Glyburide in gestational diabetes – prediction of treatment failure

Objective.?To identify factors predicting failure of glyburide treatment in women with gestational diabetes mellitus (GDM).

Methods.?A retrospective study of all women with GDM that were treated with glyburide in a single tertiary referral center. Patients were switched from glyburide to insulin if they failed to achieve glycemic goals, and were then classified as glyburide failure.

Results.?Overall, 124 women with GDM treated with glyburide were included in the study, of which 31 (25%) failed to achieve glycemic control. Women in the failure group were characterized by a higher weight gain during pregnancy, higher rates of GDM on previous pregnancies, and a glucose challenge test (GCT) result. On multivariate logistic regression analysis, a GCT value of >200?mg/dl (OR=7.1, 95% CI 2.8–27.6) and weight gain ≥12?kg (OR=3.9, 95% CI 1.2–13.0) were the only significant and independent predictors of glyburide failure. Most women who were successfully treated with glyburide required a daily dose of 5?mg or less and the time required to achieve glycemic control in these cases was 12.4±4.9 days (range 5–24 days). Of the women who failed to achieve glycemic control with gluburide, 26/31 were switched to insulin, of them only 12 (46%) achieved desired level of glycemic control.

Conclusion.?Most women with GDM achieved desired level of glycemic control under glyburide treatment.     

The effect of maternal obesity on pregnancy outcomes in women with gestational diabetes

Objective.?To examine the impact of maternal obesity on maternal and neonatal outcomes in pregnancies complicated with gestational diabetes mellitus (GDM).

Methods.?Women with singleton pregnancies and GDM enrolled in an outpatient GDM education, surveillance and management program were identified. Maternal and neonatal pregnancy outcomes were compared for obese (pre-pregnancy BMI?≥?30?kg/m²) and non-obese (pre-pregnancy BMI?<?30?kg/m²) women and for women across five increasing pre-pregnancy BMI categories.

Results.?A total of 3798 patients were identified. Maternal obesity was significantly associated with the need for oral hypoglycemic agents or insulin, development of pregnancy-related hypertension, interventional delivery, and cesarean delivery. Adverse neonatal outcomes were also significantly increased including stillbirth, macrosomia, shoulder dystocia, need for NICU admission, hypoglycemia, and jaundice. When looking across five increasing BMI categories, increasing BMI was significantly associated with the same adverse maternal and neonatal outcomes.

Conclusion.?In women with GDM, increasing maternal BMI is significantly associated with worse maternal and neonatal outcomes.     

Overweight and obese in gestational diabetes: the impact on pregnancy outcome

OBJECTIVE: We sought to investigate the relationship between prepregnancy weight, treatment modality (diet or insulin), level of glycemic control, and pregnancy outcome. STUDY DESIGN: We recruited women with gestational diabetes (GDM) from inner city prenatal clinics. All women were instructed in the use of an intensified management protocol using memory reflectance meters. Outcomes were analyzed according to maternal prepregnancy body mass index (BMI, kg/m 2 ) categories: normal weight (BMI 18.5-24.9), overweight (BMI 25-29.9), and obese (BMI > or =30), and by diet or insulin therapy and glycemic control (mean blood glucose <100 mg/dL = good control). Pregnancy outcome variables included a composite outcome (at least 1 of the following: neonatal metabolic complications, large-for-gestational age or macrosomic infants, NICU admission for >24 hours, and the need for respiratory support) (not including oxygen therapy). In addition to composite outcome, a bivariate analysis was performed for each single variable, including preeclampsia and cesarean section delivery. RESULTS: Four thousand and one women were enrolled. Obese women who achieved targeted levels of glycemic control had comparable pregnancy outcomes to normal weight and overweight women only when they were treated with insulin. Normal weight women treated with diet therapy who achieved targeted levels of glycemic control had good outcomes, but obese women treated with diet therapy who achieved targeted levels of glycemic control, nevertheless, had a 2- to 3-fold higher risk for adverse pregnancy outcome when compared with overweight and normal weight patients with well-controlled GDM. Women with GDM who failed to achieve established levels of glycemic control had significantly higher adverse pregnancy outcomes in all 3 maternal weight groups. CONCLUSION: In obese women with BMI > or =30 with GDM, achievement of targeted levels of glycemic control was associated with enhanced outcome only in women treated with insulin.     

