National Diabetes Data Group Criteria Research Articles

Variation of prevalence of macrosomia and cesarean section and its influencing factors

To investigate the varaiation of the incidence of macrosomia and its influencing factors. A population-based study of 25 944 pregnant women, who delivered in Peking University First Hospital in term birth, with singleton, between Jan. 1, 2006 and Dec. 31, 2013 and accepted the gestational diabetes mellitus (GDM) screening and diagnosis, was performed. The women are grouped according to the different clinical interventions at different period. Women delivered between Jan.1, 2006 and Dec. 31, 2006 was defined as Group 2006, and they were diagnosed with glucose metabolism disorder [gestational impaired glucose tolerance (GIGT) and GDM] and intervened only when meeting National diabetes data group (NDDG) criteria. Women delivered between Jan. 1, 2007 and Apr. 30, 2011 were defined as Group post 2007, and NDDG criteria was also applied in this period. Women delivered between May. 1, 2011 and Dec. 31, 2013 were defined as Group post 2011, and Ministry of Health (MOH) of China was used for GDM diagnosis in this group. All pregnant women in Group post 2007 accepted the preliminary pregnancy nutrition advice and weight management. All participants met MOH criteria were diagnosed as glucose metabolism disorder in this study, in which women diagnosed and intervened in pregnancy were defined as Group diagnosis and those not being identified during pregnancy were defined as Group missed diagnosis. It was analyzed retrospectively for the incidence of macrosomia and the influencing factor. (1) The prevalence of macrosomia and cesarean section was decreased every year from Jan. 2006 to Dec. 2013. The incidence of macrosomia was 9.14% in 2006, reduced to 8.02% in 2007-2011 and 6.79% in 2011-2013. The incidence of cesarean section was 55.22%, reduced to 51.04% in 2007-2011 and 44.15% in 2011-2013. However, there was not remarkable change in the prevalence of small for gestational age (P > 0.05). (2) Compared with Group 2006, the incidence of cesarean section was lower in Group post 2007 [51.04% (6 504/12 744) vs 55.22% (1 371/2 483)], and the difference is significantly (P < 0.05). Meanwhile, the incidence of cesarean section (44.15%, 4 732/10 717) and macrosomia (6.79%,728/10 717) in Group post 2011 was lower significantly than Group 2006 and Group post 2007 (P < 0.05). (3) The incidence of macrosomia was 7.41% (1 129/15 227) and 6.61% (1 006/15 227) respectively in Group diagnosis and Group missed diagnosis before May 2011, combined 14.02% (2 135/15 227) in total. It was increased significantly in the incidence of GDM 21.41% (2 294/10 717) after May 2011 compared with that before (P < 0.05). The incidence of macrosomia was decreased significantly using MOH criteria in GDM women since 2011. It was the downtrend in the incidence of macrosomia since 2007 in non GDM women. However, there was no difference in SGA in different period. (4) In glucose metabolism disorder women, compared with Group 2006 and Group post 2007, the incidence of macrosomia and cesarean section was lower in Group post 2011, and the difference is significantly (P < 0.05). However, there was no significant difference in the incidence of macrosomia and cesarean section between Group 2006 and Group post 2007, and there was no difference in SGA in the 3 groups ( P > 0.05). In non GDM women, the incidence of macrosomia and cesarean section was lower in Group post 2011 than Group 2006 (P < 0.05); meanwhile, it was the downtrend in the incidence of macrosomia in Group post 2007 compared to Group 2006, and the difference of the incidence of cesarean section was significant (P < 0.05). The prevalence of macrosomia and cesarean section might be reduced by application of suitable criteria for diagnosis of GDM and education on nutrition during pregnancy.

Diagnosis of gestational diabetes mellitus: comparison between National Diabetes Data Group and Carpenter– Coustan criteria

Abstract Background: A 100-g oral glucose tolerance test (OGTT) is commonly used to diagnose gestational diabetes mellitus (GDM). Carpenter-Coustan (CC) criteria, based on lower threshold plasma glucose values than the National Diabetes Data Group (NDDG) criteria, result in an apparently increased prevalence of GDM. However, the extent of the increase is not known, and effects on perinatal outcome are not clear. Objective: To evaluate the increase in the prevalence of GDM if CC criteria are applied to OGTT results, we compared findings with NDDG criteria. Pregnancy outcomes between women without GDM and those with GDM diagnosed by NDDG and CC criteria were compared. Methods: A total of 640 at-risk pregnant women were studied. They were either diagnosed as having GDM by initial testing (145 women), or repeat testing at 24−28 weeks of gestation (495 women). CC criteria were applied to the OGTT results and prevalence of GDM was re-evaluated. Results: The apparent prevalence of GDM increased by 22.2% using CC criteria. The change was 27.6% at the initial test and 31.5% at repeat tests during 24−28 weeks of gestation. Infant birth weight in GDM diagnosed by either NDDG or CC criteria was significantly higher than in the negative OGTT group (P &lt; 0.001). Rates of macrosomia were comparable. Neonatal hypoglycemia was 14.6% in the NDDG group, 8.2% in CC only group, and 4.6% in negative OGTT group (P &lt; 0.001). Conclusion: The CC criteria identify 22% more cases of GDM than NDDG criteria during initial and repeat tests.

