Glycemic Control In Gestational Diabetes Mellitus Research Articles

The Effectiveness of Lifestyle Changes in Glycemic Control among Pregnant Women with Gestational Diabetes Mellitus.

Background and Objectives: Gestational diabetes mellitus (GDM) is a type of diabetes that develops during pregnancy and affects approximately 10% of pregnant women worldwide. Understanding the impact of lifestyle changes on glycemic control in GDM is important for improving maternal and fetal outcomes and reducing the risk of diabetes in both the mother and child. The aim of this study is to evaluate the effectiveness as well as the factors affecting glycemic control by lifestyle changes in pregnant women with GDM. Materials and Methods: A descriptive cross-sectional study was conducted at three hospitals in the Thai Binh Province from June 2021 to May 2022. All pregnant women at 24-28 weeks of gestation, aged 18 years or older, were enrolled. GDM was diagnosed according to the guidelines of the International Association of the Diabetes and Pregnancy Study Groups. Lifestyle changes including diet and physical exercise were carried out for two weeks. The main outcome measured was successful glycemic control according to the 2018 ADA Recommendations for the Management and Treatment of GDM. Results: 1035 women were included and 20.2% diagnosed with GDM. After two weeks of lifestyle change intervention, 82.6% of the pregnant women with GDM had successful glycemic control. Pregnant women aged under 35 years had a 3.2 times higher rate of gestational glycemic control than those older than 35 (aOR = 3.22, p-value = 0.004). Women with a pre-pregnancy BMI of less than 25 had a higher rate of gestational glycemic control than those with a BMI of over 25 (aOR = 10.84, p-value < 0.001). Compared to women who had all three diagnostic criteria for gestational diabetes, those with two diagnostic criteria and one criterion were 3.8 times and 3 times more likely to have successful blood sugar control (aOR = 3.78, p-value = 0.01 and aOR = 3.03, p-value = 0.03, respectively). Conclusion: Lifestyle changes can be an effective measure for achieving glycemic control in women with GDM. Healthcare providers should consider individualized treatment plans based on the specific needs of each patient.

Continuous Glucose Monitoring for the Diagnosis of Gestational Diabetes Mellitus: A Pilot Study.

Background Gestational diabetes mellitus (GDM) is diabetes first diagnosed in pregnancy. GDM, together with its short- and long-term negative outcomes, is increasing in incidence all over the world. The current diagnostic method for GDM, the oral glucose tolerance test (OGTT), is dated and has been reported as inconvenient for women as well as poorly reproducible and reliable. Aims We aimed at assessing the acceptability, feasibility, and accuracy of continuous glucose monitoring (CGM) as a diagnostic test for GDM and explore its correlation with the OGTT and risk factors for GDM. Methods In this prospective cohort study, pregnant women due for or having completed OGTT underwent CGM for seven days, performing daily finger-prick blood glucose levels before completing an acceptability questionnaire. Data on GDM risk factors and CGM variability were analyzed and compared with OGTT results. Results Seventy-three women completed CGM (40 GDM, 33 normal glucose tolerances); 34 concurrently underwent OGTT. CGM was acceptable and generally well-tolerated, with skin irritation/itchiness the only adverse event (11 mild, one severe). CGM and OGTT strongly correlated for fasting glucose values (r = 0.86, p < 0.05) only. Triangulating GDM risk factors, OGTT results and CGM variability parameters with the application of machine learning highlighted the possibility of unmasking false positive (11 showed low CGM variability and demographic risks but positive OGTT) and false-negative OGTT diagnoses (1 showed high CGM variability and demographic risks but negative OGTT). Conclusions CGM was well-tolerated, showing poorer glycaemic control in GDM, and revealing potential misdiagnosis of the OGTT when combined with GDM risk factors. Future research is needed to determine cut-off values for CGM-defined and OGTT-independent screening criteria for GDM.

