The Burden of Hyperglycemia First Detected in Pregnancy Among Indonesian Women

Abstract OBJECTIVE: Despite improvements, Indonesian maternal health falls short of the Sustainable Development Goals. Using contemporary electronic healthcare records, this study explored the burden of Hyperglycemia First Detected in Pregnancy (HFDP) and its association with the determinants of maternal health in Indonesia. METHODS: Electronic Health Records data were extracted on high-risk pregnant women without pre-existing diabetes who were screened for HFDP between 2014 and 2015 at two West Sumatera hospitals. Screening consisted of an oral glucose tolerance test (OGTT), grouping women into Diabetes In Pregnancy (DIP, glucose 126 mg/dl), Gestational Diabetes Mellitus (GDM, glucose 92-125 mg/dl), or high-risk women without elevated glucose levels (glucose < 92 mg/dl); following the World Health Organization (WHO) standard. Maternal and neonatal outcomes, including mortality, were associated with the three diabetes statuses, using general and generalized linear models (depending on the type of outcome) adjusted for maternal age and parity. RESULT: 3536 pregnant women were screened, of which 722 (21%) had HFDP; 655 (19%) were classified as GDM and 67 (2%) as DIP. Women with HFDP did not have a significantly higher risk of death: OR 1.36 (95%-CI 0.71-2.62) for GDM and 0.90 (95%-CI 0.12-6.67) for DIP. We did observe a significantly lower neonatal death rate for children born of GDM women, with three deaths (1%) compared to 178 (6%) in high-risk normal FBG women (p-value < 0.01). This observation was not replicated when comparing DIP to normal FBG women (OR 0.58; 95%-CI 0.26-1.29). CONCLUSION: The observed lack of difference in pregnancy outcomes between HFDP and pregnant women with normal fasting blood glucose levels (at the time of screening) reflects the considerable residual risk of these women. Nevertheless, have and calls for closer monitoring of high-risk women irrespective of their OGTT results. Larger sample-sized studies are warranted to replicate findings with sufficient accuracy to detect possibly smaller, but meaningful differences.

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Management of Pregnant Women after Bariatric Surgery

Journal of Obesity ◽

10.1155/2018/4587064 ◽

2018 ◽

Vol 2018 ◽

pp. 1-14 ◽

Cited By ~ 15

Author(s):

Jürgen Harreiter ◽

Karin Schindler ◽

Dagmar Bancher-Todesca ◽

Christian Göbl ◽

Felix Langer ◽

...

Keyword(s):

Bariatric Surgery ◽

Pregnant Women ◽

Daily Intake ◽

Reproductive Age ◽

Nutritional Deficiencies ◽

Current Evidence ◽

Oral Glucose ◽

Effective Treatment Option ◽

Glucose Levels ◽

In Pregnancy

The prevalence of obesity is growing worldwide, and strategies to overcome this epidemic need to be developed urgently. Bariatric surgery is a very effective treatment option to reduce excess weight and often performed in women of reproductive age. Weight loss influences fertility positively and can resolve hormonal imbalance. So far, guidelines suggest conceiving after losing maximum weight and thus recommend conception at least 12–24 months after surgery. As limited data of these suggestions exist, further evidence is urgently needed as well for weight gain in pregnancy. Oral glucose tolerance tests for the diagnosis of gestational diabetes mellitus (GDM) should not be performed after bariatric procedures due to potential hypoglycaemic adverse events and high variability of glucose levels after glucose load. This challenges the utility of the usual diagnostic criteria for GDM in accurate prediction of complications. Furthermore, recommendations on essential nutrient supplementation in pregnancy and lactation in women after bariatric surgery are scarce. In addition, nutritional deficiencies or daily intake recommendations in pregnant women after bariatric surgery are not well investigated. This review summarizes current evidence, proposes clinical recommendations in pregnant women after bariatric surgery, and highlights areas of lack of evidence and the resulting urgent need for more clinical investigations.

