Glucose Screening Test Research Articles

Preventive effects of individualized dietary and exercise interventions on gestational diabetes mellitus in gravidas with overweight and obesity before pregnancy

Objective To investigate the preventive effects of individualized dietary and exercise intervention on gestational diabetes mellitus (GDM) in gravidas with overweight and obesity before pregnancy. Methods A quasi-experimental trial was conducted in a level three class A hospital in Beijing. A total of 66 pregnant women, who met the inclusion criteria and went to outpatient during gestational weeks 8-12, were divided into experimental group (n=32) and control group (n=34) according to the sequence of hospitalization time. The patients of control group were given prenatal diets, excises and the knowledge education of body weight increasing, while the patients of experimental group were taken individualized interventions and weekly telephone follow-up. We compared 50 glucose screening test positive rate between two groups when gravidas were in gestational 24-28 weeks. Results The incidences of 50 glucose screening test positive rate and GDM were 53.1% and 28.1% in the experimental group, while they were 82.4% and 55.9% respectively in the control group(χ2=6.491, 5.200; P<0.05). Conclusions Individualized dietary and exercise direction can effectively decrease the incidence of GDM for gravidas with overweight and obesity before pregnancy. Key words: Diabetes mellitus, Gestation; Overweight or obese before pregnant; Individualized diet guide; Individualized exercise

Early Diagnosis of Gestational Diabetes Mellitus in Patients With Elevated Body Mass Index [300

INTRODUCTION: Increased body mass index (BMI, calculated as weight (kg)/[height (m)]2) in a pregnant patient can put her at risk of gestational diabetes mellitus (GDM) by altering her insulin resistance early in pregnancy. The objective of this study was to determine a one-step test for GDM as early as 16 weeks of gestation in patients with increased BMI, thus minimizing fetal and maternal complications. METHODS: Between February 2008 and February 2012, 200 pregnant patients with BMI greater than 25 were registered for this prospective double-blind randomized study. Group A received 50 g glucola and group B received 100 g at 16 weeks of gestation. Patients who had impaired glucose tolerance (130–139 mg) received counseling about exercise and diet and those who had abnormal glucola (greater than 140 mg) also received a consult with perinatologists. Student's t test, χ2 test, and statistical analyses were run using SPSS 21. RESULTS: A total of 176 patients completed (A=89, B=87) glucola at 16 weeks of gestation. Impaired glucose tolerance was noted in 11 patients (A=6.7%, B=5.7%). Abnormal glucose tolerance was noted in 37 patients (A=12.3%, B=29.8%). Additionally 30 new cases of impaired glucose tolerance were diagnosed at 28 weeks of gestation with 50 g glucose (A=12.2%, B=4.4%). The data demonstrated that there was no statistically significant difference in weight gain, hemoglobin, hematocrit, platelet, blood pressure, mode of delivery or fetal weight between patient groups who had abnormal glucose screening test and received counseling and those who had normal glucose screening. CONCLUSION: This study showed that diagnosing impaired glucose tolerance in early pregnancy in patients with elevated BMI and providing them counseling helped to prevent GDM complications. A one-step test using a 100-g glucola test in early pregnancy in patients with elevated BMI is promising.

Relationship between Positive Glucose Screening, Obesity and Pregnancy Outcome in the Absence of Gestational Diabetes: A Retrospective Cohort Study

Background: Currently pregnant women with abnormal glucose screening test (GCT), performed at 26 - 28 weeks gestation with a subsequent normal glucose tolerance test (GTT) receive routine care. Could these women be at risk of adverse pregnancy? Objective: Compare rate of caesarean section (CS), induction of labour (IOL), macrosomia, admission to special care nursery and neonatal hypoglycaemia. Designs: Retrospective cohort study. Setting: Ipswich Hospital, Ipswich, Queensland. Participants: Pregnant women having had the test at the hospital laboratory. Methods: Charts review of outcome measures including induction of labour, caesarean section, macrosomia, RDS and short-term neonatal morbidity. Results: We reviewed 882 charts (441 cases and 441 controls). There was a higher IOL rate among cases 21.1% versus 16.6% (OR and 95% CI 1.45; 1.03 - 2.06) and a higher CS rate, 30.4 versus 23.6 (OR and 95% CI 1.41; 1.05 - 1.91). Compared to women with BMI 18.5 - 24.9, women with BMI of 30 and above had a significantly higher IOL rate (47.1% versus 22.6%), higher CS rate (47.2% versus 25.7%) and higher rate of macrosomic baby (79.2% versus 4.2%). There were more women amongst the cases who were older, smoked, had a BMI 30 and above and had previous history of GDM. After adjusting for maternal age, BMI and smoking status, there was still an increased odds of CS, IOL and macrosomia, but this did not reach statistical significance. Conclusion: Abnormal glucose screening test in the absence of gestational diabetes is associated with adverse pregnancy outcome. This is largely contributed by maternal obesity.

