International Association Of Diabetes And Pregnancy Study Groups Research Articles

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.

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.

Progression to type 2 diabetes mellitus after gestational diabetes mellitus diagnosed by IADPSG criteria: Systematic review and meta-analysis.

BackgroundTo estimate the progression rates to type 2 diabetes mellitus (T2DM) in women with gestational diabetes mellitus (GDM) diagnosed by the International Association of Diabetes and Pregnancy Study Group (IADPSG) criteria.MethodsSystematic review and meta-analysis were conducted by searching Medline, Embase, and Cochrane between January 1, 2010 and December 31, 2021 for observational studies investigating progression to T2DM after GDM. Inclusion criteria were IADPSG-diagnosed GDM, studies with both GDM and controls, postpartum follow-up duration at least one year. Data were pooled by random effects meta-analysis models. Heterogeneity was assessed by I2 statistic. The pooled relative risk for incidence of T2DM and pre-diabetes between GDM participants and controls were estimated. Reasons for heterogeneity among studies were investigated by prespecified subgroup and meta-regression analysis. Publication bias was assessed by the Begg’s and Egger’s tests.ResultsThis meta-analysis of six studies assessed a total of 61932 individuals (21978 women with GDM and 39954 controls). Women with IADPSG-diagnosed GDM were 6.43 times (RR=6.43, 95% CI:3.45-11.96) more likely to develop T2DM in the future compared with controls. For GDM women, the cumulative incidence of T2DM was 12.1% (95% CI: 6.9%-17.3%), while the pooled cumulative incidence of T2DM was estimated to be 8% (95% CI: 5-11%) in studies with 1 to 5 years of follow-up and increased to 19% (95% CI: 3-34%) for studies with more than 5 years of follow-up. Women with IADPSG-diagnosed GDM had 3.69 times (RR=3.69, 95% CI:2.70-5.06) higher risk of developing pre-diabetes (including impaired fasting glucose and/or impaired glucose tolerance) than controls. Meta-regression analysis showed that the study effect size was not significantly associated with study design, race, length of follow-up, and maternal age (P>0.05). Overall, the studies had a relatively low risk of bias.ConclusionsWomen with IADPSG-diagnosed GDM have higher risk of developing T2DM and pre-diabetes. The risk of T2DM in GDM women are higher with longer follow-up duration. Our results highlight the importance of promoting postpartum screening and keeping health lifestyle as well as pharmacological interventions to delay/prevent the onset of T2DM/pre-diabetes in GDM women.Systematic review registration https://www.crd.york.ac.uk/prospero, identifier (CRD42022314776)

The NDDG criteria versus the IADPSG or the ADA criteria for diagnosing early-onset gestational diabetes mellitus or abnormal glucose tolerance.

To analyze the effects of substituting the National Diabetes Data Group (NDDG) criteria with the International Association of Diabetes and Pregnancy Study Groups (IADPSG) or American Diabetes Association (ADA) criteria for the diagnosis of early-onset gestational diabetes mellitus (Early-GDM) or first trimester abnormal glucose tolerance (1t-AGT). A retrospective cohort study was conducted of 3200 women: 400 with Early-GDM, 800 with GDM, and 2000 with Non-GDM, according to the NDDG criteria. Rates of women with missed and new Early-GDM according to the IADPSG or ADA criteria were calculated. Multivariate logistic regression analysis was used to compare perinatal outcomes between groups. Using the IADPSG criteria, 61.6% of women with Early-GDM according to the NDDG were undiagnosed (Missed-Early-GDM group), and 25.9% of women with GDM and 15.7% of women with Non-GDM were diagnosed with Early-GDM (New-Early-GDM groups). Perinatal outcomes were worse in Missed-Early-GDM than in Non-GDM and better in New-Early-GDM groups than in the Early-GDM group. According to the ADA recommendations, only 11.8% of women with Early-GDM according to the NDDG criteria were diagnosed. Replacing the NDDG recommendations for the diagnosis of Early-GDM with the IADPSG or ADA criteria would mean depriving a large number of women with AGT and higher risk of adverse perinatal outcomes from early treatment and treating others with lower risk.

