Degree Of Glucose Intolerance Research Articles

Assessment of gestational diabetes mellitus knowledge, attitudes, and practices and associated factors among pregnant women at a district hospital in Coastal Kenya

BackgroundGestational diabetes mellitus (GDM) is any degree of glucose intolerance first recognized during pregnancy. GDM awareness among pregnant women translates into GDM prevention and early diagnosis.ObjectiveTo establish the underlying factors influencing GDM Knowledge Attitude and Practices (KAP) among pregnant women at Kinango District Hospital.MethodAn explanatory mixed-methods design was implemented by initially assessing GDM KAP quantitatively [QUAN], followed by the qualitative [qual] exploration of contextual factors behind quantitative results. In the [QUAN] strand, 354 pregnant women were interviewed from January to February 2019. Thereafter, in the [qual] strand, key informant interviews were conducted among four pregnant women and three healthcare workers; a focus group discussion was held among nine pregnant women, from May to June 2019. STATA V15 software package was used to analyze the quantitative data. Qualitative data were analyzed manually using thematic analysis.ResultAmong 354 pregnant women, 29.0% were knowledgeable, 46.98% had good attitude and 60.17% had good practice. Attending at least one antenatal clinic visit and having heard about diabetes mellitus were associated with good GDM attitude and practices. Among the knowledgeable pregnant women, one-third (33.33%) obtained GDM information from a health facility. Discussions with pregnant women and the interviews with healthcare workers highlighted that daily health talks during antenatal clinic, included GDM and diabetes mellitus information. Furthermore, attendance of at least one antenatal clinic visit was low (85.88%), among pregnant women (87.86%) who were expected to have attended at least one antenatal clinic visits.ConclusionDespite low GDM knowledge, pregnant women had relatively good GDM attitudes and good GDM practices. Daily health talks conducted during antenatal clinic as well as indigenous knowledge among pregnant women, influenced the latter. Hence, GDM information dissemination needs to be enhanced for the improvement of GDM KAP among pregnant women for GDM prevention.

Correlation between the Serum Fatty Acids and Insulin in Gestational Diabetes

Abstract Background: Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance that develops or is first recognized during pregnancy. Pregnancy is a diabetogenic condition marked by hyperinsulinemia and insulin resistance. In the early stages of pregnancy, maternal hormones enhance the production of insulin together with greater peripheral utilization, resulting in lower maternal blood sugar. Despite several research, the pathophysiology of GDM remains unknown, and the results acquired thus far point to a complicated process of interaction between multiple genetic, metabolic, and environmental variables. Methods: The aim of the present study was to find the correlation between serum fatty acid and insulin in GDM. Serum fatty acids were estimated by gas chromatography. Serum insulin levels were estimated using an enzyme-linked immunosorbent assay kit. Results: In the present study, we have collected serum samples from 50 pregnant women with GDM and normal pregnant women. We observed significantly increased levels of saturated fatty acids such as myristoleate and methyl palmitate, omega-3 fatty acids, α-linolenic acid, and omega-6 fatty acids, arachidonic acid. Conclusion: Alterations in plasma-free fatty acid (FFA) content or profile may contribute to insulin resistance. Furthermore, several FFAs can predict GDM in early pregnancy and are highly related to fetal growth and development, as well as the presence of macrosomia. Finally, proper fatty acid intake should be examined before and during pregnancy to optimize mother and newborn outcomes and introduce new preventive and therapeutic options for GDM.

Role of Fetal Cardiac ECHO and Fetal Cardiac MRI in Prediction of Post Natal Hemodynamic Maladaptation in Fetuses of Diabetic Mothers

Background: Maternal diabetes mellitus (DM) is defined as a degree of glucose intolerance with recognition during pregnancy (pregestational or gestational, type 1 or type 2), and it is estimated to be 15% in pregnant females in 2019. The current study aimed to study the role of fetal echocardiography and fetal cardiac magnetic resonance imaging (MRI) in anticipation and diagnosis of hemodynamic maladaptation changes in fetuses of diabetic mothers as predictors for (closure of Patent ductus arteriosus (PDA), persistent pulmonary hypertension and diastolic dysfunction) which were confirmed with post-natal echocardiographic and clinical assessment. Methods: This study was an observational follow-up study that included 80 pregnant diabetic females who were following in the specialized clinics of Ain Shams University Hospitals during the period starting from August 2020 till December 2022. Results: Diabetes affected left ventricle (LV) diastolic function and global cardiac function but did not affect LV systolic function (p-value=0.000). Interventricular septum (IVS) thickness had a significant positive correlation with LV- Myocardial performance index (MPI) and indices of DM such as HbA1c. Diastolic dysfunction was the most affected cardiac parameter in infants of diabetic mothers (p-value=0.002). The hemoglobin A1c (HbA1c) was the most significant predictor for IVS thickness in diabetic mothers' fetuses, especially with a long duration of DM (p-value=0.012). Conclusion: Fetal echocardiography in diabetic mothers is essential and the gold standard modality not only for diagnosing structural abnormalities but also for evaluating the cardiac function of the fetuses. Fetal cardiac MRI could be considered a complementary imaging modality that uses no ionizing radiation, good tissue contrast, and a larger field of view.

