Gestational diabetes: comparision of the carpenter and the coustan thresholds with the new thresholds of Turkish women and implications of variations in diagnostic criteria

Lower vitamin D levels during the second trimester are associated with developing gestational diabetes mellitus: an observational cross-sectional study

In this study, we aimed to compare serum 25(OH)D levels in women with and without gestational diabetes mellitus (GDM), and to identify the serum 25(OH)D levels associated with GDM. We recruited 40 women with GDM and 40 healthy pregnant women, aged 20-40 years and in the second trimester, at Gulhane Education and Research Hospital. We excluded women with chronic diseases, preeclampsia, pre-GDM, multiple pregnancies, and those taking medications related to calcium or vitamin D metabolism. We took anthropometric measurements and blood samples during the second trimester. Of the 80 pregnant women, pre-pregnancy body mass index was significantly higher among the GDM group than the healthy group (26.4 ± 5.73 kg/m² vs. 22.6 ± 3.56 kg/m², p = .001). Serum 25(OH)D levels in women with GDM were significantly lower than those in healthy women (16.8 ± 9.90 ng/mL vs. 20.9 ± 8.16 ng/mL, p = .016). The prevalence of severe vitamin D deficiency was as high as 72.5% among women in the GDM group, with a 1.74-fold increased risk of deficient status. Levels of 25(OH)D lower than a cutoff value of 14.0 ng/mL were determined to be related to GDM. These study results suggest that maternal vitamin D deficiency in mid-pregnancy is significantly associated with development of GDM.

Relationship between fetal peak systolic velocity in Middle cerebral artery and umbilical blood gas values and hemoglobin levels in diabetic pregnant women

PURPOSE

To assess the relationship between peak systolic velocity in the middle cerebral artery (MCA-PSV) and fetal hypoxia in diabetic pregnant women requiring insulin therapy.

METHODS

The data of diabetic pregnant women using insulin who were followed in our departments were reviewed retrospectively. The relationships between MCA-PSV and umbilical cord pO2, pCO2, base deficit, hemoglobin, and birth weight were analyzed.

RESULTS

A total of 120 cases were included in the final analysis. The median (Q₁ - Q₃ ) gestational age at Doppler evaluation was 37 weeks 3 days (37-38 weeks and 2 days), and the mean ± SD gestational age at delivery was 38 weeks 4 days ± 3days. The mean ± SD hemoglobin A1c (HbA1c) level was 5.7% ± 1.0% and, median (Q₁ -Q₃ ) daily total insulin dose was 25 U (10U-48U). There was no statistically significant correlation between MCA-PSV and pH, PO2, PCO2, base deficit, Hb, and birth weight (Spearman correlation, r:-.001[P = .99], r:-.011[P = .90], r:-.052 [P = .51], r: .049[P = .59], r: .049 [P = .59], r: .030 [P = .75], respectively). Using binary logistic regression analysis, no independent factor for the prediction of fetal acidosis (venous pH < 7.23), and metabolic acidosis (base deficit >6.3 mmol/L) was detected.

CONCLUSION

MCA-PSV is not a good indicator of fetal polycythemia or chronic hypoxia in fetuses of diabetic pregnant women. Fetal well-being should be monitored with other tools in these circumstances.

How does pregnancy affect the patients with pituitary adenomas: a study on 113 pregnancies from Turkey

OBJECTIVE

Data regarding pregnancies in relation to pituitary tumors are limited. The effects of pregnancy on pituitary adenomas and the effects of adenoma itself (hormonal activity, mass effects and pituitary insufficiency) and/or treatment on the ongoing gestation and developing fetus were evaluated.

METHODS

The study was a retrospective study. A questionnaire involving questions regarding medical history before index gestation, history of related pregnancy, result of index gestation and postpartum follow-up of the patients was filled by the investigator in one of the eight Referral Endocrinology Centers from Turkey.

