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Sun X, McKeaveney C, Noble H, O’Hara H, Perra O. Comparing the screening methods for gestational diabetes mellitus before and during the COVID-19 pandemic: A systematic review. J Diabetes Investig 2024; 15:500-516. [PMID: 38102930 PMCID: PMC10981150 DOI: 10.1111/jdi.14128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 11/15/2023] [Accepted: 11/30/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND The oral glucose tolerance test (OGTT) is the gold standard for detecting gestational diabetes mellitus (GDM). However, during the COVID-19 pandemic, screening practices were reevaluated due to the risk of infection associated with the prolonged hospital visit required for the OGTT. Some countries have published novel screening protocols for GDM, suggesting the utilization of hemoglobin A1c (HbA1c), random plasma glucose (RPG), or fasting plasma glucose (FPG) in favor of OGTTs during the pandemic. Therefore, differences in screening methods before and after the epidemic need to be examined. METHODS A systematic search was carried out across five electronic databases (Cinahl, Medline, Embase, Pubmed, and Web of Science) between 2016 and 2023. The Critical Appraisal Skills Programme (CASP) checklist for cohort studies was used to evaluate the quality of included papers. RESULTS A total of 13 eligible studies were included. Prior to the COVID-19 pandemic, the OGTT was the recommended measure to screen GDM, internationally based on various official guidelines. During the pandemic, it was recommended that HbA1c or FPG, or RPG be used as a substitute for OGTTs. However, the new methods have low sensitivity, may not reflect accurately the prevalence of GDM, and may lead to many false-negative results in women and to adverse pregnancy and neonatal outcomes. CONCLUSION The new screening methods for GDM have poor accuracy and a high risk of adverse pregnancy outcomes. Comparatively, targeted screening tests to detect GDM according to the risk level are more effective in an emergency. In the future, the alternatives to OGTTs still need to be further explored in more depth.
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Affiliation(s)
- Xingge Sun
- School of Nursing and MidwiferyQueen's University BelfastBelfastUK
| | - Clare McKeaveney
- School of Nursing and MidwiferyQueen's University BelfastBelfastUK
| | - Helen Noble
- School of Nursing and MidwiferyQueen's University BelfastBelfastUK
| | - Hannah O’Hara
- School of Medicine, Dentistry and Biomedical SciencesQueen's University BelfastBelfastUK
| | - Oliver Perra
- School of Nursing and MidwiferyQueen's University BelfastBelfastUK
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Souza-Pereira A, Hernandez MDS, Guerra JMDS, Nieswald BH, Bianchini MC, Godinho DB, Nascimento AS, Puntel RL, Royes LFF, Rambo LM. Swimming training and caffeine supplementation protects against metabolic syndrome-induced nuclear factor-κB activation and cognitive deficits in rats. Nutr Res 2024; 122:19-32. [PMID: 38070463 DOI: 10.1016/j.nutres.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 11/04/2023] [Accepted: 11/05/2023] [Indexed: 03/08/2024]
Abstract
Metabolic syndrome (MS) is a disorder that increasingly affects the world population, mainly because of changes in lifestyle and dietary habits. In this regard, both physical exercise and caffeine are low-cost and easily accessible therapies that separately have shown positive effects against metabolic disorders. Therefore, we hypothesized that physical exercise combined with caffeine could have a synergistic effect in the treatment of MS, risk factors, and cognitive deficits. Animals were divided into 8 groups and received fructose (15% w/v) or vehicle for 10 weeks. Swimming training and caffeine (6 mg/kg) started 4 weeks after fructose administration. Trained animals presented decreased body weight and visceral fat mass and increased soleus weight compared with untrained fructose-treated animals. Caffeine supplementation also prevented the gain of visceral fat mass induced by fructose. Furthermore, both treatments reversed fructose-induced decrease in glucose clearance over time and fructose-induced increase in 4-hydroxynonenal and nuclear factor-κB immunoreactivity. Physical training also improved the lipidic profile in fructose-treated animals (high-density lipoprotein, low-density lipoprotein, and triglycerides), improved short-term, long-term, and localization memory, and reversed the fructose-induced deficit in short-term memory. Physical training also increased nuclear factor erythroid 2-related factor 2 immunoreactivity per se. Considering that physical training and caffeine reversed some of the damages induced by fructose it is plausible to consider these treatments as alternative, nonpharmacological, and low-cost therapies to help reduce MS-associated risk factors; however, combined treatments did not show additive effects as hypothesized.
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Affiliation(s)
- Adson Souza-Pereira
- Biochemistry Graduate Program, Federal University of Pampa, Uruguaiana, RS, Brazil
| | | | | | | | | | - Douglas Buchmann Godinho
- Department of Methods and Sportive Techniques, Federal University of Santa Maria, Santa Maria, RS, Brazil
| | | | - Robson Luiz Puntel
- Biochemistry Graduate Program, Federal University of Pampa, Uruguaiana, RS, Brazil
| | - Luiz Fernando Freire Royes
- Department of Methods and Sportive Techniques, Federal University of Santa Maria, Santa Maria, RS, Brazil
| | - Leonardo Magno Rambo
- Biochemistry Graduate Program, Federal University of Pampa, Uruguaiana, RS, Brazil.
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Thakur A, Agrawal S, Chakole S, Wandile B. A Critical Review of Diagnostic Strategies and Maternal Offspring Complications in Gestational Diabetes Mellitus. Cureus 2023; 15:e51016. [PMID: 38264369 PMCID: PMC10804211 DOI: 10.7759/cureus.51016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/16/2023] [Indexed: 01/25/2024] Open
Abstract
Gestational diabetes mellitus (GDM) is a complex and significant health concern affecting pregnant individuals and their offspring. This review provides a comprehensive examination of GDM, focusing on diagnostic strategies and the associated maternal and offspring complications. We delve into the challenges and controversies surrounding GDM diagnosis, including the variability in diagnostic criteria, diagnostic accuracy and reproducibility issues, ethical considerations, and the influence of ethnicity and genetics. Maternal complications, such as preeclampsia, cesarean sections, long-term health implications, and neonatal complications like macrosomia, hypoglycemia, and respiratory distress syndrome, are explored in detail. Additionally, we investigate the long-term risks of childhood obesity and type 2 diabetes in offspring and potential cognitive and developmental outcomes. This review underscores the critical importance of early detection and effective management of GDM, the need for standardized diagnostic criteria, personalized care plans, and the ongoing pursuit of research to enhance our understanding of this complex condition. GDM remains a dynamic field where ongoing innovation and research promise to improve the health outcomes of pregnant individuals and their children.
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Affiliation(s)
- Arya Thakur
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Suyash Agrawal
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Swarupa Chakole
- Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Bhushan Wandile
- Nursing, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Rai AS, Sletner L, Jenum AK, Øverby NC, Stafne SN, Qvigstad E, Pripp AH, Sagedal LR. Employing fasting plasma glucose to safely limit the use of oral glucose tolerance tests in pregnancy: a pooled analysis of four Norwegian studies. Front Endocrinol (Lausanne) 2023; 14:1278523. [PMID: 38098869 PMCID: PMC10720624 DOI: 10.3389/fendo.2023.1278523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/10/2023] [Indexed: 12/17/2023] Open
Abstract
Background/objective There is no international consensus about the optimal approach to screening and diagnosis of gestational diabetes mellitus (GDM). Fasting plasma glucose (FPG) has been proposed as an alternative universal screening test to simplify the diagnosis of GDM. We investigate the ability of the FPG to predict a 2-hour glucose value below the cut-off for GDM, thereby "ruling out" the necessity of a full OGTT and assess the proportion of GDM-related complications associated with the identified FPG level. Materials and methods This study included secondary data from four Norwegian pregnancy cohorts (2002-2013), encompassing 2960 women universally screened with late mid-pregnancy 75g OGTT measuring FPG and 2-hour glucose. For a range of FPG thresholds, we calculated sensitivity to predict elevated 2-hour glucose, number of OGTTs needed and percentage of GDM cases missed, applying modified World Health Organization (WHO) 2013 criteria (2013WHO) and 2017 Norwegian criteria (2017Norwegian). We analyzed pregnancy outcomes for women above and below our selected threshold. Results The prevalence of GDM was 16.6% (2013WHO) and 10.1% (2017Norwegian). A FPG threshold of 4.7 mmol/L had a sensitivity of 76% (2013WHO) and 80% (2017Norwegian) for detecting elevated 2-hour glucose, with few missed GDM cases (2.0% of those ruled out and 7.5% of all GDM cases for 2013WHO, and 1.1% of those ruled out and 7% of all GDM cases for 2017Norwegian). When excluding women with FPG <4.7mmol/l and those with GDM based on FPG, only 24% (2013WHO) and 29% (2017Norwegian) would require OGTT. Women with FPG <4.7mmol/l, including missed GDM cases, had low risk of large-for-gestational-age newborns, cesarean section and operative vaginal delivery. Conclusion A FPG threshold of 4.7mmol/l as a first step when screening for GDM could potentially eliminate the need for OGTT in 70-77% of pregnancies. Women with FPG below this threshold appear to carry low risk of GDM-associated adverse pregnancy outcomes.