Gestational diabetes in Turkmenistan: implementation of a screening program and first results

Data on the prevalence of gestational diabetes (GDM) is not available for Turkmenistan or any other central Asian country with large energy resources and rapidly increasing wealth and rates of obesity. We initiated a screening program to determine the prevalence of and the risk factors for GDM in Turkmenistan. Between March 2008 and March 2011, all pregnant women presenting to the Ene-Maehri-Merkezi perinatal center in Ashgabat before week 34 of pregnancy received a glucose screening test (after 26 weeks of pregnancy; 50 g glucose). If 60-min glucose was ≥7.8 mmol/l, an oral glucose tolerance test (oGTT) (75gr) was performed. GDM was diagnosed if ≥1 glucose values were abnormal (≥5.0, ≥10.0, ≥8.0 mmol/l at 0-, 60-, 120-min, respectively). Birth weight, 30 min glucose, and APGAR (1, 5, and 10 min) were recorded for all newborns. Of 1,738 women, 22.7 % had a pathological screening test. 70 % of these, underwent an oGTT and of these, 39.5 % had GDM (overall prevalence 6.3 %). Age, BMI, parity, and blood pressure were associated with screening glucose (all p < 0.001). In a multivariate analysis, age, BMI, and family history for diabetes were associated with GDM. Newborns from affected mothers were heavier (3,622 ± 435 vs. 3,480 ± 464 g, p = 0.007) and developed postnatal hypoglycaemia more often (21.6 vs. 9.3 %, p = 0.001), while there was no difference in APGAR. GDM is a relevant problem in Turkmenistan and probably also in other central Asian countries. The prevalence is similar to other developing countries such as India or China. Risk factors are comparable to those determined in other parts of the world.

The Obstetric and Neonatal Implications of a Low Value on the 50-g Glucose Screening Test

The Obstetric and Neonatal Implications of a Low Value on the 50-g Glucose Screening Test

The Obstetric and Neonatal Implications of a Low Value on the 50-g Glucose Screening Test

To assess the relationship between a low 50-g 1-hour glucose loading test (GLT) and maternal and neonatal outcomes in women without diabetes. This was a secondary analysis of a multicenter observational cohort from a randomized trial of treatment for mild gestational diabetes. Maternal and neonatal outcomes were compared between women with GLT values < 90 mg/dL and those with results 90 to 119 mg/dL. Of 436 enrolled women, 297 (68.1%) had a GLT result of 90 to 119 mg/dL and 139 (31.9%) had a result of < 90 mg/dL. There was a lower incidence of neonatal hypoglycemia in those with a GLT < 90 mg/dL (5.7% versus 16.5%, p = 0.006). Other outcomes were not associated with test results. A GLT result < 90 mg/dL compared with 90 to 119 mg/dL is associated with a lower risk of neonatal hypoglycemia, but no other significant findings.

