638Reporting of gestational diabetes and chronic conditions of pregnancy: validation of routinely collected hospital data

Abstract Background Gestational diabetes, hypertension, thyroid conditions and morbid obesity in pregnancy are associated with increased risks of adverse outcomes. Hospital data are important for research on these conditions, however, up-to-date validation of reporting is needed to understand the extent to which the data reflect the clinical situation. Methods Women giving birth to singleton infants in two tertiary hospitals in New South Wales, Australia, between 2011 and 2015 were included. Obstetric data, from the ObstetriX system, was used as the gold standard to which linked hospital data, from the Electronic Medical Record, were compared. Results There were 35,928 births included. Gestational and pre-existing diabetes had high sensitivity (83.6% and 88.2%) and positive predictive values (PPV, 92.7% and 86.0%). Pre-eclampsia and eclampsia, gestational hypertension and any hypertension had good sensitivity (80.0%, 80.1%, 81.5%), but moderate PPVs (59.7%, 65.6%, 70.4%), while for chronic hypertension sensitivity (53.5%) and PPV (53.2%) were lower. Obesity and thyroid conditions showed low sensitivity (9.8%, 12.9%; PPV 65.6%, 82.3%). Specificity and NPV were high for all conditions. Conclusions We found reliable reporting of gestational diabetes, pre-existing diabetes and all types hypertension, except for chronic hypertension which was moderately well reported. Thyroid conditions and morbid obesity were very poorly reported. Key messages Diabetes appears well reported in the hospital data, and sensitivity for hypertension may be improved by using a grouped category. Hospital data on thyroid conditions and obesity should be used with caution.

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Reporting of gestational diabetes and other maternal medical conditions

International Journal for Population Data Science ◽

10.23889/ijpds.v6i1.1381 ◽

2021 ◽

Vol 6 (1) ◽

Author(s):

Heather J Baldwin ◽

Tanya A Nippita ◽

Kristen Rickard ◽

Siranda Torvaldsen ◽

Therese M McGee ◽

...

Keyword(s):

Morbid Obesity ◽

Gestational Diabetes ◽

Gestational Hypertension ◽

New South ◽

Health Planning ◽

New South Wales ◽

Chronic Hypertension ◽

Medical Conditions ◽

Predictive Values ◽

South Wales

IntroductionHospital datasets are a valuable resource for examining prevalence and outcomes of medical conditions during pregnancy. To enable effective research and health planning, it is important to determine whether variables are reliably captured. ObjectiveTo examine the reliability of reporting of gestational and pre-existing diabetes, hypertension, thyroid conditions, and morbid obesity in coded hospital records that inform the population-level New South Wales Admitted Patient Data Collection. MethodsCoded hospital admission data from two large tertiary hospitals in New South Wales, from 2011 to 2015, were compared with obstetric data, collected by midwives at outpatient pregnancy booking and in hospital after birth, as the reference standard. Records were deterministically linked and sensitivity, specificity, positive predictive values and negative predictive values for the conditions of interest were obtained. ResultsThere were 36,051 births included in the analysis. Sensitivity was high for gestational diabetes (83.6%, 95% CI 82.4–84.7%), pre-existing diabetes (88.2%, 95% CI 84.1–91.6%), and gestational hypertension (80.1%, 95% CI 78.2–81.9%), moderate for chronic hypertension (53.5%, 95% CI 47.8–59.1%), and low for thyroid conditions (12.9%, 95% CI 11.7–14.2%) and morbid obesity (9.8%, 95% CI 7.6–12.4%). Specificity was high for all conditions (≥97.8%, 95% CI 97.7–98.0) and positive predictive value ranged from 53.2% for chronic hypertension (95% CI 47.5–58.8%) to 92.7% for gestational diabetes (95% CI 91.8–93.5%). ConclusionOur findings suggest that coded hospital data are a reliable source of information for gestational and pre-existing diabetes and gestational hypertension. Chronic hypertension is less consistently reported, which may be remedied by grouping hypertension types. Data on thyroid conditions and morbid obesity should be used with caution, and if possible, other sources of data for those conditions should be sought.