Maternal obesity as a risk factor in gestational diabetes

Maternal obesity has been associated with both gestational diabetes mellitus (GDM) and neonatal macrosomia. Most studies of obesity in pregnancy have demonstrated an increased risk for GDM. However, the contribution of obesity as an added risk in GDM has not been examined. The purpose of this study was to examine the contribution of obesity as a risk factor to perinatal morbidity in gestationally diabetic women by comparing the maternal and neonatal outcome in obese and nonobese gestationally diabetic women. From 1979 to 1983, the maternal, intrapartum, and neonatal characteristics of all prepartum gravid patients with GDM were examined. Of the 158 patients with documented GDM, 62 (39%) were obese (weight greater than 90 kg). There was no difference in maternal age (obese 29.3 +/- 5.4 years, nonobese 28.7 +/- 6.5 years) parity, or prepartum risk score between the obese and nonobese patients. The incidence of prematurity, pre-eclampsia, fetal distress, and primary cesarean sections were not different between the groups. There were no differences in Apgar scores, gestational age, or perinatal morbidity. However, the obese patients delivered heavier neonates expressed as mean birthweight (obese 3667 +/- 682 gms, nonobese 3331 +/- 750 gms. P less than .01), the number of macrosomic (greater than 4 kg) neonates (obese 37%, nonobese 14%, P less than .001) and K-score, (obese 0.8 +/- 1, nonobese 0.4 +/- 9, P less than .05). These data indicate that obese patients with GDM have an increased risk of neonatal macrosomia.(ABSTRACT TRUNCATED AT 250 WORDS)     

Insulin detemir versus glyburide in women with gestational diabetes mellitus

Aim: To evaluate the safety, efficacy and pregnancy outcomes of insulin detemir (IDet) versus glyburide treatment in women with gestational diabetes mellitus (GDM).

Methods: We conducted a retrospective cohort study of women with GDM who were treated with either glyburide or IDet for GDM in a university-affiliated tertiary hospital.

Results: Ninety-one patients with GDM were enrolled, 62 were administered glyburide and 29 IDet. Maternal age, pregestational body mass index (BMI) and rate of abnormal oral glucose tolerance test (OGTT) blood glucose values were not significantly different between groups. Good glycemic control rates were comparable. Hypoglycemic episodes were reported only in the glyburide group (19.4% versus 0%, p?=?0.01). Maternal weight gain during pregnancy was significantly higher among women in the glyburide group (8.8?±?5.1?kg, p?p?=?0.71).

Conclusions: To the best of our knowledge, this is the first study on IDet treatment in patients with GDM. By our preliminary results, IDet is a viable treatment option in women with GDM. Further large prospective studies are needed to determine the efficacy and safety of IDet in GDM patients.     

Metformin and insulin in the management of gestational diabetes mellitus: preliminary results of a comparison

OBJECTIVE: To compare glycemic control and neonatal outcomes in women with gestational diabetes mellitus (GDM) treated with metformin vs. insulin. STUDY DESIGN: Women with GDM not controlled with diet and exercise were randomized to metformin (n = 32) or insulin (n = 31). The levels of glycemic control as well as maternal/neonatal complications were evaluated. RESULTS: The mean (+/- SD) fasting and 2-hour postprandial blood glucose did not differ statistically between the 2 treatment groups. No patient failed metformin and required insulin. The majority (27/32) were easily controlled on the initial dosage (500 mg twice a day). Gestational age at entry and delivery (p = 0.077, 0.412) were similar. The difference in the rate of cesarean delivery was not statistically significant between the 2 groups (p = 0.102). Neonatal statistics were also not different between the metformin and insulin groups: birth weight, Apgar score at 5 minutes, respiratory distress syndrome, hyperbilirubinemia, neonatal hypoglycemia and neonatal intensive care unit admission (p = 0.144-0.373). CONCLUSION: Based on these preliminary data, metformin appears to be an effective alternative to insulin in the treatment of GDM.     

