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Benham JL, Gingras V, McLennan NM, Most J, Yamamoto JM, Aiken CE, Ozanne SE, Reynolds RM. Precision gestational diabetes treatment: a systematic review and meta-analyses. COMMUNICATIONS MEDICINE 2023; 3:135. [PMID: 37794196 PMCID: PMC10550921 DOI: 10.1038/s43856-023-00371-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 09/25/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Gestational Diabetes Mellitus (GDM) affects approximately 1 in 7 pregnancies globally. It is associated with short- and long-term risks for both mother and baby. Therefore, optimizing treatment to effectively treat the condition has wide-ranging beneficial effects. However, despite the known heterogeneity in GDM, treatment guidelines and approaches are generally standardized. We hypothesized that a precision medicine approach could be a tool for risk-stratification of women to streamline successful GDM management. With the relatively short timeframe available to treat GDM, commencing effective therapy earlier, with more rapid normalization of hyperglycaemia, could have benefits for both mother and fetus. METHODS We conducted two systematic reviews, to identify precision markers that may predict effective lifestyle and pharmacological interventions. RESULTS There was a paucity of studies examining precision lifestyle-based interventions for GDM highlighting the pressing need for further research in this area. We found a number of precision markers identified from routine clinical measures that may enable earlier identification of those requiring escalation of pharmacological therapy (to metformin, sulphonylureas or insulin). This included previous history of GDM, Body Mass Index and blood glucose concentrations at diagnosis. CONCLUSIONS Clinical measurements at diagnosis could potentially be used as precision markers in the treatment of GDM. Whether there are other sensitive markers that could be identified using more complex individual-level data, such as omics, and if these can feasibly be implemented in clinical practice remains unknown. These will be important to consider in future studies.
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Affiliation(s)
- Jamie L Benham
- Department of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Véronique Gingras
- Department of Nutrition, Université de Montréal, Montreal, QC, Canada
- Research Center, Sainte-Justine University Hospital Center, Montreal, QC, Canada
| | - Niamh-Maire McLennan
- MRC Centre for Reproductive Health, Queens's Medical Research Institute, University of Edinburgh, Edinburgh, UK
- Centre for Cardiovascular Science, Queens's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Jasper Most
- Department of Orthopedics, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | | | - Catherine E Aiken
- Department of Obstetrics and Gynaecology, the Rosie Hospital, Cambridge, UK
- NIHR Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | - Susan E Ozanne
- University of Cambridge Metabolic Research Laboratories and MRC Metabolic Diseases Unit, Wellcome-MRC Institute of Metabolic Science, Cambridge, UK
| | - Rebecca M Reynolds
- MRC Centre for Reproductive Health, Queens's Medical Research Institute, University of Edinburgh, Edinburgh, UK.
- Centre for Cardiovascular Science, Queens's Medical Research Institute, University of Edinburgh, Edinburgh, UK.
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Balke S, Weid P, Fangmann L, Rostin P, Henrich W, Koenigbauer JT. Glucose Levels of the Oral Glucose Tolerance Test (oGTT) Can Predict Adverse Pregnancy Outcomes in Women with Gestational Diabetes (GDM). J Clin Med 2023; 12:3709. [PMID: 37297904 PMCID: PMC10254013 DOI: 10.3390/jcm12113709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 05/23/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023] Open
Abstract
OBJECTIVES AND BACKGROUND Gestational diabetes (GDM) is a common pregnancy complication defined as a glucose intolerance diagnosis during pregnancy. GDM is strongly associated with adverse fetal and maternal outcomes. In Germany, to screen and diagnose GDM we use a 1 h 50 g oGCT (oral glucose challenge test) followed by a 2 h 75 g oGTT if the first was pathological. This analysis examines the correlation of 75 g oGTT glucose levels and fetomaternal outcome. METHODS Data from 1664 patients from a gestational diabetes consultation clinic at the Charité University Hospital in Berlin, Germany, were analyzed retrospectively from 2015 to 2022. The 75 g oGTT blood glucose levels were categorized into isolated fasting hyperglycemia (GDM-IFH), isolated post-load hyperglycemia (GDM-IPH) and combined hyperglycemia (GDM-CH), using the levels of the fasting, 1 h and 2 h values, after glucose application. These subtypes were compared based on their baseline characteristics as well as fetal and maternal outcome. RESULTS GDM-IFH and GDM-CH women displayed higher pre-conceptional BMI and required insulin therapy more frequently (p < 0.001). The GDM-IFH group was at higher risk of having a primary cesarean section (p = 0.047), while GDM-IPH women were significantly more likely to have an emergent cesarean section (p = 0.013). The offspring of GDM-IFH and GDM-CH women were born with a significantly higher mean birthweight (p < 0.001) and birth weight percentiles (p < 0.001) and were at increased risk of being large for gestational age (LGA) (p = 0.004). Women from the GDM-IPH group delivered significantly more neonates who were small for gestational age (p = 0.027) or with low fetal weight <30th percentile (p = 0.003). CONCLUSION This analysis shows a strong association between the glucose response pattern in the 75 g oGTT and adverse perinatal fetomaternal outcome. The differences among the subgroups, specifically concerning insulin therapy, mode of delivery and fetal growth, suggest an individualized approach to prenatal care after a GDM diagnosis.
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Affiliation(s)
- Selina Balke
- Department of Obstetrics, Charité-Universitätsmedizin, 10117 Berlin, Germany; (P.W.); (L.F.); (P.R.); (W.H.); (J.T.K.)
