Higher Incidence Of Gestational Diabetes Research Articles

Sleep apnea-related hypoxic burden as a predictor of pregnancy and neonatal outcome

Study objectivesTo determine the clinical impact of sleep apnea-related hypoxic burden in pregnant women and neonates. MethodsThis is a secondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b) study. Hypoxia burden was calculated from the home sleep apnea test (HSAT) and defined as the total area under respiratory events. Logistic regression analysis assessed the relationship between hypoxia burden and pregnancy/neonatal outcomes. ResultsA total of 3006 subjects in the early term, and 2326 subjects in the middle term of pregnancy, had HSAT. A hypoxic burden greater than 6.8%min was present in 1740 at early term and associated with a higher risk of preeclampsia (odds ratio 1.297, 95 % confidence interval 1.032–1.630, p: 0.026) after adjusted by obstructive sleep apnea (OSA) severity. In the middle term, 1058 subjects had a hypoxia burden more than 11.8%min, which was a predictor for higher incidence of gestational diabetes (OR 1.795, 95 % CI 1.097–2.938, p: 0.020) and an Apgar <7 at 1 min (OR 1.446, 95 % CI 1.079–1.939, p: 0.012) after adjusted by obstructive sleep apnea (OSA) severity. After adjusted by oxygenation disturbance index, HB was not related with Apgar <7 at 1 min (p:0.565). ConclusionsThe hypoxic burden is an independent predictor for preeclampsia and gestational diabetes and an Apgar <7 at 1 min.

Effect of pre-pregnancy body mass index and gestational weight gain on fetal outcome

Fetaldevelopment and growth in uterus is most critical. Most commonly used indicator is birth weight for determining well-being of infant. Body mass index (BMI) of mother before pregnancy, pregnancy weight gain, and other factors related to behavior, socio-cultural as well as genetics influence the birth weight. To study effect of pre-pregnancy BMI and gestational weight gain on fetal outcomeHospital-based follow-up study was carried out among 189 antenatal women. Gestational age, weight, height, BMI and fetal growth were recorded. Regular sonography was carried out to rule out fetal congenital abnormalities and fetal well-being. Daily fetal movement count, fetal heart rate monitoring was carried out daily. Estimation of the “total pregnancy weight gain” was done by subtracting last measured weight before delivery from weight recorded at first visit in first trimester. Birth weight of the neonate was recorded within 24 hours of delivery. BMI before pregnanacy was normal in Majority (75.1%). Underweight women earlier to conception had either normal Gestational weight gain (GWG) or less than normal GWG. Their babies also had significantly low average birth weight compared to either normal weight females or overweight and obese before conception. Overweight and obese females before conception had higher incidence of gestational diabetes (GDM) and cesarean section. Normal weight females before conception had higher incidence of Pregnancy induced hypertension.Being underweight before conception is a risk factor for low birth weight babies whereas being overweight and obese before pregnancy is a risk factor for GDM.

Perinatal Outcomes of Monochorionic Twin Pregnancies Conceived Naturally Versus through Assisted Reproductive Techniques.

