Diabetic Pregnant Women Research Articles

Histological Change of Placenta in Diabetic Pregnant Women in Comparison to Normal Pregnant Women

Background: The placenta is a foeto-maternal organ and its alterations is directly related to the disease’s length and severity. The human placenta experiences a number of functional and structural pathologic alterations when complicated by metabolic disorder such as diabetes mellitus. Methods: This cross-sectional comparative study was conducted over a period of threeyears from January 2019 to December 2021 at the Department of Anatomy, Rajshahi Medical College, Rajshahi, in collaboration with the Department of Obstetrics and Gynaecology, Rajshahi Medical College Hospital and Diabetic Hospital Rajshahi, Bangladesh. The study was carried out on 70 pregnant women, among them 35 diabetics and 35 non-diabetics. The fibrinoid necrosis, syncytial knot and immature villi of the placenta were studied in diabetic and non-diabetic pregnant women. SPSS software, version-24 was used for data analysis, with a p-value < 0.05 indicating statistically significance for all tests. Results: The diabetic and non-diabetic pregnant women groups were almost identical in terms of attachment of umbilical cord to placenta with marginal attachment being more often found in either group (p = 0.829). Histological examination of placenta showed that fibrinoid necrosis was common in placenta of diabetic mothers than that of the normal mothers (p < 0.001). Syncytial knot and immature villi were higher in the former group than those in the latter group, here p values were also less than .001. Conclusion: Histological findings (fibrinoid necrosis, syncytial knot and immature villi) were more in placenta of diabetic mother and they were highly significant different between the groups. EWMCJ Vol. 12, No. 1&2, January-July 2024: 27-33

Postpartum cardiac reverse remodeling is reflected in urine proteome

Abstract Background The impact of postpartum cardiac reverse remodeling (RR) on urinary proteome, particularly in pregnant women with cardiovascular risk (CVR) factors who show long-term increased risk of cardiovascular disease and mortality is unknown. Purpose To profile the urinary proteome in pregnant women with/without CVR factors to identify proteins associated with postpartum RR. Methods Our study included a prospective cohort of 32 healthy and 27 obese and/or hypertensive and/or diabetic pregnant women who underwent transthoracic echocardiography, pulse-wave-velocity, and urine collection at the 3rd trimester and 6-months postpartum. Shotgun HPLC-MS/MS profiled proteins. Generalized linear mixed-effects models were used to identify associations between urinary proteins and left ventricle mass (LVM), a surrogate of RR. Results The presence of at least one CVR factor was associated with worse LVM RR. We identify 6 (alpha-galactosidase A [GLA], sialate O-acetylesterase [SIAE], trans-golgi network integral membrane protein 2 [TGOLN2], sortilin [SORT1], desmoglein-2 [DSG2] and neuroblast differentiation-associated protein [AHNAK]) and 11 (serotransferrin [TF], inter-α-trypsin inhibitor heavy chain 4 [ITIH4], complement C3 [C3], transketolase [TKT], fibronectin [FN1], ubiquitin-like modifier-activating enzyme 1 [UBA1], cell division control protein 42 homolog [CDC42], glutathione s-transferase P1 [GSTP1], sodium/potassium-transporting ATPase subunit alpha-1 [ATP1A1], ADP-ribosylation factor 1 [ARF1] and pro-cathepsin H [CTSH]) proteins associated with high and low LVM regression, respectively. These proteins were functionally linked with insulin-like growth factor (IGF) transport and uptake regulation by IGF binding-proteins, platelet activation, signaling and aggregation and the immune system’s activity. The concentration of IGF-1 in urine samples was associated with low LVM regression after delivery. Conclusions Urine proteome reflects postpartum cardiac RR. Specifically, eight urine proteins (GSTP1, ARF1, FN1, SORT1, SIAE, GLA, ITIH4 and DGS2) show clinical value in identifying women at higher risk for incomplete postpartum RR. In addition, the association between IGF and postpartum LVM regression was validated.

