Gestational Diabetes: A Review of the Current Literature and Guidelines

Hollander, Martine; Paarlberg, K.M.; Huisjes, Anjoke

doi:10.1097/01.ogx.0000253303.92229.59

Cited by 98 publications

(87 citation statements)

References 76 publications

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“…14,15 This difference is even more exaggerated if GDM is untreated or when glycemic control is poor. 16 Although dystocia is a more common indication for cesarean delivery among GDM patients, 14 fetal distress is a more common indication among smokers.…”

Section: Discussionmentioning

confidence: 97%

The impact of tobacco smoking on perinatal outcome among patients with gestational diabetes

Contreras,

Kominiarek,

Zollinger

2009

J Perinatol

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Objective: To determine the effects of tobacco use on perinatal outcomes among patients with gestational diabetes (GDM).Study Design: This was a retrospective cohort study of singleton pregnancies with GDM and live births from 2003 to 2006. The primary outcome, large for gestational age (LGA) infants, was compared between smoking and nonsmoking groups. Secondary outcomes included cesarean deliveries, shoulder dystocia, birth trauma, peripartum complications, macrosomia, 5-min Apgar score p3, birth defects, and neonatal intensive care unit (NICU) admissions. w 2 and Student t-tests compared the two groups; a P-value <0.05 was statistically significant and odds ratios (OR) were reported with 95% confidence intervals (CI). A multivariate logistic regression analysis controlled for variables known to affect outcomes in GDM. Result:We identified 915 patients with GDM, of which 130 (14.2%) smoked during pregnancy. Women who smoked during pregnancy were less likely to have LGA infants (22.4 vs 31.2%; OR, 0.61; 95% CI, 0.39 to 0.95). In a logistic regression analysis, the inverse relationship between smoking and LGA persisted (OR, 0.59; 95% CI, 0.36 to 0.97) after controlling for maternal age, multiparity, ethnicity, weight status before pregnancy, weight gain during pregnancy, and male gender. Preterm labor, preeclampsia, Cesareans, shoulder dystocia, and birth trauma were similar in both groups. PPROM was more likely to occur in nonsmokers (0 vs 4%, P ¼ 0.03), but postpartum hemorrhage was more common among smokers (OR, 2.3; 95% CI, 1.02 to 5.31). Macrosomia, low 5-min Apgar score, birth defects, and NICU admissions were similar between the groups. Conclusion:Patients with GDM who smoke during pregnancy were 40% less likely to have LGA infants. However, smoking was not protective of other common morbidities associated with GDM.

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Section: Discussionmentioning

confidence: 97%

The impact of tobacco smoking on perinatal outcome among patients with gestational diabetes

Contreras,

Kominiarek,

Zollinger

2009

J Perinatol

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“…The predictive value of maternal age in the development of GDM has been evaluated in several studies and the risk associated has been shown to be higher with increasing age (20,21,28,29). However, other authors have not reported a much higher risk for older women (22,30). A recent study examining the individual association of maternal age, BMI, and racial origin with the development of GDM has found different associated risks in relation to the prevalence of GDM for the specific racial group considered.…”

Section: Discussionmentioning

confidence: 98%

Improvement of selective screening strategy for gestational diabetes through a more accurate definition of high-risk groups

Pintaudi

Vieste

Corrado

et al. 2014

European Journal of Endocrinology

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Objective: This study aimed to assess the predictive value of risk factors (RFs) for gestational diabetes mellitus (GDM) established by selective screening (SS) and to identify subgroups of women at a higher risk of developing GDM. Design: A retrospective, single-center study design was employed. Methods: Data of 1015 women screened for GDM at 24-28 weeks of gestation and diagnosed according to the International Association of Diabetes and Pregnancy Study Groups criteria were evaluated. Information on RFs established by SS was also collected and their association with GDM was determined. To identify distinct and homogeneous subgroups of patients at a higher risk, the RECursive Partitioning and AMalgamation (RECPAM) method was used. Results: Overall, 113 (11.1%) women were diagnosed as having GDM. The application of the SS criteria would result in the execution of an oral glucose tolerance test (OGTT) in 58.3% of women and 26 (23.0%) cases of GDM would not be detected due to the absence of any RF. The RECPAM analysis identified high-risk subgroups characterized by fasting plasma glucose values O5.1 mmol/l (odds ratio (OR)Z26.5; 95% CI 14.3-49.0) and pre-pregnancy BMI (ORZ7.0; 95% CI 3.9-12.8 for overweight women). In a final logistic model including RECPAM classes, previous macrosomia (ORZ3.6; 95% CI 1.1-11.6), and family history of diabetes (ORZ1.8; 95% CI 1.1-2.8), but not maternal age, were also found to be associated with an increased risk of developing GDM. A screening approach based on the RECPAM model would reduce by over 50% (23.0 vs 10.6%) the number of undiagnosed GDM cases when compared with the current SS approach, at the expense of 50 additional OGTTs required. Conclusions: A screening approach based on our RECPAM model results in a significant reduction in the number of undetected GDM cases compared with the current SS procedure.

