Evidence-based Clinical Search PICOT question about diabetes in pregnant women

Evidence-based Clinical Search PICOT question about diabetes in pregnant women
The PICOT question is: “How do pregnant women who just found out they have diabetes (I) deal with the disease and feel about telling their doctors about their blood sugar levels (O) during their pregnancy and six weeks after giving birth? (T)

Introduction

Gestational diabetes is diabetes that happens during pregnancy. It is usually caused by the changes in hormones that happen during pregnancy. The disease could cause short-term and long-term health problems for both the mother and the fetus. Craig et al. (2020) say that there is no worldwide standard definition of gestational diabetes because it is always changing. They think that the lack of a clear definition has “increased the number of cases in some countries over the past few years, and some research suggests that there hasn’t been much improvement in clinical outcomes.” (Craig et al., 2020). The goal of this general review is to find out how pregnant women who have just been diagnosed with diabetes deal with the disease and how they feel about telling their doctor about their blood sugar levels during their pregnancy and for six weeks after giving birth.

Problem statement

During pregnancy, a woman’s body goes through many physical and chemical changes that can affect how she sees herself. Diabetes during pregnancy hasn’t been taken as seriously as it should be, but the problems it can cause are dangerous for both mother and child. Some of the problems are high blood pressure, a big birth weight, and a hard time getting the baby out. 223 million women around the world are thought to have diabetes. It is thought that by 2045, this number will rise to 343 million. “20 million or 16% of live births had some form of hyperglycemia in pregnancy,” says IDF (2020). About 84% of them were caused by diabetes during pregnancy.” IDF (2020) also says that gestational diabetes affected one out of every six births. Statistics show that between five and ten years after giving birth, about half of the women with GDM will develop type 2 diabetes.

Craig et al. (2020) say that finding out a pregnant woman has diabetes could have a big impact on her quality of life, especially if she worries about how it might affect the baby. “This could make pregnancy, which is a natural process, a condition linked to risks, poor health, and more surveillance.” (Craig et al., 2020). Once a diagnosis has been made, the right steps must be taken to improve the health of both the mother and the baby. Inconsistencies in the way things are managed hurt the health of both the mother and the baby in big ways. This makes it harder to reach the global MDG goal of providing good reproductive health.

Review of the clinical question in a planned way

Tool for research

Lookup words

Findings

Relevant documents

 

Cochrane collection

Pregnant women, diabetes, blood sugar levels, postpartum, post-partum.

178 results

22 posts

 

PubMed

Pregnant women, diabetes control, blood sugar levels reporting, post-partum.

166

16 stories

 

Review of the books

The study’s author(s)

Problem

Why and what it covers

Design

Dependability and accuracy

The amount of proof

 

Utz et al., 2018

GDM testing and treatment take too long in Morocco’s basic healthcare settings.

To find out how well early detection and initial treatment of GDM through basic health care services in Morocco are working.

In two areas of Morocco, a randomized control trial with clusters was done. For the training and control groups, ten health centers were chosen at random.

There were 210 people in the sample group, which is a good representation of the target population and adds to the reliability of the study.

Quantitative data analysis tests were used to look at 210 selected women, which added to the validity of the study.

Level I proof.

 

Martis et al., 2018

There are bad health results for both GDM moms and their babies.

To make a comprehensive summary of the data from Cochrane systematic reviews about the benefits and risks of treatments for GDM on women and their babies.

On January 5, 2018, a thorough review of the Cochrane databases was done to find out how to treat and care for women with GDM.

Standard critical rating tools for systemic reviews, such as AMSTAR, ROBIS, and GRADE, were used to make sure the study was valid.

The study could be trusted because it was based on useful, high-quality, low-risk reviews that looked at a wide range of people over a long period of time.

Level I proof.

Systematic study and an analysis of what went wrong

By typing in the key words, the right papers were found on the Cochrane and PubMed websites. The key words are “diabetes in pregnancy,” “how to manage diabetes in pregnancy,” “after giving birth,” and “reporting blood sugar levels.” Before typing in the key words, the sites were set up for either “random clinical trials” or “systemic review” to make sure that only relevant documents were found. We got 178 articles from Cochrane, and only 15 of them were useful for this systemic study. In order to do this study, only one was chosen. Out of the 166 articles that were found on PubMed, only 16 were useful for the study. One randomized controlled trial and one systemic review were found and evaluated for this task.

