A Review of the Current Status of Gestational Diabetes Mellitus in Australia-The Clinical Impact of Changing Population Demographics and Diagnostic Criteria on Prevalence

An equity audit on program completion among women with a history of gestational diabetes in a state-funded diabetes and cardiovascular risk reduction program

PURPOSE

To assess the completion of the type 2 diabetes, heart disease and stroke prevention program (the Life!) among women with a history of gestational diabetes mellitus (GDM) according to participants' characteristics.

METHODS

Data from women with a history of GDM enrolled in the Life! program in Victoria, Australia, between 2014 and 2022 were analysed. Completion rates were assessed using the PROGRESS-Plus (Place of residence, Race/ethnicity/culture/language, Occupation, Gender/sex, Religion, Education, Socioeconomic status, and Social capital Plus age and smoking) framework. Multivariable logistic regression model was fitted.

RESULTS

A total of 2399 women with a history of GDM were enrolled in the program, of which 55 % completed it. Characteristics associated with higher completion rates included being from metropolitan areas (AOR = 1.52, 95 % CI: 1.14-2.01) compared with being from regional areas, having a body mass index in a normal range (AOR = 1.50, 95 % CI: 1.06-2.15) compared with having overweight or obesity, having middle income (AOR = 1.41, 95 % CI: 1.01-1.98) compared with having low- or high-income, and enrolment after 2019 (AOR = 2.3, 95 % CI:1.80-3.06) compared with enrolment in 2019 or earlier. Conversely, having a South or Central Asian background (AOR = 0.65, 95 % CI: 0.46-0.92) is associated with a lower completion rate compared with being from Australia.

CONCLUSION

Characteristics associated with lower completion rates among women with prior GDM in a cardiometabolic risk reduction program included residing in rural and remote areas, having an elevated BMI (in the overweight or obesity range), low or high income, enrolment in 2019 or earlier and being of South or Central Asian background.

Trends in induction of labour and associated co-morbidities and demographics in Queensland, Australia from 2001 to 2020: a population-based study

BACKGROUND

Amongst women who plan a vaginal birth at term, previous studies have reported that rates of induction of labour are increasing potentially impacting other labour and birth outcomes. Indications for induction of labour (IOL) have changed over time though the influences of parity and demographic factors such as age, ethnicity and regionality are not often considered. The aim of this study was to describe the changes in demographic, co-morbidity, IOL indication and clinical outcomes in women undertaking a planned cephalic vaginal birth at term over a 20 year period.

METHODS

A retrospective population-based study was undertaken using routinely collected anonymised perinatal data from Queensland, Australia from January 2001 to December 2020. We included all singleton term (≥ 37 weeks) planned vaginal births. A total of 836,065 births met the study criteria. Data for pregnancy complications and IOL indications were grouped by ICD-10 codes. Analysis was stratified by parity and presented as frequency and percentages over time and the difference in percentages between two defined years.

RESULTS

Rates of IOL increased by 15.5% (31.6 to 47.1%) in nulliparous and 14.6% (26.2 to 40.8% in multiparous women, most notable from 2015 onwards. Over the same period infants born between 37 and 38 weeks gestation increased by 13.9%. (18.1-32%). Amongst co-morbidities gestational diabetes increased from 3.8 to 12.8% and anaemia from 1.7 to 8.1%. As an indication for IOL prolonged pregnancy decreased from 41.0 to 11.2%. In nulliparous women the percentage of intact perineum decreased from 21.3 to 6.7% while episiotomy increased from 20.2 to 38.8%.

CONCLUSIONS

We conclude that for women planning a vaginal birth not only has the rate of IOL increased substantially over the last two decades there also appears to be considerable interaction between demographic, co-morbidity, IOL indications and clinical outcomes that warrants further large population-based research.

Antioxidant Supplementation for Management of Gestational Diabetes Mellitus in Pregnancy: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

PURPOSE OF REVIEW

Gestational diabetes mellitus (GDM) is the most common medical complication of pregnancy globally. Hyperglycaemia and associated production of reactive oxygen species can lead to oxidative stress in pregnancy. However, the potential effectiveness of increased antioxidant intake in the management of GDM has not been widely examined. Its usefulness alongside medical nutrition therapy (MNT) for assisting glycaemic control in women with GDM is poorly understood. This review aimed to establish the effect of antioxidant supplementation on the risk and management of gestational diabetes mellitus (GDM).

RECENT FINDINGS

A systematic review of intervention studies was conducted based on PRISMA guidelines. Databases searched were MEDLINE, CINAHL, Global Health, Scopus, Embase and Cochrane until September 2024. Random effects meta-analyses using Cochrane Review Manager software to establish the effect of antioxidant supplementation on glucose outcomes in women with GDM were conducted. A total of 13 studies (1380 participants) were included in the review with four different antioxidants used (selenium (n = 3); alpha-lipoic (n = 4); zinc (n = 5); e-3-gallate (n = 1)). Significant pre-post differences between antioxidant supplementation and control groups were found for fasting insulin (SMD, 95%CI) (-0.97 [-1.69 -0.24]; p = 0.009, HOMA-IR (-0.90 [-1.25, -0.54]; p < 0.0000, HOMA-B (-0.86 [-1.05, -0.67]; p < 0.00001 and QUICKI (1.09 [0.32,1.87]; p = 0.005 Heterogeneity was substantial (I2 > 50%, p < 0.05) for all models except for HOMA-B (I2 = 0%, p > 0.05). Antioxidant supplementation has possible benefit as an adjunct therapy to current dietary management for women with GDM. Further clinical trials are needed to establish the preferred type and dosage of antioxidants likely to be effective.

National, state and territory trends in gestational diabetes mellitus in Australia, 2016-2021: Differences by state/territory and country of birth

OBJECTIVE

To examine trends of gestational diabetes mellitus (GDM) in Australia by state/territory and country of birth.

METHODS

A cross-sectional study was undertaken from 2016 to 2021 using data from the National Diabetes Services Scheme (NDSS) and Australian Bureau of Statistics. The trends were assessed using Average Annual Percentage Changes (AAPCs) and the Cochrane-Armitage test.

RESULTS

Nationally, the age-standardised incidence of GDM was 9.3% (95%CI; 9.1-9.4) in 2016 and 15.7% (95%CI; 15.4-15.9) in 2021, representing AAPC of +10.9%. The highest increase was in the Northern Territory, from 6.7% (95%CI; 5.1-8.3) in 2016 to 19.2% (95%CI; 16.9-21.6) in 2021, AAPC=+24.6%. In Southeast Asian-born women, the incidence of GDM rose from 12.2% (95%CI; 11.7-12.7) in 2016 to 22.5% (95%CI; 21.9-23.2) in 2021 (p-trend<0.001).

CONCLUSIONS

The incidence of GDM has risen in Australia, particularly in the Northern Territory and Victoria, as well as among those born in Southeast Asia and South and Central Asia.

