scholarly journals Early Pregnancy Screening for Women at High-Risk of GDM Results in Reduced Neonatal Morbidity and Similar Maternal Outcomes to Routine Screening

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Erin Clarke ◽  
Thomas J. Cade ◽  
Shaun Brennecke
Keyword(s):  
High Risk ◽  
Early Pregnancy ◽  
International Association ◽  
Neonatal Morbidity ◽  
Study Groups ◽  
High Risk Group ◽  
Adverse Outcomes ◽  
Study Objective ◽  
High Risk Women ◽  
Retrospective Audit

The Australasian Diabetes in Pregnancy Society recommends screening high-risk women for gestational diabetes mellitus (GDM) before 24 weeks gestation, under the assumption that an earlier diagnosis and opportunity to achieve normoglycemia will minimize adverse outcomes. However, little evidence exists for this recommendation. The study objective was to compare the pregnancy outcomes of high-risk women diagnosed with GDM before 24 weeks gestation and routinely diagnosed women after 24 weeks gestation. A retrospective audit was conducted of all pregnancies diagnosed with GDM using International Association of Diabetes and Pregnancy Study Groups criteria over 12 months at a tertiary Australian hospital. Adverse perinatal outcomes were compared between “Early GDM” diagnosed before 24 weeks (n=133) and “Late GDM” diagnosed from 24 weeks (n=636). Early GDM had a significantly lower newborn composite outcome frequency (hypoglycemia, birth trauma, NICU/SCN admission, stillbirth, neonatal death, respiratory distress, and phototherapy) compared to Late GDM (20.3% vs. 30.0%, p=0.02). Primary cesarean, hypertensive disorders, postpartum hemorrhage, birthweight >90th percentile, macrosomia, and preterm birth frequencies were not significantly different between groups. Therefore, high-risk women diagnosed with GDM in early pregnancy were not more likely to have an adverse outcome compared to routinely diagnosed women. As they are a high-risk group, this may indicate a possible benefit to the early diagnosis of GDM.

scholarly journals Multimodality Screening of High-Risk Women: A Prospective Cohort Study

2009 ◽  
Vol 27 (36) ◽  
pp. 6124-6128 ◽  
Author(s):  
Susan P. Weinstein ◽  
A. Russell Localio ◽  
Emily F. Conant ◽  
Mark Rosen ◽  
Kathleen M. Thomas ◽  
...  
Keyword(s):  
High Risk ◽  
Digital Mammography ◽  
Imaging Modality ◽  
Screening Method ◽  
High Risk Group ◽  
Breast Cancers ◽  
Screen Mammogram ◽  
Dense Breast Tissue ◽  
High Risk Women ◽  
Screening Population

Purpose Mammography has been established as the primary imaging screening method for breast cancer; however, the sensitivity of mammography is limited, especially in women with dense breast tissue. Given the limitations of mammography, interest has developed in alternative screening techniques. This interest has led to numerous studies reporting mammographically occult breast cancers detected on magnetic resonance imaging (MRI) or ultrasound. In addition, digital mammography was shown to be more sensitive than film mammography in selected populations. Our goal was to prospectively compare cancer detection of digital mammography (DM), whole-breast ultrasound (WBUS), and contrast-enhanced MRI in a high-risk screening population previously screened negative by film screen mammogram (FSM). Methods During a 2-year period, 609 asymptomatic high-risk women with nonactionable FSM examinations presented for a prospective multimodality screening consisting of DM, WBUS, and MRI. The FSM examinations were reinterpreted by study radiologists. Patients had benign or no suspicious findings on clinical examination. The cancer yield by modality was evaluated. Results Twenty cancers were diagnosed in 18 patients (nine ductal carcinomas in situ and 11 invasive breast cancers). The overall cancer yield on a per-patient basis was 3.0% (18 of 609 patients). The cancer yield by modality was 1.0% for FSM (six of 597 women), 1.2% for DM (seven of 569 women), 0.53% for WBUS (three of 567 women), and 2.1% for MRI (12 of 571 women). Of the 20 cancers detected, some were only detected on one imaging modality (FSM, n = 1; DM, n = 3; WBUS, n = 1; and MRI, n = 8). Conclusion The addition of MRI to mammography in the high-risk group has the greatest potential to detect additional mammographically occult cancers. The incremental cancer yield of WBUS and DM is much less.

scholarly journals Validation of a prospective urinalysis-based prediction model for ICU-resources and outcome of Covid-19 disease: A multicenter cohort study

