Gestational Diabetes Mellitus Care Research Articles

Metabolomics of Diabetes in Pregnancy.

The purpose of this review is to describe ways in which metabolomics may enhance understanding of gestational diabetes mellitus (GDM) etiology and refine current diagnostic criteria. Current clinical recommendations suggest screening for GDM between 24 and 28 of gestational weeks using an oral glucose tolerance test. Despite this consensus, there are discrepancies regarding the exact criteria for GDM diagnosis. Further, emerging evidence has unveiled heterogeneous physiological pathways underlying GDM-specifically, GDM with defective insulin secretion vs. sensitivity-that have important implications for disease diagnosis and management. The objectives of this review are threefold. First, we seek to provide a brief summary of current knowledge regarding GDM pathophysiology. Next, we describe the potential role of metabolomics to refine and improve the prediction, screening, and diagnosis of GDM. Finally, we propose ways in which metabolomics may eventually impact clinical care and risk assessment for GDM and its comorbidities.

The Challenges and Recommendations for Gestational Diabetes Mellitus Care in India: A Review.

Gestational diabetes mellitus (GDM) is a primary concern in India affecting approximately five million women each year. Existing literature indicate that prediabetes and diabetes affect approximately six million births in India alone, of which 90% are due to GDM. Studies reveal that there is no consensus among physicians and health-care providers in India regarding management of GDM prepartum and postpartum despite available guidelines. Also, there is no consensus among physicians as to when a woman should undergo oral glucose tolerance test after delivery. This clearly shows that management of GDM is challenging and controversial in India due to conflicting guidelines and treatment protocols, despite availability of straightforward protocols for screening and management. Also, a collaborative approach remains a key for GDM management, as patient compliance and proper educational interventions promote better pregnancy outcomes. Management of GDM plays a pivotal role, as women with GDM have an increased chance of developing diabetes mellitus 5–10 years after pregnancy. Also, children born in GDM pregnancies face an increased risk for obesity and type 2 diabetes. The cornerstone for the management of GDM is glycemic control and quality nutritional intake. GDM management is complex in India, and existing challenges are multifactorial. However, there are little published data outlining these challenges. This review gives an account of some of the key challenges from self-management and health-care provider perspective. The recommendations in this review provide insights for building a more structured model for GDM care in India. This research has several practical applications. First, it points out to reaching a consensus on approaches for screening, diagnosis, and treatment of care across clinical practices in the nation that can aid in overcoming certain challenges observed. Second, it highlights the importance to build capacities and capabilities, especially in resource-limited settings. Health education among pregnant women remains a priority to resolve issues related to self-management. More broadly, further research, specifically qualitative is vital to determine forthcoming challenges with respect to patients, caregivers, providers, and policy makers and to provide solutions fitted to practice setting and demographic background.

Liver triacylglycerol content and gestational diabetes: effects of moderate energy restriction

Aims/hypothesisWomen with a history of gestational diabetes mellitus (GDM) have raised liver triacylglycerol. Restriction of energy intake in type 2 diabetes can normalise glucose control and liver triacylglycerol concentration but it is not known whether similar benefits could be achieved in GDM. The aim of this work was to examine liver triacylglycerol accumulation in women with GDM and the effect of modest energy restriction.MethodsSixteen women with GDM followed a 4 week diet (5 MJ [1200 kcal]/day). Liver triacylglycerol, before and after diet and postpartum, was measured by magnetic resonance. Insulin secretion and sensitivity were assessed before and after diet. Twenty-six women who underwent standard antenatal care for GDM (matched for age, BMI, parity and ethnicity) were used as a comparator group.ResultsFourteen women, who completed the study, achieved a weight loss of 1.6 ± 1.7 kg over the 4 week dietary period. Mean weight change was −0.4 kg/week in the study group vs +0.3 kg/week in the comparator group (p = 0.002). Liver triacylglycerol level was normal but decreased following diet (3.7% [interquartile range, IQR 1.2–6.1%] vs 1.8% [IQR 0.7–3.1%], p = 0.004). There was no change in insulin sensitivity or production. Insulin was required in six comparator women vs none in the study group (eight vs two required metformin). Blood glucose control was similar for both groups. The hypo-energetic diet was well accepted.Conclusions/interpretationLiver triacylglycerol in women with GDM was not elevated, unlike observations in non-pregnant women with a history of GDM. A 4 week hypo-energetic diet resulted in weight loss, reduced liver triacylglycerol and minimised pharmacotherapy. The underlying pathophysiology of glucose metabolism appeared unchanged.