IMPLICATIONS FOR PUBLIC HEALTH

This increase in GDM incidence in Australia underscores the pressing need for location and culturally responsive GDM prevention interventions. The lack of information on some risk factors of GDM (e.g. high body mass index) in the NDSS registry requires further investigation.

Circulating fibroblast growth factor 21 levels in gestational diabetes mellitus and preeclampsia: a systematic review and meta-analysis

BACKGROUND

The connection between fibroblast growth factor 21 (FGF21) and the likelihood of gestational diabetes mellitus (GDM) or preeclampsia (PE) has received more attention recently. Based on published articles, meta-analysis were conducted to explore the differences in FGF21 levels in GDM or PE compared to control groups.

METHODS

Articles published before April 5, 2024 were searched across four databases: PubMed, Web of Science, Embase, and Cochrane Library, and studies exploring the association of FGF21 levels and GDM or PE were collected. Additionally, ClinicalTrials.gov was also searched for completed and ongoing trials. (Prospero Registration CRD42024504738). The standardized mean differences (SMDs) and 95% confidence intervals (CIs) were utilized to determine FGF21 levels among different groups.

RESULTS

This analysis incorporated a total of 16 articles, with 714 GDM and 701 non-GDM in the control group. The GDM-affected pregnant women had greater levels of circulating FGF21 than the control group (SMD = 0.529, 95% CI: 0.168 ~ 0.890, p = 0.004). Moreover, the PE case group covered 120 while the control group contained 134. The findings indicated that pregnant women with PE had significantly greater levels of circulating FGF21 than healthy expectant mothers (SMD = 0.743, 95% CI: 0.527 ~ 0.958, p = 0.000).

CONCLUSIONS

Our study found that FGF21 has the potential to serve as a diagnostic marker for GDM or PE. However, due to the limited number of studies and the fact that most data were from the second and third trimesters of pregnancy, more large-scale prospective studies are needed to validate these conclusions, investigate the potential of FGF21 in enabling early diagnosis, and further examine the role of FGF21 in the development and progression of GDM/PE.

TRIAL REGISTRATION

Not applicable.

StUdy of Gestational diabetes And Risk using Electronic Data (SUGARED): a population-based cohort study-study protocol

INTRODUCTION

The incidence of gestational diabetes mellitus (GDM) in Australia has tripled in the last 20 years. Consequently, over 40 000 pregnancies are now diagnosed as 'higher risk' each year. This has increased antenatal surveillance and obstetric intervention, often in the form of delivery earlier than 39 weeks gestation. The StUdy of Gestational diabetes And Risk using Electronic Data (SUGARED) project aims to use large population-based and routinely collected linked health data to (1) personalise risk prediction of adverse pregnancy outcomes for women undergoing glucose tolerance testing, (2) guide optimal birth timing for women with diet-controlled GDM and (3) examine variation in GDM management and pregnancy outcomes in New South Wales (NSW), Australia.

METHODS AND ANALYSIS

This retrospective cohort study using linked, routinely collected health data includes all women who gave birth from January 2016 to December 2020 in NSW. The cohort will include approximately 475 000 pregnancies, with >70 000 diagnosed with GDM. The study will link birth data to hospital data and birth/death registry data. In addition, clinical pathology results and detailed clinical information from a subset of public hospital pregnancies in 13 of 15 area health services will be linked. To address the three main aims, we will use statistical methods including logistic regression and K-fold cross-validation for risk prediction, a propensity-score matching 'target trial' method to examine birth timing, and multilevel modelling to examine hospital variation.

ETHICS AND DISSEMINATION

Ethics approval for the study has been granted by the NSW Population and Health Services Research Ethics Committee. We will communicate evidence generated from SUGARED to the local health districts and their clinicians, as well as potentially optimising dissemination using existing digital infrastructure.

Gestational diabetes mellitus prevalence in Brazil: a systematic review and meta-analysis

This study estimates gestational diabetes mellitus prevalence in Brazil. A systematic review was conducted with articles published between 2010 and 2021 on the PubMed, Scopus, Google Scholar, SciELO, LILACS and Virtual Health Library databases, as well as gray literature. Data were extracted using a standardized instrument together with the risk of bias assessment tool proposed by Hoy et al. A meta-analysis with robust variance and random effects was developed. Heterogeneity was verified using I2 and publication bias was assessed using funnel plot and Egger's test. Prevalence according to risk of bias, diagnostic criteria and country's regions was determined by subgroup analyses. A total of 32 studies were included, representing 21,942 women. gestational diabetes mellitus pooled prevalence was 14% (95%CI: 11.0; 16.0), considerably higher than estimates from previous studies. Regarding risk of bias, studies with low, medium, and high risk showed a pooled prevalence of 12%, 14% and 14%, respectively. Overall GRADE certainty of evidence rating was low. Most studies used the International Association of Diabetes in Pregnancy Study Group (IADPSG) criteria or the adapted IADPSG, showing a pooled prevalence of 15% and 14%, respectively. As for region, the pooled prevalence was higher in the Southeast (14%) and lower in the Central-West (9%). This is the first systematic review to provide evidence on gestational diabetes mellitus prevalence at a national level and to demonstrate considerable heterogeneity among articles and the influence of region, diagnostic criteria and study quality on the referred indicator.

A systematic review and meta-analysis of ischemia-modified albumin in diabetes mellitus

Aim

There is an ongoing search for novel biomarkers of diabetes. We conducted a systematic review and meta-analysis of the serum concentrations of ischemia-modified albumin (IMA), a candidate biomarker of oxidative stress, acidosis, and ischemia, in patients with pre-diabetes, different types of diabetes mellitus (type 1, T1DM, type 2, T2DM, and gestational, GDM), and healthy controls.

Methods

We searched for case-control studies published in PubMed, Web of Science, and Scopus from inception to December 31, 2023. The risk of bias and the certainty of evidence were assessed using the Joanna Briggs Institute Critical Appraisal Checklist and GRADE, respectively.

Results

In 29 studies, T2DM patients had significantly higher IMA concentrations when compared to controls (standard mean difference, SMD = 1.83, 95 % CI 1.46 to 2.21, p˂0.001; I2 = 95.7 %, p < 0.001; low certainty of evidence). Significant associations were observed between the SMD and glycated hemoglobin (p = 0.007), creatinine (p = 0.003), triglycerides (p = 0.029), and the presence of diabetes complications (p = 0.003). Similar trends, albeit in a smaller number of studies, were observed in T1DM (two studies; SMD = 1.59, 95 % CI -0.09 to 3.26, p˂0.063; I2 = 95.8 %, p < 0.001), GDM (three studies; SMD = 3.41, 95 % CI 1.14 to 5.67, p = 0.003; I2 = 97.0 %, p < 0.001) and pre-diabetes (three studies; SMD = 15.25, 95 % CI 9.86 to 20.65, p˂0.001; I2 = 99.3 %, p < 0.001).

