Predictors of abnormal glucose metabolism in women with polycystic ovary syndrome

OBJECTIVE: Polycystic ovary syndrome (PCOS) is a risk factor for type 2 diabetes mellitus and screening for abnormal glucose metabolism has been recommended by an oral glucose tolerance test (OGTT). This procedure is time-consuming and inconvenient, limiting its general use. Therefore, an easy method is wanted to separate PCOS women with normal from those with potentially abnormal glucose metabolism. DESIGN: Simple parameters obtained from 101 consecutive PCOS patients were assessed by receiver operating curve analysis for their ability to predict abnormal glucose metabolism. RESULTS: Comparing discriminating parameters at defined sensitivities revealed that, assessed by homeostasis model assessment (HOMA), insulin resistance (HOMA%S) had the highest specificity. At a cut-off point of 73.1%, HOMA%S had a sensitivity of 95.5% and a specificity of 51.9%. Applying this cut-off separated 59 women who had a high probability of abnormal glucose metabolism from 42 women who were at low risk (less than 2.5%). Fasting insulin was the second-best parameter and had a similar specificity. A screening strategy which applies HOMA%S or fasting insulin could almost halve the number of OGTTs by directing them to those PCOS women most likely to be suffering from abnormal glucose metabolism. The negative predictive value of this strategy was 97%. The strategy was tested and confirmed in a second and independent cohort of 264 PCOS women. CONCLUSIONS: HOMA%S, or to a lesser extent fasting insulin, appears to allow for stratified metabolic screening of PCOS women with OGTT.     

多囊卵巢综合征患者糖代谢异常发生率及其特点

目的 探讨多囊卵巢综合征患者糖代谢异常特点及其发生率.方法 回顾性分析2006年6月1日至2009年2月1日广州中山大学孙逸仙纪念医院妇产科收治的初诊多囊卵巢综合征患者654例(青春期101例,成人553例),以120名年龄匹配的健康志愿者为对照组(青春期40名,成人80名).病例和对照组均行口服葡萄糖耐量试验和胰岛素释放试验,比较病例组和对照组、成人多囊卵巢综合征与青春期多囊卵巢综合征、不同体重指数亚组中糖代谢异常的特点及其发生率.结果 多囊卵巢综合征患者糖代谢异常的发生率为24.5%(160/654),显著高于对照组的3.3%(4/120)(χ2=27.11,P<0.0001);成人病例组糖代谢异常的发生率高于青春期病例组(分别为26.6%、12.9%,χ2=8.688,P=0.003),青春期病例组代谢异常的发生率高于青春期对照组(分别为12.9%、0%,χ2=5.671,P=0.02).多囊卵巢综合征患者糖代谢异常主要表现为糖耐量受损(62.5%),其次为空腹血糖受损(43.8%),糖尿病仅占少数(8.1%);糖尿病13例,仅4例(30.8%)空腹血糖>7.0 mmol/L,9例(69.2%)通过口服葡萄糖耐量试验筛查发现.多囊卵巢综合征组糖代谢异常的发生率随体重指数升高而升高(χ2=53.71,P<0.0001).结论 多囊卵巢综合征患者为糖代谢异常的高危人群,其糖代谢异常以糖耐量受损为主,空腹血糖受损次之.多囊卵巢综合征患者(尤其是肥胖者)应行口服葡萄糖耐最试验,以早期发现其糖代谢异常.     