Going up, going down: the experience, control and management of gestational diabetes mellitus among Southeast Asian migrant women living in urban Australia.

Issue addressed In many developed countries the rate of gestational diabetes mellitus (GDM) for Asian-born women is higher than other groups. Studies suggest that some women have limited knowledge of the disease and poor self-management leading to health problems for themselves and their baby. Few studies report the experience of GDM among Southeast Asian migrant women living in Australia and factors that influence their management of the disease. Methods A qualitative interpretive design was used to explore Southeast Asian migrant women's experience and management of GDM. Women diagnosed with the disease during pregnancy were recruited from an antenatal clinic at two Sydney metropolitan hospitals. Nineteen women were interviewed in their first language. Thematic analysis was used to analyse the data. Results A diagnosis of GDM conferred an unanticipated 'up and down' experience for this group of Southeast Asian women. Their experience of the disease, likened to an elevator ride, was modulated by 'insulin' and 'information' used to control the disease and manage blood glucose levels, dietary levels, exercise levels and anxiety levels. Conclusions Health promotion material that captures the fluctuating experience of GDM has the potential to help women, particularly at the time of diagnosis, to be better prepared, and health professionals to be better informed to control and manage the disease more effectively. So what? GDM is a serious problem. The model generated from our study has the potential to better inform health professionals to prepare women for the inevitable fluctuating physical and emotional effects of the disease. Culturally sensitive material and an educational strategy based on the model may also facilitate women's lifestyle changes and compliance, and improve migrant women's relationship with, and trust in, health professionals involved in their GDM care.

Retrospective investigation of incidence of gestational diabetes mellitus and perinatal outcome in Beijing

Objective To investigate the incidence of gestational diabetes mellitus (GDM) and perinatal outcome in Beijing in 2013. Methods Fifteen hospitals in Beijing were selected by systematic and cluster sampling method. Clinical data of 15 194 pregnant women who attended prenatal care and delivered in these hospitals between June 20 and November 30, 2013 were collected. And 2 987 pregnant women were diagnosed with GDM (GDM group), and 11 999 had no diabetes (non-GDM group). The incidence of GDM, perinatal outcome and complications in mother and infant were compared between the two groups. Two independent samples t-test and Chi-square test were used for statistical analysis. Results The incidence of GDM in Beijing was 19.7% (2 987/15 194). The average age was much higher in GDM group than in non-GDM group [(29.4±4.5) vs (28.0±4.2) years, t=285.705, P<0.05]. The pre-pregnancy weight was much higher in GDM group than in non-GDM group [(59.5±10.2) vs (56.1±8.6) kg, t=352.565, P<0.05]. The incidence of GDM in pre-pregnancy overweight and obese women [29.9% (664/2 230) and 38.8% (250/664)] was much higher than in normal pre-pregnancy weight and low pre-pregnancy weight women [18.0% (1 777/9 890) and 12.9% (273/2 118)] (χ2=296.843, P<0.05). The incidence of GDM in pluripara was higher than in primipara [21.2% (910/4 298) vs 19.4% (2 077/10 688), χ2=5.813, P<0.05]. The incidence of GDM in grade Ⅲ hospitals was higher than in grade Ⅱ hospitals [21.1% (1 654/7 849) vs 18.7% (1 333/7 173), χ2=13.440, P<0.05]; and the incidence in urban areas was higher than in rural areas [21.3% (2 028/9 521) vs 17.1% (896/5 249), χ2=39.137, P<0.05]. The rate of cesarean section was 47.1% (1 407/2 987) in GDM group, significantly higher than in non-GDM group [39.8% (4 782/11 999)] (χ2=72.204, P<0.05). The incidences of preterm labor [7.3%(217/2 987)], hypertensive disorders [6.3%(185/2 987)], large-for-gestational-age infants [9.2%(275/2 987)], macrosomia [9.5%(283/2 987)] and neonatal ward admission [8.6%(258/2 987)] were all significantly higher in GDM group than in non-GDM group [5.7% (686/11 999), 3.9%(454/11 999), 5.8%(694/11 999), 7.2% (861/11 999), and 6.5% (778/11 999), respectively] (χ2=10.117, 34.371, 79.378, 20.346 and 17.236, respectively, all P<0.05). Conclusions The incidence of GDM is still high in Beijing, and advanced maternal age and pre-pregnancy overweight or obesity are high risk factors for GDM. The rate of preterm labor, hypertensive disorders, and macrosomia in GDM group is higher than in normal fasting glucose group. Systematic obstetric care for GDM should be intensified in Beijing. Key words: Diabetes, gestational; Pregnancy outcome; Incidence; Retrospective studies; Beijing

