Previous History Of Gestational Diabetes Mellitus Research Articles

Genome-Wide Polygenic Risk Score Predicts Incident Type 2 Diabetes in Women With History of Gestational Diabetes

OBJECTIVE Women with a history of gestational diabetes mellitus (GDM) are at increased risk of developing type 2 diabetes (T2D). It remains unclear whether genetic information improves prediction of incident T2D in these women. RESEARCH DESIGN AND METHODS Using five independent cohorts representing four different ancestries (n = 1,895), we investigated whether a genome-wide T2D polygenic risk score (PRS) is associated with increased risk of incident T2D. We also calculated the area under the receiver operating characteristics curve (AUROC) and continuous net reclassification improvement (NRI) following the incorporation of T2D PRS into clinical risk models to assess the diagnostic utility. RESULTS Among 1,895 women with previous history of GDM, 363 (19.2%) developed T2D in a range of 2 to 30 years. T2D PRS was higher in those who developed T2D (−0.08 vs. 0.31, P = 2.3 × 10−11) and was associated with an increased risk of incident T2D (odds ratio 1.52 per 1-SD increase, 95% CI 1.05–2.21, P = 0.03). In a model that includes age, family history of diabetes, systolic blood pressure, and BMI, the incorporation of PRS led to an increase in AUROC for T2D from 0.71 to 0.74 and an intermediate improvement of NRI (0.32, 95% CI 0.15–0.49, P = 3.0 × 10−4). Although there was variation, a similar trend was observed across study cohorts. CONCLUSIONS In cohorts of GDM women with diverse ancestry, T2D PRS was significantly associated with future development of T2D. A significant but small improvement was observed in AUROC when T2D PRS was integrated into clinical risk models to predict incident T2D.

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.

Universal Screening of Gestational Diabetes Mellitus In Upper Egypt: Prospective Cohort Study of The Prevalence, Risk Factors, and Short-Term Outcomes

Background: Despite the high prevalence of diabetes mellitus in Egypt, the real prevalence and epidemiology of gestational diabetes mellitus (GDM) in Upper Egypt is still lacking. Objective: This study aims to determine the prevalence and risk factors of GDM among pregnant women in Upper Egypt and to evaluate the foetal and maternal outcomes of this disease. Methods: This prospective cohort study was conducted between July 2014 and July 2018. Universal screening for GDM among all pregnant women attending primary health care clinics was done using Diabetes in Pregnancy Study Group of India (DIPSI) criteria. Those with GDM were followed up until the end of purpureum. Maternal and foetal outcomes were recorded. Results: GDM was diagnosed in 956 out of 7141 pregnant women (13.4%). Previous history of GDM, macrosomic babies, and family history of diabetes were all significantly higher in GDM women (P<0.001 each). However, no definite risk factors were observed in about half of the GDM women. 29% of GDM women responded to medical nutrition therapy (MNT) alone. When the oral glucose tolerance test (OGTT) was repeated Postpartum, diagnosis of DM was established in 14.3% of the cohort, while 25.7% had impaired glucose tolerance. Conclusions: The prevalence of GDM is relatively high in Upper Egypt. Half of GDM cases lack risk factors. Universal screening using OGTT should be routinely performed to all attendant pregnant ladies. Discrete MNT is not an enough management in most of GDM cases. Keywords: GDM; Postpartum OGTT; diabetes; MNT; foetal outcome; maternal outcome.

Postpartum Screening for Type 2 Diabetes Mellitus Among Women With Gestational Diabetes Mellitus at King Abdulaziz University Hospital: A Cross-Sectional Study.

