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Gestational Diabetes Management

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81. Metformin versus Insulin in the Management of Pre-Gestational Diabetes Mellitus in Pregnancy and Gestational Diabetes Mellitus at the Korle Bu Teaching Hospital: A Randomized Clinical Trial. (PubMed)

Metformin versus Insulin in the Management of Pre-Gestational Diabetes Mellitus in Pregnancy and Gestational Diabetes Mellitus at the Korle Bu Teaching Hospital: A Randomized Clinical Trial. To determine if metformin monotherapy or metformin in combination with insulin is equally effective as insulin monotherapy at glycemic control in diabetes mellitus in pregnancy among Ghanaians.This was a study involving 104 pregnant women with type 2 diabetes mellitus (T2DM) or gestational diabetes mellitus (...) weeks.The two hour post prandial blood glucose (2HPG) levels were significantly lower in the metformin group than the insulin group (p= 0.004).The findings of this study suggest that metformin monotherapy is effective in achieving glycemic targets in the management of diabetes in pregnancy. It is more effective than insulin in lowering the 2HPG level.Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12614000942651.

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2015 PloS one Controlled trial quality: uncertain

82. Diabetes in pregnancy: management from preconception to the postnatal period

guideline replaces CG63. This guideline is the basis of QS109. Ov Overview erview This guideline covers managing diabetes and its complications in women who are planning pregnancy or are already pregnant. It aims to improve the diagnosis of gestational diabetes and help women with diabetes to self-manage their blood glucose levels before and during pregnancy. In August 2015, changes were made to recommendations 1.1.17, 1.1.29, 1.1.34 and 1.3.28 for consistency with other NICE guidelines. Who (...) is it for? Healthcare professionals Commissioners and providers Women with diabetes who are planning a pregnancy or are pregnant and women at risk of, or diagnosed with, gestational diabetes Diabetes in pregnancy: management from preconception to the postnatal period (NG3) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 5 of 55Introduction Introduction This guideline updates and replaces 'Diabetes in pregnancy' (NICE guideline CG63

2015 National Institute for Health and Clinical Excellence - Clinical Guidelines

83. Guideline Supplement: Gestational diabetes mellitus

be downloaded in Portable Document Format (PDF) from www.health.qld.gov.au/qcg 4.1 Guideline resources The following guideline components are provided on the website as separate resources: • Flowchart: Screening and diagnosis of GDM • Flowchart: Intrapartum management for GDM requiring Insulin and/or Metformin • Flowchart: Postpartum management for all women with GDM • Flowchart: Antenatal schedule of care • Education resource: Gestational diabetes mellitus • Knowledge assessment: Gestational diabetes (...) Guideline Supplement: Gestational diabetes mellitus Maternity and Neonatal C linical G uideline Department of Health Supplement: Gestational diabetes mellitus Queensland Clinical Guideline Supplement: Gestational diabetes mellitus Refer to online version, destroy printed copies after use Page 2 of 12 Table of Contents 1 Introduction 3 1.1 Funding 3 1.2 Conflict of interest 3 1.3 Guideline review 3 2 Methodology 4 2.1 Topic identification 4 2.2 Scope 4 2.3 Clinical questions 4 2.4 Exclusions 4

2015 Queensland Health

84. Gestational diabetes mellitus

• Maternal age = 40 years • Family history DM (1 st degree relative or sister with GDM) • Previous macrosomia (birth weight > 4500 g or > 90 th percentile • Previous perinatal loss • Polycystic Ovarian Syndrome • Medications (corticosteroids, antipsychotics) • Multiple pregnancy Queensland Clinical Guideline: Gestational diabetes mellitus Refer to online version, destroy printed copies after use Page 4 of 38 Flowchart: Intrapartum management for GDM requiring Insulin and/or Metformin Metformin • Cease (...) -administration of Insulin therapy 26 5 Birthing 27 5.1 Pharmacotherapy as birth approaches 28 5.2 Intrapartum monitoring 28 5.3 Intrapartum BGL management 29 5.3.1 Insulin infusion 29 6 Postpartum care 30 6.1 Newborn care 30 6.2 Breastfeeding 31 6.3 Discharge planning 31 References 32 Appendix A: Antenatal schedule of care 36 Appendix B: Physical activity 37 Acknowledgements 38 Queensland Clinical Guideline: Gestational diabetes mellitus Refer to online version, destroy printed copies after use Page 8 of 38

