Prevalence Of Gestational Diabetes Research Articles

A 12-week exercise program performed during the second trimester does not prevent gestational diabetes in healthy pregnant women

Does a 12-week exercise program prevent gestational diabetes and improve insulin resistance in healthy pregnant women with normal body mass index (BMI)? Randomised, controlled trial with concealed allocation and blinded outcome assessment. Two University hospitals in Norway. White adult women with a single fetus. High-risk pregnancies or diseases that would interfere with participation were exclusion criteria. Randomisation of 855 participants allocated 429 to the exercise group and 426 to a control group. Both groups received written advice on pelvic floor muscle exercises, diet, and lumbo-pelvic pain. In addition, the intervention group participated in a standardised group exercise program led by a physiotherapist, once a week for 12 weeks, between 20 and 36 weeks gestation. The program included 30-35 minutes low impact aerobics, 20-25 minutes of strength exercises using body weight as resistance and 5-10 minutes of stretching, breathing, and relaxation exercises. They were also encouraged to follow a 45-minute home exercise program at least twice a week. The control group received standard antenatal care and the customary information given by their midwife or general practitioner. The primary outcomes were the prevalence of gestational diabetes, insulin resistance estimated by the homeostasis model assessment method (HOMA-IR), and fasting insulin and oral glucose tolerance tests at baseline and at the end of the training period. Fasting and 2-hour glucose levels were measured in serum by the routine methods. Gestational diabetes was diagnosed as fasting glucose level 2-hour value ≥7.8mmol/L. Secondary outcome measures were weight, BMI, and pregnancy complications and outcomes. 702 participants completed the study. At the end of the 12-week program, there was no difference in the prevalence of gestational diabetes (25 (7%) of intervention group compared with 18 (6%) of control group), HOMA-IR (-0.15, 95% CI -0.33 to 0.03), or oral glucose tolerance tests at 2 hours (-0.13mmol/L, 95% CI -0.28 to 0.03) between the groups. Fasting insulin was significantly lower in the intervention group by 1.0 international units/mL (95% CI -0.1 to -1.9). The groups did not differ significantly on any of the secondary outcomes. Adherence to the exercise protocol in the intervention group was 55%. A per protocol analysis of 217 women in the intervention group who adhered to the exercise program demonstrated similar results with no difference in prevalence of diabetes. A 12-week exercise program undertaken during the second trimester of pregnancy did not reduce the prevalence of gestational diabetes in pregnant women with BMI in the normal range.

Medical and Sociodemographic Risk Factors for Preterm Birth in a French Caribbean Population of African Descent

There appears to be an incompressible high rate of preterm births among populations of African origin irrespective of their geographic location. The objective of this study was to assess the risk factors for preterm birth in a French Caribbean population of African descent, offered medical care comparable to that on the French mainland, but presenting a higher rate of preterm birth. The study was based on a birth cohort at maternity hospitals in Guadeloupe (French West Indies) including 911 singleton pregnancies enrolled during their third trimester check-up visits. Associations between risk factors and the risk of preterm delivery (spontaneous and induced) were assessed using a multivariate Cox model. In addition, prevalences of sociodemographic and medical factors in Guadeloupe were compared with those on the French mainland. 144 women (15.8 %) delivered preterm, medically induced in 52 %. Women delivering preterm were more often over 35 years old (37 %), single (54 %), and had higher prevalence of prior preterm birth (20 %), prior miscarriage (37 %), lupus (3 %), asthma (14 %), gestational hypertension (26 %), gestational diabetes (13 %) and urinary tract infection (24 %) than women with term births. In the whole cohort, these risk factors were also more frequent than in mainland France. Our results suggest highly prevalent medical risk factors for preterm births in Guadeloupe. This observation combined with specific social risk factors (older maternal age, single living) less frequent on the French mainland probably explains a large part of a higher prevalence of preterm births in this population despite similar medical provision.

