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1
Opoku, Emeline. "Screening for gestational diabetes mellitus." Thesis, Буковинський державний медичний університет, 2012. http://dspace.bsmu.edu.ua:8080/xmlui/handle/123456789/1461.
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Rudland, Victoria Louise. "HETEROGENEITY OF GESTATIONAL DIABETES MELLITUS." Thesis, The University of Sydney, 2016. http://hdl.handle.net/2123/15872.
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Gestational diabetes mellitus (GDM) is a complex, heterogeneous disorder. As the prevalence of GDM increases, it is increasingly important to identify subgroups of women within the GDM umbrella whose pathophysiology and associated pregnancy risk necessitates a different management approach in order to optimise maternal and neonatal outcomes. Glucokinase maturity-onset diabetes of the young (GCK-MODY) and islet autoimmunity are two such clinical entities. Recently, new pregnancy-specific screening criteria (NSC) for GCK-MODY were proposed to identify women with GDM who warrant GCK genetic testing. We tested the NSC and HbA1c in a multiethnic GDM cohort. The prevalence of GCK-MODY in women with GDM was ~1%. The NSC performed well for Anglo-Celtic women, but less well for women from other ethnic backgrounds. Antepartum HbA1c was not higher in those with GCK-MODY. We report the first two cases of antepartum fetal GCK genotyping and demonstrate how knowledge of fetal GCK genotype guides the management of maternal hyperglycaemia. We examined the prevalence, clinical significance and antepartum to post-partum trajectory of glutamic acid decarboxylase autoantibodies (GADA), insulinoma-associated antigen-2 autoantibodies (IA-2A), insulin autoantibodies (IAA) and zinc transporter 8 autoantibodies (ZnT8A) in a multiethnic GDM cohort. 9.9% of women were positive for one islet autoantibody antepartum. No participant had multiple islet autoantibodies. ZnT8A were the most common islet autoantibody. For women with positive GADA, IA-2A or IAA antepartum, islet autoantibody positivity typically persisted post-partum and 20% of women had post-partum glucose levels consistent with diabetes. In contrast, women with positive ZnT8A antepartum typically demonstrated normal ZnT8A titres post-partum and normal post-partum glucose tolerance. ZnT8A may be a marker for islet autoimmunity in a proportion of women with GDM, but the clinical relevance of ZnT8A in GDM needs further research.
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Khin, May Oo. "Metformin in gestational diabetes mellitus." Thesis, University of Warwick, 2015. http://wrap.warwick.ac.uk/77511/.
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Gestational diabetes mellitus (GDM) can affect up to 1 in 5 of pregnancies and is associated with adverse pregnancy outcomes including pre-eclampsia, neonatal hypoglycaemia, large for gestational age, increased adiposity and birth trauma. Good glycaemic control is the key to reduce these outcomes. Diet and lifestyle modification followed by insulin as necessary is the conventional type of management. Metformin is increasingly used in pregancy but with limited evidence, its role in GDM has not been well-established. A systematic review including both randomized and non-randomized controlled studies have been conducted to evaluate the contemporary evidence of metformin in GDM. It is suggested that metformin in GDM could be a useful alternative to insulin and is regarded as the best oral anti-hyperglycaemic agent in GDM management currently. However, almost half of metformin-treated GDM patients required supplementary insulin to achieve target glucose levels (metformin failure). Women with higher metabolic risk factors are likely to develop metformin failure. A clinical cohort of metformin-treated GDM is used to develop the predictive model to identify GDM women who are at risk of metformin failure. It has been found that women identified by new IADPSG and NICE 2015 fasting criteria are highly likely to develop metformin failure. It has also been established a number of algorithm based on various baseline characters of GDM women which will help primary healthcare physicians choose the best medication for GDM management. One of the possible side-effects of metformin includes lowering of serum vitamin B12 levels whereas serum vitamin B12 deficiency during pregnancy which is associated with increased insulin resistance. It is reported that in low vitamin B12 state, offspring’s insulin resistance is found to be higher among women with high folate low B12 state. Hence, in order to fully appreciate the role of vitamin B12 deficiency in metformin failure, it is first necessary to understand the effects of folate in low vitamin B12 condition on pregnancy outcomes in GDM. It has also been found that in normal vitamin B12 GDM women, serum folate levels are negatively associated with plasma glucose levels but not low B12 state. This underlines the fact that in order for folate to have its role, it is important to have normal vitamin B12 levels. Despite increasing use of metformin, it is not yet routine to check vitamin B12 levels before it is given. It is important to understand whether vitamin B12 has a role in metformin action. Thus, the mechanism by which vitamin B12 deficiency might interfere with metformin action was studied. In vitamin B12 deficient hepatocytes, metformin stimulation of AMPK was reduced which was followed by reduced downstream signalling in lipid metabolism. This effects were reversed by vitamin B12 supplementation. Thus, it is concluded that vitamin B12 deficiency could interfere with metformin action and before metformin is given, every GDM woman should be checked for serum vitamin B12 levels and should be supplemented if deficient. Overall, vitamin B12 could play a critical role in GDM management and it is important for every GDM woman to have normal vitamin B12 levels.
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Swan, Wendy Elizabeth. "Diabetes prevention in women with previous gestational diabetes /." Connect to thesis, 2008. http://repository.unimelb.edu.au/10187/5742.
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Alkazemi, Dalal Usamah Zaid. "Modulating factors of serum oxysterol concentrations in daughters from gestational diabetes and non-gestational diabetes." Thesis, McGill University, 2007. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=100757.
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Pregestational and gestational diabetes (GDM) places the mother and her offspring at an increased risk for later development of insulin resistance and type 2 diabetes. Oxidative stress may mediate long-term disturbances in glucose homeostasis associated with type 2 diabetes and the metabolic syndrome. This thesis describes a cross-sectional study examining serum concentrations of free radical generated oxysterols as markers of oxidative stress in a cohort of teenage daughters from pregnancies with and without GDM. Daughters of GDM-pregnancies had a tendency of higher levels of serum oxysterols (7beta-hydroxycholesterol); however, this difference was not statistically significant after adjustment for total cholesterol. Serum oxysterols were significantly correlated with obesity measures such as waist circumference and BMI, which likely accounted for the tendency for higher measures of oxysterol concentrations in the GDM daughters. Oxysterols represent potentially important biomarkers for oxidative stress in adolescent girls as their levels track with the metabolic syndrome risk factors.Le diabète pré-gestationnel et le diabète de gestation (DG) augmentent le risque dedéveloppement d'une future résistance à l'insuline et de diabète de type 2 autant pourla mère que pour l'enfant. Le stress oxydatif est un facteur potentiel impliqué dans ledéséquilibre du glucose sanguin associé au diabète de type 2 et au syndromemétabolique. La présente thèse est une étude sectionnelle croisée, ayant pour but demesurer des marqueurs du stress oxidatif, notamment la concentration des oxystérolsgénérés par les radicaux libres dans le sérum d'adolescentes, nées de mères ayantprésenté ou non un diabète de gestation. Nos résultats montrent des concentrationsd'oxystérols (7P-hydroxycholesterol) plus élevées dans le sérum de filles issues degestations diabétiques à comparer aux filles de mères n'ayant pas eu de DG.Cependant, la différence entre les deux groupes n'était pas statistiquementsignificative après un ajustement au cholestérol total. La concentration d'oxystérolsétait significativement corrélée aux marqueurs d'obésité, notamment la circonférencede la taille et l'index de masse corporelle, possiblement à l'origine de la tendance desoxystérols à être plus élevés dans le cas des adolescentes issues de gestationsdiabétiques.
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Dornhorst, Anne. "Gestational diabetes : a model of non-insulin dependent diabetes." Thesis, University of Oxford, 1993. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.334887.
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Elnour, Asim Ahm. "Care of patients with gestational diabetes." Thesis, Queen's University Belfast, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.421005.
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Hatem, Hohamed. "Gestational diabetes : screening, diagnosis and outcome." Thesis, University of Southampton, 1989. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.278517.
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Dias, Stephanie Charmaine. "Investigating Molecular Biomarkers During Gestational Diabetes Mellitus." Thesis, University of Pretoria, 2019. http://hdl.handle.net/2263/73566.
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Introduction:
Gestational diabetes mellitus (GDM) is a significant public health concern, due to its association with short- and long-term complications in both mothers and offspring. DNA methylation and single nucleotide polymorphisms (SNPs) offer potential to serve as molecular biomarkers, which may lead to improved detection of GDM with positive effects on health outcomes.
Aim:
The aim of this study was to investigate whether DNA methylation and SNPs are associated with GDM and may offer potential as molecular biomarkers for GDM in South Africa (SA).
Methods:
This study followed a two-pronged approach. Firstly, literature searches were conducted to collate and synthesise all published articles reporting on the prevalence of GDM in SA, the screening and diagnostic strategies used, and the current status of DNA methylation and SNPs as biomarkers for GDM. Secondly, we conducted experiments to investigate global (n=201), genome-wide (n=24) and gene-specific DNA methylation (n=286) of the adiponectin gene (ADIPOQ) in whole blood of women with and without GDM, using an Enzyme-Linked Immunosorbent Assay, a methylationEPIC BeadChip Array and pyrosequencing, respectively. In addition, genotype and allele frequencies of ADIPOQ rs266729 and rs17300539, and methylenetetrahydrofolate reductase (MTHFR) rs1801133 were determined, using quantitative real-time PCR (n=449) and DNA sequencing for validation.
Results:
The literature search showed that the prevalence of GDM in SA has increased over the years. Furthermore, it showed that the lack of uniformity in screening and diagnosis between and within countries hamper the accurate detection of GDM. Lastly, the literature search identified several studies that support the use of DNA methylation and SNPs as potential biomarkers for GDM. Experimentally, we showed no differences in global DNA methylation between GDM and non-GDM groups. Interestingly, global DNA methylation levels were 18% (p=0.012) higher in obese compared to non-obese pregnant women. Genome-wide methylation analysis identified 1046 differentially methylated CpG sites (associated with 939 genes) (Cut-off threshold: M>0.06 and p<0.01). Among the top five CpG sites identified, one CpG mapped to the calmodulin-binding transcription activator 1 (CAMTA1) gene, which has been shown to regulate insulin production and secretion. Two CpG sites (-3410: p=0.048 and -3400: p=0.004) in the ADIPOQ promoter were hypomethylated during GDM in HIV negative, but not in HIV positive women. Lastly, no association between the ADIPOQ and MTHFR polymorphisms and GDM was observed in our population.
