Gestational Diabetes Mellitus: A Study of Women Who Fail to Attend Appointments
|
|
- Myra Eaton
- 6 years ago
- Views:
Transcription
1 Gestational Diabetes Mellitus: A Study of Women Who Fail to Attend Appointments Vincent W. Wong, MBBS, FRACP, PhD, Shanley Chong, PhD, Cecilia Astorga, BSc, and Bin Jalaludin, MBBS, MRCP, FAFPHM, PhD One of the challenges clinicians face in managing patients with diabetes is to ensure that patients comply with their therapy. Patients may lack motivation to adhere to recommendations from diabetologists, diabetes nurse educators, and dietitians, and their attendance to clinic appointments can be erratic. A recent study demonstrated that clinic nonattendance and noncompliance to therapy were both independent predictors of mortality for patients with type 2 diabetes. 1 Women with gestational diabetes mellitus (GDM) are usually informed by their obstetrics or diabetes team (at their first educational session) that suboptimal glycemic control could affect the well-being of their developing fetuses, and this may provide greater motivation for them to adhere to therapy. In addition to antenatal visits, women with GDM must attend education sessions on GDM management, and they require regular follow-up with their diabetes team until delivery. To date, there is little information in the literature addressing compliance issues for women with GDM. Because optimal GDM management has been shown to affect pregnancy outcomes for women with GDM, we hypothesized that nonattendance to diabetes-related appointments may have adverse effects on the pregnancy outcomes of women with GDM. In this study, we assessed the attendance of diabetes-related appointments for women with GDM and explored clinical factors that were associated with failureto-attend (FTA) rates for these women in a single public hospital in the southwestern part of Sydney, Australia. We also evaluated the pregnancy outcomes of women with GDM who had failed to attend two or more of their diabetes appointments during pregnancy. Materials and Methods A retrospective review was conducted on all pregnant women who were diagnosed with GDM and who had received diabetes education at the Diabetes Centre at Liverpool Hospital between 1 January and 31 December Demographic data, including age, parity, BMI, ethnicity, family history of diabetes, history of previous GDM, glucose tolerance test results, A1C, and need for insulin therapy, were documented. The women s scores on the Edinburgh Depression Scale (EDS) at the first antenatal visit were also noted. Pregnancy outcomes including prematurity (< 37 weeks), birth weight, birth weight percentile, Apgar scores, fetal death, and admission to the neonatal intensive care unit (NICU) were recorded. Macrosomia was defined by a birth weight of > 90th percentile. Attendance at diabetes-related services during pregnancy was recorded in the hospital appointment system. Women who failed to attend appointments with two clinicians scheduled on the same day were counted as having missed one appointment. Women who failed to attend two or more diabetesrelated clinic appointments were identified as multi-fta. The well-attended group was composed of women who attended all scheduled appointments or missed no more than one appointment throughout their pregnancy. 267
2 At Liverpool Hospital, a tertiary referral center located in the southwestern part of Sydney, Australia, women diagnosed with GDM were booked into a diabetes group seminar conducted by a diabetes nurse educator (DNE) and dietitian at the Diabetes Centre. During the 2-hour session, these women were educated about blood glucose monitoring and given advice on medical nutritional therapy. The DNE also discussed the implications of GDM on the developing fetus and informed the women about their future risk of developing type 2 diabetes. These women were followed up at the high-risk antenatal clinic, a multidisciplinary clinic staffed by midwives, obstetricians, renal physicians, endocrinologists, DNEs, and a dietitian. Most of the subsequent appointments were coordinated such that the women would see the obstetrics and diabetes teams at the same clinic on the same day. The frequency of diabetes-related appointments was dependent on the women s glycemic profile and dietary-related issues. Women who required insulin therapy would attend an extra education session at the Diabetes Centre to learn how to self-inject. Interpreters were readily available when required. Statistical Analysis Continuous variables were expressed as median and interquartile range, whereas categorical variables were expressed as percentages. A nonparametric method was used to compare all continuous variables between binary outcomes. χ 2 Testing was used to compare categorical variables between binary outcomes. Differences were considered significant at the level of P < All variables were first tested in a univariate model. Only variables with a P < 0.25 were included in the multivariate model. To assess the associations between binary outcome variable and potential clinical factors, a logistic regression model was used. For predicting multi-fta, these variables were ethnicity, parity, previous GDM, requirement for insulin therapy, BMI, and A1C at diagnosis. For predicting macrosomia, these variables were ethnicity, parity, need for insulin therapy, BMI, and multi-fta. The study was approved by the Sydney South West Area Health Table 1. Characteristics of Women with GDM Who Missed Two or More Appointments (Multi-FTA) Compared to Women Who Fully Attended or Missed Only One Appointment (Compliant) Compliant (n = 286) 268 Multi-FTA (n = 80) Test Statistics Median age (years [range]) 31 (17 46) 31 (17 43) Kruskal-Wallis, P = 0.73 Parity = 0 (n [%]) 106 (37.2) 19 (24.0) χ 2 = 4.74, P = 0.03 χ 2 = 6.38, P = 0.04 BMI Normal (< 25 kg/m 2 ) (n [%]) Overweight (25 30 kg/m 2 ) (n [%]) Obese (> 30 kg/m 2 ) (n [%]) 125 (44.1) 84 (29.7) 74 (26.1) 30 (38.0) 17 (21.5) 32 (40.5) Family history of diabetes (n [%]) 143 (50.0) 41 (51.3) χ 2 = 0.04, P = 0.84 Previous GDM (n [%]) 