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management diabetes gestational

Przemyslaw Rys, Agnieszka H Ludwig-Słomczyńska, Katarzyna Cyganek, Maciej T Malecki
BACKGROUND: Randomised controlled trials (RCTs) have shown an advantage of continuous subcutaneous insulin infusion (CSII) over multiple daily injections (MDI) in the general type 1 diabetes mellitus (T1DM) population. RCT data on T1DM management in pregnancy remain limited. OBJECTIVE: We performed a systematic review of both RCTs and non-RCTs evaluating CSII versus MDI in T1DM-complicated pregnancy. STUDY DESIGN: Electronic databases were searched for studies comparing CSII with MDI in T1DM-complicated pregnancy...
March 15, 2018: European Journal of Endocrinology
Carolina Fux-Otta, Manuel Maliqueo, Bárbara Echiburú, Otilio Rosato, Nicolás Crisosto, Gabriel S Iraci, Marta Fiol de Cuneo, Paula Szafryk de Mereshian, Teresa Sir-Petermann
Pregnancy complications and obstetric outcomes were compared in 80 Chilean (PPCOSCh ) and 70 Argentinian (PPCOSAr ) pregnant women. Reference groups of Chilean and Argentinian normal pregnant women from the same antenatal care units were also compared. PPCOSCh showed a higher prevalence of gestational diabetes mellitus (GDM) (OR, 2.28, 95% CI: 1.08-4.77, p = .030) and a lower prevalence of pregnancy-induced hypertension (PIH) (OR, 0.20, 95% CI: 0.07-0.54, p = .001) compared to PPCOSAr . In the normal pregnant groups, the prevalence of PIH was lower in Chilean women compared to Argentinian women (OR, 0...
March 14, 2018: Journal of Obstetrics and Gynaecology: the Journal of the Institute of Obstetrics and Gynaecology
Annie Dude, Charlotte M Niznik, Emily D Szmuilowicz, Alan M Peaceman, Lynn M Yee
Achieving maternal euglycemia in women with pregestational and gestational diabetes mellitus is critical to decreasing the risk of neonatal hypoglycemia, as maternal blood glucose levels around the time of delivery are directly related to the risk of hypoglycemia in the neonate. Many institutions use continuous insulin and glucose infusions during the intrapartum period, although practices are widely variable. At Northwestern Memorial Hospital, the "Management of the Perinatal Patient with Diabetes" policy and protocol was developed to improve consistency of management while also allowing individualization appropriate for the patient's specific diabetic needs...
March 13, 2018: American Journal of Perinatology
Shelley Macaulay, Martha Ngobeni, David B Dunger, Shane A Norris
AIMS: This study aimed to determine the prevalence of GDM amongst black South African women, describe GDM-associated risk factors and clinical management, and evaluate the efficacy of the fasting plasma glucose reading in diagnosing GDM. METHODS: A cross-sectional screening study was performed. Pregnant women were recruited from the Chris Hani Baragwanath Academic Hospital in Johannesburg. A total of 1906 women underwent a two-hour 75 g oral glucose tolerance test at 24-28 weeks gestation...
March 8, 2018: Diabetes Research and Clinical Practice
Rachel T McGrath, Sarah J Glastras, Emma S Scott, Samantha L Hocking, Gregory R Fulcher
Metformin is increasingly being used a therapeutic option for the management of gestational diabetes mellitus (GDM). The aim of this study was to compare the maternal characteristics and perinatal outcomes of women with GDM treated with metformin (with or without supplemental insulin) with those receiving other management approaches. A retrospective, case-control study was carried out and 83 women taking metformin were matched 1:1 with women receiving insulin or diet and lifestyle modification alone. Women managed with diet and lifestyle modification had a significantly lower fasting plasma glucose ( p < 0...
March 9, 2018: Journal of Clinical Medicine
Qian Chen, Ellen Francis, Gang Hu, Liwei Chen
BACKGROUND: Gestational diabetes mellitus (GDM) reflects an increased risk of developing type 2 diabetes (T2D) after pregnancy in women. Offspring born to mothers with GDM are at an elevated risk of obesity and T2D at a young age. Currently, there are lack of ways for identifying women in early pregnancy who are at risk of developing GDM. As a result, both mothers and fetus are not treated until late in the second trimester when GDM is diagnosed. The recent advance in metabolomics, a new approach of systematic investigation of the metabolites, provides an opportunity for early detection of GDM, and classifying the risk of subsequent chronic diseases among women and their offspring...
