Rates Of GDM Research Articles

Trends in gestational diabetes in Iceland before and after guideline changes in 2012: a nationwide study from 1997 to 2020.

Internationally accepted diagnostic criteria recommendations for gestational diabetes (GDM) in 2010 resulted in a rise in global prevalence of GDM. Our aim was to describe the trends in GDM before and after Icelandic guideline changes in 2012 and the trends in pregestational diabetes (PGDM). The study included all singleton births (N = 101 093) in Iceland during 1997-2020. Modified Poisson regression models were used to estimate prevalence ratios (PRs) with 95% confidence intervals (CIs) for risk of GDM overall and by maternal age group, as well as overall risk of PGDM, according to time period of birth. The overall prevalence of GDM by time period of birth ranged from 0.6% (N = 101) in 1997-2000 to 16.2% (N = 2720) in 2017-2020, and the prevalence of PGDM ranged from 0.4% (N = 57) in 1997-2000 to 0.7% (N = 120) in 2017-2020. The overall relative GDM prevalence rate difference before and after 2012 was 380%, and the largest difference was found among women aged <25 years at 473%. Risk of GDM increased in 2017-2020 (PR 14.21, CI 11.45, 17.64) compared to 1997-2000 and was highest among women aged >34 years with PR 19.46 (CI 12.36, 30.63) in 2017-2020. Prevalence rates of GDM and PGDM increased during the study period. An accelerated rate of increase in GDM was found after 2012, overall, and among all maternal age groups. Women aged >34 years had the greatest risk of GDM throughout all time periods, while women aged <25 years appear to have a higher relative rate difference after 2012.

Obstetric Care for Gestational Diabetes in Refugee and Immigrant Women in Comparison to Non-Immigrant Women in Berlin: an Analysis of Quantitative Data of the Pregnancy and Obstetric Care for Refugees (PROREF)-study

Are there differences in the frequency of gestational diabetes between women of self-defined refugee status (SDRS), immigrant women, and women born in Germany? Does the perinatal data of women with gestational diabetes (GDM) differ depending on the migration status? For the Pregnancy and Obstetric Care for Refugees (ProRef) study between June 2020 and April 2022, data was collected with the Migrant Friendly Maternity Care Questionnaire (MFMCQ) among women on the postpartum ward in three perinatal centers in Berlin. The data concerning GDM was statistically analyzed. Women of SDRS were tested for GDM (3.2%, p=0.0025) significantly less often than immigrant women (1.4%) or women born in Germany (0.6%). The rate of GDM was higher among immigrant women (19.6%, p=0.001) than among women born in Germany (15.0%) and women of SDRS (14.1%). The rate of GDM varied depending on the country of origin. Vietnam (OR 3.41) and Turkey (OR 2.18) as countries of origin, corrected for age and body mass index, increased the chance of gestational diabetes. The perinatal outcome data among women with GDM did not differ depending on the migration status. As women of SDRS are tested for GDM less frequently, this potentially suggests a supply gap in the health care system. However, the perinatal outcome data does not differ for women of SDRS.

Association between Polycystic Ovary Syndrome (PCOS) and Pregnancy Complications

Background: Polycystic ovarian syndrome (PCOS) pregnant women appear to be more vulnerable to poor maternal and neonatal outcomes. The purpose of this study was to assess the outcome of pregnancies in women with PCOS. Methord: This descriptive study was conducted at a tertiary care hospital Jashore Medical College hospital, Jashore Bangladesh, on 115 pregnant PCOS patients. SPSS version 20 was used for data analysis on the recent pregnancy, PCOS, and maternal and perinatal outcomes. Parity and others perinatal and maternal outcomes were examined as categorical variables. Result: The average age was 25.07 years, 82% had a history of primary infertility, and 66% had a high BMI. The percentage of pregnant women with hypertensive problems was 18.26%, PROM was 33.91%, and the low APGAR score at five minutes was 12.17%. gestational diabetes (23.47%), miscarriage (2.1%), preterm delivery (13.91%), caesarean delivery (37.39%), low birth weight babies (2.6%), macrosomia (0.7%), PPROM (19.52%), perinatal mortality (1.73%) and NICU admission (21.74%). Conclusion: Pregnant women with PCOS were identified with either similar or lower rates of GDM, miscarriage, preterm delivery, meconium-stained liquor, caesarean delivery, small for gestational age/IUGR, macrosomia, PPROM, perinatal mortality, NICU admission, and congenital anomalies, but higher rates of hypertensive conditions of pregnancy, PROM, low birth weight babies, and low five-minute APGAR scores.

