Exploring cultural factors contributing maternal mortality among pregnant women: an ethnographic study in the Banjarnegara community, Central Java, Indonesia

To estimate the effects of adipocytokines on the metabolic and endocrine features, and the obstetric outcome in pregnant women with polycystic ovary syndrome (PCOS). Prospective cross sectional study. Main outcome measures: plasma concentration of adipocytokines, insulin resistance/hyperinsulinism (IR/HI), lipid profile, androgens and obstetric outcome. The study included hundred pregnant PCOS (PPCOS) women with android obesity (group 1), 100 pregnant non-PCOS women with android obesity (group 2), 100 PPCOS women with gynoid obesity (group 3), and 100 pregnant non-PCOS women with gynoid obesity (group 4). All patients in the four groups were primigravidae and women with PCOS (groups 1 and 3) became pregnant after treatment with clomiphene citrate and/or gonadotropins. Plasma concentrations of fasting glucose, fasting serum insulin, insulin sensitivity by quantitative insulin sensitivity check index (QUICKI), serum concentrations of triglycerides (TGs), total cholesterol (TC), high density lipoprotein cholesterol, (HDL-c), low density lipoprotein cholesterol (LDL-c); plasma adipocytokines: interleukin (IL)-10, adiponectin (both are insulin sensitizers and anti-inflammatory), pro-inflammatory cytokines: IL-6, prothrombin activator inhibitor-1(PAI-1), high sensitivity C-reactive protein (hsCRP); serum total testosterone (TT), sex-hormone binding globulin (SHBG), free androgen index (FAI) were estimated for the four groups between 22 and 24 weeks’ gestation Glucose loading test was done at 22–24 weeks’ gestation to check for gestational diabetes mellitus and if normal it was repeated at 30–34 weeks. Gestational hypertension (GH), preeclampsia (PE) and preterm labor (PTL) (delivery <37 weeks’ gestation) were recorded. Groups 1 and 2 with android obesity had IR/HI, (QUICKI < 0.331 ± 0.010). Groups 3 and 4 with gynoid obesity had normal insulin sensitivity (NIS), (QUICKI > 0.331 ± 0.010). Serum concentration of TGs, LDL-c, and plasma concentration of IL-6, PAI-1, hsCRP were significantly higher in groups 1 and 2 than groups 3 and 4. Serum HDL-c, plasma IL-10 and adiponectin were significantly higher in groups 3 and 4 than groups 1 and 2. Serum TT and FAI were significantly higher in groups 1 and 3 (cases of PPCOS) than their controls. There was no significant difference in the serum concentration of TC between the four groups. Incidence of spontaneous early miscarriage (SM) in groups 1, 2, 3, and 4 was 36%, 12%, 33%, and 11% respectively. Incidence of SM was significantly higher in PPCOS than non-PCOS pregnancy irrespective of the type of obesity. Rate of late pregnancy complications, GDM, GH, PE and PTL was significantly higher in groups 1 and 2 with android obesity than groups 3 and 4 with gynoid obesity. There was no significant difference in the rates of cesarean section (CS) between the 4 groups. The rates of neonatal complications and perinatal mortality were significantly higher in groups 1 and 2 (android obesity) than groups 3 and 4 (gynoid obesity). 1. TT and FAI were significantly higher in PPCOS with android obesity than PPCOS with gynoid obesity. 2. Incidence of early SM (9–12 weeks) was significantly higher in PPCOS than in non-PCOS pregnancy irrespective of the type of obesity. 3. Incidence of late-onset pregnancy complications, GDM, GH, PE and PTL was significantly higher in patients with android obesity than patients with gynoid obesity. PCOS per se seemed to be not related to the incidence of late-onset pregnancy complications. Pregnant patients with android obesity, (both PCOS and non-PCOS) with diminished serum concentration of anti-inflammatory cytokines, and increased serum concentration of pro-inflammatory cytokines had IR/HI and dyslipidemia. Pregnant patients with gynoid obesity, (both PCOS and non-PCOS) with normal serum concentration of anti- and pro-inflammatory cytokines had NIS and normal lipid profile. 4. In pregnancy with android obesity patients had reduced plasma concentration of IL-10 and increased concentration of IL-6 which may impair the development of the placenta with increased risk of PTL. 5. Neonatal complications and perinatal mortality were significantly higher in PPCOS with android obesity than PPCOS with gynoid obesity.