Do pregnancy outcomes of women with false-positive early gestational diabetes mellitus differ from those of women with normal glucose tolerance?

BackgroundTo investigate whether false-positive early gestational diabetes mellitus (GDM) women can be managed similarly as normal glucose tolerance (NGT) women.MethodsThis retrospective study was conducted at a tertiary care center in Japan. Pregnancy and neonatal outcomes of 67 singleton pregnancies with false-positive early GDM and 1774 singleton pregnancies with NGT who delivered after 22 weeks of gestation were compared. GDM was diagnosed according to the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria (patients having one or more of the following: fasting plasma glucose ≥ 92 mg/dL and a 75 g oral glucose tolerance test (OGTT) value ≥ 180 mg/dL at 1 h, or ≥ 153 mg/dL at 2 h). Pregnant women diagnosed with GDM in early pregnancy who did not meet the diagnostic criteria on the second OGTT were defined as having false-positive early GDM. Women with false-positive early GDM did not receive any therapeutic intervention during gestation.ResultsMaternal age, pre-pregnancy body mass index, and gestational weight gain were significantly higher in the false-positive GDM group than in the NGT group. No significant differences were found in pregnancy outcomes, including gestational age, birth weight, large for gestational age rate, and cesarean delivery rate. Except for a higher neonatal hypoglycemia rate in the false-positive early GDM group, no significant differences were found in neonatal outcomes.ConclusionsThere were no clinically significant differences between early GDM false-positive women exhibiting GDM patterns only during early pregnancy and NGT women. False-positive early GDM women can be managed similarly as NGT women, suggesting that World Health Organization diagnostic guidelines, applying the IADPSG criteria during early pregnancy, need revision.

Circulating saturated fatty acids and risk of gestational diabetes mellitus: A cross-sectional study and meta-analysis.

BackgroundPrevious studies have analyzed the associations between the circulating saturated fatty acids (SFAs) and gestational diabetes mellitus (GDM), but no consistent conclusions have been reached. The aim of this study was to evaluate whether plasma SFAs were in correlation with GDM risks in our in-house women cross-sectional study and to better define their associations on the clinical evidence available to date by a dose-response meta-analysis.MethodsWe carried out a cross-sectional study of 807 pregnant women in 2018–2019 (Shanghai, China). GDM was defined according to the criteria of the International Association of Diabetes and Pregnancy Study Groups (IADPSG). Gas chromatography was used to determine the plasma fatty acids (FAs) in the 24–28 gestational weeks. The SFAs levels of non-GDM and GDM participants were compared by Mann–Whitney test, and the association between SFAs and GDM was explored by multivariate logistic models. Further, the potential diagnostic value of plasma SFAs was evaluated using the method of receiver operating characteristic (ROC) analysis. For meta-analysis, five databases were systematically searched from inception to March 2022, and we included 25 relevant studies for calculating pooled standard mean differences (SMDs) and 95% CI to describe the differences in SFAs profiles between non-GDM and GDM women. Study-specific, multivariable-adjusted ORs and 95% CI were also pooled using a fixed-effect model or random-effects model according to the heterogeneity to evaluate the associations between circulating SFAs and GDM prevalence.ResultsIn our cross-sectional study, we found plasma proportion of palmitic acid (C16:0) was positively associated (aOR: 1.10 per 1% increase; 95% CI: 1.04, 1.17), while plasma stearic acid (C18:0) (aOR: 0.76 per 1% increase; 95% CI: 0.66, 0.89), arachidic acid (C20:0) (aOR: 0.92 per 0.1% increase; 95% CI: 0.87, 0.97), behenic acid (C22:0) (aOR: 0.94 per 0.1% increase; 95% CI: 0.92, 0.97), and lignoceric acid (C24:0) (aOR: 0.94 per 0.1% increase; 95% CI: 0.92, 0.97) were inversely associated with GDM. The area under the receiver operative characteristic curve increased from 0.7503 (the basic diagnostic model) to 0.8178 (p = 0.002) after adding total very-long-chain SFAs (VLcSFAs). A meta-analysis from 25 studies showed the circulating levels of three individual SFAs of GDM women were different from those of normal pregnant women. The summarized ORs for GDM was 1.593 (95% CI: 1.125, 2.255, p = 0.009), 0.652 (95% CI: 0.472, 0.901, p = 0.010) and 0.613 (95% CI: 0.449, 0.838, p = 0.002), respectively, comparing the highest vs. lowest quantile of the concentrations of C16:0, C22:0, and C24:0.ConclusionOur results, combined with the findings from meta-analysis, showed that women with GDM had a particular circulating SFA profile, characterized by higher levels of palmitic acid, and lower levels of VLcSFAs. Alterations in the chain lengths of blood SFA profile were shown to be associated with the occurrence of GDM.