Novas orientações da direção-geral de saúde para a diabetes gestacional: Uma apreciação crítica

The new guidelines from the Portuguese Directorate General of Health (DGH) for gestational diabetes (GD) recommend changes in the screening, treatment and follow-up of GD. We discuss the scientific basis for these guidelines and their poten- tial implications for improvements in health, costs, the use of health service resources and their potential impact on the new- ly diagnosed population of pregnant women. No references cited by the DGH support the diagnosis of GD based on fasting plasma glucose levels above 92 mg/dL at the first prenatal appointment. Using the new cutoff point for the diagnosis of GD for an oral glucose tolerance test performed between 24 and 28 weeks pregnancy results in a tenfold increase in the prevalence of GD, leading to increased allocation of health services resources for management and follow up. A review of the literature reveals no benefit from universal prenatal screening as opposed to selective screening of pregnant women with known risk factors (grade of Recommendation B and level of evidence 3A). Cost-effectiveness studies also favour selective screening over universal screening. Treatment of women newly diagnosed with GD has not shown a reduction in perinatal morbidity, as predicted by the HAPO study. Potential adverse effects of this approach have not been assessed. It would probably be wise to keep the new guideline on hold and return to the previous protocol of GD screening until more robust evidence supports changes.

Síndrome de ovario poliquístico y embarazo

Polycystic ovary syndrome (PCOS) is a common endocrine metabolic dysfunction closely associated with insulin resistance and obesity, which predisposes to pregnancy complications and prenatal programming of the offspring. The aim of this review is to report our experience in PCOS patients who became pregnant and were followed during the whole pregnancy. Firstly, we analyzed the effect of pregnancy on PCOS pathophysiology and secondly the role of PCOS in pregnancy outcomes. Regarding the firstpoint, during normal pregnancy a progressive insulin resistance, serum lipid changes and an increase in androgen levels is observed, which is exacerbated in the PCOS condition. This adverse intrauterine environment could have a prenatal programming effect with detrimental consequences for female or male fetuses. Regarding the second point, PCOS is associated with an increased risk for maternal complications such as gestational diabetes (GDM) and pregnancy-induced hypertension. Moreover, these adverse pregnancy outcomes are more frequently associated with an increase in low birth weight and high birth weight newborns. According to our clinical experience, PCOS patients who became pregnant and were not treated with metformin during the whole pregnancy, showed a higher prevalence of gestational diabetes and SGA newborns, which was improved with metformin treatment. In summary, pregnancy may constitute a period in which an abnormal condition is established or aggravated in the fetus of a PCOS mother. Moreover, PCOS enhanced adverse obstetric and neonatal outcomes.

Gestational diabetes mellitus in Europe: prevalence, current screening practice and barriers to screening. A review

Gestational diabetes mellitus is a potentially serious condition that affects many pregnancies and its prevalence is increasing. Evidence suggests early detection and treatment improves outcomes, but this is hampered by continued disagreement and inconsistency regarding many aspects of its diagnosis. The Vitamin D and Lifestyle Intervention for Gestational Diabetes Mellitus Prevention (DALI) research programme aims to promote pan-European standards in the detection and diagnosis of gestational diabetes and to develop effective preventive interventions. To provide an overview of the context within which the programme will be conducted and its findings interpreted, systematic searching and narrative synthesis have been used to identify and review the best available European evidence relating to the prevalence of gestational diabetes, current screening practices and barriers to screening. Prevalence is most often reported as 2-6% of pregnancies. Prevalence may be lower towards the Northern Atlantic seaboard of Europe and higher in the Southern Mediterranean seaboard. Screening practice and policy is inconsistent across Europe, hampered by lack of consensus on testing methods, diagnostic glycaemic thresholds and the value of routine screening. Poor clinician awareness of gestational diabetes, its diagnosis and local clinical guidelines further undermine detection of gestational diabetes. Europe-wide agreement on screening approaches and diagnostic standards for gestational diabetes could lead to better detection and treatment, improved outcomes for women and children and a strengthened evidence base. There is an urgent need for well-designed research that can inform decisions on best practice in gestational diabetes mellitus screening and diagnosis.

