Burden Of Gestational Diabetes Mellitus Research Articles

Mean Platelet Volume as a Predictive Marker for GDM

Background: Gestational Diabetes Mellitus (GDM) is defined as first onset of any glucose intolerance diagnosed in pregnancy and certain proportion has risk of developing type 2 diabetes later in life, but risk of type 1 is also increased. Screening at the earliest and enhanced diagnostic tools can help reduce burden of GDM and further progression as it is majorly a lifestyle disease. One of the easiest and cost-effective inflammatory markers are thrombocyte indices. Objective: To determine the potential value of MPV, an inexpensive and easy tool obtained from routine complete blood picture used to study morphology of platelet and whether it can be an indicator in prediction of GDM. Methods: Hospital based comparative study was done on 100 antenatal women attending OPD during first trimester. Case group includes women with recently diagnosed GDM as per guidelines of American diabetes Association by one-step 2-hour 75g OGTT and the cut off values were considered as per IADPSG. MPV is assessed amongst cases and controls and its association was studied in both groups. Results: The present study observed that MPV values of the GDM patients were significantly higher than those compared to normal pregnancies. The current investigation reveals that MPV values in GDM patients significantly exceed those observed in normal pregnancies. Specifically, the median MPV in the GDM group is 8.6 (IQR: 6.9-11.2), while in the non-GDM group, it is 7.4 (IQR: 4.8-10.4). The Mann-Whitney U test yielded a statistic of 905, with a corresponding p-value of 0.0175, which falls below the significance threshold of 0.05. Hence, there exists a statistically significant disparity in MPV between the groups. Conclusion: GDM is found to have underlying chronic inflammatory background and varied insulin resistance which states that these parameters may exist even before clinically diagnosable glucose intolerance occurs. This may direct that GTT might not detect GDM if done early in pregnancy, but inflammatory markers might diagnose as they have already been existing. One such economical marker is the MPV as a part of routine CBC. Keywords: Mean Platelet Volume; Gestational Diabetes Mellitus; IADPSG; Exclusive Real World Evidence

Self-care Behaviour of Pregnant Women with Gestational Diabetes Mellitus at a Tertiary Care Hospital in Lucknow, India: A Quasi-experimental Study

Introduction: India is now the diabetes capital of the world. The rising burden of Gestational Diabetes Mellitus (GDM) adds to the existing diabetes burden. Euglycemia is achieved once the baby is delivered. The first line of management of GDM is mainly through lifestyle modification with diet and physical activity. There is a dearth of information from Lucknow city about how well pregnant women with GDM adhere to dietary changes and exercise recommendations, or how counselling helps them deal with their GDM. Aim: To assess the self-care behaviour related to diet, physical activity, and Self-Monitoring of Blood Glucose (SMBG) of pregnant women diagnosed with GDM. Materials and Methods: A total of 188 pregnant women diagnosed with GDM were selected for present quasiexperimental study. The study participants were recruited from the antenatal Outpatient Department (OPD) at the Department of Obstetrics and Gynaecology of Queen’s Mary Hospital, King George Medical University (KGMU), Lucknow, India. The total study duration was from November 2019 to November 2022. Pregnant women diagnosed with GDM according to Diabetes in Pregnancy Study Group in India (DIPSI) criteria, up to 28 weeks of gestation, who gave their written consent to participate in the study and were living within a 15-kilometer radius of the study Institute, were included in the study. One group of the study participants received one-to-one counselling, an individualised diet plan, along with usual GDM care, and the other group received usual GDM care during their antenatal visits. The summary of diabetes self-care was adapted to assess adherence to the recommended dietary and physical activity modifications, as well as self-monitoring of blood glucose. Data were analysed using R software version 4.1.1 (R Core Team, 2021). All categorical data were presented using frequency and percentages. The comparison of baseline demographic and clinical parameters of pregnant women between the two groups was done using the Chi-square test or Fisher’s-exact test for categorical observations based on the expected frequency. The independent sample t-test or Mann-whitney U test for continuous measurements was used after checking the normality assumption using the Shapiro-wilk test. The change in scores of general diet, specific diet, physical activity, and SMBG throughout all follow-ups was assessed by repeated measures Analysis of Variance (ANOVA). The change from the first follow-up visit to subsequent follow-up visit was compared using a mixed linear model with follow-up visits. The p-value was considered significant at a 5% level of significance for all comparisons. Results: The mean age of the pregnant women with GDM was 27.6±3.7 years in the intervention group and 27.9±3.9 years in the control group (p=0.451). The pregnant women with GDM in the two groups did not show significant differences in terms of socio-demographic variables such as age, religion, education, socio-economic status, occupation, type of family, and family history of diabetes mellitus. A significant difference was observed in the dietary and physical activity scores between the two groups of pregnant women with GDM. However, no difference was observed in the case of self-monitoring of blood glucose scores of the two groups. Conclusion: The study concluded that counseling plays an important role in helping pregnant women with GDM adhere to the recommended dietary modifications and physical activity.