Objective: It has been reported that monochorionic twin pregnancies conceived through assisted reproductive techniques (ART) display a higher risk of second-trimester miscarriage, cesarean delivery, and neonatal death than those conceived naturally. The aim of this study was to compare the perinatal outcomes of monochorionic diamniotic (MCDA) twin pregnancies conceived naturally and through ART in a tertiary hospital. Methods: This was a retrospective cohort study of all MCDA twin pregnancies that received obstetric care and delivered at La Fe University and Polytechnic Hospital between 2015 and 2021. MCDA pregnancies that were referred to the tertiary hospital for specialized management, follow-up, and delivery were also included. The study was approved by The Health Research Institute Hospital La Fe (IIS La Fe). Results: Among the 184 MCDA pregnancies, 149 (81%) had a natural conception, and 35 (19%) were conceived through ART. Patients with an MCDA pregnancy who conceived through ART had a significantly older maternal age (38.0 [35.5-42.5] vs. 32.0 [29.0-36.0], p < 0.001) and an elevated rate of nulliparity (80.0% vs. 50.3%, p = 0.001). Regarding pregnancy complications, MCDA pregnancies through ART were associated with a significantly higher incidence of gestational diabetes (22.9% vs. 2.7%, p < 0.001), hypertensive disorders during pregnancy (22.9% vs. 9.4%, p = 0.04), and other pregnancy complications such as threatened labor or preterm prelabor rupture of membranes (14.3% vs. 36.2%, p = 0.015), than naturally conceived MCDA pregnancies. No differences were found in the incidence of twin-to-twin transfusion syndrome (20% vs. 33.6%, p = 0.155). MCDA pregnancies through natural conception had a greater rate of vaginal delivery than MCDA through ART (16.8% vs. 2.9%, p = 0.032). When adjusted for confounding factors, MCDA pregnancies through ART were only more likely to develop gestational diabetes than those naturally conceived (aOR 7.86, 95% CI 1.55-39.87). No differences were found regarding neonatal outcomes between groups. Conclusions: Compared with naturally conceived MCDA twin pregnancies, those conceived through ART displayed a significantly higher risk of developing gestational diabetes. No differences regarding other pregnancy complications, mode of delivery, or neonatal outcomes were found between groups.

A 10-Year Observational Study on Twin Pregnancy: Role of Fetal Sex Pairing on Obstetric Outcome.

Fetal sex contributes to the determination of obstetric outcome, as pregnancies carrying male babies seem to have an increased risk of maternal-fetal complications. Most studies have been conducted on singleton pregnancies, whereas less evidence is available for twins. A 10-year retrospective observational study was conducted on a cohort of 1180 women with twin pregnancy delivered at a single tertiary hospital. Clinical data on maternal characteristics, and obstetric and neonatal outcomes were collected, and the analysis was performed on monochorionic (MC) and dichorionic (DC) diamniotic twins separately. The group of DC twins included 837 cases, and those conceived by assisted reproductive technologies (ART) were more likely to have one or both female fetuses rather than males. The incidence of hypertensive disorders of pregnancy (HDP) was higher in same-sex pairs than in opposite-sex pairs. No differences were found regarding other obstetric and neonatal outcomes among the three sex-pairing groups. The MC twins group included 228 cases, and in female-carrying pregnancies a higher incidence of gestational diabetes (GDM) was observed compared to the male group. Furthermore, male pairs had significantly lower Apgar scores than females. Fetal sex seems to have a mild effect in twins compared to singleton pregnancies, suggesting a more complex set of factors contributing to pregnancy outcome in multiple pregnancies. However, we observed a higher incidence of HDP among same-sex DC pairs, a higher rate of GDM among MC female-female pairs, and a worse adaptation to extrauterine life among male-male pairs in MC twins.

Maternal and neonatal outcomes in women with twin pregnancies based on gestational weight gain: An updated systematic review and meta-analysis.

This updated systematic review and meta-analysis aimed to assess maternal and fetal outcomes of pregnancies based on the Institute of Medicine (IOM) guidelines of gestational weight gain (GWG). PubMED, SCOPUS, EMBASE and Web of Science were searched up to 30th July 2022. All studies evaluating maternal and/or neonatal outcomes of twin pregnancies based on the IOM guidelines of gestational weight gain were included. Twenty two studies were included. Mothers with twin pregnancies experiencing inadequate GWG showed higher incidence of gestational diabetes with the risk ratio (RR) 1.22 95% CI (0.95,1.57), p=0.0005, i2= 69% and premature rupture of membrane (PROM) with RR 1.14 95% CI (0.99, 1.30), p=0.07; i2=0% that coincided with higher rates of preterm birth, low birth weight, small for gestational age (SGA) and admission to NICU in neonates. Mothers with excessive GWG had higher risk of developing gestational hypertension with RR 1.59 95% CI (1.22, 2.07), p=0.0006, i2=75% and extremely preterm delivery (<32 weeks). Within the limitations of this review, GWG was found to be a predictable risk factor for adverse maternal and neonatal outcomes of twin pregnancies.

