International Association Of Diabetes And Pregnancy Study Groups Research Articles

A Prospective Randomized Study of the Potential Biomarker miR-204-5p for the Differential Diagnosis of Gestational Diabetes Mellitus and its Correlation with Pregnancy Outcomes

Background: Gestational diabetes mellitus (GDM) is a common complication of pregnancy that has a certain impact on maternal and infant health. The aim of this study was to investigate the diagnostic value of microRNA-204-5p (miR-204-5p) in GDM by analyzing its differential expression between GDM patients and healthy individuals and to assess its predictive potential for the occurrence of poor maternal and infant outcomes in GDM patients. Methods: GDM patients (107; GDM group) and healthy pregnant women (92; control group) were recruited for this prospective study. GDM patients meet the relevant criteria of the International Association of Diabetes and Pregnancy Study Groups (IADPSG), which are categorized into good and poor outcome groups on the basis of maternal and infant pregnancy outcomes. Serum miR-204-5p expression was quantified via the reverse transcription quantitative polymerase chain reaction (RT-qPCR). The diagnostic potential of miR-204-5p in GDM patients was analyzed by receiver operating characteristic (ROC) curves and further assessed for its ability to predict the occurrence of poor maternal and infant outcomes in GDM patients. The difference in clinical indicators between GDM patients and healthy pregnant women was determined through Student's t-test, and the clinical indicators of GDM patients in the good outcome group and the poor outcome group were evaluated. The potential of miR-204-5p as a risk factor for poor maternal and infant outcomes in GDM patients was evaluated by binary logistic analysis. Results: miR-204-5p expression was decreased in GDM patients compared to healthy pregnant women. The area under the curve (AUC) for distinguishing the healthy people from GDM patients was 0.918, with a sensitivity and specificity of 78.5% and 90.2%. Additionally, miR-204-5p expression in GDM patients in the poor outcome group was lower than that in the good outcome group. The AUC reflecting the potential of miR-204-5p in predicting poor maternal and infant outcomes in GDM patients was 0.855, with a sensitivity of 66.7% and a specificity of 90.5%. miR-204-5p is a risk factor for poor maternal and infant outcomes in GDM patients. Conclusions: Serum miR-204-5p expression is low in GDM and has a high diagnostic potential for predicting the occurrence of GDM and poor maternal and infant pregnancy outcomes. It is expected to be a biomarker for the risk of GDM.

Is early pregnancy hemoglobin A1c useful to predict gestational diabetes mellitus diagnosed during mid pregnancy?

To verify whether hemoglobin A1c (HbA1c) levels in early pregnancy can predict the diagnosis of gestational diabetes mellitus (GDM) in mid-pregnancy. This was a retrospective cohort study of 2008 pregnant women who delivered singletons at the Yokohama City university Medical Center. Concomitant or history of diabetes mellitus and overt diabetes in pregnancy were excluded. Pregnant women at high risk for GDM underwent a one-step 75-g oral glucose tolerance test (OGTT) during mid-pregnancy. For other pregnant women, GDM was diagnosed by a two-step 75-g oral glucose tolerance test (OGTT) when the 50-g glucose challenge test result in mid-pregnancy was ≥140 mg/dL. The thresholds for 75-g OGTT followed those of the International Association of Diabetes and Pregnancy Study Group (IADPSG) criteria (92-180-153 mg/dL). The relationship between HbA1c level measured at <20 weeks of gestation and GDM diagnosis at mid pregnancy was assessed using a receiver operating characteristic curve (ROC); area under the curve (AUC) and optimal cutoff value of HbA1c, predictive of GDM were calculated. The median HbA1c level at <20 weeks of gestation was 5.3%, and 8.5% of women were diagnosed with GDM. In the ROC curve of the GDM diagnosis rate by HbA1c level, AUC was 0.706, and the optimal cutoff value was 5.4%, with a sensitivity of 0.6176, specificity of 0.6834, positive predictive value of 15.4%, and negative predictive value of 95.1%. Although HbA1c at less than 20 weeks of gestation is acceptable discrimination as a diagnostic tool of GDM in mid-pregnancy, it is not clinically useful to predict GDM in mid-pregnancy.