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Prevalence of Gestational Diabetes Mellitus, Maternal and Neonatal outcomes in a Peripheral Hospital in North India

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20172034 ◽

2017 ◽

Vol 5 (6) ◽

pp. 2343 ◽

Cited By ~ 1

Author(s):

Naiyma Choudhary ◽

Mohd Rasheed ◽

Vivek Aggarwal

Keyword(s):

Diabetes Mellitus ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Gestational Hypertension ◽

Adverse Outcomes ◽

Neonatal Outcomes ◽

North India ◽

Peripheral Hospital ◽

Medical Entity ◽

Maternal And Neonatal Outcomes

Background: Gestational diabetes mellitus (GDM) is a well-known medical entity which should be diagnosed at the earliest to prevent adverse maternal and neonatal outcomes due to hyperglycemia.Methods: This study was done in patients attending antenatal OPD in a peripheral hospital in North India. A total of 569 patients diagnosed as GDM were included in the study out of 6321 who attended the antenatal clinic.Results: The prevalence of gestational diabetes mellitus was found to be 9%. Gestational hypertension was seen in 29.35% of patients. The percent of babies who were admitted to NICU was 29.35%.Conclusions: These results stress the need for early detection and treatment of GDM to prevent adverse outcomes.

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External validation of the San Francisco Syncope Rule in the Australian context

CJEM ◽

10.1017/s1481803500014986 ◽

2007 ◽

Vol 9 (03) ◽

pp. 157-161 ◽

Cited By ~ 27

Author(s):

Teresa M. Cosgriff ◽

Anne-Maree Kelly ◽

Debra Kerr

Keyword(s):

Adverse Event ◽

San Francisco ◽

Hospital Admissions ◽

External Validation ◽

Admission Rate ◽

High Sensitivity ◽

Adverse Outcomes ◽

Predictive Values ◽

Serious Adverse Event ◽

Admission Rates

ABSTRACT Objective: The San Francisco Syncope Rule (SFSR) aims to identify patients with syncope who are at risk for short-term serious adverse outcomes. It has been reported to have high sensitivity and the potential to decrease admission rates. The aim of this study was to validate the SFSR in the Australasian setting. Methods: Our prospective, observational cohort study identified patients with syncope using emergency department (ED) databases. Data, including demographics, the presence of SFSR predictors and ED disposition, were collected either during ED stay or by explicit medical record review. Patients were followed up after 7 days for defined serious outcomes (i.e., death, myocardial infarction, arrhythmia, pulmonary embolism, stroke, subarachnoid hemorrhage, significant hemorrhage or unplanned ED re-presentation). We analyzed sensitivity, specificity, and positive and negative predictive values. We compared the results with current physician-based clinical practice. Results: We studied 89 patients with a median age of 74 years. Of them, 42% were male and the admission rate was 39%. Ten patients (11%) suffered a serious event. The SFSR was 90% sensitive (95% confidence interval [CI] 60%–98%) and 57% specific (95% CI 46%–67%) for predicting patients with a defined serious adverse event. The SFSR also categorized 48% of patients as “high risk.” If the SFSR had been strictly applied, the admission rate would have increased by 9% and 1 serious adverse event would have been missed. Conclusion: The SFSR demonstrated 90% sensitivity in this validation study. Strict application of the SFSR would have increased hospital admissions but would not have identified all adverse outcomes. In our setting, clinician judgement performed as well as the syncope rule, with a baseline admission rate of 36%.

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apoA2 correlates to gestational age with decreased apolipoproteins A2, C1, C3 and E in gestational diabetes

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2020-001925 ◽

2021 ◽

Vol 9 (1) ◽

pp. e001925

Author(s):

Manjunath Ramanjaneya ◽

Alexandra E Butler ◽

Mohammed Bashir ◽

Ilham Bettahi ◽

Abu Saleh Md Moin ◽

...

