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Mobin A, Obeid A, El‐Kebbi I, Everett D, Ibrahim S, Farhat J, Al‐Omari B. Beyond one size fits all: Probing patient choices in gestational diabetes management, from screening to postpartum. Chronic Dis Transl Med 2025; 11:33-45. [PMID: 40051823 PMCID: PMC11880122 DOI: 10.1002/cdt3.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2024] [Revised: 09/12/2024] [Accepted: 10/09/2024] [Indexed: 01/12/2025] Open
Abstract
During antenatal care, gestational diabetes mellitus (GDM) screening is crucial for early diagnosis and treatment to ameliorate clinical outcomes and limit health care expenses. Dietary management and physical activity are central to GDM treatment, however, adherence is often influenced by personal preferences, socioeconomic barriers, and psychological stress. Pharmacologically, insulin and oral hypoglycemic medications, are the main GDM treatment that can be subject to patients' resistance due to fears of needles and side effects. Metformin is increasingly preferred for its ease of administration and lower cost. In the postpartum stage, regular screening for type 2 diabetes mellitus (T2DM) should always be considered despite the possible limitations that could arise, including communication gaps, lack of long-term focus, and personal barriers. Overall, women with GDM prefer personalized, flexible management plans that consider their lifestyle, support from health care professionals (HCPs), and family involvement. Addressing psychological and socioeconomic barriers through education, counseling, and support networks is crucial for improving adherence and health outcomes. Enhancing patient-centered care and shared decision-making can empower women with GDM to manage their condition effectively and maintain lifestyle changes postpartum. Therefore, this review aimed to assess pregnant women's preferences in GDM management, focusing on screening, dietary recommendations, physical activity, and treatment. Additionally, this review examined GDM care in terms of these patients' quality of life and postpartum experiences.
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Affiliation(s)
- Ayman Mobin
- Department of Public Health and EpidemiologyCollege of Medicine and Health SciencesKhalifa University of Science and TechnologyAbu DhabiUnited Arab Emirates
| | - Amir Obeid
- Department of Public Health and EpidemiologyCollege of Medicine and Health SciencesKhalifa University of Science and TechnologyAbu DhabiUnited Arab Emirates
| | - Imad El‐Kebbi
- Division of EndocrinologySheikh Shakhbout Medical City (SSMC)Abu DhabiUnited Arab Emirates
| | - Dean Everett
- Department of Public Health and EpidemiologyCollege of Medicine and Health SciencesKhalifa University of Science and TechnologyAbu DhabiUnited Arab Emirates
- Infection Research UnitKhalifa University of Science and TechnologyAbu DhabiUnited Arab Emirates
| | - Saleh Ibrahim
- College of Medicine and Health SciencesKhalifa University of Science and TechnologyAbu DhabiUnited Arab Emirates
- Center for BiotechnologyKhalifa University of Science and TechnologyAbu DhabiUnited Arab Emirates
| | - Joviana Farhat
- Department of Public Health and EpidemiologyCollege of Medicine and Health SciencesKhalifa University of Science and TechnologyAbu DhabiUnited Arab Emirates
| | - Basem Al‐Omari
- Department of Public Health and EpidemiologyCollege of Medicine and Health SciencesKhalifa University of Science and TechnologyAbu DhabiUnited Arab Emirates
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Jiang G, Chen L, Geng L, Zhang Y, Chen Z, Zhu Y, Ma S, Zhao M. Quality of information in gestational diabetes mellitus videos on TikTok: Cross-sectional study. PLoS One 2025; 20:e0316242. [PMID: 39913422 PMCID: PMC11801523 DOI: 10.1371/journal.pone.0316242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 12/08/2024] [Indexed: 02/09/2025] Open
Abstract
BACKGROUND TikTok is an important channel for consumers to obtain and adopt health information. However, misinformation on TikTok could potentially impact public health. Currently, the quality of content related to GDM on TikTok has not been thoroughly reviewed. OBJECTIVE This study aims to explore the information quality of GDM videos on TikTok. METHODS A comprehensive cross-sectional study was conducted on TikTok videos related to GDM. The quality of the videos was assessed using three standardized evaluation tools: DISCERN, the Journal of the American Medical Association (JAMA) benchmarks, and the Global Quality Scale (GQS). The comprehensiveness of the content was evaluated through six questions covering definitions, signs/symptoms, risk factors, evaluation, management, and outcomes. Additionally, a correlational analysis was conducted between video quality and the characteristics of the uploaders and the videos themselves. RESULTS A total of 216 videos were included in the final analysis, with 162 uploaded by health professionals, 40 by general users, and the remaining videos contributed by individual science communicators, for-profit organizations, and news agencies. The average DISCERN, JAMA, and GQS scores for all videos were 48.87, 1.86, and 2.06, respectively. The videos uploaded by health professionals scored the highest in DISCERN, while the videos uploaded by individual science communicators scored significantly higher in JAMA and GQS than those from other sources. Correlation analysis between video quality and video features showed DISCERN scores, JAMA scores and GQS scores were positively correlated with video duration (P<0.001). Content scores were positively correlated with the number of comments (P<0.05), the number of shares (P<0.001), and video duration (P<0.001). CONCLUSION We found that the quality of GDM video on TikTok is poor and lack of relevant information, highlighting the potential risks of using TikTok as a source of health information. Patients should pay attention to identifying health-related information on TikTok.
