buhea-6904 | Gestational Diabetes in Pregnant Women Assignment Help
The aim of the essay is to critically appraise two selected research articles to determine that the articles could be included in further research according to the PICOT question. The purpose of this critical appraisal to determine the effectiveness of the lifestyle interventions on the prevention of gestational diabetes in pregnant women who are at the risk of developing gestational diabetes during their pregnancy. Two studies will be selected after using the keywords appropriate to the PICOT and then the studies will be critically appraised by using the PEDro scale to determine the quality of the articles. In the end, a conclusion will be made.
Gestational diabetes mellitus (GDM) is associated with an increase in glucose level during the pregnancy without the diagnosis of diabetes mellitus before the pregnancies (Gilbert et al., 2019). In GDM body either becomes sensitive to the insulin or does not produce enough insulin to manage hyperglycemia (Song et al., 2016). Usually, GDM resolves after giving birth but researches also show that it can leave adverse effects to the mother and child before, during, and after the birth of the child (Guo et al., 2018). The adverse effects due to GDM include macrosomia, neonatal hypo/hyperglycemia, child obesity, cardiovascular diseases, and primary Caesarean delivery. GDM is also associated with the risk for development of the type 2 diabetes mellitus in mothers (Chiefari et al., 2017).
Dietary control, change in physical activities and other lifestyle modifications help reduce the risk of developing type 2 diabetes mellitus in the mothers after giving birth and other child-related abnormalities like macrosomia, overweight, hypo/hyperglycemia and others (Rönö et al., 2018). However, there’s limited evidence about the effectiveness of the lifestyle interventions in the prevention of the GDM during pregnancy. More research has been required to determine the effectiveness of modification of the lifestyle for prevention of the GDM development in pregnant women.
PICOT Question and Search Terms
PICOT question for this essay is to determine the effect of the lifestyle interventions in the prevention of gestational diabetes mellitus in pregnant women. The search terms used for this research were gestational diabetes, lifestyle, interventions, modifications, prevention, physical activity, diet, and randomized control trial. Web of Science, Cochrane Library, Ovid, PubMed, and JAVA databases were used to search the research articles utilizing the above keywords. For the sake of this essay, only two articles were selected by matching the search criteria and search terms with the topic of the articles. The first article to be selected was (Koivusalo et al., 2016) and the second article selected was (Wang et al., 2015). Details of these two selected articles are given in table 1.
Appraisal
These two research articles are critically appraised by the tool PEDro score to determine the quality of the articles to be further used in the research. Pedro scale is the validated tool to determine the methodological quality of the trials (Yamato et al., 2017).
The first article (Koivusalo et al., 2016) was critically appraised by using the PEDro scale, and the following information was gathered for each criterion of the PEDro scale. Criterion 1 was fulfilled as the eligibility criteria were mentioned. Eligibility criteria were the women aged more than 18 and are pregnant with a history of GDB or at risk of GDB due to BMI more than kg/m2. Also, the exclusion criteria of the sample were mentioned which include the presence of type 1 or type 2 diabetes mellitus. The article satisfies the second criterion of the PEDro scale as the participant’s randomisation was done by the study nurse by allotting the next sequenced code to the participants and the envelop that contain the same code was opened for each participant. The closed envelope contained information about the group in which the participants were selected. The third criterion was also satisfied because the study nurse was unaware of the allocation of the group to each participant due to the use of the closed envelopes. Both groups, intervention group, and control group, were undergone with the oral glucose tolerance test (OGTT) at the start of the enrolment and again in the second trimester to determine the prognostic indicators. The clinical and demographical difference properties were not different in both groups. Hence this satisfies the fourth criterion of the PEDro scale. The fifth and sixth criterion is not satisfied as all the subjects and intervention therapists were not blind. After randomization, only the intervention group were given lifestyle counseling from the nurses and dieticians. However, the blinded physicians studied participants’ OGTT reports and other parameters for GDM which satisfy the seventh criterion of the PEDro scale. The articles satisfy the eighth criterion of the PEDro scale as it is mentioned that 155 participants were included in the intervention group and 138 participants were included in the control group. 11 participants in the intervention group were not followed until the end of the study period due to miscarriage and loss of follow-up. Whereas in the controlled group 13 participants were not followed up due to miscarriage and loss of follow up. All participants included in the study received the interventions in the intervention group and controlled environment for the control group. There was no intention to treatment was given to anyone. Hence this satisfies the ninth criterion as well. Statistical comparisons between the intervention and controlled group were mentioned in the study. GDM was diagnosed in 13.9% of the participants in the intervention group whereas 21.6% of participants were diagnosed with GDM in the control group. Comparisons of outcome measures between the intervention group and controlled group for the weight change, dietary quality, and physical activity were also mentioned. All the data were presented as means with standard deviations. Hence satisfying both tenth and eleventh criteria for the PEDro scale. The PEDro scale shows that the article is of high quality and can be used for further research. The PEDro scale score table for this article is shown in appendix 1.
