Glucose Tolerance In Pregnancy Research Articles

Study on glucose tolerance in pregnancy as a screening test and diagnostic tool for gestational diabetes mellitus

Introduction: GDM is a common medical problem that results from an increased severity of insulin resistance as well as an impairment of compensatory increase in insulin secretion. GDM is associated with a variety of maternal and fetal complications. Controversy surrounds the ideal approach for detecting GDM, and the approaches recommended for screening and diagnosis are largely based on expert opinion. Material and Method: This study enrolled 51 pregnant women aged between 20 and 39 years old. All women were invited to do fasting and two hours postprandial blood glucose every two weeks, 2 hr. 75g OGTT every trimester. Plasma glucose measurements were performed with glucose oxidase method using semi-automated spectrophotometer (Biosystems 310). Results and Conclusion: Both normal and GDM cases have normal glucose tolerance in early weeks of pregnancy. However, after 24 weeks of gestation progressive increment of hyperglycemia was obviously observed in GDM cases. Suitable cutoffs in diagnosis of GDM in third trimester are 97 mg/dl for fasting; 174 mg/dl for 1 hour; and 141 mg/dl for 2 hour. Sudan Journal of Medical Science Vol. 1 (2) December 2006: 109-114

Postpartum Dietary Changes in Women With Previous Gestational Diabetes Mellitus

ABSTRACT OBJECTIVE Women with gestational diabetes mellitus (GDM) are at high risk of developing type 2 diabetes. This study was conducted to determine whether nutrition education upon diagnosis of GDM resulted in dietary change and whether this change was sustained postpartum. METHODS Women with GDM or impaired glucose tolerance of pregnancy (≤ 32 weeks gestation) (n = 19) were recruited, and 4-day food records were collected pre-dietary intervention, 2 weeks post-dietary intervention, and 6 weeks and 6 months postpartum. Physical activity was assessed, and glucose tolerance and lipid profiles were also determined postpartum. RESULTS After nutrition education there was a significant increase in protein (% kcal), milk and milk products (servings) and dietary fibre (g) intake, as well as meal frequency (number of meals/day). However, these changes were not subsequently sustained throughout the postpartum period. Physical activity levels did not change, and at 6 months postpartum, 26% of subjects had impaired glucose tolerance and 97% had at least 1 abnormal lipid variable. CONCLUSIONS Women with GDM made changes in eating patterns during pregnancy, but these were not maintained postpartum. Further intervention is recommended during the postpartum period for women with GDM to sustain changes made during pregnancy.

Can ultrasound fetal biometry predict fetal hyperinsulinaemia at delivery in pregnancy complicated by maternal diabetes?

Objective The aim of this study was to determine whether there is an association between ultrasound fetal biometry and amniotic fluid insulin levels at delivery in women with pre-existing diabetes or impaired glucose tolerance in pregnancy. Study design This retrospective cohort study identified 93 women who had amniotic fluid insulin levels measured at time of delivery. Standardised estimated fetal weight and fetal growth velocity were calculated from serial third trimester fetal ultrasound measurements. Results Women with pre-existing diabetes had significantly greater mean growth velocity [1.39 (95% CI: 0.43–2.23) versus 0.39 (95% CI: −01.7–0.95); p = 0.04], significantly greater mean estimated fetal weight (EFW) Z score prior to delivery [2.36 (95% CI: 1.82–2.9) versus 1.38 (95% CI: 1.02–1.74); p = 0.002] and greater mean birthweight centile [82 (95% CI: 0.74–0.89) versus 67 (95% CI: 58–76); p = 0.02] than those with GDM/IGT. Amniotic fluid insulin levels demonstrated a similar significant difference between the pre-existing and GDM/IGT groups [20.5 (95% CI: 12.9–28.1) versus 8.5 (95% CI: 5.4–11.7); p = 0.001]. An association between fetal growth and size and amniotic fluid insulin was observed in women with pre-existing diabetes. Positive likelihood ratios were 1.67 and 2.08, respectively, for the prediction of liquor insulin greater than the 95th centile in women with pre-existing diabetes. Conclusion Ultrasound measures of fetal size and growth used in this study are not sufficiently accurate to predict those infants likely to be at risk from the adverse effects of fetal hyperinsulinaemia.