Ethnic-specific oral glucose tolerance (OGTT) phenotypes in women with hyperglycemia in pregnancy

IntroductionEthnic differences associated with oral glucose tolerance test (OGTT) phenotypes is less studied in Southeast Asian ethnicities, especially in women with hyperglycemia in pregnancy (HIP).Research design and methodsWe retrospectively examined...

Performance of point‐of‐care glucose testing for the diagnosis of gestational diabetes in South Africa

AbstractObjectiveLack of accessibility to oral glucose tolerance tests (OGTTs) in South Africa means many pregnant women go without testing for gestational diabetes mellitus (GDM). This study evaluated point‐of‐care (POC) glucometers against the laboratory‐based glucose method in pregnant women.MethodsThis was a cross‐sectional study on pregnant women attending the prenatal clinic in Johannesburg who were recommended for the OGTT. OGTTs were conducted as per International Association of Diabetes and Pregnancy Study Groups (IADPSG) guidelines. Women who consented to the study donated both venous and capillary blood for laboratory‐based and POC glucose measurements using seven POC glucometers: I‐STAT, Xpress, LDX, VivaChek‐Ino, Accu‐Chek Active, StatStrip, and Codefree. By assessing sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) and comparing Bland–Altman plots, the diagnostic accuracy of each glucose meter was compared with the reference method, the laboratory‐based glucose method.ResultsData were analyzed for 1076 pregnant women. Based on OGTT testing, 83 women had GDM (7.7%). Overall, the POC glucometers performed poorly, with sensitivity ranging from 17.6% to 87.18% and specificity ranging between 62.7% and 99.8%. The AUC ranged from 0.59 to 0.79. All POC glucometers showed moderate to poor reliability. Laboratory‐based fasting plasma glucose (FPG) surpassed the POC glucometers in sensitivity, specificity, and AUC, with values of 94.0%, 100%, and 0.98, respectively.ConclusionWe demonstrated that laboratory‐based FPG has the potential to be used as a diagnostic test for GDM and that the POC glucometers cannot replace OGTT laboratory‐based measurements.

Postpartum glycemic and cardiometabolic profile of women testing positive for gestational diabetes mellitus by International Association of Diabetes and Pregnancy Study Groups (IADPSG) but negative by alternate criteria: Insights from CHIP–F study

ObjectiveTo evaluate burden of postpartum diabetes and other cardiometabolic risk factors among women who test positive for gestational diabetes mellitus (GDM) by International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria, but negative by alternate criteria. MethodsThis prospective cross-sectional study was conducted from 2019 to 2022 and is a sub-study of the CHIP–F cohort (Cohort Study of Indian Women with Hyperglycemia in Pregnancy and their Families). ResultsStudy participants (n = 826; 183 with normoglycemia and 643 with GDM using IADPSG criteria) were evaluated at a median (IQR) postpartum interval of 31 (21–45) months. Using the United Kingdom National Institute of Health and Care Excellence (UK NICE), Canadian Diabetes Association (CDA), and Diabetes in Pregnancy Study Group India (DIPSI) criteria, 251 (39.0 %), 148 (23.0 %) and 384 (59.7 %) women who tested positive for GDM by IADPSG criteria, would have tested negative. The incidence of postpartum diabetes among such women was 30.4, 34.3, and 48.2 per 1000 women-years, respectively, which was significantly higher than those testing negative by both IADPSG and UK NICE (5.0 per 1000 women-years), IADPSG and CDA (9.2/1000 women-years) and IADPSG and DIPSI criteria (5.0/1000 women-years). The burden of obesity and metabolic syndrome was also significantly higher in such women. ConclusionsWe found a significant burden of postpartum diabetes and cardiometabolic risk factors among women who tested positive for GDM by IADPSG, but negative by alternate criteria. There are potential clinical implications of a “failed” diagnosis for future cardiometabolic diseases that need to be carefully examined.

Time-in-Range With Insulin Versus Metformin in Gestational Diabetes Mellitus Using Continuous Glucose Monitoring: A Randomized Control Study at a Tertiary Care Centre in South India.

