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Benhalima K, Geerts I, Calewaert P, Van Rijsselberghe M, Lee D, Bochanen N, Verstraete S, Buyse L, Lewi L, Caron R, Tency I, Staquet M, Vermeersch P, Wens J. The 2024 Flemish consensus on screening for gestational diabetes mellitus early and later in pregnancy. Acta Clin Belg 2024:1-8. [PMID: 39068500 DOI: 10.1080/17843286.2024.2384258] [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: 06/04/2024] [Accepted: 07/19/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Screening for gestational diabetes mellitus (GDM) is important to improve pregnancy outcomes and to prevent type 2 diabetes after pregnancy. Due to a lack of evidence, the 2019 Flemish consensus did not recommend screening for GDM in early pregnancy. Recently, a large randomized controlled trial (TOBOGM) demonstrated that screening for GDM before 20 weeks reduces the risk of neonatal complications in women with risk factors when using higher cut-offs to define GDM compared to the criteria used later in pregnancy. METHODS Based on this new evidence, members of the Diabetes Liga, the Flemish associations of general physicians (Domus Medica), obstetricians (VVOG), midwives (VBOV), diabetes nurse educators (BVVDV), dieticians (VBVD) and clinical chemists (RBSLM) have adapted the Flemish consensus on screening for GDM. BACKGROUND Recommendations: As in 2019, this new consensus recommends universal screening for overt diabetes in early pregnancy preferably by measuring fasting plasma glucose by using the same diagnostic criteria as in the non-pregnant state. Based on the new evidence, women with fasting plasma glucose 95-125 mg/dL (5.3-6.9 mmol/L) before 20 weeks gestation should be diagnosed as early GDM. In addition, in women with obesity and/or a history of GDM, it is advised to perform already a 75 g oral glucose tolerance test (OGTT) between 6 and 20 weeks gestation using higher cut-offs to diagnose early GDM [fasting ≥95 mg/dL (5.3 mmol/L), 1 hour ≥ 19 mg/dL (10.6 mmol/L) and/or 2 hour ≥ 162 mg/dL (9.0 mmol/L))]. The recommendation concerning screening for GDM between 24 and 28 weeks remains unchanged with a diagnosis of GDM based on the 75 g OGTT and IADPSG criteria [fasting ≥ 92 mg/dL (5.1 mmol/L), 1 hour ≥ 180 mg/dL (10.0 mmol/L) and/or 2 hour ≥ 153 mg/dL (8.5 mmol/L)].
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Affiliation(s)
- Katrien Benhalima
- Department of Endocrinology, University hospital Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Ina Geerts
- Department of Endocrinology, University hospital Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Peggy Calewaert
- Department of Endocrinology, University hospital Gasthuisberg, KU Leuven, Leuven, Belgium
| | | | - Dahae Lee
- Department of Endocrinology, Imelda ziekenhuis, Bonheiden, Belgium
| | - Niels Bochanen
- Department of Endocrinology-Diabetology-Metabolism, Antwerp University Hospital, Edegem, Belgium
| | | | | | - Liesbeth Lewi
- Vlaamse Vereniging voor Obstetrie en Gynaecologie (VVOG) and Department of Obstetrics & Gynecology, University hospital Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Rudi Caron
- Beroepsvereniging voor Vlaamse diabetesverpleegkundigen (BVVDV) and Department of Endocrinology, University hospital Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Inge Tency
- Department of Midwifery and Vlaamse Beroepsorganisatie van Vroedvrouwen (VBOV) Werkgroep Wetenschappelijk Onderzoek, Odisee University of Applied Sciences, Sint-Niklaas, Belgium
| | | | - Pieter Vermeersch
- Royal Belgian Society of Laboratory Medicine (RBSLM) and Clinical Biology, University hospital Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Johan Wens
- Domus Medica and Department of Primary and Interdisciplinary Care, University of Antwerp, Wilrijk, Belgium
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Hivert MF, Backman H, Benhalima K, Catalano P, Desoye G, Immanuel J, McKinlay CJD, Meek CL, Nolan CJ, Ram U, Sweeting A, Simmons D, Jawerbaum A. Pathophysiology from preconception, during pregnancy, and beyond. Lancet 2024; 404:158-174. [PMID: 38909619 DOI: 10.1016/s0140-6736(24)00827-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/07/2024] [Accepted: 04/19/2024] [Indexed: 06/25/2024]
Abstract
Gestational diabetes is the most common medical complication in pregnancy. Historically, gestational diabetes was considered a pregnancy complication involving treatment of rising glycaemia late in the second trimester. However, recent evidence challenges this view. Pre-pregnancy and pregnancy-specific factors influence gestational glycaemia, with open questions regarding roles of non-glycaemic factors in the aetiology and consequences of gestational diabetes. Varying patterns of insulin secretion and resistance in early and late pregnancy underlie a heterogeneity of gestational diabetes in the timing and pathophysiological subtypes with clinical implications: early gestational diabetes and insulin resistant gestational diabetes subtypes are associated with a higher risk of pregnancy complications. Metabolic perturbations of early gestational diabetes can affect early placental development, affecting maternal metabolism and fetal development. Fetal hyperinsulinaemia can affect the development of multiple fetal tissues, with short-term and long-term consequences. Pregnancy complications are prevented by managing glycaemia in early and late pregnancy in some, but not all women with gestational diabetes. A better understanding of the pathophysiology and heterogeneity of gestational diabetes will help to develop novel management approaches with focus on improved prevention of maternal and offspring short-term and long-term complications, from pre-conception, throughout pregnancy, and beyond.
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Affiliation(s)
- Marie-France Hivert
- Division of Chronic Disease Research Across the Lifecourse (CoRAL), Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, MA, USA; Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Helena Backman
- Faculty of Medicine and Health, Department of Obstetrics and Gynecology, Örebro University, Örebro, Sweden
| | - Katrien Benhalima
- Endocrinology, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Patrick Catalano
- Maternal Infant Research Institute, Obstetrics and Gynecology Research, Tufts Medical Center, Boston, MA, USA; School of Medicine, Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Gernot Desoye
- Department of Obstetrics and Gynaecology, Medical University of Graz, Graz, Austria
| | - Jincy Immanuel
- School of Medicine, Western Sydney University, Sydney, NSW, Australia; Institute for Women's Health, College of Nursing, Texas Woman's University, Denton, TX, USA
| | - Christopher J D McKinlay
- Department of Paediatrics Child and Youth Health, University of Auckland, Auckland, New Zealand; Kidz First Neonatal Care, Te Whatu Ora Counties Manukau, Auckland, New Zealand
| | - Claire L Meek
- Leicester Diabetes Centre, Leicester General Hospital, University of Leicester, Leicester, UK
| | - Christopher J Nolan
- School of Medicine and Psychology, College of Health and Medicine, Australian National University, Canberra, ACT, Australia; Department of Endocrinology, Canberra Health Services, Woden, ACT, Australia
| | - Uma Ram
- Department of Obstetrics and Gynecology, Seethapathy Clinic and Hospital, Chennai, Tamilnadu, India
| | - Arianne Sweeting
- Department of Endocrinology, Royal Prince Alfred Hospital and University of Sydney, Sydney, NSW, Australia
| | - David Simmons
- School of Medicine, Western Sydney University, Sydney, NSW, Australia.
| | - Alicia Jawerbaum
- Facultad de Medicina, Universidad de Buenos Aires (UBA)-CONICET, Buenos Aires, Argentina; Laboratory of Reproduction and Metabolism, CEFYBO-CONICET, Buenos Aires, Argentina
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Sonaglioni A, Piergallini E, Naselli A, Nicolosi GL, Ferrulli A, Bianchi S, Lombardo M, Ambrosio G. The effect of gestational diabetes mellitus on carotid artery intima-media thickness in and after pregnancy: a systematic review and meta-analysis. Acta Diabetol 2024; 61:139-149. [PMID: 37936027 DOI: 10.1007/s00592-023-02206-9] [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: 08/23/2023] [Accepted: 10/18/2023] [Indexed: 11/09/2023]
Abstract
AIMS The association between gestational diabetes mellitus (GDM) and common carotid artery (CCA) intima-media thickness (IMT) is still controversial. This systematic review and meta-analysis was performed to assess the correlation between GDM and CCA-IMT in and after pregnancy. METHODS PubMed and EMBASE databases were systematically reviewed on April 2023. Studies measuring CCA-IMT in both pregnant women with GDM and women with previous history of GDM (pGDM) vs. healthy controls were included. The subtotal and overall standardized mean differences (SMDs) of CCA-IMT were calculated using the random-effect model. RESULTS Nineteen studies with a total of 302 GDM and 861 pGDM women were analyzed. The average value of CCA-IMT measured in GDM/pGDM (0.59 ± 0.12 mm) was slightly increased in comparison to the accepted reference limits of IMT according to age classes. Substantial heterogeneity was detected for the studies involving both GDM and pGDM women, with an overall statistic I2 of 86.0% (p < 0.001). Large SMDs were obtained for the studies conducted on both GDM and pGDM women, with an overall SMD of 0.89 (95%CI 0.63-1.15, p < 0.001). Egger's test for a regression intercept gave a p-value of 0.37, indicating no publication bias. On meta-regression analysis, all potential confounders (number of patients, age at pregnancy, body mass index, measuring time, follow-up duration and GDM criteria) were not significantly associated with effect modification. CONCLUSIONS GDM in and after pregnancy is independently associated with subclinical atherosclerosis. The association between GDM and carotid remodeling is potentially mediated by the longstanding underlying risk.
