Investigating the effects of treatment based on single high blood glucose in gestational diabetes screening on maternal and neonatal complications

Mirzamoradi, Masoumeh; Bakhtiyari, Mahmood; Kimiaee, Parichehr; Najarkolaei, Azadeh Hosseini; Mansournia, Mohammad Ali

doi:10.1007/s00404-015-3670-9

Cited by 10 publications

(4 citation statements)

References 33 publications

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“…We included eight publications not included in any previous published review. One compared metformin and insulin 31 ; one, glibenclamide and insulin 32 ; four, packages of care with routine care 33–36 ; and two compared different dietary modification interventions. 37 38 Six of these trials were reported after the search dates of the previous reviews and were published in 2014 or 2015; the remaining two trials (dietary modification interventions or packages of care) did not fulfil other review’s inclusion criteria.…”

Section: Resultsmentioning

confidence: 99%

“…Nine trials compared glibenclamide with insulin ( table 3 ). 32 67–74 Figure 2E shows the RRs of dichotomous outcomes, suggesting that insulin may be relatively more effective than glibenclamide in reducing the risk of several adverse outcomes; CIs are wide and include the null value however. There was no difference between insulin and glibenclamide for continuous outcomes ( figure 2F ).…”

Section: Resultsmentioning

confidence: 99%

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Treatments for gestational diabetes: a systematic review and meta-analysis

et al. 2017

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ObjectiveTo investigate the effectiveness of different treatments for gestational diabetes mellitus (GDM).DesignSystematic review, meta-analysis and network meta-analysis.MethodsData sources were searched up to July 2016 and included MEDLINE and Embase. Randomised trials comparing treatments for GDM (packages of care (dietary and lifestyle interventions with pharmacological treatments as required), insulin, metformin, glibenclamide (glyburide)) were selected by two authors and double checked for accuracy. Outcomes included large for gestational age, shoulder dystocia, neonatal hypoglycaemia, caesarean section and pre-eclampsia. We pooled data using random-effects meta-analyses and used Bayesian network meta-analysis to compare pharmacological treatments (ie, including treatments not directly compared within a trial).ResultsForty-two trials were included, the reporting of which was generally poor with unclear or high risk of bias. Packages of care varied in their composition and reduced the risk of most adverse perinatal outcomes compared with routine care (eg, large for gestational age: relative risk0.58 (95% CI 0.49 to 0.68; I2=0%; trials 8; participants 3462). Network meta-analyses suggest that metformin had the highest probability of being the most effective treatment in reducing the risk of most outcomes compared with insulin or glibenclamide.ConclusionsEvidence shows that packages of care are effective in reducing the risk of most adverse perinatal outcomes. However, trials often include few women, are poorly reported with unclear or high risk of bias and report few outcomes. The contribution of each treatment within the packages of care remains unclear. Large well-designed and well-conducted trials are urgently needed.Trial registration numberPROSPERO CRD42013004608.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Treatments for gestational diabetes: a systematic review and meta-analysis

et al. 2017

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“…They demonstrated that the group diagnosed with the IADPSG criteria had only a decreased risk of neonatal hyperbilirubinemia (odds ratio (OR) 0.25, 95% CI 0.68–0.88). 61 Another RCT performed in 1000 pregnant women compared the incidence, maternal and fetal outcomes of GDM diagnosed using the one-step screening with IADPSG criteria versus two-step screening with GCT and diagnosis based on a 100g OGTT with CC criteria. 62 They found that the incidence of GDM using IADPSG criteria almost doubled (19.23% vs 11.81%, p=0.0001), and that maternal and neonatal outcomes were comparable in both groups except for lower rates of preterm delivery (11.6% vs 24.1%, relative risk (RR) 2.08, 95% CI 1.01–4.2, p = 0.046) and neonatal hypoglycemia (7.4% vs 29.31%, RR 3.98, 95% CI 1.75–9.01, p = 0.003) when using IADPSG criteria.…”

Section: Overview Of the Included Publicationsmentioning

confidence: 99%

An Update on Screening Strategies for Gestational Diabetes Mellitus: A Narrative Review

