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Simmons, David
Publications (10 of 22) Show all publications
de Brun, M., Magnuson, A., Montgomery, S., Patil, S., Simmons, D., Berntorp, K., . . . Backman, H. (2024). Changing diagnostic criteria for gestational diabetes (CDC4G) in Sweden: A stepped wedge cluster randomised trial. PLoS Medicine, 21(7), Article ID e1004420.
Open this publication in new window or tab >>Changing diagnostic criteria for gestational diabetes (CDC4G) in Sweden: A stepped wedge cluster randomised trial
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2024 (English)In: PLoS Medicine, ISSN 1549-1277, E-ISSN 1549-1676, Vol. 21, no 7, article id e1004420Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The World Health Organisation (WHO) 2013 diagnostic criteria for gestational diabetes mellitus (GDM) has been criticised due to the limited evidence of benefits on pregnancy outcomes in different populations when switching from previously higher glycemic thresholds to the lower WHO-2013 diagnostic criteria. The aim of this study was to determine whether the switch from previous Swedish (SWE-GDM) to the WHO-2013 GDM criteria in Sweden following risk factor-based screening improves pregnancy outcomes.

METHODS AND FINDINGS: A stepped wedge cluster randomised trial was performed between January 1 and December 31, 2018 in 11 clusters (17 delivery units) across Sweden, including all pregnancies under care and excluding preexisting diabetes, gastric bypass surgery, or multifetal pregnancies from the analysis. After implementation of uniform clinical and laboratory guidelines, a number of clusters were randomised to intervention (switch to WHO-2013 GDM criteria) each month from February to November 2018. The primary outcome was large for gestational age (LGA, defined as birth weight >90th percentile). Other secondary and prespecified outcomes included maternal and neonatal birth complications. Primary analysis was by modified intention to treat (mITT), excluding 3 clusters that were randomised before study start but were unable to implement the intervention. Prespecified subgroup analysis was undertaken among those discordant for the definition of GDM. Multilevel mixed regression models were used to compare outcome LGA between WHO-2013 and SWE-GDM groups adjusted for clusters, time periods, and potential confounders. Multiple imputation was used for missing potential confounding variables. In the mITT analysis, 47 080 pregnancies were included with 6 882 (14.6%) oral glucose tolerance tests (OGTTs) performed. The GDM prevalence increased from 595/22 797 (2.6%) to 1 591/24 283 (6.6%) after the intervention. In the mITT population, the switch was associated with no change in primary outcome LGA (2 790/24 209 (11.5%) versus 2 584/22 707 (11.4%)) producing an adjusted risk ratio (aRR) of 0.97 (95% confidence interval 0.91 to 1.02, p = 0.26). In the subgroup, the prevalence of LGA was 273/956 (28.8%) before and 278/1 239 (22.5%) after the switch, aRR 0.87 (95% CI 0.75 to 1.01, p = 0.076). No serious events were reported. Potential limitations of this trial are mainly due to the trial design, including failure to adhere to guidelines within and between the clusters and influences of unidentified temporal variations.

CONCLUSIONS: In this study, implementing the WHO-2013 criteria in Sweden with risk factor-based screening did not significantly reduce LGA prevalence defined as birth weight >90th percentile, in the total population, or in the subgroup discordant for the definition of GDM. Future studies are needed to evaluate the effects of treating different glucose thresholds during pregnancy in different populations, with different screening strategies and clinical management guidelines, to optimise women's and children's health in the short and long term.

TRIAL REGISTRATION: The trial is registered with ISRCTN (41918550).

