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A Clinical Protocol For The Screening Diagnosis And Management Of Gestational Diabetes Mellitus By The Advanced Practice Nurse In The Primary Care Setting
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Book Synopsis A Clinical Protocol for the Screening, Diagnosis, and Management of Gestational Diabetes Mellitus by the Advanced Practice Nurse in the Primary Care Setting by : Robin J. Jones
Download or read book A Clinical Protocol for the Screening, Diagnosis, and Management of Gestational Diabetes Mellitus by the Advanced Practice Nurse in the Primary Care Setting written by Robin J. Jones and published by . This book was released on 1997 with total page 86 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Book Synopsis American Dietetic Association Guide to Gestational Diabetes Mellitus by : Alyce M. Thomas
Download or read book American Dietetic Association Guide to Gestational Diabetes Mellitus written by Alyce M. Thomas and published by American Dietetic Associati. This book was released on 2005 with total page 178 pages. Available in PDF, EPUB and Kindle. Book excerpt: Gestational diabetes mellitus is a growing concern in women's health. This reference examines the pathophysiology, classification, screening, and diagnosis of gestational diabetes, and provides information on testing methods used to monitor maternal and fetal health, nutrition requirements in pregnancy, medical nutrition therapy, insulin therapy in pregnancy, and postpartum considerations. Practical forms, including questionnaires, assessment forms, and food plan calculations are included.
Book Synopsis Hamric & Hanson's Advanced Practice Nursing - E-Book by : Mary Fran Tracy
Download or read book Hamric & Hanson's Advanced Practice Nursing - E-Book written by Mary Fran Tracy and published by Elsevier Health Sciences. This book was released on 2018-01-03 with total page 696 pages. Available in PDF, EPUB and Kindle. Book excerpt: Edited and written by a Who’s Who of internationally known advanced practice nursing experts, Hamric and Hanson's Advanced Practice Nursing: An Integrative Approach, 6th Edition helps you develop an understanding of the various advanced practice registered nursing (APRN) roles. This bestselling textbook provides a clear, comprehensive, and contemporary introduction to advanced practice nursing today, addressing all major APRN competencies, roles, and issues. It covers topics ranging from the evolution of advanced practice nursing to evidence-based practice, leadership, ethical decision-making, and health policy. New to this edition is expanded coverage of interprofessional collaborative practice, updated coverage of APRN roles related to implementation of healthcare reform in the U.S., updated and expanded coverage of IOM and QSEN, a global focus on international advanced practice nursing, and much more! Coverage of all APN core competencies defines and describes all competencies, including direct clinical practice, guidance and coaching, consultation, evidence-based practice, leadership, collaboration, and ethical decision-making. Operationalizes and applies the APN core competencies to the major APN specialties including the Clinical Nurse Specialist, the Primary Care Nurse Practitioner, the Acute Care Nurse Practitioner, the Certified Nurse-Midwife, and the Certified Registered Nurse Anesthetist. Content on managing APN environments addresses such factors as business planning and reimbursement; marketing, negotiating, and contracting; regulatory, legal, and credentialing requirements; health policy; and nursing outcomes and performance improvement research. UNIQUE! Exemplar boxes (case studies), including Day in the Life vignettes of each APN specialty, emphasize innovative practices and coverage of advanced practice roles. In-depth discussions of educational strategies for APN competency development show how nurses develop competencies as they progress into advanced practice. NEW and UNIQUE! Expanded coverage of interprofessional collaborative practice includes the latest Interprofessional Education Collaborative (IPEC) Core Competencies for Interprofessional Collaborative Practice. NEW! Updated coverage of APRN roles related to implementation of healthcare in the U.S. reflects current and anticipated changes in APRN roles related to healthcare reform. NEW! Coverage of IOM and QSEN has been updated and expanded. NEW! Refocused International Development of Advanced Practice Nursing chapter has been rewritten to be more global and inclusive in focus, to reflect the state of advanced practice nursing practice throughout all major regions of the world. NEW! Expanded content on the role of advanced practice nurses in teaching/education/mentoring and health policy related to the APRN role is featured in the 6th edition.
