Gestational diabetes mellitus: are mothers being followed-up? A retrospective study

2018 ◽  
Vol 68 (suppl 1) ◽  
pp. bjgp18X697469
Author(s):  
Rebecca Ward ◽  
Fahmy W Hanna ◽  
Ann Shelley-Hitchen ◽  
Ellen Hodgson ◽  
Adrian Heald ◽  
...  
Keyword(s):  
Gestational Diabetes ◽  
Median Time ◽  
Post Partum ◽  
Tolerance Test ◽  
Oral Glucose ◽  
Tertiary Referral Centre ◽  
Alternative Approach ◽  
Nice Guidance ◽  
History Of

BackgroundWomen with gestational diabetes (GDM) have an elevated risk of developing type 2 diabetes (T2DM). NICE Guidance recommends women who develop GDM are screened 6 weeks post-partum and annually thereafter.AimTo evaluate conformity to guidance of screening in women with GDM by 6-week post-partum fasting plasma glucose (FPG) and annual FPG and determine time between delivery and development of T2DM.MethodRecords at a tertiary referral centre were used to identify women (n = 54) diagnosed with GDM by antenatal oral glucose tolerance test between July 1999 and January 2007. Data from laboratory records were used to collect investigations of glycaemic status during the follow-up period (median follow-up 12.4 years, range 9.5–17.1 years).ResultsOf 252 women, 102 (40.2%) did not have a FPG at 6 weeks (+/−2 weeks). Of these, median time to first test was 1.2 years (range 0.04–10.8 years), with only 43.1% followed-up within 1 year. In those who had a 6-week FPG, 17 (11.3%) women had no further tests. A total of 84 (33% of those with gestational diabetes in the index pregnancy) women were diagnosed with T2DM; median time from delivery to diagnosis was 5.2 years (range 0.35–15.95). We found the only significant factor for a follow-up test at 1-year post-partum was the use of insulin.ConclusionOur data suggest an alternative approach is needed for monitoring women with a history of GDM. This needs to be appropriate for a generally healthy group in which traditional screening mechanisms may not be adequate or sufficient.

Successful discontinuation of insulin treatment after gestational diabetes is shown to be a case of MODY due to a glucokinase mutation

Open Medicine ◽  
2008 ◽  
Vol 3 (2) ◽  
pp. 225-228
Author(s):  
Indrajit Talapatra ◽  
Shyam Kalavalapalli ◽  
Jonathan Robinson ◽  
Sian Ellard ◽  
David Tymms
Keyword(s):  
Gestational Diabetes ◽  
Insulin Treatment ◽  
Glucose Tolerance Test ◽  
Post Partum ◽  
Molecular Genetic ◽  
Tolerance Test ◽  
Oral Glucose ◽  
Healthy Baby ◽  
Glucokinase Mutation

AbstractWe describe a woman who first presented with gestational diabetes at 26 weeks gestation and was managed with insulin. Following delivery of a healthy baby she had an abnormal OGTT (oral glucose tolerance test) 6 weeks post partum and was managed with diet. In her second pregnancy she was diagnosed with gestational diabetes at 10 weeks and required insulin. Following delivery she was again managed on diet alone. Four years later, during her third pregnancy, she was managed with insulin from the outset. She remained on insulin post partum and for several years. Later her two younger children, aged 11 years and 7 years, were found to have GCK mutation causing MODY (Maturity Onset Diabetes Of the Young) subtype glucokinase. Following this she underwent molecular genetic testing and was also shown to have the GCK mutation. She was gradually taken off insulin and is now managed on diet alone with excellent glycaemic control. Her two children are under regular follow up care and on no medication for diabetes.

