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Copyright of Actualités Pharmaceutiques is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Actualités Pharmaceutiques is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The occurrence of pregnancy in a woman with type 1 diabetes has many potential risks for both mother and child. It is established that an optimized management is necessary, beginning before conception and throughout the pregnancy, with the objective of reducing maternal-fetal complications. However, despite the considerable progress that have been made in diabetology, complications remain frequent. The purpose of this article is to take stock of recent studies with a particular focus on the new technologies currently proposed with the hope for the first time to reach normoglycemia more easily As for the type 2 diabetic population, whose prevalence increases considerably, studies show that this population presents, during pregnancy, risks that are at least equivalent to those found in type 1 diabetic patients requiring intensive management. Finally, although we thought there was an international consensus for the diagnosis of gestational diabetes, the latest data show that the subject remains debated. On the other hand, it is perfectly demonstrated that gestational diabetes is associated with risks for the mother well beyond the risk of subsequent diabetes but also risks for the child that will be at the origin of chronic diseases hence the concept of "metabolic disease programming". [ABSTRACT FROM AUTHOR]

Gestational diabetes is a common condition during pregnancy; this condition is associated with significant fetal and neonatal morbidity, as well as considerable cost. The management of gestational diabetes was traditionally based on the rules of hygiene and dietetics and insulin therapy. Oral antidiabetic drugs have been gradually introduced into the proposed therapeutic panel and remain a subject of debate among practitioners. Our work aims to comfort the data of the literature on the use of glibenclamide in the treatment of gestational diabetes. Materials and methods: We carried out a prospective cohort involving two groups of patients with gestational diabetes requiring hypoglycemic treatment, the first group receiving glybenclamide (41 patients) and insulin for the second group (40 patients). Results: Our study showed that these two therapies gave comparable results in terms of glycemic balance and neonatal outcomes without increasing the risk of fetal or perinatal complications. Conclusion: Glibenclamide could replace insulin in the treatment of gestational diabetes while recalling that its use during pregnancy remains off-label (marketing authorization). [ABSTRACT FROM AUTHOR]

Introduction: This systematic review examines the effectiveness of metformin treatment compared to insulin treatment for gestational diabetes within the context of a low-resource environment. Methods: Electronic data searches of Medline, EMBASE, Scopus and Google scholar databases from 1 January, 2005 to 30 June, 2021 were performed using medical subject headings: 'gestational diabetes or pregnancy diabetes mellitus' AND 'Pregnancy or pregnancy outcomes' AND 'Insulin' AND 'Metformin Hydrochloride Drug Combination/or Metformin/or Hypoglycemic Agents' AND 'Glycemic control or blood glucose'. Randomized controlled trials were included if: participants were pregnant women with gestational diabetes mellitus (GDM); the interventions were metformin and/ or insulin. Studies among women with pre-gestational diabetes, non-randomised control trials or studies with a limited description of the methodology were excluded. Outcomes included adverse maternal outcomes: weight gain, C-section, pre-eclampsia and glycaemic control and adverse neonatal outcomes: birth weight, macrosomia, pre-term birth and neonatal hypoglycaemia. The revised Cochrane Risk of Bias Assessment for randomised trials was used for the evaluation of bias. Results: We screened 164 abstracts and 36 full-text articles. Fourteen studies met the inclusion criteria. The studies provide moderate to high-quality evidence demonstrating the effectiveness of metformin as an alternative therapy to insulin. Risk of bias was low; multiple countries and robust sample sizes improved external validity. All studies were from urban centres with no rural data. Conclusion: These recent high quality studies comparing metformin to insulin for the treatment of GDM generally found either improved or equivalent pregnancy outcome and good glycaemic control for most patients, although many required insulin supplementation. Its ease of use, safety and efficacy suggest metformin may simplify the management of gestational diabetes, particularly in rural and other low-resource environments. [ABSTRACT FROM AUTHOR]

Objectives: Gestational diabetes mellitus (GDM), a temporary condition of pregnancy, identifies women at high risk of developing subsequent type 2 diabetes mellitus (T2D). Lifestyle interventions have been shown to reduce the risk of developing T2D after GDM. However, they often have low attendance and adherence rates. The Avoiding Diabetes After Pregnancy Trial in Moms (ADAPT-M) is a 24-week home-based postpartum program aimed at bridging the gap from prenatal care to T2D prevention for women with GDM. Our objective was to explore the experiences of participants who completed the ADAPT-M program, to elicit their perceived benefits and opportunities for improvement., Methods: This was a qualitative descriptive study wherein we conducted semistructured interviews with 21 women with previous GDM who participated in the ADAPT-M program in Ontario, Canada. Transcripts were analyzed using NVivo software using a conventional content analysis approach., Results: Two themes describing the experience of women who underwent the ADAPT-M lifestyle-based coaching program emerged: 1) the benefits of a supportive relationship between coaches and participants; and 2) a desire for more from the program, including peer support, more customization, and addressing emotional needs., Conclusions: Our findings support the importance of fostering supportive health-care relationships in T2D prevention programs for postpartum women with a history of GDM. Enhanced customization, emotional support, and opportunities for peer support should be considered in the development of future programming to better meet the needs of participants., (Copyright © 2024 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.)