Gestational diabetes: A link between OGTT,maternal-fetal outcomes and maternal glucose tolerance after childbirth

Background and aimThe relationship among distribution of pathological values at the Oral Glucose Tolerance Test (OGTT), metabolic risk factors and pregnancy outcomes in women with Gestational Diabetes (GDM), has not been clearly identified. We retrospectively compared metabolic and therapeutic parameters, maternal–fetal outcomes and post-partum OGTTs, with respect to the number and distribution of altered values of diagnostic OGTT in pregnancy. Secondly, we assessed whether insulin therapy predictive factors were identifiable.Methods and resultsThis analysis included 602 pregnant women with GDM, followed in Diabetes and Pregnancy Unit of Perugia Hospital from diagnosis to childbirth. All women were diagnosed diabetic upon 75g OGTT, according IADPSG criteria. Women were divided into 3 groups, respect to distribution of diagnostic blood glucose (BG) values at OGTT: Group 1: only fasting BG (OGTT0h); Group 2: 1 and/or 2h (OGTT1-2h); Group 3: both fasting and 1 h and/or 2h (OGTT0+1–2h) BG.Pregnant women with fasting hyperglycemia at OGTT (Groups 1 and 3) had similar metabolic characteristics (weight, prevalence of obesity, gestational weight gain, HbA1c), a greater need for insulin therapy, and a higher risk of impaired glucose tolerance persistence after childbirth, as compared to Group 2. No significant differences were observed in terms of maternal and neonatal outcomes (p > 0.05), except for a greater prevalence of caesarean sections in Group 3.ConclusionThe metabolic characteristics of GDM women are mirrored by OGTT values at diagnosis, but are not associated with adverse pregnancy outcomes. Intensive management and a tailored treatment of GDM improve maternal-neonatal outcomes, regardless of diagnostic values distribution and pre-gestational metabolic characteristics.     

The insulin response to glucose infusion in normal human pregnancy

Summary To study insulin response and insulin sensitivity a glucose infusion test was devised. Twenty normal non-pregnant and twenty normal pregnant women had an intravenous glucose tolerance test followed by a glucose infusion test. In a normal pregnant group at 38–40 weeks gestation (n=20) the plasma insulin response was found to be 3.7 times greater than that observed in a normal non-pregnant group (n=20), while in the normal pregnant group the insulin sensitivity index was only 18 per cent of that observed in the non-pregnant group. Intravenous glucose tolerance in the non-pregnant women was observed to correlate with the insulin sensitivity index (r=0.61, p<0.05) but in the pregnant women it correlated with the insulin response (r=0.66, p<0.01). These findings support the hypothesis that in the non-pregnant state intravenous glucose tolerance may be primarily related to insulin sensitivity while during pregnancy it may be related to the degree of compensatory hyperinsulinism.     

Incidence of diabetes mellitus in women following impaired glucose tolerance in pregnancy is lower than following impaired glucose tolerance in the non-pregnant state

Summary Impaired glucose tolerance (IGT), which is asymptomatic and requires a glucose tolerance test for detection, is a well-known risk factor for diabetes mellitus. Outside the research setting it is rarely identified in people who lack specific risk factors for diabetes except during pregnancy, at which time screening with an oral glucose challenge is a routine procedure. A 75-g oral glucose tolerance test was performed during the latter part of pregnancy or during a routine epidemiology survey in 15–39-year-old Pima Indian women with no history of abnormal glucose tolerance. Those with IGT by World Health Organization criteria were included in this study. Diabetes incidence in women was compared between those whose IGT was first detected during pregnancy and those who were not pregnant when IGT was first recognized. Seventeen of 73 pregnant women and 114 of 244 non-pregnant women developed diabetes within 10 years. When controlled for plasma glucose concentration, age, body mass index, parity and duration of follow-up, those who were not pregnant were at higher risk of developing diabetes than those who were pregnant (hazard rate ratio = 1.71, 95 % confidence interval = 1.01–2.91). Previous studies had reported that women with IGT during pregnancy are at higher risk of diabetes than women with normal glucose tolerance. This study suggests that women with IGT during pregnancy are at lower risk than non-pregnant women with a similar plasma glucose concentration who, in the clinical setting, are likely to remain unrecognized. [Diabetologia (1996) 39: 1334–1337] Received: 15 February 1996 and in revised form: 8 May 1996     

Comparison of National Diabetes Data Group and World Health Organization criteria for detecting gestational diabetes mellitus