2015 Queensland Health

85. Exercise and its role in gestational diabetes mellitus (PubMed)

Exercise and its role in gestational diabetes mellitus Gestational diabetes mellitus (GDM) refers to diabetes diagnosed in the second or third trimester of pregnancy that is not clearly either type 1 or type 2 diabetes. GDM is a common medical complication in pregnancy that has been rapidly increasing worldwide. GDM is associated with both short- and long-term health issues for both mothers and offspring. Consistent with type 2 diabetes, peripheral insulin resistance contributes (...) to the hyperglycemia associated with GDM. Accordingly, it is important to identify strategies to reduce the insulin resistance associated with GDM. To date, observational studies have shown that exercise can be a non-invasive therapeutic option for preventing and managing GDM that can be readily applied to the antenatal population. However, the relevant mechanisms for these outcomes are yet to be fully elucidated. The present review aimed to explain the potential mechanisms of exercise from the perspective

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2016 Chronic diseases and translational medicine

86. Systematic review with meta analysis: In women with gestational diabetes requiring drug treatment, glibenclamide may be inferior to insulin and metformin: metformin (plus insulin when required) performs better than insulin

Statistics from Altmetric.com Commentary on : Balsells M , Garia-Patterson A , Solà I , et al . Glibenclamide, metformin, and insulin for the treatment of gestational diabetes: a systematic review and meta-analysis . Context Insulin therapy is recommended as a first-line approach after failure of diet therapy to manage gestational diabetes (GDM). 1 , 2 Not all women are suitable candidates or decline to use insulin to manage their blood glucose levels and alternative options are needed. Metformin (...) and glibenclamide are mentioned as alternatives to insulin for management of gestational diabetes mellitus (GDM) in several guidelines, 1 , 2 while National Institute for Health and Care Excellence guidelines recommend metformin as a first-line. 3 This systematic review and meta-analysis examines the short-term maternal and neonatal outcomes in women with GDM receiving glibenclamide, metformin or insulin in randomised controlled trials (RCTs). … Request Permissions If you wish to reuse any or all

2015 Evidence-Based Medicine (Requires free registration)

87. Investigation and Management Small-for-Gestational-Age Fetus

Investigation and Management Small-for-Gestational-Age Fetus The Investigation and Management of the Small–for–Gestational–Age Fetus Green–top Guideline No. 31 2nd Edition | February 2013 | Minor revisions – January 2014RCOG Green-top Guideline No. 31 2of 34 © Royal College of Obstetricians and Gynaecologists The Investigation and Management of the Small–for–Gestational–Age Fetus This is the second edition of this guideline. It replaces the first edition which was published in November 2002 (...) of fetal size is valuable in predicting birthweight and determining size-for-gestational age 2 If two AC/EFW measurements are used to estimate growth, they should be at least 3 weeks apart 3 Use cCTG when DV Doppler is unavailable or results are inconsistent – recommend delivery if STV 2 SDs, EDV present AREDV Normal AC & EFW 1,2 UA Doppler MCA Doppler after 32 weeks APPENDIX III: The Management of the Small–for–Gestational–Age (SGA) FetusAPPENDIX IV: Glossary AC Abdominal circumference AFI Amniotic

2013 Royal College of Obstetricians and Gynaecologists

88. Service evaluation of diabetes management during pregnancy in a regional maternity hospital: potential scope for increased self-management and remote patient monitoring through mHealth solutions. (PubMed)

Service evaluation of diabetes management during pregnancy in a regional maternity hospital: potential scope for increased self-management and remote patient monitoring through mHealth solutions. Pre-gestational and gestational diabetes mellitus are common complications in pregnancy affecting one in six pregnancies. The maternity services are under significant strain managing the increasing number of complex pregnancies. This has an impact on patients' experience of antenatal care. Therefore (...) , there is a clear need to address pregnancy care. One possible solution is to use home-based digital technology to reduce clinic visits and improve clinical monitoring.The aim of this study was to evaluate the antenatal services provided to pregnant women with diabetes who were monitored at the joint metabolic and obstetric clinic at the Southern Health and Social Care Trust in Northern Ireland.The questionnaires were completed by sixty-three women, most of whom had gestational diabetes mellitus. Most

2019 BMC health services research

89. What is known about options and approaches to intrapartum management of women with gestational diabetes mellitus (GDM)?