Background The prevalence of gestational diabetes mellitus (GDM) is increasing globally. When diet and lifestyle modifications are inadequate for control, managing GDM often involves insulin or metformin. Metformin's oral administration option improves patient compliance and acceptance, but concerns about its use persist, necessitating careful evaluation. Comparative studies between insulin and metformin in GDM are scarce. In pregnancies complicated by diabetes, precise glucose control is crucial for maternal-fetal well-being, and continuous glucose monitoring (CGM) plays a valuable role in achieving recommended targets. CGM provides comprehensive glucose profiles, including postprandial glucose excursions and details about time spent in hypoglycemia, euglycemia, and hyperglycemia. The time-in-range (TIR) metric, when used alongside A1C, offers more actionable information than A1C alone. To the best of our knowledge, no published trials compare TIR in GDM with metformin or insulin aspart/detemir, specifically focusing on CGM metrics. This randomized controlled trial (RCT) aims to assess TIR in women with GDM treated with either metformin or insulin. Materials and methods This study was a non-inferiority randomized control trial evaluating TIR in GDM using continuous glucose monitoring with metformin or insulin. Forty-four women with GDM were enrolled. The diagnosis of GDM was based on the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria. CGM readings were collected for 14 days after sensor activation. Results In our study, 44 women with GDM completed the protocol, with 22 in the Metformin group and 22 in the Insulin group. Baseline characteristics did not differ between the groups. Age, BMI pre-gravid, BMI at 28 weeks, parity, family history of diabetes mellitus, previous history of GDM, glycated hemoglobin (HbA1c), oral glucose tolerance tests (OGTT) at zero hours, one hour, and two hours, as well as gestational weeks, did not significantly differ between the two groups. The metformin and insulin groups did not differ significantly in CGM metrics, including TIR, time above range, time below range, mean glucose, and glucose management indicator. Conclusion Based on our findings, the metformin and insulin groups did not differ in CGM metrics, including TIR, time above range, time below range, mean glucose, and glucose management indicator. In clinical practice, CGM metrics complement fasting blood glucose, postprandial glucose, and HbA1c as appropriate and useful clinical targets and outcome measurements. Metformin's oral administration option offers advantages such as improved patient compliance and acceptance in women with GDM.

National and regional prevalence of gestational diabetes mellitus in India: a systematic review and Meta-analysis

BackgroundGestational diabetes mellitus (GDM) is frequently misdiagnosed during pregnancy. There is an abundance of evidence, but little is known regarding the regional prevalence estimates of GDM in India. This systematic review and meta-analysis aims to provide valuable insights into the national and regional prevalence of GDM among pregnant women in India.MethodsWe conducted an initial article search on PubMed, Scopus, Google Scholar, and ShodhGanga searches to identify quantitative research papers (database inception till 15th June,2022). This review included prevalence studies that estimated the occurrence of GDM across different states in India.ResultsTwo independent reviewers completed the screening of 2393 articles, resulting in the identification of 110 articles that met the inclusion criteria, which collectively provided 117 prevalence estimates. Using a pooled estimate calculation (with an Inverse square heterogeneity model), the pooled prevalence of GDM in pregnant women was estimated to be 13%, with a 95% confidence interval (CI) ranging from 9 to 16%.. In India, Diabetes in Pregnancy Study of India (DIPSI) was the most common diagnostic criteria used, followed by International Association of Diabetes and Pregnancy Study Groups (IADPSG) and World Health Organization (WHO) 1999. It was observed that the rural population has slightly less prevalence of GDM at 10.0% [6.0–13.0%, I2=96%] when compared to the urban population where the prevalence of GDM was 12.0% [9.0–16.0%, I2 = 99%].ConclusionsThis review emphasizes the lack of consensus in screening and diagnosing gestational diabetes mellitus (GDM), leading to varied prevalence rates across Indian states. It thoroughly examines the controversies regarding GDM screening by analyzing population characteristics, geographic variations, diagnostic criteria agreement, screening timing, fasting vs. non-fasting approaches, cost-effectiveness, and feasibility, offering valuable recommendations for policy makers. By fostering the implementation of state-wise screening programs, it can contribute to improving maternal and neonatal outcomes and promoting healthier pregnancies across the country.