Background Diabetes is characterized by elevated blood glucose levels due to inadequate insulin production or abnormalities in cellular activity. Gestational diabetes mellitus (GDM) is one of the most prominent indicators of type 2 diabetes mellitus (T2DM), which develops in pregnant women whose pancreatic function is insufficient to control the insulin resistance associated with pregnancy. Moreover, it is the most common metabolic disorder, with the majority of cases beginning in the second or third trimester of pregnancy and affecting up to 25% of pregnant women. Objectives The objective of this study was to identify factors associated with postpartum T2DM screening in women with GDM at King Abdulaziz University Hospital (KAUH) between 2010 and 2022. The secondary objective was to assess the factors associated with providing information to the patients about the risks of increased blood glucose and postpartum lifestyle modification. Methods We conducted a retrospective cross-sectional study at KAUH to investigate potential factors associated with postpartum screening for T2DM. Out of 564 patients diagnosed with GDM between 2020 and 2022, we included 200 women aged over 18 years with a history of GDM, as they met the inclusion criteria for our study. Patients younger than 18 years with missing or incomplete baseline characteristics were excluded. Data were analyzed using SPSS Statistics version 21 (IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp.), and p-value <0.05 was considered significant. Results A total of 200 postpartum women with GDM were included in this study. Their mean age was 35.02±5.2 years. Many of them had a family history of diabetes (83.0%) and a previous diagnosis of GDM (60.5%). The patients who performed glucose testing six weeks after birth were previously diagnosed with GDM (37.0%) or with a family history of diabetes (45.5%). The significant variables in this analysis were mothers having frequent postpartum hospital follow-up visits (P<0.001), mothers with gestationalweight gain (P=0.018), those who were informed about the risks of increased blood glucose (P=0.011), and those who were informed about plans for postpartum glucose screening (P=0.002). The motherswith a previous history of GDM were the highest to be informed of the risks of elevated blood glucose. Conclusion Frequent postpartum hospital follow-up visits, gestationalweight gain, knowledge of the risks of elevated blood sugar, and postpartum glucose screening plans were all associated withpostpartum glucose testing rates among women with GDM in Saudi Arabia.

Universal screening of gestational diabetes mellitus in Upper Egypt: Prospective cohort study of the prevalence, risk factors, and short-term outcomes

Background: Despite the high prevalence of diabetes mellitus in Egypt, the real prevalence and epidemiology of gestational diabetes mellitus (GDM) in Upper Egypt are still lacking. Objective: This study aims to determine the prevalence and risk factors of GDM among pregnant women in Upper Egypt and to evaluate the fetal and maternal outcomes of this disease. Methods: This prospective cohort study was conducted between July 2014 and July 2018. Universal screening for GDM among all pregnant women attending primary health care clinics was done using Diabetes in Pregnancy Study Group of India (DIPSI) criteria. Those with GDM were followed up until the end of purpureum. Maternal and fetal outcomes were recorded. Results: GDM was diagnosed in 956 out of 7141 pregnant women (13.4%). Previous history of GDM, macrosomic babies, and family history of diabetes were all significantly higher in GDM women (P&lt;0.001 each). However, no definite risk factors were observed in about half of the GDM women. 29% of GDM women responded to medical nutrition therapy (MNT) alone. When the oral glucose tolerance test (OGTT) was repeated Postpartum, diagnosis of DM was established in 14.3% of the cohort, while 25.7% had impaired glucose tolerance. Conclusions: The prevalence of GDM is relatively high in Upper Egypt. Half of GDM cases lack risk factors. Universal screening using OGTT should be routinely performed on all attendant pregnant ladies. Discrete MNT is not enough management in most GDM cases.

Observation of Risk Factors among Gestational Diabetes Mellitus Patients

Introduction: Gestational diabetes mellitus (GDM) is a common complication during pregnancy that affects both maternal and neonatal health outcomes. Identifying risk factors associated with GDM is crucial for early detection and intervention to improve pregnancy outcomes. Methods: This retrospective observational study was conducted at the Department of Gynecology, Gonoshasthaya Nagar Hospital, Dhaka, Bangladesh during the period of January 2019 to December 2019 with a total of 348 hospital patient records. Result: Of the 348 participants, 24.71% had GDM. Significant differences were observed between the groups in age, gravida, BMI distribution, family history of GDM, and previous history of GDM. Higher rates of non-spontaneous vaginal deliveries were found in the GDM group (36.05%) compared to the non-GDM group (22.52%). Age ≥35 years, obesity, family history of GDM, and history of GDM were significantly associated with GDM (p&lt;0.05). Conclusion: Our findings support the existing evidence that advanced maternal age, obesity, family history of GDM, and previous history of GDM are significant risk factors for GDM. These results highlight the importance of early screening and intervention for high-risk groups to prevent adverse pregnancy outcomes.

