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Huang J, Forde R, Parsons J, Zhao X, Wang J, Liu Y, Forbes A. Interventions to increase the uptake of postpartum diabetes screening among women with previous gestational diabetes: a systematic review and Bayesian network meta-analysis. Am J Obstet Gynecol MFM 2023; 5:101137. [PMID: 37619781 DOI: 10.1016/j.ajogmf.2023.101137] [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: 06/16/2023] [Revised: 08/16/2023] [Accepted: 08/18/2023] [Indexed: 08/26/2023]
Abstract
OBJECTIVE This study aimed to summarize the current interventions aimed at improving postpartum diabetes screening attendance and to compare their effectiveness. DATA SOURCES Literature searches were conducted in the Web of Science, Embase, Cochrane Library, CINAHL, and PubMed from inception to March 20, 2023. STUDY ELIGIBILITY CRITERIA Quantitative studies involving an intervention to increase postpartum diabetes screening attendance among women with gestational diabetes mellitus were included. METHODS The Joanna Briggs Institute checklists were used for the quality appraisal of the included studies. A Bayesian network meta-analysis was performed to synthesize the comparative effectiveness of the relevant interventions aimed at improving postpartum diabetes screening rates. RESULTS A total of 40 studies were included in this review with pooled data from 17,123 women. Studies included randomized controlled trials (n=11, including 3 US-based studies and 8 non-US-based studies) and nonrandomised studies (n=29, including 13 US-based studies and 16 non-US-based studies). Of the 14 studies that reported screening outcomes, 11 detected early type 2 diabetes at a rate ranging from 2.0% to 23.0%. The types of interventions identified included reminders (eg, postal letters, emails, and phone messages), educational interventions, screening methods and delivery, policy changes, antenatal groups, and multimodal interventions. Based on the network meta-analysis from randomized controlled trials, antenatal group intervention, which refers to antenatal patient education delivered in groups (1 US-based study), had the highest probability to be the most effective intervention (odds ratio, 10; 95% confidence interval, 1.6-77.0), followed by one-to-one educational intervention with written educational materials or counselling (odds ratio, 6.9; 95% confidence interval, 3.6-16.0). The results from nonrandomized studies indicated that flexible screening methods and delivery (2 US-based studies) had the greatest impact on screening uptake (odds ratio, 3.9; 95% confidence interval, 1.8-10.0), followed by educational interventions (1 US-based study and 2 non-US-based studies) with antenatal patient education and written educational materials (odds ratio, 3.4; 95% confidence interval, 1.9-6.3) and antenatal groups (odds ratio, 3.3; 95% confidence interval, 1.7-6.7). CONCLUSION The presented evidence suggests that antenatal patient education delivered in groups and offering more flexible screening methods were associated with the greatest increase in attendance. The multimodal interventions and reminders could still be important if they were more theoretically grounded and were more integrated into the healthcare system.
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Affiliation(s)
- Jing Huang
- Division of Care for Long-term Conditions, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom (Ms Huang, Drs Forde and Parsons, Ms Zhao, and Dr Forbes).
| | - Rita Forde
- Division of Care for Long-term Conditions, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom (Ms Huang, Drs Forde and Parsons, Ms Zhao, and Dr Forbes)
| | - Judith Parsons
- Division of Care for Long-term Conditions, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom (Ms Huang, Drs Forde and Parsons, Ms Zhao, and Dr Forbes)
| | - Xiaoyan Zhao
- Division of Care for Long-term Conditions, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom (Ms Huang, Drs Forde and Parsons, Ms Zhao, and Dr Forbes)
| | - Jianying Wang
- Labour room, Northwest Women's and Children's Hospital, Xi'an, China (Mses Wang and Liu)
| | - Yingjie Liu
- Labour room, Northwest Women's and Children's Hospital, Xi'an, China (Mses Wang and Liu)
| | - Angus Forbes
- Division of Care for Long-term Conditions, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom (Ms Huang, Drs Forde and Parsons, Ms Zhao, and Dr Forbes)