Gestational diabetes: The epicenter of feto-maternal crisis

Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. The rising trend in obesity and overweight globally poses a serious risk for developing GDM, more among South Asian population. The occurrence of perinatal complications seems to parallel with incidence of GDM contributing significantly to adverse pregnancy outcome. The matter of fact is that diabetes just do not affect the mothers only, but also the new-born, predisposing them to various neonatal adverse outcomes, including metabolic and cardiac disorders, and respiratory distress, as wells as neurologic impairment compromising with metal development. Further, low birth weights, macrosomia, and infections are some of the most commonly occurring outcomes of GDM, the severity of which parallels with maternal blood glucose levels and age. Further, there are higher risk of hypoglycemia among the new born of hyperglycemia diabetic mothers. The numbers are soaring high, more in developing nations, with India almost topping the list with currently, over 80 million women worldwide who are affected by GDM and pregestational diabetes mellitus. How exactly GDM affects the developing fetus is still not precisely known. Animal studies using rodent models indicated glucose mediated oxidative stress, leading to excess apoptosis in the target organs as wells production of other reactive oxygen and nitrogen species. Further, an activation of unfolded protein response leading to endoplasmic reticulum stress seems to contribute to the pathogenesis of hyperglycemia. However, what is assuring is that risk mitigation against this detrimental effect can be adopted. This involves risk assessment of pregnant females at the first prenatal visit with special focus on comorbidities such as overweight with/and obesity, glycosuria, and family history and hence should be recommended for blood glucose testing (between 24 and 28 weeks of gestation). With the prevalence of GDM reported to range from 3.8% in Kashmir 17.9% in Tamil Nadu, the stakes are high. It is also clear that India has a very high prevalence of GDM by all global standards. Rational steps to tackle this problem at the early and effectively will decide its long-term consequences on maternal and child health.

The Belgian Diabetes in Pregnancy Follow-Up Study (BEDIP-FUS): A Multi-Centric Prospective Cohort Study on the Long-Term Metabolic Risk across Different Degrees of Gestational Glucose Intolerance: Methodology and Design.

The Belgian Diabetes in Pregnancy follow-up study (BEDIP-FUS) aims to investigate the impact of body mass index (BMI), adiposity and different degrees of glucose intolerance on the metabolic profile and future risk for type 2 diabetes (T2D) in women and offspring five years after delivery in the BEDIP study. The BEDIP study was a prospective cohort study to evaluate different screening strategies for gestational diabetes (GDM) based on the 2013 WHO criteria. The aim of the BEDIP-FUS is to recruit 375 women-offspring pairs, stratified according to three different subgroups based on the antenatal result of the glucose challenge test (GCT) and oral glucose tolerance test (OGTT) during the BEDIP pregnancy. The follow-up visit consists of a 75 g OGTT, anthropometric measurements and questionnaires for the mothers, and a fasting blood sample with anthropometric measurements for the child. Primary outcome for the mother is glucose intolerance defined by the American Diabetes Association criteria and for the offspring the BMI z-score. Recruitment began in January 2021. The BEDIP-FUS study will help to better individualize follow-up in women with different degrees of hyperglycemia in pregnancy and their offspring.

CD68 expression in the placenta of gestational diabetic mothers: A case-control study.

Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with the onset or first recognition during pregnancy and is the most common metabolic complication of pregnancy. Significant maternal and fetal complications can result from undiagnosed or inadequately treated GDM. To investigate the difference in the expression of the CD-68 marker in the Hofbauer cells (HCs) and their distribution within the villi in the placentas of diabetic and non-diabetic mothers. Sixty placentas were included in the study, 30 as controls and 30 from mothers with diagnosed GDM as cases. Full-thickness cross sections of placentas were obtained. Tissue processing was done, followed by haematoxylin and eosin (H&E). A study of CD68 markers (placental macrophages) was done using standard protocols of immunohistochemistry. Frequencies and percentages of Hofbauer cells (HCs) found in case and control placental tissue were calculated. Student's t-test was used to compare two groups using SPSS 13.0 software. When P is 0.0001, differences were considered statistically significant. We studied the distribution and number of fetal macrophages (CD68+) in diabetic and non-diabetic placentas. The immunostained CD68+ cell count was identified to be significantly higher in the GDM placenta. In relation to fetal blood vessels in the villus stroma of the GDM placenta in comparison to control, CD68+ cells were found more frequently. This study shows a significant increase in the number of Hofbauer cells in the placenta of mothers with GDM in comparison to control (P < 0.0001). An increase in macrophages in these placentae might be related to the protective mechanism against inflammation. Further studies are required to investigate the mechanism in detail.

Gestational diabetes mellitus (Update 2023)

Gestational diabetes (GDM) is defined as any degree of glucose intolerance with onset during pregnancy and is associated with increased feto-maternal morbidity as well as long-term complications in mothers and the offspring. Women detected to have diabetes early in pregnancy receive the diagnosis of overt, non-gestational, diabetes (glucose: fasting ≥ 126 mg/dl, spontaneous ≥ 200 mg/dl or HbA1c ≥ 6.5% before 20weeks of gestation). GDM is diagnosed by an oral glucose tolerance test (oGTT) or increased fasting glucose (≥ 92 mg/dl). Screening for undiagnosed type2diabetes at the first prenatal visit is recommended in women at increased risk (history of GDM/pre-diabetes; malformation, stillbirth, successive abortions or birth weight > 4500 g previously; obesity, metabolic syndrome, age > 35years, vascular disease; clinical symptoms of diabetes (e.g. glucosuria) or ethnic origin with increased risk for GDM/T2DM (Arab, South- and Southeast Asian, Latin American)) using standard diagnostic criteria. Performance of the oGTT (120 min; 75 g glucose) may already be indicated in the first trimester in high-risk women but is mandatory between gestational week 24-28 in all pregnant women with previous non-pathological glucose metabolism. Following WHO recommendations, which are based on the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study, GDM is defined, if fasting venous plasma glucose is ≥ 92 mg/dl or 1 h ≥ 180 mg/dl or 2 h ≥ 153 mg/dl after glucose loading (international consensus criteria). In case of one pathological value astrict metabolic control is mandatory. After bariatric surgery we do not recommend to perform an oGTT due to risk of postprandial hypoglycemia. All women with GDM should receive nutritional counseling, be instructed in blood glucose self-monitoring and motivated to increase physical activity to moderate intensity levels-if not contraindicated (Evidence levelA). If blood glucose levels cannot be maintained in the therapeutic range (fasting < 95 mg/dl and 1 h after meals < 140 mg/dl, Evidence levelB) insulin therapy should be initiated as first choice (Evidence levelA). Maternal and fetal monitoring is required in order to minimize maternal and fetal/neonatal morbidity and perinatal mortality. Regular obstetric examinations including ultrasound examinations are recommended (Evidence levelA). Neonatal care of GDM offspring at high risk for hypoglycaemia includes blood glucose measurements after birth and if necessary appropriate intervention. Monitoring the development of the children and recommendation of healthy lifestyle are important issues to be tackled for the whole family. After delivery all women with GDM have to be reevaluated as to their glucose tolerance by a75 g oGTT (WHO criteria) 4-12weeks postpartum. Assessment of glucose parameters (fasting glucose, random glucose, HbA1c or optimally oGTT) are recommended every 2-3years in case of normal glucose tolerance. All women have to be instructed about their increased risk of type2diabetes and cardiovascular disease at follow-up. Possible preventive meassures, in particular lifestyle changes as weight management and maintenance/increase of physical activity should be discussed (evidence levelA).

