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Daglar K, Kara O, Türkmen GG, Kırbas A, Biberoğlu EH, Sanhal CY, Danisman N. Clinical significance of fasting plasma glucose in patients with normal 50-g glucose challenge test in pregnancy: Is 100 bigger than 92? J OBSTET GYNAECOL 2016; 36:957-961. [PMID: 27565573 DOI: 10.1080/01443615.2016.1174836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The present study aimed to analyse the perinatal outcomes in patients with normal 50-g Glucose Challenge Test but who are considered retrospectively to have gestational diabetes mellitus based on elevated fasting plasma glucose (FPG) levels according to recent criteria. The study was conducted between January 2010 and December 2014 to identify patients with FPG values >92 mg/dl and GCT values <130 mg/dl. The patients were divided into two groups: those with FPG values between 92 and 99 mg/dl (Group 1) and those with FPG values >99 mg/dl (Group 2). The rate of obstetric complications was similar in the three groups, except for a higher rate of preeclampsia in Group 2 than in the control group (8.3% versus 3.1%; p = 0.031). The rate of large for gestational age neonates in Group 2 was 15%, which was higher than the rate in Group 1 (5.5%) and control group (7.4%) (p = 0.046 and p = 0.047, respectively). The rate of neonatal intensive care unit admissions in Group 2 was 11.7%, which was higher than the rate in Group 1 (3.1%) and in the control group (2.4%). Our findings indicate that there is a clinically recognisable difference in perinatal outcomes when a threshold of 100 mg/dl is used for FPG instead of 92 mg/dl.
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Affiliation(s)
- Korkut Daglar
- a Department of Perinatology, Zekai Tahir Burak Research and Training Hospital , Ankara , Turkey
| | - Ozgür Kara
- a Department of Perinatology, Zekai Tahir Burak Research and Training Hospital , Ankara , Turkey
| | | | - Ayse Kırbas
- a Department of Perinatology, Zekai Tahir Burak Research and Training Hospital , Ankara , Turkey
| | - Ebru Hacer Biberoğlu
- a Department of Perinatology, Zekai Tahir Burak Research and Training Hospital , Ankara , Turkey
| | - Cem Yasar Sanhal
- a Department of Perinatology, Zekai Tahir Burak Research and Training Hospital , Ankara , Turkey
| | - Nuri Danisman
- a Department of Perinatology, Zekai Tahir Burak Research and Training Hospital , Ankara , Turkey
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Djelmis J, Pavić M, Mulliqi Kotori V, Pavlić Renar I, Ivanisevic M, Oreskovic S. Prevalence of gestational diabetes mellitus according to IADPSG and NICE criteria. Int J Gynaecol Obstet 2016; 135:250-254. [DOI: 10.1016/j.ijgo.2016.07.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 06/29/2016] [Accepted: 08/22/2016] [Indexed: 10/21/2022]
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Zsirai L, Csákány GM, Vargha P, Fülöp V, Tabák ÁG. Breech presentation: its predictors and consequences. An analysis of the Hungarian Tauffer Obstetric Database (1996-2011). Acta Obstet Gynecol Scand 2015; 95:347-54. [PMID: 26660231 DOI: 10.1111/aogs.12834] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Accepted: 10/11/2015] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Breech presentation is linked to abnormal pregnancy outcomes. However, the causality of this association is unknown. We aimed to investigate predictors of term breech presentation and pregnancy outcomes of breech presentation. MATERIAL AND METHODS Using a Hungarian registry, all term (≥ 37 weeks), singleton pregnancies with cephalic, and breech presentation in 1996-2011 were analyzed (n = 41 796). Covariates were maternal medical history and data on the present pregnancy. Multivariable logistic regression was used to investigate predictors of breech presentation and of delivery (cesarean section or other obstetrical interventions at birth) and fetal outcomes (Apgar score ≤ 7, need for perinatal intensive treatment, intrauterine death or perinatal mortality) related to breech presentation. RESULTS Breech presentation was independently associated with older maternal age, medical history (primiparity, stillbirth, spontaneous abortion, hormone treatment, and assisted reproduction), maternal morbidities (hypertension and oligohydramnios), and the fetal factors (female sex, younger gestational age at delivery, developmental abnormalities, small for gestational age, and birthweight). An adverse delivery outcome was 11.7 times (95% confidence interval 11.3-12.0) and an adverse fetal outcome was 1.39 times (95% confidence interval 1.33-1.45) more frequent in pregnancies with breech presentation compared with cephalic presentation. Further adjustment for predictors of breech presentation had no major effect on the delivery outcome, but it reduced the risk of adverse fetal outcome (odds ratio 1.18, 95% confidence interval 1.14-1.24). CONCLUSIONS Breech presentation is a marker of pathological pregnancy and is independently associated with an increased risk of gestational complications. Closer surveillance and appropriate management of pregnancies with breech presentation is warranted to prevent adverse perinatal outcomes.
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Affiliation(s)
- László Zsirai
- Department of Gynecology and Family Planning, Istenhegyi GeneDiagnostic Center, Budapest, Hungary
| | - György M Csákány
- Department of Obstetrics and Gynecology, Jahn Ferenc Hospital, Budapest, Hungary
| | - Péter Vargha
- Department of Cardiology, Cardiology Center, Semmelweis University Faculty of Medicine, Budapest, Hungary
| | - Vilmos Fülöp
- Department of Obstetrics and Gynecology, Military Hospital, Budapest, Hungary
| | - Ádám G Tabák
- 1st Department of Internal Medicine, Semmelweis University Faculty of Medicine, Budapest, Hungary.,Department of Epidemiology and Public Health, University College London, London, UK
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Monteiro LJ, Norman JE, Rice GE, Illanes SE. Fetal programming and gestational diabetes mellitus. Placenta 2015; 48 Suppl 1:S54-S60. [PMID: 26724985 DOI: 10.1016/j.placenta.2015.11.015] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 11/26/2015] [Accepted: 11/29/2015] [Indexed: 01/11/2023]
Abstract
Gestational diabetes mellitus is defined by new-onset glucose intolerance during pregnancy. About 2-5% of all pregnant women develop gestational diabetes during their pregnancies and the prevalence has increased considerably during the last decade. This metabolic condition is manifested when pancreatic β-cells lose their ability to compensate for increased insulin resistance during pregnancy, however, the pathogenesis of the disease remains largely unknown. Gestational diabetes is strongly associated with adverse pregnancy outcome as well as with long-term adverse effects on the offspring which likely occurs due to epigenetic modifications of the fetal genome. In the current review we address gestational diabetes and the short and long term complications for both mothers and offspring focusing on the importance of fetal programming in conferring risk of developing diseases in adulthood.
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Affiliation(s)
- Lara J Monteiro
- Department of Obstetrics & Gynecology, Laboratory of Reproductive Biology, Faculty of Medicine, Universidad de Los Andes, Santiago, Chile
| | - Jane E Norman
- Tommy's Centre for Fetal and Maternal Health, Medical Research Council Centre for Reproductive Health, Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
| | - Gregory E Rice
- Centre for Clinical Diagnostics, Faculty of Medicine and Biomedical Sciences, University of Queensland Centre for Clinical Research, Brisbane, QLD, Australia
| | - Sebastián E Illanes
- Department of Obstetrics & Gynecology, Laboratory of Reproductive Biology, Faculty of Medicine, Universidad de Los Andes, Santiago, Chile; Centre for Clinical Diagnostics, Faculty of Medicine and Biomedical Sciences, University of Queensland Centre for Clinical Research, Brisbane, QLD, Australia.
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Li HP, Wang FH, Tao MF, Huang YJ, Jia WP. Association between glycemic control and birthweight with glycated albumin in Chinese women with gestational diabetes mellitus. J Diabetes Investig 2015; 7:48-55. [PMID: 26816601 PMCID: PMC4718110 DOI: 10.1111/jdi.12383] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Revised: 04/25/2015] [Accepted: 05/17/2015] [Indexed: 11/30/2022] Open
Abstract
Aims/Introduction To assess glycated albumin (GA) as a potential glycemic index in managing gestational diabetes mellitus (GDM). Materials and Methods Eligible pregnant women were divided into the GDM group with abnormal result on a 75‐g oral glucose tolerance test (OGTT) and the control (normal) group. GA measurements, Pearson's correlation analysis, multiple logistic regression and receiver operating characteristic curve analysis were obtained at the follow‐up examination of participants in the two groups. Results A total of 2,118 women were assigned to the GDM group (n = 639) and control group (n = 1,479). The mean level of serum GA in GDM group was significantly greater than that in the control group at both 24–28 and 36–38 weeks of gestation (P < 0.05). The area under the receiver operating characteristic curve for GA defining good glycemic control in GDM was 0.874 (95% confidence interval 0.811–0.938). The cut‐off point for the GA levels derived from the receiver operating characteristic curve was 11.60%, which had sensitivity and specificity for detecting a poor glycemic status of 75.93% and 86.36%, respectively. The risk of birthweight ≥3,500 g and macrosomia increased significantly with GA levels ≥13.00% at 24–28 weeks and ≥12.00% at 36–38 weeks of gestation. Conclusions GA might be an appropriate and conveniently measured index that can detect poor glycemic control and predict birthweights in GDM women.