Effects of Magnesium-Vitamin E Co-supplementation on Glucose Metabolism, Oxidative Stress, and Pregnancy Outcomes Among Women with Gestational Diabetes: A Double-blind Clinical Trial Study

Background &amp; Objective: Dietary antioxidants may play a protective role in the pathophysiology of gestational diabetes mellitus (GDM). The present study aimed to evaluate the effect of magnesium-vitamin E co-supplementation on glycemic control and pregnancy outcomes in women with GDM.&#x0D; Materials &amp; Methods: This randomized clinical trial was conducted among GDM pregnant women at 24-28 weeks of gestation. The study did not include mothers who needed medication to control their blood glucose levels or had a history of DM. The subjects were randomly divided into two 30-member groups, one of which received magnesium (250 mg), and vitamin E (400 mg) daily, while the other was given a placebo. Blood samples were taken at the study baseline and six weeks after the intervention to quantify oxidative stress biomarkers, fasting plasma glucose (FPG), and fasting plasma insulin (FPI). Additionally, the effect of supplementation was assessed on neonatal outcomes. Data analysis was performed using SPSS 20 (SPSS, Chicago, IL).&#x0D; Results: A significant decrease was observed in the FPG and FPI of the supplementation group (p&lt;0.05). However, FPI elevated by progressing pregnancy in the placebo group (p=1.99×10-4). The homeostasis model assessment (HOMA) revealed that supplementation was associated with improved insulin sensitivity (p=3.38×10-13). In addition, total antioxidant capacity increased to 5.66 ± 0.86% in the treatment group. Finally, no significant difference was found between the groups regarding neonatal outcomes.&#x0D; Conclusion: The results represented that magnesium-vitamin E co-supplementation significantly reduced oxidative biomarkers and improved glycemic control in GDM.

Efficacy of Continuous Glucose Monitoring on Glycaemic Control in Pregnant Women with Gestational Diabetes Mellitus-A Systematic Review.

Gestational diabetes mellitus (GDM) is one of the most common complications of pregnancy, affecting up to 14% of pregnant women. The population of patients with risk factors of GDM is increasing; thus, it is essential to improve management of this condition. One of the key factors affecting perinatal outcomes in GDM is glycaemic control. Until recently, glucose monitoring was only available with self-monitoring of blood glucose (SMBG). However, nowadays, there is a new method, continuous glucose monitoring (CGM), which has been shown to be safe in pregnancy. Since proper glycaemia assessment has been shown to affect perinatal outcomes, we decided to perform a systematic review to analyse the role of CGM in glycaemic control in GDM. We conducted a web search of the MEDLINE, EMBASE, Cochrane Library, Scopus, and Web of Science databases according to the PRISMA guidelines. The web search was performed by two independent researchers and resulted in 14 articles included in the systematic review. The study protocol was registered in the PROSPERO database with registration number CRD42021289883. The main outcome of the systematic review was determining that, when compared, CGM played an important role in better glycaemic control than SMBG. Furthermore, glycaemic control with CGM improved qualification for insulin therapy. However, most of the articles did not reveal CGM’s role in improving neonatal outcomes. Therefore, more studies are needed to analyse the role of CGM in affecting perinatal outcomes in GDM.

Clinical usefulness of glycated albumin and glycated albumin-to-glycated hemoglobin ratio of gestational diabetes mellitus in late pregnancy for predicting infant complications

