Incidence Of Gestational Diabetes Research Articles

Change in level of physical activity during pregnancy in obese women: findings from the UPBEAT pilot trial.

BackgroundMaternal obesity is associated with an increased risk of pregnancy complications, including gestational diabetes. Physical activity (PA) might improve glucose metabolism and reduce the incidence of gestational diabetes. The purpose of this study was to explore patterns of PA and factors associated with change in PA in obese pregnant women.MethodsPA was assessed objectively by accelerometer at 16 – 18 weeks’ (T0), 27 – 28 weeks’ (T1) and 35 – 36 weeks’ gestation (T2) in 183 obese pregnant women recruited to a pilot randomised trial of a combined diet and PA intervention (the UPBEAT study).ResultsValid PA data were available for 140 (77%), 76 (42%) and 54 (30%) women at T0, T1 and T2 respectively. Moderate and vigorous physical activity as a proportion of accelerometer wear time declined with gestation from a median of 4.8% at T0 to 3% at T2 (p < 0.05). Total activity as a proportion of accelerometer wear time did not change. Being more active in early pregnancy was associated with a higher level of PA later in pregnancy. The intervention had no effect on PA.ConclusionsPA in early pregnancy was the factor most strongly associated with PA at later gestations. Women should be encouraged to participate in PA before becoming pregnant and to maintain their activity levels during pregnancy. There is a need for effective interventions, tailored to the needs of individuals and delivered early in pregnancy to support obese women to be sufficiently active during pregnancy.Trial registrationCurrent Controlled Trials ISRCTN89971375 (Registered 28/11/2008).

What neonatal complications should the pediatrician be aware of in case of maternal gestational diabetes?

In the epidemiologic context of maternal obesity and type 2 diabetes (T2D), the incidence of gestational diabetes has significantly increased in the last decades. Infants of diabetic mothers are prone to various neonatal adverse outcomes, including metabolic and hematologic disorders, respiratory distress, cardiac disorders and neurologic impairment due to perinatal asphyxia and birth traumas, among others. Macrosomia is the most constant consequence of diabetes and its severity is mainly influenced by maternal blood glucose level. Neonatal hypoglycemia is the main metabolic disorder that should be prevented as soon as possible after birth. The severity of macrosomia and the maternal health condition have a strong impact on the frequency and the severity of adverse neonatal outcomes. Pregestational T2D and maternal obesity significantly increase the risk of perinatal death and birth defects. The high incidence of maternal hyperglycemia in developing countries, associated with the scarcity of maternal and neonatal care, seriously increase the burden of neonatal complications in these countries.

Outcomes of Triplets reduced to Twins versus non-reduced Triplet Pregnancies.

This study examined the outcomes of triplet pregnancies selectively reduced to twin pregnancies, compared with non-reduced triplet pregnancies using a standardized approach. This study is an observational retrospective study of all women who presented to the Fetal Diagnostic Center between 1999-2009, had triplet pregnancies in the first trimester, received prenatal care and delivered at Abington Memorial Hospital. Data analysis was performed with SPPS version 15 for Windows using analysis of variance and Fisher's Exact test. 132 triplet pregnancies were identified. In the reduced group (n = 30) compared to the non-reduced triplet group (n = 102) average gestational age of delivery was longer 34.6 weeks versus 31.2 weeks gestation (P = <0.0005) and days in hospital were less 9.0 versus 26.7 days (P = .001). There was a significantly lower incidence of gestational diabetes and preterm labor in reduced pregnancies. Rate of loss, defined as delivery less than 24 weeks, were similar [3.3% versus 4.9%]. Women electing to reduce a triplet pregnancy to twins have higher gestational ages at delivery, lower rates of gestational diabetes and preterm labor, and spent fewer days in hospital than non-reduced triplet pregnancies.

