scholarly journals Application of a national administrative case definition for the identification of pre-existing diabetes mellitus in pregnancy

2012 ◽  
Vol 32 (3) ◽  
pp. 113-120 ◽  
Author(s):  
V.M. Allen ◽  
L. Dodds ◽  
A. Spencer ◽  
E.A. Cummings ◽  
N. MacDonald ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Nova Scotia ◽  
Pregnant Women ◽  
Administrative Data ◽  
Case Definition ◽  
Reference Standard ◽  
Standard Definition ◽  
Definition Of ◽  
In Pregnancy ◽  
Perinatal Database

Introduction Accurate ascertainment of pregnant women with pre-existing diabetes allows for the comprehensive surveillance of maternal and neonatal outcomes associated with this chronic disease. Methods To determine the accuracy of case definitions for pre-existing diabetes mellitus when applied to a pregnant population, a cohort of women who were pregnant in Nova Scotia, Canada, between 1991 and 2003 was obtained from a population-based provincial perinatal database, the Nova Scotia Atlee Perinatal Database (NSAPD). Person-level data from administrative databases using hospital discharge abstract data and outpatient physician services data were linked to this cohort. Various algorithms for defining diabetes mellitus from the administrative data, including the algorithm suggested by the National Diabetes Surveillance System (NDSS), were compared to a reference standard definition from the NSAPD. Results Validation of the NDSS case definition applied to this pregnant population demonstrated a sensitivity of 87% and a positive predictive value (PPV) of 66.4%. Use of ICD-9 and ICD-10 diagnostic codes among hospitalizations with diabetes mellitus in pregnancy showed important increases in sensitivity and PPV, especially for those pregnancies delivered in tertiary centres. In this population, pregnancy-related administrative data from the hospitalization database alone appear to be a more accurate data source for identifying pre-existing diabetes than applying the NDSS case definition, particularly when pregnant women are delivered in a tertiary hospital. Conclusion Although the NDSS definition of diabetes performs reasonably well compared to a reference standard definition of diabetes, using this definition for evaluating maternal and perinatal outcomes associated with diabetes in pregnancy will result in a certain degree of misclassification and, therefore, biased estimates of outcomes.

scholarly journals Zika virus infection in pregnancy: Establishing a case definition for clinical research on pregnant women with rash in an active transmission setting

2019 ◽  
Vol 13 (10) ◽  
pp. e0007763 ◽  
Author(s):  
Ricardo Arraes de Alencar Ximenes ◽  
Demócrito de Barros Miranda-Filho ◽  
Elizabeth B. Brickley ◽  
Ulisses Ramos Montarroyos ◽  
Celina Maria Turchi Martelli ◽  
...  
Keyword(s):  
Virus Infection ◽  
Clinical Research ◽  
Pregnant Women ◽  
Zika Virus ◽  
Case Definition ◽  
Transmission Setting ◽  
Zika Virus Infection ◽  
In Pregnancy

Modern concepts of tactics delivery of pregnant women with gestational diabetes mellitus

2014 ◽  
Vol 63 (4) ◽  
pp. 4-16
Author(s):  
Roman Viktorovich Kapustin ◽  
Olga Nikolayevna Arzhanova ◽  
Olesya Nikolayevna Bespalova ◽  
Tatyana Georgiyevna Kovaleva
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Pregnant Women ◽  
Current Literature ◽  
Mode Of Delivery ◽  
Modern Medicine ◽  
Important Task ◽  
Definition Of

The article presents the current literature devoted to the problem of delivery of pregnant women with gestational diabetes mellitus (GDM). Analyzed issues related to the definition of the optim-al timing and mode of delivery of women with GDM. On the basis of these data revealed that the principles of tactics and delivery of pregnant women with GDM worldwide ambiguous and require further research. Thus, the development of common standards for best tactics, methods and timing of delivery of pregnant women with gestational diabetes mellitus is a challenging and important task for modern medicine and requires further investigation.