2020 ◽  
Author(s):  
Oliver Gross ◽  
Onnen Moerer ◽  
Thomas Rauen ◽  
Jan Böckhaus ◽  
Elion Hoxha ◽  
...  
Keyword(s):  
High Risk ◽  
Risk Group ◽  
Kidney Injury ◽  
High Risk Group ◽  
Adverse Outcomes ◽  
Organ Support ◽  
Multicenter Cohort Study ◽  
Multicenter Cohort ◽  
At Iii ◽  
Secondary Endpoints

Abstract Purpose: Identifying preventive strategies in Covid-19 patients helps to improve ICU-resource-allocation and reduce mortality. We recently demonstrated in a post-mortem cohort that SARS-CoV-2 renal tropism was associated with kidney injury, disease severity and mortality. We also proposed an algorithm to predict the need for ICU-resources and the risk of adverse outcomes in Covid-19 patients harnessing urinalysis and protein/coagulation parameters on admission for signs of kidney injury. Here, we aimed to validate this hypothesis in a multicenter cohort. Methods: Patients hospitalized for Covid-19 at four tertiary centers were screened for an available urinalysis, serum albumin (SA) and antithrombin-III activity (AT-III) obtained prospectively within 48h upon admission. The respective presumed risk for an unfavorable course was categorized as “low”, “intermediate” or “high”, depending on a normal urinalysis, an abnormal urinalysis with SA ≥2 g/dl and AT-III ≥70%, or an abnormal urinalysis with at least one SA or AT-III abnormality. Time to ICU or death within ten days served as primary, in-hospital mortality and required organ support served as secondary endpoints.Results: Among a total of N=223 screened patients, N=145 were eligible for enrollment, falling into the low (N=43), intermediate (N=84), and high risk (N=18) categories. The risk for ICU transfer or death was 100% in the high risk group and significantly elevated in the composite of high and intermediate risk as compared to the low risk group (63.7% vs. 27.9%; HR 2.6; 95%-CI 1.4 to 4.9; P=0.0020). Having an abnormal urinalysis was associated with mortality, need for mechanical ventilation, extra-corporeal membrane oxygenation (ECMO) or renal replacement therapy (RRT). Conclusion: Our data confirm that Covid-19-associated urine abnormalities on admission predict disease aggravation and need for ICU. By engaging a simple urine dipstick on hospital admission our algorithm allows for early preventive measures and appropriate patient stratification. (ClinicalTrials.gov number NCT04347824)

scholarly journals Evaluation of glucose challenge test using cut off values 130mg/dl and 140 mg/dl for gestational diabetes mellitus screening

2018 ◽  
Vol 7 (3) ◽  
pp. 801 ◽  
Author(s):  
Tulasa Basnet ◽  
Neelam Pradhan ◽  
Poonam Koirala ◽  
Kesang D. Bista
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
High Risk ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Challenge Test ◽  
Perinatal Outcomes ◽  
High Risk Group ◽  
High Risk Women ◽  
Glucose Challenge

Background: Gestational Diabetes Mellitus (GDM) is associated with several adverse maternal and perinatal outcomes. Thus, screening for early detection of GDM and its treatment is important.Methods: This was hospital based descriptive study done over one year in department of Obstetrics and Gynecology, TUTH, Nepal. Six hundred ninety-seven women fulfilling the inclusion criteria were enrolled at 18-22 weeks of gestation. High risk factors were assessed and GCT was performed in women with risk factors during enrollment. Diagnostic OGTT was performed in women who screened positive (GCT ≥130mg/dl). Screen negative high-risk women were re-screened at 24-28 weeks. In women without known risk factors, GCT was performed at 24-28 weeks and OGTT was performed when screen positive. The diagnosis of GDM was made according to Carpenter and Coustan criteria.Results: Out of 697 enrolled women, 12 were excluded for various reasons and 685 women were analyzed. Women having risk of GDM were 28.9%. The prevalence of GDM was 2.92% and 2.48% with GCT cut off 130 mg/dl and 140 mg/dl respectively. Lowering the threshold to 130 mg/dl identified three extra cases (p=0.010). The prevalence among high risk group was 8.58% and 7.07% with the cut off value 130 mg/dl and 140 mg/dl respectively with three extra cases detected on taking cut off value 130 mg/dl (p=0.014). Among low risk women the prevalence of GDM was same i.e. 0.61% with both the cut off values.Conclusions: Lowering threshold of GCT to 130 mg/dl could identify significant percentage of extra cases of GDM especially in high risk women.

scholarly journals Vaccination against COVID-19 infection: the need of evidence for diabetic and obese pregnant women

2021 ◽  
Author(s):  
A. Lapolla ◽  
M. G. Dalfrà ◽  
S. Burlina
Keyword(s):  
High Risk ◽  
Pregnant Women ◽  
Neonatal Morbidity ◽  
Published Data ◽  
International Debate ◽  
Lactating Women ◽  
High Risk Women ◽  
Pregnancy And Lactation ◽  
Potential Benefits ◽  
Diabetes And Obesity

