Gestational Diabetes Outcomes Research Articles

Short-Term Practice of Pranayama Based Yoga Ensures Sympathovagal Balance and Facilitates Fetomaternal Outcomes in Gestational Diabetes in the 3rd Trimester of Pregnancy

Short-Term Practice of Pranayama Based Yoga Ensures Sympathovagal Balance and Facilitates Fetomaternal Outcomes in Gestational Diabetes in the 3rd Trimester of Pregnancy

Outcomes of gestational diabetes in native and non-native women - a three-year national study

Outcomes of gestational diabetes in native and non-native women - a three-year national study

Outcomes of Gestational Diabetes in Newborns

With the rising trend in obesity, the incidence of gestational diabetes mellitus (GDM) and perinatal complications associated with the condition are also on the rise. Since the early 1900s, much knowledge has been gained about the diagnosis, implications, and management of gestational diabetes with improved outcomes for the mother and fetus. Worldwide, there is variation in the definition of GDM, methods to screen for the condition, and management options. The International Association of Diabetes in Pregnancy Study Groups has published recommendations for a one-step approach to screen pregnant women for GDM, in order to develop outcome-based criteria that can be used internationally. However, management of GDM continues to be varied, and currently several options are available for treatment of hyperglycemia during pregnancy. A review of various aspects of GDM is discussed with a focus on the medical management during pregnancy, as practiced in the United States.

Effect of probiotics on pregnancy outcomes in gestational diabetes: systematic review and meta-analysis.

Gestational diabetes mellitus (GDM) is a prevalent complication during pregnancy associated with numerous adverse outcomes. There is emerging evidence suggesting the potential of probiotics as a therapeutic measure for GDM; however, existing studies have yielded contradictory results. This meta-analysis assessed the efficacy of probiotics on blood glucose management and pregnancy outcomes in patients with GDM. A comprehensive search of the PubMed, Embase, and Cochrane databases was conducted up to August 22, 2023, to identify relevant studies. The primary outcomes focused on fasting blood glucose (FBG), fasting serum insulin (FSI), homeostasis model assessment of insulin resistance (HOMA-IR), and quantitative insulin sensitivity check index (QUICKI). The secondary outcomes included various maternal and neonatal outcomes. This meta-analysis included 15 randomized controlled trials (RCTs), encompassing 1006 patients with GDM. The results showed that, compared to a placebo, probiotics demonstrated a significant reduction in FBG (MD - 2.58, 95% CI - 4.38 to - 0.79, p < 0.01), FSI (MD - 2.29, 95% CI - 3.40 to - 1.18, p < 0.01), HOMA-IR (MD - 0.56, 95% CI - 0.81 to - 0.32, p < 0.01), and birth weight (MD - 101.20, 95% CI - 184.62 to - 17.77, p = 0.02). Furthermore, it resulted in fewer neonatal intensive care unit (NICU) admissions (RR 0.60, 95% CI 0.40-0.89, p = 0.01), instances of hyperbilirubinemia (RR 0.31, 95% CI 0.16-0.61, p < 0.01), and elevated QUICKI (MD 0.01, 95% CI 0.00-0.01, p < 0.01). No significant impact was observed in the other analyzed outcomes. In conclusion, probiotics improve FBG, FSI, and HOMA-IR, and reduce the occurrence of neonatal hyperbilirubinemia, NICU admissions, and birth weight in the offspring of patients with GDM. However, the quality of the evidence, as per the GRADE approach, varies from high to low, necessitating further studies to consolidate these findings.

Statement of Retraction: The effects of probiotic supplementation on biomarkers of inflammation, oxidative stress and pregnancy outcomes in gestational diabetes

Statement of Retraction: The effects of probiotic supplementation on biomarkers of inflammation, oxidative stress and pregnancy outcomes in gestational diabetes

140 Association of neighborhood walkability with adverse pregnancy outcomes in gestational diabetes

140 Association of neighborhood walkability with adverse pregnancy outcomes in gestational diabetes

Predictive value of serum Gal-13, GLP-1 and VEGF levels in adverse pregnancy outcomes of gestational diabetes mellitus

