Does raising the glucose challenge test threshold impact birthweight in Asian gravidas?

OBJECTIVE: Some authors suggest a glucose challenge test (GCT) threshold of 150 mg/dL in Asian gravidas. The impact of such a policy on outcomes is unknown. STUDY DESIGN: A retrospective cohort of 1705 Asian gravidas. Subjects (n=95) had a GCT of 140-150 mg/dL and underwent a 3-h glucose tolerance test (GTT). Matched controls (n=190) had a GCT of <140 mg/dL. Birthweight was the primary outcome and the secondary outcomes were cesarean delivery (CD) rate and macrosomia. RESULTS: Eight subjects (11.9%) had gestational diabetes mellitus (GDM); none had GTT fasting values of >90 mg/dL. Mean birthweight was 3282 g in the subjects and 3238 g in the controls (P=0.39). There were no significant differences in the secondary outcomes. CONCLUSION: Compared with controls, study patients did not deliver significantly larger infants. However, raising the GCT threshold would have missed 8 subjects (11.9%) with GDM. Raising the GCT threshold to 150 mg/dL in Asian gravidas may unacceptably lower the sensitivity of the screening test.     

Can the 50-g glucose challenge test be important for subsequent pregnancies?

Aim: Our aim in this study was to examine the risk factors associated with gestational diabetes mellitus (GDM) in women who did not have GDM during a previous pregnancy. Materials and methods: In this retrospective cohort study, we reviewed the charts of all pregnant women who delivered two pregnancies between January 2000 and June 2010. Group 1 consisted of patients with gestational diabetes and Group 2 served as the control. Results: There were 743 women who underwent GDM screening by means of the 50-g glucose challenge test (GCT). Thirty-eight women (5.1%) were excluded because of a previous history of GDM. The recurrence of GDM was 42.1% in this group (16 of the 38). The remaining 705 patients were divided into the GDM group (n?=?38) and the control group (n?=?667). Undergoing a 50-g GCT during the previous pregnancy (p?=?0.000, 95% CI +0.01 to +0.002), age (p?=?0.009, 95% CI +0.001 to +0.009), and weight differences between the pregnancies at the first trimester (p?=?0.005, 95% CI +0.001 to +0.007) were independent parameters related to GDM. Conclusion: The 50-g GCT during the previous pregnancy was, interestingly, increased in the GDM group. It was also an independent risk factor for women without a history of GDM.     

Does high maternal first trimester iron status have an effect on the 50 g oral glucose test?

We aimed to test the hypothesis that 1st trimester high body iron status is associated with a high positive 50 g oral glucose tolerance test. In this study, 29 pregnant women with positive 50 g oral glucose tolerance test were compared with 94 negative 50 g OGTT patients as the control group in terms of 1st trimester iron status. Both groups had similar age, weight, height, body mass index and also median gravidity and parity values. Our results showed that there were no differences between groups in mean haemoglobin, haematocrit, serum iron, serum ferritin, total iron binding capacity and transferrin. Since it seems that free radicals have much influence on oxidative stress and glucose metabolism, prospective, randomised clinical trials should be designed to demonstrate the possible relation between maternal iron status and glucose intolerance.     

Is thrombophilia a risk factor for placenta-mediated pregnancy complications?

Purpose

To determine if thrombophilia is a risk factor for placenta-mediated pregnancy complications (PMPC) (i.e., preeclampsia, intrauterine growth restriction (IUGR), placental abruption, intrauterine fetal death and recurrent pregnancy loss).

Methods

A 5-year retrospective cohort study. Ongoing pregnancies in women with an antecedent PMPC with thrombophilia were compared with the pregnancies in similar women without thrombophilia. The main outcome measures were mean birth weight deviations, corrected for gestational age, and recurrence of PMPC. Low-molecular-weight heparin (LMWH) was employed for thromboprophylaxis only. Mann?CWhitney??s, Fisher??s and Chi-square tests were employed for comparison.

Results

PMPC recurred in 10/43 (23?%) in the thrombophilia group and in 7/41 (17?%) in the non-thrombophilia group, P?P?Conclusion Thrombophilia does hardly increase the risk of IUGR/PMPC or if so, it can be prevented by LMWH.     

Sleep-disordered breathing: a risk factor for adverse pregnancy outcomes?

