Papers by Heinke Adamczewski
Diabetologie und Stoffwechsel, Apr 1, 2024
Deutsches Ärzteblatt international, Apr 19, 2024
BMJ open diabetes research and care, 2024
Introduction Pregnancy is a known independent risk factor for a severe course of COVID-19. The re... more Introduction Pregnancy is a known independent risk factor for a severe course of COVID-19. The relationship of SARS-CoV-2 infection and gestational diabetes mellitus (GDM) on neonatal outcomes is unclear. Our aim was to determine if SARS-CoV-2 infection represents an independent risk factor for adverse perinatal outcomes in pregnancy with GDM. Research design and methods We compared data from two German registries including pregnant women with GDM, established during the SARS-CoV-2 pandemic (COVID-19-Related Obstetric and Neonatal Outcome Study (CRONOS), a multicenter prospective observational study) and already existing before the pandemic (German registry of pregnant women with GDM; GestDiab). In total, 409 participants with GDM and SARS-CoV-2 infection and 4598 participants with GDM, registered 2018-2019, were eligible for analyses. The primary fetal and neonatal outcomes were defined as: (1) combined: admission to neonatal intensive care unit, stillbirth, and/or neonatal death, and (2) preterm birth before 37+0 weeks of gestation. Large and small for gestational age, maternal insulin therapy, birth weight >4500 g and cesarean delivery were considered as secondary outcomes. Results Women with SARS-CoV-2 infection were younger (32 vs 33 years) and had a higher median body mass index (28 vs 27 kg/m²). In CRONOS, more neonates developed the primary outcome (adjusted OR (aOR) 1.48, 95% CI 1.11 to 1.97) and were born preterm (aOR 1.50, 95% CI 1.07 to 2.10). Fasting glucose was higher in women in CRONOS versus GestDiab (5.4 vs 5.3 mmol/L) considering each 0.1 mmol/L increase was independently associated with a 5% higher risk of preterm birth among women in CRONOS only (aOR 1.05, 95% CI 1.01 to 1.09). Conclusions GDM with SARS-CoV-2 infection in pregnancy is associated with an increased risk of adverse fetal and neonatal outcomes as compared with GDM without SARS-CoV-2 infection. http://drc.bmj.com/ BMJ Open Diab Res Care
Diabetes Aktuell, Dec 1, 2020
The translation of web content into Libras (Lingua Brasileira de Sinais-Brazilian Sign Language),... more The translation of web content into Libras (Lingua Brasileira de Sinais-Brazilian Sign Language), although adequate, cannot always be implemented, due to its high cost. Thus, the present study aims to identify and propose solutions for the potential communication breakdowns in the interaction of bilingual deaf users in corporate systems on the web. The analysis of the interaction took place at the Oswaldo Cruz (Fiocruz) Foundation, with the utilization of the Communication Evaluation Method (CEM) of Semiotic Engineering. The results showed that the population in the study, although having experience in the web, had difficulties using the corporate system.
Diabetologie Und Stoffwechsel, Jul 12, 2016
• ▶ gestational diabetes • ▶ postpartum diabetes screening • ▶ health services research • ▶ speci... more • ▶ gestational diabetes • ▶ postpartum diabetes screening • ▶ health services research • ▶ specialized diabetes practice • ▶ reality of diabetes treatment
Public Health Forum, Nov 25, 2021
Zusammenfassung: Gestationsdiabetes mellitus (GDM, ICD-10-Code: O24.4) ist eine Glukosetoleranzst... more Zusammenfassung: Gestationsdiabetes mellitus (GDM, ICD-10-Code: O24.4) ist eine Glukosetoleranzstörung, die erstmals während der Schwangerschaft auftritt. Auch wenn sich die Blutzuckerwerte nach der Entbindung häufig normalisieren, gehen jedoch kurz-und langfristige gesundheitliche Risiken für Mutter und Kind mit dem GDM einher. Prävention, Diagnose, Therapie und Nachsorge sind somit essentiell für die Gesundheit von Mutter und Kind. Im Folgenden soll ein kurzer Überblick für Deutschland gegeben werden.
