scholarly journals Improvement of selective screening strategy for gestational diabetes through a more accurate definition of high-risk groups

2014 ◽  
Vol 170 (1) ◽  
pp. 87-93 ◽  
Author(s):  
Basilio Pintaudi ◽  
Giacoma Di Vieste ◽  
Francesco Corrado ◽  
Giuseppe Lucisano ◽  
Fabio Pellegrini ◽  
...  
Keyword(s):  
High Risk ◽  
Gestational Diabetes ◽  
International Association ◽  
Risk Groups ◽  
Study Groups ◽  
Oral Glucose ◽  
Selective Screening ◽  
Family History Of Diabetes ◽  
Screening Approach ◽  
Increased Risk

ObjectiveThis study aimed to assess the predictive value of risk factors (RFs) for gestational diabetes mellitus (GDM) established by selective screening (SS) and to identify subgroups of women at a higher risk of developing GDM.DesignA retrospective, single-center study design was employed.MethodsData of 1015 women screened for GDM at 24–28 weeks of gestation and diagnosed according to the International Association of Diabetes and Pregnancy Study Groups criteria were evaluated. Information on RFs established by SS was also collected and their association with GDM was determined. To identify distinct and homogeneous subgroups of patients at a higher risk, the RECursive Partitioning and AMalgamation (RECPAM) method was used.ResultsOverall, 113 (11.1%) women were diagnosed as having GDM. The application of the SS criteria would result in the execution of an oral glucose tolerance test (OGTT) in 58.3% of women and 26 (23.0%) cases of GDM would not be detected due to the absence of any RF. The RECPAM analysis identified high-risk subgroups characterized by fasting plasma glucose values >5.1 mmol/l (odds ratio (OR)=26.5; 95% CI 14.3–49.0) and pre-pregnancy BMI (OR=7.0; 95% CI 3.9–12.8 for overweight women). In a final logistic model including RECPAM classes, previous macrosomia (OR=3.6; 95% CI 1.1–11.6), and family history of diabetes (OR=1.8; 95% CI 1.1–2.8), but not maternal age, were also found to be associated with an increased risk of developing GDM. A screening approach based on the RECPAM model would reduce by over 50% (23.0 vs 10.6%) the number of undiagnosed GDM cases when compared with the current SS approach, at the expense of 50 additional OGTTs required.ConclusionsA screening approach based on our RECPAM model results in a significant reduction in the number of undetected GDM cases compared with the current SS procedure.

scholarly journals Comparative analysis of current diagnostic criteria for gestational diabetes mellitus

2012 ◽  
Vol 5 (2) ◽  
pp. 71-77 ◽  
Author(s):  
Mariya V Boyadzhieva ◽  
Iliana Atanasova ◽  
Sabina Zacharieva ◽  
Tsvetalina Tankova ◽  
Violeta Dimitrova
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Diagnostic Criteria ◽  
International Association ◽  
Study Groups ◽  
World Health ◽  
Oral Glucose ◽  
Significant Difference ◽  
Iadpsg Criteria

Background To compare current guidelines for diagnosis of gestational diabetes mellitus (GDM) and to identify the ones that are the most relevant for application among pregnant Bulgarian population. Methods A total of 800 pregnant women at high risk for GDM underwent 75 g oral glucose tolerance test between 24 and 28 weeks of gestation as antenatal screening. The results were interpreted and classified according to the guidelines of the International Association of Diabetes and Pregnancy Study Groups (IADPSG), American Diabetes Association (ADA), Australasian Diabetes in Pregnancy Society, Canadian Diabetes Association, European Association for the Study of Diabetes, New Zealand Society for the study of Diabetes and World Health Organization. Results The application of different diagnostic criteria resulted in prevalences of GDM between 10.8% and 31.6%. Using any two sets of criteria, women who were classified differently varied between 0.1% and 21.1% ( P < 0.001).The IADPSG criteria were the most inclusive criteria and resulted in the highest prevalence of GDM. There was a significant difference in the major metabolic parameters between GDM and control groups, regardless of which of the diagnostic criteria applied. GDM diagnosed according to all criteria resulted in increased proportion of delivery by caesarean section (CS). However, only ADA and IADPSG criteria identified both increased macrosomia (odds ratio, 2.36; 2.29) and CS rate. Conclusion The need for GDM screening is indisputable. In our view, the new IADPSG guidelines offer a unique opportunity for a unified national and global approach to GDM.