In nonpregnant populations, sleep-disordered breathing (SDB) has been associated with cardiovascular and metabolic disease. Few studies have examined the relationship between SDB and adverse pregnancy outcomes (APO). The objective of this study was to examine the association between SDB and APO. Women who had a delivery as well as an in-laboratory polysomnogram (PSG) were identified. Demographics, PSG results, and pregnancy outcomes were abstracted from the medical record. Absence of SDB was defined as an apnea hypopnea index (AHI) of <5, mild SDB as an AHI of 5 to 14.9, and moderate to severe SDB as an AHI of ≥15. The primary outcome was a composite measure of APO: pregnancy-related hypertension, gestational diabetes, or preterm birth ≤34 weeks. We identified 143 women who had undergone a PSG and a delivery. Increasing severity of SDB was associated with an increasing risk of the composite APO: AHI <5, 18.1%; AHI 5 to 14.9, 23.5%; AHI ≥15, 38.5% (p = 0.038). Obese women (body mass index ≥30) with moderate to severe SDB had the highest rate of APO, 41.7%. SDB, especially moderate to severe disease, may be associated with APO. However, it is unclear if SDB is a risk factor for APO independent of obesity.     

Adverse outcome of pregnancy following air travel: a myth or a concern?

OBJECTIVE: To assess whether air travel elevates the risk of adverse pregnancy outcomes in essentially healthy women with single non-anomalous fetuses at a gestational age greater than 20 weeks. METHODS: A retrospective analysis of air travel during the current pregnancy and pregnancy outcome was undertaken in 992 women admitted for delivery over a 12-month period. The study group of 546 (55%) women, of whom 57% were primigravidae, travelled at least once during pregnancy, and were compared with a control group of 447 women (45%), of whom 54% were primigravidae, who did not travel by air. RESULTS: The primigravidae in the study group showed an increased risk of preterm birth, and this risk was statistically significant between the gestations of 34 and 37 weeks (adjusted odds ratio 1.5, 95% confidence intervals 1.2, 1.8); this risk remained elevated after adjustment for covariates. These women's pregnancies were appreciably shorter than those of primigravidae who did not fly (36.1 +/- 0.8 vs. 39.2 +/- 2.1 weeks) and their babies had lower birthweights (2684 +/- 481 vs. 3481 +/- 703 g). and were more likely to be admitted to the neonatal intensive care unit. This group of air travellers is unusual for the uncommonly long and frequent duration of air travel, which is not routinely undertaken in most parts of the world. There were no thromboembolic events complicating any pregnancies. CONCLUSIONS: Primigravid women who travel by air appear to be at higher risk for preterm birth. Multicentre large studies are required to confirm or repute these findings.     

Does the frequency of outpatient visits in addition to the regularly scheduled prenatal visits identify a poor pregnancy outcome?

Do extra outpatient visits, in addition to regularly scheduled visits, identify a pregnancy at risk of an adverse outcome? This prospective investigation analysed additional outpatient visits, by low-risk obstetric patients. One hundred and sixty-two women were evaluated with one to two additional visits and 66 had three or more visits. Antepartum and intrapartum pregnancy complications between groups was similar suggesting that frequency of additional visits does not identify a pregnancy at risk for an adverse outcome.     

Does hysteroscopic metroplasty for septate uterus represent a risk factor for adverse outcome during pregnancy and labor?

The aim of the study was to evaluate whether hysteroscopic metroplasty for septate uterus represents a risk factor of adverse outcome in pregnancy, during labor, and after delivery. This is a retrospective comparative study of obstetric complications of 99 patients who underwent hysteroscopic metroplasty in a 5-year period (study group) and 4155 women, who gave birth in the same hospital in the same period (control group). No difference in obstetric outcome (preterm labor, hemorrhage before and after delivery, mean weeks of gestation at delivery, mean birth weight, breech presentation, and cesarean section rate) between the two groups has been found. The results of this study suggest that patients who underwent hysteroscopic metroplasty for septate uterus are at no higher risk of adverse obstetric outcome at term and during labor, comparing to the general population. Though vaginal delivery seems to be safe, rare but serious complication, reported by several studies, like uterine rupture during pregnancy or labor, should always be taken into consideration.     

Can glucose tolerance test predict fetal hyperinsulinism?