Book Synopsis Screening, Diagnosis and Management of Gestational Diabetes in New Zealand by :
Download or read book Screening, Diagnosis and Management of Gestational Diabetes in New Zealand written by and published by . This book was released on 2014 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt:
Book Synopsis Gestational diabetes mellitus risk assessment, screening, diagnosis, and management before, during and after pregnancy by : A. Seval Ozgu-Erdinc
Download or read book Gestational diabetes mellitus risk assessment, screening, diagnosis, and management before, during and after pregnancy written by A. Seval Ozgu-Erdinc and published by Frontiers Media SA. This book was released on 2023-04-26 with total page 129 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Book Synopsis Gestational Diabetes During and After Pregnancy by : Catherine Kim
Download or read book Gestational Diabetes During and After Pregnancy written by Catherine Kim and published by Springer Science & Business Media. This book was released on 2014-01-02 with total page 381 pages. Available in PDF, EPUB and Kindle. Book excerpt: Gestational Diabetes Mellitus is becoming an increasingly prevalent disease as obesity and other chronic diseases are on the rise. It requires careful and informed clinical management as the care received during pregnancy affects not only perinatal health but the risk of developing type 2 diabetes even decades into the future, in both the mother and the child.From epidemiology and pathophysiology to diagnosis and management, covering recent breakthroughs in research and up-to-date developments in clinical practice, Gestational Diabetes During and After Pregnancy offers the reader a comprehensive and current look at Gestational Diabetes. Anyone involved in the research, public health or clinical aspects of Gestational Diabetes will find this volume a valuable aid in consolidating all recent developments regarding this disease.
Author :U. S. Department of Health and Human Services Publisher :Createspace Independent Pub ISBN 13 :9781483943923 Total Pages :330 pages Book Rating :4.9/5 (439 download)
Book Synopsis Screening and Diagnosing Gestational Diabetes Mellitus by : U. S. Department of Health and Human Services
Download or read book Screening and Diagnosing Gestational Diabetes Mellitus written by U. S. Department of Health and Human Services and published by Createspace Independent Pub. This book was released on 2013-03-23 with total page 330 pages. Available in PDF, EPUB and Kindle. Book excerpt: Gestational diabetes mellitus (GDM) is defined as glucose intolerance first discovered in pregnancy. Pregestational diabetes mellitus refers to any type of diabetes diagnosed before pregnancy. Pregnant women with pregestational diabetes experience an increased risk of poor maternal, fetal, and neonatal outcomes. The extent to which GDM predicts adverse outcomes for mother, fetus, and neonate is less clear. Depending on the diagnostic criteria used and the population screened, the prevalence of GDM ranges from 1.1 to 25.5 percent of pregnancies in the United States. The incidence of GDM has increased over the past decades in parallel with the increase in rates of obesity and type 2 diabetes mellitus, and this trend is expected to continue. It is unclear how much the increase in obesity will affect the proportion of women diagnosed with overt diabetes during pregnancy versus transient pregnancy-induced glucose intolerance. GDM is usually diagnosed after 20 weeks' gestation when placental hormones that have the opposite effect of insulin on glucose metabolism increase substantially. Women with adequate insulin secreting capacity overcome this insulin resistance of pregnancy by secreting more endogenous insulin to maintain normal blood glucose. Women with less adequate pancreatic reserve are unable to produce sufficient insulin to overcome the increase in insulin resistance, and glucose intolerance results. Glucose abnormalities in women with GDM usually resolve postpartum, but commonly recur in subsequent pregnancies. Women with GDM have an increased