Rising prevalence of gestational diabetes mellitus and its associated risk factors in Makurdi, North-Central Region of Nigeria

Background: The disease burden of gestational diabetes mellitus (GDM) in sub-Saharan African region have been on the rise. Proper assessment of current prevalence of GDM may inform policy changes and management approach for improved care delivery.Objective: To determine the current prevalence of Gestational Diabetes Mellitus (GDM) and evaluate its major risk factors amongst pregnant women in Makurdi, North-Central Nigeria.Method: This was a multi-center hospital-based prospective observational study. Maternal characteristics and clinical risk factors for GDM in a cohort of 281 pregnant women at 9 to 16 weeks gestational age was evaluated. The one-step 75g oral glucose tolerance test (OGTT) was carried out at 24 to 28 weeks of gestation.Result: Of the 356 women recruited, 281 (79.8%) completed the study. The GDM prevalence in the cohort was 16.7%. Increased early pregnancy BMI (adjusted OR = 1.154, 95% CI = 1.080 – 1.233, p<0.001) and presence of family history of diabetes mellitus (adjusted OR = 0.482, 95% CI = 0.233 – 0.997, P<0.05) were independent risk factors for GDM in the cohort.Conclusion: Increasing maternal age and early pregnancy BMI amongst other possible reasons, may account for the rising prevalence of GDM in the region.

Prevalence of prediabetes and type 2 diabetes mellitus in south and southeast Asian women with history of gestational diabetes mellitus: Systematic review and meta-analysis.

The burden of Gestational Diabetes Mellitus (GDM) is very high in south Asia (SA) and southeast Asia (SEA). Thus, there is a need to understand the prevalence and risk factors for developing prediabetes and type 2 diabetes mellitus (T2DM) postpartum, in this high-risk population. To conduct a systematic review and meta-analysis to estimate the prevalence of prediabetes and T2DM among the women with history of GDM in SA and SEA. A comprehensive literature search was performed in the following databases: Medline, EMBASE, Web of Knowledge and CINHAL till December 2021. Studies that had reported greater than six weeks of postpartum follow-up were included. The pooled prevalence of diabetes and prediabetes were estimated by random effects meta-analysis model and I2 statistic was used to assess heterogeneity. Meta-analysis of 13 studies revealed that the prevalence of prediabetes and T2DM in post-GDM women were 25.9% (95%CI 18.94 to 33.51) and 29.9% (95%CI 17.02 to 44.57) respectively. Women with history of GDM from SA and SEA seem to have higher risk of developing T2DM than women without GDM (RR 13.2, 95%CI 9.52 to 18.29, p<0.001). The subgroup analysis showed a rise in the prevalence of T2DM with increasing duration of follow-up. The conversion to T2DM and prediabetes is very high among women with history of GDM in SA and SEA. This highlights the need for follow-up of GDM women for early identification of dysglycemia and to plan interventions to prevent/delay the progression to T2DM.

