Diagnosis Of Diabetes In Pregnancy Research Articles

Factors affecting the quality of life in pregnant women with diabetes: the mediating effect of illnesses acceptance

IntroductionGestational diabetes, as a disorder of carbohydrate metabolism, is considered one of the most common metabolic complications in pregnancy. The diagnosis of diabetes in pregnancy leads to changes in lifestyle, and the treatments employed can affect various aspects of pregnant women’s lives, including their quality of life. The present study aimed to investigate the relationship between self-efficacy and the mediating effect of illness acceptance on the quality of life in pregnant women diagnosed with diabetes during pregnancy.Materials and methodsThis cross-sectional study was conducted on 240 pregnant women diagnosed with diabetes who were selected by convenience sampling method. Quality of life tools (SF12), the Acceptance of Illness Scale (AIS), and the Sherer self-efficacy scale were used to collect data.ResultsThe mean (SD) of quality of life, self-efficacy, and disease acceptance were 57.36 (6.63), 51.75 (7.44), and 29.07 (7.69), respectively. In the single-variable regression analysis, self-efficacy and disease acceptance variables could predict 20.6% (β = 0.457, P < 0.001) and 14.4% (β = 0.385, P < 0.001) of the variations in quality of life, respectively. In the multiple regression model, by entering the two main variables (self-efficacy and Acceptance of Illness), demographic characteristics, three disease knowledge variables, health status from an individual perspective, and type of treatment, the variables could explain 25% of the changes of the quality of life (R2adj 0.25, P < 0.001=). Income status and self-efficacy had the highest impact among the variables. According to the results of path analysis, the total effect of self-efficacy on the quality of life of pregnant women with diabetes was 0.711.ConclusionThe overall quality of life in women with diabetes was moderate, and self-efficacy, illness acceptance, and income status were predictors of overall quality of life. Self-efficacy can influence the quality of life by affecting disease acceptance. The findings highlight the importance of designing educational programs and providing midwifery services to increase self-efficacy and illness acceptance to improve the quality of life of pregnant women with diabetes.

First-trimester HbA1c in relation to plasma glucose concentrations in an oral glucose tolerance test at 12 to 16 weeks’ gestation—a population-based study

BackgroundEarly-onset GDM often requires pharmacological treatment and is associated with adverse perinatal outcomes, but data is insufficient regarding the best methods to identify high-risk women requiring early GDM screening. The aim of this study was to analyze the diagnostic accuracy of HbA1c in the prediction of (1) plasma glucose concentrations > 90th percentile in an oral glucose tolerance test (OGTT) at 12–16 weeks’ gestation; and (2) pharmacologically treated early- or late-onset GDM.MethodsHbA1c was measured at 8—14 weeks’ gestation in a population-based cohort of 1394 Finnish women recruited for the Early Diagnosis of Diabetes in Pregnancy (EDDIE) study between 3/2013 and 12/2016. Information on maternal risk factors were collected at recruitment. Subsequently, a 2-hour 75 g OGTT was performed at 12—16 weeks’ gestation (OGTT1), and if normal, repeated at 24–28 weeks’ gestation (OGTT2). Early- and late-onset GDM were diagnosed using the same nationally endorsed cut-offs for fasting, 1 h- and 2 h-plasma glucose: ≥5.3, ≥ 10.0mmol/l, and/or ≥ 8.6mmol/l, respectively. In total, 52/1394 (3.7%) women required metformin or insulin treatment for GDM, including 39 women with early-onset GDM diagnosed at OGTT1 and 13 women with late-onset GDM diagnosed at OGTT2.ResultsMaternal early-pregnancy HbA1c ≥ 35mmol/mol (≥ 5.4%) was the best cut-off to predict fasting or post-load plasma glucose > 90th percentile in OGTT1, but its diagnostic accuracy was low [AUC (95% CI) 0.65 (0.62 to 0.69), sensitivity 0.55 (0.49 to 0.60) and specificity 0.67 (0.64 to 0.70)] both alone and in combination with other maternal risk factors. However, HbA1c ≥ 35mmol/mol correlated positively with plasma glucose concentrations at all time points of OGTT1 and predicted pharmacologically treated GDM diagnosed at OGTT1 or OGTT2; AUC (95% CI) 0.75 (0.68 to 0.81), sensitivity 0.75 (0.61 to 0.86), specificity 0.64 (0.61 to 0.66).ConclusionsIn our population-based cohort, early-pregnancy HbA1c ≥ 35mmol/mol was positively associated with fasting and post-load plasma glucose concentrations in an OGTT at 12—16 weeks’ gestation and predicted pharmacologically-treated early- and late-onset GDM, suggesting potential utility in first-trimester identification of women at high risk of severe GDM subtypes.