To Study the Fetomaternal Outcomes of Pregnancy with Obesity- Retrospective Case-Control Study

Background: Increasing incidence has been seen among women of reproductive age with every one out of five women being affected by obesity. Obesity poses unfavorable outcomes for both mother and child causing ten percent of gestational diabetes and pre-eclampsia, neonatal deaths. Objective: To find the association of obesity in pregnancy with maternal and perinatal outcomes. Primary Objective: To investigate the association between maternal obesity during pregnancy and various fetomaternal outcomes. Primary Outcome: The occurrence of cesarean section deliveries, gestational diabetes, preeclampsia, macrosomia, low birth weight babies, and shoulder dystocia among pregnant women with obesity compared to non-obese pregnant women. The study will assess the relative risk and confidence intervals for all the described outcomes. Subject and Methods: This retrospective case-control study was performed in the Department of Obstetrics and Gynaecology, Kulsoom Bai Valika Hospital, site area, Karachi from February to August 2021. A total of 220 patients were included, 110 patients with a BMI equal to or more than 30 kg/m2 were exposed group and 110 cases BMI less than 30 kg/m2 were in the non-exposed group. A detailed history and examination, baseline investigations were carried out. Performa was given to patients of each group, and outcomes were recorded. Results: The average age of the patients was 28.73±6.52 years. The rate of cesarean section and PIH was 3 times more likely in obese groups than non-obese groups [RR=2.74 95%CI: 1.69-3.31] and [RR=3.08 95%CI: 2.11-4.49] respectively. The rate of GDM and preeclampsia was also 2 times more likely in the obese group than the non-obese group [RR=1.48 95%CI: 1.07-2.05] and [RR=2; 95%CI: 1.05-3.79] respectively. The rate of low birth weight was not statistically significant between obese and non-obese groups (p=0.053). While rate of macrosomia 7 times and Shoulder Dystocia time 5 more likely in obese groups than non- obese groups [RR=6.85; 95%CI: 3.24-14.48] and [RR=4.80; 95%CI: 2.56-8.99] respectively. Conclusion: Conclusion Obesity is a challenge of the present era for obstetricians, which is reaching the status of epidemic worldwide. This study shows that obesity in pregnant females is directly proportional to poor fetomaternal outcomes, therefore pregnant obese females should be managed as a high-risk case.

Interaction and joint association of gestational diabetes mellitus and subsequent weight gain rate on macrosomia

Background & aimsGestational diabetes mellitus (GDM) and gestational weight gain are two crucial modifiable nutritional factors during pregnancy in preventing macrosomia, warranting appropriate management of both glycemic levels and weight gain to prevent macrosomia, particularly in individuals with GDM. Unfortunately, current general weight targets appear not to apply to individuals with GDM, suggesting that weight gain, specifically following an oral glucose tolerance test (OGTT), may affect risk of macrosomia dependent on GDM status. Therefore, this study aims to evaluate the interaction and joint association of GDM and post-OGTT weight gain rate (PWGR) in relation to macrosomia. MethodsThis was a population-based cohort study of 59,421singleton pregnant women in South China during 2017-2020. Among them, 9,856 were diagnosed with GDM while 49,565 did not have the condition. All participants underwent an OGTT between 20 and 28 weeks of pregnancy, typically occurring between 24 and 28 weeks. PWGR was defined as the average rate of change in maternal weight with gestational weeks following OGTT, which was estimated using a repeated linear mixed effects model including a random intercept and slope for each individual. The relative risk (RR) of macrosomia associated with GDM and PWGR was estimated using a multivariate generalized linear model. ResultsThere was a significant interaction between GDM and PWGR in increasing the risk of macrosomia. The combination of GDM and a 1-SD increase in PWGR was associated with a 2.26-fold higher risk of macrosomia (95% CI 1.92 to 2.65), with the interaction of these two factors contributing to 58.0% (95% CI 31.4% to 84.7%) of this association. Moreover, we observed a significant heterogeneity in susceptibility to macrosomia due to increased PWGR between GDM and non-GDM populations, with the highest PWGR quartile having respective RRs of 2.27 (95% CI 1.62 to 3.18) and 1.41 (95% CI 1.18 to 1.69) compared to the lowest quartile category, which was corresponded to 55.9% (95% CI 38.3% to 68.6%) and 29.1% (95% CI 15.3% to 40.8%) preventable proportions of macrosomia cases in these populations. ConclusionsGDM and PWGR had a synergistic effect in increasing the risk of macrosomia. Furthermore, individuals with GDM exhibited a heightened susceptibility to macrosomia due to elevated PWGR. These findings emphasize the importance of appropriate weight interventions during late pregnancy and suggest the need for different weight targets between these two populations, with a stricter PWGR potentially being more effective for the GDM population.

