1
|
Laval N, Paquette M, Talsmat H, Marandyuk B, Wintermark P, Birca A, Pinchefsky EF, Tremblay S. Exposure to Maternal Diabetes during Pregnancy Is Associated with Aggravated Short-Term Neonatal and Neurological Outcomes following Perinatal Hypoxic-Ischemic Encephalopathy. Am J Perinatol 2024; 41:e1581-e1590. [PMID: 36918161 DOI: 10.1055/a-2053-7904] [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] [Indexed: 03/16/2023]
Abstract
OBJECTIVE Infants of diabetic mothers (IDM) are at higher risk of perinatal morbidities and glycemic instability, but the impact of maternal diabetes on neonatal and neurological short-term outcomes of neonates with hypoxic-ischemic encephalopathy (HIE) remains poorly described. Our objective was to determine the impact of maternal diabetes on neonatal and neurological short-term outcomes following neonatal HIE. STUDY DESIGN This was a retrospective single-center study including 102 term neonates with HIE who received therapeutic hypothermia (TH) treatment between 2013 and 2020. Multiple regression analysis was used to assess the relationship between the presence of maternal diabetes and short-term outcomes. RESULTS Neonates with HIE and maternal diabetes exposure had a significantly lower gestational age at birth (38.6 vs. 39.7 weeks of gestation, p = 0.005) and a significantly higher mean birth weight (3,588 ± 752 vs. 3,214 ± 514 g, p = 0.012). IDM with HIE were ventilated for longer duration (8 vs. 4 days, p = 0.0047) and had a longer neonatal intensive care unit (NICU) stay (18 vs. 11 days, p = 0.0483) as well as took longer time to reach full oral feed (15 vs. 7 days, p = 0.0432) compared with neonates of nondiabetic mother. Maternal diabetes was also associated with an increased risk of death or abnormal neurological examination at discharge in neonates with HIE (odds ratio: 6.41 [1.54-26.32]). CONCLUSION In neonates with HIE, maternal diabetes is associated with an increased risk of death or short-term neonatal morbidities, such as longer duration of ventilation, prolonged neonatal stay, greater need for tube feeding, and being discharged with an abnormal neurological examination. Strategies to prevent, reduce, or better control maternal diabetes during pregnancy should be prioritized to minimize complications after perinatal asphyxia. KEY POINTS · Maternal DB is associated with unfavorable outcomes.. · IDM have longer ventilatory support and tube feeding.. · IDM have higher risk of abnormal neurological examination..
Collapse
Affiliation(s)
- Nancy Laval
- CHU Ste-Justine Research Center, Montréal, QC, Canada
- Department of Neonatology, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Mariane Paquette
- CHU Ste-Justine Research Center, Montréal, QC, Canada
- Department of Neonatology, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Hamza Talsmat
- CHU Ste-Justine Research Center, Montréal, QC, Canada
| | | | - Pia Wintermark
- Department of Pediatrics, Montréal Children's Hospital, Montréal, QC, Canada
| | - Ala Birca
- CHU Ste-Justine Research Center, Montréal, QC, Canada
- Division of Neurology, Department of Neurosciences and Paediatrics, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Elana F Pinchefsky
- CHU Ste-Justine Research Center, Montréal, QC, Canada
- Division of Neurology, Department of Neurosciences and Paediatrics, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Sophie Tremblay
- CHU Ste-Justine Research Center, Montréal, QC, Canada
- Department of Neonatology, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| |
Collapse
|
2
|
Santos JDC, Guida JPS, Cralcev C, Dias TZ, Passini R, Lajos GJ, Pacagnella RC, Tedesco RP, Nomura ML, Rehder PM, Cecatti JG, Costa ML. Diabetes among women with preterm births: outcomes of a Brazilian multicenter study. EINSTEIN-SAO PAULO 2023; 21:eAO0515. [PMID: 38126662 PMCID: PMC10730262 DOI: 10.31744/einstein_journal/2023ao0515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 07/04/2023] [Indexed: 12/23/2023] Open
Abstract
OBJECTIVE The objective was to compare the maternal and perinatal characteristics and outcomes between women with and without diabetes in a Brazilian cohort of women with preterm births. METHODS This was an ancillary analysis of the Brazilian Multicenter Study on Preterm Birth, which included 4,150 preterm births. This analysis divided preterm births into two groups according to the presence of diabetes; pregestational and gestational diabetes were clustered in the same Diabetes Group. Differences between both groups were assessed using χ 2 or Student's t tests. RESULTS Preterm births of 133 and 4,017 women with and without diabetes, respectively, were included. The prevalence of diabetes was 3.2%. Pregnant women aged ≥35 years were more common in the Diabetes Group (31.6% versus 14.0% non-diabetic women, respectively). The rate of cesarean section among patients with diabetes was 68.2% versus 52.3% in non-diabetic cases), with a gestational age at birth between 34 and 36 weeks in 78.9% of the cases and 62.1% of the controls. Large-for-gestational-age babies were 7 times more common in the Diabetes Group. CONCLUSION Preterm birth among Brazilian women with diabetes was more than twice as prevalent; these women were older and had regular late preterm deliveries, usually by cesarean section. They also had a greater frequency of fetal morbidities, such as malformations and polyhydramnios, and a higher proportion of large-for-gestational-age and macrosomic neonates.
