Different strategies for diagnosing gestational diabetes to improve maternal and infant health

Farrar, Diane; Duley, Lelia; Dowswell, Therese; Lawlor, Debbie A.

doi:10.1002/14651858.cd007122.pub4

Cited by 89 publications

(48 citation statements)

References 74 publications

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“…In our sample, 2.8% of cases and 5.1% of controls were diagnosed with GDM. Although prevalence proportions vary greatly between populations, proportions of ≥5% are usual, suggesting potential under‐diagnosis. This would correspond with findings from the 2015 UK Confidential Enquiry into Term Antepartum Stillbirths .…”

Section: Discussionmentioning

confidence: 99%

Gestational diabetes and the risk of late stillbirth: a case–control study from England, UK

Stacey

Tennant

McCowan

et al. 2019

BJOG

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Objective To explore the separate effects of being ‘at risk’ of gestational diabetes mellitus (GDM) and screening for GDM, and of raised fasting plasma glucose (FPG) and clinical diagnosis of GDM, on the risk of late stillbirth. Design Prospective case–control study. Setting Forty‐one maternity units in the UK. Population Women who had a stillbirth ≥28 weeks of gestation (n = 291) and women with an ongoing pregnancy at the time of interview (n = 733). Methods Causal mediation analysis explored the joint effects of (i) ‘at risk’ of GDM and screening for GDM and (ii) raised FPG (≥5.6 mmol/l) and clinical diagnosis of GDM on the risks of late stillbirth. Adjusted odds ratios (aOR) were estimated by logistic regression adjusted for confounders identified by directed acyclic graphs. Main outcome measures Screening for GDM and FPG levels Results Women ‘at risk’ of GDM, but not screened, experienced 44% greater risk of late stillbirth than those not ‘at risk’ (aOR 1.44, 95% CI 1.01–2.06). Women ‘at risk’ of GDM who were screened experienced no such increase (aOR 0.98, 95% CI 0.70–1.36). Women with raised FPG not diagnosed with GDM experienced four‐fold greater risk of late stillbirth than women with normal FPG (aOR 4.22, 95% CI 1.04–17.02). Women with raised FPG who were diagnosed with GDM experienced no such increase (aOR 1.10, 95% CI 0.31–3.91). Conclusions Optimal screening and diagnosis of GDM mitigate the higher risks of late stillbirth in women ‘at risk’ of GDM and/or with raised FPG. Failure to diagnose GDM leaves women with raised FPG exposed to avoidable risk of late stillbirth. Tweetable abstract Risk of #stillbirth in gestational diabetes is mitigated by effective screening and diagnosis.

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Section: Discussionmentioning

confidence: 99%

Gestational diabetes and the risk of late stillbirth: a case–control study from England, UK

Stacey

Tennant

McCowan

et al. 2019

BJOG

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“…Hyperglycemia in pregnancy is associated with adverse perinatal outcomes and increases long‐term risks for both mother and child . Despite investigations into other screening and diagnostic tests, the 75‐g 2‐hour oral glucose tolerance test (OGTT) remains the cornerstone of diagnosis . Furthermore, there is a shift away from conducting traditional risk‐factor‐based screening among high‐risk women only to universal screening for GDM among all pregnant women …”

Section: Introductionmentioning

confidence: 99%

Evaluating the utility of a point‐of‐care glucometer for the diagnosis of gestational diabetes

Adam

Rheeder

2017

Intl J Gynecology & Obste

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“…Gestational Diabetes mellitus (GDM) is referred to as having various degrees of glucose intolerance with onset or recognition during pregnancy. [1][2][3][4] 1-14% of all pregnancies are accompanied with GDM, inducing short-and long-term maternal and prenatal complications. 1,5 During natural pregnancy, Insulin resistance increases parallel with the rise in oxidative stress.…”

Section: Introductionmentioning

confidence: 99%

<p>The Predictive Value of Selenium in Diagnosis of Gestational Diabetes: A Nested Case-Control Study</p>

Moshfeghy¹,

Bashiri²,

Dabbaghmanesh³

et al. 2020

IJGM

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The present study was conducted to determine the predictive value of Selenium (Se) in the diagnosis of Geatational diabetes Mellitus (GDM). Methods: This is a nested case-control study with 636 normal pregnant mothers in their 11th-13th weeks. Gestational diabetes screening was done in weeks 24-28. Twenty-five individuals were detected as GDM, and for every GDM two gestational age-matched normal pregnant women were selected. The blood selenium level was measured in both groups. Results: The serum Se level in the case group was lower than that of the control group (50.60 ± 10.88 versus 66.02 ± 10.57) in the first trimester. Also, in the second trimester, Se was lower in the case group (39.87 ± 10.23 versus 63.17 ± 10.22). The best cutoff point for selenium in order to predict the incidence of gestational diabetes in our study was 48.2. Pregnant women with selenium levels below 48.2 were more likely to develop gestational diabetes. Conclusion: Serum selenium was lower in the GDM subjects compared with age-matched control group; the clinical concept and mechanism of this finding need to be investigated through further studies.

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Different strategies for diagnosing gestational diabetes to improve maternal and infant health

Abstract: There is insufficient evidence to suggest which strategy is best for diagnosing GDM. Large randomised trials are required to establish the best strategy for correctly identifying women with GDM.

Cited by 89 publications

References 74 publications

Gestational diabetes and the risk of late stillbirth: a case–control study from England, UK

Gestational diabetes and the risk of late stillbirth: a case–control study from England, UK

Evaluating the utility of a point‐of‐care glucometer for the diagnosis of gestational diabetes

<p>The Predictive Value of Selenium in Diagnosis of Gestational Diabetes: A Nested Case-Control Study</p>

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