妊娠期高血糖患者产后糖代谢和脂代谢转归及其影响因素

目的 了解妊娠期不同程度高血糖患者产后6～12周糖代谢及脂代谢转归;分析影响妊娠期高血糖患者产后转归的相关因素;初步探讨国际妊娠合并糖尿病研究组近期提出的新的妊娠期糖尿病诊断标准对产后近期随访结果的影响.方法 通过对我院2007年1月1日至2009年12月31日分娩且于产后6～12周进行口服葡萄糖耐量试验(oral glucose tolerance test,OGTT)的262例妊娠期高血糖患者的临床资料进行分析,根据产后糖代谢及脂代谢状态进行分组,采用多因素Logistic回归模型对糖代谢及脂代谢影响因素进行分析,了解妊娠期高血糖患者产后6～12周糖代谢及脂代谢转归及相关因素.结果 (1)产后6～12周糖代谢异常检出率为35.1%(92/262),其中空腹血糖受损1例(0.4%),糖耐量受损81例(30.9%),空腹血糖受损+糖耐量受损4例(1.5%),糖尿病6例(2.3%).(2)Logistic回归模型分析显示,妊娠期高血糖诊断孕周,早孕期OGTT 2 h及3 h血糖值高均为产后6～12周发生糖代谢异常的危险因素,产后母乳喂养为保护因素,OR值及95%CI分别为0.824(0.724～0.941)、1.521(1.196～1.934)、1.272(1.047～1.547)、0.408(0.181～0.918).(3)250例妊娠期高血糖患者在产后6～12周进行血脂检测,产后脂代谢异常的发生率为63.2%(158/250),在血脂异常的患者中,最常见的是高胆固醇血症126例(50.4%),其次分别为高低密度脂蛋白胆固醇血症,共102例(40.8%),高甘油三酯血症60例(24.0%),低高密度脂蛋白胆固醇血症11例(4.4%).(4)Logistic回归模型分析显示,孕期OGTT 2 h血糖水平高为产后发生脂代谢异常的危险因素,OR=1.364(95%CI:1.063～1.751);孕期高密度脂蛋白胆固醇水平高为保护因素,OR=0.379(95%CI:0.169～0.851).结论 妊娠期高血糖患者产后6～12周存在糖、脂代谢异常.妊娠期高血糖发现孕周早以及孕期OGTT 2 h及3 h血糖值高均为产后发生糖代谢异常的危险因素,产后母乳喂养为保护因素.孕期OGTT 2 h血糖值高为产后发生脂代谢异常的危险因素,孕期高密度脂蛋白胆固醇水平高为保护因素.

Abstract：

Objective (1) To investigate the glucose and lipid metabolism 6-12 weeks after delivery in women with hyperglycemia during pregnancy. (2) To find out factors associated with the prognosis of women with hyperglycemia during pregnancy. (3) To investigate the feasibility of the diagnostic criteria set by the International Association of Diabetes and Pregnancy Study Group according to the follow-up data of women with hyperglycemia in pregnancy. Methods Clinical data of 262 women with hyperglycemia during pregnancy delivered in our hospital from January 1, 2007 to December 31, 2009 were collected. All patients underwent oral glucose tolerance test (OGTT) at 6-12weeks after delivery. They were divided into two groups according to the postnatal status of glucose and lipid metabolism. Multivariate Logistic regression model was used to analyze the factors affected glucose and lipid metabolism after 6-12 weeks of delivery. Results (1) Among the 262 women, 92(35.1%) were reported with abnormal glucose metabolism at 6-12 weeks of delivery, including one (0. 4 % ) woman with impaired fasting glucose, 81 (30. 9 % ) with impaired glucose tolerance, 4( 1.5 % )with impaired fasting glucose+impaired glucose tolerance and 6 (2. 3%) with diabetes mellitus.glucose levels in OGTT (OGTT 2hPG and the OGTT 3hPG) were risk factors for postpartum 0. 181-0. 918)]. (3) All markers of lipid metabolism were detected in 250 women with hyperglycemia during pregnancy at 6-12 weeks after delivery, the rate of abnormal postnatal lipid metabolism was 63.2%(158/250). In the abnormal group (n= 174), the most common abnormal marker was hypercholesterolemia (n = 126, 50. 4 % ), followed by high levels of low-density lipoprotein-cholesterol (n = 102, 40. 8 %), hypertriglyceridemia (n= 60, 24. 0 %) and low levels of high-density lipoproteincholesterol (n= 11, 4. 4 %). (4) Logistic regression model showed that elevated OGTT 2hPG was the risk factor for postpartum abnormal glucose metabolism [OR= 1. 364 (95%CI: 1. 063-1. 751)], while 0. 169-0. 851)]. Conclusions Women with hyperglycemia during pregnancy are more likely to present with abnormal glucose and lipid metabolism which commonly coexisted with insulin resistance.The risk factors for the postpartum abnormal glucose metabolism in mothers with hyperglycemia during pregnancy include early diagnosis, OGTT 2hPG and OGTT 3hPG, while the protective factor is breastfeeding. The risk factor for the postpartum dyslipidaemia in mothers with hyperglycemia during pregnancy is OGTT 2hPG, while the protective factor is high-density lipoprotein-cholesterol level in pregnancy.     