Hyperglycaemia in pregnancy: what's in a name?

Hyperglycaemia in pregnancy: what's in a name?

Abnormal glucose tolerance is associated with preterm labor and increased neonatal complications in Taiwanese women

ObjectiveTo investigate the relationship between abnormal degrees of oral glucose tolerance test (OGTT) results and pregnancy outcomes. Materials and methodsA total of 7513 singleton pregnancies screened for gestational diabetes mellitus were enrolled in this retrospective observational study. The pregnancy outcomes of six different groups with different degrees of glucose intolerance using the OGTT were compared [both the National Diabetes Data Group (NDDG) and Carpenter and Coustan (C&C) criteria were used]. The pregnancies were classified into the following groups: the normal group, consisting of pregnancies with a negative 50-g glucose challenge test (GCT), and Grade 0, 1, 2, 3 and 4 groups, consisting of pregnancies with positive 50-g GCT, and abnormal values of 0, 1, 2, 3 and 4 from the 100-g OGTT, respectively. ResultsThe adjusted odds ratios (95% confidence interval) for preterm labor and admission to the neonatal intensive care unit (NICU) were shown to be increased in the Grade 4 groups [3.31 (1.47–7.43) and 6.31 (3.14–12.70) by the NDDG criteria; 4.13 (2.30–7.43) and 5.25 (3.00–9.19) by the C&C criteria] compared with the normal group. ConclusionThe results indicated an increased risk for preterm labor and admission to the NICU as the abnormal value of the OGTT increased.

Screening for Gestational Diabetes: A Systematic Review and Meta-Analysis

Gestational diabetes mellitus (GDM) is defined as any degree of hyperglycemia with first recognition during pregnancy. The optimal time to screen for GDM that would maximize the yield and benefits remains unclear. Our objective was to appraise the evidence regarding screening for GDM (accuracy, correlation with adverse outcomes, and harms). We searched Ovid Medline, OVID EMBASE, OVID Cochrane Library, Web of Science, Scopus, PsycInfo, and CINAHL through May 2011. We included randomized controlled trials and observational studies that enrolled pregnant woman who were evaluated using different GDM screening tests. Two reviewers working independently abstracted the data. We did not find any randomized controlled trials of GDM screening that measured feto-maternal outcomes. A 1-hour 50-g glucose challenge test with a cutoff point at 140 mg/dL was the most commonly used screening method. The results of this test were statistically associated with feto-maternal outcomes (P < .001), even though only 11% of individuals with a positive test (according to Carpenter and Coustan criteria) developed GDM. Positive Carpenter and Coustan criteria were associated with macrosomia (odds ratio [OR] = 2.4, 95% confidence interval [CI] = 1.9-3.1, P < .001) and gestational hypertension (OR = 1.7, CI = 1.3-2.1, P < .001). Positive National Diabetes Data Group criteria were also associated with macrosomia (OR = 3.2, CI = 2.3-4.4, P < .001) and gestational hypertension (OR = 2.1, CI = 1.6-2.8, P < .001). Indirect evidence supports the use of contemporary screening tests for GDM to identify pregnancies at increased risk of adverse feto-maternal outcomes. It also suggests that use of these tests will place some women under unnecessary treatment for GDM.

A common gene variant in STK11 is associated with metabolic risk markers and diabetes during gestation

To assess whether the common rs8111699 (C528G) variant in STK11 is related to metabolic risk markers in pregnant women and to gestational diabetes mellitus (GDM). Cross-sectional study. Hospital. A total of 561 pregnant women: 318 without and 243 with GDM (National Diabetes Data Group criteria). None. rs8111699 variant in STK11 (Taqman technology). Fasting glucose, insulin (homeostatic model assessment of insulin resistance and β-cell function [HOMA-IR and -β]) and C-peptide assessed at 24-28 weeks' gestation. In non-GDM women, the G allele in rs8111699 was associated with lower HOMA-IR (CC: 1.3 ± 0.1 mIU/L; GG: 0.9 ± 0.1 mIU/L) and HOMA-β (CC: 165 ± 20 mIU/L; GG: 118 ± 10 mIU/L). In GDM women, the G allele was related to lower body mass index (BMI; CC: 27.9 ± 1.0 kg/m(2); GG: 24.5 ± 0.6 kg/m(2)) and C-peptide (CC: 2.3 ± 0.1 ng/mL; GG: 1.6 ± 0.1 ng/mL). The GG genotype was less frequently observed in GDM women (18% vs. 26%), particularly in heavier GDM women (BMI > median: 14% vs. 28%). In pregnant women, the G allele for the rs8111699 variant in STK11 is associated with a more favorable metabolic phenotype and may protect against the development of GDM, particularly in heavier women.

