Diet and exercise can reduce the risk of developing diabetes during pregnancy

NIHR Signal | January 2019 | Diet and exercise can reduce the risk of developing diabetes during pregnancy

A recent NIHR Signal underlines a systematic review which found that any form of lifestyle intervention reduced the risk of gestational diabetes by 23%, with similar effects for diet, exercise or both. Interventions were most successful when targeted at high-risk populations, though body mass index alone was not associated with an effect.

Diet and exercise are effective ways of preventing the development of diabetes during pregnancy, known as gestational diabetes.

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Gestational diabetes is becoming more common and is associated with poorer outcomes for mother and baby. Diet, physical activity and weight are modifiable risk factors, but trials published to date have shown inconsistent results.

As the authors suggest, comprehensive risk assessments that consider body mass index alongside other risk factors may help to identify women who could benefit most from structured lifestyle interventions during pregnancy

NIHR Signal Diet and exercise can reduce the risk of developing diabetes during pregnancy

 

BACKGROUND: Diet and exercise during pregnancy have been used to prevent gestational diabetes mellitus (GDM) with some success.

OBJECTIVES: To examine the effectiveness of lifestyle intervention on GDM prevention and to identify key effectiveness moderators to improve prevention strategy.

SEARCH STRATEGY: Pubmed, Scopus, Cochrane and cross-references were searched.

SELECTION CRITERIA: Randomized controlled trials (RCTs) evaluating lifestyle interventions during pregnancy for GDM prevention.

DATA COLLECTION AND ANALYSIS: Two independent reviewers extracted data. Random-effects model was used to analyze the relative risk and 95% confidence interval (RR and 95% CI). Meta-regressions and subgroup analyses were used to investigate important moderators of effectiveness.

MAIN RESULTS: 47 RCTs involving 15745 participants showed that diet and exercise during pregnancy were preventive of GDM (RR 0.77, 95% CI [0.69; 0.87]). Four key aspects were identified to improve the preventive effect: targeting on the high-risk population, early initiation of intervention, proper intensity and frequency of exercise, and gestational weight gain management. Although 24 RCTs targeted on overweight or obese women, BMI failed to predict the effectiveness of an intervention. Instead, interventions are most effective in high-incidence population rather than simply overweight or obese women. Furthermore, exercise of moderate intensity for 50-60 minutes twice a week could lead to about 24% reduction in GDM.

CONCLUSIONS: The best strategy to prevent GDM is to target on high-risk population predicted by risk evaluation models and to control their gestational weight gain through intensified diet and exercise modifications early in their pregnancy. This article is protected by copyright. All rights reserved.

 

Full reference:

Guo, X. et al | 2018| Improving the effectiveness of lifestyle interventions for gestational diabetes prevention: a meta-analysis and meta-regression| Bjog | doi.org/10.1111/1471-0528.15467

The full article is available to Rotherham NHS staff here

Congenital heart disease: description in brief

Public Health England | January 2019 |Congenital heart disease: description in brief

Information to help healthcare professionals speak with parents, following suspected or confirmed diagnosis of congenital heart disease.

This publication explains congenital heart disease, a condition screened for by an ultrasound scan as part of the NHS fetal anomaly screening programme (FASP).

 

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Image source: assets.publishing.service.gov.uk

The document includes information about:

  • what the condition is
  • how common it is
  • how it is diagnosed and confirmed
  • what treatment is available
  • what the outlook for the baby is
  • what happens next
  • how likely it is to happen in future pregnancy
  • where more support and information is available

Congenital heart disease: information for parents

Premature babies have fewer complications if a lower platelet count is accepted

NIHR |January 2019 |Premature babies have fewer complications if a lower platelet count is accepted

A new, NIHR Signal underlines the findings of a trial that suggests premature infants have fewer complications if  platelets are given at lower levels than currently recommended.

This trial included 660 premature infants born at less than 34 weeks’ gestation with severely reduced blood platelet count from three countries including the UK. Average gestational age was 26.6 weeks and median birth weight was 740g. A third were on antibiotics for sepsis and 19% had major bleeding.

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The included infants were randomised to receive a platelet transfusion of 15ml/kg if their platelet count dropped to either less than 25,000/mm3 or less than 50,000/mm3.

There were instances were transfusions were either indicated but not administered or administered but not indicated. Additionally, 39% of the infants had already had a transfusion before entering the trial (126 in the 50,000/mm3 group and 121 in the 25,000/mm3 group).