risk of future development of overt diabetes. The cumulative incidence of diabetes after a diagnosis of GDM varies widely depending on maternal body mass index (BMI), ethnicity, and time since index pregnancy, and it may reach levels as high as 60 percent. When glucose abnormalities persist postpartum in a woman with GDM, her diabetes is recategorized as overt diabetes. When this occurs, the likelihood that this woman had pregestational (i.e., overt) diabetes increases, especially if the diagnosis of GDM occurred before 20 weeks' gestation and glucose levels were markedly elevated in pregnancy. Based on systematic reviews published in 2003 and 2008, the USPSTF concluded that there was insufficient evidence upon which to make a recommendation regarding routine screening of all pregnant women for GDM. The primary aims of this review were to (1) identify the test properties of screening and diagnostic tests for GDM, (2) evaluate the potential benefits and harms of screening at greater than or equal to 24 weeks and less than 24 weeks' gestation, (3) assess the effects of different screening and diagnostic thresholds on outcomes for mothers and their offspring, and (4) determine the effects of treatment in modifying outcomes for women diagnosed with GDM. The benefits and harms of treatments were considered in this review to determine the downstream effects of screening on health outcomes. The intent of this review was also to assess whether evidence gaps in the previous USPSTF reviews have been filled. Key questions include: Key Question 1: What are the sensitivities, specificities, reliabilities, and yields of current screening tests for GDM? (a) After 24 weeks' gestation? (b) During the first trimester and up to 24 weeks' gestation? Key Question 2: What is the direct evidence on the benefits and harms of screening women (before and after 24 weeks' gestation) for GDM to reduce maternal, fetal, and infant morbidity and mortality? Key Question 3: In the absence of treatment, how do health outcomes of mothers who meet various criteria for GDM and their offspring compare to those who do not meet the various criteria? Key Question 4: Does treatment modify the health outcomes of mothers who meet various criteria for GDM and their offspring? Key Question 5: What are the harms of treating GDM and do they vary by diagnostic approach?
Download or read book Index Medicus written by and published by . This book was released on 2002 with total page 1612 pages. Available in PDF, EPUB and Kindle. Book excerpt: Vols. for 1963- include as pt. 2 of the Jan. issue: Medical subject headings.
Book Synopsis Gestational Diabetes Mellitus: A Clinical Approach by : Eden Kerr
Download or read book Gestational Diabetes Mellitus: A Clinical Approach written by Eden Kerr and published by American Medical Publishers. This book was released on 2021-11-16 with total page 229 pages. Available in PDF, EPUB and Kindle. Book excerpt: Gestational diabetes mellitus (GDM) is a condition characterized by the presence of a degree of glucose intolerance during pregnancy. A woman is assesed with gestational diabetes when glucose intolerance persists beyond 24 to 28 weeks of gestation. Certain risk factors predispose a woman to develop GDM, such as polycystic ovary syndrome, age that is above 35 years, a previous history of GDM or impaired glucose tolerance, obesity, etc. A blood glucose test showing glucose levels higher than 126 mg/dl after fasting can indicate gestational diabetes. Other diagnostic techniques include urinary glucose testing, oral glucose tolerance test and screening glucose challenge test. The treatment of GDM is possible with insulin, diet and lifestyle modifications. Regular exercise, self-monitoring glucose and behavioral interventions can reduce the effects of GDM on the mother and child. This book provides comprehensive insights into gestational diabetes mellitus. Also included herein is a detailed explanation of the various management strategies of gestational diabetes mellitus. This book is meant for students who are looking for an elaborate reference text on this condition.
