Should we screen for gestational diabetes? “The concept of gestational diabetes was popularised before considerations of evidence based medicine came on the scene”

Rj, Jarrett; Castro-Soares, J; Dornhorst, Anne; Rw, Beard

doi:10.1136/bmj.315.7110.736

Cited by 42 publications

(5 citation statements)

References 20 publications

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“…[9] Of the various complications resulting from hyperglycemia in pregnancy, macrosomia is the only outcome strongly associated with GDM. [10] Nevertheless, even macrosomia has been shown to be associated with maternal BMI rather than GDM itself, [11] although such an association was not seen in our study.…”

Section: Discussioncontrasting

confidence: 80%

“…The psychological impact of such rigorous blood sampling can also be significant in patients who were otherwise healthy prior to conception. [10] Needless to say, SMBG is often impracticable in daily clinical practice in developing countries due to a combination of financial constraints and ignorance of GDM in the population, resulting in patient non-compliance. Irregular monitoring of blood glucose can produce recurrent maternal hypoglycemic episodes, which can lead to further non-compliance to therapy and eventual patient dropout from follow-up.…”

Section: Discussionmentioning

confidence: 99%

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A simple score to predict fetal outcomes in gestational diabetes mellitus

Naha

Pandit

et al. 2015

Biomed J

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Background: Strict glycemic control is critical in preventing adverse maternal and fetal outcomes with gestational diabetes mellitus (GDM), but frequently results in recurrent maternal hypoglycemia and is often impracticable. This study was done to determine whether a more lenient strategy might provide satisfactory outcomes and to formulate a glycemic score for prognostication of fetal outcomes. Methods:A prospective non-interventional study was conducted on consecutive patients admitted with GDM between May 2007 and August 2009. Patients with pre-gestational diabetes were excluded. All patients received treatment at the discretion of treating consultants. Glycemic control was estimated by recording mean values of all glucose profiles performed. Fasting and postprandial blood glucose levels below 95 mg/dl and 120 mg/dl, respectively, were considered controlled. A glycemic score was calculated based on the number of mean blood glucose values controlled. Fetal outcomes were noted. Results:Ninety-four patients with GDM were included. The glycemic score was significantly predictive of adverse fetal outcomes (p < 0.001). Analysis by receiver operating characteristic (ROC) curve showed good sensitivity and specificity for macrosomia (78.3% and 81.8%, respectively) and congenital anomalies (73.9% and 66.7%, respectively) with a glycemic score of 2 or less [area under curve (AUC) 0.768; odds ratio (OR), 11.17; 95% Confidence Interval (CI), 2. p < 0.001; and AUC 0.765; OR, 2.22; 95% CI, p = 0.055, respectively]. Binomial logistic regression confirmed the glycemic score to be independently predictive of fetal outcome (p = 0.015). Conclusion:The glycemic score is a sensitive and specific prognostic marker. Tight control of three of four values of blood glucose within the glucose profile appears sufficient to prevent adverse fetal outcomes. (Biomed J 2015;38:131-135)

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Section: Discussioncontrasting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

A simple score to predict fetal outcomes in gestational diabetes mellitus

Naha

Pandit

et al. 2015

Biomed J

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“…6 However, critics argued that the review failed to include a number of studies on adverse outcomes to the neonate 7 or to fully assess long-term consequences for the mothers. 8 Critical reviews by Jarrett, 9 Stephenson 10 and Goer 11 concluded that there was no case for routine screening, but these were not fully systematic reviews by the Oxman and Guyatt criteria. 12 A review by Dornhorst and Beard 13 noted that "the obstetric benefits from screening are poorly validated" but seemed more convinced of the benefits arising from prevention of later type 2 diabetes.…”

Section: Current Issuesmentioning

confidence: 99%

Screening for gestational diabetes: a systematic review and economic evaluation

Scott

Loveman

McIntyre³

et al. 2002

Health Technol Assess

180

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“…As to screening and management of diabetes mellitus, some prospective studies have shown that adequate glycemic control and follow-up during pregnancy are a reasonable means to reduce stillbirth and numerous other complications like congenital anomalies and macrosomy [ 51 – 53 ]. The effect of prenatal corticosteroids on fetal maturity has been extensively documented and it has been observed that this intervention reduced respiratory distress syndrome (RDS) by 34 %, cerebro-ventricular hemorrhage by 46 %, and neonatal death by 31 % [ 54 ].…”

Section: Discussionmentioning

confidence: 99%

Better than nothing? maternal, newborn, and child health services and perinatal mortality, Lubumbashi, democratic republic of the Congo: a cohort study

Ntambue

Malonga

Michèle

et al. 2016

BMC Pregnancy Childbirth

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Background: The Democratic Republic of Congo (DRC) has a high rate of perinatal mortality (PMR), and health measures that could reduce this high rate of mortality are not accessible to all women. Where they are in place, their quality is not optimal. This study was initiated to assess the relationship between these suboptimal maternal, newborn and child health (MNCH) services and perinatal mortality (PM) in Lubumbashi, DRC's second-largest city. Methods: We conducted a prospective cohort study, comparing women who had no, low, moderate, or high numbers of antenatal care (ANC) visits; three different levels of delivery care; and who did or did not attend postnatal care (PNC). Women were followed for 50 days after delivery, with PM as the primary endpoint. Results: Uptake of recommended prenatal interventions was between 11-43 % among ANC attenders, regardless of the frequency of their visits. PM was 26 per 1000. ANC attendance was associated with PM. Newborns of mothers who had the lowest attendance had a mortality two times higher than newborns of women who had not attended ANC (low visits: adjusted odds ratio (aOR) = 2.2; 95 % confidence interval (CI) = 1.4-3.8). However, moderate (aOR = 1.4; 95 % CI =0.7-2.2) and high (aOR = 1.3; 95 % CI 0.7-2.2) attendance were not statistically significantly associated with PM. PNC attendance was not significantly associated with lower PM (relative risk 0.4, 95 % CI 0.1-2.6). Emergency obstetric and newborn care (EmONC) was significantly associated with a reduction in mortality (aOR = 0.2; 95 % CI = 0.2-0.8), with an 84.4 % reduction among newborns at risk, and an overall reduction in mortality of 10 % for all births. Conclusion: Perinatal mortality was high among the infants of women in the cohort under study (26 per 1000 live births). Availability of MNCH, specifically EmONC, was associated with lower perinatal mortality, and if this association is causal, might avert 84.4 % of perinatal deaths among newborns at high-risk.

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Should we screen for gestational diabetes? “The concept of gestational diabetes was popularised before considerations of evidence based medicine came on the scene”

Cited by 42 publications

References 20 publications

A simple score to predict fetal outcomes in gestational diabetes mellitus

A simple score to predict fetal outcomes in gestational diabetes mellitus

Screening for gestational diabetes: a systematic review and economic evaluation

Better than nothing? maternal, newborn, and child health services and perinatal mortality, Lubumbashi, democratic republic of the Congo: a cohort study

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