Prior Gestational Diabetes Research Articles

Barriers and facilitators of cardiovascular disease prevention services for women with prior gestational diabetes or hypertensive disorders of pregnancy in low-income, middle-income and high-income settings: a scoping review protocol

IntroductionWomen with previous pregnancy-related cardiovascular risk indicators, including gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDP), have an increased risk of future cardiovascular disease (CVD). Although CVD screening...

Impact of previous gestational diabetes management on perinatal outcomes in subsequent pregnancies affected by gestational diabetes mellitus.

To determine the impact of prior gestational diabetes mellitus (GDM) on perinatal outcomes in a subsequent GDM pregnancy. This retrospective cohort study included 544 multiparous patients with two consecutive pregnancies between 2012-2019, where the second (index) pregnancy was affected by GDM. The primary exposure was prior GDM diagnosis, categorized into medical and dietary management. The primary outcome was a composite including need for pharmacotherapy, large-for-gestational age, or neonatal hypoglycemia. Adjusted odds ratios (aOR) were calculated using multivariable logistic regressioncontrolling for maternal age, pre-pregnancy body mass index, and gestational age at GDM diagnosis in the index pregnancy. Of the 544 patients, 164 (30.1%) had prior GDM. Prior GDM significantly increased the likelihood ofcomposite outcome compared to no prior GDM (74.4% vs. 57.4%; P < 0.001). After adjusting for confounders, prior GDM remained significantly associated with the composite outcome (aOR 2.03, 95% confidence interval [CI] 1.31-3.15). Stratifying by prior GDM treatment modality, a significant association was found for prior pharmacotherapy-controlledGDM (aOR 3.29, 95% CI 1.64-6.59), but not for prior diet-controlled GDM (aOR = 1.54, 95% CI 0.92-2.60). A history of pharmacotherapy-controlled GDM in a previous pregnancy increases odds of adverse perinatal outcomes in a subsequent GDM pregnancy.

Effect of prior gestational diabetes on the risk of cardiovascular disease and death in women with type 2 diabetes: The Fremantle Diabetes Study Phase II

BackgroundTo examine whether prior gestational diabetes mellitus (GDM) is associated with prevalent coronary heart disease (CHD), cerebrovascular disease (CeVD) and peripheral arterial disease (PAD), and all-cause mortality, in community-based women with type 2 diabetes. MethodsBaseline prevalences of CHD/CeVD/PAD/prior GDM were determined in 718 females (mean ± SD age 65.5 ± 11.9 years) from the Fremantle Diabetes Study Phase II. Deaths between baseline (2008–2011) and end-2016 were ascertained. Cox regression identified predictors of mortality with GDM as a candidate variable. ResultsCompared to the 673 women without GDM, the 39 (5.4 %) with prior GDM were younger, more likely Aboriginal, smokers and obese, had longer diabetes duration and higher HbA1c levels, and were more dyslipidemic (P ≤ 0.046). Prevalences of CHD (24.6 versus 23.1 %), CeVD (7.5 % versus 2.6 %) and PAD (27.5 % versus 23.7 %) were not significantly different in those without versus with prior GDM (P ≥ 0.35). There were 116 deaths (16.2 %) during 6.8 ± 1.6 years of follow-up. Age, Aboriginal ethnicity, marital status, current smoking, heart rate, estimated glomerular filtration rate, CHD and PAD were independently associated with all-cause mortality (P ≤ 0.023); GDM status did not add to the most parsimonious model (P = 0.62). ConclusionsPrior GDM does not increase CVD risk or all-cause mortality in women with type 2 diabetes.

