Prenatal Care Adherence and Neonatal Intensive Care Unit Admission or Stillbirth among Women with Gestational and Preexisting Diabetes Mellitus

Sperling, Jeffrey D.; Maggio, Lindsay; Has, Phinnara; Daley, Julie; Khander, Amrin; Coustan, Donald R.

doi:10.1055/s-0037-1603343

Cited by 11 publications

(23 citation statements)

References 21 publications

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“…Journal of Diabetes Research with the population used in the study where women have been shown to be less adherent to medication than men in diabetes management. Furthermore, pregnant women are less adherent to medication due to worsening pregnancy symptoms, side effects of medications, perceived risks to the unborn child, and mental health issues such as anxiety and depression [18,[24][25][26]30]. These documented factors are consistent with observations from the review.…”

Section: Discussionsupporting

confidence: 79%

“…The dominant medications used in the management of gestational diabetes according to the papers reviewed were insulin [18,[20][21][22][23][24] and metformin [19,21,22,25]. Besides medications, adherence to lifestyle/behaviours like self-monitoring of blood glucose levels, dietary therapy, and physical activity were considered [18,20,[22][23][24][25][26][27][28]. Self-report measures were the recorded means of estimating adherence [18-26, 28, 29].…”

Section: Types Of Medications and Adherencementioning

confidence: 99%

“…Biological factors that impacted medication adherence included pathophysiology of diabetes [18], effects of pregnancy such as vomiting, loss of appetite, unusual discomfort [18,26,30], complicated medication regimen [26,30], the type of medications used [24], and medication side effects [25].…”

Section: Biological Factorsmentioning

confidence: 99%

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Adherence to Antidiabetic Medications among Women with Gestational Diabetes

Asiedu-Danso

Kretchy

Sekyi

et al. 2021

Journal of Diabetes Research

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Background. Optimal adherence to prescribed medications in women with gestational diabetes is relevant for perinatal outcomes. Objective. To summarize available information on the prevalence and factors contributing to medication adherence in women with gestational diabetes from the biological and psychosocial perspectives. Methods. A literature search on adherence in gestational diabetes was conducted in PubMed/MEDLINE, CINAHL, Scopus, and the Directory of Open Access Journals for studies published on the topic. The Arksey and O’Malley framework for scoping reviews was used to explore and summarize the evidence. Results. A total of 2395 studies were retrieved of which 13 fully met the eligibility criteria. The studies were reported in Zimbabwe ( n = 5 ), Iran ( n = 1 ), Mexico ( n = 1 ), South India ( n = 1 ), the United States of America ( n = 4 ), and one multinational study covering Australia, Europe, North and South America. The main types of antidiabetic medications used were insulin ( n = 6 ), metformin ( n = 4 ), and glyburide ( n = 2 ). The prevalence of adherence ranged from 35.6% to 97%, with the assessment tool being self-report measures ( n = 8 ). The main factors associated with nonadherence included worsening pregnancy symptoms, side effects of medications, perceived risks, mental health symptoms, poor social support, and socioeconomic status. Recommendations that evolved from the studies to improve adherence included education, counselling, improved support networks, and social interventions, while the main reported interventional study employed continuous education on the impact of adherence on perinatal outcomes. Conclusion. Medication nonadherence in gestational diabetes seems to be influenced by multiple factors with some educational interventions positively impacting adherence behaviours. Thus, future research in women with gestational diabetes could consider interventions from a multifactorial perspective to improve therapeutic outcomes.

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Section: Discussionsupporting

confidence: 79%

Section: Types Of Medications and Adherencementioning

confidence: 99%

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Adherence to Antidiabetic Medications among Women with Gestational Diabetes

Asiedu-Danso

Kretchy

Sekyi

et al. 2021

Journal of Diabetes Research

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“…One of the major problems in many specialties, particularly obstetrics is low women's adherence to the related health protocols. Lower adherence to prenatal care has been found to cause lower 5-minute Apgar scores, higher rates of perinatal death, intrauterine infection, and placental abruption, and increased admissions of infants in the neonatal intensive care unit (NICU) (15). Although ANC, as the significant healthcare intermediary has widely been accepted, its efficiency and efficacy in improving the maternal and neonatal outcomes have less been remained unproven.…”

Section: Introductionmentioning

confidence: 99%

The adherence adequacy to antenatal care in alleviating the adverse maternal and neonatal outcomes of Iranian pregnant women: a retrospective-prospective study