Although clinicians were aware of allocation, outcome assessors were blinded which allows us to have more confidence in the findings (source: NIHR Signal).

Read the full NIHR Signal  Premature babies have fewer complications if a lower platelet count is accepted

 

National Maternity and Perinatal Audit – Intensive Care Report

Health Quality Improvement Programme | January 2019 | National Maternity and Perinatal Audit – Intensive Care Report

This report from the National Maternity and Perinatal Audit (NMPA) focuses on maternal admissions to intensive care in England, Wales and Scotland. The NMPA’s report and the data it holds, provides a unique opportunity to link maternity data, which contain information about the mother, her pregnancy and her baby, to data from national data sets for intensive care admissions.

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The purpose of the report is to describe the feasibility of linking the NMPA’s maternity data to intensive care data and to evaluate the suitability of rates of maternal admission to intensive care as an indicator of care quality. It also describes the demographics of women admitted to intensive care and the reasons for admission.

National Maternity and Perinatal Audit – Intensive Care Report shows that the linkage of maternity data to intensive care data offers the potential to understand the demographic factors underlying admission to intensive care, and the timing of intensive care admission relative to birth (Source: HQIP).

[NICE Consultation] Intrapartum care for healthy women and babies

NICE | January 2019| Intrapartum care for healthy women and babies

A NICE consultation is open on Intrapartum care for healthy women and babies Clinical guideline [CG190]

This guideline covers the care of healthy women and their babies, during labour and immediately after the birth. It focuses on women who give birth between 37 and 42 weeks of pregnancy (‘term’). The guideline helps women to make an informed choice about where to have their baby. It also aims to reduce variation in areas of care such as fetal monitoring during labour and management of the third stage of labour (NICE).

The consultation close on 22 January 2019

Details from NICE 

[Atlas of Shared Learning] Improving the quality of care for neonatal patients

NHS England | January 2019 | Improving the quality of care for neonatal patients

NHS England spotlights a Great Ormond Street Hospital (GOSH) Quality Improvement (QI) project which focused on improving the quality and safety of core care for neonatal patients across the whole Trust, these included: Jaundice care, New Born Bloodspot screening and fluid therapy. 

Due to the specialist care focus at GOSH, neonatal patients can be located across 22 different wards, so their care must be coordinated across wards to deliver the care every newborn baby needs, in addition to the specialist input they receive for their condition.

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The focused work included:

  • Developing, testing and launching neonatal e-learning packages in jaundice and Newborn bloodspots;
  • Streamlining admission processes to ensure staff can access the demographic information required to complete Newborn Bloodspot screening;
  • Helping develop an automated prompt system that alerts the nursing leads when a baby on their ward is eligible for screening, to help reduce the risk of missing patients who need a bloodspot test;
  • Developing a new neonatal care pathway to be used across all wards, prompting staff to deliver neonatal care and screening at the right time;
  • Working with the QI Developers to develop a real-time report to identify where neonates are situated in the hospital using data from the electronic patient information system such as weight and gestation. This improved the Nurse Advisor’s ability to provide specialist care to the most vulnerable neonates;
  • Developing a Trust guideline for the management of neonatal intravenous fluids;
  • Raising awareness of the tenets fundamental neonatal care (British Association of Perinatal Medicine (BAPM) (2010)) (More examples at NHS England)

The project was initiated in response to clinical audit work, which focused on all aspects of neonatal care carried out by the Neonatal Nurse Advisor, Consultant Neonatologist and Clinical Audit Lead.

Due to the specialist care focus, neonatal patients can be located across 22 different wards, so neonatal care must be coordinated across wards to deliver the care every newborn baby needs, in addition to the specialist input they receive for their condition (Source: NHS England).

Full details from NHS England

[European Standards of Care] New standards set benchmark for preterm and sick babies’ care

The Royal College of Midwives | January 2019 |New standards set benchmark for preterm and sick babies’ care

The European Standards of Care have recently published new standards which set the benchmark for the care of preterm and sick babies. These standards  cover 11 key topics including antenatal and perinatal care, transition to home, ethical decision making, palliative care and long-term follow up.

An editorial in The Lancet welcomed the standards, saying that they were much needed because premature birth remained a major cause of under-fives mortality and lifelong morbidities (Source: RCM). 

baby-218149_640.jpgRead the guidance here

European Standards of CARE 

 

RCM press release 

Lancet editorial Putting the family at the centre of newborn health

EFCNI press release