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Affiliation(s)
- Anam Shakil Rai
- Department of Research, Sorlandet Hospital, Kristiansand, Norway
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Line Sletner
- Department of Pediatric and Adolescents Medicine, Akershus University Hospital, Akershus, Norway
| | - Anne Karen Jenum
- General Practice Research Unit (AFE), Department of General Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Nina Cecilie Øverby
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Signe Nilssen Stafne
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Clinical Services, St.Olavs Hospital Trondheim University Hospital, Trondheim, Norway
| | - Elisabeth Qvigstad
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Are Hugo Pripp
- Oslo Centre of Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Linda Reme Sagedal
- Department of Research, Sorlandet Hospital, Kristiansand, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Obstetrics and Gynaecology, Sorlandet Hospital, Kristiansand, Norway
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Sedigheh N, Hajieh S, Javad Z, Mehrdad S. Hemoglobin at the first visit of pregnancy and developing gestational diabetes mellitus: Results of a prospective registry cohort study. Clin Nutr ESPEN 2023; 57:469-474. [PMID: 37739693 DOI: 10.1016/j.clnesp.2023.07.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 07/10/2023] [Accepted: 07/18/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND AND AIM Gestational diabetes mellitus (GDM) is associated with a considerable risk of diabetes in the future. Few studies focused on the association between hemoglobin levels and developing gestational diabetes. This study aimed to determine the association of hemoglobin in early pregnancy and developing gestational diabetes mellitus. METHODS A prospective registry cohort study was designed for the recall of women with gestational diabetes mellitus. The registry was implemented in the health centers of Ahvaz City in 2019. Biological and clinical assessments were done, and interviewer-administered questionnaires were used to collect data on socio-demographic Features, medical and obstetric history, and risk factors of GDM. SPSS used for data analysis. The optimal hemoglobin cut-off point, its sensitivity, and specificity for the prediction of GDM were estimated using ROC analysis. RESULTS The prevalence of anemia was 17.1% in pregnant women (8.1% in women with gestational diabetes versus %24.2% in the healthy group, p < 0.001). The hemoglobin mean in women with GDM was significantly higher than in healthy women (P < 0.001). Hemoglobin at the first visit was significantly associated with a greater risk of gestational diabetes (OR = 3.80, 95% CI: 3.05-4.74). The area under the curve (AUC) was 0.76 (95% CI 0.73-79), and the optimal cut-off point for hemoglobin was 11.90 g/dL, with a sensitivity of 75% and a specificity of 68%. Women with a higher hemoglobin level had a 3.8- more risk of developing GDM. CONCLUSION Measurement of hemoglobin can be a relatively good tool for predicting gestational diabetes in the first months of pregnancy. The combination of hemoglobin with fasting blood sugar and BMI improves the predictive value for gestational diabetes incidence.
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Affiliation(s)
- Nouhjah Sedigheh
- Diabetes Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Shahbazian Hajieh
- Diabetes Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Zarei Javad
- Department of Health Information Technology, School of Allied Medical Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Sharifi Mehrdad
- Ahvaz Health Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
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Nazeer SA, Chen HY, Cornthwaite JA, Sadek S, Ghorayeb T, Daye N, Chauhan SP, Sibai B, Bartal MF. Time to Completion of Two-Step Screening for Gestational Diabetes and Adverse Outcomes. Am J Perinatol 2023. [PMID: 37527789 DOI: 10.1055/a-2145-7899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
OBJECTIVE This study aimed to ascertain whether the length of time to complete the gestational diabetes mellitus (GDM) screening was associated with adverse neonatal outcomes. STUDY DESIGN This was a retrospective cohort study of singleton, nonanomalous individuals who were screened for GDM at ≥24 weeks' gestation at an academic hospital system. We compared outcomes among people who were diagnosed with GDM and completed the 3-hour glucose tolerance test (GTT) ≤14 second versus >14 days from the 1-hour glucose challenge test (GCT). The primary outcome was a composite adverse neonatal outcome of the following: large for gestational age, shoulder dystocia, birth injury, respiratory distress, hypoglycemia, or fetal/neonatal death. The secondary outcomes included several individual neonatal and maternal morbidities. Multivariable Poisson's regression models were used to evaluate the association. Adjusted relative risk (aRR) and 95% confidence intervals (CI) were calculated. RESULTS Among the 313 individuals who completed the two-step screening for GDM and had an 1-hour GCT ≥ 135 mg/dL; of them, 171 (54.6%) completed the 3-hour GTT ≤14 days, 142 (45.4%) completed the 3-hour GTT > 14 days. Overall rate of the primary outcome was 44.1%. After multivariable adjustment, the risk of the primary outcome was similar between people who completed the two-step method in ≤14 versus >14 days (aRR = 1.11, 95% CI = 0.81-1.52). There was no significant difference in all secondary adverse outcomes between the two groups. Subgroup analyses, limited to people diagnosed with GDM (N = 89, 23.4%), also found similar results as the full analyses. CONCLUSION Among individuals who completed the two-step screening for GDM, completion of the 3-hour GTT within ≤14 versus ≥ 14 days was not associated with an increase rate of the adverse outcomes. KEY POINTS · Among pregnant people in an academic practice, 50% of people with abnormal 1-hour GTT completed GDM two-step screening in 14 days.. · Longer length of time to completion of diagnostic testing for GDM was not associated with an increased rate of adverse outcomes.. · Pregnant people that were diagnosed with GDM and completed the two-step method in >14 days did not have worse perinatal outcomes..
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Affiliation(s)
- Sarah A Nazeer
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Han-Yang Chen
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Joycelyn A Cornthwaite
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Sandra Sadek
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Tala Ghorayeb
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Nahla Daye
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Suneet P Chauhan
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Baha Sibai
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Michal F Bartal
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Llerena-Velastegui J, Guevara-Espinoza S, Villacis-Lopez C, Santafe-Abril G. Response to "Fasting plasma glucose level to guide the need for an OGTT to screen for gestational diabetes mellitus". Acta Diabetol 2023; 60:857-858. [PMID: 36914779 DOI: 10.1007/s00592-023-02067-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 02/24/2023] [Indexed: 03/16/2023]
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Beunen K, Neys A, Van Crombrugge P, Moyson C, Verhaeghe J, Vandeginste S, Verlaenen H, Vercammen C, Maes T, Dufraimont E, Roggen N, De Block C, Jacquemyn Y, Mekahli F, De Clippel K, Van Den Bruel A, Loccufier A, Laenen A, Devlieger R, Mathieu C, Benhalima K. Fasting plasma glucose level to guide the need for an OGTT to screen for gestational diabetes mellitus. Acta Diabetol 2022; 59:381-394. [PMID: 34725724 DOI: 10.1007/s00592-021-01812-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 10/07/2021] [Indexed: 10/20/2022]
Abstract
AIMS To determine the fasting plasma glucose (FPG) level at which an oral glucose tolerance test (OGTT) could be avoided to screen for gestational diabetes (GDM) and to evaluate the characteristics of women across this FPG threshold. METHODS A multi-centric prospective cohort study with 1843 women receiving universal screening for GDM with a 75 g OGTT. RESULTS In the total population, GDM prevalence was 12.5% (231). A FPG < 78 mg/dL was the cut-off with best trade-off to limit the number of missed GDM cases [44 (19.0%)] with a negative predictive value of 97.3% (95% CI 96.5-98.0) for GDM, while avoiding 52.2% OGTTs. Compared to GDM with FPG ≥ 78 mg/dL [187 (81.0%)], GDM women with FPG < 78 mg/dL had a significantly lower BMI (27.1 ± 4.5 vs. 29.6 ± 5.2 kg/m2, p = 0.003), less insulin resistance [Matsuda: 0.4 (0.4-0.7) vs. 0.3 (0.2-0.5), p < 0.001] and better β-cell function [ISSI-2: 0.13 (0.08-0.25) vs. 0.09 (0.04-0.15), p = 0.004]. Compared to NGT women (1612) with FPG ≥ 78 mg/dL [846 (52.5%)], NGT with FPG < 78 mg/dL [766 (47.5%)] had a significantly lower BMI (26.0 ± 3.9 vs. 27.8 ± 4.7 kg/m2, p < 0.001), less insulin resistance [Matsuda: 0.7 (0.5-0.9) vs. 0.5 (0.4-0.7), p < 0.001], better β-cell function [ISSI-2: 0.17 (0.10-0.30) vs. 0.12 (0.07-0.21), p < 0.001], and less often large-for-gestational age infants [9.2 (70) vs. 16.2% (136), p < 0.001]. CONCLUSIONS FPG < 78 mg/dL can be used to limit the number of OGTTs when screening for GDM. Women with FPG < 78 mg/dL had a better metabolic profile and in NGT women also less fetal overgrowth.
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Affiliation(s)
- Kaat Beunen
- Department of Endocrinology, University Hospital Gasthuisberg, KU Leuven, Herestraat 49, 3000, Leuven, Belgium.