Pregnancy outcomes following antenatal screening for intrahepatic cholestasis of pregnancy (ICP)

ObjectiveTo evaluate the maternal and perinatal outcomes following antenatal screening for ICP using a retrospective approach. Materials and methodsA retrospective study was conducted at the second affiliated hospital of Chongqing Medical University, Chongqing, China, from 2012 to 2017. Pregnant women registered for antenatal in our hospital were screened for ICP. The pregnant women with detailed delivery record and presenting with the diagnosis of ICP based on TBA level ≥10 mmol/L and abnormal liver enzymes were included in the study. MethodThe pregnant women with detailed delivery records presenting with the diagnosis of ICP based on TBA level ≥10 mmol/L and abnormal liver enzymes were included in the study. 1410 pregnant women were enrolled in this study. We selected 940 pregnant women without the diagnosis of ICP as our control and 470 pregnant women diagnosed with ICP as our case study. Data collection and sampling in the control group was done using microsoft excel (version 16.61) random number generator. ResultsThe mean age of the pregnant women and the gestational age at the time of diagnosis of ICP were 29.01 ± 4.3 years and 31.90 ± 8.83 weeks, respectively. It was found that a significant number of patients with ICP had a preterm birth and low birth weight (LBW), n = 151 (32.5%) P < 0.001 and n = 70 (14.9%) P < 0.001, respectively. A significant number of patients in the case group had a history of liver disease and gall bladder disease, p < 0.001 and p = 0.005, respectively, and a higher rate of GDM p < 0.001. Despite treatment, high TBA titer among ICP patients was associated with preterm delivery. ConclusionICP in pregnancy leads to complications and poor perinatal outcomes. Fetal outcomes depend on the TBA levels; therefore, early diagnosis of ICP through routine screening followed by treatment is recommended in high-risk persons/areas.

The effect of strengthening nutrition education in the second trimester on the basis of the first trimester on blood glucose

Objective: To explore the effect of strengthening individualized nutrition education in the second trimester based on first trimester on blood glucose. Methods: A retrospective study was conducted on 398 pregnant women aged (31.79±3.48) (23-41) years old who underwent an oral glucose tolerance test (OGTT) from October 2021 to December 2022 at Beijing Tsinghua Changgung Hospital. They were divided into two groups according to whether the women were re-visited in second trimester or not. The routine group consisted of 205 pregnant women aged between 24 and 41 (31.49±3.36) years old who only received the first trimester nutrition education and the strengthening group consisted of 193 pregnant women aged (31.92±3.97) (23-41) years old who received both the first and second trimester nutrition education. Then according to pre pregnancy body mass index (BMI), they were divided into normal (18.5 kg/m2≤BMI<24 kg/m2) and overweight (24 kg/m2≤BMI<28 kg/m2). The OGTT blood glucose level, the positive rate of gestational diabetes (GDM) and the weight gain during pregnancy were compared between the two groups with different BMI, in order to analyze the effect of strengthening nutrition education in the second trimester of pregnancy on blood glucose. Results: The differences between the two groups were not statistically significant in terms of the pregnant women's age, proportion of pregnant women aged≥35, proportion of pre-pregnancy BMI and overweight, parity and early pregnancy blood glucose (all P>0.05). The blood glucose levels of OGTT at 0, 1, and 2 hour were (4.57±0.37), (8.41±1.70), and (7.28±1.51) mmol/L, respectively, lower than those in the routine group [(4.74±0.48), (9.44±1.55), and (8.27±1.58) mmol/L, respectively, all P<0.001]. The positive rate of GDM in the strengthening group was 35.23% (68/193), which was lower than that in the routine group (91.71%, 188/205) (P<0.001). After the BMI stratification, the OGTT blood glucose levels and the positive rate of GDM in the strengthening group were still lower than those in the routine group (all P<0.05). The weight gain with normal BMI in the early pregnancy in routine group was higher than that in the strengthening group (P=0.003), but there was no significant statistical difference in weight gain of overweight pregnant women at different gestational weeks (all P>0.05). Conclusion: Strengthening a nutrition education about second trimester for pregnant women in the early stages of pregnancy can effectively improve blood glucose levels and reduce the positive rate of GDM.

