scholarly journals Management of Blood Sugar Degrees in Hyperglycemia in Pregnancy (Hip) Reduces Perinatal, Infant Morbidity & Mortality as a Result of a Large Prospective Cohort Learn From Up, India

2018 ◽  
Vol 3 (4) ◽  
Keyword(s):  
Public Health ◽  
Gestational Diabetes ◽  
Pregnant Women ◽  
Blood Sugar ◽  
Neonatal Mortality ◽  
Perinatal Mortality ◽  
National Health ◽  
Uttar Pradesh ◽  
Sugar Levels ◽  
In Pregnancy

Background: Gestational diabetes mellitus (GDM) is a glucose intolerance that occurs or is identified for the first time all through pregnancy. Perinatal & Neonatal morbidity mortality is significant in pregnant women in GDM with extra hazard of growing diabetes later in life. Uttar Pradesh is a largest state of India with one of the highest rate of the infant as well as maternal mortality which might be, at least partially due to GDM. Thus, Careful evaluation, administration & Training of HCPs for GDM can improve the outcomes in National health Mission supported Govt funded Program, supported by World Diabetes foundation, Denmark. Aims & Objectives: Primary objective of this study to be determine the Maternal-Fetal outcomes of GDM and management of Hyperglycemia in Pregnancy HIP reduces Neonatal & Perinatal Mortality as per the NHM, GOI Guidelines for GDM, As this will go long way help us in reduction of Perinatal & infant mortality. Thus, this study was once undertaken to recognize the extent of the burden on the healthcare and formulating further policy for Implementation of Gestational Diabetes Program in the largest state of Uttar Pradesh. Materials and Methods: A prospective cohort study was done for 2 year from October 1, 2016, to September 31, 2018, at 828 GDM screening units as a part of the Gestational Diabetes Prevention and Control Project, Uttar Pradesh approved by the Indian Government in the state of Uttar Pradesh, India, largest state with second Highest MMR & IMR, A total of 515,532 pregnant women were screened during their 16–32th weeks of pregnancy by impaired oral glucose test (OGTT) as per NHM Guidelines for GDM, 12784 GDM & 7287 Non GDM maternal and perinatal outcomes were followed up in both GDM and non‑GDM categories in the 2 year (2016-2018) after blood sugar management (September 2016-October 2018) was executed at 828 (DHs, CHCs & PHCs healthcare) facilities, 515532 Pregnant Women have been screened at 16-20 Weeks & 24th-28 weeks of pregnancy as per Guidelines of National health Mission, GOI Guideline. Results: Perinatal mortality increased significantly from 2.6% to 9.1% when blood sugar levels increased from 120 mg/dl to 199 mg/dl and above. Perinatal mortality in GDM cases were significantly to the control of blood sugar levels (P < 0.0001). Relative Risk of Stillbirth, Perinatal & neonatal mortality have been respectively 2.5, 2.3 & 2.5 times greater in GDM compare Non GDM (Table 1). Most of the GDM used to be identified in primigravida (52%). It was also found in our study those GDM who were strictly controlled with Hyperglycemia in pregnancy (HIP) to <120 mg/dl, Post Prandial blood sugar, have lowest risk for perinatal and neonatal mortality compare to those GDM pregnant women Blood sugars were not controlled, Risk for Perinatal mortality increases steadily and reaches 9.1% beyond blood sugar> 200 mg/dl. Conclusion: All the Pregnant women need screening in Public health facilities & Implementation of National health Mission, GOI Guidelines for GDM has to be followed to improve outcome for Mother and Newborn, As the lack of information about GDM amongst pregnant women is high, to decrease the risk, increase awareness & full Implementation of NHM GDM Guidelines is key to Perinatal and neonatal mortality reduction in Public health care facilities where large number of ANC visit for Maternal and fetal health care.