First trimester sex hormone-binding globulin predicts gestational diabetes mellitus in a population of Nigerian women

There has been a steady rise in the disease burden of Gestational Diabetes Mellitus (GDM) in the sub-Saharan African region over time. Diagnostic testing for GDM is currently recommended at 24 − 28 weeks of gestation, leaving a narrow window for intervention before delivery. Hence the need for early prediction and preventive intervention. The performance of first trimester serum sex hormone-binding globulin (SHBG) assay as a predictor of GDM was determined by binary logistic regression. Women with GDM (n = 49) had a significantly lower mean first trimester SHBG level (104.7 ± 61.6 nmol/L) than did those without GDM (n = 180; 265.2 ± 141.5 nmol/L; p < .001). First trimester SHBG was significantly negatively correlated (r pb = −0.460, p value = <.001) with subsequent development of GDM and an area under receiver operator characteristics (ROC) curve of 0.874 (p < .001). A cut-off value of 158.0 nmol/L predictive of GDM had a diagnostic sensitivity of 81.5%, a specificity of 80.1%, and an overall diagnostic efficiency of 80.3%. IMPACT STATEMENT What is already known on this subject? GDM is associated with high risk of various complications and is commonly diagnosed at 24–28 weeks of gestation, leaving a narrow window for intervention. The performance of current maternal clinical and demographic risk factor-based prediction approaches is unreliable. Thus, more favourable prediction approaches need to be developed. Previous studies have suggested that SHBG, a readily assessable marker, has potential to predict GDM; however, these studies have mostly involved Caucasian and other non-African populations. What the results of this study add? SHBG may serve as a reliable first trimester screening tool for GDM development in Nigerian women with singleton pregnancies. This study demonstrates that first trimester SHBG can predict GDM development in sub-Saharan African women despite racial, ethnic and geographical differences. What are the implications of these findings for clinical practice and/or further research? Effective first trimester prediction of GDM using SHBG may enable preventive interventions, thereby mitigating the high burden of the disease in the sub-Saharan African region. It may also provide relevant information that may guide adaptation of current management guidelines to ensure effective management of GDM in the region.

CO29 Subsidized Screening and Lifestyle Management of Gestational Diabetes Mellitus in Rural China: A Multi-Centre, Randomized Controlled Trial

The burden of gestational diabetes mellitus (GDM) is escalating, and the control rate is poor in rural China. This study assessed the effectiveness of a GDM subsidy program on promoting GDM screening and management in rural China.

Prevalence of Gestational Diabetes Mellitus in Nepal: A Systematic Review and Meta-analysis.

Gestational diabetes mellitus is a condition of glucose intolerance during pregnancy. The burden of Gestational diabetes mellitus is ever increasing including a lower middle-income country like Nepal. This meta-analysis was conducted in accordance to the guidance of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Databases of "Embase", "Google Scholar", "Scopus", "Web of Science" were searched for observational studies in Nepal from 2000 to July 2021. Random effect model was used to estimate the pooled prevalence subgroup analysis. This systematic review and meta-analysis analyzed 9 studies with a total of 20865 participants. Pooled prevalence of gestational diabetes mellitus was 2.61% (95% CI: 1.25- 5.37). From subgroup analysis, the prevalence of Gestational diabetes mellitus according to the diagnostic criteria were: International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria 6.56% (95% CI: 4.79-8.92), World Health Organization (WHO) criteria 4.81% (95% CI: 3.79-6.08), Diabetes in Pregnancy Study Group of India (DIPSI) criteria 4.71% (95% CI: 3.06-7.18), Carpenter and Coustan criteria (CC) 1.08% (95% CI: 0.43-2.71); prevalence according to the publication time: before 2015 1.20% (95% CI: 3.64-6.41), in and after 2015 4.84% (95% CI: 0.42-3.39); prevalence according to the place: within Kathmandu valley 2.70% (95% CI: 1.17-6.08), outside Kathmandu valley 2.28% (95% CI: 0.26-17.15). Our study revealed the increasing prevalence of GDM in Nepal. Further large observational studies at local levels are essential to measure the actual burden, risk factors and potential preventive measures for Gestational diabetes mellitus.

Serum metabolomic signatures of gestational diabetes in South Asian and white European women

IntroductionThis study aimed to identify serum metabolomic signatures associated with gestational diabetes mellitus (GDM), and to examine if ethnic-specific differences exist between South Asian and white European women.Research design and...

