Neil Ave, Columbus, OH 43201 USA
| | - Rebecca Reno
- Maternal and Child Health Department, School of Public Health, University of California, Berkeley, 2199 Addison St, Suite 435, Berkeley, CA 94710 USA
| | - Ayaz Hyder
- Division of Environmental Health Sciences, College of Public Health, The Ohio State University, 380D, 1841 Neil Ave, Columbus, OH 43201 USA
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Crowshoe L, Dannenbaum D, Green M, Henderson R, Hayward MN, Toth E. Type 2 Diabetes and Indigenous Peoples. Can J Diabetes 2018; 42 Suppl 1:S296-S306. [DOI: 10.1016/j.jcjd.2017.10.022] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Indexed: 12/16/2022]
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36
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Affiliation(s)
- Anil Kapur
- World Diabetes Foundation, Gentofte, Denmark
| | - Veeraswamy Seshiah
- Distinguished Professor, The Tamil Nadu Dr. M.G.R. Medical University; Diabetes in Pregnancy Study Group; Executive Board International Association of Diabetes & Pregnancy Study Group; Dr. Seshiah & Dr. Balaji Diabetes Care & Research Institute, Chennai 600 029, Tamil Nadu, India
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Kapur A, Mahmood T, Hod M. FIGO's response to the global challenge of hyperglycemia in pregnancy - toward a global consensus. Gynecol Endocrinol 2018; 34:1-3. [PMID: 28980832 DOI: 10.1080/09513590.2017.1381682] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Anil Kapur
- a FIGO Working Group on Hyperglycemia in Pregnancy, International Federation of Gynecology and Obstetrics (FIGO), Waterloo Court , London , UK
| | - Tahir Mahmood
- a FIGO Working Group on Hyperglycemia in Pregnancy, International Federation of Gynecology and Obstetrics (FIGO), Waterloo Court , London , UK
| | - Moshe Hod
- a FIGO Working Group on Hyperglycemia in Pregnancy, International Federation of Gynecology and Obstetrics (FIGO), Waterloo Court , London , UK
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The hefty fetal phenotype hypothesis revisited: high birth weight, type 2 diabetes and gestational diabetes in a Saskatchewan cohort of First Nations and non-First Nations women. J Dev Orig Health Dis 2017; 10:48-54. [DOI: 10.1017/s2040174417000988] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Although low birth weight (LBW) increases the risk for type 2 diabetes (T2DM), the relationship between high birth weight (HBW) and T2DM is less definitive and largely confined to North American Indigenous populations. We re-examined the relationship between LBW (<2500 g) and HBW (>4000 g) and both T2DM and gestational diabetes (GDM) among First Nations and non-First Nations women in Saskatchewan. We analyzed new data for female subjects from a 2001 case-control study that led to our hefty fetal phenotype hypothesis. Using survival analysis techniques and a validated algorithm for identifying diabetes in health care administrative data, we followed a 1950–1984 birth cohort of 2003 women until March 31, 2013. Cox regression analysis determined the time to occurrence of first episode of GDM and diagnosis of T2DM by birth weight and ethnicity. First Nations women with HBW demonstrated a greater risk for developing both T2DM [hazard ratios (HR) 1.568; 95% confidence interval (CI) 1.188, 2.069] and GDM (HR 1.468; 95% CI 1.016, 2.121) than those with normal birth weight (NBW). Non-First Nations women with LBW had a greater risk of developing GDM than those with NBW (HR 1.585; 95% CI 1.001, 2.512). HBW is a risk factor for GDM and T2DM among First Nations women. This is likely due to exposure of these women to their own mothers’ diabetic pregnancies or gestational impaired glucose tolerance. This inter-generational amplification of T2DM risk mediated throughprenatalexposures appears to play a substantial role in the epidemic of T2DM among First Nations peoples.