| | - Astrid Neys
- KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Paul Van Crombrugge
- Department of Endocrinology, OLV Ziekenhuis Aalst-Asse-Ninove, Moorselbaan 164, 9300, Aalst, Belgium
| | - Carolien Moyson
- Department of Endocrinology, University Hospital Gasthuisberg, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Johan Verhaeghe
- Department of Obstetrics and Gynecology, University Hospital Gasthuisberg, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Sofie Vandeginste
- Department of Obstetrics and Gynecology, OLV Ziekenhuis Aalst-Asse-Ninove, Moorselbaan 164, 9300, Aalst, Belgium
| | - Hilde Verlaenen
- Department of Obstetrics and Gynecology, OLV Ziekenhuis Aalst-Asse-Ninove, Moorselbaan 164, 9300, Aalst, Belgium
| | - Chris Vercammen
- Department of Endocrinology, Imelda Ziekenhuis, Imeldalaan 9, 2820, Bonheiden, Belgium
| | - Toon Maes
- Department of Endocrinology, Imelda Ziekenhuis, Imeldalaan 9, 2820, Bonheiden, Belgium
| | - Els Dufraimont
- Department of Obstetrics and Gynecology, Imelda Ziekenhuis, Imeldalaan 9, 2820, Bonheiden, Belgium
| | - Nele Roggen
- Department of Obstetrics and Gynecology, Imelda Ziekenhuis, Imeldalaan 9, 2820, Bonheiden, Belgium
| | - Christophe De Block
- Department of Endocrinology-Diabetology-Metabolism, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Belgium
| | - Yves Jacquemyn
- Department of Obstetrics and Gynecology, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Belgium
| | - Farah Mekahli
- Department of Endocrinology, Kliniek St-Jan Brussel, Kruidtuinlaan 32, 1000, Brussel, Belgium
| | - Katrien De Clippel
- Department of Obstetrics and Gynecology, Kliniek St-Jan Brussel, Kruidtuinlaan 32, 1000, Brussel, Belgium
| | - Annick Van Den Bruel
- Department of Endocrinology, AZ St Jan Brugge, Ruddershove 10, 8000, Brugge, Belgium
| | - Anne Loccufier
- Department of Obstetrics and Gynecology, AZ St Jan Brugge, Ruddershove 10, 8000, Brugge, Belgium
| | - Annouschka Laenen
- Center of Biostatics and Statistical Bioinformatics, KU Leuven, Kapucijnenvoer 35 bloc d, box 7001, 3000, Leuven, Belgium
| | - Roland Devlieger
- Department of Obstetrics and Gynecology, University Hospital Gasthuisberg, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Chantal Mathieu
- Department of Endocrinology, University Hospital Gasthuisberg, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Katrien Benhalima
- Department of Endocrinology, University Hospital Gasthuisberg, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
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Ozgu-Erdinc AS, Sert UY, Kansu-Celik H, Moraloglu Tekin O, Engin-Ustun Y. Prediction of gestational diabetes mellitus in the first trimester by fasting plasma glucose which cutoff is better? Arch Physiol Biochem 2022; 128:195-199. [PMID: 31573373 DOI: 10.1080/13813455.2019.1671457] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE We aimed to predict subsequent gestational diabetes mellitus (GDM) by fasting plasma glucose (FPG) in the first trimester. METHODS Healthy pregnant women who were screened for GDM at 24-28 gestational weeks and had FPG levels calculated during their first antenatal visit and less than 14 gestational weeks were included in this study. RESULTS Of the 2605 women who were recruited for the study, 245 (9.4%) were diagnosed with GDM at weeks 24-28. The diagnostic accuracy for FPG predicting GDM was 66.5, 78.4, and 88.2 for the cutoff values of 87.5 mg/dl, 92 mg/dl, and 99.5 mg/dl, respectively. CONCLUSIONS FPG values which are within the normoglycaemic range constitute an independent risk factor for the development of GDM. The threshold for gestational diabetes diagnosis must be revised.
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Affiliation(s)
- A Seval Ozgu-Erdinc
- Dr. Zekai Tahir Burak Women's Health Care, Education and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Umit Yasemin Sert
- Dr. Zekai Tahir Burak Women's Health Care, Education and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Hatice Kansu-Celik
- Dr. Zekai Tahir Burak Women's Health Care, Education and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Ozlem Moraloglu Tekin
- Dr. Zekai Tahir Burak Women's Health Care, Education and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Yaprak Engin-Ustun
- Dr. Zekai Tahir Burak Women's Health Care, Education and Research Hospital, University of Health Sciences, Ankara, Turkey
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10
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Lazarus G, Dirjayanto VJ, Sambowo NB, Vianca E. Detection of gestational diabetes mellitus by circulating plasma and serum microRNAs: A systematic review and meta-analysis. Diabetes Metab Syndr 2022; 16:102383. [PMID: 35016043 DOI: 10.1016/j.dsx.2021.102383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/27/2021] [Accepted: 12/28/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND AIMS The diagnostic performance of microRNAs (miRNAs), which have recently emerged as a potential early diagnostic tool capable of detecting gestational diabetes mellitus (GDM) in its early stages, has yet to be systematically investigated. This meta-analysis aims to investigate the diagnostic utility of circulating plasma or serum miRNAs in detecting GDM patients. METHODS Eligible studies were included and assessed for risk of bias with the Quality Assessment of Diagnostic Accuracy Studies 2 tool. A bivariate meta-analysis using the hierarchical summary receiver operating characteristic model was performed to estimate the pooled diagnostic value of miRNAs. RESULTS Twelve studies (32 index tests) cumulating a total of 1768 patients were included in the present study. The pooled sensitivity of miRNAs was 74.5% (95% confidence interval [CI]: 63.7-82.9) and the pooled specificity was 84.1% (95% CI: 76.8-89.3). The overall area under the curve was 0.869 (95% CI: 0.818-0.907) with a relatively narrow 95% confidence region and a wide 95% prediction region. CONCLUSION miRNAs may emerge as a promising diagnostic tool in detecting GDM. Further cross-sectional cohort studies with larger sample sizes and more heterogeneous populations, and studies evaluating the accuracy of multiple miRNAs in diagnosing GDM are required to confirm our findings.
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Affiliation(s)
- Gilbert Lazarus
- Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
| | | | | | - Elena Vianca
- Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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Argun D, Ciler Eren E. Evaluation of the circulating serum endotrophin in women with and without gestational diabetes mellitus during second trimester. Int J Diabetes Dev Ctries. [DOI: 10.1007/s13410-021-01005-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Masood SN, Lakho N, Saeed S, Masood Y. Non-fasting OGTT versus Fasting OGTT for screening of Hyperglycaemia in Pregnancy (HIP). Pak J Med Sci 2021; 37:1008-1013. [PMID: 34290774 PMCID: PMC8281142 DOI: 10.12669/pjms.37.4.3979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 03/18/2021] [Accepted: 04/02/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To compare the reliability of non-fasting oral glucose tolerance test (OGTT) versus fasting OGTT for screening of hyperglycaemia in pregnancy (HIP). METHODS This cross sectional analytic study was conducted by the Department of Obstetrics & Gynaecology, Isra University Karachi Campus from October 2016 to April 2017. A total of 225 pregnant women irrespective of gestational age were included in the study. They underwent non fasting 75 grams OGTT. Venous plasma glucose was done 02 hours after the glucose load. Same women were advised to come again within three to seven days for fasting OGTT. Venous plasma glucose (VPG) was estimated in fasting and 2 hours post glucose load. RESULTS Using the non-fasting OGTT, out of 204 women, 32 were diagnosed with hyperglycemia. All these 204 women were again called for fasting OGTT three to seven days after the initial non-fasting OGTT. Only nine were diagnosed with hyperglycemia, out of these nine women, seven women who were screen positive on non-fasting OGTT were found to be screen positive on fasting OGTT as well. However, only two women were additionally diagnosed with hyperglycemia who were initially screen negative on non-fasting OGTT. The non-fasting OGTT has diagnosed HIP with sensitivity of 77.7%, specificity of 87.1%, positive predictive value of 21.8% and negative predictive value of 98.8%. CONCLUSION The use of the non-fasting OGTT at first antenatal visit may be a practical approach to detect the HIP as screening and diagnostic tool in the resource constrained settings.
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Affiliation(s)
- Shabeen Naz Masood
- Dr. Shabeen Naz Masood, MBBS, MCPS, FCPS, PhD, DCPS. Department of Obstetrics & Gynaecology, Isra University, Karachi, Pakistan
| | - Nusrat Lakho
- Dr. Nusrat Lakho, MBBS, FCPS. Department of Obstetrics & Gynaecology, Isra University, Karachi, Pakistan
| | - Saira Saeed
- Dr. Saira Saeed, MBBS, FCPS. Department of Obstetrics & Gynaecology, Isra University, Karachi, Pakistan
| | - Yasir Masood
- Dr. Yasir Masood, MD, MPH. Department of Public Health, Brown School, Washington University in St. Louis, Missouri, USA
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Wang C, Wei Y, Yang Y, Su R, Song G, Kong L, Yang H. Evaluation of the value of fasting plasma glucose in the first trimester for the prediction of adverse pregnancy outcomes. Diabetes Res Clin Pract 2021; 174:108736. [PMID: 33705819 DOI: 10.1016/j.diabres.2021.108736] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 02/17/2021] [Accepted: 02/23/2021] [Indexed: 11/30/2022]
Abstract
AIMS To evaluate the importance and usefulness of fasting plasma glucose (FPG) in the first trimester in predicting adverse pregnancy outcomes. METHODS A retrospective study of 22,398 singleton pregnancies was conducted. Participants were divided into subgroups according to first-trimester FPG (low FPG, FPG < 5.1 mmol/L; medium FPG, 5.1 mmol/L ≤ FPG < 5.6 mmol/L; high FPG, 5.6 ≤ FPG < 7.0 mmol/L) and oral glucose tolerance test(OGTT) results (normal and abnormal) during pregnancy. Patient characteristics and risk of adverse pregnancy outcomes were compared. Then, the whole population of women with abnormal OGTT served as a reference, and the relative risks of maternal and neonatal complications in normal OGTT women were analyzed by categorical analyses and logistic regression. Subgroup analyses were performed according to pre-pregnancy body mass index (BMI). RESULTS The frequency of adverse pregnancy outcomes increased with increasing FPG levels during the first trimester, regardless of OGTT results. High FPG + Abnormal OGTT had the worst outcome. Compared to the whole population of women with abnormal OGTT, Normal OGTT + Medium FPG showed the same risk of PIH and macrosomia. Normal OGTT + High FPG showed the same risk of PIH, macrosomia as well as LGA and preterm birth. Additionally, Normal OGTT + Medium FPG + BMI ≥ 24 kg/m2 showed significantly higher risk of PIH (OR = 1.867, 1.245-2.800), macrosomia (OR = 1.748, 1.304-2.344) and LGA (OR = 1.274, 1.019-1.593). Furthermore, the OR value for PIH was 3.759 (1.680-8.412) in Normal OGTT + High FPG + BMI ≥ 24 kg/m2 compared to women with abnormal OGTT. CONCLUSIONS First-trimester FPG values can help identify women at increased risk for adverse pregnancy outcomes. Increased attention and management should be given to women with early pregnancy FPG ≥ 5.10 mmol/L despite a normal OGTT, especially if their BMI ≥ 24 kg/m2.