Adherence to gestational diabetes mellitus (GDM) management plan among pregnant women in Oman: Predictors, barriers, and motivating factors

ObjectivesThis study examined the predictors, the barriers, and the motivating factors of adherence to the gestational diabetes mellitus (GDM) management plan among Arab pregnant women with GDM. MethodsThis cross-sectional study was conducted in the Antenatal Clinics of three major tertiary hospitals in Oman. Total of 164 Arab pregnant women with GDM were recruited using a convenience sampling technique. The measurement scales included Diabetes Self-Management Questionnaire- Revised, Diabetes Management Self-Efficacy Scales, and Social Support Survey. Multiple-choice questions were used to assess barriers to and motivators of adherence. The analytical tools included multiple linear regression and descriptive statistics. ResultsFindings from stepwise regression analysis revealed three models with three significant predictors, including self-efficacy, previous history of GDM, and the type of GDM management. The major barriers to adherence were family, especially kids' responsibilities, time constraints, home responsibilities, and working status. Moreover, participants indicated their concern about maternal and neonatal GDM-related complications and husband encouragement as the main motivating factors for adherence. Conclusionsand Clinical Relevance: Our findings suggest that antenatal healthcare providers should implement strategies that enhance self-efficacy and engage families in health education programs. The study also recommends collaboration between health policy makers in the Ministries of Health, Consumer Protection Agency, and the Ministries of Municipality to ensure the availability of healthy food choices in the public areas. Additionally, flexible working conditions and an environment conducive to a healthy and active lifestyle should be made available to pregnant women with GDM.

Study on the Relationship and Predictive Value of First-Trimester Pregnancy-Associated Plasma Protein-A, Maternal Factors, and Biochemical Parameters in Gestational Diabetes Mellitus: A Large Case-Control Study in Southern China Mothers.

To investigate the relationship and predictive value of first-trimester pregnancy-associated plasma protein A (PAPP-A), maternal factors, and biochemical parameters with gestational diabetes mellitus (GDM) in southern China mothers. This study recruited 4872 pregnant women. PAPP-A, the free beta subunit of human chorionic gonadotropin (free β-HCG), fasting plasma glucose (FPG), total cholesterol (TC), triglycerides (TG), and high- and low-density lipoproteins (HDL, LDL) were measured at 11-13+ weeks of gestation. GDM was diagnosed based on a 75 g oral glucose tolerance test at 24-28 weeks of gestation. We performed stepwise logistic regression analysis to determine the odds ratio (OR) and the 95% confidence interval (CI) of GDM. We used Receiver Operating Characteristic (ROC) curves with the area under the curve (AUC) to evaluate the predictive value of PAPP-A, maternal factors, and biochemical markers. The significance of the differences between the AUC values was assessed using the DeLong test. GDM was diagnosed in 750 (15.39%) women. Independent factors for GDM were age, pre-gestational BMI, GWG before a diagnosis of GDM, previous history of GDM, family history of diabetes, FPG, TG, LDL, PAPP-A, and TC. The AUC of PAPP-A was 0.56 (95% CI 0.53-0.58). The AUC of a model based on combined maternal factors, biochemical markers, and PAPP-A was 0.70 (95% CI 0.68-0.72). Differences in AUC values between PAPP-A alone and the model based on combined maternal factors, biochemical markers, and PAPP-A were statistically significant (Z= 9.983, P<0.001). A Low serum PAPP-A level in the first trimester is an independent risk factor for developing GDM later in pregnancy. However, it is not a good independent predictor although the predictive value of a low serum PAPP-A level increases when combined with maternal factors and biochemical markers.

