Download Literature Review on Diabetes of Pregnancy

Running head: DIABETES OF PREGNANCY
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Literature Review on Diabetes of Pregnancy
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DIABETES OF PREGNANCY
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Table of Contents
Abstract ..................................................................................................................................................... 3
Introduction ............................................................................................................................................... 3
Methods .................................................................................................................................................... 4
Results ....................................................................................................................................................... 5
Discussions ................................................................................................................................................ 8
References ............................................................................................................................................... 10
DIABETES OF PREGNANCY
Abstract
This is a review on the prevalence and the trends of the pregnancy of diabetes which is
commonly known as the gestational diabetes mellitus (GDM). Diabetes of pregnancy is more
prevalent in populations that are more prevalent to the type 2 diabetes based on the research
carried out within the past ten years. The Swedish population has a low risk to the diabetes of
women while the high-risk populations are those of the Native Americans, Asians, and the
Northern California Hispanics. Diabetes during pregnancy is becoming common and has lead to
increased complications of pregnancy and delivery in women. Many methods were used in the
diabetes of women research which includes a screening of gestational diabetes in women and
carrying out the literature search using gestational diabetes criteria.
Introduction
Diabetes of pregnancy is also known as gestational diabetes mellitus (GDM) is a condition that
occurs due to glucose intolerance of variable severity with the start of the first detection during
the gestation period or pregnancy (Faser, 2013). Many cases of hyperglycemia during the
gestation period in women have been realized to be linked with various maternal and prenatal
serious outcomes. The child will have increased glucose intolerance, diabetes risk, and increased
metabolic syndrome in its lifetime while the mother is exposed to the risk of diabetes of
pregnancy in the future. The recognition of GDM during pregnancy gives an opportunity to
discover women at risk of both short-term and long-term complications. Early diagnosis and
intervention can decrease the adverse prenatal outcomes by a greater percentage. The purpose of
this review is to provide a recent update and discuss the current controversies on diabetes of
pregnancy (Bassaw, 2013).
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Methods
Various methods were used in the study to find out the prevalence and complications of diabetes
of pregnancy and this include.
Literature Search
A literature search was carried out in MEDLINE, CINHAL and the Green File using the
following search criteria: “gestational diabetes,” “epidemiology,” “gestational hypertension”,
“kidney diseases”, “Cardiovascular diseases” and “prevalence” as a MeSH term, the search was
narrow to English language articles published in the last seven years. The search criteria used
above gave rise to 1015 articles (Linn, 2008). The lead author (KJH) reviewed both the abstract
and the title of all these articles to find out if they were appropriate to assess either the diabetes of
women or the gestational diabetes trends and the prevalence in women populations. The literature
review was also limited to population-based studies that included at least 500 pregnant women or
hospital-based studies that included about 1000 pregnant women with more than 70% of the
population being screened for GDM (Lucas, 2012).
Diabetes and Gestational diabetes Screening
The definition of diabetes has changed over the past 10 years. The 1985 and 1999 World Health
Organization (WHO) criteria require a 2-hour 75g oral glucose tolerance test (OGTT), the 1997
American Diabetes Association (ADA) criteria are focused on fasting glucose, but also recognize
a casual or 2-hour 75g OGTT glucose level greater than or equal to 200 mg/dL as diagnostic of
diabetes. Therefore, epidemiologic studies based on the ADA criteria may be based exclusively
on fasting glucose levels or include information from an OGTT. The optional definition of GDM
and criteria identifying who should be screened for GDM has varied widely across populations
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and over time; therefore, we review both screening criteria and diagnostic criteria for GDM
employed in the recent epidemiologic literature. In every series of gestational diabetic patients,
there are some who have in the past undiagnosed pre-existing diabetes. The most simple
approach to screening for gestational diabetes is taking of the history and the performance of a
full 3-hour 100-g OGTT when the risk factors for diabetes are there (Brudenell, 2009).
Results
Population-Based Studies
Population-based studies in this review are those studies that attempted to include a
representative sample of the general population in a given geographical area. About 1000 women
were screened for the diabetes of women commonly known as the gestational diabetes mellitus
which is first recognized during the period of pregnancy. It was found out that the prevalence of
the disease varied depending according to the criteria used in the diagnosis process whether it
was retrospective or prospective (Faser, 2013). The retrospective studies had lower prevalence
since it uses the routinely collected statistics and where a clear screening policy was not in place.
The prospective studies reported high rates of prevalence in populations simply because universal
screening for gestational diabetes mellitus was carried out to on the selected population of
pregnant women (Lucas, 2012).
