Gestational diabetes mellitus in women of single gravidity in Tianjin City, China

OBJECTIVE: The aim of this study was to investigate the prevalence of gestational diabetes mellitus (GDM) and risk factors for the development of GDM in pregnant women in Tianjin, China, where the prevalence of GDM is still unknown. STUDY DESIGN AND METHODS: A total of 9,471 pregnant women living in the six urban districts of Tianjin, China, took part in the initial screening between December 1998 and December 1999. The screening test consisted of a 50-g 1-h glucose test. Women with a reading > or =7.8 mmol/l at the initial screening were invited to undergo a 75-g 2-h oral glucose tolerance test (OGTT). GDM was confirmed using the World Health Organization's diagnostic criteria. RESULTS: At the initial screening test, 888 women had a glucose reading of > or =7.8 mmol/l. A total of 701 (79%) women took a subsequent OGTT. Of these, 174 women were confirmed to have GDM (154 with impaired glucose tolerance [IGT] and 20 with diabetes). The prevalence of GDM was 2.31% (2.03% for IGT and 0.28% for diabetes), adjusting for serum glucose levels at the initial screening test. Independent predictors for GDM were maternal age, stature, prepregnancy BMI, weight gain in pregnancy before screening, diabetes in first-degree relatives, and habitual cigarette smoking during pregnancy. Women who smoked or had a short stature are more likely to develop GDM than their counterparts. CONCLUSIONS: The prevalence of GDM in pregnant women in the city of Tianjin, China, was 2.31%. Short stature and smoking in pregnancy were additional risk factors for GDM.     

Rates and risk factors for recurrence of gestational diabetes

OBJECTIVE: To determine the recurrence rate of gestational diabetes (GDM) during a subsequent pregnancy among women who had GDM during an index pregnancy and to identify factors associated with the probability of recurrence RESEARCH DESIGN AND METHODS: A retrospective longitudinal study was performed in Nova Scotia, Canada, of women who were diagnosed as having GDM during a pregnancy between the years of 1980 and 1996 and who had at least one subsequent pregnancy during this time period. When only the index and first subsequent pregnancy were analyzed, the cohort included 651 women. The recurrence rate of GDM in the pregnancy after the pregnancy with the initial diagnosis of GDM was determined. Multivariate regression models were constructed to model the recurrence of GDM in a subsequent pregnancy as functions of potential predictors to estimate RRs and CIs. RESULTS: The rate of recurrence of GDM in the pregnancy subsequent to the index pregnancy was found to the 35.6% (95% CI = 31.9-39.3%). Multivariate regression models showed that infant birth weight in the index pregnancy and maternal prepregnancy weight before the subsequent pregnancy were predictive of recurrent GDM. CONCLUSIONS: In this large cohort of women, slightly more than one-third of the subjects had diabetes in a subsequent pregnancy, which is consistent with recurrence rates in other predominately white populations. Strategies to reduce the occurrence of neonatal macrosomia and maternal prepregnancy obesity may help lower the rate of recurrence of GDM.     

Cigarette smoking and the risk of gestational and pregestational diabetes in two consecutive pregnancies

OBJECTIVE: Cigarette smoking during pregnancy may increase the risk of gestational diabetes mellitus (GDM) or pregestational diabetes mellitus (PDM). Smoking has been associated positively with hyperinsulinemia and insulin resistance in experimental studies, although the association with diabetes remains unclear. To further explore this issue, we examined the association with smoking in the largest prospective cohort study of GDM and PDM to date. RESEARCH DESIGN AND METHODS: The study population comprised 212190 women in the population-based Swedish Birth Registry who had their first and second deliveries between January 1987 and December 1995. Maternal characteristics were recorded in a standardized manner at the first prenatal visit, followed by a clinical examination and a standardized in-person interview to assess lifestyle habits. Women were categorized as nonsmokers, light smokers (one to nine cigarettes per day), or moderate-to-heavy smokers (at least 10 cigarettes per day). RESULTS: Women with GDM in their first pregnancy experienced an eight- to ninefold increased risk of GDM or PDM in their second pregnancy. Cigarette smoking was not associated with increased risk of these conditions. Neither women who smoked during their first and second pregnancies nor those who commenced smoking between pregnancies had a higher risk of GDM or PDM than nonsmokers. CONCLUSIONS: Our findings do not support an association between cigarette smoking and risk of GDM or PDM in young women of childbearing age.     

Racial/ethnic disparities in the prevalence of gestational diabetes mellitus by BMI

OBJECTIVE

To examine whether the association between gestational diabetes mellitus (GDM) and BMI category varies by racial/ethnic group.

RESEARCH DESIGN AND METHODS

In a cohort of 123,040 women without recognized pregravid diabetes who delivered babies between 1995 and 2006 at Kaiser Permanente of Northern California, we examined racial/ethnic disparities in the prevalence of GDM by BMI category and the population-attributable risk (PAR) associated with overweight/obesity.

