scholarly journals The timing of initiation of pharmacotherapy for women with gestational diabetes mellitus

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Rachel K. Harrison ◽  
Meredith Cruz ◽  
Ashley Wong ◽  
Caroline Davitt ◽  
Anna Palatnik
Keyword(s):  
Diabetes Mellitus ◽  
Preterm Birth ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Gestational Age ◽  
Pregnancy Outcomes ◽  
Neonatal Outcome ◽  
Group 2 ◽  
Nicu Admission ◽  
Group 1

Abstract Background The decision to initiate pharmacotherapy is integral in the care for pregnant women with gestational diabetes mellitus (GDM). We sought to compare pregnancy outcomes between two threshold percentages of elevated glucose values prior to initiation of pharmacotherapy for GDM. We hypothesized that a lower threshold at pharmacotherapy initiation will be associated with lower rates of adverse perinatal outcomes. Methods This was a retrospective cohort study of women with GDM delivering in a single tertiary care center. Pregnancy outcomes were compared using bivariable and multivariable analyses between women who started pharmacotherapy (insulin or oral hypoglycemic agent) after a failed trial of dietary modifications at two different ranges of elevated capillary blood glucose (CBG) values: Group 1 when 20–39% CBG values were above goal; Group 2 when ≥40% CBG values were above goal. The primary outcome was a composite GDM-associated neonatal adverse outcome that included: macrosomia, large for gestational age (LGA), shoulder dystocia, hypoglycemia, hyperbilirubinemia requiring phototherapy, respiratory distress syndrome, stillbirth, and neonatal demise. Secondary outcomes included cesarean delivery, preterm birth (< 37 weeks), neonatal intensive care unit (NICU) admission, and small for gestational age (SGA). Results A total of 417 women were included in the study. In univariable analysis, the composite neonatal outcome was statistically significantly higher in Group 2 compared to Group 1 (47.9% vs. 31.4%, p = 0.001). In addition, rates of preterm birth (15.7% vs 7.4%, p = 0.011), NICU admission (11.7% vs 4.0%, p = 0.006), and LGA (21.2% vs 9.1% p = 0.001) were higher in Group 2. In contrast, higher rates of SGA were noted in Group 1 (8.0% vs. 2.9%, p = 0.019). There was no difference in cesarean section rates. These findings persisted in multivariable analysis after adjusting for confounding factors (composite neonatal outcome aOR = 0.50, 95%CI [0.31–0.78]). Conclusions Initiation of pharmacotherapy for GDM when 20–39% of CBG values are above goal, compared to ≥40%, was associated with decreased rates of adverse neonatal outcomes attributable to GDM. This was accompanied by higher rates of SGA among women receiving pharmacotherapy at the lower threshold. Additional studies are required to identify the optimal threshold of abnormal CBG values to initiate pharmacotherapy for GDM.

scholarly journals Diabetes Gestacional: Serão os Atuais Critérios de Diagnóstico Mais Vantajosos?

2018 ◽  
Vol 31 (7-8) ◽  
pp. 416 ◽  
Author(s):  
Ana Filipa Ferreira ◽  
Catarina Miranda Silva ◽  
Dora Antunes ◽  
Filipa Sousa ◽  
António Carlos Lobo ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Gestational Age ◽  
International Association ◽  
Study Groups ◽  
Directorate General ◽  
Group 2 ◽  
Diabetes And Pregnancy ◽  
Group 1

Introduction: There is no international consensus regarding gestational diabetes mellitus diagnostic criteria. In Portugal, the Carpenter and Coustan criteria were replaced by an adaptation of the International Association of Diabetes and Pregnancy Study Groups criteria. Our aim was to compare the incidence and outcomes of pregnancies complicated by gestational diabetes mellitus according to the current and previous criteria.Material and Methods: Retrospective analysis of 1218 singleton pregnancies complicated with gestational diabetes mellitus, with surveillance/delivery between 2008-2015. Two groups were considered: identification according to the Directorate-General of Health criteria - International Association of Diabetes and Pregnancy Study Groups (group 1); identification through Carpenter and Coustan criteria (group 2). A comparative analysis was performed.Results: The incidence of gestational diabetes mellitus doubled (9.4% vs 4.6%), and the number of consultations/year increased (~3000 vs ~2000). In Group 1, in comparison with group 2, there was a lower risk of macrosomia in newborns [RR 0.44 (IC (95%):0.26 - 0.76)] and a higher risk of small for gestational age infants [RR 1.99 (IC (95%):1.19 - 3.31)]; a 6 - fold and 4 fold higher risk in neonatal hypoglycemia [RR 6.30 (IC (95%): 3.39 - 11.71)] and hyperbilirubinemia [RR 3.89 (IC (95%): 2.25 - 6.72)] were also observed, respectively. There were no differences regarding other outcomes. Discussion: Outcomes related to the decrease in macrosomia did now show any improvement, with even an increase in Small for Gestational Age and neonatal complications. Given the increased incidence of gestational diabetes mellitus, Directorate-General of Health – International Association of Diabetes and Pregnancy Study Groups criteria may be associated with greater healthcare-related costs due to more frequent consultations, with no apparent obstetrical/neonatal benefit.Conclusion: The Directorate-General of Health – International Association of Diabetes and Pregnancy Study Groups criteria were associated with a decrease in macrosomia, not accompanied by an improvement of obstetrical/perinatal outcomes. The benefit of using these criteria is open to debate.

