19 results on '"Yamamoto, Jennifer M."'
Search Results
2. The association between gestational diabetes and stillbirth: a systematic review and meta-analysis
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Lemieux, Patricia, Benham, Jamie L., Donovan, Lois E., Moledina, Nadia, Pylypjuk, Christy, and Yamamoto, Jennifer M.
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- 2022
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3. Metformin in Pregnancy for Women with Type 2 Diabetes: a Review
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Benham, Jamie L., Donovan, Lois E., and Yamamoto, Jennifer M.
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- 2021
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4. Thyroid function testing and management during and after pregnancy among women without thyroid disease before pregnancy
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Yamamoto, Jennifer M., Metcalfe, Amy, Nerenberg, Kara A., Khurana, Rshmi, Chin, Alex, and Donovan, Lois E.
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Hypothyroidism ,Methimazole ,Thyrotropin ,Pregnancy ,Thyroid gland ,Pregnant women ,Thyroid hormones ,Pharmacy ,Hormones ,Women ,Diseases ,Drugstores ,Time ,Physicians ,Pituitary hormones ,Thyroid diseases ,Health - Abstract
BACKGROUND: Screening in pregnancy for subclinical hypothyroidism, often defined as thyroid-stimulating hormone (TSH) greater than 2.5 mIU/L or greater than 4.0 mIU/L, is controversial. We determined the frequency and distribution of TSH testing by gestational age, as well as TSH values associated with treatment during pregnancy and the frequency of postpartum continuation of thyroid hormone therapy. METHODS: We performed a retrospective cohort study of pregnancies in Alberta, Canada. We included women without thyroid disease who delivered between October 2014 and September 2017. We used delivery records, physician billings, and pharmacy and laboratory administrative data. Our key outcomes were characteristics of TSH testing and the initiation and continuation of thyroid hormone therapy. We calculated the proportion of pregnancies with thyroid testing and the frequency of each specific thyroid test. RESULTS: Of the 188 490 pregnancies included, 111 522 (59.2%) had at least 1 TSH measurement. The most common time for testing was at gestational week 5 to 6. Thyroid hormone therapy was initiated at a median gestational age of 7 (interquartile range 5-12) weeks. Among women with first TSH measurements of 4.01 to 9.99 mIU/L who were not immediately treated, the repeat TSH measurement was 4.00 mIU/L or below in 67.9% of pregnancies. Thyroid hormone was continued post partum for 44.6% of the women who started therapy during their pregnancy. INTERPRETATION: The findings of our study suggest that current practice patterns may contribute to overdiagnosis of hypothyroidism and overtreatment during pregnancy and post partum., In the past 3 decades, undiagnosed or subclinical hypothyroidism during pregnancy has been variably associated with adverse maternal and childhood outcomes in observational studies. (1,2) However, in the absence of [...]
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- 2020
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5. Community-based pre-pregnancy care programme improves pregnancy preparation in women with pregestational diabetes
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Yamamoto, Jennifer M., Hughes, Deborah J. F., Evans, Mark L., Karunakaran, Vithian, Clark, John D. A., Morrish, Nicholas J., Rayman, Gerry A., Winocour, Peter H., Hambling, Clare, Harries, Amanda W., Sampson, Michael J., and Murphy, Helen R.
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- 2018
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6. Evidenced-Based Nutrition for Gestational Diabetes Mellitus
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Mahajan, Amita, Donovan, Lois E., Vallee, Rachelle, and Yamamoto, Jennifer M.
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- 2019
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7. Technology and Pregnancy.
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Yamamoto, Jennifer M. and Murphy, Helen R.
