Screening and subsequent management for gestational diabetes for improving maternal and infant health
ABSTRACT Gestational diabetes mellitus (GDM) is a form of diabetes that occurs in pregnancy. Although GDM usually resolves following birth, it is associated with significant morbidities for mother and baby both perinatally and in the long term. There is strong evidence to support treatment for GDM. However, there is little consensus on whether or not screening for GDM will improve maternal and infant health and if so, the most appropriate protocol to follow.
To assess the effects of different methods of screening for gestational diabetes mellitus and maternal and infant outcomes.
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (April 2010).
Randomised and quasi-randomised trials evaluating the effects of different methods of screening for gestational diabetes mellitus.
Two review authors independently conducted data extraction and quality assessment. We resolved disagreements through discussion or through a third author.
We included four trials involving 3972 women were included in the review. One quasi-randomised trial compared risk factor screening with universal or routine screening by 50 g oral glucose challenge testing. Women in the universal screening group were more likely to be diagnosed with GDM (one trial, 3152 women, risk ratio (RR) 0.44 95% confidence interval (CI) 0.26 to 0.75). Infants of mothers in the risk factor screening group were born marginally earlier than infants of mothers in the routine screening group (one trial, 3152 women, mean difference -0.15 weeks, 95% CI -0.27 to -0.53).The remaining three trials evaluated different methods of administering a 50 g glucose load. Two small trials compared glucose monomer with glucose polymer testing, with one of these trials including a candy bar group. One trial compared a glucose solution with food. No differences in diagnosis of GDM were found between each comparison. Overall, women drinking the glucose monomer experienced fewer side effects from testing than women drinking the glucose polymer (two trials, 151 women, RR 2.80, 95% CI 1.10 to 7.13). However, we observed high heterogeneity between the trials for this result (I(2) = 61%).
There was insufficient evidence to determine if screening for gestational diabetes, or what types of screening, can improve maternal and infant health outcomes.
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ABSTRACT: The need for determining Aboriginal population-specific risk factors of Type 2 Diabetes Mellitus has become increasingly urgent as the incidence and prevalence rates are increasing rapidly and as the need for prevention of diabetes in this population have become a necessity. This is a review of sci-entific literature that was conducted using PubMed and Medline databases which identified 55 relevant articles. A number of factors including lifestyle, ethnicity, access to health care, and genetic predisposition were identified as putative risk factors of this metabolic disorder. Initial results indicate a number of other risk factors of interest, such as age, Body Mass Index (BMI), Gestational Diabetes Mellitus (GDM), Hypertriglyceridemic Waist (HTGW) and HNF1A a G319S variant and Metabolic Syndrome (MetS). We have categorized these and other risk factors as modifiable, intermediate, and nonmodifiable risk factors; and each of these factors are further sub-divided into direct and indirect factors. We will compare these risk factors with those identified by Aboriginal peoples and evaluate for concordance or discordance through focus-group consultations with Aboriginal peoples in our future study. This report describes the role of risk factors acting alone or 1. Acknowledgement: This paper was presented as a poster at Canadian Society for Epidemiology and BioStatistics 2009 conference. Authors acknowledge the feedback received from conference partici-pants and judges. Hasu Ghosh's doctoral study is supported by CIHR-IAPH funded AK-NEAHR pro-gram and IHRDP program, and PHIRN Doctoral Award.
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ABSTRACT: Gestational diabetes mellitus (GDM) is defined as any carbohydrate intolerance first diagnosed during pregnancy. The prevalence of GDM is about 2-5% of normal pregnancies and depends of the prevalence of same population to type 2 diabetes mellitus. It is associated with adverse outcome for the mother, the fetus, neonate, child and adult offspring of the diabetic mother. Detection of GDM lies on screening, followed as necessary by diagnostic measures. Screening can either be selective, based upon risk stratification or universal. Timely testing enables the obstetrician to assess glucose tolerance in the presence of the insulin-resistant state of pregnancy and permits treatment to begin before excessive fetal growth has occurred. Once a diagnosis of GDM was made close perinatal surveillance is warranted. The goal of treatment is reducing fetal-maternal morbidity and mortality related with GDM. The exact glucose values needed are still not absolutely proved. The decision whether and when to induce delivery depends on gestational age, estimated fetal weight, maternal glycemic control and bishop score. Future research is needed regarding prevention of GDM, treatment goals and effectiveness of interventions, guidelines for pregnancy care and prevention of long term metabolic sequel for both the infant and the mother. Copyright © 2015. Published by Elsevier B.V.
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ABSTRACT: The increase in gestational diabetes mellitus (GDM) is challenging maternity services. We have developed an interactive, smartphone-based, remote blood glucose (BG) monitoring system, GDm-health. The objective was to determine women's satisfaction with using the GDm-health system and their attitudes toward their diabetes care. In a service development program involving 52 pregnant women (September 2012 to June 2013), BG was monitored using GDm-health from diagnosis until delivery. Following birth, women completed a structured questionnaire assessing (1) general satisfaction, (2) equipment issues, and (3) relationship with the diabetes care team. Responses were scored on a 7-point Likert-type scale. Reliability and validity of the questionnaire were assessed using statistical methods. Of 52 women, 49 completed the questionnaire; 32 had glucose tolerance test confirmed GDM (gestation at recruitment 29 ± 4 weeks (mean ± SD), and 17 women previous GDM recommended for BG monitoring (18 ± 6 weeks). In all, 45 of 49 women agreed their care was satisfactory and the best for them, 47 of 49 and 43 of 49 agreed the equipment was convenient and reliable respectively, 42 of 49 agreed GDm-health fitted into their lifestyle, and 46 of 49 agreed they had a good relationship with their care team. Written comments supported these findings, with very positive reactions from the majority of women. Cronbach's alpha was .89 with factor analysis corresponding with question thematic trends. This pilot demonstrates that GDm-health is acceptable and convenient for a large proportion of women. Effects on clinical and economic outcomes are currently under investigation in a randomized trial (clinicaltrials.gov NCT01916694).Journal of diabetes science and technology 10/2014; DOI:10.1177/1932296814556506