Management of Diabetes in Pregnancy: Comparison of Guidelines with Current Practice at Austrian and Australian Obstetric Center

Zeck, Willibald; Panzitt, Thomas; Schlembach, Dietmar; Lang, Uwe; McIntyre, H. David

doi:10.3325/cmj.2007.6.831

Cited by 11 publications

(11 citation statements)

References 31 publications

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“…Estudos realizados do mundo inteiro, analisando as mais variadas etnias 5,7,8,12,18 , encontraram a maior idade como forte preditor de diabetes mellitus gestacional. Muitos consensos utilizam 25 anos como ponto de corte para o rastreamento, mas é interessante observar que, neste estudo, uma análise complementar, categorizando a idade em < 20, 20-24, 25-29 e 30 anos ou mais, mostrou que, para as mulheres com idades entre 20-24 anos, o OR de diabetes mellitus gestacional foi quase três vezes maior do que o das adolescentes (dados não mostrados).…”

Section: Discussionunclassified

“…Recomendam, igualmente, que, na presença de fatores de risco, sendo o primeiro rastreamento negativo, que este seja repetido no terceiro trimestre 2,3,4 . A Organização Mundial da Saúde (OMS), o Australian Obstetric Center e o Austrian Obstetric Center também recomendam que o rastreamento do diabetes mellitus gestacional seja universal, independente da presença de fatores de risco 5,6,7,8 .…”

Section: Introductionunclassified

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Fatores de risco para diabetes mellitus gestacional na coorte de nascimentos de Pelotas, Rio Grande do Sul, Brasil, 2004

Dode

Santos²

2009

Cad. Saúde Pública

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Consensus statements by various countries have reported age, obesity, and family history of diabetes mellitus as risk factors for gestational diabetes mellitus. Other factors remain controversial. The aim of this study was to investigate factors associated with gestational diabetes among mothers of newborns from the birth cohort in Pelotas, Rio Grande do Sul State, Brazil, in 2004. We interviewed 4,243 postpartum women in hospital, with a 0.5% refusal rate. Diagnosis of gestational diabetes was self-reported. Prevalence of gestational diabetes was 2.95% (95%CI: 2.53-3.64). Crude analysis using the chi-square test showed a direct association with age, schooling, socioeconomic status, and body mass index (BMI) and an inverse association with maternal height. Non-white color, family history of diabetes mellitus, smoking in the first and second trimesters, and physical activity before the pregnancy and in the first trimester were associated with the outcome. Adjusted hierarchical analysis using logistic regression showed an association with age, non-white color, higher schooling, family history of diabetes, and BMI. Height showed borderline significance. Smoking in the first and second trimesters showed a protective effect.

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Section: Discussionunclassified

Section: Introductionunclassified

Fatores de risco para diabetes mellitus gestacional na coorte de nascimentos de Pelotas, Rio Grande do Sul, Brasil, 2004

Dode

Santos²

2009

Cad. Saúde Pública

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“…comparison of guidelines with current practice at Austrian and Australian obstetric center Zeck, Panzitt [15] To compare Austrian and Australian national guidelines for gestational and pre-gestational diabetes and estimate the level to which physicians comply with their country's guidelines.…”

Section: Management Of Diabetes In Pregnancymentioning

confidence: 99%

Adherence to Clinical Practice Guidelines during Antenatal Management of Gestational Diabetes Mellitus: An Integrative Review

Salama¹,

Abushaikha²

2018

OJN

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The number of pregnant women affected by gestational Diabetes (GDM) is increasing globally with an estimated prevalence as high as 15%. Gestational Diabetes Miletus is associated with birth complications for women and newborn, includes development of type II diabetes, preeclampsia during pregnancy, increasing the risk of fetal loss, stillbirth and perinatal death. An integrative literature review applied, systematic search from different data base obtained from international and middle east countries to assess adherence level of guidelines. Clinical guidelines are set to ensure and assure homogeneity as well as the quality of provision of care. National and international consensus has yet to be achieved in the management of diabetes in pregnancy, adherence of recommended antenatal care content to a minimum level appears to be unmet. Complete provider adherence to first antenatal guidelines was 48.1%, Guideline dissemination alone does not change practice; assessment of barriers/enablers and implementation is important. Guidelines are useless when they are not used or adhered to. Each guideline needs an Appendix on how adherence has to be measured, there is a need for some uniformity across guidelines to measure adherence. Diabetes management is an essential constituent to prevent prognosis of diabetes complications.