Diet Control in Pregnant Women with Gestational Diabetes Mellitus

2019 ◽  
Vol 15 (4) ◽  
pp. 245-250
Author(s):  
Piyaporn Sitkulanan ◽  
Natthananporn Sanguanklin ◽  
Sirikhwan Pomjumpa
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Pregnant Women ◽  
Blood Sugar ◽  
Type Ii Diabetes Mellitus ◽  
Negative Consequences ◽  
Normal Range ◽  
Diet Control ◽  
Sugar Levels

Background: The incidence of diabetes mellitus has significantly increased in the last two decades. Gestational diabetes mellitus, GDM, is a complication that affects both pregnant women and newborn babies. Pregnant women that are diagnosed with GDM are 7 times more likely to be diagnosed with type II diabetes mellitus. In addition, infants born by GDM mothers are at higher risk of developing diabetes mellitus in the future. Objective: The study aims to review the literature on the diet control in pregnant women with gestational diabetes mellitus. Results: Controlling blood sugar within the normal range during pregnancy can decrease negative pregnancy outcomes. However, most pregnant women with GDM cannot control their blood sugar within the normal range because of a lack of knowledge and skill in selecting appropriate foods. They also often experience inconsistency in their diet control behavior Most pregnant women worry about gaining too much weight, and most pregnant women with GDM have to learn how to choose their food properly in terms of both nutrients and quantity in order to control their blood sugar levels within the normal range. Conclusion: Diet control during pregnancy is one way to prevent the negative consequences of GDM for both mothers and infants. The food proportion for pregnant women with gestational diabetes is CHO: PRO: FAT = 50: 20:30 and also to consume an appropriate amount of vitamins and minerals and water each day.

scholarly journals The consequences of obesity and excess weight gain in pregnancy

2011 ◽  
Vol 70 (4) ◽  
pp. 450-456 ◽  
Author(s):  
Jane E. Norman ◽  
Rebecca Reynolds
Keyword(s):  
Insulin Resistance ◽  
Weight Gain ◽  
Gestational Diabetes ◽  
Pregnant Women ◽  
Postpartum Haemorrhage ◽  
Maternal Obesity ◽  
Adverse Pregnancy Outcome ◽  
Operative Delivery ◽  
Adverse Pregnancy ◽  
In Pregnancy

The prevalence of obesity in pregnancy is rising exponentially; about 15–20% of pregnant women now enter pregnancy with a BMI which would define them as obese. This paper provides a review of the strong links between obesity and adverse pregnancy outcome which operate across a range of pregnancy complications. For example, obesity is associated with an increased risk of maternal mortality, gestational diabetes mellitus, thromboembolism, pre-eclampsia and postpartum haemorrhage. Obesity also complicates operative delivery; it makes operative delivery more difficult, increases complications and paradoxically increases the need for operative delivery. The risk of the majority of these complications is amplified by excess weight gain in pregnancy and increases in proportion to the degree of obesity, for example, women with extreme obesity have OR of 7·89 for gestational diabetes and 3·84 for postpartum haemorrhage compared to their lean counterparts. The consequences of maternal obesity do not stop once the baby is born. Maternal obesity programmes a variety of long-term adverse outcomes, including obesity in the offspring at adulthood. Such an effect is mediated at least in part via high birthweight; a recent study has suggested that the odds of adult obesity are two-fold greater in babies weighing more than 4 kg at birth. The mechanism by which obesity causes adverse pregnancy outcome is uncertain. This paper reviews the emerging evidence that hyperglycaemia and insulin resistance may both play a role: the links between hyperglycaemia in pregnancy and both increased birthweight and insulin resistance have been demonstrated in two large studies. Lastly, we discuss the nature and rationale for possible intervention strategies in obese pregnant women.

scholarly journals Prevalence and aetiologies of anaemia among first trimester pregnant women in Sri Lanka; the need for revisiting the current control strategies

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Gayani Shashikala Amarasinghe ◽  
Thilini Chanchala Agampodi ◽  
Vasana Mendis ◽  
Krishanthi Malawanage ◽  
Chamila Kappagoda ◽  
...  
Keyword(s):  
Public Health ◽  
Iron Deficiency ◽  
Pregnant Women ◽  
Blood Count ◽  
First Trimester ◽  
Full Blood Count ◽  
Red Cell ◽  
Middle Income ◽  
Anaemia In Pregnancy ◽  
In Pregnancy