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Gao A, Osgood ND, Jiang Y, Dyck RF. Projecting prevalence, costs and evaluating simulated interventions for diabetic end stage renal disease in a Canadian population of aboriginal and non-aboriginal people: an agent based approach. BMC Nephrol 2017; 18:283. [PMID: 28870154 PMCID: PMC5584022 DOI: 10.1186/s12882-017-0699-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 08/22/2017] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Diabetes-related end stage renal disease (DM-ESRD) is a devastating consequence of the type 2 diabetes epidemic, both of which disproportionately affect Indigenous peoples. Projecting case numbers and costs into future decades would help to predict resource requirements, and simulating hypothetical interventions could guide the choice of best practices to mitigate current trends. METHODS An agent based model (ABM) was built to forecast First Nations and non-First Nations cases of DM-ESRD in Saskatchewan from 1980 to 2025 and to simulate two hypothetical interventions. The model was parameterized with data from the Canadian Institute for Health Information, Saskatchewan Health Administrative Databases, the Canadian Organ Replacement Register, published studies and expert judgement. Input parameters without data sources were estimated through model calibration. The model incorporated key patient characteristics, stages of diabetes and chronic kidney disease, renal replacement therapies, the kidney transplant assessment and waiting list processes, costs associated with treatment options, and death. We used this model to simulate two interventions: 1) No new cases of diabetes after 2005 and 2) Pre-emptive renal transplants carried out on all diabetic persons with new ESRD. RESULTS There was a close match between empirical data and model output. Going forward, both incidence and prevalence cases of DM-ESRD approximately doubled from 2010 to 2025, with 250-300 new cases per year and almost 1300 people requiring RRT by 2025. Prevalent cases of First Nations people with DM-ESRD increased from 19% to 27% of total DM-ESRD numbers from 1990 to 2025. The trend in yearly costs paralleled the prevalent DM-ESRD case count. For Scenario 1, despite eliminating diabetes incident cases after 2005, prevalent cases of DM-ESRD continued to rise until 2019 before slowly declining. When all DM-ESRD incident cases received a pre-emptive renal transplant (scenario 2), a substantial increase in DM-ESRD prevalence occurred reflecting higher survival, but total costs decreased reflecting the economic advantage of renal transplantation. CONCLUSIONS This ABM can forecast numbers and costs of DM-ESRD in Saskatchewan and be modified for application in other jurisdictions. This can aid in resource planning and be used by policy makers to evaluate different interventions in a safe and economical manner.
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Affiliation(s)
- Amy Gao
- Strategic Planning and Data Warehousing, University of Alberta, Edmonton, Canada
| | - Nathaniel D. Osgood
- Department of Computer Science, University of Saskatchewan, Saskatoon, Canada
| | | | - Roland F. Dyck
- Department of Medicine (Canadian Center for Health and Safety in Agriculture), University of Saskatchewan, Saskatoon, Canada
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Paths to improving care of Australian Aboriginal and Torres Strait Islander women following gestational diabetes. Prim Health Care Res Dev 2017; 18:549-562. [DOI: 10.1017/s1463423617000305] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
AimTo understand enablers and barriers influencing postpartum screening for type 2 diabetes following gestational diabetes in Australian Indigenous women and how screening might be improved.BackgroundAustralian Indigenous women with gestational diabetes mellitus (GDM) are less likely than other Australian women to receive postpartum diabetes screening. This is despite a fourfold higher risk of developing type 2 diabetes within eight years postpartum.MethodsWe conducted interviews with seven Indigenous women with previous GDM, focus groups with 20 Indigenous health workers and workshops with 24 other health professionals. Data collection included brainstorming, visualisation, sorting and prioritising activities. Data were analysed thematically using the Theoretical Domains Framework. Barriers are presented under the headings of ‘capability’, ‘motivation’ and ‘opportunity’. Enabling strategies are presented under ‘intervention’ and ‘policy’ headings.FindingsParticipants generated 28 enabling environmental, educational and incentive interventions, and service provision, communication, guideline, persuasive and fiscal policies to address barriers to screening and improve postpartum support for women. The highest priorities included providing holistic social support, culturally appropriate resources, improving Indigenous workforce involvement and establishing structured follow-up systems. Understanding Indigenous women’s perspectives, developing strategies with health workers and action planning with other health professionals can generate context-relevant feasible strategies to improve postpartum care after GDM. Importantly, we need evidence which can demonstrate whether the strategies are effective.