Conclusion:
To our knowledge, this is the first study to investigate the association between DNA methylation or ADIPOQ (rs266729 and rs17300539) and MTHFR (rs1801133) polymorphisms and GDM in SA. Findings suggest that gene-specific, but not global methylation nor SNPs rs266729, rs17300539 and rs1801133, may offer potential as molecular biomarkers of GDM in this population. Future longitudinal studies in larger samples that include both HIV negative and positive pregnant women are warranted to explore the candidacy of DNA methylation as molecular biomarkers for GDM.Thesis (PhD)--University of Pretoria, 2019.
National Research Foundation (NRF) of South Africa, Thuthuka Grant (unique grant no. 99391).
South African Medical Research Council (SAMRC)
Obstetrics and Gynaecology
PhD
Unrestricted
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Getachew, Haregewein. "Characterstics of California women who report gestational diabetes." Thesis, California State University, Long Beach, 2013. http://pqdtopen.proquest.com/#viewpdf?dispub=1523060.
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The aim of this thesis is to explore racial groups that are affected by gestational diabetes mellitus in the state of California. Hypothesis of the study to be tested are: 1. Women of minority race background are more likely than majority white women to report having gestational diabetes. 2. Women with lower household incomes, irrespective of race are more likely to report having gestational diabetes. Statistical analysis was conducted using SPSS 20 (statistical package for the social sciences). Descriptive analysis was used to examine the relationship between different race groups and their socioeconomic status. A One-Way ANOVA test was conducted to show the significance of low household income and gestational diabetes. The outcomes of this study indicate that gestational diabetes mellitus does exist within the subsamples of women who have lower socioeconomic status and are members of minority race groups.
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Snyder, Jennifer. "Nutritional predictors of infant birthweight in gestational diabetes." Thesis, McGill University, 1992. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=60724.
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The predictors of birthweight (scBWT) in normal pregnancy are well established. The objectives of this study were to characterize and determine predictors of scBWT among women diagnosed with scGDM. A cohort of 436 scGDM full-term pregnancies (followed 1978-1989) were examined using data abstracted from the Royal Victoria Hospital Antenatal Diabetic Clinic charts and McGill Obstetric and Neonatal Database. Women were treated with insulin and/or diet. Dietary treatment (mean 2047 kcal/d) significantly decreased the rate of weight gain and mean fasting plasma glucose (scFPG). Regression analysis identified several predictors of scBWT (mean 3520 g): prepregnancy body mass, height, smoking, pre-diagnostic rate of weight gain, scFPG, gestational age, infant gender, and length of treatment. Stratification by body mass indicated that among non-obese women with scGDM, scFPG and length of treatment were not significant predictors of scBWT. In conclusion, since women with normal pregravid mass and prediagnostic weight gain are at lower risk of high scBWT, these require consideration, in addition to plasma glucose criteria, when treating scGDM.
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Makgoba, Mahlatse. "The epidemiology and prediction of gestational diabetes mellitus." Thesis, Imperial College London, 2014. http://hdl.handle.net/10044/1/28573.
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Objectives: To examine the relationship between particular traditional risk factors and their effect on the development of gestational diabetes mellitus (GDM) and birthweight (Part 1) as well as to assess first trimester maternal biochemical predictors of development of GDM (Part 2). Methods: Part 1. A retrospective study of prospectively collected data from fifteen maternity units in North West London between 1988-2000- the St Mary's Maternity Information System (SMMIS) dataset. The dataset was modified to include only those who were nulliparous (thus ensuring that only one pregnancy per woman was included) and excluding women with pre-existing diabetes (thus studying only women who either did or didn't develop gestational diabetes). Birthweight z-scores were calculated. Part 2. A nested case-control study using first-trimester (11+0 to 13+6 weeks of gestation) samples. that were obtained as part of a large prospective observational on-going study aimed at identifying first-trimester predictors of adverse pregnancy outcomes. Maternal levels of lipids (cholesterol, low density lipoprotein cholesterol (LDL), high density lipoprotein cholesterol (HDL), non-fasting triglycerides, C-reactive protein (CRP), γ-glutamyl transferase (γ- GT), adiponectin, E-selectin, tissue plasminogen activator (t-PA) and vitamin D (25(OH)D) were measured. Statistical Package for the Social Sciences (SPSS) Version 17.0 and R (version 2.11.0) was used for statistical analysis. Results Part 1. There was a strong association between advancing maternal age and increasing body mass index (BMI) on the development of GDM (p < 0.01 for both). This varied within each racial group and was more pronounced in Black African and South Asian groups. Using White European women with a BMI of 18.5-24.9 as a reference group, Black African and South Asian pregnant women had higher Odds Ratios (ORs) for GDM development within all BMI categories compared to the reference group. Maternal BMI was positively associated with birthweight z-scores within all racial groups (p < 0.001 for all) irrespective of glycaemic status but its effect was much greater in women with GDM. The difference in birthweight z-scores between GDM and non-GDM women varied according to racial group and was much higher in non-white racial groups and at high rather than at low BMIs. Part 2. Simple maternal demographic and clinical characteristics obtained at the first antenatal visit provide a good prediction of GDM. Low levels of HDL and high levels of t-PA are independent predictors of GDM. (p=0.001 and p < 0.001 respectively). First trimester maternal serum 25(OH)D levels are not associated with the development of GDM. Conclusions Maternal age and BMI interact with racial group in relation to the development of GDM. Both factors are important in the development of GDM, particularly so in Black African and South Asian women. GDM strongly accentuates the effect of BMI on birthweight, especially within non-white populations. First trimester prediction of GDM can be enhanced by the measurement of specific maternal biomarkers.
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Mijatovic, Jovana. "Diet for the Treatment of Gestational Diabetes Mellitus." Thesis, The University of Sydney, 2019. http://hdl.handle.net/2123/20651.
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Medical Nutrition Therapy is currently the cornerstone of gestational diabetes mellitus (GDM) management, but conflicting clinical evidence has led to a lack of expert consensus. Low carbohydrate (LC) diets are popular to help lower blood glucose levels but can increase the formation of ketones (beta-hydroxybutyrate, BHB) through increased fat catabolism. While LC diets have been endorsed by endocrine societies for GDM management, findings from a well-designed observational study indicated that high 3rd trimester serum BHB levels negatively impact child intelligence. Our literature search showed a knowledge gap related to the safety of LC diets in GDM. To address this knowledge gap, we conducted a 6-week pilot, 2-arm randomised controlled trial (MAMI 1 study) comparing the effects of a Modestly Lower Carbohydrate diet (MLC, 135 g/d carbohydrate) and Routine Care (RC, 180-200 g/d carbohydrate) on blood BHB levels and GDM outcomes. While there were no differences in BHB levels between study groups (mean ± SEM, MLC 0.1 ± 0.0 vs RC 0.1 ± 0.0 mmol/L; P = 0.308), glycaemia (6.1 ± 0.1 vs 6.0 ± 0.1 mmol/L, P = 0.317) or insulin dose (14.6 ± 1.8 vs 21.2 ± 3.9 units, P = 0.126), food analysis confirmed lower carbohydrate (165 ± 7 vs 190 ± 9 g/d, P = 0.042), energy (7040 ± 240 vs 8230 ± 320 kJ/d, P = 0.006), protein (85 vs 103 g/d, P = 0.006), and micronutrient intake (including iron and iodine) in the MLC group. The most surprising finding was a statistically smaller infant head circumference in the MLC group (33.9 ± 0.1 vs 34.9 ± 0.3 cm; P = 0.046), which remained significant after adjustment for gestational weight gain, gestational age at delivery and infant sex (P = 0.043). Head circumference ranged from the 10-25th percentile in the MLC group and between 25-50th percentile for the RC diet group. Head circumference is a proxy measure for brain volume and development, therefore this finding suggests the need for caution on LC dietary advice in GDM.
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Donovan, Brittney Marie. "Early risk prediction tools for gestational diabetes mellitus." Diss., University of Iowa, 2018. https://ir.uiowa.edu/etd/6408.
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Gestational diabetes mellitus (GDM) is the most common metabolic complication in pregnancy and is associated with substantial maternal and neonatal morbidity. The standard of care for GDM in most developed countries is universal mid- to late- pregnancy (24-28 weeks gestation) glucose testing. While earlier diagnosis and treatment could improve pregnancy outcomes, tools for early identification of risk for GDM are not commonly used in practice. Existing models for predicting GDM risk within the first trimester of pregnancy based on maternal risk factors perform only modestly in the clinical setting. Heavy reliance on history of GDM to predict GDM development in the current pregnancy prevents these tools from being applicable to nulliparous women (i.e., women who have never given birth). In order to offer timely preventive intervention and enhanced antenatal care to nulliparous women, we need to be able to accurately identify those at high risk for GDM early in pregnancy.
Data from the California Office of Statewide Health Planning and Development Linked Birth File was used to address three aims: 1) improve early pregnancy prediction of GDM risk in nulliparous women through development of a risk factor-based model, 2) conduct a systematic review and meta-analysis assessing the relationship between first trimester prenatal screening biomarker levels and development of GDM, and 3) determine if the addition of first and second trimester prenatal screening biomarkers to risk factor-based models will improve early prediction of GDM in nulliparous women.
We developed a clinical prediction model including five well-established risk factors for GDM (race/ethnicity, age at delivery, pre-pregnancy body mass index, family history of diabetes, and pre-existing hypertension). Our model had moderate predictive performance among all nulliparous women, and performed particularly well among Hispanic and Black women when assessed within specific racial/ethnic groups. Our risk prediction model also showed superior performance over the commonly used American College of Obstetricians and Gynecologists (ACOG) screening guidelines, encouraging the prompt incorporation of this tool into preconception and prenatal care.
Biomarkers commonly assessed in prenatal screening have been associated with a number of adverse perinatal and birth outcomes. However, reports on the relationship between first trimester measurements of prenatal screening biomarkers and GDM development are inconsistent. Our meta-analysis demonstrated that women who are diagnosed with GDM have lower first trimester multiple of the median (MoM) levels of both pregnancy associated plasma protein-A (PAPP-A) and free β-human chorionic gonadotropin (free β-hCG) than women who remain normoglycemic throughout pregnancy.
Findings from our meta-analysis suggested that incorporation of prenatal screening biomarkers in clinical risk prediction models could aid in earlier identification of women at risk of developing GDM. Upon linkage of California Office of Statewide Health Planning and Development Linked Birth File and California Prenatal Screening Program records, we found that decreased levels of first trimester PAPP-A, increased second trimester unconjugated estriol, and increased second trimester dimeric inhibin A were associated with GDM development in nulliparous women. However, the addition of these biomarkers in clinical models did not offer improvements to the clinical utility (i.e., risk stratification) of models including maternal risk factors alone.