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Affiliation(s)
| | | | | | | | - Anna Ferrulli
- Department of Endocrinology, Nutrition and Metabolic Diseases, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Stefano Bianchi
- Division of Gynecology and Obstetrics, IRCCS MultiMedica, Milan, Italy
| | | | - Giuseppe Ambrosio
- Cardiology and Cardiovascular Pathophysiology, Azienda Ospedaliero-Universitaria "S. Maria Della Misericordia", Perugia, Italy
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Kgosidialwa O, Newman C, Carmody L, McGrath B, O’Shea PM, Dunne F. Abnormal Glucose Tolerance in Women Diagnosed With Gestational Diabetes (WHO 2013) 10 Years After Index Pregnancy. J Endocr Soc 2024; 8:bvae013. [PMID: 38328480 PMCID: PMC10849116 DOI: 10.1210/jendso/bvae013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Indexed: 02/09/2024] Open
Abstract
Context It is not clear if the risk of abnormal glucose tolerance (AGT) is attenuated in the long-term in women diagnosed with gestational diabetes (GDM) using the World Health Organization (WHO) 2013 criteria and who have received appropriate treatment during pregnancy. Objective We aimed to assess the long-term prevalence of AGT and other cardiovascular disease (CVD) risk factors in this cohort. Methods A retrospective cohort follow-up study was conducted of 37 and 107 women diagnosed with and without GDM respectively using the WHO 2013 criteria between June 2010 and December 2010. Women were invited to attend our center, where they underwent a 75-g oral glucose tolerance test, blood and urine collection, body measurements, and electrocardiography. Main outcome measure included the development of AGT using the American Diabetes Association criteria. Results Sixteen (43.2%) women with GDM compared to 5 (4.7%) women with normal glucose tolerance (NGT) at index pregnancy had AGT (P < .001). In the GDM group, 10 (27.0%), 7 (18.9%), and 4 (10.8%) women had impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and type 2 diabetes mellitus (T2DM), respectively. In the NGT group, 2 (1.9%), 3 (2.8%), and 1 (0.9%) woman had IFG, IGT, and T2DM, respectively. Women with AGT also had an unfavorable metabolic profile including obesity, hypertension, insulin resistance, and dyslipidemia. Conclusion Women treated for GDM (WHO 2013 criteria) remain at increased risk for developing AGT and adverse CVD risk factors as early as a decade after diagnosis. Continued efforts are needed to accurately follow this population to address modifiable risk factors.
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Affiliation(s)
- Oratile Kgosidialwa
- College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, H91TK33, Ireland
| | - Christine Newman
- College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, H91TK33, Ireland
| | - Louise Carmody
- College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, H91TK33, Ireland
| | - Brian McGrath
- College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, H91TK33, Ireland
| | - Paula M O’Shea
- College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, H91TK33, Ireland
| | - Fidelma Dunne
- College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, H91TK33, Ireland
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Minschart C, Lammertyn A, Van Crombrugge P, Moyson C, Verhaeghe J, Vandeginste S, Verlaenen H, Vercammen C, Maes T, Dufraimont E, Roggen N, De Block C, Jacquemyn Y, Mekahli F, De Clippel K, Van Den Bruel A, Loccufier A, Laenen A, Devlieger R, Mathieu C, Benhalima K. Low Gestational Weight Gain in Women With Gestational Diabetes Is Safe With Better Metabolic Profile Postpartum. J Clin Endocrinol Metab 2023; 108:665-679. [PMID: 36228141 DOI: 10.1210/clinem/dgac599] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/12/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT More data are needed on the potential benefits and risks of gestational weight gain (GWG) less than recommended and excessive GWG in women with gestational diabetes (GDM) compared to women with normal glucose tolerance (NGT) during pregnancy. OBJECTIVE This work aimed to evaluate association of gestational weight gain (GWG) as low, within, or above (excessive) according to Institute of Medicine (IOM) guidelines, with pregnancy outcomes in women with gestational diabetes (GDM) and normal glucose tolerance (NGT). METHODS This prospective cohort study included 7 Belgian hospitals and 1843 women receiving universal GDM screening with a 75-g oral glucose tolerance test. Pregnancy outcomes and postpartum characteristics were the main outcome measures. RESULTS Women with GDM and low GWG (n = 97, 52.4%) had similar rates of small-for-gestational age infants and preterm delivery, were less often overweight or obese postpartum (35.7% [30] vs 56.5% [26]; P < .022) and less often had postpartum weight retention (PPWR) (48.8% [41] vs 87.9% [40]; P < .001) compared to GWG within range (n = 58, 31.3%). GDM with excessive GWG (n = 30, 16.2%) more often had neonatal hypoglycemia (30.8% (8) vs 5.9% [3], aOR 7.15; 95% CI, 1.52-33.63; P = .013) compared to GWG within range. NGT with excessive GWG (28.3% [383]) more often had instrumental delivery (15.9% [61] vs 11.9% [64], aOR 1.53; 95% CI, 1.03-2.27; P = .035) and more large-for-gestational age infants (19.3% [74] vs 10.4% [56], aOR 1.67; 95% CI, 1.13-2.47; P = .012) compared to GWG within range. CONCLUSION GWG below IOM guidelines occurred frequently in GDM women, without increased risk for adverse pregnancy outcomes and with better metabolic profile postpartum. Excessive GWG was associated with increased risk for neonatal hypoglycemia and worse metabolic profile postpartum in women with GDM, and with higher rates of LGA and instrumental delivery in NGT women.
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Affiliation(s)
- Caro Minschart
- Department of Endocrinology, University Hospital Gasthuisberg, KU Leuven, 3000 Leuven, Belgium
| | | | - Paul Van Crombrugge
- Department of Endocrinology, OLV ziekenhuis Aalst-Asse-Ninove, 9300 Aalst, Belgium
| | - Carolien Moyson
- Department of Endocrinology, University Hospital Gasthuisberg, KU Leuven, 3000 Leuven, Belgium
| | - Johan Verhaeghe
- Department of Obstetrics & Gynecology, University Hospital Gasthuisberg, KU Leuven, 3000 Leuven, Belgium
| | - Sofie Vandeginste
- Department of Obstetrics & Gynecology, OLV ziekenhuis Aalst-Asse-Ninove, 9300 Aalst, Belgium
| | - Hilde Verlaenen
- Department of Obstetrics & Gynecology, OLV ziekenhuis Aalst-Asse-Ninove, 9300 Aalst, Belgium
| | - Chris Vercammen
- Department of Endocrinology, Imelda ziekenhuis, 2820 Bonheiden, Belgium
| | - Toon Maes
- Department of Endocrinology, Imelda ziekenhuis, 2820 Bonheiden, Belgium
| | - Els Dufraimont
- Department of Obstetrics & Gynecology, Imelda ziekenhuis, 2820 Bonheiden, Belgium
| | - Nele Roggen
- Department of Obstetrics & Gynecology, Imelda ziekenhuis, 2820 Bonheiden, Belgium
| | - Christophe De Block
- Department of Endocrinology-Diabetology-Metabolism, Antwerp University Hospital, 2650 Edegem, Belgium
| | - Yves Jacquemyn
- Department of Obstetrics & Gynecology, Antwerp University Hospital, 2650 Edegem, Belgium
| | - Farah Mekahli
- Department of Endocrinology, Kliniek St-Jan, 1000 Brussel, Belgium
| | - Katrien De Clippel
- Department of Obstetrics & Gynecology, Kliniek St-Jan, 1000 Brussel, Belgium
| | | | - Anne Loccufier
- Department of Obstetrics & Gynecology, AZ St Jan, 8000 Brugge, Belgium
| | - Annouschka Laenen
- Center of Biostatics and Statistical bioinformatics, KU Leuven, 3000 Leuven, Belgium
| | - Roland Devlieger
- Department of Obstetrics & Gynecology, University Hospital Gasthuisberg, KU Leuven, 3000 Leuven, Belgium
| | - Chantal Mathieu
- Department of Endocrinology, University Hospital Gasthuisberg, KU Leuven, 3000 Leuven, Belgium
| | - Katrien Benhalima
- Department of Endocrinology, University Hospital Gasthuisberg, KU Leuven, 3000 Leuven, Belgium
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Raets L, Van Hoorenbeeck K, Maes T, Vercammen C, De Block C, Dirinck E, Van Pottelbergh I, Wierckx K, Laenen A, Bogaerts A, Mathieu C, Benhalima K. The Belgian Diabetes in Pregnancy Follow-Up Study (BEDIP-FUS): A Multi-Centric Prospective Cohort Study on the Long-Term Metabolic Risk across Different Degrees of Gestational Glucose Intolerance: Methodology and Design. J Clin Med 2023; 12:jcm12031025. [PMID: 36769669 PMCID: PMC9917817 DOI: 10.3390/jcm12031025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/16/2023] [Accepted: 01/26/2023] [Indexed: 01/31/2023] Open
Abstract
The Belgian Diabetes in Pregnancy follow-up study (BEDIP-FUS) aims to investigate the impact of body mass index (BMI), adiposity and different degrees of glucose intolerance on the metabolic profile and future risk for type 2 diabetes (T2D) in women and offspring five years after delivery in the BEDIP study. The BEDIP study was a prospective cohort study to evaluate different screening strategies for gestational diabetes (GDM) based on the 2013 WHO criteria. The aim of the BEDIP-FUS is to recruit 375 women-offspring pairs, stratified according to three different subgroups based on the antenatal result of the glucose challenge test (GCT) and oral glucose tolerance test (OGTT) during the BEDIP pregnancy. The follow-up visit consists of a 75 g OGTT, anthropometric measurements and questionnaires for the mothers, and a fasting blood sample with anthropometric measurements for the child. Primary outcome for the mother is glucose intolerance defined by the American Diabetes Association criteria and for the offspring the BMI z-score. Recruitment began in January 2021. The BEDIP-FUS study will help to better individualize follow-up in women with different degrees of hyperglycemia in pregnancy and their offspring.