A 10-Year Observational Study on Twin Pregnancy: Role of Fetal Sex Pairing on Obstetric Outcome.

Fetal sex contributes to the determination of obstetric outcome, as pregnancies carrying male babies seem to have an increased risk of maternal-fetal complications. Most studies have been conducted on singleton pregnancies, whereas less evidence is available for twins. A 10-year retrospective observational study was conducted on a cohort of 1180 women with twin pregnancy delivered at a single tertiary hospital. Clinical data on maternal characteristics, and obstetric and neonatal outcomes were collected, and the analysis was performed on monochorionic (MC) and dichorionic (DC) diamniotic twins separately. The group of DC twins included 837 cases, and those conceived by assisted reproductive technologies (ART) were more likely to have one or both female fetuses rather than males. The incidence of hypertensive disorders of pregnancy (HDP) was higher in same-sex pairs than in opposite-sex pairs. No differences were found regarding other obstetric and neonatal outcomes among the three sex-pairing groups. The MC twins group included 228 cases, and in female-carrying pregnancies a higher incidence of gestational diabetes (GDM) was observed compared to the male group. Furthermore, male pairs had significantly lower Apgar scores than females. Fetal sex seems to have a mild effect in twins compared to singleton pregnancies, suggesting a more complex set of factors contributing to pregnancy outcome in multiple pregnancies. However, we observed a higher incidence of HDP among same-sex DC pairs, a higher rate of GDM among MC female-female pairs, and a worse adaptation to extrauterine life among male-male pairs in MC twins.

Short-term effect of plant-based Nordic diet versus carbohydrate-restricted diet on glucose levels in gestational diabetes – the eMOM pilot study

BackgroundThe optimal nutritional treatment for gestational diabetes (GDM) is still a matter of debate. With increasing rates of GDM and potential negative consequences for the health of mother and child, the best treatment should be established. The Nordic diet with emphasis on plant-based protein show promising health outcomes in other populations but has yet to be investigated in GDM population. The aim of this study, which is part of the “Effect of plant-based Nordic diet versus carbohydrate-restricted diet on glucose levels in gestational diabetes” (eMOM) pilot study was to compare the short-term effects of healthy Nordic diet (HND) and the currently recommended moderate restriction of carbohydrates diet (MCRD) on glucose and lipid metabolism in women with GDM.MethodsThis was a randomized crossover where each of the diet interventions (HND and MCRD) were consumed for 3 days with a 3-day wash-out period in between. In total, 42 pregnant women diagnosed with GDM (< 29 + 0 gestational week) were randomized. Glucose data was collected by continuous glucose monitors (CGM, Freestyle Libre®, Abbott, USA) worn for 14 days, and participants gave blood samples before and after diet interventions. The primary outcome was time spent in glucose target range (TIR, < 7.8 mmol/L). TIR, 3-day mean tissue glucose as well as changes in fasting glucose, homeostatic model of insulin resistance (HOMA-IR) and blood lipids were analyzed with paired samples statistical analyses.ResultsThirty-six women with complete 14 days CGM data were analyzed. Both diet interventions produced a high degree of TIR (99% SD 1.8), without a difference between the diets (p = 0.727). The 3-day mean glucose was significantly lower in HND than in MCRD (p = 0,049). Fasting insulin (p = 0,034), insulin resistance (p = 0,030), total and LDL cholesterol (p = 0,023 and 0,008) reduced more in the MCRD diet than the HND. NS differences in any other measure of CGM or blood tests.ConclusionsHND and MCRD did not differ in terms of their short-term effect on TIR. A larger study with sufficient power is needed to confirm the differences in short-term mean glucose, insulin resistance and lipid metabolism.Trial registrationRegistered in clinicaltrials.gov (21/09/2018, NCT03681054).

Unravelling the mechanisms by which chronic hepatitis B infection is associated with an increased risk of gestational diabetes.

An independent association between chronic hepatitis B virus (HBV) and the development of gestational diabetes (GDM) has been reported in the literature. Ethnic background and regional influences have been demonstrated to play a role in the reporting of incidence rates of GDM among women with chronic HBV. The mechanisms behind this association are poorly understood, but evidence suggests an inflammatory basis. Viral factors such as chronic HBV replication, quantifiable by HBV viral load, have been proposed to contribute to the increasing risk of insulin resistance in pregnancy. More research is needed to better characterise the association and determine if any interventions early in pregnancy for women infected with chronic HBV would mitigate the development of GDM.