Cardiovascular (reverse) remodelling induced by pregnancy: looking at the right side of the heart

Abstract Introduction Many studies have focused on pregnancy-induced left ventricular remodelling, overlooking the changes in right cardiac chambers. Purpose To characterize the right cardiovascular (CV) remodelling and reverse remodelling (RR) induced by pregnancy and postpartum, respectively, and the impact of CV risk (CVR) factors on these processes. Methods This prospective cohort was recruited at two tertiary centers from 2019 to 2022, including 51 healthy and 79 obese and/or hypertensive and/or with gestational diabetes and/or smoking habits pregnant women (cardiovascular risk [CVR] group). Women were evaluated by transthoracic echocardiography at the 1st trimester (1T) and 3rd trimester (3T) of pregnancy, as well as one-month (PP1), six-months (PP2), and one-year postpartum (PP3). Generalized linear mixed-effects models were used for the analysis of right CV remodelling and RR and to evaluate the impact of CVR factors on these processes. Results This study included 130 pregnant women, 60.8% primiparous, with a median age of 33 years. Despite all echocardiographic results being within the normality range, we describe the progression of right heart adaptations throughout pregnancy and postpartum (Table 1), namely: 1) Similar enlargement of the right atrium (RA) and right ventricle (RV) dimensions throughout pregnancy, recovering at PP2 except for RA in the CVR group; 2) Preserved RV systolic function throughout pregnancy in both groups, while the postpartum hemodynamic normalization triggers a reduction of (TAPSE) and tricuspid S' wave velocity; 3) Reduced RA strain in both groups during pregnancy, more evident in CVR group, which had a slower postpartum recovery; 4) Preserved RV global longitudinal strain (GLS) throughout follow-up time, being significantly reduced in 3T of CVR group and recovering at PP2; 5) Reduction of tricuspid E/A ratio from 1T to 3T in both groups with an early recovery at PP1, being these values significantly higher in the healthy group, and 6) Steady pulmonary artery systolic pressure (PASP) values throughout follow-up time, showing consistently higher values in the CVR group. Conclusion This study describes the subclinical right cardiac functional and structural changes within the physiological range, which recover 6 months after delivery. CVR factors impact the magnitude of the subclinical RV diastolic function changes, PASP and myocardial deformation (strain) without any impact on classic RV systolic function.

Anti-Tumor Necrosis Factor Therapy and the Risk of Gestational Diabetes in Pregnant Women With Inflammatory Bowel Disease.

Anti-tumor necrosis factor (anti-TNF) therapy may improve insulin sensitivity, and its impact during pregnancy remains unclear. We aimed to assess the risk of gestational diabetes mellitus (GDM) associated with anti-TNF treatment among pregnant women with inflammatory bowel disease (IBD). This nationwide cohort study included patients with IBD in Korea from 2010 to 2021. Anti-TNF exposure was identified from the last menstrual period (LMP) to LMP + 140 days. The development of GDM was assessed from LMP + 141 days to delivery. We performed overlap weighting to balance the covariates and used a generalized linear mixed model to measure the risk ratio (RR) and 95% confidence intervals (CIs). The anti-TNF group was compared with the unexposed group, as well as with the immunosuppressant, 5-aminosalicylate, and untreated groups. A total of 3,695 pregnancies in women with IBD were identified, of which 338 (9.2%) were exposed to anti-TNFs. GDM was found in 7.1% of the pregnancies exposed to anti-TNFs as compared with 11.0% of those unexposed. The crude and weighted RRs for GDM risk were 0.64 (95% CI 0.43-0.96) and 0.68 (95% CI 0.55-0.84), respectively. The weighted RR when compared with the immunosuppressant, 5-aminosalicylate, and untreated groups was 0.70 (95% CI 0.41-1.18), 0.71 (95% CI 0.52-0.95), and 0.85 (95% CI 0.59-1.24), respectively. This nationwide cohort reported a decreased risk of GDM among patients who used anti-TNFs during early pregnancy compared with those unexposed. GDM risk may become a consideration in the decision-making process when choosing treatment options for pregnant women with a risk factor for GDM.