Metformin in diabetes management: expanding benefits. Review

We have conducted a narrative review based on a structured search strategy, focusing on the effects of metformin on the progression of non‑diabetic hyperglycemia to clinical type 2 diabetes mellitus. The principal trials that demonstrated a significantly lower incidence of diabetes in at‑risk populations randomized to metformin (mostly with impaired glucose tolerance) were published mainly from 1999 to 2012. Metformin reduced the 3‑year risk of diabetes by ‑31% in the randomized phase of the Diabetes Prevention Program (DPP), vs.‑ 58% for intensive lifestyle intervention. Metformin was most effective in younger, heavier subjects. Diminishing but still significant reductions in diabetes risk for subjects originally randomized to these groups were present in the trial’s epidemiological follow‑up, the DPP Outcomes Study (DPPOS) at 10 years (‑18 and ‑34%, respectively), 15 years (‑18 and ‑27%), and 22 years (‑18 and ‑25%). Long‑term weight loss was also seen in both groups, with better maintenance under metformin. Subgroup analyses from the DPP/DPPOS have shed important light on the actions of metformin, including a greater effect in women with prior gestational diabetes, and a reduction in coronary artery calcium in men that might suggest a cardioprotective effect. Improvements in long‑term clinical outcomes with metformin in people with non‑diabetic hyperglycemia («prediabetes») have yet to be demonstrated, but cardiovascular and microvascular benefits were seen for those in the DPPOS who did not vs. did develop diabetes mellitus. Multiple health economic analyses suggest that either metformin or intensive lifestyle intervention is cost‑effective in a community setting. Long‑term diabetes prevention with metformin is feasible and is supported in influential guidelines for selected groups of subjects. Future research will demonstrate whether intervention with metformin in people with non‑diabetic hyperglycemia will improve long‑term clinical outcomes.

Prospective associations between breast feeding, metabolic health, inflammation and bone density in women with prior gestational diabetes mellitus

IntroductionThe aim of the study is to investigate prospective associations between breastfeeding and metabolic outcomes, inflammation, and bone density in women with prior gestational diabetes mellitus (GDM).Research design and methodsWe...

Study Recruitment, Retention, and Adherence Among Chinese American Immigrants During the COVID-19 Pandemic.

Chinese American immigrants have been underrepresented in health research partly due to challenges in recruitment. This study aims to describe recruitment and retention strategies and report adherence in a 7-day observational physical activity study of Chinese American immigrants with prior gestational diabetes during the COVID-19 pandemic. Foreign-born Chinese women aged 18-45 years, with a gestational diabetes index pregnancy of 0.5-5 years, who were not pregnant and had no current diabetes diagnosis were recruited. They wore an accelerometer for 7 consecutive days and completed an online survey. Multiple recruitment strategies were used: (a) culturally and linguistically tailored flyers, (b) social media platforms (e.g., WeChat [a popular Chinese platform] and Facebook), (c) near-peer recruitment and snowball sampling, and (d) a study website. Retention strategies included flexible scheduling and accommodation, rapid communications, and incentives. Adherence strategies included a paper diary and/or automated daily text reminders with a daily log for device wearing, daily email reminders for the online survey, close monitoring, and timely problem-solving. Participants were recruited from 17 states; 108 were enrolled from August 2020 to August 2021. There were 2,479 visits to the study webpage, 194 screening entries, and 149 inquiries about the study. Their mean age was 34.3 years, and the mean length of U.S. stay was 9.2 years. Despite community outreach, participants were mainly recruited from social media (e.g., WeChat). The majority were recruited via near-peer recruitment and snowball sampling. The retention rate was 96.3%; about 99% had valid actigraphy data, and 81.7% wore the device for 7 days. The majority of devices were successfully returned, and the majority completed the online survey on time. We demonstrated the feasibility of recruiting and retaining a geographically diverse sample of Chinese American immigrants with prior gestational diabetes during the COVID-19 pandemic. Recruiting Chinese immigrants via social media (e.g., WeChat) is a viable approach. Nonetheless, more inclusive recruitment strategies are needed to ensure broad representation from diverse socioeconomic groups of immigrants.

