High Risk Of GDM Research Articles

Mapping the insulin signalling network

are associated with adverse pregnancy outcomes including foetal overgrowth and increased risk of metabolic disease in the offspring. Our aim was to investigate the effect of a low glycemic index (GI) versus a conventional high fibre (HF) diet on pregnancy outcomes and neonatal body composition in women at high risk of developing GDM. 139 women (mean± SD age: 34.7± 0.4 y; prepregnancy BMI: 25.3± 0.5 kg/m2) at high risk of GDM (age≥ 35 yr, family history of type 2 diabetes, ethnicity, previous GDM or BMI≥ 30 kg/m2) were randomised to follow a low GI (LGI, n = 72; target GI≈ 50) or a high fibre, moderate GI diet (HF, n = 67; target GI≈ 60). Women were enrolled at 14—20 weeks gestation (mean 18 weeks). Dietary intake was assessed by 3-day food records at study entry. Neonatal body composition was measured by air displacement plethysmography using PeaPod®. Pregnancy outcomes were collected from medical records. The dietary intervention did not result in any differences in birth weight (LGI 3270± 50 vs HF 3260± 60 g, p = 0.906), ponderal index (LGI 2.71± 0.03 vs HF 2.69± 0.03 kg/m3, p = 0.958), birth weight centile (LGI 46.2± 3.2 vs HF 42.8± 3.3, p = 0.888), %fat (LGI 10± 1 vs HF 10± 1%, p = 0.347), or adverse pregnancy outcomes. However, increased maternal BMI (p = 0.02), mode of delivery (p = 0.01) and mother’s dietary GI at baseline (p = 0.035) were predictors of a higher birth weight z-score. In intensively monitored women at high risk of GDM, a low GI diet and a conventional high fibre diet produced similar pregnancy outcomes. However, maternal BMI and a high GI diet in early pregnancy appear to increase birth weight. These findings suggest that interventions to improve pregnancy outcomes need to begin prior to conception.

Women's experiences of factors that facilitate or inhibit gestational diabetes self-management.

BackgroundGestational diabetes rates have increased dramatically in the past two decades and this pattern of increase appears to relate primarily to the obesity epidemic, older maternal age and migration from world areas of high GDM risk. Women from disadvantaged and migrant backgrounds are most at risk of developing and of mismanaging this condition. The aim of the study was to explore the factors that facilitated or inhibited gestational diabetes self-management among women in a socially deprived area.MethodsFifteen pregnant women, with a diagnosis of gestational diabetes, were purposively recruited for this study. Qualitative semi structured interviews and 1 focus group were conducted when participants were approximately 28–38 weeks gestation. The study’s theoretical framework was based on interpretative phenomenology and data was analysed using a thematic analysis approach.ResultsWomen in this study identified a number of factors that complicated their task of GDM self-management. Barriers included: (1) time pressures; (2) physical constraints; (3) social constraints; (4) limited comprehension of requirements, and (5) insulin as an easier option. Factors facilitating GDM self-management included: thinking about the baby and psychological support from partners and families.ConclusionWomen from low socio economic and migrant backgrounds often struggle to comprehend GDM self-management requirements. To improve adherence to management plans, these women require educational and supportive services that are culturally appropriate and aimed at a low level of literacy.

Gamma‐glutamyltransferase level in pregnancy is an independent risk factor for gestational diabetes mellitus

To evaluate the relationship between gamma-glutamyltransferase (GGT) level in pregnant women at oral glucose tolerance test (OGTT) and the diagnosis of gestational diabetes (GDM). Blood was taken for analyzing GGT level from women at high risk of GDM at the time of their scheduled OGTT. GDM was diagnosed according to World Health Organization 1999 criteria. GGT level correlated positively with the 2-hour glucose level (Spearman's rho = 0.112: P < 0.05). GGT values that were stratified into quartiles demonstrated a significant trend with diagnosis of GDM (chi(2) for trend; P = 0.03). Multivariable logistic regression analysis taking into account maternal age, gestational age at OGTT, body mass index and a positive 50-g glucose challenge test (GCT) indicated that high GGT was an independent risk factor for GDM (adjusted odds ratio [AOR] 2.1 95% CI 1.2-3.8: P = 0.01). In the subset of women identified by a positive GCT, on multivariable logistic regression analysis, only high GGT was an independent risk factor for GDM (AOR 2.3 95% CI 1.3-4.2: P = 0.007). Raised GGT level is an independent risk factor for GDM in high risk pregnant women undergoing OGTT.

Screening for gestational diabetes at antenatal booking in a Malaysian university hospital: The role of risk factors and threshold value for the 50‐g glucose challenge test

The best method of screening for gestational diabetes (GDM) remains unsettled. The 50-g glucose challenge test (GCT) is used in a two-stage screening process but its best threshold value can vary according to population. To evaluate the role of risk factors in conjunction with GCT and to determine an appropriate threshold for the one-hour venous plasma glucose with the GCT. In a prospective study, 1600 women at antenatal booking without a history of diabetes mellitus or GDM filled a form on risk factors before GCT. Women who had GCT >or= 7.2 mmol/L underwent the 75-g oral glucose tolerance test (OGTT). GDM was diagnosed according to WHO (1999) criteria. Thirty-five per cent had GCT >or= 7.2 mmol/L, 32.6% underwent OGTT and 34.5% of OGTT confirmed GDM. The GDM rate in our population was at least 11.4%. Examination of the receiver operator characteristic curve suggested that the best threshold value for the GCT in our population was >or= 7.6 mmol/L. Multivariable logistic regression demonstrated that only GCT >or= 7.6 mmol/L was an independent predictor for GDM (adjusted odds ratio 3.7: P < 0.001). After GCT, maternal age and anthropometry, OGTT during the third trimester, family history, obstetric history and glycosuria were not independent predictors of GDM. Risk factors were not independent predictors of GDM in women with GCT >or= 7.2 mmol/L. GCT threshold value >or= 7.6 mmol is appropriate for the Malaysian population at high risk of GDM.