Prevalence, risk factors and outcomes associated with Gestational Diabetes Mellitus according to the IADPSG and NICE criteria in Mexico

In Mexico, there is still no consensus of a criteria for the diagnosis of Gestational Diabetes Mellitus (GDM). The objective was to compare characteristics among GDM diagnostic criteria by the International Association of Diabetes and Pregnancy Study Groups (IADPSG) and the National Institute for Health and Clinical Excellence (NICE) in Mexico. A prospective and descriptive study was conducted in the Northeast region of Mexico. Prevalence, risk factors, maternal-fetal outcomes were evaluated. GDM prevalence was ​​44.5% by IADPSG and 37.5% by NICE. The analysis of risk factors and outcomes tended to be equal between criteria; nonetheless, the use of only IADPSG or NICE criteria limited the number of patients diagnosed with GDM, leading to a percentage of misclassified cases. IADPSG criteria seem to have fewer limitations to identify GDM patients than NICE due to the characteristics of the cohort. Although, determining in parallel NICE criteria, could be complementary for GDM diagnosis in Mexico. As conclusions, we propose the assessment of both criteria (IADPSG and NICE) to identify the largest number of women at risk of GDM. The lack of significant differences in outcomes between criteria reflects the importance of opportune treatment for GDM patients, which is not administered in a percentage of GDM missed cases when only one criterion is used.&#x0D;

Patients with gestational diabetes mellitus may be treated in both early and late pregnancy, especially in patients with pre-pregnancy overweight: A cross-sectional study in Japan.

The significance of diagnosing gestational diabetes mellitus (GDM) in early pregnancy is controversial. We used the International Association of Diabetes and Pregnancy Study Group (IADPSG) criteria to investigate whether clinical background and neonatal outcomes differ depending on when GDM is diagnosed in early or late pregnancy. This was a single-center, observational study conducted between November 2012 and March 2020 at St. Marianna University Hospital (Kawasaki, Japan). We compared the background and perinatal outcomes of patients with GDM depending on the time of diagnosis (at < 24 gestational weeks or ≥ 24weeks). Insulin sensitivity index, homeostasis model assessment of insulin resistance, and β-cell function were calculated from a 75-g oral glucose tolerance test. Stratified analysis was performed by pre-pregnancy BMI in patients with early GDM. As a result, in the 507 patients, 89.9% gave birth at our hospital. The pre-pregnancy BMI was significantly higher in patients with early GDM than in those with late GDM (the median [interquartile range], 22.7 [20.3, 26.3] and 21.5 [19.3, 23.8] kg/m2, respectively; p = 0.001). Perinatal outcomes were not different between the two groups. However, in the subgroup analysis of patients with early GDM, the prevalence of large-for-gestational-age infants was significantly higher in the group with overweight (15.4% vs 2.1%, respectively; p = 0.008). In conclusion, patients with GDM using the IADPSG criteria in early pregnancy may be treated, especially in patients with pre-pregnancy overweight.

1187-P: Early Pregnancy Hyperglycemia and Glycemic Status at 24–28 Weeks in Indian Women

Introduction: Early pregnancy hyperglycemia threshold (FPG ≥92mg/dl (≥5.1mmol/l)) suggested by International Association of Diabetes and Pregnancy Study Groups (IADPSG) is debateable. There is no evidence of their glycemic status at 24-28 weeks in Indians. Aim: To understand the 24-28 weeks glycemic status in women with early pregnancy hyperglycemia. Methods: STratification of Risk of Diabetes in Early pregnancy (STRiDE) study, designed to identify the role of HbA1c in early pregnancy on incident GDM, recruited 2703 pregnant women from 7 centres in south India and 566 (20.9%) women had early pregnancy hyperglycemia. Of these 477 women underwent 24-28 weeks screening (OGTT n=150, FPG n=327) Results: Abnormal glucose values were present in 32.7% of women at 24-28 weeks (high FPG or GDM by OGTT). These women had higher weight, BMI, waist circumference, family history of diabetes, FPG, and HbA1c at booking compared to women who were normoglycaemic. In multiple regression analysis, early pregnancy FPG ≥95mg/dl (5.3mmol/l) was independently associated with abnormal glucose values at 24-28 weeks (aOR: 1.9; 95% CI: 1.3-3.0, p &amp;lt;0.001), adjusted for key covariates. Conclusion: Majority of women who had early pregnancy hyperglycaemia became normoglycaemic at 24-28 weeks. HAPO study FPG threshold for the adverse outcomes with aOR: 2.0 was ≥95mg/dl. It may be prudent to classify Indian women with this threshold in early pregnancy as abnormal. Disclosure W.Hannah: None. M.Deepa: None. C.Shivashri: None. H.Saite: None. U.Ram: None. R.Anjana: None. Y.Ghebremichael-weldeselassie: None. P.Saravanan: Other Relationship; Novo Nordisk, Research Support; Novo Nordisk, Amgen Inc., Abbott. V.Mohan: None. Funding Medical Research Council, UK (MR/N006232/1)

