Overt Diabetes In Pregnancy Research Articles

Cardiovascular Health Metrics of Spouses of Indian Women with a History of Gestational Diabetes and Diabetes in Pregnancy: Results from CHIP-F Study.

There are limited data on the prevalence of cardiovascular risk factors/diseases (diabetes, obesity, hypertension, and dyslipidemia) and their composite scores reflecting overall cardiovascular health among young (< 50years old) married couples. We have an established longitudinal prospective cohort of postpartum women with a history of hyperglycemia [pre-existing diabetes (PED; n = 101), overt diabetes in pregnancy (ODiP; n = 92), gestational diabetes (GDM; n = 643)], and normoglycemia (n = 183) in pregnancy and their spouses (n = 819). In this study, we report data from baseline cross-sectional evaluation of these 819 young couples regarding the burden of cardiovascular risk factors/diseases, their concordance and associations. The mean (SD) age was 33.5 (4.9) years for women and 36.9 (5.4) years for men, and the evaluation was performed at a median (IQR) postpartum interval of 30 (20-45) months. Diabetes, hypertension, obesity, and dyslipidemia were present in 25.0%, 6.9%, 25.6%, and 4.0% of women and 15.8%, 20.2%, 14.3%, and 8.2% of men, respectively. Among men, dysglycemia (diabetes/prediabetes) and adverse cardiovascular score (average/poor) showed a significant trend in progression according to the antenatal categories of their partner (highest in DIP, intermediate in GDM, and lowest in normoglycemia). The concordance was higher for adverse cardiovascular score (58.5%), overweight/obesity (48.7%), and dysglycemia (42.4%) compared to prehypertension/hypertension (29.2%) and hypercholesterolemia (8.2%). The odds ratios were significant for all associations evaluated, except for elevated blood pressure, being strongest (OR > 2.0) for overweight/obesity and adverse cardiovascular score. Nearly three in five young couples evaluated in the study showed concordance for adverse cardiovascular scores. The cardiovascular risk in men increased in a graded manner across the increasing severity of antenatal glycemic categories of their partners.

Postpartum dysglycaemia after early gestational diabetes: Follow-up of women in the TOBOGM randomised controlled trial

AimTo evaluate the incidence and predictors of postpartum dysglycaemia among high-risk women who develop early gestational diabetes (eGDM) prior to 20 weeks’ gestation. MethodsThis is a sub-study of the Treatment of Booking Gestational Diabetes (TOBOGM) Study, a randomised controlled trial of early or deferred treatment for women with risk factors for diabetes diagnosed with eGDM, using current WHO criteria. Overt diabetes in pregnancy was excluded. A repeat oral glucose tolerance test (oGTT) was recommended at 6–12 weeks postpartum. ResultsOf 793 participants, 352 (44.4%) underwent a postpartum oGTT. Baseline characteristics of participants with and without an oGTT were similar. Ninety-two (26.1%) had postpartum dysglycaemia: 11 (3.1%) diabetes, 31 (8.8%) impaired fasting glucose (IFG), 39 (11.1%) impaired glucose tolerance (IGT), and 11 (3.1%) combined IFG/IGT. Participants with postpartum dysglycaemia were more likely to have had past GDM, lower body mass index, more gestational weight gain, and higher 1 and 2-hour glucose concentrations on the early pregnancy oGTT. On logistic regression, higher 1 and 2-hour glucose concentration, previous GDM and greater gestational weight gain were independently associated with postpartum dysglycaemia. ConclusionThere is a high incidence of postpartum dysglycaemia among high-risk women with eGDM.

Is early pregnancy hemoglobin A1c useful to predict gestational diabetes mellitus diagnosed during mid pregnancy?

