Therapeutic Management, Delivery, and Postpartum Risk Assessment and Screening in Gestational Diabetes [Entered Retrospectively]

Project Summary Title and Description

Title
Therapeutic Management, Delivery, and Postpartum Risk Assessment and Screening in Gestational Diabetes [Entered Retrospectively]
Description
Objectives: We focused on four questions: (1) What are the risks and benefits of an oral diabetes agent (i.e., glyburide), as compared to all types of insulin, for gestational diabetes? (2) What is the evidence that elective labor induction, cesarean delivery, or timing of induction is associated with benefits or harm to the mother and neonate? (3) What risk factors are associated with the development of type 2 diabetes after gestational diabetes? (4) What are the performance characteristics of diagnostic tests for type 2 diabetes in women with gestational diabetes? Data Sources: We searched electronic databases for studies published through January 2007. Additional articles were identified by searching the table of contents of 13 journals for relevant citations from August 2006 to January 2007 and reviewing the references in eligible articles and selected review articles. Review Methods: Paired investigators reviewed abstracts and full articles. We included studies that were written in English, reported on human subjects, contained original data, and evaluated women with appropriately diagnosed gestational diabetes. Paired reviewers performed serial abstraction of data from each eligible study. Study quality was assessed independently by each reviewer. Main Results: The search identified 45 relevant articles. The evidence indicated that (1) maternal glucose levels do not differ substantially in those treated with insulin versus insulin analogues or oral agents; (2) average infant birth weight may be lower in mothers treated with insulin than with glyburide; (3) induction at 38 weeks may reduce the macrosomia rate, with no increase in cesarean delivery rates; (4) anthropometric measures, fasting blood glucose (FBG), and 2-hour glucose value are the strongest risk factors associated with development of type 2 diabetes; (5) FBG had high specificity, but variable sensitivity, when compared to the 75-gm oral glucose tolerance test (OGTT) in the diagnosis of type 2 diabetes after delivery. Conclusions: The evidence suggests that benefits and a low likelihood of harm are associated with the treatment of gestational diabetes with an oral diabetes agent or insulin. The effect of induction or elective cesarean on outcomes is unclear. The evidence is consistent that anthropometry identifies women at risk of developing subsequent type 2 diabetes; however, no evidence suggested the FBG out-performs the 75-gm OGTT in diagnosing type 2 diabetes after delivery.
Attribution
N/A
Authors of Report
N/A
Methodology description
We identified the primary literature on labor and postpartum management of gestational diabetes and the association with maternal and neonatal outcomes through a comprehensive search plan that included electronic and hand searching. We ran searches of the following databases for the specified periods of time: MEDLINE® (1950 through January 2007), EMBASE® (1974 through January 2007), The Cochrane Central Register of Controlled Trials (CENTRAL; Issue 1, 2007), and the Cumulative Index to Nursing & Allied Health Literature (CINAHL®; 1982 through January 2007). Hand searching for relevant citations took several forms. From our electronic search, we identified the 13 journals (see Appendix Ba) that were most likely to publish articles on this topic. We scanned the table of contents of each issue of these journals for relevant articles from August 2006 through January 2007. For the second form of hand searching, reviewers received eligible articles and flagged references of interest for the team to compare to the existing database. Two independent reviewers conducted title scans in a parallel fashion. If either reviewer thought that a title was potentially eligible, its abstract was reviewed. If the abstract was deemed to meet the inclusion criteria by two reviewers, the abstract was included in our article review. Any differences of opinion were resolved by the two primary reviewers or by a third independent reviewer. Each eligible article underwent double review by study investigators. A primary reviewer completed all data abstraction forms, and a second reviewer confirmed the first reviewer’s data abstraction forms for completeness and accuracy. The reviewers assessed study quality independently. Reviewer pairs were formed to include personnel with both clinical and methodological expertise. A third reviewer re-reviewed a random sample of articles by the first two reviewers to ensure consistency in the abstraction of the articles.
PROSPERO
N/A
DOI
10.7301/Z0F769GS
Notes
The systematic review data of this published project was retrospectively imported into SRDR by the Brown EPC on behalf of the Johns Hopkins EPC and the Agency for Healthcare Research and Quality (AHRQ). For access to the full report available on the AHRQ website, follow this link: http://www.ahrq.gov/research/findings/evidence-based-reports/gestdiabtp.html
Funding Source
The Agency for Healthcare Research and Quality (AHRQ)

Key Questions

1. Key Question 1
2. Key Question 1
3. Key Question 2
4. General Form - Parts 1 and 2
5. Key Question 1
6. Key Question 1
7. Key Question 1
8. Key Question 1
9. Key Question 1