Gestational diabetes mellitus (GDM) with poorly controlled glycemia is associated with poor pregnancy outcomes. However, adequate markers for glycemic control in GDM have not been fully evaluated. We retrospectively studied 77 patients with GDM and their infants. Mean glycated albumin (GA), glycated hemoglobin (HbA1c), and GA/HbA1c in GDM were compared between two groups stratified by the presence or absence of infant complications (complications or non-complications). We assessed the predictability of infant complications in GA, HbA1c, and GA/HbA1c of women with GDM by receiver operating characteristic analysis (ROC). In complications and non-complications, GA and GA/HbA1c were significantly associated with neonatal hypoglycemia (13.9% vs. 13.0%, p<0.001 and 2.49 vs. 2.33, p<0.001, respectively), respiratory disorders (13.7% vs. 13.2%, p=0.013 and 2.48 vs. 2.34, p<0.001, respectively), myocardial hypertrophy (14.5% vs. 13.0%, p<0.001 and 2.59 vs. 2.33, p<0.001, respectively), and large for gestational age (14.5% vs. 13.1%, p<0.001 and 2.58 vs. 2.34, p<0.001, respectively). Compared with each infant complication in ROC, GA and GA/HbA1c had higher area under the curve than HbA1c. Especially, GA and GA/HbA1c had highest AUC in predicting myocardial hypertrophy and large for gestational age (GA; 0.92 and 0.92, GA/HbA1c; 0.91 and 0.86, respectively). Although statistically significant positive correlations were found between GA and GA/HbA1c and the number of infant complications (GA: r=0.417, p<0.001; GA/HbA1c: r=0.408, p<0.001), their correlations were weak. Compared with HbA1c, GA and GA/HbA1c of GDM in late pregnancy might be useful for predicting infant complications arising from GDM.

The effect of probiotics on glycemic control of women with gestational diabetes mellitus-multicenter, randomized, double blind, placebo controlled-trial

Uncontrolled gestational diabetes mellitus (GDM) is associated with severe maternal and neonatal morbidities. Probiotic supplements were shown to modulate the gut microbiome. Promising effects on glycemic control and insulin resistance in non-pregnant diabetic patients were reported. However, the effect of probiotics on glycemic control in GDM has not been elucidated. We aimed to examine the effect of a mixture of probiotic strains given daily on maternal glycemic parameters, and pregnancy outcomes among women with GDM. A multicenter prospective randomized, double blind, placebo controlled trial was conducted at five medical centers between January 2020 and June 2021. Women newly diagnosed with GDM were divided into a research group, receiving 2 capsules of oral probiotic formula containing Bifidobacterium bifidum, Bifidobacterium lactis, Lactobacillus (L) acidophilus, L. paracasei, L. rhamnosus and Streptococcus thermophilus ( >6X109/capsule), and a control group, receiving a placebo (2 capsules/day) until delivery. Glycemic control was evaluated by daily glucose charts. After 2 weeks, pharmacotherapy was started in case of poor glycemic control defined as either mean daily glucose >100 mg/dL or more than 20% abnormal glucose values. The primary outcomes were the rate of women requiring medications for glycemic control and mean daily glucose charts after 2 weeks of treatment with the study products. In order to show a reduction of the need for pharmacotherapy for GDM from 60% to 30%, 84 women were required (5% two tailed alpha, 80% power). This sample size was sufficient to demonstrate a mean difference of 6±10 mg/dL in the mean daily glucose charts after 2 weeks of treatment with the study products. Forty one and 44 women were analyzed in the treatment and placebo cohorts, respectively. Baseline characteristics were comparable between the groups (table 1). There was no difference in glycemic control between the groups (table 2). The oral probiotic product tested in this study did not affect glycemic control of women with GDM.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Intrahepatic cholestasis of pregnancy: Association with glycaemic control in gestational diabetes.

The aim of this study was to determine whether the metabolic glucose profile, based on glycaemic control and insulin requirements, was different in women with gestational diabetes mellitus (GDM) and intrahepatic cholestasis of pregnancy (ICP) compared to women with only GDM. This retrospective cohort study comprised women with GDM and ICP matched with women with only GDM was undertaken at Aarhus University hospital, Denmark, from 2012 to 2019. A total of 46 cases and 184 controls were compared in relation to glycaemic control during pregnancy. Women with GDM and ICP were further divided into subgroups according to the severity of ICP: mild ICP (fasting bile salts 10-39μmol/L) and moderate/severe ICP (bile salts ≥40μmol/L). No statistically significant differences were observed in baseline 2-h oral glucose tolerance test values, second and third trimester HbA1c values, or maximum insulin requirements during pregnancy between women with GDM with and without ICP. Significantly more women with ICP developed preeclampsia during pregnancy: 23.9% (11/46) versus 7.6% (14/184); p=0.003. This study is the first to address the course of pregnancy in women with GDM with and without ICP in a clinical setting. Under the current treatment guidelines, ICP is not associated with clinically significant changes in glycaemic control in GDM. Significantly more women with both GDM and ICP developed preeclampsia.

