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1.
N Engl J Med ; 384(10): 895-904, 2021 03 11.
Artigo em Inglês | MEDLINE | ID: mdl-33704936

RESUMO

BACKGROUND: Gestational diabetes mellitus is common and is associated with an increased risk of adverse maternal and perinatal outcomes. Although experts recommend universal screening for gestational diabetes, consensus is lacking about which of two recommended screening approaches should be used. METHODS: We performed a pragmatic, randomized trial comparing one-step screening (i.e., a glucose-tolerance test in which the blood glucose level was obtained after the oral administration of a 75-g glucose load in the fasting state) with two-step screening (a glucose challenge test in which the blood glucose level was obtained after the oral administration of a 50-g glucose load in the nonfasting state, followed, if positive, by an oral glucose-tolerance test with a 100-g glucose load in the fasting state) in all pregnant women who received care in two health systems. Guidelines for the treatment of gestational diabetes were consistent with the two screening approaches. The primary outcomes were a diagnosis of gestational diabetes, large-for-gestational-age infants, a perinatal composite outcome (stillbirth, neonatal death, shoulder dystocia, bone fracture, or any arm or hand nerve palsy related to birth injury), gestational hypertension or preeclampsia, and primary cesarean section. RESULTS: A total of 23,792 women underwent randomization; women with more than one pregnancy during the trial could have been assigned to more than one type of screening. A total of 66% of the women in the one-step group and 92% of those in the two-step group adhered to the assigned screening. Gestational diabetes was diagnosed in 16.5% of the women assigned to the one-step approach and in 8.5% of those assigned to the two-step approach (unadjusted relative risk, 1.94; 97.5% confidence interval [CI], 1.79 to 2.11). In intention-to-treat analyses, the respective incidences of the other primary outcomes were as follows: large-for-gestational-age infants, 8.9% and 9.2% (relative risk, 0.95; 97.5% CI, 0.87 to 1.05); perinatal composite outcome, 3.1% and 3.0% (relative risk, 1.04; 97.5% CI, 0.88 to 1.23); gestational hypertension or preeclampsia, 13.6% and 13.5% (relative risk, 1.00; 97.5% CI, 0.93 to 1.08); and primary cesarean section, 24.0% and 24.6% (relative risk, 0.98; 97.5% CI, 0.93 to 1.02). The results were materially unchanged in intention-to-treat analyses with inverse probability weighting to account for differential adherence to the screening approaches. CONCLUSIONS: Despite more diagnoses of gestational diabetes with the one-step approach than with the two-step approach, there were no significant between-group differences in the risks of the primary outcomes relating to perinatal and maternal complications. (Funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development; ScreenR2GDM ClinicalTrials.gov number, NCT02266758.).


Assuntos
Diabetes Gestacional/diagnóstico , Teste de Tolerância a Glucose/métodos , Hiperglicemia/diagnóstico , Adulto , Glicemia/análise , Diabetes Gestacional/sangue , Diabetes Gestacional/epidemiologia , Feminino , Macrossomia Fetal/epidemiologia , Humanos , Hiperglicemia/sangue , Incidência , Programas de Rastreamento , Gravidez , Resultado da Gravidez
3.
Artigo em Inglês | MEDLINE | ID: mdl-33572656

RESUMO

A rapid increase in the prevalence of gestational diabetes mellitus (GDM) has been associated with various factors such as urbanization, lifestyle changes, adverse hyperglycemic intrauterine environment, and the resulting epigenetic changes. Despite this, the burden of GDM has not been well-assessed in Southeast Asia. We comprehensively reviewed published Southeast Asian studies to identify the current research trend in GDM in this region. Joanna Briggs Institute's methodology was used to guide the scoping review. The synthesis of literature findings demonstrates almost comparable clinical evidence in terms of risk factors and complications, challenges presented in diagnosing GDM, and its disease management, given the similarities of the underlying population characteristics in Southeast Asia. Evidence suggests that a large proportion of GDM risk in women may be preventable by lifestyle modifications. However, the GDM burden across countries is expected to rise, given the heterogeneity in screening approaches and diagnostic criteria, mainly influenced by economic status. There is an urgent need for concerted efforts by government and nongovernmental sectors to implement national programs to prevent, manage, and monitor the disease.


