Quality of Life in Women with Gestational Diabetes Mellitus: A Systematic Review

Gestational diabetes education management interventions implemented across Arabic-speaking countries: A systematic scoping review

Background The prevalence of Gestational Diabetes Mellitus (GDM) in Arabic-speaking countries varies from 1.2 % (Jordan) to almost 40 % (Saudi Arabia). Untreated GDM increases the risk of poor maternal and neonatal health outcomes. Objective This systematic scoping review aims to examine the current literature to determine the effectiveness of interventions designed to manage and prevent GDM across Arabic-speaking countries. Design Systematic scoping review. Methods Employing the PRISMA-ScR and the AND-EAL for study quality and bias assessment, a comprehensive review of the literature was conducted using 12 databases and search terms relevant to GDM interventions conducted across the League of Arab states. The search period includes intervention studies published up to and including August 31st, 2024. Findings Eight studies met the inclusion criteria. Interventions conducted included those modeled on the Health Behavior Change model, Theory of Reasoned Action and the PRECEDE model, constructs of Social Cognitive Theory including self-efficacy, GDM self-management, lifestyle management and BASNEF model-based empowerment. The intervention studies had positive effect on GDM knowledge, self-efficacy, A1C levels, quality of life, maternal and neonatal outcomes. Conclusion Prevention and management of GDM is important in addressing maternal and neonatal health outcomes. Interventions designed with a theoretical framework and those that are culturally tailored are more likely to elicit behavior change.

Quality of Life in Women With Gestational Diabetes Mellitus and Treatment Satisfaction Upon Intermittently Scanned Continuous Glucose Monitoring

BACKGROUND

To assess the quality of life (QoL) and treatment satisfaction with intermittently-scanned continuous glucose monitoring (isCGM) in women with gestational diabetes mellitus (GDM).

METHODS

This prospective observational study included 189 women with GDM who completed the Korean version of the Audit of Diabetes-Dependent Quality of Life Questionnaire (K-ADDQoL). Among them, 25 women who utilized isCGM between gestational weeks 30 and 34 completed the Korean version of the Diabetes Treatment Satisfaction Questionnaire change version (K-DTSQc) to evaluate their satisfaction with isCGM during pregnancy.

RESULTS

GDM had a negative impact on the perceived QoL in 89.4% of the women. All 19 domains of the K-ADDQoL were adversely influenced by GDM, with the most significant impact on the freedom to eat (weighted impact score, -6.98 ± 2.49, P < 0.001) and the least impact on the sex life (-0.25 ± 0.80, P = 0.008). Younger women and those treated with insulin perceived themselves as being more affected in their QoL due to GDM. Women perceived to have less effect on their QoL attributed to GDM exhibited higher ΔHbA1c one year after delivery (ΔHbA1c, 0.3 ± 0.4% vs. 0.0 ± 0.4% in less affected vs. more affected women). The utilization of isCGM improved treatment satisfaction (overall satisfaction score, 10.36 ± 9.21, P < 0.001), independent of glycemic control during pregnancy.

CONCLUSION

Although GDM negatively affects the perceived QoL during pregnancy, attentiveness to GDM management may have a positive impact on long-term glycemic control. Moreover, employing isCGM can enhance treatment satisfaction in women with GDM.

Gestational diabetes mellitus - more than the eye can see - a warning sign for future maternal health with transgenerational impact

Gestational diabetes mellitus (GDM) is regarded by many as maternal maladaptation to physiological insulin resistance during the second half of pregnancy. However, recent evidence indicates that alterations in carbohydrate metabolism can already be detected in early pregnancy. This observation, the increasing prevalence of GDM, and the significant short and long-term implications for the mother and offspring call for reevaluation of the conceptual paradigm of GDM as a syndrome. This review will present evidence for the syndromic nature of GDM and the controversies regarding screening, diagnosis, management, and treatment.

The impact of gestational diabetes mellitus on perceived mother-infant bonding: a qualitative study

BACKGROUND

The prevalence of gestational diabetes mellitus (GDM) is rapidly increasing. It is associated with adverse physical and mental health outcomes for women and their babies. Mother-infant bonding is important for maternal health and infant development, but the effect of GDM on mother-infant bonding has not been examined.

OBJECTIVE

To explore and describe the impact of GDM on perceived mother infant-bonding in the antenatal and postnatal period.

METHODS

Qualitative, individual, semi-structured interviews were conducted with 33 women from diverse backgrounds with current or previous GDM. Data were analysed using reflexive inductive thematic analysis.

RESULTS

Three main themes were generated from the analysis: 1) Concern for baby's health and its impact on bonding; 2) GDM management, the pregnancy experience, and bonding; 3) Continuity and discontinuity of the impact on bonding between the antenatal and postnatal periods.

CONCLUSION

It was found that GDM can have both positive and negative impacts on perceived mother-infant bonding, which appear to change over the course of the perinatal period. Further observational research is needed to assist in understanding the impact of GDM on mother-infant bonding and the potential mediating effect of mental disorders, including depression.

Self-care interventions among women with gestational diabetes mellitus in low and middle-income countries: a scoping review

BACKGROUND

Gestational diabetes mellitus (GDM) is a transitory form of diabetes occurring in pregnancy with maternal and neonatal health consequences if left untreated. GDM can, in most instances, be managed non-medically through self-care practices, such as eating healthy or engaging in physical activity. This is especially relevant in a global health context with scarce resources. There is no official definition of "GDM self-care"; hence, the content and delivery modes of such interventions may vary greatly. Therefore, this study aimed to landscape GDM self-care interventions in low- and middle-income countries according to the WHO's three dimensions of health.

METHODS

PubMed, Embase, Global Health Library, and Web of Science were searched for published intervention studies that compared the effect of a self-care intervention to standard care or had no comparator. Studies that targeted women with GDM that reported maternal health and/or neonatal health outcomes (physical, mental, and social health outcomes) and were conducted in low- and middle-income countries were included in the review.

RESULTS

Twenty-nine studies (randomised controlled trials and non-randomised studies) were included in the review. No studies were conducted in low-income countries, and studies were primarily conducted in Asia. Most interventions were complex and contained several interacting elements in relation to content, delivery mode, duration, and modality. Most interventions aimed to improve the physical health dimension (n = 28; 96.6%), whilst the mental health (n = 11; 37.9%) and social health dimensions (n = 9; 31.0%) were addressed to a lesser extent.

CONCLUSIONS

Current GDM self-care interventions in LMICs are complex, and the content of self-care interventions overlaps with lifestyle and non-pharmaceutical interventions. It is recommended that the scientific community use a standardised terminology for such interventions and that future GDM intervention studies, as a minimum, use the core outcome set for GDM when developing future studies.

SYSTEMATIC REVIEW REGISTRATION

OSF Registries (2 December 2022) [ https://doi.org/10.17605/OSF.IO/PJZQ3 ].

A latent profile analysis of heterogeneity in self-management behavior of gestational diabetes mellitus patients

OBJECTIVE

To identify latent profiles of self-management behaviors among patients with Gestational Diabetes Mellitus (GDM) and develop targeted interventions.

METHOD

s Between July 2023 and October 2023, 320 GDM patients were surveyed using a self-management behavior questionnaire. Latent profile analysis (LPA) was employed to identify subgroups of GDM patients. Subsequent multinomial latent variable regressions were used to identify factors associated with self-management behavior.

RESULTS

23.0%, 47.0%, and 29.9% of respondents were classified into high, moderate, and low self-management groups, respectively, based on the results of the latent profile analysis. The three different categories demonstrated statistically significant differences across scale scores and dimensions (all p < 0.001). The findings showed that age was a predictor of class 2 (OR:0.93,95%CI:0.872-0.994)and was associated with reduced self-management behavior. The higher BIPS(OR:1.03,95%CI:1.007-1.044;OR:1.04,95%CI:1.015-1.057) and QOL(OR:1.05,95%CI:1.028-1.077;OR:1.06,95%CI:1.036-1.092) mean scores were significantly more likely to be in class2 and class3. Patients with a sleep disorder (OR:0.32,95%CI:0.167-0.599; OR:0.27,95%CI:0.130-0.544)were significantly more likely to be class 2 and class 3. Having a blood glucose normal before pregnancy(OR:4.17,95%CI:1.013-17.295) was significantly more likely to be in class 3.

CONCLUSION

The GDM patient population is heterogeneous, with distinct subtypes that may benefit from tailored, multi-level interventions.

Gestational diabetes and mental health: longitudinal analysis of data from the GEMS randomized trial

PURPOSE

There is limited high-quality evidence about perinatal mental health among women with gestational diabetes. We aimed to assess the risks and longitudinal changes in anxiety, depression, and health-related quality of life comparing women with gestational diabetes and those without among a contemporary cohort of pregnant women.

METHODS

Prospective cohort study of participants in the GEMS Trial. Women with a singleton pregnancy were eligible if they had a 75-g diagnostic oral glucose-tolerance test between 24 and 32 weeks' gestation, provided written informed consent, and completed questionnaires about anxiety, depression, and health-related quality of life at the study time points.

