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Hyperglycaemia in Pregnancy: Detection, Management and Postnatal Care in Rural Communities

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Women's Health".

Deadline for manuscript submissions: closed (31 May 2020) | Viewed by 16048

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Special Issue Editors

Dr. Julia Marley

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Guest Editor

The University of Western Australia, Rural Clinical School of Western Australia,Other Affiliation: Kimberley Aboriginal Medical Services Inc.,Broome, WA, Australia
Interests: Improving the quality of preventive health programs for Aboriginal people by trialling new programs and evaluating their effectiveness; improving screening for chronic diseases and mental health by trialling new screening protocols; and improving the quality of primary health care for Aboriginal people by evaluating health services

Ms. Emma Jamieson

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Guest Editor

The University of Western Australia, Rural Clinical School of Western Australia,Bunbury, WA, Australia
Interests: The causes, prediction and prevention of diabetes mellitus; background in pathophysiology of type 1 diabetes and pancreatic islet transplantation models; current clinical diabetes research focus on alternate biomarkers to improve detection of gestational diabetes mellitus in rural and remote antenatal patients; translational research aimed at improving birth outcomes and prevention or delayed progression to type 2 diabetes in mother and child

Dr. Andrew Kirke

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Guest Editor

The University of Western Australia, Rural Clinical School of Western Australia,Bunbury, WA, Australia
Interests: rural obstetrics, GP obstetrics, gestational diabetes; rural health; community screening for familial hypercholesterolaemia

Special Issue Information

Dear Colleagues,

We are organising a Special Issue on "Hyperglycaemia in Pregnancy: Detection, Management and Postnatal Care in Rural Communities" in the International Journal of Environmental Research and Public Health, a peer-reviewed journal that publishes articles and communications in the interdisciplinary area of environmental health sciences and public health. For detailed information on the journal, we refer you to https://www.mdpi.com/journal/ijerph.

Increasing maternal glycaemia in pregnancy is associated with adverse perinatal outcomes as well as long-term disordered maternal glucose metabolism and worsening childhood glucose metabolism. Due to the high prevalence of hyperglycaemia in pregnancy and potential for improved perinatal outcome, the International Association of Diabetes in Pregnancy Study Groups (IADPSG) recommends that all pregnant women without pre-existing diabetes be screened for hyperglycaemia by 75 g Oral Glucose Tolerance Test (OGTT). In 2010, the IADPSG derived new OGTT diagnostic cut-points for gestational diabetes (GDM). The use of specific cut-points assumes that the result is dichotomous, despite the fact that these cut-points were predominantly based on evidence of a continuous linear association between mild maternal hyperglycaemia and adverse perinatal outcomes from the Hyperglycaemia and Adverse Pregnancy Outcomes (HAPO) study. Implementation of new screening guidelines can be challenging in resource-poor environments and can lead to unintended consquences. The 2015 International Federation of Gynaecology and Obstetrics (FIGO) guidelines for GDM recommend both optimal, evidence-based standards for testing, diagnosis, management and postnatal care, as well as pragmatic alternatives, acknowledging limitations in low-resourced countries and regions. This Special Issue will explore the on-the-ground realities of screening and managing hyperglycaemia in pregnancy and the impact on outcomes for women living in regional, rural and remote communities and their health services. The issue is open to any topic related to hyperglycaemia in pregnancy for women living in regional, rural and remote communities. The listed keywords suggest just a few of the many possibilities.

Dr. Julia Marley
Ms. Emma Jamieson
Dr. Andrew Kirke
Guest Editors

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

hyperglycaemia in pregnancy
gestational diabetes
screening
diagnosis
oral glucose tolerance test
glycated haemoglobin
glycated albumin
management
antenatal care
postnatal care
glycolysis
clinical laboratory techniques
reproducibility of results
point-of-care testing
birth outcomes
epidemiology
user acceptability
rural and remote health
primary health care
Indigenous, Aboriginal, First Nations
health policy
implementation

Published Papers (5 papers)

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Research

14 pages, 862 KiB

Open AccessArticle

Estimated Treatment Effects of Tight Glycaemic Targets in Mild Gestational Diabetes Mellitus: A Multiple Cut-Off Regression Discontinuity Study Design

by David Song, James C Hurley and Maryanne Lia

Int. J. Environ. Res. Public Health 2020, 17(21), 7725; https://doi.org/10.3390/ijerph17217725 - 22 Oct 2020