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Affiliation(s)
- Genyan Jiang
- School of Nursing, Anhui Medical University, Hefei, China
| | - Lei Chen
- School of Nursing, Anhui Medical University, Hefei, China
| | - Lan Geng
- School of Nursing, Anhui Medical University, Hefei, China
| | - Yuhan Zhang
- School of Nursing, Anhui Medical University, Hefei, China
| | - Zhiqi Chen
- School of Nursing, Anhui Medical University, Hefei, China
| | - Yaqi Zhu
- School of Nursing, Anhui Medical University, Hefei, China
| | | | - Mei Zhao
- School of Nursing, Anhui Medical University, Hefei, China
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Saravanan P, Deepa M, Ahmed Z, Ram U, Surapaneni T, Kallur SD, Desari P, Suresh S, Anjana RM, Hannah W, Shivashri C, Hemavathy S, Sukumar N, Kosgei WK, Christoffersen-Deb A, Kibet V, Hector JN, Anusu G, Stallard N, Ghebremichael-Weldeselassie Y, Waugh N, Pastakia SD, Mohan V. Early pregnancy HbA 1c as the first screening test for gestational diabetes: results from three prospective cohorts. Lancet Diabetes Endocrinol 2024; 12:535-544. [PMID: 38936371 DOI: 10.1016/s2213-8587(24)00151-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 05/15/2024] [Accepted: 05/15/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND More than 90% of gestational diabetes cases are estimated to occur in low-income and middle-income countries (LMICs). Most current guidelines recommend an oral glucose tolerance test (OGTT) at 24-28 weeks of gestation. The OGTT is burdensome, especially in LMICs, resulting in a high proportion of women not being screened. We aimed to develop a simple and effective screening strategy for gestational diabetes. METHODS STRiDE, a prospective cohort study, was set up in seven centres in south India and seven centres in western Kenya, and included pregnant women aged 18-50 years of age and at less than 16 weeks of gestation (<20 weeks in Kenya), confirmed by dating ultrasound. We assessed the efficacy of early pregnancy HbA1c (venous and capillary point-of-care), either alone or as part of a composite risk score with age, BMI, and family history of diabetes, in predicting gestational diabetes at 24-28 weeks of gestation, in two LMICs (India and Kenya) and in a UK multi-ethnic population from the PRiDE study. A key secondary outcome was to assess whether an early pregnancy composite risk score can reduce the need for OGTTs. Gestational diabetes was diagnosed using current WHO criteria. FINDINGS Between Feb 15, 2016, Dec 13, 2019, we enrolled 3070 participants in India and 4104 in Kenya. 4320 participants were included from the PRiDE cohort. Gestational diabetes prevalence by OGTT at 24-28 weeks was 19·2% in India, 3·0% in Kenya, and 14·5% in the UK. Early pregnancy HbA1c was independently associated with incidence of gestational diabetes at 24-28 weeks of gestation. Adjusted risk ratios were 1·60 (95% CI 1·19-2·16) in India, 3·49 (2·8-4·34) in Kenya, and 4·72 (3·82-5·82) in the UK. Composite risk score models that combined venous or point-of-care HbA1c with age, BMI, and family history of diabetes best predicted testing positive for gestational diabetes. A population-specific, two-threshold screening strategy of rule-in and rule-out gestational diabetes using early pregnancy composite risk score could reduce the requirement of OGTTs by 50-64%. For the HbA1c-alone model, the thresholds were 5·4% (rule in) and 4·9% (rule out) in India, 6·0% (rule in) and 5·2% (rule out) in Kenya, and 5·6% (rule in) and 5·2% (rule out) in the UK. INTERPRETATION Early pregnancy HbA1c offers a simple screening test for gestational diabetes, allowing those at highest risk to receive early intervention and greatly reduce the need for OGTTs. This can also be carried out using point-of-care HbA1c in LMICs. FUNDING UK Medical Research Council and the Indian Department of Biotechnology.
