Evaluation of the prognostic value of chosen maternal risk factors of complications existing among newborns of GDM mothers

OBJECTIVES: According to WHO definition, gestational diabetes mellitus (GDM) is a disorder of carbohydrates tolerance during pregnancy. The incidence of GDM is about 2-4% in the population at pregnant women. Prematurity, neonatal dystrophy (particularly hypertrophy), hypoglycemia and other clinical abnormalities are more frequent in the group of the neonates of diabetic mothers. DESIGN: The aim of this study was to separate the maternal risk factors of complications existing among neonates of diabetic mothers as well as the statistical analysis of their prognostic values. MATERIAL AND METHODS: 260 newborns of GDM mothers, born at Polish Mothers Health Center were observed. The group of pregnant women was divided into two subgroups according to GDM class--G1 or G2. At 116 (44.6%) pregnant women glycemia was regulated dietetic treatment (G1 class). 144 women (55.4%) were treated with insulin (G2 class). The control group were 153 newborns from pregnant women with excluded GDM after carbohydrates tolerance screening test provide between 24-28 week. Estimation of the newborns status after birth was based on Apgar Score and umbilical blood pH. Basic laboratory tests were done in umbilical blood. Blood glucose concentration were monitored in all cases. Bilirubin concentration, infection screening tests were provided due to clinical status. Statistic evaluation was performed using special computer programs. CONCLUSIONS: G2 class of the Gestational Diabetes Mellitus significantly increases the frequency of newborn macrosomia, LGA, birth trauma, hypoglycemia, hyperbilirubinemia, cardiomyopathy and respiratory disorders. Prematurity is more frequent among newborns from GDM mothers group and it determines a potent risk factor of low Apgar Score, hypoglycemia and respiratory disorders. The following risk factors are unimportant for the frequency of complications existing among newborns of diabetic mothers: mothers age, number of delivers, obstetric complications and delivery of newborn with a congenital malformation in an anamnesis.     

Diabetes and pregnancy. Maternal risk factors and neonatal morbidity

BACKGROUND: To verify in our population the incidence of infants of mother with insulin dependent diabetes mellitus (IDDM) or gestational diabetes (GD) and to evaluate the maternal characteristics influencing neonatal outcome. METHODS: The study was retrospectively performed on 6179 infants born between 1995 and 1998 at the Obstetric Clinic of the University of Messina and referred the Division of Neonatology. The following groups have been selected: group A (offsprings of IDDM mothers), group B (offsprings of DG mothers), group C and group D, controls, (2 infants of the same sex and gestational age born before and after the infants of group A and group B, respectively). The parameters analyzed were: diabetic familiarity, age, weight and body mass index (BMI) of the mothers, delivery, gestational age, weight at birth, neonatal outcome. RESULTS: The infants of IDDM mothers were 3% and the infants of GD mothers were 0.8%. Group A and group B present a significantly higher incidence of: diabetic familiarity, cesarean section, macrosomia, hypoglycemia, hypocalcemia, hyperbilirubinemia. The GD mothers had weight and BMI higher than IDDM mothers. The infant weight did not correlate with maternal weight and BMI. CONCLUSIONS: These data suggest that in our population GD is underestimated, metabolic control in pregnancy is insufficient, obstetric practices are too invasive, neonatal outcome is verosimely correlated only to metabolic control.     