Gestational diabetes is a common condition during pregnancy; this condition is associated with significant fetal and neonatal morbidity, as well as considerable cost. The management of gestational diabetes was traditionally based on the rules of hygiene and dietetics and insulin therapy. Oral antidiabetic drugs have been gradually introduced into the proposed therapeutic panel and remain a subject of debate among practitioners. Our work aims to comfort the data of the literature on the use of glibenclamide in the treatment of gestational diabetes. Materials and methods: We carried out a prospective cohort involving two groups of patients with gestational diabetes requiring hypoglycemic treatment, the first group receiving glybenclamide (41 patients) and insulin for the second group (40 patients). Results: Our study showed that these two therapies gave comparable results in terms of glycemic balance and neonatal outcomes without increasing the risk of fetal or perinatal complications. Conclusion: Glibenclamide could replace insulin in the treatment of gestational diabetes while recalling that its use during pregnancy remains off-label (marketing authorization). [ABSTRACT FROM AUTHOR]

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: The study was initiated to determine the prevalence and the complications of gestational diabetes in women attending Parakou maternities clinics in 2015. Methods: This study was longitudinal, descriptive and analytical. The study population consists of women with gestational diabetes in Parakou maternities wards. The gestational diabetes was screened by the oral glucose tolerance test. The outcome of pregnancy was appreciated by the search for complications during pregnancy. Glycemic control was achieved in women 6 weeks after delivery. The data were analyzed using EPI-INFO 3.1 Fr. Results: Of the 151 pregnant women who did the screening, 19 had a gestational diabetes; a prevalence of 12.6%. Pregnant women with gestational diabetes were at increased fetal macrosomia, hydramnios, macrosomia at birth, high birth weight of newborns compared to women without gestational diabetes (p<0,01). The maternal complications did not observed. The postprandial delivery blood glucose of women with gestational diabetes was normal. Conclusion: The gestational diabetes is associated with complications of pregnancy. Routine screening of women at risk for adequate management is necessary. [ABSTRACT FROM AUTHOR]

Objectives: Diabetes is associated with an increased risk of several cancers, including postmenopausal breast cancer. The evidence for higher breast cancer risk after diabetes in pregnancy is conflicting. We compared the incidence of breast and other cancers between pregnant women with and without diabetes., Methods: This work was a propensity-matched, retrospective cohort study using population-based health-care databases from Ontario, Canada. Those deliveries with gestational diabetes mellitus (GDM) and pregestational diabetes mellitus (pregestational DM) were identified and matched to deliveries without diabetes mellitus (non-DM). Deliveries from each diabetes cohort were matched 1:2 on age, parity, year of delivery, and propensity score to non-DM deliveries. Matched subjects were followed from delivery for incidence of breast cancer as a primary outcome, and other site-specific cancers as secondary outcomes. We performed Cox proportional hazards regression to compare rates of breast cancer between matched groups., Results: Over a median of 8 (interquartile range 4 to 13) years of follow-up, compared with non-DM deliveries, the incidence of breast cancer was significantly lower for GDM but similar for pregestational DM deliveries (hazard ratio [HR] 0.90, 95% confidence interval [CI] 0.82 to 0.98; and HR 0.92, 95% CI 0.80 to 1.07, respectively). GDM was associated with a significantly higher incidence of pancreatic and hepatocellular cancer, and pregestational DM was associated with a higher incidence of thyroid, hepatocellular, and endometrial cancers., Conclusions: Diabetes in pregnancy does not have a higher short-term risk of subsequent breast cancer, but there may be a higher incidence of other cancers., (Copyright © 2024 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.)

Background: Many of the adverse outcomes of gestational diabetes mellitus (GDM) are linked to excessive fetal growth, which is strongly mediated by the adequacy of maternal glycemic management. The COVID-19 pandemic led to a rapid adoption of virtual care models. We aimed to compare glycemic management, fetal growth, and perinatal outcomes before and during the COVID-19 pandemic., Methods: A retrospective cohort study was conducted between 2017 and 2020. Singleton pregnancies complicated by GDM were included in the study. The cohort was stratified into "before" and "during" COVID-19 subgroups, using March 11, 2020, as the demarcation time point. Women who began their GDM follow-up starting March 11, 2020, and thereafter were allocated to the COVID-19 era, whereas women who delivered before the demarcation point served as the pre-COVID-19 era. The primary outcome was the rate of large-for-gestational-age (LGA) neonates. Secondary outcomes included select maternal and neonatal adverse outcomes., Results: Seven hundred seventy-five women were included in the analysis, of which 187 (24.13%) were followed during the COVID-19 era and 588 (75.87%) before the COVID-19 era. One hundred seventy-one of the 187 women (91.44%) followed during COVID-19 had at least 1 virtual follow-up visit. No virtual follow-up visits occurred before the COVID-19 era. There was no difference in the rate of LGA neonates between groups on both univariate (5.90% vs 7.30%, p=0.5) and multivariate analyses, controlling for age, ethnicity, parity, body mass index, gestational weight gain, chronic hypertension, smoking, and hypertensive disorders in pregnancy (adjusted odds ratio [aOR] 1.11, 95% confidence interval [CI] 0.49 to 2.51, p=0.80). In the multivariate analysis, there was no difference in composite neonatal outcome between groups (GDM diet: aOR 1.40, 95% CI 0.81 to 2.43, p=0.23; GDM medical treatment: aOR 1.20, 95% CI 0.63 to 2.43, p=0.5)., Conclusions: After adjusting for differences in baseline variables, the combined virtual mode of care was not associated with a higher rate of LGA neonates or other adverse perinatal outcomes in women with GDM. Larger studies are needed to better understand the specific impact of virtual care on less common outcomes in pregnancies with GDM., (Copyright © 2023 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.)

