Epidemiology of Diabetes in Pregnancy

Simmons, David

doi:10.1002/9781119043805.ch1

Cited by 14 publications

(11 citation statements)

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“…The rate of GDM in Sweden has been around 1–4% using the current screening and diagnostic criteria [ 10 , 20 – 22 ]. This will increase markedly if an OGTT using IADPSG criteria is offered to all pregnant women [ 23 ]. This will be a challenge to the health care system, and underlines the need for further evaluating screening methods in relation to outcomes.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of different risk factors and fasting plasma glucose for identifying GDM when using IADPSG criteria: a cross-sectional study

Saeedi

Hanson

Simmons

et al. 2018

BMC Pregnancy Childbirth

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BackgroundThe Swedish National Board of Health and Welfare (SNBHW) recommended the new diagnostic criteria for GDM based upon Hyperglycaemia and Adverse Pregnancy Outcomes (HAPO) study thresholds. Due to limited knowledge base, no recommendations were made on GDM screening. The aim of this study is to evaluate test characteristics of risk factors and fasting blood glucose as screening tests for diagnosing GDM using diagnostic thresholds based upon HAPO study 1.75/2.0 (model I/II respectively) odds ratio for adverse pregnancy outcomes.MethodsThis cross-sectional, population-based study included all pregnant women who attended maternal health care in Örebro County, Sweden between the years 1994–96. A 75 g OGTT with capillary fasting and 2-h blood glucose was offered to all pregnant women at week 28–32. Risk factors and repeated random glucose samples were collected. Sensitivity, specificity and predictive values of blood glucose were calculated.ResultsPrevalence of GDM was 11.7% with model I and 7.2% with the model II criteria. Risk factors showed 28%, (95% CI 24–32) and 31%, (95% CI 25–37) sensitivity for model I and II respectively. A fasting cut off ≥4.8 mmol/l occurred in 24% of women with 91%, (95% CI 88–94) sensitivity and 85%, (95% CI 83–86) specificity using model I while a fasting cut off ≥5.0 mmol/l occurred in 14% with 91%, (95% CI 87–94) sensitivity and 92%, (95% CI 91–93) specificity using model II.ConclusionRisk factor screening for GDM was found to be poorly predictive of GDM but fasting glucose of 4.8–5.0 mmol/l showed good test characteristics irrespective of diagnostic model and results in a low rate of OGTTs.

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Section: Discussionmentioning

confidence: 99%

Characteristics of different risk factors and fasting plasma glucose for identifying GDM when using IADPSG criteria: a cross-sectional study

Saeedi

Hanson

Simmons

et al. 2018

BMC Pregnancy Childbirth

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“…Women with type 1 and type 2 diabetes have a high risk of adverse pregnancy outcomes, especially when conception is unplanned [ 1 ]. Uncontrolled hyperglycaemia before and during pregnancy leads to adverse maternal and foetal outcomes [ 2 ]. Pre-pregnancy care (PPC) includes services aimed at managing glycaemia, education on diabetes complications in pregnancy, screening and treatment of diabetic complications, management of medications, and the supplementation of higher-dose folic acid required by women of reproductive age to ensure higher chances of an uncomplicated pregnancy [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Development of an integrated, district-wide approach to pre-pregnancy management for women with pre-existing diabetes in a multi-ethnic population

