Rates Of Gestational Diabetes Mellitus Research Articles

A comparative study of efficacy of DIPSI and O’Sullivan’s method of screening for GDM in a high risk tertiary referral hospital

There is an increasing trend of making Diabetes one of the most common non-communicable diseases globally. Gestational Diabetes Mellitus (GDM) is defined as “carbohydrate intolerance variable severity that is first diagnosed during present pregnancy, regardless of the need for insulin or persistence of the diabetic state after delivery”. Diabetes Mellitus is the most common disorder of pregnancy, although the prevalence is usually reported as 2 to 5% of pregnant women, it can be as high as 14% in high risk groups. To note the Foetal Outcome of pregnancy with impaired and abnormal glucose tolerance detected with DIPSI.Total of 200 patients was included in the study from Vanivilas hospital for 1 year. A detailed history from antenatal patients was taken to reveal all risk factors. The procedure of the study was explained and required consent for the study was taken. Examination of the patients was done and all relevant data was obtained. Fasting blood glucose was taken of all antenatal patients at their first visit. Pregnant women at 24-28 weeks were tested with 50g oral glucose load or 75g oral glucose load, at random. Patients were give 50g glucose irrespective of the meal and 1 hour venous blood sample was collected. Patients of 75 g of oral glucose were asked to come in fasting state, 75g of glucose was given, and following which 2 hour venous sample was collected. Blood glucose was tested by GOD-POD method. Diagnosis of GDM was made when the plasma glucose of >140mg/dL and impaired glucose tolerance diagnosis was made when plasma glucose was between 120-140mg/dl. High prevalence rate of GDM was obtained in our study, GDM has adverse maternal and fetal outcome. GDM when identification early and treatment initiated for mothers, maternal and fetal complications can be reduced. In conclusion, intensive care of GDM mothers can help primary prevention of obesity, impaired glucose tolerance and diabetes in the offspring.

465-P: Applying the Ancestral Knowledge System Framework to Interviews with Key Stakeholders Regarding a Gestational Diabetes Mellitus Risk Reduction and Reproductive Health Planning Program for American Indian Adolescent Females

Gestational Diabetes Mellitus (GDM) is the most common complication of pregnancy and potentially causes problemsfor both mother and baby, including risks of developing type 2 diabetes (T2D). Compared to other Americans, Indigenous youth have more risk factors and higher rates of GDM. We developed Stopping GDM a GDM risk reduction and reproductive health program for American Indian adolescent females. To further deepen the cultural strengths of the program we draw on constructs from Indigenous ways of knowing, such as Ancestral Knowledge System (AKS). We conducted a secondary analysis on an existing qualitative dataset collected during the Stopping GDM study using AKS as a secondary framework. Key constructs from AKS include: relationships, place-based knowledge, generational networks, holistic approaches, language, cultural heritage, and critical reflection. This dataset includes focus groups with AI adolescent girls (age 12-20) (n=13); their adult female caregivers (n=9); and AI women with a history of GDM or T2D (n=5) from two urban sites. All focus groups were moderated by a trained qualitative researcher with a notetaker and semi-structured moderator guide and analyzed using Atlas.ti. Four primary themes supported by the AKS framework constructs emerged: 1) the important and unique role of women in Native communities; 2) traditional ways as they relate to women, reproductive health, and wellness; 3) support for women’s wellness and reproduction; 4) social determinants as challenges for Indigenous communities in promoting healthy behaviors. These findings will be used to support expansion of Stopping GDM to increase its cultural relevance for a broader Indigenous priority audience which includes Native Hawaiian and Alaska Native communities. Disclosure D. Charron-prochownik: None. R. Soon: None. S. A. Stotz: None. A. F. Fischl: None. K. L. Gonzales: None. M. Mau: None. K. R. Moore: None. Funding National Institutes of Health (UL1TR001857 to D.C-P.); National Institute of Nursing Research (1R01NR014831-01A1 to D.C-P., K.R.M.)

Maternal cardiac function at 19-23 weeks' gestation in prediction of gestational diabetes mellitus.