Outcome in a series of 1135 twin pregnancies: does the type of conception play a role?

The rate of twin pregnancies conceived via assisted reproductive technology has increased markedly in recent years. The elevated number of multiple pregnancies is the most serious and frequent complication of assisted reproductive technology. Twin pregnancies are associated with higher rates of obstetrical complications, preterm delivery, and perinatal morbidity and mortality than singleton pregnancies. This study aimed to investigate the association between the mode of conception and obstetrical and perinatal outcomes in twin pregnancies, adjusting for parity, age, and chorionicity. This was a retrospective cohort study of 1135 twin pregnancies between May 2006 and April 2021. All spontaneous (n=369) and assisted reproductive technology-conceived (n=766) twin pregnancies with antenatal care and delivery in the Universitari Quiron-Dexeus Hospital, Barcelona, Spain, a tertiary obstetrical care center, were studied according to chorionicity. The mean maternal age was higher among assisted reproductive technology twin pregnancies than among naturally conceived ones, and there were also less parous women in the assisted reproductive technology twin group. The global survival rates in both groups of twins were practically identical, namely 744 of 766 (97.1%) assisted reproductive technology twins and 357 of 369 (96.8%) spontaneously conceived twins. Patients with dichorionic assisted reproductive technology twins had a higher incidence of gestational diabetes (relative risk, 1.69; 95% confidence interval, 1.10-2.59) and gestational hypertension or preeclampsia (relative risk, 2.75; 95% confidence interval, 1.60-4.729). Monochorionic diamniotic assisted reproductive technology twins had a higher risk for gestational diabetes (relative risk, 4.12; 95% confidence interval, 1.35-12.56). We analyzed the gestational age at delivery, onset of labor, type of delivery, rate of preterm births, weight discordance, rate of small for gestational age neonates and intrauterine growth restriction, and admission to the neonatal intensive care unit. We could not find any statistical differences between monochorionic diamniotic assisted reproductive technology twins and spontaneously conceived twins. Among dichorionic twins, those conceived by assisted reproductive technology had an earlier gestational age at delivery (36.3±2.29 vs 36.6±2; P<.05) and we found statistical differences in the onset of labor with more cesarean deliveries (relative risk, 1.27; 95% confidence interval, 1.06-1.51). When adjusting for cofounding factors (maternal age, parity, chorionicity), the type of conception remained an independent risk factor for gestational hypertension and preeclampsia but not for gestational diabetes or cesarean delivery. Pregnancy outcomes are comparable between assisted reproductive technology and spontaneously conceived twins, and when adjusted for confounding factors, only the risk for gestational hypertension and preeclampsia remained increased in the assisted reproductive technology group.

Comparison of "growth promoted" and "normally grown" dichorionic-diamniotic twins: A population-based study.

ObjectivesMacrosomia in singleton pregnancies and associated risks have been well characterized. Less is known about the outcomes of macrosomic newborns in twin pregnancy.Objective of this study was to compare maternal characteristics and perinatal outcomes of "growth promoted twins" (twin pairs with a total twin birth weight above 90th percentile) to "normally grown twins" (twin pairs with a total twin birth weight between 50th and 90th percentile).MethodsWe evaluated data (maternal characteristics and perinatal outcomes) of dichorionic–diamniotic twins born at 34 weeks of gestational age or later over a sixteen-year period (2002–2018) in two birth weight groups. We excluded twin pairs born before 34th week of gestation and discordant twin pairs. We used data from the Slovenian National Perinatal Information System.To define the percentiles, twin-specific growth curves have been used.ResultsOur study population consisted of 390 twin pregnancies with a twin total birth weight over 90th percentile and 1618 pregnancies with a total twin birth weight between 50th and 90th percentile for gestational age. Women in "growth promoted" twin group were significantly taller, heavier and more often multiparous. There was a higher incidence of gestational diabetes (10.8% vs 7.3%, OR 1.53 95% CI 1.06 – 2.22), a lower rate of caesarean births (48.2% vs 53.9%, OR 0.80 CI 0.64 – 0.99) and lower rate of assisted reproduction (21.0% vs 27.1%, OR 0.71 CI 0.55 – 0.93) in women in "growth promoted" twin group. There were no statistically significant differences in neonatal outcomes in both groups.ConclusionIn contrast to macrosomia in singletons, macrosomia in twins does not appear to increase the risk for adverse perinatal outcomes.