Burden, risk factors and outcomes associated with gestational diabetes in a population-based cohort of pregnant women from North India

BackgroundThe burden of gestational diabetes mellitus (GDM) appears to be increasing in India and may be related to the double burden of malnutrition. The population-based incidence and risk factors of GDM, particularly in lower socio-economic populations, are not known. We conducted analyses on data from a population-based cohort of pregnant women in South Delhi, India, to determine the incidence of GDM, its risk factors and association with adverse pregnancy outcomes (stillbirth, preterm birth, large for gestational age babies) and need for caesarean section.MethodsWe analyzed data from the intervention group of the Women and Infants Integrated Interventions for Growth Study (WINGS), an individually randomized factorial design trial. An oral glucose tolerance test (OGTT) was performed at the time of confirmation of pregnancy, and for those who had a normal test (≤140 mg), it was repeated at 24–28 and at 34–36 weeks. Logistic regression was performed to ascertain risk factors associated with GDM. Risk ratios (RR) were calculated to find association between GDM and adverse pregnancy outcomes and need for caesarean section.Results19.2% (95% CI: 17.6 to 20.9) pregnant women who had at least one OGTT were diagnosed to have GDM. Women who had prediabetes at the time of confirmation of pregnancy had a significantly higher risk of developing GDM (RR 2.08, 95%CI 1.45 to 2.97). Other risk factors independently associated with GDM were woman’s age (adjusted OR (AOR) 1.10, 95% CI 1.06 to 1.15) and BMI (AOR 1.04, 95% CI 1.01 to 1.07). Higher maternal height was found to be protective factor for GDM (AOR 0.98, 95% CI 0.96 to 1.00). Women with GDM, received appropriate treatment did not have an increase in adverse outcomes and no increased need for caesarean sectionConclusionsA substantial proportion of pregnant women from a low to mid socio-economic population in Delhi had GDM, with older age, higher BMI and pre-diabetes as important risk factors. These findings highlight the need for interventions for prevention and provision of appropriate management of GDM in antenatal programmes.Clinical trial registrationClinical Trial Registry – India, #CTRI/2017/06/008908 (http://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=19339&EncHid=&userName=society%20for%20applied%20studies).

Level of and factors associated with awareness of gestational diabetes mellitus among pregnant women attending antenatal care at Kawempe National Referral Hospital: a cross sectional study

BackgroundThe burden of Gestational diabetes mellitus (GDM) is significantly increasing worldwide and the disorder causes substantial short term and long-term adverse effects both to the mother and the unborn baby. Public health measures to increase awareness of GDM among pregnant women may aid in prevention of the disease through life style modification, screening, early diagnosis and management but very few studies have assessed awareness of GDM among pregnant women in sub Saharan Africa and none of these are from Uganda. This study therefore sought to evaluate the level of and factors associated with awareness of GDM among pregnant women attending antenatal care at Kawempe National Referral Hospital (KNRH), the busiest obstetric unit in Uganda, so as to assess their health sensitization needs.MethodsThis was a cross-sectional study. We recruited 403 participants at 30 weeks of gestation and above after giving written informed consent. Systematic sampling was used to select participants and data was collected using pretested interviewer-administered questionnaires. The collected data was entered in Epidata version 4.2 and exported to Stata for analysis. Continuous variables were summarized using mean and standard deviation. Categorical variables were summarized using frequencies and proportions. Factors associated with awareness were assessed at both bivariate and multivariate levels.ResultsFour hundred three pregnant women were recruited, majority (35.5 %) were between 20 and 24 years and their mean age was 26.6 years. Only 125 (31 %) participants were aware of GDM. Age and educational level were significantly associated with awareness of GDM. Women aged 35 years and above were more likely to be aware of GDM (OR = 2.34 (95 % CI = 1.14–4.81) p = 0.021. Women with primary education or no education were less likely to be aware (OR = 0.48 (CI 0.24–0.96) p = 0.038.ConclusionsAwareness of GDM was poor among study participants. There is need to improve the health education programs in order to increase awareness of GDM among women attending ANC at KNRH. Women below 35 years of age and those with primary education or less should be specifically targeted when giving health education sessions so as to increase their awareness of GDM.

