scholarly journals OR08-01 One-Step Versus Two-Step Approach for Gestational Diabetes Mellitus Screening: Comparison of Maternal and Fetal Outcomes in a Canadian Population

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Fanny Goyette ◽  
Bi Lan Wo ◽  
Marie-Hélène Iglesias ◽  
Evelyne Rey ◽  
Ariane Godbout
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Screening Method ◽  
Large For Gestational Age ◽  
Screening Methods ◽  
Oral Glucose ◽  
Neonatal Hypoglycemia ◽  
Borderline Patients ◽  
One Step

Abstract Screening for gestational diabetes mellitus (GDM) is internationally recommended however there is no universal approach. Impact of the different diagnostic strategies on maternal and neonatal complications’ rates and cost-effectiveness need to be studied. Objective To compare maternal and neonatal outcomes between the two supported screening methods for GDM; the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) 75g one-step oral glucose tolerance test (OGTT) versus the 50g two-step OGTT. Methods A retrospective cohort study was performed regrouping all deliveries between 2016 and 2018 in two centers, each using one different screening method. GDM was diagnosed in center A when meeting IADPSG odds ratio (OR) 1.75 cut-offs values after a one-step 75g-OGTT. Center B used a two-step strategy and diagnosed GDM with 50g-OGTT 1hr glycemic value ≥11.1 mmol/L or failed 50g followed by 75g-OGTT results over the IADPSG OR 2.0 cut-offs. Primary outcome was the rate of large for gestational age (LGA) babies. Outcomes were analysed for singleton pregnancies with deliveries >32 weeks. Subgroup analysis of borderline GDM women (OGTT results in between IADPSG OR 1.75 and 2.0 values) were done. Group A’s borderline patients were treated as per GDM patients. Group B’s borderline patients were not considered diabetic and had normal pregnancy care. Results were adjusted for maternal age, BMI and gestational weight gain. Results At interim analysis for the year 2016, a total of 6188 pregnancies, 2664 women in center A (one-step) and 3524 in center B (two-step) were included. The prevalence of GDM was 17.1% in center A (n=456) and 14.8% in center B (n=520). Both populations were comparable in terms of risk factors for LGA except for its ethnic distribution and proportion of obese women (13.1 vs 21.6%). GDM women in center B compared to center A had significant increase in rates of LGA neonates (adjusted OR (ORa) 2.1, p=0.012); neonatal hypoglycemia (ORa 2.1, p=0.0001) and neonatal intensive care unit (NICU) admission (2.1, p=0.048). Gestational hypertension’s rate was more prevalent in center B (ORa 2.1, p=0.020) and there was a non statistical trend towards increased rate of caesareans (1.6, p=0.084). Regular prenatal care for borderline women in center B (n=94) compared to GDM care in center A (n=150) resulted in increased rate of LGA babies (ORa 3.2, p=0.049). Worse maternal outcomes were identified for gestational hypertension (9.7 vs 1.3%, p=0.035) and preeclampsia (4.3 vs 0%, p=0.021) in group B vs A, respectively. Conclusions Choosing the one-step IADPSG criteria’s for GDM screening is associated with lower rates of LGA, neonatal hypoglycemia and NICU admissions, at the expense of increased prevalence in our population. The ongoing study will include a cost-benefit evaluation to assess if improved outcomes overbalance the increased prevalence inherent to lower diagnostic criteria.

scholarly journals Obstetric and Neonatal Outcomes of Pregnancies with Mild Gestational Hyperglycemia Diagnosed at Gestational Diabetes Mellitus Screening

2018 ◽  
pp. 1 ◽  
Author(s):  
Sedat Akgol ◽  
Mehmet Sukru Budak
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Gestational Age ◽  
Challenge Test ◽  
Large For Gestational Age ◽  
Oral Glucose ◽  
Mild Gestational Hyperglycemia ◽  
Glucose Challenge ◽  
Gestational Hyperglycemia

