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      Systematic Reviews on the Prevention of Adverse Pregnancy Outcomes Related to Maternal Obesity to Improve Evidence-Based Counselling Translated title: Systematische Übersichtsarbeiten über die Verbesserung der evidenzbasierteren Beratung zur Prävention von mütterlichen adipositasbezogenen ungünstigen Schwangerschaftsausgängen

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          Abstract

          Background

          Health professionals and their patients should understand the importance of evidence. In the case of gestational diabetes mellitus, which is often associated with an abnormally high body mass index, the immediate and long-term outcome of women and their offspring depends in part on advice and implementation of lifestyle changes before, during and after pregnancy.

          Methods

          Up to September 2023, MEDLINE, CENTRAL, and WEB OF SCIENCE were used to identify systematic reviews and meta-analyses on the prevention of gestational diabetes. The ROBIS and AMSTAR criteria were analyzed for all systematic reviews.

          Results

          A total of 36 systematic reviews were identified. Dietary interventions, physical activity or a combined approach all reduced adverse pregnancy outcomes such as gestational diabetes, pregnancy-induced hypertension and related morbidities. Within the randomized controlled trials included in the 36 systematic reviews, the type, intensity and frequency of interventions varied widely. The primary outcomes, reporting and methodological quality of the 36 systematic reviews and meta-analyses also varied.

          The meta-analysis with the highest ROBIS and AMSTAR-2 scores was selected to design an icon array based on a fact box simulating 100 patients.

          Conclusions

          We propose a methodology for selecting the best evidence and transforming it into a format that illustrates the benefits and harms in a way that can be understood by lay patients, even if they cannot read. This model can be applied to counselling for expectant mothers in low and high-income countries, regardless of socioeconomic status, provided that women have access to appropriately trained healthcare providers.

          Zusammenfassung

          Hintergrund

          Die Bedeutung von Evidenz sollte medizinische Fachkräften und ihren Patientinnen klar sein. Bei Gestationsdiabetes mellitus, der oft mit einem ungewöhnlich hohen Body-Mass-Index assoziiert ist, hängen sowohl die direkten Schwangerschaftsausgänge als auch die Langzeitergebnisse der Frauen und Kinder teilweise von der Beratung und den Lebensstiländerungen während und nach der Schwangerschaft ab.

          Methoden

          Bis September 2023 wurden Recherchen in MEDLINE, CENTRAL und WEB OF SCIENCE zur Identifizierung von systematischen Übersichtsarbeiten und Metaanalysen zur Prävention von Gestationsdiabetes durchgeführt. Alle systematischen Übersichtsarbeiten wurden anhand der ROBIS- und AMSTAR-Kriterien analysiert.

          Ergebnisse

          Es wurden insgesamt 36 systematische Übersichtsarbeiten identifiziert. Ernährungsinterventionen, körperliche Aktivitäten oder eine Kombination beider Herangehensweisen konnten ungünstige Schwangerschaftsausgänge wie z. B. Gestationsdiabetes, schwangerschaftsinduzierte Hypertonie und die damit zusammenhängende Morbidität senken. In den randomisierten kontrollierten Studien, die in den 36 systematischen Übersichtsarbeiten eingeschlossen wurden, gab es starke Unterschiede in der Art, der Intensität und der Häufigkeit der Intervention. Die primären Endpunkte, die Berichterstattung und die methodologische Qualität der 36 systematischen Übersichtsarbeiten und Metaanalysen variierten ebenfalls stark.

          Es wurde die Metaanalyse mit den höchsten ROBIS- und AMSTAR-2-Punktzahlen ausgewählt, um eine Reihe von Symbolen basierend auf einer 100 Patientinnen simulierenden Faktenbox zu entwerfen.

          Schlussfolgerungen

          Es wird hier eine Methode vorgeschlagen, mit der die beste Evidenz ausgewählt und in ein Format überführt werden kann, das die Vorteile und Schäden so veranschaulicht, dass sie von Patientinnen ohne medizinische Vorbildung verstanden werden können, selbst wenn diese Frauen nicht lesen können. Dieses Modell kann bei der Beratung werdender Mütter in Ländern mit niedrigem und hohem Einkommen eingesetzt werden, unabhängig vom sozioökonomischen Status der Frauen, sofern sie Zugang zu entsprechend ausgebildeten Gesundheitsdienstleistern haben.

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          Most cited references92

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          Evidence based medicine: what it is and what it isn't

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            The triple aim: care, health, and cost.

            Improving the U.S. health care system requires simultaneous pursuit of three aims: improving the experience of care, improving the health of populations, and reducing per capita costs of health care. Preconditions for this include the enrollment of an identified population, a commitment to universality for its members, and the existence of an organization (an "integrator") that accepts responsibility for all three aims for that population. The integrator's role includes at least five components: partnership with individuals and families, redesign of primary care, population health management, financial management, and macro system integration.
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              Metabolic syndrome in childhood: association with birth weight, maternal obesity, and gestational diabetes mellitus.

