Screening for Gestational Diabetes

There are insufficient randomised controlled trial data evaluating the effects of screening for GDM based on different risk profiles and settings on maternal and infant outcomes. Low-quality evidence suggests universal screening compared with risk factor-based screening leads to more women being diagnosed with GDM. Low to very low-quality evidence suggests no clear differences between primary care and secondary care screening, for outcomes: GDM, hypertension, pre-eclampsia, caesarean birth, large-for-gestational age, neonatal complications composite, and hypoglycaemia.Further, high-quality randomised controlled trials are needed to assess the value of screening for GDM, which may compare different protocols, guidelines or programmes for screening (based on different risk profiles and settings), with the absence of screening, or with other protocols, guidelines or programmes. There is a need for future trials to be sufficiently powered to detect important differences in short- and long-term maternal and infant outcomes, such as those important outcomes pre-specified in this review. As only a proportion of women will be diagnosed with GDM in these trials, large sample sizes may be required.

In 2010, the recommended diagnostic thresholds for gestational diabetes mellitus (GDM) were amended, which has increased GDM diagnoses, as well as pressure on the services involved in GDM management, specifically impacting dietetic workloads. The present study examined the associations between dietetic intervention in women with GDM and maternal and neonatal health outcomes. The present study involved 1233 adult women with GDM who delivered at The Royal Women's Hospital (RWH), Melbourne, Australia, between July 2015 and May 2017. Retrospective data assessing GDM-care (therapy type, diagnosis time and model of care, maternal and neonatal health outcomes, and outpatient dietetic consultations) were retrieved from patient medical records. Unadjusted and adjusted linear and logistic regression were used to assess associations of GDM care dietetic intervention and GDM care and dietetic intervention with maternal and neonatal health outcomes. Women receiving dietetic intervention had a decreased likelihood of infant admission to the neonatal intensive care unit or special care nursery than women who not receiving dietetic intervention [adjusted odds ratio (OR)=0.41, 95% confidence interval (CI)=0.22-0.75; P=0.004). Women requiring pharmacotherapy were more likely to experience maternal complications (adjusted OR=3.13, 95% CI=2.23-4.41; P<0.001) and had a greater number of dietetic consultations (β-coefficient=0.28, 95% CI=0.17-0.39; P<0.001) compared to women managed through diet. Dietetic intervention plays a key role in optimising maternal and neonatal health outcomes for women with GDM. Exploring further the impact of dietetic intervention in women diagnosed with GDM is key with respect to understanding the optimal delivery of care for these women. The type and number of consultations included in a dietetic intervention should be investigated further.

Financial barriers can affect timely access to maternal health services. Health insurance can influence the use and quality of these services and potentially improve maternal and neonatal health outcomes. We conducted a systematic review of the evidence on health insurance and its effects on the use and provision of maternal health services and on maternal and neonatal health outcomes in middle- and low-income countries. Studies were identified through a literature search in key databases and consultation with experts in healthcare financing and maternal health. Twenty-nine articles met the review criteria of focusing on health insurance and its effect on the use or quality of maternal health services, or maternal and neonatal health outcomes. Sixteen studies assessed demand-side effects of insurance, eight focused on supply-side effects, and the remainder addressed both. Geographically, the studies provided evidence from sub-Saharan Africa (n = 11), Asia (n = 9), Latin America (n = 8), and Turkey. The studies included examples from national or social insurance schemes (n = 7), government-run public health insurance schemes (n = 4), community-based health insurance schemes (n = 11), and private insurance (n = 3). Half of the studies used econometric analyses while the remaining provided descriptive statistics or qualitative results. There is relatively consistent evidence that health insurance is positively correlated with the use of maternal health services. Only four studies used methods that can establish this causal relationship. Six studies presented suggestive evidence of over-provision of caesarean sections in response to providers' payment incentives through health insurance. Few studies focused on the relationship between health insurance and the quality of maternal health services or maternal and neonatal health outcomes. The available evidence on the quality and health outcomes is inconclusive, given the differences in measurement, contradictory findings, and statistical limitations. Consistent with economic theories, the studies identified a positive relationship between health insurance and the use of maternal health services. However, more rigorous causal methods are needed to identify the extent to which the use of these services increases among the insured. Better measurement of quality and the use of cross-country analyses would solidify the evidence on the impact of insurance on the quality of maternal health services and maternal and neonatal health outcomes.

