Higher Rates Of Gestational Diabetes Research Articles

Pregnancy outcome in patients with non-alcoholic fatty liver disease: a prospective cohort study.

The purpose of this investigation was to examine the potential association between non-alcoholic fatty liver disease (NAFLD) and adverse maternal and perinatal outcomes during pregnancy. Gaining insights into the effect of NAFLD on pregnancy outcomes is essential to ensure the health and well-being of mothers and infants. This prospective cohort study was conducted at Imam Khomeini and Razi hospitals of Ahvaz City in 2022. Totally, 180 pregnant women in the NAFLD group to 180 in the control group. In this study, a researcher-made checklist was used to collect the background information, medical history, and lab data during their initial visit using. Follow-up continued until one week after delivery, with pregnancy outcomes assessed. Statistical analysis used student's t-test and the Chi-Square test for group comparisons. Significant differences were observed between the NAFLD, and control groups in terms of age (P=0.003), BMI (P=0.016), ALT and AST measures (P<0.001), and hypertensive complications (P=0.044). The NAFLD group had higher rates of gestational diabetes (P<0.001) and gestational hypertension (P=0.003). However, no significant differences were found in gestational age at delivery, early postpartum hemorrhage rates, birth weight, and neonatal Apgar scores (P>0.05). The pregnant women with NAFLD may be at risk for various complications during pregnancy, including a higher prevalence of gestational diabetes, elevated liver enzymes, and higher blood pressure compared to healthy pregnant women. However, the research failed to identify any statistically significant disparities between infants born to mothers with NAFLD and those delivered to healthy mothers in relation to birth weight, Apgar scores, or neonatal mortality.

Association of PCOS with offspring morbidity: a longitudinal cohort study.

Do children whose mothers have polycystic ovary syndrome (PCOS) have an increased risk of morbidity? Maternal PCOS is associated with an increased risk of infection, allergy and other childhood morbidity. PCOS is associated with higher rates of gestational diabetes, pre-eclampsia and preterm delivery, but the long-term impact on child health is poorly understood. We conducted a retrospective longitudinal cohort study of 1 038 375 children in Quebec between 2006 and 2020. We included 7160 children whose mothers had PCOS and 1 031 215 unexposed children. Outcomes included child hospitalization for infectious, allergic, malignant and other diseases before 13 years of age. We estimated hazard ratios (HRs) and 95% CI for the association of PCOS with childhood morbidity in adjusted Cox proportional hazards regression models. Children exposed to PCOS were hospitalized at a rate of 68.9 (95% CI 66.2-71.8) per 1000 person-years, whereas unexposed children were hospitalized at a rate of 45.3 (95% CI 45.1-45.5) per 1000 person-years. Compared with no exposure, maternal PCOS was associated with 1.32 times the risk of any childhood hospitalization (95% CI 1.26-1.40), 1.31 times the risk of infectious disease hospitalization (95% CI 1.25-1.38) and 1.47 times the risk of allergy-related hospitalization (95% CI 1.31-1.66). Risk of hospitalization was also elevated for childhood metabolic (HR 1.59, 95% CI 1.16-2.18), gastrointestinal (HR 1.72, 95% CI 1.53-1.92), central nervous system (HR 1.74, 95% CI 1.46-2.07) and otologic disorders (HR 1.34, 95% CI 1.26-1.43). Subgroup analyses suggested that there was little difference in the association of PCOS with hospitalization among boys (HR 1.31, 95% CI 1.24-1.39) and girls (HR 1.34, 95% CI 1.26-1.43). We analyzed severe childhood morbidity requiring hospitalization, not mild diseases treated in ambulatory clinics. We lacked data on ethnicity, education and physical activity, and cannot rule out residual confounding. Our findings suggest that maternal PCOS is associated with an increased risk of childhood morbidity. This study was supported by grant PJT-162300 from the Canadian Institutes of Health Research. N.A. acknowledges a career award from the Fonds de recherche du Québec-Santé (296785). The authors declare no competing interests. N/A.