51 (17.8) 27 (33.8) χ 2 = 9.45, P < 0.01 Weeks of gestation when GDM diagnosed (median [range]) Ethnicity Southeast Asians (n [%]) South Asians (n [%]) Middle Easterners (n [%]) Anglo-Europeans (n [%]) Others (n [%]) 27 (18 35) 25 (16 32) Kruskal-Wallis, P = 0.08 χ 2 = 19.6, P < (23.1) 60 (21.0) 60 (21.0) 71 (24.8) 29 (10.1) 14 (17.5) 15 (18.8) 26 (32.5) 7 (8.8) 18 (22.5) Requiring interpreter service (n [%]) 61 (21.3) 19 (23.8) χ 2 = 0.21, P = 0.64 Smokers (n [%]) 11 (3.8) 5 (6.3) χ 2 = 0.86, P = 0.35 Results of 75-g glucose tolerance test Fasting glucose level (mmol/l [range]) Fasting glucose level (mg/dl [range]) 2-hour glucose level (mmol/l [range]) 2-hour glucose level (mg/dl [range]) 5.1 ( ) 82 (63 106) 8.4 ( ) 151 (72 324) 5.5 ( ) 99 (67 225) 8.2 ( ) 148 (77 234) Kruskal-Wallis, P < 0.01 Kruskal-Wallis, P = 0.11 A1C at diagnosis 5.5% (37 mmol/mol) (n [%]) 126 (45.0) 40 (53.3) χ 2 = 1.65, P = 0.20 Number of diabetes appointments (medial [range]) 8 (1 18) 8 (0 25) Kruskal-Wallis, P = 0.79
3 Service Human Research Ethics Committee. Results Between January and December 2011, 366 women with GDM received diabetes education at the Liverpool Hospital Diabetes Service. The women had a median of eight diabetes-related clinic appointments during pregnancy. Among these women, 37.2% (136 women) missed at least one appointment during their pregnancy, whereas 21.9% (80 women) missed appointments at least twice (multi-fta group). Twentytwo women missed at least four of their diabetes-related appointments. Women in the multi-fta group had greater BMIs, were less likely to be nulliparous, had a significantly higher rate of previous GDM, and were likely to be from a non- European background (Table 1). There were no differences between the multi-fta and well-attended groups in the need for interpreters, scores on the EDS, or total number of diabetes-related appointments during pregnancy. In terms of their metabolic profiles, women in the multi-fta group had higher fasting glucose levels on their glucose tolerance test at the time of GDM diagnosis. On multivariate logistic regression analysis, previous GDM and certain non-anglo-european ethnicities (South Asians, Middle Easterners, and others) were independent predictors for multi-fta (Table 2). At 36 weeks gestation, 272 women had a repeat A1C measurement. Those in the multi-fta group had poorer glycemic control, as indicated by a greater proportion of women in this group having an A1C > 5.5% (Table 3). More of them required insulin therapy. In terms of pregnancy outcomes, women in the multi-fta group gave birth to neonates with significantly larger birth weight and higher birth weight percentile, and a greater proportion were macrosomic (Table 3). There was a trend toward higher rates of neonate admission into the NICU in the multi-fta group, but mode of delivery, proportion of premature births, neonates with low Apgar scores, and peri-natal deaths were not significantly different compared to those in the compliant group. Using multivariate logistic regression analysis taking into account factors such as maternal BMI, parity, ethnicity, and insulin use, women in the multi-fta group had an increased risk of macrosomia (odds ratio [OR] 1.98, 95% CI , P = 0.076). Discussion The reasons behind nonattendance of antenatal services were complex Table 2. Multivariate Logistic Regression Analysis of Factors Predicting Multi-FTA Predictor OR 95% CI P Ethnicity Anglo-Europeans Southeast Asians South Asians Middle Easterners Others < 0.01 < 0.01 Parity = 0 yes versus no Previous GDM yes versus no BMI < 25 kg/m kg/m 2 > 30 kg/m A1C at diagnosis 5.5% (37 mmol/mol) yes versus no and involved factors relating to women s perceived value of the services, clinic set-up, and women s level of understanding of their condition and how it affects fetal well-being. 2,3 Campbell et al. 4 reported a no-show rate of 28% at their high-risk obstetric clinic. A number of studies have identified several sociodemographic factors related to late initiation or inadequate adherence to antenatal care. These have included high parity, low income, and membership in a minority ethnic group. 2,3,5 7 In the literature, there has not been any study specifically assessing the clinic attendance of women with GDM. Because unforeseen circumstances could preclude women from attending one of the many appointments scheduled during pregnancy, we chose women who missed at least two appointments as our reference FTA group (multi-fta). In our cohort, a substantial number of women with GDM (more than onefifth) missed their diabetes-related appointments two or more times during their pregnancy. We demonstrated that women with GDM who frequently missed their appointments were more likely to have previous GDM and were often from non-european ethnic groups. Women with children (parity > 0) were more likely to miss appointments, but this association was no longer significant in multivariate analysis. We also showed that depression scores on EDS did not differ between those who attended the program fully and those in the multi-fta group. We observed that women with previous GDM had a greater risk of multi-fta. These women could be more confident with GDM management from their previous experience, but it was not clear if that led to a lower threshold for missing appointments. For women with previous GDM and stable diabetes control, one might argue that these women could be reviewed at the clinic less frequently, and phone consultations could be employed more readily in these women. Although women from a non- Anglo/European background had a higher multi-fta rate, this was 269
