Gestational hyperglycaemia in Malaysia: early screening and intervention to improve outcomes of pregnancy

马来西亚妊娠高血糖：早期筛查和干预以改善妊娠结局

• 批准号: MR/P013538/1
• 负责人: Bee Kang Tan
• 金额: $ 25.54万
• 依托单位: University of Warwick
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2017
• 资助国家: 英国
• 起止时间: 2017 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FP013538%2F1
• 关键词: Gestational; hyperglycaemia; Malaysia; early; screening

High blood glucose levels in pregnancy or gestational diabetes mellitus (GDM) is one of the most common medical conditions during pregnancy. It can cause harm to the pregnant woman and her child. GDM affects 10-15% of Malaysian women. More women are being diagnosed with GDM now because a lower level of blood glucose is being used to diagnose GDM.If not treated, GDM can cause high blood pressure in pregnancy, increased numbers of caesarean deliveries, anxiety and depression. Women who have had GDM have 7-8 times higher life-time risk of type 2 diabetes mellitus (T2DM). There are risks to the children too. They may be too big or too small. If too big, they can have shoulders damaged during the birth. Their blood glucose may fall too low after birth. They may get jaundice soon after birth, or have difficulty in breathing. A very few may die before birth (stillbirth). In the long term, these children are at higher risk of becoming overweight and diabetic.The diagnosis of GDM is usually made between 24-28 weeks of pregnancy using a glucose drink test called an oral glucose tolerance test (OGTT). Although treatment can improve pregnancy outcomes, some of the damage may have already been done to the unborn baby. So screening to detect high glucose levels earlier in pregnancy may be better. However, there can be harms as well as benefits from screening. As a recent British Medical Journal article said:"a label of gestational diabetes brings with it an intervention package that includes glucose monitoring, extra clinic visits, more obstetric monitoring with greater likelihood of labour induction, operative delivery and admission of the baby to special care, and finally for the mother a label of high risk for diabetes". At present, all pregnant women in Malaysia are supposed to be screened for GDM because the population is considered to be high-risk. However, doing OGTTs can be challenging. The test requires pregnant women to come to a laboratory having not eaten anything for at least 8 hours. In many countries, including the UK, women are selected for OGTT based on risk factors such as higher body weight and older age. However, selecting women based on these factors can miss up to half of all women with GDM. Another blood glucose test done by a simple finger prick (called HbA1c) might do instead. It would be done at the first antenatal clinic visit. The HbA1c is a one-step test and patients do not need to fast. However, the value of HbA1c testing is not yet known in Malaysian women.The aims of this study is to find out whether HbA1c testing at first antenatal clinic visit can predict later GDM and if there is a level that can rule out later GDM. We also want to compare testing all pregnant women with testing only those with risk factors. We will do a trial to see if a drug called metformin can prevent women developing GDM. Metformin is safe in pregnancy.An accurate HbA1c level that can safely rule out GDM in women at low risk would help pregnant women. They can be reassured. Avoiding the need for OGTT would save them time and money. In contrast, if the HbA1c level identifies them as at high-risk, healthy eating and lifestyle advice can reduce their risk of getting GDM. In addition to the benefit to mothers and their children, this study will also be useful to people who provide health care in Malaysia. They can focus care more on women at high risk. The results could be used by other countries.

妊娠期高血糖或妊娠糖尿病（GDM）是妊娠期最常见的疾病之一。它可能会对孕妇和孩子造成伤害。GDM影响10-15%的马来西亚妇女。现在越来越多的妇女被诊断为GDM，因为较低的血糖水平被用来诊断GDM。如果不治疗，GDM会导致妊娠期高血压，增加剖腹产的数量，焦虑和抑郁。患有GDM的女性患2型糖尿病（T2 DM）的终生风险高7-8倍。孩子们也有风险。它们可能太大或太小。如果太大，他们可能会在分娩时肩膀受伤。他们的血糖在出生后可能会下降得太低。他们可能会在出生后不久出现黄疸，或呼吸困难。极少数可能在出生前死亡（死产）。妊娠期糖尿病的诊断通常在怀孕24-28周之间进行，使用称为口服葡萄糖耐量试验（OGTT）的葡萄糖饮料试验。虽然治疗可以改善妊娠结局，但一些损害可能已经对未出生的婴儿造成了。因此，在怀孕早期进行筛查以检测高血糖水平可能更好。然而，筛查既有好处也有坏处。正如《英国医学杂志》最近的一篇文章所说：“贴上妊娠糖尿病的标签，就意味着要采取一揽子干预措施，其中包括血糖监测、额外的门诊就诊、更多的产科监测，更有可能进行引产、手术分娩和让婴儿接受特殊护理，最后，母亲还被贴上糖尿病高风险的标签”。目前，马来西亚的所有孕妇都应该接受GDM筛查，因为该人群被认为是高风险人群。然而，进行OGTT可能具有挑战性。该测试要求孕妇在8小时内不吃任何东西。在包括英国在内的许多国家，选择女性进行OGTT是基于风险因素，如体重较高和年龄较大。然而，根据这些因素选择女性可能会错过多达一半的GDM女性。另一种通过简单的手指针刺（称为HbA 1c）进行的血糖测试可能会代替。这将在第一次产前门诊检查时进行。HbA 1c是一个单步测试，患者不需要禁食。然而，HbA 1c检测的价值还不知道在马来西亚women.The的目的是找出是否HbA 1c检测在第一次产前诊所访问可以预测以后GDM，如果有一个水平，可以排除以后GDM。我们还想比较检测所有孕妇和只检测有风险因素的孕妇。我们将进行一项试验，看看一种叫做二甲双胍的药物是否可以预防女性患上GDM。二甲双胍在妊娠期是安全的。准确的HbA 1c水平可以安全地排除低风险女性的GDM，这将有助于孕妇。他们可以放心。避免OGTT的需要将节省他们的时间和金钱。相比之下，如果HbA 1c水平将他们确定为高风险，健康饮食和生活方式建议可以降低他们患GDM的风险。除了对母亲及其子女有益之外，这项研究也将对马来西亚提供保健的人有用。他们可以把更多的注意力集中在高危女性身上。研究结果可供其他国家使用。

项目成果

Low Branched Chain Amino Acids and Tyrosine in Thai Patients with Type 2 Diabetes Mellitus Treated with Metformin and Metformin-Sulfonylurea Combination Therapies.

• DOI: 10.3390/jcm10225424
• 发表时间: 2021-11-20
• 期刊: Journal of clinical medicine
• 影响因子: 3.9
• 作者: Sriboonvorakul N;Pan-Ngum W;Poovorawan K;Muangnoicharoen S;Quinn LM;Tan BK
• 通讯作者: Tan BK

Association of maternal lipid profile and gestational diabetes mellitus: A systematic review and meta-analysis of 292 studies and 97,880 women.

• DOI: 10.1016/j.eclinm.2021.100830
• 发表时间: 2021-04
• 期刊: EClinicalMedicine
• 影响因子: 15.1
• 作者: Hu J;Gillies CL;Lin S;Stewart ZA;Melford SE;Abrams KR;Baker PN;Khunti K;Tan BK
• 通讯作者: Tan BK