Association of ethnicity and socioeconomic status with health outcomes in women with gestational diabetes: Clinical practice research datalink cohort study

AimsTo investigate in women with prior gestational diabetes mellitus (GDM), differences by ethnicity and socioeconomic status in the incidence of recurrent GDM, type 2 diabetes (T2D), hypertension, and depression. MethodsThis was a retrospective cohort study including 10,868 women diagnosed with GDM in the Clinical Practice Research Datalink (CPRD GOLD) between January 01, 2000 and November 05, 2018. Linked data were obtained for Hospital Episode Statistics and the Index of Multiple Deprivation. We estimated incidence rates and hazard ratios, by ethnicity and socioeconomic status. ResultsDuring a follow-up of 58,479 person years (mean (SD): 5.38 (3.67) years), the crude incidence was 9.67 (95 % confidence interval: 9.30–10.00) per 100 person years for recurrent GDM, 3.86 (3.70–4.02) for depression, 2.15 (2.03–2.27) for T2D and 0.89 (0.81–0.97) for hypertension. South Asian ethnicity was associated with an increased risk of T2D compared to White (adjusted hazard ratio: 1.65; 1.34–2.05) and Black ethnicity was associated with a greater risk of hypertension (2.93; 1.93–4.46). Black and South Asian ethnicity were associated with a reduced risk of depression compared to White: 0.23 (0.13–0.39) and 0.37 (0.29–0.46), respectively. Incidence rates were higher for all conditions with increasing deprivation level. ConclusionsThe risk of health complications in women with a prior history of GDM differs by ethnicity and socio-economic status, suggesting the opportunity for targeted assessment in the years following pregnancy. These findings may inform future guidelines on screening for health outcomes in women with GDM.

Abstract MP45: Beyond Pregnancy: Meta-Analysis of Lifestyle Intervention for Prevention of Diabetes Mellitus in Women With Prior Gestational Diabetes Mellitus

Introduction: Among parous women,1 in 3 have a pregnancy complication, increasing chances of developing Diabetes Mellitus(DM), Hypertension, or heart disease. Lifestyle intervention is recommended to reduce cardiovascular morbidity risk after complicated pregnancies. The effect of lifestyle intervention on the risk of type 2 DM in women with prior Gestational DM (GDM) is not widely studied. Our study highlights the impact of lifestyle intervention on risk of type 2 DM in women with prior GDM. Methods: We ran a systemic literature search of PubMed, EMBASE, Clinical Trials.gov, and Google Scholar from January 2000 to August 2023 for relevant articles comparing lifestyle intervention (diet and physical activity) with standard care in women with prior GDM. The relative risk (RR) of DM with 95% confidence interval (CI) and p-values were extracted with fixed effect model using RevMan v.5.4. Results: Of 3100 articles that were screened, 28 underwent full-text review, and 11 studies met the inclusion criteria. Of 11 studies, 1661 were evaluated in intervention group (IG) and 1671 in control group (CG). The mean age of participants was 26.1-39 years, with a baseline body mass index (BMI) range (R) of 23.4-31.4 kg/m2 and a follow-up duration with R of 4-36 months. On analysis, the incidence of type 2 DM was 7.6% in IG compared to CG (10.35%). IG showed a 27% reduction in DM incidence as compared to CG, RR of 0.73(CI: 0.59-0.91) (p &lt; 0.05) (Figure 1). On meta-regression analysis, duration of lifestyle intervention (R: 4-36 months) significantly impacted the observed reduction in incident type 2 DM (p &lt; 0.05) (positive relation) as compared to baseline BMI (p = 0.21) (Figure 1). Conclusion: Our analysis highlights that lifestyle intervention in women with prior GDM positively reduces risk of type 2 DM, and intervention duration significantly impacts the long-term risk of DM and cardiovascular diseases. Further data is warranted from larger studies for stronger evidence regarding the benefits of lifestyle intervention in prior GDM patients

A Systematic Review on Prevention of Type 2 Diabetes Mellitus after Gestational Diabetes Mellitus