Influence of Food Intake on the Predictive Value of the Gestational Diabetes Mellitus Screening Test

To investigate the influence of prior food ingestion on the predictive value of a screening test for gestational diabetes mellitus. This prospective, nonrandomized study enrolled 1,387 pregnant women who underwent the 50-g glucose challenge test. Gestational diabetes mellitus was diagnosed according to the National Diabetes Data Group criteria. A nutritional survey of dietary information before the glucose challenge test was conducted. The patients were stratified into three groups based on the time of last food ingestion (fasting interval): 1 hour or less, 1-2 hours, and more than 2 hours. The more than 2-hours fasting interval group was defined as the "fasting" group, and the combined 1 hour or less and 1-2 hours fasting interval groups were defined as the "fed" group. We calculated the positivity rate and the positive predictive value to detect the predictive value. Among women who fasted 1 hour or less, 1-2 hours, and more than 2 hours before a glucose challenge test, 2.5%, 3.1%, and 6.9% were diagnosed with gestational diabetes mellitus, respectively. The positive predictive value of the glucose challenge test was greater in the fasting group than in the fed group (27.1% compared with 13.7%, P=.003). A multinomial logistic analysis showed that gestational diabetes mellitus was more prevalent in the fasting group than in the fed group (adjusted odds ratio 2.86, 95% confidence interval 1.65-4.95). Our findings suggest that food intake influences the predictive value of the gestational diabetes screening test. II.

Outcome of Gestational Diabetes Mellitus from a Tertiary Referral Center in South India: A Case–Control Study

Carbohydrate intolerance is the most common metabolic complication of pregnancy. Gestational diabetes mellitus (GDM) poses numerous problems for both mother and fetus. The objective of this study was to compare the maternal and perinatal outcome between women with gestational diabetes mellitus and non-diabetic women. A case-control study with 286 cases and 292 age-matched controls was conducted for a period of 11months (August 2007-June 2008) in Sree Avittom Thirunal Hospital, Thiruvananthapuram, India. Universal screening was applied by means of glucose challenge test (GCT) using 50g of glucose. If GCT >130mg%, the patients were subjected to oral glucose tolerance test with 100g of glucose. National Diabetes Data Group criteria was taken to assign patients to study group. These women were further followed up and the maternal and perinatal outcomes were assessed. Univariate analysis was done by means of t test, Odd's ratio, Chi-square test, and Fisher Exact test. P<0.05 was taken as significant. The frequency of induction of labor was significantly higher than spontaneous labor (OR=1.84, P=0.001). 40.1 % GDM mothers and 35.8 % of non-diabetic mothers were delivered by Cesarean section. Premature rupture of membranes (PROM) was the most common complication of labor (OR=1.66, P=0.04). Babies of diabetic mothers had a positive trend toward prematurity (OR=2.3, P=0.007). Hypoglycemia was the most common neonatal complication (OR=11.97, P<0.001) and nine babies of diabetic mothers were macrosomic (OR=5.2, P=0.02). Maternal morbidities and neonatal complications such as neonatal hypoglycemia, macrosomia, and prematurity were significantly higher in GDM.

Maternal Body Mass Index Is a Predictor of Neonatal Hypoglycemia in Gestational Diabetes Mellitus

In diabetic pregnancy, neonatal hypoglycemia (NH) is usually attributed to insufficient regulation of maternal glycemic control. Recent data suggest that maternal body mass index (BMI) could have an influence. Our objective was to determine whether an association exists between maternal prepregnancy BMI category and occurrence of NH among infants born to women with gestational diabetes mellitus (GDM). This was a retrospective study including all GDM pregnancies delivered between 1986 and 2006 at a tertiary care center (Hospital de la Santa Creu i Sant Pau, Barcelona). PATIENTS AND OUTCOMES: GDM was diagnosed using universal screening and National Diabetes Data Group criteria. Two thousand ninety-two newborns (1925 singletons, 85% of total GDM offspring) were studied. NH was defined according to Cornblath criteria. In addition to maternal BMI, we considered other variables such as glucose values at diagnosis or third-trimester glycated hemoglobin as potential predictors of NH. We explored whether the association between maternal BMI and NH could be due to intermediate steps such as cesarean section or abnormal birth weight. The rate of NH was 3%. In the bivariate analysis, prepregnancy BMI was higher in the NH group (24.45 vs. 23.19 kg/m(2), P < 0.02). In the logistic regression analysis, prepregnancy BMI of at least 25 kg/m(2) was independently associated with NH whether the analysis included intermediate variables (odds ratio = 2.11; 95% confidence interval = 1.10-4.03) or not (odds ratio = 2.66; 95% confidence interval = 1.44-4.92). Pregestational BMI should be considered among the predictors of NH in offspring of women with GDM.

