Management Of Hyperglycemia In Pregnancy Research Articles

A Summary of Chinese Guidelines on Diagnosis and Management of Hyperglycemia in Pregnancy (2022)

Abstract Hyperglycemia is one of the most common complications women encounter during pregnancy, and is associated with a higher incidence of short- and long-term health risks for both the mother and offspring. In 2022, the Maternal-Fetal Medicine Committee of the Chinese Society of Obstetrics and Gynecology, Chinese Medicine Association, worked with the Chinese Society of Perinatal Medicine and the Professional Committee of Gestational Diabetes Mellitus of the Chinese Maternal and Child Health Association to update the Guidelines for the diagnosis and management of hyperglycemia in pregnancy in China. The aim was to further standardize the management of hyperglycemia in pregnancy from the aspects of screening, diagnosis, monitoring, treatment, and prevention of gestational diabetes mellitus, and consequently to further improve the health of mother and child.

IDF21-0581 IDF-MENA region guidelines for management of hyperglycemia in pregnancy

Background: Hyperglycaemia in pregnancy (HIP) is the most common medical disorder complicating pregnancy. In the Middle East and North Africa region, the prevalence of DM in women of reproductive age group is high and it varies widely between different regions due to variation in screening and diagnostic criteria for the identification of GDM. Universal blood glucose screening at first antenatal booking visit helps in identifying women with HIP. To reduce the future burden of complications of diabetes in adolescents and later age it is necessary to screen and diagnose pregnant women during pregnancy for the appropriate management and control of high levels of blood glucose during pregnancy to reduce the inter generational transmission and to reduce the future number of people with diabetes. The children exposed to diabetes inutero are likely to develop diabetes as early as 12–22 years of age. The longer the duration of diabetes more are the chances of early development of diabetes related complications. Regional guidelines if modified, developed and also implemented may address the issues of screening, diagnosis according to available evidence based protocols. Aim: The aim of the guidelines proposed here is to create a standardized pragmatic approach for the screening, diagnosis, and management of HIP that is effective, simple, and accessible to all HCPs. This will eventually assist in improving clinical practice and preventing long-term health complications in the region. Method: These recommendations are made after reviewing various existing guidelines including American College of Obstetricians and Gynecologists, Royal College of Obstetricians and Gynecologists, and American College of Sports Medicine. A literature search was done using PubMed, Cochrane Database, Google Scholar, EMBASE, various systematic reviews, and original articles. Search was done using key words “Hyperglycemia in pregnancy,” “gestational diabetes mellitus,” and “diabetes in pregnancy.” Results: The results will be available after the implementation of this published regional guideline and it will be monitored by regional and local diabetes in pregnancy Registries. Data will be analysed which will be obtained from these registries. The usefulness of the guidelines as a measure of health care practices regarding screening and diagnosis and maternal and perinatal complications data will be used to implement corrective strategy in screening and management of Hyperglycaemia in Pregnancy. The benefits of these guideline will be analyzed and the indicators will be the reduction in Maternal-prenatal complication rates. Discussion: Due to similarities in genetics and pathogenesis, the prevalence of GDM correlates and parallels with T2DM. In MENA region, the prevalence of T2DM varies from 3.9% (Yemen) to 18.3% (Saudi Arabia) and the prevalence of GDM varies from 5.1% (Yemen) to 37.7% (United Arab Emirates). The vast variation among MENA countries is because of dissimilar screening strategies, nonuniform diagnostic criteria for GDM, and economic differences among the countries. This makes accurate assessment and comparison of burden of HIP among the countries very challenging. Regional guidelines if modified, developed and also implemented may address the issues of screening, diagnosis according to available evidence based protocols. The timely diagnosis may reduce the complications of diabetes in maternal perinatal and adult life.

IDF-MENA region guidelines for management of hyperglycemia in pregnancy

Introduction: Hyperglycaemia in pregnancy (HIP) is the most common medical disorder complicating pregnancy. This includes women who have pre-existing Type 1 and Type 2 diabetes mellitus (DM) and those diagnosed to have gestational diabetes mellitus (GDM), with glucose intolerance identified for the first time in pregnancy. In the Middle East and North Africa region, the prevalence of DM in women of reproductive age group is high and it varies widely between different regions due to variation in screening and diagnostic criteria for the identification of GDM. Universal blood glucose screening at first antenatal booking visit helps in identifying women with HIP. Women who are screen negative at first antenatal should subsequently be screened with a fasting oral glucose tolerance test (OGTT) around 24-28 weeks to identify GDM. There is a clear evidence that the identification and management of hyperglycaemia improves pregnancy outcomes. Antenatal care involves more visits as these women are at higher risk of fetal malformations, preterm labour and stillbirth. Timing of delivery is based on glycaemic control, fetal wellbeing, and the presence of co-morbidities. Objective: The objective of this article is to provide guidelines regarding the management of hyperglycemia in pregnancy. Materials and Methods: These recommendations are made after reviewing various existing guidelines including American College of Obstetricians and Gynecologists, Royal College of Obstetricians and Gynecologists, and American College of Sports Medicine. A literature search was done using PubMed, Cochrane Database, Google Scholar, EMBASE, various systematic reviews, and original articles. Search was done using key words “Hyperglycemia in pregnancy,” “gestational diabetes mellitus,” and “diabetes in pregnancy.” Conclusion: Hyperglycemia in pregnancy can be managed effectively if appropriate measures are taken and potential consequences can be avoided.