Customized Nutritional Enhancement for Pregnant Women Appears to Lower Incidence of Certain Common Maternal and Neonatal Complications: An Observational Study

A retrospective chart review analyzed the effect of customized nutrition on the incidence of pregnancy-induced hypertension (PIH), gestational diabetes (GDM), and small- and large-for-gestational-age (SGA, LGA) neonates, examining consecutive deliveries between January 1, 2011, and Decem ber 31, 2012, at a low-risk community hospital. The population was divided into 3 groups: (1) study group (SG), (2) private practice (PP), and (3) community healthcare clinic (CHCC). All groups received standard perinatal management, but additionally the study group was analyzed for serum zinc, carnitine, total 25-hydroxy cholecalciferol (25 OH-D), methylene tetrahydrofolate reductase, and catechol-O-methyl transferase polymorphisms in the first trimester prior to intervention, with subsequent second trimester and postpartum assessment of zinc, carnitine, and 25 OH-D after intervention. Intervention consisted of trimesterby-trimester nutrition and lifestyle education, supplementation of L-methyl folate, magnesium, essential fatty acids, and probiotics for all SG patients, with targeted supplementation of zinc, carnitine, and 25 OH-D. Because of small case occurrence rates of individual conditions in the study group, unreportable reductions were found, except GDM (SG vs CHCC, P value .046 with 95.38% confidence interval [CI]), and PIH (SG vs PP, P value .0505 with 94.95% CIl). The aggregated occurrence rate of the four conditions, however, was significantly lower in the study population than in either comparison population (PP P value .0154 with 98.46% CI, and CHCC P value .0265 with 97.35% CI). Customized nutritional intervention appears to have significantly reduced adverse perinatal outcomes. Prospective study within larger, at-risk populations is needed to determine whether customized nutrition improves conditions individually.

Timing of elective repeat caesarean does matter: Importance of avoiding early-term delivery especially in diabetic patients

Five hundred and three elective repeat caesarean sections were analysed to examine the impact of timing of delivery between 37 and 40 weeks’ gestation on foetal and maternal short-term outcome. Gestational age, Apgar scores and admission to the neonatal intensive care unit (NICU)-based foetal outcome. Maternal complications were comparatively evaluated. Due to the increasing incidence of gestational diabetes a subgroup analysis on this issue was performed. Neonates born by elective repeat caesarean in early term had a 3.2 times increased risk of being admitted to the NICU due to foetal adaption disorders in the early post-natal phase. Overall maternal peri-operative risks were low and did not differ significantly between 37 and 41 weeks’ gestation. Maternal gestational diabetes constituted an additional independent risk factor in early term. In summary, elective early-term caesarean delivery appears to negatively impact immediate neonatal outcome. Waiting at least until 38 completed weeks’ gestation improves foetal outcome, especially in diabetic patients.

DİYABETİK ANNE BEBEKLERİNİN YENİDOĞAN DÖNEMİ SORUNLARI

Objectives: Diabetes is a disease that effects fetal development during pregnancy and leads metabolic disorders in newborns. In this study, we aimed to evaluate the problems of infants of diabetic mothers and to determine risk factors of mothers during pregnancy. Material and Methods: The morbidity rates of 31 infants of diabetic mothers who were born and followed in neonatal intensive unit between January 2013 and December 2013 at Gaziosmanpasa University and demographic properties of mothers were retrospectively evaluated. Results: A total of 31 infants were included. The incidence of insulin dependent diabetes mellitus was %22,6 and the incidence of gestational diabetes was 77,4%. Mothers’ mean age was 32,6±7,9 years and HbA1c level was 5,4±1 (4,2-10,2). The mean gestational age of infants was 37,5±1,5 weeks and the mean birth weight of infants was 3322,5± 695,8 g. Macrosomia was present in 32.2% of infants. Hypoglycemia was present in 9,7% of infants, hypocalcemia was seen 3.2%, polycytemia was seen 6.5%, anemia was seen 6.5%, thrombocytopenia was seen 9.2%, hyperbilirubinemia was seen 41.9%, respiratory distress syndrome was seen 12.9%, congenital anomaly was seen 3.7% of all infants. There was no correlation between HbA1c levels of mothers and hypoglycemia, hypocalcemia, anemia and respiratory distress syndrome. Conclusion: Many complications may be prevented with appropriate management, obstetric care and neonatal management in infants of diabetic mother. It is possible to reduce morbidities with the identification of gestational diabetes and metabolic control of hyperglycemia, the determination of risk factors, the close contact between the diabetic mother and her infant in the first hours of delivery and the close follow-up of infants of diabetic mothers with rooming-in who do not need neonatal intensive care unit care.

Pregnancy glycaemia and cord-blood levels of insulin and leptin in Pakistani and white British mother-offspring pairs: findings from a prospective pregnancy cohort.

