Appropriate Timing of Gestational Diabetes Mellitus Diagnosis in Medium- and Low-Risk Women: Effectiveness of the Italian NHS Recommendations in Preventing Fetal Macrosomia

Autor: Eusebio Chiefari, Antonio Brunetti, Massimo Borelli, Daniela Foti, Maria Mirabelli, Roberta Venturella, Luigi Puccio, Costantino Di Carlo, Federica Visconti, Paola Quaresima, Patrizia Caroleo
Přispěvatelé: Quaresima, P., Visconti, F., Chiefari, E., Mirabelli, M., Borelli, M., Caroleo, P., Foti, D., Puccio, L., Venturella, R., Di Carlo, C., Brunetti, A.
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Adult
Blood Glucose
Risk
medicine.medical_specialty
Percentile
endocrine system diseases
Article Subject
Endocrinology
Diabetes and Metabolism
Birth weight
030209 endocrinology & metabolism
Gestational Age
Weight Gain
Diseases of the endocrine glands. Clinical endocrinology
Fetal Macrosomia
Fetal Development
03 medical and health sciences
0302 clinical medicine
Endocrinology
Pregnancy
Prenatal Diagnosis
medicine
Fetal macrosomia
Birth Weight
Humans
030212 general & internal medicine
Femur
Risk factor
Retrospective Studies
Fetus
Biparietal diameter
Anthropometry
Obstetrics
business.industry
Infant
Newborn
Pregnancy Outcome
nutritional and metabolic diseases
Prenatal Care
Glucose Tolerance Test
medicine.disease
RC648-665
female genital diseases and pregnancy complications
Gestational diabetes
Diabetes
Gestational
Fetal Weight
Italy
Gestation
Female
business
Zdroj: Journal of Diabetes Research, Vol 2020 (2020)
ISSN: 2314-6745
DOI: 10.1155/2020/5393952
Popis: Background. Screening strategies for gestational diabetes mellitus (GDM) earlier than 24-28 weeks of gestation should be considered to prevent adverse pregnancy outcomes. Nonetheless, there is uncertainty about which women would benefit most from early screening and which screening strategies should be offered to women with GDM. The Italian National Healthcare Service (NHS) recommendations on selective screening for GDM at 16-18 weeks of gestation are effective in preventing fetal macrosomia in high-risk (HR) women, but the appropriateness of timing and effectiveness of these recommendations in medium- (MR) and low-risk (LR) women are still controversial. Patients and Methods. We retrospectively enrolled 769 consecutive singleton pregnant women who underwent both anomaly scan at 19-21 weeks of gestation and screening for GDM at 16-18 and/or 24-28 weeks of gestation, in agreement with the NHS recommendations and risk stratification criteria. Comparison of maternal characteristics, fetal biometric parameters at anomaly scan (head circumference (HC), biparietal diameter (BPD), abdominal circumference (AC), femur length (FL), estimated fetal weight (EFW)), and neonatal birth weight (BW) percentile among risk groups was examined. Results. 219 (28.5%) women were diagnosed with GDM, while 550 (71.5%) were normal glucose-tolerant women. Out of 164 HR women, only 62 (37.8%) underwent the recommended early screening for GDM at 16-18 weeks of gestation. AC and EFW percentiles, as well as neonates’ BW percentiles, were significantly higher in HR women diagnosed with GDM at 24-28 weeks of gestation with respect to normal glucose-tolerant women, as well as MR and LR women who tested positive for GDM. Comparative analysis between MR and LR women with GDM and women with normal glucose tolerance revealed significant differences in both AC and EFW percentiles (P<0.05), while there was no significant difference in neonatal BW percentiles. Conclusion. In MR and LR women with GDM, a mild acceleration of fetal growth can be detected at the time of anomaly scan. However, in these at-risk categories, the NHS recommendations for screening and treatment of GDM at 24-28 weeks of gestation are still effective in normalizing BW and preventing fetal macrosomia, thus supporting a risk factor-based selective screening program for GDM.
Databáze: OpenAIRE
Externí odkaz:
Nepřihlášeným uživatelům se plný text nezobrazuje