To examine differences in maternal cardiovascular indices at 19-23 weeks' gestation between pregnancies that develop gestational diabetes mellitus (GDM) and those without GDM, and to determine whether such cardiovascular changes are the consequence of maternal demographic characteristics and medical history or GDM per se. This was a prospective observational study in women attending for a routine hospital visit at 19 + 1 to 23 + 3 weeks' gestation. This visit included recording of maternal demographic characteristics and medical history, and maternal echocardiography for assessment of E/A ratio, E/e' ratio, myocardial performance index, global longitudinal systolic strain, left ventricular ejection fraction, peripheral vascular resistance, left ventricular cardiac output and left ventricular mass indexed for body surface area. The measurements of the maternal cardiac indices were standardized to remove the effects of maternal characteristics and elements from the medical history, and the adjusted values in the GDM group were compared to those in the non-GDM group. Likelihood ratios were derived for those indices that were altered significantly in GDM, and these were used to modify the prior risk derived from maternal demographic characteristics and medical history. The area under the receiver-operating-characteristics curve and the detection rate of GDM, at 10%, 20% and 40% false-positive rates, in screening by a combination of maternal factors with cardiovascular indices were determined. The study population of 2853 pregnancies contained 199 (7.0%) that developed GDM. In pregnancies that developed GDM, there were significant differences from the non-GDM group in E/A ratio, E/e' ratio, myocardial performance index and global longitudinal systolic strain. After adjustment for maternal demographic characteristics and factors from the medical history known to affect cardiac indices, the only cardiovascular indices that were significantly different between the GDM and non-GDM groups were peripheral vascular resistance and myocardial performance index, both of which were marginally increased in the GDM group. The performance of screening for GDM by maternal demographic characteristics and medical history was not improved by the addition of cardiovascular indices. Women with GDM have subtle functional and hemodynamic cardiac changes prior to the development of GDM. These cardiac changes are mostly related to the adverse risk-factor profile of these women. Maternal cardiac assessment at 20 weeks does not offer additional predictive information for GDM development in pregnancy to that calculated based on demographic characteristics and medical history. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

Effectiveness and acceptability of myoinositol in prevention of gestational diabetes mellitus: A protocol for systematic review and meta-analysis.

Background:The existing meta-analyses and randomized studies on myoinositol are of poor quality, with small sample sizes, and involve a homogeneous population. The general applicability of these findings to the National Health Service is unclear. We thus conduct this new high-quality systematic review and meta-analysis to assess the efficacy and safety of myoinositol in pregnant woman.Methods:The study protocol will be developed and executed in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. All of the following inclusion criteria in the PICOS order will be met by the studies included in our meta-analysis:1.population: pregnant woman without gestational diabetes mellitus (GDM);2.intervention: group with myoinositol;3.comparison intervention: group without myoinositol;4.outcome measures: at least one of the following outcome measures should to be reported: rate of GDM, offspring birthweight, fasting glucose, oral glucose tolerance test, and the side effects associated with the myoinositol; and5.study design: English randomized trials.The following electronic databases will be searched: PubMed, Scopus, EMBASE, and Cochrane Library databases. The Cochrane risk of bias tool will be used to evaluate the risk of bias of the included randomized trials by 2 independent reviewers.Results:We will perform a meta-analysis using standard techniques for the outcomes.Conclusions:It was hypothesized that myoinositol supplementation could increase the action of endogenous insulin and prevent GDM and its complications.Trial registration:10.17605/OSF.IO/9W8DV.

Frequency of ABO Blood Group in Pregnant Women and Its Correlation With Pregnancy-Related Complications

IntroductionThe ABO blood group type has been considered an independent risk factor in the occurrence of pregnancy-related complications leading to significant morbidity and mortality in pregnant mothers and neonates. This study aims to determine the maternal ABO blood group and its correlation with pregnancy-related complications.MethodsWe analysed data of 497 pregnant female patients aged between 25 and 40 years who presented with a gestational age of > 14 weeks from June 1, 2020, to November 30, 2020. Patients’ age, parity, gestational age at the first visit, body mass index (BMI) at the first visit, ABO blood group, gestational age at delivery, mode of delivery, birth weight of neonate, and pregnancy-related complications including preeclampsia, gestational diabetes mellitus (GDM), preterm delivery, low birth weight (LBW), and small for gestational age (SGA) infants were evaluated.ResultsThe mean age of 497 patients was 27.6 (27.62 ± 3.35) years. Mean BMI was 22.7 (22.7 ± 3.1 kg/m2), parity was 1.85 (1.85 ± 2.3), gestational age at first visit was 23.19 (23.19 ± 3.4) weeks and gestational age at delivery was 37.0 (37.0 ± 2.6) weeks. There were 205 (41.25%) spontaneous vaginal delivery and 292 (58.75%) cesarean sections. The average birth weight of the neonate was 2684.31 ± 622.4 g. Preeclampsia was observed in 107 (21.53%), GDM in 17 (3.42%), and preterm delivery in 154 (30.99%) women. Considering the neonatal outcome, 124 (24.95%) babies had LBW and 49 (9.86%) were SGA. The rate of preeclampsia and GDM was not statistically significant among different blood groups while the rate of preterm delivery, LBW, and SGA was significant among women with different blood groups.ConclusionWe conclude that the ABO blood group is associated with maternal and neonatal pregnancy-related complications when considering the risk of preterm delivery, LBW, and SGA but not with GDM and preeclampsia. This finding will help clinicians to identify the patients at risk of developing pregnancy-related complications and hence, to take timely and appropriate measures.