RESULTS

There were no differences in risk for anxiety (RR 1.13, 95% CI 0.86, 1.49; p = 0.39) or depression (RR 1.08, 95% CI 0.78, 1.50; p = 0.64) between the two groups at 36 weeks' gestation or 6 months postpartum [anxiety: (RR 1.21, 95% CI 0.90, 1.63; p = 0.21); depression: (RR 0.84, 95% CI 0.55, 1.28; p = 0.43]. However, at 36 weeks' gestation participants with gestational diabetes reported better physical functioning, and at 6 months postpartum, better mental functioning (mean difference (MD) in scores 1.28, 95% CI 0.25, 2.30; p = 0.01) although worse physical functioning (MD -2.99, 95% CI -3.90, -2.07; p = < 0.001) compared to participants without.

CONCLUSION

The risk for poor mental health during the perinatal period does not differ importantly among women diagnosed and treated for gestational diabetes compared to the general pregnant population.

Gestational diabetes mellitus and peripartum depression: a longitudinal study of a bidirectional relationship

BACKGROUND

Gestational diabetes mellitus (GDM) and peripartum depression (PPD) are increasing global health issues with potentially long-lasting adverse outcomes. While limited studies suggest a bidirectional relationship between GDM and PPD, most research has been cross-sectional and focused on one direction of the relationship, primarily if GDM predicts postpartum depression. The interplay between antenatal depression and GDM is less explored, with a critical lack of prospective bidirectional studies. This longitudinal study aimed to investigate the bidirectional relationship between GDM and PPD in a total sample and according to different pre-pregnancy body mass index (BMI) categories. Specifically, we examined whether antenatal depression symptoms predict a subsequent GDM diagnosis and whether GDM predicts subsequent postpartum depression symptoms.

METHODS

A three-wave online longitudinal study included 360 women who were followed from the second trimester (20-28 weeks, T1) through the third trimester (32-42 weeks, T2), and into the postpartum period (6-20 weeks after birth, T3). Participants completed the General Data Questionnaire, one item about the diagnosis of GDM, and the Edinburgh Postnatal Depression Scale (EPDS). The sample was stratified according to pre-pregnancy BMI into normal-weight (N = 247) and overweight/obese (N = 113) subgroups. Women with type I and II diabetes, GDM at T1, and underweight BMI were excluded.

RESULTS

In the total sample, antenatal depression symptoms predicted GDM, whereas GDM did not predict postpartum depression symptoms. A bidirectional relationship was observed in normal-weight women, where antenatal depression symptoms predicted subsequent GDM diagnosis, and GDM diagnosis predicted postpartum depression symptoms. In contrast, no associations were found in either direction in the overweight/obese subgroup.

CONCLUSIONS

This study provides evidence of a bidirectional relationship between GDM and PPD only in women with normal body weight before pregnancy. The results highlight the complexity of the relationship between peripartum mental and metabolic health, that is dependent on pre-pregnancy BMI. Clinicians should be aware that normal-weight women may have a unique sensitivity to the bidirectional interplay between GDM and PPD. Pregnant women should be closely monitored for both mental and metabolic health issues and targeted for prevention programs to reduce the risks and burdens associated with both conditions.

Examining the quality of life among pregnant women diagnosed with gestational diabetes mellitus: A systematic review and meta-analysis for women's health promotion

Background

Quality of life (QoL) of women with gestational diabetes mellitus (GDM) is one of the fundamental issues and public health challenges. This study examines the QoL among pregnant women with GDM through a systematic review and meta-analysis.

Methods

A search was conducted in Scopus, PubMed, and the Web of Science databases for articles published until Jan 30, 2024. Manual searches of gray literature, Google Scholar, reference checks, and citation checks were conducted. The JBI's Critical Appraisal Checklist for Analytical Cross-Sectional Studies was utilized to assess the quality of the articles' reporting. The random model implemented in Stata software (version 16; Stata Corp.) was utilized to conduct the meta-analysis.

Results

Among the 516 studies obtained from the literature, only 15 were deemed suitable for inclusion. Most studies (73.3%) were conducted in nations with high-income levels. Additionally, general QoL was assessed in most studies (11 studies). The SF-36 and WHOQOLBREF questionnaires were the most often utilized. Based on the SF-36 measure, there was no statistically significant difference in the QoL of patients with GDM compared to the control group in most of dimensions. The WHOQOL-BREF instrument was utilized to estimate the QoL score at 49.69. The EQ-5D-5L tool revealed a difference in QoL scores between the GDM and control groups (MD=-7.40). The research findings were highly heterogeneous. The median evaluation score for the reporting quality of the articles was calculated to be 5, with a mean of 4.8 out of 7.

Conclusion

The results of the present study showed that GDM reduces the QoL of pregnant women, especially in terms of mental and social health. Therefore, interventions and support programs should be designed and implemented to improve these women's QoL.

The relationship between quality of life and some mental problems in women with gestational diabetes mellitus (GDM): a cross-sectional study

BACKGROUND

Women with medical problems during pregnancy, including women with Gestational Diabetes Mellitus (GDM), experience an increased prevalence of mental health disorders which can affect their quality of life. This study aimed to assess the relationship between GDM-related quality of life and depression, anxiety, and stress.

METHODS

This analytical cross-sectional study was performed on 150 women with GDM. The participants were selected using a multi-stage sampling including quota and then randomized method from maternal care centers affiliated with Shahid Beheshti University of Medical Sciences, Tehran-Iran. The data were collected using a personal information questionnaire, the GDM-related quality of life questionnaire (GDMQoL-36), and the depression, anxiety, and stress scale (DASS). The data were analyzed using SPSS-23 software and statistical tests of coefficient Spearman's correlation, t-test, analysis of variance, and multiple linear regression.

RESULTS

The mean ± SD score for the GDM-related quality of life and the DASS scale were 55.51 ± 8.87 and 27.12 ± 19.43%, respectively. Different degrees of depression, anxiety, and stress were present in 40, 61.3, and 42% of women, respectively. The total score of GDM-related quality of life had a significant negative correlation with the total score of DASS and the scores of the subscales including depression, anxiety, and stress (P < 0.001). There were significant correlations between the total score of GDM-related quality of life with age, BMI, length of marriage, educational level of the woman and her spouse, the occupation of the woman and her spouse, income, and economic class of the family. Multiple linear regression revealed that depression, education, and job are predictive factors for GDM-related quality of life.

CONCLUSION

GDM-related quality of life is related to some mental disorders. Therefore, it is important to consider the mental health promotion of pregnant women with GDM in future prenatal health programs to improve their quality of life. This also shows the importance of integrating mental health promotion strategies to enhance the quality of life of pregnant women with GDM.

Epidemiology and management of gestational diabetes

Gestational diabetes is defined as hyperglycaemia first detected during pregnancy at glucose concentrations that are less than those of overt diabetes. Around 14% of pregnancies globally are affected by gestational diabetes; its prevalence varies with differences in risk factors and approaches to screening and diagnosis; and it is increasing in parallel with obesity and type 2 diabetes. Gestational diabetes direct costs are US$1·6 billion in the USA alone, largely due to complications including hypertensive disorders, preterm delivery, and neonatal metabolic and respiratory consequences. Between 30% and 70% of gestational diabetes is diagnosed in early pregnancy (ie, early gestational diabetes defined by hyperglycaemia before 20 weeks of gestation). Early gestational diabetes is associated with worse pregnancy outcomes compared with women diagnosed with late gestational diabetes (hyperglycaemia from 24 weeks to 28 weeks of gestation). Randomised controlled trials show benefits of treating gestational diabetes from 24 weeks to 28 weeks of gestation. The WHO 2013 recommendations for diagnosing gestational diabetes (one-step 75 gm 2-h oral glucose tolerance test at 24-28 weeks of gestation) are largely based on the Hyperglycemia and Adverse Pregnancy Outcomes Study, which confirmed the linear association between pregnancy complications and late-pregnancy maternal glycaemia: a phenomenon that has now also been shown in early pregnancy. Recently, the Treatment of Booking Gestational Diabetes Mellitus (TOBOGM) trial showed benefit in diagnosis and treatment of early gestational diabetes for women with risk factors. Given the diabesity epidemic, evidence for gestational diabetes heterogeneity by timing and subtype, and advances in technology, a life course precision medicine approach is urgently needed, using evidence-based prevention, diagnostic, and treatment strategies.

Association between antenatal common mental disorders symptoms, and adverse obstetric and perinatal outcomes: A community-based prospective cohort study in Eastern Ethiopia

BACKGROUND

Maternal common mental disorders have broad implications for maternal and child mental and physical health that may have a long-lasting social and economic impact. This study aimed to assess the association between symptoms of antenatal common mental disorders and obstetric and perinatal outcomes in Eastern Ethiopia.

METHODS

A community-based prospective cohort study was conducted and a total of 1011 randomly selected pregnant women were followed up from February 1, 2021, to January 30, 2022. The modified Poisson regression model with a robust variance was fitted to examine the effect of the symptoms of antenatal common mental disorders on obstetric and perinatal outcomes.

RESULTS

Antenatal common mental disorders (SRQ ≥ 6) were presented among 390 (38.58 %) pregnant women. In the final multivariate Poisson regression model, women with antenatal common mental disorders symptoms had an increased risk of some pregnancy complications (ARR = 1.65, 95 % CI: 1.59, 1.84). In the current study, symptoms of antenatal common mental disorders increased also the risk of preterm birth (ARR = 1.71; 95 % CI: 1.20, 2.42) and low birth weight (ARR = 1.93; 95 % CI: 1.36, 2.74).