Health care professionals\u2019 perspectives on screening and management of gestational diabetes mellitus in public hospitals of South India \u2013 a qualitative study

BackgroundWomen developing Gestational Diabetes Mellitus (GDM) are subsequently at a higher risk of developing Type 2 Diabetes later in life. Screening and effective management of women with GDM are essential in preventing progression to type 2 diabetes mellitus. We aimed to explore the perspectives of healthcare providers regarding the barriers from the health system context that restrict the timely screening and effective management of GDM.MethodsWe conducted six in-depth interviews of health care providers- four with nurses and two with obstetricians in the public hospitals in India’s major city (Bengaluru). The interviews were conducted in the preferred language of the participants (Kannada for nurses, English for the obstetricians) and audio-recorded. All Kannada interviews were transcribed and translated into English for analysis. The primary data were analyzed using the grounded theory approach by NVivo 12 plus. The findings are put into perspective using the socio-ecological model.ResultsHealth care providers identified delayed visits to public hospitals and stress on household-level responsibilities as barriers at the individual level for GDM screening. Also, migration of pregnant women to their natal homes during first pregnancy is a cultural barrier in addition to health system barriers such as unmet nurse training needs, long waiting hours, uneven power dynamics, lack of follow-up, resource scarcity, and lack of supportive oversight. The barriers for GDM management included non-reporting women to follow - up visits, irregular self-monitoring of drug and blood sugar, trained staff shortage, ineffective tracking, and lack of standardized protocol.ConclusionThere is a pressing need to develop and improve existing GDM Screening and Management services to tackle the growing burden of GDM in public hospitals of India.

Gestational Diabetes Mellitus in Southeast Asia: A Scoping Review.

A rapid increase in the prevalence of gestational diabetes mellitus (GDM) has been associated with various factors such as urbanization, lifestyle changes, adverse hyperglycemic intrauterine environment, and the resulting epigenetic changes. Despite this, the burden of GDM has not been well-assessed in Southeast Asia. We comprehensively reviewed published Southeast Asian studies to identify the current research trend in GDM in this region. Joanna Briggs Institute’s methodology was used to guide the scoping review. The synthesis of literature findings demonstrates almost comparable clinical evidence in terms of risk factors and complications, challenges presented in diagnosing GDM, and its disease management, given the similarities of the underlying population characteristics in Southeast Asia. Evidence suggests that a large proportion of GDM risk in women may be preventable by lifestyle modifications. However, the GDM burden across countries is expected to rise, given the heterogeneity in screening approaches and diagnostic criteria, mainly influenced by economic status. There is an urgent need for concerted efforts by government and nongovernmental sectors to implement national programs to prevent, manage, and monitor the disease.

Exploring women's priorities for the potential consequences of a gestational diabetes diagnosis: A pilot community jury.

BackgroundThere is no international diagnostic agreement for gestational diabetes mellitus (GDM). In 2014, Australia adopted a new definition and testing procedure. Since then, significantly more women have been diagnosed with GDM but with little difference in health outcomes. We explored the priorities and preferences of women potentially impacted by a GDM diagnosis.MethodWe recruited 15 women from the Gold Coast, Australia, to participate in a pilot community jury (CJ). Over two days, the women deliberated on the following: (a) which important consequences of a diagnosis of GDM should be considered when defining GDM?; (b) what should Australian health practitioners call the condition known as GDM?ResultsEight women attended the pilot CJ, and their recommendations were a consensus. Women were surprised that the level of risk for physical harms was low but emotional harms were high. The final ranking of important consequences (high to low) was as follows: women's negative emotions; management burden of GDM; overmedicalized pregnancy; minimizing infant risks; improving lifestyle; and macrosomia. To describe the four different clinical states of GDM, the women chose three different labels. One was GDM.ConclusionsThe women from this pilot CJ prioritized the consequences of a diagnosis of GDM differently from clinicians. The current glucose threshold for GDM in Australia is set at a cut‐point for adverse risks including macrosomia and neonatal hyperinsulinaemia. Definitions and guideline panels often fail to ask the affected public about their values and preferences. Community voices impacted by health policies should be embedded in the decision‐making process.