Gestational Hyperglycemia, its implications and values

Background: In Pakistan, high rates of gestational diabetes among pregnant women are associated with high rates of infant and mother death. The importance of government and business sector research on GDM management cannot be overstated. T Method: From March 2018 to January 2020, a total of 50 Private and Public hospitals of Punjab were studied in a prospective manner.1500 pregnant women were checked throughout pregnancy Results: Study showed that GDM was discovered in 96 pregnant women. OGTT was performed more frequently in private hospitals than in public hospitals, and pregnant women were tested more frequently in public hospitals than in private hospitals. GDM management necessitates the use of more than just a community health center. Conclusion: There the government should make it a priority to aggressively involve public health facilities in the care of gestational diabetes in pregnant mothers. Keywords: Gestational Diabetes Mellitus, Management, Diabetes Mellitus

767 Cesarean wound outcomes among super obese women

To evaluate the difference in wound outcomes among super obese (BMI >50 kg/m2) and obese (BMI 30-49.9 kg/m2) women undergoing cesarean delivery. This is a secondary analysis of a single site randomized clinical trial of women who underwent cesarean delivery between September 2013 and June 2016. Participants in the original study were randomized to a silver nylon dressing versus standard gauze dressing. Inclusion criteria included completion of > 36 gestational weeks, receipt of preoperative antibiotics, and scheduled or unscheduled cesarean delivery via Pfannenstiel incision. In this secondary analysis, patient characteristic of women with BMI >50 kg/m2 were compared to women with BMI 30-49.9 kg/m2 using chi-square, Students T-test, and logistic regression to generate adjusted odds ratios and 95% confidence intervals. P-value < 0.5 was considered significant. Among the 657 participants who underwent randomization, 470 were noted to have BMI >30 kg/m2. Within this cohort of obese women, 50 (10.6%) had a BMI >50 kg/m2. Sociodemographic data was similar among the groups. Women in the obese and super obese groups were similar with regard to labor prior to cesarean (30.8% vs 38.8%, p=0.255), smoking status in pregnancy (6.2% vs 0%, p=0.18), chorioamnionitis (3.3% vs 6.0%, p=0.34), and diabetes type 1 (2.1% vs 2.0%, p=0.947). Compared to women BMI 30-49.9 kg/m2, super obese women had higher rates of gestational diabetes (22% vs 8.1%, p< 0.001), diabetes type 2 (14% vs 5%, p=0.011), chronic hypertension (52% vs 15.7%, p< 0.001), and prior cesarean delivery (26.5% vs 12.6%, p=0.008). Women in the super obese category were more likely to have any wound infection (aOR 2.95 [1.14-7.62]). Composite outcome for wound complication was not statistically significantly increased for the super obese cohort (aOR 1.7 [0.73-4.09]). History of prior cesarean delivery was independently associated with increased risk of wound infection. Women with BMI > 50 kg/m2 undergoing cesarean delivery were more likely to have a wound infection compared to obese counterparts.

Maternal and perinatal outcomes of peruvian pregnant women in Chile: exploring the healthy immigrant effect.

To compare maternal and perinatal outcomes between Chilean and Peruvian pregnant women in Santiago, Chile, between January and July 2017. Analytical cross-sectional study of 1,578 Chilean and 318 Peruvian women who attended a clinical hospital in Santiago. We conducted a comparative analysis of maternal and perinatal variables by nationality. Crude and adjusted logistic models were carried out with a 95% confidence interval (95% CI). Peruvian pregnant women resided an average of 5.7 years in Chile, were older (28.1 ± 6.5 vs. 26.6 ± 6.5 years), had less unemployment (52.3% vs. 60.6%), were more likely to enter prenatal care (PC) late (OR: 2.17, 95% CI: 1.69-2.78) and had higher probability of having anemia (OR: 3.45, 95% CI: 2.13-5.56) associated with late entry to PC (adjusted OR: 0.43, 95% CI: 0.33-0.56). On the other hand, Chilean pregnant women were more likely to be obese upon entry to PC (OR: 2.48, 95% CI: 1.81-3.41) and at the time of delivery (OR: 2.03, 95% CI: 1.57-2.62). In addition, Chilean women had higher rates of gestational diabetes (GD) (OR: 2.12, 95% CI: 1.24-3.61), premature delivery (OR: 2.82, 95% CI: 1.59-5.01) and low birth weight (LBW) (OR: 3.10, 95% CI: 1.51-6.33). In the adjusted model, obesity was independently associated with GD (adjusted OR: 3.8, 95% CI: 2.44-6.18) and LBW (adjusted OR: 3.34, 95% CI: 2.33-4.85). The healthy immigrant effect was observed in pregnant Peruvian immigrants, mainly regarding the perinatal outcomes. It is necessary to promote early access to prenatal care and to stablish measures to prevent anemia and obesity, in order to avoid adverse maternal and perinatal outcomes in the studied population.