A Smartphone App to Restore Optimal Weight (SPAROW) in Women With Recent Gestational Diabetes Mellitus: Randomized Controlled Trial.

BackgroundWomen with a history of gestational diabetes mellitus (GDM) are at an increased risk of developing type 2 diabetes mellitus (T2DM). Lifestyle interventions aimed at postpartum weight loss to reduce T2DM risk have been reported, but poor compliance remains a barrier. Smartphone-based interventions may improve compliance, but data on its use in women with recent GDM are limited.ObjectiveThis trial aimed to investigate the efficacy of a smartphone app in restoring optimal weight following delivery in women with GDM, in the setting of a population with high rates of GDM and type 2 diabetes.MethodsIn this unblinded randomized controlled trial, 200 women with GDM were randomized to receive the intervention or standard care following delivery. The intervention enabled logging of weight, meals, and activity, with web-based interaction with a team comprising dieticians, a physiotherapist, and an occupational therapist. The primary outcome was an achievement of optimal weight (defined as the restoration of first trimester weight if first trimester BMI≤23 kg/m2 or weight loss of at least 5% from first trimester weight if first trimester BMI>23 kg/m2) at 4 months post partum. Secondary outcome measures included absolute weight loss, serum metabolic markers, self-reported nutritional intake, health education, and quality of life via questionnaires and user engagement in the intervention group.ResultsIn total, 40% (38/96) of women in the intervention group achieved optimal weight at 4 months post delivery compared with 32% (28/93) in the control group (P=.27). Compared with the control group, women in the intervention group reported significantly reduced caloric intake at 4 months after delivery (P<.001) and higher health-directed behavior scores (P=.045). The intervention group also reported increased emotional distress scores (P=.01). At 4 months, participant engagement with the intervention was maintained at 60.8% (SD 33.9%).ConclusionsAlthough a statistically significant increase in women achieving healthy weight was not observed, this app remains promising, as women in the intervention group reported improved health behaviors and lower caloric intake. Importantly, the high retention rates suggest that a larger study with a longer follow-up period might confirm the effectiveness of this app for weight management.Trial RegistrationClinicalTrials.gov NCT03324737; https://clinicaltrials.gov/ct2/show/NCT03324737International Registered Report Identifier (IRRID)RR2-10.1186/s12889-019-7691-3

LncRNA SNHG17 is Downregulated in Gestational Diabetes Mellitus (GDM) and Has Predictive Values.

AimLong non-coding RNA (lncRNA) SNHG17 has been shown to participate in type 2 diabetes mellitus, while its role in gestational diabetes mellitus (GDM) is unknown.MethodsQuantitative real-time PCR (qRT-PCR) assays were conducted to compare the differential expression of SNHG17 among 60 GDM patients and 60 healthy pregnant female controls. In addition, peripheral blood samples from 240 pregnant females were collected to evaluate the predictive value of SNHG17 for GDM patients. All females were followed-up until delivery to record the occurrence of GDM and perinatal outcomes. GDM-free curves were plotted to compare the occurrence of GDM between high- and low- SNHG17 expression groups. The diagnostic value of plasma SNHG17 for GDM was analyzed by ROC curve analysis. Moreover, the cell counting kit (CCK-8) assay was performed to evaluate the impact of SNHG17 on cell viability of INS-1, and the level of insulin secretion was detected by enzyme linked immunosorbent assay (ELISA) after overexpression or knockdown of SNHG17.ResultsSNHG17 was downregulated in GDM patients compared to normal pregnant females. Low plasma expression levels of SNHG17 were closely correlated with the high incidence rate of GDM (GDM-free curve). Remarkably, plasma expression levels of SNHG17 at 4 weeks before the diagnosis of GDM (diagnosed by standard method) can be used to distinguish (ROC curve) GDM patients (diagnosed during follow-up) from normal pregnant females (GDM was not diagnosed during follow-up).ConclusionPlasma circulating SNHG17 is downregulated in GDM and has predictive values.

