Gestational Diabetes: Use of Glucose Challenge Test as a Diagnostic Test

Objective:To evaluate the positive predictive value of 50-g glucose challenge test (50-g GCT) for diagnosis of gestational diabetes (GDM).Study design:Diagnostic testMaterials and methods: The study was undertaken at the Faculty of Medicine Vajira Hospital, Navamindradhiraj University by reviewing the medical records of pregnant women who had a 50-g GCT value of ≥ 140 mg/dL followed by a 100-g glucose tolerance test (100-g GTT) between October 2010 and September 2013. Results were classified in 10 mg/dL increments. GDM was diagnosed using Carpenter and Coustan criteria.Results:The current study included 1,886 cases from universal screening of 9,273 pregnant women. The incidence of GDM was 3.6%. A 50-g GCT cut-off value of ≥ 230 mg/dL provided 95% positive predictive value for diagnosis of GDM with 0.1% probability for overdiagnosis. Among population with positive screening who had at least one risk factor of GDM, a 50-g GCT threshold of ≥ 236 mg/dL could be interpreted as GDM without a false positive case and confirmation by 100-g GTT was not required. Conclusions: For a policy of universal screening of GDM, a 50-g GCT may be employed as a diagnostic test when the value is ≥ 230 mg/dL

Evidence for perinatal and child health care guidelines in crisis settings: can Cochrane help?

<p>Abstract</p> <p>Background</p> <p>It is important that healthcare provided in crisis settings is based on the best available research evidence. We reviewed guidelines for child and perinatal health care in crisis situations to determine whether they were based on research evidence, whether Cochrane systematic reviews were available in the clinical areas addressed by these guidelines and whether summaries of these reviews were provided in Evidence Aid.</p> <p>Methods</p> <p>Broad internet searches were undertaken to identify relevant guidelines. Guidelines were appraised using AGREE and the clinical areas that were relevant to perinatal or child health were extracted. We searched The Cochrane Database of Systematic Reviews to identify potentially relevant reviews. For each review we determined how many trials were included, and how many were conducted in resource-limited settings.</p> <p>Results</p> <p>Six guidelines met selection criteria. None of the included guidelines were clearly based on research evidence. 198 Cochrane reviews were potentially relevant to the guidelines. These reviews predominantly addressed nutrient supplementation, breastfeeding, malaria, maternal hypertension, premature labour and prevention of HIV transmission. Most reviews included studies from developing settings. However for large portions of the guidelines, particularly health services delivery, there were no relevant reviews. Only 18 (9.1%) reviews have summaries in Evidence Aid.</p> <p>Conclusions</p> <p>We did not identify any evidence-based guidelines for perinatal and child health care in disaster settings. We found many Cochrane reviews that could contribute to the evidence-base supporting future guidelines. However there are important issues to be addressed in terms of the relevance of the available reviews and increasing the number of reviews addressing health care delivery.</p

Prophylactic oral betamimetics for preterm labour in singleton pregnancies

BACKGROUND: Preterm birth occurs in up to 6% to 10% of all births and is the major complication of pregnancy associated with perinatal mortality and morbidity. Previous preterm delivery is a strong predictor for preterm labour, and the earlier the birth, the more likely it is to be repeated at the same gestation. In the acute setting, betamimetics can decrease contraction frequency or delay preterm birth by 24 to 48 hours. OBJECTIVES: To assess the effectiveness of prophylactic oral betamimetics for the prevention of preterm labour and birth for women with singleton pregnancies at high risk of preterm delivery. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (October 2010) and reference lists. SELECTION CRITERIA: Randomised controlled trials in singleton pregnancies at high risk of preterm labour comparing prophylactic oral betamimetics with placebo or any intervention with the specific aim of preventing preterm birth. DATA COLLECTION AND ANALYSIS: Two authors independently assessed trial quality and extracted data. MAIN RESULTS: One trial (64 singleton pregnancies) was included. The trial compared the oral betamimetic agent isoxuprine with placebo. No difference was seen for perinatal mortality rate (risk ratio (RR) 4.74, 95% confidence interval (CI) 0.50 to 45.00). There was no evidence of an effect of oral betamimetic agents in reduction of spontaneous onset of preterm labour (RR 1.07, 95% CI 0.14 to 8.09) or preterm birth, less than 37 weeks' gestation. There was no significant association between the use of oral betamimetics and side effects sufficient to stop therapy (RR 2.51, 95% CI 0.59 to 10.76). No differences were found for infant outcomes; birthweight less than 2500 grams (RR 1.74, 95% CI 0.44 to 6.87) or neonatal death (RR 4.74, 95% CI 0.50 to 45.00). This trial had adequate methodological quality; however the sample size was inappropriate to determine any significance in neonatal outcome differences between the treatment groups. AUTHORS' CONCLUSIONS: There is insufficient evidence to support or refute the use of prophylactic oral betamimetics for preventing preterm birth in women at high risk of preterm labour with a singleton pregnancy