1365-P: Type 2 Diabetes after Gestational Diabetes, a High-Risk Population

Aboriginal and Torres Strait Islander women have high rates of gestational diabetes (GDM). The Pregnancy And Neonatal Diabetes Outcomes in Remote Australia (PANDORA) study is a prospective longitudinal cohort of women with type 2 diabetes (T2D), GDM or normoglycemia in pregnancy in the Northern Territory, Australia. In this analysis we report progression to prediabetes and T2D at 2.5 years [range 2.1, 3] postpartum in a subgroup of Aboriginal and Europid women with GDM and normoglycemia in pregnancy (n=337). Women with pre-existing T2D were excluded. Data were analysed using Fisher’s exact tests. Among Aboriginal women with GDM we assessed predictions for progression using multivariate logistic regression. Aboriginal women with GDM (n=111) were younger than Europid women with GDM (n=104) (29 years (SD 5.9) vs. 32 (5.6) p&amp;lt;0.01), with similar first trimester BMI (28.9 kg/m2 (SD 7.2) vs. 28.5 (6.7) p=0.64). Of Aboriginal women with GDM, 24 (22%) progressed to T2D and 12 (11%) to prediabetes. Of Aboriginal women with normoglycemia (n=60), 1 (2%) progressed to T2D and 1 (2%) to prediabetes (p&amp;lt;0.01 for combined outcome vs. GDM women). Of Europid women with GDM, none progressed to T2D and 4 (4%) to prediabetes and of those with normoglycemia (n=62) none progressed to diabetes or prediabetes (p=0.09 vs. GDM women). Among Aboriginal women with GDM, factors associated with postpartum diabetes or prediabetes were age (OR 1.11, 1.03-1.2) and, after adjusting for age: severity of GDM (higher fasting plasma glucose (per 1 mmol/L OR 2.11, 1.23-3.62), use of insulin (OR 3.20, 1.35-7.6)) and higher first trimester BMI (per 3 kg/m2 OR 1.22, 1.01-1.47). Not smoking was protective (OR 0.35, 0.14-0.90), although any breastfeeding at 6-months postpartum was not (OR 0.95, 0.36-2.47). To our knowledge this is the only prospective study of Aboriginal and Torres Strait Islander women with GDM. We report the highest rates in the world of T2D after GDM at 2.5 years postpartum, highlighting a need for targeted interventions in this high-risk population. Disclosure A. Wood: None. J. Boyle: None. F. Barzi: None. E.L. Barr: None. M.J.I. Hare: None. A. Titmuss: None. E. Death: None. M. Kirkwood: None. A. Simmonds: None. E.M. Moore: None. J. Oats: None. D. McIntyre: Other Relationship; Self; Novo Nordisk A/S. P.Z. Zimmet: None. A.D. Brown: None. J.E. Shaw: Advisory Panel; Self; AstraZeneca, Merck Sharp &amp; Dohme Corp., Mylan, Sanofi. Research Support; Self; AstraZeneca. Speaker’s Bureau; Self; Eli Lilly and Company, Mylan. L.J. Maple-Brown: None.

The pre-gestational triglycerides and high-density lipoprotein cholesterol ratio is associated with adverse perinatal outcomes: A retrospective cohort analysis.