Keyword(s):

Gestational Diabetes ◽

Pregnant Women ◽

Pregnancy Outcome ◽

Gestational Age ◽

Gestational Hypertension ◽

Adverse Pregnancy Outcome ◽

Adverse Outcomes ◽

Bivariate Analysis ◽

Premature Delivery ◽

Gestational Age At Delivery

IntroductionPregnant women with gestational diabetes mellitus (GDM) are at risk of adverse outcomes, including gestational hypertension, pre-eclampsia, and preterm delivery. This study was undertaken to determine if apolipoprotein (apo) levels differed between pregnant women with and without GDM and if they were associated with adverse pregnancy outcome.Research design and methodsPregnant women (46 women with GDM and 26 women without diabetes (ND)) in their second trimester were enrolled in the study. Plasma apos were measured and correlated to demographic, biochemical, and pregnancy outcome data.ResultsapoA2, apoC1, apoC3 and apoE were lower in women with GDM compared with control women (p=0.0019, p=0.0031, p=0.0002 and p=0.015, respectively). apoA1, apoB, apoD, apoH, and apoJ levels did not differ between control women and women with GDM. Pearson bivariate analysis revealed significant correlations between gestational age at delivery and apoA2 for women with GDM and control women, and between apoA2 and apoC3 concentrations and C reactive protein (CRP) as a measure of inflammation for the whole group.ConclusionsApoproteins apoA2, apoC1, apoC3 and apoE are decreased in women with GDM and may have a role in inflammation, as apoA2 and C3 correlated with CRP. The fact that apoA2 correlated with gestational age at delivery in both control women and women with GDM raises the hypothesis that apoA2 may be used as a biomarker of premature delivery, and this warrants further investigation.

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Reliability of Cobas Amplicor PCR test in detection of Mycobacterium tuberculosis in respiratory and nonorespiratory specimens

Vojnosanitetski pregled ◽

10.2298/vsp0912992l ◽

2009 ◽

Vol 66 (12) ◽

pp. 992-997

Author(s):

Zorica Lepsanovic ◽

Dejana Savic ◽

Branka Tomanovic

Keyword(s):

Mycobacterium Tuberculosis ◽

High Sensitivity ◽

High Specificity ◽

Diagnostic Methods ◽

Nucleic Acid Amplification ◽

Culture Methods ◽

Predictive Values ◽

Polymerase Chain ◽

Low Sensitivity ◽

Sensitivity Specificity

Background/Aim. Traditional methods for detection of mycobacteria, such as microscopic examination for the presence of acid-fast bacilli and isolation of the organism by culture, have either a low sensitivity and/or specificity, or take weeks before a definite result is available. Molecular methods, especially those based on nucleic acid amplification, are rapid diagnostic methods which combine high sensitivity and high specificity. The aim of this study was to determine the usefulness of the Cobas Amplicor Mycobacterium tuberculosis polymerase chain reaction (CAPCR) assay in detecting the tuberculosis cause in respiratory and nonrespiratory specimens (compared to culture). Methods. Specimens were decontaminated by the N-acetyl-L-cystein- NaOH method. A 500 ?L aliquot of the processed specimen were used for inoculation of L?wenstein-Jensen (L-J) slants, a drop for acid-fast staining, and 100 ?L for PCR. The Cobas Amplicor PCR was performed according to the manufacturer's instructions. Results. A total of 110 respiratory and 355 nonrespiratory specimens were investigated. After resolving discrepancies by reviewing medical history, overall sensitivity, specificity, and positive and negative predictive values for CA-PCR assay compared to culture, were 83%, 100%, 100%, and 96.8%, respectively. In comparison, they were 50%, 99.7%, 87.5%, and 98%, respectively, for the nonrespiratory specimens. The inhibition rate was 2.8% for respiratory, and 7.6% for nonrespiratory specimens. Conclusion. CA-PCR is a reliable assay that enables specialists to start treatment promptly on a positive test result. Lower value for specificity in a group of nonrespiratory specimens is a consequence of an extremely small number of mycobacteria in some of them.

