scholarly journals Risk Factors and Diagnosis of Gestational Diabetes

Author(s):  
Lino Arturo Rojas Pérez ◽  
Lino Arturo Rojas Cruz ◽  
María Daniela Villagómez Vega ◽  
Augusto Ernesto Rojas Cruz ◽  
Andrés Eduardo Rojas Cruz

Introduction: The risk factors play a fundamental role in the prevention of Gestational Diabetes, and an early and timely diagnosis will considerably reduce the risk of complications of said pathology. Methodology: Virtual scientific libraries have been used as Cochane, BVS, Revista Panamericana de Salud Pública, EBSCO, and searchers of scientific information as Mendeley, UptoDate, Taylor & Francis, to find the best available evidence, subsequently the highest quality scientific bibliography has been selected, from which all those that meet the inclusion criteria and do not meet any criteria have been chosen exclusion, subsequently all scientific articles have been reviewed to acquire from them the most relevant and solid information for the creation of this systematic review. Results: We found 33 scientific articles that meet all the inclusion criteria and no exclusion criteria. Discussion: Gestational Diabetes is characterized from the pathophysiological point of view as a state of hyperglycemia, insulin resistance and decreased insulin secretion by beta-pancreatic cells, it is known that risk factors influence the genesis of disease and its prevention. Currently two diagnostic strategies are used, but the most recommended is the one-step strategy with an oral glucose load of 75 grams, which has shown better results for its diagnosis. Conclusions: Due to the complications that Gestational Diabetes can produce in both the mother and the fetus, it is important to create early diagnosis programs, active search for pregnant women and awareness of self-care during pregnancy. Keywords: diabetes, gestational diabetes, risk factors, diagnosis. RESUMEN Introducción: Los factores de riesgo juegan un papel fundamental en la prevención de la Diabetes Gestacional, y un diagnóstico temprano y oportuno reducirá considerablemente el riesgo de las complicaciones de dicha patología. Metodología: Se ha utilizado bibliotecas científicas virtuales como Cochane, BVS, Revista Panamericana de Salud Pública, EBSCO, además de buscadores de información científica como Mendeley, UptoDate, Taylor & Francis, para encontrar la mejor evidencia disponible, posteriormente se ha seleccionado la bibliografía científica de más alta calidad, de los cuales se han elegido todos los que cumplas los criterios de inclusión y no cumplan ningún criterio de exclusión, posteriormente se han revisado todos los artículos científicos para adquirir de ellos la información más relevante y sólida para la creación de esta revisión. Resultados: Se han encontrado 33 artículos científicos que cumplen con todos los criterios de inclusión y ningún criterio de exclusión. Discusión: La Diabetes Gestacional se caracteriza desde el punto de vista fisiopatológico como un estado de hiperglicemia, resistencia a la insulina y disminución de la secreción de insulina por parte de las células beta-pancreáticas, se conoce que los factores de riesgo influyen en la génesis de la enfermedad y de su prevención. Actualmente se utiliza dos estrategias diagnósticas, pero la más recomendada es la estrategia de un paso con carga oral de glucosa de 75 gramos, que ha demostrado mejores resultados para su diagnóstico. Conclusiones: Debido a las complicaciones que la Diabetes Gestacional puede producir tanto en la madre como el en feto, es importante crear programas de diagnóstico temprano, búsqueda activa de gestantes y generación de conciencia del autocuidado durante el embarazo. Palabras clave: diabetes, diabetes gestacional, factores de riesgo, diagnóstico.

Author(s):  
María José Cao Torija ◽  
María José Castro Alija ◽  
Magdalena Santo Tomás Pérez

Planteamos en el presente artículo una revisión de la incidencia, los principales factores de riesgo cardiovascular, y manifestaciones diferenciales de estas enfermedades entre mujeres y hombres por una parte desde el punto de vista biológico y por otra, y generalmente más olvidada desde el punto de vista del género, entendido como construcción social de lo femenino y lo masculino y poder así elaborar algunas conclusiones respecto a la prevención en general y específicamente en las mujeres.<br /><br />We propose in this article a review of the incidence, major cardiovascular risk factors, and differential signs of these diseases between women and men, on the one hand from the biological point of view and, on the other hand, and more generally neglected, from the point of view of the gender, understood as a social construction of the feminine and the masculine, and thus be able to draw some conclusions about prevention in general and specifically in women.<br /><br />


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Anam Shakil Rai ◽  
Line Sletner ◽  
Anne Karen Jenum ◽  
Nina Cecilie Øverby ◽  
Signe Nilssen Stafne ◽  
...  