TO COMPARE EFFICACY OF METFORMIN VERSUS INSULIN IN IMPROVING GLYCAEMIC CONTROL OF MATERNAL &amp; PERINATAL OUTCOME IN GESTATIONAL DIABETES MELLITUS PATIENTS

Background: Diabetes Mellitus is a great burden to society. According to ACOG, gestational diabetes mellitus is dened as, any degree of glucose intolerance that either commences, or is rst diagnosed in pregnancy Gestational diabetes mellitus pose many risks to the mother and the fetus and its consequences lead to increased maternal and fetal morbidity. Maternal complications includes increased risk of developing pre-eclampsia, preterm labour, chorioamnionitis,etc. The Fetal and Neonatal risks include Growth abnormalities like Macrosomia, Growth Restriction etc. Not enough studies are available to know the efcacy of Metformin. Our aim in this study was to compare efcacy of Metformin with Insulin. Methods: An interventional study of all women with GDM whose pregnancy was followed in the Department of Obstetrics and Gynaecology at Rohilkhand Medical College, Bareilly, U.P, India. Our study included 330 women diagnosed as Gestational Diabetes Mellitus who needed medical management for glycaemic control. Group A of 165 women were treated with Tab. Metformin 500 mg. Group B of 165 women were treated with subcutaneous Insulin. The baseline characteristics of both the groups were simi Results: lar with respect to age, enrolment, nulliparity etc. There was no signicant statistical difference (p value &gt; 0.05) between the two groups in terms of maternal and perinatal outcomes with respect to indicators like complications, HbA1c, pre eclampsia, side effects, etc. Conclusion: In our study we conclude that both metformin and insulin were equally effective in achieving the glycemic control in GDM patients. Both groups were comparable in terms of incidence of maternal and neonatal outcomes and complications with no statistical signicant difference.

Gut Microbiome Changes in Gestational Diabetes.

Gestational diabetes mellitus (GDM), one of the most common endocrine pathologies during pregnancy, is defined as any degree of glucose intolerance with onset or first discovery in the perinatal period. Physiological changes that occur in pregnant women can lead to inflammation, which promotes insulin resistance. In the general context of worldwide increasing obesity in young females of reproductive age, GDM follows the same ascending trend. Changes in the intestinal microbiome play a decisive role in obesity and the development of insulin resistance and chronic inflammation, especially in patients with type 2 diabetes mellitus (T2D). To date, various studies have also associated intestinal dysbiosis with metabolic changes in women with GDM. Although host metabolism in women with GDM has not been fully elucidated, it is of particular importance to analyze the available data and to discuss the actual knowledge regarding microbiome changes with potential impact on the health of pregnant women and newborns. We analyzed peer-reviewed journal articles available in online databases in order to summarize the most recent findings regarding how variations in diet and metabolic status of GDM patients can contribute to alteration of the gut microbiome, in the same way that changes of the gut microbiota can lead to GDM. The most frequently observed alteration in the microbiome of patients with GDM was either an increase of the Firmicutes phylum, respectively, or a decrease of the Bacteroidetes and Actinobacteria phyla. Gut dysbiosis was still present postpartum and can impact the development of the newborn, as shown in several studies. In the evolution of GDM, probiotic supplementation and regular physical activity have the strongest evidence of proper blood glucose control, favoring fetal development and a healthy outcome for the postpartum period. The current review aims to summarize and discuss the most recent findings regarding the correlation between GDM and dysbiosis, and current and future methods for prevention and treatment (lifestyle changes, pre- and probiotics administration). To conclude, by highlighting the role of the gut microbiota, one can change perspectives about the development and progression of GDM and open up new avenues for the development of innovative therapeutic targets in this disease.

Epidemio-clinical profile of gestational diabetes in two reference hospitals of Yaoundé, Cameroon

Gestational diabetes (GDM) is defined by the World Health Organization (WHO) as any degree of glucose intolerance, beginning or diagnosed during pregnancy for the first time. The global prevalence of GDM is reported to be as high as 20%. This is why we initiated the present study. The main objective of this survey was to investigate the epidemiological profile of women with GDM in two referral hospitals of Yaoundé, Cameroon. This was an observational study with descriptive longitudinal historical design, conducted at the Yaoundé Central Hospital (YCH) and the Yaoundé Gynaeco-Obstetric and Pediatric Hospital (YGOPH). The study period was from January 2018 to January 2020 and the duration of the investigation was 7 months. Data was analyzed using SPSS software (Statistical Package for the Social Sciences) version 20. A total of 34 pregnant women with GDM were identified out of 652. The overall prevalence of GDM was 5.2%. The mean age of these women was 31.8±4.4 years. Most women were multiparous (15: 44.0%). Majority (21: 61.6%) were followed by both gynecologist and endocrinologist. Known cardiovascular risk factors found were mainly smoking (34: 100%), low sports practice (20: 58%) and family history of diabetes (21: 61.1%), with first degree predominance 17 (80.5%). The first antenatal consultation (ANC) in average was at 12±2.5 weeks. Most women were symptomatic with cardinal syndrome comprising polyuria (32: 94.2%), polydipsia (22: 64.1%) and polyphagia (21: 61.6%). Majority (25: 73.3%) were managed with Insulin. GDM is prevalent and a major public health problem in our milieu. There is need for systematic screening to prevent adverse perinatal outcomes.