4 Table 3. Pregnancy Outcomes of Multi-FTA Women Compared to Compliant Women Compliant Multi-FTA Test Statistics (n = 286) (n = 80) A1C at 36 weeks 5.5% (37 mmol/mol) (n [%])* 95 (42.9) 31 (60.8) χ 2 = 2.3, P = 0.02 Need insulin therapy (n [%]) 114 (39.9) 42 (52.5) χ 2 = 4.08, P = 0.04 Gestational week of delivery (medial [range]) 39 (33 41) 39 (30 41) Kruskal-Wallis, P = 0.26 Prematurity (delivery at < 37 weeks) (n [%]) 7 (2.4) 4 (5.0) χ 2 = 1.3, P = 0.25 χ 2 = 4.9, P = 0.18 Method of delivery Emergency Caesarian section (n [%]) Elective Caesarian section (n [%]) Induction of labor (n [%]) Spontaneous vaginal delivery (n [%]) not related to the need for interpreters. Apart from language barriers, cultural differences and level of health literacy in these women could possibly affect the likelihood for nonattendance to appointments. These women would need more time and greater resources to help them understand their condition better and adhere to recommendations. The others ethnic group consisted of women from the Pacific Islands, Africa, and South America, and they had a significantly high nonattendance rate. However, because of the small number of women in each of these groups, separate analysis for each group was not valid. The important question was whether attendance at diabetesrelated appointments mattered in terms of pregnancy outcomes. In our study, those in the multi-fta group had poorer glycemic control by 36 weeks, and their risk of macrosomia was higher. There was no difference in other pregnancy outcomes, although there was a trend toward increased risk of admission to the NICU. One other study, 6 which was not limited to women with GDM, demonstrated that poor attendance at antenatal clinic appointments 16 (5.6) 56 (19.6) 62 (21.7) 143 (50.0) was associated with lower 5-minute Apgar scores of neonates, higher risk for fetal and neonatal death, and higher risk of placental abruption and intrauterine infections. At our institution, women with GDM attended a mean of eight diabetes-related appointments throughout their pregnancy. Although most of the diabetesrelated appointments were made in conjunction with obstetrics visits, attending all of the appointments could still be challenging, especially for women who worked or had young children at home. Our analysis showed no association between the number of diabetes-related appointments and the FTA rate. Nevertheless, it would be difficult to assess the impact to a woman s GDM management if she missed two out of a total of four appointments compared to missing two out of 10 appointments. The most common reasons women gave for nonattendance included lack of transportation, unsuitable appointment times, need to care for a sick child or relative, and lack of available child care facilities. 2,4 Apart from reinforcing the importance of good diabetes control (11.3) 10 (12.5) 19 (23.8) 38 (47.5) Perinatal deaths (n [%]) 1 (0.3) 1 (1.3) χ 2 = 0.9, P = 0.33 Birth weight (kg [range]) 3.3 ( ) 3.5 ( ) Kruskal-Wallis, P = 0.01 Macrosomia (birth weight 90th percentile) (n [%]) 30 (10.5) 18 (22.5) χ 2 = 7.6, P = 0.01 Apgar score at 5 minutes 7 (n [%]) 5 (1.7) 3 (3.8) χ 2 = 1.1, P = 0.29 Need for NICU admission (n [%]) 7 (2.4) 5 (6.3) χ 2 = 2.9, P = 0.09 *A total of 272 women had repeat A1C testing at 36 weeks of gestation, including 221 in the compliant group and 51 in the multi-fta group. on pregnancy outcomes, improving the clinic set-up for these women could be vital. Strategies such as offering more flexible appointment times, maintaining shorter waiting times at the clinic, and providing a more child-friendly environment at the clinic could improve clinic attendance, but these strategies would demand greater health resources. To reduce the total number of clinic appointments, phone consultations could be employed more frequently in women with stable diabetes control and those with previous GDM. However, face-to-face reviews were still invaluable in that they provided more comprehensive assessment of women s diabetes control and nutritional status. A study using a telemedicine system 8 was highly effective in enhancing communication between women with GDM and clinicians, but pregnancy outcomes were not different. There were a few limitations in our study. Information such as the education level and socioeconomic status of the women, which could affect the FTA rate, was not available. The findings of this study also could not be extrapolated to other models of care (e.g., clinics in the pri-
5 vate sector) where the service set-up, such as the scheduling of appointments and waiting times, is different. The socioeconomic background, level of health literacy, and perception of health care could also differ between women who choose private versus public antenatal services. Finally, other facets of compliance to GDM management, including adherence to self-monitoring of blood glucose, medical nutrition therapy, and insulin therapy, were not assessed in this study. In summary, this was the first study assessing factors associated with multi-fta of GDM appointments at a public hospital. At our institution, we found that women with previous GDM and those belonging to certain ethnic groups had higher rates of multi-fta. Because effective diabetes management affects both maternal and fetal well-being, each institution should review its FTA rates and formulate strategies to improve attendance of these women. References 1 Currie CJ, Peyrot M, Morgan CL, Poole CD, Jenkins-Jones S, Rubin RR, Burton CM, Evans M: The impact of treatment noncompliance on mortality in people with type 2 diabetes. Diabetes Care 35: , Blankson ML, Goldenberg RL, Keith B: Noncompliance of high-risk pregnant women in keeping appointments at an obstetric complications clinic. South Med J 87: , Sword W: Prenatal care use among women of low income: a matter of taking care of self. Qual Health Res 13: , Campbell JD, Chez RA, Queen T, Barcelo A, Patron E: The no-show rate in a high-risk obstetric clinic. J Womens Health Gend Based Med 9: , Beeckman K, Louckx F, Putman K: Determinants of the number of antenatal visits in a metropolitan region. BMC Public Health 10:527, Raatikainen K, Heiskanen N, Heinonen S: Under-attending free antenatal care is associated with adverse pregnancy outcomes. BMC Public Health 7:268, Petrou S, Kupek E, Vause S, Maresh M: Clinical, provider and sociodemographic determinants of the number of antenatal visits in England and Wales. Soc Sci Med 52: , Homko CJ, Deeb LC, Rohrbacher K, Mulla W, Mastrogiannis D, Gaughan J, Santamore WP, Bove AA: Impact of a telemedicine system with automated reminders on outcomes in women with gestational diabetes mellitus. Diabetes Technol Ther 14: , 2012 Vincent W. Wong, MBBS, FRACP, PhD, is director of the Diabetes and Endocrine Service at Liverpool Hospital and a conjoint associate professor at the University of New South Wales in Sydney, Australia. Shanley Chong, PhD, is biostatistician at the Centre for Research, Evidence Management and Surveillance in Liverpool, Sydney, Australia. Cecilia Astorga, BSc, is a clinical nurse consultant at the Diabetes and Endocrine Service at Liverpool Hospital. Bin Jalaludin, MRCP, FAFPHM, PhD, is a conjoint professor at the University of New South Wales and director of the Centre for Research, Evidence Management and Surveillance. 271