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HYPERGLYCEMIA , *FETAL macrosomia , *PRECONCEPTION care , *PREGNANCY , *HIGH-risk pregnancy , *MISCARRIAGE , *PREGNANCY outcomes , *MEDICAL personnel - Abstract
This year's diabetes pregnancy manuscripts, three for each of type 1 diabetes (T1D), type 2 diabetes (T2D), and gestational diabetes mellitus (GDM), were chosen from over 3500 published articles. Data were collected on pregnant women with diabetes (any type) with DKA events (cases) and pregnant women with diabetes without DKA (controls) from 194 maternity units between April 2019 and September 2020. Another concerning finding is the prevalence of diabetic ketoacidosis (DKA) during pregnancy in all types of diabetes. Seventy DKA events (85%) occurred in women with T1D (incidence 16.6/100,000; 95% CI, 13.0-20.9), 5 DKA events (6%) in women with T2D (incidence 1.1/100,000; 95% CI, 0.4-2.5), and 7 (9%) in women diagnosed with GDM. [Extracted from the article]
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- 2023
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8. Novel Biochemical Markers of Glycemia to Predict Pregnancy Outcomes in Women With Type 1 Diabetes
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Meek, Claire L, Tundidor, Diana, Feig, Denice S, Yamamoto, Jennifer M, Scott, Eleanor M, Ma, Diane D, Halperin, Jose A, Murphy, Helen R, Corcoy, Rosa, CONCEPTT Collaborative Group, Meek, Claire L [0000-0002-4176-8329], Scott, Eleanor M [0000-0001-5395-8261], Murphy, Helen R [0000-0001-6876-8727], Corcoy, Rosa [0000-0001-5055-6814], and Apollo - University of Cambridge Repository
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Blood Glucose ,Glycated Hemoglobin ,Diabetes Mellitus, Type 1 ,endocrine system diseases ,Pregnancy ,Blood Glucose Self-Monitoring ,Infant, Newborn ,Pregnancy Outcome ,Humans ,nutritional and metabolic diseases ,Female ,Biomarkers - Abstract
Objective: The optimal method of monitoring glycemia in pregnant women with type 1 diabetes remains controversial. This study aimed to assess the predictive performance of HbA1c, continuous glucose monitoring (CGM) metrics, and alternative biochemical markers of glycemia to predict obstetric and neonatal outcomes. Methods: 157 women from the CGM in pregnant women with type 1 diabetes trial (CONCEPTT) were included in this pre-specified secondary analysis. HbA1c, CGM data, and alternative biochemical markers (glycated CD59, 1,5 anhydroglucitol, fructosamine and glycated albumin) were compared at approximately 12, 24 and 34 weeks gestation using logistic regression and ROC curves to predict pregnancy complications (pre-eclampsia, preterm delivery, large-for-gestational-age, neonatal hypoglycemia, admission to neonatal intensive care unit). Results: HbA1c, CGM metrics, and alternative laboratory markers were all significantly associated with obstetric and neonatal outcomes at 24 weeks gestation. More outcomes were associated with CGM metrics during the 1st trimester and with laboratory markers (area under ROC generally 140 mg/dl; >7.8 mmol/l) were the most consistently predictive CGM metrics. HbA1c was also a consistent predictor of suboptimal pregnancy outcomes. Some alternative laboratory markers showed promise, but overall, they had lower predictive ability than HbA1c. Conclusions: HbA1c is still an important biomarker for obstetric and neonatal outcomes in type 1 diabetes pregnancy. Alternative biochemical markers of glycemia and other CGM metrics did not substantially increase the prediction of pregnancy outcomes compared to widely available HbA1c and increasingly available CGM metrics (TIR and TAR).
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- 2021
9. Technology and Pregnancy.
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Yamamoto, Jennifer M. and Murphy, Helen R.
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PRENATAL depression , *HYPERGLYCEMIA , *PREGNANCY , *GESTATIONAL diabetes , *TYPE 1 diabetes , *PREGNANCY complications , *MEDICAL sciences - Abstract
Similarly, in late pregnancy, women with type 2 diabetes were more likely to have anxiety symptoms (31 vs 11%; I P i =0.002) and depressive symptoms (23 vs 4%; I P i =0.002) compared to women without diabetes. Compared to women without diabetes, those with type 2 diabetes were more likely to have both anxiety symptoms (36 vs 6%; I P i <0.001) and depressive symptoms (14 vs 2%; I P i =0.003) in early pregnancy. Conclusions While mean sensor glucose over 24 h and overnight were similar between IS-CGM and RT-CGM, time below range overnight was higher when assessed using IS-CGM compared to masked RT-CGM in early pregnancy. The manuscripts chosen for this yearbook address key controversies in the screening and detection of gestational diabetes mellitus (GDM), glycemic metrics using intermittent and continuous glucose monitoring (CGM) in type 1 diabetes and the theory of beta-cell regeneration. [Extracted from the article]
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- 2022
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10. An exploration of differences in infant feeding practices among women with and without diabetes in pregnancy: A mixed‐methods study.