et al. 2020

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Background. Low adherence of pregnant women to the content of prenatal care guidelines (PCGs) is one of the most significant issues in obstetrics.Objective. This study aimed to improve the well-being of the mother and fetus by preventing maternal and neonatal complications using the adherence to antenatal care (ANC). Patients and methods. An integrated retrospective-prospective longitudinal study with participating 604 pregnant women was carried out in the Iranian community. A valid researcher-made tool was used to implement this three-stage research approach. The results of demographic and obstetric characteristics, the adequacy of adherence to PCGS, and pregnancy outcomes were analyzed using multivariate logistic regression to assess the compliance of women with pregnancy outcomes. Results. 71.36% of the total population had a complete adherence (≥ 80%) to the PCGs. The women with higher education levels substantially showed more adherence to this healthcare program guideline (p = 0.0001). In relation to pregnancy outcomes, there was a significant relationship between women's adherence to PCGs and neonatal complications (p < 0.05). Conclusion.The assessment of PCGs content was successful in evaluating ANC quality. The complete adherence to first ANC guidelines could efficiently promote neonatal outcomes, whereas it showed no effect on maternal outcomes. SOMMARIOBackground. La scarsa aderenza delle donne incinta al contenuto delle linee guida per l'assistenza prenatale (PCG) è una delle questioni più significative dell'ostetricia. Obiettivo. Questo studio mira a migliorare il benessere della madre e del feto, prevenendo le complicazioni materne e neonatali con l'aderenza alla cura prenatale (ANC). Pazienti e metodi. Nella comunità iraniana è stato condotto uno studio longitudinale retrospettivo/prospettivo integrato con 604 donne incinta partecipanti. Per implementare in tre fasi questo approccio di ricerca è stato utilizzato un valido strumento per ricercatori. I risultati delle caratteristiche demografiche e ostetriche, l'adeguatezza dell'aderenza al PCGS e gli esiti della gravidanza sono stati analizzati utilizzando la regressione logistica multivariata, al fine di valutare la conformità delle donne agli esiti della gravidanza. Risultati. Il 71,36% della popolazione totale ha avuto una completa aderenza (80%) ai PCG. Le donne con livelli di istruzione superiore hanno mostrato sostanzialmente una maggiore aderenza a questa linea guida del programma sanitario (p -0,0001). Per quanto riguarda gli esiti della gravidanza, c'è stata una relazione significativa tra l'aderenza delle donne ai PCG e le complicazioni neonatic (p < 0,05). Conclusione. La valutazione dei contenuti dei PCG è risultata efficace per la valutazione della qualità dell'ANC. La completa adesione dell'ANC alle prime linee guida potrebbe promuovere efficientemente i risultati neonatali, mentre non ha mostrato alcun effetto sui risultati materni.

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“…En Finlandia, Koiven et al realizaron un estudio de casos y controles donde encontraron que el 16,1% de los hijos de madres con DG ingresaron a UCIN frente a un 9,8% de hijos de madres con DMPG (8). Por otro lado, Sperling et al en una cohorte retrospectiva en Rhode Island (U.S.A) encontró que los hijos de gestantes con DMPG fueron admitidos a UCIN en un 54,6 % frente a un 12,5 % de los hijos de gestantes con DG (10).…”

Section: Introductionunclassified

Riesgo de admisión a UCI neonatal en hijos de madres diabéticas

Masson¹,

Liñán²

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Introducción: La diabetes gestacional es diagnosticada por primera vez en el embarazo; a diferencia de la diabetes mellitus pre gestacional; embarazo de una paciente con diabetes previa. Ambas presentan complicaciones que requieren atención especializada para resolverse. Sin embargo, la evidencia del riesgo de admisión a la unidad de cuidados intensivos neonatales (UCIN) en los hijos de gestantes con diabetes pre gestacional (DMPG) y diabetes gestacional (DG) es diferente. Objetivo: Se desea estimar el riesgo en los hijos de gestantes con DMPG y DG de ser admitidos a UCIN en el Hospital Nacional Edgardo Rebagliati Martins (HNERM). Materiales y métodos: Estudio tipo cohorte retrospectiva en gestantes diabéticas y sus hijos desde el año 2014 al 2017 en el HNERM. La DG fue definida con los criterios diagnósticos de la American Diabetes Association (ADA) y un criterio del consenso peruano de diabetes gestacional; y la DMPG como diagnóstico consignado en la historia clínica. La admisión a UCIN fue por cualquier complicación neonatal. Se utilizó el modelo de regresión de Poisson con varianza robusta para obtener razones de riesgo ajustadas. Resultados: De 159 gestantes, 52 presentaron DMPG y 107, DG. El 42,31 % de hijos de madres con DMPG ingresaron a UCIN en comparación 12.12 % de hijos de madres con DG (p<0,001). El análisis ajustado fue significativo para la variable tipo de diabetes RR 3,42 (95 % IC 1,84 a 6,36). Conclusión: Los hijos de madres con DMPG tienen 3,42 veces más riesgo que los hijos de madres con DG de ingresar a la UCIN. La razón de DG sobre la de DMPG en el HNERM fue de 2 a 1.

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Prenatal Care Adherence and Neonatal Intensive Care Unit Admission or Stillbirth among Women with Gestational and Preexisting Diabetes Mellitus

Abstract: Women with DM with lower adherence had higher rates of NICU admission and worse glycemic control. Most outcomes among women with GDM with lower adherence were similar.

Cited by 11 publications

References 21 publications

Adherence to Antidiabetic Medications among Women with Gestational Diabetes

Adherence to Antidiabetic Medications among Women with Gestational Diabetes

The adherence adequacy to antenatal care in alleviating the adverse maternal and neonatal outcomes of Iranian pregnant women: a retrospective-prospective study

Riesgo de admisión a UCI neonatal en hijos de madres diabéticas

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