Gestational Diabetes Outcomes Research Articles

Gestational diabetes outcome in a single center study: higher BMI in children after six months.

The aim of the study was to examine obstetric outcomes and metabolic disorders in patients with gestational diabetes mellitus (GDM) and their offspring compared to mothers without GDM and their offspring. We performed a retrospective single center cohort study of mothers with GDM using a questionnaire with items concerning the maternal medical history, neonatal complications, and child development. Mothers with gestational diabetes (GDM; n=130) and those with normal glucose tolerance (NGT; n=77) were recruited. GDM mothers were older (37.58 years vs. 34.32 years, p<0.0001) and had a greater body mass index (25.18 kg/m² vs. 23.37 kg/m², p<0.01). There were no significant differences regarding the mean birth weight, the frequency of Cesarean sections, and the prevalence of macrosomia (> 4 000 g). At follow-up (pediatric U5 screening visit after 6 months of birth) children of mothers with GDM had significantly higher BMI than the children of the NGT group (17.07 kg/m² vs. 16.59 kg/m², p=0.042). GDM women in need of insulin therapy during pregnancy had higher BMI than dieting GDM mothers and experienced more frequently an operative vaginal delivery (17.95% vs. 6.17%, OR 3.23, p=0.04). We found less significant differences between GDM mothers with treatment of impaired glucose tolerance and NGT mothers concerning the neonatal outcome than expected. Despite higher BMI of the GDM group's offspring at follow-up U5 visit, the children did not show any other development disorder. In conclusion treatment of GDM could minimize the frequency of obstetric and neonatal complications in this risk group.

Simple lifestyle recommendations and the outcomes of gestational diabetes. A 2×2 factorial randomized trial

The benefits of exercise and behavioural recommendations in gestational diabetes mellitus (GDM) are controversial. In a randomized trial with a 2 × 2 factorial design, we examined the effect of exercise and behavioural recommendations on metabolic variables, and maternal/neonatal outcomes in 200 GDM patients. All women were given the same diet: group D received dietary recommendations only; group E was advised to briskly walk 20-min/day; group B received behavioural dietary recommendations; group BE was prescribed the same as B + E. Dietary habits improved in all groups. In a multivariable regression model, fasting glucose did not change. Exercise, but not behavioural recommendations, was associated with the reduction of postprandial glucose (p < 0001), glycated haemoglobin (HbA1c; p < 0.001), triglycerides (p = 0.02) and C-reactive protein (CRP; p < 0.001) and reduced any maternal/neonatal complications (OR = 0.50; 95%CI=0.28-0.89;p = 0.02). In GDM patients a simple exercise programme reduced maternal postprandial glucose, HbA1c, CRP, triglycerides and any maternal/neonatal complications, but not fasting glucose values.

The degree of fetal metformin exposure does not influence fetal outcome in gestational diabetes mellitus

The purpose of the study was to examine in vivo placental transfer of metformin, its association with neonatal outcome in metformin-treated gestational diabetes (GDM) patients, and influence of metformin exposure on maternal glycemic control and weight gain. Two hundred and seventeen GDM patients were randomized to metformin or insulin in Turku University Hospital, Finland. Metformin concentrations were determined by mass spectrometry in maternal serum at 36 gestational weeks (gw) and at birth, and in umbilical cord blood. Main outcome measures were birth weight, gw at birth, umbilical artery pH and neonatal hypoglycemia, maternal weight gain, HbA1c and fructosamine concentration. Median umbilical cord/maternal serum metformin concentration ratio was 0.73. There were no differences in birth weight measured in grams or SD units (p=0.49), or gw at birth (p always≥0.49) between insulin- and metformin-treated patients stratified by trough metformin concentration tertiles measured at 36 gw. Rate of neonatal hypoglycemia (p=0.92) and umbilical artery pH value (p=0.78) was similar in insulin- and metformin-treated patients stratified by cord metformin concentration tertiles. Maternal glycemic control was similar in metformin concentration tertiles at 36 gw. Maternal weight gain was 223g greater per week (p=0.038) in the lowest metformin tertile compared to other tertiles combined. Maternal and fetal exposure to metformin is similar. Maternal or fetal metformin concentrations do not predict maternal glycemic control or neonatal outcome, but low maternal exposure may lead to greater maternal weight gain.