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Affiliation(s)
- Hua-Ping Li
- Department of Gynecology & Obstetrics Shanghai Clinical Center for Diabetes Shanghai Jiao Tong University Affiliated Sixth People's Hospital Shanghai China
| | - Feng-Huan Wang
- Department of Gynecology & Obstetrics Shenzhou City Hospital Shenzhou Hebei China
| | - Min-Fang Tao
- Department of Gynecology & Obstetrics Shanghai Clinical Center for Diabetes Shanghai Jiao Tong University Affiliated Sixth People's Hospital Shanghai China
| | - Ya-Juan Huang
- Department of Gynecology & Obstetrics Shanghai Clinical Center for Diabetes Shanghai Jiao Tong University Affiliated Sixth People's Hospital Shanghai China
| | - Wei-Ping Jia
- Department of Endocrinology and Metabolism Shanghai Clinical Center for Diabetes Shanghai Jiao Tong University Affiliated Sixth People's Hospital Shanghai China
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March MI, Modest AM, Ralston SJ, Hacker MR, Gupta M, Brown FM. The effect of adopting the IADPSG screening guidelines on the risk profile and outcomes of the gestational diabetes population. J Matern Fetal Neonatal Med 2015; 29:1141-5. [PMID: 25958989 PMCID: PMC4776727 DOI: 10.3109/14767058.2015.1038513] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective: To compare characteristics and outcomes of women diagnosed with gestational diabetes mellitus (GDM) by the newer one-step glucose tolerance test and those diagnosed with the traditional two-step method. Research design and methods: This was a retrospective cohort study of women with GDM who delivered in 2010–2011. Data are reported as proportion or median (interquartile range) and were compared using a Chi-square, Fisher's exact or Wilcoxon rank sum test based on data type. Results: Of 235 women with GDM, 55.7% were diagnosed using the two-step method and 44.3% with the one-step method. The groups had similar demographics and GDM risk factors. The two-step method group was diagnosed with GDM one week later [27.0 (24.0–29.0) weeks versus 26.0 (24.0–28.0 weeks); p = 0.13]. The groups had similar median weight gain per week before diagnosis. After diagnosis, women in the one-step method group had significantly higher median weight gain per week [0.67 pounds/week (0.31–1.0) versus 0.56 pounds/week (0.15–0.89); p = 0.047]. In the one-step method group more women had suspected macrosomia (11.7% versus 5.3%, p = 0.07) and more neonates had a birth weight >4000 g (13.6% versus 7.5%, p = 0.13); however, these differences were not statistically significant. Other pregnancy and neonatal complications were similar. Conclusions: Women diagnosed with the one-step method gained more weight per week after GDM diagnosis and had a non-statistically significant increased risk for suspected macrosomia. Our data suggest the one-step method identifies women with at least equally high risk as the two-step method.
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Affiliation(s)
- Melissa I March
- a Department of Obstetrics and Gynecology and.,b Division of Maternal Fetal Medicine , Beth Israel Deaconess Medical Center , Boston , MA , USA .,c Department of Obstetrics, Gynecology and Reproductive Biology , Harvard Medical School , Boston , MA , USA
| | | | - Steven J Ralston
- a Department of Obstetrics and Gynecology and.,b Division of Maternal Fetal Medicine , Beth Israel Deaconess Medical Center , Boston , MA , USA .,c Department of Obstetrics, Gynecology and Reproductive Biology , Harvard Medical School , Boston , MA , USA
| | - Michele R Hacker
- a Department of Obstetrics and Gynecology and.,c Department of Obstetrics, Gynecology and Reproductive Biology , Harvard Medical School , Boston , MA , USA
| | - Munish Gupta
- d Department of Neonatology , Beth Israel Deaconess Medical Center , Boston , MA , USA .,e Department of Pediatrics , Harvard Medical School , Boston , MA , USA
| | - Florence M Brown
- f Department of Internal Medicine , Beth Israel Deaconess Medical Center , Boston , MA , USA .,g Joslin Diabetes Center , Boston , MA , USA , and.,h Department of Medicine , Harvard Medical School , Boston , MA , USA
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Yang X, Tian H, Zhang F, Zhang C, Li Y, Leng J, Wang L, Liu G, Dong L, Yu Z, Hu G, Chan JCN. A randomised translational trial of lifestyle intervention using a 3-tier shared care approach on pregnancy outcomes in Chinese women with gestational diabetes mellitus but without diabetes. J Transl Med 2014; 12:290. [PMID: 25349017 PMCID: PMC4213554 DOI: 10.1186/s12967-014-0290-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 10/07/2014] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND There are no randomised controlled trials to demonstrate whether lifestyle modifications can improve pregnancy outcomes of gestational diabetes mellitus (GDM) diagnosed by the International Association of Diabetes and Pregnancy Study Group's (IADPSG) criteria. We tested the effectiveness of lifestyle modifications implemented in a 3-tier's shared care (SC) on pregnancy outcomes of GDM. METHODS Between December 2010 and October 2012, we randomly assigned 700 women with IADPSG-defined GDM but without diabetes at 26.3 (interquartile range: 25.4-27.3) gestational weeks in Tianjin, China, to receive SC or usual care (UC). The SC group received individual consultations and group sessions and performed regular self-monitoring of blood glucose compared to one hospital-based education session in the UC group. The outcomes were macrosomia defined as birth weight ≥ 4.0 kg and the pregnancy-induced hypertension (PIH). RESULTS Women in the SC (n = 339) and UC (n = 361) groups delivered their infants at similar gestational weeks. Birth weight of infants in the SC group was lower than that in the UC group (3469 vs. 3371 grams, P = 0.021). The rate of macrosomia was 11.2% (38/339) in the SC group compared to 17.5% (63/361) in the UC group with relative risk (RR) of 0.64 (95% CI: 0.44-0.93). The rate of PIH was 8.0% (27/339) in the SC compared to 4.4% (16/361) in the UC with RR of 1.80 (0.99-3.28). Apgar score at 1 min < 7 was lower but preeclampsia was higher in the SC than in the UC. CONCLUSIONS Lifestyle modifications using a SC system improved pregnancy outcomes in Chinese women with GDM. TRIAL REGISTRATION Clinicaltrials.gov; NCT01565564.
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Affiliation(s)
- Xilin Yang
- />Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, 300070 China
- />Department of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong and The Chinese University of Hong Kong-Prince of Wales Hospital-International Diabetes Federation Centre of Education, Hong Kong, China
| | - Huiguang Tian
- />Tianjin Women and Children’s Health Centre, Tianjin, China
| | - Fuxia Zhang
- />Tianjin Women and Children’s Health Centre, Tianjin, China
| | - Cuiping Zhang
- />Tianjin Women and Children’s Health Centre, Tianjin, China
| | - Yi Li
- />Tianjin Women and Children’s Health Centre, Tianjin, China
| | - Junhong Leng
- />Tianjin Women and Children’s Health Centre, Tianjin, China
| | - Leishen Wang
- />Tianjin Women and Children’s Health Centre, Tianjin, China
| | - Gongsu Liu
- />Tianjin Women and Children’s Health Centre, Tianjin, China
| | - Ling Dong
- />Tianjin Women and Children’s Health Centre, Tianjin, China
| | - Zhijie Yu
- />Population Cancer Research Program and Department of Pediatrics, Dalhousie University, Halifax, Canada
| | - Gang Hu
- />Chronic Disease Epidemiology Laboratory, Pennington Biomedical Research Center, Baton Rouge, Louisiana USA
| | - Juliana CN Chan
- />Department of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong and The Chinese University of Hong Kong-Prince of Wales Hospital-International Diabetes Federation Centre of Education, Hong Kong, China
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Intensive low-glycaemic-load dietary intervention for the management of glycaemia and serum lipids among women with gestational diabetes: a randomized control trial. Public Health Nutr 2014; 18:1506-13. [PMID: 25222105 DOI: 10.1017/s1368980014001992] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The present study aimed to compare the effects of a general dietary intervention and an intervention with low glycaemic load (GL) on glycaemic control, blood lipid metabolism and pregnancy outcomes in women with gestational diabetes mellitus. DESIGN Participants were randomly assigned to two groups, receiving either an individualized general dietary intervention (Control group) or an intensive low-GL intervention (Low-GL group) every two weeks, from 24-26 weeks of gestation to delivery. SETTING The Center of Maternal Primary Care in Guangdong General Hospital, China. SUBJECTS Ninety-five women with gestational diabetes mellitus were enrolled from June 2008 to July 2009. RESULTS After the intervention, both groups significantly decreased their dietary intakes of energy, fat and carbohydrate. The Low-GL group had significantly lower values for GL (122 v. 136) and glycaemic index (50 v. 54) but greater dietary fibre intake (33 v. 29 g/d) than did the Control group (all P<0·01). Significantly greater decreases in fasting plasma glucose (-0·33 v. -0·02 mmol/l, P<0·01) and 2 h postprandial glucose (-2·98 v. -2·51 mmol/l, P<0·01), significantly lower increases in total cholesterol (0·12 v. 0·23 mmol/l) and TAG (0·41 v. 0·56 mmol/l) and a significantly lower decrease in HDL cholesterol (-0·01 v. -0·11 mmol/l) were also observed in the Low-GL group compared with the Control group (all P<0·05). There were no significant differences in body weight gain, birth weight or other maternal-fetal perinatal outcomes between the two groups. CONCLUSIONS The low-GL targeted dietary intervention outperformed the general dietary intervention in glycaemic control and the improvement of blood lipid levels in women with gestational diabetes mellitus.