Book Synopsis Screening for Gestational Diabetes Mellitus by : Teresa A. Hillier
Download or read book Screening for Gestational Diabetes Mellitus written by Teresa A. Hillier and published by . This book was released on 2008 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: BACKGROUND: In a 2003 evidence report, the United States Preventive Services Task Force (USPSTF) concluded that the scientific evidence was insufficient to advise for or against routine screening for gestational diabetes mellitus (GDM) in all pregnant women. The 2003 review did not include evidence pertaining to GDM screening prior to 24 weeks gestation. As the prevalence of women at high risk for type 2 diabetes and GDM has continued to increase dramatically over the intervening years, the issue of early screening has taken on greater importance. PURPOSE: This review identifies and evaluates new evidence since the prior review on the risks and benefits of GDM screening at 24 weeks or later; it also newly reviews all of the available evidence pertaining to GDM screening prior to 24 weeks. DATA SOURCES: We conducted five database searches of MEDLINE(r), Cochrane Central Registry of Controlled Trials, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Health Technology Assessment, and National Institute for Health and Clinical Excellence from 2000 to September 2006, supplemented by a search for screening prior to 24 weeks gestation from 1966-99. Searches were also supplemented with recommendations from outside experts and reviews of bibliographies of other relevant articles and systematic reviews. We dual-reviewed all citations in the 2003 Evidence Synthesis for inclusion in this review. STUDY SELECTION: In conjunction with USPSTF members and with Agency for Healthcare Research and Quality staff, we developed and refined an analytic framework and five key questions (KQ). For assessing potential benefit of GDM screening and treatment, we included only randomized trials that used the standard, currently accepted one-step and two-step diagnostic criteria to evaluate screening and treatment of GDM. Study design and criteria were less stringent for considering potential harms. Using inclusion/exclusion criteria for each question, two investigators dual-reviewed 1403 abstracts and 277 potentially included articles. Of the potentially included articles, 90 were excluded for study design and 12 for poor quality, and the remainder for other reasons. DATA EXTRACTION: We abstracted, critically appraised, and synthesized 13 total articles meeting criteria for the five KQs. Abstracted elements were arrayed in evidence tables, using criteria specific to each KQ. DATA SYNTHESIS AND RESULTS: The best new evidence is a good-quality randomized controlled trial (RCT) that evaluated the maternal and neonatal outcomes for 1,000 pregnancies in which mild GDM was diagnosed between 24-34 weeks gestation and treated, compared to outcomes for pregnancies in which mild GDM was diagnosed but not treated. With treatment, there was a statistically significant reduction in the composite neonatal outcome of any serious perinatal complication (Adjusted RR 0.33 [95 percent CI 0.14-0.75]). Serious perinatal complications was defined as any of the following: death, shoulder dystocia, bone fracture, and nerve palsy. The absolute rates of these individual perinatal outcomes were also reported in the paper, but could not be compared between groups due to no events for death, bone fracture, or nerve palsy in the treatment group. Overall, there were seven infants with serious perinatal complications in the treatment group (all shoulder dystocia), compared to 23 infants with 25 serious perinatal complications in the non-treated group (five deaths, one fractured humerus, three nerve palsies, and 16 shoulder dystocia). Shoulder dystocia was not a specified health outcome for this evidence review. The remaining components in the composite outcome (neonatal death, fracture, nerve palsy) were health outcomes specified by the Task Force for this review. The causes of the five deaths in the untreated group were: two stillbirths (unexplained intrauterine deaths at term of appropriately grown infants), one stillbirth at 35 weeks gestation associated with pre-eclampsia and intrauterine growth restriction, one infant death from asphyxia during labor without antepartum hemorrhage, and one death from a lethal congenital anomaly. Treatment of GDM also reduced the risk of maternal pregnancy-induced hypertension (Adjusted RR 0.70 [0.51-0.95]). There was no evidence of harm to mother or infant with treatment in this study. In a sub-set of participants who responded to a post-partum questionnaire, mothers treated for GDM were significantly less depressed and reported a trend towards better quality-of-life at 3 months post-partum; these post-partum data may have some limitations. Of five treatment comparison trials, two achieved improved glycemic control with intensified management of different types (postprandial monitoring and four times daily insulin) and both found significant reductions in several perinatal complications (a combined outcome for perinatal morbidity in one study, hyperbilirubinemia, and macrosomia). These improved outcomes occurred without evidence of harms from significant maternal hypoglycemia with treatment. The remaining three treatment-comparison trials did not differ in glycemic control achieved and outcomes were similar. Finally, available evidence suggests that diagnosis and treatment of GDM does not worsen quality-of-life except possibly transiently for the first few weeks after diagnosis. As early as 6 weeks after diagnosis, women treated for GDM may have better self-rated quality-of-life. LIMITATIONS: We found no evidence base for trials of screening programs to test screened versus unscreened populations. However, both current clinical practice patterns for GDM and ethical constraints on research in human subjects would now likely preclude such a study in the US. Thus, the available evidence base comprises studies in only screen-detected populations. Evaluating the potential benefit and harms of screening and treatment of GDM is limited by lack of a consistent standard for screening or diagnosis and the need to consider multiple potential outcomes that are not unique to GDM. Little information is available on harms of treatment--these are relatively rare outcomes and may not be evident in trials. While antepartum surveillance was specifically restricted from the scope of this review by the Task Force, it is possible that increased antepartum surveillance of women diagnosed with GDM could result in harms that were not evaluated with this review. CONCLUSIONS: We found limited evidence to evaluate early screening for GDM prior to 24 weeks gestation, the purpose of which would be to detect previously unrecognized diabetes (GDM is defined as onset or first recognition of diabetes during pregnancy). Therefore, more research is needed before this question can be evaluated. A recent good-quality randomized controlled trial reported that treatment of screen-detected women with mild GDM diagnosed after 24 weeks gestation reduces both maternal and composite neonatal health outcomes, without apparent harm--as reported in this RCT and in several other observational studies.