EvaEvaluation of glucose challenge and oral glucose tolerance test results in pregnancy and estimation of prevalence of gestational diabetes mellitus at Sema Hospital in İstanbul

This study was designed to evaluate glucose screening and oral glucose tolerance test results, and to assess the prevalence of gestational diabetes in pregnant patients admitted to our hospital. Materials and methods: This retrospective study was carried out at Sema Hospital in İstanbul, Turkey. The study subjects were recruited between January 2006 and August 2009. A glucose challenge test (GCT) was given to 1681 pregnant women and based on the results 494 went on to take an oral glucose tolerance test (OGTT). A diagnosis of gestational diabetes mellitus (GDM) was made according to the criteria defined by the National Diabetes Data Group. Results: Out of the 1681 pregnant women tested, 58 were diagnosed with gestational diabetes. Pregnant women with GDM had GCT results greater than or equal to 145 mg/dL. While the percentage of GCT false positives was 87.8% when the cut-off value was taken to be 140 mg/dL, it was calculated to be 84.3% when the cut-off value was taken to be 145 mg/dL. For the 140 mg/dL cut-off value of GCT, specificity was 100% and sensitivity was 4.3%, and for the 145 mg/dL cut-off value of GCT, specificity was 98.3% and sensitivity was 28.3%. Conclusion: The prevalence value in this study was calculated at 3.45%. Pregnant women diagnosed with GDM had GCT results higher than 145 mg/dL. When the cut-off value was increased from 140 mg/dL to 145 mg/dL, a decrease was observed in false positives, and an increase was observed in sensitivity.

Sonographic study of the relationship between gestational diabetes mellitus and fetal activity

Objective: To evaluate the relationship between gestational diabetes mellitus (GDM) and fetal activity. Materials and methods: We prospectively studied 18 pregnant patients with GDM and 20 pregnant patients with normal glucose screening test. An ultrasound equipmentwas used to perform a 30 min transabdominal sonographic recording for each patient. Each ultrasound exam was recorded using a DVD recorder. Fetal activity was analyzed using duration and number of episodes of fetal breathing and body movements. The recordings were analyzed using a stopwatch in order to accurately evaluate each recording. The data was statistically analyzed using the parametric and non-parametric t-test. Results: The results of the study indicated that there was a significant correlation (p = 0.007) between the duration of fetal breathing movement and GDM. Fetuses of mothers suffering from GDM had a significantly longer duration of fetal breathing movements compared with fetuses of non diabetic mothers. In addition, the total duration of fetal activity (time of fetal body movements plus fetal breathing movements) was significantly higher (p = 0.005) in GDM compared with non GDM pregnancies. The difference in fetal body movements between GDM and normal pregnancies was not statistically significant. Conclusion: The results of this study support the hypothesis that GDM has a direct influence on fetal activity. The significance of this finding should be further evaluated.

Relationship of serum levels of adiponectin, leptin, tumor necrosis factor-alpha and c-reactive protein with insulin resistance during first trimester pregnancy

To explore the relationships between serum levels of adiponectin, leptin, TNF-alpha and CRP (c-reactive protein) versus insulin resistance in early pregnancy. A total of 342 pregnant women delivering at our hospital were recruited from October 2007 to July 2008. Their clinical data were collected and analyzed. According to the 50-g 1-hour oral glucose screening test, they were divided into 3 groups: gestational diabetes, gestational impaired glucose tolerance and normal pregnancy. The serum levels of adiponectin, leptin, TNF-alpha and CRP were determined by ELISA (enzyme-linked immunosorbent assay) and multivariate correlation analysis was used to analyze their relationships with the indices of insulin resistance. Among them, there were gestational diabetes (n = 13) and gestational impaired glucose tolerance (n = 19). Thirty-five normal pregnant women were selected as the control group. The result of analysis of variance indicted that adiponectin, leptin and TNF-alpha had significant statistical differences among three groups. Through the multivariate correlation analysis, adiponectin had a adverse correlation with the indices of insulin resistance. Leptin, CRP, TNF-alpha and BMI (body mass index) had positive correlations with the indices of insulin resistance. Adiponectin, leptin, TNF-alpha and CRP are correlated with the indices of insulin resistance. And TNF-alpha may become an important predictor of gestational diabetes in early pregnancy.

Skin Tag and Acanthosis Nigricans: Do they have a Predictive Value for Gestational Diabetes Mellitus?

