Impaired Glucose Tolerance In Pregnancy Research Articles

The effects of gestational diabetes mellitus with maternal age between 35 and 40\u2009years on the metabolite profiles of plasma and urine

BackgroundGestational diabetes mellitus (GDM) is defined as impaired glucose tolerance in pregnancy and without a history of diabetes mellitus. While there are limited metabolomic studies involving advanced maternal age in China, we aim to investigate the metabolomic profiling of plasma and urine in pregnancies complicated with GDM aged at 35–40 years at early and late gestation.MethodsTwenty normal and 20 GDM pregnant participants (≥ 35 years old) were enlisted from the Complex Lipids in Mothers and Babies (CLIMB) study. Maternal plasma and urine collected at the first and third trimester were detected using gas chromatography-mass spectrometry (GC-MS).ResultsOne hundred sixty-five metabolites and 192 metabolites were found in plasma and urine respectively. Urine metabolomic profiles were incapable to distinguish GDM from controls, in comparison, there were 14 and 39 significantly different plasma metabolites between the two groups in first and third trimester respectively. Especially, by integrating seven metabolites including cysteine, malonic acid, alanine, 11,14-eicosadienoic acid, stearic acid, arachidic acid, and 2-methyloctadecanoic acid using multivariant receiver operating characteristic models, we were capable of discriminating GDM from normal pregnancies with an area under curve of 0.928 at first trimester.ConclusionThis study explores metabolomic profiles between GDM and normal pregnancies at the age of 35–40 years longitudinally. Several compounds have the potential to be biomarkers to predict GDM with advanced maternal age. Moreover, the discordant metabolome profiles between the two groups could be useful to understand the etiology of GDM with advanced maternal age.

Depression precedes, but does not follow, gestational diabetes.

To determine whether past history of depression is associated with increased rates of gestational diabetes, and whether history of gestational diabetes is associated with increased rates of postpartum depression. Data for this case-control study consisted of de-identified chart records for 1439 women who received pregnancy care at a large university hospital between 1998 and 2017. A history of depression prior to pregnancy was associated with gestational diabetes requiring insulin, although not with subtler degrees of gestational hyperglycemia. Diabetes in pregnancy was not associated with an increased risk of postpartum depression. Trauma history was associated with both impaired glucose tolerance in pregnancy and postpartum depression. Past episodes of depression increase risk for the most severe form of gestational diabetes; however, gestational diabetes does not contribute significantly to risk for postpartum depression. This suggests a unidirectional association, unlike the bidirectional association of diabetes with depression among the general population. History of trauma increases risk for both gestational hyperglycemia and postpartum depression, suggesting important health effects of trauma that may differ measurably from those associated with depression.

Associations between maternal triclosan concentrations in early pregnancy and gestational diabetes mellitus, impaired glucose tolerance, gestational weight gain and fetal markers of metabolic function