Lifestyle interventions for overweight and obese pregnant women to improve pregnancy outcome: systematic review and meta-analysis

BackgroundOverweight and obesity pose a big challenge to pregnancy as they are associated with adverse maternal and perinatal outcome. Evidence of lifestyle intervention resulting in improved pregnancy outcome is conflicting. Hence the objective of this study is to determine the efficacy of antenatal dietary, activity, behaviour or lifestyle interventions in overweight and obese pregnant women to improve maternal and perinatal outcomes.MethodsA systematic review and meta-analyses of randomised and non-randomised clinical trials following prior registration (CRD420111122 http://www.crd.york.ac.uk/PROSPERO) and PRISMA guidelines was employed. A search of the Cochrane Library, EMBASE, MEDLINE, CINAHL, Maternity and Infant care and eight other databases for studies published prior to January 2012 was undertaken. Electronic literature searches, study selection, methodology and quality appraisal were performed independently by two authors. Methodological quality of the studies was assessed according to Cochrane risk of bias tool. All appropriate randomised and non-randomised clinical trials were included while exclusions consisted of interventions in pregnant women who were not overweight or obese, had pre-existing diabetes or polycystic ovarian syndrome, and systematic reviews. Maternal outcome measures, including maternal gestational weight gain, gestational diabetes and Caesarean section, were documented. Fetal outcomes, including large for gestational age and macrosomia (birth weight > 4 kg), were also documented.ResultsThirteen randomised and six non-randomised clinical trials were identified and included in the meta-analysis. The evidence suggests antenatal dietary and lifestyle intervention in obese pregnant women reduces maternal pregnancy weight gain (10 randomised clinical trials; n = 1228; -2.21 kg (95% confidence interval -2.86 kg to -1.59 kg)) and a trend towards a reduction in the prevalence of gestational diabetes (six randomised clinical trials; n = 1,011; odds ratio 0.80 (95% confidence interval 0.58 to 1.10)). There were no clear differences reported for other outcomes such as Caesarean delivery, large for gestational age, birth weight or macrosomia. All available studies were assessed to be of low to medium quality.ConclusionAntenatal lifestyle intervention is associated with restricted gestational weight gain and a trend towards a reduced prevalence of gestational diabetes in the overweight and obese population. These findings need to be interpreted with caution as the available studies were of poor to medium quality.

Prevalence, Trend and Determining Factors of Gestational Diabetes in Germany.

Purpose: The true prevalence of gestational diabetes in Germany is unknown. Thus, the study's purposes were to estimate the prevalence of gestational diabetes as well as to describe the temporal prevalence trend and to identify determinants. Material and Methods: We calculated prevalence estimates based on two datasets: the register-based German perinatal statistic (n = 650 232) and the maternal self-reports from the German children and youth health survey (KiGGS; n = 15 429). Differences between prevalence estimates were analysed using χ2 and trend tests, and determinants were identified using logistic regression. Results: According to the perinatal statistic, gestational diabetes was present in 3.7 % of pregnant women in Germany in 2010. The prevalence across the years 2001 to 2006 was estimated at 1.9 % which differed significantly from the prevalence estimate derived from the KiGGS dataset for the same period of time (5.3 %; 95 % confidence interval: 4.6-6.1 %). Both datasets show an increasing trend of gestational diabetes (p < 0.001). The risk for gestational diabetes was mainly associated with age, BMI and social class of pregnant women as well as with multiple pregnancies. Conclusion: The lack of significant screening studies among representative samples hampers a sound estimation of the true prevalence of gestational diabetes in Germany. The increasing trend in gestational diabetes might continue due to the projected increase of important risk factors (e.g., maternal age, obesity). Our analyses support the current consensus recommendations regarding standardised gestational diabetes screening.

