Exploring health professionals' knowledge, practices and attitudes regarding gestational diabetes: A cross-sectional Irish national survey.

Background: The prevalence of gestational diabetes mellitus (GDM) is ranging from 15.9% to 17% in Kerala. Women with GDM and their offsprings are at increased risk of developing type 2 diabetes mellitus in their later life. Hence, postpartum screening and follow-up of the women with GDM along with nutritional and lifestyle modification support are extremely important in Kerala. This study revealed the clients' and providers' perspective on the postpartum diabetes screening among GDM mothers. Objectives: The study aimed to assess timely postpartum diabetes screening rate and factors associated with postpartum diabetes screening among women with GDM who had recently delivered at selected hospitals in Malappuram district, Kerala. The study also assessed the clinicians' perspective on postpartum diabetes screening of women with GDM. Materials and Methods: A cross-sectional study was done among 200 women with GDM, who had delivered in selected hospitals in Malappuram districts between 9 weeks and 6 months before the survey using a pretested validated interview schedule. In-depth interview was carried out to explore the clinicians' perspective on postpartum diabetes screening of women with GDM. Results: Timely postpartum diabetes screening rate among respondents was 29%. The age-adjusted multivariate logistic regression analysis result had a significant P value for the health-care provider's advice with an adjusted OR of 3.2 (1.4–6.9). About 6% of the women with GDM received appropriate and adequate postpartum follow-up. Conclusion: There is an urgent need to enforce adherence to national guidelines for postpartum diabetes screening and establishment of registration and follow-up of women with GDM through public health-care delivery system.

Adverse pregnancy outcomes are associated with an increased risk of postpartum prediabetes and diabetes in Chinese women with gestational diabetes

BackgroundScreening for gestational diabetes mellitus (GDM) is routine during pregnancy in many countries in the world. The screening programs are either based on general screening offered to all pregnant women or risk factor based screening stipulated in local clinical guidelines. The aims of this study were to investigate: 1) the compliance with local guidelines of screening for GDM and 2) the outcomes of pregnancy and birth in relation to risk factors of GDM and whether or not exposed to oral glucose tolerance test (OGTT).MethodsThis study design was a population-based retrospective cross-sectional study of 822 women. A combination of questionnaire data and data collected from medical records was applied. Compliance to the local guidelines of risk factor based screening for GDM was examined and a comparison of outcomes of pregnancy and delivery in relation to risk factor groups for GDM was performed.ResultsOf the 822 participants, 257 (31.3%) women fulfilled at least one criterion for being exposed to screening for GDM according to the local clinical guidelines. However, only 79 (30.7%) of these women were actually exposed to OGTT and of those correctly exposed for screening, seven women were diagnosed with GDM. Women developing risk factors for GDM during pregnancy had a substantially increased risk of giving birth to an infant with macrosomia.ConclusionSurprisingly low compliance with the local clinical guidelines for screening for GDM during pregnancy was found. Furthermore, the prevalence of the risk factors of GDM in our study was almost doubled compared to previous Swedish studies. Pregnant women developing risk factors of GDM during pregnancy were found to be at substantially increased risk of giving birth to an infant with macrosomia. There is a need of actions improving compliance to the local guidelines.

Objective We aimed to explore how women with gestational diabetes mellitus (GDM) experience advice about diet and self-monitoring of blood glucose received in primary health care (PHC) and secondary health care (SHC) with a focus on how women perceived the care coordination and collaboration between healthcare professionals. Design, setting and subjects Individual interviews were conducted with 12 pregnant women diagnosed with GDM. Six women had immigrant backgrounds, and six were ethnic Norwegian. Women received GDM care in the area of Oslo, Norway. Interviews were analysed using thematic analysis. Results Women described feeling shocked when they were diagnosed with GDM and feeling an immediate need for information about the consequences and management of GDM. Most of the women felt that their general practitioner (GP) had too little knowledge about GDM. Women with an immigrant background felt that the PHC midwives provided them with sufficient dietary advice related to GDM. Ethnic Norwegian women appreciated receiving more individually tailored dietary advice in SHC. Self-monitoring of blood glucose influenced women’s daily lives; however, they perceived the training in PHC and SHC as adequate. The women experienced poor collaboration between healthcare professionals in PHC and SHC, which implied that they sometimes had to initiate follow-up steps in their GDM care by themselves. Conclusions Ideally, women diagnosed with GDM should meet healthcare professionals with sufficient knowledge about GDM as soon as possible after being diagnosed. The collaboration between healthcare professionals involved in the care of women with GDM should be improved to avoid having women feel that they need to coordinate their own care. KEY POINTS Current awareness •The management of gestational diabetes mellitus requires appropriate follow-up by healthcare professionals Main statements •Pregnant women’s need for information about the consequences and management of gestational diabetes mellitus was highest immediately after diagnosis •Women perceived that they received more individually tailored information about diet and self-monitoring of blood glucose in secondary health care compared to primary health care •Women felt that general practitioners had insufficient knowledge about gestational diabetes mellitus •Based on our results, care coordination and collaboration between healthcare professionals involved in the care of women with gestational diabetes mellitus should be improved