RESULTS

Among all racial/ethnic groups, the age-adjusted prevalence of GDM increased with increasing BMI (kg/m²) category. However, Asian and Filipina women had a prevalence of GDM of 9.9 and 8.5%, respectively, at a BMI of 22.0–24.9 kg/m², whereas in Hispanic, non-Hispanic white, and African American women, the prevalence of GDM was >8.0% at a higher BMI, such as 28–30, 34–36, and ≥37 kg/m², respectively. The estimated PARs suggest that the percentage of GDM that could be prevented if all pregnant women were of normal weight (BMI <25.0 kg/m²) ranging from 65% for African American women to only 23% among Asian women.

CONCLUSIONS

Clinicians should be aware that the BMI thresholds for increased risk of GDM varies by racial/ethnic group and that the risk is high even at relatively low BMI cutoffs in Asian and Filipina women. Asian women may benefit from different prevention strategies in addition to weight management.Gestational diabetes mellitus (GDM) is carbohydrate intolerance with onset of or first recognition during pregnancy and is one of the most common pregnancy complications in the U.S. GDM is associated with increased risk for perinatal morbidity (1,2), and, in the long-term, women with GDM have an almost sevenfold increased risk of developing type 2 diabetes after pregnancy (3). The prevalence of GDM has increased in all racial/ethnic groups, and this has been observed in several populations in recent decades (4,5). Recent data suggest that the association between glucose and risk of adverse outcomes is continuous; gestational impaired glucose tolerance (IGT) is also associated with both pregnancy complications (6) and subsequent diabetes and cardiometabolic risk (7).Race/ethnicity and obesity are the two strongest independent risk factors for GDM (8–11). However, the demographic distribution of obesity (highest among African Americans and lowest among Asians) does not mirror the demographic distribution of GDM (lowest among African Americans and highest among Asians) (12). Yet there is ongoing debate surrounding the definition of overweight and obesity in Asian populations: the World Health Organization proposed a BMI cutoff of 23.0 kg/m² for overweight among Asians in 2000 (13), compared with a cutoff of 25.0 kg/m² for non-Asian populations. More recently, the World Health Organization stated that the definition of overweight in Asians likely varies depending on the outcome of interest (14). Currently, little is known about racial disparities in the risk of GDM by BMI categories.In a cohort of 123,040 women without recognized pregravid diabetes who delivered babies between 1995 and 2006 at Kaiser Permanente of Northern California (KPNC), we examined racial/ethnic disparities in the prevalence of GDM and IGT in pregnancy by BMI category and the estimated proportion of cases that could be prevented if overweight/obesity in pregnant women were eliminated (the population-attributable risk [PAR]).     

Increasing prevalence of gestational diabetes mellitus (GDM) over time and by birth cohort: Kaiser Permanente of Colorado GDM Screening Program

OBJECTIVE: The prevalence of gestational diabetes mellitus (GDM) varies in direct proportion with the prevalence of type 2 diabetes in a given population or ethnic group. Given that the number of people with diabetes worldwide is expected to increase at record levels through 2030, we examined temporal trends in GDM among diverse ethnic groups. RESEARCH DESIGN AND METHODS: Kaiser Permanente of Colorado (KPCO) has used a standard protocol to universally screen for GDM since 1994. This report is based on 36,403 KPCO singleton pregnancies occurring between 1994 and 2002 and examines trends in GDM prevalence among women with diverse ethnic backgrounds. RESULTS: The prevalence of GDM among KPCO members doubled from 1994 to 2002 (2.1-4.1%, P < 0.001), with significant increases in all racial/ethnic groups. In logistic regression, year of diagnosis (odds ratio [OR] and 95% CI per 1 year = 1.12 [1.09-1.14]), mother's age (OR per 5 years = 1.7 [1.6-1.8]) and ethnicity other than non-Hispanic white (OR = 2.1 [1.9-2.4]) were all significantly associated with GDM. Birth year remained significant (OR = 1.06, P = 0.006), even after adjusting for prior GDM history. CONCLUSIONS: This study shows that the prevalence of GDM is increasing in a universally screened multiethnic population. The increasing GDM prevalence suggests that the vicious cycle of diabetes in pregnancy initially described among Pima Indians may also be occurring among other U.S. ethnic groups.     