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Weile LKK, Kahn JG, Marseille E, Jensen DM, Damm P, Lohse N. Global cost-effectiveness of GDM screening and management: current knowledge and future needs. Best Pract Res Clin Obstet Gynaecol 2014; 29:206-24. [PMID: 25225056 DOI: 10.1016/j.bpobgyn.2014.06.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 06/15/2014] [Indexed: 11/30/2022]
Abstract
Gestational diabetes mellitus (GDM) is an increasing cause of morbidity in women and their offspring. Screening and intervention can reduce perinatal and most likely also long-term diabetes consequences. There have been many economic studies, but not recently systematically compared. We conducted a systematic search and abstraction of cost-effectiveness and cost-utility studies from 2002 to 2014. We standardized all findings to 2014 US dollars. We found that cost-effectiveness ratios varied widely. Most variation was found to be due to differences in geographic setting, diagnostic criteria and intervention approaches, and outcomes (e.g., inclusion or exclusion of long-term type 2 diabetes risk and associated costs). We concluded that incorporation of long-term benefits of GDM screening and treatment has huge impact on cost-effectiveness estimates. Based on the large methodological heterogeneity and varying results in the existing body of evidence, we find it unreasonable to outline any global recommendations. For future economic studies, we recommend inclusion of long-term outcomes and adaptation to local preferences, as well as examination of the impact of the diagnostic criteria recently proposed by the International Association of Diabetes in Pregnancy Study Groups (IADPSG).
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Affiliation(s)
- Louise K K Weile
- Dept of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark.
| | - James G Kahn
- Philip R. Lee Institute for Health Policy Studies, Global Health Sciences, and Global Health Economics Consortium, University of California, San Francisco, USA.
| | - Elliot Marseille
- Health Strategies International and UCSF Global Health Economics Consortium, Oakland, USA.
| | - Dorte M Jensen
- Dept of Endocrinology, Odense University Hospital, Odense, Denmark.
| | - Peter Damm
- Centre for Pregnant Women with Diabetes, Dept. of Obstetrics, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Nicolai Lohse
- Dept of Anaesthesiology and Intensive Care, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
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Orecchio A, Periard D, Kashef A, Magnin JL, Hayoz D, Fontana E. Incidence of gestational diabetes and birth complications in Switzerland: screening in 1042 pregnancies. Gynecol Endocrinol 2014; 30:561-4. [PMID: 24871384 DOI: 10.3109/09513590.2013.879853] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
To evaluate the incidence of gestational diabetes mellitus (GDM), gestational glucose intolerance (GGI), and birth major complications, a population of 1042 pregnant women was screened after the end of the second trimester with a two-step screening method. Patients with a positive 50-g screening test (plasma glucose ≥ 7.8 mmol/l at 1 h) underwent a 3-h standard 100-g oral glucose tolerance test. Clinical records of patients and newborns were analysed and compared to normotolerant patients group. GDM was found in 4.8% and GGI in 2.6% of all screened women of this study population. The patient group with GDM significantly differed from control, with a higher proportion of Asiatic women (32.0% versus 2.9%, p = 0.001) and high prevalence of previous GDM (26.0% versus 0.0%, p < 0.001). Major neonatal complications occurred more frequently in the dysmetabolic groups compared to normotolerant group. Macrosomia was not noted in our population. Asiatic origin and previous GDM were strongly associated with an increased incidence of GDM in multivariate analysis. This study represents the first epidemiological evaluation of GDM/GGI in Switzerland, with a two-step screening method. Incidence of GDM and GGI as well as birth complications resulted significant in our country.
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Pilone V, Hasani A, Di Micco R, Vitiello A, Monda A, Izzo G, Iacobelli L, Villamaina E, Forestieri P. Pregnancy after laparoscopic gastric banding: maternal and neonatal outcomes. Int J Surg 2014; 12 Suppl 1:S136-9. [PMID: 24866073 DOI: 10.1016/j.ijsu.2014.05.027] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Accepted: 05/03/2014] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Laparoscopic Adjustable Gastric Banding (LAGB) is a safe and effective treatment for obesity. A strong evidence links weight loss with improved fertility outcomes and reduced gestational complications in subsequent pregnancies. Our aim is to describe the impact of LAGB on maternal and neonatal outcomes. METHODS Data were collected retrospectively from the database of our University Center for the Multicentric Treatment of Severe Obesity. From January 2006 to December 2011, 438 patients underwent LAGB. Of these, 140 women of reproductive age (18-46 years old) were included in our study. The following parameters were registered during follow-up: number of pregnancies, delivery and miscarriage, time from LAGB to pregnancy, band adjustments, weight gain during pregnancy, gestational and obstetrical complications (gestational diabetes mellitus, hypertensive disorders, prolonged labor), mode of delivery, neonatal birth weight and complications (low birth weight, IUGR, prematurity, macrosomy). RESULTS We registered 26 pregnancies with a total of 22 babies born and 4 miscarriages. The mean time from LAGB to pregnancy was 15.8 months. Band adjustments were performed in 100% of patients during the first trimester; the average weight gain at the end of pregnancy was 14.66 kg. None presented gestational or obstetrical complications. One patient presented band slippage, which required surgery, and one patient presented iron-deficiency anemia. 100% of deliveries were by cesarean section. No perinatal complications or malformations were recorded, and the average baby weight was 3027 g. CONCLUSION LAGB is a safe procedure, well tolerated during pregnancy and without negative implications on both the mother and the baby. According to our experience and recent studies, band loosening should be reserved to symptomatic patients to avoid unhealthy weight gain.
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Affiliation(s)
- Vincenzo Pilone
- Department of Medicine and Surgery, University of Salerno, Italy
| | - Ariola Hasani
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131 Italy.
| | - Rosa Di Micco
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131 Italy
| | - Antonio Vitiello
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131 Italy
| | - Angela Monda
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131 Italy
| | - Giuliano Izzo
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131 Italy
| | - Leucio Iacobelli
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131 Italy
| | - Elisabetta Villamaina
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131 Italy
| | - Pietro Forestieri
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131 Italy
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Saunders L, Guldner L, Costet N, Kadhel P, Rouget F, Monfort C, Thomé JP, Multigner L, Cordier S. Effect of a Mediterranean diet during pregnancy on fetal growth and preterm delivery: results from a French Caribbean Mother-Child Cohort Study (TIMOUN). Paediatr Perinat Epidemiol 2014; 28:235-44. [PMID: 24754337 DOI: 10.1111/ppe.12113] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Recent studies suggest that a Mediterranean dietary pattern during pregnancy may influence pregnancy outcomes. The aim of this study was to evaluate the effect of adherence to a Mediterranean diet (MD) during pregnancy on fetal growth restriction (FGR) and preterm delivery (PTD) in a French Caribbean island where the population is largely of African descent and presents dietary patterns similar to MD. METHODS Using data from the TIMOUN Mother-Child Cohort Study conducted in Guadeloupe (French West Indies) between 2004 and 2007, we analysed data for 728 pregnant women who delivered liveborn singletons without any major congenital malformations. Degree of adherence to MD during pregnancy was evaluated with a semi-quantitative food frequency questionnaire based on nine dietary criteria. Multiple logistic regression models were used to analyse birth outcomes while taking potential confounders into account. RESULTS Overall there was no association between MD adherence during pregnancy and the risk of PTD or FGR. However, pre-pregnancy body mass index was a strong effect modifier, and MD adherence was associated with a decreased risk of PTD specifically in overweight and obese women (adjusted odds ratio 0.7, 95% confidence interval 0.6, 0.9) (P heterogeneity <0.01). CONCLUSIONS These results suggest that Caribbean diet during pregnancy may carry some benefits of MD and may contribute to reduce the risk of PTD in overweight and obese pregnant women.