Women with gestational diabetes have a high risk of type 2 diabetes postpartum, with Indigenous women particularly affected. This study reports postpartum diabetes screening rates among Indigenous and non-Indigenous women with gestational diabetes, in Far North Queensland, Australia. Retrospective study including 1,012 women with gestational diabetes giving birth at a regional hospital from 1/1/2004 to 31/12/2010. Data were linked between hospital records, midwives perinatal data, and laboratory results, then analysed using survival analysis and logistic regression. Indigenous women had significantly longer times to first oral glucose tolerance test (OGTT) [hazards ratio (HR) 0.62, 95 % confidence interval (CI) 0.48-0.79, p < 0.0001) and 'any' postpartum glucose test (HR 0.81, 95 % CI 0.67-0.98, p = 0.03], compared to non-Indigenous women. Postpartum screening rates among all women were low. However, early OGTT screening rates (<6 months) were significantly lower among Indigenous women (13.6 vs. 28.3 %, p < 0.0001), leading to a persistent gap in cumulative postpartum screening rates. By 3 years postpartum, cumulative rates of receiving an OGTT, were 24.6 % (95 % CI 19.9-30.2 %) and 34.1 % (95 % CI 30.6-38.0 %) among Indigenous and non-Indigenous women, respectively. Excluding OGTTs in previous periods, few women received OGTTs at 6-24 months (7.8 vs. 6.7 %) or 2-4 years (5.2 vs. 6.5 %), among Indigenous and non-Indigenous women, respectively. Low rates of postpartum diabetes screening demonstrate that essential 'ongoing management' and 'equity' criteria for population-based screening for gestational diabetes are not being met; particularly among Indigenous women, for whom recent guideline changes have specific implications. Strategies to improve postpartum screening after gestational diabetes are urgently needed.

To examine temporal trends in, as well as social and clinical factors associated with, the prevalence of postpartum diabetes screening after gestational diabetes mellitus (GDM) in the United States (U.S.). Cross-sectional, population-based data were from the Pregnancy Risk Assessment Monitoring System (PRAMS) 2016-2022 from 44 U.S. states and jurisdictions. The analytic sample included postpartum individuals with self-reported GDM who attended a postpartum checkup and reported on postpartum diabetes screening (n = 21,559). Overall and annual prevalence of postpartum diabetes screening were calculated, and associations between social and clinical factors and postpartum diabetes screening were examined using multivariable modified Poisson regression (adjusted prevalence ratios [aPR] with 95% confidence intervals [CI]). Overall weighted prevalence of postpartum diabetes screening was 55.8% (95% CI: 54.8-56.9). Screening prevalence increased from 2016 (55.6%) to 2019 (60.3%), declined at the onset of the COVID-19 pandemic (2020: 52.6%) and subsequently increased through 2022 (55.8%). Screening prevalence was 6%-38% higher among individuals who were ≥30 years of age; identified as racial or ethnic minoritized groups; did not graduate from high school; had public prenatal health insurance; had pre-pregnancy overweight or obesity and had adequate plus prenatal care. Screening prevalence was 5%-14% lower among individuals with a previous live birth, preterm birth and residents of rural areas, the South or U.S. Territories. While postpartum diabetes screening has increased and aligns with recognized risk factors, overall prevalence remains suboptimal. Postpartum diabetes screening represents a critical opportunity to identify individuals at elevated cardiometabolic disease risk and initiate timely interventions.