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Halipchuk J, Temple B, Dart A, Martin D, Sellers EAC. Prenatal, Obstetric and Perinatal Factors Associated With the Development of Childhood-Onset Type 2 Diabetes. Can J Diabetes 2017; 42:71-77. [PMID: 28583472 DOI: 10.1016/j.jcjd.2017.04.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 03/24/2017] [Accepted: 04/06/2017] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To explore associations among prenatal, obstetric and perinatal factors and the development of childhood-onset type 2 diabetes. METHODS This retrospective, case-control study utilized administrative data housed at the Manitoba Centre for Health Policy. De-identified health records were examined from a sample of 270 children (aged 10 to 17 years at time of diagnosis) with type 2 diabetes and 1341 children without type 2 diabetes matched for age, sex and geographic location. Patients and control subjects were linked to their de-identified biological mothers' health records. Prenatal, obstetric and perinatal factors were investigated. Univariate and multivariable conditional regression analyses were conducted to identify key factors associated with the development of type 2 diabetes in children. RESULTS The mean age at diagnosis was 13.1 years, and 61% of patients were girls. The majority (71.1%) of children with type 2 diabetes resided in rural areas. Exposure to maternal pregestational diabetes increased the odds of childhood-onset type 2 diabetes nearly 6-fold, and exposure to gestational diabetes carried a 4-fold increased risk. Breastfeeding was found to be protective, decreasing the risk of childhood-onset type 2 diabetes (odds ratio = 0.52, 95% confidence interval = 0.36-0.74). Low maternal income was significantly associated with development of childhood-onset type 2 diabetes (odds ratio = 6.67, 95% confidence interval = 3.01-14.79). CONCLUSIONS Health and social policies and programs are needed to provide financial, educational and clinical resources that target women whose pregnancies are affected by poverty, type 2 diabetes or gestational diabetes. Breastfeeding should be encouraged to aid in the prevention of childhood-onset type 2 diabetes.
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Affiliation(s)
- Julie Halipchuk
- Health Sciences Centre Winnipeg, Winnipeg, Manitoba, Canada.
| | - Beverley Temple
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Allison Dart
- Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; The Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Donna Martin
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Elizabeth A C Sellers
- Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; The Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
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Chamberlain CR, Wilson AN, Amir LH, O'Dea K, Campbell S, Leonard D, Ritte R, Mulcahy M, Eades S, Wolfe R. Low rates of predominant breastfeeding in hospital after gestational diabetes, particularly among Indigenous women in Australia. Aust N Z J Public Health 2017; 41:144-150. [PMID: 28110518 DOI: 10.1111/1753-6405.12629] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 07/01/2016] [Accepted: 09/01/2016] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES To investigate rates of 'any' and 'predominant' breastfeeding in hospital among Indigenous and non-Indigenous women with and without gestational diabetes mellitus (GDM). METHODS A retrospective study of singleton infants born from July 2007 to December 2010 at Cairns Hospital, Australia, following GDM pregnancy, using linked hospital and birth data (n=617 infants), with a subsample of medical record reviews (n=365 infants). Aggregate data were used to compare to breastfeeding rates among infants born following non-GDM pregnancy (n=7,894 infants). RESULTS More than 90% of all women reported any breastfeeding before hospital discharge. About 80% of women without GDM reported predominant breastfeeding. Despite significant increases over time (p<0.0001), women with GDM were less likely to predominantly breastfeed (OR 0.32, 95%CI 0.27-0.38, p<0.0001); with lower rates among Indigenous women (53%) compared with non-Indigenous (60%) women (OR 0.78, 0.70-0.88, p<0.0001); and women having a caesarean birth or pre-term infant. CONCLUSIONS Rates of predominant in-hospital breastfeeding were lower among women with GDM, particularly among Indigenous women and women having a caesarean or pre-term birth. IMPLICATIONS Strategies are needed to support predominant in-hospital breastfeeding among women with GDM.