Place, publisher, year, edition, pages
Public Library of Science (PLoS), 2024
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:oru:diva-114706 (URN)10.1371/journal.pmed.1004420 (DOI)38976676 (PubMedID)
Funder
Swedish Research Council, 2018-00470Region Örebro County, OLL-930268; OLL-693551; OLL-786911Nyckelfonden, OLL-597601Mary von Sydow Foundation, 1017, 4917; 2618; 3718Region StockholmRegion Västmanland, LTV-966501Region Skåne, REGSKANE-622891
Note

Funding: Swedish Research Council (https://www.vr.se/english.html) HB, 2018-00470 ALF Funding Region Örebro County (HB) OLL-930268 The Swedish state under the agreement between the Swedish government and the county councils, the ALF-agreement , (VS), GBG-823211, ALFGBG-932692 Nyckelfonden,Region Örebro County, HB), OLL-597601 Region Örebro County Research committee (HB), OLL-693551, OLL-786911 Regional Research committee Uppsala-Örebro (HB), RFR-749241 Stiftelsen Mary von Sydows, född Wijk, donation fund, (VS), numbers 1017, 4917, 2618, and 3718) Clinical therapy research, Region Stockholm County, The Centre of Clinical Research, (ESL), Västmanland County Council, (MdB), LTV-966501 Research Funds of Skåne University Hospital and the Skåne County Council Research and Development Foundation (KB), REGSKANE-622891.

Available from: 2024-07-09 Created: 2024-07-09 Last updated: 2024-07-09Bibliographically approved
Backman, H. E., Karefylakis, C., Schwarcz, E., Magnuson, A., Branzell, I., Nolan, C. J. & Simmons, D. (2024). Diagnosis of Gestational Diabetes Mellitus: How Should We Measure Glucose?. Diabetes Care, Article ID dc231557.
Open this publication in new window or tab >>Diagnosis of Gestational Diabetes Mellitus: How Should We Measure Glucose?
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2024 (English)In: Diabetes Care, ISSN 0149-5992, E-ISSN 1935-5548, article id dc231557Article in journal, Editorial material (Refereed) Epub ahead of print
Place, publisher, year, edition, pages
American Diabetes Association, 2024
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:oru:diva-111024 (URN)10.2337/dc23-1557 (DOI)38241086 (PubMedID)
Funder
Region Örebro County, OLL- 970566; OLL-942177
Note

This study was funded by Region€Orebro Research Committee (grants Dnr OLL-970566 and OLL-942177). This study was alsosupported by the National Health and Medi-cal Research Council (1104231).

Available from: 2024-02-01 Created: 2024-02-01 Last updated: 2024-02-01Bibliographically approved
Fadl, H., Saeedi, M., Magnuson, A., Patil, S., Simmons, D., Schwarcz, E., . . . Montgomery, S. (2023). Changing diagnostic criteria for gestational diabetes (CDC4G) in Sweden: a stepped wedge cluster randomised controlled trial. In: : . Paper presented at 55th DPSG annual meeting 2023, Poznan, Polen, 7-10 September, 2023.. (1)
Open this publication in new window or tab >>Changing diagnostic criteria for gestational diabetes (CDC4G) in Sweden: a stepped wedge cluster randomised controlled trial
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2023 (English)Conference paper, Oral presentation only (Other academic)
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:oru:diva-109825 (URN)
Conference
55th DPSG annual meeting 2023, Poznan, Polen, 7-10 September, 2023.
Available from: 2023-11-22 Created: 2023-11-22 Last updated: 2024-01-02Bibliographically approved
Valgeirsdóttir, I. R., Hildén, K., Patil, S., Simmons, D., Schwarcz, E., de Brun, M., . . . Backman, H. (2023). Metformin as treatment of GDM. In: : . Paper presented at Diabetes Pregnancy Study Group (DPSG) Meeting 2023, Poznan, Poland, September 7-9, 2023..
Open this publication in new window or tab >>Metformin as treatment of GDM
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2023 (English)Conference paper, Poster (with or without abstract) (Other academic)
Abstract [en]

Background: Whether metformin should be used as treatment for gestational diabetes mellitus (GDM) is a matter of controversy. Concerns about the effects on neonatal birth weight (mainly small for gestational age, SGA) have been raised in one randomized controlled trial in type 2 diabetes in pregnancy. [1] The aim of this study was to evaluate pregnancy outcomes based on different GDM treatment modalities with focus on metformin.

