Incidence of adverse outcomes associated with gestational diabetes mellitus in low‐ and middle‐income countries

Wang, Zheng; Kanguru, Lovney; Hussein, Julia; Fitzmaurice, Ann; Ritchie, Katherine

doi:10.1016/j.ijgo.2012.10.032

Cited by 54 publications

(55 citation statements)

References 27 publications

(27 reference statements)

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“…Their risk to experience a complication during pregnancy or at birth such as preeclampsia or eclampsia, postpartum bleeding, and prolonged labor or to develop a long-term chronic condition is higher compared with healthy pregnant women. Moreover, their newborns are more prone to die around the time of birth, to be born prematurely or with malformations, or to be large for gestational age, with the additional risk of the delivery being complicated by a shoulder dystocia that can result in a plexus injury or a fracture (3, 4). Newborns might suffer from asphyxia, respiratory distress, or hypoglycemia (5) and also may develop metabolic abnormalities later in life (6).…”

Section: Introductionmentioning

confidence: 99%

Diagnosis a posteriori? Assessing gestational diabetes screening and management in Morocco

Utz

Assarag

Essolbi

et al. 2016

Global Health Action

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BackgroundIn Morocco, gestational diabetes affects 1 in 10 pregnant women, but knowledge about screening and management practices outside university settings is limited.ObjectiveTo provide a comprehensive picture about the current situation of screening and management of gestational diabetes at different levels of care and to highlight existing challenges.DesignWe conducted a descriptive mixed methods study in the districts of Al Haouz and Marrakech by using both quantitative and qualitative methods, including document reviews of 369 antenatal cards and 299 hospital files, health facility inventories related to resource availability, 20 key informant interviews as well as focus group discussions with 32 pregnant women and exit interviews with 122 antenatal care (ANC) clients. Quantitative data were descriptively analyzed using STATA Version 13, whereas qualitative data were thematically analyzed using NVIVO Version 10.ResultsThe findings revealed that sensitization of women about gestational diabetes is low, and only 34.4% have ever heard about it before attending ANC. Fasting blood sugar is used for screening, and women are sent to external laboratories for testing. A fasting blood sugar of 0.92 g/l and above was documented in 12.3% of all antenatal cards examined. Women diagnosed with gestational diabetes are usually referred to a specialist despite general practitioners at health center level being responsible for the management of non-pregnant diabetic patients.ConclusionsDecentralization of screening for gestational diabetes and initial management of uncomplicated cases at the primary level of care could ease access to care and reduce the number of mothers who are diagnosed after a complication occurred.

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Section: Introductionmentioning

confidence: 99%

Diagnosis a posteriori? Assessing gestational diabetes screening and management in Morocco

Utz

Assarag

Essolbi

et al. 2016

Global Health Action

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“…Gestational diabetes mellitus (GDM), defined as hyperglycemia diagnosed at pregnancy, has been associated with many adverse maternal and newborn outcomes (1), especially increased number of cesarean deliveries, newborns large for gestational age, and macrosomia (2). According to diagnostic criteria (3), the prevalence of GDM ranges from 1.7 to 11.6% (4,5).…”

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confidence: 99%

Dietary Intervention in Patients With Gestational Diabetes Mellitus: A Systematic Review and Meta-analysis of Randomized Clinical Trials on Maternal and Newborn Outcomes

2014

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OBJECTIVEDiet is the cornerstone treatment of patients with gestational diabetes mellitus (GDM), but its role in maternal and newborn outcomes has been scarcely studied. The purpose of this study was to analyze the efficacy of dietary interventions on maternal or newborn outcomes in patients with GDM. RESEARCH DESIGN AND METHODSA systematic review and meta-analysis of randomized clinical trials (RCTs) of dietary intervention in GDM or pregnancy with hyperglycemia was performed. MEDLINE, Embase, ClinicalTrials.gov, Cochrane, and Scopus were searched through to March 2014. The main evaluated maternal outcomes were proportion of patients using insulin and proportion of cesarean delivery; the newborn outcomes were proportion of macrosomia and hypoglycemia and newborn weight. RESULTSFrom 1,170 studies, nine RCTs, including 884 women aged 31.5 years (28.7-33.2) with 27.4 weeks (24.1-30.3) of gestation, were eligible. We divided the RCTs according to the type of dietary intervention: low glycemic index (GI) (n = 4; 257 patients), total energy restriction (n = 2; 425 patients), low carbohydrates (n = 2; 182 patients), and others (n = 1; 20 patients). Diet with low GI reduced the proportion of patients who used insulin (relative risk 0.767 [95% CI 0.597, 0.986]; P = 0.039) and the newborn birth weight (weight mean differences 2161.9 g [95% CI 2246.4, 277.4]; P = 0.000) as compared with control diet. Total restriction and low carbohydrate diets did not change either maternal or newborn outcomes. CONCLUSIONSA low GI diet was associated with less frequent insulin use and lower birth weight than control diets, suggesting that it is the most appropriate dietary intervention to be prescribed to patients with GDM.

