Antenatal Care Experience In Pregnant Women With Gestational Diabetes

Background: Globally, one of the increasing health problems that occur during pregnancy is gestational diabetes. The experience of women diagnosed with diabetes in pregnancy has the possibility of experiencing risks such as pre-eclampsia and polyhydramnios (excess amniotic fluid). Babies of mothers who experience this are also at risk for complications such as macrosomia (birth weight > 4000g). Meanwhile, the experience of women during antenatal visits who have a diagnosis of diabetes in pregnancy, often feel anxious about themselves and the fetus and the risks that will occur in the future. Purpose: To review the evidence related to the experience of antenatal care in pregnant women with gestational diabetes. Methods: The method used is the scoping review. created a framework, selecting article studies with Prism Flow Charts, mapping charting data and Critical Appraisal. Results: Based on 9 articles with quantitative and qualitative research types, it was found that there were 8 articles with grade A and 1 article with grade B. The tool used in the scoping review was the Mixed Method Appraisal Tool (MMAT). Based on the articles collected, 4 themes were selected consisting of Antenatal Care (ANC), Knowledge of Pregnant Women, Gestational Impact of Diabetes, and Health Service Efforts. Conclusion: Antenatal care experiences for mothers with gestational diabetes carry a significant risk of maternal and fetal complications and a significant risk of developing type 2 diabetes. Gestational diabetes can contribute to potential emotional imbalances during pregnancy that can trigger depressive symptoms.

Obstetric Outcomes in the Surviving Fetus after Intrauterine Fetal Death in Bichorionic Twin Gestations

Twin pregnancies are high-risk gestations that increase the odds of obstetrical complications. They can also present specific and rare complications such as single intrauterine fetal death (IUFD). This complication has been extensively studied in monochorionic but not in bichorionic gestations. Today, the repercussions of IUFD may have on the surviving fetus, mother and bichorionic pregnancy are not known. Our objective was to study materno-obstetrical, fetal, and immediate delivery neonatal complications in bichorionic twin gestations with single IUFD compared to those with both fetuses alive. A retrospective and observational case-control study was performed in bichorionic biamniotic twin pregnancies, 22 complicated with single IUFD after 14 weeks (cases; IUFD group) and 51 with both fetuses alive (controls; non-IUFD group, from Obstetrics Service of La Paz Hospital (Madrid; Spain). The data were collected from obstetrical records. No significant differences were found in the rates of gestational diabetes, gestational hypertension, preeclampsia, neonatal complications, and prematurity between IUFD and non-IUFD groups. Statistical differences were found for the incidence of intrauterine growth restriction in the surviving fetus compared to first fetus of pregnancy with both fetuses alive (22.7% versus 2.0%, respectively; p-value = 0.012). There were no differences compared to second fetus (11.8%; p-value = 0.23). There was a high C-section rate in both groups (IUFD = 63.6%, non-IUFD = 64.7%; p-value = 0.19). In conclusion, single IUFD in bichorionic biamniotic twin gestations is a rare complication that should be closely monitored. It is essential that these gestations be attended by a clinical multidisciplinary team.

Pregnancy in a woman with congenital adrenal hyperplasia with 11-beta-hydroxylase deficiency: A case report

Background Successful pregnancy with congenital adrenal hyperplasia due to 11-beta-hydroxylase deficiency is an extremely rare condition. Only two cases have been reported in the literature. Methods and results Described here is a 30-year-old woman diagnosed as a neonate with congenital adrenal hyperplasia related to 11-beta-hydroxylase deficiency classic type, who subsequently underwent clitoral resection and vaginoplasty. She was started on lifelong steroid therapy after surgery. She developed hypertension at 11 years of age and was on antihypertensive therapy from then on. In later life, she underwent division of vaginal scar tissue and perineal refashioning. She spontaneously conceived but her pregnancy was complicated by severe pre-eclampsia and delivery was required at 33 weeks of gestation by cesarean section. A healthy male infant was delivered. Conclusion Management of these women is similar to those with more common causes of congenital adrenal hyperplasia, with careful monitoring throughout pregnancy for complications such as gestational diabetes, gestational hypertension, and intrauterine growth restriction.

Risk Factors and Diagnosis of Gestational Diabetes

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.