January 31, 2018: Journal of Diabetes and its Complications
Claudia Caissutti, Gabriele Saccone, M D Adeeb Khalifeh, Awathif Dhanya Mackeen, M D Melisa Lott, Vincenzo Berghella
INTRODUCTION: There is inconclusive evidence to support any criteria for starting pharmacologic therapy after diet in women with gestational diabetes mellitus (GDM). We aimed to analyze the most used criteria for starting pharmacologic treatment for patients with GDM. MATERIAL AND METHODS: Electronic databases were searched from their inception to September 2017. We included all randomized controlled trials (RCTs) of GDM managed initially by diet and exercise reporting criteria for starting pharmacologic therapy...
March 5, 2018: Journal of Maternal-fetal & Neonatal Medicine
Oded Langer
Controversies persist over the most efficacious pharmacologic treatment for gestational diabetes mellitus. For purposes of accuracy in this article, the individual American College of Obstetricians and Gynecologists Practice Bulletin and American Diabetes Association Standards of Medical Care positions on each issue are quoted and then deliberated with evidence of counter claims presented in point/counterpoint. This is a review of all the relevant evidence for the most holistic picture possible. The main issues are (1) which diabetic drugs cross the placenta, (2) the quality of evidence and data source validity, (3) the rationale for the designation of glucose control as the primary outcome in gestational diabetes mellitus, and (4) which drugs (metformin, glyburide, or insulin) are most effective in improving secondary outcomes...
February 28, 2018: American Journal of Obstetrics and Gynecology
Brian McMillan, Katherine Easton, Elizabeth Goyder, Brigitte Delaney, Priya Madhuvrata, Reem Abdelgalil, Caroline Mitchell
BACKGROUND: Despite the seven-fold increased risk of type 2 diabetes mellitus (T2DM) among females previously diagnosed with gestational diabetes (GD), annual rates of follow-up in primary care are low. There is a need to consider how to reduce the incidence of progression to T2DM among this high-risk group. AIM: To examine the views of females diagnosed with GD to ascertain how to improve primary care support postnatally, and the potential role of technology in reducing the risk of progression to T2DM...
February 26, 2018: British Journal of General Practice: the Journal of the Royal College of General Practitioners
Eleanor M Scott, Rudy W Bilous, Alexandra Kautzky-Willer
BACKGROUND: Accuracy of the FreeStyle Libre™ Flash Glucose Monitoring System has not been evaluated in pregnant women with diabetes. The aim of this study was to determine accuracy (compared to self-monitoring of blood glucose [SMBG]), clinical safety, and acceptability of the FreeStyle Libre System when used at home by this population. MATERIALS AND METHODS: Seventy-four participants, with type 1 (T1D, n = 24), type 2 (T2D, n = 11), or gestational (n = 39) diabetes, were enrolled across 13 sites (9 in United Kingdom, 4 in Austria)...
February 22, 2018: Diabetes Technology & Therapeutics
Reem Abdwani, Laila Al Shaqsi, Ibrahim Al-Zakwani
Objectives: Systemic lupus erythematous (SLE) is a chronic autoimmune disease that affects women primarily of childbearing age. The objective of this study was to determine the neonatal and maternal outcomes of pregnancies in SLE patients compared to pregnancies in healthy controls. Methods: We conducted a retrospective cohort study in a tertiary care hospital in Oman between January 2007 and December 2013. We analyzed 147 pregnancies and compared 56 (38.0%) pregnancies in women with SLE with 91 (61...
January 2018: Oman Medical Journal
Reena Oza-Frank, Elizabeth Conrey, Jo Bouchard, Cynthia Shellhaas, Mary Beth Weber
Introduction An important yet understudied component of postpartum type 2 diabetes risk reduction among high risk women is experiences with the healthcare system. Our objective was to describe the healthcare experiences of a diverse, low-income sample of women with prior GDM, including their suggestions for improving care. Methods Focus groups were conducted among African American, Hispanic, and Appalachian women who were diagnosed with GDM within the past 10 years. Participants were recruited from community and medical resources...
February 17, 2018: Maternal and Child Health Journal
Laura T Dickens, Rochelle N Naylor
PURPOSE OF REVIEW: Monogenic diabetes accounts for 1-2% of all diabetes cases, but is frequently misdiagnosed as type 1, type 2, or gestational diabetes. Accurate genetic diagnosis directs management, such as no pharmacologic treatment for GCK-MODY, low-dose sulfonylureas for HNF1A-MODY and HNF4A-MODY, and high-dose sulfonylureas for KATP channel-related diabetes. While diabetes treatment is defined for the most common causes of monogenic diabetes, pregnancy poses a challenge to management...