Objective: To analyze the association between different treatment timings and adverse neonatal outcomes (premature birth, death, congenital syphilis) in syphilis-infected pregnant women. Methods: The National Management Information System for Prevention of HIV, Syphilis and HBV Mother-to-Child Transmission was used to collect information on the detection and treatment of syphilis-infected pregnant women and their newborns in Guangdong Province from October 2011 to December 2021. According to the gestational weeks of syphilis-infected pregnant women receiving penicillin treatment for the first time, they were divided into four groups: treatment in the first trimester, treatment in the second trimester, treatment in the third trimester, and no treatment during pregnancy. Multivariate logistic regression was used to analyze the association between different treatment timings and adverse neonatal outcomes in syphilis-infected pregnant women. Results: A total of 22 483 syphilis-infected pregnant women were included. The number of pregnant women who started treatment in the first trimester, second trimester, and third trimester and did not receive treatment during pregnancy were 4 549 (20.23%), 8 719 (38.78%), 2 235 (9.94%) and 6 980 (31.05%), respectively. Compared with pregnant women who started treatment in the first trimester, pregnant women who did not receive anti-syphilis treatment during pregnancy had increased risks of neonatal preterm birth (OR=1.42, 95%CI: 1.24-1.62), death (OR=4.27, 95%CI: 1.64-14.69) and congenital syphilis (OR=12.26, 95%CI: 6.35-27.45). At the same time, the risk of congenital syphilis in the newborns of pregnant women who started anti-syphilis treatment in the second trimester (OR=2.68, 95%CI: 1.34-6.16) and third trimester (OR=6.27, 95%CI: 2.99-14.80) also increased. Conclusion: Early initiation of anti-syphilis treatment during pregnancy in patients with syphilis can improve neonatal outcomes.

Mother's milk (ASI) is the ideal food for babies. Preparation for exclusive breastfeeding should start during pregnancy. Successful exclusive breastfeeding requires a lot of support from the husband and family. Health cadres are the spearhead of providing health information in villages so it is necessary to empower health cadres in socializing exclusive breastfeeding to pregnant women. The aim of the activity is to empower health cadres regarding the importance of exclusive breastfeeding so that they can provide exclusive breastfeeding assistance for pregnant women. The activity method is to empower health cadres about exclusive breastfeeding. Before the activity, a pre-test and post-test are carried out as an evaluation. The tools and materials used are LCD, screen, leaflets, questionnaires. The sample was 15 health cadres. The results of the research, before empowering health cadres, were 8 health cadres who had sufficient knowledge about exclusive breastfeeding (53%) and 2 health cadres who had good knowledge about exclusive breastfeeding (13.3%). After empowering health cadres, there was an increase in health cadres' knowledge, namely 13 health cadres had good knowledge about exclusive breastfeeding (86.6%) and the remaining 2 health cadres had sufficient knowledge (13.3%). At the mentoring stage, 15 health cadres succeeded in assisting 15 pregnant women who were willing to prepare themselves during pregnancy to provide exclusive breast milk to their babies after birth. The conclusion is that there is an increase in the knowledge of health cadres after empowering health cadres so that pregnant women receive assistance in preparing for exclusive breastfeeding.