RESULTS

One hundred and thirteen (83 prolactinoma, 21 acromegaly, 8 NFPA and 1 plurihormonal pituitary adenoma) pregnancies of 87 (60 prolactinoma, 19 acromegaly, 7 NFPA and 1 plurihormonal pituitary adenoma) patients were reviewed. The clinically important pregnancy-related tumor growth of pituitary adenomas was found to be low in previously treated adenomas. Prolactinomas were more likely to increase in size during pregnancy especially if effective prior treatment was lacking. The risk of hypopituitarism is also minimal due to pituitary adenomas during pregnancy. The results of pregnancies did not differ in patients who were on medical treatment or not for prolactinomas and acromegaly during gestation. Neural tube defect and microcephaly associated with maternal cabergoline use; Down syndrome and corpus callosum agenesis associated with maternal bromocriptine use; unilateral congenital cataract, craniosynostosis and microcephaly associated with maternal acromegaly were detected for the first time.

CONCLUSION

Medical treatment can be safely done stopped in patients with prolactinoma and acromegaly when pregnancy is confirmed and reinstituted when necessary. Prospective studies may help to determine the effects of medical treatment during gestation on the mother and fetus.

Use of the National Diabetes Data Group and the Carpenter-Coustan criteria for assessing gestational diabetes mellitus and risk of adverse pregnancy outcome

Background

The influence of different diagnostic thresholds for gestational diabetes mellitus (GDM) on pregnancy outcomes is not fully understood. Degrees of glucose intolerance according to the Carpenter-Coustan (CC) criteria were less severe than the National Diabetes Data Group (NDDG) criteria for GDM. Recent studies have shown inconsistent results regarding the risk of adverse pregnancy outcomes between the NDDG and CC criteria. Therefore, the objective of this study was to investigate whether pregnant women who met only the CC criteria but not the NDDG criteria and those who met the NDDG criteria had increased risks of adverse pregnancy outcomes compared to a negative screening group.

Methods

A total of 11,486 Taiwanese pregnancies were enrolled in a retrospective cohort study. The study subjects were classified as follows: (1) negative screening group: women with negative 50-g glucose challenge test (GCT) results, (2) false-positive screening group: women with positive GCT results and negative 100-g OGTT results according to both CC and NDDG criteria, (3) CC-only-GDM group: women with positive GCT results plus GDM diagnosis meeting the CC but not the NDDG criteria, and (4) NDDG-GDM group: women diagnosed with GDM using the NDDG criteria. Multiple mixed effects logistic regression analysis was used to examine the relationships between the groups and pregnancy outcomes.

Results

There were 9002 (78.4 %), 1776 (15.5 %), 251 (2.2 %), and 457 (4.0 %) study pregnancies in the 4 groups. Compared with the negative screening group, the maternal outcomes were not different within groups except for gestational hypertension/preeclampsia. For neonatal outcomes, the CC-only-GDM group had significantly greater risks of macrosomia, low birth weight, and admission to a neonatal intensive care unit [adjusted odds ratio (aOR), (95 % confidence interval, CI): 2.73 (1.18–6.31), 1.64 (1.01–2.64), and 1.61 (1.05–2.46), respectively]. The NDDG-GDM group also showed significantly greater risks, and the false-positive screening group showed no differences from the negative screening group.

Conclusion

Women who met only the CC criteria and women who met NDDG criteria had significant increased risks of adverse neonatal outcomes. This evidence adds important information to the current debate about the diagnostic criteria for GDM regarding pregnancy outcomes.

Electronic supplementary material

The online version of this article (doi:10.1186/s12884-016-1030-9) contains supplementary material, which is available to authorized users.

Association of first trimester serum uric acid levels gestational diabetes mellitus development

OBJECTIVE

To investigate the association of first trimester serum uric acid levels with the development of gestational diabetes mellitus (GDM) in low-risk pregnant women.

MATERIALS AND METHODS

In this retrospective data analysis, the results of pregnant women who completed both first trimester biochemical panel and two-step GDM screening were compared with an age-, body mass index, and gestational age-matched control group. The women were grouped as either GDM or impaired glucose tolerance (IGT) according to 100-g oral glucose challenge results. Uric acid levels were compared between the groups and diagnostic utility was tested with receiver-operating characteristics curves.

