Impact of maternal education on response to lifestyle interventions to reduce gestational weight gain: Individual participant data meta-Analysis

Objectives To identify if maternal educational attainment is a prognostic factor for gestational weight gain (GWG), and to determine the differential effects of lifestyle interventions (diet based, physical activity based or mixed approach) on GWG, stratified by educational attainment. Design Individual participant data meta-Analysis using the previously established International Weight Management in Pregnancy (i-WIP) Collaborative Group database (https://iwipgroup.wixsite.com/collaboration). Preferred Reporting Items for Systematic reviews and Meta-Analysis of Individual Participant Data Statement guidelines were followed. Data sources Major electronic databases, from inception to February 2017. Eligibility criteria Randomised controlled trials on diet and physical activity-based interventions in pregnancy. Maternal educational attainment was required for inclusion and was categorised as higher education ( 65tertiary) or lower education ( 64secondary). Risk of bias Cochrane risk of bias tool was used. Data synthesis Principle measures of effect were OR and regression coefficient. Results Of the 36 randomised controlled trials in the i-WIP database, 21 trials and 5183 pregnant women were included. Women with lower educational attainment had an increased risk of excessive (OR 1.182; 95% CI 1.008 to 1.385, p =0.039) and inadequate weight gain (OR 1.284; 95% CI 1.045 to 1.577, p =0.017). Among women with lower education, diet basedinterventions reduced risk of excessive weight gain (OR 0.515; 95% CI 0.339 to 0.785, p = 0.002) and inadequate weight gain (OR 0.504; 95% CI 0.288 to 0.884, p=0.017), and reduced kg/week gain (B-0.055; 95% CI-0.098 to-0.012, p=0.012). Mixed interventions reduced risk of excessive weight gain for women with lower education (OR 0.735; 95% CI 0.561 to 0.963, p=0.026). Among women with high education, diet based interventions reduced risk of excessive weight gain (OR 0.609; 95% CI 0.437 to 0.849, p=0.003), and mixed interventions reduced kg/week gain (B-0.053; 95% CI-0.069 to-0.037,p<0.001). Physical activity based interventions did not impact GWG when stratified by education. Conclusions Pregnant women with lower education are at an increased risk of excessive and inadequate GWG. Diet based interventions seem the most appropriate choice for these women, and additional support through mixed interventions may also be beneficial

Individualized versus standard FSH dosing in women starting IVF/ICSI:An RCT. Part 2: The predicted hyper responder

STUDY QUESTION: Does a reduced FSH dose in women with a predicted hyper response, apparent from a high antral follicle count (AFC), who are scheduled for IVF/ICSI lead to a different outcome with respect to cumulative live birth rate and safety? SUMMARY ANSWER: Although in women with a predicted hyper response (AFC > 15) undergoing IVF/ICSI a reduced FSH dose (100 IU per day) results in similar cumulative live birth rates and a lower occurrence of any grade of ovarian hyperstimulation syndrome (OHSS) as compared to a standard dose (150 IU/day), a higher first cycle cancellation rate and similar severe OHSS rate were observed. WHAT IS KNOWN ALREADY: Excessive ovarian response to controlled ovarian stimulation (COS) for IVF/ICSI may result in increased rates of cycle cancellation, the occurrence of OHSS and suboptimal live birth rates. In women scheduled for IVF/ICSI, an ovarian reserve test (ORT) can be used to predict response to COS. No consensus has been reached on whether ORT-based FSH dosing improves effectiveness and safety in women with a predicted hyper response. STUDY DESIGN SIZE, DURATION: Between May 2011 and May 2014, we performed an open-label, multicentre RCT in women with regular menstrual cycles and an AFC > 15. Women with polycystic ovary syndrome (Rotterdam criteria) were excluded. The primary outcome was ongoing pregnancy achieved within 18 months after randomization and resulting in a live birth. Secondary outcomes included the occurrence of OHSS and cost-effectiveness. Since this RCT was embedded in a cohort study assessing over 1500 women, we expected to randomize 300 predicted hyper