Non-efficacy of early intervention strategy for non-obese patients with early-onset gestational diabetes mellitus: solely based on the short-term outcomes

IntroductionTo verify the effectiveness of intervention in early pregnancy for women with early-onset gestational diabetes mellitus (GDM).Research design and methodsThis study included women with a singleton pregnancy who were diagnosed...

Cardiovascular risk management following gestational diabetes and hypertensive disorders of pregnancy: a narrative review.

Cardiovascular risk management following gestational diabetes and hypertensive disorders of pregnancy: a narrative review.

Risk of fetal undergrowth in the management of gestational diabetes mellitus in Japan.

In Japan, the increasing frequency of underweight among women of reproductive age and the accompanying increase in the rate of low birth weight (LBW) are social issues. The study aimed to establish a prospective registry system for gestational diabetes mellitus (GDM) in Japan and to clarify the actual status of GDM according to the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria. Pregnant women with gestational diabetes mellitus and those in the normal glucose tolerance (NGT) group were enrolled in the Diabetes and Pregnancy Outcome for Mother and Baby study from October 2015. Pregnant women with positive glucose screening in early and mid-to-late pregnancy underwent a 75 g oral glucose tolerance test by gestational week 32. Gestational diabetes mellitus was diagnosed according to IADPSG criteria. Women with a positive glucose screening test at mid-to-late pregnancy but NGT were enrolled as references (NGT group). Treatment for gestational diabetes mellitus and maternal and neonatal pregnancy data were prospectively collected on outcomes. In total 1,795 singleton pregnancies (878 women with GDM and 824 NGT women) were analyzed. The risk of LBW and small-for-gestational age in the GDM group was significantly higher than in the NGT group. A similar relationship was found for LBW risk in the non-overweight/obese group but not in the overweight/obese group. We established a prospective GDM registry system in Japan. In the management of GDM in Japan, suppression of maternal weight gain may be associated with reduced fetal growth, especially in non-overweight/obese women with GDM; however, further investigation is required.