妊娠期糖尿病孕妇产后转归及保健情况调查

目的：了解妊娠期糖尿病（GDM）孕妇产后2年转归情况、保健现状和产后保健需求,为完善GDM孕妇产后保健、减少不良转归提供参考。方法：通过便利抽样对2年内在天津市某三级甲等医院产科分娩的妊娠期糖尿病孕妇产后转归现状及保健需求进行问卷调查。结果：13.6%GDM孕妇出现产后体质量滞留;56.5%GDM孕妇产后从未监测过血糖,4.2%GDM孕妇在产后不同时间出现了糖耐量受损,1例GDM孕妇产后2年内已确诊2型糖尿病;59.7%GDM孕妇在产后42天内进行了产后保健,34.6%GDM孕妇从未进行过产后保健,36.1%GDM孕妇没有得到任何相关专业人士的指导;GDM孕妇更希望由妇产科医生、助产士、社区保健医生通过孕妇学校课程、宣传手册、微信公众号等线上形式提供新生儿保健指导、膳食指导、运动指导、主要照护者健康教育等保健内容。结论：目前GDM孕妇对血糖变化重视程度较低,自我监测意识较差;产后保健不够系统、规范,未来应进一步加强筛查与管理,以减少GDM产后不良转归的发生。     

Healthy eating and active living after gestational diabetes mellitus (HEALD-GDM): Rationale,design, and proposed evaluation of a randomized controlled trial

BackgroundGestational diabetes mellitus (GDM) is a common complication in pregnancy and a significant risk factor for type 2 diabetes (T2D). Most women who have had GDM are not engaging in health behaviours known to reduce their risk for developing future T2D. The objective of this study is to evaluate the effectiveness of a lifestyle modification program targeting healthy eating and active living behaviours after a GDM pregnancy.MethodThis trial will randomize 100 women to either a lifestyle modification program or a control condition. Those allocated to the Healthy Eating and Active Living for Diabetes and Gestational Diabetes Mellitus (HEALD-GDM), program will receive a previously developed and tested 24-week program led by an Exercise Specialist at a local recreational facility. The original HEALD program will be tailored for women with GDM through the provision of complementary childcare at HEALD-GDM sessions and theory-guided peer-led telephone support. Our primary outcome is the 6-month change in objectively derived average daily moderate and vigorous physical activity.DiscussionPrograms to increase physical activity in women with GDM should carefully consider and find ways to address known barriers specific to this population. We believe that our modified program may be successfully translated to women who have had GDM.Clinical Trials Registration: NCT02483949     

Effect of selective screening for gestational diabetes

OBJECTIVE: To estimate the percentage of pregnant women who would not be screened and the percentage of women with gestational diabetes mellitus (GDM) who would possibly remain undiagnosed if the American Diabetes Association's (ADA's) new selective screening recommendations are used rather than universal screening for GDM. RESEARCH DESIGN AND METHODS: Since 1987, the University of Michigan Health System has performed universal screening for GDM. In 1997, the ADA recommended that women having all four of the following characteristics need not be screened: age < 25 years, not members of an ethnic/racial group with a high prevalence of diabetes, normal body weight, and no family history of diabetes. We studied a random sample of the 25,118 deliveries at the University of Michigan between 1987 and 1997 to determine the prevalence of these four characteristics in our obstetric population. We also studied the prevalence of these four characteristics in 200 women who were diagnosed with GDM in the Endocrine Testing Unit and delivered at the University of Michigan between 1987 and 1997. RESULTS: Approximately 10-11% of women who delivered possessed all four low-risk characteristics and would not have been screened for GDM according to the new ADA recommendations. Only 4% of women (5 of 141) with GDM who delivered and for whom data on all four characteristics were reported possessed all four low-risk characteristics and would not have been screened. CONCLUSIONS: If the new ADA selective screening recommendations are used, few women with GDM will be missed (4%) but approximately 90% of pregnant women will still need to be screened for GDM.     

Is there any association between fruit consumption and the risk of gestational diabetes mellitus? A systematic review and meta-analysis

AimAlthough a considerable number of studies have illustrated the positive effects of fresh fruits on metabolic status, the impacts of fruits on the risk of gestational diabetes mellitus (GDM) are inconsistent. In consideration of this issue, we aimed to systematically summarize the findings of cohort studies with respect to the link between fresh fruits and the risk of GDM.MethodWe selected cohort studies with English language indexed in PubMed/Medline, Scopus, Web of Science, and Embase from 2000 to 31 January 2018. To examine the link between fresh fruits and the risk of GDM development, relative risk (RR) and 95 % confidence intervals (CIs) for the highest versus the lowest consumption of fruits were pooled using a random effect model and the DerSimonian and Laird method.ResultsOut of 2522 publications, finally 5 cohort studies were obtained. No significant association between fruit consumption and GDM incidence was found (Pooled RR: 0.95; 95 % CI: 0.84, 1.08; I²: 90.3 %, p = 0001). In women who consumed higher amount of fruits before pregnancy, the risk of GDM was 5% lower than in those who consumed lower amount of fruits (0.95; 95 %CI: 0.91, 0.99, I²: 0%, p = 0.85). No link was obtained between fruit consumption during the pregnancy and GDM onset (1.18, 95 % CI: 0.48, 2.91; I²:94.6 %, p = 0.0001).ConclusionIn women who consumed greater fruits before pregnancy, the risk for GDM was 5 % lower than those consumed lower amounts of fruits, while there was no link between fruit consumption throughout the pregnancy and GDM onset. However, due to limited studies and considerable heterogeneity, the findings must be interpreted with great caution.     