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Affiliation(s)
- Catherine R Chamberlain
- Indigenous Health Equity Unit, School of Population and Global Health, University of Melbourne, Victoria.,Aboriginal Health Domain, Baker IDI Heart and Diabetes Institute, Victoria
| | - Alyce N Wilson
- Indigenous Health Equity Unit, School of Population and Global Health, University of Melbourne, Victoria
| | - Lisa H Amir
- Judith Lumley Centre, La Trobe University, Victoria
| | - Kerin O'Dea
- Centre for Population Health Research, School of Health Sciences, University of South Australia
| | - Sandra Campbell
- Apunipima Cape York Health Council, Queensland.,Centre for Chronic Disease Prevention, Cairns Institute, James Cook University, Queensland
| | - Dympna Leonard
- Centre for Chronic Disease Prevention, Cairns Institute, James Cook University, Queensland
| | - Rebecca Ritte
- Indigenous Health Equity Unit, School of Population and Global Health, University of Melbourne, Victoria
| | | | - Sandra Eades
- Aboriginal Health Domain, Baker IDI Heart and Diabetes Institute, Victoria
| | - Rory Wolfe
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Victoria
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Khooshehchin TE, Keshavarz Z, Afrakhteh M, Shakibazadeh E, Faghihzadeh S. Perceived needs in women with gestational diabetes: A qualitative study. Electron Physician 2016; 8:3412-3420. [PMID: 28163857 PMCID: PMC5279975 DOI: 10.19082/3412] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Accepted: 07/13/2016] [Indexed: 11/20/2022] Open
Abstract
Introduction Diabetes is the most common medical complication of pregnancy. It can be associated with many complications for mother and fetus. Gestational diabetes is also one of the main health issues in Iran. Therefore, the present study is aimed at a deeper understanding of women’s experiences of gestational diabetes and their perceived needs to inform future lifestyle interventions. Methods This qualitative content analysis study was carried out in 2015. Participants were pregnant women diagnosed with gestational diabetes in the 24th to 36th week of pregnancy, who were referred to the clinics affiliated with Shahid Beheshti Medical Science University in Tehran, Iran. In-depth interviews were conducted with participants, using semi-structured questions. Interviews were audio taped and transcribed verbatim. Conventional content analysis was carried out for data analysis. Interviews continued until data saturation was obtained. Data were coded in MAXQDA software (version 11). Results Content analysis highlighted two themes; educational needs and need to support. The former was featured with five main categories: information sources, education process, unknown and known, weaknesses of public information system, and eagerness to learn. The latter was featured with two main categories: family support and social support. Conclusion Clarifying the needs of the mothers with gestational diabetes, leads to better and proper education planning and a program toward the improvement of health, self-care, and prevention of diabetes.