Does gestational diabetes mellitus influence the morphological characteristics of the placenta?

Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance, with a decrease in insulin sensitivity during pregnancy, with recognition in the second or third trimester of pregnancy and disappearing after delivery. This mini-review is to provide a broad view of some recent studies that investigated the placental morphology in cases of maternal diagnosis of gestational diabetes. A literature search was carried out in PubMed, Medline, Google Scholar data sources, verifying the morphological characteristics of the placenta in situations of diagnosis of gestational diabetes, through prospective and observational studies, with the key terms “gestational diabetes”, “placenta” and ‘morphological”. We show, in table format, the studies carried out between 2015 and 2020 with the main placental morphological changes that reflect the condition of pregnant women with diabetes mellitus, the most considered in the literature, increase in placental weight and thickness. It was evident that there are still few studies on placental changes, requiring the encouragement of scientific productions on the approach. In conclusion, understanding the mechanism of placental development allows the assessment of changes when pregnant women are diagnosed with GDM, taking into account therapeutic strategies that can intervene in glycemic and metabolic control, in order to ensure maternal-fetal health.

Gestational Diabetes Mellitus: Diagnostic Approaches and Maternal-Offspring Complications.

Gestational diabetes mellitus (GDM) is the most common complication during pregnancy and is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. GDM is associated with adverse pregnancy outcomes and long-term offspring and maternal complications. For GDM screening and diagnosis, a two-step approach (1-hour 50 g glucose challenge test followed by 3-hour 100 g oral glucose tolerance test) has been widely used. After the Hyperglycemia and Adverse Pregnancy Outcome study implemented a 75 g oral glucose tolerance test in all pregnant women, a one-step approach was recommended as an option for the diagnosis of GDM after 2010. The one-step approach has more than doubled the incidence of GDM, but its clinical benefit in reducing adverse pregnancy outcomes remains controversial. Long-term complications of mothers with GDM include type 2 diabetes mellitus and cardiovascular disease, and complications of their offspring include childhood obesity and glucose intolerance. The diagnostic criteria of GDM should properly classify women at risk for adverse pregnancy outcomes and long-term complications. The present review summarizes the strengths and weaknesses of the one-step and two-step approaches for the diagnosis of GDM based on recent randomized controlled trials and observational studies. We also describe the long-term maternal and offspring complications of GDM.

Ensemble Classifier Technique to Predict Gestational Diabetes Mellitus (GDM)

Gestational Diabetes Mellitus (GDM) is an illness that represents a certain degree of glucose intolerance with onset or first recognition during pregnancy. In the past few decades, numerous investigations were conducted upon early identification of GDM. Machine Learning (ML) methods are found to be efficient prediction techniques with significant advantage over statistical models. In this view, the current research paper presents an ensemble of ML-based GDM prediction and classification models. The presented model involves three steps such as preprocessing, classification, and ensemble voting process. At first, the input medical data is preprocessed in four levels namely, format conversion, class labeling, replacement of missing values, and normalization. Besides, four ML models such as Logistic Regression (LR), k-Nearest Neighbor (KNN), Support Vector Machine (SVM), and Random Forest (RF) are used for classification. In addition to the above, RF, LR, KNN and SVM classifiers are integrated to perform the final classification in which a voting classifier is also used. In order to investigate the proficiency of the proposed model, the authors conducted extensive set of simulations and the results were examined under distinct aspects. Particularly, the ensemble model has outperformed the classical ML models with a precision of 94%, recall of 94%, accuracy of 94.24%, and F-score of 94%.

Study of Serum Adiponectin and Interleukin-1β Levels in Women with Gestational Diabetes.

