scholarly journals Service evaluation of diabetes management during pregnancy in a regional maternity hospital: potential scope for increased self-management and remote patient monitoring through mHealth solutions

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Abdelrahim Alqudah ◽  
Paul McMullan ◽  
Anna Todd ◽  
Conor O’Doherty ◽  
Anne McVey ◽  
...  

Abstract Background Pre-gestational and gestational diabetes mellitus are common complications in pregnancy affecting one in six pregnancies. The maternity services are under significant strain managing the increasing number of complex pregnancies. This has an impact on patients’ experience of antenatal care. Therefore, there is a clear need to address pregnancy care. One possible solution is to use home-based digital technology to reduce clinic visits and improve clinical monitoring. Methods The aim of this study was to evaluate the antenatal services provided to pregnant women with diabetes who were monitored at the joint metabolic and obstetric clinic at the Southern Health and Social Care Trust in Northern Ireland. Results The questionnaires were completed by sixty-three women, most of whom had gestational diabetes mellitus. Most of the participants were between 25 and 35 years of age (69.8%), had one or more children (65.1%) and spent over 2 h attending the clinics (63.9%); 78% of women indicated that their travel time to and from the clinic appointment was over 15 min. Over 70% of women used smartphones for health-related purposes. However, only 8.8% used smartphones to manage their health or diabetes. Less than 25% of the women surveyed expressed concerns about using digital technology from home to monitor various aspects of their health in pregnancy. Conclusions Overall, pregnant women who had or developed diabetes in pregnancy experience frequent hospital visits and long waiting times in the maternity clinics. Most of these pregnant women are willing to self-manage their condition from home and to be monitored remotely by the healthcare staff.

Author(s):  
Kai Wei Lee ◽  
Siew Mooi Ching ◽  
Navin Kumar Devaraj ◽  
Seng Choi Chong ◽  
Sook Yee Lim ◽  
...  

Previous literature has reported that patients with diabetes in pregnancy (DIP) are at risk of developing antepartum depression but the results have been inconsistent in cohort studies. We conducted a systematic review and performed a meta-analysis to quantify the association between DIP and risk of antepartum depression in cohort studies. Medline, Cinahl, and PubMed databases were searched for studies investigating DIP involving pregnant women with pre-existing diabetes and gestational diabetes mellitus and their risk of antepartum depression that were published in journals from inception to 27 December 2019. We derived the summary estimates using a random-effects model and reported the findings as pooled relative risks (RR) and confidence interval (CI). Publication bias was assessed using a funnel plot and was quantified by Egger and Begg’s tests. Ten studies, involving 71,036 pregnant women were included in this meta-analysis. The pooled RR to develop antepartum depression was (RR = 1.430, 95% CI: 1.251–1.636) among women with gestational diabetes mellitus. Combining pregnant women with pre-existing diabetes mellitus and gestational diabetes mellitus, they had a significant increased risk of developing antepartum depression (RR = 1.431, 95% CI: 1.205–1.699) compared with those without it. In comparison, we found no association between pre-existing diabetes mellitus in pregnancy (RR = 1.300, 95% CI: 0.736–2.297) and the risk of developing antepartum depression. This study has a few limitations: first, different questionnaire and cut-off points were used in evaluation of depression across the studies. Second, there was a lack of data on history of depression prior to pregnancy, which lead to confounding bias that could not be solved by this meta-analysis. Third, data were dominated by studies in Western countries; this is due to the studies from Eastern countries failing to meet our inclusion criteria for statistical analysis. Women with gestational diabetes mellitus have an increased risk of developing antepartum depression compared to those without the disease. Therefore, more attention on the mental health status should be given on pregnant women diagnosed with pre-existing diabetes mellitus and gestational diabetes mellitus.


2013 ◽  
Vol 62 (2) ◽  
pp. 101-109
Author(s):  
Roman Viktorovich Kapustin ◽  
Olga Nikolayevna Arzhanova ◽  
Tatyana Nikolayevna Shlyakhtenko ◽  
Tatyana Ivanovna Oparina ◽  
Yevgeniy Konstantinovich Komarov

Been analyzed and studied the characteristics of hemostasis in pregnant women with gestational diabetes mellitus. Found that for women with disorders of carbohydrate metabolism characte-rized by increased activity of procoagulant, vascular-platelet hemostasis, and decreased activity of fibrinolityc system. It is shown that the violations of the haemostatic system is directly dependent on the degree of compensation of carbohydrate metabolism and require adequate correction of glycemia. Thus, GDM is an important predictor of hemostatic disorders and possible venous thromboembolism in pregnancy.


