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Prevalence of overweight and obesity in children aged 5 to 6 years exposed to Gestational Diabetes Mellitus complicated pregnancies in the Western Cape, South Africa
Get PDFBackground: Gestational Diabetes Mellitus (GDM) has been linked with later metabolic
abnormalities in offspring due to subsequent overweight and obesity. In Sub-Saharan Africa,
there is a paucity of data on the outcomes of children exposed to GDM in utero.
Aims: The primary aim of this sub-study was to investigate the prevalence of overweight and
obesity in 5 and 6-year-old children from GDM complicated pregnancies and macrosomia at
birth in the same cohort. The secondary aim was to identify risk factors associated with
overweight and obesity in these 5 and 6-year-old children.
Outcome measures: The main outcome was the prevalence of overweight and obesity in
these children as measured by their age-specific body mass index (BMI) and Z-scores.
Additionally, the association between other risk factors, overweight and obesity was
investigated.
Methods: A cross-sectional sub-study design was employed nested within a larger study that
is investigating the progression to type 2 diabetes in women managed for GDM during 2010
and 2011. Mothers who participated in the larger study were informed about the sub-study and
invited to allow their children to participate in the sub-study. Written informed consent was
obtained from the mothers for the sub-study. The following data were collected: anthropometric
data at birth and pregnancy related information from the mothers’ hospital record, additional
demographic, social and medical information by questionnaire from the mother and at the
research center. In addition, the children were weighed and had their height measured using
standardized methods. Anthropometry was standardized using WHO standards. Risk factors
for overweight and obesity were tested using a BMI>1 Z-score cut-off, (as a binary variable) in
a manual multivariate logistic regression model.
Results: The sub-study recruited 176 participants; 78 boys (44.3%) and 98 girls (55.7%). The
mean (SD) Z-scores for the children’s anthropometry at ages 5 to 6 years were 0.28 (1.40) for
weight, 0.01 (1.07) for height and 0.37 (1.63) for BMI. The overall prevalence of macrosomia
at birth (birth weight>4000 gm) was 12.3 % (95% CI 8.2-9.1). The overall prevalence of
overweight in the 5 and 6-year-old children was 13.4% (95% CI 8.6-20.4), while the prevalence
of obesity was 14.2% (95% CI 9.2-21.2). The combined prevalence of overweight and obesity
was 27.6% (95% CI 20.6-35.9). The prevalence of macrosomia (P=0.53) or overweight/obesity
proportions (P=0.37) at ages 5 to 6 years did not differ by gender. In multivariate logistic
regression analysis, factors independently associated with the risk of overweight and obesity
were: mothers’ oral glucose tolerance test 2-hour blood glucose level during pregnancy
(AOR=2.06, 95% CI 1.14-3.74, P=0.02), birth weight (AOR=1.00, 95% CI 1.00-1.00, P=0.01),
child’s age in years (AOR=0.03, 95% CI 0.002-0.29, P=0.004) and number of adults in the
house (AOR=0.38, 95% CI 0.17-0.86, P=0.02).
Conclusion: This is the first study to report the prevalence of overweight and obesity in
children born from GDM complicated pregnancies, in the Western Cape, South Africa. The
combined prevalence of overweight and obesity found in 5 and 6-year-old children exposed to
GDM in the Western Cape is higher than overweight and obesity in children reported in other
South African studies. This can imply a higher tendency towards overweight and obesity in
children exposed to GDM which needs further exploration
Integrated Management of Type 2 Diabetes and Gestational Diabetes in the Context of Multi-Morbidity in Africa: A Systematic Review
No full textINTRODUCTION: Many adults diagnosed with gestational diabetes mellitus (GDM) and type 2 diabetes mellitus (T2DM) also have other known or unknown comorbid conditions. The rising prevalence of GDM and T2DM within a broader context of multimorbidity can best be addressed through an integrated management response, instead of stand-alone programs targeting specific infectious and/or chronic diseases. AIM: To describe GDM and T2DM screening, care and cost-effectiveness outcomes in the context of multimorbidity through integrated interventions in Africa. METHODS: A systematic review of all published studies was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Risk Of Bias in Non-randomised Studies of Interventions (ROBINS-I) was used to assess risk of bias. Data synthesis was conducted using narrative synthesis of included studies. RESULTS: A total of 9 out of 13 included studies reported integrated diabetes mellitus (DM) screening, 7 included integrated care and 9 studies addressed cases of newly detected DM who were asymptomatic in pre-diabetes stage. Only 1 study clearly analysed cost-effectiveness in home-based care; another 5 did not evaluate cost-effectiveness but discussed potential cost benefits of an integrated approach to DM screening and care. Compared to partial integration, only 2 fully integrated interventions yielded tangible results regarding DM screening, care and early detection of cases despite many that reported barriers to its sustainability. CONCLUSION: Though few, integrated interventions for screening and/or care of DM in the context of multimorbidity within available resources in health systems throughout Africa exist and suggest that this approach is possible and could improve health outcomes