Gestational weight gain and adverse maternal and perinatal outcomes among women with gestational diabetes mellitus according to International Association of Diabetes and Pregnancy Study Group (IADPSG) criteria: A cross sectional study.

To evaluate the association of gestational weight gain and adverse maternal and perinatal outcomes among Brazilian women with gestational diabetes mellitus (GDM). Cross-sectional study conducted in women with GDM, and their newborns, who attended a public maternity hospital. The Institute of Medicine criteria were adopted to assess adequacy of gestational weight gain (GWG). Cesarean delivery, maternal hypertensive disorders of pregnancy (HDP), premature birth, macrosomia, and birth weight adequacy for gestational age were analyzed as outcomes. Simple and multiple logistic regression models were tested to assess the effect of adequacy of GWG on maternal and newborn outcomes. Among the 545 women studied, 64.2% (n=344) had inadequate weight gain: 27.2% (n=146) insufficient and 37% (n=198) excessive. Women with insufficient GWG were more likely to have a preterm birth (OR 2.57; 95% CI: 1.06-6.19), while those with excessive GWG had a greater chance of HDP (OR 2.62; 95% CI: 1.54-4.45) and large for gestational age newborn (OR 1.88; 95% CI: 1.08-3.29), compared with those with adequate weight gain. Inadequate gestational weight gain was frequent in women with GDM, especially in pregnant women with overweight and obesity, and is associated with unfavorable outcomes.

Clinical Updates on Screening and Diagnosis Criteria for Gestational Diabetes Mellitus Patients, as well as Therapeutic Management

The most prevalent metabolic and endocrine perinatal issue is gestational diabetes mellitus (GDM), which is an increasing health problem worldwide. It is a controversial entity, with conflicting guidelines and treatment protocols. In the United States, most doctors utilise a two-step strategy, first with a 50-g non fasting oral glucose challenge test at 24 to 28 weeks and then a 100-g fasting test for women who have a positive screening result. Alternatively, Clinicians take a one step Diabetes in Pregnancy Study Group India (DIPSI) method and perform simply a 75-g two hour fasting oral glucose tolerance test. The DIPSI approach of antenatal GDM screening has been demonstrated to be straightforward, cost effective, easy to use, patient friendly, and convenient. When comparing the findings to the gold standard of the International Association of Diabetes and Pregnancy Study Group (IADPSG), DIPSI shows high specificity and acceptable sensitivity. To maintain euglycemia, glucose monitoring, dietary changes, exercise, and, if necessary, medicines are used. Although insulin therapy is the most common treatment, glyburide and metformin may become more popular. Prenatal testing with nonstress tests and amniotic fluid indices, commencing in the third trimester, is commonly used to assess foetal well-being in women undergoing medication. The delivery technique and time are contentious. Women who have gestational diabetes are at a significant risk of developing type 2 diabetes later in life. As a result, along with routine diabetes screening, lifestyle adjustment should be recommended.