COMPLICATIONS OF PRE-GESTATIONAL AND GESTATIONAL DIABETES IN SAUDI WOMEN: ANALYSIS FROM RIYADH MOTHER AND BABY COHORT STUDY (RAHMA)
COMPLICATIONS OF PRE-GESTATIONAL AND GESTATIONAL DIABETES IN SAUDI WOMEN: ANALYSIS FROM RIYADH MOTHER AND BABY COHORT STUDY (RAHMA) Prof. Hayfaa Wahabi, King Saud University, Riyadh Saudi Arabia Hayfaa
More informationGestational Diabetes Mellitus (GDM) and Diabetes in Pregnancy: Diagnostic Recommendations, NSLHD
Guideline Gestational Diabetes Mellitus (GDM) and Diabetes in Pregnancy: Diagnostic Document Number GE2017_003 Publication Date 31 January 2017 Intranet location/s Summary Author Department Contact (Details)
More informationDiabetes Educator. Australian. Diabetes in Pregnancy. Policy Discussion. GDM Model of Care the Role of the Credentialled Diabetes Educator
Australian Diabetes Educator Volume 17, Number 3, August 2014 Diabetes in Pregnancy GDM Model of Care the Role of the Credentialled Diabetes Educator GDM a New Era in Diagnosis and the Impact for Diabetes
More informationGESTATIONAL DIABETES for GP Obstetric Shared Care Accreditation Seminar. Simon Kane March 2016
GESTATIONAL DIABETES for GP Obstetric Shared Care Accreditation Seminar Simon Kane March 2016 Objectives History and definitions Definition and Australian data Pathophysiology and prevalence Rationale
More informationThe New GDM Screening Guidelines. Jennifer Klinke MD, FRCPC Endocrinologist and Co director RCH Diabetes in Pregnancy Program
The New GDM Screening Guidelines Jennifer Klinke MD, FRCPC Endocrinologist and Co director RCH Diabetes in Pregnancy Program Disclosures Current participant (RCH site) for MiTy study Metformin in women
More informationGestational Diabetes in Rural Antenatal Clinics:
Gestational Diabetes in Rural Antenatal Clinics: How do we compare? Cook SJ 1,2, Phelps L 1, Kwan M 2 Darling Downs Health and Hospital Service University of Queensland Rural Clinical School Gestational
More informationThe Ever-Changing Approaches to Diabetes in Pregnancy
The Ever-Changing Approaches to Diabetes in Pregnancy Kirsten E. Salmeen, MD Assistant Professor Obstetrics, Gynecology & Reproductive Sciences Maternal-Fetal Medicine I have nothing to disclose. Approaches
More informationScreening, Diagnosis and Management of Gestational Diabetes in New Zealand: A Clinical Practice Guideline
Screening, Diagnosis and Management of Gestational Diabetes in New Zealand: A Clinical Practice Guideline 6 November 2014 Gary Tonkin Today Process to develop the guideline What the guideline recommends
More informationGestational Diabetes: An Update on Testing. Kimberlee A McKay, M.D. Avera Medical Group Ob/GYN
Gestational Diabetes: An Update on Testing Kimberlee A McKay, M.D. Avera Medical Group Ob/GYN Gestational Diabetes Increased risks of: Still Birth Hydramnios Should Dystocia Prolonged Labor Preeclampsia
More informationGestational Diabetes Mellitus Dr. Fawaz Amin Saad
Gestational Diabetes Mellitus Dr. Fawaz Amin Saad Senior Consultant OB/GYN, Al-Hayat Medical Center, Doha, Qatar DISCLOSURE OF CONFLICT OF INTEREST I am a full-time Employee at Al-Hayat Medical Center.
More informationEffect of Various Degrees of Maternal Hyperglycemia on Fetal Outcome
ORIGINAL ARTICLE Effect of Various Degrees of Maternal Hyperglycemia on Fetal Outcome ABSTRACT Shagufta Tahir, Shaheen Zafar, Savita Thontia Objective Study design Place & Duration of study Methodology
More informationDIABETES WITH PREGNANCY
DIABETES WITH PREGNANCY Prof. Aasem Saif MD,MRCP(UK),FRCP (Edinburgh) Maternal and Fetal Risks Diabetes in pregnancy is associated with risks to the woman and to the developing fetus. Maternal and Fetal
More informationVishwanath Pattan Endocrinology Wyoming Medical Center
Vishwanath Pattan Endocrinology Wyoming Medical Center Disclosure Holdings in Tandem Non for this Training Introduction In the United States, 5 to 6 percent of pregnancies almost 250,000 women are affected
More informationContinuous Glucose Monitoring in Women With Type 1 Diabetes in Pregnancy Trial
Continuous Glucose Monitoring in Women With Type 1 Diabetes in Pregnancy Trial Dr Sandra Neoh on behalf of: Dr Denice Feig and Professor Helen Murphy Funders: JDRF (Juvenile Diabetes Research Foundation),
More informationManagement of Pregestational and Gestational Diabetes Mellitus
Background and Prevalence Management of Pregestational and Gestational Diabetes Mellitus Pregestational Diabetes - 8 million women in the US are affected, complicating 1% of all pregnancies. Type II is
More informationScreening and Diagnosis of Diabetes Mellitus in Taiwan
Screening and Diagnosis of Diabetes Mellitus in Taiwan Hung-Yuan Li, MD, MMSc, PhD Attending Physician, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan Associate Professor,
More informationResearch Article Implementation of the International Association of Diabetes and Pregnancy Study Groups Criteria: Not Always a Cause for Concern
Hindawi Publishing Corporation Journal of Pregnancy Volume 2015, Article ID 754085, 5 pages http://dx.doi.org/10.1155/2015/754085 Research Article Implementation of the International Association of Diabetes
More information2/13/2018. Update on Gestational Diabetes. Disclosure. Objectives. I have no financial conflicts of interest.