The purpose of this study is to investigate the impact of subclinical hypothyroidism (SCH) during pregnancy and levothyroxine (LT4) therapy on pregnancy outcomes. Among 6,510 pregnant women who came to The Fourth Hospital of Shijiazhuang for pregnancy examination and delivery, 266 pregnant women with SCH and treated with LT4 were selected as the SCH group and 672 pregnant women without SCH were selected as the non-SCH group, and the incidence rates of adverse pregnancy outcomes in pregnant women and newborns of the two groups were compared using Chi-square test and logistic regression. According to the therapeutic effect, pregnant women treated with LT4 were categorized into sustained euthyroid status (SES) and suboptimal thyroid status (STS) groups and compared with the non-SCH group using chi-square test. The correlation of thyroid stimulating hormone (TSH) levels at different stages of pregnancy was explored using Spearman's rank test. The incidence of hypertensive disorders of pregnancy (HDP), premature rupture of membranes (PROM), and neonatal outcomes were ventricular or atrial septal defect (V/ASD), hyperbilirubinemia, and pneumonia were higher in the SCH group (SCH pregnant women) than in the non-SCH group (non-SCH pregnant women) (p<0.05). The incidence of multiple maternal and neonatal complications was higher in the SCH-STS group (SCH in two or three gestational trimesters) compared to the SCH group. With a tendency for TSH levels to increase as the pregnancy progressed. SCH during pregnancy is associated with a high incidence of various pregnancy complications, and LT4 therapy that controls serum TSH levels at normal levels throughout pregnancy can reduce these risks.

Purpose/Objectives: Poor health literacy is a problem for over 45% of American adults and is associated with a variety of adverse health outcomes. Low health literacy has been associated with poor prenatal care utilization and a higher likelihood of poorer glycemic control. Poor glycemic control can lead to poor birth outcomes for both the mother and infant. Health literacy levels of pregnant women with diabetes can influence these outcomes and need to be known early in the pregnancy. Interventions can influence tighter glycemic control and lessen the impact of diabetes for the mother and infant. Therefore, the purpose of this study was to explore the associations among health literacy levels and health outcomes in pregnant women with pregestational and gestational diabetes. Methods: With a sample of 32 pregnant women in an urban, safety-net clinic in the South we measured health literacy using the Rapid Estimate of Adult Literacy in Medicine (REALM), the Literacy Assessment for Diabetes (LAD), and the Rapid Estimate of Adult Literacy in Genetics (REAL-G) and determined glycemic control. In addition, we evaluated three questions from the Short Test of Functional Health Literacy in Adults (S-TOFHLA) as a potential health literacy screening instrument in this sample. Outcome measures included birth outcomes for the mother of hypertension, premature birth, delivery method, polyhydramnios, and vaginal laceration, and for the infant, gestational age at birth, birth weight, respiratory distress, congenital anomalies, and fetal demise. The sample was characterized with descriptive statistics. Parametric and nonparametric tests were conducted to compare levels of health literacy and birth outcomes between groups. Results: Over 81% of the participants in this study were African American with 56.3% of the women demonstrating high health literacy as determined by the REALM. Glycemic control, measured by glucose self-report, demonstrated that women with high health literacy recorded more glucose readings (p = .02) than women with low health literacy scores. Mothers with high health literacy experienced more spontaneous labor at term (p = .10), a higher cesarean section rate and more normal weight infants than the mothers with low health literacy. While not statistically significant, women with low health literacy experienced more adverse birth outcomes. Women with pregestational diabetes trended toward higher health literacy than did women with gestational diabetes on all three instruments. In fact, those with gestational diabetes initiated prenatal care later than those with pregestational diabetes. The 3 questions from the S-TOFHLA did not show high enough correlation to the REALM (r = -.25) and thus were not considered as an effective as a screening tool for health literacy in this study. Conclusions: In our small sample, higher health literacy was associated with more glucose readings by maternal self-report and more spontaneous labor at term. A better understanding of health literacy and its’ role in maintaining health, specifically in relation to the health of pregnant women with diabetes, is needed by health providers as this knowledge may improve birth outcomes. These results need to be interpreted cautiously because of the small sample size and further research is needed.