Screening for Gestational Diabetes Mellitus: Is There a Need for Early Screening for All Women in Developing Countries?

Gestational diabetes mellitus (GDM) is associated with significant adverse pregnancy outcomes. Early diagnosis and treatment have been proven to reduce adverse pregnancy outcomes among women diagnosed with GDM. Current guidelines recommend routine screening for GDM at 24-28 weeks of pregnancy, with early screening offered to those considered high risk. However, risk stratification may not always be helpful for those who would benefit from early screening, especially in non-Western settings. To determine the need for early screening for GDM among pregnant women attending antenatal clinics in two tertiary hospitals in Nigeria. We conducted a cross-sectional study from December 2016 to May 2017. We identified women who presented at the antenatal clinics of the Federal Teaching Hospital Ido-Ekiti and Ekiti State University Teaching Hospital, Ado Ekiti. A total of 270 women who fulfilled the study inclusion criteria were enrolled. The 75 g oral glucose tolerance test was used to screen participants for GDM before 24 weeks and between 24 and 28 weeks for those who screened negative before 24 weeks. Pearson's chi-square test, Fisher's exact test, independent t-test, and Mann-Whitney U test were utilized in the final analysis. The median age of the women in the study was30 (interquartile range: 27-32) years. Of our study participants, 40 (14.8%) were obese, 27 (10%) had a history of diabetes mellitus in a first-degree relative, and three (1.1%) women had a previous history of GDM.Twenty-one women (7.8%) were diagnosed with GDM, and six (28.6%) were diagnosed before 24 weeks. Women diagnosed with GDM before 24 weeks were older (37 years; interquartilerange: 34-37) and more likely to be obese (80.0%). A significant number of these women also had identifiable risk factors for GDM: previous GDM (20.0%), family history of diabetes mellitus in a first-degree relative (80.0%), prior delivery of fetal macrosomia (60.0%), and previous history of congenital fetal anomaly (20.0%). The findings from the present study did not justify universal screening for GDM in all pregnant women. Patients diagnosed before the 24-28 weeks of universal screening are more likely to have significant risk factors for GDM and, therefore, would have been selected for screening based on the risk factor screening.

PREDICTIVE VALUE OF NEUTROPHIL TO LYMPHOCYTE RATIO (NLR) IN EARLY DETECTION OF GESTATIONAL DIABETES MELLITUS (GDM) AMONG PREGNANT WOMEN IN FIRST TRIMESTER OF PREGNANCY

Background &amp; Objective: A substantial number of pregnant women develop gestational diabetes mellitus (GDM). Various biomarkers are being used to diagnose gestational diabetes mellitus. Early detection of GDM can done by using inflammatory markers like neutrophil-to-lymphocyte ratio (NLR) and the platelet- to-lymphocyte ratio (PLR) that are rapid, inexpensive and easy to use in different clinical setting. The objective of this study was to evaluate diagnostic accuracy of raised neutrophil to lymphocyte ratio for detection of gestational diabetes mellitus taking OGTT as gold standard.&#x0D; Methods: This was a cross-sectional study held in Department of Obstetrics and Gynecology CMH Lahore from November, 2018 –May, 2020. After approval from hospital ethical review committee and taking an informed consent, 473 pregnant women enrolled in first trimester between age 18-35 years, fulfilling the inclusion criteria were included whereas known diabetics, patients with cardiovascular disorders, previous history of GDM were excluded. Blood samples in sterilized manner were drawn and sent to hospital laboratory for analysis of NLR. Then they were screened during 24-28 weeks of gestation for diagnosis of gestational diabetes mellitus on OGGT. The females were labelled for positive NLR and GDM as per operational definition. Diagnostic accuracy of NLR was calculated for development of gestational diabetes mellitus.&#x0D; Results: Mean age of females was 26.72 ± 4.90 years and mean gestational age was 15.50 ± 1.67 weeks. 94(19.9%) females who had raised neutrophil to lymphocyte ratio while 397(80.1%) females had normal neutrophil to lymphocyte ratio and there were 90(19%) females who had gestational diabetes mellitus while rests of 383(81%) did not have gestational diabetes mellitus. The sensitivity, specificity, positive predictive value, negative predictive value and overall diagnostic accuracy of NRL was 95.56%, 97.91%, 91.49%, 98.94% and 97.46%, respectively.&#x0D; Conclusion: The study concluded that raised neutrophil to lymphocyte ratio is significantly high among gestational diabetes mellitus and NLR has a high diagnostic accuracy for predicting gestational diabetes mellitus.