BackgroundTriclosan is a phenolic biocide used in a multitude of consumer products and in health care settings. It is widely detected in the American and Canadian populations and has been shown in animal models to act as an endocrine disrupting agent. However, there has been little examination to date of the effects of triclosan exposure in pregnancy on perinatal metabolic outcomes in human populations. MethodsUsing data from the Maternal-Infant Research on Environmental Chemicals (MIREC) Study, a Canadian pregnancy cohort, we measured associations of first-trimester urinary triclosan concentrations with total gestational weight gain, gestational diabetes mellitus and impaired glucose tolerance in pregnancy, and fetal markers of metabolic function. Leptin and adiponectin were measured in plasma from umbilical cord blood samples in term neonates and categorized into low (< 10th percentile), intermediate (10th–90th percentile) and high (> 90th percentile) levels. Triclosan concentrations were grouped into quartiles and associations with study outcomes were examined using logistic regression models with adjustment for maternal age, race/ethnicity, pre-pregnancy BMI, education and urinary specific gravity. Restricted cubic spline analysis was performed to help assess linearity and shape of any dose-response relationships. All analyses for leptin and adiponectin levels were performed on the entire cohort as well as stratified by fetal sex. ResultsTriclosan measures were available for 1795 MIREC participants with a live born singleton birth. Regression analyses showed a non-significant inverse association between triclosan concentrations and leptin levels above the 90th percentile that was restricted to female fetuses (OR for highest quartile of triclosan compared to lowest quartile = 0.4 (95% CI 0.2–1.1), p-value for trend across quartiles = 0.02). Triclosan concentrations in the second quartile were associated with elevated odds of adiponectin below the 10th percentile in male fetuses (OR for Q2 compared to Q1 = 2.5, 95% CI 1.1–5.9, p-value for trend across quartiles = 0.93). No significant linear associations between triclosan concentrations and leptin or adiponectin levels in overall or sex-specific analyses were observed from restricted cubic spline analyses. No significant associations were observed in adjusted analyses between triclosan concentrations and gestational diabetes mellitus, impaired glucose tolerance or gestational weight gain. ConclusionsThis study does not support an association between triclosan concentrations in pregnancy and fetal metabolic markers, glucose disorders of pregnancy, or excessive gestational weight gain.

Postpartum Diabetes Testing Rates after Gestational Diabetes Mellitus in Canadian Women: A Population-Based Study.

We assessed the rate and type of postpartum glycemic testing in women with impaired glucose tolerance of pregnancy (IGTp) and gestational diabetes mellitus (GDM). We examined whether the likelihood of testing was modulated by patients' characteristics and pregnancy outcomes. Our population-level cohort study included data from 132,905 pregnancies between October 1, 2008, and December 31, 2011, in Alberta, Canada. Laboratory data within 270 days before and 1 year after delivery were used to identify pregnancies involving IGTp/GDM and postpartum glycemic testing, respectively. Logistic regression was used to identify maternal and pregnancy factors associated with postpartum testing. A total of 8,703 pregnancies were affected by IGTp (n=3669) or GDM (n=5034) as defined by the prevailing Canadian Diabetes Association 2008 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada. By 1 year postpartum, 55.1% had undergone glycemic assessments. Of those, 59.7% had had 75 g oral glucose tolerance tests, 17.4% had had glycated hemoglobin tests without oral glucose tolerance tests and 22.9% had had only fasting or random glucose tests. Women with IGTp or GDM, respectively, who were younger, smokers and residing in rural areas and whose labours were not induced were less likely to be tested postpartum. Having large for gestational age infants was also associated with a lower likelihood of postpartum testing in women with GDM. Despite a universal health-care system in Canada, many women with IGTp or GDM do not undergo postpartum glucose testing. Maternal and pregnancy characteristics influence postpartum testing and provide valuable information for creating targeted strategies to improve postpartum testing in this group of high-risk women.

Validation of administrative and clinical case definitions for gestational diabetes mellitus against laboratory results.

To examine the validity of International Classification of Disease, version 10 (ICD-10) codes for gestational diabetes mellitus in administrative databases (outpatient and inpatient), and in a clinical perinatal database (Alberta Perinatal Health Program), using laboratory data as the 'gold standard'. Women aged 12-54 years with in-hospital, singleton deliveries between 1 October 2008 and 31 March 2010 in Alberta, Canada were included in the study. A gestational diabetes diagnosis was defined in the laboratory data as ≥2 abnormal values on a 75-g oral glucose tolerance test or a 50-g glucose screen ≥10.3 mmol/l. Of 58 338 pregnancies, 2085 (3.6%) met gestational diabetes criteria based on laboratory data. The gestational diabetes rates in outpatient only, inpatient only, outpatient or inpatient combined, and Alberta Perinatal Health Program databases were 5.2% (3051), 4.8% (2791), 5.8% (3367) and 4.8% (2825), respectively. Although the outpatient or inpatient combined data achieved the highest sensitivity (92%) and specificity (97%), it was associated with a positive predictive value of only 57%. The majority of the false-positives (78%), however, had one abnormal value on oral glucose tolerance test, corresponding to a diagnosis of impaired glucose tolerance in pregnancy. The ICD-10 codes for gestational diabetes in administrative databases, especially when outpatient and inpatient databases are combined, can be used to reliably estimate the burden of the disease at the population level. Because impaired glucose tolerance in pregnancy and gestational diabetes may be managed similarly in clinical practice, impaired glucose tolerance in pregnancy is often coded as gestational diabetes.