Comparison of Physical Activity and Nutritional Intake in First Nations Pregnant Women in Remote Communities and Urban-Living Pregnant Women

Increased prevalence of gestational diabetes has been detected in First Nations (FN) pregnant women living in rural communities compared to FN or non-FN pregnant women living in urban areas in Manitoba. Physical activity and nutritional intake during pregnancy may affect maternal metabolism and pregnancy outcomes. We examined physical activity and food intake in 63 pregnant women in 3 groups: FN in rural/remote communities (FNR, n=24); FN in an urban environment (FNU, n=17); and Caucasians in an urban environment (CU, n=22). The physical activity levels in the FNR and FNU groups (physical activity index 1.29 ± 0.75 and 1.00 ± 0.71) were significantly lower than that in the CU group (physical activity index 1.94 ± 0.24, p<0.01). Daily intakes of total calories, carbohydrate, protein, fat and saturated fat were not significantly different among the 3 groups. Daily cholesterol intake in the FNR group (325 ± 186 mg/day) was significantly higher than that in the CU group (205 ± 137 mg/day, p<0.05). Vegetable consumption in the FNR group (0.64 ± 0.98 servings/day) was significantly lower than that in the CU group (2.94 ± 3.14 servings/day, p<0.01). The consumption of skim milk in the FNR and FNU groups (0.12 ± 0.43 and 0.25 ± 0.64 servings/day) were lower than that of the CU group (1.49 ± 1.37 servings/day, p<0.01). These findings suggest that physical activity levels and nutritional intake need to be improved in FN pregnant women, particularly those living in rural/remote communities.

Regular Exercise During Pregnancy to Prevent Gestational Diabetes

To assess whether exercise during pregnancy can prevent gestational diabetes and improve insulin resistance. A total of 855 women in gestational week 18-22 were randomly assigned to receiving a 12-week standard exercise program (intervention group) or standard antenatal care (control group). The exercise program followed standard recommendations and included moderate-intensity to high-intensity activity 3 or more days per week. Primary outcomes were gestational diabetes and insulin resistance estimated by the homeostasis model assessment method. For the power calculation, we assumed a gestational diabetes prevalence of 9% in the control group and a prevalence of 4% in the exercise group (risk difference of 5%). Under these assumptions, a two-sample comparison with a 5% level of significance and power of 0.80 gave a study population of 381 patients in each group. At 32-36 weeks of gestation there were no differences between groups in prevalence of gestational diabetes: 25 of 375 (7%) in the intervention group compared with 18 of 327 (6%) in the control group (P=.52). There were no differences in insulin resistance between groups when adjusting for baseline values. Only 55% of women in the intervention group managed to follow the recommended exercise protocol. No serious adverse events related to physical exercise were seen, and the outcomes of pregnancy were similar in the two groups. There was no evidence that offering women a 12-week standard exercise program during the second half of pregnancy prevents gestational diabetes or improves insulin resistance in healthy pregnant women with normal body mass indexes. : ClinicalTrials.gov, www.clinicaltrials.gov, NCT00476567.

EvaEvaluation of glucose challenge and oral glucose tolerance test results in pregnancy and estimation of prevalence of gestational diabetes mellitus at Sema Hospital in İstanbul

This study was designed to evaluate glucose screening and oral glucose tolerance test results, and to assess the prevalence of gestational diabetes in pregnant patients admitted to our hospital. Materials and methods: This retrospective study was carried out at Sema Hospital in İstanbul, Turkey. The study subjects were recruited between January 2006 and August 2009. A glucose challenge test (GCT) was given to 1681 pregnant women and based on the results 494 went on to take an oral glucose tolerance test (OGTT). A diagnosis of gestational diabetes mellitus (GDM) was made according to the criteria defined by the National Diabetes Data Group. Results: Out of the 1681 pregnant women tested, 58 were diagnosed with gestational diabetes. Pregnant women with GDM had GCT results greater than or equal to 145 mg/dL. While the percentage of GCT false positives was 87.8% when the cut-off value was taken to be 140 mg/dL, it was calculated to be 84.3% when the cut-off value was taken to be 145 mg/dL. For the 140 mg/dL cut-off value of GCT, specificity was 100% and sensitivity was 4.3%, and for the 145 mg/dL cut-off value of GCT, specificity was 98.3% and sensitivity was 28.3%. Conclusion: The prevalence value in this study was calculated at 3.45%. Pregnant women diagnosed with GDM had GCT results higher than 145 mg/dL. When the cut-off value was increased from 140 mg/dL to 145 mg/dL, a decrease was observed in false positives, and an increase was observed in sensitivity.