妊娠期糖尿病不同诊断标准的临床适宜性比较

2010年国际糖尿病与妊娠研究组(International Association of Diabetes and Pregnancy Study Groups,IADPSG)基于高血糖与不良妊娠结局关系的研究(Hyperglycemia and Adverse Pregnancy Outcome Study,HAPO)结果[1]制定了妊娠期糖尿病(gestational diabetes mellitus,GDM)新的诊断标准(IADPSG标准),即75g口服葡萄糖耐量试验(oral glucose tolerance test,OGTT)0、1和2 h的界值分别为5.1、10.0和8.5 mmol/L,其中任何一项达到或超过界值即可诊断为GDM[2].目前,IADPSG标准在世界范围内被广泛提倡,2011年美国糖尿病协会(American Diabetes Association,ADA)糖尿病诊疗指南也采纳了这一标准[3],但是也有研究对这一标准持不同意见[4].     

妊娠早期空腹血浆血糖与妊娠期糖尿病诊断的相关性

目的 探讨妊娠早期空腹血浆血糖(fasting plasma glucose,FPG)水平与妊娠期糖尿病(gestational diabetes mellitus,GDM)诊断之间的相关性.方法 选择2008年1月1日至2009年12月31日在北京大学第一医院完成产前检查并住院分娩且资料完整的单胎孕妇5299例的临床资料进行回顾性分析.结果 (1)按照妊娠早期FPG的水平将孕妇分为A、B、C 3组.A组:FPG＜5.1 mmol/L,共4565例;B组:FPG≥5.1 mmol/L且＜5.8 mmol/L,共701例;C组:FPG≥5.8 mmol/L且＜7.0 mmol/L,共33例.A、B、C组在妊娠中、晚期被诊断为GDM的比例分别为10.69%(488/4565)、26.11%(183/701)、54.55%(18/33).(2)针对A和B组内不同人群进行母儿预后的比较,包括大于胎龄儿(large for gestational age,LGA)、新生儿高胆红素血症、新生儿低血糖、新生儿红细胞增多症、新生儿感染、早产、子痫前期及子痫、剖宫产等的发生率.2组内非GDM(妊娠中、晚期未被诊断)人群的母儿预后比较,B组除剖宫产与新生儿低血糖的发生率高于A组[54.63%(282/518)与49.03%(1999/4077)、1.54%(8/518)与0.61%(25/4077),P＜0.05],其余各项指标差异均无统计学意义(P均＞0.05);2组内未经孕期血糖管理的GDM人群母儿预后的比较,差异均无统计学意义(P均＞0.05);2组内经过孕期血糖管理的GDM人群母儿预后的比较,差异均无统计学意义(P均＞0.05);将A组和B组非GDM人群合并,与2组内未经过孕期管理的GDM患者(分别为A2组和B2组)比较,LGA发生率A2组高于合并组(12.00%与4.94%,x2=21.4159,P＜0.05),B2组高于合并组(18.39%与4.94%,X2=28.7189,P＜0.05);剖宫产率A2组高于合并组(57.78%与49.64%,x2=5.6806,P＜0.05),B2组高于合并组(66.67%与49.64%,x2=9.9003,P＜0.05);其余各指标比较,差异均无统计学意义.结论 将国际妊娠合并糖尿病研究组推荐的妊娠早期FPG≥5.1 mmol/L作为GDM的诊断标准,尚不适合推广,妊娠中、晚期葡萄糖耐量试验仍是最主要的诊断手段.