Gestational diabetes mellitus (GDM) is a metabolic condition that can cause severe fetal and maternal morbidity. Early diagnosis and treatment of GDM can significantly prevent maternal and perinatal morbidity. To investigate and compare the prevalence of gestational diabetes mellitus in pregnant women with skin tag (ST) and/or acanthosis nigricans (AN) and a control group. This cross-sectional study was conducted at Adana Numune Educational and Research Hospital, Seyhan Practice Center, Dermatology and Obstetrics Clinics between March, 2006 and July, 2008. All 249 pregnant women without risk factors for GDM examined dermatologically in terms of AN and ST in the first antenatal visit. A 50 g glucose screening test and, if test positive, 100 g oral glucose tolerance test was performed between theirs 24 and 28 weeks of pregnancy. GDM was diagnosed according to American Diabetes Association (ADA) criteria. AN and ST prevalence were compared in women with GDM and without GDM. 35.8% of the pregnant women with AN had GDM, while the same ratio was 9.2% for the women without AN. The probability of pregnant women with AN having GDM is 5.5 (95%CI: 2.6-11.6) times more than the pregnant women without AN. Among the pregnant women with both ST and AN, 40.0% of them had GDM, while the same ratio was 12.3% for the women free of both ST and AN. In this instance, the difference between the ratios was found statistically significant (p=0.001). Based on the results, the probability of pregnant women with both ST and AN having GDM is 4.8 (95%CI: 1.9-11.7) times more than the pregnant women without ST and AN. AN or AN with ST may be a risk factor for GDM. If this supported with large case-control study, early screening for GDM to prevent serious complications of disease should be done in pregnant women with AN.

A Cost-Effective Screening Method for Preoperative Hyperglycemia

The preoperative encounter may offer a cost-effective opportunity for diabetes screening. Three hundred forty-seven fasting patients had a preoperative glucose measurement determined from blood residue left on the IV needle, measured with an Accu-Chek glucometer (Roche Diagnostics, Indianapolis, IN). After excluding patients with a diabetes history, 4.0% had a glucose measurement between 100 and 125 mg/dL, at a cost of $14.22 per identification, and 1.2% had a glucose measurement more than 125 mg/dL, at a cost of $32.00 per identification. This preoperative blood glucose screening test was implemented at a cost of approximately one-tenth of current methods.

Early Pregnancy Glucose Screening Is the Preferred Method for Diagnosing Gestational Diabetes Mellitus

In our prior studies in the United States, we found that (1) 1 st -trimester oral 1-hour 50-gm glucose screening test results are highly correlated with 3 rd -trimester values, 2 and (2) the positive predictive value of an oral 1-hour 50-gm glucose screening test result >135 mg/dl administered between weeks 14-18 of pregnancy is 55% for the diagnosis of gestational diabetes, with an overall mean sensitivity of 84%. 3 In the current study by Kushtagi and Mahto, an early glucose screening test result >140 mg/dl before 20 weeks of pregnancy occurred in 29% of gravidas and resulted in a sensitivity of 78% with a positive predictive value of 44% for gestational diabetes mellitus before the 3 rd -trimester. In our previous study, we found that only 15% of gravidas had an oral 1-hour 50-gm glucose screening test result >135 mg/dl at 16 ± 2 weeks of pregnancy and that 37% of these early screen-positive women were diagnosed with gestational diabetes by follow-up 3-hour 100-gm glucose tolerance test in advance of the 3 rd trimester. 3 Of particular importance is that the populations investigated in our two U.S. studies were comprised of women of different racial and ethnic backgrounds (Caucasians, Blacks, Filipinos, Orientals, and Pacific Islanders) than the population studied by Kushtagi and Mahto in India. 2,3 We view the current study as confirmatory of the universal applicability of the early pregnancy glucose screening approach for identifying gestational diabetes mellitus in gravidas of all racial and ethnic groups.

Initial impact and cost of a nationwide population screening campaign for diabetes in Brazil: a follow up study.

