International Federation of Gynecology and Obstetrics

WORKINGGROUPONHYPERGLYCEMIA INPREGNANCY(HIP)

Members:ProfessorMosheHod(Chair)DrHema Divakar (Co-Chair)DrHectorBolattiProfessorLuisCaberoRouraDrMaryD’AltonDrBlami DaoDrGernotDesoyeProfessorFidelma DunnDrYirguGebrehiwotFerede (Ex-officio)

DrAnilKapurDrTahirMahmoodDrMohamedMomtazDrDavidMcIntyreDrUmbeto SimeoniDrHuixia YangProfessorMarkHanson(Ex-officio)ProfessorGianCarloDiRenzo(Ex-officio)ProfessorGerardVisser (Ex-officio)

FIGO GUIDELINES ONDIAGNOSIS,MANAGEMENT &CARE

OFGIRLS ANDWOMENWITHGESTATIONAL DIABETES

MaternalObesity42 million pregnancies

MaternalHyperglycaemia~21 million pregnancies

MaternalAnaemia

56millionpregnancies

MaternalUndernutrition

26 million pregnancies

MaternalMalaria20millionpregnancies

~127 million live births

Maternalhypertensivedisorders

~7 million pregnancies

127 millionlivebirths/year

~3to4milliondetectedandtreated

ReceivePostpartumfollowupandlifestyleadvice?

~21million/yearcomplicatedbyhyperglycaemia

India, China, Pakistan, Indonesia,Bangladesh,

Brazil, Mexico>65 million deliveries

HIPisamajorglobalhealthproblem

“…Facing a “Slow-Motion Disaster”UN Meeting on Non Communicable Diseases- Margaret Chan, Director-General, World Health Organization (WHO),Sept. 2011

• There is an increasing global crisis in NCD • NCD are associated with mortality, morbidity, and long-term disability• Two of three deaths globally are attributable NCDs

HIPisamajorglobalhealthproblem

Diagnosis and management may help turn the tide of the

Diabetes - NCD pandemic

Dec2013 Oct2015FIGOExpertGrouponGDMestablished

Launchofguidelinesondiagnosis,managementandcare

Recommendationsgradedbyqualityof

evidence

Providesacallforactiontopolicymakers

Providesoptionsaccordingtoresource

setting

Identifieskeypointsof

intervention

FIGOGDMguidelinesExecutivesummaryThetargetaudienceAssessmentofqualityofevidenceandgradingofrecommendationGestationalDiabetesMellitus(GDM)–Background,Definition,Epidemiology,PathophysiologyDiagnosingGestationalDiabetesMellitusGlucoseMeasurement:Technicalconsiderationsinlaboratoryandpointofcare(POC)testingManagementduringpregnancyPost-PartumManagementPreConceptionCareResearchPrioritiesAppendix

CurrentApproachestoGDMdiagnosisinselectedhighburdendevelopingcountriesGestationalDiabetesFormulasforCost-Effectiveness- GeDiForCE®ResearchPrioritiesinGestationalDiabetes

Recommendationsgradedbyquality

ofevidence

Providesacallforactiontopolicymakers

Providesoptionsaccordingto

resourcesetting

Identifieskeypointsof

intervention

FIGOGDMguidance:Somehighlights1:DescribesanddifferentiatesGDM

FIGO (WHO) Classification

DIP&GDM=HIP

Significanceforglobalhealth

FIGOBoxeshighlight

salientpoints

AdvocatesUniversalTesting

Universalcriteriafordiagnosis

Recommendationfordiagnosis

Whilethisistheoptimalrecommendation,alternativesaregiveninacknowledgementoflimitationsfacedindiversesettings

Technicalconsiderationsinlaboratoryandpointofcare(POC)testing

Standardsforlabtesting

ManagementofGDM

AssessingFetal wellbeing

DeliveryforwomenwithGDM

ManagementofGDM

LifestyleManagement

TreatmentofGDM

Pre-conceptionandinter-pregnancy

Postpartumcare

Focusanddissemination

Working Group onHyperglycaemia in Pregnancy (HIP)