What is known about options and approaches to intrapartum management of women with gestational diabetes mellitus (GDM)? KTA Evidence Summary: Intrapartum Management of Patients with Gestational Diabetes Mellitus (GDM) Page 1 of 19 May 2010 May 2010 – Knowledge to Action Evidence Summary What is known about options and approaches to fetal surveillance and intrapartum management of women with gestational diabetes mellitus (GDM)? This report aims to summarize the evidence around the intrapartum (...) management of women with gestational diabetes mellitus (GDM) to help inform evidence-based guidelines and advance practice in the province of Ontario. Key Messages ? Gestational Diabetes Mellitus (GDM) can cause serious complications in the intrapartum care of pregnant women and their fetuses. The impact and treatment differs somewhat from that of Type 1 and Type 2 diabetes. ? Fetal surveillance is a key aspect of the intrapartum care of the fetus. The most prominent methods appear to be: fetal movement

2010 OHRI Knowledge to Action

90. Oral hypoglycemic agents vs insulin in management of gestational diabetes: a systematic review and metaanalysis

Oral hypoglycemic agents vs insulin in management of gestational diabetes: a systematic review and metaanalysis Oral hypoglycemic agents vs insulin in management of gestational diabetes: a systematic review and metaanalysis Oral hypoglycemic agents vs insulin in management of gestational diabetes: a systematic review and metaanalysis Dhulkotia JS, Ola B, Fraser R, Farrell T CRD summary This review found no significant differences between oral hypoglycaemic agents and insulin in glycaemic (...) , these agents may be used as adjunctive treatments to insulin in the management of gestational diabetes. CRD commentary The review addressed a clear question. Criteria for the inclusion of studies were defined. Appropriate electronic databases were used to identify relevant studies. There were no language restrictions. The review appeared to be restricted to published studies, so there was some risk of publication bias. Steps were taken by the reviewers to minimise errors and bias at all parts of the review

2010 DARE.

91. Screening and Diagnosis of Gestational Diabetes Mellitus*

of Difference There are no significant areas of disagreement between the guidelines. Screening and Diagnosis of GDM TES (2013) NGC Note : See the TES guideline summary for recommendations on the following topics, which are beyond the scope of this synthesis: Preconception care of women with diabetes Testing for overt diabetes in early pregnancy Management of gestational diabetes Labor, delivery, lactation and postpartum care Gestational Diabetes Testing for Gestational Diabetes at 24 to 28 Weeks Gestation (...) Screening and Diagnosis of Gestational Diabetes Mellitus* Screening and Diagnosis of Gestational Diabetes Mellitus | National Guideline Clearinghouse success fail JUL Aug 12 2018 2019 30 Sep 2016 - 13 Jul 2018 COLLECTED BY Organization: Formed in 2009, the Archive Team (not to be confused with the archive.org Archive-It Team) is a rogue archivist collective dedicated to saving copies of rapidly dying or deleted websites for the sake of history and digital heritage. The group is 100% composed

2014 National Guideline Clearinghouse (partial archive)

92. ADIPS Consensus guidelines for the testing and diagnosis of gestational diabetes mellitus in Australia

ADIPS Consensus guidelines for the testing and diagnosis of gestational diabetes mellitus in Australia Page 1 of 8 ADIPS Consensus Guidelines for the Testing and Diagnosis of Gestational Diabetes Mellitus in Australia Nankervis A, McIntyre HD, Moses R, Ross GP, Callaway L, Porter C, Jeffries W, Boorman C, De Vries B, McElduff A for the Australasian Diabetes in Pregnancy Society The Australasian Diabetes in Pregnancy Society (ADIPS) originally formulated recommendations for the testing (...) and diagnosis of gestational diabetes mellitus (GDM) in 1991. 1 These guidelines were primarily based on expert opinion. With some local variations, the ADIPS guidelines have been used nationally since that time. In the light of more recent evidence, ADIPS has elected to revise these guidelines in the current document. Recommendations for future research are summarized at the end of this document. The Hyperglycemia and Adverse Pregnancy Outcome study (HAPO) published in 2008 2 was a large, prospective