The effect of DASH diet on pregnancy outcomes in gestational diabetes: a randomized controlled clinical trial

The current study was performed to investigate the effects of the Dietary Approaches to Stop Hypertension (DASH) eating plan on pregnancy outcomes in pregnant women with gestational diabetes mellitus (GDM). This randomized controlled clinical trial was performed among 52 women diagnosed with GDM. Participants were randomly assigned to consume either the control (n=26) or the DASH diet (n=26) for 4 weeks. The control diet was designed to contain 45-55% carbohydrates, 15-20% protein and 25-30% total fat. The DASH diet was rich in fruits, vegetables, whole grains and low-fat dairy products, and contained lower amounts of saturated fats, cholesterol and refined grains with a total of 2400 mg/day sodium. The numbers of women who commenced insulin therapy after dietary intervention, the mode of delivery and prevalence of polyhydramnios were assessed. The length, weight and head circumference of infants were measured during the first 24 h after birth. Whereas 46.2% of women in the DASH diet needed to have a cesarean section, this percentage for the control group was 80.8% (P=0.01). The percentage of those who needed to commence insulin therapy after intervention was also significantly different between the two groups (23% for DASH vs 73% for control group, P<0.0001). Infants born to mothers on the DASH diet had significantly lower weight (3222.7 vs 3818.8 g, P<0.0001), head circumference (34.2 vs 35.1 cm, P=0.01) and ponderal index (2.50 vs 2.87 kg/m(3), P<0.0001) compared with those born to mothers on the control diet. In conclusion, consumption of DASH diet for 4 weeks among pregnant women with GDM resulted in improved pregnancy outcomes.

5.2. Effectiveness of Continuous Glucose Monitoring and Fingerstick Blood Glucose Monitoring in Pregnancy Outcome of Gestational Diabetes (2692-PO)

The purpose of this study is to evaluate the blood glucose management effectiveness through glucose variability evaluation with two different glucose monitoring methods (Continuous Glucose Monitoring (CGM) and Fingerstick Blood Glucose Monitoring) on pregnancy outcomes of the Gestational Diabetes Mellitus (GDM) patients.

Type 2 Diabetes in Aboriginal Peoples

Type 2 Diabetes in Aboriginal Peoples

Maternal weight gain in women with gestational diabetes mellitus

The aim of the study was to examine the perinatal outcomes in gestational diabetes in women with body mass index (BMI)-adjusted gestational weight gain (GWG) according to the Institute of Medicine (IOM) 2009 recommendations. The clinic's database was used to analyze 675 singleton GDM pregnancy outcomes. GWG for the entire pregnancy was compared to IOM recommendations and adjusted for prepregnancy BMI categories: underweight <18.5; normal 18.5-24.9; overweight 25-29.9; and obese >30. The study group was divided into three categories: below IOM limits, within IOM limits and above IOM limits. Only 37% of women achieved the proper weight gain (n=256). Almost 30% of women with GDM (n=196) had an excessive weight gain. GWG above limits was associated with a significantly higher neonatal measurements and a higher rate of large-for-gestational-age neonates. In underweight and normal-prepregnancy-weight women, no relation between GWG and birth-weight percentile was noted. For the overweight and obese women, a positive significant correlation between GWG until GDM diagnosis and birth-weight percentile was noted (P=0.002), which was not present when GWG until delivery was considered. Limited weight gain in overweight and obese women with gestational diabetes mellitus results in favourable pregnancy outcomes.