Abstract Aim The recent availability of vaccines against COVID-19 has sparked national and international debate on the feasibility of administering them to pregnant and lactating women, given that these vaccines have not been tested to assess their safety and efficacy in such women. As concerns the risks of COVID-induced disease, published data show that pregnant women who develop COVID-19 have fewer symptoms than patients who are not pregnant, but they are more likely to need hospitalization in intensive care, and neonatal morbidity. Aim of the present perspective paper is to analyze the current literature regarding the use of the vaccine against COVID-19 infection, in terms of safety and protection, in high risk pregnant women as those affected by diabetes and obesity. Methods Analysis of literature about vaccination against COVID-19 infection in pregnancy. Results The main health organizations and international scientific societies, emphasize that—although data regarding the use of COVID vaccines during pregnancy and lactation are still lacking—vaccination should not be contraindicated. It should be considered for pregnant women at high risk of exposure to COVID-19. For such women, the potential benefits and risks should be assessed by the healthcare professionals caring for them. A recent prospective study to test the immunogenicity and reactogenicity of vaccination with COVID-19 mRNA in pregnant and lactating women, has showed that SARS-CoV-2 mRNA vaccination triggers a robust humoral immunity in pregnant and lactating women; there was also evidence of an immune transfer to their newborn. Conclusions We urgently need data on the effect of COVID-19 vaccination, in terms of maternal and fetal outcomes and vaccine related symptoms in high risk women during pregnancy and breastfeeding. It is important to run campaigns to promote vaccination, in particular in pregnant women at high risk to have severe COVID infection as those diabetics and/or obese.

Prediction and prevention of pre-eclampsia and fetal growth restriction at 11–14 weeks of gestation: analysis of 1001 cas

2018 ◽  
Author(s):  
M.V. Medvedev, N.A. Altynnik, P.V. Knyazev
Keyword(s):  
High Risk ◽  
First Trimester ◽  
High Risk Group ◽  
Growth Restriction ◽  
High Risk Women ◽  
Uterine Arteries ◽  
Prediction And Prevention ◽  
Trimester Screening ◽  
Data History ◽  
Specialized Program

This was a retrospective analysis of 1001 women at 11 to 14 weeks’ gestation screened for pre-eclampsia (PE) and intrauterine growth restriction (IUGR) using specialized program, including data history, blood pressure, biochemical markers (PAPP-A, PLGF) and pulsatility index in uterine arteries. 55 high-risk women offered aspirin (150 mg at night). There are no cases of PE in low-risk 946 women and IUGR was in 3 (0,32 %) cases. In high-risk first subgroup only 3 (8,6 %) from 35 women offered aspirin 150 mg at night delivering babies with IUGR and there are no cases of PE in this subgroup. In high-risk second subgroup 9 (45%) from 20 women without aspirin delivering babies with IUGR and 2 (10 %) with PE. A strategy of first-trimester screening for PE and IUGR with prescription of aspirin to the high-risk group appears to be effective in reducing the prevalence of PE and IUGR

The role of biomarkers in predicting pre-eclampsia in high-risk women

2019 ◽  
Vol 57 (2) ◽  
pp. 128-137 ◽  
Author(s):  
Kelly-Ann Eastwood ◽  
Alyson J Hunter ◽  
Christopher C Patterson ◽  
David R Mc Cance ◽  
Ian S Young ◽  
...  
Keyword(s):  
High Risk ◽  
First Trimester ◽  
High Risk Group ◽  
Added Value ◽  
Screening Tests ◽  
Roc Curve Analysis ◽  
Logistic Regression Models ◽  
High Risk Women ◽  
Net Reclassification Improvement ◽  
Baseline Characteristics

