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Feng Y, Wang Y, Feng Q, Song X, Wang L, Sun L. Whey protein preloading can alleviate stress adaptation disorder and improve hyperglycemia in women with gestational diabetes mellitus. Gynecol Endocrinol 2021; 37:753-757. [PMID: 34060419 DOI: 10.1080/09513590.2021.1932803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
AIMS To investigate the change of stress hormones, oxidative stress and insulin resistance (IR) in women with gestational diabetes mellitus (GDM) after supplement whey protein, in an attempt to gain insights into the prevention and treatment of GDM. MATERIALS AND METHODS 60 GDM women were recruited in this study, and 30 women received a preload drink containing 20 g whey protein as group GDM-W, and the other 30 women received control flavoring drink as group GDM, and the trial lasted for 14 days. Plasma epinephrine (E), noradrenaline (NE), and cortisol were detected; we also determined levels of malondialdehyde (MDA), superoxide dismutase (SOD), and glutathione (GSH). Homeostasis model assessment of insulin resistance (HOMA-IR) was used to assess IR. RESULTS In the GDM-W group, postprandial blood glucose was decreased significantly on 3, 5, 7, and 14 days (all p < .05), plasma 2 h insulin was increased by 7.2, 8.6, and 20.5% on days 5, 7, and 14 (p < .05, .05, .01). HOMA-IR was decreased significantly on day 14 (p < .05). MDA was decreased by 20.7% on day 14 (p < .01), and anti-oxidative enzymes' SOD was decreased by 13.4% on day 14 (p < .05) and GSH was decreased by 16.7 and 29.1% on days 7 and 14 (both p < .05). Stress hormones E and cortisol were decreased by 10.8 and 19.8%, respectively, on day 14 (p < .05). There was no significant difference in NE between the two groups within 14 days. CONCLUSIONS Whey protein supplementation may improve hyperglycemia by alleviating stress disorder and oxidative stress injury in GDM women. This trial was registered at chictr.org.cn/as ChiCTR1800020413.
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Affiliation(s)
- Yan Feng
- Department of Clinical Nutrition, Yuhuangding Hospital Affiliated to Qingdao University, Yantai, China
| | - Yuping Wang
- Department of Obstetrics and Gynecology, Yuhuangding Hospital Affiliated to Qingdao University, Yantai, China
| | - Qi Feng
- Department of General Surgery, CPLA No. 71897, Xi'an, China
| | - Xinna Song
- Department of Clinical Nutrition, Yuhuangding Hospital Affiliated to Qingdao University, Yantai, China
| | - Lanlan Wang
- Department of Obstetrics and Gynecology, Yuhuangding Hospital Affiliated to Qingdao University, Yantai, China
| | - Li Sun
- Department of Obstetrics and Gynecology, Yuhuangding Hospital Affiliated to Qingdao University, Yantai, China
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Abstract
Diabetes mellitus is a chronic heterogeneous metabolic disorder with complex pathogenesis. It is characterized by elevated blood glucose levels or hyperglycemia, which results from abnormalities in either insulin secretion or insulin action or both. Hyperglycemia manifests in various forms with a varied presentation and results in carbohydrate, fat, and protein metabolic dysfunctions. Long-term hyperglycemia often leads to various microvascular and macrovascular diabetic complications, which are mainly responsible for diabetes-associated morbidity and mortality. Hyperglycemia serves as the primary biomarker for the diagnosis of diabetes as well. In this review, we would be focusing on the classification of diabetes and its pathophysiology including that of its various types.