To explore the application value of serum Gal-13, GLP-1 and VEGF in the prevention and guidance of adverse pregnancy outcomes in gestational diabetes (GDM). A retrospective study with case-control method was used to select 1 012 GDM patients from Haikou Maternal and Child Health Hospital from January 2019 to December 2022 as the study objects, and they were divided into poor pregnancy outcome group (n=342) and good pregnancy outcome group (n=670) according to whether they had adverse pregnancy outcomes. The medical records of 521 healthy women with normal glucose metabolism were selected as the control group. Serum Gal-13 and GLP-1 were detected by enzyme-linked immunosorbent assay and VEGF was determined by IAMMGE specific protein analyzer. After comparing the differences of the above factors among the three groups, multivariate logistic regression model was used to analyze the influencing factors of adverse pregnancy outcomes in GDM patients, and ROC curve was drawn to analyze the predictive value of serum Gal-13, GLP-1 and VEGF levels on adverse pregnancy outcomes in GDM patients. The results showed that Fasting blood glucose (FPG), glycosylated hemoglobin (HbA1c) and fasting insulin (FINS) in the adverse pregnancy outcome group were 5.92(4.98, 6.41) mmol/L, 5.32(4.96, 5.47)%, 62.56(49.21,99.50) pmol/L, VEGF was 495.47(389.14, 567.13) ng/L, TSH was 1.48(1.34, 1.58) mIU/L, right ventricular myocardial work index (Tei index) was 0.59(0.45, 0.67), 89 cases of elderly parturients; FPG was 4.45(4.16, 5.03) mmol/L, HbA1c was 5.04(4.86, 5.29)%, FINS was 57.41(46.90, 74.08) pmol/L, VEGF was 405.84(348.02, 462.68) ng/L, TSH was 1.42(1.25, 1.50) mIU/L, Tei index was 0.50(0.47, 0.64), there were 142 cases of old women. In the control group, FPG was 4.33(4.05, 4.75) mmol/L, HbA1c was 5.01(4.13, 5.18)%, FINS was 38.48(36.76, 41.72) pmol/L and VEGF was 302.45(283.14, 336.56) ng/L, TSH was 1.32(1.24, 1.47)mIU/L, Tei index was 0.48(0.39, 0.59), and there were 106 elderly parturiencies. The levels of FPG, HbA1c, FINS, VEGF, TSH and Tei index in the adverse pregnancy outcome group and the good pregnancy outcome group were higher than those in the control group, and the proportion of elderly parturients was higher than that in the control group, and the adverse pregnancy outcome group was higher than that in the good pregnancy outcome group. The differences were statistically significant (H=8.620, P<0.001, H=2.616, P=0.014, H=6.156, P<0.001, H=3.051, P<0.001, H=4.892, P=0.044, χ2=2.548, P=0.045). In the adverse pregnancy outcome group, Gal-13 was 15.27(8.35, 24.45)pg/ml, GLP-1 was 9.27(8.26, 12.35) pmol/L and FT4 was 11.59(9.67, 13.48) pmol/L. In the group with good pregnancy outcome, Gal-13 was 25.34(20.14, 29.73) pg/ml, GLP-1 was 12.38(10.25, 15.63) pmol/L and FT4 was 13.86(10.67, 15.10) pmol/L. In the control group, Gal-13 was 31.21(27.48, 34.45) pg/ml, GLP-1 was 11.34(10.40, 14.37) pmol/L and FT4 was 14.15(10.75, 15.43)pmol/L. The levels of Gal-13, GLP-1 and FT4 in the adverse pregnancy outcome group and the good pregnancy outcome group were significantly lower than those in the control group, and the adverse pregnancy outcome group was lower than that in the good pregnancy outcome group. The differences were statistically significant (H=6.458, P=0.011, H=8.445, P<0.001, H=5.694, P<0.001). The levels of Gal-13 and GLP-1 in normal blood glucose recovery group were higher than those in non-normal blood glucose recovery group, and the levels of VEGF were lower than those in non-normal blood glucose recovery group (P<0.05).In multivariate logistic regression analysis, Gal-13, GLP-1, VEGF, TSH, FT4 and Tei indexes were independent influencing factors for adverse pregnancy outcomes with GDM (P<0.05). ROC curve analysis showed that the AUC of Gal-13, GLP-1 and VEGF alone in predicting adverse pregnancy were 0.779, 0.761 and 0.615, respectively. The value of the combined diagnosis was the highest (AUC=0.912), the sensitivity was 90.1%, and the specificity was 80.0%. In conclusion, Gal-13, GLP-1 and VEGF may be independent influencing factors for adverse pregnancy outcomes in GDM patients, and the combined detection of the three may help to improve the auxiliary diagnostic efficacy for predicting adverse pregnancy outcomes.

Impact of Antenatal Care Modifications on Gestational Diabetes Outcomes During the COVID-19 Pandemic

