Gestational Diabetic Women Research Articles

Serum calcium, vitamin D and parathyroid hormone relationship among diabetic and non-diabetic pregnant women and their neonates

Aims The purpose of the study was to determine the prevalence of osteomalacia and hypovitaminosis D among diabetic and non-diabetic pregnant women and in their neonates. Methods Serum calcium, phosphorus, heat labile alkaline phosphatase, 25(OH) vitamin D and PTH were measured in 32 non-diabetic, 16 gestational diabetic and 8 Type 1 diabetic pregnant women and in cord blood of their newborn. Results Among 32 non-diabetic subjects, 4 subjects (12.5%) had biochemical osteomalacia. 4 out of 16 gestational diabetic subjects (25%) had biochemical osteomalacia whereas 5 out of 8 Type 1 diabetic subjects (62.5%) had biochemical osteomalacia. Mean concentration of 25(OH) vitamin D in the non-diabetic group was 17.18 ± 9.88 ng/ml. Mean concentration of 25(OH) vitamin D in the Gestational diabetic group was 14.75 ± 6.90 ng/ml, while in Type 1 diabetic group, it was 7.81 ± 3.79 ng/ml. 50% of neonates of normal pregnant women had vitamin D deficiency whereas, 50% had vitamin D insufficiency. 40% of neonates of Gestational diabetic pregnant women had vitamin D deficiency whereas, 40% had vitamin D insufficiency. Conclusion Vitamin D deficiency and biochemical osteomalacia was present in significant percentage of normal pregnant women and their neonates. Gestational diabetes and Type 1 diabetic women were more prone to develop vitamin D deficiency and biochemical osteomalacia.

Plasma visfatin levels in pregnant women with normal glucose tolerance, gestational diabetes and pre-gestational diabetes mellitus

Objective. Visfatin, an adipocytokine, is a peptide predominantly expressed in and secreted from visceral adipose. In this study, we aimed to compare visfatin levels in gestational (GDM) and pre-gestational diabetic (pre-GDM) women with healthy pregnant women. We also sought to determine whether there was a correlation between visfatin levels and serum glucose levels at 1 h after the 50-g oral glucose challenge test in pregnant women with GDM and normal glucose tolerance.Methods. The study consisted of 65 pregnant women: 21 patients with GDM (Group 1), 20 patients with pre-GDM (Group 2) and 24 gestational age and BMI-matched healthy pregnant women (Group 3) were enrolled.Results. Plasma visfatin levels in Groups 1 and 2 were significantly higher than in Group 3 (P < 0.001). Plasma visfatin levels in Groups 1 and 2 were similar (P > 0.05). There was no significant correlation between visfatin levels and serum glucose levels at 1 h after the glucose tolerance test in both Groups 1 and 3 (P > 0.05).Conclusions. Our results support the literature indicating higher visfatin levels in women with GDM compared to women with normal glucose tolerance. Interestingly, we found similarly high visfatin levels in women with pre-GDM.

Antioxidant Vitamins and Lipoperoxidation in Non-pregnant, Pregnant, and Gestational Diabetic Women: Erythrocytes Osmotic Fragility Profiles