Abstract：

Objective To explore the relevance between fasting plasma glucose (FPG) level in early pregnancy and gestational diabetes mellitus (GDM). Methods Clinical data of 5299 singletonpregnant women accepted antenatal examination and delivered in the Department of Obstetrics and Gynecology, Peking University First Hospital from January 1, 2008 to December 31, 2009 were retrospectively analyzed. Results (1) The pregnant women were divided into 3 groups according to their FPG levels at early stage of gestation: Group A, FPG ＜5. 1 mmol/L (n= 4565); Group B,FPG≥5.1, but ＜5.8 mmol/L (n=701); Group C, FPG≥5.8 mmol/L, but ＜7.0 mmol/L(n=33). The incidence of GDM in Group A, B and C was 10. 69% (488/4565), 26. 11% (183/701)and 54. 55% (18/33). (2) The incidences of large for gestational age (LGA), cesarean section,premature birth, preeclampsia, neonatal hyperbilirubinemia, neonatal hypoglycemia, neonatal polycythemia, and neonatal infection were compared between Group A and B. The cesarean section rate [54. 63% (282/518)]and neonatal hypoglycemia rate [1.54% (8/518)]of those who were not diagnosed as GDM in middle and late term in Group B were higher than those of Group A [49.03%(1999/4077) and 0. 61% (25/4077)] (P＜0. 05); while there were no differences between the other six index of Group A and Group B (P＞0. 05). The prognosis of the GDM patients who did not accept gestational glucose management in two groups were similar (P＞0. 05), so did the prognosis of the GDM patients who accepted gestational glucose management in two groups. After combining the patients of the two groups who were not diagnosed as GDM as a new group, they were compared with those who did not accept gestational glucose management of the two groups (Group A2 and B2)respectively. The incidence of LGA rate of the new group was lower than that of Group A2 (12. 00%va 4. 94 %, x2=21. 4159, P＜0. 05) and Group B2 (18. 39 % vs 4. 94%, x2 = 28. 7189, P＜0. 05).Cesarean section rate of the new group was lower than that of Group A2 (57. 78% vs 49.64%,x2 =5. 6806,P＜0.05) and Group B2 (66. 67% vs 49.64%, x2 =9. 9003, P＜0. 05). And there were no differences between the other six index between the new group and the other two groups (P＞0. 05). Conclusions The diagnosis criteria of GDM set as FPG≥5.1 mmol/L at early stage of gestation, recommended by International Association of Diabetes and Pregnancy Study Group, is not applicable in China yet. Oral glucose tolerance test in middle and late term is still the most important diagnostic tool for GDM.     

重视宫内高血糖暴露子代的远期转归

近年来,妊娠合并糖尿病的临床诊治和基础研究均取得了极大进展[1-12].2010年国际糖尿病与妊娠研究组(International Association of Diabetes and Pregnancy Study Groups,IADPSG)制定的国际妊娠合并糖尿病诊断标准出台[2],随后我国也颁布了妊娠期糖尿病(gestational diabetes mellitus,GDM)的诊断标准[3],对我国GDM诊断标准的统一起到巨大推动作用.这些重大进展也引起广大临床工作者对妊娠合并糖尿病的关注.     

围产期心肌病不同诊断标准的比较与分析

目的 探讨目前国内围产期心肌病诊断标准中产科标准及内科标准与国外Hibbard标准的符合情况及差异点.方法 1995年3月至2009年9月北京大学人民医院及中国医学科学院阜外心血管病医院住院的围产期心肌病患者49例.其中由北京大学人民医院产科按产科标准诊断的8例,内科按内科标准诊断的22例和由中国医学科学院阜外心血管病医院内科按内科标准诊断19例,按内科标准共诊断41例.(1)产科诊断标准:既往无心血管系统疾病史,于妊娠28周后至产后6个月内发生的扩张型心肌病即为围产期心肌病.(2)内科诊断标准:围产期心肌病是指发生于妊娠最后1个月或产后5个月内的不明原冈的心脏扩大和心功能衰竭,超声心动图诊断标准为:左心室舒张末期内径(LVEDd)>5.0 cm;左心室射血分数(LVEF)<45%和(或)左心室缩短分数(LVFS)<30%;或LVEDd>2.7 cnL/体表面积(m2);或LVEDd>年龄和体表面积预测值的117%.(3)Hibbard诊断标准:妊娠最后1个月至产后5个月内发生的心功能衰竭;既往无心脏病病史;无其他导致心功能衰竭的原凶;超声心动图标准为:LVEF<45%和(或)LVFS<30%;LVEDd>2.7 cm/m2;此4项标准必须全部符合才能诊断围产期心肌病.分析产科标准和内科标准诊断围产期心肌病与Hibbard标准的符合情况及不符合的原因.结果 (1)产科标准诊断围产期心肌病与Hibbard标准的符合情况:产科标准诊断的8例围产期心肌病患者中,不符合Hibbard标准有6例(6/8).其中,发病时间不符合2例,分别合并子痫前期和急性肾盂肾炎重度感染,可以成为导致心功能衰竭的原因;LVEF.均不符合超声心动图标准.另4例患者中,2例同时合并重度子痫前期和重度贫血,1例单纯合并子痫前期,1例单纯合并中度贫血,可以成为导致心功能衰竭的原因;同时该4例中LVEDd和LVEF均不符合标准者2例,LVEDd或LVEF不符合标准者各1例.(2)内科标准诊断围产期心肌病与Hibbard标准的符合情况:内科标准诊断的41例围产期心肌病患者中,不符合Hibbard标准者有7例(17%,7/41),与产科标准诊断的不符合率比较,差异有统计学意义(P<0.01).其中,发病时间不符合3例,均合并子痫前期,成为导致心功能衰竭的原因.另4例中LVEDd和INEF均不符合标准者1例,LVEF不符合标准者3例.(3)国内标准诊断围产期心肌病与Hibbard标准不符合的原因:国内标准诊断的49例围产期心肌病患者中共有13例不符合Hibbard标准,其中,发病时间不符合5例(10%,5/49),均为孕期发病患者;存在其他导致心功能衰竭的原因9例(18%,9/49),包括子痫前期5例、子痫前期合并贫血2例、贫血 1例、急性肾盂肾炎重度感染1例,均为孕期发病患者,合并子痫前期共7例(7/9);超声心动图检杏结果 不符合10例(20%,10/49).结论 与Hibbard标准相比,国内围产期心肌病诊断标准缺乏严格统一性;比较而言,内科标准有较好的符合性;而产科标准则有较大差异,成为导致产科诊断嗣产期心肌病符合率不高的主要原因;国内诊断围产期心肌病与Hibbard标准不符合的主要原因在于超声心动图检查结果 不达标.