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Affiliation(s)
- Chen Wang
- Department of Obstetrics and Gynecology of Peking University First Hospital, Beijing, China; Beijing Key Laboratory of Maternal Fetal Medicine of Gestational Diabetes Mellitus
| | - Yumei Wei
- Department of Obstetrics and Gynecology of Peking University First Hospital, Beijing, China; Beijing Key Laboratory of Maternal Fetal Medicine of Gestational Diabetes Mellitus
| | - Yide Yang
- Teaching and Researching Office of Child and Adolescent Health, School of Medicine, Hunan Normal University, Changsha, China
| | - Rina Su
- Department of Obstetrics and Gynecology of Peking University First Hospital, Beijing, China; Beijing Key Laboratory of Maternal Fetal Medicine of Gestational Diabetes Mellitus
| | - Geng Song
- Department of Obstetrics and Gynecology of Peking University First Hospital, Beijing, China; Beijing Key Laboratory of Maternal Fetal Medicine of Gestational Diabetes Mellitus
| | - Lingying Kong
- Department of Obstetrics and Gynecology of Peking University First Hospital, Beijing, China; Beijing Key Laboratory of Maternal Fetal Medicine of Gestational Diabetes Mellitus
| | - Huixia Yang
- Department of Obstetrics and Gynecology of Peking University First Hospital, Beijing, China; Beijing Key Laboratory of Maternal Fetal Medicine of Gestational Diabetes Mellitus.
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Lappharat S, Liabsuetrakul T. Accuracy of screening tests for gestational diabetes mellitus in Southeast Asia: A systematic review of diagnostic test accuracy studies. Medicine (Baltimore) 2020; 99:e23161. [PMID: 33181689 PMCID: PMC7668444 DOI: 10.1097/md.0000000000023161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 10/09/2020] [Accepted: 10/16/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND To investigate the accuracy of screening tests for gestational diabetes mellitus (GDM) in Southeast Asian pregnant women. METHODS We searched PubMed (MEDLINE), Web of Science, Cochrane Library, ClinicalTrials.gov, Google Scholar, and Google for relevant articles published in English up to November 2018 using search terms related to GDM, screening tests for GDM and diagnostic performance. The studies were independently screened and selected by both authors. The methodological quality of the included studies was independently assessed by quality assessment of diagnostic accuracy studies 2. A hierarchical summary receiver operating characteristic (HSROC) model was created to estimate the HSROC curve. The summary sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were calculated in a meta-analysis using bivariate random-effects model. RESULTS A total of 19 studies were included in which the 100 g oral glucose tolerance test (OGTT) and 75 g OGTT were the two common reference standards for diagnosis of GDM. Most points of diagnostic performance in the HSROC 50 g GCT curve compared with the 100 g OGTT reference standard were clustered in the upper left-hand quadrant. The pooled sensitivity and specificity of the 50 g GCT were 79% (95% confidence interval [CI] 64%-89%) and 74% (95% CI 59%-85%), respectively. For the 75 g OGTT reference standard, the non-fasting 2-hour plasma glucose showed quite similar sensitivity the 50 g GCT compared with the 100 g OGTT reference standard. The pooled sensitivities and specificities of the fasting plasma glucose and hemoglobin A1c were 81% (95% CI 76%-86%) and 70% (95% CI 67%-72%), and 80% (95% CI 66%-90%) and 69% (95% CI 58%-78%), respectively. CONCLUSION Our findings indicate that the 50 g GCT using the threshold of 140 mg/dL is a good screening test for identifying GDM at 24 to 28 weeks' gestational age for both high-risk and universal screening strategies in Southeast Asian countries. The non-fasting 2-hour PG, fasting plasma glucose or hemoglobin A1c are alternative choices for screening.
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Nouhjah S, Jahanfar S, Shahbazian H. Temporary changes in clinical guidelines of gestational diabetes screening and management during COVID-19 outbreak: A narrative review. Diabetes Metab Syndr 2020; 14:939-942. [PMID: 32593935 PMCID: PMC7299858 DOI: 10.1016/j.dsx.2020.06.030] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/03/2020] [Accepted: 06/15/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS New clinical approaches are needed to minimize complications of gestational diabetes during the COVID-19 outbreak with timely screening and proper management. The present study aims to highlight changes in the clinical guideline for gestational diabetes during the pandemic. METHODS In a narrative review, multiple databases were searched. Furthermore, online searches were conducted to identify guidelines or support documents provided by NGOs, local health authorities, and societies and organizations in the field of diabetes and obstetrics. RESULTS We included five national guidelines that were published in English from Canada, the United Kingdom, Australia, New Zealand, and Australia health agencies. FBG, A1C, RPG were recommended as alternative tests instead of a 2-h oral glucose tolerance test (OGGT) for GDM screening at 24-28 weeks of gestation. Recommendations also included a deferral of postpartum screening till the end of the pandemic, or postponement of testing to 6-12 months after delivery, use telemedicine and telecare. CONCLUSIONS Updated temporary changes in clinical guidelines are sensible and accommodates social distancing and minimizes risk of exposure to COVID-19. Despite many unsolved controversies in screening, treatment, and follow-up of gestational diabetes, it seems involvement with novel coronavirus have made a reach to a global agreement simpler.
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Affiliation(s)
- Sedigheh Nouhjah
- Diabetes Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Shayesteh Jahanfar
- MPH Program, Central Michigan University, Health Sciences Building, 2209, Mount Pleasant, MI, 48859, USA.
| | - Hajieh Shahbazian
- Diabetes Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Simmons D, Rudland VL, Wong V, Flack J, Mackie A, Ross GP, Coat S, Dalal R, Hague BM, Cheung NW. Options for screening for gestational diabetes mellitus during the SARS-CoV-2 pandemic. Aust N Z J Obstet Gynaecol 2020; 60:660-666. [PMID: 32779188 PMCID: PMC7436309 DOI: 10.1111/ajo.13224] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/22/2020] [Accepted: 06/29/2020] [Indexed: 11/27/2022]
Abstract
The balance between avoiding severe acute respiratory syndrome coronavirus‐2 contagion and reducing wider clinical risk is unclear for gestational diabetes mellitus (GDM) testing. Recent recommendations promote diagnostic approaches that limit collection but increase undiagnosed GDM, which potentially increases adverse pregnancy outcome risks. The most sensitive approach to detecting GDM at 24–28 weeks beyond the two‐hour oral glucose tolerance test (OGTT) is a one‐hour OGTT (88% sensitivity). Less sensitive approaches use fasting glucose alone (≥5.1 mmol/L: misses 44–54% GDM) or asking ~20% of women for a second visit (fasting glucose 4.7–5.0 mmol/L (62–72% sensitive)). Choices should emphasise local and patient decision‐making.
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Affiliation(s)
- David Simmons
- Campbelltown Hospital, Sydney, New South Wales, Australia.,Macarthur Clinical School, School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia
| | | | - Vincent Wong
- Liverpool Hospital, Sydney, New South Wales, Australia
| | - Jeff Flack
- Bankstown Hospital, Sydney, New South Wales, Australia
| | - Adam Mackie
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Glynis P Ross
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Suzette Coat
- University of Adelaide and Women's and Children's Hospital, Adelaide, South Australia, Australia
| | | | - Bill M Hague
- University of Adelaide and Women's and Children's Hospital, Adelaide, South Australia, Australia
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Shriyan P, Babu GR, Ravi D, Ana Y, van Schayck OCP, Thankachan P, Murthy GVS. Ambient and Indoor Air Pollution in Pregnancy and the risk of Low birth weight and Ensuing Effects in Infants (APPLE): A cohort study in Bangalore, South India. Wellcome Open Res 2020. [DOI: 10.12688/wellcomeopenres.14830.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Exposure to air pollution (IAP) from the combustion of solid fuels is a significant cause of morbidity and mortality in developing countries. Pregnant women exposed to higher pollutant levels are at higher risk of delivering a low-birth-weight (LBW) baby. There is a lack of standardized data regarding the levels and types of specific pollutants and how they impact LBW. We aim to prospectively assess the association between ambient and indoor air pollution levels in pregnancy and low birth weight and understand the subsequent risk of adiposity in these infants. Methods: We will conduct a prospective cohort study of 516 pregnant women recruited before 18 weeks of gestation in the urban slums of Bangalore, who have voluntarily consented to participate. We will estimate the level of air pollutants including particulate matter (<10 μm, <2.5 μm) and carbon monoxide (CO) parts per million (ppm) levels in both indoor and ambient environment. The follow-up of the delivered children will be done at delivery until the infant is one year old. The association between pollutants and LBW will be evaluated using logistic regression adjusting for potential confounders.Further, we will explore the mediation role of LBW in the hypothesized causal chain of air pollution and adiposity. Nested within a large cohort titled "Maternal Antecedents of Adiposity and Studying the Transgenerational role of Hyperglycemia and Insulin (MAASTHI)", we can estimate the absolute risk of having low birth weight caused by air pollution and other variables. Discussion: Understanding the association between exposures to ambient and indoor air pollution and low birth weight is essential in India. LBW babies have a higher risk of developing obesity and Non-Communicable Diseases (NCDs) during adulthood. The results from this study can inform the efforts for controlling the air pollution-related chronic diseases in India.
