Early Diagnosis of Prediabetes Among Pregnant Women that Develop Gestational Diabetes Mellitus and Its Influence on Perinatal Outcomes

2021 ◽  
Author(s):  
Gianna Wilkie ◽  
Ellen Delpapa ◽  
Heidi K Leftwich
Keyword(s):  
Gestational Diabetes ◽  
Glucose Tolerance ◽  
Pregnant Women ◽  
Impaired Glucose Tolerance ◽  
Insulin Treatment ◽  
Perinatal Outcomes ◽  
First Trimester ◽  
Neonatal Outcomes ◽  
Diabetes Screening ◽  
Nicu Admission

Objective: This purpose of this study was to determine among pregnant women with gestational diabetes (GDM) if early identification of impaired glucose tolerance consistent with prediabetes in the first trimester impacts maternal and neonatal outcomes. Study Design: This was a retrospective cohort study of patients that were screened for pregestational diabetes in early pregnancy at a large academic tertiary care center from October 1, 2017 to January 31, 2021 and who subsequently developed GDM. Demographic and perinatal outcomes were compared among women with GDM with a positive early diabetes screen consistent with prediabetes to women that screened negative in the first trimester. Multivariable logistic regression was performed to adjust for baseline demographic differences. Results: During the study period, 260 women screened had negative first trimester diabetes screening and subsequently developed GDM, while 696 screened positive for prediabetes and developed GDM. Women with prediabetes were more likely to require insulin treatment for their GDM compared to those that screened negative (79.5% vs. 45.4%, p<0.001), while those that screened negative were more likely to take an oral medication of metformin or glyburide for GDM management than those with prediabetes (41.5% vs. 16.4%, P<0.001). Infants born to mothers who screened positive for prediabetes were more likely to require NICU admission compared to those that screened negative even when adjusted for type of GDM treatment used (aOR 8.5, 95% CI 1.5-49.9). Conclusion: Women identified as having early impaired glucose tolerance consistent with prediabetes that subsequently develop gestational diabetes are more likely to be prescribed insulin treatment and may be at increased risk of adverse neonatal outcomes leading to NICU admission than women with negative first trimester diabetes screening. Future studies should focus on whether different methods of early treatment and/or intervention improve perinatal outcomes.

Perinatal Outcomes of Gestational Impaired Glucose Tolerance Without Diagnosis of Gestational Diabetes [21E]

2019 ◽  
Vol 133 (1) ◽  
pp. 56S-57S
Author(s):  
Christopher A. Enakpene ◽  
Tiffany N. Jones ◽  
Micaela Della Torre ◽  
Lauren R. Knazze ◽  
Ming Jin ◽  
...  
Keyword(s):  
Gestational Diabetes ◽  
Glucose Tolerance ◽  
Impaired Glucose Tolerance ◽  
Perinatal Outcomes

scholarly journals Economic burden of IADPSG gestational diabetes diagnostic criteria in China: propensity score matching analysis from a 7-year retrospective cohort

2020 ◽  
Vol 8 (1) ◽  
pp. e001538
Author(s):  
Zonglin He ◽  
Yuan Tang ◽  
Huatao Xie ◽  
Yuchen Lin ◽  
Shangqiang Liang ◽  
...  
Keyword(s):  
Propensity Score ◽  
Gestational Diabetes ◽  
Glucose Tolerance ◽  
Pregnant Women ◽  
Propensity Score Matching ◽  
Retrospective Cohort ◽  
Perinatal Outcomes ◽  
Medical Expenditure ◽  
Iadpsg Criteria ◽  
The Difference