Inflammation and glucose intolerance: a prospective study of gestational diabetes mellitus

OBJECTIVE: Increased leukocyte count is a marker of inflammation that has been associated with the development of type 2 diabetes in prospective studies. Although gestational diabetes mellitus (GDM) and type 2 diabetes share certain pathophysiological mechanisms, few studies have examined inflammation and risk of GDM. RESEARCH DESIGN AND METHODS: We prospectively examined routine leukocyte counts collected at the first prenatal visit in a cohort of 2,753 nulliparous euglycemic women, 98 (3.6%) of whom were later diagnosed with GDM. Subjects were divided into quartiles of leukocyte count, and the results of third-trimester glucose screening tests and the incidence of GDM among these quartiles were compared. Logistic regression was used to calculate univariate and multivariable-adjusted relative risks (RRs) of GDM according to leukocyte quartiles. RESULTS: Leukocyte counts were increased among women who subsequently developed GDM compared with those who remained free of GDM (10.5 +/- 2.2 vs. 9.2 +/- 2.2 x 10(3) cells/ml; P < 0.01). There was a linear increase in postloading mean glucose levels (P for trend <0.01), the area under the glucose tolerance test curves (P for trend <0.01), and the incidence of GDM (quartile 1, 1.1; quartile 2, 2.5; quartile 3, 4.2; and quartile 4, 6.4%; P for trend <0.01) with increasing leukocyte quartiles. In the multivariable-adjusted analysis, the linear trend in the RR of GDM with increasing leukocyte quartiles remained statistically significant (quartile 1, reference; quartile 2, RR 2.3 [95% CI 0.9-5.7]; quartile 3, 3.3 [1.4-7.8]; quartile 4, 4.9 [2.1-11.2]; P for trend <0.01). CONCLUSIONS: Increased leukocyte count early in pregnancy is independently and linearly associated with the results of GDM screening tests and the risk of GDM. Although overlap in the leukocyte count distributions precludes it from being a clinically useful biomarker, these data suggest that inflammation is associated with the development of GDM and may be another pathophysiological link between GDM and future type 2 diabetes.     

Applying Current Screening Tools for Gestational Diabetes Mellitus to a European Population: Is It Time for Change?

OBJECTIVE

The optimal screening regimen for gestational diabetes mellitus (GDM) remains controversial. Risk factors used in selective screening guidelines vary. Given that universal screening is not currently adopted in our European population, we aimed to evaluate which selective screening strategies were most applicable.

RESEARCH DESIGN AND METHODS

Between 2007 and 2009, 5,500 women were universally screened for GDM, and a GDM prevalence of 12.4% using International Association of Diabetes in Pregnancy Study Groups (IADPSG) criteria was established. We retrospectively applied selective screening guidelines to this cohort.

RESULTS

When we applied National Institute for Health and Clinical Excellence (NICE), Irish, and American Diabetes Association (ADA) guidelines, 54% (2,576), 58% (2,801), and 76% (3,656) of women, respectively, had at least one risk factor for GDM and would have undergone testing. However, when NICE, Irish, and ADA guidelines were applied, 20% (120), 16% (101), and 5% (31) of women, respectively, had no risk factor and would have gone undiagnosed. Using a BMI ≥30 kg/m² for screening has a specificity of 81% with moderate sensitivity at 48%. Reducing the BMI to ≥25 kg/m² (ADA) increases the sensitivity to 80% with a specificity of 44%. Women with no risk factors diagnosed with GDM on universal screening had more adverse pregnancy outcomes than those with normal glucose tolerance.