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Affiliation(s)
- Ponnusamy Saravanan
- Warwick Applied Health, Warwick Medical School, University of Warwick, Coventry, UK; Warwick Centre for Global Health, University of Warwick, Coventry, UK; Department of Diabetes, Endocrinology and Metabolism, George Eliot Hospital, Nuneaton, UK.
| | - Mohan Deepa
- Department of Epidemiology, Madras Diabetes Research Foundation, Chennai, India
| | - Zain Ahmed
- Warwick Applied Health, Warwick Medical School, University of Warwick, Coventry, UK
| | - Uma Ram
- Seethapathy Clinic and Hospital, Chennai, India; Fetal Care Research Foundation, Chennai, India
| | | | | | - Papa Desari
- Obstetrics and Gynaecology, Jawaharlal Institute of Post Graduate Medical Education, Puducherry, India
| | - Seshadri Suresh
- Fetal Care Research Foundation, Chennai, India; Mediscan Systems, Chennai, India
| | - Ranjit Mohan Anjana
- Department of Diabetology, Madras Diabetes Research Foundation, Chennai, India; Department of Diabetology, Dr Mohan's Diabetes Specialities Centre, Chennai, India
| | - Wesley Hannah
- Department of Epidemiology, Madras Diabetes Research Foundation, Chennai, India; School of Medicine, Deakin University, Melbourne, VIC, Australia
| | - Chockalingam Shivashri
- Warwick Applied Health, Warwick Medical School, University of Warwick, Coventry, UK; Department of Epidemiology, Madras Diabetes Research Foundation, Chennai, India
| | - Saite Hemavathy
- Department of Epidemiology, Madras Diabetes Research Foundation, Chennai, India; University of Madras, Chennai, India
| | - Nithya Sukumar
- Warwick Applied Health, Warwick Medical School, University of Warwick, Coventry, UK; Department of Diabetes, Endocrinology and Metabolism, George Eliot Hospital, Nuneaton, UK
| | | | - Astrid Christoffersen-Deb
- Moi Teaching and Referral Hospital, Eldoret, Kenya; Department of Obstetrics and Gynaecology, University of Toronto, ON, Canada; Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
| | | | | | | | - Nigel Stallard
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Yonas Ghebremichael-Weldeselassie
- Warwick Applied Health, Warwick Medical School, University of Warwick, Coventry, UK; School of Mathematics and Statistics, The Open University, Milton Keynes, UK
| | - Norman Waugh
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Sonak D Pastakia
- Moi Teaching and Referral Hospital, Eldoret, Kenya; Purdue University College of Pharmacy, Center for Health Equity and Innovation, West Lafayette, IN, USA
| | - Viswanathan Mohan
- Department of Diabetology, Madras Diabetes Research Foundation, Chennai, India; Department of Diabetology, Dr Mohan's Diabetes Specialities Centre, Chennai, India
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Bashir M, Ibrahim I, Beer S, Shahbic H, Eltaher F, Al-Mutawaa K, Zirie M, Abou-Samra AB. Integrated care of diabetes during pregnancy: a Qatari nationwide cohort. EClinicalMedicine 2024; 72:102605. [PMID: 38680518 PMCID: PMC11053263 DOI: 10.1016/j.eclinm.2024.102605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 05/01/2024] Open
Abstract
Background Diabetes in pregnancy (DIP) is associated with adverse fetal and maternal outcomes. DIP is classified as either pre-existing or new-onset diabetes mellitus (DM), which is classified into gestational DM (GDM) and newly detected type 2 (N-T2D). All pregnant women in Qatar who are not known to have pre-existing DM are offered screening for DIP during the first antenatal care visit and after 24 weeks gestation. The study aims to report the DIP screening rates, the prevalence of DIP, and the impact of the universal screening program on adverse pregnancy outcomes. Methods This retrospective study included all women who gave birth in Hamad Medical Corporation (HMC) hospitals between 2019 and 2022. New-onset DIP was defined using the WHO-2013 criteria. The primary outcomes were the screening rates and the prevalence of DIP in Qatar. The secondary outcomes were the difference in preterm delivery, C-section, macrosomia, large for gestational age (LGA), small for gestational age (SGA), and intra-uterine fetal death (IUFD) between women with or without GDM. Findings We included 94,422 women who gave birth to 96,017 neonates (85.7%) out of 112,080 neonates born nationwide. The number of women with pre-existing diabetes was 2496 women. Of 91,926 eligible women, 77,372 (84.2%) were screened for DIP. The prevalence of GDM is 31.6% (95% CI: 31.3-32.0%); N-T2D is 2.2% (95% CI: 2.1-2.3%), and pre-existing Type 2 DM and Type 1 DM was 2.6% (95% CI: 0.8-3.0%) and 0.2% (0.19-0.25), respectively. Compared to the non-GDM group, women with GDM were older (30.8 ± 5.3 versus 29.7 ± 5.2 years, p < 0.001). After adjusting for age, women with GDM had lower risk of IUFD and SGA (0.63 [95% CI 0.50-0.80, p < 0.001], 0.88 [95% CI 0.84-0.92, p < 0.001] respectively) but higher risk of C-section and LFD (1.07 [95% CI 1.04-1.10, p < 0.001], 1.09 [95% CI 1.01-1.15, p = 0.01], respectively, compared to women with no-GDM. Interpretation Of the women eligible for screening, 84.2% were screened by the DIP program in Qatar. The prevalence of DIP in Qatar is 36.9%. Integrated care is critical for the screening and management of diabetes during pregnancy. Fundings The authors did not receive any funding for this project.