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Limiting the Use of Oral Glucose Tolerance Tests to Screen for Hyperglycemia in Pregnancy during Pandemics

Journal of Clinical Medicine ◽

10.3390/jcm10030397 ◽

2021 ◽

Vol 10 (3) ◽

pp. 397

Author(s):

Charlotte Nachtergaele ◽

Eric Vicaut ◽

Sopio Tatulashvili ◽

Sara Pinto ◽

Hélène Bihan ◽

...

Keyword(s):

High Risk ◽

Glucose Tolerance ◽

False Negative ◽

Oral Glucose ◽

Oral Glucose Tolerance ◽

High Risk Women ◽

Oral Glucose Tolerance Tests ◽

History Of ◽

Glucose Tolerance Tests ◽

In Pregnancy

We aimed to evaluate each proposal of Australian–New Zealand Societies to limit the number of oral glucose tolerance tests (OGTTs) to diagnose hyperglycemia in pregnancy (HIP) during the coronavirus disease 2019 (COVID-19) pandemic. At our university hospital (2012–2016), we retrospectively applied in 4245 women who had OGTT between 22 and 30 weeks of gestation (reference standard: WHO criteria) the proposals in which OGTT is performed only in high-risk women; in all (Option 1) or high-risk (Option 1-Sel) women with fasting plasma glucose (FPG) 4.7–5.0 mmol/L; in all (Option 2) or high-risk (Option 2-Sel) women without history of HIP and with FPG 4.7–5.0 mmol/L. We also tested FPG measurement alone in all high-risk women. Measuring FPG alone had a sensitivity of 49% (95% confidence interval 45–54) applying universal screening. Option 2 appeared to have the best balance considering the needed OGTT (17.3%), sensitivity (72% (67–76)) and rates of a composite outcome (true negative cases: 10.6%, false positive cases: 24.4%; true positive cases: 19.5%; false negative cases: 10.2%). Consideration of a history of HIP and measuring first FPG can avoid more than 80% of OGTTs and identify women with the highest risk of adverse HIP-related events.

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Use of Oral Glucose Tolerance Testing and HbA1c At 6-14 Gestational Weeks to Predict Gestational Diabetes Mellitus In High-Risk Women

10.21203/rs.3.rs-1162930/v1 ◽

2021 ◽

Author(s):

Xiaoxiao Peng ◽

Mingyi Liu ◽

Jun Gang ◽

Ying Wang ◽

XiuHua Ma

Keyword(s):

Diabetes Mellitus ◽

Blood Glucose ◽

High Risk ◽

Glucose Tolerance ◽

Pregnant Women ◽

First Trimester ◽

Tolerance Test ◽

Oral Glucose ◽

Oral Glucose Tolerance ◽

High Risk Women

Abstract Objective:To study the prediction of gestational diabetes mellitus (GDM) in high-risk pregnant women by testing the 1-hour (1hPG) and 2-hour plasma glucose (2hPG) after an oral glucose tolerance test and the glycated hemoglobin (HbA1c) in early pregnancy (6-14 weeks).Methodology:We recruited 1311 pregnant women at high risk for diabetes from the Obstetrics Clinic of Daxing District People's Hospital between June 2017 and December 2019. Fasting blood glucose (FPG) and HbA1c were tested and a 75 g oral glucose tolerance test (OGTT) with 1-hour blood glucose (1hPG) and 2-hour blood glucose (2hPG) was performed during the first trimester of pregnancy. The women were seen at 24-28 weeks to follow-up for GDM. We calculated the receiver operating characteristic (ROC) and the area under the ROC curve (AUC) to determine the predictive values for early pregnancy FPG, 1hPG, 2hPG, and HbA1c for GDM in high-risk pregnant women.Results:The prevalence of pregestational diabetes mellitus among pregnant women at high risk of diabetes was 5.6%, and GDM was 24.7%. The AUCs for the predictive value of FPG, 1hPG, 2hPG, and HbA1c in high-risk pregnant women were 0.64, 0.76, 0.71, and 0.67, respectively. The AUC for 1hPG prediction of GDM in high-risk pregnant women is greater than FPG, 2hPG, and HbA1c. All differences were statistically significant.Conclusion:FPG, 1hPG, 2hPG, and HbA1c measured in the first trimester pregnancy of high-risk women are significant predictors of GDM. 1hPG was the most significant predictive value for GDM in high-risk pregnant women.