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Affiliation(s)
- Lore Raets
- Department of Endocrinology, University Hospital Gasthuisberg, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
- Correspondence: ; Tel.: +32-1634-7296
| | - Kim Van Hoorenbeeck
- Department of Pediatrics, Antwerp University Hospital, Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - Toon Maes
- Department of Endocrinology, Imelda Ziekenhuis, Imeldalaan 9, 2820 Bonheiden, Belgium
| | - Chris Vercammen
- Department of Endocrinology, Imelda Ziekenhuis, Imeldalaan 9, 2820 Bonheiden, Belgium
| | - Christophe De Block
- Department of Endocrinology-Diabetology-Metabolism, Antwerp University Hospital, Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - Eveline Dirinck
- Department of Endocrinology-Diabetology-Metabolism, Antwerp University Hospital, Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - Inge Van Pottelbergh
- Department of Endocrinology, OLV-Ziekenhuis Aalst-Asse-Ninove, Moorselbaan 164, 9300 Aalst, Belgium
| | - Katrien Wierckx
- Department of Endocrinology, OLV-Ziekenhuis Aalst-Asse-Ninove, Moorselbaan 164, 9300 Aalst, Belgium
| | - Annouschka Laenen
- Center of Biostatics and Statistical Bioinformatics, KU Leuven, Kapucijnenvoer 35 bloc d-box 7001, 3000 Leuven, Belgium
| | - Annick Bogaerts
- Department of Development & Regeneration, REALIFE Research Group KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Chantal Mathieu
- Department of Endocrinology, University Hospital Gasthuisberg, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Katrien Benhalima
- Department of Endocrinology, University Hospital Gasthuisberg, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
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Jiang L, Tang K, Magee LA, von Dadelszen P, Ekeroma A, Li X, Zhang E, Bhutta ZA. A global view of hypertensive disorders and diabetes mellitus during pregnancy. Nat Rev Endocrinol 2022; 18:760-775. [PMID: 36109676 PMCID: PMC9483536 DOI: 10.1038/s41574-022-00734-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/28/2022] [Indexed: 11/23/2022]
Abstract
Two important maternal cardiometabolic disorders (CMDs), hypertensive disorders in pregnancy (HDP) (including pre-eclampsia) and gestational diabetes mellitus (GDM), result in a large disease burden for pregnant individuals worldwide. A global consensus has not been reached about the diagnostic criteria for HDP and GDM, making it challenging to assess differences in their disease burden between countries and areas. However, both diseases show an unevenly distributed disease burden for regions with a low income or middle income, or low-income and middle-income countries (LMICs), or regions with lower sociodemographic and human development indexes. In addition to many common clinical, demographic and behavioural risk factors, the development and clinical consequences of maternal CMDs are substantially influenced by the social determinants of health, such as systemic marginalization. Although progress has been occurring in the early screening and management of HDP and GDM, the accuracy and long-term effects of such screening and management programmes are still under investigation. In addition to pharmacological therapies and lifestyle modifications at the individual level, a multilevel approach in conjunction with multisector partnership should be adopted to tackle the public health issues and health inequity resulting from maternal CMDs. The current COVID-19 pandemic has disrupted health service delivery, with women with maternal CMDs being particularly vulnerable to this public health crisis.
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Affiliation(s)
- Li Jiang
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
| | - Kun Tang
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Laura A Magee
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Peter von Dadelszen
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Alec Ekeroma
- Department of Obstetrics and Gynecology, Wellington School of Medicine, University of Otago, Wellington, New Zealand
- National University of Samoa, Apia, Samoa
| | - Xuan Li
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Enyao Zhang
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada.
- Center of Excellence in Women and Child Health, the Aga Khan University, Karachi, Pakistan.
- Institute for Global Health & Development, the Aga Khan University, Karachi, Pakistan.
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Sonaglioni A, Nicolosi GL, Migliori C, Bianchi S, Lombardo M. Usefulness of second trimester left ventricular global longitudinal strain for predicting adverse maternal outcome in pregnant women aged 35 years or older. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:1061-1075. [PMID: 34865191 DOI: 10.1007/s10554-021-02485-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/27/2021] [Indexed: 01/20/2023]
Abstract
The present study was primarily designed to accurately determine biventricular and biatrial myocardial function, assessed by two-dimensional speckle tracking echocardiography (2D-STE), in a prospective cohort of pregnant women aged ≥ 35 years, at the second trimester of pregnancy. Secondly, we aimed at investigating the main independent predictors of adverse maternal outcome (AMO) in the same study population. 80 consecutive pregnant women aged ≥ 35 years, 80 gestational week-matched (18.4 ± 1.6 vs 18.5 ± 1.8 weeks, p = 0.71) pregnant women aged < 35 years and 80 non-pregnant women aged ≥ 35 years without any comorbidity were included in this prospective study. All pregnant women underwent obstetric evaluation, modified Haller index (MHI) assessment and a conventional two-dimensional transthoracic echocardiography implemented with complete 2D-STE analysis of both ventricles and atria at the second trimester of pregnancy. AMO was defined as the occurrence of any of the following: gestational hypertension (GH) including preeclampsia; gestational diabetes mellitus (GDM); preterm delivery (PD); emergency caesarean section (ECS); postpartum haemorrhage (PPH); premature rupture of membranes (PROM); maternal death. Compared to younger pregnant women, pregnant women aged ≥ 35 years were more likely to be found with: (1) body mass index (BMI) ≥ 30 kg/m2 (37.5% of total); (2) significantly increased inflammatory markers; (3) significantly greater left ventricular mass index; (4) significantly impaired hemodynamics; (5) significantly reduced bi-atrial and bi-ventricular myocardial strain parameters, despite normal ejection fraction. A strong inverse correlation between second trimester BMI and left ventricular (LV)-global longitudinal strain (GLS) (r = - 0.84) and between second trimester MHI and LV-GLS (r = - 0.81) was demonstrated in pregnant women aged ≥ 35 years. GH, GDM, PD, ECS, PPH and PROM were detected in 15%, 12.5%, 10%, 8.7%, 8.7% and 7.5% of women, respectively. Age (OR 2.04, 95% CI 1.46-2.84), second trimester BMI (OR 2.40, 95% CI 1.64-3.51) and second trimester LV-GLS (OR 0.07, 95%C I 0.01-0.34) were independently associated with outcome. Age ≥ 37 years, BMI ≥ 30 kg/m2 and LV-GLS less negative than - 18% were the best cut-off values for predicting AMO. A LV-GLS less negative than - 18% allows to identify, among older pregnant women, those with an increased risk of AMO. Both intrinsic myocardial dysfunction and extrinsic compressive mechanical phenomena might affect global myocardial deformation during gestation.
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Affiliation(s)
- Andrea Sonaglioni
- Department of Cardiology, Ospedale San Giuseppe MultiMedica IRCCS, Via San Vittore 12, 20123, Milan, Italy.
| | | | | | - Stefano Bianchi
- Department of Gynecology and Obstetrics, IRCCS MultiMedica, Milan, Italy
| | - Michele Lombardo
- Department of Cardiology, Ospedale San Giuseppe MultiMedica IRCCS, Via San Vittore 12, 20123, Milan, Italy
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Abnormal glucose tolerance in women with prior gestational diabetes mellitus: a 4-year follow-up study. Ir J Med Sci 2022; 192:641-648. [PMID: 35419723 DOI: 10.1007/s11845-022-03005-x] [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: 01/16/2022] [Accepted: 04/01/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Adoption of the International Association of Diabetes and Pregnancy Study Group (IADPSG) criteria for diagnosis of gestational diabetes mellitus (GDM) varies worldwide. Early detection of women at increased risk of developing type 2 diabetes mellitus (T2DM) following GDM enables initiation of measures to delay disease onset. OBJECTIVES To determine the 4-year cumulative incidence and risk factors for developing abnormal glucose tolerance (AGT) among women with previous GDM using modified IADPSG criteria. Additionally, to review post-natal attendance at diabetes screening and the impact of post-partum lifestyle modifications and breastfeeding on the risk of T2DM development. METHODS Four hundred twenty-six women with a prior history of GDM were invited to participate in the study, 4 years after the index pregnancy. The following were completed: body measurements, oral glucose tolerance test (OGTT), glycated haemoglobin (HbA1c), vitamin D, and other biochemistry measurements. Participants also completed a lifestyle questionnaire. RESULTS Of the 74 women who participated, 15 (20%) had AGT. Predictive factors for AGT development were as follows: fasting glucose levels (p = 0.004), HbA1c (p = 0.008) at GDM diagnosis, and early pregnancy BMI (p = 0.001). Thirty-three (45%) women had not attended their postnatal screening. The odds ratio of the association between breastfeeding and AGT development was 0.16 (95% CI: 0.05 to 0.53). CONCLUSION The proportion of women who develop AGT after a diagnosis of GDM remains high. The factors associated with progression to AGT are available at GDM diagnosis. Preventing AGT in this group is possible by supporting breastfeeding. Attendance at post-natal screening should also be encouraged.
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Muglia L, Tong S, Ozanne S, Benhalima K. Maternal factors during pregnancy influencing maternal, fetal and childhood outcomes: Meet the Guest Editors. BMC Med 2022; 20:114. [PMID: 35264147 PMCID: PMC8908555 DOI: 10.1186/s12916-022-02294-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 02/09/2022] [Indexed: 01/04/2023] Open
Affiliation(s)
- Louis Muglia
- Burroughs Wellcome Fund, Research Triangle Park, NC, USA.
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Stephen Tong
- Department of Obstetrics and Gynaecology, University of Melbourne and Mercy Perinatal, Mercy Hospital for Women, Melbourne, Australia
| | - Susan Ozanne
- Wellcome-MRC Institute of Metabolic Science and Medical Research Council Metabolic Diseases Unit, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Katrien Benhalima
- Department of Endocrinology, University Hospital Gasthuisberg, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
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Sonaglioni A, Barlocci E, Adda G, Esposito V, Ferrulli A, Nicolosi GL, Bianchi S, Lombardo M, Luzi L. The impact of short-term hyperglycemia and obesity on biventricular and biatrial myocardial function assessed by speckle tracking echocardiography in a population of women with gestational diabetes mellitus. Nutr Metab Cardiovasc Dis 2022; 32:456-468. [PMID: 34893411 DOI: 10.1016/j.numecd.2021.10.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/09/2021] [Accepted: 10/13/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND AIMS To compare biventricular and biatrial myocardial strain indices assessed by two-dimensional speckle tracking echocardiography (2D-STE) in women with gestational diabetes mellitus (GDM) and those with uncomplicated pregnancy at the third trimester of pregnancy and in post-partum. METHODS AND RESULTS 30 consecutive GDM women and 30 age-, ethnicity- and gestational week-matched controls without any comorbidity were examined in this prospective case-control study. All women underwent obstetric visit, blood tests and transthoracic echocardiography (TTE) implemented with 2D-STE analysis of all cardiac chambers at 36-38 weeks' gestation. TTE and 2D-STE were repeated at 6-10 weeks after delivery. At 36-38 weeks' gestation, GDM women, compared to controls, had significantly higher body mass index (BMI), blood pressure values and inflammatory markers. TTE showed increased left ventricular (LV) mass and impaired LV diastolic function in GDM women, whereas there was no significant difference between the groups in ejection fraction. 2D-STE revealed that biventricular global longitudinal strain (GLS) and biatrial reservoir strain indices were significantly lower in GDM women than controls. Third trimester BMI was inversely correlated with LV-GLS (r = -0.86) and was independently associated with reduced LV-GLS (less negative than -20%) in GDM women in post-partum (OR 1.81, 95%CI 1.14-2.89). A BMI value ≥ 30 kg/m2 had 100% sensitivity and 99.5% specificity for identifying GDM women with impaired LV-GLS in post-partum (AUC = 0.97). CONCLUSION Women with GDM, compared to women with uncomplicated pregnancy, have significantly lower biventricular and biatrial myocardial deformation indices. These abnormalities may be persistent in post-partum in GDM women with obesity.