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Affiliation(s)
- Taraneh Emamgoli Khooshehchin
- Student Research Office, Ph.D. Candidate, Department of Reproductive Health, School of Nursing and Midwifery, International Branch, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zohre Keshavarz
- Assistant Professor, Department of Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Afrakhteh
- Department of Obstetrics and Gynecology of Shohada Tajresh Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elham Shakibazadeh
- Assistant Professor, Department of Health Education and Promotion, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Soghrat Faghihzadeh
- Department of Biostatistics, Zanjan University of Medical Sciences, Zanjan, Iran
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Huhn EA, Fischer T, Göbl CS, Todesco Bernasconi M, Kreft M, Kunze M, Schoetzau A, Dölzlmüller E, Eppel W, Husslein P, Ochsenbein-Koelble N, Zimmermann R, Bäz E, Prömpeler H, Bruder E, Hahn S, Hoesli I. Screening of gestational diabetes mellitus in early pregnancy by oral glucose tolerance test and glycosylated fibronectin: study protocol for an international, prospective, multicentre cohort trial. BMJ Open 2016; 6:e012115. [PMID: 27733413 PMCID: PMC5073542 DOI: 10.1136/bmjopen-2016-012115] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION As the accurate diagnosis and treatment of gestational diabetes mellitus (GDM) is of increasing importance; new diagnostic approaches for the assessment of GDM in early pregnancy were recently suggested. We evaluate the diagnostic power of an 'early' oral glucose tolerance test (OGTT) 75 g and glycosylated fibronectin (glyFn) for GDM screening in a normal cohort. METHODS AND ANALYSIS In a prospective cohort study, 748 singleton pregnancies are recruited in 6 centres in Switzerland, Austria and Germany. Women are screened for pre-existing diabetes mellitus and GDM by an 'early' OGTT 75 g and/or the new biomarker, glyFn, at 12-15 weeks of gestation. Different screening strategies are compared to evaluate the impact on detection of GDM by an OGTT 75 g at 24-28 weeks of gestation as recommended by the International Association of Diabetes and Pregnancy Study Groups (IADPSG). A new screening algorithm is created by using multivariable risk estimation based on 'early' OGTT 75 g and/or glyFn results, incorporating maternal risk factors. Recruitment began in May 2014. ETHICS AND DISSEMINATION This study received ethical approval from the ethics committees in Basel, Zurich, Vienna, Salzburg and Freiburg. It was registered under http://www.ClinicalTrials.gov (NCT02035059) on 12 January 2014. Data will be presented at international conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT02035059.
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Affiliation(s)
- E A Huhn
- Department of Obstetrics and Gynaecology, University Hospital Basel, Basel, Switzerland
| | - T Fischer
- Department of Obstetrics and Gynaecology, Salzburger Landeskrankenhaus, Paracelsus Medical University, Salzburg, Austria
| | - C S Göbl
- Division of Obstetrics and Feto-maternal Medicine, Department of Obstetrics and Gynaecology, Medical University of Vienna, Vienna, Austria
| | - M Todesco Bernasconi
- Department of Obstetrics and Gynaecology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - M Kreft
- Department of Obstetrics and Gynaecology, University Hospital Zurich, Zurich, Switzerland
| | - M Kunze
- Department of Obstetrics and Gynaecology, University Hospital Freiburg, Freiburg, Germany
| | - A Schoetzau
- Department of Obstetrics and Gynaecology, University Hospital Basel, Basel, Switzerland
| | - E Dölzlmüller
- Department of Obstetrics and Gynaecology, Salzburger Landeskrankenhaus, Paracelsus Medical University, Salzburg, Austria
| | - W Eppel
- Division of Obstetrics and Feto-maternal Medicine, Department of Obstetrics and Gynaecology, Medical University of Vienna, Vienna, Austria
| | - P Husslein
- Division of Obstetrics and Feto-maternal Medicine, Department of Obstetrics and Gynaecology, Medical University of Vienna, Vienna, Austria
| | - N Ochsenbein-Koelble
- Department of Obstetrics and Gynaecology, University Hospital Zurich, Zurich, Switzerland
| | - R Zimmermann
- Department of Obstetrics and Gynaecology, University Hospital Zurich, Zurich, Switzerland
| | - E Bäz
- Department of Obstetrics and Gynaecology, University Hospital Freiburg, Freiburg, Germany
| | - H Prömpeler
- Department of Obstetrics and Gynaecology, University Hospital Freiburg, Freiburg, Germany