Outcomes of gestational diabetes in Sweden depending on country of birth

To analyze maternal and neonatal outcomes for women with gestational diabetes mellitus (GDM) in Sweden, depending on country of birth (Nordic vs. non-Nordic women). Population-based cohort study using the Swedish Medical Birth register. Data on pregnant women in Sweden with diagnosed GDM. All singleton births to women with GDM between 1998 and 2007 (n = 8560). Logistic regression in an adjusted model to assess the risk of adverse maternal and neonatal outcomes. Chi-squared tests or Student's unpaired t-tests were used to analyze differences between maternal and fetal characteristics. Maternal and neonatal complications. GDM incidence was higher at 2.0% among non-Nordic women, compared with 0.7% in the Nordic group. The non-Nordic women were older, had less chronic hypertensive disease, smoked less, and had lower BMI and shorter height. Preeclampsia was significantly lower in the non-Nordic group. The mean birthweight (3561 vs. 3698 g, p < 0.001) and the large-for-gestational age rate (11.7 vs. 17.5%, p < 0.001) were significantly lower in the non-Nordic group. Large-for-gestational age was dependent on maternal height [crude odds ratio 0.6 (0.5-0.7) and adjusted odds ratio 0.8 (0.6-0.9)]. Non-Nordic women with GDM in Sweden have better obstetrical and neonatal outcomes than Nordic women. These results do not support the idea of inequality of health care. Large-for-gestational age as a diagnosis is highly dependent on maternal height, which raises the question of the need for individualized growth curves.

Assessment of Bridelia ferruginea benth for its therapeutic potential in pregnancy-induced impaired glucose tolerance in rats

Background : Pregnancy induced diabetes also known as gestational diabetes develops during pregnancy. Pregnancy is an insulin resistant state that may induce impaired glucose tolerance and often gestational diabetes in susceptible women. Gestational diabetes causes serious problems to the mother and the baby. Therefore, the use of herbal remedies such as Bridelia ferruginea with the potential ability to improve glucose tolerance during pregnancy will definitely improve pregnancy outcome in gestational diabetes. Aim : This paper presents an evaluation of possible therapeutic potential of B. ferruginea in gestational diabetes by assessing the anti-glycaemic effects of the plant’s aqueous extracts on pregnancy-induced glucose intolerance in rats. Materials and Methods : Adult virgin, timed-pregnant and non-pregnant rats were subjected to brief ether anaesthesia after 18-hour overnight fasting period to allow for oro-gastric administration of glucose load at 3.0g/kg body weight as 30% solution. The oral glucose load was given at an administration volume of 1.0ml/100g bw. Results : Oral glucose tolerance test showed that pregnancy induced glucose intolerance in the rats. However, B. ferruginea caused a reduction in glycaemic response to glucose challenge and an increased glucose tolerance in rats that had pregnancy-induced glucose intolerance. Thus, diabetogenic effect of pregnancy was ameliorated by oral administration of aqueous extracts of B. ferruginea to pregnant albino rats. Keywords : Gestational diabetes, pregnancy-induced diabetes, hypoglycaemic, glycaemic response, glucose tolerance.

264: Pregnancy outcome in gestational diabetes controlled with glyburide: is it just the glucose?

Poor control of gestational diabetes (GDM) is associated with adverse neonatal outcome. However, little is known about other factors that may affect neonatal outcome in women with GDM that attain good glycemic control with glyburide therapy. This is a prospective observational study of GDM patients treated with glyburide according to our previously described protocol (NEJM, 2000). Neonatal outcome was determined in women who were treated with glyburide and who achieved good glycemic control (mean blood glucose ≤ 105 mg/dl), and included the following: macrosomia (birth weight ≥ 4000 g), LGA (birth weight ≥ 90th% for gestational age), SGA (birth weight <10th% for gestational age). Patients who achieved good glycemic control were further categorized according to their mean blood glucose values (≤85, 86-95, and 96-105 mg/dL) and the outcomes of interest were determined in each sub-group. From 2004-2009, 567 GDM patients were treated with glyburide, and 431 of these (76%) achieved good glycemic control. Neonatal outcomes are depicted in the table below. There were no significant differences between groups with respect to neonatal growth abnormalities. Multiple logistic regression analysis determined that birth weight percentile was not associated with maternal BMI, severity of GDM, or maternal blood glucose at delivery, but was positively associated with the ultimate glyburide dose. Mean blood glucose of patients who delivered an AGA infant was 101±13 mg/dl compared to 105±13 mg/dl in those who delivered an LGA infant (p=0.06).Tabled 1Rates of Growth Abnormalities by Mean Maternal Glucose in Well Controlled GDM≤ 85mg/dl86-95mg/dl96-105mg/dlLGA %14.38.413.7Macrosomia %5.93.18.1SGA %7.17.78.6 Open table in a new tab Women with GDM whose mean blood glucose falls below the threshold of good control do not have an increased rate of LGA infants compared to the general population, regardless of the actual mean glucose achieved. Once this target is attained, other pre-existing maternal factors do not seem to affect the rate of fetal growth.