INTRODUCTION: L´hépatite C est une infection dont la transmission mère-enfant est possible. L´objectif de ce travail était d´étudier la prévalence du portage des anticorps anti-VHC chez des femmes enceintes à Cotonou et d´identifier les facteurs qui y sont associés. METHODES: il s´est agi d´une étude transversale menée du 01/06/2018 au 01/09/2018 auprès de 253 gestantes reçues pour des soins prénatals dans quatre grandes maternités de Cotonou (Bénin). Les anticorps anti-VHC avaient été détectés par des tests rapides d´orientation diagnostique. Un échantillon de sang veineux avait été prélevé chez les gestantes avec anti-VHC positifs en vue de tests sérologiques de confirmation et d´un dépistage du diabète gestationnel. RESULTATS: la prévalence des anticorps anti-VHC était de 1,2% (3/253 gestantes). Les facteurs associés au portage du VHC n´avaient pu être identifiés compte tenu du faible nombre de cas positifs. Cependant, les gestantes porteuses des anticorps anti-VHC avaient une moyenne d´âge élevée (32 ± 3) comparativement au reste de la population (29,58 ± 5,5). Les facteurs de risque potentiels d´infection par le VHC retrouvés étaient les scarifications, le piercing, le tatouage, le partage du matériel de manucure, un antécédent d´intervention chirurgicale et de transfusion sanguine. La prévalence du diabète gestationnel dans notre étude était de 7,9% (20/253). Aucune association n´était trouvée entre le diabète gestationnel et l´hépatite C. CONCLUSION: la prévalence des anticorps anti-VHC chez les gestantes à Cotonou était faible. Une étude d´envergure nationale s´avère nécessaire afin d´identifier les facteurs associés à cette infection.

Introduction: hepatitis C is an infection which can be passed from mother to child. The purpose of this study was to investigate the prevalence of colonization by anti-HCV antibodies in pregnant women living in Cotonou and to identify factors associated with it. Methods: we conducted a cross-sectional study of 253 pregnant women admitted for prenatal care in four major maternity hospitals in Cotonou (Benin) from 01/06/2018 to 01/09/2018. Anti-HCV antibodies were detected using rapid diagnostic tests. A venous blood sample was collected from pregnant women tested positive for anti-HCV before confirmatory serological tests and screening tests for gestational diabetes. Results: the prevalence of anti-HCV antibodies was 1.2% (3/253 pregnant women). Factors associated with HCV carriage couldn't be identified given the low number of positive cases. However, pregnant women who were carriers of hepatitis C antibodies had higher mean age (32 ± 3) compared to the remainder of the population (29.58 ± 5.5). Potential risk factors for HCV infection were scarifications, piercing, tattooing, sharing of manicure equipment, a history of surgery and blood transfusions. The prevalence of gestational diabetes in our study population was 7.9% (20/253). No association was found between gestational diabetes and hepatitis C. Conclusion: the prevalence of anti-HCV antibodies in pregnant women living in Cotonou was low. A national-level study is needed to identify factors associated with this infection. [ABSTRACT FROM AUTHOR]

Introduction: We estimate the screening and prevalence of gestational diabetes mellitus (GDM) in a primarily first nations obstetrical population in Northwestern Ontario. Methods: The study is an 8 year retrospective analysis of all gestational glucose challenge and tolerance tests performed at the Sioux Lookout Meno Ya Win Health Centre (SLMHC) laboratory from 1 January, 2010 to 31 December, 2017. Test, gestational timing and completion rate of screening were recorded, and GDM prevalence was calculated on the tested population. Screening completion rates were recorded for the subset of women who delivered at SLMHC from 2014 to 2017. Results: The average annual GDM prevalence was 12%, double the Ontario rate. Over the 8 year period, 513 patients were diagnosed with GDM among the 4298 patients screened. Patients were screened with the 2 step (90%) or the 1 step (10%) protocol. Screening occurred <20 weeks in 3%; 54% occurred in <28 weeks and 40% >28 weeks. Seventy percent of the tests were from remote nursing stations. The screening completion rate for women delivering at SLMHC in 2017 was 80.8%. Conclusion: The prevalence of GDM in Northwestern Ontario is twice the provincial rate. Most screening used the 2 step protocol; early screening was underused. Improvements in screening programming are underway and future research may match surveillance rates and results to GDM outcomes. [ABSTRACT FROM AUTHOR]

INTRODUCTION : les objectifs de cette étude étaient de décrire les aspects diagnostiques, pronostiques et thérapeutiques du diabète gestationnel au CHU Sylvanus Olympio de Lomé.Méthodes: il s'est agi d'une étude descriptive transversale réalisée sur 5 ans allant du 1er janvier 2013 au 31 décembre 2017. Elle a concerné 125 gestantes ayant accouché, suivies en médecine interne et dans le Service de Gynéco-obstétrique.Résultats: la moyenne d'âge maternelle était de 30,84±4,17 ans. Les facteurs de risque les plus rencontrés étaient le surpoids et l'obésité (57,7%), antécédent de diabète familial (33,3%), antécédent de fausse couche spontanée (26,6%), antécédent de MFIU (15,5%) et de l'antécédent du diabète gestationnel (8,8%). Le dépistage du diabète gestationnel a été réalisé par la glycémie à jeun et HGPO à 75g. Le diagnostic a été posé au premier trimestre dans 55,6% des cas, au deuxième trimestre dans 33,3% et 11,1% au troisième trimestre. Le recours à l'insulinothérapie a été nécessaire dans 24,4% des cas et 66,6% sous régime seul. Soixante-six virgule sept pour cent (66,7%) des femmes ont accouché par césarienne et 33,3% par voie basse. Parmi les complications maternelles à l'accouchement, nous avons retrouvé 22,2% de HTA, 17,7% de pré-éclampsie et 2,2% de RPM. Parmi les complications du nouveau-né, il y avait 48,9% de macrosomie, 11,1% de prématurité, 11,1% d'hypoglycémie, 4,4% de malformation et 4,4% mort-né. Quatre-vingt-huit virgule neuf pour cent (88,9%) des nouveaux nés avaient un score d'APGAR supérieur à 7 et plus de 48% étaient des macrosomes.Conclusion: le diabète gestationnel entraîne des complications materno-fœtales. La nécessité d'un dépistage systématique est obligatoire même en l'absence de facteur de risque afin de programmer une prise en charge optimale.