To investigate associations between pre-gestational dyslipidemia, expressed as the ratio between triglycerides (TG) and high-density lipoprotein cholesterol (HDL), and adverse maternal and neonatal outcomes. A retrospective cohort analysis included women with TG and HDL measurements available up to 52weeks before conception who delivered a singleton, non-anomalous infant. The study population was stratified according to a TG/HDL ratio cutoff of 3. Primary maternal outcomes included gestational diabetes or hypertensive disorders of pregnancy and neonatal outcomes after delivery before 37weeks. Among 5226 women included, 4446 (85.1%) had TG/HDL <3 and 780 (14.9%) ≥3. TG/HDL ratio ≥3 vs <3 was associated with higher rates of gestational diabetes (13.1% vs 5.2%, P<0.0001) and hypertensive disorders of pregnancy (5.3% vs 2.2%, P<0.0001). Larger babies (3229.7±520.7g vs 3181.7±504.4g, P=0.015) with higher birth weight percentile (59.0±26.4 vs 55.1±26.6, P<0.0001) and increased rates of large-for-gestational-age (14.5% vs 10.8%, P=0.007) and macrosomia (5.6% vs 3.9%, P=0.026) were found. In multivariate analysis, TG/HDL ≥3 remained an independent risk-factor for gestational diabetes (adjusted odds ratio [aOR] 1.56, 95% confidence interval [CI] 1.02-2.39) and pre-eclampsia (aOR 3.02, 95% CI 1.82-5.01). An increase in adverse pregnancy outcomes was reported, mainly gestational diabetes and pre-eclampsia, when TG/HDL ratio up to 1year before pregnancy was ≥3.

Risk Factors for Preoperative Developmental Delay in Patients with Nonsyndromic Sagittal Craniosynostosis.

Some patients with isolated sagittal craniosynostosis have demonstrated mild neurodevelopmental delays. This study examined potential preoperative risk factors for developmental delay. Patients completed preoperative Bayley Scales of Infant and Toddler Development, Third Edition, and medical records were reviewed. Multivariate analyses of covariance and correlations were calculated. Participants (n = 77) were predominantly male (77.9 percent) and were aged 2 to 12 months (mean, 5.1 ± 2.3 months). Patients were classified with no delays [n = 63 (82 percent)] or delays [n = 14 (18 percent)] in one or more developmental area(s). There were no group sociodemographic differences. Prenatally, patients with delays versus no delays had lower mean gestational age in weeks (36.9 ± 2.8 weeks versus 39.1 ± 1.7 weeks; p = 0.001) with higher rates of gestational diabetes (36 percent versus 5 percent; p = 0.006) and premature rupture of membranes (14 percent versus 2 percent; p = 0.026). At birth, patients with delays had lower mean birth weight (2982 ± 714 g versus 3374 ± 544 g; p = 0.053), higher rates of respiratory distress (29 percent versus 5 percent; p = 0.005), additional medical diagnoses (57 percent versus 13 percent; p = 0.001), and longer mean neonatal intensive care unit stays (1.4 ± 1.8 weeks versus 0.2 ± 0.9 week; p = 0.002). Variables differing by group had moderate correlations. Patients with nonsyndromic sagittal craniosynostosis that had delays in development had lower gestational age and birth weight, with more prenatal and birth complications. These factors can help identify patients who might be at risk for delay and need close monitoring. Risk, III.

2392 - Multimodal Accessibility and Maternal-Infant Health across the Urban Rural Continuum in Southwest Michigan

Background Kalamazoo County, Michigan is an urban-rural county with high rates of gestational diabetes among expectant mothers and high disparities in the quality of birth outcomes among its population segments. Analysis of health outcomes in the county has primarily focused on densely populated areas of low socioeconomic status. However, the county has a clear urban to rural continuum. Because women without appropriate access to healthcare during particular stages of pregnancy have poorer outcomes than women with regular access to care, this paper examines the disparities in transportation network accessibility by public transit and private vehicle across the urban-rural continuum. Multimodal accessibility estimates were analyzed especially for individuals relying on Medicaid for perinatal health care from 2012–2014. Methods Reported, confirmed cases gestational diabetes, low birthweight infants and premature births for Kalamazoo County, were retrieved from 2012-14 Michigan birth records. For each case, the dataset includes mother's home address, Medicaid status, race, ethnicity, and an estimate of prenatal care. Batch geocoding was supplemented with extensive manual placement, resulting in an overall address match accuracy of over 90% of cases. Open Trip Planner and Google Maps JavaScript API were used to estimate travel time from census block centroids to pedicatric, obstetric, gynocological and emergency health services by both public vehicle and private transit. Results Individuals in the urban core had the highest multimodal accessibility, because of general proximity to the one central public transit hub. While hospitals are centrally accessible, and all pediatricians, 92 percent of OBGYNs, and 88 percent of family medical locations are transit accessible only 53 percent of pregnant women did not live within 400 m of the bus line. A travel time matrix for this data will be presented at the conference. Several specific areas of concern were identified, such as areas outside the urban core, along a rural continuum which is punctuated by low socioeconomic enclaves of high density, low-income housing (trailer parks). Analysis of Medicaid status and maternal health issues is ongoing. Conclusions Accessibility maps at the census block level have been distributed to community stakeholders. Further analysis of rural health in trailer park communities is imperative. This study has implications for Kalamazoo County health, but also the health of other urban-rural counties across the country with similar vulnerable populations.