Assuntos
Diabetes Gestacional , Ásia Sudeste/epidemiologia , Diabetes Gestacional/epidemiologia , Feminino , Humanos , Programas de Rastreamento , Gravidez , Prevalência , Fatores de Risco
4.
Diabetes Metab Syndr ; 15(1): 391-395, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33571889

RESUMO

BACKGROUND AND AIMS: Gestational diabetes (GDM) is one of the most common medical complications of pregnancy and associated with significant perinatal and long-term morbidity. Temporary changes to the diagnostic testing for GDM have been recommended for the COVID-19 pandemic. This study aims to identify what proportion of women with GDM would be missed by the COVID-19 GDM screening criteria. Secondly an analysis of the relationship between HbA1c, fasting blood glucose (FBG) and pregnancy outcomes will be completed. METHODS: This was a retrospective analysis of all GDM patients at an Australian secondary hospital between January 2019 and February 2020. The proportion of women with GDM who would have been missed using the COVID-19 guidelines was assessed. Patients were divided into groups according to how their GDM was managed during the pregnancy: Diet, Metformin (MF), Insulin and MF + Insulin groups. Differences between the groups were compared using one-way ANOVA and post-hoc analysis was completed using the Bonferroni test. Logistic regression was employed to further compare the differences between the groups. RESULTS: The study group comprised 237 patients. Sixty patients (25.3%) would not have had GDM detected in their pregnancy using the COVID-19 guidelines. FBG was the most significant predictor for intervention with medication for GDM (p = 0.001). CONCLUSION: HbA1c and FBG are poor screening tests for GDM. During the COVID-19 pandemic, the OGTT should be given clinical priority in high risk patients. Elevated FBG is a significant predictor for needing medical management and could be used in the future to better enable individualised treatment.


Assuntos
/diagnóstico , Diabetes Gestacional/diagnóstico , Programas de Rastreamento/normas , Guias de Prática Clínica como Assunto/normas , Adulto , Austrália/epidemiologia , Glicemia/metabolismo , /epidemiologia , Estudos de Coortes , Diabetes Gestacional/sangue , Diabetes Gestacional/epidemiologia , Feminino , Humanos , Programas de Rastreamento/métodos , Gravidez , Estudos Retrospectivos
6.
Int J Mol Sci ; 22(3)2021 Jan 26.
Artigo em Inglês | MEDLINE | ID: mdl-33530554

RESUMO

The aim of this review is to highlight the influence of the Mediterranean Diet (MedDiet) on Gestational Diabetes Mellitus (GDM) and Gestational Weight Gain (GWG) during the COVID-19 pandemic era and the specific role of interleukin (IL)-6 in diabesity. It is known that diabetes, high body mass index, high glycated hemoglobin and raised serum IL-6 levels are predictive of poor outcomes in coronavirus disease 2019 (COVID-19). The immunopathological mechanisms of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection include rising levels of several cytokines and in particular IL-6. The latter is associated with hyperglycemia and insulin resistance and could be useful for predicting the development of GDM. Rich in omega-3 polyunsaturated fatty acids, vitamins, and minerals, MedDiet improves the immune system and could modulate IL-6, C reactive protein and Nuclear Factor (NF)-κB. Moreover, polyphenols could modulate microbiota composition, inhibit the NF-κB pathway, lower IL-6, and upregulate antioxidant enzymes. Finally, adhering to the MedDiet prior to and during pregnancy could have a protective effect, reducing GWG and the risk of GDM, as well as improving the immune response to viral infections such as COVID-19.