Early Pregnancy Insulin Resistance and Subsequent Gestational Diabetes Mellitus

Gestational diabetes mellitus (GDM), which complicates 3–7% of all pregnancies, is associated with increased maternal and fetal morbidity (1). Identification of early risk markers may result in improved understanding of disease pathogenesis and identification of potential targets for intervention. We sought to determine the association between early pregnancy insulin resistance and subsequent abnormal glucose tolerance in pregnancy. We conducted two institutional review board–approved, prospective, nested, case-control studies within Massachusetts General Hospital’s Obstetrical Maternal Study (MOMS) comparing subjects with GDM and subjects with abnormal glucose loading test (GLT) results but no GDM with control subjects. Consecutive MOMS participants with singleton gestations between February 2002 and February 2004 who provided fasting blood samples between 16–18 weeks’ gestation, underwent GLT testing at 24–28 weeks’ gestation, and delivered after 34 weeks were eligible. To limit confounding by other etiologies of insulin …

Glucose tolerance in pregnancy in South India: relationships to neonatal anthropometry

The incidence of type 2 diabetes is increasing worldwide, most rapidly in developing countries such as India. Exposure as a fetus to maternal gestational diabetes is thought to be a risk factor for developing the disease. This study was set up to determine the incidence of gestational diabetes mellitus in one urban maternity unit in South India and to examine its effect on the offspring's neonatal anthropometry, childhood growth, and glucose/insulin metabolism. This paper reports neonatal outcomes. Seven hundred and eighty five women were recruited consecutively from the antenatal clinic of the Holdsworth Memorial Hospital, Mysore and underwent a 100 g, 3-hr oral glucose tolerance test at 30 +/- 2 weeks gestation. Gestational diabetes was defined using Carpenter and Coustan criteria. The babies were measured in detail at birth. Mean maternal age and body mass index were 23.6 years and 23.1 kg/m(2). The incidence of gestational diabetes was 6.2%. Mothers with gestational diabetes had babies that were heavier (3339 g compared with 2956 g for non-diabetic mothers) and larger in measurements of fat, muscle, and skeleton. Even in non-diabetic pregnancies, neonatal weight, head circumference, and ponderal index were positively related to maternal fasting glucose concentrations (P < or = 0.05 for all). The incidence of gestational diabetes was high in this unselected sample of mothers booking into one urban Indian maternity unit. Community-based studies are required to confirm this. The effect of maternal glucose concentrations on neonatal anthropometry is continuous and extends into the "normal" glycemic range.

Glucose tolerance in pregnancy in South India: relationships to neonatal anthropometry

Glucose tolerance in pregnancy in South India: relationships to neonatal anthropometry

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.

Gestational diabetes: Is there a relationship between leg length and glucose tolerance?

To assess the relationship between leg length and glucose tolerance in pregnancy. The leg length and leg-to-height percentage were prospectively determined on 161 glucose-tolerant women during pregnancy and 61 women with gestational diabetes mellitus (GDM). Women with GDM were a mean of 2.8 cm shorter than women who were glucose tolerant, due entirely to their leg lengths being a mean of 3.2 cm shorter. With respect to the 2-h result on the glucose tolerance test (GTT), there were negative correlations for height (r = -0.161, P = 0.017), leg length (r = -0.266, P < 0.0005), and the leg-to-height percentage (r = -0.294, P < 0.0005). The correlation between the leg-to-height percentage and the 2-h result on the GTT remained significant after adjustment for age (r = -0.252, P < 0.0005) and for age and BMI (r = -0.224, P = 0.001). Women with GDM are shorter than glucose-tolerant women and have a lower leg-to-height percentage. Consideration of short stature as a risk factor for GDM is not valid without taking into account the leg-to-height percentage.

Reduced adiponectin concentration in women with gestational diabetes: a potential factor in progression to type 2 diabetes.

Adiponectin, a novel protein secreted exclusively by adipocytes, has emerged as an important potential mediator of the insulin resistance that is so characteristic of obesity, type 2 diabetes, and atherosclerotic cardiovascular disease (1,2). Consistent with the established inverse relationship between plasma adiponectin concentration and insulin resistance, hypoadiponectinemia has been documented in patients with each of these pathologic conditions (3–7). Moreover, in the Pima Indian population, low baseline adiponectin concentration predicts the subsequent development of insulin resistance (8), whereas conversely, elevated baseline adiponectin levels have been shown to be protective against the future development of type 2 diabetes (9). Taken together, these observations suggest that hypoadiponectinemia may be an important factor in the development of insulin resistance and the pathophysiology of type 2 diabetes. Gestational diabetes mellitus (GDM) identifies a population of young women at high risk of developing type 2 diabetes (10), representing an early stage in the natural history of the disease. Thus, we hypothesized that hypoadiponectinemia may be associated with GDM. The present study investigated the relationship between adiponectin and glucose tolerance in pregnancy. The study design, protocol, and laboratory methods have been fully described previously (11). The study protocol was approved by the research ethics board at Mount Sinai Hospital, and all subjects gave written informed …

Hypoadiponectinaemia in South Asian women during pregnancy: evidence of ethnic variation in adiponectin concentration.