First‐trimester glycosylated hemoglobin (HbA1c) and maternal characteristics in the prediction of gestational diabetes: An observational cohort study

This study aimed to investigate the extent to which gestational diabetes mellitus (GDM) can be predicted in the first trimester by combining a marker of growing interest, glycosylated hemoglobin A1c (HbA1c), and maternal characteristics. This observational study was conducted in the outpatient obstetric department of our institution. The values of HbA1c and venous random plasma glucose were prospectively assessed in the first trimester of pregnancy. We determined maternal characteristics that were independent predictors from the regression analysis and calculated areas under the receiver-operating curves by combining the maternal age, body mass index, previous history of GDM, and first-degree family history for diabetes mellitus. Moreover we investigated the predictive capability of HbA1c to exclude GDM. Patients with a first-trimester HbA1c level of 6.5% (48 mmol/mol) or more were excluded. The study was registered at ClinicalTrials.gov ID: NCT02139254. We included 785 cases with complete dataset. The prevalence of GDM was 14.7% (115/785). Those who developed GDM had significantly higher HbA1c and random plasma glucose values (p < 0.0001 and p=0.0002, respectively). In addition, they had a higher body mass index, were more likely to have a history of GDM and/or a first-degree family history of diabetes. When these maternal characteristics were combined with the first-trimester HbA1c and random plasma glucose the combined area under the receiver operating characteristics curve was 0.76 (95% CI 0.70-0.81). Our results indicate that HbA1c and random plasma glucose values combined with age, body mass index, and personal and family history, allow the identification of women in the first trimester who are at increased risk of developing GDM.

Gestational Diabetes Mellitus in a Multi-Ethnic, High-Risk Population: Adequacy of Screening for Diabetes Mellitus 6 Weeks after Delivery.

Gestational diabetes mellitus (GDM) during pregnancy is a marker for future type 2 diabetes mellitus (T2DM); therefore, a meticulous follow-up after delivery can help identify women at risk for T2DM. In a cohort of 5504 pregnant women, the postpartum follow-up of all 1043 women with GDM for hyperglycemia in a multi-ethnic, high-risk Arab population was investigated. The prevalence of GDM was 18.9%. A total of 265 (25.4%) women returned for an oral glucose tolerance test (OGTT) 4-6 weeks after delivery, with more South Asian than Arab women (p < 0.01). The other factors associated with return were (a) family history of T2DM, (b) lower basic metabolic index, (c) higher abortions and (d) lower gravida (p < 0.05), all with minimal effect. An abnormal postpartum OGTT was statistically associated with previous GDM history and hypoglycemic drug treatment, although these effects were small. Overall, the follow-up of women with GDM postpartum was dismal, ethnicity being the major factor influencing return. Urgent public measures are needed to educate women with GDM about follow-up highlighting (a) risk awareness for T2DM and (b) a healthy lifestyle after childbirth-if we are to turn the tide on the epidemic of T2DM plaguing the Arab world.

Early vs. Late Gestational Diabetes: Comparison between Two Groups Diagnosed by Abnormal Initial Fasting Plasma Glucose or Mid-Pregnancy Oral Glucose Tolerance Test.

