BACKGROUND Gestational diabetes mellitus(GDM)is a special type of diabetes that commonly occurs in women during pregnancy and involves impaired glucose tolerance and abnormal glucose metabolism;GDM is diagnosed for th...BACKGROUND Gestational diabetes mellitus(GDM)is a special type of diabetes that commonly occurs in women during pregnancy and involves impaired glucose tolerance and abnormal glucose metabolism;GDM is diagnosed for the first time during pregnancy and can affect fetal growth and development.AIM To investigate the associations of serum D-dimer(D-D)and glycosylated hemoglobin(HbA1c)levels with third-trimester fetal growth restriction(FGR)in GDM patients.METHODS The clinical data of 164 pregnant women who were diagnosed with GDM and delivered at the Obstetrics and Gynecology Hospital of Fudan University from January 2021 to January 2023 were analyzed retrospectively.Among these women,63 whose fetuses had FGR were included in the FGR group,and 101 women whose fetuses had normal body weights were included in the normal body weight group(normal group).Fasting venous blood samples were collected from the elbow at 28-30 wk gestation and 1-3 d before delivery to measure serum D-D and HbA1c levels for comparative analysis.The diagnostic value of serum D-D and HbA1c levels for FGR was evaluated by receiver operating characteristic analysis,and the influencing factors of third-trimester FGR in GDM patients were analyzed by logistic regression.RESULTS Serum fasting blood glucose,fasting insulin,D-D and HbA1c levels were significantly greater in the FGR group than in the normal group,while the homeostasis model assessment of insulin resistance values were lower(P<0.05).Regarding the diagnosis of FGR based on serum D-D and HbA1c levels,the areas under the curves(AUCs)were 0.826 and 0.848,the cutoff values were 3.04 mg/L and 5.80%,the sensitivities were 81.0%and 79.4%,and the specificities were 88.1%and 87.1%,respectively.The AUC of serum D-D plus HbA1c levels for diagnosing FGR was 0.928,and the sensitivity and specificity were 84.1%and 91.1%,respectively.High D-D and HbA1c levels were risk factors for third-trimester FGR in GDM patients(P<0.05).CONCLUSION D-D and HbA1c levels can indicate the occurrence of FGR in GDM patients in the third trimester of pregnancy to some extent,and their combination can be used as an important index for the early prediction of FGR.展开更多
Objective:To explore the effect of allocating case managers for gestational diabetes patients.Methods:200 patients with gestational diabetes mellitus from December 2021 to December 2022 were included in this study,and...Objective:To explore the effect of allocating case managers for gestational diabetes patients.Methods:200 patients with gestational diabetes mellitus from December 2021 to December 2022 were included in this study,and the collection period.They were divided into groups according to the interventions received.Each patient in the observation group was managed by a case manager,while the control group were managed with conventional methods without the supervision of a case manager.There were 100 cases in each group,and the curative effects of the two groups were compared.Results:The fasting blood glucose and 2-hour postprandial blood glucose in the observation group were significantly lower than those of the control group(P<0.05).The re-admission rate of patients due to poor blood sugar control in the observation group was lower than that in the control group(P<0.05).The pregnancy outcome of the observation group was better than that of the control group(P<0.05).Conclusion:Case management of gestational diabetes can not only control the blood glucose of pregnant women,but also improve pregnancy outcomes.展开更多
Self-monitoring of blood glucose(SMBG)is critical for gestational diabetes mellitus(GDM)care.However,there are several hurdles to its practice during the coronavirus disease 2019(COVID-19)pandemic in GDM patients in l...Self-monitoring of blood glucose(SMBG)is critical for gestational diabetes mellitus(GDM)care.However,there are several hurdles to its practice during the coronavirus disease 2019(COVID-19)pandemic in GDM patients in low-and middle-income countries when GDM care recommendations emphasize telemedicine-based care.Based on available knowledge,this letter proposes the following barriers to SMBG in these GDM patients during the ongoing COVID-19 pandemic:Poor internet connectivity,affordability of SMBG and digital applications to connect with healthcare providers,government-imposed social mobility restriction,psychological stress,and mental health conditions.Nevertheless,definitive evidence will only be acquired from rigorous research.展开更多
