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- Harreiter, Jürgen, et al.
(author)
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Behandlung von früh diagnostiziertem Gestationsdiabetes mellitus vor der 20. Schwangerschaftswoche : [Treatment of early diagnosed Gestational Diabetes mellitus before the 20th Week of Pregnancy]
- 2023
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In: Wiener Klinische Wochenschrift. - : Springer. - 0043-5325 .- 1613-7671. ; 135:Suppl. 7, s. S762-S762
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Journal article (other academic/artistic)abstract
- Einleitung: Bei Diagnose eines Gestationsdiabetes (GDM) vor der 20.Schwangerschaftswoche (SSW) wird leitliniengemäß eine Therapie begonnen. Für diese Praxis liegt keine Evidenz vor, die eine Verbesserung der Gesundheit von Mutter oder Nachkommen bei GDM-Behandlung in der frühen Schwangerschaft belegt.Methoden: Frauen mit einem Risikofaktor für GDM wurden zwischen 4.−20.SSW bei Vorliegen einer GDM Diagnose nach WHO 2013 Kriterien randomisiert einer Behandlungsgruppe oder einer Kontrollgruppe zugeordnet. Die Behandlungs-gruppe erhielt sofortige GDM Behandlung, während die Kontrollgruppe je nach Ergebnissen eines erneuten oralen Glukosetoleranztests (OGTT) in der 24.−28.SSW eine verschobene oder keine Behandlung erhielt. Die Studie hatte drei primäre Endpunkte: eine Kombination ungünstiger neonataler Ereignisse (Geburt <37.SSW, Geburtstrauma, Geburtsgewicht ≥4500 g, RDS, Phototherapie, Totgeburt/neonataler Tod oder Schulterdystokie), schwangerschaftsbedingte Hypertonieerkrankungen (Präeklampsie, Eklampsie, gestationsbedingter Bluthochdruck) und neonatale fettfreie Körpermasse.Ergebnisse: Insgesamt wurden 802 Frauen randomisiert (406 Sofortbehandlung, 396 Kontrollgruppe). Die Erstvisite fand durchschnittlich in der 15,6 ± 2,5 SSW statt. Der neonatale Kombinationsendpunkt trat bei 94/378 Frauen (24,9 %) bei sofortiger Behandlung und bei 113/370 Frauen (30,5 %) in der Kontrollgruppe auf (adj. Risikounterschied −5,6 %;95 % KI,–10,1;−1,2, RR 0,82;0,68-0,98). Schwangerschaftsbedingter Bluthochdruck trat bei 40/378 Frauen (10,6 %) bei sofortiger Behandlung und bei 37/372 Frauen (9,9 %) in der Kontrollgruppe auf (0,7 %,95 % KI,–1,6;2,9, RR 1.08;0.85–1.38). Die fettfreie Körpermasse der Neugeborenen betrug 2,86 kg bei sofortiger Behandlung und 2,91 kg in der Kontrollgruppe (−0,04 kg; 95 % KI,–0,09;0,02). Untergruppenanalysen zeigten eine stärkere Wirkung der Intervention auf neonatale Ergebnisse bei Frauen mit höheren Blutzuckerwerten und bei OGTT Durchführung vor der 14.SSW.Schlussfolgerung: Die sofortige Behandlung von Gestationsdiabetes vor der 20.SSW führte zu einer geringeren Häufigkeit ungünstiger neonataler Ergebnisse im Vergleich zu späterem Behandlungsbeginn.
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- Simmons, David, et al.
(author)
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Perinatal Outcomes in Early and Late Gestational Diabetes Mellitus After Treatment From 24-28 Weeks' Gestation : A TOBOGM Secondary Analysis
- 2024
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In: Diabetes Care. - : American Diabetes Association. - 0149-5992 .- 1935-5548.
