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Tsur N, Frankel M, Cahn A, Tsur A. Gestational diabetes and risk of future diabetes in a multi-ethnic population. J Diabetes Complications 2024; 38:108720. [PMID: 38452402 DOI: 10.1016/j.jdiacomp.2024.108720] [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: 02/03/2024] [Revised: 02/28/2024] [Accepted: 03/02/2024] [Indexed: 03/09/2024]
Abstract
AIM To investigate ethnic disparities in risk of gestational diabetes-mellitus (GDM) and future diabetes. METHODS A population-based retrospective cohort study of women who underwent a 100-g oral glucose-tolerance-test (oGTT) during pregnancy between 2007 and 2017 in Clalit-Health-Services of the Jerusalem district. Univariate and multivariate logistic regression analyses were used to compare the risk of GDM in Arab versus Jewish women. Further, Cox-regression analysis was used to establish the risk of future diabetes. RESULTS A total of 9875 women, 71 % of Jewish ethnicity and 29 % of Arab ethnicity were included. Arab women had a higher incidence of GDM compared to Jewish women (17.3 % vs. 10.6 %, p < 0.001), which persisted after adjusting for age, BMI, and metabolic profile (aOR 1.7; CI 1.48-2.0, P < 0.001). Additionally, Arab ethnicity was associated with an increased risk of future diabetes, even after adjusting for GDM status (aHR 5.9; 95 % CI 3.7-9.4, P < 0.001). CONCLUSIONS Women of Arab ethnicity have a higher risk for both GDM and future diabetes, a risk that is beyond the initial increased risk associated with GDM. These findings highlight the need for increased focus on preventing diabetes in women of Arab ethnicity, especially those with a history of GDM.
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Affiliation(s)
- Noa Tsur
- Department of Internal Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Meir Frankel
- Endocrinology Unit, Shaare Zedek Medical Center, Jerusalem, Israel; Department of Endocrinology and Metabolism, Clalit Health Services, Jerusalem, Israel
| | - Avivit Cahn
- The Diabetes Unit, Department of Endocrinology and Metabolism, Hadassah Medical Center, Jerusalem, Israel; The Faculty of Medicine, Hadassah Hebrew University, Jerusalem, Israel
| | - Anat Tsur
- Department of Endocrinology and Metabolism, Clalit Health Services, Jerusalem, Israel; The Faculty of Medicine, Hadassah Hebrew University, Jerusalem, Israel.
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Vinograd A, Wainstock T, Sergienko R, Simon-Tuval T, Yoles I. The association between normal 50-g glucose challenge test results and risk for future metabolic morbidities: A retrospective cohort study. Int J Gynaecol Obstet 2023; 163:265-270. [PMID: 37078487 DOI: 10.1002/ijgo.14803] [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: 11/23/2022] [Revised: 03/27/2023] [Accepted: 03/31/2023] [Indexed: 04/21/2023]
Abstract
OBJECTIVE To study the association between normal glucose challenge test (GCT) results during pregnancy and the incidence of future maternal metabolic morbidities. METHOD This was a population-based retrospective cohort study conducted between the years 2005 and 2020. The study included all women aged 17-55 years who underwent GCT as part of the routine prenatal care at the Central District of Clalit Health Services, Israel. The highest GCT result per woman was categorized into five study groups: <120 (reference), 120-129, 130-139, 140-149, and ≥150 mg/dL. Adjusted hazard ratios of the study groups for metabolic morbidities were calculated with Cox proportional survival analysis models. RESULTS Among a total of 77 568 women participants, 53%, 12.3%, and 10.3% had normal GCT results of <120, 120-129, and 130-139 mg/dL, respectively. During the study period of 6.07 ± 4.35 years, 13 151 (17.0%) cases of metabolic morbidities were documented. High-normal GCT results of 120-129 and 130-139 mg/dL were significantly associated with increased risk for future metabolic morbidity compared with <120 mg/dL (adjusted hazard ratio [aHR] 1.15, 95% confidence interval [CI] 1.08-1.22 and aHR 1.32, 95% CI 1.24-1.41, respectively). CONCLUSION Although GCT is only recommended as a screening tool for gestational diabetes mellitus, high results, even within the normal range, may point to maternal increased risk for future metabolic morbidity.
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Affiliation(s)
- Adi Vinograd
- Department of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Tamar Wainstock
- Department of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ruslan Sergienko
- Department of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Tzahit Simon-Tuval
- Department of Health Policy and Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Israel Yoles
- Central District, Clalit Health Services, Rishon Le-Tzion, Israel
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Beer-Sheva, Israel
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Bardugo A, Bendor CD, Rotem RS, Tsur AM, Derazne E, Gerstein HC, Tzur D, Pinhas-Hamiel O, Cukierman-Yaffe T, Raz I, Hod M, Tirosh A, Lebenthal Y, Afek A, Chodick G, Twig G. Glucose intolerance in pregnancy and risk of early-onset type 2 diabetes: a population-based cohort study. Lancet Diabetes Endocrinol 2023; 11:333-344. [PMID: 37011646 DOI: 10.1016/s2213-8587(23)00062-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 03/01/2023] [Accepted: 03/01/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND The risk of type 2 diabetes among women with glucose intolerance during pregnancy that does not meet gestational diabetes criteria requires further investigation. We aimed to explore the associations between various degrees of gestational glucose intolerance and the risk of type 2 diabetes in young adulthood. METHODS For this population-based cohort study, the national Israeli conscription database was linked to Maccabi Healthcare Services (MHS), the second-largest state-mandated health provider in Israel. We included 177 241 women who underwent a pre-recruitment evaluation at adolescence (age 16-20 years), 1 year before mandatory military service, and later underwent, from Jan 1, 2001, to Dec 31, 2019, two-step gestational diabetes screening with a 50 g glucose challenge test (GCT) based on a threshold of 140 mg/dL (7·8 mmol/L), followed as needed by a 100 g oral glucose tolerance test (OGTT). Abnormal OGTT values were defined according to the Carpenter-Coustan thresholds: 95 mg/dL (5·3 mmol/L) or higher in the fasting state; 180 mg/dL (10·0 mmol/L) or higher at 1 h; 155 mg/dL (8·6 mmol/L) or higher at 2 h; and 140 mg/dL (7·8 mmol/L) or higher at 3 h. The primary outcome was incident type 2 diabetes in the MHS diabetes registry. Cox proportional hazards models were applied to estimate adjusted hazard ratios (HRs) with 95% CIs for incident type 2 diabetes. FINDINGS During a cumulative follow-up of 1 882 647 person-years, and with a median follow-up of 10·8 (IQR 5·2-16·4) years, 1262 women were diagnosed with type 2 diabetes. Crude incidence rates of type 2 diabetes were 2·6 (95% CI 2·4-2·9) per 10 000 person-years in women with gestational normoglycaemia, 8·9 (7·4-10·6) per 10 000 person-years in women with an abnormal GCT and normal OGTT, 26·1 (22·4-30·1) per 10 000 person-years in women with one abnormal OGTT value (in the fasting state or 1 h, 2 h, or 3 h post-challenge), and 71·9 (66·0-78·3) per 10 000 person-years in women with gestational diabetes. After adjustment for sociodemographic characteristics, adolescent BMI, and age at gestational screening, the risk of type 2 diabetes was higher, compared to the gestational normoglycaemia group, in women with an abnormal GCT and normal OGTT (adjusted hazard ratio [HR] 3·39 [95% CI 2·77-4·16]; p<0·0001), in women with one abnormal OGTT value (9·11 [7·64-10·86]; p<0·0001), and in women with gestational diabetes (24·84 [21·78-28·34]; p<0·0001). The risk of type 2 diabetes was modestly increased in women with isolated elevated fasting glucose (adjusted HR 11·81 [95% CI 8·58-16·25]; p<0·0001), and in women with gestational diabetes and an abnormal fasting glucose (38·02 [32·41-44·61]; p<0·0001). INTERPRETATION Gestational glucose intolerance, including conditions not meeting gestational diabetes criteria of the two-step strategy, confers a high risk of type 2 diabetes in young adulthood. These conditions should be recognised as risk factors for type 2 diabetes, especially among women with abnormal fasting glucose concentrations during pregnancy. FUNDING None.