Abstract Background There is still no worldwide agreement on the best diagnostic thresholds to define gestational diabetes (GDM) or the optimal approach for identifying women with GDM. Should all pregnant women perform an oral glucose tolerance test (OGTT) or can easily available maternal characteristics, such as age, BMI and ethnicity, indicate which women to test? The aim of this study was to assess the prevalence of GDM by three diagnostic criteria and the predictive accuracy of commonly used risk factors. Methods We merged data from four Norwegian cohorts (2002–2013), encompassing 2981 women with complete results from a universally offered OGTT. Prevalences were estimated based on the following diagnostic criteria: 1999WHO (fasting plasma glucose (FPG) ≥7.0 or 2-h glucose ≥7.8 mmol/L), 2013WHO (FPG ≥5.1 or 2-h glucose ≥8.5 mmol/L), and 2017Norwegian (FPG ≥5.3 or 2-h glucose ≥9 mmol/L). Multiple logistic regression models examined associations between GDM and maternal factors. We applied the 2013WHO and 2017Norwegian criteria to evaluate the performance of different thresholds of age and BMI. Results The prevalence of GDM was 10.7, 16.9 and 10.3%, applying the 1999WHO, 2013WHO, and the 2017Norwegian criteria, respectively, but was higher for women with non-European background when compared to European women (14.5 vs 10.2%, 37.7 vs 13.8% and 27.0 vs 7.8%). While advancing age and elevated BMI increased the risk of GDM, no risk factors, isolated or in combination, could identify more than 80% of women with GDM by the latter two diagnostic criteria, unless at least 70–80% of women were offered an OGTT. Using the 2017Norwegian criteria, the combination “age≥25 years or BMI≥25 kg/m2” achieved the highest sensitivity (96.5%) with an OGTT required for 93% of European women. The predictive accuracy of risk factors for identifying GDM was even lower for non-European women. Conclusions The prevalence of GDM was similar using the 1999WHO and 2017Norwegian criteria, but substantially higher with the 2013WHO criteria, in particular for ethnic non-European women. Using clinical risk factors such as age and BMI is a poor pre-diagnostic screening method, as this approach failed to identify a substantial proportion of women with GDM unless at least 70–80% were tested.


2020 ◽  
Vol 36 (2) ◽  
pp. 271-282
Author(s):  
Eva María Taboada Ares ◽  
Patricia María Iglesias Souto ◽  
Santiago López Gómez ◽  
Rosa María Rivas Torres

Un número considerable de estudiantes presenta dificultades de aprendizaje y bajo rendimiento académico, sin embargo su evaluación no siempre deriva en un diagnóstico concreto. Son categorizados como inmaduros, pero no se determinan ni la naturaleza ni las características de sus dificultades. El objetivo de este estudio fue identificar los dominios evolutivos afectados en niños con retraso del desarrollo (RD) con la finalidad de valorar el concepto de dificultades neuroevolutivas como categoría comprensiva y perfil de las dificultades generalizadas de aprendizaje. Para ello, se realizó una revisión sistemática en las bases electrónicas Medline, PsycINFO, WOS, Eric, Dialnet y CSIC y, tras aplicar los criterios de inclusión, se seleccionaron 18 artículos. Los resultados confirman que RD se utiliza como etiqueta diagnóstica para caracterizar a niños con retrasos significativos en uno o varios ámbitos del desarrollo, pero no existe una definición de consenso ni criterios específicos para su diagnóstico, y solo sería de aplicación a niños de corta edad. Los dominios afectados coinciden con funciones neuroevolutivas y, en su etiología, destacan factores de riesgo biológico y ambiental. Las dificultades neuroevolutivas abarcarían un amplio espectro de déficits con distintos niveles de gravedad que, al interactuar entre sí, dan lugar a una variedad de perfiles. A considerable number of students have learning difficulties and low academic performance, yet their evaluation does not always lead to a concrete diagnosis. They are categorized as immature, but neither the nature nor the characteristics of their difficulties are determined. The aim of this study was to identify the developmental domains which are affected in children with developmental delay (DD) in order to assess the concept of neurodevelopmental difficulties as a comprehensive category and profile of generalized learning difficulties. To this end, a systematic review was carried out on the electronic databases Medline, PsycINFO, WOS, Eric, Dialnet and CSIC and, after applying the inclusion criteria, 18 articles were selected. The results confirm that DD is used as a diagnostic label to characterize children with significant delays in one or more developmental domains, but there is no definition of consensus nor specific criteria for its diagnosis, and it would only be applicable to young children. The affected domains coincide with neurodevelopmental functions, and biological and environmental risk factors stand out in their aetiology. Neurodevelopmental difficulties would encompass a wide spectrum of deficits with different levels of severity that, on interacting with each other, give rise to a variety of profiles.