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Affiliation(s)
- Lauren Saunders
- Team of Epidemiological Research on Environment, Reproduction and Development, National Institute for Health and Medical Research (INSERM U1085), Rennes, France
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Boghossian NS, Yeung E, Albert PS, Mendola P, Laughon SK, Hinkle SN, Zhang C. Changes in diabetes status between pregnancies and impact on subsequent newborn outcomes. Am J Obstet Gynecol 2014; 210:431.e1-14. [PMID: 24361790 DOI: 10.1016/j.ajog.2013.12.026] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 11/08/2013] [Accepted: 12/17/2013] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Pregnancies complicated by gestational diabetes mellitus (GDM) or preexisting diabetes mellitus (DM) are at high risk for adverse newborn outcomes. Whether GDM history, recurrence, or transition to DM modifies such risks is unknown. STUDY DESIGN Medical record data on 62,013 repeat singleton pregnancies were collected retrospectively from women who delivered at least twice in Utah (2002 through 2010). Poisson regression models with robust variance estimators were used to estimate relative risks (RR) and 95% confidence intervals (CI) associated with GDM/DM status at the previous and/or current pregnancy relative to those without GDM/DM at either. Large for gestational age (LGA), shoulder dystocia, preterm birth (<37 weeks), respiratory distress syndrome, and other neonatal morbidities were examined adjusting for study site, maternal age, race, parity, interpregnancy interval, prepregnancy body mass index, and smoking status. RESULTS GDM in the previous pregnancy alone increased the risk of LGA in the current pregnancy (RR, 1.20; 95% CI, 1.05-1.38). Recurrent GDM increased the risks of LGA (RR, 1.76; 95% CI, 1.56-1.98), shoulder dystocia (RR, 1.98; 95% CI, 1.46-2.70), and preterm birth (RR, 1.68; 95% CI, 1.44-1.96) beyond that observed for pregnancies with current GDM alone. Women with GDM in a previous pregnancy that transitioned to DM in the current pregnancy and women with DM prior to the previous pregnancy had increased risks of all above outcomes. CONCLUSION GDM in a previous pregnancy alone without recurrence may still confer an increased LGA risk. Pregnancies complicated by GDM that transition to DM and those with DM prior to the previous pregnancy have the highest risks of adverse newborn outcomes.
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Affiliation(s)
- Nansi S Boghossian
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Edwina Yeung
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Paul S Albert
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Pauline Mendola
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - S Katherine Laughon
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Stefanie N Hinkle
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Cuilin Zhang
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
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Hartling L, Dryden DM, Guthrie A, Muise M, Vandermeer B, Donovan L. Diagnostic thresholds for gestational diabetes and their impact on pregnancy outcomes: a systematic review. Diabet Med 2014; 31:319-31. [PMID: 24528230 DOI: 10.1111/dme.12357] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 10/05/2013] [Accepted: 10/08/2013] [Indexed: 01/22/2023]
Abstract
AIMS To assess different diagnostic thresholds for gestational diabetes on outcomes for mothers and their offspring in the absence of treatment for gestational diabetes. This information was used to inform a National Institutes of Health consensus conference on diagnosing gestational diabetes. METHODS We searched 15 electronic databases from 1995 to May 2012. Study selection was conducted independently by two reviewers. Randomized controlled trials or cohort studies were eligible if they involved women without known pre-existing diabetes mellitus and who did not undergo treatment for gestational diabetes. One reviewer extracted, and a second reviewer verified, data for accuracy. Two reviewers independently assessed methodological quality. RESULTS Thirty-eight studies were included. Three large, methodologically strong studies showed a continuous positive relationship between increasing glucose levels and the incidence of Caesarean section and macrosomia. When data were examined categorically (i.e. women meeting or not meeting specific diagnostic thresholds), women with gestational diabetes across all glucose criteria had significantly more Caesarean sections, shoulder dystocia, macrosomia (except for International Association of Diabetes in Pregnancy Study Groups' criteria) and large for gestational age. Higher glucose thresholds did not consistently demonstrate greater risk for all outcomes. CONCLUSIONS Higher glucose thresholds did not consistently demonstrate greater risk, possibly because studies did not compare mutually exclusive groups of women. A pragmatic approach for diagnosis of gestational diabetes using Hyperglycemia and Adverse Pregnancy Outcome Study odds ratio 2.0 thresholds warrants further consideration until additional analysis of the data comparing mutually exclusive groups of women is provided and large randomized controlled trials investigating different diagnostic and treatment thresholds are completed.
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Affiliation(s)
- L Hartling
- Alberta Research Center for Health Evidence and the University of Alberta Evidence-Based Practice Center, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
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65
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Correa PJ, Vargas JF, Sen S, Illanes SE. Prediction of gestational diabetes early in pregnancy: targeting the long-term complications. Gynecol Obstet Invest 2014; 77:145-9. [PMID: 24401480 DOI: 10.1159/000357616] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 11/28/2013] [Indexed: 11/19/2022]
Abstract
Gestational diabetes (GD), defined as carbohydrate intolerance with onset or first recognition during pregnancy, has a prevalence of 7% and is a growing problem worldwide. Infants born to mothers with GD are more likely to be large for gestational age, incur traumatic birth injury, require a stay in the intensive care unit and develop postnatal metabolic disturbances. As the worldwide epidemic of obesity worsens, more women are entering pregnancy with metabolic alterations and preexisting insulin resistance, which is heightened by the hormonal milieu of pregnancy. The Hyperglycemia Adverse Pregnancy Outcome (HAPO) study has clearly shown that GD-related complications correlate with glycemic control. We will review the current understanding of the physiology of GD and the screening and treatment guidelines that are commonly utilized in clinical care. In addition, we will discuss the need for development of multiparametric models combining maternal clinical risk factors and biomarkers early in pregnancy to better stratify and predict risk of GD-related complications and offer targeted intervention.
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Affiliation(s)
- Paula J Correa
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universidad de los Andes, Santiago, Chile
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66
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Overweight, Gestational Weight Gain and Elevated Fasting Plasma Glucose and Their Association with Macrosomia in Chinese Pregnant Women. Matern Child Health J 2014; 18:10-15. [DOI: 10.1007/s10995-013-1253-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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67
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History of having a macrosomic infant and the risk of diabetes: the Japan public health center-based prospective diabetes study. PLoS One 2013; 8:e84542. [PMID: 24367673 PMCID: PMC3868652 DOI: 10.1371/journal.pone.0084542] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 11/16/2013] [Indexed: 11/25/2022] Open
Abstract
Objective The aim of the present study was to test a hypothesis that a history of having a macrosomic infant (≥4000g) is associated with the risk of diabetes. Methods Data on the Japan Public Health Center-based Prospective diabetes cohort were analyzed, which is a population-based cohort study on diabetes. The survey of diabetes was performed at baseline and at the 5-year follow-up. A history of having a macrosomic infant was assessed using a self-administered questionnaire. A cross-sectional analysis was performed among 12,153 women who participated in the 5-year survey of the cohort. Logistic regression was used to examine the relationship between a history of having a macrosomic infant and the presence of diabetes. A longitudinal analysis was also conducted among 7,300 women without diabetes who participated in the baseline survey. Logistic regression was used to investigate the relationship between a history of having a macrosomic infant and the incidence of diabetes between the baseline survey and the 5-year survey. Results In the cross-sectional analysis, parous women with a positive history were more likely to have diabetes in relation to parous women without (OR = 1.44, 95% CI = 1.13-1.83). The longitudinal analysis showed a modest but non-significant increased risk of developing diabetes among women with a positive history (OR = 1.24, 95% CI = 0.80-1.94). Conclusions An increased risk of diabetes was implied among women with a history of having a macrosomic infant although the longitudinal analysis showed a non-significant increased risk.
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68
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Harizopoulou VC, Tsiartas P, Goulis DG, Vavilis D, Grimbizis G, Theodoridis TD, Tarlatzis BC. Intrapartum application of the continuous glucose monitoring system in pregnancies complicated with diabetes: A review and feasibility study. World J Obstet Gynecol 2013; 2:42-46. [DOI: 10.5317/wjog.v2.i3.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Revised: 04/01/2013] [Accepted: 05/19/2013] [Indexed: 02/05/2023] Open
Abstract
Intrapartum maternal normoglycemia seems to play an important role in the prevention of adverse perinatal, maternal and neonatal outcomes. Several glucose monitoring protocols have been developed, aiming to achieve a tight glucose monitoring and control. Depending on the type of diabetes and the optimal or suboptimal glycemic control, the treatment options include fasting status of the parturient, frequent monitoring of capillary blood glucose, intravenous dextrose infusion and subcutaneous or intravenous use of insulin. Continuous glucose monitoring system (CGMS) is a relatively new technology that measures interstitial glucose at very short time intervals over a specific period of time. The resulting profile provides a more comprehensive measure of glycemic excursions than intermittent home blood glucose monitoring. Results of studies applying the CGMS technology in patients with or without diabetes mellitus (DM) have revealed new insights in glucose metabolism. Moreover, CGMS have a potential role in the improvement of glycemic control during pregnancy and labor, which may lead to a decrease in perinatal morbidity and mortality. In conclusion, the use of CGMS, with its important technical advantages compared to the conventional way of monitoring, may lead into a more etiological intrapartum management of both the mother and her fetus/infant in pregnancies complicated with DM.
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69
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Gurau J, Cronk A, Pelliccia M, Vandenbussche K. Role of the Nutrition Professional: In High-risk Obstetrics Inpatient Teams. CAN J DIET PRACT RES 2013; 74:75-9. [DOI: 10.3148/74.2.2013.75] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Beyond the management of gestational diabetes and weight control, limited literature exists on nutritional management in high-risk pregnancies. This study is a starting point for understanding the role of the registered dietitian (RD) in high-risk obstetrics (HRO) inpatient teams. Demographic information was gathered on Ontario HRO inpatient units and patient characteristics, and the RD’s role in this setting was explored. Representatives from all six HRO units in Ontario completed a questionnaire. Five of the HRO units had an RD on the team. The RDs stated that their primary role in the unit involved providing nutrition education and support, screening patients for nutritional risk, and writing vitamin and mineral orders. This was the first study in which RDs’ role in HRO inpatient units was examined. Existing literature supports the role of good nutrition in preventing and treating the conditions seen in HRO units; however, RDs’ specific role remains unclear. Future studies are needed to analyze the effect of nutrition on these HRO conditions, and to support the development of best practice guidelines.
