Prevalence Of GDM Research Articles

1066 Defining cutoffs for 1-hour GCT in early diagnosis of gestational diabetes

To determine the ideal cutoff for the 1-hour 50-gram glucose challenge test performed prior to 16 weeks of gestation Single center retrospective cohort study of adult singleton pregnant women who had glucose challenge (GCT) and tolerance testing (GTT) prior to 16 weeks (early) or between 24 and 28 weeks of gestation (routine), sent to the laboratory at Weill Cornell Medicine between December 2007 and June 2017. We calculated the sensitivity, specificity and Youden Index of cutoffs between 130 mg/dL and 199 mg/dL for the early GCT and routine GCT. 20,619 women met study criteria, overall prevalence of GDM was 14.9% (7.4% early diagnosis, 17.2% routine diagnosis). Youden index estimates optimal cutoff value of 132 mg/dL for early GCT with corresponding sensitivity and specificity of 100% and 80% whereas optimal cutoff for routine GCT was 130mg/dL with corresponding sensitivity and specificity of 100% and 82%. Area under the curve for early GCT is 0.95 ± 0.0022 and for routine GCT is 0.95 ± 0.0074 (p=0.81). Both the early and routine GCT are good screening tests with optimal cutoff values of 132 mg/dL and 130mg/dL, respectively. Lower cutoffs are crucial in order to capture all cases of GDM within the population. As the ROC for the early and late GCT are similar, using a similar threshold for the early GCT is clinically justified. Further studies are needed to correlate cutoff values with clinical outcomes.

CORRELATION BETWEEN BLOOD GLUCOSE LEVEL AND BODY MASS INDEX AMONG PREGNANT WOMEN WITH EXCESS BODY WEIGHT

Amount of 207 million (83.6%) women who give birth simultaneously are diagnosed with GDM in 2019. Prevalence of GDM reaches 1.9-3.6% in Indonesia. Amount of 40-60% of GDM will suffer from postpartum Non-Dependent Insulin Diabetes Mellitus. Hence, this study was aimed to look for the distribution of blood sugar levels among pregnant women who are overweight. This research was performed among pregnant women in the Obstetrics and Gynecology polyclinic of Royal Prima Medan Hospital against 41 people as the sample with a cross-sectional model (Longitudinal study). The aspects evaluated in this study were age, gestational age, BMI, occupation, income, recent education, history of gestational DM, Macrosomia, and obstetrics. All research data was analyzed with SPSS 25 by spearman correlation. The trend of random et blood sugar levels of pregnant women as respondents was 100 mg/dL, while the BMI tendency was 31.72 kg/m2. Based on these parameters, they had a correlation with each other among overweight pregnant women (Value P = 0.007) that was moderate (R = 0.417). Blood sugar levels were moderate correlated with BMI among pregnant women with excess body weight.

BMI and risk of gestational diabetes among women of South Asian and Chinese ethnicity: a population-based study.

The aim of this study was to examine how BMI influences the association between Asian ethnicity and risk of gestational diabetes (GDM). This population-based cohort study included pregnant women without pre-existing diabetes mellitus in Ontario, Canada between 2012 and 2014. Women of Chinese and South Asian ethnicity were identified using a validated surname algorithm. GDM was ascertained using hospitalisation codes. The relationship between ethnicity and GDM was modelled using modified Poisson regression, adjusted for maternal age, pre-pregnancy BMI, parity, previous GDM, long-term residency status, income quintile and smoking status. An interaction term between ethnicity and pre-pregnancy BMI was tested. Of 231,618 pregnant women, 9289 (4.0%) were of South Asian ethnicity and 12,240 (5.3%) were of Chinese ethnicity. Relative to women from the general population, in whom prevalence of GDM was 4.3%, the adjusted RR of GDM was higher among those of South Asian ethnicity (1.81 [95% CI 1.64, 1.99]) and Chinese ethnicity (1.66 [95% CI 1.53, 1.80]). The association between GDM and Asian ethnicity remained significant across BMI categories but differed according to BMI. The prevalence of GDM exceeded 5% at an estimated BMI of 21.5kg/m2 among South Asian women, 23.0kg/m2 among Chinese women and 29.5kg/m2 among the general population. The risk of GDM is significantly higher in South Asian and Chinese women, whose BMI is lower than that of women in the general population. Accordingly, targeted GDM prevention strategies may need to consider lower BMI cut-points for Asian populations.