Objective To discuss whether the capillary whole blood glucose (CBG) test can be used in glucose screening test (GST) for gestational diabetes mellitus (GDM) compared to the venous plasma glucose (VPG) method, and to ...Objective To discuss whether the capillary whole blood glucose (CBG) test can be used in glucose screening test (GST) for gestational diabetes mellitus (GDM) compared to the venous plasma glucose (VPG) method, and to determine the cutoff value of CBG. Methods This was a self-control test. The 50-g oral GST was conducted among 1 557 pregnant women between 24-28 weeks. Every woman was measured CBG and VPG at the same time and same arm. Three hundred and forty women underwent 100-g 3-h oral glucose tolerance test (OGTT). Receiver operation curve (ROC) was used to determine the potential cutoff level of CBG and VPG. Diagnose criteria of GDM was based on NDDG criteria. OGTT diagnosed GDM and VPG≥7.8 mmol/L were used as golden standard for ROC. Results There was good relationship between CBG and VPG (P<0.01). Correlation coefficient was 0.86. The value of CBG was lower than VPG. The statistical and high-sensitivity cutoff values were 7.4 mmol/L in CBG and 7.8 mmol/L in VPG when GDM was used as golden standard. Cutoff value of CBG was 7.0 mmol/L when VPG≥7.8 mmol/L was used as golden standard. The pregnant outcomes of positive cases of three thresholds had no significant differences. But it was better in case of the pregnant woman when the CBG value was more than 7.4 mmol/L. Conclusion CBG can be used in GST, the threshold of CBG was suggested as 7.4 mmol/L. CBG test was more convenience and effective than VPG test.展开更多
Gestational diabetes mellitus(GDM)is the most prevalent metabolic disorder during pregnancy.Women diagnosed with GDM have a substantially greater risk of developing type 2 diabetes within 5-10 years after delivery,and...Gestational diabetes mellitus(GDM)is the most prevalent metabolic disorder during pregnancy.Women diagnosed with GDM have a substantially greater risk of developing type 2 diabetes within 5-10 years after delivery,and the risk is increased by excess body weight.Uncontrolled hyperglycemia during pregnancy is potentially harmful to both mother and fetus,resulting in a greater need for Caesarian-section deliveries,delivery of larger infants with more excess body fat,a greater risk of infant death and stillbirth,and an elevated risk of infant hypoglycemia immediately after birth.Fortunately,engaging in physical activity prior to and during pregnancy may lower the risk of developing GDM.Pregnant women should also be advised how to safely increase their physical activity during pregnancy and the postpartum period.An initial approach to becoming more physically active can simply be to encourage women to incorporate more unstructured physical activity into daily living,both before and during pregnancy.Giving women an appropriate exercise prescription can encourage them to participate in physical activity safely and effectively throughout pregnancy to prevent and/or manage GDM.Engaging in 30 min of moderate intensity physical activity on most,if not all,days of the week has been adopted as a recommendation for all pregnant women.展开更多
Gestational diabetes mellitus (GDM) and large for gestational age (LGA) offspring are two common pregnancy complications. Connections also exist between the two conditions, including mutual maternal risk factors for t...Gestational diabetes mellitus (GDM) and large for gestational age (LGA) offspring are two common pregnancy complications. Connections also exist between the two conditions, including mutual maternal risk factors for the conditions and an increased prevalence of LGA offspring amongst pregnancies affected by GDM. Thus, it is important to elucidate potential shared underlying mechanisms of both LGA and GDM. One potential mechanistic link relates to macronutrient metabolism. Indeed, derangement of carbohydrate and lipid metabolism is present in GDM, and maternal biomarkers of glucose and lipid control are associated with LGA neonates in such pregnancies. The aim of this paper is therefore to reflect on the existing nutritional guidelines for GDM in light of our understanding of the pathophysiological mechanisms of GDM and LGA offspring. Lifestyle modification is first line treatment for GDM, and while there is some promise that nutritional interventions may favourably impact outcomes, there is a lack of definitive evidence that changing the macronutrient composition of the diet reduces the incidence of either GDM or LGA offspring. The quality of the available evidence is a major issue, and rigorous trials are needed to inform evidence-based treatment guidelines.展开更多
