Meta-analysis of insulin detemir treatment of pregnancy with diabetes

Objective:To evaluate the meta-analysis of evaluate the clinical efficacy and safety of insulin deside in improving pregnancy with diabetes,and to conduct a Meta-analysis study on the treatment of pregnancy with diabetes.Methods:Before this study,we comprehensively and systematically searched the major literature websites at home and abroad.From the establishment of the database to January 9,2022,we searched the Chinese and English literature on the randomized controlled trial(RCT)of insulin detemir in the treatment of pregnancy complicated with diabetes.We screened them in strict accordance with the acceptance criteria.The bias risk assessment tool in Cochrane system evaluator manual 5.1.0 was used to evaluate the quality of the selected literature,and the Review Manager 5.4 software was used for meta-analysis.Results:Finally,24 RCTs target literatures were obtained,with a cumulative sample size of 2,362 cases.The results of meta-analysis showed that the reduction range of fasting blood glucose,2 h postprandial blood glucose and glycosylated hemoglobin in patients with insulin detemir combined with routine treatment was greater than that in the control group(P<0.05);compared with conventional treatment,the incidence of premature delivery,macrosomia and cesarean section of the diabetes group were lower than those of the control group(P<0.05).Among them,preterm birth(RR=0.44,95%CI[0.28,0.68],P=0.0002),macrosomia(RR=0.35,95%CI[0.21,0.59],P<0.0001),cesarean section(RR=0.82,95%CI[0.72,0.94],P=0.005),fasting blood glucose(SMD=-1.21,95%CI[-1.54,-0.88],P<0.00001),2 h postprandial blood glucose(SMD=-1.63,95%CI[-1.91,-1.35],P<0.00001),glycosylated hemoglobin(SMD=-2.41,95%CI[-3.12,-1.70],P<0.00001).Conclusion:Routine treatment can improve the clinical effect of pregnancy with diabetes.However,there are low limits on the reference level of this study,so this conclusion has some limitations.

Amount of polyhydramnios attributable to diabetes may be less than previously reported

AIM To evaluate the frequency and the quantity of polyhydramnios attributable to diabetes in pregnancy.METHODS The charts of patients with a four-quadrant amniotic fluid index(AFI) ≥ 20 cm and either a diagnosis of diabetes or a diabetes screening test during the index pregnancy were retrospectively reviewed. AFI was stratified into 5 categories and the frequency of diabetes was evaluated for each group. The frequency of polyhydramnios attributable to diabetes was compared to the frequency of polyhydramnios in the setting of fetal anomalies or no known cause. RESULTS One thousand five hundred and forty-five patients were included in the study. Eight point five percent(n = 131) had diabetes and no other cause for polyhydramnios. Eleven point two percent(173) had antenatally diagnosed anomalies. For all categories of AFI except the largest(> 40.9 cm) the most common cause of polyhydramnios was idiopathic. In patients with diabetes the AFI was most likely to be between 26 cm and 35.9 cm.CONCLUSION The rate of polyhydramnios in this study is 8.5%. Patients with diabetes most commonly have mild polyhydramnios between 26 and 35.9 cm of fluid on a four-quadrant AFI.

Gestational diabetes from A to Z

Gestational diabetes mellitus(GDM) is defined as any degree of hyperglycaemia that is recognized for the first time during pregnancy. This definition includes cases of undiagnosed type 2 diabetes mellitus(T2 DM) identified early in pregnancy and true GDM which develops later. GDM constitutes a greater impact on diabetes epidemic as it carries a major risk of developing T2 DM to the mother and foetus later in life. In addition, GDM has also been linked with cardiometabolic risk factors such as lipid abnormalities, hypertensive disorders and hyperinsulinemia. These might result in later development of cardiovascular disease and metabolic syndrome. The understanding of the different risk factors, the pathophysiological mechanisms and the genetic factors of GDM, will help us to identify the women at risk, to develop effective preventive measures and to provide adequate management of the disease. Clinical trials have shown that T2 DM can be prevented in women with prior GDM, by intensive lifestyle modification and by using pioglitazone and metformin. However, a matter of controversy surrounding both screening and management of GDM continues to emerge, despite several recent welldesigned clinical trials tackling these issues. The aim of this manuscript is to critically review GDM in a detailed and comprehensive manner, in order to provide a scientific analysis and updated write-up of different related aspects.