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Manoharan N, Jayaseelan V, Kar SS, Jha N. Barriers and facilitating factors of postnatal blood glucose monitoring after structured intervention among mothers with gestational diabetes mellitus receiving care from a tertiary health centre, Puducherry - A qualitative study. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:131. [PMID: 37397117 PMCID: PMC10312433 DOI: 10.4103/jehp.jehp_1166_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 10/07/2022] [Indexed: 07/04/2023]
Abstract
BACKGROUND In India, women with GDM are at an increased risk of developing type 2 diabetes mellitus (T2DM). Despite this, the rate of postnatal blood glucose monitoring is low, and the reasons are not well known. Hence, our study explored the barriers and facilitating factors associated with T2DM postnatal screening six weeks after delivery. MATERIALS AND METHODS We conducted a qualitative study among 21 mothers with GDM in obstetrics and gynecology department, women and child hospital (WCH), JIPMER, from December 2021 to January 2022. Mothers with GDM were selected purposively between 8 and 12 weeks after delivery to explore the barriers and facilitating factors associated with postnatal screening six weeks after getting mobile call reminders and health information booklet interventions. In-depth interviews were transcribed; manual content analysis with deductive and inductive coding was done. RESULTS We identified two themes; three categories and subcategories that illustrated barriers and five categories that illustrated facilitators to postnatal blood glucose monitoring. Lack of awareness and misconceptions about GDM, knowledge practice gap, lack of family support, and perception of health system failure by mothers with GDM were barriers to postnatal blood glucose monitoring. Concerns about health, standard advice on postnatal screening, information in health education booklet, mobile reminders, and family support were found to be facilitators. CONCLUSION We found several barriers and facilitating factors that showed mobile call reminders and booklet interventions had improved postnatal blood glucose monitoring. Our qualitative study has strengthened the findings of the previous RCT, and it would provide more insights to develop further interventions which we must focus on improving postnatal blood glucose monitoring.
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Affiliation(s)
| | | | | | - Nivedita Jha
- Department of Obstetrics and Gynecology, JIPMER, Puducherry, India
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Kindermann L, Costa LDL, Trapani Júnior A. Prevalence of Screening for Diabetes Mellitus in Patients Previously Diagnosed with Gestational Diabetes: Factors Related to its Performance. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRICIA : REVISTA DA FEDERACAO BRASILEIRA DAS SOCIEDADES DE GINECOLOGIA E OBSTETRICIA 2022; 44:1032-1039. [PMID: 36580948 PMCID: PMC9800064 DOI: 10.1055/s-0042-1757955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To determine how many patients underwent screening for diabetes mellitus (DM) in the puerperium after a diagnosis of gestational DM (GDM) and which factors were related to its performance. METHODS The present is a prospective cohort study with 175 women with a diagnosis of GDM. Sociodemographic and clinico-obstetric data were collected through a questionnaire and a screening test for DM was requested six weeks postpartum. After ten weeks, the researchers contacted the patients by telephone with questions about the performance of the screening. The categorical variables were expressed as absolute and relative frequencies. The measure of association was the relative risk with a 95% confidence interval (95%CI), and values of p ≤ 0.05 were considered statistically significant and tested through logistic regression. RESULTS The survey was completed by 159 patients, 32 (20.1%) of whom underwent puerperal screening. The mean age of the sample was of 30.7 years, and most patients were white (57.9%), married (56.6%), and had had 8 or more years of schooling (72.3%). About 22.6% of the patients used medications to treat GDM, 30.8% had other comorbidities, and 76.7% attended the postnatal appointment. Attendance at the postpartum appointment, the use of medication, and the presence of comorbidities showed an association with the performance of the oral glucose tolerance test in the puerperium. CONCLUSION The prevalence of screening for DM six weeks postpartum is low in women previously diagnosed with GDM. Patients who attended the postpartum consultation, used medications to treat GDM, and had comorbidities were the most adherent to the puerperal screening. We need strategies to increase the rate of performance of this exam.