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Affiliation(s)
- Aya Bardugo
- Department of Military Medicine, Hebrew University, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan, Israel
| | - Cole D Bendor
- Department of Military Medicine, Hebrew University, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan, Israel
| | - Ran Shmuel Rotem
- Department of Environmental Health, Harvard T H Chan School of Public Health, Boston, MA, USA; Kahn-Sagol-Maccabi Research and Innovation Institute, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Avishai M Tsur
- Department of Military Medicine, Hebrew University, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan, Israel; Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Medicine "B," Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Estela Derazne
- Department of Military Medicine, Hebrew University, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan, Israel; Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Dorit Tzur
- Department of Military Medicine, Hebrew University, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan, Israel
| | - Orit Pinhas-Hamiel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel
| | - Tali Cukierman-Yaffe
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Ramat Gan, Israel
| | - Itamar Raz
- The Diabetes Unit, Department of Internal Medicine, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Moshe Hod
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Diabetes in Pregnancy Clinic, Perinatal Division, Department of Obstetrics and Gynecology, Beilinson Medical Campus, Petah Tiqva, Israel
| | - Amir Tirosh
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Ramat Gan, Israel
| | - Yael Lebenthal
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Arnon Afek
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Central Management, Sheba Medical Center, Ramat Gan, Israel
| | - Gabriel Chodick
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Maccabitech, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Gilad Twig
- Department of Military Medicine, Hebrew University, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan, Israel; Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Ramat Gan, Israel; The Gertner Institute for Epidemiology & Health Policy Research, Sheba Medical Center, Ramat Gan, Israel.
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Bendor CD, Bardugo A, Rotem RS, Derazne E, Gerstein HC, Tzur D, Pinhas-Hamiel O, Tsur AM, Cukierman-Yaffe T, Lebenthal Y, Afek A, Chodick G, Twig G. Glucose Intolerance in Pregnancy and Offspring Obesity in Late Adolescence. Diabetes Care 2022; 45:1540-1548. [PMID: 35670776 DOI: 10.2337/dc21-2634] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 02/25/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Gestational hyperglycemia is associated with deleterious neonatal outcomes, but long-term risks for offspring obesity are less clear. We estimated the odds for offspring adolescent overweight and obesity among mothers with gestational glucose intolerance. RESEARCH DESIGN AND METHODS In a mother-offspring historical cohort, the Israel military conscription data set was linked to a large health maintenance organization. Included were women who were evaluated at adolescence and underwent two-step gestational diabetes screening (mean age, 31 years) with a 50-g glucose challenge test (GCT), followed by a 100-g oral glucose tolerance test (OGTT) if the result was abnormal. Glucose tolerance categories included gestational normoglycemia, abnormal GCT with normal OGTT, impaired glucose tolerance (IGT; one abnormal OGTT value), and gestational diabetes. The primary outcome was offspring overweight/obesity (BMI ≥85th percentile) at adolescence, measured prior to military conscription. Logistic regression models were applied. RESULTS Of 33,482 mother-offspring pairs, overweight and obesity were observed in 6,516 offspring. Across increasing categories of pregnancy glycemia, the proportions of offspring with adolescent overweight/obesity increased: normoglycemia, 19%; abnormal GCT with normal OGTT, 22%; gestational IGT, 24%; and gestational diabetes, 25% (P < 0.0001). Corresponding odds ratios after adjustment for the mother's late adolescent characteristics (sociodemographic confounders and BMI) and pregnancy age were 1.2 (95% CI 1.1-1.4), 1.3 (1.2-1.5), and 1.4 (1.3-1.6), respectively. Further adjustment for offspring birth weight percentile and sociodemographic variables did not materially change results. Associations were more pronounced with increasing obesity severity. CONCLUSIONS Gestational glucose intolerance, including categories not meeting the gestational diabetes threshold, was associated with increased odds for offspring overweight/obesity at late adolescence.
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Affiliation(s)
- Cole D Bendor
- Department of Military Medicine, Hebrew University, Jerusalem, and the Israel Defense Forces Medical Corps, Ramat Gan, Israel
| | - Aya Bardugo
- Department of Military Medicine, Hebrew University, Jerusalem, and the Israel Defense Forces Medical Corps, Ramat Gan, Israel
| | - Ran Shmuel Rotem
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA.,Kahn-Sagol-Maccabi Research and Innovation Institute, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Estela Derazne
- Department of Military Medicine, Hebrew University, Jerusalem, and the Israel Defense Forces Medical Corps, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Dorit Tzur
- Department of Military Medicine, Hebrew University, Jerusalem, and the Israel Defense Forces Medical Corps, Ramat Gan, Israel
| | - Orit Pinhas-Hamiel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel
| | - Avishai M Tsur
- Department of Military Medicine, Hebrew University, Jerusalem, and the Israel Defense Forces Medical Corps, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Medicine "B," Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Tali Cukierman-Yaffe
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Endocrinology, Sheba Medical Center, Ramat Gan, Israel
| | - Yael Lebenthal
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Arnon Afek
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Central Management, Sheba Medical Center, Ramat Gan, Israel
| | - Gabriel Chodick
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Maccabitech, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Gilad Twig
- Department of Military Medicine, Hebrew University, Jerusalem, and the Israel Defense Forces Medical Corps, Ramat Gan, Israel.,Institute of Endocrinology, Sheba Medical Center, Ramat Gan, Israel.,Department of Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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5
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Di Filippo D, Ahmadzai M, Chang MHY, Horgan K, Ong RM, Darling J, Akhtar M, Henry A, Welsh A. Continuous Glucose Monitoring for the Diagnosis of Gestational Diabetes Mellitus: A Pilot Study. J Diabetes Res 2022; 2022:5142918. [PMID: 36299907 PMCID: PMC9592228 DOI: 10.1155/2022/5142918] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 09/23/2022] [Accepted: 09/29/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is diabetes first diagnosed in pregnancy. GDM, together with its short- and long-term negative outcomes, is increasing in incidence all over the world. The current diagnostic method for GDM, the oral glucose tolerance test (OGTT), is dated and has been reported as inconvenient for women as well as poorly reproducible and reliable. AIMS We aimed at assessing the acceptability, feasibility, and accuracy of continuous glucose monitoring (CGM) as a diagnostic test for GDM and explore its correlation with the OGTT and risk factors for GDM. METHODS In this prospective cohort study, pregnant women due for or having completed OGTT underwent CGM for seven days, performing daily finger-prick blood glucose levels before completing an acceptability questionnaire. Data on GDM risk factors and CGM variability were analyzed and compared with OGTT results. RESULTS Seventy-three women completed CGM (40 GDM, 33 normal glucose tolerances); 34 concurrently underwent OGTT. CGM was acceptable and generally well-tolerated, with skin irritation/itchiness the only adverse event (11 mild, one severe). CGM and OGTT strongly correlated for fasting glucose values (r = 0.86, p < 0.05) only. Triangulating GDM risk factors, OGTT results and CGM variability parameters with the application of machine learning highlighted the possibility of unmasking false positive (11 showed low CGM variability and demographic risks but positive OGTT) and false-negative OGTT diagnoses (1 showed high CGM variability and demographic risks but negative OGTT). CONCLUSIONS CGM was well-tolerated, showing poorer glycaemic control in GDM, and revealing potential misdiagnosis of the OGTT when combined with GDM risk factors. Future research is needed to determine cut-off values for CGM-defined and OGTT-independent screening criteria for GDM.