Präzisionsmedizin – Eine Reise in die Zukunft der Diabetologie www.diabeteskongress.de, May 1, 2021
Diabetic Medicine, May 3, 2022
BackgroundGestational diabetes (GDM) in the short term is associated with various complications d... more BackgroundGestational diabetes (GDM) in the short term is associated with various complications during pregnancy; however, in the long run, women have an increased risk of type 2 diabetes mellitus (T2DM). Therefore, short‐ and long‐term follow‐up postpartum is recommended.MethodsWe assessed the proportion of postpartum diabetes screening among 12,991 women with their first GDM‐diagnosed pregnancy in the study period in the nationwide German GestDiab register between 2015 and 2017. In addition to assessing prevalence, we assessed if the probability of postpartum screening was associated with maternal characteristics or pregnancy outcomes.ResultsIn total, 38.2% (95% CI 32.8%–43.7%) of our sample underwent postpartum diabetes screening, irrespective of its timing. Around 50% of women (19.3% of the total sample) undertook the screening in the recommended time frame of 6–12 weeks postpartum. We found that age, native language, pre‐pregnancy BMI, smoking status, number of previous pregnancies, fasting plasma glucose and HbA1c levels as well as previous pregnancies with GDM and treatment with insulin were associated with participation in the postpartum diabetes screening in our sample.ConclusionIn our study, more than 60% of the women with GDM did not participate in postpartum diabetes screening. This is a missed opportunity in a high‐risk population to detect glucose intolerance. Consequently, appropriate interventions to prevent the progression to T2DM cannot be initiated. Further research should investigate barriers and enabling factors and allow developing a multilevel approach for GDM postpartum care.
Diabetologie Und Stoffwechsel, Apr 1, 2023
Deutsches Arzteblatt International, Feb 10, 2023
BackgroundDiabetes mellitus (DM) is a major risk factor for complications of pregnancy. Based on ... more BackgroundDiabetes mellitus (DM) is a major risk factor for complications of pregnancy. Based on information for all inpatient births in Germany, we assessed the risks for selected pregnancy complications in women with pregestational diabetes mellitus (preDM) or gestational diabetes mellitus (GDM).MethodThe underlying data comprised all singleton births contained in the inpatient perinatal medicine quality assurance statistics for the years 2013–2019. The frequencies of premature birth, elevated birth weight (large for gestational age, LGA), cesarean section, transfer of the newborn to the perinatal unit, and stillbirth were stratified by maternal age and diabetes status (preDM, GDM, no DM). Poisson regression was used to calculate the relative risks (RR) with 95% confidence intervals (95% CI) for the whole period and for each individual year in women with preDM or GDM relative to women without DM.ResultsAmong the 4 991 275 singleton births included, GDM was documented in 283 210 (5.7%) and preDM in 46 605 (0.93%) cases. GDM was associated with higher RR for premature birth (1.13 [1.12; 1.15]), LGA (1.57 [1.55; 1.58]), cesarean section (1.26 [1.25; 1.27]), and transfer of the newborn (1.54 [1.52; 1.55]). These associations were even stronger in women with preDM: premature birth (2.13 [2.08; 2.18]), LGA (2.72 [2.67; 2.77]), cesarean section (1.62 [1.60; 1.64]), transfer of the newborn (2.61 [2.56; 2.66]). PreDM increased the risk of stillbirth (RR: 2.34 [2.11; 2.59]); GDM was associated with a lower risk (RR: 0.67 [0.62; 0.72]). For women with preDM, the risk of pregnancy complications increased over the study period.ConclusionGDM and preDM are still associated with elevated risks of pregnancy complications. In the case of preDM, the risks may be attributable to the fact that the hyperglycemia is more severe and is already present before conception. Continuous monitoring should include risk factors in pregnant women and care-relevant aspects.
Diabetologie Und Stoffwechsel, Dec 1, 2020
Scientific Reports
Gestational diabetes mellitus (GDM) is one of the most common medical complications in pregnancy.... more Gestational diabetes mellitus (GDM) is one of the most common medical complications in pregnancy. Information on key figures such as screening rates, prevalence of GDM or utilization of follow-up care and associated factors varies widely and is often lacking. The aim of our study is to provide information on screening rates for and prevalence of GDM as well as utilization of follow-up care in Germany. We used data (2010–2020) from a large, nationwide statutory health insurance containing information on inpatient and outpatient care, including diagnoses, medication and treatments. Descriptive analyses were performed to assess screening rates, prevalence of GDM and participation rates in follow-up care. A log-binomial regression model was calculated to analyze associated factors. Screening rates among pregnant women increased from 40.2% (2010) to 93.3% (2020) and prevalence from 9.4% (2010) to 15.1% (2020). The proportion of women attending follow-up care remained stable over time (ar...
