Comparative epidemiology of gestational diabetes in ethnic Chinese from Shanghai birth cohort and growing up in Singapore towards healthy outcomes cohort

BACKGROUND

Gestational diabetes mellitus (GDM) has been associated with adverse health outcomes for mothers and offspring. Prevalence of GDM differs by country/region due to ethnicity, lifestyle and diagnostic criteria. We compared GDM rates and risk factors in two Asian cohorts using the 1999 WHO and the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria.

METHODS

The Shanghai Birth Cohort (SBC) and the Growing Up in Singapore Towards healthy Outcomes (GUSTO) cohort are prospective birth cohorts. Information on sociodemographic characteristics and medical history were collected from interviewer-administered questionnaires. Participants underwent a 2-h 75-g oral glucose tolerance test at 24-28 weeks gestation. Logistic regressions were performed.

RESULTS

Using the 1999 WHO criteria, the prevalence of GDM was higher in GUSTO (20.8%) compared to SBC (16.6%) (p = 0.046). Family history of hypertension and alcohol consumption were associated with higher odds of GDM in SBC than in GUSTO cohort while obesity was associated with higher odds of GDM in GUSTO. Using the IADPSG criteria, the prevalence of GDM was 14.3% in SBC versus 12.0% in GUSTO. A history of GDM was associated with higher odds of GDM in GUSTO than in SBC, while being overweight, alcohol consumption and family history of diabetes were associated with higher odds of GDM in SBC.

CONCLUSIONS

We observed several differential risk factors of GDM among ethnic Chinese women living in Shanghai and Singapore. These findings might be due to heterogeneity of GDM reflected in diagnostic criteria as well as in unmeasured genetic, lifestyle and environmental factors.

Evaluation of fetal cardiac function in pregnancies with well-controlled gestational diabetes

OBJECTIVE

To evaluate fetal ventricular diastolic function in pregnancies of women with gestational diabetes (GD), to determine whether minimal anomalies of glucose metabolism may influence fetal cardiac function.

STUDY DESIGN

Fetal ventricular filling time was measured by transabdominal ultrasound in singleton pregnancies between 34 and 37 weeks of gestation. We used a measurement which consists in the ratio between the diastolic time and the whole cardiac cycle time.

RESULTS

The study included 35 women with a GD and 217 non-diabetic. Right ventricular filling time (RVFT) was significantly lower in the GD group (mean of RVFT = 39.2 ± 4.4 vs 43.6 ± 4.6; p  <  0.01). Likewise, left ventricular filling time (LVFT) was shorter in the GD group compared to the non-GD group, though the difference was not significant (mean of LVFT = 43.6 ± 4.6 vs 44.6 ± 5.5; p  = 0.33).

CONCLUSIONS

Fetal right cardiac function is altered also in pregnancies where gestational diabetes is well controlled.

Management of gestational diabetes in women with a concurrent severe acute respiratory syndrome coronavirus 2 infection, experience of a single center in Northern Italy

Objective

In this study we describe the management of women with gestational diabetes (GD) and an ongoing severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection. The aim of the study is to evaluate whether coronavirus disease 2019 (COVID‐19) can further complicate pregnancies, and if the protocol we usually use for GD pregnancies is also applicable to patients who have contracted a SARS‐CoV‐2 infection.

Methods

This is a retrospective study analyzing all pregnant women with GD and concomitant COVID‐19 admitted to our institution for antenatal care between March 1 and April 30, 2020.

Results

Among pregnant women with GD and a concomitant SARS‐CoV‐2 infection, the mean age was 32.9 (SD 5.6) years. Two patients (33%) were of white racial origin and four (67%) were of non‐white racial origin. All patients were diagnosed with COVID‐19 during the third trimester of pregnancy. Two women were asymptomatic and four were symptomatic. Only two (33.3%) women received treatment with insulin. None of the patients required intensive care or mechanical ventilation. No complications were found among the neonates.

Conclusion

COVID‐19 was not found to worsen the prognosis of patients with GD or of their offspring. Glycemic monitoring, diet therapy, and insulin, when needed, are sufficient for good metabolic control and favorable maternal and fetal outcomes.