Book Synopsis Clinical Case Studies for the Family Nurse Practitioner by : Leslie Neal-Boylan
Download or read book Clinical Case Studies for the Family Nurse Practitioner written by Leslie Neal-Boylan and published by John Wiley & Sons. This book was released on 2011-11-28 with total page 432 pages. Available in PDF, EPUB and Kindle. Book excerpt: Clinical Case Studies for the Family Nurse Practitioner is a key resource for advanced practice nurses and graduate students seeking to test their skills in assessing, diagnosing, and managing cases in family and primary care. Composed of more than 70 cases ranging from common to unique, the book compiles years of experience from experts in the field. It is organized chronologically, presenting cases from neonatal to geriatric care in a standard approach built on the SOAP format. This includes differential diagnosis and a series of critical thinking questions ideal for self-assessment or classroom use.
Book Synopsis Documentation of the Diagnosis of Gestational Diabetes Mellitus by Advanced Practice Nurses by : Carol Lee Willoughby
Download or read book Documentation of the Diagnosis of Gestational Diabetes Mellitus by Advanced Practice Nurses written by Carol Lee Willoughby and published by . This book was released on 1999 with total page 120 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Book Synopsis Prentice Hall Nursing Diagnosis Handbook with NIC Interventions and NOC Outcomes by : Judith M. Wilkinson
Download or read book Prentice Hall Nursing Diagnosis Handbook with NIC Interventions and NOC Outcomes written by Judith M. Wilkinson and published by Prentice Hall. This book was released on 2009 with total page 1076 pages. Available in PDF, EPUB and Kindle. Book excerpt: For all undergraduate- and graduate-level courses across the Nursing curriculum, especially clinical courses. This easy-to-use guide gives students instant access to information needed to write thorough, individualized care plans based on the most recent NANDA-approved nursing diagnoses. Nursing Interventions Classifications (NIC) and Nursing Outcome Classifications (NOC) are incorporated throughout. The guide presents diagnoses associated with medical, surgical, psychiatric, perinatal, and pediatric patient populations. Each Plan of Care includes: definition of nursing diagnosis, defining characteristics, related factors, suggestions for use, suggested alternative diagnoses, expected outcomes and evaluation criteria, NIC/NOC taxonomy, and suggested nursing actions.