Background: Women with prior gestational diabetes mellitus (GDM) have a high risk of developing type 2 diabetes mellitus (T2DM) in later life. Lifestyle interventions aimed at postpartum weight loss to reduce T2DM risk have been reported but poor compliance remains a barrier. Objectives: To assess what preventative measures reduce type 2 diabetes prevalence among women with previous gestational diabetes. Method: Search Strategy: Electronic databases CINAHL Web of Science PubMed and EMBASE were searched via the e-library gateway of the University of Nottingham using key words combined in a formal search strategy. Selection Criteria: Randomized Controlled Trials and Cluster Randomized Controlled Trials examining what preventative measures reduce type 2 diabetes prevalence among women with previous gestational diabetes were selected. Results: 14 studies were identified for inclusion in the review after a stringent criterion and their data was extracted using JBI data extraction tool. Three themes were identified across the 14 studies mainly: weight management healthy eating and medication and physical activities. Most interventions had positive outcomes however a few had no significant impact in the prevention of T2DM. Conclusion: The likelihood of developing diabetes is higher for women with a history of GDM, increases with a high BMI, high fasting glucose, impaired glucose tolerance, and elevated fasting glucose. This risk can be greatly reduced by making lifestyle adjustments or taking medication. The main risk factors that increase the risk of T2DM after GDM identified in this review were obesity, poor quality of diet and a sedentary lifestyle.

Dietary intakes of branch chained amino acids and obesity risk among Chinese gestational diabetes women.

Epidemiological studies have assessed the correlation between daily dietary branch chain amino acid (BCAA) intakes and the risk of obesity, however, the findings from these studies were inconsistent and investigations among GDM women were few. The present study was to investigate the associations of daily BCAA intakes with the risks of overweight and abdominal obesity among women with prior gestational diabetes mellitus (GDM) postpartum. We performed a cross-sectional study of 1,263 women with prior GDM at 1-5 years post-delivery. Logistic regression models were used to estimate the associations of daily dietary intakes of BCAAs with the risks of overweight and abdominal obesity. The multivariable-adjusted odds ratios (ORs) across quartiles of daily BCAA intakes postpartum were 1.42 (95% confidence interval [CI] 1.02-1.97), 1.00 (reference), 1.21 (95% CI 0.88-1.68), and 1.31 (95% CI 0.95-1.81) for general overweight, and 1.38 (95% CI 0.99-1.90), 1.00, 1.19 (95% CI 0.86-1.64), and 1.43 (95% CI 1.04-1.98) for abdominal obesity, respectively. Women with the lowest quartile of daily BCAA intakes significantly increased the risks of general overweight (OR 1.49; 95 %CI 1.06-2.09) and abdominal obesity (OR 1.50; 95 %CI 1.08-2.11) compared with women at quartile 2 of daily BCAA intakes after further adjustment of daily energy intake. The present study indicated that daily lower BCAA intakes were associated with increased risks of general overweight and abdominal obesity among women with prior GDM.

Lifestyle Interventions to Prevent Type 2 Diabetes in Women with a History of Gestational Diabetes: A Systematic Review and Meta-Analysis through the Lens of Health Equity.

Type 2 diabetes mellites is one of the health problems disproportionally affecting people with low socioeconomic statuses. Gestational diabetes mellites increases the risk of type 2 diabetes by up to ten-fold for women. Lifestyle interventions prevent type 2 diabetes in women with prior gestational diabetes. However, it is unknown if similar effectiveness can be expected for all population subgroups. This study aims to assess the prevention of type 2 diabetes in women with prior gestational diabetes using population characteristics according to the PROGRESS (place of residence, race/ethnicity/culture/language, occupation, gender/sex, religion, education, socioeconomic status, and social capital) criteria. MEDLINE, CINAHL, EMBASE, PubMed, PsycINFO, Web of Science, and EBM Reviews databases were searched for interventional studies of diet, physical activity, or behavioural interventions published up to 21 February 2023. Random effects subgroup meta-analysis was conducted to evaluate the association of population characteristics and intervention effects. All studies were conducted in high-income countries or middle-income countries. Two-thirds of the studies reported on race/ethnicity and education level. Less than one-third reported on place (urban/rural), occupation, and socioeconomic status. None reported on religion or social capital. Studies from high-income countries (MD = -1.46; 95% CI: -2.27, -0.66, I2 = 70.46, p < 0.001) showed a greater reduction in bodyweight compared with the studies conducted in middle-income countries (MD = -0.11; 95% CI: -1.12, 0.89, I2 = 69.31, p < 0.001) (p for subgroup difference = 0.04). There are significant equity gaps in the evidence for the prevention of type 2 diabetes in women with prior gestational diabetes due to reports on population characteristics being poor. Interventions may be less effective in reducing bodyweight in women from middle-income countries compared to high-income countries. Collecting and analysing data related to equity is needed to understand the effect of lifestyle interventions on type 2 diabetes for different population subgroups.