Increased Perinatal Morbidity and Mortality Among Asian American and Pacific Islander Women in the United States

(Anesth Analg. 2017;124(3):879–886) Small studies have suggested that there is a difference in obstetric maternal morbidities between Asian American/Pacific Islanders (AAPIs) and Caucasian women, including higher rates of gestational diabetes, peripartum hemorrhage, perineal lacerations, and infections. However, no large nationwide epidemiologic study regarding this issue exists. Therefore, the authors of the present study analyzed data from the National Inpatient Sample (NIS) and compared comorbidities, severe maternal conditions, peripartum complications, and mortality between AAPI and Caucasian women.

Glucose tolerance in singleton, twin and triplet pregnancies.

Data regarding the effects of multifetal pregnancy on the incidence of gestational diabetes mellitus (GDM) are inconsistent and even conflicting. Twin pregnancies have been associated with no increase, a marginal increase or a higher incidence of gestational diabetes. In triplet pregnancies, these effects have not been investigated yet. To analyze the results of the glucose challenge and tolerance tests in singleton, twin and triplet pregnancies. A retrospective database analysis of pregnant women with singletons, twins or triplets who had complete results of the 50 g glucose challenge test (GCT) and the 100 g oral glucose tolerance test (OGTT). The cohort included 12,382 singletons, 515 twins and 39 triplets. There were significantly higher rates of abnormal GCTs in twins and triplets compared to singletons (45.4% and 33.3%, respectively vs. 13.7%, P<0.001 and P<0.05). Significantly higher rates of gestational diabetes in twins (10.1% vs. 2.9 %, P<0.001) and triplets (12.8% vs. 2.9%, P<0.05) compared to singletons were observed. Mean glucose levels after the GCT were higher in twins compared to singletons, and even more in triplets (108 mg/dL in singletons vs. 120 mg/dL in twins vs. 129 mg/dL in triplets, P<0.001). Glucose intolerance is aggravated in multifetal pregnancies. The likelihood of an abnormal GCT and gestational diabetes is higher in twins and triplets compared to singletons.

310 Predictors of Preoperative Developmental Delay in Nonsyndromic Sagittal Craniosynostosis

Patients with nonsyndromic sagittal craniosynostosis (SC) were previously thought to have normal neurocognitive development; however, a pattern of mild delays has been described in these patients. We reviewed our patients with SC to identify potential perinatal risk factors that serve as indicators for subsequent developmental delay.Nonsyndromic patients with SC (n = 66) completed preoperative Bayley Scales of Infant and Toddler Development (III) with a single examiner between August 2009 and April 2015. Patients were classified as having no delays (n = 52; 79%) or having delays (n = 14; 21%) below the ninth percentile in one or more area(s) of development. Mean differences were compared using Multivariate Analyses of Variance.Participants were mostly male (79%) and aged 2 to 12 months at testing. There were no group differences in sociodemographic categories. Prenatally, patients in the group with delays vs the group with no delays had lower gestational age in weeks (36.9 vs 39.2, P <.000) with higher rates of gestational diabetes (36% vs 6%, P =.002) and premature rupture of membranes (14% vs 0%, P =.006). There were no group differences in maternal hypertension, maternal age, breech position, preterm labor, emergency cesarean delivery, or failure to progress. At birth, patients with delays had lower birth weight in grams (2982 vs 3359, P =.041), higher rates of respiratory distress (29% vs 4%, P =.005), additional medical diagnoses (57% vs 15%, P =.001), and longer NICU stays in weeks (1.6 vs 0.2, P =.001). There were no differences for infection, hyperbilirubinemia, age at SC diagnosis, or subsequent surgery age.Patients with SC with delays in development had a lower gestational age and birth weight with more prenatal and birth complications. Further studies are required to validate appropriate follow-up and genetic testing in these groups.

