Implications of Decreasing Insulin Requirements for Diabetes in Pregnancy: A Systematic Review [15D]
Bibliographic record
Abstract
INTRODUCTION: Increased insulin resistance is a known physiologic change of pregnancy. For patients with gestational or preexisting diabetes being treated with insulin therapy, insulin requirements are expected to steadily increase throughout pregnancy. In a small subset of patients, insulin requirements decrease in the third trimester. It is felt by some practitioners that this clinical change is indicative of placental insufficiency, although current evidence is limited and conflicting. METHODS: A search strategy was developed to identify studies that compared maternal and neonatal outcomes in women with insulin-dependent diabetes who experienced a decrease in insulin requirement against those with insulin requirements that did not decrease in the third trimester. A systematic review was then carried out using MEDLINE, EMBASE, Cochrane Library, EBSCOHost CINAHL, Scopus, WOS Core Citation Indexes, Biosis Citation Index and Proquest Dissertations & Thesis Global databases. RESULTS: 1514 studies were identified using the search strategy, and 21 were selected for full-text review. Data extraction from these studies is ongoing. CONCLUSION: There are currently no guidelines to inform management of insulin-dependent diabetes in pregnancy when insulin requirements drop. However, this clinical scenario is often considered to be an indication for increased surveillance and/or delivery. This review will help clarify whether the additional surveillance of such patients is warranted, and may aid in the development of future guidelines regarding the management of such patients.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.038 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.007 | 0.007 |
| Bibliometrics | 0.006 | 0.008 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".