BackgroundMany of the adverse outcomes of gestational diabetes mellitus (GDM) are linked to excessive fetal growth, which is strongly mediated by the adequacy of maternal glycemic management. The COVID-19 pandemic led to a rapid adoption of virtual care models. We aimed to compare glycemic management, fetal growth, and perinatal outcomes before and during the COVID-19 pandemic. MethodsA retrospective cohort study was conducted between 2017 and 2020. Singleton pregnancies complicated by GDM were included in the study. The cohort was stratified into “before” and “during” COVID-19 subgroups, using March 11, 2020, as the demarcation time point. Women who began their GDM follow-up starting March 11, 2020, and thereafter were allocated to the COVID-19 era, whereas women who delivered before the demarcation point served as the pre–COVID-19 era. The primary outcome was the rate of large-for-gestational-age (LGA) neonates. Secondary outcomes included select maternal and neonatal adverse outcomes. ResultsSeven hundred seventy-five women were included in the analysis, of which 187 (24.13%) were followed during the COVID-19 era and 588 (75.87%) before the COVID-19 era. One hundred seventy-one of the 187 women (91.44%) followed during COVID-19 had at least 1 virtual follow-up visit. No virtual follow-up visits occurred before the COVID-19 era. There was no difference in the rate of LGA neonates between groups on both univariate (5.90% vs 7.30%, p=0.5) and multivariate analyses, controlling for age, ethnicity, parity, body mass index, gestational weight gain, chronic hypertension, smoking, and hypertensive disorders in pregnancy (adjusted odds ratio [aOR] 1.11, 95% confidence interval [CI] 0.49 to 2.51, p=0.80). In the multivariate analysis, there was no difference in composite neonatal outcome between groups (GDM diet: aOR 1.40, 95% CI 0.81 to 2.43, p=0.23; GDM medical treatment: aOR 1.20, 95% CI 0.63 to 2.43, p=0.5). ConclusionsAfter adjusting for differences in baseline variables, the combined virtual mode of care was not associated with a higher rate of LGA neonates or other adverse perinatal outcomes in women with GDM. Larger studies are needed to better understand the specific impact of virtual care on less common outcomes in pregnancies with GDM.

Group vs Individual Prenatal Care and Gestational Diabetes Outcomes

The impact of group-based prenatal care (GPNC) model in the US on the risk of gestational diabetes (GD) and related adverse obstetric outcomes is unknown. To determine the effects of the GPNC model on risk of GD, its progression, and related adverse obstetric outcomes. This is a single-site, parallel-group, randomized clinical trial conducted between February 2016 and March 2020 at a large health care system in Greenville, South Carolina. Participants were individuals aged 14 to 45 years with pregnancies earlier than 21 weeks' gestational age; follow-up continued to 8 weeks post partum. This study used an intention-to-treat analysis, and data were analyzed from March 2021 to July 2022. Eligible participants were randomized to receive either CenteringPregnancy, a widely used GPNC model, with 10 group-based sessions or traditional individual prenatal care (IPNC). The primary outcome was the incidence of GD diagnosed between 24 and 30 weeks of gestation. The secondary outcomes included progression to A2 GD (ie, GD treated with medications) and GD-related adverse obstetric outcomes (ie, preeclampsia, cesarean delivery, and large for gestational age). Log binomial models were performed to estimate risk differences (RDs), 95% CIs, and P values between GPNC and IPNC groups, adjusting for all baseline covariates. Of all 2348 participants (mean [SD] age, 25.1 [5.4] years; 952 Black participants [40.5%]; 502 Hispanic participants [21.4%]; 863 White participants [36.8%]), 1176 participants were randomized to the GPNC group and 1174 were randomized to the IPNC group. Among all participants, 2144 (91.3%) completed a GD screening (1072 participants [91.3%] in GPNC vs 1071 [91.2%] in IPNC). Overall, 157 participants (6.7%) developed GD, and there was no difference in GD incidence between the GPNC (83 participants [7.1%]) and IPNC (74 participants [6.3%]) groups, with an adjusted RD of 0.7% (95% CI, -1.2% to 2.7%). Among participants with GD, GPNC did not reduce the risk of progression to A2 GD (adjusted RD, -6.1%; 95% CI, -21.3% to 9.1%), preeclampsia (adjusted RD, -7.9%; 95% CI, -17.8% to 1.9%), cesarean delivery (adjusted RD, -8.2%; 95% CI, -12.2% to 13.9%), and large for gestational age (adjusted RD, -1.2%; 95% CI, -6.1% to 3.8%) compared with IPNC. In this secondary analysis of a randomized clinical trial among medically low-risk pregnant individuals, the risk of GD was similar between participants who received GPNC intervention and traditional IPNC, indicating that GPNC may be a feasible treatment option for some patients. ClinicalTrials.gov Identifier: NCT02640638.