Predictors of recurrent gestational diabetes mellitus: A Japanese multicenter cohort study and literature review.

To clarify whether maternal characteristics or laboratory parameters could help predict the onset of recurrent gestational diabetes mellitus (GDM). We enrolled 615 women with consecutive singleton deliveries at or after 28 GW from two perinatal medical centers between 2011 and 2019 and divided them into four groups according to whether they had GDM in the first and second pregnancies. The outcome of this study was to clarify the incidence and the predictors of recurrent GDM. We found that among 72 women (11.7%) who had GDM during their first pregnancy, the rate of recurrent GDM was 47.2%. The 34 women (5.5%) with recurrent GDM gained significantly less weight in the first and second pregnancies and lost less weight between the first delivery and the second conception compared with those women without GDM in both pregnancies. Of women with GDM during the first pregnancy, 21 scored 2 or 3 (multiple) positive points on a 75-g oral glucose tolerance test (OGTT) during their first pregnancies; the GDM recurrence rate among these women (66.7%) was significantly higher than that among the 51 women who scored 1 positive point (39.2%; p = 0.0411). During the first pregnancy, insulin administration therapy was significantly more frequent in women with recurrent GDM than in women without recurrent GDM (23.5% vs. 5.3%, p = 0.0396, respectively). A predictor of recurrent GDM onset was a score of 2 or 3 positive points on the OGTT during the first pregnancy.

Association between thyroid function and risk of gestational diabetes mellitus in assisted pregnancies: A retrospective cohort study

AimsTo explore the association between thyroid function and gestational diabetes mellitus (GDM) risk in assisted pregnancies. MethodsWe screened 57,386 pregnant women treated from February 2013 to October 2017, and 2211 patients were retrospectively enrolled, and their data were analyzed based on quintile groups constituted based on serum thyroid-stimulating hormone (TSH), free thyroxine (FT4), and thyroid peroxidase antibody (TPOAb) levels. Odds ratios (ORs) of GDM were analyzed by multivariate logistic regression, adjusted for maternal age and pre-pregnancy body mass index (BMI). ResultsThe prevalence rate of GDM was 20.1%. Lower FT4 levels were associated with an increased risk of GDM (ORQ2 = 1.512, 95% confidence interval [CI] 1.073–2.132, p = 0.018; ORQ1 = 1.620, 95% CI 1.161–2.261, p = 0.005), but this association disappeared after adjustments. TPOAb+ titer was associated with an increased risk of GDM (aOR = 1.472, 95% CI 1.068–2.028, p = 0.018). Higher TSH (aORQ5 = 2.882, 95% CI 1.919–6.975, p = 0.019) or lower FT4 (aORQ1 = 3.156, 95% CI 1.088–9.115, p = 0.034) levels were associated with an increased risk of GDM in assisted pregnancies for TPOAb+ patients. ConclusionTPOAb+ is an independent risk factor for GDM in patients with assisted pregnancies. Higher TSH or lower FT4 levels, with TPOAb+ detection, are risk factors for GDM in assisted pregnancies.

Effect of a Mediterranean Diet-Based Nutritional Intervention on the Risk of Developing Gestational Diabetes Mellitus and Other Maternal-Fetal Adverse Events in Hispanic Women Residents in Spain.

Gestational diabetes mellitus (GDM) is the most frequent morbidity found in pregnancy, and it increases the risk for several maternal-fetal complications. Hispanic women are considered at high risk. The St. Carlos GDM prevention study is a randomized controlled trial (RCT) conducted from 2016–2017. Normoglycemic women were randomized at 12–14 Gestation week (WG) to an intervention group (IG) receiving recommendations based on the MedDiet (supplemented with ExtraVirgin Olive Oil/pistachios), or to a control group (CG), recommended to limit fat intake. After RCT conclusion, IG recommendations were applied to a real-world group (RW) in routine clinical practice. The primary endpoint of the current study is an assessment of the GDM rate in Hispanic participants of the aforementioned studies: 132 RCT, 128 CT, 284 RW participants. The GDM rate was lower in IG: 19/128(14.8%), p = 0.021, and RW: 38/284(13.4%), p = 0.029) than in CG: 34/132(25.8%). Adjusted RR (95%CI) for GDM: 0.72 (0.50–0.97), p = 0.037 in IG and 0.77 (0.61–0.97), p = 0.008 in RW. Rates of urinary tract infections, emergency caesarean-sections and perineal trauma were also lower in IG and RW. Other adverse outcomes were lower in IG vs. CG. In conclusion, a MedDiet-based intervention reduces the rate of GDM and several adverse maternal-fetal outcomes in Hispanic women residing in Spain.