Book Synopsis Gestational Diabetes: from Diagnosis to Treatment by : Hasan Aydin
Download or read book Gestational Diabetes: from Diagnosis to Treatment written by Hasan Aydin and published by Nova Science Publishers. This book was released on 2020-10-09 with total page 648 pages. Available in PDF, EPUB and Kindle. Book excerpt: Gestational diabetes, because of its not only high prevalence but also resulting complications in both mother and fetus makes it one of the most important problem of a pregnant woman. The exact cause of gestational diabetes is unknown. Obviously, there is no one reason for the development of the disease. Placental hormones likely play a role. Insulin resistance is in the center and some factors like adipokines, lipids, inflammation, oxidative stress, heavy metals, gut microbiota, autoimmunity, metabolomics, genetic factors and vitamin D are the determinants for the development of insulin resistance and disease itself.Worldwide distribution of the disease changes according to geography. Ethnic factors also play role. Although some well-known risk factors have role in the development of the disease, 1 in 20 women without any risk factors also develop GDM. There is no universal screening and diagnostic methods. Some countries use universal screening some others prefer selective screening of women with risk factors. In addition, some suggest use of one-step diagnosis, while others two-step. The most challenging issue is use of some biomarkers in early (first trimester) diagnosis of pregnancy to prevent development of GDM. Many modalities are used in treatment. Medical nutrition therapy is still the basis of management. Exercise has some roles, too. Besides pharmacotherapies like insulin and oral antidiabetics, some modern modalities like insulin pump therapy together with continuous glucose monitoring, telemedicine, dietary supplements like myoinositols are also covered in this book. Monitorization is important in diabetes and role of nurses in follow-up is incontrovertible. If not treated well, both fetus and mother are open to complications. From congenital malformations to macrosomia, if inevitable, proper management of these problems has to be considered. Some comorbidities like hypertension, thyroid problems and psychosocial stress complicate the problem further. Fetal monitorization, time and type of delivery and management of glycaemia during peripartum period are the issues to be considered towards to end of pregnancy.The problem does not finish with the birth of baby. Both mother and newborn has to be followed for the development of future problems like postpartum diabetes and obesity. Nutrition and benefits of breastfeeding are important points for the health of the baby. In addition, every efforts has to be spent to prevent recurrence of the disease in subsequent pregnancies.The most important instrument against fighting a disease is information i.e. how much we know about it. Understanding the problem thoroughly strengthens our hands to cope and overcome it more easily. The main target of this book is to handle every aspect of the disease from diagnosis to treatment as evident from the title. It is a candidate for a reference guide in this subject. It includes most recent and update data on gestational diabetes.
Book Synopsis Medical Management of Pregnancy Complicated by Diabetes by : Erika Werner
Download or read book Medical Management of Pregnancy Complicated by Diabetes written by Erika Werner and published by . This book was released on 2019 with total page 184 pages. Available in PDF, EPUB and Kindle. Book excerpt: Pregnancy complicated by diabetes is a medical challenge that can be minimized through a program of expert protocols and patient partnerships. This newly revised edition presents a complete package of these protocols that can help produce healthy infants in pregnancies complicated by type 1, type 2, and gestational diabetes. Topics include: --Pre and Inter-pregnancy counceling, assessment, and management --Contraception in diabetes and prediabetes --Nutrition management of preexisting diabetes --Risk assessment, fetal surveillance and delivery in prenancies complicated by diabetes --Neonatal care of infants of mothers with diabetes --Management of gestational diabetes --Diagnostic testing and fetal surveillance --Use of insulin in pregnancy and assessment of glycemic control --Postpartum concerns for women with diabetes
Book Synopsis Universal Diagnostic Criteria for Gestational Diabetes Mellitus by : Kristen A. Hasler
