Pregnancy Gestational Diabetes Research Articles

Maternal and fetal outcomes of Asian pregnancies after bariatricsurgery.

Obesity is a risk factor for pregnancy-induced hypertension, preeclampsia, gestational diabetes, and large gestational age pregnancy. Bariatric surgery is widely accepted to treat obesity but associated with small for gestational age fetuses. To report maternal and fetal outcomes after bariatric surgery in morbidly obese Asian females. University Hospital, Singapore. We maintain a prospective cohort of patients who underwent bariatric surgery in our institution. Maternal and fetal outcomes are compared with a control group of 31 pregnancies matched for age, parity, presurgery weight, and year of delivery. Twenty-four pregnancies occurred in 16 patients in our postoperative cohort. Morbidly obese women in the control group were more likely to develop gestational diabetes (19.3% versus 5.0%, P = .150) and pregnancy-induced hypertension/preeclampsia (32.2% versus 0%, P = .003) compared with the postoperative group. Of fetuses, 37.5% in the bariatric group had low birth weight compared with only 9.4% fetuses in the control group (P = .016). Preoperative body mass index, short interval between conception and surgery, and poor weight gain during pregnancy did not predict for small for gestational age fetuses. Subsequent weights were available for 37.5% of the children in the surgical cohort and none of these children exhibited growth retardation. Bariatric surgery lowers the risk of maternal co-morbidities and large gestational age fetus during pregnancy. Asians are at high risk of small for gestational age pregnancies after bariatric surgery and should undergo close monitoring for fetal growth throughout their pregnancy.

Screening for gestational diabetes in pregnancy in Northwestern Ontario.

We estimate the screening and prevalence of gestational diabetes mellitus (GDM) in a primarily first nations obstetrical population in Northwestern Ontario. The study is an 8-year retrospective analysis of all gestational glucose challenge and tolerance tests performed at the Sioux Lookout Meno Ya Win Health Centre (SLMHC) laboratory from 1 January, 2010 to 31 December, 2017. Test, gestational timing and completion rate of screening were recorded, and GDM prevalence was calculated on the tested population. Screening completion rates were recorded for the subset of women who delivered at SLMHC from 2014 to 2017. The average annual GDM prevalence was 12%, double the Ontario rate. Over the 8-year period, 513 patients were diagnosed with GDM among the 4298 patients screened. Patients were screened with the 2-step (90%) or the 1-step (10%) protocol. Screening occurred <20 weeks in 3%; 54% occurred in <28 weeks and 40% >28 weeks. Seventy percent of the tests were from remote nursing stations. The screening completion rate for women delivering at SLMHC in 2017 was 80.8%. The prevalence of GDM in Northwestern Ontario is twice the provincial rate. Most screening used the 2-step protocol; early screening was underused. Improvements in screening programming are underway and future research may match surveillance rates and results to GDM outcomes.

Pregnancy Complications as a Window to Future Cardiovascular Disease.

Pregnancy is a time of significant hemodynamic, metabolic, and hormonal stress that can unmask underlying subclinical cardiovascular abnormalities, and pregnancy-related complications may serve as early warning signs for future risk of cardiovascular disease. The increased recognition of these sex-specific risk factors could identify women who may benefit from more intensive risk factor modification to reduce morbidity and mortality later in life. In this review, we describe several pregnancy-related complications that have been associated with the risk of cardiovascular disease, including hypertensive disorders of pregnancy, gestational diabetes mellitus, preterm delivery, and pregnancy loss. Pregnancy-associated risk factors must be identified to fully assess a woman's future cardiovascular risk and may influence strategies for risk reduction.