1280-PUB: The Impact of Proactive and Personalized Strategies in the Self-Monitoring of Blood Glucose in Women with Diabetes in Pregnancy: The Experience of the Cohort Cuido Mi Embarazo in Mexico

Women with Diabetes in Pregnancy (DP) have a higher risk of maternal-fetal complications, unfortunately in Mexico, its detection is only carried out in 1% of cases, and glucometers and glucose strips are not available for self-monitoring of blood glucose (SMBG). The cohort Cuido mi Embarazo (CME) ensures supplies for the Oral Glucose Tolerance Test (OGTT) and glucose screening through MIDO Embarazo®. Educational strategies have been implemented for health personnel focused on prevention, diagnosis and management. Patients with DP have been offered medical and nutritional counseling, and digital glucometers and glucose strips for SMBG. Up to now, 854 women are actively monitored and have performed the OGTT. 117 women have been found with diabetes, of which 96 (82.05%) are Gestational Diabetes (GDM) and 21 (17.95%) are pre-gestational diabetes, finding a prevalence of GDM of 11.2%. Regarding the SMBG in 84 women with diabetes that completed their pregnancy, 62 (73.8%) completed glucose measurements, representing a higher figure than the international literature. From those patients that completed their pregnancy with complete SMBG according to international standards, 39 (62.9%) women achieved control, 23 (37.1%) did not achieve control. No cases of children with macrosomia were detected. In the framework of the CME Cohort, it is demonstrated that: 1) Performing the OGTT and capillary glucose screening through MIDO Embarazo® allow the timely detection of DP. 2) Providing digital glucometers and glucose strips for SMBG, guarantees measurement, increases adherence and glucose control, and improves the health of the newborn and the mother. 3) The systematic approach that also includes the proactive participation of health professionals in the health center is a key element for success for the timely and adequate diagnosis of DP. These conclusions represent a significant public health lesson in Mexico. Disclosure L. Martinez-juarez: Research Support; Self; Lilly Global Health Partnership. R. Tapia-conyer: None. J. Lomelin-gascon: None. J. Ortega-montiel: Research Support; Self; Lilly Global Health Partnership. A. Benitez-herrera: None. D. Reyes-gómez: None. M. Carmona-ramos: None. L. Hernández-gonzález: None. E. Reyes-muñoz: Consultant; Self; Nestlé, Research Support; Self; Nestlé. H. Gallardo-rincón: None. Funding Eli Lilly and Company

Inpatient Glycemic Management of the Pregnant Patient.

There is a rising prevalence of type 1 diabetes (T1DM), type 2 diabetes (T2DM), and gestational diabetes (GDM) in pregnancy. Reaching and maintaining glycemic targets during and after this time are important for both the health of the mother and her baby. Based on recently published guidelines from various societies, we review the diagnosis of diabetes in pregnancy, types of therapies available to maintain euglycemia, important keys to management of T1DM, T2DM, and GDM, and strategies for reaching inpatient glycemic targets during the peripartum period. Care for pregnant patients with T1DM is especially challenging, and providers should be aware of the varying insulin requirements at different stages of pregnancy and how to reduce hypoglycemia and avoid diabetic ketoacidosis. Insulin sensitivity fluctuates throughout pregnancy due to physiologic changes, especially during labor and delivery and immediately post-partum. We review recommendations regarding how to manage this dynamic time and present our own institution's inpatient management protocol. Finally, we review management of diabetes post-partum, including medications, breast-feeding, and continued monitoring and screening. With the collaborative efforts of the patient and an interdisciplinary team and in-depth knowledge of the most up-to-date management principles, it is possible to achieve euglycemia during this critical time of a mother and baby's life.