Collapse
Affiliation(s)
- Juliana da Costa Santos
- Universidade Estadual de CampinasCampinasSPBrazil Universidade Estadual de Campinas
,
Campinas
,
SP
,
Brazil
.
| | - José Paulo Siqueira Guida
- Universidade Estadual de CampinasCampinasSPBrazil Universidade Estadual de Campinas
,
Campinas
,
SP
,
Brazil
.
| | - Christopher Cralcev
- Universidade Estadual de CampinasCampinasSPBrazil Universidade Estadual de Campinas
,
Campinas
,
SP
,
Brazil
.
| | - Tabata Zumpano Dias
- Universidade Estadual de CampinasCampinasSPBrazil Universidade Estadual de Campinas
,
Campinas
,
SP
,
Brazil
.
| | - Renato Passini
- Universidade Estadual de CampinasCampinasSPBrazil Universidade Estadual de Campinas
,
Campinas
,
SP
,
Brazil
.
| | - Giuliane Jesus Lajos
- Universidade Estadual de CampinasCampinasSPBrazil Universidade Estadual de Campinas
,
Campinas
,
SP
,
Brazil
.
| | - Rodolfo Carvalho Pacagnella
- Universidade Estadual de CampinasCampinasSPBrazil Universidade Estadual de Campinas
,
Campinas
,
SP
,
Brazil
.
| | - Ricardo Porto Tedesco
- Universidade Estadual de CampinasCampinasSPBrazil Universidade Estadual de Campinas
,
Campinas
,
SP
,
Brazil
.
| | - Marcelo Luis Nomura
- Universidade Estadual de CampinasCampinasSPBrazil Universidade Estadual de Campinas
,
Campinas
,
SP
,
Brazil
.
| | - Patricia Moretti Rehder
- Universidade Estadual de CampinasCampinasSPBrazil Universidade Estadual de Campinas
,
Campinas
,
SP
,
Brazil
.
| | - José Guilherme Cecatti
- Universidade Estadual de CampinasCampinasSPBrazil Universidade Estadual de Campinas
,
Campinas
,
SP
,
Brazil
.
| | - Maria Laura Costa
- Universidade Estadual de CampinasCampinasSPBrazil Universidade Estadual de Campinas
,
Campinas
,
SP
,
Brazil
.
