Gestational diabetes and pregnancy outcome – do we have right diagnostic criteria?

Abstract

Objective: To determine thresholds of maternal glycemia at which specific adverse pregnancy outcomes occur in high-risk population.

Methods: A total of 1002 pregnant women with risk factors for gestational diabetes mellitus (GDM) underwent an originally modified glucose tolerance test (OGTT) with 75?g of glucose. Information on OGTT results and pregnancy outcomes were collected from database and medical records.

Results: Large for gestational age (LGA) newborn, infant’s stay in the neonatal intensive care unit (NICU) >24?h, neonatal hyperbilirubinemia and cesarean section due to cephalopelvic disproportion were identified as specific GDM adverse outcomes. In the study group of participants with one or more specific GDM adverse outcomes, mean glycemic values during the modified OGTT (4.2?±?1.0?mmol/L at 0?min, 6.8?±?1.7?mmol/L at 30?min, 7.9?±?2.1?mmol/L at 60?min, 7.7?±?2.3?mmol/L at 90?min and 7.5?±?2.3?mmol/L at 120?min) according to Student’s t-test for independent samples were significantly higher than mean glycemic values in the control group of participants without specific adverse outcomes (p?<?0.001, p?=?0.02, p?<?0.001, p?<?0.001, p?<?0.001).

Conclusion: This study provides additional data that support the acceptance of the newly recommended outcome-based GDM diagnostic criteria.     

Gestational diabetes screening: the low-cost algorithm

The American Diabetes Association has endorsed the demanding recommendation by the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) that every pregnant woman should undergo the oral glucose tolerance test (OGTT) for the screening of gestational diabetes mellitus (GDM). The aim of this study was to find out if the fasting plasma glucose (FPG) and newer emerging technologies could simplify the cumbersome IADPSG algorithm. Two FPG thresholds (of the OGTT) were used to rule in and rule out GDM in the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) cohort (n = 23316) and a population at high risk for GDM (n = 10283). For the HAPO cohort and the high-risk population, respectively, FPG thresholds of: (a) ≥ 5.1 mmol/L (specificity 100%) independently ruled in GDM in 1769 (8.3%) women and 2975 (28.9%) women; and (b) ≤ 4.4 mmol/L ruled out GDM in 11526 (49.4%) women (84.1% sensitivity) and 2228 (21.7%) women (95.4% sensitivity). Use of the FPG independently could have avoided 13295 (57.0%) and 5203 (50.6%) OGTTs in the 2 groups. The initial FPG-by significantly reducing the number of cumbersome OGTTs needed-can make the IADPSG recommendations more acceptable worldwide. The number of GDM women missed is population dependent. For low-resource countries, alternative newer and cheaper tests in development hold an exciting future.     

Adverse pregnancy outcome among women with pre-gestational diabetes mellitus: a population-based multi-centric study in Beijing

Objective: To investigate the prevalence of pre-gestational diabetes mellitus (pGDM) incidence and to evaluate whether the 2-h plasma glucose value of the oral glucose tolerance test (OGTT) should be used to diagnose pGDM during pregnancy.

Design: Observational cohort study of 15 194 women in 15 medical centers in Beijing from 20 June 2013 to 30 November 2013. The incidence of adverse pregnancy outcomes among women with pGDM was compared stratified according to diagnostic time and criteria.

Results: The prevalence of pGDM was 1.4% (208/15 194), of which only 32.2% (67/208) were diagnosed before pregnancy. The incidence of cesarean delivery (53.8% versus 67.2% and 66.3%), preeclampsia (1.9% versus 11.9% and 8.0%), insulin required (38.5% versus 65.7% and 52.8%) in those with 2-h plasma glucose ≥11.1?mmol/L during is lower than those with pGDM known prior pregnancy or diagnosed during pregnancy according to hemoglobin A1c (HbA1C)?≥?6.5% or fasting plasma glucose (FPG)?≥?7.0?mmol/L.

Conclusions: More than two-thirds of pGDM patients were diagnosed during pregnancy. FPG should be used as screening test to identify pGDM at first antenatal care. An abnormal 2-h glucose value only may not be suitable to diagnose pGDM during pregnancy in China.     