Comparison of glyburide and insulin for the management of gestational diabetes in a large managed care organization

OBJECTIVE: This study was undertaken to compare the use of glyburide with insulin for the treatment of gestational diabetes mellitus (GDM) unresponsive to diet therapy. STUDY DESIGN: A retrospective study was performed among women with singleton pregnancies who had GDM diagnosed, with fasting plasma glucose 140 mg/dL or less on glucose tolerance testing, between 12 and 34 weeks who failed diet therapy from 1999 to 2002. We identified 584 women and compared those treated with insulin between 1999 and 2000 with women treated with glyburide between 2001 and 2002. Maternal and neonatal outcomes and complications were assessed. Statistical methods included univariate analyses and multivariable logistic regression. RESULTS: In 1999 through 2000, 268 women had GDM diagnosed and were treated with insulin; in 2001 through 2002, 316 women had GDM diagnosed of which 236 (75%) received glyburide. The 2 groups were similar with regard to age, nulliparity, and historical GDM risk factors; however, women in the insulin group had a higher mean body mass index (31.9 vs 30.6 kg/m 2 , P=.04), a greater proportion identified themselves as white (43%, 28%, P<.001) and fewer as Asian (24%, 37%, P=.001), and they had a significantly higher mean fasting on glucose tolerance test (105.4 vs 102.4 mg/dL , P=.005) compared with the glyburide group. There were no significant differences in birth weight (3599+/-650 g vs 3661+/-629 g, P=.3), macrosomia (24%, 25%, P=.7), or cesarean delivery (35%, 39 %, P=.4). Women in the glyburide group had a higher incidence of preeclampsia (12%, 6%, P=.02), and neonates in the glyburide group were more likely to receive phototherapy (9%, 5%, P<.05), and less likely to be admitted to the neonatal intensive care unit (NICU) (15%, 24%, P=.008) though they had a longer NICU length of stay (4.3+/-9.6 vs 8.0+/-10.1, P=.002). Posttreatment glycemic control data were available for 122 women treated with insulin and 137 women treated with glyburide. More women in the glyburide group achieved mean fasting and postprandial goals (86%, 63%, P<.001). These findings remained significant in logistic regression analysis. CONCLUSION: In a large managed care organization, glyburide was at least as effective as insulin in achieving glycemic control and similar birth weights in women with GDM who failed diet therapy. The increased risk of preeclampsia and phototherapy in the glyburide group warrant further study.     

Use of glyburide for the treatment of gestational diabetes: the San Antonio experience.

OBJECTIVES: Equivalent efficacy of glyburide and insulin for treatment of gestational diabetes (GDM) was demonstrated in a recent randomized trial. We describe our experience with glyburide in practice, and suggest factors that predict failure of glyburide treatment. METHODS: Women with GDM treated with glyburide were studied. They were divided into two groups: those who achieved adequate glycemic control with glyburide, and those who did not. The groups were compared in terms of baseline characteristics, including diabetes risk factors and glucose testing values. Receiver operating characteristics (ROC) curves were generated to identify thresholds for fasting plasma glucose and body mass index (BMI) that would predict glyburide failure. RESULTS: Seventy-five women were analyzed: 63 (84%) were successfully treated with glyburide, and 12 (16%) were not. Baseline characteristics were similar between the groups, except that failures had higher 3-h glucose tolerance test (GTT) values at all time points. ROC curves for fasting plasma glucose, pre-pregnancy BMI and BMI at diagnosis revealed no cut-off points for predicting failure of glyburide therapy. However, when fasting plasma glucose value on the GTT was > or = 110 mg/dl, 24% of women failed to respond to glyburide, compared to 12% at < 110 mg/dl (p = 0.15). CONCLUSIONS: In treatment of GDM, glyburide is successful in achieving good glycemic control in most women. Women with high fasting plasma glucose levels, however, may not respond adequately to glyburide therapy.     

Comparison of glyburide and insulin for the management of gestational diabetics with markedly elevated oral glucose challenge test and fasting hyperglycemia.