The relationship between early life modifiable risk factors for childhood obesity, ethnicity and body mass index at age 3years: findings from the Born in Bradford birth cohort study.

BackgroundMany modifiable risk factors in early infancy have been shown to be associated with childhood overweight and obesity. These risk factors have not been studied within children of South Asian origin in the UK. The aims of this paper are to describe differences in the prevalence of modifiable risk factors for childhood obesity between children of White British and Pakistani origin and investigate the association between these risk factors and childhood BMI measured at age 3 years. We used data from a sub-study of the Born in Bradford birth cohort with detailed follow-up visits throughout early childhood. 987 participants with a BMI measurement at age 3 were included; 39% were White British, 48% were of Pakistani origin and 13% were of other ethnicities. Linear and Poisson regression models were used to assess the association between risk factors and two outcomes at age 3; BMI z-scores and child overweight.ResultsCompared to Pakistani mothers, White British mothers were more likely to smoke during pregnancy, have higher BMI, breastfeed for a shorter duration and wean earlier, while Pakistani mothers had higher rates of gestational diabetes and were less active. There was no strong evidence that the relationship between risk factors and BMI z-score differed by ethnicity. There were associations between BMI z-score and maternal smoking (mean difference in BMI z-score 0.33 (95% CI 0.13, 0.53)), maternal obesity (0.37 (0.19, 0.55)), indulgent feeding style (0.15 (−0.06, 0.36)), lower parental warmth scores (0.21 (0.05, 0.36)) and higher parental hostility scores (0.17 (0.01, 0.33)). Consistent associations between these risk factors and child overweight were found. Mean BMI and the relative risk of being overweight were lower in children of mothers with lower parental self-efficacy scores and who watched more hours of TV. Other risk factors (gestational diabetes, child diet, child sleep, child TV viewing and maternal physical activity) were not associated with BMI.ConclusionsWhilst the prevalence of risk factors that have been associated with childhood greater BMI differ between White British and Pakistani the magnitude of their associations with BMI are similar in the two groups.Electronic supplementary materialThe online version of this article (doi:10.1186/s40608-015-0037-5) contains supplementary material, which is available to authorized users.

Intrahepatic Cholestasis of Pregnancy and Associated Adverse Pregnancy and Fetal Outcomes

Objective To determine the risk for adverse pregnancy and fetal outcomes in intrahepatic cholestasis of pregnancy (ICP). Design Population-based cohort study. Setting Swedish Medical Birth Register (MBR) 1997–2009. Population A total of 1 213 668 singleton deliveries. Methods Linkage of Hospital Discharge Register for exposure (ICP; n = 5477) with MBR for covariates. Main outcome measures Gestational diabetes, pre-eclampsia, prematurity, and stillbirth. Results Intrahepatic cholestasis (ICP) was diagnosed in 0.32–0.58% of all pregnancies, with an increasing trend until 2005 (P < 0.0001). Compared with women who did not have ICP, women with ICP were more likely to have gestational diabetes (adjusted odds ratio, aOR, 2.81; 95% CI 2.32–3.41) and pre-eclampsia (aOR 2.62, 95% CI 2.32–2.78). Women with ICP were also more likely to have spontaneous (aOR 1.60, 95% CI 1.47–1.93) and iatrogenic (aOR 5.95, 95% CI 5.23–6.60) preterm delivery, with increased rates of induction of labour (aOR 11.76, 95% CI 11.04–11.62). However, this actively managed cohort of ICP cases was not at increased risk of stillbirth (aOR 0.92, 95% CI 0.52–1.62). Infants in ICP deliveries were more likely to have a low (<7) 5-minute Apgar score (aOR 1.45, 95% CI 1.14–1.85) and be large for gestational age at birth (aOR 2.27, 95% CI 2.02–2.55). Conclusions Over time, a greater proportion of Swedish pregnant women have received a diagnosis of ICP, probably because of an increased awareness of the disorder. Our data confirm an increased risk of preterm delivery, but not of stillbirth, in actively managed ICP. The high rates of gestational diabetes and pre-eclampsia are new findings, and need to be considered in the management of ICP pregnancies.