妊娠期糖代谢异常并发新生儿低血糖的相关研究

目的:探讨妊娠期糖代谢异常与新生儿低血糖的关系.方法:对我院2006年1月1日至2007年6月30日在我院产前检查及分娩的1221例单胎孕妇及其分娩的新生儿,按50 g葡萄糖筛查(GCT)和75g葡萄糖耐量试验(OGTT)检查结果将产妇分为:血糖正常孕妇组、GCT阳性组、妊娠期糖耐量减低组(GIGT组)、妊娠期糖尿病组(GDM组),同时根据GDM组患者是否应用胰岛素分为无胰岛素治疗组(GDM-A1组)和胰岛素治疗组(GDM-A2组).分别统计5组产妇分娩的新生儿中低血糖发生率及血糖均值之间的变化情况.结果:GDM-A2组的新生儿与血糖正常孕妇组、GCT阳性组、GIGT组、GDM-A1组相比,其新生儿低血糖发生率、血糖均值之间差异均有高度统计学意义(P＜0.01).结论:GDM-A2组孕妇虽经系统治疗,其分娩的新生儿仍应加强产后2小时血糖的监测,做到早发现、早处理新生儿低血糖.     

Long-term endocrine outcome of small for gestational age infants born to mothers with and without gestational diabetes mellitus

Abstract

Small for gestational age (SGA) infants and infants born to mothers with gestational diabetes mellitus (GDM) are at an increased risk for significant morbidity and mortality, mainly metabolic disorders. We aimed to question the long-term endocrine morbidity of SGA infants born to mothers with GDM compared to SGA infants born to non- diabetic mothers. A population-based cohort study was performed to assess the risk for endocrine morbidity among children born SGA to mothers with and without GDM. The main outcome evaluated was endocrine morbidity of the offspring up to the age of 18 years, predefined in a set of ICD-9 codes. Endocrine morbidity included thyroid disease, insulin and non-insulin dependent diabetes mellitus, hypoglycemia, childhood obesity, parathyroid hormone disease, adrenal disease, and sex hormone disease. All SGA infants born between the years 1991 and 2014 and discharged alive from the hospital were included in the study. Multiple pregnancies, infants with congenital malformations or chromosomal abnormalities and mothers lacking prenatal care were excluded from the analysis. Kaplan–Meier survival curve was constructed to compare cumulative endocrine morbidity. A Cox proportional hazards model was conducted to control for confounders. During the study period, 9312 newborn infants met the inclusion criteria, of them 259 SGA infants were born to mothers with GDM and 9053 SGA infants were born to mother without GDM. No significant differences in long-term endocrine morbidity were noted between the groups (0.8% in children born to mothers with GDM vs. 0.5% in children born to non-diabetic mothers, p?=?.62). Likewise, the Kaplan–Meier survival curve did not demonstrate a significantly higher cumulative incidence of endocrine morbidity in offspring of women with GDM (log rank test p=.67). In a Cox regression model, while controlling for ethnicity, hypertensive disorders, preterm birth, and maternal age, delivery of an SGA neonate to mother with GDM was not associated with long-term endocrine morbidity of the offspring (adjusted HR 1.2, 95% confidence interval 0.27–5.00, p=.82). SGA infants born to mothers with GDM are not at an increased risk for long-term endocrine morbidity as compared with SGA infants born to non-diabetic mothers.     

Hypoglycemia during the 100-g oral glucose tolerance test: incidence and perinatal significance

OBJECTIVE: To estimate and report the incidence and perinatal significance of hypoglycemia during the 100-g oral glucose tolerance test in pregnant women. METHODS: Over a 3-year period, we analyzed the incidence and perinatal outcome of pregnant women who experienced hypoglycemia, defined as a plasma glucose level of 50 mg/dL or less while undergoing the 100-g oral glucose tolerance test. The study group included women who delivered singletons at term. Women who underwent the 100-g oral glucose tolerance test during the same period and had no hypoglycemia served as the control group. RESULTS: A total of 805 women were included in the study, which comprised 51 women (6.3%) who experienced hypoglycemia during the test and 754 women in the control group. Gestational diabetes mellitus was diagnosed in 5/51 (9.8%) women in the study group, compared with 216/754 (28.6%) women in the control group (P < .03), and the neonates born to these women had significantly lower birth weights. CONCLUSION: The incidence of reactive hypoglycemia during the 100-g oral glucose tolerance test in our population is 6.3%. Women who experience hypoglycemia during the test have a significantly lower incidence of gestational diabetes and neonatal birth weights.     

