The Impact of Ethnicity on Awareness and Knowledge of and Attitudes Towards the Human Papillomavirus and Vaccine Among Adult Women

ObjectiveTo determine whether ethnicity affects awareness, knowledge, and attitudes regarding the human papillomavirus (HPV) and the HPV vaccine.MethodsEnglish speaking women (n = 172) aged 18 and older were recruited from an outpatient gynaecology clinic to complete a self-administered cross-sectional questionnaire that gathered information about (1) virus awareness and knowledge, (2) vaccine awareness and knowledge, (3) attitudes towards the vaccine and (4) participant demographics. Subjects received a virus knowledge score (0 to 6), a vaccine knowledge score (0 to 10) and an attitudes score (8 to 40), with a higher score indicating more positive attitudes towards the vaccine.ResultsVirus and vaccine awareness was significantly higher in Caucasian respondents than in non-Caucasian respondents: 93% versus 69% (P < 0.001) and 94% versus 64%, (P < 0.001), respectively. In a multivariate logistic regression model, the Caucasian ethnic group, higher education status, and greater number of years in Canada each emerged as independent predictors of vaccine awareness. Both virus and vaccine knowledge scores were significantly higher in Caucasian than non-Caucasian women: 4.6 versus 3.89 (P = 0.001) and 7.2 versus 6.4, (P = 0.042), respectively. Caucasian women had significantly higher (more positive) attitudes towards the vaccine than non-Caucasians (31.4 vs. 29.2, P = 0.021). Higher HPV vaccine knowledge was positively associated with an interest in vaccination (r² = 0.26, P < 0.01) and a more positive vaccine attitudes score (r² = 0.40, P < 0.001).ConclusionVirus and vaccine awareness were both higher in Caucasian women than in non-Caucasian women. Improving HPV vaccination knowledge has the potential to improve attitudes and vaccine uptake.     

Risks of Gestational Diabetes and Preeclampsia Over the Last Decade in a Cohort of Alberta Women

ObjectiveThe incidence of gestational diabetes mellitus (GDM) is increasing. However, less is known about the incidence of preeclampsia (PE) and whether it is affected by the presence of GDM. We sought to document the population-level incidence of GDM and PE during the last decade and examine the association between GDM and PE after accounting for established risk factors.MethodsWe selected a population-based cohort retrospectively using data from the Alberta Perinatal Health Program registry. Logistic regression was used to examine the association between GDM and PE after adjusting for baseline characteristics.ResultsOf 426 296 deliveries between 2000 and 2009, 422 672 were in women without pre-existing diabetes. Among these women, the incidence of GDM increased from 3.1% in 2000 to 4.6% in 2009 (P < 0.01), while the incidence of PE remained stable at approximately 1.3% per year. The incidence of PE was significantly higher in women with GDM than in those without GDM (2.6% vs. 1.2%; P < 0.01). After adjustment, women with GDM had a 90% higher risk of PE than those without GDM (OR 1.9; 95% CI 1.7 to 2.1). Other significant risk factors for PE were age, obesity, nulliparity, multifetal gestation, pre-existing hypertension, and chronic kidney disease.ConclusionIn this contemporary population-based study spanning 10years, there was a significant increase in the incidence of GDM over time. The higher incidence of PE in women with GDM than in normoglycemic women suggests a need for heightened surveillance and monitoring of women with GDM for the development of PE.     

Enfermedad periodontal y diabetes mellitus gestacional: estudio caso-control

BackgroundStudies linking periodontal disease (PD) and gestational diabetes mellitus (GDM) are not consistent. Our main objective is to evaluate the possible association between PD and GDM. We also analysed the risk factors for GDM in our sample.Methods180 pregnant women participated, 90 with GDM and 90 controls, from Valencia's Hospital La Fe. A questionnaire was completed and a periodontal examination was performed, assessing the following parameters: number of teeth, plaque and bleeding on probing indices, probing depth (PD) and clinical attachment level (CAL). Periodontitis was defined according to the criteria of CDC-AAP.ResultsThe GDM group had a higher mean value of PD (p = .001) and CAL (p = .028). Of the patients with GDM, 74.4% had gingival inflammation compared to 57.8% of the non-diabetic patients. Periodontitis was more prevalent in patients with GDM (p < .05). Maternal age, educational level and periodontitis are independent risk factors for GDM (OR = 1.16, 95% CI 1.07 to 1.25, p < .001), (OR = .37, 95% CI .19 to .72, p < .005) and (OR = 2.79, 95% CI 1.40 to 5.59, p < .005) respectively.ConclusionsThe results suggest that pregnant women with gestational diabetes have more associated periodontal disease than those without gestational diabetes. In our sample, the risk for GDM can be estimated from periodontitis, age, and educational level.     