Associated Extraction Forms

Associated Studies (each link opens a new tab)

TitleAuthorsYear
A prospective study comparing insulin and glibenclamide in gestational diabetes mellitus in Asian Indian women.
Perinatal outcomes and the use of oral hypoglycemic agents.2005
Comparison of glyburide and insulin for the management of gestational diabetes in a large managed care organization.2005
Undiagnosed asymptomatic hypoglycemia: diet, insulin, and glyburide for gestational diabetic pregnancy.2004
Prospective observational study to establish predictors of glyburide success in women with gestational diabetes mellitus.2004
Use of glyburide for the treatment of gestational diabetes: the San Antonio experience.2004
Maternal metabolic control and perinatal outcome in women with gestational diabetes treated with regular or lispro insulin: comparison with non-diabetic pregnant women.2003
Not Entered Yet
A comparison of glyburide and insulin in women with gestational diabetes mellitus.2000
Twice daily versus four times daily insulin dose regimens for diabetes in pregnancy: randomised controlled trial.1999
Metabolic and immunologic effects of insulin lispro in gestational diabetes.1999
Prophylactic insulin in the management of gestational diabetes.1990
Consequences of routine delivery at 38 weeks for A-2 gestational diabetes.2005
Gestational diabetes mellitus--implications of different treatment protocols.2004
Diet-controlled gestational diabetes mellitus does not influence the success rates for vaginal birth after cesarean delivery.2004
Elective delivery of infants with macrosomia in diabetic women: reduced shoulder dystocia versus increased cesarean deliveries.1998
Induction of labor at 38 to 39 weeks of gestation reduces the incidence of shoulder dystocia in gestational diabetic patients class A2.1996
Insulin-requiring diabetes in pregnancy: a randomized trial of active induction of labor and expectant management.1993
Outcome of pregnancy in class A1 and A2 gestational diabetic patients delivered beyond 40 weeks' gestation.1992
Shoulder dystocia and birth trauma in gestational diabetes: a five-year experience.
The importance of a postpartum 75 g oral glucose tolerance test in women with gestational diabetes.2006
Long-acting injectable progestin contraception and risk of type 2 diabetes in Latino women with prior gestational diabetes mellitus.2006
Predictors of postpartum diabetes in women with gestational diabetes mellitus.2006
Gestational diabetes: the significance of persistent fasting hyperglycemia for the subsequent development of diabetes mellitus.-- Not Found --
Elevated homocysteine as a risk factor for the development of diabetes in women with a previous history of gestational diabetes mellitus: a 4-year prospective study.2005
Waist circumference is the key risk factor for diabetes in Korean women with history of gestational diabetes.2006
Gestational diabetes: implications of variation in post-partum follow-up criteria.2004
Detecting glucose intolerance after gestational diabetes: inadequacy of fasting glucose alone and risk associated with gestational diabetes and second trimester waist-hip ratio.
Gestational diabetes mellitus in Korea: prevalence and prediction of glucose intolerance at early postpartum.2003
A postnatal fasting plasma glucose is useful in determining which women with gestational diabetes should undergo a postnatal oral glucose tolerance test.2003
Clinical predictors for a high risk for the development of diabetes mellitus in the early puerperium in women with recent gestational diabetes mellitus.2002
Detecting glucose intolerance after gestational diabetes: inadequacy of fasting glucose alone and risk associated with gestational diabetes and second trimester waist-hip ratio.2002
Post-partum reclassification of glucose tolerance in women previously diagnosed with gestational diabetes mellitus.2000
Effects of new criteria for type 2 diabetes on the rate of postpartum glucose intolerance in women with gestational diabetes.
Early postpartum metabolic assessment in women with prior gestational diabetes.1999
Implications of new diagnostic criteria for abnormal glucose homeostasis in women with previous gestational diabetes.
Contraception and the risk of type 2 diabetes mellitus in Latina women with prior gestational diabetes mellitus.1998
Gestational diabetes: antepartum characteristics that predict postpartum glucose intolerance and type 2 diabetes in Latino women.1998
Gestational diabetes is a herald of NIDDM in Navajo women. High rate of abnormal glucose tolerance after GDM.
Long-term diabetogenic effect of single pregnancy in women with previous gestational diabetes mellitus.1996
Predicting future diabetes in Latino women with gestational diabetes. Utility of early postpartum glucose tolerance testing.1995
Gestational diabetes: postpartum glucose tolerance testing.

Downloadable Data Content

Files
  • XLSX Project Data