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Affiliation(s)
- Julia Gurau
- Department of Clinical Nutrition, Sunnybrook Health Sciences Centre, Toronto, ON
| | - Aleris Cronk
- Department of Clinical Nutrition, Sunnybrook Health Sciences Centre, Toronto, ON
| | - Maria Pelliccia
- Department of Clinical Nutrition, Sunnybrook Health Sciences Centre, Toronto, ON
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70
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Jang EH, Kwon HS. β-Cell dysfunction and insulin resistance in gestational glucose intolerance. Korean J Intern Med 2013; 28:294-6. [PMID: 23682221 PMCID: PMC3654125 DOI: 10.3904/kjim.2013.28.3.294] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 04/24/2013] [Indexed: 11/27/2022] Open
Affiliation(s)
- Eun-Hee Jang
- Department of Internal Medicine, Hando Hospital, Ansan, Korea
| | - Hyuk-Sang Kwon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
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71
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Marseille E, Lohse N, Jiwani A, Hod M, Seshiah V, Yajnik CS, Arora GP, Balaji V, Henriksen O, Lieberman N, Chen R, Damm P, Metzger BE, Kahn JG. The cost-effectiveness of gestational diabetes screening including prevention of type 2 diabetes: application of a new model in India and Israel. J Matern Fetal Neonatal Med 2013; 26:802-10. [DOI: 10.3109/14767058.2013.765845] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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72
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Deierlein AL, Siega-Riz AM, Evenson KR. Physical activity during pregnancy and risk of hyperglycemia. J Womens Health (Larchmt) 2012; 21:769-75. [PMID: 22537020 DOI: 10.1089/jwh.2011.3361] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To determine the association between moderate and vigorous physical activities (MVPA) during midpregnancy and the risk of hyperglycemia. METHODS Data were from 1437 pregnant women. Frequency, duration, and intensity of MVPA during the previous 7 days were collected via questionnaire at 17-22 weeks' gestation. Modes of MVPA included work, recreation, transportation, caregiving, and indoor and outdoor household activities. Hyperglycemia was defined as a glucose concentration ≥130 mg/dL on a 1-hour, 50-g glucose challenge test or gestational diabetes mellitus (GDM) assessed at ~27 weeks' gestation. Multivariable Poisson regression estimated risks of hyperglycemia associated with total and mode-specific MVPA. RESULTS There were 269 women (18.7%) with hyperglycemia. Any metabolic equivalent (MET) hours/week of recreational MVPA was associated with a 27% lower risk of hyperglycemia (adjusted relative risk, [aRR] 0.73, 95% confidence interval [95%CI] 0.54-0.99). Multiplicative interaction terms were significant for prepregnancy body mass index (BMI) and recreational MVPA (p=0.01). Among women with prepregnancy BMI <25 kg/m(2), recreational MVPA was associated with a 48% lower risk of hyperglycemia (aRR 0.52, 95%CI 0.33-0.83) compared to women who reported none. There was no association of hyperglycemia and recreational MVPA among women with prepregnancy BMI <25 kg/m(2). CONCLUSIONS Recreational MVPA during pregnancy is associated with a lower risk of hyperglycemia, specifically among women with prepregnancy BMI <25 kg/m(2). Further research is warranted to determine recommended amounts and intensities of physical activity and to discern whether there are differences in the effects of physical activity between specific modes of physical activity or among subgroups of women in relation to hyperglycemia.
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Affiliation(s)
- Andrea L Deierlein
- Department of Preventive Medicine, Mount Sinai School of Medicine, New York, NY 10029, USA.
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73
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Gojnic M, Perovic M, Pervulov M, Ljubic A. The effects of adjuvant insulin therapy among pregnant women with IGT who failed to achieve the desired glycemia levels by diet and moderate physical activity. J Matern Fetal Neonatal Med 2012; 25:2028-34. [PMID: 22480146 DOI: 10.3109/14767058.2012.672598] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Evaluation of adjuvant insulin therapy effects on glycemic control, perinatal outcome and postpuerperal glucose tolerance in impaired glucose tolerance (IGT) pregnant women who failed to achieve desired glycemic control by dietary regime. METHODS A total of 280 participants were classified in two groups: Group A patients continued with dietary regime and Group B patients were treated with adjuvant insulin therapy. Glycemic control was assessed by laboratory and ultrasonograph means. Pregnancy outcomes were evaluated by prevalence of pregnancy induced hypertension (PIH), high birth weight, neonatal hypoglycemia and caesarean section rates. Postpuerperal glucose tolerance was assessed by oral glucose tolerance test (oGTT). RESULTS All laboratory and ultrasound indicators of glycemic control had significantly lower values in Group B. Group A women were more likely to develop the EPH (Edema, Proteinuria, Hypertension) syndrome, 20% versus 7.86% (p = 0.003). High birth weight occurred more frequently in Group A, but the difference was not significant (p = 0.197). Higher rate of caesarean delivery was in Group A than in Group B, 16.43% versus 26.43% (p = 0.041). The difference in neonatal hypoglycemia was not significant (p = 0.478). Pathological oGTT results were observed in 73 Group A patients and in 15 Group B patients. CONCLUSION Lower caesarean section rates and the EPH syndrome incidence are the benefits of adjuvant insulin therapy in IGT patients.
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Affiliation(s)
- Miroslava Gojnic
- Institute of Gynecology and Obstetrics, Clinical Centre of Serbia, Clinical Hospital Centre, Zemun, Belgrade, Serbia
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74
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Fetal Macrosomia in the Diabetic Woman. ROMANIAN JOURNAL OF DIABETES NUTRITION AND METABOLIC DISEASES 2012. [DOI: 10.2478/v10255-012-0006-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Fetal Macrosomia in the Diabetic WomanDiabetes mellitus complicates up to 10% of pregnancies, while in Romania the incidence is this under 5%. In most of the cases we are talking about gestational diabetes, while only in 0.1 - 0.3% of the cases, the diabetes was pregestational (mainly Type 1 diabetes and rarely Type 2 diabetes or Mody). The study we conducted concerned the incidence of macrosomia in the general population; in the study we investigated 3,000 pregnant patients who gave birth in the Unit of Obstetrics & Gynecology of ‘Dr Cantacuzino’ Hospital from 13th January 2007 to 30th March 2010. The 7.1% of incidence of diabetes mellitus highlighted by the study which aimed to trace gestational diabetes conducted in 2007-2010 period with the assistance of the ‘Dr Cantacuzino’ Hospital, represents just the tip of the iceberg. The positive diagnosis of gestational diabetes identified not only women who had diabetes mellitus pre-existing the pregnancy, without their being aware of it, but also women with a pathology of carbohydrate metabolism who will in the future run a higher risk of developing type 2 diabetes mellitus.
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75
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Eilertsen TB, Vanky E, Carlsen SM. Increased prevalence of diabetes and polycystic ovary syndrome in women with a history of preterm birth: a case-control study. BJOG 2011; 119:266-75. [DOI: 10.1111/j.1471-0528.2011.03206.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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76
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Lohse N, Marseille E, Kahn JG. Development of a model to assess the cost-effectiveness of gestational diabetes mellitus screening and lifestyle change for the prevention of type 2 diabetes mellitus. Int J Gynaecol Obstet 2011; 115 Suppl 1:S20-5. [DOI: 10.1016/s0020-7292(11)60007-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Jiwani A, Marseille E, Lohse N, Damm P, Hod M, Kahn JG. Gestational diabetes mellitus: results from a survey of country prevalence and practices. J Matern Fetal Neonatal Med 2011; 25:600-10. [PMID: 21762003 DOI: 10.3109/14767058.2011.587921] [Citation(s) in RCA: 193] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The association between gestational diabetes mellitus (GDM), perinatal complications and long-term morbidity is gaining increased attention. However, the global burden of GDM and the existing responses are not fully understood. We aimed to assess country prevalence and to summarize practices related to GDM screening and management. METHODS Data on prevalence and country practices were obtained from a survey administered to diabetologists, obstetricians and others working on GDM in 173 countries. RESULTS GDM prevalence estimates range from <1% to 28%, with data derived from expert estimates, and single-site, multi-site and national prevalence assessments. Seventy-four percent of countries that completed the survey have national GDM guidelines or recommendations. Countries use a variety of screening approaches. In the countries where universal screening is recommended, the percentage of pregnant women screened ranges from 10% to >90%. CONCLUSIONS We found large variations in estimated GDM prevalence, but direct comparison between countries is difficult due to different diagnostic strategies and subpopulations. Many countries do not perform systematic screening for GDM, and practices often diverge from guidelines. Countries need to carefully assess the cost and health impact of scaling up GDM screening and management in order to identify the best policy option for their population.
