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Guideline for screening and diagnosing gestational diabetes mellitus
Get PDFGestational diabetes mellitus (GDM) is on the rise, especially with the increase in obesity in childbearing women as well as the rising prevalence of diabetes mellitus type 2. The Maltese gestational women are of no exception especially with an established link to intra-uterine nutritional environment adverse effects as well as to genetic factors.
There is no set international screening strategy for GDM and so diagnosis differs between countries. The most common diagnostic test for GDM is by performing a 75g oral glucose tolerance test (oGTT). Most countries and organizations including the World Health Organization have adopted the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria for diagnosing GDM.
Performing a 75g OGTT on all women at risk of GDM is expensive as well as unpleasant for the women. A combination of risk criteria including pre-pregnancy body mass index with random plasma glucose and/or fasting plasma glucose based on Maltese and Mediterranean population studies have shown to be a useful screening tool. This tool would help identify women likely to have an abnormal or normal oGTT without the need to perform an oGTT.
A screening GDM protocol is essential to pick up and manage at an early stage those that are at risk to develop GDM without the need to have an oGTT performed in every pregnant woman. This would result in better perinatal and maternal outcomes.peer-reviewe
Screening for gestational diabetes : a systematic review and economic evaluation
Get PDFBackground
Screening for gestational diabetes mellitus (GDM) has been controversial, with some expert bodies advising universal screening, others selective screening, and yet others advising against screening at all. This has partly been a result of debate about the definition of GDM, and partly because of the profusion of different tests available, both for screening and definite diagnosis. In the UK, there is no national policy on screening, and a variety of practices exist in different parts of the country. There have also been doubts about the treatment of GDM, and particularly about management of minor degrees of glucose elevation, which are better described as glucose intolerance rather than true diabetes.
Objectives
To provide an updated review of current knowledge, to clarify research needs, and to assist with policy making in the interim, pending future research.
Methods
A literature review was carried out, with a particular focus on screening methods and costs, and an appraisal of screening for GDM against the criteria for assessing screening programmes used by the UK National Screening Committee (NSC).
Results
There is still debate about what is meant by GDM – the threshold for diagnosis is not soundly based; the terms GDM and impaired glucose tolerance are not used in a standard fashion in pregnancy; there is almost certainly a continuum of risk to the baby, rather than there being separate normal and abnormal groups; and the key risk factor in most women may be maternal overweight, with glucose intolerance being an associate of that. In addition there are some rare genetic conditions, which affect a few women, such as glucokinase and hepatic nuclear factor disorders.
GDM is usually defined according to divergence from normal glucose levels, but glucose levels are usually raised in pregnancy, and so diagnosis by normal levels in non-pregnant women may misclassify many normal pregnant women as abnormal. This may lead to anxiety and the inconvenience of extra investigations and ‘disease’ care. The Caesarean section rate appears to be increased by the diagnosis alone.
Ideally, the condition should be defined by the incidence of adverse effects. However, the most common reported complication of GDM is ‘macrosomia’ in the baby. This is usually defined by arbitrary weight cut-offs (usually a birth weight of 4000 g, but sometimes 4500 g), but such neat thresholds fail to distinguish between larger than average healthy babies and those that have the abnormal growth patterns associated with high insulin levels in the womb.
Screening for GDM fails to meet some of the NSC criteria.
A number of screening tests have been used but some, such as glycosylated haemoglobin and fructosamine, have proved unsatisfactory and can be discarded. Others, such as urine testing or random blood glucose, are far from satisfactory, although they may be cheap to do. There is marked international variation. Risk factors such as weight, age and family history are useful for selective screening but some patients with GDM would be missed. Fasting plasma glucose (FPG) is convenient and reliable, but some pregnant women have normal fasting levels but raised levels of glucose after meals, and would be missed by screening based on FPG alone. Glucose challenge tests (GCTs) are based on glucose levels after a glucose drink, but also have shortcomings. The definitive diagnosis is usually by oral glucose tolerance test (OGTT), but the glucose load and timing vary in different countries; taking a 75 g glucose load is unnatural, makes some women sick, and the reproducibility of the test is poor. More natural methods such as test meals have been used, but not widely.
Conclusions
Interim conclusions
There are clearly some women whose glucose levels rise sufficiently in pregnancy to cause harm to their babies. However, there are also many women with lower levels of glucose intolerance whose babies are not at risk, but who may suffer anxiety and inconvenience as a result of being classed as abnormal. On balance, the present evidence suggests that we should not have universal screening, but a highly selective policy, based on age and overweight.
