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Wood AJ, Lee I, Barr ELM, Barzi F, Boyle JA, Connors C, Moore E, Oats JJN, McIntyre HD, Titmuss A, Simmonds A, Zimmet PZ, Brown ADH, Corpus S, Shaw JE, Maple‐Brown LJ. Postpartum uptake of diabetes screening tests in women with gestational diabetes: The PANDORA study. Diabet Med 2023; 40:e14999. [PMID: 36336995 PMCID: PMC10946515 DOI: 10.1111/dme.14999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 09/21/2022] [Accepted: 10/23/2022] [Indexed: 11/09/2022]
Abstract
AIMS To determine rates and predictors of postpartum diabetes screening among Aboriginal and/or Torres Strait Islander and non-Indigenous women with gestational diabetes mellitus (GDM). METHODS PANDORA is a prospective longitudinal cohort of women recruited in pregnancy. Postpartum diabetes screening rates at 12 weeks (75-g oral glucose tolerance test (OGTT)) and 6, 12 and 18 months (OGTT, glycated haemoglobin [HbA1C ] or fasting plasma glucose) were assessed for women with GDM (n = 712). Associations between antenatal factors and screening with any test (OGTT, HbA1C , fasting plasma glucose) by 6 months postpartum were examined using Cox proportional hazards regression. RESULTS Postpartum screening rates with an OGTT by 12 weeks and 6 months postpartum were lower among Aboriginal and/or Torres Strait Islander women than non-Indigenous women (18% vs. 30% at 12 weeks, and 23% vs. 37% at 6 months, p < 0.001). Aboriginal and/or Torres Strait Islander women were more likely to have completed a 6-month HbA1C compared to non-Indigenous women (16% vs. 2%, p < 0.001). Screening by 6 months postpartum with any test was 41% for Aboriginal and/or Torres Strait Islander women and 45% for non-Indigenous women (p = 0.304). Characteristics associated with higher screening rates with any test by 6 months postpartum included, insulin use in pregnancy, first pregnancy, not smoking and lower BMI. CONCLUSIONS Given very high rates of type 2 diabetes among Aboriginal and Torres Strait Islander women, early postpartum screening with the most feasible test should be prioritised to detect prediabetes and diabetes for intervention.
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Affiliation(s)
- Anna J. Wood
- Menzies School of Health ResearchCharles Darwin UniversityCasuarinaNorthern TerritoryAustralia
- Department of EndocrinologyRoyal Darwin HospitalDarwinNorthern TerritoryAustralia
| | - I‐Lynn Lee
- Menzies School of Health ResearchCharles Darwin UniversityCasuarinaNorthern TerritoryAustralia
| | - Elizabeth L. M. Barr
- Menzies School of Health ResearchCharles Darwin UniversityCasuarinaNorthern TerritoryAustralia
- Baker Heart and Diabetes InstituteMelbourneVictoriaAustralia
| | - Federica Barzi
- Menzies School of Health ResearchCharles Darwin UniversityCasuarinaNorthern TerritoryAustralia
| | - Jacqueline A. Boyle
- Menzies School of Health ResearchCharles Darwin UniversityCasuarinaNorthern TerritoryAustralia
- Monash Centre for Health Research and ImplementationMonash UniversityClaytonVictoriaAustralia
| | - Christine Connors
- Top End Health ServiceNorthern Territory Department of HealthCasuarinaNorthern TerritoryAustralia
| | - Elizabeth Moore
- Aboriginal Medical Services Alliance Northern TerritoryNorthern TerritoryDarwinAustralia
| | - Jeremy J. N. Oats
- Melbourne School of Population and Global HealthUniversity of MelbourneMelbourneVictoriaAustralia
| | - Harold D. McIntyre
- Mater ResearchThe University of QueenslandSouth BrisbaneQueenslandAustralia
| | - Angela Titmuss
- Menzies School of Health ResearchCharles Darwin UniversityCasuarinaNorthern TerritoryAustralia
- Department of Paediatrics, Division of WomenChildren and Youth, Royal Darwin HospitalCasuarinaNorthern TerritoryAustralia
| | - Alison Simmonds
- Menzies School of Health ResearchCharles Darwin UniversityCasuarinaNorthern TerritoryAustralia
| | - Paul Z. Zimmet
- Department of DiabetesCentral Clinical School, Monash UniversityClaytonVictoriaAustralia
| | - Alex D. H. Brown
- University of AdelaideAdelaideSouth AustraliaAustralia
- South Australian Health and Medical Research InstituteAdelaideSouth AustraliaAustralia
| | - Sumaria Corpus
- Aboriginal and Torres Strait Islander Advisory GroupMenzies School of Health Research, Charles Darwin UniversityCasuarinaNorthern TerritoryAustralia
| | | | - Louise J. Maple‐Brown
- Menzies School of Health ResearchCharles Darwin UniversityCasuarinaNorthern TerritoryAustralia
- Department of EndocrinologyRoyal Darwin HospitalDarwinNorthern TerritoryAustralia
- Aboriginal and Torres Strait Islander Advisory GroupMenzies School of Health Research, Charles Darwin UniversityCasuarinaNorthern TerritoryAustralia
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Wood AJ, Boyle JA, Barr ELM, Barzi F, Hare MJL, Titmuss A, Longmore DK, Death E, Kelaart J, Kirkwood M, Graham S, Connors C, Moore E, O'Dea K, Oats JJN, McIntyre HD, Zimmet PZ, Lu ZX, Brown A, Shaw JE, Maple-Brown LJ. Type 2 diabetes after a pregnancy with gestational diabetes among first nations women in Australia: The PANDORA study. Diabetes Res Clin Pract 2021; 181:109092. [PMID: 34653565 DOI: 10.1016/j.diabres.2021.109092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/22/2021] [Accepted: 09/29/2021] [Indexed: 11/20/2022]
Abstract
AIMS To determine among First Nations and Europid pregnant women the cumulative incidence and predictors of postpartum type 2 diabetes and prediabetes and describe postpartum cardiovascular disease (CVD) risk profiles. METHODS PANDORA is a prospective longitudinal cohort of women recruited in pregnancy. Ethnic-specific rates of postpartum type 2 diabetes and prediabetes were reported for women with diabetes in pregnancy (DIP), gestational diabetes (GDM) or normoglycaemia in pregnancy over a short follow-up of 2.5 years (n = 325). Pregnancy characteristics and CVD risk profiles according to glycaemic status, and factors associated with postpartum diabetes/prediabetes were examined in First Nations women. RESULTS The cumulative incidence of postpartum type 2 diabetes among women with DIP or GDM were higher for First Nations women (48%, 13/27, women with DIP, 13%, 11/82, GDM), compared to Europid women (nil DIP or GDM p < 0.001). Characteristics associated with type 2 diabetes/prediabetes among First Nations women with GDM/DIP included, older age, multiparity, family history of diabetes, higher glucose values, insulin use and body mass index (BMI). CONCLUSIONS First Nations women experience a high incidence of postpartum type 2 diabetes after GDM/DIP, highlighting the need for culturally responsive policies at an individual and systems level, to prevent diabetes and its complications.
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Affiliation(s)
- Anna J Wood
- Menzies School of Health Research, Charles Darwin University, John Mathews Building, Royal Darwin Hospital Campus, 58 Rocklands Drive, Tiwi, NT 0810, Australia; Department of Endocrinology, Royal Darwin Hospital, 58 Rocklands Drive, Tiwi, NT 0810, Australia.