| | - E Bruder
- Department of Pathology, University Hospital Basel, Basel, Switzerland
| | - S Hahn
- Department of Biomedicine, Laboratory of Perinatology, University Basel, Basel, Switzerland
| | - I Hoesli
- Department of Obstetrics and Gynaecology, University Hospital Basel, Basel, Switzerland
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Freebairn L, Atkinson J, Kelly P, McDonnell G, Rychetnik L. Simulation modelling as a tool for knowledge mobilisation in health policy settings: a case study protocol. Health Res Policy Syst 2016; 14:71. [PMID: 27654897 PMCID: PMC5031301 DOI: 10.1186/s12961-016-0143-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 09/05/2016] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Evidence-informed decision-making is essential to ensure that health programs and services are effective and offer value for money; however, barriers to the use of evidence persist. Emerging systems science approaches and advances in technology are providing new methods and tools to facilitate evidence-based decision-making. Simulation modelling offers a unique tool for synthesising and leveraging existing evidence, data and expert local knowledge to examine, in a robust, low risk and low cost way, the likely impact of alternative policy and service provision scenarios. This case study will evaluate participatory simulation modelling to inform the prevention and management of gestational diabetes mellitus (GDM). The risks associated with GDM are well recognised; however, debate remains regarding diagnostic thresholds and whether screening and treatment to reduce maternal glucose levels reduce the associated risks. A diagnosis of GDM may provide a leverage point for multidisciplinary lifestyle modification interventions. This research will apply and evaluate a simulation modelling approach to understand the complex interrelation of factors that drive GDM rates, test options for screening and interventions, and optimise the use of evidence to inform policy and program decision-making. METHODS/DESIGN The study design will use mixed methods to achieve the objectives. Policy, clinical practice and research experts will work collaboratively to develop, test and validate a simulation model of GDM in the Australian Capital Territory (ACT). The model will be applied to support evidence-informed policy dialogues with diverse stakeholders for the management of GDM in the ACT. Qualitative methods will be used to evaluate simulation modelling as an evidence synthesis tool to support evidence-based decision-making. Interviews and analysis of workshop recordings will focus on the participants' engagement in the modelling process; perceived value of the participatory process, perceived commitment, influence and confidence of stakeholders in implementing policy and program decisions identified in the modelling process; and the impact of the process in terms of policy and program change. DISCUSSION The study will generate empirical evidence on the feasibility and potential value of simulation modelling to support knowledge mobilisation and consensus building in health settings.
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Affiliation(s)
- L Freebairn
- ACT Health, GPO Box 825, Canberra, ACT 2601, Australia.
- The Australian Prevention Partnership Centre, Sax Institute, PO Box K617, Haymarket, NSW, 1240, Sydney, Australia.
- School of Medicine, University of Notre Dame, PO Box 944, 2007, Sydney, Australia.
| | - J Atkinson
- The Australian Prevention Partnership Centre, Sax Institute, PO Box K617, Haymarket, NSW, 1240, Sydney, Australia
| | - P Kelly
- ACT Health, GPO Box 825, Canberra, ACT 2601, Australia
- The Australian Prevention Partnership Centre, Sax Institute, PO Box K617, Haymarket, NSW, 1240, Sydney, Australia
- Australian National University, Canberra, ACT 2601, Australia
| | - G McDonnell
- The Australian Prevention Partnership Centre, Sax Institute, PO Box K617, Haymarket, NSW, 1240, Sydney, Australia
- University of New South Wales, Sydney, NSW, 2052, Australia
| | - L Rychetnik
- The Australian Prevention Partnership Centre, Sax Institute, PO Box K617, Haymarket, NSW, 1240, Sydney, Australia
- School of Medicine, University of Notre Dame, PO Box 944, 2007, Sydney, Australia
