Glucose Metabolism In Pregnancy Research Articles

Dietary regulation for 'gestational diabetes'.

Impaired glucose metabolism in pregnancy may be associated with adverse pregnancy outcomes. Primary dietary therapy is used in the management of diabetes, including gestational diabetes. The objective of this review was to assess the effects of primary dietary therapy in women identified as having gestational diabetes on fetal growth and neonatal outcomes. I searched the Cochrane Pregnancy and Childbirth Group trials register. Randomised trials of primary dietary therapy compared with no specific treatment in pregnant women with abnormal glucose tolerance test results. Trial quality was assessed. Four studies involving 612 women were included. Trials were small and of variable quality. No differences were detected between primary dietary therapy and no primary dietary therapy for birthweight greater than 4000 grams (odds ratio 0.78, 95% confidence interval 0.45 to 1.35) or caesarean deliveries (odds ratio 0.97, 95% confidence interval 0.65 to 1.44). There is not enough evidence to evaluate the use of primary dietary therapy for women who show impaired glucose metabolism during pregnancy.

Reference values for 75 g oral glucose tolerance test in pregnancy.

A 75 g oral glucose tolerance test was performed in 212 pregnant women with no predisposing factors suggesting glucose intolerance to establish the normal pattern of glucose metabolism in pregnancy. Reference values for the test were established for the middle of pregnancy (14-20 weeks, n = 43) and late pregnancy (28-37 weeks, n = 168). One woman was excluded because she had diabetes that required treatment with insulin. There were statistically significant differences between the two groups for samples taken both one and two hours after the glucose load. Reference ranges for the interpretation of the glucose tolerance test in pregnancy should therefore take account of the period of gestation. Arbitrary upper limits of normal (represented by the 97.5 centile) two hours after a 75 g oral glucose load are proposed at 7.5 and 9.6 mmol/l for the second and third trimesters, respectively.

Glucose metabolism in pregnancy.

Pregnancy is characterized by a number of maternal metabolic modifications in order to meet the energy requirements of the growing fetus. A progressive alteration of maternal glucose homeostasis develops throughout gestation and becomes maximal during the last trimester. A relative hypoglycemia is observed during the postabsorptive period despite an elevated plasma insulin concentration and an enhanced hepatic glucose production. In addition, the glucose utilization rate by peripheral maternal tissues is lowered in late gestation indicating that the mother supplies glucose to the fetus at the expense of her own tissues. Concomitantly, an insulin-resistant state develops in the mother to help sparing glucose for the pregnant uterus. It involves both glucose-producing (liver) and glucose-utilizing tissues. So far, the factor(s) responsible for the development of pregnancy-induced insulin resistance has not been identified although a number of circulating hormones are known to counteract insulin effects.

The need for adequate and consistent diagnostic classifications for diabetes mellitus diagnosed during pregnancy

The terms gestational diabetes and Class A diabetes are not used in a consistent manner even by recognized authorities on glucose metabolism in pregnancy. Needed is a general acceptance of unambiguous diagnostic categories relative to abnormal metabolism of glucose in pregnancy. Also required is standardization of the assay used for plasma glucose in the fasting state and after a glucose challenge and of the limits of normality of these tests.

Altered glucose metabolism in pregnancy: Its determination and fetal outcome

Current evidence increasingly suggests that the rapid intravenous glucose tolerance test is the simplest and most reliable method of detecting disappearance rates consistent with gestational diabetes. Five hundred and sixty-four selected third trimester patients yielded 99 with decreased glucose tolerance. Patients with positive obstetric histories yielded twice the number of abnormals as those with positive family history or glycosuria, but the presence of marked obesity, not unexpectedly, was a most important factor. The perinatal mortality rate was 3.0 per cent in patients with gestational diabetes.

Studies of Abnormal Glucose Metabolism in Pregnancy

Studies of Abnormal Glucose Metabolism in Pregnancy