Guidelines for management of hyperglycemia in pregnancy (HIP) by Society of Obstetricians & Gynaecologists of Pakistan (SOGP)#

Hyperglycemia in pregnancy (HIP) is an important component of primary prevention of diabetes both globally and in Pakistan. To ensure that the opportunity of primary prevention is not missed it is important to diagnose hyperglycemia early in pregnancy. Universal screening in pregnant women at booking is recommended with its implementation at primary, secondary and tertiary levels of health care settings. These guidelines by Society of Obstetricians and Gynecologists (SOGP) are pragmatic addressing screening methodology, preconception care screening & diagnosis, antenatal care plan, intrapartum and postpartum management & follow up, neonatal care, breastfeeding, contraception, counseling for future pregnancy, lifestyle modification, nutritional recommendations and proper techniques for insulin injection, management of diabetic ketoacidosis (DKA) and recommendations for future research. There are many available guidelines for the screening, diagnosis and management of HIP. The SOGP GDM guidelines recommendations are simple, tailored to the local context especially for the busy health care providers; medical as well as nurse practitioners, for whom it is confusing to choose the recommendations from different available guidelines. These guidelines are meant to standardize clinical practice at all health care levels across the country. In order to ensure its practical utilization, a national GDM registry has been proposed and designed so as to observe its applicability in the clinical practice by health care providers.

Clinical practice recommendations for the detection and management of hyperglycemia in pregnancy from South Asia, Africa and Mexico during COVID-19 pandemic.

The human coronavirus disease 2019 (COVID-19) pandemic has affected overall healthcare delivery, including prenatal, antenatal and postnatal care. Hyperglycemia in pregnancy (HIP) is the most common medical condition encountered during pregnancy. There is little guidance for primary care physicians for providing delivery of optimal perinatal care while minimizing the risk of COVID-19 infection in pregnant women. This review aims to describe pragmatic modifications in the screening, detection and management of HIP during the COVID- 19 pandemic. In this review, articles published up to June 2021 were searched on multiple databases, including PubMed, Medline, EMBASE and ScienceDirect. Direct online searches were conducted to identify national and international guidelines. Search criteria included terms to extract articles describing HIP with and/or without COVID-19 between 1st March 2020 and 15th June 2021. Fasting plasma glucose, glycosylated hemoglobin (HbA1c) and random plasma glucose could be alternative screening strategies for gestational diabetes mellitus screening (at 24–28 weeks of gestation), instead of the traditional 2 h oral glucose tolerance test. The use of telemedicine for the management of HIP is recommended. Hospital visits should be scheduled to coincide with obstetric and ultrasound visits. COVID-19 infected pregnant women with HIP need enhanced maternal and fetal vigilance, optimal diabetes care and psychological support in addition to supportive measures. This article presents pragmatic options and approaches for primary care physicians, diabetes care providers and obstetricians for GDM screening, diagnosis and management during the pandemic, to be used in conjunction with routine antenatal care.

American Diabetes Association "Standards of Medical Care-2020 for Gestational Diabetes Mellitus": A Critical Appraisal.

IntroductionGestational diabetes mellitus (GDM) is a major public health problem, affecting about one in every six pregnancies globally. The guidelines provided by the American Diabetes Association (ADA) on diagnosis and management of hyperglycemia in pregnancy are widely followed. We aim to provide a critical appraisal of the recently published ADA guidance document, highlighting its strength and limitations with regard to the diagnosis of GDM.Methods and ResultsWe reviewed the recent ADA recommendations for the diagnosis and management of hyperglycemia in pregnancy. A periodic update in keeping with the emerging evidence, an inclusive diagnostic approach which increases generalizability, and a clear proposed approach for prenatal testing and postpartum follow-up are strengths of the ADA guidance document. On the other hand, its limitations are a lack of clarity on the applicability of diagnosis of GDM during early pregnancy, use of scientifically inaccurate terms such as “prediabetes” in the context of pregnancy and “overt diabetes prior to gestation” in the definition of GDM, and inconsistent use of terminology between successive publications. Certain issues which merit attention in future publications include a need for uniform global definition of GDM, demarcation of overt diabetes in pregnancy as a distinct entity, clarity on the diagnosis of GDM during early pregnancy, and clear delineation of timelines and appropriate testing strategy for the first prenatal visit.ConclusionsThis article provides a critical appraisal of the recently published ADA guidance document with regard to the diagnosis of GDM. We also share our perspective on issues warranting attention in the future publications. Experts from various professional organizations should aim for a consensus document which can resolve existing controversies in this field, and help clinicians and researchers achieve better health for women in their care.