Evaluation of Thyroid Function during Pregnancy and Effects of Thyroid Dysfunction on Maternal Outcome: A Prospective Cross Sectional Study in a Tertiary Care Hospital in Northern India

Background: Thyroid disorders are prevalent in women of child-bearing age and for this reason commonly present in pregnancy and the puerperium. Thyroid disease is the second most common endocrine disease to affect women of reproductive age. Uncorrected thyroid dysfunction in pregnancy has adverse effects maternal well-being [1]. In this context, the study was conducted with the objective to evaluate the thyroid function in pregnant females attending antenatal clinic at Post Graduate Department of Obstetrics and Gynaecology, SKIMS, Soura and to study the adverse effects of thyroid dysfunction on maternal health. Methods: This prospective cross sectional study was carried out in pregnant women who attended the antenatal clinic at post graduate department of obstetrics and gynecology, SKIMS from September 2018 for a period of 12 months. The study cases selected were pregnant women at 10 weeks of gestation and their TSH, T3, T4 levels were evaluated as is done here as a routine antenatal work up. Total of 600 patients were taken from the said gestational age and were evaluated for TSH, T3, T4 levels. Well informed consent was taken from all patients. Only those subjects who met the eligibility criteria, as described later were taken for study. After proper scrutiny, 600 patients who were fit to be included in study were selected. For thyroid function test (TFT) 10 ml of blood sample of pregnant women was drawn at 10 weeks in the first trimester. TFT were assessed by quantitative analysis of serum. Depending upon the fasting TSH values they were grouped as group A including patients having TSH &gt; 2.5mIU/L, and patients with TSH &lt; 0.1mIU/Land group B having TSH levels of 0.1mIU/l– 2.5mIU/L. Results: The mean age of the population studied was 25.31+/-4.20 years (mean age +/-SD). The range was from 18 – 38 years. 232 patients (38.6%) were from urban areas and 368 patients (61.38%) were from rural areas. The patients with TSH value of &gt; 2.5mIU/L and &lt; 0.1mIU/L were taken as Group A, and patients with TSH value of 0.1 – 2.5mIU/L were taken as Group B. It was observed that rates of abortion, pre eclampsia, preterm labour, IUGR and placental abruptionwere significantly higher in group A. The rates of GDM, stillbirth, PPH, congenital malformations, however, were comparable between the two groups.

Association of Above-Average Healthy Eating Index and Pregnancy Outcomes [ID: 1375493

INTRODUCTION: Nutritional health plays an important role in the intrauterine environment's effect on the developmental origins of disease. The Healthy Eating Index (HEI), a measure of dietary quality scaled 0–100 with 100 being ideal, has been shown to be poor on average in Americans. In a prospective cohort study of healthy pregnant individuals with a singleton gestation, we assessed dietary quality and its association with pregnancy outcomes. METHODS: Individuals completed their first study visit at a mean gestational age of 15 weeks, and three, 24-hour dietary recalls were obtained. Participants were dichotomized by HEI scores as above and at or below the U.S. average (&gt;58 and ≤58). We assessed outcomes including gestational diabetes (GDM), hypertensive disorders of pregnancy (HDP), and large for gestational age (LGA &gt;90th percentile). Statistical analysis was completed using two-sample t tests and Fisher's exact tests (P=.05). The study was IRB approved. RESULTS: Of the 67 participants included in the analysis, 45 (67%) had above average and 22 (33%) had below average HEI scores. The incidence of HDP was significantly lower among individuals with higher dietary quality (22.8% versus 4.4%, P=.03). Although the rates of GDM were not different between the two groups (15.6% versus 9.1%, P=.71), the proportion of LGA infants trended lower in those with higher HEI (4% versus 22%, P=.19). CONCLUSION: Our data suggest that higher dietary quality may lead to improved pregnancy outcomes and support the potential role of the HEI for further exploring these relationships in future research.