2021 ◽  
Vol 5 (1) ◽  
pp. 102-111
Author(s):  
Syntia Ambelina ◽  
Dovy Djanas ◽  
Hafni Bachtiar

Introduction : Magnesium is one of important micronutrients in pregnancy. Pregnant women needs higher magnesium intake than non-pregnant women at similar age. Decreased blood and cellular magnesium level was related to insulin resistance.Objective : To determine relationship between mean magnesium level in pregnant women with incidence of gestational diabetes mellitus.Methods : This was quantitative analytic study using cross sectional comparative design conducted in 8 Primary Health Care in Padang and 5 General Hospital in West Sumatra. This study was done from December 2019 until March 2020. Total sample collected was 36 samples consisted of 18 pregnant mother with gestational diabetes mellitus and 18 control sample with normal pregnancy, both were in gestational age between 24-28 weeks. Statistical analysis was done using independent sample T-test.Results : Mean magnesium level of pregnant mother with gestational diabetes mellitus was 1.85 ± 0.12 mg/dL, while in control sample was 2.10 ± 0.15 mg/dL. Statistical result using independent sample T-test showed significant correlation between mean magnesium level and incidence of gestational diabetes mellitus with p <0.001 (p value <0.05)Conclusion : Magnesium level during pregnancy is related to gestational diabetes mellitus incidence.Keywords: magnesium level, pregnant women, gestational diabetes mellitus


2014 ◽  
Vol 7 (2) ◽  
pp. 21-27
Author(s):  
M Abu Sayeed ◽  
Samsad Jahan ◽  
Mir Masudur Rhaman ◽  
M Mainul Hasan Chowdhury ◽  
Parvin Akter Khanam ◽  
...  

Gestational diabetes mellitus (GDM) or hyperglycemia in pregnancy is associated with adverse perinatal outcomes such as large for gestational age (LGA), excess fetal adiposity and cesarean delivery. This study addressed the prevalence of diabetes in pregnancy and to compare the perinatal outcomes between GDM and non-GDM in a rural pregnancy cohort of Bangladesh. Ten villages were purposively selected in a rural area about 100 km off Dhaka City. A population census was conducted. A randomized sample of married women of age 15-45y was drawn from the census data. These women having either regular menstruation (non-regnant) or cessation of menstruation for ?24weeks (pregnant) were considered eligible. Both the pregnant and non-pregnant women were invited to volunteer the study. Weight, height, waist- and hip-girth and blood pressure were taken. Fasting blood sample was collected for the estimation of plasma glucose (FPG), triglycerides (TG), cholesterol (chol), high-density lipoprotein (HDL). FPG >5.1 mmol/L was taken as cut-off for hyperglycemia in non-pregnant and gestational diabetes mellitus (GDM) for the pregnant women. The biophysical characteristics were compared between pregnant and non-pregnant; and then GDM and non-GDM. Only the pregnant women were taken as a pregnancy cohort. The cohort had followup from 24wks of pregnancy through 28 post-natal days. Results The census yielded 23545 (m / f=11896 / 11649) people of all ages. The married women of age 15-45y were 4526. Of them, 2100 were randomly selected for investigation and 1585 (75.5%) volunteered. The overall prevalence (95% CI) of hyperglycemia (FPG >5.1 mmol/L) was 18.5% (16.7 – 20.3). The prevalence of GDM was 8.9% (7.0 – 10.8) and non-GDM was 19.8% (18.8 – 20.8). The BMI and WHR were significantly higher in the pregnant than non-pregnant women; whereas, there was no significant difference between GDM and non-GDM group. The prevalence rates of abortions, stillbirths, hospital delivery, cesarean delivery, hospital stay ?7days, puerperal sepsis and neonatal death did not differ between GDM and non-GDM subjects significantly. The prevalence of GDM in rural Bangladesh is comparable with any other population with higher prevalence of GDM. The prevalence of hyperglycemia was found significantly higher in the non-pregnant than the pregnant women. The anthropometric measures did not differ significantly between GDM and non-GDM though FPG was found significantly higher in the former. Compared with the non-GDM the GDM subjects had no significantly higher fetomaternal morbidity and mortality possibly due to non-sedentary habit, non-obesity, non-dyslipidemia or may be due to inherent genetic makeup. A well designed study in a larger sample may explain our findings. DOI: http://dx.doi.org/10.3329/imcj.v7i2.20101 Ibrahim Med. Coll. J. 2013; 7(2): 21-27