Abstract：

Objective To compare the differences and similarities between the diagnostic criteria of obstetrics and internal medicine in China with that of Hibbard for peripartum cardiomyopathy (PPCM).Methods From March 1995 to September 2009, a total of 49 patients were diagnosed as PPCM at the Peking University People's Hospital and the Fu Wai Hospital in Beijing, China. Obstetric diagnostic criteria was:PPCM was one of dilated cardiomyopathy,occurred during the third trimester of pregnancy through the 6th month postpartum,and without cardiovascular diseases before. Internal medicine diagnostic criteria was:PPCM was unexplained cardiomegaly and heart failure, occurred during the last month of pregnancy through the 5th month postpartum, and meet the echocardiographic criteria of dialated cardiomyopathy as follows:left ventricular end-diastolic dimension (LVEDd) greater than 5.0 cm; left ventricular ejection fraction (LVEF)less than 45% , and(or) left ventricular fractional shortening (LVFS) less than 30% ; or LVEDd greater than 2. 7 cm/body surface area (m2) ; or LVEDd > 117% of age and body surface area predictive value. Hibbard diagnostic criteria was: All four of the following: (1) heart failure within last month of pregnancy and 5 months postpartum; (2) absence of prior heart disease; (3) no determinable cause; (4) strict echocardiographic indication of left ventricular dysfunction; LVEF less than 45% , and/or LVFS less than 30% , and LVEDd greater than 2. 7 cm/m2. The compliance between obstetric and internal criteria with Hibbard criteria, and the reasons of incompliance between Chinese and international criteria were analyzed. Results Eight patients were diagnosed of PPCM by obstetricians according to Chinese obstetric criteria. Among them, 6 patients (6/8) did not meet Hibbard criteria. 2 of the six did not reach the time regulated in the criteria. All of the six had other determinable causes for heart failure, and their echocardiographic results did not meet the diagnostic standard either. The other 41 patients were diagnosed of PPCM by physicians according to Chinese internal medicine criteria. Among them, 7 patients (17%) did not meet Hibbard criteria, 3 of the seven did not reach the time regulated in the criteria, and had other determinable causes for heart failure either. 4 of the seven did not meet the echocardiographic standard part in the criteria. The Chinese internal medicine diagnostic criteria has a significant higher coincidence rate with Hibbard criteria, compared to Chinese obstetric criteria (83% vs. 25% ; P <0. 01). Among all 13 patients whose PPCM diagnosis did not meet Hibbard criteria, 5 cases did not reach the time regulated in the criteria, 9 cases had other determinable causes for heart failure, and 10 cases did not meet the echocardiographic standard part in the criteria. Preeclampsia was the most common determinable causes for heart failure, accounted for 7 cases. Conclusion There is obvious difference between Chinese and Hibbard diagnostic criteria for PPCM, especially Chinese obstetric criteria.     

糖化血红蛋白在妊娠合并糖尿病诊治中的应用价值

糖尿病(diabetes mellitus,DM)是以高血糖为特点的一组代谢紊乱综合征.妊娠期糖尿病(gestational diabetes mellitus,GDM)自20世纪50年代开始被人们关注,并认为与孕妇及胎儿的不良结局有关[1],1979年世界卫生组织(World Health Organization,WHO)将其归为DM的分类之一.2010年国际糖尿病和妊娠研究组(International Association of Diabetes and Pregnancy Study Groups,IADPSG)依据不同血糖水平与胎儿及新生儿结局的研究结果,推出了GDM的诊断新标准,并将首次产前检查时满足非妊娠期DM诊断标准的血糖异常归为显性DM范畴[2].     