Comparison of criteria of International Association of Diabetes and Pregnancy Study Groups (IADPSG) with National Institute for Health and Care Excellence (NICE) for diagnosis of gestational diabetes mellitus

BACKGROUND

Different screening procedures and diagnostic criteria are being followed in the same as well as in different countries with no single standard criteria established for diagnosis of GDM. So far, there are no studies in the Indian population comparing IADPSG with NICE criteria.

OBJECTIVE

To compare International Association of Pregnancy and Study Groups (IADPSG) criteria with the National Institute for Health and Care Excellence (NICE) for diagnosis of gestational diabetes mellitus and its influence on maternal and perinatal outcomes.

METHOD

This prospective observational study was conducted in the Department of Obstetrics and Gynaecology of a tertiary care institute in South India from March 2017 to October 2018. Six-hundred and eighty women with or without risk factors for GDM were recruited in the study and screened for GDM based on IADPSG and NICE criteria. Women with preexisting diabetes mellitus or with fasting plasma glucose ≥ 126 mg/dl were excluded.

RESULTS

The overall prevalence of GDM in our study was 27.2% by either IADPSG/NICE criteria. In this study, 25.1% women and 11.6% women were diagnosed as GDM using IADPSG and NICE criteria, respectively. The level of agreement between the two diagnostic criteria was found to be poor in our study and was statistically significant (kappa = 0.429, p < 0.001). Women testing IADPSG-positive NICE-negative had a higher risk of GHTN, abortions, PROM, preterm delivery, caesarean section and congenital anomalies, meconium-stained liquor, and low Apgar scores at 1 min when compared to non GDM group. In addition, except for preterm delivery, women diagnosed as GDM by both IADPSG and NICE criteria had adverse outcomes such as preeclampsia, urinary tract infection, and polyhydramnios. Women diagnosed as GDM in IADPSG-negative NICE-positive had no significant adverse maternal or perinatal outcomes.

CONCLUSIONS

IADPSG criteria appear to be more robust than NICE criteria for diagnosis of GDM. Women with substantial risk of maternal and perinatal outcomes are better identified by IADPSG criteria who would have been missed if NICE criteria was used.

Ultrasound assessment of maternal adipose tissue during 1st trimester screening for aneuploidies and risk of developing gestational diabetes

INTRODUCTION

The objective of the present study is to compare the sonographic measurement of subcutaneous adipose thickness and visceral adipose thickness during 1st trimester screening for aneuploidies between non-diabetic pregnant women and patients who develop 1st trimester or 2nd trimester gestational diabetes mellitus (GDM).

MATERIAL AND METHODS

Adipose thickness was measured by transabdominal ultrasound imaging in pregnant women attending our clinic for screening for fetal aneuploidies between 11 and 13 weeks of gestation. During the 1st trimester all patients were evaluated for fasting glycemia in accordance with the International Association of Diabetes and Pregnancy Study Groups (IADPSG) recommendations. Patients with confirmed fasting glycemia (FPG) ≥92 mg/dL were diagnosed as 1st trimester GDM. Patients with FPG <92 mg/dL underwent a 75-g oral glucose tolerance test between 24 and 28 weeks.

RESULTS

The study population included 238 non-diabetic women, 29 women with 1st trimester GDM and 28 women with 2nd trimester GDM. Mean subcutaneous adipose thickness and visceral adipose thickness values in non-diabetic women were 9.8 mm (standard deviation [SD = 4.9) and 7.2 mm (SD = 3.5), respectively. Values in women with 1st trimester GDM were 12.8 mm (SD = 6.5) and 9.9 mm (SD = 4.4). In the 2nd trimester GDM group, the mean subcutaneous adipose thickness was 11.1 mm (SD = 4.6) and the mean visceral adipose thickness 10.5 mm (SD = 5.3). Multiple logistic regression analysis showed that visceral adipose thickness, but not subcutaneous adipose thickness, was significantly and independently associated with both 1st trimester GDM (OR 1.15, 95% CI 1.02-1.29) and 2nd trimester GDM (odds ratio [OR] 1.19, 95% confidence interval [CI] 1.05-1.34).

CONCLUSIONS

Sonographic thickness of maternal visceral adipose tissue was greater in women with GDM than in non-diabetic patients, independently of other known risk factors associated with GDM in the 1st and in the 2nd trimester of pregnancy. Thus, this measurement may be considered of clinical use in 1st trimester screening.