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Affiliation(s)
- Mohammed Bashir
- Endocrine Section, Internal Medicine Department, Hamad Medical Corporation, P.O Box 3050, Doha, Qatar
- Qatar Metabolic Institute, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Ibrahim Ibrahim
- Sidra Medicine, Qatar Foundation, P.O Box 26999, Doha, Qatar
| | - Stephen Beer
- Endocrine Section, Internal Medicine Department, Hamad Medical Corporation, P.O Box 3050, Doha, Qatar
- Qatar Metabolic Institute, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Hessa Shahbic
- Women's Health Program, Primary Health Care Corporation, Box: 26555, Doha, Qatar
| | - Faten Eltaher
- Department of Obstetrics and Gynaecology, Women's Wellness and Research Centre, Hamad Medical Corporation, P.O Box 3050, Doha, Qatar
| | - Kholoud Al-Mutawaa
- Non-communicable Diseases, Public Health Department, Ministry of Public Health, P.O Box. 7744, Doha, Qatar
- Qatar National Diabetes Committee, Ministry of Public Health, P.O Box. 7744, Doha, Qatar
| | - Mahmoud Zirie
- Endocrine Section, Internal Medicine Department, Hamad Medical Corporation, P.O Box 3050, Doha, Qatar
- Qatar National Diabetes Committee, Ministry of Public Health, P.O Box. 7744, Doha, Qatar
| | - Abdul-Badi Abou-Samra
- Qatar Metabolic Institute, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
- Qatar National Diabetes Committee, Ministry of Public Health, P.O Box. 7744, Doha, Qatar
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He J, Wang H, Chen X. Experiences and self-care of pregnant nurses with gestational diabetes mellitus: a qualitative study. BMC Nurs 2024; 23:33. [PMID: 38212724 PMCID: PMC10782759 DOI: 10.1186/s12912-023-01679-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 12/20/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Pregnant nurses are at high risk of developing gestational diabetes mellitus (GDM), and nurses diagnosed with GDM face challenges in balancing disease management and work, which affects maternal and child health and the quality of care. GDM requires significant changes to lifestyle and physical activity to control blood glucose levels, which is key to reducing adverse pregnancy outcomes. However, few studies have focused on the experiences of pregnant nurses with GDM. This study aimed to gain insight into the experiences of pregnant nurses with GDM in China in terms of their illness, work burdens, and self-care. METHODS This qualitative study used an interpretative phenomenological analysis. Face-to-face semi-structured in-depth interviews were conducted with pregnant nurses with GDM to investigate their experiences and self-care. The study was performed at Chongqing's maternal and child health hospital in China. A purposive sampling was used. Nine pregnant nurses diagnosed with GDM were recruited and interviewed. RESULTS The interview data generated four themes and 11 sub-themes. The four themes were 'the perceptions and feelings of GDM', 'experiences of lifestyle changes', 'social support needs', and 'health expectations and risk perception.' CONCLUSION Many factors such as the unique occupational environment, overwork, occupational pressure, shift work, family status, and education level may lead to difficulties in managing blood glucose in nurses with GDM. These findings suggest that managers should pay more attention to nurses with GDM and develop personalized medical care and work arrangements. These measures can improve the self-care and well-being of nurses with GDM and promote the health of nurses and their offspring.
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Affiliation(s)
- Jing He
- Nursing department, Tongji Hospital of Tongji Medical College of Huazhong, University of Science and Technology, NO.1095 Jiefang Avenue, Wuhan, China
- School of Nursing, Tongji Medical College of Huazhong, University of Science and Technology, NO.13 Aviation Road, Wuhan, China
- School of Nursing, Wuhan University, NO. 115 Donghu Road, Wuhan, China
| | - Hui Wang
- Nursing department, Tongji Hospital of Tongji Medical College of Huazhong, University of Science and Technology, NO.1095 Jiefang Avenue, Wuhan, China.
| | - Xiaoli Chen
- School of Nursing, Wuhan University, NO. 115 Donghu Road, Wuhan, China.