Association of interpregnancy interval and risk of adverse pregnancy outcomes in woman by different previous gestational ages

Background:With an increasing proportion of multiparas,proper interpregnancy intervals(IPIs)are urgently needed.However,the association between IPIs and adverse perinatal outcomes has always been debated.This study aimed to explore the association between IPIs and adverse outcomes in different fertility policy periods and for different previous gestational ages.Methods:We used individual data from China’s National Maternal Near Miss Surveillance System between 2014 and 2019.Multivariable Poisson models with restricted cubic splines were used.Each adverse outcome was analyzed separately in the overall model and stratified models.The stratified models included different categories of fertility policy periods(2014-2015,2016-2017,and 2018-2019)and infant gestational age in previous pregnancy(<28 weeks,28-36 weeks,and≥37 weeks).Results:There were 781,731 pregnancies enrolled in this study.A short IPI(≤6 months)was associated with an increased risk of preterm birth(OR[95%CI]:1.63[1.55,1.71]for vaginal delivery[VD]and 1.10[1.03,1.19]for cesarean section[CS]),low Apgar scores and small for gestational age(SGA),and a decreased risk of diabetes mellitus in pregnancy,preeclampsia or eclampsia,and gestational hypertension.A long IPI(≥60 months)was associated with an increased risk of preterm birth(OR[95%CI]:1.18[1.11,1.26]for VD and 1.39[1.32,1.47]for CS),placenta previa,postpartum hemorrhage,diabetes mellitus in pregnancy,preeclampsia or eclampsia,and gestational hypertension.Fertility policy changes had little effect on the association of IPIs and adverse maternal and neonatal outcomes.The estimated risk of preterm birth,low Apgar scores,SGA,diabetes mellitus in pregnancy,and gestational hypertension was more profound among women with previous term births than among those with preterm births or pregnancy loss.Conclusion:For pregnant women with shorter or longer IPIs,more targeted health care measures during pregnancy should be formulated according to infant gestational age in previous pregnancy.

Euglycemic diabetic ketoacidosis:A missed diagnosis

Euglycemic diabetic ketoacidosis(DKA)is an acute life-threatening metabolic emergency characterized by ketoacidosis and relatively lower blood glucose(less than 11 mmol/L).The absence of hyperglycemia is a conundrum for physicians in the emergency department and intensive care units;it may delay diagnosis and treatment causing worse outcomes.Euglycemic DKA is an uncommon diagnosis but can occur in patients with type 1 or type 2 diabetes mellitus.With the addition of sodium/glucose cotransporter-2 inhibitors in diabetes mellitus management,euglycemic DKA incidence has increased.The other causes of euglycemic DKA include pregnancy,fasting,bariatric surgery,gastroparesis,insulin pump failure,cocaine intoxication,chronic liver disease and glycogen storage disease.The pathophysiology of euglycemic DKA involves a relative or absolute carbohydrate deficit,milder degree of insulin deficiency or resistance and increased glucagon/insulin ratio.Euglycemic DKA is a diagnosis of exclusion and should be considered in the differential diagnosis of a sick patient with a history of diabetes mellitus despite lower blood glucose or absent urine ketones.The diagnostic workup includes arterial blood gas for metabolic acidosis,serum ketones and exclusion of other causes of high anion gap metabolic acidosis.Euglycemic DKA treatment is on the same principles as for DKA with correction of dehydration,electrolytes deficit and insulin replacement.The dextrosecontaining fluids should accompany intravenous insulin to correct metabolic acidosis,ketonemia and to avoid hypoglycemia.