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Journal article (peer-reviewed)abstract
- OBJECTIVE: In most gestational diabetes mellitus (GDM) studies, cohorts have included women combined into study populations without regard to whether hyperglycemia was present earlier in pregnancy. In this study we sought to compare perinatal outcomes between groups: women with early GDM (EGDM group: diagnosis before 20 weeks but no treatment until 24-28 weeks if GDM still present), with late GDM (LGDM group: present only at 24-28 weeks), and with normoglycemia at 24-28 weeks (control subjects).RESEARCH DESIGN AND METHODS: This is a secondary analysis of a randomized controlled treatment trial where we studied, among women with risk factors, early (<20 weeks' gestation) GDM defined according to World Health Organization 2013 criteria. Those receiving early treatment for GDM treatment were excluded. GDM was treated if present at 24-28 weeks. The primary outcome was a composite of birth before 37 weeks' gestation, birth weight ≥4,500 g, birth trauma, neonatal respiratory distress, phototherapy, stillbirth/neonatal death, and shoulder dystocia. Comparisons included adjustment for age, ethnicity, BMI, site, smoking, primigravity, and education.RESULTS: Women with EGDM (n = 254) and LGDM (n = 467) had shorter pregnancy duration than control subjects (n = 2,339). BMI was lowest with LGDM. The composite was increased with EGDM (odds ratio [OR] 1.59, 95% CI 1.18-2.12)) but not LGDM (OR 1.19, 95% CI 0.94-1.50). Induction of labor was higher in both GDM groups. In comparisons with control subjects there were higher birth centile, higher preterm birth rate, and higher rate of neonatal jaundice for the EGDM group (but not the LGDM group). The greatest need for insulin and/or metformin was with EGDM.CONCLUSIONS: Adverse perinatal outcomes were increased with EGDM despite treatment from 24-28 weeks' gestation, suggesting the need to initiate treatment early, and more aggressively, to reduce the effects of exposure to the more severe maternal hyperglycemia from early pregnancy.
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- Simmons, David, et al.
(author)
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Regression From Early GDM to Normal Glucose Tolerance and Adverse Pregnancy Outcomes in the Treatment of Booking Gestational Diabetes Mellitus Study
- 2024
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In: Diabetes Care. - 0149-5992 .- 1935-5548.
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Journal article (peer-reviewed)abstract
- OBJECTIVE: To compare pregnancy outcomes among women with a normal oral glucose tolerance test (OGTT) before 20 weeks' gestation (early) and at 24-28 weeks' gestation (late) (no gestational diabetes mellitus, or No-GDM), those with early GDM randomized to observation with a subsequent normal OGTT (GDM-Regression), and those with GDM on both occasions (GDM-Maintained).RESEARCH DESIGN AND METHODS: Women at <20 weeks' gestation with GDM risk factors who were recruited for a randomized controlled early GDM treatment trial were included. Women with treated early GDM and late GDM (according to the World Health Organization's 2013 criteria) were excluded from this analysis. Logistic regression compared pregnancy outcomes.RESULTS: GDM-Regression (n = 121) group risk factor profiles and OGTT results generally fell between the No-GDM (n = 2,218) and GDM-Maintained (n = 254) groups, with adjusted incidences of pregnancy complications similar between the GDM-Regression and No-GDM groups.CONCLUSIONS: Women with early GDM but normal OGTT at 24-28 weeks' gestation had pregnancy outcomes that were similar to those of individuals without GDM. Identifying early GDM likely to regress would allow treatment to be avoided.
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- Simmons, David, et al.