Objective To establish cut off levels for oral glucose tolerance test in pregnancy using fetal hyperinsulinism as a clinical endpoint.
Design Capillary blood glucose levels at 0, 1, and 2 hours after the ingestion of either 1 g/kg or 75 g glucose, at 28 (SD 5) weeks of gestation were analysed in 220 women with elevated amniotic fluid insulin levels [≥ 42 pmol/L (≥ 7 μU/mL)] after a mean (SD) of 31 weeks (3) and in 220 nondiabetic controls.
Results In women with elevated amniotic fluid insulin levels the mean (SD) capillary blood glucose values at 0, 1, and 2 hours were 5.2 mmol/L (1.0) [94 mg/dL (18)], 10.5 mmol/L (1.4) [189 mg/dL (25)] and 8.2 mmol/L (2.0) [147 mg/dL (36)], respectively. The one-hour value had the highest sensitivity to predict elevated amniotic fluid insulin levels. The 5th centile of the one-hour blood glucose levels representing a detection rate of 95% was 8.9 mmol/L (160 mg/dL).
Conclusion Glucose cut off levels in most established oral glucose tolerance test criteria are too high, to accurately predict amniotic fluid hyperinsulinism. A one-hour test may be sufficient for detecting amniotic fluid hyperinsulinism. Since different loads (1 g/kg, 75 g or 100 g) and blood fractions (venous plasma or capillary blood) have minimal impact on oral glucose tolerance test results, a single one-hour cut off of 8.9 mmol/L (160 mg/dL), independent of the sampling method, may be appropriate for the diagnosis of gestational diabetes mellitus severe enough to cause amniotic fluid hyperinsulinism.     

Does anovulation induced by oral contraceptives favor pregnancy during the following two menstrual cycles?

OBJECTIVE: To compare IVF and pregnancy outcomes before and after anovulation induced by oral contraceptives.Design: Observational clinical study. SETTING: Infertility clinic. PATIENT(s): Forty women with two intact ovaries (32 of 40 couples with male factor infertility and 8 with unknown causes of infertility) underwent 190 IVF treatment cycles (55 natural cycles and 135 clomiphene citrate-stimulated cycles). INTERVENTION(s): If the women failed to conceive after 2-4 IVF treatment cycles, oral contraceptives were used to induce anovulation for 1 month before IVF was performed in two consecutive cycles. MAIN OUTCOME MEASURE(s): Rates of oocyte retrieval, fertilization, cleavage, preembryo formation, pregnancy, and implantation were compared before and after a period of anovulation. RESULT(s): The pregnancy rate per cycle of the first and second cycle combined (23%) and that of the second cycle alone (30%) after a period of anovulation were significantly higher than that observed before a period of anovulation (9%). CONCLUSION(s): Anovulation induced by oral contraceptives, showing bilateral ovarian quiescence, enhances pregnancy rates in the following two menstrual cycles of IVF treatment.     

50-Gram glucose challenge test: is it indicative of outcomes in women without gestational diabetes mellitus?

Objective.?To examine whether the 50-gram glucose challenge test (GCT) is associated with perinatal outcomes in women without gestational diabetes mellitus (GDM).

Methods.?This is a retrospective cohort study of 13,789 women who received the GCT and did not have a diagnosis of GDM at the University of California, San Francisco UCSF. GCT values were categorized and examined as predictors of perinatal morbidity using chi-square test and multivariable logistic regression analyses adjusting for maternal characteristics.

Results.?In women with an elevated GCT but without GDM, the odds of preeclampsia, cesarean delivery, and elevated birth weight were increased. The odds of large-for-gestational age status were increased with aOR 2.0 (95% CI 1.38–2.90) in the 160–179 mg/dl group. The odds of shoulder dystocia was increased with aOR 3.35 (CI 1.03–10.88) in the?≥180mg/dl group.

Conclusion.?In women without GDM, elevated 50-gram GCT values were associated with higher odds of perinatal morbidity. These findings further support evidence that impaired glucose tolerance is a continuum with possible associated adverse outcomes even at mild ranges; additional research is required to investigate appropriate interventions for women with abnormal screens for GDM.     

The association between low 50 g glucose challenge test result and fetal growth restriction

Abstract

Objective: To determine whether a low-GCT result is predictive of low birthweight and to identify the lower GCT threshold for prediction of fetal growth restriction.