Increasing prevalence of gestational diabetes mellitus when implementing the IADPSG criteria: A systematic review and meta-analysis

Quantify the proportional increase in gestational diabetes (GDM) prevalence when implementing the new International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria compared to prior GDM criteria, and to assess risk factors that might affect the change in prevalence. A systematic review and meta-analysis was performed of cohort and cross-sectional studies between January 1, 2010 to December 31, 2018 among pregnant women with GDM using IADPSG criteria compared to, and stratified by, old GDM criteria. Web of science, PubMed, EMBASE, Cochrane, Open Grey and Grey literature reports were included. The relative risk for each study was calculated. Subgroup analyses were performed by maternal age, body mass index, study design, country of publication, screening method, sampling method and data stratified according to diagnostic criteria. Thirty-one cohort and cross-sectional studies with 136 705 women were included. Implementing the IADPSG criteria was associated with a 75% (RR 1.75, 95% CI 1.53-2.01) increase in number of women with GDM with evidence of heterogeneity. The IADPSG criteria increase the prevalence of GDM, but allow movement towards more homogeneity. More studies are needed of the benefits, harms, psychological effects and health costs of implementing the IADPSG criteria.

Feasibility of a Dietary Intervention to Limit Gestational Weight Gain and Gestational Diabetes in Overweight and Obese Pregnant Women

Background: Maternal overweight and obesity rates are rising. Increasingly, pregnant women are gaining weight in excess of gestational weight gain (GWG) recommendations, which is a risk factor for gestational diabetes (GDM). The aim of this study was to test the feasibility of a pilot dietary intervention to limit GWG and GDM and to examine eating behavior and dietary intake in pregnant women with overweight and obesity. Methods: Pregnant women (n=17) were recruited for a dietary intervention during the first trimester at antenatal maternal health clinics. Public health nurses recruited women with overweight and obesity into intervention (n=9) and control groups (n=8). The dietary intervention included printed material on healthy eating for all participants, plus two dietary counseling sessions with a clinical nutritionist for the intervention group. The Three Factor Eating Questionnaire R-18 (TFEQ R-18), Binge Eating Scale (BES), and 4-day food records were used for all participants to assess their eating behaviors and dietary intake during the study. GWG and the results of all oral glucose tolerance tests (OGTT) were collected at the end of pregnancy. Results: GWG during pregnancy was 9.7 ± 4.4 kg (mean ± SD) in the intervention group and 13.0 ± 3.4 kg in the control group (p=0.165). The prevalence of GDM was 42.9% in the intervention group and 33.3% in the control group (p= 0.725). Conclusions: This approach could be applicable in a larger group as a potential intervention to help control GWG and promote the health of pregnant women with overweight and obesity.

Prevalence of Gestational Diabetes Mellitus among pregnant women attending for antenatal care- A Hospital based study

GDM is a condition in which high blood glucose level is exhibited in a women during pregnancy without a previous diagnosis of Diabetes Mellitus. Indian women are considered to be more prone for developing GDM. The increasing prevalence of GDM may be due to obesity, family history of Diabetes Mellitus, sedentary lifestyle, genetic predisposition and dietary habits. The screening and management of GDM in the general population remain controversial with conflicting guidelines and treatment protocols. Adequate blood sugar control in GDM women might reduce various maternal, foetal and neonatal complications. Prospective Observational study was done to find out the prevalence and risk factors of GDM. The study was conducted in the OBG department of the study center and pregnant women with 24-28 weeks of gestation attending for antenatal care were included. The results obtained from the study says the prevalence of GDM was found to be 16% in the study center, which is at par with South Indian prevalence. This study concludes that GDM is largely associated with a family history of diabetes mellitus, obesity and higher maternal age in that particular study setup.