Background: Gestational Diabetes Mellitus (GDM) is the most common complication of pregnancy that causes chronic hypertension, increased rate of cesarean delivery, fetal mortality and morbidity. Therefore, early diagn...Background: Gestational Diabetes Mellitus (GDM) is the most common complication of pregnancy that causes chronic hypertension, increased rate of cesarean delivery, fetal mortality and morbidity. Therefore, early diagnosis of GDM is vital to reduce maternal and fetal morbidity. Moreover, it can circumvent or procrastinate the onset of type 2 diabetes. Objectives: The main objective of this study was to determine the prevalence of GDM in pregnant women attending Kimironko, Kicukiro and Muhima Health Centres. The specific objectives were to determine the blood glucose during the second trimester in pregnant women aged between 21 and 45 years, to find out the frequencies of pregnant women presenting with GDM according to age and to assess some promising risk factors associated with GDM. Methods: A cross-sectional study was carried out at Kimironko, Kicukiro and Muhima Health centers using a sample size of 96 pregnant women. Blood glucose levels were measured using glucose oxidase method with a glucometer. Data were analyzed by using Microsoft Office Excel and SPSS version 20. Results: Out of 96 pregnant women who participated in the study, 8.3% were found to have GDM with the mean ± 2SD of 194.12 ± 25.53 mg/dl of their blood glucose results (Mean ± 2SD: A 95% level of confidence Intervals). The highest proportion of GDM was revealed in pregnant women aged between 26 - 30 years, representing a frequency of 5.2% whereas 2.1% of GDM was reflected in women aged between 21 - 25 years. The lowest proportion of GDM fell in age group of 31 - 35 years contributing to 1% of the total GDM. There were no cases of GDM in pregnant women in the 36 - 40 or 41 - 45 age groups. The mean ± 2SD of participant’s age groups was 27.12 ± 5.01 years. In addition, while obesity did not show to be associated with GDM, age and family history were found to be risk factors of GDM. Conclusion: The findings of this study revealed that the prevalence of GDM was 8.3% and the most affected pregnant women were in the age group of 26 - 30 years.展开更多
目的:探讨妊娠期肝内胆汁淤积症(ICP)与妊娠期糖尿病(GDM)的相关性。方法:选取2013年2月至2021年2月在北京大学深圳医院产科分娩的GDM孕妇5517例(GDM组)和非GDM孕妇5517例(非GDM组),采用单因素、多因素和分层分析法分析ICP与GDM、ICP与...目的:探讨妊娠期肝内胆汁淤积症(ICP)与妊娠期糖尿病(GDM)的相关性。方法:选取2013年2月至2021年2月在北京大学深圳医院产科分娩的GDM孕妇5517例(GDM组)和非GDM孕妇5517例(非GDM组),采用单因素、多因素和分层分析法分析ICP与GDM、ICP与血糖水平、总胆汁酸与GDM的相关性。结果:GDM组中ICP比例显著大于非GDM组,差异有统计学意义(P<0.05)。GDM合并ICP患者的OGTT-1h血糖显著高于GDM未合并ICP患者(P<0.05),两组患者OGTT-0h或2h血糖比较,差异无统计学意义(P>0.05)。与非GDM组比较,GDM组中重度ICP占ICP总体的比例显著增高(34.88%vs 9.68%,P<0.001);ICP病例中,与未合并GDM患者比较,合并GDM的患者血清总胆汁酸显著升高(中位数29.10μmol/L vs 20.65μmol/L,P<0.01)。多因素分析提示,ICP与GDM显著相关(OR=1.426,95%CI为1.011~2.011,P=0.043),这与非高龄妊娠、单胎妊娠、经产妇中的分层分析结果一致。结论:ICP与GDM存在显著相关性,并且这种相关性在重度ICP中更明显,ICP可能是GDM的风险因素之一。展开更多
文摘BACKGROUND Gestational diabetes mellitus(GDM)is a special type of diabetes that commonly occurs in women during pregnancy and involves impaired glucose tolerance and abnormal glucose metabolism;GDM is diagnosed for the first time during pregnancy and can affect fetal growth and development.AIM To investigate the associations of serum D-dimer(D-D)and glycosylated hemoglobin(HbA1c)levels with third-trimester fetal growth restriction(FGR)in GDM patients.METHODS The clinical data of 164 pregnant women who were diagnosed with GDM and delivered at the Obstetrics and Gynecology Hospital of Fudan University from January 2021 to January 2023 were analyzed retrospectively.Among these women,63 whose fetuses had FGR were included in the FGR group,and 101 women whose fetuses had normal body weights were included in the normal body weight group(normal group).Fasting venous blood samples were collected from the elbow at 28-30 wk gestation and 1-3 d before delivery to measure serum D-D and HbA1c levels for comparative analysis.The diagnostic value of serum D-D and HbA1c levels for FGR was evaluated by receiver operating characteristic analysis,and the influencing factors of third-trimester FGR in GDM patients were analyzed by logistic regression.RESULTS Serum fasting blood glucose,fasting insulin,D-D and HbA1c levels were significantly greater in the FGR group than in the normal group,while the homeostasis model assessment of insulin resistance values were lower(P<0.05).Regarding the diagnosis of FGR based on serum D-D and HbA1c levels,the areas under the curves(AUCs)were 0.826 and 0.848,the cutoff values were 3.04 mg/L and 5.80%,the sensitivities were 81.0%and 79.4%,and the specificities were 88.1%and 87.1%,respectively.The AUC of serum D-D plus HbA1c levels for diagnosing FGR was 0.928,and the sensitivity and specificity were 84.1%and 91.1%,respectively.High D-D and HbA1c levels were risk factors for third-trimester FGR in GDM patients(P<0.05).CONCLUSION D-D and HbA1c levels can indicate the occurrence of FGR in GDM patients in the third trimester of pregnancy to some extent,and their combination can be used as an important index for the early prediction of FGR.