The best test at present, for those deemed to need testing, is probably the GCT, preferably combined with an FPG. The benefits of a follow-up OGTT are doubtful
Elevated soluble CD163 in gestational diabetes mellitus : secretion from human placenta and adipose tissue
Get PDFRecently soluble CD163 (sCD163), a cleaved form of the macrophage receptor CD163, was identified as a macrophage-specific risk-predictor for developing Type 2 Diabetes. Here, we investigate circulating levels of sCD163 in gestational diabetes mellitus (GDM). Furthermore, given the role of the placenta in the pathogenesis of GDM, we assessed placental contribution to sCD163 secretion. Paired maternal (venous) and umbilical vein blood samples from GDM (n = 18) and Body Mass Index (BMI) matched control women (n = 20) delivered by caesarean section at 39–40 week gestation were assessed for circulating levels of sCD163, Tumour necrosis factor alpha (TNF-α) and Interleukin 6 (IL-6). Media from explant culture of maternal subcutaneous fat and corresponding placental tissues were assayed for these same molecules. CD163 positive cell numbers were determined in placental and adipose tissues of GDM and control women. We found significantly elevated circulating sCD163 levels in GDM mothers (688.4±46.9 ng/ml vs. 505.6±38.6 ng/ml) and their offspring (418.2±26.6 ng/ml vs. 336.3±24.4 ng/ml [p<0.05 for both]) as compared to controls, together with elevated circulating TNF-α and IL-6 levels. Moreover, both GDM placentae (268.1±10.8 ng/ml/mg vs. 187.6±20.6 ng/ml/mg) and adipose explants (41.1±2.7 ng/ml/mg vs. 26.6±2.4 ng/ml/mg) released significantly more sCD163 than controls. Lastly, significantly more CD163 positive cells were observed in GDM placentae (25.7±1.1 vs. 22.1±1.2) and adipose tissue (19.1±1.1 vs 12.7±0.9) compared to controls. We describe elevated sCD163 levels in GDM and identify human placenta as a novel source of sCD163 suggesting that placental tissues might contribute to the increased levels of circulating sCD163 in GDM pregnancies
Abiturstandards Mathematik veröffentlicht – Chance vertan?
Get PDFGemeinsame Pressemitteilung der Fachverbände DMV, GDM und MN
A composite risk assessment model to screen for gestational diabetes mellitus among Mediterranean women.
No full textOBJECTIVE:
To determine whether clinical risk assessment for gestational diabetes mellitus (GDM) may preclude the need for universal screening with an oral glucose tolerance test (OGTT) in situations of economic restraint.
METHODS:
Women with either GDM (n=119) or normal glucose tolerance (n=1249) were recruited from centers among 11 Mediterranean countries between August 1, 2010, and May 31, 2011. Outcome measures included anthropomorphic and biological data, obstetric outcomes, and infant outcomes.
RESULTS:
Significant risk factors for GDM included maternal age of 30 years or more; elevated body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters); elevated diastolic blood pressure; previous history of macrosomia; and family history of diabetes mellitus. These factors each had high specificity but low sensitivity for predicting GDM; however, when used in combination, sensitivity increased but specificity fell. Fasting blood glucose (FBG) level had high sensitivity (73.9%) and specificity (90.2%) for predicting GDM. Sensitivity was further increased by combining FBG measurement with maternal age and BMI (96.6%).
CONCLUSION:
Use of a composite model to prescreen women for GDM risk may reduce the need for universal screening with the OGTT among centers facing health-cost pressures
Jahresbericht 2023 GDM Schweiz
Get PDFIm vorliegenden Jahresbericht der GDM Schweiz gibt die Präsidentin Esther Brunner einen Überblick über die Aktivitäten, die im Rahmen der GDM Schweiz im Kalenderjahr 2023 durchgeführt wurden.In this annual report of GDM Switzerland, President Esther Brunner provides an overview of the activities carried out within the framework of GDM Switzerland in the 2023 calendar year
Annual Report 2024 GDM Switzerland
No full textDer Jahresbericht der GDM Schweiz gibt eine Übersicht über die Vereinsaktivitäten und -geschäfte des Landesverbandes GDM Schweiz im Jahr 2024.The annual report of GDM Switzerland provides an overview of the activities and business of the national association GDM Switzerland in 2024
Zur aktuellen Diskussion über die Qualität des Mathematikunterrichts
Get PDFStellungnahme der gemeinsamen Mathematik-Kommission Übergang Schule-Hochschule der DMV, GDM und MNU. Die Deutsche Mathematiker-Vereinigung (DMV), die Gesellschaft für Didaktik der Mathematik (GDM) und der Verband zur Förderung des MINT-Unterrichts (MNU) haben vor fünf Jahren die Mathematik-Kommission „Übergang Schule-Hochschule“ gegründet und begleiten seither u.a. die politische Diskussion um die Ausbildung in Mathematik an deutschen Schulen und ihre Eignung zur Vorbereitung zukünftiger Studienanfänger an Hochschulen. DMV, GDM und MNU begrüßen daher, dass dieses wichtige Thema durch die aktuelle Diskussion u.a. im Kontext eines offenen Briefes zu „Mathematikunterricht und Kompetenzorientierung“ stärker in den Fokus der öffentlichen Aufmerksamkeit rückt.Aus Sicht der Fachgesellschaften werden in der gegenwärtigen Diskussion jedoch einige Aspekte verzerrt oder verkürzt dargestellt. In der Stellungnahme wird dargelegt, wie sich für DMV, GDM und MNU die Probleme, ihre Ursachen und sinnvolle Lösungsansätze darstellen.
Jahrestagung der GDM 2022
Get PDFAnkündigung der Jahrestagung der GDM 2022 an der Goethe-Universität Frankfur
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