1.Prevalence and risk factors of gestational diabetes in pregnant women, followed up at the Department of Obstetrics and Gynecology, Bach Mai Hospital, Hanoi.
Nga Bich Vu ; Thao Thi Phuong Nguyen ; Hung Viet Nguyen
Journal of Medical and Pharmaceutical Information 2005;0(10):21-23
Background: Gestational diabetes is a special form of diabetes mellitus, which is initially diagnosed during gestation. In Vietnam, routine screens for gestational diabetes are not performed. The risk factors of the disease are not taken into account during early screening. Many pregnancies are later diagnosed when complications present themselves. Objective: To determine the prevalence and discover the risk factors for Gestational Diabetes (GD) among pregnant women, who followed up at the Department of Obstetrics and Gynecology, Bach Mai Hospital. Subject and methods: A cross-sectional, prospective study was conducted on 415 pregnant women, who had 24-28 weeks of gestation, followed up at the Department of Obstetrics and Gynecology, Bach Mai Hospital from December, 2006 to April, 2007. All were asked about the risk factors and given an oral glucose tolerance test with 75g of glucose. Results: The prevalence of GD in general population accounted for 7.9%. The prevalence of GD, who had BMI \u226523, family history with 1st degree relative of diabetes and positive glycosuria at gestational age under 24 weeks in subgroups were 25.8%, 37.8% and 55.6%, respectively. None of the pregnant women who had a child weighed \u22654.000g at the previous delivery was diagnosed as GD. However, all thepregnant women, who had history of abnormal glucose tolerance, were GD. Conclusion: Prevalence of GD is increasing. BMI\u226523, family history with 1st degree relative of diabetes and positive glycosuria at age of gestation <24 weeks are considered as high risk factors of GD.
gestational diabetes
3.Effectiveness of selective risk based screening for Gestational Diabetes (GDM) in Malaysia: A retrospective cohort study based on the National Obstetric Registry (NOR) of Malaysia
Muniswaran Ganeshan ; Shahrul Aiman Soelar ; Shamala Devi Karalasingam ; Mohammad Adam Bujang ; Jeganathan R, M. ; Harris Suharjono
The Medical Journal of Malaysia 2017;72(1):46-49
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.
Diabetes, Gestational
4.A Clinical Audit of the Process of Care for Women with Gestational Diabetes Mellitus in a Malaysian Public Polyclini
Malaysian Journal of Medicine and Health Sciences 2019;15(2):69-76
Introduction: Proper gestational diabetes mellitus (GDM) care is essential for optimal control and thus prevents adverse perinatal outcomes. This audit aimed to determine the quality of GDM care provided by a public polyclinic. Methods: The audit was performed on the clinic-based medical record of GDM patients who had undergone at least three prenatal follow-ups and one postnatal follow-up between January and November 2012. Patients with pre-existing diabetes mellitus were excluded. Results: A total of 74 medical records were audited and it showed that 94.6% of patients were of age 25 and above, 91.9% were Malays, 71.6% were multigravida and 98.6% had risk factors of GDM. 54.1% of diagnoses were made during the second trimester, while 25.7% and 20.2% of cases were detected during the first and third trimester respectively. All of the GDM patients had their weight and blood pressure monitored, 85.1% had their fundal height checked as scheduled and 85.1% were referred for diet counselling. 81.9% and 100% of GDM patients who were not on treatment and on treatment correspondingly had their blood sugar profile monitoring done as recommended. Only 13.5% of GDM patients were given prenatal family planning counselling and 35.1% were given a six weeks’ postnatal oral glucose tolerance test appointment. Monthly ultrasound screening and HbA1c monitoring was done in merely 51.4% and 58.1% of the GDM patients respectively. Conclusion: The GDM care process in this public polyclinic could be improved further to achieve the standard recommendations
Gestational diabetes
5.A retrospective cohort study in a university hospital evaluating the effect of maternal glucose containing intravenous fluid in neonatal glycemia
Gelinemae G MALAZA ; Elaine C CUNANAN
Journal of Medicine University of Santo Tomas 2019;3(1):290-294
Abstract Maternal hyperglycemia during the peripartum period is highly correlated with fetal hyperinsulinemia and consequent neonatal hypoglycemia.
Liberal use of intravenous glucose therapy prior to
delivery can potentially cause maternal hyperglycemia, therefore, it is prudent to implement all preventive measures.
This study aims to determine the occurrence of neonatal hypoglycemia with intravenous glucose therapy prior to delivery in maternal diabetes mellitus.
This was a retrospective cohort study of neonates
born from diabetic mothers at the University of Santo
Tomas Hospital Clinical and Private Divisions from
January 1, 2013 to December 15, 2017. Clinical
information gathered was divided into maternal and
neonatal characteristics. Maternal intravenous fl uid
use, rate, and duration were noted; maternal and
neonatal blood glucose results were obtained.