To verify whether hemoglobin A1c (HbA1c) levels in early pregnancy can predict the diagnosis of gestational diabetes mellitus (GDM) in mid-pregnancy. This was a retrospective cohort study of 2008 pregnant women who delivered singletons at the Yokohama City university Medical Center. Concomitant or history of diabetes mellitus and overt diabetes in pregnancy were excluded. Pregnant women at high risk for GDM underwent a one-step 75-g oral glucose tolerance test (OGTT) during mid-pregnancy. For other pregnant women, GDM was diagnosed by a two-step 75-g oral glucose tolerance test (OGTT) when the 50-g glucose challenge test result in mid-pregnancy was ≥140 mg/dL. The thresholds for 75-g OGTT followed those of the International Association of Diabetes and Pregnancy Study Group (IADPSG) criteria (92-180-153 mg/dL). The relationship between HbA1c level measured at <20 weeks of gestation and GDM diagnosis at mid pregnancy was assessed using a receiver operating characteristic curve (ROC); area under the curve (AUC) and optimal cutoff value of HbA1c, predictive of GDM were calculated. The median HbA1c level at <20 weeks of gestation was 5.3%, and 8.5% of women were diagnosed with GDM. In the ROC curve of the GDM diagnosis rate by HbA1c level, AUC was 0.706, and the optimal cutoff value was 5.4%, with a sensitivity of 0.6176, specificity of 0.6834, positive predictive value of 15.4%, and negative predictive value of 95.1%. Although HbA1c at less than 20 weeks of gestation is acceptable discrimination as a diagnostic tool of GDM in mid-pregnancy, it is not clinically useful to predict GDM in mid-pregnancy.

Incidence of overt diabetes in pregnancy among women with 50-g glucose challenge test ≥ 200mg/dL.

To determine the incidence of overt diabetes in pregnancy (ODIP) among women with 50-g GCT results ≥ 200mg/dL and compare characteristics and pregnancy outcomes between women with and without gestational diabetes (GDM). A retrospective cohort study was conducted in 212 pregnant women whose 50-g GCT results ≥ 200mg/dL. ODIP was diagnosed from 75-g OGTT if fasting plasma glucose ≥ 126 and/or 2-h plasma glucose ≥ 200mg/dL. Various characteristics and pregnancy outcomes were compared between ODIP and those with and without GDM. Incidence of ODIP was 1.9% of all pregnant women and 23.6% of women with 50-g GCT ≥ 200mg/dL. Women with ODIP and GDM were more likely to be overweight or obese than those without GDM (52%, 39.6%, and 18.2%, p < 0.001). Women with ODIP had significantly higher 50-g GCT results, lower gestational weight gain, and were less likely to deliver vaginally. Insulin therapy was significantly more common in women with ODIP compared to GDM (70.2% vs. 15.4%, p < 0.001). Rates of LGA, macrosomia, and other neonatal outcomes were comparable. BMI ≥ 25kg/m2 and 50-g GCT ≥ 240mg/dL independently increased the risk of any abnormal glucose tolerance [adjusted OR 3.22 (95% CI 1.55-6.70) and 2.28 (95% CI 1.14-4.58)] and ODIP [adjusted OR 9.43 (95% CI 2.15-41.38) and 6.36 (95% CI 2.85-14.18)], respectively. Incidence of ODIP was 23.6% of women with 50-g GCT ≥ 200mg/dL. BMI ≥ 25kg/m2 and 50-g GCT ≥ 240mg/dL independently increased the risk of GDM and ODIP. Neonatal complications were comparable between ODIP and those with and without GDM.

Maternal and neonatal outcomes according to the timing of diagnosis of hyperglycaemia in pregnancy: a nationwide cross-sectional study of 695,912 deliveries in France in 2018.