<p><strong>Objective:</strong> The aim of this study was to evaluate obstetric and neonatal outcomes of pregnancies with mild gestational hyperglycemia diagnosed at gestational diabetes mellitus screening.</p><p><strong>Study design:</strong> Between September 2016 and August 2017, the pregnant women diagnosed as normal glycaemia or mild gestational hyperglycemia according to the results of gestational diabetes mellitus screening with 50 g oral glucose challenge test, and 100 g oral glucose tolerance test were compared [Normal glycaemia: Blood glucose value &lt;140 mg/dL 1 hour after 50 g oral glucose challenge test].</p><p><strong>Results:</strong> The following results were obtained in the normal glycaemia and mild gestational hyperglycemia groups respectively: Mean gestational age at birth, 38.9±1.6 and 39±1.9 weeks; preterm, term, post-term birth rates, 6%, 86.2% 7.8% and 6.8%, 86.4% and 6.8%; cesarean delivery rate, 30.9% and 34.9%; birth weight 3227.9±394.9 and 3241.05±418.5 g; small for gestational age, 4.4% and 2.3%; large for gestational age 4.6% and 7%; without any significant difference between the groups. Five minute APGAR scores were significantly lower in the mild gestational hyperglycemia group compared to the normal glycaemia group.</p><p><strong>Conclusion:</strong> There was no significant increase in adverse pregnancy outcomes such as preterm birth, post-term birth, increased caesarean delivery rate, small for gestational age and large for gestational age, except for a significant decrease in 5 minute APGAR scores in the mild gestational hyperglycemia group compared to the normal glycaemia group in our study.</p>

scholarly journals Diagnosis of gestational diabetes mellitus: comparison between National Diabetes Data Group and Carpenter– Coustan criteria

2014 ◽  
Vol 8 (4) ◽  
pp. 505-509
Author(s):  
Dittakarn Boriboonhirunsarn ◽  
Tripop Lertbunnaphong ◽  
Kamaitorn Tientong
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Glucose Tolerance Test ◽  
Tolerance Test ◽  
Oral Glucose ◽  
Neonatal Hypoglycemia ◽  
Apparent Prevalence ◽  
Infant Birth ◽  
Data Group

Abstract Background: A 100-g oral glucose tolerance test (OGTT) is commonly used to diagnose gestational diabetes mellitus (GDM). Carpenter-Coustan (CC) criteria, based on lower threshold plasma glucose values than the National Diabetes Data Group (NDDG) criteria, result in an apparently increased prevalence of GDM. However, the extent of the increase is not known, and effects on perinatal outcome are not clear. Objective: To evaluate the increase in the prevalence of GDM if CC criteria are applied to OGTT results, we compared findings with NDDG criteria. Pregnancy outcomes between women without GDM and those with GDM diagnosed by NDDG and CC criteria were compared. Methods: A total of 640 at-risk pregnant women were studied. They were either diagnosed as having GDM by initial testing (145 women), or repeat testing at 24−28 weeks of gestation (495 women). CC criteria were applied to the OGTT results and prevalence of GDM was re-evaluated. Results: The apparent prevalence of GDM increased by 22.2% using CC criteria. The change was 27.6% at the initial test and 31.5% at repeat tests during 24−28 weeks of gestation. Infant birth weight in GDM diagnosed by either NDDG or CC criteria was significantly higher than in the negative OGTT group (P < 0.001). Rates of macrosomia were comparable. Neonatal hypoglycemia was 14.6% in the NDDG group, 8.2% in CC only group, and 4.6% in negative OGTT group (P < 0.001). Conclusion: The CC criteria identify 22% more cases of GDM than NDDG criteria during initial and repeat tests.

scholarly journals Evaluation of guidelines on the screening and diagnosis of gestational diabetes mellitus: systematic review

BMJ Open ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. e023014 ◽  
Author(s):  
Liao Li-zhen ◽  
Xu Yun ◽  
Zhuang Xiao-Dong ◽  
Hong Shu-bin ◽  
Wang Zi-lian ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Systematic Review ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Oral Glucose ◽  
Endocrine Society ◽  
Iadpsg Criteria ◽  
One Step ◽  
Screening And Diagnosis