Summary We compared the criteria for diagnosis of gestational diabetes mellitus (GDM) of the National Diabetes Data Group (NDDG) and the World Health Organization (WHO) and studied the outcomes of pregnancy. A 50-g glucose screening test and 75-g oral glucose tolerance test (OGTT) were scheduled for 709 pregnant women in the same week between the 24th and 28th week of pregnancy. Blood glucose was measured 1 h after the 50-g glucose screening test and if found to be 7.8 mmol/l or more, a 100-g OGTT was scheduled within 7 days after a 75-g OGTT. The prevalence of GDM was found to be 1.4% (10/709) and 15.7% (111/709) by NDDG and WHO criteria (2 h 7.8 mmol/l), respectively. Using NDDG criteria, all the GDM patients had abnormal 75-g OGTT by WHO criteria. NDDG and WHO criteria were significantly different when compared with normal OGTT by each criteria for age, BMI, pregnancy-induced hypertension, Caesarian delivery, macrosomia and neonatal hypoglycaemia. Of 14 women with macrosomic infants 6 had an abnormal WHO test while only 3 of 14 had an abnormal NDDG test. These findings suggest that WHO criteria GDM patients had significantly worse outcomes of pregnancy and fewer perinatal complications were missed than with the more cumbersome NDDG criteria, and no case of GDM as diagnosed by NDDG criteria was missed.Abbreviations GDM Gestational diabetes mellitus - NDDG National Diabetes Data Group - WHO World Health Organization - OGTT oral glucose tolerance test - BMI body mass index     

Increased plasma leptin in gestational diabetes

Aims/hypothesis. Insulin resistance as well as marked changes in body weight and energy metabolism are associated with pregnancy. Its impact on plasma leptin is not known and was determined in this longitudinal study in both diabetic and normal pregnancy. Methods. At 28 gestational weeks plasma concentrations of leptin and B-cell hormones were measured at fasting and after an oral glucose load (OGTT:75 g) in women with gestational diabetes and pregnant women with normal glucose tolerance and compared with women who were not pregnant (C). Results. Plasma leptin (ng/ml) was higher (p < 0.001) in women with gestational diabetes (24.9 ± 1.6) than in women with normal glucose tolerance (18.2 ± 1.5) and increased in both groups when compared with the non-pregnant women (8.2 ± 1.3; p < 0.0005). No change in plasma leptin concentrations was induced by OGTT in any group. Basal insulin release was higher (p < 0.05) in women with gestational diabetes compared with the pregnant women with normal glucose tolerance. Marked insulin resistance was confirmed by a 20 % lower (p < 0.05) insulin sensitivity in subgroup analysis and a decrease of almost 40 % in fasting glucose/insulin ratio (p < 0.005) in women with gestational diabetes. Leptin correlated in women with gestational diabetes with basal plasma concentrations of glucose (p < 0.02), insulin (p < 0.004) and proinsulin (p < 0.01) as well as with BMI (p < 0.001) and overall pregnancy induced maternal weight gain (p < 0.009). With normalisation of blood glucose 8 weeks after delivery in women with gestational diabetes their plasma leptin decreased (p < 0.0005) to 17.3 ± 1.9 ng/ml but did not completely normalize (p < 0.05 vs non-pregnant women). Conclusion/interpretation. Our data show that women with gestational diabetes without any change in plasma leptin upon oral glucose loading have increased plasma leptin concentrations during and after pregnancy, a clear association of plasma leptin with the respective concentration of glucose and insulin resistance as well as with changes in body weight, and a failure to normalize spontaneously BMI to the same extent as pregnant women with normal glucose tolerance when compared with matched control subjects. [Diabetologia (2001) 44: 164–172] Received: 11 July 2000 and in revised form: 10 October 2000     

