Gestational diabetes: A case-control study of women's experience of pregnancy, health and the child
Abstract
Women with previous gestational diabetes (n = 113) and controls (n = 226) were studied retrospectively by means of questionnaires. Women with gestational diabetes reported less well-being (p<0.05), psychic health (p<0.001) and vigour (p<0.001) during pregnancy and a less positive experience of pregnancy (p<0.001) than controls. They also recalled more worry about health during pregnancy than controls (p<0.001), reported more physical health problems (p<0.05), more worry about health (p<0.05) and kept to a diet more often after pregnancy (women with gestational diabetes 34%, controls 13%, p<0.001). Although most of the women in the groups were not troubled, it was clear that the gestational diabetes influenced their experience of health negatively but motivated them to adopt a healthy lifestyle. Initial treatment with insulin seemed to be slightly more stressful than diet only.
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Cited by (41)
Fear of childbirth in primiparous Italian pregnant women: The role of anxiety, depression, and couple adjustment
2018, Women and BirthThe prevalence of fear of childbirth in pregnant women is described to be about 20–25%, while 6–10% of expectant mothers report a severe fear that impairs their daily activities as well as their ability to cope with labour and childbirth. Research on fear of childbirth risk factors has produced heterogeneous results while being mostly done with expectant mothers from northern Europe, northern America, and Australia.
The present research investigates whether fear of childbirth can be predicted by socio-demographic variables, distressing experiences before pregnancy, medical-obstetric factors and psychological variables with a sample of 426 Italian primiparous pregnant women.
Subjects, recruited between the 34th and 36th week of pregnancy, completed a questionnaire packet that included the Wijma Delivery Expectancy Questionnaire, the Edinburgh Postnatal Depression Scale, the State-Trait Anxiety Inventory, the Dyadic Adjustment Scale, the Multidimensional Scale of Perceived Social Support, as well as demographic and anamnestic information. Fear of childbirth was treated as both a continuous and a dichotomous variable, in order to differentiate expectant mothers as with a severe fear of childbirth.
Results demonstrate that anxiety as well as couple adjustment predicted fear of childbirth when treated as a continuous variable, while clinical depression predicted severe fear of childbirth.
Findings support the key role of psychological variables in predicting fear of childbirth. Results suggest the importance of differentiating low levels of fear from intense levels of fear in order to promote adequate support interventions.
Impact of an educational DVD on anxiety and glycaemic control in women diagnosed with gestational diabetes mellitus (GDM): A randomised controlled trial
2017, Diabetes Research and Clinical PracticeThe diagnosis of gestational diabetes mellitus (GDM) during pregnancy can lead to anxiety. This study evaluated the impact of an innovative patient-centred educational DVD on anxiety and glycaemic control in women newly diagnosed with GDM.
150 multi-ethnic women, aged 19–44 years, from three UK hospitals were randomised to either usual care plus DVD (DVD group, n = 77) or usual care alone (control group, n = 73) at GDM diagnosis. Primary outcomes were anxiety (State-Trait Anxiety Inventory) and mean 1-h postprandial capillary self-monitored blood glucose for all meals, on day prior to follow-up.
No significant difference between the DVD and control group were reported, for anxiety (37.7 ± 11.7 vs 36.2 ± 10.9; mean difference after adjustment for covariates (95% CI) 2.5 (−0.8, 5.9) or for mean 1-h postprandial glucose for all meals (6.9 ± 0.9 vs 7.0 ± 1.2 mmol/L; −0.2 (−0.5, 0.2). However, the DVD group had significantly lower postprandial breakfast glucose compared to the control group (6.8 ± 1.2 vs 7.4 ± 1.9 mmol/L; −0.5 (−1.1, −<0.1; p = 0.04).
The results in this trial did not highlight any differences between those who received the intervention and those who received usual care. It is possible that women already felt supported by their frequent attendance at specialist clinics for monitoring and advice. Healthcare professional and family support are key elements to empowering women with GDM and require further consideration in future interventions. Nonetheless, educational resources such as this will be beneficial to help support women given the current resource and time implications of the year on year rises in the incidence of gestational diabetes.