Early diabetes screening in pregnancy.

The present literature review was conducted to evaluate early diabetes screening in pregnancy. The review focuses on the various guidelines for early screening, the target populations for screening, and the assessment of various early screening targets and strategies. The advantages and disadvantages of each screening method are highlighted. The review emphasizes that there are no validated criteria for selecting high-risk pregnant women for early screening. The different early screening modalities, including fasting plasma glucose, random plasma glucose, postload glucose, and hemoglobin A1c, lack concordance and have not been validated for the early diagnosis of diabetes in pregnancy. Moreover, the benefit of early screening by earlier initiation of treatment has not been shown. Until a randomized controlled trial demonstrates benefit to screening and validates a particular screening method, it is not possible to provide evidence to support any single strategy for early diabetes screening in pregnancy.

Barriers of Adherence and Possible Solutions to Nonadherence to Antidiabetic Therapy in Women with Diabetes in Pregnancy: Patients' Perspective.

Diabetes in pregnancy contributes to maternal mortality and morbidity though it receives little attention in developing countries. The purpose of the study was to explore the barriers to adherence and possible solutions to nonadherence to antidiabetic therapy in women with diabetes in pregnancy. Antidiabetic therapy referred to diet, physical activity, and medications. Four focus group discussions (FGDs), each with 7 participants, were held at a central hospital in Zimbabwe. Included were women with a diagnosis of diabetes in pregnancy, aged 18 to 49 years, and able to speak Shona or English. Approval was obtained from respective ethical review boards. FGDs followed a semistructured questionnaire. Detailed notes were taken during the interviews which were also being audiotaped. Data were analysed thematically and manually. Themes identified were barriers and possible solutions to nonadherence to therapy. Barriers were poor socioeconomic status, lack of family, peer and community support, effects of pregnancy, complicated therapeutic regimen, pathophysiology of diabetes, cultural and religious beliefs, and poor health care system. Possible solutions were fostering social support, financial support, and improvement of hospital services. Individualised care of women with diabetes is essential, and barriers and possible solutions identified can be utilised to improve care.

Development of an Adherence Promotion Framework for Women with Diabetes in Pregnancy to Improve Adherence to Anti-Diabetic Therapy and Perinatal Outcomes

Diabetes is now a major public health problem especially in developing countries. The purpose of this study was to develop an adherence promotion framework for diabetes in pregnancy. The study followed a mixed methods sequential dominant status design utilizing both quantitative and qualitative methods. Approval for the study was granted by the respective ethical review committees. All participants gave informed consent. The quantitative phase was conducted with a cohort of 157 pregnant women with a diagnosis of diabetes in pregnancy. The exposure was adherence to anti-diabetic therapy while the outcomes were perinatal outcomes. Data was collected using semi structured interviews and was analyzed using the Statistical Package for the Social Sciences (SPSS) version 20 and STATA. A descriptive qualitative design was used in the qualitative phase where four focus group discussions (FGDs) were held with pregnant women with diabetes. Eight key informant interviews (KII) were conducted with health professionals. Thematic analysis was separately done for the FGDs and KIIs. Adherence to anti-diabetic therapy was suboptimal and the mean was 66.7%. The most common adverse perinatal outcomes were (34.4%), caesarean delivery (45.9%) and macrosomia (33.8%). There were significant associations between adherence and caesarean delivery (RR 1.90 CI 0.8 to 2.03 p>0.001), low Apgar score (RR 1.95 CI 1.03 to 3.69 p>0.039) and perinatal mortality (RR 3.08 CI 1.11 to 8.52 p>0.018). Some barriers to adherence identified in the qualitative phase were financial barriers and lack of social support. Contextual factors deduced from the study were used to develop the Adherence Promotion Framework. Chinn and Kramer’s theory of knowledge development was used to guide development of the Framework.

Nutritional manipulation for the primary prevention of gestational diabetes mellitus: a meta-analysis of randomised studies.