Gestational Diabetes in the Arab Gulf Countries: Sitting on a Land-Mine.

Type 2 diabetes mellitus (T2DM) has become a modern-day plague by reaching epidemic levels throughout the world. Due to its similar pathogenesis, gestational diabetes (GDM) increases in parallel to T2DM. The prevalence of T2DM (3.9–18.3%) and GDM (5.1–37.7%) in countries of the Arab Gulf are amongst the highest internationally, and they are still rising precipitously. This review traces the reasons among the Arab nations for (a) the surge of T2DM and GDM and (b) the failure to contain it. During the last five decades, the massive oil wealth in many Arab countries has led to the unhealthy lifestyle changes in physical activity and diet. The excess consumption of calories turned the advantageous genes, originally selected for the famine-like conditions, detrimental: fueling obesity and insulin resistance. Despite genetic differences in these populations, GDM—a marker for future obesity and T2DM—can overcome this scourge of T2DM through active follow-up and screening after delivery. However, the health policies of most Arab countries have fallen short. Neglecting this unique chance will miss an irreplaceable opportunity to turn the tide of the T2DM and obesity epidemic in the Middle Eastern Arab Gulf countries—as well as globally.

Prevalence of early-onset GDM and associated risk factors in a university hospital in Thailand

This retrospective cohort study aimed to determine prevalence of GDM diagnosed before 24 weeks of gestation (early-onset GDM) and evaluate associated risk factors and compare pregnancy outcomes between different GDM status. A total of 1200 pregnant women attending antenatal clinic before 24 weeks of gestation were included. GDM screening was offered during first visit and repeat during 24–28 weeks of gestation, using 50-g GCT and 100-g OGTT. GDM was diagnosed in 110 women (13.9%) and early-onset GDM was found in 57 women (9.2%), which accounted for 65.9% of all GDM. Early-onset GDM had significant lower gestational weight gain and higher rates of preeclampsia, LGA infants, and NICU admission. Independent associated factors for early-onset GDM were age ≥30 years (aOR 4.89, 95%CI: 2.08–11.50, p < .001), and previous GDM (aOR 12.26, 95%CI: 3.86–38.93, p < .001) while DM in family was the only independent factor for late-onset GDM (aOR 2.53, 95%CI: 1.42–4.51, p = .002). IMPACT STATEMENT What is already known on this subject? Reported prevalence of early-onset GDM varies between studies, depending on the screening strategy and criteria used. Despite treatment, early-onset GDM has been associated with increased adverse maternal and neonatal outcomes in many previous studies. The risks associated with early-onset GDM and the evidence for benefit of early treatment are still unclear. What do the results of this study add? The results showed that early-onset GDM accounted for majority (65.9%) of all GDM. Despite treatment, early-onset GDM increased risk of preeclampsia, LGA infants, and NICU admission. Independent associated factors for early-onset GDM were age ≥30 years, and previous GDM while DM in family was the only independent factor for late-onset GDM. What are the implications of these findings for clinical practice and/or further research? Early GDM screening and intensive management, especially in high-risk women, should be implemented to minimise the risks of adverse outcomes. Further studies are needed to determine appropriate criteria to define early-onset GDM and to identify women at higher risk in different population and settings with different screening strategies. Effective management and approaches for this subgroup of GDM should also be further investigated.

