Research – GDM

Recently Reported Research Gestational Diabetes

21st Oct 2011

Controlling weight gain in pregnancy.

There is no magic way to control weight in pregnancy. Some people just seem to gain the appropriate amounts (see charting and blogs on weight in pregnancy) but others gain despite their best efforts. Julie Quinlivan and colleagues from Freemantle, Australia recently reported on a simple commonsense approach that seemed to work (Aust N Zeal Jour Obstet Gynecol 51:141,2011).
They studied women who were already overweight and at the first antenatal visit divided them into two groups: one routine care and the other had a planned multidisciplinary approach.  There were just four aspects to this planned approach: at each visit they tried to have (1) the same care giver for continuity (2) the women were weighed (3) the women spent five minutes with a food technologist reviewing what they ate and (4) a psychological assessment and intervention was available if needed.  A simple approach.
What was remarkable was how well the pregnant women who got the intervention did.  At the first visit 97% had drank a fizzy pop drink the day before but only 3% used water as a beverage. By the last visit the number drinking fizzy drinks dropped to 37% and those using water increased to 75%! Fast food use fell from 32% to 17% and the use of fruit and vegetables increased from 13% to 67%. This turnaround was associated with 7.0 Kgs (15.4 pounds) weight gain in the intervention group versus 13.8 Kgs (30.4 pounds) in the usual follow up group and translated into less gestational diabetes in the women getting the multidisiplinary care, 6%, versus 29% in the standard care group.
While it will take larger studies to confirm this success as Dr Quinlivan notes “The key factor appears to be repetition of the intervention”. Most centers have continuity of care and weigh people at each visit.  Having back up psychological  support is  helpful but having someone at each visit simply asking what you ate and  drank yesterday seems to really work in the highly motivated setting of pregnancy.

 

1st September 2011

Normal blood sugars in pregnancy

Teri Hernandez and colleagues have analyzed 12 studies and reports on what normal glucose levels are in non diabetic pregnancies (Diabetes Care 34:1660-1668, 2011). The investigators found that before breakfast normal glucose levels during later pregnancy were 3.9 mmol/l on average (71 mgs/dl).  The normal range (the range that over 95% fall into) was 3.0 to 4.8 mmol/l (55 – 87 mgs/dl).
At one hour after a meal the average glucose was 6.1 mmol/l (109 mgs/dl) with a range of 4.6 to 7.5 mmol/l (83 – 135 mgs/dl).  Two hours after a meal the average blood sugar was 5.5 mmol/l (99 mgs/dl) with a range of 4.4 to 6.7 mmol/l (79 – 120 mgs/dl).   The glucose peaked at 69 minutes but with a range of 21 to 117 minutes.
However, it striking the average fasting glucose derived from this total group of 255 women was 0.6 mmol/l (11 mgs/dl) lower than that reported in the huge HAPO study derived from 23,316 pregnant women raising some doubts about accuracy.  The author speculates that maybe the target blood sugar should be under 6.8 mmol/l (122 mgs/dl) at one hour and under 6.1 mmol/l (110 mgs/dl) at two hours after a meal but most feel the usual targets of under 7.8 mmol/l (140 mgs/dl) at one hour and under 6.7 (121 mgs/dl) at two hours are reasonable – studies show good results using them and they appear very close to the upper limits of what is seen in non diabetic women.
ER

 

 

25th March 2011

Accuracy of your glucose meter

A recent report from Sydney (Diabetes Care 34:335-337, 2011, February) confirms older studies in showing that the glucose meters are not super accurate with average differences of 0.2 to 0.7 mmol/l (4-13 mgs/dl) when compared to the laboratory.  Typically the meters read higher than the laboratory.

While this difference is not a big deal for those with preexisting diabetes, if you have gestational diabetes and on diet with glucose readings just above the acceptable level, maybe before you start medications or insulin you should make sure it is not just your meter reading a bit high.  Dr Perera says “awareness of the potential inaccuracies of glucose readings is important in advising diabetes in pregnancy patients on diet and insulin adjustment”, I would agree but think it is more important in making the initial decision, does someone need insulin.

ER

27th December 2010

Will I get diabetes is a question that often comes up in the clinic. While the diabetes usually goes away after the baby is born we know that if the mom had gestational diabetes her pancreas is not perfect and so she is prone to diabetes.  A study from Finland looked at this recently (Journal of Clinical Endocrinology and Metabolism, volume 95, page 772, 2010) and found that at 20 year followup the chance of diabetes in the women related to the findings during the pregnancy as follows:

Mom during pregnancy                                            Risk of Diabetes

No gestational diabetes, normal weight                      1.3%

No gestational diabetes, overweight                           8.4%

Had gestational diabetes but normal weight              7.1%

Had gestational diabetes and was overweight           25.9%

As the lead author, Jatta Pirkola, notes GDM in normal weight women increased the risk of subsequent diabetes but if the mother was also overweight the chance of diabetes was alarmingly high.  GDM especially when coupled with obesity sets the stage for real future mischief.  Researchers are working on trying to get the pancreas to make more insulin, in the meantime if you had GDM then working on the weight is vital.  Would that there was an easy solution.

ER


 

18th Sept 2014

New Research looking for input from women with GDM

Lots of reseach is onging in the area of GDM but a group in Alberta are looking for what women with GDM think.  Thus, you are invited to share any ideas, issues, concerns and experience you have around the management of your gestational diabetes (diabetes diagnosed during pregnancy). Your responses will be used to identify areas of research that are required in order to improve care for women with gestational diabetes in Alberta.

The researchers hope that you will share your opinions with us by completing an anonymous survey available, at fluidsurveys.com/s/achord-gdm/

Please contact Sandra Rees at achord@ualberta.ca or 1-855-819-2223 for more information.

ER