IntroductionThe International Association of Diabetes and Pregnancy Study Group (IADPSG) criteria for gestational diabetes mellitus (GDM) increased the morbidity significantly, but the cost and effectiveness of its application are still unclear. This study aimed to analyze the impact of the IADPSG criteria for diagnosing GDM in China on the perinatal outcomes, and medical expenditure of GDM women versus those with normal glucose tolerance (NGT).Research design and methodsWe conducted a retrospective cohort study involving 7794 women admitted at the First Affiliated Hospital of Jinan University (Guangzhou, China), from November 1, 2010 to October 31, 2017. The perinatal outcomes and medical expenditure were retrieved from the electronic medical records in the hospital. Propensity score matching (PSM, in a 1:1 ratio) algorithm was used to minimize confounding effects on the difference in the two cohorts.ResultsPSM minimized the difference of baseline characteristics between women with and without GDM. Of 7794 pregnant women, half (n=3897) were all of the pregnant women with GDM admitted to the hospital during the period, the other half women had NGT and were selected randomly to match with their counterparts. Adopting the IADPSG criteria was associated with reduced risk of emergency cesarean section, polyhydramnios, turbid amniotic fluid and perineal injury (p<0.01 for all) and having any one of the adverse fetal outcomes (p<0.01), including fetal distress, umbilical cord around the neck, neonatal encephalopathy, admission to neonatal intensive care unit, birth trauma, neonatal hypoglycemia and fetal death. After PSM, the median total medical expenditure by the GDM women was ¥912.9 (US$140.7 in 2015) more than that of the the NGT women (p=0.09).ConclusionsDespite the increasing medical expenditure, screening at 24–28 gestational weeks under the IADPSG guidelines with the 2-hour, 75 g oral glucose tolerance test can improve short-term maternal and neonatal outcomes.

scholarly journals Application of a Pedometer for the Management of Impaired Glucose Tolerance in Pregnant Women

2020 ◽  
Author(s):  
Mariko Ueno ◽  
Mitsue Muraoka ◽  
Koichiro Takagi
Keyword(s):  
Internal Medicine ◽  
Glucose Tolerance ◽  
Pregnant Women ◽  
Impaired Glucose Tolerance ◽  
Insulin Treatment ◽  
Exercise Intervention ◽  
Nutritional Intervention ◽  
The Other ◽  
Proper Management ◽  
Other Hand

The proper management of impaired glucose tolerance (IGT) in pregnant women is important for both obstetricians and diabetologists as this condition is of interest to both obstetrics and internal medicine. Although nutritional intervention along with insulin treatment is the mainstream approach of IGT treatment in pregnant women, exercise intervention is another important component of the IGT management. A pedometer is a useful tool for objective exercise evaluation. Nonetheless, its application in the management of IGT in pregnant women is limited. On the other hand, with the widespread use of smartphones equipped with pedometer function, exercise by walking is easily monitored and utilised in both healthy pregnant women and pregnant women with obesity and impaired glucose tolerance. In this chapter, we review the present perspective on the use of a pedometer in the management of IGT in pregnant women by introducing our recently published work.

scholarly journals First Trimester Iron Status and Obstetric and Perinatal Outcomes

2021 ◽  
Author(s):  
Rebecka Hansen ◽  
Anne Lærke Spangmose ◽  
Veronika Markova Sommer ◽  
Charlotte Holm ◽  
Finn Stener Jørgensen ◽  
...  
Keyword(s):  
Iron Deficiency ◽  
Gestational Diabetes ◽  
Pregnant Women ◽  
Iron Supplementation ◽  
Iron Status ◽  
Perinatal Outcomes ◽  
First Trimester ◽  
University Hospital ◽  
Deficiency Anemia ◽  
Iron Deficient

Abstract Purpose: To assess the following in singleton pregnant women: 1) associations between first trimester iron deficiency and obstetric and perinatal outcomes, 2) overall first trimester iron status and 3) post-treatment iron status after intensified iron supplementation.Methods: Prospective cohort study with linkage of first trimester hemoglobin and plasma ferritin with obstetric and perinatal data from a hospital database. Blood sample data were obtained at a Danish University Hospital. The cohort was divided into groups according to ferritin and hemoglobin: (1) iron deficient anemic (ferritin <30 ng/mL and Hb <110 g/L), (2) iron deficient non-anemic (ferritin <30 ng/mL and Hb ≥110 g/L), and (3) iron replete non-anemic (ferritin 30–200 ng/mL and Hb ≥110 g/L). Obstetric and perinatal outcomes in each iron deficient group were compared to the iron replete non-anemic group using multivariable logistic regression. The effect of 2–8 weeks intensified iron supplementation on hemoglobin and ferritin were assessed by pairwise comparisons.Results: The cohort comprised 5,763 singleton pregnant women, of which 14.2% had non-anemic iron deficiency, and 1.2% had iron deficiency anemia. Compared to iron replete non-anemic women, iron deficient anemic women had a higher risk of gestational diabetes (aOR 3.8, 95% CI 1.4–9.0), and iron deficient non-anemic women had a higher risk of stillbirth (aOR 4.0, 95% CI 1.0–14.3). In group 1 and 2, 78.7% and 67.8% remained iron deficient after intensified iron supplementation. Conclusion: First trimester iron deficiency may be associated with gestational diabetes and stillbirth. First trimester iron deficiency was present in 15.4% and often persisted despite 2–8 weeks intensified iron supplementation.