Lower Versus Higher Glycemic Criteria for Diagnosis of Gestational Diabetes

ABSTRACT Gestational diabetes mellitus (GDM) in pregnancy is a global health problem. Maternal risks associated with this condition include higher rates of induced labor, cesarean delivery, and preeclampsia. Fetal exposure to GDM can increase the risk of large for gestational age (LGA), as well as operative birth, shoulder dystocia, and birth injuries. To reduce these risks, GDM is managed with nutritional therapy, blood glucose monitoring, and pharmacologic treatment. However, the criteria to diagnose GDM in pregnant individuals vary globally. Although the International Association of Diabetes and Pregnancy Study Groups (IADPSG) recommends using a lower glycemic threshold to diagnose maternal hyperglycemia, its adoption has been mixed. The aim of this study was to evaluate whether lower glycemic criteria to diagnosis GDM would improve perinatal and maternal outcomes. This was a randomized trial conducted in 2 health boards in New Zealand between April 2015 and August 2020. Included were women with singleton pregnancies who had a 75-g oral glucose tolerance test (OGTT) at 24 to 32 weeks of gestation. Excluded were those with diabetes mellitus or a history of GDM. The women were randomly assigned to be evaluated for GDM using lower glycemic criteria for diagnosis or higher criteria in a 1:1 ratio. The lower criteria were defined as a fasting plasma glucose level ≥5.1 mmol/L, a 1-hour level ≥10.1 mmol/L, or a 2-hour level ≥8.5 mmol/L. The higher criterion was a fasting plasma glucose level ≥5.5 mmol/L or a 2-hour level ≥9 mmol/L. The primary outcome was LGA. A total of 4050 women and their infants were randomized and included in the analysis—2019 in the lower criteria group and 2013 in the higher criteria group. There were 8.8% LGA infants born in the lower criteria group and 8.9% in the higher criteria group (unadjusted relative risk, 0.99; 95% confidence interval [CI], 0.81–1.21; P = 0.91). Infants in the lower criteria group were more likely to have hypoglycemia compared with those in the higher criteria group (10.7% vs 8.4%; adjusted relative risk [aRR], 1.27; 95% CI, 1.05–1.54). Women in the lower criteria group were more likely to undergo induced labor (33.7% vs 30.2%; aRR, 1.12; 95% CI, 1.02–1.22) or use pharmaceutical treatment for GDM (10.9% vs 4.6%; aRR, 2.40; 95% CI, 1.90–3.03). They also had more diabetes service visits (0.6 ± 1.6 vs 0.2 ± 1.0; aRR, 2.42; 95% CI, 1.80–3.26), as well as visits with diabetes medical specialists post-OGTT (0.3 ± 0.9 vs 0.1 ± 0.6; aRR, 2.39; 95% CI, 1.80–3.18), diabetes nurses (0.4 ± 1.2 vs 0.2 ± 0.8; aRR, 2.41; 95% CI, 1.80–3.21), and dietitians (0.1 ± 0.3 vs &lt;0.1 ± 0.3; aRR, 2.26; 95% CI, 1.73–2.95). Among women in both groups whose OGTT results were between the lower and higher thresholds, 195 received GDM treatment, and 178 did not. Those in the lower criteria group had fewer LGA infants (6.2% vs 18.%; aRR, 0.33; 95% CI, 0.18–0.62) than those in the higher criteria group. They also experienced less gestational weight gain (10 vs 11.9 kg), had a lower incidence of preeclampsia (0.5% vs 5.6%), were more likely to have labor induced (56.9% vs 30.3%), and had a higher prevalence of breastfeeding when discharged from the hospital (99.5% vs 94.9%). In conclusion, pregnant women evaluated for GDM using lower glycemic criteria group were more than 2.5 times as likely as those in the higher criteria group to receive a diagnosis and treatment. However, despite increased identification and treatment of GDM, the lower glycemic criteria did not result in apparent perinatal or maternal benefit in the population being screened, but some potential benefit was identified in the subpopulation of those with the test values just below the higher threshold.

Fasting Plasma Glucose and Its Relationship to Anthropometric Phenotype in Women Diagnosed with Gestational Diabetes According to IADPSG Criteria.

Gestational diabetes mellitus (GDM) is characterized by new-onset hyperglycemia in pregnancy. According to the International Association of Diabetes and Pregnancy Study Groups (IADPSG) recommendations, GDM may be diagnosed based on repeatedly increased fasting glucose levels in the first trimester, or later, the detection of increased fasting glucose and/or increased glucose levels during a 75 g oral glucose tolerance test (OGTT). The study aimed to assess whether differences may be found between women diagnosed with GDM by fasting glucose or glucose challenge tests in early or late pregnancy. The retrospective observational study enrolled 418 women diagnosed with GDM in accordance with the IADPSG criteria: early pregnancy fasting plasma glucose (FPG) ≥ 5.1 mmol/L; late pregnancy FPG ≥ 5.1 mmol/L (0 min) and/or postprandial plasma glucose (PPG) ≥ 10.0 mmol/L (60 min), PPG ≥ 8.5 mmol/L (120 min) 75 g OGTT. The analyses included anthropometric parameters at the beginning and during pregnancy, laboratory values of glycated hemoglobin, fructosamine, birth weight measures and the presence of neonatal complications. There were significant differences in body weight (78.3 ± 19.1; 74.0 ± 16.7; 67.2 ± 15.7 kg) and body mass index (BMI) (27.9 ± 6.6; 26.4 ± 5.8; 24.4 ± 5.2 kg/m2) in early pregnancy. Differences were also found in gestational weight gain (9.3 ± 6.8 vs. 12.4 ± 6.9 vs. 11.1 ± 4.7 kg) and the need for insulin therapy (14.7%; 7.1%; 4.0%). The study revealed no difference in the presence of neonatal complications but differences in birth weight (3372.2 ± 552.2 vs. 3415.6 ± 529.0 vs. 3199.0 ± 560.5 g). Gestational diabetes, characterized by FPG ≥ 5.1 mmol/L in early pregnancy, is associated with higher body weight and BMI at the beginning of pregnancy as well as with a higher risk for insulin therapy and increased birth weight.