Screening for gestational diabetes mellitus in southern Asian women

AIM: To compare fasting plasma glucose (FPG) against 2-h postprandial plasma glucose (PPPG), following a carbohydrate meal, for screening of gestational diabetes mellitus (GDM) in southern Asian women with one or more risk factors. METHODS: A comparative study was conducted at a university obstetric unit in Sri Lanka. Two hundred and seventy one women undergoing oral glucose tolerance test (OGTT) according to the WHO criteria of 1999 had a 2-h PPPG performed within the following week. Sensitivity, specificity, predictive values and correlation coefficients for predicting a diagnosis of GDM and areas under receiver-operator curves (ROC) were calculated for FPG and PPPG. The ability to predict GDM and to reduce the need for OGTT were the main outcome measures. RESULTS: The mean period of gestation was 26.43 weeks (SD = 5.4) Seventy-five (27.7%) women were diagnosed with GDM. The optimal threshold for FPG was 4.4 mmol/L and for PPPG 4.7 mmol/L. At these, sensitivity was 92.0% and 90.7%, specificity 48.7% and 25.4% and the areas under the ROC 0.82 and 0.73 for FPG and PPPG, respectively. Nine (12%) women could be diagnosed as having GDM on the basis of the FPG being above the threshold. CONCLUSIONS: FPG is superior to 2-h PPPG for screening high-risk women for GDM. Nine women were diagnosed as having GDM on the basis of having an FPG above 7 mmol/L. FPG could reduce the number of OGTT needed by 40.9%, compared to 20.6% by PPPG. FPG is a less cumbersome and cost-effective screening test.     

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.     

妊娠早期空腹血浆血糖与妊娠期糖尿病诊断的相关性

目的 探讨妊娠早期空腹血浆血糖(fasting plasma glucose,FPG)水平与妊娠期糖尿病(gestational diabetes mellitus,GDM)诊断之间的相关性.方法 选择2008年1月1日至2009年12月31日在北京大学第一医院完成产前检查并住院分娩且资料完整的单胎孕妇5299例的临床资料进行回顾性分析.结果 (1)按照妊娠早期FPG的水平将孕妇分为A、B、C 3组.A组:FPG＜5.1 mmol/L,共4565例;B组:FPG≥5.1 mmol/L且＜5.8 mmol/L,共701例;C组:FPG≥5.8 mmol/L且＜7.0 mmol/L,共33例.A、B、C组在妊娠中、晚期被诊断为GDM的比例分别为10.69%(488/4565)、26.11%(183/701)、54.55%(18/33).(2)针对A和B组内不同人群进行母儿预后的比较,包括大于胎龄儿(large for gestational age,LGA)、新生儿高胆红素血症、新生儿低血糖、新生儿红细胞增多症、新生儿感染、早产、子痫前期及子痫、剖宫产等的发生率.2组内非GDM(妊娠中、晚期未被诊断)人群的母儿预后比较,B组除剖宫产与新生儿低血糖的发生率高于A组[54.63%(282/518)与49.03%(1999/4077)、1.54%(8/518)与0.61%(25/4077),P＜0.05],其余各项指标差异均无统计学意义(P均＞0.05);2组内未经孕期血糖管理的GDM人群母儿预后的比较,差异均无统计学意义(P均＞0.05);2组内经过孕期血糖管理的GDM人群母儿预后的比较,差异均无统计学意义(P均＞0.05);将A组和B组非GDM人群合并,与2组内未经过孕期管理的GDM患者(分别为A2组和B2组)比较,LGA发生率A2组高于合并组(12.00%与4.94%,x2=21.4159,P＜0.05),B2组高于合并组(18.39%与4.94%,X2=28.7189,P＜0.05);剖宫产率A2组高于合并组(57.78%与49.64%,x2=5.6806,P＜0.05),B2组高于合并组(66.67%与49.64%,x2=9.9003,P＜0.05);其余各指标比较,差异均无统计学意义.结论 将国际妊娠合并糖尿病研究组推荐的妊娠早期FPG≥5.1 mmol/L作为GDM的诊断标准,尚不适合推广,妊娠中、晚期葡萄糖耐量试验仍是最主要的诊断手段.