Update on Gestational Diabetes Lorie M. Harper, MD, MSCI Department of Obstetrics & Gynecology Division of Maternal-Fetal Medicine 2/18/2018 Disclosure I have no financial conflicts of interest. Objectives
More informationEpidemiology and Prevention
Epidemiology and Prevention Associations of Pregnancy Complications With Calculated Cardiovascular Disease Risk and Cardiovascular Risk Factors in Middle Age The Avon Longitudinal Study of Parents and
More informationGESTATIONAL DIABETES MELLITUS AND SUBSEQUENT MANAGEMENT OF CONFIRMED GESTATIONAL DIABETES MELLITUS (GDM) AND SELECTIVE SCREENING - CLINICAL GUIDELINE
GESTATIONAL DIABETES MELLITUS AND SUBSEQUENT MANAGEMENT OF CONFIRMED GESTATIONAL DIABETES MELLITUS (GDM) AND SELECTIVE SCREENING - CLINICAL GUIDELINE V 1.5 2017 Screening - Clinical Guideline Page 1 of
More informationWellness Coaching for People with Prediabetes
Wellness Coaching for People with Prediabetes PUBLIC HEALTH RESEARCH, PRACTICE, AND POLICY Volume 12, E207 NOVEMBER 2015 ORIGINAL RESEARCH Wellness Coaching for People With Prediabetes: A Randomized Encouragement
More informationType 1 diabetes accounts for 5e10% of diabetes diagnoses,
Contemporary type 1 diabetes pregnancy outcomes: impact of obesity and glycaemic control Sally K Abell 1,2, Jacqueline A Boyle 1,3, Barbora de Courten 1,2, Michelle Knight 3, Sanjeeva Ranasinha 1, John
More informationPregnancy and Diabetes
Pregnancy and Diabetes Aim(s) and objective(s) This guideline aims to highlight the importance of maintaining good glycaemic control in women of childbearing age contemplating pregnancy, during pregnancy
More informationReminder: NPIC/QAS CME/CEU Program
V.12.2 Special Report: Perinatal Complications associated with Gestational and Pregestational Diabetes I. Introduction Diabetes mellitus is a metabolic disease characterized by chronic hyperglycemia and
More informationDiagnosis of gestational diabetes mellitus: comparison between National Diabetes Data Group and Carpenter Coustan criteria
Asian Biomedicine Vol. 8 No. 4 August 2014; 505-509 Brief communication (Original) DOI: 10.5372/1905-7415.0804.320 Diagnosis of gestational diabetes mellitus: comparison between National Diabetes Data
More informationThey are updated regularly as new NICE guidance is published. To view the latest version of this NICE Pathway see:
Gestational diabetes: risk assessment, testing, diagnosis and management bring together everything NICE says on a topic in an interactive flowchart. are interactive and designed to be used online. They
More informationGESTATIONAL DIABETES TESTING AND TREAMENT
Boston Medical Center Maternity Care Guideline: GESTATIONAL DIABETES TESTING AND TREAMENT Accepted: August 2015 Updated: December 2018 Contributors: Aviva Lee-Parritz, MD, Sara Alexanian, MD, Kari Radoff,
More informationDiabetes in Pregnancy Network: Scoping survey March 2013
Diabetes in Pregnancy Network: Scoping survey March 2013 Diabetes in Pregnancy Network Scoping Survey Aim To inform the development of a National Diabetes in Pregnancy Network Objectives To identify the
More informationGestational Diabetes. Benjamin Byers, D.O., FACOG Center for Maternal and Fetal Care Bryan Physician Network
Gestational Diabetes Benjamin Byers, D.O., FACOG Center for Maternal and Fetal Care Bryan Physician Network Outline Definition Prevalence Risk factors complications Diagnosis Management Nonpharmacologic
More informationDiabetes and Pregnancy
Diabetes and Pregnancy Dr Warren Gillibrand Deputy Director of Postgraduate Education Department of Nursing & Midwifery Department of AHP and Sports Science w.p.gillibrand@hud.ac.uk Aims of the session
More informationA novel validated model for the prediction of insulin therapy initiation and adverse perinatal outcomes in women with gestational diabetes mellitus
Diabetologia (2016) 59:2331 2338 DOI 10.1007/s00125-016-4047-8 ARTICLE A novel validated model for the prediction of insulin therapy initiation and adverse perinatal outcomes in women with gestational
More informationPostpartum Diabetes Screening: adherence rate and the performance of fasting plasma glucose versus oral glucose tolerance test
Diabetes Care Publish Ahead of Print, published online September 9, 2009 adherence of postpartum diabetes screening Postpartum Diabetes Screening: adherence rate and the performance of fasting plasma glucose
More informationCadmium body burden and gestational diabetes mellitus in American women. Megan E. Romano, MPH, PhD
Cadmium body burden and gestational diabetes mellitus in American women Megan E. Romano, MPH, PhD megan_romano@brown.edu June 23, 2015 Information & Disclosures Romano ME, Enquobahrie DA, Simpson CD, Checkoway
More informationOriginal paper A.-S. MARYNS 1, I. DEHAENE 1, G. PAGE 2. Abstract
FACTS VIEWS VIS OBGYN, 2017, 9 (3): 133-140 Original paper Maternal and neonatal outcomes in a treated versus nontreated cohort of women with Gestational Diabetes Mellitus according to the HAPO 5 and 4
More informationNational Pregnancy in Diabetes Audit Report, England, Wales and the Isle of Man 12th October 2017
National Pregnancy in Diabetes Audit Report, 2016 England, Wales and the Isle of Man 12th October 2017 Prepared in collaboration with: The National Pregnancy in Diabetes (NPID) audit is part of the National
More informationMaternal Child Health and Chronic Disease
Maternal Child Health and Chronic Disease The Odd Couple or A Marriage Made in Heaven? AMCHP Women and Perinatal Health Information Series July 17, 2008 Joan Ware, MSPH, RN, Consultant, Women s s Health
More informationEarly life influences on adult chronic
Early life influences on adult chronic disease among aboriginal people Sandra Eades, Lina Gubhaju, Bridgette McNamara, Ibrahima Diouf, Catherine Chamberlain, Fiona Stanley University of Sydney October
More informationGestational Diabetes. Gestational Diabetes:
Gestational Diabetes Detection and Management Steven Gabbe, MD The Ohio State University Medical Center Gestational Diabetes: Detection and Management Learning Objectives: At the conclusion of this presentation,
More informationSurveillance report Published: 9 January 2017 nice.org.uk
Surveillance report 2017 Caesarean section (2011) NICE guideline CG132 Surveillance report Published: 9 January 2017 nice.org.uk NICE 2017. All rights reserved. Contents Surveillance decision... 3 Reason
More informationEffect of Gestational Diabetes mellitus Health Education Module on Pregnancy Outcomes
World Journal of Nursing Sciences 1 (3): 76-88, 2015 ISSN 2222-1352 IDOSI Publications, 2015 DOI: 10.5829/idosi.wjns.2015.76.88 Effect of Gestational Diabetes mellitus Health Education Module on Pregnancy
More informationDiabetes in pregnancy
Diabetes in pregnancy Patient information This leaflet provides information about gestational diabetes during pregnancy and delivery. Sometimes women who are not known to have diabetes develop it during
More informationSocioeconomic inequalities in lipid and glucose metabolism in early childhood
10 Socioeconomic inequalities in lipid and glucose metabolism in early childhood Gerrit van den Berg, Manon van Eijsden, Francisca Galindo-Garre, Tanja G.M. Vrijkotte, Reinoud J.B.J. Gemke BMC Public Health
More informationA CLINICAL STUDY OF GESTATIONAL DIABETES MELLITUS IN A TEACHING HOSPITAL IN KERALA Baiju Sam Jacob 1, Girija Devi K 2, V.