Burden, risk factors and maternal and offspring outcomes of gestational diabetes mellitus (GDM) in sub-Saharan Africa (SSA): a systematic review and meta-analysis

BackgroundThe burden, determinants and outcomes of gestational diabetes mellitus (GDM) in sub-Saharan Africa are not known. We summarized existing evidence on the prevalence, risk factors and complications of GDM in the region.MethodsPubMed was searched from inception to January 31st 2019. Studies were included if carried out in any of the sub-Saharan Africa countries and were available as abstracts or full texts. Interventional studies and those only including qualitative data were excluded. We employed random effects modelling to estimate the pooled GDM prevalence and risk ratios (RRs) for risk factors and outcomes of GDM and their 95%CI.Results283 papers were identified in the initial search, 33 of which met the inclusion criteria. Data on GDM burden suggest a pooled prevalence of 9% (95%CI, 7–12%). Family history of type 2 diabetes and previous history of GDM, macrosomia, stillbirth and abortion were important risk factors of GDM. In addition, being overweight or obese, over 25 years of age or hypertensive increased the risk of GDM. In terms of complications, GDM more than doubles the risk macrosomia (RR; 95%CI: 2.2; 1.1–4.4).ConclusionsThere is a high burden of gestational diabetes mellitus in sub-Saharan Africa, but more studies are needed to document locally important risk factors as well as maternal and offspring outcomes. Interventions to reduce obesity among older African women might lead to reduced risk of GDM in sub-Saharan Africa.

Short-term health and economic burden of gestational diabetes mellitus in Mexico: A modeling study

AimTo estimate the annual burden of gestational diabetes mellitus (GDM) in Mexico. MethodsA model was built to conduct estimates from a healthcare system perspective, namely, the incremental costs of GDM pregnancy compared with non-GDM pregnancy from the first trimester until childbirth. The model used probabilities from the literature and surveys, and costs obtained from the Ministry of Health and national healthcare institutions. Scenario analyses were performed to estimate the GDM burden at different levels of incidence. ResultsAlthough a non-GDM pregnancy cost on average USD 1880.6 (low risk was USD 1043.9 and high risk was USD 1673.5), a pregnancy with GDM cost USD 2934.9. Therefore, the total additional cost was USD 1576.2 per case. Given the considerable variability of the GDM incidence in Mexico, the total burden could range from USD 86.8 to USD 827.4 million per year. ConclusionsGDM is one of the most frequent complications of pregnancy, but research has been insufficient regarding its epidemiological and economic burden in Latin America. This paper shows that the GDM economic burden in Mexico is substantial despite only accounting for short-term medical costs. Further research to assess the GDM incidence and evaluate its long-term consequences from a broader societal perspective in Mexico is recommended.

GESTATIONAL DIABETES;

Objective: To find sensitivity specificity and diagnostic accuracy of GlucoseChallenge test in diagnosing Gestational Diabetes in Pregnant women. Due to poor socioeconomicaland educational status, dietary habits and ignorance regarding pregnancy relatedproblems probably increase the prevalence and burden of gestational diabetes mellitus (GDM)and its complications in pregnancy. Best and simple strategy to identify women with gestationaldiabetes is still lacking and unclear. Study Design: Cross sectional study. Setting and Duration:This study was performed at Jinnah Hospital Lahore, from Nov 2005 to Dec 2006. Methodology:A glucose challenge test (GCT) was performed on 500 selected pregnant women by giving 50-gglucose in water orally. A serum glucose level ≥140 mg/dl after an hour was taken as positive test.To confirm GDM, 75 g glucose in 200 ml of water was given and sugar levels after 2 hrs byGlucometer, &gt;200 mg/dl confirmed GDM. Results: An increasing trend in age, gestational ageand BMI and a significant difference regarding positive family history of diabetes and graviditywas seen in patients with GDM compared to normal pregnant. The maximum percentage of GDM2 was noted in multigravida, between 25-29 years, BMI &gt;28kg/m , and a gestational age of 28weeks. The sensitivity of GCT was 80%, specificity 97.8%., and diagnostic accuracy was 96.4%.Conclusions: Screening is necessary to identify women with GDM. A 50-g glucose challengetest might be acceptable as a screening test for GDM as it has high sensitivity, specificity anddiagnostic accuracy.

