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Abstract Multiple studies undertaken on cord blood demonstrate analyte perturbations in infants exposed to gestational diabetes mellitus (GDM). Cord blood as a sample is influenced by maternal and placental metabolism. Newborn screening (NBS), performed after the first 24 hours of life reflects early neonatal metabolism. We compared NBS analytes between women with and without GDM with different management approaches in the Treatment of Booking of Gestational Diabetes (TOBOGM) pilot randomised controlled trial. Pregnant women with GDM risk factors were randomised to early or deferred GDM treatment following an oral glucose tolerance test (<20 weeks gestation). Women without GDM served as "decoys". From the decoy group 11 developed GDM (screened at 26-28 weeks), were analysed separately; their results were compared with the other groups. De-identified controls were chosen from NBS results from the same analytic run matched for sex, birthweight and gestational age. Results were available for 73/78 women participating in the pilot and 358 de-identified controls. Tyrosine levels (μmol/l; whole blood)were higher in the late GDM group vs early, deferred treatment, and decoy groups (medians:106.28; IQR: 96.73-151.11) (76.33; 64.64-97.90) (75.68; 66.59-110.88)(73.74; 58.32-90.36) (p=0.009) and remained elevated when compared to normal, age-matched controls (106.28; 96.73-151.11) (87.26; 68.55-111.26) (p value=0.01) Immunoreactive trypsinogen (μgm/l; whole blood)was highest in the early treatment group when compared with group-specific controls (22.30; 13.90-29.90 vs 14.00, 10.60-21.10) (p=0.02). These results provide evidence of biochemical perturbations detectable on NBS of in-utero exposure to hyperglycemia and treatment and provide data for hypothesis building.
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Background: Gestational diabetes mellitus (GDM) is defined as carbohydrate intolerance of variable severity with onset or first recognition during the present pregnancy. It affects 7% of all pregnancies worldwide and in India it ranges from 6 to 9% in rural and 12 to 21% in urban area. The aim of this study was to compare the DIPSI criteria with the two-step method (Carpenter and Couston criteria.) and to study merits and demerits of one step and two step tests for GDM.Methods: A total 400 pregnant women of gestational age between 24-28 weeks attending antenatal clinic at this study tertiary care center were enrolled in this study. 200 pregnant women were enrolled in each of the study group (Group I OGTT and Group II DIPSI).Results: In Group I (OGTT) screening 47 (23.5%) were tested positive. In Group II cases, screening test results were found positive among 44 (22%). Out of 95 high-risk pregnant women 38 (40%) were positive for GDM by OGTT and 34 (35.78%) were positive by DIPSI. Out of 305 non high-risk pregnant women, 9 (2.95%) were positive for GDM by OGTT and 10 (3.27%) were positive by DIPSI.Conclusions: Present study concludes that DIPSI is the test which can predict GDM in population comparable to another test like OGTT. Also, India’s major population reside in rural areas, ANC are mostly conducted by ANM, therefore screening test should be easy to perform and interpret.
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Background: Considering the magnitude of adverse pregnancy outcomes related to gestational diabetes, the present study was undertaken to find out the prevalence of gestational diabetes mellitus using the international association of diabetes in pregnancy study groups criteria (IADPSG) and diabetes in pregnancy study group India (DIPSI) criteria to ascertain whether the present practice of diagnosing GDM by the guidelines recommended by DIPSI 21 based on WHO criterion of 2-h PG ≥140 mg/dL can still be followed in this study settings or adopt IADPSG recommendation.Methods: This study was done at Antenatal Clinic, department of obstetrics and gynecology, KLES Dr Prabhakar Kore Hospital, Belgaum from January 2013 to December 2013. A total of 225 pregnant women between 24 to 28 weeks gestations were studied. Diagnosis and the prevalence of GDM were assessed by applying both DIPSI and IADPSG criteria.Results: Most of the women (58.11%) were between 22 to 25 years and the mean age was 23.78±3.38 years. Based on the IADPSG criteria, the prevalence of GDM was 19.11% and by applying DIPSI criteria, prevalence of GDM was 16.89%. The difference in diagnostic capability between IADPSG and DIPSI was found to be 2.8% and the kappa statistics showed good strength of agreement between the two tests (p>0.302; Kappa=0.774).Conclusions: It was concluded that, the diagnosis GDM based on DIPSI is as effective as IADPSG criteria. Further, in resource poor countries like India, DIPSI procedure would be used with an advantage of being less costly and without compromising the clinical equipoise.