A CLINICAL STUDY OF GESTATIONAL DIABETES MELLITUS IN A TEACHING HOSPITAL IN KERALA Baiju Sam Jacob 1, Girija Devi K 2, V. Baby Paul 3 HOW TO CITE THIS ARTICLE: Baiju Sam Jacob, Girija Devi K, V. Baby Paul.
More informationMANAGEMENT OF DIABETES IN PREGNANCY
MANAGEMENT OF DIABETES IN PREGNANCY Ministry of Health Malaysia Malaysian Endocrine & Metabolic Society Perinatal Society of Malaysia Family Medicine Specialists Association of Malaysia Academy of Medicine
More informationTo see a description of the Academy Recommendation Rating Scheme (Strong, Fair, Weak, Consensus, Insufficient Evidence), click here.
Gestational Diabetes Gestational Diabetes (GDM) Guideline (2016) Gestational Diabetes GDM: Executive Summary of Recommendations (2016) Executive Summary of Recommendations Below are the major recommendations
More informationCynthia Feltner, MD MPH
Early Screening for Gestational Diabetes Mellitus: A Systematic Review by Dana K Kelley A Master s Paper submitted to the faculty of the University of North Carolina at Chapel Hill in partial fulfillment
More informationPregnancy outcomes in Korean women with diabetes
Pregnancy outcomes in Korean women with diabetes Sung-Hoon Kim Department of Medicine, Cheil General Hospital & Women s Healthcare Center, Dankook University College of Medicine, Seoul, Korea Conflict
More informationThe Role of the Diabetes Educator within the Patient-Centered Medical Home & Future Roles
The Role of the Diabetes Educator within the Patient-Centered Medical Home & Future Roles Linda M. Siminerio, RN, PhD, CDE Professor of Medicine University of Pittsburgh School of Medicine & Nursing Objectives
More informationDiabetes in pregnancy
Issue date: March 2008 Diabetes in pregnancy Management of diabetes and its complications from pre-conception to the postnatal period Developed by the National Collaborating Centre for Women s and Children
More informationDr Shelley Wilkinson AdvAPD NHMRC TRIP Fellow/Senior Research Dietitian Maternal Health Mater Health Services/Mater Medical Research Institute
Diagnosing the Gestational Diabetes Mellitus Medical Nutrition Therapy evidence-practice gap: informing a project to translate guidelines into practice Dr Shelley Wilkinson AdvAPD NHMRC TRIP Fellow/Senior
More informationRETIRED: REVIEWED/Revised: 12/14; 10/15; 1/16; 9/16, 10/16, 5/17, 5/18, 9/18
PAGE: 1 of 9 Scope Louisiana Healthcare Connections (LHCC) Medical Department Purpose To provide medical necessity criteria for obstetrical Home Health programs offered by vendors such as Optum Obstetrical
More informationManagement of Gestational Diabetes
Management of Gestational Diabetes A Diabetes risk assessment should be ascertained at the First prenatal visit. Low Risk: Early blood glucose screening is NOT routinely required if most of the following
More informationOtt et al. BMC Pregnancy and Childbirth (2018) 18:250 (Continued on next page)
Ott et al. BMC Pregnancy and Childbirth (2018) 18:250 https://doi.org/10.1186/s12884-018-1889-8 RESEARCH ARTICLE Open Access Maternal overweight is not an independent risk factor for increased birth weight,
More informationA S Y N T H E S I Z E D H A N D B O O K ON G E S T A T I O N A L D I A B E T E S
A S Y N T H E S I Z E D H A N D B O O K ON G E S T A T I O N A L D I A B E T E S P R E F A C E Dear reader, This is a synthesized handbook conceived to serve as a tool to health personnel in the screening,
More informationDiabetes in Pregnancy
Disclosure Diabetes in Pregnancy I have no conflicts of interest to disclose Jennifer Krupp, MD Maternal Fetal Medicine St. Marys Hospital/SSM Health Madison, WI Objectives Classification of Diabetes Classifications
More informationPregnancy Smoking Intervention in NE Tennessee: Effectiveness Data from the First Two Years of TIPS
Pregnancy Smoking Intervention in NE Tennessee: Effectiveness Data from the First Two Years of TIPS Beth A. Bailey, PhD Associate Professor of Family Medicine Director, Tennessee Intervention for Pregnant
More informationOptimizing Postpartum Maternal Health to Prevent Chronic Diseases
Optimizing Postpartum Maternal Health to Prevent Chronic Diseases Amy Loden, MD, FACP, NCMP Disclosures Research: None Financial: none applicable to this presentation PRIUM QEssentials Market Research
More informationThe Aboriginal Maternal and Infant Health Service: a decade of achievement in the health of women and babies in NSW
The Aboriginal Maternal and Infant Health Service: a decade of achievement in the health of women and babies in NSW Elisabeth Murphy A,B and Elizabeth Best A A Maternity, Children and Young People s Health
More informationDiabetes in pregnancy
Diabetes in pregnancy NDSS initiatives to support women before, during and after pregnancy Melinda Morrison, NDSS Diabetes in Pregnancy Priority Area Leader and the NDSS Diabetes in Pregnancy Expert Reference
More informationTuberculosis and Diabetes
Tuberculosis and Diabetes National Web-based Seminar Francis J. Curry National TB Center San Francisco, California December 1, 29 Jane Kelly, M.D. Centers for Disease Control and Prevention jkelly@cdc.gov
More informationNevada Journal of Public Health, (2010). Vol. 7 Shen et al., 27
Nevada Journal of Public Health, (2010). Vol. 7 Shen et al., 27 Adverse Maternal Outcomes in Nevada: Does Asthma Matter? Jay J. Shen, Ph.D. Department of Health Care Administration and Policy School of
More informationHepatitis B vaccine alone or with HBIG in neonates of HBsAg+/HBeAg- mothers: a systematic review and meta-analysis.