Knowledge and Practice of Physicians to Hyperglycemia in Pregnancy: A Nationwide Survey in Bangladesh

The frequency of hyperglycemia in pregnancy is high in Bangladesh, but very little is known about the current knowledge and practice about hyperglycemia in pregnancy in our practicing doctors. The objective of the present study was to assess the knowledge and practice of the doctors across the country who are involved in the management of hyperglycemia in pregnancy. Structured pretested data collection sheets were sent to the doctors taking care of hyperglycemia in pregnancy (endocrinologists, obstetricians, and others) through email and postage. The questionnaire focused on their knowledge and practice pattern on hyperglycemia in pregnancy. In total, 950 doctors of Bangladesh were invited to join the survey, and 262 (24.89%) responded. Among the participants, 42.3% (111) were endocrinologists, 27.10% (71) obstetrician/gynecologist, and 30.53% (80) were other physicians, including internists, diabetes family physicians. The majority of the participants were aware of hyperglycemia's adverse outcomes in pregnancy, advocates universal screening, and followed the American Diabetes Association’s recommendations for the screening purpose. Though most of them use insulin to manage hyperglycemia in pregnancy, more than half prefer to continue metformin if used for other causes. The majority of the responders favored the Caesarian section as the preferred delivery method. The study participants admit that more than half of the gestational diabetes cases are lost to follow up after delivery. This study's findings may serve as a baseline for the management of hyperglycemia in pregnancy in this country. The doctors involved in managing hyperglycemia in pregnancy require more training for knowledge building and rational practice.

Telemedicine for the initial management of newly diagnosed gestational diabetes in the pandemic period: A report of three case studies

Amidst the coronavirus disease of 2019 (COVID-19) pandemic and the subsequent guidance regarding movement restrictions, people may not be able to or willing to visit hospitals for a diabetes consultation. This especially applies to women with gestational diabetes mellitus (GDM) who are worried about getting infected during their visit to hospital. National telemedicine guidelines have now paved the way for using telemedicine for clinical care in India. We describe a series of three cases, where telemedicine aided the management of GDM. Aided by the use of digital technology, along with glucometers which synchronize with mobile phones and store data in the cloud for clinicians to access, we suggest that telemedicine could be considered in management of hyperglycemia in pregnancy in the current scenario.

Prevalence of hyperglycemia in pregnancy and influence of body fat on development of hyperglycemia in pregnancy among pregnant women in urban areas of Arusha region, Tanzania

BackgroundHyperglycemia in pregnancy is a medical condition resulting from either pre-existing diabetes or insulin resistance developed during pregnancy. This study aimed to determine the prevalence of hyperglycemia in pregnancy and influence of body fat percentage and other determinants on developing hyperglycemia in pregnancy among women in Arusha District, Tanzania.MethodsA cross–sectional study was conducted between March and December 2018 at selected health facilities in Arusha District involving 468 pregnant women who were not known to have diabetes before pregnancy. Blood glucose was tested by Gluco-Plus™ using the World Health Organization criteria at fasting and 2 h after consuming 75 g of glucose dissolved in 300 ml of water. Body fat was measured using a bioelectric impedance analyzer, mid-upper arm circumference using a regulated tape, weight using SECA™, blood pressure using a GT-868UF Geratherm™ machine, and height using a stadiometer. Demographic and maternal characteristics were collected through face to face interviews using a structured questionnaire.ResultsThe participants’ mean age was 28 years (SD ± 6), mid-upper arm circumference 27 cm (SD ± 3.7), body fat 33.72% (SD ± 7.2) and pre-pregnancy body mass index 25.6 kg/m2 (SD ± 5.5). One-third of participants had mid-upper arm circumferences ≥28 cm with 25% being overweight and 22.7% obese before pregnancy. Prevalence of hyperglycemia in pregnancy was 16.2% (n = 76) of which 13% had gestational diabetes and 3.2% diabetes in pregnancy. Hyperglycemia in pregnancy was significantly associated with body fat percentage (AOR 1.33; 95% CI: 1.22–1.44), family history of Type 2 diabetes mellitus (AOR 6.95, 95% CI: 3.11–15.55), previous delivery of babies ≥4 kg (AOR 2.3, 95% CI: 1.00–5.28), mid-upper arm circumference ≥ 28 cm (AOR 1.2, 95% CI: 1.09–1.32), and Type 2 diabetes mellitus symptoms (AOR 2.83, 95% CI: 1.53–6.92).ConclusionThe prevalence of hyperglycemia in pregnancy was high, particularly among women with history of delivering ≥4-kg babies, increased body fat, mid-upper arm circumference, symptoms and/or family history of Type 2 diabetes mellitus. These findings identify opportunities to further explore the utility of body fat percentage and other determinants for rapid screening and management of hyperglycemia in pregnancy.

