Birthweight in women with potential gestational diabetes mellitus--an effect of obesity rather than glucose intolerance?

BACKGROUND: The purpose was to compare the influence of varying levels of glycemia on the perinatal outcome. METHODS: The data charts of 383 women screened for gestational diabetes mellitus with an oral glucose tolerance test during two birthyears were retrospectively evaluated. In 55 women gestational diabetes mellitus was diagnosed and treated with diet. The non-diabetic women (n=328) were subdivided into a borderline diabetes group (n=74) and a normal group (n= 254) on the basis of the oral glucose tolerance test result. The birth registry of 8196 singleton pregnancies from The Perinatal Research Unit at Skejby University Hospital served as the background population. RESULTS: Birthweight was highest in the borderline group. Weight increase during pregnancy was larger in the non-diabetic than the gestational diabetic women (15 vs. 8 kg p<0.01). The women with less increase of body weight delivered neonates with lower birthweight than those with higher increase. Birthweight was associated with maternal weight during pregnancy (p<0.01). Birthweight ratio increased with increasing glucose intolerance. Vaginal delivery rate was less and cesarean section rate higher in women with gestational diabetes mellitus compared to the non-diabetic women. No significant difference was found in the incidence of hypertensive disorders during pregnancy or neonatal morbidity. CONCLUSIONS: Even minor hyperglycemia is associated with increasing birthweight. Birthweight is reduced in GDM when dietary treatment is instituted and effect on weight gain is achieved.     

Determinants of birth size in Northeast Spain

Abstract

Objective: To update knowledge on determinants of newborn body size in Northeast of Spain considering gestational, parental and socio-cultural variables.

Methods: Cross-sectional assessment of 1442 infants from Aragón (Spain), born at term between March 2009 and March 2010. Obstetric, neonatal, socio-demographic and parental anthropometry data were collected during the first infant scheduled health examination. Hierarchical linear regression models were used to explore associations between newborn anthropometry and included variables.

Results: Birth weight was significantly higher in males than in females (130.7?g), when mother did not smoke during pregnancy (126.3?g), in immigrant mothers (113.1?g) and when parity increased (67.1?g per additional birth). Body weight at birth was 16.9?g higher per kg of maternal weight gain during pregnancy, 5.4?g higher per kg of maternal pre-pregnancy weight and 5.1?g higher per cm of maternal height. Birth length was also significantly higher in males than in females (0.87?cm), when mother did not smoke (0.48?cm), in immigrant mothers (0.64?cm), and it was positively associated with parity, maternal anthropometry and paternal height. Newborn anthropometry was not associated with maternal age, educational level or living location.

Conclusions: Independently of gestational age and newborn sex, the main predictors of birth weight and length were maternal pre-pregnancy anthropometry and weight gain during gestation, to smoke during pregnancy, parity and maternal origin. Our results identify potential modifiable factors influencing newborn body size.     

Outcome of Gestational Diabetes Mellitus from a Tertiary Referral Center in South India: A Case–Control Study

Background

Carbohydrate intolerance is the most common metabolic complication of pregnancy. Gestational diabetes mellitus (GDM) poses numerous problems for both mother and fetus. The objective of this study was to compare the maternal and perinatal outcome between women with gestational diabetes mellitus and non-diabetic women.

Study Design

A case–control study with 286 cases and 292 age-matched controls was conducted for a period of 11 months (August 2007–June 2008) in Sree Avittom Thirunal Hospital, Thiruvananthapuram, India.

Materials and Methods

Universal screening was applied by means of glucose challenge test (GCT) using 50 g of glucose. If GCT >130 mg%, the patients were subjected to oral glucose tolerance test with 100 g of glucose. National Diabetes Data Group criteria was taken to assign patients to study group. These women were further followed up and the maternal and perinatal outcomes were assessed.

Statistical Analysis

Univariate analysis was done by means of t test, Odd’s ratio, Chi-square test, and Fisher Exact test. P < 0.05 was taken as significant.