Screening for gestational diabetes: Still many unsolved issues
2016, Revue Sage - FemmeDepuis de nombreuses années, il y a un débat sur le dépistage du diabète gestationnel, notamment sur quel examen de dépistage et quels seuils utiliser. Le but de cette revue de la littérature est de déterminer si le dépistage du diabète gestationnel en France répond aux 10 critères de définition d’un test de dépistage par l’OMS. Le DG est bien un problème de santé publique, avec une histoire naturelle partiellement connue et décelable à un stade précoce. Il a été démontré que des hyperglycémies moins sévères que celles dépistées par le dépistage en 2 temps sont associées à une augmentation des taux de césarienne, de macrosomie fœtale et d’hypoglycémie néonatale. Par ailleurs, ce dépistage permet, lorsqu’il est positif, de suivre de plus près ces patientes qui sont à risque de développer un diabète de type 2. Enfin, traiter le diabète gestationnel diagnostiqué par le dépistage en 2 étapes s’est révélé efficace. Il n’existe pas de données permettant de dire si traiter les femmes diagnostiquées avec des seuils plus bas seraient efficaces ou inefficaces. Le test de dépistage en 1 temps ne permet de dépister que des complications fœtales et non des complications maternelles. Il apparaît comme acceptable pour la population de femmes enceintes. Le test diagnostique et le traitement nous semblent également acceptables. À ce jour, sa reproductibilité est mal connue. Le dépistage entraîne une augmentation du nombre d’interventions obstétricales. Plusieurs études retrouvent que le dépistage du diabète gestationnel serait coût-efficace mais dans des contextes de soins différents du nôtre.
For many years, there is a debate on gestational diabetes screening, including what screening test and thresholds to use. The purpose of this literature review is to determine whether gestational diabetes screening in France meets the 10 definition criteria of the WHO. The DG is a public health problem, with a natural history partially known and detectable at an early stage. Currently, there is no data showing that there is a benefit to treat patient screens by the new criteria. The one-step approach-screening test can only detect fetal complications and not maternal complications. It seems to be acceptable for the population of pregnant women. The diagnostic test and treatment also seem to be acceptable to us. To this day, its reproducibility is uncertain. Screening leads to an increase in obstetric interventions. Several studies found that screening for gestational diabetes is cost-effective but in a different context of care than in France.
Gestational diabetes mellitus
2016, Gynecologie Obstetrique et FertiliteAlors que la prévalence du diabète gestationnel était estimée entre 5 et 10 % en 2010, l’application des nouveaux seuils recommandés par l’IADPSG, puis adoptés en 2010 par le CNGOF, semble augmenter considérablement le nombre de patientes concernées par cette pathologie. Une étude prospective monocentrique française a estimé en 2014 la prévalence du diabète gestationnel à 14 % avec ces critères, ce qui en fait l’une des pathologies les plus fréquentes au cours de la grossesse sans qu’aucune étude à large échelle n’ait à ce jour montré un bénéfice pour la santé des femmes et des enfants. Si un diagnostic certain de diabète gestationnel ou de diabète de type 2 en cours de grossesse lorsqu’il est établi est un facteur de risque important dans la survenue des complications périnatales, des complications du nouveau-né et de l’enfant et des complications chez la mère, il n’en est probablement pas de même pour les hyperglycémies modérées découvertes en cours de grossesse.
While the prevalence of gestational diabetes mellitus (GDM) was estimated between 5 and 10% in 2010, the application of new thresholds recommended by IADPSG and adopted in 2010 by CNGOF seems to significantly increase the number of patients affected by this pathology. A prospective single-center French study estimated in 2014 the prevalence of gestational diabetes at 14% with these criteria, making it one of the most frequent complications during pregnancy. However, to date, there is no published study using these criteria to show a benefit to the health of women and children. If a diagnosis of GDM or type 2 diabetes during pregnancy is definitively an important risk factor for maternal as well as newborn and child complications, it is probably not the case for moderate hyperglycemia discovered during pregnancy.