A first trimester prediction model for gestational diabetes utilizing aneuploidy and pre-eclampsia screening markers

Objective: We examined whether first trimester aneuploidy and pre-eclampsia screening markers predict gestational diabetes mellitus (GDM) in a large multi-ethnic cohort and the influence of local population characteristics on markers.

Methods: Clinical and first trimester markers (mean arterial pressure (MAP), uterine artery pulsatility index (UtA PI), pregnancy associated plasma protein A (PAPP-A), free-β human chorionic gonadotropin (free-hCGβ)) were measured in a case-control study of 980 women (248 with GDM, 732 controls) at 11 to 13?+?6 weeks’ gestation. Clinical parameters, MAP-, UtA PI-, PAPP-A-, and free-hCGβ-multiples-of-the-median (MoM) were compared between GDM and controls; stratified by ethnicity, parity, and GDM diagnosis?<24 versus?≥24 weeks’ gestation. GDM model screening performance was evaluated using AUROC.

Results: PAPP-A- and UtA PI-MoM were significantly lower in GDM versus controls (median ((IQR) PAPP-A-MoM 0.81 (0.58–1.20) versus 1.00 (0.70–1.46); UtA PI-MoM 1.01 (0.82–1.21) versus 1.05 (0.84–1.29); p?p?Conclusions: Addition of aneuploidy and pre-eclampsia markers is cost-effective and enhances early GDM detection, accurately identifying early GDM, a high-risk cohort requiring early detection, and intervention. Ethnicity and parity modified marker association with GDM, suggesting differences in pathophysiology and vascular risk.     

Acute Caffeine Ingestion and Glucose Tolerance in Women With or Without Gestational Diabetes Mellitus

ObjectiveRecent work showing that caffeine impairs glucose tolerance may be of particular concern in pregnancy because of a possible negative effect on fetal outcome. The current study sought to assess the effect of acute caffeine ingestion on glucose tolerance in women with or without gestational diabetes mellitus (GDM).MethodsNineteen women whose routine GDM test was negative (control) and eight women with an initial positive GDM screen completed two trials one week apart in a double-blind randomized crossover study. Following an overnight fast, subjects ingested caffeine (3 mg/kg pre-pregnancy body weight) or an identical-appearing placebo (gelatin) capsule and one hour later began a 75 g 2-hour oral glucose tolerance test.ResultsIn the control group, caffeine did not significantly affect blood glucose, insulin, or C-peptide. In the GDM group, glucose area under the curve (AUC) was greater (P < 0.01), C-peptide AUC was greater (P < 0.05), and insulin sensitivity index was lower (18%, P < 0.05) after caffeine than after placebo.ConclusionCaffeine impaired insulin sensitivity in women with GDM. Additional research regarding more specific dietary caffeine recommendations for women with GDM is warranted.     

Effect of a Brief Educational Intervention on the Attitudes of Young Women Toward the Intrauterine Device