O-210 Sperm DNA fragmentation (SDF) is not associated with adverse maternal and neonatal outcomes in IVF-ICSI cycles with autologous oocytes

Abstract Study question Does an elevated SDF (&amp;gt;15%) increase the odds of adverse maternal and neonatal outcomes in autologous oocyte IVF-ICSI cycles from unselected couples? Summary answer No adverse effects of high SDF on obstetric and neonatal outcomes have been found in couples with sperm fragmentation undergoing IVF-ICSI cycles with own eggs. What is known already Sperm chromatin integrity assessment has been implemented as an additional tool in the clinical evaluation of sperm quality in infertile patients undergoing an assisted reproduction treatment. All of the published reports to date appraise its effect on clinical outcomes, and how it impacts embryo quality and the pregnancy chances after IVF and ICSI cycles. Sperm DNA integrity has also been hypothesized to affect offspring health but not many studies have reported in humans if an elevated SDF raises the risks of obstetric, delivery and neonatal outcomes. Study design, size, duration Multicentric retrospective cohort study of all IVF-ICSI cycles using autologous oocytes between January 2000-March 2019 at Spain IVIRMA clinics of couples with a SDF test on their ejaculated semen. The sperm fragmentation index was measured in all men with TUNEL assay. The database included 228 couples which had a delivery with at least a newborn. Subjects were divided into two study groups according to their level of SDF: ≤15% (low SDF) or &amp;gt; 15% (high SDF). Participants/materials, setting, methods Patients with missed information on maternal and neonatal outcomes were not counted for the analysis. The obstetric outcomes were gestational age, gestational diabetes, preeclampsia (hypertension with proteinuria after 20 weeks of gestation) and type of delivery. Neonatal outcomes were sex, birth weight, length, head circumference, Apgar score at 1, 5, 10 minutes, and neonatal intensive care unit (NICU) admission. Student’s t-test and Fisher’s test were used for statistical analysis. A p-value&amp;lt;0.05 was considered statistically significant. Main results and the role of chance Maternal age mean was 37.4 years (95%CI 36.9-38.0) in ≤ 15%SDF group and 37.2 years (95%CI 36.1-38.4) in &amp;gt; 15%SDF group (p = 0.8). Similar gestational age was found, 41.8 weeks (95%CI 41.3-42.2) in ≤ 15%SDF and 41.3 weeks (95%CI 40.4-42.3) in &amp;gt; 15%SDF. Gestational diabetes incidence was higher in &amp;gt; 15%SDF compared to ≤ 15%SDF group (3.5% versus 1.7% (OR = 2.0 (95%CI 0.03-39.8), p = 0.5). Equally, the incidence of preeclampsia was 3.6% in patients with high SDF versus 1.7% in couples with low SDF, OR = 2.1 (95%CI 0.03-41.3), p = 0.5. Type of delivery frequency was in the ≤15%SDF group 61.9% vaginal and 38.1% cesarean, while in the &amp;gt;15%SDF group 62.1% vaginal and 37.9% cesarean (OR = 1.0 (95%CI 0.4-2.6), p = 1.0). The overall proportion of singleton pregnancies was 87.2% (95%CI 82.4-91.2) and twins 12.8% (95%CI 8.8-17.6). There were no statistically differences between groups in the rate of delivery of twins and in the sex ratio of the newborns. When comparing the newborns of ≤ 15%SDF with &amp;gt;15%SDF group, the average of weight was 3011.7g (95%CI 2912.2-3111.2) versus 2986.4g (95%CI 2753.1-3219.7), of length was 49.2cm (95%CI 48.3-50.0) versus 49.5cm (95%CI 49.2-49.9), of head circumference was 34.9cm (95%CI 34.6-35.2) versus 34.3cm (95%CI 33.4-35.2). No statistically differences were observed for Apgar punctuation and for NICU admission. Limitations, reasons for caution Due to the retrospective nature of the study we have missing data from the lack of follow-up of many patients after the confirmation of the ongoing pregnancy. Although pregnancies of couples with elevated SDF have a higher incidence of gestational diabetes and preeclampsia, the sample size evaluated is a limitation. Wider implications of the findings This is one of the first reports to evaluate the relationship between paternal DNA damage and obstetric risks and neonatal health in couples with high SDF who underwent IVF-ICSI in our centers. Despite SDF did not jeopardize the maternal and neonatal outcomes, more studies are needed to confirm this conclusion. Trial registration number NA