Pregnancy is associated with alterations in the regulation of glucose metabolism caused by actions of various placental hormones and substances that antagonise the action of insulin leading to a state of relative insulin resistance as pregnancy progresses. Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. Adiponectin is known to be synthesised by adipocytes as well as by the placenta during pregnancy. It has an insulin-sensitising and anti-atherosclerotic actions. Interleukin-1β (IL-1β) is a member of interleukin-1 cytokine family and is known to involve in immune-mediated disease and regulation of inflammation. Accumulating evidence indicates that diseases related to metabolic syndrome are characterised by abnormal cytokine production, including IL-1β. To evaluate serum adiponectin and IL-1β levels in women with GDM and correlate their levels with blood glucose level. A hospital-based case-control study was conducted in which 30 cases of GDM along with age-matched normal glucose tolerance (NGT) pregnant controls were taken. Informed consent was taken and subjects were screened at 24-28th weeks of gestation for GDM by glucose challenge test (GCT), followed by oral glucose tolerance test. Socio-demographic data and clinical evaluation were done using a pre-structured perfoma. Serum concentration of adiponectin and IL-1β was measured using enzyme-linked immunosorbent assay. The mean value of serum adiponectin level was significantly lower, 5.76 μg/ml SD ± 2.01351 in cases of GDM compared to NGT controls (14.12 μg/dl SD ± 4.99734), P < 0.05. A cutoff value of serum adiponectin level ≤8.7 μg/ml gave a sensitivity and specificity of 100% when used alone for identifying cases of GDM in the present study. Serum level of IL-1β was less than the detectable level (<6.5 pg/ml) in NGT controls. In this study, 26.7% of GDM cases showed levels >6.5 pg/ml (median 18.2 [12.8-34.62]), rest of the cases (73.3%) had levels less than 6.5 pg/ml. A significant inverse correlation was seen between serum adiponectin and HbA1c, pre-gestational BMI, and blood glucose level at GCT. There was no significant correlation of serum IL-1β level with any of the parameters. GDM is associated with low level of serum adiponectin, and serum adiponectin may be used as a biomarker for detecting cases of GDM to complement blood glucose level.

Feto-Maternal Outcomes and Treatment Compliance in Metformin Versus Insulin-Treated Gestational Diabetic and Non-Diabetic Patients at the Rehman Medical Institute, Peshawar.

IntroductionGestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. The diagnosis is made on the basis of the oral glucose tolerance test (OGTT) which according to the guidelines of ACOG regards a blood glucose level higher than 190mg/dL after the one-hour test as the criteria for GDM. The first-line agent for GDM is insulin injections; however, it has high costs and also causes its own feto-maternal complications which can include weight gain and polyhydramnios. On the contrary, metformin has fewer complications, is cheaper, and is emerging as a better alternative for the first-line agent for the treatment of diabetes mellitus type 2. GDM had a prevalence of 11.8% in the year 2018 in all trimesters of pregnancy in Pakistan. This study was thus conducted to determine the feto-maternal outcomes of non-GDM and GDM patients on insulin, metformin, and combined treatment respectively admitted to gynecology ward Rehman Medical Institute (RMI) Khyber Pakhtunkhwa, Pakistan in the year 2019.ObjectivesTo determine the feto-maternal outcomes in patients of GDM on metformin treatment and the feto-maternal outcomes in patients of GDM on insulin treatment and to compare the feto-maternal outcomes of mothers with GDM to those without GDM.MethodologyThis is a retrospective study conducted from January to April 2020 on patients of gestational diabetes mellitus undergoing either metformin, insulin, or both therapies admitted to the gynecology ward, Rehman Medical Institute (RMI). After getting ethical approval from the institutional ethical approval board, data were collected for the entire year of 2019 on the basis of proforma with the variables: demographic data, glycemic control (via OGTT), mode of labor, primary open-angle glaucoma (POAG), and feto-maternal outcomes. Data was entered and analyzed via SPSS version 21.0 (IBM SPSS Statistics for Windows, IBM Corp., Armonk, NY) and the data were run through various tests including descriptive statistics, cross-tabulations, and chi-square. Results were formulated on the basis of these reports which were then presented in the form of graphs and tables.ResultsOut of 150 mothers who were admitted for delivery at the gynecology ward, 123 (82.0%) women were 30-40 years of age. Non-gestational diabetics patients were 78 (52%) whereas gestational diabetic mothers were 72 (48%); within these GDM-positive mothers 44 (61.1%) were on metformin, 21 (29.1%) were on insulin and seven (9.7%) were on combined treatment. Among modes of delivery, C-section was the most common (113 [76%]), mostly in non-GDM mothers (95 [45.1%]) followed by those on metformin treatment (36 [31.8%]). Considering fetal outcomes there was a significant association between NICU admissions, neonatal jaundice, and breech presentation with insulin-treated mothers (p=0.06, p=0.003, p=0.004, respectively CI=95%). Among maternal outcomes, there was a significant association between pregnancy-induced hypertension (PIH) and insulin-treated patients (p=0.02 CI=95%), premature rupture of membranes (PROM), and metformin-treated patients (p=0.01 CI=95%) whereas eclampsia was significantly associated with mothers not having GDM (p=0.001 CI=95%).ConclusionBased on this preliminary data and considering feto-maternal outcomes, metformin appears to be a safer drug as compared to insulin in the treatment of GDM with more compliance.