Hepatitis B vaccine alone or with HBIG in neonates of HBsAg+/HBeAg- mothers: a systematic review and meta-analysis. Vana Papaevangelou (Greece) National and Kapodistrian University of Athens Chang SemFNM
More information2018 Standard of Medical Care Diabetes and Pregnancy
2018 Standard of Medical Care Diabetes and Pregnancy 2018 Standard of Medical Care Diabetes and Pregnancy Marjorie Cypress does not have any relevant financial relationships with any commercial interests
More informationGestational Diabetes: Long Term Metabolic Consequences. Outline 5/27/2014
Gestational Diabetes: Long Term Metabolic Consequences Gladys (Sandy) Ramos, MD Associate Clinical Professor Maternal Fetal Medicine Outline Population rates of obesity and T2DM Obesity and metabolic syndrome
More informationScreening, Diagnosis and Management of Gestational Diabetes in New Zealand. A clinical practice guideline
Screening, Diagnosis and Management of Gestational Diabetes in New Zealand 2014 Citation: Ministry of Health. 2014. Screening, Diagnosis and Management of Gestational Diabetes in New Zealand:. Wellington:
More informationComparative Study between Acarbose and Insulin in the Treatment of GDM.
Original Article DOI: 10.21276/aimdr.2018.4.2.OG5 ISSN (O):2395-2822; ISSN (P):2395-2814 Comparative Study between Acarbose and Insulin in the Treatment of GDM. Minthami Sharon 1, Niloufur Syed Bashutheen
More informationADVERSE PREGNANCY OUTCOMES IN GESTATIONAL DIABETES MELLITUS - STUDY IN AN APEX HOSPITAL
ADVERSE PREGNANCY OUTCOMES IN GESTATIONAL DIABETES MELLITUS - STUDY IN AN APEX HOSPITAL *Anuradha Ghosh 1 and Sudip Kumar Saha 2 1 Department of Gynecology and Obstetrics, Sagar Dutta Medical College and
More informationOral glucose lowering agents in gestational diabetes. Yes: E. Sobngwi (Cameroon) No: A. Vambergue (France)
Oral glucose lowering agents in gestational diabetes Yes: E. Sobngwi (Cameroon) No: A. Vambergue (France) CONTROVERSIES Oral glucose lowering agents in gestational diabetes «NO» Pr Anne VAMBERGUE Department
More informationCommUnityCare Women s Health Brackenridge Professional Office Building
Guidelines for Diabetes in Pregnancy Effective Date 7/1/11 *This document does not define a standard of care, nor is it intended to dictate an exclusive course of management. There are other accepted strategies
More informationGestational diabetes
Southend University Hospital NHS Foundation Trust Patient Information Service Women and children s business unit Gestational diabetes What is gestational diabetes? Gestational diabetes mellitus (GDM) is
More informationGestational Diabetes in Resouce. Prof Satyan Rajbhandari (RAJ)
Gestational Diabetes in Resouce Limited Area Prof Satyan Rajbhandari (RAJ) Case History RP, 26F Nepali girl settled in the UK Primi Gravida BMI: 23 FH of type 2 DM 75 gm Glucose OGTT in week 25 0 Min
More informationHbA1c level in last trimester pregnancy in predicting macrosomia and hypoglycemia in neonate
International Journal of Contemporary Pediatrics Subash S et al. Int J Contemp Pediatr. 2016 Nov;3(4):1334-1338 http://www.ijpediatrics.com pissn 2349-3283 eissn 2349-3291 Original Research Article DOI:
More informationAneurin Bevan University Health Board Diabetes in Pregnancy: Care Pathway for Management of Diabetes in Pregnancy
Aneurin Bevan University Health Board Diabetes in Pregnancy: Care Pathway for Management of Diabetes in Pregnancy N.B. Staff should be discouraged from printing this document. This is to avoid the risk
More informationMETFORMIN A CONVENIENT ALTERNATIVE TO INSULIN FOR INDIAN WOMEN WITH DIABETES IN PREGNANCY
491 METFORMIN A CONVENIENT ALTERNATIVE TO INSULIN FOR INDIAN WOMEN WITH DIABETES IN PREGNANCY ABSTRACT LAVANYA RAI, MEENAKSHI D, ASHA KAMATH 1 OBJECTIVE: To compare the use of metformin with that of insulin
More informationObstetrics and Gynaecology
Purpose Pregnancy is associated with changes to insulin sensitivity which can lead to elevated maternal blood glucose levels (BGLs). When elevated BGLs are first diagnosed during pregnancy the mother has
More informationLow uptake of postpartum screening for Type 2 diabetes in women after a
Received Date : 18-Dec-2015 Accepted Date : 25-Jan-2016 Article type : Letter Low uptake of postpartum screening for Type 2 diabetes in women after a diagnosis of gestational diabetes Postpartum screening
More informationSurveillance report Published: 8 June 2017 nice.org.uk. NICE All rights reserved.
Surveillance report 2017 Antenatal and postnatal mental health: clinical management and service guidance (2014) NICE guideline CG192 Surveillance report Published: 8 June 2017 nice.org.uk NICE 2017. All
More informationDiabetes in obstetric patients
Diabetes in obstetric patients Swedish Society of Obstetric Anaesthesia & Intensive Care Anita Banerjee Obstetric Physician Diabetes & Endocrinology Consultant Outline Scope of the problem Diabetes and
More informationGDM. Literature Review. GESTATIONAL DIABETES MELLITUS: A review for midwives AUTHORS BACKGROUND CONTRIBUTORS TABLE OF CONTENTS
GDM Literature Review GESTATIONAL DIABETES MELLITUS: A review for midwives AUTHORS Sophia Kehler, BA; Tasha MacDonald, RM, MHSc; Anna Meuser, MPH CONTRIBUTORS Clinical Practice Guideline Committee (2015):
More informationRisk factors of gestational diabetes mellitus among the re-birth pregnant women in Xiamen City in
46 6 2017 11 JOURNAL OF HYGIENE RESEARCH Vol. 46 No. 6 Nov. 2017 925 1000-8020 2017 06-0925-05 檾檾檾檾 DANONE INSTITUTE CHINA Young Scientists' Forum 檾檾檾檾檾檾檾檾檾檾檾檾檾檾檾檾檾檾檾檾檾檾檾檾檾檾檾檾 2015 2016 1 361003 gestational
More informationCurrent Trends in Diagnosis and Management of Gestational Diabetes
Current Trends in Diagnosis and Management of Gestational Diabetes Shreela Mishra, MD Assistant Clinical Professor UCSF Fresno Medical Education Program 2/2/2019 Disclosures No disclosures 2/2/19 Objectives
More informationTrends in Obstetric and Perinatal Outcomes of Women with Type 1 Diabetes During
DISSERTATIONES SCHOLAE DOCTORALIS AD SANITATEM INVESTIGANDAM UNIVERSITATIS HELSINKIENSIS 97/2015 MIIRA KLEMETTI Trends in Obstetric and Perinatal Outcomes of Women with Type 1 Diabetes During 1988-2011
More informationOverview. In Vitro Fertilization: a Success Story
Does IVF cause adverse perinatal outcomes? Paolo Rinaudo *, MD PhD Rebecca A. Jackson %, MD Departments of Ob/Gyn & *Center for Reproductive Sciences & % Epi/Biostats University of California, San Francisco
More informationDiabetes in Pregnancy. L.Sekhavat MD
Diabetes in Pregnancy L.Sekhavat MD Diabetes in Pregnancy Gestational Diabetes Pre-gestational diabetes (overt) Insulin dependent (type1) Non-insulin dependent (type 2) Definition Gestational diabetes
More informationDiabetes Mellitus: Management of Gestational Diabetes
1. Purpose The Women s is committed to the provision of best practice multidisciplinary care for women with gestational diabetes based on the best available evidence. This guideline outlines the recommended
More informationMaternal and Fetal Outcomes if Gestational Impaired Glucose Tolerance Is Not Treated
Pathophysiology/Complications O R I G I N A L A R T I C L E Maternal and Fetal Outcomes if Gestational Impaired Glucose Tolerance Is Not Treated INGRID ÖSTLUND, MD, PHD 1,2 ULF HANSON, MD, PHD 1 ANDERS
More informationImproving Health Services for Diabetic Pregnant Women who are Attending Governmental Clinics in Nablus and Jenin Districts.