Rate and risk factors of hypoglycemia in large-for-gestational-age newborn infants of nondiabetic mothers

OBJECTIVE: The purpose of this study was to investigate the rate of hypoglycemia in large-for-gestational-age infants of nondiabetic mothers in relation to maternal or neonatal risk factors. STUDY DESIGN: Hospital charts of all term large-for-gestational-age infants born between 1994 and 1998 (n = 1136) were analyzed for the rate of neonatal hypoglycemia (capillary glucose level, < or =30 mg/dL) during the first 24 hours of life. Infants of women with preexisting or gestational diabetes mellitus were excluded (n = 180). Neonatal glucose testing was performed at 1 or 2 hours of life, with subsequent measurements every 4 to 6 hours. Maternal and neonatal parameters were compared between neonates with and without hypoglycemia, including recent oral glucose tolerance test values in those women who were tested (n = 358). RESULTS: Of 956 infants, 69 infants (7.2%) were not tested for hypoglycemia. In the remaining 887 infants, hypoglycemia occurred in 142 infants (16%) within the first 24 hours of life. The incidence of hypoglycemia decreased sharply during the first few hours of life, from 9.2% within the first hour of life, to 3.5% between 2 to 5 hours (cumulative) of life, and 2.4% between 6 and 24 hours of life. Gestational age at delivery was the only neonatal parameter that differed significantly between infants with and without hypoglycemia (39.5 vs 39.3 weeks, P =.01). The antenatal 1-hour oral glucose tolerance test value was the only predictive maternal parameter (141.5 vs 163.0 mg/dL, P <.006). There was an incremental risk of hypoglycemia with increasing 1-hour oral glucose tolerance test values, with hypoglycemia rates of 2.5%, 9.3%, 22.0%, and 50.0% that were associated with maternal 1-hour glucose values of <120, 120-179, 180-239, and > or =240 mg/dL, respectively (P <.05, for all comparisons). CONCLUSION: Routine glucose testing is indicated in large-for-gestational-age newborn infants of nondiabetic mothers. The 1-hour glucose value of the maternal oral glucose tolerance test is a fairly good predictor of subsequent neonatal hypoglycemia. A single elevated 1-hour value of > or =180 mg/dL markedly increases the risk of neonatal hypoglycemia.     

Effect of maternal intrapartum glucose therapy on neonatal blood glucose levels and neurobehavioral status of hypoglycemic term newborn infants

Two groups of 45 term, vaginally delivered infants were studied to determine effect of maternal intrapartum glucose therapy on neonatal blood glucose level at birth and at one and 2 hours of age. Twenty-three infants whose mother received glucose infusion prior to delivery (study group) had a significantly higher mean cord blood glucose level, lower 2 hour blood glucose levels and about three times higher incidence of hypoglycemia (glucose level less than or equal to 2.2 mmol/l) as compared to 22 infants whose mothers did not receive any glucose or fluid therapy. Neurobehavioral evaluation of the infants at 1 and 2 hour demonstrated, a significant association between hypoglycemia and a low muscle tone score and a delayed habituation to various stimuli. Blood glucose levels must be routinely monitored in infants whose mother receive glucose infusion prior to delivery to detect and treat early neonatal hypoglycemia.     