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Affiliation(s)
- Daria Di Filippo
- School of Women's and Children's Health, University of New South Wales Sydney, Locked Bag 2000, Barker Street, Randwick, NSW 2031, Australia
| | - Marrwah Ahmadzai
- School of Women's and Children's Health, University of New South Wales Sydney, Locked Bag 2000, Barker Street, Randwick, NSW 2031, Australia
| | - Melissa Han Yiin Chang
- School of Women's and Children's Health, University of New South Wales Sydney, Locked Bag 2000, Barker Street, Randwick, NSW 2031, Australia
| | - Ksana Horgan
- School of Women's and Children's Health, University of New South Wales Sydney, Locked Bag 2000, Barker Street, Randwick, NSW 2031, Australia
| | - Ru Min Ong
- School of Women's and Children's Health, University of New South Wales Sydney, Locked Bag 2000, Barker Street, Randwick, NSW 2031, Australia
| | - Justine Darling
- Diabetes Clinic, Royal Hospital for Women, Barker street-Randwick, NSW 2031, Australia
| | - Mahmood Akhtar
- School of Women's and Children's Health, University of New South Wales Sydney, Locked Bag 2000, Barker Street, Randwick, NSW 2031, Australia
| | - Amanda Henry
- School of Women's and Children's Health, University of New South Wales Sydney, Locked Bag 2000, Barker Street, Randwick, NSW 2031, Australia
| | - Alec Welsh
- School of Women's and Children's Health, University of New South Wales Sydney, Locked Bag 2000, Barker Street, Randwick, NSW 2031, Australia
- Department of Maternal-Fetal Medicine, Royal Hospital for Women, Barker street-Randwick, NSW 2031, Australia
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Chodick G, Omer-Gilon M, Derazne E, Puris G, Rotem R, Tzur D, Pinhas-Hamiel O, Cukierman-Yaffe T, Shina A, Zucker I, Tirosh A, Afek A, Shalev V, Twig G. Adolescent body mass index and changes in pre-pregnancy body mass index in relation to risk of gestational diabetes. EClinicalMedicine 2021; 42:101211. [PMID: 34849479 PMCID: PMC8609013 DOI: 10.1016/j.eclinm.2021.101211] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 10/29/2021] [Accepted: 11/04/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Pregestational excessive body mass index (BMI) is linked to an increased risk for gestational diabetes mellitus (GDM), but less is known on the effect of adolescent BMI on GDM occurrence. The study aimed to investigate possible associations of adolescent BMI and changes in BMI experienced before first pregnancy, with gestational diabetes risk. METHODS This retrospective study was based on linkage of a military screening database of adolescent health status (Israel Defence Forces) including measured height and weight, with medical records (Maccabi Healthcare Services, MHS) of a state-mandated health provider. The latter covers about 25% of the Israeli population; about 90% of pregnant women undergo screening by the two-step Carpenter-Coustan method. Adolescent BMI was categorized according to Center of Disease Control and Prevention percentiles. Only first documented pregnanies were analyzed and GDM was the outcome. FINDINGS Of 190,905 nulliparous women, 10,265 (5.4%) developed GDM. Incidence proportions of GDM were 5.1%, 6.1%, 7.3%, and 8.9% among women with adolescent normal BMI, underweight, overweight, and obesity (p<0.001), respectively. In models that accounted for age at pregnancy, birth year, and sociodemographic variables, the adjusted odd ratios (aORs) for developing GDM were: 1.2 (95%CI, 1.1-1.3), 1.5 (1.4-1.6), and 1.9 (1.7-2.1) for adolescent underweight, overweight, and obesity (reference group, normal BMI). Adolescent BMI tracked with BMI notes in the pre-pregnancy period (r=63%). Resuming normal pre-pregnancy BMI from overweight or obesity in adolescence diminished GDM risk, but this diminished risk was not observed among those who returned to a normal per-pre-pregnancy BMI from being underweight in adolescence. Sustained overweight or obesity conferred an aOR for developing GDM of 2.5 (2.2-2.7); weight gain from adolescent underweight and normal BMI to pre-pregnancy excessive BMI conferred aORs of 3.1 (1.6-6.2) and 2.6 (2.2-2.7), respectively. INTERPRETATION Change in BMI status from adolescence to pre-pregnancy may contribute to GDM risk. Identifying at-risk populations is important for early preventive interventions. FUNDING None.
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Affiliation(s)
- Gabriel Chodick
- Maccabitech Research Institute, Maccabi Healthcare Services, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Corresponding Authors: Gabriel Chodick, PhD, Maccabitech Research Institute, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Maayan Omer-Gilon
- Department of Military Medicine, Hebrew University, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan, Israel
| | - Estela Derazne
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gal Puris
- Department of Military Medicine, Hebrew University, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan, Israel
| | - Ran Rotem
- Maccabitech Research Institute, Maccabi Healthcare Services, Tel Aviv, Israel
- Department of Environmental Health, Harvard T H Chan School of Public Health, Boston, MA
| | - Dorit Tzur
- Department of Military Medicine, Hebrew University, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan, Israel
| | - Orit Pinhas-Hamiel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children's Hospital, Institute of Endocrinology, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Tali Cukierman-Yaffe
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Chaim Sheba Medical Center at Tel Hashomer, Ramat Gan, Israel
| | - Avi Shina
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Military Medicine, Hebrew University, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan, Israel
| | - Inbar Zucker
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Israeli Ministry of Health, Jerusalem, Israel
| | - Amir Tirosh
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Chaim Sheba Medical Center at Tel Hashomer, Ramat Gan, Israel
| | - Arnon Afek
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Central Management, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Varda Shalev
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gilad Twig
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Military Medicine, Hebrew University, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan, Israel
- Chaim Sheba Medical Center at Tel Hashomer, Ramat Gan, Israel
- Co-Corresponding Authors: Gilad Twig, M.D., MPH, Ph.D., Academy and Research Division, Surgeon General Headquarters, Israel Defense Forces, Ramat-Gan, Israel
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7
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Poirier J, Kattini R, Kelly L, Madden S, Voth B, Dooley J, Marazan B, Hummelen R. Screening for gestational diabetes in pregnancy in Northwestern Ontario. CANADIAN JOURNAL OF RURAL MEDICINE 2020; 25:61-66. [PMID: 32235107 DOI: 10.4103/cjrm.cjrm_51_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Introduction We estimate the screening and prevalence of gestational diabetes mellitus (GDM) in a primarily first nations obstetrical population in Northwestern Ontario. Methods The study is an 8-year retrospective analysis of all gestational glucose challenge and tolerance tests performed at the Sioux Lookout Meno Ya Win Health Centre (SLMHC) laboratory from 1 January, 2010 to 31 December, 2017. Test, gestational timing and completion rate of screening were recorded, and GDM prevalence was calculated on the tested population. Screening completion rates were recorded for the subset of women who delivered at SLMHC from 2014 to 2017. Results The average annual GDM prevalence was 12%, double the Ontario rate. Over the 8-year period, 513 patients were diagnosed with GDM among the 4298 patients screened. Patients were screened with the 2-step (90%) or the 1-step (10%) protocol. Screening occurred <20 weeks in 3%; 54% occurred in <28 weeks and 40% >28 weeks. Seventy percent of the tests were from remote nursing stations. The screening completion rate for women delivering at SLMHC in 2017 was 80.8%. Conclusion The prevalence of GDM in Northwestern Ontario is twice the provincial rate. Most screening used the 2-step protocol; early screening was underused. Improvements in screening programming are underway and future research may match surveillance rates and results to GDM outcomes.