MATERNAL OBESITY AND OBSTETRIC OUTCOMES IN A TERTIARY CARE CENTER

BACKGROUND: Pregnancy is unique, yet normal physiological chapter in women’s life. Pre-existing morbidity can complicate pregnancy affecting mother and fetus resulting in high risk pregnancy .One of which is obesity causing antepartum, intrapartum and postpartum complications both in mother and child. AIM OF THE STUDY: The aim of this study is to evaluate the effect of obesity on the maternal and perinatal outcome in pregnancies complicated by obesity. MATERIALS: A prospective study is done in Govt. RSRM lying in hospital during June 2019-june 2020 .Among antenatal mothers attending antenatal outpatient department, mothers were chosen in their first trimester who had Body Mass Index&gt;30kg/m2 as study group and mothers with a Body Mass Indexbetween18.5kg/m2and25kg/m2 as control group. Detailed history taking and investigations done and they were followed up to delivery and postpartum until discharge and outcome studied. RESULTS: In the present study, increasing age, sedentary lifestyle and low socio economic status show a positive relation to obesity. The proportion of primiparous Women was more in obese group(51.9%)when compared to control group(48.1%). Higher incidence of gestational diabetes and pre eclampsia are seen in obese group. Higher rates of cesarean deliveries among this group. Preterm delivery in obese women 10.4% compared to control group. CONCLUSION: Maternal BMI has a strong association with pregnancy complications and outcome. The best time of intervention may be before a woman considers a pregnancy and attempts are to be made to maintain a normal BMI in women of childbearing age.

Endometrial cavity fluid is associated with deleterious pregnancy outcomes in patients undergoing in vitro fertilization/intracytoplasmic sperm injection: a retrospective cohort study.

BackgroundThe effects of endometrial cavity fluid (ECF) on in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) pregnancy outcomes following embryo transfer (ET) are still controversial. We conducted the present study to investigate whether the presence of ECF in infertile patients scheduled to undergo IVF or ICSI was associated with pregnancy outcomes.MethodsA retrospective cohort study design was used. Among infertile patients undergoing IVF/ICSI, those with and without ECF were matched 1:1 using propensity score matching (PSM). After ensuring that the baseline levels of the two matched groups were consistent, the pregnancy and obstetrical outcomes of the two groups were compared.ResultsPatients with ECF had significantly lower clinical rates of pregnancy (1,061/1,862, 57% vs. 1,182/1,862, 63.5%; P<0.001), live birth (902/1,862, 48.4% vs. 1,033/1,862, 55.5%; P<0.001), biochemical pregnancy (1,182/1,862, 63.5% vs. 1,288/1,862, 69.2%; P<0.001), and embryo implantation (1,500/3,740, 40.1% vs. 1,661/3,740, 44.4%, P<0.001) than patients without ECF. Also, patients with ECF had a higher incidence of gestational diabetes (17/78, 22% vs. 8/94, 9%, P=0.014). However, there were no differences in gestational weeks at delivery or birth weight between the two groups.ConclusionsECF was significantly associated with adverse pregnancy outcomes but showed no significant association with adverse obstetric outcomes (except for gestational diabetes).

