Perspectives on mHealth Interventions During and After Gestational Diabetes

Abstract Objectives To systematically review the perspectives of women with gestational diabetes (GDM) or a recent history of GDM on mHealth lifestyle interventions during pregnancy and postpartum to inform future intervention development. Methods This systematic review was published according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The research was conducted in PubMed, MEDLINE, EMBASE, CINAHL, PsycInfo, and Cochrane Central Register of Controlled Trials for qualitative studies up until 28 April 2020. Study quality was evaluated using Joanna Briggs Institute critical appraisal checklist for qualitative research and a reflexive thematic synthesis was performed. The COM-B model was used to apply findings to improve future intervention development. Results 14 studies met the inclusion criteria representing the views of 327 women. Differences emerged within the themes identified in pregnancy and postpartum. In pregnancy 3 overarching themes emerged relating to mHealth interventions- support, connectedness and trust. Pregnant women valued the support of healthcare professionals (HCPs) when participating in mHealth interventions, along with information from sources they can trust. The use of self-monitoring was useful in pregnancy as they could see their progress and feel connected to their pregnancy. Using mHealth alongside usual care in pregnancy was seen as beneficial. Postpartum 2 overarching themes emerged- support and connectedness. Postpartum women did not value the input of HCPs as much as pregnant women. They valued connections made with their peers. They indicated more limitations with mHealth interventions than women during pregnancy. They discussed the use of rewards to remain motivated, while in pregnancy the health of the baby appeared to be the main motivator. 7 key recommendations have been made for future intervention design using the COM-B model, most with high or moderate confidence. Conclusions Women's views on mHealth lifestyle interventions differ between pregnancy and the postpartum period, and these needs should be reflected in intervention design. The results also reflect the impact a GDM diagnosis has on women highlighting the need for ongoing support continuing into postpartum. Funding Sources No funding was received for this research.

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A Correlation between Complication in Pregnancy and Postpartum Depression: Literature Review

International Journal of Clinical Inventions and Medical Science ◽

10.36079/lamintang.ijcims-0301.181 ◽

2021 ◽

Vol 3 (1) ◽

pp. 31-39

Author(s):

Desy Meldawati

Keyword(s):

Literature Review ◽

Postpartum Depression ◽

Pregnant Women ◽

General Hospital ◽

Maternal Anemia ◽

Pregnancy And Postpartum ◽

History Of ◽

The Impact ◽

History Of Depression ◽

In Pregnancy

Postpartum depression is a depression syndrome that occurs in mothers after childbirth and can be prevented and cured. According to Fazraningtyas, in South Kalimantan, to be precise in the city of Banjarmasin, namely Ulin General Hospital of Banjarmasin and Dr. H.M. Ansari Saleh General Hospital of Banjarmasin showed 56.8% mild postpartum depression, 26.1% moderate postpartum depression, 17.0% severe postpartum depression. The impact of mothers experiencing postpartum depression is that mothers have difficulty interacting and can endanger their children. Postpartum depression is caused by several factors, the factors that contributed are complications in pregnancy. This study used a literature review approach. The articles obtained from Google Scholar, Biomed Central, and Pubmed. The criterias applied be restricted. As many as 10 journals are found. Based on the previous study, complications in pregnancy are the cause of postpartum depression. Complications that are often experienced by pregnant women are maternal anemia that can appear during the pregnancy process until the birth process occurs and 30-70% of pregnant women with maternal anemia have a risk of postpartum depression. Second, gestational diabetes is one of the complications of pregnancy that occurs in women who are pregnant. Pregnant women can increase hormones including the progesterone hormone, human placental lactogen estrogen, and cortisol. The last, a history of depression is a cause of postpartum depression because if pregnant women have a history of depression before pregnancy, they will have a higher risk of experiencing postpartum depression.