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Fasting Plasma Glucose and Its Relationship to Anthropometric Phenotype in Women Diagnosed with Gestational Diabetes According to IADPSG Criteria. LIFE (BASEL, SWITZERLAND) 2023; 13:life13010137. [PMID: 36676086 PMCID: PMC9867190 DOI: 10.3390/life13010137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/16/2022] [Accepted: 12/30/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is characterized by new-onset hyperglycemia in pregnancy. According to the International Association of Diabetes and Pregnancy Study Groups (IADPSG) recommendations, GDM may be diagnosed based on repeatedly increased fasting glucose levels in the first trimester, or later, the detection of increased fasting glucose and/or increased glucose levels during a 75 g oral glucose tolerance test (OGTT). The study aimed to assess whether differences may be found between women diagnosed with GDM by fasting glucose or glucose challenge tests in early or late pregnancy. METHODS The retrospective observational study enrolled 418 women diagnosed with GDM in accordance with the IADPSG criteria: early pregnancy fasting plasma glucose (FPG) ≥ 5.1 mmol/L; late pregnancy FPG ≥ 5.1 mmol/L (0 min) and/or postprandial plasma glucose (PPG) ≥ 10.0 mmol/L (60 min), PPG ≥ 8.5 mmol/L (120 min) 75 g OGTT. The analyses included anthropometric parameters at the beginning and during pregnancy, laboratory values of glycated hemoglobin, fructosamine, birth weight measures and the presence of neonatal complications. RESULTS There were significant differences in body weight (78.3 ± 19.1; 74.0 ± 16.7; 67.2 ± 15.7 kg) and body mass index (BMI) (27.9 ± 6.6; 26.4 ± 5.8; 24.4 ± 5.2 kg/m2) in early pregnancy. Differences were also found in gestational weight gain (9.3 ± 6.8 vs. 12.4 ± 6.9 vs. 11.1 ± 4.7 kg) and the need for insulin therapy (14.7%; 7.1%; 4.0%). The study revealed no difference in the presence of neonatal complications but differences in birth weight (3372.2 ± 552.2 vs. 3415.6 ± 529.0 vs. 3199.0 ± 560.5 g). CONCLUSIONS Gestational diabetes, characterized by FPG ≥ 5.1 mmol/L in early pregnancy, is associated with higher body weight and BMI at the beginning of pregnancy as well as with a higher risk for insulin therapy and increased birth weight.
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Oleszczuk-Modzelewska L, Malinowska-Polubiec A, Romejko-Wolniewicz E, Zawiejska A, Czajkowski K. What is the "cost" of reducing adverse pregnancy outcomes in patients with gestational diabetes mellitus - risk factors for perinatal complications in a retrospective cohort of pregnant women with GDM. BMC Pregnancy Childbirth 2022; 22:654. [PMID: 35986350 PMCID: PMC9392248 DOI: 10.1186/s12884-022-04980-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 06/07/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is a frequent pregnancy complication, affecting the maternal and neonatal health. The new diagnostic strategy for GDM, proposed by the International Association of Diabetes and Pregnancy Study Groups in 2010 and World Health Organization in 2013, raised hope to reduce perinatal complications. The purpose of the study was to compare risk factors influencing maternal and foetal outcomes in a group of pregnant women diagnosed with GDM, and in a group of pregnant women without GDM, regardless of the adopted diagnostic criteria. Also, the aim of the study was to evaluate the impact of risk factors on perinatal results and the "cost" of reducing adverse pregnancy outcomes in patients with GDM. METHODS It was a retrospective study based on the analysis of births given after 37 weeks of pregnancy at the 2nd Department of Obstetrics and Gynaecology, Warsaw Medical University during the years 2013 to 2015. All pregnant women had a 75 g OGTT between the 24th and 28th weeks of pregnancy. The study compared risk factors for perinatal complications in 285 GDM patients and in 202 randomly selected women without GDM. The impact of selected risk factors on perinatal outcomes was analysed. RESULTS Both the diagnosis of GDM and maternal BMI prior to pregnancy, significantly modified the risk of excessive and insufficient weight gain during pregnancy. The parameters significantly influencing the risk of the composite adverse maternal outcome were the maternal abdominal circumference [OR: 1.08 (1.04; 1.11)] and multiparity, which reduced the risk by almost half [OR: 0.47 (0.30; 0.75)]. The maternal abdominal circumference before the delivery was a strong factor correlating with the occurrence of perinatal complications in both the mother and the foetus in the entire cohort. A circumference over 100 cm increased the risk of at least one maternal complication (increased blood loss, soft tissue injury, pre-eclampsia) by almost 40% (OR 1.38, p < 0.001). CONCLUSIONS No differences were found in maternal and foetal outcomes in GDM and non-GDM women except gestational weight gain below Institute of Medicine recommendations. The only "cost" of reducing adverse pregnancy outcomes in GDM patients seems to be lowering gestational weight gain, the future impact of which on GDM pregnant population should be assessed. The maternal abdominal circumference measured before delivery not the severity of carbohydrate intolerance, remained the main predictor for significant perinatal complications.