Assuntos
/sangue , Diabetes Gestacional/prevenção & controle , Dieta Mediterrânea , Interleucina-6/sangue , Animais , Diabetes Gestacional/sangue , Diabetes Gestacional/epidemiologia , Feminino , Ganho de Peso na Gestação , Humanos , Estilo de Vida , Obesidade/sangue , Obesidade/epidemiologia , Obesidade/prevenção & controle , Gravidez
7.
Wei Sheng Yan Jiu ; 50(1): 63-68, 2021 Jan.
Artigo em Chinês | MEDLINE | ID: mdl-33517962

RESUMO

OBJECTIVE: To evaluate the red meat intake of pregnant women in Chengdu area and explore the effect of red meat intake in the first and second trimesters on gestational diabetes mellitus(GDM). METHODS: From February to July 2017, a prospective study was conducted among healthy singleton pregnant women within 8-14 weeks of gestation in a prenatal clinic of maternal-and-child medical institution in Chengdu City through purposive sampling. Data on maternal demographic characteristics was collected through questionnaire in early pregnancy. 3-day 24 hour dietary recall was used to collect dietary intake information in the first and second trimesters. The 75 g oral glucose tolerance test(OGTT)was conducted at 24 to 28 weeks of gestation, and GDM was diagnosed according to the Guidelines for the Diagnosis and Treatment of Pregnancy Diabetes in China(2014). Multivariate unconditional Logistic regression model was used to explore the association between tertiles of red meat intake and the risk of GDM in the first and second trimesters. RESULTS: A total of 985 valid samples were followed up. The mean intake of total meat and red meat in middle pregnancy(102. 9 g/d and 74. 6 g/d) was higher than that in early pregnancy(70. 7 g/d and 52. 0 g/d). The difference was statistically significant(P<0. 05). Red meat accounted for 73. 6% and 72. 5% of total meat intake in early and middle pregnancy, respectively. After adjusting the confounding factors, multivariate unconditional Logistic regression analysis showed the risk of GDM was 1. 499 times(95%CI 1. 028-2. 185) in the highest red meat intake(>86 g/d)women compared with the lowest red meat intake(<44 g/d) women in the second trimester. No association was found between red meat intake in the first trimester and the occurrence of GDM(OR=1. 029, 95%CI 0. 716-1. 481). CONCLUSION: Pregnant women in Chengdu area have excessive intake of red meat in the second trimester. Higher intake of red meat in the second trimester(>86 g/d) may increase the risk of gestational diabetes.


Assuntos
Diabetes Gestacional , Carne Vermelha , Criança , China/epidemiologia , Diabetes Gestacional/epidemiologia , Diabetes Gestacional/etiologia , Feminino , Humanos , Gravidez , Segundo Trimestre da Gravidez , Estudos Prospectivos , Fatores de Risco
8.
Ecotoxicol Environ Saf ; 210: 111854, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33422839