Study ObjectiveThe intrauterine device (IUD) is underused by young women, who are at high risk for unintended pregnancy. We aimed to assess the impact of a brief educational intervention on the attitudes of young women toward intrauterine contraception and to assess characteristics associated with a change in attitude.Design, Setting, and ParticipantsThis is a planned secondary analysis of a survey of 144 women, aged 14–24 years, which assessed attitudes toward the IUD.InterventionThe analysis was planned to fully examine the impact of a 3-minute educational intervention about the IUD given during administration of the survey, which included risks and benefits of IUD use, costs, side effects, and a demonstration of the IUD insertion and removal process.Main Outcome MeasureProportions of participants with a positive attitude toward the IUD before and after the intervention were compared using McNemar's chi-square test for paired proportions. Factors associated with a change in attitude toward the IUD were evaluated using multivariable analysis.ResultsBefore the educational intervention, 14.7% (21/143) had both heard of the IUD and expressed a positive attitude toward it. After the intervention, this proportion increased to 53.8% (77/143) (P < .01). The increase in proportion with a positive attitude was consistent for all subpopulations. In multivariable analysis, the only significant predictor of a positive change in attitude toward the IUD was a history of voluntary sexual activity (adjusted odds ratio 10.3, 95% confidence interval 2.0–53.1).ConclusionsA brief educational intervention significantly improves the attitude of young sexually active women toward the IUD.     

Validation of Tamil Version of Cranley’s 24-Item Maternal–Fetal Attachment Scale in Indian Pregnant Women

Background

Maternal–fetal attachment has not been formally studied among pregnant Indian women using Cranley’s 24-item maternal–fetal attachment scale.

Objective

The purpose of this study was to validate the Cranley’s 24-item maternal–fetal attachment scale (MFAS-24).

Methods

Consecutive pregnant Indian women of all trimesters were studied in Pondicherry, India.

Statistical Analysis

The mean, standard deviation (SD), Cronbach’s alpha, content validity index (CVI), correlation coefficient, and simple correlation analyses were calculated.

Results

230 pregnant women of various sociodemographic, religious and educational background formed the sample. Mean age of sample was 23 (SD ± 3) years, mean MFAS scores was 87.4 (SD ± 10), mean GHQ scores was 14 (SD ± 1.2), and mean gestational age was 27.2 (SD ± 7) weeks. Cronbach’s reliability alpha of MFAS was high (0.71). There was no correlation between MFAS scores and gestational age or the pregnancy trimester. CVI of the scale, for the Tamil version was 0.72 and for the English version was 0.78.

Conclusions

This study shows applicability of MFAS-24 in Indian settings also for measuring maternal–fetal attachment.     

Female sexual function and gestational diabetes

IntroductionThe number of women with gestational diabetes mellitus (GDM) is growing worldwide in parallel with the obesity epidemic. The diagnosis of GDM leads to substantial modifications in the daily routine of these women, and these adjustments could potentially affect their sexual function. There are no previous studies on the sexual function of patients with GDM.AimThe aim of this study was to investigate the sexual function of patients with GDM in comparison with healthy pregnant women at the same gestational age.MethodsBrazilian women in the third trimester of pregnancy with and without GDM were invited to participate in this cross‐sectional study while waiting for their antenatal care visits at a single public tertiary teaching institution between March and December 2010. The Brazilian version of the Female Sexual Function Index (FSFI) questionnaire was used to assess sexual function.Main Outcome MeasuresDesire, arousal, lubrication, orgasm, sexual satisfaction, and pain during and after coitus in the last 4 weeks, measured according to a standardized and validated questionnaire.ResultsA total of 87 participants were enrolled (43 healthy women and 44 with GDM). There were no significant differences in the sociodemographic characteristics of both groups. The total FSFI scores of GDM patients was 21.0 ± 9.59 compared with 22.3 ± 9.17 for healthy women (P = 0.523). Difficulty in desire was the most common sexual dysfunction symptom in both groups, being reported by 42% and 50% of GDM and healthy women, respectively (P = 0.585).ConclusionThe sexual function of Brazilian patients with GDM does not differ significantly from that of healthy pregnant women at the same gestational age. Ribeiro MC, Nakamura MU, Scanavino Mde T, Torloni MR, and Mattar R. Female sexual function and gestational diabetes. J Sex Med 2012;9:786–792.     