Perinatal outcome of in vitro fertilization pregnancies in women with polycystic ovary syndrome by pregravid BMI.

Given the adverse effects of either polycystic ovary syndrome (PCOS) or overweight/obesity, one could speculate that patients with both would fare worse than others. We sought to evaluate the relationship between pregravid BMI and pregnancy complications in PCOS patients conceived by assisted reproductive techniques (ART). Maternal and fetal/neonatal outcomes of singleton pregnancies after assisted reproduction in women with and without PCOS were compared by pregravid body mass index (BMI, <24.9 vs.≥25kg/cm2). The study population comprised 185 with a BMI <24.9kg/cm2 including 39 (21%) with PCOS and 146 (79%) without. We also included 84 patients with BMI≥25kg/cm2, involving 34 (40.5%) with PCOS and 50 (59.5%) without. PCOS (total 73 patients) was significantly more common among overweight/obese patients, OR 2.5 (95% CI 1.4, 4.4). Neonates >4,000g were born only to the overweight/obese mothers in the PCOS group. A higher incidence of gestational diabetes, chronic hypertension, and gestational hypertension was related to pregravid overweight/obesity rather than PCOS. In this specific subgroup of patients conceived after assisted reproduction, pregravid BMI>25kg/cm2 rather than PCOS itself appears to be associated with GDM and hypertensive disorders.

Risk factors and pregnancy outcome in women aged over 40years at Korle-Bu Teaching Hospital in Accra, Ghana.

To examine the risk factors and pregnancy outcomes in women aged 40years and older at the Korle-Bu Teaching Hospital, Accra, Ghana. A descriptive case-control study comparing women aged 40years and older at the time of delivery with those between 20 and 34 who delivered at the Korle-Bu Teaching Hospital between April 1, 2014 and March 31, 2015. Data were collected using interviewer-administered questionnaires and supplemented with information from patients' medical records. A multivariate logistic regression was used to estimate the odds ratio and the 95% confidence interval of various risk factors and complications associated with delivery in women aged 40years or older. Statistical significance was set at P<0.05. There were 339 women in the study of which 113 were aged 40years or older and 226 were aged between 20 and 34years. Delivery at age 40years or older was associated with grand multiparity, and unplanned and undesirable pregnancy. There was a higher incidence of gestational diabetes (7.1% vs 2.2%, P=0.036), cesarean delivery (70.1% vs 57.1%, P=0.018), and venous thromboembolism (VTE) (7.1% vs 1.3%, P=0.008) among women older than 40years. VTE risk was increased sixfold in the women older than 40years compared with the younger ones. Women delivering after age 40years had a higher incidence of gestational diabetes, cesarean delivery, and VTE compared with younger women. VTE risk increased sixfold in the older women.

Risk of preterm delivery in singletons conceived by in vitro fertilization

To evaluate the preterm delivery and other obstetrics complications similar in singleton pregnancies achieved through IVF compared to spontaneous pregnancies. Retrospective case-control study included 1663 women with singleton pregnancies following IVF-ICSI (study group) and 3326 women with singleton spontaneous pregnancies (control group) who delivered between January 2015 and January 2018 at the Peking University Third Hospital. The control group matched 1:2 by age, BMI, parity, and gravidity. Maternal outcomes included preterm delivery and complications. There was significantly higher incidence of gestational diabetes, hypertensive disorders, and placenta previa in IVF-ICSI pregnancies versus controls (p < .05). IVF-ICSI resulted in significantly higher rate of preterm birth than in spontaneous pregnancies (p < .05) and the difference remained significant for deliveries that occurred before 28, 32, and 34 weeks gestation (p < .05). Multivariate logistic regression analysis revealed that female-factor infertility, hypertensive disorder, placenta previa, and PROM were significant prognostic factors associated with increased risk of prematurity. IVF-ICSI is associated with increased risk of obstetric complications including preterm delivery in singleton pregnancies. Female-factor infertility is an independent prognostic factor for preterm birth. This information is important for patient counseling and helps to refine the recommendation to optimize maternal health before embarking on fertility treatments.