Outcomes in Gestational Diabetes Stratified by Treatment With Oral Agents Only, Insulin Transition From Oral Agents, and Insulin Only [ID: 1378229

INTRODUCTION: Patients with gestational diabetes (GDM) requiring insulin after inadequate glycemic control on oral agents have increased rates of fetal macrosomia and neonatal intensive care unit admission compared to patients with insulin-only treatment. Our objective was to stratify additional GDM outcomes by treatment type. METHODS: Single-center retrospective cohort study of 617 patients with GDM, 2011–2018, excluding pre- and diet-controlled GDM. We stratified by treatment: oral agents (referent), transition to insulin from oral agents, and insulin only. Generalized linear modeling adjusted for group differences and biologically plausible covariates. RESULTS: Most patients were treated with oral agents only (74.5%), 7.1% changed to insulin, and 19.7% insulin only. Patients on oral agents only were more likely to be Black, Asian, or Hispanic/Latina race and ethnicity, non-English-speaking, lower body mass index (BMI), and later diagnosis. Insulin addition was significantly associated with increased hyperglycemia admissions and gestational weight gain (GWG), after adjusting for BMI, treatment initiation gestational age (GA), race and ethnicity, language, and insurance. Insulin transition was also significantly associated with increased cesarean delivery (CD) rate, after adjusting for age, delivery GA, parity, BMI, chronic hypertension, race and ethnicity, and insurance. To examine abdominal circumference (AC90) and estimated fetal weight (EFW90) above the 90th percentile, we adjusted for age, weight gain, parity, and race and ethnicity. Insulin use after oral agents increased risk of AC90, while insulin only decreased risk of EFW90. CONCLUSION: Oral agent failure was associated with excess GWG, admission for hyperglycemia, CD rate, and AC90. Insulin-only treatment was associated with decreased risk of EFW90, perhaps indicating identification of patients likely to fail oral agents could improve outcomes.

The association between maternal HbA1c and adverse outcomes in gestational diabetes.

The role of HbA1c in women with gestational diabetes mellitus (GDM) is still unclear, particularly in the Asian population. To investigate the association between HbA1c levels and adverse outcomes considering maternal age, pre-pregnancy body mass index (BMI), and gestational weight gain (GWG) in women with GDM. A retrospective study included 2048 women with GDM and singleton live births. Using logistic regression, the associations between HbA1c and adverse pregnancy outcomes were assessed. Compared to women with HbA1c ≤ 5.0%, HbA1c was significantly associated with macrosomia (aOR 2.63,95%CI1.61,4.31), pregnancy-induced hypertension (PIH, aOR 2.56,95%CI1.57,4.19), preterm birth (aOR 1.64,95%CI 1.05,2.55), and primary Cesarean section (primary C-section, aOR1.49,95%CI1.09,2.03) in GDM women with HbA1c ≥5.5% while significantly associated with PIH (aOR 1.91,95%CI1.24,2.94) in women with HbA1c 5.1-5.4%. The associations between HbA1c and adverse outcomes varied with maternal age, pre-pregnancy BMI, and GWG. In women aged ≤29 years, there's significant association between HbA1c and primary C-section when HbA1c was 5.1-5.4% and ≥5.5%. In women aged 29-34 years and HbA1c ≥5.5%, HbA1c was significantly associated with macrosomia. In women aged ≥35 years, there's significant association between HbA1c and preterm birth when HbA1c was 5.1-5.4% and macrosomia and PIH when HbA1c ≥5.5%. In pre-pregnant normal-weight women, HbA1c was significantly associated with macrosomia, preterm birth, primary C-section, and PIH when HbA1c ≥5.5% while HbA1c was significantly associated with PIH when HbA1c was 5.1-5.4% . In pre-pregnant underweight women with HbA1c 5.1-5.4%, HbA1c was significantly associated with primary C-section. HbA1c was significantly associated with macrosomia among women with inadequate GWG or excess GWG and HbA1c≥5.5%. In women with adequate GWG, there's significant association between HbA1c and PIH when HbA1c was 5.1-5.4% and ≥5.5% . Conclusively, HbA1c at the time of diagnosis is significantly associated with macrosomia, preterm birth, PIH, and primary C-section in Chinese women with GDM.

Vitamin C supplementation for diabetes management: A comprehensive narrative review.

Growing evidence suggests that vitamin C supplementation may be an effective adjunct therapy in the management of people with diabetes. This paper critically reviews the current evidence on effects of vitamin C supplementation and its potential mechanisms in diabetes management. Evidence from meta-analyses of randomized controlled trials (RCTs) show favourable effects of vitamin C on glycaemic control and blood pressure that may be clinically meaningful, and mixed effects on blood lipids and endothelial function. However, evidence is mostly of low evidence certainty. Emerging evidence is promising for effects of vitamin C supplementation on some diabetes complications, particularly diabetic foot ulcers. However, there is a notable lack of robust and well-designed studies exploring effects of vitamin C as a single compound supplement on diabetes prevention and patient-important outcomes (i.e. prevention and amelioration of diabetes complications). RCTs are also required to investigate potential preventative or ameliorative effects of vitamin C on gestational diabetes outcomes. Oral vitamin C doses of 500-1000mg per day are potentially effective, safe, and affordable for many individuals with diabetes. However, personalisation of supplementation regimens that consider factors such as vitamin C status, disease status, current glycaemic control, vitamin C intake, redox status, and genotype is important to optimize vitamin C's therapeutic effects safely. Finally, given a high prevalence of vitamin C deficiency in patients with complications, it is recommended that plasma vitamin C concentration be measured and monitored in the clinic setting.