The Prevalence of Gestational Diabetes Mellitus and Glucose Abnormalities in Pregnant Women With Hepatitis C Virus Infection in British Columbia

ObjectiveThere is evidence to support an association between diabetes mellitus (DM) and hepatitis C virus (HCV) infection. The insulin resistant state of pregnancy suggests a predisposition to developing gestational diabetes mellitus (GDM) in women infected with HCV. The aim of this study was to compare the prevalence of GDM and impaired glucose tolerance (IGT) of pregnancy between women infected with HCV and the general population of British Columbia screened for GDM.MethodsThe HCV cohort was drawn from a population-based prospective cohort of 148 pregnant women infected with HCV in British Columbia. GDM screening tests were completed in 84 women. The prevalence of GDM and IGT of pregnancy in the general population of British Columbia was estimated by acquiring 24 321 GDM screening tests performed by the two major laboratories in the province.ResultsNon-compliance was the primary reason for incomplete screening. The prevalence of GDM was 9.5% in the HCV cohort and 6.8% in the screened general population (χ² test P = 0.33). Similarly, there was no difference in IGT of pregnancy between the two cohorts (2.4% vs. 3.5%; χ² test P = 0.57).ConclusionA difference in the prevalence of either GDM or IGT of pregnancy was not detected between HCV-infected patients who were screened for GDM and those screened in the general population. Further studies are required to assess whether HCV infection is an independent risk factor for GDM.     

A higher prevalence of endometriosis among Asian women does not contribute to poorer IVF outcomes

Purpose

The purpose of the study was to determine whether diagnosis of endometriosis or endometriosis with endometrioma influences in vitro fertilization (IVF) outcomes in an ethnically diverse population.

Methods

Women undergoing a first IVF cycle (n = 717) between January 1, 2008 and December 31, 2009, at a university-affiliated infertility clinic, were retrospectively assessed for an endometriosis diagnosis. Differences in prevalence of endometriosis by ethnicity were determined, as well as differences in IVF success by ethnicity, with a focus on country of origin for Asian women. A multivariate model was generated to assess the relative contributions of country of origin and endometriosis to chance of clinical pregnancy with IVF.

Results

Endometriosis was diagnosed in 9.5% of participants; 3.5% also received a diagnosis of endometrioma. Endometriosis prevalence in Asian women was significantly greater than in Caucasians (15.7 vs. 5.8%, p < 0.01). Women of Filipino (p < 0.01), Indian (p < 0.01), Japanese (p < 0.01), and Korean (p < 0.05) origin specifically were more likely to have endometriosis than Caucasian women, although there was no difference in endometrioma presence by race/ethnicity. Oocyte quantity, embryo quality, and fertilization rates did not relate to endometriosis. Clinical pregnancy rates were significantly lower for Asian women, specifically in Indian (p < 0.05), Japanese (p < 0.05), and Korean (p < 0.05) women, compared to Caucasian women, even after controlling for endometriosis status.

Conclusions

The prevalence of endometriosis appears to be higher in Filipino, Indian, Japanese, and Korean women presenting for IVF treatment than for Caucasian women; however, the discrepancy in IVF outcomes was conditionally independent of the presence of endometriosis. Future research should focus on improving pregnancy outcomes for Asian populations whether or not they are affected by endometriosis, specifically in the form of longitudinal studies where exposures can be captured prior to endometriosis diagnoses and infertility treatment.

     

Impact of the creation of a specialized clinic for prenatal blood sampling and follow-up care in pregnant women

ObjectiveTo evaluate (1) the effect on gestational diabetes mellitus (GDM) screening rates of having a specialized clinic for pregnant women offering blood sampling and screening for GDM, and (2) the impact on perinatal outcomes of having early GDM screening and follow-up provided by the specialized clinic.MethodsWe performed a retrospective cohort study, based on electronic health records. We compared data from women who delivered during a period when the Blood Sampling in Pregnancy (BSP) clinic was operating (2008–2009; n = 2780) to a time period before the clinic was established (2006–2007; n = 2591). During the 2008–2009 period, we compared data from women who had GDM screening in the first trimester with women who had screening during the second trimester and with women who were not screened.ResultsFollowing the creation of the BSP clinic, overall GDM screening rates reached 72.4% in 2008–2009, compared with 48.9% in 2006-2007 (P < 0.001) and GDM screening was more likely to be performed in the first trimester (36.7% vs. 0.4%; P < 0.001). During the period when the BSP clinic was operating (2008-2009), women who had GDM screening in the first trimester had lower rates of Caesarean section (15.7% vs. 22.1 %; P < 0.001) and neonatal complications (bradycardia: 3.6% vs. 6.8%; P = 0.003; respiratory distress: 9 6% vs 13 2%; P = 0 02; and admission to NICU: 15.4% vs. 26.8%; P < 0.001) than women who did not perform GDM screening.ConclusionIn our population, creation of a clinic offering specialized care to pregnant women improved GDM screening rates. With the support of the BSP clinic, women who had early GDM screening were less likely to undergo Caesarean section and their offspring had fewer perinatal complications.     