文摘Objective:To explore the effect of allocating case managers for gestational diabetes patients.Methods:200 patients with gestational diabetes mellitus from December 2021 to December 2022 were included in this study,and the collection period.They were divided into groups according to the interventions received.Each patient in the observation group was managed by a case manager,while the control group were managed with conventional methods without the supervision of a case manager.There were 100 cases in each group,and the curative effects of the two groups were compared.Results:The fasting blood glucose and 2-hour postprandial blood glucose in the observation group were significantly lower than those of the control group(P<0.05).The re-admission rate of patients due to poor blood sugar control in the observation group was lower than that in the control group(P<0.05).The pregnancy outcome of the observation group was better than that of the control group(P<0.05).Conclusion:Case management of gestational diabetes can not only control the blood glucose of pregnant women,but also improve pregnancy outcomes.
文摘Self-monitoring of blood glucose(SMBG)is critical for gestational diabetes mellitus(GDM)care.However,there are several hurdles to its practice during the coronavirus disease 2019(COVID-19)pandemic in GDM patients in low-and middle-income countries when GDM care recommendations emphasize telemedicine-based care.Based on available knowledge,this letter proposes the following barriers to SMBG in these GDM patients during the ongoing COVID-19 pandemic:Poor internet connectivity,affordability of SMBG and digital applications to connect with healthcare providers,government-imposed social mobility restriction,psychological stress,and mental health conditions.Nevertheless,definitive evidence will only be acquired from rigorous research.
基金Supported by grants from the Natrual Science Foundation of Shanghai, China (99ZB14071).
文摘Objective To discuss whether the capillary whole blood glucose (CBG) test can be used in glucose screening test (GST) for gestational diabetes mellitus (GDM) compared to the venous plasma glucose (VPG) method, and to determine the cutoff value of CBG. Methods This was a self-control test. The 50-g oral GST was conducted among 1 557 pregnant women between 24-28 weeks. Every woman was measured CBG and VPG at the same time and same arm. Three hundred and forty women underwent 100-g 3-h oral glucose tolerance test (OGTT). Receiver operation curve (ROC) was used to determine the potential cutoff level of CBG and VPG. Diagnose criteria of GDM was based on NDDG criteria. OGTT diagnosed GDM and VPG≥7.8 mmol/L were used as golden standard for ROC. Results There was good relationship between CBG and VPG (P<0.01). Correlation coefficient was 0.86. The value of CBG was lower than VPG. The statistical and high-sensitivity cutoff values were 7.4 mmol/L in CBG and 7.8 mmol/L in VPG when GDM was used as golden standard. Cutoff value of CBG was 7.0 mmol/L when VPG≥7.8 mmol/L was used as golden standard. The pregnant outcomes of positive cases of three thresholds had no significant differences. But it was better in case of the pregnant woman when the CBG value was more than 7.4 mmol/L. Conclusion CBG can be used in GST, the threshold of CBG was suggested as 7.4 mmol/L. CBG test was more convenience and effective than VPG test.
文摘Gestational diabetes mellitus(GDM)is the most prevalent metabolic disorder during pregnancy.Women diagnosed with GDM have a substantially greater risk of developing type 2 diabetes within 5-10 years after delivery,and the risk is increased by excess body weight.Uncontrolled hyperglycemia during pregnancy is potentially harmful to both mother and fetus,resulting in a greater need for Caesarian-section deliveries,delivery of larger infants with more excess body fat,a greater risk of infant death and stillbirth,and an elevated risk of infant hypoglycemia immediately after birth.Fortunately,engaging in physical activity prior to and during pregnancy may lower the risk of developing GDM.Pregnant women should also be advised how to safely increase their physical activity during pregnancy and the postpartum period.An initial approach to becoming more physically active can simply be to encourage women to incorporate more unstructured physical activity into daily living,both before and during pregnancy.Giving women an appropriate exercise prescription can encourage them to participate in physical activity safely and effectively throughout pregnancy to prevent and/or manage GDM.Engaging in 30 min of moderate intensity physical activity on most,if not all,days of the week has been adopted as a recommendation for all pregnant women.