People of South Asian descent face an increased risk of Type 2 diabetes mellitus (DM) and coronary artery disease (CAD) compared with other ethnic groups. One candidate factor underlying this risk may be adiponectin, as circulating levels of this adipocyte-derived protein are reduced in both Type 2 DM and CAD. In a recent study, we assessed the relationship between adiponectin and gestational diabetes (GDM), a potential model of early events in the natural history of Type 2 DM. Here, we report the impact of ethnicity on plasma adiponectin concentration in that study. A cross-sectional study was performed in 180 women undergoing oral glucose tolerance testing in late second or early third trimester to investigate the relationship between adiponectin and glucose tolerance in pregnancy. Based on self-reported ethnicity, participants were stratified into three groups: (i) Caucasian (n = 116), (ii) South Asian (n = 31), and (iii) Asian (n = 28). Median adiponectin concentration was much lower in the South Asian group (9.7 micro g/ml) than in Caucasians (15.8 micro g/ml) or Asians (16.1 micro g/ml) (overall P < 0.0001). With adjustment for age, prepregnancy body mass index, weight gain in pregnancy, previous history of GDM, family history of DM, fasting insulin and glucose intolerance, mean adiponectin remained significantly lower among South Asians compared with either Caucasians (P < 0.0001) or Asians (P = 0.0034). Women of South Asian descent exhibit significantly reduced plasma concentrations of adiponectin in pregnancy compared with Caucasian and Asian counterparts. This observation raises the possibility of hypoadiponectinaemia as a potential factor contributing to the increased risk of diabetes and cardiovascular disease in South Asians.

Treatments for gestational diabetes and impaired glucose tolerance in pregnancy.

Gestational diabetes and impaired glucose tolerance (IGT) in pregnancy affects between 3 and 6% of all pregnancies and both have been associated with pregnancy complications. A lack of conclusive evidence has led clinicians to equate the risk of adverse perinatal outcome with pre-existing diabetes. Consequently, women are often intensively managed with increased obstetric monitoring, dietary regulation, and in some cases insulin therapy. However, there has been no sound evidence base to support intensive treatment. The key issue for clinicians and consumers is whether treatment of gestational diabetes and IGT will improve perinatal outcome. The objective of this review was to compare alternative policies of care for women with gestational diabetes and IGT in pregnancy. We searched the Cochrane Pregnancy and Childbirth Group trials register (12 September 2002) and the bibliographies of relevant papers. The Cochrane Central Register of Controlled Trials was also searched (The Cochrane Library, Issue 3, 2002). Randomised controlled trials comparing alternative management strategies for women with gestational diabetes and IGT in pregnancy. Quality was assessed according to the criteria defined by the Cochrane Reviewers' Handbook. Data were extracted and checked independently by two reviewers. Any disagreements were resolved through discussion with the third reviewer. Three studies with a total of 223 women were included. All three included studies involved women with IGT. No trials reporting treatments for gestational diabetes met the criteria. There are insufficient data for any reliable conclusions about the effect of treatments for IGT on perinatal outcome. The difference in abdominal operative delivery rates is not statistically significant (relative risk (RR) 0.86, 95% confidence interval 0.51 to 1.45) and the effect on special care baby unit admission is also not significant (RR 0.49, 95% confidence interval (CI) 0.19 to 1.24). Reduction in birthweight greater than 90th centile (RR 0.55, 95% CI 0.19 to 1.61) was not found to be significant. This review suggests that an interventionist policy of treatment may be associated with a reduced risk of neonatal hypoglycaemia (RR 0.25, 95% CI 0.07 to 0.86). No other statistically significant differences were detected. A number of outcomes are only reported by one study resulting in a small sample and wide confidence intervals. There are insufficient data for any reliable conclusions about the effects of treatments for impaired glucose tolerance on perinatal outcome.