Abstract Background The Sustainable development goals, which focus strongly on equity, aim to end all forms of malnutrition by 2030. However, a significant cause of intergenerational transfer of malnutrition, anaemia in pregnancy, is still a challenge. It is especially so in the low- and middle-income settings where possible context-specific aetiologies leading to anaemia have been poorly explored. This study explores the prevalence of etiological factors significantly contributing to anaemia in pregnancy in Sri Lanka, a lower-middle-income country with a high prevalence of malnutrition albeit robust public health infrastructure. Methods All first-trimester pregnant women registered in the public maternal care programme in the Anuradhapura district from July to September 2019 were invited to participate in Rajarata Pregnancy Cohort (RaPCo). After a full blood count analysis, high-performance liquid chromatography, peripheral blood film examination, serum B12 and folate levels were performed in anaemic participants, guided by an algorithm based on the red cell indices in the full blood count. In addition, serum ferritin was tested in a random subsample of 213 participants. Anaemic women in this subsample underwent B12 and folate testing. Results Among 3127 participants, 14.4% (95%CI 13.2–15.7, n = 451) were anaemic. Haemoglobin ranged between 7.4 to 19.6 g/dl. 331(10.6%) had mild anaemia. Haemoglobin ≥13 g/dl was observed in 39(12.7%). Microcytic, normochromic-normocytic, hypochromic-normocytic and macrocytic anaemia was observed in 243(54%), 114(25.3%), 80(17.8%) and two (0.4%) of full blood counts in anaemic women, respectively. Microcytic anaemia with a red cell count ≥5 * 106 /μl demonstrated a 100% positive predictive value for minor haemoglobinopathies. Minor hemoglobinopathies were present in at least 23.3%(n = 105) of anaemic pregnant women. Prevalence of iron deficiency, B12 deficiency and Southeast Asian ovalocytosis among the anaemic was 41.9% (95%CI 26.4–59.2), 23.8% (95%CI 10.6–45.1) and 0.9% (95%CI 0.3–2.3%), respectively. Folate deficiency was not observed. Conclusion Even though iron deficiency remains the primary cause, minor hemoglobinopathies, B 12 deficiency and other aetiologies substantially contribute to anaemia in pregnancy in this study population. Public health interventions, including screening for minor hemoglobinopathies and multiple micronutrient supplementation in pregnancy, should be considered in the national programme for areas where these problems have been identified.

scholarly journals Perspectives on mHealth Interventions During and After Gestational Diabetes

2021 ◽  
Vol 5 (Supplement_2) ◽  
pp. 768-768
Author(s):  
Niamh Kelly-Whyte ◽  
Ciara McNulty ◽  
Sharleen O'Reilly
Keyword(s):  
Gestational Diabetes ◽  
Pregnant Women ◽  
Intervention Development ◽  
Intervention Design ◽  
Cochrane Central Register ◽  
Lifestyle Interventions ◽  
Pregnancy And Postpartum ◽  
Meta Analyses ◽  
The Impact ◽  
In Pregnancy