Diagnosis of High-risk Gestational Diabetes

Gestational diabetes mellitus (GDM) can be defined as any degree of glucose intolerance with onset or first recognition during pregnancy. Screening for GDM is done usually at 24-28 weeks of gestation. In this case a 27-year-old primigravida who was diagnosed as GDM after a one step approach at 22 weeks of pregnancy. Institution of management early by the help of one step diagnosis was associated with successful outcome. The case highlights the importance of diagnosing GDM early especially in developing countries where resources are limited.

Comparison of one hour versus 90 minute postprandial glucose measurement in women with gestational diabetes; which one is more effective?

In the present study, we aimed to compare postprandial 90 minute measurements and postprandial 1 hour (PP1-HR) measurements for prediction of foetal growth disturbances and pregnancy complications. This was a prospective study conducted in Acıbadem Mehmet Ali Aydınlar University Altunizade Hospital in Department of Perinatology. The study group consisted of patients diagnosed with gestational diabetes. In each antepartum visit, the patients fasting plasma glucose as well as PP1-HR and 90 minute measurements were made. Perinatal and neonatal data were obtained from each patient. The rate of large for gestational age infants was increased in patients when either PP1-HR measurement above 140 mg/dl or postprandial 90 minute measurement above 165 mg/dl compared to patients with normal PP1-HR or postprandial 90 minute measurement. Preterm delivery rate was increased in patients with postprandial 90 minute measurement above 165 mg/dl but not in patients with PP1-HR measurement above 140 mg/dl. The optimal cut-off for postprandial 90 minute measurement was 165 mg/dl based on receiver operating characteristics curve. Our preliminary data show that postprandial 90 minute measurements are superior to PP1-HR measurements in predicting large for gestational age infants. Impact Statement What is already known on this subject? Gestational diabetes (GDM) is defined as any degree of glucose intolerance with onset or first recognition in pregnancy. Maternal hyperglycaemia has been linked to metabolic alterations in the foetus and thus brings about foetal macrosomia as well as other pregnancy complications such as preterm delivery and preeclampsia. What the results of this study add? The findings of the present study suggest that postprandial 90 minute predicted more cases of LGA infants than postprandial 1-hour (PP1-HR) measurements. In addition, the rate of preterm deliveries was found to be increased in patients with mean postprandial 90 minute measurements above 165 mg/dl compared to patients with postprandial 90 minute measurements below 165 mg/dl. However, the rate of preterm deliveries was similar in patients with elevated PP1-HR measurements and patients with normal PP1-HR measurements. What the implications are of these findings for clinical practice and/or further research? Our study is the first to investigate the usefulness of postprandial 90 minute in a prospective design. Our preliminary data show that postprandial 90 minute measurements are superior to PP 1 measurements in predicting LGA babies. It also correlates better with preterm deliveries.

Meta Analysis the Effect of Gestational Diabetes Mellitus on Macrosomia and Sectio Caesarea

Background: Gestational Diabetes Mellitus (GDM) is the degree of glucose intolerance that occurs during pregnancy. DMG is caused by damage to cells and insulin resistance, resulting in hyperglycemia and an increase in abnormal growth/macrosomia which causes cesarean delivery. This study aims to analyze the magni­tude of the effect of DMG on the incidence of macrosomia and caesarean section with a meta-analysis study. Subjects and Method: This research is a systematic review and meta-analysis conducted using PRISMA flow diagram. Article searches were conducted through journal databases including: PubMed, Science Direct, and Google Scholar by selecting articles published in 2000-2020. The keywords used were: "gestational diabetes mellitus" OR "diabetes in pregnancy" AND macrosomiaAND "sectio caesarean" OR "perinatal outcomes" OR "pregnancy outcome". The inclusion criteria in this study were full text articles with an observational study design, articles using English, analysis using multi­variate with adjusted odds ratio. Eligible arti­cles were analyzed using Revman 5.3 app. Results: A total of 22 articles were reviewed in this study with a cohort study design. Meta-analysis of 12 articles showed that pregnant women with gestational diabetes mellitus had a 1.36 times risk of giving birth to a macrosomic baby compared to those without gestational diabetes mellitus (aOR=1.36; 95% CI=1.15 to 1.60; p&lt;0.003), while 10 articles showed preg­nant women with gestational diabetes mellitus had a 1.35 times risk for cesarean delivery than those without gestational diabetes mellitus (aOR=1.35; 95% CI=1.17 to 1.55; p&lt;0.001). Conclusion: Gestational Diabetes Mellitus has a weak effect on macrosomia births and caesarean section.