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Sensitivity and Specificity of Sheard and Percival’s Criteria for the Diagnosis of Young People with Near-heterophoria

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2021.6399 ◽

2021 ◽

Vol 9 (B) ◽

pp. 1128-1134

Author(s):

Saif Hassan Alrasheed ◽

Amel Mohamed Yousif ◽

Majid A. Moafa ◽

Abd Elaziz Mohamed Elmadina ◽

Mohammad Alobaid

Keyword(s):

Young People ◽

Negative Predictive Value ◽

Sensitivity And Specificity ◽

Binocular Vision ◽

Predictive Value ◽

High Sensitivity ◽

The Other ◽

Cross Sectional ◽

Predictive Values ◽

Low Sensitivity

BACKGROUND: Sheard and Percival assumed that symptoms from latent strabismus can be avoided if the relevant fusional vergence is adequate to support the heterophoria. AIM: The aim of the study was to determine the sensitivity and specificity of Sheard’s and Percival’s criterion for the diagnosis of heterophoria. METHODS: A cross-sectional hospital-based study was performed at Al-Neelain Eye Hospital Khartoum, Sudan from February to October 2019. Heterophoria was measured using Maddox Wing and fusional vergence using a prism bar. Thereafter, Sheard’s and Percival’s criteria were used for the diagnosis of heterophoria. RESULTS: A total of 230 participants (age = 15–30 years; mean age = 19.34 ± 3.325 years) were recruited for this study. The Sheard’s criteria showed a high sensitivity of 87.2% and a low specificity of 8.0% for the diagnosing of exophoria, with positive and negative predictive values of 65.5% and 26%, respectively. The criteria showed a relatively low sensitivity of 77.8% and a specificity of 9.0% in the diagnosis of esophoria, with a positive and negative predictive values of 56% and 20%, respectively. Percival criteria showed high sensitivity 84.2% and low specificity 9.1% in diagnosing esophoria, with a positive and negative predictive value of 61.5% and 25%, respectively. On the other hand, the criteria showed low sensitivity 67.4% and specificity 13.8% in diagnosing exophoria, with positive and negative predictive value 61.9% and 17%, respectively. CONCLUSION: Sheard’s and Percival’s criteria are useful in diagnosing binocular vision problems. Sheard’s criteria are accurate in diagnosing near exophoria and Percival’s criteria are more accurate in diagnosing near esophoria. Therefore, these criteria provide good clues and predictions for the diagnosis of binocular vision problems.

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Adverse Outcomes during Postpartum Readmissions after Deliveries Complicated by Hypertensive Disorders of Pregnancy

American Journal of Perinatology ◽

10.1055/s-0041-1739429 ◽

2021 ◽

Author(s):

Ukachi N. Emeruwa ◽

Cynthia Gyamfi-Bannerman ◽

Timothy Wen ◽

Whitney Booker ◽

Jason D. Wright ◽

...

Keyword(s):

Heart Failure ◽

Pulmonary Edema ◽

Gestational Hypertension ◽

Adverse Outcomes ◽

Chronic Hypertension ◽

Linear Regression Models ◽

Adjusted Risk ◽

Increased Risk ◽

Log Linear ◽

Adjusted Model

Objective This study aimed to characterize risk for postpartum complications based on specific hypertensive diagnosis at delivery. Study Design This retrospective cohort study used the 2010 to 2014 Nationwide Readmissions Database to identify 60-day postpartum readmissions. Delivery hospitalizations were categorized based on hypertensive diagnoses as follows: (1) preeclampsia with severe features, (2) superimposed preeclampsia, (3) chronic hypertension, (4) preeclampsia without severe features, (5) gestational hypertension, or (6) no hypertensive diagnosis. Risks for 60-day readmission was determined based on hypertensive diagnosis at delivery. The following adverse outcomes during readmissions were analyzed: (1) stroke, (2) pulmonary edema and heart failure, (3) eclampsia, and (4) severe maternal morbidity (SMM). We fit multivariable log-linear regression models to assess the magnitude of association between hypertensive diagnoses at delivery and risks for readmission and associated complications with adjusted risk ratios (aRR) as measures of effect. Results From 2010 to 2014, 15.7 million estimated delivery hospitalizations were included in the analysis. Overall risk for 60-day postpartum readmission was the highest among women with superimposed preeclampsia (6.6%), followed by preeclampsia with severe features (5.2%), chronic hypertension (4.0%), preeclampsia without severe features (3.9%), gestational hypertension (2.9%), and women without a hypertensive diagnosis (1.5%). In adjusted analyses for pulmonary edema and heart failure as the outcome, risks were the highest for preeclampsia with severe features (aRR = 7.82, 95% confidence interval [CI]: 6.03, 10.14), superimposed preeclampsia (aRR = 8.21, 95% CI: 5.79, 11.63), and preeclampsia without severe features (aRR = 8.87, 95% CI: 7.06, 11.15). In the adjusted model for stroke, risks were similarly highest for these three hypertensive diagnoses. Evaluating risks for SMM during postpartum readmission, chronic hypertension and superimposed preeclampsia were associated with the highest risks. Conclusion Chronic hypertension was associated with increased risk for a broad range of adverse postpartum outcomes. Risk estimates associated with chronic hypertension with and without superimposed preeclampsia were similar to preeclampsia with severe features for several outcomes. Key Points