Objective: Our aim in this study was to evaluate the accuracy of alternative algorithms for identifying pre-existing type 1 or 2 diabetes (T1DM or T2DM) and gestational diabetes mellitus (GDM) in pregnant women., Methods: Data from a clinical registry of pregnant women presenting to an Edmonton diabetes clinic between 2002 and 2009 were linked and administrative health records. Three algorithms for identifying women with T1DM, T2DM, and GDM based on International Classification of Diseases---tenth revision (ICD-10) codes were assessed: delivery hospitalization records (Algorithm #1), outpatient clinics during pregnancy (Algorithm #2), and delivery hospitalization plus outpatient clinics during pregnancy (Algorithm #3). In a subset of women with clinic visits between 2005 and 2009, we examined the performance of an additional Algorithm #4 based on Algorithm #3 plus outpatient clinics in the 2 years before pregnancy. Using the diabetes clinical registry as the "gold standard," we calculated true positive rates and agreement levels for the algorithms., Results: The clinical registry included data on 928 pregnancies, of which 90 were T1DM, 89 were T2DM, and 749 were GDM. Algorithm #3 had the highest true positive rate for the detection of T1DM, T2DM, and GDM of 94%, 72%, and 99.9%, respectively, resulting in an overall agreement of 97% in diagnosis between the administrative databases and the clinical registry. Algorithm #4 did not provide much improvement over Algorithm #3 in overall agreement., Conclusions: An algorithm based on ICD-10 codes in the delivery hospitalization and outpatient clinic records during pregnancy can be used to accurately identify women with T1DM, T2DM, and GDM., (Copyright © 2023 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.)

Objective: Our aim in this study was to implement a newly validated algorithm to identify pregnant women with type 1 diabetes mellitus (T1DM), type 2 diabetes mellitus (T2DM), and gestational diabetes mellitus (GDM), and to identify temporal trends in rates over the last decade. We also compared obstetric and neonatal outcomes of pregnancies with and without diabetes mellitus (DM)., Methods: Among women with live births between 2005 and 2018 in Alberta, we calculated yearly rates of T1DM, T2DM, and GDM, overall, and stratified by ethnicity, urban or rural residence, material deprivation score, and maternal age., Results: Between 2005 and 2018, GDM rates increased from 42.3 to 101.8 per 1,000 deliveries (p<0.0001), T2DM rates increased from 2.6 to 6.4 per 1,000 deliveries (p<0.0001), whereas T1DM remained constant at 3.0 per 1,000 deliveries each year (p=0.4301). Higher GDM and T2DM rates were observed among Chinese and South Asian women, respectively, and among women who were materially deprived and living in urban areas. Women with T2DM were older and had the highest rates of pre-existing hypertension (16%). In contrast, women with T1DM were younger and had the highest rates of gestational hypertension (12%), pre-eclampsia (12%), and cesarean section deliveries (62%). Children of women with T1DM had the highest rates of large for gestational age (46%), neonatal hypoglycemia (41.1%), respiratory distress syndrome (7.7%), and jaundice (29.3%)., Conclusions: Diabetes-in-pregnancy rates have more than doubled over the last decade, driven primarily by increases in GDM and T2DM. These trends may have significant implications for the future health of mothers and children in Alberta., (Copyright © 2023 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.)

Introduction: the purpose of this study was to describe the diagnostic, prognostic and therapeutic features of gestational diabetes at the Sylvanus Olympio University Hospital Center. Methods: we conducted a retrospective descriptive study over a period of 5 years from 1st January 2013 to 31st December 2017. It involved 125 pregnant women who had given birth in the Department of Internal Medicine and in the Gyneco-Obstetric Department. Results: the average age of patients was 30.84±4.17 years. The most common risk factors were overweight and obesity (57.7%), a family history of diabetes (33.3%), a history of spontaneous miscarriage (26.6%), a history of fetal death in utero (15.5%) and a history of gestational diabetes (8.8%). Gestational diabetes screening was performed using fasting blood glucose test and 75g oral glucose-tolerance test. Diagnosis was made in the first quarter in 55.6% of cases, in the second quarter in 33.3% and in the third quarter in 11.1%. Insulin therapy was necessary in 24.4% of cases and a healthy meal-plan alone in 66.6%. Sixty-six point seven percent (66.7%) of women had given birth by cesarean section and 33.3% vaginally. Maternal complications at birth included: arterial hypertension (22.2%), preeclampsia (17.7%) and premature ruptured membranes (2.2%). Newborn complications included macrosomia (48.9%), prematurity (11.1%), hypoglycaemia (11.1%), malformations (4.4%) and stillborn child (4.4%). Eighty-eight point nine percent (88.9%) of newborns had Apgar score greater than 7 and more than 48% were macrosomes. Conclusion: gestational diabetes leads to maternofetal complications. Systematic screening is essential even in the absence of risk factors for optimal patient management. [ABSTRACT FROM AUTHOR]

