scholarly journals The Impact of Risk Factors and More Stringent Diagnostic Criteria of Gestational Diabetes on Outcomes in Central European Women

2008 ◽  
Vol 93 (5) ◽  
pp. 1689-1695 ◽  
Author(s):  
A. Kautzky-Willer ◽  
D. Bancher-Todesca ◽  
R. Weitgasser ◽  
T. Prikoszovich ◽  
H. Steiner ◽  
...  
Keyword(s):  
Risk Factors ◽  
Gestational Diabetes ◽  
Glucose Tolerance ◽  
Tertiary Care ◽  
World Health ◽  
Large For Gestational Age ◽  
Oral Glucose ◽  
Who Criteria ◽  
Prospective Longitudinal ◽  
The Impact

Abstract Objectives: In the face of the ongoing discussion on the criteria for the diagnosis of gestational diabetes (GDM), we aimed to examine whether the criteria of the Fourth International Workshop Conference of GDM (WC) select women and children at risk better than the World Health Organization (WHO) criteria. Design and Setting: This was a prospective longitudinal open study in five tertiary care centers in Austria. Patients and Outcome Measures: The impact of risk factors, different thresholds (WC vs. WHO), and numbers of abnormal glucose values (WC) during the 2-h, 75-g oral glucose tolerance test on fetal/neonatal complications and maternal postpartum glucose tolerance was studied in 1466 pregnant women. Women were treated if at least one value according to the WC (GDM-WC1) was met or exceeded. Results: Forty-six percent of all women had GDM-WC1, whereas 29% had GDM-WHO, and 21% of all women had two or three abnormal values according to WC criteria (GDM-WC2). Eighty-five percent of the GDM-WHO were also identified by GDM-WC1. Previous GDM [odds ratio (OR) 2.9], glucosuria (OR 2.4), preconceptual overweight/obesity (OR 2.3), age 30 yr or older (OR 1.9), and large-for-gestational age (LGA) fetus (OR 1.8) were the best independent predictors of the occurrence of GDM. Previous GDM (OR 4.4) and overweight/obesity (OR 4.0) also independently predicted diabetes postpartum. GDM-WC1 had a higher rate of obstetrical complications (LGA neonates, neonatal hypoglycemia, cesarean sections; P < 0.001) and impaired postpartum glucose tolerance (P < 0.0001) than GDM-WHO. Conclusion: These results suggest the use of more stringent WC criteria for the diagnosis of GDM with the initiation of therapy in case of one fasting or stimulated abnormal glucose value because these criteria detected more LGA neonates with hypoglycemia and mothers with impaired postpartum glucose metabolism than the WHO criteria.

Comparison of the effectivity of two internationally recommended screening methods for the recognition of gestational diabetes

2013 ◽  
Vol 154 (20) ◽  
pp. 776-783
Author(s):  
Mónika Salamon ◽  
Zsuzsanna Soós ◽  
Roland Oláh ◽  
Máté Hazai ◽  
László Sóvágó ◽  
...  
Keyword(s):  
Gestational Diabetes ◽  
Glucose Tolerance ◽  
Gestational Age ◽  
Pregnancy Outcomes ◽  
International Association ◽  
World Health ◽  
Large For Gestational Age ◽  
Screening Methods ◽  
Oral Glucose ◽  
Adverse Pregnancy

Introduction: Early diagnosis and adequate care of gestational diabetes is of great importance for both the mother and her fetus. Although several national and international guidelines are known on the methodology for screening gestational diabetes, a not negligible part of the cases remain unrecognized when applying even the most widely used criteria recommended by the World Health Organization (1st recommendation). A connection has been found between the maternal blood glucose values and the prevalence of still-birth, preeclampsia and large for gestational age neonates in several studies, from which the Hyperglycaemia and Adverse Pregnancy Outcomes study has come into prominence. According to conclusions of this study the International Association of Diabetic Pregnancy Study Groups suggested new numeric criteria for the evaluation of the 75-gramm oral glucose tolerance test (2nd rercommendation), which differs from the evaluation used in the afore mentioned screening system. Aims: The aim of the study was to compare the effectiveness of the two screening systems by evaluation of the pregnancy outcomes. Methods: By following non-twin pregnancies of 1107 pregnant mothers (831 with normal glucose tolerance, 276 with gestational diabetes based on any of the applied screening methods) the maternal (pre- and postterminal birth, caesarean section, toxaemia) and newborns pregnancy outcomes (infants small and large for gestational age, hypoglycaemia) were analysed. Results: With the exception of the prevalence of large for gestational age infants – which was higher among women screened by the new evaluation – no substantial difference in the efficacy of the two investigated methods was found. Conclusion: The decision whether the screening of gestational diabetes using the new criteria results in safer recognition of the disturbances of glucose metabolism during pregnancy requires further investigations including a large number of cases. Orv. Hetil., 2013, 154, 776–783.