Results

The frequency of induction of labor was significantly higher than spontaneous labor (OR = 1.84, P = 0.001). 40.1 % GDM mothers and 35.8 % of non-diabetic mothers were delivered by Cesarean section. Premature rupture of membranes (PROM) was the most common complication of labor (OR = 1.66, P = 0.04). Babies of diabetic mothers had a positive trend toward prematurity (OR = 2.3, P = 0.007). Hypoglycemia was the most common neonatal complication (OR = 11.97, P < 0.001) and nine babies of diabetic mothers were macrosomic (OR = 5.2, P = 0.02).

Conclusions

Maternal morbidities and neonatal complications such as neonatal hypoglycemia, macrosomia, and prematurity were significantly higher in GDM.     

Gestational diabetes mellitus increased the risk of adverse neonatal outcomes: A prospective cohort study in Northwest Ethiopia

BackgroundGestational diabetes mellitus is a rising global public health problem that can have short- and long-term sequelae for both mother and offspring. However, there are limited evidences on the effect of gestational diabetes mellitus on adverse neonatal outcomes using the updated international diagnostic criteria on adverse effects on neonatal outcomes. Therefore, this study was aimed to examine the effects of gestational diabetes mellitus on the risk of adverse neonatal outcomes in Ethiopia.MethodsA prospective cohort study was conducted among pregnant women recruited from antenatal clinics and followed through pregnancy to delivery. Gestational diabetes mellitus was diagnosed using a two-hour 75g oral glucose tolerance test strategy with recent criteria. Multivariable log-binomial model was used to identify the effects of gestational diabetes mellitus on the risk of adverse neonatal outcomes which includes macrosomia, low birth weight, large for gestational age, small for gestational age, preterm birth, low Apgar score at the first minute, low Apgar score at fifth minute, and composite adverse neonatal outcome.ResultsAmong pregnant women (n=1027) included in the follow up data on neonatal outcomes were available for 684 (118 newborns of mothers with gestational diabetes mellitus and 566 newborns of women without gestational diabetes mellitus). There was a statistical baseline difference between the two groups by maternal age, dietary diversity status, level of physical activity, and antenatal depression. The incidence of composite adverse neonatal outcome was significantly higher (P<0.001) among newborns from mothers with gestational diabetes mellitus (51.7%) than among newborns from mothers without gestational diabetes mellitus (25.8%). Significantly higher risk of developing adverse neonatal outcomes among newborns from gestational diabetes mellitus mothers was observed for composite adverse neonatal outcome (Adjust Relative Risk (ARR)=1.72; 95% CI: 1.35, 2.19), macrosomia (ARR= 3.81; 95% CI: 1.95, 7.45), large for gestational age (ARR= 2.38; 95% CI: 1.41, 4.03), preterm birth (ARR= 2.03; 95% CI: 1.17, 3.53), low Apgar score at the first minute (ARR= 1.71; 95% CI: 1.02, 2.86), and fifth minute (ARR= 2.14; 95% CI: 1.05, 4.36). However, no significant differences in the risk of low birth weight and small for gestational age by gestational diabetes mellitus status.ConclusionsGestational diabetes mellitus increases the risk of adverse neonatal outcomes particularly macrosomia, large for gestational age, preterm birth, and poor Apgar score. Hence, the role of preventing gestational diabetes mellitus is quite crucial to improve neonatal outcomes.     

Glycosylated hemoglobin (HbA1), glucose tolerance and neonatal outcome in gestational diabetic and non-diabetic mothers