IntroductionThe rise in gestational diabetes (GDM), defined as first onset or diagnosis of diabetes in pregnancy, is a global problem. GDM is often associated with unhealthy diet and is a major contributor to adverse outcomes maternal and fetal outcomes. Manipulation of nutrition has the potential to prevent GDM.MethodsWe assessed the effects of nutritional manipulation in pregnancy on GDM and relevant maternal and fetal outcomes by a systematic review of the literature. We searched MEDLINE, EMBASE, and Cochrane Database from inception to March 2014 without any language restrictions. Randomised controlled trials (RCT) of nutritional manipulation to prevent GDM were included. We summarised dichotomous data as relative risk (RR) and continuous data as standardised mean difference (SMD) with 95% confidence interval (CI).ResultsFrom 1761 citations, 20 RCTs (6,444 women) met the inclusion criteria. We identified the following interventions: diet-based (n = 6), mixed approach (diet and lifestyle) interventions (n = 13), and nutritional supplements (myo-inositol n = 1, diet with probiotics n = 1). Diet based interventions reduced the risk of GDM by 33% (RR 0.67; 95% CI 0.39, 1.15). Mixed approach interventions based on diet and lifestyle had no effect on GDM (RR 0.95; 95% CI 0.89, 1.22). Nutritional supplements probiotics combined with diet (RR 0.40; 95% CI 0.20, 0.78) and myo-inositol (RR 0.40; 95% CI 0.16, 0.99) were assessed in one trial each and showed a beneficial effect. We observed a significant interaction between the groups based on BMI for diet-based intervention. The risk of GDM was reduced in obese and overweight pregnant women for GDM (RR 0.40, 95% CI 0.18, 0.86).ConclusionsNutritional manipulation in pregnancy based on diet or mixed approach do not appear to reduce the risk of GDM. Nutritional supplements show potential as agents for primary prevention of GDM.

Maternal clinical diagnoses and hospital variation in the risk of cesarean delivery: analyses of a National US Hospital Discharge Database.

Cesarean delivery is the most common inpatient surgery in the United States, where 1.3 million cesarean sections occur annually, and rates vary widely by hospital. Identifying sources of variation in cesarean use is crucial to improving the consistency and quality of obstetric care. We used hospital discharge records to examine the extent to which variability in the likelihood of cesarean section across US hospitals was attributable to individual women's clinical diagnoses. Using data from the 2009 and 2010 Nationwide Inpatient Sample from the Healthcare Cost and Utilization Project--a 20% sample of US hospitals--we analyzed data for 1,475,457 births in 1,373 hospitals. We fitted multilevel logistic regression models (patients nested in hospitals). The outcome was cesarean (versus vaginal) delivery. Covariates included diagnosis of diabetes in pregnancy, hypertension in pregnancy, hemorrhage during pregnancy or placental complications, fetal distress, and fetal disproportion or obstructed labor; maternal age, race/ethnicity, and insurance status; and hospital size and location/teaching status. The cesarean section prevalence was 22.0% (95% confidence interval 22.0% to 22.1%) among women with no prior cesareans. In unadjusted models, the between-hospital variation in the individual risk of primary cesarean section was 0.14 (95% credible interval 0.12 to 0.15). The difference in the probability of having a cesarean delivery between hospitals was 25 percentage points. Hospital variability did not decrease after adjusting for patient diagnoses, socio-demographics, and hospital characteristics (0.16 [95% credible interval 0.14 to 0.18]). A limitation is that these data, while nationally representative, did not contain information on parity or gestational age. Variability across hospitals in the individual risk of cesarean section is not decreased by accounting for differences in maternal diagnoses. These findings highlight the need for more comprehensive or linked data including parity and gestational age as well as examination of other factors-such as hospital policies, practices, and culture--in determining cesarean section use. Please see later in the article for the Editors' Summary.