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Affiliation(s)
- Luiza Oleszczuk-Modzelewska
- 2nd Department of Obstetrics and Gynaecology, Medical University of Warsaw, 2 Karowa St, 00-315, Warsaw, Poland
| | - Aneta Malinowska-Polubiec
- 2nd Department of Obstetrics and Gynaecology, Medical University of Warsaw, 2 Karowa St, 00-315, Warsaw, Poland.
| | - Ewa Romejko-Wolniewicz
- 2nd Department of Obstetrics and Gynaecology, Medical University of Warsaw, 2 Karowa St, 00-315, Warsaw, Poland
| | - Agnieszka Zawiejska
- Department of Medical Simulation, Chair of Medical Education, Poznan University of Medical Sciences, 41 Jackowskiego St, 60-512, Poznan, Poland
| | - Krzysztof Czajkowski
- 2nd Department of Obstetrics and Gynaecology, Medical University of Warsaw, 2 Karowa St, 00-315, Warsaw, Poland
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Obstructive Sleep Apnea Is Associated with Newly Diagnosed Gestational Diabetes Mellitus. Ann Am Thorac Soc 2021; 17:754-761. [PMID: 32040334 DOI: 10.1513/annalsats.201906-473oc] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Rationale: Sleep-disordered breathing (SDB) is associated with increased risk of adverse pregnancy outcomes, including gestational diabetes mellitus (GDM). GDM is a significant cause of maternal and infant morbidities. Assessing these risk factors concurrently may facilitate both the identification of women at GDM risk and the initiation of GDM prevention strategies.Objectives: To investigate whether SDB events, including SDB in rapid eye movement (REM) sleep and other sleep parameters, are associated with increased risk of GDM and to evaluate the performance of the models investigating associations between breathing and sleep parameters and GDM risk.Methods: In this case-control study, 46 women with newly diagnosed GDM and 46 healthy control subjects, who were individually matched for age, gestational age, body mass index, race, and parity, completed overnight polysomnographic studies and sleep questionnaires after being screened for GDM during the late-second to mid-third trimesters. Conditional logistic regression analysis was used to identify models investigating associations between risk factors and GDM risk. The Bayesian information criterion (BIC) was employed to compare models; the model with the lowest BIC is preferred.Results: Obstructive sleep apnea (OSA; defined as an apnea-hypopnea index [AHI] >5 events/h) was present in 22% of subjects with GDM and 9% of control subjects (P < 0.001). Women with OSA had a higher GDM risk (odds ratio [OR], 4.71; 95% confidence interval [CI], 1.05-21.04). In individual models, GDM risk was also significantly higher among women with higher overall AHI (events/h OR, 1.81; 95% CI, 1.01-3.27), higher AHI in REM (events/h OR, 2.09; 95% CI, 1.02-4.31), higher oxygen desaturation index greater than or equal to 4% (ODI4; events/h OR, 2.21; 95% CI, 1.03-4.73), and higher Sleep Apnea Symptom Score (OR, 2.72; 95% CI, 1.11-6.69). The percentage of non-REM sleep was significantly associated with decreased risk of GDM (percentage of non-REM sleep OR, 0.88; 95% CI, 0.78-0.99). The BIC supports the conclusion that there is a strong association between AHI in REM and GDM risk compared with the other significant models.Conclusions: SDB events, including REM-related OSA, are linked to increased GDM risk. GDM risk is also influenced by intercorrelated sleep variables.
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Gorban de Lapertosa S, Sucani S, Salzberg S, Alvariñas J, Faingold C, Jawerbaum A, Rovira G. Prevalence of gestational diabetes mellitus in Argentina according to the Latin American Diabetes Association (ALAD) and International Association of Diabetes and Pregnancy Study Groups (IADPSG) diagnostic criteria and the associated maternal-neonatal complications. Health Care Women Int 2020; 42:636-656. [PMID: 32886577 DOI: 10.1080/07399332.2020.1800012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
In Argentina, gestational diabetes mellitus (GDM) is diagnosed by the Latin American Diabetes Association (ALAD) diagnostic criterion. In this work, we investigated GDM prevalence according to the ALAD and IADPSG diagnostic criteria, evaluated maternal and fetal outcomes and assessed whether fasting glycemia between 92-99 mg/dL was associated with increased risk of macrosomia and maternal obesity/overweight in an Argentine cohort of pregnant women. GDM prevalence was 9.8% with the ALAD diagnostic criterion and 25% considering the IADPSG criterion. Increased prevalence of maternal obesity/overweight was observed in patients with fasting glycemia over 99 mg/dL. A population of high metabolic risk is identified by the ALAD criterion.
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Affiliation(s)
| | - Stella Sucani
- Hospital Materno Provincial Dr R F Lucini, Córdoba, Argentina
| | - Susana Salzberg
- Department of Clinical Investigations, Instituto Centenario, Buenos Aires, Argentina
| | - Jorge Alvariñas
- Nutrition Department, Enrique Tornu Hospital, Buenos Aires, Argentina
| | - Cristina Faingold
- Endocrinology Service, Dr. Milstein Hospital, Buenos Aires, Argentina
| | - Alicia Jawerbaum
- Laboratory of Reproduction and Metabolism, Universidad de Buenos Aires, Facultad de Medicina and CEFYBO-CONICET-Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Gabriela Rovira
- Department of Endocrinology, Diabetes, Metabolism and Nutrition, British Hospital, Buenos Aires, Argentina
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- Diabetes and Pregnancy Study Group of the Argentine Society of Diabetes (DPSG-SAD)
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LaManna JB, Quelly SB, Stahl M, Giurgescu C. A Florida public health-based endocrine clinic for low-income pregnant women with diabetes. Public Health Nurs 2020; 37:729-739. [PMID: 32761865 DOI: 10.1111/phn.12783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/18/2020] [Accepted: 07/19/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To evaluate pregnancy outcomes of low-income women with diabetes-complicated pregnancies who received care from an embedded, public health-based endocrine specialty clinic (ESC) in Florida. DESIGN This program evaluation used retrospective chart data to analyze client characteristics, pre-program and during-program glycemic control, and pregnancy outcomes of women enrolled in a prenatal ESC. SAMPLE Ninety-two low-income, pregnant women with type 1/type 2 diabetes or gestational diabetes (GDM) comprised this racially/ethnically diverse sample. VARIABLES/ANALYSIS Neonatal outcomes included frequencies of prematurity, hypoglycemia, hyperbilirubinemia, and birth weight-for-gestational-age categories. Differences in maternal HbA1C at program entry and mean HbA1C during ESC care were determined by a Wilcoxon and paired sample t test. RESULTS HbA1C levels during ESC care (6.9 ± 1.4) were less than program entry HbA1C levels (7.9 ± 1.8) for women with pregestational diabetes (Z = -3.364, p = .001). Among women with GDM, mean HbA1C values during ESC care (5.5 ± 0.4) did not significantly differ (t(51) = -0.532, p > .05) from program entry HbA1C levels (5.5 ± 0.5), suggestive of glycemic goal achievement. No neonatal hypoglycemia or hyperbilirubinemia cases were observed in both groups. Approximately 11% of births were preterm, and 16% of neonates were large-for-gestational-age. CONCLUSIONS A public health-based ESC for low-income pregnant women with diabetes may positively affect pregnancy outcomes.