To the best our knowledge, data on the effects of magnesium-zinc-calcium-vitamin D co-supplementation on glycemic control and markers of cardiometabolic risk in gestational diabetes mellitus (GDM) are scarce. The purpose of this study was to establish the effects of magnesium-zinc-calcium-vitamin D co-supplementation on glycemic control and markers of cardiometabolic risk of GDM patients. Sixty patients with GDM, aged 18-40 years, were randomized into 2 groups to intake either magnesium-zinc-calcium-vitamin D co-supplements or placebo ( n = 30 each group) for 6 weeks in a randomized, double-blind, placebo-controlled trial. Fasting blood samples were taken at baseline and week 6 to quantify related markers. After the 6-week intervention, compared with the placebo, magnesium-zinc-calcium-vitamin D co-supplementation resulted in significant reductions in fasting plasma glucose (−0.37 ± 0.09 vs. +0.01 ± 0.09 mmol/L, P = 0.003), serum insulin levels (−21.0 ± 4.8 vs. +7.2 ± 4.8 pmol/L, P < 0.001), homeostatic model of assessment for insulin resistance (−1.0 ± 1.1 vs. +0.3 ± 1.3, P < 0.001), and a significant increase in quantitative insulin sensitivity check index (+0.02 ± 0.03 vs. −0.002 ± 0.03, P = 0.003). In addition, magnesium-zinc-calcium-vitamin D co-supplementation significantly decreased serum triglycerides (−0.25 ± 0.10 vs. +0.34 ± 0.10 mmol/L, P = 0.001) and very-low-density-cholesterol concentrations (−0.11 ± 0.04 vs. +0.15 ± 0.04 mmol/L, P = 0.001) compared with the placebo. Overall, the results of this study demonstrated that magnesium-zinc-calcium-vitamin D co-supplementation for 6 weeks among patients with GDM had beneficial effects on glycemic control and few markers of cardiometabolic risk. [ABSTRACT FROM AUTHOR]

Objectives: To determine the prevalence and predictors of gestational diabetes mellitus (GDM) as well as acceptability of returning for glucose tolerance testing among pregnant women in Moshi municipality, northern Tanzania.Methods: Cross-sectional study from October 2015 to April 2016 among women with gestation age of 24-28 weeks of pregnancy attending at Kilimanjaro Christian Medical Centre (KCMC) referral hospital, Majengo and Pasua Health Centres. Women were interviewed and requested to return the next day (window within a month, depending on gestational age) for fasting plasma glucose (FPG) testing, followed immediately by a 75 g oral glucose tolerance test (OGTT). GDM was diagnosed using the 2013 WHO criteria. Logistic regression was conducted to reveal independent predictors for GDM.Results: Of 433 interviewed women, 100 (23%) did not return for FPG and OGTT testing. The prevalence of GDM among the 333 screened women was 19.5%, and 3% had diabetes in pregnancy (DIP). GDM was significantly associated with age ≥35 years (adjusted OR 6.75), pre-pregnancy obesity (AOR 2.22) and history of abortion (AOR 2.36).Conclusion: Prevalence of GDM is high in Moshi. We recommend introduction of routine screening for hyperglycaemia during pregnancy along with strategies for follow-up to prevent long-term effects of GDM and DIP in women and their children. [ABSTRACT FROM AUTHOR]

Le diabète gestationnel (DG) se définit comme un trouble de la tolérance glucidique, de sévérité variable, diagnostiqué pour la première fois pendant la grossesse, quel que soit le terme et quelle que soit son évolution dans le post-post-partum. L'objectif de cette étude est de déterminer les caractéristiques de notre population et d'évaluer leur prise en charge. Il s'est agi d'une étude rétrospective sur cinq ans (janvier 2010-janvier 2015), incluant 200 patientes consultant ou hospitalisée pour diabète gestationnel. L'âge de nos patientes variait entre 18 et 45ans. Le dépistage était ciblé sur des facteurs de risque dans 80 % des cas et systématique dans 20 %. Les facteurs de risque retenus (et leur prévalence dans la population) étaient : âge ≥ 30 ans (71,5 % des cas), obésité (71,5 %), antécédent (ATCD) d'hypertention artérielle gravidique (9 %), ATCD de macrosomie (40 %), ATCD de DG (5,5 %), ATCD de mort foetale in utero (10,5 %), ATCD d'avortement (32 %), ATCD de diabète de type 2 (DT2) (32 %). L'âge gestationnel moyen de découverte du DG était de 19,36 semaines aménorrhées [7-39]. Les complications maternelles étaient dominées par la survenue d'infections urinaires et/ou génitales chez quarante-deux parturientes, de menace d'accouchement prématuré chez vingthuit patientes et l'apparition d'hypertension artérielle chez dix. Les complications foetales étaient surtout représentées par les macrosomies : vingt-six cas. Après l'accouchement, 26 % des patientes étaient perdues de vue ; 11 % présentaient un DT2, 21 % un prédiabète et il s'agissait plutôt d'un DG chez les autres. [ABSTRACT FROM AUTHOR]