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Affiliation(s)
- Aliya Jiwani
- Health Strategies International, San Francisco, USA.
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78
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Sadikot SM. The IADSPG criteria for the diagnosis of GDM: has the pendulum swung too far to the other side? Diabetes Metab Syndr 2011; 5:113-114. [PMID: 22813561 DOI: 10.1016/j.dsx.2012.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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79
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Magon N. Gestational diabetes mellitus: Get, set, go From diabetes capital of the world to diabetes care capital of the world. Indian J Endocrinol Metab 2011; 15:161-9. [PMID: 21897891 PMCID: PMC3156534 DOI: 10.4103/2230-8210.83398] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Screening and diagnosis for gestational diabetes mellitus (GDM) as well as interventions for its management evoke considerable controversy. There are different types of screening methods: universal or risk-based, one step or two step. Different thresholds for diagnosis of GDM have been in vogue. Previous definition and diagnostic criteria had no place for diagnosis of overt diabetes in pregnancy. Following Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study and International Association of Diabetes and Pregnancy Study Groups (IADPSG) recommendations, new screening and diagnostic criteria around the world seem to be gaining consensus. The present recommendation given by IADPSG for screening and diagnosis of diabetes mellitus in pregnancy has two discrete phases. The first is detection of women with overt diabetes not previously diagnosed or treated outside of pregnancy. Universal early testing in populations is recommended at the first prenatal visit. The second phase is a 75-g OGTT at 24-28 week gestation in all women not previously found to have overt diabetes or GDM. ACHOIS and MFMU Network trails have proven benefit in treating hyperglycemias less than what is diagnostic for diabetes. DIPSI has shown the alternative way for resource-challenged communities. Efforts from all stake holders with interest in GDM are required to make the diabetes capital of the world into the diabetes care capital of the world.
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Affiliation(s)
- Navneet Magon
- Department of Obstetrics and Gynaecology, Air Force Hospital, Kanpur Cantt, India
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80
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Zhang F, Dong L, Zhang CP, Li B, Wen J, Gao W, Sun S, Lv F, Tian H, Tuomilehto J, Qi L, Zhang CL, Yu Z, Yang X, Hu G. Increasing prevalence of gestational diabetes mellitus in Chinese women from 1999 to 2008. Diabet Med 2011; 28:652-7. [PMID: 21569085 DOI: 10.1111/j.1464-5491.2010.03205.x] [Citation(s) in RCA: 140] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS To investigate the trend in the prevalence of gestational diabetes mellitus during 1999-2008 in women living in urban Tianjin, China. METHODS A universal screening for gestational diabetes mellitus has become an integral part of the antenatal care in Tianjin, China from 1998. A total of 105,473 pregnant women living in the six urban districts of Tianjin, China, participated in the gestational diabetes mellitus screening programme between December 1998 and December 2008. The screening test consisted of a 50-g 1-h glucose test. Women who had a glucose reading ≥7.8 mmol/l at the initial screening were invited to undergo the standard 2-h oral glucose tolerance test with a 75-g glucose load. Gestational diabetes mellitus was confirmed using the World Health Organization's diagnostic criteria. RESULTS The adjusted prevalence of gestational diabetes mellitus increased by 2.8 times during 1999-2008, from 2.4 to 6.8% (P<0.0001 for linear trend). In 2008, the age-specific prevalence of gestational diabetes mellitus was the highest among women aged 30-34 years (11.3%) and lowest among women aged 25 and under (1.2%). In women aged 35 years and more, the prevalence was 5.3%. CONCLUSIONS The prevalence of gestational diabetes mellitus has markedly been increasing in a universally screened urban Chinese female population and has become an important public health problem in China.
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Affiliation(s)
- F Zhang
- Tianjin Women's and Children's Health Center, Tianjin, China
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81
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Abstract
AIM To answer two questions: is there a threshold for pathological hyperglycaemia after 24 weeks of gestation? What are the diagnostic criteria for gestational diabetes mellitus? MATERIALS AND METHODS Review of the literature considering the relationships between glucose values and complications during pregnancy in women without specific care for this condition. Only the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study meets sufficient quality criteria. RESULTS Increasing glucose values during pregnancy, either at fasting and after a 75-g oral glucose tolerance test, are independently associated according to a continuum with an increased risk of maternal-foetal complications, especially birth weight above the 90th percentile for gestational age, Caesarean delivery and foetal hyperinsulinemia. There is no obvious threshold at which risks increase. The International Association of Diabetes Pregnancy Study Group has proposed the following criteria, considering the glycemic values associated with a 1.75-fold increased risk of macrosomia, foetal hyperinsulinemia and adiposity in the HAPO study: fasting plasma glucose ≥ 0.92 g/L (5.1 mmol/L) and/or 1-hour plasma glucose value ≥ 1.80 g/L (10.0 mmol/L) and/or 2-hour plasma glucose value ≥ 1.53 g/L (8.5 mmol/L). CONCLUSION The choice of glycemic thresholds for defining gestational diabetes mellitus is necessarily arbitrary because of a continuum (NP2). Only experts may propose definition criteria.
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Affiliation(s)
- E Cosson
- AP-HP, Hôpital Jean Verdier, Service D'Encrinologie-Diabétologie-Nutrition Et Université Paris-Nord, CRNH-IdF, Avenue Du 14 Juillet, 93143 Bondy Cedex, France.
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82
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Beucher G, Viaris de Lesegno B, Dreyfus M. Maternal outcome of gestational diabetes mellitus. DIABETES & METABOLISM 2011; 36:522-37. [PMID: 21163418 DOI: 10.1016/j.diabet.2010.11.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To estimate maternal outcome of treated or untreated gestational diabetes mellitus (GDM). METHODS French and English publications were searched using PubMed and the Cochrane library. RESULTS The diagnosis of GDM includes a high risk population for preeclampsia and Caesarean sections (EL3). The risks are positively correlated with the level of hyperglycaemia in a linear way (EL2). Intensive treatment of mild GDM compared with routine care reduces the risk of pregnancy-induced hypertension (preeclampsia, gestational hypertension). Moreover, it does not increase the risk of operative vaginal delivery, Caesarean section and postpartum haemorrhage (EL1). Being overweight, obesity and maternal hyperglycaemia are independent risk factors for preeclampsia (EL2). Their association with GDM increases the risk of preeclampsia and Caesarean section compared to diabetic women with a normal body mass index (EL3). The association of several risk factors (such as advanced maternal age, pre-existing chronic hypertension, pre-existing nephropathy, obesity, suboptimal glycaemic control) increases the risk of preeclampsia. In that case, the classic follow-up (blood pressure measurement, proteinuria) should be more frequent than monthly (professional consensus). The risk of Caesarean section is increased by macrosomia, whether suspected prenatally or not, but this increased risk remains whatever the birth weight (EL3). Diagnosis and treatment of GDM do not reduce the risk of severe perineal lesions, operative vaginal delivery and postpartum haemorrhage (EL2). Some psychological symptoms, such as anxiety and alteration of self-perception, can occur upon diagnosis of GDM (EL3). The treatment of GDM appears to reduce the risk of postpartum depression symptoms (EL2). CONCLUSION Most of the information published on GDM covers the risks of preeclampsia and Caesarean section; intensive care of GDM reduces these risks. Pregnancy care should be adjusted to the risk factors.
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Affiliation(s)
- G Beucher
- Service de gynécologie obstétrique et médecine de la reproduction, CHU de Caen, Avenue Côte de Nacre, 14033 Caen cedex 9, France.
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83
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Köck K, Köck F, Klein K, Bancher-Todesca D, Helmer H. Diabetes mellitus and the risk of preterm birth with regard to the risk of spontaneous preterm birth. J Matern Fetal Neonatal Med 2010; 23:1004-8. [PMID: 20059440 DOI: 10.3109/14767050903551392] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION It is internationally agreed that diabetes mellitus (DM) is associated with increased maternal and fetal morbidity and long-term complications. To avoid these complications, it is often necessary to induce birth before term. The impact of DM on spontaneous preterm birth (spontaneous labor, preterm premature rupture of membranes and/or cervical incompetence resulting in delivery before the completion of 37 gestation weeks) is still unexplained. Preterm birth accounts for the most neonatal deaths and infant morbidities, and therefore it still remains one of the biggest challenges in obstetrics. OBJECTIVE Our study determined if there is an increasing tendency towards spontaneous preterm birth in mothers with gestational and preexisting DM. METHODS In this retrospective cohort study, 187 pregnant women with gestational DM and preexisting DM were compared to a randomized control group consisting of 192 normoglycemic women concerning gestational age and perinatal outcome. Data were collected by the Medical University of Vienna. Multiple pregnancies and women with severe maternal diseases, such as preeclampsia, were excluded. RESULTS Women with DM tended significantly more often to preterm births (P = 0.002). A significant difference in the incidence of spontaneous preterm birth was found (P = 0.047). CONCLUSION DM affects the length of gestation and incidence of spontaneous preterm birth.
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Affiliation(s)
- Katharina Köck
- Department of Obstetrics and Feto-Maternal Medicine, University of Vienna General Hospital, Austria.