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Misita, Dragana, Yamamoto, Jennifer M., Yuan, Yan, Donovan, Lois E., Bell, Rhonda C., and Jarman, Megan
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PREMATURE infants , *ACQUISITION of data methodology , *CONFIDENCE intervals , *SOCIAL support , *RESEARCH methodology , *QUANTITATIVE research , *INTERVIEWING , *INFANT nutrition , *DIARY (Literary form) , *QUALITATIVE research , *BREASTFEEDING , *PSYCHOLOGY of women , *QUESTIONNAIRES , *MEDICAL records , *DESCRIPTIVE statistics , *GESTATIONAL diabetes , *POSTNATAL care , *BODY mass index , *DELIVERY (Obstetrics) , *THEMATIC analysis , *ODDS ratio , *PSYCHOLOGICAL resilience - Abstract
Aims: (1) To determine the likelihood of full breastfeeding at 3 months postpartum in women with and without diabetes in pregnancy (DiP); (2) to explore the associations between diabetes management practices and infant feeding practices in those who had DiP and (3) to examine women's experiences of feeding their infants after having DiP. Methods: The quantitative study used data from Alberta Pregnancy Outcomes and Nutrition (APrON) cohort study. Participants who had DiP (n = 62) were matched 1:3 to participants without DiP for pre‐pregnancy BMI, parity, mode of delivery and pre‐term birth. Infant feeding questionnaires, prospective breastfeeding diaries and medical chart data were analysed to determine likelihood of fully breastfeeding at 3 months postpartum. For the qualitative study, interviews were conducted with postpartum women who had DiP to explore the experiences of infant feeding. Interviews were thematically analysed, and the results were compared between women who were categorized as 'full breast feeders' or 'mixed feeders'. Results: The odds of fully breastfeeding were 50% lower in women with DiP than women without DiP (OR: 0.50, 95% CI 0.25–0.99, p = 0.04). Qualitative interviews identified that although all women showed resilience in the face of infant feeding challenges, those who were fully breastfeeding reported seeking out external infant feeding supports, for example, classes or Doula's. Mixed Feeders perceived there was a lack of infant feeding information and support given to them prior to giving birth. Conclusion: Women with DiP may require additional prenatal and postnatal infant feeding support to be better prepared to overcome feeding challenges they may face. [ABSTRACT FROM AUTHOR]
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- 2021
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11. Technology and Pregnancy.
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Yamamoto, Jennifer M. and Murphy, Helen R.
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PREGNANCY , *GESTATIONAL diabetes , *SMALL for gestational age , *MEDICAL research , *MEDICAL sciences - Abstract
Results Case 1 presented at 4-weeks gestation in her second pregnancy, having had a previous miscarriage at 7-weeks gestation. They encompass improvements in our understanding of continuous glucose monitoring (CGM) in pregnancy, early data on the first commercially available closed-loop system used (off-license) during pregnancy, and advancements in our understanding of screening for GDM. As CGM in pregnancy continues to gain more widespread use, identifying these patterns using FDA may not only aid in the understanding of the pathophysiology of various glycemic-related complications but also help diabetes clinicians and women with diabetes identify and target patterns to reduce adverse outcomes. The manuscripts chosen for this year's article on technology and pregnancy demonstrated advances in our understanding of type 1, type 2, and gestational diabetes (GDM) in pregnant women. [Extracted from the article]
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- 2021
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12. Thyroid Laboratory Testing and Management in Women on Thyroid Replacement Before Pregnancy and Associated Pregnancy Outcomes.