Introduction: There are conflicting data on COVID-19 outcomes in pregnant women. Using the AHA COVID-19 CVD Registry we evaluated COVID-19 outcomes in pregnant vs non-pregnant women with COVID-19. Methods: Women 18-40 years old hospitalized from March 2020 to December 2021 with symptomatic COVID-19 were included (n=2,068), with 110 (5.3%) pregnant at admission. Women with unknown pregnancy status were excluded. Vaccine data were limited (2.8% of participants), therefore omitted from analysis. Baseline demographics and symptoms at presentation were compared between pregnant and non-pregnant women (Table). Rates of death, mechanical ventilation, ICU admission, hospital stay ≥5 days, myocardial infarction, stroke, DVT, PE, and a composite of all outcomes were determined. Multivariable Cox regression analyses were performed, adjusting for comorbidities and prior CVD. Results: Pregnant women hospitalized with COVID-19 had fewer comorbidities than non-pregnant women (Table). There were no deaths in the pregnant group and 44 (2.3%) in the non-pregnant group. Fewer pregnant women were hospitalized ≥5 days (29.1% vs 41.2% non-pregnant); this difference was not statistically significant after multivariable adjustment [adjusted HR (95% CI), 0.67 (0.43-1.02)]. There were no significant differences between the groups in the composite outcome [adjusted HR (95% CI), 0.72 (0.48-1.07)] or its components (Table). Conclusions: Pregnant women hospitalized with symptomatic COVID-19 had fewer comorbidities compared with non-pregnant women. There were fewer deaths and lower rates of hospitalization ≥5 days in pregnant vs non-pregnant women which was no longer statistically significant after multivariable adjustment. The potential for residual confounding due to healthier pregnant women presenting with milder COVID-19 illness or being admitted for non-COVID-19 indications compared to non-pregnant women must be considered when interpreting these findings.

The questionnaire results on pregnant women at the Primary Health Service of Jetis II in Bantul, Yogyakarta, show that a woman contracts Covid-19. Meanwhile, other findings are that pregnant women get tired quickly (81.82%), many are not orderly to wear masks (76%), about the effects of Covid on mothers and fetuses (over 50%). Health cadres have not been optimal in assisting pregnant women in preventive and follow-up efforts. This community service program aims to empower health cadres in helping pregnant women during the pandemic by increasing knowledge "About Covid-19 for pregnant women, prevention, and management efforts". The service methods are a lecture and brainstorming activity for ten health cadres representing five hamlets. It is hoped that health cadres can become companions for pregnant women during the pandemic, as mediators in delivering health knowledge for mothers and fetuses, and also giving preventive efforts they must. Community service activities through face-to-face and online meetings in Turen Hamlet, Jetis II Community Health Center, and Bantul shows an increasing knowledge of health cadres. The discussion results before the lecture are that 35% of health cadres can answer correctly, and 85% can answer and explain accurately and adequately after the lecture. Conclusion: Efforts to increase knowledge about Covid-19 for pregnant women through health cadres' assistance are necessary to reduce the morbidity and mortality rate of mothers and fetuses.

Introduction: Birth Preparedness and Complication Readiness (BPCR) is the Indonesia government program aimed at reducing the Maternal Mortality Rate (MMR) and Infant Mortality Rate (IMR). The program requires the active participation of pregnant women and their families, as well as the community. Health cadres are recruited from the community to help pregnant women and their families in monitoring their health status and recognising the early signs of pregnancy complications. Therefore, this study aimed to examine the effect of the factors related to the health cadre�s perception and BPCR implementation in high risk pregnancies. Method: The study employed an observational analysis with a cross sectional approach. 126 health cadres in Surabaya, Indonesia, were recruited as the study subjects. The data collection was carried out through interviews and observations using a structured questionnaire. The data analysis was conducted using univariate, bivariate and multivariate analysis. Results: Based on the health cadre�s perception, the implementation of BPCR was moderately satisfactory (52.4). Most of respondents had a moderate understanding of the standard procedure and policy targets (48.4). Most of the respondents selected moderate when rating the resource�s availability (72.2), interpersonal communication (85.7), technical support (58.7) and the attitude of the BPCR implementer (92.1). From the path analysis, the BPCR implementation was significantly affected by the understanding of the standard procedures and policy targets, the technical support from the public health centres, the interpersonal/ organisational communication, the attitude of the implementers, and the availability of resources. Conclusions: The public health centre should provide a clear standard procedure and effectively communicate the BPCR program to the health cadres, pregnant women and their families, as well as to the community. © 2018, Indian Journal of Public Health Research and Development. All rights reserved.