Abstract：

Objective To explore the relevance between fasting plasma glucose (FPG) level in early pregnancy and gestational diabetes mellitus (GDM). Methods Clinical data of 5299 singletonpregnant women accepted antenatal examination and delivered in the Department of Obstetrics and Gynecology, Peking University First Hospital from January 1, 2008 to December 31, 2009 were retrospectively analyzed. Results (1) The pregnant women were divided into 3 groups according to their FPG levels at early stage of gestation: Group A, FPG ＜5. 1 mmol/L (n= 4565); Group B,FPG≥5.1, but ＜5.8 mmol/L (n=701); Group C, FPG≥5.8 mmol/L, but ＜7.0 mmol/L(n=33). The incidence of GDM in Group A, B and C was 10. 69% (488/4565), 26. 11% (183/701)and 54. 55% (18/33). (2) The incidences of large for gestational age (LGA), cesarean section,premature birth, preeclampsia, neonatal hyperbilirubinemia, neonatal hypoglycemia, neonatal polycythemia, and neonatal infection were compared between Group A and B. The cesarean section rate [54. 63% (282/518)]and neonatal hypoglycemia rate [1.54% (8/518)]of those who were not diagnosed as GDM in middle and late term in Group B were higher than those of Group A [49.03%(1999/4077) and 0. 61% (25/4077)] (P＜0. 05); while there were no differences between the other six index of Group A and Group B (P＞0. 05). The prognosis of the GDM patients who did not accept gestational glucose management in two groups were similar (P＞0. 05), so did the prognosis of the GDM patients who accepted gestational glucose management in two groups. After combining the patients of the two groups who were not diagnosed as GDM as a new group, they were compared with those who did not accept gestational glucose management of the two groups (Group A2 and B2)respectively. The incidence of LGA rate of the new group was lower than that of Group A2 (12. 00%va 4. 94 %, x2=21. 4159, P＜0. 05) and Group B2 (18. 39 % vs 4. 94%, x2 = 28. 7189, P＜0. 05).Cesarean section rate of the new group was lower than that of Group A2 (57. 78% vs 49.64%,x2 =5. 6806,P＜0.05) and Group B2 (66. 67% vs 49.64%, x2 =9. 9003, P＜0. 05). And there were no differences between the other six index between the new group and the other two groups (P＞0. 05). Conclusions The diagnosis criteria of GDM set as FPG≥5.1 mmol/L at early stage of gestation, recommended by International Association of Diabetes and Pregnancy Study Group, is not applicable in China yet. Oral glucose tolerance test in middle and late term is still the most important diagnostic tool for GDM.     

Third trimester abnormal oral glucose tolerance test and adverse perinatal outcome

Objective: To compare perinatal outcome of women after third trimester oral glucose tolerance test (GTT) following normal glucose challenge test (GCT) stratified by test results.

Study design: Retrospective cohort study of women delivered in a tertiary, university affiliated medical center (2007–2012). Inclusion criteria were women with a normal 50?g GCT (<140?mg/dl) followed by GTT, who delivered a live-born fetus >28 gestational weeks. Gestational diabetes mellitus (GDM) was defined as ≥2 pathological values on GTT (Carpenter and Coustan’s criteria). Perinatal outcome was stratified by GTT results: normal (if all 4 values were normal), single pathological value or GDM. Logistic regression analysis was utilized to adjust outcomes to potential confounders.

Results: Overall, 323 women met inclusion criteria. Of them, 277 (85.8%) had 4 normal values, 32 (9.9%) had a single pathological value and 14 (4.3%) had late-onset GDM. Infants of mothers diagnosed and treated as GDM had lower birth weights, compared to non-diabetics and those with a single pathological value GTT. Mothers with GTT ≥1 pathological values had statistically insignificant higher rates of cesarean delivery. However, this difference was not significant after adjustment to potential confounders.

Conclusion: Treatment of late-onset GDM may lead to lower birthweights, presumably due to glucose control. No association was found with cesarean delivery or neonatal outcome.     