Conclusion

Our study suggests that IMA is a promising biomarker for determining the presence of oxidative stress, acidosis, and ischemia in pre-diabetes and T1DM, T2DM, and GDM. However, the utility of measuring circulating IMA warrants confirmation in prospective studies investigating clinical endpoints in pre-diabetes and in different types of diabetes (PROSPERO registration number: CRD42024504690).

'No matter what time of day': The value of joining Facebook groups supporting women's self-management of gestational diabetes mellitus

BACKGROUND

Gestational diabetes mellitus (GDM) affects a significant and growing proportion of pregnant women each year. The condition entails additional monitoring, self-management and healthcare use during pregnancy, and some women also join GDM support groups on Facebook. Little is known about the practices inside these groups, but examining them may elucidate support needs, women's experience of healthcare and improve overall outcomes. The aims of this study were to explore motivations for joining GDM Facebook groups and the perceived value and benefits of such spaces.

DESIGN

A cross-sectional design using a web-based survey collected data from two peer-led GDM Facebook groups; relevant quantitative and qualitative data were extracted from open and closed questions, and analysed using descriptive statistics and content analysis.

RESULTS

A total of 340 women responded to the survey, with 306 (90%) tendering their motivations to join a GDM Facebook group. Their answers were classified into six categories: peer support; information and practical advice; lived experiences; community; a safe place to ask questions and being recommended. The most commonly reported benefits of membership were 'reading about food ideas' and 'finding helpful information and tips'. Respondents reported finding their group strongly sympathetic, sincere, compassionate, heart-felt, tolerant, sensitive, warm and supportive.

DISCUSSION AND CONCLUSIONS

GDM Facebook groups are valuable for informational and emotional support, and the sharing and perusal of lived experiences; another key benefit for women is feeling belonging to a community. GDM Facebook groups provide women with access to more tailored and readily available support, filling gaps not addressed by healthcare providers.

PATIENT CONTRIBUTION

This study was led by a person with lived experience of GDM, and the survey was pilot tested with women who had also experienced GDM, which contributed to its development.

Associations between diet quality and dietary patterns and gestational diabetes mellitus in a low-risk cohort of pregnant women in Australia: a cross-sectional study

INTRODUCTION

Evidence of associations between the Mediterranean Diet Score (MDS) and Dietary Approaches to Stop Hypertension (DASH) score and gestational diabetes mellitus (GDM) in pregnant women is limited. This study examined changes in MDS and DASH and dietary patterns in Australian pregnant women between early and late pregnancy and their associations with GDM.

METHODS

The data from n = 284 participants were analysed. Diet quality indices and empirical dietary patterns were determined in early (15 ± 3 weeks gestation) and late pregnancy (35 ± 2 weeks gestation). Paired t-tests were used to examine changes in scores for diet quality indices and dietary patterns from early to late pregnancy. Logistic regression analysis was used to examine associations between GDM, diet quality indices and dietary patterns.

RESULTS

Three major dietary patterns were identified at early pregnancy. The first and second dietary patterns included unhealthier and healthier food groups, respectively, and the third comprised mixed food groups. Although diet quality scores did not change over time, consumption of the first dietary pattern increased (p = 0.01), and consumption of the second dietary pattern decreased by late pregnancy in women without GDM (p < 0.001).

CONCLUSION

No associations between DASH score, MDS and GDM were found; however an inverse association was observed between the first dietary pattern and GDM in late pregnancy (p = 0.023). Longitudinal studies are needed to examine diet quality and dietary patterns at early and late pregnancy to inform the development of tailored dietary advice for GDM.

The holistic maternity care needs of women with Gestational Diabetes Mellitus: A systematic review with thematic synthesis

PROBLEM

Models of care for women with gestational diabetes mellitus (GDM) have evolved in an ad hoc way and do not meet women's needs.

BACKGROUND

GDM affects 50,000 Australian women per annum with prevalence quadrupling in the last ten years. Many health services are struggling to provide a quality service. People with diabetes are calling for care that focuses on their wellbeing more broadly.

AIM

To examine the holistic (emotional, social, economic, and spiritual) care needs of women with GDM.

METHODS

Qualitative and mixed-methods studies capturing the healthcare experiences of women with GDM were searched for in CINAHL, Medline, Web of Science and Scopus. English-language studies published between 2011 and 2023 were included. Quality of studies was assessed using Crowe Critical Appraisal Tool and NVIVO was used to identify key themes and synthesise data.

FINDINGS

Twenty-eight studies were included, representing the experiences of 958 women. Five themes reflect women's holistic needs through their journey from initial diagnosis to postpartum: psychological impact, information and education, making change for better health, support, and care transition.

DISCUSSION

The biomedical, fetal-centric model of care neglects the woman's holistic wellbeing resulting in high levels of unmet need. Discontinuity between tertiary and primary services results in a missed opportunity to assist women to make longer term changes that would benefit themselves (and their families) into the future.

CONCLUSIONS

The provision of holistic models of care for this cohort is pivotal to improving clinical outcomes and the experiences of women with GDM.

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.

Promoting breastfeeding in women with gestational diabetes mellitus in high-income settings: an integrative review

BACKGROUND

Breastfeeding provides many short- and long-term health benefits for mothers and their infants and is a particularly relevant strategy for women who experience Gestational Diabetes Mellitus (GDM) during pregnancy. However, breastfeeding rates are generally lower amongst this group of women than the general population. This review's objective is to identify the factors that influence breastfeeding by exploring the experiences and outcomes of women in in high-income health care contexts when there is a history of GDM in the corresponding pregnancy.

METHODS

A comprehensive search strategy explored the electronic databases Medline, CINAHL, Web of Science and Scopus for primary studies exploring breastfeeding practices for papers published between January 2011 and June 2023. All papers were screened independently by two researchers with included papers assessed using the Crowe Critical Appraisal tool. Findings were analysed using a narrative synthesis framework.

RESULTS

From an initial search result of 1037 papers, 16 papers representing five high-income nations were included in this review for analysis - the United States of America (n = 10), Australia (n = 3), Finland (n = 1), Norway (n = 1), and Israel (n = 1). Fifteen papers used a quantitative design, and one used a qualitative design. The total number of participants represented in the papers is 963,718 of which 812,052 had GDM and 151,666 did not. Women with an immediate history of GDM were as likely to initiate breastfeeding as those without it. However, they were more likely to have the first feed delayed, be offered supplementation, experience delayed lactogenesis II and or a perception of low supply. Women were less likely to exclusively breastfeed and more likely to completely wean earlier than the general population. Maternity care practices, maternal factors, family influences, and determinants of health were contextual and acted as either a facilitator or barrier for this group.