Battling the rising prevalence of gestational diabetes in India: Are clinicians on the right track?

Background: Gestational diabetes (GDM) is associated with increased long term problems of type 2 diabetes in the mother. In the offspring, GDM can append an intrauterine environmental risk factor to the increased genetic risk for the development of childhood obesity and/or type two early adult onset diabetes. Given the high prevalence of GDM in India, there is a real threat of an epidemic of type 2 diabetes in INDIA. Objective: (a) To assess knowledge among obstetricians in India, regarding management of GDM with respect to strict glycemic monitoring to provide the right environment to the fetus and timely intervention. (b) To assess the attitudes and practices with respect to long term follow up of the mother. Materials and methods: A 25-question online survey (www.abcofobg.com) was developed to assess providers' knowledge, practices and attitudes related to the management of GDM. The final sample consisted of 584 respondents. Data were analyzed using SPSS version 16.0. Results: When patients were on insulin, 41% of the clinicians did not insist on daily home monitoring using a glucometer.They resorted to estimation of post breakfast blood glucose at two-week intervals. Only 60% had access to endocrinologists for advice regarding insulin dosage adjustments. Only 35.71% of the clinicians said to wait for spontaneous labor. 64.29% of doctors said they would intervene and deliver at 38 weeks. Out of 584 respondents, 70.24% were aware of long term complication of childhood obesity and adult onset diabetes. Majority of doctors (92.86%) knew that T2DM was the long-term complication in GDM mother and 67.86% were aware of possibility of GDM in next pregnancy. Only 17% of clinicians offered WHO 75 gm testing for sugar estimation at the six weeks postpartum visit and 70% of the practitioners advised regarding exercises and diet. Conclusions: This study raises the challenge of how to translate the evidence from well-resourced research studies into initiatives that are affordable and feasible, whether in richer or poorer parts of the world. Also, the study results reveal the urgent need to improve the quality of diabetes treatment and care: accessible, community-based, multi-disciplinary teams, and patient-centered approach.

The genetic interface between gestational diabetes and type 2 diabetes

Objective: Although the Western diet and lifestyle has contributed to an increase in the prevalence of gestational diabetes (GDM) worldwide, genetic predisposition also plays an important role. This article reviews the current state of knowledge regarding the genetic interface between type 2 diabetes (T2D) and GDM. Methods: Review of the current literature on genetics of T2D and GDM. Results: Maturity Onset Diabetes of the Young (MODY) due to glucokinase mutations may account for as much as 5% of GDM patients. Knowledge of both maternal and fetal genotypes may be useful for individualizing glycemic goals during pregnancy in families harboring these mutations. Of the 38 common T2D susceptibility variants identified to date, several are also associated with GDM. Presumably, these mutations increase GDM risk through decreased ability of β-cells to compensate for the insulin resistance associated with pregnancy. The effect of these alleles on risk for GDM is modest (odds ratios (odds ratio (OR)~1.1–1.6); thus, they individually are poorly predictive. Conclusions: Future studies must concentrate on understanding the biological underpinnings of known T2D risk alleles and the discovery of new alleles for both GDM and T2D. These insights may lead to more effective strategies for preventing and treating GDM.