LIMITATION

The indirect effects of some potential mediators and moderators were not assessed in this study.

CONCLUSION

The study found a high rate of symptoms of antenatal common mental disorders and adverse obstetric and perinatal outcomes. Antenatal common mental disorders symptoms may have considerable effects on individual and combined pregnancy complications and adverse perinatal outcomes.

Exploring Structural Uncertainty in Cost-Effectiveness Modeling of Gestational Diabetes Screening: An Application Example from Norway

BACKGROUND

Screening pregnant women for gestational diabetes mellitus (GDM) has recently been expanded in Norway, although screening eligibility criteria continue to be debated. We aimed to compare the cost-effectiveness of alternative GDM screening strategies and explored structural uncertainty and the value of future research in determining the most cost-effective eligibility criteria for GDM screening in Norway.

DESIGN

We developed a probabilistic decision tree to estimate the total costs and health benefits (i.e., quality-adjusted life-years; QALYs) associated with 4 GDM screening strategies (universal, current guidelines, high-risk, and no screening). We identified the most cost-effective strategy as the strategy with the highest incremental cost-effectiveness ratio below a Norwegian benchmark for cost-effectiveness ($28,400/QALY). We excluded inconclusive evidence on the effects of screening on later maternal type 2 diabetes mellitus (T2DM) in the primary analysis but included this outcome in a secondary analysis using 2 different sources of evidence (i.e., Cochrane or US Preventive Services Task Force). To quantify decision uncertainty, we conducted scenario analysis and value-of-information analyses.

RESULTS

Current screening recommendations were considered inefficient in all analyses, while universal screening was most cost-effective in our primary analysis ($26,014/QALY gained) and remained most cost-effective when we assumed a preventive effect of GDM treatment on T2DM. When we assumed no preventive effect, high-risk screening was preferred ($19,115/QALY gained). When we assumed GDM screening does not prevent perinatal death in scenario analysis, all strategies except no screening exceeded the cost-effectiveness benchmark. In most analyses, decision uncertainty was high.

CONCLUSIONS

The most cost-effective screening strategy, ranging from no screening to universal screening, depended on the source and inclusion of GDM treatment effects on perinatal death and T2DM. Further research on these long-term outcomes could reduce decision uncertainty.

HIGHLIGHTS

This article analyses the cost-effectiveness of 4 alternative gestational diabetes mellitus (GDM) screening strategies in Norway: universal screening, current (broad) screening, high-risk screening, and no screening.The current Norwegian screening recommendations were considered inefficient under all analyses.The most cost-effective screening strategy ranged from no screening to universal screening depending on the source and inclusion of GDM treatment effects on later maternal diabetes and perinatal death.The parameters related to later maternal diabetes and perinatal death accounted for most of the decision uncertainty.

Mediterranean Diet Adherence and Health-Related Quality of Life during Pregnancy: Is the Mediterranean Diet Beneficial in Non-Mediterranean Countries?

This study aimed to examine the association of Mediterranean diet (MD) adherence and MD components with health-related quality of life (HRQoL) in pregnant women from Spain and Sweden. A total of 138 pregnant women from Spain (age: 32.9 ± 4.6 years old) and 302 pregnant women from Sweden (age: 31.3 ± 4.1 years old) were included. MD adherence was assessed with the Mediterranean food pattern (i.e., a MD index) at the 14-16th gestational weeks. HRQoL was assessed with the Spanish and Swedish versions of the 36-item Short-Form Health Survey (SF-36 and RAND-36, respectively) at the 14-16th and 34-37th gestational weeks. A greater MD adherence was associated with better physical functioning, bodily pain, vitality, emotional role, and mental health in cross-sectional associations (2nd trimester) in the Spanish sample (all p < 0.05). Furthermore, a greater MD adherence was associated with lower bodily pain in both Spanish and Swedish samples (both p < 0.05) in the 3rd trimester. The associations of MD adherence with pain seem to be explained by a greater intake of fiber, fish, fruits, nuts, and legumes (all p < 0.05). A greater MD adherence, driven by a higher intake of fiber, fish, fruits, nuts, and legumes, was associated with lower pain throughout pregnancy in both Mediterranean and non-Mediterranean populations.

Gestational diabetes and risk of perinatal depression in low- and middle-income countries: a meta-analysis

Background

The relationship between gestational diabetes (GDM) and the risk of depression has been thoroughly investigated in high-income countries on their financial basis, while it is largely unexplored in low- and middle- income countries. This meta-analysis aims to assess how GDM influences the risk of perinatal depression by searching multiple electronic databases for studies measuring the odds ratios between them in low- and middle-income countries.

Methods

Two independent reviewers searched multiple electronic databases for studies that investigated GDM and perinatal mental disorders on August 31, 2023. Pooled odds ratios (ORs) and confidence intervals (CIs) were calculated using the random effect model. Subgroup analyses were further conducted based on the type of study design and country income level.

Results

In total, 16 observational studies met the inclusion criteria. Only the number of studies on depression (n=10) satisfied the conditions to conduct a meta-analysis, showing the relationship between mental illness and GDM has been overlooked in low- and middle-income countries. Evidence shows an elevated risk of perinatal depression in women with GDM (pooled OR 1.92; 95% CI 1.24, 2.97; 10 studies). The increased risk of perinatal depression in patients with GDM was not significantly different between cross-sectional and prospective design. Country income level is a significant factor that adversely influences the risk of perinatal depression in GDM patients.

Conclusion

Our findings suggested that women with GDM are vulnerable to perinatal depressive symptoms, and a deeper understanding of potential risk factors and mechanisms may help inform strategies aimed at prevention of exposure to these complications during pregnancy.

Establishing novel diagnostic criteria for the glucose tolerance test for the diagnosis of gestational diabetes and gestational hyperglycemia

OBJECTIVE

To establish diagnostic criteria for the 75-g 2-h glucose tolerance test (GTT) to diagnose gestational diabetes and define the clinical entity of gestational hyperglycemia.

METHODS

A retrospective analysis was performed of the results from 500 patients who had a 75-g 1-h glucose challenge test (GCT) in early pregnancy as part of a two-step approach to screening and testing for gestational diabetes. The selected cohort was considered to have normal islet β-cell function, and upper glycemic levels of normal glucose tolerance in the third trimester were statistically calculated, taking the cutoff threshold values to be the diagnostic criteria for the 75-g 2-h GTT. Gestational hyperglycemia was diagnosed from the false-positive GCT result when ≥8.0 mmol/L (144 mg/dL).

RESULTS

The diagnostic criteria for the 75-g 2-h GTT were calculated as follows: fasting plasma glucose ≥5.4 mmol/L (97 mg/dL); 1-h plasma glucose ≥10.5 mmol/L (189 mg/dL); and 2-h plasma glucose ≥8.4 mmol/L (151 mg/dL). The new criteria confirmed a prevalence of gestational diabetes of 11.1% and gestational hyperglycemia of 13.6% in the study population.

CONCLUSION

Novel diagnostic criteria for the 75-g 2-h GTT were established by statistical analysis. This resulted in a more acceptable prevalence of gestational diabetes in our community and the false-positive GCT allowed the detection of gestational hyperglycemia.

An explanatory model of quality of life in high-risk pregnant women in Korea: a structural equation model

PURPOSE

This study aimed to develop and validate a structural model for the quality of life (QoL) among high-risk pregnant women, based on Roy's adaptation model.

METHODS

This cross-sectional study collected data from 333 first-time mothers diagnosed with a high-risk pregnancy in two obstetrics and gynecology clinics in Cheonan, Korea, or participating in an online community, between October 20, 2021 and February 20, 2022. Structured questionnaires measured QoL, contextual stimuli (uncertainty), coping (adaptive or maladaptive), and adaptation mode (fatigue, state anxiety, antenatal depression, maternal identity, and marital adjustment).

RESULTS

The mean age of the respondents was 35.29±3.72 years, ranging from 26 to 45 years. The most common high-risk pregnancy diagnosis was gestational diabetes (26.1%). followed by preterm labor (21.6%). QoL was higher than average (18.63±3.80). Above-moderate mean scores were obtained for all domains (psychological/baby, 19.03; socioeconomic, 19.00; relational/spouse-partner, 20.99; relational/family-friends, 19.18; and health and functioning, 16.18). The final model explained 51% of variance in QoL in high-risk pregnant women, with acceptable overall model fit. Adaptation mode (β=-.81, p=.034) and maladaptive coping (β=.46 p=.043) directly affected QoL, and uncertainty (β=-. 21, p=.004), adaptive coping (β=.36 p=.026), and maladaptive coping (β=-.56 p=.023) indirectly affected QoL.

CONCLUSION

It is essential to develop nursing interventions aimed at enhancing appropriate coping strategies to improve QoL in high-risk pregnant women. By reinforcing adaptive coping strategies and mitigating maladaptive coping, these interventions can contribute to better maternal and fetal outcomes and improve the overall well-being of high-risk pregnant women.