CONCLUSION

Breastfeeding education and support need to be tailored to recognise the individual needs and challenges of women with a history of GDM. Interventions, including the introduction of commercial milk formula (CMF) may have an even greater impact and needs to be very carefully considered. Supportive strategies should encompass the immediate and extended family who are major sources of influence.

Time trends and projections in the prevalence of gestational diabetes mellitus in Queensland, Australia, 2009-2030: Evidence from the Queensland Perinatal Data Collection

BACKGROUND

Gestational diabetes mellitus (GDM) is the fastest-growing type of diabetes in Australia. We aimed to assess the time trends during 2009-2018 and projections of GDM in Queensland, Australia up to 2030.

MATERIALS AND METHODS

The study data were from the Queensland Perinatal Data Collection (QPDC) and included data on 606 662 birth events with the births reported from at least 20 weeks gestational age or birth weight at least 400 g. Bayesian regression model was used to assess the trends in the prevalence of GDM.

RESULTS

The prevalence of GDM increased from 5.47 to 13.62% from 2009 to 2018 (average annual rate of change, AARC = +10.71%). If the trend remains the same, the projected prevalence will increase to 42.04% (95% uncertainty interval = 34.77-48.96) by 2030. Observing AARC across different subpopulations, we found that the trend of GDM increased markedly among women living in inner regional areas (AARC = +12.49%), were non-Indigenous (AARC = +10.93%), most disadvantaged (AARC = +11.84%), aged either of two age groups (AARC = +18.45% and + 15.17% for <20 years and 20-24 years, respectively), were with obesity (AARC = +11.05%) and smoked during pregnancy (AARC = +12.26%).

CONCLUSIONS

Overall, the prevalence of GDM has sharply increased in Queensland, and if this trend continues, about 42% of pregnant women will experience GDM by 2030. The trends vary across different subpopulations. Therefore, targeting the most vulnerable subpopulations is vital to prevent the development of GDM.

Effects of Gestational Diabetes Mellitus and Selenium Deficiency on the Offspring Growth and Blood Glucose Mechanisms of C57BL/6J Mice

This study aimed to explore the effects and mechanisms of maternal gestational diabetes mellitus (GDM) and selenium (Se) deficiency on the growth and glucose metabolism of offspring. Female C57BL/6J mice were divided into four groups as follows: a control group, a GDM group, a Se deficiency group, and a GDM with Se deficiency group. GDM animal models were established via S961. Pregnant mice fed their offspring until weaning. Then, offspring continued to be fed with a basic diet until adulthood. Body weight and fasting blood glucose were measured weekly. Se content, oxidative stress indicators, and the protein expression of the PI3K/Akt signaling pathway were detected. GDM increased susceptibility to obesity in lactating offspring, with gender differences observed in adult offspring. The effect of Se deficiency on SOD activity only appeared in female offspring during adulthood but was shown in male offspring during weaning though it disappeared during adulthood. GDM and Se deficiency increased the risk of abnormal glucose metabolism in female offspring from weaning to adulthood but gradually decreased in male offspring. The influence on the expression of PI3K/Akt signaling pathway-related proteins showed the same trend. GDM and Se deficiency affected the growth and glucose metabolism of offspring through oxidative stress and PI3K/Akt signaling pathway-related proteins, and gender differences existed.

Gestational diabetes mellitus care re-imagined - A cost-minimisation analysis: Cost savings from a tertiary hospital, using a novel, digital-based gestational diabetes management model

BACKGROUND

Diagnosis of gestational diabetes mellitus (GDM) in a pregnancy has a significant impact on health service resources and represents a substantial financial and time impost on women.

AIM

To describe a cost-minimisation analysis conducted following the demonstration of clinically equivalent care of women using a novel, digital model for GDM management, compared with conventional care.

MATERIALS AND METHODS

A pre-implementation model of care was compared with the post-implementation model of care which included systematic development and delivery of education videos, use of the Commonwealth Scientific and Industrial Research Organisation 'M♡THer' smart phone app/portal and a dramatically reduced schedule of visits. The Mater Mothers' Hospital Brisbane cares for approximately 1200 women with GDM per annum, on which the cost estimates were based. Service costs were estimated using the resource method, where resource volumes and costs were gathered from experts within the health service. Patient costs were estimated using results from a short survey completed by a cohort of the study population.

RESULTS

Health service costs showed a modest saving of AU$17 441.78 (US$12 158.92) in the intervention group over a 12-month period. Cost savings for the woman were estimated at $566.56 (US$394.96) per patient after accounting for lost wages, childcare expenses, and travel expenses avoided. This reduction led to an overall saving of $679 872 (US$473 948.82) for the cohort of 1200 women, primarily due to the reduction in face-to-face visits.

CONCLUSION

Re-imagining GDM patient care by introducing a novel, digital-based GDM model of care has substantial positive cost implications for patients.

Associations of a current Australian model of dietetic care for women diagnosed with gestational diabetes and maternal and neonatal health outcomes

BACKGROUND

Gestational diabetes mellitus (GDM) is a significant public health burden in Australia. Subsequent strain on healthcare systems is widespread and current models of care may not be adequate to provide optimal healthcare delivery. This study aimed to assess a current model of dietetic care with maternal and neonatal outcomes.

METHODS

Hospital medical record data from The Women's Hospital, Melbourne, for women with GDM (n = 1,185) (July 2105-May 2017) was retrospectively analysed. Adjusted linear and logistic regression were used to analyse associations between the number of dietitian consultations and maternal and neonatal health outcomes.

RESULTS

Half of all women (50%) received two consultations with a dietitian. 19% of women received three or more consultations and of these women, almost twice as many were managed by medical nutrition therapy (MNT) and pharmacotherapy (66%) compared with MNT alone (34%). Higher odds of any maternal complication among women receiving 3 + consultations compared to those receiving zero (OR = 2.33 [95% CI: 1.23, 4.41], p = 0.009), one (OR = 1.80 [95% CI: 1.09, 2.98], p = 0.02), or two (OR = 1.65 [95% CI: 1.04, 2.60], p = 0.03) consultations were observed. Lower odds of infant admission to the Neonatal Intensive Care Unit (NICU) were observed among women receiving one (OR = 0.38 [95% CI: 0.18, 0.78], p = 0.008), two (OR = 0.37 [95% CI: 15 0.19, 0.71], p = 0.003), or three + consultations (OR = 0.43 [95% CI: 0.21, 0.88], p = 0.02), compared to no consultations.

CONCLUSION

The optimal schedule of dietitian consultations for women with GDM in Australia remains largely unclear. Alternate delivery of education for women with GDM such as telehealth and utilisation of digital platforms may assist relieving pressures on the healthcare system and ensure optimal care for women during pregnancy.