Oral hypoglycemic agents vs insulin in management of gestational diabetes: a systematic review and metaanalysis

The objective of this review was to provide pooled estimates of randomized controlled trials comparing the effects of oral hypoglycemic agents with insulin in achieving glycemic control and to study the maternal and perinatal outcomes in gestational diabetes mellitus. A protocol for the study was developed. All metaanalyses were performed using Stats Direct statistical software (Stats Direct Ltd, Cheshire, UK). Six studies comprising 1388 subjects were analyzed. No significant differences were found in maternal fasting (weighted mean difference [WMD], 1.31; 95% confidence interval [CI], 0.81-3.43) or postprandial (WMD, 0.80; 95% CI, -3.26 to 4.87) glycemic control. Use of oral hypoglycemic agents (OHAs) was not associated with risk of neonatal hypoglycemia (odds ratio [OR], 1.59; 95% CI, 0.70-3.62), increased birthweight (WMD, 56.11; 95% CI, -42.62 to 154.84), incidence of caesarean section (OR, 0.91; 95% CI, -0.68 to 1.22), or incidence of large-for-gestational-age babies (OR, 1.01; 95% CI, 0.61-1.68). Our study demonstrates that there are no differences in glycemic control or pregnancy outcomes when OHAs were compared with insulin.

Comparison of maternal–fetal outcomes in gestational diabetes and lesser degrees of glucose intolerance†

To determine the relationships between maternal and fetal outcomes and gestational diabetes mellitus (GDM), impaired fasting glucose (IFG) and impaired glucose tolerance (IGT), respectively. A retrospective cohort study design was used with 149 patients with abnormal oral glucose tolerance test (OGTT) and 149 normal patients. Statistical analysis used was the chi-squared test, Fisher's exact test or the Student's t-test, as appropriate. P < 0.05 was considered significant. The level of hyperglycemia according to the OGTT (World Health Organization criteria) was associated with pre-eclampsia, polyhydramnios and macrosomia in GDM patients. There was no increase in the complications of preterm labor and premature rupture of membranes, despite the increased risk of polyhydramnios. Although treated with insulin, macrosomia still occurred in patients with GDM, but there was no shoulder dystocia as there was an increase in the incidence of cesarean section (CS). The IGT group was not associated with adverse fetal or maternal outcomes, but there was an increase in intervention and the incidence of CS. The IFG group was associated with a significantly increased risk of pre-eclampsia and macrosomia. These findings challenge the concept of IFG being a lesser pathology than GDM. Further prospective studies with a larger number of patients are needed to ascertain the significance of these findings. There was an increased risk of pre-eclampsia and macrosomia in both the GDM and IFG patients, but IGT was not associated with adverse fetal or maternal outcomes.

An audit of gestational diabetes in the National Maternity Hospital, Dublin: 2000

The aims of this study were (1) to review maternal and neonatal outcome in gestational diabetes and (2) to compare outcome in those requiring insulin vs. diet alone. This was a retrospective chart review of 79 women with a diagnosis of gestational diabetes in the National Maternity Hospital, Dublin in 2000. A family history of diabetes was found in 51% of cases, with 52.2% of women giving a past history of gestational diabetes and a further 32.7% having previously delivered a baby >4 kg.

Gestational diabetes mellitus

The proposed risks from abnormal glucose tolerance in pregnancy are continuous. Gestational diabetes is thus an arbitrary condition. The risks to the fetus are largely determined by fetal size, and those of the mother by the severity of glucose intolerance. Screening policies vary throughout the world, and all have deficiencies. Policies should be determined locally, as population and organizational issues will influence efficacy. Clinicians need to agree diagnostic criteria as minor alterations in these can alter the disease incidence. There is no universal agreement on diagnostic testing. There is no conclusive evidence from randomized trials that therapy alters pregnancy outcome in gestational diabetes. Therapy targeted at those fetuses shown to have evidence of hyperinsulinism may be the best way forward. Follow-up of women with early diagnosis, or who have required insulin during pregnancy is vital to allow prevention strategies against type 2 diabetes.