妊娠期糖尿病IADPSG诊断标准的探讨

目的:探讨国际糖尿病与妊娠关系研究协会(IADPSG)推荐的妊娠期糖尿病(GDM)新标准(2011年ADA诊断标准)是否适用于我国。方法:选取2011年6月至2012年2月在暨南大学附属第一医院妇产科产检的孕妇1101例,于妊娠24～28周行葡萄糖耐量实验(OGTT)。结果:(1)纳入研究的1054例孕妇OGTT空腹、1h、2h血糖的95%医学参考值分别为5.2、10.7、9.1 mmol/L;90%医学参考值分别为5.0、9.9、8.5mmol/L。(2)2011年ADA诊断标准诊断GDM的发病率为18.7%,显著高于第7版《妇产科学》诊断标准(4.2%)、日本诊断标准(4.4%)及本研究95%参考值(10.3%)(P'均<0.005);(3)空腹血糖与餐后1h血糖、餐后2h血糖的相关性较低;依据第7版《妇产科学》及2011年ADA诊断标准诊断为GDM者分别为44例和197例,其中空腹血糖≤4.4mmol/L者分别为11例(25%)和66例(33.5%)。结论:(1)在获得我国相关临床研究数据之前,IADPSG诊断标准在我国的全面推广会显著增加GDM发病率,值得商榷;(2)不建议使用空腹血糖排除GDM,即使空腹血糖≤4.4mmol/L。     

Homeostatic indices of insulin resistance among gestational diabetics in anticipating pregnancy complications

Abstract

Objective: This was to determine HOMA-IR score as well as to assess its association in fetal and maternal outcomes among pregnant women with diabetes risks.

Methods: A prospective cohort study of pregnant women with diabetes risks was done. GDM was diagnosed using modified glucose tolerance test. Serum insulin was taken and measured by an electrochemiluminescence immunoassay method. Plasma glucose was measured by enzymatic reference method with hexokinase. HOMA-IR score was calculated for each patient. Maternal and fetal outcomes were analyzed.

Results: From 279 women recruited, 22.6% had GDM with higher HOMA-IR score (4.07?±?2.44 versus 2.08?±?1.12; p?=?0.001) and fasting insulin (16.76?±?8.63?µIU/L versus 10.15?±?5.07?µIU/L; p?=?0.001). Area under ROC curve for HOMA-IR score was 0.79 (95% confidence interval, 0.74–0.84) with optimum cut-off value of 2.92 (sensitivity?=?63.5%; specificity?=?89.8%), higher than recommended by IDF (2.38). This point showed significant association with neonatal hypoglycemia (p?=?0.02) and Cesarean section (p?=?0.04) in GDM mothers.

Conclusions: HOMA-IR score and insulin resistance levels were higher in GDM women in our population. With the cut-off HOMA-IR value of 2.92, neonatal hypoglycemia and Cesarean section were significant complications in GDM mothers. This can be used in anticipation of maternal and fetal morbidities.     

糖化血红蛋白联合空腹血糖检测在妊娠期糖尿病诊断中的应用价值

目的：建立天津市中心妇产科医院（我院）孕妇孕中期糖化血红蛋白（HbA1c）的正常参考区间,并探讨HbA1c联合空腹血糖（FPG）检测在妊娠期糖尿病（GDM）诊断中的应用价值。方法：依据2010年国际妊娠合并糖尿病研究组织（IADPSG）推荐的GDM诊断标准,从2016年5-12月期间在我院行75 g口服葡萄糖耐量试验（OGTT）产前检查的孕24～28周的孕妇中筛查出196例GDM孕妇作为GDM组,以同期健康孕妇320例作为对照组（健康孕妇组）,同时收集其相关的临床资料。采用高效液相色谱法检测HbA1c水平,采用受试者工作特征（ROC）曲线分析HbA1c联合FPG用于筛查GDM的价值。结果：①GDM组的年龄、孕前体质量和孕前体质量指数（BMI）均高于健康孕妇组（P＜0.01）,2组孕妇的孕周和身高比较差异无统计学意义（P＞0.05）;②GDM组HbA1c水平和OGTT各时点血糖水平均高于健康孕妇组,差异有统计学意义（P＜0.01）;③320例健康孕妇HbA1c水平符合正态分布,其孕中期HbA1c水平的正常参考区间（取其第2.5～97.5百分位数）为4.4%～5.8%;④当HbA1c为5.35%时,其预测GDM的敏感度（44.9%）和特异度（77.5%）最高,此时HbA1c诊断GDM的ROC曲线下面积（AUC）为0.665（95%CI：0.617～0.713）;HbA1c（≥5.35%）联合FPG（≥5.1 mmol/L）诊断GDM的AUC为0.933（95%CI：0.909～0.957）。结论：建立了我院孕妇孕中期HbAlc的正常参考区间。HbAlc联合FPG检测简单、方便,有望成为GDM诊断的有力补充。     

Maternal hyperglycemia according to IADPSG criteria as a predictor of perinatal complications in women with gestational diabetes: a retrospective observational study

Abstract

Objective: We investigated the association between abnormal maternal glucose levels according to International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria and perinatal complications.