Management of hyperglycemia in pregnancy: a major step to promote the health of whole life cycle

As one common complication, hyperglycemia in pregnancy (HIP) can lead to short- and long- term effects on maternal-offspring and result in a vicious cycle when euglycemia is not achieved. HIP is proposed as the priority by multiple global stakeholders, from health policy makers (United Nation, Chinese government), academic organization (International Federation of Gynecology and Obstetrics, International Diabetes Federation and Developmental Origin of Health and Disease in China), health care providers, to the public. To solve the issue, united actions should be undertaken in various capacities to address the link between HIP and chronic non communicable diseases, including obesity and diabetes. Key words: Hyperglycemia; Pregnancy complications; Human development; Life style; Risk factors; Time factors

Impact of clinical pharmacists intervention on management of hyperglycemia inpregnancy in Jordan.

Background and objective Hyperglycemia in pregnancy is a risk factor for cardiovascular disease and postpartum (PP) diabetes. This study aimed to assess the impact of the clinical pharmacist-assisted program (CPAP) of optimizing drug therapy and intensive education on main management outcome measures of patient knowledge about diabetes, Quality of life (QoL) as measured by SF-36 including maternal complications, fasting plasma glucose (FPG) control, and HbA1c. Method This is a randomized controlled study. Pregnant (20-28weeks) patients with hyperglycemia received CPAP (n=51) as compared with conventional management (n=34). Patients were then followed up for 6weekspp. Results A significant change was shown in the intervention group for diabetes knowledge (3.47% vs. control 2.03%, P<0.05) and three aspects of health-related QoL. The need for caesarian delivery (58.8% vs. control 35.3%) and severe episodes of hypoglycemia (0% vs. control 8.8%) were significantly (P<0.05) reduced in the intervention group. Six weeks PP reduction in HbA1c values was greater in the intervention group (-0.54% vs. control -0.08%, P=0.04) with more FPG-controlled patients during pregnancy (94% vs. control 64.7%). Conclusion Clinical pharmacist assisted services in the management of pregnancy hyperglycemia fundamentally and significantly improve knowledge and disease control.

The clinical management of hyperglycemia in pregnancy complicated by maturity-onset diabetes of the young

Women with maturity-onset diabetes of the young (MODY) are often first identified and diagnosed with diabetes during pregnancy. Genetics and hyperglycemia play an important role in determining fetal size in MODY pregnancies. The principal objective of the current study is to determine the outcomes and clinical management of hyperglycemia in pregnancies complicated by glucokinase gene (GCK) and hepatocyte nuclear factor (HNF)-1α MODY mutations. A retrospective chart review of 37 women with a GCK/HNF-1α mutation was conducted. Data on variables such as birthweight, mode of delivery, and the treatment of hyperglycemia were available on 89 pregnancies. The birthweight in unaffected GCK offspring was significantly higher than in the affected GCK offspring (4.8 [4.1-5.2] kg vs 3.2 [3.1-3.7] kg; P = .01). Seven-point home blood glucose monitoring over a 7-day period in each trimester demonstrated higher fasting and postprandial glycemic excursions in the first trimester of GCK pregnancies when compared to HNF-1α pregnancies (fasting 104 [90-115] mg/dL vs 84 [77-88] mg/dL; P = .01 and postprandial 154 [135-196] mg/dL vs 111 [100-131] mg/dL; P = .04) despite insulin treatment. There was a higher percentage of miscarriages in the GCK group when compared to the HNF-1α MODY group (33.3% vs 14%; P = .07), which was similar to the background population. Insulin initiated at an early gestation appeared to lower the incidence of macrosomia in GCK unaffected offspring. Hyperglycemia in HNF-1α pregnancies is easily managed with current insulin protocols; in contrast, glycemic excursions are difficult to manage in GCK pregnancies. There was an increased percentage of miscarriages in GCK pregnancies highlighting the importance of a diagnosis of GCK-MODY in women prior to conception and the necessity for preconception care.

247: Use of glucose stabilizer technology in the management of acute hyperglycemia in pregnancy

247: Use of glucose stabilizer technology in the management of acute hyperglycemia in pregnancy