Diabetologie Und Stoffwechsel, Apr 1, 2023
Diabetic Medicine
BackgroundGestational diabetes (GDM) in the short term is associated with various complications d... more BackgroundGestational diabetes (GDM) in the short term is associated with various complications during pregnancy; however, in the long run, women have an increased risk of type 2 diabetes mellitus (T2DM). Therefore, short‐ and long‐term follow‐up postpartum is recommended.MethodsWe assessed the proportion of postpartum diabetes screening among 12,991 women with their first GDM‐diagnosed pregnancy in the study period in the nationwide German GestDiab register between 2015 and 2017. In addition to assessing prevalence, we assessed if the probability of postpartum screening was associated with maternal characteristics or pregnancy outcomes.ResultsIn total, 38.2% (95% CI 32.8%–43.7%) of our sample underwent postpartum diabetes screening, irrespective of its timing. Around 50% of women (19.3% of the total sample) undertook the screening in the recommended time frame of 6–12 weeks postpartum. We found that age, native language, pre‐pregnancy BMI, smoking status, number of previous pregnan...
Hintergrund und Stand (inter)nationaler Forschung: Gestationsdiabetes (GDM) ist eine Komplikation... more Hintergrund und Stand (inter)nationaler Forschung: Gestationsdiabetes (GDM) ist eine Komplikation während der Schwangerschaft. Je nach Datenbasis und Definition schwankt die Prävalenz zwischen 4% und 20%. In den meisten Fällen reguliert sich der Blutzuckerspiegel zwar nach der [zum vollständigen Text gelangen Sie über die oben angegebene URL]
Hintergrund und Stand (inter)nationaler Forschung: Man schätzt, dass etwa 4% bis über 20% der Sch... more Hintergrund und Stand (inter)nationaler Forschung: Man schätzt, dass etwa 4% bis über 20% der Schwangeren einen Gestationsdiabetes (GDM) entwickeln. GDM ist mit teils schweren perinatalen Komplikationen für Mutter und Kind assoziiert. Zusätzlich haben betroffene Frauen [zum vollständigen Text gelangen Sie über die oben angegebene URL]
Hintergrund und Stand (inter)nationaler Forschung: Gestationsdiabetes (GDM) ist eine Komplikation... more Hintergrund und Stand (inter)nationaler Forschung: Gestationsdiabetes (GDM) ist eine Komplikation während der Schwangerschaft. Schätzungen, wie viele der schwangeren Frauen einen GDM entwickeln, variieren stark: je nach Datenbasis und Definition schwanken diese zwischen 4% und 20%.[zum vollständigen Text gelangen Sie über die oben angegebene URL]
Hintergrund: Gestationsdiabetes (GDM) ist eine Komplikation während der Schwangerschaft. Je nach ... more Hintergrund: Gestationsdiabetes (GDM) ist eine Komplikation während der Schwangerschaft. Je nach Datenbasis und Definition schwankt die Prävalenz zwischen 4% und 20%. In den meisten Fällen reguliert sich der Blutzuckerspiegel zwar nach der Geburt, jedoch zeigen epidemiologische [zum vollständigen Text gelangen Sie über die oben angegebene URL]
Public Health Forum, 2021
Zusammenfassung Gestationsdiabetes mellitus (GDM, ICD-10-Code: O24.4) ist eine Glukosetoleranzstö... more Zusammenfassung Gestationsdiabetes mellitus (GDM, ICD-10-Code: O24.4) ist eine Glukosetoleranzstörung, die erstmals während der Schwangerschaft auftritt. Auch wenn sich die Blutzuckerwerte nach der Entbindung häufig normalisieren, gehen jedoch kurz- und langfristige gesundheitliche Risiken für Mutter und Kind mit dem GDM einher. Prävention, Diagnose, Therapie und Nachsorge sind somit essentiell für die Gesundheit von Mutter und Kind. Im Folgenden soll ein kurzer Überblick für Deutschland gegeben werden.
BMJ Open, 2021
IntroductionWomen with gestational diabetes mellitus (GDM) have a higher risk of developing type ... more IntroductionWomen with gestational diabetes mellitus (GDM) have a higher risk of developing type 2 diabetes mellitus compared with women who never had GDM. Consequently, the question of structured aftercare for GDM has emerged. In all probability, many women do not receive care according to the guidelines. In particular, the process and interaction between obstetrical, diabetic, gynaecological, paediatric and general practitioner care lacks clear definitions. Thus, our first goal is to analyse the current aftercare situation for women with GDM in Germany, for example, the participation rate in aftercare diabetes screening, as well as reasons and attitudes stated by healthcare providers to offer these services and by patients to participate (or not). Second, we want to develop an appropriate, effective and patient-centred care model.Methods and analysisThis is a population-based mixed methods study using both quantitative and qualitative research approaches. In various working packag...
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Papers by Heinke Adamczewski