Probiotics in obese pregnancy do not reduce maternal fasting glucose: a double-blind, placebo-controlled, randomized trial (Probiotics in Pregnancy Study)

Recent studies have reported beneficial effects of probiotics on maternal glycemia in healthy pregnant women. Obesity significantly increases risk of impaired glucose tolerance in pregnancy, but glycemic effects of probiotics in this specific obstetric group require additional investigation. The aim of the Probiotics in Pregnancy Study was to investigate the effect of a probiotic capsule on maternal fasting glucose in obese pregnant women. In this placebo-controlled, double-blind, randomized trial, 175 pregnant women with an early pregnancy body mass index (BMI; in kg/m²) from 30.0 to 39.9 were recruited from antenatal clinics at the National Maternity Hospital, Dublin, Ireland. Exclusion criteria were BMI <30.0 or >39.9, prepregnancy or gestational diabetes, age <18 y, multiple pregnancy, and fetal anomaly. Women were randomly assigned to receive either a daily probiotic or a placebo capsule from 24 to 28 wk of gestation in addition to routine antenatal care. The primary outcome was the change in fasting glucose between groups from preintervention to postintervention. Secondary outcomes were the incidence of gestational diabetes and neonatal anthropometric measures. In 138 women who completed the study (63 women in the probiotic group; 75 women in the placebo group), mean (±SD) early pregnancy BMI was 33.6 ± 2.6, which differed significantly between probiotic (32.9 ± 2.4) and placebo (34.1 ± 2.7) groups. With adjustment for BMI, the change in maternal fasting glucose did not differ significantly between treated and control groups [-0.09 ± 0.27 compared with -0.07 ± 0.39 mmol/L; P = 0.391; B = -0.05 (95% CI: -0.17, 0.07)]. There were also no differences in the incidence of impaired glycemia (16% in the probiotic group compared with 15% in the placebo group; P = 0.561), birth weight (3.70 kg in the probiotic group compared with 3.68 kg in the placebo group; P = 0.723), or other metabolic variables or pregnancy outcomes. A secondary analysis of 110 women, excluding antibiotic users and poor compliers, also revealed no differences in maternal glucose or other outcomes between groups. Probiotic treatment of 4 wk during pregnancy did not influence maternal fasting glucose, the metabolic profile, or pregnancy outcomes in obese women.

Abstract P107: Are Sleep Disturbances Associated with the Development of Gestational Diabetes? A Systematic Review and Meta-analysis.