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Affiliation(s)
- Lucas Kindermann
- Departament of Gynecology and Obstetrics, Hospital Regional de São José Dr. Homero de Miranda Gomes, São José, SC, Brazil,Address for correspondence Lucas Kindermann Departament of Gynecology and Obstetrics, Hospital Regional de São José Dr. Homero de Miranda GomesSão José, SCBrazil
| | - Leandro de Liz Costa
- Faculdade de Medicina, Universidade do Sul de Santa Catarina, Palhoça, SC, Brazil
| | - Alberto Trapani Júnior
- Departament of Gynecology and Obstetrics, Hospital Regional de São José Dr. Homero de Miranda Gomes, São José, SC, Brazil,Faculdade de Medicina, Universidade do Sul de Santa Catarina, Palhoça, SC, Brazil
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Cumulative Lactation and Clinical Metabolic Outcomes at Mid-Life among Women with a History of Gestational Diabetes. Nutrients 2022; 14:nu14030650. [PMID: 35277008 PMCID: PMC8839876 DOI: 10.3390/nu14030650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 01/28/2022] [Accepted: 01/31/2022] [Indexed: 12/10/2022] Open
Abstract
Lactation is associated with a lower risk of subsequent cardiometabolic disease among parous women; however, the underlying mechanisms are unknown. Further, the potential protective effects of lactation on cardiometabolic risk markers at mid-life among high-risk women with past gestational diabetes (GDM) are not established. Using data from the Diabetes & Women’s Health Study (2012−2014; n = 577), a longitudinal cohort of women with past GDM from the Danish National Birth Cohort (1996−2002), we assessed associations of cumulative lactation duration (none, <6 months, 6−12 months, ≥12−24 months, and ≥24 months) with clinical metabolic outcomes (including type 2 diabetes [T2D], prediabetes, and obesity) and cardiometabolic biomarkers (including biomarkers of glucose/insulin metabolism, fasting lipids, inflammation, and anthropometrics) 9−16 years after enrollment when women were at mid-life. At follow-up, women were 43.9 years old (SD 4.6) with a BMI of 28.7 kg/m2 (IQR 24.6, 33.0); 28.6% of participants had T2D, 39.7% had prediabetes, and 41.2% had obesity. Relative risks (95% CI) of T2D for 0−6, 6−12, 12−24, and ≥24 months of cumulative lactation duration compared to none were 0.94 (0.62,1.44), 0.88 (0.59,1.32), 0.73 (0.46,1.17), and 0.71 (0.40,1.27), respectively. Cumulative lactation duration was not significantly associated with any other clinical outcome or continuous biomarker. In this high-risk cohort of middle-aged women with past GDM, T2D, prediabetes, and obesity were common at follow-up, but not associated with history of cumulative lactation duration 9−16 years after the index pregnancy. Further studies in diverse populations among women at mid-age are needed to understand associations of breastfeeding with T2D.
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Paulo MS, Abdo NM, Bettencourt-Silva R, Al-Rifai RH. Gestational Diabetes Mellitus in Europe: A Systematic Review and Meta-Analysis of Prevalence Studies. Front Endocrinol (Lausanne) 2021; 12:691033. [PMID: 34956073 PMCID: PMC8698118 DOI: 10.3389/fendo.2021.691033] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 11/17/2021] [Indexed: 01/14/2023] Open
Abstract
Background Gestational Diabetes Mellitus (GDM) is defined as the type of hyperglycemia diagnosed for the first-time during pregnancy, presenting with intermediate glucose levels between normal levels for pregnancy and glucose levels diagnostic of diabetes in the non-pregnant state. We aimed to systematically review and meta-analyze studies of prevalence of GDM in European countries at regional and sub-regional levels, according to age, trimester, body weight, and GDM diagnostic criteria. Methods Systematic search was conducted in five databases to retrieve studies from 2014 to 2019 reporting the prevalence of GDM in Europe. Two authors have independently screened titles and abstracts and full text according to eligibility using Covidence software. A random-effects model was used to quantify weighted GDM prevalence estimates. The National Heart, Lung, and Blood Institute criteria was used to assess the risk of bias. Results From the searched databases, 133 research reports were deemed eligible and included in the meta-analysis. The research reports yielded 254 GDM-prevalence studies that tested 15,572,847 pregnant women between 2014 and 2019. The 133 research reports were from 24 countries in Northern Europe (44.4%), Southern Europe (27.1%), Western Europe (24.1%), and Eastern Europe (4.5%). The overall weighted GDM prevalence in the 24 European countries was estimated at 10.9% (95% CI: 10.0-11.8, I2 : 100%). The weighted GDM prevalence was highest in the Eastern Europe (31.5%, 95% CI: 19.8-44.6, I2 : 98.9%), followed by in Southern Europe (12.3%, 95% CI: 10.9-13.9, I2 : 99.6%), Western Europe (10.7%, 95% CI: 9.5-12.0, I2 : 99.9%), and Northern Europe (8.9%, 95% CI: 7.9-10.0, I2 : 100). GDM prevalence was 2.14-fold increased in pregnant women with maternal age ≥30 years (versus 15-29 years old), 1.47-fold if the diagnosis was made in the third trimester (versus second trimester), and 6.79- fold in obese and 2.29-fold in overweight women (versus normal weight). Conclusions In Europe, GDM is significant in pregnant women, around 11%, with the highest prevalence in pregnant women of Eastern European countries (31.5%). Findings have implications to guide vigilant public health awareness campaigns about the risk factors associated with developing GDM. Systematic Review Registration PROSPERO [https://www.crd.york.ac.uk/PROSPERO/], identifier CRD42020161857.