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“…Babies of affected mothers are at higher risk of being delivered preterm, of being macrosomic or suffering from hypoglycemia, jaundice or respiratory distress. Mothers have an increased risk of developing pregnancy-induced hypertension or pre-eclampsia, of experiencing a shoulder dystocia or a postpartum hemorrhage and are more likely to deliver by caesarean section [8]. Maternal diabetes is also a known condition associated with stillbirths [9], 10 % of which are attributable to non-communicable diseases [10].…”

Section: Introductionmentioning

confidence: 99%

“…Maternal diabetes is also a known condition associated with stillbirths [9], 10 % of which are attributable to non-communicable diseases [10]. In the long term, GDM affected women and their newborns are more prone to developing manifest diabetes mellitus [8, 11]. …”

Section: Introductionmentioning

confidence: 99%

“Why screen if we cannot follow-up and manage?” Challenges for gestational diabetes screening and management in low and lower-middle income countries: results of a cross-sectional survey

Utz

2016

BMC Pregnancy Childbirth

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BackgroundThe prevalence of gestational diabetes (GDM) in low and lower middle income countries (LLMIC) is increasing. Despite its associated short and long term complications for mothers and their newborns, there is a lack of knowledge about how to detect and manage GDM. The objective of our study was to identify the challenges that first line healthcare providers in LLMIC face in screening and management of GDM.MethodsWe conducted a cross-sectional survey of key informants from 40 low and lower-middle income countries in Africa, South-Asia and Latin-America by sending out questionnaires to 182 gynecologists, endocrinologists and medical doctors. Sixty-seven respondents from 26 LLMIC provided information on the challenges they encounter. Data was thematically analyzed and revealed eight overarching themes, including guidelines; human resources; access; costs; availability of services, equipment and drugs; patient and community factors; and collaboration and communication.ResultsUnavailability of guidelines combined with lack of knowledge about GDM on the part of both providers and patients poses a substantial barrier to detection and management of GDM, leading to deficiencies in screening and counseling. Limited access to regular monitoring and follow-up care as a result of distance and costs, in particular with respect to additional expenses related to specific tests and changes in diet were identified as important challenges. Services were not available at all levels nor was adequate testing equipment. Patient factors included lack of motivation and compliance with the recommended therapy. Respondents also highlighted the lack of communication and collaboration between different specialists and treatment delays as a result of patients being seen by multiple providers.ConclusionsProviders from LLMIC face various challenges related to screening and managing GDM. Policy makers need to address these challenges by strengthening their health care system as a whole and by assuring that non-communicable diseases are better integrated into the existing packages of free or subsidized maternal health care.

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Incidence of adverse outcomes associated with gestational diabetes mellitus in low‐ and middle‐income countries

Abstract: The high incidence of some complications of GDM is a concern and may indicate poorer care for women with GDM in low-resource settings. The wide IQRs found indicate uncertainty about the burden of GDM in these settings.

Cited by 54 publications

References 27 publications

Diagnosis a posteriori? Assessing gestational diabetes screening and management in Morocco

Diagnosis a posteriori? Assessing gestational diabetes screening and management in Morocco

Dietary Intervention in Patients With Gestational Diabetes Mellitus: A Systematic Review and Meta-analysis of Randomized Clinical Trials on Maternal and Newborn Outcomes

“Why screen if we cannot follow-up and manage?” Challenges for gestational diabetes screening and management in low and lower-middle income countries: results of a cross-sectional survey

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