Indian Research in Gestational Diabetes Mellitus during the Past Three Decades: A Scientometric Analysis

BackgroundIndia plays an important role in global research on gestational diabetes mellitus (GDM), but a bibliometric assessment of this research is lacking.ObjectiveTo provide a comprehensive analysis of Indian GDM research during the last 30 years using select bibliometric indicators. MethodsThe Scopus international database was used to retrieve publication data, using a defined search strategy. The analysis focused on research output of Indian authors and organizations and their collaborations. The qualitative performance was assessed in terms of relative citation index and citations per paper (CPP).ResultsOverall, 100 countries participated in GDM research producing 13,193 publications during 1990–2019. India ranked ninth in global output (1182 publications, 3.1% share) and CPP of 18.6. Only 21.3% of publications had international collaboration and 9.4% were funded. Of the 235 organizations and 544 authors that participated in India’s research on GDM, the top 50 organizations and authors contributed 53.8 and 36.4% to national publication share, respectively. The leading productive organizations were AIIMS, New Delhi, KEMH, Pune and PGIMER, Chandigarh, whereas the most productive authors were S. Kalra, V. Seshiah and C.S. Yajnik. Indian Journal of Endocrinology and Metabolism, Journal of Clinical and Diagnostic Research, Journal of Obstetrics and Gynecology of India and Diabetes Research and Clinical Practice were the most productive journals.ConclusionsIndian research on GDM is lagging behind other countries which have a similar disease burden. Increasing national and international collaborations, and active support of national and international funding agencies is urgently required to produce quality research on GDM.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13224-021-01444-7.     

Predictors and Clinical Implications of a False Negative Glucose Challenge Test in Pregnancy

ObjectiveA common approach to screening for glucose intolerance in pregnant women is the use of a 50g glucose challenge test (GCT) in the late second trimester, followed by a diagnostic oral glucose tolerance test (OGTT) when the GCT is positive (1-hour post-challenge blood glucose ≥ 7.8 mmol/L). As women with a negative GCT do not undergo the diagnostic OGTT, it is possible that they could have undiagnosed gestational diabetes (GDM) or gestational impaired glucose tolerance (GIGT). Thus, we sought to characterize predictors of a false negative GCT and its clinical implications.MethodsTwo hundred two women with a negative GCT screening test underwent subsequent OGTT, which enabled their stratification into two groups: (1) those with normal glucose tolerance on OGTT (n = 166) and (2) those with either GDM (n = 8) or GIGT (n = 28).ResultsThe 36 women found to have GDM or GIGT at the time of OGTT had higher GCT glucose values than those with normal glucose tolerance (mean 6.6 mmol/L vs. 5.9 mmol/L, P < 0.001), as well as poorer insulin sensitivity (P = 0.004) and pancreatic beta-cell function (P < 0.001). On logistic regression analysis, the only significant independent predictor of GDM/GIGT was the GCT glucose value (OR 2.19; 95% CI 1.40 to 3.41, P < 0.001). However, there was no clear GCT glucose threshold for identifying GDM/GIGT, consistent with its modest area under the receiver operating characteristic curve (0.71). Importantly, there were also no differences between the two groups in median length of gestation, median birth weight, prevalence of macrosomia, or proportion of low Apgar scores.ConclusionFalse negative GCTs cannot be readily predicted by risk factors. However, their clinical implications at delivery may be benign.     