BackgroundIn 2001 Brazilian citizens aged 40 or older were invited to participate in a nationwide population screening program for diabetes. Capillary glucose screening tests and procedures for diagnostic confirmation were offered through the national healthcare system, diagnostic priority being given according to the severity of screening results. The objective of this study is to evaluate the initial impact of the program.MethodsPositive testing was defined by a fasting capillary glucose ≥ 100 mg/dL or casual glucose ≥ 140 mg/dL. All test results were tabulated locally and aggregate data by gender and clinical categories were sent to the Ministry of Health. To analyze individual characteristics of screening tests performed, a stratified random sample of 90,106 tests was drawn. To describe the actions taken for positive screenees, a random sub-sample of 4,906 positive screenees was actively followed up through home interviews.Main outcome measures considered were the number of diabetes cases diagnosed and cost per case detected and incorporated into healthcare.ResultsOf 22,069,905 screening tests performed, we estimate that 3,417,106 (95% CI 3.1 – 3.7 million) were positive and that 346,168 (290,454 – 401,852) new cases were diagnosed (10.1% of positives), 319,157 (92.2%) of these being incorporated into healthcare. The number of screening tests needed to detect one case of diabetes was 64. As many cases of untreated but previously known diabetes were also linked to healthcare providers during the Campaign, the estimated number needed screen to incorporate one case into the healthcare system was 58. Total screening and diagnostic costs were US$ 26.19 million, the cost per diabetes case diagnosed being US$ 76. Results were especially sensitive to proportion of individuals returning for diagnostic confirmation.ConclusionThis nationwide population-based screening program, conducted through primary healthcare services, demonstrates the feasibility, within the context of an organized national healthcare system, of screening campaigns for chronic diseases. Although overall costs were significant, cost per new case diagnosed was lower than previously reported. However, cost-effectiveness analysis based on more clinically significant outcomes needs to be conducted before this screening approach can be recommended in other settings.

Review: glycated haemoglobin A1c and fasting plasma glucose screening tests have similar sensitivities and specificities for early detection of type 2 diabetes

Study selection and assessment: English language crosssectional studies that compared the HbA1C test with the FPG test as screening tools for detecting type 2 diabetes, reported sensitivities and specificities using...

Can increased nuchal translucency in the first trimester of pregnancy predict gestational diabetes mellitus

SummaryThe current study was designed to evaluate whether increased nuchal translucency can predict gestational diabetes mellitus. This was a prospective observational study. Among the pregnant women at 11–14 weeks of pregnancy who came to our prenatal unit for a first trimester screening test, 389 pregnant women whose nuchal translucency above 95th centile were selected as the study group and 386 age-matched pregnant women whose nuchal translucency were within the normal range were enrolled as a control group. First, subjects underwent a 50 g glucose screening test; if it was positive then a 100 g oral glucose tolerance test was performed. The main outcome measures were the prevalence of gestational diabetes mellitus and impaired glucose tolerance and the number of macrosomic infants. Impaired glucose tolerance was more common in pregnant women whose nuchal translucency was above the 95th centile (p = 0.048). In addition, macrosomic infants were also more common in pregnant women with a fetal nuchal translucency above the 95th centile (p = 0.045). Macrosomia was more common in the study group with gestational diabetes mellitus (p = 0.046). In conclusion, increased nuchal translucency seems to be predictive for impaired glucose tolerance and macrosomia, which are associated with gestational diabetes mellitus.

Diabetes mellitus, tuberculosis and the mycobacteria: Two millenia of enigma

The thought that tuberculosis and the mycobacteria could cause diabetes seems farfetched, but is not. The peculiar relationship and frequent association of diabetes mellitus and tuberculosis has been observed for more than 2000 years, yet the reason for this correlation is, to this day, not known. Before the discovery of insulin, a diagnosis of diabetes was a death sentence within 5 years, and the usual cause of that death was tuberculosis. Despite this, in the 5th century, tuberculosis was already being portrayed as a "complication" of diabetes, a view little changed to this day, parroting Root's original 1934 description of "a one-sided relationship": tuberculosis still seen as a common complication of diabetes, while diabetes is thought to be no more common among TB patients than in the population at large. To Nichol's, this was "not logically tenable" and in his study of 178 otherwise healthy, non-diabetic military men with tuberculosis at Fitzsimmons Army Hospital, one-third had abnormal glucose screening tests. But despite his findings and those of Reaud in New York and others, this was not being recognized elsewhere, and Nichols wanted to know why. Nichols concluded that the incidence of diabetes among tuberculosis patients was considerably underestimated and that in tuberculosis patients, diabetes develops quite commonly. Diabetes was easy to detect. Tuberculosis and the mycobacteria were not. The evidence for a mycobacterial cause of diabetes is mounting rapidly. Schwartz and Haas both linked Type-2 diabetes to tuberculosis. And the pancreatic islet amyloid deposits that they found as a by-product of systemic tubercular infection have recently been dissolved by rifampicin, a first line drug against tuberculosis. Engelbach spoke of "transitory" diabetes in TB and Karachunskii noted changes in carbohydrate metabolism in patients with tuberculosis which commonly led to insulin deficiency with persistent hyperglycemia. Furthermore, mycobacterial elements have been shown recently not only to cause "autoimmune" Type-1 diabetes in NOD (non-obese diabetic) mice, but act as a vaccine to stop the inevitable diabetes that would otherwise materialize. The documentation of patient cases where TB has preceded and come before the development of diabetes is extensive yet underplayed and both Lin's and Tsai's studies speak of tuberculosis complicated by diabetes. Diabetes has been around since the first century AD, in a perpetual state of coping and managing. It is time, it is long past time, to cure diabetes. But current models as to its cause are not equipping us to do so.