BackgroundInconsistent reports are available in the literature regarding the oxidative status and antioxidant capacity during the pathogenesis of gestational diabetes. Present study was aimed to evaluate oxidative stress during the development of gestational diabetes and to evaluate antioxidant capability in non-pregnant (control), pregnant and gestational diabetics.MethodsThe study consisted of non-pregnant, healthy pregnant and patients suffering from gestational diabetes mellitus (GDM). Each group consisted of 23 women. We compared their oxidative and anti-oxidative system in blood. Their blood malondialdehyde (MDA) and antioxidant vitamins (C, E, A) were determined and compared to evaluate the oxidative status and anti-oxidative capacity of these groups. We have also compared the osmotic fragility profiles of the erythrocytes of these groups.ResultsPlasma MDA content in pregnant was significantly higher compared to non-pregnant (p < 0.001, 67.5%) and even in gestational diabetics; its value was found significantly further elevated (p = 0.001, 13.8%) compared to healthy pregnant. There was significant decline (p < 0.001, 41.9%) in the level of vitamin C in pregnant as compared to non-pregnant. Although in GDM the decrease was significant (p = 0.025, 20.6%) but comparatively lesser when compared to healthy pregnant. Vitamin E showed the increase of 9.6% during pregnancy, although this alteration was non-significant (p = 0.09), but the level was found to decline significantly (p < 0.001, 25.5%) in GDM compared to pregnant group. Vitamin A contents were also decreased in pregnant (p = 0.002, 17.4%) compared to non-pregnant and in GDM (p = 0.012, 11.2%) compared to pregnant group. Osmotic fragility (O.F.) profiles showed insignificant (p = 0.325) enhanced mean erythrocyte fragility (MEF) in pregnant but this increase was significant (p = 0.003) in case of GDM. The O.F. profiles of pregnant and GDM erythrocytes got shifted to the right side of the control one.ConclusionsOur findings indicate highly enhanced lipid peroxidation and significant depletion in antioxidant capacity during the development of gestational diabetes, and these alterations are not the cause but the consequence of GDM. However, further studies are warranted to examine a wider range of biochemical parameters to evaluate the potential risks of oxidative damage in GDM.KeywordsGestational diabetes; Oxidative stress; Anti-oxidants; Vitamins C, E, A; Osmotic fragility; Non-pregnant; Pregnant; GDM

Familial diabetes aggregation in type I diabetics: gestational diabetes an apparent risk factor for increased diabetes susceptibility in the offspring.

A significantly decreased familial diabetes aggregation on the maternal side of insulin-dependent diabetic children born between 1974 and 1984 as compared to those born between 1960 and 1973 was observed. This phenomenon was explained by an increased prevention of hyperglycaemia during pregnancy since 1974, particularly of gestational diabetes in women with familial diabetes aggregation. A highly significant predominance of Type II diabetes was found in great-grandmothers of infantile-onset diabetics on the maternal side as compared to the paternal side. This finding may suggest that gestational diabetes, which can represent a risk factor for diabetes transmission on the maternal side, is often followed by "extragestational" type II diabetes in higher age. This conclusion is supported by the data of familial diabetes aggregation obtained in insulin-dependent infantile- or juvenile-onset diabetics, when familial diabetes aggregation was ascertained as late as at least 20 years after birth of the diabetics. In this case, a significant predominance of familial diabetes aggregation in first- and second-degree relatives, particularly in grandmothers, was found on the maternal side as compared to the paternal side. All these findings are consistent with a teratogenetic effect of gestational diabetes on diabetes susceptibility in the offspring, which can be prevented by avoiding hyperglycaemia in pregnant women and hyperinsulinism in foetuses.

Carbohydrate metabolism and cardiovascular risk factors 4 years after a pregnancy complicated by gestational diabetes

Aims The aim of the present study was to determine the prevalence of abnormal glucose tolerance and the metabolic syndrome in a cohort of previously gestational diabetic (GDM) women 4 years after delivery. Methods Sixty-eight prior GDM and a control group of 39 women with normal glucose tolerance during pregnancy were invited to participate in a follow-up study. Results The prevalence of diabetes, impaired glucose tolerance and impaired fasting glucose (IFG) was 21%, 16%, and 6% among prior GDM women and 0%, 15%, and 0% among controls respectively ( P = 0.0039). Independently of the metabolic syndrome criteria used this status was found more frequently among women with prior GDM (all P < 0.05). The prevalence of the metabolic syndrome showed a dose–response relationship with the level of weight categories ( P < 0.005) as well as with the level of glucose intolerance ( P = 0.024). Conclusion According to our results a disturbed carbohydrate metabolism and a clustering of cardiovascular risk factors might be observed in previous GDM women 4 years after delivery.