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Affiliation(s)
- Marília Silva Paulo
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Noor Motea Abdo
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Rita Bettencourt-Silva
- Department of Endocrinology and Nutrition, Unidade Local de Saúde do Alto Minho, Viana do Castelo, Portugal
- Department of Endocrinology, Hospital Lusíadas Porto, Porto, Portugal
| | - Rami H. Al-Rifai
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
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Recurrence of Gestational Diabetes Mellitus: To Assess Glucose Metabolism and Clinical Risk Factors at the Beginning of a Subsequent Pregnancy. J Clin Med 2021; 10:jcm10204794. [PMID: 34682918 PMCID: PMC8540668 DOI: 10.3390/jcm10204794] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 12/16/2022] Open
Abstract
Women with a history of gestational diabetes mellitus (GDM) are at high risk of developing hyperglycemia in a subsequent pregnancy. This study aimed to assess parameters of glucose metabolism at the beginning of a subsequent pregnancy in women with a history of GDM. This prospective cohort study included 706 women who had at least one previous pregnancy (120 with prior GDM and 586 without GDM history). All study participants received a broad risk evaluation and laboratory testing at the beginning of a subsequent pregnancy and were followed up until delivery to assess GDM status, risk factors for GDM recurrence, and pregnancy outcomes. Women with a history of GDM exhibited lower insulin sensitivity and subtle impairments in β-cell function associated with subclinical hyperglycemia already at the beginning of a subsequent pregnancy compared to women without GDM history. This was associated with a markedly increased risk for the later development of GDM (OR: 6.59, 95% CI 4.34 to 10.09, p < 0.001). Early gestational fasting glucose and HbA1c were identified as the most important predictors. Mothers with a history of GDM showed marked alterations in glucose metabolism at the beginning of a subsequent pregnancy, which explains the high prevalence of GDM recurrence in these women.
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Napoli A, Sciacca L, Pintaudi B, Tumminia A, Dalfrà MG, Festa C, Formoso G, Fresa R, Graziano G, Lencioni C, Nicolucci A, Rossi MC, Succurro E, Sculli MA, Scavini M, Vitacolonna E, Bonomo M, Torlone E. Screening of postpartum diabetes in women with gestational diabetes: high-risk subgroups and areas for improvements-the STRONG observational study. Acta Diabetol 2021; 58:1187-1197. [PMID: 33842997 PMCID: PMC8316164 DOI: 10.1007/s00592-021-01707-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/12/2021] [Indexed: 12/18/2022]
Abstract
AIMS To assess the proportion of women with gestational diabetes (GDM) by performing postpartum Oral Glucose Tolerance Test (OGTT) and to identify GDM phenotypes at high-risk of postpartum dysglycemia (PPD). METHODS Observational, retrospective, multicenter study involving consecutive GDM women. Recursive partitioning (RECPAM) analysis was used to identify distinct and homogeneous subgroups of women at different PPD risk. RESULTS From a sample of 2,736 women, OGTT was performed in 941 (34.4%) women, of whom 217 (23.0%) developed PPD. Insulin-treated women having family history of diabetes represented the subgroup with the highest PPD risk (OR 5.57, 95% CI 3.60-8.63) compared to the reference class (women on diet with pre-pregnancy BMI < = 28.1 kg/m2). Insulin-treated women without family diabetes history and women on diet with pre-pregnancy BMI > 28.1 kg/m2 showed a two-fold PPD risk. Previous GDM and socioeconomic status represent additional predictors. Fasting more than post-prandial glycemia plays a predictive role, with values of 81-87 mg/dl (4.5-4.8 mmol/l) (lower than the current diagnostic GDM threshold) being associated with PPD risk. CONCLUSIONS Increasing compliance to postpartum OGTT to prevent/delay PPD is a priority. Easily available characteristics identify subgroups of women more likely to benefit from preventive strategies. Fasting BG values during pregnancy lower than those usually considered deserve attention.