妊娠合并甲状腺功能减退症或亚临床甲状腺功能减退症77例临床分析

Objective To investigate the maternal and fetal outcomes of pregnant women with hypothyroidism or subclinical hypothyroidism. Methods From Jan. 2005 to Mar. 2008, clinical records of 77 women with hypothyroidism (n=57) or subclinical hypothyroidism (n = 20) during pregnancy who delivered at Peking Union Medical College Hospital were reviewed. The basic information, maternal complications and neonatal outcomes of the patients were compared with 79 healthy women who delivered during the same period. Results The prevalence of maternal hypothyroidism during the study period was 0.74% ,and that of maternal subclinical hypothyroidism was 0.26%. The mean neonatal birth weight of women with hypothyroidism was lower than that of the control [(3191.8±659.47 g) vs (3301.9±423. 1 g), P<0.05], the incidence of abnormal glucose metabolism was higher (24.6% vs 11.4% ,P<0.05), and small for gestational age infants were more common than in the control group (12. 3% vs 2. 5%, P<0. 05). The maternal and fetal outcomes of women with subclinical hypothyroidism during pregnancy showed no difference compared with the control. Conclusions Early screening for the high risk women and appropriate management are important to improve the neonatal and fetal outcomes of women with hypothyroidism and subclinical hypothyroidism during pregnancy.     

妊娠合并甲状腺功能减退症或亚临床甲状腺功能减退症77例临床分析

Objective To investigate the maternal and fetal outcomes of pregnant women with hypothyroidism or subclinical hypothyroidism. Methods From Jan. 2005 to Mar. 2008, clinical records of 77 women with hypothyroidism (n=57) or subclinical hypothyroidism (n = 20) during pregnancy who delivered at Peking Union Medical College Hospital were reviewed. The basic information, maternal complications and neonatal outcomes of the patients were compared with 79 healthy women who delivered during the same period. Results The prevalence of maternal hypothyroidism during the study period was 0.74% ,and that of maternal subclinical hypothyroidism was 0.26%. The mean neonatal birth weight of women with hypothyroidism was lower than that of the control [(3191.8±659.47 g) vs (3301.9±423. 1 g), P<0.05], the incidence of abnormal glucose metabolism was higher (24.6% vs 11.4% ,P<0.05), and small for gestational age infants were more common than in the control group (12. 3% vs 2. 5%, P<0. 05). The maternal and fetal outcomes of women with subclinical hypothyroidism during pregnancy showed no difference compared with the control. Conclusions Early screening for the high risk women and appropriate management are important to improve the neonatal and fetal outcomes of women with hypothyroidism and subclinical hypothyroidism during pregnancy.     

妊娠合并甲状腺功能减退症或亚临床甲状腺功能减退症77例临床分析

Objective To investigate the maternal and fetal outcomes of pregnant women with hypothyroidism or subclinical hypothyroidism. Methods From Jan. 2005 to Mar. 2008, clinical records of 77 women with hypothyroidism (n=57) or subclinical hypothyroidism (n = 20) during pregnancy who delivered at Peking Union Medical College Hospital were reviewed. The basic information, maternal complications and neonatal outcomes of the patients were compared with 79 healthy women who delivered during the same period. Results The prevalence of maternal hypothyroidism during the study period was 0.74% ,and that of maternal subclinical hypothyroidism was 0.26%. The mean neonatal birth weight of women with hypothyroidism was lower than that of the control [(3191.8±659.47 g) vs (3301.9±423. 1 g), P<0.05], the incidence of abnormal glucose metabolism was higher (24.6% vs 11.4% ,P<0.05), and small for gestational age infants were more common than in the control group (12. 3% vs 2. 5%, P<0. 05). The maternal and fetal outcomes of women with subclinical hypothyroidism during pregnancy showed no difference compared with the control. Conclusions Early screening for the high risk women and appropriate management are important to improve the neonatal and fetal outcomes of women with hypothyroidism and subclinical hypothyroidism during pregnancy.     

妊娠合并甲状腺功能减退症或亚临床甲状腺功能减退症77例临床分析

Objective To investigate the maternal and fetal outcomes of pregnant women with hypothyroidism or subclinical hypothyroidism. Methods From Jan. 2005 to Mar. 2008, clinical records of 77 women with hypothyroidism (n=57) or subclinical hypothyroidism (n = 20) during pregnancy who delivered at Peking Union Medical College Hospital were reviewed. The basic information, maternal complications and neonatal outcomes of the patients were compared with 79 healthy women who delivered during the same period. Results The prevalence of maternal hypothyroidism during the study period was 0.74% ,and that of maternal subclinical hypothyroidism was 0.26%. The mean neonatal birth weight of women with hypothyroidism was lower than that of the control [(3191.8±659.47 g) vs (3301.9±423. 1 g), P<0.05], the incidence of abnormal glucose metabolism was higher (24.6% vs 11.4% ,P<0.05), and small for gestational age infants were more common than in the control group (12. 3% vs 2. 5%, P<0. 05). The maternal and fetal outcomes of women with subclinical hypothyroidism during pregnancy showed no difference compared with the control. Conclusions Early screening for the high risk women and appropriate management are important to improve the neonatal and fetal outcomes of women with hypothyroidism and subclinical hypothyroidism during pregnancy.     