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Quantifying Pregnant Women’s Knowledge of Educational Components of Antenatal Care in Lesotho

Africa Journal of Nursing and Midwifery ◽

10.25159/2520-5293/4317 ◽

2019 ◽

Vol 21 (1) ◽

Author(s):

Tabeta Seeiso ◽

Mamutle M. Todd-Maja

Keyword(s):

Antenatal Care ◽

Maternal Mortality ◽

Pregnant Women ◽

Rural Areas ◽

Geographic Location ◽

Sub Saharan Africa ◽

World Health ◽

Cross Sectional ◽

Danger Signs ◽

In Pregnancy

Antenatal care (ANC) literacy is particularly important for pregnant women who need to make appropriate decisions for care during their pregnancy and childbirth. The link between inadequate health literacy on the educational components of ANC and maternal mortality in sub-Saharan Africa (SSA) is undisputable. Yet, little is known about the ANC literacy of pregnant women in SSA, with most studies inadequately assessing the four critical components of ANC literacy recommended by the World Health Organization, namely danger signs in pregnancy; true signs of labour; nutrition; and preparedness for childbirth. Lesotho, a country with one of the highest maternal mortality rates in SSA, is also underexplored in this research area. This cross-sectional study explored the levels of ANC literacy and the associated factors in 451 purposively sampled women in two districts in Lesotho using a structured questionnaire, making recourse to statistical principles. Overall, 16.4 per cent of the participants had grossly inadequate ANC literacy, while 79.8 per cent had marginal levels of such knowledge. The geographic location and level of education were the most significant predictors of ANC literacy, with the latter variable further subjected to post hoc margins test with the Bonferroni correction. The participants had the lowest scores on knowledge of danger signs in pregnancy and true signs of labour. Adequate ANC literacy is critical to reducing maternal mortality in Lesotho. Improving access to ANC education, particularly in rural areas, is recommended. This study also provides important recommendations critical to informing the national midwifery curriculum.

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Prevalence and factors associated with anemia in pregnancy among women receiving antenatal care at the West Gonja District Hospital of Northern Ghana.

Obstetrics Gynecology and Reproductive Sciences ◽

10.31579/2578-8965/042 ◽

2020 ◽

Vol 4 (3) ◽

pp. 01-12

Author(s):

Martin Malick

Keyword(s):