Our findings demonstrate that incorporation of maternal risk factors in a clinical risk prediction model can more accurately identify nulliparous women at high risk for GDM early in pregnancy compared to current standard practice. The maternal characteristics model we developed is based on clinical history and demographic variables that are already routinely collected by clinicians in the United States so that it may be easily adapted into existing prenatal care practice and screening programs. Future work should focus on evaluating the clinical impact of model implementation on maternal and infant outcomes as well as financial costs to the health care system.
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Eltahla, Auda Abdelsalam Biotechnology & Biomolecular Sciences Faculty of Science UNSW. "Gestational diabetes mellitus: a model for the genetics of type 2 diabetes." Awarded by:University of New South Wales. Biotechnology & Biomolecular Sciences, 2009. http://handle.unsw.edu.au/1959.4/44607.
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The striking similarity between Gestational Diabetes Mellitus (GDM) and Type 2 Diabetes (T2D) in terms of the pathophysiologies and the risk factors has led to the hypothesis that GDM is an early manifestation of T2D, expressed under the stress of pregnancy, and therefore both diseases should share similar susceptibility genes. GDM patients may provide a more homogeneous sample for the genetic causes of the disease than T2D, and therefore make a useful group for the identification of the genes involved. Over 200 GDM affected sib-pairs from 178 families were investigated, with parents available in 40% of cases. Genomic regions from 4 different chromosomes, 6, 8, 14 and 18 were chosen from regions that showed clustering for positive linkage scores in previous linkage studies on T2D and one control region on 13, where no previous positive linkage was reported. A total of 19 microsatellite markers were analysed for linkage to GDM using sib-pair analysis. Subset analyses were performed by ranking sib-pairs on GDM-related variables, e.g. mean BMI of sibs, age at GDM episode, etc. GENEHUNTER was run multiple times, each time including the next highest ranked family in the analysis. This gave a continuous range of scores where increasing or decreasing NPL scores indicated heterogeneity associated with different environmental factors such as age and weight. To evaluate the significance of the subset analyses, the results were compared to 10,000 permutations generated by randomly ranking the sib-pairs. Using the entire dataset, the analysis showed no significant linkage to a disease locus. Positive evidence for linkage was found with the subset analysis on chromosomes 8 and 14, suggesting heterogeneity between sib-pairs in the dataset. Marker D8S1742 on 8p23 showed an NPL score of 3.01 (p=0.001) when age at GDM diagnosis was used as a covariate. Using waist-to-hip ratio (WHR), marker D14S275 on 14q12 showed an NPL score of 2.474 (p=0.006). When adjusted for multiple testing, the results were not statistically significant for linkage to a diabetes disease locus, but gave evidence that GDM and T2D share similar genetic determinants, and defined groups of siblings for follow-up analysis of both types of diabetes.
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Sweeting, Arianne Natasha. "Risk Management in Gestational Diabetes Mellitus: The Impact of Early Gestational Diabetes Mellitus and the Utility of Early Antenatal Risk Assessment." Thesis, The University of Sydney, 2018. http://hdl.handle.net/2123/18967.
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Gestational diabetes mellitus (GDM), increasing in prevalence, is placing significant demands on limited health resources. In this context, to better target finite resources to those at highest risk we aimed to improve GDM risk stratification approaches and examined whether the timing of GDM diagnosis could infer risk. We found that early GDM (diagnosed before 24 weeks’ gestation) was associated with the highest risk of adverse pregnancy outcomes, despite treatment. Secondly, we explored the utility of a single HbA1c as a pragmatic index of risk at GDM diagnosis. In standard GDM, a threshold HbA1c >5.9% (41 mmol/mol) identified women at increased risk of adverse outcomes and thus baseline HbA1c would have utility as a risk stratification tool at diagnosis. In contrast, HbA1c did not have the same utility in early GDM which should be considered a high-risk cohort. These studies confirm a heterogeneity of risk within GDM and the potential utility of timing of diagnosis and baseline HbA1c as risk stratification tools. The ability in early pregnancy to accurately assess the risk for the development of GDM would allow for limited resources and preventative interventions to be applied in a targeted manner. Thus, we examined the utility of several first trimester multivariate prediction models for GDM. A clinical model achieved an area under the curve (AUC) of 0.88 [95% CI 0.85-0.92], improving on the binary clinical risk scoring systems in current use. The addition of routinely tested first trimester aneuploidy/ pre-eclampsia markers (maternal pregnancy associated plasma protein A, free-β human chorionic gonadotropin, mean arterial pressure and uterine artery pulsatility index), improved prediction and best predicted early GDM (AUC 0.96 [95% CI 0.94-0.98]). Finally, a novel multivariate risk prediction model combining previous markers, glucose, lipids and adipokine biomarkers achieved the highest detection rate for GDM for any given false positive rate of all models tested. Dependent on validation and cost benefit studies, such a model could have potential application to best define a population for GDM preventive strategies or as an alternative to universal screening. Taken together, these findings have important implications for the risk management of GDM.
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Collier, Jason. "Gestational diabetes self-management and remote monitoring mobile platform." Master's thesis, Faculty of Health Sciences, 2019. https://hdl.handle.net/11427/31722.
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There is a high prevalence of gestational diabetes (GD) in South Africa, which is continually growing. South African women with GD are not effectively managed or educated about selfcare, do not self-monitor frequently enough and, therefore, often succumb to various GD induced complications. The ineffective management of GD is largely due to financial and time constraints caused by the regularly required outpatient services. On the other hand, healthcare professionals do not monitor their patients frequently enough because of accessibility issues, which means they cannot intervene timeously to prevent diabetes complications. The aim of this project was to develop a mobile health (mHealth) platform for GD self-management and for remote monitoring to improve the GD cycle of care in South Africa. The objectives were to assess the current GD management practices in South Africa, to assess the existing mHealth solutions for GD and to design, develop and test a GD mHealth platform. The existing GD management practices and current GD mHealth solutions were investigated. The results of the investigation informed the design of low-fidelity and high-fidelity mock-ups of the platform. The high-fidelity mock-up underwent usability testing and the insights gained were used to develop a working prototype of the new mHealth platform, which was then ready for in-lab testing. It was found that GD had a prevalence of up to 25% in parts of South Africa. Over 70% of patients in both private and public healthcare sectors did not meet their diabetic goals, which directly correlated with diabetes induced complications. However, previous research found that using mHealth as an intervention caused a statistically significant decrease of 0.38 mmol/L (95% confidence interval (CI) 0.52 mmol/L to 0.23 mmol/L) in overall blood glucose levels during pregnancy when compared to a control group. There was a higher probability of vaginal deliveries in the intervention group than in the control group (risk ratio = 1.18). It was less likely for new-borns from the intervention group to be diagnosed with hypoglycaemia than new-borns from the control group (risk ratio = 0.67). Based on the research and usability studies conducted, an alpha version of the GD mHealth platform was developed, including a mobile app used to track the patient’s blood glucose levels via a Bluetooth-enabled glucose meter. The food intake, exercise and weight gain during pregnancy were manually captured by the patient. The app reminded the patient to take medication, measure glucose levels and attend appointments. A GD educational component was available for the patient throughout the pregnancy. The platform included a web app which allowed healthcare professionals to remotely monitor and communicate with their patients so that they could analyse trends in the data and intervene when necessary. The testing done on the prototype resulted in positive feedback with 60% of participants saying that they would use the GooDMoM mobile app to manage their GD and 70% of participants saying that they would use the GooDMoM web app to manage their patients with GD. This put the platform in a good position for beta development. The solution has the potential to benefit patients both financially and timewise, by reducing the frequency of hospital visits required. It also has the potential to positively impact the healthcare professionals by reducing the tediousness of their workload and allowing for remote monitoring of patients. The platform can, thus, optimise the GD management process in South Africa and worldwide.
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勞子僖 and Tzu-hsi Terence Lao. "The obstetric implications of gestational impaired glucose tolerance." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2002. http://hub.hku.hk/bib/B31981793.
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Lao, Tzu-hsi Terence. "The obstetric implications of gestational impaired glucose tolerance." Hong Kong : University of Hong Kong, 2002. http://sunzi.lib.hku.hk/hkuto/record.jsp?B24463863.
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Ojeaga, Celia T. "Implementation and Evaluation of Dietary Modification With Gestational Diabetes." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/1911.
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Gestational diabetes mellitus (GDM) negatively affects the health of both mothers and babies, and is the most common pregnancy complication in the United States. Many dietary modification programs for pregnant women diagnosed with GDM rely on a one-size-fits-all approach to menu planning. The purpose of this project was to develop a diet modification program for GDM management using a patient-centered approach. The project objective was to develop the policies, procedures, and supporting documents needed to implement a successful GDM management program for pregnant women receiving antenatal care at an obstetrical clinic. The developed program incorporated strategies for clinic nursing staff to involve pregnant patients and their family members in the planning of individualized daily menus addressing social, motivational, and economic factors. Patient understanding of diet management will be evaluated through the administration of written pre and post-tests, which were included with the program materials. Long term program evaluation will be determined through the tracking of maternal weight gain and infant birth weights. This program has the potential to contribute to positive social change through the reduction of complications resulting from inadequately managed gestational diabetes mellitus.
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Lee, Chi-wai. "Impact of gestational diabetes mellitus on placental thioredoxin system." Click to view the E-thesis via HKUTO, 2007. http://sunzi.lib.hku.hk/HKUTO/record/B39558897.
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Lee, Chi-wai, and 李志慧. "Impact of gestational diabetes mellitus on placental thioredoxin system." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2007. http://hub.hku.hk/bib/B39558897.
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Dembowitz, Marti. "Improving Postpartum Glucose Monitoring in Women with Gestational Diabetes." Thesis, Icahn School of Medicine at Mount Sinai, 2015. http://pqdtopen.proquest.com/#viewpdf?dispub=1595257.
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OBJECTIVE: To improve 6-week postpartum visit attendance, glucose test ordering, and test completion among postpartum GDM patients.
METHODS: Pre- and post-intervention GDM women at Mount Sinai were studied via chart review. Interventions included advanced order sets for glucose monitoring at the 35-week pregnancy visit, educational modules, and nutritionist phone calls reminding patients to attend postpartum visits fasting.
RESULTS: 107 pre-intervention and 42 post-intervention women were studied. Percentages of orders placed for postpartum testing was higher post-intervention vs. pre-intervention (57% vs. 42%, p=0.03). There were higher test completion rates post-intervention vs. pre-intervention (36% vs. 17%, p=0.01). Postpartum visit attendance rates didn’t vary between groups (73% vs. 69% p=0.60). 6% pre-intervention fasted for postpartum visits vs. 60% post-intervention.