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Lemieux, Patricia, Yamamoto, Jennifer M., Nerenberg, Kara A., Metcalfe, Amy, Chin, Alex, Khurana, Rshmi, and Donovan, Lois Elizabeth
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PREGNANCY outcomes , *LABORATORY management , *PREGNANCY , *THYROID gland , *PREMATURE labor - Abstract
Background: Women with hypothyroidism before pregnancy often require an increase in their levothyroxine dosage to maintain a euthyroid state during pregnancy. The objectives of this study were to investigate: (i) the frequency and distribution of thyrotropin (TSH) testing and levothyroxine dosage adjustment by gestational age, (ii) the magnitude of levothyroxine increase by the underlying etiology of hypothyroidism, and (iii) the relationship of overtreatment or undertreatment during pregnancy with adverse pregnancy outcomes among women using thyroid replacement before pregnancy. Methods: A retrospective cohort study of pregnancies in women on thyroid replacement before pregnancy in Alberta, Canada, was performed. Women using thyroid replacement anytime during the two years before pregnancy who delivered between October 2014 and September 2017 were included. Delivery records, physician billing, and laboratory and pharmacy administrative data were linked. Outcomes included characteristics of TSH testing, levothyroxine dosing, and pregnancy outcomes. The frequency and gestational timing of TSH testing and levothyroxine adjustments were calculated. Multiple logistic regression was used to test whether pregnancies with TSH <0.10 mIU/L (overtreatment) or TSH ≥10.00 mIU/L (undertreatment) compared with control pregnancies (TSH 0.10–4.00 mIU/L) were associated with adverse pregnancy and neonatal outcomes. Results: Of the 10,680 deliveries, 8774 (82.2%) underwent TSH testing at least once during pregnancy, at a median gestational age of six weeks. An adjustment of levothyroxine dosage was made for 4321 (43.7%) during pregnancy. TSH in pregnancy below 0.10 mIU/L increased the odds of preterm delivery when compared with control pregnancies (adjusted odds ratio, 2.14 [95% confidence interval 1.51–2.78]). TSH ≥10.00 mIU/L during pregnancy was not associated with any adverse pregnancy or neonatal outcomes in the multivariable analysis. Conclusions: Although most women on thyroid replacement before conception had TSH measured at some point during pregnancy, it is concerning that 17.8% did not. Levothyroxine overtreatment in pregnancy was associated with preterm delivery. These findings suggest that clinicians should be careful to avoid overtreatment with levothyroxine in pregnancy. [ABSTRACT FROM AUTHOR]
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- 2021
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13. Benefits of Real-Time Continuous Glucose Monitoring in Pregnancy.
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Yamamoto, Jennifer M. and Murphy, Helen R.
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BLOOD sugar monitoring , *TYPE 1 diabetes , *BLOOD sugar , *PREGNANCY outcomes , *LONGITUDINAL method - Abstract
In recent years, continuous glucose monitoring (CGM) has become increasingly available with the introduction of devices that are specifically approved for use during pregnancy. Evidence in the form of randomized-controlled trials and cohort studies continues to build support for the use of CGM during pregnancy to improve measures of maternal glycemia as well as obstetric and neonatal outcomes. Based on data from the CGM in pregnant women with type 1 diabetes (CONCEPTT) trial alongside a Swedish cohort study of real-world outcomes of pregnant women with type 1 diabetes, the UK National Institute for Health and Clinical Excellence (NICE) guidelines now recommend that real-time CGM be offered to all pregnant women with type 1 diabetes. Based on these guidelines, all pregnant individuals in the United Kingdom with type 1 diabetes will receive government-funded real-time CGM for a 12-month duration. These guidelines are a game-changer and will continue to facilitate more widespread access to CGM use in the United Kingdom and beyond. This review describes the role of CGM in the management of diabetes in pregnancy, discusses contemporary maternal glucose levels and their relationship with outcomes in diabetes pregnancies, and examines the high-quality, randomized-controlled trial and the real-world clinical data evaluating the impact of CGM use. [ABSTRACT FROM AUTHOR]
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- 2021
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14. Technology and Pregnancy.
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Yamamoto, Jennifer M. and Murphy, Helen R.
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INSULIN pumps , *BLOOD sugar monitors , *PRECONCEPTION care , *GESTATIONAL diabetes , *GLYCEMIC control , *PREGNANCY , *TECHNOLOGY , *MEDICAL sciences - Abstract
The manuscripts chosen for this year's technology and pregnancy article provide new insights into fetal exposure to maternal glucose during pregnancies complicated by gestational diabetes, and type 1 diabetes. Data relating continuous glucose monitoring (CGM) in type 1 diabetes pregnancy to neonatal outcomes are scarce. Healthcare providers and women with diabetes can focus on increasing CGM time in range during the latter half of pregnancy to reduce the risk of neonatal hypoglycemia. Women with gestational diabetes were more likely to develop type 2 diabetes or prediabetes than women without gestational diabetes (adjusted OR 3.44 [95% CI 2.84, 4.14]). [Extracted from the article]
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- 2020
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15. Neurocognitive and behavioural outcomes in offspring exposed to maternal pre-existing diabetes: a systematic review and meta-analysis.