Glycosylated hemoglobin (HbA1) was determined in three subject groups: 69 non-diabetic mothers who were delivered of normal weight infants at term (Group I), 33 non-diabetic mothers who were delivered of macrosomic infants (greater than 4000 g) at term (Group II), 51 gestational diabetics in the 3rd trimester--before onset of the diabetes therapy (Group III). In all three groups diagnostic assessment of glucose regulation was done by means of the oral glucose tolerance test during the 3rd trimester. Glycosylated hemoglobin was assayed by cation-exchange chromatography in small disposable columns. The mean values and standard deviations of HbA1 were 6.51 +/- 0.46% in Group I, 6.59 +/- 0.42% in Group II and 7.11 +/- 0.56% in Group III. Between the HbA1 values of Group III (gestational diabetes) on the one hand and those of the non-diabetic groups I and II on the other, there were highly significant differences (p less than 0.001; x2-test). HbA1 values above 7.4%--i.e. above mean + 2 s. d. of HbA1 in the non-diabetic mothers--were with 95% probability abnormal and indicative of gestational diabetes. HbA1 values between 7.0% and 7.4% were suspected of impaired glucose tolerance and gestational diabetes respectively. Between the HbA1 levels in the non-diabetic groups and those in the gestational diabetic group there was a vast zone with overlapping values. HbA1 data situated in this transitional area could be found both in non-diabetic subjects and also in those with abnormal glucose regulation. HbA1 values below 6.0% excluded gestational diabetes or otherwise impaired glucose tolerance with a high degree of probability.     

Leptin concentrations in the umbilical vein and artery. Relationship to maternal and neonatal anthropometry

OBJECTIVE: To determine the relationships between serum leptin levels in the umbilical vein (UV) and artery (UA) and the anthropometry of mothers and neonates. STUDY DESIGN: Blood was taken from 61 pregnant women who were admitted for delivery and from the umbilical vein and artery just before delivery of the placenta. Leptin level was measured by immunoradiometric assay. Comparisons between serum leptin concentrations in UVs and both maternal and neonatal anthropometry were made according to neonatal sex. RESULTS: Mean leptin UA and UV concentrations in female infants were significantly higher than those in male infants (both, P = .002). Leptin concentrations in UVs of the total infants were related to maternal body weight and body mass index preconceptionally as well as at birth, to neonatal birth weight, to gestational age, to Kaup index and to body fat content of the infants. CONCLUSION: A sex difference was observed not only in serum leptin concentrations UA and UV but also in the degree of significance between the relationship of cord leptin and both maternal and neonatal anthropometry. Also, the UA leptin level had a closer relationship to neonatal anthropometry, but the UV leptin level was more closely related to maternal anthropometry.     

Obstetrical and neonatal outcomes of gestational diabetes mellitus at Reunion Island (France)

OBJECTIVE: To assess maternal and fetal outcomes in patients with gestational diabetes mellitus. PATIENTS AND METHODS: A retrospective study was conducted at the Sud-Reunion Hospital's maternity (French overseas department located in the Indian Ocean), during the period from January 1, 2001, through December 31, 2004. During this period, 1172 pregnant women presenting gestational diabetes mellitus were compared with 1172 non-diabetic controls matched on the basis of age, parity. Student t test, Pearson chi-square test and logistic regression model were used for statistical analysis. RESULTS: Gestational diabetes mellitus complicates about 7.5% of pregnancies in Reunion Island. Its occurrence was associated with a significantly increased prevalence of pre-pregnancy obesity (27 versus 9.4%) and chronic hypertension (5.3 versus 3.3%). The prevalence of preeclampsia and obstetrical vascular disorders were not different between the two groups, respectively 2.2 versus 2.7% (P=0.43) and 6.2 versus 4.4% (P=0.06). The rate of caesarean sections and inductions of labour was increased in the study group. The term of delivery was inferior in the study group, consecutive to increased rate of labour induction at 38 week-gestation. Macrosomia and large for gestational age (LGA) newborns rate were significantly higher in the study group, respectively 8.9 versus 4.2% and 22.5 versus 10.1% (P<0.001) but the rate of admission into neonatal unit was not significantly different. DISCUSSION AND CONCLUSION: Active management of gestational diabetes mellitus is associated with low maternal and perinatal morbidity. While age and parity are controlled by the study design, the prevalence of preeclampsia and gestational hypertension are not increased in women presenting gestational diabetes mellitus.     