responders. PARTICIPANTS/MATERIALS, SETTING, METHODS: Women with an AFC > 15 were randomized to an FSH dose of 100 IU or 150 IU/day. In both groups, dose adjustment was allowed in subsequent cycles (maximum 25 IU in the reduced and 50 IU in the standard group) based on pre-specified criteria. Both effectiveness and cost-effectiveness were evaluated from an intention-to-treat perspective. MAIN RESULTS AND THE ROLE OF CHANCE: We randomized 255 women to a daily FSH dose of 100 IU and 266 women to a daily FSH dose of 150 IU. The cumulative live birth rate was 66.3% (169/255) in the reduced versus 69.5% (185/266) in the standard group (relative risk (RR) 0.95 [95%CI, 0.85-1.07], P = 0.423). The occurrence of any grade of OHSS was lower after a lower FSH dose (5.2% versus 11.8%, RR 0.44 [95%CI, 0.28-0.71], P = 0.001), but the occurrence of severe OHSS did not differ (1.3% versus 1.1%, RR 1.25 [95%CI, 0.38-4.07], P = 0.728). As dose reduction was not less expensive (€4.622 versus €4.714, delta costs/woman €92 [95%CI, -479-325]), there was no dominant strategy in the economic analysis. LIMITATIONS, REASONS FOR CAUTION: Despite our training programme, the AFC might have suffered from inter-observer variation. Although strict cancellation criteria were provided, selective cancelling in the reduced dose group (for poor response in particular) cannot be excluded as observers were not blinded for the FSH dose and small dose adjustments were allowed in subsequent cycles. However, as first cycle live birth rates did not differ from the cumulative results, the open design probably did not mask a potential benefit for the reduced dosing group. As this RCT was embedded in a larger cohort study, the power in this study was unavoidably lower than it should be. Participants had a relatively low BMI from an international perspective, which may limit generalization of the findings. WIDER IMPLICATIONS OF THE FINDINGS: In women with a predicted hyper response scheduled for IVF/ICSI, a reduced FSH dose does not affect live birth rates. A lower FSH dose did reduce the incidence of mild and moderate OHSS, but had no impact on severe OHSS. Future research into ORT-based dosing in women with a predicted hyper response should compare various safety management strategies and should be powered on a clinically relevant safety outcome while assessing non-inferiority towards live birth rates. STUDY FUNDING/COMPETING INTEREST(S): This trial was funded by The Netherlands Organization for Health Research and Development (ZonMW, Project Number 171102020). SCO, TCvT and HLT received an unrestricted research grant from Merck Serono (the Netherlands). CBL receives grants from Merck, Ferring and Guerbet. BWJM is supported by a NHMRC Practitioner Fellowship (GNT1082548) and reports consultancy for OvsEva, Merck and Guerbet. FJMB receives monetary compensation as a member of the external advisory board for Ferring pharmaceutics BV and Merck Serono for consultancy work for Gedeon Richter (Belgium) and Roche Diagnostics (Switzerland) and for a research cooperation with Ansh Labs (USA). All other authors have nothing to declare. TRIAL REGISTRATION NUMBER: Registered at the ICMJE-recognized Dutch Trial Registry (www.trialregister.nl). Registration number: NTR2657. TRIAL REGISTRATION DATE: 20 December 2010. DATE OF FIRST PATIENT’S ENROLMENT: 12 May 2011

Aberrant lipid metabolism: an emerging diagnostic and therapeutic target in ovarian cancer

Ovarian cancer remains the most lethal gynaecological cancer. A better understanding of the molecular pathogenesis of ovarian cancer is of critical importance to develop early detection tests and identify new therapeutic targets that would increase survival. Cancer cells depend on de novo lipid synthesis for the generation of fatty acids to meet the energy requirements for increased tumour growth. There is increasing evidence that lipid metabolism is deregulated in cancers, including ovarian cancer. The increased expression and activity of lipogenic enzymes is largely responsible for increased lipid synthesis, which is regulated by metabolic and oncogenic signalling pathways. This article reviews the latest knowledge on lipid metabolism and the alterations in the expression of lipogenic enzymes and downstream signalling pathways in ovarian cancer. Current developments for exploiting lipids as biomarkers for the detection of early stage ovarian cancer and therapeutic targets are discussed. Current research targeting lipogenic enzymes and lipids to increase the cytotoxicity of chemotherapy drugs is also highlighted.Carmen E. Pyragius, Maria Fuller, Carmela Ricciardelli and Martin K. Oehle