Objectives: Our aim in this study was to determine the risk for diabetes mellitus (DM) among Saskatchewan First Nations (FN) and non-FN women with prior gestational DM (GDM)., Methods: Using Ministry of Health administrative databases, we conducted a retrospective cohort study of DM risk by GDM occurrence among FN and non-FN women giving birth from 1980 to 2009 and followed to March 31, 2013. We determined frequencies and odds ratios (ORs) of DM in women with/without prior GDM after stratifying by FN status, while adjusting for other DM determinants. Survival curves of women until DM diagnosis were obtained by prior GDM occurrence and stratified by ethnicity and total parity., Results: De-identified data were obtained for 202,588 women. Of those who developed DM, 2,074 of 10,114 (20.5%) had previously experienced GDM (811 of 3,128 [25.9%]) FN and 1,263 of 6,986 [18.1%] non-FN). Cumulative survival of women with prior GDM until DM was higher for FN than for non-FN women (82% vs 46%), but prior GDM was a stronger predictor of DM within the non-FN cohort (prior GDM vs no GDM: OR, 9.64 for non-FN; OR, 7.05 for FN). Finally, higher total parity interacted with prior GDM to increase DM risk in both groups. With prior GDM and parity ≥3, 93% of FN and 57% of non-FN women subsequently developed DM., Conclusions: GDM is a leading determinant of T2DM among FN and non-FN women, amplified by higher parity. This contributes to earlier onset diabetes, affecting subsequent pregnancies and increasing risk for chronic diabetic complications. It may also factor into higher type 2 DM rates observed in FN women compared with men., (Copyright © 2023 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.)

Pregnancy in obese women increases the risk of late-term foetal demise, early neonatal death and prematurity, particularly in nulliparous women. The risk of birth defects is increased in obese women, and includes not only neural tube defects but also affects other organs, such as the heart and the digestive tract. Maternal obesity changes foetal growth through an increase in nutrients being passed through the placenta; the effect is an increase in body fat. The risk of neonatal morbidity, such as perinatal asphyxia, respiratory distress and obstetric trauma increases with maternal BMI. Macrosomia and maternal morbidity associated with obesity, such as hypertension and diabetes, are likely to partially contribute to the increase in these risks. Numerous experimental and epidemiological data suggests that obesity during pregnancy, as with diabetes, contributes to foetal susceptibility towards cardiovascular diseases, insulin resistance or type 2 diabetes and childhood and adult obesity. [ABSTRACT FROM AUTHOR]

Obesity during pregnancy increases the risk of complications for both the mother (gestational hypertension, gestational diabetes mellitus) and the newborn (malformations and macrosomia). Deliveries are also more difficult with more C-section and failure in peridural analgesia. A specific organization supported by the perinatal network should improve the management of these women, especially for morbid obesity. [ABSTRACT FROM AUTHOR]

Intolérance au glucose survenant lors de la grossesse, le diabète gestationnel se traduit par une augmentation de la glycémie. La surveillance scrupuleuse de la femme enceinte est indispensable et un traitement adapté permet d'éviter les risques de complications. Le pharmacien doit bien connaître cette forme de diabète afin de pouvoir rassurer, conseiller et accompagner les patientes qui en sont atteintes. [ABSTRACT FROM AUTHOR]

Objective: Our aim in this study was to evaluate the impact of virtual care for gestational diabetes mellitus (GDM) in the context of the COVID-19 pandemic., Methods: This multiple methods program evaluation used the Quadruple Aim Framework. The impact on patient experience, cost, and provider satisfaction was assessed using surveys and interviews. Chi-square and Poisson statistics were used to compare clinical outcomes before (April 2019 to February 2020) and after (May 2020 to March 2021) the shift to virtual care., Results: Patient experience surveys were completed by 85 women. Most of them rated their virtual care experience as good or excellent (93%), with a preference for continued virtual visits in the future (84%). Most respondents felt virtual care saved them money (93%) and time (98%). Six health-care providers at the Diabetes in Pregnancy Clinic were interviewed and all believed the switch to virtual care was largely positive. Overall, interview transcripts revealed that health-care providers were happy with the transition, although nurses initially perceived an increased workload. There were no significant differences in rates of cesarean section procedures, macrosomia, neonatal intensive care unit admissions or the proportion of appointments at which insulin was initiated between in-person and virtual care patient outcomes. There was a decreased proportion of missed appointments after the switch to virtual care (6.15% vs 1.21%, p<0.0001)., Conclusions: There has been high patient and provider satisfaction with virtual GDM care, with no difference in clinical outcomes and fewer missed appointments. Virtual GDM care should remain an option in the future., (Copyright © 2022 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.)

Objectives: The purpose of this study was to evaluate the effects of maternal high folic acid (FA) supplementation during pregnancy on glucose intolerance in dams and insulin resistance in offspring., Methods: Wistar female rats (n=18) were mated and randomly divided into 3 groups: a control group and 2 experimental groups. Three different feeding protocols were administered during pregnancy: control group, 2 mg/kg FA (recommended level FA supplementation); experimental 1 group, 5 mg/kg FA (tolerable upper intake level of FA supplementation [ULFolS]); and experimental 2 group, 40 mg/kg FA (high FA supplementation [HfolS]). All dams were fed the same FA content diet (2 mg/kg FA) during the lactation period. An oral glucose tolerance test was performed on day 16 of pregnancy. After the lactation period, body weight and food intake of 36 pups were monitored. Dams were euthanized at the end of the lactation period and half of the pups were euthanized at the end of week 7 and the others at the end of week 12. Serum FA, homocysteine, vitamin B 12 , insulin, glucose, interleukin-6, tumor necrosis factor-alpha, glycated hemoglobin (A1C), and adiponectin levels of mothers and pups were evaluated. The homeostatic model of insulin resistance (HOMA-IR) was used to determine insulin resistance in dams and offspring., Results: According to glucose tolerance test results of dams, blood glucose values at minutes 0, 60, 90, and 120 for the HFolS group were significantly higher compared with the control group (p<0.05). The A1C level in HFolS dams was significantly higher than in the control group (p<0.05). The mean birthweight of the pups in the HFolS group was significantly higher than that of control pups (p<0.05). HOMA-IR values for control and HFolS offspring were similar at weeks 7 and 12 and higher than in ULFolS offspring (p>0.05)., Conclusions: It was determined that high doses of FA exposure during pregnancy might be effective in the development of glucose intolerance in dams and insulin resistance in offspring in this study., (Copyright © 2022 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.)