RESUMO

OBJECTIVE: To explore the prospective correlation between serum metals before 24 weeks' gestation and gestational diabetes mellitus (GDM) or glucose in the late second trimester among southern Chinese pregnant women. METHODS: A total of 8169 pregnant women were included in our retrospective cohort study. Logistic regression was used to investigate the relationships between metals (Manganese [Mn], copper [Cu], lead [Pb], calcium [Ca], zinc [Zn], magnesium [Mg]) and GDM. Quantile regression was performed to detect the shifts and associations with metals and three time-points glucose distribution of oral glucose tolerance test (OGTT) focused on the 10th, 50th, and 90th percentiles. Weighted quantile sum (WQS) regression was used to explore the relationship of metal mixtures and GDM as well as glucose. RESULTS: Maternal serum concentrations of metals were assessed at mean 16.55 ± 2.92 weeks' gestation. Women with under weight might have 25% decreased risk of GDM for every 50% increase in Cu concentration within the safe limits. A 50% increase in Mn and Zn levels was related to a 0.051 µmol/L (95% CI: 0.033-0.070) and 0.059 µmol/L (95% CI: 0.040-0.079) increase in mean fasting plasma glucose of OGTT (OGTT0), respectively. The magnitude of association with Mn was smaller at the upper tail of OGTT0 distribution, while the magnitude of correlation with Zn was greater at the upper tail. However, there was a 0.012 mmol/L (95% CI: -0.017 to -0.008), 0.028 mmol/L (95% CI: -0.049 to -0.007), and 0.036 mmol/L (95% CI: -0.057 to -0.016) decrease in mean OGTT0 levels for every 50% increase in Pb, Ca, and Mg, respectively. The negative association of Pb, Ca, and Mg was greater at the lower tail of OGTT0 distribution. No significant relationship was observed in Cu and mean OGTT0 level (-0.010 mmol/L, 95% CI: -0.021 to 0.001), however, it showed a protective effect at the upper tail (-0.034 mmol/L, 95% CI: -0.049 to -0.017). No obvious correlation was found between metals and postprandial glucose levels (OGTT1 and OGTT2 from OGTT). The WQS index was significantly related to OGTT0 (P < 0.001). The contribution of Mn (80.19%) to metal mixture index was the highest related to OGTT0, followed by Cu (19.81%). CONCLUSIONS: Higher Mn and Zn but lower Pb, Ca, and Mg concentrations within a certain range before 24 weeks' gestation might prospectively impair fasting plasma glucose during pregnancy; a greater focus is required on Mn. It could provide early markers of metal for predicting later glucose and suggest implement intervention for pregnant women.


Assuntos
Glicemia/análise , Diabetes Gestacional/sangue , Metais/sangue , Adulto , Monitoramento Biológico , Biomarcadores/sangue , China/epidemiologia , Diabetes Gestacional/epidemiologia , Feminino , Humanos , Gravidez
9.
Artigo em Inglês | MEDLINE | ID: mdl-33435536

RESUMO

Our objective was to describe the development and validation of a survey investigating barriers to weight loss, perception of diabetes risk, and views of diet strategies following gestational diabetes (GDM). The survey underwent three stages of development: generation of items, expert evaluation, and pilot testing. A content validation index (CVI) was calculated from expert responses regarding item relevance, coherence, clarity, and response options. Experts also responded to the domain fit of questions linked to the Theoretical Domains Framework (TDF). Pilot responders answered the survey and responded to review questions. Six experts in the field of nutrition, midwifery, psychology, or other health or medical research completed the expert review stage of the survey. In the pilot test, there were 20 responders who were women with previous GDM and who were living in Australia. The overall CVI from the expert review was 0.91. All questions except one received an I-CVI of >0.78 for relevance (n = 35). Fourteen of the 27 items linked to the TDF received an agreement ratio of <1.0. Twenty-seven of the 31 pilot questions were completed by ≥90% of responders. Pilot review questions revealed an agreement percentage of ≥86% (n = 12) regarding the survey's ease to complete, understand, importance, length, and interest level. The final survey tool consists of 30 items and achieved content validation through expert evaluation and pilot testing.


Assuntos
Diabetes Gestacional , Austrália/epidemiologia , Diabetes Gestacional/epidemiologia , Feminino , Humanos , Percepção , Gravidez , Reprodutibilidade dos Testes , Inquéritos e Questionários , Perda de Peso
10.
Artigo em Inglês | MEDLINE | ID: mdl-33440848