CONCLUSIONS

This analysis provides a strong argument for universal screening. However, if selective screening were adopted, the ADA guidelines would result in the highest rate of diagnosis and the lowest number of missed cases.The World Health Organization (WHO) defines gestational diabetes mellitus (GDM) as any degree of glucose intolerance with onset or first recognition during pregnancy (1). GDM results in higher maternal and neonatal morbidities in the short- and long-term. GDM is common, and prevalence is increasing due to the increase in overweight and obesity in the background population. In Ireland it complicates ∼12% (2) of pregnancies.Diagnosis of GDM and subsequent treatment decreases morbidities for the mother and baby in the index pregnancy. Diagnosis of GDM also highlights an at-risk population that can be targeted for primary prevention of type 2 diabetes. The optimal screening regimen for GDM remains controversial, with conflicting recommendations for universal and selective screening among various expert groups. Currently, the American Diabetes Association (ADA), the U.S. Preventive Services Task Force (USPSTF), the National Institute for Health and Clinical Excellence (NICE), and the 2010 Irish guidelines recommend risk factor–based screening. The Australasian Diabetes in Pregnancy society recommends universal screening (3). With studies from North America (4) showing that ∼90% of women have at least one risk factor for GDM, there is a strong argument for universal screening. However, a lack of randomized-controlled trials addressing this issue means there is insufficient evidence to definitely determine whether a universal approach to screening should be the gold standard of care. Also, the population of North America is phenotypically different from that of Europe, so evidence-based recommendations from North American studies may not be directly applicable to a European population.The Atlantic Diabetes in Pregnancy (ATLANTIC DIP) network is a research collaboration among five antenatal centers along the Irish Atlantic seaboard. The aim of this clinical network is to provide optimal, evidence-based care for women before, during, and after pregnancy. Between 2007 and 2009, universal screening for GDM was offered. Given that universal screening is not currently adopted or supported financially at a national level, we aimed to analyze which selective screening modalities and single risk factors had the highest sensitivity and specificity for diagnosing GDM. An additional objective was to calculate the proportion of women with GDM who would be missed if selective screening methods were adopted. Finally, there is a suggestion that women with GDM who carry no risk factors for the condition, who are only detected as part of universal screening, have a “milder” form of glucose intolerance and that their pregnancy outcomes may be similar to those of the background population. As such, this study analyzed pregnancy outcomes of these “low-risk” GDM women and compared them with the outcomes in women with normal glucose tolerance (NGT).     

Understanding exercise beliefs and behaviors in women with gestational diabetes mellitus

OBJECTIVE: The purpose of this study was to examine the exercise beliefs and behaviors of postpartum women who had gestational diabetes mellitus (GDM) during a recent pregnancy. RESEARCH DESIGN AND METHODS: Postpartum women with GDM (n = 28) completed a mail survey assessing their self-reported exercise beliefs (advantages, barriers, and important social influences) and behaviors. RESULTS: We found that 1) the strongest perceived advantage of exercise during pregnancy was controlling blood glucose and postpartum it was controlling weight, 2) the most common barrier to exercise during pregnancy was fatigue and postpartum it was a lack of time, 3) women's husband/partner most strongly influenced their exercise during pregnancy and postpartum, 4) women exercised more during the postpartum period than before or during pregnancy, and 5) the number of exercise advantages was positively associated with women's pregnancy and postpartum exercise behavior. CONCLUSIONS: To increase exercise behavior and reduce the risk of type 2 diabetes in women with GDM, researchers and health care professionals are encouraged to use women's exercise beliefs, that is, advantages, social influences, and perceived barriers to exercise, as a framework for designing effective diabetes treatment and prevention programs.     

CA6-01: A System-based Intervention to Improve Postpartum Diabetes Screening Among Women with Gestational Diabetes

Background/Aims Postpartum diabetes screening is recommended for women with gestational diabetes (GDM); up to 36.0% of them will have glucose abnormalities after delivery. To improve the <60% rate of postpartum diabetes screening in Kaiser Permanente Northwest, we conducted a multi- faceted process improvement project. Methods The intervention included revision of protocols used to guide outpatient care provided to pregnant patients with types 1, 2, and gestational diabetes, and revision of electronic order entry tools; development of an electronic reminder system to trigger phone calls to patients who had not completed postpartum glucose testing within 3 months after delivery; and a series of 60 minute educational sessions for clinicians, nurses, and medical assistants conducted between January and April 2009. The pre-implementation population was GDM-affected deliveries July 1, 2007-June 30, 2008 (n=200) and the post-implementation population was GDM-affected deliveries July 1, 2009- June 30, 2010 (n=179). Two main outcomes were evaluated: clinician orders for either a fasting blood glucose (FBG) test or 2-hr oral glucose tolerance test (OGTT) placed between one month before to 3 months after delivery, and a completed FBG or 2-hour OGTT performed between 14 days after delivery and December 31, 2008 (pre-implementation) or December 31, 2010 (post-implementation). Because patient characteristics did not differ significantly between the pre-and post-implementation populations, an unadjusted Cox Proportional Hazards model was used to evaluate test completion. Results The prevalence of GDM was 3.8% in pre-(200/5250) and post- populations (179/4765). The proportion of women who received an order for a postpartum glucose test within 3 months of delivery increased from 77.5% (155/200) to 88.8% (159/179) (p=.004); the proportion completing the test Within 3 months of delivery increased from 53.5% (107/200) to 60.3% (108/179) (p=.18). When including tests completed beyond the first 3 months postpartum (through December 2008 pre-and December 2010 post-implementation), women in the post-implementation group had a significantly higher rate of test completion (59.5% [119/200] vs. 71.5% [128/179], p=0.01, Hazards Ratio 1.37, 95% CI 1.07 to 1.7. Discussion Rates of postpartum diabetes testing among women with recent GDM can be improved with system changes and reminders to women.     