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Affiliation(s)
- Mujeeb Z Banday
- Department of Biochemistry, Government Medical College and Associated Shri Maharaja Hari Singh Hospital, Srinagar, Kashmir, India
| | - Aga S Sameer
- Department of Basic Medical Sciences, College of Medicine, King Saud Bin Abdul Aziz University for Health Sciences, King Abdullah International Medical Research Centre, National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Saniya Nissar
- Department of Biochemistry, Government Medical College and Associated Shri Maharaja Hari Singh Hospital, Srinagar, Kashmir, India
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Cosson E, Vicaut E, Sandre-Banon D, Gary F, Pharisien I, Portal JJ, Banu I, Bianchi L, Cussac-Pillegand C, Dina R, Chiheb S, Valensi P, Carbillon L. Early screening for gestational diabetes mellitus is not associated with improved pregnancy outcomes: an observational study including 9795 women. DIABETES & METABOLISM 2019; 45:465-472. [DOI: 10.1016/j.diabet.2018.11.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 10/29/2018] [Accepted: 11/15/2018] [Indexed: 01/09/2023]
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Lubin V, Shojai R, Darmon P, Cosson E. A pilot study of gestational diabetes mellitus not controlled by diet alone: First-line medical treatment with myoinositol may limit the need for insulin. DIABETES & METABOLISM 2016; 42:192-5. [PMID: 26948394 DOI: 10.1016/j.diabet.2016.01.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 01/26/2016] [Accepted: 01/31/2016] [Indexed: 12/24/2022]
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Sadeghi A, Hami J, Razavi S, Esfandiary E, Hejazi Z. The Effect of Diabetes Mellitus on Apoptosis in Hippocampus: Cellular and Molecular Aspects. Int J Prev Med 2016; 7:57. [PMID: 27076895 PMCID: PMC4809120 DOI: 10.4103/2008-7802.178531] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 10/17/2015] [Indexed: 02/06/2023] Open
Abstract
Background: Diabetes mellitus is associated with cognitive deficits in humans and animals. These deficits are paralleled by neurophysiological and structural changes in brain. In diabetic animals, impairments of spatial learning, memory, and cognition occur in association with distinct changes in hippocampus, a key brain area for many forms of learning and memory and are particularly sensitive to changes in glucose homeostasis. However, the multifactorial pathogenesis of diabetic encephalopathy is not yet completely understood. Apoptosis plays a crucial role in diabetes-induce neuronal loss in hippocampus. Methods: The effects of diabetes on hippocampus and cognitive/behavioral dysfunctions in experimental models of diabetes are reviewed, with a focus on the negative impact on increased neuronal apoptosis and related cellular and molecular mechanisms. Results: Of all articles that were assessed, most of the experimental studies clearly showed that diabetes causes neuronal apoptosis in hippocampus through multiple mechanisms, including oxidative stress, inhibition of caspases, disturbance in expression of apoptosis regulator genes, as well as deficits in mitochondrial function. The balance between pro-apoptotic and anti-apoptotic signaling may determine the neuronal apoptotic outcome in vitro and in vivo models of experimental diabetes. Conclusions: Dissecting out the mechanisms responsible for diabetes-related changes in the hippocampal cell apoptosis helps improve treatment of impaired cognitive and memory functions in diabetic individuals.
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Affiliation(s)
- Akram Sadeghi
- Department of Anatomical Sciences and Molecular Biology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Javad Hami
- Department of Anatomical Sciences, School of Medicine, Birjand University of Medical Sciences, Birjand, Iran
| | - Shahnaz Razavi
- Department of Anatomical Sciences and Molecular Biology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ebrahim Esfandiary
- Department of Anatomical Sciences and Molecular Biology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Hejazi
- Department of Genetic Biology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Abstract
INTRODUCTION Gestational diabetes mellitus (GDM), defined as glucose intolerance with first recognition or onset during pregnancy, is steadily rising in prevalence. GDM affects ∼ 3 - 5% of pregnancies in the US and is associated with significant adverse perinatal and maternal outcomes. Diagnosing and treating GDM early in pregnancy is of utmost importance as it can prevent poor outcomes such as macrosomia, shoulder dystocia and obstetric complications. AREAS COVERED This review describes the importance of treating GDM and the various available interventions for glycemic control in women with GDM, including the latest evidence regarding pharmacological treatments and specifically anti-hyperglycemic agents. It deals with timing of pharmacological treatments, recommended doses and what pharmacological agent should be used. EXPERT OPINION Unless diagnosed late during pregnancy, a stepwise approach is the best way to treat GDM, beginning with diet and exercise and proceeding to pharmacological interventions if failure occurred. Although insulin is the dominant treatment, the use of anti-hyperglycemic agents such as glyburide and metformin in treating GDM has gained popularity and consideration should be made using these agents as first-line pharmacological treatment. Anti-hyperglycemic agents do not require frequent monitoring or injections and may therefore appeal more to patients. Further studies are needed regarding long-acting insulin and other anti-hyperglycemic agents such as thiazolidinediones, as well as identifying treatment options more specific to an individual based on risk factors and other variables predicting treatment outcomes in GDM.
