Diabetes in pregnancy: management of diabetes and its complications from preconception to the postnatal period (NG3)

Webber, Jonathan; Charlton, M.; Johns, Nina

doi:10.15277/bjdvd.2015.029

Cited by 70 publications

(54 citation statements)

References 4 publications

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“…Other associations such as the “International Federation of Gynecology and Obstetrics” (FIGO) recommend to screen universally in early pregnancy for diabetes and GDM [ 5 ]. In contrast, the “National Institute for Health and Care Excellence” recommends screening for early GDM if there are risk factors present, such as obesity, previous history of GDM, family history of diabetes (first-degree relative), previous macrocosmic baby or an ethnicity with a high prevalence of diabetes [ 6 ]. Early testing for overt diabetes will lead to the identification of hyperglycemia under the threshold of overt diabetes.…”

Section: Introductionmentioning

confidence: 99%

Screening for Gestational Diabetes Mellitus in Early Pregnancy: What Is the Evidence?

Raets

Beunen

Benhalima

2021

JCM

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The incidence of gestational diabetes mellitus (GDM) is increasing worldwide. This has a significant effect on the health of the mother and offspring. There is no doubt that screening for GDM between 24 and 28 weeks is important to reduce the risk of adverse pregnancy outcomes. However, there is no consensus about diagnosis and treatment of GDM in early pregnancy. In this narrative review on the current evidence on screening for GDM in early pregnancy, we included 37 cohort studies and eight randomized controlled trials (RCTs). Observational studies have shown that a high proportion (15–70%) of women with GDM can be detected early in pregnancy depending on the setting, criteria used and screening strategy. Data from observational studies on the potential benefit of screening and treatment of GDM in early pregnancy show conflicting results. In addition, there is substantial heterogeneity in age and BMI across the different study populations. Smaller RCTs could not show benefit but several large RCTs are ongoing. RCTs are also necessary to determine the appropriate cut-off for HbA1c in pregnancy as there is limited evidence showing that an HbA1c ≥6.5% has a low sensitivity to detect overt diabetes in early pregnancy.

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Section: Introductionmentioning

confidence: 99%

Screening for Gestational Diabetes Mellitus in Early Pregnancy: What Is the Evidence?

Raets

Beunen

Benhalima

2021

JCM

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“…GDM has been estimated to affect around 1-14% of all pregnant women, depending on the diagnostic test employed and the population studied (American Diabetes Association 2013), being higher in Asian population (Chawla et al 2006;Ferrara et al 2004). However, most guidelines and recommendations for the detection of GDM suggest screening for GDM at 24-28 weeks of gestation, because current evidence is not sufficient for advising it before 24 weeks of gestation in asymptomatic pregnant (Webber et al 2015;Moyer 2014;Thompson et al 2013; American College of Obstetricians and Gynecologists 2013; Blumer et al 2013). Therefore, early detection of the risk of developing GDM would be of great importance for its prevention and the health consequences associated with it.…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, early detection of the risk of developing GDM would be of great importance for its prevention and the health consequences associated with it. However, most guidelines and recommendations for the detection of GDM suggest screening for GDM at 24-28 weeks of gestation, because current evidence is not sufficient for advising it before 24 weeks of gestation in asymptomatic pregnant (Webber et al 2015;Moyer 2014;Thompson et al 2013; American College of Obstetricians and Gynecologists 2013; Blumer et al 2013).…”

Section: Introductionmentioning

confidence: 99%

Elevated iron status and risk of gestational diabetes mellitus: A systematic review and meta‐analysis