A Study on Comparison of different Phenotypic methods for detection of Extended Spectrum Beta Lactamase Production among Enterobacteriaceae in Urinary Tract Infection in a Tertiary Care Centre

INTRODUCTION: Urinary Tract Infections are serious threat to human health affecting millions of people every year resulting in high morbidity and mortality. Escherichia coli, Klebsiella spp, Proteus mirabilis of Enterobacteriaceae are the commonest uropathogens. Antibiotic resistance in uropathogens is increasing worldwide most of the uropathogens of Enterobacteriaceae carry resistance gene for Extended Spectrum Beta Lactamase production on plasmid that can easily spread from organism to organism. Aims and OBJECTIVES: To identify and to compare the rate of detection of ESBL strains by different phenotypic methods and confirmation by genotypic method among Enterobacteriaceae of UTI. MATERIALS AND METHODS: About 122 isolates of Enterobacteriaceae isolated from 400 urine samples of both inpatient and out patients of Government Rajaji Hospital, Madurai during Sep 2015-Aug 2016 were included. ESBL strains were identified by screening methods and confirmed by Phenotypic methods DDST,PCT, CHROM agar, Etest. The results are confirmed by presence of ESBL genes by genotypic method. RESULTS: Among 81 isolates of Escherichia coli 34(41.98%), among 32 isolates of Klebsiella spp 14(43.75%),among 6 isolates of Proteus mirabilis 2(33.33%) were ESBL producers. Totally in Enterobacteriaceae 20.49% by DDST method and 40.98% by PCT, ESBL CHROM agar and E-test were detected as ESBL producers. The commonest gene isolated was CTX-M either alone or in combination with other genes TEM and SHV. CONCLUSION: For early detection of ESBL producers PCT can be performed in Microbiology Laboratory as they are simple to perform and cost effective

Victorian Chinese medicine workforce and practitioner capability

Chinese medicine (CM), a popular form of complementary and alternative medicine (CAM), has been increasingly used in the Western world over the last three decades. Quality, safety and efficacy of CAM therapies including CM have been major public concerns associated with the use of these interventions, for example, the variability of quality of herbal medicines, potential herb-drug interactions, organ injuries due to poor acupuncture practice, inadequate aseptic techniques, and the overall lack of high level clinical evidence of efficacy. Consequently, significant resources have been allocated to the generation of the new scientific evidence concerning quality, safety and efficacy of CAM therapies to address the public concerns and to support the clinical application of validated CAM therapies. Acupuncture and herbal medicines have been amongst the most popular CAM research areas. While the importance of such original research is well argued and supported, there has been a general negligence of the role of education in protecting public safety, promoting CM as a form of evidence-based healthcare and improving the quality of clinical CM services. This study aimed to determine the essential practitioner capabilities to ensure the safe, competent and contemporary CM clinical practice in complex healthcare systems such that of Australia. The specific objectives of this study are: a. to understand the utilisation of CM in Australia, China and a number of developed countries; b. to review issues related capabilitybased curriculum development and to compare the similarities and differences of CM education in China and Australia; c. to provide a comprehensive profile of the Victorian CM workforce based on reliable and authoritative source of data; d. to investigate registered practitioners’ views on the desired capabilities for CM practice; and e. to identify knowledge and skill gaps of practitioners who were registered under the transitional arrangements (between 1 January 2002 and 31 December 2004) which will provide the basis