Prevention of gestational diabetes mellitus by continuing metformin therapy throughout pregnancy in women with polycystic ovary syndrome

The aim of the present study was to assess whether continuation of metformin therapy throughout pregnancy can reduce the development of gestational diabetes in women with polycystic ovarian syndrome (PCOS). This experimental study was conducted in a private tertiary level infertility care center between June 2002 and December 2006. Fifty-nine non-diabetic PCOS patients who conceived while taking metformin and different ovulation-inducing agents comprised the sample group. Twenty-nine of them continued metformin throughout pregnancy and 30 did not The main outcome measure was development of gestational diabetes in women with PCOS and their fetal outcome. Basic parameters such as age, body mass index, levels of follicle-stimulating hormone and luteinizing hormone, free testosterone, dihydroepiandrosterone sulfate, fasting sugar and fasting insulin did not differ between the two groups. Among 29 women who received metformin, gestational diabetes developed during one of 29 pregnancies (3.44%) versus nine of 30 pregnancies (30%) without metformin. The odds ratio for gestational diabetes in women without metformin versus with metformin was 12 (95% confidence interval: 6.20-18.08). All babies born in the metformin group had average birthweight and those in the control group 4 (13.33%) were large for date. In PCOS use of metformin throughout pregnancy is associated with and might be responsible for a ninefold reduction (30-3.44%) of gestational diabetes.

Effects of early breastfeeding on neonatal glucose levels of term infants born to women with gestational diabetes

Infants born to diabetic women are at higher risk for hypoglycaemia related to hyperinsulinism in response to maternal hyperglycaemia during pregnancy. As such, recommendations to prevent neonatal hypoglycaemia include infant feeding in the early postpartum period. The present study aimed to examine the effect of early breastfeeding and type of nutrition used for the first feed (human milk or formula) on glucose levels in infants born to women with gestational diabetes. The prospective pilot study of 84 infants born to gestational diabetic women examined the glycaemic levels of infants who were breastfed in the delivery room compared to glycaemic levels of those who were not. The study also compared the glycaemic levels of infants who breastfed with those who received formula for their first feed. Infants who were breastfed in the delivery room had a significantly lower rate of borderline hypoglycaemia than those who were not breastfed in the early postpartum period (10% versus 28%; Fisher's exact test., P = 0.05,). Likewise, infants breastfed in the delivery room had significantly higher mean blood glucose level compared to infants who were not breastfed in the delivery room (3.17 versus 2.86 mmol L(-1), P = 0.03). Additionally, breastfed infants had a significantly higher mean blood glucose level compared to those who were formula fed for their first feed (3.20 versus 2.68 mmol L(-1), P = 0.002). Early breastfeeding may facilitate glycaemic stability in infants born to women with gestational diabetes.

Definition, size of the problem, screening and diagnostic criteria: Who should be screened, cost-effectiveness, and feasibility of screening

The epidemic of obesity and increased prevalence of diabetes necessitates reconsideration of its definition and screening by separating type 2 diabetic women from women with gestational diabetes to provide a better model of care. The unique problems concerning an undiagnosed type 2 diabetic woman are not major issues in the gestational diabetic woman. This review underscores the need for a unique diagnosis for women with moderate to severe hyperglycemia and/or other evidence of long-standing diabetes complications, and the urgent need for more intensive surveillance and treatment than is otherwise available for gestational diabetic women.