Antenatal Care ◽

Pregnant Women ◽

Hemoglobin Concentration ◽

World Health ◽

Multiple Gestation ◽

The West ◽

Factors Associated ◽

Folate Supplement ◽

Anemia In Pregnancy ◽

In Pregnancy

Background: Anemia in pregnancy is a major public health problem especially in Low and Middle-income countries (LMIC) including Ghana and is defined by the World Health Organization (WHO) as being present when the hemoglobin concentration in the peripheral blood is 11g/dl or less. In most African countries anemia in pregnancy occurs if the hemoglobin concentration falls below 10g/dl. Pregnant women are at a higher risk of developing anemia due to several factors such as hemodilution, nutritional factors, multiple gestation, socio-economic status and malaria infestation. Anemia in pregnancy is an important cause of maternal mortality and affects half of pregnant women worldwide; with 56% of West African pregnant women being anemic. The objective of this study is to assess the prevalence and identify the risk factors associated with anemia among pregnant women receiving antenatal care at the West Gonja Hospital (WGH) Methods: A cross-sectional was conducted with 136 pregnant women receiving antenatal care at the WGH between January 2017 to February 2018. Random sampling was used to select participants and data was collected using a structured questionnaire. Data was analyzed using the SPSS Version 24.0. Results: A total 71(52.2%) of the study population were anemic, while 65 (47.8%) were not anemic. 20(74.1%) of the 27 pregnant housewives were anemic, while 11(64.7%) of the pregnant farmers were anemic. 27 (96.4%) of the 28 pregnant women who took their iron/folate supplement only some few days were anemic. 12 (100%) of the 12 participants who took their iron/folate supplement a few times a week were anemic. 4 (80%) of the 5 participants who never took their iron/folate supplement were anemic. 21 (70%) of those who did not sleep under ITN were anemic. 33 (84.6%) of the 39 patients who were diagnosed with malaria were also anemic. 28 (87.5%) of the 32 participants who took only 2 meals a day were anemic. 27 (79.4%) of the 34 patients who took liver, beef, chicken and fish only twice weekly were anemic. 15 (88.2%) of the 17 patients who drank tea some days in a week were anemic. Conclusion: Although most of the pregnant women were adequately educated on the most relevant aspects of anemia in pregnancy, more than half of them were still anemic. Anemia was more prevalent among pregnant uneducated housewives with poor nutritional habits. All the pregnant sickle cell disease patients as well as those diagnosed with malaria were also anemic.

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Hyperglycemia at 1h-OGTT in Pregnancy: A Reliable Predictor of Metabolic Outcomes?

Frontiers in Endocrinology ◽

10.3389/fendo.2021.612829 ◽

2021 ◽

Vol 12 ◽

Author(s):

Elena Succurro ◽

Federica Fraticelli ◽

Marica Franzago ◽

Teresa Vanessa Fiorentino ◽

Francesco Andreozzi ◽

...

Keyword(s):

High Risk ◽

Independent Predictor ◽

Perinatal Outcomes ◽

Tolerance Test ◽

Oral Glucose ◽

Cell Dysfunction ◽

Metabolic Outcomes ◽

Impaired Insulin ◽

In Pregnancy

Gestational diabetes mellitus (GDM) is associated with a high risk of developing type 2 diabetes (T2DM) and cardiovascular disease (CVD). Identifying among GDM women those who are at high risk may help prevent T2DM and, possibly CVD. Several studies have shown that in women with GDM, hyperglycemia at 1 h during an oral glucose tolerance test (OGTT) (1-h PG) is not only associated with an increase in adverse maternal and perinatal outcomes but is also an independent predictor of T2DM. Interestingly, also in pregnant women who did not meet the criteria for a GDM diagnosis, 1-h PG was an independent predictor of postpartum impaired insulin sensitivity and beta-cell dysfunction. Moreover, maternal 1- and 2-h PG levels have been found to be independently associated with insulin resistance and impaired insulin secretion also during childhood. There is evidence that hyperglycemia at 1h PG during pregnancy may identify women at high risk of future CVD, due to its association with an unfavorable CV risk profile, inflammation, arterial stiffness and endothelial dysfunction. Overall, hyperglycemia at 1h during an OGTT in pregnancy may be a valuable prediction tool for identifying women at a high risk of future T2DM, who may then benefit from therapeutic strategies aimed at preventing cardiovascular outcomes.

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Prediabetes, undiagnosed diabetes and diabetes risk in Italy in 2017–2018: results from the first National screening campaign in community pharmacies

Journal of Public Health ◽

10.1093/pubmed/fdab046 ◽

2021 ◽

Author(s):

P Brunetti ◽

L Baldessin ◽

S Pagliacci

Keyword(s):

