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@#This study examined the impact of universal screening in diagnosing and managing gestational diabetes (GDM) amongst antenatal mother and associated neonatal outcomes. It is a single-centre, retrospective study on routinely collected data of antenatal women in Health Clinic Seremban over one year in 2018. All women diagnosed with GDM, who were not known sufferers of type 1 or type 2 diabetes were included in this study. Participants were stratified according to risk factors for GDM to compare the performance of a selective high-risk screening approach to that of universal screening for detecting GDM. Subjects were categorized as high-risk for GDM based on the guidelines recommended by the Malaysian Clinical Practice guidelines. It was found that through universal screening, 246 antenatal mothers were tested positive for GDM out of the 987 of these mothers without prior diabetes, giving a prevalence of 24.9%. If selective screening using traditional risk factors had been employed, 54 (22%) of the antenatal mothers diagnosed with GDM would have been missed. It was established that risk factors for GDM included advancing age, other ethnicities (patients that are not of Malay, Chinese nor Indian ethnicities), obesity, history of abortion or GDM and family history of diabetes mellitus. Neonatal outcomes of those with GDM as compared to those without were similar. This study highlights that universal screening improved GDM detection rates amongst antenatal mothers. The increased detection helped facilitate an earlier intervention which may have contributed to better antenatal management and outcomes for neonates and their mothers.
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Introducción: La diabetes gestacional constituye la enfermedad endocrina más frecuente del embarazo y aparece generalmente cuando existen factores de riesgo. Objetivo: Describir los factores de riesgo de la diabetes gestacional. Métodos: Estudio transversal-descriptivo de una base de datos que incluyó a 242 mujeres con diabetes gestacional, atendidas en el Hospital Ginecobstétrico América Arias de La Habana, en el periodo 2004-2006. Se analizaron variables categóricas (dicotómicas), consideradas como factores de riesgo de diabetes gestacional: diabetes en familiar de primer grado, edad ≥ 30 años, peso pregestacional excesivo, historia de diabetes gestacional, macrosomía fetal y muerte fetal inexplicable, hipertensión arterial relacionada con embarazo y glucemia en ayunas de riesgo . Se efectuó análisis porcentual (determinación de frecuencias relativas). Resultados: La media de edad fue 29,2 ± 5,3 años y de índice de masa corporal, 27,1 ± 4,2 kg/m2. Un 96,69 por ciento tenía factores de riesgo y 79,49 por ciento de estas, más de uno, los más frecuentes fueron: glucemia en ayunas de riesgo (64,53 por ciento), edad; 30 años (60,26 por ciento) y peso pregestacional excesivo (51,71 por ciento). Predominó la forma combinada de presentación de factores de riesgo, en forma única solo se presentó: glucemia en ayunas de riesgo (14,57 por ciento), diabetes en familiar de primer grado (8,43 por ciento), edad 30 años (7,80 por ciento) y peso pregestacional excesivo (5,79 por ciento). Conclusiones: Los factores de riesgo de diabetes gestacional se presentaron en la mayoría de las mujeres con la enfermedad, fundamentalmente de forma combinada(AU)
Introduction: Gestational diabetes is the most frequent endocrine disease of pregnancy and generally appears when there are risk factors. Objective: To describe the risk factors for gestational diabetes. Methods: Cross-sectional and descriptive study of a database that included 242 women with gestational diabetes, treated at América Arias Gyneco-obstetric Hospital in Havana, in the period 2004-2006. Categorical (dichotomous) variables were analyzed, considered as risk factors for gestational diabetes: diabetes in a first-degree relative, age equal to or over 30 years, excessive pre-pregnancy weight, clinical history of gestational diabetes, fetal macrosomia and unexplained fetal death, pregnancy-related high blood pressure, and at-risk fasting blood glucose. Percentage analysis (determination of relative frequencies) was carried out. Results: The mean age was 29.2±5.3 years. The mean body mass index was 27.1±4.2 kg/m2. 96.69 percent had risk factors; 79.49 percent of these had more than one risk factor. The most frequent were at-risk fasting blood glucose (64.53 percent), age equal to or over 30 years (60.26 percent), and excessive pre-pregnancy weight (51.71 percent). There was a predominance in manifestation of combined risk factors; manifestation of one risk factor alone occurred only in at-risk fasting blood glucose (14.57 percent), diabetes in first-degree relative (8.43 percent), age equal to o over 30 years (7, 80 percent), and excessive pre-pregnancy weight (5.79 percent). Conclusions: The risk factors for gestational diabetes appeared in the majority of women with the disease, mainly in combination(AU)
Subject(s)
Humans , Female , Pregnancy , Blood Glucose , Risk Factors , Diabetes, Gestational/epidemiology , Epidemiology, Descriptive , Cross-Sectional StudiesABSTRACT
Introduction: Gestational diabetes (GDM) has significant maternal and foetal implications. screening allows active interventions which significantly improves pregnancy outcomes. Despite World Health Organization (WHO), FIGO and National Institute of clinical Excellence (NIcE) recommendations for universal screening especially among high risk population; Malaysia currently adopts a selective risk based screening for GDM. Objective: the objective is to audit the effectiveness of the current practice of selective risk based screening in detection of GDM in Malaysia. Methodology: this is a retrospective cohort study based on the National Obstetric Registry (NOR) which comprises of 14 major tertiary hospitals in Malaysia. the study period was from 1st January 2011 till 31st December 2012 and a total of 22,044 patients with GDM were analysed. Logistic regression analysis was used to calculate the crude odd ratio. Results: the incidence of GDM in Malaysia is 8.4%. Maternal age of ≥25, booking bMI ≥27kg/m2, booking weight ≥80kg and previous hypertension are non-significant risk of developing GDM in Malaysia. Parity 5 and more was only associated with an odds-ratio of 1.02 (95% confidence Interval: 0.90-1.17) as compared to parity below 5. the association of women with previous stillbirth with GDM was not significant. conclusion: current risk based screening for GDM based on maternal age, booking bMI, weight and hypertension is inappropriate. An ideal screening tool should precede disease complications, which is the novel objective of screening. Universal screening for GDM in Malaysia may be a more accurate measure, especially with regards to reducing maternal and foetal complications.