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Background: Gestational diabetes mellitus is defined as any glucose intolerance with the onset or first recognition during pregnancy. Objectives of this study were to diagnose cases of GDM by screening with DIPSI criteria at less than 28 weeks. And observation and comparison of maternal and perinatal outcome in women diagnosed of GDM in less than 20 weeks and at 24-28 weeks.Methods: This was the prospective analytical study conducted in the department of obstetrics and gynecology for one year in Muzaffarnagar medical college and Hospital. After history taking, clinical and obstetrics examination 1503 antenatal patients of less than 28 weeks were enrolled underwent screening with DIPSI criteria. Out of which 80 patients with abnormal OGTT of gestational age less than 20 weeks and 69 patients with abnormal OGTT of gestational age 24 -28 weeks.Results: In early diagnosed GDM group alive and healthy babies were slightly lower as compared with late diagnosed GDM group.Conclusions: The diagnosis of GDM gives us an opportunity in identifying individuals who will be benefitted by early therapeutic intervention with diet, exercise, and normalizing the weight to delay or prevent the onset of the disease.
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Background: The screening of GDM is important as various pregnancy related complications are associated to it. With early screening and diagnosis, the complications associated with GDM can be reduced. Studies have shown various ethnic groups are at increasing risk of developing GDM with prevalence differing in different ethnicity. No data is available about frequency of GDM in different ethnic women of Sikkim. This study was performed to determine the frequency of GDM and its variation according to different demographic profiles of Sikkimese women.Methods: Pregnant women between 16-34 weeks of gestation, attending antenatal OPD were included for this study. All the patients were subjected to DIPSI recommended 75 gm oral glucose tolerance test. Diagnosis of impaired glucose tolerance was made when plasma glucose of ≥120-140 mg/dl and diagnosis of GDM was made when the plasma glucose of >140 mg/dl as per DIPSI guidelines.Results: A total of 202 consenting pregnant women during 16-34 weeks of pregnancy were evaluated with DIPSI recommended 75 g oral glucose tolerance test. Overall frequency of GDM was 11.9% among the Sikkimese women while 10.9% had impaired results in OGTT.Conclusions: Frequency of GDM was high (12%) in pregnant women attending tertiary hospital of Sikkim. This implies Sikkimese women should be universally screened for GDM. There was also high occurrence of GDM among Lepcha and Bhutia women which need further study to find out the contributing factors in these women.
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Background: The oral glucose tolerance test (OGTT) is considered the current standard for diagnosis of gestational diabetes mellitus (GDM). International association of diabetes and pregnancy study groups (IADPSG) recommends OGTT, with fasting, one-hour and two-hour venous blood samples drawn after intake of 75g oral glucose. In the Indian context, diabetes in pregnancy study group in India (DIPSI) recommends glucose challenge test (GCT), where 75 g glucose is given irrespective of the fasting state, and a single venous sample is drawn after two-hour. Diagnosis of GDM is made, if any cut-off value is met or exceeded. This prospective study was conducted to compare the DIPSI and IADPSG criteria for diagnosis of GDM.Methods: Pregnant women between 24 to 28 weeks of gestation were subjected to non-fasting GCT. Capillary sample were also drawn simultaneously using Accu check active glucometer. These women were counselled to undergo a standard 75gram OGTT, within a week of recruitment.Results: According to IADPSG criteria, 17.6% (18/102) of our participants had GDM, as compared to 19.6% (20/102) by DIPSI criteria using venous samples, and 25.3% (25/99) by capillary sample method. Sensitivity and specificity of GCT using venous sample was 72.22% and 91.67%, and using capillary sample was 70.59% and 84.15% respectively. DIPSI criteria using venous samples wrongly labelled 8.3% women as GDM, and capillary samples wrongly labelled 15.9% women as GDM. More importantly DIPSI criteria using venous samples labelled 27.8% women as false-negative and capillary samples labelled 29.4% women as false-negative for GDM. Almost one quarter of women with GDM will be missed if DIPSI criteria is used as a universal screening modality.Conclusions: We suggest that the IADPSG criteria be used for diagnosis of GDM in antenatal women in India.