Novel Associations of Early Pregnancy Vitamin B12 and Folate Levels with Gestational Diabetes: Results from a Large, Prospective, Multi-Ethnic UK Cohort (PRiDE Study)

Background: Women from certain ethnic groups are at higher risk of Gestational Diabetes Mellitus (GDM). While altered methylation potential due to low vitamin B12 and/or imbalance of B12 and folate levels may be potential contributing factors, there is conflicting evidence. Methods: In a prospective multi-ethnic UK cohort study (n=4746), maternal first trimester B12, folate and total homocysteine (tHcy) levels were measured, and GDM status was assessed at 26-28 weeks of gestation. Findings: GDM rates were 12·5% by NICE and 14·7% by International Association of Diabetes and Pregnancy Study Group (IADPSG) criteria. Early pregnancy median B12 levels were lower, and folate levels higher, in women who have diagnosed with GDM. B12 was negatively associated with fasting (FPG)(1-SD: -0·06mmol/l; p<0·0001) and 2-hour plasma glucose levels (2hr-PG)(-0·07mmol/l, p=0·004); associations were stronger in South Asians (FPG: -0·07mmol/l, p=0·001; 2hr-PG: -0·14mmol/l, p=0·02). Higher B12 was associated with lower odds of GDM [aOR(95%CI): NICE-GDM: 0·888(0·80,0·985), p=0·02; IADPSG-GDM: 0·838(0·758,0·927), p=0·0006]. Approximately half of this association was mediated through BMI. Folate was positively associated with 2hr-PG (0·08mmol/l, p=0·0005) but its relationship with FPG was U-shaped (quadratic b:0·011; p=0·05). Low B12-high folate combination was associated with higher glycaemia and risk of GDM. tHcy was inversely associated with glycaemia and GDM risk. Interpretation: Low B12 and high folate levels in early pregnancy were associated with subsequent hyperglycaemia but do not explain the higher risk of GDM in ethnic minority groups. There is a need to investigate the effect of optimising early pregnancy or pre-conception B12 and folate levels on subsequent hyperglycaemia. Trial Registration: (PRiDE) study (clinicaltrials.gov number: NCT03008824). Funding: Medical Research Council, UK (MR/94/1). Declaration of Interests: All authors declare no conflict of interest. Ethics Approval Statement: Ethical approval was obtained from the National Research Ethics Committee (12/WM/0010).

Intensive Approaches to Prenatal Care May Reduce Risk of Gestational Diabetes.

Objectives: To observe gestational diabetes mellitus (GDM) prevalence among participants receiving enhanced prenatal care through one of three care models: Birth Centers, Group Prenatal Care, and Maternity Care Homes. Materials and Methods: This study draws upon data collected from 2014 to 2017 as part of the Strong Start II evaluation and includes data from nearly 46,000 women enrolled across 27 awardees with more than 200 sites throughout the United States. Descriptive and statistical analyses utilized data from participant surveys completed upon entry to the program and a limited chart review. Results: A total of 6.3% of Strong Start participants developed GDM during their pregnancy. Rates varied significantly and substantially by model. After adjusting for participant risk factors, we find that Birth Center participants of all races and ethnicities experienced significantly lower rates of GDM than women of the same race/ethnicity in Maternity Care Homes. Conclusions: The lower rates of gestational diabetes among women receiving Birth Center prenatal care suggest the need for further investigation of how prenatal care approaches can reduce GDM and address health disparities.

LncRNA MEG8 is upregulated in gestational diabetes mellitus (GDM) and predicted kidney injury.