| | - Jacqueline A Boyle
- Menzies School of Health Research, Charles Darwin University, John Mathews Building, Royal Darwin Hospital Campus, 58 Rocklands Drive, Tiwi, NT 0810, Australia; Monash Centre for Health Research and Implementation, Monash University, 43-51 Kanooka Grove, Clayton, Vic 3168, Australia
| | - Elizabeth L M Barr
- Menzies School of Health Research, Charles Darwin University, John Mathews Building, Royal Darwin Hospital Campus, 58 Rocklands Drive, Tiwi, NT 0810, Australia; Baker Heart and Diabetes Institute, 75 Commercial Road, Vic 3004, Australia
| | - Federica Barzi
- Menzies School of Health Research, Charles Darwin University, John Mathews Building, Royal Darwin Hospital Campus, 58 Rocklands Drive, Tiwi, NT 0810, Australia; UQ Poche Centre for Indigenous Health, The University of Queensland, 31 Upland Road, St Lucia, QLD 4067, Australia
| | - Matthew J L Hare
- Menzies School of Health Research, Charles Darwin University, John Mathews Building, Royal Darwin Hospital Campus, 58 Rocklands Drive, Tiwi, NT 0810, Australia; Department of Endocrinology, Royal Darwin Hospital, 58 Rocklands Drive, Tiwi, NT 0810, Australia
| | - Angela Titmuss
- Menzies School of Health Research, Charles Darwin University, John Mathews Building, Royal Darwin Hospital Campus, 58 Rocklands Drive, Tiwi, NT 0810, Australia; Department of Paediatrics, Division of Women, Children and Youth, Royal Darwin Hospital, 58 Rocklands Drive, Tiwi, NT 0810, Australia
| | - Danielle K Longmore
- Menzies School of Health Research, Charles Darwin University, John Mathews Building, Royal Darwin Hospital Campus, 58 Rocklands Drive, Tiwi, NT 0810, Australia
| | - Elizabeth Death
- Menzies School of Health Research, Charles Darwin University, John Mathews Building, Royal Darwin Hospital Campus, 58 Rocklands Drive, Tiwi, NT 0810, Australia
| | - Joanna Kelaart
- Baker Heart and Diabetes Institute, 75 Commercial Road, Vic 3004, Australia
| | - Marie Kirkwood
- Menzies School of Health Research, Charles Darwin University, John Mathews Building, Royal Darwin Hospital Campus, 58 Rocklands Drive, Tiwi, NT 0810, Australia
| | - Sian Graham
- Menzies School of Health Research, Charles Darwin University, John Mathews Building, Royal Darwin Hospital Campus, 58 Rocklands Drive, Tiwi, NT 0810, Australia
| | - Christine Connors
- Top End Health Service, Northern Territory Department of Health, P.O. Box 41326, Casuarina, NT 0811, Australia
| | - Elizabeth Moore
- Aboriginal Medical Services Alliance Northern Territory, 43 Mitchell Street, Darwin City, NT 0800, Australia
| | - Kerin O'Dea
- University of South Australia, 101 Currie Street, SA 5001, Australia
| | - Jeremy J N Oats
- Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton, Vic 3053, Australia
| | - Harold D McIntyre
- Mater Research, The University of Queensland, Raymond Terrace, South Brisbane, QLD 4101, Australia
| | - Paul Z Zimmet
- Department of Diabetes, Central Clinical School, Monash University, Wellington Road, Clayton, Vic 3800, Australia
| | - Zhong X Lu
- Monash Health Pathology, Monash Health, Clayton Road, Clayton, Vic 3168, Australia; Department of Medicine, Monash University, Wellington Road, Clayton, Vic 3800, Australia
| | - Alex Brown
- University of Adelaide, SA 5005, Australia; South Australian Health and Medical Research Institute, North Terrace, SA 5000, Australia
| | - Jonathan E Shaw
- Baker Heart and Diabetes Institute, 75 Commercial Road, Vic 3004, Australia
| | - Louise J Maple-Brown
- Menzies School of Health Research, Charles Darwin University, John Mathews Building, Royal Darwin Hospital Campus, 58 Rocklands Drive, Tiwi, NT 0810, Australia; Department of Endocrinology, Royal Darwin Hospital, 58 Rocklands Drive, Tiwi, NT 0810, Australia
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McIntyre HD, Oats JJN, Kihara AB, Divakar H, Kapur A, Poon LC, Hod M. Update on diagnosis of hyperglycemia in pregnancy and gestational diabetes mellitus from FIGO's Pregnancy & Non-Communicable Diseases Committee. Int J Gynaecol Obstet 2021; 154:189-194. [PMID: 34047364 DOI: 10.1002/ijgo.13764] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
| | - Jeremy J N Oats
- Melbourne School of Population Heath, University of Melbourne, Melbourne, VIC, Australia
| | - Anne B Kihara
- Department of Obstetrics and Gynecology, School of Medicine, University of Nairobi, Nairobi, Kenya
| | | | - Anil Kapur
- World Diabetes Foundation, Bagsvaerd, Denmark
| | - Liona C Poon
- Department of Obstetrics and Gynecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Moshe Hod
- Mor Women's Health Care Center, Tel Aviv, Israel
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Immanuel J, Flack J, Wong VW, Yuen L, Eagleton C, Graham D, Lagstrom J, Wolmarans L, Martin M, Cheung NW, Padmanabhan S, Rudland V, Ross G, Moses RG, Maple-Brown L, Fulcher I, Chemmanam J, Nolan CJ, Oats JJN, Sweeting A, Simmons D. The ADIPS Pilot National Diabetes in Pregnancy Benchmarking Programme. Int J Environ Res Public Health 2021; 18:ijerph18094899. [PMID: 34064492 PMCID: PMC8125192 DOI: 10.3390/ijerph18094899] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/18/2021] [Accepted: 04/30/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND To test the feasibility of benchmarking the care of women with pregnancies complicated by hyperglycaemia. METHODS A retrospective audit of volunteer diabetes services in Australia and New Zealand involving singleton pregnancies resulting in live births between 2014 and 2020. Ranges are shown and compared across services. RESULTS The audit included 10,144 pregnancies (gestational diabetes mellitus (GDM) = 8696; type 1 diabetes (T1D) = 435; type 2 diabetes (T2D) = 1013) from 11 diabetes services. Among women with GDM, diet alone was used in 39.4% (ranging among centres from 28.8-57.3%), metformin alone in 18.8% (0.4-43.7%), and metformin and insulin in 10.1% (1.5-23.4%); when compared between sites, all p < 0.001. Birth was by elective caesarean in 12.1% (3.6-23.7%) or emergency caesarean in 9.5% (3.5-21.2%) (all p < 0.001). Preterm births (<37 weeks) ranged from 3.7% to 9.4% (p < 0.05), large for gestational age 10.3-26.7% (p < 0.001), admission to special care nursery 16.7-25.0% (p < 0.001), and neonatal hypoglycaemia (<2.6 mmol/L) 6.0-27.0% (p < 0.001). Many women with T1D and T2D had limited pregnancy planning including first trimester hyperglycaemia (HbA1c > 6.5% (48 mmol/mol)), 78.4% and 54.6%, respectively (p < 0.001). CONCLUSION Management of maternal hyperglycaemia and pregnancy outcomes varied significantly. The maintenance and extension of this benchmarking service provides opportunities to identify policy and clinical approaches to improve pregnancy outcomes among women with hyperglycaemia in pregnancy.
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Affiliation(s)
- Jincy Immanuel
- School of Medicine, Western Sydney University, 2560 Sydney, Australia; (J.I.); (J.F.); (L.Y.)
| | - Jeff Flack
- School of Medicine, Western Sydney University, 2560 Sydney, Australia; (J.I.); (J.F.); (L.Y.)
- Department of Diabetes and Endocrinology, Bankstown-Lidcombe Hospital, 2200 Sydney, Australia
- South Western Sydney Clinical School, University of New South Wales, 2170 Liverpool, Australia;
| | - Vincent W Wong
- South Western Sydney Clinical School, University of New South Wales, 2170 Liverpool, Australia;
- Diabetes and Endocrinology Service, Liverpool Hospital, 2170 Sydney, Australia
| | - Lili Yuen
- School of Medicine, Western Sydney University, 2560 Sydney, Australia; (J.I.); (J.F.); (L.Y.)
| | - Carl Eagleton
- Department of Endocrinology, Auckland City Hospital, 1023 Auckland, New Zealand;
| | - Dorothy Graham
- Obstetrics and Gynaecology, King Edward Memorial Hospital, University of Western Australia, 6008 Subiaco, Australia;
| | - Janet Lagstrom
- Nathalia Cobram Numurkah Health, 3636 Victoria, Australia;
| | | | - Michele Martin
- Diabetes Service, Illawarra Shoalhaven Local Health District, 2500 Wollongong, Australia; (M.M.); (R.G.M.)
| | - Ngai Wah Cheung
- Department of Diabetes and Endocrinology, Westmead Hospital, 2145 Sydney, Australia; (N.W.C.); (S.P.); (V.R.)
| | - Suja Padmanabhan
- Department of Diabetes and Endocrinology, Westmead Hospital, 2145 Sydney, Australia; (N.W.C.); (S.P.); (V.R.)
| | - Victoria Rudland
- Department of Diabetes and Endocrinology, Westmead Hospital, 2145 Sydney, Australia; (N.W.C.); (S.P.); (V.R.)
| | - Glynis Ross
- Department of Diabetes and Endocrinology, Royal Prince Alfred Hospital, 2050 Sydney, Australia; (G.R.); (A.S.)
| | - Robert G Moses
- Diabetes Service, Illawarra Shoalhaven Local Health District, 2500 Wollongong, Australia; (M.M.); (R.G.M.)
| | - Louise Maple-Brown
- Menzies School of Health Research, Charles Darwin University, 0810 Darwin, Australia;
- Department of Endocrinology, Royal Darwin Hospital, 0810 Darwin, Australia
| | - Ian Fulcher
- Department of Obstetrics and Gynaecology, Liverpool Hospital, 2170 Sydney, Australia;
| | - Julie Chemmanam
- Endocrinology and Diabetes Centre, Women’s and Children’s Hospital, 5006 Adelaide, Australia;
| | - Christopher J Nolan
- Department of Diabetes and Endocrinology, The Canberra Hospital, 2605 Garran, Australia;
- Medical School, Australian National University, 2605 Canberra, Australia
| | - Jeremy J N Oats
- Melbourne School of Population and Global Health, University of Melbourne, 3053 Victoria, Australia;
| | - Arianne Sweeting
- Department of Diabetes and Endocrinology, Royal Prince Alfred Hospital, 2050 Sydney, Australia; (G.R.); (A.S.)
| | - David Simmons
- School of Medicine, Western Sydney University, 2560 Sydney, Australia; (J.I.); (J.F.); (L.Y.)
- Macarthur Diabetes Service, Campbelltown Hospital, 2560 Sydney, Australia
- Correspondence: ; Tel.: +61-246-203-899
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Homer CSE, Cheah SL, Rossiter C, Dahlen HG, Ellwood D, Foureur MJ, Forster DA, McLachlan HL, Oats JJN, Sibbritt D, Thornton C, Scarf VL. Maternal and perinatal outcomes by planned place of birth in Australia 2000 - 2012: a linked population data study. BMJ Open 2019; 9:e029192. [PMID: 31662359 PMCID: PMC6830673 DOI: 10.1136/bmjopen-2019-029192] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE To compare perinatal and maternal outcomes for Australian women with uncomplicated pregnancies according to planned place of birth, that is, in hospital labour wards, birth centres or at home. DESIGN A population-based retrospective design, linking and analysing routinely collected electronic data. Analysis comprised χ2 tests and binary logistic regression for categorical data, yielding adjusted ORs. Continuous data were analysed using analysis of variance. SETTING All eight Australian states and territories. PARTICIPANTS Women with uncomplicated pregnancies who gave birth between 2000 and 2012 to a singleton baby in cephalic presentation at between 37 and 41 completed weeks' gestation. Of the 1 251 420 births, 1 171 703 (93.6%) were planned in hospital labour wards, 71 505 (5.7%) in birth centres and 8212 (0.7%) at home. MAIN OUTCOME MEASURES Mode of birth, normal labour and birth, interventions and procedures during labour and birth, maternal complications, admission to special care/high dependency or intensive care units (mother or infant) and perinatal mortality (intrapartum stillbirth and neonatal death). RESULTS Compared with planned hospital births, the odds of normal labour and birth were over twice as high in planned birth centre births (adjusted OR (AOR) 2.72; 99% CI 2.63 to 2.81) and nearly six times as high in planned home births (AOR 5.91; 99% CI 5.15 to 6.78). There were no statistically significant differences in the proportion of intrapartum stillbirths, early or late neonatal deaths between the three planned places of birth. CONCLUSIONS This is the first Australia-wide study to examine outcomes by planned place of birth. For healthy women in Australia having an uncomplicated pregnancy, planned births in birth centres or at home are associated with positive maternal outcomes although the number of homebirths was small overall. There were no significant differences in the perinatal mortality rate, although the absolute numbers of deaths were very small and therefore firm conclusions cannot be drawn about perinatal mortality outcomes.