2014 Clinical Practice Guidelines Portal

93. Benefits and harms of treating gestational diabetes mellitus: a systematic review and meta-analysis for the US Preventive Services Task Force and National Institutes of Health Office of Medical Applications of Research

diagnosed with gestational diabetes mellitus (including foetal surveillance protocols) were required in order to guide obstetric investigations and management of gestational diabetes mellitus. Funding Agency for Healthcare Research and Quality, USA. Bibliographic details Hartling L, Dryden DM, Guthrie A, Muise M, Vandermeer B, Donovan L. Benefits and harms of treating gestational diabetes mellitus: a systematic review and meta-analysis for the US Preventive Services Task Force and National Institutes (...) Benefits and harms of treating gestational diabetes mellitus: a systematic review and meta-analysis for the US Preventive Services Task Force and National Institutes of Health Office of Medical Applications of Research Benefits and harms of treating gestational diabetes mellitus: a systematic review and meta-analysis for the US Preventive Services Task Force and National Institutes of Health Office of Medical Applications of Research Benefits and harms of treating gestational diabetes mellitus

2013 DARE.

94. Screening tests for gestational diabetes: a systematic review for the US Preventive Services Task Force

Screening tests for gestational diabetes: a systematic review for the US Preventive Services Task Force Screening tests for gestational diabetes: a systematic review for the US Preventive Services Task Force Screening tests for gestational diabetes: a systematic review for the US Preventive Services Task Force Donovan L, Hartling L, Muise M, Guthrie A, Vandermeer B, Dryden DM CRD summary This review concluded that the oral glucose challenge test and fasting plasma glucose could identify women (...) without gestational diabetes mellitus, and the challenge test was better at identifying women with the condition. Despite some data issues, such as low quality and a variety of reference standards, this review was well conducted and these conclusions are likely to be reliable. Authors' objectives To assess the accuracy of various screening tests, in detecting gestational diabetes mellitus, across a range of recommended diagnostic glucose thresholds. Searching Fifteen databases, including MEDLINE

2013 DARE.

95. Systematic review with meta-analysis: Treating mild gestational diabetes yields benefits with little or no evidence of harms

Systematic review with meta-analysis: Treating mild gestational diabetes yields benefits with little or no evidence of harms Treating mild gestational diabetes yields benefits with little or no evidence of harms | BMJ Evidence-Based Medicine We use cookies to improve our service and to tailor our content and advertising to you. You can manage your cookie settings via your browser at any time. To learn more about how we use cookies, please see our . Log in using your username and password (...) For personal accounts OR managers of institutional accounts Username * Password * your user name or password? Search for this keyword Search for this keyword Main menu Log in using your username and password For personal accounts OR managers of institutional accounts Username * Password * your user name or password? You are here Treating mild gestational diabetes yields benefits with little or no evidence of harms Article Text Therapeutics Systematic review with meta-analysis Treating mild gestational

2014 Evidence-Based Medicine (Requires free registration)

96. Gestational hypertension

' gestation in a previously normotensive patient, without the presence of proteinuria. Patient requires regular monitoring of BP and urinalysis during the pregnancy to exclude pre-eclampsia and gestational diabetes. Mild hypertension is managed with lifestyle modification and antihypertensive therapy. Severe hypertension (BP ≥160/110 mmHg) requires admission for antihypertensive therapy. For women over 37 weeks' gestation, induction should be considered. Definition Gestational hypertension is defined (...) by sustained BP readings of ≥140/90 mmHg during pregnancy after 20 weeks’ gestation in a previously normotensive patient, without the presence of proteinuria (<300 mg in 24 hours). All manifestations of gestational hypertension are presumptive until retrospectively confirmed by complete resolution of hypertension and any other new abnormalities by 12 weeks postpartum; otherwise, other diagnoses should be considered. Sibai BM. Diagnosis and management of gestational hypertension and preeclampsia. Obstet