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Sesmilo G, Prats P, Garcia S, Rodríguez I, Rodríguez-Melcón A, Berges I, Serra B. First-trimester fasting glycemia as a predictor of gestational diabetes (GDM) and adverse pregnancy outcomes. Acta Diabetol 2020; 57:697-703. [PMID: 31984438 DOI: 10.1007/s00592-019-01474-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 12/30/2019] [Indexed: 12/28/2022]
Abstract
AIMS Studies to prevent gestational diabetes (GDM) have shown the best results when lifestyle measures have been applied early in pregnancy. We aimed to investigate whether first-trimester fasting plasma glucose (FPG) could predict GDM risk and adverse pregnancy outcomes. METHODS A retrospective analysis of prospectively collected data from singleton pregnancies who were attended at our hospital between 2008 and 2018 (n = 27,198) was performed. We included patients with a recorded first-trimester FPG and complete pregnancy data (n = 6845). Patients under 18, with pregestational diabetes or reproductive techniques, were excluded. First-trimester FPG was evaluated as a continuous variable and divided into quartiles. GDM was diagnosed by NDDG criteria. The relationship between first- and second-trimester glucose > 92 mg/dL was also investigated. The relationship between FPG and pregnancy outcomes was assessed in 6150 patients who did not have GDM. RESULTS Maternal age was 34.2 ± 3.9 years, BMI 23.1 ± 3.7 kg/m2 and mean FPG 83.0 ± 7.3 mg/dL. Glucose quartiles were: ≤ 78, 79-83, 84-87 and ≥ 88 mg/dL. First-trimester FPG predicted the risk of GDM (7%, 8%, 10.2% and 16% in each quartile, p < 0.001) and the risk of second-trimester glucose > 92 mg/dL (2.6%, 3.8%, 6.3% and 11.4% in each quartile, p < 0.001). FPG was significantly associated with LGA (8.2%, 9.3%, 10% and 11.7% in each quartile, p = 0.011) but not with other obstetrical outcomes. In a multivariate analysis including age, BMI, tobacco use, number of pregnancies and weight gained during pregnancy, first-trimester FPG was an independent predictor of LGA. CONCLUSIONS First-trimester FPG is an early marker of GDM and LGA.
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Affiliation(s)
- G Sesmilo
- Endocrine Unit, Hospital Universitari Quirón-Dexeus, C/Sabino de Arana 5-19, 08028, Barcelona, Spain.
| | - P Prats
- Obstetrical, Gynecologic and Reproductive Unit, Hospital Universitari Quirón-Dexeus, C/Sabino de Arana 5-19, 08028, Barcelona, Spain
| | - S Garcia
- Obstetrical, Gynecologic and Reproductive Unit, Hospital Universitari Quirón-Dexeus, C/Sabino de Arana 5-19, 08028, Barcelona, Spain
| | - I Rodríguez
- Obstetrical, Gynecologic and Reproductive Unit, Hospital Universitari Quirón-Dexeus, C/Sabino de Arana 5-19, 08028, Barcelona, Spain
| | - A Rodríguez-Melcón
- Obstetrical, Gynecologic and Reproductive Unit, Hospital Universitari Quirón-Dexeus, C/Sabino de Arana 5-19, 08028, Barcelona, Spain
| | - I Berges
- Endocrine Unit, Hospital Universitari Quirón-Dexeus, C/Sabino de Arana 5-19, 08028, Barcelona, Spain
| | - B Serra
- Obstetrical, Gynecologic and Reproductive Unit, Hospital Universitari Quirón-Dexeus, C/Sabino de Arana 5-19, 08028, Barcelona, Spain
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Abstract
BACKGROUND Recently, we reported that the microRNAs (miRNAs) miR-20a-5p and-to a lesser extent-miR-222-3p hold potential as biomarkers for gestational diabetes mellitus (GDM) in human immunodeficiency virus (HIV)-negative South African women. METHODS In this preliminary study, we measured the expression of these miRNAs in HIV-positive women (GDM 15, non-GDM 52; median 26.0 weeks; range 16-30). RESULTS Although the same trend of decreased expression of miR-20a-5p (1.5-fold decrease) and miR-222-3p (1.4-fold decrease) was observed in sera of women with and without GDM, these differences were not statistically significant. Stratification according to antiretroviral treatment (ART) confirmed decreased expression of miR-20a-5p and miR-222-3p in ART-naïve and ART-treated women with GDM, although again this was not statistically significant. CONCLUSION Our results demonstrate that HIV infection modifies the expression of miR-20a-5p and miR-222-3p in women with GDM. Importantly, this study highlights the complexities of miRNA profiling and the need for GDM biomarker discovery in both HIV-infected and uninfected individuals, particularly in South Africa, where approximately 30% of pregnancies are complicated by HIV. Further studies to elucidate the mechanisms that underlie these miRNA differences are needed.
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Affiliation(s)
- Carmen Pheiffer
- Biomedical Research and Innovation Platform (BRIP), South African Medical Research Council, Francie Van Zijl Drive, Tygerberg, Western Cape, 7505, South Africa. .,Division of Medical Physiology, Faculty of Health Sciences, Stellenbosch University, Tygerberg, South Africa.
| | - Stephanie Dias
- Biomedical Research and Innovation Platform (BRIP), South African Medical Research Council, Francie Van Zijl Drive, Tygerberg, Western Cape, 7505, South Africa.,Department of Obstetrics and Gynecology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Paul Rheeder
- Department of Internal Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Sumaiya Adam
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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Machado C, Monteiro S, Oliveira MJ. Impact of overweight and obesity on pregnancy outcomes in women with gestational diabetes - results from a retrospective multicenter study. Arch Endocrinol Metab 2020; 64:45-51. [PMID: 31576966 PMCID: PMC10522280 DOI: 10.20945/2359-3997000000178] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 08/04/2019] [Indexed: 11/23/2022]
Abstract
Objective The aim of this study was to evaluate the impact of pre-pregnancy body mass index (BMI) on pregnancy outcomes in women with gestational diabetes (GD). Subjects and methods Retrospective multicenter study using data from the Portuguese National Register. We included women with GD with a singleton pregnancy. GD diagnosis was according to the International Association of the Diabetes and Pregnancy Study Group criteria. Women were divided into groups according to their pre-pregnancy BMI: < 18.5 kg/m2 (underweight), ≥ 18.5 and < 25.0 kg/m2 (normal weight), ≥ 25 and < 30 kg/m2 (overweight) and ≥ 30 kg/m2 (obese). Results We included 3,103 pregnant women with GD, 29.6% (n = 918) were overweight and 27.3% (n = 846) were obese. Compared to normal weight, the overweight and obese groups had a higher percentage of gestational hypertension (4.0% and 8.5% vs. 2.1%), cesarean delivery (32.8% and 41.3% vs. 27.9%), macrosomia (3.9% and 6.7% vs. 2.4%), and large for gestational age (LGA) newborns (8.3% and 13.5% vs. 6.0%). Obesity increased the risk of gestational hypertension (OR 4.5, p < 0.001), preeclampsia (OR 1.9, p = 0.034), cesarean delivery (OR 2.0, p < 0.001), macrosomia (OR 3.1, p < 0.001) and LGA (OR 2.3, p < 0.001). Conclusion In pregnant women with GD, pregnancy complications increase with pre-pregnancy BMI. In obese women, appropriate diet and counseling prior to gestation and more aggressive medical intervention during pregnancy are needed in order to prevent macrosomic and LGA newborns and to reduce maternal complications.
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Affiliation(s)
- Catarina Machado
- Departamento de Endocrinologia, Centro Hospitalar de Vila Nova de Gaia, Espinho, Porto, Portugal
| | - Sara Monteiro
- Departamento de Endocrinologia, Centro Hospitalar de Vila Nova de Gaia, Espinho, Porto, Portugal
| | - Maria João Oliveira
- Departamento de Endocrinologia, Centro Hospitalar de Vila Nova de Gaia, Espinho, Porto, Portugal
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Abstract
An ideal screening test for gestational diabetes should be capable of identifying not only women with the disease but also the women with a high risk of developing gestational diabetes mellitus (GDM). Screening and diagnosis are the main steps leading to the way of management. There is a lack of consensus among healthcare professionals regarding the screening methods worldwide. Different study groups advocate a variety of screening methods with the support of evidence-based comprehensive data. Some of the organizations suggest screening for high risk or all pregnant women, while others prefer to offer definitive testing without screening. Glycemic thresholds are also not standardized to decide GDM among different guidelines. Prevalence rates of GDM vary between populations and with the choice of glucose thresholds for both screening and definitive tests. One-step or two-step methods have been used for GDM diagnosis. However, screening includes selecting patients with historical risk factors, 50 g 1-h glucose challenge test, fasting plasma glucose, random plasma glucose, and hemoglobin A1c with different cutoffs. In this chapter, screening and diagnosis methods of GDM accepted by different study groups will be discussed which will be followed by the evaluation of different glycemic thresholds. Then the advantages and disadvantages of used methods will be explained and the chapter will finish with an evaluation of the current international guidelines.
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Affiliation(s)
- U Yasemin Sert
- Ministry of Health-Ankara City Hospital, Universiteler Mahallesi Bilkent Cad, Ankara, Turkey
| | - A Seval Ozgu-Erdinc
- Ministry of Health-Ankara City Hospital, Universiteler Mahallesi Bilkent Cad, Ankara, Turkey.