Résumé Alors que la prévalence du diabète gestationnel était estimée entre 5 et 10 % en 2010, l’application des nouveaux seuils recommandés par l’IADPSG, puis adoptés en 2010 par le CNGOF, semble augmenter considérablement le nombre de patientes concernées par cette pathologie. Une étude prospective monocentrique française a estimé en 2014 la prévalence du diabète gestationnel à 14 % avec ces critères, ce qui en fait l’une des pathologies les plus fréquentes au cours de la grossesse sans qu’aucune étude à large échelle n’ait à ce jour montré un bénéfice pour la santé des femmes et des enfants. Si un diagnostic certain de diabète gestationnel ou de diabète de type 2 en cours de grossesse lorsqu’il est établi est un facteur de risque important dans la survenue des complications périnatales, des complications du nouveau-né et de l’enfant et des complications chez la mère, il n’en est probablement pas de même pour les hyperglycémies modérées découvertes en cours de grossesse. While the prevalence of gestational diabetes mellitus (GDM) was estimated between 5 and 10% in 2010, the application of new thresholds recommended by IADPSG and adopted in 2010 by CNGOF seems to significantly increase the number of patients affected by this pathology. A prospective single-center French study estimated in 2014 the prevalence of gestational diabetes at 14% with these criteria, making it one of the most frequent complications during pregnancy. However, to date, there is no published study using these criteria to show a benefit to the health of women and children. If a diagnosis of GDM or type 2 diabetes during pregnancy is definitively an important risk factor for maternal as well as newborn and child complications, it is probably not the case for moderate hyperglycemia discovered during pregnancy. [ABSTRACT FROM AUTHOR]

Objectives: Our aim in this study was to determine the test characteristics of algorithms using hospitalization and physician claims data to predict gestational diabetes (GDM)., Methods: Using population-level health-care administrative data, we identified all pregnant women in Ontario in 2019. The presence of GDM was determined based on glucose screening laboratory results. Algorithms using hospitalization records and/or physician claims were tested against this "gold standard." The selected algorithm was applied to administrative data records from 1999 to 2019 to determine GDM prevalence in each year., Results: Identifying GDM based on either a diabetes mellitus code on the delivery hospitalization record, OR at least 1 physician claim with a diabetes diagnosis code with a 90-day lookback before delivery yielded a sensitivity of 95.9%, a specificity of 99.2% and a positive predictive value of 87.6%. The prevalence of GDM increased from 4.2% of pregnancies in 1999 to 12.0% in 2019., Conclusion: Algorithms using hospitalization or physician claims administrative data can accurately identify GDM., (Copyright © 2022 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.)

Objectives: For women with pre-existing and gestational diabetes, pregnancy involves specialized and intensive medical care to optimize maternal and infant outcomes. Medical management for patients with diabetes in pregnancy typically occurs via frequent face-to-face outpatient appointments. COVID-19-induced barriers to face-to-face care have identified the need for high-quality, patient-centred virtual health-care modalities, such as mobile health (mHealth) technologies. Our aim in this review was to identify the patient-reported benefits and limitations of mHealth technologies among women with diabetes in pregnancy. We also aimed to determine how the women's experiences aligned with the best practice standards for patient-centred communication., Methods: The framework presented by Arksey and O'Malley for conducting scoping reviews, with refinements by Levac et al, was used to guide this review. Relevant studies were identified through comprehensive database searches of MEDLINE, Embase, Emcare and PsycINFO. Thomas and Harden's methods for the thematic synthesis of qualitative research in systematic reviews guided the synthesis of patient-reported benefits and limitations of mHealth technology., Results: Overall, 19 studies describing the use of 16 unique mHealth technologies among 742 women were included in the final review. Patient-reported benefits of mHealth included convenience, support of psychosocial well-being and facilitation of diabetes self-management. Patient-reported limitations included lack of important technological features, perceived burdensome aspects of mHealth and lack of trust in virtual health care., Conclusions: Women with diabetes report some benefits from mHealth use during pregnancy. Codesigning future technologies with end users may help address the perceived limitations and effectiveness of mHealth technologies., (Copyright © 2022 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.)