What is the best cut-off point for screening gestational diabetes in Turkish women?

To find an optimal threshold level with higher sensitivity and specificity for screening of gestational diabetes mellitus (GDM) in Turkish pregnant women. Materials and methods: This was a retrospective study. Screening for GDM was performed in all pregnant women between 24 and 28 weeks of gestation using the 1 h 50 g glucose challenge test (GCT) with a subsequent 3 h 100 g oral glucose tolerance test (OGTT) for confirmation if screened positive. The glucose values obtained were analyzed by both the Carpenter and Coustan (C&C criteria) and National Diabetes Data Group (NDDG) criteria. Results: There were 808 women meeting the study inclusion criteria. There were 66 (8.1%) women diagnosed with GDM using the C&C criteria and 45 (5.7%) using the NDDG criteria. The best cut-off point for GCT was 132 mg/dL for detecting GDM. No diabetes was found below the glucose level of 130 mg/dL. Conclusion: GCT is suitable for screening of Turkish women, but place of residence as well as race must be taken into consideration to establish the best cut-off level of GCT, since ethnic and environmental factors may contribute to the occurrence of GDM.

555: The association of glycosylated hemoglobin (HbA1c) with infant birthweight among women with gestational diabetes: a classification and regression tree (CART) analysis

with infant birthweight among women with gestational diabetes: a classification and regression tree (CART) analysis Erica K Berggren, Thomas Stewart, Kim Boggess UNC Hospitals, Obstetrics & Gynecology, Chapel Hill, NC, UNC Gillings School of Global Public Health, Biostatistics, Chapel Hill, NC, University of North Carolina at Chapel Hill, Obstetrics and Gynecology, Chapel Hill, NC OBJECTIVE: To determine if third trimester HbA1c is associated with infant birthweight in women with gestational diabetes (GDM), using traditional regression analysis as well as a classification and regression tree (CART) analysis that examines non-independent relationships of variables associated with birthweight. STUDY DESIGN: We conducted a retrospective cohort study of women diagnosed with GDM using National Diabetes Data Group criteria between April 1996 and May 2010. A subset of women with GDM had a HbA1c collected during the third trimester, in addition to routine screening and diagnostic test results. This subset comprised our sample for analysis. We used linear regression to estimate the association between birthweight, body mass index (BMI), and log transformed measures of all glucose values. We performed a CART analysis to develop a decision tree that offers data-drive thresholds and explores potential interactions and non-linear relationships between variables and infant birthweight. RESULTS: Over 14 years, 1082/33179 (3.3%) of women screened were diagnosed with GDM. A subset of 114 had complete data that included HbA1c. Mean birthweight was 3506 g (SD 678g). Maternal BMI, one-hour screening glucose load result, and fasting diagnostic OGTT were independently associated with infant birthweight (p 0.01, 0.02, 0.02, respectively). HbA1c increased, but not significantly, with increasing birthweight (p 0.05). CART analysis classified each pregnancy into one of four groups. The analysis selected HbA1c 5.7 as the most discriminating variable to predict birthweight, followed by BMI 29.8mg/kg2, and fasting GDM diagnostic test result of 126mg/dL. Values above these hierarchical thresholds denote a group with higher birthweight. (Figure). CONCLUSION: CART analysis, allowing for variable interaction, suggests HbA1c may be associated with infant birthweight, beyond associations identified by a traditional linear regression analysis. Prospective studies examining the predictive use of HbA1C for birthweight is warranted based on this analysis. 556 The NICHD-MFMU GDM study: differences in perinatal outcomes between Hispanic women and Non-Hispanic White women with and without gestational diabetes Erica Berggren For the Eunice Kennedy Shriver National Institute of Child Health and Human Development, MFMU Network, Bethesda, MD OBJECTIVE: Racial/ethnic differences in pathophysiology of gestational diabetes (GDM) may impact perinatal outcomes among these women. We evaluated differences in perinatal outcomes between Hispanic women and non-Hispanic White women with treated or untreated GDM and with glucose intolerance. STUDY DESIGN: We evaluated perinatal outcomes among Hispanic women and Non-Hispanic White women enrolled in a multicenter study of mild GDM treatment. Racial/ethnic comparisons were performed using multiple regression for 1) 931 women assigned to an observational cohort with glucose intolerance but not GDM (50 gram 1-hr glucose load result 135-199 mg/dl with subsequent negative 100 gram 3-hr oral glucose tolerance test), 2) 473 women with mild gestational diabetes and assigned to usual prenatal care, and 3) 485 women with mild gestational diabetes and assigned to treatment. Outcomes included: composite perinatal outcome (stillbirth, neonatal death, hypoglycemia, hyperbilirubinemia, neonatal hyperinsulinemia, birth trauma), gestational age at delivery, birth weight, and hypertensive disorders of pregnancy. RESULTS: The study cohort was 59.8% Hispanic and 27.5% non-Hispanic White. Outcomes are shown in the Table. Within the observational cohort, Hispanic women had more frequent composite perinatal outcome (aOR 1.64 95%CI 1.14, 2.37) and delivered at a greater gestational age (0.38 / 0.14 weeks, P .008), compared with nonHispanic White women. Similarly, among those diagnosed with but not treated for mild GDM, Hispanic women delivered at a greater gestational age (0.52 / 0.21 weeks, P .014). Perinatal outcomes were similar for Hispanic and non-Hispanic White women with mild GDM, regardless of treatment. CONCLUSION: Treated and untreated Hispanic women and non-Hispanic White women with mild GDM have comparable outcomes. Composite adverse perinatal outcome is more frequent among Hispanic women with glucose intolerance but without a diagnosis of GDM. PosterSessionIV Epidemiology, Infectious Disease, Intrapartum Fetal Assessment, Operative Obstetrics, Obstetric Quality & Safety, Public Health-Global Health www.AJOG.org