A comparison of rates, risk factors, and outcomes of gestational diabetes between aboriginal and non-aboriginal women in the Saskatoon health district

OBJECTIVE: To determine possible differences in gestational diabetes mellitus (GDM) between aboriginal and non-aboriginal people in the Saskatoon Health District. RESEARCH DESIGN AND METHODS: This was a prospective survey of all women admitted for childbirth to the Saskatoon Royal University Hospital between January and July 1998. We compared prevalence rates, risk factors, and outcomes of GDM between aboriginal and non-aboriginal women. RESULTS: Information was obtained from 2,006 women, of whom 252 aboriginal and 1,360 non-aboriginal subjects had been tested for GDM. The overall rates of GDM were 3.5% for women in the general population and 11.5% for aboriginal women. For those living within the Saskatoon Health District, GDM rates were 3.7 and 6.4%, respectively. Multivariate analysis demonstrated that aboriginal ethnicity, most notably when combined with obesity, was an independent predictor for GDM. Pregravid BMI > or = 27 kg/m(2) and maternal age > or = 33 years were the most important risk factors for GDM in aboriginal women, whereas previous GDM, family history of diabetes, and maternal age > or = 38 years were the strongest predictors for GDM in non-aboriginal women. CONCLUSIONS: There may be fundamental differences in GDM between aboriginal and non-aboriginal people. Because GDM contributes to an increased risk for type 2 diabetes in aboriginal women and their offspring, the impact of prevention and optimal treatment of GDM on the type 2 diabetes epidemic in susceptible populations are important areas for further investigation.     

Gestational diabetes mellitus increases the risk of cardiovascular disease in women with a family history of type 2 diabetes

OBJECTIVE: We sought to determine whether a history of gestational diabetes mellitus (GDM) further increases the risk of cardiovascular disease (CVD) in parous women with first-degree relatives with type 2 diabetes. RESEARCH DESIGN AND METHODS: Women with (n = 332) and without (n = 663) a history of GDM were compared regarding 1) the revised National Cholesterol Education Program Adult Treatment Panel III metabolic syndrome criteria, 2) the prevalence of type 2 diabetes, and 3) self-reported CVD. RESULTS: Women with prior GDM were younger (48.6 +/- 0.7 vs. 52.4 +/- 0.6 years [means +/- SE];P < 0.001) and less likely to be postmenopausal (48.3 vs. 57.9%; P < 0.005). Although both groups were obese (BMI 34.4 +/- 1.2 vs. 33.7 +/- 0.6 kg/m(2)), women with prior GDM were more likely to have metabolic syndrome (86.6 vs. 73.5%; P < 0.001) and type 2 diabetes (93.4 vs. 63.3%; P < 0.001). Moreover, they had a higher prevalence of CVD (15.5 vs. 12.4%; adjusted odds ratio 1.85 [95% CI 1.21-2.82];P = 0.005) that occurred at a younger age (45.5 +/- 2.2 vs. 52.5 +/- 1.9 years;P = 0.02) and was independent of metabolic syndrome (1.74 [1.10-2.76]; P = 0.02) and type 2 diabetes (1.56 [1.002-2.43];P < 0.05). CONCLUSIONS: Among women with a family history of type 2 diabetes, those with prior GDM were even more likely to not only have CVD risk factors, including metabolic syndrome and type 2 diabetes, but also to have experienced CVD events, which occurred at a younger age. Thus, women with both a family history of type 2 diabetes and personal history of GDM may be especially suitable for early interventions aimed at preventing or reducing their risk of CVD and diabetes.     

First-trimester C-reactive protein and subsequent gestational diabetes

OBJECTIVE: Systemic inflammation is associated with the development of type 2 diabetes. We tested the hypothesis that increased inflammation, measured early in pregnancy, is associated with the subsequent development of gestational diabetes mellitus (GDM), a precursor of type 2 diabetes. RESEARCH DESIGN AND METHODS: We conducted a prospective nested case-control study in a pregnancy cohort. First-trimester C-reactive protein (CRP) levels were measured using a high-resolution assay in 43 women who subsequently developed GDM and in a random sample of 94 women who remained euglycemic throughout pregnancy. Median CRP levels were compared using Wilcoxon's rank-sum test. Logistic regression was used to compute unadjusted and multivariable-adjusted odds ratios for developing GDM among CRP tertiles. RESULTS: First-trimester CRP levels were significantly increased among women who subsequently developed GDM compared with control subjects (3.1 vs. 2.1 mg/l, P < 0.01). The risk of developing GDM among women in the highest CRP tertile compared with the lowest tertile was 3.2 (95% CI 1.2-8.8). After adjusting for age, race/ethnicity, smoking, parity, blood pressure, and gestational age at CRP sampling, the risk of developing GDM among women in the highest compared with the lowest tertile was 3.6 (95% CI 1.2-11.4). When BMI was included in the model, however, the association between increased CRP and GDM was attenuated (odds ratio for the highest compared with lowest tertile 1.5 [95% CI 0.4-5.5]). CONCLUSIONS: In women who develop GDM, there is evidence of increased inflammation during the first trimester. This association is mediated in part by increased BMI. Larger studies are needed to verify these results.     