Minschart¹,

Beunen²,

Benhalima³

2021

DMSO

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Gestational diabetes mellitus (GDM) is a frequent medical complication during pregnancy. Screening and diagnostic practices for GDM are inconsistent across the world. This narrative review includes data from 87 observational studies and randomized controlled trials (RCTs), and aims to give an overview of the current evidence on screening strategies and diagnostic criteria for GDM. Screening in early pregnancy remains controversial and studies show conflicting results on the benefit of screening and treatment of GDM in early pregnancy. Implementing the one-step "International Association of Diabetes and Pregnancy Study Groups" (IADPSG) screening strategy at 24-28 weeks often leads to a substantial increase in the prevalence of GDM, without conclusive evidence regarding the benefits on pregnancy outcomes compared to a two-step screening strategy with a glucose challenge test (GCT). In addition, RCTs are needed to investigate the impact of treatment of GDM diagnosed with IADPSG criteria on long-term maternal and childhood outcomes. Selective screening using a risk-factor-based approach could be helpful in simplifying the screening algorithm but carries the risk of missing significant proportions of GDM cases. A two-step screening method with a 50g GCT and subsequently a 75g oral glucose tolerance test (OGTT) with IADPSG could be an alternative to reduce the need for an OGTT. However, to have an acceptable sensitivity to screen for GDM with the IADPSG criteria, the threshold of the GCT should be lowered from 7.8 to 7.2 mmol/L. A pragmatic approach to screen for GDM can be implemented during the COVID-19 pandemic, using fasting plasma glucose (FPG), HbA1c or even random plasma glucose (RPG) to reduce the number of OGTTs needed. However, usual guidelines and care should be resumed as soon as the COVID pandemic is controlled.

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“…It is estimated that 85% of the embryos by assisted reproductive techniques do not implant after transfer. [ 6 7 8 ] Studies have shown that different methods have been used to manage recurrent implantation failures, but there is little consensus on the most effective ones. The common methods used include blastocyst transmission, pre-transplant genetic screening, hatching, co-culture system, sequential transmission, hysteroscopy, endometrial scratch, salpingectomy, additional ET, egg donation, and immunotherapy, but there is no proven evidence for these treatments.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the effect of intrauterine injection of platelet-rich plasma on the pregnancy rate of patients with a history of implantation failure in the in vitro fertilization cycle

Ershadi

Noori

Dashipoor

et al. 2022

Journal of Family Medicine and Primary Care

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Objectives: Implantation failure is a major problem in reproductive medicine, and despite the various methods described for treatment, there is little consensus on the most effective method. This study was conducted to investigate the effect of intrauterine injection of platelet-rich plasma (PRP) on the pregnancy rate of patients with a history of implantation failure in the in vitro fertilization (IVF) cycle. Study Design: In this study, women attending the infertility clinic of Ali ibn Abi Taleb Hospital, who had a history of implantation failure and were candidates for frozen embryo transfer (FET), were examined in Zahedan (Iran) in 2019. The patients were divided into two groups of PRP recipients and the control group. IVF was performed routinely, and in the PRP-receiving group, an intrauterine injection was given 48 h before embryo transfer (ET). The number of gestational sacs, the rate of implantation, the frequency of chemical and clinical pregnancies as well as the frequency of abortion were compared in the two groups. The collected data were analyzed by the SPSS software version 21 Results: Ninety patients with a history of implantation failure participated in the study, and finally, the information of 85 patients was studied. The frequency of chemical pregnancy was 40% in the experimental group, 27% in the control group, and regarding clinical pregnancy, 33% in the experimental group and 24% in the control group, but there was no significant difference between the two groups. The rate of implantation, the mean thickness of the endometrium, and the frequency of abortion did not differ significantly between the two groups Conclusion: In patients with endometrial thickness greater than 8 mm with a history of recurrent implantation failure, intrauterine injection of PRP had no effect on the fertility outcome.

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Investigating the effects of treatment based on single high blood glucose in gestational diabetes screening on maternal and neonatal complications

Abstract: Although the treatment of mild gestational diabetes could not significantly decrease severe neonatal outcomes, it did significantly reduce the risk of hyperbilirubinemia and its subsequent complications.

Cited by 10 publications

References 33 publications

Treatments for gestational diabetes: a systematic review and meta-analysis

Treatments for gestational diabetes: a systematic review and meta-analysis

An Update on Screening Strategies for Gestational Diabetes Mellitus: A Narrative Review

Evaluation of the effect of intrauterine injection of platelet-rich plasma on the pregnancy rate of patients with a history of implantation failure in the in vitro fertilization cycle

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