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Affiliation(s)
- Jenna Poirier
- Sioux Lookout Local Education Group, Sioux Lookout, Canada
| | - Ribal Kattini
- Sioux Lookout Local Education Group, Sioux Lookout, Canada
| | - Len Kelly
- Sioux Lookout Meno Ya Win Health Centre, Sioux Lookout, Canada
| | - Sharen Madden
- Northern Ontario School of Medicine, Sioux Lookout, ON, Canada
| | - Brenda Voth
- Sioux Lookout Meno Ya Win Health Centre, Sioux Lookout, Canada
| | - Joe Dooley
- Northern Ontario School of Medicine, Sioux Lookout, ON, Canada
| | | | - Ruben Hummelen
- Northern Ontario School of Medicine, Sioux Lookout, ON, Canada
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8
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Jaffe A, Giveon S, Rubin C, Novikov I, Ziv A, Kalter-Leibovici O. Gestational diabetes risk in a multi-ethnic population. Acta Diabetol 2020; 57:263-269. [PMID: 31494746 PMCID: PMC7049543 DOI: 10.1007/s00592-019-01404-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 08/06/2019] [Indexed: 11/15/2022]
Abstract
AIMS To compare gestational diabetes mellitus (GDM) risk among two ethnic minority groups, with high type-2 diabetes (T2DM) prevalence, as compared to the Jewish population majority group. METHODS A historical cohort study was conducted using clinical data collected between January 1, 2007, and December 31, 2011. The study sample included 20-45-year-old women; 2938 Ethiopian, 5849 Arab and 5156 non-Ethiopian Jewish women. GDM was defined according to the two-step strategy: step 1: glucose ≥ 140 mg/dl and step 2: using Coustan and Carpenter's diagnostic criteria. GDM risk was tested in a multivariable model, adjusted for age, parity and pre-gestational values of the metabolic syndrome components. RESULTS Mean body mass index (BMI) values and morbid obesity rates were lowest among Ethiopian women and highest among Arab women. The prevalence of pre-gestational diabetes was significantly higher among Ethiopian (2.7%) and Arab (4.1%) women than among non-Ethiopian Jewish women (1.6%), and GDM screening rates were relatively high (85.5%, 87.2% and 83%, respectively). The proportion of pregnancies complicated with GDM was higher among Ethiopian women (4.3%) but not significantly different between Arab (2.9%) and non-Ethiopian Jewish (2.2%) women. In multivariable analysis, GDM was associated with Ethiopian ancestry (OR, 2.55; 95% CI, 1.60-4.08), adjusted for age, BMI, plasma triglyceride level and parity. Arab ethnicity was not significantly associated with GDM risk in multivariable analysis. CONCLUSIONS Both Ethiopian and Arab minority ethnicities have a higher risk of T2DM in comparison with other Israeli women, but only Ethiopian origin is an independent risk factor for GDM while Arab ethnicity is not.
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Affiliation(s)
- Anat Jaffe
- Endocrinology and Diabetes Unit, Hillel Yaffe Medical Center, Hashalom St., 38100 Hadera, Israel
| | | | - Carmit Rubin
- Information and Computerization Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
| | - Ilya Novikov
- Information and Computerization Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
| | - Arnona Ziv
- Information and Computerization Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
| | - Ofra Kalter-Leibovici
- Unit of Cardiovascular Epidemiology, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
- The School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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9
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Petry CJ, Ong KK, Hughes IA, Acerini CL, Dunger DB. Temporal Trends in Maternal Food Intake Frequencies and Associations with Gestational Diabetes: The Cambridge Baby Growth Study. Nutrients 2019; 11:E2822. [PMID: 31752255 PMCID: PMC6893826 DOI: 10.3390/nu11112822] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 11/08/2019] [Accepted: 11/13/2019] [Indexed: 12/11/2022] Open
Abstract
Previous studies have suggested that in the first decade of this century the incidence of gestational diabetes (GDM) in pregnancy rose worldwide. In the Cambridge Baby Growth Study cohort we observed that this temporal trend was associated with an index of multiple deprivation and reductions in indices of insulin secretion. Deprivation level was not directly associated with GDM, suggesting that the temporal trend may relate more to other factors linked to it, such as dietary composition. In this study we investigated temporal trends in perceived food intake frequencies, derived from a qualitative, short questionnaire, in 865 pregnant Cambridge Baby Growth Study (CBGS) recruits. A number of food frequency ranks showed both temporal trends and associations with GDM, but of note is the frequency of egg consumption (negative temporal trend p = 0.03, slope = -6.2 ranks/year; negative association with GDM p = 3.0 × 10-8, slope = -0.002 increased risk/rank) as it was also positively associated with the insulin disposition index (p = 1.17 × 10-3, slope = 0.42 ranks. L/mmoL). These results are consistent with a potential protective effect of factors related to the frequency of egg consumption in pregnancy. Such factors may have contributed to the observed temporal trend in GDM risk but the overall detectable effect appears to have been small.
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Affiliation(s)
- Clive J. Petry
- Department of Paediatrics, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK; (K.K.O.); (I.A.H.); (D.B.D.)
| | - Ken K. Ong
- Department of Paediatrics, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK; (K.K.O.); (I.A.H.); (D.B.D.)
- MRC Epidemiology Unit, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK
- Institute of Metabolic Science, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK
| | - Ieuan A. Hughes
- Department of Paediatrics, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK; (K.K.O.); (I.A.H.); (D.B.D.)
| | - Carlo L. Acerini
- Department of Paediatrics, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK; (K.K.O.); (I.A.H.); (D.B.D.)
| | - David B. Dunger
- Department of Paediatrics, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK; (K.K.O.); (I.A.H.); (D.B.D.)