Influence of different diagnostic criteria on gestational diabetes mellitus incidence and medical expenditures in China

AIMS/INTRODUCTION

To summarize the development of the criteria for diagnosing gestational diabetes mellitus (GDM) in China, and investigate how different GDM diagnostic criteria influence the national prevalence of GDM, the national health system and the economic burden of GDM in China.

MATERIALS AND METHODS

Retrospectively using data from women undergoing a 2-h, 75-g oral glucose tolerance test at 24-28 gestational weeks in the First Affiliated Hospital of Jinan University (Guangzhou, Guangdong, China) from January 2011 to December 2017, the prevalence rate of GDM and its impacts on the national health system were evaluated using different criteria (the 7th edition textbook criteria, National Diabetes Data Group 1979, World Health Organization 1985, European Association for the Study of Diabetes 1996, Japan 2002, American Diabetes Association [ADA] 2011 [International Association of the Diabetes and Pregnancy Study Groups], and National Institute for Heath and Care Excellence 2015).

RESULTS

The incidence rates of GDM based on the ADA 2011 and National Institute for Heath and Care Excellence 2015 were, respectively, 22.94% (P < 0.01) and 21.72% (P < 0.01), over threefold higher than implementing the 7th edition textbook criteria (P < 0.001). On the contrary, the incidence rates of GDM diagnosed with the National Diabetes Data Group 1979 and World Health Organization 1985 guidelines were significantly less than the 7th edition textbook criteria (P < 0.001). From 2001 to 2016, the estimated national cost of treating GDM rose from ¥3.9 billion to ¥27.4 billion after implementing the ADA 2011 guidelines.

CONCLUSIONS

With the implementation of ADA 2011 (International Association of the Diabetes and Pregnancy Study Groups) guidelines, there are fewer adverse perinatal outcomes and cases of type 2 diabetes mellitus in the long term, but the medical costs increased significantly, and the cost-effectiveness of diagnostic criteria in China is still yet to be confirmed.

Pregnancy outcome of gestational diabetes mellitus using a structured model of care : WINGS project (WINGS-10)

AIM

To evaluate the impact of a structured model of care (MOC) prepared for resource-constrained settings, on the pregnancy outcomes of Asian Indian women with gestational diabetes mellitus (GDM).

METHODS

Pregnant women were screened under the Women in India with GDM Strategy (WINGS) MOC for GDM using the International Association of Diabetes and Pregnancy Study Groups criteria. Women with GDM went through a structured MOC that included medical nutrition therapy (MNT), regular physical activity (PA); and insulin when indicated. Fasting blood glucose and post-prandial blood sugar were monitored every 2 weeks. The pregnancy outcomes of women with GDM who underwent the MOC were compared with those without GDM.

RESULTS

Under the MOC, 212 women with GDM were followed through pregnancy, of whom 33 (15.6%) required insulin and 179 (84.4%) were managed with MNT and PA. The maternal and neonatal outcomes of women with GDM were similar to the non-GDM women: there were no significant differences in pregnancy complications such as cesarean section, macrosomia, pre-eclampsia, oligo/polyhydramnios, preterm delivery, neonatal death, fetal distress, hyperbilirubinemia and low birthweight.

CONCLUSION

Implementation of a structured MOC for women with GDM helped achieve pregnancy outcomes similar to those without GDM.

Gestational diabetes mellitus in an Iranian pregnant population using IADPSG criteria: Incidence, contributing factors and outcomes

AIMS

Different approaches for screening and diagnosis of gestational diabetes mellitus(GDM) have great impact on all process of management of gestational diabetes and its future complications. The aims of this study were to evaluate rate, risk factors and outcomes of GDM based on International Association of Diabetes and Pregnancy Study Groups diagnostic criteria.

MATERIALS

In a prospective study pregnant women attended 5 clinics in Ahvaz, screened for gestational diabetes mellitus using IADPSG criteria and followed up delivery from August 2014 to February 2015. At the first prenatal visit women underwent the fasting blood sugar test. A 75-g oral glucose tolerance test (OGTT) was performed for 750 mothers between 24 and 32 weeks of gestation. Logistic regression test for calculating the odds ratios and 95% confidence intervals was used.