Gestational diabetes: comparision of the carpenter and the coustan thresholds with the new thresholds of Turkish women and implications of variations in diagnostic criteria

Objective: To find optimal 100-g 3-h oral glucose tolerance test (OGTT) threshold levels for diagnosis of gestational diabetes (GDM) in Turkish pregnant women. Methods: This study was conducted with 808 women screened for GDM between 24–28 weeks of gestation using the 1-h 50-g glucose challenge test (GCT) with a subsequent 3-h 100-g OGTT for confirmation if screen was positive. The glucose values obtained were analysed by both the Carpenter and Coustan (C&C criteria) and National Diabetes Data Group (NDDG) criteria for the diagnosis of GDM and IGT. Optimal OGTT cutoff values for Turkish population were calculated by ROC curve analysis. Results: The new diagnostic criteria, based on the result of the 100-g OGTT obtained from the healthy pregnant women, were 82.5, 171.5, 151.5, and 111.5 mg/dl at 0, 1, 2, and 3 h. The prevalence of GDM was 15.7% by the new criteria, 8.1% by C&C criteria, and 5.6% by the NDDG criteria. According to new criteria, 7.7% of infants of diabetic mothers had macrosomia. This ratio was 2.6% for non diabetic women. Conclusions: Ethnic differences, enviromental factors and nutritional habits may effect development of GDM. Application of some pre-determined nomograms to all races and ethnic groups can lead errors.

National Diabetes Data Group vs Carpenter-Coustan criteria to diagnose gestational diabetes

The objective of the study was to compare perinatal outcomes among women diagnosed with gestational diabetes by the National Diabetes Data Group (NDDG) criteria with women meeting only Carpenter-Coustan criteria. This was a 14 year retrospective cohort. Women who screened positive with 1 hour glucose load 140 mg/dL or greater underwent a diagnostic 3 hour oral glucose tolerance test. We report adjusted prevalence ratios (aPRs) of perinatal outcome risk. Of the 4659 screen-positive women with diagnostic testing, 1082 (3.3%, of 33,179) met NDDG criteria; 1542 (4.6%, of 33,179), or 460 more, met Carpenter-Coustan criteria. These 460 untreated women had greater risk of preeclampsia than women diagnosed by NDDG criteria (aPR, 1.70; 95% confidence interval [CI], 1.23-2.35). They had a greater risk of cesarean delivery (aPR, 1.16; 95% CI, 1.04-1.30) and infants greater than 4000 g (aPR, 1.25; 95% CI, 1.01-1.56) than women not meeting either diagnostic criteria. The 42.5% additional women diagnosed only by Carpenter-Coustan criteria are at greater risk for some adverse outcomes. Cost-effectiveness of a change remains to be determined.