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Background: India is the diabetic capital of the world and gestational diabetes mellitus contributes to a significant number of cases. Gestational diabetes mellitus is a common medical complication of pregnancy and may lead to serious consequences. Because of these reasons, it was felt that if there was a biomarker for predicting carbohydrate intolerance in pregnancy, it could help in earlier intervention and mitigate the consequences related to it. Hence, for this purpose, the role of HbA1c was studied as a predictor of gestational diabetes mellitus.Methods: This was a cross sectional study. Five hundred antenatal cases were considered for this study. All antenatal patients before 18 weeks of gestation attending antenatal clinic for the first time were selected and these patients were subjected to HbA1c followed by diabetes in pregnancy study group of India (DIPSI) test between 24-28 weeks and the results were analyzed to find any correlation between the two.Results: The main objective of the present study was to find whether HbA1c can be used as a predictor of gestational diabetes mellitus. In this study out of 500 women screened, 60 women turned out to have gestational diabetes mellitus. When comparing DIPSI positivity with various levels of HbA1c, it was found that maximum number of DIPSI positive patients (93.33%), had raised HbA1c levels.Conclusions: Maximum number of DIPSI positive cases had HbA1c level between 5.5 to 6 and this association was found to be statistically significant and a positive correlation was established between the two.
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Background: Diabetes in Pregnancy Study group, India (DIPSI) diagnostic criteria is a single step method of screening and diagnosis of gestational Diabetes. Therefore, this prospective study was undertaken to ascertain the validity of DIPSI criteria to diagnose GDM based on pregnancy outcome in Indian population.Method: The present Hospital based prospective study was conducted at OBGY department, GSL Medical College and General Hospital, Rajahmundry during 2013 to 2015. Women who were attending OBGY OPD for Antenatal check-ups within 24-28 weeks of GA during the study period were included in the study. Each mother at 24-28 weeks of gestation irrespective of last meal timing, fasting / non fasting was given 75 gm glucose dissolved in a glass of 200 ml water to drink and after two hours venous blood was collected.Result: Out of 500 cases, 26 cases are diagnosed as having gestational diabetes by DIPSI criteria and 474 cases are Normal glucose tolerant. Maximum number 53.9% of cases diagnosed as GDM by DIPSI are of age >25 yrs (53.9%), primigravida (65.7%), BMI>25 (57.7%). In present study, family h/o diabetes is a risk factor for GDMConclusion: Our results suggest that a policy of universal screening for GDM should be adopted in all antenatal clinics and 75 gm OGTT has a high predictive value. This single step procedure is a simple economic and feasible method. It serves both for the purpose of screening and diagnosis at the same time.