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Affiliation(s)
- Caroline S E Homer
- Centre for Midwifery, Child and Family Health, University of Technology Sydney, Sydney, New South Wales, Australia
- Maternal and Child Health, Burnet Institute, Melbourne, Victoria, Australia
| | - Seong L Cheah
- Centre for Midwifery, Child and Family Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Chris Rossiter
- Centre for Midwifery, Child and Family Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Hannah G Dahlen
- School of Nursing and Midwifery, University of Western Sydney, Parramatta, New South Wales, Australia
| | - David Ellwood
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Maralyn J Foureur
- Centre for Midwifery, Child and Family Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Della A Forster
- Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
- Maternity Services, Royal Women's Hospital, Parkville, Victoria, Australia
| | - Helen L McLachlan
- Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
- School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
| | - Jeremy J N Oats
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - David Sibbritt
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Charlene Thornton
- College of Nursing and Health Sciences, Flinders University Faculty of Medicine Nursing and Health Sciences, Adelaide, South Australia, Australia
| | - Vanessa L Scarf
- Centre for Midwifery, Child and Family Health, University of Technology Sydney, Sydney, New South Wales, Australia
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Shen EX, Moses RG, Oats JJN, Lowe J, McIntyre HD. Seasonality, temperature and pregnancy oral glucose tolerance test results in Australia. BMC Pregnancy Childbirth 2019; 19:263. [PMID: 31340766 PMCID: PMC6657158 DOI: 10.1186/s12884-019-2413-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 07/16/2019] [Indexed: 01/12/2023] Open
Abstract
Background The oral glucose-tolerance test (OGTT) is currently the standard method for diagnosis of gestational diabetes (GDM). We conducted a post hoc analysis using the Australian Hyperglycemia and Adverse Pregnancy Outcome (HAPO) data to determine seasonal variations in OGTT results, the consequent prevalence of GDM, and association with select perinatal parameters. Method Women enrolled in the Australian HAPO study sites (Brisbane and Newcastle) from 2001 to 2006 were included if OGTT results between 24 to 32 weeks gestation were available (n = 2120). Fasting plasma glucose, 1-h plasma glucose, 2-h plasma glucose, HbA1c, HOMA-IR, and umbilical cord C-peptide and glucose values were categorized by season and correlated to monthly temperature records from the Australian Bureau of Meteorology for Brisbane and Newcastle. GDM was defined post hoc using the IADPSG/WHO criteria. Results Small but significant (p < 0.01 on ANOVA) elevations in fasting glucose (+ 0.12 mM), HbA1c (+ 0.09%), and HOMA-IR (+ 0.88 units) were observed during the winter months. Conversely, higher 1-h (+ 0.19 mM) and 2-h (+ 0.33 mM) post-load glucose values (both p < 0.01) were observed during the summer months. The correlations between fasting glucose, 1-h glucose, 2-h glucose, and HbA1c with average monthly temperatures confirmed this trend, with positive Pearson’s correlations between 1-h and 2-h glucose with increasing average monthly temperatures, and negative correlations with fasting glucose and HbA1c. Further, umbilical cord C-peptide and glucose displayed negative Pearson’s correlation with average monthly temperature, aligned with trends seen in the fasting plasma glucose. Overall prevalence of GDM did not display significant seasonal variations due to the opposing trends seen in the fasting versus 1-h and 2-h post-load values. Conclusion A significant winter increase was observed for fasting plasma glucose, HbA1c, and HOMA-IR, which contrasted with changes in 1-h and 2-h post-load venous plasma glucose values. Interestingly, umbilical cord C-peptide and glucose displayed similar trends to that of the fasting plasma glucose. While overall prevalence of GDM did not vary significantly by seasons, this study illustrates that seasonality is indeed an additional factor when interpreting OGTT results for the diagnosis of GDM and provides new direction for future research into the seasonal adjustment of OGTT results.
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Affiliation(s)
- Eddie X Shen
- Faculty of Medicine, The University of Queensland, 288 Herston Road, Brisbane, Queensland, 4006, Australia
| | - Robert G Moses
- Illawarra and Shoalhaven Local Health District, Wollongong Hospital, Loftus Street, Wollongong, New South Wales, 2500, Australia
| | - Jeremy J N Oats
- Melbourne School of Global and Population Health, University of Melbourne, Parkville, Victoria, 3010, Australia
| | - Julia Lowe
- University of Toronto, 27 King's College Circle, Toronto, Ontario, M5S 1A1, Canada
| | - H David McIntyre
- Faculty of Medicine, The University of Queensland, 288 Herston Road, Brisbane, Queensland, 4006, Australia. .,Mater Research, Level 3, Aubigny Place, Raymond Terrace, Brisbane, Queensland, 4101, Australia.
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McIntyre HD, Gibbons KS, Lowe J, Oats JJN. Reprint of "Development of a risk engine relating maternal glycemia and body mass index to pregnancy outcomes". Diabetes Res Clin Pract 2018; 145:31-38. [PMID: 30471322 DOI: 10.1016/j.diabres.2018.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIMS To develop a risk "engine" or calculator, integrating the risks of hyperglycemia, maternal BMI and other basic demographic data commonly available at the time of the pregnancy oral glucose tolerance test (OGTT), to predict an individual's absolute risk of specific adverse pregnancy outcomes. METHODS Data from the Brisbane HAPO cohort was analysed using logistic regression to determine the relationship between four clinical outcomes (primary CS, birth injury, large-for-gestational age, excess neonatal adiposity) with different combinations of OGTT results and maternal demographics (age, height, BMI, parity). Existing sets of international GDM diagnostic criteria were also applied to the cohort. RESULTS 191 (15.3%) women were diagnosed as GDM by one or more existing criteria. All international criteria performed poorly compared to risk models utilising OGTT results only, or OGTT results in combination with maternal demographics. CONCLUSIONS The risk engine's empirical performance on receiver - operator curve analysis was superior to the existing GDM diagnostic criteria tested. This concept shows promise for use in clinical practice, but further development is required.
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Affiliation(s)
- H David McIntyre
- Mater Clinical Unit, Faculty of Medicine, The University of Queensland, Raymond Terrace, South Brisbane, Queensland 4101, Australia; Mater Research, Faculty of Medicine, The University of Queensland, Raymond Terrace, South Brisbane, Queensland 4101, Australia.
| | - Kristen S Gibbons
- Mater Research, Faculty of Medicine, The University of Queensland, Raymond Terrace, South Brisbane, Queensland 4101, Australia
| | - Julia Lowe
- University of Toronto, 27 King's College Circle, Toronto, Ontario M5S 1A1, Canada
| | - Jeremy J N Oats
- University of Melbourne, Parkville, Victoria 3010, Australia
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Boyle DIR, Versace VL, Dunbar JA, Scheil W, Janus E, Oats JJN, Skinner T, Shih S, O’Reilly S, Sikaris K, Kelsall L, Phillips PA, Best JD. Results of the first recorded evaluation of a national gestational diabetes mellitus register: Challenges in screening, registration, and follow-up for diabetes risk. PLoS One 2018; 13:e0200832. [PMID: 30089149 PMCID: PMC6082534 DOI: 10.1371/journal.pone.0200832] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 07/02/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Gestational Diabetes Mellitus (GDM) increases the risk of type 2 diabetes. A register can be used to follow-up high risk women for early intervention to prevent progression to type 2 diabetes. We evaluate the performance of the world's first national gestational diabetes register. RESEARCH DESIGN AND METHODS Observational study that used data linkage to merge: (1) pathology data from the Australian states of Victoria (VIC) and South Australia (SA); (2) birth records from the Consultative Council on Obstetric and Paediatric Mortality and Morbidity (CCOPMM, VIC) and the South Australian Perinatal Statistics Collection (SAPSC, SA); (3) GDM and type 2 diabetes register data from the National Gestational Diabetes Register (NGDR). All pregnancies registered on CCOPMM and SAPSC for 2012 and 2013 were included-other data back to 2008 were used to support the analyses. Rates of screening for GDM, rates of registration on the NGDR, and rates of follow-up laboratory screening for type 2 diabetes are reported. RESULTS Estimated GDM screening rates were 86% in SA and 97% in VIC. Rates of registration on the NGDR ranged from 73% in SA (2013) to 91% in VIC (2013). During the study period rates of screening at six weeks postpartum ranged from 43% in SA (2012) to 58% in VIC (2013). There was little evidence of recall letters resulting in screening 12 months follow-up. CONCLUSIONS GDM Screening and NGDR registration was effective in Australia. Recall by mail-out to young mothers and their GP's for type 2 diabetes follow-up testing proved ineffective.
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Affiliation(s)
- Douglas I. R. Boyle
- Department of General Practice, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Vincent L. Versace
- School of Medicine, Deakin Rural Health, Deakin University, Warrnambool, Victoria, Australia
| | - James A. Dunbar
- School of Medicine, Deakin Rural Health, Deakin University, Warrnambool, Victoria, Australia
| | - Wendy Scheil
- Public Health & Clinical Systems, SA Health, Adelaide, South Australia, Australia
- Discipline of Obstetrics & Gynaecology, The University of Adelaide, Adelaide, South Australia, Australia
| | - Edward Janus
- Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
- General Internal Medicine Unit, Western Health, St Albans, Victoria, Australia
| | - Jeremy J. N. Oats
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Timothy Skinner
- School of Psychological and Clinical Sciences, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Sophy Shih
- Centre for Population Health Research, Faculty of Health, Deakin University, Melbourne, Australia
| | - Sharleen O’Reilly
- School of Agriculture and Food Science, University College, Dublin, Ireland
| | - Ken Sikaris
- Melbourne Pathology, Collingwood, Victoria, Australia
| | - Liza Kelsall
- Health Intelligence Unit, System Intelligence & Analytics, Department of Health and Human Services, Melbourne, Victoria, Australia
| | | | - James D. Best
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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9
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McIntyre HD, Gibbons KS, Lowe J, Oats JJN. Development of a risk engine relating maternal glycemia and body mass index to pregnancy outcomes. Diabetes Res Clin Pract 2018; 139:331-338. [PMID: 29550360 DOI: 10.1016/j.diabres.2018.02.036] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 02/27/2018] [Indexed: 12/01/2022]
Abstract
AIMS To develop a risk "engine" or calculator, integrating the risks of hyperglycemia, maternal BMI and other basic demographic data commonly available at the time of the pregnancy oral glucose tolerance test (OGTT), to predict an individual's absolute risk of specific adverse pregnancy outcomes. METHODS Data from the Brisbane HAPO cohort was analysed using logistic regression to determine the relationship between four clinical outcomes (primary CS, birth injury, large-for-gestational age, excess neonatal adiposity) with different combinations of OGTT results and maternal demographics (age, height, BMI, parity). Existing sets of international GDM diagnostic criteria were also applied to the cohort. RESULTS 191 (15.3%) women were diagnosed as GDM by one or more existing criteria. All international criteria performed poorly compared to risk models utilising OGTT results only, or OGTT results in combination with maternal demographics. CONCLUSIONS The risk engine's empirical performance on receiver - operator curve analysis was superior to the existing GDM diagnostic criteria tested. This concept shows promise for use in clinical practice, but further development is required.
