Evidence‐based screening for gestational diabetes?

Hadden, David R.

doi:10.1046/j.1464-5491.2000.00292-7.x

Cited by 10 publications

(4 citation statements)

References 3 publications

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“…Thus, there is a need for additional randomized controlled trials in order to obtain substantial evidence for the benefit of different interventional strategies in pregnancies complicated by gestational diabetes (21). A worldwide prospective multicenter study of 25,000 women with untreated carbohydrate intolerance (2‐hour blood glucose of 7.8–11.0 mmol/l and fasting blood glucose of 5.8 mmol/l or less during a 2‐hour 75 g OGTT performed after 8 gestational weeks) is in progress (25). This study, called HAPO (Hyperglycemia and Adverse Pregnancy Outcome), might hopefully add to our knowledge of treatment in GDM pregnancies.…”

Section: Discussionmentioning

confidence: 99%

Perinatal complications in women with gestational diabetes mellitus

Svare

Hansen

Mølsted‐Pedersen

2001

Acta Obstet Gynecol Scand

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This study of women with gestational diabetes mellitus and non-diabetic pregnant women showed that gestational diabetes mellitus was associated with a significantly lower gestational age at delivery and an increased rate of admission to the neonatal ward. Women diagnosed with GDM before 20 weeks of gestation had an increased need for insulin treatment during pregnancy and a high risk of subsequent overt DM, compared with women diagnosed with GDM later in pregnancy.

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Section: Discussionmentioning

confidence: 99%

Perinatal complications in women with gestational diabetes mellitus

Svare

Hansen

Mølsted‐Pedersen

2001

Acta Obstet Gynecol Scand

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“…There is an ongoing worldwide study, the Hyperglycemia and Adverse Perinatal Outcome (HAPO) (16), which aims to include a group of 25,000 women in which those with IGT will remain untreated (fasting blood glucose level Յ5.8 mmol/l and 2-h blood glucose level 7.8 -11.0 mmol/l). There are hitherto no data published from that study.…”

Section: Research Design Andmentioning

confidence: 99%

Maternal and Fetal Outcomes if Gestational Impaired Glucose Tolerance Is Not Treated

et al. 2003

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OBJECTIVE -To evaluate whether there is increased maternal or neonatal morbidity in connection with impaired glucose tolerance (IGT) during pregnancy when the condition is not treated. RESEARCH DESIGN AND METHODS-During the study period of 1997-2001, in a defined geographical area in Sweden, the diagnostic criteria for gestational diabetes mellitus (GDM) were limited to the criteria for diabetes. Prospectively, 213 women who were identified with IGT during pregnancy were undiagnosed and untreated. Data on maternal and fetal outcome was collected from records. For each case subject, four control subjects were taken from the same delivery department.RESULTS -The proportion of women who underwent cesarean section was significantly higher in the case subjects than in the control subjects and was independently associated with IGT. The adjusted odds ratio (OR) was 1.9 (95% CI 1.2-2.9). The proportion of infants who were large for gestational age (LGA), defined as birth weight Ͼ2 SDs greater than the mean for gestation and sex, was independently significantly associated with untreated IGT during pregnancy (OR 7.3, 95% CI 4.1-12.7). Admission to a neonatal intensive care unit (NICU) for 2 days or longer was more common (adjusted OR 2.0, 95% CI 1.1-3.8). However, 71.3% of the children in the IGT group and 87.3% of the control subjects had no neonatal complications.CONCLUSIONS -There is increased independent association between cesarean section rate, prematurity, LGA, and macrosomic infants born to mothers with untreated IGT. Most of the children were healthy, but there is still increased morbidity. Therefore, to evaluate the effects of treatment, there is a need for a randomized study. Diabetes Care 26:2107-2111, 2003G estational diabetes mellitus (GDM) is defined as carbohydrate intolerance of varying degrees of severity with onset or first recognition during pregnancy (1). Originally, the purpose of identifying GDM was the prediction of diabetes later in life (2). Observations that GDM may be associated with an increased risk of fetal malformation and perinatal mortality are likely to be confined to a subgroup of patients with GDM in whom diabetes was present but unrecognized before pregnancy (3,4). Later, the main purpose was to detect women at risk for adverse perinatal outcomes, such as macrosomia, birth trauma, neonatal metabolic abnormalities, and cesarean section (5). In the past decade, however, screening for GDM has been strongly questioned because of the lack of convincing data regarding the possibility to improve these outcomes. Risks associated with GDM have also been attributed to confounding characteristics such as obesity, advanced maternal age, or other medical complications, rather than to the glucose intolerance per se. Identification of impaired glucose tolerance (IGT) during pregnancy has especially been questioned (6 -8).Maternal and fetal complications associated with GDM are often reported from observational studies in which GDM is identified and treated in different ways (9 -11). There is, howeve...