326: Placental changes in diabetic pregnancies and the contribution of hypertension

To evaluate placental abnormalities in pregnancies affected by diabetes compared to unaffected pregnancies from a single academic center This is a retrospective cohort study of women with singleton gestations delivered from 2007 to 2016. Pathologic examination of placentas from pregestational and gestational diabetic pregnancies were compared to placentas from patients without diabetes using twelve histologic elements. Maternal and neonatal outcomes were extracted from the medical record and compared between groups. Findings were adjusted for hypertensive disorders of pregnancy. Pathology reports of 590 placentas along with corresponding medical records were reviewed. The diabetic group (N=484) consisted of 188 patients with pregestational diabetes and 296 patients with gestational diabetes. The nondiabetic group consisted of 106 patients. The diabetic group was older, had a higher average BMI, and more hypertensive disorders (p< 0.0001). Out of the 12 histologic elements investigated, accelerated villous maturation (aOR 8.45, 95%CI (1.13-62.95)) and increased placental weight (aOR 3.131, 95% CI (1.558-6.293)) were noted to be significantly increased in placentas from diabetic pregnancies after controlling for hypertension. Intervillous thrombi were not significantly increased in pregnancies affected by diabetes. Neonates of the diabetic group were more likely to be large for gestational age (p< 0.0001) and had a higher rate of preterm delivery (p< 0.0001). Accelerated villous maturation was found to be more frequent in pregnancies complicated by diabetes. Accelerated villous maturation is a placental finding that indicates maternal vascular malperfusion. In contrast with prior studies, there was no increase in thrombotic lesions of the placenta in patients with diabetes.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

The impact of implementing the WHO-2013 criteria for gestational diabetes mellitus on its prevalence and pregnancy outcomes: A comparison of the WHO-1999 and WHO-2013 diagnostic thresholds

Aims/hypothesisTo determine the impact of implementing the new WHO-2013 criteria on prevalence of gestational diabetes mellitus (GDM) and pregnancy outcomes compared to the WHO-1999 criteria. MethodsA retrospective study conducted in pregnant women who were referred to the Erasmus MC for an oral glucose tolerance test (OGTT) between 2010 and 2015. ResultsOf 3089 women, 11.5 % (n = 354) were diagnosed with GDM based on the WHO-1999 criteria and 17.0 % (n = 524) based on the 2013–criteria, with 97 (3.1 %) reclassified as non-GDM and 267 (8.6 %) reclassified as GDM when shifting from the 1999 to 2013-criteria. In contrast to 60 % of patients in the WHO-2013 group, only 2 % of the WHO-1999 group was diagnosed with GDM because of an elevated fasting glucose only. Patients reclassified as GDM by WHO-2013 criteria had a higher body mass index (p < 0.001) and delivered babies with a higher birth weight (p = 0.01). Maternal and neonatal adverse outcomes were comparable between patients with GDM based on WHO-1999 criteria and patients newly included by WHO-2013 criteria. ConclusionsImplementing the new diagnostic criteria leads to a considerable increase of prevalence of GDM. The newly included patients were more frequently overweighed and delivered babies with a higher birth weight. The added diagnostic value of the fasting glucose threshold of the WHO-1999 criteria is very low compared to the 2-h post-OGTT threshold, supporting the use of a lower fasting glucose threshold value as advocated by the WHO-2013 criteria. TweetThe new WHO-2013 criteria leads to a considerable increase of prevalence of GDM.

Elevated fasting vs post-load glucose levels and pregnancy outcomes in gestational diabetes: a population-based study.

To examine the relative association between fasting plasma glucose vs post-load (1-h and 2-h) glucose levels based on the oral glucose tolerance test in pregnancy and large-for-gestational-age and hypertensive disorders of pregnancy outcomes. All live singleton births between October 2008 and December 2014 in Alberta, Canada were included. Gestational diabetes mellitus was diagnosed using Diabetes Canada criteria. Logistic regression models were used to examine the association between fasting plasma glucose vs post-load values and large-for-gestational-age infants and hypertensive disorders of pregnancy after adjusting for maternal characteristics and pharmaceutical intervention in gestational diabetes pregnancies. Among 257 547 pregnancies, 208 344 (80.9%) had negative 50-g glucose challenge tests, 36 261 (14.1%) had negative 75-g oral glucose tolerance tests, and 12 942 (5.0%) had gestational diabetes based on either elevated fasting plasma glucose (n=4130, 1.6%) or elevated 1-h and/or 2-h oral glucose tolerance test values (n=8812, 3.4%). Large-for-gestational-age and hypertensive disorders of pregnancy rates were 8.1% and 5.1% in negative glucose challenge test pregnancies, 11.0% and 7.0% in negative oral glucose tolerance test pregnancies, 22.4% and 11.9% in gestational diabetes pregnancies with elevated fasting plasma glucose, and 9.1% and 8% in gestational diabetes pregnancies with elevated post-load levels, respectively. Among gestational diabetes pregnancies, those with elevated fasting plasma glucose were at higher risk of large-for-gestational age (adjusted odds ratio 2.66, 95% CI 2.39-2.96) and hypertensive disorders of pregnancy (adjusted odds ratio 1.51, 95% CI 1.33-1.72) outcomes relative to pregnancies with post-load glucose elevations only. Fasting plasma glucose remained significantly associated with adverse outcomes in gestational diabetes pregnancies with and without pharmacological intervention. Elevated fasting plasma glucose in women with gestational diabetes is a stronger predictor of large-for-gestational-age and hypertensive disorders of pregnancy outcomes than elevated post-load glucose.