Sex hormone-binding globulin of gestational diabetes mellitus pregnant women with well-controlled glucose and pregnancy outcomes

To explore the relationship between sex hormone-binding globulin (SHBG) of gestational diabetes mellitus (GDM) pregnant women with well-controlled glucose and pregnancy outcomes. Two hundred and fifty-one GDM pregnant women of 24 - 28 weeks in Shengjing Hospital of China Medical University were recruited from Mar. 2005 to Mar. 2010. Two hundred and sixteen cases of GDM with well-controlled glucose were defined as glycemic satisfied group, and they were treated by diet therapy (169 cases) or insulin therapy (47 cases). Thirty-five cases with unsatisfied glucose were defined as glycemic unsatisfied group. One hundred and ninety-two healthy pregnant women of 24 - 28 weeks were defined as healthy control group. Serum SHBG and homeostasis model analysis of insulin resistance (HOMA-IR) at 24 - 28 weeks and above 36 weeks were measured. GDM was diagnosed by "two-step" method according to the National Diabetes Data Group (NDDG) criteria. The pregnancy outcomes and complications of the three groups were recorded. (1) Comparison of pregnancy outcomes and complications:glycemic satisfied group was less likely to develop hypertensive disorders in pregnancy (10.6%), premature birth (8.3%), large for gestational age (LGA) (8.8%), neonatal asphyxia (3.7%) and neonatal hypoglycemia (2.3%) compared to glycemic unsatisfied group (42.9%, 34.3%, 31.4%, 22.9% and 11.4%, respectively). And the difference was statistically significant (P < 0.05 or P < 0.01). There was no significant difference for incidence of polyhydramnios, pueperal infection, postpartum hemorrhage, neonatal hyperbilirubinemia between the two groups (P > 0.05). When compared to healthy control group (7.3%, 2.1%, 4.2%, 2.1% and 1.6%), no significant difference was found for incidence of premature birth (8.3%), pueperal infection (3.2%), postpartum hemorrhage (5.1%), neonatal asphyxia (3.7%) and neonatal hypoglycemia (2.3%, P > 0.05). (2) Comparison of results of 24 - 28 weeks and above 36 weeks: serum SHBG of glycemic satisfied group [(384 ± 88), (457 ± 48) nmol/L] was significantly higher than that of glycemic unsatisfied group [(313 ± 45), (401 ± 73) nmol/L]; HOMA-IR of glycemic satisfied group (5.3 ± 1.1, 5.5 ± 1.1) was significantly lower than that of glycemic unsatisfied group (7.0 ± 1.3, 7.6 ± 1.7; P < 0.01). Serum SHBG of glycemic satisfied group was significantly lower than that of healthy control group [(492 ± 95), (565 ± 40) nmol/L]; and HOMA-IR of glycemic satisfied group (5.3 ± 1.1, 5.5 ± 1.1) was significantly higher than that of healthy control group (3.6 ± 0.6, 3.9 ± 0.5; P < 0.01). FPG of glycemic satisfied group [(5.84 ± 0.28), (5.16 ± 0.13) mmol/L] was significantly lower than that of glycemic unsatisfied group [(6.13 ± 0.16), (5.68 ± 1.14) mmol/L;P < 0.01]. FINS of glycemic satisfied group [(20.4 ± 2.1), (24.1 ± 4.2) mmol/L] was significantly lower than that of glycemic unsatisfied group [(24.7 ± 4.5), (29.9 ± 2.7) mmol/L; P < 0.01]. (3) Correlation analysis. Between 24-28 weeks, SHBG was negatively correlated with HOMA-IR in the three groups (r = -0.952, P < 0.01); and SHBG was negatively correlated with HOMA-IR in glycemic satisfied group (r = -0.903, P < 0.01). Well-controlled glucose can not completely improve maternal and fetal outcomes of GDM pregnant women. High insulin resistance and low serum SHBG can influence pregnancy outcomes.

Battling with Rising Prevalence of Gestational Diabetes Mellitus: Screening and Diagnosis

ABSTRACT Introduction Gestational diabetes affects 2 to 4% of all pregnancies, with an increased risk of developing diabetes for both the mother and the child. The prevalence of gestational diabetes mellitus (GDM) in India varied from 3.8 to 21% with the geographical locations and diagnostic methods used. Objective To study the differences in the type of tests and timing of tests; failure to screen and diagnose; this could explain the varying prevalence reported from different centers indicating that there could be an underestimation due to missed diagnosis. Materials and methods A 15-question online survey (www.abcofobg.com) was developed to assess providers’ knowledge; practices and attitudes related to the screening and management of GDM. All data were entered into an electronic database without personal identifiers, to maintain confidentiality. The data was analyzed by using SPSS version 16.0. Results A total of 584 respondents were participated in the survey. Overall, 82.14% of doctors screened all their antenatal patients for GDM. A total of 65.48% of them ordered for a blood glucose test during first antenatal visit even in first trimester. During screening, 39.29% of doctors preferred 50 gm glucose challenge test and 26.19% of doctors preferred 75 gm glucose and 2-hour reading. When the test was positive, 47.62% of doctors ordered for 100 gm oral glucose tolerance test (OGTT) and 38.1% for 75 gm OGTT. A total of 40.48% of doctors used C and C criteria, 26.4 % used National Diabetes Data Group (NDDG) criteria and 32.14% took 140 at 2 hours for 75 gm OGTT criteria of cutoff to diagnose the GDM. Conclusion Preventive measures against type 2 diabetes (T2DM) should start with proper screening and diagnosis during pregnancy. Many tests with varied criteria are in use. There is an urgent need to institute uniform standards for the timing and type of tests done for identifying the cases of GDM. This is crucial to reduce the burden of T2DM in India for now and for generations to come.