This shows that screening of diabetes and the gestational diabetes is very important for the
pregnant women to reduce the complications that the condition causes. From the World Health
Organization’s criteria and the universal screening done in the year 2008, the prevalence was
recorded at 2.5 percent while the study carried out in Japan using the Japanese Society of
Obstetrics and Gynecology (JSOG) criteria for the gestational diabetes mellitus (GDM) or the
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diabetes of women and the universal screening prevalence recorded 3 percent. The blood
pressure of patients with diabetes 1 and 2 types increases leading to increased complications for
the pregnant women (Lucas, 2012). The effect of GDM has increased complications for women
as they cause increased high blood pressure which is very serious if not corrected earlier. The
study shows that the complications caused by gestational diseases do have an impact on the
pregnancies and the development of the baby.
The Hospital Based Studies
The hospital-based studies carried out for about 1000 selected populations were screened
universally and testing was employed for at least 70 percent of the populations screened for the
diabetes of women. This study also looks at the variation in the prevalence of the disease
depending on the diagnostic criteria employed in the study. Eight retrospective studies carried out
in the past 8 years in the United States, Canada, and Australia examines trends in the prevalence
of GDM. Three of the four studies conducted in the U.S report either universal screening criteria
in place and the evidence of regular screening in the population with a screening rate of 95 to
97% (Faser, 2013).
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The Results Table
Author/Date
Study Aim
Type of study
Conclusion
Strength and
limitation
Fraser (2013)
The aim is to find Prospective
There is an
The study
out the effect of
increase in the
employed
increased blood
number of
screening of
pressure and
women with
selected
hypertension in
increased blood
populations for
pregnant women
pressure for the
GDM. The
women with
limitation of this
diabetes of
type of study is
pregnancy.
that it consumes
Study
a lot of time.
Lucas (2012)
The aim was to
Retrospective
Women with
This study used
find out the
study
GDM
the hospital
complications
encountered
based study an d
caused by the
many
showed a high
diabetes of
complications
rate. The data
pregnancy
during the
collection is
condition.
gestation period.
tiresome making
making it a
DIABETES OF PREGNANCY
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limitation in the
study.
Maresh (2011)
To know the
Population based
High blood
The strength is
effect of high
Study
pressure exposes
that about 5000
blood pressure on
pregnant women
women were
myocardial
to higher risk of
involved in the
conditions in
myocardial
study. The
pregnant women.
conditions.
limitation of the
study is that it
does not take into
account the
diastolic
brokenness.
Discussions
In this study, the review is based on the studies published in the last seven years on the diabetes
of women that looks at the prevalence, complications and the trends of this condition. The
prevalence of the diabetes of women or GDM in a population is reflective of the prevalence of
the type 2 diabetes in that population (Brudenell, 2009). The ethnic and racial populations with a
high dominance of type 2 diabetes are at greater risk of GDM. In low-risk populations like the
Swedish populations, the prevalence in the in the population-based studies are lower and are
recorded at the rate of 2 percent even when universal testing is provided. On the other hand, the
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studies in populations with a higher risk for the Americans and the Asians recorded a higher rate
of 5% based on the diagnostic criteria and the universal screening provided to the selected
populations. The rates for the prevalence of diabetes for women or the GDM recorded from
hospital-based studies likewise shows the risk of type 2 diabetes in a population. A particular
hospital-based study in Australia using ADIPS diagnostic method and universal screening shows
prevalence ranging from 5.0% to 18.0% in Celtic and Indian women. The eight studies published
in the past seven years that showed the trends in the prevalence of diabetes of women and reports
a considerable decrease in the prevalence of GDM (Linn, 2008).
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References
Bassaw, B., Ataullah, I., Roopnarinesingh, S., & Sirjusingh, A. (2015). Diabetes in
pregnancy. International Journal of Gynecology & Obstetrics,50(1), 5-9.
Brudenell, M., & Beard, R. (2009). Diabetes in pregnancy. Clinics in endocrinology and
metabolism, 1(3), 673-695.
Fraser, R. (2013). Diabetes in pregnancy. Archives of Disease in Childhood Fetal and Neonatal
edition, 71(3), F224.
Hod, M., & Meizner, I. (2012). Diabetes in pregnancy. Annali dell'Istituto superiore di
sanita, 33(3), 317-322.
Linn, T., & Bretzel, R. G. (2008). Diabetes in pregnancy. European Journal of Obstetrics &
Gynecology and Reproductive Biology, 75(1), 37-41.
Lucas, M. J. (2012). Diabetes complicating pregnancy. Obstetrics and gynecology clinics of
North America, 28(3), 513-536.
Maresh, M. (2011). Diabetes in pregnancy. Current Opinion in Obstetrics and
Gynecology, 13(2), 103-107.
Panel, I. C. (2010). International association of diabetes and pregnancy study groups
recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes
care, 33(3), 676-682.