LncRNA MEG8 can be induced by high glucose, indicating the potential role of this lncRNA in high glucose-induced diseases, such as gestational diabetes mellitus (GDM). In this study, a 6-year follow-up was performed on 400 females who had a plan for pregnancy. It was observed that patients with high pre-pregnancy plasma level of MEG8 showed high incidence rate of GDM during pregnancy. The patients with GDM had significantly higher levels of MEG8 in plasma. Plasm levels of MEG8 at one month before the diagnosis of GDM was sufficient to distinguish GDM patients from healthy controls. In addition, this study revealed that GDM patients who had higher level of MEG8 (on the day of discharge) showed significantly higher incidence of kidney injury. Therefore, these results suggest that MEG8 is upregulated in GDM and predicted kidney injury.

The impact of revised diagnostic criteria on hospital trends in gestational diabetes mellitus rates in a high income country

ObjectiveIn 2010, national guidelines were published in Ireland recommending more sensitive criteria for the diagnosis of Gestational Diabetes Mellitus (GDM). The criteria were based on the 2008 Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) Study and were endorsed subsequently by the World Health Organization (WHO). Screening nationally is selective based on risk factors. We examined the impact of the new criteria on hospital trends nationally for GDM over the 10 years 2008–17.Research design and methodsData from three national databases, the Hospital Inpatient Enquiry System (HIPE), National Perinatal Reporting System (NPRS) and the Irish Maternity Indicator System (IMIS), were analyzed using descriptive statistics, analysis of variance, and Poisson loglinear modelling.ResultsThe overall incidence of GDM nationally increased almost five-fold from 3.1% in 2008 to 14.8% in 2017 (p ≤ 0.001). The incidence varied widely across maternity units. In 2008, the incidence varied from 0.4 to 5.9% and in 2017 it varied from 1.9 to 29.4%. There were increased obstetric interventions among women with GDM over the decade, specifically women with GDM having increased cesarean sections (CS) and induction of labor (IOL) (p ≤ 0.001). These trends were significant in large and mid-sized maternity hospitals (p ≤ 0.001). The increase in GDM diagnosis could not be explained by an increase in maternal age nationally over the decade. The data did not include information on other risk factors such as obesity. The increased incidence in GDM diagnosis was accompanied by a decrease in high birthweight ≥ 4.5 kg nationally.ConclusionsWe found adoption of the new criteria for diagnosis of GDM resulted in a major increase in the incidence of GDM rates. Inter-hospital variations increased over the decade, which may be explained by variations in the implementation of the new national guidelines in different maternity units. It is likely to escalate further as compliance with national guidelines improves at all maternity hospitals, with implications for provision and configuration of maternity services. We observed trends that may indicate improvements for women and their offspring, but more research is required to understand patterns of guideline implementation across hospitals and to demonstrate how increased GDM diagnosis will improve clinical outcomes.

Gestational diabetes mellitus among Sub-Saharan African and Surinamese women in the Netherlands

AimWe assessed the association between ethnicity and the risk of gestational diabetes mellitus (GDM) in the Netherlands. MethodsA cohort of 7815 women with known GDM status and ethnicity, including women of Sub-Saharan African ethnicity who are currently not identified as high-risk in guidelines. We compared GDM rates among participants of ethnicity to those of ethnic Dutch participants. We employed multivariable regression to correct for possible confounders, including maternal age, pre-pregnancy body mass index (BMI), and education. GDM prevalence and odds ratios based on ethnicity were the main outcome measures. ResultsThe prevalence rates of GDM according to ethnicity were: Dutch 0.6%, South-Asian Surinamese 6.9%, African-Surinamese 3.5%, Antillean 1.0%, Turkish 1.0%, Moroccan 1.4%, Ghanaian 6.8%, Sub-Saharan African 3.5%, other Western 0.5% and other non-Western 2.8%. After adjustment for age, pre-pregnancy BMI, and education duration, compared with the reference Dutch-ethnicity population, adjusted odds ratios (aOR) for GDM were statistically significantly higher in South-Asian Surinamese (aOR 10.9; 95% Confidence Interval (CI), 4.7–25.0), African-Surinamese (4.3; 2.0–9.2), Ghanaian (6.5; 3.0–14.5), Sub-Saharan African (5.7; 2.0–16.0), and other non-Western women (4.5; 2.2–9.0). GDM was not significantly increased among Antillean (1.4; 0.2–10.3), Turkish (1.4; 0.4–4.2), Moroccan (1.8; 0.8–4.0), and other Western women (0.8; 0.3–2.2). ConclusionsThis study shows for the first time in the Netherlands that women of Ghanaian or other Sub-Saharan African ethnicity have an increased risk of developing GDM than the Dutch. This calls for adaptation of the Dutch guidelines of screening high-risk groups for GDM and more awareness amongst obstetric caregivers.