A comparative study to assess Hba1c levels in antenatal non diabetic women with anemia and without anemia

BackgroundGlycosylated hemoglobin (HbA1c) has a glucose residue attached to the terminal NH2 group (valine residue) of one or both HbA beta chains. HbA1c levels are not affected by blood glucose levels alone. HbA1c results are affected by several factors, such as anemia, structural hemoglobinopathies and thalassemia syndromes. HbA1c concentrations are affected by conditions that affect erythrocyte turnover. Iron deficiency anemia is the most common form of anemia. The prevalence of anemia among pregnant women in India is above 50 %. Although many forms of anemia are associated with the lowering of HbA1c, iron deficiency has been shown to shift HbA1c slightly upward. Research on this topic has yielded a variety of findings. In some research, there was no association observed between anemia and HbA1c levels; in other investigations, there was a rise or fall in this number. Iron deficiency anemia and HbA1c′s relationship is therefore still unclear. Therefore, this study aims to determine the correlation between Iron deficiency anemia and HbA1c levels among non diabetic pregnant women with anemia. MethodologyThis prospective observational study was conducted among singleton pregnant women attending antenatal clinic OPD in a private tertiary hospital in Chengalpattu, Kanchipuram district. After the complete review of their obstetric record, blood was collected in 5 ml sterile syringes and transferred equally to the two separate test tubes containing ethylene-diamine-tetra acetic acid (EDTA) anticoagulant for determining RBC indices and HbA1c levels. The difference in mean between two independent samples (between Anemia and Non-anemia) was determined using an independent sample t-test, and the difference between two independent proportions was calculated using a z-test. Bivariate Pearson's correlation analysis was used to adjudicate the relationship between red blood cell indices and HbA1c level, and correlation coefficient (r)was calculated, and the p-value of <0.05* was considered statistically significant. ResultsBivariate Pearson's correlation analysis was done to determine the relationship between HbA1c levels and red blood cells in anemic pregnant women. HbA1c levels negatively correlated with Hemoglobin (r = −0.875, p < 0.01*), PCV (r = −0.732, p =<0.01*) and transferrin saturation (r = 0.224, p < 0.01*) and it was statistically significant. Other indices, such as serum iron concentration and TIBC, demonstrated no correlation with HbA1c level. ConclusionThis study shows that the reliability of Hba1c in diagnosing diabetes among pregnant women with iron deficiency anemia is misguiding and can be considered after treating the condition. Also, more studies are needed to improve our understanding of this topic.

Unraveling the Magnesium Connection: The Cincinnati PPG's Pioneering Work on Mineral Metabolism in Diabetes and Pregnancy.

This study aimed to review the Cincinnati PPG's contribution to the understanding and treatment of neonatal hypocalcemia (NHC) in infants of diabetic mothers. This study is a retrospective review of the NIH-funded Program Project Grant (PPG) works related to mineral metabolism in type 1 diabetic pregnant women. The PPG investigators first described the epidemiology and the additional risk factors for NHC, namely prematurity and neonatal asphyxia, but also recognized the independent effect of maternal diabetes mellitus. They explored the link between NHC and maternal/neonatal hypomagnesemia. They finally conducted a randomized control trial of prevention of NHC by early administration of magnesium sulfate soon after birth to prevent NHC. The PPG in its various phases has allowed to reveal the important role that magnesium plays in the regulation of mineral metabolism in pregnancy and in particular the pregnancy complicated by pregestational diabetes. KEY POINTS: · Poor glycemic control during pregnancy leads to maternal magnesium deficiency.. · Maternal magnesium deficiency leads to fetal and neonatal magnesium deficiency.. · Neonatal magnesium deficiency leads to functional hypoparathyroidism and parathyroid hormone resistance..