妊娠期糖代谢异常对妊娠的不良影响

目的了解妊娠期糖代谢异常对孕妇和围生儿的影响。方法对10809名孕妇在孕24～28周做50g葡萄糖负荷试验，阳性者再做75gOGTT，据血糖结果分为糖代谢正常（GNGT）组、妊娠糖尿病（GDM）组和妊娠期糖耐量减低（GIGT）组，比较三组妊娠的结局。结果GDM和GIGT组的患病率分别为0．61％和2．50％。GDM组孕妇产后即时出血、剖宫产、妊娠高血压综合征、羊水过多、巨大儿、早产儿和新生儿低血糖的发生率均显著高于GNGT组；GIGT组剖宫产、羊水过多、巨大儿的发生率显著高于GNGT组，低体重儿发生率低于GNGT组。结论妊娠期糖代谢异常对孕产妇和围生儿有不良影响，因此应重视孕期糖代谢异常的筛查、诊断和治疗。     

Vitamin D deficiency in pregnant women: Influenced by multiple risk factors and increase the risks of spontaneous abortion and small-for-gestational age

Objective:To analyze the level of vitamin D and its influencing factors in pregnant women, and to explore the influence of vitamin D deficiency on common adverse pregnancy outcomes in pregnant women, providing evidence for prevention and intervention of vitamin D deficiency in pregnant women.Methods:The basic data and blood samples of pregnant women in our hospital from January 2019 to June 2020 were collected, and the 25-(OH) D levels of the serum samples were detected. Then the vitamin D levels and its influencing factors were analyzed, and the relationships between vitamin D levels and common adverse pregnancy outcomes in the pregnant women as well as the incidence of small-for-gestational-age newborns were analyzed.Results:The vitamin D deficiency rate, insufficiency rate and sufficiency rate of pregnant women were 83.28%, 15.36%, and 1.36% respectively, with vast majority of the pregnant women in a state of vitamin D deficiency. Analysis of the influencing factors on the vitamin D level of pregnant women showed “28 weeks ≤ gestational age ≤32 weeks, summer and autumn, high school education and above, weekly time outdoors ≥10 hours, supplement of vitamin D and trace elements during pregnancy” were protective factors for vitamin D sufficiency in pregnant women. Linear correlation analysis showed the vitamin D level of pregnant women was highly positively correlated with temperature, the higher the temperature, the higher the vitamin D level (r = 0.907, t = 6.818, P < .001). The level of vitamin D in pregnant women was related to the occurrence of spontaneous abortion and small-for-gestational age (SGA), with the incidence of spontaneous abortion and SGA in the “vitamin D deficiency group” higher than those of other groups (P = .018, P = .016).Conclusions:The vitamin D level of pregnant women in this area is relatively low, which is affected by multiple factors such as gestational age, season, education level of pregnant women, weekly time outdoors, vitamin D and trace element supplement during pregnancy. Low vitamin D levels can increase the risk of spontaneous abortion and SGA in pregnant women, so relevant measures should be adopted to improve the vitamin D status of pregnant women.     

育龄妇女妊娠期糖代谢异常及维生素D相关知识调查

目的了解北京地区正常育龄妇女对于妊娠糖代谢异常及维生素D相关知识的了解情况。方法采用问卷方式对2010年12月北京城区育龄妇女170例进行调查。结果调查对象中妊娠糖代谢异常知晓率达90.6%,妊娠糖代谢异常对母婴的危害认知程度分别为91.2%及89.4%;糖代谢异常常见的危险因素如饮食、高龄、肥胖的认知程度也较高,认知度均大于50.0%。维生素D在妊娠期糖尿病(GDM)中的作用认知程度知晓率为29.4%;怎样预防GDM的认知程度最低,知晓率只有9.4%;不同文化程度对于维生素D在GDM中的作用认知程度没有差异;育龄妇女对于维生素D在骨钙化方面的认知度较高,达到72.4%;富含维生素D的食物认知度达到52.3%;户外活动与维生素D的关系认知度最低,只有37.0%;目前坚持食用强化维生素D食物者只有18.2%,坚持服用维生素D制剂者只有5.3%,坚持户外运动者只有21.8%。结论北京城区育龄妇女对于妊娠糖代谢异常关注度很高,对于常见高危因素也有认知,但对维生素D在预防妊娠糖代谢异常中的作用认知程度低,对补充维生素D不够关注。应重视预防妊娠糖代谢异常相关知识的宣传与普及,提高育龄妇女围妊娠期保健意识。     

No deterioration of oral glucose tolerance during pregnancy in rural Tanzania.