Gestational diabetes mellitus and neonatal hyperthyrotropinemia

OBJECTIVE: To determine whether gestational diabetes mellitus (GDM) is associated with increased incidence of neonatal hyperthyrotropinemia. STUDY DESIGN: In a retrospective study, maternal characteristics, infant outcome and cord blood thyrotropin (TSH) concentration were compared between 469 diet-treated GDM pregnancies diagnosed by the World Health Organization 75 g oral glucose tolerance test (OGTT) with 474 non-diabetic pregnancies with normal OGTT results. RESULTS: Hyperthyrotropinemia (TSH >16 mIU/l) was found in 7.2% of the GDM pregnancies and 2.1% of the controls (p < 0.001), but there was no difference in the birth weight or gestational age. The TSH concentration was correlated with the OGTT 2-hour glucose value (rho = 0.0948, p = 0.029) and Apgar score at the fifth minute (rho = -0.1197, p = 0.009). There was no difference in the TSH or free thyroxine concentrations between the hyperthyrotropinemic newborns of the GDM and control groups. In the GDM group, the hyperthyrotropinemic newborns had a higher incidence (p = 0.017) of neonatal jaundice. CONCLUSIONS: Neonatal hyperthyrotropinemia is more frequently found in pregnancies with GDM, and this could have reflected increased fetal in-utero hypoxic stress in these pregnancies.     

Assessment of glucose tolerance and pregnancy outcome of polycystic ovary patients.

OBJECTIVES: To determine the impact of polycystic ovary syndrome (PCOS) on glucose tolerance during pregnancy and perinatal outcome. METHODS: Pregnancy records of 38 PCOS patients were compared retrospectively with 136 non-PCOS patients randomly. Patients with glucose challenge tests values of >130 mg/dl were referred for the 3-h, 100-g oral glucose tolerance test (OGTT). RESULTS: A family history of diabetes mellitus, pre-pregnancy body mass index (BMI), gestational weight gain was significantly higher in PCOS patients than controls. The prevalence of gestational diabetes mellitus (GDM) was similar in both groups. Impaired glucose tolerance (IGT) was observed in 18.4% of PCOS patients vs. 5.1% of controls. The main predictor of GDM was found pre-pregnancy BMI >25 while main predictor of IGT was found as PCOS. Mean gestational age at delivery, prevalence of preterm labor, modes of delivery, mean birthweight, mean Apgar score at 5 min, proportion of babies admitted to the neonatal intensive care unit (NICU) were similar in both groups. CONCLUSIONS: Higher IGT prevalence in PCOS patients might be related to maternal obesity and excess gestational weight gain and does not affect perinatal outcome.     

Excessive Birth Weight and Maternal Glucose Tolerance A 19-year Review

The incidence of birth-weight of 4,540 g (10 lb) or more rose from 0.87% in the years 1971 to 1977 to 1.16% in the 12 years from 1978 to 1989 with a concomitant increase in hyperglycaemia in our antenatal population. The relationship between excessive birth-weight and maternal glucose tolerance was investigated in the light of these observations. The results from glucose tolerance tests performed routinely during the pregnancies of 510 women who delivered infants with a birth-weight of 4,540 g or more were compared with those from a control series of 5,003 women with consecutively tested pregnancies. Glucose tolerance in subsequent pregnancies was also compared with the control series, and in 1991 the study group women were investigated for emergence of permanent diabetes mellitus. Excessive birth-weight was associated with maternal hyperglycaemia (p < 0.05) but not with gestational diabetes; 79% of infants with birth-weight > or = 4,540 g were born to mothers who were not hyperglycaemic. There was no increase in glucose intolerance in subsequent pregnancies in the study group and only 2 of 49 women with follow-up testing had diabetes mellitus. Birth-weight > or = 4,540 g occurred in 1.1% of the total population and 1.1% of women with gestational diabetes, and was related to maternal hyperglycaemia in about 1 in 5 cases. The increased incidence of excessive birth-weight infants was not related to the increased incidence of gestational diabetes in our pregnant population. Birth-weight > or = 4,540 g had a poor association with later development of diabetes.     