Cited by 4 | Viewed by 2126

Abstract

Background: We investigated the treatment effects of tight glycaemic targets in a population universally screened according to the International Association of Diabetes and Pregnant Study Groups (IADPSG)/World Health Organisation (WHO) gestational diabetes mellitus (GDM) guidelines. As yet there, have been no randomized control trials evaluating the effectiveness of treatment of mild GDM diagnosed under the IADPSG/WHO diagnostic thresholds. We hypothesize that tight glycaemic control in pregnant women diagnosed with GDM will result in similar clinical outcomes to women just below the diagnostic thresholds. Methods: A multiple cut-off regression discontinuity study design in a retrospective observational cohort undergoing oral glucose tolerance tests (OGTT) (n = 1178). Treatment targets for women with GDM were: fasting capillary blood glucose (CBG) of ≤5.0 mmol/L and the 2-h post-prandial CBG of ≤6.7 mmol/L. Regression discontinuity study designs estimate treatment effects by comparing outcomes between a treated group to a counterfactual group just below the diagnostic thresholds with the assumption that covariates are similar. The counterfactual group was selected based on a composite score based on OGTT plasma glucose categories. Results: Women treated for GDM had lower rates of newborns large for gestational age (LGA), 4.6% versus those just below diagnostic thresholds 12.6%, relative risk 0.37 (95% CI, 0.16–0.85); and reduced caesarean section rates, 32.2% versus 43.0%, relative risk 0.75 (95% CI, 0.56–1.01). This was at the expense of increases in induced deliveries, 61.8% versus 39.3%, relative risk 1.57 (95% CI, 1.18–1.9); notations of neonatal hypoglycaemia, 15.8% versus 5.9%, relative risk 2.66 (95% CI, 1.23–5.73); and high insulin usage 61.1%. The subgroup analysis suggested that treatment of women with GDM with BMI ≥30 kg/m² drove the reduction in caesarean section rates: 32.9% versus 55.9%, relative risk 0.59 (95%CI, 0.4–0.87). Linear regression interaction term effects between non-GDM and treated GDM were significant for LGA newborns (p = 0.001) and caesarean sections (p = 0.015). Conclusions: Tight glycaemic targets reduced rates of LGA newborns and caesarean sections compared to a counterfactual group just below the diagnostic thresholds albeit at the expense of increased rates of neonatal hypoglycaemia, induced deliveries, and high insulin usage. Full article

(This article belongs to the Special Issue Hyperglycaemia in Pregnancy: Detection, Management and Postnatal Care in Rural Communities)

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11 pages, 442 KiB

Open AccessArticle

High Prevalence of Gestational Diabetes Mellitus in Rural Tanzania—Diagnosis Mainly Based on Fasting Blood Glucose from Oral Glucose Tolerance Test

by Louise Groth Grunnet, Line Hjort, Daniel Thomas Minja, Omari Abdul Msemo, Sofie Lykke Møller, Rashmi B. Prasad, Leif Groop, John Lusingu, Birgitte Bruun Nielsen, Christentze Schmiegelow, Ib Christian Bygbjerg and Dirk Lund Christensen

Int. J. Environ. Res. Public Health 2020, 17(9), 3109; https://doi.org/10.3390/ijerph17093109 - 29 Apr 2020

Cited by 13 | Viewed by 3768

Abstract

Gestational diabetes mellitus (GDM) is associated with poor pregnancy outcomes and increased long-term risk of metabolic diseases for both mother and child. In Tanzania, GDM prevalence increased from 0% in 1991 to 19.5% in 2016. Anaemia has been proposed to precipitate the pathogenesis of GDM. We aimed to examine the prevalence of GDM in a rural area of Tanzania with a high prevalence of anaemia and to examine a potential association between haemoglobin concentration and blood glucose during pregnancy. The participants were included in a population-based preconception, pregnancy and birth cohort study. In total, 538 women were followed during pregnancy and scheduled for an oral glucose tolerance test (OGTT) at week 32–34 of gestation. Gestational diabetes mellitus was diagnosed according to the WHO 2013 guidelines. Out of 392 women screened, 39% (95% CI: 34.2–44.1) had GDM, the majority of whom (94.1%) were diagnosed based solely on the fasting blood sample from the OGTT. No associations were observed between haemoglobin or ferritin and glucose measurements during pregnancy. A very high prevalence of GDM was found in rural Tanzania. In view of the laborious, costly and inconvenient OGTT, alternative methods such as fasting blood glucose should be considered when screening for GDM in low- and middle-income countries. Full article

(This article belongs to the Special Issue Hyperglycaemia in Pregnancy: Detection, Management and Postnatal Care in Rural Communities)

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19 pages, 320 KiB

Open AccessArticle

“If I Don’t Eat Enough, I Won’t Be Healthy”. Women’s Experiences with Gestational Diabetes Mellitus Treatment in Rural and Urban South India

by Karoline Kragelund Nielsen, Thilde Vildekilde, Anil Kapur, Peter Damm, Veerasamy Seshiah and Ib C. Bygbjerg

Int. J. Environ. Res. Public Health 2020, 17(9), 3062; https://doi.org/10.3390/ijerph17093062 - 28 Apr 2020