ObjectiveGuidelines for screening and diagnosis of gestational diabetes mellitus (GDM) have been updated in the past several years, and various inconsistencies exist across these guidelines. Moreover, the quality of these updated guidelines has not been clarified. We thus conducted this systematic review to evaluate the relationship between the quality and detailed recommendations of these guidelines.Data sourcesThe Guidelines International Network Library, the National Institute for Health and Clinical Excellence (NICE) database, the Medline database, the Embase and the National Guidelines Clearinghouse were searched for guidelines containing recommendations on screening and diagnosis strategies for GDM between 2009 and November 2018.MethodsGuidelines included a target group of women with GDM, and contained recommendations for screening and diagnostic strategies for GDM were included in the present systematic review. Reviewers summarised recommendations on screening and diagnosis strategies from each guideline and rated the quality of guidelines by using the Appraisal of Guidelines Research and Evaluation (AGREE) criteria.ResultsA total of 459 citations were collected by the preliminary literature selection, and 16 guidelines that met the inclusion criteria were assessed. The inconsistencies of the guidelines mainly focus on the screening process (one step vs two step) and criteria of oral glucose tolerance test (OGTT) (International Association of Diabetes and Pregnancy Study Groups [IADPSG] vs CarpenterandCoustan). Guidelines with higher AGREE scores usually recommend a one-step OGTT strategy with IADPSG criteria between 24 and 28 gestational weeks, and the majority of these guidelines likely to select evidence by Grading of Recommendations Assessment, Development and Evaluation criteria.ConclusionsThe guidelines of WHO-2013, NICE-2015, American Diabetes Association-2018, Endocrine Society-2013, Society of Obstetricians and Gynaecologists of Canada-2016, International Federation of Gynecology and Obstetrics-2015, American College of Obstetricians and Gynecologists-2018, United States Preventive Services Task Force-2014 and IADPSG-2015 are strongly recommended in the present evaluation, according to the AGREE II criteria. Guidelines with higher quality tend to recommend a one-step 75 g OGTT strategy with IADPSG criteria between 24 and 28 gestational weeks.

scholarly journals A Study on Glycosylated Haemoglobin Values at 6 - 12 Weeks of Pregnancy as an Early Predictor of Gestational Diabetes Mellitus

2021 ◽  
Vol 10 (31) ◽  
pp. 2485-2489
Author(s):  
Staeny Rex ◽  
Preet Agarwal ◽  
Sarmishta Murugesan ◽  
Rajeshwari K.S
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
First Trimester ◽  
Glycosylated Haemoglobin ◽  
Morbidity And Mortality ◽  
World Health ◽  
Screening Methods ◽  
Oral Glucose ◽  
Major Health Problem

BACKGROUND Gestational diabetes mellitus (GDM) is a major health problem arising due to insulin resistance in pregnant women. It is associated with multiple maternal complications which may cause end organ failure, complicated labour and delivery and thereby increasing the maternal morbidity and mortality. The foetus is also at risk for problems beginning from in utero and extending into the neonatal period and adult life. We wanted to correlate first trimester HbA1c values with the subsequent development of gestational diabetes mellitus and identify if glycosylated haemoglobin can be used as an adjunct with other screening methods. METHODS It is a prospective cohort study. This study was conducted from August 2015 to August 2017. All women of gestational age 6 to 12 weeks who came to Sri Ramachandra University outpatient department were taken for this study. Informed consent was obtained and a detailed history taking was done as per proforma. Along with routine antenatal investigations, Glycosylated haemoglobin (HbA1c) was also done. Oral Glucose Tolerance Test was to be performed at 24 - 28 weeks as per the World Health Organisation –with 75gm criteria and the results were tabulated and analysed to know the significance of Glycosylated haemoglobin (HbA1c) in the outcome of gestational diabetes mellitus. Further a fasting and postprandial blood sugar was done in the 3rd trimester for all patients as a secondary screening tool for gestational diabetes mellitus. Secondary outcomes of obstetric and neonatal complications were also studied. RESULTS In the present study a total of 323 patients were screened for HbA1c during the first trimester and followed till delivery. Only 21.9 % developed gestational diabetes mellitus. Elevated Glycosylated haemoglobin (HbA1c) value of 5.7 - 6.4 % was seen in 5.9 %. CONCLUSIONS Most of the patients with elevated Glycosylated Haemoglobin in the first trimester had high chance of developing gestational diabetes mellitus. Glycosylated haemoglobin is indeed a simple way of screening, but its solitary use remains controversial and hence could possibly be tried as an adjunct with other screening methods. KEY WORDS Glycosylated Haemoglobin, Gestational Diabetes Mellitus, Glycaemic Control, Maternal and Foetal Morbidity and Mortality

scholarly journals An Evaluation of the Effect of a One or Two-Step Gestational Diabetes Mellitus Screening Program on Obstetric and Neonatal Outcomes in Pregnancies

2018 ◽  
pp. 1 ◽  
Author(s):  
Sedat Akgol ◽  
Mehmet Obut ◽  
İhsan Baglı ◽  
Bekir Kahveci ◽  
Mehmet Sukru Budak
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Pregnant Women ◽  
Screening Program ◽  
Oral Glucose ◽  
Term Birth ◽  
Screening Programs ◽  
One Step ◽  
The One

