Evidence for the utility of antenatal HbA1c to predict early postpartum diabetes after gestational diabetes in South Africa

Coetzee, André; Mason, Deidre; Hall, David; Hoffmann, Monika

doi:10.1016/j.diabres.2018.06.021

Cited by 11 publications

(12 citation statements)

References 24 publications

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“…A maioria dos participantes dos estudos foram mulheres que apresentaram hiperglicemia durante o período gestacional 4,5,6,7 ou receberam diagnóstico de diabetes mellitus gestacional, 8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31 sendo que em apenas dois 32,30 dos estudos, foi avaliado também pacientes sem essas condições, a título de comparação. Alguns estudos mostraram a importância de se utilizar mais de um exame laboratorial como forma de diagnosticar hiperglicemia e diabetes mellitus gestacional.…”

Section: Resultsunclassified

Persistência Hiperglicêmica No Pós Parto

Almeida¹,

Kunzendorff²,

Motté³

et al. 2021

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Introdução: analisar a persistência de hiperglicemia no pós parto em pacientes com histórico de diabetes mellitus gestacional. Metodologia: Revisão sistemática no Pubmed e Scopus, usando ensaios clínicos randomizados, dos últimos 10 anos (Pubmed), 20 anos (Scopus) em inglês. Com descritores: Post partum period AND Diabetes mellitus, gestational AND Hyperglicemia e Diabetes AND Mellitus AND Gestation AND Puerperium AND Hyperglicemia. Resultados: Os estudos demonstraram a importância de se utilizar mais de um método diagnóstico para DMG. As medidas não farmacológicas de mudanças de estilo de vida se mostram suficientes na maioria das pacientes. Discussão: Outros estudos levantaram questões como a necessidade de utilização de mais de um teste para diagnosticar tais condições patológicas, níveis elevados de proteína C reativa, hiperglicemia gestacional, níveis elevados de triglicerídeos, fatores étnicos, histórico familiar, tratamento e ganho excessivo de peso, sendo alguns consoantes e outros dissonantes em relação aos resultados dos estudos selecionados pelo presente artigo. Conclusão: Faz-se necessário uma padronização de um diagnóstico eficaz e propostas de intervenção com melhor evolução para a paciente, além de realizar avaliação individual, nos quesitos ambientais étnicos, história pregressa do paciente e histórico familiar da doença, a fim de predizer as suas chances de cursar com doença gestacional.

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Section: Resultsunclassified

Persistência Hiperglicêmica No Pós Parto

Almeida¹,

Kunzendorff²,

Motté³

et al. 2021

bjdv

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“…The prevalence of abnormal glucose homeostasis after HFDP in South Africa is high, with recent reported figures ranging between 40–46% [ 22 ] The poor attendance rates of the recommended 4–12 weeks postpartum assessments globally, argues against the convenience of this visit for mothers who prioritize the care of their new-born at this time. This problem is reflected locally with a low retention rate at Tygerberg Hospital of ~30% despite an established electronic reminder strategy directed at all patients with HFDP (reminders via SMS or WhatsApp calls) [ 15 ] . The ability, therefore, to identify women with HFDP at highest risk for sustained glucose abnormalities, during delivery hospitalization could reduce the need for early postpartum assessment and enable clinicians to direct resources towards those most in need.…”

Section: Discussionmentioning

confidence: 99%

“…Early identification of T2DM in its asymptomatic state in high risk women diagnosed with HFDP is of paramount importance, but this opportunity is thwarted by low uptake for postpartum screening [15]. Innovative and pragmatic strategies are required to bridge the gap between the need for postpartum evaluation and sub-optimal follow-up in this high risk group.…”

Section: Introductionmentioning

confidence: 99%

“…The postpartum glucose evaluation compliments antenatal glucose control, allows for timeous interventions to delay T2DM or provides an opportunity for early diagnosis and prevention of complications of pre-existing T2DM [ 9 , 10 , 13 ] . The timing of the 4–12 week postpartum OGTT appears to have been chosen for convenience [ 14 ], but poor attendance rates globally argue against the convenience of this visit for mothers who prioritize the care of their new-born including immunisation at this time, a problem reflected locally [ 15 ] . Primary health care facilities in South Africa tasked with immunization of babies at 6 weeks only offer postpartum glucose testing in the context of a clinical research setting.…”