We aimed to assess maternal-fetal outcomes according to various subtypes of hyperglycaemia in pregnancy. We used data from the French National Health Data System (Système National des Données de Santé), which links individual data from the hospital discharge database and the French National Health Insurance information system. We included all deliveries after 22 gestational weeks (GW) in women without pre-existing diabetes recorded in 2018. Women with hyperglycaemia were classified as having overt diabetes in pregnancy or gestational diabetes mellitus (GDM), then categorised into three subgroups according to their gestational age at the time of GDM diagnosis: before 22 GW (GDM<22); between 22 and 30 GW (GDM22-30); and after 30 GW (GDM>30). Adjusted prevalence ratios (95% CI) for the outcomes were estimated after adjusting for maternal age, gestational age and socioeconomic status. Due to the multiple tests, we considered an association to be statistically significant according to the Holm-Bonferroni procedure. To take into account the potential immortal time bias, we performed analyses on deliveries at ≥31 GW and deliveries at ≥37 GW. The study population of 695,912 women who gave birth in 2018 included 84,705 women (12.2%) with hyperglycaemia in pregnancy: overt diabetes in pregnancy, 0.4%; GDM<22, 36.8%; GDM22-30, 52.4%; and GDM>30, 10.4%. The following outcomes were statistically significant after Holm-Bonferroni adjustment for deliveries at ≥31 GW using GDM22-30 as the reference. Caesarean sections (1.54 [1.39, 1.72]), large-for-gestational-age (LGA) infants (2.00 [1.72, 2.32]), Erb's palsy or clavicle fracture (6.38 [2.42, 16.8]), preterm birth (1.84 [1.41, 2.40]) and neonatal hypoglycaemia (1.98 [1.39, 2.83]) were more frequent in women with overt diabetes. Similarly, LGA infants (1.10 [1.06, 1.14]) and Erb's palsy or clavicle fracture (1.55 [1.22, 1.99]) were more frequent in GDM<22. LGA infants (1.44 [1.37, 1.52]) were more frequent in GDM>30. Finally, women without hyperglycaemia in pregnancy were less likely to have preeclampsia or eclampsia (0.74 [0.69, 0.79]), Caesarean section (0.80 [0.79, 0.82]), pregnancy and postpartum haemorrhage (0.93 [0.89, 0.96]), LGA neonate (0.67 [0.65, 0.69]), premature neonate (0.80 [0.77, 0.83]) and neonate with neonatal hypoglycaemia (0.73 [0.66, 0.82]). Overall, the results were similar for deliveries at ≥37 GW. Although the estimation of the adjusted prevalence ratio of perinatal death was five times higher (5.06 [1.87, 13.7]) for women with overt diabetes, this result was non-significant after Holm-Bonferroni adjustment. Compared with GDM22-30, overt diabetes, GDM<22 and, to a lesser extent, GDM>30 were associated with poorer maternal-fetal outcomes.

Hidden MODY in Young Lean Women with Mild Glucose Intolerance Detected During Health Check-ups: Potential for Improved Pregnancy Outcomes Through Preconception Care.

Mild glucose intolerance (positive urine glucose or mild hyperglycemia) during health checkups in young, lean women may require specialist consultation. We herein report a 31-year-old Japanese woman with mild hyperglycemia detected during a checkup who was diagnosed with overt diabetes in pregnancy and HNF4A-MODY postpartum, without prior follow-up. This case highlights the following: MODY may be present in young, lean women with mild glucose intolerance, and preconception care may improve pregnancy outcomes. Fetal outcomes vary with MODY subtype. Preconception care is important.

Prevalence and Predictors of Gestational Diabetes Mellitus and Overt Diabetes in Pregnancy: A Secondary Analysis of Nationwide Data from India

Abstract Background: This analysis was conducted to understand prevalence and determinants of gestational diabetes mellitus (GDM) and (overt) diabetes in pregnancy (DIP) in India, and also ascertain their health-seeking behaviour. Materials and Methods: The authors analysed data from the fifth National Family Health Survey of India. Binary logistic regression was used to assess the factors independently associated with GDM and (overt) DIP. Results: The weighted prevalence of GDM was 4.2% (95% confidence interval [CI]: 3.9–4.5), and the age-adjusted prevalence was 5.4% (95% CI: 4.5–6.4). The prevalence of GDM increased with age. The weighted prevalence of (overt) DIP was 0.38% (95% CI: 0.30–0.48), and the age-adjusted prevalence was 1.04% (95% CI: 0.64–1.68). On adjusted analysis, it was found that increasing age and obesity had significantly higher odds of having GDM. Higher odds of access to private facilities were found amongst women with higher education and those who were overweight. Significant regional variation in the prevalence of GDM was observed, with a very low burden observed in northeastern states and a comparatively higher burden in Central, Western and Southern Indian states. Conclusions: There is an increasing prevalence of GDM in India. Strengthening primary health systems to enhance GDM-related service availability, quality and delivery could be logical policy intervention.

Cardiometabolic profile of women with a history of overt diabetes compared to gestational diabetes and normoglycemia in index pregnancy: Results from CHIP-F study.