Attenuated early pregnancy weight gain by prenatal lifestyle interventions does not prevent gestational diabetes in the LIFE-Moms consortium

To examine the effect of lifestyle (diet and physical activity) interventions on the prevalence of GDM, considering the method of GDM ascertainment and its association with early pregnancy characteristics and maternal and neonatal outcomes in the LIFE-Moms consortium. LIFE-Moms evaluated the effects of lifestyle interventions to optimize gestational weight gain in 1148 pregnant women with BMI≥25kg/m2 and without known diabetes at enrollment, compared with standard care. GDM was assessed between 24 and 31-weeks gestation by a 2-hour, 75-gram OGTT or by local clinical practice standards. Lifestyle interventions initiated prior to 16weeks reduced early excess GWG compared with standard care (0.35±0.24 vs 0.43±0.26kg per week, p=<0.0001) but did not affect GDM diagnosis (11.1% vs 11.6%, p=0.91). Using the 75-gram, 2-hour OGTT, 13. 0% of standard care and 11.0% of the intervention group had GDM by the IADPSG criteria (p=0.45). The 'type of diagnostic test' did not change the result (p=0.86). Women who developed GDM were significantly heavier, more likely to have obesity, and more likely to have dysglycemia at baseline. Moderate-to-high intensity lifestyle interventions grounded in behavior change theory initiated between 9 and 16-weeks gestation did not affect the prevalence of GDM despite reducing early GWG. CLINICALTRIALS.GOV: NCT01545934, NCT01616147, NCT01771133, NCT01631747, NCT01768793, NCT01610752, NCT01812694.

Fetal sex and maternal insulin resistance during mid-pregnancy: a retrospective cohort study

BackgroundRecent studies have suggested that fetal sex influences maternal glucose and insulin metabolism during pregnancy. We examined whether fetal sex is associated with maternal insulin resistance and the β-cell function during mid-pregnancy.MethodsThis retrospective study included singleton pregnant women who underwent a 75-g oral glucose tolerance test (OGTT) at 24–34 weeks of gestation due to positive diabetic screening. In addition to plasma glucose (PG), we measured plasma insulin during the OGTT to obtain surrogate indices associated with insulin resistance (IR), including homeostasis assessment model (HOMA) -IR and insulin sensitivity index (IsOGTT), and β-cell function, including insulinogenic index (II), HOMA-β, and area under the curve of insulin response. We compared these indices between women carrying male fetuses to those carrying female fetuses.ResultsThe study population included 617 women (mean age, 32.4 ± 4.9 years) with a mean pre-pregnancy body mass index (BMI) of 22.6±4.5. They underwent the 75g-OGTT at 29.0 ± 2.5 weeks. Two hundred fifty-eight (42%) women were diagnosed with gestational diabetes (GDM). There was no significant difference in maternal age, pre-pregnancy BMI, gestational age at OGTT, PG at OGTT, or the prevalence of GDM between women with a male fetus (n=338) (male group) and those with a female fetus (n=279) (female group). Regarding the indices of IR, IR was significantly higher and insulin sensitivity was lower in the female group than in the male group (HOMA-IR: 7.0 [5-9.6] vs. 6.2 [4.6-8.8], p< 0.05; IsOGTT: 5.86 [4.29-7.83] vs. 6.29 [4.59-8.84], p< 0.01) (median [quartile range]). These differences remained significant after adjustment for maternal age, pre-pregnancy BMI, gestational age and fasting PG at OGTT, and the diagnosis of GDM. In contrast, the β-cell function did not differ between the two groups.ConclusionMaternal IR during mid-pregnancy was significantly higher in women carrying a female fetus than in those with a male fetus. The sex of the fetus may affect maternal insulin sensitivity during mid-pregnancy.

