What do we know about gestational diabetes mellitus and risk for postpartum depression among ethnically diverse low-income women in the USA?

Objective: Gestational diabetes mellitus is increasing worldwide, mainly in developing countries, and physical activity has not been studied in gestational diabetes mellitus prevention among low-income population. This prospective cross-sectional study assessed the gestational diabetes mellitus risk related to physical activity in early pregnancy among low-income women. Methods: A prospective cross-sectional study with 544 low-income pregnant women was conducted at the Instituto de Medicina Integral Prof. Fernando Figueira, Brazil. Gestational diabetes mellitus was diagnosed using the International Association of Diabetes and Pregnancy Study Groups criteria. Physical activity was assessed during early pregnancy using the Pregnancy Physical Activity Questionnaire and categorized as sedentary, light, moderate, or vigorous intensity. Results: Gestational diabetes mellitus occurred in 95 of 544 women (17.4%). Body mass index was higher in the gestational diabetes mellitus group. Nearly half of all pregnant women studied were physically inactive, and none of them were classified as vigorous physical active. Sedentary physical activity pattern was associated with a higher odds of gestational diabetes mellitus (odds ratio = 1.8, 95% confidence interval = 1.1–2.9), which did not change after adjusting for several covariates (odds ratio = 1.9, 95% confidence interval = 1.2–3.1). Conclusion: Physical inactivity in early pregnancy is associated with a higher risk of gestational diabetes mellitus among low-income women.

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A Comparison of Apgar Scores and Changes in the Neonates of Gestational Diabetes Mellitus Patients Treated with Metformin versus Glyburide: A Systematic Review

Dubai Diabetes and Endocrinology Journal ◽

10.1159/000507244 ◽

2020 ◽

Vol 26 (1) ◽

pp. 21-26

Author(s):

Sumanta Saha ◽

Sujata Saha

Keyword(s):

Diabetes Mellitus ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Apgar Score ◽

Population Characteristics ◽

Apgar Scores ◽

Randomized Controlled ◽

The Usa ◽

And Performance ◽

Performance Bias

Aims: This study aims to compare the Apgar scores (at different time points after birth) and their changes between the newborns of gestational diabetes mellitus (GDM) patients treated with metformin and glyburide, respectively. Methods: Electronic databases were searched for randomized controlled trials that compared these outcomes between the above-depicted intervention groups. The data about the study design, the population characteristics, the interventions compared, and the outcomes of interest were extracted from the eligible trials. Then, these trials were critically appraised by the Cochrane tool. After that, the effect of the tested interventions on the respective outcomes of interest was reported narratively. Results: The literature search produced 4 single-center trials sourcing data from about 538 participants in the USA, Brazil, and Israel. The risk of detection and performance bias was unclear in the respective trials. The trials primarily reported about the Apgar scores at 1 and 5 min after birth. These scores were not different between glyburide- and metformin-treated GDM patients in any trial. No trial reported the Apgar score at 10 min after birth or the changes in Apgar score between 1, 5, or 10 min after birth. Conclusion: In all trials, the Apgar scores at 1 and 5 min after birth did not vary between the newborns of GDM mothers treated with metformin and glyburide, respectively.

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A simplified diagnostic work-up for the detection of gestational diabetes mellitus in low resources settings: achievements and challenges

Archives of Gynecology and Obstetrics ◽

10.1007/s00404-020-05708-x ◽

2020 ◽

Vol 302 (5) ◽

pp. 1127-1134

Author(s):

Giovanni Putoto ◽

Edgardo Somigliana ◽

Federico Olivo ◽

Simona Ponte ◽

Michael Momoh Koroma ◽

...

Keyword(s):

Diabetes Mellitus ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Low Income ◽