| |
Collapse
|
3
|
Wang Z, Chen J, Long T, Liang L, Zhong C, Li Y. Clinical analysis of diabetes in pregnancy with stillbirth. Medicine (Baltimore) 2023; 102:e33898. [PMID: 37233404 PMCID: PMC10219722 DOI: 10.1097/md.0000000000033898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 05/10/2023] [Indexed: 05/27/2023] Open
Abstract
We analyzed the clinical characteristics of patients with diabetes in pregnancy (DIP) associated with stillbirth and explored strategies to reduce its incidence. We retrospectively analyzed 71 stillbirths associated with DIP (group A) and 150 normal pregnancies (group B) during 2009 to 2018. The incidence of the following was higher in group A (P < .05): hypertensive disorders (38.03% vs 6.00%), placenta previa (14.08% vs 2.67%), placental abruption (5.63% vs 0.67%), fetal malformation (8.45% vs 0.67%), fasting plasma glucose (FPG) ≥ 7.0 mmol/L (46.48% vs 0.67%), 2-h postprandial plasma glucose ≥ 11.1 mmol/L (57.75% vs 6.00%), HbA1c ≥ 6.5% (63.38% vs 6.00%), and polyhydramnios (11.27% vs 4.67). The incidence of oligohydramnios (4.23% vs 6.67%) was lower in group A than in group B (P < .05). According to the gestational age at the time of stillbirth, Group-A cases were subgrouped into miscarriages (20-27+6 weeks), premature deliveries (28-36+6 weeks), and full-term deliveries (≥37 weeks). Age, parity, and DIP type did not differ among the subgroups (P > .05). Among patients with DIP, antenatal FPG, 2-h postprandial plasma glucose, and HbA1c were significantly associated with stillbirth (P < .05). Stillbirth was first detected at 22 weeks and typically occurred at 28-36+6 weeks. DIP was associated with a higher incidence of stillbirth, and FPG, 2-h postprandial plasma glucose, and HbA1c were potential indicators of stillbirth in DIP. Age (odds ratio [OR]: 2.21, 95% confidence interval [CI]: 1.67-2.74), gestational hypertension (OR: 3.44, 95% CI: 2.21-4.67), body mass index (OR: 2.86, 95% CI: 1.95-3.76), preeclampsia (OR: 2.29, 95% CI: 1.45-3.12), and diabetic ketoacidosis (OR: 3.99, 95% CI: 1.22-6.76) were positively correlated with the occurrence of stillbirth in DIP. Controlling perinatal plasma glucose, accurately detecting and managing comorbidities/complications, and timely termination of pregnancy can reduce the incidence of stillbirths associated with DIP.
Collapse
Affiliation(s)
- Zhenyu Wang
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangzhou, China
- Department of Obstetrics and Gynecology, Sun Yat-Sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jia Chen
- Department of Obstetrics, Foshan Women and Children Hospital, Foshan, China
| | - Tuhong Long
- Department of Medical Affairs Section, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Lixuan Liang
- Department of Obstetrics, Dongguan Songshan Lake Central Hospital, Dongguan, China
| | - Caijuan Zhong
- Department of Obstetrics, Maternal and Child Health Hospital of Guangdong, Guangzhou, China
| | - Yingtao Li
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangzhou, China
| |
Collapse
|
4
|
Zhao D, Liu D, Shi W, Shan L, Yue W, Qu P, Yin C, Mi Y. Association between Maternal Blood Glucose Levels during Pregnancy and Birth Outcomes: A Birth Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2102. [PMID: 36767469 PMCID: PMC9915873 DOI: 10.3390/ijerph20032102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 01/16/2023] [Accepted: 01/16/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE This study aimed to investigate the relationship between maternal blood glucose levels during pregnancy and neonatal birth outcomes in Northwest China. METHODS This population-based cohort study included 10,010 first-trimester pregnant women who joined the birth cohort of the Northwest Women's and Children's Hospital from July 2018 to July 2020. Basic demographic characteristics, lifestyle and behavior patterns were collected. Oral glucose tolerance test (OGTT) results during the second trimester and pregnancy outcomes after childbirth were also collected. A generalized linear model was constructed to analyze the effects of blood glucose levels on neonatal birth outcomes. RESULTS We found that every 1 mmol/L increase in fasting plasma glucose (FPG) was associated with an increase in birth weight (β = 100.22 g, 95% confidence interval (95%CI): 81.91, 118.52), birth weight Z score (β = 0.23, 95%CI: 0.19, 0.27) and birth weight Z centile (β = 6.72%, 95%CI: 5.51, 7.94). Moreover, the risk of macrosomia, premature birth and being born large for gestational age (LGA) increased by 2.01 (95%CI: 1.67, 2.43), 1.35 (95%CI: 1.09, 1.66) and 1.80 (95%CI: 1.57, 2.07) times, respectively. Additionally, for every 1 mmol/L increase in FPG associated with a decrease in gestational age (β = -0.12 weeks, 95%CI: -0.19, -0.06), the risk of SGA decreased by 0.70 (OR = 0.70, 95%CI: 0.55, 0.89) times. Every 1 mmol/L increase in 1/2-h PG had similar outcomes as FPG, besides premature birth and SGA. CONCLUSIONS Higher blood glucose in pregnant women may increase neonatal birth weight, decrease gestational age and lead to a higher risk of macrosomia, premature birth and LGA. Mothers should actively prevent and control hyperglycemia to promote maternal and infant health.