CONCLUSION: There was no increase in women attending their 6-week postpartum visits, yet rates of completed orders for postpartum testing, women attending visits fasting, and postpartum test completions were higher post-intervention. More research may identify the barriers to attendance at 6-week post-partum visits.
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Venkataraman, Hema. "Ethnic differences in gestational diabetes : impact on South Asians." Thesis, University of Warwick, 2016. http://wrap.warwick.ac.uk/80229/.
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Background: GDM is a state of glucose intolerance first diagnosed in pregnancy. It is a pre-diabetes state, predisposing both the mother and offspring to future risk of diabetes. GDM is associated with increased risk to macrosomia, adiposity, Caesarean Section (CS) delivery, shoulder dystocia, and neonatal hypoglycaemia. SA have a greater than two fold risk of both GDM and future diabetes risk compared to WC. However, despite having higher levels of hyperglycaemia in pregnancy, SA babies are amongst the smallest babies in the world. The mechanism behind this increased glycaemic risk in SA is complex, multifactorial and unclear. Disordered hypothalamic-pituitary-adrenal axis (HPA) has been linked to adult diabetes, obesity and metabolic syndrome in WC but has not been studied in SA. The current management of GDM is largely based on evidence from studies in WC and has been extrapolated to other ethnic groups such as SA. This includes: diagnostic criteria to define GDM, postnatal screening methods for postpartum glucose abnormalities, effect of GDM on offspring birth weight (BW) and fetal growth in GDM. Through this research we aim to explore the ethnic differences between SA and WC in the applicability of diagnostic criteria, post partum screening methods, effect of GDM on BW, fetal growth patterns in GDM and also examine ethnic differences in HPA activity as a potential mechanism underlying the increased glycaemic risk in SA in pregnancy. Methods: i. Retrospective analysis of a routinely collected multicentre data (n=14477) over a 3-year period was used to study the applicability of various GDM diagnostic criteria and post partum screening methods. A subgroup analysis of the above data set was used to compare fetal growth between SA and WC (177 WC and 160 SA). ii. A retrospective analysis of a large birth weight cohort (n=53,128) from Leicestershire between 1994 and 2006 was used to compare the effect of maternal diabetes and GDM on BW in SA and WC. iii. To examine fetal growth in SA, a retrospective case control analysis of serial fetal biometry was performed between GDM and control population from India. (178 controls and 153 GDM) iv. To explore underlying HPA dysfunction as a potential mechanism for increased glycemia in SA and ethnic differences in HPA behaviour a prospective cohort study comprising of high risk pregnant SA and WC women was performed. Diurnal salivary and urinary cortisol excretion was studied in relation to glycaemia in SA and WC (n=100, 50 SA, 50WC) Results: i. The newer IADPSG detects obese women with mild fasting hyperglycaemia. The benefits of treatment of hyperglycemia are not well established. The increase in detection rates of GDM with the new NICE and IADPSG criteria were uniform across ethnic groups in a selectively screened population. ii. Postnatal screening with oral glucose tolerance test (OGTT) is associated with poor uptake in all ethnic groups, which improves substantially with using HbA1c. SA were more likely to attend postnatal screening with HbA1c compared to WC. Screening for postnatal diabetes using FPG is more likely to miss women of non-WC ethnicity owing to the larger proportion of post-load glucose abnormalities. iii. The BW increase associated with maternal diabetes was lower in SA by 139g compared to WC. iv. Important ethnic differences in fetal growth were noted. SA fetuses had overall smaller measures of head and abdomen circumferences, but with disproportionately smaller abdominal circumference compared to WC, signifying early evidence of a head sparing growth restricted pattern. v. SA fetuses of GDM mothers showed early evidence of increased abdominal adiposity at 20 weeks with smaller measures of other fat free mass and skeletal growth compared to non-GDM controls vi. SA had higher cortisol awakening responses compared to WC. First trimester waking cortisol was an independent predictor of glycaemia in the third trimester. Despite significantly lower BMI, SA had similar glucocorticoid (GC) excretion to WC. Urinary GC excretion was independently predicted by maternal adiposity and not BMI in SA. Conclusion: This research addresses important gaps in the literature in gestational diabetes in SA. There are important ethnic differences in the impact of maternal diabetes and gestational diabetes on BW and fetal growth, and evidence of early increase in adiposity at the expense of lean body mass in SA. This research provides novel evidence to support the argument for ethnicity tailored management of GDM. Our research also provides novel evidence for disordered HPA activity as a possible mechanism for the increased glycemic risk in SA. Larger randomized prospective studies incorporating offspring outcomes in relation to HPA are needed.
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Gu, Qi, and Liuyi Zhou. "Woman’s experiences of gestational diabetes mellitus : A descriptive review." Thesis, Högskolan i Gävle, Avdelningen för vårdvetenskap, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:hig:diva-36822.
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Dawson, Shelagh I. "Gestational glucose intolerance : the long-term implications." Thesis, University of Aberdeen, 2001. http://digitool.abdn.ac.uk/R?func=search-advanced-go&find_code1=WSN&request1=AAIU142009.
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During pregnancy glucose tolerance in the mother is affected. Glucose tolerance in pregnancy, as in the non-pregnant state is a continuum, represented by a distribution curve shifted to the right, with no clear divide between normal and abnormal. Many of the problems associated with overt diabetic pregnancies can be seen in infants of GDM pregnancies, such as macrosomia, neural tube defects, neonatal hypocalcemia, birth trauma and subsequent childhood and adolescent obesity. Impaired glucose intolerance (IGT) in pregnancy is also a major risk factor for the development of NIDDM (non-insulin dependent diabetes mellitus) and IGT in later life and is associated with not only an increased risk for coronary heart disease (CHD) disease but also many other morbidities and mortalities associated with overt diabetes. The problem remaining to be resolved is the precise level of glucose intolerance in pregnancy that poses a significant risk for the later health of the mother. Nor is increased gestational glucose intolerance the only reproductive event that has been linked with future NIDDM risk. Other factors have been known to predispose pregnant women to the risk of future diabetes (e.g. BMI, age and weight change). The findings of the present study suggest that the association of glucose intolerance during pregnancy, with the subsequent incidence of diabetes and certain co-morbidities in the mother, is continuous throughout the range of glucose concentrations studied. The risk of future diabetes is also affected by certain maternal characteristics (BMI at index pregnancy and at follow-up, weight change).
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Östlund, Ingrid. "Aspects of Gestational Diabetes : Screening System, Maternal and Fetal Complications." Doctoral thesis, Uppsala University, Department of Women's and Children's Health, 2003. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-3267.
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The appropriateness of universal screening for gestational diabetes mellitus (GDM) has been strongly questioned, since it does not satisfy ethical principles for screening.
The aims of these studies were to determine the prevalence of GDM, expressed in terms of impaired glucose tolerance (IGT) and diabetes mellitus (DM), to evaluate different screening models using traditional anamnestic risk factors and repeated random B-glucose, to determine whether GDM increases risks for maternal complications such as preeclampsia, and to determine whether IGT during pregnancy, if left untreated, is associated with increased maternal or neonatal morbidity.
Of 4,918 pregnant non-diabetic women attending maternal health care, 73.5% agreed to have a 75 g oral glucose tolerance test (OGTT). GDM was diagnosed in 1.7%, IGT in 1.3% and DM in 0.4%. Traditional risk factor criteria were fulfilled by 15.8%. Prior GDM and a prior macrosomic infant showed the highest association with GDM. No selective or two-step universal screening model would have detected all cases of GDM. A constructed model comprising prior GDM, a prior LGA/macrosomic infant, or a cut-off random B-glucose level of 8 mmol/l as an indication for OGTT reduced the need for OGTT to 7.3% compared to the selective screening model with traditional risk factors. Such a universal two-step screening model had 100% sensitivity for DM, and 44.7% sensitivity for IGT.
The Swedish Medical Birth Register was used to evaluate GDM as risk factor for preeclampsia. GDM occurred in 0.8% and preeclampsia in 2.9% of 430,852 singleton pregnancies. There is an independent and significant association between GDM and preeclampsia. Obesity is a major confounding factor, but cannot explain the total excess risk.
In a prospective population-based case-control study 213 women with untreated IGT during pregnancy were identified. For each case, four controls were recruited from the same delivery department. The analyses confirmed that maternal and fetal morbidity were increased in the cases in terms of cesarean section rate, pre-term delivery, Erb’s palsy and admission to NICU. There was a marked, independent increase in the proportion of LGA infants (OR 7.3; 95% CI 4.1-12.7). To determine whether treatment has an effect when IGT is diagnosed during pregnancy, a randomized study is required.
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Alnaji, Alia Abdulahamid A. "The relationship between sleep and glucose control in gestational diabetes." Thesis, University of Leeds, 2017. http://etheses.whiterose.ac.uk/19228/.
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This study set out to investigate the association between sleep among pregnant women with gestational diabetes (GDM) and their glucose control. Functional data analysis (FDA) methods were applied to glucose data collected via continuous glucose monitoring (CGM) systems. FDA is an advanced statistical method that respects the complexity of the dense auto-correlated data produced from repeated measurement of glucose over time. 192 pregnant women with GDM at their third trimester were recruited. Over a period of one week participants wore an actigraph (Actiwatch2 Respironics) which is a watch-like device on their non-dominant wrist to objectively measure their sleep, have a professional CGM system (iPro2 Medtronic) attached to them to continuously measure and record their interstitial glucose every 5 minutes, and complete the Pittsburgh Sleep Quality Index (PSQI) questionnaire to self-report their habitual sleep pattern for the previous month. Their demographic data and type of treatment they received were also collected. 152 participants had sufficient data retrieved from them, i.e. the PSQI questionnaire data and at least one night actigraphy-derived sleep data and one 24-hour day of CGM data. Using FDA methods, sequential glucose values data-points recorded over time with the CGM system were converted into a smooth 24-hour glucose curves with a functional form (as a function of time). The glucose curve was then used as one value, instead of the multiple data-points values it represents. Glucose control was assessed using the smooth glucose curves, as well as, a conventional summary metrics. The associations between participants’ actigraphy-derived and self-reported sleep characteristics and glucose control, were evaluated using standard and multilevel regression modelling for the conventional CGM data summary metrics and functional regression modelling for the smooth glucose curves. The study discovered a positive association between sleep disturbances and glucose control. Sleep disturbances were measured as poor sleep quality, short and long sleep durations compared to an average 6-8 hours sleep duration and difficulties in initiating and maintaining sleep. The timing and the amplitude of these associations were more apparent with FDA regression models than regression models with summary metrics. This study recommends the use of FDA in research involving the use of CGM systems, and encourages the clinician and the policy makers to consider sleep disturbances as a risk factor in glycaemic dysregulation in GDM.