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Affiliation(s)
- Jacqueline B LaManna
- University of Central Florida College of Nursing, Orlando, FL, USA.,Florida Department of Health, Melbourne, FL, USA
| | - Susan B Quelly
- University of Central Florida College of Nursing, Orlando, FL, USA
| | - Maria Stahl
- Florida Department of Health, Melbourne, FL, USA
| | - Carmen Giurgescu
- University of Central Florida College of Nursing, Orlando, FL, USA
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Effect of High Versus Low Carbohydrate Intake in the Morning on Glycemic Variability and Glycemic Control Measured by Continuous Blood Glucose Monitoring in Women with Gestational Diabetes Mellitus-A Randomized Crossover Study. Nutrients 2020; 12:nu12020475. [PMID: 32069857 PMCID: PMC7071236 DOI: 10.3390/nu12020475] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 01/30/2020] [Accepted: 02/10/2020] [Indexed: 01/09/2023] Open
Abstract
Carbohydrate is the macronutrient that has the greatest impact on blood glucose response. Limited data are available on how carbohydrate distribution throughout the day affects blood glucose in women with gestational diabetes mellitus (GDM). We aimed to assess how a high-carbohydrate morning-intake (HCM) versus a low-carbohydrate-morning-intake (LCM), affect glycemic variability and glucose control. In this randomized crossover study continuous glucose monitoring (CGM) was performed in 12 women with diet treated GDM (75 g, 2-h OGTT ≥ 8.5 mmol/L), who went through 2 × 3 days of HCM and LCM. A within-subject-analysis showed a significantly higher mean amplitude of glucose excursions (MAGE) (0.7 mmol/L, p = 0.004) and coefficient of variation (CV) (5.1%, p = 0.01) when comparing HCM with LCM, whereas a significantly lower mean glucose (MG) (-0.3 mmol/L, p = 0.002) and fasting blood glucose (FBG) were found (-0.4 mmol/L, p = 0.01) on the HCM diet compared to the LCM diet. In addition, insulin resistance, expressed as Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), decreased significantly during HCM. Results indicate that a carbohydrate distribution of 50% in the morning favors lower blood glucose and improvement in insulin sensitivity in women with GDM, but in contrary gives a higher glycemic variability.
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Pedersen ML. Diabetes care in the dispersed population of Greenland. A new model based on continued monitoring, analysis and adjustment of initiatives taken. Int J Circumpolar Health 2019; 78:1709257. [PMID: 31996108 PMCID: PMC7034430 DOI: 10.1080/22423982.2019.1709257] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 12/17/2019] [Accepted: 12/19/2019] [Indexed: 12/16/2022] Open
Abstract
Diabetes used to be a rare condition among Inuit in Greenland. However, research in recent decades has shown a high prevalence of undiagnosed diabetes. Addressing diabetes in the geographically dispersed population of Greenland presents a challenge to the health care system. In 2008, a new model of diabetes care was introduced in Greenland that included continual monitoring, analysis, and adjustment of initiatives taken. The overall aim of this review was to review the feasibility of the monitoring of an ongoing national diabetes care programme. After ten years of observation it was clear that monitoring of such a programme based on information in electronic medical records in Greenland was feasible. It was found that the majority of the population in Greenland was in contact with the health care system. Increased diagnostic activity resulted in an increased prevalence of diagnosed diabetes. The quality of diabetes care in Greenland and the testing effectiveness of gestational diabetes were improved. Microvascular complications were frequently observed among Greenlandic diabetic patients, except for retinopathy that was as an exception. In summary, this model may improve diabetes care and potentially care for other chronic conditions in Greenland, and may also be helpful in other remote settings where chronic disease care is difficult.Abbreviations: AD: Anno Domini; ADA: American Diabetes Association; BC: Before Christ; BMI: Body Mass Index; BP: Blood Pressure; CWB: Capillary Whole Blood; EMR: Electronic Medical Record; EASD: European Association for Study of Diabetes; GA: Gestational Age; GDM: Gestational Diabetes Mellitus; FIGO: The International Federation of Gynaecology and Obstetrics; HbA1c: Glycosylated haemoglobin; IDF: International Diabetes Federation; LDL: Low density lipoprotein; NDQIA: National Diabetes Quality Improvement Alliancel; NICE: National Institute for Health and Care Excellence; OECD: Organisation for Economic Co-operation and Development; OGTT: Oral Glucose Tolerance Test; QIH: Queen Ingrid Hospital; RCT: Randomised Controlled Tria;l T1D: Type 1 Diabetes; T2D: Type 2 Diabetes; UACR: Urine Albumin Creatinine Ratio; WHO: World Health Organisation.