Liraglutide treatment for the prevention of glucose tolerance deterioration in women with prior gestational diabetes mellitus: A 52-week randomized controlled clinical trial.

We investigated the effect of 52-week treatment with liraglutide, a glucagon-like peptide 1 receptor agonist, on glucose tolerance and incretin effect in women with previous gestational diabetes mellitus (pGDM). Women with overweight/obesity and pGDM were randomized to once daily subcutaneous liraglutide 1.8 mg or placebo for 52 weeks. Participants underwent oral glucose tolerance test (OGTT) and isoglycaemic intravenous glucose infusion at baseline and at 52 weeks, and an additional OGTT after the drug wash-out. In total, 104 women [age: mean ± SD, 38 ± 5 years; fasting plasma glucose (FPG): 5.5 ± 0.4 mmol/L; glycated haemoglobin (HbA1c): 33 ± 4 mmol/mol, bodyweight: 88.2 ± 14.8 kg, body mass index: 31.1 ± 4.3 kg/m2 ] were assigned to liraglutide (n = 49) or placebo (n = 55). Estimated treatment difference (ETD) for area under curve during OGTT was -173 (95% confidence interval -250 to -97) mmol/L × min, p < .0001, but after wash-out the difference disappeared [ETD 58 (-30 to 146) mmol/L × min, p = .536]. Liraglutide reduced FPG [ETD -0.2 (-0.4 to -0.1) mmol/L, p = .018], HbA1c [-2.2 (-3.5 to -0.8) mmol/mol, p = .018] and bodyweight [-3.9 (-6.2 to -1.6) kg, p = .012]. No change in the incretin effect was observed. The number of women with prediabetes was reduced from 64% to 10% with liraglutide vs. 50% with placebo [adjusted odds ratio 0.10 (0.03-0.32), p = .002]. Treatment with liraglutide for 52 weeks improved glucose tolerance, FPG, HbA1c and bodyweight in women with overweight/obesity and pGDM. Progression to prediabetes while on drug was markedly reduced, but after a 1-week drug wash-out, the effect was lost.

Postpartum lifestyle behaviour among women with prior gestational diabetes mellitus: evidence from the HUNT study

IntroductionWomen with a history of gestational diabetes mellitus (GDM) are at increased risk of type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). Recommendations for postpartum follow-up include targeted lifestyle...

The incidence and risk factors of postpartum diabetes in women from Bangladesh, India and Sri Lanka (South Asia) with prior gestational diabetes mellitus: Results from the LIVING study

