Evidence to support the classification of hyperglycemia first detected in pregnancy to predict diabetes 6–12 weeks postpartum: A single center cohort study

Coetzee, André; Sadhai, Nishendra; Mason, Deidre; Hall, David

doi:10.1016/j.diabres.2020.108421

Cited by 7 publications

(14 citation statements)

References 27 publications

(24 reference statements)

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“…This condition precedes pregnancy and persists after delivery. The finding that one in four South African women with HFDP has T2DM 6-12 weeks after delivery also bears witness that, in women of childbearing age, diabetes often goes undetected at the primary healthcare level until formally assessed during pregnancy (38,78).…”

Section: Local Screening Guidelinesmentioning

confidence: 95%

Hyperglycemia First Detected in Pregnancy in South Africa: Facts, Gaps, and Opportunities

Coetzee

Hall²,

Conradie³

2022

Front. Clin. Diabetes Healthc.

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This review contextualizes hyperglycemia in pregnancy from a South-African perspective. It aims to create awareness of the importance of hyperglycemia in pregnancy in low-middle-income countries. We address unanswered questions to guide future research on sub-Saharan African women with hyperglycemia first detected in pregnancy (HFDP). South African women of childbearing age have the highest prevalence of obesity in sub-Saharan Africa. They are predisposed to Type 2 diabetes (T2DM), the leading cause of death in South African women. T2DM remains undiagnosed in many African countries, with two-thirds of people living with diabetes unaware. With the South African health policy’s increased focus on improving antenatal care, women often gain access to screening for non-communicable diseases for the first time in pregnancy. While screening practices and diagnostic criteria for gestational diabetes mellitus (GDM) differ amongst geographical areas in South Africa (SA), hyperglycemia of varying degrees is often first detected in pregnancy. This is often erroneously ascribed to GDM, irrespective of the degree of hyperglycemia and not overt diabetes. T2DM and GDM convey a graded increased risk for the mother and fetus during and after pregnancy, with cardiometabolic risk accumulating across the lifespan. Resource limitations and high patient burden have hampered the opportunity to implement accessible preventative care in young women at increased risk of developing T2DM in the broader public health system in SA. All women with HFDP, including those with true GDM, should be followed and undergo glucose assessment postpartum. In SA, studies conducted early postpartum have noted persistent hyperglycemia in a third of women after GDM. Interpregnancy care is advantageous and may attain a favourable metabolic legacy in these young women, but the yield of return following delivery is suboptimal. We review the current best evidence regarding HFDP and contextualize the applicability in SA and other African or low-middle-income countries. The review identifies gaps and shares pragmatic solutions regarding clinical factors that may improve awareness, identification, diagnosis, and management of women with HFDP.

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Section: Local Screening Guidelinesmentioning

confidence: 95%

Hyperglycemia First Detected in Pregnancy in South Africa: Facts, Gaps, and Opportunities

Coetzee

Hall²,

Conradie³

2022

Front. Clin. Diabetes Healthc.

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“…Guidelines recommend screening at 4–12 weeks postpartum for timely T2D prevention and treatment, which coincides with timing for the standard postpartum medical visit. Several alternative approaches to the type and timing of postpartum screening have been examined,5–7 in addition to studies examining the use of pregnancy glucose levels to predict postpartum diabetes risk 8–10. However, the OGTT remains the gold standard for detecting postpartum abnormalities.…”

Section: Introductionmentioning

confidence: 99%

“…Several alternative approaches to the type and timing of postpartum screening have been examined, [5][6][7] in addition to studies examining the use of pregnancy glucose levels to predict postpartum diabetes risk. [8][9][10] However, the OGTT remains the gold standard for detecting postpartum abnormalities. Despite clinical guidelines, uptake of timely postpartum screening after GDM is suboptimal.…”

mentioning

confidence: 99%

Uptake of guideline-recommended postpartum diabetes screening among diverse women with gestational diabetes: associations with patient factors in an integrated health system in the USA