Prediction of gestational diabetes mellitus using machine learning from birth cohort data of the Japan Environment and Children's Study

Recently, prediction of gestational diabetes mellitus (GDM) using artificial intelligence (AI) from medical records has been reported. We aimed to evaluate GDM-predictive AI-based models using birth cohort data with a wide range of information and to explore factors contributing to GDM development. This investigation was conducted as a part of the Japan Environment and Children's Study. In total, 82,698 pregnant mothers who provided data on lifestyle, anthropometry, and socioeconomic status before pregnancy and the first trimester were included in the study. We employed machine learning methods as AI algorithms, such as random forest (RF), gradient boosting decision tree (GBDT), and support vector machine (SVM), along with logistic regression (LR) as a reference. GBDT displayed the highest accuracy, followed by LR, RF, and SVM. Exploratory analysis of the JECS data revealed that health-related quality of life in early pregnancy and maternal birthweight, which were rarely reported to be associated with GDM, were found along with variables that were reported to be associated with GDM. The results of decision tree-based algorithms, such as GBDT, have shown high accuracy, interpretability, and superiority for predicting GDM using birth cohort data.

Does fasting plasma glucose values 5.1-5.6 mmol/l in the first trimester of gestation a matter?

Objectives

The aim of the study was to investigate the effect of treatment on pregnancy outcomes among women who had fasting plasma glucose (FPG) 5.1-5.6 mmol/l in the first trimester of pregnancy.

Methods

We performed a secondary-analysis of a randomized community non-inferiority trial of gestational diabetes mellitus (GDM) screening. All pregnant women with FPG values range 5.1-5.6 mmol/l in the first trimester of gestation were included in the present study (n=3297) and classified to either the (i) intervention group who received treatment for GDM along with usual prenatal care (n=1,198), (ii) control group who received usual-prenatal-care (n=2,099). Macrosomia/large for gestational age (LGA) and primary cesarean-section (C-S) were considered as primary-outcomes. A modified-Poisson-regression for binary outcome data with a log link function and robust error variance was used to RR (95%CI) for the associations between GDM status and incidence of pregnancy outcomes.

Results

The mean maternal age and BMI of pregnant women in both study groups were similar. There were no statistically significant differences in the adjusted risks of adverse pregnancy outcomes, including macrosomia, primary C-S, preterm birth, hyperbilirubinemia, preeclampsia, NICU-admission, birth trauma, and LBW both groups.

Conclusions

It is found that treating women with first-trimester FPG values of 5.1-5.6 mmol/l could not improve adverse pregnancy outcomes including macrosomia, Primary C-S, Preterm birth, hypoglycemia, hypocalcemia, preeclampsia, NICU admission, Birth trauma and LBW. Therefore, extrapolating the FPG cut-off point of the second trimester to the first -which has been proposed by the IADPSG, might therefore not be appropriate.

Clinical Trial Registration

https://www.irct.ir/trial/518, identifier IRCT138707081281N1.

Disease Perception and Mental Health in Pregnancies with Gestational Diabetes-PsychDiab Pilot Study

(1) Background: The aim of this work is to investigate the extent to which pregnant women's well-being is burdened by the diagnosis of gestational diabetes, as well as their sensitivities and illness perceptions. Since gestational diabetes is associated with mental disorders, we hypothesized that the burden of illness might be related to pre-existing mental distress. (2) Methods: Patients treated for gestational diabetes in our outpatient clinic were retrospectively asked to complete a survey, including the self-designed Psych-Diab-Questionnaire to assess treatment satisfaction, perceived limitations in daily life and the SCL-R-90 questionnaire to assess psychological distress. The association between mental distress and well-being during treatment was analyzed. (3) Results: Of 257 patients invited to participate in the postal survey, 77 (30%) responded. Mental distress was found in 13% (n = 10) without showing other relevant baseline characteristics. Patients with abnormal SCL-R-90 scores showed higher levels of disease burden, were concerned about glucose levels as well as their child's health, and felt less comfortable during pregnancy. (4) Conclusions: Analogous to the postpartum depression screening, screening for mental health problems during pregnancy should be considered to target psychologically distressed patients. Our Psych-Diab-Questionnaire has been shown to be suitable to assess illness perception and well-being.

Adherence to medical nutrition therapy and it's challenges among antenatal women with gestational diabetes mellitus in South India- A sequential explanatory mixed-method study

BACKGROUND

Globally, one in ten pregnant women have diabetes; out of which, 90% contribute to gestational diabetes mellitus (GDM). Medical Nutrition Therapy (MNT) is the cornerstone for GDM treatment yet adherence to MNT among the masses is not adequately monitored as part of the routine antenatal services. The study aimed to estimate the proportion of adherence to MNT and determine the factors related toadherence among antenatal women with GDM. This study also explores the facilitators, barriers, and possible suggestions for improving adherence.

MATERIALS AND METHODS

This facility-based sequential explanatory mixed-method study was conducted among 341 antenatal women with GDM at, Puducherry. The study was conducted in 2021. Dietary adherence was evaluated using Perceived Dietary Adherence Questionnaire and based on the scores obtained they were selected for in-depth interviews to explore the facilitators and barriers. Collected data wereanalysed by Chi-square test using STATA version 16.

RESULTS

Out of 341 participants, the proportion of participants adherent to MNT was 135 (39.6%) with 95% CI of 34%-44%. Thepredictors for poor adherence were unemployment (PR: 0.65; 95%CI: 0.48-0.88) and good adherence was antenatal women in the 2^nd trimester (PR: 1.541; 95%CI: 1.18-2.025). Barrierstonon-adherence were financial crisis, lack of awareness ofthe need for MNT, and joint family pressure.

CONCLUSIONS

About two-thirds of antenatal women with GDM are non-adherent to MNT. Unemployment and period of gestation were found to be theirdeterminants. Appropriate action has to be implemented for improving the adherence rate.

The prevalence of gestational diabetes, associated factors and feto-maternal outcome among antenatal women attending health clinics in Terengganu

INTRODUCTION

Gestational diabetes mellitus (GDM) is a known risk factor for diabetes mellitus (DM). The rising prevalence of GDM in the Asian population (11.7%) may explain the increasing incidence of DM in women. This study examined the prevalence of GDM, its associated factors and the foeto-maternal outcomes of women with GDM in Terengganu.

METHOD

A cross-sectional study was conducted between April and September 2019 using secondary data from antenatal records in 40 health clinics in Terengganu for 2018. All pregnant women aged 25 years and above with or without risk factors for GDM were included in the study. Those with pre-existing type 1 or 2 DM were excluded. A total of 270 respondents were included. The prevalence of GDM and its associated factors were determined using descriptive statistics followed by multiple logistic regression.

RESULTS

The prevalence of GDM in Terengganu was 27.3% (n=72). Logistic regression analysis found that BMI at booking (adjusted OR=4.51, 95% CI 2.13-9.55, p<0.001), history of GDM (adjusted OR=5.31, 95% CI 2.17-12.99, p<0.001) and family history of DM (adjusted OR=4.24, 95% CI 2.23-8.05, p<0.001) were the significant associated risk factors. Of women with GDM, 17.7% (n=11) had postpartum pre-diabetes based on modified oral glucose tolerance at 6 weeks postpartum. Univariate analysis using chi-square tests showed a significant association of neonatal jaundice and hypoglycaemia with GDM.

CONCLUSION

Because the prevalence of GDM in Terengganu is high, surveillance of GDM in highrisk pregnancies and effective glycaemic management should be emphasised to prevent adverse foeto-maternal outcomes.

Study protocol on risk factors for the diagnosis of gestational diabetes mellitus in different trimesters and their relation to maternal and neonatal outcomes (GDM-RIDMAN)

INTRODUCTION

Gestational diabetes mellitus (GDM) is often associated with adverse pregnancy outcomes. However, the association of risk factors with GDM diagnosis, maternal and neonatal health outcomes is less established when compared with women without GDM. We aim to examine the diagnostic accuracy of the conventional and novel risk factors for a GDM diagnosis and their impact on maternal and neonatal health outcomes.

METHODS AND ANALYSIS

This retrospective cohort and nested case-control study at six public health clinics is based on medical records and questionnaire survey of women between 2 and 12 months postpartum. The estimated required sample size is 876 complete records (292 cases, 584 control, at a ratio of 1:2). Oral glucose tolerance test results will be used to identify glucose dysregulation, and maternal and neonatal outcomes include maternal weight gain, pre-eclampsia, polyhydramnios, mode of delivery, preterm or postdate birth, complications in labour, birth weight, gestational age at birth, Apgar score, congenital anomaly, congenital hypothyroidism, neonatal death or stillbirth, hypoglycaemia and hyperbilirubinaemia. Psychosocial measures include the WHO Quality of Life: brief, mother-infant bonding (14-item Postpartum Bonding Questionnaire and 19-item Maternal Postnatal Attachment Scale), anxiety (7-item Generalised Anxiety Disorder), depression (9-item Patient Health Questionnaire) and stress (Perceived Stress Scale symptoms) questionnaires. The comparative incidences of maternal and neonatal health outcomes, the comparative prevalence of the psychosocial outcomes between women with GDM and without GDM, specificity, sensitivity, positive and negative predictive values of the risk factors, separately and combined, will be reported. All GDM risk factors and outcomes will be modelled using multivariable regression analysis and the receiver operating characteristics curve will be reported.

ETHICS AND DISSEMINATION

This study was approved by the Malaysia Research and Ethics Committee, Ministry of Health Malaysia. Informed consent will be obtained from all participants. Findings will be submitted for publications in scientific journals.