No Differences in Metabolic Parameters Between Roux-en-Y Gastric Bypass and Sleeve Gastrectomy, Regardless of Achieved Weight Loss

Background: Roux-en-y (RYGB) is considered a procedure with more malabsorptive impact than sleeve Gastrectomy (SG), so the risk of chronic complications seems greater. Aim: To describe the metabolic profile and weight regain of patients who underwent bariatric surgery, according to each procedure. Method: A retrospective cohort with patients who underwent bariatric surgery (2003–2018). The sample was divided into SG group and RYGB group. Comparisons were made to analyze the relationship between the procedure itself and metabolic improvements, weight loss and weight regain. Results: We included 117 eligible participants (91.5 % female, 51.2% RYGB surgery), mean follow-up was 4.4± 3.3 years. Mean age was 41.8±6.8 years, without significant difference between the groups. Before the surgery, the groups were similar according metabolic profile (fasting glucose, Hba1c, total cholesterol, LDLc, triglycerides and HOMA IR), except by non-HDLc (RYGB 108.8±26.3 vs SG 127.2±33.2 mg/dl, p=0,002) and 25OHD (RYGB 28.9±4,7 vs SG 34.3±9,5 ng/ml, p=0.044). The RYGB group had greater weight than the SG group (mean 114.1±13.5 kg vs 122.7±20.5 Kg, p<0.0001) and almost 23.3% of the participants had T2DM and 36.2% of them had systemic arterial hypertension, without significant difference between the groups. The RYGB group had a greater postoperative time than the SG group (mean 5.0±4.0 vs 3.6± 2.9 years, respectively). After the surgery, although weight loss was greater in the RYGB group than the SG group (mean 39%±10.2 vs 34.1%±9.8, p<0.0001, respectively), both groups were similar regarding BMI, body fat percentage (BFP) and abdominal circumference. Also, there were no differences in the metabolic profile (fasting glucose, Hba1c, HOMA IR, leptin, triglycerides and HDLc), according to the type of surgery, except in the total cholesterol and LDLc levels (RYGB 167.9±28.2 vs SG 187.9±35.1 and RYGB 92.6±25.6 vs SG 109.5±30.8). Nearly the whole sample (95%) has reached > 20% weight loss. Despite that, 37.6% of the patients have regained > 20% of weight loss, with no relation regarding the type of surgery. Only 7% of the patients remained with some degree of glucose intolerance, with no difference between the groups. Conclusion: We found similar benefits among metabolic markers and weight regain after SG, compared to RYGB.

A systematic review and meta-analysis of the prevalence and determinants of gestational diabetes mellitus in Nigeria.

Background:Gestational diabetes mellitus (GDM) is any degree of glucose intolerance with onset or first diagnosis in pregnancy. GDM has numerous potential complications and it is important to estimate its burden and risk factors. The objective of the meta-analysis was to determine the pooled prevalence of GDM in Nigeria and identify its determinants.Methods:The study design was a meta-analysis; therefore the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Electronic databases (African Journal Online, PubMed, SCOPUS, and Google Scholar) and the gray literature were systematically searched. Statistical analysis was done with MetaXL using the random effect model. Heterogeneity was determined using the I2 statistic and the publication bias was checked with the Doi plot.Results:The total sample size was 46 210. The prevalence of GDM in Nigeria was 0.5 – 38% and the pooled prevalence was 11.0% (95% CI 8-13). The I2 statistic was 99%. The Doi plot suggested some degree of bias. The most frequently reported determinants of GDM were previous macrosomic babies, maternal obesity, family history of diabetes, previous miscarriage, and advanced maternal age.Conclusion:The prevalence of GDM in Nigeria is high and efforts should be geared at modifying its risk factors so as to reduce its prevalence and prevent the associated complications.