Training, advocacy and evidence generation on hyperglycaemia in

pregnancy to reduce poor pregnancy outcomes; decrease maternal and neonatal morbidity and mortality; and cut future risk of diabetes &

cardio-vascular disease

Dec2013 Oct2015

Jan2016Oct2018

FIGOExpertGrouponGDMestablished

Launchofguidelinesondiagnosis,management

andcare

FIGOWorkingGrouponHIPinstated

ReportonsuccessesatFIGOWorldCongress

KeyMilestones

Awareness&Advocacy

CapacityBuilding&Training

Research

Thenextthreeyears….

WorkingGroupHyperglycaemiainPregnancy(HIP)

GOAL- Internationalorganizationsandkeygovernmentsimplementingtargetedcommunicationandadvocacystrategies

FIGOwillenagagewithmajororganisations(NGOs,UNOrganisations,professionalossociationsandgovernmentagencies)workinginthefieldofmaternalhealthtorecognizethathypeglycaemiainpregnancyisakeyissueimpactingmaternalandwomen'shealth,thatneedstobeaddressedaspartofSustainableDevelopmentGoal3onhealthandwelbeing.

AwarenessandAdvocacy

WorkingGroupHyperglycaemiainPregnancy(HIP)

GOAL- Comprehensive,rolebasedtrainingprogramsbeingrolled-outto healthcareworkers;andtoimprovetheknowledge,skillsandattitudesof FIGOaffiliatesinthe

managementofHIP

CapacityBuildingandTraining

FIGOwill developandimplementcomprehensiveandcompetancybasedlearningresourcepackage(LRP)trainingonHIPtohealthcareworkersatalllevels.FIGOwillassistitsmemberorganizationstorolloutthetrainingonHIPusingthenewlydevelopedLRP.

WorkingGroupHyperglycaemiainPregnancy(HIP)

GOAL:ToidentifyandimplementaresearchagendawhichwilladdressprioritygapsinknowledgeofHIP

FIGOwilldevelopaprioritizedresearchagendabasedonthebroadneedsidentifiedbytheFIGOrecommendations,createaresearchnetworkwhichwillworktowardsconductingresearchaimedataddressingprioritygaps.ThethreeyearworkplanfortheFIGOHyperglycemia inPregnancy(HIP)Groupisrelativelyshortforthedevelopment,funding,conductandanalysisofamajorindividualresearchproject(s).Nonetheless,theFIGOResearchNetworkwillachievesomeshort-termgoalstodemonstrateitskeycoordinatingroleinshapingtheglobalresearchagendaregardingHIP.TheInternationalFederationofGynecology andObstetrics(FIGO)InitiativeonGestationalDiabetes

Mellitus:APragmaticGuideforDiagnosis,ManagementandCarewhichaspublishedintheInternationalJournalofGynecology andObstetrics(IJGO)inOctober2015,

ResearchNetwork

ØTAKE HOME MESSAGES

ØHyperglycemia InPregnancyv The most common medical conditions women encounter during pregnancy

v Is associated with :

üLeading causes of maternal mortalityüHigher incidence of maternal morbidity

üHigher incidence of perinatal and neonatal morbidityüLater long term consequences for both mother and child

v Pregnancy offers a window of opportunity to:

üEstablish servicesü Improve health

üPrevent intergenerational transmission no communicable diseases

ØFIGO recommendsAll pregnant women should be tested for hyperglycemia during pregnancy

vUniversal testing

vA one-step procedure

The postpartum period Ø An important platform to initiate early preventive health for

mother and offspringwho are both at higher risk of:

v Future Obesity

v Metabolic Syndrome

v Diabetes

v Hypertension

v Cardiovascular Disorders

Working Group onHyperglycaemia in Pregnancy (HIP)

Thankyouforlistening

www.figo.org

ContactJessica@figo.org andMatt@figo.org formoreinformation