GDM: Postpartum Care (2008)
- Each of relevant articles was reviewed by at least two of the authors.
- All studies involved term, singleton infants unless otherwise noted.
- All articles were selected for inclusion in the review and critically evaluated based on:
1. study design-all studies were descriptive
2. target population
3. sample size/power
4. clear definition of diabetes
5. control for confounding variables
Recruitment - Medline search from 1966 - 2003. References in bibliographies of pertinent articles and major texts also searched. Search was limited to English language and to human subjects. In addition, entire Cochrane database and NIH clinical trials website searched. Specific search terms included breastfeeding, breast-feeding, breast feeding, infant nutrition and lactation.
Design: Systematic Review
Blinding used (if applicable): not applicable
Intervention (if applicable): not applicable
Statistical Analysis -not applicable
Timing of Measurements- not applicable
Dependent Variables- not applicable
Independent Variables- not applicable
Control Variables- not applicable
Initial N: 12 of 15 studies (80%) met the selection criteria.
Attrition (final N):
Age:
Ethnicity:
Other relevant demographics:
Anthropometrics (e.g., were groups same or different on important measures)
Location: worldwide studies
Table I. Differences in Diagnosis Criteria for Impaired Glucose Tolerance and Type 2 Diabetes
Authors | Diagnostic Criteria | Reference |
Impaired Glucose (IGT) | ||
Job et al.,1976 | Fasting Glucose>=110 mg/dL,1-hour>=160;2-hour>=120 mg/dl(after 50-g OGTT) | Not specified |
Plagemam et al.,2002 | Fasting Glucose<140 mg/dL and 2-hour glucose>140 mg/dL(after 75g/kg OGTT) | National Diabetes Data Group,1979 |
Type 2 Diabetes or NIDDM | ||
Kjos et al.,1993,1998 | Fasting glucose>140mg/dL or 2-hour glucose >=200 mg/dL(after 75g OGTT) | National Diabetes Data Group,1979 |
Pettitt et al.,1997 | 2-hour glucose>=200mg/dL(after 75 g OGGTT) | World Health Organization,1994 |
Pettitt et al.,1998 | 2-hour glucose>=200mg/dL(after 75 g OGGTT) | World Health Organization,1985 |
Young et al.,2002 | Fasting glucose>=126mg/dL | American Diabetes Association,1997 |
Expert Comm. 2003 | Fasting glucose>=126mg/dL, on 2 occasions | American Diabetes Association,2003 |
Table 2: Differences in Diagnostic Criteria for Gestational Diabetes(GDM)
Authors | Diagnostic Criteria | Reference |
>=2 of the following: |
||
Kjos et al.,1993,1998 | Fasting glucose>=105 mg/dL,1-hour>=190, 2-hour>=165,3-hour>=145(after 100g OGTT) | National Diabetes Data Group,1979 |
Pettitt et al.,1998 | 2-hour glucose>=mg/dL(after 75g OGTT) | World Health Organization,1985 |
>=2 of the following: |
||
Cordero et al.,1999 | Fasting glucose>=95 mg/dL,1-hour>=180, 2-hour>=155, 3 -hour >=140(after 100g OGTT) | American College of Obstetricians and Gynecologists,1994 |
Knights et al.,1999 | 2-hour glucose>=144 mg/dL(after 75 g OGTT) | Australasian Diabetes in Pregnancy Society |
MacNeill et al.,2001 | 1-hour glucose>140 mg/dL(after 50g OGTT) and >=2 of the following : fasting glucose>=95 mg/dL,1-hour>=190, 2-hour>=165, 3-hour>=145(after 100 g OGTT) | O'Sullivan,1984 |
Sebire et al. 2001 |
Criteria not specified |
|
>= 2 of the following |
||
Plagemann et al.,2002 | Fasting glucose>100 mg/dL,1-hour>160,2-hour>130(after 50 g OGGTT) | Fuhrmann,1998 |
OGTT=Oral glucose tolerance test
Key teaching points:
- Women with type 2 diabetes or gestational diabetes are less likely to breastfeed than women without diabetes.
- Breastfeeding improves the subsequent glucose tolerance of mothers with diabetes.
- Breastfeeding may reduce the risk of type 2 diabetes in children.
- Current recommendations include 6 months of exclusive breastfeeding and continued breastfeeding for at least 12 months.
- Women with a history of gestational diabetes should be screened with a fasting plasma glucose at 6 weeks postpartum and annually.
Limitations:
- Definition of breast feeding - lack of detailed information on exclusivity, frequency or duration across the studies reviewed.
- Definition of diabetes- (1) the definitions of diabetes varied among the outcomes including impaired glucose tolerance, type 2 diabetes, NIDDM, and gestational diabetes; (2) most researchers, not all, utilized either the American Diabetes Association or World Health Organization criteria; (3) oral glucose tolerance testing was a commonly used test, although there was considerable variation in the amount of the glucose load, the timing of the testing, and thresholds for diagnosis.
Quality Criteria Checklist: Review Articles
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Relevance Questions | |||
1. | Will the answer if true, have a direct bearing on the health of patients? | Yes | |
2. | Is the outcome or topic something that patients/clients/population groups would care about? | Yes | |
3. | Is the problem addressed in the review one that is relevant to dietetics practice? | Yes | |
4. | Will the information, if true, require a change in practice? | Yes | |
Validity Questions | |||
1. | Was the question for the review clearly focused and appropriate? | Yes | |
2. | Was the search strategy used to locate relevant studies comprehensive? Were the databases searched and the search termsused described? | Yes | |
3. | Were explicit methods used to select studies to include in the review? Were inclusion/exclusion criteria specified andappropriate? Wereselectionmethods unbiased? | Yes | |
4. | Was there an appraisal of the quality and validity of studies included in the review? Were appraisal methodsspecified,appropriate, andreproducible? | Yes | |
5. | Were specific treatments/interventions/exposures described? Were treatments similar enough to be combined? | Yes | |
6. | Was the outcome of interest clearly indicated? Were other potential harms and benefits considered? | Yes | |
7. | Were processes for data abstraction, synthesis, and analysis described? Were they applied consistently acrossstudies and groups? Was thereappropriate use of qualitative and/or quantitative synthesis? Was variation in findings among studies analyzed? Were heterogeneity issued considered? If data from studies were aggregated for meta-analysis, was the procedure described? | Yes | |
8. | Are the results clearly presented in narrative and/or quantitative terms? If summary statistics are used, are levels ofsignificance and/or confidence intervals included? | Yes | |
9. | Are conclusions supported by results with biases and limitations taken into consideration? Are limitations ofthe review identified anddiscussed? | Yes | |
10. | Was bias due to the review's funding or sponsorship unlikely? | Yes | |