Methods: A cohort study, based on data from the stepped wedge cluster randomized trial; CDC4G (Changing diagnostic criteria for GDM in Sweden - www.cdc4g.se). Screening for GDM involved repeated random plasma glucose measurements and/or clinical risk factors. [2] Data were collected from electronic case record forms, and national health and quality registers. Singleton pregnancies during 2018 (last birth in August 2019) from eight clusters were included. Women with pregestational diabetes and/or previous gastric bypass surgery were excluded. Pregnancy outcomes for different treatment regimens were analyzed for women with GDM compared to the background population without GDM. Logistic regression analyzes with adjustments for confounders (body mass index, age, smoking, country of birth, chronic hypertensive disease and cluster) was performed (adjusted odds ratio (aOR) with 95% confidence interval (CI)) for all outcomes. 

Results: Of the 54 678 pregnancies included, 2 169 (4.0%) were diagnosed with GDM; of whom 1 076 (49.6%) were treated with diet only (dGDM), 668 (30.8%) with metformin only (mGDM), 116 (5.3%) with insulin only (iGDM), and 309 (14.2%) with both metformin and insulin (miGDM). Pregnancy outcomes were as follows: SGA (10th percentile) was significantly decreased in the mGDM group [aOR 0.57 (95% CI 0.41-0.79)] compared to the background population and no significant difference was found in the miGDM group [aOR 0.78 (95% CI 0.51-1.18)] compared to the background population. No significant difference in SGA (10th percentile) was found in the dGDM group [aOR 1.02 (CI 0.83-1.25)] compared to the background population. There was significant difference in neonates born large for gestational age (LGA, 90th percentile) in both mGDM and miGDM groups compared to the background population [aOR 2.29 (95% CI 1.88-2.78) and aOR 2.32 (95% CI 1.76-3.07), respectively]. There was not significant difference in LGA (90th percentile) in dGDM compared to the background population [aOR 0.90 (95% CI 0.73-1.12].

Conclusions: These preliminary unpublished results show no increase in SGA for metformin treated GDM compared to the background population. Outcomes in the diet treated GDM group were similar to the background population. Further analyzes are needed to compare outcomes between pharmacologic treatment groups and assess whether specific treatment regimens lead to similar outcomes in different subgroups (eg ethnicity, obesity and glucose values on diagnostic oral glucose tolerance test).

References:

1.Feig DS, Donovan LE, Zinman B, Sanchez JJ, Asztalos E, Ryan EA, et al. Metformin in women with type 2 diabetes in pregnancy (MiTy): a multicentre, international, randomised, placebo-controlled trial. The lancet Diabetes & endocrinology. 2020;8(10):834-44.

2.Fadl H, Saeedi M, Montgomery S, Magnuson A, Schwarcz E, Berntorp K, et al. Changing diagnostic criteria for gestational diabetes in Sweden - a stepped wedge national cluster randomised controlled trial - the CDC4G study protocol. BMC pregnancy and childbirth. 2019;19(1):398.