BMC Nutrition ◽  
2020 ◽  
Vol 6 (1) ◽  
Author(s):  
R. Deepa ◽  
Melissa Glenda Lewis ◽  
Onno C. P. Van Schayck ◽  
Giridhara R. Babu

Abstract Background Few studies have explored the relationship between food habits and the risk of gestational diabetes mellitus (GDM) in women from India. We aimed to investigate the associations of food habits and the risk of GDM. Methods As part of the MAASTHI prospective cohort study in urban Bengaluru, India, pregnant women between 18 and 45 years, less than 36 weeks of gestation were included. During baseline, the participant’s age, education, physical activity levels, and food habits were recorded. Screening of GDM was done by the World Health Organization diagnostic criteria using a 2-h 75-g oral glucose tolerance test between the 24th–36th weeks of gestation. Results We included 1777 pregnant women in the study. We show that 17.6% of the women had GDM, of which 76.7% consume red meat. Red meat consumption was associated with an increased risk of GDM (aRR = 2.1, 95% CI 1.5, 2.9) after adjusting for age, family history of diabetes and socioeconomic status. Conclusion The high intake of red meat consumption in pregnancy needs further examination. Also, future evaluations should consider evaluating the risk of red meat consumption against the combined effect of inadequate consumption of vegetables, fruits, and dairy products in pregnant women. Interventions to educate women in lower socioeconomic status on inexpensive, seasonal, and healthy food might be helpful.


Author(s):  
Suvarna Jyothi Ganta ◽  
Sunanda R. Kulkarni

Background: The prevalence of diabetes mellitus (DM) is increasing worldwide and more in developing countries like India. The diabetic epidemic experienced in India can be due to strong genetic factors coupled with increasing urbanization, sedentary lifestyle, changes in the dietary patterns and increasing obesity. Indians are at an 11-fold increased risk of developing gestational glucose intolerance and hence universal screening is essential. Uric acid is a known marker of oxidative stress. Hyperuricemia in early pregnancy may be an indicator of the existing metabolic disturbance which can hinder the maternal physiological adaptations generally seen in pregnancy thus making the pregnant women more vulnerable to the development of gestational diabetes mellitus. The objective of this study was to investigate the association between elevated uric acid levels in the first trimester of pregnancy with gestational diabetes.Methods: This prospective observational study was conducted in Chinmaya mission hospital, Bangalore from June 2016 to March 2017 (10 months). Three hundred and twelve (312) pregnant women of gestational age less than 12 weeks who attended the OBG outpatient department within this time of period for regular antenatal check-up were enrolled in the study. Along with the other antenatal investigations serum uric acid levels were estimated before 12 weeks and also between 24-28 weeks. At 24-28 weeks screening for GDM was done by OGCT using 75 gms of glucose (IADPISG criteria). Other parameters like age, parity, BMI, family history of diabetes was noted and compared.Results: In our study, among the 312 pregnant women, 88 (28%) developed GDM. Of these 74 Women (84%) with GDM had uric acid levels above 3.5 mg/dl and 14 women (15.9%) with GDM had uric acid levels below 3.5 mg/dl. Women with higher BMI showed high uric acid levels.Conclusions: Elevated serum uric acid in the first trimester has a significant correlation with development of GDM. In present study; the cut-off level of maternal serum uric acid of 3.5 mg/dl in the first trimester appears to have a good sensitivity and specificity in identifying those patients who are most likely to develop GDM later in pregnancy.


2019 ◽  
Vol 13 (5) ◽  
pp. 1202
Author(s):  
Alexandre Lins Werneck ◽  
Isadora Salani De Queiros ◽  
Daniela Comelis Bertolin

