Early diagnosis of gestational diabetes mellitus and prevention of diabetes-related complications

Bartha, José Luis; Martinez-Del-Fresno, Pilar; Comino-Delgado, Rafael

doi:10.1016/s0301-2115(02)00480-3

Cited by 84 publications

(59 citation statements)

References 8 publications

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“…Although the true prevalence of early GDM is unknown, due to the differing diagnostic criteria used and the population screened, our rate of ;30% is consistent with those of other studies reporting early GDM prevalence in both unselected and high-risk cohorts of 29-42% (23,28-30), although, notably, rates have been as high as 62-66% in certain high-risk populations (25,31). Thus, early GDM is a frequent finding, and the application of systematic testing in early pregnancy will identify a substantial number of women and potentially affect their pregnancy outcomes.…”

Section: Discussionsupporting

confidence: 89%

“…This showed that women in whom GDM was diagnosed early (before 24 weeks of gestation) were more likely to be hypertensive, to have poorer glycemic control, and to have greater need for insulin therapy, with all cases of neonatal morbidity and mortality occurring in this cohort (23). Similar findings have been reported in retrospective cohort studies (24)(25)(26)(27); however, all these studies were limited by the heterogeneity of their early GDM cohorts. In contrast, our data, by removing the confounder of pre-existing diabetes from the early-onset cohort, convincingly demonstrate that early GDM per se in high-risk women represents a particularly high-risk subset.…”

Section: Discussionsupporting

confidence: 76%

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Gestational Diabetes Mellitus in Early Pregnancy: Evidence for Poor Pregnancy Outcomes Despite Treatment

et al. 2015

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OBJECTIVERecent guidelines recommend testing at <24 weeks of gestation for maternal dysglycemia in "high-risk" women. Evidence to support the early identification and treatment of gestational diabetes mellitus (GDM) is, however, limited. We examined the prevalence, clinical characteristics, and pregnancy outcomes of high-risk women with GDM diagnosed at <24 weeks of gestation (early GDM) and those with pre-existing diabetes compared with GDM diagnosed at ‡24 weeks of gestation, in a large treated multiethnic cohort. RESEARCH DESIGN AND METHODSOutcomes from 4,873 women attending a university hospital antenatal diabetes clinic between 1991 and 2011 were examined. All were treated to standardized glycemic targets. Women were stratified as pre-existing diabetes (n = 65) or GDM diagnosed at <12 weeks of gestation (n = 68), at 12-23 weeks of gestation (n = 1,247), or at ‡24 weeks of gestation (n = 3,493). RESULTSHypertensive disorders in pregnancy including pre-eclampsia, preterm delivery, cesarean section, and neonatal jaundice (all P < 0.001) were more prevalent in women with pre-existing diabetes and early GDM. Macrosomia (21.8% vs. 20.3%, P = 0.8), large for gestational age (39.6% vs. 32.8%, P = 0.4), and neonatal intensive care admission (38.5% vs. 39.7%, P = 0.9) in women in whom GDM was diagnosed at <12 weeks of gestation were comparable to rates seen in women with pre-existing diabetes. CONCLUSIONSDespite early testing and current best practice treatment, early GDM in high-risk women remains associated with poorer pregnancy outcomes. Outcomes for those in whom GDM was diagnosed at <12 weeks of gestation approximated those seen in pre-existing diabetes. These findings indicate the need for further studies to establish the efficacy of alternative management approaches to improve outcomes in these high-risk pregnancies.Gestational diabetes mellitus (GDM) is associated with significant transgenerational maternal and neonatal morbidity (1-3). The prevalence of GDM is rising, in part reflecting the changing demographics of women of childbearing age, with an increasing incidence of both obesity and advanced maternal age (4-6). These observations have important implications for the current GDM testing paradigm.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 76%

Gestational Diabetes Mellitus in Early Pregnancy: Evidence for Poor Pregnancy Outcomes Despite Treatment

et al. 2015

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“…GDM diagnosis may not be missed by screening around 24 -28 weeks of gestation, but a substantial number of pregnant women who develop GDM in the earlier weeks of pregnancy are likely to have delayed diagnosis and may not receive appropriate medical care. Further, early screening for glucose intolerance and care could avoid some diabetes related complications in women with gestational diabetes (Bartha et al, 2003). To substantiate the above observation the present author's group screened 207 pregnant women attending their referral centre for diabetes and pregnancy with a 75g OGTT .…”

Section: Gestational Weeks For Screeningmentioning

confidence: 88%

Gestational Diabetes Mellitus - A Perspective

Seshiah¹,

Balaji²,

Balaji³

2011

Gestational Diabetes

216

287

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“…Detection of women at higher risk for adverse pregnancy outcomes early in pregnancy is a desirable goal because interventions such as diet, medication, and exercise may be applied earlier and have a positive effect on maternal and fetal outcomes (7)(8)(9). Therefore, we wanted to evaluate, retrospectively, the associations between fasting glucose level in the first trimester within what is currently considered normoglycemia and adverse pregnancy outcomes.…”

mentioning

confidence: 99%

“…Indeed, a small study (9) found that first-trimester screening and therapy in women at high risk for GDM result in appropriate-for-gestational-age newborns. Another study (7) has showed that early glucose tolerance screening could prevent some diabetes-related complications in women with GDM. Also, several large population studies (18 -21) found that excessive weight gain during pregnancy, especially in overweight and obese pregnant women, greatly increases their risks for adverse pregnancy outcomes, including LGA infants and cesarean delivery.…”

mentioning

confidence: 99%