scholarly journals Diabetes in Pregnancy and Risk of Antepartum Depression: A Systematic Review and Meta-Analysis of Cohort Studies

2020 ◽  
Vol 17 (11) ◽  
pp. 3767 ◽  
Author(s):  
Kai Wei Lee ◽  
Siew Mooi Ching ◽  
Navin Kumar Devaraj ◽  
Seng Choi Chong ◽  
Sook Yee Lim ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Cohort Studies ◽  
Pregnant Women ◽  
Meta Analysis ◽  
Diabetes In Pregnancy ◽  
Antepartum Depression ◽  
Increased Risk ◽  
In Pregnancy

Previous literature has reported that patients with diabetes in pregnancy (DIP) are at risk of developing antepartum depression but the results have been inconsistent in cohort studies. We conducted a systematic review and performed a meta-analysis to quantify the association between DIP and risk of antepartum depression in cohort studies. Medline, Cinahl, and PubMed databases were searched for studies investigating DIP involving pregnant women with pre-existing diabetes and gestational diabetes mellitus and their risk of antepartum depression that were published in journals from inception to 27 December 2019. We derived the summary estimates using a random-effects model and reported the findings as pooled relative risks (RR) and confidence interval (CI). Publication bias was assessed using a funnel plot and was quantified by Egger and Begg’s tests. Ten studies, involving 71,036 pregnant women were included in this meta-analysis. The pooled RR to develop antepartum depression was (RR = 1.430, 95% CI: 1.251–1.636) among women with gestational diabetes mellitus. Combining pregnant women with pre-existing diabetes mellitus and gestational diabetes mellitus, they had a significant increased risk of developing antepartum depression (RR = 1.431, 95% CI: 1.205–1.699) compared with those without it. In comparison, we found no association between pre-existing diabetes mellitus in pregnancy (RR = 1.300, 95% CI: 0.736–2.297) and the risk of developing antepartum depression. This study has a few limitations: first, different questionnaire and cut-off points were used in evaluation of depression across the studies. Second, there was a lack of data on history of depression prior to pregnancy, which lead to confounding bias that could not be solved by this meta-analysis. Third, data were dominated by studies in Western countries; this is due to the studies from Eastern countries failing to meet our inclusion criteria for statistical analysis. Women with gestational diabetes mellitus have an increased risk of developing antepartum depression compared to those without the disease. Therefore, more attention on the mental health status should be given on pregnant women diagnosed with pre-existing diabetes mellitus and gestational diabetes mellitus.

scholarly journals Validation of a case definition for depression in administrative data against primary chart data as a reference standard

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Chelsea Doktorchik ◽  
Scott Patten ◽  
Cathy Eastwood ◽  
Mingkai Peng ◽  
Guanmin Chen ◽  
...  
Keyword(s):  
Administrative Data ◽  
Case Definition ◽  
Reference Standard

scholarly journals Establishing the Incidence and Prevalence of Multiple Sclerosis in Saskatchewan

2018 ◽  
Vol 45 (3) ◽  
pp. 295-303 ◽  
Author(s):  
Lina H. Al-Sakran ◽  
Ruth Ann Marrie ◽  
David F. Blackburn ◽  
Katherine B. Knox ◽  
Charity D. Evans
Keyword(s):  
Multiple Sclerosis ◽  
Administrative Data ◽  
Predictive Value ◽  
Disease Surveillance ◽  
Population Based ◽  
Case Definition ◽  
Case Definitions ◽  
Health Administrative Data ◽  
Disease Surveillance System ◽  
Definition Of