Objective Pregnant women afflicted with gestational diabetes mellitus (GDM) and diabetes mellitus (DM) are prone to both maternal and neonatal complications. Due to this, it is of importance to sustain a strict glycemic control during this time. Unfortunately, there is a lack of evidence-based medical research for the control criteria during pregnancy. Therefore, to develop better method of glycemic control for pregnant women, we conducted a multicenter all-inclusive prospective study to investigate the association between glycemic control markers and maternal and neonatal outcomes. Research design and methods: Four hundred fifty-two women were included in the study. Fasting blood glucose (FBG), HbA1c and glycated albumin (GA), and ferritin levels were measured at different gestational periods and compared to the pregnancy outcomes. Results The reference interval of GA and HbA1c was determined in Trimester I, II, III: 11.0–16.3%, 10.1–15.2%, and 9.5–14.6%, and 4.8–5.7%, 4.4–5.4%, and 4.7–5.8%, respectively. It was found that at the later stages of pregnancy, there was a reduction in ferritin levels and increase in HbA1c levels. Only in the GDM group, it was noticed that the frequency of total neonatal and maternal complications were significantly higher on comparison with the normal group (30.1 vs. 18.4%, p = .017 and 21.0% vs. 12.0%, p = .031, respectively). For the frequency of cesarean section and macrosomia in GDM group, GA > 15.69% group was significant higher compared to those of GA ≤ 15.69% group (p = .021 and p = .001, respectively). For HbA1c, no significant differences were observed. Conclusions A reference interval of HbA1c and GA was developed for Chinese pregnant women. We found that the GDM group had a higher frequency of neonatal and maternal complications. As only GA levels and not HbA1c, were associated with cesarean section and macrosomia in GDM, we hypothesize that GA could be an appropriate glycemic control marker for pregnant mothers.

To describe the epidemiology and the effect of asthma on pregnancy outcomes in pregnant women from a rural geography. We conducted a prospective cohort study in Anuradhapura district, Sri Lanka enrolling all eligible pregnant women registered in the maternal care program. An interviewer-administered questionnaire-based symptom analysis and clinical assessment was conducted in the first and second trimesters. We recruited 3374 pregnant women aged 15-48 years at conception. Self-reported physician-diagnosed asthma prevalence was 6.6% (n = 223) with only 41.7% (n = 93) on regular medical follow-up for asthma. The prevalence of wheeze reduced from pre-pregnancy (67.0%) to the first (46.4%) and second trimesters (47.7%; p<0.01). Of the 73 asthmatic women who did not have wheeze in the last 3 months preceding pregnancy, new-onset wheeze was reported by 6(8.2%) and 12(16.4%) in the first and second trimester, respectively. Pregnant women who sought medical care for asthma in the private sector had a lower likelihood of developing new-onset wheeze in the first trimester (p = 0.03; unadjusted OR = 0.94;95%CI 0.89-0.99). Thirty-four (33.3%) pregnant women had at least one hospital admission due to exacerbation of wheeze during the first and second trimester. The prevalence of low birth weight (16.0%) was higher among pregnant asthmatic women. This study reports the high prevalence of asthma and asthma-associated pregnancy outcomes in women from a rural geography signifying the importance of targeted management.