We aimed to evaluate the prevalence of postpartum diabetes among women with a history of overt diabetes in pregnancy (ODiP) and compare with women having a history of gestational diabetes mellitus (GDM) and normoglycemia in pregnancy. We have an established longitudinal cohort of postpartum women with a history of hyperglycemia (preexisting diabetes [PED] [n = 101], ODiP [n = 92], GDM [n = 643]), and normoglycemia (n = 183) in pregnancy. For this study, we excluded women with PED and invited other eligible women in a fasting state for clinical and biochemical evaluation. We evaluated 918 women with a mean (SD) age of 33.6 (5.0) years and at a median (interquartile range) postpartum interval of 31 (20-45) months. Diabetes was diagnosed in 65 (70.7%) women in ODiP compared to 99 (15.4%) in GDM (p < .001) and 4 (2.2%) in normoglycemia group (p < .001). In the ODiP group, the prevalence of diabetes was 47.4% among women tested in the first year postpartum, increasing to 86.8% among women tested at >3 years postpartum. Diabetes was more common when ODiP was diagnosed in the first (27/29, 93.1%) compared to the second trimester of pregnancy (35/57, 61.4%). The adjusted odds ratio for diabetes in ODiP was 14.82 (95% confidence interval, 8.49-25.87; p < .001; reference category: GDM). The prevalence of postpartum diabetes was significantly higher in women with ODiP compared to GDM. Nearly 50% of women with ODiP did not develop diabetes in the first year of follow-up, especially when ODiP was diagnosed after the first trimester of pregnancy and on the basis of a 2-h oral glucose tolerance test value. Such women are amenable to prevention strategies.

Association between poor parent-daughter relationships and the risk of hyperglycemia in pregnancy: a hospital-based prospective cohort study in Japan

BackgroundAdverse child experiences (ACEs), childhood maltreatment and household dysfunction, are risk factors of hyperglycemia in pregnancy (HIP), including diabetes before pregnancy, gestational diabetes (GDM), and overt diabetes in pregnancy, through increased risk of unhealthy behaviors, obesity, and stress response system dysfunction. While ACEs are often difficult to be assessed in hospital settings, parent-daughter relationship, that is, pregnant women’s relationship with their parents can be considered as a measurable maker for ACEs that may be associated with HIP. The purpose of this study is to examine the association between poor parent-daughter relationship and HIP.MethodsHospital-based prospective cohort study was conducted in Japan (N = 6,264). Women visiting participating 58 facilities for delivery between April 2019 and March 2020 were included. Parent-daughter relationship was assessed by a questionnaire asking whether participants were satisfied with their relationship with their parents. HIP was diagnosed based on the criteria used in Japan. A multiple logistic regression model was applied to adjust for covariates.ResultsPregnant women who were not very satisfied and not satisfied at all with the relationship with their parents, and HIP were 343 (5.5%), 74 (1.2%), and 274 (4.4%), respectively. Pregnant women who were not very satisfied with their parent-daughter relationship showed a significant positive association with HIP in the crude model (odds ratio (OR): 1.71, 95% confidence interval (CI): 1.11–2.63). When stratified by psychiatric disease history, we found a significant positive association among those without psychiatric disease history (OR: 1.77, 95% CI: 1.11–2.84), but not among those with psychiatric disease history (OR: 0.61, 95% CI: 0.16–2.28).ConclusionsPoor parent-daughter relationship was associated with the risk of HIP among pregnant women without psychiatric disease history, suggesting that this simple question could be used to estimate the risk of HIP when it was challenging to inquire directly about ACEs. Further research is needed to elucidate the mechanism of the association.

Effect of Overt Diabetes and Gestational Diabetes Mellitus on Pregnancy Outcomes and Progression.

To study the clinical characteristics, outcomes, and the incidence of postpartum diabetes in women with overt diabetes and GDM. This prospective cohort observational study was done on women with GDM diagnosed after the first trimester, attending the tertiary care hospitals for 2.3years. Comparison of clinical variables and maternal and neonatal outcomes were recorded in women with overt diabetes and GDM. The postpartum glycemic status was determined at 1 and 6months. There were 32(17.9%) women with overt diabetes and 146(82.1%) women with GDM. Women with overt diabetes were older, had a higher frequency of pre-pregnancy and maternal obesity, family history of diabetes, previous history of GDM, polycystic ovarian syndrome (PCOS), signs of insulin resistance, and need for insulin treatment than women with GDM. The prevalence of gestational hypertension and frequency of spontaneous abortion and large for gestational age (LGA) neonates were significantly higher in women with overt diabetes than in GDM, despite comparable glycemic goals. Postpartum diabetes at 1 and 6months was significantly higher in women with overt diabetes than in those with GDM. It is critical to identify women with overt diabetes in pregnancy because of increased risk of adverse maternal and neonatal outcomes, and rapid progression to postpartum diabetes, despite achieving optimal glycemic goals.

Correction to: Overt Diabetes in Pregnancy

Correction to: Overt Diabetes in Pregnancy

Overt Diabetes in Pregnancy.