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Background: In the Indian context, screening for Diabetes is essential in all pregnant women, as the Indian women have an eleven-fold increased risk of developing glucose intolerance during pregnancy. For this, we need a simple procedure which is economical and feasible. Hence this study was undertaken as a screening as it is acceptable, economical and feasible to perform. Aim of this study was to assess the feasibility of one step procedure for screening and diagnosis of Gestational Diabetes Mellitus by Diabetes in Pregnancy Study Group of India (DIPSI).aim of the study was to study the occurrence of Gestational Diabetes mellitus, Tumkur, to assess the sensitivity and specificity of glucose challenge test, to assess the need for universal screening and to study the maternal and perinatal outcomes in patient with Gestational Diabetes Mellitus.Method: Type of study was prospective study. this study included 200 pregnant women attending the antenatal OPD in Sri Siddhartha Medical College, Tumkur. Data collection was in a predesigned proforma. Pregnant women with 24-28 weeks of gestation were given 75 grams of oral glucose load, irrespective of their meal and venous blood sample drawn after 2 hours. If blood glucose value was ≥140mg/dl, the screening was considered as DIPSI positive. These patients underwent OGTT.Results: Incidence of GDM was found to be 3.5% in the patients studied. 40% of cases did not have risk factors, hencethere is a need for universal screening. DIPSI was positive in 10 cases, of which 7 were OGTT positive. Patients were managed with diet and insulin. The maternal and perinatal outcome of pregnancy was good.Conclusion: For universal screening, DIPSI performed irrespective of last meal timing with 75g glucose load is a patient friendly approach. This method recommended by WHO serves both as a one-step screening and diagnostic procedure & is easy to perform besides being economical.
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Atualmente o número de pessoas afetadas pelo diabetes mellitus (DM) está aumentando, principalmente devido ao aumento do envelhecimento populacional e de comorbidades como obesidade e hipertensão. Para o ano de 2030, é estimado que o DM seja a sétima doença mais prevalente e a sétima causa de morte no mundo. O DM pré-gestacional (DMPG) e o DM gestacional (DMG) podem causar danos ao desenvolvimento fetal e à saúde materna. O objetivo do presente estudo foi analisar a influência do DMPG e do DMG sobre o surgimento de complicações durante a gestação e no desenvolvimento de malformações congênitas (MCs). Foi realizada uma pesquisa de literatura no banco de dados do PubMed. Foram analisados estudos em humanos e animais, publicados entre janeiro de 2012 e junho de 2017. Foram encontradas 131 publicações, das quais 73 foram utilizadas. Os estudos analisados demonstraram que o DMPG e o DMG estão associados a um aumento das complicações gestacionais e ao risco de desenvolver MCs. O DMPG e o DMG estão associados a um aumento no risco de desenvolver MCs nos sistemas cardiovascular, nervoso, genital, esquelético e urinário. As malformações cardíacas são as mais relatadas; dentre as quais, destacam-se os defeitos septais. Esta revisão conclui que o DM na gravidez deve ser prevenido principalmente na fase de organogênese, por meio do controle de peso e do sedentarismo materno, com o diagnóstico precoce das alterações hiperglicêmicas, tendo o intuito de evitar uma epidemia de morbimortalidade em gerações afetadas pelo diabetes no período gestacional. (AU)
Currently the number of people affected by diabetes mellitus (DM) is increasing, mainly due to the increase of the aging population and of comorbidities such as obesity and hypertension. By the year 2030 it is estimated that DM is the seventh most prevalent disease and the seventh cause of death in the world. Pre-gestational DM (PGDM) and gestational DM (GDM) can cause damage to fetal development and maternal health. Objective of the present study was to analyze the influence of PGDM and GDM on the development of complications during pregnancy and the development of congenital malformations (MCs). A literature search was made on the PUBMED database. We analyzed human and animal studies, published between January 2012 and June 2017. We found 131 publications, of which 73 were used. Studies have shown that DMPG and DMG are associated with an increase in gestational complications and the risk of developing MCs. DMPG and DMG in pregnancy is associated with an increased risk of developing MCs in the cardiovascular, nervous, genital, skeletal, and urinary systems. Cardiac malformations are the most frequently reported, among which septal defects are prominent. This review concludes that DM in pregnancy should be prevented mainly in the organogenesis phase, with weight control and maternal sedentarism and with the early diagnosis of hyperglycemic alterations, in order to avoid an epidemic of morbidity and mortality in generations affected by diabetes in the gestational period.(AU)
