Maternal and Fetal Outcomes in Women with Diabetes in Pregnancy Treated before and after the Introduction of a Standardized Multidisciplinary Management Protocol

Background. Diabetes in pregnancy is associated with an increased risk to the woman and to the developing fetus. Currently, there is no consensus on the optimal management strategies for the follow-up and the timing of delivery of pregnancies affected by gestational and pregestational diabetes, with different international guidelines suggesting different management options. Materials and Methods. We conducted a retrospective cohort study from January 2017 to January 2021, to compare maternal and neonatal outcomes of pregnancies complicated by gestational and pregestational diabetes, followed-up and delivered in a third level referral center before and after the introduction of a standardized multidisciplinary management protocol including diagnostic, screening, and management criteria. Results. Of the 131 women included, 55 were managed before the introduction of the multidisciplinary management protocol and included in group 1 (preprotocol), while 76 were managed according to the newly introduced multidisciplinary protocol and included in group 2 (after protocol). We observed an increase in the rates of vaginal delivery, rising from 32.7% to 64.5% (<0.001), and the rate of successful induction of labor improved from 28.6% to 86.2% ( P < 0.001 ). No differences were found in neonatal outcomes, and the only significant difference was demonstrated for the rates of fetal macrosomia (20% versus 5.3%, P : 0.012). Therefore, the improvements observed in the maternal outcomes did not impact negatively on fetal and neonatal outcomes. Conclusion. The introduction of a standardized multidisciplinary management protocol led to an improvement in the rates of vaginal delivery and in the rate of successful induction of labor in our center. A strong cooperation between obstetricians, diabetologists, and neonatologists is crucial to obtain a successful outcome in women with diabetes in pregnancy.

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Pregnancy and neonatal outcomes in Indigenous Australians with diabetes in pregnancy

World Journal of Diabetes ◽

10.4239/wjd.v6.i6.880 ◽

2015 ◽

Vol 6 (6) ◽

pp. 880 ◽

Cited By ~ 4

Author(s):

Victor Duong

Keyword(s):

Neonatal Outcomes ◽

Indigenous Australians ◽

Diabetes In Pregnancy ◽

In Pregnancy

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Implementation of an Intrapartum Glucose Management Protocol for Diabetes in Pregnancy

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2021.11.444 ◽

2022 ◽

Vol 226 (1) ◽

pp. S261

Author(s):

Patrick Schneider ◽

Erin Cleary ◽

Wasi Khatri ◽

Keri Cooper ◽

Keiko Smith ◽

...

Keyword(s):

Diabetes In Pregnancy ◽

Management Protocol ◽

Glucose Management ◽

In Pregnancy

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962: Induction of labor vs. pre-labor cesarean in Pregnancy-Associated Hypertension <33 weeks gestation: success rate, duration, and maternal and neonatal outcomes

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2016.11.871 ◽

2017 ◽

Vol 216 (1) ◽

pp. S543-S544

Author(s):

Sarah Anderson

Keyword(s):

Success Rate ◽

Induction Of Labor ◽

Neonatal Outcomes ◽

Maternal And Neonatal Outcomes ◽

In Pregnancy

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Clinical Effectiveness of Different Technologies for Diabetes in Pregnancy: Systematic Literature Review (Preprint)

10.2196/preprints.24982 ◽

2020 ◽

Author(s):

Claudia Eberle ◽

Maxine Loehnert ◽

Stefanie Stichling

Keyword(s):