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Fang, Qing. "An evaluation of the screening approaches for gestational diabetes mellitus." Thesis, University of Warwick, 2016. http://wrap.warwick.ac.uk/90276/.
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Background: Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance that occurs or is first recognised during pregnancy. The prevalence of GDM is 1-28% globally and 11% in China. Although GDM can cause severe maternal and neonatal outcomes, there is no consensus worldwide as to whether universal or selective screening of expectant mothers should be recommended. In 2010, The International Association of Diabetes and Pregnancy Study Groups (IADPSG) recommended that all pregnant women should be screened via a one-step universal screening approach for GDM, using a 75g oral glucose tolerance test (OGTT) with reduced thresholds. Despite ongoing debate over the efficacy and use of the IADPSG approach, China was the first country to adopt the new screening approach. A number of observational studies have shown that the new IADSPG approach is clinically more effective. However, reservations exist as to the associated increase in health costs and inconvenience to pregnant women. Aim: To assess and explore the best screening approach for GDM both globally and in China. Methods: The research involved three projects. Project I (Chapter 3) was a systematic review of the effectiveness and cost-effectiveness of universal versus selective screening for GDM, which followed a standard systematic review procedure for Diagnostic Test Accuracy studies. Project II (Chapter 4) was a Q methodology study to investigate the pregnant women’s attitudes towards and experience of the IADPSG one-step screening approach for GDM in China. A total of 30 pregnant women who visited the hospital for antenatal care in 2014 were recruited to participate in the study. The Q methodology study was undertaken using the FlashQ software and were analysed using the PQMethod software. Project III (Chapter 5) was a case-control study to establish and assess a risk score algorithm in order to improve the IADPSG approach for GDM screening in China. Medical records of 550 pregnant women (272 GDM cases and 278 controls) who had given birth in the year 2013 at the Chengdu First People’s Hospital were retrospectively collected and analysed. Univariable analysis and multiple logistic regression analysis were used to identify GDM risk factors and to formulate the risk score algorithm. A Receiver Operating Characteristic (ROC) curve was employed to assess the effectiveness of the risk score algorithm for GDM screening. Results: The systematic review (Chapter 3) included 28 effectiveness studies, four cost studies and one cost-effectiveness study. Seven out of the 28 effectiveness studies and the cost-effectiveness study favoured selective screening. The Q methodology study (Chapter 4) suggested that the participants agreed as to the importance and necessity of the IADPSG one-step GDM screening for all pregnant women. However, the non-GDM women felt somewhat burdened in undertaking the fasting and 2-hour oral Glucose Tolerance Test (OGTT) for GDM under the IADPSG approach. The participants also desired more information on GDM and OGTT both before and after the test. The case-control study (Chapter 5) identified age, height, body mass index (BMI), family history of diabetes, waist circumference, previous deliveries and blood pressure before 24th week of gestation to be risk factors for GDM in the Chinese population. Subsequently, a risk score algorithm was established, whereby the use of the risk score to select high-risk women for screening could help to exclude nearly half (45%) of non-GDM women from the OGTT while still diagnosing 80% of the GDM cases. Conclusion: Universal screening for GDM is recommended for areas where GDM prevalence is relatively high and where economic constraints circumscribing implementation of the approach do not exist. For areas where GDM prevalence is low, it is recommended that current practice, whether it is universal or selective screening, should be retained until more robust evidence emerges. The IADPSG one-step universal screening was viewed positively in terms of importance and necessity by participants of the study, and they felt that GDM screening is necessary to be undergone by every pregnant woman. At the same time, the non-GDM women also felt strongly that the two-hour OGTT requiring 3 blood samples over the test period was inconvenient and burdensome. Alternatively, the use of a risk score-based selective IADPSG approach was observed to be conducive to the exemption of nearly half (45%) of non-GDM women from the OGTT test while still diagnosing 80% of the GDM cases in China. A future validation cohort from other parts of China is required to affirm the effectiveness of this risk scoring algorithm.
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Hill, Jacqueline Charlotte. "Glucose tolerance and insulin status during pregnancy in South India : relationships to maternal and neonatal body composition." Thesis, University of Southampton, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.326396.
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Iqbal, Romaina. "Elucidation of lifestyle predictors of gestational diabetes mellitus in Pakistani women." Thesis, McGill University, 2005. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=85559.
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As women who experience Gestational Diabetes Mellitus (GDM) are at considerably greater risk of developing type 2 diabetes in life, prevention of GDM is particularly important. The objectives of this research were to identify lifestyle predictors associated with GDM in a developing country and to validate a physical activity questionnaire for assessing total energy expenditure in a Pakistani population.A prospective cohort study of 750 South Asian women recruited early in gestation was conducted in Karachi, Pakistan. Eligibility criteria included South Asian origin and ≤ 18 weeks gestation. Data on physical activity, diet, socio-demographic covariates, weight, height and body composition were obtained at recruitment and women were followed to assess GDM status at ≥ 26 weeks of gestation.
Logistic regression analysis of data from 611 women to assess the impact of age, body fat percentage, height, family history of diabetes, parity, level of education, rate of weight gain during pregnancy, and daily energy expenditure on the development of GDM was undertaken. The risk of GDM increased with increasing maternal age (yr), OR 1.13 (CI 1.06-1.21), body fat (%), OR 1.07 (CI 1.03-1.13), and decreased with daily energy expenditure (100 kcal), OR 0.89 (CI 0.79-0.99). Replacing body fat (%) with pre-gravid BMI provided similar results. Using a nested case (n=49) control (n=98) study design, conditional logistic regression analysis was conducted to assess the association between total energy, macronutrient and fiber intake and GDM. The risk of GDM decreased with increasing amounts of protein as a percentage of total energy intake, OR 0.75 (CI 0.60-0.95).
The Monitoring trends and determinants of cardiovascular disease Optional Study of Physical Activity (MOSPA) questionnaire was assessed against a Caltrac accelerometer (n=50). Subjects wore a caltrac accelerometer for 5 consecutive days. A correlation of 0.51 (P<0.01) was found between MOSPA questionnaire and Caltrac accelerometer values.
Advanced maternal age and body fat (%) predicted increased risk for GDM while physical activity was protective. Hence, prevention strategies should target increasing physical activity, sufficient to alter body composition, in this South Asian population.
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Franco-Liñán, M. C., G. Ramos-Masson, and Nilton Yhuri Carreazo. "Cut-off points for weight gain during pregnancy: Risk of gestational diabetes." Elsevier Ltd, 2017. http://hdl.handle.net/10757/622498.
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Algaba, Chueca Francisco. "Impact of gestational diabetes on fetal precursors and lipoprotein profile: effects on offspring." Doctoral thesis, Universitat Rovira i Virgili, 2020. http://hdl.handle.net/10803/669980.
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La diabetis mellitus gestacional (DMG) és una de les complicacions més comunes de l'embaràs i s'ha associat amb alteracions metabòliques i nutricionals maternes que pertorben les adaptacions metabòliques d'ell mateix. Aquests trastorns s'han associat amb patrons de creixement alterats i una major predisposició a desenvolupar malalties posteriors a la vida per la programació fetal. Les cèl·lules precursores fetals i el metabolisme dels lípids són components clau de la programació fetal que es poden veure directament afectats per la DMG. Aquest treball estudia l'impacte de la DMG en la funcionalitat de les cèl·lules precursores fetals trobades en la membrana amniòtica i en les característiques morfològiques i funcionals de les lipoproteïnes fetals, i també si aquestes alteracions potencials podrien programar el metabolisme fetal i contribuir directament a la major predisposició a malalties metabòliques i cardiovasculars durant el desenvolupament de la vida adulta. Portem a terme dos estudis observacionals cas-control amb DMG i embarassades amb tolerància normal a la glucosa. Vam demostrar que la DMG indueix canvis en les característiques biològiques de les cèl·lules mare mesenquimàtiques de la membrana amniòtica (AMSC), moltes de les quals estan relacionades amb paràmetres metabòlics fetals, el que suggereix que l'entorn de la DMG podria programar les cèl·lules mare i posteriorment afavorir la disfunció metabòlica més endavant en la vida. D'altra banda, trobem un contingut alterat de triglicèrids i lipoproteïnes de colesterol a la descendència de mares amb DMG dividida per categories de naixement. Concretament, els nounats amb pes adequat per a l'edat gestacional (AGA) mostren un perfil més similar als adults amb dislipidèmia i aterosclerosi que els nascuts de mares DMG. A més, trobem que les partícules de lipoproteïnes de baixa densitat (LDL) són biomarcadors potencials d'obesitat futura.La diabetes mellitus gestacional (DMG) es una de las complicaciones más comunes del embarazo y se ha asociado con alteraciones metabólicas y nutricionales maternas que perturban las adaptaciones metabólicas del mismo. Estos trastornos se han asociado con patrones de crecimiento alterados y una mayor predisposición a desarrollar enfermedades posteriores en la vida por la programación fetal. Las células precursoras fetales y el metabolismo de los lípidos son componentes clave de la programación fetal que pueden verse directamente afectados por la DMG. Este trabajo estudia el impacto de la DMG en la funcionalidad de las células precursoras fetales encontradas en la membrana amniótica y en las características morfológicas y funcionales de las lipoproteínas fetales, y también si estas alteraciones potenciales podrían programar el metabolismo fetal y contribuir directamente a la mayor predisposición a enfermedades metabólicas y cardiovasculares durante el desarrollo de la vida adulta. Llevamos a cabo dos estudios observacionales caso-control con DMG y embarazadas con tolerancia normal a la glucosa. Demostramos que la DMG induce cambios en las características biológicas de las células madre mesenquimatosas de la membrana amniótica (AMSC), muchas de las cuales están relacionadas con parámetros metabólicos fetales, lo que sugiere que el entorno de la DMG podría programar las células madre y posteriormente favorecer la disfunción metabólica más adelante en la vida. Por otro lado, encontramos un contenido alterado de triglicéridos y lipoproteínas de colesterol en la descendencia de madres con DMG dividida por categorías de nacimiento. Concretamente, los neonatos con peso adecuado para la edad gestacional (AGA) muestran un perfil más similar a los adultos con dislipidemia y aterosclerosis que los nacidos de madres DMG. Además, encontramos que las partículas de lipoproteína de baja densidad (LDL) son biomarcadores potenciales de obesidad futura.