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Sobngwi E, Sobngwi-Tambekou J, Katte JC, Echouffo-Tcheugui JB, Balti EV, Kengne AP, Fezeu L, Ditah CM, Tchatchoua AP, Dehayem M, Unwin NC, Rankin J, Mbanya JC, Bell R. Gestational diabetes mellitus in Cameroon: prevalence, risk factors and screening strategies. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2024; 4:1272333. [PMID: 38374923 PMCID: PMC10876121 DOI: 10.3389/fcdhc.2023.1272333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 12/07/2023] [Indexed: 02/21/2024]
Abstract
Background The burden of gestational diabetes (GDM) and the optimal screening strategies in African populations are yet to be determined. We assessed the prevalence of GDM and the performance of various screening tests in a Cameroonian population. Methods We carried out a cross-sectional study involving the screening of 983 women at 24-28 weeks of pregnancy for GDM using serial tests, including fasting plasma (FPG), random blood glucose (RBG), a 1-hour 50g glucose challenge test (GCT), and standard 2-hour oral glucose tolerance test (OGTT). GDM was defined using the World Health Organization (WHO 1999), International Association of Diabetes and Pregnancy Special Group (IADPSG 2010), and National Institute for Health Care Excellence (NICE 2015) criteria. GDM correlates were assessed using logistic regressions, and c-statistics were used to assess the performance of screening strategies. Findings GDM prevalence was 5·9%, 17·7%, and 11·0% using WHO, IADPSG, and NICE criteria, respectively. Previous stillbirth [odds ratio: 3·14, 95%CI: 1·27-7·76)] was the main correlate of GDM. The optimal cut-points to diagnose WHO-defined GDM were 5·9 mmol/L for RPG (c-statistic 0·62) and 7·1 mmol/L for 1-hour 50g GCT (c-statistic 0·76). The same cut-off value for RPG was applicable for IADPSG-diagnosed GDM while the threshold was 6·5 mmol/L (c-statistic 0·61) for NICE-diagnosed GDM. The optimal cut-off of 1-hour 50g GCT was similar for IADPSG and NICE-diagnosed GDM. WHO-defined GDM was always confirmed by another diagnosis strategy while IADPSG and GCT independently identified at least 66·9 and 41·0% of the cases. Interpretation GDM is common among Cameroonian women. Effective detection of GDM in under-resourced settings may require simpler algorithms including the initial use of FPG, which could substantially increase screening yield.
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Affiliation(s)
- Eugene Sobngwi
- Department of Internal Medicine and Specialities, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- Laboratory of Molecular Medicine and Metabolism, Biotechnology Center, University of Yaoundé I, Yaoundé, Cameroon
- Department of Non-Communicable Diseases, Recherche Santé et Développement (RSD) Institute, Yaoundé, Cameroon
| | - Joelle Sobngwi-Tambekou
- Department of Non-Communicable Diseases, Recherche Santé et Développement (RSD) Institute, Yaoundé, Cameroon
| | - Jean Claude Katte
- Department of Non-Communicable Diseases, Recherche Santé et Développement (RSD) Institute, Yaoundé, Cameroon
- Department of Clinical and Biomedical Sciences, University of Exeter Medical School, Exeter, United Kingdom
| | - Justin B. Echouffo-Tcheugui
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Eric V. Balti
- Diabetes Research Center, Faculty of Medicine and Pharmacy, Brussels Free University-Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Andre-Pascal Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council and University of Cape Town, Cape Town, South Africa
| | - Leopold Fezeu
- Nutritional Epidemiology Research Unit-UMR U557 Institut National de la Santé et de la Recherche Médicale (INSERM), U1125 INRA, CNAM, University of Paris 13, Bobigny, France
| | - Chobufo Muchi Ditah
- Department of Internal Medicine and Specialities, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Alain-Patrick Tchatchoua
- Department of Internal Medicine and Specialities, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Mesmin Dehayem
- Department of Internal Medicine and Specialities, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Nigel C. Unwin
- Faculty of Medical Sciences, Public Health and Epidemiology, University of the West Indies at Cave Hill, Bridgetown, Barbados
| | - Judith Rankin
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Jean Claude Mbanya
- Department of Internal Medicine and Specialities, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- Laboratory of Molecular Medicine and Metabolism, Biotechnology Center, University of Yaoundé I, Yaoundé, Cameroon
| | - Ruth Bell
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, United Kingdom
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Chebrolu P, Chalem A, Ponticiello M, Broderick K, Vaidyanathan A, Lorenc R, Kulkarni V, Onawale A, Mathad JS, Sundararajan R. A community health worker-led program to improve access to gestational diabetes screening in urban slums of Pune, India: Results from a mixed methods study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001622. [PMID: 37889879 PMCID: PMC10610081 DOI: 10.1371/journal.pgph.0001622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 09/14/2023] [Indexed: 10/29/2023]
Abstract