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Affiliation(s)
- H David McIntyre
- Mater Clinical Unit, Faculty of Medicine, The University of Queensland, Raymond Terrace, South Brisbane, Queensland 4101, Australia; Mater Research, Faculty of Medicine, The University of Queensland, Raymond Terrace, South Brisbane, Queensland 4101, Australia.
| | - Kristen S Gibbons
- Mater Research, Level 3, Aubigny Place, Raymond Terrace, Brisbane, Queensland 4101, Australia
| | - Julia Lowe
- University of Toronto, 27 King's College Circle, Toronto, Ontario M5S 1A1, Canada
| | - Jeremy J N Oats
- University of Melbourne, Parkville, Victoria 3010, Australia
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10
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Zeki R, Oats JJN, Wang AY, Li Z, Homer CSE, Sullivan EA. Cesarean section and diabetes during pregnancy: An NSW population study using the Robson classification. J Obstet Gynaecol Res 2018; 44:890-898. [PMID: 29442404 DOI: 10.1111/jog.13605] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 12/29/2017] [Indexed: 12/01/2022]
Abstract
AIM The aim of this study was to identify the main contributors to cesarean section (CS) among women with and without diabetes during pregnancy using the Robson classification and to compare CS rates within Robson groups. METHODS A population-based cohort study was conducted of all women who gave birth in New South Wales, Australia, between 2002 and 2012. Women with pregestational diabetes (types 1 and 2) and gestational diabetes mellitus (GDM) were grouped using the Robson classification. Adjusted odd ratios (AOR) and 95% confidence intervals (CI) were calculated using multivariable logistic regression. RESULTS The total CS rate was 53.6% for women with pregestational diabetes, 36.8% for women with GDM and 28.5% for women without diabetes. Previous CS contributed the most to the total number of CS in all populations. For preterm birth, the contribution to the total was 20.5% for women with pregestational diabetes and 5.7% for women without diabetes. Compared to women without diabetes, for nulliparous with pregestational diabetes, the odds of CS was 1.4 (95% CI, 1.1-1.8) for spontaneous labor and 2.0 (95% CI, 1.7-2.3) for induction of labor. CONCLUSION A history of CS was the main contributor to the total CS. Reducing primary CS is the first step to lowering the high rate of CS among women with diabetes. Nulliparous women were more likely to have CS if they had pregestational diabetes. This increase was also evident in all multiparous women giving birth. The high rate of preterm births and CS reflects the clinical issues for women with diabetes during pregnancy.
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Affiliation(s)
- Reem Zeki
- The Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Jeremy J N Oats
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Alex Y Wang
- The Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Zhuoyang Li
- The Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Caroline S E Homer
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Elizabeth A Sullivan
- The Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
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11
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Zeki R, Wang AY, Lui K, Li Z, Oats JJN, Homer CSE, Sullivan EA. Neonatal outcomes of live-born term singletons in vertex presentation born to mothers with diabetes during pregnancy by mode of birth: a New South Wales population-based retrospective cohort study. BMJ Paediatr Open 2018; 2:e000224. [PMID: 29637191 PMCID: PMC5843011 DOI: 10.1136/bmjpo-2017-000224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 12/11/2017] [Accepted: 01/12/2018] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES To investigate the association between the mode of birth and adverse neonatal outcomes of macrosomic (birth weight ≥4000 g) and non-macrosomic (birth weight <4000 g) live-born term singletons in vertex presentation (TSV) born to mothers with diabetes (pre-existing and gestational diabetes mellitus (GDM)). DESIGN A population-based retrospective cohort study. SETTING New South Wales, Australia. PATIENTS All live-born TSV born to mothers with diabetes from 2002 to 2012. INTERVENTION Comparison of neonatal outcomes by mode of birth (prelabour caesarean section (CS) and planned vaginal birth resulted in intrapartum CS, non-instrumental or instrumental vaginal birth). MAIN OUTCOME MEASURES Five-minute Apgar score <7, admission to neonatal intensive care unit (NICU) or special care nursery (SCN) and the need for resuscitation. RESULTS Among the 48 882 TSV born to mothers with diabetes, prelabour CS was associated with a significant increase in the rate of admission to NICU/SCN compared with planned vaginal birth.For TSV born to mothers with pre-existing diabetes, compared with non-instrumental vaginal birth, instrumental vaginal birth was associated with increased odds of the need for resuscitation in macrosomic (adjusted ORs (AOR) 2.6; 95% CI (1.2 to 7.5)) and non-macrosomic TSV (AOR 3.3; 95% CI (2.2 to 5.0)).For TSV born to mothers with GDM, intrapartum CS was associated with increased odds of the need for resuscitation compared with non-instrumental vaginal birth in non-macrosomic TSV (AOR 2.3; 95% CI (2.1 to 2.7)). Instrumental vaginal birth was associated with increased likelihood of requiring resuscitation compared with non-instrumental vaginal birth for both macrosomic (AOR 2.3; 95% CI (1.7 to 3.1)) and non-macrosomic (AOR 2.5; 95% CI (2.2 to 2.9)) TSV. CONCLUSION Pregnant women with diabetes, particularly those with suspected fetal macrosomia, need to be aware of the increased likelihood of adverse neonatal outcomes following instrumental vaginal birth and intrapartum CS when planning mode of birth.
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Affiliation(s)
- Reem Zeki
- Faculty of Health, The Australian Centre for Public and Population Health Research, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Alex Y Wang
- Faculty of Health, The Australian Centre for Public and Population Health Research, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Kei Lui
- School of Women's and Children's Health, The University of New South Wales, Sydney, New South Wales, Australia
| | - Zhuoyang Li
- Faculty of Health, The Australian Centre for Public and Population Health Research, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Jeremy J N Oats
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Caroline S E Homer
- Faculty of Health, Centre for Midwifery, Child and Family Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Elizabeth A Sullivan
- Faculty of Health, The Australian Centre for Public and Population Health Research, University of Technology Sydney, Sydney, New South Wales, Australia
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12
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Waters TP, Dyer AR, Scholtens DM, Dooley SL, Herer E, Lowe LP, Oats JJN, Persson B, Sacks DA, Metzger BE, Catalano PM. Maternal and Neonatal Morbidity for Women Who Would Be Added to the Diagnosis of GDM Using IADPSG Criteria: A Secondary Analysis of the Hyperglycemia and Adverse Pregnancy Outcome Study. Diabetes Care 2016; 39:2204-2210. [PMID: 27634392 PMCID: PMC5127228 DOI: 10.2337/dc16-1194] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 08/26/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess the frequency of adverse outcomes for women who are diagnosed with gestational diabetes mellitus (GDM) by the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria using data from the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study. RESEARCH DESIGN AND METHODS This is a secondary analysis from the North American HAPO study centers. Glucose measurements from a 75-g oral glucose tolerance test were used to group participants into three nonoverlapping categories: GDM based on Carpenter-Coustan (CC) criteria (also GDM based on IADPSG criteria), GDM diagnosed based on IADPSG criteria but not CC criteria, and no GDM. Newborn outcomes included birth weight, cord C-peptide, and newborn percentage fat above the 90th percentile; maternal outcomes included primary cesarean delivery and preeclampsia. Outcome frequencies were compared using multiple logistic regression, adjusting for predefined covariates. RESULTS Among 25,505 HAPO study participants, 6,159 blinded participants from North American centers were included. Of these, 81% had normal glucose testing, 4.2% had GDM based on CC criteria, and 14.3% had GDM based on IADPSG criteria but not CC criteria. Compared with women with no GDM, those diagnosed with GDM based on IADPSG criteria had adjusted odds ratios (95% CIs) for birth weight, cord C-peptide, and newborn percentage fat above the 90th percentile, as well as primary cesarean delivery and preeclampsia, of 1.87 (1.50-2.34), 2.00 (1.54-2.58), 1.73 (1.35-2.23), 1.31 (1.07-1.60), and 1.73 (1.32-2.27), respectively. CONCLUSIONS Women diagnosed with GDM based on IADPSG criteria had higher adverse outcome frequencies compared with women with no GDM. These data underscore the need for research to assess the effect of treatment to improve outcomes in such women.