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Bolognani, Cláudia Vicari [UNESP]. "Circunferência da cintura na predição do Diabetes mellitus gestacional." Universidade Estadual Paulista (UNESP), 2011. http://hdl.handle.net/11449/99257.
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As alterações no metabolismo materno são importantes para suprir as demandas do feto. Entretanto, mulheres que engravidam com algum grau de resistência à insulina, como nos casos de sobrepeso/obesidade, obesidade central e síndrome dos ovários policísticos, associado à ação dos hormônios placentários anti-insulínicos favorece o quadro de hiperglicemia de intensidade variada, caracterizando o diabetes mellitus gestacional (DMG) e levando a efeitos adversos maternos e fetais. Diante da ausência de um consenso universal para o rastreamento e diagnóstico do DMG, esta revisão teve como objetivos, elencar os variados protocolos que foram propostos, bem como ressaltar os fatores de risco associados ao DMG e suas complicações. O mais recente protocolo é o da Associação Americana de Diabetes, com mudanças que se justifi cariam pelo aumento alarmante da obesidade mundial e, em decorrência, o potencial incremento na ocorrência do diabetes mellitus tipo 2, nem sempre diagnosticado antes do período gestacional. A intenção deste protocolo é identifi car as gestantes que se benefi ciariam do controle da hiperglicemia, melhorando o prognóstico destas gestações e prevenindo complicações futuras para as mães e seus filhos
Alterations in maternal metabolism are important in order to supply the demands of the fetus. However, pregnant women with some degree of insulin resistance, such as in cases of overweight/obesity, central obesity and polycystic ovaries syndrome, associated to the action of anti-insulin placental hormones, contribute to a case of hyperglycemia of varied intensity, characterizing gestational diabetes mellitus (GDM) and leading to adverse effects both maternal and fetal. At the absence of a universal consensus to the tracking and diagnosis of GDM, this review had the purpose of listing the various protocols that have been proposed, as well as highlighting the risk factors associated with GDM and its complications. The most recent protocol is the one from the American Diabetes Association, with changes that would be justifi ed by the alarming raise in worldwide obesity and, consequently, the potential increase to the occurrence of type 2 diabetes mellitus, not always diagnosed before the gestational period. The intention of this protocol is to identify the gestating women that could benefi t from hyperglycemia control, improving the prognostic of these pregnancies and preventing future complications for mothers and their children
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Bolognani, Cláudia Vicari. "Circunferência da cintura na predição do Diabetes mellitus gestacional /." Botucatu : [s.n.], 2011. http://hdl.handle.net/11449/99257.
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Orientador: Iracema Mattos ParanhosCoorientador: Sulani Silva de Souza
Banca: José Guilherme Cecatti
Banca: Maria Aparecida Mourão Brasil
Resumo: As alterações no metabolismo materno são importantes para suprir as demandas do feto. Entretanto, mulheres que engravidam com algum grau de resistência à insulina, como nos casos de sobrepeso/obesidade, obesidade central e síndrome dos ovários policísticos, associado à ação dos hormônios placentários anti-insulínicos favorece o quadro de hiperglicemia de intensidade variada, caracterizando o diabetes mellitus gestacional (DMG) e levando a efeitos adversos maternos e fetais. Diante da ausência de um consenso universal para o rastreamento e diagnóstico do DMG, esta revisão teve como objetivos, elencar os variados protocolos que foram propostos, bem como ressaltar os fatores de risco associados ao DMG e suas complicações. O mais recente protocolo é o da Associação Americana de Diabetes, com mudanças que se justifi cariam pelo aumento alarmante da obesidade mundial e, em decorrência, o potencial incremento na ocorrência do diabetes mellitus tipo 2, nem sempre diagnosticado antes do período gestacional. A intenção deste protocolo é identifi car as gestantes que se benefi ciariam do controle da hiperglicemia, melhorando o prognóstico destas gestações e prevenindo complicações futuras para as mães e seus filhos
Abstract: Alterations in maternal metabolism are important in order to supply the demands of the fetus. However, pregnant women with some degree of insulin resistance, such as in cases of overweight/obesity, central obesity and polycystic ovaries syndrome, associated to the action of anti-insulin placental hormones, contribute to a case of hyperglycemia of varied intensity, characterizing gestational diabetes mellitus (GDM) and leading to adverse effects both maternal and fetal. At the absence of a universal consensus to the tracking and diagnosis of GDM, this review had the purpose of listing the various protocols that have been proposed, as well as highlighting the risk factors associated with GDM and its complications. The most recent protocol is the one from the American Diabetes Association, with changes that would be justifi ed by the alarming raise in worldwide obesity and, consequently, the potential increase to the occurrence of type 2 diabetes mellitus, not always diagnosed before the gestational period. The intention of this protocol is to identify the gestating women that could benefi t from hyperglycemia control, improving the prognostic of these pregnancies and preventing future complications for mothers and their children
Mestre
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Chukwuemeka, Scholarstica Chinwe. "Adverse Foetal Outcomes in Gestational Diabetes: A Systematic Review and Meta-analysis." University of the Western Cape, 2020. http://hdl.handle.net/11394/7920.
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Magister Pharmaceuticae - MPharmGestational diabetes mellitus (GDM) is a condition that affects pregnant women and is one of the most common complications related to pregnancy. According to the World health organisation (WHO), the usual window for diagnosing GDM is between 24 and 28 weeks of gestation and the primary aim of diagnosing gestational diabetes is to identify women and infants at risk of short- or longer-term adverse outcomes. Recent results from the hyperglycaemia and adverse pregnancy outcome (HAPO) study have suggested that even mild levels of hyperglycaemia can have adverse effects on foetal outcomes but there are uncertainties about the prevalence of these outcomes in GDM diagnosed according to the latest WHO 2013 guideline and/or IADPSG 2010 criteria in diverse populations. GDM prevalence has been studied by different researchers, but the prevalence of adverse foetal outcomes in GDM diagnosed based on the latest WHO 2013 guideline and/or IADPSG 2010 criteria have not yet been explored except for the data published by the HAPO study. Due to the lack of sufficient knowledge on foetal outcomes in GDM, this study was conducted to review the evidence on the prevalence of adverse foetal outcomes in GDM diagnosed according to WHO 2013 guideline and/or the IADPSG 2010 criteria. Different databases including PubMed, Science Direct, Google Scholar and CINAHL as well as bibliographic citations were searched using a well-formulated search strategy to find the relevant observational studies (prospective/retrospective cohort and case-control) using explicit inclusion and exclusion criteria. The following search terms were used, “gestational diabetes”, “pregnancy”, “adverse fetal outcomes” and “adverse foetal outcomes”. The findings of this study were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the obtained data analysed using MetaXL ® version 5.3. This review was registered online on PROSPERO, the International prospective register of systematic reviews (registration number: CRD42020155061). Fifteen studies with 88,831 pregnant women (range: 83-25,543 participants) from 12 countries around the world were identified, with a wide variation in the prevalence of foetal outcomes in GDM using the stipulated criteria. These studies were unevenly distributed geographically as six of them were conducted in Asia, four in Europe, four in North America, one in Australia and none in Africa, Antarctica and South America. A meta-analysis found that the overall prevalence of foetal outcomes ranged from 1% (perinatal mortality) to 11% ( large for gestational age). The finding is limited due to the paucity of data on the prevalence of foetal outcomes in GDM. However, more studies using these criteria in low- and middle- income countries (LMICs) are needed by health care providers, to inform practice and allocate resources for control of GDM and its adverse foetal outcomes in diverse settings and ethnic groups, especially in LMICs.
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Deol, Harleen. "The lived experience of South Asian women with gestational diabetes mellitus." Thesis, University of British Columbia, 2015. http://hdl.handle.net/2429/54564.
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Factors that influence differentially managed gestational diabetes mellitus (GDM) and variances in adherence to GDM guidelines among the South Asian women were investigated using a qualitative design. There is a lack of descriptive literature related to this topic and subsequently the need for a better understanding to provide optimal care for this population of women. A phenomenological approach provided the research approach to generate descriptive knowledge of women’s lived experience of managing and adhering to GDM guidelines. Thus, the purpose of this research was to understand the lived experiences of South Asian women managing GDM. The research question guiding the study was: What is the lived experience of managing GDM for women of South Asian descent? The results from this research study will assist health care providers to understand the experiences of South Asian women and how their experience affects their ability to effectively manage GDM. Findings from this study will aid in developing and implementing strategies that can raise awareness and contribute to successful management of GDM among this population. The overall aim is to contribute such knowledge to assist with the development of population-specific intervention strategies to enable these women to successfully manage GDM.Applied Science, Faculty of
Nursing, School of
Graduate
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Adam, Sumaiya. "Comparing Screening Strategies for Gestational Diabetes in a South African Population." Thesis, University of Pretoria, 2017. http://hdl.handle.net/2263/64092.
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Globally, there is an alarming increase in the incidence of Type II diabetes mellitus (T2DM). It is well recognized that women who develop gestational diabetes (GDM) in their pregnancies are at increased risk of T2DM in later life. In addition, poor glycaemic control in pregnancy impacts adversely on the neonatal outcome, as well as the long term disease risks of that child. The risk of these outcomes increases continuously as maternal fasting plasma glucose levels increases. Several adverse outcomes have been associated with DM during pregnancy. These include pre-eclampsia, polyhydramnios, fetal macrosomia, fetal hepatomegaly and cardiomegaly, birth trauma, operative delivery, perinatal mortality and neonatal respiratory problems and metabolic complications such as hypoglycaemia, hyperbilirubinaemia, hypocalcaemia and polycythaemia.
Despite five decades of research there is little consensus regarding the optimal approach to screening for GDM. Recently most international organisations have recommended that all women should be screened for GDM. South Africa is a diverse multi-racial society with an increasing burden of non-communicable diseases. The health system is already overburdened, and the optimal approach to screening for GDM remains unclear.
A prospective cohort observational study was conducted at the Eyethu Yarona clinic (Lion Park Clinic), in Johannesburg, South Africa (SA). One thousand (1000) consecutive non-diabetic women who were less than 26 weeks pregnant were recruited. At recruitment the women completed a demographic questionnaire, and had a random glucose and glycated haemoglobin (HbA1c) drawn. A fasting blood glucose was assessed within 2 weeks, and a serum specimen was frozen at -40°C for further testing at a later stage.
Patients had a 75 g 2-hour oral glucose tolerance test (OGTT) and HbA1c between 24 – 28 weeks gestation. All glucose measurements were done at the laboratory using standardized tests (venous blood) and on a Roche Accuchek Active® glucometer (Roche Diagnostics, Mannheim, Germany) (capillary blood). GDM was diagnosed according to the International Federation of Gynecology and Obstetrics (FIGO) criteria, i.e. any one abnormal reading was diagnostic of GDM: 0-hour ≥5.1 mmol/l, 1-hour ≥10 mmol/l, or 2-hour ≥8.5 mmol/l.
