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.     

Longitudinal changes of adiponectin,carbohydrate and lipid metabolism in pregnant women at high risk for gestational diabetes

To evaluate, in pregnant women at high risk for gestational diabetes (GDM), the longitudinal changes of adiponectin, carbohydrate and lipid metabolism, and to assess their independent value as risk factors for the development of GDM. Fifty women at beginning of pregnancy were studied. Adiponectin, insulin sensitivity (homeostasis model assessment, HOMA) and lipid panel were measured at 1st, 2nd and 3rd trimesters of pregnancy. Twelve patients developed GDM. In both groups, GDM and normal glucose tolerance (NGT), adiponectin decreased from 1st to 2nd and 3rd trimesters by about 5 and 20% (GDM, p?<?0.05), and of about 17 and 25% in NGT (p?<?0.05), respectively. Values observed in NGT were similar to those of GDM (F?=?9.401; p?=?0.238). The Cox regression model identified as the strongest independent risk factor for GDM HOMA over 1.24 (RR?=?14.12) at 1st trimester, fasting glycaemia over 87?mg/dl (RR?=?42.68) triglycerides over 158?mg/dl (RR?=?5.87) and body mass index (BMI) over 27?kg/m² (RR?=?4.38) at 2nd trimester. Adiponectin in high-risk women is characterised by a constant reduction throughout gestation, irrespective of the development of GDM. HOMA, fasting glycaemia, triglycerides and BMI, but not adiponectin are independent predictors of GDM.     

Role of A1c in the postpartum screening of women with gestational diabetes

Abstract

Objective: This study aimed to determine whether A1c detects a different prediabetes prevalence in women with a history of gestational diabetes mellitus (GDM) compared to those diagnosed with oral glucose tolerance test (OGTT) and the influence of haemoglobin concentrations on A1c levels.

Design and patients: We evaluated carbohydrate metabolism status by performing OGTT and A1c tests in 141 postpartum women with prior GDM in the first year post-delivery.

Results: The overall prevalence of prediabetes was 41.8%. Prevalence of isolated A1c 5.7–6.4%, impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) was 10.6%, 7.1%, and 9.2%, respectively. Isolated A1c 5.7–6.4% was associated with Caucasian origin (66.7% versus 32.6%, p?=?0.02) and with higher LDL cholesterol concentrations (123?±?28.4?mg/dl versus 101.6?±?19.2?mg/dl, p?=?0.037) compared with patients diagnosed by OGTT (IFG or IGT). Women with postpartum anaemia had similar A1c levels to those with normal haemoglobin concentrations (5.5%?±?0.6% versus 5.4%?±?0.4%, p?=?0.237).

Conclusions: Use of A1c in postpartum screening of women with GDM detected an additional 10.6% of patients with prediabetes and a more adverse lipid profile. Haemoglobin concentrations did not influence A1c values.     

Neopterin and hsCRP are not correlated in gestational diabetes mellitus

Objective: To determine serum neopterin and high sensitive C-reactive protein (hsCRP) levels in patients with and without gestational diabetes mellitus (GDM).

Methods: Neopterin and hsCRP levels were quantified in 28 women with GDM and 20 pregnant women with normal glucose tolerance (NGT). Postpartum neopterin and hsCRP levels were measured in a follow-up study.

Results: Neopterin levels were significantly higher in women with GDM than in women with NGT (15.89?±?8.19?nmol/L versus 10.4?±?3.8?nmol/L, p?p?p?=?0.9, respectively). In contrast, hsCRP levels decreased after delivery in patients with GDM (5.74?±?3.91 versus 3.78?±?2.78, p?r?=?0.3, p?=?0.02) and fasting glucose (r?=?0.4, p?=?0.004), postprandial glucose (r?=?0.3, p?=?0.01), HbA1c (r?=?0.3, p?=?0.02), whereas hsCRP levels were correlated with pre-pregnancy (r?=?0.3, p?=?0.04) and pregnancy body mass index (r?=?0.4, p?=?0.008). No correlation between serum neopterin and hsCRP levels was found (p?=?0.9).