OBJECTIVE: To compare the effectiveness of glyburide and insulin for the treatment of Gestational diabetes mellitus (GDM) in women who had OGCT >or=200 mg/dl and fasting hyperglycemia. STUDY DESIGN: A retrospective study was performed among a subset of women treated with glyburide or insulin for GDM from 1999 to 2002 with an OGCT >or=200 mg/dl and pretreatment fasting plasma glucose >or=105 mg/dl. Exclusion criteria included pretreatment fasting >or=140 mg/dl, gestational age >or=34 weeks and multiple gestation. Maternal and neonatal outcomes were assessed. Statistical methods included bivariate and multivariable logistic regression analyses. RESULTS: In 1999 to 2000, 78 women were treated with insulin; in 2001 to 2002, 44 of 69 (64%) received glyburide. There were no statistically significant differences between the two groups with regards to mean OGCT (230+/-25 vs 223+/-23 mg/dl, P=0.07) and mean pretreatment fasting (120+/-10 vs 119+/-11 mg/dl, P=0.45). Seven women (16%) failed glyburide. Women in the insulin group were younger (31.5+/-5.8 vs 35.2+/-4.7 years, P<0.001) and had a higher mean BMI (32.4+/-6.4 vs 29.1+/-5.8 kg/m(2), P=0.003) compared to glyburide group. There were no significant differences in birth weight (3524+/-548 vs 3420+/-786 g, P=0.65), macrosomia (19 vs 23%, P=0.65), pre-eclampsia (12 vs 11%, P=0.98) or cesarean delivery (39 vs 46%, P=0.45). Neonates in the glyburide group were diagnosed more frequently with hypoglycemia (34 vs 14%, P=0.01). When controlled for confounders, macrosomia was found to be associated with glyburide treatment (OR 3.5, 95% CI 1.1 to 11.4). CONCLUSION: In women with GDM who had a markedly elevated OGCT and fasting hyperglycemia, glyburide achieved similar birth weights and delivery outcomes but was associated with an increased risk of macrosomia. The possible increased risk of neonatal hypoglycemia in the glyburide group warrants further investigation.     

Association of obesity with pulmonary and nonpulmonary complications of pregnancy in asthmatic women

OBJECTIVE: To evaluate whether maternal obesity is associated with pulmonary and nonpulmonary pregnancy complications in asthmatic women. METHODS: This is a secondary analysis of the prospective cohort Asthma During Pregnancy Study. Asthma patients were classified as having either mild or moderate to severe disease at the beginning of the study. Rates of pulmonary complications of asthma in asthmatic women and rates of nonpulmonary complications of pregnancy among asthma patients and controls, were compared between obese (body mass index > or = 30 kg/m2) and nonobese women. RESULTS: Maternal body mass index and pregnancy outcome data were available for 1,699 of 1,812 asthmatic women and for 867 of 881 controls. Of the asthma subjects, 30.7% (521) were obese compared with 25.5% of the controls, P = .006. Obese women, regardless of whether they had asthma, were more likely to undergo cesarean delivery (OR 1.6, 95% confidence interval [CI]1.3-2.0) to develop preeclampsia or gestational hypertension (OR 1.7 95% CI 1.3-2.3) and gestational diabetes (OR 4.2, 95% CI 2.8-6.3). There were no differences in the rates of overall asthma improvement (20.6% compared with 23.6%, P = .36) or deterioration (33.3% compared with 28.8%, P = .20) between obese and nonobese asthma patients. After adjustment for confounding variables, obesity, not asthma, was associated with nonpulmonary complications of pregnancy, and obesity was associated with an increase in asthma exacerbations as well (OR 1.3, 95% CI 1.1-1.7). CONCLUSION: Obesity is associated with an increased risk of asthma exacerbations during pregnancy. The increased rate of nonpulmonary complications of pregnancy in asthma patients is associated with obesity in this population and not with asthma status. LEVEL OF EVIDENCE: II-1.     