Download or read book Universal Diagnostic Criteria for Gestational Diabetes Mellitus written by Kristen A. Hasler and published by . This book was released on 2017 with total page 174 pages. Available in PDF, EPUB and Kindle. Book excerpt: Gestational diabetes mellitus (GDM) is of growing concern for many populations due to its association with other diseases, such as type 2 diabetes mellitus (T2DM), cardiovascular disease, adult metabolic syndrome, childhood obesity, and obesity in adults. GDM is often the precursor to future disease in both the mother and the offspring creating a vicious cycle carried throughout generations. Information presented in this thesis describes the pathology of, risk factors for, and adverse maternal and neonatal outcomes associated with GDM. Review and analysis of scientific and clinical literature was done to establish the need for a universal diagnostic protocol that would identify women that would benefit from treatment interventions for GDM. Pros and cons of current methods demonstrate the complexity in establishing such protocols. Ease and benefits of testing methods, treatment options, and compliance were considered in the scientific and clinical literature analyzed. Other studies assessed the cost-effectiveness of healthcare of a large increase in GDM prevalence that would result from lowering the diagnostic thresholds. Scientists in the field are in agreement that establishing universal diagnostic criteria for GDM will make it easier for researchers to analyze and interpret data, but lack of evidence has them at odds about what that criteria should be. The Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study showed strong continuous associations of maternal glucose levels with adverse feto-maternal outcomes. In 2008, the International Association of Diabetes and Pregnancy Study Groups (IADPSG) held a conference with over 200 experts representing 40 countries. The experts reviewed the HAPO study results and came to a consensus which they expected would become the basis for internationally endorsed criteria for gestational diabetes (Metzger, 2010). Around the same time the HAPO trial was conducted, two other studies contributed significant findings that assisted the IADPSG consensus panel. In 2005, the Australian Carbohydrate Intolerance Study in Pregnant Women (ACHOIS) provided conclusive evidence that minimal treatment for hyperglycemia in pregnancy meeting the World Health Organization (WHO) criteria for GDM improves maternal and fetal outcomes and Landon et al. (2009) concluded that the same minimal treatment for mild hyperglycemia not meeting the WHO thresholds also improves maternal and fetal outcomes. Fuller and Borgida (2015) question the effect that ease of testing would have on compliance since data showed a less than expected rise in GDM incidence using the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria compared to the 2-step screening method and without marked improvements in outcomes. This suggests that low compliance of screening with the IADPSG group could explain the less than expected rise in GDM. Had the IADPSG group been more compliant, a greater rise in GDM would have been expected increasing healthcare costs without significantly improving maternal and fetal outcomes. Other studies done in the UK conclude otherwise with data showing significant improvement in outcomes that are cost-effective. In summary, the task of establishing universal diagnostic criteria for gestational diabetes mellitus remains a challenge. There is no clear solution and more evidence is needed to assess risk-benefit ratios. The one thing that is clear is that GDM, type 2 diabetes, cardiovascular disease, obesity, and adult metabolic syndrome are a vicious cycle and prevalence of each is on the rise at alarming rates. The emerging field of epigenetics has only complicated matters by adding yet another variable. The variables that could be controlled would be the screening and diagnostic tests used for GDM.
Book Synopsis Screening and Diagnosing Gestational Diabetes Mellitus by :
Download or read book Screening and Diagnosing Gestational Diabetes Mellitus written by and published by . This book was released on 2012 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: BACKGROUND: There is uncertainty as to the optimal approach for screening and diagnosis of gestational diabetes mellitus (GDM). Based on systematic reviews published in 2003 and 2008, the U.S. Preventive Services Task Force concluded that there was insufficient evidence upon which to make a recommendation regarding routine screening of all pregnant women. OBJECTIVES: (1) Identify properties of screening tests for GDM, (2) evaluate benefits and harms of screening for GDM, (3) assess the effects of different screening and diagnostic thresholds on outcomes for mothers and their offspring, and (4) determine the benefits and harms of treatment for a diagnosis of GDM. DATA SOURCES: We searched 15 electronic databases from 1995 to May 2012, including MEDLINE and Cochrane Central Register of Controlled Trials (which contains the Cochrane Pregnancy and Childbirth Group registry); gray literature; Web sites of relevant organizations; trial registries; and reference lists. METHODS: Two reviewers independently conducted study selection and quality assessment. One reviewer extracted data, and a second reviewer verified the data. We included published randomized and nonrandomized controlled trials and prospective and retrospective cohort studies that compared any screening or diagnostic test with any other screening or diagnostic test; any screening with no screening; women who met various thresholds for GDM with those