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López Morales CM, Brito Zurita OR, González Heredia R, Cruz López M, Méndez Padrón A, Matute Briseño JA. [Placental atherosclerosis and markers of endothelial dysfunction in infants born to mothers with gestational diabetes]. Med Clin (Barc) 2016; 147:95-100. [PMID: 27242015 DOI: 10.1016/j.medcli.2016.03.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 03/18/2016] [Accepted: 03/31/2016] [Indexed: 01/17/2023]
Abstract
BACKGROUND AND OBJECTIVE The pathophysiology of gestational diabetes itself causes hyperstimulation of adipose tissue and of the placenta cells increasing the production of inflammatory cytokines, which cause changes in the tissues exposed such as the placenta and foetus. Therefore, the objective of this study was to compare metabolic markers and endothelial dysfunction in umbilical cord blood, as well as to determine the presence of atherosclerosis in the placentas of newborn infants of patients with gestational diabetes and in patients with normally progressing pregnancies. PATIENTS AND METHOD An analytical cross-sectional study was carried out in 84 patients, obtaining data such as age, smoking and weight gain in pregnancy; the gestational age of the newborns was determined by Capurro, and their weight and destination subsequent to birth, the placentas were also collected in order to look for atherosclerosis through histological studies and glucose, insulin, VLDL-C, HDL-C, triglycerides, cholesterol, fibrinogen, PCR and markers of endothelial dysfunction (adiponectin, VCAM-1, ICAM-1 and IL-6) were determined in blood samples obtained from the umbilical cord. RESULTS Placental atherosclerosis presented in 28.94% of the group with gestational diabetes compared to 10.52% of the group with normally progressing pregnancies (P=.044); differences were found in glucose, cholesterol, triglycerides, fibrinogen, HOMA-IR, PCR-us, HDL-C, not in VLDL-C. Twenty-one point five percent of the newborns of the gestational diabetes patients required hospitalization, against 5.2% in the control group, CONCLUSIONS Pregnancies that involve diabetes have higher proportion of atherosclerosis, hospitalization of the newborn, insulin resistance, as well as elevation of markers associated with inflammation and endothelial dysfunction in umbilical cord blood.
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Affiliation(s)
- Cruz Mónica López Morales
- Coordinación Auxiliar de Investigación, Instituto Mexicano del Seguro Social, Delegación de Sonora, Obregón, Sonora, México.
| | - Olga Rosa Brito Zurita
- Dirección de Educación e Investigación, Unidad Médica de Alta Especialidad, Instituto Mexicano del Seguro Social, Obregón, Sonora, México
| | - Ricardo González Heredia
- Centro de Investigación Educativa y Formación Docente, Instituto Mexicano del Seguro Social, Obregón, Sonora, México
| | - Miguel Cruz López
- Unidad de Investigación Médica en Bioquímica, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Obregón, Sonora, México
| | - Araceli Méndez Padrón
- Unidad de Investigación Médica en Bioquímica, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Obregón, Sonora, México
| | - Juan Antonio Matute Briseño
- Departamento de Patología, Hospital General Regional 1, Instituto Mexicano del Seguro Social, Obregón, Sonora, México
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Shapiro GD, Dodds L, Arbuckle TE, Ashley-Martin J, Ettinger AS, Fisher M, Taback S, Bouchard MF, Monnier P, Dallaire R, Morisset AS, Fraser W. Exposure to organophosphorus and organochlorine pesticides, perfluoroalkyl substances, and polychlorinated biphenyls in pregnancy and the association with impaired glucose tolerance and gestational diabetes mellitus: The MIREC Study. ENVIRONMENTAL RESEARCH 2016; 147:71-81. [PMID: 26852007 DOI: 10.1016/j.envres.2016.01.040] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 01/06/2016] [Accepted: 01/26/2016] [Indexed: 05/21/2023]
Abstract
BACKGROUND Studies report increases in rates of gestational diabetes mellitus (GDM) over recent decades. Environmental chemicals may increase the risk of diabetes through impacts on glucose metabolism, mitochondrial dysfunction, and endocrine-disrupting mechanisms including effects on pancreatic β-cell function and adiponectin release. OBJECTIVES To determine the associations between pesticides, perfluoroalkyl substances (PFASs) and polychlorinated biphenyls (PCBs) measured in early pregnancy and impaired glucose tolerance (IGT) and GDM in a Canadian birth cohort. METHODS Women enrolled in the Maternal-Infant Research on Environmental Chemicals (MIREC) Study were included if they had a singleton delivery and did not have pre-existing diabetes. Exposure