CARDIAC VALVE DISEASE IN DIABETIC PREGNANT WOMEN: FETAL COMPROMISE AND MATERNAL RISK

Introduction: Cardiac valve diseases represent a significant concern in the management of pregnant women, particularly those with diabetes mellitus, a condition that alters the hemodynamic profile and can exacerbate pre-existing cardiac issues. During pregnancy, a woman's body undergoes physiological changes that can affect the function of the cardiac valves. Diabetes mellitus can accelerate the progression of valvulopathies, leading to complications affecting both the mother and the fetus. Fetal compromise often results from maternal hemodynamic instability and changes in blood flow, while maternal risk includes worsening cardiac symptoms and an increased likelihood of adverse events during pregnancy. Objective: The objective of this systematic review was to analyze the available evidence on the impact of cardiac valve diseases in diabetic pregnant women, focusing on the consequences for the fetus and the risks for the mother. Methodology: To conduct the systematic review, the PRISMA checklist criteria were followed. The search was performed in electronic databases, including PubMed, Scielo, and Web of Science, using five main descriptors: "cardiac valve disease," "diabetic pregnant women," "fetal compromise," "maternal risk," and "diabetes mellitus." Studies published in the last 10 years were included, prioritizing peer-reviewed articles and original research. Inclusion criteria comprised: (1) studies specifically addressing valvulopathies in pregnant women with diabetes mellitus, (2) articles providing data on fetal and maternal outcomes, and (3) research published in peer-reviewed journals. Exclusion criteria included: (1) studies not directly focusing on diabetic pregnant women, (2) research with non-rigorous methodologies or lack of relevant data, and (3) articles published more than 10 years ago. Results: The results indicated that pregnant women with valvulopathies and diabetes mellitus face a heightened risk of complications. Key findings included increased neonatal mortality and maternal cardiovascular complications, such as heart failure and worsening valvular symptoms. Fetal compromise often involved intrauterine growth problems and a higher incidence of prematurity. Conclusion: The review highlighted that the combination of diabetes mellitus and cardiac valve diseases presents a significant challenge in managing pregnant women, with important implications for both maternal and fetal health. Early identification and appropriate management of valvulopathies are crucial to reducing associated risks and improving outcomes for both mother and baby. Future studies should focus on treatment strategies and monitoring approaches that can mitigate these complications and promote better outcomes.

Prediksi Dini Penyakit Diabetes Pada Ibu Hamil Dengan Algoritma Random Forest

Diabetes in pregnant women, otherwise known as gestational diabetes, is a serious health condition that can negatively affect the mother and fetus. Early detection and appropriate intervention are essential to reduce the risk of complications during pregnancy and childbirth. This study aims to develop a prediction model that can detect the risk of diabetes in pregnant women using the Random Forest algorithm. The data used in this study included relevant clinical and demographic parameters of pregnant women, such as age, body mass index, family history, and laboratory test results. The Random Forest model was chosen because of its ability to handle complex data and provide accurate prediction results. The results of this study show that the model developed has an accuracy rate of 98% in predicting the risk of gestational diabetes. In addition, important features that contribute to diabetes risk prediction have also been identified, providing additional insights for medical practitioners in conducting risk evaluations. The implementation of this model is expected to help in efforts to prevent and manage gestational diabetes, thereby improving maternal and infant health.

The Relationship Between Vitamin B12 and Gestational Diabetes in Pregnant Women With and Without Gestational Diabetes Mellitus

The Relationship Between Vitamin B12 and Gestational Diabetes in Pregnant Women With and Without Gestational Diabetes Mellitus

Impact of Diabetes in Pregnancy on Stage II Lactogenesis among Postpartum Diabetic Women Compared to Non-Diabetics