Collapse
Affiliation(s)
- Doudou Zhao
- Translational Medicine Center, Northwest Women’s and Children’s Hospital, No. 1616 Yanxiang Road, Xi’an 710061, China
| | - Danmeng Liu
- Translational Medicine Center, Northwest Women’s and Children’s Hospital, No. 1616 Yanxiang Road, Xi’an 710061, China
| | - Wenhao Shi
- The Assisted Reproduction Center, Northwest Women’s and Children’s Hospital, No. 1616 Yanxiang Road, Xi’an 710061, China
| | - Li Shan
- Department of Obstetrics and Gynecology, Northwest Women’s and Children’s Hospital, No. 1616 Yanxiang Road, Xi’an 710061, China
| | - Wentao Yue
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing 100026, China
| | - Pengfei Qu
- Translational Medicine Center, Northwest Women’s and Children’s Hospital, No. 1616 Yanxiang Road, Xi’an 710061, China
| | - Chenghong Yin
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing 100026, China
| | - Yang Mi
- Department of Obstetrics and Gynecology, Northwest Women’s and Children’s Hospital, No. 1616 Yanxiang Road, Xi’an 710061, China
| |
Collapse
|
5
|
Lemieux P, Benham JL, Donovan LE, Moledina N, Pylypjuk C, Yamamoto JM. The association between gestational diabetes and stillbirth: a systematic review and meta-analysis. Diabetologia 2022; 65:37-54. [PMID: 34676425 DOI: 10.1007/s00125-021-05579-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 07/21/2021] [Indexed: 12/16/2022]
Abstract
AIMS/HYPOTHESIS Controversy exists over whether gestational diabetes increases the risk of stillbirth. The aim of this review was to examine the association between gestational diabetes and stillbirth. METHODS We performed searches of the published literature to May 2021. Study selection and data extraction were performed in duplicate by independent reviewers. Meta-analyses of summary measures were conducted using random-effect models for cohort and case-control studies separately. The study protocol was registered in PROSPERO (registration ID CRD42020166939). RESULTS From 9981 citations, 419 were identified for full-text review and 73 met inclusion criteria (n = 70,292,090). There was no significant association between gestational diabetes and stillbirth in cohort studies (pooled OR 1.04 [95% CI 0.90, 1.21]; I2 86.1%) or in case-control studies (pooled OR 1.57 [95% CI 0.83, 2.98]; I2 94.8%). Gestational diabetes was associated with lower odds of stillbirth among cohort studies presenting with an adjusted OR (pooled OR 0.78 [95% CI 0.68, 0.88]; I2 42.7%). Stratified analyses by stillbirth ≥28 weeks' gestation, studies published prior to 2013 and studies identified as low quality demonstrated a significantly higher odds of stillbirth in meta-regression (p = 0.016, 0.023 and 0.005, respectively). Egger's test for all included cohort studies (p = 0.018) suggests publication bias for the main meta-analysis. CONCLUSIONS/INTERPRETATION Given the substantial heterogeneity across studies, there are insufficient data to define the relationship between stillbirth and gestational diabetes adequately. In the main analyes, gestational diabetes was not associated with an increased risk of stillbirth. However, heterogeneity across studies means this finding should be interpreted cautiously.
Collapse
Affiliation(s)
- Patricia Lemieux
- Department of Medicine, CHU de Québec - University Laval, Quebec City, QC, Canada
| | - Jamie L Benham
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Lois E Donovan
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Obstetrics and Gynecology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Nadia Moledina
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Christy Pylypjuk
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, MB, Canada
- Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, MB, Canada
| | - Jennifer M Yamamoto
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, MB, Canada.
- Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada.