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Affiliation(s)
- Angela Napoli
- AMD-SID Diabetes and Pregnancy Study Group, Rome, Italy.
- Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy.
| | - Laura Sciacca
- AMD-SID Diabetes and Pregnancy Study Group, Rome, Italy
- Department of Clinical and Experimental Medicine, Endocrinology Section, University of Catania Medical School, Catania, Italy
| | - Basilio Pintaudi
- AMD-SID Diabetes and Pregnancy Study Group, Rome, Italy
- SSD Diabetology, Ca'Granda Niguarda Hospital, Milan, Italy
| | - Andrea Tumminia
- AMD-SID Diabetes and Pregnancy Study Group, Rome, Italy
- Department of Clinical and Experimental Medicine, Endocrinology Section, University of Catania Medical School, Catania, Italy
| | | | - Camilla Festa
- AMD-SID Diabetes and Pregnancy Study Group, Rome, Italy
| | - Gloria Formoso
- AMD-SID Diabetes and Pregnancy Study Group, Rome, Italy
- Department of Medicine and Aging Sciences; Center for Advanced Studies and Technology (CAST, Ex CeSI-Met), G. D'Annunzio University, Chieti, Italy
| | - Raffaella Fresa
- AMD-SID Diabetes and Pregnancy Study Group, Rome, Italy
- Endocrinology and Diabetes Unit, ASL Salerno, Salerno, Italy
| | - Giusi Graziano
- CORESEARCH - Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - Cristina Lencioni
- AMD-SID Diabetes and Pregnancy Study Group, Rome, Italy
- Diabetes and Endocrinology Unit, Usl Nord Ovest Tuscany, Lucca, Italy
| | - Antonio Nicolucci
- CORESEARCH - Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - Maria Chiara Rossi
- CORESEARCH - Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - Elena Succurro
- AMD-SID Diabetes and Pregnancy Study Group, Rome, Italy
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Maria Angela Sculli
- AMD-SID Diabetes and Pregnancy Study Group, Rome, Italy
- Endocrinology and Diabetes, Bianchi Melacrino Morelli Hospital, Reggio Calabria, Italy
| | - Marina Scavini
- AMD-SID Diabetes and Pregnancy Study Group, Rome, Italy
- Division of Immunology, Transplantation and Infectious Diseases, Diabetes Research Institute (DRI), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ester Vitacolonna
- AMD-SID Diabetes and Pregnancy Study Group, Rome, Italy
- Department of Medicine and Aging, School of Medicine and Health Sciences, "G. D'Annunzio" University, Chieti-Pescara, Chieti, Italy
| | - Matteo Bonomo
- AMD-SID Diabetes and Pregnancy Study Group, Rome, Italy
- SSD Diabetology, Ca'Granda Niguarda Hospital, Milan, Italy
| | - Elisabetta Torlone
- AMD-SID Diabetes and Pregnancy Study Group, Rome, Italy
- Internal Medicine, Endocrinology and Metabolism, S. Maria Della Misericordia Hospital, Perugia, Italy
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Increased Risk of Hospitalization for Pancreatic Cancer in the First 8 Years after a Gestational Diabetes Mellitus regardless of Subsequent Type 2 Diabetes: A Nationwide Population-Based Study. Cancers (Basel) 2021; 13:cancers13020308. [PMID: 33467667 PMCID: PMC7829937 DOI: 10.3390/cancers13020308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/05/2021] [Accepted: 01/12/2021] [Indexed: 12/12/2022] Open
Abstract
Simple Summary Pancreatic cancer is one of the cancers with the highest mortality rate which is most often attributed to late diagnosis. The identification of risk factors is therefore important. While gestational diabetes also shares mechanisms of action with diabetes mellitus, several studies have provided hypotheses that could explain the pathophysiology of the link between diabetes mellitus and risk of pancreatic cancer. Accordingly, the aim of our study was to determine the risk of developing pancreatic cancer in women with a history of gestational diabetes from a quasi-exhaustive national medico-administrative database for deliveries in France. We included 1,368,755 women in our study. We showed that gestational diabetes was significantly associated with a greater risk of pancreatic cancer, regardless of subsequent type 2 diabetes. Our results suggest a better follow-up of patients after a gestational diabetes in order to identify high-risk profiles of developing more serious conditions, such as pancreatic cancer. Abstract The aim of this large retrospective cohort study was to use a quasi-exhaustive national medico-administrative database of deliveries in France to determine the risk of developing pancreatic cancer (PC) in women with a history of gestational diabetes mellitus (GDM). This nationwide population-based study included women aged 14–55 who gave birth between 1st January 2008 and 31 December 2009. The women were followed-up epidemiologically for eight years. Survival analyses using Cox regression models, adjusted for age, subsequent type 2 diabetes, and tobacco consumption, were performed on the time to occurrence of hospitalization for PC. The onset of GDM, tobacco consumption and subsequent type 2 diabetes were considered as time-dependent variables. Among 1,352,560 women included, 95,314 had a history of GDM (7.05%) and 126 women were hospitalized for PC (0.01%). Over the eight years of follow-up, GDM was significantly associated with a higher risk of hospitalization with PC in the first Cox regression model adjusted for age and subsequent type 2 diabetes (HR = 1.81 95% CI [1.06–3.10]). The second Cox regression model adjusted for the same covariates, plus tobacco consumption, showed that GDM was still significantly associated with a higher risk of hospitalization for PC with nearly the same estimated risk (HR = 1.77 95% CI [1.03–3.03]). Gestational diabetes was significantly associated with a greater risk of hospital admission for pancreatic cancer within eight years, regardless of subsequent type 2 diabetes.