Maternal hyperglycemia according to IADPSG criteria as a predictor of perinatal complications in women with gestational diabetes: a retrospective observational study

Abstract

Objective: We investigated the association between abnormal maternal glucose levels according to International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria and perinatal complications.

Materials and methods: Retrospective observational study of data of 492 women in singleton pregnancy and gestational diabetes (GDM) diagnosed according to WHO criteria. Perinatal outcome and maternal characteristics were compared between normo- and hyperglycemic patients using IADPSG criteria and odds ratios calculated for particular outcomes.

Results: Maternal fasting hyperglycemia (≥5.1?mmol/L) was associated with significantly higher proportion of birth weight ≥ 4000?g (19.3% versus 9.7%, p?=?0.004, OR: 2.2; 95% CI: 1.3–3.8), gestational insulin therapy (27.7% versus 9.1%, p?<?0.001, OR: 3.8; 95% CI: 2.3–6.5), poor long-term metabolic control (HbA_1c at diagnosis?≥?6.5% [48?mmol/mol]: 19.9% versus 4.6%, p?<?0.001, OR: 5.2; 95% CI: 2.5–10.9). Pre-pregnancy obesity (BMI?≥?30?kg/m², 26.0% versus 11.9%, p?<?0.001, OR: 2.6; 95% CI: 1.6–4.3) and positive family history of diabetes (45.2% versus 30.8%, p?<?0.002, OR: 1.8; 95% CI: 1.3–2.7) was more frequent in women with fasting hyperglycemia. Two-hour post-load hyperglycemia was only associated with increased prevalence of gestational hypertension (5.1% versus 11.4%, p?=?0.046).

Conclusions: Women with fasting but not 2-h hyperglycemia according to IADPSG criteria are at significantly elevated risk of perinatal complications.     

An evaluation of two different screening criteria in gestational diabetes mellitus

Background: The objective of this study was to identify the gestational diabetes mellitus (GDM) prevalence difference according to American Diabetes Association (ADA) criteria and International Association of Diabetes and Pregnancy Study Group (IADPSG) criteria for 75?g oral glucose tolerance test (OGTT).

Methods: This study was conducted at Erciyes University Department of Obstetrics and Gynecology. A total of 320 pregnant who met the criteria were included in the study and 75?g OGTT was applied. Irrespective of the first results, the test was applied to most participants 2?weeks later.

Results: The GDM prevalence was found to be 9.1% according to the ADA criteria and 19.4% according to the IADPSG criteria. According to the ADA criteria, GDM prevalence was found to be statistically significantly high (p?p?>?.05). The patients diagnosed with GDM were observed not to reach the threshold levels for HbA1c.

Conclusion: According to the IADPSG criteria, GDM prevalence doubles and leads to an increase in healthcare costs and workloads. HbA1c has no role in the diagnosis of GDM.     

Prevalence of gestational diabetes mellitus and gestational impaired glucose tolerance in pregnant women evaluated by National Diabetes Data Group and Carpenter and Coustan criteria

Objective

To determine the prevalence of gestational diabetes mellitus (GDM) and gestational impaired glucose tolerance (GIGT) using National Diabetes Data Group (NDDG), and Carpenter and Coustan (CC) criteria.

Method

Retrospective study of the prevalence of GDM and GIGT in 21 531 pregnant women screened for GDM between 2005 and 2007 using NDDG and CC criteria. Linear trends in prevalence of GDM and GIGT by age were calculated using logistic regression.

Results

Mean prevalence rates for GDM were 3.17% (95% CI, 3.05-3.29; n = 683) and 4.48% (95% CI, 4.36-4.6; n = 964) according to NDDG and CC criteria, respectively. Mean prevalence rates for GIGT were 1.97% (95% CI, 1.85-2.09; n = 426) and 2.46% (95% CI, 2.34-2.58; n = 529) according to NDDG and CC criteria, respectively. Prevalence of GDM and GIGT increased with increasing age with both criteria (P < 0.001). The prevalence of GDM increased by 41.1% and GIGT increased by 24.2% using the CC criteria compared with the NDDG criteria.

Conclusion

The prevalence of GDM and GIGT was higher when CC criteria were used compared with NDDG criteria, particularly in younger age groups. The prevalence of both GIGT and GDM increased with increasing age with both criteria.     