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“…Relevancia clínica de la investigación En el manejo de la diabetes mellitus gestacional con mal control metabólico en respuesta a la dieta: ¿es posible utilizar metformina en lugar de insulina para optimizar el control metabólico y mejorar el resultado perinatal? Escenario clínico: La diabetes gestacional se presenta en una proporción variable de las embarazadas, con un rango entre 3 y 10%, dependiendo de la población estudiada, el tipo de screening utilizado y el tipo de medio diagnóstico (2). Si bien sus consecuencias son moderadas, la diabetes gestacional significa un mayor riesgo materno y perinatal, y un incremento en el riesgo de presentar diabetes mellitus tipo 2 en años posteriores.…”

Section: Análisis De La Investigaciónunclassified

Metformina versus insulina para el tratamiento de diabetes gestacional

Vargas

2008

Rev. chil. obstet. ginecol.

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RESUMEN (1)Introducción: Metformina es un tratamiento lógi-co para pacientes con diabetes gestacional, pero existe una deficiencia de estudios randomizados que demuestren su eficacia y seguridad. Métodos: Se randomizaron 751 mujeres con diagnóstico de diabetes gestacional entre 20-33 semanas de gestación, se inició tratamiento abierto de metformina (agregando insulina cuando fuera necesario) e insulina. El resultado primario a medir fue compuesto en relación a hipoglicemia neonatal, distrés respiratorio, trauma en el parto, Apgar a los 5 minutos < 7, necesidad de fototerapia y prematurez. El estudio fue diseñado para lograr un 33% de aumento (de 30 a 40%) en este resultado compuesto en pacientes tratadas con metformina vs pacientes que recibieron insulina. Resultados secundarios incluyeron medidas antropométricas neonatales, control de glicemia materna, complicaciones hipertensivas maternas, tolerancia a la glucosa postparto y aceptación del tratamiento. Resultados: De las 363 mujeres asignadas a metformina, 92,6% mantuvo el tratamiento hasta el parto, 46,3% debió agregar insulina como suplemento. La tasa de resultado primario compuesto fue 32% en el grupo asignado a metformina y 32,2% en el grupo de insulina (riesgo relativo: 1,0; IC 95%, 0,9 -1,1). Más mujeres en el grupo de metformina que el de insulina declararon que si tuvieran que repetir seguirían con el tratamiento asignado (76,6% vs 27,2%; p<0,001). La tasa de resultados secundarios no tuvo diferencia significativa entre los grupos. No hubo efectos adversos serios asociados con uso de metformina. Conclusiones: En mujeres con diabetes gestacional, el uso de metformina (sola o asociada a insulina) comparado con insulina, no se asocia a aumento de complicaciones perinatales. Las mujeres prefieren usar metformina que insulina como tratamiento. ANÁLISIS DE LA INVESTIGACIÓN A. Relevancia clínica de la investigaciónEn el manejo de la diabetes mellitus gestacional con mal control metabólico en respuesta a la dieta: ¿es posible utilizar metformina en lugar de insulina para optimizar el control metabólico y mejorar el resultado perinatal? Escenario clínico: La diabetes gestacional se presenta en una proporción variable de las embarazadas, con un rango entre 3 y 10%, dependiendo de la población estudiada, el tipo de screening utilizado y el tipo de medio diagnóstico (2). Si bien sus consecuencias son moderadas, la diabetes gestacional significa un mayor riesgo materno y perinatal, y un incremento en el riesgo de presentar diabetes mellitus tipo 2 en años posteriores. La mayoría de las mujeres logra un buen control metabólico mediante ajuste dietario, sin embargo, cerca de un 5% de las mujeres requiere un tratamiento adicional, siendo el estándar el uso de insulina. De modo más reciente, se ha demostrado la seguridad y factibilidad del uso de hipoglicemiantes orales en este escenario, principalmente gliburida y en menor proporción metformina (3).

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Gestational Diabetes: A Review of the Current Literature and Guidelines

Cited by 98 publications

References 76 publications

The impact of tobacco smoking on perinatal outcome among patients with gestational diabetes

The impact of tobacco smoking on perinatal outcome among patients with gestational diabetes

Improvement of selective screening strategy for gestational diabetes through a more accurate definition of high-risk groups

Metformina versus insulina para el tratamiento de diabetes gestacional

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