Introduction and objectives: Physiological and hormonal changes occurring in pregnancy increase the risk of sleep disordered breathing (SDB), which, along with short sleep (SS) duration, may be associated with an increased risk of gestational diabetes mellitus (GDM). Exposure to GDM in the mother increases her lifetime risk of type-2 diabetes (T2D) as well as the risk of obesity, metabolic syndrome and, in later life, T2D of her children. The aim of this study was to systematically review the collective published evidence of associations between snoring/sleep-disordered breathing or sleep duration and increased risk of GDM. Hypothesis: We assessed the hypotheses that sleep disturbances, and/or short sleep during pregnancy may be associated with an increased risk of GDM. Materials and Methods: We performed systematic searches using MEDLINE, EMBASE, the Cochrane library and PsycINFO to assess the effect of snoring/sleep disordered breathing (SDB) or short sleep (SS) on the development of gestational diabetes (GDM) and impaired glucose tolerance in pregnancy. Prospective studies with measures of sleep disturbances at baseline and outcome measures of GDM or levels of glucose 1hr post GCT were included in a meta-analysis. We extracted odds ratios (OR) or relative risks (RR) and 95% confidence intervals (CI) and pooled them using a random effect model. Results: Overall, 7 studies met the inclusion criteria. They included 4,292 participants with 311 cases of GDM. In the pooled analysis, snoring/SDB and SS were both associated with a greater risk of GDM (RR: 2·27; 95% CI 1·65 to 3·12; P &lt; 0· 00001) and (3·19 [1·56 to 6·54]; P &lt; 0·002), respectively. There was no evidence of heterogeneity but there was evidence of publication bias and not all studies adjusted for obesity. Sensitivity analyses did not influence the pooled risk estimates. Conclusions: In conclusion, sleep disturbances may represent a risk factor for the development of GDM. Further studies are required to address the issues of publication bias and potential confounding, and to extend these observations to high-risk groups like women of ethnic minority groups whose risk of GDM is the greatest. Prevention, detection and treatment strategies need to be explored.

Estimating risk factors and perinatal outcomes for gestational diabetes and impaired glucose tolerance in teen mothers

Our objective was to identify potentially modifiable risk factors and outcomes for gestational diabetes and impaired glucose tolerance in a contemporary American teen population. We conducted a retrospective cohort analysis of all teenage deliveries (≤18 years old) at one institution over a 4-year period with documented oral glucose tolerance testing. All cases of gestational diabetes and impaired glucose tolerance were identified using the Carpenter and Coustan diagnostic criteria and compared with teenage mothers with normal glucose tolerance testing. Of the 670 included teen deliveries, 668 were either African American or Hispanic/Latino; 31 (5%) were diagnosed with gestational diabetes (n = 5) or impaired glucose tolerance (n = 26). Higher maternal prepregnancy body mass index (34.3 ± 7.8 vs 30.3 ± 6.4, p = 0.001) and morbid obesity (body mass index ≥ 35 kg/m(2) , RR 2.0, 95% CI 1.1-3.6) were associated with gestational diabetes and impaired glucose tolerance. There was no association with weight gain above the Institute of Medicine recommended levels (RR 1.6, 95% CI 0.77-3.4). On postpregnancy follow up, three of the five (60%) teens with gestational diabetes and none of the 26 (0%) teens with impaired glucose tolerance were diagnosed with diabetes mellitus. Higher prepregnancy body mass index, especially morbid obesity, places the gravid teen at higher risk for development of gestational diabetes and impaired glucose tolerance in pregnancy. The potentially modifiable nature of these risk factors coupled with the emerging teen obesity epidemic underscores the need for increased public health focus on this problem.

Effect of maternal weight, adipokines, glucose intolerance and lipids on infant birth weight among women without gestational diabetes mellitus

The delivery of excess maternal nutrients to the fetus is known to increase the risk of macrosomia, even among infants of women without gestational diabetes mellitus. With the current obesity epidemic, maternal adiposity and its associated effects on circulating adipokines and inflammatory proteins may now have a greater impact on fetal growth. We sought to evaluate the independent effects of maternal glycemia, lipids, obesity, adipokines and inflammation on infant birth weight. We included 472 women who underwent an oral glucose tolerance test in late pregnancy and were found not to have gestational diabetes; 104 (22.0%) had gestational impaired glucose tolerance. We also measured fasting levels of insulin, low-and high-density lipoprotein cholesterol, triglycerides, leptin, adiponectin and C-reactive protein. Obstetric outcomes were assessed at delivery. The mean birth weight was 3481 g (standard deviation 493 g); 68 of the infants were large for gestational age. On multiple linear regression analysis, positive determinants of birth weight were length of gestation, male infant, weight gain during pregnancy up to the time of the oral glucose tolerance test, body mass index (BMI) before pregnancy and impaired glucose tolerance in pregnancy. Leptin, adiponectin and C-reactive protein levels were each negatively associated with birth weight. On logistic regression analysis, the significant metabolic predictors of having a large-for-gestational-age infant were BMI before pregnancy (odds ratio [OR] 1.16, 95% confidence interval [CI] 1.05-1.27, per 1 kg/m(2) increase), weight gain during pregnancy up to the time of the oral glucose tolerance test (OR 1.12, 95% CI 1.05-1.19, per 1 kg increase) and leptin level (OR 0.50, 95% CI 0.30-0.82, per 1 standard deviation change). Among women without gestational diabetes, maternal adiposity and leptin levels were the strongest metabolic determinants of having a large-for-gestational-age infant rather than glucose intolerance and lipid levels.