Counseling programs and the outcome of gestational diabetes in Austrian and Mediterranean Turkish women

An increasing number of patients from different ethnic groups is admitted to European diabetes treatment centers. Counseling programs are of central importance in disease treatment, especially in gestational diabetes where counseling is of influence also on the outcome of pregnancy. We report about the outcome of gestational diabetes in 39 Mediterranean Turkish and 72 Caucasian Austrian women treated at our outpatient clinic. Both groups of patients underwent repeated counseling including information about the cause of gestational diabetes and therapeutic instructions with an emphasis on dietary recommendations adapted to the eating habits. Individually adapted and repeated instructions with the help of trained translators were of great importance for the Turkish women because nearly one third of them turned out to be illiterates. Under comparable treatment modalities, Turkish and Austrian women revealed no differences in metabolic control, the mean birth weight of the children was 3311±467 and 3370±600 g, respectively, and 12.8% of the Turkish and 16.6% of the Austrian children still had a birth weight above 4000 g. These results suggest that women with gestational diabetes and different ethnicity reveal a comparable outcome of gestational diabetes when therapeutic instructions are adapted to the social and cultural background as well as to the individual need of the patient.

Perinatal outcomes in gestational diabetes: A comparison of criteria for diagnosis

Objective: The purpose of this study was to compare the perinatal outcomes of women after diagnosis of gestational diabetes by the current American College of Obstetricians and Gynecologists–National Diabetes Data Group recommendations with outcomes after diagnosis by the American Diabetes Association criteria. Study Design: We identified records of 242 women who had had the standard 3-hour oral glucose tolerance test between 1995 and 1999 at the Regional Medical center in Memphis. Patients were categorized into 1 of 3 groups as follows: euglycemic control subjects (n = 69), subjects with gestational diabetes diagnosed by the National Diabetes Data Group criteria (n = 130), and subjects with gestational diabetes diagnosed by the American Diabetes Association criteria (n = 43). Maternal and infant charts were reviewed. Primary outcomes included frequency of cesarean delivery, preeclampsia, and macrosomia. In univariate analysis the χ2 test was used to compare group differences, and in multivariate analysis we used stepwise logistic regression and controlled for confounding factors. Results: No differences existed among the 3 groups regarding maternal race, body mass index, history of preeclampsia, or family history of diabetes. The frequency of overall cesarean delivery, of cesarean delivery for macrosomia or arrest disorder, of preeclampsia, and of macrosomia did not differ significantly among the 3 groups. Neonatal hypoglycemia was more frequent in the groups with a diagnosis by the American Diabetes Association criteria (23.3%) and by the National Diabetes Data Group criteria (16.2%) than in the control subjects (7.2%), reaching near significance (P =.057). In the multivariate analysis, cesarean delivery for macrosomia or an arrest disorder correlated negatively with parity and positively with body mass index. Preeclampsia was associated with African American race and body mass index; macrosomia correlated with a history of macrosomia and familial diabetes. Neonatal hypoglycemia was more common in the American Diabetes Association group (odds ratio, 2.45; 95% confidence interval, 1.004-5.97) and in the insulin-requiring National Diabetes Data Group category (odds ratio, 3.71; 95% confidence interval, 1.20-11.44). Conclusion: The benefits of defining an additional high-risk population of women with gestational diabetes by the American Diabetes Association criteria are unclear. Further large-scale prospective clinical trials are required. (Am J Obstet Gynecol 2001;184:1118-21.)

