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Screening for pregestational and gestational diabetes in pregnancy: a survey of obstetrical centers in the northern part of Belgium.

ABSTRACT: BACKGROUND:There is lack of consensus concerning the best screening strategy for gestational diabetes (GDM). The aim of our survey was therefore to investigate attitudes and practices of all obstetrical centers in the northern part of Belgium regarding screening for pregestational diabetes in early pregnancy and screening for GDM. We also aimed to identify the penetrance of the 'International Association of Diabetes in Pregnancy Study Groups' (IADPSG) screening strategy for GDM. METHODS:The survey was conducted from May 2012 till January 2013. The survey was distributed to every obstetrical center in the northern part of Belgium by email and/or mail with reminders by phone and personal contact. RESULTS:From the 65 obstetrical centers, 69% responded. Of all centers, 27% had a structured database on the number of women with GDM. Of all centers, 82% screened for pregestational diabetes in early pregnancy and 56% of centers screened for GDM before 24 weeks. Screening before 24 weeks was mostly based on risk factors. Screening for GDM after 24 weeks, was done universally in 87% of centers. The mean estimated prevalence of GDM was 7?±?5%. The most commonly used screening strategy was a two-step approach with a glucose challenge test (GCT) and 100 g oral glucose tolerance test (OGTT), used by 56% of centers, with 23 centers using the Carpenter & Coustan criteria. The 75 g OGTT with the IADPSG criteria was used by 33% of centers but 4 of these centers still used a GCT before proceeding to the full OGTT. CONCLUSIONS:This survey demonstrates that in the northern part of Belgium, there still is a large variation in screening strategy for pregestational diabetes in early pregnancy and GDM. Only 25% of centers have already implemented the one-step IADPSG screening strategy.

SUBMITTER: Benhalima K

PROVIDER: S-EPMC3833269 | biostudies-literature | 2013 Nov

REPOSITORIES: biostudies-literature

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Screening for pregestational and gestational diabetes in pregnancy: a survey of obstetrical centers in the northern part of Belgium.

Benhalima Katrien K Van Crombrugge Paul P Devlieger Roland R Verhaeghe Johan J Verhaegen Ann A De Catte Luc L Mathieu Chantal C

Diabetology & metabolic syndrome 20131111 1

<h4>Background</h4>There is lack of consensus concerning the best screening strategy for gestational diabetes (GDM). The aim of our survey was therefore to investigate attitudes and practices of all obstetrical centers in the northern part of Belgium regarding screening for pregestational diabetes in early pregnancy and screening for GDM. We also aimed to identify the penetrance of the 'International Association of Diabetes in Pregnancy Study Groups' (IADPSG) screening strategy for GDM.<h4>Metho ...[more]