Effects of Prepregnancy Body Mass Index, Weight Gain, and Gestational Diabetes Mellitus on Pregnancy Outcomes: A Population-Based Study in Xiamen, China, 2011–2018

2019 ◽  
Vol 75 (1) ◽  
pp. 31-38 ◽  
Author(s):  
Wei-juan Su ◽  
Yin-ling Chen ◽  
Pei-ying Huang ◽  
Xiu-lin Shi ◽  
Fang-fang Yan ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Body Mass Index ◽  
Weight Gain ◽  
Preterm Birth ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Pregnancy Outcomes ◽  
Population Based ◽  
Population Based Study ◽  
Prepregnancy Body Mass Index

Background: It is unclear that how prepregnancy body mass index (BMI), gestational weight gain (GWG), and gestational diabetes mellitus (GDM) affect pregnancy outcomes in ­China. Thus, we explored how BMI, GWG, and GDM affect the risks of adverse pregnancy outcomes. Methods: We performed a retrospective, population-based study included all births in Xiamen, China, 2011–2018. Demographic data and pregnancy outcomes of 73,498 women were acquired from the Medical Birth Registry of Xiamen. Women were categorized into groups on prepregnancy BMI and GWG in order to assess the risk of pregnancy outcomes. Multivariable logistic regression was performed to evaluate risk factors. Results: Overall, 6,982 (9.37%) women were obese, and 8,874 (12.07%) women were overweight. Obese women are more vulnerable to cesarean delivery, preterm birth, large-for-gestational age (LGA), and macrosomia (crude OR [cOR] 2.00, 1.89–2.12; 1.35, 1.20–1.51; 2.12, 1.99–2.26; 2.53, 2.25–2.86, respectively, adjusted ORs 1.73, 1.62–1.84; 1.25, 1.10–1.42; 2.03, 1.90–2.18; 2.77, 2.44–3.16, respectively). Similar results were observed in overweight women (cORs 1.49, 1.42–1.57; 1.02, 0.91–1.15; 1.60, 1.50–1.70; 2.01, 1.78–2.26, respectively). Furthermore, women who gain weight in excessive group were 1.43, 2.06, and 2.16 times to deliver cesarean, LGA, and macrosomia, respectively. Additionally, GDM women were easily subjected to cesarean section, preterm birth, LGA, low birth weight, and macrosamia (cORs 1.52, 1.55, 1.52, 1.37, 1.27, respectively). Conclusions: Obesity prior to pregnancy, excessive GWG, and GDM were all associated with increased odds of cesarean, LGA, and macrosomia. Blood glucose and weight control before and during pregnancy are needed that may reduce the complications of pregnancy.

scholarly journals Complications of the Early Neonatal Period in Children from Mothers with Gestational Diabetes Mellitus

2021 ◽  
Vol 11 (4) ◽  
pp. 414-417
Author(s):  
Agamurad Orazmuradov ◽  
Irina Bekbaeva ◽  
Gayane Arakelyan ◽  
Anastasia Minaeva ◽  
Anastasiya Akhmatova ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Pregnant Women ◽  
Therapy Group ◽  
Control Group ◽  
Balanced Diet ◽  
Functional Immaturity ◽  
Group 2 ◽  
Group 1