              C. Boney (2005)
              Childhood obesity has contributed to an increased incidence of type 2 diabetes mellitus and metabolic syndrome (MS) among children. Intrauterine exposure to diabetes and size at birth are risk factors for type 2 diabetes mellitus, but their association with MS in childhood has not been demonstrated. We examined the development of MS among large-for-gestational-age (LGA) and appropriate-for-gestational age (AGA) children. The major components of MS (obesity, hypertension, dyslipidemia, and glucose intolerance) were evaluated in a longitudinal cohort study of children at age 6, 7, 9, and 11 years who were LGA (n = 84) or AGA (n = 95) offspring of mothers with or without gestational diabetes mellitus (GDM). The cohort consisted of 4 groups, ie, LGA offspring of control mothers, LGA offspring of mothers with GDM, AGA offspring of control mothers, and AGA offspring of mothers with GDM. Biometric and anthropometric measurements were obtained at 6, 7, 9, and 11 years. Biochemical testing included measurements of postprandial glucose and insulin levels and high-density lipoprotein (HDL) cholesterol levels at 6 and 7 years and of fasting glucose, insulin, triglyceride, and HDL cholesterol levels at 9 and 11 years. We defined the components of MS as (1) obesity (BMI >85th percentile for age), (2) diastolic or systolic blood pressure >95th percentile for age, (3) postprandial glucose level >140 mg/dL or fasting glucose level >110 mg/dL, (4) triglyceride level >95th percentile for age, and (5) HDL level 85th percentile) at 11 years was present in 25% to 35% of the children, but rates were not different between LGA and AGA offspring. There was a trend toward a higher incidence of insulin resistance, defined as a fasting glucose/insulin ratio of or =2 components of MS was 50% for the LGA/GDM group, which was significantly higher than values for the LGA/control group (29%), AGA/GDM group (21%), and AGA/control group (18%). The prevalence of > or =3 components of MS at age 11 was 15% for the LGA/GDM group, compared with 3.0% to 5.3% for the other groups. Cox regression analysis was performed to determine the independent hazard (risk) of developing MS attributable to birth weight, gender, maternal prepregnancy obesity, and GDM. For Cox analyses, we defined MS as > or =2 of the following 4 components: obesity, hypertension (systolic or diastolic), glucose intolerance, and dyslipidemia (elevated triglyceride levels or low HDL levels). LGA status and maternal obesity increased the risk of MS approximately twofold, with hazard ratios of 2.19 (95% CI: 1.25-3.82) and 1.81 (95% CI: 1.03-3.19), respectively. GDM and gender were not independently significant. To determine the cumulative hazard of developing MS with time, we plotted the risk according to LGA or AGA category for the control and GDM groups from 6 years to 11 years, with Cox regression analyses. The risk of developing MS with time was not significantly different between LGA and AGA offspring in the control group but was significantly different between LGA and AGA offspring in the GDM group, with a 3.6-fold greater risk among LGA children by 11 years. We showed that LGA offspring of diabetic mothers were at significant risk of developing MS in childhood. The prevalence of MS in the other groups was similar to the prevalence (4.8%) among white adolescents in the 1988-1994 National Health and Nutrition Examination Survey. This effect of LGA with maternal GDM on childhood MS was previously demonstrated for Pima Indian children but not the general population. We also found that children exposed to maternal obesity were at increased risk of developing MS, which suggests that obese mothers who do not fulfill the clinical criteria for GDM may still have metabolic factors that affect fetal growth and postnatal outcomes. Children who are LGA at birth and exposed to an intrauterine environment of either diabetes or maternal obesity are at increased risk of developing MS. Given the increased obesity prevalence, these findings have implications for perpetuating the cycle of obesity, insulin resistance, and their consequences in subsequent generations.
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                Author and article information

                Journal
                Geburtshilfe Frauenheilkd
                Geburtshilfe Frauenheilkd
                10.1055/s-00000020
                Geburtsh Frauenheilk
                Geburtshilfe und Frauenheilkunde
                Georg Thieme Verlag KG (Rüdigerstraße 14, 70469 Stuttgart, Germany )
                0016-5751
                1438-8804
                13 June 2024
                June 2024
                1 June 2024
                : 84
                : 6
                : 564-572
                Affiliations
                [1 ]Clara Angela Foundation Witten und Berlin, Witten, Germany
                [2 ]Philipps University Marburg, Marburg, Germany
                [3 ]Ringgold 38696, Dr. Horst Schmidt Hospital, Wiesbaden, Germany;
                Author notes
                Correspondence Susann Behnam, MD Clara Angela Foundation Koenigsallee 3614193 BerlinGermany subehnam@ 123456gmail.com
                Article
                GebFra-2024-02-2154-U
                10.1055/a-2295-1725
                11175830
                38884029
                7438d45c-d784-4a7c-96bf-cd3f52b5ec27
                The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

                This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License, which permits unrestricted reproduction and distribution, for non-commercial purposes only; and use and reproduction, but not distribution, of adapted material for non-commercial purposes only, provided the original work is properly cited.

                History
                : 03 February 2024
                : 13 March 2024
                Categories
                GebFra Science
                Review

                maternal obesity,gestational diabetes,health literacy,evidence-based medicine,counselling,mütterliche adipositas,gestationsdiabetes,gesundheitskompetenz,evidenzbasierte medizin,beratung

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