Inappropriate gestational weight gain impact on maternofetal outcomes in gestational diabetes

Objective To evaluate the association between the dimension of deviation from appropriate gestational weight gain (GWG) and adverse maternofetal outcomes in women with gestational diabetes mellitus (GDM). Methods We performed a multicentric retrospective study based on the Portuguese GDM Database. Women were classified as within GWG, insufficient (IGWG) or excessive (EGWG) than the Institute of Medicine recommendations. EGWG and IGWG were calculated for each prepregnancy BMI category. Large-for-gestational-age (LGA) and macrosomia were defined as a birthweight more than the 90th percentile for the gestational age and newborn weight greater than 4000 g, respectively. Logistic regression models (adjusted odds ratio [aOR] plus 95% confidence interval [95%CI]) were derived to evaluate the association between EGWG or IGWG and adverse maternofetal outcomes. Results A total of 18961 pregnant women were included: 39.7% with IGWG and 27.8% with EGWG. An EGWG over 3 kg was associated with a higher risk of LGA infants (aOR 1.95, 95%CI 1.17–3.26) and macrosomia (aOR 2.01, 95%CI 1.23–3.27) in prepregnancy normal weight women. An EGWG greater than 4 kg was associated with a higher risk of LGA infants (aOR 1.67, 95%CI 1.23–2.23) and macrosomia (aOR 1.90, 95%CI 1.38–2.61) in obese women. In overweight women, an EGWG above 3.5 kg was associated with a higher risk of LGA infants (aOR 1.65, 95%CI 1.16–2.34), macrosomia (aOR 1.85, 95%CI 1.30–2.64), preeclampsia (aOR 2.40, 95%CI 1.45–3.98) and pregnancy-induced hypertension (aOR 2.21, 95%CI 1.52–3.21). An IGWG below −3.1 kg or −3kg was associated with a higher risk of small-for-gestational-age [SGA] infants in women with normal (OR 1.40, 95%CI 1.03–1.90) and underweight (OR 2.29, 95%CI 1.09–4.80), respectively. Conclusions Inappropriate gestational weight gain seems to be associated with an increased risk for adverse maternofetal outcomes, regardless of prepregnancy BMI. Beyond glycemic control, weight management in women with GDM must be a focus of special attention to prevent adverse pregnancy outcomes. KEY MESSAGES The dimension of deviation from appropriate gestational weight gain was associated with an increased risk for adverse maternofetal outcomes among women with gestational diabetes. Weight management must be a focus of special attention in women with gestational diabetes to prevent adverse pregnancy outcomes.

Effects of Additional Dietary Fiber Supplements on Pregnant Women with Gestational Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Studies.

The efficacy of different types and doses of dietary fiber supplementation in the treatment of gestational diabetes (GDM) remains controversial. The purpose of this study is to investigate the effect of dietary fiber on blood glucose control in pregnant women with gestational diabetes mellitus, and further observe the effect on their blood lipids and pregnancy outcomes. We searched on Web of Science, PubMed, Embase, Scopus, and Cochrane, and included several articles on additional fortification with dietary fiber for gestational diabetes interventions. This meta-analysis included 8 trials. We found that additional dietary fiber supplements significantly reduced fasting glucose (Hedges'g = -0.3; 95% CI [-0.49, -0.1]), two-hour postprandial glucose (Hedges'g = -0.69; 95% CI [-0.88, -0.51]), glycated hemoglobin (Hedges'g = -0.5; 95% CI [-0.68, -0.31]), TC (Hedges'g = -0.44; 95% CI [-0.69, -0.19]), TG (Hedges'g = -0.3; 95% CI [-0.4, -0.2]) and LDL-C (Hedges'g = -0.48; 95% CI [-0.63, -0.33]). It also significantly reduced preterm delivery (Hedges'g = 0.4, 95% CI [0.19~0.84]), cesarean delivery (Hedges'g = 0.6; 95% CI [0.37~0.97]), fetal distress (Hedges'g = 0.51; 95% CI [0.22~1.19]), and neonatal weight (Hedges'g = -0.17; 95% CI [-0.27~-0.07]). In a subgroup analysis comparing dietary fiber type and dose, insoluble dietary fiber was more effective than soluble dietary fiber in reducing fasting glucose (Hedges'g = -0.44; 95% CI [-0.52, -0.35]). ≥12 g fiber per day may be more effective in improving glycemic lipid and pregnancy outcomes than &lt;12 g/day, but the difference was not statistically significant. In conclusion, our meta-analysis showed that dietary fiber supplementation significantly improved glycolipid metabolism and pregnancy outcomes in gestational diabetes. Dietary fiber may be considered adjunctive therapy for gestational diabetes, and an additional supplement with insoluble dietary fiber is more recommended for those with poor fasting glucose. However, more high-quality studies are needed on the further effect of fiber type and the dose-effect relationship.