RESULTS

The mean age of participants was 28.43±5.52years. The overall rate of GDM in our study was 29.9% (224/750). Incidence of gestational diabetes was associated with age group≥35years [OR=1.92(95% CI, 1.19-3.09)], family history of diabetes [OR=2.47(95% CI, 1.33-4.59)], previous GDM [OR=3.12(1.35-7.19)], BMI≥25 [OR=1, 71(1.10-2.67)] Using logistic regression. The most common maternal complication in studied women was cesarean section followed by hypertension and preeclampsia.

CONCLUSION

About one third of studied women diagnosed as GDM according to the IADPSG criteria. Risk factors of GDM were maternal age, family history of diabetes, Previous GDM, overweight and obesity before pregnancy, the same reported factors with 2 steps approach. Higher rate of GDM using this criterion may increase concern about healthcare costs and workloads.

Current practices in the diagnosis and management of gestational diabetes mellitus in India (WINGS-5)

AIM

To obtain information on existing practices in the diagnosis and management of gestational diabetes mellitus (GDM) among physicians/diabetologists/endocrinologists and obstetricians/gynecologists (OB/GYNs) in India.

METHODS

Details regarding diagnostic criteria used, screening methods, management strategies, and the postpartum follow-up of GDM were obtained from physicians/diabetologists/endocrinologists and OB/GYNs across 24 states of India using online/in-person surveys using a structured questionnaire.

RESULTS

A total of 3841 doctors participated in the survey of whom 68.6% worked in private clinics. Majority of OB/GYNs (84.9%) preferred universal screening for GDM, and screening in the first trimester was performed by 67% of them. Among the OB/GYNs, 600 (36.7%) reported using the nonfasting 2 h criteria for diagnosing GDM whereas 560 (29.4%) of the diabetologists/endocrinologists reported using the same. However, further questioning on the type of blood sample collected and the glucose load used revealed that, in reality, only 208 (12.7%) and 72 (3.8%), respectively, used these criteria properly. The survey also revealed that the International Association of Diabetes and Pregnancy Study Groups criteria was followed properly by 299 (18.3%) of OB/GYNs and 376 (19.7%) of physicians/diabetologists/endocrinologists. Postpartum oral glucose tolerance testing was advised by 56% of diabetologists and 71.6% of OB/GYNs.

CONCLUSION

More than half of the physicians/diabetologists/endocrinologists and OB/GYNs in India do not follow any of the recommended guidelines for the diagnosis of GDM. This emphasizes the need for increased awareness about screening and diagnosis of GDM both among physicians/diabetologists/endocrinologists and OB/GYNs in India.

Impact of the new IADPSG gestational diabetes diagnostic criteria on pregnancy outcomes in Western Australia

BACKGROUND

There is debate as to the most appropriate diagnostic criteria to diagnose gestational diabetes mellitus (GDM). The proposed International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria have recently been endorsed by various bodies, but there remains no national consensus.

AIM

To assess the perinatal outcomes of women with GDM classified according to the 1998 Australasian Diabetes in Pregnancy Society (ADIPS) criteria compared to those with GDM by the IADPSG criteria.

MATERIALS AND METHODS

Results of glucose tolerance tests performed between January 2011 and January 2014 were linked with the perinatal data of those who delivered singleton fetuses after 24 weeks' gestation. Analysed data included birthweight, gestational age at birth, macrosomia, mode of delivery, perinatal mortality, nursery admission, maternal body mass index, and gestational weight gain.

RESULTS

Of 3571 women, 466 (13%) and 559 (16%) met the criteria for the 1998 ADIPS and IADPSG criteria for GDM, respectively. Those with GDM according to the IADPSG criteria only (6%) were more obese (95% CI 2.3-4.8 kg/m(2) ), delivered neonates on average 106 g heavier (95% CI 19-193 g) and had more fetal macrosomia (18% vs 11%, P = 0.002) than those with normal glucose tolerance.

CONCLUSIONS

The IADPSG criteria for GDM identified a group of women at previously unrecognised increased risk of adverse perinatal outcomes. Adopting the IADPSG criteria would increase the number of women diagnosed with GDM by 20%; however, the improvements in perinatal morbidity, in addition to potential long-term benefits, may justify the increase in healthcare workload.