Background: Changes in the course of gestational diabetes mellitus (GDM) at the present stage determine the emergence of a certain spectrum of completely new problems associated with the health status of newborns from mothers with GDM. The aim of the study was to investigate early neonatal complications in newborns from mothers with GDM. Methods and Results: The study included 404 pregnant women (gestational age of 37.0–41.0 weeks) with GDM. All patients with GDM were divided into 2 groups. Group 1 included 188 patients receiving insulin therapy; Group 2 included 216 patients receiving a well-balanced diet. The control group (Group 3) consisted of 68 pregnant women without disorders of carbohydrate metabolism. In Group 1, macrosomia occurred in 44(23.4%) newborns, in Group 2 - in 48(22.0%) newborns; in newborns from mothers of the control group, the frequency of macrosomia was only in 7.35% of newborns (P=0.01). Morpho-functional immaturity of newborns had the highest frequency of occurrence, despite the fact that all children were born on time; 80(42.6%) newborns from mothers of Group 1 and 77(35.6%) newborns from mothers of Group 2 had signs of morpho-functional immaturity. Conclusion: Diabetic fetopathy in newborns from mothers with GDM is manifested by morpho-functional immaturity of organs and systems developing in unfavorable hyperglycemic conditions.

scholarly journals Effect of Endogenic and Exogenic Oxidative Stress Triggers on Adverse Pregnancy Outcomes: Preeclampsia, Fetal Growth Restriction, Gestational Diabetes Mellitus and Preterm Birth

2021 ◽  
Vol 22 (18) ◽  
pp. 10122
Author(s):  
Eun Hui Joo ◽  
Young Ran Kim ◽  
Nari Kim ◽  
Jae Eun Jung ◽  
Seon Ha Han ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Diabetes Mellitus ◽  
Preterm Birth ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Fetal Growth ◽  
Pregnancy Outcomes ◽  
Fetal Growth Restriction ◽  
Growth Restriction ◽  
Adverse Pregnancy

Oxidative stress is caused by an imbalance between the production of reactive oxygen species (ROS) in cells and tissues and the ability of a biological system to detoxify them. During a normal pregnancy, oxidative stress increases the normal systemic inflammatory response and is usually well-controlled by the balanced body mechanism of the detoxification of anti-oxidative products. However, pregnancy is also a condition in which this adaptation and balance can be easily disrupted. Excessive ROS is detrimental and associated with many pregnancy complications, such as preeclampsia (PE), fetal growth restriction (FGR), gestational diabetes mellitus (GDM), and preterm birth (PTB), by damaging placentation. The placenta is a tissue rich in mitochondria that produces the majority of ROS, so it is important to maintain normal placental function and properly develop its vascular network to ensure a safe and healthy pregnancy. Antioxidants may ameliorate these diseases, and related research is progressing. This review aimed to determine the association between oxidative stress and adverse pregnancy outcomes, especially PE, FGR, GDM, and PTB, and explore how to overcome this oxidative stress in these unfavorable conditions.

scholarly journals Evaluation of anxiety levels of pregnant women with gestational diabetes mellitus

2020 ◽  
Vol 28 (2) ◽  
pp. 89-94
Author(s):  
Aşkın Evren Güler ◽  
Zeliha Çiğdem Demirel Güler ◽  
Asil Budak ◽  
Buket Koparal ◽  
Özge Şehirli Kıncı
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Pregnant Women ◽  
Control Group ◽  
Significant Difference ◽  
Group 3 ◽  
Anxiety Levels ◽  
Group 2 ◽  
Group 1

Objective The aim of this study was to investigate the anxiety levels of pregnant women with gestational diabetes mellitus (GDM) followed by different treatment methods. Methods Our study was carried out with 141 cases whose pregnancy follow ups were made in Gynecology and Obstetrics Clinic. Cases which had GDM screening with 75-g oral glucose tolerance test (OGTT) were divided into 3 groups. Group 1 (control group) consisted of 50 cases with 75-g OGTT results in normal range, Group 2 consisted of 50 cases which had significant 75-g OGTT results and followed up by diet (A1), and Group 3 consisted of 41 cases which were diagnosed with GDM as a result of 75-g OGTT and received diet as well as medical therapy (A2). Beck anxiety inventory (BAI) was administered to the patients in Group 1 in 24th week, and to patients in Groups 2 and 3 in the 24th and 32nd weeks. Results In the first evaluation of the patients, BAI scores of the control group were statistically found to be significantly lower than the patients with GDM (p=0.001). There was no significant difference in BAI scores among patients diagnosed with GDM, and high anxiety scores were found in both groups. There was a significant decrease in anxiety levels in the Groups 2 and 3 after the treatment (p<0.01). In the Group 2, the BAI scores were observed to decrease from 51.76±4.47 to 45.62±3.65, and from 51.73±5.27 to 41.48±3.29 in the Group 3 (p<0.001). Conclusion In addition to the metabolic disorders brought by the disease itself, GDM can cause various problems by increasing the levels of anxiety in patients. With an effective treatment for glycemic control, anxiety levels of patients can be reduced.

scholarly journals Association of Gestational Diabetes Mellitus with Adverse Pregnancy Outcomes and Its Interaction with Maternal Age in Chinese Urban Women