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Affiliation(s)
- Jamie Klein
- Ben-Gurion University of the Negev, Soroka University Medical Center, Department of Obstetrics and Gynecology, Faculty of Health Sciences , POB 151, Beer Sheva 84101 , Israel
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Cosson E, Valensi P, Carbillon L. Screening for dysglycaemia during pregnancy: Proposals conciliating International Association of Diabetes and Pregnancy Study Group (IADPSG) and US National Institutes of Health (NIH) panels. DIABETES & METABOLISM 2014; 41:239-43. [PMID: 25282605 DOI: 10.1016/j.diabet.2014.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 08/05/2014] [Accepted: 08/22/2014] [Indexed: 10/24/2022]
Abstract
The International Association of Diabetes and Pregnancy Study Group (IADPSG) has proposed that blood glucose levels for the diagnosis of gestational diabetes mellitus (GDM) be the values associated with a 1.75-fold increase in the risk of neonatal complications in the Hyperglycaemia and Adverse Pregnancy Outcomes (HAPO) study. However, this recommendation was not adopted by the US National Institutes of Health (NIH) panel as it would have been responsible for a huge increase in the prevalence of GDM with no clear evidence of a reduction of events at such blood glucose values. Considering this aspect, we now propose the use of a blood glucose threshold combination associated with an odds-ratio of 2.0 for neonatal disorders [fasting plasma glucose (FPG)≥ 95 mg/dL, or a 1-h glucose value after a 75-g oral glucose tolerance test (OGTT)≥ 191 mg/dL or a 2-h glucose value ≥ 162 mg/dL] for GDM diagnosis. This would lead to a lower prevalence of GDM and concentrate medical resources on those with the highest risk of complications. This would also allow the use of a similar FPG value for both the diagnosis and therapeutic target of GDM. The IADPSG also proposed screening for dysglycaemia during early pregnancy, using FPG measurement with a similar threshold after 24 weeks of gestation. We propose the same strategy considering an FPG value ≥ 95 mg/dL as abnormal, but only after confirmatory measurements. We also believe that an OGTT should not be used before 24 weeks of gestation as normal values during that time are as yet unknown.
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Affiliation(s)
- E Cosson
- Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, Jean-Verdier Hospital, Paris 13 University, Sorbonne Paris Cité, AP-HP, Bondy, France; UMR U1143 Inserm/U1125 Inra/Cnam/Université Paris 13, Sorbonne Paris Cité, Bobigny, France.
| | - P Valensi
- Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, Jean-Verdier Hospital, Paris 13 University, Sorbonne Paris Cité, AP-HP, Bondy, France
| | - L Carbillon
- Department of Gynaecology-Obstetrics, Jean-Verdier Hospital, Paris 13 University, Sorbonne Paris Cité, AP-HP, Bondy, France
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Cosson E, Cussac-Pillegand C, Benbara A, Pharisien I, Jaber Y, Banu I, Nguyen MT, Valensi P, Carbillon L. The diagnostic and prognostic performance of a selective screening strategy for gestational diabetes mellitus according to ethnicity in Europe. J Clin Endocrinol Metab 2014; 99:996-1005. [PMID: 24423342 DOI: 10.1210/jc.2013-3383] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
CONTEXT The performance of standard selective screening strategies for gestational diabetes mellitus (GDM) may vary according to ethnicity. OBJECTIVE We aimed to evaluate the diagnostic and prognostic performance of a selective screening tool to determine whether it accurately predicts GDM and events in women of different ethnicities. The tool selectively screens based on patients having one or more of the following risk factors (RFs): body mass index ≥25 kg/m(2), age ≥35 years, family history of diabetes, and personal history of GDM or macrosomia. DESIGN AND SETTING We conducted an observational prospective study at a university hospital. PARTICIPANTS We included 17 344 women of European (30.9%), North African (29.6%), Sub-Saharan African (22.2%), Caribbean (8.7%), Indian-Pakistani-Sri Lankan (5.5%), and Asian (3.3%) ethnicities who were without pregravid diabetes and had singleton deliveries (2002-2010). MAIN OUTCOME