Abstract Background Diabetes in pregnancy -whether preexisting or gestational can have negative impact on pregnancy, labor and lactation. Infants of diabetic mothers benefit most from early establishment of breastfeeding as it helps them regulate their blood glucose levels on the short term and decrease their risk of developing diabetes later on life. Aim of the Work This study aims to compare diabetic and non-diabetic pregnant women regarding the onset of stage II lactogenesis at 72 hours postpartum and to associate the degree of diabetes control in antepartum period with the delay in stage II of lactogenesis. Subjects and Methods This study is an observational prospective cohort study, carried out on 203 pregnant women aged from 18 to 40 years old during their routine antenatal care visits in the third trimester of pregnancy at Ain-Shams University Maternity hospital outpatient clinic from December 2020 to August 2021, Cairo, Egypt. Results We found that Diabetes in pregnancy can cause a delay in the onset of Lactogenesis stage II regardless of the degree of control. We can also say that diabetes can affect lactation directly and indirectly. For example, Diabetes can cause higher rates of cesarean section, infant separation from mother and delayed initiation of first breastfeed which was found to cause DOLII. And early initiation of lactation can be a modifiable risk factor to protect from DOLII especially in Diabetic mothers. Conclusion Diabetes can cause series of unfortunate events in pregnancy, labor, and lactation. Many of diabetes implications on peripartum health can affect lactation directly and indirectly. For example, Diabetes can cause higher rates of cesarean section, infant separation from mother, delayed initiation of first breastfeed and other birth complications. All these can cause DOL II. Diabetes itself is a risk factor for delayed onset of lactogenesis II which can cause further neonatal hypoglycemia and/or early introduction of infant formula. The cascade of these events can hinder the breastfeeding establishment when it is most needed. The control of diabetes was not found to have impact on DOL II. Further research needs to be done in this regard. Early initiation of lactation can be a modifiable risk factor to protect from DOLII especially in Diabetic mothers.

The Effect of Vitamin D Supplementation on the Risk of Gestational Diabetes in Pregnant Women Over the Age of 18 Without a Diabetes or Gestational Diabetes Diagnosis

The Effect of Vitamin D Supplementation on the Risk of Gestational Diabetes in Pregnant Women Over the Age of 18 Without a Diabetes or Gestational Diabetes Diagnosis

The extent of postpartum cardiac reverse remodeling is reflected in urine proteome

The association of postpartum cardiac reverse remodeling (RR) with urinary proteome, particularly in pregnant women with cardiovascular (CV) risk factors who show long-term increased risk of cardiovascular disease and mortality is unknown. We aim to profile the urinary proteome in pregnant women with/without CV risk factors to identify proteins associated with postpartum RR. Our study included a prospective cohort of 32 healthy and 27 obese and/or hypertensive and/or diabetic pregnant women who underwent transthoracic echocardiography, pulse-wave-velocity, and urine collection at the 3rd trimester and 6 months postpartum. Shotgun HPLC–MS/MS profiled proteins. Generalized linear mixed-effects models were used to identify associations between urinary proteins and left ventricle mass (LVM), a surrogate of RR. An increase in arterial stiffness was documented from 3rd trimester to 6 months after delivery, being significantly elevated in women with CV risk factors. In addition, the presence of at least one CV risk factor was associated with worse LVM RR. We identified 6 and 11 proteins associated with high and low LVM regression, respectively. These proteins were functionally linked with insulin-like growth factor (IGF) transport and uptake regulation by IGF binding-proteins, platelet activation, signaling and aggregation and the immune system’s activity. The concentration of IGF-1 in urine samples was associated with low LVM regression after delivery. Urinary proteome showed a predicting potential for identifying pregnant women with incomplete postpartum RR.