Quality of care from the perspective of women with gestational diabetes in China

ObjectiveTo explore the quality of gestational diabetes mellitus (GDM) care experienced by women in China and how it could be improved. MethodsA qualitative study was conducted at a municipal hospital in south east China. Women who had been diagnosed with GDM at 34–38weeks of pregnancy were enrolled during two periods; between May 1 and July 31, 2012, and between April 1 and July 31, 2013. Data regarding patient-perceived care quality were collected through semi-structured individual interviews and were analyzed by qualitative content analysis. ResultsThe study enrolled 44 patients; the interviews recorded a lack of professional care resources for GDM, a lack of high-quality personalized care for women with GDM, and patients’ suggestions regarding how to improve GDM care. ConclusionThe participants reported a lack of high-quality GDM care, describing the core problem as an imbalance between over-stretched hospitals and low-efficiency under-utilized primary healthcare centers. Clinical-practice reforms identified, particularly in primary healthcare settings, included improving services through increasing the number of health professionals and material resources to comply with diabetes guidelines, and incorporating a humanistic approach in the provision of care.

Prevalence of Gestational Diabetes Mellitus in Korea: A National Health Insurance Database Study.

Aims/IntroductionThis study aimed to estimate the prevalence of gestational diabetes mellitus (GDM) and use of anti-diabetic medications for patients with GDM in Korea, using data of the period 2007–2011 from the Health Insurance Review and Assessment (HIRA) database, which includes the claims data of 97% of the Korean population.Materials and MethodsWe used the Healthcare Common Procedure Coding System codes provided by the HIRA to identify women with delivery in the HIRA database between 2009 and 2011. GDM was defined according to ICD-10 codes, and patients with pre-existing diabetes between January 1, 2007 and pregnancy were excluded. A Poisson regression was performed to evaluate the trends in annual prevalence rates.ResultsThe annual numbers of deliveries in 2009–2011 were 479,160 in 2009, 449,747 in 2010, and 377,374 in 2011. The prevalence of GDM during that period was 7.5% in 2009–2011: 5.7% in 2009, 7.8% in 2010, and 9.5% in 2011. The age-stratified analysis showed that the prevalence of GDM was highest in women aged 40–44 years, at 10.6% in 2009–2011, and that the annual prevalence significantly increased even in young women aged 20–29 years during that period (P < 0.05). More than 95% of the patients with GDM did not take any anti-diabetic medication. Among the anti-diabetic medications prescribed for patients with GDM, insulin was most commonly prescribed (for >98% of the patients with GDM on medication).ConclusionsThe prevalence of GDM in Korean women recently reached 5.7–9.5% in recent years. This represents a public health concern that warrants proper screening and medical care for GDM in women during the childbearing years.

Women in India with Gestational Diabetes Mellitus Strategy (WINGS): Methodology and development of model of care for gestational diabetes mellitus (WINGS 4).