Effect of Different Types of Diagnostic Criteria for Gestational Diabetes Mellitus on Adverse Neonatal Outcomes: A Systematic Review, Meta-Analysis, and Meta-Regression

BACKGROUND

Evidence supporting various diagnostic criteria for diagnose gestational diabetes mellitus (GDM) are consensus-based, needs for additional evidence related to outcomes. Therefore, the aim of this systematic-review and meta-analysis was to assess the impact of different GDM diagnostic-criteria on the risk of adverse-neonatal-outcomes.

METHODS

Electronic databases including Scopus, PubMed, and Web of Sciences were searched to retrieve English original, population-based studies with the universal GDM screening approach, up to January-2020. GDM diagnostic criteria were classified in seven groups and International Association of the Diabetes and Pregnancy Study Groups (IADPSG) was considered as reference one. We used the Mantel-Haenszel method to calculate the pooled odds of events. The possibility of publication bias was examined by Begg's test.

RESULTS

A total of 55 population-based studies consisting of 1,604,391 pregnant women with GDM and 7,770,855 non-GDM counterparts were included. Results showed that in all diagnostic-criteria subgroups, the risk of adverse neonatal outcomes including macrosomia, hyperbilirubinemia, respiratory distress syndrome, neonatal hypoglycemia, neonatal intensive care unit admission, preterm birth, and birth-trauma were significantly higher than the non-GDM counterparts were significantly higher than non-GDM counterparts. Meta-regression analysis revealed that the magnitude of neonatal risks in all diagnostic-criteria subgroups are similar.

CONCLUSION

Our results showed that the risk of adverse-neonatal-outcome increased among women with GDM, but the magnitude of risk was not different among those women who were diagnosed through more or less intensive strategies. These findings may help health-care-providers and policy-makers to select the most cost-effective approach for the screening of GDM among pregnant women.

Prognostic Gene Predictors of Gestational Diabetes in Endometrium and Follicular Fluid of Women after Infertility

Background and objectives. Gestational diabetes mellitus is an increasingly diagnosed metabolic disorder during pregnancy with unknown pathological pathways. Taking into account the growing numbers of women who are conceiving after assisted reproductive technologies, they comprise an engaging target group for gestational diabetes mellitus etiopathogenesis research. In terms of metabolism and genetics, as the evidence shows, both unexplained infertility and gestational diabetes mellitus pose challenges for their interpretation due to the complex bodily processes. Materials and Methods. Our study examined the expression of genes (IGF2, GRB10, CRTC2, HMGA2, ESR1, DLK1, SLC6A15, GPT2, PLAGL1) associated with glucose metabolism in unexplained infertility patients who conceived after in vitro fertilization procedure, were diagnosed with GDM and their findings were compared with control population. Results. There were no significant differences in gene expression of endometrium stromal cells between healthy pregnant women and women with gestational diabetes, although the significant downregulation of CRTC2 was observed in the follicular fluid of women with gestational diabetes mellitus. Moreover, expression of HMGA2 and ESR1 was significantly reduced in FF cells when compared to endometrial cells. Conclusions. These findings may indicate about the importance of follicular fluid as an indicator for gestational diabetes and should be explored more by further research.

Evaluation of a Type 2 diabetes risk reduction online program for women with recent gestational diabetes: a randomised trial

Background

To evaluate the preliminary efficacy, feasibility and acceptability of the 3-month Body Balance Beyond (BBB) online program among Australian women with overweight/obesity and recent gestational diabetes mellitus.

Methods

Women were  randomised into either: 1) High Personalisation (HP) (access to ‘BBB’ website, video coaching sessions, text message support); 2) Medium Personalisation (MP) (website and text message support); or 3) Low Personalisation (LP) (website only). Generalised linear mixed models were used to evaluate preliminary efficacy, weight, diet quality, physical activity levels, self-efficacy and quality of life (QoL) at baseline and 3-months. Feasibility was assessed by recruitment and retention metrics and acceptability determined via online process evaluation survey at 3-months.

Results

Eighty three women were randomised, with 76 completing the study. Self-efficacy scores showed significant improvements in confidence to resist eating in a variety of situations from baseline to 3-months in HP compared to MP and LP groups (P=.03). The difference in mean QoL scores favoured the HP compared to MP and LP groups (P=.03). Half of the women (HP n=17[81%], MP n=12[75%], LP n=9[56%]) lost weight at 3-months. No significant group-by-time effect were reported for other outcomes. Two-thirds of women in the HP group were satisfied with the program overall and 86% would recommend it to others, compared with 25% and 44% in the MP group, and 14% and 36% in the LP group, respectively.

Conclusions

Video coaching sessions were associated with improvements in QoL scores and self-efficacy, however further refinement of the BBB website and text messages support could improve program acceptability.

Trial registration

Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12619000162112, registered 5 February 2019.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-022-01275-3.

Affective temperaments and the risk of gestational diabetes mellitus

OBJECTIVE

Gestational diabetes mellitus (GDM) is the most common medical complication of pregnancy. The current study aimed to investigate the possibility of a relationship between affective temperaments and GDM.

METHODS

This ethically approved cross-sectional study was conducted on 120 pregnant women with impaired glucose tolerance and 120 healthy pregnant women, all of whom were admitted to hospitals affiliated with Mashhad University of Medical Sciences for delivery during 2019. Depression Anxiety Stress Scale (DASS)-21 and Temperament Evaluation of Memphis, Pisa, Paris and San Diego-auto-questionnaire (TEMPS-A) were used to gather data. Mann-Whitney test was used to compare data between the two groups. A multivariate binary logistic regression model with maternal age, body mass index, and multiparity as the covariates was used to assess factors associated with GDM.

RESULTS

Outcomes of TEMPS-A showed significantly higher scores of anxious and irritable temperaments in the GDM group compared to the control group (p = 0.014 and 0.023, respectively). Multivariate regression showed anxious temperament to be the sole independent predictor of GDM (odds ratio = 1.09, 95%confidence interval = 1.030-1.153; p = 0.003). DASS-21 anxiety score was also significantly higher among patients with GDM (p = 0.002). Severity of anxiety and stress according to DASS-21 was also significantly greater in patients with impaired glucose tolerance (p < 0.001 and p = 0.016, respectively).

CONCLUSIONS

It is ostensible that affective temperaments, especially anxious temperament, are potentially associated with the development of GDM and impaired glucose metabolism during pregnancy.Key pointsThe association of affective temperaments with pregnancy complications has drawn compelling interest.The findings of this study showed significantly higher scores of anxious and irritable temperaments in GDM patients.GDM patients also showed significantly higher levels of anxiety compared to controls.Predominance of anxious temperament can be a potential risk factor that contributes to the development of GDM.Monitoring for GDM is especially recommended in pregnant women with predominant anxious and irritable temperaments.

High level of complement factor Ba within first prenatal test of gestation increases the risk of subsequent gestational diabetes: a propensity score-matched study

OBJECTIVE

This study was to assess the alteration of circulating complement factor Ba (CFBa) within 11 to 17 weeks of gestation and its association with subsequent gestational diabetes mellitus (GDM) and its delivery outcome.

METHODS

Biochemical parameters and blood samples were collected from 399 pregnant women within 11 to 17 weeks of gestation. At 24 to 28 weeks of gestation, all participants underwent 75-g oral glucose tolerance test and were assigned to GDM group (n = 80) and normal control group (n = 319). Perinatal data were collected after delivery. A propensity score-matched (PSM) analysis was performed to reduce the impact of confounding factors on glucose metabolism during pregnancy between the two groups.

RESULTS

Two groups of 74 well-matched patients who maintained balance in terms of baseline characteristics. The levels of CFBa in pregnant women who later developed GDM were significantly higher than those in healthy pregnant women [0.4(0.1-0.8) vs. 0.2(0.2-0.3), p = 0.024]. Logistic regression analysis results confirmed that the level of CFBa was an independent impact factor for the occurrence of GDM (OR = 1.57, 95% CI: 1.118-2.210, p = 0.009). Further grouping according to the median level of CFBa, it was found that the incidence of GDM in category two (>0.23 ng/ml, n = 74) was markedly higher than that in the first category (≤0.23 ng/ml, n = 74) (p = 0.021).

CONCLUSIONS

High level of the CFBa within 11 to 17 weeks of gestation increases the risk of subsequent GDM, and maybe a biomarker for predicting GDM.

Evaluation of quality of life in diabetic pregnant women

AIMS

Gestational diabetes is the most common clinical complication during pregnancy. Women with gestational diabetes face many problems in their personal, family and social lives that affect their quality of life. The aim of this study was to evaluate the quality of life of diabetic pregnant women.

METHODS

This study was a descriptive study and the study population was all diabetic pregnant women referred to health centers in Kermanshah, Iran in 2019-2020. The studied variables were collected using a short form of quality of life questionnaire (WHOQOL-BREF-26 items). Then, with the help of SPSS software version 25, data analysis was performed based on frequency table and independent t-test.

RESULTS

101 pregnant women with gestational diabetes were studied. Their mean age was 33.06 ± 05.05 years. The quality of life of all mothers participating in the study was above average. The average quality of life and psychological domains, social and environmental relationships of mothers were higher in people with higher incomes and employment, and also the average quality of life and psychological domains, social and environmental relationships were higher in mothers who had less than 6 months.