Section: Introductionmentioning

confidence: 99%

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Utility of in-hospital post-delivery fasting plasma glucose to predict postpartum glucose status in women with hyperglycaemia first detected in pregnancy: A prospective cohort study

et al. 2020

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Background Women with hyperglycaemia first detected in pregnancy (HFDP), including those with gestational diabetes mellitus (GDM), should undergo a glucose evaluation 4-12 weeks after delivery. Globally, suboptimal postpartum return rates limit the opportunity to intervene in women with sustained hyperglycaemia and pragmatic solutions should be sought to bridge this gap. Objective To assess the utility of postpartum in-hospital glucose evaluation to predict the outcome of the oral glucose tolerance test (OGTT) performed 4-12 weeks after delivery. Methods The study was performed prospectively at Tygerberg Hospital, Cape Town, South Africa. Women with HFDP, classified as GDM based on the modified National Institute for Health and Care Excellence criteria, who delivered between November 2018 and June 2019 were included in the study. Fasting plasma glucose (FPG) was performed 24-72 hours after delivery (t1) in the postnatal ward, provided glucose lowering medication was discontinued at delivery. An OGTT 4-12 weeks postpartum (t2) was scheduled for the total cohort. We compared glucose values and glucose categories at t1 and t2 and evaluated antenatal characteristics of women who returned, compared to the group that was lost to follow-up. Results In-hospital post-delivery glucose assessment (t1) was performed in 115 women. Glucose levels were significantly lower at t1 compared to antenatal diagnostic values (t0) and

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“…Women may be advised to monitor capillary blood glucose at home if they have persistent hyperglycemia after delivery in the immediate postpartum period or had high insulin requirements during pregnancy. [ 13 70 ] These women can be monitored via telemedicine services for continued care. RCOG and Australian guidelines recommend HbA1c for screening instead of OGTT at 3-6 months.…”

Section: Postpartum Care and Screening For Diabetes In Women With Gdmmentioning

confidence: 99%

Clinical practice recommendations for the detection and management of hyperglycemia in pregnancy from South Asia, Africa and Mexico during COVID-19 pandemic

Priya

Bajaj

Kalra³

et al. 2021

J Family Med Prim Care

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The human coronavirus disease 2019 (COVID-19) pandemic has affected overall healthcare delivery, including prenatal, antenatal and postnatal care. Hyperglycemia in pregnancy (HIP) is the most common medical condition encountered during pregnancy. There is little guidance for primary care physicians for providing delivery of optimal perinatal care while minimizing the risk of COVID-19 infection in pregnant women. This review aims to describe pragmatic modifications in the screening, detection and management of HIP during the COVID- 19 pandemic. In this review, articles published up to June 2021 were searched on multiple databases, including PubMed, Medline, EMBASE and ScienceDirect. Direct online searches were conducted to identify national and international guidelines. Search criteria included terms to extract articles describing HIP with and/or without COVID-19 between 1 st March 2020 and 15 th June 2021. Fasting plasma glucose, glycosylated hemoglobin (HbA1c) and random plasma glucose could be alternative screening strategies for gestational diabetes mellitus screening (at 24–28 weeks of gestation), instead of the traditional 2 h oral glucose tolerance test. The use of telemedicine for the management of HIP is recommended. Hospital visits should be scheduled to coincide with obstetric and ultrasound visits. COVID-19 infected pregnant women with HIP need enhanced maternal and fetal vigilance, optimal diabetes care and psychological support in addition to supportive measures. This article presents pragmatic options and approaches for primary care physicians, diabetes care providers and obstetricians for GDM screening, diagnosis and management during the pandemic, to be used in conjunction with routine antenatal care.

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Evidence for the utility of antenatal HbA1c to predict early postpartum diabetes after gestational diabetes in South Africa

Cited by 11 publications

References 24 publications

Persistência Hiperglicêmica No Pós Parto

Persistência Hiperglicêmica No Pós Parto

Utility of in-hospital post-delivery fasting plasma glucose to predict postpartum glucose status in women with hyperglycaemia first detected in pregnancy: A prospective cohort study

Clinical practice recommendations for the detection and management of hyperglycemia in pregnancy from South Asia, Africa and Mexico during COVID-19 pandemic

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