Review of the Screening Guidelines for Gestational Diabetes Mellitus: How to Choose Wisely.

Currently, there is no international unanimity regarding the timings, the optimal cut-off points, and standardized methods of screening or diagnosis of gestational diabetes mellitus (GDM). The screening guidelines and recommendations for GDM evolved over time; concise information has been presented here in the review. We searched electronic databases for various guidelines for screening of GDM in PubMed, Medical Literature Analysis and Retrieval System Online (MEDLINE), Embase, Cochrane, Google Scholar, Scopus, Guidelines International Network (GIN library), National Guidelines Clearinghouse (NGC); Web sites of relevant organizations; and trial registries. The mesh headings derived after reviewing the articles and were used to further search the articles are: ("Screening Guidelines GDM" or "Screening Criteria for GDM") and ("Glucose Intolerance in Pregnancy" or "Gestational Diabetes Mellitus"). The articles published from 1960 till December 2022 were included. Key outcomes included the prevalence of GDM is 14.6% according to the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria and 13.4% according to Diabetes in Pregnancy Study Group India (DIPSI) criteria, making the DIPSI criterion a cost-effective method for low-resource settings. The IADPSG) criterion diagnoses and treats GDM earlier, thus reducing the complications associated with GDM in the mother and newborn. The IADPSG criteria at a cut-off of ≥140 mg/dL have a sensitivity of 81% and specificity of 93%, whereas the World Health Organization (2013) criteria at the same cut-off has a lower sensitivity of 59% and specificity of 81%. The risk factors of having GDM are family history, history during past pregnancy, medical history, multiple current pregnancies, and raised hemoglobin A1c. The screening guidelines have been developed by different organizations and institutions over the years. The guidelines with the threshold values for screening and their standardization for detecting GDM in Indian mothers are yet to be established.

Clinicians’ Perspectives on Glucose Tolerance Test Practices at a Tertiary Care Hospital in Coimbatore, Tamil Nadu, India

Introduction: The overuse of laboratory investigations is prevalent in hospital settings, with a major contributing factor being ignorance of test characteristics. The utilisation of laboratory tests depends on clinicians' perspectives. Aim: Present study aimed to assess clinicians' perspectives on Glucose Tolerance Test (GTT) practices in a tertiary care hospital in Coimbatore and identify any process deviations. Materials and Methods: A descriptive study was conducted in the Department of Biochemistry at PSG IMSR, Coimbatore, Tamil Nadu, India, involving 27 clinicians. Structured interviews were conducted in March 2019, covering indications for GTT, preferred glucose loads, fasting duration, blood sample collection time intervals, cut-off levels for glucose values at different time intervals (0, 1, 2, 3, 4 hours), and reference criteria used for interpretation {World Health Organisation (WHO), American Diabetes Association (ADA), The International Association of Diabetes and Pregnancy Study Groups (IADPSG)} . Test Request Forms (TRFs) for GTT over a one-month period were also analysed. Quantitative data was expressed as mean±SD, and qualitative data was expressed as frequency and percentage. Results: The structured interviews were conducted with 27 clinicians, predominantly from the Department of Obstetrics and Gynaecology. GTT usage was rare in other departments. A total of 217 TRFs were received for the one-month duration, with 94.9% indicating a glucose load of 75 grams (g). Conclusion: GTT is influenced by various factors throughout the testing process, that can have an impact on results and patient care. This study revealed differences between end- users' requirements and the laboratory's procedures. By revising the TRF and sample collection manual according to clinicians' needs, better optimisation between the laboratory and end-users of the test can be achieved.