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“…Die Grenzwerte werden nach Veröffentlichung der weltweiten multizentrischen HAPO-Studie (Hyperglycemia, and Adverse Perinatal Outcome) bestätigt bzw. modifiziert und korrigiert werden [60,61].…”

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Diabetes-Screening in der Schwangerschaft

Bancher‐Todesca¹,

Leipold²,

Husslein³

et al. 2003

Geburtshilfe Frauenheilkd

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ZusammenfassungDer Gestationsdiabetes (GDM) wird auch die verborgene Epidemie genannt, da er ohne generelles Screening zumeist nicht erkannt wird. Von vielen Fachgesellschaften wird daher ein generelles Screening gefordert. Die Deutsche Gesellschaft für Geburtshilfe und Gynäkologie hat Anfang 2001 in Gemeinschaft mit der Deutschen Diabetesgesellschaft und der Deutschen Gesellschaft für perinatale Medizin eine Empfehlung zu einem generellen Screening mittels eines 75 g oGTT zwischen der 24. ± 28. SSW herausgegeben. Mutmaûlich werden in Europa ohne Screening weniger als 10% der Fälle aufgedeckt. Ein unerkannter GDM ist jedoch eine Bedrohung der Schwangerschaft, sein Anteil an der generellen perinatalen Mortalität beträgt zumindest 1/ 1000. Bei unerkanntem und unbehandeltem GDM entwickeln die Kinder bereits im Mutterleib eine Störung ihrer Insulinhomöostase, die ihrerseits eine erhöhte Diabetesneigung dieser Kinder im späteren Leben verursacht. Darüber hinaus ist die Schwangerschaft eine besondere physiologische Situation, die es ermöglicht, eine spätere Diabetesneigung der Frauen frühzeitig zu erkennen. Dies ist von groûer volksgesundheitlicher Bedeutung, da Präventiv-und Früherkennungsmaûnahmen ergriffen werden können. Es muss daher ein generelles Screening nach Glukosetoleranzstörungen in der Schwangerschaft gefordert werden. AbstractGestational diabetes has been referred to as a hidden epidemic. It is estimated that less than 10 % of cases are detected in Europe without generalized screening. But untreated gestational diabetes and disturbed insulin homeostasis in utero is a risk factor for perinatal morbidity and accounts for at least 1/1000 of overall perinatal mortality. Furthermore, offspring of pregnancies complicated by diabetes have a predisposition to diabetes in adolescence and adulthood. Pregnancy is also a unique physiologic opportunity to identify increased maternal risk for diabetes later in life. This is significant from a public health perspective, because preventive measures can be taken. Accordingly, in 2001 the German Society of Obstetrics and Gynecology recommended screening all pregnant women with a 75-g oral glucose tolerance test between the 24th and the 28th weeks of gestation.

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Evidence‐based screening for gestational diabetes?

Cited by 10 publications

References 3 publications

Perinatal complications in women with gestational diabetes mellitus

Perinatal complications in women with gestational diabetes mellitus

Maternal and Fetal Outcomes if Gestational Impaired Glucose Tolerance Is Not Treated

Diabetes-Screening in der Schwangerschaft

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