Early glycemic control reduces large-for-gestational-age infants in 250 Japanese gestational diabetes pregnancies

Our objective was to test if tight glycemic control versus loose glycemic control in gestational diabetic patients and a gestational age of < 32 weeks influence fetal growth, fetal distress, and neonatal complication. We performed a retrospective study with 250 gestational diabetes mellitus in Japanese women. Two groups were categorized according to the timing at which good maternal glycemic control was attained at < 32 weeks and kept so until delivery (group 1) and > 32 weeks or never until delivery (group 2). In these two groups, neonatal growth (large-for-gestational age: LGA; appropriate- : AGA; and small- : SGA), neonatal complications (hypoglycemia, jaundice, polycythemia, and cumulative incidence), and incidence of fetal distress were compared. The chi2 test, unpaired t test, one-way analysis of variance (ANOVA) and multiple logistic regression analyses were used for statistical analyses. Maternal age, height, prepregnancy body mass index (BMI), gestational age at delivery were not different between the groups. In group 2 (> 32 weeks), LGA, macrosomia (> 4 kg), neonatal hypoglycemia was significantly increased compared with those in group 1. Incidence of SGA, fetal distress, and neonatal jaundice were not different between the groups. Multiple logistic regression analysis for LGA showed significant relation to timing of maternal glycemic control. We concluded that good glycemic control should be attained at < 32 weeks and maintained until delivery to reduce LGA infants and neonatal hypoglycemia in gestational diabetes mellitus. This management did not appear to decrease SGA infants or fetal distress.     

Effects of intervention to mild GDM on outcomes

Objective: To evaluate pregnancy outcomes in women with gestational diabetes mellitus (GDM) diagnosed by the IADPSG criteria at 24–28 weeks of gestation but with fasting plasma glucose (FPG) less than 4.4?mmol/L.

Research design and methods: A retrospective study was conducted. Medical records of 25?674 pregnant women attending the Peking University First Hospital (PUFH) were analyzed. Women with FPG value <4.4?mmol/L were segregated into those with and without GDM based on the IADPSG criteria. Pregnancy outcomes in the form of birth weight, neonatal hypoglycemia and cesarean delivery were compared between the two groups.

Results: The incidence of macrosomia between GDM 7.1% (treated 6.9%; untreated 7.2%) was not different from the non GDM group 6.3%, similarly neonatal hypoglycemia 1.9% (treated 2.0%; untreated 1.7%) was were not significantly different from the non GDM group 1.1%. Rate of cesarean delivery in the untreated GDM group 59.7% was significantly higher compared to both with treated GDM (48.4%) and the non GDM group (47.6%).

Conclusions: There is no difference in the incidence of select adverse pregnancy outcomes amongst Chinese women with mild GDM (FPG<4.4?mmol/L) with or without intervention compared to women without GDM.     

妊娠期糖尿病诊断标准的探讨

目的　探讨妊娠期糖尿病 ( GDM)的诊断标准。　方法　对 1 578例孕妇进行血糖筛查试验 ,阳性者进行葡萄糖耐量试验 ( OGTT)。按照世界卫生组织 ( WHO)、美国糖尿病资料组 ( NDDG)和国内 (董志光等 )三种诊断标准对孕妇进行诊断并分组 ,随机选择糖筛查试验阴性孕妇 1 0 0例作为对照组 ,对四组母儿妊娠结局进行比较。　结果　血糖筛查试验阳性 2 76例 ,OGTT试验达到 WHO、NDDG、国内标准者分别为 3 3、60、68例 ,检出率分别为 2 .1 % ( 3 3 / 1 578) ,3 .8% ( 60 / 1 578) ,和 4 .3 %( 68/ 1 578)。各 GDM组间比较 ,产母重度妊高征、羊水过多、羊水过少、巨大儿的发生率和剖宫产率均无显著性差异 ( P>0 .0 5) ,而与对照组相比 ,存在显著性差异 ( P<0 .0 5)。　结论　及时诊断并积极处理 GDM对获得良好的妊娠结局是极为必要的。 WHO标准过于严格 ;NDDG标准可以应用 ,但有漏诊的可能 ,国内标准有待大样本证实。     

Obstetric outcomes with a false-positive one-hour glucose challenge test by the Carpenter-Coustan criteria.

OBJECTIVE: Pregnancies complicated by a false-positive one-hour glucose challenge test (GCT), as determined by the National Diabetes Data Group (NDDG) criteria, have higher rates of adverse maternal and neonatal outcomes. This study was conducted to determine if pregnancies complicated by a false-positive GCT, as determined by the Carpenter-Coustan (CC) criteria, also have higher rates of adverse maternal and neonatal outcomes. STUDY DESIGN: In this retrospective case-control study, we compared 165 patients with a false-positive GCT, as determined by the Carpenter-Coustan criteria, to a cohort of 165 pregnant controls with a normal screening GCT. Multiple variables for maternal and neonatal outcomes were compared between the two groups. RESULTS: The racial distribution and gestational age of delivery were similar in both groups. The study group had a higher one-hour GCT (148.2 mg/dl vs. 95.3 mg/dl, p < 0.001), was older (27.4 yrs vs. 23.8 years, p < 0.001), was more likely to be multiparous (71.5% vs. 58.2%, p = 0.011), and had a higher BMI (26.7 kg/m2 vs. 24.6 kg/m2, p = 0.002). There were no differences between the two groups in mode of delivery, birth weight, rates of macrosomia, shoulder dystocia, antenatal death and maternal laceration. There were also no differences between the two groups in rates of preeclampsia, chorioamnionitis, endometritis, ICN admission, neonatal hypoglycemia, Erb's palsy, clavicular fracture, neonatal sepsis, neonatal death or use of phototherapy. CONCLUSION: Women with a false-positive one-hour GCT by the Carpenter-Coustan criteria do not have higher rates of adverse perinatal outcomes. Using the Carpenter-Coustan criteria to diagnose GDM appears to be superior to NDDG criteria in terms of avoiding adverse maternal and neonatal outcomes.     