Aims/hypothesisTo determine the extent to which gestational fasting and postload levels of glucose explain differences in infant fat mass between UK-born Pakistani and white British infants.MethodsAnalyses were undertaken in a prospective pregnancy cohort study of 1,415 women and their singleton live-born infants (629 white British and 786 Pakistani). Infant fat mass was assessed by cord-blood leptin levels and fetal insulin secretion by cord-blood insulin levels. Maternal OGTTs were completed at 26–28 weeks of gestation.ResultsPakistani women had higher fasting and postload glucose levels and greater incidence of gestational diabetes than white British women. Higher fasting and postload glucose levels were associated with higher cord-blood levels of insulin and leptin in all participants, irrespective of ethnicity. Cord-blood leptin levels were 16% (95% CI 6, 26) higher in Pakistani than in white British infants. After adjustment for fasting glucose levels, this difference attenuated to 7% (−3, 16), and with additional adjustment for cord-blood insulin levels it attenuated further to 5% (−4, 14). Path analyses supported the hypothesis that fasting glucose levels mediate the relationship of Pakistani ethnicity to greater fat mass at birth, as measured by cord-blood leptin levels; on average, 19% of this mediation involved fetal insulin secretion. Postload glucose levels did not act as an important mediator of ethnic differences in cord-blood leptin levels. Results were very similar when 130 women with gestational diabetes were removed.Conclusions/interpretationThese novel findings suggest a role of maternal pregnancy glycaemia in mediating differences in fat mass between Pakistani and white British infants.Electronic supplementary materialThe online version of this article (doi:10.1007/s00125-014-3386-6) contains peer-reviewed but unedited supplementary material, which is available to authorised users.

Fast food consumption and gestational diabetes incidence in the SUN project.

BackgroundGestational diabetes prevalence is increasing, mostly because obesity among women of reproductive age is continuously escalating. We aimed to investigate the incidence of gestational diabetes according to the consumption of fast food in a cohort of university graduates.MethodsThe prospective dynamic “Seguimiento Universidad de Navarra” (SUN) cohort included data of 3,048 women initially free of diabetes or previous gestational diabetes who reported at least one pregnancy between December 1999 and March 2011. Fast food consumption was assessed through a validated 136-item semi-quantitative food frequency questionnaire. Fast food was defined as the consumption of hamburgers, sausages, and pizza. Three categories of fast food were established: low (0–3 servings/month), intermediate (>3 servings/month and ≤2 servings/week) and high (>2 servings/week). Non-conditional logistic regression models were used to adjust for potential confounders.ResultsWe identified 159 incident cases of gestational diabetes during follow-up. After adjusting for age, baseline body mass index, total energy intake, smoking, physical activity, family history of diabetes, cardiovascular disease/hypertension at baseline, parity, adherence to Mediterranean dietary pattern, alcohol intake, fiber intake, and sugar-sweetened soft drinks consumption, fast food consumption was significantly associated with a higher risk of incident gestational diabetes, with multivariate adjusted OR of 1.31 (95% conficence interval [CI]:0.81–2.13) and 1.86 (95% CI: 1.13–3.06) for the intermediate and high categories, respectively, versus the lowest category of baseline fast food consumption (p for linear trend: 0.007).ConclusionOur results suggest that pre-pregnancy higher consumption of fast food is an independent risk factor for gestational diabetes.

Pregnancy outcomes in super-obese women – an even bigger problem? A prospective cohort study

Objective. To investigate whether differences exist in adverse pregnancy outcomes between morbidly obese (body mass index (BMI, kg/m 2 ) 40 - 49.9) and super-obese women (BMI ≥50). Methods: A prospective cohort study was undertaken at Tygerberg Hospital, a referral centre in the Western Cape Province of South Africa, of morbidly obese and super-obese pregnant women recruited from the antenatal clinic. Data were collected from the files 6 weeks after delivery. Primary outcomes included hypertension, diabetes mellitus and fetal macrosomia. Secondary outcomes included baseline characteristics, previous complications, antenatal and peripartum complications, and short-term neonatal outcomes. Results. Sixty-six morbidly obese and 46 super-obese women were enrolled. Super-obese women experienced significantly higher incidences of pre-eclampsia (24% v. 9%; p =0.03) and interuterine growth restriction (13% v. 2%; p =0.02) than morbidly obese women, and both groups had a high incidence of gestational diabetes (24% v. 24%; non-significant (NS)). Both super-obese and morbidly obese women experienced high rates of caesarean section (54% v. 41%; NS). In super-obese women these procedures lasted longer (50 v. 41 minutes; p 3 days) after delivery was also more common in super-obese women (65% v. 42%; p =0.03). Conclusion. Super-obese women encounter more major pregnancy complications (especially hypertensive, pre-eclamptic and surgical) than morbidly obese women, emphasising the fact that these women should be managed at institutions with sufficient expertise.