There is still controversy concerning the reference ranges for glucose tolerance tests in pregnancy. The WHO has recommended the universal use of the 75 g oral glucose load with 2-h post-load values of greater than 6.7 mmol l-1 to be considered impaired glucose tolerance (IGT) in the non-pregnant, and equivalent to gestational diabetes in the pregnant. Some data are available for pregnant Caucasians but little information is available for other ethnic groups. Oral glucose tolerance tests (75 g) have therefore been performed in 189 pregnant women in rural Tanzania. Mean fasting blood glucose values were 4.0 mmol l-1 in non-pregnant women, and 3.7, 3.5, and 3.3 mmol l-1 in pregnant women in the first, second, and third trimesters, respectively. Two-hour OGTT values were 4.7 mmol l-1, and 4.6, 4.5, and 4.2 mmol l-1 while the upper limit of normal values (mean + 2SD) were 7.1 mmol l-1, and 6.8, 6.8, and 6.1 mmol l-1. The 2-h glucose levels are therefore close to WHO recommendations but lower than those reported for Caucasians. By contrast with reports for Caucasians, glucose tolerance did not deteriorate during pregnancy. The prevalence of diabetes and IGT was zero in the pregnant group.     

Safety of Exposure From Extremely Low Frequency Magnetic Fields During Prenatal Ultrasound Examinations in Clinicians and Pregnant Women

Investigations into the safety of ultrasonography in pregnancy have focused on the potential harm of ultrasound itself. However, no data have been published regarding the electromagnetic fields that ultrasound devices might produce. This study is the first to measure extremely low-frequency magnetic field (ELF-MF) exposure of clinicians and pregnant women during prenatal ultrasound examinations in the examination room from 2 different ultrasound devices and compare them with ELF-MFs during patient consultation in the consulting room.The ELF-MF intensities that clinicians and pregnant women were exposed to were measured every 10 seconds for 40 prenatal ultrasound examinations using Philips iU22 or Accuvix V20 Prestige machines and 20 patient consultations in a consulting room using portable ELF-MF measurement devices.The mean ELF-MF exposure of both clinicians and pregnant women was 0.18 ± 0.06 mG during prenatal ultrasound examination. During patient consultation, the mean ELF-MF exposures of clinicians and pregnant women were 0.10 ± 0.01 and 0.11 ± 0.01 mG, respectively. Mean ELF-MF exposures during prenatal ultrasound examination were significantly higher than those during patient consultations (P < 0.001 by Mann–Whitney U test).Our results provide basic reference data on the ELF-MF exposure of both clinicians and pregnant women during prenatal ultrasound monitoring from 2 different ultrasound devices and patient consultation, all of which were below 2 mG, the most stringent level considered safe in many studies, thus relieving any anxiety of clinicians and pregnant women regarding potential risks of ELF-MFs.     

Do patients with gestational diabetes mellitus and their own blood glucose meter have better pregnancy outcomes than those not using a glucose meter?