| |
Collapse
|
6
|
The Differences of Gestational Diabetes Outpatient Management Between China and the United Kingdom: from the Perspective of a First-Year Resident. MATERNAL-FETAL MEDICINE 2021. [DOI: 10.1097/fm9.0000000000000110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
7
|
Belay DM, Bayih WA, Alemu AY, Ayele AS, Mekonen DK, Birhane BM. Stillbirth Among Patients With Diabetes in Pregnancy in Ethiopia: Systematic Review and Meta-Analysis. Front Pediatr 2021; 9:634670. [PMID: 34422712 PMCID: PMC8374151 DOI: 10.3389/fped.2021.634670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 06/30/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: Maternal diabetes mellitus and the resulting adverse fetal outcomes including stillbirth in low- and middle-income countries (LMICs) are high. Thus, setting specific evidence is pivotal to plan, evaluate, and improve national preventive measures and to achieve international sustainable development goals. Therefore, this systematic review and meta-analysis was the first of its kind to estimate the pooled prevalence of stillbirth and its determinants among diabetic mothers in Ethiopia. Methods: Primary studies were exhaustively searched using PubMed, ScienceDirect, Web of Science, SCOPUS, and Google Scholar databases, and gray literature found in Addis Ababa and Haramaya University online repositories was accessed. Eligible studies were selected and critically appraised for quality using the Joanna Briggs Institute (JBI) quality appraisal checklist. The overall prevalence of stillbirth among diabetic mothers was estimated using a weighted inverse random-effect model. I 2 statistic was used for evidence of heterogeneity. Egger's test and funnel plot were used to check the presence of publication bias. Results: The pooled prevalence of stillbirth among diabetic mothers was 2.39 [95% confidence interval (CI): -0.20, 4.97]. Being a housewife [adjusted odds ratio (AOR) = 2.25; 95% CI: 1.26, 3.23], maternal age of <30 years [AOR = 2.08 (95% CI: 1.02, 3.13)], and gestational age of <37 completed weeks [AOR = 9.76 (95% CI: 7.83, 11.70)] increased the risk of stillbirth among diabetic mothers. Conclusions: The national pooled prevalence of stillbirth among diabetic mothers was 2.39%. Maternal age of <30 years, gestational age of <37 completed weeks, and being a housewife were significantly associated with stillbirth. Trial registration: PROSPERO 2020: CRD4202016774.
Collapse
Affiliation(s)
- Demeke Mesfin Belay
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Wubet Alebachew Bayih
- Department of Maternity and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Abebaw Yeshambel Alemu
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Amare Simegn Ayele
- Department of Midwifery, Reproductive Health, Debre Tabor University, Debre Tabor, Ethiopia
| | - Demewoz Kefale Mekonen
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Binyam Minuye Birhane
- Department of Maternity and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| |
Collapse
|
8
|
Zhang M, Zhou Y, Zhong J, Wang K, Ding Y, Li L. Current guidelines on the management of gestational diabetes mellitus: a content analysis and appraisal. BMC Pregnancy Childbirth 2019; 19:200. [PMID: 31196116 PMCID: PMC6567433 DOI: 10.1186/s12884-019-2343-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 05/16/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite many guidelines for the management of gestational diabetes available internationally, little work has been done to summarize and assess the content of existing guidelines. A paucity of analysis guidelines within in a unified system may be one explanatory factor. So this study aims to analyze and evaluate the contents of all available guidelines for the management of gestational diabetes. METHOD Relevant clinical guidelines were collected through a search of relevant guideline websites and databases (PubMed, Web of Science, Embase, etc.). Fourteen guidelines were identified, and each guideline was assessed for quality using the Appraisal of Guidelines for Research & Evaluation (AGREE) II instrument. Two independent reviewers extracted guideline recommendations using a "recommendation matrix" through which basic guideline information and consistency between search strategy and selection of evidence, between selected evidence and interpretation, and between interpretation and resulting recommendations were analyzed. RESULTS Fourteen documents were analyzed, and a total of 361 original recommendations for gestational diabetes mellitus (GDM) management were assessed. In all guidelines included, the recommendations were developed in five domains, namely, diagnosis of GDM, prenatal care, intrapartum care, neonatal care and postpartum care. Different guidelines appeared to have significant discrepancy in consistency of guideline content, but overall, there was consistency between search strategy and selection of evidence, between selected evidence and interpretation, and between interpretation and resulting recommendations (scilicet 49.31, 57.20 and 58.17%, respectively). CONCLUSION Although commonality in most recommendations existed, there were still some discrepancies between guidelines. Consistency of guidelines on the management of GDM in pregnancy is highly variable and needs to be improved.