Conclusion: Neopterin levels increased in patients with GDM; hence, it may be related to inflammation. However, the lack of correlation between neopterin and hsCRP suggests the role of different attitudes of these two parameters in the course of pregnancy and GDM.     

Circulating galanin and IL-6 concentrations in gestational diabetes mellitus

Objective: The aim of this study is to compare galanin and IL-6 levels in pregnant women with gestational diabetes mellitus (GDM) and normal glucose tolerance (NGT). Also association of insulin resistance markers, galanin and IL-6 was investigated.

Materials and Methods: The study registered 30 pregnant women with GDM and 30 pregnant women with NGT. Fasting venous blood samples were collected from all patients. Galanin and IL-6 levels were measured by an enzyme-linked immunosorbent assay.

Results: Galanin and IL-6 levels were found higher in pregnant women with GDM (p?r?=?0.240, p?=?0.065), insulin (r?=?0.681, p?r?=??0.644, p?r?=?0.783, p?r?=?0.745, p?r?=?0.058, p?=?0.662), body mass index (r?=??0.019, p?=?0.886).

Conclusion: Galanin and IL-6 were found to be significantly associated with insulin resistance markers in GDM, thus may play important roles in regulation of glucose hemostasis.     

Thiol/disulfide homeostasis in predicting adverse perinatal outcomes at 24–28 weeks of pregnancy in gestational diabetes

Objective: The main aim of this study was to investigate thiol/disulfide homeostasis at 24–28 weeks of pregnancy and to evaluate whether it is predictive for adverse perinatal outcomes or not in gestational diabetes mellitus (GDM).

Methods: A total of 110 pregnant women at 24–28 weeks of pregnancy (74 GDM patients and 36 age- and BMI-matched healthy pregnant women) were enrolled in this prospective case–control study. Thiol/disulfide homeostasis was evaluated with a novel spectrophotometric method to determine if there is an association with adverse perinatal outcomes in GDM, by using logistic regression analysis.

Results: GDM patients, with decreased native thiol levels at 24–28 weeks (OR: 4.890, 95% CI: 1.355–5.764, p?=?0.015) and with higher pre-pregnancy BMI (OR: 1.280, 95% CI: 1.072–1.528, p?=?0.006), were found to be at increased risk of adverse perinatal outcomes in GDM. There were no statistically significant differences in thiol/disulfide homeostasis between diet- and insulin-treated GDM subgroups. Additionally, 1-h and 2-h glucose levels on 100?g OGTT were found to be predictive for the insulin need in achieving good glycemic control in GDM (OR: 1.022, 95% CI: 1.005–1.038, p?=?0.010 and OR: 1.019, 95% CI: 1.004–1.035, p?=?0.015).

Conclusions: GDM patients, with decreased native thiol levels at 24–28 weeks of pregnancy and with higher pre-pregnancy BMI, have an increased risk of possible adverse perinatal outcomes. Also, increased 1-h and 2-h glucose levels on 100?g OGTT can predict the need for insulin treatment for GDM.     

Glycemic control in twin pregnancies with gestational diabetes: are we improving or worsening outcomes?

Objective: To estimate the association between glycemic control and adverse outcomes in twin pregnancies with gestational diabetes (GDM).

Study design: A cohort of patients with twin pregnancies and GDM were identified from one maternal–fetal medicine practice from 2005 to 2014. Patients with prepregnancy diabetes were excluded. First, outcomes were compared between patients with GDMA1 and GDMA2 (gestational age at delivery, birthweight, small for gestational age (SGA, birthweight <10th percentile), preeclampsia, and cesarean delivery). Then, finger stick glucose logs were reviewed and correlated with the risk of SGA and preeclampsia. Abnormal finger stick values were defined as: fasting ≥90?mg/dL, 1-h postprandial ≥140?mg/dL, 2-h postprandial ≥120?mg/dL.