妊娠期糖尿病产后发展为2型糖尿病的相关因素研究进展

妊娠期糖尿病（GDM）是产科常见并发症,会增加妊娠风险。由于生活方式和饮食结构的改变,GDM发病率逐年上升。大部分GDM患者产后短期内血糖会恢复正常,但生活中远期发生2型糖尿病（T2DM）的风险并未降低,GDM妇女已经成为日后发生糖尿病、代谢综合征的潜在危险人群。GDM发展为T2DM的相关危险因素很多,如高龄、肥胖和糖尿病家族史,另外空腹血糖水平、孕期胰岛素治疗、早发型GDM也逐渐被重视。通过认识GDM发展为T2DM的相关危险因素和包括临床特征、生化指标、基因等多种早期预测标志物,预测T2DM发生的风险,以利于提高公众风险意识及GDM妇女产后随访,可以提前进行生活方式干预或药物治疗,预防和延缓T2DM的发生,改善健康结局。     

Weight gain in gestational diabetes: the effect of treatment modality

Objective: To evaluate treatment effectiveness (diet alone, insulin or glyburide) on maternal weight gain in gestational diabetes (GDM).

Methods: GDM patients were treated with diet alone, insulin or glyburide. Weight gain was stratified into: prior to GDM diagnosis, from diagnosis to delivery and total pregnancy weight gain. Good glycemic control was defined as mean blood glucose ≤105?mg/dl and obesity as Body Mass Index (BMI)?≥?30?kg/m², overweight BMI 25–29?kg/m² and normal <?25?kg/m².

Results: Total weight gain was similar in all the treatment groups. Two-thirds of weight gain occurred prior to diagnosis (diet 85%, insulin 67% and glyburide 78%). Post-diagnosis, patients on diet alone gained less weight than those on insulin or glyburide (p?<?0.001); insulin-treated patients showed greater weight gain than glyburide-treated patients (p?<?0.001). Patients on diet with good glycemic control showed less weight gain after diagnosis than patients on insulin or glyburide (2.8?±?13, 6.6?±?10, 5.2?±?7.9 lbs, respectively, p?<?0.02). Poorly-controlled patients, regardless of treatment, had similar patterns of weight gain throughout pregnancy.

Conclusion: Patterns of maternal weight gain in GDM pregnancies are associated with treatment modality and level of glycemic control.     

Perinatal outcomes and the use of oral hypoglycemic agents

OBJECTIVE: To compare neonatal results from patients with gestational diabetes mellitus (GDM) who were treated with insulin, glyburide and acarbose. RESULTS: Seventy patients diagnosed with GDM who needed therapy to complement diet and physical activities were included in the study. One group was assigned to insulin therapy (n = 27), a second group was assigned to glyburide therapy (n = 24) and a third group was assigned to acarbose therapy (n = 19). Maternal characteristics were similar in the three groups. Glucose control was not achieved in five (20.8%) of the patients using glyburide and in eight (42.1%) of patients using acarbose. No statistical difference was observed in fasting and post-prandial glucose levels or in average newborn weight in the three groups. The rate of large for gestational age (LGA) fetuses was 3.7, 25 and 10.5% in the groups treated with insulin, glyburide and acarbose, respectively. Neonatal hypoglycemia was observed in eight newborns, six of which from the glyburide group. CONCLUSION: We believe that glyburide and acarbose can be promising alternative therapies for the treatment of GDM. Glyburide controlled glucose levels in most patients and it was more efficient than acarbose. Glyburide showed a higher rate of macrosomia and neonatal hypoglycemia as compared to other therapies.     

Predictors of glyburide failure in the treatment of gestational diabetes

OBJECTIVE: Our objective was to identify among women with gestational diabetes mellitus (GDM) the patient characteristics that predict treatment failure with glyburide. METHODS: Historical cohort of 95 GDM women offered glyburide after dietary failure with defined entry criteria. RESULTS: From November 2000 to May 2005, 118 women had 124 pregnancies and were offered glyburide therapy by the 2 codirectors of our Diabetes Clinic. All but 2 women elected glyburide, and 27 pregnancies were excluded due to criteria defined a priori to the study. A cohort of 95 women with 95 pregnancies were included for analysis. Nineteen percent failed glyburide. Significant predictors of failure were maternal age (34 years compared with 29 years, P = .001), earlier diagnosis of GDM (23 weeks compared with 28 weeks, P = .002), higher gravidity (P = .01) and parity (P = .03), and a higher mean fasting blood glucose (112 compared with 100 mg/dL; P = .045) compared with those successfully treated. After adjustment in the multivariable logistic regression analysis, GDM women diagnosed at a gestational age less than 25 weeks were 8.3 times more likely to fail glyburide compared with those diagnosed after 25 weeks. Maternal and fetal outcomes were favorable with a cesarean delivery rate of 25% and macrosomia rate of 7%. CONCLUSION: Glyburide was more likely to fail in women diagnosed earlier in pregnancy, of older age and multiparity, and with higher fasting glucoses, suggesting that earlier glucose intolerance and a reduced capacity to respond to an insulin secretagogue may distinguish this group. The time for glyburide as an alternative treatment has come; however, it should be prescribed after careful consideration of these patient characteristics to minimize the likelihood of failure. LEVEL OF EVIDENCE: II-2.     