scholarly journals Characterisation of children hospitalised with pneumonia in central Vietnam: a prospective study

2019 ◽  
Vol 54 (1) ◽  
pp. 1802256 ◽  
Author(s):  
Phuong T.K. Nguyen ◽  
Hoang T. Tran ◽  
Dominic A. Fitzgerald ◽  
Thach S. Tran ◽  
Stephen M. Graham ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hospital Admissions ◽  
Adverse Outcome ◽  
Tertiary Care ◽  
Clinical Signs ◽  
Severe Pneumonia ◽  
Careful Consideration ◽  
World Health ◽  
Management Approach ◽  
Who Criteria

Pneumonia is the most common reason for paediatric hospital admission in Vietnam. The potential value of using the World Health Organization (WHO) case management approach in Vietnam has not been documented.We performed a prospective descriptive study of all children (2–59 months) admitted with “pneumonia” (as assessed by the admitting clinician) to the Da Nang Hospital for Women and Children to characterise their disease profiles and assess risk factors for an adverse outcome. The disease profile was classified using WHO pneumonia criteria, with tachypnoea or chest indrawing as defining clinical signs. Adverse outcome was defined as death, intensive care unit admission, tertiary care transfer or hospital stay >10 days.Of 4206 admissions, 1758 (41.8%) were classified as “no pneumonia” using WHO criteria and only 252 (6.0%) met revised criteria for “severe pneumonia”. The inpatient death rate was low (0.4% of admissions) with most deaths (11 out of 16; 68.8%) occurring in the “severe pneumonia” group. An adverse outcome was recorded in 18.7% of all admissions and 60.7% of the “severe pneumonia” group. Children were hospitalised for a median of 7 days at an average cost of 253 USD per admission. Risk factors for adverse outcome included WHO-classified “severe pneumonia”, age <1 year, low birth weight, previous recent admission with an acute respiratory infection and recent tuberculosis exposure. Breastfeeding, day-care attendance and pre-admission antibiotic use were associated with reduced risk.Few hospital admissions met WHO criteria for “severe pneumonia”, suggesting potential unnecessary hospitalisation and use of intravenous antibiotics. Better characterisation of the underlying diagnosis requires careful consideration.

scholarly journals Comparison of the American Diabetes Association and World Health Organization criteria for gestational diabetes mellitus and the outcomes of pregnancy

2009 ◽  
Vol 2 (4) ◽  
pp. 149-153 ◽  
Author(s):  
Latika Sahu ◽  
R Satyakala ◽  
Reddi Rani
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
World Health Organization ◽  
American Diabetes Association ◽  
Mode Of Delivery ◽  
World Health ◽  
Oral Glucose ◽  
Who Criteria ◽  
Health Organization

Two to five percent of pregnancies are complicated by diabetes, of which 90% are classified as gestational diabetes mellitus.The aims and objectives of this study were to analyse the screening and diagnostic procedure for gestational diabetes mellitus (GDM) recommended by American Diabetes Association (ADA) in comparison with the World Health Organization (WHO) criteria and to study the outcome of GDM diagnosed by both the criteria. This prospective study was carried out in the Department of Obstetrics and Gynaecology, JIPMER between August 2006 and July 2008. Three-hundred-and-fifty antenatal cases of gestational age ≥24 weeks attending the outpatient department, with any one of the risk factors for GDM, were included in the study. A seventy-five gram oral glucose tolerance test (GTT) was performed on each subject. Results were interpreted using both ADA and WHO criteria. Antenatal complications of GDM, mode of delivery, intrapartum or postnatal maternal and neonatal complications in cases diagnosed with GDM by either criterion were noted. The data collected were analysed using the SPSS software program. The prevalence of GDM was 4% by ADA criteria versus 19.4% by WHO criteria. The diagnostic pick-up rate was approximately five times more with WHO than with ADA criteria. In total, 43% (ADA) and 29% (WHO) of GDM cases had antenatal complications. Seventy-four percent of mothers with macrosomic babies were identified by WHO criteria whereas only 26% of mothers with macrosomic babies were diagnosed by ADA criteria. ADA criteria identify more severe cases of GDM but mild cases diagnosed by WHO are missed. The GTT by WHO criteria was abnormal in a greater percentage of women with adverse outcomes especially macrosomia, than the GTT using ADA criteria.

