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Gestational diabetes mellitus in Sweden: screening, outcomes, and consequences
Örebro University, School of Health and Medical Sciences.ORCID iD: 0000-0002-2691-7525
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Place, publisher, year, edition, pages
Örebro: Örebro universitet , 2012. , p. 68
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 65
Keywords [en]
Gestational diabetes mellitus, fasting blood glucose, screening, neonatal and obstetric outcomes, ethnicity, cardiovascular disease
National Category
Surgery
Research subject
Surgery
Identifiers
URN: urn:nbn:se:oru:diva-20621ISBN: 978-91-7668-847-2 (print)OAI: oai:DiVA.org:oru-20621DiVA, id: diva2:468953
Public defence
2012-02-17, Wilandersalen, M-huset, Universitetssjukhuset, Örebro, 09:00 (English)
Opponent
Supervisors
Available from: 2011-12-22 Created: 2011-12-22 Last updated: 2019-04-24Bibliographically approved
List of papers
1. Fasting capillary glucose as a screening test for gestational diabetes mellitus
Open this publication in new window or tab >>Fasting capillary glucose as a screening test for gestational diabetes mellitus
2006 (English)In: BJOG: an International Journal of Obstetrics and Gynaecology, ISSN 1470-0328, Vol. 113, no 9, p. 1067-71Article in journal (Refereed) Published
Abstract [en]

Objective: To evaluate fasting capillary glucose as a screening test for gestational diabetes mellitus (GDM) compared with traditional risk factors and repeated random capillary glucose measurements.

Design: Cross-sectional, population-based study.

Setting: Maternal Health Care Clinics in Orebro County, Sweden.

Population: An unselected population of women without diabetes.

Methods: Fasting capillary glucose levels were measured at gestational weeks 28-32. Random capillary glucose levels were measured four to six times during pregnancy. Traditional risk factors for GDM were registered. GDM was diagnosed using a 75-g oral glucose tolerance test.

Main outcome measures: Sensitivity, specificity, likelihood ratios.

Results: In 55 of 3616 women participating in the study, GDM was diagnosed before 34 weeks of gestation. For fasting capillary glucose cutoff values between 4.0 and 5.0 mmol/l, sensitivity was in the range between 87 and 47% and specificity between 51 and 96%. Using a combined screening model of traditional risk factors with fasting capillary glucose at various cutoff values increased the sensitivity only slightly compared with using fasting capillary glucose alone.

Conclusion: In this Swedish, unselected, low-risk population, fasting capillary glucose measurements were found to be an acceptable and useful screening test for GDM.

Place, publisher, year, edition, pages
Oxford: Blackwell Publishing, 2006
Keywords
fasting capillary glucose; gestational diabetes mellitus; screening; sensitivity; specificity
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
urn:nbn:se:oru:diva-4668 (URN)10.1111/j.1471-0528.2006.01032.x (DOI)000240030600015 ()16956338 (PubMedID)2-s2.0-33748161345 (Scopus ID)
Note

Comment in: BJOG. 2007 Feb;114(2):237-8; author reply 238-9. BJOG. 2007 Mar;114(3):372; author reply 373.

Available from: 2008-11-11 Created: 2008-11-11 Last updated: 2017-10-18Bibliographically approved
2. Maternal and neonatal outcomes and time trends of gestational diabetes mellitus in Sweden from 1991 to2003
Open this publication in new window or tab >>Maternal and neonatal outcomes and time trends of gestational diabetes mellitus in Sweden from 1991 to2003
2010 (English)In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 27, no 4, p. 436-441Article in journal (Refereed) Published
Abstract [en]

Aims To determine maternal and neonatal outcomes for women with gestational diabetes mellitus (GDM) in Sweden during 1991–2003, and to compare the outcomes in the two time periods.

Methods This is a population-based cohort study using the Swedish Medical Birth Register data for the period 1991–2003. There were 1 260 297 women with singleton pregnancies registered during this time, of whom 10 525 were diagnosed with GDM, based on a 75 g oral glucose tolerance test. The main diagnostic criteria were fasting capillary whole blood glucose ≥ 6.1 mmol⁄l and 2 h blood glucose ≥ 9.0 mmol⁄l.

Results Maternal characteristics differed significantly between the GDM and non-GDM group. Adjusted odds ratios (OR) were as follows: for pre-eclampsia, 1.81 (95% confidence interval (CI) 1.64–2.00); for shoulder dystocia, 2.74 (2.04–3.68); and for Caesarean section, 1.46 (1.38–1.54).No difference was seen in perinatal mortality, stillbirth rates, Apgar scores, fetal distress or transient tachypnoea. There was a markedly higher risk of large for gestational age,OR3.43 (3.21–3.67), and Erb’s palsy, OR 2.56 (1.96–3.32), in the GDMgroup, and statistically significant differences in prematurity < 37 weeks, birthweight > 4.5 kg, and major malformation, OR 1.19–1.71. No statistically significant improvement in outcomes was seen between the two study periods.

Conclusions Women with GDM have higher risks of pre-eclampsia, shoulder dystocia and Caesarean section. Their infants are often large for gestational age and have higher risks of prematurity, Erb’s palsy and major malformations. These outcomes did not improve over time.

Place, publisher, year, edition, pages
Malden 02148, MA USA: Wiley-Blackwell, 2010
Keywords
gestational diabetes mellitus, maternal outcome, neonatal outcome
National Category
Medical and Health Sciences Obstetrics, Gynecology and Reproductive Medicine
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-21259 (URN)10.1111/j.1464-5491.2010.02978.x (DOI)000276466600011 ()
Available from: 2012-01-23 Created: 2012-01-23 Last updated: 2019-04-24Bibliographically approved
3. Outcomes of gestational diabetes in Sweden depending on country of birth
Open this publication in new window or tab >>Outcomes of gestational diabetes in Sweden depending on country of birth
(Swedish)Manuscript (preprint) (Other academic)
Keywords
Gestational diabetes mellitus (GDM), ethnicity, LGA, maternal and neonatal outcomes, maternal anthropometrics
National Category
Medical and Health Sciences Obstetrics, Gynecology and Reproductive Medicine
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-21269 (URN)
Note

Funding: Örebro County Council Research Funds, Sweden.

Available from: 2012-01-23 Created: 2012-01-23 Last updated: 2019-04-24Bibliographically approved
4. Gestational diabetes mellitus is associated with later cardiovascular disease, particularly among overweight women: a Swedish population based case-control study
Open this publication in new window or tab >>Gestational diabetes mellitus is associated with later cardiovascular disease, particularly among overweight women: a Swedish population based case-control study
Show others...
(English)Manuscript (preprint) (Other academic)
National Category
Medical and Health Sciences Obstetrics, Gynecology and Reproductive Medicine
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-21270 (URN)
Note

Helena Fadl is also affiliated to Maternal Health Care Unit,Primary Care, Örebro, Sweden and to Department of Obstetrics and Gynaecology, Örebro University Hospital, Örebro, Sweden Ulf Hanson is affliated to Department of Obstetrics and Gynaecology, Örebro University Hospital, Örebro, Sweden and to Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden Ingrid Östlund is also affiliated to Department of Obstetrics and Gynaecology, Örebro University Hospital, Örebro, Sweden Scott Montgomery is also affiliated to Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden; Department of Primary Care and Public Health, Charing Cross Hospital, Imperial College, London, UK Erik Schwarcz is also affiliated to Department of Internal Medicine, Örebro University Hospital, Sweden

Available from: 2012-01-23 Created: 2012-01-23 Last updated: 2019-04-24Bibliographically approved

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