Thereafter a nested cohort study of HIV negative patients was conducted to investigate the association between the concentrations of biomarkers associated with glucose homeostasis and GDM in a South African population. C-reactive protein (CRP), adiponectin, and fasting insulin were measured on the stored serum samples. The Insulin Sensitivity Index (HOMA-IR = fasting insulin (microU/L) x fasting glucose (mmol/L) / 22.5), and Quantitative Insulin Sensitivity Check Index (QUICKI = 1 / [log (I0) + log (G0)]) were calculated for further evaluation of markers of insulin sensitivity.
The significance of this research was to assess the burden of disease of GDM in a South African population. The different diagnostic criteria were also compared, as well as the universal versus the traditional risk-factor based screening approach to GDM. Screening methods were compared so as to propose a simple, effective, cost efficient screening and diagnostic tool that may be implemented at primary health care level, which will in turn identify those pregnant women who warrant referral to a high care obstetric unit, thus improving both maternal and neonatal outcomes in our population.Thesis (PhD) - University of Pretoria, 2017.
SEMDSA
SASA
Roche
Obstetrics and Gynaecology
PhD
Unrestricted
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Zankman, Stephanie Marissa. "A Guide to the Understanding, Prevention, and Treatment of Gestational Diabetes." Thesis, The University of Arizona, 2011. http://hdl.handle.net/10150/145118.
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Gallo, Sina. "The determinants of adiponectin in female adolescents : offspring of gestational diabetes and non-diabetes affected pregnancies." Thesis, McGill University, 2007. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=101125.
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Daughters of gestational diabetes (GDM) affected pregnancies are at greater risk for the development of type 2 diabetes mellitus (DM) later in life. Adiponectin is an early marker of DM risk. Dietary fat quality has been proposed to be involved in the development of insulin resistance. Plasma fatty acids are a marker of recent dietary exposure. The objectives of this research were to determine whether differences in adiponectin exist in daughters of GDM pregnancies, and to describe how dietary fatty acids impact adiponectin concentrations. Fasting adiponectin and plasma fatty acids were examined for 180 adolescent daughters born to mothers with and without GDM. No differences were observed in adiponectin between study groups, however; a significant difference was detected upon comparison of daughters from mothers who were presently diabetic with those from healthy mothers. The association between fatty acids and adiponectin varied by visceral adiposity. Adiponectin was inversely associated with monounsaturated and omega-3 (n-3) fatty acids in the high waist group. Further knowledge on the interactions between fatty acids, desaturase activity and adiponectin would be helpful in planning early interventions for individuals at risk for diabetes.
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Ekpebegh, Chukwuma Ogbonna. "Retrospective analysis of pregnancies at the Grootte Schuur Hospital : a comparison of pregnancy outcomes in pre-gestational and gestational diabetes." Master's thesis, University of Cape Town, 2006. http://hdl.handle.net/11427/2783.
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Includes bibliographical references (leaves 67-80).Although the treatment of gestational impaired glucose tolerance (GIGT) has been shown to be beneficial, the cost implications in treating GIGT in resource constrained economies needs examination. Thus this study assessed: (i) pregnancy outcomes in pre-gesational types 1 and 2 diabetes (DM) with particular emphasis on the modality of therapy for pregnant women with type 2 DM, (ii) pregnancy outcomes in subjects with gestational diabetes (GDM) and the effect of stratification by fasting plasma glucose (FPG) and 2 hour oral glucose tolerance test (OGTT) plasma glucose values, and (iii) the effect of OGLAs on pregnancy outcomes in GDM.
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Amason, Janeen S. "The Effect of an Educational Intervention in Women with Gestational Diabetes: A Pilot Study." Digital Archive @ GSU, 2013. http://digitalarchive.gsu.edu/nursing_diss/34.
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Women with gestational diabetes (GD) are at higher risk of developing type 2 diabetes (DM) after delivery compared to those without GD. Numerous studies in the general population have identified that adoption of healthy lifestyles can prevent DM; however limited research has focused on women with GD. The purpose of this randomized pilot study was to determine the effectiveness of an educational intervention of SUGAR (Start Understanding Gestational Diabetes and Risk of Type 2 Diabetes), on women’s perceived risk of developing DM, knowledge of DM, self-efficacy to adopt healthy lifestyle behaviors and adoption of healthy lifestyle behaviors after childbirth among women with GD.
A total of 23 women (mean age of 29.7, SD=3.9), 18 in SUGAR group and 5 in control group (CG) completed self-reported standardized questionnaires (Risk Perception Survey for Developing Diabetes adapted for women with GD; Self-Rated Abilities for Health Practices; Health Promotion Lifestyle Profile II; General Sleep Disturbance Scale; and Demographic Questionnaire) at baseline (third trimester) and post-test (postpartum 6-8 weeks). Intervention was given post the baseline data collection with a booster session at 2-4 weeks postpartum. The women in CG received attention control treatment.
Study participants were obese (BMI M=33.1, SD=7.7) and a majority had a family history of DM. Findings showed that self-efficacy was the single significant predictor and accounted for 22% of the variance of healthy lifestyle behaviors. Participants had a clinical significant sleep disturbance during both pregnancy and postpartum. At baseline, poor sleepers reported a lower self-efficacy. The intervention significantly increased DM knowledge for women in the SUGAR group; however, not for perceived risk, self-efficacy nor healthy lifestyle behaviors. There was no difference between groups for postpartum glucose screening rates with only 39% receiving recommended testing.
Future research needs to focus on prevention programs and center on self-efficacy, postpartum glucose screening, improve sleep, and adoption of healthy lifestyle behaviors. To ensure a better preventive care for GD women, education provided for both patients and health care provider is needed.
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Gonçalves, Luciana Colnago. "Ocorrência de hipertensão arterial em mulheres com passado de distúrbios hiperglicêmicos na gestação /." Botucatu : [s.n.], 2003. http://hdl.handle.net/11449/94770.
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Orientador: Walkyria de Paula PimentaResumo: Está estabelecida a associação entre diabetes mellitus (DM) tipo 2 e hipertensão arterial sistêmica (HAS). É conhecida a maior ocorrência de distúrbios hipertensivos no diabetes mellitus gestacional (DMG). No Serviço de Obstetrícia da Faculdade de Medicina de Botucatu, as gestantes são avaliadas quanto ao metabolismo da glicose por meio do teste oral de tolerância à glicose (TOTG) e o perfil glicêmico (PG), sendo classificadas em 4 grupos: IA - com ambos os testes normais, têm tolerância à glicose normal; IB - com apenas o PG alterado, têm hiperglicemia diária; IIA - com apenas o TOTG alterado, têm DMG; IIB - com ambos os testes alterados, têm DMG e hiperglicemia diária. Anteriormente, observamos maior risco de desenvolvimento de DM tipo 2 nos três grupos com distúrbios hiperglicêmicos em relação ao grupo IA. O objetivo deste estudo foi avaliar a freqüência de ocorrência de HAS nos quatro grupos gestacionais após três a 12 anos do parto. De 3113 gestantes acompanhadas pelo Serviço de Obstetrícia, foram selecionadas 551 por meio de processo aleatório e proporcional ao número de gestantes de cada grupo. Destas, puderam participar do estudo 535, assim distribuídas nos grupos: IA - 250 (100,0%); IB - 120 (100,0%); IIA - 77 (87,5%) e IIB - 88 (94,6%). As participantes eram avaliadas clinicamente e quanto à tolerância à glicose, com medição da glicemia de jejum e realização do TOTG quando a glicemia estava alterada (110 a 125 mg/dL). O estudo da associação entre a freqüência de ocorrência das variáveis e os grupos gestacionais foi feito pelo teste de Goodman. Para as variáveis quantitativas, utilizou-se a análise de variância não paramétrica na comparação entre os quatro grupos. Na análise da associação entre a pressão arterial atual e as variáveis... (Resumo completo, clicar acesso eletrônico abaixo)
Abstract: High blood pressure is associated with type 2 diabetes mellitus (T2DM). There is an increased prevalence of hypertensive disorders in gestational diabetes mellitus (GDM). Glucose intolerance is evaluated at the Obstetrics Unit of Botucatu School of Medicine using the oral glucose tolerance test (OGTT) and glucose profile (GP). Pregnant women are classified into 4 groups: IA, both tests are normal - they have normal glucose tolerance; IB, only the GP is abnormal - they have habitual gestational hyperglycemia; IIA, only the OGTT is abnormal - they have GDM; and IIB, both tests are abnormal - they have GDM and habitual gestational hyperglycemia. Previously, we have observed higher risk of developing T2DM in the 3 above groups with hyperglycemic disorders in relation to the IA group. The aim of this study was to compare hypertension frequency in women among the 4 groups of glucose tolerance, 3 to 12 years after index-pregnancy. From 3,113 pregnant women followed at our Obstetrics Unit, we selected 551 by a process that was randomized and proportional to the number of pregnant women in each group. Of these, 535 could participate in this study and were distributed into the following groups: 250 (100.0%) - IA, 120 (100.0%) - IB, 77 (87.5%) - IIA, and 88 (94.6%) - IIB. The women were evaluated clinically and in relation to glucose tolerance. This was done by measuring fasting plasma glucose and performing the OGTT when plasma glucose was between 110 and 125 mg/dL. Analysis of association between frequency of the variables and the 4 groups was by Goodman's test. Comparison between the groups in relation to quantitative variables was performed by the non-parametric analysis of variance. The c2 test analyzed the association between normal or high... (Complete abstract click electronic address below)
Mestre
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Renz, Paula Breitenbach. "Avaliação do desempenho diagnóstico do teste de Hemoglobina Glicada (A1c) para detecção de Diabetes mellitus em gestantes." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2013. http://hdl.handle.net/10183/143433.