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Pereda J, Bove I, Pineyro MM. Excessive Maternal Weight and Diabetes Are Risk Factors for Macrosomia: A Cross-Sectional Study of 42,663 Pregnancies in Uruguay. Front Endocrinol (Lausanne) 2020; 11:588443. [PMID: 33224106 PMCID: PMC7669744 DOI: 10.3389/fendo.2020.588443] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/09/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To evaluate the risk of macrosomia in newborns from women with gestational diabetes, pregestational diabetes, overweight, and obesity in Uruguay in 2012, as well as its association with prolonged pregnancy, maternal age, multiparity, and excessive gestational weight gain (EGWG). METHODS We performed a cross-sectional study of 42,663 pregnant women. The risk of macrosomia was studied using logistic regression. RESULTS Mean maternal age was 26.7 ± 6.8 years. Pregestational overweight and obesity was present in 20.9% and 10.7% of women, respectively. There were 28.1% and 19.8% of women overweight and obese at the end of the pregnancy, respectively. Furthermore, 0.5% had pregestational diabetes and 8.5% were multiparous. Twenty two percent developed gestational diabetes and 44.9% had EGWG. The prevalence of macrosomia was 7.9%, significantly more prevalent in males (10.0% vs. 5.5%, p<0.005). Univariate analysis showed that obesity and overweight pre-pregnancy, obesity and overweight at the end of pregnancy, EGWG, pregestational diabetes, gestational diabetes, multiparity, prolonged pregnancy, and male newborn were strongly associated with macrosomia (p<0.0001). Maternal age >35 years did not increase the risk of macrosomia. After multiple logistic regression macrosomia was more likely in pre-gestational obese women (OR 1.24; CI 1.07-1.44), overweight women at the end of pregnancy (OR 1.66; CI 1.46-1.87), obese women at the end of pregnancy (OR 2.21; CI 1.90-2.58), women with EGWG (OR 1.78; CI 1.59-1.98), pregestational diabetes (OR 1.75; CI 1.15-2.69), gestational diabetes (OR 1.39; CI 1.25-1.53), prolonged pregnancy (OR 2.67; CI 2.28-3.12), multiparity (OR 1.24; CI 1.04-1.48), and male newborn (OR 1.89; CI 1.72-2.08). CONCLUSION Maternal overweight, obesity, EGWG, and gestational diabetes are prevalent in Uruguay, increasing the risk of macrosomia. Efforts to implement strategies to decrease the prevalence of overweight and obesity among women of reproductive age are essential to improve maternal and neonatal outcomes.
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Affiliation(s)
- Jimena Pereda
- Clinica de Endocrinología y Metabolismo, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Isabel Bove
- Departamento de Ciencias Cognitivas y de la Salud, Universidad Católica del Uruguay, Montevideo, Uruguay
| | - Maria M. Pineyro
- Clinica de Endocrinología y Metabolismo, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
- *Correspondence: Maria M. Pineyro, ; orcid.org/0000-0003-2083-7839
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Jamieson EL, Spry EP, Kirke AB, Atkinson DN, Marley JV. Real-World Gestational Diabetes Screening: Problems with the Oral Glucose Tolerance Test in Rural and Remote Australia. Int J Environ Res Public Health 2019; 16:E4488. [PMID: 31739513 DOI: 10.3390/ijerph16224488] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 11/10/2019] [Accepted: 11/11/2019] [Indexed: 01/28/2023]
Abstract
Gestational diabetes mellitus (GDM) is the most common antenatal complication in Australia. All pregnant women are recommended for screening by 75 g oral glucose tolerance test (OGTT). As part of a study to improve screening, 694 women from 27 regional, rural and remote clinics were recruited from 2015–2018 into the Optimisation of Rural Clinical and Haematological Indicators for Diabetes in pregnancy (ORCHID) study. Most routine OGTT samples were analysed more than four hours post fasting collection (median 5.0 h, range 2.3 to 124 h), potentially reducing glucose levels due to glycolysis. In 2019, to assess pre-analytical plasma glucose (PG) instability over time, we evaluated alternative sample handling protocols in a sample of participants. Four extra samples were collected alongside routine room temperature (RT) fluoride-oxalate samples (FLOXRT): study FLOXRT; ice slurry (FLOXICE); RT fluoride-citrate-EDTA (FC Mix), and RT lithium-heparin plasma separation tubes (PST). Time course glucose measurements were then used to estimate glycolysis from ORCHID participants who completed routine OGTT after 24 weeks gestation (n = 501). Adjusting for glycolysis using FLOXICE measurements estimated 62% under-diagnosis of GDM (FLOXRT 10.8% v FLOXICE 28.5% (95% CI, 20.8–29.5%), p < 0.001). FC Mix tubes provided excellent glucose stability but gave slightly higher results (Fasting PG: +0.20 ± 0.05 mmol/L). While providing a realistic alternative to the impractical FLOXICE protocol, direct substitution of FC Mix tubes in clinical practice may require revision of GDM diagnostic thresholds.
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Shriyan P, Babu GR, Ravi D, Ana Y, van Schayck OCP, Thankachan P, Murthy GVS. Ambient and Indoor Air Pollution in Pregnancy and the risk of Low birth weight and Ensuing Effects in Infants (APPLE): A cohort study in Bangalore, South India. Wellcome Open Res 2019. [DOI: 10.12688/wellcomeopenres.14830.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Exposure to air pollution (IAP) from the combustion of solid fuels is a significant cause of morbidity and mortality in developing countries. Pregnant women exposed to higher pollutant levels are at higher risk of delivering a low-birth-weight (LBW) baby. There is a lack of standardized data regarding the levels and types of specific pollutants and how they impact LBW. We aim to prospectively assess the association between ambient and indoor air pollution levels in pregnancy and low birth weight and understand the subsequent risk of adiposity in these infants. Methods: We will conduct a prospective cohort study of 516 pregnant women recruited before 18 weeks of gestation in the urban slums of Bangalore, who have voluntarily consented to participate. We will estimate the level of air pollutants including coarse particulate matter 10 ug/m3 (PM10 ), fine particulate matter 2.5 ug/m3(PM2.5) and carbon monoxide (CO) parts per million (ppm) levels in both indoor and ambient environment. The follow-up of the delivered children will be done at delivery until the infant is two years old. The association between pollutants and LBW will be evaluated using logistic regression adjusting for potential confounders.Further, we will explore the mediation role of LBW in the hypothesized causal chain of air pollution and adiposity. Nested within a larger Maternal Antecedents of Adiposity and Studying the Transgenerational role of Hyperglycemia and Insulin (MAASTHI) cohort, we can estimate the absolute risk of having low birth weight caused by air pollution and other variables. Discussion: Understanding the association between exposures to ambient and indoor air pollution and low birth weight is essential in India. LBW babies have a higher risk of developing obesity and Non-Communicable Diseases (NCDs) during adulthood. The results from this study can inform the efforts for controlling the air pollution-related chronic diseases in India.
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25
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Volanski W, do Prado AL, Al-Lahham Y, Teleginski A, Pereira FS, Alberton D, Rego FGDM, Valdameri G, Picheth G. d-GDM: A mobile diagnostic decision support system for gestational diabetes. Arch Endocrinol Metab 2019; 63:524-530. [PMID: 31482958 PMCID: PMC10522262 DOI: 10.20945/2359-3997000000171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 07/09/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The aim of the study is to describe a portable and convenient software to facilitate the diagnostics of gestational (GDM) and pre-gestational diabetes (PGDM). MATERIALS AND METHODS An open source software, d-GDM, was developed in Java. The integrated development environment Android Studio was used as the Android operational system. The software for GDM diagnosis uses the criteria endorsed by the International Association of Diabetes and Pregnancy Study Group, modified by the World Health Organization. RESULTS GDM diagnosis criteria is not simple to follow, therefore, errors or inconsistencies in diagnosis are expected and could delay the appropriate treatment. The d-GDM, was developed to assist GDM diagnosis with precision and consistency diagnostic reports. The open source software can be manipulated conveniently. The operator requires information regarding the gestational period and selects the appropriate glycaemic marker options from the menu. During operation, pressing the button "diagnosticar" on the screen will present the diagnosis and information for the follow up. d-GDM is available in Portuguese or English and can be downloaded from the Google PlayStore. A responsive web version of d-GDM is also available. The usefulness and accuracy of d-GDM was verify by field tests involving 22 subjects and 5 mobile phone brands. The approval regards user-friendliness and efficiency were 95% or higher. The GDM diagnosis were 100% correct, in this pilot test. d-GDM is a user-friendly, free software for diagnosis that was developed for mobile devices. It has the potential to contribute and facilitate the diagnosis of gestational diabetes for healthcare professionals.