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Affiliation(s)
- Michael Lynge Pedersen
- Greenland Center for Health Research, Institute Nursing and Health Science, University of Greenland, Nuuk, Greenland
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Hung CH, Yu CY, Huang MC. The Perinatal Biopsychosocial Consequences of Various Levels of Gestational Hyperglycemia. Clin Nurs Res 2018; 29:268-275. [PMID: 29631415 DOI: 10.1177/1054773818769210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
This study was to compare biopsychosocial consequences among three groups of women with gestational hyperglycemia. We conducted a repeated-measures study at five time points among 132 women with gestational hyperglycemia. Women's physiological indicators and their psychosocial indicators were measured. There were 22.7% of participants had gestational diabetes mellitus (GDM), 11.4% had gestational impaired glucose tolerance (G-IGT), and 65.9% had mild gestational hyperglycemia (MGH). Women with GDM had higher fasting blood glucose and systolic/diastolic blood pressure than women with MGH. Women with GDM had higher diastolic blood pressure compared to women with G-IGT. Significant differences were found between the five time points regarding women's fasting blood glucose, diastolic blood pressure, depression, and health status. Health care providers should conduct early screening for predictors of metabolic syndrome in women with any degree of gestational hyperglycemia. Nursing interventions could be offered as early as the perinatal period to promote women's health.
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Affiliation(s)
- Chich-Hsiu Hung
- Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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Huang Y, Yin B, Liang X, Mei H, Lu H, Xie S, Bei W, Mei W, Zhang J. Effect of maternal glycemia and weight status on offspring birth measures and BMI-z among Chinese population in the first year. Sci Rep 2017; 7:16030. [PMID: 29167502 PMCID: PMC5700092 DOI: 10.1038/s41598-017-15932-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 11/03/2017] [Indexed: 11/25/2022] Open
Abstract
To investigate the effects of maternal fasting plasma glucose (FPG) and pre-pregnancy weight status (PPWS) on offspring birth measures and body mass index z-score (BMI-z) in the first year, we conducted a prospective study of 1,096 mother-infant dyads in Guangdong, China, 2014–2015. Multivariate logistic regression was used to test independent/interaction associations of maternal FPG and PPWS with macrosomia/large for gestational age (LGA). Association of PPWS and FPG with offspring BMI-z in the first year was assessed by the linear mixed effects models. For each 1-mmol/L increase in FPG, the risk of macrosomia and LGA was elevated by 2.74 and 2.01 (95% CI: 1.85, 7.60 and 1.54, 5.88), respectively. No main effect of PPWS or interaction association of FPG and PPWS on macrosomia/LGA was observed (P > 0.05). A relation between maternal FPG and PPWS was detected (P < 0.05). Infants of Q5 FPG mothers, those who were born to OWO mothers, had a 0.35 increase in the BMI-z (95% CI: 0.16, 0.55) compared with infants of NW mothers. In conclusion, maternal FPG is positively associated with macrosomia/LGA. Maternal PPWS and FPG considerably interacted for the association with the risk of offspring high BMI-z in the first year.
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Affiliation(s)
- Yilin Huang
- Department of Maternal and Child Health Care, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Rd., Wuhan, 430030, Hubei, China
| | - Baoming Yin
- Department of Gynecology and Obstetric, Maternal and Child Health Hospital of Zhuhai Municipality,, 543 Ningxi Rd., Zhuhai, 519001, Guangdong, China
| | - Xiaohong Liang
- Department of Child Health, Maternal and Child Health Hospital of Zhuhai Municipality,, 543 Ningxi Rd., Zhuhai, 519001, Guangdong, China
| | - Hong Mei
- Department of Maternal and Child Health Care, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Rd., Wuhan, 430030, Hubei, China
| | - Hongyan Lu
- Department of Maternal and Child Health Care, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Rd., Wuhan, 430030, Hubei, China
| | - Shuixian Xie
- Department of Maternal and Child Health Care, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Rd., Wuhan, 430030, Hubei, China
| | - Weihong Bei
- Department of Child Health, Maternal and Child Health Hospital of Zhuhai Municipality,, 543 Ningxi Rd., Zhuhai, 519001, Guangdong, China
| | - Wenhua Mei
- Public Hospital Administration of Zhuhai Municipality,, 41 Jiaoyu Rd., Zhuhai, 519000, Guangdong, China
| | - Jianduan Zhang
- Department of Maternal and Child Health Care, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Rd., Wuhan, 430030, Hubei, China.