AbstractObjective: To validate a case definition of multiple sclerosis (MS) using health administrative data and to provide the first province-wide estimates of MS incidence and prevalence for Saskatchewan, Canada. Methods: We used population-based health administrative data between January 1, 1996 and December 31, 2015 to identify individuals with MS using two potential case definitions: (1) ≥3 hospital, physician, or prescription claims (Marrie definition); (2) ≥1 hospitalization or ≥5 physician claims within 2 years (Canadian Chronic Disease Surveillance System [CCDSS] definition). We validated the case definitions using diagnoses from medical records (n=400) as the gold standard. Results: The Marrie definition had a sensitivity of 99.5% (95% confidence interval [CI] 92.3-99.2), specificity of 98.5% (95% CI 97.3-100.0), positive predictive value (PPV) of 99.5% (95% CI 97.2-100.0), and negative predictive value (NPV) of 97.5% (95% CI 94.4-99.2). The CCDSS definition had a sensitivity of 91.0% (95% CI 81.2-94.6), specificity of 99.0% (95% CI 96.4-99.9), PPV of 98.9% (95% CI 96.1-99.9), and NPV of 91.7% (95% CI 87.2-95.0). Using the more sensitive Marrie definition, the average annual adjusted incidence per 100,000 between 2001 and 2013 was 16.5 (95% CI 15.8-17.2), and the age- and sex-standardized prevalence of MS in Saskatchewan in 2013 was 313.6 per 100,000 (95% CI 303.0-324.3). Over the study period, incidence remained stable while prevalence increased slightly. Conclusion: We confirm Saskatchewan has one of the highest rates of MS in the world. Similar to other regions in Canada, incidence has remained stable while prevalence has gradually increased.

scholarly journals Hemostasis in pregnant women with gestational diabetes mellitus

2013 ◽  
Vol 62 (2) ◽  
pp. 101-109
Author(s):  
Roman Viktorovich Kapustin ◽  
Olga Nikolayevna Arzhanova ◽  
Tatyana Nikolayevna Shlyakhtenko ◽  
Tatyana Ivanovna Oparina ◽  
Yevgeniy Konstantinovich Komarov
Keyword(s):  
Diabetes Mellitus ◽  
Venous Thromboembolism ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Pregnant Women ◽  
Carbohydrate Metabolism ◽  
Important Predictor ◽  
Hemostatic Disorders ◽  
Increased Activity ◽  
In Pregnancy

Been analyzed and studied the characteristics of hemostasis in pregnant women with gestational diabetes mellitus. Found that for women with disorders of carbohydrate metabolism characte-rized by increased activity of procoagulant, vascular-platelet hemostasis, and decreased activity of fibrinolityc system. It is shown that the violations of the haemostatic system is directly dependent on the degree of compensation of carbohydrate metabolism and require adequate correction of glycemia. Thus, GDM is an important predictor of hemostatic disorders and possible venous thromboembolism in pregnancy.

scholarly journals The hemostatic parameters in pregnant women with different types of diabetes mellitus

2021 ◽  
Vol 24 (3) ◽  
pp. 251-261
Author(s):  
R. V. Kapustin ◽  
E. V. Kopteeva ◽  
O. N. Arzhanova ◽  
A. V. Tiselko ◽  
N. Е. Androsova ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Pregnant Women ◽  
Von Willebrand Factor ◽  
Antithrombin Iii ◽  
Correction Method ◽  
Diabetic Pregnancy ◽  
Von Willebrand ◽  
Willebrand Factor ◽  
D Dimer ◽  
In Pregnancy