Does preconception care work?

To date, there is a lack of evidence to suggest that a systematic and coordinated approach to prepregnancy care might make a difference. To evaluate whether women who receive preconception care through a structured approach will be more likely to be healthy around the time of conception compared with women who plan their pregnancy but have not been exposed to preconception care. A case control study was undertaken of women who attended the preconception care service and subsequently conceived, received maternity care and gave birth at Mater Health Services Brisbane between January 2010 and January 2013. Pregnancy information and birth outcomes for each woman who attended the service were matched with those of three women who reported that they had planned their pregnancy but did not attend the service. Records were matched for prepregnancy BMI, age, parity, prepregnancy smoking status and number of health conditions. Pregnant women who attended preconception care were more likely to have received adequate peri-conceptual folate, to report being vaccinated against influenza and hepatitis B, to have consulted with a specialist with the specific aim of optimising a pre-existing health condition and to report less weight gain up until booking. Preterm birth and hypertensive disorders of pregnancy were less common amongst women who had attended preconception care, and there were trends towards a decreased incidence of gestational diabetes, LGA and fetal anomalies. These preliminary data provide some optimism that a comprehensive preconception care service may positively influence maternal and neonatal outcomes.

Pre-pregnancy obesity compromises obstetric and neonatal outcomes.

Obesity is an important issue among fertile women as it may affect obstetric and neonatal outcomes. Obstetric and neonatal outcomes of primiparous women were retrospectively analyzed in non-obese (n=11387) and obese (n=943) women. A subgroup analysis was performed in obese women divided into three groups: Grade I obesity (Group A, n=654), Grade II obesity (Group B, n=192), and Grade III obesity (Group C, n=97). Odds ratios (OR) were expressed with the corresponding 95% confidence intervals (CI). The incidence of gestational diabetes (non-obese, 1.9%; obese, 7.6%; Group C, 19.6%) and preeclampsia (non-obese, 3.3%; obese, 13.5%; Group C, 17.5%) increased with rising weight. The risk of non-elective cesarean section was significantly higher in obese women than in non-obese women (21.7% vs. 13.2%). The risk of extreme preterm birth (before 28 weeks of gestation) doubled in the Grade I obesity group (OR, 2.1; 95% CI, 1.4-3.2) and nearly tripled in women with body mass index ≥35 kg/m2 (OR, 2.9; 95% CI, 1.7-4.9). Pre-pregnancy obesity is associated with higher incidences of gestational diabetes and preeclampsia. Our study shows that obese women have a higher risk of non-elective cesarean section and preterm birth.

PPO.19 Probiotics in obese pregnancy to reduce maternal fasting glucose: A randomised controlled trial

ObjectivesProbiotics are live microorganisms which may confer health benefits on the host. Recent studies have demonstrated various beneficial effects of probiotics in pregnancy among healthy women.1 The aim of this...

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.

Incidence of gestational diabetes and birth complications in Switzerland: screening in 1042 pregnancies

To evaluate the incidence of gestational diabetes mellitus (GDM), gestational glucose intolerance (GGI), and birth major complications, a population of 1042 pregnant women was screened after the end of the second trimester with a two-step screening method. Patients with a positive 50-g screening test (plasma glucose ≥7.8 mmol/l at 1 h) underwent a 3-h standard 100-g oral glucose tolerance test. Clinical records of patients and newborns were analysed and compared to normotolerant patients group. GDM was found in 4.8% and GGI in 2.6% of all screened women of this study population. The patient group with GDM significantly differed from control, with a higher proportion of Asiatic women (32.0% versus 2.9%, p = 0.001) and high prevalence of previous GDM (26.0% versus 0.0%, p < 0.001). Major neonatal complications occurred more frequently in the dysmetabolic groups compared to normotolerant group. Macrosomia was not noted in our population. Asiatic origin and previous GDM were strongly associated with an increased incidence of GDM in multivariate analysis. This study represents the first epidemiological evaluation of GDM/GGI in Switzerland, with a two-step screening method. Incidence of GDM and GGI as well as birth complications resulted significant in our country.