Myo-inositol may prevent gestational diabetes in PCOS women

To evaluate retrospectively the prevalence of gestational diabetes (GD) in pregnancies obtained with myo-inositol administration in women with polycystic ovary syndrome. A total of 98 pregnancies in PCOS women obtained in a 3-year period, either with myo-inositol (n. 54), or with metformin (n. 44) were considered. While myo-inositol was assumed through the whole pregnancy, the group of women treated with metformin stopped the drug assumption after pregnancy diagnosis, and was considered as a control group. After having eliminated cases of miscarriages and twin pregnancies, a definitive number of 46 women in the myo-inositol group and 37 in the control group was taken in account to be retrospectively evaluated. The primary outcome measure was GD occurrence in both groups; whereas secondary outcome measures were pregnancy outcomes: hypertensive disorders, pre-term birth, macrosomia and caesarean section occurrence. Prevalence of GD in the myo-inositol group was 17.4% versus 54% in the control group, with a highly significant difference also after adjusting for covariates. Consequently, in the control group the risk of GD occurrence was more than double compared to the myo-inositol group, with an odds ratio 2.4 (confidence interval 95%, 1.3–4.4). There was no difference between the groups in relation to secondary outcome measures. This study suggests a possible effect of myo-inositol in the primary prevention of GD in PCOS women.

Prevalence of gestational diabetes and associated maternal and neonatal complications in a fast-developing community: global comparisons

BackgroundThe prevalence of gestational diabetes (GDM) is increasing all over the world. Hence, the impact of GDM on maternal and infant health is an important topic of research. No study has been conducted in Qatar to evaluate the outcome of pregnancies complicated by diabetes mellitus.ObjectiveThe aim of the study was to determine the prevalence of GDM, compare the maternal–neonatal complications among women with GDM and non-GDM pregnant women, and investigate the risk factors and potential outcomes associated with GDM.DesignThis is a prospective cohort study.SettingThe survey was carried out at the antenatal clinics of the Women’s Hospital, Qatar.Subjects and methodsA representative sample of 2056 pregnant women who attended the antenatal clinics of the Women’s Hospital were surveyed during the period from the first week of January 2010 to April 2011. From this sample, 1608 women (78.2%) expressed their consent to participate in the study. Questionnaires were administered to pregnant women who were seeking antenatal care at this urban hospital. The questionnaire covered variables related to sociodemographic factors, family history, medical history, maternal complications, and neonatal outcome.ResultsThe prevalence of GDM in Qatar was 16.3%. Women with GDM were significantly higher in the age group of 35–45 years (45%; P = 0.001). Family history of diabetes (31.7%; P < 0.001), increased parity (55.3%; P = 0.004), and obesity (59.2%; P < 0.001) were determinants of GDM in pregnant women. Maternal complications like pregnancy-induced hypertension (19.1% vs 10.3%; P < 0.001), pre-eclampsia (7.3% vs 3.8%; P = 0.012), antepartum hemorrhage (19.2% vs 14.6%; P = 0.05), and cesarean (27.9% vs 12.4%; P < 0.001) were significantly higher in GDM women. Neonates were at increased risk of preterm birth (12.6% vs 8.3%; P = 0.03), macrosomia (10.3% vs 5.9%; P = 0.01), and birth trauma (8% vs 3%; P < 0.001).ConclusionThe study findings revealed that GDM was higher in women in Qatar and that they were at increased risk of developing maternal and neonatal complications. Obesity emerged as an essential risk factor for subsequent GDM. The advanced maternal age, low monthly income, family history of diabetes, and obesity were the main significant risk factors for GDM.