Aim:The Women In India with GDM Strategy (WINGS) project was conducted with the aim of developing a model of care (MOC) suitable for women with gestational diabetes mellitus (GDM) in low- and middle-income countries.Methodology:The WINGS project was carried out in Chennai, Southern India, in two phases. In Phase I, a situational analysis was conducted to understand the practice patterns of health-care professionals and to determine the best screening criteria through a pilot screening study.Results:Phase II involved developing a MOC-based on findings from the situational analysis and evaluating its effectiveness. The model focused on diagnosis, management, and follow-up of women with GDM who were followed prospectively throughout their pregnancy. An educational booklet was provided to all women with GDM, offering guidance on self-management of GDM including sample meal plans and physical activity tips. A pedometer was provided to all women to monitor step count. Medical nutrition therapy (MNT) was the first line of treatment given to women with GDM. Women were advised to undergo fasting blood glucose and postprandial blood glucose testing every fortnight. Insulin was indicated when the target blood glucose levels were not achieved with MNT. Women were evaluated for pregnancy outcomes and postpartum glucose tolerance status.Conclusions:The WINGS MOC offers a comprehensive package at every level of care for women with GDM. If successful, this MOC will be scaled up to other resource-constrained settings with the hope of improving lives of women with GDM.

Comparison of maternal and fetal outcomes among Asian Indian pregnant women with or without gestational diabetes mellitus: A situational analysis study (WINGS-3).

Aim:To compare the existing maternal and fetal outcomes in Asian Indian women with or without gestational diabetes mellitus (GDM) before the development of the Women in India with GDM Strategy (WINGS) GDM model of care (MOC).Materials and Methods:Records of pregnant women were extracted retrospectively from three maternity centers in Chennai. GDM was diagnosed using the International Association for Pregnancy Study Groups criteria or the Carpenter and Coustan criteria. Demographic details, obstetric history, antenatal follow-up, treatment for GDM, and outcomes of delivery were collected from the electronic medical records.Results:Of the 3642 records analyzed, 799 (21.9%) had GDM, of whom 456 (57.1%) were treated with insulin and medical nutrition therapy (MNT), 339 (42.4%) with MNT alone, and 4 (0.5%) with metformin. Women with GDM were older than those without (28.5 ± 4.5 vs. 27.1 ± 4.5 years; P < 0.001) and had higher mean body mass index at first booking (26.4 ± 5.2 kg/m2 vs. 25.2 ± 5.1 kg/m2; P < 0.001). Rates of cesarean section (26.2% vs. 18.7%; P < 0.001), preeclampsia (1.8% vs. 0.8%; P = 0.04), and macrosomia (13.9% vs. 10.8%; P = 0.02) were significantly higher among women with GDM. In women with GDM treated with insulin and MNT, emergency cesarean section (16.2% vs. 36.6%; P < 0.0001), preeclampsia (0.7% vs. 3.2%; P = 0.015), and macrosomia (9.9% vs. 18.6%; P = 0.0006) were significantly lesser compared to those treated with MNT alone.Conclusion:Pregnancy outcomes were in general worse in GDM women. Treatment with insulin was associated with a significantly lower risk of complications. However, in countries with limited access to insulin and other medicines may lead to poor follow-up and management of GDM. Data from this retrospective study will form the basis for the development of the WINGS GDM MOC, which will address these gaps in GDM care in low-resource settings.

Effects evaluation of extended care after "one-day care" for delivery women with gestational diabetes mellitus

Objective To explore the effects evaluation of extended after one-day care for delivery women with gestational diabetes mellitus (GDM). Methods From May to September 2013 in Department of Gynaecology and Obstetrics Peking University First Hospital, a total of 354 GDM pregnant women participated one-day care and then they were divided into experimental group (171 cases) and control group(183 cases) according to whether attended the extended care. Using repeated variance analysis measurement, the fasting blood glucose and postprandial 2h blood glucose values were compared whether the values had statistical significance between two groups at different visit time. Results The uterine-incision rates were 48.55%(83/171) and 49.7%(91/183) in the experimental group and control group respectively, and the incidence of giant babies were 9.4%(16/171) and 12.0%(22/183) respectively in the experimental group and control group (P>0.05). The time point of before visit, during visit and last visit in the experimental group, the fasting blood glucose and postprandial 2 h blood glucose were lower than that of the control group (P<0.05). Conclusions One-day care for GDM can reduce the blood glucose level of GDM delivery women, but it has not significant effects on the control of gestation′s body weight and to decline the uterine-incision rate and incidence of giant babies. Key words: Gestational diabetes mellitus; Delivery outcome; Extended care; Blood glucose level; Delivery woman