Materials and methods: Retrospective observational study of data of 492 women in singleton pregnancy and gestational diabetes (GDM) diagnosed according to WHO criteria. Perinatal outcome and maternal characteristics were compared between normo- and hyperglycemic patients using IADPSG criteria and odds ratios calculated for particular outcomes.

Results: Maternal fasting hyperglycemia (≥5.1?mmol/L) was associated with significantly higher proportion of birth weight ≥ 4000?g (19.3% versus 9.7%, p?=?0.004, OR: 2.2; 95% CI: 1.3–3.8), gestational insulin therapy (27.7% versus 9.1%, p?<?0.001, OR: 3.8; 95% CI: 2.3–6.5), poor long-term metabolic control (HbA_1c at diagnosis?≥?6.5% [48?mmol/mol]: 19.9% versus 4.6%, p?<?0.001, OR: 5.2; 95% CI: 2.5–10.9). Pre-pregnancy obesity (BMI?≥?30?kg/m², 26.0% versus 11.9%, p?<?0.001, OR: 2.6; 95% CI: 1.6–4.3) and positive family history of diabetes (45.2% versus 30.8%, p?<?0.002, OR: 1.8; 95% CI: 1.3–2.7) was more frequent in women with fasting hyperglycemia. Two-hour post-load hyperglycemia was only associated with increased prevalence of gestational hypertension (5.1% versus 11.4%, p?=?0.046).

Conclusions: Women with fasting but not 2-h hyperglycemia according to IADPSG criteria are at significantly elevated risk of perinatal complications.     

两种标准诊断妊娠期糖尿病妊娠结局的对比观察

目的对比教科书标准和国际妊娠与糖尿病研究组织（IADPSG）标准诊断妊娠期糖尿病的母婴结局。方法 2011年至2012年在煤炭总医院诊断并分娩的妊娠期糖尿病患者246例,按不同诊断标准分为两组,教科书组（73例）和IADPSG组（173例）,并给予相应的临床干预,对比两组患者的母婴结局。结果教科书标准诊断GDM的诊断率为9.61%,IADPSG标准为14.62%,差异有统计学意义（P〈0.05）。比较两组患者胎膜早破的发生率：教科书组为38.36%,IADPSG组为23.12%,差异有统计学意义（P〈0.05）。而比较两组患者胰岛素使用率、孕期体重增长、剖宫产率及巨大儿、妊娠期高血压、羊水过多、产后出血、胎儿宫内窘迫、新生儿高胆红素血症、新生儿低血糖发生率差异均无统计学意义（P〉0.05）。结论 IADPSG标准诊断妊娠期糖尿病,可以提高诊断率,改善不良母婴结局。     

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

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

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

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

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

Is a value of over 200 mg/dL in the oral glucose tolerance test,a marker of severity in patients with gestational diabetes mellitus?

Abstract

Objective: To determine whether blood glucose values of over 200?mg/dL in the oral glucose tolerance test (OGTT) are associated with pregnancy complications and adverse perinatal outcomes in patients with gestational diabetes mellitus (GDM).

Methods: A retrospective cohort study was performed comparing patients with GDM A1 (diet controlled) that had at least one value of 200?mg/dL or higher in the OGTT, to those who did not. Patients were treated at the diabetes day care clinic of a tertiary medical center between the years 1999 and 2010. Data were available from the computerized perinatal databases.

Results: During the study period, 778 women with GDM were treated at the diabetes day care clinic. Of these, 162 had at least one test value of 200?mg/dL or greater. No significant differences regarding maternal and perinatal complications, such as polyhydramnios, macrosomia (birth-weight above 4?kg), shoulder dystocia, low Apgar scores at 5?min (<7) and cesarean section were noted between the groups.

Conclusions: A value of 200?mg/dL or more in the OGTT is not an indicator of perinatal complications.     