for 15 determining the needs of continuing professional education. Based on outcomes from the two literature reviews (addressing objectives a and b, see Chapters 2 and 4, publications 1, 6, 7, and 9), this research involves a workforce study (addressing objective c, see Chapter 3, publications 3, 4, 5, and 10) and a capability survey (addressing objective d, see Chapter 5, publications 2, and 8). Ethics approvals were obtained for both studies. For the workforce study, a specific instrument with a coding system was developed and approved by the Chinese Medicine Registration Board of Victoria (CMRBVic) prior to the commencement of the data collection based on registration forms submitted by all practitioners registered with CMRBVic during the transitional (also known as grandparenting) period. There were 639 Registered CM practitioners in Victoria as of December 2004. Acupuncture was practiced by almost all practitioners while Chinese herbal medicine was practised by about 60% of them. The mean age of the Victorian CM workforce was 44 years and 55% of them were male. Over 60% of CM practitioners had completed at least a bachelor degree with another one-third of them holding a diploma in CM. Furthermore, over half of the practitioners spoke English as their first language and over one-third (38%) spoke Chinese as their first language. The vast majority of the CM practitioners (90%) worked in the metropolitan areas of Melbourne. These findings provide comprehensive data on the current state of the Victorian CM workforce concerning their educational background, clinical experience and their current practice of CM. They are of significant value to educational institutions, professional associations, healthcare practitioners, government agencies, policymakers, and human resources and workforce managements for future planning. The capability survey was divided into three stages: the literature review stage, a pilot stage and a survey that was sent to all registered CM practitioners. The literature review 16 stage resulted in a draft capabilities chart that was initially developed for the curriculum development of a Master of Applied Science (Chinese Herbal Medicine) at the Division of Chinese Medicine, RMIT University between 2001 and 2003. This draft capabilities chart was piloted through interviews with CM academic staff, regulators and CM practitioners in Victoria prior to the finalisation of the chart. In October 2005, the main postal survey was sent to all (701) eligible practitioners. The response rate was 32.5% with a total of 228 participants completing and returning the bilingual (English and Chinese) questionnaire. In addition, to seek their views on the importance of the individual items of the capabilities, demographic data were also gathered. The demography of the survey respondents did not differ appreciably from that of the Victorian CM workforce. Findings of the survey indicated that of the four categories of capabilities (28 items in total), technical capabilities were considered to be the most important aspects of clinical practice. Specifically, the ability to perform acupuncture treatment and/or dispense an herbal prescription was ranked the highest. In relation to very important capabilities, seven technical capabilities and three capabilities concerning responsible and sustainable practice were ranked the highest of importance, while none of the research and information management capabilities were given the same scores. In addition, communication capabilities were considered to be important, but not to the extent of being very important. New graduates considered the capabilities of identifying key business issues as important while this was not the case for existing practitioners. Furthermore, over one-third of male participants considered patient referral capability to be less important. For continuing professional education, clinical skills courses were considered as a priority while research degree studies were not. The 17 educational background of practitioners appeared to be an important factor influencing their rating of capabilities. Significantly, nearly double the number of practitioners with Australian qualifications compared with practitioners trained overseas valued communication as an important