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Scientific Session - Chemical - Updates or Changing the Paradigm
Scientific
Scientific
3:30 pm
22 February 2025
Meeting Room 110
Discipline Streams
Chemical Pathology
Session Scientific Program
David Simmons1,2
1Macarthur Clinical School, Western Sydney University, Campbelltown, Sydney; 2Campbelltown Hospital, Campbelltown, Sydney
The traditional view of gestational diabetes mellitus (GDM) is that hyperglycaemia commenced, and was only worth treating, after insulin resistance increased 24-28 weeks’ gestation. This thesis culminated in Hyperglycaemia and Adverse Pregnancy Outcomes (HAPO:2008), a large international observational study relating glucose on a one step 75g oral glucose tolerance test at 24 to 32 weeks’ gestation with pregnancy complications: the relationships were linear. Criteria were extrapolated by consensus from the relationship but were not globally implemented. Meanwhile, maternal weight and glycaemia has been increasing with up to 17% of women entering pregnancy with hyperglycaemia less than overt diabetes. New observational studies have shown that pregnancies complicated by such early hyperglycaemia (early GDM) were more likely to have adverse outcomes, that on ultrasound the fetus was often large by 28 weeks’ gestation and that the glucose-pregnancy complication relationship shown in the HAPO study was also present in the first trimester. The only large RCT of treatment of GDM in early pregnancy, the Treatment Of BOoking Gestational diabetes Mellitus (TOBOGM) study, has now shown that early treatment reduces complications, is cost saving and improves maternal quality of life. There is now RCT evidence that early GDM should be identified and treated.
References
1. Hivert MF, Backman H, Benhalima K, Catalano P, Desoye G, Immanuel J, McKinlay CJD, Meek C, Christopher J Nolan CJ, Ram U, Simmons D, Sweeting A, Jawerbaum A. Gestational Diabetes Mellitus 1: Pathophysiology from preconception, during pregnancy, and beyond. The Lancet. 2024;404:158-174. doi.org/10.1016/S0140-6736(24)00827-4
2. Sweeting A, Hannah W, Backman H, Catalano P, Feghali M, Herman WH, Hivert MF, Immanuel J, Meek C, Oppermann ML, Nolan CJ, Ram U, Schmidt MI, Simmons D, Chivese T, Benhalima K. Gestational Diabetes Mellitus 2: Epidemiology and management of gestational diabetes mellitus. The Lancet. 2024;404:175-192. doi.org/10.1016/S0140-6736(24)00825-0
3. Simmons D, Gupta Y, Hernandez TL, Levitt N, Poppel MV, Yang X, Zarowsky C, Backman H, Feghali M, Nielsen KK. Gestational Diabetes Mellitus 3: Call to action for a new paradigm: GDM as part of a life-course approach to health. The Lancet. 2024;404:193-214. doi.org/10.1016/S0140-6736(24)00826-2
1Macarthur Clinical School, Western Sydney University, Campbelltown, Sydney; 2Campbelltown Hospital, Campbelltown, Sydney
The traditional view of gestational diabetes mellitus (GDM) is that hyperglycaemia commenced, and was only worth treating, after insulin resistance increased 24-28 weeks’ gestation. This thesis culminated in Hyperglycaemia and Adverse Pregnancy Outcomes (HAPO:2008), a large international observational study relating glucose on a one step 75g oral glucose tolerance test at 24 to 32 weeks’ gestation with pregnancy complications: the relationships were linear. Criteria were extrapolated by consensus from the relationship but were not globally implemented. Meanwhile, maternal weight and glycaemia has been increasing with up to 17% of women entering pregnancy with hyperglycaemia less than overt diabetes. New observational studies have shown that pregnancies complicated by such early hyperglycaemia (early GDM) were more likely to have adverse outcomes, that on ultrasound the fetus was often large by 28 weeks’ gestation and that the glucose-pregnancy complication relationship shown in the HAPO study was also present in the first trimester. The only large RCT of treatment of GDM in early pregnancy, the Treatment Of BOoking Gestational diabetes Mellitus (TOBOGM) study, has now shown that early treatment reduces complications, is cost saving and improves maternal quality of life. There is now RCT evidence that early GDM should be identified and treated.
References
1. Hivert MF, Backman H, Benhalima K, Catalano P, Desoye G, Immanuel J, McKinlay CJD, Meek C, Christopher J Nolan CJ, Ram U, Simmons D, Sweeting A, Jawerbaum A. Gestational Diabetes Mellitus 1: Pathophysiology from preconception, during pregnancy, and beyond. The Lancet. 2024;404:158-174. doi.org/10.1016/S0140-6736(24)00827-4
2. Sweeting A, Hannah W, Backman H, Catalano P, Feghali M, Herman WH, Hivert MF, Immanuel J, Meek C, Oppermann ML, Nolan CJ, Ram U, Schmidt MI, Simmons D, Chivese T, Benhalima K. Gestational Diabetes Mellitus 2: Epidemiology and management of gestational diabetes mellitus. The Lancet. 2024;404:175-192. doi.org/10.1016/S0140-6736(24)00825-0
3. Simmons D, Gupta Y, Hernandez TL, Levitt N, Poppel MV, Yang X, Zarowsky C, Backman H, Feghali M, Nielsen KK. Gestational Diabetes Mellitus 3: Call to action for a new paradigm: GDM as part of a life-course approach to health. The Lancet. 2024;404:193-214. doi.org/10.1016/S0140-6736(24)00826-2
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