Missed Opportunities for Early Diabetes Screening in Pregnancy

Abstract Objective This study aimed to identify characteristics of women at risk of undiagnosed type 2 diabetes mellitus (T2DM) that fail to receive early pregnancy screening. Study Design This was a retrospective case–control study of at-risk women who initiated care at the University of North Carolina at Chapel Hill at <21 weeks from January 2015 to December 2015. In 2013, the American College of Obstetricians and Gynecologists and the American Diabetes Association recommended women with prior GDM, glucose intolerance, or body mass index (BMI) ≥ 30 kg/m2 receive early pregnancy screening for undiagnosed T2DM. We defined early screening as 1-hour 50-g glucose challenge test or hemoglobin A1c at <21 weeks' gestation. Cases were women who did not have early screening, and controls were women who did. Modified Poisson regression with robust error variance estimated relative risks of factors associated with missed early screening. Results Of the 1,932 women who initiated care at <21 weeks, 257 (13%) women were at risk of undiagnosed T2DM and, thus, candidates for early screening. However, 129 (50.2%) women were not screened. Higher BMI and prior GDM were associated with a lower relative risk of missed screening. Conclusion Higher BMI and prior GDM increased the likelihood of early diabetes screening, but only half of at-risk women were screened. Provider education and best practice alert systems are needed to increase screening for undiagnosed T2DM.

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Pregnancy Outcomes Associated with Introduction of Early Diabetes Screening Guidelines

American Journal of Perinatology ◽

10.1055/s-0040-1721712 ◽

2020 ◽

Author(s):

Rebecca E. Weiss ◽

Nevert Badreldin ◽

Kathleen Drexler ◽

Charlotte Niznik ◽

Lynn M. Yee

Keyword(s):

Weight Gain ◽

Prenatal Care ◽

Gestational Weight Gain ◽

Multivariable Analysis ◽

Neonatal Outcomes ◽

Diabetes Screening ◽

Early Diabetes ◽

Screening Criteria ◽

Screening Guidelines ◽

Gestational Weight

Objective The study aimed to evaluate perinatal outcomes associated with introduction of and adherence to early diabetes screening guidelines. Study Design Retrospective cohort study of all women who received prenatal care at a single, high-volume tertiary care center before (“preguidelines”) and after (“postguidelines”) American College of Obstetrics and Gynecology guidelines for early pregnancy diabetes screening for women at high risk for diabetes. Women with known pregestational diabetes, late entry to prenatal care, a fetus with a known anomaly, or multiple gestation were excluded. Multivariable linear and logistic regression models were constructed to compare maternal and neonatal outcomes between women in the preguidelines cohort to those in the postguidelines cohort. Similarly, adherence to screening guidelines was assessed, and among all women who were eligible for early diabetes screening, multivariable linear, and logistic models were created to compare outcomes between those women who were screened early to those who were not. Results Of the 2,069 women eligible for analysis, 64.6% (n = 1,337) were in the postguideline cohort. Women in the postguideline cohort were older, less likely to have a history of smoking, and more likely to be non-Hispanic white. On multivariable analysis, women in the postguideline cohort had significantly less gestational weight gain (aβ = −2.3; 95% confidence interval [CI]: −3.4 to −1.1), but a higher odds of 5-minute Apgar's score of <7 (adjusted odds ratio: 2.51; 95% CI: 1.11–5.66). Of 461 women who met ACOG early diabetes screening criteria, 58.7% (n = 270) were screened appropriately. Adherence to screening was associated with parity, race, insurance, and BMI. On multivariable analysis, there were no significant differences in neonatal outcomes between women meeting early screening criteria who were screened early and those who were not. Conclusion Introduction of early diabetes screening guidelines was associated with a significant decrease in gestational weight gain, but did not improve neonatal outcomes. Key Points

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Optimizing diabetes screening frequencies for at-risk groups

Health Care Management Science ◽

10.1007/s10729-021-09575-z ◽

2021 ◽

Author(s):