Type 2 diabetes, cardiovascular risk factors and offspring overweight and obesity 5 to 6 years after hyperglycaemia first detected in pregnancy in Cape Town, South Africa
Get PDFBackground The number of people with type 2 diabetes mellitus (T2DM) is increasing rapidly in Africa, straining already overstretched health systems. The association between hyperglycaemia first detected in pregnancy (HFDP), which includes both diabetes mellitus in pregnancy (DIP) and gestational diabetes mellitus (GDM), and the later development of T2DM and cardiovascular disease risk in the mothers and possibly overweight in their children is well recognised. This thesis contributes to the largely unexplored body of work on the prevalence of T2DM and CVD risk factors in African women after HFDP and the relationship between HFDP and childhood overweight and obesity. The thesis investigated: 1) the prevalence of T2DM and impaired glucose metabolism in African women of childbearing age; 2) the prevalence of T2DM and cardiovascular disease risk factors in women within 6 years after HFDP, and 3) the influence of maternal blood glucose levels during pregnancy and overweight and obesity in the offspring at the preschool age. Methods A systematic review and meta-analysis of all studies published from January 2000 to 2017 was carried out to estimate the prevalence of T2DM and impaired glucose regulation states. In the PROgression to Diabetes study (PRO2D), women diagnosed with GDM using the 2008 National Institute for Health and Care Excellence (NICE) criteria during 2010 and 2011 at a major referral hospital and their offspring were reviewed up to 6 years later. Relevant maternal and foetal/neonatal data were routinely collected during pregnancy and birth. The women were recalled for an assessment of T2DM (OGTT and HbA1C) and other cardiovascular risk factors (insulin resistance, dysglycaemia, dyslipidaemia and obesity) and their offspring for overweight/obesity. The women were reclassified into DIP and GDM using the WHO 2013 criteria for the diagnosis of HFDP. The pooled prevalence of T2DM was; 7.2% (95% CI 5.6% to 8.9%), impaired fasting glycaemia, 6.0% (95% CI 4.2% to 8.2%) IGT, 0.9% to 37.0% from 39 studies in 27 African countries, and 53 075 participants. The response rate for the PRO2D was 44.2% (final sample n=220). At follow up, almost half of the women, [48% (95% CI 41.2–54.4)], had T2DM, 83% in the DIP subtype and 31% with GDM had T2DM. The type of treatment [insulin (OR 25.8, 95% CI 3.9–171.4, p = 0.001), oral antidiabetic drugs (OR 4.1, 95% CI 1.3–12.9, p = 0.018)], fasting glucose(OR 2.7, 95% CI 1.5–4.8, p = 0.001), OGTT 2-hour glucose (OR 4.3, 95% CI 2.4–7.7, p < 0.001), during pregnancy; current anthropometry [waist circumference (OR 1.1, 95% CI 1.0–1.1, p = 0.007), hip circumference (OR 0.9, 95% CI 0.8–1.0, p = 0.001), BMI (OR 1.1, 95% CI 1.0–1.3, p = 0.001)]) were associated with T2DM. The prevalence of CVD risk factors was: insulin resistance 75% (95%CI 65.9-82.3), dyslipidaemia 74.6% (95%CI 68.3- 79.9), dysglycaemia 62.3% (95%CI 55.6-68.5), and raised blood pressure 41.4% (95%CI 35.0-48.0) and metabolic syndrome 60.9% (95%CI 54.3- 67.2). Of the 443 neonates exposed to HFDP during pregnancy, almost one-third [29.6% (95%CI 25.5 – 34.0)] were large-for-gestational-age (LGA) at birth and just over a fifth [21% (95%CI 15.4 – 27.8)] were either overweight or obese at preschool age. A strong association was found between maternal fasting glucose at HFDP diagnosis and birth weight zscore (OR 1.11, 95%CI 1 -1.22, p=0.046), maternal postprandial 2-hour glucose during the third trimester and weight z-score at birth (OR 1.23, 95%CI: 1.07 - 1.42, p = 0.005) and at preschool age (OR 1.37, 95%CI: 1.03 - 1.81, p = 0.031). Conclusion The high prevalence of T2DM and CVD risk factors in relatively young women and overweight and obesity in their offspring within 6 years of the index pregnancy demonstrates the need for context-specific interventions to prevent HFDP, to optimise screening for HFDP and to reduce cardiometabolic disease risk in the postpartum period
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Get PDFWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Progression to type 2 diabetes mellitus and associated risk factors after hyperglycemia first detected in pregnancy: A cross-sectional study in Cape Town, South Africa
No full textGlobal data indicate that women with a history of hyperglycemia first detected in pregnancy (HFDP) are at up to 7 times risk of progressing to type 2 diabetes mellitus (T2DM) compared with their counterparts who have pregnancies that are not complicated by hyperglycemia. However, there are no data from the sub-Saharan African region, which has the highest projected rise in diabetes prevalence globally. The aim of this study was to determine the proportion of women who progress to T2DM and associated risk factors 5 to 6 years after HFDP in Cape Town, South Africa
Dispelling the Myths Behind First-author Citation Counts
Get PDFWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
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