Gestational diabetes mellitus— why awareness is paramount

Incidence and prevalence of gestational diabetes mellitus (GDM) and impaired glucose tolerance (IGT) in pregnancy have increased significantly in the past 10 years. Evidence indicates that these increases can be categorically linked to parallel increases in the incidence of pre-pregnancy obesity and the diagnosis of Type 2 diabetes mellitus on a national and international level. This article addresses the potential role of assistant practitioners (APs) and healthcare assistants (HCAs) to further develop their professional role in advocating healthy eating to women who might be pregnant or contemplating pregnancy in the near future. Raising the awareness of GDM and IGT in women who are not currently pregnant, the author suggests, might be one mechanism by which presenting cases could potentially be reduced. The article discusses the likely long- and short-term prognostic outcomes for both the mother and the neonate during pregnancy, following a diagnosis of either GDM or IGT and the specific needs of this patient cohort both during pregnancy and following parturition, when the statistical likelihood of women progressing to Type 2 diabetes mellitus is significantly greater. The article concludes with the recognition that APs and HCAs have a unique social opportunity to empower women of childbearing age to be proactive in the management of their reproductive health specifically and their general health and wellbeing overall, in relation to the potential development of GDM and IGT in pregnancy.

Effect of a low glycaemic index diet on blood glucose in women with gestational hyperglycaemia

Aim The objectives of this pilot study were to determine the feasibility and effect on glycaemic control of a low-glycaemic-index (GI) diet in women with gestational diabetes or impaired glucose tolerance of pregnancy. Methods Participants, recruited from the Diabetes-in-Pregnancy Clinic of an inner-city teaching hospital serving a predominantly non-Caucasian population, were randomized to a low-GI ( n = 23) or control ( n = 24) diet and followed from 28 weeks gestation until delivery. Self-monitored-blood-glucose (SMBG), maternal and infant weight were collected from medical charts. Dietary intakes were assessed using diet records and questionnaires. Results Diet GI on control (58, 95% CI: 56,60) was significantly higher than on low-GI (49, 95% CI: 47,51; p = 0.001). Glycaemic control improved on both diets, but more postprandial glucose values were within target on low-GI (58.4% of n = 1891) than control (48.7% of n = 1834; p < 0.001). SMBG post-breakfast was directly related to pre-pregnancy BMI in the control, but not the low-GI group (BMI * diet interaction; p = 0.021). Participants accepted the study foods and were willing to consume them post-intervention. Conclusions A low-GI diet was feasible and acceptable in this sample and facilitated control of postprandial glucose. A larger study is needed to determine the effect of a low-GI diet on maternal and infant outcomes.