<p><strong>Objectives:</strong> The aim of this study was to compare the obstetric and neonatal outcomes of pregnant women who were screened with one or two-step screening programs for diagnosis of gestational diabetes mellitus.</p><p><strong>Study Design:</strong> A retrospective evaluation was made of pregnant women who were screened with one step [75 g oral glucose tolerance test] or two-step screening programs [50 g oral glucose challenge test and 100 g oral glucose tolerance test] depending on the preference of the physician between September 2016 and August 2017.</p><p><strong>Results:</strong> The one-step screening program was applied to 34.1% (n:1358) of the pregnancies and the remaining 65.9% (n=2623) were screened using the two-step program. The following results were obtained for the pregnant women applied with the one and two-step screening programs, respectively; mean age: 29.37±7.6 years and 28.1 ± 6.2 years, gestational diabetes mellitus: 8.8% and 4.8%, pre-term birth:5.2% and 6.9%, term birth: 89.8% and 85.5%, post-term birth: 5% and 7.6%, vaginal delivery: 74.8% and 67.5%, caesarean section delivery: 25.2% and 32.5%, birth weight: 3389±432 gr and 3234.1 ± 415.9 gr, and mean 5-minute APGAR score: 9.1 ± 0.4 and 9.2 ± 0.7. Comparisons showed statistically significant differences between the groups. </p><p><strong>Conclusion:</strong> The study results showed a significantly higher rate of gestational diabetes mellitus diagnosis for the pregnant women screened with the one-step screening program than the two-step screening program. Although the mean maternal age was significantly higher in the pregnant women screened with the one-step screening program, these pregnancies were observed to have better outcomes (low rates of preterm birth, post-term birth, caesarean delivery and high rates of term birth, vaginal delivery). These results can be attributed to the early referral to a treatment program and follow-up, even though more cases of gestational diabetes mellitus were diagnosed with the one-step screening program.</p>

scholarly journals Neonatal outcome in pregnancies complicated by gestational diabetes mellitus: a hospital based study

2018 ◽  
Vol 5 (3) ◽  
pp. 737 ◽  
Author(s):  
Masaraddi Sanjay K. ◽  
Saranya Andal Kishore ◽  
Nedunchezian P. ◽  
Sulekha C.
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Family History ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Pregnant Women ◽  
Large For Gestational Age ◽  
Oral Glucose ◽  
Family History Of Diabetes ◽  
History Of

Background: Gestational diabetes mellitus (GDM) is amongst the most common medical complications of pregnancy associated with adverse maternal and perinatal outcomes. The prevalence of GDM is increasing worldwide especially in India with increasing obesity and lifestyle and dietary changes. Hence this study was undertaken to study the prevalence of GDM and to evaluate its neonatal outcomes.Methods: This was a prospective study. During the study period, 205 pregnant women between 24 to 28 weeks of gestation were screened for GDM using 75 g oral glucose tolerance test (OGTT) and were diagnosed to have GDM based on WHO criteria. Risk factors for GDM, maternal and neonatal outcomes were studied.Results: The prevalence of GDM in the study population was 7.8%. Prevalence of GDM cases was significantly associated with body mass index (BMI) >25 kg/m2, family history of diabetes, previous macrosomia/large for gestational age (LGA) baby and past history of GDM with p <0.001 and with multiparity (p = 0.024). Maternal age >25 years was not statistically associated with prevalence of GDM (p = 0.358). Incidence of pre-eclampsia and polyhydramnios were significantly higher among GDM cases. Operative delivery and assisted (forceps) delivery had strongly significant association with GDM (p <0.001). GDM cases were significantly associated with higher birth weight (>3.5 kg) in the neonates (p <0.001). Hypoglycemia was the most common complication noted in neonates of GDM women. Incidence of respiratory distress, transient tachypnea of the newborn (TTN), polycythemia and neonatal hyperbilirubinemia were also significantly more common among neonates born to GDM women.Conclusions: BMI >25 kg/m2, family history of diabetes, past GDM and previous LGA baby were important risk factors for GDM. The study emphasizes the need to screen all pregnant women for GDM, so that timely diagnosis and intervention will reduce both maternal and perinatal complications.