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Affiliation(s)
- Waldemar Volanski
- Universidade Federal do ParanáPrograma de Pós-graduação em Ciências FarmacêuticasUniversidade Federal do ParanáCuritibaPRBrasilPrograma de Pós-graduação em Ciências Farmacêuticas, Universidade Federal do Paraná, Curitiba, PR, Brasil
- Prefeitura Municipal de CuritibaPrefeitura Municipal de CuritibaCuritibaPRBrasilPrefeitura Municipal de Curitiba, Curitiba, PR, Brasil
| | - Ademir Luiz do Prado
- Instituto Federal de Educação, Ciência e Tecnologia do ParanáInstituto Federal de Educação, Ciência e Tecnologia do ParanáPRBrasilInstituto Federal de Educação, Ciência e Tecnologia do Paraná, PR, Brasil
| | - Yusra Al-Lahham
- Universidade Federal do ParanáPrograma de Pós-graduação em Ciências FarmacêuticasUniversidade Federal do ParanáCuritibaPRBrasilPrograma de Pós-graduação em Ciências Farmacêuticas, Universidade Federal do Paraná, Curitiba, PR, Brasil
| | - Adriana Teleginski
- Universidade Federal do ParanáPrograma de Pós-graduação em Ciências FarmacêuticasUniversidade Federal do ParanáCuritibaPRBrasilPrograma de Pós-graduação em Ciências Farmacêuticas, Universidade Federal do Paraná, Curitiba, PR, Brasil
| | - Fabiana Santos Pereira
- Universidade Federal do ParanáPrograma de Pós-graduação em Ciências FarmacêuticasUniversidade Federal do ParanáCuritibaPRBrasilPrograma de Pós-graduação em Ciências Farmacêuticas, Universidade Federal do Paraná, Curitiba, PR, Brasil
| | - Dayane Alberton
- Universidade Federal do ParanáPrograma de Pós-graduação em Ciências FarmacêuticasUniversidade Federal do ParanáCuritibaPRBrasilPrograma de Pós-graduação em Ciências Farmacêuticas, Universidade Federal do Paraná, Curitiba, PR, Brasil
| | - Fabiane Gomes de Moraes Rego
- Universidade Federal do ParanáPrograma de Pós-graduação em Ciências FarmacêuticasUniversidade Federal do ParanáCuritibaPRBrasilPrograma de Pós-graduação em Ciências Farmacêuticas, Universidade Federal do Paraná, Curitiba, PR, Brasil
| | - Glaucio Valdameri
- Universidade Federal do ParanáPrograma de Pós-graduação em Ciências FarmacêuticasUniversidade Federal do ParanáCuritibaPRBrasilPrograma de Pós-graduação em Ciências Farmacêuticas, Universidade Federal do Paraná, Curitiba, PR, Brasil
| | - Geraldo Picheth
- Universidade Federal do ParanáPrograma de Pós-graduação em Ciências FarmacêuticasUniversidade Federal do ParanáCuritibaPRBrasilPrograma de Pós-graduação em Ciências Farmacêuticas, Universidade Federal do Paraná, Curitiba, PR, Brasil
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Li P, Lin S, Li L, Cui J, Zhou S, Fan J. First-trimester fasting plasma glucose as a predictor of gestational diabetes mellitus and the association with adverse pregnancy outcomes. Pak J Med Sci 2019; 35:95-100. [PMID: 30881404 PMCID: PMC6408635 DOI: 10.12669/pjms.35.1.216] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Objective: To evaluate the usefulness of a fasting plasma glucose (FPG) at the first trimester in predicting gestational diabetes mellitus (GDM) and the association between FPG and adverse pregnancy outcomes. Methods: The levels of FPG in women with singleton pregnancies were measured at 9-13+6 weeks. A two hour 75-g oral glucose tolerance test (OGTT) was completed at 24-28 weeks and the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria was used. Adverse pregnancy outcomes were assessed and recorded. Results: Among 2112 pregnant women enrolled in the study, 224 (10.6%) subjects were diagnosed with GDM. The AUC for FPG in predicting GDM was 0.63 (95% CI 0.61- 0.65) and the optimal cutoff value was 4.5 mmol/L (sensitivity 64.29% and specificity 56.45%). Higher first-trimester FPG increased the prevalence of GDM, large for gestational age (LGA) and assisted vaginal delivery and/or cesarean section (all P < 0.05). Conclusion: FPG at first trimester could be used to predict GDM and higher first-trimester FPG was associated with adverse pregnancy outcomes.
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Affiliation(s)
- Ping Li
- Ping Li, MD. Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
| | - Shuo Lin
- Shuo Lin, DD. Department of Endocrinology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
| | - Ling Li
- Ling Li, MD. Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
| | - Jinhui Cui
- Jinhui Cui, MD. Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
| | - Shuisheng Zhou
- Shuisheng Zhou, MD. Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
| | - Jianhui Fan
- Jianhui Fan, MD. Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
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27
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Shriyan P, Babu GR, Ravi D, Ana Y, van Schayck OCP, Thankachan P, Murthy GVS. Ambient and Indoor Air Pollution in Pregnancy and the risk of Low birth weight and Ensuing Effects in Infants (APPLE): A cohort study in Bangalore, South India. Wellcome Open Res 2018. [DOI: 10.12688/wellcomeopenres.14830.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Exposure to air pollution (IAP) from the combustion of solid fuels is a significant cause of morbidity and mortality in developing countries. Pregnant women exposed to higher pollutant levels are at higher risk of delivering a low-birth-weight (LBW) baby. There is a lack of standardized data regarding the levels and types of specific pollutants and how they impact LBW. We aim to prospectively assess the association between ambient and indoor air pollution levels in pregnancy and low birth weight and understand the subsequent risk of adiposity in these infants. Methods: We will conduct a prospective cohort study of 516 pregnant women recruited before 18 weeks of gestation in the urban slums of Bangalore, who have voluntarily consented to participate. We will estimate the level of air pollutants including coarse particulate matter 10 ug/m3 (PM10 ), fine particulate matter 2.5 ug/m3(PM2.5) and carbon monoxide (CO) parts per million (ppm) levels in both indoor and ambient environment. The follow-up of the delivered children will be done at delivery until the infant is two years old. The association between pollutants and LBW will be evaluated using logistic regression adjusting for potential confounders.Further, we will explore the mediation role of LBW in the hypothesized causal chain of air pollution and adiposity. Nested within a larger Maternal Antecedents of Adiposity and Studying the Transgenerational role of Hyperglycemia and Insulin (MAASTHI) cohort, we can estimate the absolute risk of having low birth weight caused by air pollution and other variables. Discussion: Understanding the association between exposures to ambient and indoor air pollution and low birth weight is essential in India. LBW babies have a higher risk of developing obesity and Non-Communicable Diseases (NCDs) during adulthood. The results from this study can inform the efforts for controlling the air pollution-related chronic diseases in India.
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28
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Lekva T, Godang K, Michelsen AE, Qvigstad E, Normann KR, Norwitz ER, Aukrust P, Henriksen T, Bollerslev J, Roland MCP, Ueland T. Prediction of Gestational Diabetes Mellitus and Pre-diabetes 5 Years Postpartum using 75 g Oral Glucose Tolerance Test at 14-16 Weeks' Gestation. Sci Rep 2018; 8:13392. [PMID: 30190548 PMCID: PMC6127333 DOI: 10.1038/s41598-018-31614-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 08/22/2018] [Indexed: 01/24/2023] Open
Abstract
Early detection and treatment of women at risk for gestational diabetes mellitus (GDM) could improve perinatal and long-term outcomes in GDM women and their offspring. We explored if a 75 g oral glucose tolerance test (OGTT) at 14–16 weeks of gestation could identify women who will (1) develop GDM or give birth to large-for-gestational-age (LGA) babies in 1031 pregnant women from the STORK study using different diagnostic criteria (WHO1999, IADPSG2010, WHO2013, NORWAY2017) and (2) develop pre-diabetes 5 years postpartum focusing on first trimester β-cell function in a separate study of 300 women from the STORK cohort. The sensitivity of the 14–16 week OGTT to identify women who would develop GDM or have LGA babies was low, and we could not identify alternative cut-offs to exclude women not at risk or identify women that could benefit from early intervention. First trimester β-cell function was a stronger determinant than third trimester β-cell function of predicting maternal pre-diabetes. In conclusion, in our normal low-risk population, the 75 g OGTT at 14–16 weeks is insufficient to identify candidates for early treatment of GDM or identify women not likely to develop GDM or have LGA babies. First trimester β-cell function may predict pre-diabetes 5 years postpartum.
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Affiliation(s)
- Tove Lekva
- Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
| | - Kristin Godang
- Section of Specialized Endocrinology, Department of Endocrinology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Annika E Michelsen
- Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Elisabeth Qvigstad
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Aker, Oslo, Norway
| | - Kjersti Ringvoll Normann
- Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Section of Specialized Endocrinology, Department of Endocrinology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Errol R Norwitz
- Mother Infant Research Institute, Tufts Medical Center, Boston, MA, USA.,Department of Obstetrics & Gynecology, Tufts Medical Center and Tufts University School of Medicine, Boston, MA, USA
| | - Pål Aukrust
- Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway.,Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,K.G. Jebsen Inflammatory Research Center, University of Oslo, Oslo, Norway.,K.G. Jebsen Thrombosis Research and Expertise Center, University of Tromsø, Tromsø, Norway
| | - Tore Henriksen
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Obstetrics, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Jens Bollerslev
- Section of Specialized Endocrinology, Department of Endocrinology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Marie Cecilie Paasche Roland
- National Advisory Unit for Womens Health, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Department of Obstetrics, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Thor Ueland
- Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway.,K.G. Jebsen Thrombosis Research and Expertise Center, University of Tromsø, Tromsø, Norway
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Abstract
AIM In 2010, in light of the data coming from the HAPO study, the International Association of Diabetes and Pregnancy Study Groups (IADPSG) proposed a new detection strategy and diagnostic criteria for gestational diabetes based on a one-step approach with a 75 g OGTT. This review analyzes and discusses the bright and dark sides of their application. METHODS The assessment of these recommendations by the international organizations involved in the care of gestational diabetes and a series of observational, retrospective and prospective studies that have been published since 2010 regarding the use of the IADPSG recommendations have been evaluated. RESULTS The different international associations involved in the care of pregnancy and of pregnancy complicated by diabetes have not taken an univocal position some of which have accepted them, while others have criticized them. Then, the actual application of the approach recommended by the IADPSG for detecting and diagnosing GDM varies, even at centers that reportedly accept the new diagnostic criteria. CONCLUSION So the challenge lies in making every effort to achieve a global standardization of the strategies for detecting, diagnosing and treating GDM.
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Affiliation(s)
- Annunziata Lapolla
- Diabetology and Dietetics Unit, Department of Medicine, Padova University, Padova, Italy.
| | - Boyd E Metzger
- Division of Endocrinology, Metabolism and Molecular Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, USA
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Hosseini E, Janghorbani M, Shahshahan Z. Comparison of risk factors and pregnancy outcomes of gestational diabetes mellitus diagnosed during early and late pregnancy. Midwifery 2018; 66:64-69. [PMID: 30130677 DOI: 10.1016/j.midw.2018.07.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 06/14/2018] [Accepted: 07/30/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compare risk factors and pregnancy outcomes of gestational diabetes mellitus (GDM) diagnosed during early and late pregnancy. DESIGN Prospective population-based cohort study. SETTING Community health care centers of Isfahan, Iran. PARTICIPANTS AND MEASUREMENTS 1000 pregnant women who were eligible and consented to participate underwent fasting plasma glucose testing at the first prenatal visit (6-14 weeks). The women free from GDM or overt diabetes were screened at 24-28 weeks of gestation using a 75-g, 2-hour oral glucose tolerance test. The diagnosis of GDM was reached through the International Association of the Diabetes and Pregnancy Study Groups. Early-onset GDM was defined as the diagnosis of GDM at the first prenatal visit. Late-onset GDM was defined as the diagnosis of GDM later at 24-28 weeks. FINDINGS Prevalence of GDM was 10% (95% CI: 8.1-11.9) at the first prenatal visit. GDM incidence was 9.3% (95% CI: 7.4-11.2) at 24-28 weeks of gestation. Family history of diabetes, and previous gestational diabetes and maternal age were the independent risk factors for GDM during early and late diagnosis. GDM was associated with increased risk of macrosomia, large for gestational age, and cesarean section in both periods while, neonates of women with early-onset GDM were more likely to have an apgar score at 1-min < 7, and neonatal respiratory distress syndrome and were more admitted to the neonatal intensive care unit. KEY CONCLUSION AND IMPLICATION FOR PRACTICE Despite early screening and current practice management, early-onset GDM was associated with poorer pregnancy outcomes compared to the late-onset group. Women with early-onset GDM would benefit from more strict surveillance and management strategies to improve pregnancy outcomes. Further studies are needed to evaluate the efficacy of alternative management approaches in these high risk women.