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Associations between plasma protein, IgG and IgA N-glycosylation and metabolic health markers in pregnancy and gestational diabetes

10.21203/rs.3.rs-344452/v1 ◽

2021 ◽

Author(s):

Tamara Štambuk ◽

Domagoj Kifer ◽

Lea Duvnjak ◽

Marijana Vučić Lovrenčić ◽

Olga Gornik

Keyword(s):

Gestational Diabetes ◽

Pregnant Women ◽

Plasma Protein ◽

Positive Association ◽

Protein Glycosylation ◽

Valuable Insight ◽

Fasting Insulin ◽

Significant Difference ◽

The Impact ◽

In Pregnancy

Abstract Background. Monitoring of the human circulating N-glycome could provide valuable insight into an individual’s metabolic status. Therefore, we examined if aberrant carbohydrate metabolism in gestational diabetes mellitus (GDM) associates with alterations in plasma protein, immunoglobulin G (IgG) and immunoglobulin A (IgA) N-glycosylation.Methods. Plasma protein, IgG and IgA N-glycans were enzymatically released, purified and chromatographically profiled in 48 pregnant women with normal glucose tolerance and 41 pregnant women with GDM, all sampled at 24-28 weeks of gestation.Results. Fasting insulin exhibited significant associations to numerous glycan traits, including several plasma protein N-glycans bearing bisecting GlcNAc, afucosylated fully sialylated IgG glycan and fully sialylated triantennary IgA glycan (padj range: 7.66x10-05–1.15x10-02). Insulin resistance markers HOMA2-IR and HOMA2-%B were mostly associated to the same glycan structures as fasting insulin. Both markers also showed positive association with high-branched plasma glycans (padj=1.15x10-02 and 2.26x10-03) and negative association with low-branched plasma glycans (padj=1.25x10-02 and 2.27x10-03). Additionally, HOMA2-%B index was significantly related to the glycosylation features describing IgG sialylation. Multiple glycans showed significant associations with total cholesterol and triglyceride levels. None of the tested glycan traits showed a significant difference between GDM and normoglycemic pregnancies.Conclusion. Markers of glucose homeostasis and lipid metabolism in pregnancy show extensive associations to various N-glycosylation features. However, plasma protein, IgG and IgA N-glycans were not able to differentiate pregnant women with and without GDM, possibly due to numerous physiological changes accompanying pregnancy, which confound the impact of GDM on protein glycosylation.

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Clinical Pharmacokinetic Studies in Pregnant Women and the Relevance of Pharmacometric Tools

Current Pharmaceutical Design ◽

10.2174/1381612825666190320135137 ◽

2019 ◽

Vol 25 (5) ◽

pp. 483-495 ◽

Cited By ~ 7

Author(s):

André Dallmann ◽

Paola Mian ◽

Johannes Van den Anker ◽

Karel Allegaert

Keyword(s):

Pregnant Women ◽

Clinical Pharmacokinetic ◽

Individual Variability ◽

Current Status ◽

Pharmacokinetic Studies ◽

Full Potential ◽

Pbpk Models ◽

Pregnancy And Postpartum ◽

Population Pk ◽

The Impact

Background: In clinical pharmacokinetic (PK) studies, pregnant women are significantly underrepresented because of ethical and legal reasons which lead to a paucity of information on potential PK changes in this population. As a consequence, pharmacometric tools became instrumental to explore and quantify the impact of PK changes during pregnancy. Methods: We explore and discuss the typical characteristics of population PK and physiologically based pharmacokinetic (PBPK) models with a specific focus on pregnancy and postpartum. Results: Population PK models enable the analysis of dense, sparse or unbalanced data to explore covariates in order to (partly) explain inter-individual variability (including pregnancy) and to individualize dosing. For population PK models, we subsequently used an illustrative approach with ketorolac data to highlight the relevance of enantiomer specific modeling for racemic drugs during pregnancy, while data on antibiotic prophylaxis (cefazolin) during surgery illustrate the specific characteristics of the fetal compartments in the presence of timeconcentration profiles. For PBPK models, an overview on the current status of reports and papers during pregnancy is followed by a PBPK cefuroxime model to illustrate the added benefit of PBPK in evaluating dosing regimens in pregnant women. Conclusions: Pharmacometric tools became very instrumental to improve perinatal pharmacology. However, to reach their full potential, multidisciplinary collaboration and structured efforts are needed to generate more information from already available datasets, to share data and models, and to stimulate cross talk between clinicians and pharmacometricians to generate specific observations (pathophysiology during pregnancy, breastfeeding) needed to further develop the field.