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Xueyin Wang ◽  
Xiaosong Zhang ◽  
Min Zhou ◽  
Juan Juan ◽  
Xu Wang
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Preterm Birth ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Cesarean Delivery ◽  
Pregnancy Outcomes ◽  
Maternal Age ◽  
Urban Women ◽  
Adverse Pregnancy

Background. The prevalence of gestational diabetes mellitus (GDM) has been dramatically increasing worldwide. The aims of this study were to examine associations of GDM with pregnancy outcomes in Chinese urban women and to evaluate the interaction between GDM and other major risk factors for the risk of adverse pregnancy outcomes. Methods. A retrospective analysis included 8844 women who delivered live singletons at ≥28 weeks of gestation between June 2012 and March 2013 among Chinese urban women. Structured questionnaires were used to collect information on demographic characteristics, lifestyle behavior, medical history, and pregnancy outcomes. The diagnosis of GDM was made between 24 and 28 gestational weeks according to the International Association of Diabetes and Pregnancy Study Groups criteria. Logistic regression models were used to assess the association of GDM with pregnancy outcomes and to examine the interaction between GDM and other major risk factors including maternal age, prepregnancy body mass index, and gestational weight gain for the risk of pregnancy outcomes. Results. 13.9% of women were diagnosed with GDM. We found that GDM was associated with higher risk of cesarean delivery ( odds   ratio   OR = 1.69 , 95% CI (confidence interval): 1.48-1.92), preterm birth ( OR = 1.32 , 95% CI: 1.07-1.64), macrosomia ( OR = 1.69 , 95% CI: 1.34-2.13), and large for gestational age (LGA, OR = 1.43 , 95% CI: 1.18-1.73) after adjustment for potential confounders. We also observed the interaction between GDM and maternal age for the risk of cesarean delivery ( P   for   interaction = 0.025 ), and the OR of GDM for cesarean delivery was 1.71 (95% CI: 1.49-1.97) among women aged less than 35 years. Conclusions. GDM was associated with an increased risk of cesarean delivery, preterm birth, macrosomia, and LGA in Chinese urban women, and there was an interaction between GDM and maternal age for the risk of cesarean delivery.

scholarly journals How Do Serum Zonulin Levels Change in Gestational Diabetes Mellitus, Pregnancy Cholestasis, and the Coexistence of Both Diseases?

2021 ◽  
Vol 18 (23) ◽  
pp. 12555
Author(s):  
Huri Güvey ◽  
Samettin Çelik ◽  
Canan Soyer Çalışkan ◽  
Zehra Yılmaz ◽  
Merve Yılmaz ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Pregnant Women ◽  
Control Group ◽  
Group 4 ◽  
Group 3 ◽  
Group 2 ◽  
Adverse Pregnancy ◽  
Group 1

We investigated the question of how serum zonulin levels change in intrahepatic cholestasis of pregnancy (ICP) and gestational diabetes mellitus (GDM) and, in the case of the coexistence of ICP and GDM, evaluated the eventual increase in zonulin plasmatic levels. Participants were enrolled for the study between 25 February 2021 and 20 August 2021. The prospective case-control study included: group 1 of 95 pregnant women diagnosed with ICP; group 2 of 110 pregnant women diagnosed with GDM; group 3 of 16 women diagnosed with both GDM and ICP; group 4 of 136 healthy pregnant women as the control group. The groups were compared in terms of age, body mass index (BMI), gravidity, parity, gestational week of delivery, plasma zonulin levels, delivery type, birth weight, first- and fifth-minute APGAR scores, newborn intensive care unit (NICU) admission, and meconium staining of amniotic fluid parameters. The results suggested that the plasma zonulin levels of ICP (group 1), GDM (group 2), and GDM with ICP (group 3) patients were higher than those of the healthy pregnant women of group 4 (p < 0.001). Among the patient groups, the highest median plasma zonulin levels were found in group 3 (110.33 ng/mL). Zonulin levels were also associated with the severity of ICP and adverse pregnancy outcomes. High serum zonulin levels were related to GDM, ICP, and adverse perinatal outcomes. The coexistence of GDM and ICP led to higher serum zonulin concentrations.

scholarly journals The Effect of Mild Gestational Diabetes Mellitus Treatment on Adverse Pregnancy Outcomes: A Systemic Review and Meta-Analysis

2021 ◽  
Vol 12 ◽  
Author(s):  
Samira Behboudi-Gandevani ◽  
Razieh Bidhendi-Yarandi ◽  
Mohammad Hossein Panahi ◽  
Mojtaba Vaismoradi
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Gestational Age ◽  
Pregnancy Outcomes ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Systemic Review ◽  
Large For Gestational Age ◽  
Adverse Pregnancy