Updated Requirements for Measurement Quality and Quality Assurance of Point-Of-Care Testing (POCT) – Blood Glucose Measurement Systems with Unit-Use Reagents Suitable for the Initial Diagnosis of Diabetes Manifested in Pregnancy or Gestational Diabetes Mellitus (GDM) According to the GDM Guideline of the German Diabetes Association (DDG)

In 2011, the German Diabetes Association (DDG) and the German Society of Obstetrics and Gynecology (DGGG) published a new, inter-disciplinary, evidence-based S3-guideline (AWMF guideline 057/008) for gestational diabetes mellitus (GDM, ICD-10: 024.4G) [1]. It contains recommendations on the diagnostic procedure, treatment and follow-up care of GDM. This guideline also makes it possible for the first time for the attending physician to use POCT glucose measurement systems with unit-use reagents in the initial diagnostic procedure of GDM. At the same time, a corresponding manufacturer's recommendation is a requirement for this use [1] [2]: "For the initial diagnostic procedure of diabetes manifested in pregnancy or gestational diabetes when using unit-use reagents and related measurement systems, these systems are explicitly intended for physician use in the diagnostic procedure according to the manufacturer's recommendations (instructions for use)."

Early Screening and Treatment of Women with Prediabetes: A Randomized Controlled Trial.

To examine whether women with prediabetes benefit from early treatment for gestational diabetes mellitus (GDM). Women with a glycosylated hemoglobin A1C (A1C) of 5.7 to 6.4% at <14 weeks were recruited. Participants were randomized to usual care or treatment for GDM with diet, blood glucose monitoring, and insulin as needed. The primary outcome was a 75-g oral glucose tolerance test at 26 to 28 weeks. Secondary outcomes included cesarean delivery, birthweight, weight gain, and A1C change. Between May 2012 and June 2014, 95 women were enrolled and 83 had data for analysis; 42 were randomized to treatment and 41 to usual care. The groups were similar in baseline characteristics with 40% obese. There was no difference in the primary outcome (treatment 45.2% vs. control 56.1%; relative risk [RR] 0.80; 95% confidence interval [CI] 0.53-1.24) except that women in the treatment group had a significantly lower A1C over time than women in the control group (p = 0.04). Nonobese women (n = 50) treated for GDM experienced a 50% reduction in GDM compared with controls (29.6 vs. 60.9%; RR 0.49; 95% CI 0.25-0.95). Early treatment for women with a first-trimester A1C of 5.7 to 6.4% did not significantly reduce the risk of GDM except in nonobese women.

Gestational Diabetes in the Gulf Region: Streamlining care to optimise outcome

The burden of gestational diabetes mellitus (GDM) has notably been on the increase in many countries. This observed trend feeds into the growing problem of obesity and type 2 diabetes, especially in regions with higher background prevalence of diabetes such as the Gulf Cooperation Countries (GCC). Despite the emerging body of evidence indicating adverse maternal and perinatal risks related to GDM, significant variations exist globally regarding the key components of GDM care, particularly, screening, diagnosis and long term follow up. This article appraises these key aspects of GDM across the GCC region against the backdrop of new global insights into the diagnosis and management of GDM. The options for minimising variations in screening and diagnosis and new opportunities for streamlining care across the Gulf region are explored. This proposition has the potential for driving an enabling environment for sharing best practices as well as engaging in collaborative research across the GCC.

Patient-reported outcomes in women with gestational diabetes: a longitudinal study.