There were 109 infants of diabetic mothers, of
which 105 were delivered as singleton and 4 from twin pregnancies. Neonatal hypoglycemia was
present in 14.68%. Comparing the risk factors, there
was a higher amount of glucose infused to the mothers whose offspring developed hypoglycemia compared to those without hypoglycemia. Statistically,
this did not demonstrate a signifi cant difference. The
rate of glucose infusion and frequency of maternal
insulin use were similar between the groups. Linear
correlation was not evident when the total glucose
infused and the rate of intravenous glucose infusion
was compared to the neonatal glucose in the fi rst
hour of life.
Based on this study, routine administration of glucose-containing intravenous fl uid did not infl uence
the incidence of neonatal hypoglycemia. It is recommended that further prospective studies be conducted.
Diabetes, Gestational
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6.Diagnosis of gestational diabetes mellitus using the international association of the diabetes and pregnancy study groups criteria and adverse pregnancy outcomes among a cohort of Filipino women: An association analysis
Kristine S. de Luna ; Elaine C. Cunanan
Philippine Journal of Internal Medicine 2017;55(4):1-8
Introduction:
Locally, there is no unified set of diagnostic
criteria for gestational diabetes mellitus (GDM) and this can
lead to potential confusion on the part of the physician and
the patient as well. Moreover, whether the adoption of the
International Association of the Diabetes and Pregnancy
Study Groups (IADPSG) threshold values for GDM diagnosis
among Filipino women is appropriate is still unclear. This study
serves to give a clinically important insight whether utilizing
the abovementioned diagnostic criteria is appropriate in
the local setting or not. The study aims to determine the
association of the threshold values set up by the IADPSG to
diagnose GDM with adverse pregnancy outcomes among
a cohort of Filipino women.
Methods:
A retrospective analysis of medical files of the
women diagnosed with GDM using the IADPSG criteria from
January 2013 to March 2016 was done. The results of seventyfive gram oral glucose tolerance test (75-g OGTT) were
recorded. The association between each IADPSG threshold
values (fasting blood glucose of ≥92 mg/dL, one-hour post
glucose load of ≥180 mg/dL, two-hour post glucose load
of ≥153 mg/dL) used to define GDM and maternal and
perinatal outcomes were determined.
Results:
One hundred twenty women with GDM were
included in the analysis. Each of IADPSG-defined cut-off values was not significantly associated with increased
likelihood of having adverse maternal outcomes namely:
hypertensive disorders of pregnancy, miscarriage, primary
cesarean section, operative vaginal delivery, and maternal
death. Similarly, the likelihood of perinatal outcomes namely:
macrosomia, perinatal death, prematurity, birth injuries,
congenital anomalies, neonatal hypoglycemia, jaundice,
low APGAR score, acute respiratory distress syndrome, and
infection were not significantly higher even if these cut-off
values were met. Of note, high odds ratio was noted for neonatal
hypoglycemia at FBS >92 mg/dL and <92 mg/dL and the low
Apgar Score in first minute at >153 mg/dL and <153 mg/dL
even though they were statistically not significant.
Conclusion
We did not find a statistically significant positive
association between IADPSG threshold values and specified
adverse maternal and perinatal outcomes.
Diabetes, Gestational
7.Maternal and neonatal outcomes among women with gestational diabetes mellitus treated with metformin in a tertiary hospital: A retrospective cohort study
Francis Xavier Fernandez Mislang ; Rebecca Lim Alba
Philippine Journal of Internal Medicine 2023;61(4):215-220
Background:
Gestational diabetes mellitus (GDM) is a common disorder associated with both maternal and fetal
complications. Treatment for GDM requires lifestyle modification, as well as insulin and oral anti-diabetes medications to prevent unwarranted fetal and maternal outcomes.
Objective:
To determine the feto-maternal outcomes of GDM patients treated with either metformin-monotherapy, insulin-
monotherapy, and with insulin plus metformin (combination) therapy in a private tertiary hospital in Metro Manila.
Methods:
This is a retrospective cohort study involving 209 GDM patients admitted from January 2017 to December 2019. Census and chart reviews were done for demographic and clinical data. These were divided into 3 groups: metformin-monotherapy, insulin-monotherapy, and combination treated groups. Analysis of Variance was used to compare the average capillary blood glucose (CBG) levels of patients. Chi-square and Fisher’s Exact tests were used for nonparametric data.
Results:
Birthweight was significant across all groups: metformin-monotherapy group highest with large-for-gestational-
age (LGA) at 25%, small-for-gestational-age (SGA) highest on the insulin-monotherapy group (11.3%) and appropriate-for-
gestational-age (AGA) highest in the combination therapy group (84.6%). Age of gestation (AOG) at delivery (p=0.005), maternal CBG during labor (p=0.007), and chronic hypertension (p=0.001) were statistically significant across all groups.