Chou-Chun Wu ◽

Sze-chuan Suen

Keyword(s):

At Risk ◽

Risk Groups ◽

Diabetes Screening

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Understanding early pregnancy health behaviours among overweight and obese women at risk of gestational diabetes mellitus

Obesity Research & Clinical Practice ◽

10.1016/j.orcp.2011.08.106 ◽

2011 ◽

Vol 5 ◽

pp. 27

Author(s):

C.L. Harrison ◽

C.B. Lombard ◽

H.J. Teede

Keyword(s):

Diabetes Mellitus ◽

At Risk ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Early Pregnancy ◽

Health Behaviours ◽

Obese Women

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Development of a 'toolkit' to identify medical students at risk of failure to thrive on the course: an exploratory retrospective case study

BMC Medical Education ◽

10.1186/1472-6920-11-95 ◽

2011 ◽

Vol 11 (1) ◽

Cited By ~ 29

Author(s):

Janet Yates

Keyword(s):

At Risk ◽

Medical Students ◽

Failure To Thrive ◽

Retrospective Case ◽

Students At Risk ◽

Risk Of Failure ◽

Retrospective Case Study

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Multifactorial pathways facilitate resilience among kindergarteners at risk for dyslexia: A longitudinal behavioral and neuroimaging study

10.1101/618298 ◽

2019 ◽

Author(s):

Jennifer Zuk ◽

Jade Dunstan ◽

Elizabeth Norton ◽

Xi Yu ◽

Ola Ozernov-Palchik ◽

...

Keyword(s):

At Risk ◽

Age Factors ◽

Positive Association ◽

Screening Methods ◽

Compensatory Mechanisms ◽

Early Screening ◽

Decoding Skills ◽

Cognitive Linguistic ◽

At Risk Children ◽

The Right

ABSTRACTRecent efforts have focused on screening methods to identify children at risk for dyslexia as early as preschool/kindergarten. Unfortunately, while low sensitivity leads to under-identification of at-risk children, low specificity can lead to over-identification, resulting in inaccurate allocation of limited educational resources. The present study focused on children identified as at-risk in kindergarten who donotsubsequently develop dyslexia to specify factors associated with better reading outcomes among at-risk children. Early screening was conducted in kindergarten and a subset of children was tracked longitudinally until second grade. Potential protective factors were evaluated at cognitive-linguistic, environmental, and neural levels. Relative to at-risk kindergarteners who subsequently developed dyslexia, those who did not were characterized by significantly higher socioeconomic status (SES), speech production accuracy, and microstructure of the posterior right-hemispheric superior longitudinal fasciculus (SLF). A positive association between microstructure of the right SLF and subsequent decoding skills was found to be specific to at-risk children and not observed among typical controls. Among at-risk children, several kindergarten-age factors were found to significantly contribute to the prediction of subsequent decoding skills: microstructure of the posterior right SLF, age, gender, SES, and phonological awareness. These findings suggest that putative compensatory mechanisms are already present by the start of kindergarten. The right SLF, in conjunction with the cognitive-linguistic and socioeconomic factors identified, may play an important role in facilitating reading development among at-risk children. This study has important implications for approaches to early screening, and assessment strategies for at-risk children.

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Randomization of Early Diabetes Screening Among Obese Pregnant Women (REDSOAP Study)

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2021.11.100 ◽

2022 ◽

Vol 226 (1) ◽

pp. S42

Author(s):

Christopher A. Enakpene ◽

Micaela Della Torre ◽

Laura DiGiovanni ◽

Martha Wojtowycz ◽

Abida Hasan ◽

...