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Affiliation(s)
- Thaddeus P Waters
- Department of Obstetrics and Gynecology, Loyola University Medical Center, Maywood, IL
| | - Alan R Dyer
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Sharon L Dooley
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Elaine Herer
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Lynn P Lowe
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jeremy J N Oats
- Obstetric Medicine, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Bengt Persson
- Department of Pediatrics, Karolinska Institute, Stockholm, Sweden
| | - David A Sacks
- Department of Obstetrics and Gynecology, Kaiser Foundation Hospital, Bellflower, CA
| | - Boyd E Metzger
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Patrick M Catalano
- Department of Reproductive Biology, Case Western Reserve University at MetroHealth Medical Center, Cleveland, OH
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13
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O’Reilly SL, Dunbar JA, Versace V, Janus E, Best JD, Carter R, Oats JJN, Skinner T, Ackland M, Phillips PA, Ebeling PR, Reynolds J, Shih STF, Hagger V, Coates M, Wildey C. Mothers after Gestational Diabetes in Australia (MAGDA): A Randomised Controlled Trial of a Postnatal Diabetes Prevention Program. PLoS Med 2016; 13:e1002092. [PMID: 27459502 PMCID: PMC4961439 DOI: 10.1371/journal.pmed.1002092] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 06/15/2016] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is an increasingly prevalent risk factor for type 2 diabetes. We evaluated the effectiveness of a group-based lifestyle modification program in mothers with prior GDM within their first postnatal year. METHODS AND FINDINGS In this study, 573 women were randomised to either the intervention (n = 284) or usual care (n = 289). At baseline, 10% had impaired glucose tolerance and 2% impaired fasting glucose. The diabetes prevention intervention comprised one individual session, five group sessions, and two telephone sessions. Primary outcomes were changes in diabetes risk factors (weight, waist circumference, and fasting blood glucose), and secondary outcomes included achievement of lifestyle modification goals and changes in depression score and cardiovascular disease risk factors. The mean changes (intention-to-treat [ITT] analysis) over 12 mo were as follows: -0.23 kg body weight in intervention group (95% CI -0.89, 0.43) compared with +0.72 kg in usual care group (95% CI 0.09, 1.35) (change difference -0.95 kg, 95% CI -1.87, -0.04; group by treatment interaction p = 0.04); -2.24 cm waist measurement in intervention group (95% CI -3.01, -1.42) compared with -1.74 cm in usual care group (95% CI -2.52, -0.96) (change difference -0.50 cm, 95% CI -1.63, 0.63; group by treatment interaction p = 0.389); and +0.18 mmol/l fasting blood glucose in intervention group (95% CI 0.11, 0.24) compared with +0.22 mmol/l in usual care group (95% CI 0.16, 0.29) (change difference -0.05 mmol/l, 95% CI -0.14, 0.05; group by treatment interaction p = 0.331). Only 10% of women attended all sessions, 53% attended one individual and at least one group session, and 34% attended no sessions. Loss to follow-up was 27% and 21% for the intervention and control groups, respectively, primarily due to subsequent pregnancies. Study limitations include low exposure to the full intervention and glucose metabolism profiles being near normal at baseline. CONCLUSIONS Although a 1-kg weight difference has the potential to be significant for reducing diabetes risk, the level of engagement during the first postnatal year was low. Further research is needed to improve engagement, including participant involvement in study design; it is potentially more effective to implement annual diabetes screening until women develop prediabetes before offering an intervention. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12610000338066.
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Affiliation(s)
- Sharleen L. O’Reilly
- Institute of Physical Activity and Nutrition, Deakin University, Burwood, Victoria, Australia
- * E-mail:
| | - James A. Dunbar
- Centre for Population Health Research, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Vincent Versace
- School of Medicine, Deakin University, Warrnambool, Victoria, Australia
| | - Edward Janus
- Department of Medicine, Melbourne Medical School–Western Precinct, University of Melbourne, St Albans, Victoria, Australia
- General Internal Medicine Unit, Western Health, Sunshine Hospital, St Albans, Victoria, Australia
| | - James D. Best
- Lee Kong Chian School of Medicine, Imperial College London and Nanyang Technological University, Singapore
| | - Rob Carter
- Centre for Population Health Research, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Jeremy J. N. Oats
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
| | - Timothy Skinner
- School of Psychological and Clinical Sciences, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Michael Ackland
- Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Paddy A. Phillips
- Department of Medicine, Flinders University, Bedford Park, South Australia, Australia
- SA Health, Adelaide, South Australia, Australia
| | - Peter R. Ebeling
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - John Reynolds
- Alfred Health and Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Sophy T. F. Shih
- Centre for Population Health Research, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | | | - Michael Coates
- School of Medicine, Deakin University, Warrnambool, Victoria, Australia
| | - Carol Wildey
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
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14
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Chamberlain CR, Oldenburg B, Wilson AN, Eades SJ, O'Dea K, Oats JJN, Wolfe R. Type 2 diabetes after gestational diabetes: greater than fourfold risk among Indigenous compared with non-Indigenous Australian women. Diabetes Metab Res Rev 2016; 32:217-27. [PMID: 26385131 DOI: 10.1002/dmrr.2715] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 07/06/2015] [Accepted: 07/28/2015] [Indexed: 01/28/2023]
Abstract
BACKGROUND Gestational diabetes is associated with a high risk of type 2 diabetes. However, progression rates among Indigenous women in Australia who experience high prevalence of gestational diabetes are unknown. METHODS This retrospective cohort study includes all births to women at a regional hospital in Far North Queensland, Australia, coded as having 'gestational diabetes' from 1 January 2004 to 31 December 2010 (1098 births) and receiving laboratory postpartum screening from 1 January 2004 to 31 December 2011 (n = 483 births). Women who did not receive postpartum screening were excluded from the denominator. Data were linked between hospital electronic records, routinely collected birth data and laboratories, with sample validation by reviews of medical records. Analysis was conducted using Cox-proportional regression models. RESULTS Indigenous women had a greater than fourfold risk of developing type 2 diabetes within 8 years of having gestational diabetes, compared with non-Indigenous women (hazards ratio 4.55, 95% confidence interval 2.63-7.88, p < 0.0001). Among women receiving postpartum screening tests, by 3, 5 and 7 years postpartum, 21.9% (15.8-30.0%), 25.5% (18.6-34.3%) and 42.4% (29.6-58.0%) Indigenous women were diagnosed with type 2 diabetes after gestational diabetes, respectively, compared with 4.2% (2.5-7.2%), 5.7% (3.3-9.5%) and 13.5% (7.3-24.2%) non-Indigenous women. Multivariate analysis showed an increased risk of developing type 2 diabetes among women with an early pregnancy body mass index ≥25 kg/m(2) , only partially breastfeeding at hospital discharge and gestational diabetes diagnosis prior to 17 weeks gestation. CONCLUSIONS This study demonstrates that, compared with non-Indigenous women, Indigenous Australian women have a greater than fourfold risk of developing type 2 diabetes after gestational diabetes. Strategies are urgently needed to reduce rates of type 2 diabetes by supporting a healthy weight and breastfeeding and to improve postpartum screening among Indigenous women with gestational diabetes. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Catherine R Chamberlain
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Brian Oldenburg
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Alyce N Wilson
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Sandra J Eades
- Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Kerin O'Dea
- School of Population Health, University of South Australia, Adelaide, SA, Australia
| | - Jeremy J N Oats
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Rory Wolfe
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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15
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Feig DS, Corcoy R, Jensen DM, Kautzky-Willer A, Nolan CJ, Oats JJN, Sacks DA, Caimari F, McIntyre HD. Diabetes in pregnancy outcomes: a systematic review and proposed codification of definitions. Diabetes Metab Res Rev 2015; 31:680-90. [PMID: 25663190 DOI: 10.1002/dmrr.2640] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 01/29/2015] [Indexed: 12/18/2022]
Abstract
Rising rates of diabetes in pregnancy have led to an escalation in research in this area. As in any area of clinical research, definitions of outcomes vary from study to study, making it difficult to compare research findings and draw conclusions. Our aim was to compile and create a repository of definitions, which could then be used universally. A systematic review of the literature was performed on published and ongoing randomized controlled trials in the area of diabetes in pregnancy between 01 Jan 2000 and 01 Jun 2012. Other sources included the World Health Organization and Academic Society Statements. The advice of experts was sought when appropriate definitions were lacking. Among the published randomized controlled trials on diabetes and pregnancy, 171 abstracts were retrieved, 64 full texts were reviewed and 53 were included. Among the ongoing randomized controlled trials published in ClinicalTrials.gov, 90 protocols were retrieved and 25 were finally included. The definitions from these were assembled and the final maternal definitions and foetal definitions were agreed upon by consensus. It is our hope that the definitions we have provided (i) will be widely used in the reporting of future studies in the area of diabetes in pregnancy, that they will (ii) facilitate future systematic reviews and formal meta analyses and (iii) ultimately improve outcomes for mothers and babies.
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Affiliation(s)
- Denice S Feig
- Department of Medicine, University of Toronto, Toronto, Canada
- Division of Endocrinology and Metabolism, Mount Sinai Hospital, Toronto, Canada
| | - Rosa Corcoy
- Servei d'Endocrinologia i Nutrició, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Spain; CIBER-BBN, Madrid, Spain
| | | | - Alexandra Kautzky-Willer
- Internal Medicine III, Endocrinology & Metabolism, Gender Medicine Unit, Medical University of Vienna, Vienna, Austria
| | - Christopher J Nolan
- Department of Diabetes and Endocrinology, The Canberra Hospital and the Australian National University Medical School, Canberra, ACT, Australia
| | - Jeremy J N Oats
- Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
| | - David A Sacks
- Department of Research and Evaluation, Kaiser Permanente Southern California, CA, USA
| | - Francisca Caimari
- Servei d'Endocrinologia i Nutrició, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - H David McIntyre
- Mater Research Institute and School of Medicine, The University of Queensland, (HDM), Brisbane, Australia
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16
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Longman J, Pilcher JM, Donoghue DA, Rolfe M, Kildea SV, Kruske S, Oats JJN, Morgan GG, Barclay LM. Identifying maternity services in public hospitals in rural and remote Australia. AUST HEALTH REV 2014; 38:337-44. [PMID: 24882523 DOI: 10.1071/ah13188] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 02/25/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This paper articulates the importance of accurately identifying maternity services. It describes the process and challenges of identifying the number, level and networks of rural and remote maternity services in public hospitals serving communities of between 1000 and 25000 people across Australia, and presents the findings of this process. METHODS Health departments and the national government's websites, along with lists of public hospitals, were used to identify all rural and remote Australian public hospitals offering maternity services in small towns. State perinatal reports were reviewed to establish numbers of births by hospital. The level of maternity services and networks of hospitals within which services functioned were determined via discussion with senior jurisdictional representatives. RESULTS In all, 198 rural and remote public hospitals offering maternity services were identified. There were challenges in sourcing information on maternity services to generate an accurate national picture. The nature of information about maternity services held centrally by jurisdictions varied, and different frameworks were used to describe minimum requirements for service levels. Service networks appeared to be based on a combination of individual links, geography and transport infrastructure. CONCLUSIONS The lack of readily available centralised and comparable information on rural and remote maternity services has implications for policy review and development, equity, safety and quality, network development and planning. Accountability for services and capacity to identify problems is also compromised.