2018 BMJ Best Practice

97. Management of Preexisting Diabetes in Pregnancy: A Review. (PubMed)

Management of Preexisting Diabetes in Pregnancy: A Review. The presence of preexisting type 1 or type 2 diabetes in pregnancy increases the risk of adverse maternal and neonatal outcomes, such as preeclampsia, cesarean delivery, preterm delivery, macrosomia, and congenital defects. Approximately 0.9% of the 4 million births in the United States annually are complicated by preexisting diabetes.Women with diabetes have increased risk for adverse maternal and neonatal outcomes, and similar risks (...) are present with type 1 and type 2 diabetes. Both forms of diabetes require similar intensity of diabetes care. Preconception planning is very important to avoid unintended pregnancies and to minimize risk of congenital defects. Hemoglobin A1c goals are less than 6.5% at conception and less than 6.0% during pregnancy. It is also critical to screen for and manage comorbid illnesses, such as retinopathy and nephropathy. Medications known to be unsafe in pregnancy, such as angiotensin-converting enzyme

2019 JAMA

98. Knowledge and Implementation of the S3 Guideline on Gestational Diabetes among Gynecologists and Diabetologists Four Years after Publication: Results of a Survey of 773 Gynecologists and 76 Diabetologists on their Knowledge of the Guideline on Gestational (PubMed)

Knowledge and Implementation of the S3 Guideline on Gestational Diabetes among Gynecologists and Diabetologists Four Years after Publication: Results of a Survey of 773 Gynecologists and 76 Diabetologists on their Knowledge of the Guideline on Gestational An S3 guideline on the diagnosis and differentiated management of gestational diabetes (GDM) was published in Germany in 2011. This guideline replaced the previously applicable recommendations for the diagnosis and treatment of GDM

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2016 Geburtshilfe Und Frauenheilkunde

99. Perinatal changes in fetal cardiac geometry and function in gestational diabetic pregnancies at term. (PubMed)

Perinatal changes in fetal cardiac geometry and function in gestational diabetic pregnancies at term. To evaluate the effect of gestational diabetes mellitus (GDM) on fetal and neonatal cardiac geometry and function around the time of birth.A prospective study of 75 pregnant women delivering at term, comprising of 54 normal pregnancies and 21 with a diagnosis GDM. Fetal and neonatal conventional cardiac indices, spectral tissue Doppler and 2D speckle tracking imaging were performed a few days (...) exhibit cardiac indices indicative of myocardial impairment reflecting a response to a relatively hyperglycaemic intrauterine environment with alteration in fetal loading conditions (LV preload deprivation and increased RV afterload) and adaptation to subsequent acute changes in haemodynamic load at birth. Elucidating mechanisms that contribute to the alterations in perinatal cardiac function in GDM could help in refining management and evolve better therapeutic strategies to reduce the risk

2018 Ultrasound in Obstetrics and Gynecology

100. The experience of gestational diabetes for indigenous Māori women living in rural New Zealand: qualitative research informing the development of decolonising interventions. (PubMed)

The experience of gestational diabetes for indigenous Māori women living in rural New Zealand: qualitative research informing the development of decolonising interventions. Although early detection and management of excess rates of gestational diabetes mellitus (GDM) among Indigenous women can substantially reduce maternal and offspring complications, current interventions seem ineffective for Indigenous women. While undertaking a qualitative study in a rural community in Northland, New Zealand (...) effects of deprivation and living with GDM compounded the complexities of participant' lives including perceptions of powerlessness and mental health deterioration. Missed opportunities for health services to detect and manage diabetes had ongoing health consequences for the women and their offspring. Positive relationships with healthcare providers facilitated management of GDM and helped women engage with self-management.Māori women living with T2DM were clear that health providers had failed

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2018 BMC Pregnancy and Childbirth

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