Standards of Polish Society of Gynecologists and Obstetricians in management of women with diabetes

Wender-Ożegowska, Ewa; Bomba‐Opoń, Dorota; Brązert, Jacek; Celewicz, Zbigniew; Czajkowski, Krzysztof; Gutaj, Paweł; Malinowska-Polubiec, Aneta; Zawiejska, Agnieszka; Wielgoś, Mirosław

doi:10.5603/gp.a2018.0059

Cited by 48 publications

(80 citation statements)

References 34 publications

(40 reference statements)

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“…Our attention was given to the much stricter control of BP from the beginning of pregnancy and lower targets for glycemia. The PDA has recommended, since the year 2000, to all patients with diabetes, ACE inhibitors or angiotensin II receptor blockers in the case of hypertension or the presence of microalbuminuria [ 3 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

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Pregnancy Outcomes in Women with Long-Duration Type 1 Diabetes—25 Years of Experience

Wender-Ożegowska

Gutaj

Mantaj

et al. 2020

JCM

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Aims: Our study aimed to examine the pregnancy outcomes (maternal and fetal) concerning different models of antenatal care across a period of over 25 years (1993–2018) in 459 women with type 1 diabetes. Data from patients with a history of the condition lasting at least 15 years were considered eligible for analysis. Methods: The study group was divided into three cohorts based on the different models of treatment used in Poznan University Hospital, Poland: 1993–2000 (cohort I, n = 91), 2001–2005 (cohort II, n = 83), 2006–2018 (cohort III, n = 284). To identify predictors for the selected dichotomous outcomes, we calculated the risks for fetal or maternal complications as dependent variables for cohorts II and III against cohort I, using multivariate logistic regression analysis. Results: The mean gestational age was 36.8 ± 2.4 weeks in the total cohort. The percentages of deliveries before the 33rd and the 37th weeks was high. We observed a decreasing percentage during the following periods, from 41.5% in the first period to 30.4% in the third group. There was a tendency for newborn weight to show a gradual increase across three time periods (2850, 3189, 3321 g, p <0.0001). In the last period, we noticed significantly more newborns delivered after 36 weeks with a weight above 4000 g and below 2500 g. Caesarean section was performed in 88% of patients from the whole group, but in the subsequent periods this number visibly decreased (from 97.6%, 86.7%, to 71%, p = 0.001). The number of emergency caesarean sections was lowest in the third period (27.5%, 16.7%, 11.2%, p = 0.006). We observed a decreasing number of “small for gestational age” newborns (SGA) in consecutive periods of treatment (from 24.4% to 8.7%, p = 0.002), but also a higher percentage of “large for gestational age” (LGA) newborns (from 6.1% to 21.6%, p = 0.001). Modification of treatment might be associated with the gradual reduction of SGA rates (cohort I 3.6%, cohort III 2.3% p <0,0005). Conclusions: Strict glycemic and blood pressure control from the very beginning of pregnancy, as well as modern fetal surveillance techniques, may contribute to the improvement of perinatal outcomes in women with long-duration type 1 diabetes.

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Section: Discussionmentioning

confidence: 99%

“…The duration of diabetes is the main risk factor for the development of diabetic vasculopathy. Almost all patients with type 1 diabetes (T1DM) develop changes in the eye after 20 years [ 3 ]. Studies show a relationship between diabetic retinopathy and perinatal outcome.…”

Section: Introductionmentioning

confidence: 99%

Pregnancy Outcomes in Women with Long-Duration Type 1 Diabetes—25 Years of Experience

Wender-Ożegowska

Gutaj

Mantaj

et al. 2020

JCM

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“…This disease is now identified as one of the main health burdens behind increased maternal and neonatal morbidity, from the perspectives of both the short-term and long-term implications. Therefore, both international and local organisations are calling for more studies on the risk factors, effective prevention modes and mechanisms of maternofetal intergenerational transmission of non-communicable disorders [13,14]. In our cohort, we linked some maternal and neonatal traits to genetic variations of well-described candidate genes for T2DM.…”

Section: Discussionmentioning

confidence: 99%

An observational study of the risk of neonatal macrosomia, and early gestational diabetes associated with selected candidate genes for type 2 diabetes mellitus polymorphisms in women with gestational diabetes mellitus

et al. 2018

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Objectives: 1) to analyse the prevalence of selected candidate genes for type 2 diabetes mellitus polymorphisms (IRS1 G972R; ENPP1 K121Q; ADRB3 W64R) among women with gestational diabetes; and 2) to investigate any association between variants of these genes and risk of neonatal macrosomia. Material and methods: We conducted a prospective observational study of a group of women (N = 140) in singleton pregnancies who delivered at term.

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“…The diabetic group was divided into subgroups of sufficient (SGC-DM, n = 15) and poor glycemic control (PGC-DM, n = 6) according to American Diabetes Association and Polish Society of Gynaecologists and Obstetricians guidelines. They both recommend a sustained level of Hb A1c values < 6.5% in preconception counselling [26,27]. Sufficient glycemic control group was characterized by Hb A1c values �6,5%, (48 mmol/mol) and poor glycemic control by Hb A1c values > 6,5%, (n = 6).…”

Section: Plos Onementioning

confidence: 99%

Poor glycaemic control contributes to a shift towards prothrombotic and antifibrinolytic state in pregnant women with type 1 diabetes mellitus

et al. 2020

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Ojectives Thrombotic and antifibrinolytic influence of Diabetes mellitus type 1 (T1DM) on haemostasis have been well demonstrated. There has been no research assessing the influence of poor glycemic control on thrombus formation under flow conditions in vitro or in pregnant type 1 diabetic women to date. Patients/Methods This study compared singleton pregnant T1DM women (n = 21) and control pregnant subjects without any metabolic disease (n = 15). The T1DM group was divided into two subgroups of sufficient (SGC-DM; Hb A1c �6,5%,n = 15) and poor glycaemic control (PGC-DM; Hb A1c >6,5%,n = 6). Evaluation of the whole blood thrombogenicity we assessed using T-TAS ® at a shear rate of 240 s-1 (Total-Thrombus Analysis System, Zacros, Japan). Results Blood clot formation initiation time (T10) was significantly shortened in PGC-DM subgroup when compared to SGC-DM subgroup (p = 0,03). The area under the curve (AUC30) of blood clot time formation and the MPV (mean platelet volume) values were substantially higher in the PGC-DM subgroup in comparison to the SGC-DM group (p = 0,03). Negative correlations were noted between Hb A1c and T10 values (p = 0,02) and between T10 and MPV values in the T1DM group (p = 0,04). Conclusions Poor glycaemic control in T1DM subjects triggers a shift towards a prothrombotic and antifibrinolytic state. This phenomenon can be detected using the novel system for quantitative assessment of the platelet thrombus formation process under flow conditions in vitro. The alteration of T-TAS values in PGC-DM subgroup proves that a poor glycemic control-related

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Standards of Polish Society of Gynecologists and Obstetricians in management of women with diabetes

Cited by 48 publications

References 34 publications

Pregnancy Outcomes in Women with Long-Duration Type 1 Diabetes—25 Years of Experience

Pregnancy Outcomes in Women with Long-Duration Type 1 Diabetes—25 Years of Experience

An observational study of the risk of neonatal macrosomia, and early gestational diabetes associated with selected candidate genes for type 2 diabetes mellitus polymorphisms in women with gestational diabetes mellitus

Poor glycaemic control contributes to a shift towards prothrombotic and antifibrinolytic state in pregnant women with type 1 diabetes mellitus

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