Risk for developing gestational diabetes in women with twin pregnancies

Objective. To examine the risk of developing gestational diabetes mellitus (GDM) in women with twin compared with singleton pregnancies.Research design and methods. We examined a cohort of 23,056 pregnant women who gave birth to a live infant between 1 September 1998 and 31 December 2006, 553 of whom had twin pregnancy. The primary exposure was twin versus singleton pregnancy, and the primary outcome was the development of GDM. Standard univariate analyses were performed, as were multivariable analysis with logistic regression to control for potential confounding variables. GDM was diagnosed using criteria of the National Diabetes Data Group.Results. Patients with twin pregnancies had a higher rate of GDM when compared with singleton pregnancies (3.98%vs. 2.32%; p = 0.01). In a multiple regression analysis after adjusting for age, race/ethnicity, body mass index, maximal systolic and diastolic blood pressure, smoking and parity, twin pregnancy was associated with an approximately two-fold increase in risk for developing GDM (OR 2.2, 95% CI 1.4–3.6). In a stratified analysis, women between the ages of 25 and 30 years and African-American women had the highest risk of developing GDM in twin pregnancies. When compared with twins of non-diabetic mothers, twins of gestational diabetics had a higher rate of admission to the neonatal intensive care unit (37%vs. 52%; p = 0.05), had longer hospitalisation (8 ± 0.5 vs. 16 ± 4 days; p = 0.01) and higher rate for respiratory distress syndrome (7%vs. 27%; p = 0.001).Conclusion. There is a significant increase in the incidence of GDM in twin pregnancies versus singleton pregnancies. The risk is highest in African-American and young women.

Continuous Glucose Monitoring: Is it Helpful in Pregnancy?

The effects of diabetes in pregnancy were first noticed in the beginning of the 19(th) century. Today approximately seven percent of all pregnancies in the United States are affected by gestational diabetes. Since becoming more knowledgeable of the disease, the medical community has developed diagnostic criteria for detecting gestational diabetes and has created treatment options for lowering the risk of adverse fetal outcomes. A pregnancy affected by diabetes is associated with macrosomia, fetal malformations, spontaneous preterm delivery, and labor complications. These risks can be minimized by tight glycemic control through diet, insulin, and attentive monitoring of blood glucose levels. Although most pregnant diabetic women currently monitor their diabetes using self-monitoring blood glucose, the technology of continuous glucose monitoring (CGM) offers a myriad of benefits. This mini-review looks at the advantages of using CGM in pregnancy which includes decreasing the risks of poor fetal outcomes, improving a patient's overall glucose profile, helping start or adjust insulin treatment, adjusting current screening protocol and developing a normoglycemic target for gestational diabetic women to aim for during their pregnancy. With the use of CGM, the complications of diabetic pregnancies first seen nearly two centuries ago will become a problem of the past.

Hypertensive Disorders During Pregnancy in Gestational Diabetic Women

Gestational diabetes is often compounded by hypertensive disease of pregnancy. Women diagnosed as suffering from gestational diabetes were subdivided into two groups: those found to be suffering from some form of hypertension during their pregnancy [n = 78]; and those who did not develop hypertension [n = 345]. The maternal characteristics and perinatal outcome of the two groups were statistically correlated. The results show that obesity was the only statistically significant correlate, and that obstetric outcome more often required planned delivery by induction of labour or caesarean section. The infant was more likely to be delivered prematurely. While the perinatal morbidity did not show any significant differences, this was only because of the more active intervention policy in these women.

Maternal vitamin D deficiency, ethnicity and gestational diabetes

Vitamin D deficiency has been linked to impaired glucose metabolism. We determined whether serum 25-hydroxyvitamin D (25OHD) is associated with glucose metabolism in pregnant women and the effect of ethnicity on this relationship. We analysed serum 25OHD concentrations in 307 pregnant women attending a metropolitan obstetric clinic between October 2003 and May 2005. Measurements from 264 of the women were taken at the time of glucose tolerance testing at mid-gestation, a population therefore at increased risk for gestational diabetes. Pearson correlation analysis was used to test for univariate linear relationships between the natural log of serum 25OHD (ln-25OHD) and other variables. Multiple regression analysis was used to adjust for confounding factors. Mean serum 25OHD concentration was 53.8 +/- 23.9 nmol/l (sd). Ln-25OHD was negatively correlated with serum parathyroid hormone as expected (r -0.24, confidence intervals -0.35 to -0.12). Ln-25OHD was also negatively correlated with fasting plasma glucose (r-0.20, -0.31 to -0.08), fasting insulin (r -0.20, -0.31 to -0.08) and insulin resistance as calculated by homeostasis model assessment (r -0.21, -0.32 to -0.09). The association between fasting glucose and log-transformed 25OHD concentration was of borderline significance after accounting for ethnicity, age and body mass index in multivariate analyses (-0.13, -0.26 to 0.01). The odds ratio of gestational diabetes in women with 25OHD < 50 nmol/l did not reach statistical significance (1.92, 95% confidence interval 0.89-4.17). Maternal 25OHD concentrations are inversely related to fasting glucose, although further studies are required to establish whether this is independent of the effects of ethnic background.