(author)
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Treatment of Gestational Diabetes Mellitus Diagnosed Early in Pregnancy
- 2023
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In: New England Journal of Medicine. - : Massachusetts Medical Society. - 0028-4793 .- 1533-4406. ; 388:23, s. 2132-2144
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Journal article (peer-reviewed)abstract
- BACKGROUND: Whether treatment of gestational diabetes before 20 weeks' gestation improves maternal and infant health is unclear.METHODS: We randomly assigned, in a 1:1 ratio, women between 4 weeks' and 19 weeks 6 days' gestation who had a risk factor for hyperglycemia and a diagnosis of gestational diabetes (World Health Organization 2013 criteria) to receive immediate treatment for gestational diabetes or deferred or no treatment, depending on the results of a repeat oral glucose-tolerance test [OGTT] at 24 to 28 weeks' gestation (control). The trial included three primary outcomes: a composite of adverse neonatal outcomes (birth at <37 weeks' gestation, birth trauma, birth weight of ≥4500 g, respiratory distress, phototherapy, stillbirth or neonatal death, or shoulder dystocia), pregnancy-related hypertension (preeclampsia, eclampsia, or gestational hypertension), and neonatal lean body mass.RESULTS: A total of 802 women underwent randomization; 406 were assigned to the immediate-treatment group and 396 to the control group; follow-up data were available for 793 women (98.9%). An initial OGTT was performed at a mean (±SD) gestation of 15.6±2.5 weeks. An adverse neonatal outcome event occurred in 94 of 378 women (24.9%) in the immediate-treatment group and in 113 of 370 women (30.5%) in the control group (adjusted risk difference, -5.6 percentage points; 95% confidence interval [CI], -10.1 to -1.2). Pregnancy-related hypertension occurred in 40 of 378 women (10.6%) in the immediate-treatment group and in 37 of 372 women (9.9%) in the control group (adjusted risk difference, 0.7 percentage points; 95% CI, -1.6 to 2.9). The mean neonatal lean body mass was 2.86 g in the immediate-treatment group and 2.91 g in the control group (adjusted mean difference, -0.04 g; 95% CI, -0.09 to 0.02). No between-group differences were observed with respect to serious adverse events associated with screening and treatment.CONCLUSIONS: Immediate treatment of gestational diabetes before 20 weeks' gestation led to a modestly lower incidence of a composite of adverse neonatal outcomes than no immediate treatment; no material differences were observed for pregnancy-related hypertension or neonatal lean body mass. (Funded by the National Health and Medical Research Council and others; TOBOGM Australian New Zealand Clinical Trials Registry number, ACTRN12616000924459.).
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- Vikner, Pia, 1981, et al.
(author)
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Att diagnostiseras med graviditetsdiabetes - påverkar �det upplevelsen av graviditet, förlossning och amning?
- 2023
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In: Konferens Reproduktiv Hälsa 2023.
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Conference paper (other academic/artistic)abstract
- Graviditetsdiabetes uppkommer på grund av en ökad insulinresistens hos den gravida kvinnan. Sedan 2013 förespråkar WHO striktare diagnoskriterier för graviditetsdiabetes vilka även Socialstyrelsen rekommenderar sedan 2015. Trots rekommendationen används olika diagnoskriterier runtom i Sverige och förekomsten av graviditetsdiabetes varierar stort, allt från 1–22% (nationellt 6,2%). Att få diagnosen graviditetsdiabetes kan upplevas stigmatiserande och medföra ett ökat fokus på risker, övervakning och medicinska interventioner. Hur detta påverkar kvinnans upplevelse av graviditet, förlossning och amning är inte tillräckligt studerat. Syftet med studien är att undersöka om diagnosen graviditetsdiabetes påverkar kvinnans tillit till egen förmåga och känsla av sammanhang, hennes förlossningsupplevelse och tillit till egen förmåga att amma. Studien är en del av multicenterstudien CDC4G (ISRCTN 41918550) och förlossningsklinikerna i Örebro, Lund, Uppsala, Göteborg och Falun deltar. De kvinnor som enligt lokala riktlinjer för screening planeras för oralt glukostoleranstest (OGTT), kan tillfrågas om medverkan. Studien har etiktillstånd (2019–02080, 2020-00122). Studien pågår med insamling av enkäter som mäter känsla av sammanhang (SOC-13), tilltro till egen förmåga (GSE), förlossningsupplevelse (CEQ2) och tillit till egen förmåga att amma (BSE). Mätningarna sker före OGTT samt cirka åtta veckor postpartum. Jämförande analyser kommer att göras mellan svarande kvinnor som fått diagnosen (studiegrupp) med de som inte fått diagnosen (kontrollgrupp). Då diagnoskriterierna varierar på studieorterna kommer en andra kontrollgrupp bestå av kvinnor som inte fick diagnosen men vars resultat från OGTT överskred de rekommenderade diagnoskriterierna från Socialstyrelsen. Resultatet kommer att ge en ökad förståelse för om diagnosen graviditetsdiabetes påverkar kvinnans känsla av sammanhang och tilltro till egen förmåga under graviditet och amning samt fylla kunskapsluckan om diagnosen påverkar kvinnans förlossningsupplevelse. Slutsatserna kan bli ett viktigt bidrag i diskussionen om när och hur diagnosen graviditetsdiabetes ska användas under graviditet.
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- 2019
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Journal article (peer-reviewed)
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