Sina

MacMillan

Dune

et al. 2018

BMC Pregnancy Childbirth

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BackgroundPoor diabetes management prior to conception, results in increased rates of fetal malformations and other adverse pregnancy outcomes. We describe the development of an integrated, pre-pregnancy management strategy to improve pregnancy outcomes among women of reproductive age with diabetes in a multi-ethnic district.MethodsThe strategy included (i) a narrative literature review of contraception and pre-pregnancy interventions for women with diabetes and development of a draft plan; (ii) a chart review of pregnancy outcomes (e.g. congenital malformations, neonatal hypoglycaemia and caesarean sections) among women with type 1 diabetes (T1D) (n = 53) and type 2 diabetes (T2D) (n = 46) between 2010 and 2015 (iii) interview surveys of women with T1D and T2D (n = 15), and local health care professionals (n = 13); (iv) two focus groups (n = 4) and one-to-one interviews with women with T1D and T2D from an Australian background (n = 5), women with T2D from cultural and linguistically diverse (CALD) (n = 7) and indigenous backgrounds (n = 1) and partners of CALD women (n = 3); and (v) two group meetings, one comprising predominantly primary care, and another comprising district-wide multidisciplinary inter-sectoral professionals, where components of the intervention strategy were finalised using a Delphi approach for development of the final plan.ResultsOur literature review showed that a range of interventions, particularly multifaceted educational programs for women and healthcare professionals, significantly increased contraception uptake, and reduced adverse outcomes of pregnancy (e.g. malformations and stillbirth). Our chart-review showed that local rates of adverse pregnancy outcomes were similarly poor among women with both T1D and T2D (e.g. major congenital malformations [9.1% vs 8.9%] and macrosomia [34.7% vs 24.4%]). Challenges included lack of knowledge among women and healthcare professionals relating to diabetes management and limited access to specialist pre-pregnancy care. Group meetings led to a consensus to develop a district-wide approach including healthcare professional and patient education and a structured approach to identification and optimisation of self-management, including contraception, in women of reproductive age with diabetes.ConclusionsSufficient evidence exists for consensus on a district-wide strategy to improve pre-pregnancy management among women with pre-existing diabetes.Electronic supplementary materialThe online version of this article (10.1186/s12884-018-2028-2) contains supplementary material, which is available to authorized users.

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“…Gestational diabetes (GDM), defined as hyperglycaemia with onset or first recognition in pregnancy, 1,2 is becoming increasingly common in many populations worldwide. 3 In the United Kingdom, around 700,000 women give birth every year and 5% are thought to be affected by GDM. 4 Untreated, GDM is associated with adverse maternal and neonatal outcomes, including macrosomia (high birth weight, usually above a threshold of 4 or 4.5 kg), shoulder dystocia and pre-eclampsia, which can be prevented or ameliorated with appropriate intrapartum treatment to reduce blood glucose concentrations to euglycaemic concentrations.…”

Section: Introductionmentioning

confidence: 99%

Natural selection? The evolution of diagnostic criteria for gestational diabetes

Meek

2016

Ann Clin Biochem

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Gestational diabetes is a common pregnancy disorder which is generally managed with diet, exercise, metformin or insulin treatment and which usually resolves after delivery of the infant. Identifying and treating gestational diabetes improves maternal and fetal outcomes and allows for health promotion to reduce the mother's risk of type 2 diabetes in later life. However, there remains considerable controversy about the optimal method of identification and diagnosis of women with gestational diabetes. The NICE-2015 diagnostic criteria (75 g oral glucose tolerance test (OGTT) 0 h ≥5.6 mmol/L; 2 h ≥7.8 mmol/L) are based upon cost-effectiveness estimates using observational data, while the WHO-2013 criteria (75 g OGTT 0 h ≥5.1 mmol/L; 1 h ≥10.0 mmol/L; 2 h ≥8.5 mmol/L) identify women and infants at risk of adverse outcomes according to prospective data. There is also considerable controversy about testing for gestational diabetes using universal or risk factor-based screening, and when and how testing should be performed. The aim of this review is to provide a summary of the clinical biochemistry aspects to these debates and to highlight the importance of appropriate identification of gestational diabetes and subsequent type 2 diabetes in this population.

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Epidemiology of Diabetes in Pregnancy

Cited by 14 publications

References 56 publications

Characteristics of different risk factors and fasting plasma glucose for identifying GDM when using IADPSG criteria: a cross-sectional study

Characteristics of different risk factors and fasting plasma glucose for identifying GDM when using IADPSG criteria: a cross-sectional study

Development of an integrated, district-wide approach to pre-pregnancy management for women with pre-existing diabetes in a multi-ethnic population

Natural selection? The evolution of diagnostic criteria for gestational diabetes

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