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Yamamoto, Jennifer M., Benham, Jamie L., Dewey, Deborah, Sanchez, J. Johanna, Murphy, Helen R., Feig, Denice S., and Donovan, Lois E.
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Aims/hypothesis: We performed a systematic review and meta-analysis to determine whether exposure to maternal pre-existing diabetes in pregnancy is associated with neurocognitive or behavioural outcomes in offspring. Methods: We searched MEDLINE, EMBASE, PsychINFO, the Cochrane Database of Systematic Reviews and Scopus for studies that examined any neurocognitive or behavioural outcomes in offspring of mothers with pre-existing diabetes in pregnancy in accordance with a published protocol (PROSPERO CRD42018109038). Title and abstract review, full-text review and data extraction were performed independently and in duplicate. Risk of bias was assessed using the Newcastle–Ottawa scale. Meta-analyses of summary measures were performed using random-effects models. Results: Nineteen articles including at least 18,681 exposed and 2,856,688 control participants were identified for inclusion. Exposure to maternal pre-existing diabetes in pregnancy was associated with a lower pooled intelligence quotient in the offspring (pooled weighted mean difference −3.07 [95% CI −4.59, −1.55]; I
2 = 0%) and an increased risk of autism spectrum disorders (effect estimate 1.98 [95% CI 1.46, 2.68]; I2 = 0%). There was also an increased risk of attention deficit/hyperactivity disorder (pooled HR 1.36 [95% CI 1.19, 1.55]; I2 = 0%), though this was based on only two studies. Although most studies were found to be high quality in terms of participant selection, in many studies, comparability of cohorts and adequacy of follow-up were sources of bias. Conclusions/interpretation: There is evidence to suggest that in utero exposure to maternal pre-existing diabetes is associated with some adverse neurocognitive and behavioural outcomes. It remains unclear what the role of perinatal factors is and the degree to which other environmental factors contribute to these findings. [ABSTRACT FROM AUTHOR]- Published
- 2019
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16. A Practical Approach for the Verification and Determination of Site- and Trimester-Specific Reference Intervals for Thyroid Function Tests in Pregnancy.
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Donovan, Lois E., Metcalfe, Amy, Chin, Alex, Yamamoto, Jennifer M., Virtanen, Heidi, Johnson, Jo-Ann, and Krause, Richard
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THYROID gland function tests - Abstract
Background: Population-, assay-, and trimester-specific reference intervals for thyroid function tests are necessary to assess thyroid status accurately and manage thyroid disease throughout pregnancy. This study's objective was to verify if the manufacturer's recommended trimester-specific reference intervals for thyroid tests and the American Thyroid Association's recommended total thyroxine (TT4) pregnancy reference intervals were verifiable and appropriate for use in the authors' multicultural population. Methods: Blood samples were obtained from the following sources: stored frozen surplus blood from women undergoing routine aneuploidy screening (first- and second-trimester samples, n = 274), women participating in an observational cohort study (second- and third-trimester samples, n = 135), and blood collected from women presenting for assessment to the labor and delivery ward (third-trimester samples, n = 35). Exclusions included thyroid medication or disease and positive thyroid peroxidase antibodies (anti-TPO). Samples were analyzed for thyrotropin (TSH), free T4 (fT4), free triiodothyronine (fT3), TT4, and anti-TPO using the Roche Cobas 8000 Modular e602 electrochemiluminescence immunoassay. Results: Nine percent of the aneuploidy screening samples were excluded prior to thyroid testing due to maternal use of thyroid medication. Six percent of analyzed samples were excluded: 5.9% with positive anti-TPO and one with a TSH >10 mIU/L. The manufacturer's recommended trimester-specific reference intervals for TSH were not verified by described standardized methods. Therefore, 95th percentile reference intervals were determined using a minimum number of samples. Reference intervals for TSH and fT4 were as follows: 9–12 weeks, 0.18–2.99 mIU/L and 11–19.2 pmol/L; second trimester, 0.11–3.98 mIU/L and 10.5–18.2 pmol/L; and third trimester, 0.48–4.71 mIU/L and 9.0–16.1 pmol/L, respectively. The TT4 reference interval after 19 weeks' gestation was 77–186 nmol/L. Conclusions: This study provides a simple approach to verify or establish trimester-specific thyroid function reference intervals in local populations. The TT4 reference interval was lower than the interval proposed by the American Thyroid Association, suggesting the need for further study of TT4 in pregnancy and reliance on locally established fT4 reference intervals after 19 weeks, especially when there are no equivalent reference intervals for TT4. [ABSTRACT FROM AUTHOR]
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- 2019
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17. Adaptability of Closed Loop During Labor, Delivery, and Postpartum: A Secondary Analysis of Data from Two Randomized Crossover Trials in Type 1 Diabetes Pregnancy.