Fructosamine in the management of gestational diabetes

The role of maternal serum fructosamine estimation in the management of gestational diabetes was assessed in 78 consecutive patients over a 3-year period. Fructosamine results correlated significantly with mean plasma glucose levels over a 1- to 3-week interval, with the closest association being in the preceding week. Eighty-five percent of women with gestational diabetes had peak serum fructosamine levels above the normal range. If maternal levels exceeded 3.2 mmol/L, there was an 88% chance of abnormal glucose tolerance post partum. Our aim of management was a serum fructosamine level less than 2.5 mmol/L; patients who achieved this goal by 35 to 37 weeks' gestation had fewer obese babies with lower cord insulin and C-peptide levels as compared with neonates of mothers with elevated fructosamine concentrations.     

Diabetes and pregnancy. Maternal risk factors and neonatal morbidity

BACKGROUND: To verify in our population the incidence of infants of mother with insulin dependent diabetes mellitus (IDDM) or gestational diabetes (GD) and to evaluate the maternal characteristics influencing neonatal outcome. METHODS: The study was retrospectively performed on 6179 infants born between 1995 and 1998 at the Obstetric Clinic of the University of Messina and referred the Division of Neonatology. The following groups have been selected: group A (offsprings of IDDM mothers), group B (offsprings of DG mothers), group C and group D, controls, (2 infants of the same sex and gestational age born before and after the infants of group A and group B, respectively). The parameters analyzed were: diabetic familiarity, age, weight and body mass index (BMI) of the mothers, delivery, gestational age, weight at birth, neonatal outcome. RESULTS: The infants of IDDM mothers were 3% and the infants of GD mothers were 0.8%. Group A and group B present a significantly higher incidence of: diabetic familiarity, cesarean section, macrosomia, hypoglycemia, hypocalcemia, hyperbilirubinemia. The GD mothers had weight and BMI higher than IDDM mothers. The infant weight did not correlate with maternal weight and BMI. CONCLUSIONS: These data suggest that in our population GD is underestimated, metabolic control in pregnancy is insufficient, obstetric practices are too invasive, neonatal outcome is verosimely correlated only to metabolic control.     

Incidence of the Respiratory Distress Syndrome in Infants of Diabetic Mothers – Perinatal Influences

Summary: This survey of 73 infants of insulin dependent (ID) diabetic mothers and 70 infants of gestational diabetics (GD) born at King George V Memorial Hospital between January, 1968 and December, 1975, showed that all 12 babies with RDS were from the ID group. RDS was the cause of all 6 neonatal deaths and together with the 5 stillbirths gave this high risk group a 15% mortality rate. Since no deaths occurred in the GD group, the overall mortality was 8%.
In the 6 years, 1970–1975, RDS occurred 21 times more often in babies of ID mothers than in control babies born to non-diabetics. Babies born to ID mothers were of significantly lower mean gestational age than those born to the GD mothers. Within the ID group, those babies with RDS were of significantly lower gestation than those without and the mean gestation was similar to control babies with RDS.
Provided the diabetes is controlled and fetal welfare ensured, later delivery, following documentation of lung maturity, may lower the incidence of RDS and therefore perinatal mortality and morbidity.     

Maternal Weight Gain, Smoking and Other Factors in Pregnancy as Predictors of Infant Birth-weight in Sydney Women