High Risk ◽

Diabetes Risk ◽

World Health ◽

Undiagnosed Diabetes ◽

Community Pharmacies ◽

Glucose Levels ◽

Blood Glucose Levels ◽

Health Organization ◽

Very High

Abstract Background Effective policies for diabetes prevention remain urgent. We conducted a mass screening campaign in Italy to identify subjects potentially having undiagnosed diabetes, prediabetes or at diabetes risk. Methods This cohort study was conducted in community pharmacies joining the unitary National federation of pharmacy holders (Federfarma) and participating in the 7-day screening campaign ‘DiaDay’ in 2017–2018. Capillary blood glucose levels and the risk of developing diabetes in 10 years (through the Finnish Diabetes Risk Score) were assessed. Results 145 651 volunteers aged ≥20 years without known diabetes were screened at 5671 community pharmacies in 2017 and 116 097 at 5112 in 2018. Overall, 3.6% had glucose values suggestive of undiagnosed diabetes; under fasting conditions (N = 94 076), 39.9% and 16.4% had values suggestive of prediabetes by the American Diabetes Association and the World Health Organization criteria, respectively. Of those without diabetes (N = 252 440), 19.2% had scores compatible with a high risk (1:3) and 2.7% with a very high risk (1:2) of developing the disease; in the prediabetes group, the risk rose with higher impaired fasting glucose values. Conclusions DiaDay, the first National screening campaign, highlights the need to screen the population and the key role of the pharmacist both in screening activities and education promotion.

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The islet-expressed Lhx1 transcription factor interacts with Islet-1 and contributes to glucose homeostasis

AJP Endocrinology and Metabolism ◽

10.1152/ajpendo.00235.2018 ◽

2019 ◽

Vol 316 (3) ◽

pp. E397-E409

Author(s):

Maigen Bethea ◽

Yanping Liu ◽

Alexa K. Wade ◽

Rachel Mullen ◽

Rajesh Gupta ◽

...

Keyword(s):

Transcription Factor ◽

Glucose Homeostasis ◽

Target Genes ◽

Fasting Blood Glucose ◽

Oral Glucose ◽

Β Cell ◽

Knockout Mouse Model ◽

Glucose Levels ◽

Cell Extracts ◽

Islet 1

The LIM-homeodomain (LIM-HD) transcription factor Islet-1 (Isl1) interacts with the LIM domain-binding protein 1 (Ldb1) coregulator to control expression of key pancreatic β-cell genes. However, Ldb1 also has Isl1-independent effects, supporting that another LIM-HD factor interacts with Ldb1 to impact β-cell development and/or function. LIM homeobox 1 (Lhx1) is an Isl1-related LIM-HD transcription factor that appears to be expressed in the developing mouse pancreas and in adult islets. However, roles for this factor in the pancreas are unknown. This study aimed to determine Lhx1 interactions and elucidate gene regulatory and physiological roles in the pancreas. Co-immunoprecipitation using β-cell extracts demonstrated an interaction between Lhx1 and Isl1, and thus we hypothesized that Lhx1 and Isl1 regulate similar target genes. To test this, we employed siRNA-mediated Lhx1 knockdown in β-cell lines and discovered reduced Glp1R mRNA. Chromatin immunoprecipitation revealed Lhx1 occupancy at a domain also known to be occupied by Isl1 and Ldb1. Through development of a pancreas-wide knockout mouse model ( Lhx1∆Panc), we demonstrate that aged Lhx1∆Panc mice have elevated fasting blood glucose levels, altered intraperitoneal and oral glucose tolerance, and significantly upregulated glucagon, somatostatin, pancreatic polypeptide, MafB, and Arx islet mRNAs. Additionally, Lhx1∆Panc mice exhibit significantly reduced Glp1R, an mRNA encoding the insulinotropic receptor for glucagon-like peptide 1 along with a concomitant dampened Glp1 response and mild glucose intolerance in mice challenged with oral glucose. These data are the first to reveal that the Lhx1 transcription factor contributes to normal glucose homeostasis and Glp1 responses.