Food intake in pregnant women with gestational diabetes mellitus

Rationale: The aim of this study was to verify the fulfillment of the nutritional requirements of macronutrients in pregnant women diagnosed with Gestational Diabetes Mellitus (GDM) at Lusíadas Lisboa Hospital. Inadequate glycemic control in GDM increases the risk of maternal, fetal and neonatal consequences. In this sense, nutritional therapy is essential during the follow-up of these pregnant women.

Comparison the efficacy and safety between Insulin and Metformin in gestational diabetes mellitus management

Objective The objective of this study was to evaluate the efficacy and safety between insulin and metformin in the management of gestational diabetes mellitus (GDM). Background GDM is a common complication of pregnancy. Blood glucose control improves perinatal outcomes. Medical nutrition therapy is the milestone management. Patients and methods In a prospective randomized comparative study, 240 antenatal women whose pregnancies had been complicated by GDM and did not respond to diet alone were recruited from antenatal clinics at the Obstetrics Department in Menofia University Hospitals and Shebin El-Kom Teaching Hospital from November 2016 to March 2018. They were divided randomly into two groups; 120 patients in each group were subjected to either insulin or metformin medications. Outcomes were comparing the effects of medications on maternal glycemic control, maternal complications and neonatal outcome. Results There was no significant difference in controlling high blood sugar in GDM with the use of insulin or metformin. Maternal complications in both groups had no significant difference, and fetal outcomes were as well similar. Conclusion Glycemic control in GDM can be achieved by using metformin orally without increasing the risk for maternal complications with a satisfying neonatal outcome.

Serum Fructosamine and Glycosylated Hemoglobin in Monitoring the Glycemic Control in Gestational Diabetes Mellitus

Background: Diabetes mellitus complicates 1%-2% of all pregnancies, and associates with high perinatal morbidity. Gestational diabetes mellitus (GDM) is treatable condition, and women who have adequate glycemic control during pregnancy can effectively decrease the adverse outcomes of GDM. Objectives: This study was designed to compare the serum fructosamine, and the glycosylated hemoglobin (HbA1c), in monitoring the glycemic control in GDM. Patients and Methods: 1516 women with GDM included, and were advised for dietary modification to achieve proper glycemic control. If the target glucose levels were not reached by the diet regimen or by the dietary modification, insulin was prescribed for the studied women. The average values of the pre- and post-prandial glucose levels were calculated, and the insulin doses were adjusted to achieve the target glucose values during the antenatal visits. HbA1c, and fructosamine were measured to assess the glycemic control for the studied women. Results: The fructosamine, and the HbA1c were significantly high in the uncontrolled GDM compared to controlled group, and there was positive significant correlation between fractuosamine, and HbA1c in monitoring the glycemic control in GDM (r = 0.93, and P = 0.001). The Odds ratio (OR), and relative risk (RR) analysis for the current pregnancy outcome showed that the polyhydramnios (OR 3.8; RR 3.7), the cesarean delivery (OR 1.7; RR 1.4), the fetal macrosomia (OR 6.4; RR 6.3), the fetal anomalies (OR 6.5; RR 6.4), and the (IUFD) intrauterine fetal death (OR 8.7; RR 8.6) were significantly high in uncontrolled GDM group. In addition, the (NND) neonatal death (OR 11.6; RR 11.4), the neonatal intensive care unit (NICU) admission (OR 3.1; RR 2.9), the neonatal hyperbilirubinemia (OR 3.7; RR 3.6), the transient tachypnea of the newborn (OR 3.1; RR 2.9), and the neonatal hypoglycemia (OR 3.5; RR 3.4) were significantly high in uncontrolled GDM group. Conclusion: Fructosamine assay is simple, reliable, useful indicator for the glycemic control in GDM over the last 2 - 3 weeks, and poor glycemic control in GDM increases the risk of adverse maternal and neonatal outcomes.