Restricted gestational weight gain in overweight/obese women with gestational diabetes mellitus and pregnancy outcomes

Purpose of Investigation: Obesity and gestational diabetes mellitus (GDM) are risk factors for adverse pregnancy outcomes. This retrospective study examined the effects of GDM treatment on pregnancy outcomes and gestational weight gain (GWG) among overweight/obese women. Materials and Methods: This study included 1,936 women with singleton pregnancies. Multivariate logistic regression analysis and Pearson’s chi-square tests were performed to the association of interest. Results: Overweight/obese women had higher rates of adverse outcomes than normal weight women. In overweight/obese group, women with GDM had a lower risk of primary cesarean section, instrumental delivery, and admission to neonatal intensive care unit (NICU) than women without GDM. Overweight/obese women with GDM had lower GWG than those without GDM and the prevalence of excessive GWG was also lower among overweight/obese women with GDM than those without GDM. Conclusion: Diet and exercise interventions improved pregnancy outcomes and limited GWG in overweight/obese women with GDM. Lower GWG limits may be more applicable to GDM population.

Low levels of free thyroxine in umbilical cord blood is associated with a reduce in deiodinase 2 activity in human trophoblast from gestational diabetes pregnancies

Low levels of free thyroxine in umbilical cord blood is associated with a reduce in deiodinase 2 activity in human trophoblast from gestational diabetes pregnancies

1435-P: Impaired Early-Phase Suppression of Glucagon Secretion after Glucose Load Associated with Insulin Need during Pregnancy in Gestational Diabetes

Aims: The prevalence of gestational diabetes mellitus (GDM) has recently increased all over the world. It is hard to predict insulin need during pregnancy even if the insulin secretory capacity is evaluated when studying 75-g OGTT to screen for GDM. The role of glucagon abnormality has remarked in pathogenesis of type 2 diabetes, however, still unknown in GDM. This study was aimed to evaluate glucagon responses in GDM and to investigate whether measurement of glucagon is useful to anticipate insulin need during pregnancy. Methods: Forty-nine women diagnosed with GDM based on IADPSG criteria were enrolled into the study and re-studied OGTT during mid-gestation to evaluate glucagon responses. Plasma glucagon levels were measured before and 30, 60, 120 min after glucose load using a sandwich ELISA kit. Insulin treatment was initiated when either a fasting glucose &amp;gt;95 mg/dL or postprandial 2-h glucose &amp;gt;120 mg/dL continues for more than a week after starting diet therapy. Results: Of 49 patients, fifteen were required insulin (defined as GDM/Insulin) and 34 could be treated with diet therapy alone until delivery (defined as GDM/Diet). GDM/Insulin was started insulin treatment at 29.6±3.6 weeks of gestation and the maximum insulin dose was 39.0±24.8 units/day. There were no significant differences in maternal age, pre-gravid BMI and insulin secretory responses during OGTT between the groups. Although fasting glucagon levels were not different between the groups, paradoxical increases in early-phase glucagon secretion after glucose load were observed in GDM/Insulin but not in GDM/Diet. The changes in glucagon levels (pg/mL) from 0 min to 30 min were significantly different between the groups (1.3±8.1 in GDM/Insulin vs. -4.2±4.0 in GDM/Diet, p&amp;lt;0.01), and the ROC analysis of the value to predict insulin need was -2.01 pg/mL. Conclusions: Impaired early-phase glucagon suppression might be useful to predict for insulin need during pregnancy in GDM. Disclosure I. Horie: None. A. Haraguchi: None. N. Abiru: None. A. Kawakami: None.