Screening for gestational diabetes: Still many unsolved issues
2016, Journal de Gynecologie Obstetrique et Biologie de la ReproductionDepuis de nombreuses années, il y a un débat sur le dépistage du diabète gestationnel, notamment sur quel examen de dépistage et quels seuils utiliser. Le but de cette revue de la littérature est de déterminer si le dépistage du diabète gestationnel en France répond aux 10 critères de définition d’un test de dépistage par l’OMS. Le DG est bien un problème de santé publique, avec une histoire naturelle partiellement connue et décelable à un stade précoce. Il a été démontré que des hyperglycémies moins sévères que celles dépistées par le dépistage en 2 temps sont associées à une augmentation des taux de césarienne, de macrosomie fœtale et d’hypoglycémie néonatale. Par ailleurs, ce dépistage permet, lorsqu’il est positif, de suivre de plus près ces patientes qui sont à risque de développer un diabète de type 2. Enfin, traiter le diabète gestationnel diagnostiqué par le dépistage en 2 étapes s’est révélé efficace. Il n’existe pas de données permettant de dire si traiter les femmes diagnostiquées avec des seuils plus bas seraient efficaces ou inefficaces. Le test de dépistage en 1 temps ne permet de dépister que des complications fœtales et non des complications maternelles. Il apparaît comme acceptable pour la population de femmes enceintes. Le test diagnostique et le traitement nous semblent également acceptables. À ce jour, sa reproductibilité est mal connue. Le dépistage entraîne une augmentation du nombre d’interventions obstétricales. Plusieurs études retrouvent que le dépistage du diabète gestationnel serait coût-efficace mais dans des contextes de soins différents du nôtre.
For many years, there is a debate on gestational diabetes screening, including what screening test and thresholds to use. The purpose of this literature review is to determine whether gestational diabetes screening in France meets the 10 definition criteria of the WHO. The DG is a public health problem, with a natural history partially known and detectable at an early stage. Currently, there is no data showing that there is a benefit to treat patient screens by the new criteria. The one-step approach-screening test can only detect fetal complications and not maternal complications. It seems to be acceptable for the population of pregnant women. The diagnostic test and treatment also seem to be acceptable to us. To this day, its reproducibility is uncertain. Screening leads to an increase in obstetric interventions. Several studies found that screening for gestational diabetes is cost-effective but in a different context of care than in France.
Screening for gestational diabetes mellitus in Germany: A qualitative study on pregnant women's attitudes, experiences, and suggestions
2015, Midwiferyto explore pregnant women׳s experiences with the recently implemented screening for gestational diabetes mellitus (GDM).
qualitative study.
Rhine-Neckar Metropolitan region, Germany.
20 pregnant women aged 27–41 years (mean: 32.6 years) who were at least in gestational week 29, i.e., those who should have already been screened for GDM.
semi-structured interviews with open-ended questions were conducted via telephone between November 2013 and February 2014. All interviews were audiotaped, transcribed verbatim and subsequently analyzed using qualitative content analysis according to Mayring. The screening was seen as an important instrument to detect GDM and thus to prevent possible health problems in both mother and child. Some deviations from the recommended screening procedure were reported in the interviews, e.g., collecting capillary blood instead of venous blood during an oral glucose tolerance test (OGTT); offering an OGTT without a prior glucose challenge test (GCT); conducting a GCT after an overnight fast. Two women had to actively ask for the screening to be done. One woman reported that her gynaecologist advised her against the screening.
this qualitative study reflects the women׳s experiences with the new screening for GDM. Our findings show that two years after the introduction of universal GDM screening in Germany the screening procedure does not always seem to meet the standards of the German maternity guidelines.