Intrahepatic cholestasis of pregnancy and associated adverse pregnancy and fetal outcomes: a 12‐year population‐based cohort study

To determine the risk for adverse pregnancy and fetal outcomes in intrahepatic cholestasis of pregnancy (ICP). Population-based cohort study. Swedish Medical Birth Register (MBR) 1997-2009. A total of 1,213,668 singleton deliveries. Linkage of Hospital Discharge Register for exposure (ICP; n=5,477) with MBR for covariates. Gestational diabetes, pre-eclampsia, prematurity, and stillbirth. Intrahepatic cholestasis (ICP) was diagnosed in 0.32-0.58% of all pregnancies, with an increasing trend until 2005 (P<0.0001). Compared with women who did not have ICP, women with ICP were more likely to have gestational diabetes (adjusted odds ratio, aOR, 2.81; 95% CI 2.32-3.41) and pre-eclampsia (aOR 2.62, 95% CI 2.32-2.78). Women with ICP were also more likely to have spontaneous (aOR 1.60, 95% CI 1.47-1.93) and iatrogenic (aOR 5.95, 95% CI 5.23-6.60) preterm delivery, with increased rates of induction of labour (aOR 11.76, 95% CI 11.04-11.62). However, this actively managed cohort of ICP cases was not at increased risk of stillbirth (aOR 0.92, 95% CI 0.52-1.62). Infants in ICP deliveries were more likely to have a low (<7) 5-minute Apgar score (aOR 1.45, 95% CI 1.14-1.85) and be large for gestational age at birth (aOR 2.27, 95% CI 2.02-2.55). Over time, a greater proportion of Swedish pregnant women have received a diagnosis of ICP, probably because of an increased awareness of the disorder. Our data confirm an increased risk of preterm delivery, but not of stillbirth, in actively managed ICP. The high rates of gestational diabetes and pre-eclampsia are new findings, and need to be considered in the management of ICP pregnancies.

The effect of 17-alpha hydroxyprogesterone caproate on the risk of gestational diabetes in singleton or twin pregnancies

To compare the rates of gestational diabetes among women who received serial doses of 17-alpha hydroxyprogesterone caproate vs placebo. Secondary analysis of 2 double-blind randomized placebo-controlled trials of 17-alpha hydroxyprogesterone caproate given to women at risk for preterm delivery. The incidence of gestational diabetes was compared between women who received 17-alpha hydroxyprogesterone caproate or placebo. We included 1094 women; 441 had singleton and 653 had twin gestations. Combining the 2 studies, 616 received 17-alpha hydroxyprogesterone caproate and 478 received placebo. Among singleton and twin pregnancies, rates of gestational diabetes were similar in women receiving 17-alpha hydroxyprogesterone caproate vs placebo (5.8% vs 4.7%; P = .64 and 7.4% vs 7.6%; P = .94, respectively). In the multivariable model, progesterone was not associated with gestational diabetes (adjusted odds ratio, 1.04; 95% confidence interval, 0.62-1.73). Weekly administration of 17-alpha hydroxyprogesterone caproate is not associated with higher rates of gestational diabetes in either singleton or twin pregnancies.

Are babies getting bigger? An analysis of birthweight trends in New South Wales, 1990–2005

To determine whether the proportion of babies born large for gestational age (LGA) in New South Wales has increased, and to identify possible reasons for any increase. Population-based study using data obtained from the NSW Midwives Data Collection, a legislated surveillance system of all births in NSW. All 1 273 924 live-born singletons delivered at term (> or = 37 complete weeks' gestation) in NSW from 1990 to 2005. LGA, defined as > 90th centile for sex and gestational age using 1991-1994 Australian centile charts; maternal factors associated with LGA were assessed using logistic regression. The proportion of babies born LGA increased from 9.2% to 10.8% (18% increase) for male infants and from 9.1% to 11.0% (21% increase) for female infants. The mean birthweight increased by 23 g for boys and 25 g for girls over the study period. Increasing maternal age, higher rates of gestational diabetes and a decline in smoking contributed significantly to these increases, but did not fully explain them. There is an increasing trend in the proportion of babies born LGA, which is only partly attributable to decreasing maternal smoking, increasing maternal age and increasing gestational diabetes.