Metabolic syndrome after a pregnancy complicated by gestational diabetes

Annak ellenére, hogy a szív- és érrendszeri betegségek kockázati tényezőinek együttes és halmozott előfordulása nem megkérdőjelezhető, napjainkban a metabolikus szindróma mint különálló cardiovascularis rizikófaktor vitatott. A szerzők előző vizsgálatai szerint a gesztációs diabéteszt átlagosan 8 évvel követően gyakori a szénhidrát-anyagcsere zavara, és ehhez az állapothoz gyakran kedvezőtlen metabolikus paraméterek társulnak. A szerzők jelen tanulmányukban 68, előzőleg gesztációs diabétesz miatt gondozott asszony esetében, 4 évvel a szülést követően vizsgálták a metabolikus szindróma prevalenciáját különböző kritériumrendszerek szerint. Az eredményeket 39, terhesség alatt szénhidrát-anyagcsere szempontjából egészséges asszony adataival hasonlították össze. A kontrollasszonyokhoz képest az előzőleg gesztációs diabéteszes csoportban a metabolikus szindróma valamennyi kritériumrendszer alapján jelentősen gyakoribb volt. Korábbi gesztációs diabétesz esetében a glükózintolerancia súlyosbodásával gyakoribbá vált a metabolikus szindróma előfordulása. A túlsúlyos asszonyok körében mind a volt gesztációs diabétesz, mind a metabolikus szindróma prevalenciája tízszeres volt a normál súlyúakhoz hasonlítva. Előző gesztációs diabétesz esetén már a szülést követően 4 évvel számítani kell a cardiovascularis rizikófaktorok gyakori, együttes előfordulására. Ezért ezen asszonyok követése és a „metabolikus szindróma” elemeinek minél korábbi, individuális kezelése, életmód-változtatás és testsúlycsökkentés kívánatos.

Magnetic resonance imaging in pregnancies complicated by gestational diabetes predicts infant birthweight ratio and neonatal morbidity.

The use of magnetic resonance imaging (MRI) has been shown to be safe during pregnancy and can accurately assess fetal fat and rate of growth. The purpose of this study was to investigate with MRI the relationship between maternal weight, fat distribution, and glucose levels and neonatal birthweight ratio, percent fat, and infant outcome in pregnancies complicated by gestational diabetes. Twenty gestational diabetic women were studied at 36 to 38 weeks' gestation with hemoglobin A1c, a glucose tolerance test and maternal body fat by electrical impedance. MRI scans of the maternal upper arm and from her zyphoid process to her pubic symphysis, including all fetal components, were analyzed for percent fat of the mother's arm and trunk and her fetus' trunk. All variables were then related to infant outcome (birthweight, birthweight ratio, and neonatal morbidity). Maternal body composition was related to maternal weight (p = 0.012, r = 0.54), as was maternal arm fat (p < 0.005, r = 0.60). Arm fat did correlate with trunk fat, but trunk fat did not correlate was well with weight (p = NS). Although maternal Hb A1c correlated with maternal weight (p = 0.05, r = 0.43), it did not correlate with infant birthweight. In contrast, maternal mean glucose levels correlated with both maternal and infant weight and infant birthweight ratio (p = 0.05, r = 0.60; p = 0.05, r = 0.42; and p = 0.01, r = 0.64, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Serum Chromium and Gestational Diabetes