Keywords
Gestational diabetes
National Category
Medical and Health Sciences Obstetrics, Gynecology and Reproductive Medicine Endocrinology and Diabetes
Research subject
Obstetrics and Gynaecology
Identifiers
urn:nbn:se:oru:diva-114096 (URN)
Conference
Diabetes Pregnancy Study Group (DPSG) Meeting 2023, Poznan, Poland, September 7-9, 2023.
Available from: 2024-06-05 Created: 2024-06-05 Last updated: 2024-06-07Bibliographically approved
Daley, J. R., Wang, X., Simmons, D., Osuagwu, U. L., Vellayutham, V., Khoo, C. L., . . . Kaushik, S. (2022). Development of a deep learning algorithm for provision of a South Western Sydney diabetes retinal screening service. Paper presented at The Royal Australian and New Zealand College of Ophthalmologists 52nd Annual Scientific Congress, February 25 – March 1, 2022. Clinical and Experimental Ophthalmology, 49(8), 805-805
Open this publication in new window or tab >>Development of a deep learning algorithm for provision of a South Western Sydney diabetes retinal screening service
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2022 (English)In: Clinical and Experimental Ophthalmology, ISSN 1442-6404, E-ISSN 1442-9071, Vol. 49, no 8, p. 805-805Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Purpose: Diabetic retinopathy (DR) is highly prevalent in the multi-ethnic and low socioeconomic population of South Western Sydney. This is a significant public health burden, demanding efficient and cost-effective diabetes retinal screening. The multi-centre South Western Eye and Diabetes Deep Learning Algorithm study, supported by an Ophthalmic Research Institute of Australia grant, aims to develop and validate a novel deep learning algorithm, capable of grading DR, for a new diabetes retinal screening service. This abstract evaluates the performance of the Diabetic retinopathy OCT Open souRce Artificial Intelligence (Doctor AI©SK) program.

Methods: Doctor AI analyses fundus photographs and optical coherence tomography (OCT) images simultaneously to grade diabetic retinopathy. It was trained with over 50,000 fundus photographs and 8000 OCT scans, using a combination of Australasian and publicly available datasets. As a screening tool, the algorithm's operating point was optimised for sensitivity and negative predictive value, and its performance reevaluated. Clinical validation is being undertaken in the recruited population at each study site.

Results: For the detection of diabetic macula oedema from OCT images, Doctor AI achieved a 96.8% sensitivity, 98.1% specificity and 97.5% accuracy. Area under the receiver operating characteristic curve was 0.996. For the diagnosis of DR from fundus photographs, Doctor AI achieved a 90.4% sensitivity, 96.8% specificity and 88.9% accuracy. Preliminary clinical validation revealed an accuracy of 89% and 85% for the OCT and fundus photograph modules of the algorithm, respectively.

Conclusion: Doctor AI is a unique deep learning algorithm capable of diagnosing DR and diabetic macula oedema with high sensitivity and accuracy.

Place, publisher, year, edition, pages
Blackwell Publishing, 2022
National Category
Ophthalmology
Identifiers
urn:nbn:se:oru:diva-110409 (URN)000721587100005 ()
Conference
The Royal Australian and New Zealand College of Ophthalmologists 52nd Annual Scientific Congress, February 25 – March 1, 2022
Available from: 2023-12-18 Created: 2023-12-18 Last updated: 2023-12-18Bibliographically approved
Wang, X., Daley, J. R., Simmons, D., Osuagwu, U. L., Vellayutham, V., Khoo, C. L., . . . Kaushik, S. (2022). Establishing a diabetes retinal screening service in South Western Sydney: Patient satisfaction with retinal imaging and the correlation between diabetic retinopathy and quality of life. Paper presented at The Royal Australian and New Zealand College of Ophthalmologists 52nd Annual Scientific Congress, February 25 – March 1, 2022. Clinical and Experimental Ophthalmology, 49(8), 899-900
Open this publication in new window or tab >>Establishing a diabetes retinal screening service in South Western Sydney: Patient satisfaction with retinal imaging and the correlation between diabetic retinopathy and quality of life
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2022 (English)In: Clinical and Experimental Ophthalmology, ISSN 1442-6404, E-ISSN 1442-9071, Vol. 49, no 8, p. 899-900Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Purpose: The multicentre, prospective South Western Eye and Diabetes Deep Learning Algorithm study has developed a new diabetes retinal screening service, incorporating a novel deep learning algorithm, for a low socio-economic, multi-ethnic, outer-metropolitan Sydney region. This preliminary report examines patient satisfaction with retinal imaging and correlation between diabetic retinopathy (DR) and quality of life (QOL).