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Affiliation(s)
| | - Eugenio Barlocci
- Department of Gynecology and Obstetrics, IRCCS MultiMedica, Milan, Italy
| | - Guido Adda
- Department of Endocrinology, Nutrition and Metabolic Diseases, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
| | - Valentina Esposito
- Department of Gynecology and Obstetrics, IRCCS MultiMedica, Milan, Italy
| | - Anna Ferrulli
- Department of Endocrinology, Nutrition and Metabolic Diseases, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy; Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | | | - Stefano Bianchi
- Department of Gynecology and Obstetrics, IRCCS MultiMedica, Milan, Italy
| | | | - Livio Luzi
- Department of Endocrinology, Nutrition and Metabolic Diseases, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy; Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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Beunen K, Vercauter L, Van Crombrugge P, Moyson C, Verhaeghe J, Vandeginste S, Verlaenen H, Vercammen C, Maes T, Dufraimont E, Roggen N, De Block C, Jacquemyn Y, Mekahli F, De Clippel K, Van Den Bruel A, Loccufier A, Laenen A, Devlieger R, Mathieu C, Benhalima K. Type 1 diabetes-related autoimmune antibodies in women with gestational diabetes mellitus and the long-term risk for glucose intolerance. Front Endocrinol (Lausanne) 2022; 13:973820. [PMID: 36093103 PMCID: PMC9449803 DOI: 10.3389/fendo.2022.973820] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/04/2022] [Indexed: 11/13/2022] Open
Abstract
AIMS To characterize women with gestational diabetes mellitus (GDM) positive for type 1 diabetes-related autoimmune antibodies (T1D-related autoantibodies) in pregnancy and to evaluate their risk for long-term glucose intolerance. METHODS In a multi-centric prospective cohort study with 1843 women receiving universal screening for GDM with a 75 g oral glucose tolerance test (OGTT), autoantibodies were measured in women with GDM: insulin autoantibodies (IAA), islet cell antibodies (ICA), insulinoma-associated protein-2 antibodies (IA-2A) and glutamic acid decarboxylase antibodies (GADA). Long-term follow-up ( ± 4.6 years after delivery) with a 75 g OGTT and re-measurement of autoantibodies was done in women with a history of GDM and autoantibody positivity in pregnancy. RESULTS Of all women with GDM (231), 80.5% (186) received autoantibody measurement at a mean of 26.2 weeks in pregnancy, of which 8.1% (15) had one positive antibody (seven with IAA, two with ICA, four with IA-2A and two with GADA). Characteristics in pregnancy were similar but compared to women without autoantibodies, women with autoantibodies had more often gestational hypertension [33.3% (5) vs. 1.7% (3), p<0.001] and more often neonatal hypoglycemia [40.0% (6) vs. 12.5% (19), p=0.012]. Among 14 of the 15 autoantibody positive women with an early postpartum OGTT, two had impaired fasting glucose (IFG). Of the 12 women with long-term follow-up data, four tested again positive for T1D-related autoantibodies (three positive for IA-2A and one positive for ICA and IAA). Five women were glucose intolerant at the long-term follow-up of which two had IA-2A (one had IFG and one had T1D) and three without autoantibodies. There were no significant differences in long-term characteristics between women with and without autoantibodies postpartum. CONCLUSIONS Systematic screening for T1D-related autoantibodies in GDM does not seem warranted since the low positivity rate for autoantibodies in pregnancy and postpartum. At 4.6 years postpartum, five out of 12 women were glucose intolerant but only two still had autoantibodies. In women with clinically significant increased autoantibody levels during pregnancy, postpartum autoantibody re-measurement seems useful since the high risk for further increase of autoantibody levels.
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Affiliation(s)
- Kaat Beunen
- Department of Endocrinology, University Hospitals Gasthuisberg, KU Leuven, Leuven, Belgium
- *Correspondence: Kaat Beunen,
| | | | - Paul Van Crombrugge
- Department of Endocrinology, Onze Lieve Vrouw (OLV) Hospital Aalst-Asse-Ninove, Aalst, Belgium
| | - Carolien Moyson
- Department of Endocrinology, University Hospitals Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Johan Verhaeghe
- Department of Obstetrics and Gynecology, University Hospitals Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Sofie Vandeginste
- Department of Obstetrics and Gynecology, OLV Hospital Aalst-Asse-Ninove, Aalst, Belgium
| | - Hilde Verlaenen
- Department of Obstetrics and Gynecology, OLV Hospital Aalst-Asse-Ninove, Aalst, Belgium
| | - Chris Vercammen
- Department of Endocrinology, Imelda Hospital, Bonheiden, Belgium
| | - Toon Maes
- Department of Endocrinology, Imelda Hospital, Bonheiden, Belgium
| | - Els Dufraimont
- Department of Obstetrics and Gynecology, Imelda Hospital, Bonheiden, Belgium
| | - Nele Roggen
- Department of Obstetrics and Gynecology, Imelda Hospital, Bonheiden, Belgium
| | - Christophe De Block
- Department of Endocrinology-Diabetology-Metabolism, Antwerp University Hospital, Edegem, Belgium
| | - Yves Jacquemyn
- Department of Obstetrics and Gynecology, Antwerp University Hospital, Edegem, Belgium
| | - Farah Mekahli
- Department of Endocrinology, Hospital St Jan Brussel, Brussel, Belgium
| | - Katrien De Clippel
- Department of Obstetrics and Gynecology, Hospital St Jan Brussel, Brussel, Belgium
| | | | - Anne Loccufier
- Department of Obstetrics and Gynecology, General Hospital St Jan Brugge, Brugge, Belgium
| | - Annouschka Laenen
- Center of Biostatics and Statistical Bioinformatics, KU Leuven, Leuven, Belgium
| | - Roland Devlieger
- Department of Obstetrics and Gynecology, University Hospitals Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Chantal Mathieu
- Department of Endocrinology, University Hospitals Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Katrien Benhalima
- Department of Endocrinology, University Hospitals Gasthuisberg, KU Leuven, Leuven, Belgium
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Sonaglioni A, Nicolosi GL, Esposito V, Bianchi S, Lombardo M. Prognostic indicators of persistent carotid intima-media thickness increase in postpartum period in a population of normotensive women with gestational diabetes mellitus. Eur J Obstet Gynecol Reprod Biol 2021; 269:47-54. [PMID: 34968874 DOI: 10.1016/j.ejogrb.2021.12.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 11/07/2021] [Accepted: 12/11/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The association between gestational diabetes mellitus (GDM) and common carotid artery (CCA)-intima media thickness (IMT) is still controversial. In the present study, we aimed to compare the CCA-IMT measured in GDM women to that obtained in healthy pregnant women in the third trimester of pregnancy. Secondly, we investigated the main independent predictors of persistent CCA-IMT increase (defined as CCA-IMT ≥ 0.6 mm) in postpartum period in GDM women. STUDY DESIGN 30 consecutive GDM women and 30 healthy pregnant women matched for anagraphic age (34.1 ± 4.5 vs 32.8 ± 4.2 yrs, p = 0.25), ethnicity (caucasian 56.7 vs 63.3%, p = 0.59), gestational age (36.2 ± 1.7 vs 36.5 ± 1.6 weeks, p = 0.48) and cardiovascular risk factors were examined in this prospective case-control study. All women underwent obstetric visit, blood tests, conventional transthoracic echocardiography implemented with two-dimensional speckle tracking echocardiography analysis of left ventricular and left atrial myocardial strain parameters and carotid ultrasound examination at two time points: 36-38 weeks' gestation and 6-10 weeks after delivery. RESULTS At 36.2 ± 1.7 weeks of gestation, CCA-IMT was significantly increased in GDM women than controls (0.81 ± 0.11 vs 0.55 ± 0.12, p < 0.001). Twelve GDM women (40% of the total) were found with persistent CCA-IMT increase (0.76 ± 0.14 mm) in postpartum period (8.2 ± 2.2 weeks), whereas the remaining 18 (60% of the total) showed a normalization in CCA-IMT (0.56 ± 0.1 mm). At multivariate logistic regression analysis, third trimester body mass index (BMI) (OR 1.78, 95%CI 1.24-2.54, p = 0.01), glycosylated hemoglobin (HbA1C) (OR 1.51, 95%CI 1.13-1.89, p = 0.03) and neutrophil-to-lymphocyte ratio (NLR) (OR 1.68, 95%CI 1.25-4.65, p = 0.02) resulted to be independently associated with persistent CCA-IMT increase in postpartum period in GDM women. A BMI ≥ 29.2 Kg/m2, an HbA1C ≥ 37.5 mmol/mol and a NLR ≥ 5.5 were the best cut-off values for identifying GDM women with persistent CCA-IMT increase in postpartum period. CONCLUSIONS GDM is associated with increased CCA-IMT during pregnancy. This increase may be persistent in postpartum period in GDM women with obesity, uncontrolled diabetes and increased inflammatory markers.