scholarly journals Comparison between 100-g glucose tolerance test and two other screening tests for gestational diabetes: combined fasting glucose with risk factors and 50-g glucose tolerance test

2006 ◽  
Vol 124 (1) ◽  
pp. 4-9 ◽  
Author(s):  
Wilson Ayach ◽  
Roberto Antonio Araújo Costa ◽  
Iracema de Mattos Paranhos Calderon ◽  
Marilza Vieira Cunha Rudge
Keyword(s):  
Risk Factors ◽  
Gestational Diabetes ◽  
Glucose Tolerance ◽  
Pregnant Women ◽  
Glucose Tolerance Test ◽  
Fasting Glucose ◽  
Tolerance Test ◽  
Screening Tests ◽  
Mato Grosso ◽  
Prospective Longitudinal

CONTEXT AND OBJECTIVE: Lack of consensus about which screening tests to use for gestational diabetes mellitus (GDM) and difficulties in performing the gold-standard diagnostic test, the 100-g glucose tolerance test (100-g GTT), justify comparison with alternatives. The aim was to compare this with two other screening tests: combined fasting glucose with risk factors (FG + RF) and 50-g GTT. DESIGN AND SETTING: Prospective longitudinal cohort study in the Hospital School of Universidade Federal de Mato Grosso do Sul. METHODS: The three tests were performed independently on 341 pregnant women. Sensitivity (S), specificity (Sp), positive (PPV) and negative (NPV) predictive values, positive (PLR) and negative (NLR) likelihood ratios, and false-positive (FP) and false-negative (FR) rates obtained with FG + RF and 50-g GTT were compared with values from 100-g GTT. The average one-hour post-intake glucose levels (1hPG) with 50-g and 100-g were compared. Student’s t test was used in the statistical analysis. RESULTS: FG + RF led more pregnant women (53.9%) to diagnostic confirmation than did 50-g GTT (14.4%). The tests were equivalent for S (86.4 and 76.9%), PPV (98.7 and 98.9%), NLR (0.3 and 0.27) and FR (15.4 and 23.1%). Average 1hPG values were similar: 50-g GTT = 106.8 mg/dl and 100-g GTT = 107.5 mg/dl. CONCLUSION: Diagnostic efficiency with simplicity, practicality and low cost make FG + RF more appropriate for screening for GDM. The equivalence of 1hPG allows a new, cheaper and less uncomfortable protocol to be proposed for screening and diagnosing GDM.

scholarly journals Prevalence and risk factors of gestational diabetes in Punjab, North India: results from a population screening program

2015 ◽  
Vol 173 (2) ◽  
pp. 257-267 ◽  
Author(s):  
Geeti P Arora ◽  
Richa G Thaman ◽  
Rashmi B Prasad ◽  
Peter Almgren ◽  
Charlotte Brøns ◽  
...  
Keyword(s):  
Risk Factors ◽  
Gestational Diabetes ◽  
Plasma Glucose ◽  
Adult Height ◽  
North India ◽  
World Health ◽  
Urban Habitat ◽  
Oral Glucose ◽  
Who 1999 Criteria ◽  
Independent Risk Factors

ObjectiveThe World Health Organization (WHO) has in 2013 changed the diagnostic criteria for gestational diabetes mellitus (GDM) to acknowledge the putative effect of mildly elevated fasting plasma glucose (FPG) levels on pregnancy outcomes. We aimed to determine the prevalence and risk factors of GDM comparing the previous WHO 1999 criteria to the WHO 2013 criteria in North India.MethodsIn a population-based screening programme, 5100 randomly selected North Indian women were studied using a cross-sectional design with a questionnaire, venous FPG and 2-h capillary plasma glucose (PG) after a 75 g oral glucose tolerance test performed between 24 and 28 weeks of pregnancy.ResultsThe prevalence of GDM was 35% using WHO 2013 criteria vs 9% using WHO 1999 criteria. FPG measurements identified 94% of WHO 2013 GDM cases as opposed to 11% of WHO 1999 GDM cases. In contrast, 2-h PG measurements identified only 13% of WHO 2013 GDM cases compared with 96% of the WHO 1999 GDM cases. Using logistic regression with backward elimination, urban habitat, illiteracy, non-vegetarianism, increased BMI, Hindu religion and low adult height were all independent risk factors of GDM using the 1999 criteria, whereas only urban habitat, low adult height and increased age were independent risk factors of GDM using the 2013 criteria.ConclusionsIntervention studies are needed to justify the WHO 2013 GDM criteria increasing the prevalence four fold to include more than one third of North Indian pregnant women.

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