Results: Sixty-six patients with twin pregnancies and GDM were identified (incidence 9.1%). Comparing the 43 patients with GDMA1 to the 23 patients with GDMA2, outcomes were similar, aside from patients with GDMA1 having lower birthweight of the smaller twin (2184?±?519?g versus 2438?±?428?g, p?=?0.040). The risk of preeclampsia was not associated with glycemic control. Patients with SGA had lower mean fasting values (83.3?±?5.5 versus 87.2?±?7.7?mg/dL, p?=?0.033), and a lower percentage of abnormal fasting values (24.0% versus 36.9%, p?=?0.040), abnormal post-breakfast values (9.9% versus 27.1%, p?=?0.003), and total abnormal values (20.1% versus 27.7%, p?=?0.055).

Conclusion: In twin pregnancies with GDM, improved glycemic control is not associated with improved outcomes, and is associated with a higher risk of SGA. Prospective trials in twin pregnancies should be performed to establish goals for glycemic control in twin pregnancies.     

Isolated abnormal value during the 3-hour glucose tolerance test: which value is associated with macrosomia?

Objective.?The aim of this retrospective review was to evaluate obstetric outcomes in patients with an isolated abnormal value on the oral glucose tolerance test (OGTT) at 0, 1, 2, and 3?h.

Methods.?From January 2003 through June 2009, all consecutive pregnant women who presented to Baskent University were screened for gestational diabetes mellitus (GDM). Patients with one abnormal value based on findings of the OGTT were grouped according to increased levels of glucose at 0, 1, 2, and 3?h (Group 1?>?95 mg/dl for fasting glucose concentration, Group 2?>?180 mg/dl for the serum glucose concentration in the first hour, Group 3?>?155 mg/dl for the serum glucose concentration in the second hour, Group 4?>?140 mg/dl for serum glucose concentration in the third hour). The four groups were compared for classic GDM risk factors. The primary outcome measures were large for gestational age (LGA) (birthweight?>95th percentile for gestational age using population birth weight centile charts) and macrosomia.

Results.?The incidence of LGA baby (Group 1, 10%; Group 2, 3.8%; Group 3 20.3%; Group 4, 13.2%; p?=?0.008) was significantly highest in Group 3 and macrosomia (Group 1, 30%; Group 2, 5.1%; Group 3, 18.6%; Group 4, 15.8%; p?=?0.039) was significantly higher in Groups 1 and 3.

Conclusions.?Our results suggest that even with relatively mild degrees of glucose intolerance at 2?h, no treatment is associated with LGA babies.     

Effect of vitamin D deficiency on the 75 g oral glucose tolerance test screening and insulin resistance

Abstract

Gestational diabetes mellitus (GDM), is the most common medical complications of pregnancy. This study aimed to clarify the effect of second-trimester vitamin D deficiency on the 75?g oral glucose tolerance test (OGTT) screening and insulin resistance. A total of 120 pregnant women with a singleton pregnancy at a gestational age of 26–28?weeks were analyzed. Participants were divided into two groups according to 25-hydroxyvitamin D levels; vitamin D deficiency, and control groups. For GDM scan, 75?g OGTT was preferred. GDM prevalence was 17.5% in vitamin D deficiency group and 13.75% in control group, there is no significant difference in GDM prevalence (p?=?0.149). Fasting plasma glucose and 1-h plasma glucose levels were significantly higher in the vitamin D deficiency group than in the control group (p?<?.001 and p?<?.001, respectively). No significant differences were observed between 2-hour plasma glucose levels (p?=?.266). The HOMA-IR level was significantly higher in the vitamin D deficiency group than in the control group (p?<?.001). The findings of the present study suggested that vitamin D deficiency in the second trimester was inversely correlated with fasting and 1-h plasma glucose after 75?g glucose challenge test; also, low 25 OHD₃ levels were associated with insulin resistance.     

Maternal serum atrial natriuretic peptide (ANP) and brain-type natriuretic peptide (BNP) levels in gestational diabetes mellitus

Objective: The aim of the study is to evaluate maternal serum atrial natriuretic peptide (ANP) and brain-type natriuretic peptide (BNP) levels in patients with getational diabetes mellitus compared with a control group.

Methods: We have measured maternal serum ANP and BNP levels in 35 otherwise healthy and 45 gestational diabetic women between gestational week 24 and 28 referred to our unit in a cross-sectional study. Independent samples t-test or the Mann–Whitney U-test was used for comparison of two groups where appropriate.