Diabetes in pregnancy in Mexican Americans

Diabetes in pregnant Mexican-American women is a serious and expensive health problem. At the University of California, San Diego Medical Center, 44% of pregnant women are Mexican American. In the Diabetes in Pregnancy Clinic, only 7% of women with insulin-dependent diabetes are in this ethnic group compared with 66% of non-insulin-dependent diabetic patients and 51% of those with gestational diabetes mellitus (GDM). GDM is the most common complication of pregnancy in Mexican Americans with a prevalence approximately three times higher than that of whites (4.5 vs. 1.5%). Mexican-American obese GDM subjects had more frequent cesarean sections and were more likely to have complications of premature rupture of membranes and preterm labor (NS). Polycythemia and sepsis also occurred more often in their infants. Anthropometric measurements in infants of both lean and obese GDM subjects differed from those of infants of mothers without GDM. Infants of lean mothers with GDM were heavier and longer than those of lean mothers without GDM. In addition, they had increased waist-hip ratio and triceps and subscapular skin folds. Infants of obese mothers with GDM were heavier than those of lean mothers with GDM. Moreover, they were longer (P less than 0.04); had a higher body mass index (P less than 0.04); and larger waist and hip circumferences (P less than 0.03) and buccal (P less than 0.01), subscapular (P less than 0.01), and sum of skin-fold measurements (P less than 0.03). Our observations indicate that pregnant diabetic Mexican-American women have predominantly GDM and non-insulin-dependent diabetes. They represent a major public health problem because of increased maternal and neonatal morbidity.     

Gestational Diabetes Mellitus Alone in the Absence of Subsequent Diabetes Is Associated With Microalbuminuria: Results from the Kidney Early Evaluation Program (KEEP)

OBJECTIVE

Women with gestational diabetes mellitus (GDM) maintain a higher risk for recurrent GDM and overt diabetes. Overt diabetes is a risk factor for development of chronic kidney disease (CKD), but GDM alone, without subsequent development of overt diabetes, may also pose a risk for CKD.

RESEARCH DESIGN AND METHODS

This cross-sectional analysis included Kidney Early Evaluation Program (KEEP) participants from 2000 to 2009. Patient characteristics and kidney function among three categories (GDM alone, overt diabetes, and no history of diabetes) were compared. The prevalence of microalbuminuria, macroalbuminuria, and CKD stages 1–2 and 3–5 was assessed using logistic regression.

RESULTS

Of 37,716 KEEP female participants, 571 (1.5%) had GDM alone and 12,100 (32.1%) had overt diabetes. Women with GDM had a higher rate of microalbuminuria but not macroalbuminuria than their nondiabetic peers (10.0 vs. 7.7%) that was substantially lower than the 13.6% prevalence in diabetic women. In multivariate analysis, women with GDM alone, compared with nondiabetic women, demonstrated increased odds of CKD stages 1–2 (multivariate odds ratio 1.54 [95% CI 1.16–2.05]) similar to the odds for women with overt diabetes (1.68 [1.55–1.82]). In stratified analyses, age, race, BMI, and hypertension modified the odds for CKD stages 1 –2 but not CKD stages 3–5 among women with GDM.

CONCLUSIONS

Women with GDM alone have a higher prevalence of microalbuminuria than women without any history of diabetes, translating to higher rates of CKD stages 1–2. These results suggest that GDM, even in the absence of subsequent overt diabetes, may increase the risk for future cardiovascular and kidney disease.Most women who develop diabetes during a pregnancy, gestational diabetes mellitus (GDM), are normoglycemic after delivery but still maintain a higher risk for recurrent GDM, impaired glucose tolerance, and overt diabetes. Indeed, the odds of developing subsequent type 2 diabetes for women with GDM is roughly 5 times higher than that for women with normoglycemic pregnancies in the first 5 years after delivery; the odds rise to more than 9 times higher in the years afterward (1).Although overt diabetes is recognized as a potent risk factor for development of chronic kidney disease (CKD), it is currently unclear whether GDM alone, without subsequent development of overt diabetes, also poses any risk to kidney function. Because certain clinical factors (e.g., waist circumference, BMI, and years postdelivery) have been shown to increase the risk for development of overt diabetes in women with GDM (2), these factors could potentially also modify the risk for development of CKD.We hypothesized that GDM alone would impart an increased risk for CKD and, specifically, that women with GDM would have a level of risk intermediate between that of women without any history of glucose abnormalities and women with overt diabetes. Using data from the National Kidney Foundation''s Kidney Early Evaluation Program (KEEP), a program designed to screen participants at higher risk for CKD than the general population, we examined in cross-sectional analyses whether GDM, in the absence of subsequent overt diabetes, increases the odds of abnormal urinary albumin excretion and impaired glomerular filtration rate. In addition, we examined whether age, race, BMI, or hypertension modifies this relationship between GDM and CKD.     