Incidence of neonatal hypoglycemia in large-for-gestational-age infants of dichorionic twin pregnancies

The aim of this study was to estimate standards of large-for-gestational-age (LGA) infants of twin pregnancies based on the incidence of neonatal hypoglycemia. We examined 277 dichorionic twin infants (in 201 dichorionic twin pregnancies) who were delivered weighing ≥ 2500 g at 37–41 weeks of gestation. LGA in twin pregnancies was identified when the infant deviated > by 1.5SD from the mean gestational age of this study (LGA based on the twin pregnancy standard), or when the infant deviated by >1.5 SD of the intrauterine growth curve of Japanese (LGA based the singleton pregnancy standard). Using the twin pregnancy standard, the incidence of neonatal hypoglycemia in LGA twin infants was not measurably different from that in appropriate-for-gestational-age (AGA). However, using the singleton pregnancy standard, the incidence of neonatal hypoglycemia was significantly higher than that in AGA infants. In conclusion, LGA in twin pregnancies should be studied based on the singleton pregnancy standard to assess the incidence of neonatal hypoglycemia. Received: 20 May 1999 / Accepted: 2 December 1999     

The diagnosis of gestational diabetes mellitus: new paradigms or status quo?

The Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study showed significant perinatal risks at levels of maternal hyperglycemia below values that are diagnostic for diabetes. A Consensus Panel of the International Association of Diabetes and Pregnancy Study Groups (IADPSG) reviewed HAPO Study results and other work that examined associations of maternal glycemia with perinatal and long-term outcomes in offspring and published recommendations for diagnosis and classification of hyperglycemia in pregnancy in 2010. Subsequently, some commentaries and debate challenged the IADPSG recommendations. In this review, we provide details regarding some points that were considered by the IADPSG Consensus Panel but not published and address the following issues: 1) what should be the frequency of gestational diabetes mellitus (GDM); 2) were appropriate outcomes and odds ratios used to define diagnostic thresholds for GDM; 3) to improve perinatal outcome, should the focus be on GDM, obesity, or both; 4) should results of randomized controlled trials of treatment of mild GDM influence recommendations for diagnostic thresholds; and, 5) other issues related to diagnosis of GDM. Other groups are independently considering strategies for the diagnosis of GDM. However, after careful consideration of these issues, we affirm our support for the recommendations of the IADPSG Consensus Panel.     

Comparison of One-Step Versus Two-Step Screening for Diagnosis of GDM in Indian Population: A Randomized Controlled Trial

Objective

To compare the incidence, maternal and fetal outcomes of gestational diabetes mellitus using one step versus two steps as a screening procedure.

Methodology

A prospective randomized trial involving screening of 1000 pregnant women for gestational diabetes mellitus was conducted. Women were divided in two groups (500 each). Group A comprised of patients screened with two-step approach (ACOG recommendation), and group B comprised of women screened by one-step method (IADPSG criteria). Women diagnosed with ‘gestational diabetes’ were followed in an antenatal clinic, and incidence of GDM and maternal and fetal outcome between two groups were analyzed using SPSS.

Results

The incidence of GDM was almost double using one-step versus two-step approach which was 19.2 and 11.8%, respectively. Maternal outcomes were comparable in both the groups except the risk of preterm delivery which was 2.5 times more in group A than group B (odds ratio = 2.43 95% CI 1.01–5.79). Further, fetal outcomes were also comparable except neonatal hypoglycemia which was seen in 29.31% in group A versus 7.4% in group B. In the group B, 15 patients (15.8%) with GDM (based on FBS ≥ 92 mg/dl at first ANC visit) showed clinical symptoms and blood sugars in hypoglycemic range on MNT requiring resumption of normal diet.

Conclusion

The incidence of GDM using IADPSG criteria was almost double versus ACOG criteria. Maternal and fetal outcomes were comparable except in 15.8% women diagnosed as GDM (using FBS ≥ 92 mg/dl at first ANC visit as per IADPSG) and suffered from hypoglycemia. A large trial is being proposed before these criteria are adopted.