Gestational diabetes mellitus

The proposed risks from abnormal glucose tolerance in pregnancy are continuous. Gestational diabetes is thus an arbitrary condition. The risks to the fetus are largely determined by fetal size, and those of the mother by the severity of glucose intolerance. Screening policies vary throughout the world, and all have deficiencies. Policies should be determined locally, as population and organizational issues will influence efficacy. Clinicians need to agree diagnostic criteria as minor alterations in these can alter the disease incidence. There is no universal agreement on diagnostic testing. There is no conclusive evidence from randomized trials that therapy alters pregnancy outcome in gestational diabetes. Therapy targeted at those fetuses shown to have evidence of hyperinsulinism may be the best way forward. Follow-up of women with early diagnosis, or who have required insulin during pregnancy is vital to allow prevention strategies against type 2 diabetes.

Protease inhibitors and decreased birth weight in HIV-infected pregnant women with impaired glucose tolerance.

To assess the impact of highly active antiretroviral therapy, including a protease inhibitor (HAART/PI), on maternal glucose tolerance and fetal growth. A retrospective chart review of pregnancy outcomes of human immunodeficiency virus-infected pregnant women receiving HAART/PI (n=41) or zidovudine monotherapy (n=23). Abnormal 1-hour glucose tolerance tests (1hGTT) were observed in 30% of subjects receiving HAART/PI between 24 and 28 weeks' gestation. An elevated 1hGTT was associated with a significantly lower mean birth weight in subjects receiving HAART/PI compared to babies born to mothers with a normal 1hGTT (3.40+/-0.09 vs 3.00+/-0.18 kg, p<0.05, ANOVA). HAART/PI therapy is associated with an increased rate of impaired glucose tolerance in pregnancy and impaired fetal growth. This finding merits further investigation.

Risk factor screening for abnormal glucose tolerance in pregnancy

Objectives: To assess the prevalence and association of frequently used screening risk factors for gestational diabetes mellitus (GDM) and to compare the validity and cost of universal screening with risk factor screening. Method: A cross-sectional survey of 768 pregnant women at ≥24 weeks’ gestation who were attending the antenatal clinic at the Hospital Universiti Kebangsaan Malaysia (HUKM) was made. Risk factors were determined using a questionnaire. An abnormal oral glucose tolerance test was defined as a 2-h post-prandial blood sugar level of ≥7.8 mmol/l. Results: A total of 191 pregnant mothers (24.9%) had GDM. The most commonly identified screening factors were positive family history of diabetes mellitus (31.4%), history of spontaneous abortion (17.8%), vaginal discharge and pruritis vulvae in current pregnancy (16.0%), and maternal age greater than 35 years (14.7%). Five hundred and thirteen mothers (66.8%) had at least one risk factor. All screening risk factors, except past history of diabetes mellitus in previous pregnancy and maternal age, were not significantly associated with abnormal glucose tolerance (GT). Risk factor screening gave a sensitivity of 72.2% and a specificity of 35.0%. Universal screening would cost RM 12.06 while traditional risk factor screening would cost RM 11.15 per identified case and will have missed 53 of the 191 cases. Conclusions: Risk factor screening scored poorly in predicting GDM. Cost analysis of universal compared with traditional risk factor screening showed a negligible difference. Thus universal screening appears to be the most reliable method of diagnosing GDM.

Dietary variables and glucose tolerance in pregnancy.

To investigate relationships between dietary macronutrient intakes and glucose tolerance in pregnancy Nulliparous pregnant Chinese women diagnosed with gestational diabetes mellitus (GDM) (n = 56) were compared to age-, gestational age-, height-, and parity-matched groups with normal glucose tolerance (n = 77) and glucose intolerance (IGT) (n = 38) based on the results of an oral glucose tolerance test (National Diabetes Data Group criteria), performed between 24 and 28 weeks of pregnancy. A 24-h recall dietary assessment was also obtained at the time of screening. Subjects with IGT and GDM were significantly heavier (66.1 +/- 1.4 and 68.6 +/- 1.2 kg, respectively, mean +/- SEM) (P < 0.0001) than the normal group (61.2 +/- 1.8 kg) and had a higher BMI. Overall energy intake was similar between groups, as were the intakes of each macronutrient (%kcal). However, there was a highly significant reduction in polyunsaturated fat intake in the IGT and GDM groups whether expressed as %kcal, % of total fat, or fat kcal. This effect was independent of body weight or BMI whether assessed by ordinal logistic regression or by analysis of a weight- and BMI-matched subgroup of the subjects (P = 0.002 for %kcal; n = 47 normal, 26 IGT, and 43 GDM subjects). In logistic regression analysis of the complete data set, increased body weight (P < 0.0001) and decreased polyunsaturated fat intake (P = 0.0014) were both independent predictors of glucose intolerance (IGT and GDM), as were increased body weight and a low dietary polyunsaturated to saturated fat ratio. Increased polyunsaturated fat intake is associated with a reduced incidence of glucose intolerance during pregnancy. This finding may have major implications for dietary management of women with or at risk of developing GDM.

