The unmet need for universal testing for hyperglycaemia in pregnancy and the FIGO guideline

The epidemiology of obesity in reproduction

Over the last decades, overweight and obesity rates have been rising exponentially and have now reached epidemic proportions. These are significantly higher in women than men, and indeed, data from 2022 show rates varying from the lowest (12%) in the South East Asian Region to the highest (82.8%) in the Western Pacific Region. This rise is mirrored by the increasing health cost of obesity and overweight. Recent estimates put the percentage of medical spending in various countries to vary from 3 to 21%. Obesity is associated with noncommunicable diseases, such as hypertension, diabetes mellitus, and cardiovascular disorders. It is associated with 13 cancers, among which are breast, endometrial, and ovarian. The reproductive consequences of obesity are variable and include but not exclusively menstrual disorders; fertility difficulties; recurrent miscarriages; gestational diabetes, hypertension, and pre-eclampsia; postpartum hemorrhage; and fetal macrosomia. Various factors are responsible for these increasing rates (which are more marked in middle- and low-income countries). These include genetic, epigenetic, environmental, physiologic, cultural, political, and socioeconomic factors that interact in most cases, making it challenging to develop effective interventions on both a local and global scale. In this article, we review the epidemiology of obesity and the factors which modify rates, as well as an overview of the reproductive consequences of obesity. We discuss approaches to reduce the rates and that these should be at three levels: individual, national, and international.

Adherence rates to a prediction tool identifying women with an increased gestational diabetes risk: An implementation study

OBJECTIVE

The best screening strategy for gestational diabetes mellitus (GDM) remains a topic of debate. Several organizations made a statement in favor of universal screening, but the volume of oral glucose tolerance tests (OGTT) required may burden healthcare systems. As a result, many countries still rely on selective screening using a checklist of risk factors, but reported diagnostic characteristics vary. Moreover, women's discomfort due to an OGTT is often neglected. Since 2017, obstetric healthcare professionals in a Dutch region assessed women's GDM risk with a prediction model and counseled those with an increased risk regarding an OGTT.

METHODS

From 2017 to 2018, 865 women were recruited in a multicenter prospective cohort.

RESULTS

In total, 385 women (48%) had an increased predicted GDM risk. Of all women, 78% reported that their healthcare professional discussed their GDM risk. Predicted GDM risks were positively correlated with conducting an OGTT.

CONCLUSION

Implementation of a GDM prediction model resulted in moderate rates of OGTTs performed in general, but high rates in high-risk women. As 25% of women experienced discomfort from the OGTT, a selective screening strategy based on a prediction model with a high detection rate may be an interesting alternative to universal screening.

STUDY COHORT REGISTRATION

Netherlands Trial Register: NTR4143; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4143.

Joint position statement on universal screening for GDM in Europe by FIGO, EBCOG and EAPM

Hyperglycaemia in Pregnancy (HIP) is a global issue as it increases risks for both the mother and child. There remains considerable disparity in clinical practice and national policies for HIP screening. FIGO, EBCOG and EAPM have joined forces to address this disparity in clinical care and reduce the burden of inter-generational Non-Communicable disease.