Multiple comparisons showed the following statistically significant results as well: chronic hypertension between metformin
and combination group (p <0.01), AOG during delivery between metformin vs insulin group (p=0.004), maternal CBGs
during labor between metformin vs insulin group (p=0.022), and insulin vs combination treatment group (p=0.029).
Average maternal CBG levels were also showed statistically significant difference between the metformin vs insulin group
(p=0.029).
Conclusion
Metformin may be used in controlling CBG levels in GDM patients. Although metformin may be comparable to insulin, more long-term studies need to be done to determine its long-term effects on neonates.
Diabetes, Gestational
8.Strategic Interventions in the Management of Gestational Diabetes to Reduce Type 2 Diabetes Mellitus in Women in Malaysia
The Medical Journal of Malaysia 2015;70(4):211-213
According to the Global status report on non-communicable
diseases 2010, the prevalence of high blood sugars among
adults exceeds 11 % in both males and females in Malaysia.
This is the highest among ASEAN countries. This ties up
closely with the prevalence of overweight adults in both sexes
in the same report, again Malaysians rank highest among
ASEAN countries. The burden of diabetes mellitus in
Malaysia is estimated to be 12% of the population with a
projected figure exceeding 15 % in 2020.
1
This enormous rise in both obesity and hyperglycaemia in
adults is alarming and clear strategies to combat this noncommunicable
disease is urgently warranted. One such
strategy is to relook at the focussed approach of gestational
diabetes mellitus (GDM) management currently in vogue in
Malaysia, and suggest more effective preventive measures in
view of information currently coming to light on both short
and long term implications of GDM on both mother and
offspring.
Although information on actual prevalence of GDM in
Malaysia is lacking, available crude data from hospital births
obtained from the National Obstetric Register in 2010
involving 14 major government hospitals was 9.9% with
Indians ranking highest followed by Malays and Chinese.
Incidence of macrosomia in GDM mothers was double that of
non-GDM mothers. A higher caesarean section rate with a
threefold increase in shoulder dystocia was also recorded in
those with GDM.
Diabetes Mellitus
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Diabetes, Gestational
9.Survey of epidemiology about diabetes mellitus of people from over 16 years old at 3 districts in Ha Noi
Journal of Vietnamese Medicine 2003;285(6):58-64
After researching epidemiology about diabetes mellitus of 2017 people from over 16 years old at 964 families of 40 groups-hamlets, 20 wards-communes, 2 districts (Gia Lam, Soc Son) and Dong Da in Ha Noi communities. Diabetes mellitus is the most of common and presented of 3.62%, in which high rate affected belongs Dong Da (6.61%), next is Soc Son (2.98%) and Gia Lam district (1.63%). Some factors related to be diabetes mellitus: male are more higher than females (3.95% - 3.46%). More older has high risks to be affected by diabetes mellitus. Obese physical, Hypertention, Pregnant women has been child 4 kgs. Other factors: High standard, unresonable eating, less removing, family factor
Diabetes Mellitus
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Diabetes, Gestational
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Diseases
10.Dietary Characteristics of Women With Gestational Diabetes Mellitus
Malaysian Journal of Medicine and Health Sciences 2019;15(SP1):69-76
Introduction: The role of dietary intake on maternal glucose is uncertain. This study described the dietary characteristics of women with gestational diabetes mellitus (GDM) and examined the differences in dietary characteristics based on GDM diagnosis. Methods: This study recruited GDM women (n =45; age =31.1±5.1 years old) from health clinics in Seremban. Dietary intake, glycemic index (GI) and glycemic load (GL) were assessed using a semi-quantitative food frequency questionnaire (SFFQ) during first and second trimester of pregnancy. GDM diagnosis was made at 28 weeks gestation with the following cut-off for FPG ≥ 5.1 or 2hPG ≥ 7.8 mmol/L following oral glucose tolerance test. Results: Women with GDM had a reasonable intake of protein and fat but consumed high-carbohydrate at second trimester and high-sugar diet at both trimesters. Fibre, iron and calcium from the food sources did not meet the recommended nutrient intakes for pregnancy. About 75.6% (n = 34) GDM women had high 2hPG (9.3 ± 1.5 mmol/L) with a normal FPG (4.7 ± 0.7 mmol/L). While dietary characteristics were not significantly different, women with a higher 2hPG tended to take a higher proportion of protein at first trimester and a higher dietary GI, serving of rice, and sugars and creamer at second trimester than high FPG. Conclusion: Suboptimal maternal nutrition in women with GDM are of particular concern. Dietary characteristics of women with high fasting and 2-hour glucose were comparable but not optimal. The needs of tailored nutritional intervention are evident in women known to be at high risk of GDM.
Gestational diabetes mellitus (GDM)
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