Gestational diabetes mellitus (GDM) is a form of gestational diabetes mellitus characterized by insulin resistance and abnormal function of pancreatic beta cells. In recent years, genomic association studies have revealed risk and susceptibility genes associated with genetic susceptibility to GDM. However, genetic predisposition cannot explain the rising global incidence of GDM, which may be related to the increased influence of environmental factors, especially the gut microbiome. Studies have shown that gut microbiota is closely related to the occurrence and development of GDM. This paper reviews the relationship between gut microbiota and the pathological mechanism of GDM, in order to better understand the role of gut microbiota in GDM, and to provide a theoretical basis for clinical application of gut microbiota in the treatment of related diseases. The current research results on the interaction between GDM and gut microbiota were collected and analyzed through literature review. Keywords such as "GDM", "gut microbiota" and "insulin resistance" were used for literature search, and the methodology, findings and potential impact on the pathophysiology of GDM were systematically evaluated. It was found that the composition and diversity of gut microbiota were significantly associated with the occurrence and development of GDM. Specifically, the abundance of certain gut bacteria is associated with an increased risk of GDM, while other changes in the microbiome may be associated with improved insulin sensitivity. In addition, alterations in the gut microbiota may affect blood glucose control through a variety of mechanisms, including the production of short-chain fatty acids, activation of inflammatory pathways, and metabolism of the B vitamin group. The results of this paper highlight the importance of gut microbiota in the pathogenesis of GDM. The regulation of the gut microbiota may provide new directions for the treatment of GDM, including improving insulin sensitivity and blood sugar control through the use of probiotics and prebiotics. However, more research is needed to confirm the generality and exact mechanisms of these findings and to explore potential clinical applications of the gut microbiota in the management of gestational diabetes. In addition, future studies should consider the interaction between environmental and genetic factors and how together they affect the risk of GDM.

Applying a User-Centric Design Approach to Develop a Mobile Application for Management and Treatment of Gestational Diabetes in Nepal

Gestational diabetes mellitus (GDM) has considerable and increasing health effects as it raises both the mother’s and offspring’s risk for short- and long-term health problems. GDM can usually be treated with a healthier lifestyle, such as appropriate dietary modifications and engaging insufficient physical activity. While telemedicine interventions requiring weekly or more frequent feedback from health care professionals have shown the potential to improve glycemic control amongst women with GDM, apps without extensive input from health care professionals are limited and have not shown to be effective. We aimed to improve the efficacy of GDM self-management apps by exploring desirable features in a review. We derived six desirable features from the multidisciplinary literature and we evaluated the state of implementation of these features in existing GDM apps. The results showed that features for increasing competence to manage GDM and for providing social support were largely lacking.

Racial differences of incident diabetes postpartum in women with a history of gestational diabetes

BackgroundPeople with gestational diabetes have enhanced learning requirements during pregnancy, and management of their disease often requires the translation of health information into new health behavior changes. Seeking information from the internet to augment learning from health professionals is becoming more common during pregnancy. YouTube is a popular free and accessible web-based resource, which may be particularly useful for individuals with low health literacy or other barriers to receiving high-quality health care; however, the quality and content of YouTube videos varies, and little is known about those covering gestational diabetes.ObjectiveWe aimed to systematically evaluate the quality, content, and reliability of YouTube videos about gestational diabetes.MethodsA systematic search of YouTube videos was conducted over the course of 1 week in April 2020 using the following keywords: “gestational diabetes,” “gestational diabetes management,” “gestational diabetes treatment,” and “pregnancy and diabetes.” The search results were displayed by relevance, replicating a default YouTube search attempt. The first 60 results from each keyword were reviewed (n=240). Exclusion criteria were videos unrelated to gestational diabetes, videos not in English, and those for which the full video was not available at the time of review. For each unique video, a gestational diabetes content score was used to rate video comprehensiveness and accuracy, and the DISCERN instrument, a validated metric to assess consumer health information, was used to evaluate the reliability of information presented. Videos were further categorized by quality: videos with DISCERN scores lower than 3 (out of 5) or a content score less than 4 (out of 7) were categorized as low quality, and all others were designated high quality. We performed descriptive analysis and compared video characteristics by source and quality rating.ResultsFor 115 unique videos, the mean content score (out of 7) was 3.5 (SD 2.0) , and the mean DISCERN score (out of 5) was 2.7 (SD 0.7), representing low to moderate information comprehensiveness and reliability respectively. Video sources were categorized as personal vlog (12/115, 10.4%), web-based education (37/115, 32.2%), medical (52/115, 45.2%), business or company (13/115, 11.3%), and media clip (1/115, 0.9%). DISCERN and content scores trended higher among medical and web-based education videos. The majority of videos (n=88) were categorized as low quality, while 27 videos were categorized as high quality. Video duration was longer for high-quality videos (P<.001); high- and low-quality videos otherwise had similar views and viewer interaction numbers.ConclusionsAlthough high-quality videos about gestational diabetes exist, reliability, accuracy, and comprehensiveness were low overall, and higher quality was not associated with increased viewer interaction. It is important to acknowledge the limitations of this platform and to assist patients in accessing high quality content and differentiating the quality of information sources.