Social Contributors to Glycemic Control in Gestational Diabetes Mellitus.

To evaluate the association of social factors with glycemic control in women with gestational diabetes mellitus (GDM). A survey instrument assessing social support, access to healthy food, cooking and meal preparation, chaotic lifestyle, employer support, and physical and emotional responses to food was developed and administered to women with GDM at maternal-fetal medicine office visits. Validated scales were used to measure social support and life chaos (defined as organization, instability, and the ability to plan and prepare for the future). Glycemic control and pregnancy outcome were ascertained by chart review. Multivariable logistic regression was used to quantify the association of these factors with the primary outcome of satisfactory glycemic control, defined as greater than 70% of blood sugars within goal. We approached 145 women, of whom 111 agreed to participate (76.5%). Seventy-seven percent of patients (86/111) achieved satisfactory glycemic control. Chaotic lifestyle (Confusion, Hubbub and Order Scale score 12.5±2.9 for those with good control, 16.3±3.9 for poor control; odds ratio [OR] 0.71, 95% confidence interval [CI] 0.59-0.85) and receipt of food stamps (11/86 [12.9%] for good control and 10/25 [40%] for poor control; OR 0.22, 95% CI 0.08-0.62) were associated with decreased likelihood of achieving glycemic control. Being married (67/86 [77.9%] for good control and 12/25 [48.0%] for poor control; OR 3.82, 95% CI 1.49-9.74) and regular exercise (49/86 [57.0%] for good control and 5/25 [20.0%] for poor control; OR 5.03, 95% CI 1.72-14.72) increased the likelihood of achieving glycemic control. Transportation time to food stores, home cooking, and social support were not associated with glycemic control or pregnancy outcomes. Social factors are associated with glycemic control in GDM and may be modifiable to improve glucose control.

An expert Personal Health System to monitor patients affected by Gestational Diabetes Mellitus: A feasibility study

PURPOSE: Gestational Diabetes Mellitus (GDM) is a condition affecting 3–4% of pregnant women due to increased resistance to insulin caused by the growth of the fetus. Such a condition disappears just after delivery, but it is an indicator of the insurgence of diabetes type 2 (DT2) later in life: about 40% of the women affected by GDM also develop DT2 [Diabetes Care 25(10) (2002), 1862–1868]. GDM brings several complications during pregnancy to both the mother and the fetus. The aim is to present a personal health system (PHS) for monitoring GDM and to present the results of outpatient monitoring and management by utilizing a PHS for GDM. METHODS: The Personal Health System (PHS) was deployed in a feasibility study, modelled as a single-center, parallel group, open randomized controlled trial conducted in Lausanne University Hospital. Patients (n = 24) were assigned to 2 different groups: standard protocol group (SP) and telemedicine group (TM). SP patients were managed by regular clinic visits. TM patients were managed with our EPHS system. The targeted feasibility outcome was whole trial feasibility, functioning of the PHS and its appropriateness for patient use. RESULTS: Mean age was 32 ± 5 years and patients were pregnant for 29.1 ± 1.9 weeks at study inclusion. Patients came from 16 different countries. The follow-up rate was 100%. Acceptability in the TM-group was high, as 100% were satisfied with the care provided and equally 100% were at ease with the technology. Overall median[IQR] glucose control was 5.4 mmol/l [4.7–6.4] in the TM-group and 5.7 mmol/l [4.9–6.7] in the SP-group (p < 0.001). Four out of 6 daily plasma glucose values were significantly better controlled with telemedicine compared to standard care. CONCLUSION: The feasibility study that was conducted shows that PHSs have a great potential to improve the life of the patient by allowing a better communication of their physiological values to the caregivers. With respect to the particular case of GDM, the study suggests that use of PHS technology may improve glycaemic control in GDM, but to confirm this trend, a main trial is needed.