- Institute of Metabolic Science, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK
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10
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Maroufizadeh S, Navid B, Alizadeh A, Amini P, Almasi-Hashiani A, Mohammadi M, Khedmati Morasae E, Omani-Samani R. Risk of gestational diabetes mellitus following assisted reproductive technology: systematic review and meta-analysis of 59 cohort studies. J Matern Fetal Neonatal Med 2019; 34:2731-2740. [PMID: 31570010 DOI: 10.1080/14767058.2019.1670790] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The use of assisted reproductive technology (ART) has been associated with an increased risk of gestational diabetes mellitus (GDM) in previous studies, but its risk has not been consistent. Therefore, we aimed to estimate the risk of GDM in women who conceived with ART via a systematic review and meta-analysis of cohort studies. METHODS ISI Web of Knowledge, Medline/PubMed, Scopus, and Embase databases were searched to identify studies that evaluated the risk of GDM through May 2017 using the relevant keywords. Two reviewers independently performed the screening, data extraction, and quality assessment. Meta-analysis was performed with a random effects model. RESULTS The search yielded 957 records relating to GDM and use of ART, from which 59 eligible cohorts were selected for meta-analysis (n = 96,785). There was evidence of substantial heterogeneity among these studies (χ(58)2 = 3072.34, p < .001; I2=98.1%). The pooled estimate of GDM risk using the random effects model was 9.00% (95% CI: 7.90-10.20). Visual inspection of the funnel plot indicated the presence of low publication bias, but Egger's test did not reveal publication bias. CONCLUSIONS The findings revealed that the risk of GDM was very high among women who conceived with ART treatment. GDM screening, management, and improved care are vital in ART pregnancy.
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Affiliation(s)
- Saman Maroufizadeh
- School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Behnaz Navid
- Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Ahad Alizadeh
- Metabolic Diseases Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Payam Amini
- Department of Biostatistics and Epidemiology, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Amir Almasi-Hashiani
- Department of Epidemiology, School of Health, Arak University of Medical Sciences, Arak, Iran
| | - Maryam Mohammadi
- Department of Biostatistics, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Esmaeil Khedmati Morasae
- Department of Health Services Research, Institute of Psychology, Health, and Society, University of Liverpool, Liverpool, UK
| | - Reza Omani-Samani
- Department of Medical Ethics and Law, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
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11
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Petry CJ, Fisher BG, Ong KK, Hughes IA, Acerini CL, Dunger DB. Temporal trends without seasonal effects on gestational diabetes incidence relate to reductions in indices of insulin secretion: the Cambridge Baby Growth Study. Acta Diabetol 2019; 56:1133-1140. [PMID: 31087162 PMCID: PMC6746879 DOI: 10.1007/s00592-019-01354-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 04/26/2019] [Indexed: 12/16/2022]
Abstract
AIMS The incidence of gestational diabetes has been reported to have risen over the first decade of this century. Some studies have also found it to vary with seasons of the year. We investigated temporal and seasonal trends on gestational diabetes incidence in a single-centre cohort study from Cambridge, UK, and attempted to explain trends using associated risk factors. METHODS Using a cosinor model, we tested both temporal and seasonal trends in gestational diabetes incidence in 1074 women recruited to the Cambridge Baby Growth Study in 2001-2009 who underwent oral glucose tolerance tests around week 28 of pregnancy. RESULTS There was a temporal increase in gestational diabetes incidence over the course of recruitment to this study [0.014 (0.005, 0.022) proportional increase per year, p = 2.1 × 10-3], but no seasonal effect (p = 0.7). HOMA B [- 0.015 (- 0.025, - 0.005) per year, p = 3.0 × 10-3] and the insulin disposition index [- 0.036 (- 0.060, - 0.013) per year, p = 3.0 × 10-3], unlike HOMA S, showed negative temporal trends. Risk factor analyses showed a concomitant temporal slight increase in the index of multiple deprivation [0.191 (0.138, 0.257) units per year, p = 4.6 × 10-10]. This index was positively associated with HOMA B (p = 6.1 × 10-5) but not directly with gestational diabetes (p = 0.6), HOMA S (p = 0.2) or the insulin disposition index (p = 0.4). CONCLUSIONS In this cohort, there were temporal, but not seasonal, increases in gestational diabetes incidence between the years 2001 and 2009, which appeared to be related more to reductions in insulin secretion than sensitivity. Possible mediators of this link include confounding factors related to deprivation.
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Affiliation(s)
- Clive J Petry
- Department of Paediatrics, University of Cambridge, Box 116, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK.
| | - Benjamin G Fisher
- Department of Paediatrics, University of Cambridge, Box 116, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
| | - Ken K Ong
- Department of Paediatrics, University of Cambridge, Box 116, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, CB2 0QQ, UK
- The Institute of Metabolic Science, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Ieuan A Hughes
- Department of Paediatrics, University of Cambridge, Box 116, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
| | - Carlo L Acerini
- Department of Paediatrics, University of Cambridge, Box 116, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
| | - David B Dunger
- Department of Paediatrics, University of Cambridge, Box 116, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
- The Institute of Metabolic Science, University of Cambridge, Cambridge, CB2 0QQ, UK
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12
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Badakhsh M, Daneshi F, Abavisani M, Rafiemanesh H, Bouya S, Sheyback M, Rezaie Keikhaie K, Balouchi A. Prevalence of gestational diabetes mellitus in Eastern Mediterranean region: a systematic review and meta-analysis. Endocrine 2019; 65:505-514. [PMID: 31376101 DOI: 10.1007/s12020-019-02026-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 07/19/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE Gestational diabetes mellitus (GDM) is one of the costly challenges in the health field. Despite the individual studies in the Eastern Mediterranean, there is no comprehensive study in this regard. The aim of this study was to determine the prevalence of GDM in the Eastern Mediterranean region. METHODS In this meta-analysis and systematic review, three international databases (PubMed, Web of science and Scopus) were searched from inception until 30 December 2018. The Hui tool was used to assess the quality of the included studies. RESULTS Thirty-three studies performed on 887166 participants were included in the meta-analysis. Based on the results of random effect method, the overall prevalence of GDM was 11.7%. Between six country with have three or more study, pooled prevalence for Saudi Arabi it was 3.6 times more than Israel (17.6 vs. 4.9%), and for Pakistan, Qatar, Bahrain and Iran were 15.3%, 14.7%, 12.2%, and 8.6%, respectively. CONCLUSION Despite the high diversity of methods, the results of the present study indicate a high prevalence of GDM in the Eastern Mediterranean region, indicating more policymakers' interest in timely screening and proper management.