Gestational diabetes mellitus (GDM) is one of the most common complications in pregnancy. It may be diagnosed using a fasting plasma glucose (FPG) early in pregnancy (eGDM) or a 75-g oral glucose tolerance test (OGTT) (late GDM). This retrospective cohort of women with GDM presents data from 1891 patients (1004 in the eGDM and 887 in the late GDM group). Student's t-test, chi-squared or Fisher's exact test and the Bonferroni test for post hoc analysis were used to compare the groups. Women with eGDM had higher pre-pregnancy BMI, more frequent family history of DM, more frequent history of previous GDM, and were more likely to have chronic hypertension. They were more likely to deliver by cesarean section and to present an abnormal puerperal OGTT. Even though they received earlier treatment and required insulin more frequently, there was no difference in neonatal outcomes. Diagnosing and treating GDM is necessary to reduce complications and adverse outcomes, but it is still a challenge. We believe that women with eGDM should be treated and closely monitored, even though this may increase healthcare-related costs.

Breastfeeding Intensity and Associated Factors Among GDM Mothers: Evidence from Malaysia

Introduction: Breastfeeding confers numerous protective health effects, particularly concerning mothers associated with gestational diabetes mellitus (GDM). However, breastfeeding rates recorded in the National Health and Morbidity Survey (2016 ) remain unsatisfactory and research shows that breastfeeding practices are notably poor in GDM mothers. This study aimed to investigate the factors associated with breastfeeding intensity among mothers with and without a previous history of GDM. Methods: This cross-sectional study conducted across Malaysia involving 322 mothers with (n=161) and without (n=161) a previous history of GDM. Eligible mothers were randomly recruited and were asked to complete the Infant Feeding Survey through an online survey. Breastfeeding intensity was measured as the percentage of feedings per 24-hour that were from breast milk. Pearson’s Chi-Square test and independent t-test were used to investigate potential significant association between a previous history of GDM and breastfeeding intensity. Multiple linear regression was used to explore any association between sociodemographic and obstetrical variables and breastfeeding intensity. Results: No statistically significant association was found between a previous history of GDM (p=0.612) and breastfeeding intensity (p= 0.410). Mothers without a previous history of GDM who received less than 12 years of education (p= 0.009) and were in the upper-middle wealth quantile (RM3000 – RM6000) (p= &lt;0.001) had significantly reduced rates of breastfeeding intensity. Conclusion: Efforts need to be shifted to strategize and prioritize less educated mothers and working mothers within the identified income capacity so that the aim of intensifying breastfeeding practices can be achieved.

Prevalence and Associated Factors of Prediabetes in Postpartum Gestational Diabetes Mellitus Mothers in the East Coast of Malaysia

Introduction: Majority of gestational diabetes mellitus (GDM) mothers resume normal glycaemic state after delivery. However, this hyperglycaemic condition may persist in some women. Postpartum GDM mothers have a higher risk of progression to diabetes and prediabetes than those with normal pregnancy. This study was aimed to determine the prevalence of prediabetes among postpartum GDM mothers and its associated factors during six weeks of postpartum glucose testing. Materials and method: A cross-sectional secondary data review was conducted from January 2021 until May 2021 among postpartum mothers with history of GDM who performed postpartum glucose testing in all government health clinics in Besut, Terengganu from January 2018 until December 2019. A descriptive and multiple logistic regression analysis were performed using IBM SPSS Statistics version 26 software. Result: A total of 429 cases were included. Prevalence of diabetes and prediabetes was 2.3% (95% CI 1.6%, 3.0%) and 13.8% (95% CI 12.1%, 15.5%), respectively. There was significant associations found between previous history of GDM (Adj. OR 3.28; 95% CI 1.83, 5.87; p &lt; 0.001) and insulin usage (Adj. OR 2.75; 95% CI 1.51, 4.99; p= 0.001) with development of prediabetes at postpartum period. Conclusion: The prevalence of diabetes and prediabetes among postpartum GDM mothers in Besut district was as high as other studies in Malaysia and globally. Women with a previous history of GDM and insulin usage should be focused on prevention strategies as they were at higher risk of developing prediabetes in the postpartum period.

