Guidelines for the screening and diagnosis of gestational diabetes in Italy from 2010 to 2019: critical issues and the potential for improvement

Vitacolonna, Ester; Succurro, Elena; Lapolla, Annunziata; Scavini, Marina; Bonomo, Matteo; Cianni, Graziano Di; Benedetto, A. Di; Napoli, Angela; Tumminia, Andrea; Festa, Camilla; Lencioni, Cristina; Torlone, Elisabetta; Sesti, Giorgio; Mannino, Domenico

doi:10.1007/s00592-019-01397-4

Cited by 14 publications

(16 citation statements)

References 53 publications

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“…The inclusion criteria accepted women with ≥ 18 years of age. The GDM diagnosis was performed following the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria [ 33 , 34 ]. The exclusion criteria were type 1 or 2 diabetes, overt diabetes, other chronic diseases (including malignancy, hypercholesterolemia) as well as a positive history of drug or alcohol abuses.…”

Section: Methodsmentioning

confidence: 99%

Fat mass and obesity-associated (FTO) gene epigenetic modifications in gestational diabetes: new insights and possible pathophysiological connections

et al. 2021

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Aims Gestational diabetes mellitus (GDM) can lead to short- and long-term complications for the child. Epigenetic alterations could contribute to explaining the metabolic disturbances associated with foetal programming. Although the role of the FTO gene remains unclear, it affects metabolic phenotypes probably mediated by epigenetic mechanisms. The aim of this study was to assess whether placental DNA epigenetic modifications at FTO promoter-associated cysteine–phosphate–guanine (CpG) sites are correlated with GDM. A secondary aim was to evaluate the association between the placental FTO DNA methylation and the maternal metabolic traits in women with and without GDM. Methods Socio-demographic characteristics, clinical parameters at the third trimester of pregnancy, Mediterranean diet adherence, and physical activity were assessed in 33 GDM women and 27 controls. Clinical information about the newborns was registered at birth. The FTO rs9939609 (T > A) was genotyped. Results No association between FTO DNA methylation and GDM was found. DNA methylation on the maternal side at the CpG1 was associated with maternal smoking in GDM (p = 0.034), and DNA methylation at the CpG3 was correlated with smoking or former smoking in controls (p = 0.023). A higher level of TGs was correlated with higher foetal placental DNA methylation at the CpG2 (p = 0.036) in GDM. An inverse association between HDL-C and maternal placental DNA methylation at the CpG3 in controls (p = 0.045) was found. An association between FTO rs9939609 and neonatal birthweight (p = 0.033) was detected. Conclusions In the awareness that the obesity pathophysiology is complex, the study adds a piece to this intricate mosaic.

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Section: Methodsmentioning

confidence: 99%

Fat mass and obesity-associated (FTO) gene epigenetic modifications in gestational diabetes: new insights and possible pathophysiological connections

et al. 2021

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“…According to the current Italian guidelines on GDM, PCOS women carrying high risk (i.e., obesity, previous macrosomia or GDM, fasting blood sugar 100-125 mg/dL at the beginning of pregnancy) should be investigated by oral glucose tolerance test (OGTT) between the 16th and 18th week of gestation and, if normal, by repeating it between the 24th and 28th week of pregnancy (101).…”

Section: Expert Opinionmentioning

confidence: 99%

Fundamental Concepts and Novel Aspects of Polycystic Ovarian Syndrome: Expert Consensus Resolutions