Author(s):  
Ke Manga Reddy ◽  
Lakshmi Sailaja P. ◽  
Sahithi Balmuri ◽  
Avinash Jagarlamudi ◽  
Kalpana Betha

Background: Gestational diabetes mellitus is the commonest medical disorder in pregnancy. Women with GDM are at increased risk for adverse obstetric and perinatal outcome. Prevalence of GDM is known to vary widely depending on region of the country, dietary habits and socio-economic status. This study was undertaken to evaluate the prevalence of GDM and risk factors associated with it among women delivered in a rural tertiary teaching hospital in Telangana and further assess its impact on feto-maternal outcome.Methods: A retrospective study was conducted at Mediciti Institute of Medical Sciences on GDM cases delivered from May 2015 to April 2017. GDM was diagnosed using 2 step procedure of screening with glucose challenge test followed by confirmation with oral glucose tolerance test using Carpenter and Couston criteria. Demographic data and details about perinatal outcome were obtained from medical records and analyzed.Results: The prevalence was low (1.83%) compared to other studies. Majority of the women did not have risk factors. Preeclampsia is the commonest maternal complication seen (18%). Hypothyroidism is more often associated with GDM (15%). Caesarean section rate was high (62%). Though the NICU admission rate was high (76%), neonatal outcome was found to be satisfactory.Conclusions: The low prevalence of GDM seen highlights the importance of carrying out studies in different population groups of India to know the exact prevalence of GDM in the country. Pregnancies in women with GDM continue to be at increased risk of maternal and perinatal complications.


1997 ◽  
pp. 27-33 ◽  
Author(s):  
G Mello ◽  
E Parretti ◽  
F Mecacci ◽  
R Lucchetti ◽  
C Lagazio ◽  
...  

OBJECTIVE: The aim of this study was to investigate whether minor abnormalities of glucose metabolism without gestational diabetes are a risk factor for fetal overgrowth. DESIGN: A sample of 1883 unselected white mother-infant pairs were screened for gestational diabetes using a 50 g 1-h oral glucose challenge test (GCT) in two periods of pregnancy: early (16-20 weeks) and late (26-30 weeks). METHODS: The effects of risk factors (glucose metabolism, previous history of mothers, obesity, multiparity and age of mothers) were estimated using a multinomial logit model. RESULTS: The level of risk was related to gestational age at the appearance of an abnormal GCT. Patients with an abnormal GCT in the early and late periods of pregnancy (Group 1) had a risk of delivering a large for gestational age (LGA) infant seven times higher than the control group (normal GCT in both periods), and patients with a normal GCT in the early period and an abnormal GCT in the late period (Group 2) showed a risk three times higher than the control group. Among the historical risk factors for LGA infants, such as maternal obesity, multiparity, previous gestational diabetes and previous delivery of an infant weighing 4000 g or more, only the latter was associated with fetal overgrowth with a risk level 4.7 higher than the control group. Group 1 patients had a significantly higher incidence of pregnancy-induced hypertension and preterm birth. There were no differences in the frequency of 5-min Apgar score < 7 and metabolic complications among the infants of all groups. We found a significantly higher rate of shoulder dystocia in Group 1 infants than in infants in the other groups. CONCLUSIONS: Our results suggest that a positive GCT at 26-30 weeks is the most important risk factor for fetal overgrowth. This result was strongly enforced in patients who had also shown a positive early GCT at 16-20 weeks.


2021 ◽  
Vol 11 (6) ◽  
pp. 1-5
Author(s):  
Aradhana Singh ◽  
Raj K Singh ◽  
Vani Aditya