scholarly journals ADCY5, CAPN10 and JAZF1 Gene Polymorphisms and Placental Expression in Women with Gestational Diabetes

Life ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. 806
Author(s):  
Przemysław Ustianowski ◽  
Damian Malinowski ◽  
Patrycja Kopytko ◽  
Michał Czerewaty ◽  
Maciej Tarnowski ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Gestational Diabetes ◽  
Glucose Tolerance ◽  
Pregnant Women ◽  
International Association ◽  
Study Groups ◽  
Oral Glucose ◽  
Iadpsg Criteria ◽  
Capn10 Gene

Gestational diabetes mellitus (GDM) is carbohydrate intolerance that occurs during pregnancy. This disease may lead to various maternal and neonatal complications; therefore, early diagnosis is very important. Because of the similarity in pathogenesis of type 2 diabetes and GDM, the genetic variants associated with type 2 diabetes are commonly investigated in GDM. The aim of the present study was to examine the associations between the polymorphisms in the ADCY5 (rs11708067, rs2877716), CAPN10 (rs2975760, rs3792267), and JAZF1 (rs864745) genes and GDM as well as to determine the expression of these genes in the placenta. This study included 272 pregnant women with GDM and 348 pregnant women with normal glucose tolerance. The diagnosis of GDM was based on a 75 g oral glucose tolerance test (OGTT) at 24–28 weeks gestation, according to International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria. There were no statistically significant differences in the distribution of the ADCY5 gene (rs11708067, rs2877716) and CAPN10 gene (rs2975760, rs3792267) polymorphisms between pregnant women with normal carbohydrate tolerance and pregnant women with GDM. We have shown a lower frequency of JAZF1 gene rs864745 C allele carriers among women with GDM CC + CT vs. TT (OR = 0.60, 95% CI = 0.41–0.87, p = 0.006), and C vs. T (OR = 0.75, 95% CI = 0.60–0.95, p = 0.014). In addition, ADCY5 and JAZF1 gene expression was statistically significantly increased in the placentas of women with GDM compared with that of healthy women. The expression of the CAPN10 gene did not differ significantly between women with and without GDM. Our results indicate increased expression of JAZF1 and ADCY5 genes in the placentas of women with GDM as well as a protective effect of the C allele of the JAZF1 rs864745 gene polymorphism on the development of GDM in pregnant women.

scholarly journals The Risk for Glucose Intolerance after Gestational Diabetes Mellitus since the Introduction of the IADPSG Criteria: A Systematic Review and Meta-Analysis

2019 ◽  
Vol 8 (9) ◽  
pp. 1431 ◽  
Author(s):  
Benhalima ◽  
Lens ◽  
Bosteels ◽  
Chantal
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Diagnostic Criteria ◽  
Glucose Intolerance ◽  
International Association ◽  
Study Groups ◽  
Increased Risk ◽  
Iadpsg Criteria ◽  
History Of

The aim of the study was to assess the postpartum risk for glucose intolerance since the introduction of the ‘International Association of Diabetes and Pregnancy Study Groups’ (IADPSG) criteria for gestational diabetes mellitus (GDM). Studies published since 2010 were included, which evaluated the risk for type 2 diabetes mellitus (T2DM), impaired glucose tolerance (IGT), and cardiovascular (CV) events in women with previous GDM compared to normal glucose tolerant women. We included forty-three studies, evaluating 4,923,571 pregnant women of which 5.8% (284,312) had a history of GDM. Five studies used IADPSG criteria (n = 6174 women, 1314 with GDM). The overall pooled relative risk (RR) for postpartum T2DM was 7.42 (95% CI: 5.99–9.19) and the RR for postpartum T2DM with IADPSG criteria was 6.45 (95% CI: 4.74–8.77) compared to the RR of 9.08 (95% CI: 6.96–11.85; p = 0.17) for postpartum T2DM based on other diagnostic criteria. The RR for postpartum IGT was 2.45 (95% CI: 1.92–3.13), independent of the criteria used. None of the available studies with IADPSG criteria evaluated the risk for CV events. Women with a history of GDM based on the IADPSG criteria have a similarly increased risk for postpartum glucose intolerance compared to GDM based on other diagnostic criteria. More studies with GDM based on the IADPSG criteria are needed to increase the quality of evidence concerning the long-term metabolic risk.