scholarly journals Transient hyperglycemia, impaired glucose tolerance and gestational diabetes mellitus (GDM) in preterm pregnant women receiving antenatal steroids

2021 ◽  
Vol 10 (4) ◽  
pp. 206-209
Author(s):  
Saniya Naheed ◽  
Sajida Guftaar ◽  
Dure Shahwar ◽  
Seema Gul ◽  
Mahwash Jamil ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Glucose Tolerance ◽  
Gestational Diabetes Mellitus ◽  
Pregnant Women ◽  
Impaired Glucose Tolerance ◽  
Blood Sugar ◽  
Preterm Delivery ◽  
Preterm Labor ◽  
Antenatal Steroids

OBJECTIVE:To determine the frequency of transient hyperglycemia, impaired glucose tolerance and gestational diabetes mellitus(GDM) in preterm pregnant women receiving antenatal steroids. METHODOLOGY:This descriptive cross-sectional study was carried out in Maternal and Child Health Center unit 1 (MCH-1) at Pakistan Institute of Medical Sciences Islamabad Pakistan from January 2017 till August 2017. A total of 365 pregnant women presenting to emergency and outpatient department with preterm labor (alive morphologically normal babies), with preterm premature rupture of membranes (PPROM) and other conditions which require early delivery including preeclampsia, IUGR requiring preterm delivery, severe oligohydramnios, antepartum hemorrhage(APH), women receiving two doses dexamethasone and all those with BSR>126mg/dl were included in the study. Multiple pregnancies, advanced preterm labor (cervix > 5cm dilated), gestational diabetes mellitus (GDM) or type I/II diabetes mellitus (DM), chorioamnionitis and taking any medication that affects glucose metabolism were excluded from the study. After ethical approval, informed consent was taken from study participants. Blood sugar levels before the commencement of 1st dose of dexamethasone were noted. Blood sugar profile (fasting, 2 hours after lunch, 2 hours after dinner) were carried out. 2nd dose of dexamethasone was given after 12 hours of 1st dose. Profile was carried out till euglycemia or 5 days if sugars remain deranged.  Patients having deranged levels for greater than 5 days were advised 75 g oral glucose tolerance test(OGTT) and labelled as having impaired glucose tolerance or gestational diabetes mellitus. RESULTS: In our study, 57.57%(n=213) were between 18-30 years, 42.43%(n=157) were between 31-40 years of age, mean age was calculated as 28.92+5.54 while mean gestational age was 31.19+1.92 weeks. Frequency of transient hyperglycemia, impaired glucose tolerance and gestational diabetes mellitus(GDM) in preterm pregnant women receiving antenatal steroids revealed 62.16%(n=230) had transient hyperglycemia, 9.46%(n=35) had impaired glucose tolerance, 2.16%(n=8) had gestational diabetes and 26.22%(n=97) had no blood glucose abnormality.   CONCLUSION: We concluded that the frequency of abnormal glucose levels increases in preterm pregnant women receiving antenatal steroids. Therefore, single blood sugar level done routinely before dexamethasone therapy are insufficient to judge the glucose metabolic status and should be closely monitored during the use of antenatal corticosteroids. KEYWORDS: Preterm delivery, antenatal steroids, transient hyperglycemia, impaired glucose tolerance and gestational diabetes mellitus(GDM)

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