1436-P: Gestational Diabetes Pregnancy by Pregnancy

Gestational diabetes mellitus (GDM) is a risk factor for GDM in next pregnancies.The aims of this observational study are to measure GDM recurrence rate in post index pregnancy of women with prior GDM and to compare maternal and neonatal outcomes and pancreatic beta cells function in two consecutive pregnancies. Methods: Longitudinal observational study in 68 women with GDM in index pregnancy (G1), followed by a post index pregnancy (G2) and normal glucose tolerance in-between [G1 vs. G2: age 32,1±4,6 vs. 35,5±4,7 years, BMI 24,5 (19,2-42,7) vs. 24,7 (17,5-42,2) kg/m2, ns]. GDM diagnosis according to IADPSG criteria. Statistics: SPSS. Results: significantly earlier first visit gestational age in G2 [17 (6-36) weeks] than in G1 [28,5 (8-35) weeks] (p&amp;lt;0,001). GDM recurrence rate was 85,3% (n58) 3,32±1,8 years after index pregnancy: of these women, n31 (45,6%) [36.5±4 years; BMI 24.7 (19.3-42.1) Kg/m2] developed GDM in early pregnancy (16-18 weeks), while n27 (39,7%) [35.66±4 years; BMI 25.26 (17.6-42.2) Kg/m2] at the end of second trimester (24-28 weeks). Women who reported a negative OGTT at both time-points (n10, 14,7%) [33.7±5.5 years; BMI 20.45 (17.5-25.4) Kg/m2;] showed a significantly lower BMI (p&amp;lt;0,0015) and a higher disposition index (p=0.07) than those with positive OGTT. In women who did not relapse GDM, no significant inter-pregnancy weight gain was observed and GDM diagnosis in G1 was performed by post-load OGTT points. Lower 24-28thOGTT post load blood glucose levels and AUCglucose were found in G2 (p&amp;lt;0,02, Wilcoxon). No pancreatic beta cells function deterioration was recorded in post index pregnancy. We found a lower rate of cumulative neonatal adverse outcomes in G2 (30,2% in G1 vs. 25,7% in G2, p&amp;lt;0,04) and a reduced maternal hypertension rate even though it did not reach the level of significance (4vs8). Conclusions: GDM relapsed in the majority of women with previous GDM with no weight gain between pregnancies and no pancreatic function deterioration. However, a normal OGTT in second pregnancy was found in normoweight women. Disclosure C. Giuliani: None. O. Bitterman: None. F. Amorosi: None. C. Festa: None. A. Napoli: None.

Ethnicity and Immigration Status as Risk Factors for Gestational Diabetes Mellitus, Anemia and Pregnancy Outcomes Among Food Insecure Women Attending the Montreal Diet Dispensary Program.

The primary aim of this study was to characterize the rate of adverse pregnancy outcomes in a multicultural group of low-income women. Data were extracted from the Montreal Diet Dispensary's database between June 2013 and December 2015. Risk was evaluated using logistic regression adjusted for covariates. Of the 1,387 pregnancies, the prevalence of gestational diabetes mellitus (GDM) was 17.2% (95% confidence interval [CI], 15.1% to 19.3%), maternal anemia 44.9% (95% CI, 41.9% to 47.9%) and hypertension 3.8% (95% CI, 2.8% to 4.8%). The prevalence of small-for-gestational-age infants was 5.5% (95% CI, 4.3% to 6.7%), preterm births 4.7% (95% CI, 3.6% to 5.9%), low birthweight 4.2% (95% CI, 3.1% to 5.2%) and large-for-gestational-age infants was 10.6% (95% CI, 9.0% to 12.2%). Asian women had an increased odds of gestational diabetes mellitus (adjusted odds ratio [aOR], 1.86; 95% CI, 1.17 to 2.98) and SGA infants (aOR, 2.35; 95% CI 1.21 to 4.57) compared with white women. Anemia was more likely for black women compared with white women (aOR, 1.74; 95% CI, 1.29 to 2.35). Black women were more at risk of preterm birth (aOR, 1.79; 95% CI, 1.01 to 3.19). Immigrants showed an increased risk of maternal anemia compared with Canadian-born women (aOR, 1.85; 95% CI, 1.06 to 3.21). As disparities in maternal and infant outcomes were present, nutritional intervention(s) need to be targeted toward prevention of adverse pregnancy outcomes, prioritization of higher-risk groups and adaptation of the program to a multiethnic low-income population.