Pregnancy Outcomes of Taiwanese Women with Gestational Diabetes Mellitus: A Comparison of Carpenter-Coustan and National Diabetes Data Group Criteria

To evaluate the pregnancy outcome of pregnant women in whom the 100-g oral glucose tolerance test (OGTT) met the criteria of Carpenter and Coustan (C&C) but not those of the National Diabetes Data Group (NDDG) for diagnosis of gestational diabetes mellitus (GDM). The medical records of 10,990 singleton pregnancies, delivered at Cathay General Hospital, Taiwan, between 2001 and 2008, were reviewed retrospectively. All pregnant women followed the two-step diagnostic algorithm for GDM; that is, women with a positive (>or=140 mg/dL) 50-g glucose challenge test (GCT) underwent a 100-g OGTT at 24-28 weeks of gestation. The pregnancies were classified as follows: group 1, women without GDM; group 2, women with GDM meeting the C&C criteria but not the NDDG criteria; and group 3, women with GDM diagnosed by NDDG criteria. Of the pregnancies, 10,116 (92%), 489 (4.4%), and 385 (3.5%) were classified into groups 1, 2, and 3, respectively. Women with GDM by the C&C criteria but not by the NDDG criteria had an increase in macrosomia compared with women without GDM, 22 (4.5%) infants vs. 236 (2.3%) infants, respectively (p < 0.05); however, there were no associated adverse complications. If the C&C criteria were used, the incidence of GDM increased to 874 (7.9%) pregnancies. GDM as defined by either NDDG or C&C criteria identified pregnancies complicated by macrosomia, cesarean section, and gestational hypertension compared with the healthy population (p < 0.05). In a Taiwanese population, using C&C criteria has no added advantages over using NDDG criteria.

Antenatal oral glucose-tolerance test values and pregnancy outcomes

AbstractObjectiveThe aim of the present study was to explore the impact of individual blood glucose values (n = 4; i.e. fasting and 1, 2 and 3 h following oral glucose administration) obtained during antenatal oral glucose-tolerance testing, together with two different sets of criteria used for diagnosis of gestational diabetes mellitus (GDM) — Carpenter and Coustan Criteria (CCC) and National Diabetes Data Group (NDDG) criteria — in predicting pregnancy outcomes and maternal insulin need.SettingAl Ain Hospital, United Arab Emirates.MethodThis observational uncontrolled cohort study gained its study subjects from a randomised, controlled, longitudinal, prospective clinical trial performed at Al Ain Hospital, Al Ain, United Arab Emirates. The eligible population was made up of all women (n = 720) who participated in an early screening programme for GDM. Those who had a positive oral glucose-tolerance test (OGTT) based on CCC were included in the study (n = 165). All recruited women with GDM were followed from time of recruitment to 6months postpartum. The sources of information used were maternal and neonatal medical records and laboratory findings for women both antenatally and postnatally.ResultsThe maternal and neonatal outcomes indicated that the number of abnormally elevated antenatal OGTT values obtained during the diagnosis of GDM was significantly correlated with development of a number of pregnancy complications. Data analysis also indicated that the number of abnormal diagnostic antenatal OGTT values using CCC was significantly correlated with development of postpartum diabetes mellitus (P = 0.044) within 6months of delivery. The number of abnormal OGTT values significantly contributed to insulin need during the index pregnancy (P &amp;lt; 0.05). The CCC approach was more sensitive than the NDDG methodology for predicting the onset of GDM and a number of the associated complications.ConclusionsThe study highlighted the importance of abnormal values for antenatal OGTT in identifying the need for insulin management in women with GDM.