Socioeconomic status and perinatal outcomes in a setting with universal access to essential health care services.

The health care system in Canada provides essential health services to all women irrespective of socioeconomic status. Our objective was to determine whether perinatal and infant outcomes varied by family income and other socioeconomic factors in this setting. We included all 92,914 women who delivered in Nova Scotia between 1988 and 1995 following a singleton pregnancy. Family income was obtained for 76,440 of these women through a confidential link to income tax records and was divided into 5 groups. Outcomes studied included pregnancy complications, preterm birth, small-for-gestational-age live birth, perinatal death, serious neonatal morbidity, postneonatal death and infant death. Logistic regression models were used to adjust for potential confounders. Compared with women in the highest family income group, those in the lowest income group had significantly higher rates of gestational diabetes (crude rate ratio [RR] 1.44, 95% confidence interval [CI] 1.21-1.73), preterm birth (crude RR 1.20, 95% CI 1.06-1.35), small-for-gestational-age live birth (crude RR 1.81, 95% CI 1.66-1.97) and postneonatal death (crude RR 5.54, 95% CI 2.21-13.9). The opposite was true for rates of perinatal death (crude RR 0.74, 95% CI 0.56-0.96), and there was no significant difference between the 2 groups in the composite of perinatal death or serious neonatal morbidity (crude RR 1.01, 95% CI 0.82-1.24). Adjustment for behavioural and lifestyle factors accentuated or attenuated socioeconomic differences. Lower family income is associated with increased rates of gestational diabetes, small-for-gestational-age live birth and postneonatal death despite health care services being widely available at no out-of-pocket expense.

A brief report of attitudes towards physical activity during pregnancy

An exploratory study was undertaken to discover women's issues on the importance of physical activity during pregnancy. The authors were interested in exploring the topic with women from different cultural groups as well as with Anglo-Saxon women. Indigenous women and women from Pacific Island background were selected because of their high rates of gestational diabetes (the most common complication of pregnancy), of which physical inactivity is a risk factor. Four focus groups of two to five members were held to explore women's opinions about physical activity during pregnancy. Two specific cultural focus groups were organised with women of Western Samoan background and Indigenous women. The other two groups included women from the broader community. The women were concerned that they had not received enough information from various health agencies and agents during pregnancy. The women identified several benefits and barriers to physical activity when they were pregnant and explained how they felt about physical activity when pregnant. There were minimal differences between cultural groups in the women's voiced opinions. The themes derived from focus groups provide a snapshot of women's attitudes towards pregnancy and physical activity. Few women had a clear understanding of how physical activity should be incorporated in the gestational lifestyle period.

To Induce or Not to Induce Labor: A Macrosomic Dilemma

We assessed the effect of labor induction among parturients carrying macrosomic fetuses on the risk of a cesarean section (CS). The study population consisted of consecutive women with singleton fetuses weighing ≧4,000 g, delivered between 1988 and 1999. A comparison was made between parturients who delivered after labor induction and those who delivered without labor induction. The Mantel-Haenszel procedure was used to obtain the weighted odds ratios while controlling for confounding variables. During the study period, 4,755 women delivered macrosomic newborns in our institution. In 20% of the women (n = 951) labor was induced, while 80% of them (n = 3,804) delivered without labor induction. The women who delivered after labor induction were more likely to be nulliparous (18.0 vs. 10.0%; p < 0.001). In addition, these women had significantly higher rates of gestational diabetes (23.3 vs. 10.7%; p < 0.001), hypertensive disorders (10.1 vs. 5.3%; p < 0.001), hydramnios (17.4 vs. 9.9%; p < 0.001), and oligohydramnios (2.1 vs. 0.2%; p < 0.001). The CS rate was significantly higher among the patients who delivered after labor induction as compared with those in whom labor was not induced (17.8 vs. 11.9%; odds ratio 1.6, 95% confidence interval 1.3–1.9, p < 0.001). Stratified analysis using the Mantel-Haenszel technique was performed to control for confounders such as gestational diabetes, hypertensive disorders, previous CS, hydramnios, oligohydramnios, and nulliparity. None of these variables changed the significant association between induction of labor and CS. The induction of labor among women carrying macrosomic fetuses was found to be an independent risk factor for a CS.