The Role of Periodontal Disease in Preterm Labour - A Prospective Cohort Study (A Path Analysis) from Iran

BACKGROUND Periodontal infections are the most common oral diseases in pregnancy. This condition can cause complications during pregnancy. Therefore, this study was designed to determine the factors affecting preterm birth and their relationship with periodontal diseases. METHODS This was a prospective cohort study and the population, consisted of old women in the age group of 18 – 45 years attending prenatal care centers in their second trimester of pregnancy. After obtaining informed and free consent from the female parent, a periodontal examination was performed and her medical information was recorded. Examination of Rumford’s teeth was performed to assess the severity of gingivitis, plaque, calculus, and attachment loss. AMOS software was used to investigate the association between preterm labor and delivery and to provide a conceptual model. RESULTS The consequences showed a direct association between preterm labour and factors, such as attachment loss, calculus, bleeding on probing (BOP), age, current diabetes, gestational diabetes, gestational hypertension, lack of calcium, folic acid, and iron supplementation, mothers’ depression, polyhydramnios, smoking severity, and history of premature rupture of the membrane. The results also indicated an indirect relationship between irregular tooth brushing and preterm birth. CONCLUSIONS Attachment loss, calculus, bleeding on probing, are directly related to premature labour and irregular tooth brushing is indirectly associated with early birth. Due to the direct relationship between periodontal diseases and preterm delivery, regular brushing, oral hygiene, oral examinations during pregnancy and follow-up treatment of periodontal disease during pregnancy are recommended. KEY WORDS Periodontal Disease, Preterm Labour, Cohort Study, Path Analysis, Pregnancy

Risk factors associated with gestational diabetes mellitus: a retrospective case-control study

Objectives The prevalence of gestational diabetes mellitus (GDM) has increased year-after-year globally, especially in low-income and developing countries. This study aims to identify the prevalence of GDM, the risk factors, and the effect on pregnancy outcome based on a retrospective case-control study. Methods Two hundred ninety-three parturients with GDM who delivered in a general hospital in Fujian province and met the inclusion criteria were selected as the case group from January to June 2018. Two hundred ninety-three parturients without GDM who delivered in the same period served as the control group. Risk factors for GDM were determined by univariate and binary logistic regression analysis. The prevalence of pregnancy outcomes was determined by a chi-square test. Results The prevalence of GDM was 15.69%. The percentages of 1, 2, and 3 abnormal OGTT values were 55.6%, 30.7%, and 13.7%, respectively. Gravidas with GDM have a higher risk of macrosomia, polyhydramnios, pre-eclampsia, placenta previa, and gestational hypertension than gravidas without GDM (p < 0.05). Analysis of the factors influencing the development of GDM was advanced age, married, parents with a history of diabetes, gestational hypertension, and number of abortions. Conclusions The prevalence of GDM was 15.69% in this geographic region, and > 50% of the patients had one abnormal OGTT value. The risk factors for GDM were advanced age, parents with diabetes, gestational hypertension, and the number of abortions. Pregnancy outcomes of the two groups of patients were different with respect to macrosomia, polyhydramnios, pre-eclampsia, placenta previa, and hypertensive disorders of pregnancy.

Diabetes changes the outcome of tuberculosis?

Background: Diabetes has become a global epidemic affecting children, adolescents, and adults. It is recognized as a group of heterogeneous disorders with the common elements of hyperglycemia and glucose intolerance, due to insulin deficiency, impaired effectiveness of insulin action, or both. Diabetes mellitus (DM) is classified on the basis of etiology and clinical presentation of the disorder into four types: type 1 diabetes, type 2 diabetes, gestational diabetes, and other specific types. Failures, deaths, relapse rates and favorable outcomes (cured/treatment completed) were comparable in pulmonary tuberculosis (TB) patients with or without DM. It is also documented that in well-controlled diabetes the course of pulmonary tuberculosis is not different from that in patients without diabetes.Methods: Diabetic patients visiting the outpatient department/diabetic clinic of our facility were enrolled after taking written informed consent. The data on socio-demographic and diabetic parameters and examination findings were recorded on proforma as attached.Results: X-ray findings at start of treatment showed that proportion of patient of group I was higher than group II in left site (26.00% versus 8.00%) and proportion of patient of group II was higher than group I in right site (58.00% versus 48.00%) and bilateral (34.00% versus 26.00%), though left side was affected in higher proportion of group I patients as compared to group II but this difference was not found to be statistically significant.Conclusions: Our study concluded that even though the state in which patient presented that is diabetic or non-diabetic the outcome of treatment didn’t change but the earlier one was more associated with complications and also the healing took more time in patients with diabetes.