Maternal obesity is a major risk factor for large-for-gestational-infants in pregnancies complicated by gestational diabetes

Objectives  Our aim was to evaluate the relative contribution of maternal weight, GDM severity and glycemic control in women with gestational diabetes (GDM) on the prevalence of LGA infants. Methods  A total of 233 women with GDM were classified according to the fasting and/or postprandial glucose levels as in “good” or “poor” glycemic control. Severity of GDM was categorized using fasting plasma glucose on the 3-h 100 g oral glucose tolerance test (OGTT). Results  The incidence of LGA infants was significantly higher in obese women than in those with lower BMI. There was no significant correlation between GDM severity or level of glycemic control and birth weight or proportion of LGA infants. On multivariate regression analyses, only maternal weight at delivery and fasting glucose level on OGTT were found to be independently and significantly associated with the birth weight, and only maternal weight at delivery was a significant and independent predictor of LGA infants. Conclusions  Both the GDM severity and maternal weight are independent predictors of infants’ birth weights. Maternal weight at delivery is a major risk factor for LGA infants. The study was presented at the SMFM 27th annual meeting on February, 2007.     

妊娠糖尿病对母婴影响的分析

目的研究早期诊断妊娠糖尿病(GDM)有效控制血糖,减少母婴并发症的发生.方法回顾分析1992年1月至1999年12月期间的GDM患者16例及健康孕妇40例妊娠结局.结果GDM组中病理妊娠的发生率占56.25%,胎婴儿并发症的发生率为62.5%,手术产率占62.5%;对照组病理妊娠的发生率占15%,胎婴儿并发症的发生率为12.5%,手术产率为22.5%.GDM组母婴并发症的发生率明显高于正常孕妇,随血糖升高而发病率呈上升趋势.结论早期诊断GDM及控制血糖是减少母婴并发症的关键.     

Maternal and umbilical resistin levels do not correlate with infant birth weight either in normal pregnancies and or in pregnancies complicated with gestational diabetes

Objective.?To evaluate the role of resistin in the pathophysiology of insulin resistance during pregnancy and on the birth weight of infants born from women with gestational diabetes (GDM).

Material and methods.?Thirty women diagnosed with GDM were compared to 30 normal pregnant controls. Maternal serum resistin and insulin levels were measured at the time of the oral glucose tolerance test screening. In addition, umbilical levels of resistin and insulin were measured at the time of delivery.

Results.?There was no difference in maternal serum resistin levels in women with GDM as compared to normal controls at 24–26 weeks. There was no difference in umbilical resistin levels between the infants born in the two groups. There was no correlation between infant weight and either maternal resistin at 24–26 week or umbilical resistin levels.

Conclusion.?There were no significant differences in umbilical resistin levels between infants born of women with GDM as compared to normal pregnant women. In addition, there was no correlation between resistin levels during pregnancy, as well as between umbilical resistin levels and neonatal birth weight. In conclusion, resistin seems to play a rather minor role in the pathophysiology of GDM and the energy metabolism during fetal life.     

Randomized trial of human versus animal species insulin in diabetic pregnant women: improved glycemic control, not fewer antibodies to insulin, influences birth weight.

OBJECTIVE: Macrosomia occurs in infants of diabetic mothers in spite of "nearly normal maternal blood glucose levels" with insulin treatment. Insulin antibodies may carry bound insulin into the fetal blood and thus may be associated with fetal hyperinsulinemia and macrosomia in these infants. Our objective was to test the hypothesis that human insulin is associated with lower insulin antibody levels and less macrosomia than is animal species insulin. STUDY DESIGN: Forty-three insulin-requiring pregnant (< 20 weeks' gestation) women, previously treated with animal insulin, were randomized to human and animal insulins and studied at weeks 10 through 20, 24, 28, 32, 36, and 38, at delivery, and at 3 months post partum. Infant blood was drawn at delivery (cord) and at 1 day and 3 months post partum 1 hour after a glucose-amino acid challenge. RESULTS: Women receiving human insulin required significantly less insulin per kilogram of body weight and showed significant dampening of glucose excursions (p < 0.05 for each comparison). Infants born to mothers receiving human insulin weighed 2880 +/- 877 gm compared with 3340 +/- 598 gm for infants of women treated with animal insulin (p < 0.05). There was no difference in insulin antibody levels between groups for either mothers or infants. Infants born to mothers receiving human insulin had a 1 hour C-peptide level after the glucose-amino acid challenge at 3 months of age of 0.21 +/- 0.13 pmol/ml compared with 0.32 +/- 0.13 pmol/ml (p = 0.01). CONCLUSION: Administration of human insulin to pregnant diabetic women has a therapeutic advantage over animal insulin, with less maternal hyperglycemia or hypoglycemia, fewer larger-for-gestational-age infants, and less neonatal hyperinsulinemia. Our data do not support the hypothesis that maternal antibodies to insulin influence infant birth weight.     