Foetal outcome in gestational diabetes in south Indians

The study was performed to reassess the prevalence of gestational diabetes mellitus (GDM) in south Indians and to study the foetal outcome in women with GDM in comparison with normal pregnancies. In 1036 pregnant women, glucose tolerance was tested with 75-g oral glucose load, in the second or third trimester. Those with 2-h plasma glucose of ≥200 mg/dl were considered as diabetic (WHO Criteria). Those with 2-h values of 140–199 underwent a 3-h glucose tolerance test (GTT) with 100-g glucose load (O'Sullivan and Mahan criteria). GDM was diagnosed in nine women (0.87%) by this criteria. Foetal outcome in 211 GDM referred to the diabetes centre was compared with the outcome in 853 normal pregnancies. There were no cases of aborted pregnancy among the GDM, while six cases were reported among the normal glucose tolerance (NGT). Still birth and the number of premature babies were higher in GDM. Babies with birth weight ≥3.5 kg were more among the GDM ( P<0.001). There was no difference in the occurrence of congenital anomalies in the two groups. It was noted that congenital abnormalities in the foetus were more common among those born of mothers with higher plasma glucose (9 versus 1.1%). Multiple linear regression analyses in NGT and GDM showed that the birth weight of the baby was dependent on the plasma glucose and the body mass index of the mothers. The results of the present study show that the prevalence of GDM in urban south India was low, when the NDDG criteria was used. It also indicated that the WHO criteria may be more appropriate as the foetal outcome was determined by even a small rise in maternal plasma glucose. With good metabolic control in GDM, the foetal risks are very much reduced.

Pancreatic Disorders of Pregnancy: Diagnosis, Management, and Outcome of Gestational Diabetes

Gestational diabetes is one of the more common medical problems of pregnancy. This article reviews the literature regarding the diagnosis and treatment and the controversy that surrounds gestational diabetes. The need for stricter guidelines for diagnosis and treatment and the evidence supporting this need are presented. Long-term follow-up evaluation for women with gestational diabetes and for their children is discussed.

Outcome of gestational diabetes in Bengali Asians living in an East London health district

The characteristics and outcome of pregnancy complicated by gestational glucose intolerance are described in a consecutive series of 69 Bengali Asian patients and a parallel group of 22 Caucasian patients. The Bengali patients were older and of higher parity than the Caucasians and more frequently required insulin therapy. However, the outcome of pregnancy was similar in terms of antenatal clinic attendance, the number of antenatal hospital admissions, glycaemic control, birthweight and mode of delivery. Of those patients who attended for postnatal glucose tolerance test, 20% of the Bengali population demonstrated persisting abnormality of glucose tolerance, whereas no abnormalities were evident in the Caucasian group. These findings are consistent with the high prevalence and early age of onset of non-insulin-dependent diabetes in Asian populations. The World Health Organisation (WHO) criteria for the diagnosis of impaired glucose tolerance proved insufficiently sensitive for the diagnosis of gestational diabetes. This was particularly demonstrated by four patients with apparently normal glucose tolerance by WHO criteria who subsequently required insulin therapy.

Fetal outcome in gestational diabetes with elevated amniotic fluid insulin levels: Dietary versus insulin treatment

Of 228 women with gestational diabetes between 28 and 32 gestational weeks, 195 had a normal amniotic fluid insulin level (4.8 +/- 3.6 microU/ml) while 33 (14.5%) had an elevated level (23.1 +/- 10 microU/ml). Women with a normal amniotic fluid insulin level were treated by diet alone. Fourteen of the women with an elevated level were treated by diet alone; 19 received insulin treatment additionally. The fetal outcome of patients with a normal amniotic fluid insulin level and dietary therapy and of those with an elevated level and insulin treatment was similar to that of metabolically healthy women. The newborns of gestational diabetics with elevated amniotic fluid insulin treated by diet alone showed a significantly higher incidence of neonatal hyperinsulinism, hypoglycemia, hyperbilirubinemia, high birth weight, respiratory distress syndrome and hypocalcemia. While 2/14 (14%) of the neonates in the dietary group had fatal respiratory distress syndrome, there were no deaths in the group with elevated amniotic fluid insulin and insulin treatment. The data demonstrate that in gestational diabetics with normal amniotic fluid insulin (low-risk group), dietary therapy is sufficient while insulin therapy is required to ensure healthy offspring in patients with elevated amniotic insulin (high-risk group).