Obesity, gestational diabetes and macrosomia are associated with increasing rates of early-term induction of labour at The Canberra Hospital.

Early-term delivery is an important cause of short-term neonatal morbidity and associated high healthcare costs, with possible additional long-term developmental ramifications. As a form of 'iatrogenic' delivery, induction of labour (IOL) is a potentially modifiable contributor to this burden. To determine patterns of, and primary indication for, early-term IOL, as well as temporal trends in this primary indication and differences from other modes of delivery with respect to maternal factors and maternal/neonatal outcomes. The Canberra Hospital births database (2012-2016) was queried; patients who underwent IOL were included in the analysis. Total deliveries and the proportion of early-term IOL procedures rose markedly over the time period. Gestational diabetes mellitus (GDM) was the most frequent and an increasing main indication for IOL. GDM was associated with significantly higher body mass index, an increased proportion of obesity, and a greater incidence of labour complications related to macrosomia. Birthweight of neonates of diabetic mothers was significantly higher, which was associated with decreased rates of admission to the special care nursery/neonatal intensive care unit (SCN/NICU) compared to all other babies. GDM increased relative risk of early-term IOL in obese women by 1.8 times. The burden of GDM and early-term IOL have increased at The Canberra Hospital although adverse short-term neonatal outcomes have not, possibly suggesting appropriate management of these patients. Nonetheless, effort should be made to identify patients who can safely continue pregnancy to full term, given the higher proportion of SCN/NICU admissions among early-term neonates.

Comparing the Efficacy of a Mobile Phone-Based Blood Glucose Management System With Standard Clinic Care in Women With Gestational Diabetes: Randomized Controlled Trial.

BackgroundTreatment of hyperglycemia in women with gestational diabetes mellitus (GDM) is associated with improved maternal and neonatal outcomes and requires intensive clinical input. This is currently achieved by hospital clinic attendance every 2 to 4 weeks with limited opportunity for intervention between these visits.ObjectiveWe conducted a randomized controlled trial to determine whether the use of a mobile phone-based real-time blood glucose management system to manage women with GDM remotely was as effective in controlling blood glucose as standard care through clinic attendance.MethodsWomen with an abnormal oral glucose tolerance test before 34 completed weeks of gestation were individually randomized to a mobile phone-based blood glucose management solution (GDm-health, the intervention) or routine clinic care. The primary outcome was change in mean blood glucose in each group from recruitment to delivery, calculated with adjustments made for number of blood glucose measurements, proportion of preprandial and postprandial readings, baseline characteristics, and length of time in the study.ResultsA total of 203 women were randomized. Blood glucose data were available for 98 intervention and 85 control women. There was no significant difference in rate of change of blood glucose (–0.16 mmol/L in the intervention and –0.14 mmol/L in the control group per 28 days, P=.78). Women using the intervention had higher satisfaction with care (P=.049). Preterm birth was less common in the intervention group (5/101, 5.0% vs 13/102, 12.7%; OR 0.36, 95% CI 0.12-1.01). There were fewer cesarean deliveries compared with vaginal deliveries in the intervention group (27/101, 26.7% vs 47/102, 46.1%, P=.005). Other glycemic, maternal, and neonatal outcomes were similar in both groups. The median time from recruitment to delivery was similar (intervention: 54 days; control: 49 days; P=.23). However, there were significantly more blood glucose readings in the intervention group (mean 3.80 [SD 1.80] and mean 2.63 [SD 1.71] readings per day in the intervention and control groups, respectively; P<.001). There was no significant difference in direct health care costs between the two groups, with a mean cost difference of the intervention group compared to control of –£1044 (95% CI –£2186 to £99). There were no unexpected adverse outcomes.ConclusionsRemote blood glucocse monitoring in women with GDM is safe. We demonstrated superior data capture using GDm-health. Although glycemic control and maternal and neonatal outcomes were similar, women preferred this model of care. Further studies are required to explore whether digital health solutions can promote desired self-management lifestyle behaviors and dietetic adherence, and influence maternal and neonatal outcomes. Digital blood glucose monitoring may provide a scalable, practical method to address the growing burden of GDM around the world.Trial RegistrationClinicalTrials.gov NCT01916694; https://clinicaltrials.gov/ct2/show/NCT01916694 (Archived by WebCite at http://www.webcitation.org/6y3lh2BOQ)