Obesity during Pregnancy and SARS-CoV-2/COVID-19-Case Series of the Registry Study “COVID-19 Related Obstetric and Neonatal Outcome Study” (CRONOS-Network)

(1) Background: Obesity is an increasing challenge in the care of pregnant women. The aim of our study was to investigate whether obesity is an independent risk factor for severe maternal and neonatal outcomes in pregnant women with COVID-19. (2) Methods: Data from the COVID-19 Related Obstetric and Neonatal Outcome Study (CRONOS), a prospective multicenter registry for SARS-CoV-2 positive pregnant women, was used to analyze the effect of obesity on selected individual and combined outcome parameters (3) Results: With 20.1%, the prevalence of obesity in the CRONOS registry exceeds the German background rate of 17.5%. Obese women showed significantly higher rates of GDM (20.4% vs. 7.6%; p < 0.001), hypertensive pregnancy disorders (6.2% vs. 2%; p = 0.004) and C-sections (50% vs. 34.5%; p < 0.001). BMI was revealed to be an individual risk factor for the severe combined pregnancy outcome (maternal death, stillbirth or preterm birth < 32 weeks) (OR 1.050, CI 1.005-1.097). (4) Conclusions: Maternal BMI is a predictor for the most severe outcome as maternal or neonatal death and preterm delivery <32 weeks of gestation. Unexpectedly, categorized obesity seems to have limited independent influence on the course and outcome of pregnancies with COVID infections.

One-step versus two-step screening for diagnosis of gestational diabetes mellitus in Iranian population: A randomized community trial.

There is considerable worldwide controversy regarding optimal screening and diagnostic approaches for GDM. This study aimed to compare the prevalence, maternal and neonatal outcomes of a One-step with a Two-step approach for the screening and diagnosis of GDM in a large community sample of pregnant women. We conducted a secondary analysis of a randomized community non-inferiority trial of GDM screening in Iran. For the current study, all pregnant women who met the inclusion criteria were randomized into two groups for GDM screening. The first group of women (n = 14611) was screened by a One-step screening approach [75-g 2-h oral glucose tolerance test (OGTT)] and the second group (n = 14160) by a Two-step method (the 50-g glucose challenge test followed by the 100-g OGTT). All study participants were followed up until delivery, and the adverse maternal and neonatal outcomes were recorded in detail. GDM was diagnosed in 9.3% of the pregnant women who were assigned to the One-step and in 5.4% of those assigned to the Two-step approach with a statistically significant difference between them (p < 0.001). Intention-to-treat analyses showed no significant differences between the One-step and the Two-step group in the unadjusted risks of the adverse pregnancy outcomes of macrosomia, primary cesarean-section, preterm birth, hypoglycemia, hypocalcemia, hyperbilirubinemia, preeclampsia, neonatal intensive care unit admission, birth trauma, low birth weight, and intrauterine fetal death. Results remained unchanged after adjustment for potential confounder variables including gestational age at enrollment and delivery, maternal body mass index, gestational weight gain, type of delivery, treatment modality, and GDM diagnosis in the first trimester. We found that although the rates of GDM more than doubled with the One-step strategy, the One-step approach was similar to the Two-step approach in terms of maternal and neonatal outcomes. These findings may warn that more caution should be exercised in adopting the One-step method worldwide. Future research is needed to assess the long-term harm and benefits of those approaches to GDM screening for both mothers and their offspring. https://www.irct.ir/trial/518, identifier (IRCT138707081281N1).

PS-P11-8: GESTATIONAL DIABETES MELLITUS AS A PREDICTOR OF TYPE 2 DIABETES MELLITUS: CARDIOVASCULAR RISK FACTORS AND BIOLOGICAL MARKERS IN KAZAKH WOMEN