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84
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Beucher G, Viaris de Lesegno B, Dreyfus M. Complications maternelles du diabète gestationnel. ACTA ACUST UNITED AC 2010; 39:S171-88. [DOI: 10.1016/s0368-2315(10)70045-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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85
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86
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Hadar E, Hod M. Establishing consensus criteria for the diagnosis of diabetes in pregnancy following the HAPO study. Ann N Y Acad Sci 2010; 1205:88-93. [PMID: 20840258 DOI: 10.1111/j.1749-6632.2010.05671.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The current diagnostic criteria for gestational diabetes mellitus are controversial because they lack correlation to maternal and perinatal outcome. The results of the hyperglycemia and adverse pregnancy outcome (HAPO) study demonstrate a linear association between increasing levels of fasting, 1- and 2-h plasma glucose post a 75 g oral glucose tolerance test to several significant outcome endpoints, such as birth weight above the 90th percentile, cord blood serum C-peptide level above the 90th percentile, primary cesarean delivery, clinical neonatal hypoglycemia, premature delivery, shoulder dystocia or birth injury, intensive neonatal care admission, hyperbilirubinemia, and preeclampsia. A consensus report by the IADPSG, based on a vigorous assessment of the HAPO results and other studies, recommended an endorsement of risk-based, internationally accepted criteria for the diagnosis and classification of diabetes in pregnancy. This review follows the steps from defining the problem to the endpoint of achieving a worldwide policy change.
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Affiliation(s)
- Eran Hadar
- Perinatal Division, Helen Schneider's Hospital for Women, Rabin Medical Center, Petah-Tiqva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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87
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Abstract
Gestational diabetes mellitus (GDM) is one of the most common complications of pregnancy. It is defined as diabetes that is first recognized during pregnancy. The diagnosis of GDM is important because it impacts maternal health care during and after pregnancy. The American Diabetes Association, American Congress of Obstetrics and Gynecology, the World Health Organization, and the National Diabetes Data Group all have recommendations for screening; however, there is no consensus. The Hyperglycemia and Adverse Pregnancy Outcome Research Cooperative Study Group published their findings that show hyperglycemia has a significant effect on pregnancy outcome. In addition, recent studies showed that treatment of mild hyperglycemia may affect adverse outcomes. However, at this time no new guidelines for screening and diagnosis of gestational diabetes have been published. This article summarizes the current state of screening for gestational diabetes.
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Affiliation(s)
- Wadia R Mulla
- Department of OB/GYN, Temple University School of Medicine, Philadelphia, PA 19140, USA.
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88
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Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA, Damm P, Dyer AR, Leiva AD, Hod M, Kitzmiler JL, Lowe LP, McIntyre HD, Oats JJN, Omori Y, Schmidt MI. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 2010. [PMID: 20190296 DOI: 10.2337/dc10-0719] [Citation(s) in RCA: 1113] [Impact Index Per Article: 79.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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89
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Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA, Damm P, Dyer AR, Leiva AD, Hod M, Kitzmiler JL, Lowe LP, McIntyre HD, Oats JJN, Omori Y, Schmidt MI. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 2010; 33:676-82. [PMID: 20190296 PMCID: PMC2827530 DOI: 10.2337/dc09-1848] [Citation(s) in RCA: 2916] [Impact Index Per Article: 208.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2009] [Accepted: 12/02/2009] [Indexed: 02/03/2023]
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90
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Abstract
Gestational diabetes mellitus (GDM) is defined as a carbohydrate intolerance, with onset or first recognition during pregnancy. The prevalence of GDM, and the occurrence of related complications, depends upon the definition of normal glucose values during gestation. The diagnostic criteria for GDM are controversial mainly because they lack correlation to outcome, be it maternal or perinatal. To date, there are no risk based guidelines to make the diagnosis of GDM and determine practice guidelines that are extrapolated from perinatal and maternal outcome and endpoints. To answer some of the above-mentioned controversies, the hyperglycemia and adverse pregnancy outcome study (HAPO) was planned and executed. This review outlines the results of the HAPO study, which demonstrates that fasting glucose levels and post 75 g OGTT are correlated to maternal, perinatal and neonatal outcomes. It is anticipated that the international recommendation for GDM diagnosis, will be shortly published.
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Affiliation(s)
- Eran Hadar
- Perinatal Division, Helen Schneider Hospital for Women, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Petah-Tiqva, Israel
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91
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Development of macrosomia resulting from gestational diabetes mellitus: physiology and social determinants of health. Adv Neonatal Care 2010; 10:7-12. [PMID: 20150774 DOI: 10.1097/anc.0b013e3181bc8559] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This integrative review sought to advance understanding of the literature pertaining to gestational diabetes mellitus (GDM) and subsequent lifestyle changes in Canadian and American populations. Gestational diabetes mellitus includes glucose intolerance identified during pregnancy and affects approximately 7% of all pregnancies worldwide or more than 200,000 cases annually. Depending upon the population studied and the diagnostic tests employed, the prevalence may range from 1% to 14% of all pregnancies. The article comprises 2 parts in which internal and external factors are discussed concerning pathophysiologic pathways and psychosocial influences. Social determinants of health affect the development of GDM. Gestational diabetes mellitus is increasing in all socioeconomic strata, particularly because of stress, sedentary lifestyle, and poor nutritional choices. Questions are raised about future research directions.
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92
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Spiegl G, Zupkó I, Minorics R, Csík G, Csonka D, Falkay G. Effects of experimentally induced diabetes mellitus on pharmacologically and electrically elicited myometrial contractility. Clin Exp Pharmacol Physiol 2009; 36:884-91. [PMID: 19298542 DOI: 10.1111/j.1440-1681.2009.05162.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
1. Diabetes is one of the most frequent complications of gestation, affecting approximately 7% of pregnancies. However, little is known about its effects on electrically and pharmacologically stimulated myometrial contractility. The aim of the present study was to investigate the consequences of streptozotocin (STZ)-induced diabetes on: (i) electrical field stimulation (EFS)-evoked contraction of isolated uterine rings as a function of gestational age; and (ii) the uterotonic and tocolytic actions of α- and β-adrenoceptor stimulation, respectively. The effects of oxytocin in late pregnancy were also investigated. 2. During pregnancy, EFS-evoked contractions of isolated uterine rings from intact rats declined, whereas isolated uterine rings from diabetic rats exhibited continuously low sensitivity to EFS. 3. In non-pregnant rats, diabetes resulted in increased noradrenaline-mediated contractility and a decreased relaxation response to terbutaline. At the mRNA level, diabetes enhanced the expression of α1B-adrenoceptors in non-pregnant rats from 14.65 to 18.39 μg/mL (P < 0.05), whereas the expression of α1D-adrenoceptors decreased (from 42.87 to 35.67 μg/mL; P < 0.05). During pregnancy, the responses to these sympathomimetics did not differ between diabetic and intact rats. 4. In late pregnancy (on Days 15 and 21), oxytocin caused greater maximum contractility of uterine rings from diabetic rats without affecting the EC(50). In addition, on Day 15 of pregnancy, the expression of oxytocin receptors in the myometrium of diabetic rats was higher than that in intact rats. 5. The results of the present study indicate that experimental diabetes facilitates gestation-induced denervation and increases myometrial sensitivity to oxytocin in late pregnancy. If similar mechanisms operate in humans, this could contribute to a tendency to premature uterine contractions in diabetes-complicated pregnancies.
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Affiliation(s)
- Gábor Spiegl
- Department of Pharmacodynamics and Biopharmacy, University of Szeged, Szeged, Hungary
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93
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Hadar E, Hod M. Gestational diabetes and pregnancy outcome: do we need an update on diagnostic criteria? Nutr Metab Cardiovasc Dis 2009; 19:75-76. [PMID: 19181501 DOI: 10.1016/j.numecd.2008.11.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2008] [Accepted: 11/24/2008] [Indexed: 11/17/2022]
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94
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Ma RCW, Chan JCN. Pregnancy and diabetes scenario around the world: China. Int J Gynaecol Obstet 2009; 104 Suppl 1:S42-5. [PMID: 19150059 DOI: 10.1016/j.ijgo.2008.11.032] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Asians adopting a modern lifestyle have a higher risk of diabetes than their white counterparts living in high-income countries. Asian ethnicity is an independent risk factor for gestational diabetes mellitus (GDM), which is associated with a 2-fold increased risk of diabetes. In this burgeoning epidemic of diabetes, 40 million people in China are affected, with the most rapid rate of increase in disease prevalence in the young to middle-aged group. This rising trend of young onset diabetes is largely driven by the rising prevalence of childhood obesity/metabolic syndrome. In Asia, both low and high birth weights are independent risk factors for diabetes and metabolic syndrome. Apart from the high prevalence of maternal history of diabetes in women with diabetes, the metabolic milieu of GDM may have long-term effects on the metabolic profile and future risk of diabetes in the offspring. This complex interplay between environmental, genetic, and perinatal factors puts both mothers with a history of GDM and their offspring at risk of diabetes and metabolic syndrome, thus setting up a vicious cycle of "diabetes begetting diabetes." Given the public health burden of diabetes in low-income nations such as China, there is an urgent need to design and implement large-scale awareness and intervention programs targeted at these mother-offspring pairs to interrupt this transgenerational effect of diabetes and the socioeconomic and humanistic impacts.