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The Impact of Diagnostic Criteria for Gestational Diabetes Mellitus on Adverse Maternal Outcomes: A Systematic Review and Meta-Analysis

Journal of Clinical Medicine ◽

10.3390/jcm10040666 ◽

2021 ◽

Vol 10 (4) ◽

pp. 666

Author(s):

Fahimeh Ramezani Tehrani ◽

Marzieh Saei Ghare Naz ◽

Razieh Bidhendi Yarandi ◽

Samira Behboudi-Gandevani

Keyword(s):

Systematic Review ◽

Gestational Diabetes ◽

Pregnant Women ◽

Diagnostic Criteria ◽

Meta Analysis ◽

Population Based ◽

Maternal Outcomes ◽

Care Providers ◽

Iadpsg Criteria ◽

The Impact

This systematic review and meta-analysis aimed to examine the impact of different gestational-diabetes (GDM) diagnostic-criteria on the risk of adverse-maternal-outcomes. The search process encompassed PubMed (Medline), Scopus, and Web of Science databases to retrieve original, population-based studies with the universal GDM screening approach, published in English language and with a focus on adverse-maternal-outcomes up to January 2020. According to GDM diagnostic criteria, the studies were classified into seven groups. A total of 49 population-based studies consisting of 1409018 pregnant women with GDM and 7,667,546 non-GDM counterparts were selected for data analysis and knowledge synthesis. Accordingly, the risk of adverse-maternal-outcomes including primary-cesarean, induction of labor, maternal-hemorrhage, and pregnancy-related-hypertension, overall, regardless of GDM diagnostic-criteria and in all diagnostic-criteria subgroups were significantly higher than non-GDM counterparts. However, in meta-regression, the increased risk was not influenced by the GDM diagnostic-classification and the magnitude of the risks among patients, using the IADPSG criteria-classification as the most strict-criteria, was similar to other criteria. In conclusion, a reduction in the diagnostic-threshold increased the prevalence of GDM, but the risk of adverse-maternal-outcome was not different among those women who were diagnosed through more or less intensive strategies. Our review findings can empower health-care-providers to select the most cost-effective approach for the screening of GDM among pregnant women.

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Peripheral Immunological Cells in Pregnant Women and their Change during Diabetes

Experimental and Clinical Endocrinology & Diabetes ◽

10.1055/s-0043-104935 ◽

2017 ◽

Vol 125 (10) ◽

pp. 677-683 ◽

Cited By ~ 1

Author(s):

Ulrike Friebe-Hoffmann ◽

Linda Antony ◽

Jan-Steffen Kruessel ◽

Brigitte Pawlowski ◽

Thomas Hoffmann

Keyword(s):

