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dc.contributor.authorWong, Tang
dc.date.accessioned2019-08-01
dc.date.available2019-08-01
dc.date.issued2019-02-28
dc.identifier.urihttp://hdl.handle.net/2123/20831
dc.description.abstractBackground: Risk informed models of care are critical to addressing the workload for diabetes services with the rising prevalence of Gestational Diabetes (GDM) Aim: To explore the effect of glycaemic, weight and non-glycaemic/weight related factors on the risk of adverse pregnancy outcomes Methods: Data was obtained from 11,011 singleton pregnancies at Bankstown-Lidcombe Hospital from 2010-2015. Outcomes included the incidence of pre-eclampsia, prematurity, induction of labour, caesarean section, low birthweight, SGA (<10thcentile), macrosomia, LGA (>90thcentile), Apgar scores and neonatal ICU admissions. Birthweight centiles were calculated using the customised calculator. Outcomes were assessed in women in fasting glucose 5.1-5.4mmol/L (IADPSG-GDM) compared to normal glucose tolerant women (NGT) and ADIPS1998-GDM versus NGT women. In another dataset of 3095 singleton GDM pregnancies from 1992-2013, outcomes were assessed in women with GWG below, according to or above the Institute of Medicine (IOM) targets. Modifying these targets was evaluated. Risk prediction models and calculators for adverse pregnancy outcomes were formulated to integrate non-glycaemic and non-weight related variables. Results: Women with fasting glucose between 5.1-5.4mmol/L were at a two-fold risk of LGA compared to women with NGT, thus supporting the new IADPSG criteria change. Treatment of GDM reduced maternal GWG and attenuated the risk of LGA Excessive GWG above IOM, resulted in increased rates of LGA, macrosomia and caesarean section. Modifying the IOM weight gain targets did not attenuate adverse outcomes. Finally, a number of non-glycaemic factors were associated with adverse pregnancy outcomes in GDM and were integrated into a risk prediction model. This thesis also presents a proposed risk informed model of care. Conclusion: A combination of glycaemic, weight gain and non-glycaemic/non-weight related factors could be used to predict the risk of adverse outcomes in GDM pregnancies.en_AU
dc.publisherUniversity of Sydneyen_AU
dc.publisherFaculty of Medicine and Healthen_AU
dc.publisherWestmead Clinical Schoolen_AU
dc.rightsThe author retains copyright of this thesis. It may only be used for the purposes of research and study. It must not be used for any other purposes and may not be transmitted or shared with others without prior permission.en_AU
dc.subjectGDMen_AU
dc.subjectRisk Stratificationen_AU
dc.subjectPregnancyen_AU
dc.subjectLGAen_AU
dc.subjectInsulinen_AU
dc.titleThe Risk Stratification of Women with Gestational Diabetes: Can we predict adverse pregnancy outcomes?en_AU
dc.typeMasters Thesisen_AU
dc.type.pubtypeMaster of Philosophy M.Philen_AU
dc.description.disclaimerAccess is restricted to staff and students of the University of Sydney . UniKey credentials are required. Non university access may be obtained by visiting the University of Sydney Library.en_AU


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