The Prevalence of Gestational Diabetes Mellitus and Glucose Abnormalities in Pregnant Women With Hepatitis C Virus Infection in British Columbia

ObjectiveThere is evidence to support an association between diabetes mellitus (DM) and hepatitis C virus (HCV) infection. The insulin resistant state of pregnancy suggests a predisposition to developing gestational diabetes mellitus (GDM) in women infected with HCV. The aim of this study was to compare the prevalence of GDM and impaired glucose tolerance (IGT) of pregnancy between women infected with HCV and the general population of British Columbia screened for GDM. MethodsThe HCV cohort was drawn from a population-based prospective cohort of 148 pregnant women infected with HCV in British Columbia. GDM screening tests were completed in 84 women. The prevalence of GDM and IGT of pregnancy in the general population of British Columbia was estimated by acquiring 24 321 GDM screening tests performed by the two major laboratories in the province. ResultsNon-compliance was the primary reason for incomplete screening. The prevalence of GDM was 9.5% in the HCV cohort and 6.8% in the screened general population (χ2 test P = 0.33). Similarly, there was no difference in IGT of pregnancy between the two cohorts (2.4% vs. 3.5%; χ2 test P = 0.57). ConclusionA difference in the prevalence of either GDM or IGT of pregnancy was not detected between HCV-infected patients who were screened for GDM and those screened in the general population. Further studies are required to assess whether HCV infection is an independent risk factor for GDM.

The effect of a low glycemic index diet on gestational hyperglycemia: A pilot trial

The main objective of this study was to determine the effect of a low glycemic index (low‐GI) diet on fasting glucose, HbA1c and self monitored blood glucose (SMBG). Secondary outcomes included intervention feasibility, maternal weight gain and infant birth‐weight. Women (n=47) with gestational diabetes or impaired glucose tolerance of pregnancy were randomized to low‐GI (n=23) or control (n=24) diets and were followed from 28 weeks gestation until delivery. This study was conducted at St. Michael's Hospital, Toronto. Diet GI was significantly higher on control, 58 (95% CI:56,60) than low‐GI, 49 (47,51; p=0.001). Glycemic control improved in both groups (p&lt;0.05) with no significant difference between groups. SMBG after breakfast was directly related to pre‐pregnancy BMI in the control but not the Low‐GI group (p=0.021). Mean infant birth weight on low‐GI was less than on control (not significant). Maternal weight gain was not significantly different between groups. Study foods were rated “good” by participants. Participants were willing to consume them post‐intervention. A low‐GI diet was accepted by participants and attenuated the relationship between pre‐pregnancy BMI and postprandial SMBG.

Teratogenetic maternofoetal transmission and prevention of diabetes susceptibility.

Gestational diabetes and impaired glucose tolerance in pregnancy were found to be important teratogenetic risk factors for the development of diabetes in the offspring. Mechanisms of action and prevention of maternofetal transmission of teratogenetic susceptibility to diabetes are presented. Gestational diabetes induced in the F0 generation produced the following effects in the F1 and/or F2 generation: Early postnatal hyperinsulinaemia, decreased noradrenaline and serotonin and increased endorphin concentrations in specific brain regions, permanent hypoplasia of the hypothalamic ventromedial nuclei, decreased insulin responsiveness to glucose, impaired glucose tolerance and increased diabetes susceptibility.

Weight gain in pregnancy and risk of maternal hyperglycemia

The purpose of this study was to examine associations of weight gain from prepregnancy to glycemic screening with glucose tolerance status. Main outcomes were failed glycemic screening (1-hour glucose result >or= 140 mg/dL) with either 1 high value on 3-hour oral glucose tolerance testing (impaired glucose tolerance in pregnancy) or >or= 2 high values on 3-hour oral glucose tolerance testing (gestational diabetes mellitus). We performed multinomial logistic regression to determine the odds of these glucose intolerance outcomes by quartile of gestational weight gain among 1960 women in Project Viva. Mean gestational weight gain was 10.2 +/- 4.3 (SD) kg. Compared with the lowest quartile of weight gain, participants in the highest quartile had an increased odds of impaired glucose tolerance in pregnancy (adjusted odds ratio, 2.54; 95% confidence interval, 1.25-5.15), but not gestational diabetes mellitus (odds ratio, 0.93; 95% confidence interval, 0.50-1.70). Higher weight gain predicted impaired glucose tolerance in pregnancy, but not gestational diabetes mellitus.