Pregnancy and Diabetes Management: Advances and Controversies

The treatment of diabetes in pregnancy has potentially far-reaching benefits for both pregnant women with diabetes and their children and may provide a cost-effective approach to the prevention of obesity, type 2 diabetes mellitus, and metabolic syndrome. Early and accurate diagnosis of diabetes in pregnancy is necessary for optimizing maternal and fetal outcomes. Optimal control of diabetes in pregnancy requires achieving normoglycemia at all stages of a woman's pregnancy, including preconception and the postpartum period. In this review we focus on new universal guidelines for the screening and diagnosis of diabetes in pregnancy, including the 75-g oral glucose tolerance test, as well as the controversy surrounding the guidelines. We review the best diagnostic and treatment strategies for the pregestational and intrapartum periods, labor and delivery, and the postpartum period, and discuss management algorithms as well as the safety and efficacy of diabetic medications for use in pregnancy. Global guidelines for screening, diagnosis, and classification have been established, and offer the potential to stop the cycle of diabetes and obesity caused by hyperglycemia in pregnancy. Normoglycemia is the goal in all aspects of pregnancy and offers the benefits of decreased short-term and long-term complications of diabetes.

New Recommendations for the Diagnosis of Diabetes in Pregnancy

New Recommendations for the Diagnosis of Diabetes in Pregnancy

Establishing consensus criteria for the diagnosis of diabetes in pregnancy following the HAPO study

The current diagnostic criteria for gestational diabetes mellitus are controversial because they lack correlation to maternal and perinatal outcome. The results of the hyperglycemia and adverse pregnancy outcome (HAPO) study demonstrate a linear association between increasing levels of fasting, 1- and 2-h plasma glucose post a 75 g oral glucose tolerance test to several significant outcome endpoints, such as birth weight above the 90th percentile, cord blood serum C-peptide level above the 90th percentile, primary cesarean delivery, clinical neonatal hypoglycemia, premature delivery, shoulder dystocia or birth injury, intensive neonatal care admission, hyperbilirubinemia, and preeclampsia. A consensus report by the IADPSG, based on a vigorous assessment of the HAPO results and other studies, recommended an endorsement of risk-based, internationally accepted criteria for the diagnosis and classification of diabetes in pregnancy. This review follows the steps from defining the problem to the endpoint of achieving a worldwide policy change.

P150 Screening and diagnosis of diabetes in pregnancy – a need to change the attitudes and practices of obstetricians in India

International Journal of Gynecology & ObstetricsVolume 107, Issue S2 p. S454-S454 Poster presentations P150 Screening and diagnosis of diabetes in pregnancy – a need to change the attitudes and practices of obstetricians in India U. Thanawala, U. ThanawalaSearch for more papers by this author U. Thanawala, U. ThanawalaSearch for more papers by this author First published: 20 November 2009 https://doi.org/10.1016/S0020-7292(09)61641-6AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume107, IssueS2Abstracts of XIX FIGO World Congress of Gynecology and ObstetricsOctober 2009Pages S454-S454 RelatedInformation

Fetal lung development in pregnancies of diabetic women assessed by quantitative ultrasonic tissue characterization

This study was performed to compare quantitative ultrasonic tissue characterization of the fetal lung at different gestational ages in uncontrolled diabetic patients with that in normal uncomplicated pregnancies. A total of 44 women at 24-37 weeks' gestation with the diagnosis of diabetes in pregnancy were enrolled. Data were compared to those of the control group, which consisted of 140 women with uncomplicated pregnancies of the same gestational age. Longitudinal and transverse sections of the fetal thorax and upper abdomen were examined. A region of interest of constant size was defined and the tissue-specific gray scale was determined by using interactive software. Compared with normal pregnancies, fetal lungs of diabetic pregnancies have a higher echogenicity between 28 and 37 weeks of gestation. The lung mean gray values (MGV) only differed significantly between 30 and 31 weeks of gestation in the group with diabetes (P = 0.033) compared to the control group. The MGV of the liver in diabetic and normal pregnancies is similar during pregnancy, significant differences being found only at 30-31 weeks of gestation (P = 0.038). The lung-to-liver ratio in the control group showed a significant increase from 24 to 31 weeks and a slight non-significant decrease after 31 weeks. The ratio in the group with diabetes increased slightly up to week 33 and decreased slightly afterwards. Fetal lung MGV in uncontrolled diabetic pregnancies compared to that in uncomplicated pregnancies differs significantly only between 30 and 31 weeks of gestation.