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“…In zahlreichen publizierten Richtlinien werden zur Diagnose des GDM zumindest 2 auffällige Werte in einem Glukosetoleranztest gefordert [7] . Sollte sich beim oralen Glukosetoleranztest (oGTT) nur 1 pathologisch erhöhter Wert finden, wird vielerorts von einer «impaired glucose tolerance» gesprochen.…”

Section: Definition Des Gdmunclassified

“…120 mg% nach 2 h nicht übersteigen sollen. Die Grazer Empfehlungen decken sich dabei weitgehend mit den anderen international empfohlenen Standards [7] . Nach unserer Ansicht ist es wichtig, diätetische Massnahmen unmittelbar nach Vorliegen eines pathologischen oGTT einzuleiten und mütterliche Blutzuckerkontrollen möglichst vor der 28.- [4, 11, 13-15, 28, 29] .…”

Section: Beratungunclassified

Diagnose und Behandlung des Gestationsdiabetes – das Grazer Modell

Panzitt

Zeck²,

Mayer-Pickel³

2009

Gynäkol Geburtshilfliche Rundsch

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Fragestellung: Trotz der Häufigkeit des Gestationsdiabetes (GDM) wird ein Grossteil der betroffenen Fälle nicht erkannt oder unzureichend therapiert. Problematisch sind ein genereller Trend zur Unterschätzung des Morbiditätsrisikos, eine fehlende Verankerung des GDM in den Mutterschaftsrichtlinien, sowie uneinheitliche Leitlinien zu Screening und Therapie des GDM. Methoden: Das Grazer Modell zu Diagnostik und Therapie des GDM bietet seit Jahrzehnten ein einstufiges generelles Screening aller Schwangeren zwischen der 24. und 28. Schwangerschaftswoche (SSW) an; zusätzlich ermöglicht die Option der Bestimmung der Fruchtwasserinsulinkonzentration mittels Amniozentese in der 31.–32. SSW die Erfassung von hyperinsulinämischen Feten, die ein geburtshilfliches Hochrisikokollektiv darstellen. Schlussfolgerungen: Die im Vergleich zu anderen Richtlinien niedrigeren Grenzwerte des oralen Glukosetoleranztests sowie das Angebot zur Bestimmung der Fruchtwasserinsulinkonzentration, welche im Grazer Konzept seit langer Zeit verankert sind, ermöglichen eine höhere Erkennungsrate sowie eine zielgerichtete Therapie von Hochrisikofällen. Screening und Therapie des GDM stellen kosteneffiziente Massnahmen zur Verbesserung des geburtshilflichen Outcomes dar, weshalb die Forderung nach einer Verankerung des GDM in den Mutterschaftsrichtlinien nachdrücklich vertreten werden soll.

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Management of Diabetes in Pregnancy: Comparison of Guidelines with Current Practice at Austrian and Australian Obstetric Center

Cited by 11 publications

References 31 publications

Fatores de risco para diabetes mellitus gestacional na coorte de nascimentos de Pelotas, Rio Grande do Sul, Brasil, 2004

Fatores de risco para diabetes mellitus gestacional na coorte de nascimentos de Pelotas, Rio Grande do Sul, Brasil, 2004

Adherence to Clinical Practice Guidelines during Antenatal Management of Gestational Diabetes Mellitus: An Integrative Review

Diagnose und Behandlung des Gestationsdiabetes – das Grazer Modell

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