The World Health Organization recommends all pregnant women receive screening for gestational diabetes (GDM) with a fasting oral glucose tolerance test (OGTT). However, very few women receive recommended screening in resource-limited countries like India. We implemented a community health worker (CHW)-delivered program to evaluate if home-based, CHW-delivered OGTT would increase GDM screening in a low-resource setting. We conducted a mixed methods study in two urban slum communities in Pune, India. CHWs were trained to deliver home-based, point-of-care fasting OGTT to women in their third trimester of pregnancy. The primary outcome was uptake of CHW-delivered OGTT. Secondary outcomes included GDM prevalence and linkage to GDM care. Individual interviews were conducted with purposively sampled pregnant women, CHWs, and local clinicians to assess barriers and facilitators of this approach. From October 2021-June 2022, 248 eligible pregnant women were identified. Of these, 223 (90%) accepted CHW-delivered OGTT and 31 (14%) were diagnosed with GDM. Thirty (97%) women diagnosed with GDM subsequently sought GDM care; only 10 (33%) received lifestyle counseling or pharmacologic therapy. Qualitative interviews indicated that CHW-delivered testing was considered highly acceptable as home-based testing saved time and was more convenient than clinic-based testing. Inconsistent clinical management of GDM was attributed to providers' lack of time to deliver counseling, and perceptions that low-income populations are not at risk for GDM. Convenience and trust in a CHW-delivered GDM screening program resulted in high access to gold-standard OGTT screening and identification of a high GDM prevalence among pregnant women in two urban slum communities. Appropriate linkage to care was limited by clinician time constraints and misperceptions of GDM risk. CHW-delivered GDM screening and counseling may improve health education and access to preventive healthcare, offloading busy public clinics in high-need, low-resource settings.
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Affiliation(s)
- Puja Chebrolu
- Center for Global Health, Weill Cornell Medicine, New York, New York, United States of America
| | - Andrea Chalem
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Matthew Ponticiello
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Kathryn Broderick
- Center for Global Health, Weill Cornell Medicine, New York, New York, United States of America
| | - Arthi Vaidyanathan
- Center for Global Health, Weill Cornell Medicine, New York, New York, United States of America
| | - Rachel Lorenc
- Center for Global Health, Weill Cornell Medicine, New York, New York, United States of America
| | | | | | - Jyoti S. Mathad
- Center for Global Health, Weill Cornell Medicine, New York, New York, United States of America
| | - Radhika Sundararajan
- Center for Global Health, Weill Cornell Medicine, New York, New York, United States of America
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Kahimakazi I, Tornes YF, Tibaijuka L, Kanyesigye H, Kiptoo J, Kayondo M, Ngonzi J, Adu-Bonsaffoh K, Abesiga L, Lugobe HM. Prevalence of gestational diabetes mellitus and associated factors among women receiving antenatal care at a tertiary hospital in South-Western Uganda. Pan Afr Med J 2023; 46:50. [PMID: 38188887 PMCID: PMC10768552 DOI: 10.11604/pamj.2023.46.50.38355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 09/05/2023] [Indexed: 01/09/2024] Open
Abstract
INTRODUCTION gestational diabetes mellitus is one of the major causes of morbidity and mortality among pregnant women worldwide. We aimed to determine the prevalence and factors associated with gestational diabetes mellitus among women attending the antenatal care clinic at a tertiary care hospital in South-Western Uganda. METHODS this was a hospital-based cross-sectional study conducted among women at ≥24 weeks of amenorrhea attending the antenatal care clinic at Mbarara Regional Referral Hospital between December 2020 and March 2021. We screened all women for gestational diabetes mellitus using the World Health Organization 2013 diagnostic criteria. We obtained socio-demographic, medical, and obstetric data. Multivariable logistic regression was used to determine the factors independently associated with gestational diabetes mellitus. RESULTS we enrolled 343 pregnant women with a mean age of 27.3 (SD ±12.3) years. Of the 343 participants, 35 (10.2%) had gestational diabetes mellitus (GDM) (95% C.I: 7.4%-13.9%) and 7 (2%) had diabetes in pregnancy. The factors significantly associated with gestational diabetes mellitus were; previous history of foetal macrosomia in any of the previous pregnancies (aOR: 5.53, 95% C.I: 1.29-23.65) and family history of diabetes mellitus in the first-degree relatives (aOR: 4.45, 95% C.I:1.48-13.34). CONCLUSION one in every ten pregnant women attending the antenatal care clinic at Mbarara Regional Referral Hospital is likely to have gestational diabetes mellitus in pregnancy. There is a need to strengthen routine testing for gestational diabetes mellitus among women attending the antenatal care clinic, especially pregnant women with a prior history of foetal macrosomia and a family history of diabetes mellitus in first-degree relatives.