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O Diabetes mellitus gestacional (DMG) é uma séria condição que afeta muitas gestantes e traz muitos riscos tanto para a gestante, como para o feto. A recomendação é que se faça o rastreamento com teste oral de tolerância à glicose (TOTG) entre 24 e 28 semanas de gestação. O objetivo desse estudo é determinar a utilidade do teste de hemoglobina glicada (A1c) como teste diagnóstico de DMG, comparado com os critérios baseados na medida de glicemia. Métodos: este é um estudo de acurácia de teste diagnóstico. Nós avaliamos o metabolismo dos carboidratos através dos testes de TOTG e A1c em mulheres grávidas brasileiras atendidas nas visitas de pré-natal do Hospital de Clínicas de Porto Alegre (HCPA). Além dos testes de TOTG e A1c, foi analisada a história clínica das pacientes. O DMG foi definido de acordo com critério da American Diabetes Association (ADA) - um ou mais pontos alterados, glicemia de jejum, 1h ou 2h com concentrações de glicose plasmática ≥5.1, 10.0, ou 8.5 mmol/L, respectivamente-, ou de acordo com os critérios da Organização Mundial da Saúde (OMS) - glicemia de jejum ou 2h com concentrações de glicose plasmática ≥7.0mmol/L ou ≥7.8mmol/L, respectivamente. Presença de anemia, hemoglobinas variantes e doença renal crônica foram excluídas. Para avaliar o desempenho do teste de A1c foi utilizada a curva ROC (receiver operating characteristic curve). Resultados: um total de 262 mulheres grávidas (média de idade de 30 anos, média de idade gestacional de 26 semanas) foram avaliadas e 82 (31,3%) tiveram diagnóstico positivo (40 pelo critério da ADA e 42 pelo critério da OMS). Baseado na análise da curva ROC, considerando os critérios da ADA e OMS juntos e o TOTG como teste de referência, o ponto de corte para obter o melhor equilíbrio entre sensibilidade e especificidade (diagonal 100% a 100%) foi o valor de A1c de 31mmol/mol (5,3%). A sensibilidade e especificidade para este ponto de corte foi de 69,9% e 65,9%, respectivamente. Os pontos de corte de 40 mmol/mol (5.8%), 41 mmol⁄mol (5.9%) e 42 mmol⁄mol (6.0%) representaram especificidades de 96,1%, 96,6% e 98,3%, respectivamente. Conclusões: o teste de A1c apresenta baixa sensibilidade e alta especificidade para o diagnóstico de DMG, quando comparado com o critério tradicional. Nossos resultados mostraram que 39% dos casos de DMG foram diagnosticados usando o ponto de corte de A1c≥ 40 mmol/mol (5.8%). O teste de A1c, sozinho ou em combinação com o TOTG, talvez seja bastante útil no diagnóstico de DMG.BACKGROUND: Gestational diabetes mellitus (GDM) is a potentially serious condition that affects many pregnancies and it carries risk for the mother and neonate. The current recommendation is to perform screening before 24 - 28 weeks of gestation by an oral glucose tolerance test (OGTT). The aim of this study is to determine the usefulness of glycated hemoglobin (A1c) as a diagnostic tool for GDM compared with the traditional criteria based on glycemia measurements. METHODS: This is a study of diagnostic test accuracy. We evaluated the status of carbohydrate metabolism by performing OGTT and A1c in Brazilian pregnant women attending prenatal visits at Hospital de Clínicas de Porto Alegre (HCPA). A1c, OGTT, and clinical history were analyzed. GDM was defined according to the American Diabetes Association (ADA) criteria (one or more fasting, 1-h, or 2-h plasma glucose concentrations ≥5.1, 10.0, or 8.5 mmol/L; respectively) or World Health Organization (WHO) criteria (fasting or 2-h plasma glucose ≥7.0mmol/L or ≥7.8mmol/L, respectively). Presence of anemia, variant hemoglobins and chronic renal disease were excluded. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic performance of A1c. RESULTS: A total of 262 pregnant women (mean age 30 years, mean gestational duration 26 weeks) were enrolled and 82 (31.3%) were diagnosed with diabetes (40 by ADA criteria and 42 by WHO criteria). Based on ROC curve analysis, and considering OGTT as the reference criterion, the cut-off point obtained by the point with the best equilibrium between sensitivity and specificity (100%-to-100% diagonal) was A1c value of 31 mmol⁄mol (5.3%). The sensitivity and specificity for this cut-off 27 point were 69.9 % and 65.9 %, respectively. The cut-off points of A1c of 40 mmol/mol (5.8%), 41 mmol⁄mol (5.9%) and 42 mmol⁄mol (6.0%) presented specificities of 96,1%, 96,6% and 98,3%, respectively. CONCLUSIONS: A1c test presented low sensitivity and very high specificity for GDM diagnosis when compared with traditional criteria. Our results show that 39% of GDM cases would be diagnosed by using the cut-off point A1c≥ 40 mmol/mol (5.8%) alone. A1c test, alone or in combination with OGTT, may be a very useful diagnostic tool in GDM.
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Roberson, Lauren Brinkman. "EXAMINING REASONS FOR LOW FIDELITY TO EDUCATIONAL PROGRAMS IN PATIENTS WITH GESTATIONAL DIABETES: A QUALITATIVE STUDY." UKnowledge, 2014. http://uknowledge.uky.edu/foodsci_etds/18.
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Gestational diabetes mellitus (GDM) is an increasing problem in the U.S. Many comorbidities are associated with GDM: increased risk for type 2 diabetes, neonatal hypoglycemia and fetal malformation. Healthcare organizations develop GDM educational programs to provide women with knowledge and skills to manage GDM and reduce health risks. While there are significant benefits to attending GDM educational programs, attendance rates are low. Little research has been conducted to determine reasons for low attendance in GDM educational programs. The purpose of this study was to explore the experiences of women with GDM and to describe factors influencing GDM educational program attendance. Semi-structured telephone interviews were conducted with GDM program participants at a large hospital in central Kentucky. The sample size was N=21. Results indicated that meal management changes and blood glucose monitoring characterized the GDM experience and many attended the educational program to receive information on these topics. Few participants reported barriers to attendance. The majority was satisfied with information received. Motivators to attendance included flexibility, location, and support of family members.. Participants preferred face-to-face meetings although some expressed a need for online classes and communication via text messaging. Participants expressed the need for GDM information postpartum.
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Stirm, Laura [Verfasser], and Harald [Akademischer Betreuer] Staiger. "Placental and humoral alterations in gestational diabetes / Laura Stirm ; Betreuer: Harald Staiger." Tübingen : Universitätsbibliothek Tübingen, 2018. http://d-nb.info/119935564X/34.
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Dunham, Patricia M. "Nursing intervention of gestational diabetes mellitus: a literature review, analysis and synthesis." Honors in the Major Thesis, University of Central Florida, 2000. http://digital.library.ucf.edu/cdm/ref/collection/ETH/id/187.
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This item is only available in print in the UCF Libraries. If this is your Honors Thesis, you can help us make it available online for use by researchers around the world by following the instructions on the distribution consent form at http://library.ucf.edu/Systems/DigitalInitiatives/DigitalCollections/InternetDistributionConsentAgreementForm.pdf You may also contact the project coordinator, Kerri Bottorff, at kerri.bottorff@ucf.edu for more information.Bachelors
Health and Public Affairs
Nursing
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Jansen, Tracey. "Predictors of anxiety during the perinatal period in women with gestational diabetes." Thesis, University of Birmingham, 2013. http://etheses.bham.ac.uk//id/eprint/4065/.
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Background: The treatment of type 1 diabetes includes daily injections of insulin and requires attention to diet, exercise, and monitoring of blood glucose levels. Coping Skills Training is an intervention based on social learning theory and aims to develop an individual’s skills and ability to cope with the stressful situations related to managing diabetes on a daily basis. Aim: This paper has reviewed the literature examining the impact of Coping Skills Training on metabolic control and psychosocial outcomes in children and adolescents and aims to: (1) Describe and compare the characteristics of CST across the available literature, (2) Provide a quality assessment of studies evaluating CST, (3) Describe the impact of CST on metabolic control and psychosocial variables in children and adolescents, in light of the quality assessment. Method: A keyword search in Embase, Medline, PsycINFO and Pubmed Central databases yielded a total of 15 quantitative articles using a variety of designs. Results: The small number of well-designed studies indicated that metabolic control is not improved in a limited population of children who participate in CST. However the results in adolescents are more promising. Conclusions: The evidence on whether CST can improve psychosocial outcomes in children and adolescents is mixed and appeared dependent on the mode of delivery and whether CST is compared to routine care or diabetes related education. A summary of recommendations for future research is provided along with the clinical implications of the results described in this review.
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Carr, Ana-Alicia. "An examination of gestational diabetes mellitus among Latinas using an ecological approach." Thesis, California State University, Long Beach, 2016. http://pqdtopen.proquest.com/#viewpdf?dispub=10076451.
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Latinas experience disproportionate rates of gestational diabetes mellitus (GDM). Continued research efforts are necessary in order to gain a more comprehensive understanding of the factors associated with this condition among Latinas. To date, a significant amount of research has been conducted examining intrapersonal predictors of GDM. The aim of this study was to explore potential, broader-level, correlates of GDM among Latinas (N = 5,440) in California. Results from unadjusted logistic regression analyses indicated both interpersonal and community-level variables are significantly associated with GDM among Latinas. In the nested logistic regression analyses including community, interpersonal, and intrapersonal variables, one interpersonal variable (i.e., difficulty understanding the doctor) remained significant in the final model. Moreover, results suggested intrapersonal variables may mediate the relationship between community-level variables and GDM. Future research should aim to identify additional correlates, as well as examine causal mechanisms.
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Radler, Theresa. "LONG-TERM OUTCOMES OF GESTATIONAL DIABETES MELLITUS EDUCATIONAL PROGRAM FOR HISPANIC WOMEN." Thesis, The University of Arizona, 2002. http://hdl.handle.net/10150/610593.
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Gestational diabetes mellitus (GDM) is one of the most common medical
complications that occurs during pregnancy, and has both immediate and long-term
effects. It occurs in about 2-5% of all pregnancies. Hispanic Americans are
at 1.9 times greater risk of type 2 diabetes than non-Hispanic whites of similar
age. Hispanic women have higher rates of GDM than non-Hispanic white
women. The purpose of this project was to describe long-term outcomes of the
gestational diabetes education component of the Santa Cruz Collaborative
Diabetes Project. The program, established in 1997, provides diabetes
education and diabetes screening to residents of Santa Cruz County by
physicians, nurse practitioners and RNs to increase awareness of and to prevent
or delay the onset of diabetes and/or complications attributed to the disease in
the Hispanic population. Data gathered in this project indicated that self-care and
lifestyle behaviors learned during the gestational period were not all sustained in
the long-term. Awareness about diabetes and its complications was evident,
however, was insufficient to translate into behaviors to lower risk factors. All
participants acknowledged an increased risk for developing type 2 diabetes,
however, this risk was related to family history. There was no mention of GDM as
a risk factor. A continued relationship with the GDM clients is recommended to
ensure ongoing concern, knowledge and self-care practices that would decrease
the risk of developing type 2 diabetes in these clients.