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Humanos , Animales , Femenino , Embarazo , Complicaciones del Embarazo , Anomalías Congénitas , Diabetes Gestacional , Diabetes Mellitus , PubMed , Complicaciones de la Diabetes , HiperglucemiaRESUMEN
Diabetes in pregnancy is associated with higher rates of miscarriage, pre-eclampsia, preterm labor, and fetal malformation. To prevent these obstetric and perinatal complications, women with diabetes have to control levels of blood sugar, both prior to and during pregnancy. Thus, individualized medical nutrition therapy for each stage of pregnancy is essential. We provided in-depth medical nutrition therapy to a 38-year-old pregnant woman with diabetes at all stages of pregnancy up to delivery. She underwent radiation therapy after surgery for breast cancer and was diagnosed with diabetes. At the time of diagnosis, her glycated hemoglobin level was 8.3% and she was planning her pregnancy. She started taking an oral hypoglycemic agent and received education regarding the management of diabetes and preconception care. She became pregnant while maintaining a glycated hemoglobin level of less than 6%. We provided education program for diabetes management during the pregnancy, together with insulin therapy. She experienced weight loss and ketones were detected; furthermore, she was taking in less than the recommended amount of foods for the regulation of blood sugar levels. By giving emotional support, we continued the counseling and achieved not only glycemic control but also instilled an appreciation of the importance of appropriate weight gain and coping with difficulties. Through careful diabetes management, the woman had a successful outcome for her pregnancy, other than entering preterm labor at 34 weeks. This study implicated that the important things in medical nutrition therapy for pregnant women with diabetes are frequent follow-up care and emotional approach through the pregnancy process.
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Adulto , Femenino , Humanos , Embarazo , Aborto Espontáneo , Glucemia , Neoplasias de la Mama , Consejo , Diagnóstico , Educación , Estudios de Seguimiento , Hemoglobina Glucada , Insulina , Cetonas , Terapia Nutricional , Trabajo de Parto Prematuro , Preeclampsia , Atención Preconceptiva , Mujeres Embarazadas , Aumento de Peso , Pérdida de PesoRESUMEN
El manejo adecuado de la diabetes durante el embarazo es fundamental para prevenir morbi-mortalidad materna y perinatal. No hay consenso en las pautas internacionales, existiendo muchos aspectos controversiales. Se realizó una revisión del tema buscando criterios científicos y costo-efectivos que sirvan de base para prestar la mejor atención a las pacientes con Diabetes y Embarazo. Hay acuerdo general sobre la necesidad de equipos interdisciplinarios que proporcionen seguimiento clínico-metabólico materno, donde el control glucémico óptimo alcanzado y mantenido durante toda la gestación constituye la piedra angular, para lo cual resulta indispensable la indicación y cumplimiento de medidas no farmacológicas como educación, plan alimentario, ejercicios, cesación tabáquica y apoyo psico-social; y medidas farmacológicas, donde la insulina constituye el tratamiento de elección. Además de realizar la vigilancia de la salud fetal, la atención obstétrica de un embarazo de alto riesgo y los cuidados inmediatos del recién nacido. Desafortunadamente, persisten numerosas controversias particularmente en cuanto a la pesquisa de las hiperglucemias en el embarazo (Diabetes Gestacional y Diabetes en el Embarazo) y las medidas terapéuticas y de control metabólico a aplicar. En el momento de seleccionar las opciones disponibles, se destaca la importancia del razonamiento clínico individualizado, el cumplimiento de las regulaciones y el abordaje ético, con el fin de garantizar la mayor seguridad al binomio madre-feto.