Soluble CD163 and TWEAK in early pregnancy gestational diabetes and later glucose intolerance.

Gestational diabetes mellitus (GDM) is today universally diagnosed during late pregnancy. Treating hyperglycaemia during pregnancy reduces the risk of complications, the effect of interventions is however limited due to the late diagnosis. It is thus important to identify biomarkers reaching a high precision for GDM development in early pregnancy. Here we aim to investigate soluble CD163 (sCD163) and soluble tumour necrosis factor-like weak inducer of apoptosis (sTWEAK) in early pregnancy GDM and their association to the development of later glucose intolerance. In this case-control study, women diagnosed with GDM in early pregnancy (n = 70) at Lund University Hospital, Lund, Sweden in 2011–2015 were age- and BMI matched to pregnant volunteers without diabetes (n = 70) recruited in early pregnancy from maternal health care centres in 2014–2015. Plasma levels of sCD163 and sTWEAK were analysed using commercial ELISA. Plasma levels of sCD163 did not differ between patients with and without GDM in early pregnancy (p = 0.86), plasma levels of sTWEAK however was decreased in women with GDM (0.71 [0.4–1.75] ng/ml) compared to controls (1.38 [0.63–4.86] ng/ml; p = 0.003). Women with sTWEAK levels in the lowest tertile had an increased risk of GDM in early pregnancy (p = 0.014). Neither sCD163 nor sTWEAK were associated with later glucose intolerance in women with GDM. This study reports decreased levels of sTWEAK in women with early pregnancy GDM, independent of age and BMI. Neither sCD163 nor sTWEAK were found to be associated to later glucose intolerance.

Corrigendum: Placental Nutrient Transport in Gestational Diabetic Pregnancies.

[This corrects the article DOI: 10.3389/fendo.2017.00306.].

Causes of stillbirths in diabetic and gestational diabetes pregnancies at a NSW tertiary referral hospital.

Diabetes in pregnancy may result in stillbirth or neonatal death. This audit examined stillbirths of mothers with pre-existing diabetes in pregnancy (DIP) and gestational diabetes (GDM) to determine maternal and diabetic characteristics implicated in these deaths. A retrospective cohort study was conducted to identify stillbirths occurring in diabetic pregnancies at Westmead Hospital during 2006-2017. Medical records were reviewed to obtain data relating to maternal factors, diabetes history, glycaemic control and cause of death. There were 37 women (seven with type 1 diabetes [T1DM], 11 with type 2 diabetes [T2DM] and 19 with GDM) who had 38 stillbirths. The leading cause of stillbirth was lethal congenital malformations in nine cases, followed by placental and umbilical abnormalities in six, intra-uterine growth restriction (IUGR) in six, and obstetric factors in four cases. Malformations were predominantly cardiovascular (n=7), musculoskeletal (n=5) and gastrointestinal (n=4). There was no difference in the proportion of stillbirths related to malformations between the DIP and GDM groups (P=0.22). In the pre-conception period or first trimester, all T1DM subjects and all but two T2DM subjects had HbA1c >7% or there was no measurement. HbA1c was >7% in 6/7 T1DM subjects and 7/11 T2DM subjects at some stage during the pregnancy. Stillbirth remains a problem in diabetic pregnancy in the 21st century. Lethal malformations, placental abnormalities and IUGR were the leading causes of stillbirth related to diabetes. Pre-conception counselling and planning to achieve better glycaemic control in pregnancy needs to be improved.