Background There are limited data on performance of biomarkers to predict pre-eclampsia (PE) in high-risk women. This study investigated the ability of FABP4, PAPP-A, PlGF, sFlt-1 and sEng to predict PE in a high-risk group. Methods Non-fasting samples were analysed at 11 + 0–13 + 6 (V1) and 19 + 0–21 + 6 weeks (V2) ( n = 195). Logistic regression models were determined. Area under (AUC) the receiver operating characteristic (ROC) curve analysis was performed. The added value of biomarkers to clinical characteristics for PE prediction was quantified using integrated discrimination improvement (IDI) and net reclassification improvement (NRI) indices. Results Prevalence of PE was 12%. Lower concentrations of sFlt-1:PlGF (V1) and PlGF and PlGF:sEng (V2) were seen in women who developed PE. Controlling for baseline characteristics (V1), a doubling of sFlt-1 (pg/mL) (median 896.0, IQR 725.5–1097.0) and sFlt-1:PlGF (median 21.2, IQR 14.7–32.3) was associated with reduction in odds of PE (OR 0.20, 95% CI 0.06–0.65, P = 0.007 and OR 0.48, 95% CI 0.25–0.92, P = 0.04). Addition of sFlt-1 and sFlt-1:PlGF to baseline characteristics non-significantly improved AUC (0.74) (AUC 0.77, P = 0.40 and 0.76, P = 0.39). NRI and IDI analyses confirmed added clinical utility of sFlt-1 (NRI = 0.539, P = 0.01 and IDI = 0.052, P = 0.03). In V2, doubling of PlGF:sEng (median 71.9, IQR 47.0–102.8) was associated with reduction in the risk of PE (OR 0.56, 95% CI 0.35–0.98, P = 0.04). The addition of PlGF:sEng to baseline characteristics non-significantly improved AUC from 0.78 to 0.82 ( P = 0.25) and improved reclassification of cases (NRI = 0.682, P = 0.002). Conclusions Screening tests incorporating first trimester sFlt-1 and second trimester PlGF:sEng have potential to aid PE prediction in high-risk pregnancies.

scholarly journals Gestational Diabetes Mellitus: Screening and Outcomes in Southern Italian Pregnant Women

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
Carmelo Capula ◽  
Eusebio Chiefari ◽  
Anna Vero ◽  
Biagio Arcidiacono ◽  
Stefania Iiritano ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
High Risk ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Pregnant Women ◽  
International Association ◽  
Study Groups ◽  
Large For Gestational Age ◽  
Iadpsg Criteria

Recent Italian guidelines exclude women <35 years old, without risk factors for gestational diabetes mellitus (GDM), from screening for GDM. To determine the effectiveness of these measures with respect to the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria, we evaluated 2,448 pregnant women retrospectively enrolled in Calabria, southern Italy. GDM was diagnosed following the IADPSG 2010 criteria. Among 538 women <35 years old, without risk factors, who would have not been tested according to the Italian guidelines, we diagnosed GDM in 171 (31.8%) pregnants (7.0% of total pregnants). Diagnosis was made at baseline (55.6%), 1 hour (39.8%), or 2 hours (4.7%) during OGTT. Despite of appropriate treatment, GDM represented a risk factor for cesarean section, polyhydramnios, increased birth weight, admission to neonatal intensive care units, and large for gestational age. These outcomes were similar to those observed in GDM women at high risk for GDM. In conclusion, Italian recommendations failed to identify 7.0% of women with GDM, when compared to IADPSG criteria. The risk for adverse hyperglycaemic-related outcomes is similar in low-risk and high-risk pregnants with GDM. To limit costs of GDM screening, our data suggest to restrict OGTT to two steps (baseline and 1 hour).

scholarly journals A Qualitative Study to Explore the Barriers for Nonadherence to Referral to Hospital Births by Women with High-Risk Pregnancies in Nepal

2021 ◽  
Vol 18 (11) ◽  
pp. 5801
Author(s):  
Sushma Rajbanshi ◽  
Mohd Noor Norhayati ◽  
Nik Hussain Nik Hazlina
Keyword(s):  
High Risk ◽  
Qualitative Study ◽  
Neonatal Morbidity ◽  
Referral Hospital ◽  
Sociocultural Factors ◽  
Targeted Interventions ◽  
Hospital Birth ◽  
High Risk Women ◽  
Information Barriers ◽  
Hospital Births

Maternal and neonatal morbidity and mortality tend to decrease if referral advice during pregnancy is utilized appropriately. This study explores the reasons for nonadherence to referral advice among high-risk pregnant women. A qualitative study was conducted in Morang District, Nepal. A phenomenological inquiry was used. Fourteen participants were interviewed in-depth. High-risk women who did not comply with the referral to have a hospital birth were the study participants. Participants were chosen purposively until data saturation was achieved. The data were generated using thematic analysis. Preference of homebirth, women’s diminished autonomy and financial dependence, conditional factors, and sociocultural factors were the four major themes that hindered hospital births. Women used antenatal check-ups to reaffirm normalcy in their current pregnancies to practice homebirth. For newly-wed young women, information barriers such as not knowing where to seek healthcare existed. The poorest segments and marginalized women did not adhere to referral hospital birth advice even when present with high-risk factors in pregnancy. Multiple factors, including socioeconomic and sociocultural factors, affect women’s decision to give birth in the referral hospital. Targeted interventions for underprivileged communities and policies to increase facility-based birth rates are recommended.

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