ObjectivesIt is uncertain whether the treatment of mild gestational diabetes mellitus (GDM) improves pregnancy outcomes. The aim of this systemic review and meta-analysis was to investigate the effect of mild GDM treatment on adverse pregnancy outcomes.MethodsA comprehensive literature search was conducted on the databases of PubMed, Scopus, and Google Scholar to retrieve studies that compared interventions for the treatment of mild GDM with usual antenatal care. The fixed/random effects models were used for the analysis of heterogeneous and non-heterogeneous results. Publication bias was assessed using the Harbord test. Also, the DerSimonian and Laird, and inverse variance methods were used to calculate the pooled odds ratio of events. The quality assessment of the included studies was performed using the Modified Newcastle–Ottawa Quality Assessment scale and the CONSORT checklist. In addition, the risk of bias was evaluated using the Cochrane Collaboration’s tool for assessing risk of bias.ResultsThe systematic review and meta-analysis involved ten studies consisting of 3317 pregnant women who received treatment for mild GDM and 4407 untreated counterparts. Accordingly, the treatment of mild GDM significantly reduced the risk of macrosomia (OR = 0.3; 95%CI = 0.3–0.4), large for gestational age (OR = 0.4; 95%CI = 0.3–0.5), shoulder dystocia (OR = 0.3; 95%CI = 0.2–0.6), caesarean-section (OR = 0.8; 95%CI = 0.7–0.9), preeclampsia (OR = 0.4; 95%CI = 0.3–0.6), elevated cord C-peptide (OR = 0.7; 95%CI = 0.6–0.9), and respiratory distress syndrome (OR = 0.7; 95%CI = 0.5–0.9) compared to untreated counterparts. Moreover, the risk of induced labor significantly increased in the treated group compared to the untreated group (OR = 1.3; 95%CI = 1.0–1.6). However, no statistically significant difference was observed between the groups in terms of small for gestational age, hypoglycemia, hyperbilirubinemia, birth trauma, admission to the neonatal intensive care unit, and preterm birth. Sensitivity analysis based on the exclusion of secondary analysis data was all highly consistent with the main data analysis.ConclusionTreatment of mild GDM reduced the risk of selected important maternal outcomes including preeclampsia, macrosomia, large for gestational age, cesarean section, and shoulder dystocia without increasing the risk of small for gestational age. Nevertheless, the treatment could not reduce the risk of neonatal metabolic abnormalities or several complications in newborn.

scholarly journals Programmed Labor in Gestational Diabetes Mellitus as a Reserve for Reducing the Frequency of Cesarean Section

2021 ◽  
Vol 11 (2) ◽  
pp. 156-159
Author(s):  
Agamurad Orazmuradov ◽  
Marina Khamoshina ◽  
Anastasiya Akhmatova ◽  
Irina Bekbaeva ◽  
Gayane Arakelyan ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Cesarean Section ◽  
Gestational Diabetes Mellitus ◽  
Neonatal Period ◽  
Group 2 ◽  
Cns Depression ◽  
Minute Apgar Score ◽  
Abdominal Delivery ◽  
Group 1

The aim of this study was to investigate the perinatal outcomes of delivery by various methods in patients with gestational diabetes mellitus (GDM). Methods and Results: The study included 403 pregnant women (gestational age of 37.0–41.0 weeks) with GDM and 68 without disorders of carbohydrate metabolism, who gave birth from the second quarter of 2018 to the third quarter of 2020 in the maternity ward of the City Clinical Hospital No. 29 named after N.E. Bauman. All patients with GDM were divided into 2 groups. Group 1 included 187 patients receiving insulin therapy; Group 2 included 216 patients receiving a well-balanced diet. The main indicators of the health status of newborns in the early neonatal period were assessed taking into account the methods of delivery: programmed labor (PL), planned cesarean section (PCS), and spontaneous delivery. The 1-minute Apgar score in newborns from mothers of Groups 1 and 2 was higher at the PL, compared with PCS. The 5-minute Apgar score in newborns from mothers of Group 2 was also statistically significantly higher at the PL, compared with planned CS. The incidence of hypoglycemia in newborns from mothers of all groups was minimal at the PL, including a statistically significant low rate in newborns from mothers of Group 1. Symptoms of neonatal CNS depression were significantly more common in newborns born by abdominal delivery from mothers with GDM. Conclusion: PL in women with GDM reduces the incidence of the main complications of the early neonatal period: hypoglycemia and symptoms of neonatal CNS depression. PL may be considered more acceptable than abdominal delivery for women with GDM.

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