Trends in the frequency of obesity and gestational diabetes in an eleven years period

The prevalence of gestational diabetes (GDM) is increasing along with obesity and gestational age. This prevalence varies in populations and with different guidelines used for the diagnoses. To estimate the change in prevalence of GDM and obesity in a period 11 years. Analysis of pregnancies attended at an obstetrics ward of a general hospital between 2001 and 2018. Those women who were diabetic prior to their pregnancy were excluded from the analysis. Annual crude and adjusted prevalence using direct standardization by age were estimated. We analyzed 33,985 pregnancies. GDM screening was performed in 20,139 (59%), and 1,466 (7%) had GDM. In 2007 the crude and adjusted prevalence of GDM were 4.9 and 5.2%, respectively. The figures in 2018 were 8.8 and 8.5%, respectively, with an annual percentage of change (APC) of 6.9% (p < 0.001). The frequency of obesity also increased with an APC of 4.1% (p < 0.001). In women with GDM the APC of obesity was 4.6% (p < 0.001). There was also an increase in the frequency of screening, with a joinpoint in 2011. The APC of screening in the periods 2007-2011 and 2011-2018 were 16.6 and 2.9%, respectively (p < 0.001). The prevalence of GDM increased in this period of eleven years along with the prevalence of obesity.

Plasma glycated CD59 (gCD59), a novel biomarker for the diagnosis, management and follow up of women with Gestational Diabetes (GDM) \u2013 protocol for prospective cohort study

BackgroundThe prevalence of Gestational Diabetes (GDM) is rising and with it the number of mothers and children at risk of adverse outcomes. As treatment has been shown to reduce adverse events, it is imperative that we identify all at-risk pregnant women. In Ireland, the national standard of care is selective screening with a 2-hour 75 g oral glucose tolerance test (OGTT). Aiming for universal screening is of utmost importance but this is difficult given the length, the unfeasibility and impracticability of the OGTT. We aim to assess if the novel biomarker glycated CD59 (gCD59) is a suitable contender for the OGTT in identifying women with GDM.MethodsIn this prospective cohort study, the study participants will be consecutive pregnant women at Galway University Hospital, Galway, Ireland. Samples for the plasma gCD59 biomarker will be taken together with routine bloods at the first antenatal visit, at weeks 24–28 at the time of routine 75 g OGTT, in trimester 3- and 12-weeks post-partum for women with GDM while having their routine post-partum 75 g OGTT. The constructed database will contain baseline information on each study participant, baseline laboratory data, follow-up laboratory data and pregnancy related outcomes. We aim to recruit a total of 2,000 participants over the project period and with a national GDM prevalence of 12–13%, we will have 240–260 subjects who meet OGTT criteria for GDM. Following regional prevalence, we expect to have 34–37 women who will develop either diabetes or pre-diabetes in the early post-partum period. The sensitivity and specificity of plasma gCD59 to predict the results of the OGTT will be assessed using nonparametric estimates of the receiver operating characteristic (ROC) curves and respective area under the ROC curve (AUROC).DiscussionA body of clinical and experimental evidence supports a link between the complement system, complement regulatory proteins, and the pathogenesis of diabetes complications.Building on this research, our study plans to look at the plasma gCD59 capacity to classify pregnant women with normal or abnormal glucose tolerance but also to assess if plasma gCD59 can be used as an early predictor for GDM, for adverse pregnancy outcomes and/or post-partum glucose intolerance.

Barriers to Gestational Diabetes Management and Preferred Interventions for Women With Gestational Diabetes in Singapore: Mixed Methods Study.

BackgroundGestational diabetes mellitus (GDM) is associated with risks for both the mother and child. The escalated prevalence of GDM because of obesity and changes in screening criteria demands for greater health care needs than before.ObjectiveThis study aimed to understand the perception of patients and health care providers of the barriers to GDM management and preferred interventions to manage GDM in an Asian setting.MethodsThis mixed methods study used a convergent parallel design. Survey data were collected from 216 women with GDM, and semistructured interviews were conducted with 15 women and with 8 health care providers treating patients with GDM. Participants were recruited from 2 specialized GDM clinics at the National University Hospital, Singapore.ResultsThe patients were predominantly Chinese (102/214, 47.6%), employed (201/272, 73.9%), with higher education (150/216, 69.4%) and prenatal attendance at a private clinic (138/214, 64.2%), already on diet control (210/214, 98.1%), and receiving support and information from the GDM clinic (194/215, 90.2%) and web-based sources (131/215, 60.9%). In particular, working women reported barriers to GDM management, including the lack of reminders for blood glucose monitoring, diet control, and insufficient time for exercise. Most women preferred getting such support directly from health care providers, whether at the GDM clinic (174/215, 80.9%) or elsewhere (116/215, 53.9%). Smartphone apps were the preferred means of additional intervention. Desirable intervention features identified by patients included more information on GDM, diet and exercise options, reminders for blood glucose testing, a platform to record blood glucose readings and illustrate or understand trends, and a means to communicate with care providers.ConclusionsA GDM-focused smartphone app that is able to integrate testing, education, and communication may be a feasible and acceptable intervention to provide support to women with GDM, particularly for working women.