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Affiliation(s)
- Jo Longman
- University Centre for Rural Health, University of Sydney, PO Box 3074, Lismore, NSW 2480, Australia. ; ; ;
| | - Jennifer M Pilcher
- University Centre for Rural Health, University of Sydney, PO Box 3074, Lismore, NSW 2480, Australia. ; ; ;
| | - Deborah A Donoghue
- University Centre for Rural Health, University of Sydney, PO Box 3074, Lismore, NSW 2480, Australia. ; ; ;
| | - Margaret Rolfe
- University Centre for Rural Health, University of Sydney, PO Box 3074, Lismore, NSW 2480, Australia. ; ; ;
| | - Sue V Kildea
- Women's Health and Newborn Services (Maternity) Mater Health Services, Australian Catholic University and Mater Medical Research Institute, Level 1, Aubigny Place, Raymond Terrace, South Brisbane, Qld 4101, Australia.
| | - Sue Kruske
- Queensland Centre for Mothers & Babies, The University of Queensland, Brisbane, Qld 4072, Australia
| | - Jeremy J N Oats
- Melbourne School of Population and Global Health, University of Melbourne, PO Box 5266, Burnley, Victoria 3121, Australia.
| | - Geoffrey G Morgan
- University Centre for Rural Health, University of Sydney, PO Box 3074, Lismore, NSW 2480, Australia. ; ; ;
| | - Lesley M Barclay
- University Centre for Rural Health, University of Sydney, PO Box 3074, Lismore, NSW 2480, Australia. ; ; ;
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17
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Chamberlain C, Banks E, Joshy G, Diouf I, Oats JJN, Gubhaju L, Eades S. Prevalence of gestational diabetes mellitus among Indigenous women and comparison with non-Indigenous Australian women: 1990-2009. Aust N Z J Obstet Gynaecol 2014; 54:433-40. [PMID: 24773552 DOI: 10.1111/ajo.12213] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 03/27/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Evidence on long-term trends in gestational diabetes mellitus (GDM) prevalence in Australia is lacking. AIMS To assess and compare trends in GDM prevalence among Indigenous and non-Indigenous Australian women. MATERIALS AND METHODS Analysis of crude and age-adjusted GDM prevalence over time by Indigenous status and age, using routinely collected midwives data from Australian states and territories on mothers giving birth from 1990 to 2009. RESULTS Despite considerable data variation, particularly in 1990-1999, and likely underestimation of GDM prevalence, crude and age-adjusted GDM prevalences were higher in Indigenous than non-Indigenous women at all time-points (4.7% vs 3.1% in 1990-1999; 5.1% vs 4.5% in 2000-2009, P < 0.0001). Data variability precluded quantitative assessment of trends and changes in prevalence ratios before 2000. From 2000 to 2009, GDM prevalence increased significantly among Indigenous women by a mean 2.6% annually (Ptrend <0.0001), and non-Indigenous women by 3.2% annually (Ptrend <0.0001), with no significant trend in the age-adjusted Indigenous/non-Indigenous prevalence ratios (PR) (P = 0.34). GDM prevalence increased significantly with age (P < 0.0001), although the increase with age was significantly greater among Indigenous women (PR 5.34 (4.94-5.77), ≥35 vs <25 years) compared to non-Indigenous women (PR 3.72 (3.64-3.81), ≥35 vs <25 years), Pinteraction <0.0001. CONCLUSIONS Bearing data quality concerns in mind, GDM prevalence is increasing rapidly among Australian women, more than doubling in non-Indigenous women between 1990 and 2009. Prevalence is consistently higher in Indigenous versus non-Indigenous women, with statistically consistent differences between the groups in recent years. The marked increase in prevalence with age highlights an important period for prevention, particularly for Indigenous women.
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Affiliation(s)
- Catherine Chamberlain
- Global Health and Society Unit, Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Prahan, Victoria, Australia
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Affiliation(s)
- H David McIntyre
- Mater Health Services, Brisbane, QLD
- University of Queensland, Brisbane, QLD
| | - Jeremy J N Oats
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC
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Affiliation(s)
- H David McIntyre
- Mater Health Services, Brisbane, QLD
- University of Queensland, Brisbane, QLD
| | - Jeremy J N Oats
- School of Population Health, University of Melbourne, Melbourne, VIC
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Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PM, Damm P, Dyer AR, Hod M, Kitzmiller JL, Lowe LP, McIntyre HD, Oats JJN, Omori Y. The diagnosis of gestational diabetes mellitus: new paradigms or status quo? J Matern Fetal Neonatal Med 2012; 25:2564-9. [PMID: 22876884 DOI: 10.3109/14767058.2012.718002] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study showed significant perinatal risks at levels of maternal hyperglycemia below values that are diagnostic for diabetes. A Consensus Panel of the International Association of Diabetes and Pregnancy Study Groups (IADPSG) reviewed HAPO Study results and other work that examined associations of maternal glycemia with perinatal and long-term outcomes in offspring and published recommendations for diagnosis and classification of hyperglycemia in pregnancy in 2010. Subsequently, some commentaries and debate challenged the IADPSG recommendations. In this review, we provide details regarding some points that were considered by the IADPSG Consensus Panel but not published and address the following issues: 1) what should be the frequency of gestational diabetes mellitus (GDM); 2) were appropriate outcomes and odds ratios used to define diagnostic thresholds for GDM; 3) to improve perinatal outcome, should the focus be on GDM, obesity, or both; 4) should results of randomized controlled trials of treatment of mild GDM influence recommendations for diagnostic thresholds; and, 5) other issues related to diagnosis of GDM. Other groups are independently considering strategies for the diagnosis of GDM. However, after careful consideration of these issues, we affirm our support for the recommendations of the IADPSG Consensus Panel.
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Affiliation(s)
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- Northwestern University Feinberg School of Medicine, Division of Endocrinology, 645 N. Michigan Avenue, Suite 530-22,Chicago, IL 60611, USA.
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McIntyre HD, Oats JJN, Zeck W, Seshiah V, Hod M. Matching diagnosis and management of diabetes in pregnancy to local priorities and resources: an international approach. Int J Gynaecol Obstet 2012; 115 Suppl 1:S26-9. [PMID: 22099436 DOI: 10.1016/s0020-7292(11)60008-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The International Association of the Diabetes and Pregnancy Study Groups' (IADPSG) criteria for the diagnosis and classification of hyperglycemia in pregnancy are described and application of these in differing healthcare contexts on a worldwide basis is reported. Existing local protocols and known epidemiologic and clinical data regarding the detection and management of overt diabetes and gestational diabetes in the context of human pregnancy are considered. Although the IADPSG criteria are uniform, their introduction poses a variety of practical and technical challenges in differing healthcare contexts, both between and within countries. Knowledge of local factors will be vital in the implementation of the new guidelines and will require extensive liaison with local clinical and health policy groups. Resource availability will be critical in determining the type of treatment available in this context. The IADPSG criteria offer an important opportunity for a uniform approach to diabetes in pregnancy. Scaled implementation of these criteria adapted to a variety of local healthcare contexts should improve both research endeavors and patient care.
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Affiliation(s)
- H David McIntyre
- University of Queensland, Mater Health Services and Mater Medical Research Institute, South Brisbane, Australia.
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Lowe LP, Metzger BE, Dyer AR, Lowe J, McCance DR, Lappin TRJ, Trimble ER, Coustan DR, Hadden DR, Hod M, Oats JJN, Persson B. Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study: associations of maternal A1C and glucose with pregnancy outcomes. Diabetes Care 2012; 35:574-80. [PMID: 22301123 PMCID: PMC3322718 DOI: 10.2337/dc11-1687] [Citation(s) in RCA: 192] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To compare associations of maternal glucose and A1C with adverse outcomes in the multinational Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study and determine, based on those comparisons, if A1C measurement can provide an alternative to an oral glucose tolerance test (OGTT) in pregnant women. RESEARCH DESIGN AND METHODS Eligible pregnant women underwent a 75-g OGTT at 24-32 weeks' gestation. A sample for A1C was also collected. Neonatal anthropometrics and cord serum C-peptide were measured. Associations with outcomes were assessed using multiple logistic regression with adjustment for potential confounders. RESULTS Among 23,316 HAPO Study participants with glucose levels blinded to caregivers, 21,064 had a nonvariant A1C result. The mean ± SD A1C was 4.79 ± 0.40%. Associations were significantly stronger with glucose measures than with A1C for birth weight, sum of skinfolds, and percent body fat >90th percentile and for fasting and 1-h glucose for cord C-peptide (all P < 0.01). For example, in fully adjusted models, odds ratios (ORs) for birth weight >90th percentile for each measure higher by 1 SD were 1.39, 1.45, and 1.38, respectively, for fasting, 1-, and 2-h plasma glucose and 1.15 for A1C. ORs for cord C-peptide >90th percentile were 1.56, 1.45, and 1.35 for glucose, respectively, and 1.32 for A1C. ORs were similar for glucose and A1C for primary cesarean section, preeclampsia, and preterm delivery. CONCLUSIONS On the basis of associations with adverse outcomes, these findings suggest that A1C measurement is not a useful alternative to an OGTT in pregnant women.
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Affiliation(s)
- Lynn P Lowe
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
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Sacks DA, Hadden DR, Maresh M, Deerochanawong C, Dyer AR, Metzger BE, Lowe LP, Coustan DR, Hod M, Oats JJN, Persson B, Trimble ER. Frequency of gestational diabetes mellitus at collaborating centers based on IADPSG consensus panel-recommended criteria: the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study. Diabetes Care 2012; 35:526-8. [PMID: 22355019 PMCID: PMC3322716 DOI: 10.2337/dc11-1641] [Citation(s) in RCA: 491] [Impact Index Per Article: 40.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To report frequencies of gestational diabetes mellitus (GDM) among the 15 centers that participated in the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study using the new International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria. RESEARCH DESIGN AND METHODS All participants underwent a 75-g oral glucose tolerance test between 24 and 32 weeks' gestation. GDM was retrospectively classified using the IADPSG criteria (one or more fasting, 1-h, or 2-h plasma glucose concentrations equal to or greater than threshold values of 5.1, 10.0, or 8.5 mmol/L, respectively). RESULTS Overall frequency of GDM was 17.8% (range 9.3-25.5%). There was substantial center-to-center variation in which glucose measures met diagnostic thresholds. CONCLUSIONS Although the new diagnostic criteria for GDM apply globally, center-to-center differences occur in GDM frequency and relative diagnostic importance of fasting, 1-h, and 2-h glucose levels. This may impact strategies used for the diagnosis of GDM.