Diabetes in Sub Saharan Africa 1999-2011: Epidemiology and public health implications. a systematic review

BackgroundDiabetes prevalence is increasing globally, and Sub-Saharan Africa is no exception. With diverse health challenges, health authorities in Sub-Saharan Africa and international donors need robust data on the epidemiology and impact of diabetes in order to plan and prioritise their health programmes. This paper aims to provide a comprehensive and up-to-date review of the epidemiological trends and public health implications of diabetes in Sub-Saharan Africa.MethodsWe conducted a systematic literature review of papers published on diabetes in Sub-Saharan Africa 1999-March 2011, providing data on diabetes prevalence, outcomes (chronic complications, infections, and mortality), access to diagnosis and care and economic impact.ResultsType 2 diabetes accounts for well over 90% of diabetes in Sub-Saharan Africa, and population prevalence proportions ranged from 1% in rural Uganda to 12% in urban Kenya. Reported type 1 diabetes prevalence was low and ranged from 4 per 100,000 in Mozambique to 12 per 100,000 in Zambia. Gestational diabetes prevalence varied from 0% in Tanzania to 9% in Ethiopia. Proportions of patients with diabetic complications ranged from 7-63% for retinopathy, 27-66% for neuropathy, and 10-83% for microalbuminuria. Diabetes is likely to increase the risk of several important infections in the region, including tuberculosis, pneumonia and sepsis. Meanwhile, antiviral treatment for HIV increases the risk of obesity and insulin resistance. Five-year mortality proportions of patients with diabetes varied from 4-57%. Screening studies identified high proportions (> 40%) with previously undiagnosed diabetes, and low levels of adequate glucose control among previously diagnosed diabetics. Barriers to accessing diagnosis and treatment included a lack of diagnostic tools and glucose monitoring equipment and high cost of diabetes treatment. The total annual cost of diabetes in the region was estimated at US$67.03 billion, or US$8836 per diabetic patient.ConclusionDiabetes exerts a significant burden in the region, and this is expected to increase. Many diabetic patients face significant challenges accessing diagnosis and treatment, which contributes to the high mortality and prevalence of complications observed. The significant interactions between diabetes and important infectious diseases highlight the need and opportunity for health planners to develop integrated responses to communicable and non-communicable diseases.

Patterns of Glycemia in Normal Pregnancy

Despite the well-known influence of maternal glucose on infant birth weight (BW), the prevalence of large for gestational age (LGA) infants (≥90th percentile for age) has been increasing steadily over decades, particularly in pregnancies complicated by pregestational or gestational diabetes mellitus (1). Although the overall prevalence of macrosomia (BW ≥4,000 g) is 17–29% in women with untreated gestational diabetes, the majority of macrosomic infants are born to women with obesity but no gestational diabetes (2,3). Moreover, epidemiologic data show that a higher BW is associated with higher BMI and glucose intolerance later in life (4,5), suggesting life-long metabolic implications for offspring. Recent data from the Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study suggested that concentrations of maternal glucose below the previously accepted diagnostic thresholds for gestational diabetes are predictive of LGA and fetal hyperinsulinemia (6). On the basis of this landmark study, the International Association of Diabetes in Pregnancy Study Group and the American Diabetes Association (ADA) recommended new lower diagnostic criteria for gestational diabetes (7,8). However, a significant number of women with gestational diabetes whose glucose values are within the current targeted therapeutic ranges deliver macrosomic infants (9). Although glucose plays a major role in fetal growth, this paradox underscores the likely role of other nutrients in fetal growth, but also the need to critically reexamine our definition of “normal” maternal patterns of glycemia and the effects on fetal growth. The new diagnostic criteria recommended by the International Association of Diabetes in Pregnancy Study Group and ADA are expected to increase the prevalence of gestational diabetes to 18%. Thus, treatment targets may need to be reevaluated. Historically, the treatment goal in pregnancies complicated by diabetes has been to mimic patterns of glycemia in normal pregnancy (1). Although the HAPO study better defined abnormal …

Running into spring

Running into spring

Early Onset and High Prevalence of Gestational Diabetes in PCOS and Insulin Resistant Women Before and After Assisted Reproduction