Utz et al. (2018) did a cluster random controlled trial to find out how well early detection and initial management of GDM through basic healthcare services in Morocco worked. For the study, 210 people from 10 hospitals in two Moroccan areas were chosen to take part. To make sure that the study results are likely to be accurate, the sample population came from different health centers in two districts. This means that the results can be used for a larger group of people. The validity of the study was helped by the use of statistical analysis studies for the variables. The study’s results show that a “context-adapted screening and management approach to allow early interventions” should be used to deal with the high rate of GDM in the area. (Utz et al., 2018).

Martis et al.’s (2018) systemic review was meant to provide a comprehensive summary of the data from Cochrane systematic reviews about the benefits and risks of interventions for treating GDM on women and their babies. From January 5 to August 2018, a thorough review of the Cochrane databases was done to find out how to treat and care for women with GDM. The AMSTAR and ROBIS checklist tools showed that 10 of the 14 reviews were applicable, of high quality, and had a low risk of bias. Using the GRADE tool, 128 randomized, controlled studies showed that the quality ranged from very high to very low. The studies showed that the best way to help women with GDM is to make good changes to their lifestyles. (Martis et al., 2018).

Some of the mistakes in the studies are not easy to spot. One thing that could go wrong with the studies, especially the systematic review, is that the data entry could be wrong. When a person looks at more than 10,000 variables, there are sure to be mistakes like transposition and data entry mistakes. In the same way, there could be transposition mistakes in the data analysis for the random controlled trial because the processes are done by people using software.

Summary of the Randomized Controlled Trial

The cluster random controlled trial was done in two different districts in Morocco. Ten health centers in each district were used as study areas. 210 pregnant women who were going to these health centers’ prenatal clinics and were qualified to take part in the study were signed up. “GDM screening by capillary glucose testing according to International Association of Diabetes in Pregnancy Study Groups/WHO criteria” was the thing that was done. (Utz et al., 2018). People who tested positive for GDM were given advice on what to eat and how to exercise, and their health offices did follow-up. At control facilities, the hospital’s normal routine practice was used. After looking at both continuous and categorical variables, the study’s results showed that a “context-adapted screening and management approach to allow early interventions” should be used to deal with the high rate of GDM in the area. (Utz et al., 2018).

How I can use the review in my work

The results and conclusions of the randomized controlled trials and systematic reviews have a big effect on my work because they add to the body of knowledge. The results of the systematic review by Martis et al. (2020) add to my work by helping me figure out the best ways to help women who have been diagnosed with GDM. Martis et al. (2020) say that making changes to your living is the best way to deal with GDM. I can use what I’ve learned in my work by encouraging moms to get regular exercise and eat a healthy diet. From the random controlled study, I would use what I learned to screen for gestational diabetes and treat it as soon as possible, starting in the first trimester.

Outcome report

The internal and external processes of the studies were done carefully to make sure that the results were valid and reliable. The random clinical study tried to be as accurate as possible by taking samples from two districts with ten health centers each. This makes sure that the results can be applied to a larger group of people, which makes them more reliable. Standard measurement tools were also used to look at the study factors. The same results have been found in other studies that used the same tools. As a result, this adds to the study’s credibility. In a systematic review, bias is kept to a minimum when a standard checklist is used to review the research variables. This increases the internal validity of the study. Also, the data came from reviews done over a six-month period, and the study used 10 relevant, high-quality data with a low chance of being biased. Randomized controlled studies were used to get 128 reviews, which were used to make 27 comparisons. There were 17,984 women in the RCTs that were looked at, and there were 16,305 babies and 1441 children. (Martis et al., 2018). Since a large number of people were looked at, the data can be used with a larger group. So, there is a good chance that the study is reliable. Measures were taken to make sure that both studies were accurate and reliable, so there was very little bias.

References

Craig, L., Sims, R., Glasziou, P., & Thomas, R. (2020). Women’s experiences of a diagnosis of gestational diabetes mellitus: a systematic review. BMC pregnancy and childbirth, 20(1), 76.

International Diabetes Federation (IDF). (2020). Gestational Diabetes. Retrieved from https://www.idf.org/our-activities/care-prevention/gdm#:~:text=There%20were%20an%20estimated%20223,were%20due%20to%20gestational%20diabetes.

Martis, R., Crowther, C. A., Shepherd, E., Alsweiler, J., Downie, M. R., & Brown, J. (2018). Treatments for women with gestational diabetes mellitus: an overview of Cochrane systematic reviews. Cochrane Database of Systematic Reviews, (8).

Utz, B., Assarag, B., Smekens, T., Ennassiri, H., Lekhal, T., El Ansari, N., … & De Brouwere, V. (2018). Detection and initial management of gestational diabetes through primary health care services in Morocco: An effectiveness-implementation trial. PloS one, 13(12), e0209322.

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