Characterization of Perinatal Risk Factors and Complications Associated With Nonsyndromic Craniosynostosis.

Certain intrauterine risk factors are known to increase the risk of premature cranial suture fusion and may cause complications during birth. Some of these risk factors may be modifiable. Therefore, the authors sought to characterize the institutional patterns of prenatal risk factors and perinatal complications in nonsyndromic craniosynostosis patients compared to normal births from the surrounding area to identify areas for possible intervention or prevention. The medical records of all infants with nonsyndromic craniosynostosis and full birth records born at Duke University Health System from 2006 to 2017 were retrospectively reviewed. Maternal comorbidities, prenatal risk factors, and perinatal complications were collected. The North Carolina State Center for Health Statistics was queried for perinatal statistics from Durham county and the Northeastern Perinatal Care Region to represent a control cohort of normal births from the same time period and region. The primary outcome investigated was the incidence of prenatal risk factors and complications at birth associated with premature fusion of cranial sutures. Eighty births with nonsyndromic craniosynostosis were included in this study. The majority of these patients were males (61.7%) and born via cesarean section (55.0%). Intrauterine growth restriction occurred in 10.0% and head trauma during delivery occurred in 2.5%. Twinning (14.8% vs 3.6%, P < 0.0001), cesarean births (55.5% vs 30.0%, P < 0.0001), and breech presentation (17.3% vs 3.2%, P < 0.0001) were significantly more common in craniosynostosis patients. Prenatally, mothers of craniosynostosis infants had higher incidence of gestational diabetes (13.5% vs 5.0%, P < 0.0001) and oligohydramnios (6.1% vs 1.3%, P < 0.0001) compared to regional controls. This study demonstrates that premature suture fusion is associated with prenatal risk factors such as gestational diabetes and oligohydramnios. Continued research into potentially modifiable prenatal risk factors and more refined prenatal diagnostic tools has the potential to reduce both the incidence of premature suture fusion and the sequelae of birth complications in this population.

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.

Do Changing Diagnostic Criteria for Gestational Diabetes Influence Pregnancy Outcome?

The incidence of pregnancy related diabetes has been steadily increasing during the past decade. The aim of this retrospective study was to evaluate the type and prevalence of gestational diabetes complications after implementing new diagnostic criteria for gestational diabetes. The incidence of gestational diabetes, maternal age, mode of delivery and birth weight were analyzed. Study patients were divided into three groups. The first group consisted of patients who gave birth during 2005, the second group during 2011 and the third group during 2012. In 2005, the World Health Organization criteria were used on diagnosing gestational diabetes, whereas in 2011 and 2012 the criteria issued by the International Association of Diabetes and Pregnancy Study Groups were considered. There was no statistically significant difference among the groups according to maternal age, birth weight (p=0.203) and mode of delivery (p=0.883). Cesarean section was performed in about 30% of deliveries in all groups combined. There was no significant difference in the number of neonatal hypertrophy (p=0.348), although the distribution of hypertrophy showed a tendency towards higher values in 2005. The incidence of gestational diabetes was 2.2% in 2005, 6.6% in 2011 and 12% in 2012. In conclusion, difference in the incidence of pregnancy related diabetes appeared to have resulted directly from using different diagnostic criteria. The new criteria contributed to a relatively higher incidence of gestational diabetes but also achieved better gestational glycemic control and consequently better fetal growth regulation.