AimTo study, the incidence and risk factors for postpartum diabetes (DM), in women with gestational diabetes mellitus (GDM) from South Asia (Bangladesh, India and Sri Lanka), followed for nearly two years after delivery. MethodsWomen with prior GDM diagnosed using IADPSG criteria were invited at 19 centres across Bangladesh, India and Sri Lanka for an oral glucose tolerance test (OGTT) following childbirth, and were enrolled in a randomized controlled trial. The glycaemic category (outcome) was defined from an OGTT based on American Diabetes Association criteria. ResultsParticipants (n = 1808) recruited had a mean ± SD age of 31.0 ± 5.0 years. Incident DM was identified, between childbirth and the last follow-up, in 310 (17.1 %) women [incidence 10.75/100 person years], with a median follow-up duration of 1.82 years after childbirth. Higher age, lower education status, higher prior pregnancy count, prior history of GDM, family history of DM, and postpartum overweight/obese status were significantly associated with incident DM. Women in Bangladesh had a higher cumulative incidence of DM [16.49/100 person years] than in Sri Lanka [12.74/100 person years] and India [7.21/100 person years]. ConclusionsA high incidence of DM was found in women with prior GDM in South Asia, with significant variation between countries. Women from Bangladesh had a significantly higher pregnancy count, family history of DM and overweight/obese status, despite having significantly lower age, which could be responsible for their higher rates of DM.Registration of this study: The study was registered with the Clinical Trials Registry of India (CTRI/2017/06/008744), Sri Lanka Clinical Trials Registry (SLCTR/2017/001), and ClinicalTrials.gov (NCT03305939).

Synergistic effect of non-alcoholic fatty liver disease and history of gestational diabetes to increase risk of type 2 diabetes.

Whether non-alcoholic fatty liver disease (NAFLD) improves risk prediction for subsequent type 2 diabetes mellitus (T2DM) in women with prior gestational diabetes mellitus (pGDM) is uncertain. We examined the combined effects of NAFLD and pGDM on risk prediction for incident T2DM. This retrospective cohort study included 97,347 Korean parous women without diabetes mellitus at baseline whose mean (SD) age was 39.0 (7.8) years. Cox proportional hazards models were used to estimate hazard ratios (HRs) for incident T2DM according to self-reported pGDM and ultrasound-diagnosed NAFLD at baseline. When combined with conventional diabetes risk factors, the incremental predictive ability of NAFLD and pGDM to identify incident T2DM was assessed. During a median follow-up of 3.9 years, 1,515 cases of incident T2DM occurred. Multivariable-adjusted HRs (95% confidence intervals [CIs]) for incident T2DM comparing pGDM alone, NAFLD alone, and both NAFLD and pGDM to the reference (neither NAFLD nor pGDM) were 2.61 (2.06-3.31), 2.26 (1.96-2.59), and 6.45 (5.19-8.00), respectively (relative excess risk of interaction = 2.58 [95% CI, 1.21-3.95]). These associations were maintained after adjusting for insulin resistance, body mass index, and other potential confounders as time-dependent covariates. The combination of NAFLD and pGDM improved risk prediction for incident T2DM (based on Harrell's C-index, also known as the concordance index, and net reclassification improvement) compared to conventional diabetes risk factors. In conclusion, NAFLD synergistically increases the risk of subsequent T2DM in women with pGDM. The combination of NAFLD and pGDM improves risk prediction for T2DM.

The association between immigration status and the development of type 2 diabetes in women with a prior diagnosis of gestational diabetes: A population-based study.

The aim of this study was to examine the influence of immigration status and region of origin on the risk of type 2 diabetes in women with prior gestational diabetes (GDM). This retrospective population-based cohort study included women with gestational diabetes (GDM) aged 16 to 50 years in Ontario, Canada, who gave birth between 2006 and 2014. We compared the incidence of type 2 diabetes after delivery between long-term residents and immigrants-overall, by time since immigration and by region of-using Cox regression adjusted for age, year, neighbourhood income, rurality, infant birth weight and presence of hypertensive disorders of pregnancy (HDP). Among 38,515 women with prior GDM (42% immigrants), immigrants had a significantly higher risk of type 2 diabetes compared with long-term residents (adjusted hazard ratio [HR] 1.19, 95% confidence interval [CI] 1.13-1.26), with no meaningful difference based on time since immigration. The highest adjusted relative risks of type 2 diabetes compared with long-term residents were found for immigrants from Sub-Saharan Africa (HR 1.63, 95% CI 1.40-1.90), Latin America/Caribbean (HR 1.44, 95% CI 1.28-1.62) and South Asia (HR 1.34, 95% CI 1.25-1.44). Immigration is associated with a significantly higher risk of type 2 diabetes after GDM, particularly for women from certain low- and middle-income countries. Diabetes prevention strategies will need to consider the unique needs of immigrants from these regions.