Background Rising global temperatures have resulted in an increase in the frequency and severity of heatwaves. Pregnancy is a time of substantial physiological change and thus maternal and neonatal health outcomes are susceptible to adverse effects of heat. There is a lack of knowledge about thermoregulation in pregnancy, including how effectively pregnant people adapt in different climate contexts and what specific environmental conditions present the largest thermoregulatory challenges. The primary aim of this study is to examine the associations between exposure to heatwaves during pregnancy and maternal, neonatal, and child health outcomes in Western Australia (WA) climatic regions. Methods All neonates born in WA between 1991 and 2023 will be identified from perinatal records (~960,000 neonates). Perinatal records will be linked to weather data from the ERA5 database using Statistical Area 2 geocoding to identify heatwave exposed pregnancies. Commonly used definitions of heatwave exposure will be tested against three neonatal outcomes (pre-term birth, low birth weight, and congenital anomalies). From this, a single definition will be selected to examine maternal, neonatal, and child health outcomes using linked hospital, emergency department, and education assessment data, as well as data from the WA congenital anomalies and death register. The association between heatwaves during pregnancy and health outcomes will be performed using generalised estimating equations, adjusting for covariates including cigarette smoking, parity, maternal age, and Aboriginality where appropriate. Stratification by socio-economic status and geographic region will also be carried out. Discussion Examining the association between exposure to heatwaves in pregnancy and maternal, neonatal and child outcomes is important given the increasing frequency of heatwaves. The study will highlight which heat definitions confers the highest vulnerability as well as demographic and geographic subgroups who are particularly vulnerable to the effects of heatwaves. It will provide valuable information for future planning, including targets for intervention.

Gestational diabetes mellitus (GDM) is a form of diabetes that occurs in pregnancy. Although GDM usually resolves following birth, it is associated with significant morbidities for mother and baby both perinatally and in the long term. There is strong evidence to support treatment for GDM. However, there is little consensus on whether or not screening for GDM will improve maternal and infant health and if so, the most appropriate protocol to follow. To assess the effects of different methods of screening for gestational diabetes mellitus and maternal and infant outcomes. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (April 2010). Randomised and quasi-randomised trials evaluating the effects of different methods of screening for gestational diabetes mellitus. Two review authors independently conducted data extraction and quality assessment. We resolved disagreements through discussion or through a third author. We included four trials involving 3972 women were included in the review. One quasi-randomised trial compared risk factor screening with universal or routine screening by 50 g oral glucose challenge testing. Women in the universal screening group were more likely to be diagnosed with GDM (one trial, 3152 women, risk ratio (RR) 0.44 95% confidence interval (CI) 0.26 to 0.75). Infants of mothers in the risk factor screening group were born marginally earlier than infants of mothers in the routine screening group (one trial, 3152 women, mean difference -0.15 weeks, 95% CI -0.27 to -0.53).The remaining three trials evaluated different methods of administering a 50 g glucose load. Two small trials compared glucose monomer with glucose polymer testing, with one of these trials including a candy bar group. One trial compared a glucose solution with food. No differences in diagnosis of GDM were found between each comparison. Overall, women drinking the glucose monomer experienced fewer side effects from testing than women drinking the glucose polymer (two trials, 151 women, RR 2.80, 95% CI 1.10 to 7.13). However, we observed high heterogeneity between the trials for this result (I(2) = 61%). There was insufficient evidence to determine if screening for gestational diabetes, or what types of screening, can improve maternal and infant health outcomes.

Maternal healthcare services during pregnancy and childbirth are essential to reducing adverse maternal and child health outcomes, including maternal and child mortality. Midwives in Indonesia play an important role in providing maternal healthcare services. The purpose of this study is to analyze trends in midwifery care utilization for antenatal care (ANC), intranatal care (INC), and postnatal care (PNC) among Indonesian women between in 2012 and 2017, and to examine the sociodemographic, economic, and regional factors associated with access and utilization to inform strategies for improving maternal and neonatal health outcomes. This study uses data from the Indonesia Demographic and Health Survey (IDHS) from 2012 to 2017. A total of 15,269 women aged 15-49 from the Indonesia Demographic and Health Survey (IDHS) participated in this study, consisting of 7,712 women from the 2012 survey and 7,557 from the 2017 survey. Only respondents who completed the Women's Questionnaire were included in the analysis. A multiple logistic regression model was used to analyze factors associated with midwives' engagement in maternal healthcare service provision. This study used multivariate analyses for 2012 and 2017 to examine the relationships between various socio-demographic characteristics and the utilization of specific maternal health services in Indonesia. Several factors consistently influenced service utilization of midwifery services, including younger maternal age, secondary education, being married, without health insurance, rural residence, and higher ANC visit frequency. Women with normal births and without complications were significantly utilizing the service from midwives. Conversely, disparities remained for women in the eastern part of Indonesia and among those with higher parity. Midwives play a critical role as accessible and trusted providers and remain central to strengthening service delivery and extending community-level reach across Indonesia. These insights offer valuable guidance for policymakers and health planners in enhancing midwife-led service coverage and improving maternal health outcomes. Not applicable.

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.