Perinatal outcomes after adopting 1- versus 2-step approach to diagnosing gestational diabetes

Objective: The American College of Obstetricians and Gynecologists (ACOG) and the IADPSG (International Association of Diabetes and Pregnancy Study Groups) proposed distinct approaches to diagnosing gestational diabetes mellitus (GDM). We sought to analyze these paradigms: (1) ACOG 2-step approach where screening is followed by diagnostic testing, (2) IADPSG 1-step diagnostic testing.

Study design: We reviewed data from pregnant women (24–28 wks) screened for GDM over two periods: (1) November 2011–May 2012 (2) November 2012–May 2013. Period 1: 2-step approach (screening 1-h glucose challenge test (GCT) followed by a diagnostic 3-h 100-g glucose tolerance test (GTT) when abnormal (≥140?mg/dl)). Period 2: an abnormal value after a 2-h 75-g GTT result was diagnostic of GDM. We compared the incidence of GDM and perinatal outcomes using either approach.

Results: Out of 471 patients screened by ACOG 2-step approach, 72 (15.3%) had an abnormal 1-h screening and underwent the 3-h diagnostic GTT, and 26 (5.5%) developed GDM. The 1-step approach resulted in 53 (15.96%) with GDM of a total 332 evaluated. There was no statistically significant difference in perinatal outcomes between the two cohorts. Maternal weight at the start and the end of pregnancy was greater for patients diagnosed by the ACOG 2-step approach.

Conclusion: Adopting 1-step approach (ADA) to diagnose GDM resulted in a 3-fold increase in prevalence of GDM with no differences in perinatal outcomes.     

Increased risk of macrosomia among overweight women with high gestational rise in fasting glucose

Objectives.?Maternal overweight is a risk factor for gestational diabetes (GDM) and for newborn macrosomia. Among women without GDM, it is not well understood why some women with high body mass index (BMI) give birth to macrosomic newborns while others do not. We wanted to explore the effect of BMI and fasting plasma glucose (FPG), fasting plasma insulin (FPI) and insulin resistance (HOMA-IR) on the risk of newborn macrosomia.

Methods.?A cohort of 553 Caucasian women was followed throughout pregnancy. The dependent variable was high birth weight (≥4200?g). Independent variables included gestational age, intake of macronutrients and energy, maternal BMI, weight gain, FPG, FPI and HOMA-IR.

Results.?FPG in late pregnancy (30–32 weeks) remained a significant determinant of newborn macrosomia in multiple regression analysis (OR: 1.9, 95% CI: [1.1, 3.4]), whereas FPI and HOMA-IR did not. The women in the highest BMI quartile (≥27?kg/m²) who gave birth to macrosomic newborns had higher increase in FPG and HOMA-IR from early to late pregnancy. Among women in this BMI category, the risk for delivering a macrosomic infant was higher among those with an increase in FPG above 0.60?mmol/l (upper quartile) (OR?=?4.5, 95% CI: [1.7, 12.5]).

Conclusion.?Fasting plasma glucose at week 30–32, but not fasting plasma insulin or insulin resistance, is a determinant of newborn macrosomia. Overweight women with high increase in fasting plasma glucose from early to late pregnancy had a 4.5-fold increase in risk of newborn macrosomia compared to the remaining group with high BMI.     

Management of fetal death after 20 weeks of gestation complicated by placenta previa

Objective.?To determine the frequency and risk factors associated with neonatal chemical hypoglycemia in neonates of mothers with type 2 diabetes and gestational diabetes mellitus (GDM).

Research Design and Methods.?A retrospective cohort study of women with type 2 diabetes or GDM and their singleton neonates. The primary outcome measure was the presence of neonatal chemical hypoglycemia (capillary plasma equivalent glucose <45?mg/dl) within 1?h of birth. Statistical methods included bivariate and multivariate analyses.

Results.?242 mother infant dyads were identified. Sixty-eight (28%) were treated with diet, 110 (46%) with glyburide, and 64 (26%) with insulin. The incidence of neonatal chemical hypoglycemia was 18% (44/242). The incidence was significantly higher in those requiring pharmacotherapy (25% vs. 3%, p?p?=?0.58). The frequency of neonatal chemical hypoglycemia was statistically associated with birth weight, macrosomia and ponderal index (p?Conclusion.?Neonatal chemical hypoglycemia occurs more frequently in infants from women with type 2 diabetes and GDM treated with glyburide or insulin. An increased neonatal ponderal index is a strong predictor of significant neonatal chemical hypoglycemia.     