RESUMO

Obesity and diabetes increase the risk of complications during gestation and at delivery. The aim of this study was to compare the perinatal outcomes in the populations of diabetic and obese Polish women, based on the results of a national survey performed in years 2012 and 2017, as well as to determine the risk factors of the gestational diabetes mellitus (GDM). Questionnaires from 6276 women were collected. Obese women constituted 5.5% and 7.5% of study population in years 2012 and 2017, respectively. Among women whose pregnancies were complicated by diabetes mellitus, GDM constituted the most common type of glucose intolerance during both time periods (2012: 89% vs. 2017: 85.6%). In the group of obese women an insignificant increase in the rate of induced deliveries was noted (2012: 9.9% vs. 2017: 11.7%), whereas the fetal birth-weight decreased significantly (2012: 3565 g vs. 2017: 3405 g, p < 0.05). In the group of diabetic pregnant women the percentage of cesarean sections, labour inductions and fetal birth defects was characterized by an insignificant upward trend. Risk of GDM was significantly increased in women aged over 35 years-(2012: OR 1.9 (95% CI: 1.1-2.9) and 2017: OR = 2.1 (95% CI: 1.5-2.9), p < 0.05-, as well as in overweight women-2012: OR 1.8 (95% CI: 1.2-2.7) and 2017: OR 2.6 (95% CI: 1.9-3.4), p < 0.05-during both analysed time periods. Based on the study results, it is necessary to develop population-based programmes to prevent obesity and to introduce and enforce the rules of appropriate screening for glucose tolerance disorders during pregnancy.


Assuntos
Diabetes Gestacional , Gestantes , Idoso , Diabetes Gestacional/epidemiologia , Feminino , Humanos , Obesidade/epidemiologia , Sobrepeso , Polônia/epidemiologia , Gravidez
11.
Adv Exp Med Biol ; 1307: 231-255, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32314318

RESUMO

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.


Assuntos
Diabetes Gestacional , Programas de Rastreamento , Glicemia/análise , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/epidemiologia , Feminino , Teste de Tolerância a Glucose , Humanos , Gravidez
12.
Sci Total Environ ; 754: 142085, 2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-32898782

RESUMO

BACKGROUND: Endocrine-disrupting chemicals (EDCs) are considered to be related to diabetes, but studies of the association between phenolic EDCs and gestational diabetes mellitus (GDM) are limited. OBJECTIVES: To assess associations of maternal urinary bisphenol A (BPA), nonylphenol (NP), and 2-tert-octylphenol (2-t-OP) with GDM occurrence. METHODS: A cross-sectional study was performed among 390 Chinese women at 24-28 weeks of gestation. GDM was diagnosed with a 2-h 75-g oral glucose tolerance test (OGTT). BPA, NP, and 2-t-OP concentrations were determined in urine samples. Linear and logistic regression tests evaluated associations of BPA, NP, and 2-t-OP with blood glucose levels and GDM prevalence. RESULTS: The 2-t-OP concentrations in GDM patients were significantly higher than in non-GDM women with median values of 2.23 µg/g Cr and 1.79 µg/g Cr, respectively. No significant difference was observed in BPA and NP. Urinary 2-t-OP was positively associated with blood glucose levels after adjustment for several confounding factors and urinary BPA and NP. Higher 2-t-OP levels were associated with higher odds of GDM (OR: 5.78; 95% CI: 2.04, 16.37), whereas higher NP levels were associated with lower odds (OR: 0.22; 95% CI: 0.05, 0.85) in the adjusted models. In addition, compared to the first quartile of 2-t-OP, the adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) for GDM in the second, third, and fourth quartiles were 2.81 (1.23, 6.42), 3.01 (1.30, 6.93), and 5.49 (2.24, 13.46), respectively. CONCLUSION: Our study indicates that, for the first time to our knowledge, exposure to 2-t-OP is associated with a higher risk of GDM. However, higher NP exposure is associated with lower GDM risk. Further studies are necessary to affirm the associations of 2-t-OP and NP with GDM, and to elucidate the causality of these findings.