Methods: Supported by an Ophthalmic Research Institute of Australia grant, South Western Eye and Diabetes Deep Learning Algorithm participants were recruited from diabetes outpatient clinics and underwent two-field, table-top fundus photography and ocular coherence tomography. Questionnaires regarding patient satisfaction with retinal imaging and self-perceived QOL (EQ5D) were completed. Proportion of participants with high satisfaction levels were reported and mean self-perceivedQ OL (EQ-VAS) scores for those with and without DR were compared.

Results: The study is ongoing and preliminary data (n=54) is presented. DR was detected in 50.0% of recruited participants. All participants found it very convenient to undergo photography on the same day as their diabetes appointment and 83.3% would undergo retinal imaging for DR screening again. This was despite 50.0% of participants requiring pharmacological pupil dilation. Preliminary QOL data showed that although DR did not correlate with greater disability, pain or anxiety/depression, average self-perceived health was lower (mean EQ-VAS scores of 68.3% vs 76.3%) in participants with DR than those without DR.

Conclusions: The correlation between DR and lower self-perceived QOL, occurring independently of both visual acuity and knowledge of DR diagnosis, supports the need for efficient screening and early treatment. Retinal imaging was well-tolerated with an overwhelming preference for same-day outpatient DR screening.

Place, publisher, year, edition, pages
Blackwell Publishing, 2022
National Category
Ophthalmology
Identifiers
urn:nbn:se:oru:diva-110429 (URN)000721587100171 ()
Conference
The Royal Australian and New Zealand College of Ophthalmologists 52nd Annual Scientific Congress, February 25 – March 1, 2022
Available from: 2023-12-18 Created: 2023-12-18 Last updated: 2023-12-18Bibliographically approved
Saeedi, M., Cao, Y., Fadl, H., Gustafson, H. & Simmons, D. (2021). Increasing prevalence of Gestational Diabetes Mellitus when implementing the IADPSG criteria: a systematic review and meta-analysis. Diabetes Research and Clinical Practice, 172, Article ID 108642.
Open this publication in new window or tab >>Increasing prevalence of Gestational Diabetes Mellitus when implementing the IADPSG criteria: a systematic review and meta-analysis
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2021 (English)In: Diabetes Research and Clinical Practice, ISSN 0168-8227, E-ISSN 1872-8227, Vol. 172, article id 108642Article, review/survey (Refereed) Published
Abstract [en]

AIMS: Quantify the proportional increase in gestational diabetes (GDM) prevalence when implementing the new International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria compared to prior GDM criteria, and to assess risk factors that might affect the change in prevalence.

METHODS: A systematic review and meta-analysis was performed of cohort and cross-sectional studies between January 1, 2010 to December 31, 2018 among pregnant women with GDM using IADPSG criteria compared to, and stratified by, old GDM criteria. Web of science, PubMed, EMBASE, Cochrane, Open Grey and Grey literature reports were included. The relative risk for each study was calculated. Subgroup analyses were performed by maternal age, body mass index, study design, country of publication, screening method, sampling method and data stratified according to diagnostic criteria.

RESULTS: Thirty-one cohort and cross-sectional studies with 136 705 women were included. Implementing the IADPSG criteria was associated with a 75% (RR 1.75, 95% CI 1.53-2.01) increase in number of women with GDM with evidence of heterogeneity CONCLUSIONS: The IADPSG criteria increase the prevalence of GDM, but allow movement towards more homogeneity. More studies are needed of the benefits, harms, psychological effects and health costs of implementing the IADPSG criteria.

Place, publisher, year, edition, pages
Elsevier, 2021
Keywords
Gestational diabetes mellitus, IADPSG criteria, incidence, prevalence
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:oru:diva-88419 (URN)10.1016/j.diabres.2020.108642 (DOI)000632552500001 ()33359574 (PubMedID)2-s2.0-85099215102 (Scopus ID)
Note

Funding Agency:

ALF funding Region Örebro County OLL-930268, 2019, OLL-889211, 2019

Available from: 2021-01-11 Created: 2021-01-11 Last updated: 2023-05-24Bibliographically approved
Kristensen, K., Wangel, A.-M., Katsarou, A., Shaat, N., Simmons, D., Fadl, H. & Berntorp, K. (2020). Diagnosis of Gestational Diabetes Mellitus with Point-of-Care Methods for Glucose versus Hospital Laboratory Method Using Isotope Dilution Gas Chromatography-Mass Spectrometry as Reference. Journal of Diabetes Research, 2020, Article ID 7937403.
Open this publication in new window or tab >>Diagnosis of Gestational Diabetes Mellitus with Point-of-Care Methods for Glucose versus Hospital Laboratory Method Using Isotope Dilution Gas Chromatography-Mass Spectrometry as Reference
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2020 (English)In: Journal of Diabetes Research, ISSN 2314-6745, E-ISSN 2314-6753, Vol. 2020, article id 7937403Article in journal (Refereed) Published
Abstract [en]

Background: In Sweden, both glucose analyzers in accredited laboratories and point-of-care glucose devices are used for gestational diabetes mellitus (GDM) diagnosis. The aim of this study was to compare the diagnostic performance of the HemoCue Glucose 201+ (HC201+) and RT (HC201RT) systems with that of the hospital central laboratory hexokinase method (CL) based on lyophilized citrate tubes, using the isotope dilution gas chromatography-mass spectrometry (ID GC-MS) as reference.

Methods: A 75 g oral glucose tolerance test was performed on 135 women screened positive for GDM. Diagnosis was based on the World Health Organization 2013 diagnostic thresholds for fasting (n=135), 1 h (n=52), and 2 h (n=135) glucose measurements. Bland-Altman analysis and surveillance error grids were used to evaluate analytical and clinical accuracy.

Results: Significantly more women were diagnosed with GDM by HC201+ (80%) and CL (80%) than with the reference (65%, P<0.001) based on fasting and/or 2 h thresholds, whereas the percentage diagnosed by HC201RT (60%) did not differ significantly from the reference. In Bland-Altman analysis, a positive bias was observed for HC201+ (4.2%) and CL (6.1%) and a negative bias for HC201RT (-1.8%). In the surveillance error grid, 95.9% of the HC201+ values were in the no-risk zone as compared to 98.1% for HC201RT and 97.5% for CL.

Conclusions: A substantial positive bias was found for CL measurements resulting in overdiagnosis of GDM. Our findings suggest better performance of HC201RT than HC201+ in GDM diagnosis. The results may have possible implications for GDM diagnosis in Sweden and require further elucidation.

Place, publisher, year, edition, pages
Hindawi Publishing Corporation, 2020
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:oru:diva-81222 (URN)10.1155/2020/7937403 (DOI)000522892500001 ()32280717 (PubMedID)2-s2.0-85082967727 (Scopus ID)
Note

Funding Agencies:

Research Funds of Skåne University Hospital  

Skåne County Council Research and Development Foundation

Available from: 2020-04-20 Created: 2020-04-20 Last updated: 2020-12-01Bibliographically approved
Harreiter, J., Fadl, H., Kautzky-Willer, A. & Simmons, D. (2020). Do Women with Diabetes Need More Intensive Action for Cardiovascular Reduction than Men with Diabetes?. Current Diabetes Reports, 20(11), Article ID 61.
Open this publication in new window or tab >>Do Women with Diabetes Need More Intensive Action for Cardiovascular Reduction than Men with Diabetes?
2020 (English)In: Current Diabetes Reports, ISSN 1534-4827, E-ISSN 1539-0829, Vol. 20, no 11, article id 61Article, review/survey (Refereed) Published
Abstract [en]

Purpose of review: This narrative review makes the case for greater efforts to reduce cardiovascular disease (CVD) risk in women with diabetes.