MEASURES We universally screened GDM and GDM-related events (pre-eclampsia, birth weight ≥4000 g, or dystocia). RESULTS Independent of confounding factors, North African (odds ratio [OR], 1.35; 95% confidence interval [CI], 1.21-1.52; P < .001) and Indian-Pakistani-Sri Lankan (OR, 2.52; 95% CI, 2.13-3.00; P < .001) women had more GDM than Europeans, whereas Sub-Saharan African women had less (OR, 0.82; 95% CI, 0.71-0.94; P < .01). Having one or more RFs was associated with GDM among Europeans (OR, 1.45; 95% CI, 1.22-1.76), North African (OR, 1.33; 95% CI, 1.13-1.55), Sub-Saharan African (OR, 1.48; 95% CI, 1.20-1.83), and Caribbean (OR, 1.55; 95% CI, 1.12-2.14) women. Having one or more RFs was also associated with GDM-related events only in European (P < .01) and North African (P < .05) women, with the following incidences in Europeans: no GDM/no RF, 6.9%; no GDM/RF, 9.0%; GDM/no RF, 14.7%; and GDM/RF, 12.6%. CONCLUSION Standard selective screening criteria were not predictive of GDM in women from India-Pakistan-Sri Lanka and Asia and were associated with GDM-related events only in European and North African women. However, the women with GDM, who were routinely treated, had a poor prognosis, even for those free of RFs. These results support universal screening, irrespective of ethnicity.
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Affiliation(s)
- Emmanuel Cosson
- Paris 13 University, Sorbonne Paris Cité (E.C., C.C.-P., Y.J., I.B., M.T.N., P.V.), Assistance Publique-Hôpitaux de Paris (AP-HP), Centre Intégré Obésité Nord Francilien, Jean Verdier Hospital, Department of Endocrinology-Diabetology-Nutrition, Centre de Recherche en Nutrition Humaine Ile de France, 93143 Bondy, France; Paris 13 University, Sorbonne Paris Cité (E.C., M.T.N.), Unité Mixte de Recherche U557 INSERM/U11125 Institut National de la Recherche Agronomique/Caisse Nationale d'Assurance Maladie/Université Paris 13, Unité de Recherche Epidémiologique Nutritionnelle, 93430 Bobigny, France; and Paris 13 University, Sorbonne Paris Cité (A.B., I.P., L.C.), AP-HP, Jean Verdier Hospital, Department of Obstetrics and Gynecology, 93143 Bondy, France
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Oriot P, Selvais P, Radikov J, Jacobs JL, Gilleman U, Loumaye R, Fernandez C. Assessing the incidence of gestational diabetes and neonatal outcomes using the IADPSG guidelines in comparison with the Carpenter and Coustan criteria in a Belgian general hospital. Acta Clin Belg 2014; 69:8-11. [PMID: 24635392 DOI: 10.1179/0001551213z.0000000004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
We have conducted a systematic universal screening for gestational diabetes mellitus (GDM) since 2008, following the criteria outlined by the International Association of Diabetes and Pregnancy Study Group (IADPSG) since 2011. However, we recently replaced the IADPSG standards with those established by the Belgian French Language Gynecologists and Obstetricians Group (GGOLFB). These new criteria indicate GDM when fasting plasma glucose (FPG) is ≥0·92 g/l at the beginning of pregnancy or when an orally provoked hyperglycaemia test (75 g of glucose) between the twenty-fourth and twenty-eighth week results in an FPG of ≥0·92 g/l and/or ≥1·80 g/l after 1 hour and/or ≥1·53 g/l after 2 hours. The goal of this retrospective study was to evaluate the incidence of GDM, neonatal outcomes, and the use of insulin therapy 21 months post-implementation of the IADPSG criteria within our centre. A total of 393 patients were diagnosed with GDM from January 2009 to December 2012. After applying the new criteria, the incidence of GDM rose significantly from 8 to 23% (P<0·0001). However, there were no significant changes in the proportion of GDM patients requiring insulin therapy (34·2% versus 34·7%) or the rate of foetal large for gestational age (11·2% versus 8·8%). In addition, the ≥90% percentile decreased non-significantly from 96·3±0·6% to 94·3±0·70% (P = 0·057), whereas the lower quartiles and the proportion of cesarean deliveries (27·0% versus 25·6%) did not change significantly. Therefore, non-targeted screening significantly increased the incidence of GDM in our centre without significantly decreasing large for gestational age or the number of cesarean deliveries.