Maternal Lipid Profile Changes in Gestational Diabetes Mellitus

Introduction: Pregnancy is commonly recognized as a state of physiological and temporary insulin resistance. This condition is driven by high concentrations of steroid hormones such as progesterone, estrogens, prolactin, cortisol and placenta-derived human placental lactogen. All of these are diabetogenic and combined cause for decreased sensitivity of insulin receptors within target tissues. Women with prior GDM are at greater risk for developing hypertension, hyperlipidaemia and electrocardiogram abnormalities. Materials and Methods: seventy five patients with Gestational diabetes mellitus and 75 healthy Normal pregnant women were enrolled for the study after the institutional ethical committee’s clearance was obtained. The fasting blood samples of the study subjects were evaluated for the glucose, lipid profile, Glycated Haemoglobin (HbA1c), Malondialdehyde (MDA) and calculated BMI. Results: Lipid peroxidation is enhanced in GDM group as MDA values have elevated significantly (p &lt; 0.0001) compared to normal pregnancy. Total cholesterol (p&lt; 0.001) and LDL (p = 0.001) are found to be significantly higher in GDM, but there are no significant differences in triglycerides and HDL between normal and diabetic pregnant women. Obesity is observed in GDM group as their BMI (p &lt; 0.001) is significantly higher than that of the control group. Conclusions: It was found that GDM is associated with hyperlipidaemia as evidenced by the significantly elevated total cholesterol and LDL concentrations. Obesity and lipid peroxidation are significantly high in GDM. Keywords: Gestational diabetes mellitus, HbA1c, lipid profile, lipid peroxidation, BMI.

Anxiety and Depression Levels in Women with Hyperglycemia in Pregnancy: A Comparative Study with Normoglycemic Women

Aim: The aim of this study is to investigate the anxiety and depression levels of women with hyperglycemia in pregnancy and to compare them with normoglycemic women at similar gestational weeks. Materials and Methods: Diabetic pregnant women (pregestational diabetes mellitus, gestational diabetes mellitus) at 32-34 weeks and normoglycemic pregnant women at similar gestational weeks were evaluated with the Hospital Anxiety and Depression Scale to determine anxiety and depression levels. Results: In our study patients with fetal complications associated with poorly controlled diabetes, such as large for gestational age (p: 0.04) and polyhydramnios (p: 0.03), exhibited significantly lower levels of anxiety symptoms. No significant difference was found between the diabetes group and the control group in terms of anxiety and depression symptoms Conclusion: The fact that anxiety symptoms were significantly less in polyhydramnios and large for gestational age patients, which are the result of poorly controlled diabetes, suggests that hyperglycemia may have an impact on anxiety levels.

Diabetic pregnancy: adherence and benefits of regular physical activity on blood sugar control in diabetic pregnant women

Diabetic pregnancy: adherence and benefits of regular physical activity on blood sugar control in diabetic pregnant women

Predictors of glycemic control monitoring in diabetic pregnant women from 449 patients

Predictors of glycemic control monitoring in diabetic pregnant women from 449 patients

Investigation of Phosphorylated and O-Glycosylated Proteins in Gestational Diabetes Mellitus

Gestational Diabetes Mellitus (GDM) is a common but temporary type of diabetes that develops among 10-20% of all pregnant women. It is a major cause of several pre- and post-pregnancy diseases in both mother and offspring. The main causative is altered pregnancy hormones that lead to deficient glucose metabolism. Complications can be preeclampsia, caesarean sections and cardiovascular diseases. This study was designed to determine the phosphorylated and glycosylated proteins present in GDM and to investigate the role of their post-translational modifications (PTMs) in the pathogenesis of GDM. The study was performed on 30 blood samples from pregnant diabetic women (diseased), 30 pregnant non-diabetic women (control) and 30 women without pregnancy and gestational diabetes (normal). Protein extraction was done from blood plasma, and phosphorylated and glycosylated proteins were determined by Enzyme-Linked Immuno-Sorbent Assay (ELISA) by use of specific antibodies. This study showed that proteins found in GDM are highly phosphorylated and O-glycosylated (p&lt;0.01). Furthermore, a bioinformatic investigation was done, which showed that blood coagulation proteins such as the Fibrinogen alpha chain and lipid metabolism-regulating proteins apolipoprotein E, L1 and C-III showed a high potential for phosphorylation, which suggests that phosphorylation can be used as a therapeutic marker in GDM.