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P0263A NEPHROLOGIST'S LOOK AT HYPERTENSIVE DISORDERS OF PREGNANCY

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p0263 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Bianca Covella ◽

Luigi Rossi ◽

Domenico Caringella ◽

Maurizio Guido ◽

Giorgina Piccoli ◽

...

Keyword(s):

Uric Acid ◽

Kidney Disease ◽

Gestational Diabetes ◽

Gestational Hypertension ◽

Chronic Hypertension ◽

Hypertensive Disorders Of Pregnancy ◽

Hypertensive Disorders ◽

Coagulation Abnormalities ◽

Family Medical History ◽

High Prevalence

Abstract Background and Aims Preeclampsia (PE) is a pregnancy-related syndrome of variable severity that falls under the broad category of hypertensive disorders of pregnancy (HDP). The relationship between PE and chronic kidney disease (CKD) is not entirely understood. Once considered a self-limited disease healed by delivery, it is now acknowledged that PE is a marker of cardiovascular and kidney health in the long term. The aim of this study was to review the data of women with hypertensive disorders of pregnancy at our institution, to identify need and to organize a conjoint nephrology and obstetrical activity in our setting Method We retrospectively reviewed all the medical charts of the patients hospitalized in the last two years for hypertensive disorders of pregnancy and who delivered in our Hospital. The cohort was divided into two groups: gestational hypertension (GH) and PE. A descriptive analysis of the clinical-laboratoristic was performed (t-test for continuous data with normal distribution). Results We identified 93 cases of hypertensive disorders of pregnancy on a total of 3279 deliveries (2.8%), 47 GH and 46 PE [2 cases of HELLP syndrome and 1 of eclampsia included in the PE group]. These two groups showed similar mean age: 33.5±6 vs 34.9±6 years (p value= 0.25); serum creatinine (sCr) and uric acid at admission were statistically different, and higher in the PE group (sCr 0.57±0.15 and 0.66±0.2 – p=0.01 and uric acid 4.5±1.38 and 5.6±1.47 – p=0.01). Comorbidities were frequent in the PE group: thyroid disfunction was found in 17% of cases (7 hypothyroidism and 1 hyperthyroidism, all under treatment), coagulation abnormalities were present in 15% of cases (4 MTHFR mutation, 1 protein S deficiency, 1 prothrombin-gene mutation, 1 patient was positive for LLAC); gestational diabetes was diagnosed in 13% of the cases. We identified 1 renal transplant recipient, 1 IgA-vasculitis patient, 1 patient with family medical history positive for PE (in her twin sister); none of these patients had been identified as at high risk for PE. At hospital admission, 54% of the patients were on antihypertensive treatment, 7 of them for chronic hypertension and 18 for gestational hypertension (12 of these patients underwent a previous hospitalization during the same pregnancy, diagnosed with gestational hypertension); at admission only 24% of PE patients were treated with anticoagulant or antiplatelet prophylaxis. Caesarean section was performed in 36 cases (78%). All but one children live-born, the exception being a child from a multiple pregnancy (quadruplets). Conclusion A multidisciplinary approach and a nephrological follow-up are increasingly indicated in PE. Our series underlines a high prevalence of comorbidity or risk factors, including thyroid disfunction, gestational diabetes and coagulation abnormalities. The high prevalence (7/46) of chronic hypertension and the fact that the two patients with kidney disease were not identified as at risk for PE underlines the potential role for developing a synergic approach between nephrologist and obstetricians.