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Affiliation(s)
| | | | - Valentina Esposito
- Department of Gynecology and Obstetrics, IRCCS MultiMedica, Milan, Italy
| | - Stefano Bianchi
- Department of Gynecology and Obstetrics, IRCCS MultiMedica, Milan, Italy
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Gestationsdiabetes mellitus – Teil 2: Therapie und Nachsorge. DIABETOLOGE 2021. [DOI: 10.1007/s11428-021-00835-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Benhalima K, Ma DD, Laenen A, Mathieu C, Halperin JA. Plasma glycated CD59 predicts postpartum glucose intolerance after gestational diabetes. Eur J Endocrinol 2021; 185:755-763. [PMID: 34524975 PMCID: PMC8511340 DOI: 10.1530/eje-21-0635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 09/15/2021] [Indexed: 11/08/2022]
Abstract
AIM To assess whether in women with gestational diabetes mellitus (GDM), postpartum plasma glycated CD59 (pGCD59) levels predict conversion to glucose intolerance diagnosed with an oral glucose tolerance test (OGTT). METHODS Blood levels of pGCD59 were measured in a case-control study of 105 women with GDM who underwent a 75 g OGTT 3 months postpartum. The 35 postpartum glucose intolerant cases were individually matched for age, BMI, ethnic origin, and parity with 70 women with GDM but normal postpartum OGTT (controls). The GDM cohort (105) was also matched with 105 normal glucose tolerant women during pregnancy. pGCD59 was measured by ELISA in standard peptide units (SPU). RESULTS Mean pGCD59 postpartum was significantly higher in cases than in controls (1.5 ± 0.6 SPU vs 1.0 ± 0.6 SPU, P < 0.001). The area under the receiving operating characteristic curve (AUC) in cases vs controls was 0.72 (95% CI: 0.62-0.83) for postpartum pGCD59 and 0.50 (95% CI: 0.36-0.61) for postpartum HbA1c. A 0.5-unit increase in postpartum pGCD59 was associated with an odds ratio (OR) of 3.3 (95% CI: 1.82-6.16, P < 0.001) for glucose intolerance postpartum. A pGCD59 cut-off postpartum of 0.9 SPU had a sensitivity of 85.7% (95% CI: 69.7-95.2%), specificity of 47.8% (95% CI: 35.6-60.2%), positive predictive value of 45.4% (95% CI: 33.1-58.2%), and negative predictive value of 86.8% (95% CI: 71.9-95.6%). pGCD59 in pregnancy was a poor predictor for glucose intolerance postpartum (AUC of 0.61 (95% CI: 0.50-0.72)). CONCLUSION pGCD59 might identify women at low risk for glucose intolerance postpartum and could help to avoid an OGTT.
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Affiliation(s)
- Katrien Benhalima
- Department of Endocrinology, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Diane D Ma
- Divisions of Hematology, Bringham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Annouschka Laenen
- Center of Biostatics and Statistical bioinformatics, KU Leuven, Leuven, Belgium
| | - Chantal Mathieu
- Department of Endocrinology, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Jose A Halperin
- Divisions of Hematology, Bringham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Minschart C, Beunen K, Benhalima K. An Update on Screening Strategies for Gestational Diabetes Mellitus: A Narrative Review. Diabetes Metab Syndr Obes 2021; 14:3047-3076. [PMID: 34262311 PMCID: PMC8273744 DOI: 10.2147/dmso.s287121] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 06/18/2021] [Indexed: 12/16/2022] Open
Abstract
Gestational diabetes mellitus (GDM) is a frequent medical complication during pregnancy. Screening and diagnostic practices for GDM are inconsistent across the world. This narrative review includes data from 87 observational studies and randomized controlled trials (RCTs), and aims to give an overview of the current evidence on screening strategies and diagnostic criteria for GDM. Screening in early pregnancy remains controversial and studies show conflicting results on the benefit of screening and treatment of GDM in early pregnancy. Implementing the one-step "International Association of Diabetes and Pregnancy Study Groups" (IADPSG) screening strategy at 24-28 weeks often leads to a substantial increase in the prevalence of GDM, without conclusive evidence regarding the benefits on pregnancy outcomes compared to a two-step screening strategy with a glucose challenge test (GCT). In addition, RCTs are needed to investigate the impact of treatment of GDM diagnosed with IADPSG criteria on long-term maternal and childhood outcomes. Selective screening using a risk-factor-based approach could be helpful in simplifying the screening algorithm but carries the risk of missing significant proportions of GDM cases. A two-step screening method with a 50g GCT and subsequently a 75g oral glucose tolerance test (OGTT) with IADPSG could be an alternative to reduce the need for an OGTT. However, to have an acceptable sensitivity to screen for GDM with the IADPSG criteria, the threshold of the GCT should be lowered from 7.8 to 7.2 mmol/L. A pragmatic approach to screen for GDM can be implemented during the COVID-19 pandemic, using fasting plasma glucose (FPG), HbA1c or even random plasma glucose (RPG) to reduce the number of OGTTs needed. However, usual guidelines and care should be resumed as soon as the COVID pandemic is controlled.
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Affiliation(s)
- Caro Minschart
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, 3000, Belgium
| | - Kaat Beunen
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, 3000, Belgium
| | - Katrien Benhalima
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, 3000, Belgium
- Department of Endocrinology, University Hospital Gasthuisberg, KU Leuven, Leuven, 3000, Belgium
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Ye X, Li Z, Li Y, Cai Q, Sun L, Zhu W, Ding X, Guo D, Qin Y, Lu X. Reduced mechanical function of the left atrial predicts adverse outcome in pregnant women with clustering of metabolic risk factors. BMC Cardiovasc Disord 2021; 21:265. [PMID: 34051751 PMCID: PMC8164318 DOI: 10.1186/s12872-021-02082-7] [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: 01/04/2021] [Accepted: 05/25/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The left atrial (LA) strain and strain rate are sensitive indicators of LA function. However, they are not widely used for the evaluation of pregnant women with metabolic diseases. The aim of this study was to assess the LA strain and strain rate of pregnant women with clustering of metabolic risk factors and to explore its prognostic effect on adverse pregnancy outcomes. MATERIALS AND METHODS Sixty-three pregnant women with a clustering of metabolic risk factors (CMR group), fifty-seven women with pregnancy-induced hypertension (PIH group), fifty-seven women with gestational diabetes mellitus (GDM group), and fifty matched healthy pregnant women (control group) were retrospectively evaluated. LA function was evaluated with two-dimensional speckle-tracking imaging. Iatrogenic preterm delivery caused by severe preeclampsia, placental abruption, and fetal distress was regarded as the primary adverse outcome. RESULTS The CMR group showed the lowest LA strain during reservoir phase (LASr), strain during contraction phase (LASct) and peak strain rate during conduit phase (pLASRcd) among the three groups (P < 0.05). LA strain during conduit phase (LAScd) and peak strain rate during reservoir phase (pLASRr) in the CMR group were lower than those in the control and GDM groups (P < 0.05). Multivariable Cox regression analysis demonstrated systolic blood pressure (HR = 1.03, 95% CI 1.01-1.05, p = 0.001) and LASr (HR = 0.86, 95% CI 0.80-0.92, p < 0.0001) to be independent predictors of iatrogenic preterm delivery. An LASr cutoff value ≤ 38.35% predicted the occurrence of iatrogenic preterm delivery. CONCLUSIONS LA mechanical function in pregnant women with metabolic aggregation is deteriorated. An LASr value of 38.35% or less may indicate the occurrence of adverse pregnancy outcomes.
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Affiliation(s)
- Xiaoguang Ye
- Department of Echocardiography, Heart Center, Beijing ChaoYang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Zhitian Li
- Department of Thoracic Surgery, Beijing ShiJiTan Hospital, Capital Medical University, Beijing, China
| | - Yidan Li
- Department of Echocardiography, Heart Center, Beijing ChaoYang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Qizhe Cai
- Department of Echocardiography, Heart Center, Beijing ChaoYang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Lanlan Sun
- Department of Echocardiography, Heart Center, Beijing ChaoYang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Weiwei Zhu
- Department of Echocardiography, Heart Center, Beijing ChaoYang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Xueyan Ding
- Department of Echocardiography, Heart Center, Beijing ChaoYang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Dichen Guo
- Department of Echocardiography, Heart Center, Beijing ChaoYang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Yunyun Qin
- Department of Echocardiography, Heart Center, Beijing ChaoYang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Xiuzhang Lu
- Department of Echocardiography, Heart Center, Beijing ChaoYang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China.
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Hung T, Chuang Y, Chu F, Huang L, Shaw SW, Hsieh T, Chen S. Risk factors for abnormal postpartum glycemic states in women diagnosed with gestational diabetes by the International Association of Diabetes and Pregnancy Study Groups criteria. J Diabetes Investig 2021; 12:859-868. [PMID: 32916029 PMCID: PMC8089005 DOI: 10.1111/jdi.13400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 08/27/2020] [Accepted: 09/02/2020] [Indexed: 11/28/2022] Open
Abstract
AIMS/INTRODUCTION To evaluate the rate of postpartum glycemic screening tests (PGST) in women with gestational diabetes mellitus (GDM), and to investigate risk factors for abnormal PGST results. MATERIALS AND METHODS We retrospectively analyzed the obstetric data of 1,648 women with GDM who gave birth after 28 completed weeks of gestation between 1 July 2011 and 31 December 2019 at Taipei Chang Gung Memorial Hospital, Taiwan. GDM was diagnosed by the International Association of Diabetes and Pregnancy Study Groups criteria. PGST was carried out at 6-12 weeks postpartum with a 75-g, 2-h oral glucose tolerance test, and the results were classified into normal, prediabetes and diabetes mellitus. Multiple logistic regression was used to assess the associations between various risk factors and abnormal PGST results. RESULTS In total, 493 (29.9%) women underwent PGST and 162 (32.9%) had abnormal results, including 135 (27.4%) with prediabetes and 27 (5.5%) with diabetes mellitus. Significant risk factors for postpartum diabetes mellitus included insulin therapy during pregnancy (adjusted odds ratio [OR] 10.79, 95% confidence interval [CI] 4.07-28.58), birthweight >4,000 g (adjusted OR 10.22, 95% CI 1.74-59.89) and preterm birth <37 weeks' gestation (adjusted OR 3.33, 95% CI 1.09-10.22); whereas prepregnancy body mass index >24.9 kg/m2 (adjusted OR 1.99, 95% CI 1.24-3.21) was the major risk factor for postpartum prediabetes. CONCLUSIONS Less than one-third of women with GDM underwent PGST, and nearly one-third of these women had abnormal results. Future efforts should focus on reducing the barriers to PGST in women with GDM.