capability. These findings represent a major step in the development of a capability-based curriculum that meets the needs of the Chinese medicine workforce. In the short-term, the findings of this study provide the basis for developing specific continuing professional educational programs that address knowledge and skill gaps such as communication, referral, research training and for some practitioners, basic biomedical sciences. These are particularly relevant and important for those who had not completed a qualification in Australia. The limitations of these studies were a relatively low (32.5%) response rate and the lack of clarity of specific terminologies used in the survey and application for registration form, such as postgraduate education, highest qualification in CM versus highest qualification that may be in another academic discipline. It is unlikely that these issues would have an impact on the validity of the key data, findings of these studies need to be interpreted in the context that these findings represented the state of the CM workforce in a specific point in time. In conclusion, this study, for the first time, provided the comprehensive data on the state of the Victorian CM workforce and CM practitioners’ views on desired practitioner capabilities. A number of continuing professional education needs were identified and the successful implementation of these programs will contribute to the safe and competent CM practice and thus protect the public safety

Behavioural intervention to reduce sexually transmitted infections in people aged 16–24 years in the UK: the safetxt RCT

BACKGROUND: The prevalence of genital chlamydia and gonorrhoea is higher in the 16–24 years age group than those in other age group. With users, we developed the theory-based safetxt intervention to reduce sexually transmitted infections. OBJECTIVES: To establish the effect of the safetxt intervention on the incidence of chlamydia/gonorrhoea infection at 1 year. DESIGN: A parallel-group, individual-level, randomised superiority trial in which care providers and outcome assessors were blinded to allocation. SETTING: Recruitment was from 92 UK sexual health clinics. PARTICIPANTS: Inclusion criteria were a positive chlamydia or gonorrhoea test result, diagnosis of non-specific urethritis or treatment started for chlamydia/gonorrhoea/non-specific urethritis in the last 2 weeks; owning a personal mobile phone; and being aged 16–24 years. ALLOCATION: Remote computer-based randomisation with an automated link to the messaging system delivering intervention or control group messages. INTERVENTION: The safetxt intervention was designed to reduce sexually transmitted infection by increasing partner notification, condom use and sexually transmitted infection testing before sex with new partners. It employed educational, enabling and incentivising content delivered by 42–79 text messages over 1 year, tailored according to type of infection, gender and sexuality. COMPARATOR: A monthly message regarding trial participation. Main outcomes: The primary outcome was the incidence of chlamydia and gonorrhoea infection at 12 months, assessed using nucleic acid amplification tests. Secondary outcomes at 1 and 12 months included self-reported partner notification, condom use and sexually transmitted infection testing prior to sex with new partner(s). RESULTS: Between 1 April 2016 and 23 November 2018, we assessed 20,476 people for eligibility and consented and randomised 6248 participants, allocating 3123 to the safetxt intervention and 3125 to the control. Primary outcome data were available for 4675 (74.8%) participants. The incidence of chlamydia/gonorrhoea infection was 22.2% (693/3123) in the intervention group and 20.3% (633/3125) in the control group (odds ratio 1.13, 95% confidence interval 0.98 to 1.31). There was no evidence of heterogeneity in any of the prespecified subgroups. Partner notification was 85.6% in the intervention group and 84.0% in the control group (odds ratio 1.14, 95% confidence interval 0.99 to 1.33). At 12 months, condom use at last sex was 33.8% in the intervention group and 31.2% in the control group (odds ratio 1.14, 95% confidence interval 1.01 to 1.28) and condom use at first sex with most recent new partner was 