Diabetes in pregnancy

2020 ◽  
pp. 2627-2637
Author(s):  
Bryony Jones ◽  
Anne Dornhorst
Keyword(s):  
Gestational Diabetes ◽  
Post Partum ◽  
Insulin Dose ◽  
Tolerance Test ◽  
Oral Glucose ◽  
Oral Glucose Tolerance ◽  
Diabetes In Pregnancy ◽  
In Pregnancy

Diabetes in pregnancy is predominantly either pre-existing type 1 or type 2 diabetes mellitus, or gestational diabetes, the latter defined as diabetes or glucose intolerance first diagnosed during the pregnancy. Gestational diabetes usually arises in the late second trimester and is common, affecting from 2–6% to 15–20% of pregnant women depending on diagnostic criteria and country of origin. Gestational diabetes is most commonly diagnosed on the basis of an oral glucose tolerance test performed at 24–28 weeks’ gestation by a plasma glucose at 0 minutes of more than 5.1 (or >5.6, depending on the authority) mmol/L, or at 120 minutes of more than 8.5 (or >7.8) mmol/L. The effect of pregnancy on maternal glycaemic control ceases very quickly post-partum, hence women with pre-existing diabetes taking insulin should immediately revert to their pre-pregnancy regimen after birth, but with a lower insulin dose.

scholarly journals Hepatic fat and glucose tolerance in women with recent gestational diabetes

2018 ◽  
Vol 6 (1) ◽  
pp. e000549 ◽  
Author(s):  
Sadia Mehmood ◽  
Myles Margolis ◽  
Chang Ye ◽  
Louise Maple-Brown ◽  
Anthony J Hanley ◽  
...  
Keyword(s):  
Insulin Sensitivity ◽  
Gestational Diabetes ◽  
Glucose Tolerance ◽  
Cell Function ◽  
Post Partum ◽  
Tolerance Test ◽  
Liver Fat ◽  
Oral Glucose ◽  
Increased Risk ◽  
Hepatic Fat

ObjectiveWomen with a history of gestational diabetes mellitus (GDM) have an elevated risk of ultimately developing pre-diabetes and diabetes later in life. They also have an increased prevalence of fatty liver, but recent studies have reported conflicting findings on whether hepatic fat affects their risk of pre-diabetes/diabetes. Thus, we sought to evaluate the associations of liver fat with glucose homeostasis and determinants thereof in women with and without recent gestational dysglycemia.MethodsTwo hundred and fifty-seven women underwent an antepartum oral glucose tolerance test (OGTT), which diagnosed 97 with GDM, 40 with gestational impaired glucose tolerance (GIGT), and 120 with normal glucose tolerance (NGT). At a mean of 4.8 years post partum, they underwent an OGTT (which revealed that 52 had progressed to pre-diabetes/diabetes) and hepatic ultrasound, on which liver fat was graded as none (n=164), mild (n=66), or moderate (n=27).ResultsLiver fat was more prevalent in women with previous GDM than in those with GIGT or NGT (p=0.009) and in women with current pre-diabetes/diabetes than in those without (p=0.0003). As the severity of liver fat increased, there was a progressive worsening of insulin sensitivity and beta-cell function, coupled with rising fasting and 2-hour glucose (all p<0.0001). On multiple linear regression analyses, moderate liver fat was independently associated with lower insulin sensitivity (p=0.0002) and higher 2-hour glucose (p=0.009). Moreover, moderate liver fat emerged as an independent predictor of pre-diabetes/diabetes (OR=3.66, 95% CI 1.1 to 12.5).ConclusionThe higher prevalence of liver fat in women with previous GDM is associated with their increased risk of pre-diabetes/diabetes.

scholarly journals Evaluation of home testing to improve follow up after gestational diabetes (Fingerstick Assessments of Sugar Two-months postpartum or FAST)

2013 ◽  
Vol 6 (3) ◽  
pp. 120-124 ◽  
Author(s):  
Michael P Carson ◽  
Beth G Lewis ◽  
Elvis R Pagan ◽  
Martin Evers
Keyword(s):  
Gestational Diabetes ◽  
Glucose Tolerance ◽  
Glucose Tolerance Test ◽  
Tolerance Test ◽  
Care Staff ◽  
Health Care Staff ◽  
Oral Glucose ◽  
Home Testing ◽  
Tolerance Testing

Objective Historically the rates of postpartum glucose tolerance testing for women with gestational diabetes (GDM) average a suboptimal 33%. Barriers include the need for new mothers to miss work and/or arrange for childcare in order to engage in a two-hour test at a commercial lab. This pilot study was initiated to test the theory that a home testing regimen would be accepted by patients and increase the rate of postpartum glucose assessments relative to published rates, without requiring additional health-care staff or resources to achieve this goal. Study design Six weeks postpartum, women with GDM from an academic private practice were asked to check fingerstick blood glucose (FAST Protocol) four times a day for two days, and then obtain an oral glucose tolerance test (OGTT). The physician consultants saw the women each month during pregnancy and arranged the postpartum testing. Results Two of 69 refused to be consented. Twelve of the remaining 67(18%) women completed both the FAST regimen and the OGTT, three completed only the OGTT and five completed only the FAST regimen for a final follow-up rate of 20/67 (30%). The demands of caring for a newborn, or the annoyance of fingersticks, were barriers to compliance. Conclusions In spite of intense physician involvement, this home testing regimen was not associated with an increase in the rates of women participating in postpartum glucose assessments.