To compare pregnancy outcomes between patients with gestational diabetes mellitus (GDM) with and without their own blood glucose meter.We conducted a retrospective-cohort study of 835 women with GDM at the Second Hospital of Tianjin Medical University, Tianjin, China from 1 January 2016 to 31 December 2018. Perinatal outcomes of these patients were monitored and collected in the Tianjin Maternal and Child Health System. Each patient was advised by a certified clinical nutritionist regarding dietary analysis and lifestyle recommendations. All pregnant women with GDM were divided into the following 2 groups according to whether they had their own blood glucose meter: women with self-measured blood glucose levels with a routine obstetric examination in the study group (n = 424); and those with non-self-measured blood glucose levels with a double obstetric examination in the control group (n = 411). Maternal and fetal pregnancy outcomes were compared between these 2 groups. According to different self-management modes, the women were also divided into eight subgroups to compare blood sugar control and compliance with recommended insulin therapy.The cesarean section rate was significantly lower in the study group than in the control group (P < .05). The prevalence of large-for-gestational age (P < .05) and macrosomia was significantly lower in the study group than in the control group (both P < .05). The prevalence of appropriate-for-gestational age was significantly higher in the study group than in the control group (P < .05). Birth weight was significantly lower in the study group than in the control group (P < .05). The mean times for blood sugar control and from the doctor recommendation for insulin treatment to the patient compliance in the study group were significantly shorter than those in the control group (both P < .05). The proportion of insulin required in the study group was significantly lower than that in the control group (P < .05). There were no significant differences in the time of controlling blood sugar and compliance among the 4 subgroups of the study group. However, subgroups with a dietary diary in the control group were better.Self-monitoring blood sugar plus a routine obstetric examination can help patients with GDM control blood sugar, even without dietary diaries and treadmills. In addition to increasing the number of obstetric examinations, recording dietary diaries is helpful for controlling blood sugar in patients with GDM who are unwilling to measure blood sugar by themselves.     

Predicting impaired glucose metabolism in women with polycystic ovary syndrome by decision tree modelling

Aims/hypothesis Polycystic ovary syndrome (PCOS) is a risk factor of type 2 diabetes. Screening for impaired glucose metabolism (IGM) with an OGTT has been recommended, but this is relatively time-consuming and inconvenient. Thus, a strategy that could minimise the need for an OGTT would be beneficial.Materials and methods Consecutive PCOS patients (n=118) with fasting glucose <6.1 mmol/l were included in the study. Parameters derived from medical history, clinical examination and fasting blood samples were assessed by decision tree modelling for their ability to discriminate women with IGM (2-h OGTT value ≥7.8 mmol/l) from those with NGT.Results According to the OGTT results, 93 PCOS women had NGT and 25 had IGM. The best decision tree consisted of HOMA-IR, the proinsulin:insulin ratio, proinsulin, 17-OH progesterone and the ratio of luteinising hormone:follicle-stimulating hormone. This tree identified 69 women with NGT. The remaining 49 women included all women with IGM (100% sensitivity, 74% specificity to detect IGM). Pruning this tree to three levels still identified 53 women with NGT (100% sensitivity, 57% specificity to detect IGM). Restricting the data matrix used for tree modelling to medical history and clinical parameters produced a tree using BMI, waist circumference and WHR. Pruning this tree to two levels separated 27 women with NGT (100% sensitivity, 29% specificity to detect IGM). The validity of both trees was tested by a leave-10%-out cross-validation.Conclusions/interpretation Decision trees are useful tools for separating PCOS women with NGT from those with IGM. They can be used for stratifying the metabolic screening of PCOS women, whereby the number of OGTTs can be markedly reduced.     

Increased Serum Levels of Growth-Differentiation Factor 3 (GDF3) and Inflammasome-Related Markers in Pregnant Women during Acute Zika Virus Infection