Placental size and large-for-gestational-age infants in women with abnormal glucose tolerance in pregnancy.

To determine if the placental size is disproportionately increased in the large-for-gestational age infants in pregnancies complicated by impaired glucose tolerance. A retrospective study was performed on 568 consecutive singleton pregnancies complicated by gestational impaired glucose tolerance controlled with diet and who delivered within a 15-month period. The cases were categorized by the infant birthweight percentile into three groups, i.e. small-for-gestational age (< 10th percentile), appropriate-for-gestational age (10th to 90th percentile) and large-for-gestational age (> 90th percentile). Maternal and infant anthropometric data, glycaemic status, and placental weight-to-birthweight ratio were compared among the three groups. The infant body mass index and placental weight showed a significantly increasing trend from the small-for-gestational age to the large-for-gestational age groups, but there was no significant difference in the placental weight-to-birthweight ratio, values of the oral glucose tolerance test, or haemoglobin A1c among the three groups. On the other hand, the maternal body mass index before pregnancy and at delivery were significantly higher in the large-for-gestational age group. The placental weight, but not the ratio, was significantly correlated with the maternal body mass index before pregnancy and at delivery (P < 0.001). The results indicate that the placenta is not disproportionately bigger, and therefore unlikely to be the cause, in large-for-gestational age infants. Maternal size appeared to be the major determinant of birthweight percentile ranking in pregnancies with gestational impaired glucose tolerance.

Effects of a short-term moderate exercise program on glucose tolerance in pregnancy

Effects of a short-term moderate exercise program on glucose tolerance in pregnancy

Incidence of diabetes mellitus in women following impaired glucose tolerance in pregnancy is lower than following impaired glucose tolerance in the non-pregnant state

Impaired glucose tolerance (IGT), which is asymptomatic and requires a glucose tolerance test for detection, is a well-known risk factor for diabetes mellitus. Outside the research setting it is rarely identified in people who lack specific risk factors for diabetes except during pregnancy, at which time screening with an oral glucose challenge is a routine procedure. A 75-g oral glucose tolerance test was performed during the latter part of pregnancy or during a routine epidemiology survey in 15-39-year-old Pima Indian women with no history of abnormal glucose tolerance. Those with IGT by World Health Organization criteria were included in this study. Diabetes incidence in women was compared between those whose IGT was first detected during pregnancy and those who were not pregnant when IGT was first recognized. Seventeen of 73 pregnant women and 114 of 244 non-pregnant women developed diabetes within 10 years. When controlled for plasma glucose concentration, age, body mass index, parity and duration of follow-up, those who were not pregnant were at higher risk of developing diabetes than those who were pregnant (hazard rate ratio = 1.71, 95% confidence interval = 1.01-2.91). Previous studies had reported that women with IGT during pregnancy are at higher risk of diabetes than women with normal glucose tolerance. This study suggests that women with IGT during pregnancy are at lower risk than non-pregnant women with a similar plasma glucose concentration who, in the clinical setting, are likely to remain unrecognized.

WITHDRAWN: 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.

Impaired glucose tolerance in pregnancy--is it of consequence?

This study was done to determine if impaired glucose tolerance in pregnancy was associated with increased maternal and neonatal morbidity and if so, whether the increased morbidity was due to the confounding factors of increased maternal age and maternal obesity. It was a retrospective analysis to compare 944 women with impaired glucose tolerance (IGT) in pregnancy with 10,065 women without abnormal glucose tolerance. The incidence of impaired glucose tolerance in pregnancy was 8.6% in this study. Even when maternal age and obesity were excluded, the IGT group had significantly higher risks of labour induction (relative risk, RR, 1.15); Caesarean section (RR: overall 1.43, elective 1.72, emergency 1.31); Caesarean section for dystocia/no progress (RR 1.60); macrosomia (RR 1.69, 1.76, 1.61 for birth-weight > = 97th, 95th, 90th percentiles respectively) and shoulder dystocia (RR 2.84) when compared to the nondiabetics (NDM). The risks of hypertensive disease (RR 1.22) and Caesarean section for fetal distress/thick meconium-stained liquor (RR 1.53) were also higher in the IGT group but these increases were not statistically significant when maternal age and obesity were excluded. There was no significant difference in the rates of low Apgar scores at 1 and 5 minutes between the 2 groups.