Introduction: In view of the alarmingly increasing incidence of Gestational Diabetes Mellitus (GDM), worldwide, as well as in India, a consensus to bring about standardization for diagnosis of GDM is needed. Internationally, the WHO 2013 criteria is being widely used, while (Diabetes In Pregnancy Study Group of India) DIPSI non fasting criteria is popularly used in India. There still remains many missed cases of GDM in India, which is a cause of concern. This study was done to compare the DIPSI non fasting, with WHO 2013 criteria for diagnosis of GDM. Methods: this cross-sectional study included 530 pregnant women, attending antenatal clinic of a tertiary care center, of North India, from Feb. 2018 to March 2019 and fulfilling inclusion criteria. All women attending antenatal clinic, during the study period, were subjected to capillary glucose evaluation, 2 hours after 75g oral glucose load, irrespective of the timing of last meal (DIPSI), as part of routine antenatal checkup. After 7 days, only those 530 women, who turned up in fasting state, and fulfilled inclusion criteria, were enrolled in the study and subjected to fasting 75g, oral glucose tolerance test (OGTT) (WHO 2013). Accuracy of DIPSI test was compared, to the fasting WHO 2013 criteria. Capillary glucose was measured using regular, well calibrated, point of care, “Optium Free Style” glucometer. Results: Out of 107 women diagnosed to have GDM by WHO 2013 criteria, only 89 were diagnosed by the DIPSI criteria. DIPSI had a low sensitivity (83.18%) when compared to the WHO 2013 criteria, Conclusion: This study showed that when non fasting DIPSI criteria was used as diagnostic criteria, 10.58% women with GDM, missed the diagnosis. Considering the adverse maternal and perinatal outcome of GDM, implication of missed diagnosis would be grave, especially in a developing country, like India. Hence, use of DIPSI criteria for diagnosing GDM should be reconsidered. Key words: GDM, DIPSI, OGTT, Diabetes in Pregnancy.


2020 ◽  
Author(s):  
Naohisa Masuko ◽  
Kenji Tanimura ◽  
Nobue Kojima ◽  
Hitomi Imafuku ◽  
Masashi Deguchi ◽  
...  

Abstract This prospective cohort study aimed to evaluate the risk factors for pregnancy complications and postpartum glucose intolerance (GI) in women with gestational diabetes mellitus (GDM). A total of 140 women with GDM were enrolled. Of these, 115 underwent a 75-g oral glucose tolerance test (OGTT) at 12 weeks after delivery. Clinical factors and parameters in the antepartum 75-g OGTT associated with pregnancy complications and postpartum GI were evaluated. Women with GDM experienced pregnancy complications, including hypertensive disorders of pregnancy (HDP, n=19), preterm delivery (PD, n=17), heavy-for-date (HFD, n=19), and light-for-date (LFD, n=12), and 22 of the 115 women with GDM developed postpartum GI. The univariate and multivariable logistic regression analyses revealed the following risk factors: histories of hypertension (odds ratio [OR], 23.8; 95% confidence interval [CI], 4.2–134.7; p<0.01) for HDP; histories of hypertension (OR, 9.8; 95% CI, 2.5–38.9; p<0.01) for PD; HbA1c levels (OR, 7.6; 95% CI, 1.5–37.9; p<0.05) for HFD; and oral deposition index (DI) (OR, 0.1; 95% CI, 0.02–0.7; p<0.01) for postpartum GI. Higher HbA1c levels and lower oral DI on the antepartum 75-g OGTT may be useful markers for identifying GDM women who are at high risk for HFD and postpartum GI, respectively.


Author(s):  
E. De Franchis ◽  
A. Ferramosca ◽  
V. Zara ◽  
L. Piper

In this study the authors evaluated the prevalence of Gestational Diabetes Mellitus (GDM) and the incidence in determining the occurrence thereof, given by the following risk factors: age, family history for Diabetes Mellitus (DM), Body Mass Index (BMI), smoking, diet, macrosomia in previous pregnancies and physical activity. To this end, they investigated a cohort of 61 pregnant women, who had at least one risk factor, in a total period of nine months, during which women checked in the Clinic of Endocrinology and Diabetology of the Hospital “F. Ferrari” in Casarano (Lecce) Italy, and were subjected to an anamnestic investigation and then to a diagnostic test (Oral Glucose Tolerance Test, OGTT 75 g). The anamnesis has allowed to identify the type of risk factors that are present in the population, while the OGTT has allowed to diagnose gestational diabetes. Later, an analysis of the cross-collected data was performed in order to evaluate the percentage incidence of the disease, in relation to risk factors observed. The authors’ results confirmed a prevalence of GDM of 26.23% and the existence of a close association between risk factors and GDM. In particular, the risk factors, macrosomia, BMI = 25 kg/m2, a hypercaloric diet, light physical activity, and age = 35 years, seem to have more influence than smoking and family history for DM, inducing the onset of the illness.


Author(s):  
Julia Günther ◽  
Julia Hoffmann ◽  
Lynne Stecher ◽  
Monika Spies ◽  
Kristina Geyer ◽  
...  