Summary: Two hundred and four (204) women attending a Sydney maternity hospital and their babies were followed throughout pregnancy in a study, which aimed: 1) to describe the distribution of maternal weight gain in present day Australian women and 2) to determine the effect of weight gain and other factors on birth-weight.
Maternal weights and skinfold thicknesses were measured serially to give an indication of weight gain. Mean weight gain from conception to term was 14.2kg and mean birth-weight was 3,442g.
Maternal predictors of birth-weight such as maternal weight gain, parity, age, education, height, public or private booking status, smoking, prepregnancy weight, and sex of the infant and gestational age were explored using simple and multiple regression analysis. Weight gain was predictive of birth-weight, each kg increase in total weight gain resulting in about a 30g increase in birthweight. Other strong predictors were gestational age, maternal smoking, sex of the infant and maternal parity. Maternal height was less strongly predictive and age and prepregnant weight were not predictive.
Smoking mothers had infants who were 268g lighter than those of nonsmoking mothers. However, smokers were also younger, shorter, had less education and were more likely to book as public patients than nonsmokers. After adjusting for all other predictors, the birth-weight of infants whose mothers smoked, was still 224g less than that for nonsmoking mothers.     

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.     

Early neonatal hypoglycemia: incidence of and risk factors. A cohort study using universal point of care screening

Objective: The objective of this study is to determine the true incidence of early neonatal hypoglycemia and to confirm potential risk factors.

Study design: The study was conducted at tertiary Medical Center in Israel, between June and September 2014. First blood glucose concentrations of all infants admitted to the nursery were measured using a “point of care” analyzer (Accu-Chek). We recorded risk factors for hypoglycemia such as birth weight, gestational age, maternal diabetes and demographics and analyzed their association with two hypoglycemia cutoffs: 40 and 47?mg/dl.

Results: Of 4000 newborns admitted during that period, 3595 were analyzed after excluding 405 who had missing data. Glucose level was obtained at a mean age of 74?±?30?min. One hundred and twenty-four newborns (3.4%) had blood glucose levels below 40?mg/dl and 435 (12.1%) below 47?mg/dl. Univariate analyses revealed that gestational age, maternal diabetes, low birth weight (<2500?g), and twin delivery were associated with early neonatal hypoglycemia. Other risk factors (e.g. large or small for gestational age, birth weight >3800?g) were not. In multivariate analysis, gestational age remained the strongest association, while maternal diabetes and low birth weight became non-significant.

Conclusions: We showed a high occurrence of early hypoglycemia in normal newborns using universal screening. The strongest risk factor was early gestational age. Surprisingly, incidence of early hypoglycemia in the presence of other classical risk factors was like that of the general population.     

Large for Gestational Age Births Among South Indian Women: Temporal Trend and Risk Factors from 1996 to 2010

Background/Purpose

Mean birth weight is a good health indicator for any population. In the recent past, there have been many reports in the West indicating that there has been an increase in the proportion of large for gestational age (LGA) babies. The objective is to describe the change in the incidence of LGA babies from 1996 to 2010 in South India and the maternal risk factors.

Methods

A rotational sampling scheme was used, i.e., the 12 months of the year were divided into 4 quarters and a month was from each quarter was selected rotationally. All deliveries for that month were considered. Only deliveries that occurred between 28 and 42 weeks of pregnancy were considered. The association between risk variables was studied using multivariable logistic regression.

Results

There were 35,718 deliveries that occurred during these 15-year-study period in the gestational age 28–42 weeks were registered through the outpatient clinics. The incidence of LGA was 9.4 % that has mostly remained at the same level. The incidence of LGA in mothers with gestational diabetes was 6.7, 3 and 17.6 % in overweight, obese and gestational l diabetes mothers. Overweight, obesity in pregnant women and cesarean section were significant risk factors.

Conclusion

Unlike in Western countries, where the incidence of LGA babies has spiraled upward, has remained nearly at the same level over one and a half decades, in South India. The risk factors for giving birth to LGA babies in South India were similar to other studies.