Results: Mean maternal serum homeostasis model assessment of insulin resistance (HOMA-IR), HbA1c, fasting glucose and insulin levels in gestational diabetes mellitus (GDM) group were significantly higher than the control group (p?<?0.01). Mean maternal serum ANP and BNP levels of women with GDM were significantly lower than the control group (12.9?±?9.9 versus 34.8?±?16.9?pg/ml, p?<?0.001; 416.6?±?209.7 versus 629.7?±?162.2?mg/dl, p?<?0.001, respectively). Maternal serum ANP and BNP levels were negatively correlated with insulin levels, HbA1c and HOMA-IR values (p?<?0.05).

Conclusions: Maternal serum ANP and BNP levels are significantly lower in patients with GDM. These biomarkers might be valuable in clinical setting for identifying high-risk women for developing diabetes during pregnancy.     

The relationship of fat soluble antioxidants with gestational diabetes in Iran: a case–control study

Abstract

Objective: The primary aim of this study was to evaluate the relationship of fat soluble antioxidants (retinol and α-tocopherol) with gestational diabetes (GDM).

Methods: This was a case–control study in which 41 pregnant women with GDM and 41 healthy women were recruited. The inclusion criteria were gestational age ≥32 weeks, singleton foetus, nulliparous or parous women up to four pregnancies and normal fasting blood sugar in the early pregnancy. Two groups were matched regarding age, gestational age and body mass index. A 5?ml venous blood sample were drawn and analysed with the chromatograph for measuring retinol and α-tocopherol. Data were analysed through Chi-square and t test.

Results: The mean serum retinol of the GDM group was 0.46?µg/dl and in the control group it was 0.59?mg/dl (p?=?0.01).The mean α-tocopherol in the women with GDM was 6.21?mg/dl and in the control group it was 6.92?mg/dl (p?>?0.05).

Conclusion: The level of retinol in the diabetic pregnant women was significantly lower than that in the control group. This reduction may be due to the reduced antioxidant defences in women with GDM.     

Insulin detemir versus glyburide in women with gestational diabetes mellitus

Aim: To evaluate the safety, efficacy and pregnancy outcomes of insulin detemir (IDet) versus glyburide treatment in women with gestational diabetes mellitus (GDM).

Methods: We conducted a retrospective cohort study of women with GDM who were treated with either glyburide or IDet for GDM in a university-affiliated tertiary hospital.

Results: Ninety-one patients with GDM were enrolled, 62 were administered glyburide and 29 IDet. Maternal age, pregestational body mass index (BMI) and rate of abnormal oral glucose tolerance test (OGTT) blood glucose values were not significantly different between groups. Good glycemic control rates were comparable. Hypoglycemic episodes were reported only in the glyburide group (19.4% versus 0%, p?=?0.01). Maternal weight gain during pregnancy was significantly higher among women in the glyburide group (8.8?±?5.1?kg, p?p?=?0.71).

Conclusions: To the best of our knowledge, this is the first study on IDet treatment in patients with GDM. By our preliminary results, IDet is a viable treatment option in women with GDM. Further large prospective studies are needed to determine the efficacy and safety of IDet in GDM patients.     

Macrophage infiltration and stress-signaling in omental and subcutaneous adipose tissue in diabetic pregnancies

Abstract

Objective: To examine if, as in obesity, pregnancies complicated by gestational diabetes mellitus (GDM) exhibit increased macrophage infiltration and activated MAP-kinases in omental adipose tissue.

Methods: Paired omental (OM) and abdominal subcutaneous (SC) fat samples were collected from 11 GDM and 20 normal pregnancies during cesarean delivery. Tissues were stained to detect macrophages, and analyzed to assess MAP-kinases.