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Affiliation(s)
- Mahin Badakhsh
- Department of Midwifery, School of Nursing and Midwifery, Zabol University of Medical Science, Zabol, Iran
| | - Fereshteh Daneshi
- Department of Pediatric Nursing, School of Nursing and Midwifery, Jiroft University of Medical Sciences, Jiroft, Iran
| | - Mahnaz Abavisani
- MSc of Medical Surgical Nursing, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Hosien Rafiemanesh
- Student Research Committee, Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Salehoddin Bouya
- Clinical Immunology Research Center, Ali-ebne Abitaleb Hospital, Zahedan University of Medical Sciences, Zahedan, Iran
| | | | | | - Abbas Balouchi
- Student Research Committee, Nursing and Midwifery School, Iran University of Medical Sciences, Tehran, Iran
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13
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Pregnant Women Become Sweeter: A Population-Based Study of Trends in Glucose Challenge Test Results Over a Decade. J Womens Health (Larchmt) 2019; 28:1322-1326. [DOI: 10.1089/jwh.2018.7227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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14
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Behboudi-Gandevani S, Amiri M, Bidhendi Yarandi R, Ramezani Tehrani F. The impact of diagnostic criteria for gestational diabetes on its prevalence: a systematic review and meta-analysis. Diabetol Metab Syndr 2019; 11:11. [PMID: 30733833 PMCID: PMC6359830 DOI: 10.1186/s13098-019-0406-1] [Citation(s) in RCA: 177] [Impact Index Per Article: 35.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 01/22/2019] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The absence of universal gold standards for screening of gestational diabetes (GDM) has led to heterogeneity in the identification of GDM, thereby impacting the accurate estimation of the prevalence of GDM. We aimed to evaluate the effect of different diagnostic criteria for GDM on its prevalence among general populations of pregnant women worldwide, and also to investigate the prevalence of GDM based on various geographic regions. METHODS A comprehensive literature search was performed in PubMed, Scopus and Google-scholar databases for retrieving articles in English investigating the prevalence of GDM. All populations were classified to seven groups based-on their diagnostic criteria for GDM. Heterogeneous and non-heterogeneous results were analyzed using the fixed effect and random-effects inverse variance model for calculating the pooled effect. Publication bias was assessed by Begg's test. The Meta-prop method was used for the pooled estimation of the prevalence of GDM. Meta-regression was conducted to explore the association between prevalence of GDM and its diagnostic criteria. Modified Newcastle-Ottawa Quality Assessment Scale for nonrandomized studies was used for quality assessment of the studies included; the ROBINS and the Cochrane Collaboration's risk of bias assessment tools were used to evaluate the risk of bias. RESULTS We used data from 51 population-based studies, i.e. a study population of 5,349,476 pregnant women. Worldwide, the pooled overall-prevalence of GDM, regardless of type of screening threshold categories was 4.4%, (95% CI 4.3-4.4%). The pooled overall prevalence of GDM in the diagnostic threshold used in IADPSG criteria was 10.6% (95% CI 10.5-10.6%), which was the highest pooled prevalence of GDM among studies included. Meta-regression showed that the prevalence of GDM among studies that used the IADPSG criteria was significantly higher (6-11 fold) than other subgroups. The highest and lowest prevalence of GDM, regardless of screening criteria were reported in East-Asia and Australia (Pooled-P = 11.4%, 95% CI 11.1-11.7%) and (Pooled-P = 3.6%, 95% CI 3.6-3.7%), respectively. CONCLUSION Over the past quarter century, the diagnosis of gestational diabetes has been changed several times; along with worldwide increasing trend of obesity and diabetes, reducing the threshold of GDM is associated with a significant increase in the incidence of GDM. The harm and benefit of reducing the threshold of diagnostic criteria on pregnancy outcomes, women's psychological aspects, and health costs should be evaluated precisely.
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Affiliation(s)
- Samira Behboudi-Gandevani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No 24, Parvane Street, Yaman Street, Velenjak, Tehran, P.O.Box: 19395-4763, Iran
| | - Mina Amiri
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No 24, Parvane Street, Yaman Street, Velenjak, Tehran, P.O.Box: 19395-4763, Iran
| | - Razieh Bidhendi Yarandi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Poor sina street, Tehran, P.O.Box: 1417653761, Iran
| | - Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No 24, Parvane Street, Yaman Street, Velenjak, Tehran, P.O.Box: 19395-4763, Iran
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15
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Lee KW, Ching SM, Ramachandran V, Yee A, Hoo FK, Chia YC, Wan Sulaiman WA, Suppiah S, Mohamed MH, Veettil SK. Prevalence and risk factors of gestational diabetes mellitus in Asia: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2018; 18:494. [PMID: 30547769 PMCID: PMC6295048 DOI: 10.1186/s12884-018-2131-4] [Citation(s) in RCA: 243] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Accepted: 11/30/2018] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is a of the major public health issues in Asia. The present study aimed to determine the prevalence of, and risk factors for GDM in Asia via a systematic review and meta-analysis. METHODS We systematically searched PubMed, Ovid, Scopus and ScienceDirect for observational studies in Asia from inception to August 2017. We selected cross sectional studies reporting the prevalence and risk factors for GDM. A random effects model was used to estimate the pooled prevalence of GDM and odds ratio (OR) with 95% confidence interval (CI). RESULTS Eighty-four studies with STROBE score ≥ 14 were included in our analysis. The pooled prevalence of GDM in Asia was 11.5% (95% CI 10.9-12.1). There was considerable heterogeneity (I2 > 95%) in the prevalence of GDM in Asia, which is likely due to differences in diagnostic criteria, screening methods and study setting. Meta-analysis demonstrated that the risk factors of GDM include history of previous GDM (OR 8.42, 95% CI 5.35-13.23); macrosomia (OR 4.41, 95% CI 3.09-6.31); and congenital anomalies (OR 4.25, 95% CI 1.52-11.88). Other risk factors include a BMI ≥25 kg/m2 (OR 3.27, 95% CI 2.81-3.80); pregnancy-induced hypertension (OR 3.20, 95% CI 2.19-4.68); family history of diabetes (OR 2.77, 2.22-3.47); history of stillbirth (OR 2.39, 95% CI 1.68-3.40); polycystic ovary syndrome (OR 2.33, 95% CI1.72-3.17); history of abortion (OR 2.25, 95% CI 1.54-3.29); age ≥ 25 (OR 2.17, 95% CI 1.96-2.41); multiparity ≥2 (OR 1.37, 95% CI 1.24-1.52); and history of preterm delivery (OR 1.93, 95% CI 1.21-3.07). CONCLUSION We found a high prevalence of GDM among the Asian population. Asian women with common risk factors especially among those with history of previous GDM, congenital anomalies or macrosomia should receive additional attention from physician as high-risk cases for GDM in pregnancy. TRIAL REGISTRATION PROSPERO (2017: CRD42017070104 ).
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Affiliation(s)
- Kai Wei Lee
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Malaysia
| | - Siew Mooi Ching
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Malaysia
- Malaysian Research Institute on Ageing, Universiti Putra Malaysia, 43400 Serdang, Malaysia
| | - Vasudevan Ramachandran
- Malaysian Research Institute on Ageing, Universiti Putra Malaysia, 43400 Serdang, Malaysia
| | - Anne Yee
- Department of Psychological Medicine, University of Malaya Center for Addiction Sciences (UMCAS), Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Fan Kee Hoo
- Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Malaysia
| | - Yook Chin Chia
- Department of Medical Sciences, School of Healthcare and Medical Sciences, Sunway University, 47500 Bandar Sunway, Selangor Malaysia
| | - Wan Aliaa Wan Sulaiman
- Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Malaysia
| | - Subapriya Suppiah
- Department of Imaging, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Malaysia
| | - Mohd Hazmi Mohamed
- Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Malaysia
| | - Sajesh K. Veettil
- Department of Pharmacy Practice, School of Pharmacy, International Medical University, 57000 Kuala Lumpur, Malaysia
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Hocaoglu M, Turgut A, Guzin K, Yardimci OD, Gunay T, Bor ED, Akdeniz E, Karateke A. Why some pregnant women refuse glucose challenge test? Turkish pregnant women's perspectives for gestational diabetes mellitus screening. North Clin Istanb 2018; 6:7-12. [PMID: 31180376 PMCID: PMC6526983 DOI: 10.14744/nci.2018.37167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 01/08/2018] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Diabetes in pregnancy is associated with several adverse outcomes for both mother and baby. Awareness is the first step toward identifying pregnant women with diabetes. The purpose of this study was to assess Turkish pregnant women's opinion and practice about 50-g glucose challenge test (GCT) and to assess the reasons why some of them refuse the test. METHODS This study was conducted on 312 patients at any age and gestational week in Istanbul, Turkey, by a personal interview using self-created questionnaire. Women were asked about their opinion and practice about 50-g GCT. RESULTS Among women who were ≤28 weeks of gestation, 42.5% (n=82/193) exhibited their desire to have a GCT in their ongoing pregnancy, 40.9% (n=79/193) pointed out their reluctance, and 16.6% (n=32/193) indicated that they had no opinion about the subject. Women who were ≤28 weeks of gestation and did not want to have GCT, were asked to explain the reasons of their reluctance. The most frequently indicated reason was the belief that GCT is harmful for their babies and themselves (n=62/79, 78.5%). Of the women who were >28 weeks of gestation, 37.8% (n=45/119) had GCT in the ongoing pregnancy, while 62.2% (n=74/119) did not have GCT. The most frequently indicated reason why women did not have a GCT was the belief that GCT is harmful for themselves and the baby (n=37/74, 50%). CONCLUSION This study exposes an important problem - misinformation about 50-g GCT - that carries a dangerous potential for missing the diagnosis of gestational diabetes. Study findings put forth the need for raising awareness among pregnant women and training health-care professionals about the subject.