et al. 2020

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Polycystic ovary syndrome (PCOS) is a very common endocrine and metabolic disorder with the involvement of both genetic and environmental factors. Although much has been clarified on its pathogenesis, diagnosis, clinical manifestations, and therapy, there are still areas of uncertainty. To address fundamental concepts, novel aspects and hypotheses, and future perspectives, including the possible additional benefits of treatment with nutraceuticals, an expert consensus panel formed by endocrinologists and gynecologists was established. After an independent review of the literature, the panel convened electronically on February 3, 2020, and six resolutions were created, debated, and agreed upon discussion, and finally approved in their final form in a consensus livestream meeting held on April 15. The summary of the resolutions are: (1) PCOS is a well-established medical condition that negatively affects reproduction, general health, sexual health, and quality of life; (2) the symptoms and signs of PCOS appear early in life especially in female newborns from PCOS carriers; (3) women with PCOS have significantly increased risk of pregnancy-related complications including gestational diabetes mellitus; (4) a male PCOS equivalent exists, and it may impact on metabolic health and probably on reproduction; (5) the evidence supports that medical therapy for PCOS is effective, rational, and evidence-based; (6) the evidence supports a major research initiative to explore possible benefits of nutraceutical therapy for PCOS. The proposed resolutions may be regarded as points of agreement based on the current scientific evidence available.

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“…However, there is still no agreement on GDM screening type (universal versus selective), timing, and diagnostic methods. Early pregnancy screening is recommended, but no agreement has been reached on the methods and interpretation of results between different guidelines [ 7 , 8 ]. Regarding diagnosis, the current WHO statement applies the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria [ 9 ], performing a “one-step” 75 g oral glucose tolerance test (OGTT) at 24-28 weeks of gestation, but alternative “two-step” methods are recommended by other guidelines committees [ 2 , 10 – 12 ], by screening with a 50 g glucose load test (50 g GLT) followed by diagnosis by 100 g OGTT.…”

Section: Introductionmentioning

confidence: 99%

Continuous Glucose Monitoring in Women with Normal OGTT in Pregnancy

Tartaglione

Stasio

Sirico

et al. 2021

Journal of Diabetes Research

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Continuous glucose monitoring (CGM) might be an effective tool to improve glycemic control in gestational diabetes mellitus (GDM). Few data are available about its utilization as a diagnostic tool to find potential alterations of glycemia in subjects with normal oral glucose tolerance test (OGTT). In this preliminary prospective real-life observational study, we aimed to analyze the glycemic pattern in normal and gestational diabetes mellitus (GDM) women by continuous glucose monitoring (CGM) in order to detect potential differences between the two groups and glycemic alterations despite a normal OGTT. After the screening for GDM, subjects were connected to a CGM system for seven consecutive days. The areas under the curve of the first 60 minutes after each meal and 60 minutes before breakfast were analyzed. Women with normal OGTT that during CGM showed impaired glycemic values (more than 95 fasting or more than 140 one hour after meals or more than 120 two hours after meals) performed one week of self-monitoring of blood glucose (SMBG). After OGTT, 53 women considered normal and 46 affected by GDM were included. CGM parameters did not show any differences between the two groups with impaired glycemic excursions found in both groups. After CGM period, 33 women with normal OGTT showed abnormal glycemic patterns. These 33 women then performed one week of SMBG. After evaluation of one week of SMBG, 21 required diet therapy and 12 required insulin treatment and were followed until the delivery. An increase in gestational weight gain was observed in normal women with normal OGTT but this was not significant. No significant data were found regarding neonatal outcomes in the two groups of women. In conclusion, CGM use in pregnancy might help to detect glycemic fluctuations in women with normal OGTT, improving their treatment and outcomes.

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Guidelines for the screening and diagnosis of gestational diabetes in Italy from 2010 to 2019: critical issues and the potential for improvement

Cited by 14 publications

References 53 publications

Fat mass and obesity-associated (FTO) gene epigenetic modifications in gestational diabetes: new insights and possible pathophysiological connections

Fat mass and obesity-associated (FTO) gene epigenetic modifications in gestational diabetes: new insights and possible pathophysiological connections

Fundamental Concepts and Novel Aspects of Polycystic Ovarian Syndrome: Expert Consensus Resolutions

Continuous Glucose Monitoring in Women with Normal OGTT in Pregnancy

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