The role of first trimester fetal heart rate in the prediction of gestational diabetes: A multicenter study
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01.12.2019 |
Sirico A.
Lanzone A.
Mappa I.
Sarno L.
Słodki M.
Pitocco D.
Zullo F.
Maruotti G.
Rizzo G.
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European Journal of Obstetrics and Gynecology and Reproductive Biology |
10.1016/j.ejogrb.2019.10.019 |
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Ссылка
© 2019 Elsevier B.V. Objective: Early pregnancy models for prediction of GDM have been proposed, mostly using anamnestic and biochemical parameters. The aim of our study was to evaluate the strength of association of first trimester fetal heart rate (FHR) in predicting the development of gestational diabetes (GDM). Study design: We considered in our analysis singleton non-diabetic pregnant women who underwent a first trimester screening at 11–14 weeks. Data on maternal age, BMI, cigarette smoking, NT, FHR, CRL, DV-PVI, β-hCG and PAPP-A were included in the analysis. Multivariate logistic regression analysis was used to estimate the association between maternal characteristics and first-trimester ultrasound measurements and GDM. We evaluated the efficacy of different models for the prediction of GDM. Results: We considered 603 women, of whom 199 (33%) were subsequently diagnosed with GDM. ROC analysis showed that first trimester FHR was highly predictive of GDM (AUC 0.809, 95% CI 0.769–0.849, p < 0.001). At FPR of 20%, first trimester FHR had a detection rate of 65.2% for GDM (positive likelihood ratio: 3.26; negative likelihood ratio: 0.43), which increased to 89.5% at FPR of 40% (positive likelihood ratio: 2.24; negative likelihood ratio: 0.17). When considering as threshold 162 bpm, FHR showed detection rate of 76.9%, specificity of 67.1% and negative predictive value of 85.5% for GDM. Conclusion: This is the first study to highlight the potential role of first trimester FHR as early predictor of GDM. In our cohort, a threshold of 162 bpm has shown high detection rate and NPV for GDM.
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Features of medical care for gestational diabetes mellitus (In case of a specialized obstetric hospital)
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01.01.2018 |
Radzinsky V.
Papysheva O.
Esipova L.
Startseva N.
Kotaish G.
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Akusherstvo i Ginekologiya (Russian Federation) |
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Ссылка
© Bionika Media Ltd. Objective. To evaluate the efficiency of methodological approaches to optimizing the care of pregnant women with gestational diabetes mellitus (GDM) under the present-day conditions of a progressive increase in the incidence of this disease in case of a specialized obstetric hospital. Materials and methods. The statistical data on the 2015–2016 activities of the Outpatient Department and the Maternity Department, Moscow City Clinical Hospital Twenty-Nine, were retrospectively analyzed. Results. GDM was diagnosed in two thirds of the pregnant women at more than 30 weeks’ gestation in primary outpatient care services. In the management of pregnant women with untimely detected GDM, the sensitivity of ultrasound fetometry using the specific markers of diabetic fetopathy (DF) was 65.5%. Programmed labor (PL) was one of the leading methods during childbirth. Conclusion. Ultrasound fetometry using specific markers for DF and the strict continuity of outpatient and inpatient care permitted the frequency of DF to be reduced about 1.5-fold. The use of PL methods in GDM contributed to a two-fold decrease in the cesarean delivery rate without deteriorating the perinatal outcomes of labor.
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