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Stewart, Zoe A., Yamamoto, Jennifer M., Wilinska, Malgorzata E., Hartnell, Sarah, Farrington, Conor, Hovorka, Roman, and Murphy, Helen R.
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PREGNANCY in diabetic women , *BLOOD sugar monitoring , *TYPE 1 diabetes - Abstract
Tight glucose control during labor and delivery is recommended for pregnant women with type 1 diabetes. This can be challenging to achieve using the current treatment modalities. The automated nature of closed loop and its ability to adapt to real-time glucose levels make it well suited for use during labor, delivery, and the immediate postpartum period. We report observational data of participants from two randomized crossover trials who chose to continue using closed loop during labor, delivery, and postpartum. Labor was defined as the 24 h before delivery and postpartum as the 48 h after delivery. The glucose target range during pregnancy was 3.5-7.8 mmol/L (63-140 mg/dL) and 3.9-10 mmol/L (70-180 mg/dL) after delivery. Twenty-seven (84.4%) of the potential 32 trial participants used closed loop through labor, delivery, and postpartum. Use of closed loop was associated with 82.0% (interquartile range [IQR] 49.3, 93.0) time-in-target range during labor and delivery and a mean glucose of 6.9 ± 1.4 mmol/L (124 ± 25 mg/dL). Closed loop performed well throughout vaginal, elective, and emergency cesarean section deliveries. Postpartum, women spent 83.3% (IQR 75.2, 94.6) time-in-target range (3.9-10.0 mmol/L [70-180 mg/dL]), with a mean glucose of 7.2 ± 1.4 mmol/L (130 ± 25 mg/dL). There was no difference in maternal glucose concentration between mothers of infants with and without neonatal hypoglycemia (6.9 ± 1.6 mmol/L and 6.8 ± 1.1 mmol/L [124 ± 29 mg/dL and 122 ± 20 mg/dL] respectively; P = 0.84). Automated closed-loop insulin delivery is feasible during hospital admissions for labor, delivery, and postpartum. Larger scale studies are needed to evaluate its efficacy compared with current clinical approaches as well as understand how women and healthcare providers will adopt this technology. [ABSTRACT FROM AUTHOR]
- Published
- 2018
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18. Large-for-gestational-age (LGA) neonate predicts a 2.5-fold increased odds of neonatal hypoglycaemia in women with type 1 diabetes.
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Yamamoto, Jennifer M., Kallas‐Koeman, Melissa M., Butalia, Sonia, Lodha, Abhay K., and Donovan, Lois E.