Feto-maternal outcomes in women with and without gestational diabetes mellitus according to the International Association of Diabetes and Pregnancy Study Groups (IADPSG) diagnostic criteria

BACKGROUND

Gestational diabetes mellitus (GDM) is responsible for majority of pregnancies complicated with diabetes mellitus. Both the screening (universal vs. selective) and the diagnostic criteria of GDM has been the subject of considerable controversy.

METHODS

This prospective cohort study was undertaken at Pondicherry Institute of Medical Sciences, Puducherry from August 2011 to July 2012. All the patients attending antenatal clinic underwent oral glucose tolerance test (OGTT) with 75g of anhydrous glucose between 24 and 32 weeks of gestation. Those patients diagnosed as GDM according to IADPSG diagnostic criteria were treated with diet and physical activity with or without insulin. All the antenatal and perinatal outcomes were noted.

RESULTS

The prevalence of GDM in our study was 27% (83/304). Out of all the GDM patients, 87% (72/83) cases were diagnosed by raised FBS alone or with other two values. A significant family history of diabetes mellitus was found among GDM mothers compared to non-GDM group (10.8% vs. 3.6%, p=0.01). Insulin was required only in 8 patients for glycemic control. The GDM patients delivered at significantly lower gestational age (p=0.02) with more antenatal complications (25% vs. 12%, p=0.02). Among neonatal outcomes, there was a significant difference only in the need for NICU admission>24h between GDM and non-GDM groups (p=0.02).

CONCLUSION

The prevalence of GDM increases with universal screening using IADPSG diagnostic criteria in India. The antenatal complications are present in up to one fourth of these patients.

Gestational diabetes mellitus is rare in primigravida Pakistani women

BACKGROUND

Gestational diabetes mellitus is a metabolic disorder defined as glucose intolerance with onset or first recognition during pregnancy. Similar to other members of the Asian race, Pakistani women are also considered to be at a high risk for developing gestational diabetes.

MATERIALS AND METHODS

In order to better understand whether this heightened risk attributed to race really exists, we conducted a prospective study to assess the glycemic status of primigravida women presenting to our hospital.

RESULTS

The mean age of 135 subjects enrolled was 22 (16-31), with 21 (16%), 60 (44%), and 54 (40%) subjects in the first, second, and third trimesters of pregnancy, respectively. The mean fasting, 1-hour, and 2-hour plasma glucose levels were 69.9 mg/dL (3.9 mmol/L), 129 mg/dL (7.2 mmol/L), and 103.6 mg/dL (5.76 mmol/L), respectively. Of 135 women, 6 had a blood pressure reading ≥140/90 mm Hg and only one met the criteria for gestational diabetes mellitus. In our study, despite using the newly proposed International Association of Diabetes and Pregnancy Study (IADPS) cut-offs for diagnosis of gestational diabetes, the incidence rate of gestational diabetes mellitus in primigravida was still <1%.

CONCLUSION

Larger trials are needed to truly assess the disease burden of gestational diabetes mellitus in Pakistani women.

Gestational diabetes mellitus: Get, set, go From diabetes capital of the world to diabetes care capital of the world

Screening and diagnosis for gestational diabetes mellitus (GDM) as well as interventions for its management evoke considerable controversy. There are different types of screening methods: universal or risk-based, one step or two step. Different thresholds for diagnosis of GDM have been in vogue. Previous definition and diagnostic criteria had no place for diagnosis of overt diabetes in pregnancy. Following Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study and International Association of Diabetes and Pregnancy Study Groups (IADPSG) recommendations, new screening and diagnostic criteria around the world seem to be gaining consensus. The present recommendation given by IADPSG for screening and diagnosis of diabetes mellitus in pregnancy has two discrete phases. The first is detection of women with overt diabetes not previously diagnosed or treated outside of pregnancy. Universal early testing in populations is recommended at the first prenatal visit. The second phase is a 75-g OGTT at 24-28 week gestation in all women not previously found to have overt diabetes or GDM. ACHOIS and MFMU Network trails have proven benefit in treating hyperglycemias less than what is diagnostic for diabetes. DIPSI has shown the alternative way for resource-challenged communities. Efforts from all stake holders with interest in GDM are required to make the diabetes capital of the world into the diabetes care capital of the world.