Outcome of Gestational Diabetes during Pregnancy and at Delivery

Gestational diabetes (GDM) is a state of intolerance to glucose that initiates or is first diagnosed during gestation. About 1-14% of all pregnancies are complicated by GDM. The pregnancy-related morbidity and mortality in gestational diabetes is lower than in overt diabetes; however, if left untreated, it is significantly higher than in nondiabetic women. Treating GDM is important because appropriate treatment reduces side effects on the mother and newborn. GDM during pregnancy has a number of adverse short- and long-term consequences for both the mother and the fetus. Aim: To establish the relationship between gestational diabetes and complications related to pregnancy and childbirth. Study Design: A prospective cohort study. Place and Duration: The study was conducted at the Karachi Aga Khan University Hospital in the Department of Obstetrics and Gynecology from 22 November, 2018 to 22 May 2019, six months after the approval of the study. Methods: 130 patients, 65 patients in the GDM group and 65 patients in the non-GDM group were enrolled in the study. Demographic data were presented as standard deviation and mean as well as simple descriptive statistics, while qualitative variables as percentage and frequency. Chi-square test was applied for comparison of the incidence of complications related to pregnancy and childbirth. P&lt;0.05 was considered statistically significant. Relative risk was calculated. Results: 130 total patients, including 65 patients in GDM group and 65 patients in non GDM group were included. Mean age in GDM and non GDM group was 29.27±2.79 years and 28.49±3.40 years. Outcome of pregnancy in GDM and non GDM group showed that 27 (41.5%) and 18 (27.7%) had pregnancy induced hypertension, 07 (10.8%) and 03 (4.6%) had pre-eclampsia, 29 (44.6%) and 07 (10.8%) had polyhydramnios, 04 (6.2%) and 02 (3.1%) had antepartum hemorrhage, 01 (1.5%) and 06 (9.2%) had premature rupture of membrane, 11 (16.9%) and 09 (13.8%) had preterm labour, 13 (20%) and 04 (6.2%) had urinary tract infection. Outcome of pregnancy in GDM and non GDM group showed 51 (78.5%) and 33 (50.8%) had induction of labour, 17 (26.2%) and 14 (21.5%) had low birth weight, 14 (51%) and 03 (4.6%) had macrosomia, 02 (3.1%) and 01 (1.5%) had birth injury and 10 (15.4%) and 11 (16.9%) had NICU admission. Conclusion: Gestational diabetes (GDM) is the utmost communal medicinal complication of pregnancy. It has negative consequences for the mother and the newborn baby. Maintaining glycemia in GDM decreases the morbidity of both baby and mother. Keywords: Gestational diabetes mellitus, delivery outcome, pregnancy outcome, maternal and fetal outcomes.

Perinatal Outcomes of Gestational Diabetes: A Hospital-Based Investigation in Yaoundé, Cameroon

Gestational diabetes (GDM) can be considered as glucose intolerance, diagnosed for the first time during pregnancy. It is a global issue with maternal, obstetrical and neonatal implications. We aimed to investigate and describe perinatal outcomes of GDM among a group of affected Cameroonian women. We carried out an observational study with a cross-sectional design at the Yaoundé Central Hospital (YCH) and the Yaoundé Gynaeco-Obstétric and Pediatric Hospital (YGOPH). This was a seven-month investigation from files of all women admitted with GDM from January 2018 to January 2020. Data were analyzed using SPSS software (Statistical Package for the Social Sciences) version 20. Our study sample comprised 34 pregnant women diagnosed with GDM out of 652 women admitted to the service during the same period (5.2%). Their average age was 31.8±4.4 years. Most women were multiparous (15: 44.0%) and were followed by both gynecologists and endocrinologists (21: 61.6%). The mean Gestational age (GA) at first antenatal consultation (ANC) was 12±2.5 weeks. The mean GA at delivery was 37.7 ±1.8. Most women were symptomatic with cardinal syndrome comprising polyuria (32: 94.2%), polydipsia (22: 64.1%), and polyphagia (21: 61.6%). The mainstay of the management was insulin therapy (25: 73.3%). The rate of cesarean delivery was (22: 64.1%) and most were term (20: 58.3%) live births (30: 88.4%). Nevertheless, 14: 41.7% were born prematurely. The majority of neonates were macrosomes (13: 38.4%) and big babies (9: 26.7%) with the main complications being hypoglycemia (13: 38.4%) and neonatal infection (8: 23.52%). From these results, we observed that GDM is a major issue in pregnancy with the potential of severe perinatal implications in both newly delivered women and babies. Adequate management includes prompt diagnosis and multidisciplinary follow-up until after delivery to prevent complications.