妊娠糖尿病孕妇健康教育干预的效果

目的探讨健康教育在控制妊娠糖尿病(gestational diabetes mellitus,GDM)孕妇孕期血糖和改善妊娠结局中的作用,并摸索针对GDM孕妇的孕期教育模式。方法对干预组60例GDM孕妇进行糖尿病相关知识的问卷调查并实施糖尿病系统化教育和治疗,同时设60例常规产前护理的GDM孕妇为对照组,就其血糖变化和妊娠结局进行比较。结果实施糖尿病系统化教育前后,GDM孕妇的相关知识水平有了极大的提高(P<0.01),干预组的血糖控制与对照组相比有显著差异(P<0.01),其妊娠结局也明显优于对照组(P<0.01)。结论对GDM孕妇实施健康教育能使她们更好地控制血糖,改善妊娠结局,从而保证母婴健康。     

Sociodemographic correlates of the increasing trend in prevalence of gestational diabetes mellitus in a large population of women between 1995 and 2005

OBJECTIVE—Gestational diabetes mellitus (GDM) is an increasingly prevalent risk factor for the development of type 2 diabetes in the mother and is responsible for morbidity in the child. To better identify women at risk of developing GDM we examined sociodemographic correlates and changes in the prevalence of GDM among all births between 1995 and 2005 in Australia''s largest state.RESEARCH DESIGN AND METHODS—A computerized database of all births (n = 956,738) between 1995 and 2005 in New South Wales, Australia, was used in a multivariate logistic regression that examined the association between sociodemographic characteristics and the occurrence of GDM.RESULTS—Between 1995 and 2005, the prevalence of GDM increased by 45%, from 3.0 to 4.4%. Women born in South Asia had the highest adjusted odds ratio (OR) of any region (4.33 [95% CI 4.12–4.55]) relative to women born in Australia. Women living in the three lowest socioeconomic quartiles had higher adjusted ORs for GDM relative to women in the highest quartile (1.54 [1.50–1.59], 1.74 [1.69–1.8], and 1.65 [1.60–1.70] for decreasing socioeconomic status quartiles). Increasing age was strongly associated with GDM, with women aged >40 years having an adjusted OR of 6.13 (95% CI 5.79–6.49) relative to women in their early 20s. Parity was associated with a small reduced risk. There was no association between smoking and GDM.CONCLUSIONS—Maternal age, socioeconomic position, and ethnicity are important correlates of GDM. Future culturally specific interventions should target prevention of GDM in these high-risk groups.Type 2 diabetes affects an estimated 246 million individuals worldwide—a figure that is predicted to increase to 380 million by 2025, with a disproportionate number of affected individuals living in lower- and middle-income countries of the Asia-Pacific region (1). Diabetes is a major cardiovascular risk factor, more than doubling the risk of having a stroke or heart attack. Moreover, diabetes appears to be particularly hazardous in women, as there is a 50% greater risk of dying from coronary heart disease compared with that of men with the same condition (2).Gestational diabetes mellitus (GDM), defined as glucose intolerance first detected during pregnancy, is a strong predictor of type 2 diabetes. Women with GDM are up to six times more likely to develop type 2 diabetes than women with normal glucose tolerance in pregnancy (3). The incidence of GDM varies among populations, similar to the variation of type 2 diabetes, with recent prevalence estimates ranging from 2.8% of pregnant women in Washington, DC, to 18.9% in India and 22% in Sardinia, Italy (4). The risk for GDM increases with age, and incidence rates vary by ethnicity within a population, again similar to the risk for type 2 diabetes (4,5). There is also evidence that obesity, parity, smoking, and family history are risk factors for GDM (5). However, less is known regarding the sociodemographic distribution of GDM. Given the strong link between GDM and the subsequent risk of diabetes for the mother and the perinatal morbidity for mother and child—an association recently updated with findings of a continuous association of maternal glucose levels and adverse perinatal outcomes by the Hyperglycemia and Adverse Pregnancy Outcomes Study Cooperative Research Group (6)—a better understanding of the sociodemographic determinants of GDM may provide novel opportunities to reduce the incidence and to prevent the onset of type 2 diabetes in later life.Most studies that have examined the etiology of GDM have been hospital based or have been based on samples of births in a particular region (4,5). There are currently no large, comprehensive population-wide urban and rural datasets that have been collected in an attempt to examine multiple risk factors for GDM over a number of years and no population-based studies outside the U.S. The New South Wales (NSW) Midwives Dataset has information on nearly 1 million births in the state of NSW during the period from 1995 to 2005 in a health system in which there is almost universal screening for GDM. This dataset was used to study the current and changing population rates of GDM and its associated sociodemographic risk factors in a large, ethnically diverse population of women.