The systemic inflammatory response elicited by acute Zika virus (ZIKV) infection during pregnancy plays a key role in the clinical outcomes in mothers and congenitally infected offspring. The present study aimed to evaluate the serum levels of GDF-3 and inflammasome-related markers in pregnant women during acute ZIKV infection. Serum samples from pregnant (n = 18) and non-pregnant (n = 22) women with acute ZIKV infection were assessed for NLRP3, IL-1β, IL-18, and GDF3 markers through an enzyme-linked immunosorbent assay. ZIKV-negative pregnant (n = 18) and non-pregnant women (n = 15) were used as control groups. All serum markers were highly elevated in the ZIKV-infected groups in comparison with control groups (p < 0.0001). Among the ZIKV-infected groups, the serum markers were significantly augmented in the pregnant women in comparison with non-pregnant women (NLRP3 p < 0.001; IL-1β, IL-18, and GDF3 p < 0.0001). The IL-18 marker was found at significantly higher levels (p < 0.05) in the third trimester of pregnancy. Bivariate and multivariate analyses showed a strong positive correlation between GDF3 and NLRP3 markers among ZIKV-infected pregnant women (r = 0.91, p < 0.0001). The findings indicated that acute ZIKV infection during pregnancy induces the overexpression of GDF-3 and inflammasome-related markers, which may contribute to congenital disorders and harmful pregnancy outcomes.     

Repeated pregnancy among women with known HIV status in Pune, India

HIV-positive women of reproductive age face challenges in decision making related to pregnancy. Understanding factors influencing repeat pregnancies in women with known HIV status are necessary to guide interventions and counseling strategies to better inform and support them. We compared three groups of women attending a large antenatal clinic in Pune, India. They include: Group A--63 HIV-positive women coming for care for a repeat pregnancy after being diagnosed in a previous pregnancy; Group B--64 HIV-negative (repeat) pregnant women attending this antenatal clinic; and Group C--63 HIV-positive non-pregnant women currently enrolled in an ongoing clinical trial. Comparisons of Group A and B indicate that the likelihood of unplanned repeat pregnancies was significantly higher in HIV-positive (70%) than HIV-negative (36%) women (OR=4.1, CI: 2.0-8.7). Inability to terminate the pregnancy (31%) and familial obligations (40%) appear to be important for continuing the unplanned repeat pregnancy. Despite high reported contraceptive use by HIV-positive women, pregnancies still occurred. Death of their youngest child is an important factor as 21% of HIV-positive pregnant women lost their youngest child compared with 3% of HIV-negative women and 3% of HIV-positive non-pregnant women (p<0.001). Repeat pregnancies were more likely to occur for women who did not disclose their HIV status to their spouse. Thus the majority of the repeat pregnancies for HIV-positive women were both unplanned and unwanted.     

Heterogeneity of pregnancy outcomes and risk of LGA neonates in Caucasian females according to IADPSG criteria for gestational diabetes mellitus

ObjectiveThe International Association of Diabetes and Pregnancy Study Group (IADPSG) guidelines for gestational diabetes mellitus (GDM) diagnosis determines that fasting, 1-h and 2-h glucose values may contribute independently to adverse outcomes. However, given the different physiological bases of impaired fasting glucose (IFG) and impaired glucose tolerance (IGT), differences in pregnancy outcomes are to be expected. This study aimed to determine whether classification of GDM women according to glucose homoeostasis results in heterogeneity in maternal and/or fetal outcomes.Material and methodsOf the 75 pregnant women included after a 75-g 2-h OGTT performed between weeks 24–32 of gestation as per WHO criteria, 55 were classified as GDM (16 with IFG and 39 with IGT) according to IADSPG criteria. Their anthropometric and metabolic characteristics were compared with those of non-GDM women with IFG or IGT. Maternal and neonatal outcomes were prospectively recorded for each group.ResultsGDM women with IFG, including isolated IFG and combined IFG + IGT, were significantly heavier, had higher leptin values and were more frequently multiparous than GDM women with isolated IGT. HOMA-IR was significantly higher when fasting glucose was impaired. There were no significant differences in maternal outcomes according to metabolic status. In addition, large for gestational age (LGA) neonates were significantly seen more often in the IFG group. Fasting glucose was significantly associated with LGA independently of BMI and 2-h OGTT glucose. The > 5.1 mmol/L cut-off value for fasting glucose was highly predictive of delivery of LGA infants.ConclusionIFG in GDM women was associated with increases in BMI, fat mass and hepatic insulin resistance. Delivery of LGA neonates was more frequent when fasting glycaemia was increased during the third trimester of pregnancy, and was independent of BMI and 2-h OGTT glucose values.     