RESULTS

Sixty-six women in GDM group and 358 women in the IGT group were compared against 202 healthy pregnant women. The groups did not differ significantly in terms of parity, pre-gestational body mass index and gestational age. Serum samples for uric acid levels were obtained. The mean serum uric acid levels were significantly higher in the GDM and IGT groups (5.95 mg/dL (±0.97 mg/dL) and 4.76 mg/dL (±1.51 mg/dL), respectively) compared with the control group (3.76 mg/dL (±1.07 mg/dL) (p<0.001). The area under the curve for uric acid levels was 0.92 (95% confidence interval 0.88-0.95) for diagnosis of GDM. At a diagnostic threshold of 3.95 mg/dL, uric acid levels predicted development of GDM with 60% specificity and 100% sensitivity.

CONCLUSION

First trimester serum uric acid has a linear association with the development of GDM and IGT.

Should we interpret the results of 'two-step' glucose screening again according to the obstetric outcomes?

We aimed to re-evaluate the 'two-step' antenatal glucose screening programme in relation to maternal and foetal outcomes in pregnant women screened for gestational diabetes mellitus and to compare maternal and foetal outcomes between different groups divided according to glucose tolerance test results. Two-thousand four-hundred and two pregnant women attending for antenatal care were recruited retrospectively for the study. Mean birthweight for pregnancies with single-value abnormality (SVA) in 100-g oral glucose tolerance test (OGTT) was significantly higher than the control group [3420 ± 378 vs. 3294 ± 444]. We found a significantly higher rate of macrosomia in the subgroup of 50-g glucose challenge test (GCT) between 130 and 140 mg/dl [9.7% vs. 4.8%]. Pregnant women whose 50-g GCT results are between 130 and 140 mg/dl or who have SVA in 100-g OGTT not only have gestational diabetes, but are also at increased risk for diabetic complications.

The burden of diabetes mellitus during pregnancy in low- and middle-income countries: a systematic review

BACKGROUND

Little is known about the burden of diabetes mellitus (DM) in pregnancy in low- and middle-income countries despite high prevalence and mortality rates being observed in these countries.

OBJECTIVE

To investigate the prevalence and geographical patterns of DM in pregnancy up to 1 year post-delivery in low- and middle-income countries.

SEARCH STRATEGY

Medline, Embase, Cochrane (Central), Cinahl and CAB databases were searched with no date restrictions.

SELECTION CRITERIA

Articles assessing the prevalence of gestational diabetes mellitus (GDM), and types 1 and 2 DM were sought.

DATA COLLECTION AND ANALYSIS

Articles were independently screened by at least two reviewers. Forest plots were used to present prevalence rates and linear trends calculated by linear regression where appropriate.

MAIN RESULTS

A total of 45 articles were included. The prevalence of GDM varied. Diagnosis was made by the American Diabetes Association criteria (1.50-15.5%), the Australian Diabetes in Pregnancy Society criteria (20.8%), the Diabetes in Pregnancy Study Group India criteria (13.4%), the European Association for the Study of Diabetes criteria (1.6%), the International Association of Diabetes and Pregnancy Study Groups criteria (8.9-20.4%), the National Diabetes Data Group criteria (0.56-6.30%) and the World Health Organization criteria (0.4-24.3%). Vietnam, India and Cuba had the highest prevalence rates. Types 1 and 2 DM were less often reported. Reports of maternal mortality due to DM were not found. No geographical patterns of the prevalence of GDM could be confirmed but data from Africa is particularly limited.

CONCLUSION

Existing published data are insufficient to build a clear picture of the burden and distribution of DM in pregnancy in low- and middle-income countries. Consensus on a common diagnostic criterion for GDM is needed. Type 1 and 2 DM in pregnancy and postpartum DM are other neglected areas.