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Chamberlain C, Fredericks B, Davis B, Mein J, Smith C, Eades S, Oldenburg B. Postpartum care for Aboriginal and non-Aboriginal women with Gestational Diabetes Mellitus across urban, rural and remote locations: a protocol for a cohort linkage study. SPRINGERPLUS 2013; 2:576. [PMID: 25674406 PMCID: PMC4320232 DOI: 10.1186/2193-1801-2-576] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 10/28/2013] [Indexed: 12/23/2022]
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is increasing, along with obesity and type 2 diabetes (T2DM), with Aboriginal and Torres Strait Islander (Aboriginal(a)) women in Australia particularly affected. GDM causes serious complications in pregnancy, birth, and the longer term, for women and their infants. Women with GDM have an eightfold risk of developing T2DM after pregnancy, compared to women without GDM. Indigenous women have an even higher risk, at a younger age, and progress more quickly from GDM to T2DM, compared to non-Indigenous women. If left undetected and untreated, T2DM increases risks in subsequent pregnancies, and can lead to heart disease, stroke, kidney failure, limb amputations and blindness for the woman in the longer term. A GDM diagnosis offers a 'window of opportunity' to provide acceptable and effective prevention, treatment, and postpartum care. Low rates of postpartum T2DM screening are reported among non-Aboriginal women in Australia and Indigenous women in other countries, however, data for Aboriginal women in Australia are scarce. A healthy diet, exercise and breastfeeding can delay the onset of T2DM, and together with T2DM screening are recommended elements of postpartum care for women with GDM. This paper describes methods for a study evaluating postpartum care among Aboriginal and non-Aboriginal women with GDM. METHODS/DESIGN This retrospective cohort includes all women who gave birth at Cairns Hospital in far north Queensland, Australia, from 2004 to 2010, coded as having GDM in the Cairns Hospital Clinical Coding system. Data is being linked with the Midwives Perinatal Data Collection, and the three local laboratories. Hospital medical records are being reviewed to validate accuracy of GDM case ascertainment, and gather information on breastfeeding and provision of dietary advice. Survival analysis is being used to estimate time to screening, and rates of progression from GDM to T2DM. Logistic regression is being used to compare postpartum care between Aboriginal and non-Aboriginal women, and assess factors that may be associated with provision of postpartum care. DISCUSSION There are challenges to collecting postpartum data for women with GDM, however, this research is urgently needed to ensure adequate postpartum care is provided for women with GDM.
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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, L3/89 Commercial Rd, Prahan, Victoria, 3181 Australia
| | - Bronwyn Fredericks
- Office of Indigenous Engagement, Central Queensland University, Bruce Highway, North Rockhampton, Queensland, 4701 Australia
| | - Bronwyn Davis
- Cairns Diabetes Centre, PO Box 902, Cairns, Queensland 4870 Australia
| | - Jacqueline Mein
- Apunipima Cape York Health Council, 186 McCoombe Street, Cairns, Queensland 4870 Australia
| | - Catherine Smith
- Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, L6/96 Commercial Rd, Prahan, Victoria, 3181 Australia
| | - Sandra Eades
- Sydney School of Public Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales 2006 Australia
| | - Brian Oldenburg
- Global Health and Society Unit, Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, L3/89 Commercial Rd, Prahan, Victoria, 3181 Australia
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Chamberlain C, McNamara B, Williams ED, Yore D, Oldenburg B, Oats J, Eades S. Diabetes in pregnancy among indigenous women in Australia, Canada, New Zealand and the United States. Diabetes Metab Res Rev 2013; 29:241-56. [PMID: 23315909 PMCID: PMC3698691 DOI: 10.1002/dmrr.2389] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Revised: 12/13/2012] [Accepted: 12/20/2012] [Indexed: 12/16/2022]
Abstract