Cited by 10 | Viewed by 3363

Abstract

Gestational diabetes mellitus (GDM) is associated with a range of adverse pregnancy outcomes as well as increased risk of future type 2 diabetes and cardiovascular disease. In India, 10%–35% of pregnant women develop GDM. In this study, we investigated women’s experiences with the dietary and pharmaceutical treatment for GDM in rural and urban Tamil Nadu, India. Semi-structured interviews were conducted with 19 women diagnosed with GDM. Data were analyzed using qualitative content analysis. Three overall aspects were discovered with several sub-aspects characterizing women’s experiences: emotional challenges (fear and apprehension for the baby’ health and struggling to accept a treatment seen as counterintuitive to being safe and healthy), interpersonal challenges (managing treatment in the near social relations and social support, and coordinating treatment with work and social life), and health system-related challenges (availability and cost of treatment, interaction with health care providers). Some aspects acted as barriers. However, social support and positive, high-quality interactions with health care providers could mitigate some of these barriers and facilitate the treatment process. Greater efforts at awareness creation in the social environment and systemic adjustments in care delivery targeting the individual, family, community and health system levels are needed in order to ensure that women with GDM have the opportunity to access treatment and are enabled and motivated to follow it as well. Full article

(This article belongs to the Special Issue Hyperglycaemia in Pregnancy: Detection, Management and Postnatal Care in Rural Communities)

12 pages, 928 KiB

Open AccessArticle

Initial Validation of the Diabetes and Breastfeeding Management Questionnaire (DBM-Q)

by Karolina Linden, Marie Berg, Carina Sparud-Lundin, Annsofie Adolfsson and Jeanette Melin

Int. J. Environ. Res. Public Health 2020, 17(9), 3044; https://doi.org/10.3390/ijerph17093044 - 27 Apr 2020

Cited by 2 | Viewed by 2383

Abstract

Women with pre-gestational diabetes face additional challenges after birth as they struggle with breastfeeding and managing unpredictable blood glucose levels. The aim of this study is to validate the Diabetes and Breastfeeding Management Questionnaire (DBM-Q). In total, 142 mothers with type 1 diabetes mellitus answered the questionnaire, which initially consisted of 11 items. The response rate was 82.5% (n = 128) at two months, and 88.4% (n = 137) at six months postpartum. The measurement properties of the Diabetes and Breastfeeding Management Questionnaire were tested according to the Rasch measurement theory (RMT). One item showed both disordered thresholds and several model misfits and was removed. Two items showed disordered thresholds which were resolved by collapsing response categories. This resulted in a 10-item questionnaire with all the fit residuals within the range of +2.5, minor significant differential item functioning, well-targeted items and a person separation index of 0.73. Evaluating the DBM-Q according to the RMT is a strength, as it evaluates data against strict measurement criteria. This study provides an initial validation of the questionnaire. The DBM-Q shows good measurement properties for measuring diabetes and breastfeeding management postpartum in women with pre-gestational diabetes. Further studies are needed to identify cutoffs for when professional support is needed. Full article

(This article belongs to the Special Issue Hyperglycaemia in Pregnancy: Detection, Management and Postnatal Care in Rural Communities)

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12 pages, 1351 KiB

Open AccessArticle

Primary Health Care for Aboriginal Australian Women in Remote Communities after a Pregnancy with Hyperglycaemia

by Anna Wood, Diana MacKay, Dana Fitzsimmons, Ruth Derkenne, Renae Kirkham, Jacqueline A. Boyle, Christine Connors, Cherie Whitbread, Alison Welsh, Alex Brown, Jonathan E. Shaw and Louise Maple-Brown

Int. J. Environ. Res. Public Health 2020, 17(3), 720; https://doi.org/10.3390/ijerph17030720 - 22 Jan 2020

Cited by 5 | Viewed by 3940

Abstract

Background: Hyperglycaemia in pregnancy contributes to adverse outcomes for women and their children. The postpartum period is an opportune time to support women to reduce cardiometabolic and diabetes risk in subsequent pregnancies. Aims: To identify strengths and gaps in current care for Aboriginal women after a pregnancy complicated by hyperglycaemia. Methods: A retrospective review of the 12 month postpartum care provided by primary health centres in remote Australia in 2013–2014 identified 195 women who experienced hyperglycaemia in pregnancy (gestational diabetes (GDM) (n = 147), type 2 diabetes (T2D) (n = 39), and unclear diabetes status (n = 9)). Results: Only 80 women (54%) with GDM had postpartum glycaemic checks. Of these, 32 women were diagnosed with prediabetes (n = 24) or diabetes (n = 8). Compared to women with GDM, women with T2D were more likely to have their weight measured (75% vs. 52%, p <0.01), and smoking status documented as “discussed” (65% vs. 34%, p < 0.01). Most women (97%) accessed the health centre at least once in the 12 month postpartum period but, during these visits, only 52% of women had service provision, either structured or opportunistic, related to diabetes. Conclusion: High rates of dysglycaemia among women screened for T2D after GDM in the 12 month postpartum period highlight the need for increased screening and early intervention to prevent the development of T2D and its complications. Whilst a clear strength was high postpartum attendance, many women did not attend health services for diabetes screening or management. Full article

(This article belongs to the Special Issue Hyperglycaemia in Pregnancy: Detection, Management and Postnatal Care in Rural Communities)

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