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Cho HY, Jung I, Kim SJ. The association between maternal hyperglycemia and perinatal outcomes in gestational diabetes mellitus patients: A retrospective cohort study. Medicine (Baltimore) 2016; 95:e4712. [PMID: 27603367 PMCID: PMC5023889 DOI: 10.1097/md.0000000000004712] [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: 12/16/2022] Open
Abstract
Pregnancies complicated by gestational diabetes mellitus (GDM) are associated with increased risks of adverse maternal and fetal outcomes. The risks of adverse pregnancy outcomes differ depending on the glucose values among GDM patients. For accurate and effective prenatal counseling, it is necessary to understand the relationship between different maternal hyperglycemia values and the severity of adverse outcomes. With this objective, this study reexamines the relationship between maternal hyperglycemia versus maternal and perinatal outcomes in GDM patients. For this study, maternal hyperglycemia was diagnosed using the 2-step diagnostic approach.Medical records of 3434 pregnant women, who received the 50-g glucose challenge test (GCT) between March 2001 and April 2013, were reviewed. As a result, 307 patients were diagnosed with GDM, and they were divided into 2 groups according to their fasting glucose levels. A total of 171 patients had normal fasting glucose level (<95 mg/dL), and 136 patients had abnormal fasting glucose level (≥95 mg/dL). The 50-g GCT results were subdivided by 20-unit increments (140-159, n = 123; 160-179, n = 84; 180-199, n = 50; and ≥200, n = 50), and the maternal and perinatal outcomes were compared against the normal 50-g GCT group (n = 307).Maternal fasting blood glucose (FBG) level showed clear association with adverse perinatal outcomes. The odds ratio (OR) of macrosomia was 6.72 (95% CI: 2.59-17.49, P < 0.001) between the 2 groups. The ORs of large for gestational age (LGA) and neonatal hypoglycemia were 3.75 (95% CI: 1.97-7.12, P < 0.001) and 1.65 (95% CI: 0.79-3.43, P = 0.183), respectively. Also, the results of the 50-g GCT for each category showed strong association with increased risks of adverse perinatal outcomes compared to the normal 50-g GCT group. The OR of macrosomia (up to 20.31-fold), LGA (up to 6.15-fold), and neonatal hypoglycemia (up to 84.00-fold) increased with increasing 50-g GCT result.
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Affiliation(s)
- Hee Young Cho
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Yonsei University Health System, Seoul
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University, Seongnam
- Correspondence: Hee Young Cho, Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea; Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University, Seongnam, Korea (e-mail: )
| | - Inkyung Jung
- Department of Biostatistics and Medical Informatics
| | - So Jung Kim
- Department of Medicine, Yonsei University College of Medicine, Seoul, Korea
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Pedersen ML, Olesen J, Jørgensen ME, Damm P. Gestational diabetes mellitus in Greenland: a national study of prevalence and testing efficacy. Int J Circumpolar Health 2016; 75:32167. [PMID: 27562574 PMCID: PMC4999506 DOI: 10.3402/ijch.v75.32167] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 07/05/2016] [Accepted: 08/02/2016] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Within the last 20 years, the prevalence of gestational diabetes mellitus (GDM) has been reported to be increasing worldwide in correlation with ethnic and geographic variations. The actual prevalence of GDM throughout all of Greenland remains unknown. OBJECTIVE The aim of this study was to estimate the prevalence of GDM among Greenlanders and non-Greenlanders living in Greenland and to estimate the efficacy of testing for GDM. DESIGN This study was performed as an observational, cross-sectional study including all women with permanent address in Greenland who had given birth to a singleton during 2014. The prevalence of GDM was calculated as the proportion of all pregnant women tested with a 75-g 2-h glucose tolerance test who had a 2-h capillary whole-blood glucose value of 8.5 mmol/l or above. Testing efficacy was calculated as the proportion of women who fulfilled the testing criteria who were actually tested in Greenland in 2014. RESULTS A total of 794 women (727 Greenlanders and 67 non-Greenlanders) were included in the study. The prevalence of GDM among tested women was 3.3% (confidence interval, CI: 0.9-5.6) among Greenlanders and 12.5% (CI: 0-25.7) among non-Greenlanders, corresponding, respectively, to 1.0% (CI: 0.3-1.3) and 4.5% (CI: 0-9.4) of all singleton pregnancies in Greenland in 2014. The overall testing efficacy was 69.0% among all eligible residents of Greenland and 85.1% among eligible residents in the capital city, Nuuk. CONCLUSION In conclusion, the prevalence of GDM seems quite low in Greenland. Although diagnostic testing activity has improved within the last 6 years, still around one-third of all pregnant women in all Greenland fulfilling the testing criteria were not tested. Universal testing for GDM may be needed to improve testing of GDM in Greenland.
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Affiliation(s)
- Michael Lynge Pedersen
- Greenland Center of Health Research, Institute of Nursing and Health Science, University of Greenland, Nuuk, Greenland.,Queen Ingrid Primary Health Care Center, Nuuk, Greenland;
| | - Jesper Olesen
- Queen Ingrid Primary Health Care Center, Nuuk, Greenland
| | - Marit Eika Jørgensen
- Steno Diabetes Center, Gentofte, Denmark.,National Institute of Public Health, Southern Denmark University, Denmark
| | - Peter Damm
- Center for Pregnant Women with Diabetes, Department of Obstetrics, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
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Bhavadharini B, Mahalakshmi MM, Anjana RM, Maheswari K, Uma R, Deepa M, Unnikrishnan R, Ranjani H, Pastakia SD, Kayal A, Ninov L, Malanda B, Belton A, Mohan V. Prevalence of Gestational Diabetes Mellitus in urban and rural Tamil Nadu using IADPSG and WHO 1999 criteria (WINGS 6). Clin Diabetes Endocrinol 2016; 2:8. [PMID: 28702243 PMCID: PMC5471800 DOI: 10.1186/s40842-016-0028-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 03/31/2016] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND To determine the prevalence of Gestational Diabetes Mellitus (GDM) in urban and rural Tamil Nadu in southern India, using the International Association of Diabetes and Pregnancy Study Groups (IADPSG) and the World Health Organization (WHO) 1999 criteria for GDM. METHODS A total of 2121 pregnant women were screened for GDM from antenatal clinics in government primary health centres of Kancheepuram district (n = 520) and private maternity centres in Chennai city in Tamil Nadu (n = 1601) between January 2013 to December 2014. Oral glucose tolerance tests (OGTT) were done after an overnight fast of at least 8 h, using a 75 g glucose load and venous samples were drawn at 0, 1 and 2 h. GDM was diagnosed using both the IADPSG criteria as well as the WHO 1999 criteria for GDM. RESULTS The overall prevalence of GDM after adjusting for age, BMI, family history of diabetes and previous history of GDM was 18.5 % by IADPSG criteria with no significant urban/rural differences (urban 19.8 % vs rural 16.1 %, p = 0.46). Using the WHO 1999 criteria, the overall adjusted prevalence of GDM was 14.6 % again with no significant urban/rural differences (urban 15.9 % vs rural 8.9 %, p = 0.13). CONCLUSION The prevalence of GDM by IADPSG was high both using IADPSG as well as WHO 1999 criteria with no significant urban/rural differences. This emphasizes the need for increasing awareness about GDM and for prevention of GDM in developing countries like India.