Lajing Village in the Arosbaya Community Health Center area is recorded as a village with a fairly high incidence of anemia in pregnant women. In 2021, it was reported that out of 83 pregnant women, 17 people (20.5%). The high incidence of anemia is due to, among other things, the poor behavior of mothers in preventing anemia. To reduce the risk of anemia in pregnant women, prevention efforts are needed which are supported and carried out by all parties, including health cadres. The lack of cadres' understanding of anemia in pregnant women is a problem in providing support to pregnant women. Community Service aims to increase the participation of health cadres in early detection and prevention of anemia in pregnant women. The method used in this service is to increase cadres' knowledge about anemia. The next stage is to accompany cadres in providing education about anemia in pregnant women and being a motivator in preventing anemia in pregnant women. Based on the results of the service, it was found that there was an increase in knowledge about anemia in the cadre group. Health cadres' knowledge before receiving information was 58.3% in the poor category, after receiving information 91.7% was in the good category. Health cadres are able to provide counseling to pregnant women and are able to become caring cadres.

Women in low- and middle-income countries (LMICs) may engage in a range of cultural food practices during pregnancy, including restricting or avoiding foods high in protein and iron, and foods rich in vitamins and minerals. While research has explored the cultural food practices of pregnant women in LMICs, there is less understanding of the continued cultural food practices of women who migrate to high-income countries and then become pregnant. This systematic review explores the existing research on cultural food practices and sources of nutrition information among pregnant and postpartum migrant women from LMICs, residing in high-income countries. A systematic search was conducted in April 2024 across Global Health, CINAHL, and MEDLINE, published in English, with no date restrictions. Eligible studies included those focused on pregnant and postpartum women who had migrated from LMICs to high-income countries. Studies were excluded if they comprised of non-immigrant women or did not involve LMIC participants. Screened were studies for eligibility, data were extracted, and study quality was assessed. In total, 17 studies comprising qualitative (n = 10) and quantitative (n = 7) approaches were included. In 14 studies participants adhered to cultural food practices, wherein certain nutritious foods were restricted during pregnancy or the postpartum period; three studies noted limited adherence due to support, acculturation, and access to traditional foods. Most studies (n = 10) reported traditional "hot" and "cold" food beliefs during pregnancy and postpartum, aiming to maintain humoral balance for maternal and child health and to prevent miscarriage. Nutrition advice was sought from family members, friends, relatives, healthcare providers, and media sources, with a preference for advice from family members in their home countries. There is a need for culturally appropriate nutrition education resources to guide pregnant migrants through healthy and harmful cultural food practices and overall nutrition during this crucial period. (PROSPERO Registration: CRD42023409990).

The clinical features, maternal and fetal complications, and the potential for vertical transmission of SARS-CoV-2 infection in pregnant women are still unknown. This cohort study aimed to determine the relation of coronavirus infection to the incidence of fetal and neonatal complications by comparing outcomes in pregnant women with COVID-19 to those in non-infected pregnant women. This prospective cohort study was conducted on all pregnant women who gave birth between September 2020 to September 2021 at Rouhani Hospital, Iran. The case group included pregnant women infected with SARS-CoV-2, confirmed by clinical signs, symptoms and positive result of Real-time polymerase chain reaction (real-time PCR), who were followed up until 72 hours after birth. All fetal and neonatal complications, such as premature birth, oligohydramnios, fetal growth restriction, perinatal death and vertical transmission were recorded. Risk ratios for adverse pregnancy outcomes were analyzed by a modified Poisson regression model adjusted for relevant variables. The final sample included 234 pregnant women (100 COVID-19 infected and 134 non-infected). The mean age was 29.42 ± 6.16 years (p = 0.12), and the mean BMI (body mass index) was 26.51 ± 4.16) Kg/m2 (p = 0.30). Cesarean delivery was more common among women with COVID -19 [adjusted risk ratio (aRR): 1.12, 95% confidence interval (CI): 1.09-1.25, p = 0.03]. A significant increase was observed in neonatal intensive care unit (NICU) admission in SARS-CoV-2 infected pregnant women compared to non-infected pregnant women [adjusted risk ratio (aRR):2.46, 95% confidence interval (CI): 1.06-5.42, P = 0.034]. Neonate born to women with COVID-19 had significantly higher rate of preterm birth (22% versus 11.2%) and low 5 minutes APGAR score (2% versus 0%) significantly (P < 0.05). Nearly all newborns tested negative for SARS-CoV-2 infection after birth (97.94%). Of 76 cord blood samples tested, 16 (21.05%) and 4 (5.26%) cases of infants born to mothers infected with COVID-19 had positive IgG and IgM antibodies, respectively. Neonates born to mothers with COVID-19 faced a significantly higher risk of cesarean delivery and NICU admission, but no significant differences in other pregnancy complications were observed between COVID-19 and non-infected groups, highlighting the complex effects of the virus on pregnancy outcomes.