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Immediate Postpartum Glucose Tolerance Testing in Women with Gestational Diabetes: A Pilot Study

American Journal of Perinatology ◽

10.1055/s-0037-1606620 ◽

2017 ◽

Vol 34 (12) ◽

pp. 1264-1270 ◽

Cited By ~ 4

Author(s):

Jolene Muscat ◽

Hye Heo ◽

Shahidul Islam ◽

Anthony Vintzileos ◽

Cheryl Dinglas

Keyword(s):

Gestational Diabetes ◽

Glucose Tolerance ◽

High Sensitivity ◽

Tolerance Test ◽

Predictive Values ◽

Glucose Testing ◽

Institutional Review ◽

Sensitivity Specificity ◽

Tolerance Testing

Objective Due to poor adherence for glucose testing at 6- to 12-week postpartum among women with gestational diabetes, we sought to determine whether a 2-hour glucose tolerance test (GTT) during postpartum hospitalization is predictive of 6- to 12-week postpartum glucose testing. Study Design An institutional review board–approved prospective cohort study was performed over 3 years. Patients underwent an inpatient fasting 75-g, 2-hour GTT on either postpartum days 2 through 4 and instructed to follow up in 6- to 12-weeks for postpartum glucose testing. Sensitivity, specificity, positive predictive value (PPV), and negative predictive values (NPV) of the immediate GTT to predict abnormal 6- to 12-week postpartum glucose testing were determined. Results Eighty women enrolled in the study completed the immediate GTT; of these, only 35 (44%) underwent 6- to 12-week postpartum glucose testing. The sensitivity, specificity, PPV, and NPV of the immediate GTT were 100, 42.8, 30.4, and 100%, respectively. Conclusion More than 50% of our study patients did not undergo recommended postpartum glucose testing, coinciding with similar poor follow-up reported in the literature. With a high NPV and high sensitivity, a negative immediate GTT may obviate the need for the 6- to 12-week GTT, while a positive GTT may identify women who should follow up closely.

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Maternal and perinatal outcome in women with hypertensive disorders in pregnancy

Women s Health ◽

10.15406/mojwh.2021.10.00287 ◽

2021 ◽

Vol 10 (2) ◽

pp. 46-49

Author(s):

Lakshmi A ◽

Akshatha DS ◽

Pooja P ◽

Prashanth FG ◽

Veena MV ◽

...

Keyword(s):

Gestational Hypertension ◽

Adverse Outcomes ◽

Fetal Mortality ◽

Chronic Hypertension ◽

Hypertensive Disorder ◽

Mortality And Morbidity ◽

Hypertensive Disorders ◽

Study Results ◽

Hypertensive Disorders In Pregnancy ◽

In Pregnancy

Aims and objectives To determine the effect of hypertension in pregnancy To determine the maternal and fetal outcome in patients with hypertensive disorders of pregnancy. Materials and methods This is a retrospective study conducted in ESIC MC and PGIMSR, Bangalore from January 2020 to December 2020. All pregnant women who presented with Hypertensive disorder in pregnancy were included in the study. Results A total of 1503 patients who delivered during the study period were included in the study of which 172 patients had hypertensive disorder (11.44 %). Gestational hypertension occurred in 113 cases, preeclampsia in 45 cases, chronic hypertension in 8 cases, chronic hypertension with superimposed preeclampsia in 2 cases and eclampsia in 4 cases. Of these 85(49.41%) cases were primigravida and 87(50.58%) were multigravida. 38 deliveries occurred preterm and 134 were term. 4 patients had intrauterine fetal demise. Gestational diabetes occurred in 30(17.44%) cases, hypothyroidism in 45 cases(26.16%), IUGR in 11 cases(6.39%), oligohydramnios in 10 cases(5.81%). Discussion Hypertensive disorders in pregnancy is a spectrum of disease. It is one of the non communicable diseases occurring in pregnancy. It is the third most common cause of maternal mortality. By timely detection and proper management, it is possible to decrease the complications and adverse outcomes associated with this condition. Conclusion Hypertensive disorders in pregnancy is an important cause for maternal and fetal mortality and morbidity. Hence it is important to identify the risk factors and prevent it for better outcome.

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