The critical appraisal for the second selected article (Wang et al., 2015) is also done by utilizing the PEDro scale. The eligibility criteria were clearly defined as pregnant women at least showing on the risk of GDM during the risk assessment. This contains age more than 35 years, BMI more than 25 kg/m2, history of GDM, or family history of GDM. Hence satisfying the first criterion of the PEDro scale. The article also satisfies the second and the third criteria of the PEDro scale as the allocation of the groups were randomized. Exponential random numbers were used as a randomization method to allot groups to participants. The article satisfies the fourth criterion of the PEDro scale as the baseline demographical properties were compared between intervention and controlled group. The baseline demographical interventions include the fat composition and biochemistry indicators of glucose and lipid metabolism. The article does not satisfy the fifth, sixth, and seventh criteria as there is no description of blinding the participants or the researcher in the study. 151 participants were allocated to intervention and 150 participants were allocated to the controlled group. 134 participants have followed up this the end of the study in the intervention group and 138 were followed up in the control group. Hence this article satisfies the eighth criteria of the PEDro scale. No intervention as intend to treatment was given and interventions were given to participants as mentioned. So, this article satisfies the ninth criterion of the PEDro scale. The data of the outcome was presented in the standard deviation and comparison between the outcome of the intervention and control group was given. The positive rate of GDM was 17.16% lower in the intervention group as compared to the controlled group. However, no significant difference was found for weight gain between both groups. The PEDro scale shows that the article is of high quality and can be further used for the research. The PEDro scale score table for this article is shown in appendix 2.
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Clinical Importance
The study can have a strong relationship with a public health concern. GDM is a preventable metabolic disorder and can be prevented by lifestyle intervention during the first trimester. Preventing GDM in the second and third trimester can prevent the occurrence of side effects to both mother and the child. Many women around the world go unplanned pregnancy. Hence the knowledge of lifestyle modification during the first trimester of pregnancy can prevent GDM and possible adverse effects from GDM.
Conclusion
GDM is a preventable metabolic disorder during pregnancy. Lifestyle interventions like physical activity, dietary changes, and appropriate weight gain during pregnancy can prevent GDM in the second and third trimester. There are limited studies done for the lifestyle intervention for GDM. The PEDro scale is used to determine the quality of such articles and selected high-quality articles could be used in further research on lifestyle interventions for preventing GDM.
References
Chiefari, E., Arcidiacono, B., Foti, D., & Brunetti, A. (2017). Gestational diabetes mellitus: An updated overview. Journal of Endocrinological Investigation, 40(9), 899–909.
Gilbert, L., Gross, J., Lanzi, S., Quansah, D. Y., Puder, J., & Horsch, A. (2019). How diet, physical activity and psychosocial well-being interact in women with gestational diabetes mellitus: An integrative review. BMC Pregnancy and Childbirth, 19(1), 60.
Guo, W., Zhang, B., & Wang, X. (2018). Lifestyle interventions for gestational diabetes mellitus to control blood glucose: A meta-analysis of randomized studies. International Journal of Diabetes in Developing Countries, 38(1), 26–35.
Koivusalo, S. B., Rönö, K., Klemetti, M. M., Roine, R. P., Lindström, J., Erkkola, M., Kaaja, R. J., Pöyhönen-Alho, M., Tiitinen, A., & Huvinen, E. (2016). Gestational diabetes mellitus can be prevented by lifestyle intervention: The Finnish Gestational Diabetes Prevention Study (RADIEL): A randomized controlled trial. Diabetes Care, 39(1), 24–30.
Rönö, K., Grotenfelt, N. E., Klemetti, M. M., Stach-Lempinen, B., Huvinen, E., Meinilä, J., Valkama, A., Tiitinen, A., Roine, R. P., & Pöyhönen-Alho, M. (2018). Effect of a lifestyle intervention during pregnancy—Findings from the Finnish gestational diabetes prevention trial (RADIEL). Journal of Perinatology, 38(9), 1157–1164.
Song, C., Li, J., Leng, J., Ma, R., & Yang, X. (2016). Lifestyle intervention can reduce the risk of gestational diabetes: A meta‐analysis of randomized controlled trials. Obesity Reviews, 17(10), 960–969.
Wang, S., Ma, J.-M., & Yang, H.-X. (2015). Lifestyle intervention for gestational diabetes mellitus prevention: A cluster-randomized controlled study. Chronic Diseases and Translational Medicine, 1(3), 169–174.
Yamato, T. P., Maher, C., Koes, B., & Moseley, A. (2017). The PEDro scale had acceptably high convergent validity, construct validity, and interrater reliability in evaluating methodological quality of pharmaceutical trials. Journal of Clinical Epidemiology, 86, 176–181.
Table 1
[Table Title]
|
Title |
Authors |
Publications |
Purpose |
Conclusion |
|
GESTATIONAL DIABETES MELLITUS CAN Be PREVENTED by LIFESTYLE INTERVENTION: The FINNISHGESTATIONAL DIABETES PREVENTION STUDY (RADIEL). A RANDOMIZED CONTROLLED TRIAL
|
Koivusalo, S. B., Rönö, K., Klemetti, M. M., Roine, R. P., Lindström, J., Erkkola, M., Kaaja, R. J., Pöyhönen-Alho, M., Tiitinen, A., Huvinen, E., Andersson, S., Laivuori, H., Valkama, A., Meinilä, J., Kautiainen, H., Eriksson, J. G., & Stach-Lempinen, B.
|
American Diabetes Association
|
Gastational diabetes can be preventable by lifestyle interventions. |
GDM can be prevented in a high-risk population by simple, easily applicable lifestyle interventions
|
|
Lifestyle intervention for gestational diabetes mellitus prevention: A cluster-randomized controlled study
|
Wang, S., Ma, J.-M., & Yang, H.-X |
Chronic Disease and Traditional Medicine |
The study was to examine whether gestational diabetes mellitus (GDM) can be prevented by early trimester lifestyle counseling in a high-risk population. |
The positive rate of GDM could be reduced by certain lifestyle interventions from the beginning of pregnancy. More validated effective intervention should be explored for the high-risk pregnant women |