Evaluation of fetal liver volume by tridimensional ultrasound in women with gestational diabetes mellitus

ObjectiveTo evaluate the effect of gestational diabetes mellitus (GDM) on fetal liver growth during the third trimester.MethodsWe performed a longitudinal study of pregnant women recruited at the time of GDM screening (24 to 28 weeks of gestation), with follow-up visits at 32 weeks, 36 weeks, and delivery. Women with GDM were followed with nutritional recommendations and insulin when necessary according to the Canadian Diabetes Association guidelines. Fetal liver volume was evaluated using 3-D ultrasound at each antenatal visit, and fetal liver growth was compared between women with and without GDM.ResultsTwenty-seven women were recruited, 10 with normal glucose tolerance (NGT) and 17 with confirmed GDM, five who required insulin and 12 who were treated by diet only. We found no difference in fetal liver volume between groups at any of the three visits, and median birth weight was also similar between groups On the other hand, we found a strong correlation between fetal liver volume at 36 weeks’ gestation and birth weight (ρ = 0.61, P < 0.001).ConclusionsIn our preliminary study, we found that fetal liver volume could be a strong predictor of infant birth weight independent of GDM status This suggests that fetal liver volume of offspring of women with NGT is similar to that of offspring of women with GDM treated following recommended targets. Larger studies are required.     

Maternal serum leptin concentration in gestational diabetes

ObjectiveThe aim of this study was to evaluate fasting serum leptin concentration and its relation to insulin resistance in women with gestational diabetes mellitus (GDM) and gestational impaired glucose tolerance (IGT).Materials and MethodsThis case-control study, at 28 weeks of gestation, measured serum concentration of fasting leptin, insulin, and homeostatic model assessment index in three groups, GDM, IGT, and normal control, and compared them with each other.ResultsThe serum leptin level was significantly higher in women with GDM than in the two other groups (p = 0.03). In women with GDM and IGT, leptin was significantly positively related with insulin and homeostatic model assessment index (r = 0.221, p = 0.03) and (r = 0.246, p = 0.03), respectively. In all of the participants, there was a significant correlation between leptin and body mass index before pregnancy (r = 0.416, p = 0.001).ConclusionOur data showed that serum leptin level was higher in GDM and had a positive correlation with insulin resistance. Our findings suggest that high leptin levels might be a risk factor for GDM and IGT in pregnant women.     

Religion,Spirituality, Social Support,and Perceived Stress in Pregnant and Postpartum Hispanic Women

Objective:To examine the association between religion/spirituality and perceived stress in prenatal and postpartum Hispanic women.Design:Cross‐sectional survey.Setting:An urban, publicly funded hospital in California.Participants:Two hundred and forty‐eight pregnant and postpartum Hispanic women between age 18 and 45 years.Method:Patients presenting for prenatal or postpartum care or for the first infant visit were recruited to participate in the current study. Participants completed surveys consisting of questions about demographic characteristics, religiosity, spirituality, social support, and stress.Results:Most participants were unmarried, low‐income women with low educational attainment. Ninety percent of women reported a religious affiliation, with more than one half (57.4%) listing their religious affiliation as “Catholic.” Overall religiousness/spirituality was significantly associated with increased negative experiences of stress in women who selected English language instruments (Spearman's r=.341, p=.007); there was no such relationship in women who selected Spanish language instruments. Social support and greater relationship quality with a significant other were significantly associated with reduced perceived stress in Spanish reading and English reading women.Conclusions:In this sample of pregnant and postpartum Latinas, religiousness/spirituality was not associated with reduced perceived stress and was in fact associated with increased perceived stress among women who selected English‐language surveys. Additional research is needed to investigate this association. On the other hand, the current study reinforces the importance of social support and relationship quality for pregnant and postpartum women.     