To prospectively assess if chromium levels are different in gestational diabetics than in nondiabetic pregnant women. Therapeutic options could exist if levels are different. We conducted a 2-year prospective, gestational cohort study. The cohort included newly diagnosed pregnant patients. Two blood samples were taken, the first at consent, the second at the time of diabetes screening. Five hundred eighty patients entered the cohort. One hundred fifty-five were lost to follow up and 425 patients completed the study (396 nondiabetics and 29 diabetics). The patients with gestational diabetes were significantly older, with a family history of gestational diabetes, and were significantly more likely to have been a gestational diabetic in a previous pregnancy (P < 05). There was no significant difference between the 2 groups for chromium levels both at enrollment (0.15 +/- 0.06 ng/mL vs 0.14 +/- 0.03 ng/mL; P = .28) and during the second trimester (0.14 +/- 0.06 ng/mL vs 0.14 +/- 0.04 ng/mL; P = .82). Serum chromium levels do not exhibit any significant variation between gestational diabetic women and nondiabetic women when assessed prospectively.

Increased Incidence of Gestational Diabetes in Women Receiving Prophylactic 17α-Hydroxyprogesterone Caproate for Prevention of Recurrent Preterm Delivery

Meta-analysis of both older and current studies supports the use of 17α-hydroxyprogsterone caproate (17P) for preventing preterm birth. At the same time, progesterone is known to be diabetogenic. This study was planned to evaluate whether weekly prophylaxis with 17P alters the incidence of gestational diabetes mellitus (GDM). Women with singleton gestations who had a history of preterm delivery were enrolled for outpatient management before 27 weeks' gestation and delivered after 28 weeks' gestation. None of those participating had preexisting diabetes. The treatment group included 557 women who, starting at 16-21 weeks' gestation, received weekly intramuscular injections of 250 mg of 17P. The control group numbered 1524 parturients who also had a history of at least 1 preterm delivery. The 2 groups were similar with respect to maternal age and body mass index. Women given 17P had a significantly higher incidence of GDM than did control women (12.9% vs. 4.9%). The odds ratio (OR) was 2.9, and the 95% confidence interval, 2.1-4.1. Gestational age at the time of delivery was similar in the 2 groups, as were rates of spontaneous recurrent preterm delivery at less than 35 weeks' gestation (12.4% in the treatment group and 9.6% in the control group). Overweight and obese women had the highest risk of developing GDM, but 17P prophylaxis remained positively and independently associated with GDM in a logistic regression analysis that controlled for maternal weight, smoking, use of betamimetic drugs, and gestational age at the first outpatient visit. The overall adjusted OR was 3.09. These findings support the practice of screening for GDM early in gestation in women with a previous history of preterm delivery who receive 17P in an attempt to avoid another preterm birth.

Bone mineral density changes in gestational diabetic pregnancies–a longitudinal study using quantitative ultrasound measurements of the os calcis

To compare the maternal bone mineral density (BMD) changes in gestational diabetic and non-diabetic pregnancies using quantitative ultrasound measurements of the os calcis, BMD measurements were performed at the os calcis in early pregnancy before 20 weeks and in the late third trimester after 36 weeks, using a Hologic Sahara Clinical Bone Sonometer system. Random glucose screening and direct oral glucose tolerance testing were used to diagnose gestational diabetes mellitus (GDM) according to World Health Organization criteria, which was then treated according to a standard protocol. In a cohort of 480 patients, there were 96 gestational diabetic patients (14 GDM and 82 with impaired glucose tolerance). The mean BMD loss was higher in diabetic patients compared with controls (0.038 vs. 0.025 g/cm2, p = 0.048). A regression model of all pregnancies showed that higher fat accumulation was related to lower BMD loss, but diabetic status was not in the equation. Within diabetic pregnancies, lower initial BMD values, higher fat accumulation and higher early-pregnancy body mass index were associated with lower BMD loss. While gestational diabetic women had higher BMD loss than non-diabetic women, this was apparently secondary to other anthropometric factors rather than due directly to the gestational diabetic state.