Methods: A retrospective cohort study of 12?899 women who underwent a GCT (24–28 weeks). Women with a low-GCT result (<10th percentile (70?mg/dL) were compared to women with normal-GCT result (70–140?mg/dL). ROC analysis was used to determine the optimal lower GCT threshold for the prediction of growth restriction.

Results: Women in the low GCT had significant lower rates of cesarean delivery (18.7% versus 22.5%), shoulder dystocia (0.0% versus 0.3%), mean birthweight (3096?±?576 versus 3163?±?545) and birthweight percentile (49.1?±?27.0 versus 53.1?±?26.7) and significant higher rates of birthweight <2500?g (11.3% versus 8.5%), below the 10th percentile (8.3% versus 6.5%) and 3rd percentile (2.3% versus 1.4%). Low GCT was independently associated with an increased risk for birthweight <2500?g (OR?=?1.6, 1.2–2.0), birthweight <10th percentile (OR?=?1.3, 1.1–1.6), birthweight <3rd percentile (OR?=?1.7, 1.2–2.5) and neonatal hypoglycemia (OR?=?1.4, 1.02–2.0). The optimal GCT threshold for the prediction of birthweight <10th percentile was 88.5?mg/dL (sensitivity 48.5%, specificity 58.1%).

Conclusion: Low-GCT result is independently associated with low birthweight and can be used in combination with additional factors for the prediction of fetal growth restriction.     

Problems of recurrent loss of pregnancy: are procoagulant microparticles a risk factor for pregnancy outcome?

BACKGROUND: Circulating procoagulant microparticles (PM) are a novel risk factor for pregnancy outcome. They derive from cytosol and membranes of the cells undergoing apoptosis or pathological activation. Tissue factor and phospholipids are the active components of PM responsible for "placental thrombosis" and pregnancy loss. STUDY DESIGN: The paper is a survey of the literature on the pathological role of PM in complicated pregnancy. RESULTS AND CONCLUSIONS: The published studies suggest that PM play a role of a pathogenic factor in women with repeated pregnancy loss. Prophylaxis within low-molecular heparin is a promising clinical procedure.     

Does air travel affect pregnancy outcome?

Introduction Primary ovarian carcinoid tumours are uncommon neoplasias. There are distinct histological types with different behaviours: insular, trabecular, mucinous and mixed. The trabecular subtype is very rare and unlike other carcinoid subtypes, it is characterised by the absence of a clinical carcinoid syndrome and has been related with a better prognosis than the others. No distant metastases have yet been reported. Case report We present a case of a 76-year-old woman diagnosed with a left ovarian tumour. She underwent a radical hysterectomy with bilateral salpingo-oophorectomy and regional lymph node clearance. Histology revealed an ovarian trabecular carcinoid tumour and no adjuvant treatments were performed. The patient is alive and free of disease 70 months following diagnosis. Discussion Immunohistochemical staining for p53 protein, and a comparative study with other subtypes of ovarian carcinoid tumours (insular and mucinous) is discussed in this report.     

Does pregnancy affect pelvic organ mobility?

BACKGROUND: It is generally accepted that parity is a strong predictor of pelvic organ prolapse and incontinence. However, controversy persists as to whether this effect is due to pregnancy itself or parturition. AIMS: To define the contribution of early and late pregnancy to bladder mobility. METHODS: Case control series, using 88 non-pregnant control subjects recruited for a heritability study on urinary incontinence and prolapse, matched for age and ethnicity with 28 pregnant women seen at 10-17 weeks and again at 32-39 weeks' gestation. Main outcome parameters were ultrasound measures of anterior, central and posterior compartment descent as well as joint mobility measurements. RESULTS: Patients in early pregnancy showed higher values for bladder mobility in comparison with non-pregnant controls, although this did not reach significance for all parameters. However, when late pregnancy data were tested against non-pregnant controls, this difference reached significance for all tested parameters. Uterine and rectal descent did not show any significant differences between groups. Results for joint mobility were inconsistent. CONCLUSIONS: This study supports the hypothesis that bladder and urethral mobility increase in pregnancy. This effect is already noticeable at 6-18 weeks. As similar changes are also seen in elbow hyperextension, a generalised effect on connective tissue biomechanics, likely hormonal, can be hypothesised.