Prevalence of gestational diabetes mellitus, maternal obesity and associated perinatal outcomes over 10 years in an Australian tertiary maternity provider

BACKGROUND

The International Association of Diabetes in Pregnancy Study Groups (IADPSG) gestational diabetes mellitus (GDM) criteria have been heavily scrutinised with concerns that the consequent GDM prevalence increase has not been associated with improved perinatal outcomes.

AIMS

At a tertiary hospital in Melbourne, Australia we aimed to evaluate prevalence trends for GDM, type 2 diabetes (T2DM), maternal obesity and large-for-gestational age (LGA) and assess changes in perinatal outcomes following IADPSG criteria uptake in 2015.

METHODS

A retrospective cohort study of singleton births from 20 weeks' gestation was conducted between 1st January 2011 and 31st December 2020. Maternal characteristics and perinatal outcomes were extracted from medical records.

RESULTS

52,795 pregnancies were included. GDM prevalence increased 2.7 times from 8.9% in 2011 to 23.7% in 2020 and increased annually by 8.59% (95%CI 7.77, 9.42). The rate of T2DM increased annually by 11.69% (95%CI 7.72, 16.67). Obesity prevalence increased annually by 3.18% (95%CI 2.58, 3.78). Induction of labour (IOL) prevalence increased annually by 8.35% (95%CI 5.69, 11.06). LGA prevalence remained unchanged. Increasing maternal obesity was the major contributing factor for LGA prevalence.

CONCLUSIONS

From 2011 to 2020 GDM, obesity and T2DM prevalence increased significantly, with associated increased IOL, without change in LGA rates. Prospective studies are required to explore interactions between GDM, obesity, LGA and obstetric interventions.

Benefits and harms associated with an increase in gestational diabetes diagnosis in Queensland, Australia: a retrospective cohort comparison of diagnosis rates, outcomes, interventions and medication use for two periods, 2011-2013 and 2016-2018, using a large perinatal database

OBJECTIVES

To assess benefits and harms arising from increasing gestational diabetes (GDM) diagnosis, including for women with normal-sized babies.

DESIGN, SETTING AND PARTICIPANTS

Diagnosis rates, outcomes, interventions and medication use are compared in a retrospective cohort study of 229 757 women birthing in public hospitals of the Australian State of Queensland during two periods, 2011-2013 and 2016-2018, using data from the Queensland Perinatal Data Collection.

OUTCOME MEASURES

Comparisons include hypertensive disorders, caesarean section, shoulder dystocia and associated harm, induction of labour (IOL), planned birth (PB), early planned birth <39 weeks (EPB), spontaneous labour onset with vaginal birth (SLVB) and medication use.

RESULTS

GDM diagnosis increased from 7.8% to 14.3%. There was no improvement in shoulder dystocia associated injuries, hypertensive disorders or caesarean sections. There was an increase in IOL (21.8%-30.0%; p<0.001), PB (36.3% to 46.0%; p<0.001) and EPB (13.5%-20.6%; p<0.001), and a decrease in SLVB (56.0%-47.3%; p<0.001). Women with GDM experienced an increase in IOL (40.9%-49.8%; p<0.001), PB (62.9% to 71.8%; p<0.001) and EPB (35.3%-45.7%; p<0.001), and a decrease in SLVB (30.01%-23.6%; p<0.001), with similar changes for mothers with normal-sized babies. Of women prescribed insulin in 2016-2018, 60.4% experienced IOL, 88.5% PB, 76.4% EPB and 8.0% SLVB. Medication use increased from 41.2% to 49.4% in women with GDM, from 3.2% to 7.1% in the antenatal population overall, from 3.3% to 7.5% in women with normal-sized babies and from 2.21% to 4.38% with babies less than the 10th percentile.

CONCLUSION

Outcomes were not apparently improved with increased GDM diagnosis. The merits of increased IOL or decreased SLVB depend on the views of individual women, but categorising more pregnancies as abnormal, and exposing more babies to the potential effects of early birth, medication effects and growth limitation may be harmful.

Elevated Maternal Folate Status and Changes in Maternal Prolactin, Placental Lactogen and Placental Growth Hormone Following Folic Acid Food Fortification: Evidence from Two Prospective Pregnancy Cohorts

Folic acid (FA) food fortification in Australia has resulted in a higher-than-expected intake of FA during pregnancy. High FA intake is associated with increased insulin resistance and gestational diabetes. We aimed to establish whether maternal one-carbon metabolism and hormones that regulate glucose homeostasis change in healthy pregnancies post-FA food fortification. Circulating folate, B12, homocysteine, prolactin (PRL), human placental lactogen (hPL) and placental growth hormone (GH2) were measured in early pregnancy maternal blood in women with uncomplicated pregnancies prior to (SCOPE: N = 604) and post (STOP: N = 711)-FA food fortification. FA food fortification resulted in 63% higher maternal folate. STOP women had lower hPL (33%) and GH2 (43%) after 10 weeks of gestation, but they had higher PRL (29%) and hPL (28%) after 16 weeks. FA supplementation during pregnancy increased maternal folate and reduced homocysteine but only in the SCOPE group, and it was associated with 54% higher PRL in SCOPE but 28% lower PRL in STOP. FA food fortification increased maternal folate status, but supplements no longer had an effect, thereby calling into question their utility. An altered secretion of hormones that regulate glucose homeostasis in pregnancy could place women post-fortification at an increased risk of insulin resistance and gestational diabetes, particularly for older women and those with obesity.

Regional divergence and time trends in the prevalence of gestational diabetes mellitus: a national Danish cohort study

AIMS

To evaluate the prevalence and time trends of gestational diabetes mellitus (GDM) across the five regions of Denmark with uniform national guidelines for screening and diagnosing GDM.

METHODS

This register-based national cohort study included 287,684 births from 2013 to 2017. Trends in GDM prevalence over time and differences between the five regions were evaluated. Crude and adjusted odd ratios (ORs) for GDM were calculated including potential confounding clinical risk factors as age, BMI, educational level, marital status, parity, country of origin and assisted reproduction.

RESULTS

From 2013 to 2017, GDM prevalence in Denmark increased by 7% per year (OR 1.07, 95% CI 1.06-1.09, P < 0.001). GDM prevalence varied considerably between regions and ranged from 3.0 to 5.9% in 2017, corresponding to a maximal regional difference of 97%. In crude analyses, the risk of GDM in 2017 was significantly different in four of five regions compared to the remaining regions (OR ranging from 0.60 to 1.55), and these differences persisted after adjusting for confounding clinical risk factors (adjusted OR: 0.59-1.45).

CONCLUSION

The prevalence of GDM increased over time in all Danish regions with substantial regional divergence. Up to a 97%, difference in GDM prevalence was observed between Danish regions, which was not explained by available clinical risk factors. This occurred despite national guidelines and raises the question of whether regional variations in screening efficacy, diagnostic procedures or inequality in clinical health care access may explain the observed differences.