CONCLUSIONS

The majority of mothers were overweight (BMI = 25-29.9) and obese (BMI ≥ 30), which is one of the most important risk factors for gestational diabetes. Given the importance of quality of life of pregnant mothers, health policy makers are asked to provide more training for pregnant mothers on nutrition and increased physical activity to prevent gestational diabetes and improve their quality of life.

Diagnostic accuracy of first and early second trimester multiple biomarkers for prediction of gestational diabetes mellitus: a multivariate longitudinal approach

BACKGROUND

Gestational Diabetes Mellitus (GDM) is an underlying cause of maternal and newborn morbidity and mortality all around the world. Timely diagnosis of GDM plays an important role in reducing its adverse consequences and burden. This study aimed to determine diagnostic accuracy of multiple indicators in complete blood count (CBC) test for early prediction of GDM.

METHODS

In this prospective cohort study, the data from 600 pregnant women was analyzed. In the study sample, the two-step approach was utilized for the diagnosis of GDM at 24-28 weeks of gestation. We also used the repeated measures of hemoglobin (Hb), hematocrit (Hct), fasting blood sugar (FBS) and red blood cell count (RBC) in the first and early second trimesters of pregnancy as the longitudinal multiple indicators for early diagnosis of GDM. The classification of pregnant women to GDM and non-GDM groups was performed using a statistical technique based on the random-effects modeling framework.

RESULTS

Among the sample, 49 women (8.2%) were diagnosed with GDM. In the first and early second trimester of pregnancy, the mean HcT, Hb and FBS of women with GDM was significantly higher than non-GDMs (P < 0.001). The concurrent use of multiple longitudinal data from HcT, Hb, RBC and FBS in the first and early second trimester of pregnancy resulted in a sensitivity, specificity and area under the curve (AUC) of 87%, 70% and 83%, respectively, for early prediction of GDM.

CONCLUSIONS

In general, our findings showed that the concurrent use of repeated measures data on Hct, Hb, FBS and RBC in the first and early second trimester of pregnancy might be utilized as an acceptable tool to predict GDM earlier in pregnancy.

One-step versus two-step screening for diagnosis of gestational diabetes mellitus in Iranian population: A randomized community trial

OBJECTIVES

There is considerable worldwide controversy regarding optimal screening and diagnostic approaches for GDM. This study aimed to compare the prevalence, maternal and neonatal outcomes of a One-step with a Two-step approach for the screening and diagnosis of GDM in a large community sample of pregnant women.

METHODS

We conducted a secondary analysis of a randomized community non-inferiority trial of GDM screening in Iran. For the current study, all pregnant women who met the inclusion criteria were randomized into two groups for GDM screening. The first group of women (n = 14611) was screened by a One-step screening approach [75-g 2-h oral glucose tolerance test (OGTT)] and the second group (n = 14160) by a Two-step method (the 50-g glucose challenge test followed by the 100-g OGTT). All study participants were followed up until delivery, and the adverse maternal and neonatal outcomes were recorded in detail.

RESULTS

GDM was diagnosed in 9.3% of the pregnant women who were assigned to the One-step and in 5.4% of those assigned to the Two-step approach with a statistically significant difference between them (p < 0.001). Intention-to-treat analyses showed no significant differences between the One-step and the Two-step group in the unadjusted risks of the adverse pregnancy outcomes of macrosomia, primary cesarean-section, preterm birth, hypoglycemia, hypocalcemia, hyperbilirubinemia, preeclampsia, neonatal intensive care unit admission, birth trauma, low birth weight, and intrauterine fetal death. Results remained unchanged after adjustment for potential confounder variables including gestational age at enrollment and delivery, maternal body mass index, gestational weight gain, type of delivery, treatment modality, and GDM diagnosis in the first trimester.

CONCLUSION

We found that although the rates of GDM more than doubled with the One-step strategy, the One-step approach was similar to the Two-step approach in terms of maternal and neonatal outcomes. These findings may warn that more caution should be exercised in adopting the One-step method worldwide. Future research is needed to assess the long-term harm and benefits of those approaches to GDM screening for both mothers and their offspring.

CLINICAL TRIAL REGISTRATION

https://www.irct.ir/trial/518, identifier (IRCT138707081281N1).

Comparing the effect of individual counseling with counseling on social application on self-care and quality of life of women with gestational diabetes

INTRODUCTION

The present study aimed to compare the effect of two different forms of face-to-face and counseling on a social application, i.e., WhatsApp, on self-care and quality of life of women with gestational diabetes.

METHODS

The present research was an educational trial with control group, which was conducted on diabetic women between 24 and 26 weeks of pregnancy. A total of 126 subjects were included in the study using the convenient sampling method. They were assigned into three groups. All of the participants answered the questionnaires gestational diabetes self-care, and quality of life at the beginning and end of the study. The GATHER approach to counseling (G = Greeting, A = Ask, T = Tell, H = Help, R = Return) was performed in four 45-min sessions for face-to-face and WhatsApp groups in the pregnancy weeks of 27, 28, 29, and 30. The subjects in the control group received only the routine cares for gestational diabetes. T test, Chi squared test, and ANOVA repeated measurement test were used to analyze the data.

RESULTS

Findings showed a significant difference among the three groups in self-care and quality of life (p = 0.001). There was also a significant difference among the three groups in fasting blood sugar after the intervention (p = 0.005).

CONCLUSION

Self-care counseling, both in the form of face-to-face and on social networks, improved the score of self-care and quality of life as well as glucose tolerance test (GTT) in women with gestational diabetes.

A systematic review and meta-analysis of gestational diabetes mellitus and mental health among BAME populations

BACKGROUND

Gestational diabetes mellitus (GDM) is a common complication of pregnancy and is associated with an increased risk of mental health (MH) disorders including antenatal and postnatal depression (PND), anxiety and post-traumatic-stress-disorder (PTSD). We hypothesized GDM and MH disorders will disproportionately affect individuals from Black, Asian and Minority Ethnic backgrounds.

METHODS

A systematic methodology was developed, and a protocol was published in PROSPERO (CRD42020210863) and a systematic review of publications between 1st January 1990 and 30th January 2021 was conducted. Multiple electronic databases were explored using keywords and MeSH terms. The finalised dataset was analysed using statistical methods such as random-effect models, subgroup analysis and sensitivity analysis. These were used to determine odds ratio (OR) and 95% confidence intervals (CI) to establish prevalence using variables of PND, anxiety, PTSD and stress to name a few.

FINDINGS

Sixty studies were finalised from the 20,040 data pool. Forty-six studies were included systematically with 14 used to meta-analyze GDM and MH outcomes. A second meta-analysis was conducted using 7 studies to determine GDM risk among Black, Asian and Minority Ethnic women with pre-existing MH disorders. The results indicate an increased risk with pooled adjusted OR for both reflected at 1.23, 95% CI of 1.00-1.50 and 1.29, 95% CI of 1.11-1.50 respectively.

INTERPRETATION

The available studies suggest a MH sequalae with GDM as well as a sequalae of GDM with MH among Black, Asian and Minority Ethnic populations. Our findings warrant further future exploration to better manage these patients.

FUNDING

Not applicable.

Estimated impact of introduction of new diagnostic criteria for gestational diabetes mellitus

BACKGROUND

Implementation of new diagnostic criteria for gestational diabetes mellitus (GDM) are still a subject of debate, mostly due to concerns regarding the effects on the number of women diagnosed with GDM and the risk profile of the women newly diagnosed.

AIM

To estimate the impact of the World Health Organization (WHO) 2013 criteria compared with the WHO 1999 criteria on the incidence of gestational diabetes mellitus as well as to determine the diagnostic accuracy for detecting adverse pregnancy outcomes.

METHODS

We retrospectively analyzed a single center Dutch cohort of 3338 women undergoing a 75 g oral glucose tolerance test where the WHO 1999 criteria to diagnose GDM were clinically applied. Women were categorized into four groups: non-GDM by both criteria, GDM by WHO 1999 only (excluded from GDM), GDM by WHO 2013 only (newly diagnosed) and GDM by both criteria. We compared maternal characteristics, pregnancy outcomes and likelihood ratios for adverse pregnancy outcomes.

RESULTS

Retrospectively applying the WHO 2013 criteria increased the cohort incidence by 13.1%, from 19.3% to 32.4%. Discordant diagnoses occurred in 21.3%; 4.1% would no longer be labelled as GDM, and 17.2% were newly diagnosed. Compared to the non-GDM group, women newly diagnosed were older, had higher rates of obesity, higher diastolic blood pressure and higher rates of caesarean deliveries. Their infants were more often delivered preterm, large-for-gestational-age and were at higher risk of a 5 min Apgar score < 7. Women excluded from GDM were older and had similar pregnancy outcomes compared to the non-GDM group, except for higher rates of shoulder dystocia (4.3% vs 1.3%, P = 0.015). Positive likelihood ratios for adverse outcomes in all groups were generally low, ranging from 0.54 to 2.95.

CONCLUSION

Applying the WHO 2013 criteria would result in a substantial increase in GDM diagnoses. Newly diagnosed women are at increased risk for pregnancy adverse outcomes. This risk, however, seems to be lower than those identified by the WHO 1999 criteria. This could potentially influence the treatment effect that can be achieved in this group. Evidence on treatment effects in newly diagnosed women is urgently needed.