Gestational Diabetes Mellitus (GDM) is a common health problem among pregnant women and may be associated with distress. The purpose of the study was to describe changes in patient-reported outcomes in women with GDM and identify factors associated with increased distress in these patients. The study was conducted in 205 women diagnosed with GDM. Study participants underwent a physical examination and completed a questionnaire two times during pregnancy. On average, the questionnaire was completed at 27 weeks of gestation at baseline and 36 weeks at follow-up. The questionnaire included socio-demographic and clinical variables, standardized patient-reported outcome measures, and questions about the impact of GDM on daily life, satisfaction with care, knowledge about GDM, and social and professional support. Our main outcome of interest was diabetes-related distress, measured by the Problem Areas in Diabetes (PAID) questionnaire. Data were analyzed using descriptive statistics and multivariable regression models. At baseline, 80% of the women were satisfied with their diabetes care and 58% said they managed their diabetes well. The proportion reporting little or no knowledge of GDM dropped from almost 50% at baseline to 14% at follow-up. However, the proportion reporting that GDM affected their social life increased from 26 to 35%, and the proportion reporting interference with family life increased from 14 to 26%. Insulin treatment, frequency of blood glucose measurements, lack of knowledge about GDM, and lack of support from family and health care providers were strongly and significantly associated with distress. In women with GDM, intensified treatment and lack of informational and social support are associated with distress. These aspects of GDM care appear to be appropriate targets for future research and interventions aimed at reducing the level of distress in these patients.

Technology and Pregnancy

Technology and Pregnancy

From screening to postpartum follow-up – the determinants and barriers for gestational diabetes mellitus (GDM) services, a systematic review

BackgroundGestational diabetes mellitus (GDM) – a transitory form of diabetes first recognised during pregnancy complicates between < 1% and 28% of all pregnancies. GDM has important short and long-term health consequences for both the mother and her offspring. To prevent adverse pregnancy outcomes and to prevent or delay future onset of type 2 diabetes in mother and offspring, timely detection, optimum treatment, and preventive postpartum care and follow-up is necessary. However the area remains grossly under-prioritised.MethodsTo investigate determinants and barriers to GDM care from initial screening and diagnosis to prenatal treatment and postpartum follow-up, a PubMed database search to identify quantitative and qualitative studies on the subject was done in September 2012. Fifty-eight relevant studies were reviewed.ResultsAdherence to prevailing GDM screening guidelines and compliance to screening tests seems sub-optimal at best and arbitrary at worst, with no clear or consistent correlation to health care provider, health system or client characteristics. Studies indicate that most women express commitment and motivation for behaviour change to protect the health of their unborn baby, but compliance to recommended treatment and advice is fraught with challenges, and precious little is known about health system or societal factors that hinder compliance and what can be done to improve it. A number of barriers related to health care provider/system and client characteristics have been identified by qualitative studies. Immediately following a GDM pregnancy many women, when properly informed, desire and intend to maintain healthy lifestyles to prevent future diabetes, but find the effort challenging. Adherence to recommended postpartum screening and continued lifestyle modifications seems even lower. Here too, health care provider, health system and client related determinants and barriers were identified. Studies reveal that sense of self-efficacy and social support are key determinants.ConclusionsThe paper identifies and discusses determinants and barriers for GDM care, fully recognising that these are highly dependent on the context.

Clinical profile, outcomes, and progression to type 2 diabetes among Indian women with gestational diabetes mellitus seen at a diabetes center in south India.

Aim:To describe the clinical profile, maternal and fetal outcomes, and the conversion rates to diabetes in women with gestational diabetes mellitus (GDM) seen at a tertiary care diabetes center in urban south India.Materials and Methods:Clinical case records of 898 women with GDM seen between 1991 and 2011 were extracted from the Diabetes Electronic Medical Records (DEMR) of a tertiary care diabetes center in Chennai, south India and their clinical profile was analyzed. Follow-up data of 174 GDM women was available. To determine the conversion rates to diabetes, oral glucose tolerance test (OGTT) was done in these women. Glucose tolerance status postpartum was classified based on World Health Organization (WHO) 2006 criteria.Results:The mean maternal age of the women was 29 ± 4 years and mean age of gestation at first visit were 24 ± 8.4 weeks. Seventy percent of the women had a family history of diabetes. Seventy-eight percent of the women delivered full-term babies and 65% underwent a cesarean section. The average weight gain during pregnancy was 10.0 ± 4.2 kg. Macrosomia was present in 17.9% of the babies, hypoglycemia in 10.4%, congenital anomalies in 4.3%, and the neonatal mortality rate was 1.9%. Mean follow-up duration of the 174 women of whom outcome data was available was 4.5 years. Out of the 174, 101 women who were followed-up developed diabetes, of whom half developed diabetes within 5 years and over 90%, within 10 years of the delivery.Conclusions:Progression to type 2 diabetes mellitus (T2DM) in Indian women with GDM is rapid. There is an urgent need to develop standardized protocols for GDM care in India that can improve the maternal and fetal outcomes and help prevent future diabetes in women with GDM.