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Affiliation(s)
- Tai‐Ho Hung
- Department of Obstetrics and GynecologyTaipei Chang Gung Memorial HospitalTaipeiTaiwan
- Department of MedicineCollege of MedicineChang Gung UniversityTaoyuanTaiwan
- Department of Obstetrics and GynecologyKeelung Chang Gung Memorial HospitalKeelungTaiwan
| | - Ya‐Chun Chuang
- Department of Obstetrics and GynecologyTaipei Chang Gung Memorial HospitalTaipeiTaiwan
| | - Fu‐Chieh Chu
- Department of Obstetrics and GynecologyTaipei Chang Gung Memorial HospitalTaipeiTaiwan
| | - Lulu Huang
- Department of Obstetrics and GynecologyTaipei Chang Gung Memorial HospitalTaipeiTaiwan
| | - Steven W Shaw
- Department of Obstetrics and GynecologyTaipei Chang Gung Memorial HospitalTaipeiTaiwan
- Department of MedicineCollege of MedicineChang Gung UniversityTaoyuanTaiwan
| | - T’sang‐T’ang Hsieh
- Department of Obstetrics and GynecologyTaipei Chang Gung Memorial HospitalTaipeiTaiwan
| | - Szu‐Fu Chen
- Department of Physical Medicine and RehabilitationCheng Hsin General HospitalTaipeiTaiwan
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Kleinwechter H, Demandt N, Nolte A. Prädisposition/Phänotypen des Gestationsdiabetes mellitus. DIABETOL STOFFWECHS 2021. [DOI: 10.1055/a-1217-2233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Vasan SK, Jobe M, Mathews J, Cole F, Rathore S, Jarjou O, Thompson D, Jarde A, Bittaye M, Ulijaszek S, Fall C, Osmond C, Prentice A, Karpe F. Pregnancy-related interventions in mothers at risk for gestational diabetes in Asian India and low and middle-income countries (PRIMORDIAL study): protocol for a randomised controlled trial. BMJ Open 2021; 11:e042069. [PMID: 33597136 PMCID: PMC7893661 DOI: 10.1136/bmjopen-2020-042069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Lifestyle modification is the mainstay of gestational diabetes mellitus (GDM) prevention. However, clinical trials evaluating the safety and efficacy of diet or physical activity (PA) in low-income and middle-income settings such as Africa and India are lacking. This trial aims to evaluate the efficacy of yoghurt consumption and increased PA (daily walking) in reducing GDM incidence in high-risk pregnant women. METHODS AND ANALYSIS The study is a 2×2 factorial, open-labelled, multicentre randomised controlled trial to be conducted in Vellore, South India and The Gambia, West Africa. 'High-risk' pregnant women (n=1856) aged ≥18 years and ≤16 weeks of gestational age, with at least one risk factor for developing GDM, will be randomised to either (1) yoghurt (2) PA (3) yoghurt +PA or (4) standard antenatal care. Participants will be followed until 32 weeks of gestation with total active intervention lasting for a minimum of 16 weeks. The primary endpoint is GDM incidence at 26-28 weeks diagnosed using International Association of the Diabetes and Pregnancy Study Groups criteria or elevated fasting glucose (≥5.1 mmol/L) at 32 weeks. Secondary endpoints include absolute values of fasting plasma glucose concentration at 32 weeks gestation, maternal blood pressure, gestational weight gain, intrapartum and neonatal outcomes. Analysis will be both by intention to treat and per-protocol. Continuous outcome measurements will be analysed using multiple linear regression and binary variables by logistic regression. ETHICS AND DISSEMINATION The study is approved by Oxford Tropical Research Ethics Committee (44-18), ethics committees of the Christian Medical College, Vellore (IRB 11367) and MRCG Scientific Coordinating Committee (SCC 1645) and The Gambia Government/MRCG joint ethics committee (L2020.E15). Findings of the study will be published in peer-reviewed scientific journals and presented in conferences. TRIAL REGISTRATION NUMBER ISRCTN18467720.
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Affiliation(s)
- Senthil K Vasan
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, Oxfordshire, UK
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Modou Jobe
- MRC Nutrition Group, MRC Unit The Gambia at LSHTM, Banjul, The Gambia
| | - Jiji Mathews
- Obstetrics and Gynaecology, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | - Fatoumata Cole
- Data Management, MRC Unit The Gambia at LSHTM, Banjul, The Gambia
| | - Swathi Rathore
- Obstetrics and Gynaecology, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | - Ousman Jarjou
- MRC Nutrition Group, MRC Unit The Gambia at LSHTM, Banjul, The Gambia
| | - Dylan Thompson
- Department for Health, University of Bath, Bath, Somerset, UK
| | - Alexander Jarde
- Statistics, MRC Unit The Gambia at LSHTM, Banjul, The Gambia
| | - Mustapha Bittaye
- Obstetrics and Gynaecology, MRC Unit The Gambia at LSHTM, Banjul, The Gambia
| | - Stanley Ulijaszek
- School of Anthropology, University of Oxford, Oxford, Oxfordshire, UK
| | - Caroline Fall
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Clive Osmond
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Andrew Prentice
- MRC International Nutrition Group, London School of Hygiene & Tropical Medicine, London, London, UK
| | - Fredrik Karpe
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, Oxfordshire, UK
- NIHR Oxford Biomedical Centre, Oxford University Hospital Trust and University of Oxford, Oxford, UK
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21
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Raets L, Vandewinkel M, Van Crombrugge P, Moyson C, Verhaeghe J, Vandeginste S, Verlaenen H, Vercammen C, Maes T, Dufraimont E, Roggen N, De Block C, Jacquemyn Y, Mekahli F, De Clippel K, Van Den Bruel A, Loccufier A, Laenen A, Devlieger R, Mathieu C, Benhalima K. Preference of Women for Gestational Diabetes Screening Method According to Tolerance of Tests and Population Characteristics. Front Endocrinol (Lausanne) 2021; 12:781384. [PMID: 34858350 PMCID: PMC8630544 DOI: 10.3389/fendo.2021.781384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 10/22/2021] [Indexed: 12/31/2022] Open
Abstract
AIMS To determine the preferred method of screening for gestational diabetes mellitus (GDM). METHODS 1804 women from a prospective study (NCT02036619) received a glucose challenge test (GCT) and 75g oral glucose tolerance test (OGTT) between 24-28 weeks. Tolerance of screening tests and preference for screening strategy (two-step screening strategy with GCT compared to one-step screening strategy with OGTT) were evaluated by a self-designed questionnaire at the time of the GCT and OGTT. RESULTS Compared to women who preferred one-step screening [26.2% (472)], women who preferred two-step screening [46.3% (834)] were less often from a minor ethnic background [6.0% (50) vs. 10.7% (50), p=0.003], had less often a previous history of GDM [7.3% (29) vs. 13.8% (32), p=0.008], were less often overweight or obese [respectively 23.1% (50) vs. 24.8% (116), p<0.001 and 7.9% (66) vs. 18.2% (85), p<0.001], were less insulin resistant in early pregnancy (HOMA-IR 8.9 (6.4-12.3) vs. 9.9 (7.2-14.2), p<0.001], and pregnancy outcomes were similar except for fewer labor inductions and emergency cesarean sections [respectively 26.6% (198) vs. 32.5% (137), p=0.031 and 8.2% (68) vs. 13.0% (61), p=0.005]. Women who preferred two-step screening had more often complaints of the OGTT compared to women who preferred one-step screening [50.4% (420) vs. 40.3% (190), p<0.001]. CONCLUSIONS A two-step GDM screening involving a GCT and subsequent OGTT is the preferred GDM screening strategy. Women with a more adverse metabolic profile preferred one-step screening with OGTT while women preferring two-step screening had a better metabolic profile and more discomfort of the OGTT. The preference for the GDM screening method is in line with the recommended Flemish modified two-step screening method, in which women at higher risk for GDM are recommended a one-step screening strategy with an OGTT, while women without these risk factors, are offered a two-step screening strategy with GCT. CLINICAL TRIAL REGISTRATION NCT02036619 https://clinicaltrials.gov/ct2/show/NCT02036619.