An adequate management of diabetes during pregnancy is fundamental to prevent related maternal and perinatal morbidity and mortality. There is no consensus on existing international guidelines, and many controversial aspects persist. A review of the subject was conducted, searching for scientific and costeffective criteria as the basis to provide the best care to patients with diabetes and pregnancy. There is a general agreement on the need for interdisciplinary teams that provide maternal clinicalmetabolic monitoring, where optimal glycemic control, achieved and maintained throughout pregnancy, is the cornerstone. For this, the indication and compliance of non-pharmacological measures, such as education, diet planning, exercise, smoking cessation and psychosocial support are essential, in addition to pharmacological measures, where insulin is the treatment of choice. Also, surveillance of fetal health, obstetric care in high risk pregnancies and immediate care of the newborn are needed. Unfortunately, many controversies still persist, particularly in terms of screening for hyperglycemia in pregnancy (Gestational Diabetes and Diabetes in pregnancy), as well as regarding applicable therapeutic and metabolic control measures. When selecting available options, the importance of an individualized clinical reasoning, compliance with regulations and ethical issues are emphasized in order to ensure greater safety to the mother-fetus binomial.
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Women with gestational diabetes mellitus (GDM) have higher rates of foetal macrosomia, shoulder dystocia and pregnancy-induced hypertension, and are at higher risk of developing type 2 diabetes. Herein, we introduce a new conceptual term, “gestational prediabetes”, which requires the absence of diabetes before pregnancy, and the presence of blood glucose levels (or a related marker) in early pregnancy that are higher than normal, but not yet high enough to meet the diagnostic criteria for GDM. Identifying women with gestational prediabetes might be done in early pregnancy (e.g., 12 weeks’ gestation) using conventional glycaemic testing, assessment of visceral abdominal adiposity or hepatic fat by ultrasonography, or measuring serum sex hormone-binding globulin or adiponectin. However, none of these approaches has been systematically compared to conventional predictors, such as maternal body mass index or waist circumference. Any early-pregnancy predictor of gestational prediabetes risk needs to have low cost, ease of administration, and a short turnaround time. The theoretical advantage of identifying women with gestational prediabetes would be to “prevent” the onset of GDM (and its inherent risks to the pregnancy) in a timelier manner. One sensible starting point would be an intervention to prevent early excessive weight gain in pregnancy, which is currently being evaluated by two randomized clinical trials. In addition, early intervention could offset the need for resource-intense GDM management or insulin therapy.
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Biomarcadores/sangre , Glucemia/análisis , Diabetes Gestacional/clasificación , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/patología , Femenino , Humanos , Estado Prediabético/clasificación , Estado Prediabético/diagnóstico , Estado Prediabético/patología , Embarazo , Aumento de Peso/fisiologíaRESUMEN
Objective : To compare the use of metformin with that of insulin for the treatment of gestational diabetes mellitus (GDM) and type 2 diabetes mellitus (T2DM) unresponsive to diet therapy. Materials and Methods : In this prospective observational study, maternal glycemic control and perinatal outcome in diabetic pregnancies were compared between 2 obstetric units, one using insulin therapy and the other using metformin therapy. Baseline pretreatment glycemic profile was done and then repeated weekly throughout pregnancy. The outcome measures studied were glycemic control, maternal complications and perinatal outcome. Results :Sixty women with gestational and type 2 diabetes were enrolled, 30 each for metformin and insulin. Both groups were comparable with respect to age, body mass index (BMI), parity and pretreatment plasma glucose levels. Glycemic control was better with metformin after 1 week of therapy and also throughout gestation (P = 0.03-0.007). There were no major complications or perinatal deaths in this study. Mean gestational age and birth weight (2.9 ± 0.4 kg versus 3.1 ± 0.4 kg, P = 0.30) were comparable. However, there was a significant increase in neonatal intensive care unit (NICU) admission and stay for babies born in the insulin group. The cost of treatment was tenfold higher in thethe insulin group. Conclusion :Metformin is clinically effective, cheap and a safe alternative to insulin therapy in pregnant diabetic women.