The short-term economic burden of gestational diabetes mellitus in Italy

BackgroundThe incidence of Gestational Diabetes Mellitus (GDM) is rising in all developed countries. This study aimed at assessing the short-term economic burden of GDM from the Italian healthcare system perspective.MethodsA model was built over the last pregnancy trimester (i.e., from the 28th gestational week until childbirth included). The National Hospital Discharge Database (2014) was accessed to estimate delivery outcome probabilities and inpatient costs in GDM and normal pregnancies (i.e., euglycemia). International Classification of Disease-9th Revision-Clinical Modification (ICD9-CM) diagnostic codes and Diagnosis-Related Group (DRG) codes were used to identify GDM cases and different types of delivery (i.e., vaginal or cesarean) within the database. Neonatal outcomes probabilities were estimated from the literature and included macrosomia, hypoglycemia, hyperbilirubinemia, shoulder dystocia, respiratory distress, and brachial plexus injury. Additional data sources such as regional documents, official price and tariff lists, national statistics and expert opinion were used to populate the model. The average cost per case was calculated at national level to estimate the annual economic burden of GDM. One-way sensitivity analyses and Monte Carlo simulations were performed to quantify the uncertainty around base case results.ResultsThe amount of pregnancies complicated by GDM in Italy was assessed at 54,783 in 2014 using a prevalence rate of 10.9%. The antenatal outpatient cost per case was estimated at €43.7 in normal pregnancies compared to €370.6 in GDM patients, which is equivalent to a weighted sum of insulin- (14%; €1034.6) and diet- (86%; €262.5) treated women’s costs. Inpatient delivery costs were assessed at €1601.6 and €1150.3 for euglycemic women and their infants, and at €1835.0 and €1407.7 for GDM women and their infants, respectively. Thus, the overall cost per case difference between GDM and normal pregnancies was equal to €817.8 (+ 29.2%), resulting in an economic burden of about €44.8 million in 2014 at national level. Probabilistic sensitivity analysis yielded a cost per case difference ranging between €464.9 and €1164.8 in 80% of simulations.ConclusionsThe economic burden of GDM in Italy is substantial even accounting for short-term medical costs only. Future research also addressing long-term consequences from a broader societal perspective is recommended.

Assessing the effectiveness of an educational program for patients with gestational diabetes in Assiut University

Objective The aim was to evaluate the effectiveness of an individualized educational program in improving patient’s awareness, knowledge, and attitude and to assess its role in reducing the burden of gestational diabetes mellitus (GDM). Patients and methods A prospective study was conducted on women diagnosed to have GDM at 24–28 weeks of gestation according to The Diabetes In Pregnancy Study group India criteria 2015 (2 h blood glucose ≥140 mg/dl) between December 2015 and December 2016 who were enrolled into an individualized GDM educational program. A modified and shortened version of a validated questionnaire developed by Carolan and colleagues was tested before and after education to evaluate the feedback of education. Follow-up was every 2 weeks till labor to assess awareness together with both maternal and fetal outcomes. Results A total of 60 pregnant women diagnosed to have GDM were included. The questions that were answered correctly in the post-test by more than 50% of the participants fell into these categories: definition of GDM (100%), associated risk factors (75%), way of diagnosis (83.3%), management of GDM (71.7%), and postpartum follow-up (56.7%). As regards fetal and maternal outcome it was observed that both weight gain and glycemic control were better in the well-educated group versus other groups (P=0.02, 0.01, respectively). Conclusion Health education plays an important role in increasing patients awareness regarding the GDM risk and its proper management in order to reduce its complications both for the mother and the fetus.