AimsOvert diabetes in pregnancy is defined as hyperglycemia first recognized during pregnancy which meets the diagnostic threshold of diabetes in non-pregnant adults. This case-based narrative review aims to describe this unique condition and discuss the potential implications for its accurate diagnosis and management.Methods and ResultsWe conducted a literature search in PubMed for relevant articles published in English language up to January 2022. Women with overt diabetes have a higher risk for adverse pregnancy outcomes and postpartum diabetes, compared to their counterparts with gestational diabetes mellitus (GDM). Such women often need aggressive management, including early and prompt initiation of insulin therapy, and a close follow-up during pregnancy and in the postpartum period. Not all pregnant women with overt diabetes have persistent diabetes in the postpartum period. Early diagnosis, especially during the first trimester, and fasting plasma glucose elevation (≥ 126 mg/dl or 7 mmol/L) at the time of initial diagnosis are predictors of postpartum diabetes.ConclusionsBoth GDM and overt diabetes in pregnancy are hyperglycemic conditions first recognized during pregnancy, but the two conditions differ in severity; the latter is a more severe form of hyperglycemia associated with worse maternal and fetal outcomes, and a higher risk of postpartum diabetes.

Antenatal management and maternal/fetal outcomes associated with hyperglycaemia in pregnancy (HIP) in Uganda; a prospective cohort study

BackgroundHyperglycaemia in pregnancy (HIP) is associated with complications for both mother and baby. The prevalence of the condition is likely to increase across Africa as the continent undergoes a rapid demographic transition. However, little is known about the management and pregnancy outcomes associated with HIP in the region, particularly less severe forms of hyperglycaemia. It is therefore important to generate local data so that resources may be distributed effectively. The aim of this study was to describe the antenatal management and maternal/fetal outcomes associated with HIP in Ugandan women.MethodsA prospective cohort study of 2917 pregnant women in five major hospitals in urban/semi-urban central Uganda. Women were screened with oral glucose tolerance test (OGTT) at 24–28 weeks of gestation. Cases of gestational diabetes (GDM) and diabetes in pregnancy (DIP) were identified (WHO 2013 diagnostic criteria) and received standard care. Data was collected on maternal demographics, anthropometrics, antenatal management, umbilical cord c-peptide levels, and pregnancy outcomes.ResultsTwo hundred and seventy-six women were diagnosed with HIP (237 classified as GDM and 39 DIP). Women had between one and four fasting capillary blood glucose checks during third trimester. All received lifestyle advice, one quarter (69/276) received metformin therapy, and one woman received insulin. HIP was associated with large birthweight (unadjusted relative risk 1.30, 95% CI 1.00–1.68), Caesarean delivery (RR 1.34, 95% CI 1.14–1.57) and neonatal hypoglycaemia (RR 4.37, 95% CI 1.36–14.1), but not perinatal mortality or preterm birth. Pregnancy outcomes were generally worse for women with DIP compared with GDM.ConclusionHIP is associated with significant adverse pregnancy outcomes in this population, particularly overt diabetes in pregnancy. However pregnancy outcomes in women with milder forms of hyperglycaemia are similar to those with normoglycaemic pregnancies. Intervention strategies are required to improve current monitoring and management practice, and more research needed to understand if this is a cost-effective way of preventing poor perinatal outcomes.

The fetal heart in gestational diabetes: long-term effects.

Hyperglycemia is the most common medical complication of pregnancy. It is a broad term that encompasses various forms of glucose dysregulation seen during pregnancy. The International Diabetes Federation estimates that 1 in 6 live births (16.8%) occur to women with some form of hyperglycemia; 16% of these due to overt diabetes in pregnancy (DIP) and the remaining 84% due to gestational diabetes mellitus (GDM). DIP maybe either preexisting diabetes (type 1 or type 2) antedating pregnancy, or overt diabetes first diagnosed during pregnancy.

Pregnancy outcomes among multi-ethnic women with different degrees of hyperglycaemia during pregnancy in an urban New Zealand population and their association with postnatal HbA1c uptake.