Subject(s)
Diabetes, GestationalABSTRACT
OBJECTIVE: To identify chromosomal imbalances by whole-genome microarray-based comparative genomic hybridization (array-CGH) in DNA samples of neonates with congenital anomalies of unknown cause from a birth defects monitoring program at a public maternity hospital. METHODS: A blind genomic analysis was performed retrospectively in 35 stored DNA samples of neonates born between July of 2011 and December of 2012. All potential DNA copy number variations detected (CNVs) were matched with those reported in public genomic databases, and their clinical significance was evaluated. RESULTS: Out of a total of 35 samples tested, 13 genomic imbalances were detected in 12/35 cases (34.3%). In 4/35 cases (11.4%), chromosomal imbalances could be defined as pathogenic; in 5/35 (14.3%) cases, DNA CNVs of uncertain clinical significance were identified; and in 4/35 cases (11.4%), normal variants were detected. Among the four cases with results considered causally related to the clinical findings, two of the four (50%) showed causative alterations already associated with well-defined microdeletion syndromes. In two of the four samples (50%), the chromosomal imbalances found, although predicted as pathogenic, had not been previously associated with recognized clinical entities. CONCLUSIONS: Array-CGH analysis allowed for a higher rate of detection of chromosomal anomalies, and this determination is especially valuable in neonates with congenital anomalies of unknown etiology, or in cases in which karyotype results cannot be obtained. Moreover, although the interpretation of the results must be refined, this method is a robust and precise tool that can be used in the first-line investigation of congenital anomalies, and should be considered for prospective/retrospective analyses of DNA samples by birth defect monitoring programs. .
OBJETIVO: Identificar desequilíbrios cromossômicos por meio da hibridização genômica comparativa baseada em microarranjos (CGH-array) em amostras de DNA de neonatos com anomalias congênitas de causa desconhecida de um programa de monitoramento de defeitos congênitos em uma maternidade pública. MÉTODOS: Uma análise genômica cega foi realizada retrospectivamente em 35 amostras armazenadas de DNA de neonatos nascidos entre julho de 2011 e dezembro de 2012. Todas as possíveis variações no número de cópias (CNVs) de DNA foram comparadas com as relatadas em bases de dados genômicos públicas, e sua relevância clínica foi avaliada. RESULTADOS: De um total de 35 amostras testadas, foram detectados 13 desequilíbrios genômicos em 12/35 casos (34,3%). Em 4/35 casos (11,4%), os desequilíbrios cromossômicos poderiam ser definidos como patogênicos; em 5/35 (14,3%) deles foram identificadas CNVs de DNA de relevância clínica incerta; e, em 4/35 (11,4%), foram detectadas variações normais. Dentre os quatro casos com resultados considerados relacionados causalmente aos achados clínicos, 2/4 (50%) apresentaram alterações causais já relacionadas a síndromes de microdeleção bem definidas. Em 2/4 amostras (50%), os desequilíbrios cromossômicos encontrados, embora preditivos como patogênicos, não estavam relacionados anteriormente a entidades clínicas reconhecidas. CONCLUSÕES: A análise de CGH-array permitiu maior taxa de detecção de anomalias cromossômicas, e essa determinação é valiosa principalmente em neonatos com anomalias congênitas de etiologia desconhecida ou em casos em que os resultados do cariótipo não podem ser obtidos. Além disso, embora a interpretação dos resultados deva ser refinada, esse método é uma ferramenta robusta e precisa que pode ser usada na investigação de primeira linha de anomalias congênitas e deve ser considerada em análises futuras/retrospectivas de amostras de DNA por programas de monitoramento de defeitos congênitos. .
Subject(s)
Female , Humans , Infant, Newborn , Male , Chromosome Aberrations , Comparative Genomic Hybridization/methods , Congenital Abnormalities/genetics , Neonatal Screening/methods , Congenital Abnormalities/diagnosis , Karyotyping , Oligonucleotide Array Sequence Analysis/methods , Retrospective StudiesABSTRACT
The importance of screening and diagnosis of gestational diabetes mellitus (GDM) is universally accepted but there is controversy and uncertainty about the most suitable method of screening among various populations. The majority of the patients are asymptomatic. After nearly 60 years of research the screening and diagnosis of GDM, universal screening evades uniform acceptance and remains debatable. Multiple studies, numerous global consensus conferences and several multicenter trials had not identified the unique procedure. Surprisingly still there is uncertainty regarding the most effective method of screening among various populations. The prevalence of GDM varies from less than 1% to more than 10% It is increasing due to dietary habits, overweight, maternal age, ethnicity, family history and past history .Prevalence vary due to the use of a wide range of definitions and diagnostic test criteria, as well as variations across regions and ethnic groups. The merits of available screening methods such as urine testing for glycosuria, 50g glucose challenge test (GCT), random blood sugar testing, fasting blood glucose (FBS) , estimation of glycosylated haemoglobin , fructosamine ,75g oral Glucose Tolerance Test (75g OGTT) and two step approach (Combination of methods) are analysed. In countries where funds are limited, certainly the selective screening is cost effective compared to whole population screening. After many decades of research, only up-to-date considerations are Random blood glucose, O’Sullivan, 75g and Complete OGTT.