Aim: To study the prevalence of gestational diabetes mellitus in the regions of the Republic of Kazakhstan, cardiovascular risk factors and biological markers in women of the Kazakh population Design and method: Analysis of the prevalence of gestational diabetes mellitus was carried out according to the data of the medical information systems “Diabetes mellitus” and “Register of pregnant women and women of childbearing age”. Results: Analysis of the primary incidence of DM2 among adults, within 5 years there has been a steady increase, while women with type 2 diabetes are much more - 65.5%. The increase in cases of type 2 diabetes was 140 thousand cases (46%), and among women over this period - 85 thousand cases (41%). At the same time, an analysis of the prevalence of type 1 diabetes indicates that there is no gender difference in this type of diabetes mellitus, the number of women left 47.3%. The increase since 2016 was 34.2%, among women 29.5%. The increase DM2 among women of childbearing age is 58.3%, which is significantly higher than in women of all age groups (41%). DM1 increase was 37.4%. Analysis of the prevalence of GDM according to the statistical data of the “Register of pregnant women and women of childbearing age” showed differences in frequency across the regions of Kazakhstan (from 4.0% to 11.0%). At the same time, in 2021 alone, the growth in GDM amounted to about 50% compared to 2020. Abdominal obesity was found in more than 50% of patients with GDM (the highest rate in the Almaty region, the lowest in Aktobe). The prevalence of hypertension among women with GDM is also lower in Aktobe region. An analysis of the prevalence of behavioral risk factors for CVD showed that the largest number of smokers was in Almaty and Almaty region. To study gene polymorphism, GWAS-associated SNPs polymorphisms with the development of GDM were selected: genes for impaired insulin synthesis and those associated with insulin signal transmission; genes for impaired insulin secretion; genes that regulate carbohydrate and lipid metabolism. Conclusion: The results of the analysis demonstrate high prevalence rates of GDM and DM 2. among women in the studied regions, including women of childbearing age, and high variability between regions.There is a need to standardize approaches to screening for GDM. Abdominal obesity and hypertension are the leading risk factors for the development of GDM.

Gestational diabetes prevalence and outcomes in women undergoing assisted reproductive techniques (ART)

Infertility affects millions worldwide and use of assisted reproductive techniques (ART) is in high demand. AimsTo investigate whether women that underwent ART at our hospital had a higher incidence of GDM than women who conceived spontaneously, if the ART subtype affects the GDM rate and to study obstetrical outcomes in women with GDM in both groups. MethodsThis was a retrospective analysis of prospectively collected data of singleton pregnancies attended at Hospital Universitari Dexeus between 2008 and 2019. Age<18 years, pregestational diabetes, metformin prior to pregnancy and multiple pregnancies were excluded. ResultsA total of 29,529 patients were included. Pregnancy was achieved by ART in 2596 (8.8%): in vitro fertilisation (IVF/ICSI) 32.8%, frozen embryo transfer (FET) 37.7%, oocyte donor receptors (ODR) 17.2% and insemination 12.2%. The GDM rate was 8.9% (12.7% in ART vs 8.5% in non-ART, p<0.001). The GDM was 11.2% in IVF/ICSI, 17.7% in ODR, 13% in FET and 9.1% in the insemination group (p=0.001). In a multivariable analysis adjusting for age, parity and BMI, ART was not associated with GDM [OR 1.03 (0.90–1.19)], nor was type of ART. Pregnancy outcomes in GDM patients were similar in both groups except for C-section rates (30.0% in ART vs 15.9% in non-ART (p<0.001). ConclusionsDespite a higher prevalence of GDM in ART pregnancies, ART was not associated with an increased risk of GDM when adjusting for age, parity and BMI. The prognosis of GDM in ART and non-ART was similar except for C-section rates.

A randomized controlled trial of a shared decision making intervention for diabetes prevention for women with a history of gestational diabetes mellitus: The Gestational diabetes Risk Attenuation for New Diabetes (GRAND study)

BackgroundGestational diabetes mellitus (GDM) is a risk factor for the development of type 2 diabetes. Metformin and lifestyle change through a Diabetes Prevention Program (DPP) are equally effective in preventing diabetes in patients with a GDM history, so women can choose a strategy based on their preferences. This study aims to test whether shared decision making (SDM) can help women with a history of GDM increase adoption of evidence-based strategies and lose weight to lower their risk of incident diabetes in real-world settings. MethodsThis pragmatic randomized controlled trial (RCT) will test the effectiveness of SDM for diabetes prevention among 310 overweight/obese women with a history of GDM and prediabetes from two large health care systems (n = 155 from UCLA Health and n = 155 from Intermountain Healthcare). The primary outcome is the proportion of participants who lose ≥5% body weight at 12 months. Secondary outcomes include uptake of DPP and/or metformin and other patient-reported outcomes such as patient activation and health-related quality of life. Rates of GDM in a subsequent pregnancy will be an exploratory outcome. A descriptive analysis of costs related to SDM implementation will also be conducted. ConclusionThis is the first RCT to examine the effectiveness of SDM on weight loss, lifestyle change and/or metformin use, and other patient-reported outcomes in participants with a GDM history at risk of developing diabetes.Trial registration: ClinicalTrials.gov, NCT03766256. Registered on 6 December 2018.