Gestational Diabetes Mellitus

Gestational diabetes mellitus (GDM) refers to chronic hyperglycemia during pregnancy in women with no diabetic history before pregnancy. As per the surveys it is estimated that gestational diabetes affects 16% of pregnancies worldwide. This percentage is increasing day by day. Most of the cases of GDM suffer from glucose intolerance because of impaired pancreatic β-cell during pregnancy. Although GDM vanishes after delivery but may cause fetal macrosomia, type-2 diabetes, and maternal CVD are some of the main outcomes of gestational diabetes. In the long-term effect of GDM, a child may suffer from obesity, type-2 diabetes as well as heart diseases at later ages [1]. Several factors work as a root cause of GDM like pregnancy after 35 years of age, genetic history of diabetes, obesity, nutrients deficiency (especially micronutrients), and high consumption of western diet. Gestational diabetes opens ways for diabetes and obesity from generation to generation. At present time, under advanced medical technologies, we still have no instant procedure for treating gestational diabetes completely except modifying diet and physical activity to maintain GDM till delivery. Oral medications of gestational diabetes work well but can cause long-term health issues in both mother and child. To manage these consequences of GDM and to develop the latest strategies it is important to understand gestational diabetes from its roots [2-3]. Public health researchers and clinicians are highly concerned about the alarming situation of the increased number of gestational diabetes all over the world. This condition is directly causing economic crisis as well as declining health conditions of the vast number of populations. Due to the lack of treatments for GDM, researchers often debate upon several interventions to treat gestational diabetes mellitus. The main concern for researching GDM is higher complications during pregnancies due to gestational diabetes. These complications include higher chances of C-sections, shoulder dystocia in case of vaginal delivery, and more chances that the infant is born with a hypoglycemic condition. Medical petitioners often recommended oral glycemic control medications, healthy weight management, and exercise to females diagnosed with GDM but, these strategies are not enough. It is mandatory to rule out more possible causes and indicators of gestational diabetes mellitus before it appears. It is a need of hours to upgrade strategies and interventions to protect future generations from the outcomes of GDM. It can only be possible with advanced research, experiments and surveys so we can play a potent role in developing emerging techniques for the best possible treatment of gestational diabetes mellitus for future generations [4].

Gestational Diabetes Mellitus

Gestational diabetes mellitus (GDM) refers to chronic hyperglycemia during pregnancy in women with no diabetic history before pregnancy. As per the surveys it is estimated that gestational diabetes affects 16% of pregnancies worldwide. This percentage is increasing day by day. Most of the cases of GDM suffer from glucose intolerance because of impaired pancreatic β-cell during pregnancy. Although GDM vanishes after delivery but may cause fetal macrosomia, type-2 diabetes, and maternal CVD are some of the main outcomes of gestational diabetes. In the long-term effect of GDM, a child may suffer from obesity, type-2 diabetes as well as heart diseases at later ages [1]. Several factors work as a root cause of GDM like pregnancy after 35 years of age, genetic history of diabetes, obesity, nutrients deficiency (especially micronutrients), and high consumption of western diet. Gestational diabetes opens ways for diabetes and obesity from generation to generation. At present time, under advanced medical technologies, we still have no instant procedure for treating gestational diabetes completely except modifying diet and physical activity to maintain GDM till delivery. Oral medications of gestational diabetes work well but can cause long-term health issues in both mother and child. To manage these consequences of GDM and to develop the latest strategies it is important to understand gestational diabetes from its roots [2-3]. Public health researchers and clinicians are highly concerned about the alarming situation of the increased number of gestational diabetes all over the world. This condition is directly causing economic crisis as well as declining health conditions of the vast number of populations. Due to the lack of treatments for GDM, researchers often debate upon several interventions to treat gestational diabetes mellitus. The main concern for researching GDM is higher complications during pregnancies due to gestational diabetes. These complications include higher chances of C-sections, shoulder dystocia in case of vaginal delivery, and more chances that the infant is born with a hypoglycemic condition. Medical petitioners often recommended oral glycemic control medications, healthy weight management, and exercise to females diagnosed with GDM but, these strategies are not enough. It is mandatory to rule out more possible causes and indicators of gestational diabetes mellitus before it appears. It is a need of hours to upgrade strategies and interventions to protect future generations from the outcomes of GDM. It can only be possible with advanced research, experiments and surveys so we can play a potent role in developing emerging techniques for the best possible treatment of gestational diabetes mellitus for future generations [4].

Effects of Telemetric Interventions on Maternal and Fetal or Neonatal Outcomes in Gestational Diabetes: Systematic Meta-Review.