文摘Gestational diabetes mellitus (GDM) and large for gestational age (LGA) offspring are two common pregnancy complications. Connections also exist between the two conditions, including mutual maternal risk factors for the conditions and an increased prevalence of LGA offspring amongst pregnancies affected by GDM. Thus, it is important to elucidate potential shared underlying mechanisms of both LGA and GDM. One potential mechanistic link relates to macronutrient metabolism. Indeed, derangement of carbohydrate and lipid metabolism is present in GDM, and maternal biomarkers of glucose and lipid control are associated with LGA neonates in such pregnancies. The aim of this paper is therefore to reflect on the existing nutritional guidelines for GDM in light of our understanding of the pathophysiological mechanisms of GDM and LGA offspring. Lifestyle modification is first line treatment for GDM, and while there is some promise that nutritional interventions may favourably impact outcomes, there is a lack of definitive evidence that changing the macronutrient composition of the diet reduces the incidence of either GDM or LGA offspring. The quality of the available evidence is a major issue, and rigorous trials are needed to inform evidence-based treatment guidelines.
文摘Background: Gestational Diabetes Mellitus (GDM) is the most common complication of pregnancy that causes chronic hypertension, increased rate of cesarean delivery, fetal mortality and morbidity. Therefore, early diagnosis of GDM is vital to reduce maternal and fetal morbidity. Moreover, it can circumvent or procrastinate the onset of type 2 diabetes. Objectives: The main objective of this study was to determine the prevalence of GDM in pregnant women attending Kimironko, Kicukiro and Muhima Health Centres. The specific objectives were to determine the blood glucose during the second trimester in pregnant women aged between 21 and 45 years, to find out the frequencies of pregnant women presenting with GDM according to age and to assess some promising risk factors associated with GDM. Methods: A cross-sectional study was carried out at Kimironko, Kicukiro and Muhima Health centers using a sample size of 96 pregnant women. Blood glucose levels were measured using glucose oxidase method with a glucometer. Data were analyzed by using Microsoft Office Excel and SPSS version 20. Results: Out of 96 pregnant women who participated in the study, 8.3% were found to have GDM with the mean ± 2SD of 194.12 ± 25.53 mg/dl of their blood glucose results (Mean ± 2SD: A 95% level of confidence Intervals). The highest proportion of GDM was revealed in pregnant women aged between 26 - 30 years, representing a frequency of 5.2% whereas 2.1% of GDM was reflected in women aged between 21 - 25 years. The lowest proportion of GDM fell in age group of 31 - 35 years contributing to 1% of the total GDM. There were no cases of GDM in pregnant women in the 36 - 40 or 41 - 45 age groups. The mean ± 2SD of participant’s age groups was 27.12 ± 5.01 years. In addition, while obesity did not show to be associated with GDM, age and family history were found to be risk factors of GDM. Conclusion: The findings of this study revealed that the prevalence of GDM was 8.3% and the most affected pregnant women were in the age group of 26 - 30 years.
文摘目的:探讨妊娠期肝内胆汁淤积症(ICP)与妊娠期糖尿病(GDM)的相关性。方法:选取2013年2月至2021年2月在北京大学深圳医院产科分娩的GDM孕妇5517例(GDM组)和非GDM孕妇5517例(非GDM组),采用单因素、多因素和分层分析法分析ICP与GDM、ICP与血糖水平、总胆汁酸与GDM的相关性。结果:GDM组中ICP比例显著大于非GDM组,差异有统计学意义(P<0.05)。GDM合并ICP患者的OGTT-1h血糖显著高于GDM未合并ICP患者(P<0.05),两组患者OGTT-0h或2h血糖比较,差异无统计学意义(P>0.05)。与非GDM组比较,GDM组中重度ICP占ICP总体的比例显著增高(34.88%vs 9.68%,P<0.001);ICP病例中,与未合并GDM患者比较,合并GDM的患者血清总胆汁酸显著升高(中位数29.10μmol/L vs 20.65μmol/L,P<0.01)。多因素分析提示,ICP与GDM显著相关(OR=1.426,95%CI为1.011~2.011,P=0.043),这与非高龄妊娠、单胎妊娠、经产妇中的分层分析结果一致。结论:ICP与GDM存在显著相关性,并且这种相关性在重度ICP中更明显,ICP可能是GDM的风险因素之一。