Feasibility of a Follow-up Program for Low Socio-Economic status Gestational Diabetes Women (GDM) in a Community SettingDepartment of Nutrition and Endocrinology, Laval, QC

Feasibility of a Follow-up Program for Low Socio-Economic status Gestational Diabetes Women (GDM) in a Community SettingDepartment of Nutrition and Endocrinology, Laval, QC

Differences in low-grade chronic inflammation and insulin resistance in women with previous gestational diabetes mellitus and women with polycystic ovary syndrome

Background. Polycystic ovary syndrome (PCOS) and gestational diabetes mellitus (GDM) are both characterized by an increase in insulin resistance. Our goal in the present study was to measure insulin resistance (as estimated by homeostasis model assessment, sex hormone-binding globulin (SHBG) and adiponectin concentrations) and parameters of low-grade inflammation in non-diabetic, non-hyperandrogenic ovulatory women with previous GDM (pGDM) and in non-diabetic women with classic PCOS, characterized by hyperandrogenism and oligo/anovulation.Patients and design. We evaluated 20 women with PCOS, 18 women with pGDM and 19 controls, all matched according to body mass index (BMI). Fasting blood samples were drawn in all women 3–6 days after spontaneous or dydrogesterone-induced withdrawal bleeding. Body fat distribution was assessed using dual-energy X-ray absorptiometry in all women.Results. After adjusting for age and percent body fat, measures of insulin resistance such as SHBG and adiponectin concentrations were decreased and central obesity was increased in women with PCOS and pGDM compared with controls (all p < 0.05). Parameters of low-grade inflammation such as serum tumor necrosis factor-α and highly sensitive C-reactive protein concentrations, white blood cell and neutrophil count were increased only in women with PCOS compared with BMI-matched controls (all p < 0.05).Conclusions. Certain markers of insulin resistance are increased in both women with PCOS and women with pGDM, while low-grade inflammation is increased only in PCOS. PCOS and GDM might represent specific phenotypes of one disease entity with an increased risk of cardiovascular disease, whereby women with PCOS demonstrate an augmented cardiovascular risk profile.

Abnormal results on a second testing and risk of gestational diabetes in women with normal baseline glucose levels

Objective To examine the rate of women with normal initial results to glucose tolerance tests who have abnormal results to subsequent testing, and estimate the risk of gestational diabetes mellitus (GDM) in these women. Methods Baseline plasma glucose levels were classified as normal if they were less than 120 mg/dL (group 1) or between 120 and 139 mg/dL (group 2) by the 50-g glucose challenge test (GCT); as abnormal if they were found abnormal by the 50-g GCT but normal by the 100-g glucose tolerance test (OGTT) (group 3); and as abnormal if 1 of the four 100-g OGTT values was abnormal (group 4). A second testing session with the 50-g GCT and 100-g OGTT was performed between the 24th and 28th weeks of pregnancy for 900 women at risk whose initial test results were normal. Results Of the 823 women with normal baseline results who completed the study, 41.4% had abnormal results to the second 50-g GCT, and gestational diabetes mellitus was diagnosed by the 100-g OGTT in 7.0% of these 823 women. Compared with group 1, the women in groups 2, 3, and 4 were at a significantly increased risk of having an abnormal result to the second 50-g GCT. They were also at a significantly increased risk for GDM. The adjusted odds ratios (ORs) were 3.0 for group 2 (95% confidence interval [CI], 1.2–7.2), 4.9 for group 3 (95% CI, 2.2–11.0), and 11.3 for group 4 (95% CI, 3.9–32.6). Conclusion The risk of developing GDM significantly increased with increasing baseline plasma glucose levels by the 50-g GCT.