Nucleated red blood cells in healthy infants of women with gestational diabetes

OBJECTIVE: To evaluate whether absolute nucleated red blood cell (RBC) counts are elevated in large-for-gestational-age (LGA) infants of women with gestational diabetes compared with appropriate-for-gestational-age (AGA) infants of women with or without gestational diabetes. METHODS: We compared absolute nucleated RBC counts during the first 12 hours of life in three groups of term, vaginally delivered infants, LGA infants of women with gestational diabetes (n = 20), AGA infants of women with gestational diabetes (n = 20), and AGA infants of nondiabetic women (n = 30). We excluded infants of women with hypertension, smoking, alcohol or drug abuse, and those with fetal heart rate abnormalities in labor, low Apgar scores, hemolysis, blood loss, or chromosomal anomalies. RESULTS: There were no significant differences among groups in gestational age, gravidity, parity, maternal analgesia, 1- and 5-minute Apgar scores, and lymphocyte counts. Corrected white blood cell counts and hematocrit were significantly higher in LGA infants of women with gestational diabetes than in the other groups. The median nucleated RBC count was significantly higher in LGA infants of women with gestational diabetes (0.56 x 10(9)/L, range 0-1.8 x 10(9)/L) than AGA infants of women with gestational diabetes (0.13 x 10(9)/L, range 0-0.65 x 10(9)/L) and controls (0.0005 x 10(9)/L, range 0-0.6 x 10(9)/L) (P < .001). Multiple regression analysis showed that absolute nucleated RBC count was significantly correlated with birth weight (or macrosomia) and maternal diabetic status (r2 = .25, P < .001 for the multiple regression, contribution of birth weight r2 = .19, and diabetes r2 = .06). CONCLUSION: At birth, term LGA infants born to women with gestational diabetes had higher absolute nucleated RBC counts compared with AGA infants born to women with gestational diabetes and controls.     

Glucose transporter (Glut1, Glut3) mRNA in human placenta of diabetic and non-diabetic pregnancies

Transport of glucose into the cell is catalyzed by glucose transporters (Glut). Glut1 and Glut3 are expressed at various levels in many human tissues, including the placenta. It has been reported that ambient glucose can affect both glucose transport activity and expression of the Glut genes, and protein. To date, very few studies concerning Glut in the placenta have been published, and studies in vivo in human diabetic pregnancy are lacking. We therefore investigated placental Glut1 and Glut3 mRNA by Northern blot analysis in ten diabetic (five insulin dependent diabetes mellitus (IDDM), two non-insulin dependent diabetes mellitus (NIDDM) and three gestational diabetes mellitus (GDM)) and nine non-diabetic women. The quantitative results of specific mRNA/beta-actin ratios were expressed as arbitrary units. The results were evaluated according to metabolic and clinical findings. Glut1 and Glut3 mRNA values in diabetic and non-diabetic pregnant women were similar. The metabolic environment seems to affect the Glut3 mRNA levels in IDDM pregnant women but not the control women. In addition, Glut3 mRNA decreased in late pregnancy in the diabetic but not in the control women. Moreover, Glut1 mRNA levels were correlated with maternal age in the diabetic as well as in the control women (significantly). Finally, an inverse correlation was found between Glut1 mRNA levels and placental weight (in both diabetic and non-diabetic women). These results, although preliminary, shed some light on the function of these glucose transporters in normal as well as in diabetic pregnancies and prompt us to carry out a further investigation to better elucidate fetomaternal metabolic correlation at the placental level.     