RESUMO:Objetivo: descrever as principais complicações e doenças pré-existentes em gestantes com Diabetes Mellitus Gestacional. Método: trata-se de estudo quantitativo, analítico, transversal. Compôs-se a amostra do estudo por 591 prontuários de gestantes, sendo 47 com DMG e 544 sem DMG. Realizou-se a coleta de dados em prontuários de um hospital e maternidade. Utilizou-se um instrumento para a coleta dos dados das pacientes. Analisaram-se os dados por meio de estatística descritiva em sua predominância e apresentaram-se os resultados em forma de tabelas. Resultados: selecionaram-se 47 prontuários de gestantes com Diabetes Mellitus Gestacional. Mostrou-se, que 38,71% tinham hipertensão arterial como doença já existente e 10,07% tinham dor em baixo ventre como principal complicação. Conclusão: observou-se que as principais complicações na amostra de gestantes com Diabetes Mellitus Gestacional são dor em baixo ventre, doença hipertensiva específica da gravidez, leucorreia, cefaleia, infecção do trato urinário e dispneia; em relação às doenças já existentes, a hipertensão arterial foi a doença que mais prevaleceu nas gestantes antes mesmo da gestação, seguida de tabagismo, hipotireoidismo, asma e hepatite C. Descritores: Diabetes Gestacional; Doenças; Gravidez de Alto Risco; Gestantes; Complicações na Gravidez; Enfermagem; Diabetes Mellitus.ABSTRACT Objective: to describe the main complications and preexisting diseases in pregnant women with Gestational Diabetes Mellitus. Method: this is a quantitative, analytical, cross-sectional study. The study sample was composed of 591 records of pregnant women, 47 of whom had GDM and 544 without GDM. Data were collected in medical records of a hospital and maternity hospital. An instrument was used to collect patient data. The data were analyzed by means of descriptive statistics in their predominance and the results were presented in the form of tables. Results: 47 charts of pregnant women with Gestational Diabetes Mellitus were selected. It was shown that 38.71% had arterial hypertension as an existing disease and 10.07% had lower belly pain as the main complication. Conclusion: it was observed that the main complications in the sample of pregnant women with Gestational Diabetes Mellitus are low belly pain, pregnancy-specific hypertensive disease, leukorrhea, headache, urinary tract infection and dyspnea; in relation to existing diseases, arterial hypertension was the most prevalent disease in pregnant women even before pregnancy, followed by smoking, hypothyroidism, asthma and hepatitis C. Descriptors: Gestational Diabetes; Diseases; High Risk Pregnancy; Pregnant women; Pregnancy Complications; Nursing; Diabetes Mellitus.RESUMEN Objetivo: describir las principales complicaciones y enfermedades preexistentes en mujeres embarazadas con Diabetes Mellitus Gestacional. Método: se trata de un estudio cuantitativo, analítico, transversal. Se compuso la muestra del estudio por 591 prontuarios de gestantes, siendo 47 con DMG y 544 sin DMG. Se realizó la recolección de datos en prontuarios de un hospital y maternidad. Se utilizó un instrumento para la recolección de los datos de las pacientes. Se analizaron los datos por medio de estadística descriptiva en su predominancia y se presentaron los resultados en forma de tablas. Resultados: se seleccionaron 47 prontuarios de gestantes con Diabetes Mellitus Gestacional. Se mostró, que el 38,71% tenía hipertensión arterial como enfermedad ya existente y el 10,07% tenían dolor en el vientre como principal complicación. Conclusión: se observó que las principales complicaciones en la muestra de gestantes con Diabetes Mellitus Gestacional son dolor en bajo vientre, enfermedad hipertensiva específica del embarazo, leucorrea, cefalea, infección del tracto urinario y disnea; en relación a las enfermedades ya existentes, la hipertensión arterial fue la enfermedad que más prevaleció en las gestantes antes de la gestación, seguida de tabaquismo, hipotiroidismo, asma y hepatitis C. Descriptores: Diabetes Gestacional; Embarazo de Alto Riesgo; Mujeres Embarazadas; Complicaciones del Embarazo; Nursing; Diabetes Mellitus.


2021 ◽  
Vol 8 (3) ◽  
pp. 292-295
Author(s):  
Ushadevi Gopalan ◽  
Irkm Sivasarupa ◽  
Sivankumar Kumarapillai

Women with raised uric acid in pregnancy are interlinked with more incidence of unfavourable outcomes in pregnancy such as gestational diabetes mellitus. The study aims at testing the hypothesis that elevated uric acid in first trimester of pregnancy is associated with subsequent development of gestational diabetes.: All pregnant women less than 12 weeks were included in this study after informed consent. Blood samples were collected for serum uric acid analysis and all these patients were followed up with oral glucose tolerance test at twenty-four to twenty-eight weeks of gestation.The mean age of pregnant women was 29.84 ± 4.94 years. The mean height and weight was 151.52 ± 7.49 cms and 50.60 ± 6.88 kg respectively. The body mass index of patients was 22.13 ± 3.31 kg/m.The mean gestational age of pregnant women was 11.14 ± 1.30 weeks. The mean uric acid level was 3.81 ± 1.24 mg/dl. In this study the p value was 0.018 using chi-square test which was significant. Hyperuricemia in first trimester is a reliable marker for the prediction of gestational diabetes mellitus in later pregnancy.


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