who did not meet various criteria, where women in both groups did not receive treatment; any treatment for GDM with no treatment. We conducted a descriptive analysis for all studies and meta-analyses when appropriate. Key outcomes included preeclampsia, maternal weight gain, birth injury, shoulder dystocia, neonatal hypoglycemia, macrosomia, and long-term metabolic outcomes for the child and mother. RESULTS: The search identified 14,398 citations and included 97 studies (6 randomized controlled trials, 63 prospective cohort studies, and 28 retrospective cohort studies). Prevalence of GDM varied across studies and diagnostic criteria: American Diabetes Association (75 g) 2 to 19 percent; Carpenter and Coustan 3.6 to 38 percent; National Diabetes Data Group 1.4 to 50 percent; and World Health Organization 2 to 24.5 percent. Lack of a gold standard for the diagnosis of GDM and little evidence about the accuracy of screening strategies for GDM remain problematic. The 50 g oral glucose challenge test with a glucose threshold of 130 mg/dL versus 140 mg/dL improves sensitivity and reduces specificity. Both thresholds have high negative predictive values (NPV) but variable positive predictive values (PPVs) across a range of prevalence. There was limited evidence for the screening of GDM diagnosed less than 24 weeks' gestation (three studies). One study compared the International Association of Diabetes in Pregnancy Study Groups' (IADPSG) diagnostic criteria with a two-step strategy. Sensitivity was 82 percent, specificity was 94 percent. Only two studies examined the effects on health outcomes from screening for GDM. One retrospective cohort study (n=1,000) showed more cesarean deliveries in the screened group. A survey within a prospective cohort study (n=93) found the same incidence of macrosomia (|́Æ4.3 kg) in screened and unscreened groups (7 percent each group). Thirty-eight studies examined health outcomes for women who met different criteria for GDM and did not undergo treatment. Methodologically strong studies showed a continuous positive relationship between increasing glucose levels and the incidence of primary cesarean section and macrosomia. One of these studies also found significantly fewer cases of preeclampsia, cesarean section, shoulder dystocia and/or birth injury, clinical neonatal hypoglycemia, and hyperbilirubinemia for women without GDM compared with those meeting IADPSG criteria. Among the other studies, fewer cases of preeclampsia were observed for women with no GDM and women who were false positive versus those meeting Carpenter and Coustan criteria. For maternal weight gain, few comparisons showed differences. For fetal birth trauma, single studies showed no differences for women with Carpenter and Coustan GDM and World Health Organization impaired glucose tolerance versus women without GDM. Women diagnosed based on National Diabetes Data Group GDM had more fetal birth trauma compared with women without GDM. Fewer cases of macrosomia were seen in the group without GDM compared with Carpenter and Coustan GDM, Carpenter and Coustan 1 abnormal oral glucose tolerance test, National Diabetes Data Group GDM, National Diabetes Data Group false positives, and World Health Organization impaired glucose tolerance. Fewer cases of neonatal hypoglycemia were found among patient groups without GDM compared with those meeting Carpenter and Coustan criteria. There was more childhood obesity for Carpenter and Coustan GDM versus patient groups with no GDM. Eleven studies compared diet modification, glucose monitoring, and insulin as needed with no treatment. Moderate evidence showed fewer cases of preeclampsia in the treated group. The evidence was insufficient for maternal weight gain and birth injury. Moderate evidence found less shoulder dystocia with treatment for GDM. Low evidence showed no difference for neonatal hypoglycemia between treated and untreated GDM. Moderate evidence showed benefits of treatment for reduction of macrosomia (>4,000 g). There was insufficient evidence for long-term metabolic outcomes among offspring. Five studies provided data on harms of treating GDM. No difference was found for cesarean delivery, induction of labor, small for gestational age, or admission to a neonatal intensive care unit. There were significantly more prenatal visits among those treated. CONCLUSIONS: While evidence supports a positive association with increasing plasma glucose on a 75 g or 100 g oral glucose tolerance test and macrosomia and primary cesarean section, clear thresholds for increased risk were not found. The 50 g oral glucose challenge test has high NPV but variable PPV. Treatment of GDM results in less preeclampsia and macrosomia. Current evidence does not show that treatment of GDM has an effect on neonatal hypoglycemia or future poor metabolic outcomes. There is little evidence of short-term harm from treating GDM other than an increased demand for services. Research is needed on the long-term metabolic outcome for offspring as a result of GDM and its treatment, and the "real world" effects of GDM treatment on use of care.