54.4% in the intervention group and 48.7% in the control group (odds ratio 1.27, 95% confidence interval 1.11 to 1.45). Testing before sex with a new partner was 39.5% in the intervention group and 40.9% in the control group (odds ratio 0.95, 95% confidence interval 0.82 to 1.10). Having two or more partners since joining the trial was 56.9% in the intervention group and 54.8% in the control group (odds ratio 1.11, 95% confidence interval 1.00 to 1.24) and having sex with someone new since joining the trial was 69.7% in the intervention group and 67.4% in the control group (odds ratio 1.13, 95% confidence interval 1.00 to 1.28). There were no differences in safety outcomes. Additional sensitivity and per-protocol analyses showed similar results. LIMITATIONS: Our understanding of the mechanism of action for the unanticipated effects is limited. CONCLUSIONS: The safetxt intervention did not reduce chlamydia and gonorrhoea infections, with slightly more infections in the intervention group. The intervention increased condom use but also increased the number of partners and new partners. Randomised controlled trials are essential for evaluating health communication interventions, which can have unanticipated effects

Gestational Diabetes Mellitus in Ghana: Validity of Screening Tests, Prevalence, Maternal Risk Factors and Pregnancy Outcomes

Background: Gestational diabetes is increasing globally. Studies from Sub-Saharan Africa have investigated the risk factors but reported prevalence is often based on one diagnostic test while short-term outcomes have scarcely been explored. In primary settings, gestational diabetes is tested after screen-positive glycosuria and/or presence of clinical risk factors. There is suspicion of missing cases due to likelihood of active hyperglycemia without detectable glycosuria and the wide profile of risk facts associated with gestational diabetes. Despite recent updates of diagnostic guidelines with lowered diagnostic cut-off in most cases, opinions are divided on the screening methods diagnostic cut-offs to apply, and whether to do selective screening followed by diagnostic testing of screen-positive cases vis-à-vis universal testing of all pregnant women. Objective: This study was conducted to address three overarching objectives: (1) validate the diagnostic validity of screening tests for gestational diabetes and estimate the proportion of cases that could be missed if selective screening is applied; (2) estimate the prevalence of gestational diabetes and assess the risk factors; and (3) assess the pregnancy outcomes including the extent of attainment of euglycemia at 12 weeks postpartum. Materials and methods: This study employed blind-comparison-to-the-gold-standard and case-control designs embedded in a prospective cohort study. Singleton non-diabetic singleton pregnant women (n=807) were recruited in the first trimester from five state-owned hospitals serving rural and peri-urban communities in Ghana. They were all screened for gestational diabetes from 13-20 weeks using dipstick glycosuria, random glucose and clinical risk factor assessment. Between 20-34 weeks, 491 pregnant women were tested for gestational diabetes using glycated hemoglobin, fasting glucose, 1-hour and the ‘gold standard’ 2-hour oral glucose tolerance test following the universal ‘one-step’ approach. Dietary and obstetric history were assessed retrospectively while physiologic measurements were repeated throughout pregnancy. Case definition was fasting ≥5.6 mmol/L and/or 2-hour postprandial glucose ≥8.5 mmol/L. Short-term outcomes of 403 and 100 women were traced at delivery and 12 weeks postpartum respectively. Validity of test instruments were estimated using standard disease measures. Adjusted odds ratio for gestational diabetes and relative risk for adverse birth outcomes were estimated by logistic regressions. Results: Fasting plasma glucose had the highest diagnostic validity among all the screening and diagnostic tests evaluated. Fasting glucose cut-off ≥5.1 mmol/L threshold had the highest clinically relevant sensitivity and specificity but the ≥5.6 mmol/L threshold had higher disease prediction. Selective screening using glycosuria, random glucose and risk factors missed 97.4%, 87.2% and 45.7% of cases