Background: To screen patients at average risk for Gestational Diabetes using 50g Glucose Challenge test, to ascertain the prevalence of Gestational diabetes through further diagnostic testing and to prevent and manage complications. Gestational diabetes mellitus (GDM) is defined as carbohydrate intolerance of variable severity with onset or first recognition during pregnancy. Women with GDM are at risk for maternal and foetal complications, so it is important to screen all the pregnant woman.Methods: This study was conducted in 198 patients between 24 and 28 weeks of gestation, attending the Antenatal clinic. 50g oral glucose is administered irrespective of time of the last meal and plasma glucose is measured one hour later. Patients with plasma glucose levels more than 140 mg/dl were subjected to a 100g oral glucose tolerance test, patients with two or more abnormal reading were labelled as GDM and managed accordingly.Results: Prevalence of GDM in our study was 9.59%. Maternal complications like gestational hypertension, vaginal infections and foetal complications were much higher in GDM patients as compare to non GDM group.Conclusions: GDM is a disease which adversely affects both mother as well as foetus. It is concluded that 50 gm glucose challenge test at 24-28 weeks of gestation with a cut-off value of 140 mg/dl is a reliable screening test for GDM. This test offers the best combination of ease and economy of use and reproducibility in screening for gestational diabetes mellitus in average risk patients.

Gestational diabetes mellitus (GDM) is defined as impaired glucose tolerance with onset during the second or third trimester of pregnancy. The purpose of this study was to investigate the prevalence of pregnant women who were not screened for gestational diabetes mellitus and compare the maternal and fetal outcomes of women who had undergone GDM screening. Women who refused to attend the gestational diabetes screening test (n = 162) at a maternity hospital in Ankara, Turkey, between October 2014 and January 2015 were included in this prospective cohort study. The control group (matched for age and body mass index) was recruited from women who agreed to have the gestational diabetes screening test (n = 194). Just 12% of pregnant women did not attend gestational diabetes screening test; these women were at higher risk for idiopathic polyhydramnios (P = 0.026). Prevalence of GDM was 8.8% (n = 17) in the control group and 30.9% (n = 50) in those who refused GDM screening. The maternal and fetal outcomes of GDM patients were similar in both groups. Women who did not attend GDM screening test had increased risk for mild idiopathic polyhydramnios in late gestation. Fasting and postprandial plasma glucose screening can replace gestational diabetes mellitus screening in women who refuse to have the glucose load test.

Climate change has severe and wide-ranging health impacts, especially for vulnerable groups. Despite growing evidence of heat-associated adverse maternal and neonatal health outcomes, there remains a lack of synthesis quantifying associations and identifying specific risk periods. We systematically reviewed the literature on heat impacts on maternal, fetal and neonatal health and quantified impacts through meta-analyses. We found 198 studies across 66 countries, predominantly high income (63.3%) and temperate climate zones (40.1%), and 23 outcomes. Results showed increased odds of preterm birth of 1.04 (95% confidence interval (CI) = 1.03, 1.06; n = 12) per 1 °C increase in heat exposure and 1.26 (95% CI = 1.08, 1.47; n = 10) during heat waves. Similarly, high heat exposure increased the risk for stillbirths (odds ratio (OR) = 1.13 (95% CI = 0.95, 1.34; n = 9)), congenital anomalies (OR = 1.48 (95% CI = 1.16, 1.88; n = 6)) and gestational diabetes mellitus (OR = 1.28 (95% CI = 1.05, 1.74; n = 4)). The odds of any obstetric complication increased by 1.25 (95% CI = 1.09, 1.42; n = 11) during heat waves. Patterns in susceptibility windows varied by condition. The findings were limited by heterogeneity in exposure metrics and study designs. The systematic review demonstrated that escalating heat exposure poses a major threat to maternal and neonatal health, highlighting research priorities, guiding the selection and monitoring of heat-health indicators and emphasizing the need to prioritize maternal and neonatal health in national climate health programs.

AimsThis study aimed to investigate maternal preferences for gestational diabetes mellitus (GDM) screening options in rural China to identify an optimal GDM screening strategy.MethodsPregnant women at 24–28 gestational weeks were recruited from Shandong province, China. A discrete choice experiment (DCE) was conducted to elicit pregnant women's preferences for GDM screening strategy defined by five attributes: number of blood draws, out-of-pocket costs, screening waiting-time, number of hospital visits, and positive diagnosis rate. A mixed logistic model was employed to quantify maternal preferences, and to estimate the relative importance of included attributes in determining pregnant women's preferences for two routinely applied screening strategies (“one-step”: 75 g oral glucose tolerance test [OGTT] and “two-step”: 50 g glucose challenge-test plus 75 g OGTT). Preference heterogeneity was also investigated.ResultsN = 287 participants completed the DCE survey. All five predefined attributes were associated with pregnant women's preferences. Diagnostic rate was the most influential attribute (17.5 vs. 8.0%, OR: 2.89; 95%CI: 2.10 to 3.96). When changes of the attributes of “two-step” to “one-step” strategies, women's uptake probability from full “two-step” to “one-step” significantly increased with 71.3% (95%CI: 52.2 to 90.1%), but no significant difference with the first step of “two-step” (−31.0%, 95%CI: −70.2 to 8.1%).ConclusionChinese pregnant women preferred the “one-step” screening strategy to the full “two-step” strategy, but were indifferent between “one-step” and the first step of “two-step” strategies.