Thiol/disulfide homeostasis in predicting adverse perinatal outcomes at 24–28 weeks of pregnancy in gestational diabetes

Objective: The main aim of this study was to investigate thiol/disulfide homeostasis at 24–28 weeks of pregnancy and to evaluate whether it is predictive for adverse perinatal outcomes or not in gestational diabetes mellitus (GDM).Methods: A total of 110 pregnant women at 24–28 weeks of pregnancy (74 GDM patients and 36 age- and BMI-matched healthy pregnant women) were enrolled in this prospective case–control study. Thiol/disulfide homeostasis was evaluated with a novel spectrophotometric method to determine if there is an association with adverse perinatal outcomes in GDM, by using logistic regression analysis.Results: GDM patients, with decreased native thiol levels at 24–28 weeks (OR: 4.890, 95% CI: 1.355–5.764, p = 0.015) and with higher pre-pregnancy BMI (OR: 1.280, 95% CI: 1.072–1.528, p = 0.006), were found to be at increased risk of adverse perinatal outcomes in GDM. There were no statistically significant differences in thiol/disulfide homeostasis between diet- and insulin-treated GDM subgroups. Additionally, 1-h and 2-h glucose levels on 100 g OGTT were found to be predictive for the insulin need in achieving good glycemic control in GDM (OR: 1.022, 95% CI: 1.005–1.038, p = 0.010 and OR: 1.019, 95% CI: 1.004–1.035, p = 0.015).Conclusions: GDM patients, with decreased native thiol levels at 24–28 weeks of pregnancy and with higher pre-pregnancy BMI, have an increased risk of possible adverse perinatal outcomes. Also, increased 1-h and 2-h glucose levels on 100 g OGTT can predict the need for insulin treatment for GDM.

Could Metformin Manage Gestational Diabetes Mellitus instead of Insulin?

Gestational diabetes mellitus (GDM) complicates a significant number of pregnancies. Blood glucose control improves perinatal outcomes. Medical nutrition therapy is the foundation in management. Aim of This Study. To evaluate efficacy of metformin in comparison to insulin for managing GDM. Methods. In prospective randomized comparative study, 150 antenatal women whose pregnancies had been complicated by GDM and did not respond to diet alone were recruited from antenatal clinics at Obstetrics Department in Zagazig University Hospitals from November 2012 to December 2014. They were divided randomly into two groups, 75 patients in each, and were subjected to either insulin or metformin medication. Outcomes were comparing the effects of both medications on maternal glycemic control, antenatal complications, and neonatal outcome. Results. No significant difference in controlling high blood sugar in GDM with the use of metformin or insulin (P = 0.95, 0.15). Maternal complications in both groups had no significant difference and fetal outcomes were as well similar except the fact that the hypoglycemia occurred more in insulin group with P value 0.01. Conclusion. Glycaemic control in GDM can be achieved by using metformin orally without increasing risk of maternal hypoglycemia with satisfying neonatal outcome.

Association between glycemic control and birthweight with glycated albumin in Chinese women with gestational diabetes mellitus.

To assess glycated albumin (GA) as a potential glycemic index in managing gestational diabetes mellitus (GDM). Eligible pregnant women were divided into the GDM group with abnormal result on a 75-g oral glucose tolerance test (OGTT) and the control (normal) group. GA measurements, Pearson's correlation analysis, multiple logistic regression and receiver operating characteristic curve analysis were obtained at the follow-up examination of participants in the two groups. A total of 2,118 women were assigned to the GDM group (n=639) and control group (n=1,479). The mean level of serum GA in GDM group was significantly greater than that in the control group at both 24-28 and 36-38weeks of gestation (P<0.05). The area under the receiver operating characteristic curve for GA defining good glycemic control in GDM was 0.874 (95% confidence interval 0.811-0.938). The cut-off point for the GA levels derived from the receiver operating characteristic curve was 11.60%, which had sensitivity and specificity for detecting a poor glycemic status of 75.93% and 86.36%, respectively. The risk of birthweight ≥3,500g and macrosomia increased significantly with GA levels ≥13.00% at 24-28weeks and ≥12.00% at 36-38weeks of gestation. GA might be an appropriate and conveniently measured index that can detect poor glycemic control and predict birthweights in GDM women.