Impact des nouveaux critères de dépistage sur la prévalence du diabète gestationnel

To evaluate the impact of the new IADPSG thresholds on gestational diabetes mellitus (GDM) prevalence. Universal screening for GDM was performed in 200 consecutive patients at 24 to 28 weeks with 75 g oral glucose tolerance test. The prevalence of GDM was 14.0%. We observed that among the 28 patients with GDM, 16 (57.1%) had only one abnormal value, 10 (35.7%) two abnormal values and only two (7.2%) had three abnormal values. For the 16 patients with one abnormal value, 13 of them (81.2%) have an abnormal fasting plasma glucose (FPG). Patients with GDM had an increased body mass index (29.6 kg/m(2) vs 25.1 kg/m(2), P<0.001) and more important rates of familial history of type II diabetes (46.4% vs 21.5%, P<0.005) and history of GDM in a previous pregnancy (21.4% vs 2.9%, P<0.002) compared to non-GDM patients. Birth weight was increased in offspring of mothers with GDM (3451.3g vs 3387.4 g, P<0.05). Our study found an increased rate of GDM with the new IADPSG criteria compared to previous published data. Higher rates of GDM represent a challenge for the organization of perinatal teams involved in GDM care.

Health system and societal barriers for gestational diabetes mellitus (GDM) services - lessons from World Diabetes Foundation supported GDM projects.

BackgroundMaternal mortality and morbidity remains high in many low- and middle-income countries (LMIC). Gestational Diabetes Mellitus (GDM) represents an underestimated and unrecognised impediment to optimal maternal health in LMIC; left untreated – it also has severe consequences for the offspring. A better understanding of the barriers hindering detection and treatment of GDM is needed. Based on experiences from World Diabetes Foundation (WDF) supported GDM projects this paper seeks to investigate societal and health system barriers to such efforts.MethodsQuestionnaires were filled out by 10 WDF supported GDM project partners implementing projects in eight different LMIC. In addition, interviews were conducted with the project partners. The interviews were analysed using content analysis.ResultsBarriers to improving maternal health related to GDM nominated by project implementers included lack of trained health care providers - especially female doctors; high staff turnover; lack of standard protocols, consumables and equipment; financing of health services and treatment; lack of or poor referral systems, feedback mechanisms and follow-up systems; distance to health facility; perceptions of female body size and weight gain/loss in relation to pregnancy; practices related to pregnant women’s diet; societal negligence of women’s health; lack of decision-making power among women regarding their own health; stigmatisation; role of women in society and expectations that the pregnant woman move to her maternal home for delivery.ConclusionsA number of barriers within the health system and society exist. Programmes need to consider and address these barriers in order to improve GDM care and thereby maternal health in LMIC.

Patterns of weight gain in pregnant women with and without gestational diabetes mellitus: An observational study

To quantify late-pregnancy weight gain in women with and without gestational diabetes mellitus (GDM) and to determine factors associated with gestational weight gain. A prospective clinical audit of 212 women (115 GDM and 97 non-GDM) who were weighed at each antenatal visit from 24-32 weeks gestation until delivery. Women received routine antenatal clinical care. For women with GDM, this included a 2-h lifestyle counselling session, capillary blood glucose testing and frequent clinical review. Women with GDM gained less weight than nondiabetic women (GDM: 1.18 kg (1.6%) [range, 3.8-7.1 kg]; non-GDM: 4.0 kg (4.8%) [range, 0.7-18.5 kg]; P < 0.0001). Weight gain was influenced by body mass index and country of birth. Women with GDM showed reduced weight gain at weeks 1-4 postrecruitment, relative to weeks 4-8 (0.04 kg/week vs 0.45 kg/week; P < 0.0001). Nondiabetic women gained weight at a constant rate. GDM status was the only independent predictor of postrecruitment weight gain. Application of a model of care for GDM (lifestyle advice and regular clinical review, in addition to home glucose monitoring) may reduce weight gain in women with GDM. The potential for applying a modified version of this model to all women in pregnancy warrants further study.