A study of prevalence gestational diabetes mellitus and pregnancy out come at tertiary health care center

A study of prevalence gestational diabetes mellitus and pregnancy out come at tertiary health care center

Women’s experience with peer counselling and social support during a lifestyle intervention among women with a previous gestational diabetes pregnancy

ABSTRACTPurposeWomen who are diagnosed with gestational diabetes mellitus have an increased risk of developing type 2 diabetes, but most receive little guidance regarding disease prevention. This study examined the role and usefulness of social support, including peer counselling in facilitating behaviour change as a part of a healthy eating and physical activity intervention among women with a previous gestational diabetes mellitus pregnancy.MethodsWe used a qualitative descriptive approach to investigate participants’ experiences with the social support they received during the intervention. We used purposeful sampling and invited women and peer counsellors to participate in semi-structured interviews. Data were analyzed using content analysis.ResultsWe interviewed nine women and two peer counsellors. Participants received emotional, appraisal, and informational types of social support from the peer counsellor and exercise specialist that they reported as useful. Additionally, participants’ received informal emotional and instrumental support from family, friends, and colleagues that they found useful in supporting behaviour change.ConclusionsDifferent types of social support are important to encourage behaviour change. These findings provide insight into the types of social support women with previous gestational diabetes mellitus find useful, in addition to practical ways that social support can be incorporated into future interventions.

85: Real-time continuous glucose monitoring in gestational diabetic pregnancies: a randomized controlled trial

To evaluate whether real-time continuous glucose monitoring (CGM) improves glycemic control over intermittent self-monitoring of blood glucose (SMBG) in gestational diabetes (GDM). This represented a randomized controlled trial at a single academic institution. Patients with GDM were randomized to use either real-time or blinded CGM. The blinded CGM group wore a CGM system that only collected, but did not display data. The real-time CGM group wore a CGM system that collected and displayed continuous glycemic feedback. Both groups also completed SMBG 4-7 times daily. The primary outcome was mean sensor glucose level during the fourth week of CGM use. Secondary outcomes included time spent in and out of a glycemic target of 70-140 mg/dL, polyhydramnios, macrosomia, and a composite of obstetric and neonatal outcomes. Sample size calculations were designed to detect a 20% decrease in mean glucose level with 80% power. From December 2017 through May 2018, a total of 374 patients diagnosed with GDM were referred to our practice. Of these, 40 met inclusion criteria and were enrolled. Twenty patients were randomized into the blinded CGM group and 20 into the real-time CGM group. Twelve (60%) patients in the blinded CGM group and 11 (55%) in the real-time CGM group completed 4 weeks of monitoring and were included in the final analysis. Demographic characteristics were similar between groups. There was no significant difference in mean sensor glucose level between the blinded CGM group (98.9+8.9 mg/dL) and the real-time CGM group (107.5+11.4 mg/dL) in the fourth week of CGM use. There were also no significant differences in time spent in glycemic target, maternal, or neonatal outcomes. An end of participation survey showed that all study patients would consider CGM to monitor glucose in a subsequent pregnancy and all patients in the real-time CGM group believed that the real-time feedback was helpful in managing their GDM. Our study showed that the feedback provided by real-time CGM did not significantly decrease mean glucose values compared to SMBG alone after four weeks of CGM use. All patients considered CGM an effective motivational tool for use in GDM.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Neonatal outcomes among offspring of obese women diagnosed with gestational diabetes mellitus in early versus late pregnancy