An-Najah National University Faculty of Graduate Studies Improving Health Services for Diabetic Pregnant Women who are Attending Governmental Clinics in Nablus and Jenin Districts. By Lana Ameen Saleem
More informationDiet Quality and History of Gestational Diabetes
Diet Quality and History of Gestational Diabetes PUBLIC HEALTH RESEARCH, PRACTICE, AND POLICY Volume 12, E25 FEBRUARY 2015 ORIGINAL RESEARCH Diet Quality and History of Gestational Diabetes Mellitus Among
More informationDanielle M Nash, Dr. Jason A Gilliland, Dr. Susan E Evers, Dr. Piotr Wilk & Dr. M Karen Campbell. JNEB Journal Club November 3, 2014
Danielle M Nash, Dr. Jason A Gilliland, Dr. Susan E Evers, Dr. Piotr Wilk & Dr. M Karen Campbell JNEB Journal Club November 3, 2014 Presentation Overview Background Objective/ Rationale Methods Prenatal
More informationDr Aftab Ahmad Consultant Diabetologist at Royal Liverpool University Hospital Regional Diabetes Network Lead
Dr Aftab Ahmad Consultant Diabetologist at Royal Liverpool University Hospital Regional Diabetes Network Lead Today s Presentation HbA1c & diagnosing Diabetes What is Impaired Glucose & IGR? Implications
More informationTrust Guidelines for the Diagnosis and Management of Gestational Diabetes Mellitus (GDM)
A Clinical Guideline recommended for use In: Maternity By: For: Division responsible for document: Key words: Name of document author: Job title of document author: Name of document author s Line Manager:
More informationMETABOLIC SYNDROME IN REPRODUCTIVE FEMALES
METABOLIC SYNDROME IN REPRODUCTIVE FEMALES John J. Orris, D.O., M.B.A Division Head, Reproductive Endocrinology & Infertility, Main Line Health System Associate Professor, Drexel University College of
More information2204 Diabetes Care Volume 39, December 2016
2204 Diabetes Care Volume 39, December 2016 CLIN CARE/EDUCATION/NUTRITION/PSYCHOSOCIAL Maternal and Neonatal Morbidity for Women Who Would Be Added to the Diagnosis of GDM Using IADPSG Criteria: A Secondary
More informationLaura Smith University of Cincinnati. June 7 th, 2012
Laura Smith University of Cincinnati June 7 th, 2012 1. Background 2. Grant 3. Research Strategy Background Practical /Relevant Useful skill Filled a need 25.8 million in the U.S. (2011) A leading cause
More informationAn Adaptive Reinforcement-Based Treatment (RBT) Intervention for Pregnant Substance Dependent Women
An Adaptive Reinforcement-Based Treatment (RBT) Intervention for Pregnant Substance Dependent Women Michelle Tuten, Ph.D. Assistant Professor Department of Psychiatry and Behavioral Sciences and Johns
More informationDIABETES MELLITUS IN PREGNANCY; MATERNAL & PRENATAL OUTCOME
Basrah Journal Of Surgery DIABETES MELLITUS IN PREGNANCY; MATERNAL & PRENATAL OUTCOME Rabia A Alkaban* & Methal A AL-Rubaee @ * MB,ChB. @ MB,ChB, DGO, CABOG, Department of Obstetric & Gynecology, Medical
More informationIt s Never Too Early To Prevent Diabetes: The Lasting Impact of Gestational Diabetes on Mothers and Children
It s Never Too Early To Prevent Diabetes: The Lasting Impact of Gestational Diabetes on Mothers and Children Robert Ratner, M.D., F.A.C.P. Vice President for Scientific Affairs, Medstar Research Institute
More informationDiabetes in pregnancy among Sri Lankan women: gestational or pre-gestational?
Original Paper Diabetes in pregnancy among Sri Lankan women: gestational or pre-gestational? K G H Jayathilaka 1, S Dahanayake 1, R Abewardhana 2, A K P Ranaweera 3, M R M Rishard 3, C N Wijeyaratne 4
More informationEVALUATION OF THYROID FUNCTION IN PRE-ECLAMPSIA
EVALUATION OF THYROID FUNCTION IN PRE-ECLAMPSIA K. Sunanda 1, P. Sravanthi 2, H. Anupama 3 1Assistant Professor, Department of Obstetrics & Gynaecology, Gandhi Medical College/Hospital. 2Post Graduate,
More informationIsolated proteinuria in Chinese pregnant women with pre-eclampsia: Results of retrospective observational study
Biomedical Research 2017; 28 (11): 5162-5166 ISSN 0970-938X www.biomedres.info Isolated proteinuria in Chinese pregnant women with pre-eclampsia: Results of retrospective observational study Jing Cai 1,
More information