Fasting Glucose Level on the Oral Glucose Tolerance Test Is Associated with the Need for Pharmacotherapy in Gestational Diabetes Mellitus

Gestational diabetes mellitus (GDM) has a rapidly increasing prevalence, which poses challenges to obstetric care and service provision, with known serious long-term impacts on the metabolic health of the mother and the affected offspring. The aim of this study was to evaluate the association between glucose levels on the 75 g oral glucose tolerance test and GDM treatment and outcomes. We performed a retrospective cohort study of women with GDM attending a tertiary Australian hospital obstetric clinic between 2013 and 2017, investigating the relationship between the 75 g oral glucose tolerance test (OGTT) glucose values, and obstetric (timing of delivery, caesarean section, preterm birth, preeclampsia), and neonatal (hypoglycaemia, jaundice, respiratory distress and NICU admission) outcomes. This time frame encompassed a change in diagnostic criteria for gestational diabetes, due to changes in international consensus guidelines. Our results showed that, based on the diagnostic 75 g OGTT, fasting hyperglycaemia, either alone or in combination with elevated 1 or 2 h glucose levels, was associated with the need for pharmacotherapy with either metformin and/or insulin (p < 0.0001; HR 4.02, 95% CI 2.88-5.61), as compared to women with isolated hyperglycaemia at the 1 or 2 h post-glucose load timepoints. Fasting hyperglycaemia on the OGTT was more likely in women with higher BMI (p < 0.0001). There was an increased risk of early term birth in women with mixed fasting and post-glucose hyperglycaemia (adjusted HR 1.72, 95% CI 1.09-2.71). There were no significant differences in rates of neonatal complications such as macrosomia or NICU admission. Fasting hyperglycaemia, either alone or in combination with post-glucose elevations on the OGTT, is a strong indicator of the need for pharmacotherapy in pregnant women with GDM, with significant ramifications for obstetric interventions and their timing.

Supports and Barriers to Lifestyle Interventions in Women with Gestational Diabetes Mellitus in Australia: A National Online Survey

BACKGROUND

Gestational diabetes mellitus (GDM) affects approximately one in six pregnancies, causing a significant burden on maternal and infant health. Lifestyle interventions are first-line therapies to manage blood glucose levels (BGLs) and prevent future cardiometabolic complications. However, women with GDM experience considerable barriers to lifestyle interventions; thus, the aim of this study was to determine how women with GDM manage their condition and to identify the primary supports and barriers to lifestyle intervention participation.

METHODS

An online cross-sectional survey of women in Australia with a history of GDM was conducted. Questions included participant demographics, strategies used to manage BGLs, physical activity and dietary habits, and barriers and supports to lifestyle interventions.

RESULTS

A total of 665 individuals consented and responded to the advertisement, of which 564 were eligible and provided partial or complete responses to the survey questions. Most respondents were between 35 and 39 years of age (35.5%), not pregnant (75.4%), working part-time (26.7%), university-educated (58.0%), and had only one child (40.1%). Most respondents managed their BGLs through diet (88.3%), with "low-carbohydrate" diets being the most popular (72.3%), and 46.2% of respondents were undertaking insulin therapy. Only 42.2% and 19.8% of respondents reported meeting the aerobic and strengthening exercise recommendations, respectively. Women with one child or currently pregnant expecting their first child were 1.51 times more likely (95% CI, 1.02, 2.25) to meet the aerobic exercise recommendations than those with two or more children. The most common reported barriers to lifestyle intervention participation were "lack of time" (71.4%) and "childcare" commitments (57.7%). Lifestyle interventions delivered between 6 and 12 months postpartum (59.0%), involving an exercise program (82.6%), and delivered one-on-one were the most popular (64.9%).

CONCLUSION

Most women report managing their GDM with lifestyle strategies. The most common strategies reported involve approaches not currently included in the clinical practice guidelines such as reducing carbohydrate consumption. Furthermore, despite being willing to participate in lifestyle interventions, respondents report significant barriers, including lack of time and childcare commitments, whereas mentioned supports included having an online format. Lifestyle interventions for women with a history of GDM should be designed in a manner that is both tailored to the individual and considerate of existing barriers and supports to participation.

Evolution of Gestational Diabetes Mellitus across Continents in 21st Century

Over the last few decades, several definitions of gestational diabetes mellitus (GDM) have been described. There is currently not enough research to show which way is the best to diagnose GDM. Opinions differ in terms of the optimal screening and diagnostic measures, in part due to the differences in the population risks, the cost-effectiveness considerations, and the lack of an evidence base to support large national screening programs. The basic method for identifying the disease is the measurement of glucose plasma levels which may be determined when fasting, two hours after a meal, or simply at any random time. The currently increasing incidence of diabetes in the whole population, the altering demographics and the presence of lifestyle changes still require better methods of screening for hyperglycemia, especially during pregnancy. The main aim of this review is to focus on the prevalence and modifications to the screening criteria for GDM across all continents in the 21st century. We would like to show the differences in the above issues and correlate them with the geographical situation. Looking at the history of diabetes, we are sure that more than one evolution in GDM diagnosis will occur, due to the development of medicine, appearance of modern technologies, and the dynamic continuation of research.

Pregnancy outcomes in women with gestational diabetes mellitus by models of care: a retrospective cohort study

OBJECTIVE

To compare birth outcomes of women with gestational diabetes mellitus (GDM) with background obstetric population, stratified by models of care.

DESIGN

Retrospective cohort study.

SETTING

A tertiary referral centre in Sydney, Australia.

PARTICIPANTS

All births 1 January 2018 to 30 November 2020. Births <24 weeks, multiple gestations and women with pre-existing diabetes were excluded.

METHODS

Data were obtained from electronic medical records. Women were classified according to GDM status and last clinic attended prior to delivery. Model of care included attendance at dedicated GDM obstetric clinics, and routine antenatal care.

MAIN OUTCOME MEASURES

Hypertensive disorders of pregnancy (HDP), pre-term birth (PTB), induction of labour (IOL), operative delivery, small for gestational age (SGA), large for gestational age, postpartum haemorrhage, obstetric anal sphincter injury (OASIS), neonatal hypoglycaemia, neonatal hypothermia, neonatal respiratory distress, neonatal intensive care unit (NICU) admission.

RESULTS

The GDM rate was 16.3%, with 34.0% of women managed in dedicated GDM clinics. Women with GDM had higher rates of several adverse outcomes. Only women with GDM attending non-dedicated clinics had increased odds of HDP (adjusted OR (adj OR) 1.6, 95% CI 1.2 to 2.0), PTB (adj OR 1.7, 95% CI 1.4 to 2.0), OASIS (adj OR 1.4, 95% CI 1.0 to 2.0), similar odds of induction (adj OR 1.0, 95% CI 0.9 to 1.1) compared with non-GDM women. There were increased odds of NICU admission (adj OR 1.5, 95% CI 1.3 to 1.8) similar to women attending high-risk GDM clinics.