scholarly journals Gestational Diabetes Mellitus: Screening and Outcomes in Southern Italian Pregnant Women

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
Carmelo Capula ◽  
Eusebio Chiefari ◽  
Anna Vero ◽  
Biagio Arcidiacono ◽  
Stefania Iiritano ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
High Risk ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Pregnant Women ◽  
International Association ◽  
Study Groups ◽  
Large For Gestational Age ◽  
Iadpsg Criteria

Recent Italian guidelines exclude women <35 years old, without risk factors for gestational diabetes mellitus (GDM), from screening for GDM. To determine the effectiveness of these measures with respect to the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria, we evaluated 2,448 pregnant women retrospectively enrolled in Calabria, southern Italy. GDM was diagnosed following the IADPSG 2010 criteria. Among 538 women <35 years old, without risk factors, who would have not been tested according to the Italian guidelines, we diagnosed GDM in 171 (31.8%) pregnants (7.0% of total pregnants). Diagnosis was made at baseline (55.6%), 1 hour (39.8%), or 2 hours (4.7%) during OGTT. Despite of appropriate treatment, GDM represented a risk factor for cesarean section, polyhydramnios, increased birth weight, admission to neonatal intensive care units, and large for gestational age. These outcomes were similar to those observed in GDM women at high risk for GDM. In conclusion, Italian recommendations failed to identify 7.0% of women with GDM, when compared to IADPSG criteria. The risk for adverse hyperglycaemic-related outcomes is similar in low-risk and high-risk pregnants with GDM. To limit costs of GDM screening, our data suggest to restrict OGTT to two steps (baseline and 1 hour).

scholarly journals Screening of postpartum diabetes in women with gestational diabetes: high-risk subgroups and areas for improvements—the STRONG observational study

2021 ◽  
Author(s):  
Angela Napoli ◽  
◽  
Laura Sciacca ◽  
Basilio Pintaudi ◽  
Andrea Tumminia ◽  
...  
Keyword(s):  
High Risk ◽  
Gestational Diabetes ◽  
Recursive Partitioning ◽  
Tolerance Test ◽  
Oral Glucose ◽  
Family History Of Diabetes ◽  
History Of ◽  
Predictive Role ◽  
Postpartum Diabetes ◽  
Retrospective Multicenter Study

Abstract Aims To assess the proportion of women with gestational diabetes (GDM) by performing postpartum Oral Glucose Tolerance Test (OGTT) and to identify GDM phenotypes at high-risk of postpartum dysglycemia (PPD). Methods Observational, retrospective, multicenter study involving consecutive GDM women. Recursive partitioning (RECPAM) analysis was used to identify distinct and homogeneous subgroups of women at different PPD risk. Results From a sample of 2,736 women, OGTT was performed in 941 (34.4%) women, of whom 217 (23.0%) developed PPD. Insulin-treated women having family history of diabetes represented the subgroup with the highest PPD risk (OR 5.57, 95% CI 3.60–8.63) compared to the reference class (women on diet with pre-pregnancy BMI <  = 28.1 kg/m2). Insulin-treated women without family diabetes history and women on diet with pre-pregnancy BMI > 28.1 kg/m2 showed a two-fold PPD risk. Previous GDM and socioeconomic status represent additional predictors. Fasting more than post-prandial glycemia plays a predictive role, with values of 81–87 mg/dl (4.5–4.8 mmol/l) (lower than the current diagnostic GDM threshold) being associated with PPD risk. Conclusions Increasing compliance to postpartum OGTT to prevent/delay PPD is a priority. Easily available characteristics identify subgroups of women more likely to benefit from preventive strategies. Fasting BG values during pregnancy lower than those usually considered deserve attention.