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Affiliation(s)
- Elham Hosseini
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohsen Janghorbani
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Zahra Shahshahan
- Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
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Agarwal MM. Consensus in Gestational Diabetes MELLITUS: Looking for the Holy Grail. J Clin Med 2018; 7:E123. [PMID: 29843401 PMCID: PMC6025068 DOI: 10.3390/jcm7060123] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 05/21/2018] [Accepted: 05/23/2018] [Indexed: 12/17/2022] Open
Abstract
The world's pre-eminent diabetes, obstetric, endocrine, and health organizations advocate a plethora of diverse algorithms for the screening, diagnosis, management, and follow-up of gestational diabetes mellitus (GDM). Additionally, there are regional recommendations of local health societies. Several of these proposals for GDM are contentious because some of them were developed from unscientific studies, based on expert-opinion, catered to preserve resources, and subjectively modified for convenience. Due to the wide variety of choices available, the approach to GDM can be extremely diverse even within the same hospital. This lack of consensus creates major problems in addressing prevalence, complications, efficacy of treatment, and follow-up of GDM. Moreover, it becomes nearly impossible to compare the numerous studies. Furthermore, the lack of consensus confuses the health care providers of obstetric health who look to the experts for guidance. Therefore, a clear, objective, "evidence-based" global approach, which is simple, easy to follow, and validated by corroborative research, is crucial. We contend that, despite decades of research, a single acceptable global guideline is not yet on the horizon.
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Affiliation(s)
- Mukesh M Agarwal
- Departments of Pathology and Medical Education, School of Medicine, California University of Science & Medicine, San Bernardino, CA 92408, USA.
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32
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Reyes-Muñoz E, Sandoval-Osuna NL, Reyes-Mayoral C, Ortega-González C, Martínez-Cruz N, Ramírez-Torres MA, Arce-Sánchez L, Lira-Plascencia J, Estrada-Gutiérrez G, Montoya-Estrada A. Sensitivity of fasting glucose for gestational diabetes mellitus screening in Mexican adolescents based on International Association of Diabetes and Pregnancy Study Groups criteria: a diagnostic accuracy study based on retrospective data analysis. BMJ Open 2018; 8:e021617. [PMID: 29654051 PMCID: PMC5905784 DOI: 10.1136/bmjopen-2018-021617] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 02/24/2018] [Accepted: 03/02/2018] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To evaluate fasting plasma glucose (FPG) as a screening test for gestational diabetes mellitus (GDM) among Mexican adolescents using International Association of Diabetes and Pregnancy Study Groups criteria. DESIGN Retrospective cohort study. SETTING Level-three medical institution in Mexico City. PARTICIPANTS The study population comprised 1061 adolescent women aged 12-19 years with singleton pregnancies, who underwent a 75 g oral glucose tolerance test (OGTT) between 11 and 35 weeks of gestation. PRIMARY AND SECONDARY OUTCOME MEASURES The sensitivity (Sn), specificity (Sp), positive and negative predictive values (PPV and NPV, respectively), and positive and negative likelihood ratios LR (+) and LR (-), respectively) with 95% CIs for selected FPG cut-off values were compared. Secondary measures were perinatal outcomes in women with and without GDM. RESULTS GDM was present in 71 women (6.7%, 95% CI 5.3% to 8.4%). The performances of FPG at thresholds of ≥80 (4.5 mmol/L), 85 (4.7 mmol/L) and 90 mg/dL (5.0 mmol/L) were as follow (95% CI): Sn: 97% (89% to 99%), 94% (86% to 97%) and 91% (82% to 95%); Sp: 50% (47% to 53%), 79% (76% to 81%) and 97% (95% to 97%); PPV: 12% (9% to 15%), 23% (18% to 28%) and 64% (54% to 73%); NPV: 99% (98.5% to 99.9%) for all three cut-offs; LR (+): 1.9 (1.8 to 2.1), 4.3 (3.8 to 5.0) and 26.7 (18.8 to 37.1) and LR (-): 0.06 (0.02 to 0.23), 0.07 (0.03 to 0.19) and 0.09 (0.04 to 0.19), respectively. No significant differences in perinatal outcomes were found between adolescents with and without GDM. CONCLUSIONS An FPG cut-off of ≥90 mg/dL (5.0 mmol/L) is ideal for GDM screening in Mexican adolescent women. An FPG threshold of 90 mg/dL would miss 6 (8.5%) women with GDM, pick up 34 (3.4%) women without GDM and avoid 962 (90.7%) OGTTs.
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Affiliation(s)
- Enrique Reyes-Muñoz
- Department of Gynecological and Perinatal Endocrinology, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Norma Lidia Sandoval-Osuna
- Division of Obstetrics and Gynecology, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Christian Reyes-Mayoral
- Division of Obstetrics and Gynecology, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Carlos Ortega-González
- Department of Endocrinology, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Nayeli Martínez-Cruz
- Department of Endocrinology, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - María Aurora Ramírez-Torres
- Department of Endocrinology, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Lidia Arce-Sánchez
- Department of Endocrinology, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Josefina Lira-Plascencia
- Research Unit in Adolescent Medicine, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Guadalupe Estrada-Gutiérrez
- Direction of Research, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Araceli Montoya-Estrada
- Department of Gynecological and Perinatal Endocrinology, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
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Abstract
The present literature review was conducted to evaluate early diabetes screening in pregnancy. The review focuses on the various guidelines for early screening, the target populations for screening, and the assessment of various early screening targets and strategies. The advantages and disadvantages of each screening method are highlighted. The review emphasizes that there are no validated criteria for selecting high-risk pregnant women for early screening. The different early screening modalities, including fasting plasma glucose, random plasma glucose, postload glucose, and hemoglobin A1c, lack concordance and have not been validated for the early diagnosis of diabetes in pregnancy. Moreover, the benefit of early screening by earlier initiation of treatment has not been shown. Until a randomized controlled trial demonstrates benefit to screening and validates a particular screening method, it is not possible to provide evidence to support any single strategy for early diabetes screening in pregnancy.
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Affiliation(s)
- Shiri Shinar
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Howard Berger
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
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Shen S, Lu J, Zhang L, He J, Li W, Chen N, Wen X, Xiao W, Yuan M, Qiu L, Cheng KK, Xia H, Mol BWJ, Qiu X. Single Fasting Plasma Glucose Versus 75-g Oral Glucose-Tolerance Test in Prediction of Adverse Perinatal Outcomes: A Cohort Study. EBioMedicine 2017; 16:284-91. [PMID: 28122694 DOI: 10.1016/j.ebiom.2017.01.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 01/16/2017] [Accepted: 01/17/2017] [Indexed: 01/20/2023] Open
Abstract
Background There remains uncertainty regarding whether a single fasting glucose measurement is sufficient to predict risk of adverse perinatal outcomes. Methods We included 12,594 pregnant women who underwent a 75-g oral glucose-tolerance test (OGTT) at 22–28 weeks' gestation in the Born in Guangzhou Cohort Study, China. Outcomes were large for gestational age (LGA) baby, cesarean section, and spontaneous preterm birth. We calculated the area under the receiver operator characteristic curves (AUCs) to assess the capacity of OGTT glucose values to predict adverse outcomes, and compared the AUCs of different components of OGTT. Results 1325 women had a LGA baby (10.5%). Glucose measurements were linearly associated with LGA, with strongest associations for fasting glucose (odds ratio 1.37, 95% confidence interval 1.30–1.45). Weaker associations were observed for cesarean section and spontaneous preterm birth. Fasting glucose have a comparable discriminative power for prediction of LGA to the combination of fasting, 1 h, and 2 h glucose values during OGTT (AUCs, 0.611 vs. 0.614, P = 0.166). The LGA risk was consistently increased in women with abnormal fasting glucose (≥ 5.1 mmol/l), irrespective of 1 h or 2 h glucose levels. Conclusions A single fasting glucose measurement performs comparably to 75-g OGTT in predicting risk of having a LGA baby. Fasting glucose had a significantly stronger association with large for gestational age than post-load glucoses. Single fasting glucose has comparable predictive ability of large for gestational age to 75g OGTT. Single fasting glucose test can be an alternative for identifying high risk of large for gestational age in Chinese women.
The new criteria for gestational diabetes (GDM) screening and diagnosis suggests that single abnormal of a fasting, 1 h or 2 h glucose measured by an universal, single-stage screening of 2 h 75-g oral glucose-tolerance test (OGTT) is adequate to make a diagnosis. However, the utility of each glucose measurement in the prediction of poor perinatal outcomes was unclear. Here, we reported single fasting plasma glucose performs comparably to 75 g OGTT in identification of women at increased risk of delivering a large for gestational age baby. Single fasting glucose testing can be an alternative for GDM screening, which will substantially reduce the psychological impact, opportunity and direct health costs for women and their families.
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