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Affiliation(s)
- Lore Raets
- Department of Endocrinology, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium
- *Correspondence: Lore Raets,
| | | | - Paul Van Crombrugge
- Department of Endocrinology, OLV ziekenhuis Aalst-Asse-Ninove, Aalst, Belgium
| | - Carolien Moyson
- Department of Endocrinology, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Johan Verhaeghe
- Department of Obstetrics & Gynecology, UZ Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Sofie Vandeginste
- Department of Obstetrics & Gynecology, OLV ziekenhuis Aalst-Asse-Ninove, Aalst, Belgium
| | - Hilde Verlaenen
- Department of Obstetrics & Gynecology, OLV ziekenhuis Aalst-Asse-Ninove, Aalst, Belgium
| | - Chris Vercammen
- Department of Endocrinology, Imelda ziekenhuis, Bonheiden, Belgium
| | - Toon Maes
- Department of Endocrinology, Imelda ziekenhuis, Bonheiden, Belgium
| | - Els Dufraimont
- Department of Obstetrics & Gynecology, Imelda ziekenhuis, Bonheiden, Belgium
| | - Nele Roggen
- Department of Obstetrics & Gynecology, Imelda ziekenhuis, Bonheiden, Belgium
| | - Christophe De Block
- Department of Endocrinology-Diabetology-Metabolism, Antwerp University Hospital, Edegem, Belgium
| | - Yves Jacquemyn
- Department of Obstetrics & Gynecology, Antwerp University Hospital, Edegem, Belgium
| | - Farah Mekahli
- Department of Endocrinology, Kliniek St-Jan Brussel, Brussel, Belgium
| | - Katrien De Clippel
- Department of Obstetrics & Gynecology, Kliniek St-Jan Brussel, Brussel, Belgium
| | | | - Anne Loccufier
- Department of Obstetrics & Gynecology, AZ St Jan Brugge, Brugge, Belgium
| | - Annouschka Laenen
- Center of Biostatics and Statistical bioinformatics, KU Leuven, Leuven, Belgium
| | - Roland Devlieger
- Department of Obstetrics & Gynecology, UZ Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Chantal Mathieu
- Department of Endocrinology, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Katrien Benhalima
- Department of Endocrinology, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium
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Vercammen E, Van Hoof L, Vercammen C, Goderis G, Benhalima K. Screening and follow-up of pregestational diabetes and gestational diabetes mellitus: A survey of primary care physicians in Belgium. Prim Care Diabetes 2020; 14:628-632. [PMID: 32471771 DOI: 10.1016/j.pcd.2020.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/16/2020] [Accepted: 04/25/2020] [Indexed: 11/19/2022]
Abstract
AIMS Consensus regarding the best screening and follow-up strategy for gestational diabetes mellitus (GDM) is lacking, resulting in heterogeneity in clinical practice. We aimed to evaluate screening and follow-up practices for pregestational type 2 diabetes (T2DM) and GDM in primary care in Belgium. METHODS We performed an online survey among primary care physicians (PCPs) in the northern part of Belgium, Flanders. RESULTS Responses were obtained from 379 PCPs. Approximately two thirds of participants estimated the prevalence of pregestational T2DM and GDM in Flanders at 5% and <10%, respectively. The risk of developing T2DM within 10 years after a history of GDM was estimated at <30% by nearly half of all participants. The majority of interviewed PCPs screen for pre-existing T2DM and GDM. For T2DM, fasting glycaemia was used by 92.2% whereas for GDM, 75.2% used the 50g glucose challenge test (GCT). Fasting glycaemia was the preferred test for postpartum follow-up. CONCLUSIONS While overall guideline adherence appears favourable, the prevalence of GDM is underestimated. Increased awareness on the long-term risk for women with a history of GDM is needed. The overall preference for the two-step strategy with GCT indicates that the 2019 Flemish guidelines on GDM screening are attainable in primary care.
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Affiliation(s)
- Eveline Vercammen
- Academic Centre for General Practice, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Lucas Van Hoof
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Chris Vercammen
- Department of Endocrinology, Imeldaziekenhuis, Bonheiden, Belgium
| | - Geert Goderis
- Academic Centre for General Practice, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Katrien Benhalima
- Department of Endocrinology, UZ Gasthuisberg, KU Leuven, Leuven, Belgium.
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Prevalence, risk factors and perinatal outcomes of gestational diabetes in Mexican adolescents when applying diagnostic criteria from three different international guidelines. Int J Diabetes Dev Ctries 2020. [DOI: 10.1007/s13410-020-00876-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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Minschart C, Maes T, De Block C, Van Pottelbergh I, Myngheer N, Abrams P, Vinck W, Leuridan L, Mathieu C, Billen J, Matthys C, Weyn B, Laenen A, Bogaerts A, Benhalima K. Mobile-Based Lifestyle Intervention in Women with Glucose Intolerance after Gestational Diabetes Mellitus (MELINDA), A Multicenter Randomized Controlled Trial: Methodology and Design. J Clin Med 2020; 9:E2635. [PMID: 32823771 PMCID: PMC7465345 DOI: 10.3390/jcm9082635] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/22/2020] [Accepted: 08/12/2020] [Indexed: 12/27/2022] Open
Abstract
The aims of the 'Mobile-based lifestyle intervention in women with glucose intolerance after gestational diabetes mellitus (GDM)' study (MELINDA) are: (1) to evaluate the prevalence and risk factors of glucose intolerance after a recent history of GDM; and (2) to evaluate the efficacy and feasibility of a telephone- and mobile-based lifestyle intervention in women with glucose intolerance after GDM. This is a Belgian multicenter randomized controlled trial (RCT) in seven hospitals with the aim of recruiting 236 women. Women in the intervention group will receive a blended program, based on one face-to-face education session and further follow-up through a mobile application and monthly telephone advice. Women in the control group will receive follow-up as in normal routine with referral to primary care. Participants will receive an oral glucose tolerance test (OGTT) one year after baseline. Primary endpoint is the frequency of weight goal achievement (≥5% weight loss if pre-pregnancy BMI ≥ 25 Kg/m2 or return to pre-gravid weight if BMI < 25 Kg/m2). At each visit blood samples are collected, anthropometric measurements are obtained, and self-administered questionnaires are completed. Recruitment began in May 2019.
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Affiliation(s)
- Caro Minschart
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, 3000 Leuven, Belgium; (C.M.); (C.M.); (K.B.)
| | - Toon Maes
- Department of Endocrinology, Imelda Hospital, 2820 Bonheiden, Belgium;
| | - Christophe De Block
- Department of Endocrinology-Diabetology-Metabolism, Antwerp University Hospital, 2650 Edegem, Belgium;
| | | | - Nele Myngheer
- Department of Endocrinology, General Hospital Groeninge, 8510 Kortrijk, Belgium;
| | - Pascale Abrams
- Department of Endocrinology, GZA Hospital Sint-Vincentius, 2018 Antwerp, Belgium;
- Department of Endocrinology, GZA Hospital Sint-Augustinus, 2610 Wilrijk, Belgium;
| | - Wouter Vinck
- Department of Endocrinology, GZA Hospital Sint-Augustinus, 2610 Wilrijk, Belgium;
| | - Liesbeth Leuridan
- Department of Endocrinology, General Hospital Klina, 2930 Brasschaat, Belgium;
| | - Chantal Mathieu
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, 3000 Leuven, Belgium; (C.M.); (C.M.); (K.B.)
- Department of Endocrinology, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Jaak Billen
- Department of Laboratory Medicine, University Hospitals Leuven, 3000 Leuven, Belgium;
| | - Christophe Matthys
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, 3000 Leuven, Belgium; (C.M.); (C.M.); (K.B.)
- Department of Endocrinology, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Babs Weyn
- Department of Electrical Engineering, Processing Speech and Images, KU Leuven, 3000 Leuven, Belgium;
| | - Annouschka Laenen
- Centre of Biostatics and Statistical Bioinformatics, KU Leuven, 3000 Leuven, Belgium;
| | - Annick Bogaerts
- Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium;
- Faculty of Medicine and Health Sciences, Centre for Research and Innovation in Care (CRIC), University of Antwerp, 2610 Wilrijk, Belgium
| | - Katrien Benhalima
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, 3000 Leuven, Belgium; (C.M.); (C.M.); (K.B.)
- Department of Endocrinology, University Hospitals Leuven, 3000 Leuven, Belgium
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Mao P, Jiang S, Guo J, Jiang Y, Long Q, Tang Y, Luo J, Wiley J, Vorderstrasse A. Progression to Abnormal Glucose Tolerance and Its Related Risk Factors Among Women with Prior Gestational Diabetes in Rural Communities of China. Diabetes Metab Syndr Obes 2020; 13:2259-2268. [PMID: 32636660 PMCID: PMC7334007 DOI: 10.2147/dmso.s252542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 06/08/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The purpose of this study was to describe the status of abnormal glucose tolerance with a longer duration after delivery among women with prior gestational diabetes mellitus (GDM) in a rural community of China, and to explore the influence of socio-demographic factors, GDM-related factors (family history of diabetes, number of children, receipt of treatment for GDM), psychosocial factors (perceived stress, self-efficacy, and social support), lifestyle behaviors (physical activity, sedentary activity, fruit or vegetables intake), and obesity indicators (body mass index and waist circumferences) on abnormal glucose tolerance. PATIENTS AND METHODS A cross-sectional descriptive survey was conducted among women with prior GDM in two county-level hospitals in Western and Eastern Hunan, China from November 2017 to June 2018. Under the guidance of life course theory, data were collected using self-report measures of socio-demographic and GDM-related factors as well as psychosocial factors (perceived stress, self-efficacy, and social support) and postpartum lifestyle behaviors (physical activity, sedentary activity, and fruit and vegetable intake). Additionally, a 75-g oral glucose tolerance test was conducted, and weight, height, and waist circumference were measured on site. RESULTS A total of 425 women were included in this study, with an average postpartum duration of 18.04 months. Of these women, 20.9% had abnormal glucose tolerance (AGT). A multivariate analysis indicated that the proportion of abnormal glucose tolerance increased with increased age (OR = 2.13; 1.27-3.57, p=0.004), ethnic minority (OR: 1.62, 95% CI: 0.96-2.72, p=0.069), lower educational levels (OR:0.58, 95% CI: 0.33-1.02, p=0.057), receipt of treatment for GDM during pregnancy (OR =1.93; 1.11-3.37, p=0.020) and larger waist circumference (OR = 1.08; 1.05-1.12, p=0.000). CONCLUSION More than one-fifth of the women with GDM in rural China had progression to AGT. More postpartum programs aimed at reducing waist circumference are warranted to delay or prevent progression to type 2 diabetes mellitus for rural Chinese women with prior GDM.