Diabetes during pregnancy and birthweight trends among Aboriginal and non-Aboriginal people in the Northern Territory of Australia over 30 years

BackgroundEarly-life risk factors, including maternal hyperglycaemia and birthweight, are thought to contribute to the high burden of cardiometabolic disease experienced by Indigenous populations. We examined rates of pre-existing diabetes in pregnancy, gestational diabetes mellitus (GDM) and extremes of birthweight over three decades in the Northern Territory (NT) of Australia. MethodsWe performed a retrospective cohort analysis of the NT Perinatal Data Collection from 1987 to 2016, including all births >20 weeks gestation, stratified by maternal Aboriginal identification. Key outcomes were annual rates of pre-existing diabetes, GDM, small-for-gestational-age, large-for-gestational-age, low birthweight (<2500 g), and high birthweight (>4000 g). Logistic regression was used to assess trends and interactions. Findings109 349 babies were born to 64 877 mothers, 36% of whom identified as Aboriginal ethnicity. Among Aboriginal women, rates of GDM and pre-existing diabetes, respectively, were 3 · 4% and 0 · 6% in 1987 and rose to 13% and 5 · 7% in 2016 (both trends p<0 · 001). Among non-Aboriginal women, rates of GDM increased from 1 · 9% in 1987 to 11% in 2016 (p<0 · 001), while pre-existing diabetes was uncommon (≤0 · 7% throughout). Rates of small-for-gestational-age decreased, while rates of large-for-gestational-age and high birthweight increased in both groups (all trends p<0 · 001). Multivariable modelling suggests that hyperglycaemia was largely responsible for the growing rate of large-for-gestational-age births among Aboriginal women. InterpretationThe burden of hyperglycaemia in pregnancy has grown substantially in the NT over three decades and is impacting birthweight trends. The prevalence of pre-gestational diabetes in Aboriginal women is among the highest in the world. FundingDiabetes Australia Research Program.

High haemoglobin levels in early pregnancy and gestational diabetes mellitus among Sudanese women

A longitudinal study was carried out to investigate the prevalence and risk factors (including haemoglobin levels) for gestational diabetes mellitus (GDM) in Khartoum, Sudan. The study was carried out at Saad Abuelela Hospital (Khartoum, Sudan) during February to November 2017. Pregnant women in early pregnancy (gestational age <14 weeks) were enrolled in the study. The detailed medical and obstetrics history was recorded for each participant using a questionnaire. The women were then followed up, where a 75-g oral glucose tolerance test was performed at 24 − 28 weeks of gestation. Of 290 women, 259 (89.3%) completed the follow-up. The mean (standard deviation [SD]) of the age, gravidity and gestational age at enrolment were 28.02 (5.7) years, 2.37 (2.42) and 10.86 (2.63) weeks, respectively. Forty-eight women (18.5%) had GDM. Binary regression showed that while age, parity, residence, education and body mass index (BMI) were not associated with GDM, a high haemoglobin level was the only factor associated with GDM (OR = 1.52, 95% confidence interval [CI] = 1.07 − 2.16, p = .019). Women with haemoglobin > 10.8 g/dl were at a higher risk of GDM (OR = 2.52, 95% CI = 1.02 − 6.27, p = .044). There is a high prevalence of GDM, especially among women with high haemoglobin levels. Impact statement What is already known on this subject? Gestational diabetes mellitus (GDM) is one of the most common complications during pregnancy, contributing significantly to maternal, perinatal morbidity and mortality and can lead to adverse consequences for the health of both mother and offspring later in life. The rate of GDM varies with the various settings and populations, and a prevalence of 1–14% has been reported depending on the population studied. High haemoglobin levels were recently reported to be associated with GDM. What do the results of this study add? There is a high prevalence of GDM in Khartoum, Sudan, especially among women with high haemoglobin levels in early pregnancy. What are the implications of these findings for clinical practice and/or further research? Haemoglobin levels could be used as reliable markers to detect GDM. These markers could be used in the prevention of GDM.

Prevalence of Gestational Diabetes in Triplet Pregnancies: A Retrospective Cohort Study and Meta-Analysis.