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Affiliation(s)
- David A Sacks
- Department of Obstetrics and Gynecology, Kaiser Foundation Hospital, Bellflower, California, USA
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Metzger BE, Persson B, Lowe LP, Dyer AR, Cruickshank JK, Deerochanawong C, Halliday HL, Hennis AJ, Liley H, Ng PC, Coustan DR, Hadden DR, Hod M, Oats JJN, Trimble ER. Hyperglycemia and adverse pregnancy outcome study: neonatal glycemia. Pediatrics 2010; 126:e1545-52. [PMID: 21078733 DOI: 10.1542/peds.2009-2257] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The goal was to describe the temporal pattern of neonatal plasma glucose levels and associations with maternal glucose levels, cord serum C-peptide levels, and neonatal size and adiposity. METHODS A total of 17,094 mothers and infants were included in the Hyperglycemia and Adverse Pregnancy Outcome Study (15 centers in 9 countries). Mothers underwent a 75-g, 2-hour, oral glucose tolerance test (OGTT) at 24 to 32 weeks of gestation. Cord blood and neonatal blood samples were collected. Biochemical neonatal hypoglycemia was defined as glucose levels of <10th percentile (2.2 mmol/L). Clinically identified hypoglycemia was ascertained through medical record review and associations were assessed. RESULTS Plasma glucose concentrations were stable during the first 5 hours after birth. Maternal glucose levels were weakly positively associated with biochemical neonatal hypoglycemia (odds ratios: 1.07-1.14 for 1-SD higher OGTT glucose levels). Frequency of neonatal hypoglycemia was higher with higher cord C-peptide levels (odds ratio: 11.6 for highest versus lowest C-peptide category). Larger and/or fatter infants were more likely to have hypoglycemia (P < .001), and infants with hypoglycemia tended to have a higher frequency of cord C-peptide levels of >90th percentile. CONCLUSIONS Mean neonatal plasma glucose concentrations varied little in the first 5 hours after birth, which suggests normal postnatal adjustment. Biochemical and clinical hypoglycemia were weakly related to maternal OGTT glucose measurements but were strongly associated with elevated cord serum C-peptide levels. Larger and/or fatter infants were more likely to develop hypoglycemia and hyperinsulinemia. These relationships suggest physiologic relationships between maternal glycemia and fetal insulin production.
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Affiliation(s)
- Boyd E Metzger
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, USA.
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Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA, Damm P, Dyer AR, Leiva AD, Hod M, Kitzmiler JL, Lowe LP, McIntyre HD, Oats JJN, Omori Y, Schmidt MI. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 2010. [PMID: 20190296 DOI: 10.2337/dc10-0719] [Citation(s) in RCA: 1078] [Impact Index Per Article: 77.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA, Damm P, Dyer AR, Leiva AD, Hod M, Kitzmiler JL, Lowe LP, McIntyre HD, Oats JJN, Omori Y, Schmidt MI. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 2010; 33:676-82. [PMID: 20190296 PMCID: PMC2827530 DOI: 10.2337/dc09-1848] [Citation(s) in RCA: 2769] [Impact Index Per Article: 197.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Metzger BE, Lowe LP, Dyer AR, Trimble ER, Chaovarindr U, Coustan DR, Hadden DR, McCance DR, Hod M, McIntyre HD, Oats JJN, Persson B, Rogers MS, Sacks DA. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med 2008; 358:1991-2002. [PMID: 18463375 DOI: 10.1056/nejmoa0707943] [Citation(s) in RCA: 3405] [Impact Index Per Article: 212.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND It is controversial whether maternal hyperglycemia less severe than that in diabetes mellitus is associated with increased risks of adverse pregnancy outcomes. METHODS A total of 25,505 pregnant women at 15 centers in nine countries underwent 75-g oral glucose-tolerance testing at 24 to 32 weeks of gestation. Data remained blinded if the fasting plasma glucose level was 105 mg per deciliter (5.8 mmol per liter) or less and the 2-hour plasma glucose level was 200 mg per deciliter (11.1 mmol per liter) or less. Primary outcomes were birth weight above the 90th percentile for gestational age, primary cesarean delivery, clinically diagnosed neonatal hypoglycemia, and cord-blood serum C-peptide level above the 90th percentile. Secondary outcomes were delivery before 37 weeks of gestation, shoulder dystocia or birth injury, need for intensive neonatal care, hyperbilirubinemia, and preeclampsia. RESULTS For the 23,316 participants with blinded data, we calculated adjusted odds ratios for adverse pregnancy outcomes associated with an increase in the fasting plasma glucose level of 1 SD (6.9 mg per deciliter [0.4 mmol per liter]), an increase in the 1-hour plasma glucose level of 1 SD (30.9 mg per deciliter [1.7 mmol per liter]), and an increase in the 2-hour plasma glucose level of 1 SD (23.5 mg per deciliter [1.3 mmol per liter]). For birth weight above the 90th percentile, the odds ratios were 1.38 (95% confidence interval [CI], 1.32 to 1.44), 1.46 (1.39 to 1.53), and 1.38 (1.32 to 1.44), respectively; for cord-blood serum C-peptide level above the 90th percentile, 1.55 (95% CI, 1.47 to 1.64), 1.46 (1.38 to 1.54), and 1.37 (1.30 to 1.44); for primary cesarean delivery, 1.11 (95% CI, 1.06 to 1.15), 1.10 (1.06 to 1.15), and 1.08 (1.03 to 1.12); and for neonatal hypoglycemia, 1.08 (95% CI, 0.98 to 1.19), 1.13 (1.03 to 1.26), and 1.10 (1.00 to 1.12). There were no obvious thresholds at which risks increased. Significant associations were also observed for secondary outcomes, although these tended to be weaker. CONCLUSIONS Our results indicate strong, continuous associations of maternal glucose levels below those diagnostic of diabetes with increased birth weight and increased cord-blood serum C-peptide levels.
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Cheung NW, Oats JJN. Re: Glucose tolerance abnormalities in Australian women with polycystic ovary syndrome. Med J Aust 2008; 188:126-7. [PMID: 18205595 DOI: 10.5694/j.1326-5377.2008.tb01547.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2007] [Accepted: 10/18/2007] [Indexed: 11/17/2022]
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Giles M, Garland S, Oats JJN. Management of preterm prelabour rupture of membranes: an audit. How do the results compare with clinical practice guidelines? Aust N Z J Obstet Gynaecol 2006; 45:201-6. [PMID: 15904444 DOI: 10.1111/j.1479-828x.2005.00389.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Preterm prelabour rupture of membranes is a common clinical event. It is associated with infection in approximately 50% of cases. Clinical practice guidelines have been developed at the Royal Women's Hospital, Melbourne, Australia for investigation and management of this condition. AIM To perform an audit of management of women presenting with this diagnosis and assess how inpatient management compares with the Hospital's current clinical practice guideline and how the clinical practice guideline compares with the evidence in the literature. METHODS Retrospective audit over a 3-month period collecting data on maternal age, gestation, microbiological results, other investigations, pharmacological treatment and outcome. RESULTS All the 56 women admitted for this reason received at least one dose of antibiotic, most commonly erythromycin. More than two thirds of patients had the antibiotic changed at least once during their admission. Ten patients were prescribed intravenous antibiotics without a clear indication. Sixty-four percent received steroids for lung maturation of the neonate and 30% received tocolysis with nifedipine. Almost two thirds of patients delivered within 7 days and there were four neonatal deaths. CONCLUSION In general management of women with premature rupture of membranes is in keeping with the current clinical practice guideline at the Royal Women's Hospital although antibiotic prescribing and management of Group B streptococcus colonisation could be improved. In addition, routine measurement of C reactive protein should cease. The current clinical practice guideline should be modified to reflect the current evidence in the literature.
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Affiliation(s)
- Michelle Giles
- Department of Microbiology Infectious Diseases, Royal Women's Hospital, Melbourne, Australia.
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Cheung NW, Oats JJN, McIntyre HD. Australian carbohydrate intolerance study in pregnant women: implications for the management of gestational diabetes. Aust N Z J Obstet Gynaecol 2005; 45:484-5. [PMID: 16401212 DOI: 10.1111/j.1479-828x.2005.00481.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- N Wah Cheung
- Centre for Diabetes and Endocrinology Research, Westmead Hospital, New South Wales, Australia.