Assuntos
Diabetes Gestacional , Disruptores Endócrinos , Glicemia , Estudos Transversais , Diabetes Gestacional/induzido quimicamente , Diabetes Gestacional/epidemiologia , Estrogênios , Feminino , Humanos , Gravidez
13.
Diabetes Res Clin Pract ; 171: 108586, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33316311

RESUMO

AIMS: This population-based cross-sectional study aimed to investigate recent trends in the prevalence and treatment of gestational diabetes mellitus (GDM) in Korea. We also investigated trends in annual prevalence rate of pregnancy-induced hypertension (PIH) and cesarean section (C-section) in GDM patients. METHODS: We used data from the Health Insurance Review and Assessment-National Patient Sample (HIRA-NPS) database, 2012-2016. Non-GDM (n = 53,698) and GDM (n = 7956) patient data were analyzed for each year. RESULTS: The annual increase in the prevalence of GDM was 11.1% over 2012-2016, with a significant continuously increasing trend (p < 0.0001). Age-stratified analysis showed that the annual prevalence of GDM significantly increased in patients below 40 years of age, but was not statistically significant as an increasing trend in patients above 40 years of age. Annual PIH prevalence rate among GDM women showed decreasing trend but was not statistically significant. An annual increase in C-section rate above 5% in GDM patients was statistically significant in both unadjusted and adjusted for age and PIH models. CONCLUSIONS: The prevalence of GDM in Korean women and C-section rates in women with GDM showed a significantly increasing trend, 2012-2016. There is a need for further efforts to monitor this trend and to identify associated risk factors for GDM in Korean women.


Assuntos
Cesárea/efeitos adversos , Diabetes Gestacional/epidemiologia , Diabetes Gestacional/terapia , Programas Nacionais de Saúde/normas , Adulto , Estudos Transversais , Bases de Dados Factuais , Feminino , História do Século XXI , Humanos , Gravidez , Prevalência , República da Coreia/epidemiologia , Fatores de Risco
14.
Maturitas ; 144: 68-73, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33358211

RESUMO

OBJECTIVES: Gestational diabetes mellitus (GDM) is a common pregnancy complication. This study aims to investigate the association between a history of GDM and bone mineral density (BMD), fractures, and falls in later life. STUDY DESIGN: We used data from the Norfolk cohort of the European Prospective Investigation into Cancer (EPIC-Norfolk) where BMD at calcaneum was measured at second health check (1997-2000) using broadband ultrasound attenuation (BUA) and velocity of sound (VOS) in 7,515 women. Fractures and falls were documented from hospital admissions data via linkage with ENCORE (East Norfolk Commission Record) and history of GDM from health questionnaires at baseline. We examined the relationship between GDM and BUA/VOS using linear regression. Cox regression was used to estimate hazard ratios (HRs) for incident fractures and falls, controlling for age, BMI, smoking status, physical activity, area deprivation, self-reported stroke, use of diuretics, calcium and vitamin D supplements, social class and education, statin and total blood cholesterol, prevalent diabetes, hormone therapy and menopausal status. RESULTS: History of GDM (n = 183) was not statistically significantly associated with BUA/VOS in fully adjusted linear regression models with unstandardised beta coefficients (standard error): -0.37 (1.40) and -5.41 (3.48). GDM was significantly (p < 0.05) associated with risk of hip and all fractures, fully adjusted HRs(95 %CI) 2.46(1.54-3.92) and 1.60(1.09-2.35), respectively. Median follow-up from first live birth to date of admission was 53 and 52 years, respectively. CONCLUSION: There was an association between history of GDM and risk of any fracture as well as hip fracture specifically. Further research is required to confirm this.


Assuntos
Densidade Óssea , Diabetes Gestacional/epidemiologia , Fraturas Ósseas/epidemiologia , Acidentes por Quedas , Adulto , Idoso , Calcâneo/diagnóstico por imagem , Estudos de Coortes , Europa (Continente)/epidemiologia , Feminino , Fraturas Ósseas/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Gravidez , Ultrassonografia
15.
Artigo em Inglês | MEDLINE | ID: mdl-33333879

RESUMO

The current status of gestational diabetes mellitus in Australia reveals an almost quadrupling prevalence over the last decade. A narrative review of the current Australian literature reveals unique challenges faced by Australian maternity clinicians when addressing this substantial disease burden in our diverse population. Rising rates of maternal overweight and obesity, increasing maternal age and the diversity of ethnicity are key epidemiological impactors, overlaid by the 2015 changes in screening and diagnostic parameters. Our vast land mass and the remote location of many at risk women requires innovative and novel ideas for pathways to diagnose and effectively manage women with gestational diabetes mellitus. By modifying and modernizing models of care for women with gestational diabetes mellitus, we have the ability to address accessibility, resource management and our acute response to global events such as the COVID 19 pandemic. With continuing research, education and robust discourse, Australia is well placed to meet current and future challenges in the management of gestational diabetes mellitus.