There is an emerging Muslim and diabetic population in the United States and other Western countries and majority of pregnant women and patients with diabetes mellitus choose to fast during Ramadan. Fasting during Ramadan in pregnant women with diabetes may represent a ‘perfect storm’ of metabolic disturbances including hyperglycemia, hypoglycemia and ketosis. Recent continuous and flash glucose monitoring data suggests increased glycemic variability (fasting hypo- and post-Iftar hyperglycemia) in non-pregnant patients with diabetes during Ramadan. Only five small-scale studies, predominantly focused on women with gestational diabetes mellitus in Muslim-majority nations have explored maternal glycemic outcomes during Ramadan which is associated with lower mean blood glucose levels and higher frequency of fasting hypoglycemia. Data is limited however on important clinical outcomes such as symptomatic and serious hypoglycemia requiring hospitalization. Results have been conflicting regarding maternal Ramadan fasting and association with fetal outcomes in women without diabetes. Only one recently published study reported on perinatal outcomes in pregnant women with gestational diabetes which found no effect of Ramadan exposure on mean birthweight or macrosomia frequency but lower neonatal hypoglycemia prevalence, however a significant limitation was lack of documentation of maternal fasting status. At this stage, due to paucity of data, the current medical recommendation is against Ramadan fasting for pregnant Muslim women with diabetes. Large-scale population-based studies are warranted regarding maternal and fetal outcomes in pregnant fasting women with diabetes and such studies should characterize maternal fasting status and have meaningful and consistent clinical outcomes. High-quality data derived from these studies can assist clinicians in providing more evidence-based advice to safely navigate both mother and fetus through a potentially challenging pregnancy.

To estimate the incidence of gestational diabetes mellitus (GDM) according to The International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria and the pregnancy complications in women fulfilling these criteria but who are not considered diabetic according to the Canadian Diabetes Association criteria. We estimated the rate of GDM according to the IADPSG criteria from November 2008 to October 2010. Then, we conducted a chart review to compare maternal and neonatal outcomes between women classified as GDM according to the IADPSG criteria but not by the Canadian Diabetes Association criteria (group 1; n=186) and nondiabetic women according to both criteria (group 2; n=372). Results were expressed as crude (odds ratio [OR]) or adjusted OR and 95% confidence interval (CI). The study has a statistical power of 80% to detect a difference between 16% and 8% in large for gestational age newborns (α level of 0.05; two-tailed). The rate of GDM using the IADPSG criteria was 27.51% (95% CI 25.92-29.11). Group 1 presented similar rates of large-for-gestational-age newborns (9.1% compared with 5.9%, adjusted OR 1.58, 95% CI 0.79-3.13; P=.19), delivery complications (37.1% compared with 30.1%, OR 1.37, 95% CI 0.95-1.98; P=.10), preeclampsia (6.5% compared with 2.7%, adjusted OR 2.40, 95% CI 0.92-6.27; P=.07), prematurity (6.5% compared with 2.7%, OR 1.10, 95% CI 0.53-2.27; P=.85), neonatal complications at delivery (13.4% compared with 9.7%, OR 1.45, 95% CI 0.84-2.49; P=.20), and metabolic complications (10.8% compared with 14.2%, OR 0.73, 95% CI 0.42-1.26; P=.29) compared with group 2. Women classified as nondiabetic by the Canadian Diabetes Association Criteria but considered GDM according to the IADPSG criteria have similar pregnancy outcomes as women without GDM. More randomized studies with cost-effectiveness analyses are needed before implementation of these criteria. II.