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Affiliation(s)
- Irene Kahimakazi
- Department of Obstetrics and Gynaecology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Yarine Fajardo Tornes
- Department of Obstetrics and Gynaecology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Leevan Tibaijuka
- Department of Obstetrics and Gynaecology, Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Hamson Kanyesigye
- Department of Obstetrics and Gynaecology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Joshua Kiptoo
- Department of Pharmacy, Clinical Pharmacy Unit, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Musa Kayondo
- Department of Obstetrics and Gynaecology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Joseph Ngonzi
- Department of Obstetrics and Gynaecology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Kwame Adu-Bonsaffoh
- Department of Obstetrics and Gynaecology, University of Ghana Medical School, Accra, Ghana
| | - Lenard Abesiga
- Department of Obstetrics and Gynaecology, Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Henry Mark Lugobe
- Department of Obstetrics and Gynaecology, Mbarara University of Science and Technology, Mbarara, Uganda
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Imoh L, Longwap A, Yersib N, Gowok D, Muhammad Z, Imoh J, Banwat M. Hyperglycaemia in pregnancy: knowledge and correlates amongst antenatal care providers in healthcare facilities in Jos, Nigeria. Afr Health Sci 2023; 23:384-393. [PMID: 37545912 PMCID: PMC10398434 DOI: 10.4314/ahs.v23i1.40] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Abstract
Background Antenatal healthcare providers' (AHPs) knowledge about hyperglycaemia in pregnancy (HIP) and its screening best practices affect the management of affected pregnant women. We assessed the knowledge of HIP and associated factors amongst first line AHPs. Methods This descriptive cross-sectional study involved 188 Doctors, Nurses and Community Health providers directly involved in providing antenatal care at all levels of health care in Jos, Plateau State, Nigeria, selected through total sampling technique. Result A total of 103 AHPs (54.8%) were females. The mean knowledge score (SD) score was 17.0+/-5.5 (out of 30). Only 93 (49.5%) had a good knowledge of HIP (Knowledge score ≥18). Only 88 (46.8%) could correctly identify 75g OGTT or 100g OGTT as diagnostic tests for GDM. Gender, category of hospital, level of care of the institution and job designation were significantly associated with knowledge of HIP after bivariate analysis (p < 0.05). After multivariate analysis using logistic regression analysis, only the category of institution and job designation were independently associated with knowledge of HIP. Conclusion The general level of knowledge of HIP among AHPs is average but awareness of testing and management guidelines is very poor hence the need for regular updates for health professionals.
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Affiliation(s)
- Lucius Imoh
- University of Jos, Department of Chemical Pathology
| | | | | | | | | | - Joy Imoh
- University of Jos, Department of Geography and Planning
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Nwose EU, Bwititi PT, Agofure O, Oshionwu EJ, Young EE, Aganbi E, Egwenu SE, Chime HE, Gbeinbo FD, Odufu A, Okuzor JN, Okuleye A, Aninze K, Onyia IC, Ezugwu EC, Igumbor EO, Ulasi II. Prediabetes and cardiovascular complications study: Highlights on gestational diabetes, self-management and primary health care. World J Meta-Anal 2021; 9:543-556. [DOI: 10.13105/wjma.v9.i6.543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 05/21/2021] [Accepted: 11/28/2021] [Indexed: 02/06/2023] Open
Abstract
International collaboration on the prediabetes and cardiovascular complications study started in 2013. In 2017, a reflection was reported. Incompleteness of documentation and screening of antenatal cases for gestational diabetes mellitus (GDM) was concerning. Hence, further observations have been made that warrant an update. The objective of this review is to highlight gaps between clinical knowledge and practice in GDM, diabetes self-management and primary health care (PHC) for rural dwellers. We followed a descriptive field notes method. Antenatal records of patients screened for GDM with incomplete documentation were examined to determine incompleteness of data in those that also met the criteria for GDM risk assessment. Experiences on development of a diabetes register and education and notes on behavioural change wheel were also reviewed. Other data included cross-sectional evaluation of activities of daily living at two private hospitals. Up to 29% had high GDM risk factors, which fulfilled selection criteria for laboratory screening. Demographic data was complete in all women; however, incomplete documentation was observed with as much as 98% of basic data. High levels of physical activity were found in the population, and health lectures proved effective in food choices. The workforce need for diabetes care seems underestimated, but this may be better understood with reactivation of PHC services. The observations highlight behavioural change wheel issues on GDM and PHC services that need concerted focus. Two proposals are to advance the use of a ‘risk assessment and screening sheet’ for GDM screening and enlightenment of stakeholders on the central hub role of PHC in diabetes management.