Gestational Diabetes: Glycemic Control in the Last Two Weeks Before Delivery Contributes to Newborn Insulinemia

Introduction

Fetal hyperinsulinemia in gestational diabetes mellitus (GDM) not only is important during intrauterine life, a time when it can result in macrosomia, but also at delivery, since it can result in neonatal hypoglycemia and hyperbilirubinemia. The question is, how long before delivery does maternal glycemic control contribute to newborn insulinemia in GDM?

Cord blood insulin and erythropoietin levels in relation to the mode of delivery

The aim of the study was evaluation, whether cord blood insulin (Ic) and erythropoietin (EPO) levels differ in accordance with mode of delivery: cesarean section (CS) or vaginal delivery (VD). Material and methods: The study was performed in the diabetic group consisted of 148 newborns of diabetic mothers (NDM)--90 of them with GDM and 58 with IDDM as well as in the control group consisted of 100 newborns born to healthy mothers. 52.0% of NDM and 38.0% control subjects were delivered by cesarean section. The most frequent reason for performing CS in the diabetic group was fetal distress before labor and in the control group--fetal distress during labor. Cord blood Ic and EPO levels were compared in accordance with type of delivery: CS or VD. Into statistical analysis Mann-Whitney test was used. RESULTS: There were found that cord blood Ic and EPO levels in NDM born by CS are significantly higher than in those born by VD (Ic--38.2 +/- 41.5 versus 26.6 +/- 38.6 mIU/ml adequately and EPO--51.8 +/- 76.0 versus 26.8 +/- 29.9 mU/ml adequately). There were no such differences in the control group. CONCLUSIONS: 1. Fetal hyperinsulinemia in perinatal period is often connected with occurrence of indications for performing cesarean section in pregnant women with diabetes mellitus. 2. Cesarean section in diabetic pregnant women is often connected with previous fetal hypoxia.     

Glucose kinetics in nondiabetic and diabetic women during the third trimester of pregnancy

Glucose kinetics were measured with 78% enriched D-[U-13C] glucose by the prime constant infusion technique during the third trimester of pregnancy in nine nondiabetic women, nine insulin-dependent diabetic women, six gestational diabetic women, and five control women (nonpregnant, nondiabetic) after an overnight fast. The patients not dependent on insulin were diagnosed as diabetic by oral glucose tolerance tests with the use of O'Sullivan and Mahan's criteria as modified by Carpenter and Coustan during the third trimester. The turnover studies were repeated post partum (6 weeks to 5 months after delivery) in 14 of the 24 pregnant subjects. All pregnant groups had a progressive fall in plasma glucose concentration during the study, but there was a steady state of plasma glucose concentration during the turnover period. In comparison to the control subjects, both the pregnant nondiabetic and pregnant insulin-dependent diabetic women had significantly higher plasma insulin concentrations throughout the study (p less than 0.05). There were no differences in the glucose turnover rate between any of the pregnant groups (1.7 +/- 0.2 mg . kg-1 min-1 in pregnant nondiabetic women; 1.5 +/- 0.2 mg . kg-1 min-1 in pregnant insulin-dependent diabetic women; and 2.1 +/- 0.4 mg . kg-1 min-1 in gestational diabetic women) and the control group of women (1.8 +/- 0.2 mg . kg-1 min-1) (mean +/- SEM). When the pregnant patients were studied post partum, the glucose turnover rate was similar when referenced to body weight; however, because of a 9.6% to 14.5% fall in weight post partum, the absolute values were higher in the pregnant women. We conclude that, in the basal state after an overnight fast, (1) both nondiabetic and diabetic patients accelerated their glucose turnover rate during pregnancy to provide for increased maternal and fetoplacental metabolic requirements, and (2) in the diabetic subjects the nearly normal plasma glucose and insulin concentrations and other metabolic parameters, as well as the glucose turnover rate, suggested good metabolic control during pregnancy in most of the insulin-dependent and in all of the gestational diabetic patients.     