Type 2 Diabetes ◽

Type 1 Diabetes ◽

Glycemic Control ◽

Clinical Effectiveness ◽

Neonatal Outcomes ◽

Diabetes In Pregnancy ◽

Pregnancy And Birth ◽

In Pregnancy

BACKGROUND Hyperglycemia in pregnancy occurs worldwide and is closely associated with health issues in women and their offspring, such as pregnancy and birth complications, respectively, as well as comorbidities, such as metabolic and cardiovascular diseases. To optimize the management of diabetic pregnancies, sustainable strategies are urgently needed. Investigation of constantly evolving technologies for diabetes that help to manage pregnancy and health is required. OBJECTIVE We aimed to conduct a systematic review to assess the clinical effectiveness of technologies for diabetes in pregnancy. METHODS Relevant databases including MEDLINE (PubMed), Cochrane Library, Embase, CINAHL, and Web of Science Core Collection were searched in September 2020 for clinical studies (2008-2020). Findings were organized by type of diabetes, type of technology, and outcomes (glycemic control, pregnancy- and birth-related outcomes, and neonatal outcomes). Study quality was assessed using Effective Public Health Practice Project criteria. RESULTS We identified 15 randomized controlled trials, 3 randomized crossover trials, 2 cohort studies, and 2 controlled clinical trials. Overall, 9 studies focused on type 1 diabetes, 0 studies focused on gestational diabetes, and 3 studies focused on both type 1 diabetes and type 2 diabetes. We found that 9 studies were strong quality, 11 were moderate quality, and 2 were weak quality. Technologies for diabetes seemed to have particularly positive effects on glycemic control in all types of diabetes, shown by some strong and moderate quality studies. Positive trends in pregnancy-related, birth-related, and neonatal outcomes were observed. CONCLUSIONS Technologies have the potential to effectively improve the management of diabetes during pregnancy. Further research on the clinical effectiveness of these technologies is needed, especially in pregnant women with type 2 diabetes.

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Elevated Anthropometric and Metabolic Indicators among Young Adult Offspring of Mothers with Pregestational Diabetes: Early Results from the Transgenerational Effect on Adult Morbidity Study (the TEAM Study)

Journal of Diabetes Research ◽

10.1155/2021/6590431 ◽

2021 ◽

Vol 2021 ◽

pp. 1-10

Author(s):

Katherine Bowers ◽

Shelley Ehrlich ◽

Lawrence M. Dolan ◽

Resmi Gupta ◽

Mekibib Altaye ◽

...

Keyword(s):

Young Adult ◽

In Utero ◽

Adult Offspring ◽

Diabetes In Pregnancy ◽

Pregestational Diabetes ◽

Metabolic Outcomes ◽

Early Results ◽

Increased Risk ◽

Maternal Glucose ◽

In Pregnancy

Exposure to maternal diabetes in utero increases the risk in the offspring for a range of metabolic disturbances. However, the timing and variability of in utero hyperglycemic exposure necessary to cause impairment have not been elucidated. The TEAM Study was initiated to evaluate young adult offspring of mothers with pregestational diabetes mellitus. This paper outlines the unique enrollment challenges of the TEAM Study and preliminary analysis of the association between exposure to diabetes in pregnancy and adverse metabolic outcomes. The TEAM Study enrolls offspring of women who participated in a Diabetes in Pregnancy (DiP) Program Project Grant between 1978 and 1995. The DiP Study collected medical and obstetric data across pregnancy. The first 96 eligible offspring of women with pregestational diabetes were age-, sex-, and race-matched to adults from the National Health and Nutrition Examination Survey (NHANES) 2015-2016 with an OGTT. Descriptive and regression analyses were employed to compare TEAM participants to NHANES participants. Among a subset of TEAM participants, we compared the metabolic outcomes across maternal glucose profiles using a longitudinal data clustering technique that characterizes level and variability, in maternal glucose across pregnancy. By comparing categories of BMI, TEAM Study participants had over 2.0 times the odds of being obese compared to matched NHANES participants (for class III obesity, OR = 2.81 ; 95% confidence interval (CI): 1.15, 6.87). Increasing levels of two-hour glucose were also associated with in utero exposure to pregestational diabetes in matched analyses. Exposure to pregestational diabetes in utero may be associated with an increased risk of metabolic impairment in the offspring with clinical implications.

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