BackgroundIn 2019, 1 of 6 births was affected by gestational diabetes mellitus (GDM) globally. GDM results in adverse maternal, fetal, and neonatal outcomes in the short and long term, such as pregnancy and birth complications, type 2 diabetes, metabolic syndrome, and cardiovascular disease. In the context of “transgenerational programming,” diabetes mellitus during pregnancy can contribute to “programming” errors and long-term consequences for the child. Therefore, early therapy strategies are required to improve the clinical management of GDM. The interest in digital therapy approaches, such as telemetry, has increased because they are promising, innovative, and sustainable.ObjectiveThis study aimed to assess the current evidence regarding the clinical effectiveness of telemetric interventions in the management of GDM, addressing maternal glycemic control, scheduled and unscheduled visits, satisfaction, diabetes self-efficacy, compliance, maternal complications in pregnancy and childbirth, as well as fetal and neonatal outcomes.MethodsMedline via PubMed, Web of Science Core Collection, Embase, Cochrane Library, and CINAHL databases were systematically searched from January 2008 to April 2020. We included randomized controlled trials, systematic reviews, meta-analyses, and clinical trials in English and German. Study quality was assessed using “A MeaSurement Tool to Assess systematic Reviews” and “Effective Public Health Practice Project.”ResultsOur search identified 1116 unique studies. Finally, we included 11 suitable studies (including a total of 563 patients and 2779 patient cases): 4 systematic reviews or meta-analyses (1 of high quality and 3 of moderate quality), 6 randomized controlled trials (2 of high quality and 4 of moderate quality), and 1 low-quality nonrandomized controlled trial. We classified 4 “asynchronous interventions” and 3 “asynchronous and real-time interventions.” Our findings indicate that telemetric therapy clearly improves glycemic control and effectively reduces glycated hemoglobin A1c levels. Furthermore, in 1 study, telemetry proved to be a significant predictor for a better glycemic control (hazard ratio=1.71, 95% CI 1.11-2.65; P=.02), significantly fewer insulin titrations were required (P=.04), and glycemic control was achieved earlier. Telemetric therapy significantly reduced scheduled and unscheduled clinic visits effectively, and women were highly satisfied with the treatment (P<.05). From fetal and neonatal short-term outcomes, some improving tendencies in favor of telemetry were determined. No long-term outcomes were detected.ConclusionsTelemetric interventions clearly improved glycemic control, notably glycated hemoglobin A1c levels, and reduced scheduled and unscheduled clinic visits effectively, which reinforces this digital approach in the treatment of GDM.

Maternal Chronotype and Pregnancy Outcomes in Gestational Diabetes

Introduction: Gestational diabetes mellitus (GDM) is an increasingly frequent complication of pregnancy and its presence is related to the development of adverse maternal and fetal outcomes. Pregnancy is deeply influenced by the circadian rhythm and the misalignment of the maternal rhythm can lead to disturbances in the temporal organization of physiological and metabolic functions. Previously, the association between circadian rhythm disorders and diabetes has been well described in pregnancy. Objective: To investigate the influence of chronotype on the development of maternal and fetal complications during pregnancy in GDM. Methodology: Prospective cohort study of patients with GDM. Clinical data and behavior questionnaires were collected by face- to- face interview. Questionnaires evaluated the chronotype (Morning-Eveningness-Questionnaire- MEQ), sleep quality (Pittsburgh Sleep Quality Index- PSQI), daytime sleepiness (Epworth Sleepiness Scale -ESS), depressive symptoms (Edinburgh Postnatal Depression Scale-EDPS) and insomnia (Insomnia Severity Index- ISI). Sleep diaries (14 days) and actigraphic record (5 to 7 days) were obtained. Results: Overall, 305 2nd to 3rd trimester GDM patients were evaluated. Eighty-nine GDM patients completed the sleep diary and 53 performed a valid actigraphic registry. Amongst these, 49.5% were identified as morning chronotypes (MEQ≥59), 43.6% intermediate types (MEQ from 42 to 58) and 6.9% had evening type preference (MEQ<41). Evening preference patients were younger (p< 0.005), had more unstable marital status (P = 0.04), had worse sleep quality (p = 0.02); latter sleep midpoint (p= 0.01), higher prevalence of insomnia (p< 0.005) and depression (p= 0.004) before and during pregnancy. No differences were found in total sleep duration as recorded by sleep diary (p=0.4) or actigraphic measurements (p=0.83). Evening type preference in GDM was associated with pre-eclampsia (p= 0.02) and neonatal ICU admission (p= 0.03). Conclusion: This study suggests that the presence of the evening-type chronotype in pregnant women with GDM is associated with adverse pregnancy outcomes such as the development of hypertensive syndromes, insomnia and depressive symptoms. In addition, a higher prevalence of newborns admitted to the neonatal ICU was found in the offspring of GDM patients with evening preference.