Gestational diabetes mellitus management: diet and lifestyle

PurposeGestational diabetes mellitus (GDM) is one of the most common complications of pregnancy. GDM is defined as glucose intolerance of variable severity with onset or first recognition during pregnancy. The purpose of this paper is to produce information on prevalence, screening and diagnosis, pathophysiology and dietary, medical and lifestyle management of GDM.Design/methodology/approachThis literature review aimed to document and record the results of the most updated studies published dealing with dietary, medical and lifestyle factors in managing GDM.FindingsThe prevalence of GDM differs worldwide based on population characteristics, race/ethnicity and diagnostic criteria. The pathophysiology of GDM is multifactorial and it is likely that genetic and environmental factors are associated with the occurrence of GDM. Medical nutritional therapy remains the mainstay of GDM management and aerobic and resistance physical activities are helpful adjunctive therapy when euglycemia is not attained by the medical nutritional therapy alone. When diet and exercise fail to achieve glycemic control, pharmacological agents such as insulin therapy and oral hypoglycemic medications are prescribed. Plasma glucose measurement is an essential part of glycemic control during pregnancy, as well as glycemic control can be evaluated using indicators of glycemic control such as hemoglobin A1c (HbA1c), glycated albumin and fructosamine.Originality/valueThis review is a comprehensive review that illustrates the effect of healthy diet, medical therapy and lifestyle change on improving GDM condition.

1392-P: Assisted Reproduction Technology Treatment and Risk of Gestational Diabetes

Assisted reproduction technology (ART) treatment has been suggested to increase the risk of gestational diabetes (GDM), though the nature of this association remains unclear. In the attempt to gain more insight in such an association we have carried out a study to evaluate whether ART represents an independent risk factor for GDM in single pregnancies. We collected retrospectively clinical and anthropometric data of 221 ART- and 256 age and BMI matched women with natural conception (NC) screened for GDM between 2011-2019. Out of 477 women, 32 were excluded from the analysis due to multiple pregnancies (PMA: 24; CN: 8). Between the two groups there were no differences in age (ART: 39 ± 5; NC: 38 ± 3 years; ns), BMI (ART: 23.6 ± 4.4; NC: 22.9 ± 3.6 Kg/m2; ns) and family history of diabetes (ART: 31.4%; NC: 24.2%; ns). ART-women were more frequently primiparous (62.6% vs. 22.6%; p&amp;lt;0.0001), while a higher prevalence of previous GDM was observed among NC-women (9.7% vs. 2.6%; p=0.002). The prevalence of GDM in the whole cohort was 36.1% and was significantly higher in women with ART (52.3% vs. 23.4%; p &amp;lt;0.0001). In the whole cohort, risk factors for GDM were: age (OR 1.07 95% CI 1.02-1.13), first degree family history of diabetes (OR 2.02 95% CI 1.31-3.10), previous GDM (OR 2.09 95% CI 1.39- 3.14), pre-pregnancy obesity (OR 3.28; 95% CI 1.57-6.86) and ART (OR 3.59; 95% CI: 2.39 - 5.39). On multivariate analysis, family history of diabetes (OR 1.67; 95% CI: 1.03-2.69), previous GDM (OR 7.05; 95% CI: 2.92-17.04); pre-pregnancy obesity (OR 2.72; 95% CI 1.21-6.13) and ART (OR 4.14; 95% CI 2.65-6.48) were independent risk factors for GDM . Among women requesting ART treatment, at least one in two develops GDM, and ART appears to be an independent risk factors for GDM. Disclosure C. Bianchi: None. C. Della Pelle: None. G. de Gennaro: None. M. Aragona: None. V. Cela: None. S. DelPrato: None. A. Bertolotto: None.