Body composition and energy metabolism in normotensive and hypertensive pregnancy

Objective To determine whether the insulin resistance syndrome and altered body composition are features of hypertensive pregnancy.
Design Women were recruited in the third trimester of pregnancy from the antenatal clinic, day assessment unit, and maternity ward of St George Hospital, Sydney.
Population Women with pre-eclampsia (   n =12  ), gestational hypertension (   n =12  ), essential hypertension in pregnancy (   n =11  ), and normotensive pregnancy (   n =10  ).
Methods Energy metabolism was assessed by indirect calorimetry to measure basal metabolic rate and diet-induced thermogenesis. Body composition was measured as lean body mass, total body water and fat mass by bio-electrical impedance. Blood was collected for measurement of glucose, insulin and lipid profiles. Insulin resistance was indirectly assessed by the insulin and glucose concentrations and diet-induced thermogenesis.
Results Women with essential hypertension and gestational hypertension were heavier than women with normotensive pregnancies both pre-pregnancy and in the third trimester, whereas women with pre-eclampsia were similar to those with normotensive pregnancy. Women with essential hypertension were otherwise similar to normotensive pregnancy but women with gestational hypertension had a reduced diet-induced thermogenesis and almost double insulin levels. Women with pre-eclampsia had a similar body composition and insulin levels but reduced basal metabolic rate, diet-induced thermogenesis and glucose levels compared with normotensive pregnancy.
Conclusions Women who develop gestational hypertension, but not pre-eclampsia, are more likely to be overweight. Women with essential hypertension are similar to women with normotensive pregnancy throughout pregnancy. Both gestational hypertension and pre-eclampsia appear to be associated with some degree of insulin resistance, greater than that occurring in normal pregnancy.     

Perinatal complications in women with gestational diabetes mellitus

BACKGROUND: The aim of the study was to examine the outcome of the pregnancy and neonatal period in 1) women with gestational diabetes mellitus and non-diabetic pregnant women, and 2) in women with early and late diagnosis of gestational diabetes mellitus. METHODS: Included were 327 women with gestational diabetes mellitus and 295 non-diabetic women, who were screened with a 75 g oral glucose tolerance test because of risk factors for gestational diabetes. Women with gestational diabetes mellitus were treated with low-caloric diet and insulin when appropriate, while women in the control group received routine antenatal care. RESULTS: Gestational age at delivery was significantly lower in the group with gestational diabetes mellitus, both when considering all deliveries (39.1+/-1.7 weeks versus 39.8+/-2.0 weeks, p<0.05) and only those with spontaneous onset of labor (38.8+/-2.0 weeks versus 40.0+/-1.6 weeks, p<0.05). The frequency of macrosomia was increased, although not statistically significant (8% vs. 2%, p=0.07), and the rate of admission to the neonatal ward was significantly increased (18% vs. 9%, p<0.05) in the group with gestational diabetes. Women with early diagnosis of gestational diabetes mellitus had a significantly increased need for insulin treatment during pregnancy (36% vs. 9% p<0.05) and a significantly higher occurrence of diabetes mellitus at follow-up from two months until three years postpartum. CONCLUSIONS: This study of women with gestational diabetes mellitus and non-diabetic pregnant women showed that gestational diabetes mellitus was associated with a significantly lower gestational age at delivery and an increased rate of admission to the neonatal ward. Women diagnosed with GDM before 20 weeks of gestation had an increased need for insulin treatment during pregnancy and a high risk of subsequent overt DM, compared with women diagnosed with GDM later in pregnancy.     