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Bordin P, Dotto L, Battistella L, Rosso E, Pecci L, Valent F, Collarile P, Vanin M. Gestational diabetes mellitus yesterday, today and tomorrow: A 13 year italian cohort study. Diabetes Res Clin Pract 2020; 167:108360. [PMID: 32758619 DOI: 10.1016/j.diabres.2020.108360] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 07/13/2020] [Accepted: 07/28/2020] [Indexed: 12/14/2022]
Abstract
AIMS To describe all cases of gestational diabetes mellitus (GDM) managed at the Italian Hospital of San Daniele del Friuli from 2006 to 2018, after the establishment of a dedicated multidisciplinary team. METHODS Data on mothers, pregnancies, and newborns have been recorded since the team establishment. The associations of maternal, pregnancy, and delivery characteristics with complications of pregnancy and delivery and adverse birth outcomes were assessed. RESULTS 894 cases of GDM were observed, representing 6.8% of all deliveries. More than 20% of women were non-Italian, 5.3% had a previous macrosomic child, 12.5% previous diabetes or GDM, 27.3% family history of diabetes. On average, women had 4 visits at the clinic; mean glycated hemoglobin was 5.3%; starting body mass index (BMI) 26.2 and weight gain 10.3 kg. Cesarean sections were 21.8%. Pre-eclampsia was the most common pregnancy complication (4.7%). 6.0% of newborns were macrosomic and there were 3 fetal deaths. Only 26.3% of women had a post-partum oral glucose tolerance test. Initial BMI, weight gain, nationality, family history of diabetes or previous diabetes-related pregnancy complications were associated with pregnancy complications or adverse outcomes. CONCLUSIONS We identified factors to be targeted for preventing GDM complications. Further efforts should be directed at post-partum.
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Affiliation(s)
- Paolo Bordin
- Department of Prevention, ASUFC Azienda Sanitaria Universitaria Friuli Centrale, Italy
| | - Luciana Dotto
- Diabetes Clinic, Department of Internal Medicine, ASUFC Azienda Sanitaria Universitaria Friuli Centrale, San Antonio Hospital, San Daniele del Friuli, Italy
| | - Liliana Battistella
- Unit of Obstetrics and Gynechology, AAS3 "Alto Friuli-Collinare-Medio Friuli" San Antonio Hospital, San Daniele del Friuli, Italy
| | - Elena Rosso
- Diabetes Clinic, Department of Internal Medicine, ASUFC Azienda Sanitaria Universitaria Friuli Centrale, San Antonio Hospital, San Daniele del Friuli, Italy
| | - Lucia Pecci
- Unit of Obstetrics and Gynechology, AAS3 "Alto Friuli-Collinare-Medio Friuli" San Antonio Hospital, San Daniele del Friuli, Italy
| | - Francesca Valent
- Unit of Hygiene and Clinical Epidemiology, ASUFC Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy.
| | - Paolo Collarile
- Department of Prevention, ASUFC Azienda Sanitaria Universitaria Friuli Centrale, Italy
| | - Michele Vanin
- Unit of Obstetrics and Gynechology, AAS3 "Alto Friuli-Collinare-Medio Friuli" San Antonio Hospital, San Daniele del Friuli, Italy
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