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Affiliation(s)
- Balaji Bhavadharini
- Madras Diabetes Research Foundation, 4, Conran Smith Road, Gopalapuram, Chennai, 600 086 India
| | | | - Ranjit Mohan Anjana
- Madras Diabetes Research Foundation, 4, Conran Smith Road, Gopalapuram, Chennai, 600 086 India
| | - Kumar Maheswari
- Madras Diabetes Research Foundation, 4, Conran Smith Road, Gopalapuram, Chennai, 600 086 India
| | - Ram Uma
- Seethapathy Clinic and Hospital, Chennai, India
| | - Mohan Deepa
- Madras Diabetes Research Foundation, 4, Conran Smith Road, Gopalapuram, Chennai, 600 086 India
| | - Ranjit Unnikrishnan
- Madras Diabetes Research Foundation, 4, Conran Smith Road, Gopalapuram, Chennai, 600 086 India
| | - Harish Ranjani
- Madras Diabetes Research Foundation, 4, Conran Smith Road, Gopalapuram, Chennai, 600 086 India
| | | | | | - Lyudmil Ninov
- International Diabetes Federation, Brussels, Belgium
| | - Belma Malanda
- International Diabetes Federation, Brussels, Belgium
| | - Anne Belton
- International Diabetes Federation, Brussels, Belgium
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation, 4, Conran Smith Road, Gopalapuram, Chennai, 600 086 India
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Laafira A, White SW, Griffin CJ, Graham D. Impact of the new IADPSG gestational diabetes diagnostic criteria on pregnancy outcomes in Western Australia. Aust N Z J Obstet Gynaecol 2015; 56:36-41. [PMID: 26293845 DOI: 10.1111/ajo.12394] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 07/13/2015] [Indexed: 01/07/2023]
Abstract
BACKGROUND There is debate as to the most appropriate diagnostic criteria to diagnose gestational diabetes mellitus (GDM). The proposed International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria have recently been endorsed by various bodies, but there remains no national consensus. AIM To assess the perinatal outcomes of women with GDM classified according to the 1998 Australasian Diabetes in Pregnancy Society (ADIPS) criteria compared to those with GDM by the IADPSG criteria. MATERIALS AND METHODS Results of glucose tolerance tests performed between January 2011 and January 2014 were linked with the perinatal data of those who delivered singleton fetuses after 24 weeks' gestation. Analysed data included birthweight, gestational age at birth, macrosomia, mode of delivery, perinatal mortality, nursery admission, maternal body mass index, and gestational weight gain. RESULTS Of 3571 women, 466 (13%) and 559 (16%) met the criteria for the 1998 ADIPS and IADPSG criteria for GDM, respectively. Those with GDM according to the IADPSG criteria only (6%) were more obese (95% CI 2.3-4.8 kg/m(2) ), delivered neonates on average 106 g heavier (95% CI 19-193 g) and had more fetal macrosomia (18% vs 11%, P = 0.002) than those with normal glucose tolerance. CONCLUSIONS The IADPSG criteria for GDM identified a group of women at previously unrecognised increased risk of adverse perinatal outcomes. Adopting the IADPSG criteria would increase the number of women diagnosed with GDM by 20%; however, the improvements in perinatal morbidity, in addition to potential long-term benefits, may justify the increase in healthcare workload.