Maternal metabolic derangements associated with early pregnancy gestational diabetes may affect the fetus differently compared with gestational diabetes diagnosed later in pregnancy. The aim of this observational study was to assess neonatal outcomes according to timing of gestational diabetes diagnosis in obese women. Women ≥18 years of age with a pre-pregnancy body mass index ≥30 kg/m2 were grouped according to the results of a 75 g 2-h oral glucose tolerance test performed at 13.1 weeks of gestation and repeated at 23.4 weeks if normal at first testing. The main outcomes were birthweight and large for gestational age. Out of 361 women, 164 (45.4%) were diagnosed with gestational diabetes, 133 (81.1%) of them in early pregnancy. The mean offspring birthweight was 3673 g (standard deviation (SD) 589 g) in the early and 3710 g (SD 552 g) in the late gestational diabetes group. In a multivariate logit model, the odds ratio for large for gestational age was 2.01 (95% CI: 0.39-10.39) in early compared with late gestational diabetes. We observed no statistically significant differences in neonatal outcomes according to timing of gestational diabetes diagnosis. In addition to lack of power, early treatment of hyperglycemia may partly explain the results.

Association of Vitamin D and Parathyroid Hormone with Insulin Sensitivity, Beta Cell Function and Gestational Diabetes in Pregnancy: A Cross-Sectional, Observational Study.

IntroductionVitamin D (25OHD) and parathyroid hormone (PTH) are associated with dysglycemia, and we investigated them in gestational diabetes mellitus (GDM).MethodsIn this cross-sectional, observational study, we included 75 pregnant women between 24 and 28 weeks of gestation. A fasting venous sample was collected for plasma glucose (FPG), insulin, PTH and 25OHD. Glucose and insulin samples were collected hourly after 75 g glucose load for 2 h. Insulin sensitivity was estimated by the Matsuda index (MI) and beta cell function by the insulin secretion sensitivity index (ISSI-2). The subjects were stratified into three groups and tertiles according to the 25OHD and PTH, respectively. Appropriate statistical tests were used to compare the MI, ISSI-2 and GDM among the groups.ResultsGDM was seen in 14/75, and of these patients, 2 were 25OHD deficient, 7 insufficient and 5 had sufficient 25OHD. MI and ISSI-2, though not correlated with the 25OHD, decreased from the lower to higher PTH tertile (P < 0.001). FPG, AUCgluc (area under the curve glucose) and prevalence of GDM increased from the lower to higher PTH tertile (P < 0.001).ConclusionIncreased PTH was associated with decreased insulin sensitivity, beta cell function and GDM in pregnancy, irrespective of the underlying 25OHD level.

Knowledge and health beliefs about gestational diabetes and healthy pregnancy's breastfeeding intention.

If the knowledge and health beliefs relating to gestational diabetes mellitus during pregnancy are associated with behaviours during pregnancy and lactation, this suggests potential educational interventions. Women with gestational diabetes mellitus are more likely to develop type 2 diabetes mellitus, and babies with gestational diabetes mellitus incur increased risk of neonatal hypoglycaemia and childhood obesity. Breastfeeding is an effective way to improve maternal and lipid metabolism of gestational diabetes mothers, and to lower the risk of type 2 diabetes mellitus after birth, to prevent conception. Nurses have an important role in encouraging mothers to breastfeed for health promotion. The importance of cognitive factors such as knowledge, beliefs and attitudes is emphasised to increase the breastfeeding rate and to improve the quality of breastfeeding for pregnant women. Little research has been undertaken exploring cognitive factors and breastfeeding intention. Cross-sectional descriptive survey in healthy pregnant women. A questionnaire about gestational diabetes mellitus-related knowledge and health beliefs of gestational diabetes mellitus management composed of perceived susceptibility, severity, benefits, barriers and self-efficacy was developed by investigators. The association of two predictor variables of interest, gestational diabetes mellitus-related knowledge and health beliefs of gestational diabetes mellitus management, was tested with the outcome variable, breastfeeding intention, using chi-square test, t test, ANOVA and multiple logistic regression. Two hundred and thirty-seven of the 250 participants returned questionnaires for a final response rate of 94.8%. Breastfeeding intention after childbirth was associated with stronger perceived benefit, higher levels of self-efficacy and lower alcohol consumption. History of drinking and health beliefs such as perceived benefits and self-efficacy were highly associated with breastfeeding intention relating to gestational diabetes mellitus. Education for breastfeeding in gestational diabetes mellitus mothers should focus upon the benefit of breastfeeding and strengthening self-efficacy.