Adverse pregnancy outcomes are more common in women with hyperglycaemia. Many women have suboptimal uptake of HbA1c testing postdelivery. To compare pregnancy outcomes among multi-ethnic women with different degrees of hyperglycaemia during pregnancy, and their association with postnatal HbA1c uptake after the introduction of email reminders. A retrospective and prospective single-centre study was conducted in South Auckland in 2639 women with early gestational diabetes mellitus (GDM) (diagnosed<20weeks), late GDM (diagnosed≥20weeks), overt diabetes in pregnancy, or known type 2 diabetes (T2DM) during pregnancy. Automated email reminders were sent to general practitioners to increase postnatal HbA1c screening. HbA1c during pregnancy increased across the late GDM (n=1425), early GDM (n=148), overt diabetes (n=573) and T2DM (n=493) groups (P<0.001). Stillbirth was least common in the late GDM group (0, 0.7, 0.5, and 1.9%, respectively, P<0.001), as were caesarean delivery (32.7, 45.1, 39.4, and 53.5%, respectively, P<0.001), large for gestational age (LGA) (14.7, 18.2, 22.3, and 30.5%, respectively, P<0.001), small for gestational age (8.8, 16.7, 11.0, and 11.1%, respectively, P=0.02), and preeclampsia/eclampsia (7.7, 9.2, 13.0, and 14.8%, respectively, P<0.001). LGA and preeclampsia/eclampsia were more common among Pacific and Māori women than European women (LGA, 30.1, 22.7, 10.3%, respectively, P<0.001; preeclampsia/eclampsia, 13.5, 14.0, and 8.1%, respectively, P<0.001). Postpartum HbA1c screening increased among women with GDM/overt diabetes after the introduction of the reminder emails (39.6% vs 34.0%, P=0.03). Women with late GDM are least likely to experience adverse outcomes. Email reminders to improve postpartum HbA1c screening warrant further investigation.

American Diabetes Association "Standards of Medical Care-2020 for Gestational Diabetes Mellitus": A Critical Appraisal.

IntroductionGestational diabetes mellitus (GDM) is a major public health problem, affecting about one in every six pregnancies globally. The guidelines provided by the American Diabetes Association (ADA) on diagnosis and management of hyperglycemia in pregnancy are widely followed. We aim to provide a critical appraisal of the recently published ADA guidance document, highlighting its strength and limitations with regard to the diagnosis of GDM.Methods and ResultsWe reviewed the recent ADA recommendations for the diagnosis and management of hyperglycemia in pregnancy. A periodic update in keeping with the emerging evidence, an inclusive diagnostic approach which increases generalizability, and a clear proposed approach for prenatal testing and postpartum follow-up are strengths of the ADA guidance document. On the other hand, its limitations are a lack of clarity on the applicability of diagnosis of GDM during early pregnancy, use of scientifically inaccurate terms such as “prediabetes” in the context of pregnancy and “overt diabetes prior to gestation” in the definition of GDM, and inconsistent use of terminology between successive publications. Certain issues which merit attention in future publications include a need for uniform global definition of GDM, demarcation of overt diabetes in pregnancy as a distinct entity, clarity on the diagnosis of GDM during early pregnancy, and clear delineation of timelines and appropriate testing strategy for the first prenatal visit.ConclusionsThis article provides a critical appraisal of the recently published ADA guidance document with regard to the diagnosis of GDM. We also share our perspective on issues warranting attention in the future publications. Experts from various professional organizations should aim for a consensus document which can resolve existing controversies in this field, and help clinicians and researchers achieve better health for women in their care.

Quantitative analysis of exercise among pregnant women with impaired glucose tolerance using pedometer data: An observational study.

The aim of our study was to examine the feasibility of the use of a pedometer to quantify the amount of exercise and the relationship between the amount of exercise and carbohydrate metabolism in pregnant women with impaired glucose tolerance. Seven pregnant women with impaired glucose tolerance (gestational diabetes: three, overt diabetes in pregnancy: one, pregestational diabetes type 2: three) were provided with pedometers. The relationship between pedometer data with blood glucose levels, maternal body weight, amount of insulin administered, blood hemoglobin A1c (HbA1c) levels, blood glycoalbumin levels and infant birth weight was investigated. When the 24-h-based data were examined, there was no correlation between the number of steps walked and blood glucose level immediately after walking, nor the average number of steps per day and the fasting blood glucose level in the next day. However, 4-week-based data showed that there was a negative correlation between the number of steps per day and the change in HbA1c level. Moreover, there was a negative correlation between the average number of steps per day and change in the maternal body weight. A 1-week-based data from five participants who were being administered insulin indicated that there was a negative correlation between the average number of steps per day and the total amount of insulin administered per day. Active application of pedometers is suggested to be feasible to improve metabolic control in pregnant women with glucose intolerance through the quantification of their exercise.