Issues obstétricales des grossesses obtenues par Assistance médicale à la procréation chez les femmes endométriosiques

ObjectiveWhile association between endometriosis and infertility is well established, there are few studies about the impact of endometriosis on adverse pregnancy outcomes. The aim of this study was to determine the effect of endometriosis on obstetric outcomes and whether the severity of the disease had an influence on these. Patients and methodsWe performed a retrospective study to investigate the obstetric outcomes of a population of 1204 subfertile women, including 258 with endometriosis, who obtained, thanks to assisted reproduction technology, a singleton pregnancy evolving beyond embryonic stage. Two analyzes were performed. The first compared women with endometriosis to women with other causes of infertility. The second observed adverse pregnancy outcomes according to AFS-R stages of endometriosis. ResultsThe overall rate of live birth children was 95.8%. In case of endometriosis, there was a significant increase of the incidence of preterm delivery, especially before 32weeks amenorrhea (6.2% vs 3.1% in the group “without endometriosis”, P=0.03), antenatal bleeding (5.3% vs 2.2%, P=0.01) and placenta previa (4.9% vs 0.9%, P<0.0001). The incidence of gestational diabetes was significantly decreased (0.4% vs 2.7%, P=0.04). There was no correlation between endometriosis and cesarean section or preeclampsia, or between the AFS-R stage and adverse pregnancy outcomes. Discussion and conclusionEndometriosis is a factor of obstetrical risk, independently of the infertility it causes. The AFS-R score does not seem to be representative of obstetric outcomes beyond first trimester of pregnancy for women with endometriosis.

Perinatal outcome of twin pregnancies after early transvaginal multifetal pregnancy reduction

To compare the pregnancy outcomes of twin pregnancies following early transvaginal multifetal pregnancy reduction (MPR) with nonreduced twin gestations. Prospective cohort study. Two tertiary medical centers. A cohort of 77 multiple pregnancies after reduction to twins and 78 dichorionic-diamniotic nonreduced twins. Early fetal reduction. Pregnancy outcome. Triplet pregnancies reduced to twins (n = 55) and nonreduced twin pregnancies (n = 78) had comparable outcomes. The rates of preterm delivery ≤32 weeks (1.9% vs. 1.4%) and ≤34 weeks of gestation (15.1% vs. 19.2%) were similar among both groups. There was no difference in the mean gestational age (36.54 vs. 36.35 weeks) or mean birth weight (2,365 vs. 2,365 g) between the two groups. Similarly, there was no significant difference in the incidence of gestational diabetes (15.1% vs. 14.1%) and intrauterine growth retardation (IUGR; 1.9% vs. 9%) between the two groups. The incidence of gestational hypertension was higher in the study group (24.5% vs. 9%), but it was not associated with an increased risk for prematurity or IUGR. The perinatal outcome of twin pregnancies after early transvaginal fetal reduction from triplets seems to be comparable to the outcome of nonreduced twin pregnancies.

Prevention of gestational diabetes through lifestyle intervention: study design and methods of a Finnish randomized controlled multicenter trial (RADIEL)

BackgroundMaternal overweight, obesity and consequently the incidence of gestational diabetes are increasing rapidly worldwide. The objective of the study was to assess the efficacy and cost-effectiveness of a combined diet and physical activity intervention implemented before, during and after pregnancy in a primary health care setting for preventing gestational diabetes, later type 2 diabetes and other metabolic consequences.MethodsRADIEL is a randomized controlled multi-center intervention trial in women at high risk for diabetes (a previous history of gestational diabetes or prepregnancy BMI ≥30 kg/m2). Participants planning pregnancy or in the first half of pregnancy were parallel-group randomized into an intervention arm which received lifestyle counseling and a control arm which received usual care given at their local antenatal clinics. All participants visited a study nurse every three months before and during pregnancy, and at 6 weeks, 6 and 12 months postpartum. Measurements and laboratory tests were performed on all participants with special focus on dietary and exercise habits and metabolic markers.Of the 728 women [mean age 32.5 years (SD 4.7); median parity 1 (range 0-9)] considered to be eligible for the study 235 were non-pregnant and 493 pregnant [mean gestational age 13 (range 6 to 18) weeks] at the time of enrollment. The proportion of nulliparous women was 29.8% (n = 217). Out of all participants, 79.6% of the non-pregnant and 40.4% of the pregnant women had previous gestational diabetes and 20.4% of the non-pregnant and 59.6% of the pregnant women were recruited because of a prepregnancy BMI ≥30 kg/m2. Mean BMI at first visit was 30.1 kg/m2 (SD 6.2) in the non-pregnant and 32.7 kg/m2 (SD 5.6) in the pregnant group.DiscussionTo our knowledge, this is the first randomized lifestyle intervention trial, which includes, besides the pregnancy period, both the prepregnancy and the postpartum period. This study design also provides an opportunity to focus upon the health of the next generation. The study is expected to produce novel information on the optimal timing and setting of interventions and for allocating resources to prevent obesity and diabetes in women of reproductive age.Trial registrationClinicaltrials.gov Identifier: NCT01698385