Gestational Diabetes Mellitus: Perspectives on Lifestyle Changes during Pregnancy and Post-partum, Physical Activity and the Prevention of Future Type 2 Diabetes

2008 ◽  
Vol 14 (3) ◽  
pp. 85 ◽  
Author(s):  
Frances Doran
Keyword(s):  
Physical Activity ◽  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Post Partum ◽  
Oral Glucose ◽  
The Impact

This paper reports on a mixed methods study which sought to explore the role of physical activity in relation to the management of gestational diabetes mellitus (GDM); the impact of a diagnosis of GDM on a woman?s life; follow-up support and factors that both hinder and support women to engage in physical activity post-partum in order to reduce their risk of developing future type 2 diabetes. Thirty-eight women who had a pregnancy complicated by GDM completed surveys. In-depth interviews were then conducted with a subset of eight women who completed these surveys, to further explore their experiences. Women reported making changes to their lifestyle to improve diet and engage in physical activity during pregnancy. These changes were harder to sustain after the baby was born. In this study few women underwent the recommended six-weekly oral glucose tolerance testing, and post-partum follow-up support was virtually non-existent. There is a clear role for health promotion across a number of sectors to support sustained behaviour change in this high-risk group of women. Factors are identified that could enhance follow-up support, particularly for lifestyle change.

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.

Gestational Diabetes Mellitus: A Prospective Study

2010 ◽  
Vol 2 (2) ◽  
pp. 109-113
Author(s):  
Paban K Sharma ◽  
Ashis Shrestha
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Tertiary Care ◽  
Challenge Test ◽  
Tolerance Test ◽  
Study Data ◽  
Oral Glucose ◽  
Family History Of Diabetes ◽  
History Of

ABSTRACT Background Maternal hyperglycemia is considered a risk factor for both fetus and mother which can lead to significant morbidity and sometimes, even mortality. Here, we present a two years study of gestational diabetes which was intended to see the incidence and its determinants in the Patan Hospital, Kathmandu, Nepal. Patan Hospital is a tertiary care level teaching hospital. Subjects and Methods All pregnant women visiting ANC clinic or admitted to the ward with the diagnosis of GDM from July 2005 to June 2007 at Patan Hospital were taken for the study. In Patan Hospital, pregnant ladies are routinely screened for diabetes with 50 gm glucose challenge test (GCT) and if the value is more than 140 mg/dl, they are subjected to 100 gm Oral Glucose Tolerance Test (OGTT). If two or more than two values are increased, they are managed as gestational diabetes. These cases of gestational diabetes are enrolled for the study. Data was collected by interview and laboratory investigations using standard set of questioner. Results Out of 13,382 consecutive deliveries, 53 patients were admitted with the diagnosis of gestational diabetes mellitus (GDM). Among them, 40.4% were Brahmin, 38.5% Newar, 11.5% Chettri and 9.6% from other cast. GDM was more common in the age group 26 to 35 years and was more prevalent in urban population than rural (urban 84.6% vs rural 15.4%). Similarly, it was more common in multipara patients. Only 28.8% of the cases were having polyhydramnios on ultrasound. Mean weight gain in pregnancy was 8.96 kg with a range of 3 to 20 kg approximately, 58% of patients had family history of diabetes, 48.7% of patients had history of GDM in previous pregnancy and 7.7% of patients had overt diabetes. Most of the patients needed insulin (92.3%) and only 7.7% of patients were managed with only diet and exercise. No significant fetomaternal complication was observed in our study. Conclusion There was significant number of cases diagnosed as GDM. All patients who were diagnosed early and treated accordingly had less complications related to mother and child.

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