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McElduff A, Cheung NW, McIntyre HD, Lagström JA, Walters BNJ, Oats JJN, Wein P, Ross GP, Simmons D. The Australasian Diabetes in Pregnancy Society consensus guidelines for the management of type 1 and type 2 diabetes in relation to pregnancy. Med J Aust 2005. [DOI: 10.5694/j.1326-5377.2005.tb07087.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Aidan McElduff
- Department of Endocrinology, Royal North Shore Hospital, St Leonards, NSW
| | - N Wah Cheung
- Department of Endocrinology, Royal North Shore Hospital, St Leonards, NSW
| | - H David McIntyre
- Department of Endocrinology, Royal North Shore Hospital, St Leonards, NSW
| | - Janet A Lagström
- Centre for Diabetes and Endocrinology Research, Westmead Hospital, Westmead, NSW
| | | | | | - Peter Wein
- Department of Obstetrics, Royal Women's Hospital, Melbourne, VIC
| | - Glynis P Ross
- Diabetes Centre, Royal Prince Alfred Hospital, Camperdown, NSW
| | - David Simmons
- Waikato Clinical School, University of Auckland, Waikato Hospital, Hamilton, New Zealand
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McElduff A, Cheung NW, McIntyre HD, Lagström JA, Oats JJN, Ross GP, Simmons D, Walters BNJ, Wein P. The Australasian Diabetes in Pregnancy Society consensus guidelines for the management of type 1 and type 2 diabetes in relation to pregnancy. Med J Aust 2005; 183:373-7. [PMID: 16201957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2005] [Accepted: 08/23/2005] [Indexed: 05/04/2023]
Abstract
Strict control of blood glucose levels should be pursued before conception and maintained throughout the pregnancy (glycohaemoglobin [HbA(1c)] level as close as possible to the reference range). Before conception: high-dose (5 mg daily) folate supplementation should be commenced; oral hypoglycaemic agents should be ceased; and diabetes complications screening should take place. Management should be by a multidisciplinary team experienced in the management of diabetes in pregnancy. Blood glucose monitoring is mandatory during pregnancy, and targets are: fasting 4.0-5.5 mmol/L; postprandial < 8.0 mmol/L at 1 hour; < 7 mmol/L at 2 hours. A first trimester nuchal translucency (possibly with first trimester biochemical screening with pregnancy-associated plasma protein A and beta-human chorionic gonadotropin) should be offered. Ultrasound should be performed for fetal morphology at 18-20 weeks, if required, for cardiac views at 24 weeks and for fetal growth at 28-30 and 34-36 weeks. Induction of labour or operative delivery should be based on obstetric and/or fetal indications. Level 3 neonatal nursing facilities may be required and should be anticipated when birth occurs before 36 weeks, or if there has been poor glycaemic control. Insulin requirements fall rapidly during labour and in the puerperium. At this time, close monitoring and adjustment of insulin therapy is necessary.
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Affiliation(s)
- Aidan McElduff
- Department of Endocrinology, Royal North Shore Hospital, St Leonards, NSW.
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McIntyre HD, Cheung NW, Oats JJN, Simmons D. Gestational diabetes mellitus: from consensus to action on screening and treatment. Med J Aust 2005; 183:288-9. [PMID: 16167866 DOI: 10.5694/j.1326-5377.2005.tb07056.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2005] [Accepted: 08/10/2005] [Indexed: 11/17/2022]
Abstract
Results of a recent Australian trial suggest it is time to stop equivocating about screening and treatment.
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Abstract
BACKGROUND Fetal scalp lactate testing has been shown to be as useful as pH with added benefits. One remaining question is 'What level of lactate should trigger intervention in the first stage of labour?' AIMS This study aimed to establish the lactate level in the first stage of labour that indicates the need for intervention to ensure satisfactory outcomes for both babies and mothers. METHODS A prospective study at Mater Mothers' Hospital, Brisbane, Australia, a tertiary referral centre. One hundred and forty women in labour, with non-reassuring fetal heart rate traces, were tested using fetal blood scalp sampling of 5 microL of capillary blood tested on an Accusport (Boeringer, Mannheim, East Sussex, UK) lactate meter. Decision to intervene in labour was based on clinical assessment plus a predetermined cut off. Main outcome measures were APGAR scores, cord arterial pH, meconium stained liquor and Intensive Care Nursery admission. RESULTS Two-graph receiver operating characteristic (TG-ROC) analysis showed optimal specificity, and sensitivity for predicting adverse neonatal outcomes was a scalp lactate level above 4.2 mmol/L. CONCLUSIONS Fetal blood sampling remains the standard for further investigating-non-reassuring cardiotocograph (CTG) traces. Even so, it is a poor predictor of fetal outcomes. Scalp lactate has been shown to be at least as good a predictor as scalp pH, with the advantages of being easier, cheaper and with a lower rate of technical failure. Our study found that a cut off fetal scalp lactate level of 4.2 mmol/L, in combination with an assessment of the entire clinical picture, is a useful tool in identifying those women who need intervention.
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Affiliation(s)
- Rod M Allen
- Mater Hospital, South Brisbane, Queensland, Australia.
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Wong SF, Chan FY, Cincotta RB, McIntyre HD, Oats JJN. Cardiac function in fetuses of poorly-controlled pre-gestational diabetic pregnancies--a pilot study. Gynecol Obstet Invest 2004; 56:113-6. [PMID: 12939561 DOI: 10.1159/000073191] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2003] [Accepted: 07/21/2003] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Cardiac impairment is frequently found in babies of diabetic mothers. It is still controversial whether this is due to poor glucose control. The aim of this study is to compare the cardiac function in fetuses of well- and poorly-controlled pre-gestational diabetic pregnancy in third trimester. METHODS Women with type 1 pre-gestational diabetes were enrolled at 30-32 weeks. Cardiac size and interventricular septal wall thickness were measured by M-mode at end-diastolic phase. The right and left ventricular ejection fractions were calculated. At the mitral and tricuspid valves inflow, the ratio between early ventricular filling and active atrial filling (E/A) at both atrioventricular valves were measured by Doppler echocardiography. Peak velocities of ascending aorta and pulmonary artery were assessed. The angle of isonation was kept at <20 degrees. Women with poorly-controlled diabetes (HbA1c>6.5%) were compared with those with satisfactorily controlled diabetes (HbA1c < or = 6.5%). RESULTS A total of 21 women with pre-gestational diabetes were recruited for this study. Eight women with well-controlled diabetes were compared with 9 women who had poorly-controlled diabetes. HbA1c in the poorly-controlled group was 7.3% and in the well-controlled group it was 5.4% (p<0.001). There was no difference between the two groups in cardiac size, interventricular septal wall thickness, ejection fraction, aorta and pulmonary artery peak flow velocities. The right atrioventricular E/A ratio was significantly lower among the poorly-controlled diabetic pregnancies (0.71 vs. 0.54; p<0.05). CONCLUSION Fetuses of poorly-controlled diabetic mothers had a lower right atrioventricular E/A ratio. This may be due to metabolic acidosis, non-hypertrophic cardiac dysfunction or fetal polycythemia.
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Affiliation(s)
- S F Wong
- Department of Maternal Fetal Medicine, Mater Mothers' Hospital, South Brisbane, Qld., Australia.
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Abstract
OBJECTIVE To assess the timing of fetal growth spurt among pre-existing diabetic pregnancies (types 1 and 2) and its relationship with diabetic control. To correlate fetal growth acceleration with factors that might influence fetal growth. RESEARCH DESIGN AND METHODS This retrospective study involved all pregestational diabetic pregnancies delivered at a tertiary obstetric hospital in Australia between 1 January 1994 and 31 December 1999. Pregnancies with major congenital fetal anomalies, multiple pregnancies, small-for-gestational-age pregnancies (<10th centile), and those that were terminated before 20 weeks were excluded. In this cohort, pregnancies delivered at term had at least four ultrasound scans performed. The first scans were performed before 14 weeks of gestation and were regarded as dating scans. Abdominal circumference measurements were retrieved from the ultrasound reports. The z-scores for abdominal circumferences, according to the gestational age, were calculated. The gestations when the ultrasound scans were performed were stratified at four weekly intervals beginning at 18 weeks and continuing through the rest of the study. Majority of these diabetic pregnancies had ultrasound scans performed at 18, 28, 32, and 36 weeks. The abdominal circumference z-scores for pregnancies with large-for-gestational-age (LGA) babies (>90th centile for gestation) were compared with babies with normal birth weights. RESULTS A total of 101 diabetic pregnancies were included. Diabetic mothers, who had LGA babies, had significantly higher prepregnancy body weight and BMI (P < 0.05). There were no differences in maternal age or parity among the two groups. There were also no differences in the first-, second-, and third-trimester HbA(1c) levels between the two groups. The abdominal circumference z-scores were significantly higher for LGA babies from 18 weeks and thereafter. The differences increased progressively as the gestation advanced. Maximum difference was noted in the third trimester (30-38 weeks). CONCLUSIONS Fetal growth acceleration in LGA fetuses of diabetic mothers starts in the second trimester, from as early as 18 weeks. In this study, glucose control did not appear to have a direct effect on the incidence of LGA babies, and such observation might result from the effects of other confounding factors.
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Affiliation(s)
- Shell Fean Wong
- Department of Maternal Fetal Medicine, Mater Mothers' Hospital, South Brisbane, Queensland, Australia.
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Abstract
OBJECTIVES To assess the detection rate of congenital fetal malformations and specific problems related to routine ultrasound screening in women with pre-existing diabetes. METHODS A retrospective study was carried out to assess the performance of routine ultrasound screening in women with pre-existing diabetes (Types 1 and 2) within a tertiary institution. The incidence, type and risk factors for congenital fetal malformations were determined. The detection rate of fetal anomalies for diabetic women was compared with that for the low-risk population. Factors affecting these detection rates were evaluated. RESULTS During the study period, 12 169 low-risk pregnant women and 130 women with pre-existing diabetes had routine ultrasound screening performed within the institution. A total of 10 major anomalies (7.7%) and three minor anomalies (2.3%) were present in the fetuses of the diabetic women. Central nervous system and cardiovascular system anomalies accounted for 60% of the major anomalies. Periconceptional hemoglobin A1c of more than 9% was associated with a high prevalence of major anomalies (143/1000). Women who had fetuses with major anomalies had a significantly higher incidence of obesity (78% vs. 37%; P < 0.05). Ultrasound examination of these diabetic pregnancies showed high incidences of suboptimal image quality (37%), incomplete examinations, and repeat examinations (17%). Compared to the 'low-risk' non-diabetic population from the same institution, the relative risk for a major congenital anomaly among the diabetic women was 5.9-fold higher (95% confidence interval, 2.9-11.9). The detection rate for major fetal anomalies was significantly lower for diabetic women (30% vs. 73%; P < 0.01), and the mean body mass index for the diabetic group was significantly higher (29 vs. 23 kg/m2; P < 0.001). CONCLUSION The incidence of congenital anomalies is higher in diabetic pregnancies. Unfortunately, the detection rate for fetal anomalies by antenatal ultrasound scan was significantly worse than that for the low-risk population. This is likely to be related to the maternal body habitus and unsatisfactory examinations. Methods to overcome these difficulties are discussed.
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Affiliation(s)
- S F Wong
- Department of Maternal Fetal Medicine, Mater Mothers' Hospital, South Brisbane, Queensland, Australia
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