Impact of a mother's weight history on her offspring

ObjectiveTo explore the relationship between maternal lifelong body weight history and anthropometric measurements in the offspring.MethodsWe studied a prospective sample of 48 pregnant women with either gestational diabetes mellitus (GDM, n = 21) or normal glucose tolerance (NGT, n = 27). Reported maternal weight at birth, 20 years of age and 30 years of age, and pre-pregnancy and maximal weight outside pregnancy were obtained by questionnaire. BMI was calculated using data from the questionnaire. Maternal anthropometric parameters were measured during pregnancy. Offspring anthropometrics were obtained at birth and eight weeks later.ResultsMaternal weight at birth, weight or BMI at 20 years of age and at 30 years of age, and maximal weight or BMI did not differ between groups. In all women, maternal birth weight, BMI at 20 years of age, and maximal BMI correlated with newborn birth weight (ρ = 0.39, 0.37, and 0.27, respectively, P ≤ 0.05), with newborn length (ρ = 0.46, 0.32, and 0.30 respectively, P < 0.05), and with infant weight eight weeks later (ρ = 0.43, 0.30, and 0.31, respectively, P < 0.05). Reported maternal BMI at 30 years of age correlated with infant weight (ρ = 0.31) and cranial circumference (ρ = 0.33) at eight weeks of life (P < 0.05). Besides gestational age, maternal weight at screening was the most significant predictor of infant birth weight.ConclusionSeveral parameters of maternal weight history were related to offspring anthropometric measurements in early life in a sample of women with and without GDM.     

Identificación de factores que se asocian a alto riesgo de desarrollar diabetes gestacional

ObjectivesThe main objective is to determine the current prevalence of recognised risk factors for gestational diabetes mellitus (GDM) in our region, and to define the profile of patients at higher risk of developing this condition. We also investigate patient acceptability of the screening tests.Material and methodsThis is an ambispective study with 1,448 pregnant women recruited between December 2017 and July 2019 from a single centre. Inclusion criteria were no diabetes mellitus prior to the pregnancy, no history of GDM in any previous pregnancy, no history of bariatric surgery before the pregnancy, and GDM screening tests performed.ResultsThe prevalence of GDM was 6.7%. Risk factors associated with development of GDM were: age ≥ 27.5 years (OR: 3.8; 95% CI: 2.01-9.16); BMI ≥ 28.5 kg/m² (OR: 2.3; 95% CI: 1.47-3.59); history of diabetes mellitus in first-degree relatives (OR: 2.3; 95% CI: 1.5-3.66); and multiple pregnancy (OR: 2.8; 95% CI: 0.86-6.36); Prevalence of GDM increased with the number of risk factors presented by patients: from 1.4% with no risk factor, to 25.2% with 3. The O'Sullivan test (50 g glucose) and oral glucose tolerance test (100 g glucose) were perceived as “unpleasant” by 26.8% and 65.4% of patients, respectively.ConclusionsAge ≥ 27.5 years, BMI ≥ 28.5 kg/m², history of diabetes mellitus in first-degree relatives, and multiple pregnancy are factors related to an increased risk of GDM; these factors would be enough to identify most pregnant women developing GDM. Our findings may be used to improve programmes aimed at early diagnosis of gestational diabetes and supporting high-risk mothers in antenatal care.     

Post-partum follow-up of women with gestational diabetes mellitus: effectiveness,determinants, and barriers

Background: Despite the recommendations for postpartum blood glucose monitoring post gestational diabetes mellitus (GDM); scientific evidence reveals that these recommendations may not be fully complied to. This study aimed to follow-up women up to 2 years post-delivery with pregnancies complicated by GDM and healthy controls to assess this fact.

Methods: Women with GDM (n?=?78) and normal glucose tolerant (n?=?89) delivered in 2014 were followed up for 2 years. They were informed and enquired via telephone about their blood glucose screening, physical activity, postpartum complications, and current weight status of mother and baby.

Results: Women with previous GDM were older and reported higher body weight 2 years post-delivery. At the 2?year follow-up, n?=?11 (14.1%) participants had developed diabetes, all with previous GDM. Both weight at birth (3.8?±?0.5?kg) and at 2-year (10.7?±?2.3?kg) for the babies born to GDM mothers was significantly higher than the NGT group babies (2.6?±?0.63 and 7.1?±?1.4?kg; p?Conclusions: The high incidence of T2DM in women with previous GDM is an alarming finding. Given this trend, systematic follow-up programs are needed to reduce obesity and diabetes risk.