Recent findings: In a recent meta-analysis including five CVOTs of diabetes medications with 46,606 subjects, women (vs men) with type 2 diabetes had a higher relative risk for stroke (RR 1.28; 95% CI 1.09, 1.50) and heart failure (1.30; 1.21, 1.40). Prior studies found higher "within-gender" RR for CVD mortality in women with diabetes although men have an absolute higher risk. Women with prior gestational diabetes mellitus (GDM) have a 2-fold higher CVD risk than the background population. Worse CVD and CVD risk factor management in women, as well as lower female therapy adherence, contribute further to these disparities.

Summary: The mechanism behind this excess risk includes biological, hormonal, socioeconomic, clinical, and behavioral factors that still require further investigation. The need for more intensive CVD reduction in women now includes more attention to screening for both incident diabetes and CVD risk factors among high-risk women.

Place, publisher, year, edition, pages
Springer, 2020
Keywords
CVD risk factors, Cardiovascular disease, Diabetes management, Diabetes mellitus, Gender, Gestational diabetes, Lipids, Prevention, Sex, Sex hormones
National Category
Cardiac and Cardiovascular Systems Endocrinology and Diabetes
Identifiers
urn:nbn:se:oru:diva-86396 (URN)10.1007/s11892-020-01348-2 (DOI)000576783000001 ()33033953 (PubMedID)2-s2.0-85092319054 (Scopus ID)
Note

Funding Agencies:

Medical University of Vienna  

WWTF (Vienna Science and Technology Fund) MA16-045

Austrian Science Fund (FWF)

GENDER-NET Plus ERA-NET cofund 

Available from: 2020-10-13 Created: 2020-10-13 Last updated: 2023-07-04Bibliographically approved
Hildén, K., Magnuson, A., Hanson, U., Simmons, D. & Fadl, H. (2020). Trends in pregnancy outcomes for women with gestational diabetes mellitus in Sweden 1998-2012: a nationwide cohort study. Diabetic Medicine, 37(12), 2050-2057
Open this publication in new window or tab >>Trends in pregnancy outcomes for women with gestational diabetes mellitus in Sweden 1998-2012: a nationwide cohort study
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2020 (English)In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 37, no 12, p. 2050-2057Article in journal (Refereed) Published
Abstract [en]

AIM: To assess whether incidence of maternal and neonatal outcomes for women with or without gestational diabetes mellitus (GDM) have changed over time.

METHODS: Population-based cohort study in Sweden including all singleton pregnancies over the period 1998-2012. GDM was diagnosed following Diabetic Pregnancy Study Group 1991 criteria. Poisson regression or negative binomial regression was used to model yearly relative change in numbers of cases and incidence of the outcomes with 95% confidence intervals (CI), and yearly absolute change in birthweight z-score.

RESULTS: The study included 1 455 667 pregnancies. The number of pregnancies increased over time and the overall prevalence of GDM was 1%. For women with GDM there was a significantly decreasing trend in incidence per year for large for gestational age (LGA) (0.986, 95% CI 0.975 to 0.996), birthweight z-score (-0.012, 95% CI -0.017 to -0.007) and birth trauma (0.937, 95% CI 0.907 to 0.968). The trend for small for gestational age (SGA) among women with GDM increased by an OR per year (1.016, 95% CI 1.002 to 1.029). No significant interaction tests for maternal characteristics were found. Trends in outcomes for women without diabetes were similar to those for women with GDM.

CONCLUSIONS: This study shows that there were improvements in pregnancy outcomes for women with GDM between 1998 and 2012, although the incidence of SGA increased. Improvements followed similar trends in the background population. Inequalities in obstetric outcomes between women with GDM and those without have continued unchanged over 15 years, suggesting that new management strategies are required to reduce this gap.

Place, publisher, year, edition, pages
Wiley-Blackwell Publishing Inc., 2020
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:oru:diva-79938 (URN)10.1111/dme.14266 (DOI)000561648600001 ()32027045 (PubMedID)2-s2.0-85081633439 (Scopus ID)
Note

Funding Agency:

Örebro County Council 

Available from: 2020-02-19 Created: 2020-02-19 Last updated: 2022-02-03Bibliographically approved
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