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Affiliation(s)
- Ezekiel Uba Nwose
- Department of Public and Community Health, Novena University, Kwale 322107, Nigeria
- School of Dentistry and Medical Sciences, Charles Sturt University, Wagga campus, New South Wales 2650, Australia
- Global Medical Research and Development Organization (GMRDO) group, Abbi Delta State 322107, Nigeria
| | - Phillip Taderera Bwititi
- School of Dentistry and Medical Sciences, Charles Sturt University, Wagga campus, New South Wales 2650, Australia
| | - Otovwe Agofure
- Department of Public and Community Health, Novena University, Kwale 322107, Nigeria
| | - Echinei Jacob Oshionwu
- Global Medical Research and Development Organization (GMRDO) group, Abbi Delta State 322107, Nigeria
- California Department of State Hospital, Stockton, CA 95215, United States
| | - Ekenechukwu Esther Young
- Department of Medicine, College of Medicine, University of Nigeria, Ituku-Ozalla campus, Enugu 402109, Nigeria
| | - Eferhire Aganbi
- Biochemistry Department, Delta State University, Abraka 330105, Nigeria
| | | | - Helen Egoyibo Chime
- Department of Public and Community Health, Novena University, Kwale 322107, Nigeria
| | | | - Alex Odufu
- Global Medical Research and Development Organization (GMRDO) group, Abbi Delta State 322107, Nigeria
| | - John Nwakaego Okuzor
- Global Medical Research and Development Organization (GMRDO) group, Abbi Delta State 322107, Nigeria
- Department of Clinical Laboratory Services, Texas Health (HMH HEB), Bedford, TX 76022, United States
| | - Azuka Okuleye
- Global Medical Research and Development Organization (GMRDO) group, Abbi Delta State 322107, Nigeria
| | - Kennedy Aninze
- Global Medical Research and Development Organization (GMRDO) group, Abbi Delta State 322107, Nigeria
- Clinic Department, Donak Hospital, Kwale 2539083, Nigeria
| | - Innocent Chuks Onyia
- Global Medical Research and Development Organization (GMRDO) group, Abbi Delta State 322107, Nigeria
- Clinic Department, U-Turn Hospital, U-Turn Abule Egba 100276, Nigeria
| | - Euzebus Chinonye Ezugwu
- Department of Medicine, College of Medicine, University of Nigeria, Ituku-Ozalla campus, Enugu 402109, Nigeria
| | | | - Ifeoma Isabel Ulasi
- Department of Medicine, College of Medicine, University of Nigeria, Ituku-Ozalla campus, Enugu 402109, Nigeria
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Prevalence and Risk Factors of Gestational Diabetes Mellitus among Women Attending Antenatal Care in Hadiya Zone Public Hospitals, Southern Nation Nationality People Region. BIOMED RESEARCH INTERNATIONAL 2021; 2021:5564668. [PMID: 33880369 PMCID: PMC8046536 DOI: 10.1155/2021/5564668] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/13/2021] [Accepted: 03/27/2021] [Indexed: 11/17/2022]
Abstract
Introduction In low- and middle-income countries, gestational diabetes mellitus is increasing globally; it is also a double burden of illness for both mothers and children. While gestational diabetes mellitus is recognized in Ethiopia, according to recent diagnostic criteria, information regarding it remains scarce. Objective To assess the prevalence of gestational diabetes mellitus and associated factors among women attending antenatal care in Hadiya Zone public Hospitals, Southern Ethiopia. Methods An institution-based cross-sectional research on a total of 470 pregnant mothers was conducted in the Hadiya Region from August 2019 to December 2020. Finally, via the systematic random sampling process, the study subjects were chosen. A two-hour oral glucose tolerance test of 75 g was used to conduct the universal one-step screening and diagnostic technique. Bivariate and multivariate analyses were used to identify factors associated with gestational diabetes mellitus. Results Gestational diabetes mellitus prevalence was 26.2% (95% CI, 21.8, 30.5). Urban residents (AOR: 2.181; 95% CI: 1.274, 3.733), primary education (AOR:2.286; 95% CI: 1.396, 3.745), without previous history of abortion (AOR: 0.097; 95% CI: 0.048, 0.196), with history of late gestational age in weeks (29-32) (AOR: 0.393; 95% CI: 0.213, 0.723), with no history of coffee drinking (AOR: 2.704; 95% CI: 1.044, 7.006), and adequate dietary diversity (AOR: 2.740; 95% CI: 1.585, 4.739) were significantly associated with gestational diabetes mellitus. Conclusion In Hadiya Zone public Hospitals, the prevalence of gestational diabetes mellitus among women attending antenatal treatment was higher compared to other studies conducted. The urban residents, primary schooling, no prior history of abortion, late gestational age, no history of coffee drinking, and sufficient dietary diversity were significantly linked with gestational diabetes mellitus. To enhance maternal and child health, reinforcing screening, treatment, and prevention strategies for gestational diabetes mellitus is essential.
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