Results: OM had higher macrophage counts than SC in GDM (6.10?±?2.20 versus 2.53?±?1.45, p?=?0.04), but not in normal pregnancies (p?=?0.346). GDM pregnancies had more macrophages than normal pregnancies in OM (6.10?±?2.20 versus 1.29?±?0.55, p?=?0.01), while only a trend was observed in SC fat (p?=?0.08). Significant correlation (R?=?0.619, p?=?0.005) was observed between OM-macrophage infiltration and insulin resistance. Using multivariate analysis, only obesity independently associated with GDM. Expression of total p38MAP-kinase was higher in OM versus SC in both normal and GDM pregnancies, without significant differences between these groups. However, expression of activated p-p38MAP-kinase, and its upstream kinase MKK4, was comparable between fat depots.

Conclusion: GDM pregnancies demonstrate increased macrophage infiltration to OM fat, correlating with higher insulin resistance. As in non-pregnant-patients obesity and OM macrophage infiltration may be on the same causal pathway, leading to GDM. Yet, this occurs without activation of p38MAP-kinase signaling.     

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.     

Relationship of maternal serum resistin and visfatin levels with gestational diabetes mellitus

Introduction: Adiponectin, resistin and visfatin are thought to play role in the pathophysiology of gestational diabetes (GDM). In this study, we aimed to investigate the association of maternal second trimester serum resistin and visfatin levels with GDM.

Materials and methods: Screening and diagnosis for GDM was performed between the 24–28th gestational weeks. About 40 women diagnosed with GDM and 40 non-diabetic women constituted the study and control groups, respectively. Groups were compared for second trimester maternal serum resistin, visfatin and HbA1c levels, HOMA-IR and postpartum 75?g OGTT results.

Results: Mean serum resistin (p?=?0.071) and visfatin (p?=?0.194) levels were similar between the groups. However, mean BMI (p?=?0.013), HOMA-IR (p?=?0.019), HbA1c (p?p?=?0.037) were significantly higher in GDM group compared to controls. Type 2 diabetes and impaired glucose tolerance were detected in 2 (5%) and 7 (20%) women in the GDM group, respectively, with 75?g OGTT performed at the postpartum 6th week. Resistin levels of patients with GDM and postpartum glucose intolerance were higher than those with GDM but no postpartum glucose intolerance (p?=?0.012). Visfatin levels in the GDM group showed a positive correlation with biparietal diameter, head circumference, abdominal circumference and femur length (p?Conclusion: Maternal serum resistin and visfatin levels are unchanged in GDM. In patients with GDM, second trimester resistin levels may be predictive for postpartum glucose intolerance and second trimester visfatin levels may be related with fetal biometric measurements. Further larger studies are needed.     

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.     

Clinical significance of neuregulin 4 (NRG4) in gestational diabetes mellitus

Objective: Gestational diabetes mellitus (GDM) is defined as glucose intolerance detected during pregnancy. GDM is increasing worldwide and is associated with adverse maternal and fetal outcomes. Neuregulin 4 (NGR4) is epidermal growth factor like signaling molecule. It plays an important role in cell to cell communication furthermore recent studies indicate that NRG4 may work as a novel adipokine with a possible role in maintaining energy and metabolic homeostasis. The aim of the present study was to assess serum NRG4 levels along with several metabolic parameters in patients diagnosed with gestational diabetic mellitus.

Materials and methods: In this prospective cross-sectional study, the study group was composed of 63 women with GDM and 64 healthy pregnant women matched for age, body mass index (BMI) and gestational age. Blood samples were collected at the 24–28th gestational weeks. Serum NRG4, total cholesterol, high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), triglycerides, glucose levels during 75-gr OGTT, fasting insulin, glycosylated hemoglobin A1c (HbA1c), alanine aminotransferase (ALT) and creatinine levels were measured. Homeostasis model assessment of insulin resistance (HOMA-IR) values were calculated.

Results: Serum NRG4 values were significantly elevated in the GDM group compared to the control group (p?β?=?0.910, p?β?=?0.866, p?β?=?0.222, p?Conclusions: Serum NRG4 levels were associated with metabolic parameters of GDM. The present study can be considered to be a guide for future studies to clarify the pathophysiology of NGR4 in GDM patients.     

Pregnancy outcome and placental pathology differences in term gestational diabetes with and without hypertensive disorders

Objective: To compare pregnancy outcome and placental pathology in pregnancies complicated by gestational diabetes mellitus (GDM A1 and A2), with and without hypertensive disorders.