Why do Asian-born Women Have a Higher Incidence of Gestational Diabetes? An Analysis of Racial Differences in Body Habitus, Lipid Metabolism and the Serum Insulin Response to an Oral Glucose Load

Summary: We have observed a higher incidence of gestational diabetes (GDM) in Asian-born than in Caucasian women. Body habitus, serum lipid levels and the serum insulin response to a glucose load in pregnancy were compared in 15 women with normal glucose tolerance, 16 Caucasian women with GDM and 19 Asian-born women with GDM. Caucasian women with GDM, unlike Asian-born women with GDM, were obese compared with control women as measured by body mass index (p = 0.022). Both groups of GDM women had similar patterns of insulin response to oral glucose with a delayed insulin peak and an elevated 2-hour insulin level (p = 0.0021). In addition, the insulin response per unit of glycaemic stimulus (incremental insulin area/incremental glucose area at 1 hour) was reduced in both GDM groups (p = 0.035). Fasting serum triglyceride levels were higher in women with GDM although this was only significant in the     

Period of gestational diabetes mellitus diagnosis and maternal and fetal morbidity

BACKGROUND: The aim of the study was to analyze the association between the period of diagnosis of gestational diabetes mellitus (GDM) and maternal and neonatal outcome. METHODS: In this retrospective study, 1708 offspring (1571 singleton, 119 twins, and 18 triplets) born to women with GDM who attended the Diabetic and Pregnancy Clinic were included. Pregnancies were divided into three groups according to the gestational age at GDM diagnosis. The association of the period of diagnosis with maternal and fetal outcome was assessed adjusting for potentially confounding variables (logistic regression analysis). RESULTS: The period of diagnosis was a predictor in two out of three maternal outcomes (pregnancy-induced hypertension and insulin treatment) and in four out of 12 fetal outcomes (preterm birth, 5-min Apgar <7, perinatal mortality, and hyperbilirubinemia). Whereas pregnancy-induced hypertension was higher in women diagnosed with GDM in the second period, the other outcomes displayed higher occurrences with earlier diagnosis. CONCLUSIONS: Diagnosis of GDM earlier in pregnancy is a predictor of adverse maternal and neonatal outcome.     

Prevalence of gestational diabetes mellitus in polycystic ovarian syndrome (PCOS) patients pregnant after ovulation induction with gonadotrophins

Our aims were: 1. To investigate if women with PCOS who become pregnant using gonadotrophins have a higher incidence of gestational diabetes mellitus (GDM) compared to spontaneously pregnant matched control women, 2. To compare the prevalence of GDM in PCOS women with that in women with hypo/eugonadotrophic hypogonadism and in unexplained infertility and 3. To investigate differences in pregnancy outcomes between the groups. This was a retrospective case-control study. Women with PCOS were matched with a control by age, BMI, and ethnicity. There were 60 women with PCOS, 11 with hypogonadotrophic hypogonadism, 6 with eugonadotrophic hypogonadism, and 12 with unexplained infertility. Control women were those who attended a major public hospital for antenatal care and delivery We found no difference in the prevalence of GDM between the PCOS (22%) and the controls (17%) or between the PCOS and other groups. Women with GDM (diet or insulin controlled) had a significantly higher BMI than women without GDM (p = 0.019). There was no difference in pregnancy outcomes between the groups. There was a significant dependence of babies' birthweight on mother's BMI (p<0.001).     

Gestational diabetes mellitus management with oral hypoglycemic agents

Oral hypoglycemic agents such as glyburide (second-generation sulfonylurea) and metformin (biguanide) are attractive alternatives to insulin due to lower cost, ease of administration, and better patient adherence. The majority of evidence from retrospective and prospective studies suggests comparable efficacy and safety of oral hypoglycemic agents such as glyburide and metformin as compared to insulin when used in the treatment of women with gestational diabetes mellitus (GDM). Glyburide and metformin have altered pharmacokinetics during pregnancy and both agents cross the placenta. In this article, we review the efficacy, safety, and dosage of oral hypoglycemic agents for the treatment of gestational diabetes mellitus. Additional research is needed to evaluate optimal dosage for glyburide and metformin during pregnancy. Comparative studies evaluating the effects of glyburide and metformin on long-term maternal and fetal outcomes are also needed.