1362-P: Influence of Ethnicity on the Association between Body Mass Index and Prevalence of Gestational Diabetes

Gestational diabetes (GDM) prevalence increases with increasing body mass index (BMI), and evidence suggests that the association may vary by ethnicity. Using a cross-sectional study, we examined the association between BMI and GDM by ethnicity. Data were obtained from administrative health datasets for all of Ontario, Canada. Using a validated algorithm, we identified Chinese and South Asian maternal ethnicity; all others were categorized as the general population. GDM was ascertained through hospital and claims records. The study population consisted of women without pre-existing diabetes who had a livebirth between April 2012 and March 2014. The relation between pre-pregnancy BMI and GDM was modeled using adjusted logistic regression, stratified by ethnicity. The study population consisted of 231,618 women, of whom 10,895 (4.7%) developed GDM. The prevalence of GDM was 9.9% among South Asians, 8.2% among Chinese and 4.3% of the general population of women. Compared to a normal BMI, having an overweight BMI (25-30 kg/m2) was associated with a higher aOR of GDM among Chinese (1.96, 95% CI: 1.50-2.56), South Asian (1.87, 1.47-2.36) and the general population of women (1.84, 1.69-2.01) (Figure). GDM prevalence is considerably higher across all levels of BMI in South Asian and Chinese women compared with the general population, suggesting the need for an ethnicity-specific screening approach for GDM. Disclosure S. Read: None. H. Berger: None. D. Feig: Advisory Panel; Self; Novo Nordisk A/S. Speaker’s Bureau; Self; Medtronic. K. Fleming: None. J.G. Ray: None. B.R. Shah: None. L. Lipscombe: None. Funding Diabetes Action Canada (PSI19-23)

1223-P: Diabetes in Pregnancy in the Caribbean: A Systems Enablement Approach to Universal Access, Screening, and Treatment

In Trinidad and Tobago there is a high background prevalence of diabetes in women of reproductive age and wide variability of screening practices for diabetes in pregnancy (DiP). A systems enablement approach was implemented to achieve national consensus on clinical guidelines and facilitate universal screening. A secure ICT solution (app) for real-time communication of blood glucose results was designed and piloted to standardize reporting systems and integrate services for pregnancy care. National consensus was achieved through consultations with healthcare professionals and followed up with training on the standardized guidelines for DIP and continuous medical education for over 300 in the field to improve adoption. The app facilitated a system of data capture, storage and retrieval among antenatal caregivers, patients and health administrators. The app is scalable and can integrate with other standards-based ICT health systems. The app was pilot tested and 658 pregnant women, 7 lab technologists and 24 doctors were trained registered users. All pregnant women registered on the app were screened using a standard 75g 2-hour OGTT after an overnight fast. Gestational diabetes prevalence was 14.1%. The high GDM prevalence justifies a need for systems change and universal screening for diabetes in pregnancy in Trinidad and Tobago. The app facilitates timely delivery of results to patient and healthcare provider. Training healthcare teams in diagnosis and management of diabetes in pregnancy using ICT simultaneously provides the platform to enhance patient self-management. Disclosure S. Teelucksingh: None. H. Chow: None. F.K. Lutchmansingh: None. S. Ramsewak: None.

Comparison of criteria of International Association of Diabetes and Pregnancy Study Groups (IADPSG) with National Institute for Health and Care Excellence (NICE) for diagnosis of gestational diabetes mellitus.