Trying Modified Approaches to the Management of Pregnancy Induced Diabetes Mellitus (GDM) a Prospective Study

Background: To investigate maternal and foetal outcomes in patients with gestational diabetes mellitus diagnosed according to the criteria of the International Association of Diabetes and Pregnancy Study Groups (IADPSG), but who were evaluated using a twenty-four hour seven-value sugar profile prior to the implementation of management. This study sought to examine maternal and fetal outcomes in patients with gestational diabetes mellitus. Place of Study: Sialkot Medical College Sialkot Duration of Study: JUNE 2021 TO JUNE2022 Methods: This prospective observational study was undertaken at the Sialkot Medical College Hospital over the course of one year. The hospital served as the study's location. Prior to starting any medication between 24 and 28 weeks of pregnancy, women diagnosed with GDM based on IADPSG criteria were needed to undertake a seven-value sugar profile within twenty-four hours. This criterion applied to women diagnosed with gestational diabetes between 24 and 28 weeks of pregnancy. The remaining patients were treated with medical nutrition therapy (MNT), which may or may not have been supplemented with medication depending on what was necessary to maintain their normal blood sugar levels. Documentation and analysis of maternal and fetal outcomes were conducted to assess whether or not the groups displayed differentiating characteristics. Results: GDM was diagnosed in 198 out of a total of 1867 pregnant women, representing a 9.1% prevalence rate. In 81 patients, or 40.90% of the total, the 7-point blood glucose profile (ITT) was normal, and these individuals required no medical intervention other than watchful observation. Other patients received treatment; 89 (44.9% of patients) required only MNT control, while 19 (9.59%) received supplementary medication in the form of metformin and 9 (4.5%) required insulin. It was determined that there were no statistically significant differences between the treated and untreated groups in terms of maternal–fetal outcomes. Upon comparing treated and untreated groups, this was the result that was reached. Conclusions: After an abnormal Oral Glucose Tolerance Test, the technique of evaluating patients with a seven-value, twenty-four-hour sugar profile limited the capacity of nearly one-third of women to get medication and treatment for GDM without compromising maternal–fetal outcomes. This was the case despite the absence of a link between an aberrant OGT and a diminished capacity to receive therapy and treatment for GDM. Keywords: GDM IADPSG Maternal fetal outcomes

Exploring the Optimal Diagnostic Thresholds of Hyperglycemia During Pregnancy

Exploring the Optimal Diagnostic Thresholds of Hyperglycemia During Pregnancy

Efficacy and safety of hypoglycemic agents on gestational diabetes mellitus in women: A Bayesian network analysis of randomized controlled trials.

To compare the efficacy and safety of metformin, glyburide, and insulin for GDM, we conducted a subgroup analysis of outcomes for women with GDM according to the International Association of Diabetes and Pregnancy Study Groups (IADPSG) diagnostic criteria. We searched the NCBI, Embase, and Web of Science databases from inception to March 2022. Randomized controlled trials (RCTs) that compared the outcomes of hypoglycemic agents in women with GDM were included. Bayesian network analysis was employed. A total of 29 RCTs were included. Metformin was estimated to lead to a slight improvement in total gestational weight gain (WMD - 1.24 kg, 95% CI -2.38, -0.09), a risk of unmet treatment target in the sensitivity analysis (OR 34.50, 95% CI 1.18-791.37) than insulin. The estimated effect of metformin showed improvements in birth weight than insulin (WMD - 102.58 g, 95% CI -180.45 to -25.49) and glyburide (WMD - 137.84 g, 95% CI -255.31 to -25.45), for hypoglycemia within 1 h of birth than insulin (OR 0.65, 95% CI 0.47 to 0.84). The improvement in the estimated effect of metformin for hypoglycemia within 1 h of birth still existed when compared with glyburide (OR 0.41, 95% CI 0.26 to 0.66), whether in the IADPSG group (OR 0.33, 95% CI 0.12 to 0.92) or not (OR 0.43, 95% CI 0.20 to 0.98). Metformin is beneficial for GDM women to control total GWG compared with insulin, regulate fetal birth weight more than insulin and glyburide, and increase the risk of unmet treatment targets compared with insulin. Compared to metformin, glyburide is associated with neonatal hypoglycemia.