Is 1-hour glucose screening test reliable after a short-term administration of antenatal betamethasone?

This study was designed to determine whether betamethasone has any effect on 1-hour (50-g) glucose screening test in nongestational diabetic pregnancy, and if any exists, to determine if this effect is transient or permanent. If the effect is temporary, the study was designed to determine the duration of this glucose intolerance effect and to determine the timing of 1-hour glucose screening test after betamethasone usage. One hundred fourteen pregnant women with a diagnosis of preterm labor at 24 to 34 weeks gestation were enrolled into the prospective study. One-hour glucose screening test was performed before initiation of hydration treatment. Forty pregnant women with normal 1-hour glucose results, who also had responded to hydration therapy, made up our study group. Twenty-four hours, 72 hours, and 1 week after administration of betamethasone, 50-g glucose challenge tests were again performed. A 3-hour glucose tolerance test was performed in pregnant women, whose 1-hour screening test had been positive 1 week after corticosteroid administration. In the evaluation of data, one-way, variance analysis and Tukey's multiple comparison test were used. The mean value of 1-hour glucose results of 50-g challenge test at the 24 hours was significantly higher than the mean value of 1-hour glucose results of the test done initially before betamethasone administration and than those of the tests done at 72 hours and 1 week (p < 0.001 for these three groups). There was no statistically significant difference between the mean values of 1-hour glucose results of the test done before betamethasone administration and both the results of the tests done at 72 hours (p = 0.96) and 1 week (p = 0.99), separately. There was no significant difference between the mean 1-hour glucose results of the tests at 72 hours and 1 week (p = 0.99). The test results were positive in 42.5%, 10%, and 5% of the patients, respectively at 24 hours, 72 hours, and 1 week. The betamethasone administration significantly deteriorates 1-hour glucose screening test results in the nongestational diabetic patients but this effect of betamethasone is transient. Because of its high false-positivity at 24 hours (42.5%) and at 72 hours (10%) in women with initial negative 1-hour glucose screening test, we suggest that 1-hour glucose screening test in pregnant women be postponed at least 1 week after betamethasone administration or perform the test before administration of betamethasone.

Glucose tolerance in pregnant women with vaginal candidiasis

BackgroundThe use of traditional historic risk factors to identify gestational diabetes mellitus (GDM) will miss half of women with gestational diabetes mellitus. Our aim was to evaluate whether impaired glucose tolerance is a risk factor for vaginal candidiasis in pregnant women.Patients and MethodsIn a cross-sectional study, we compared the prevalence of impaired glucose tolerance in 64 pregnant women with vaginal candidiasis (positive microscopy) and 59 Candida-negative control subjects. Subjects underwent standardized 75-gram oral glucose tolerance testing between the 24th and 28th weeks of their pregnancies. Patients were included only if they had no known diabetes mellitus or historic risk factors for gestational diabetes mellitus, and had not been receiving antibiotic or steroid therapy. We compared glucose levels at fasting, 30 minutes, 60 minutes and 120 minutes, and perinatal and neonatal outcomes in the two groups.ResultsThere were no statistical differences between cases and controls in demographic characteristics. Glucose concentrations were higher in pregnant women with vaginal candidiasis than in control subjects at fasting (89 vs. 84 mg/dL, P=0.021), 30 minutes (139 vs. 126 mg/dL, P=0.050), and 60 minutes (124 vs. 106 mg/dL, P=0.018) after intake of 75 gram of glucose. The two groups did not differ in glucose level at 120 minutes after glucose administration. Gestational diabetes prevalence was 3.1% and 3.4% in the study and control group, respectively (P=0.274).ConclusionThe tolerance to glucose in pregnant women with vaginal candidiasis seems discretely impaired.