BACKGROUND: The prevalence of diabetes mellitus (DM) in pregnancy is on the rise. Despite that gestational hypercoagulability is a physiological condition, diabetic pregnancy is associated with a high risk of venous thromboembolic complications (VTEC). There are many surveys related to the hemostatic parameters in non-pregnant women, but studies in pregnant women are not enough.AIMS: To assess the coagulation and vascular-platelet hemostasis parameters in pregnant women with various types of diabetes mellitus, taking into account its correction method. The data were compared with these indicators in women with preeclampsia and healthy pregnant women at the same gestational age.MATERIALS AND METHODS: An observational, single-center, retrospective cohort study was carried out at D.O. Ott ­Research Institute of Obstetrics, Gynecology, and Reproductive Medicine. The study included 1994 pregnant women who presented several groups taking into account the type of DM and its correction method, a group of women with preeclampsia (PE), and healthy women. The analysis of clinical data was carried out at 28–32 gestational weeks from 2012 to 2017. The study’s primary endpoint was taken as indicators of fibrinogen content, prothrombin index, thrombin time, activated partial thromboplastin time (APTT), and international normalized ratio (INR) antithrombin III, D-dimer, von Willebrand factor, and fibronectin. Additionally, the incidence of VTEC during pregnancy and within six weeks after delivery, gestational arterial hypertension, preeclampsia, fetal growth restriction, premature birth, and stillbirth cases was assessed.RESULTS: in pregnant women with various types of diabetes mellitus and preeclampsia, a state of pathological hypercoagulation was observed compared to the control group. These changes were characterized by an increase and activation of the following blood parameters: fibrinogen, the degree and rate of platelet aggregation, D-dimer, homocysteine, von Willebrand factor, and fibronectin. At the same time, the content of antithrombin III was significantly reduced in patients with DM. Correlation analysis established a direct relationship between the range of the studied factors with the degree of glycemic control and the frequency of obstetric complications.CONCLUSIONS: Diabetes mellitus in pregnancy is associated with a hypercoagulation condition and overexpression in the synthesis of endothelial dysfunction markers. Moreover, the severity of these processes depends on the type of DM and the severity of metabolic disorders. In diabetic pregnancy, exceptional attention to coagulation indicators, regular monitoring, and preventive treatment is required in order to improve the perinatal outcomes.

scholarly journals Participation in a randomised controlled trial (RCT) of metformin in gestational diabetes mellitus (GDM): pregnant women’s perceptions and experiences of the decision-making process

2021 ◽  
Vol 4 ◽  
pp. 65
Author(s):  
Sinead Wallace ◽  
Catherine Houghton ◽  
Fidelma Dunne
Keyword(s):  
Diabetes Mellitus ◽  
Clinical Trial ◽  
Decision Making ◽  
Clinical Trials ◽  
Gestational Diabetes ◽  
Pregnant Women ◽  
Controlled Trial ◽  
Decision Making Process ◽  
Randomised Controlled ◽  
In Pregnancy

Background: Research in pregnancy and childbirth is required to advance healthcare needs for this population. Fears around potential fetal risk and the history of drug scandals renders it an area of research that is somewhat neglected. Due to the growing medical complexities facing pregnant women, efforts have been made in recent times to recognise the ethical importance of including this population in clinical research. Although clinical trials are becoming more common in pregnancy, recruitment of this population remains difficult with a common assumption that pregnant women would be reluctant to participate in clinical trials. This study set out to explore pregnant women’s perspectives and experiences of the decision-making process to participate in a randomised controlled trial of metformin in gestational diabetes mellitus (the EMERGE clinical trial). Methods: This study employed a qualitative descriptive design with thematic analysis. Data were collected by conducting individual semi-structured interviews (n=11) with participants (n=9) and decliners (n=2) of the EMERGE clinical trial.  Results: The main findings reveal that a significant perception of personal benefit from participation was the biggest influence on women’s decisions to participate. Concerns about the impact of gestational diabetes on their pregnancies, the option of a favourable intervention treatment, a low perception of risk associated with the trial and the opportunity to help medical research appeared to have significantly influenced their decision. Receiving detailed information, personal interactions with the study team, a perception of voluntariness in participation and accessibility of the trial positively impacted on women’s decisions to participate.  Conclusions: Personal contact during recruitment, presenting clear and thorough trial information, providing previous participant testimonials, and facilitating women to participate in clinical trials are all important strategies when trying to enhance recruitment in pregnancy trials. Further research on pregnant women declining participation in clinical trials is needed.

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