Keyword(s):

Pregnant Women ◽

Diabetes Screening ◽

Early Diabetes

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Private Preschool Teachers’ Competencies in Early Identification of Children at Risk of Learning Disabilities

Journal of Research in Psychology ◽

10.31580/jrp.v1i3.976 ◽

2019 ◽

Vol 1 (3) ◽

pp. 18-25

Author(s):

Norzah Md Yunus ◽

Suziyani Mohamed

Keyword(s):

At Risk ◽

Learning Disabilities ◽

Preschool Teachers ◽

Influential Factor ◽

Children At Risk ◽

Early Screening ◽

Significant Difference ◽

Common Learning ◽

The Relationship ◽

Private Preschool

Not only education is important in developing one’s intellectual and personal quality, but also an influential factor in seeking employment. Therefore, education is even more important for disabled individuals, as it enables them to read and write, communicate, make decisions and most importantly be employed. However, Dr. Mullai Ramaiah stated that the current Malaysian education system does not only lack in early screening, but also teachers who are equipped to teach and handle children with special needs (Arukesamy, 2017). Therefore, this current study intends to investigate the competency of preschool teachers in identifying children who are at risk of any learning disabilities (LD). This was done by administering a questionnaire survey to examine teachers’ knowledge of some common learning disabilities that usually affects preschool children. In this research, the relationship between teachers’ competency and teacher’s education level has been investigated. Findings from the data analysis indicated that the level of teacher’s competency in identifying children at risk is relatively low. It was revealed, a majority of general preschool teachers do not have any knowledge or acquired minimal knowledge in identifying children who are at risk of an LD. Findings also show that there was a significant difference in competencies between teachers of different levels of education. Finally, it was found teachers’ experience does not contribute to their knowledge in identifying children at risk of LD.

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A retrospective case-control service evaluation of CAARMS scores of patients with autism in York EIP, compared to age matched controls

BJPsych Open ◽

10.1192/bjo.2021.203 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S59-S60

Author(s):

Daniel Whitney ◽

Stephen Wright

Keyword(s):

At Risk ◽

Statistical Significance ◽

Mental States ◽

Autism Spectrum ◽

Mean Difference ◽

Autism Spectrum Conditions ◽

First Episode ◽

Retrospective Case ◽

Significant Difference ◽

Early Intervention In Psychosis

AimsStudies show the prevalence of Autism Spectrum Conditions in Early Intervention in Psychosis (EIP) populations is 3.6-3.7%, compared to approximately 1-1.5% in the general population. The CAARMS (Comprehensive Assessment of At Risk Mental States) is a national tool used by EIP services as a screening tool to bring patients into services and stratify their symptoms to determine what pathway may be most appropriate (First Episode Psychosis pathway (FEP) or At Risk Mental State pathway (ARMS)). As far as we are aware the CAARMS has not been validated in an autistic population. It is our view that several of the questions in the CAARMS may be interpreted differently by people with autism, thus affecting the scores. The aim of this evaluation was to identify whether CAARMS scores differ between patients diagnosed with autism and matched controls in York EIP.MethodFrom their mental health records, we identified all patients in the service with a diagnosis of autism. We then compared the CAARMS scores, at the time of referral, to those of age matched controls (matched by being in the age range 16-30) without an autism diagnosis, using continuous sampling by date of referral.Result14 patients in the service had a diagnosis of autism and had completed a CAARMS. CAARMS domains are all scored between 0 and 6 (indicating increasing severity or frequency). Compared to the age matched controls, autistic patients had a higher mean difference in their scores for ‘Non-Bizarre Ideas’ (mean difference of 0.86 for severity and 0.57 for frequency) and ‘Disorganised Speech’ (mean difference of 0.28 for severity and 0.57 for frequency). These results did not reach statistical significance which was unsurprising given the sample size. The gender split between groups was similar.ConclusionOur evaluation suggests a difference in CAARMS scores between patients in our service with a diagnosis of autism and those without. A larger study would be needed to confirm a statistically significant difference and multicentre results would be needed as evidence of generalisability. However, if such a difference were confirmed it might question the validity of CAARMS in autistic patients or suggest that modifications, perhaps in the form of reasonable adjustments to the questions or scoring, were needed to increase the validity in this population. We would suggest that spending extra time checking the patient has understood the intended meaning of the questions in the CAARMS may increase validity, particularly in the ‘Non-Bizarre Ideas’ domain.

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