February 15, 2018: Current Diabetes Reports
Dana Vitner, Kristin Harris, Cynthia Maxwell, M D Farine
BACKGROUND: Obesity in pregnancy has become one of the most important challenges in obstetrical care given its prevalence and potential adverse impact on both mother and fetus. The primary objective of this descriptive review is to identify common themes and distinctions within the current recommendations for maternal obesity in the most updated version of four published national guidelines. METHODS: We reviewed the following guidelines for obesity in pregnancy: American College of Obstetricians and Gynecologists (ACOG) 2015, Royal Australian and New Zealand College of Obstetricians and Gynecologists (RANZCOG) 2013, Royal College of Obstetrics and Gynecology (RCOG) 2010, and Society of Obstetrics and Gynecologists of Canada (SOGC) 2010...
February 15, 2018: Journal of Maternal-fetal & Neonatal Medicine
Zohoor Nabhani, Seyed Jamal Ghaemmaghami Hezaveh, Elham Razmpoosh, Mohammad Asghari-Jafarabadi, Bahram Pourghassem Gargari
AIMS: The role of gut microbiota in the management of diabetes is shown. In this randomized clinical trial we assessed the effects of synbiotic supplementation on insulin, lipid profile and antioxidative status among women with gestational diabetes mellitus (GDM). METHODS: Ninety pregnant women with GDM were randomly assigned into two groups to receive either a daily synbiotic capsule - consisting of L. acidophilus, L. plantarum, L. fermentum, L. gasseri (1.5-7...
February 10, 2018: Diabetes Research and Clinical Practice
Aida Kalok, Pravin Peraba, Shamsul Azhar Shah, Zaleha Abdullah Mahdy, Mohamad Abdul Jamil, Nirmala Kampan, Suraya Sulaiman, Nor Azlin Mohamed Ismail
Background Gestational diabetes mellitus (GDM) is on the rise globally and there are various screening guidelines with regard to patients' criteria. Materials and methods We conducted a prospective cross-sectional study to determine the prevalence of GDM amongst low-risk pregnant women above the age of 25 years. A modified glucose tolerance test (MGTT) was performed between 24 and 36 weeks of gestation. Women with GDM were divided into two groups for analysis: age between 25 and 34 years (group A) and above 35 years (group B)...
February 9, 2018: Hormone Molecular Biology and Clinical Investigation
Linda M Biesty, Aoife M Egan, Fidelma Dunne, Valerie Smith, Pauline Meskell, Eugene Dempsey, G Meabh Ni Bhuinneain, Declan Devane
BACKGROUND: Pregnant women with pre-existing diabetes (Type 1 or Type 2) have increased rates of adverse maternal and neonatal outcomes. Current clinical guidelines support elective birth, at or near term, because of increased perinatal mortality during the third trimester of pregnancy.This review replaces a review previously published in 2001 that included "diabetic pregnant women", which has now been split into two reviews. This current review focuses on pregnant women with pre-existing diabetes (Type 1 or Type 2) and a sister review focuses on women with gestational diabetes...
February 9, 2018: Cochrane Database of Systematic Reviews
Seyedeh Noushin Ghalandarpoor-Attar, Seyedeh Mojgan Ghalandarpoor-Attar, Sedigheh Borna, Fahimeh Ghotbizadeh
BACKGROUND: Early diagnosis of pheochromocytoma and its proper management can lessen its mortality and morbidity. This case report describes a 24-year-old pregnant woman with an unusual presentation of pheochromocytoma. CASE PRESENTATION: An Iranian 24-year-old primigravid woman from Kordistan province was referred to our center with left flank pain at 37 weeks of gestation. She had a history of gestational diabetes mellitus since the 12th week of gestation which was managed by insulin administration...
February 9, 2018: Journal of Medical Case Reports
Luciana F Franco, Renata Peixoto-Barbosa, Renata P Dotto, José Gilberto H Vieira, Magnus R Dias-da-Silva, Luiz Carlos F Reis, Fernando M A Giuffrida, Andre F Reis
Identification of the correct etiology of diabetes brings important implications for clinical management. In this report, we describe a case of a 4-year old asymptomatic girl with diabetes since age 2, along with several individuals in her family with different etiologies for hyperglycemia identified in youth. Genetic analyses were made by Sanger sequencing, laboratory measurements included HbA1c, lipid profile, fasting C-peptide, pancreatic auto-antibodies (glutamic acid decarboxylase [GAD], Islet Antigen 2 [IA-2], and anti-insulin)...
December 2017: Archives of Endocrinology and Metabolism
Katarina Hjelm, Karin Bard, Jan Apelqvist
BACKGROUND: Gestational diabetes (GDM) is associated with health risks for both mother and child, and is particularly relevant to migrant women and women of African origin. With today's extensive global migration, contact with the new society and health system confronts the migrant's culture of origin with the culture of the host country. The question is whether immigrants' patterns of beliefs about health, illness, and health-related behaviour change over time, as no previous studies have been found on this topic...
February 5, 2018: BMC Women's Health
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