Fetal and Maternal Health Implications by Pregnancy Trimesters in Gestational Diabetes

Introduction: Gestational diabetes (GD) is defined as intolerance to glucose or the presence of high levels of glycemia during pregnancy. Its incidence in Europe reaches 3-5% of all pregnancies, but in some Mediterranean countries it goes up to 7%. 1,2(This includes our country). GD usually disappears after birth.3 Its importance is not only important as a pathology of women's health but also because of the risk factors that lead to the development of the fetus. Occasionally new research and studies on the correlates of diabetes in pregnancy, glycemic values that affect maternal or fetal health, or changes in baseline parameters depending on external and internal factors affecting pregnancy. An indication of the latter is the prediabetes group or IGM. Our aim: To study intrauterine complications or fetal consequences by trimesters in diabetic pregnant women attending Regional Hospital Durres. Maternal health close observation of GD complications. Methodology: Following the primary processing of patient data, individuals at risk were separated, and categorized according to trimester of pregnancy. The data were worked out on crostabulary statistical tables, where a selected number of participants with prediabetes or gestational diabetes were associated with a risk factor to analyze the correlational correlation in our population. Results. Reported to the gynecology services, for first-trimester pathology, 1954 women, of which 1176 have had one of the diagnoses: missed abortion, blighest ovum or recurrent abortion. Reported to the Pathology Pregnancy Pathology Service about 3268 of which were monitored and resulted based in examinations in 163 cases with prediabetes and diabetes in pregnancy. We have grouped and extracted the results based on correlations of baseline glycemic index to diagnose DG and the onset of complications in the fetus and in pregnancy.&#x0D; &#x0D; Received: 19 February 2024 / Accepted: 15 March 2024 / Published: 23 March 2024

Insulin Use During Gestational and Pre-existing Diabetes in Pregnancy: A Systematic Review of Study Design.

Insulin is the first-line pharmacologic therapy for women with diabetes in pregnancy. However, conducting well-designed randomized clinical trials (RCTs) and achieving recommended glycemic targets remains a challenge for this unique population. This systematic literature review (SLR) aimed to understand the evidence for insulin use in pregnancy and the outcome metrics most often used to characterize its effect on glycemic, maternal and fetal outcomes in gestational diabetes mellitus (GDM) and in pregnant women with diabetes. An SLR was conducted using electronic databases in Medline, EMBASE via Ovid platform, evidence-based medicine reviews (2010-2020) and conference proceedings (2018-2019). Studies were included if they assessed the effect of insulin treatment on glycemic, maternal or fetal outcomes in women with diabetes in pregnancy. Studies on any type of diabetes other than gestational or pre-existing diabetes as well as non-human studies were excluded. In women diagnosed with GDM or pre-existing diabetes, most studies compared treatment of insulin with metformin (n = 35) followed by diet along with lifestyle intervention (n = 24) and glibenclamide (n = 12). Most studies reporting on glycemic outcomes compared insulin with metformin (n = 22) and glibenclamide (n = 4). Fasting blood glucose was the most reported clinical outcome of interest. Among the studies reporting maternal outcomes, method of delivery and delivery complications were most commonly reported. Large for gestational age, stillbirth and perinatal mortality were the most common fetal outcomes reported. This SLR included a total of 108 clinical trials and observational studies with diverse populations and treatment arms. Outcomes varied across the studies, and a lack of consistent outcome measures to manage diabetes in pregnant women was observed. This elucidates a need for global consensus on study design and standardized clinical, maternal and fetal outcomes metrics.

A service improvement project to improve follow up screening rates of women with gestational diabetes

Diabetes in pregnant women presents significant implications for long-term health. The best way to manage them in practice is outlined here by Joanna Stace A history of Gestational Diabetes Mellitus (GDM) can have significant implications for women's long-term health. Despite these risks, primary care rates for post-natal screening are low. A Service Improvement Project (SIP) was implemented as part of an MSc in Advanced Diabetes Care undertaken at Birmingham City University. Its aims were to improve post-natal follow-up care for women with GDM, reduce the risk of developing T2DM enhancing their long-term health. A key success of the SIP is the improved knowledge of the importance of post-natal screening amongst staff and women. Increased numbers of women being correctly coded and offered post-natal screening highlighting the importance of healthcare integration for better patient outcomes. Work continues to improve referral rates and attendance of the National Diabetes Prevention Programme with the roll out of an Electronic Care Pathway.