Insulin therapy among women with impaired glucose tolerance of pregnancy

aventisG. Vespasiani: Novo Nordisk, sanofi-aventis, Roche Diagnostics Employee: K. Admane: sanofi-aventis Commercially-sponsored research: L. Blonde: Amylin Pharmaceuticals, AstraZeneca, Boehringer-Ingelheim Pharmaceutical, Bristol-Myers Squibb, Eli Lilly and Company, MannKind Corporation, Merck & Co., Inc., Novo Nordisk, Novartis Corporation, Pfizer Inc. and sanofi aventis Other substantive relationships: This study is sponsored by sanofi-aventis. P. Home and institutions with which he is associated receive funding for research, lecturing and health-care development activities from all major pharmaceutical companies active in diabetes, including sanofi-aventis.L. Blonde has recevied honoraria from Abbott, Amylin Pharmaceuticals, AstraZeneca, Bristol-Myers Squibb, Daiichi Sankyo, Eli Lilly and Company, GlaxoSmithKline, LifeScan, Merck & Co., Inc., Novartis Corporation, Novo Nordisk, Pfizer Inc. and sanofi aventis for acting as a speaker and consultant, and from BoehringerIngelheim Pharmaceutical and Hazlozyme for acting as a consultant.

Screening for gestational diabetes: The effect of varying blood glucose definitions in the prediction of adverse maternal and infant health outcomes

Impaired glucose tolerance in pregnancy and gestational diabetes are associated with increased maternal and fetal risks. There is considerable uncertainty in the literature relating to the merits of screening for gestational diabetes and impaired glucose tolerance, and variable definitions in the cut-off values to be used. To assess different levels of glucose intolerance in predicting adverse pregnancy outcomes. Retrospective cohort study involving screening pregnant women with a 50-g oral glucose load, followed by a formal 75-g oral glucose tolerance test for women who screened positive (defined as a plasma glucose level > or = 7.8 mmol/L). Plasma glucose results were correlated with pregnancy and birth outcomes, and receiver-operator curves were constructed. A total of 16,975 women were screened with a glucose challenge test, with pregnancy outcome information available for 1804 women who screened positive on glucose challenge test. With increasing plasma glucose values, there was a significant increase in pre-eclampsia, Caesarean section, shoulder dystocia and neonatal hypoglycaemia. The risk of adverse maternal and infant pregnancy outcomes increases with increasing levels of glucose impairment despite treatment.

Postpartum Dietary Changes in Women With Previous Gestational Diabetes Mellitus

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

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

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

The relationship between pregnancy weight gain and glucose tolerance status among black and white women in central North Carolina

The objective of the study was to examine weight and its relationship to glucose intolerance during pregnancy. Women were classified into mutually exclusive glucose tolerance groups; impaired glucose tolerance of pregnancy defined as 1 high value on the oral glucose tolerance test, gestational diabetes mellitus as 2 high values, and normal glucose tolerance as a normal value on the universal screen test. Logistic regression was used to examine the relationship between prepregnancy body mass index and weight gain, and glucose tolerance status and predicted probabilities were calculated. Weight gain ratio (observed/expected) was significantly higher for women with gestational diabetes mellitus, compared with women with normal glucose tolerance. The likelihood of developing gestational diabetes mellitus was significantly increased by both prepregnancy overweight (odds ratio 2.2, 95% confidence interval 1.1-4.3) and obese status (odds ratio 3.7, 95% confidence interval 2.2-6.3) but only marginally by weight gain ratio. In contrast, the likelihood of developing impaired glucose tolerance was increased by weight gain ratio for women who started pregnancy overweight. Prepregnancy weight was strongly associated with gestational diabetes mellitus, whereas weight gain during pregnancy was associated with impaired glucose tolerance only among overweight women.