scholarly journals Contribution of maternal obesity and weight gain in pregnancy to the occurrence of gestational diabetes

2015 ◽  
Vol 67 (2) ◽  
pp. 583-589
Author(s):  
Cristina Teodorescu ◽  
Carmen Dobjanschi ◽  
Florin Isopescu ◽  
Emilia Rusu ◽  
Antoine Edu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Weight Gain ◽  
Gestational Diabetes ◽  
Pregnant Women ◽  
Diagnostic Criteria ◽  
Maternal Obesity ◽  
International Association ◽  
Study Groups ◽  
Tolerance Test ◽  
Oral Glucose

An increase in prevalence of gestational diabetes mellitus (GDM) was observed using new diagnostic criteria. We evaluated the prevalence of GDM in a population of pregnant women (109 women with gestational age of 24-28 weeks) and risk factors for GDM, such as maternal obesity and weight gain. The evaluation of each patient included an oral glucose tolerance test (OGTT) using the new diagnostic criteria of the International Association of Diabetes and Pregnancy Study Groups (IADPSG) for GDM, 2D ultrasounds and the registration of risk factors. The prevalence of GDM in the age group ?30 years was 11.9%, which is comparable to the results of other studies. The relative risk (RR) for GDM was 1.738 (95% CI 0.630-4.795) in women over 30 years and 3.782 (95% CI 1.127-12.686) in women over 35. Weight gain in the group with GDM was significantly higher than in the group that included pregnant women without GDM (p <0.01). Considering the high risk of GDM with excessive gestational weight gain, educational nutrition programs should be established for the fertile-age population, not only to prevent obesity but also to prevent excessive weight gain during pregnancy.

Abstract 11861: Ethnic Differences in the 10-Year Risk of Coronary Heart Disease Among High Risk Individuals in a Large Contemporary Population

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Jamal S Rana ◽  
Jennifer Liu ◽  
Howard H Moffet ◽  
Marc Jaffe ◽  
Andrew J Karter
Keyword(s):  
High Risk ◽  
Ethnic Differences ◽  
Policy Development ◽  
High Risk Patient ◽  
Risk Groups ◽  
Study Groups ◽  
Integrated Delivery System ◽  
Chd Risk ◽  
Hazard Ratios ◽  
Age And Sex

Purpose: To evaluate ethnic differences in CHD risk in high risk patient populations in 4 study cohorts: 1) No diabetes (DM) and no prior CHD 2) DM but no prior CHD, 2) non-DM with prior CHD and 3) DM with prior CHD. Methods: 1,586,061 members of an integrated health care system, with self reported race/ethnicity of Asians (14.1%), blacks (8.6%), Latinos (12.6%), and whites (64.5%), ages 30- 90 years, were evaluated from 01/01/2002 through 12/31/2011. We specified Cox proportional hazard models and compared the Hazard Ratios (HRs), relative to that of whites, for incident CHD in the 4 study cohorts. Results: The median follow up time for this cohort was ten years (10,980,800 person years). Figure shows the age and sex adjusted (squares) hazard ratios (relative to that of whites) for CHD for Blacks, Latinos and Asians, respectively for the 4 study groups. These age and sex-adjusted effect estimates were not altered substantively by further adjustment for smoking, HTN, lipid levels and statin use (figure, circles). However a slightly higher risk (HR of 1.15 95%, CI, 1.05-1.27) was noted among Blacks with prior CHD and no DM. No increase risk was noted in blacks with both DM and CHD. Conclusions: In this integrated delivery system with uniform medical care coverage, we observed slightly reduced risk or no difference in risk for Blacks, Asians, and Latinos compared to whites in all 4 risk groups, and observed a greater risk of CHD for Blacks without prior DM but with previously diagnosed CHD. These findings may inform policy development and interventions designed to identify and eliminate disparities.

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