Malay Version of Acceptance and Action Questionnaire-II (AAQ-II): A Reliability and Validity Analysis in Non-Clinical Samples

INTRODUCTION: Majority of gestational diabetes mellitus (GDM) mothers resume normal glycaemic state after delivery. However, this hyperglycaemic condition may persist in some women. Postpartum GDM mothers have a higher risk of progression to diabetes and prediabetes than those with normal pregnancy. This study was aimed to determine the prevalence of prediabetes among postpartum GDM mothers and its associated factors during six weeks of postpartum glucose testing. MATERIALS AND METHOD: A cross-sectional secondary data review was conducted from January 2021 until May 2021 among postpartum mothers with history of GDM who performed postpartum glucose testing in all government health clinics in Besut, Terengganu from January 2018 until December 2019. A descriptive and multiple logistic regression analysis were performed using IBM SPSS Statistics version 26 software. RESULT: A total of 429 cases were included. Prevalence of diabetes and prediabetes was 2.3% (95% CI 1.6%, 3.0%) and 13.8% (95% CI 12.1%, 15.5%), respectively. There was significant associations found between previous history of GDM (Adj. OR 3.28; 95% CI 1.83, 5.87; p &lt; 0.001) and insulin usage (Adj. OR 2.75; 95% CI 1.51, 4.99; p= 0.001) with development of prediabetes at postpartum period. CONCLUSION: The prevalence of diabetes and prediabetes among postpartum GDM mothers in Besut district was as high as other studies in Malaysia and globally. Women with a previous history of GDM and insulin usage should be focused on prevention strategies as they were at higher risk of developing prediabetes in the postpartum period.

A case of severe neonatal transient hyperinsulinemic hypoglycaemia without identifiable risk factors: a case report

BackgroundNeonatal hypoglycaemia is one of the major metabolic disorders that causes irreversible brain injury. Assessing for maternal glucose metabolism disorders can predict and avoid this perinatal complication. Accordingly, diagnosing maternal gestational diabetes mellitus (GDM) is important in protecting neonatal neurological prognosis. However, there are various methods of screening for maternal GDM. The intervention for neonatal hypoglycaemia also varies within each guideline.Case presentationA female infant was born at 37 weeks of gestation by vaginal delivery with no asphyxia. Her mother had no abnormal findings, including glucose metabolism disorders, upon periodic prenatal visits. Upon routine examination at the first hour of life, the baby was lethargic, pale, hypotonic, and rarely cried. An emergent systemic evaluation was performed, and she was diagnosed with severe hyperinsulinemic hypoglycaemia with blood glucose of 11 mg/dL and insulin of 2.7 µU/mL. She was soon fed with milk and her symptoms of hypoglycaemia was resolved before receiving intravenous glucose infusion. Her blood glucose level reached 78 mg/dL 3 h after delivery. She was discharged home with her mother on day 6 of age without relapse of hypoglycaemia. Upon review, we determined that the mother was diagnosed with GDM during her previous pregnancy but not during this current pregnancy. The infant had no developmental delay upon check-up at 6 months.ConclusionsThe infant of this case was not a candidate for neonatal hypoglycaemia screening since her mother had no identifiable risk factors. This case suggests that previous maternal history of GDM might be the cause of neonatal hyperinsulinemic hypoglycaemia. Clinicians need to be aware of the possibility of hypoglycaemia among newborns with a maternal previous history of GDM, regardless of the mother’s current diagnosis. Immediate oral feeding can be one of the treatments, even for symptomatic neonatal severe hypoglycaemia, when rapid intravenous access is difficult. The present case also suggests the necessity of considering neonatal outcomes as well as maternal ones when screening for maternal disorders of glucose metabolism.