CONCLUSIONS

Women with GDM receiving care in lower risk clinics had similar or higher rates of adverse outcomes. Pathways of care need to be similar in all women with GDM.

Predictors for insulin use in gestational diabetes mellitus

OBJECTIVES

Gestational diabetes mellitus (GDM) affects about 15% of pregnancies in Australia, with approximately 30% of those diagnosed with GDM requiring insulin therapy. There are several established risk factors for developing GDM, however limited studies show how these can be used to predict need for insulin treatment. The aim of this study is to identify predictors of insulin therapy in women diagnosed with GDM once an oral glucose tolerance test (OGTT) is performed during pregnancy.

STUDY DESIGN

This is a retrospective cohort study of women with singleton pregnancies complicated by GDM between 2016 and 2017 at a single, large health network in Melbourne, Australia. Data were obtained from hospital record and pathology result systems. Univariable and multivariable logistic regression models were fit to the data to obtain crude and adjusted odds ratios.

RESULTS

Of 2,048 women diagnosed with GDM, 647 (31.6%) required insulin therapy. Positive predictors included in the final multivariable model after backwards, stepwise elimination were an elevated fasting result on an OGTT (adjusted odds ratio (AOR) 2.93 [95% CI 2.34-3.66]), previous birth weight greater than 90th% (AOR 2.04 [95% CI 1.412.94]), previous diagnosis of GDM (AOR 1.68 [95% CI 1.28-2.21]), being born in the South Asian region (AOR 1.58 [95% CI 1.27-1.98]), the 2hr OGTT result (AOR 1.14 [95% CI 1.05-1.24]), body mass index (BMI; AOR 1.13 [95% CI 1.04-1.23]) and age (AOR 1.03 [95% CI 1.00-1.05]) The final predictive model had an area under the receiver-operating characteristics (ROC) curve of 0.744 (95% CI 0.720-0.767).

CONCLUSIONS

This study highlights the possible predictors of insulin use, informing counselling for women who are newly diagnosed with gestational diabetes.

The association between serum selenium level and gestational diabetes mellitus: A systematic review and meta-analysis

BACKGROUND

The relationship between serum selenium level and gestational diabetes mellitus (GDM) is controversial. The purpose is to update and summarize previous studies to understand the relationship in more detail.

METHODS

PubMed, The Cochrane Library, EMBASE, Web of science, CNKI, WANFANG DATA and Cqvip were searched for studies published up to 3 September 2021. The random-effects model was used to measure the combined estimation. The overall effect was reported in a standard mean difference (SMD) and 95% confidence interval (95% CI). All data were analysed by Review Manager 5.4.

RESULTS

Twenty-seven studies involving 1588 patients with GDM and 2450 healthy pregnant women contributed to this meta-analysis. Selenium level was significantly lower in women with GDM than those without GDM (SMD = -1.29; 95% CI: -1.60 to -0.97, p < 0.00001). Subgroup analyses showed that such trend was consistent within the non-European population (Asia: SMD = -1.44; 95% CI: -1.79 to -1.08, p < 0.00001; Africa: SMD = -2.62; 95% CI: -4.50 to -0.74, p = 0.006) and in the second and third trimesters (the second trimester: SMD = -1.41; 95% CI: -1.82 to -0.99, p < 0.00001; the third trimester: SMD = -1.54; 95% CI: -2.09 to -0.98, p < 0.00001), but not within the European population (SMD = -0.47; 95% CI: -1.09 to 0.16, p = 0.14) or in the first trimester (SMD = -0.52; 95% CI: -1.13 to 0.10, p = 0.10).

CONCLUSIONS

This meta-analysis showed that the serum selenium level of patients with GDM was lower than that in healthy pregnant women, especially within the non-European population and in the second and third trimesters.

Development and evaluation of an online questionnaire to identify women at high and low risk of developing gestational diabetes mellitus

BACKGROUND

Established risk factors for Gestational Diabetes Mellitus (GDM) include age, ethnicity, family history of diabetes and previous GDM. Additional significant influences have recently been demonstrated in the literature. The oral glucose tolerance test (OGTT) used for GDM diagnosis has sub-optimal sensitivity and specificity, thus often results in GDM misdiagnoses. Comprehensive screening of risk factors may allow more targeted monitoring and more accurate diagnoses, preventing the devastating consequences of untreated or misdiagnosed GDM. We aimed to develop a comprehensive online questionnaire of GDM risk factors and triangulate it with the OGTT and continuous glucose monitoring (CGM) parameters to better evaluate GDM risk and diagnosis.

METHODS

Pregnant women participating in two studies on the use of CGM for GDM were invited to complete the online questionnaire. A risk score, based on published literature, was calculated for each participant response and compared with the OGTT result. A total risk score (TRS) was then calculated as a normalised sum of all risk factors. Triangulation of OGTT, TRS and CGM score of variability (CGMSV) was analysed to expand evaluation of OGTT results.

RESULTS

Fifty one women completed the questionnaire; 29 were identified as 'high-risk' for GDM. High-risk ethnic background (p < 0.01), advanced age, a family diabetic history (p < 0.05) were associated with a positive OGTT result. The triangulation analysis (n = 45) revealed six (13%) probable misdiagnoses (both TRS and CGMSV discordant with OGTT), consisting of one probable false positive and five probable false negative by OGTT results.

CONCLUSIONS

This study identified pregnant women at high risk of developing GDM based on an extended evaluation of risk factors. Triangulation of TRS, OGTT and CGMSV suggested potential misdiagnoses of the OGTT. Future studies to explore the correlation between TRS, CGMSV and pregnancy outcomes as well as additional GDM pregnancy biomarkers and outcomes to efficiently evaluate OGTT results are needed.

Use of a smartphone-based, interactive blood glucose management system in women with gestational diabetes mellitus: A pilot study

AIMS

To determine patient satisfaction, impact on maternal and neonatal outcomes and resource utilisation of a smartphone-based, remote blood glucose level (BGL) monitoring platform with software surveillance inwomen with gestational diabetes (GDM) compared with historical controls.

METHODS

This intervention study prospectively enrolled 98 women with GDM to the NET-Health smartphone-based application and compared them to 94 historical controls. The application allows automatic, real-time BGL upload to a central server for software monitoring, with automatic alerts generated for out-of-range results. Data recorded included demographics, outcomes and occasions of service (OOS). A validated satisfaction questionnaire was completed post-delivery.

RESULTS

The groups had comparable baseline characteristics and no significant difference in maternal and neonatal outcomes. The NET-Health application intervention reduced resource utilisation, with 1.9 fewer OOS and 37 min less clinician time - equivalent to AUD$68 saved per woman (based on clinician time only) or AUD$23 after taking into account the cost of the application. Patient satisfaction was high.