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Affiliation(s)
- Meryem Hocaoglu
- Department of Obstetrics and Gynecology, Istanbul Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Abdulkadir Turgut
- Department of Obstetrics and Gynecology, Istanbul Medeniyet University Faculty of Medicine, Istanbul, Turkey
| | - Kadir Guzin
- Department of Obstetrics and Gynecology, Kahramanmaras Sutcu Imam University Faculty of Medicine, Kahramanmaras, Turkey
| | - Oguz Devrim Yardimci
- Department of Obstetrics and Gynecology, Istanbul Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Taner Gunay
- Department of Obstetrics and Gynecology, Istanbul Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Ergul Demircivi Bor
- Department of Obstetrics and Gynecology, Istanbul Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Esra Akdeniz
- Division of Biostatistics, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Ates Karateke
- Department of Obstetrics and Gynecology, Istanbul Medeniyet University Faculty of Medicine, Istanbul, Turkey
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Frank Wolf M, Peleg D, Stahl-Rosenzweig T, Kurzweil Y, Yogev Y. Isolated polyhydramnios in the third trimester: is a gestational diabetes evaluation of value? . Gynecol Endocrinol 2017; 33:849-852. [PMID: 28488900 DOI: 10.1080/09513590.2017.1323857] [Citation(s) in RCA: 9] [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] [Indexed: 10/19/2022] Open
Abstract
We evaluated implications of testing for gestational diabetes mellitus (GDM) in pregnancies complicated by third trimester isolated polyhydramnios with previous negative diabetes screening test. In this retrospective cohort study of 104 pregnant women with polyhydramnios between 2005 and 2013, all had normal first trimester fasting glucose and normal glucose challenge test (GCT < 140 mg/dL). Late onset GDM was diagnosed in five women (4.8%) with isolated polyhydramnios, one abnormal value in the oral glucose tolerance test (OGTT) was identified in four additional women (3.8%). No significant differences were found in risk factors for GDM, mean second trimester GCT (117.5 vs. 107.2 mg/dL, p = 0.38) or fasting glucose values (82 vs. 86 mg/dL, p = 0.29) between women in the polyhydramnios group with and without late GDM diagnosis. Moreover, no significant difference was found in relation to the mode of delivery or birth weight between the studied groups (3437 ± 611 vs. 3331 ± 515 g, p = 0.63). Diagnosis of third trimester polyhydramnios was not associated with increased risk for GDM or neonatal complications.
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Affiliation(s)
- Maya Frank Wolf
- a Department of Obstetrics & Gynecology , Galilee Medical Center, Ziv Medical Center, Faculty of Medicine in Galilee, Bar-Ilan University , Zefat , Israel
| | - David Peleg
- b Department of Obstetrics and Gynecology , Ziv Medical Center, Faculty of Medicine in Galilee, Bar-Ilan University , Zefat , Israel
| | - Talia Stahl-Rosenzweig
- c Department of Obstetrics and Gynecology , Baruch Padeh Medical Center , Poriya , Israel
| | - Yaffa Kurzweil
- d Department of Obstetrics and Gynecology , Assaf Harofeh Medical Center , Zerifin , Israel
| | - Yariv Yogev
- e Helen Schneider Hospital for Women, Rabin Medical Center , Petach Tikva , Israel , and
- f Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel
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Donovan LE, Savu A, Edwards AL, Johnson JA, Kaul P. Prevalence and Timing of Screening and Diagnostic Testing for Gestational Diabetes Mellitus: A Population-Based Study in Alberta, Canada. Diabetes Care 2016; 39:55-60. [PMID: 26486187 DOI: 10.2337/dc15-1421] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 09/03/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The extent to which pregnant women are screened for gestational diabetes mellitus (GDM) at the population level is not known. We examined the rate, type, and timing of GDM screening and diagnostic testing in the province of Alberta, Canada. Geographic and temporal differences in screening rates, and maternal risk factors associated with lower likelihood of screening, were also determined. RESEARCH DESIGN AND METHODS Our retrospective linked-database cohort study included 86,842 primiparous women with deliveries between 1 October 2008 and 31 December 2012. Multivariable logistic regression analysis was used to examine maternal factors associated with lower likelihood of GDM screening. RESULTS Overall, 94% (n = 81,304) of women underwent some form of glycemic assessment in the 270 days prior to delivery. The majority (91%) received a 50-g glucose screen (GDS). Women not screened were younger and more likely to smoke and had lower maternal weight and median household income. When a diagnostic 75-g oral glucose tolerance test (OGTT) was indicated, it occurred a median of 10 (interquartile range 7, 15) days after the screen. CONCLUSIONS GDS occurred widely in a system where it was universally recommended and paid for publicly. When indicated, a 75-g OGTT was completed within 15 days in 75% of cases. Our finding that this two-step approach was widely implemented in a timely fashion supports continued endorsement of a two-step approach to screening and diagnosis of GDM. Further research is merited to assess whether the one-step GDM diagnostic approach results in different rates and timing of the 75-g OGTT and affects pregnancy outcomes.
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Affiliation(s)
- Lois E Donovan
- Division of Endocrinology and Metabolism, Department of Medicine, University of Calgary, Calgary, Alberta, Canada Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada
| | - Anamaria Savu
- Canadian VIGOUR Center, University of Alberta, Edmonton, Alberta, Canada
| | - Alun L Edwards
- Division of Endocrinology and Metabolism, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jeffrey A Johnson
- Canadian VIGOUR Center, University of Alberta, Edmonton, Alberta, Canada
| | - Padma Kaul
- Canadian VIGOUR Center, University of Alberta, Edmonton, Alberta, Canada School of Public Health, University of Alberta, Edmonton, Alberta, Canada Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Cho GJ, Kim LY, Sung YN, Kim JA, Hwang SY, Hong HR, Hong SC, Oh MJ, Kim HJ. Secular Trends of Gestational Diabetes Mellitus and Changes in Its Risk Factors. PLoS One 2015; 10:e0136017. [PMID: 26292282 PMCID: PMC4546365 DOI: 10.1371/journal.pone.0136017] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Accepted: 07/30/2015] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the secular trends of incidence of gestational diabetes mellitus (GDM) and insulin treatment for GDM in a Korean population and to determine the factors that contribute to the trends in the incidence of GDM. STUDY DESIGN We used data collected by the Health Insurance Review & Assessment Service of Korea and analyzed data from women who had given birth from 2006 to 2010. We evaluated the trends in the incidence of GDM and GDM requiring insulin treatment and the changes in risk factors. RESULTS There were 1,824,913 births during the study period, which included 129,666 cases of GDM, an incidence of 7.11% over this period. The incidence of GDM increased from 3.86% in 2007 to 11.83% in 2010, with a continuous increase after adjustment for age. However, the number of GDM cases that required insulin treatment decreased significantly from 13.87% in 2007 to 5.94% in 2010. The proportion of patients who were at an older age and multiparity, 2 GDM risk factors, increased during the study period. CONCLUSIONS In Korea, the incidence of GDM, especially mild GDM, increased dramatically during the period from 2006 to 2010. Further efforts are needed to monitor this trend and to identify associated factors.
