Gestational diabetes mellitus

Gestational diabetes mellitus (GDM) is defined as glucose intolerance of various degrees that is first detected during pregnancy. GDM is detected through the screening of pregnant women for clinical risk factors and, among at-risk women, testing for abnormal glucose tolerance that is usually, but not invariably, mild and asymptomatic. GDM appears to result from the same broad spectrum of physiological and genetic abnormalities that characterize diabetes outside of pregnancy. Indeed, women with GDM are at high risk for having or developing diabetes when they are not pregnant. Thus, GDM provides a unique opportunity to study the early pathogenesis of diabetes and to develop interventions to prevent the disease.     

Gestational diabetes mellitus

Gestational diabetes is an asymptomatic disease of pregnant women, which results in significant morbidity and mortality. However, prompt diagnosis and treatment of this disorder have been found to be effective in decreasing complications. The increased risk for eventual diabetes in the patient and obesity or glucose intolerance in her off-spring suggests that long-term weight control and medical follow-up for both are important.     

妊娠期糖尿病患者的标准化管理探讨

目的探讨妊娠期糖尿病患者的标准化管理方法。方法将2010年1月至2012年10月分娩经产前检查确诊为妊娠期糖尿病孕妇68例作为观察组,经标准化管理血糖控制满意,以血糖正常的68例孕妇作为对照组,比较两组孕妇并发症及新生儿并发症情况。结果 68例妊娠期糖尿病患者经饮食、运动等管理,血糖控制良好,52例患者没有使用胰岛素治疗而顺利分娩,两组产妇并发症和新生儿并发症各指标比较无统计学差异(P>0.05)。结论制定强妊娠期糖尿病患者标准化管理有利于孕妇的顺利分娩,可有效降低孕期产后并发症及新生儿并发症的发生率。     

Gestational diabetes

The perinatal morbidity and mortality associated with gestational diabetes can be significantly reduced when cases are recognized and closely monitored. There is much controversy about the diagnosis of gestational diabetes and the practicality of universal screening.     

Gestational diabetes mellitus screening tests: a review of current recommendations.

Early recognition and management of gestational diabetes decreases the incidence of macrosomia. Infant morbidity and mortality are also decreased. While there continues to be little agreement regarding precise methods of screening and diagnostic criteria for GDM, most specialists recommend screening with the 50-g oral glucose load followed by a 3-hour GTT. Screening only those women with select risk factors may result in 30% to 50% of women with gestational diabetes being overlooked. Careful explanation of testing methods and implications may result in improved patient understanding of the importance of this diagnosis and of its impact on future health care needs.     

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.     

Gestational diabetes mellitus: now is the time for detection and treatment.

The extent of universal screening for gestational diabetes and the incidence of gestational diabetes mellitus (GDM) by diagnosis were analyzed in four primary-care sites. The medical records of 798 women were reviewed to identify the presence of historical risk factors, familial determinants, and biophysical attributes associated with GDM and to determine whether screening and diagnostic tests consistent with national criteria had been completed, as well as to obtain the method of delivery and the weight and overall medical status of the infants. Of the 798 women, less than 60% underwent screening. Overall, 1.5% of the women were diagnosed with GDM, seven of whom were identified through screening. Eighty-nine infants were classified as large for gestational age, 61 of whom weighed more than 4,000 g. Of these 61 infants with macrosomia, 61% were born to women who either were not screened or had negative screening results. Most of these women had risk factors consistent with GDM. The likelihood that a substantial proportion of these women would have delivered normal-sized infants had they undergone proper screening, diagnosis, and treatment prompted us to conclude that universal screening for GDM should be adopted.     

Gestational diabetes mellitus: fetal liver length measurements between 21and 24 weeks' gestation

PURPOSE: To evaluate sonographic measurements of the fetal liver, fetal abdominal fat layer, interventricular septum, and Wharton's jelly area between 21 and 24 weeks' gestation in women with gestational diabetes mellitus (GDM). METHODS: A total of 123 consecutive healthy pregnant women underwent sonographic examination at 21-24 weeks' gestational age. The measurements included fetal biometry, detailed anomaly scan, and fetal body composition measurements (subcutaneous fat, liver size, cardiac muscle thickness, and Wharton's jelly area). GDM was confirmed by way of a 75-g oral glucose tolerance test using World Health Organization criteria within 1 week of the examination. RESULTS: Nineteen (15.4%) women were diagnosed with GDM, while 104 (84.6%) women were without GDM. The mean fetal liver length was 36 mm (95% CI 32-37) in women with GDM and 31 mm (95% CI 30-33) in women without GDM (p < 0.01). Liver enlargement was related to maternal fasting glucose levels and not 2-hour postprandial levels. There was no significant difference in the fetal biometric and other fetal body measurements between the 2 groups. CONCLUSIONS: The findings of this study suggest that midtrimester fetal liver length appears to be longer in GDM than in normal pregnancies. However, the fetal abdominal fat layer, interventricular septum, and Wharton's jelly were not affected. Nevertheless, further, larger randomized studies are required to confirm these findings.     