OBJECTIVE We systematically reviewed publications on prevalence and risk factors for gestational diabetes mellitus (GDM) in the 47 countries of sub-Saharan Africa. METHODS We conducted a systematic search in PUBMED and reviewed articles published until June 2014 and searched the references of retrieved articles. We explored sources of heterogeneity among prevalence proportions with metaregression analysis. RESULTS Of 1069 articles retrieved 22 studies were included. Half were from West Africa, specifically Nigeria, five from South Africa and six from East and Central Africa. There were differences in screening methods and diagnosis criteria used, even between studies carried out in the same country and same time period. Metaregression analysis indicated high heterogeneity among the studies (I2 = 100, P < 0.001), which could not be sufficiently explained by study setting, population, diagnostic criteria or time trend, although we observed a relatively higher prevalence in studies carried out after 2000 (5.1% vs. 3.2%), when women at risk were selected (6.5% vs. 3.8%) and when more current diagnostic criteria were used (5.1% vs. 4.2%). Associations with risk factors were reported in six studies. Significant risk factors reported in more than one study were overweight and/ or obesity, family history for type 2 diabetes, previous stillbirth, previous macrosomic child and age >30 years. CONCLUSIONS There are few studies on prevalence and risk factors for GDM in Sub-Saharan Africa and heterogeneity is high. Prevalence was up to about 14% when high-risk women were studied. Preventive actions should be taken to reduce the short- and long-term complications related to GDM in Sub-Saharan Africa. [ABSTRACT FROM AUTHOR]

Résumé: Objectifs: Nous avons voulu mesurer l’impact du passage d’un dépistage en deux temps du diabète gestationnel (HGPO 50g puis HGPO 100g) à un dépistage en un temps HGPO 75g (méthode OMS). Patientes et méthodes: Étude prospective portant sur les patientes ayant consulté entre le 1er juillet 2008 et le 31 octobre 2009. Le dépistage était réalisé au premier trimestre en présence de facteurs de risque et entre 24 et 28 semaines d’aménorrhée Résultats: Durant notre période d’étude de 15 mois, 706 femmes enceintes ont été incluses. La prescription d’un test de dépistage était réalisée chez 403 femmes soit 57 % des cas. Sur les 403 femmes dépistées, 33 avaient un diabète gestationnel soit une prévalence de 8,2 %. En analyse univariée, sont considérés comme facteurs de risque : l’âge, les antécédents familiaux de diabète et les antécédents de macrosomie lors d’une grossesse précédente. Entre 24 et 28 SA, le nombre de tests de dépistage du DG prescrit est de 34,34 %. L’HGPO à 75g est prescrite dans 96,2 % des cas comme test de dépistage du DG mais la glycémie à jeun reste prescrite dans 3,8 % des cas. Par ailleurs, avant 12 SA, l’HGPO à 75g représente 64,7 % des tests prescrits. Discussion: Malgré la simplification de la procédure de dépistage du DG, notre travail ne montre pas de différence significative entre le taux de dépistage et la prévalence du DG entre notre présente étude et le premier travail réalisé au sein du même service (57 % versus 61 %, p =0,7 et 8,2 % versus 7,7 %, p =0,9). Les facteurs de risque du DG retrouvés sont également identiques entre les deux études : l’âge, les antécédents familiaux au premier degré de diabète de type 2 et les antécédents de macrosomie. Par ailleurs, il y a une amélioration statistiquement significative de l’âge de dépistage (23 SA±6,7 versus 20,9±6,8 lors du premier semestre 2008, p <0,001) ainsi que du nombre de tests prescrits pendant la période entre 24 et 28 SA (34,34 % versus 23,9 % lors du premier semestre 2008, p <0,001). Pour les tests utilisés pour le dépistage du DG entre 24 et 28 SA, l’HGPO à 75g a remplacé l’HGPO à 50g (test utilisé lors de la première étude) mais la glycémie à jeun reste prescrite dans 3,8 % des cas sachant qu’une glycémie à jeun seule normale entre 24 et 28 SA a une sensibilité médiocre et ne permet pas d’exclure le diagnostic de DG. Par ailleurs, avant 12 SA, l’HGPO à 75g de glucose représente 64,7 % des tests prescrits. Il n’existe cependant à ce jour, aucune donnée permettant de valider des tests de charge avant 24 SA Conclusion: Notre étude comparative a mis en évidence le maintien d’une faible application du dépistage systématique du DG malgré la simplification du protocole. Une réunion de sensibilisation regroupant l’ensemble des intervenants est à organiser avec proposition d’actions correctives. L’objectif final étant la systématisation du dépistage du diabète gestationnel avec l’utilisation de la glycémie à jeun au cours du premier trimestre et de l’HGPO à 75g de glucose entre la 24 et la 28 SA. [ABSTRACT FROM AUTHOR]

Résumé: Le syndrome des ovaires polymicrokystiques (SOPMK) est le désordre endocrinien le plus fréquent chez la femme en âge de procréer et la première cause d’infertilité féminine. Cette pathologie est très fréquemment associée à l’obésité et à d’importants troubles métaboliques, notamment l’hyperinsulinisme. Par conséquent, il est légitime de s’intéresser aux grossesses de ces patientes. De nombreuses études suggèrent en effet une augmentation des risques obstétricaux dans cette pathologie. Le SOPMK semble en rapport avec une fréquence accrue des fausses couches spontanées précoces, de l’hypertension artérielle gravidique, de la pré-éclampsie, du diabète gestationnel diagnostiqué dès le premier trimestre de la grossesse, de la prématurité, de l’hypotrophie néonatale ou de la macrosomie, des complications néonatales et des césariennes. Néanmoins, il est difficile de conclure de façon claire à ce sujet, du fait de la grande hétérogénéité de définition du SOPMK dans les différentes études. De plus, les nombreux facteurs confondants inhérents au SOPMK et notamment l’obésité ne sont pas toujours pris en compte ce qui engendre un réel problème d’interprétation. Toutefois, il semble possible de conclure que le SOPMK ne majore pas le risque d’hématome rétroplacentaire, de HELLP syndrome, d’hépatopathie gravidique, d’hémorragie du post-partum, de fausse couche tardive et de mort fœtale in utero. [ABSTRACT FROM AUTHOR]