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Affiliation(s)
- Ping Mao
- Department of Nursing, Third Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of China
| | - Shan Jiang
- Xiangya School of Nursing, Central South University, Changsha, Hunan, People’s Republic of China
| | - Jia Guo
- Xiangya School of Nursing, Central South University, Changsha, Hunan, People’s Republic of China
| | - Yuanyuan Jiang
- Xiangya School of Nursing, Central South University, Changsha, Hunan, People’s Republic of China
| | - Qing Long
- Xiangya School of Nursing, Central South University, Changsha, Hunan, People’s Republic of China
| | - Yujia Tang
- Xiangya School of Nursing, Central South University, Changsha, Hunan, People’s Republic of China
| | - Jiaxin Luo
- Xiangya School of Nursing, Central South University, Changsha, Hunan, People’s Republic of China
| | - James Wiley
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA
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Mao P, Jiang S, Guo J, Long Q, Zhang H, Chen JL. Do obesity and low levels of physical activity increase the risk for developing type 2 diabetes mellitus among women with prior gestational diabetes in rural China? Res Nurs Health 2020; 43:387-395. [PMID: 32515856 DOI: 10.1002/nur.22043] [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: 09/24/2019] [Revised: 03/22/2020] [Accepted: 05/19/2020] [Indexed: 12/15/2022]
Abstract
Moderate-to-vigorous intensity physical activity (MVPA) and obesity play important roles in the development of type 2 diabetes mellitus (T2DM) among women with prior gestational diabetes mellitus (GDM). Yet, how MVPA affects the risk of developing T2DM among women with prior GDM across the different categories of obesity indicators is unclear. This study aimed to describe the levels of postpartum abnormal glucose tolerance (AGT), obesity indicators (body mass index [BMI] and waist circumference [WC]), and MVPA and to explore the independent effect and joint effect of MVPA and obesity indicators (BMI and WC) on the risk for developing AGT among women with prior GDM in rural China. A total of 425 women with prior GDM were recruited from two county-level hospitals in Western and Eastern Hunan, China. Data were collected with self-reported measurements on sociodemographics and clinical factors as well as postpartum weight-related behaviors (physical activity and dietary intake). The 75-g oral glucose tolerance test, weight, height, and WC were measured on site. Binary logistic regression models and multiplitive interaction models were used to explore the independent and joint associations of BMI and MVPA as well as WC and MVPA on AGT, respectively. One-fifth (20.9%) of the sample women had AGT. The obesity indicators were significantly associated with an increased risk of postpartum AGT, but MVPA was not. In joint effect analyses, larger WC and insufficient MVPA were not significantly associated with increased risk of AGT compared with normal WC and sufficient MVPA (mutually adjusted odds ratio [OR], 1.43; 95% confidence interval [CI], 0.46-4.43; p > .05). In joint effect analyses of MVPA and BMI, the mutually adjusted OR for developing AGT in women who were obese and had insufficient MVPA was 4.49 (95% CI, 1.35-14.92; p < .05) compared with normal weight and sufficient MVPA. Adequate weight management and increased MVPA are warranted for Chinese women with prior GDM to prevent T2DM.
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Affiliation(s)
- Ping Mao
- Department of Nursing, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Shan Jiang
- Department of Clinical Nursing, Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Jia Guo
- Department of Clinical Nursing, Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Qing Long
- Department of Clinical Nursing, Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Honghui Zhang
- Department of Hepatobiliary Surgery, Hunan Provincial People's Hospital, Chingsha, Hunan, China
| | - Jyu-Lin Chen
- Department of Family Nursing, School of Nursing, University of California, San Francisco, California
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27
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Benhalima K, Van Crombrugge P, Moyson C, Verhaeghe J, Vandeginste S, Verlaenen H, Vercammen C, Maes T, Dufraimont E, De Block C, Jacquemyn Y, Mekahli F, De Clippel K, Van Den Bruel A, Loccufier A, Laenen A, Minschart C, Devlieger R, Mathieu C. Estimating the risk of gestational diabetes mellitus based on the 2013 WHO criteria: a prediction model based on clinical and biochemical variables in early pregnancy. Acta Diabetol 2020; 57:661-671. [PMID: 31915927 DOI: 10.1007/s00592-019-01469-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 12/16/2019] [Indexed: 12/16/2022]
Abstract
AIMS We aimed to develop a prediction model based on clinical and biochemical variables for gestational diabetes mellitus (GDM) based on the 2013 World Health Organization (WHO) criteria. METHODS A total of 1843 women from a Belgian multi-centric prospective cohort study underwent universal screening for GDM. Using multivariable logistic regression analysis, a model to predict GDM was developed based on variables from early pregnancy. The performance of the model was assessed by receiver-operating characteristic (AUC) analysis. To account for over-optimism, an eightfold cross-validation was performed. The accuracy was compared with two validated models (van Leeuwen and Teede). RESULTS A history with a first degree relative with diabetes, a history of smoking before pregnancy, a history of GDM, Asian origin, age, height and BMI were independent predictors for GDM with an AUC of 0.72 [95% confidence interval (CI) 0.69-0.76)]; after cross-validation, the AUC was 0.68 (95% CI 0.64-0.72). Adding biochemical variables, a history of a first degree relative with diabetes, a history of GDM, non-Caucasian origin, age, height, weight, fasting plasma glucose, triglycerides and HbA1c were independent predictors for GDM, with an AUC of the model of 0.76 (95% CI 0.72-0.79); after cross-validation, the AUC was 0.72 (95% CI 0.66-0.78), compared to an AUC of 0.67 (95% CI 0.63-0.71) using the van Leeuwen model and an AUC of 0.66 (95% CI 0.62-0.70) using the Teede model. CONCLUSIONS A model based on easy to use variables in early pregnancy has a moderate accuracy to predict GDM based on the 2013 WHO criteria.
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Affiliation(s)
- Katrien Benhalima
- Department of Endocrinology, University Hospital Gasthuisberg, KU Leuven, Herestraat 49, 3000, Louvain, Belgium.
| | - Paul Van Crombrugge
- Department of Endocrinology, OLV ziekenhuis Aalst-Asse-Ninove, Moorselbaan 164, 9300, Aalst, Belgium
| | - Carolien Moyson
- Department of Endocrinology, University Hospital Gasthuisberg, KU Leuven, Herestraat 49, 3000, Louvain, Belgium
| | - Johan Verhaeghe
- Department of Obstetrics and Gynecology, University Hospital Gasthuisberg, KU Leuven, Herestraat 49, 3000, Louvain, Belgium
| | - Sofie Vandeginste
- Department of Obstetrics and Gynecology, OLV ziekenhuis Aalst-Asse-Ninove, Moorselbaan 164, 9300, Aalst, Belgium
| | - Hilde Verlaenen
- Department of Obstetrics and Gynecology, OLV ziekenhuis Aalst-Asse-Ninove, Moorselbaan 164, 9300, Aalst, Belgium
| | - Chris Vercammen
- Department of Endocrinology, Imelda ziekenhuis, Imeldalaan 9, 2820, Bonheiden, Belgium
| | - Toon Maes
- Department of Endocrinology, Imelda ziekenhuis, Imeldalaan 9, 2820, Bonheiden, Belgium
| | - Els Dufraimont
- Department of Obstetrics and Gynecology, Imelda ziekenhuis, Imeldalaan 9, 2820, Bonheiden, Belgium
| | - Christophe De Block
- Department of Endocrinology-Diabetology-Metabolism, Antwerp University Hospital, Wilrijkstraat 10, 2560, Edegem, Belgium
| | - Yves Jacquemyn
- Department of Obstetrics and Gynecology, Antwerp University Hospital, Wilrijkstraat 10, 2560, Edegem, Belgium
- ASTARC and Global Health Institute, Antwerp University, UA, Prinsstraat 13, 2000, Antwerp, Belgium
| | - Farah Mekahli
- Department of Endocrinology, Kliniek St-Jan Brussel, Kruidtuinlaan 32, 1000, Brussels, Belgium
| | - Katrien De Clippel
- Department of Obstetrics and Gynecology, Kliniek St-Jan Brussel, Kruidtuinlaan 32, 1000, Brussels, Belgium
| | - Annick Van Den Bruel
- Department of Endocrinology, AZ St Jan Brugge, Ruddershove 10, 8000, Brugge, Belgium
| | - Anne Loccufier
- Department of Obstetrics and Gynecology, AZ St Jan Brugge, Ruddershove 10, 8000, Brugge, Belgium
| | - Annouschka Laenen
- Center of Biostatics and Statistical Bioinformatics, KU Leuven, Kapucijnenvoer 35 bloc d - box 7001, 3000, Louvain, Belgium
| | - Caro Minschart
- Department of Endocrinology, University Hospital Gasthuisberg, KU Leuven, Herestraat 49, 3000, Louvain, Belgium
| | - Roland Devlieger
- Department of Obstetrics and Gynecology, University Hospital Gasthuisberg, KU Leuven, Herestraat 49, 3000, Louvain, Belgium
| | - Chantal Mathieu
- Department of Endocrinology, University Hospital Gasthuisberg, KU Leuven, Herestraat 49, 3000, Louvain, Belgium
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Saito M, Hirai C, Makino S, Takeda J, Nojiri S, Takeda S, Itakura A. A Retrospective Multicenter Study on the Usefulness of 50 g Glucose Challenge Test in Gestational Diabetes Mellitus Screening. JMA J 2020; 3:125-130. [PMID: 33150244 PMCID: PMC7590393 DOI: 10.31662/jmaj.2019-0072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 02/20/2020] [Indexed: 11/29/2022] Open
Abstract
Introduction: To clarify the usefulness of glucose challenge test (GCT), the rate of gestational diabetes mellitus (GDM) detection and perinatal outcomes were compared between the groups of random blood glucose level (RBG) and 50 g GCT in this study. Methods: The first survey was conducted at 255 institutions registered by the Kanto Society of Obstetrics and Gynecology and clinical training institutions in the Kanto Area, followed by a second survey. The included women were broadly classified into the RBG and GCT groups, according to the mid-trimester blood glucose screening method, and the perinatal outcomes of the two groups were retrospectively compared. The primary outcomes were the proportion of infants weighing 3,500 g or more and birth weight ≥90th-percentile infants. Results: The rate of GDM diagnosis was significantly higher in the GCT group (7.6%) than that in the RBG group (4.8%). However, no significant differences were observed in perinatal outcomes, i.e., the proportion of infants weighing 3,500 g or more or birth weight ≥90th percentile. Conclusions: GCT is not superior for predicting infants weighing 3,500 g or more and birth weight ≥90th percentile, as compared with RBG.
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Affiliation(s)
- Miho Saito
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Chihiro Hirai
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Shintaro Makino
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Jun Takeda
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Shuko Nojiri
- Medical Technology Innovation Center Clinical Research and Trial Center, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Satoru Takeda
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Atsuo Itakura
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
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