Gestational diabetes mellitus in relation to maternal dietary heme iron and nonheme iron intake

OBJECTIVE

Higher heme iron intake is associated with increased type 2 diabetes risk. However, no previous study has evaluated gestational diabetes mellitus (GDM) risk in relation to heme iron intake during pregnancy. We investigated associations of maternal preconceptional and early pregnancy heme and nonheme iron intake with subsequent GDM risk.

RESEARCH DESIGN AND METHODS

We conducted a prospective cohort study of 3,158 pregnant women. A food frequency questionnaire was used to assess maternal diet. Multivariable generalized linear regression models were used to derive estimates of relative risks (RRs) and 95% CIs.

RESULTS

Approximately 5.0% of the cohort developed GDM (n = 158). Heme iron intake was positively and significantly associated with GDM risk (P_trend = 0.04). After adjusting for confounders, women reporting the highest heme iron intake levels (≥1.52 vs. <0.48 mg per day) experienced a 3.31-fold–increased GDM risk (95% CI 1.02–10.72). In fully adjusted models, we noted that a 1-mg per day increase in heme iron was associated with a 51% increased GDM risk (RR 1.51 [95% CI 0.99–2.36]). Nonheme iron was inversely, though not statistically significantly, associated with GDM risk, and the corresponding RRs were 1.00, 0.83, 0.62, and 0.61 across quartiles of nonheme iron intake (P_trend = 0.08).

CONCLUSIONS

High levels of dietary heme iron intake during the preconceptional and early pregnancy period may be associated with increased GDM risk. Associations of GDM risk with dietary nonheme iron intake are less clear. Confirmation of these findings by future studies is warranted.Iron deficiency is the most common nutritional deficiency in the U.S. and worldwide (1). In recent years, concerns about iron overload in developed countries have spurred research designed to assess cardiometabolic risks secondary to excess body iron stores and high dietary iron intake (2,3). As a result, iron now is viewed as a double-edged sword for living systems. Increasingly, clinical and epidemiological evidence suggest that both iron deficiency and iron overload influence the production of reactive oxygen species, leading to oxidative stress, systemic inflammation, and alternations in mitochondrial function (4). Taken together, cellular and metabolic alterations secondary to iron overload are thought to contribute to increased risks of hypertension (2), cardiovascular disease (5), and type 2 diabetes (3,6–8).The two kinds of dietary iron, heme and nonheme iron, with distinct metabolic pathways and intestinal absorption potential, are thought to play distinct roles in the pathophysiology of cardiometabolic disorders (4). Heme iron is exclusively present in hemoglobin and myoglobin from animal sources, including red meat and poultry. Nonheme iron, which is abundant in cereals, vegetables, fruits, beans, and dairy products, accounts for >85% of dietary iron intake. Although heme iron accounts for a smaller proportion of dietary iron, it is absorbed two to three times more readily than nonheme iron and is less affected by other dietary constituents. The bioavailability of heme and nonheme iron is influenced by dietary factors, including ascorbic acid, coffee, and whole grains (9). Body iron stores also are important determinants of intestinal absorption of heme and nonheme iron (10).The expanding literature suggests that iron influences glucose metabolism (3). Statistically significant positive associations of dietary iron intake, particularly heme iron, with incident type 2 diabetes has been reported (6–8). These epidemiological associations are supported by findings documenting increased risks of incident type 2 diabetes among individuals with elevated serum ferritin concentrations (6,11). The relationship between nonheme iron intake and type 2 diabetes, however, has been far less consistent. Some (7), but not all (8), investigators have reported inverse associations of incident type 2 diabetes and dietary nonheme iron intake.Although there have been several studies investigating the possible role of dietary iron and body iron stores on glucose metabolism, only a few have enrolled pregnant women, and the results have been inconsistent (12–14). The effect of iron supplement use on gestational diabetes mellitus (GDM) risk also is controversial (14,15). To the best of our knowledge, no previous study has examined the associations of dietary heme and nonheme iron with the risk of GDM. Given mounting available experimental and epidemiological evidence from studies of men and nonpregnant women supporting associations of heme iron and risk of type 2 diabetes, we hypothesized that higher preconceptional and early pregnancy dietary heme iron intake may be associated with increased GDM risk. We also hypothesized that diets high in nonheme iron may be associated with reduced GDM risk. We investigated these hypotheses among a well-characterized prospective cohort of pregnant women.     

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.