The effect of carbohydrate intolerance on neonatal birth weight in pregnant women without gestational diabetes mellitus.

BackgroundThere is still no consensus on screening, threshold levels and treatment of gestational diabetes mellitus. Furthermore, the importance of a positive 50-g glucose screening test in patients who had a negative 100-g oral glucose tolerance test remains controversial. We investigated the impact of the 50-g glucose screening test results on neonatal outcome in pregnant women with uncomplicated pregnancies, who had no risk factors according to ACOG criteria.Patients and MethodsThree hundred eighty-six pregnant women with singleton pregnancies were prospectively screened with 50-g glucose challenge test between 24 and 28 weeks. If the test result was >140 mg/dl, a 100-g 3-hour oral glucose tolerance test was performed. Patients with a positive screening test, but not diagnosed as gestational diabetes mellitus constituted the study group, and patients with a negative screening test constituted the control group. Cesarean rates, neonatal birth weights and complications were compared between these groups.ResultsThe cesarean delivery rates were not statistically different between the study and control groups (8.3% vs. 6.4%, P>0.05). The rates of macrosomic births were 10.0% in the study group, and 6.4% in the control group (P>0.05), but the mean birth weight (3451.67 ± 355.70 g) in the study group was significantly higher than the mean birth weight (3296.29 ± 365.14 g) in the control group (P=0.003). Neonatal hypoglycemia and hyperbilirubinemia was also encountered more often in babies of pregnant women with a positive 50-g glucose challenge test but negative 100-g glucose tolerance test.ConclusionBecause of similarities with gestational diabetes mellitus on the basis of perinatal outcomes, the non-diabetic pregnant women with 50-g glucose screen test result over 140 mg/dl but a negative 100-g OGTT should be followed closely.

Inflammation and Glucose Intolerance

Increased leukocyte count is a marker of inflammation that has been associated with the development of type 2 diabetes in prospective studies. Although gestational diabetes mellitus (GDM) and type 2 diabetes share certain pathophysiological mechanisms, few studies have examined inflammation and risk of GDM. We prospectively examined routine leukocyte counts collected at the first prenatal visit in a cohort of 2,753 nulliparous euglycemic women, 98 (3.6%) of whom were later diagnosed with GDM. Subjects were divided into quartiles of leukocyte count, and the results of third-trimester glucose screening tests and the incidence of GDM among these quartiles were compared. Logistic regression was used to calculate univariate and multivariable-adjusted relative risks (RRs) of GDM according to leukocyte quartiles. Leukocyte counts were increased among women who subsequently developed GDM compared with those who remained free of GDM (10.5 +/- 2.2 vs. 9.2 +/- 2.2 x 10(3) cells/ml; P < 0.01). There was a linear increase in postloading mean glucose levels (P for trend <0.01), the area under the glucose tolerance test curves (P for trend <0.01), and the incidence of GDM (quartile 1, 1.1; quartile 2, 2.5; quartile 3, 4.2; and quartile 4, 6.4%; P for trend <0.01) with increasing leukocyte quartiles. In the multivariable-adjusted analysis, the linear trend in the RR of GDM with increasing leukocyte quartiles remained statistically significant (quartile 1, reference; quartile 2, RR 2.3 [95% CI 0.9-5.7]; quartile 3, 3.3 [1.4-7.8]; quartile 4, 4.9 [2.1-11.2]; P for trend <0.01). Increased leukocyte count early in pregnancy is independently and linearly associated with the results of GDM screening tests and the risk of GDM. Although overlap in the leukocyte count distributions precludes it from being a clinically useful biomarker, these data suggest that inflammation is associated with the development of GDM and may be another pathophysiological link between GDM and future type 2 diabetes.