Assessing the incidence of gestational diabetes and neonatal outcomes using the IADPSG guidelines in comparison with the Carpenter and Coustan criteria in a Belgian general hospital

We have conducted a systematic universal screening for gestational diabetes mellitus (GDM) since 2008, following the criteria outlined by the International Association of Diabetes and Pregnancy Study Group (IADPSG) since 2011. However, we recently replaced the IADPSG standards with those established by the Belgian French Language Gynecologists and Obstetricians Group (GGOLFB). These new criteria indicate GDM when fasting plasma glucose (FPG) is ⩾0·92 g/l at the beginning of pregnancy or when an orally provoked hyperglycaemia test (75 g of glucose) between the twenty-fourth and twenty-eighth week results in an FPG of ⩾0·92 g/l and/or ⩾1·80 g/l after 1 hour and/or ⩾1·53 g/l after 2 hours. The goal of this retrospective study was to evaluate the incidence of GDM, neonatal outcomes, and the use of insulin therapy 21 months post-implementation of the IADPSG criteria within our centre. A total of 393 patients were diagnosed with GDM from January 2009 to December 2012. After applying the new criteria, the incidence of GDM rose significantly from 8 to 23% (P<0·0001). However, there were no significant changes in the proportion of GDM patients requiring insulin therapy (34·2% versus 34·7%) or the rate of foetal large for gestational age (11·2% versus 8·8%). In addition, the ⩾90% percentile decreased non-significantly from 96·3±0·6% to 94·3±0·70% (P = 0·057), whereas the lower quartiles and the proportion of cesarean deliveries (27·0% versus 25·6%) did not change significantly. Therefore, non-targeted screening significantly increased the incidence of GDM in our centre without significantly decreasing large for gestational age or the number of cesarean deliveries.

Timing of delivery in women with diabetes in pregnancy.

The incidence of both gestational and pre-gestational diabetes is increasing worldwide. The main cause of this increase is likely the concomitant increase in the incidence of global obesity, but in the case of gestational diabetes, changes in the diagnostic criteria are also a contributing factor. The adverse outcomes associated with pre-gestational diabetes are well known and have led clinicians to implement various strategies that include increased fetal surveillance and induction of labour at various gestational ages. In many cases these same strategies have been applied in clinical practice also to women with gestational diabetes despite there being differences in the type and magnitude of perinatal complications associated with this diagnosis. Despite the widespread application of these clinical practices, there is a paucity of quality data in the medical literature to guide the clinician in choosing a strategy for fetal surveillance and timing of delivery in both gestational diabetes and pre-gestational diabetes pregnancies. In the following review, we will discuss the rationale and consequences of planned delivery in gestational diabetes and pre-gestational diabetes, the evidence supporting different strategies for delivery and finally highlight future targets for research in this area.

Gestational Diabetes: Risk Factors, Perinatal Complications and Screening Importance in Niger Delta Region of Nigeria: A Public Health Dilemma

Aim: The study identified the incidence of undiagnosed gestational diabetes and its consequences on maternal/neonatal mortality and highlighted screening importance in an African urban setting in the Niger Delta region in Nigeria. Study Design: Randomised study. Place and Duration of Study: Pregnant women attending antenatal clinics in one tertiary, six primary, six secondary, hospitals, and six maternity homes in the Niger delta area of Nigeria between May 2006 to May 2009. Method: A total of 1920 pregnant women were recruited into the study. While 956 received the oral glucose test and formed the study group, 964 declined from continuing in the study, and formed the control group. Results: Women with gestational diabetes were at increased risk for premature rupture of membranes, preterm birth; breech presentation and high birth weight adjusting for maternal age. Conclusion: The presence of gestational diabetes in pregnancy is predictive of poor pregnancy outcome as it remains undetected in conception resulting in unto wards maternal/neonatal complications.