Abstract 12316: Association of State Medicaid Expansion With Incidence of Gestational Diabetes Mellitus Among Nulliparous Individuals in the US, 2012-2019

Introduction: The frequency of GDM and pregnancy-related complications of GDM are increasing in the United States. Detection and treatment are important to manage GDM and reduce the risk of pregnancy-related complications. The objective of this analysis was to assess whether expanding Medicaid, a state-level policy change that enhances access to care, was associated with changes in rates of GDM and outcomes among those with GDM. Methods: Data from nulliparous individuals aged 20-44 years with a first live birth from 30 states between 2012-2019 were included from the National Center for Health Statistics. The primary outcome, age-standardized incidence of GDM, was compared between Medicaid expansion states (N=16) and Medicaid non-expansion states (N=14) using a quasi-experimental analysis with difference-in-differences (DID) models. DID models utilized multivariate linear regression with random intercepts for state (to adjust for unobserved state-level fixed effects), fixed effect for year, and adjustment for state-level covariates including demographics, and health and economic indicators. Secondary outcomes included GDM complicated by preterm birth (≤36 weeks) and high (&gt;4000 grams) or low (&lt;2500 grams) birthweight infants. Results: Among 7,502,838 individuals, age-standardized rates of GDM increased in both Medicaid expansion (49.3 to 56.8 per 1000 births) and non-expansion states (48.6 to 52.7 per 1000 births). Expansion status was associated with a greater increase in rates of GDM (DID +4.32 [95% CI, +1.73 to +6.92] per 1000 births; Figure). Among individuals with GDM, rates of having a preterm birth or a high or low birthweight infant were not significantly different in expansion relative to nonexpansion states. Conclusions: Between 2012-2019, states that expanded Medicaid had a significantly greater increase in incidence of GDM. However, among those with GDM, rates of preterm birth and high or low birthweight did not differ by expansion status.

Periconceptional diet quality is associated with gestational diabetes risk and glucose concentrations among nulliparous gravidas.

BackgroundGestational diabetes mellitus (GDM) and elevated glucose concentrations below the threshold for GDM diagnosis have been associated with adverse pregnancy and offspring outcomes. Dietary interventions initiated during pregnancy have demonstrated inconsistent beneficial effects. Limited data exist regarding the effects of periconceptional diet on gestational glycemia.ObjectiveTo evaluate independent associations between periconceptional diet quality with GDM frequency and glucose concentrations from GDM screening and diagnostic tests among nulliparous gravidas.DesignThis is a secondary analysis of N=7997 participants from the NuMoM2b multicenter, prospective, observational cohort study of first pregnancies. The Alternative Healthy Eating Index (AHEI)-2010 was computed from food frequency questionnaires completed in early pregnancy (6-13 weeks), reporting usual dietary intake over the preceding 3 months. GDM screening was performed either by non-fasting 1-hour 50g glucose load (N=6845), followed by 3-hour 100g glucose tolerance test (GTT) for those with raised glucose concentrations (N=1116; at risk for GDM), or by a single 2-hour 75g GTT (N=569; all GDM risk levels). Logistic and linear regression were used to estimate the associations between the AHEI-2010 score with odds of GDM, having raised blood glucose on the 1-hour screening test, and continuous glucose concentrations on screening and diagnostic tests. All models were adjusted for a priori covariates: maternal age, race/ethnicity, early-pregnancy body mass index, smoking habits, rate of gestational weight gain, energy intake, nausea and vomiting in early pregnancy, study site.ResultsPoorer periconceptional diet quality was observed among participants who were younger, with higher BMI, lower income levels, and of non-Hispanic Black or Hispanic ethnicity. The GDM rate was 4%. Each 1-point increase in AHEI-2010 score was associated with a 1% decrease in the odds of being diagnosed with GDM (beta=-0.015, p=0.022, OR=0.986, 95% CI 0.973 to 0.998). Diet quality was inversely associated with each post glucose load concentration on the non-fasting screening test and the 2-hour and 3-hour GTT.ConclusionPoor periconceptional diet quality is independently associated with an increased risk of GDM and with minor elevations in serum glucose concentrations on GDM screening and diagnostic tests, in a diverse cohort of nulliparas. Periconception intervention studies targeting diet quality are warranted.

Incidence and risk factors of gestational diabetes mellitus in Goba town, Southeast Ethiopia: a prospective cohort study

ObjectiveGestational diabetes mellitus (GDM) is becoming a public health concern in low/middle-income countries, and is known to cause severe morbidity and mortality for mothers and newborns. However, evidence reported for...