Tolerance Test ◽

Low Income Countries ◽

Oral Glucose ◽

Capillary Glucose ◽

Working Day ◽

Diagnostic Work

Abstract Purpose Modern strategies for the screening and diagnosis of Gestational Diabetes Mellitus (GDM) rely on universal Oral Glucose Tolerance Test (OGTT). However, they are unsustainable in low-income countries. In this study, we aimed at assessing the feasibility of a simplified diagnostic policy. Methods The study took place in an urban referral hospital in Freetown, Sierra Leone. During an 11-month period, pregnant women were offered capillary blood test for glucose assessment. They could be screened at any time during pregnancy. GDM was diagnosed if fasting glucose was ≥ 92 mg/dl or if the OGTT was positive. The latter was prescribed only to women presenting after 24 weeks’ gestation with at least one risk factor for GDM and fasting capillary glucose between 85 and 91 mg/dl. A definitive diagnosis required confirmation to this aim, women with values above the thresholds were invited to refer the next working day for repeating the test after fasting overnight. Results Overall, 7827 women were referred for screening, of whom 6872 (87%) underwent at least one capillary glucose assessment. However, 895 of those who had a positive test did not return for confirmation. Overall, a definite assessment could be done in 5799 subjects corresponding to 76% (95% CI 75–77%) of those eligible. GDM was diagnosed in 128 women (1.9%, 95% CI 1.6–2.2%). Based on an expected confirmation rate of 22% (calculated from those who referred for confirmation) in the 895 women who did not come back, one could infer that GDM would have been diagnosed in additional 197 women, raising the prevalence to 4.7% (95% CI 4.2–5.3%). Conclusion Three quarters of subjects could be assessed with our approach. Data also suggest that GDM is not rare even if identification of affected cases remains challenging.

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Trends in the Prevalence of Preexisting Diabetes and Gestational Diabetes Mellitus Among a Racially/Ethnically Diverse Population of Pregnant Women, 1999-2005

Diabetes Care ◽

10.2337/dc07-2345 ◽

2008 ◽

Vol 31 (5) ◽

pp. 899-904 ◽

Cited By ~ 383

Author(s):

J. M. Lawrence ◽

R. Contreras ◽

W. Chen ◽

D. A. Sacks

Keyword(s):

Diabetes Mellitus ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Pregnant Women ◽

Ethnically Diverse ◽

Diverse Population

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An Exploratory Analysis of Factors Associated with Low Risk Perception for Developing Type 2 Diabetes amongst Low-income, Primarily Latina Women with prior Gestational Diabetes Mellitus

10.21203/rs.2.21040/v1 ◽

2020 ◽

Author(s):

Priyanka Athavale ◽

Ndola Prata ◽

Karen Sokal-Gutierrez ◽

Maureen Lahiff ◽

Adriana Najmabadi ◽

...

Keyword(s):

Diabetes Mellitus ◽

Risk Perception ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Low Income ◽

Lower Risk ◽

Post Partum ◽

Latina Women ◽

Migrant Status ◽

Spanish Speaking

Abstract Background: Gestational diabetes mellitus (GDM) is a significant contributor to the development of diabetes (DM2) post-partum, with higher rates amongst low-income and Latina women. Understanding one’s risk perception for developing DM2 postpartum amongst women with GDM can help target preventive interventions that promote positive health behaviors and lifestyle changes. This study aims to assess how the interplay of individual level factors, healthcare based factors, and structural factors influence risk perception for developing DM2 amongst low-income, primarily migrant Latina women with recent gestational diabetes mellitus. Methods: Data is from the baseline assessment of the STAR MAMA intervention. Women (N=171) receiving prenatal care at low-income urban clinics in San Francisco Bay Area were surveyed for basic demographics, healthcare access, and health-related behaviors. The outcome variable, risk perception for developing DM2 post-partum, was measured using the RPS-DM tool. Associations between risk perception for developing DM2 and individual, health-care based and structural (eg. health insurance, food insecurity, educational attainment) covariates were estimated using descriptive statistics and logistic regression. Results: Although all participants had a high risk for subsequently developing DM2, 76% reported lower risk perception for developing diabetes within the next 1, 5, and 10 years. Migrant status, less than high school education, and food insecurity were associated with lower risk perception (p<0.05). Spanish-speaking women with GDM who did not have family histories of DM2 were at greatest risk of underestimating their DM2 risk (OR=6.5; CI= (1.149, 11.795)). On the other hand, Spanish-speaking women who had family histories of DM2 were more likely to correctly assess their DM2 risk (OR=0.16; CI= (0.031, 0.824)). Conclusions: Structural and individual factors, rooted in migrant status and cultural backgrounds, influence personal risk perception. The majority of high-risk GDM women in this sample underestimate their risk for developing diabetes. This poses an opportunity for the healthcare system to improve patient-provider communication to improve risk perceptions and motivation for behavioral risk reduction. Improved counseling regarding risk perception for vulnerable, migrant populations with GDM is critical to accurately convey risk and engage individuals in preventive behaviors. Trial Registration: The clinical trial registration number is: NCT02240420 and date of registration: 9/11/2014.

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