Fernández‐Cao

Aranda

Ribot

et al. 2016

Maternal & Child Nutrition

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The aim of this systematic review and meta-analysis of observational studies was to assess the relationship between elevated iron status, measured as hemoglobin and ferritin levels, and the risk of gestational diabetes mellitus (GDM). The present study was recorded in PROSPERO (2013:CRD42013005717). The selected studies were identified through a systematic review of scientific literature published in The Cochrane Library and PubMed/MEDLINE databases from their inception until March 10, 2016, in addition to citation tracking and hand-searches. The search strategy of original articles combined several terms for hemoglobin, ferritin, pregnancy, and GDM. OR and 95% CI of the selected studies were used to identify associations between hemoglobin and/or ferritin levels with the risk of GDM. Summary estimates were calculated by combining inverse-variance using fixed-effects model. 2468 abstracts were initially found during the search. Of these, 11 with hemoglobin and/or ferritin data were selected for the meta-analyses. We observed that high hemoglobin (OR = 1.52; 95% CI: 1.23-1.88), as well as ferritin (OR = 2.09; 95% CI: 1.48-2.96) levels were linked to an increased risk of GDM. Low heterogeneity was observed in hemoglobin (I = 33.3%, P = 0.151) and ferritin (I = 0.7%, P = 0.418) meta-analyses, respectively. Publication bias was not appreciated. High hemoglobin or ferritin levels increase the risk of GDM by more than 50% and more than double, respectively, in the first and third trimester. Therefore, determining of hemoglobin or ferritin concentration in early pregnancy might be a useful tool for recognizing pregnant women at risk of GDM.

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“…1 The IADPSG diagnostic criteria have been adopted by the World Health Organization (WHO), the International Federation of Gynaecology and Obstetrics (FIGO), 7 the International Diabetes Federation (IDF), 8 and many countries internationally (e.g., the Australasian Diabetes in Pregnancy Society [ADIPS] 9 ). However, other approaches to the criteria include the HAPO adjusted odds ratio of 2 for adverse outcomes (used in Canada, for example) 10 and locally developed criteria (used in England), 11 while the American Diabetes Association (ADA) 12 accepts both the American College of Obstetricians and Gynecologists (ACOG) 13 and IADPSG diagnostic criteria. Moreover, there remains diversity in screening practice to identify those who require an OGTT (if not universal), including risk factor screening and the 50 g glucose challenge test which misses relative fasting hyperglycaemia, a better correlate of adverse pregnancy outcomes.…”

Section: Challenges In Gestational Diabetes Mellitus Screening and Diagnosismentioning

confidence: 99%

Continuing Challenges in The Medical Management of Gestational Diabetes Mellitus

2020

EMJ Diabet

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The management of gestational diabetes mellitus (GDM) involves screening (or universal testing), a diagnostic oral glucose tolerance test, patient counselling/education, gestational weight management and medical nutrition therapy, and self-monitoring of blood glucose levels with regular glycaemia reviews. This is in addition to pharmacological treatment, often insulin therapy, if glycaemia is above target. Females with GDM receive more frequent ultrasound testing to assess fetal growth, and birth is planned and not usually allowed to go much past term. A range of challenges continue to arise in GDM management including screening approaches and diagnostic criteria, dealing with the increasing numbers of females diagnosed, weight and glycaemic targets, the long-term safety of oral antihyperglycaemic agents for the offspring, particularly metformin, and adjunct medication for complication prevention. GDM management involves additional complexities including differentiating between those with likely undiagnosed Type 2 diabetes mellitus (diabetes in pregnancy), how to manage females with high glucose early in pregnancy less than diabetes in pregnancy, and identifying females with rare causes, for example monogenic diabetes or new Type 1 diabetes mellitus in pregnancy. While the management of GDM has evolved from identifying females at high risk of progressing to Type 2 diabetes mellitus, to greater focus on improving pregnancy outcomes, females with prior GDM and their offspring have the highest need for follow-up and prevention strategies. To date, follow-up and intervention remains limited for this high-risk group for both diabetes and cardiovascular disease. Follow-up in these females is particularly important for the next pregnancy, especially as GDM prevention from the second trimester onwards remains another continuing challenge.

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Diabetes in pregnancy: management of diabetes and its complications from preconception to the postnatal period (NG3)

Cited by 70 publications

References 4 publications

Screening for Gestational Diabetes Mellitus in Early Pregnancy: What Is the Evidence?

Screening for Gestational Diabetes Mellitus in Early Pregnancy: What Is the Evidence?

Elevated iron status and risk of gestational diabetes mellitus: A systematic review and meta‐analysis

Continuing Challenges in The Medical Management of Gestational Diabetes Mellitus

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