Background: Over the last decades, there has been a substantial increase in the incidence of higher-order multiple gestations. Twin pregnancies are associated with an increased risk of gestational diabetes mellitus (GDM). The literature on GDM rates in triplet pregnancies is scarce. Methods: A retrospective cohort study was performed to assess the prevalence of GDM in women with a triplet pregnancy. GDM was defined through an abnormal oral glucose tolerance test (OGTT). A meta-analysis of GDM prevalence was also carried out. Results: A cohort of 60 women was included in the analysis. Of these, 19 (31.7%) were diagnosed with GDM. There were no differences in pregnancy outcomes between women with and without GDM. In the meta-analysis of 12 studies, which used a sound GDM definition, an estimated pooled prevalence of 12.4% (95% confidence interval: 6.9–19.1%) was found. In a leave-one-out sensitivity analysis, the estimated GDM prevalence ranged from 10.7% to 14.1%. Conclusion: The rate of GDM seems increased in women with triplets compared to singleton pregnancies. However, GDM did not impact short-term pregnancy outcomes.

Influence of Socioeconomic Status on Adverse Outcomes in Pregnancy [15C

INTRODUCTION: Lower socioeconomic status (SES) has been associated with adverse pregnancy outcomes. We determined whether ZIP-code level-based SES indicator was associated with adverse pregnancy outcomes. METHODS: Retrospective study of OHSU births from 2009–2014 compared adverse pregnancy outcomes among women living in 88 Portland metro-area ZIP-codes stratified into 3 median household income groups: Low (below 10th percentile), medium (10th-90th percentile), and high (above 90th percentile) socioeconomic status (SES). Perinatal outcomes were compared by univariate analysis; multivariable logistical regression determined strength of association of low and high SES with adverse outcomes (medium SES=reference group), adjusting for significant variables. RESULTS: Of 8,118 deliveries included, 1,654 (20%) were in low SES, 5,856 (72%) were in medium SES, and 608 (8%) were in high SES. Women in low SES were more likely to be younger, have higher BMI and tobacco use, and have less private insurance. Lower SES was associated with higher rates of preeclampsia (PEC) (9.02% vs 7.48% vs 5.93%, P&lt;.028) and small for gestational age (SGA) (10.7% vs 9.34% v 6.61%, P&lt;.012), and lower birth weights (mean 3,280 g vs 3,340 g vs 3,592 g, P&lt;.001). High SES was associated with lower gestational diabetes mellitus (GDM) rates (10.8% vs 11.0% vs 7.58%, P&lt;.036), even after adjusting for confounders (aRR high SES 0.710, 95% CI 0.507–0.995). CONCLUSION: In the Portland metro-area, low SES is associated with higher rates of PEC and SGA. High SES is associated with lower rates of GDM. ZIP-code level SES indicator detects perinatal outcome differences and may be useful for identifying healthcare disparities.

The impact of educational attainment on the occurrence of gestational diabetes mellitus in two successive pregnancies of Finnish primiparous women: a population-based cohort study

AimsTo assess the impact of educational attainment on the occurrence and recurrence of gestational diabetes mellitus (GDM) in two successive pregnancies in primiparous women.MethodsThis is a population-based observational cohort study including all 2347 Finnish women without previously diagnosed diabetes, aged ≥ 20 years from the city of Vantaa, Finland, who gave birth to their first and second child between 2009 and 2015. National registries provided data on study participants. We divided the population into four groups according to the presence of GDM in the two pregnancies (GDM−/−, n = 1820; GDM−/+, n = 223; GDM+/−, n = 113; GDM+/+, n = 191).ResultsThe occurrence of GDM in the first pregnancy was 13.0% (n = 304) and 17.6% (n = 414) in the second. The recurrence rate of GDM was 62.8%. The four groups did not differ in relation to educational attainment (p = 0.11). In multinomial regression analysis, educational attainment protected from GDM in the second pregnancy [relative risk ratio 0.93 (95% confidence interval (CI) 0.86–0.99) per year of schooling for being GDM−/+ compared with GDM−/−]. In multivariate logistics models, prepregnancy body mass index at the first pregnancy [odds ratio (OR) 1.53 per 1-standard deviation (SD) (95% CI 1.22–1.91)], first-born birth weight z-score [OR 1.30 per 1-SD (95% CI 1.00–1.67)], and inter-pregnancy weight change [OR 1.66 per 1-SD (95% CI 1.27–2.16)], but not educational attainment, predicted recurrence of GDM.ConclusionsThe recurrence rate of GDM was high. Education protected from novel GDM in the second pregnancy, but was not associated with GDM recurrence.