Abstract 59: Prenatal predictive factors and prevalence of early postpartum maternal dysglycemia in patients with gestational diabetes

Background: Women with gestational diabetes mellitus (GDM) have increased risk of postpartum diabetes which may be further exacerbated by fat accretion during pregnancy and post-partum deterioration in lifestyle behaviours.Aims and objectives: To determine prenatal predictive factors and prevalence of maternal dysglycemia at 6-12weeks postpartum in patients with GDM.Results: In this prospective cohort study, of 118 subjects recruited initially, only 83 (81.3%) followed for postpartum screening. Among them 38.56%, 22.89% and 8.43% had family history of Diabetes Mellitus, Previous history of GDM and PCOD respectively. We observed that 62.7% reverted to NGT postpartum, however; 8.4%, 3.6%, 10.8% and14.5% had IFG, IGT, IFG+IGT and overt DM respectively.In univariate analysis, BMI (p=0.001), family history of DM (p=0.008), PCOD (p=0.012), impaired fasting glucose (p<0.001), HbA1c at diagnosis (p<0.001) and fetal macrosomia (p=0.019) were the risk factors for postpartum diabetes. However on Multivariate analyses, only HbA1c at diagnosis, Family history of DM and BMI showed statistically significant association with postpartum diabetes.Conclusion: GDM patients have a high prevalence of postpartum glucose intolerance and diabetes. The prenatal risk factors identified could be useful for prenatal risk stratification for early detection and interventions to reduce the risk of progression and complications of diabetes mel.

Population-centric risk prediction modeling for gestational diabetes mellitus: A machine learning approach

AimsThe heterogeneity in Gestational Diabetes Mellitus (GDM) risk factors among different populations impose challenges in developing a generic prediction model. This study evaluates the predictive ability of existing UK NICE guidelines for assessing GDM risk in Singaporean women, and used machine learning to develop a non-invasive predictive model. MethodsData from 909 pregnancies in Singapore’s most deeply phenotyped mother-offspring cohort study, Growing Up in Singapore Towards healthy Outcomes (GUSTO), was used for predictive modeling. We used a CatBoost gradient boosting algorithm, and the Shapley feature attribution framework for model building and interpretation of GDM risk attributes. ResultsUK NICE guidelines showed poor predictability in Singaporean women [AUC:0.60 (95% CI 0.51, 0.70)]. The non-invasive predictive model comprising of 4 non-invasive factors: mean arterial blood pressure in first trimester, age, ethnicity and previous history of GDM, greatly outperformed [AUC:0.82 (95% CI 0.71, 0.93)] the UK NICE guidelines. ConclusionsThe UK NICE guidelines may be insufficient to assess GDM risk in Asian women. Our non-invasive predictive model outperforms the current state-of-the-art machine learning models to predict GDM, is easily accessible and can be an effective approach to minimize the economic burden of universal testing & GDM associated healthcare in Asian populations.

Awareness of gestational diabetes mellitus among women in Qassim region, Saudi Arabia

Background: Gestational diabetes mellitus (GDM) is more common among African, Hispanic, Indian, and Asian women than Caucasian women GDM prevalence has risen by 2-3 times in recent years, ranging from 8.9% to 53.4%. This study aimed to investigate Qassim women&amp;apos;s awareness of gestational diabetes. Methods: An observational cross-sectional study was conducted among women living in the Qassim region of Saudi Arabia. A self-administered questionnaire was distributed among women using an electronic questionnaire. The questionnaire comprised socio-demographic data and 17 items focused on broad awareness and knowledge regarding DM and GDM risk factors, assessment, therapy, and implications to measure GDM knowledge and awareness. Results: Among the 633 women studied, 48.5% were aged more than 35 years old. The prevalence of women with a previous history of GDM was 15.3%. Based on our results, the level of awareness regarding GDM was poor among 60.3% of women, 33% had moderate awareness, and only 6.6% were estimated to have good awareness levels. Factors associated with increased awareness were being younger, living in Buraydah, having better education, being employed, having associated chronic disease, having a previous history of GDM, and knowing someone with GDM. Conclusion: The awareness of women in the Qassim region regarding gestational diabetes was deficient. However, increased awareness was demonstrated more frequently by younger women who were currently working with better education, a previous history of GDM, and knowing someone with the same disease. It is necessary to improve the awareness of women regarding GDM so they can effectively manage the disease and alleviate fears of getting complications. The healthcare providers&amp;apos; role is imperative.