CONCLUSIONS

Use of this smartphone-based application with software surveillance in women with GDM has high patient satisfaction and no differences in maternal or neonatal outcomes despite reduced resource utilisation. It is the first to demonstrate a financial benefit. Larger studies are needed.

Trends in percentages of gestational diabetes mellitus attributable to overweight, obesity, and morbid obesity in regional Victoria: an eight-year population-based panel study

BACKGROUND

Gestational diabetes mellitus (GDM) is the fastest growing type of diabetes in Australia with rates trebling over the past decades partially explained by rising obesity rates and maternal age among childbearing women. Percentage of GDM attributable to obesity has been documented, mostly focusing on metropolitan populations. In parts of regional (areas outside capital cities) and rural Australia where overweight, obesity and morbid obesity are more prevalent, intertwined with socioeconomic disadvantage and higher migrant communities, trends over time in adjusted percentages of GDM attributed to obesity are unknown.

METHODS

In this population-based retrospective panel study, women, without pre-existing diabetes, delivering singletons between 2010 and 2017 in a tertiary regional hospital that serves 26% of Victoria's 6.5 million Australian population were eligible for inclusion. Secular trends in GDM by body mass index (BMI) and age were evaluated. The percentage of GDM that would have been prevented each year with the elimination of overweight or obesity was estimated using risk-adjusted regression-based population attributable fractions (AFp). Trends in the AFp over time were tested using the augmented Dickey-Fuller test.

RESULTS

Overall 7348 women, contributing to 10,028 births were included. The age of expecting mothers, their BMI, proportion of women born overseas, and GDM incidence significantly rose over time with GDM rising from 3.5% in 2010 to 13.7% in 2017, p <  0.001, increasing in all BMI categories. The incidence was consistently highest among women with obesity (13.8%) and morbid obesity (21.6%). However, the highest relative increase was among women with BMI < 25 kg/m2, rising from 1.4% in 2010 to 7.0% in 2017. Adjusting for age, country of birth, socioeconomic status, comorbidities, antenatal and intrapartum factors, an estimated 8.6% (confidence interval (CI) 6.1-11.0%), 15.6% (95% CI 12.2-19.0%), and 19.5% (95% CI 15.3-23.6%) of GDM would have been prevented by eliminating maternal overweight, obesity, and morbid obesity, respectively. However, despite the rise in obesity over time, percentages of GDM attributable to overweight, obesity, and morbid obesity significantly dropped over time. Scenario analyses supported these findings.

CONCLUSIONS

Besides increasing prevalence of obesity over time, this study suggests that GDM risk factors, other than obesity, are also increasing over time.

Molecular Mechanism of miR-29b on Gestational Diabetes and Its Influence on Trophoblast Cell Function

To explore the mechanism of miR-29b in gestational diabetes mellitus (GDM) and its effect on the function of trophoblast cell (TBC), the placenta tissues of 55 normal term pregnancies and 55 GDM patients were selected and rolled into control group and observation group. In the early stage, microRNA (miRNA) chips were utilized to screen the differentially expressed miRNAs in the placenta of observation group and control group. According to the microarray results of miRNAs, three differentially expressed miRNAs, namely let-7b, miR-1202, and miR-29b were selected. Then, the differences in the miR-29b level in the four groups were analyzed, namely the microRNA-29b (miR-29b minic), mini-control (minic control), microRNA-29b inhibitor (miR-29b inhibitor), and inhibitor control (inhibitor control). The results showed that miR-29b level in the placenta of observation group was substantially inferior to that of controls, with remarkable differences (P < 0.05). miR-29b level in miR-29b minic and minic control had significant changes (P < 0.01). The TBC activity of minic control was greatly superior to that of minic control, and there was considerable difference between the two (P < 0.05). The difference between miR-29b inhibitor and inhibitor control in TBC was not obvious, without considerable differences (P > 0.05). The invasion ability of miR-29b inhibitor TBC was notably superior to inhibitor control, and there were substantial differences (P < 0.05). To sum up, miR-29b had a significant inhibitory effect on the proliferation and cell activity of TBC, and can promote the apoptosis and death of TBC. Moreover, its inhibitory effect on cell migration and invasion was also suggested.

Evaluation of the implementation of a best practice gestational diabetes model of care in two Australian metropolitan services

INTRODUCTION AND AIMS

Dissemination and local adaptation of best practice models of care are often poorly achieved in knowledge translation processes. Understanding and documenting the iterative cycles of improvement can elucidate barriers, enablers and benefits of the process for future adoption and service integration improvements. This project examined the process of local adaptation for a third stage translation of a gestational diabetes dietetic model of care through collaboration with two Queensland (Australia) hospitals.

METHODS

Using a hub (research team)-spoke (sites) model, two Queensland Hospital and Health Service Districts were supported to assess and address evidence-practice dietetic model of care gaps in their gestational diabetes mellitus (GDM) services. Sites selected demonstrated strong GDM team cohesiveness and project commitment. The project phases were: Consultation; Baseline; Transition; Implementation; and Evaluation.

RESULTS

Despite strong site buy-in and use of a previously successful model of care dissemination and adoption strategy, unexpected global, organisational, team and individual barriers prevented successful implementation of the model of care at both sites. Barriers included challenges with ethics and governance requirements for health service research, capacity to influence and engage multidisciplinary teams, staff turnover and coronavirus disease 2019's (COVID-19's) disruption to service delivery.

CONCLUSION

This third iteration of the dissemination of a best practice model of nutrition care for GDM in two Queensland Hospital and Health Service Districts did not achieve successful clinical or process outcomes. However, valuable learnings and recommendations regarding future clinical and research health service redesign aligned with best practice are suggested.

Metabolomic Biomarkers in Gestational Diabetes Mellitus: A Review of the Evidence

Gestational diabetes mellitus (GDM) is the fastest growing type of diabetes, affecting between 2 to 38% of pregnancies worldwide, varying considerably depending on diagnostic criteria used and sample population studied. Adverse obstetric outcomes include an increased risk of macrosomia, and higher rates of stillbirth, instrumental delivery, and birth trauma. Metabolomics, which is a platform used to analyse and characterise a large number of metabolites, is increasingly used to explore the pathophysiology of cardiometabolic conditions such as GDM. This review aims to summarise metabolomics studies in GDM (from inception to January 2021) in order to highlight prospective biomarkers for diagnosis, and to better understand the dysfunctional metabolic pathways underlying the condition. We found that the most commonly deranged pathways in GDM include amino acids (glutathione, alanine, valine, and serine), carbohydrates (2-hydroxybutyrate and 1,5-anhydroglucitol), and lipids (phosphatidylcholines and lysophosphatidylcholines). We also highlight the possibility of using certain metabolites as predictive markers for developing GDM, with the use of highly stratified modelling techniques. Limitations for metabolomic research are evaluated, and future directions for the field are suggested to aid in the integration of these findings into clinical practice.