Abstract Objectives To systematically review the perspectives of women with gestational diabetes (GDM) or a recent history of GDM on mHealth lifestyle interventions during pregnancy and postpartum to inform future intervention development. Methods This systematic review was published according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The research was conducted in PubMed, MEDLINE, EMBASE, CINAHL, PsycInfo, and Cochrane Central Register of Controlled Trials for qualitative studies up until 28 April 2020. Study quality was evaluated using Joanna Briggs Institute critical appraisal checklist for qualitative research and a reflexive thematic synthesis was performed. The COM-B model was used to apply findings to improve future intervention development. Results 14 studies met the inclusion criteria representing the views of 327 women. Differences emerged within the themes identified in pregnancy and postpartum. In pregnancy 3 overarching themes emerged relating to mHealth interventions- support, connectedness and trust. Pregnant women valued the support of healthcare professionals (HCPs) when participating in mHealth interventions, along with information from sources they can trust. The use of self-monitoring was useful in pregnancy as they could see their progress and feel connected to their pregnancy. Using mHealth alongside usual care in pregnancy was seen as beneficial. Postpartum 2 overarching themes emerged- support and connectedness. Postpartum women did not value the input of HCPs as much as pregnant women. They valued connections made with their peers. They indicated more limitations with mHealth interventions than women during pregnancy. They discussed the use of rewards to remain motivated, while in pregnancy the health of the baby appeared to be the main motivator. 7 key recommendations have been made for future intervention design using the COM-B model, most with high or moderate confidence. Conclusions Women's views on mHealth lifestyle interventions differ between pregnancy and the postpartum period, and these needs should be reflected in intervention design. The results also reflect the impact a GDM diagnosis has on women highlighting the need for ongoing support continuing into postpartum. Funding Sources No funding was received for this research.

scholarly journals Low Protein Diets for Pregnant Women and Its Association with Insulin Secretion and Resistance

2019 ◽  
Vol 7 (4) ◽  
pp. 686-689
Author(s):  
Jacqueline Zarkos ◽  
Daniel Addai ◽  
Anna Tolekova
Keyword(s):  
Diabetes Mellitus ◽  
Insulin Secretion ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Pregnant Women ◽  
Neonatal Mortality ◽  
Review Article ◽  
Protein Diet ◽  
Low Protein ◽  
Protein Diets

Gestational diabetes mellitus (GDM) complicates 3.5% of pregnancies in England and Wales and continues to show an increase in incidence each year. GDM can lead to diabetes postpartum, it is associated with an increased perinatal risk, and an increase in neonatal mortality. This review article looks at different studies regarding protein diets and their potential effects on GDM. We aimed to determine if a certain protein diet could potentially help protect against GDM using. We found that while a few studies have shown that increasing proteins in the diet of pregnant women, specifically that from poultry, whey, fish, nuts and legumes, may reduce the risk of GDM, there is certainly room for further research on the topic.

scholarly journals Insulin-stimulated adiponectin secretion in pregnancy is mediated by inhibition of adiponectin ubiquitination and degradation and is impaired in obesity

2021 ◽  
Author(s):  
Irving L. M. H. Aye ◽  
Fredrick J. Rosario ◽  
Anita Kramer ◽  
Oddrun Kristiansen ◽  
Trond M. Michelsen ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Adipose Tissue ◽  
Gestational Diabetes ◽  
Er Stress ◽  
Pregnant Women ◽  
Fetal Growth ◽  
Molecular Mechanisms ◽  
Placental Function ◽  
Increased Risk ◽  
In Pregnancy

ABSTRACTIn pregnancy, adiponectin serves as an endocrine link between maternal adipose tissue, placental function and fetal growth, with low adiponectin promoting placental function and fetal growth. Circulating adiponectin levels are decreased in obese pregnant women and in gestational diabetes, which is believed to contribute to the insulin resistance and increased risk of fetal overgrowth associated with these conditions. However, the molecular mechanisms governing adiponectin secretion from maternal adipose tissues in pregnancy are poorly understood. Using visceral adipose tissue from lean and obese pregnant mice, we show that obesity in pregnancy is associated with adipose tissue inflammation, ER stress, insulin resistance, increased adiponectin ubiquitination and decreased total abundance of adiponectin. Moreover, adiponectin ubiquitination was increased in visceral fat of obese pregnant women as compared to lean pregnant women. We further observed that insulin prevents, whereas ER stress and inflammation promote, adiponectin ubiquitination and degradation in differentiated 3T3-L1 adipocytes. We have identified key molecular pathways regulating adiponectin secretion in pregnancy. This information will help us better understand the mechanisms controlling maternal insulin resistance and fetal growth in pregnancy and may provide a foundation for the development of strategies aimed at improving adiponectin production in pregnant women with obesity or gestational diabetes.

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.

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