     

Neonatal and maternal serum levels of soluble ICAM-1 in preeclamptic and normal pregnancies

The aim of this study is to determine whether circulating levels of sICAM-1 were changed in infants of preeclamptic mothers, and factors influencing these levels. Peripheral venous blood samples were obtained from preeclamptic and nonpreeclamptic pregnant women (control) and their babies in the first 2 hours post partum. The enzyme-linked immunoadsorbent assay (ELISA) technique was used to determine concentrations of sICAM-1. Compared with the control group, maternal and neonatal serum sICAM-1 levels were higher in the preeclamptic group. Neonatal levels were correlated with the maternal levels only, and there were no difference between premature and term babies and their mothers. In the control group, on the other hand, premature babies and their mothers had higher sICAM-1 levels than term babies and their mothers, with values close to those of premature group in the preeclamptic group. Neonatal sICAM-1 levels were correlated with gestational age, birth weight, and also with maternal levels. Linear regression analysis of these parameters, however, showed that only the gestational age was significant. The study suggests that perinatal sICAM-1 levels possibly are not independent from the maternal levels. High sICAM-1 levels in infants of preeclamptic mothers and premature babies might reflect the high maternal levels.     

Gestational diabetes: the forerunner for the development of maternal and childhood obesity and metabolic syndrome?

OBJECTIVE: To examine the risk of obesity and metabolic syndrome in women with a history of gestational diabetes mellitus and in offspring born to mothers with gestational diabetes mellitus. METHODS: A review of studies examining the development of obesity, hypertension, metabolic abnormalities, metabolic syndrome, and type II diabetes in mothers with a history of gestational diabetes mellitus and control mothers, and offspring of mothers with a history of gestational diabetes and control mothers. RESULTS: Longitudinal studies demonstrate that women with a prior history of gestational diabetes mellitus and obesity are at significantly greater risk of developing metabolic syndrome than mothers with no history of gestational diabetes or obesity. The development of metabolic syndrome in children with increasing age is related to maternal gestational diabetes mellitus, maternal glycemia in the 3rd trimester, maternal obesity, neonatal macrosomia, and childhood obesity. CONCLUSIONS: The current prevalence of obesity in both adults and children and associated disorders of blood pressure and lipid metabolism, suggest a perpetuating cycle of increasing obesity, insulin resistance, and abnormal lipid metabolism, which has ominous consequences for future generations.     

Low values on 50 gram glucose challenge test or oral 100 gram glucose tolerance test are associated with good perinatal outcome.

We set out to reevaluate the hypothesis that high normal (negative) results of 50 g oral glucose challenge test or high normal glucose level on 100 g oral glucose tolerance test are associated with complications of pregnancy and delivery. This was a prospective study involving 735 nondiabetic women. The first group (n=352) was made up of pregnant women with normal 50 g oral glucose challenge test without previous history of diabetes mellitus or gestational diabetes. The second group (n=383) was made up of pregnant women without previous history of diabetes mellitus or gestational diabetes with an abnormal 50 g oral glucose challenge test and with normal 100 g oral glucose tolerance test and not more than one previous delivery. In nondiabetic women, we demonstrated a positive correlation between high normal 50 g glucose challenge test values and the incidence of preeclampsia, caesarean section rate, macrosomia, neonatal hyperlipidaemia and minor congenital abnormalities. We failed to confirm any relationship to any pregnancy complication in pregnant women with 2-hour glucose levels in the range 6.7-9.1 mmol/l on the 100 g oral glucose tolerance test. We have demonstrated a positive relationship between the incidence of premature rupture of membranes and 1-hour glucose level, caesarean section rate and maternal 1-hour glucose level or 1-hour glucose level minus fasting glucose level of 4.2 mmol/l, instrumental delivery rate and maternal 3-hour glucose level, incidence of neonatal macrosomia and 1-hour glucose level, and incidence of neonatal hyperlipidaemia and at least one high but normal glucose level on the 100 g oral glucose tolerance test. With regard to pregnancy and delivery complications there were no significant difference if the high normal value is on the 50 g glucose challenge test or on the 100 g oral glucose tolerance test. It is concluded that one high normal 100 g oral glucose tolerance test or high normal 50 g glucose challenge test are associated with adverse pregnancy and delivery outcome. Nondiabetic women with 50 g glucose challenge test value of 6.1 mmol/l and/or 100 g oral glucose tolerance test values of 5 mmol/l have a favourable pregnancy and delivery outcome.