Abstract #1402115: A Case of Starvation Ketoacidosis in Pregnancy Secondary to Perforated Appendicitis

Starvation ketoacidosis in pregnant patients is a rare but life-threatening condition. There are few case reports in the literature of starvation ketoacidosis of pregnancy with no consensus on treatment. We present a case of starvation ketoacidosis in pregnancy that was successfully treated with dextrose and insulin infusion. A 35-year-old pregnant woman with a history of prior gestational diabetes diagnosed in a previous but not current pregnancy presented at 33 weeks of gestation with severe abdominal and poor oral intake for 3 days prior to admission. On evaluation, the patient was found to have a perforated appendix with peritonitis and was taken to the operating room for open laparotomy. During surgery, she was noted to have an anion gap metabolic acidosis. Arterial blood gas revealed pH of 7.06 (range 7.35-7.45), pCO2 of 43mmHg (range 32-35 mmHg), pO2 of 120 mmHg (range 83-108 mmHg), and bicarbonate of 12 mmol/L (range 22-26 mmol/L). Further blood work demonstrated serum bicarbonate of 14 mmol/L (range 21-30 mmol/L), and an anion gap of 18 (4-16). Beta-hydroxybutyrate was elevated at 58.5 mg/dL (range 0-3 mg/dL), with serum glucose of 134 mg/dL (range 70-99 mg/dL) and normal lactate of 1.3 mmol/L (range 0.5-2.2 mmol/L). Urinalysis demonstrated 2+ ketones (range negative). She was started on a dextrose 5% infusion with insulin infusion at a fixed rate to overcome any inherent insulin resistance and suppress lipolysis. Metabolic parameters were corrected in 12 hours and the patient was extubated in 24 hours. At 48 hours, insulin and dextrose infusions were discontinued. She then underwent cesarian section 1.5 weeks later due to development of pelvic abscess requiring surgical intervention. She delivered a healthy baby girl. Women in late pregnancy are at increased risk for ketosis during even brief periods of fasting. This is due to increased relative insulin resistance and enhanced lipolysis, a protective mechanism to ensure adequate glucose supply to the growing fetus. Prompt recognition of ketosis and timely management are essential to prevent profound acidosis and avoid maternal-fetal mortality. Although there is no consensus on management of starvation ketoacidosis in pregnancy, most case reports suggest carbohydrate administration is the cornerstone of treatment, although insulin administration can be considered if there is concern for marginal insulin reserve or there is treatment failure with carbohydrate administration alone. In our case, given the profound degree of acidosis, simultaneous administration of carbohydrate and insulin was pursued with rapid resolution of the patient’s metabolic derangements.

Acceptability and adoption of the Face-it health promotion intervention targeting women with prior gestational diabetes and their partners: a qualitative study of the perspectives of healthcare professionals.

In this study, we investigated healthcare professionals' (HCPs) experiences with delivering home visits and digital coaching in the Face-it health promotion intervention targeting women with recent GDM and their families. Understanding the acceptability and adoption of a health promotion intervention can provide insights into intervention fidelity and future scalability. In total, 13 HCPs were interviewed. Data were analysed thematically through an abductive approach using Sekhon et al.'s theoretical framework of acceptability and Greenhalgh et al.'s framework for non-adoption, abandonment, scale-up, spread, and sustainability. Acceptability and adoption of the intervention among HCPs were influenced by 1) skills and technology, 2) values, and 3) organisation. The intervention was experienced as acceptable to HCPs because the dialogue tool, visualising different topics, used in the home visits and digital coaching through the LIVA app were flexible and enabled them to address psychosocial health and personalise goal setting in families. However, delivering asynchronous and non-verbal communication was experienced as straining HCPs' relationship with families, which misaligned with HCPs' values. Establishing a non-judgemental environment was needed to increase intervention acceptability among HCPs towards addressing type 2 diabetes risk after GDM. Increased collaboration between HCPs may have aligned advice and support to families and could have benefitted delivery. When delivering health promotion to women with prior GDM, flexible intervention components which support psychosocial- and mental health topics may increase acceptability and adoption of the intervention among HCPs. HCPs' skills, values and organisational factors should be considered prior and during implementation.