Assuntos
Diabetes Gestacional/diagnóstico , Diabetes Gestacional/epidemiologia , Austrália/epidemiologia , Feminino , Humanos , Gravidez , Prevalência
16.
Medicine (Baltimore) ; 99(51): e23793, 2020 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-33371150

RESUMO

ABSTRACT: To compare pregnancy outcomes between patients with gestational diabetes mellitus (GDM) with and without their own blood glucose meter.We conducted a retrospective-cohort study of 835 women with GDM at the Second Hospital of Tianjin Medical University, Tianjin, China from 1 January 2016 to 31 December 2018. Perinatal outcomes of these patients were monitored and collected in the Tianjin Maternal and Child Health System. Each patient was advised by a certified clinical nutritionist regarding dietary analysis and lifestyle recommendations. All pregnant women with GDM were divided into the following 2 groups according to whether they had their own blood glucose meter: women with self-measured blood glucose levels with a routine obstetric examination in the study group (n = 424); and those with non-self-measured blood glucose levels with a double obstetric examination in the control group (n = 411). Maternal and fetal pregnancy outcomes were compared between these 2 groups. According to different self-management modes, the women were also divided into eight subgroups to compare blood sugar control and compliance with recommended insulin therapy.The cesarean section rate was significantly lower in the study group than in the control group (P < .05). The prevalence of large-for-gestational age (P < .05) and macrosomia was significantly lower in the study group than in the control group (both P < .05). The prevalence of appropriate-for-gestational age was significantly higher in the study group than in the control group (P < .05). Birth weight was significantly lower in the study group than in the control group (P < .05). The mean times for blood sugar control and from the doctor recommendation for insulin treatment to the patient compliance in the study group were significantly shorter than those in the control group (both P < .05). The proportion of insulin required in the study group was significantly lower than that in the control group (P < .05). There were no significant differences in the time of controlling blood sugar and compliance among the 4 subgroups of the study group. However, subgroups with a dietary diary in the control group were better.Self-monitoring blood sugar plus a routine obstetric examination can help patients with GDM control blood sugar, even without dietary diaries and treadmills. In addition to increasing the number of obstetric examinations, recording dietary diaries is helpful for controlling blood sugar in patients with GDM who are unwilling to measure blood sugar by themselves.


Assuntos
Automonitorização da Glicemia/instrumentação , Diabetes Gestacional/terapia , Resultado da Gravidez/psicologia , Adulto , Glicemia/análise , Automonitorização da Glicemia/psicologia , Automonitorização da Glicemia/normas , China , Estudos de Coortes , Diabetes Gestacional/sangue , Diabetes Gestacional/epidemiologia , Feminino , Humanos , Gravidez , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/prevenção & controle , Estudos Retrospectivos
17.
Artigo em Inglês | MEDLINE | ID: mdl-33353136