T Cells ◽

Gestational Diabetes ◽

Pregnant Women ◽

Immune Cell ◽

Γδ T Cells ◽

Complication Rates ◽

And Shifts ◽

The Impact ◽

Pregnant Diabetic

AbstractDuring the last decades the incidence of diabetes has dramatically increased as well as the number of pregnant diabetic women. There is still missing data regarding patterns and shifts of immune cell populations due to pregnancy with or without diabetes. The study aimed to investigate the impact of pregnancy, type 1 diabetes (T1D) and gestational diabetes mellitus (GDM) on different immune cells in female. The number and proportion of CD3-, CD4-, CD8- and γδ T-cells as well as B-, NK-, NKT- and dendritic cells (DC) incl. rate of apoptosis was analyzed in peripheral blood samples from 24 non-pregnant women, 24 pregnant controls, 25 non-pregnant T1D, 18 women with GDM and 15 pregnant T1D (PT1D) women. Compared to healthy controls, healthy pregnant women had reduced numbers of lymphoid DC and γδ T-cells, while women with gestational diabetes presented with increased numbers of γδ T-cells. Pregnant women with T1D showed increased NKT cells and a decrease of NK cells compared to healthy pregnant or non-pregnant T1D women. Apoptosis of γδ T-cells in healthy pregnant women was found to be decreased in comparison to their non-pregnant controls while apoptosis of myeloid and lymphoid DC was increased in pregnant T1D in comparison to non-pregnant T1D. Those results may indicate that increased complication rates during diabetic pregnancies might be due to an impaired adaptation of the immune system.

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The consequences of obesity and excess weight gain in pregnancy

Proceedings of The Nutrition Society ◽

10.1017/s0029665111003077 ◽

2011 ◽

Vol 70 (4) ◽

pp. 450-456 ◽

Cited By ~ 81

Author(s):

Jane E. Norman ◽

Rebecca Reynolds

Keyword(s):

Insulin Resistance ◽

Weight Gain ◽

Gestational Diabetes ◽

Pregnant Women ◽

Postpartum Haemorrhage ◽

Maternal Obesity ◽

Adverse Pregnancy Outcome ◽

Operative Delivery ◽

Adverse Pregnancy ◽

In Pregnancy

The prevalence of obesity in pregnancy is rising exponentially; about 15–20% of pregnant women now enter pregnancy with a BMI which would define them as obese. This paper provides a review of the strong links between obesity and adverse pregnancy outcome which operate across a range of pregnancy complications. For example, obesity is associated with an increased risk of maternal mortality, gestational diabetes mellitus, thromboembolism, pre-eclampsia and postpartum haemorrhage. Obesity also complicates operative delivery; it makes operative delivery more difficult, increases complications and paradoxically increases the need for operative delivery. The risk of the majority of these complications is amplified by excess weight gain in pregnancy and increases in proportion to the degree of obesity, for example, women with extreme obesity have OR of 7·89 for gestational diabetes and 3·84 for postpartum haemorrhage compared to their lean counterparts. The consequences of maternal obesity do not stop once the baby is born. Maternal obesity programmes a variety of long-term adverse outcomes, including obesity in the offspring at adulthood. Such an effect is mediated at least in part via high birthweight; a recent study has suggested that the odds of adult obesity are two-fold greater in babies weighing more than 4 kg at birth. The mechanism by which obesity causes adverse pregnancy outcome is uncertain. This paper reviews the emerging evidence that hyperglycaemia and insulin resistance may both play a role: the links between hyperglycaemia in pregnancy and both increased birthweight and insulin resistance have been demonstrated in two large studies. Lastly, we discuss the nature and rationale for possible intervention strategies in obese pregnant women.

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A review of guidance on fish consumption in pregnancy: is it fit for purpose?

Public Health Nutrition ◽

10.1017/s1368980018000599 ◽

2018 ◽

Vol 21 (11) ◽

pp. 2149-2159 ◽

Cited By ~ 11

Author(s):

Caroline M Taylor ◽

Pauline M Emmett ◽

Alan M Emond ◽

Jean Golding

Keyword(s):

