Insulin Therapy in Gestational Diabetes

Pantea‐Stoian, Anca; Stoica, Roxana Adriana; Stefan, Simona

doi:10.5772/intechopen.84569

Cited by 4 publications

(4 citation statements)

References 86 publications

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“…Routine blood pressure measurement in pregnancy is accessible and allow an early diagnosis and management of preeclampsia symptoms [46]. There are several risk factors, that can be easily identified at first prenatal visit, that are statistically related with the development of preeclampsia [47,48] [53], so the detailed anamnesis remains the only pertinent predictive tool, being more sensitive than any laboratory or imaging screening test [54].…”

Section: Preeclampsia-predictionmentioning

confidence: 99%

The Role of Anticoagulant Therapy in the Prevention of Preeclampsia Pharmacokinetic and pharmacodynamic mechanisms

Ţurcan¹,

Bohîlțea²,

Neacşu³

et al. 2019

Rev. Chim.

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Pregnancies complicated with preeclampsia associate a high incidence of intrauterine fetal death, intrauterine growth restriction, premature ruptures of membranes, abruption placentae and prematurity. Understanding the pathogenesis of preeclampsia is mandatory for a correct approach and prevention management of high risk cases. Placental hypoperfusion seems to be a key factor in developing systemic resounding. By placental necrosis and apoptosis, cell-free DNA is released in maternal circulation in early pregnancy, respectively prior 17 weeks of gestation. There is no test, useful in early pregnancy, accurate enough to predict preeclampsia. Various screening test have been proposed in order to predict the development of preeclampsia, but most of them are not sufficiently accurate for general screening. There is a continuous debate regarding the algorithm of administration, doses and timing of low dose aspirin. The initiation moment is crucial, as the administration after the development symptoms and signs of preeclampsia do not interfere with the progression and the severity of the disease. Early initiation of therapy with low dose aspirin, prior the end of the first trimester is important since the pathogenesis mechanisms of preeclampsia take place in the first trimester. The action of acetylsalicylic acid consists in inhibition of COX-1 and COX-2 (cyclooxygenase isoenzymes), necessary for prostaglandin biosynthesis. Preferential inhibition of Thromboxane A2 by low dose aspirin, counterbalance the increased production of thromboxanes characteristic to preeclampsia and modulate the inflammatory process, amplified in pregnant women with preeclampsia.

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Section: Preeclampsia-predictionmentioning

confidence: 99%

The Role of Anticoagulant Therapy in the Prevention of Preeclampsia Pharmacokinetic and pharmacodynamic mechanisms

Ţurcan¹,

Bohîlțea²,

Neacşu³

et al. 2019

Rev. Chim.

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“…In this diet, carbohydrate consumption should be decreased to 33-45% of the overall daily calories with the remaining 20% for proteins and 40% for lipids. 14 glycemic index diet should be coupled with regular moderate-to-intense physical activity for at least 30-60 minutes (aerobic and resistance exercise) three times per week or more to prevent weight gain consequences in pregnancy. 15 When women on MNT/lifestyle changes cannot reach targeted glycemic levels (fixed by the ADA and the American College of Obstetricians and Gynecologists [ACOG] at a fasting glycemia <95 mg/dL, post-prandial glycemia <140 mg/dL after one hour and <120 mg/dL after two hours, and HbA1c <6-6.5% or even less if possible), insulin is initiated due to its proved safety and efficacy profile in GDM.…”

Section: Discussionmentioning

confidence: 99%

Insulin requiring Gestational Diabetes: Risk factors and correlation with postpartum diabetes and prediabetes

Ghamri

2023

Pak J Med Sci

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Objective: A2 gestational diabetes mellitus (A2GDM) is a more severe form of GDM that requires additional medical intervention, such as insulin or oral antidiabetic drug (OAD). The present study explored the determinants of A2GDM and analyzed the associated risk of post-partum diabetes or prediabetes. Methods: This retrospective study included 247 pregnant women, diagnosed with GDM and followed up until delivery at the Obstetric Medicine Clinic of King Abdulaziz University Hospital, Jeddah, Saudi Arabia, between January 2014 and January 2018. Women with personal history of diabetes or prediabetes were excluded. Collected data included patient’s age, body mass index, personal history of thyroid dysfunction and GDM, HbA1c level at diagnosis, management of GDM (diet only, insulin, or OAD), and postpartum metabolic assessment. Results: The prevalence of A2GDM was 29.6%, of which 21.5% were insulin-requiring and 8.1% were OAD-requiring cases. The risk of A2GDM was independently associated with a positive history of GDM (OR=3.19, 95% CI = 1.41-7.20) and HbA1c >7% (OR=8.66, 95%CI = 2.15- 34.94); the model explained 20% of the variance of A2GDM. The postpartum assessment showed that 10.1% have developed prediabetes, while no one developed overt diabetes. Postpartum prediabetes was independently predicted by age category ≥45 years (OR=39.94, 95%CI = 4.62-345.06), history of GDM (OR=0.18, 95%CI = 0.03 – 0.97), and A2GDM (OR=6.96, 95%CI = 1.91-25.42). Conclusion: Approximately one-third of GDM patients in our institution require insulin or OAD for glycemic control and are at high risk of developing prediabetes postpartum. Adherence to and effectiveness of medical nutrition therapy should be further explored among GDM patients to improve their glycemic control and both maternal and fetal prognosis. doi: https://doi.org/10.12669/pjms.39.5.7648 How to cite this: Ghamri KA. Insulin requiring Gestational Diabetes: Risk factors and correlation with postpartum diabetes and prediabetes. Pak J Med Sci. 2023;39(5):---------. doi: https://doi.org/10.12669/pjms.39.5.7648 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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“…The use of both insulin lispro and aspart in gestational diabetes is associated with improved postprandial glycaemic control compared with regular insulin however no improvement in fetal outcomes have been demonstrated [108][109][110][111].…”

Section: Insulinmentioning

confidence: 99%

Single site pilot clinical investigation of a novel app-assisted self-management programme for gestational diabetes

Smyth

Daly²,

Molphy³

et al. 2023

American Journal of Obstetrics and Gynecology

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Insulin Therapy in Gestational Diabetes

Cited by 4 publications

References 86 publications

The Role of Anticoagulant Therapy in the Prevention of Preeclampsia Pharmacokinetic and pharmacodynamic mechanisms

The Role of Anticoagulant Therapy in the Prevention of Preeclampsia Pharmacokinetic and pharmacodynamic mechanisms

Insulin requiring Gestational Diabetes: Risk factors and correlation with postpartum diabetes and prediabetes

Single site pilot clinical investigation of a novel app-assisted self-management programme for gestational diabetes

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