Resolving the Gestational Diabetes Diagnosis Conundrum: The Need for a Randomized Controlled Trial of Treatment

The diagnosis of and criteria for gestational diabetes mellitus (GDM) continue to divide the scientific and medical community, both between and within countries. Many argue for universal adoption of the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria and feel that further clinical trials are unjustified and even unethical. However, there are concerns about the large increase in number of women who would be diagnosed with GDM using these criteria and the subsequent impact on health care resources and the individual. This Perspective reviews the origins of the IADPSG consensus and points out some of its less well-known limitations, particularly with respect to identifying women at risk for an adverse pregnancy outcome. It also questions the clinical and cost-effectiveness data often cited to support the IADPSG glycemic thresholds. We present the argument that adoption of diagnostic criteria defining GDM should be based on response to treatment at different diagnostic thresholds of maternal glycemia. This will likely require an international multicenter trial of treatment.

The Impact of Diagnostic Criteria for Gestational Diabetes Mellitus on Adverse Maternal Outcomes: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis aimed to examine the impact of different gestational-diabetes (GDM) diagnostic-criteria on the risk of adverse-maternal-outcomes. The search process encompassed PubMed (Medline), Scopus, and Web of Science databases to retrieve original, population-based studies with the universal GDM screening approach, published in English language and with a focus on adverse-maternal-outcomes up to January 2020. According to GDM diagnostic criteria, the studies were classified into seven groups. A total of 49 population-based studies consisting of 1409018 pregnant women with GDM and 7,667,546 non-GDM counterparts were selected for data analysis and knowledge synthesis. Accordingly, the risk of adverse-maternal-outcomes including primary-cesarean, induction of labor, maternal-hemorrhage, and pregnancy-related-hypertension, overall, regardless of GDM diagnostic-criteria and in all diagnostic-criteria subgroups were significantly higher than non-GDM counterparts. However, in meta-regression, the increased risk was not influenced by the GDM diagnostic-classification and the magnitude of the risks among patients, using the IADPSG criteria-classification as the most strict-criteria, was similar to other criteria. In conclusion, a reduction in the diagnostic-threshold increased the prevalence of GDM, but the risk of adverse-maternal-outcome was not different among those women who were diagnosed through more or less intensive strategies. Our review findings can empower health-care-providers to select the most cost-effective approach for the screening of GDM among pregnant women.

Factors Associated with Gestational Diabetes Mellitus: A Meta-Analysis

Gestational diabetes mellitus (GDM) is a major public health issue, and the aim of the present study was to identify the factors associated with GDM. Databases were searched for observational studies until August 20, 2020. Pooled odds ratios (ORs) were calculated using fixed- or random-effects models. 103 studies involving 1,826,454 pregnant women were identified. Results indicated that maternal age ≥ 25 years (OR: 2.466, 95% CI: (2.121, 2.866)), prepregnancy overweight or obese (OR: 2.637, 95% CI: (1.561, 4.453)), family history of diabetes (FHD) (OR: 2.326, 95% CI: (1.904, 2.843)), history of GDM (OR: 21.137, 95% CI: (8.785, 50.858)), macrosomia (OR: 2.539, 95% CI: (1.612, 4.000)), stillbirth (OR: 2.341, 95% CI: (1.435, 3.819)), premature delivery (OR: 3.013, 95% CI: (1.569, 5.787)), and pregestational smoking (OR: 2.322, 95% CI: (1.359, 3.967)) increased the risk of GDM with all P < 0.05, whereas history of congenital anomaly and abortion, and HIV status showed no correlation with GDM (P > 0.05). Being primigravida (OR: 0.752, 95% CI: (0.698, 0.810), P < 0.001) reduced the risk of GDM. The factors influencing GDM included maternal age ≥ 25, prepregnancy overweight or obese, FHD, history of GDM, macrosomia, stillbirth, premature delivery, pregestational smoking, and primigravida.

Effect of Gestational Diabetes Mellitus History on Future Pregnancy Behaviors: The Mutaba'ah Study

Gestational diabetes mellitus (GDM) increases the risk of adverse pregnancy outcomes in any pregnancy and recurrence rates are high in future pregnancies. This study aims to investigate the effect of self-reported history of previous GDM on behaviors in a future pregnancy. This is an interim cross-sectional analysis of the pregnant women who participated in the Mutaba'ah Study between May 2017 and March 2020 in the United Arab Emirates. Participants completed a baseline self-administered questionnaire on sociodemographic and pregnancy-related information about the current pregnancy and previous pregnancies. Regression models assessed the relationships between self-reported history of GDM and pre-pregnancy and pregnancy behaviors in the current pregnancy. Out of 5738 pregnant parous women included in this analysis, nearly 30% (n = 1684) reported a history of GDM in a previous pregnancy. Women with a history of previous GDM were less likely to plan their current pregnancies (adjusted odds ratio (aOR): 0.84, 95% confidence interval (CI) 0.74-0.96) and more likely to be worried about childbirth (aOR: 1.18, 95% CI 1.03-1.36). They had shorter interpregnancy intervals between their previous child and current pregnancy (aOR: 0.88, 95% CI 0.82-0.94, per SD increase). There were no significant differences between women with and without a history of GDM in supplement use, sedentary behavior, or physical activity before and during this current pregnancy. Nearly a third of parous pregnant women in this population had a history of GDM in a previous pregnancy. Pregnant women with a previous history of GDM were similar to their counterparts with no history of GDM in the adopted pre-pregnancy and prenatal health behaviors. More intensive and long-term lifestyle counseling, possibly supported by e-health and social media materials, might be required to empower pregnant women with a history of GDM. This may assist in adopting and maintaining healthy prenatal behaviors early during the pregnancy or the preconception phase to minimize the risk of GDM recurrence and the consequential adverse maternal and infant health outcomes.

The Relationship Between Alexithymia and Type 2 Diabetes: A Systematic Review

Background: This systematic review analyzed the relationship between alexithymia, considered as the inability to recognize and express thoughts and emotions, and type 2 diabetes mellitus (T2DM), one of the most common chronic illness, characterized by a metabolic disorder burdened by high morbidity and mortality worldwide due to its outcomes. Methods: PRISMA guidelines were followed throughout this systematic review of the recent literature indexed in the databases PubMed, PsycInfo, Scopus, and Web of Science. Search terms for eligible studies were: "Type 2 diabetes" OR "T2DM" AND "Toronto Alexithymia Scale" OR "TAS-20"[All Fields]. Results: The initial search identified 61 indexed scientific publications. After screening we found that seven publications met the established scientific inclusion and exclusion criteria. It emerged that alexithymic patients ranged from 25 to 50% across the examined publications and it appeared that patients with T2DM generally reflected greater values of alexithymia, revealing particular differences among TAS domains. Moreover, emlpoyed participants were alexithymic to a greater extent compared to non-working participants (77.8 vs. 35.4%) and alexithymia was 2.63 times more severe among working participants when examining predictors of alexithymia. When evaluating the correlations between alexithymia and HbA1c or fasting blood glucose levels we found strong associations equal to 0.75 and 0.77 for TAS-20 total scores, respectively. While alexithymic participants showed significantly higher levels of HbA1c and blood glucose when compared to the non-alexithymic participants. Conclusions: The results of this systematic review of the current literature highlight the need of alexithymia evaluation in patients with T2DM. The high prevalence in T2DM and strong associations with poorly regulated diabetes and psychological distress, indicate a significant relationship between poor glycemic control and psychological distress, such as anxiety and depression, and quality of life. Further studies are needed focusing on age and gender differences in order to be able to improve clinical psychological care and prevention.

Prevalence of anxiety among gestational diabetes mellitus patients: A systematic review and meta-analysis

BACKGROUND

A diagnosis of gestational diabetes mellitus (GDM) negatively influences maternal mental health. There is a lack of systematic review and meta-analysis on prevalence of anxiety among GDM women.

AIM

To pool data from existing literature to determine the pooled estimates for the prevalence of anxiety among women diagnosed with GDM.

METHODS

We searched multiple databases including MEDLINE, Cinahl, PubMed and Scopus to identify studies published up to 31 October 2019 with data on the prevalence of anxiety among women diagnosed with GDM. Data were extracted from published reports. Estimates were pooled using random-effects meta-analyses.

RESULTS

We reviewed 19 abstracts, retrieved 10 articles and included three studies incorporating 12744 GDM women from three countries. The pooled prevalence of anxiety was 29.5% (95%CI: 6.9, 52.0) among GDM women.

CONCLUSION

Prevalence of anxiety among GDM women was high. We suggest that epidemiological studies on anxiety should be conducted urgently as it merits clinical attention. In addition, it is important to identify factors associated with anxiety among women diagnosed with GDM.

Factors associated with poor-to-moderate quality of life among pregnant women with gestational diabetes mellitus: a cross-sectional study in Malaysia

PURPOSE

This study aimed to identify factors associated with poor-to-moderate quality of life (QOL) among women with gestational diabetes mellitus (GDM) in two tertiary hospitals in Malaysia.

METHODS

A cross-sectional study was conducted among 526 pregnant women with GDM in two tertiary hospitals in Malaysia. Diabetes-related QOL was assessed using the Asian Diabetes Quality of Life Scale (AsianDQoL). Socio-demographic characteristics, glucose monitoring treatments for GDM, past obstetric history, concurrent medical problems and a family history of diseases were captured from patient records. A multiple logistic regression was used for analysis.