Recently proposed international guidelines for screening for gestational diabetes mellitus (GDM) recommend additional screening in early pregnancy for sub-populations at a high risk of type 2 diabetes mellitus (T2DM), such as indigenous women. However, there are criteria that should be met to ensure the benefits outweigh the risks of population-based screening. This review examines the published evidence for early screening for indigenous women as related to these criteria. Any publications were included that referred to diabetes in pregnancy among indigenous women in Australia, Canada, New Zealand and the United States (n = 145). The risk of bias was appraised. There is sufficient evidence describing the epidemiology of diabetes in pregnancy, demonstrating that it imposes a significant disease burden on indigenous women and their infants at birth and across the lifecourse (n = 120 studies). Women with pre-existing T2DM have a higher risk than women who develop GDM during pregnancy. However, there was insufficient evidence to address the remaining five criteria, including the following: understanding current screening practice and rates (n = 7); acceptability of GDM screening (n = 0); efficacy and cost of screening for GDM (n = 3); availability of effective treatment after diagnosis (n = 6); and effective systems for follow-up after pregnancy (n = 5). Given the impact of diabetes in pregnancy, particularly undiagnosed T2DM, GDM screening in early pregnancy offers potential benefits for indigenous women. However, researchers, policy makers and clinicians must work together with communities to develop effective strategies for implementation and minimizing the potential risks. Evidence of effective strategies for primary prevention, GDM treatment and follow-up after pregnancy are urgently needed.
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Affiliation(s)
- Catherine Chamberlain
- International Public Health Unit, Department of Epidemiology and Preventive Medicine, School of Medicine, Nursing and Health Sciences, Monash University, Prahan, Victoria, Australia.
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Cosson E, Benbara A, Pharisien I, Nguyen MT, Revaux A, Lormeau B, Sandre-Banon D, Assad N, Pillegand C, Valensi P, Carbillon L. Diagnostic and prognostic performances over 9 years of a selective screening strategy for gestational diabetes mellitus in a cohort of 18,775 subjects. Diabetes Care 2013; 36:598-603. [PMID: 23150287 PMCID: PMC3579341 DOI: 10.2337/dc12-1428] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We aimed to evaluate a selective screening strategy for gestational diabetes mellitus (GDM) based on the presence of risk factors: BMI ≥25 kg/m(2), age ≥35 years, family history of diabetes, personal history of GDM, or birth of a child with macrosomia. RESEARCH DESIGN AND METHODS Of 20,630 deliveries between 2002 and 2010, we selected 18,775 deliveries in women with no known diabetes and for whom all risk factors were known. GDM was universally screened and defined as fasting plasma glucose level ≥5.3 mmol/L and/or 2-h postload (75 g) glucose level ≥7.8 mmol/L. RESULTS The prevalence of at least one risk factor has increased since 2002 (P < 0.001) from 51.7 to 61.5%, with no change in the GDM prevalence (mean 14.4%, intention to screen). At least one risk factor was present in 58.5% of women who represented 65.3% of all those with GDM. The presence of risk factors was significantly associated with GDM (odds ratio 1.4 [95% CI 1.3-1.5], P < 0.001) and with GDM-related events (preeclampsia/large for gestational age/dystocia) (P < 0.001) with the following incidences: no GDM/no risk factor 8.8%, no GDM/risk factor 11.1%, GDM/no risk factor 16.7%, and GDM/risk factor 18.2%. CONCLUSIONS The presence of risk factors increased during the last decade. This condition is predictive of GDM and GDM-related events. However, a selective screening would lead to missing one-third of the women with GDM who, even without risk factors, had more events than women without GDM. Therefore, these data stand against the present selective screening currently proposed in the French guidelines.
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Affiliation(s)
- Emmanuel Cosson
- Centre de Recherche en Nutrition Humaine d’Ile-de-France, Department of Endocrinology-Diabetology-Nutrition, Jean Verdier Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Paris Cité, Paris 13 University, Bondy, France.
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Langer O, Umans JG, Miodovnik M. The proposed GDM diagnostic criteria: a difference, to be a difference, must make a difference. J Matern Fetal Neonatal Med 2012; 26:111-5. [DOI: 10.3109/14767058.2012.734874] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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