The Association between Maternal/Fetal Insulin Receptor Substrate 1 Gene Polymorphism rs1801278 and Gestational Diabetes Mellitus in a Chinese Population

2021 ◽  
pp. 1-8
Author(s):  
Lingling Wu ◽  
Changping Fang ◽  
Jun Zhang ◽  
Yanchou Ye ◽  
Haiyan Zhao
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gene Polymorphism ◽  
Gestational Diabetes Mellitus ◽  
Insulin Receptor ◽  
Tolerance Test ◽  
Oral Glucose ◽  
Insulin Receptor Substrate ◽  
Single Center ◽  
Insulin Receptor Substrate 1

<b><i>Objectives:</i></b> Insulin receptor substrate 1 (IRS1) is a crucial factor in the insulin signaling pathway. IRS1 gene polymorphism rs1801278 in mothers has been reported to be associated with gestational diabetes mellitus (GDM). However, it is not clear whether IRS1 gene polymorphism rs1801278 in fetuses is associated with their mothers’ GDM morbidity. The purpose of this study is to analyze the association between maternal, fetal, or maternal/fetal <i>IRS1</i> gene polymorphism rs1801278 and GDM risk. <b><i>Design:</i></b> The study was a single-center, prospective cohort study. In total, 213 pairs of GDM mothers/fetuses and 191 pairs of control mothers/fetuses were included in this study. They were recruited after they underwent oral glucose tolerance test during 24–28 weeks of gestation and followed up until delivery. All participants received the conventional interventions (diet and exercise), and no special therapy except routine treatment. <b><i>Methods:</i></b> A total of 213 pairs of GDM mothers/fetuses and 191 pairs of normal blood glucose pregnant mothers/fetuses were ge­notyped using PCR and DNA sequencing from January 2015 to September 2016. Maternal/fetal <i>IRS1</i> gene polymorphism rs1801278 was analyzed and compared between 2 groups. <b><i>Results:</i></b> There were no significant differences in the frequency of individual mothers’ or fetuses’ <i>IRS1</i> rs1801278 polymorphisms between 2 groups; if both the mothers and fetuses carried A allele, significantly lower GDM morbidity was observed in the mothers. <b><i>Limitations:</i></b> The sample size was relatively small as a single-center study. <b><i>Conclusions:</i></b> Our study suggested that maternal/fetal rs1801278 polymorphism of <i>IRS1</i> is a modulating factor in GDM; both mothers/fetuses carrying the A allele of rs1801278 may protect the mothers against the development of GDM.

scholarly journals Breastfeeding Duration and Development of Dysglycemia in Women Who Had Gestational Diabetes Mellitus: Evidence from the GUSTO Cohort Study

Nutrients ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 408
Author(s):  
Sumali S. Hewage ◽  
Xin Yu Hazel Koh ◽  
Shu E. Soh ◽  
Wei Wei Pang ◽  
Doris Fok ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Tolerance Test ◽  
Diabetes Risk ◽  
Breastfeeding Duration ◽  
Oral Glucose ◽  
Inverse Association ◽  
Index Pregnancy

(1) Background: Breastfeeding has been shown to support glucose homeostasis in women after a pregnancy complicated by gestational diabetes mellitus (GDM) and is potentially effective at reducing long-term diabetes risk. (2) Methods: Data from the Growing Up in Singapore Towards healthy Outcomes (GUSTO) study were analyzed to understand the influence of breastfeeding duration on long-term dysglycemia (prediabetes and diabetes) risk in women who had GDM in the index pregnancy. GDM and dysglycemia four to seven years postpartum were determined by the oral glucose tolerance test (OGTT). A Poisson regression model with a robust error variance was used to estimate incidence rate ratios (IRRs) for dysglycemia four to seven years post-delivery according to groupings of the duration of any breastfeeding (<1, ≥1 to <6, and ≥6 months). (3) Results: Women who had GDM during the index pregnancy and complete breastfeeding information and OGTT four to seven years postpartum were included in this study (n = 116). Fifty-one women (44%) had postpartum dysglycemia. Unadjusted IRRs showed an inverse association between dysglycemia risk and ≥1 month to <6 months (IRR 0.91; 95% confidence interval [CI] 0.57, 1.43; p = 0.68) and ≥6 months (IRR 0.50; 95% CI 0.27, 0.91; p = 0.02) breastfeeding compared to <1 month of any breastfeeding. After adjusting for key confounders, the IRR for the ≥6 months group remained significant (IRR 0.42; 95% CI 0.22, 0.80; p = 0.008). (4) Conclusions: Our results suggest that any breastfeeding of six months or longer may reduce long-term dysglycemia risk in women with a history of GDM in an Asian setting. Breastfeeding has benefits for mothers beyond weight loss, particularly for those with GDM.

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