Pregnant Women ◽

Fish Consumption ◽

Evidence Base ◽

Positive Contribution ◽

National Guidelines ◽

International Guidelines ◽

Beneficial Effects ◽

Use Of Technology ◽

The Impact ◽

In Pregnancy

AbstractObjectivePublic health messages to reduce Hg exposure for pregnant women have focused exclusively on advice on fish consumption to limit Hg exposure, with little account being taken of the positive contribution of fish to nutritional quality. The aim of the present review was to compare and contrast the content and presentation of national guidelines on fish consumption in pregnancy, and comment on their evidence base and impact on consumption.DesignWe searched for national and international guidelines on fish consumption in pregnancy using Internet search strategies. The detailed content and style of presentation of the guidelines were compared. The evidence base for the guidelines, and evidence for the impact of the guidelines on fish consumption levels, were assessed.ResultsWe identified nineteen national guidelines and three international guidelines. There was great variation in the content, complexity and presentation style. The guidelines were based largely on the Hg content of fish with far less consideration being given to the positive beneficial effects of nutrients provided by fish. The complexity of the guidelines may lead to pregnant women reducing their fish intake, or not eating fish at all.ConclusionsGuidelines on fish consumption in pregnancy should take the beneficial effects of fish into account. Guidelines need to be clear and memorable, and appropriately disseminated, to achieve impact. Guidelines could include visual rather than narrative content. Use of technology, for example apps, could enable women to record their fish consumption in real time and log compliance with guidance over a week or other time period.

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RELATIONSHIP OF MATERNAL VITAMIN B12 STATUS IN PREGNANCY WITH PRETERM BIRTH AND MATERNAL HEALTH RISKS

International Medical Journal ◽

10.37436/2308-5274-2020-2-7 ◽

2020 ◽

pp. 32-38

Author(s):

VICTORIA LAZAROVA SPASOVA ◽

LILIA IVANOVA KOLEVA ◽

MARIETA ANTONOVA POPOVA ◽

VALENTINA BOYANOVA PETKOVA ◽

MILEN VENTZISLAVOV DIMITROV

Keyword(s):

Preterm Birth ◽

Vitamin B12 ◽

Pregnant Women ◽

Serum Vitamin ◽

Vitamin B12 Deficiency ◽

Inverse Association ◽

Maternal Vitamin ◽

B12 Deficiency ◽

The Impact ◽

In Pregnancy

Vitamin B12 is known to be vital for cell growth and population during pregnancy. This retrospective and prospective case−control study was aimed to disclose a health risk for pregnant women with vitamin B12 deficiency, as well as the one of the preterm birth. The main tasks set and performed in this research were as follows: to compare the obstetrics anamnesis between the women who gave birth on term and women who gave birth before term; to find the prevalence of vitamin B12 insufficiency in pregnancy; to determine its association with preterm birth and low birth weight; to examine its association with spontaneous abortions, and to investigate its relationship with obesity and hemoglobin levels in pregnant women. The conducted investigation involved 107 women who gave birth before the 37th week of gestation and 101 women who gave birth after the 37th week of gestation at the outpatient clinic of the University Hospital "Maichin Dom" in Bulgaria. Our study revealed a correlation between maternal vitamin B12 deficiency, overweight and low hemoglobin level. Our results showed no significant correlation between serum vitamin B12 level and the risk of preterm birth. However, we found an inverse association between vitamin B12 level and overweight before pregnancy and at the time of giving birth. As well there was confirmed the strong connection between meat consumption and vitamin B12 level. The paper emphasizes that the deficiency of the vitamin occurs most likely in the women with inadequate diets. Such a deficiency is actually confirmed to have serious health consequences for pregnant women and their offspring. Therefore further profound and numerous studies should be performed to properly assess the correlation between vitamin B12 and preterm birth, as well as to understand better the impact of vitamin B12 over pregnant women. Key words: vitamin B12, preterm birth, pregnancy, overweight, hemoglobin.