Maternal Diabetes: A Potential Risk Factor of Congenital Hearing Loss

Objective. The purpose of this study is to identify the incidence rate of 'refer' result in neonates born to diabetic mothers and to determine the association of maternal diabetes and the initial 'refer' result. Methods. This was a retrospective cross-sectional study which included neonates who had hearing screening test using transient-evoked otoacoustic emissions test (TEOAE) on both ears at the Philippine General Hospital Ear unit during three weeks. We obtained the demographic characteristics, presence/absence of maternal diabetes, and OAE results. Results. Among the 150 neonates, ten were born to diabetic mothers, with an age range of 2-8 days old. Forty percent of neonates of diabetic mothers had an initial 'refer' result compared with 7.9% of nondiabetic mothers' neonates. After logistic regression analysis, there is a significant association between maternal diabetes and initial 'refer' result in OAE with a p-value <0.05. If the mother is diagnosed with diabetes (gestational/pre-gestational), the odds of having an initial 'refer' result in the hearing screening is 2x higher. The odds can range from 2-43 times. Conclusion. The incidence rate of an initial 'refer' result in neonates of diabetic mothers is 40%. There is a significant association between maternal diabetes and the initial 'refer' result in the OAE test.

Generating evidence on screening, diagnosis and management of non-communicable diseases during pregnancy; a scoping review of current gap and practice in India with a comparison of Asian context

Background Children born to high-risk pregnancies are more likely to experience adverse health outcomes later in life. As estimated, 15% of all pregnancies are at risk of various life-threatening conditions leading to adverse maternal and foetal outcomes. Millennium Development Goal resulted in the global reduction of maternal death from 390,000 to 275000 in 1990–2015). Similarly, to keep this momentum, the current United Nations Sustainable Development Goal (SDG: 3.1) aims at reducing the global maternal mortality ratio to less than 70 per 100,000 live births by 2030, and this can be achieved by addressing high-risk pregnancy contributing to significant mortality and morbidity. In India, gestational diabetes, gestational hypertension, and gestational hypothyroidism were identified as factors contributing to the high-risk pregnancy. This review summarises the commonly used approach for screening, diagnosis, and management of these conditions in the Asian population. It draws a comparison with the current protocols and guidelines in the Indian setting. Methods Electronic search in PubMed and Google Scholar, reference snowballing, and review of current guidelines and protocols were done between January 2010 to October 2019. Published studies reporting Screening, diagnosis, and management of these conditions were included. Articles selected were then screened, appraised for quality, extract relevant data, and synthesised. Results Screening, diagnosis, and management of these three conditions vary and no single universally accepted criteria for diagnosis and management exist to date. In India, national guidelines available have not been evaluated for feasibility of implementation at the community level. There are no national guidelines for PIH diagnosis and management despite the increasing burden and contribution to maternal and perinatal morbidity and mortality. Criteria for diagnosis and management of gestational diabetes, gestational hypertension, and gestational hypothyroidism varies but overall early screening for predicting risk, as reported from majority of the articles, were effective in minimizing maternal and foetal outcome. Conclusion Existing National guidelines for Screening, Diagnosis, and Management of Gestational Diabetes Mellitus (2018) and Gestational Hypothyroidism (2014) need to be contextualized and modified based on the need of the local population for effective treatment. Findings from this review show that early screening for predicting risk to be an effective preventive strategy. However, reports related to a definitive diagnosis and medical management were heterogeneous.

DIABETES MELLITUS AND COGNITIVE IMPAIRMENT. A MODERN VIEW ON THE PROBLEM

Today, diabetes is one of the most common diseases in the world. Every 13-15 years, the number of patients with diabetes doubles. The risk of type 2 diabetes is determined by an interplay of genetic and metabolic factors. Ethnicity, family history of diabetes, gestational diabetes, old age, overweight, obesity, poor diet, low physical activity, and smoking to increase risk. Diabetes reduces life expectancy, leads to early disability, it is a leading cause of terminal renal failure, blindness, diabetes increases the risk of amputation of the lower extremities and the development of cognitive impairment. The problem of cognitive impairment is especially relevant because we can observe a trend of increasing life expectancy and an increase in the proportion of older people in all countries. Also, we can observe an increase in the number of patients with cognitive impairment and dementia. Diabetes treatment should be comprehensive, with the participation of a multidisciplinary team. To successfully treat and control diabetes, physicians and patients must work together to educate and raise awareness about the disease. Patient education should be provided at all stages of therapy. Adequate treatment of diabetes and comorbidities will help reduce the risk of developing and progressing cognitive impairments and other dangerous complications.