PMID: 24405764

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Project description:AIMS/HYPOTHESIS:Women with diabetes remain at increased risk of adverse pregnancy outcomes associated with poor pregnancy preparation. However, women with type 2 diabetes are less aware of and less likely to access pre-pregnancy care (PPC) compared with women with type 1 diabetes. We developed and evaluated a community-based PPC programme with the aim of improving pregnancy preparation in all women with pregestational diabetes. METHODS:This was a prospective cohort study comparing pregnancy preparation measures before and during/after the PPC intervention in women with pre-existing diabetes from 1 June 2013 to 28 February 2017. The setting was 422 primary care practices and ten National Health Service specialist antenatal diabetes clinics. A multifaceted approach was taken to engage women with diabetes and community healthcare teams. This included identifying and sending PPC information leaflets to all eligible women, electronic preconception care templates, online education modules and resources, and regional meetings and educational events. Key outcomes were preconception folic acid supplementation, maternal HbA1c level, use of potentially harmful medications at conception and gestational age at first presentation, before and during/after the PPC programme. RESULTS:A total of 306 (73%) primary care practices actively participated in the PPC programme. Primary care databases were used to identify 5075 women with diabetes aged 18-45 years. PPC leaflets were provided to 4558 (89.8%) eligible women. There were 842 consecutive pregnancies in women with diabetes: 502 before and 340 during/after the PPC intervention. During/after the PPC intervention, pregnant women with type 2 diabetes were more likely to achieve target HbA1c levels ?48 mmol/mol (6.5%) (44.4% of women before vs 58.5% of women during/after PPC intervention; p?=?0.016) and to take 5 mg folic acid daily (23.5% and 41.8%; p?=?0.001). There was an almost threefold improvement in 'optimal' pregnancy preparation in women with type 2 diabetes (5.8% and 15.1%; p?=?0.021). Women with type 1 diabetes presented for earlier antenatal care during/after PPC (54.0% vs 67.3% before 8 weeks' gestation; p?=?0.003) with no other changes. CONCLUSIONS/INTERPRETATION:A pragmatic community-based PPC programme was associated with clinically relevant improvements in pregnancy preparation in women with type 2 diabetes. To our knowledge, this is the first community-based PPC intervention to improve pregnancy preparation for women with type 2 diabetes. DATA AVAILABILITY:Further details of the data collection methodology, individual clinic data and the full audit reports for healthcare professionals and service users are available from https://digital.nhs.uk/data-and-information/clinical-audits-and-registries/our-clinical-audits-and-registries/national-pregnancy-in-diabetes-audit .

Project description:BACKGROUND:Advanced maternal age generally denotes age after 35?years during the time of delivery. Despite the fact that being pregnant at any reproductive age is not risk-free, older gravidity usually culminates with adverse outcomes both to the mother and fetus or neonate. This study aimed to determine the association of adverse obstetrical and perinatal outcomes with advanced maternal age pregnancy. The study was conducted in Ayder comprehensive specialized hospital, north Ethiopia, from 2015 to 2017. METHODS:chart review comparative cross-sectional study was employed. Data were retrieved from medical charts of 752 pregnant mothers (376 each for both the study;>?35-year-old and reference group;20-34?year old). Data was collected using a pretested and structured checklist using systematic sampling and data was entered & analyzed using SPSS version 20. Binary and multivariable logistic regression was run to determine the association of independent variables with dependent variables. RESULTS:This study revealed that advanced maternal age pregnancy was significantly associated with pregnancy induced hypertension [AOR 4.15, 95% CI (2.272-7.575), p?<? 0.001], ante partum hemorrhage [AOR 2.54, 95% CI (1.32-4.91), P?=?0.005] & cesarean delivery [AOR 2.722, 95% CI (1.777-4.170), p?<? 0.001]. Furthermore, advanced maternal age pregnancy was also increasingly associated with adverse perinatal outcomes like preterm delivery [AOR 3.622, 95% CI (1.469-8.930), p?=?0.005], low birth weight [AOR 3.137, 95% CI (1.324-7.433), p?=?0.009], perinatal death [AOR 2.54, 95% CI (1.141-5.635), p?=?0.022] and low fifth minute APGAR score [AOR 7.507, 95% CI (3.134-17.98), p?<? 0.001]. Notwithstanding this, maternal age was not found to be associated with amniotic fluid disturbances, premature rupture of membranes and post-term pregnancy. CONCLUSIONS:Advanced maternal age is markedly linked with adverse obstetrical and perinatal outcomes. Therefore, it is better for health care providers to counsel couples, who seek to have a child in their later ages, about the risks of advanced maternal age pregnancy. In addition, health care workers need to emphasize on how to improve advanced age mothers' health through the utilization of contraception to reduce pregnancy in this age group.

Dataset Information

Screening for pregestational and gestational diabetes in pregnancy: a survey of obstetrical centers in the northern part of Belgium.

Publications

Screening for pregestational and gestational diabetes in pregnancy: a survey of obstetrical centers in the northern part of Belgium.

Similar Datasets

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