Current guidelines on the management of gestational diabetes mellitus: a content analysis and appraisal

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Abstract

Background

Despite many guidelines for the management of gestational diabetes available internationally, little work has been done to summarize and assess the content of existing guidelines. A paucity of analysis guidelines within in a unified system may be one explanatory factor. So this study aims to analyze and evaluate the contents of all available guidelines for the management of gestational diabetes.

Method

Relevant clinical guidelines were collected through a search of relevant guideline websites and databases (PubMed, Web of Science, Embase, etc.). Fourteen guidelines were identified, and each guideline was assessed for quality using the Appraisal of Guidelines for Research & Evaluation (AGREE) II instrument. Two independent reviewers extracted guideline recommendations using a “recommendation matrix” through which basic guideline information and consistency between search strategy and selection of evidence, between selected evidence and interpretation, and between interpretation and resulting recommendations were analyzed.

Results

Fourteen documents were analyzed, and a total of 361 original recommendations for gestational diabetes mellitus (GDM) management were assessed. In all guidelines included, the recommendations were developed in five domains, namely, diagnosis of GDM, prenatal care, intrapartum care, neonatal care and postpartum care. Different guidelines appeared to have significant discrepancy in consistency of guideline content, but overall, there was consistency between search strategy and selection of evidence, between selected evidence and interpretation, and between interpretation and resulting recommendations (scilicet 49.31, 57.20 and 58.17%, respectively).

Conclusion

Although commonality in most recommendations existed, there were still some discrepancies between guidelines. Consistency of guidelines on the management of GDM in pregnancy is highly variable and needs to be improved.

Electronic supplementary material

The online version of this article (10.1186/s12884-019-2343-2) contains supplementary material, which is available to authorized users.

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Most cited references 20

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AGREE II: advancing guideline development, reporting and evaluation in health care.

M. Brouwers, M E Kho, G P Browman … (2010)

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The Hyperglycemia and Adverse Pregnancy Outcome Study

Patrick Catalano, H McIntyre, J. Kennedy Cruickshank … (2012)

OBJECTIVE To determine associations of gestational diabetes mellitus (GDM) and obesity with adverse pregnancy outcomes in the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study. RESEARCH DESIGN AND METHODS Participants underwent a 75-g oral glucose tolerance test (OGTT) between 24 and 32 weeks. GDM was diagnosed post hoc using International Association of Diabetes and Pregnancy Study Groups criteria. Neonatal anthropometrics and cord serum C-peptide were measured. Adverse pregnancy outcomes included birth weight, newborn percent body fat, and cord C-peptide >90th percentiles, primary cesarean delivery, preeclampsia, and shoulder dystocia/birth injury. BMI was determined at the OGTT. Multiple logistic regression was used to examine associations of GDM and obesity with outcomes. RESULTS Mean maternal BMI was 27.7, 13.7% were obese (BMI ≥33.0 kg/m2), and GDM was diagnosed in 16.1%. Relative to non-GDM and nonobese women, odds ratio for birth weight >90th percentile for GDM alone was 2.19 (1.93–2.47), for obesity alone 1.73 (1.50–2.00), and for both GDM and obesity 3.62 (3.04–4.32). Results for primary cesarean delivery and preeclampsia and for cord C-peptide and newborn percent body fat >90th percentiles were similar. Odds for birth weight >90th percentile were progressively greater with both higher OGTT glucose and higher maternal BMI. There was a 339-g difference in birth weight for babies of obese GDM women, compared with babies of normal/underweight women (64.2% of all women) with normal glucose based on a composite OGTT measure of fasting plasma glucose and 1- and 2-h plasma glucose values (61.8% of all women). CONCLUSIONS Both maternal GDM and obesity are independently associated with adverse pregnancy outcomes. Their combination has a greater impact than either one alone.

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Diabetes and Pregnancy: An Endocrine Society Clinical Practice Guideline

Ian Blumer, Eran Hadar, David R. Hadden … (2013)

Abstract Objective Our objective was to formulate a clinical practice guideline for the management of the pregnant woman with diabetes. Participants The Task Force was composed of a chair, selected by the Clinical Guidelines Subcommittee of The Endocrine Society, 5 additional experts, a methodologist, and a medical writer. Evidence This evidence-based guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to describe both the strength of recommendations and the quality of evidence. Consensus Process One group meeting, several conference calls, and innumerable e-mail communications enabled consensus for all recommendations save one with a majority decision being employed for this single exception. Conclusions Using an evidence-based approach, this Diabetes and Pregnancy Clinical Practice Guideline addresses important clinical issues in the contemporary management of women with type 1 or type 2 diabetes preconceptionally, during pregnancy, and in the postpartum setting and in the diagnosis and management of women with gestational diabetes during and after pregnancy.

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Author and article information

Contributors

Mengxing Zhang: 15211170005@fudan.edu.cn

Yingfeng Zhou: zyingfeng@fudan.edu.cn

Jie Zhong: 16211170005@fudan.edu.cn

Kairong Wang: 17211170003@fudan.edu.cn

Yan Ding: jonish@vip.sina.com

Li Li: lilifck@163.com

Journal

Journal ID (nlm-ta): BMC Pregnancy Childbirth

Journal ID (iso-abbrev): BMC Pregnancy Childbirth

Title: BMC Pregnancy and Childbirth

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2393

Publication date (Electronic): 13 June 2019

Publication date PMC-release: 13 June 2019

Publication date Collection: 2019

Volume: 19

Electronic Location Identifier: 200

Affiliations

[1 ]ISNI 0000 0001 0125 2443, GRID grid.8547.e, Fudan University Centre for Evidence-based Nursing: A Joanna Briggs Institute Centre of Excellence, School of Nursing, , Fudan University, ; Shanghai, China

[2 ]ISNI 0000 0001 0125 2443, GRID grid.8547.e, Obstetrics and Gynecology Hospital, , Fudan University, ; Shanghai, China

Article

Publisher ID: 2343

DOI: 10.1186/s12884-019-2343-2

PMC ID: 6567433

PubMed ID: 31196116

SO-VID: aba6bca3-b385-4f26-a705-d9eccf0c4cca

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 14 December 2018

Date accepted : 16 May 2019

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100010032, Foundation of Shanghai Municipal Commission of Health and Family Planning;

Award ID: 201640324

Award Recipient : Yingfeng Zhou

Funded by: 2015 Nursing Research Project of Fudan University

Award ID: FNF201502

Award Recipient : Yingfeng Zhou

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ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: gestational diabetes mellitus,content analysis method,clinical practice guideline,recommendation matrix

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ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: gestational diabetes mellitus, content analysis method, clinical practice guideline, recommendation matrix

Current guidelines on the management of gestational diabetes mellitus: a content analysis and appraisal

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Background

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Most cited references 20

AGREE II: advancing guideline development, reporting and evaluation in health care.

The Hyperglycemia and Adverse Pregnancy Outcome Study

Diabetes and Pregnancy: An Endocrine Society Clinical Practice Guideline

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