Hypoglycemia in infants of diabetic mothers: experience in a rural hospital

The purpose of this study was to identify which factors contribute to neonatal hypoglycemia in infants of diabetic mothers. A chart review of infants of diabetic mothers was undertaken noting the timing of blood glucose levels, symptoms of hypoglycemia, and interventions provided. The impact of maternal and gestational factors was assessed using marginal mixed models and Poisson regression. Of the 66 infants who had blood glucose determinations, none developed symptomatic hypoglycemia and none required intravenous glucose. The first 90 minutes of life had the lowest mean blood glucose level (mean, 3.01 mmol/L [54.24 mg/dL]) and nearly all of the blood glucose levels < 1.7 mmol/L (30 mg/dL). The risk of a blood glucose level < 1.7 mmol/L decreased with maternal age. With presumably tighter control of gestational diabetes, the risk of symptomatic hypoglycemia appears diminished. If glucose monitoring of asymptomatic newborns is to be performed, it need only be done in the first 2 hours of life.     

Role of mean platelet volume and ischemia modified albumin in evaluation of oxidative stress and its association with postnatal complications in infants of diabetic mothers

Gestational diabetes mellitus (GDM) is accompanied by increased oxidative stress, causing many complications to pregnant women and their newborns. We aimed to determine cord blood levels of mean platelet volume (MPV) and ischemia modified albumin (IMA) as a reflection of oxidative stress in babies born to mothers suffering from GDM. Eighty pregnant women were enrolled in the study. They were divided into two groups: 40 with GDM and 40 healthy matched controls. Each group included twenty giving birth by normal vaginal delivery (NVD) and twenty by cesarean section (C.S). The MPV and the IMA levels were measured. Complete physical examination of babies was done at birth and follow up at age of one?week. Comparison between infants of diabetic mothers and of healthy mothers showed statistically significant difference in the levels of MPV (p?p?=?.001). Also, there was a statistically significant difference in MPV (p?p?=?.005) between diabetic females who gave birth by NVD and C.S. ROC curve analysis showed that IMA and MPV variables were related to the postnatal outcomes. MPV and IMA are useful markers of the potential oxidative stress in infants of diabetic mothers and of postnatal complications.     

Gestational diabetes. Is a 50-g screening result > or = 200 mg/dL diagnostic?

OBJECTIVE: To evaluate the diagnosis of gestational diabetes based on a 50-g, one-hour glucose screening test result > or = 200 mg/dL. STUDY DESIGN: Retrospective ascertainment of pregnant women who had a 50-g, one-hour glucose screening test result > or = 200 mg/dL was performed among prenatal care registrants. The diagnosis of gestational diabetes was determined by 100-g, three-hour oral glucose tolerance test (GTT) results and/or repeated fasting serum glucose measures. RESULTS: In 1995, 69 women were referred to the gestational diabetes clinic with a 50-g result > or = 200 mg/dL. Four women could not be classified, two had pregestational glucose intolerance and four charts were unavailable. Of the remaining 59 women, 11 (19%) had normal three-hour GTTs, and 48 (81%) were diagnosed with gestational diabetes (35 [59%], A1; 13 [22%], A2). There was one large-for-gestational-age (LGA) infant born in the nondiabetic group (9%), 13 LGA infants born in the A1 group (37%) and 6 LGA infants born to the A2 diabetics (46%). The relationship between maternal diagnosis and LGA outcome was statistically significant. CONCLUSION: A 50-g screening test result > or = 200 mg/dL is not diagnostic of gestational diabetes. Nearly one of five such women had a normal three-hour oral GTT. Overdiagnosis of gestational diabetes may lead to unnecessary pregnancy surveillance and intervention.     

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.