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Affiliation(s)
- Ronald C W Ma
- Department of Medicine and Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
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95
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Schoenfisch AL, Dement JM, Rodríguez-Acosta RL. Demographic, clinical and occupational characteristics associated with early onset of delivery: findings from the Duke Health and Safety Surveillance System, 2001-2004. Am J Ind Med 2008; 51:911-22. [PMID: 18942663 DOI: 10.1002/ajim.20637] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND This cross-sectional study explores associations between preterm delivery and demographic, clinical and occupational characteristics of women employed within a university and health system. METHODS A comprehensive surveillance system linking individual-level data from Human Resources, medical insurance claims and a job-exposure matrix was used to identify women with a single live birth between 2001 and 2004 and describe maternal characteristics during pregnancy. RESULTS Preterm delivery occurred in 7.1% (n = 74) of the 1,040 women, a lower preterm delivery prevalence than observed in the general U.S. population. Nearly all (>99.5%) women utilized prenatal care services. Prevalence of preterm delivery was highest for inpatient nurses, nurses' aides and office staff. In multivariate analyses, preterm delivery was positively associated with several clinical conditions: placenta previa, diabetes and cardiovascular disorder/disease. CONCLUSIONS We observed associations between preterm delivery and several previously indicated clinical conditions. Further study of the effect of job characteristics on preterm delivery is warranted.
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Affiliation(s)
- Ashley L Schoenfisch
- Division of Occupational and Environmental Medicine, Department of Community and Family Medicine, Duke University Medical Center, Durham, North Carolina 27705, USA.
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96
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Snapp CA, Donaldson SK. Gestational Diabetes Mellitus: Physical Exercise and Health Outcomes. Biol Res Nurs 2008; 10:145-55. [DOI: 10.1177/1099800408323728] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: Gestational diabetes mellitus (GDM) is a serious complication of pregnancy associated with increased risk of adverse outcomes for both mother and infant. This study assesses the association of maternal exercise during GDM pregnancy and selected maternal and infant adverse GDM-related outcomes. The analysis uses information derived from the 1988 National Maternal Infant Health Survey (NMIHS) data. Methods: Women in the 1988 NMIHS database were identified and grouped as to having experienced a non-GDM (n = 2,952,482) or GDM (n = 105,600) pregnancy. Non-GDM and GDM groups were compared as to demographic and personal-attribute variables. The second part of this study focused on the women with GDM pregnancy, specifically a subset (n = 75,160) who met inclusion/exclusion criteria for the study of exercise during pregnancy. Each was categorized to either the exercise group or the nonexercise group. Results: The non-GDM and GDM groups of pregnant women were not different as to the variables studied, except that older age and increased body mass index (BMI) were associated with GDM pregnancy. For the study of exercise during GDM pregnancy, the only variable that was associated with the exercise group was size of the infant. Participants in the exercise group were less likely than those in the nonexercise group to have delivered a large for gestational age (LGA) infant (F [1, 4314] = 9.82, p = .0017). Implications: The results of this study suggest that moderate maternal leisure time physical exercise during GDM pregnancy may reduce the risk of delivery of an LGA infant.
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Affiliation(s)
- Carol A. Snapp
- Department of Obstetrics, Gynecology and Reproductive
Sciences, University of Maryland, School of Medicine, Baltimore, Maryland,
| | - Sue K. Donaldson
- Nell Hodgson Woodruff School of Nursing, Emory University,
Atlanta, Georgia
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97
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Abnormal preconception oral glucose tolerance test predicts an unfavorable pregnancy outcome after an in vitro fertilization cycle. Fertil Steril 2008; 90:613-8. [DOI: 10.1016/j.fertnstert.2007.07.1289] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2007] [Revised: 07/05/2007] [Accepted: 07/05/2007] [Indexed: 11/22/2022]
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98
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Abstract
Now that we have been forewarned of the growing pandemic of type 2 diabetes and obesity in pregnancy, we need to become forearmed. Over the past few decades there has been no significant improvement in perinatal outcome complicated by diabetes mellitus (type 1 and type 2). The recognition of modifiable risk factors such as maternal glycemic control using self-monitoring blood glucose in combination with pharmacological therapy (intensified therapy) and weight gain in pregnancy should enhance pregnancy outcome. The overemphasis and concentration on the non-modifiable risk factors in pregnancy is a futile pursuit that may generate lively discussion but paucity of results. The focus needs to be in education for the care provider, i.e., enhanced recognition of this growing entity and a heightened awareness of the need for pre-pregnancy counseling about preconception glycemic control. Another center of attention should be the dissemination of information to patients of the impending maternal and fetal risks of type 2 diabetes in pregnancy. This care would include antenatal care for surveillance of maternal diabetes complications as well as careful obstetric surveillance to improve maternal and fetal outcomes.
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Affiliation(s)
- Oded Langer
- Department of Obstetrics and Gynecology, St. Luke's-Roosevelt Hospital Center, Columbia University, New York, NY 10019, USA.
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99
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Retnakaran R, Qi Y, Sermer M, Connelly PW, Zinman B, Hanley AJG. Isolated hyperglycemia at 1 hour on oral glucose tolerance test in pregnancy resembles gestational diabetes mellitus in predicting postpartum metabolic dysfunction. Diabetes Care 2008; 31:1275-81. [PMID: 18356402 PMCID: PMC2453676 DOI: 10.2337/dc08-0126] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Gestational impaired glucose tolerance (GIGT), defined by a single abnormal value on antepartum 3-h oral glucose tolerance test (OGTT), is a metabolically heterogeneous disorder. Indeed, the antepartum metabolic phenotype of women with a single abnormal value at 1 h during the OGTT (1-h GIGT) resembles that of women with gestational diabetes mellitus (GDM), whereas GIGT at 2 or 3 h (2/3-h GIGT) is similar to normal glucose tolerance (NGT). Thus, we hypothesized that 1-h GIGT would be associated with the same adverse outcomes as GDM, i.e., increased infant birth weight and postpartum metabolic dysfunction. RESEARCH DESIGN AND METHODS A total of 361 women underwent an antepartum glucose challenge test (GCT) and a 3-h OGTT, assessment of obstetrical outcome at delivery, and metabolic characterization by OGTT at 3 months postpartum. The antepartum GCT/OGTT identified five study groups: GDM (n = 97), 1-h GIGT (n = 28), 2/3-h GIGT (n = 34), abnormal GCT NGT (abnormal GCT with NGT on OGTT) (n = 128), and normal GCT NGT (normal GCT with NGT on OGTT) (n = 74). RESULTS Caesarian section rate was higher in women with 1-h GIGT, but birth weight did not differ significantly between the non-GDM groups (P = 0.1978). At 3 months postpartum, glycemia (area under the glucose curve) progressively increased across the groups from normal GCT NGT to abnormal GCT NGT to 2/3-h GIGT to 1-h GIGT to GDM (P < 0.0001), while both insulin sensitivity (IS(OGTT)) and beta-cell function (insulinogenic index/homeostasis model assessment of insulin resistance [HOMA-IR]) progressively decreased (P = 0.002 and P < 0.0001, respectively). The strongest independent negative predictors of insulinogenic index/HOMA-IR were GDM (t = -4.1, P < 0.0001) and 1-h GIGT (t = -3.8, P = 0.0002). CONCLUSIONS Like GDM, 1-h GIGT is associated with postpartum glycemia, insulin resistance, and beta-cell dysfunction.
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Affiliation(s)
- Ravi Retnakaran
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Canada.
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100
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Dasanayake AP, Chhun N, Tanner ACR, Craig RG, Lee MJ, Moore AF, Norman RG. Periodontal pathogens and gestational diabetes mellitus. J Dent Res 2008; 87:328-33. [PMID: 18362313 DOI: 10.1177/154405910808700421] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
In previous cross-sectional or case-control studies, clinical periodontal disease has been associated with gestational diabetes mellitus. To test the hypothesis that, in comparison with women who do not develop gestational diabetes mellitus, those who do develop it will have had a greater exposure to clinical and other periodontal parameters, we measured clinical, bacteriological (in plaque and cervico-vaginal samples), immunological, and inflammatory mediator parameters 7 weeks before the diagnosis of gestational diabetes mellitus in 265 predominantly Hispanic (83%) women in New York. Twenty-two cases of gestational diabetes mellitus emerged from the cohort (8.3%). When the cases were compared with healthy control individuals, higher pre-pregnancy body mass index (p=0.004), vaginal levels of Tannerella forsythia (p=0.01), serum C-reactive protein (p=0.01), and prior gestational diabetes mellitus (p=0.006) emerged as risk factors, even though the clinical periodontal disease failed to reach statistical significance (50% in those with gestational diabetes mellitus vs. 37.3% in the healthy group; p=0.38).
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Affiliation(s)
- A P Dasanayake
- Department of Epidemiology and Health Promotion, New York University College of Dentistry, 345 East 24th Street, New York, NY 10010, USA.
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