Brown

Hedderson

Zhu

et al. 2022

BMJ Open Diab Res Care

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IntroductionClinical guidelines urge timely postpartum screening for diabetes among women with gestational diabetes mellitus (GDM), yet patient factors associated with screening uptake remain unclear. We aimed to identify patient factors associated with completed postpartum diabetes screening (2-hour oral glucose tolerance test within 4–12 weeks postpartum), as recommended by the American Diabetes Association (ADA).Research design and methodsWithin the context of Gestational Diabetes’ Effects on Moms (GEM), a pragmatic cluster randomized trial (2011–2012), we examined survey and electronic health record data to assess clinical and sociodemographic factors associated with uptake of ADA-recommended postpartum screening. Participants included 1642 women (76% racial/ethnic minorities) identified with GDM according to the Carpenter and Coustan criteria in a health system that deploys population-level strategies to promote screening. To contextualize these analyses, screening rates derived from the GEM trial were compared with those in the health system overall using registry data from a concurrent 10-year period (2007–2016, n=21 974).ResultsOverall 52% (n=857) completed recommended postpartum screening in the analytic sample, comparable to 45.7% (n=10 040) in the registry. Screening in the analytic sample was less likely among women at elevated risk for type 2 diabetes, assessed using items from an ADA risk test (vs non-elevated; adjusted rate ratio (aRR)=0.86 (95% CI 0.75 to 0.98)); perinatal depression (0.88 (0.79 to 0.98)); preterm delivery (0.84 (0.72 to 0.98)); parity ≥2 children (vs 0; 0.80 (0.69 to 0.93)); or less than college education (0.79 (0.72 to 0.86)). Screening was more likely among Chinese Americans (vs White; 1.31 (1.15 to 1.49)); women who attended a routine postpartum visit (5.28 (2.99 to 9.32)); or women who recalled receiving healthcare provider advice about screening (1.31 (1.03 to 1.67)).ConclusionsGuideline-recommended postpartum diabetes screening varied by patient clinical and sociodemographic factors. Findings have implications for developing future strategies to improve postpartum care.

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“…The type and severity of maternal valvular illness and the ensuing anomalies of functional capacity left ventricular function, and pulmonary pressure is related to the chance of a poor outcome. (Coetzee et al, 2020)Clinical recommendations for individuals with valvular heart disease during pregnancy are based on sparse information from case reports and observational research, or inferences drawn from information for patients in other patient groups. A normal pregnancy is associated with an increase in cardiac output of 30 to 50% and a 30 to 50% increase in blood volume.…”

Section: Introductionmentioning

confidence: 99%

The Effect of Valvular Heart Disease on Maternal and Fetal Outcome of Pregnancy in Young Pregnant Females

Altaf¹,

Faiz²,

Badalyan³

et al. 2022

PJMHS

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Objective: The objective of this study is to determine the effect of valvular heart disease on maternal and fetal outcomes of pregnancy in young pregnant females Study design: Retrospective study Methodology: A retrospective study was conducted to get an analysis of 321 healthy women and 312 women with valvular heart disease who received care at a tertiary care hospital during the same time period and compared the results of their pregnancies. The chi (2)-test was used for statistical analysis, with a significance set at 0.05. Results: n comparison to women in the control group, women with valvular heart disease had significantly higher rates of congestive heart failure (5.1 percent vs. 0 percent, P0.001), mortality (0.64% [two women] vs. 0 percent), and surgical interventions during pregnancy (13.4 percent (balloon mitral valvotomy) vs. 0.6 percent [ovarian cystectomy Additionally, the perinatal outcome was worse in the valvular heart disease group than in the control group, with higher preterm delivery rates (48.3 percent vs. 20.5 percent), lower birth weights (2434+/-599 g vs. 2653+/-542 g; P0.001), and a higher incidence of APGAR scores below 8 (8.3 percent vs. 4 percent; P0.01). Additionally, the rate of instrumental delivery increased (9.9 percent vs. 3.4 percent). The proportion of cesarean deliveries, however, was comparable across the two groups. Conclusion: In conclusion, there is a substantial link between valvular heart disease and maternal and neonatal mortality. Close fetal and maternal monitoring are required, and valvular stenosis should be repaired before conception. To avoid difficulties for both the mother and the fetus, balloon valvuloplasty should be taken into consideration in cases of severe stenosis during the second trimester of pregnancy. The hospitals that deal with heart illness and pregnancy should create practical recommendations. Keywords: Valvular heart disease (VHD), Pregnancy outcome; maternal outcome; Fetal outcome, young pregnant.

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Evidence to support the classification of hyperglycemia first detected in pregnancy to predict diabetes 6–12 weeks postpartum: A single center cohort study

Cited by 7 publications

References 27 publications

Hyperglycemia First Detected in Pregnancy in South Africa: Facts, Gaps, and Opportunities

Hyperglycemia First Detected in Pregnancy in South Africa: Facts, Gaps, and Opportunities

Uptake of guideline-recommended postpartum diabetes screening among diverse women with gestational diabetes: associations with patient factors in an integrated health system in the USA

The Effect of Valvular Heart Disease on Maternal and Fetal Outcome of Pregnancy in Young Pregnant Females

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