Comparison of Glycated Albumin (GA) and Glycosylated Hemoglobin (A1C) in monitoring glycemic excursions during pregnancy

Objective: To compare GA with A1Cin monitoring glycemic excursions during pregnancy. Research Design and Methods: This study included 30 women with Gestational Diabetes Mellitus (GDM) and an equal number with Normal Glucose Tolerance (NGT). GDM were followed up every 2 weeks till 36 - 37 weeks and NGT were reviewed monthly once. Fasting Plasma Glucose (FPG), Postprandial Plasma Glucose (PPG), Ferritin, GA and A1Cwere estimated. GDM were advised Medical Nutritional Therapy (MNT). Target glycemic control was FPG ~ 5 mmol/L and 2 hr PPG ~ 6.6 mmol/L. Non-responders to MNT were administered insulin. Results: In GDM, mean FPG was 5.16 ± 0.55 mmol/L in the first visit and 4.73 ± 0.52 mmol/L in the last visit. The PPG at first visit was 7.07 ± 1.51 mmol/L and 6.16 ± 0.70 mmol/L in the last visit. The mean GA was 12.48% ± 0.8%, 12.51% ± 0.9%, 12.40% ± 1.0%, 12.30% ± 0.86% and 12.38% ± 0.87% at the first, second, third, fourth and fifth visit respectively. The mean A1Cat first, third and fifth visits was 5.16% ± 0.35%, 5.24% ± 0.29% and 5.21% ± 0.28% respectively. In NGT women, mean FPG at first visit was 4.37 ± 0.37 mmol/L and 4.39 ± 0.43 mmol/L in the last visit. The mean PPG was 5.95 ± 1.01 mmol/L in the first visit and 5.75 ± 1.61 mmol/L in the last visit. The mean GA was 12.17% ± 0.85% in first visit and 12.10% ± 0.77% in the last visit. A1Cwas 4.84% ± 0.31% and 4.91% ± 0.33% in the first and last visit respectively. Conclusions: Glycemic control was observed earlier with GA than A1C. GA is a better indicator of recent past short-term glycemic control in GDM.

Serum 25‐hydroxyvitamin D and glycated haemoglobin levels in women with gestational diabetes mellitus

To test the hypothesis that lower 25-hydroxyvitamin D (25[OH]D) levels in late pregnancy are associated with poorer glucose control in gestational diabetes mellitus (GDM). Retrospective cross-sectional study, in a GDM clinic at a tertiary referral centre. Women attending the GDM clinic at Westmead Hospital from 1 February 2007 to 1 February 2008, excluding those with prepregnancy glucose intolerance. Levels of glycated haemoglobin (HbA(1c)) and 25(OH)D measured during the third trimester; maternal age, ethnicity, body mass index (BMI) and occupational status; and results of oral glucose tolerance testing (OGTT). 147 women with a mean gestational age of 35 ± 2 weeks were included, of whom 41% had insufficient or deficient levels of 25(OH)D (≤ 50 nmol/L). Ethnicity, occupational status and season significantly influenced 25(OH)D levels (P < 0.01 for all) but BMI did not. 25(OH)D levels were inversely associated with fasting and 2-hour blood glucose levels during OGTT (Spearman r = - 0.16; P = 0.05 for both) and with log[HbA(1c)] (Spearman r = - 0.32; P < 0.001). BMI and insulin doses were also associated with HbA(1c) levels. Multivariable analysis identified 25(OH)D and blood glucose levels during the OGTT as independent predictors of HbA(1c) levels. Lower 25(OH)D levels are independently associated with poorer glycaemic control. Future randomised trials are needed to determine whether vitamin D plays a role in glycaemic control in GDM. Regardless, maternal vitamin D insufficiency has adverse effects including neonatal hypocalcaemia and rickets. The 41% prevalence of inadequate 25(OH)D levels in the women in our study is unacceptably high. We propose routine 25(OH)D testing of all pregnant women at screening for GDM or earlier, and treatment of women who are found to be deficient.