Abstract Objectives We aimed to investigate the predictive potential of early pregnancy factors such as lifestyle, gestational weight gain (GWG) and mental well-being on gestational diabetes mellitus (GDM) beyond established risk factors. Methods GDM risk was investigated in the cohort of the German ‘Gesund leben in der Schwangerschaft’/healthy living in pregnancy study. Women were recruited up to the 12th week of gestation. GDM was diagnosed with a 75 g oral glucose tolerance test between the 24th and 28th weeks of gestation. Pre-pregnancy age and weight, mental health and lifestyle were assessed via questionnaires. Maternal weight was measured throughout pregnancy. Early excessive GWG was defined based on the guidelines of the Institute of Medicine. The association between several factors and the odds of developing GDM was assessed using multiple logistic regression analyses. Results Of 1694 included women, 10.8% developed GDM. The odds increased with pre-pregnancy BMI and age (women with obesity: 4.91, CI 3.35–7.19, p < 0.001; women aged 36–43 years: 2.84, CI 1.45–5.56, p = 0.002). Early excessive GWG, mental health and general lifestyle ratings were no significant risk factors. A 31% reduction in the odds of GDM was observed when <30% of energy was consumed from fat (OR 0.69, CI 0.49–0.96, p = 0.026). Vigorous physical activity tended to lower the odds without evidence of statistical significance (OR 0.59 per 10 MET-h/week, p = 0.076). Conclusions Maternal age and BMI stand out as the most important drivers of GDM. Early pregnancy factors like dietary fat content seem to be associated with GDM risk. Further evaluation is warranted before providing reliable recommendations.


2020 ◽  
Vol 10 (32) ◽  
pp. 248-258
Author(s):  
Kydja Milene Souza Torres de Araújo ◽  
Suelane Renata de Andrade Silva ◽  
Daniela De Aquino Freire ◽  
Isabella Joyce Silva de Almeida ◽  
Amanda Oliveira Bernardino Cavalcanti de Albuquerque ◽  
...  

O presente estudo objetiva identificar os fatores de risco para o desenvolvimento da depressão pós-parto. Trata-se de uma revisão integrativa com busca nas bases de dados: BDENF, LILACS e MEDLINE; utilizando os descritores Fatores de Risco e Depressão Pós-Parto. Foram avaliados 163 artigos, sendo incluídos no estudo 18 por atenderem aos critérios de inclusão. Predominaram estudos em inglês (77,8%), com abordagem quantitativa (100%) e realizados no Continente Asiático (33,3%). Diversos são os fatores de risco, dentre eles encontra-se o nível de HDL, a presença de diabetes gestacional, dentre outros fatores ginecológicos, sociodemográficos, familiares, clínicos e psicológicos. As evidências mostram que estes são fatores que perpassam o cotidiano dos profissionais de saúde independente da categoria que ocupam, entretanto, devido à sua dinâmica de trabalho ou até mesmo a falta de conhecimento, não há rastreio efetivo para este agravo.Descritores: Fatores de Risco, Depressão Pós-Parto, Enfermagem, Saúde Mental. Risk factors for post-delivery depression: literature reviewAbstract: The present study aims to identify the risk factors for the development of postpartum depression. It is an integrative review with a search in the databases: BDENF, LILACS and MEDLINE; using the keywords Risk Factors and Postpartum Depression. 163 articles were evaluated and 18 were included in the study because they met the inclusion criteria. Studies in English predominated (77.8%), with a quantitative approach (100%) and carried out in Asia (33.3%). There are several risk factors, among which is the level of HDL, the presence of gestational diabetes, among other gynecological, sociodemographic, family, clinical and psychological factors. Evidence shows that these are factors that permeate the daily lives of health professionals regardless of the category they occupy, however, due to their work dynamics or even the lack of knowledge, there is no effective screening for this condition.Descriptors: Risk factors, Depression, Postpartum, Nursing, Health Mental. Factores de riesgo de depresión  postparto: revisión de la literaturaResumen: El presente estudio tiene como objetivo identificar los factores de riesgo para el desarrollo de la depresión posparto. Es una revisión integradora con una búsqueda en las bases de datos: BDENF, LILACS y MEDLINE; utilizando las palabras clave Factores de riesgo y depresión posparto. Se evaluaron 163 artículos y 18 se incluyeron en el estudio porque cumplían los criterios de inclusión. Predominaron los estudios en inglés (77.8%), con un enfoque cuantitativo (100%) y realizados en Asia (33.3%). Existen varios factores de riesgo, entre los cuales se encuentra el nivel de HDL, la presencia de diabetes gestacional, entre otros factores ginecológicos, sociodemográficos, familiares, clínicos y psicológicos. La evidencia muestra que estos son factores que impregnan la vida cotidiana de los profesionales de la salud, independientemente de la categoría que ocupen, sin embargo, debido a su dinámica de trabajo o incluso a la falta de conocimiento, no existe una evaluación efectiva para esta afección.Descriptores: Factores de Riesgo, Depresión Posparto, Enfermería, Salud Mental.


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