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Affiliation(s)
- Aminath Laafira
- King Edward Memorial Hospital, Subiaco, Western Australia, Australia
| | - Scott W White
- School of Women's and Infants' Health, The University of Western Australia, Subiaco, Western Australia, Australia.,Women and Infants Research Foundation, King Edward Memorial Hospital, Subiaco, Western Australia, Australia.,Maternal Fetal Medicine Service, King Edward Memorial Hospital, Subiaco, Western Australia, Australia
| | - Christopher J Griffin
- Maternal Fetal Medicine Service, King Edward Memorial Hospital, Subiaco, Western Australia, Australia
| | - Dorothy Graham
- King Edward Memorial Hospital, Subiaco, Western Australia, Australia.,School of Women's and Infants' Health, The University of Western Australia, Subiaco, Western Australia, Australia
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Lenoir-Wijnkoop I, van der Beek EM, Garssen J, Nuijten MJC, Uauy RD. Health economic modeling to assess short-term costs of maternal overweight, gestational diabetes, and related macrosomia - a pilot evaluation. Front Pharmacol 2015; 6:103. [PMID: 26042038 PMCID: PMC4438224 DOI: 10.3389/fphar.2015.00103] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 04/25/2015] [Indexed: 12/20/2022] Open
Abstract
Background: Despite the interest in the impact of overweight and obesity on public health, little is known about the social and economic impact of being born large for gestational age or macrosomic. Both conditions are related to maternal obesity and/or gestational diabetes mellitus (GDM) and associated with increased morbidity for mother and child in the perinatal period. Poorly controlled diabetes during pregnancy, pre- pregnancy maternal obesity and/or excessive maternal weight gain during pregnancy are associated with intermittent periods of fetal exposure to hyperglycemia and subsequent hyperinsulinemia, leading to increased birth weight (e.g., macrosomia), body adiposity, and glycogen storage in the liver. Macrosomia is associated with an increased risk of developing obesity and type 2 diabetes mellitus later in life. Objective: Provide insight in the short-term health-economic impact of maternal overweight, GDM, and related macrosomia. To this end, a health economic framework was designed. This pilot study also aims to encourage further health technology assessments, based on country- and population-specific data. Results: The estimation of the direct health-economic burden of maternal overweight, GDM and related macrosomia indicates that associated healthcare expenditures are substantial. The calculation of a budget impact of GDM, based on a conservative approach of our model, using USA costing data, indicates an annual cost of more than $1,8 billion without taking into account long-term consequences. Conclusion: Although overweight and obesity are a recognized concern worldwide, less attention has been given to the health economic consequences of these conditions in women of child-bearing age and their offspring. The presented outcomes underline the need for preventive management strategies and public health interventions on life style, diet and physical activity. Also, the predisposition in people of Asian ethnicity to develop diabetes emphasizes the urgent need to collect more country-specific data on the incidence of macrosomic births and health outcomes. In addition, it would be of interest to further explore the long-term health economic consequences of macrosomia and related risk factors.
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Affiliation(s)
| | | | - Johan Garssen
- Department of Pharmaceutical Sciences, Utrecht University Utrecht, Netherlands ; Nutricia Research, Utrecht Netherlands
| | | | - Ricardo D Uauy
- Institute of Nutrition INTA, University of Chile Santiago, Chile
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Olagbuji BN, Atiba AS, Olofinbiyi BA, Akintayo AA, Awoleke JO, Ade-Ojo IP, Fasubaa OB. Prevalence of and risk factors for gestational diabetes using 1999, 2013 WHO and IADPSG criteria upon implementation of a universal one-step screening and diagnostic strategy in a sub-Saharan African population. Eur J Obstet Gynecol Reprod Biol 2015; 189:27-32. [PMID: 25855324 DOI: 10.1016/j.ejogrb.2015.02.030] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 11/18/2014] [Accepted: 02/19/2015] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To investigate the impact of the new consensus diagnostic criteria on the prevalence of gestational diabetes, evaluate risk factors, and missed opportunities for diagnosis if selective screening strategy was employed. STUDY DESIGN A prospective observational data of 1059 women with singleton pregnancy screened for gestational diabetes between 24 and 32 weeks gestation in a universal one-step screening and diagnostic strategy using 75-g oral glucose tolerance testing in an obstetric unit in Nigeria. Logistic regression was used to identify risk factors for GDM. RESULTS The prevalence of gestational diabetes in accordance with 1999 WHO, new 2013 WHO modified IADPSG and IADPSG criteria was 3.8%, 8.1%, 7.5%, and 8.6%, respectively. Overt diabetes was diagnosed in 1.03% of the study population. Using the new consensus criteria, approximately 20% of GDM cases would have been missed if selective screening strategy was employed. Using multivariable analysis, glycosuria [aOR 8.60 (3.29-22.46)] and previous poor obstetric outcome [aOR 3.01 (1.23-7.37)] were significantly associated with GDM on 1999 WHO criteria. Glycosuria [aOR 2.54 (1.10-6.42)] was the only risk significantly associated with increased risk of developing GDM diagnosed based on new 2013 and IADPSG criteria. CONCLUSION Using the new consensus screening and diagnostic guidelines, gestational diabetes is prevalent in our obstetric population. Missed opportunities exist with selective screening approach.
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Affiliation(s)
- Biodun N Olagbuji
- PhD Candidate, Women's Health Research Unit, School of Public Health and Family Medicine, University of Cape Town, South Africa; Department of Obstetrics and Gynaecology, Ekiti State University, Ado-Ekiti, Ekiti State, Nigeria.
| | - Adeniran S Atiba
- Department of Chemical Pathology, Ekiti State University, Ado-Ekiti, Ekiti State, Nigeria
| | - Babatunde A Olofinbiyi
- Department of Obstetrics and Gynaecology, Ekiti State University, Ado-Ekiti, Ekiti State, Nigeria
| | - Akinyemi A Akintayo
- Department of Obstetrics and Gynaecology, Ekiti State University, Ado-Ekiti, Ekiti State, Nigeria
| | - Jacob O Awoleke
- Department of Obstetrics and Gynaecology, Ekiti State University, Ado-Ekiti, Ekiti State, Nigeria
| | - Idowu P Ade-Ojo
- Department of Obstetrics and Gynaecology, Ekiti State University, Ado-Ekiti, Ekiti State, Nigeria
| | - Olusola B Fasubaa
- Department of Obstetrics, Gynaecology and Perinatalogy, Obafemi Awolowo University, Ile-Ife, Nigeria
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