Collapse
Affiliation(s)
- Mengxing Zhang
- Fudan University Centre for Evidence-based Nursing: A Joanna Briggs Institute Centre of Excellence, School of Nursing, Fudan University, Shanghai, China
| | - Yingfeng Zhou
- Fudan University Centre for Evidence-based Nursing: A Joanna Briggs Institute Centre of Excellence, School of Nursing, Fudan University, Shanghai, China
| | - Jie Zhong
- Fudan University Centre for Evidence-based Nursing: A Joanna Briggs Institute Centre of Excellence, School of Nursing, Fudan University, Shanghai, China
| | - Kairong Wang
- Fudan University Centre for Evidence-based Nursing: A Joanna Briggs Institute Centre of Excellence, School of Nursing, Fudan University, Shanghai, China
| | - Yan Ding
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Li Li
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| |
Collapse
|
9
|
Hagen G, Brown C, Dietrich J, Gibbs C, Lee GT. The Utility of Lower Glycemic Targets for Treating Gestational Diabetes: A Retrospective Study. J Diabetes Res 2019; 2019:6372474. [PMID: 31886283 PMCID: PMC6915122 DOI: 10.1155/2019/6372474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 11/16/2019] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE In vivo study of glucose homeostasis in pregnancy suggests normal glucose levels are lower than current glycemic targets used in gestational diabetes. After the HAPO study results, our institution began using glycemic targets of fasting 85 mg/dL and 2-hour postprandial of 110 mg/dL. We reviewed our results. METHODS A retrospective cohort of GDM patients that delivered at KUMC from January 2007 to May 2017 was reviewed. All patients were diagnosed with the 2-step Carpenter-Coustan thresholds. High targets were compared with low targets. The primary outcome investigated was birthweight > 90% (large for gestational age, LGA). RESULTS 604 patients were studied, and 34% were treated with low glycemic targets. Our unadjusted results showed that the low-target group had a lower incidence of LGA infants (24.0 vs. 31.8%), higher incidence of neonatal hypoglycemia (20.7 vs. 11.6%), and inductions (39.4 vs. 20.5%). After adjustment for demographic variables, only a higher risk of inductions remained (aOR 2.54 (1.44, 4.49)). CONCLUSION Lower glycemic targets did not produce large reductions in fetal overgrowth, but they were associated with a higher rate of inductions. As there were no observed differences in maternal or neonatal outcomes otherwise, aiming for lower glycemic targets in GDM is likely not cost-effective.
Collapse
Affiliation(s)
- Grace Hagen
- Department of OBGYN, University of Kansas Medical Center, Kansas City, KS, USA
| | - Crystal Brown
- Department of OBGYN, University of Kansas Medical Center, Kansas City, KS, USA
| | - Jordan Dietrich
- Department of OBGYN, University of Kansas Medical Center, Kansas City, KS, USA
| | - Charles Gibbs
- Department of OBGYN, University of Kansas Medical Center, Kansas City, KS, USA
| | - Gene T. Lee
- Department of OBGYN, University of Kansas Medical Center, Kansas City, KS, USA
| |
Collapse
|
10
|
C-Reactive Protein Levels at the Midpregnancy Can Predict Gestational Complications. BIOMED RESEARCH INTERNATIONAL 2018; 2018:1070151. [PMID: 30533423 PMCID: PMC6247639 DOI: 10.1155/2018/1070151] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 10/16/2018] [Accepted: 10/25/2018] [Indexed: 12/18/2022]
Abstract
Although essential for a successful pregnancy, a growing body of evidence suggests that maternal inflammation, when dysregulated, may represent a risk factor for both maternal and neonatal outcomes. Here, we assessed the accuracy of maternal C-reactive protein (CRP) concentrations at the middle phase of pregnancy in the identification of maternal adverse outcomes (MAO) until delivery. A correlation between CRP and a complicated pregnancy including both maternal and neonatal adverse outcomes has been investigated, too. In this retrospective study, conducted at the Diabetology Unit of IRCCS Ospedale Policlinico San Martino, Genoa (Italy), 380 outpatient pregnant women have been enrolled at the prenatal visit before performing a 75 g oral glucose tolerance test at 24th-26th gestational week for gestational diabetes mellitus (GDM) screening. Demographic, medical, and reproductive history has been obtained by verbal interview. Data about pregnancy and delivery have been retrieved from medical records. The median value of maternal baseline serum CRP was 3.25 μg/mL. Women experiencing MAO were older, more frequently suffering from hypertension, and showed higher CRP concentrations, with a cutoff value >1.86 μg/mL found by a ROC curve analysis to be accurately predictive for MAO. By a logistic regression analysis, serum CRP levels >1.86 μg/mL have been found to predict MAO also considering maternal age, hypertension, and GDM. Maternal CRP levels have been positively associated with overall pregnancy adverse outcomes (maternal and neonatal), too. In conclusion, in pregnant women serum levels of CRP can early recognize subjects at higher risk for maternal and neonatal complications needing a more stringent follow-up.
Collapse
|