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How Can Maternal Lifestyle Interventions Modify the Effects of Gestational Diabetes in the Neonate and the Offspring? A Systematic Review of Meta-Analyses

Nutrients ◽

10.3390/nu12020353 ◽

2020 ◽

Vol 12 (2) ◽

pp. 353 ◽

Cited By ~ 4

Author(s):

Delphine Mitanchez ◽

Cécile Ciangura ◽

Sophie Jacqueminet

Keyword(s):

Systematic Review ◽

Gestational Diabetes ◽

Maternal Obesity ◽

Adverse Outcomes ◽

Lifestyle Interventions ◽

Obese Women ◽

Gestational Weight ◽

Excessive Gestational Weight Gain ◽

Adverse Neonatal Outcomes ◽

Meta Analyses

Gestational diabetes (GDM) has deleterious effects on the offspring. Maternal obesity and excessive gestational weight gain (GWG), often associated with diabetes, also contribute to these adverse outcomes. Objectives: To assess the benefit for the offspring of maternal lifestyle interventions, including diets and physical activity, to prevent or to improve GDM and to limit excessive GWG. Method: Systematic review of meta-analyses published in English between December 2014 and November 2019. Results: Lifestyle interventions to reduce the risk of GDM reported a decreased risk of 15% to 40%, with a greater effect of exercise compared to diet. Combined lifestyle interventions specifically designed to limit GWG reduced GWG by 1.6 kg in overweight and obese women, and on average by 0.7 to 1 kg in all pregnant women. In these trials, adverse neonatal outcomes were poorly studied. Combined lifestyle interventions in women with GDM significantly reduced fetal growth. Altogether, lifestyle interventions reduced the risk of preterm birth and shoulder dystocia, but individually, diets or exercise alone had no effect on neonatal adverse outcomes. Conclusion: Specific maternal, neonatal and offspring benefits of lifestyle interventions during pregnancy to prevent or improve GDM control or to limit GWG still require clarification.

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Perspectives on the psychological and emotional burden of having gestational diabetes amongst low-income women in Cape Town, South Africa

BMC Women s Health ◽

10.1186/s12905-020-01093-4 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Lorrein Shamiso Muhwava ◽

Katherine Murphy ◽

Christina Zarowsky ◽

Naomi Levitt

Keyword(s):

Mental Health ◽

South Africa ◽

Gestational Diabetes ◽

Focus Groups ◽

Lived Experiences ◽

Cape Town ◽

Psychological Burden ◽

Pregnancy And Postpartum ◽

The Impact ◽

Depth Interviews

Abstract Background The diagnosis of gestational diabetes mellitus (GDM) may affect women’s mental wellbeing, functioning and quality of life, with potentially negative effects on treatment adherence. Identifying and addressing the psychological and emotional needs of women with GDM, could have benefits for sustainable long-term behavioural change following the affected pregnancy. This study explored the lived experiences of women with GDM and the impact of GDM on their experience of pregnancy and sense of well-being. Methods Purposive sampling was used to recruit women who had been diagnosed with GDM in their previous pregnancy and received antenatal care at a tertiary hospital in Cape Town, South Africa. This was a descriptive qualitative study using a combination of focus groups and in-depth interviews for an in- depth exploration of women’s lived experiences of GDM, their context and perceived needs. Data analysis followed an iterative thematic analysis approach. Results Thirty-five women participated in nine focus groups and five in-depth interviews. Women discussed the emotional and psychological burden of having GDM, highlighting (i) their initial emotional reactions to receiving a GDM diagnosis, (ii) their experience of adjusting to the constraints of living with GDM (iii) their feelings of apprehension about childbirth and their maternal role and (iv) their feelings of abandonment in the post-partum period once the intensive support from both health system and family ends. Conclusions The current biomedical model used in the management of GDM, is highly foetal-centric and fails to acknowledge important psychological factors that contribute to women’s overall wellbeing and experience of pregnancy. These results demonstrate the importance of incorporating mental health support in the management and care for women with GDM in public health services, along with facilitating emotional support from partners and family members. Based on our findings, we recommend routine mental health and psychosocial vulnerability screening and monitoring for women diagnosed with GDM throughout pregnancy and postpartum to improve prognoses.

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