Different screening procedures and diagnostic criteria are being followed in the same as well as in different countries with no single standard criteria established for diagnosis of GDM. So far, there are no studies in the Indian population comparing IADPSG with NICE criteria. To compare International Association of Pregnancy and Study Groups (IADPSG) criteria with the National Institute for Health and Care Excellence (NICE) for diagnosis of gestational diabetes mellitus and its influence on maternal and perinatal outcomes. This prospective observational study was conducted in the Department of Obstetrics and Gynaecology of a tertiary care institute in South India from March 2017 to October 2018. Six-hundred and eighty women with or without risk factors for GDM were recruited in the study and screened for GDM based on IADPSG and NICE criteria. Women with preexisting diabetes mellitus or with fasting plasma glucose ≥ 126mg/dl were excluded. The overall prevalence of GDM in our study was 27.2% by either IADPSG/NICE criteria. In this study, 25.1% women and 11.6% women were diagnosed as GDM using IADPSG and NICE criteria, respectively. The level of agreement between the two diagnostic criteria was found to be poor in our study and was statistically significant (kappa = 0.429, p < 0.001). Women testing IADPSG-positive NICE-negative had a higher risk of GHTN, abortions, PROM, preterm delivery, caesarean section and congenital anomalies, meconium-stained liquor, and low Apgar scores at 1min when compared to non GDM group. In addition, except for preterm delivery, women diagnosed as GDM by both IADPSG and NICE criteria had adverse outcomes such as preeclampsia, urinary tract infection, and polyhydramnios. Women diagnosed as GDM in IADPSG-negative NICE-positive had no significant adverse maternal or perinatal outcomes. IADPSG criteria appear to be more robust than NICE criteria for diagnosis of GDM. Women with substantial risk of maternal and perinatal outcomes are better identified by IADPSG criteria who would have been missed if NICE criteria was used.

Dietary fiber and blueberry intervention lowers gestational weight gain and C-reactive protein in women at high risk for gestational diabetes

Background: The prevalence of GDM has been shown to be higher in specific ethnicities (e.g. Asian, Black and Hispanic origin vs. non-Hispanic whites), who also disproportionately carry the burden of obesity, low socioeconomic status, and nutritional disparities as prominent risks. Dietary bioactive compounds, such as polyphenols and fiber have been shown to play an important role in the management of diabetes, but there is a lack of studies in GDM. The objective of this randomized controlled trial was to examine the effects of a 20-week dietary intervention (blueberry +soluble fiber) vs. control (standard prenatal care) on gestational weight gain and cardio-metabolic parameters in high-risk Hispanic women with obesity and previous history of GDM. Women [n=25; BMI: 36.3±4.3 (means±SD] were recruited in early pregnancy (14±4 weeks gestation), and data were collected at baseline (< 20wk), 24-28wk and at 32-36wk gestation. Those in the intervention group were provided with frozen blueberries (2 cups/day) and soluble fiber (12g/day); both groups received nutrition education based on Dietary Guidelines for Americans. Results: The prevalence of GDM was observed as follows: one in the dietary intervention (n=12; 8%) and three in standard care group (n=13; 23%). Gestational weight gain and serum C-reactive protein was significantly lower in the dietary intervention vs. standard care (16.5&#177;9.2lb vs. 27.0&#177;11.3lb, respectively; 7.0&#177;3.1 mg/L vs. 17.0&#177;10.2 mg/L, respectively, mean&#177;SD, all p<0.05). Conclusions: Dietary strategies that increase fiber and fruit intake may ameliorate excess gestational weight gain and subsequently reduce the risk of GDM in obese women with previous history of GDM.

Exploring abnormal glucose metabolism in pregnancy among Australian Chinese migrants

ObjectiveGestational diabetes mellitus (GDM) is a metabolic disorder of pregnancy that is increasingly prevalent among Chinese women. Few studies have examined whether the migration status of Chinese women contributes to...