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Affiliation(s)
- Geum Joon Cho
- Department of Obstetrics and Gynecology, College of Medicine, Korea University, Seoul, Korea
| | - Log Young Kim
- The Health Insurance Review & Assessment Service of Korea, Seoul, Korea
| | - Ye Na Sung
- The Health Insurance Review & Assessment Service of Korea, Seoul, Korea
| | - Jee Ae Kim
- The Health Insurance Review & Assessment Service of Korea, Seoul, Korea
| | - Soon Young Hwang
- Department of Biostatistics, College of Medicine, Korea University, Seoul, Korea
| | - Hye-Ri Hong
- Department of Obstetrics and Gynecology, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Soon-Cheol Hong
- Department of Obstetrics and Gynecology, College of Medicine, Korea University, Seoul, Korea
| | - Min-Jeong Oh
- Department of Obstetrics and Gynecology, College of Medicine, Korea University, Seoul, Korea
| | - Hai-Joong Kim
- Department of Obstetrics and Gynecology, College of Medicine, Korea University, Seoul, Korea
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Nicotra F, Molinari C, Dozio N, Castiglioni MT, Ibrahim B, Zambon A, Corrao G, Scavini M. Screening for gestational diabetes in the Lombardy region: A population-based study. DIABETES & METABOLISM 2014; 41:319-325. [PMID: 25530450 DOI: 10.1016/j.diabet.2014.11.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 09/24/2014] [Accepted: 11/18/2014] [Indexed: 12/12/2022]
Abstract
AIM As the treatment of hyperglycaemia during pregnancy with diet or insulin reduces the risk of adverse maternal outcomes and perinatal complications, screening for gestational diabetes mellitus (GDM) is included, albeit to variable extents, in all guidelines of care for pregnant women. The aim of the present investigation was to estimate the proportion of pregnancies screened for GDM in Lombardy between 2007 and 2010, and to identify predictors of screening. METHODS A retrospective cross-sectional study using regional healthcare utilization databases of Lombardy was conducted. The study included all residents of Lombardy without pregestational diabetes who delivered between 1 January 2007 and 31 December 2010. The proportion of pregnancies with at least one screening test for GDM was calculated, along with the odds ratios and 95% confidence intervals associated with selected covariates for GDM screening. RESULTS Of the 362,818 pregnancies included in the sample, 30% were screened for GDM. The proportion of pregnancies screened increased slightly from 2007 (27%) to 2010 (33%) and with maternal age (from 28% among women<25 years to 32% among those ≥35 years), and varied widely across local health management organizations (HMOs) of residence (range: 20% to 68%). Socioeconomic indicators (education, immigrant status), obstetric history and prepregnancy hypertension were independent predictors of GDM screening. CONCLUSION The study finding of a low rate of pregnant women screened for GDM among residents of Lombardy supports the need for programmes to improve training of healthcare professionals, to raise women's awareness of GDM and to eliminate barriers to GDM screening.
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Affiliation(s)
- F Nicotra
- Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, Laboratory of Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Via Bicocca degli Arcimboldi 8, 20126 Milan, Italy
| | - C Molinari
- Università Vita Salute San Raffaele, Department of Internal Medicine, Division of General Internal Medicine, Diabetes and Endocrine Diseases, IRCCS San Raffaele Scientific Institute, via Olgettina, 60, 20132 Milan, Italy
| | - N Dozio
- Università Vita Salute San Raffaele, Department of Internal Medicine, Division of General Internal Medicine, Diabetes and Endocrine Diseases, IRCCS San Raffaele Scientific Institute, via Olgettina, 60, 20132 Milan, Italy
| | - M T Castiglioni
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Scientific Institute, via Olgettina, 60, 20132 Milan, Italy
| | - B Ibrahim
- Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, Laboratory of Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Via Bicocca degli Arcimboldi 8, 20126 Milan, Italy
| | - A Zambon
- Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, Laboratory of Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Via Bicocca degli Arcimboldi 8, 20126 Milan, Italy.
| | - G Corrao
- Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, Laboratory of Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Via Bicocca degli Arcimboldi 8, 20126 Milan, Italy
| | - M Scavini
- Division of Immunology, Transplantation and Infectious Diseases, Diabetes Research Institute (DRI), IRCCS San Raffaele Scientific Institute, via Olgettina, 60, 20132 Milan, Italy
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Elective induction of labor in women with gestational diabetes mellitus: an intervention that modifies the risk of cesarean section. Arch Gynecol Obstet 2014; 290:905-12. [PMID: 24973018 DOI: 10.1007/s00404-014-3313-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 06/04/2014] [Indexed: 10/25/2022]
Abstract
AIM To evaluate the effect of elective induction at term for women with gestational diabetes mellitus (GDM) on the risk for cesarean delivery. STUDY DESIGN This is a retrospective case-control matched study, based on a single-center computerized database, 2005-2011. The medical records were reviewed for GDM management and glycemic control. For the study, two groups were defined: Group 1, women diagnosed with GDM with an estimated fetal weight <4,000 g, electively induced at term; Group 2, women induced due to Term-PROM, an indication for term induction in normoglycemic women with uncomplicated pregnancies, matched for age and parity (ratio 1:2). The primary outcome was cesarean delivery and secondary outcomes included other maternal and neonatal events. Descriptive analyses and multivariate analyses models were fitted. RESULTS GDM was diagnosed in 1,873 (2.6 %) women of 72,374 births; 227 (12.1 %) were eligible for inclusion in Group 1 and matched with 454 women in Group 2. GDM management included diet in 103 (45.4 %), insulin in 81 (35.7 %), and oral hypoglycemic agents in 43 (18.9 %).The cesarean delivery rate was significantly higher in Group 1, 17.1 vs. 11.2 % (p = 0.02). Three out of four births complicated by shoulder dystocia and BW <4,000 g, occurred in Group 1 (p = 0.076) and were associated with no glycemic control. Other obstetrical-related outcomes such as instrumental birth, severe perineal tears, early postpartum hemorrhage and peripartum transfusion were similar between groups. CONCLUSION Elective induction at term for women with GDM is associated with an increased risk for cesarean delivery as compared to other elective induction of labor.
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Trabert B, Chodick G, Shalev V, Sella T, Longnecker MP, McGlynn KA. Gestational diabetes and the risk of cryptorchidism and hypospadias. Epidemiology 2014; 25:152-3. [PMID: 24296929 PMCID: PMC3928021 DOI: 10.1097/ede.0000000000000014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Britton Trabert
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, Medical Division, Maccabi Healthcare Services, Tel Aviv, Israel, Sackler Faculty of Tel-Aviv University, Tel Aviv, Israel Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD
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