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BODY size ,GESTATIONAL diabetes ,GESTATIONAL age ,HYPOGLYCEMIA ,TYPE 1 diabetes ,LONGITUDINAL method ,EVALUATION of medical care ,PREGNANCY ,SECOND trimester of pregnancy ,RETROSPECTIVE studies ,FETAL macrosomia ,DISEASE complications - Abstract
Objective: The objective of the study is to assess the impact of maternal glycaemic control and large-for-gestational-age (LGA) infant size on the risk of developing neonatal hypoglycaemia in offspring of women with type 1 diabetes and to determine possible predictors of neonatal hypoglycaemia and LGA.Research Methods and Design: This retrospective cohort study evaluated pregnancies in 161 women with type 1 diabetes mellitus at a large urban centre between 2006 and 2010. Mean trimester A1c values were categorized into five groups. Multiple logistic regression analyses were used to examine predictors of neonatal hypoglycaemia and large-for-gestational-age (LGA).Results: Hypoglycaemia occurred in 36.6% of neonates. There was not a linear association between trimester specific A1c and LGA. After adjusting for maternal age, body mass index (BMI), smoking and premature delivery, neonatal hypoglycaemia was not linearly associated with A1c in the first, second or third trimesters. LGA was the only significant predictor for neonatal hypoglycaemia (OR, 95% CI 2.51 [1.10, 5.70]) in logistic regression analysis that adjusted for glycaemic control, maternal age, smoking, prematurity and BMI. An elevated third trimester A1c increased the odds of LGA (1.81 [1.03, 3.18]) after adjustment for smoking, parity and maternal BMI.Conclusions: Large-for-gestational-age imparts a 2.5-fold increased odds of hypoglycaemia in neonates of women with type 1 diabetes and may be a better predictor of neonatal hypoglycaemia than maternal glycaemic control. Our data suggest that LGA neonates of women with type 1 diabetes should prompt increased surveillance for neonatal hypoglycaemia and that the presence of optimum maternal glycaemic control should not reduce this surveillance. Copyright © 2016 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]- Published
- 2017
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19. Community-based pre-pregnancy care programme improves pregnancy preparation in women with pregestational diabetes
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Yamamoto, Jennifer M, Hughes, Deborah JF, Evans, Mark L, Karunakaran, Vithian, Clark, John DA, Morrish, Nicholas J, Rayman, Gerry A, Winocour, Peter H, Hambling, Clare, Harries, Amanda W, Sampson, Michael J, and Murphy, Helen R
- Subjects
Glucose ,Folic acid ,Pregnancy ,Pre-pregnancy care ,Diabetes ,Glycaemic control ,Community-based ,Antenatal ,Primary care ,3. Good health - Abstract
AIMS/HYPOTHESIS: Women with diabetes remain at increased risk of adverse pregnancy outcomes associated with poor pregnancy preparation. However, women with type 2 diabetes are less aware of and less likely to access pre-pregnancy care (PPC) compared with women with type 1 diabetes. We developed and evaluated a community-based PPC programme with the aim of improving pregnancy preparation in all women with pregestational diabetes. METHODS: This was a prospective cohort study comparing pregnancy preparation measures before and during/after the PPC intervention in women with pre-existing diabetes from 1 June 2013 to 28 February 2017. The setting was 422 primary care practices and ten National Health Service specialist antenatal diabetes clinics. A multifaceted approach was taken to engage women with diabetes and community healthcare teams. This included identifying and sending PPC information leaflets to all eligible women, electronic preconception care templates, online education modules and resources, and regional meetings and educational events. Key outcomes were preconception folic acid supplementation, maternal HbA1c level, use of potentially harmful medications at conception and gestational age at first presentation, before and during/after the PPC programme. RESULTS: A total of 306 (73%) primary care practices actively participated in the PPC programme. Primary care databases were used to identify 5075 women with diabetes aged 18-45 years. PPC leaflets were provided to 4558 (89.8%) eligible women. There were 842 consecutive pregnancies in women with diabetes: 502 before and 340 during/after the PPC intervention. During/after the PPC intervention, pregnant women with type 2 diabetes were more likely to achieve target HbA1c levels ≤48 mmol/mol (6.5%) (44.4% of women before vs 58.5% of women during/after PPC intervention; p = 0.016) and to take 5 mg folic acid daily (23.5% and 41.8%; p = 0.001). There was an almost threefold improvement in 'optimal' pregnancy preparation in women with type 2 diabetes (5.8% and 15.1%; p = 0.021). Women with type 1 diabetes presented for earlier antenatal care during/after PPC (54.0% vs 67.3% before 8 weeks' gestation; p = 0.003) with no other changes. CONCLUSIONS/INTERPRETATION: A pragmatic community-based PPC programme was associated with clinically relevant improvements in pregnancy preparation in women with type 2 diabetes. To our knowledge, this is the first community-based PPC intervention to improve pregnancy preparation for women with type 2 diabetes. DATA AVAILABILITY: Further details of the data collection methodology, individual clinic data and the full audit reports for healthcare professionals and service users are available from https://digital.nhs.uk/data-and-information/clinical-audits-and-registries/our-clinical-audits-and-registries/national-pregnancy-in-diabetes-audit .
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