The effects of probiotic supplementation on biomarkers of inflammation,oxidative stress and pregnancy outcomes in gestational diabetes

Objective: This study was designed to evaluate the effects of probiotic supplementation on biomarkers of inflammation, oxidative stress and pregnancy outcomes among subjects with gestational diabetes (GDM).

Methods: This randomized, double-blind, placebo-controlled clinical trial was done among 60 subjects with GDM who were not on oral hypoglycemic agents. Patients were randomly allocated to intake either probiotic capsule containing Lactobacillus acidophilus, Lactobacillus casei and Bifidobacterium bifidum (2?×?10⁹ CFU/g each) (n?=?30) or placebo (n?=?30) for six?weeks.

Results: Compared with the placebo, probiotic supplementation resulted in significant decreases in fasting plasma glucose (FPG) (?5.3?±?6.7 vs.?+0.03?±?9.0?mg/dL, p?=?.01), serum high-sensitivity C-reactive protein (hs-CRP) (?2.2?±?2.7 vs.?+0.5?±?2.4?μg/mL, p?p?=?.03) and MDA/TAC ratio (?0.0003?±?0.0008 vs.?+0.0009?±?0.002, p?=?.004), and a significant increase in total antioxidant capacity (TAC) levels (+65.4?±?103.3 vs. ?37.2?±?143.7?mmol/L, p?=?.002). Probiotic supplementation did not affect pregnancy outcomes.

Conclusions: Overall, probiotic supplementation among women with GDM for six?weeks had beneficial effects on FPG, serum hs-CRP, plasma TAC, MDA and oxidative stress index, but did not affect pregnancy outcomes.     

Obesity or diabetes: which is more hazardous to the health of the offspring?

Objective: To examine impact on perinatal outcome of untreated gestational diabetes (GDM) and non-diabetics stratified by body mass index (BMI).

Research design and methods: This is a secondary analysis of our investigation of the consequences of not treating GDM. We evaluated 555 untreated GDMs matched to 1100 non-diabetics. BMI was determined using subjects’ recalled pre-pregnancy weight. A primary composite variable consisted of stillbirth, neonatal macrosomia/large-for-gestational-age (LGA), neonatal hypoglycemia, erythrocytosis and hyperbilirubinemia. Secondary outcomes included shoulder dystocia, respiratory complications, cesarean delivery and pregnancy-related hypertension.

Results: Untreated subjects in the normal weight category had an ～2-fold increase for composite outcome and LGA and a 7-fold increase in metabolic complications. The overweight untreated group showed composite outcome, LGA and metabolic complications 2–3-fold higher and induction of labor 5-fold higher. For obese untreated GDMs, significantly higher rates of composite outcome, LGA and metabolic complications, induction of labor and cesarean delivery were 10-, 3-, 5-, 4- and 9-fold, respectively. Perinatal outcome for normal weight untreated GDM was similar to obese non-diabetics.

Conclusions: Maternal obesity and GDM independently affect adverse pregnancy outcome. The combination has a greater impact than each one alone. However, glycemic level contributes a greater portion to the adverse pregnancy equation.     

An evaluation of two different screening criteria in gestational diabetes mellitus

Background: The objective of this study was to identify the gestational diabetes mellitus (GDM) prevalence difference according to American Diabetes Association (ADA) criteria and International Association of Diabetes and Pregnancy Study Group (IADPSG) criteria for 75?g oral glucose tolerance test (OGTT).

Methods: This study was conducted at Erciyes University Department of Obstetrics and Gynecology. A total of 320 pregnant who met the criteria were included in the study and 75?g OGTT was applied. Irrespective of the first results, the test was applied to most participants 2?weeks later.

Results: The GDM prevalence was found to be 9.1% according to the ADA criteria and 19.4% according to the IADPSG criteria. According to the ADA criteria, GDM prevalence was found to be statistically significantly high (p?p?>?.05). The patients diagnosed with GDM were observed not to reach the threshold levels for HbA1c.

Conclusion: According to the IADPSG criteria, GDM prevalence doubles and leads to an increase in healthcare costs and workloads. HbA1c has no role in the diagnosis of GDM.