Methods: Pregnancy outcome and placental pathology from term deliveries of women complicated with GDM with (GDM?+?H) and without (GDM???H) hypertensive disorders were compared. Results of the GDM?+?H group were compared also with the non-diabetic patients but with hypertensive disorders (non-GDM?+?H). Composite neonatal outcome was defined as one or more of early complications: respiratory distress or need of ventilation support, sepsis, phototherapy, transfusion, seizure, hypoxic-ischemic encephalopathy. Placental lesions were categorized to lesions related to maternal and fetal vascular supply abnormalities, and maternal and fetal inflammatory responses.

Results: Of the 192 women with GDM, the GDM?+?H group (n?=?41) were more obese, p?<?0.001, with higher rate of placental maternal and fetal vascular supply lesions, p?=?0.008, p?=?0.03, respectively, but similar neonatal outcome, compared to the GDM???H (n?=?151) group. Compared to the non-GDM?+?H group (n?=?41), the GDM?+?H group had higher birth weights, similar neonatal outcome and similar rate of placental vascular lesions.

Conclusions: Higher rate of placental maternal and fetal vascular supply lesions express underlying placental pathology in women with diabetes and hypertensive disorders, similar to women without DM and with hypertensive complications.     

Oral versus vaginal prostaglandin for labor induction

Objective: To compare the efficacy and safety of oral prostaglandin (PG) in solution versus vaginal PG gel for labor induction.

Design: A retrospective study.

Methods: Data from original obstetric records at a university hospital in Sweden 2012–2013.

Results: In all women, oral PG resulted in vaginal birth (VB)?p?p?=?0.02). In primiparous women, oral PG was followed by VB <24?h in 54% compared to 71% (p?=?0.01), and CS in 25% versus 41% (p?=?0.03). In women with an unripe cervix, oral PG lead to VB <24?h in 66% compared to 79% (p?=?0.01), and CS in 21% versus 33% (p?=?0.04). Despite a longer induction to vaginal delivery interval with oral PG, the rates of obstetric bleeding, chorioamnionitis, and neonatal asphyxia were not increased.

Conclusions: Oral PG in solution was less effective than vaginal PG gel in achieving VB <24?h. However, oral PG was safer, since it resulted in fewer CSs without increasing maternal morbidity or neonatal asphyxia.     

Omega-3 fatty acid supplementation affects pregnancy outcomes in gestational diabetes: a randomized,double-blind,placebo-controlled trial

Objective: This study was designed to assess the effects of omega-3 fatty acid supplementation on inflammatory factors, biomarkers of oxidative stress, and pregnancy outcomes among pregnant women with gestational diabetes (GDM).

Methods: This randomized, double-blind, placebo-controlled clinical trial was performed among 56 women with GDM. Subjects were randomly selected to receive either 1000?mg omega-3 fatty acid supplements (containing 180?mg eicosapentaenoic acid and 120?mg docosahexanoic acid) (n?=?27) or a placebo (n?=?27) for 6 weeks. Fasting blood samples were taken at study baseline and after 6 weeks of intervention to quantify biochemical variables. Newborn’s weight, height, head circumference, Apgar score, and hyperbilirubinemia were determined.

Results: At the end of the 6 weeks, taking omega-3 fatty acid significantly decreased serum high-sensitivity C-reactive protein (hs-CRP) (change from baseline: ?245.1?±?1570.5 versus?+?913.9?±?2329.4?ng/mL, p?=?0.03) and plasma malondialdehyde (MDA) concentrations (?0.4?±?1.3 versus?+?0.6±2.3, p?=?0.04) compared with the placebo. Supplementation with omega-3 had a low incidence of hyperbilirubinemiain newborns (7.7% versus 33.3%, p?=?0.02) and decreased newborns’ hospitalization rate (7.7% versus 33.3%, p?=?0.02).

Conclusions: Taken together, omega-3 fatty acid supplementation in GDM women had beneficial effects on maternal serum hs-CRP, plasma MDA levels, incidence of newborn’s hyperbilirubinemia, and hospitalization.