268: The impact of gestational change in body mass index (BMI) on adverse pregnancy outcomes among women with gestational diabetes

Previous studies have shown that women who have minimal to no weight gain have a higher incidence of gestational diabetes (GDM). This is likely an example of reverse causality resulting from dietary counseling once the diagnosis of GDM is made. In general, weight restriction is not advocated in pregnancy. However, given that better dietary intake among gestational diabetics may result in weight loss, its impact on adverse pregnancy outcomes warrants investigation.

Differences in the Incidence of Gestational Diabetes between Women of Turkish and German Origin: An Analysis of Health Insurance Data From a Statutory Health Insurance in Berlin, Germany (AOK), 2005-2007.

Background: Gestational diabetes increases the risk of maternal and infant complications and long-term health effects. A study of differences in the incidence of gestational diabetes between women of Turkish and German origin can identify high risk groups and may indicate the need for culturally sensitive diabetes information and treatment during pregnancy. Method: We analysed all pregnancy related health insurance data from the AOK Berlin (a statutory health insurance in Berlin) based on data from 2005 to 2007, using a name algorithm to identify cases with Turkish migrant background. A group of German women insured with the AOK Berlin served as a comparison group. Results: After exclusion of miscarriages and multiple births the data set comprised 3338 pregnancies in total. The incidence of gestational diabetes was significantly higher in women of Turkish origin with 183 per 1000 pregnancies than in German women (138 per 1000 pregnancies). Regression analyses showed that women of Turkish origin with obesity were at the highest risk of gestational diabetes (OR = 2.67; 95 % confidence interval 1.97-3.60). Conclusion: Obesity is an important factor in explaining the higher incidence of gestational diabetes in women of Turkish origin, especially among young Turkish women. These findings should stimulate discussion as to whether or not information about risk factors such as diabetes within the scope of prenatal care adequately addresses the needs of migrant women. Further research is needed to identify potential differences in undetected and primarily in insufficiently treated gestational diabetes between Turkish and German women.

The Moderating Influence of Asthma Diagnosis on Biobehavioral Health Characteristics of Women of Reproductive Age

Promoting healthy behaviors to improve pregnancy outcomes requires an understanding of the factors influencing health behaviors among at-risk populations. We hypothesized that women with an asthma diagnosis would have poorer biobehavioral health risk factors and pregnancy outcomes compared to women without an asthma diagnosis. The Central Pennsylvania Women's Health Study (CePAWHS) included a population-based survey examining health status indicators, risk factors and outcomes, and detailed pregnancy histories among 2,002 women (ages 18-45). 213 asthmatics were identified. Compared with Non-asthmatic women (NA), Asthmatic (A) women reported lower rates of excellent health status (45% A vs. 65% NA, P < 0.001), were more likely to be overweight or obese (68% A vs. 50% NA, P < 0.001), and were more likely to have smoked cigarettes during their first pregnancy (25% A vs. 17% NA, P < 0.01). Psychological measures (psychosocial hassles, low self-esteem, depression) were reported more often in asthmatics than non-asthmatics. Also, asthmatics reported a higher incidence of gestational diabetes (10% A vs. 6% of NA, P = 0.05), preterm births (25% A vs. 16% NA, P < 0.01), and had a higher proportion of low birth weight infants (20% A vs. 13% NA, P = 0.03) compared with non-asthmatics. As predicted, asthmatics had poorer biobehavioral risk factors and outcomes compared to non-asthmatics. These findings illustrate the need to target asthmatic women of reproductive age, particularly in this largely rural setting, with interventions to reduce biobehavioral risk factors as part of a strategy to improve pregnancy outcomes.

Un déficit en vitamine B12 pendant la grossesse est associé à une augmentation du risque de diabète gestationnel et de diabète de type 2 à cinq ans

Aims/hypothesis This study was designed to test the hypothesis that low plasma vitamin B12 concentrations combined with high folate concentrations in pregnancy are associated with a higher incidence of gestational diabetes (GDM) and later diabetes.