Effectiveness of the National Diabetes Prevention Program After Gestational Diabetes

Women with previous gestational diabetes are at high risk of developing Type 2 diabetes. The National Diabetes Prevention Program (NDPP) is a widely disseminated lifestyle intervention to prevent Type 2 diabetes. Although NDPP programs are open to adults of any age, participants are usually older adults. Effectiveness among younger women with previous gestational diabetes is largely unknown. The NDPP was delivered by lifestyle coaches in a large network of Federally Qualified Health Centers. Reach, retention, physical activity, and weight loss outcomes were compared between women aged <40 years with previous gestational diabetes and all other participants. Data were collected from 2013 to 2019 and analyzed in 2022. Among 2,865 enrollees who agreed to start the yearlong NDPP, 63.3% were Latinx, 18.8% were non-Latinx Black, and 16.4% were non-Latinx White. Younger women with previous gestational diabetes represented <4% (n=107) of participants. There was no significant difference in the frequency of attending ≥1 NDPP session between these women and all other participants (37.4% vs 44.6%; p=0.146). However, among those attending ≥1 session (n=1,265), younger women with previous gestational diabetes attended more (11.27 ± 1.27 vs 8.50 ± 0.22 sessions, p=0.021) and had greater weight loss (3.04% ± 0.59 vs. 1.49% ± 0.11, p=0.010) in covariate-adjusted models than other participants. Diverse younger women with previous gestational diabetes attending the NDPP had one third greater attendance and twice as much weight loss as other NDPP participants but represented a much smaller proportion of enrollees. Thus, the NDPP appears to be a beneficial but underutilized resource for this high-risk population.

Barriers to and enablers of type 2 diabetes screening among women with prior gestational diabetes: A qualitative study applying the Theoretical Domains Framework.

Women with previous gestational diabetes mellitus (GDM) are at increased risk of type 2 diabetes (T2D). Guidelines recommend postnatal diabetes screening (oral glucose tolerance test or HbA1c) typically 6-12 weeks after birth, with screening maintained at regular intervals thereafter. Despite this, around half of women are not screened, representing a critical missed opportunity for early identification of prediabetes or type 2 diabetes. While policy and practice-level recommendations are comprehensive, those at the personal-level primarily focus on increasing screening knowledge and risk perception, potentially missing other influential behavioral determinants. We aimed to identify modifiable, personal-level factors impacting postpartum type 2 diabetes screening among Australian women with prior gestational diabetes and recommend intervention functions and behavior change techniques to underpin intervention content. Semi-structured interviews with participants recruited via Australia's National Gestational Diabetes Register, using a guide based on the Theoretical Domains Framework (TDF). Using an inductive-deductive approach, we coded data to TDF domains. We used established criteria to identify 'important' domains which we then mapped to the Capability, Opportunity, Motivation-Behavior (COM-B) model. Nineteen women participated: 34 ± 4 years, 19 ± 4 months postpartum, 63% Australian-born, 90% metropolitan, 58% screened for T2D according to guidelines. Eight TDF domains were identified: 'knowledge', 'memory, attention, and decision-making processes', 'environmental context and resources', 'social influences', 'emotion', 'beliefs about consequences', 'social role and identity', and 'beliefs about capabilities'. Study strengths include a methodologically rigorous design; limitations include low recruitment and homogenous sample. This study identified numerous modifiable barriers and enablers to postpartum T2D screening for women with prior GDM. By mapping to the COM-B, we identified intervention functions and behavior change techniques to underpin intervention content. These findings provide a valuable evidence base for developing messaging and interventions that target the behavioral determinants most likely to optimize T2D screening uptake among women with prior GDM. .