Gestational diabetes mellitus (GDM) is increasing in prevalence in tandem with the dramatic increase in the prevalence of overweight and obesity in women of childbearing age. Much controversy surrounds the diagnosis and management of gestational diabetes, emphasizing the importance and relevance of clarity and consensus. If newly proposed criteria are adopted universally a significantly growing number of women will be diagnosed as having GDM, implying new therapeutic challenges to avoid foetal and maternal complications related to the hyperglycemia of gestational diabetes. This review provides an overview of clinical issues related to GDM, including the challenges of screening and diagnosis, the pathophysiology behind GDM, the treatment and prevention of GDM and the long and short term consequences of gestational diabetes for both mother and offspring.

To investigate whether 2-hour postprandial blood glucose levels up to 8.0 mmol/L affect maternal or neonatal outcomes in pregnancies complicated by gestational diabetes mellitus (GDM). Retrospective analysis of data collated by the Victorian Perinatal Data Collection Unit. 394 GDM women and 394 control women matched for age and country of birth who gave birth at a university teaching hospital, 1991-1997. Maternal--hypertension/pre-eclampsia, obstetric intervention, gestation at delivery, length of hospital stay; neonatal--Apgar scores, time to establish respiration, birthweight, macrosomia, large or small for gestational age (LGA or SGA), fetopelvic disproportion, jaundice, hypoglycaemia. For most outcome measures there were no statistically significant differences between the GDM and control groups. However, in the GDM group, gestation was shorter, hospital stays longer and delivery interventions more common. Our study suggests that maternal and neonatal outcomes in GDM women are comparable with those of women without GDM when 2-hour postprandial glucose levels of up to 8mmol/L are maintained. This is 1.0 mmol/L higher than the current Australian Diabetes in Pregnancy Society recommendation.

The present study aimed to compare the pregnancy outcomes, efficacy, and safety of faster aspart with insulin aspart among Indian women with gestational diabetes. In several countries, fast-acting insulin aspart (faster aspart) has been approved for use in pregnancy. There is a lack of data related to maternal glycemic control and fetal and perinatal outcomes with faster aspart in gestational diabetes among the Indian population. To compare and evaluate the efficacy and safety of faster aspart and insulin aspart in the management of gestational diabetes. This retrospective study evaluated the medical records of 60 pregnant women diagnosed with gestational diabetes and managed with faster aspart or insulin aspart at a tertiary care center, between March 2019 and September 2020. Self-monitored blood glucose levels recorded at 4 timepoints (fasting, and 1 hour post breakfast, lunch, and dinner) during 6 consecutive days any time before delivery were analyzed. Pregnancy and neonatal outcomes across both groups were compared. The mean postprandial glucose value following dinner was significantly lesser in the faster aspart group compared to the insulin aspart group (123.61 ± 2.52 mg/dL vs. 125.87 ± 2.98 mg/dL, respectively; p=0.0024). Women in the faster aspart group had significantly lower glycemic variability (fluctuations). Lesser number of hypoglycemic events were noted in the faster aspart group (10 vs. 20; p=0.0595). Faster aspart was associated with better glycemic control compared to insulin aspart among women with gestational diabetes. Further large-scale studies are needed to validate the outcomes.

Gestational diabetes is a violation of carbohydrates tolerance of any severity that detected for the first time during pregnancy. The need for timely and accurate diagnosis of gestational diabetes is caused by a high frequency of pregnancy complications and neonatal morbidity.The oral glucose tolerance test is recommended to use for the gestational diabetes diagnostics. This test is considered positive (the diagnosis of gestational diabetes installed), if at least one of the glucose indicators exceeds normal levels. The optimal duration of oral glucose tolerance test is 24–28 weeks of pregnancy; in exceptional cases is up to 32 weeks (at high risk for gestational diabetes, ultrasonic symptoms of diabetic fetopathy).Glycated hemoglobin (HbA1c) evaluations can a useful as a test to assess the state of carbohydrate metabolism during pregnancy. HbA1c provides an integrated view of the level of blood glucose over a long period of time, can be used in the detection and monitoring of carbohydrate metabolism disorders during pregnancy. Many studies have confirmed the assosiation of glycated hemoglobin and blood glucose level. Determination of glycated hemoglobin has several advantages: the test result on HbA1c is independent of food intake (possible evaluation is not an empty stomach, which is important for toxicosis in pregnant), patient’s psycho-emotional state, blood samples can be carried out at any time (stable over a wide temperature interval and time).If diagnosis of “gestational diabetes” confirmed it is recommended diet with restriction of carbohydrate and fat, dosed physical activity and glycemic control. Criteria for gestational diabetes compensate on the diet background: fasting glucose level &lt; 5.0 mmol/l, in 1 hour after ingestion &lt; 7.5 mmol/l. Inability to achieve glycemic targets within 2 weeks of self-control or the presence of ultrasonic signs of diabetic fetopathy are indications for insulin therapy.