Polycystic ovary syndrome (PCOS) and/or insulin resistance (IR) are frequent conditions in women choosing assisted reproduction techniques (ART). However, infertility work-up has to include testing of insulin sensitivity to diagnose IR. It was the aim of the study to analyze the frequency of impaired glucose tolerance (IGT) or gestational diabetes (GD) in the first weeks of gestation after ART in women receiving metformin. This study included 107 women who were seeking ART under the pretreatment of metformin for PCOS, confirmed IR, recurrent spontaneous miscarriages (RSA) or other fertility disorders. They were examined for prepregnancy health parameters (weight, glucose tolerance). When pregnancy was confirmed a 75 g oral glucose tolerance test (OGTT) was conducted between the 5(th) and 7(th) week of gestation. A high rate of GD or IGT already was observed in the first weeks of pregnancy in our cohort under metformin treatment. The predominant risk factor for diagnosed early onset of IGT or GD (58 cases) was PCOS (p=0.014). The frequency of GD was the highest in the subgroup with prepregnancy confirmed IR not fulfilling the criteria of PCOS (55%); it was 40.6% in PCOS women and 26.1% in women neither exhibiting IR nor PCOS. Women seeking ART and being treated with metformin still show a very high rate of GD or IGT after achieving pregnancy by ART. Therefore in women undergoing ART screening for GD should be performed as soon as pregnancy is confirmed to avoid miscarriages due to overlooked uncontrolled glucose metabolism.

Diagnosing gestational diabetes

The newly proposed criteria for diagnosing gestational diabetes will result in a gestational diabetes prevalence of 17.8%, doubling the numbers of pregnant women currently diagnosed. These new diagnostic criteria are based primarily on the levels of glucose associated with a 1.75-fold increased risk of giving birth to large-for-gestational age infants (LGA) in the Hyperglycemia Adverse Pregnancy Outcome (HAPO) study; they use a single OGTT. Thus, of 23,316 pregnancies, gestational diabetes would be diagnosed in 4,150 women rather than in 2,448 women if a twofold increased risk of LGA were used. It should be recognised that the majority of women with LGA have normal glucose levels during pregnancy by these proposed criteria and that maternal obesity is a stronger predictor of LGA. The expected benefit of a diagnosis of gestational diabetes in these 1,702 additional women would be the prevention of 140 cases of LGA, 21 cases of shoulder dystocia and 16 cases of birth injury. The reproducibility of an OGTT for diagnosing mild hyperglycaemia is poor. Given that (1) glucose is a weak predictor of LGA, (2) treating these extra numbers has a modest outcome benefit and (3) the diagnosis may be based on a single raised OGTT value, further debate should occur before resources are allocated to implementing this change.Electronic supplementary materialThe online version of this article (doi:10.1007/s00125-010-2005-4) contains supplementary material, which is available to authorised users.

Prevalence and regional differences of gestational diabetes mellitus and oral glucose tolerance tests in Finland

The prevalence of gestational diabetes (GDM) is constantly increasing all around the world. Aim of this study is to report prevalence and regional differences of GDM, oral glucose tolerance tests (OGTT) and register-based GDM risk factors [age and body mass index (BMI)] among Finnish women. Data from the Finnish Medical Birth Register including all deliveries in Finland during 2004-06 (N = 174 634) were used. The criteria for GDM were abnormal results in OGTT, GDM diagnosis based on ICD-10 classification or use of insulin treatment during pregnancy. Pregnant women with type I diabetes were excluded, but women with pregestational diabetes (type II) were included since they also can receive GDM diagnosis. The prevalence of GDM was 10-11% and OGTTs 22-28% between the period 2004 until 2006. Regional differences were 2-fold both in prevalence of GDM (8-15%) and OGTTs (19-34%). Proportions of obese women varied between 28% and 35% and women aged >40 years between 3% and 4%. The regional differences in GDM prevalence were not attenuated when risk factors were taken into account. Overweight and age ≥years explained only a fourth of the variation in GDM prevalence. Proportion of women undergoing OGTT increased but the prevalence of GDM did not during the study period. Two-fold regional differences in OGTT prevalence explained higher proportion of variation in prevalence of GDM than risk factors available from birth registry, age and BMI.