variables included three organophosphorus (OP) pesticide metabolites detected in first-trimester urine samples, as well as three organochlorine (OC) pesticides, three PFASs, and four PCBs in first-trimester blood samples. Gestational IGT and GDM were assessed by chart review in accordance with published guidelines. Adjusted logistic regression models were used to calculate odds ratios (ORs) and 95% confidence intervals (CI) for the association between quartiles of environmental chemicals and both gestational IGT and GDM. RESULTS Of the 2001 women recruited into the MIREC cohort, 1274 met the inclusion criteria and had outcome and biomonitoring data available. Significantly lower odds of GDM were observed in the third and fourth quartiles of dimethylphosphate (DMP) and in the fourth quartile of dimethylthiophosphate (DMTP) in adjusted analyses (DMP Q3: OR=0.2, 95% CI=0.1-0.7; DMP Q4: OR=0.3, 95% CI=0.1-0.8; DMTP: OR=0.3, 95% CI=0.1-0.9). Significantly elevated odds of gestational IGT was observed in the second quartile of perfluorohexane sulfonate (PFHxS) (OR=3.5, 95% CI=1.4-8.9). No evidence of associations with GDM or IGT during pregnancy was observed for PCBs or OC pesticides. CONCLUSIONS We did not find consistent evidence for any positive associations between the chemicals we examined and GDM or IGT during pregnancy. We observed statistical evidence of inverse relationships between urine concentrations of DMP and DMTP with GDM. We cannot rule out the influence of residual confounding due to unmeasured protective factors, such as nutritional benefits from fruit and vegetable consumption, also associated with pesticide exposure, on the observed inverse associations between maternal OP pesticide metabolites and GDM. These findings require further investigation.
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Affiliation(s)
- Gabriel D Shapiro
- McGill University, Montreal, QC, Canada; CHU Sainte-Justine Research Centre, Université de Montréal, Montreal, QC, Canada
| | | | | | | | | | | | | | - Maryse F Bouchard
- CHU Sainte-Justine Research Centre, Université de Montréal, Montreal, QC, Canada
| | | | | | | | - William Fraser
- CHU Sainte-Justine Research Centre, Université de Montréal, Montreal, QC, Canada; Centre de recherche du CHUS, Sherbrooke, QC, Canada; Université de Sherbrooke, Sherbrooke, QC, Canada
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Mishra S, Rao CR, Shetty A. Trends in the Diagnosis of Gestational Diabetes Mellitus. SCIENTIFICA 2016; 2016:5489015. [PMID: 27190681 PMCID: PMC4844895 DOI: 10.1155/2016/5489015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 03/05/2016] [Accepted: 03/24/2016] [Indexed: 06/05/2023]
Abstract
Introduction. Gestational diabetes mellitus (GDM) is defined as carbohydrate intolerance of variable degree with onset or recognition during pregnancy. As prevalence of diabetes is linked to impaired glucose tolerance during antenatal period, routine antenatal screening of GDM is required. However, screening tests for GDM remain controversial. Objective. To review different diagnostic criteria for GDM. Materials and Methods. Freely accessible, full-text articles from 1964 to 2015, available in PubMed in English language, pertaining to screening of GDM were reviewed. Results. First diagnostic criteria for GDM in 1964 by O'Sullivan and Mahan, modified by the National Diabetes Data Group (NDDG) in 1979 and Carpenter in 1982. The cut-off value as per WHO definition of GDM was 140 mg/dL, 2 hours after 75 g glucose intake. Diabetes in Pregnancy Study Group India (DIPSI), in 2006, endorsed WHO criteria but irrespective of the last meal timings. Being cost-effective, it formed the basis of national guidelines for Indians in 2014. Conclusions. As typical clinical scenarios are usually varied, practical guidelines that meet the constraints of low-resource settings like India are required.
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Affiliation(s)
- Surabhi Mishra
- Department of Community Medicine, Kasturba Medical College, Manipal University, Manipal, Karnataka 576104, India
| | - Chythra R. Rao
- Department of Community Medicine, Kasturba Medical College, Manipal University, Manipal, Karnataka 576104, India
| | - Avinash Shetty
- Department of Community Medicine, Kasturba Medical College, Manipal University, Manipal, Karnataka 576104, India
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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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