Economical and evidence-based procedure to diagnose gestational diabetes mellitus in the community

exceed the above figures is diagnosed as GDM. These values were recommended based on the predictive value of the subsequent risk of diabetes in the mother and not specifically on the fetal outcome. NDDG also has the same deficiency. To clarify the associations of levels of maternal glucose lower than those diagnostic of diabetes with perinatal outcome, Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study was initiated. The objective was accomplished by performing a 75 g OGTT directly without screening in diverse cohort of 23,316 women in third trimester of gestation. Gestational diabetes mellitus (GDM) is associated with a significant incidence of diabetes in the later life of the mother and an increase in the fetal, neonatal morbidity, and future development of obesity and diabetes in the offspring. Studies conducted in different populations and with different methodologies consistently reported an increase in GDM in all ethnic groups, suggesting that there is an increase in GDM prevalence. (1) A true increase in the prevalence of GDM aside from its adverse consequences for the infant in the newborn period might reflect or contribute to the ongoing pattern of increasing diabetes and obesity. (1) The existing diagnostic criteria except World Health Organization (WHO) are country specific, e.g., American Diabetes Association, Canadian Diabetes in Pregnancy Study Group (CanDIPS), National Diabetes Data Group (NDDG) criteria, Australasian criteria, Japan Diabetes Association, German Diabetes Association, and Diabetes UK. These diagnostic criteria require the pregnant woman to visit the prenatal clinic twice, (1) for screening and (2) then to undergo diagnostic oral glucose tolerance test (OGTT). The pregnant woman resents undergoing the present diagnostic procedure, as she has to allot 2 days to attend the prenatal clinic and in addition, the numbers of blood samples drawn are too many. These observations emphasize the need for an appropriate tool to diagnose GDM and to incorporate them into the local health service strategies. Diagnostic Criteria American Diabetes Association (Carpenter and Coustan) criteria: The diagnostic criteria for GDM suggested by O'Sullivan and Mahan were based on whole blood glucose values. Carpenter and Coustan by applying conversion formula switched from whole blood glucose to venous plasma glucose values and suggested that normal glucose level during pregnancy with 100 g OGTT as fasting plasma glucose (FPG) ≤ 95 mg/dL, 1 h PG ≤ 180 mg/dL, 2 h PG ≤ 155 mg/dL, and 3 h ≤ 140 mg/dL, respectively. Any two values meet or

Effect of HCV Infection on Glucose Metabolism in Pregnant Women with HIV Receiving HAART

Objective: A prospective study was designed to evaluate the prevalence and determinants of glucose metabolism abnormalities (GMAs) among HIV-1–infected pregnant women receiving highly active antiretroviral therapy (HAART). Methods: Blood samples were collected in fasting conditions and following a 100 g oral glucose tolerance test among HIV-infected pregnant women consecutively followed at asingle HIV reference centre in 2001–2008. GMAs were defined by glucose intolerance(IGT) or gestational diabetes (GDM), according to the National Diabetes Data Group criteria. Predictors of GMAs were assessed in univariate and multivariate analyses. Results: Overall, 78 women with no history of diabetes or GMAs were eligible for analysis. All were on stable HAART with either nevirapine or protease inhibitors (PIs) from at least 4 weeks at the time of sampling. GMAs during pregnancy were observed in 20 women (25.6%; GDM: 6, 7.7%; IGT: 14, 17.9%). In a multivariate analysis, after adjusting for age and ongoing antiretroviral treatment (PI or nevirapine), GMAs in pregnancy were significantly associated with HCV coinfection(adjusted odds ratio 4.16; 95% CI, 1.22–14.1;p = .022). No maternal or neonatalcomplications were observed. Conclusion: GMAs represent a relevant issue in the management of HIV-1–infected pregnant women. Our data suggest that these abnormalities are relatively common in this particular group. Women with HCV coinfection have an increased risk of developing GMAs during pregnancy and should be monitored for potential complications.

Prediction of Diabetes Recurrence in Women with Class A1(Diet-Treated) Gestational Diabetes

We sought to evaluate the likelihood of recurrent diabetes in women with a prior history of diet-treated (class A(1)) gestational diabetes mellitus (GDM). In a retrospective cohort analysis, nulliparous women diagnosed based upon National Diabetes Data Group criteria with diet-treated GDM who had recurrent diabetes in a subsequent pregnancy were compared with those who did not have recurrent diabetes. The probability of recurrent diabetes was calculated using maternal age at first pregnancy, interpregnancy interval, and body mass index (BMI) during the subsequent pregnancy. Three hundred forty-four nulliparous women with diet-treated GDM had a subsequent delivery in our database. One hundred thirty-seven (40%) had recurrent diabetes. Women with a history of GDM were more likely to have recurrent diabetes if they were heavier (193 versus 173 lbs; P < 0.001; BMI 35.7 versus 32.2; P < 0.001) and waited longer between pregnancies (2.9 versus 2.4 years, P = 0.02). Age, interpregnancy interval, and BMI can be used to predict diabetes recurrence in pregnant women with a history of GDM.