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The Role of Untimed Blood Glucose in Screening for Gestational Diabetes Mellitus in a High Prevalent Diabetic Population

Scientifica ◽

10.1155/2016/3984024 ◽

2016 ◽

Vol 2016 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Sarah Cuschieri ◽

Johann Craus ◽

Charles Savona-Ventura

Keyword(s):

Blood Glucose ◽

Gestational Diabetes ◽

Pregnant Women ◽

Fasting Blood Glucose ◽

Diabetes Type 2 ◽

Obstetric Outcomes ◽

Oral Glucose ◽

Stepwise Logistic Regression ◽

Operating Characteristics ◽

Screening Protocol

Global prevalence increase of diabetes type 2 and gestational diabetes (GDM) has led to increased awareness and screening of pregnant women for GDM. Ideally screening for GDM should be done by an oral glucose tolerance test (oGTT), which is laborious and time consuming. A randomized glucose test incorporated with anthropomorphic characteristics may be an appropriate cost-effective combined clinical and biochemical screening protocol for clinical practice as well as cutting down on oGTTs. A retrospective observational study was performed on a randomized sample of pregnant women who required an OGTT during their pregnancy. Biochemical and anthropomorphic data along with obstetric outcomes were statistically analyzed. Backward stepwise logistic regression and receiver operating characteristics curves were used to obtain a suitable predictor for GDM without an oGTT and formulate a screening protocol. Significant GDM predictive variables were fasting blood glucose (p=0.0001) and random blood glucose (p=0.012). Different RBG and FBG cutoff points with anthropomorphic characteristics were compared to carbohydrate metabolic status to diagnose GDM without oGTT, leading to a screening protocol. A screening protocol incorporating IADPSG diagnostic criteria, BMI, and different RBG and FBG criteria would help predict GDM among high-risk populations earlier and reduce the need for oGTT test.

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Effect of Probiotics on the Glucose Levels of Pregnant Women: A Meta-Analysis of Randomized Controlled Trials

Medicina ◽

10.3390/medicina54050077 ◽

2018 ◽

Vol 54 (5) ◽

pp. 77 ◽

Cited By ~ 6

Author(s):

Tzu-Rong Peng ◽

Ta-Wei Wu ◽

You-Chen Chao

Keyword(s):

Blood Glucose ◽

Randomized Controlled Trials ◽

Pregnant Women ◽

Cell Function ◽

Fasting Blood Glucose ◽

Controlled Trials ◽

Model Assessment ◽

Glucose Levels ◽

Randomized Controlled ◽

Blood Glucose Levels

Background: Gestational diabetes mellitus (GDM) is a condition, in which women develop high blood sugar levels during pregnancy without having diabetes. Evidence on the effects of probiotics on the blood glucose levels of women with GDM is inconsistent. Objective: The present study aimed to investigate the effects of probiotics on the blood glucose levels of pregnant women. Methods: Online databases, such as PubMed, Cochrane, and Excerpta Medica Database (EMBASE) were searched for randomized controlled trials (RCTs) published before July 2018. Trials had to meet the inclusion criteria of our study. Methodological quality and risk bias were independently assessed by two reviewers. Data were pooled using a random effects model and were expressed as the mean difference (MD) and 95% confidence interval (CI). Heterogeneity was evaluated and quantified as I2. Results: In total, 12 RCTs were included in this study. Studies have shown that the use of probiotics significantly reduced the fasting blood glucose (FBG) level (MD: −0.10 mmol/L; 95% CI: −0.19, −0.02), insulin concentration (MD: −2.24 μIU/mL; 95% CI: −3.69, −0.79), Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) score (MD: −0.47; 95% CI: −0.74, −0.21), and Homeostasis model of assessment-estimated β cell function (HOMA-B) score (MD: −20.23; 95% CI: −31.98, −8.49) of pregnant women. In a subgroup analysis, whether the blood glucose-lowering effect of probiotics influenced the diagnosis of pregnant women with GDM was assessed. The results showed that probiotics had significantly reduced the fasting blood glucose (FBG) level (MD: −0.10 mmol/L; 95% CI: −0.17, −0.04) and HOMA-IR score (MD: −0.37; 95% CI: −0.72, −0.02) of pregnant women who were not diagnosed with GDM. Conclusion: Probiotics reduce the blood glucose level of pregnant women, especially without GDM diagnosis. However, further research using RCTs must be conducted to validate the results of the present study.

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