Controversies in Screening and Diagnostic Criteria for Gestational Diabetes in Early and Late Pregnancy.

This review serves to evaluate the screening and diagnostic strategies for gestational diabetes and overt diabetes in pregnancy. We focus on the different early screening and diagnostic approaches in first trimester including fasting plasma glucose, random plasma glucose, oral glucose tolerance test, hemoglobin A1c, risk prediction models and biomarkers. Early screening for gestational diabetes is currently not recommended since the potential benefits and harms of early detection and subsequent treatment need to be further evaluated in randomized controlled trials.

Prevalence and predictive factors of early postpartum diabetes among women with gestational diabetes in a single-center cohort.

To determine the prevalence of diabetes at 6-12weeks postpartum among women with gestational diabetes mellitus (GDM), and to identify prenatal postpartum diabetes predictors. In the present prospective cohort study, glucose statuses of consecutive women newly diagnosed with hyperglycemia during pregnancy were evaluated at6-12weeks postpartum between November 1, 2015, and November 1, 2016, atTygerberg Hospital, Cape Town, South Africa. Women with known diabetes wereexcluded. There were 78 patients included; 36 (46%) patients had abnormal postpartum glucose values (21 [27%] diabetes; 15 [19%] pre-diabetes) and 29 (37%) had overt diabetes in pregnancy. In univariate analyses, GDM diagnosis before 24weeks of pregnancy (P<0.001), degree of hyperglycemia at diagnosis (P=0.001), need for insulin (P=0.001), glycosylated hemoglobin (HbA1c) in the month preceding delivery (P=0.006), older than 36years (P=0.039), family history of diabetes (P=0.048), and preterm labor (P=0.039) were risk factors for postpartum diabetes. Multivariate analyses confirmed family history of diabetes (OR 7.45, 95% CI 1.05-52.76; P=0.044), HbA1c at diagnosis (OR 5.33, 95% CI 2.25-12.60; P<0.001), and age (OR 8.8, 95% CI 1.35-58.45; P=0.023), as robust predictors of diabetes after GDM. The high prevalence of diabetes supports early postpartum oral glucose tolerance testing. Several women had undiagnosed diabetes. The risk factors identified could be useful for prenatal risk stratification.

Risk factors associated with the development of postpartum diabetes in Japanese women with gestational diabetes

BackgroundAlthough the onset of gestational diabetes (GDM) is known to be a significant risk factor for the future development of type 2 diabetes, this risk specifically in women with GDM diagnosed by the International Association of Diabetes and Pregnancy Study Group (IADPSG) criteria has not yet been thoroughly investigated. This study was performed to investigate the risk factors associated with the development of postpartum diabetes in Japanese women with a history of GDM, and the effects of the differences in the previous Japanese criteria and the IADPSG criteria.MethodsThis retrospective cohort study included Japanese women with GDM who underwent at least one postpartum oral glucose tolerance test (OGTT) between 2003 and 2014. Cases with overt diabetes in pregnancy were excluded. We investigated the risk factors including maternal baseline and pregnancy characteristics associated with the development of postpartum diabetes.ResultsAmong 354 women diagnosed with GDM during the study period, 306 (86%) (116/136 [85.3%] and 190/218 [87.2%] under the previous criteria and the IADPSG criteria, respectively) who underwent at least 1 follow-up OGTT were included in the study. Thirty-two women (10.1%) developed diabetes within a median follow-up period of 57 weeks (range, 6–292 weeks). Eleven (9.5%) and 21 (11.1%) were diagnosed as GDM during pregnancy based on the previous Japanese criteria and the IADPSG criteria, respectively, which did not significantly differ between those criteria. A multivariate logistic regression analysis revealed that HbA1c and 2-h plasma glucose (PG) at the time of the diagnostic OGTT during pregnancy were independent predictors of the development of diabetes after adjusting for confounders. The adjusted relative risk of HbA1c ≥5.6% for the development of diabetes was 4.67 (95% confidence interval, 1.53-16.73), while that of 2-h PG ≥183 mg/dl was 7.02 (2.51-20.72).ConclusionsA modest elevation of the HbA1c and 2-h PG values at the time of the diagnosis of GDM during pregnancy are independent predictors of the development of diabetes during the postpartum period in Japanese women with a history of GDM. The diagnostic criteria did not affect the incidence of postpartum diabetes.