RESUMO

Gestational diabetes mellitus (GDM) has become an epidemic and has caused a tremendous healthy and economic burden in China, especially after the "two-child policy" put into effect on October 2015. The prevalence of GDM has continued to increase during the past few decades and is likely to see a further rise in the future. The public health impact of GDM is becoming more apparent in China and it might lead to the development of chronic non-communicable diseases in the long-term for both mothers and their children. Early identification of high-risk individuals could help to take preventive and intervention measures to reduce the risk of GDM and adverse perinatal outcomes. Therefore, a focus on prevention and intervention of GDM in China is of great importance. Lifestyle interventions, including dietary and physical exercise intervention, are effective and first-line preventive strategies for GDM prevention and intervention. The GDM One-day Care Clinic established in 2011, which educates GDM patients on the basic knowledge of GDM, dietary intervention, physical exercise, weight management, and blood glucose self-monitoring methods, sets a good model for group management of GDM and has been implemented throughout the hospitals as well as maternal and child health centers in China. The current review focus on the prevalence, risk factors, as well as prevention and lifestyle intervention of GDM in China for better understanding of the latest epidemiology of GDM in China and help to improve maternal and neonatal pregnancy outcomes and promote long-term health for women with GDM.


Assuntos
Diabetes Gestacional , Estilo de Vida , Criança , China/epidemiologia , Diabetes Gestacional/epidemiologia , Diabetes Gestacional/prevenção & controle , Exercício Físico , Feminino , Humanos , Gravidez , Prevalência
18.
Artigo em Inglês | MEDLINE | ID: mdl-33371325

RESUMO

With the rising trend in obesity, the incidence of gestational diabetes mellitus (GDM) and perinatal complications associated with the condition are also on the rise. Since the early 1900s, much knowledge has been gained about the diagnosis, implications, and management of gestational diabetes with improved outcomes for the mother and fetus. Worldwide, there is variation in the definition of GDM, methods to screen for the condition, and management options. The International Association of Diabetes in Pregnancy Study Groups has published recommendations for a one-step approach to screen pregnant women for GDM, in order to develop outcome-based criteria that can be used internationally. However, management of GDM continues to be varied, and currently several options are available for treatment of hyperglycemia during pregnancy. A review of various aspects of GDM is discussed with a focus on the medical management during pregnancy, as practiced in the United States.


Assuntos
Diabetes Gestacional , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/tratamento farmacológico , Diabetes Gestacional/epidemiologia , Feminino , Humanos , Hiperglicemia , Incidência , Mães , Obesidade , Gravidez , Resultado da Gravidez/epidemiologia
19.
Artigo em Inglês | MEDLINE | ID: mdl-33322416

RESUMO

Type 2 diabetes mellitus (T2DM) has become a modern-day plague by reaching epidemic levels throughout the world. Due to its similar pathogenesis, gestational diabetes (GDM) increases in parallel to T2DM. The prevalence of T2DM (3.9-18.3%) and GDM (5.1-37.7%) in countries of the Arab Gulf are amongst the highest internationally, and they are still rising precipitously. This review traces the reasons among the Arab nations for (a) the surge of T2DM and GDM and (b) the failure to contain it. During the last five decades, the massive oil wealth in many Arab countries has led to the unhealthy lifestyle changes in physical activity and diet. The excess consumption of calories turned the advantageous genes, originally selected for the famine-like conditions, detrimental: fueling obesity and insulin resistance. Despite genetic differences in these populations, GDM-a marker for future obesity and T2DM-can overcome this scourge of T2DM through active follow-up and screening after delivery. However, the health policies of most Arab countries have fallen short. Neglecting this unique chance will miss an irreplaceable opportunity to turn the tide of the T2DM and obesity epidemic in the Middle Eastern Arab Gulf countries-as well as globally.


Assuntos
Diabetes Mellitus Tipo 2 , Diabetes Gestacional , África do Norte/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Gestacional/epidemiologia , Feminino , Humanos , Oriente Médio/epidemiologia , Gravidez
20.
Artigo em Inglês | MEDLINE | ID: mdl-33374764

RESUMO

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


Assuntos
Diabetes Gestacional , Comportamentos Relacionados com a Saúde , Resultado da Gravidez , Adulto , Estudos Transversais , Diabetes Gestacional/epidemiologia , Diabetes Gestacional/prevenção & controle , Exercício Físico , Feminino , Humanos , Estilo de Vida , Paridade , Gravidez , Comportamento Sedentário , Emirados Árabes Unidos
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