respectively. Using the area under the curve to determine the diagnostic accuracy and test performance, fasting and 1-hour postprandial glucose tests were found to be very good, random glucose was poor whereas glycated hemoglobin was not diagnostically useful. Depending on the diagnostic test and cut-off used, 5-27% of participants were diagnosed with gestational diabetes. Overall 15.9% met the case definition; prevalence per 2-hour postprandial glucose ≥8.5 mmol/L was 9.0% and per fasting glucose ≥5.6 mmol/L was 10.8%; 3.9% were positive in both tests. Adjusted risk factors for gestational diabetes included high glycemic intake, obesity, previous Cesarean section and antenatal care in a primary facility. In terms of outcomes, a unit rise in blood glucose significantly increased maternal blood loss and fetal birthweight. Associated adverse birth outcomes were perineal tear and birth asphyxia. At 12 weeks postpartum, 30% of the diagnosed women did not achieve euglycemia. Conclusions and recommendations: Findings show rising gestational diabetes in the general population. Selective screening using glycosuria, random glucose and clinical risk factors are unnecessary due to their low diagnostic validity. Fasting glucose monitoring need to be integrated into all gestational diabetes detection protocols. Cut-off ≥5.1 mmol/L could be applicable for screening at the population level but to make therapeutic decision, cut-off ≥5.6 mmol/L is recommended where 2-hour oral glucose tolerance test is unavailable. Primary facilities need strengthening to test and refer cases. Diet and adiposity are key risk factors that necessitate lifestyle modifications with focus on nutrition education and weight control. Fetuses exposed to hyperglycemia uterine environment require quality obstetric care as birth asphyxia which is a key outcome is likely to compromise their survival. Follow-up on women diagnosed with gestational diabetes is crucial to avert transition into active diabetes. Cut-off values that would balance risks and benefits of adverse pregnancy and long-term outcomes is needed for the Ghanaian population. Physiologic interactions between fasting and oral glucose tolerance tests need further research. ZUSAMMENFASSUNG Hintergrund: Gestationsdiabetes steigt weltweit an. Studien aus Subsahara-Afrika untersuchen die Risikofaktoren; es gibt aber wenig Studien zur Prävalenz und diese basieren oft nur auf einem einzigen diagnostischen Test. Es gibt auch kaum Studien zur Nachverfolgung post partum. In primären Gesundheitseinrichtungen in Ghana beruht die Diagnose Gestationsdiabetes auf einem positiven Glykosurie-Test oder dem Vorhandensein klinischer Risikofaktoren. Vermutlich werden aber viele Fälle übersehen, bei denen eine aktive Hyperglykämie ohne feststellbare Glykosurie besteht. Trotz kürzlich angepasster internationaler Richtlinien für das Screening und die Diagnostik, mit in den meisten Fällen gesenkten Grenzwerten, sind die Meinungen bezüglich der Screening-Möglichkeiten nach wie vor gespalten zwischen einem universellen Screening aller schwangeren Frauen und einem selektiven Screening nach Risikobelastung. Darüber hinaus gibt es unterschiedliche Vorschläge für diagnostische Tests und deren Grenzwerte. Zielsetzung: Diese Studie wurde durchgeführt, um die folgenden drei Ziele zu erreichen: (1) die Validität von Tests zum Screening und zur Diagnose von Gestationsdiabetes in Ghana zu ermitteln, sowie den Anteil von Fällen einzuschätzen, die bei selektivem Screening übersehen werden; (2) (2) die Prävalenz von Gestationsdiabetes in Ghana zu ermitteln, sowie Risikofaktoren zu identifizieren und (3) (3) die kindlichen und mütterlichen Schwangerschaftsergebnisse, einschließlich der mütterlichen glykämischen Situation 12 Wochen postpartum zu untersuchen. Material und Methoden: Die vorliegende Studie ist eine Kohortenstudie mit eingebetteter Fall-Kontroll-Studie die Schwangere während der Schwangerschaft und bis zu 12 Wochen post partum einschließt. Nicht-diabetische Frauen mit einer Einlings-Schwangerschaft (n=807) wurden in ihrem ersten Trimester in fünf staatlichen Krankenhäusern, welche ländliche und halb-städtische Gemeinden in Ghana versorgen, rekrutiert. Sie wurden alle zwischen der 13. und 20. Schwangerschaftswoche auf Gestationsdiabetes