Abnormal screening glucose challenge test in pregnancy and future risk of diabetes in young women

Aims Pregnant women commonly undergo screening for gestational diabetes mellitus (GDM) using a 50‐g glucose challenge test (GCT), followed by a diagnostic oral glucose tolerance test (OGTT) in those women in whom the GCT is abnormal. Although it has long been recognized that GDM is associated with subsequent Type 2 diabetes, it has recently emerged that any degree of abnormal antepartum glucose homeostasis predicts an increased risk of postpartum glucose intolerance. Thus, in this context, we sought to determine whether women who have a pregnancy complicated by an abnormal GCT, but who do not have GDM, are at increased risk of subsequent diabetes, compared with their peers with an abnormal GCT. Methods A population‐based, retrospective cohort study was conducted. Women referred for an antepartum OGTT indicative of an abnormal GCT (n = 15 381), but without GDM, were matched (for age, region, socioeconomic status, and year of delivery) with up to four other women without such referral (n = 61 237). The two cohorts were followed over a median 6.4 years for the development of diabetes. Results The rate of incident diabetes was 5.04 cases per 1000 person‐years in the cohort of women who underwent an antepartum OGTT, compared with 1.74 cases per 1000 person‐years in women without an OGTT. The hazard ratio for subsequent diabetes in women with an antepartum OGTT was 2.56 (95% confidence interval 2.28, 2.87) (P < 0.0001). Conclusions Even in the absence of GDM, abnormal screening GCT in pregnancy is associated with an increased future risk of diabetes in young women.     

Controlled Ovarian Stimulation Using Medroxyprogesterone Acetate and hMG in Patients With Polycystic Ovary Syndrome Treated for IVF: A Double-Blind Randomized Crossover Clinical Trial

Ovarian hyperstimulation syndrome (OHSS) during ovarian stimulation is a current challenge for patients with polycystic ovarian syndrome (PCOS). Our previous studies indicated that progestin can prevent premature luteinizing hormone (LH) surge or moderate/severe OHSS in the general subfertile population, both in the follicular-phase and luteal-phase ovarian stimulation but it is unclear if this is true for patients with PCOS.The aim of the article was to analyze cycle characteristics and endocrinological profiles using human menopausal gonadotropin (hMG) in combination with medroxyprogesterone acetate (MPA) for PCOS patients who are undergoing IVF/intracytoplasmic sperm injection (ICSI) treatments and investigate the subsequently pregnancy outcomes of frozen embryo transfer (FET).In the randomized prospective controlled study, 120 PCOS patients undergoing IVF/ICSI were recruited and randomly classified into 2 groups according to the ovarian stimulation protocols: hMG and MPA (group A, n = 60) or short protocol (group B, n = 60).In the study group, hMG (150–225IU) and MPA (10 mg/d) were administered simultaneously beginning on cycle day 3. Ovulation was cotriggered by a gonadotropinreleasing hormone (GnRH) agonist (0.1 mg) and hCG (1000IU) when dominant follicles matured. A short protocol was used as a control.The primary end-point was the ongoing pregnancy rate per transfer and incidence of OHSS.Doses of hMG administrated in group A are significantly higher than those in the controls. LH suppression persisted during ovarian stimulation and no incidence of premature LH surge was seen in both groups. The fertilization rate and the ongoing pregnant rate in the study group were higher than that in the control. The number of oocytes retrieved, mature oocytes, clinical pregnancy rates per transfer, implantation rates, and cumulative pregnancy rates per patient were comparable between the 2 groups. The incidence of OHSS was low between the 2 groups, with no significant difference.The study showed that MPA has the advantages of an oral administration route, easy access, more control over LH levels. A possible reduction in the incidence of moderate or severe OHSS with the MPA protocol should be viewed with caution as the data is small. Large randomized trials with adequate sample size remain necessary.