Maternal, fetal, and neonatal health outcomes are interdependent. Designing public health strategies that link fetal and neonatal outcomes with maternal outcomes is necessary in order to successfully reduce perinatal and neonatal mortality, particularly in low- and middle- income countries. However, to date, there has been no standardized method for documenting, reporting, and reviewing facility-based stillbirths and neonatal deaths that links to maternal health outcomes would enable a more comprehensive understanding of the burden and determinants of poor fetal and neonatal outcomes. We developed and pilot-tested an adapted RAPID tool, Perinatal-Neonatal Rapid Ascertainment Process for Institutional Deaths (PN RAPID), to systematically identify and quantify facility-based stillbirths and neonatal deaths and link them to maternal health factors in two countries: Liberia and Nepal. This study found an absence of stillbirth timing documented in records, a high proportion of neonatal deaths occurring within the first 24 hours, and an absence of documentation of pregnancy-related and maternal factors that might be associated with fetal and neonatal outcomes. The use of an adapted RAPID methodology and tools was limited by these data gaps, highlighting the need for concurrent strengthening of death documentation through training and standardized record templates.

Midwife-led continuity of care improved maternal and neonatal health outcomes in north Shoa zone, Amhara regional state, Ethiopia: A quasi-experimental study

ABSTRACTAims/IntroductionThis study aimed to evaluate the problems in screening for gestational diabetes mellitus (GDM) by casual blood glucose (CBG) measurements at 24–28 gestational weeks.Materials and MethodsOverall, 763 pregnant women who underwent the 50‐g glucose challenge test (GCT) at 24–28 gestational weeks were enrolled. The preload blood glucose (0‐h BG) level of 50‐g GCT was considered as CBG.ResultsA total of 240 women with BG levels at 1‐h after loading (1‐h BG) on 50‐g GCT ≥140 mg/dL underwent the 75‐g oral glucose tolerance test, and 98 (40.8%) were diagnosed with GDM. Of the 99 women with GDM, 71 (71.7%) had 0‐h BG on 50‐g GCT <100 mg/dL.ConclusionsThis study, where pregnant women underwent both CBG and 50‐g GCT simultaneously, showed that when CBG at 24–28 gestational weeks ≥100 mg/dL alone was used for screening GDM, many pregnant women with GDM were overlooked.

To estimate the incidence of gestational diabetes mellitus (GDM) according to The International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria and the pregnancy complications in women fulfilling these criteria but who are not considered diabetic according to the Canadian Diabetes Association criteria. We estimated the rate of GDM according to the IADPSG criteria from November 2008 to October 2010. Then, we conducted a chart review to compare maternal and neonatal outcomes between women classified as GDM according to the IADPSG criteria but not by the Canadian Diabetes Association criteria (group 1; n=186) and nondiabetic women according to both criteria (group 2; n=372). Results were expressed as crude (odds ratio [OR]) or adjusted OR and 95% confidence interval (CI). The study has a statistical power of 80% to detect a difference between 16% and 8% in large for gestational age newborns (α level of 0.05; two-tailed). The rate of GDM using the IADPSG criteria was 27.51% (95% CI 25.92-29.11). Group 1 presented similar rates of large-for-gestational-age newborns (9.1% compared with 5.9%, adjusted OR 1.58, 95% CI 0.79-3.13; P=.19), delivery complications (37.1% compared with 30.1%, OR 1.37, 95% CI 0.95-1.98; P=.10), preeclampsia (6.5% compared with 2.7%, adjusted OR 2.40, 95% CI 0.92-6.27; P=.07), prematurity (6.5% compared with 2.7%, OR 1.10, 95% CI 0.53-2.27; P=.85), neonatal complications at delivery (13.4% compared with 9.7%, OR 1.45, 95% CI 0.84-2.49; P=.20), and metabolic complications (10.8% compared with 14.2%, OR 0.73, 95% CI 0.42-1.26; P=.29) compared with group 2. Women classified as nondiabetic by the Canadian Diabetes Association Criteria but considered GDM according to the IADPSG criteria have similar pregnancy outcomes as women without GDM. More randomized studies with cost-effectiveness analyses are needed before implementation of these criteria. II.