untersucht, und zwar mittels Tests auf Glucosurie und Blutzucker. Ebenso wurde ein klinisches Risikoassessment gemacht. Zwischen der 20. und 34. Schwangerschaftswoche, wurden 491 schwangere Frauen nach dem „single-step“ Verfahren untersucht. Dabei wurden glykosyliertes Hämoglobin, Nüchtern-Blutzucker, oraler Glukosebelastungstest 1-Stunden-Wert und als „Goldstandard“ der 2-Stunden-Wert erhoben. Ernährungs- und geburtshilfliche Anamnesen wurden retrospektiv erhoben und bewertet. Die Falldefinition für Gestationsdiabetes lautete: Nüchtern-Blutzucker ≥ 5,6 mmol/L und/ oder 2-Stunden Wert nach oralem Glukosebelastungstest ≥ 8,5 mmol/L. Von 403 Frauen wurden die Geburtsergebnisse erfasst; 100 Frauen aus dieser Gruppe wurden zusätzlich nach 12 Wochen postpartum untersucht. Die adjustierten Odds Ratios für Gestationsdiabetes und für weitere Schwangerschaftskomplikationen wurden mittels logistischen Regression ermittelt. Ergebnisse: Nüchtern-Blutzucker im Plasma hatte die höchste diagnostische Validität von allen getesteten Screening- und Diagnostik-Tests. Nüchtern-Blutzucker-Grenzwerte von ≥5,1 mmol/L hatte die höchste klinisch relevante Spezifität, aber der Schwellenwert ≥5,6 mmol/L hatte einen höheren Krankheitsvorhersagewert. Selektive Screenings, welche mit Testen von Glykosurie, spontanen Blutzuckermessungen und Risikoprofilen durchgeführt wurden, verfehlten 97,4%, 87,2% beziehungsweise 45,7% der Fälle. Benutzt man die „area under the curve“, um die diagnostische Genauigkeit und die Leistung eines Tests zu bestimmen, ergaben der Nüchtern-Blutzucker und der 1-Stunde-Wert des Glukosebelastungstests die besten Ergebnisse. Spontane Blutzuckermessungen hingegen schnitten schlecht ab, während das glykolisierte Hämoglobin diagnostisch nicht brauchbar war. Abhängig davon, welcher diagnostische Test und welcher Grenzwert verwendet wurde, ergaben sich Prävalenzen von 5-27%. Unter Verwendung des eingangs genannten Goldstandards für diese Studie (Nüchtern-Blutzucker ≥ 5,6 mmol/L und/ oder 2-Stunden Wert nach oralem Glukosebelastungstest ≥ 8,5 mmol/L) ergab sich eine Prävalenz für Gestationsdiabetes von 15,9%: Die Prävalenz für den 2-Stundenwert des Glukosebelastungstests von ≥8,5 mmol/L war 9,0% und für den Nüchtern-Blutzucker ≥5,6 mmol/L war 10,8%; bei 3,9 % waren beide Tests positive. Die Risikofaktoren für Gestationsdiabetes beinhalteten großen Zuckerkonsum, Adipositas und vorhergehenden Sectio caesarea. Ein Anstieg der Glukose im Blut um eine Einheit hatte einen signifikanten Anstieg des mütterlichen Blutverlusts sowie des Geburtsgewichts des Neugeborenen zur Folge. Assoziierte ungünstige Geburtenergebnisse beinhalteten perineale Geburtsverletzungen und kindliche Asphyxie. Zwölf Wochen post partum hatten 30% der Frauen mit Gestationsdiabetes noch keine Euglykämie erreicht. Schlussfolgerung und Empfehlungen: Die Ergebnisse zeigen, dass die Prävalenz des Gestationsdiabetes in der Ghana zunimmt. Selektive Screening-Verfahren wie Glykosurie und spontane Blutzuckermessung sind wenig valide und unnötig. Die Nüchtern-Blutzucker-Überwachung sollte jedoch routinemäßig in die Schwangerenvorsorge integriert werden. Die Nüchtern-Blutzucker-Obergrenze von ≥5,1 mmol/L sollte in Ghana für Screenings der aller Schwangeren benutzt werden, um jedoch therapeutische Entscheidungen zu treffen, soll ein diagnostischer Grenzwert von ≥5,6 mmol/L gelten, falls kein oraler Glukosetoleranztest durchführbar ist. Primäre Gesundheitseinrichtungen sollten beim Screening und in der Überweisung von Gestationsdiabetes-Fällen unterstützt werden. Diabetogene Ernährung und Adipositas sind Hauptrisiken, welche eine Änderung des Lebensstils benötigen. Der Fokus der Beratung sollte in der Ernährung und der Gewichtskontrolle liegen. Feten welche intrauterinen Hyperglykämien ausgesetzt waren, brauchen eine spezialisierte Geburtshilfe, da Geburts-Asphyxien eine häufige Folge von Gestationsdiabetes sind und diese das Sterberisiko erhöhen. Es ist wichtig, Frauen mit Gestationsdiabetes nachzubetreuen, um zu verhindern bzw. zu erkennen, ob ein Gestationsdiabetes in einen manifesten Diabetes mellitus übergeht. Die spezifische klinische Wertigkeit von erhöhtem Nüchternblutzucker und pathologischem oralem Glukosetoleranztest im Kontext der Situation in Ghana sollte weiter untersucht werden