RESULTS

A total of 526 respondents with GDM entered the analysis. The median age of the respondents was 32 (interquartile range = 7) while 82.3% were Malay women. More than half of the respondents (69.5%) received an oral hypoglycaemic agent (OHA), and/or diet modification in controlling their GDM. The study reported that 23.2% of the respondents had poor-to-moderate QOL. Those with a family history of depression and/or anxiety (adjusted Odds ratio [AOR] 6.934, 95% confidence interval [CI] 2.280-21.081), and a family history of GDM (AOR 1.814, 95% CI 1.185-2.778) were at higher odds of suffering from poor-to-moderate QOL compared to those without a family history. Similarly, those who received insulin, with or without OHA, and/or are on diet modification (AOR 1.955, 95% CI 1.243-3.074) were at higher odds of suffering from poor-to-moderate QOL compared to those receiving OHA and/or diet modification.

CONCLUSION

Nearly one-quarter of Malaysian women with GDM have poor-to-moderate QOL. GDM women with a family history of depression and/or anxiety, family history of GDM, and those who received insulin, with or without OHA, and/or are on diet modification were associated with poor-to-moderate QOL.

TRIAL REGISTRATION

NMRR-17-2264-37814.

A Systematic Review of Metacognitive Beliefs in Chronic Medical Conditions

Background: Psychological functioning plays an important role in medical conditions and impacts patients' quality of life. Previously, many studies have highlighted the association of metacognition to both the development and maintenance of emotional disorders. Recently, several researchers pointed out the relevant role of dysfunctional metacognitive beliefs in the context of chronic diseases. Hence, dysfunctional metacognitive beliefs could be directly related to anxiety and depression, regardless of the medical condition's expression. The aim of this systematic review was to summarize the available evidence regarding the association of metacognition with anxiety, depression, and perceived quality of life, in the context of medical conditions, according to Wells' theory.

Methods: A systematic review based on electronic bibliographic databases (PsycINFO, PubMed, Scopus, Web of Science, and Web of Knowledge) of scientific literature was carried out. Studies involving patients evaluated in clinical settings were included in the analysis.

Results: Our findings indicated that metacognition appears to be related to anxiety, depression, and quality of life in patients with medical chronic conditions. Therefore, dysfunctional metacognitive beliefs might be a relevant factor associated with the process of adapting to illness.

Conclusions: The additional evaluation of metacognitive factors in the context of several medical chronic conditions appears valuable. Due to the rising interest in the study of metacognition, suggestions for future research have also been provided.

Excessive gestational weight gain in the first trimester is associated with risk of gestational diabetes mellitus: a prospective study from Southwest China

OBJECTIVE

To evaluate the effects of gestational weight gain (GWG) in the first trimester (GWG-F) and the rate of gestational weight gain in the second trimester (RGWG-S) on gestational diabetes mellitus (GDM), exploring the optimal GWG ranges for the avoidance of GDM in Chinese women.

DESIGN

A population-based prospective study was conducted. Gestational weight was measured regularly in every antenatal visit and assessed by the Institute of Medicine (IOM) criteria (2009). GDM was assessed with the 75-g, 2-h oral glucose tolerance test at 24-28 weeks of gestation. Multivariable logistic regression was performed to assess the effects of GWG-F and RGWG-S on GDM, stratified by pre-pregnancy BMI. In each BMI category, the GWG values corresponding to the lowest prevalence of GDM were defined as the optimal GWG range.

SETTING

Southwest China.

PARTICIPANTS

Pregnant women (n 1910) in 2017.

RESULTS

After adjusting for confounders, GWG-F above IOM recommendations increased the risk of GDM (OR; 95 % CI) among underweight (2·500; 1·106, 5·655), normal-weight (1·396; 1·023, 1·906) and overweight/obese women (3·017; 1·118, 8·138) compared with women within IOM recommendations. No significant difference was observed between RGWG-S and GDM (P > 0·05) after adjusting for GWG-F based on the previous model. The optimal GWG-F ranges for the avoidance of GDM were 0·8-1·2, 0·8-1·2 and 0·35-0·70 kg for underweight, normal-weight and overweight/obese women, respectively.

CONCLUSIONS

Excessive GWG in the first trimester, rather than the second trimester, is associated with increased risk of GDM regardless of pre-pregnancy BMI. Obstetricians should provide more pre-emptive guidance in achieving adequate GWG-F.

Cost effectiveness of different screening strategies for gestational diabetes mellitus screening: study protocol of a randomized community non-inferiority trial

BACKGROUND

There is lack of ideal and comprehensive economic evaluations of various GDM strategies. The aim of this study is to the compare efficacy and cost-effectiveness of five different methods of screening for gestational diabetes mellitus (GDM).

METHODS

This study is a randomized community non-inferiority trial among 30,000 pregnant women in five different geographic regions of Iran, who were randomly assigned to one of the five GDM screening methods. All first trimester pregnant women, seeking prenatal care in governmental health care systems, who met our eligibility criteria were enrolled. The criteria suggested by the International-Association-of-Diabetes-in-Pregnancy-Study-Group, the most intensive approach, were used as reference. We used the non-inferiority approach to compare less intensive strategies to the reference one. Along with routine prenatal standard care, all participants were scheduled to have two phases of GDM screening in first and second-trimester of pregnancy, based on five different pre-specified protocols. The screening protocol included fasting plasma glucose in the first trimester and either a one step or a two-step screening method in the second trimester of pregnancy. Pregnant women were classified in three groups based on the results: diagnosed with preexisting pre-gestational overt diabetes; gestational diabetes and non-GDM women. Each group received packages for standard-care and all participants were followed till delivery; pregnancy outcomes, quality of life and cost of health care were recorded in detail using specific standardized questionnaires. Primary outcomes were defined as % birth-weight > 90th percentile and primary cesarean section. In addition, we assessed the direct health care direct and indirect costs.

RESULTS

This study will enable us to compare the cost effectiveness of different GDM screening protocols and intervention intensity (low versus high).

CONCLUSION

Results which if needed, will also enable policy makers to optimize the national GMD strategy as a resource for enhancing GDM guidelines.Trial registration Name of the registry: Iranian Registry of Clinical Trials. Trial registration number: IRCT138707081281N1. Date of registration: 2017-02-15. URL of trial registry record: https://www.irct.ir/trial/518.

Experiences of lifestyle change among women with gestational diabetes mellitus (GDM): A behavioural diagnosis using the COM-B model in a low-income setting

Background

Lifestyle change can reduce the risk of developing type 2 diabetes among women with prior gestational diabetes mellitus (GDM). While understanding women’s lived experiences and views around GDM is critical to the development of behaviour change interventions to reduce this risk, few studies have addressed this issue in low- and middle- income countries. The aim of the study was to explore women’s lived experiences of GDM and the feasibility of sustained lifestyle modification after GDM in a low-income setting.

Methods

This was a descriptive qualitative study on the lived experiences of women with prior GDM, who received antenatal care at a public sector tertiary hospital in Cape Town, South Africa. Nine focus groups and five in-depth interviews were conducted with a total of thirty-five women. Data were analysed using content analysis and the COM-B (Capabilities, Opportunities, Motivations and Behaviour) model to identify factors influencing lifestyle change during and beyond the GDM pregnancy.

Results

The results suggest that the COM-B model’s concepts of capability (knowledge and skills for behaviour change), opportunity (resources for dietary change and physical activity) and motivation (perception of future diabetes risk) are relevant to lifestyle change among GDM women in South Africa. The results will contribute to the design of a postpartum health system intervention for women with recent GDM.

Conclusion

Our findings highlight the need for health services to improve counselling and education for women with GDM in South Africa. Support from family and health professionals is essential for women to achieve lifestyle change. The experience of GDM imposed a significant psychological burden on women, which affected motivation for lifestyle change. To achieve long-term lifestyle change, behaviour interventions for women with prior GDM need to address their capability, opportunity and motivation for lifestyle change during and beyond pregnancy.

Gestational diabetes mellitus

Hyperglycaemia that develops during pregnancy and resolves after birth has been recognized for over 50 years, but uniform worldwide consensus is lacking about threshold hyperglycaemic levels that merit a diagnosis of 'gestational diabetes mellitus' (GDM) and thus treatment during pregnancy. GDM is currently the most common medical complication of pregnancy, and prevalence of undiagnosed hyperglycaemia and even overt diabetes in young women is increasing. Maternal overweight and obesity, later age at childbearing, previous history of GDM, family history of type 2 diabetes mellitus and ethnicity are major GDM risk factors. Diagnosis is usually performed using an oral glucose tolerance test (OGTT), although a non-fasting, glucose challenge test (GCT) is used in some parts of the world to screen women for those requiring a full OGTT. Dietary modification and increased physical activity are the primary treatments for GDM, but pharmacotherapy, usually insulin, is used when normoglycaemia is not achieved. Oral hypoglycaemic agents, principally metformin and glibenclamide (glyburide), are also used in some countries. Treatment improves immediate pregnancy outcomes, reducing excess fetal growth and adiposity and pregnancy-related hypertensive disorders. GDM increases the risk of long-term complications, including obesity, impaired glucose metabolism and cardiovascular disease, in both the mother and infant. Optimal management of mother and infant during long-term follow-up remains challenging, with very limited implementation of preventive strategies in most parts of the world.